https://ojs.tdmu.edu.ua/index.php/ijmr/issue/feed International Journal of Medicine and Medical Research 2022-09-05T12:40:38+03:00 Prof. Mykhaylo Korda ijmmr@tdmu.edu.ua Open Journal Systems <p><em>International Journal of Medicine and Medical Research (IJMMR) is the peer-reviewed international journal published semiannually. The overall goal of the IJMMR is to promote medical research and to serve as a platform dedicated to increasing the exchange of experience and collaboration in all fields of medical research, including dentistry and pharmacology. IJMMR accepts original research, reviews, commentaries and letters to the editor in the areas of medicine and medical research covering non-clinical and clinical subjects, population health sciences and public health topics.</em><br><em><strong>ISSN 2414-9985 (Online), ISSN 2413-6077 (Print)</strong></em></p> https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13090 ATTITUDE TOWARDS PSYCHIATRY AND PSYCHIATRISTS AMONG MEDICAL STUDENTS IN TERTIARY HEALTH CARE HOSPITAL 2022-07-15T09:02:39+03:00 R. Jahagirdar drjahagirdarrohan@gmail.com <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background</span></strong><span lang="EN-US">. Psychiatry is a medical subject; many medical students ignore its importance in medicine. Regarding mental illness, many medical professionals and students are less aware as mental illness is very important in affecting the quality of care the patient receives and in choosing psychiatry as a career. This study specializes in psychiatry based on many factors, however undergraduate students’ attitude towards career choice is the most important.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective.</span></strong><span lang="EN-US"> This study aims to explore attitude towards psychiatry subject among undergraduate medical students.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods.</span> </strong><span lang="EN-US">This is a Descriptive cross-sectional study done at Vikhe Patil Medical College, Ahmednagar. The total of 295 volunteer students from all phases of MBBS (Bachelor of Medicine and Bachelor of Surgery) were enrolled by purposive sampling, a 30-item self-administered questionnaire, ATP-30 (Attitude towards Psychiatry) was used to measure the attitude of medical students. Data collected was analysed using SPSS version 24. The results were reported as percentage and frequencies.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> In the study, 47.4% of the respondents were males and 52.6% were females. Out of total study participants 52.3% of our study respondents strongly agreed that psychiatry was a respected branch of medicine; 56.7% strongly agreed that psychiatry should be an important part of medical curriculum; 19.4% of study respondents considered it in the list of the career choice while the majority did not think that it should be in their career list options.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions.</span></strong><span lang="EN-US"> In the study, the students from the later phases of MBBS showed positive attitude than that of the initial phases. Many students found it as respected subject and essential field of medicine for their choice of profession. However, shortcoming knowledge and awareness was observed in the responses pertaining to present available treatment and recent trends in the field. </span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13098 ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES 2022-07-20T10:08:46+03:00 S. Y. Zaporozhan zaporozhan@tdmu.edu.ua D. B. Fira firadb@tdmu.edu.ua O. V. Pokryshko pokryshko@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective.</span></strong><span lang="EN-US"> The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results. </span></strong><span lang="EN-US">The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13095 ONCOPLASTIC CONE-SHAPED REMOVAL OF MELANOMA IN SITES WITH LIMITED SKIN RESOURCES 2022-07-16T20:53:13+03:00 I. Y. Galaychuk halaychuk@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">According to the existing recommendations of the NCCN, 2-cm margins are optimal for surgical excision of skin melanoma (SM).</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">A method of cone-shaped oncoplastic surgery of SM in sites with limited skin-plastic resources is presented. