MORAL AND ETHICAL PECULIARITIES AND PROBLEMS OF ORGANISATION OF THE PUBLIC HEALTHCARE SYSTEM IN UKRAINE

The problems of modern domestic medicine, based on the flaws in ideological-moral and ethical foundations of the public healthcare system, are analysed in the report. The impossibility to develop high-quality medical services without introduction of strict ethical standards of the profession and improvement of the doctors’ social and legal responsibility level is substantiated. The author formulates a point of view that in conditions of obstructed realization of reforms in various other spheres of social life, such transformations could be the most effective in the sphere of medicine

PROBLEMS OF UKRAINIAN MEDICAL INSTITUTIONS AND THE SPECIFICITY OF PERSONAL AND PROFESSIONAL TRAITS OF THEIR DIRECTORS

The peculiarities of functioning of modern medical institutions in Ukraine in conditions of a set of economic and political crises are considered in the report. It is stated that medical administrators are forced to fulfill a number of formal and informal administrative functions in order to keep hospitals and polyclinics operating. It is specified that now a significant volume of the current problems of domestic public health care are resolved at the level of heads of medical institutions

Arrhythmias and conduction abnormalities in children after repair of tetralogy of Fallot

Aim. To find out types and frequency of cardiac arrhythmias and conduction abnormalities in the group of children who underwent surgery for tetralogy of Fallot (TOF). Methods. Fortysix pedicatric patients who underwent a complete repair of TOF at the age of 1 to 13 (mean 2.89 ± 2.36) were studied. Thirty-eight (82.60%) had total correction and 8 (17.40%) had palliative operation first, and total correction afterwards. Twenty-four-hour Holter ECG monitoring was performed in all 46 pediatric patients aged from 1 to 16 yrs (mean 6.48 ± 4.04) after surgery as follows: in 1 patient (2.17%) after a year, in 20 patients (43.47%) after 2 to 5 years and in 25 patients (54.34%) after 5 years. Mean age of patients on Holter monitoring was 9.25 ± 4.39 (range 4−19). Twenty of them (43.47%) were girls and 28 (56.53%) were boys. All the patients were evaluated by standard methods (clinical signs, clinical findings, ECG before surgery, ECG before Holter monitoring and 2D Doppler echocardiography. Results. Types of heart rhythm found out by Holter monitoring were: sinus nodus dysfunction in 1 child (2.17%), significant premature atrial contraction (PAC) in 8 (17.39%), supraventricular paroxysmal tachycardia in 3 (6.53%), transient nodal rhythm in 2 (4.34%), premature ventricular contraction (PVC) Lown grade I-III in 9 (19.56%) and Lown grade IV in 2 (4.34), atrioventricular (AV) block grade I in 2, right bundle branch block (RBBB) in all 46 (100%) and RBBB + left anterior hemiblock (LAH) in 4 (8.96%). There was no presence of atrial flutter, ventricular tachycardia or complete AV block. None of them experienced sudden death. Using cross procedure statistical methods, it was found that all the patients with PVC had right ventricular dilatation. There was no relation of other types of arrhythmia found on Holter monitoring to the other parameters from echocardiography, neither to the other standard methods. Children did not need the pace-maker, but 36.95% of the them required antiarrhythmic drugs. Conclusion. Twenty-four hour Holter ECG is a noninvasive and very sensitive method for discovering heart rhythm disturbances in children after the repair of tetralogy of Fallot, especially in asymptomatic patients. The patients after the repair of this congenital heart disease needed a long-term follow-up for early recognition of serious heart rhythm disturbances and their treatment

CERTAIN CRITERIA OF ROLE IDENTIFICATION AND TACTICAL MODELLING OF THE PSYCHIATRIST’S BEHAVIOUR WHEN TREATING NEUROSES

The necessity of role identification and tactical modelling of the psychiatrist’s behaviour when treating neuroses is substantiated in the report. The author shows that establishment of trust between the doctor and the patient acts as one of the crucial factors of successful treatment. For this purpose the doctor must initially appear in the role partially corresponding to expectations of the patient, but at the same time demonstrating the strength of the doctor’s identity and his confidence in effectiveness of the offered treatment

The role of plants on the impact of cultural and historical monuments

Visual impact of cultural and historical monuments determined by surrounding plants is the focus of discussion in the paper. Their influence on passengers and onlookers sidelong roadways and trails is described in detail. A great number of practical examples have been examined with the purpose of drawing some general conclusions from this problem to the advantage of landscape design practice. The result of the analysis shows a considerable role of vegetation in visual impact of monuments over the observers. Using color photographs and observations from a number of different positions for a lot of monuments and memorials the survey concludes that from the standpoint of aesthetic value or attractiveness the vegetation often plays a leading role. It is not a detailed study of compositional principles for the formation of spaces around the monuments, but demonstrates the complexity of the problem and gave some results in addition to the theoretical foundations in this respect. Although the scenic beauty metrics are quite debatable and controversial case it is hoped that the conclusions of this paper will facilitate needed discussion on vegetation appropriateness and usefulness in monument's landscape design

The role of plants on the impact of cultural and historical monuments

Visual impact of cultural and historical monuments determined by surrounding plants is the focus of discussion in the paper. Their influence on passengers and onlookers sidelong roadways and trails is described in detail. A great number of practical examples have been examined with the purpose of drawing some general conclusions from this problem to the advantage of landscape design practice. The result of the analysis shows a considerable role of vegetation in visual impact of monuments over the observers. Using color photographs and observations from a number of different positions for a lot of monuments and memorials the survey concludes that from the standpoint of aesthetic value or attractiveness the vegetation often plays a leading role. It is not a detailed study of compositional principles for the formation of spaces around the monuments, but demonstrates the complexity of the problem and gave some results in addition to the theoretical foundations in this respect. Although the scenic beauty metrics are quite debatable and controversial case it is hoped that the conclusions of this paper will facilitate needed discussion on vegetation appropriateness and usefulness in monument's landscape design

