Galician Medical Journal <p>“Galician Medical Journal” is an open access, double-blinded peer-reviewed scholarly journal, publishes articles in medicine.</p> <p>The aim of journal is to provide scientific communication, share experience and presentation of scientific results and clinical observations between members of the global medical community.</p> <p>Journal publishes original research articles, clinical case reports, letters to the editor, literature review in pathology, internal medicine, dentistry, and new trends in medical education.</p> <p><strong><span lang="EN-GB">ISSN&nbsp;</span></strong><strong><span lang="EN-US">2414-1518 (English ed. Online) </span></strong><strong><span lang="EN-US">ISSN 2306-4285 (Ukrainian ed. Print)</span></strong></p> <div class="page" title="Page 3">&nbsp;</div> Ivano-Frankivsk National Medical University en-US Galician Medical Journal 2414-1518 <div id="copyrightNotice"><span style="font-family: Georgia, serif; font-size: 17px;">Authors who publish with this journal agree to the following terms:</span> <ul style="list-style-type: circle;"> <li class="show"><span style="font-family: Georgia, serif; font-size: 16px;">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_blank" rel="noopener">Creative Commons Attribution License&nbsp;(CC BY-NC)</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</span></li> <li class="show"><span style="font-size: 16px;"><span style="font-family: Georgia,serif;">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</span></span></li> <li class="show"><span style="font-size: 16px;"><span style="font-family: Georgia,serif;">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See&nbsp;<a href="" target="_new">The Effect of Open Access</a>).</span></span></li> </ul> </div> Investigating the Factors Affecting Depression By Using Structural Equation Modeling <p><strong>The objective</strong> of the research was to study the factors affecting depression in general population.</p> <p><strong>Materials and Methods.</strong> A total of 1,291 individuals at the age of 15-68 years participated in this cross-sectional study. The Demographic Information Form, the Beck Depression Inventory for Primary Care and the Generalized Anxiety Disorder Scale were used as data collection tools. The data obtained were evaluated in the SPSS 23 package program. Missing data were validated for extreme values, and, then, tested for normality and homogeneity. Testing for the research model was implemented by structural equation modeling using the AMOS program.</p> <p><strong>Results</strong>. The following goodness-of-fit values were determined for the revised model predicting the factors influencing depression: χ<sup>2</sup> = 535.62, χ<sup>2</sup>/df = 4.74, the normed fit index = 0.95, the Tucker-Lewis index = 0.95, the comparative fit index = 0.96, the goodness-of-fit index = 0.95, the adjusted goodness-of-fit index = 0.94, the root-mean-square error of approximation = 0.05, the root mean square residual = 0.12, which were within acceptable limits. According to our model, the generalized anxiety disorder-7 (t = 15.923; p &lt; 0.001), gender (t = -5.866; p &lt; 0.001), age (t = -8.193; p &lt; 0.001) and marital status (t = -6.107; p &lt; 0.001) had a significant effect on depression. However, there was no significant relationship between depression score and educational status, place of residence, family type, and smoking.</p> <p><strong>Conclusions</strong>. In this model of our study, generalized anxiety disorder was found to have the greatest effect on depression, followed by age, marital status, and gender, respectively.</p> Meryem Firat Yalçın Kanbay Burcu Demir Gökmen Mehmet Utkan Ayşe Okanli Copyright (c) 2021 Meryem Firat, Yalçın Kanbay, Burcu Demir Gökmen, Mehmet Utkan, Ayşe Okanli 2021-03-01 2021-03-01 28 1 E202111 E202111 10.21802/gmj.2021.1.1 Blood Plasma Serotonin and von Willebrand Factor as Biomarkers of Unstable Angina Progression Toward Myocardial Infarction <p><strong>Aim: </strong> To investigate the serotonin and von Willebrand factor (vWF) concentrations among unstable angina (UA) patients without and with progression toward myocardial infarction (outcome) and to assess the utility of both as prognostic markers of UA complications.</p> <p><strong>Materials and methods: </strong> In observational cohort study, we recruited 103 patients with ischemic heart disease (the median age 65.0 (59.0-69.0) years, 45 females (43.7%)). After full set of investigations including high sensitive Troponin I test and 28-day follow-up period, we defined three groups: Group 1 - stable angina patients (n=22) as control, Group 2 - UA patients without outcome (n=71), Group 3 - UA patients with outcome (n=10). We analyzed the blood plasma serotonin content by the ion-exchange chromatography with measurement of serotonin on fluorescence spectrophotometer. VWF concentration was determined by ELISA. We compared the concentrations of observed parameters among the groups with the Kruskal-Wallis test (with post-hoc Mann-Whitney test with Bonferroni-Holm correction). We assessed binary logistic models, receiver operating characteristic curves, calculated sensitivity (Se), specificity (Sp), and positive likelihood ratio (LR+) for each indicator.