Archive of Clinical Medicine

Changes in the Oral Microbiocenosis in the Process of Different Adhesive Agents Use for Fixation of Complete Removable Laminar Dentures

Yuriy Redushko, Roman Kutsyk — Mon, 17 Oct 2022 10:17:37 +0300

The use of adhesives to improve the fixation of complete removable laminar dentures, along with numerous benefits for the patient, creates additional risks of imbalance in some representatives of the oral microflora and, consequently, may cause or maintain the development of prosthetic stomatitis and worsen oral hygiene. Therefore, it is important to study the prevention of disorders of the normobiocenosis of the oral cavity due to the differentiated choice of adhesives based on their antimicrobial activity. The study represents the peculiarities of changes in the oral normomicrobiocenosis in the process of the prescribed adhesives’ use for fixing complete removable laminar dentures.

The aim of the study – is to study the changes in the oral microbiocenosis in the process of adhesives use for fixing complete removable laminar dentures and to assess the effectiveness of their choice based on the results.

Materials and methods of the study. There were examined 120 people, who used full removable laminar dentures, 90 of them used adhesive means prescribed by a dentist for three weeks to improve fixation. All patients were sampled for bacteriological examination. Based on the analysis of culture results for microorganisms in each Group, the constancy index was determined – sowing frequency in percent and population level – colonization mass in lg CFU/ml.

Results of the study. In comparison with persons who did not use adhesives to improve the fixation of removable dentures and data before the study it was determined that the adhesive “Corega” had a preservative effect on the normoflora, reduced the population level of pathogenic coccal microflora, yeasts; adhesive “Laсalut” had an inhibitive effect on all representatives of the normal microflora, reduced sowing frequency and population level of β-hemolytic streptococci, but did not affect the pathogenic activity of Staphylococcus aureus, yeasts and gram-negative bacteria; adhesive “Protefix” had a suppressive effect on the normoflora, did not affect the population level of pathogenic microorganisms and even increased the massiveness of colonization by gram-negative bacteria.

Conclusions. Taking into account the determined changes in the oral microbiocenosis in persons who used adhesives to improve the fixation of complete removable laminar dentures, we can talk about the effectiveness of the adhesive “Сorega” for long-term use in the absence of complications in prosthetic bed tissues and with proper hygienic care of the oral cavity; adhesives “Laсalut” and “Protefix” in patients with existing dysbiotic disorders and with subsequent control of the impact on the resident microflora of the oral cavity.

Components of the Effectiveness of Endodontic Treatment Based on Long-term X-ray Criteria

Nataliya Kobryn, Vitalii Hereliuk — Mon, 17 Oct 2022 10:18:44 +0300

The objective of the research was to determine the effectiveness of obturation of the root canals and crown part of the teeth, and to identify the most important factors influencing its results, based on the X-ray examination.

Materials and methods: The study was conducted at the Dental Center (University Clinic, Ivano-Frankivsk National Medical University). Evaluation of 140 orthopantomograms, computed tomograms and digital intraoral images of patient, aged 18-68 years with endodontically treated teeth, was made with the aim to determine the obturation state of root canals and the state of periodontal tissues. The radiological picture of 579 teeth and 1120 roots in particular was evaluated.

Results: the state of apical constriction, the state of obturation of root canals, sealing conditions of coronal part of the tooth, the state of periodontal tissues were analyzed, compared and discussed.

Conclusions: According to the results obtained in this study, the relationships between the presence of periapical changes and state of apical constructions, obturation level of filling material in roots canals, coronal leakage, and periodontal tissue changes were found.

