Imaging Evaluation of Mesenteric Ischemia: Is There a Golden Period for This Entity?

Background.The study was aimed at assessing the role of ultrasonography and multidetector computed tomography angiography in evaluating patients with suspected mesenteric ischemia, as well as assessing the effect of the time from presentation to management on mortality and morbidity. Materials and Methods. Patients with clinically suspected mesenteric ischemia underwent Doppler ultrasound and contrast-enhanced computed tomography. On ultrasonography, we assessed any filling defect in the superior mesenteric artery/vein, narrowing or occlusion of the proximal superior mesenteric artery, ascites, bowel wall thickening, and pneumatosis/portal venous gas. Computed tomography angiography was performed looking for any filling defect in the superior mesenteric artery/vein, superior mesenteric artery/vein calibre, bowel wall thickening, calibre and enhancement and pneumatosis/portal vein gas. Most of our patients underwent emergency surgery and the findings correlated with imaging. All the patients were divided into Group A (n=30) and Group B (n=17) based on the time from presentation to management: within 48 hours of presentation and 48 hours after presentation, respectively. Results. On computed tomography scan, mesenteric vascular involvement was seen in 27 (55%) patients, mesenteric/intestinal twist was observed in 12 (25%) patients, and non-occlusive mesenteric ischemia was found in 6% of patients. The computed tomography findings were found to have a sensitivity of 86%, a specificity of 94% and an accuracy of 90% in cases of mesenteric ischemia. Among 35 patients operated on, those presenting within 48 hours, had a significantly less mortality (63%) in comparison to those presenting after 48 hours (90%). Conclusions. Clinical, laboratory and ultrasound features are non-specific in diagnosing mesenteric ischemia. Computed tomography angiography is a sine qua non in mesenteric ischemia diagnosis. Patients with venous ischemia respond well to conservative management. Early intervention within the first 48 hours is associated with better prognosis

Major Clinical Phenotypes of Polypous Rhinosinusitis

Polypous rhinosinusitis remains one of the major problems of modern otorhinolaryngology, its prevalence in general population reaches 4%. There is a wide range of variants of clinical course and a different response to traditional methods of treatment, however all these cases are diagnosed as “polypous rhinosinusitis”. It suggests the heterogeneity of a group of patients diagnosed with “polypous rhinosinusitis” and the need for a detailed study of various clinical variants of nasal polyposis, i.e. clinical phenotypes of the disease.The objective of the research was to assess clinical features of chronic polypous rhinosinusitis depending on trigger of the disease as well as to determine clinical phenotypes of nasal polyposis.Materials and methods. The article presents the results of clinical and anamnestic investigations, radiology examinations and laboratory studies of 150 patients with various types of polypous rhinosinusitis. Patients were divided into three groups: Group I included 50 patients with aspirin-intolerant polyposis; Group II consisted of 50 patients with polyposis due to violations of aerodynamics of the nasal breathing; Group III included 50 patients with Ig-E-dependent (allergic) polyposis,Results. The research revealed significant differences in studied indicators  between different clinical groups. The presence of differences in gender, age, severity of clinical symptoms and the character of pathological changes allowed us to determine the most common clinical phenotypes of polypous rhinosinusitis.Conclusions. The onset of the disease affecting primarily females in adulthood, severity of clinical manifestations, total or subtotal lesions of sinuses resulting in resistance to traditional methods of treatment are typical for patients with aspirin-intolerant polyposis. The above mentioned phenotypes are considered within a clearly defined pathology and allow us to optimize the diagnostic process as well as to determine adequate therapeutic tactics for each clinical case

A Comparative Study of the Canine Tooth as a Tool in Gender Determination in Nigerian Population

Dental evidence has been demonstrated as a major forensic tool for the identification of individuals and sex determination. The objective of the research was to determine sex in Delta Ibo ethnic group of Nigeria using the mandibular and maxillary canine teeth. Materials and methods. The study comprised 201 (100 males and 101 females) subjects of Delta Ibo ethnicity at the age of 17 – 25 years. The mesiodistal crown width and intercanine distance of both the maxillary and mandibular canines were measured intraorally using a pair of dividers and a ruler. Unpaired T-test at a probability value of p<0.05 was used to ascertain the mean significant differences between the male and female canine indices.   Results. Study results showed a statistically significant difference between male and female mandibular and maxillary canine mesiodistal width. This implied a sexual and reversed sexual dimorphism in the studied population.        Conclusions. The study confirmed that the canines of Delta Ibos exhibit sexual dimorphism like other populations and the maxillary canine indices give the most accurate prediction in sex determination

