Analysis of the Dynamics of Cardiovascular Health in the Population of Ivano-Frankivsk Region over the Past Seventeen Years

The key to increase the level of life expectancy is good health. To study the indicators of cardiovascular health in the population of the Carpathian region, the analysis of the indicators of cardiovascular disease prevalence over the period 1998-2014 was made. The analysis was conducted based on statistical data of the Regional Information-Analytical Center of Medical Statistics and medical records of the Ivano-Frankivsk Regional Clinical Cardiology Dispensary over the period 1998-2014.To identify the population structure in Ivano-Frankivsk region, the analysis of the main demographic indices over the period 1998-2014 was made. The analysis revealed that in 2007, the total population of the Carpathian region was 1,386,000 people while in 2014, it was 1,379,400 people that was 1.05% and 5.76% lower compared to the total population in 1998 (1,463,600 people). Similar tendency was observed across the whole country. During the studied period, the indicators of the overall prevalence of hypertension (all forms) increased by 2.89 times while the indicators of primary disease incidence increased by 1.89 times. The indicator of the overall prevalence of ischemic heart disease among the adult population of Ivano-Frankivsk region during the studied period increased by 2.11 times ranging from 9780.3 to 20629.1 cases per 100,000 population. It should be noted that since 2012 a reduction in the prevalence of angina pectoris from 6545.7 to 6126.2 cases per 100,000 population (by 1.07 times) was observed. The increase in the incidence of acute myocardial infarction from 81 to 108.2 cases per 100,000 population (by 1.34 times) was detected as well. Cardiovascular diseases are known to be the most urgent problem of modern health care system having no geographical, socioeconomic and sexual preferences. They remain to be the major cause of mortality accounting for about 17,300,000 cases per year.Conclusions. Thus, important factors affecting life expectancy of Ivano-Frankivsk region residents include morbidity and mortality due to cardiovascular diseases which have increased recently

Prognostic Value of Serum Interleukin-6 Level in Hypertensive Patients with COVID-19-Associated Pneumonia

Background. An interleukin-6 (IL-6) is a proinflammatory cytokine which plays an important role in COVID-19-associated hyperinflammation. Aim. This study aimed to assess the predictive ability of serum IL-6 levels for the development of severe/critical clinical conditions, a hypoxemic state requiring supplemental oxygen, and lethal outcomes in patients with COVID-19-associated pneumonia and arterial hypertension (AH). Materials and Methods. One hundred and thirty-five unvaccinated patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. AH was diagnosed in 78.5% of cases. Pneumonia was confirmed radiologically. SARS-COV-2 as an etiological factor was confirmed by either PCR or ELISA. In addition to conventional laboratory tests, IL-6, ferritin, and soluble interleukin-2 levels were measured. Results. Among AH patients, the median levels of IL-6 were higher in non-survivors (95.1 [37.8 - 158.8] pg/mL) as compared to survivors (39.5 [13.6 - 81.1] pg/mL) (p=0.04). Among AH patients, the median serum level of IL-6 was 98.3 [37.8 - 158.8] pg/mL in critically ill patients, 41.7 [11.8 - 83.4] pg/mL in severely ill patients, 37.8 [13.6 - 74.4] pg/mL in moderately ill patients (p=0.051). The median serum level of IL-6 was lower at the time of discharge (6.5 [2.0 - 21.5] pg/mL) as compared to that on admission (43.2 [16.1 - 92.0] pg/mL) (p< 0.001). IL-6 level failed to predict severe/critical condition (AUC=0.59, p=0.13) and the need for supplemental oxygen (AUC=0.61, p=0.06); however, it might be used for the prediction of the lethal outcome (AUC=0.69, p=0.03). The cut-off value of IL-6 level for lethal outcome prediction of 91.0 pg/mL showed a sensitivity of 58.3% and a specificity of 78.7%. Patients with IL-6 levels > 91.0 pg/mL on admission had higher odds of lethal outcomes (OR = 4.87 [1.40 - 16.92], p=0.01). Conclusions. Serum IL-6 level on admission did not show significant predictive ability for severe/critical conditions and hypoxemic states requiring supplemental oxygen in AH patients. However, serum IL-6 levels on admission were higher in non-survivors and might be used for the prediction of lethal outcomes with a cut-off value of 91.0 pg/mL in AH patients