Keywords: periapical changes, endodontic treatment, coronal leakage, x-ray examination

Therapeutic Doctors` Competency during the Providing Emergency Medical Care at the Scene

Mon, 17 Oct 2022 10:21:54 +0300

During the last years it has been observed the worldwide trend in regular creation, upgrading and implementation of emergency care protocols at the prehospital stage in the medical practice. The huge role is given to the methods of doctors` simulation preparedness in case of the emergency care at the scene. Modern doctors` preparedness requires practicing of the resuscitation in the simulation centers on the specific dummies or devices without the risk of making any harm to the patient, developing the ability to make quick and correct decision and conduct all necessary manipulations and interferences without any mistake. According to the professional literature, it is usually observed the lack of practical skills concerning the emergency care at the scene of an accident among therapeutic doctors`. Nowadays, one of the most important task undergraduate and postgraduate medical educations is the creation of simulation centers for quality training of highly qualified specialists, including emergency medical care.

The aim of given investigation is the evaluation of the professional therapeutic doctors` competency in providing emergency medical care at the scene in accordance to the latest recommendations of the European Resuscitation Council (2021) and American Heart Association (2020). According to tests conducted in the 2017-2018s among therapeutic doctors about their abilities of the resuscitation conducting, it was revealed that only 52% were able to diagnose the state of clinical death; 63% - were able to perform chest compression; 15% were able to provide opening of airways; extremely low was the numbers of those who were able to use AED and ventilation – 5% and 9% correspondently. Therefore, one of the key tasks of the modern medical simulative education is to prepare therapeutic doctors to be able to perform emergency resuscitation at the scene.

Key words. Simulative medicine, emergency medical care, the scene of an accident, therapeutic doctors.

Nearest and Long-Term Results of Surgical Treatment of Acute Varicothrombophlebitis

Ivan Hadzheha — Mon, 17 Oct 2022 10:23:37 +0300

Introduction. Acute varicothrombophlebitis is one of the most common and dangerous complications of varicose veins of the lower extremities, as it is a common cause of deep vein thrombosis and pulmonary embolism. It develops in 30-60% of patients with varicose veins.

Methods. The evaluation of early and long-term results of surgical treatment of acute varicothrombophlebitis in 234 patients with acute varicothrombophlebitis in the basin of the great saphenous vein was performed.

Results. Depending on the prevalence of thrombotic process in the basin of the great saphenous vein, patients were divided into the following groups: Group I – inflow varicothrombophlebitis (n = 23 (9.8%); Group II – varicothrombophlebitis of the shin (n = 51 (21.8%); Group III – varicothrombophlebitis of the thigh (n = 21 (9.0%); Group IV – total varicothrombophlebitis (n = 27 (11.6%); Group V – ascending varicothrombophlebitis (n = 67 (28.6%); VI group – transfascial thrombosis (n = 45 (19.2%).

Conclusions. Surgical treatment of acute varicothrombophlebitis of the lower extremities according to the cumulative analysis allowed to achieve a positive treatment result in 94.5% of patients. Recurrence of thrombosis in the early and distant postoperative period was observed in 0.5% and 2.2%, respectively.

Cognitive Disorders in Patients with Parkinson's Disease

Iryna Khubetova — Mon, 17 Oct 2022 10:25:42 +0300

The aim of the study was to identify cognitive disorders in patients with Parkinson's disease

Material and methods. The study was conducted on the basis of the neurological department of the Regional Clinical Hospital (Odesa) during 2011-2021. 364 patients were diagnosed with Parkinson disease (PD) on the basis of diagnostic criteria of the British Brain Bank. Clinical and demographic data were studied: age, sex, severity according to the UPDRS scale, stage of the disease according to the Hoen-Yahr scale, the presence of cognitive impairment and their nature. MMSE (Mini-Mental State Examination;) and PD-CRS (Parkinson’s Disease-Cognitive Rating Scale) were used to study cognitive functions. Statistical processing was performed by analysis of variance, correlation and factor analysis using Statistica 13.0 software (TIBCO, USA).

Results.