ВИВЧЕННЯ ОБІЗНАНОСТІ МЕДИЧНИХ ПРАЦІВНИКІВ ЩОДО ОРГАНІЗАЦІЙНИХ АСПЕКТІВ ВАКЦИНАЦІЇ НАСЕЛЕННЯ

Aim. To analyze the awareness of healthcare workers on the organization of vaccination. Materials and Methods. In 2018 – 2019 sociological survey was conducted among 1384 healthcare workers from 4 Ukrainian regions: 353 primary care physicians, 233 specialized medical care doctors, 88 healthcare managers, 700 nurses, and 10 others. Results. Gaps in the knowledge and beliefs of health professionals associated with the organization of vaccination were founded: less than half of the surveyed health workers understand that vaccination is carried out with any certified vaccine, regardless of the country of origin; a significant part of respondents tend to prescribe drugs not recommended by international guidelines (53.6%), antihistamines (15.9%) and anti-inflammatory (8.0%) drugs before vaccination; do not know about the possibility of doing several vaccinations in one visit (47.3%) and that the cold chain breach affects the effectiveness of the vaccine (52.4%). It was found that the most knowledgeable about the organization of immunoprophylaxis of the population are the health care managers and medical personnel who have passed special training on vaccination vs the least informed specialized medical care doctors. Conclusions. It is necessary to develop a set of scientifically based measures to improve the awareness of health professionals about the organization of vaccination in order to improve the coverage of the population with immunoprophylaxis.Мета. Проаналізувати обізнаність медичних працівників з організації проведення вакцинації населення у межах їх компетенції. Матеріали і методи. Впродовж 2018-2019 років провели соціологічне дослідження 1384 медичних працівників 4-х областей України: лікарів первинної медичної допомоги (353 особи), лікарів-спеціалістів (233), керівників медичних закладів (88) та молодших спеціалістів з медичною освітою (700), інших (10). Результати. Встановлено прогалини у знаннях та переконаннях медичних працівників, пов’язаних з організацією вакцинації населення: менше половини опитаних медичних працівників розуміють, що щеплення проводять будь-якою сертифікованою вакциною, незалежно від країни-виробника; значна частка респондентів схильні призначати перед щепленням не рекомендовані міжнародними настановами обстеження (53,6%), антигістамінні (15,9%) та протизапальні (8,0%) лікарські засоби; не знають про можливість робити за один візит декілька щеплень (47,3%), і що порушення холодового ланцюга впливає на ефективність вакцини (52,4%). Виявлено, що найбільш обізнаними з питань організації імунопрофілактики населення є керівники медичних закладів і медпрацівники, які пройшли спеціальні тренінги з вакцинації, а найменш поінформовані – лікарі-спеціалісти. Висновки. Необхідно розробити комплекс науково обґрунтованих заходів із поліпшення обізнаності медичних працівників щодо організації вакцинації з метою поліпшення охоплення населення імунопрофілактикою. Ключові слова: організація вакцинації, обізнаність, медичні працівник

Cytokine Response of CD4+ T-Lymphocytes with Red Rose (Rosa Rosaceae – Pierre de Ronsard) Extracts by in Vitro Evaluation

Background. Red rose extract is known to have anti-inflammatory and immune-modulation effects. In this study, the red rose extract was tested on CD4+T lymphocytes in vitro, and cytokine response was evaluated. Materials and Methods. The red rose (Rosa Rosaceae - Pierre de Ronsard) extract used in this study was prepared and stored at -20° C until use. CD4+T-cells were seeded in 96-well plates at 313,500 cells/well in 100μ l cell culture medium in duplicate. One-half of the wells were used for biomarker screening in the culture medium, and the other half was used for cytotoxicity assay. Twenty-four hours after plating, the cells were treated in duplicate with 100μ l of the red rose extract diluted at 0.5%, 0.1%, 0.05%, 0.01% and 0.005% (v/v) in the cell culture medium or with culture medium only as control for 72 hours. Some other wells were allocated for untreated cells, and cells treated with the rose extract at 0.005% for 48-h incubation time. Results. Several cytokines (GRO; IFN-γ; IL-1α, 6, 10; MCP-1; RANTES; TGF-β1; TIMP 1, 2; Ang1, Ang2; G-CSF; MMP-9; and VEGF R2) were elevated. Except for MMP-9, which had fold changes > 2, other cytokines were minimally elevated at various concentrations and timing of rose extract treatment. None of the mentioned cytokines were less than 0.8-fold after treatment with the rose extract. Cytotoxicity assay revealed insignificant changes in the viability of T-cells. Conclusions. There was a mild elevation in few inflammatory markers by CD4+ T-lymphocytes after in vitro treatment with the red rose extract (Rosa Rosacea - Pierre De Ronsard). Further in vitro and in vivo studies are required to evaluate the benefits of the red rose extract in immune regulation

Peculiarities of the Course and Provision of Medical Care to Patients with Acute Coronary Syndrome in the Precarpathian Region