</p> <p><strong>Results: </strong> We registered elevation in serotonin concentration and decline in vWF concentration in Group 3 in comparison with Group 2 (22.670 (20.687-24.927) μg/ml vs 11.980 (8.120-15.000) μg/ml, p&lt; 0.001, and 0.117 (0.109-0.120) rel.units/ml vs 0.134 (0.127-0.143) rel.units/ml, p &lt; 0.001) and Group 1 (12.340 (10.052-13.619) μg/ml, p &lt; 0.001, and 0.137 (0.127-0.156) rel.units/ml, p &lt; 0.001), respectively. No significant differences in serotonin and vWF concentrations between Group 1 and Group 2 were detected (p=0.81 and p=0.36, respectively). The probability of outcome increased significantly (by 60.7% and 59.7%, LR+ 19.0 [6.0, 60.0] and 18.0 [3.9, 80.0]) if serotonin concentration was above 21.575 μg/ml (Se=80.0%, Sp=95.8%, AUC=0.975) and vWF concentration was below 0.114 rel.units/ml (Se=50.0%, Sp=97.2%, AUC=0.973), respectively.</p> <p><strong>Conclusions: </strong> Serotonin and vWF as biomarkers are demonstrated promising results for rule-in the patients with risk of short-term UA progression toward myocardial infarction.</p> Yuliya Tyravska Oleksandr Savchenko Viktor Lizogub Nataliia Raksha Olexiy Savchuk Copyright (c) 2021 Yuliya Tyravska, Oleksandr Savchenko, Nataliia Raksha, Viktor Lizogub, Prof., Olexiy Savchuk, Prof. 2021-03-01 2021-03-01 28 1 E202112 E202112 10.21802/gmj.2021.1.2 Theoretical Justification of the Dermatoglyphics Use As Basic Identification Method <p>The article analyzes the main literature sources providing a holistic view of the state and issues of studying the issue related to the possibility of using the dermatoglyphic research method for identification purpose; it is about external recognition, behavioral, psychological identification. The main directions of application of the dermatoglyphic method, providing the study of this issue, are highlighted. Problematic issues related to the areas of application of the dermatoglyphic method have been studied and further prospects for its study have been outlined.</p> Oleksandr Dunayev Igor Gunas Oksana Popadynets Ruslan Kozoviy Elvira Kindrativ Copyright (c) 2021 Oleksandr Dunayev, Igor Gunas, Oksana Popadynets, Ruslan Kozoviy, Elvira Kindrativ 2021-03-01 2021-03-01 28 1 E202116 E202116 10.21802/gmj.2021.1.6 Bifocal Tuberculosis with Adalimumab Revealed by Laryngeal Involvement: Case Report <p><strong>Introduction</strong>. Anti-TNF treatment has transformed the treatment of chronic inflammatory rheumatism. Although the therapy can be highly effective, anti-TNF drugs are associated with an increased risk of tuberculosis, especially extra-pulmonary tuberculosis.</p> <p>Laryngeal tuberculosis is rare and its symptoms are not specific. Laryngeal tuberculosis is often secondary to another localization, particularly pulmonary. In the use of anti-TNF therapy, its development is unusual.</p> <p><strong>Case report.</strong> We report a case of bifocal tuberculosis: laryngeal and pulmonary tuberculosis revealed by laryngeal involvement in a patient aged 41 years with axial spondylarthritis treated with Adalimumab.</p> <p><strong>Conclusion.</strong> This presentation highlights the importance to consider the rare possibility of laryngeal tuberculosis in the presence of atypical otorhinolaryngologic signs under anti-TNF therapy and underlines the importance of looking for other tuberculosis involvement.</p> Najlae El Ouardi Laila Taoubane Adil Zegmout Marouane Balouki Siham Sadni Lahsen Achemlal Copyright (c) 2021 Najlae El Ouardi, Laila Taoubane, Adil Zegmout, Marouane Balouki, Siham Sadni, Lahsen Achemlal 2021-03-01 2021-03-01 28 1 E202117 E202117 10.21802/gmj.2021.1.7 Assessment of Relationship Between Serum Vitamin D Levels and Metabolic Syndrome Components in Hemodialysis Patients <p><strong>Aim: </strong>This study is aimed to evaluate the relationship between serum vitamin D levels and metabolic syndrome in hemodialysis patients.</p> <p><strong>Materials and Methods: </strong>This study was conducted with participation of 80 patients undergoing hemodialysis for more than 6 months three times a week, aged &gt; 18 years. Their height, dry weight, waist circumference were measured. Biochemical parameters such as serum 25-hydroxyvitamin D, lipid profile, and fasting blood glucose were analyzed. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Severe vitamin D deficiency, 25 (OH) vitamin D &lt; 5 ng/ml; mild vitamin D deficiency, 25 (OH) vitamin D 5-15 ng/ml; vitamin D insufficiency, 25 (OH) vitamin D 16-30 ng/ml, and vitamin D sufficiency, 25 (OH) vitamin D &gt; 30 ng/ml were categorized. Statistical analysis of the data was performed with the use of SPSS version 21.0.</p> <p><strong>Results: </strong>48.4% of hemodialysis patients were identified to have metabolic syndrome. According to the serum levels of vitamin D; 35.0% of patients had severe vitamin D deficiency, 37.4% of patients had mild vitamin D deficiency, 18.8% of patients had vitamin D insufficiency and 8.8% of patients had vitamin D sufficiency (&gt; 30 ng/ml). Vitamin D insufficiency was significantly associated with metabolic syndrome and central obesity.