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">In the study 30 patients (11 men, 19 women) underwent cone-shaped removal of primary SM on arm and shin, epigastria and subclavicular sites. Oncosurgical approach involves the following: primary SM is excised with 2 cm margins around with transforming this round wound into conical using additional incisions; then conical wound is closed by transverse displacement of lateral skin-fatted flap. The postoperative seam looks like hook-shaped line. SM thickness is measured by sonography before surgery. Morphological verification is obtained by cytological examination of smears after superficial scraping biopsy.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> Postoperative histology confirmed melanomas in all cases with “clear margins” in all surgical specimens, and postoperative staging was as follows: pT2bN0M0 – in 3 patients, pT2bN1-2M0 – 4 patients, pT3bN0M0 – 9 patients, pT4bN0M0 – 7 patients, and pT4bN1-2M0 – in 7 patients. Partial marginal necrosis of displaced flaps was of 4 patients (13.3%). There were no recurrences of melanoma at site of postoperative scar. 3-years disease free survival (DFS) rate was 76.6%, and 5 years DFS rate – 60.0%. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">Cone-shaped radical excision of primary melanoma is an appropriate surgery for patients with SM on the forearms, shoulders, epigastria and subclavicular sites and legs. The one-step oncoplastic radical surgery without intermediate biopsy prevents local recurrence in site of surgery as well as iatrogenic metastasis to regional lymph nodes.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/12674 CASE REPORT ON RARE OUTCOME OF A RETROPERITONEAL MASS: MANAGEMENT CHALLENGES AND LESSONS LEARNT 2022-01-18T09:10:52+02:00 V. V. Nair vipinvenugopalnair@gmail.com P. Sharma drpawansharma55@gmail.com N. Rajendran nagaa.mahendran@gmail.com S. Raja santoshrajasarali@gmail.com P. P. Rao surgeonrao@gmail.com R. Mehta doctorritumehta@gmail.com <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">Gastrointestinal stromal tumours (GIST) are non-epithelial mesenchymal solid neoplasm with varied presentation. The study reports the case of a retroperitoneal GIST in a 21‑year‑old male presented with an abdominal lump for six months. The lesion was initially thought to be a retroperitoneal sarcoma. Exploratory laparotomy revealed an abdominopelvic mass covering the entire right side of abdomen and pelvis. The tumour was adherent to the terminal ileum and ascending colon. There were dense adhesions between the retroperitoneum with involvement of the middle third of the right ureter. The tumour was resected with right hemicolectomy with ileotransverse anastomosis. Post-operative histopathology revealed it as high-grade spindle cell type GIST. The patient is presently on post-operative chemotherapy with Imatinib mesylate.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">Atypical presentations of GIST are seldom discussed but frequently encountered in clinical practice. This article depicts different challenges the surgeon has to face while diagnosing such atypical entity.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">Case report of atypical GIST presenting as retroperitoneal lump.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results. </span></strong><span lang="EN-US">The patient underwent surgical resection and is presently on post-operative chemotherapy with good overall outcome for a one year follow up.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">GISTs presenting as retroperitoneal lumps are very rare, they should be considered in their differential diagnosis of an atypical retroperitoneal mass.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13083 AN OBSERVATIONAL STUDY TO FIND RELATIONSHIP OF ACUTE APPENDICITIS TO MENSTRUATION CYCLE IN NORTHERN AND NORTHEASTERN PART OF INDIA 2022-07-10T20:50:53+03:00 T. B. Singh bishwajitsingh6068@gmail.com R. Kumar ranjan_afmc@yahoo.co.in A. Nigam ankurnigam8511@yahoo.com T. R. Devi tekchamroshini12@gmail.com <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background.</span></strong><span lang="EN-US"> Diagnosing acute appendicitis correctly in a female patient is a challenge for a practicing surgeon. Rate of misdiagnosis of acute appendicitis is very high among female patients. There are many studies carried out to find incidence of acute appendicitis as per various phases of menstruation cycle but the results were conflicting. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">The study was conducted to find the relationship of acute appendicitis with the different phases of the menstruation cycle. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">This research was an observational study carried out in two regional hospitals in northern and north-eastern part of India. Duration of study was 24 months between 01 June 2019 and 31 May 2021. Inclusion Criteria were for all female patients, non-pregnant and menstruating, who were histopathologically confirmed as acute appendicitis. All pathologically proven negative appendectomy patients were excluded from this study. All female patients taking oral contraceptive pills (OCP) were excluded from the study.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> A total of 96 females were hospitalized in both hospitals during the study period; 12 of them did not attain menarche (12.5%), 6 had menopause (6.3%) and 78 were menstruating (81.25%). Of those 78 patients, who had physiological menstrual cycles, 6 were in menstrual phase (7.6%), 18 were in proliferative phase (23%), and 54 in luteal phase (69.2%). In our study, there were only 6 cases of acute appendicitis during menstruation. therefore, the expected ratio of cases was 6/14=0.42. The corresponding expected rate for the proliferative phase was 2.78×9=25 cases, whereas for the luteal phase it was 2.78×14=38.92. The expected ratio was 18/25=0.72 for the proliferative phase and 54/39=1.38 for the luteal phase. There was a significant increase in number of cases of acute appendicitis among the menstruating women in luteal phase with p value &lt;0.05. Mean age of the study participants was 28.31±9.56. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions.</span></strong><span lang="EN-US"> According to the result of the study, the incidence of acute appendicitis significantly differs in different phases of menstruation cycle with highest incidence in luteal phase. Hence, female hormones (estrogen and progesterone) are significant in causing acute appendicitis.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13043 CLINICAL OUTCOMES OF REVERSAL OF HARTMANN’S PROCEDURE 2022-06-20T14:01:09+03:00 I. Ya. Dzyubanovskyy dzubanovsky@tdmu.edu.ua A. D. Bedeniuk bedenyuk@tdmu.edu.ua S. Y. Grytsenko stepan_grytsenko@ukr.net <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background</span><span lang="EN-US">. </span></strong><span lang="EN-US">Reversal of Hartmann’s procedure (HP) is one of the most complex surgical interven­tions in abdominal surgery with high morbidity rates of up to 58% in the patients after HP and mortality of up to 3.6%.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">This was a retrospective observational study to analyze the Hartmann’s reversal (HR) outcomes.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">The study involved 31 patients (16 males and 15 females), average age 59.6±10.31 (range 26-80), who underwent HR at Ternopil Regional Hospital in 2010 - 2021. The reasons for the HP were: cancer in 20 (64.5%) cases, perforation of the diverticulum – 6 (19.3%), traumatic rupture – 3 (9.7%) and Crohn’s disease - 2 (6.4%) cases.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> Median time from Hartmann’s procedure to reversal was 11.13±9.24 months (interval 3-38). Intraoperative time was 210.33±56.91 minutes (range 120-330). HR was performed in 30 (96.8 %) patients. Dense pelvic adhesions of the stump of the rectum was diagnosed in 13 (41.9%) patients. Hand-sewn anastomosis was performed for 22 (71%) patients, stapler anastomosis – 4 (12.9%), pull-through technique – 3 (9.7%) patients. AL occurred in 3 (9.7%) patients on the 15<sup>th</sup>, 23<sup>rd</sup> and 35<sup>th</sup> postoperative days. pseudomembranous colitis was diagnosed in 2 (6.4%) patients with AL. The mortality rate was 1 (3.3%) as a result of septic complications due to AL; this case was not operated by a colorectal surgeon due to administrative issue in the hospital.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">Hartmann’s reversal is still one of the most difficult operations in colorectal surgery with high incidence of postoperative complications. Sound selection of patients with low comorbidity and in suitable time period is crucial for successful HR.