Abstract. Cardiovascular diseases are the first ones in mortality among other diseases. Particular attention should be paid to patients after acute coronary syndrome, since their quality of life, the possibility of restoration of work capacity. Objective of the research. To evaluate indicators of medical care provision for patients with acute coronary syndrome in the Precarpathian region. Materials and methods. The medical-geographical indicators, data of the local registry (2014-2018) included clinical and objective parameters, peculiarities of the course, rehabilitation and treatment of patients with acute coronary syndrome. Results. The peculiarities of the course of acute coronary syndrome, clinical characteristics of patients depend on the form of IHD and the applied method of ACS treatment. There is an increase of the number of PCI performance and the reduction of TLT, the percentage of admission of patients up to 2 hours remains low. The increase of PCI performed in the districts of the region in the dynamics from 2014 to 2018 has been determined, as well as the geographical peculiarities of the Ivano-Frankivsk region. The percentage of patients’ undergoing rehabilitation after acute coronary syndrome remains low. Conclusions. The Precarpathian region has a number peculiarities that are related to the location of the region. Taking into account the characteristics will contribute to the improvement of the organizational model of medical care provision in the region

Ensuring the Quality of Higher Education Under Current Conditions

Abstract. In the present conditions, especially during a pandemic, higher education requires academic staff to master and implement innovative methods of teaching and learning based on information programs, knowledge transfer systems. The tasks of interactive educational forms are as follows: awakening students’ interest; motivating students to solve the problem under study; effective mastering educational material; independent searching for the methods and options how to solve the educational task; interactions between students; teamwork skills; tolerance for any point of view; forming students’ own opinion, life and professional skills; reaching the level of student’s conscious competence. After analyzing our research, we can state that interactive learning creates an environment of educational communication, which is characterized by openness, equal-footing interaction of participants, accumulation of mutual knowledge, that provides high motivation, strength of knowledge, creativity, sociability, active life position, preservation of individuality, freedom of expression, mutual respect.           This paper examined the current problems of innovative technologies and teaching methods in modern higher education, as the tendency to humanization and humanitarization of the content of medical education has intensified, new academic disciplines have been introduced and, consequently, the need for academic staff, who could provide an innovative approach to implementing these trends during the educational process, has been increased. It is significant that today teachers are able to create and implement their own innovative methods. In addition, the paper focused on the safety of the educational environment of higher education. Information security is especially important, as nowadays the information media have an extremely big impact on the student environment.В умовах сьогодення, особливо під час пандемії, вища освіта вимагає від науково-педагогічних працівників опанування і впровадження інноваційних методів навчання й викладання, заснованих на інформаційних програмах, системах передання знань. Задачі інтерактивних форм навчання: пробудження інтересу, мотивація студентів до досліджуваної проблеми; ефективне засвоєння навчального матеріалу; самостійний пошук шляхів та варіантів вирішення поставленої навчальної задачі; взаємодії між студентами, навички роботи в команді, прояв терпимості до будь-якої точки зору; формування у студентів власної думки, життєвих і професійних навичок; вихід на рівень усвідомленої компетентності студента. Проаналізувавши наші дослідження, ми переконалися, що при інтерактивному навчанні створюється середовище освітнього спілкування, яке характеризується відкритістю, взаємодією учасників на рівних правах, накопиченням спільних знань, що дозволяє забезпечити високу мотивацію, міцність знань, творчість, комунікабельність, активну життєву позицію, збереження індивідуальності, свободу самовираження, взаємоповагу. Дана стаття розглядає актуальні проблеми інноваційних технологій і методів навчання в сучасній вищій освіті, оскільки посилилася тенденція до гуманізації і гуманітаризації змісту навіть медичної освіти, введено нові навчальні дисципліни і, як наслідок, зросла потреба в науково-педагогічних працівниках, які змогли б забезпечити інноваційний підхід до реалізації цих тенденцій під час навчально-виховного процесу. Показово, що викладачі отримали можливість створювати і втілювати власні інноваційні методики. Крім того, у статті акцентована увага на проблемах безпеки освітнього середовища вищої освіти. Особливо важливою є інформаційна безпека, тому що в наш час надзвичайно великий вплив мають інформаційні засоби на студентське середовище

Clinical Neuroimaging Peculiarities and Functional Consequences of Ischemic Stroke in Patients with MS