</p> <p><strong>Conclusions: </strong>Deficiency/insufficiency is observed in serum 25-hydroxyvitamin D levels in hemodialysis patients. Vitamin D insufficiency is associated with metabolic syndrome.</p> Sevil Karahan Yılmaz Cuma Mertoğlu Aylin Ayaz Copyright (c) 2021 Sevil Karahan Yılmaz, Cuma Mertoğlu, Aylin Ayaz 2021-03-01 2021-03-01 28 1 E202113 E202113 10.21802/gmj.2021.1.3 Styloid Process: What Length Is Abnormal? <p>The length of the styloid process varies greatly in different populations and depends on ethnicity and geographical background. The elongated styloid process may be associated with Eagle’s syndrome. Therefore, the mean normal length of the styloid process in different population groups needs to be calculated and the upper cutoff limit for elongated styloid process should be found.</p> <p><strong> The objective </strong>of the research was to evaluate the styloid process length in the Kashmiri population using multidetector computed tomography.</p> <p><strong> Materials and Methods</strong>. We retrospectively evaluated 304 patients who underwent computed tomography of the head and paranasal sinuses, and the mean styloid process length was calculated on both sides. The mean of three measurements of styloid process length was taken. The study population was grouped as follows: Group I included patients at the age of 21-30 years; Group II comprised patients at the age of 31-40 years; Group III included 68 patients at the age of 41-50 years; Group IV comprised patients &gt; 50 years old.</p> <p><strong>Results. </strong>The mean length of the styloid process in the studied population varied from 20 to 51 mm (mean 31.3 ± 4.5 mm). There was no significant difference in the length on both sides (p=0.835). The mean length of the styloid process was 30.1 ± 4.2 mm in females and 32.3 ± 4.8 mm in males (p&lt; 0.034). The lengths of the styloid process in different age groups were as follows: in Group I - 30.9 ± 4.4 mm; in Group II - 31.2 ± 4.8 mm; in Group III - 31.6 ± 4.3 mm; in Group IV - 31.5 ± 4.5 mm.</p> <p><strong> Conclusions</strong>. The mean length of the styloid process in our population was higher as compared to many other ethnic groups. The styloid process in males was longer. The elongated styloid process on computed tomography scan should not be labeled as Eagle’s syndrome unless clinical symptoms are present.</p> Omair Shah Faiz Shera Naseer Choh Tariq Gojwari Fahad Shafi Jan Suhail Musadiq Rafiq Copyright (c) 2021 Omair Shah, faiz shera, naseer choh, tariq gojwari, fahad shafi, jan suhail, musadiq rafiq 2021-03-01 2021-03-01 28 1 E202114 E202114 10.21802/gmj.2021.1.4 Effects of Different Applications on Postoperative Seroma Formation and Wound Healing Following Mastectomy and Axillary Dissection in Rats <p>The most frequent postoperative complication after breast surgery is seroma formation. Seroma occurs due to lymphatic and vascular fluid leakage into the dead space created by surgical dissection.</p> <p><strong>The objective</strong> of the research was to evaluate the effects of local fibrin glue, tetracycline, talc applications, and flap fixation technique on reducing seroma formation after mastectomy and axillary dissection. In addition, we aimed to determine the level of efficacy for these applications, as well as to identify the most appropriate method to be used in operations with high risk of seroma formation.</p> <p><strong> Materials and Methods. </strong>This experimental study was conducted using a total of 60 female Wistar albino rats. They were allocated into six groups and each comprised ten rats. Unilateral mastectomy and axillary dissection were performed on all the rats. Local applications of fibrin glue, tetracycline, talc, and alcoholic iodine were performed in four separate groups. Flap fixation technique was applied in one group and those rats that did not receive any intervention constituted the control group. On the 10<sup>th</sup> postoperative day, seroma was aspirated under anesthesia, and the amount of seroma fluid was recorded. Seroma fluid was analyzed for interleukin 1-β, vascular endothelial growth factor, and C-reactive protein levels. Tissue samples were obtained from the skin overlaying the dissection area, the axilla, and the thoracic wall. Wound healing was evaluated with histopathological examination.</p> <p><strong> Results</strong>. Seroma volume was lower and the wound healing scores were the highest in the flap fixation group and the tetracycline group as compared to the control group. However, the alcoholic iodine group and the talc group had a greater amount of seroma (p &lt; 0.05). There was no difference between the fibrin glue group and the control group.</p> <p><strong> Conclusions.</strong> In our mastectomy model, local application of alcoholic iodine and talc substances caused more wound site problems and postoperative seroma formation. While fibrin glue did not cause wound site problems, it did increase seroma formation. These three substances were determined to be inefficacious in postoperative seroma formation. Local tetracycline application and flap fixation technique were found to reduce postoperative seroma and benefit wound healing.