Pneumonia in patients on the background of blood cancer.

Problematic issues of etiologic diagnosis and treatment of community-acquired and nosocomial pneumonia are being studied actively. At the same time specific features of pneumonia in patients with severe immune defects, against blood cancer including are studied insufficiently. By the result of microbiological examinations of 149 patients with pneumonia on the background of blood cancer, who have undergone treatment in hematological center of CE “Dnipropetrovsk local multi-field clinical hospital №4” in 2010-2012, bacterial causative agents were determined in 59,7% of accidents, among which gram-negative microorganisms made up 69,7%, gram-positive – 30,3%. In 63% of accidents the asso­ciations of causative agents were determined: the combination of fungal flora made up 58, 4% bacterial associations – 25, 8%. Invasive methods of research have demonstrated a considerably bigger informativeness in determination of possible etiological diagnosis of pneumonia. In determination of causative agent in fluid of brochoalveolar lavage the part of positive results made up 77,4% against 30,3% in examination of sputum

Difficult diagnosis. Clinical analysis of pneumonia overdiagnosis case.

Despite advances in modern medicine, the prevalence and mortality rates from pneumonia remain high, and the frequency of diagnostic errors ranges from 20 to 50%. This trend to increased morbidity and mortality heads the list in problems of early diagnosis, timely and adequate antibiotic therapy of pneumonia. The greatest attention is given to problems of pneumonia hypodiagnostics, while questions of its hyperdiagnostics, especially by narrow specialists, remain unaddressed. This article discusses the most common causes of pneumonia overdiagnosis at various stages of patients’ management, namely the evaluation of clinical symptoms, assess ment of radiological data and at the stage of additional diagnostic program. On the example of a clinical case, basic errors in diagnostic tactics in case of atypical course of cardiac pathology, which have led to the mistaken diagnosis of pneumonia are considered

The influence of adequate drug therapy on the clinical symptoms and level of serum amyloid A in patients with chronic obstructive pulmonary disease.

The aim of our research was to study the dynamics of the level of SAA in COPD patients in the stable phase of the pathological process against the background of basic therapy. We studied 37 stable COPD patients with II-IV degree of ventilation violations according to the GOLD classification, distributed in two subgroups depending on the adequacy of taking basic therapy. Stable COPD patients, irrespective of the severity of the course of the disease in conditions of inadequate treatment have greater symptom severity, the number of exacerbations over the past year and the level of SAA than patients taking long-term therapy according to COPD severity. Taking therapy corresponding to the severity of the disease within three months by COPD patients helps to reduce the severity of COPD symptoms to the level of these indicators in patients taking adequate therapy for a longer period of time. Treatment of COPD patients which corresponds to the severity of the disease within three months contributes to a significant reduction of SAA level

Neutrophil-to-lymphocyte ratio in predicting prognosis and course of community community-acquired pneumonia in hospitalized patients.

Currently, a marker which could be used both to assess the severity of community acquired pneumonia (CAP) and determine the risk of complications is being searched. According to some authors, Neutrophil-to-Lymphocyte Ratio (NLR) could be such a marker. Therefore, the aim of our research was to determine the diagnostic significance of NLR in patients with CAP and to establish the relationship of NLR with other clinical and laboratory parameters. We conducted a retrospective analysis of 171 case histories of patients with CAP of 3 and 4 clinical groups, with the calculation of NLR (according to the common blood count). In the course of the work, it was found that NLR reflects a balance between the response of neutrophils and lymphocytes and this parameter is associated with the severity of systemic inflammation in patients with CAP. NLR has good diagnostic value in determining the mortality risk in patients with CAP, specially an increase in the level of NLR (more than 10) is associated with a high risk of life-threatening complications

Выраженность системных воспалительных реакций у больных хронической обструктивной болезнью легких