The Modern Aspects of Acute Heart Failure Management

Acute heart failure (AHF) is one the most common causes of morbidity and mortality. The prognosis of patients admitted with AHF remains dismal, with over 20% experiencing recurrent HF admission and over 20% dying during the first year after initial admission.The purpose of this study was to provide contemporary perspective for hospital management of AHF within the context of the most recent data and to provide guidance, based on expert opinions, to practicing physicians and other healthcare professionals. Material and methods: In this paper we reviewed of current updated European Cardiology Society (ESC) HF guideline (2016) and modern trials for AHF from Medscape database. Results: Diuretics are the main medications in the treatment of patients with AHF and signs of fluid overload and congestion. Intravenous vasodilators are the second most used agent in AHF. Their use was shown to be associated with lower mortality, and a delay in administration was associated with a higher mortality.Use of an inotropic medications (such as dopamine, dobutamine, milrinone, levosimendan, epinephrine, norepenephrine) should be reserved for patients with a severe reduction in cardiac output resulting in compromised vital organ perfusion, which occurs most often in hypotensive AHF. Conclusion: Acute heart failure is a life-threatening medical condition, which needs emergency management for death prevention

THE ISSUE OF AGGRESSION IN PATIENTS WITH VENTRICULAR TACHYCARDIA WITH PULSE AND A SHORT EPISODE OF CARDIAC ARREST — A CASE OF A 68-YEAR-OLD MALE

   INTRODUCTION: Ventricular tachycardia (VT) is a life-threatening event. The role of the medical rescue team is to diagnose this disorder on the basis of resuscitation guidelines and general recommendations concern­ing ECG diagnoses. Patients with ventricular tachycardia, as a result of cerebral hypoxia, may react with aggression. In such situations, taking one’s medical history, conducting a physical examination or attempting emergency rescue operations may become difficult, or even impossible. OBJECTIVE: The objective of the paper is to demonstrate the issue of unintentional aggression that may occur in patients with ventricular tachycardia (VT) with a high heart rate and a short episode of cardiac arrest (CA), and the impact of such a disorder on attempted medical rescue operations. MATERIAL AND METHODS: The analysis of the case study was performed on the basis of medical documen­tation, i.e. an emergency dispatch order and an emergency medical services form. CASE DESCRIPTION: A medical emergency unit stationed at one of the substations in Łódź Province, 27 km away from a multi-disciplinary hospital, received a call from a medical dispatcher. The person calling emer­gency services requested the urgent arrival of an ambulance for her husband, who had suddenly passed out and was now lying on the kitchen floor showing no signs of life. In the course of the ambulance’s arrival at the location, the patient’s wife urged the ambulance to arrive soon, on account of her husband’s aggres­sive behaviour. CONCLUSIONS: Cardiac dysrhythmia and particularly ventricular tachycardia (VT) may constitute a serious health issue for the patient. The clinical picture may also vary across patients. An analysis of the case study demonstrates that medical personnel must be prepared to handle unconventional scenarios. The article shows that the procedure of cardioversion may be the only right choice when handling a patient with an unstable tachycardia

Tutors’ psychological readiness for professional activity in Ukraine

The article deals with the issue of tutors’ psychological readiness for professional activity in the system of Ukrainian higher education. The concepts that are defined are psychological readiness, tutor, professional tutors training, tutor activity, competence, and innovations in the educational system; and the core activity of the Center of Excellence at Bogdan Khmelnitsky Melitopol State Pedagogical University is described. Innovative strategies for the development of the international community lead to the creation of such a system of education which will enable the growth of creative potential of the individuals, and their spiritual and moral characteristics. The cultural and educational institutions have the task to organize the educational process in such a way that the educational-dominant theory and practice of developmental education will focus on methodologies and methods of self-development of the individuals, on the one hand, and the program of expanded professional (psychological) support of self-education of the individuals, on the other hand. The purpose of the article is to determine the update on the problem of tutors’ psychological readiness for professional activity in the system of higher education of Ukraine. The analysis of the respondents’ answers, and the comparison of the results of teachers training for the tutor activity at the start and end of the experimental work give grounds to fix quantitative and qualitative changes in the formation of psychological readiness for tutor activity in teachers. The level of future tutors’ psychological readiness for the tutor activity in the experimental and control groups at the formative stage of the experiment has been increased due to a qualitatively prepared certification program «professional tutors training»; active participation in practical trainings including discussions, round tables, thematic conferences devoted to introduction of excellence tutoring; and conducting training exercises for the development of innovative skills, research and experimental work