</p> Oktay Karaköse Hüseyin Pülat Kazım Çağlar Özçelik İsmail Zihni Kemal Kürşat Bozkurt Serdar Şenol Fatma Nihan Cankara Hasan Erol Eroğlu Copyright (c) 2021 Oktay Karaköse, Hüseyin Pülat, Kazım Çağlar Özçelik, İsmail Zihni, Kemal Kürşat Bozkurt, Serdar Şenol, Fatma Nihan Cankara, Hasan Erol Eroğlu 2021-03-01 2021-03-01 28 1 E202115 E202115 10.21802/gmj.2021.1.5 Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy <p>Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y<sub>12</sub> inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y<sub>12&nbsp; </sub>inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (&gt; 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.</p> Nestor Seredyuk Andrii Matlakh Yaroslava Vandzhura Mykyta Bielinskyi Oleksii Skakun Ruslana Denina Copyright (c) 2020 Nestor Seredyuk, Andrii Matlakh, Yaroslava Vandzhura, Mykyta Bielinskyi, Oleksii Skakun, Ruslana Denina 2020-12-26 2020-12-26 28 1 E202041 E202041 10.21802/gmj.2020.4.1 Fistulized Crohn’ Disease Mimicking Sigmoid Cancer: A Case Report <p>Crohn’s disease is an inflammatory bowel disease of unknown etiology, progressing with frequent exacerbation periods that can involve any part of the gastrointestinal tract. Although, it can manifest itself with complaints from the entire gastrointestinal tract; abdominal pain, diarrhea, nausea, weight loss and fever are the most important clinical symptoms. In this presentation, a 41-year-old male patient with known Crohn’s disease was presented to our hospital with the help of operation images.</p> Bartu Badak Ercument Pasaoglu Huseyin Tarik Caga Enver Ihtiyar Adnan Sahin Serdar Erkasap Ersin Ates Necdet Fatih Yasar Copyright (c) 2020 Bartu Badak, Ercument Pasaoglu, Huseyin Tarik Caga, Enver Ihtiyar, Adnan Sahin, Serdar Erkasap, Ersin Ates, Necdet Fatih Yasar 2020-12-26 2020-12-26 28 1 E202042 E202042 10.21802/gmj.2020.4.2 Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study <p><strong>Introduction: </strong> Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder.&nbsp; It is estimated that approximately 90% of cholecystectomies in the&nbsp; United States are performed using a laparoscopic approach.&nbsp; The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital.&nbsp;</p> <p><strong>Methods: </strong> This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J &amp; K, India and necessary data was collected and reviewed.</p> <p><strong>Results: </strong> In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%).&nbsp;</p> <p><strong>Conclusions: </strong> Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.</p> Aamir Hussain Hela Haseeb Mohammad Khandwaw Rahul Kumar Mir Adnan Samad Copyright (c) 2020 Aamir Hussain Hela, Haseeb Mohammad Khandwaw, Rahul Kumar, Mir Adnan Samad 2020-12-26 2020-12-26 28 1 E202043 E202043 10.21802/gmj.2020.4.3 Mycotic Infection (Fungal Ball) of the Paranasal Sinuses: A Clinicopathological Observation <p>Mycotic infections of the nasal cavity and paranasal sinuses represent a wide spectrum of disorders that vary in clinical presentation, histopathologic appearances, and biological significance. The second most common form is a fungal ball.</p> <p><strong>The objective </strong>of the research was to describe the cases of paranasal sinus fungal ball found in the files of patients with chronic rhinosinusitis.</p> <p><strong>Materials and Methods.</strong> There were demonstrated clinical and histopathological data of two patients.</p> <p><strong>Results.</strong> A 42-year-old woman and a 40-year-old man with chronic hypertrophic sinusitis had a large amount of friable cheesy mass in the maxillary sinus. The female patient previously underwent upper dental arch sanation. Histology revealed dense laminated masses of matted fungal hyphae that were separate from the mucosa. Sinonasal mucosa showed mild chronic inflammation (male) and severe non-specific chronic active inflammation (female). No evidence of fungal invasion in the mucosa was found.</p> <p><strong>Conclusions.</strong> Fungal ball represents a non-invasive form of mycotic rhinosinusitis with favourable prognosis. Biopsy examination plays an important role in the diagnostic process. Although the diagnosis can also be achieved by polymerase chain reaction assays, biopsy is the only way to explore the status of an inflammatory damage to adjacent tissue and, thus, to rule out potential invasive mycotic sinus disease with much worse clinical outcome.</p> Vladimír Bartoš Veronika Bartošová Copyright (c) 2020 Vladimír Bartoš, Veronika Bartošová 2020-12-26 2020-12-26 28 1 E202046 E202046 10.21802/gmj.2020.4.6 The Effect of the Infectious Disease Nursing Course on Turkish Students’ Knowledge and Attitudes Towards AIDS: A Quasi-Experimental Study <p>There is no available treatment or vaccine for HIV/AIDS, and health education has, therefore, become a top priority in the prevention of disease. It is of great importance to have sufficient information about HIV/AIDS and how to control infection. This study was conducted to determine the effect of the Infectious Disease Nursing course on nursing students’ knowledge and attitudes towards AIDS.