Summary. We analyzed plasma level of an inflammatory mediator lipoxin A4 in patients with chronic obstructive pulmonary disease (COPD) which could be used as a marker of systemic inflammation in COPD patients. Relationships between the lipoxin A4 level and cellular markers of inflammation, persistent lipid peroxidation and reduced exercise tolerance have been found. Improvement in lipoxin A4 level could be an attractive contribution to rehabilitation of COPD patients and should be considered in predictive multivariable models of clinical course and in therapeutic algorithms.Резюме. Исследован уровень медиатора воспаления липоксина А4 плазмы крови при хронической обструктивной болезни легких (ХОБЛ), который может служить одним из маркеров активности системных воспалительных процессов у больных ХОБЛ. Показана взаимосвязь уровня липоксина А4 с клеточными маркерами воспаления, процессом персистирующего перекисного окисления липидов и сниженной толерантностью больных к физической нагрузке. Нормализация уровня липоксина А4 может стать перспективным направлением реабилитации больных ХОБЛ, что необходимо учитывать при разработке прогностических многофакторных моделей клинического течения заболевания и алгоритмов лечебно–профилактических мероприятий

Results from the Survey of Antibiotic Resistance (SOAR) 2011–13 in Ukraine

Objectives: To determine the antibiotic susceptibility of respiratory isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2011–13 from Ukraine. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: A total of 134 isolates of S. pneumoniae and 67 of H. influenzae were collected from eight sites in Ukraine. Overall, 87.3% of S. pneumoniae were penicillin susceptible by CLSI oral breakpoints and 99.3% by CLSI iv breakpoints. Susceptibility to amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin was 100% by CLSI and PK/PD breakpoints. Cephalosporin and macrolide susceptibility was ≥95.5% and 88.1%, respectively using CLSI breakpoints. Trimethoprim/sulfamethoxazole was essentially inactive against pneumococci. Of the 67 H. influenzae tested, 4.5% were b-lactamase positive and all H. influenzae were fully susceptible to amoxicillin/ clavulanic acid, ceftriaxone, ciprofloxacin, cefixime and levofloxacin (all breakpoints). Cefuroxime susceptibility was 100% by CLSI but 73.1% by EUCAST and PK/PD breakpoints. A discrepancy was found in macrolide susceptibility between CLSI (100% susceptible), EUCAST (22%–43% susceptible) and PK/PD (0%–22% susceptible) breakpoints. Trimethoprim/sulfamethoxazole was poorly active (59.7% susceptible). Conclusions: Generally, antibiotic resistance was low in respiratory pathogens from Ukraine. However, only amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin were fully active against both species. Trimethoprim/sulfamethoxazole was the least active, particularly against S. pneumoniae. Some susceptibility differences were apparent between CLSI, EUCAST and PK/PD breakpoints, especially with macrolides against H. influenzae. These data suggest that further efforts are required to harmonize these international breakpoints. Future studies are warranted to monitor continued low resistance levels in Ukraine compared with other parts of Eastern Europe

Results from the Survey of Antibiotic Resistance (SOAR) 2011–13 in Ukraine

Objectives: To determine the antibiotic susceptibility of respiratory isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2011–13 from Ukraine. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: A total of 134 isolates of S. pneumoniae and 67 of H. influenzae were collected from eight sites in Ukraine. Overall, 87.3% of S. pneumoniae were penicillin susceptible by CLSI oral breakpoints and 99.3% by CLSI iv breakpoints. Susceptibility to amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin was 100% by CLSI and PK/PD breakpoints. Cephalosporin and macrolide susceptibility was ≥95.5% and 88.1%, respectively using CLSI breakpoints. Trimethoprim/sulfamethoxazole was essentially inactive against pneumococci. Of the 67 H. influenzae tested, 4.5% were b-lactamase positive and all H. influenzae were fully susceptible to amoxicillin/ clavulanic acid, ceftriaxone, ciprofloxacin, cefixime and levofloxacin (all breakpoints). Cefuroxime susceptibility was 100% by CLSI but 73.1% by EUCAST and PK/PD breakpoints. A discrepancy was found in macrolide susceptibility between CLSI (100% susceptible), EUCAST (22%–43% susceptible) and PK/PD (0%–22% susceptible) breakpoints. Trimethoprim/sulfamethoxazole was poorly active (59.7% susceptible). Conclusions: Generally, antibiotic resistance was low in respiratory pathogens from Ukraine. However, only amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin were fully active against both species. Trimethoprim/sulfamethoxazole was the least active, particularly against S. pneumoniae. Some susceptibility differences were apparent between CLSI, EUCAST and PK/PD breakpoints, especially with macrolides against H. influenzae. These data suggest that further efforts are required to harmonize these international breakpoints. Future studies are warranted to monitor continued low resistance levels in Ukraine compared with other parts of Eastern Europe