LIGHT-HUMUS CARBONATE-ACCUMULATIVE AND PALE-METAMORPHIC SOILS IN THE COLLECTION OF V. V. DOKUCHAEV CENTRAL SOIL MUSEUM: VERIFICATION OF DIAGNOSTICS AT TYPE LEVEL

Results of 24 soil monoliths studying in the collection of Dokuchaev Central Soil Museum were analyzed in terms of diagnostic criteria in Russian soil classification system; these were chestnut, brown aridic, pale and cryoaridic soils. The topsoils of chestnut and brown aridic soils meet the criteria for the light-humus horizon (AJ), but their values in Munsell readings proved to be lower. In pale soils, the upper horizons were identified as gray-humus instead of light-humus ones as prescribed in the system. The cryohumus AK horizon, diagnostic for cryoaridic soils, is peculiar by the abundance of reddish frost-fragmented plant residues (detritus). We failed to differentiate metamorphic BM and xerometamorphic BMK horizon, they had more features of the latter. Both horizons are similar to the pale-metamorphic BPL horizon in color, although the BPL has a definitely weaker structure displaying some cryogenic features. These are less prominent in cryoaridic soils than in pale soils, hence, the diagnostic BPL horizon in cryoaridic soils may be removed to the category of diagnostic property. A similar re-evaluation may be proposed for the carbonate-textural CAT horizon: to consider it as a diagnostic property in the carbonate-accumulative horizon (ВСАt). The ВСА horizon in all soils studied differed by carbonate pedofeatures, namely, segregations in brown and chestnut soils, impregnations in pale soils, impregnations and coatings in cryoaridic soils

Impaired cognitive function in Crohn's disease: relationship to disease activity

Background & aims: Impaired attention and response inhibition have been reported in patients with Crohn’s disease (CD) in clinical remission. Prospective studies are needed to determine whether this is a stable feature of CD and whether a similar impairment is evident in ulcerative colitis (UC). Thus, our aims were to examine whether patients with CD and UC exhibited a persistent impairment in attentional performance, and if this impairment was related to key biological indices of relevance to cognition. Methods: A prospective observational study was conducted on fifteen patients with CD and 7 with UC in clinical remission recruited from a specialty clinic and 30 healthy matched control participants. A neuropsychological assessment was carried out at baseline (visit 1) and at a 6 month follow-up (visit 2). Plasma proinflammatory cytokines, the plasma kynurenine:tryptophan (Kyn:Trp) ratio and the salivary cortisol awakening response (CAR) were also determined at each visit. Results: Across visits, patients with CD exhibited impaired attentional performance (p ¼ 0.023). Plasma IL-6 (P ¼ 0.001) and the Kyn:Trp ratio (P ¼ 0.03) were consistently elevated and the CAR significantly blunted (P < 0.05) in patients with CD. No significant relationships were identified between any biochemical parameter and altered cognitive performance. Conclusions: Impaired cognitive function is a stable feature of patients with CD. These data suggest that even where remission has been achieved, the functional impact of an organic gastrointestinal disorder on cognition is still evident. However, it is unclear at present if physiological changes due to disease activity play a role in cognitive impairment in CD

Адаптивная фаготерапия пациентов с рецидивирующими пневмониями (пилотное исследование)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics.Цель. Оценка безопасности и эффективности технологии адаптивной фаготерапии в лечении пациентов с рецидивирующими пневмониями в нейрореаниматологии.Материал и методы. В клиническое исследование включили 83 пациента в хроническом критическом состоянии с тяжелым повреждением головного мозга. У 43 пациентов ингаляционно применили комплексный препарат бактериофагов, адаптированный к госпитальным штаммам данного учреждения. Группу сравнения сравнения составили пациенты (n=40), получавшие традиционную антибактериальную терапию. Оценивали динамику клинико-лабораторных, инструментальных показателей, биомаркеров, результаты микробиологических и ПЦР-исследований бронхо-альвеолярного лаважа, в том числе — раздельно в подгруппах «фаготерапия с антибиотиками» (n=29) и «фаготерапия без антибиотиков» (n=14).Результаты. Группы были сопоставимы по основным показателям (возраст, пол, диагноз, степень органных дисфункций по APACHE II, применение вазоактивных препаратов) и уровню бактериальной колонизации дыхательных путей антибиотикорезистентными штаммами. При ингаляционном введении комплексного препарата бактериофагов наблюдали хорошую переносимость, отсутствие клинически значимых побочных эффектов. По данным компьютерной томографии, к 21-му дню выявили значимое снижение степени повреждения легких. У пациентов, получавших лечение бактериофагами без антибиотиков, значимо снизилась потребность в проведении искусственной вентиляции легких. Летальность к 28-м сут. значимо не различалась: при фаготерапии — 2/43 (4,7%), в группе сравнения — 2/40 (5%).Заключение. Первый опыт применения технологии адаптивной фаготерапии в лечении хронических реанимационных пациентов в нейрореаниматологии продемонстрировал безопасность ингаляционного введения комплексного препарата бактериофагов. Эффективность технологии подтверждена результатами лечения, полученными в группе фаготерапии, которые не уступали таковым в группе с традиционной антибиотикотерапией, а ряд клинико-лабораторных показателей имел тенденцию к улучшению даже в случаях полного отказа от антибиотиков в пользу бактериофагов

Adaptive Phage Therapy in the Treatment of Patients with Recurrent Pneumonia (Pilot Study)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics