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 forecast of lethal outcome in chronic leukemia patients with pneumonia

Цель исследования - создание математической модели прогноза летального исхода пневмонии у больных на фоне хронических лейкозов для определения и своевременной оптимизации лечения. Исследовано 323 больных с пневмониями, которые розвились на фоне хронических лейкозов. Все показатели, полученные в результате исследования, внесены в электронную базу данных формализованных историй болезней в виде таблицы «объект-признак», которую подвергали поэтапной многоплановой статистической обработке методами непараметрического дисперсионного анализа Краскела-Уоллиса, корреляционного анализа с расчетом коэффициента ранговой корреляции Спирмена, Roc-анализа. Статистически достоверным считалось значение уровня значимости p<0,05 (5%). Выявлено, что с летальным исходом больных различными формами пневмонии, которые развились на фоне хронических лейкозов ассоциированы показатели лейкоцитов, лимфоцитов, нейтрофилов, тромбоцитов, эритроцитов, гемоглобина и показатели иммунитета (B(CD19+), Т (СD4+), (СD4+/СD8+), IgG). В результате проведенного исследования создана математическая модель прогноза возникновения летального исхода пневмонии у больных на фоне хронических лейкозов: ПЛИ = exp(-0,073-0,994*(лейкоциты) + 4,842 * (Р. Aerogиnosa)) / [1 + exp (-0,073-0,994 * (лейкоциты) + 4,842 * (Р. aerogиnosa)]. Использование в клинической практике разработаной математической модели позволит определить место лечения больных пневмонией в сочетании с хроническим лейкозом, что позволит своевременно оптимизировать программу лечения. The aim of the study - to create a mathematical model for forecasting of poor pneumonia outcome in patients with chronic leukemia in order to optimize treatment. Study included 323 patients with pneumonia and chronic leukemia. All indicators obtained in the study were entered into electronic database of formalized medical histories like a table "object-feature". These results were subjected to stepwise multidimensional statistical processing using non-parametric dispersive analysis by Kruskal-Wallis, correlation analysis with Spearman's rank correlation coefficient, and ROC - analysis. The statistically significant level was p < 0,05 (5%). We determined that the forecast of pneumonia poor outcome in patients with chronic leukemia is associated with: leukocytes, lymphocytes, neutrophils, platelets, erythrocytes, hemoglobin and immunity: B (CD19+) (G/L), T (CD4+) (%), immunoregulatory index (CD4+/СD8+) and IgG (g/l). A mathematical model for predicting the pneumonia poor outcome in patients with chronic leukemia was created in our study: PPO=exp (-0.073-0.994*(leukocytes) + 4.842*(P.aeroginosa)) / [1 + exp (-0.073-0.994*(leukocytes) + 4.842*(R. aeroginosa)]. Using in clinical practice the proposed mathematical model of prediction pneumonia poor outcome in patients with chronic leukemia will allow determining the treatment place and timely optimizing the treatment program

Features of resistance of major pathogens of respiratory tract infections in Dnipropetrovsk region.

According to the retrospective analysis of data obtained for the period of the last four years, the resistance level of major infectious agents (Strepto­coccus pneumoniae, Hаemophilus influenzaе)  to the most of commonly used classes of antibacterial agents (β-lactams, macrolides, lincosamides, fluoroquinolones) was rather low, except for the established resistance level of penicillin-resistant Streptococcus pneumoniae (19% of tested strains were resistant to oxacillin). Multiply resistance of Streptococcus pneumoniae strains in Dnipropetrovsk region was 4,3%. Prognosed by world-wide trials growth of bacterial resistance levels requires decrease of the irrational antibiotics using and constant monitoring of resistance in each region and in the country as a whole to preserve the potential of clinical effective antibacterial agents

Relevant approaches to modernization of academic and material and technical process support of academic process in the field of knowledge “Health care” in terms of adapting to international assessment criteria.

One of the important tasks in modernization of Ukrainian medical education is to bring it in line with international assessment criteria, which has become especially relevant after the introduction of the International Basic Medicine Examination in 2018. The aim of this work was to identify the most significant differences between international medical exams (for example, The United States Medical Licensing Examination, USMLE) and the national system of licensed exams KROK, and based on this, determine the direction of modernization of Ukrainian medical education for its adequate adaptation to new systems of assessment. The most significant differences between the two exams are: format (on computers / on paper); presence / absence of digital files with images and audio data in tasks; thematic focus of tests within one / several subjects; different list of items by which tasks are distributed; in the case of USMLE, there is a much higher motivation to pass the exam with the highest possible result. To adapt the medical education system to such features, it is necessary: to provide students with high-quality illustrated textbooks and meaningful digital data bases for each specialized subject; to actively use images (audio, video files) from these sources during the analysis of the material and all types of control (including test ones); to establish cooperation between the fundamental and clinical departments in the process of creating test tasks, as well as the exchange of digital materials for practical classes. Of particular importance is the synchronization of methodological approaches to conducting practical classes and assessment criteria not only in theoretical but also in clinical departments, which will make the learning process more transparent and understandable. Such a set of measures will help not only to adapt students to exams at the international level, but also will increase their interest and improve the effectiveness of the educational process. The employment of digital images, audio, video files will also contribute to the adequate preparation of students for new directions in medicine, such as telemedicine and telepathology

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

Вплив лозартану на ультраструктурну морфологію формених елементів крові у хворих на цукровий діабет та артеріальну гіпертензію

Ultrastructural changes of blood cells in with patients with hypertension of 1-2-degree, in patients with diabetes mellitus type 2 at compensation and subcompensation phase as well as in patientswith diabetes mellitus and hypertensionduring correction of blood pressure with losartan was defined. It is shown that in patients with hypertension of 1-2-degree relative content of activated platelets does not differ from the normal level. In patients with diabetes mellitus type 2 at compensation or subcompensation phase increase of degree of platelet activation, regardless of presence (150.9%) or absence of hypertension (141.5%) is observed. Conducted antihyper­tensive therapy does not affect the spontaneous activation of platelets within 1 year. In patients with hypertension potential aggregation of platelets is the most sensitive element of platelet hemostasis damage, which can be normalized beginning with 6-th month of losartan treatment. In patients with diabetes mellitus type 2 with hypertension elevation of platelet aggregation is the most significant (75.4%) and areliable effect of antihypertensive therapy on limitation of platelet aggregation is achieved in 9 months of treatment. The degree of platelet degranulation is not different from the norm in patients with hypertension and significantly elevated in patients with diabetes mellitus type 2 (by 81.0%), during 1-year observation a constant level of the parameter is revealed. In the group of patients with diabetes mellitus andhypertension, where the original content of degranulated platelets is sharplyincreased (by 76.2%), a significant positive dynamics in the course of treatment with losartan is observed.Определены ультраструктурные изменения форменных элементов крови у пациентов с артериальной гипертонией 1-2-й степеней, у больных сахарным диабетом 2-го типа в фазе компенсации и субкомпенсации, а также у больных сахарным диабетом с артериальной гипертонией при коррекции артериального давления лозартаном. Показано, что у пациентов с артериальной гипертонией 1-2-й степеней относительное содержание активированных тромбоцитов не отличается от нормального уровня. У больных сахарным диабетом 2-го типа в фазе компенсации или субкомпенсации наблюдается резкое повышение степени активации тром­боцитов независимо от наличия (+150,9%) или отсутствия артериальной гипертензии (+141,5%). Прове­дённая антигипертензивная терапия не влияет на спонтанную активацию тромбоцитов в течение 1 года. У пациентов с артериальной гипертонией агрегационный потенциал тромбоцитов является наиболее чувстви­тельным звеном повреждения тромбоцитарного гемостаза, который возможно нормализовать, начиная с 6-го месяца применения лозартана. У больных сахарным диабетом 2-го типа с артериальной гипертонией повышение содержания агрегированных тромбоцитов является наиболее существенным (на 75,4%), а достоверный эффект антигипертензивной терапии по ограничению агрегации тромбоцитов достигается через 9 месяцев лечения. Степень дегрануляции тромбоцитов не отличается от нормы у пациентов с артериальной гипертонией и значительно повышен у больных сахарным диабетом 2-го типа (на 81,0%), причём в течение 1 года наблюдения выявляется постоянный уровень параметра. В группе больных сахарным диабетом с артериальной гипертензией, в которой исходное содержание дегранулированных тромбоцитов является резко повышенным (на 76,2%), наблюдается существенная положительная динамика в течение терапии с использованием лозартана.Ultrastructural changes of blood cells in with patients with hypertension of 1-2-degree, in patients with diabetes mellitus type 2 at compensation and subcompensation phase as well as in patients with diabetes mellitus and hypertension during correction of blood pressure with losartan was defined. It is shown that in patients with hypertension of 1-2-degree relative content of activated platelets does not differ from the normal level. In patients with diabetes mellitus type 2 at compensation or subcompensation phase increase of degree of platelet activation, regardless of presence (150.9%) or absence of hypertension (141.5%) is observed. Conducted antihyper­tensive therapy does not affect the spontaneous activation of platelets within 1 year. In patients with hypertension potential aggregation of platelets is the most sensitive element of platelet hemostasis damage, which can be normalized beginning with 6-th month of losartan treatment. In patients with diabetes mellitus type 2 with hypertension elevation of platelet aggregation is the most significant (75.4%) and a reliable effect of antihypertensive therapy on limitation of platelet aggregation is achieved in 9 months of treatment. The degree of platelet degranulation is not different from the norm in patients with hypertension and significantly elevated in patients with diabetes mellitus type 2 (by 81.0%), during 1-year observation a constant level of the parameter is revealed. In the group of patients with diabetes mellitus and hypertension, where the original content of degranulated platelets is sharply increased (by 76.2%), a significant positive dynamics in the course of treatment with losartan is observed

МОЖЛИВОСТІ КОРЕКЦІЇ СУРФАКТАНТНОЇ СИСТЕМИ ЛЕГЕНЬ У ХВОРИХ НА ІНФЕКЦІЇ НИЖНІХ ДИХАЛЬНИХ ШЛЯХІВ. МЕТОДИ КОНТРОЛЮ ЕФЕКТИВНОСТІ

Метою нашої роботи стало визначення оцінки ефективності проведення сурфактантної терапії у доповнення до стандартної лікувальної програми у хворих на інфекції нижніх дихальних шляхів. У дослідження було включено 83 особи хворі на негоспітальну пневмонію (НП) та інфекційне загострення ХОЗЛ (ІЗ ХОЗЛ). Хворих поділили на дві групи відповідно до додавання до лікувальної програми препарату сурфактанту: першу групу склали 49 хворих на НП, другу – 34 хворих з ІЗ ХОЗЛ.

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

ШЛЯХИ ВДОСКОНАЛЕННЯ ВИКЛАДАННЯ КЛІНІЧНИХ ДИСЦИПЛІН В АНГЛОМОВНИХ СТУДЕНТІВ

The aim of the study – to investigate the efficiency of combining the classical educational and methodical process of foreign students with English language learning and innovative technologies that are currently growing in terms of modernity in teaching of clinical disciplines.The main body. The contingent of foreign English-speaking students, their success rate in clinical subjects, the level of practical skills, the acquisition of diagnostic, therapeutic and surgical skills are investigated. The results of development in educational process of modern simulation, computer and interactive technologies for mastering practical skills in clinical discipline teaching with English language education have been studied.The results of the study indicate that to improve the training quality of foreign English-speaking students, it would be advisable to raise the standards for students from English-speaking contingent. When the student wants to enter on English form of education the foreign students who are native English speakers should be preferred; for applicants the criteria level to their knowledge we have to increase, the documents of previous education and the subjects for entrance exams. To improve the quality of practically-based education and mastering the practical skills with the patient our foreign students with English education try to collect complaints and even the basic elements of history on Ukrainian or Russian language and this happens from the middle till the senior courses, it would be very useful for independent work.The results of modern simulation, and interactive computer technologies in educational process of foreign English-speaking students demonstrate the achievement of performance in these groups, increasing the speed of diagnostic manipulations and students’ practical skills, the increasing of self-esteem and self-confidence in showing these skills directly at the bedside of the patient. However, the results are better just after the classes, and at a remote quality control of skills.Conclusion. The effective combination of classical educational and methodical process of foreign English language speaking students and innovative technologies help to achieve the ultimate aims, which were defined in educational programs for professionals.Мета роботи – вивчення ефективності поєднання класичної організації системи навчально-методичного процесу у студентів-іноземців з англомовною формою навчання та інноваційних технологій, що наразі динамічно розвиваються в умовах сучасності, при викладанні клінічних дисциплін.Основна частина. Досліджено контингент англомовних іноземних студентів, показники їх успішності з клінічних дисциплін, рівень засвоєння практичних навичок, набуття діагностичних, терапевтичних та хірургічних вмінь. Вивчали результати впровадження в навчальний процес сучасних симуляційних, комп’ютерних та інтерактивних технологій для опанування практичних навичок та вмінь при викладанні клінічних дисциплін у студентів-іноземців з англомовною формою навчання.Результати дослідження свідчать, що для підвищення якості підготовки англомовних іноземних студентів доцільно підвищити вимоги щодо англомовного кон­тингенту студентів. При вступі на англомовну форму навчання слід надавати перевагу іноземним громадянам, які є носіями англійської мови, для вступників збільшити критерії щодо рівня знань у документах про попередню освіту та безпосередньо з профільних конкурсних предметів на вступних іспитах. Для підвищення якості практично-орієнтованого навчання та опанування практичних навичок роботи безпосередньо з пацієнтом у студентів-іноземців з англомовною формою навчання ми намагаємось привчити студента до збору скарг та хоча б основних елементів анамнезу українською чи російською мовою ще з середніх курсів, щоб на старших він міг працювати більш самостійно.Результати впровадження новітніх симуляційних, комп’ютерних та інтерактивних технологій у навчальний процес в англомовних іноземних студентів наочно демонструють покращення показників успішності таких груп, збільшення швидкості виконання студентами діагностичних маніпуляцій та практичних навичок, підвищення самооцінки і впевненості у собі при відтворенні цих навичок безпосередньо біля ліжка хворого. При цьому результати виявляються краще як відразу після заняття, так і при віддаленому контролі якості навичок.Висновки. Ефективне поєднання класичної організації системи навчально-методичного процесу у студентів-іноземців з англомовною формою навчання та інноваційних технологій дозволяє досягти кінцевих цілей, визначених в освітньо-професійних програмах підготовки спеціалістів