At the onset of the disease, left lesions were noted in 126 of 364 patients, ie 34.6%, right - 127 (34.9%), the remaining 111 (30.5%) - bilateral lesions. The structure of the disease was dominated by mixed forms. Akinetic-rigid form was observed in 92 (25.3%) cases, trembling - in 27 (7.4%), mixed rigid-trembling in 157 (43.1%) cases, trembling-rigid in 92 (7.4%). Patients with stage 2 and 3 CP were most often registered in 28.6% and 28.0% of cases, respectively. 31 (8.5%) patients had more severe motor disorders (stages 3.5 and 4). Cognitive impairment was detected in a significant number of patients (238 or 45.2%), the mean score on the MMSE scale was 25.3 ± 0.3. Accordingly, on the PD-CRS scale, the average score was 91.2 ± 3.4 points. Subdemental changes were present in 82 (15.6%) patients. Accordingly, mild dementia was found in 15 (2.8%) patients, moderate dementia - in 18 (3.4%).

Conclusions:

The frequency of detection of cognitive impairment in patients with CP was 45.2% with a mean score on the MMSE scale of 25.3 ± 0.3, and on the PD-CRS scale - 91.2 ± 3.4 points
Dementia changes were in 82 (15.6%) patients, mild dementia was found in 15 (2.8%) patients, moderate dementia - in 18 (3.4%)
There is a direct correlation between the age and severity of intellectual disabilities (r = 0.50).
Self-care disorders are determined by the severity of both motor and cognitive disorders by 72% (R = 0.851; R2 = 0.723; Adjusted R2 = 0.721; F (2.2) = 309; p <10-4; SE = 4.6 ).

Key words: Parkinson's disease, cognitive impairment, quality of life

The Role of Adrenoreceptors and Calcium Ions in the Pathogenesis of Endocardium Endothelium Damage of Rats Under Stress Action on the Background of Hypercholesterolemia

Ihor Luchko, Tetyana Huranych, Iryna Dubkovetska, Leonid Storozhuk — Mon, 17 Oct 2022 10:27:50 +0300

Abstract. Topicality. Endothelial dysfunction is a key link in the pathogenesis, formation and progression of clinical manifestations of a significant number of cardiovascular system diseases. Some pathogenetic links and structures associated with morphofunctional disorders of cardiac endothelial cells under the stress conditions and its combination with hypercholesterolemia need further examination.

The aim of the study was to investigate the role of adrenoreceptors and calcium ions (by using of adrenoreceptors and Ca²⁺-channels blockers) in the pathogenesis of endocardium endothelium damage (by the content of free fatty acids in it and the number of exfoliated cells) as a result of emotional and pain stress action and its influence on the background of hypercholesterolemia.

Materials and methods of research. An electro-pulse model was used for stress reproduction. The alimentary hypercholesterolemia was simulated by keeping animals on an atherogenic diet during 2 months. To establish the role of the above-mentioned cellular structures in the mechanisms of endothelial cell damage, the following pharmacological drugs were administered to animals: β-adrenoblocker,
α-adrenoblocker and Ca²⁺-channel blocker. The endocardium endothelium state was studied by using light microscopy, by analyzing the smears-imprints from macropreparations of ventricles by counting the number of endothelial cells in them. The content of free fatty acids was determined by radiochemical method.

Research results. It has been shown that β-adrenoblocker and Ca²⁺-channel blocker significantly limit the damage of endocardium endothelium of left ventricle under the action of emotional and pain stress, and to a much lesser extent, the same effect has α-adrenoblocker. The protective effect of mentioned preparations under the action of stressor factor against the background of alimentary hypercholesterolemia significantly decreases.

Conclusions. The obtained data, their analysis and comparison with the results of other experimental and clinical studies allow to make certain conclusions about the pathogenesis of endothelial dysfunction under emotional stress, as well as under conditions of its combination with hypercholesterolemia. In particular, an important link in the development of structural and some biochemical changes of endocardial endothelial cells is the toxic effect of catecholamines, which affect the organism’s functional systems mainly by β-adrenoreceptors (involving Ca²⁺ ions), to a lesser extent – by α-adrenoreceptors.

Key words: endocardium, stress, hypercholesterolemia, adrenoreceptors, calcium.

Changes in the Metabolism of Nitric Oxide, Hydrogen Sulfide of the Oral Fluid Taking into Account Age and Dental Status

Oleh Barabash, Nataliia Voronych-Semchenko, Taras Kryvenkyi — Mon, 17 Oct 2022 10:28:36 +0300

The relevance of the study is conditioned by the prevalence of dental pathology, its complicated course in senior age and the search for the age-associated metabolic markers of oral fluid.