</p> <p><strong> Materials and Methods. </strong>This quasi-experimental study was carried out between February 12 - May 28, 2019 and included 50 nursing students who were taking the Infectious Disease Nursing course for the first time and attended the pre-test and post-test. The data were collected using a Personal Information Form and the AIDS Knowledge and Attitude Scale. Descriptive statistics, the paired sample t-test and Pearson correlation analysis were used in the evaluation of the data.</p> <p><strong> Results. </strong>Among the students who participated in the study, 94.0% of students were at the age of 18-21 years; 80.0% of students were females; 54.0% of students stated that they had adequate knowledge of AIDS; 78.0% of students stated that they did not want to provide care to individuals with HIV/AIDS. There was found a significant strong positive correlation between the mean pre- and post-education scores for the AIDS Knowledge and Attitude Scale (p&lt;0.05, r=0.34; p&lt;0.01, r=0.72). There was a significant, weak negative correlation between the mean post-education AIDS total Attitude mean score and the status of having contact with a patient with HIV/AIDS and wanting to provide care for a patient with HIV/AIDS (p&lt;0.05, r=-0.31), and a significant weak positive correlation between the status of wanting to provide care for a patient with HIV/AIDS and seeing people with HIV/AIDS as a threat (p&lt;0.01; r=-0.50).</p> <p><strong> Conclusions. </strong>All the students benefited from the information on AIDS and became informed due to attending the Infectious Diseases Nursing course and their attitudes towards AIDS improved.</p> Sibel Şentürk Alev Yıldırım Keskin Copyright (c) 2020 Sibel Şentürk, Alev Yıldırım Keskin 2020-12-26 2020-12-26 28 1 E202045 E202045 10.21802/gmj.2020.4.5 Surgical Correction of Hirschsprung's Disease in Children Using the Soave-Boley Technique with Manual Colorectal Anastomosis <p><strong>Introduction.</strong> Current trends in surgical treatment of Hirschsprung's disease are aimed at minimally invasive interventions. However, the experience of using Soave-Boley procedure in surgical treatment of Hirschsprung's disease in children of different ages is valuable in the arsenal of differentiated approach to the treatment of this pathology.</p> <p><strong>The objective of the research</strong> was to evaluate the results of surgical correction of Hirschsprung's disease in children using the Soave-Boley technique with manual colorectal anastomosis.</p> <p><strong>Materials and Methods.</strong> The analysis of surgical treatment of 1,187 children with different forms of Hirschsprung’s disease aged from birth to 18 years over the period 1980-2020 was conducted in the National Children's Specialized Hospital“ Okhmatdyt”. Surgical correction of Hirschsprung's disease using the Soave-Boley technique was performed in 597 children. Before surgery, 156 patients underwent the first stage of treatment that consisted in the creation of a protective colostomy; in 441 cases, this intervention was performed without an intestinal stoma; the benefits of the Soave-Boley technique were evaluated.</p> <p><strong>Results</strong>. All the patients survived. In 15 (2.51%) out of 597 children, in the early postoperative period, there were observed: retrocolic hematoma (n = 2), retrocolic abscess (n = 7), anastomotic leak (n = 2), adhesive intestinal obstruction (n = 3), intussusception (n = 1). Fourteen (2.36%) patients developed surgical complications in the long-term period: residual aganglionosis (n = 9), anastomotic stenosis (n = 4) and coloptosis. Repeated Soave-Boley operation with manual colorectal anastomosis was successfully performed in 26 (4.362%) patients after primary correction of Hirschsprung's disease using different methods. Periodic episodes of fecal smearing in the remote period in 45 (7.53%) children were eliminated by conservative treatment. The success of this technique is confirmed by a much lower number of early (2.51%) and late (2.36%) postoperative surgical complications, as compared to those after using other methods of open surgical correction - 17.52% and 16.35%, respectively.</p> <p><strong> Conclusions.</strong> Surgical correction of Hirschsprung's disease in children using the Soave-Boley technique with manual colorectal anastomosis allows better control over applying each suture, anatomical joining the edges of the bowel, and reducing trauma to the rectal mucosa, which ensures the high reliability of colorectal anastomosis; it is the most effective way of radical correcting Hirschsprung' s disease in children in an open way in one-stage or two-stage interventions, and this technique is the operation of choice for secondary surgical correction of Hirschsprung's disease.</p> Oleh Kurtash Copyright (c) 2020 Oleh Kurtash 2020-12-26 2020-12-26 28 1 E2020410 E2020410 10.21802/gmj.2020.4.10 Congenital Aneurysm/Diverticulum of the Left Ventricle in the Newborn <p>Left ventricular aneurysms and diverticula are severe congenital heart defects. The low prevalence and mostly asymptomatic course of these anomalies do not always allow us to suspect these defects in time and to differentiate them among themselves. That is why early detection of pathology with the help of fetal echocardiography is a key factor in determination of the tactics of patients’ management. The paper reviews the literature and describes a complex case of prenatally diagnosed left ventricular aneurysm.