Tutor's psychological readiness for professional activity in Ukraine

The article deals with the issue of tutors’ psychological readiness for professional activity in the system of Ukrainian higher education. The concepts that are defined are psychological readiness, tutor, professional tutors training, tutor activity, competence, and innovations in the educational system; and the core activity of the Center of Excellence at Bogdan Khmelnitsky Melitopol State Pedagogical University is described. Innovative strategies for the development of the international community lead to the creation of such a system of education which will enable the growth of creative potential of the individuals, and their spiritual and moral characteristics. The cultural and educational institutions have the task to organize the educational process in such a way that the educational-dominant theory and practice of developmental education will focus on methodologies and methods of self-development of the individuals, on the one hand, and the program of expanded professional (psychological) support of self-education of the individuals, on the other hand. The purpose of the article is to determine the update on the problem of tutors’ psychological readiness for professional activity in the system of higher education of Ukraine. The analysis of the respondents’ answers, and the comparison of the results of teachers training for the tutor activity at the start and end of the experimental work give grounds to fix quantitative and qualitative changes in the formation of psychological readiness for tutor activity in teachers. The level of future tutors’ psychological readiness for the tutor activity in the experimental and control groups at the formative stage of the experiment has been increased due to a qualitatively prepared certification program «professional tutors training»; active participation in practical trainings including discussions, round tables, thematic conferences devoted to introduction of excellence tutoring; and conducting training exercises for the development of innovative skills, research and experimental work

Особенности определения энергии формирования вакансии в 5d-переходных металлах из первых принципов с учетом фактора температуры

Статтю присвячено дослідженню особливостей поведінки найбільш поширеного структурного дефекту, який визначає властивості матеріалу, а саме вакансії, за високих температур. Теоретично досліджено температурну залежність енергії формування вакансії в чистих 5d ГЦК та ОЦК перехідних металах Au, Pt і W методами теорії функціоналу щільності. Особливістю цієї роботи є використання експериментальних значень параметрів ґратки для відповідних температур. Обговорено внески в енергію формування вакансій, результати комп’ютерного моделювання свідчать, що всі вони можуть відігравати важливу роль. Показано, що теплове збудження має істотний вплив на енергію формування вакансій за високих температур. Також доведено можливість існування компенсаційного ефекту, тобто одночасної зміни внесків вільної енергії до енергії формування вакансії в 5d ГЦК та ОЦК перехідних металах Au, Pt та W. Урахування внесків вільної енергії коливань і теплового збудження електронів залежно від температури дає змогу отримати якісну картину ефекту теплового розширення. Розраховані енергії формування вакансій добре узгоджуються з попередніми теоретичними й експериментальними дослідженнями. Ефект взаємної компенсації різних внесків у енергію формування вакансії дає можливість пояснити, чому при експериментальних дослідженнях спостерігається майже однакове значення енергії формування вакансії за різних температур, та виправдовує нехтування температурною залежністю при моделюванні властивостей чистих 5d ГЦК та ОЦК перехідних металів.This work is devoted to investigation of the behavior of the most common structural defect that determines the properties of the material - vacancies - at high temperatures. Theoretical study of the temperature dependence of the vacancy formation energy in pure 5-d fcc and bcc transition metals Au, Pt and W by means of density functional theory (DFT). The feature of this work is usage of experimental values of lattice parameters for the respective temperatures. The article discusses contributions to the vacancy formation energy, the results of computer simulation show that all of them can play an important role. It is shown, that thermal excitation has a significant impact on the vacancy formation energy at high temperatures. Also the possibility of compensation effect, i.e. the simultaneous change of free energy contributions to the vacancy formation energy in the 5-d fcc and bcc transition metals Au, Pt and W was confirmed. Contribution of the free energy vibrations and thermal electronic excitation depending on the temperature gives a good picture of the effect thermal expansion. Calculated vacancy formation energies are in good agreement with previous theoretical and experimental research. The effect of the compensation of different contributions to the vacancy formation energy can explain equality of vacancy formation energy values at different temperatures, observed in experimental studies, and justifies temperature dependence neglecting when modeling the properties of pure 5-d fcc and bcc transition metals.Статья посвящена исследованию особенностей поведения наиболее распространенного структурного дефекта, который определяет свойства материала, а именно вакансии, при высоких температурах. Теоретически исследована температурная зависимость энергии формирования вакансии в чистых 5d ГЦК и ОЦК переходных металлах Au, Pt и W методами теории функционала плотности. Особенностью этой работы является использование экспериментальных значений параметров решетки для соответствующих температур. Обсуждены взносы в энергию формирования вакансий, результаты компьютерного моделирования показывают, что все они могут играть важную роль. Показано, что тепловое возбуждение оказывает существенное влияние на энергию формирования вакансий при высоких температурах. Также доказана возможность существования компенсационного эффекта, то есть одновременного изменения взносов свободной энергии к энергии формирования вакансии в 5d ГЦК и ОЦК переходных металлах Au, Pt и W. Учет взносов свободной энергии колебаний и теплового возбуждения электронов в зависимости от температуры позволяет получить качественную картину эффекта теплового расширения. Рассчитаные энергии формирования вакансий хорошо согласовываются с предварительными теоретическими и экспериментальными исследованиями. Эффект взаимной компенсации различных взносов в энергию формирования вакансии дает возможность объяснить, почему при экспериментальных исследованиях наблюдается почти одинаковое значение энергии формирования вакансии при различных температурах, и оправдывает пренебрежение температурной зависимостью при моделировании свойств чистых 5d ГЦК и ОЦК переходных металлов