Results from the Survey of Antibiotic Resistance (SOAR) 2014–16 in Ukraine and the Slovak Republic

S. pneumoniae isolates collected in Ukraine (n"100) showed susceptibility 97% fratesor amoxicillin, amoxicillin/clavulanic acid, penicillin [intravenous (iv) non-meningitis] and fluoroquinolones, between 83% and 86% for oral penicillin, macrolides and cefaclor, and 75% for trimethoprim/sulfamethoxazole. Susceptibility was substantially lower in the Slovak Republic (n"95). All isolates were susceptible to ratesthe fluoroquinolones, but susceptibility to penicillin, amoxicillin, amoxicillin/clavulanic acid, cefuroxime and trimethoprim/sulfamethoxazole varied between 61% and 64%, with only 44% of isolates susceptible to the macrolides. Susceptibility of H. influenzaewasmorehomogeneous,with susceptibilitytoamoxicillin/clavulanic acid,ceftriaxone,cefuroxime, azithromycin and the fluoroquinolones seen in .90% of isolates by CLSI criteria in both countries. Much greater variability was seen across breakpoints, especially for azithromycin, cefaclor and cefuroxime. The b-lactamase rate was 5.1% (5/98) in the Slovak Republic and 7.3% (7/96) in Ukraine, but the Slovak Republic also had a relativelyhighrateofb-lactamase-negative-ampicillin-resistant(BLNAR)isolates(7.1%;7/98)

Психологические расстройства у пациентов с синдромом бронхиальной обструкции

Summary. The aim of our study was to assess reliability and availability for a general practitioner of screening tools for diagnosing depression and anxiety and for identifying factors contributing a severity of these disorders in patients with asthma and chronic obstructive pulmonary disease (COPD). We examined 57 patients with COPD (n = 27) and asthma (n = 30). We have found that frequency and severity of depression and anxiety in patients with COPD and asthma did not depend either on anthropometric data or duration of the disease or severity of bronchial obstruction. In COPD patients, symptoms of depression increased with aging and were significantly associated with number of comorbidities. The incidence of psychological disorders did not differ significantly between patients with COPD and asthma. Both the diseases could be accompanied by isolated symptoms of anxiety without depression, whereas depressive disorders were always associated with a high level of anxiety. In patients with associated psychological disorders, depression severity correlated with the severity of anxiety.Резюме. Целью исследования было определение надежных и доступных для врача общей практики методов скрининга депрессии и тревожных расстройств, а также выявление факторов, влияющих на выраженность этих нарушений у больных бронхиальной астмой (БА) и хронической обструктивной болезнью легких (ХОБЛ). Были обследованы 57 пациентов с бронхообструктивным синдромом (27 больных ХОБЛ и 30 – БА). Все они в зависимости от основного заболевания были разделены на 2 группы. В ходе исследования было установлено, что частота и выраженность симптомов депрессии и тревоги у больных ХОБЛ и БА не зависит от антропометрических данных, длительности заболевания, выраженности бронхообструкции, но у пациентов с ХОБЛ проявления депрессии усиливаются с возрастом и достоверно связаны с количеством сопутствующих заболеваний. Частота встречаемости психологических расстройств существенно не отличалась у больных ХОБЛ и БА. Для ХОБЛ и БА возможны изолированные проявления тревоги без депрессии, в то время как депрессивные расстройства всегда сочетаются с повышенным уровнем тревоги. При наличии сочетанных психологических расстройств интенсивность депрессии коррелирует с интенсивностью тревоги