</p> Oleksandra Tsaruk Valerian Ryzhyk Khrystyna Ilnytska Copyright (c) 2020 Oleksandra Tsaruk, Valerian Ryzhyk, Khrystyna Ilnytska 2020-12-26 2020-12-26 28 1 E2020415 E2020415 10.21802/gmj.2020.4.15 Disposition and Challenges of Alternative to Physical Classroom Teaching and Learning in a Pandemic; an Appraisal of Biochemistry Students COVID-19 Learning with WhatsApp <p><strong>The objective</strong> of the study was to assess the disposition and challenges of students towards teaching and learning of biochemistry through WhatsApp.</p> <p><strong>Materials and Methods.</strong> The study was a cross-sectional survey which had 200 level (Second Year) and 400 level (Fourth Year) students of biochemistry as respondents. Data collection was done using a self-developed questionnaire administered through the WhatsApp group created for learning and collected through a designated e-mail address. Data analysis was carried out using the mean and standard deviation setting a mean score of 2.5 as a benchmark for accepting or rejecting statements made in the questionnaire.</p> <p><strong>Results.</strong> The study revealed that students had a level of openness to using online teaching resources for biochemistry; they do not believe that the use of WhatsApp for teaching and learning of biochemistry as a means of alternative to face to face classroom interaction will be effective in imparting the right knowledge in biochemistry. Several challenges identified are linked to not just money but is hinged around the curriculum structure of the biochemistry programme.</p> <p><strong>Conclusion.</strong> It is concluded that WhatsApp represents a potential means of instruction but may be hampered by challenges hinged on the curriculum structure of biochemistry.</p> Peter Agbadobi Uloku Ossai Chukwudi Ogwu Patrick Chukwuyenum Ichipi-Ifukor Fidelis Ifeakachuku Achuba Copyright (c) 2020-12-26 2020-12-26 28 1 E2020411 E2020411 10.21802/gmj.2020.4.11 Laser-Induced Spectral-Selective Autofluorescent Microscopy as a Prospective Method of Research in Biomedicine <p>In modern medical diagnostics, optical methods of studying living tissues have become widespread and are collectively called "optical biopsy". One such method is autofluorescence microscopy, which provides additional information about the structural and functional features of the sample. In this paper, an analysis of existing data was performed on the properties of autofluorescence of cells and tissues to evaluate the available instrumental systems and methods for monitoring autofluorescence and the potential for its application in the biomedical field.</p> <p>Over the past few years, advanced optical-electronic methods have become available to detect various pathological conditions of tissues and environments of the human body by evaluating signals emitted by endogenous fluorophores. Because these molecules are often involved in basic biological processes, they are important parameters for checking the condition of cells and tissues. In our opinion, analytical methods based on autofluorescence monitoring have great potential in both research and diagnosis, and interest in the use of these new analytical tools is constantly growing. Methods based on autofluorescence can give more information about the object under study with relatively lower costs and less diagnostic error.</p> Nataliia Kozan Ivan Savka Viktor Kryvetskyi Igor Oliynyk Copyright (c) 2020 Nataliia Kozan, Ivan Savka, Viktor Kryvetskyi, Igor Oliynyk 2020-12-26 2020-12-26 28 1 E202048 E202048 10.21802/gmj.2020.4.8 Morphological Characteristics of Changes in the Duodenal Wall Within 14-56 Days of the Development of Streptozotocin-Induced Experimental Diabetes Mellitus <p><strong>The objective </strong>of the research was to determine the morphological features of the duodenal wall of animals within 14-56 days of developing streptozotocin-induced diabetes mellitus using light optical microscopy.</p> <p><strong>Materials and Methods.</strong> The research was carried out on 40 white nonlinear adult male rats. Diabetes mellitus was simulated by a single intraperitoneal injection of streptozotocin (Sigma, USA) at a dose of 60 mg/kg body weight. The material was taken from the duodenum on the 14<sup>th</sup>, 28<sup>th</sup> and the 56<sup>th</sup> days after the onset of experimental diabetes mellitus. For histological study, the preparations were made using the conventional method, which included the staining of sections with hematoxylin and eosin.</p> <p><strong>Results.</strong> Streptozotocin-induced diabetes mellitus was experimentally found to lead to dystrophic changes in the epithelial components of the duodenal mucosa from the 14<sup>th</sup> day of developing. There were observed a shortening of the villi of the mucous membrane and a lack of distinctness of striated border contours on the apical surface of epitheliocytes. Between the connective-tissue fibers of the lamina propria of the mucosa and thin-walled vessels, the cellular elements, including mainly macrophages, lymphocytes, were found. There was a shortening of the villi, edema and histiolymphocytic infiltration of the villous stroma 28 days after developing experimental diabetes mellitus. The epithelium covering was discontinuous; numerous areas of desquamation were found at the apex of the villi. Fifty-six days after developing experimental diabetes mellitus, the destruction and desquamation of the epithelium of the villi and crypts were observed. The surface of the duodenal mucosa smoothed down due to the shortening and flattening of the villi (indicating their atrophy), while the crypts elongated and their depth increased.