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13157 ENDOVASCULAR ANGIOPLASTY FOR MULTI-LEVEL STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL-DISTAL ARTERIAL BED IN CASES OF STENOTIC-OCCLUSIVE PROCESS OF THE TIBIAL ARTERIES 2022-09-01T17:35:13+03:00 I. K. Venher vengerik@tdmu.edu.ua S. Ya. Kostiv kostivsj@tdmu.edu.ua B. P. Selskyi selskyi_bp@tdmu.edu.ua D. V. Khvalyboha hvalyboga@tdmu.edu.ua M. Yu. Orlov orlov_mypa@tdmu.edu.ua I. V. Faryna faryna_ivol@tdmu.edu.ua N. I. Tsiupryk tsyupryk_cnad@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">Occlusive-stenotic lesions of the lower extremity arteries are the second in the structure of cardiovascular diseases, after only coronary heart disease. Surgical treatment of patients with infrainguinal atherosclerotic lesions of the arterial segment is challenging in a number of cases. At the same time, revascularizing surgical interventions on the femoral-distal artery and especially on the tibial arteries in chronic critical ischemia is the only chance to avoid amputation of the lower limb. In this regard, the search and study of optimal methods of revascularizing surgery on the infrainguinal artery for stenotic-occlusive lesions of the arteries of the tibial segment is urgent.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">This study is aimed at promotion of endovascular and hybrid technology in cases of stenotic-occlusive process of the tibial arteries and choosing the optimal surgical treatment tactics in this case.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods.</span></strong><span lang="EN-US"> Endovascular interventions of the femoral-distal arterial bed in cases of stenotic-occlusive process of the tibial arteries performed for 135 patients at the Department of Vascular and Cardiac Surgery of Ternopil Regional Clinical Hospital have been analysed.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results. </span></strong><span lang="EN-US">In most cases, endovascular angioplasty of two tibial arteries in hybrid and endovascular methods of revascularization of multilevel atherosclerotic process of the femoral-distal arterial segment of the lower extremity prevents development of thrombosis in tibial segment and allows maintaining the patency of the reconstruction segment and preservation of the lower extremity in 97.57% and 93.44% of cases, respectively.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">Endovascular angioplasty of two tibial arteries provides a better result than angioplasty of one isolated tibial artery and allows maintaining the patency of the reconstructed segment for more than 90&nbsp;percent compare to one isolated angioplasty.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/12934 SHORT TERM STUDY ON CLINICAL RELEVANCE AND OUTCOMES OF FOETAL HYDRONEPHROSIS 2022-05-20T12:55:25+03:00 J. S. Randhawa moshesingh2000@yahoo.co.in N. Rajendran nagaa.mahendran@gmail.com J. Husain jafarhusain01@gmail.com R. Shankaran drshankaran@gmail.com V. V. Nair vipinvenugopalnair@gmail.com S. Dorai B. drshakthidorai@gmail.com <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">Hydronephrosis is the most common urinary tract pathology detected on antenatal screening by Ultrasound. The detection of fetal hydronephrosis by ultrasound pres­ents a treatment dilemma to the treating surgeon and parental anxiety. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">This study aims to examine the role of serial ultrasounds in antenatally detected fetal hydronephrosis to know the disease progression, and to assess indications and timing of surgery in these patients to preserve renal function. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods.</span></strong><span lang="EN-US"> This is an observational study of 30 cases of foetal hydronephrosis conducted at a tertiary care paediatric surgery centre. A foetal renal pelvic Antero-posterior diameter (APD) &gt;7 mm at 32 weeks of gestation is considered to indicate Foetal hydronephrosis. These patients are followed up for a period of two years from 2018 to 2020. Progression of disease and need for surgical intervention is noted.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results. </span></strong><span lang="EN-US">The study comprised 30 cases of antenatal foetal hydronephrosis (42 renal units). Of 26 renal units with mild hydronephrosis, all are resolved in the post-natal period. Of 10 renal units with moderate hydronephrosis, 3 (30%) resolved and 7 (70%) worsened and required surgical intervention. Of 6 renal units with severe hydronephrosis, all required surgical intervention and underwent surgery between 12 to 18 months of age.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">These results suggest a grading system with antero-posterior diameter of renal pelvis distinguishes those cases with moderate and severe degrees of hydronephrosis that are at higher risk of surgery.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/12910 PREDICTORS OF LOW FUNCTIONAL RESERVES IN REHABILITATION OF PATIENTS WITH MYOCARDIAL INFARCTION COMPLICATED BY COMORBID PATHOLOGY 2022-05-15T22:32:13+03:00 L. V. Levytska levytskal@tdmu.edu.ua V. V. Yurkiv yurkiv_vikvit@tdmu.edu.ua M. M. Korda kordamm@yahoo.com <p><strong>Background.