ІНТЕРАКТИВНІ ТЕХНОЛОГІЇ НАВЧАЛЬНО-ПІЗНАВАЛЬНОЇ ДІЯЛЬНОСТІ – ІННОВАЦІЙНІ МЕТОДИКИ ЗМІШАНОГО НАВЧАННЯ

The aim of the work – to determine the efficiency of introducing innovative technologies into the educational process at the Department of Internal Medicine 1 of the State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine” (SI “DMA”). The main body. New approaches to student learning envisage the activation of creative abilities. Creativity involves a new vision, that is, the willingness to abandon the usual teaching materials teaching curriculum and readiness for self-transformation. One of the most important tasks of a higher school is that the forms and methods of teaching contribute to the discovery of creative abilities, and continuous self-improvement. The introduction of innovative educational technologies within the framework of a higher medical school – including interactive approaches to teaching students, interns in modern conditions is an important step that involves activating their creative abilities, a new vision of a problem willing to abandon the usual learning schemes and readiness for self-transformation. Interactive technologies are also aimed at creating motivation in different periods of professional development and are especially important in the training of doctors, including internists, for whom training is one of the key stages in the path of becoming an independent specialist. Conclusion. The application of interactive forms of training among medical students effectively influences on the process of assimilating them to a complex of clinical knowledge, characterized by the individualization of educational approaches, is a powerful factor in optimizing the educational process, which provides greater manageability and efficacy of training.Мета роботи: визначити ефективність впроваждення інноваційних технологій у навчальний процес на кафедрі внутрішньої медицини 1 Державного закладу «Дніпропетровська медична академія Міністерства охорони здоров’я України» (ДЗ «ДМА»). Мета роботи – визначити ефективність впровадження інноваційних технологій у навчальний процес на кафедрі внутрішньої медицини 1 Державного закладу “Дніпропетровська медична академія Міністерства охорони здоров’я України” (ДЗ “ДМА”). Основна частина. Нові підходи до навчання студентів передбачають активацію творчих здібностей. Творчість передбачає нове бачення, тобто готовність відмовитися від звичних схем викладання навчального матеріалу та готовність до самозмінювання. Одне з найважливіших завдань вищої школи полягає в тому, щоб форми та методи навчання сприяли виявленню творчих здібностей та безперервному самовдосконаленню. Впровадження інноваційних освітніх технологій у рамках вищої медичної школи, у тому числі інтерактивних підходів до навчання студентів, інтернів, у сучасних умовах є важливим кроком, що передбачає активацію їх творчих здібностей, нове бачення проблеми з готовністю відмовитися від звичних схем навчання та готовністю до самозмінювання. Інтерактивні технології також спрямовані на формування мотивації у різні періоди професійного становлення та мають особливо важливе значення у підготовці лікарів, у тому числі інтерністів, для яких навчання є одним із ключових етапів на шляху становлення самостійного фахівця. Висновок. Застосування інтерактивних форм навчання серед студентів-медиків ефективно впливає на процес засвоєння ними комплексу клінічних знань, характеризується індивідуалізацією навчальних підходів, є потужним фактором оптимізації навчального процесу, що забезпечує більшу керованість, результативність та ефективність навчання. Висновки. Застосування інтерактивних форм навчання серед студентів-медиків ефективно впливає на процес засвоєння ними комплексу клінічних знань, характеризується індивідуалізацією навчальних підходів, є потужним фактором оптимізації навчального процесу, що забезпечує більшу керованість, результативність та ефективність навчання