</p> <p><strong>Conclusions.</strong> Histological study of the duodenal wall of diabetic animals showed pronounced desquamation at the apex of the villi, destructive and dystrophic changes in the surface epithelium, edema and increased cellular infiltration of the lamina propria of the mucosa. Thus, in diabetes mellitus, structural changes in the duodenal wall of rats are characterized by the dystrophic processes, which can be considered as the morphological reflection of enteropathy.</p> Ihor Bilinskyi Copyright (c) 2020 Ihor Bilinskyi 2020-12-26 2020-12-26 28 1 E2020413 E2020413 10.21802/gmj.2020.4.13 Determination of Caregiver Burden and Social Support Levels among Caregivers Providing Care for Patients Hospitalized in Palliative Care Clinics <p>Providing care to someone with a chronic disease requires being physically, emotionally, and mentally energetic. In particular, the presence of a patient with a disease that requires palliative care changes daily activities and routines, increases responsibilities of those who take the responsibility for patient’s care and changes the roles in the family.</p> <p><strong>The objective</strong> of this study was to determine the care burden and social support levels among the caregivers providing care for patients hospitalized in palliative care clinics.</p> <p><strong>Materials and Methods:</strong> The population of this descriptive and correlational study consisted of caregivers taking care of patients treated at the Palliative Care Clinic of Training and Research Hospital between May and October 2018; the sample consisted of 73 caregivers who volunteered to join the study and were open to communication. Data were collected by questioning patients and their caregivers about their sociodemographic characteristics, using the Caregiver Burden Scale and the Multidimensional Scale of Perceived Social Support. Data analysis included percentages, the Kruskal-Wallis test, the Mann-Whitney U test, and the Spearman’s Correlation Coefficient.</p> <p><strong>Results:</strong> The average caregivers’ age was 45.44±13.76 years; 75.3% of caregivers were females, 30.1% of caregivers were literate or had primary school degrees. Caregiver’s gender and educational levels were found not to affect caregiving and social support levels; however, the economic status affected caregiving and social support levels. There was a reverse correlation between the caregiver burden and their social support levels.</p> <p><strong>Conclusions:</strong> With increased caregiver burden, their social support level decreased. Nurses caring for patients in palliative care clinics will benefit from educating and supporting caregivers about clinic and home care; it will result in a positive level of social support for both caregivers and patients receiving care.</p> Papatya Karakurt Sevinç Köse Tuncer Nadire Yildiz Çiltaş Mehmet Doğan Copyright (c) 2020 Papatya Karakurt, Sevinç Köse Tuncer, Nadire Yildiz Çiltaş, Mehmet Doğan 2020-12-26 2020-12-26 28 1 E2020414 E2020414 10.21802/gmj.2020.4.14 Effects of Siam Weed (Chromolaena odorata) Leaf Extract on Crude Oil-induced Toxicity <p style="text-align: justify;"><strong>The objective</strong> of this study was to investigate the effects of the different extracts&nbsp; (aqueous, ethanol and blended mixture) of <em>Chromolaena odorata</em> leaves on Wistar rats feed with crude petroleum (CP) tainted feed (4 ml/100 g diet).</p> <p style="text-align: justify;"><strong>Materials and methods</strong>: Twenty-five male Wistar rats weighing 140 -180 g were used for this study. The rats were kept one in a cage. Group A which was the control was allowed diet free of crude oil and were not treated with any of the extracts. Group B were exposed to a diet contaminated with crude oil that contained 4ml of crude oil per 100 gram of animal feed without treatment. Groups C-E were fed with diets contaminated with 4ml of crude oil per 100g of feed and treated with 500mg/Kg<sup>-1</sup> bodyweight of aqueous, ethanol and blended mixture of ethanol and aqueous extracts, respectively. The respective extracts and blended mixture were given daily to the rats via oral gavage in line with body weights. The study was for duration of twenty eight days after which the rats were sacrificed under sedation with chloroform. This was followed with collection of blood samples and organs of interest. All samples were stored at 4<sup>0</sup>C and used within forty eight hour for various biochemical analyses.