</strong> Myocardial infarction (MI) is one of the leading causes of death in working age population; the risk of cardiovascular complications for survivors of acute MI complicated by comorbid pathology (CP) is very high.</p> <p><strong>Objective.</strong> The study is aimed to search for reliable prognostic markers for risk of reducing the functional reserves of the cardiovascular system in myocardial infarction with comorbid pathology.</p> <p><strong>Methods. </strong>The prospective study involved 371 patients with MI, who received non-invasive therapy and were observed for a 90-day period after admission to the hospital. All patients were examined and treated according to current protocols.</p> <p><strong>Results. </strong>It was found that 6-minute walk test (6MWT) is a specific and highly sensitive prognostic marker of functional reserves for patients with MI with CP (specificity – 100%, sensitivity – 63%, prognostic value of a positive result – 100%) with the Charlson comorbidity index (CCI) ≥2. The correlation of 6MWT performed on the 10<sup>th</sup>, 30<sup>th</sup> and 90<sup>th</sup> day of rehabilitation was revealed with the age of patients, SpO<sub>2</sub>, respiratory rate, systolic blood pressure, heart rate, left ventricular ejection fraction, levels of troponin T, creatinine, the number of lymphocytes in the peripheral blood, CCI (p&lt;0.05).</p> <p><strong>Conclusions. </strong>During the 90-day rehabilitation period of a patient with MI complicated by CP, the markers of reduced exercise tolerance to be monitored are: blood pressure levels, respiratory rate, troponin T, creatinine, cholesterol, low-density lipoprotein, SpO<sub>2</sub>, the number of lymphocytes in the peripheral blood. To improve control over the process of rehabilitation in patients with MI complicated by CP the 6MWT and CCI should be used.</p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13156 GENDER DIFFERENCES IN THE INFLUENCE OF COMORBID CONDITIONS ON THE LONG-TERM OUTCOMES OF PATIENTS WITH ACUTE CORONARY SYNDROME 2022-09-01T10:07:27+03:00 T. V. Lunova lunovatetiana@gmail.com I. M. Klishch klishch@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background.</span> </strong><span lang="EN-US">Gender differences in the baseline characteristics of patients with the acute coronary syndrome (ACS) have been widely acknowledged. Women are known to be generally older with a higher prevalence of comorbidities. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objectives.</span></strong><span lang="EN-US"> Gender differences in the baseline characteristics of patients with the acute coronary syndrome (ACS) have been widely acknowledged. Women are known to be generally older with a higher prevalence of comorbidities. At the same time, it is now yet clear which comorbid conditions have the most significant impact on the long-term outcomes of patients with ACS and if there are any gender differences in this respect. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods</span></strong><span lang="EN-US">. We performed a retrospective cohort study of 167 patients (109 men and 58 women) admitted to the acute coronary unit of Ternopil Municipal Hospital with ACS in 2016-2017. All relevant clinical information has been recorded in the pre-designed data charts. The incidence of repeated major adverse cardiovascular events (MACEs) has been assessed over 36 months after the hospital discharge via an e-Health electronic system. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> In this cohort, female patients with ACS had a higher prevalence of comorbid conditions: 15.5% of women vs. 11% of men with ACS had ≥5 comorbidities, 65.5% of women and 60% of men had 2-4 comorbid conditions, and 19% of women vs. 29% ≤1 concomitant disease. The comorbidity structure also differed between genders. Women more often had concomitant cerebrovascular diseases (17.2% vs. 7.3%, p=0.05), dementia (15.5% vs. 5.5 %, p=0.03), connective tissue disorders (17.25 vs. 6.42%, p=0.03) and thyroid disease (12.1% vs. 2.8%, p=0.02). Men more often suffered from peptic ulcer (13.7% vs. 3.4%, p=0.05). The incidence of MACEs during the follow-up period rose sharply with age and was higher in females (55% vs. 33%, p=0.003). In the multivariable model, PAD (OR 9.5, 95% CI: 1.7-52.3, p=0.01) and thyroid disease (OR 7.2, 95% CI: 1.19-43.2, p=0.03) demonstrated the most significant impact on the long-term event-free survival of females in the cohort. In turn, a solid metastatic tumor was the most significant predictor of poor prognosis in men (OR 6.3, 95% CI: 2.13-18.9, p=0.001). </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions.</span></strong><span lang="EN-US"> We observed significant gender differences in the prevalence of comorbid conditions and their influence on the three-year event-free survival of patients with ACS. The predictive value of comorbidities should be further investigated, preferably, with the involvement of larger cohorts. </span></p> <div id="gtx-trans" style="position: absolute; left: 145px; top: 380.09px;"> <div class="gtx-trans-icon">&nbsp;</div> </div> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/12924 ANTIOXIDANT PROTECTION IN WHITE RATS ON THE BACKGROUND OF DRINKING WATER USE WITH EXCESSIVE NITRATE CONCENTRATION 2022-05-18T17:51:25+03:00 M. V. Danchyshyn danchyshyn@tdmu.edu.ua O. V. Lototska lototska@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">The problem of nitrate pollution in terms of its scale and consequences has reached a global level. Approximately one-third of groundwater bodies for which information is currently available exceed the maximum allowable concentrations of nitrates in drinking water.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objectives.</span></strong><span lang="EN-US"> The aim of the research is to study the features of antioxidant protection in the body of white rats on the background of drinking water with excessive concentrations of nitrates for 30 days regarding the age.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods.</span></strong><span lang="EN-US"> The experiment was performed on 2 groups of outbred white female rats of different age (mature and immature), 30 animals each, divided into 5 subgroups, which differed in the quality of drinking water they consumed independently. In a 30-day study, nitrates were given to rats with drinking water at a dose of 50, 150, 250, 500 mg of sodium nitrate per liter. The animals of the control group drank water from the city water supply. The effect of nitrates on superoxide dismutase (SOD), catalase (CAT) and ceruloplasmin (CP) in the serum of rats was evaluated.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> The research has shown increased SOD, CAT and CP in blood serum on the background of drinking water with a nitrate concentration of 150 to 500 mg/l in the experimental groups of animals of both ages. According to the research, the most significant changes in parameters are caused by drinking water with nitrates at a concentration of 500 mg/l. More significant changes were in immature animals then the mature ones.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions.</span></strong><span lang="EN-US"> Excessive concentrations of nitrates in drinking water adversely affect the body of experimental animals causing activation of the studied parameters of the antioxidant system.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/13094 SUBMICROSCOPIC CHANGES IN HEMOCAPILLARIES OF ADRENAL GLAND AND PANCREATIC ISLETS OF LANGERHANS IN CASES OF IMMOBILIZATION STRESS WITH UNDERLYING HYPOTHYROIDISM 2022-07-16T14:20:17+03:00 I. M. Klishch klishch@tdmu.edu.ua A. V. Dovbush dovbush@tdmu.edu.ua H. O. Havryliuk-Skiba galinags712@gmail.com O. P. Andriyishyn andriyshyn@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background.</span></strong><span lang="EN-US"> Today, among the increasing number of various diseases, stress is a trigger in the development of diseases and mortality among the population. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Objective. </span></strong><span lang="EN-US">To establish submicroscopic changes in the hemocapillaries of the islets of Langerhans of the pancreas and adrenal glands in the presence of immobilization stress with underlying hypothyroidism.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">The experiment was carried out on 20 mature white male rats. Hypothyroidism was modeled by daily per os injection with a probe of the pharmacopoeial mercazole thyreostatics at a dose of 25 mg/kg for 21 days. Acute immobilization stress was modeled by tying the experimental rats in a supine position in 4 limbs without restricting head mobility for 3 hours. The study was conducted 2 hours later (anxiety stage) after the end of the stress impact. The material was collected for electron microscopy and tissue processing was performed according to generally accepted methods.