Objective. The aim of the study is: to determine the age peculiarities of the content of nitric oxide and hydrogen sulfide metabolism in the oral fluid of patients, taking into account their dental status.

Materials and Methods. Indicators of nitric oxide metabolism, L-arginine/arginase, hydrogen sulfide content in oral fluid, dental status of different aged people under conditions of intact dentitions, their defects and against the background of correction with different types of dentures, were studied.

Results. It was determined that with age, changes in oral fluid are characterized by an increase in nitrite ion, the amount of nitrites and nitrates, increasing the formation of peroxynitrite against the background of lower levels of L-arginine and hydrogen sulfide, inhibition of arginase activity. The results obtained are confirmed by the presence of close correlations between the concentrations of hydrogen sulfide and peroxynitrite (reverse, strong), caries intensity and: the total level of nitrites and nitrates (direct, strong), peroxynitrite content (direct, medium strength).

Conclusion. The studied biomarkers of oral fluid depend more on age, hygienic condition of the oral cavity, intensity of dental caries and defects of dentitions than types of dentures. Therefore, age-related changes in the biochemical composition of oral fluid, metabolic, somatic, comorbid pathologies are likely to be a trigger for structural-functional disorders of the dental-maxillofacial system.

Clinical Course and Lipid Metabolism Indicators in Patients with Chronic Heart Failure of Ischemic Genesis and Coexisting Hypothyroidism

Iryna Kupnovytska, Yuliia Mykula — Mon, 17 Oct 2022 10:31:01 +0300

Cardiac diseases, especially chronic heart failure which, according to the World Health Organization, affects 1.5-2% of the global population, are the number one cause of mortality and morbidity worldwide, including Ukraine. Chronic heart failure is often accompanied by endocrine disorders, especially hypothyroidism, the diagnosis of which has increased over the past 10 years, and which facilitates the rapid progression of heart failure due to reduced metabolic processes and altered lipid metabolism.

The objective of the research was to study clinical manifestations, lipid metabolism indicators and their relationship in patients with chronic heart failure of ischemic genesis and coexisting primary hypothyroidism.

Materials and Methods. 73 patients with the average age of 55.92±2.66 years were examined. They were divided into 2 groups: Group I included 38 patients with chronic heart failure and coexisting hypothyroidism; Group II comprised 35 heart failure patients without hypothyroidism. The clinical course of chronic heart failure itself and chronic heart failure with coexisting hypothyroidism was studied, the patients’ quality of life was evaluated, the myocardial function was studied by means of the 6-minute walk test, the indicators of lipid profile were analyzed by determining the serum levels of total cholesterol, low-density lipoprotein cholesterol. To assess thyroid function, thyroid-stimulating hormone and thyroxine levels were determined by the electrochemiluminescence immunoassay.

Results and Discussion. The clinical course and quality of life of patients with chronic heart failure and coexisting hypothyroidism were worse as compared to patients without hypothyroidism. The serum levels of total cholesterol, low-density lipoprotein cholesterol differed between both groups of patients (p<0.05).

Conclusions. Blood lipid profile was more significantly impaired in the patients with chronic heart failure of ischemic genesis and coexisting primary hypothyroidism that could result in the rapid progression of chronic heart failure, a more severe clinical course, and more frequent complications. The quality of life was higher in patients with heart failure without hypothyroidism and their condition was significantly better.

Analysis of Unsatisfactory Consequences of Erysipelas Treatment

Serhii Shapoval, Larysa Vasylevska — Mon, 17 Oct 2022 10:32:56 +0300

Goal. Find out the cause of unsatisfactory treatment outcomes in patients with destructive forms of erysipelas in the general population.

Materials and methods. Retrospectively and prospectively analyzed 284 case histories of patients who were hospitalized in the center of purulent - septic surgery KNP "City Hospital G3" Zaporozhye for the period 2016-2022.