The objective of the research was to study the peculiarities of post-stroke period in patients with metabolic syndrome (MS), functional consequences, cognitive impairment, to identify structural brain changes on the basis of MRI results; to perform correlation analysis between the brain volumetric test results and cognitive deficit.Materials and methods. The study involved 116 patients, aged 51 to 81, with ischemic stroke, 79 patients – main group – during the early and late recovery periods after ischemic stroke related to MS. The control group included 37 patients in the early and late recovery periods after acute cerebrovascular accident (ACVA) without MS. To determine the functional consequences of ischemic stroke after 12 weeks and 1 year after it, the examination was conducted and the results were evaluated according to modified Rankine scale (MSHR) and Barthel Index (BI). We determined patients’ mortality rate within 1 year after the ischemic stroke. Their condition of cognitive functions was measured according to MMSE, MOSA and FAB scales. The volume of cortex and white matter of the cerebral hemispheres, temporal and frontal lobes were measureed (cm³) by applying MRI scanner Toshiba Vantage Titan 1,5. Workstation Vitrea was used for images post-processing.Results. Patients with MS had more common significant signs (p<0.05) of neurological status functional disorders, delayed recovery and disability. Within a year, in the main group mortality rate because of recurrent stroke was 5.06%, which was significantly higher than in the control group, where the mortality rate was 2.7%. Within a year, the process of lost functions restoring according to MSHR occurred in both groups, but in the main group, this rate was significantly lower in comparison to the control group. Patients with MS were determined to have a significant impairment of cognitive functions according to cognitive scales. However, a year later cognitive performance did not differ significantly in the main and control groups, although they declined in both groups. Volumetric parameters were determined: the volume of cortex and white matter of the cerebral hemispheres, temporal and frontal lobes (cm³). Results obtained: reduced total volume of the brain, of the temporal and frontal lobes in patients of the main group (p<0.05). Patients of both study groups were determined to have cognitive functions impairment - reduced volume of the cortex in the frontal and temporal lobes according to MMSE scale. The correlation index between cortex indicators of frontal and temporal lobes volume and the results of cognitive functions according to MMSE scale was: r = 0,62 - temporal and r = 0,59 frontal lobes indicators. Modules of correlation coefficients were within the average strength.Conclusions. Patients who have suffered from primary ischemic stroke related to MS restored their lost functions slower and the mortality rate among them was significantly higher (p<0.05) within the first year after stroke than in patients without MS. Patients had cognitive deficits related to cortex atrophy in the frontal and temporal lobes after the primary ischemic stroke. Atrophy in these areas of the cortex was more distinct (p<0.05) than in patients without MS. Positive correlation relationship was determined between cognitive performance and the degree of cortex atrophy in the frontal (r = 0.59) and temporal (r = 0.62) lobes of patients with ischemic stroke related to MS

Study of Macro- and Microelement Status in Patients with Nodular Goiter Residing in Kyiv Region

Sixty-one residents of Kiev region (16 individuals with nodular goiter and 45 individuals without thyroid pathology – the control group) were examined. When studying urinary iodine excretion, median urinary iodine concentration in the control group was 65.0 μg/l, while in patients with nodular goiter, it was 72.15 μg/l indicating mild iodine deficiency. In patients with nodular goiter, there were observed decreased serum levels of calcium - 74.17 mg/l (p<0.05), magnesium - 17.67 mg/l, zinc - 0.73 mg/l (p<0.05) and selenium - 0.03 mg/l (p<0.05) as compared to those in the control group. The relative risk of developing nodular goiter in decreased serum calcium concentration was 1.66 (95% confidence interval 1.07-2.09), (p<0.05); in decreased serum concentration of both calcium and selenium, it was 2.30 (95% confidence interval 1.147–4.085), (p<0.05); in low serum magnesium concentration, the relative risk was 2.6 (95% confidence interval 1.11-6.09) (p<0.05).

Clinical Case of Lymphomatoid Papulosis

Lymphomatoid papulosis is a rare skin disease. The incidence averages 1.5 cases per 1 million population. It is the most common in adults around the age of 40. It was previously considered as paraneoplastic dermatosis, but recent studies have confirmed that lymphomatoid papulosis is a primary CD30 + T-lymphoma of the skin. Despite the aggressive morphological features, it is benign. The disease is characterized by a tendency to spontaneous regression. Typically, skin lesions last 3-12 weeks, although in some severe cases they may last longer. Skin lesions may disappear or recur over decades. Patients require observation because a second lymphoproliferative disease develops in 10-40% of patients.           A case of lymphomatoid papulosis in a patient with diffuse astrocytoma is presented. The patient was treated with systemic retinoids. The results of differential diagnosis and additional research methods, including dermoscopy, are given. Although the use of dermoscopy was not crucial, the results of the research showed microscopic visual differences between the elements of the rash, depending on the stage of the disease. The picture was mostly typical, however, spots formed by the areas of central erythema on the background of light brown areas, with a predominance of the reticular vessels pattern were also noted in addition to the rash elements on the hairy skull. Clarification of this feature requires further study.           The purpose of our report is to draw the attention of dermatologists and family doctors to cases of rare dermatoses. The rareness of the disease, lack of knowledge on the clinical findings lead to diagnostic errors, “inadequate treatment”