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

INTERNATIONAL JOURNAL OF ADVANCES IN CASE REPORTS THE PREVALENCE OF RISK FACTORS IN PATIENTS WITH HEART FAILURE

ABSTRACT Chronic heart failure (HF) is a highly prevalent chronic pathological condition with high morbidity and mortality rates. The purpose of this study was to determine the common and important risk factors in patients with ischemic HF. 389 patients with HF of ischemic genesis were observed in this cross-sectional descriptive study. We established, that the most prevalent risk-factors in patients with ischemic heart failure were: previous history of myocardial infarction, comorbidities (arterial hypertension, 2 type diabetes, chronic kidney disease etc.), cigarette smoking, untargeted blood pressure and low density lipoproteins cholesterol level

Problemy diagnostyczne ostrego zespołu wieńcowego w warunkach zespołu ratownictwa medycznego

INTRODUCTION: Acute coronary syndromes are one of the leading causes of death due to cardiovascular diseases. The diagnosis is made on the basis of the clinical picture, ECG record and laboratory tests. Diagnosis of critical myocardial ischemia in pre-hospital conditions is a challenge for emergency medical teams. MATERIAL AND METHODS: In order to determine the level of knowledge and the ability to recognize and deal with patients with acute coronary syndrome tests were carried out among fifty employees of the emergency medical service (doctors, nurses and paramedics) in the region of central Poland. Statistical analysis was carried out using the normality test of the Shapiro-Wilk distribution and non-parametric chi-square test of independence. The results were considered significant at the level p 0.05), nor being the head of the emergency medical team (ᵡ² = 0,43; p>0,05). CONCLUSIONS: The level of preparation of ambulance service personnel in the field of identifying and dealing with patients with suspected acute coronary syndrome is insufficient. Further research is indicated indicating the greatest substantive deficiencies of emergency doctors, paramedics and emergency nurses to implement the necessary professional development.WSTĘP: Ostre zespoły wieńcowe są jedną z głównych przyczyn zgonów z powodu chorób sercowo-naczyniowych. Diagnozę stawia się na podstawie obrazu klinicznego, zapisu ekg oraz badań laboratoryjnych. Rozpoznanie krytycznego niedokrwienia mięśnia sercowego w warunkach przedszpitalnych stanowi wyzwanie dla zespołów ratownictwa medycznego. MATERIAŁ I METODY: W celu określenia poziomu wiedzy i umiejętności rozpoznawania oraz postępowania z pacjentem z ostrym zespołem wieńcowym przeprowadzono testy wśród pięćdziesięciu pracowników systemu Państwowego Ratownictwa Medycznego (lekarzy, pielęgniarek i ratowników medycznych) w rejonie centralnej Polski. Analizę statystyczną przeprowadzono za pomocą testu normalności rozkładu Shapiro-Wilka oraz testu nieparametrycznego chi-kwadrat niezależności. Wyniki uznano za istotne na poziomie p 0,05), ani pełnieniem funkcji kierownika zespołu ratownictwa medycznego (ᵡ² = 0,43; p>0,05). WNIOSKI: Poziom przygotowania personelu zespołów ratownictwa medycznego w zakresie rozpoznawania i postępowania z pacjentem z podejrzeniem ostrego zespołu wieńcowego jest niewystarczający. Wskazane są dalsze badania wskazujące na największe braki merytoryczne lekarzy systemu, ratowników medycznych i pielęgniarek systemu, aby wdrożyć niezbędne doskonalenie zawodowe