Results. It was found that most often the local focus was localized on the upper and lower extremities. The most common clinical manifestations of intoxication in bullous and phlegmonous forms of erysipelas were: general weakness, hyperthermia, muscle pain. In the necrotic form of erysipelas, patients showed signs of severe intoxication with nausea, vomiting and confusion. In the complex treatment of patients with erysipelas, the main place belongs to the early surgical treatment of the area of the pathological process and antibiotic therapy (ABT). Determination of serum procalcitonin allows to assess the progression and generalization of the process and is a sensitive test for the effectiveness of treatment.

Conclusions. Radical surgery and timely targeted ABT are key elements of success in the treatment of surgical forms of erysipelas and are not subject to revision. The main causes of unsatisfactory consequences in patients with erysipelas are: aggravation of the disease at the time of hospitalization by septic shock and multiple organ failure, severe decompensated comorbidities. Procalcitonin is a diagnostic marker that can predict the development of sepsis.

Key words: erysipelas, unsatisfactory treatment consequences, procalcitonin.

Pathogenetic Role of Disorders of Insulin Signaling Pathways and Diabetes-Associated Hyperglycemia in the Mechanisms of Diabetic Encephalopathy Formation and Hypersensitivity of the Brain to Ischemia-Reperfusion

Svitlana Tkachuk, Oleksiy Tkachuk, Olha Nika, Yuliya Hodovanets — Mon, 17 Oct 2022 10:33:47 +0300

The aim of the study was to analyze the literature data regarding the pathogenetic role of insulin signaling disorders and diabetes-associated hyperglycemia in the mechanisms of diabetic encephalopathy and hypersensitivity of the brain to ischemia-reperfusion.

Conclusion. Analysis of the literature data shows a number of common links between the pathogenesis of diabetic encephalopathy and ischemic-reperfusion brain injury, which may, to some extent, explain the predisposition of diabetics to acute cerebral circulatory disorders and their adverse course. However, it is clear that the severity of such comorbid pathology cannot be explained only by the additive effect of individual links in the pathogenesis, which indicates the necessity for further in-depth study of its molecular-genetic aspects.

Clinical Case of Lymphomatoid Papulosis

Mon, 17 Oct 2022 10:19:16 +0300

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”.

Technologization of Innovative Educational Processes in Higher Education Establishments

Nadiia Skrobach, Oksana Shapoval, Vira Vyshyvanyuk, Vitalii Petryna — Mon, 17 Oct 2022 10:17:01 +0300

The needs of Ukraine’s economic development require the creation of new, innovative technologies that take into account changes in the social and spiritual life of young people, the need to form a harmonious personality and optimize the learning process. New pedagogical technologies are aimed primarily at “providing conditions for self-realization of student’s essential capabilities in various kinds of theoretical and practical activities, in dynamic life in the new market conditions”.

An essential feature of modern innovation processes in the field of education and upbringing is their technologization – a strict compliance with the content and sequence of stages of innovation implementation.

The difference between technology and methodology is a fundamental issue for modern pedagogics. Technology and methodology are distinguished by two main points: the guarantee of the final outcome and planning of the future educational process.

The varieties of personality-centered pedagogical technologies include personality developmental teaching, productive teaching, personalized teaching and technology of higher labor, self-development, technology of humanism.

Analyzing the features of higher pedagogical education technologization, the attention should be paid to an increase in the need for the use of new information technologies in the training of new generation specialists for modern educational systems. New information technologies (NIT) are defined as a set of methods and technological means of collecting, organizing, storing, processing, transmitting and presenting information that increases people’s knowledge and develops their capabilities to manage technological and social problems.

Pedagogical technology is interpreted according to three aspects: the scientific aspect (pedagogical technology as a component of pedagogical science that creates pedagogical processes in pedagogical systems); procedural and descriptive aspect (description, process algorithm, a set of goals, content of methods and means to achieve guaranteed results according to the goal); procedural and effectual aspect (implementation of the technological process, functioning of all personal tools).