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results. </span></strong><span lang="EN-US">Electron microscopic examination of the blood capillaries of the islets of Langerhans in the pancreas and the hemocapillaries of the adrenal cortex after the action of the stress factor in cases of hypothyroidism showed slightly enlarged lumens and moderate perivascular edema. The basement membrane was moderately thickened but clearly contoured. Endotheliocyte nuclei were mostly hypertrophied, euchromatin was uniformly located in the nucleoplasm, and nucleoli were defined. The karyolemma was clearly contoured, the number of nuclear pores was small, and the perinuclear lumen was locally widened. Endoplasmic reticulum with moderately expanded and short tubules, moderately thickened cisterns of the Golgi complex were observed in the cytoplasm of endotheliocytes. There were two types of mitochondria: hypertrophied with an electron-light matrix, single cristae, and with clear visible cristae and a moderately electron-dense matrix. In addition to the capillaries mentioned above, there were also single narrowed microvessels that had perivascular edema and vaguely contoured fenestrae.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions. </span></strong><span lang="EN-US">When modeling a stressor in cases of hypothyroidism, structural changes of all components of the walls of blood capillaries of the pancreas and adrenal glands take place.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research https://ojs.tdmu.edu.ua/index.php/ijmr/article/view/12903 STRUCTURAL ORGANIZATION OF RAT TISSUES IN EXPERIMENTAL COMBINED TRAUMA OF THE CHEST AND BOTH THIGHS 2022-05-12T00:47:29+03:00 M. Marushchak marushchak@tdmu.edu.ua O. Mialiuk oksankamp@ukr.net M. Kaskiv maryana_kaskiv@ukr.net M. Demjanchuk dmr-rv@ukr.net I. Krynytska krynytska@tdmu.edu.ua <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">In cases of severe trauma, fractures of long bones are the most often combined with trauma of the chest, head, and abdomen, as well as development of hemorrhagic shock. Therefore, it is reasonable to study the combined trauma of the chest and lower extremities in details, as well as the post-traumatic multiple organ dysfunction especially in early manifestation stage. </span></p> <p class="a"><strong><span lang="EN-US">Objective.</span></strong><span lang="EN-US"> The aim of the study was to identify the features of structural organization of the lungs, heart and liver with underlying combined trauma of the chest and both thighs on the 7<sup>th</sup> day of the post-traumatic period.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods. </span></strong><span lang="EN-US">The experimental study involved 22 adult nonlinear white male rats with body mass of 200-210 g, kept on a standard diet at animal facility with food and drinking regimes recommended by the standards for laboratory animals. All animals were divided into 2 groups: the control group (1<sup>st</sup>, n=10), the experimental group (the 2<sup>nd</sup>) chest trauma and both thighs trauma, observation for 7 days (n=12). The animals of the experimental group were simulated for right-sided closed pneumothorax with a rib fracture by a trocar under thiopental-sodium anesthesia (40 mg/kg of body weight of the rat, intraperitoneally); it was combined with a fracture of the left and right femurs. Skeletal injury was modeled on each thigh that caused a closed fracture by a single dosed blow with a specially designed device. The blow energy was 0.375 J that corresponds to a severe injury. The associated injury was simulated by successive infliction of both injuries. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results</span></strong><span lang="EN-US">. Examination of the liver of animals on the 7<sup>th</sup> day of the experiment revealed a rapid growth of lesions in their parenchyma. The central veins were poorly visible and contained single erythrocytes; the vessels of medium caliber of myocardial stroma were dilated and blood-filled, which was manifested by the development of perivascular oedema. In the lungs of experimental animals, a moderate decrease of interstitial tissue oedema of the interalveolar septa was present, while cellular infiltration of mast cells, macrophages and lymphocytes also decreased significantly. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions.</span></strong><span lang="EN-US"> Multiple organ injuries, which are characterized by structural changes in the liver, heart and lungs in the combined trauma of the thorax and thighs on the 7<sup>th</sup> day of experiment were evidenced.</span></p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 International Journal of Medicine and Medical Research