</p> <p style="text-align: justify;"><strong>Results</strong>: There were significant decrease in haematological indices, liver proteins, oxidative enzymes, &nbsp;and antioxidant enzymes when compare with&nbsp; Group 1. Also, liver function maker enzymes, white blood cells (WBC), and malondialdehyde (MDA) &nbsp;&nbsp;were significantly increased &nbsp;by petroleum intoxication. Significant increase were observed in Hb, PCV, RBC, SO, MO, XO, SOD, CAT, albumin, total protein in the serum, liver and kidney; as against decreases in WBC, AST, ALT, ALP and MDA&nbsp; in rats fed crude petroleum (CP) tainted feed that was treated with<em> C. &nbsp;odorata </em>extract.&nbsp;</p> <p style="text-align: justify;"><strong>Conclusion</strong>: This study showed that administration of <em>C. odorata</em> leaves extracts to rats prevented health risk associated with crude petroleum toxicity.</p> Fidelis Ifeakachuku Achuba Charles Offor Copyright (c) 2020 Fidelis Ifeakachuku Achuba, Charles Offor 2020-09-28 2020-09-28 28 1 E202031 E202031 10.21802/gmj.2020.3.1 Impact of Periodontal Pocket Depth on the Efficiency of Surgical Treatment of Generalized Periodontitis <p>The paper is aimed at increasing the efficiency of surgical treatment by using a combination of platelet-rich fibrin, a synthetic hydroxyapatite Kergap, minimizing the body’s response to operative wound, and improving diagnostic and therapeutic approaches in surgical treatment of stage II-III generalized periodontitis.</p> <p><strong>The objective </strong>of the research was to study the efficiency of using the combination of platelet-rich fibrin, synthetic hydroxyapatite Kergap, magnesium preparation in comprehensive treatment of stage II-III generalized periodontitis at various stages and in different depths of the periodontal pockets.</p> <p><strong>Materials and Methods. </strong>The efficiency of surgical treatment was evaluated using clinical (periodontal pocket depth, attachment level, gingival bleeding, tooth mobility) and laboratory methods (X-ray, computed tomography) 3, 6, and 12 months after surgical treatment.</p> <p><strong>Results. </strong>The clinical picture was characterized by positive changes in all clinical indicators 3, 6 and 12 months after treatment. The best results by clinical and laboratory findings were obtained in case of an average pocket depth of 5-7 mm.</p> <p><strong>Conclusions. </strong>There was demonstrated a high clinical efficiency of using the combination of platelet-rich fibrin, synthetic hydroxyapatite Kergap and magnesium preparation in comprehensive treatment of stage II-III generalized periodontitis.</p> Mariana Ilkiv Mykola Rozhko Vitalii Hereliuk Copyright (c) 2020 Mariana Ilkiv, Mykola Rozhko, Vitalii Hereliuk 2020-09-28 2020-09-28 28 1 E202032 E202032 10.21802/gmj.2020.3.2 Study of the Association Between Antihyperglycemic Therapy and Cancer in Patients with Type 2 Diabetes Mellitus <p><strong>The objective </strong>of the research was to investigate the features and association of antihyperglycemic therapy and cancer in patients with type 2 diabetes mellitus.</p> <p><strong>Materials and Methods. </strong>The study included the analysis of medical records of patients with type 2 diabetes mellitus who were diagnosed with cancer during 2012-2016. The obtained results were processed by statistical methods using the software packages Microsoft Excel and Statistika-12. The significance of differences between the frequency of using different treatment schemes was assessed by the Pearson’s test (χ²). To determine the risk of predicted events, the odds ratio, the 95% confidence interval, the positive and negative prognostic values were calculated.</p> <p><strong>Results.</strong> There were diagnosed 533 cases of cancer in patients with type 2 diabetes mellitus. The most common scheme of antihyperglycemic therapy prior to the detection of malignant diseases was a combination of metformin and sulfonylurea derivatives (35.65%), as well as monotherapy with sulfonylurea derivatives (17.26%) and metformin (11.28%). Prior to diagnosing cancer in 396 (74.30%) patients, antihyperglycemic therapy<br>along with sulfonylurea derivatives and insulin was used. Among obese patients 68.82% used sulfonylureas and insulin as part of antidiabetic therapy before diagnosis of cancer. The connection between insulin therapy and the risk of cancer development in patients with type 2 diabetes mellitus was proved (the odds ratio=2.35; the 95% confidence interval (1.91 - 2.91); p&lt;0.001).</p> <p><strong>Conclusions.</strong> Prior to the detection of cancer in patients with type 2 diabetes mellitus, the combination therapy with metformin and sulfonylurea derivatives was most often used. The association between insulin therapy and the development of cancer in patients with type 2 diabetes mellitus was revealed. Cancer screening is advisable for patients with type 2 diabetes mellitus and obesity, who receive as a therapy sulfonylurea derivates and/or insulin.</p> Tamara Vatseba Liubov Sokolova Volodymyr Pushkarev Nataliia Koshel Copyright (c) 2020 Tamara Vatseba, Liubov Sokolova, Volodymyr Pushkarev, Nataliia Koshel 2020-09-28 2020-09-28 28 1 E202033 E202033 10.21802/gmj.2020.3.3 Assessment of Relationship Between Nutritional Status and Handgrip Strength in Hemodialysis Patients <p>In hemodialysis patients, the prevalence of malnutrition is high; a decrease in muscle strength is observed.</p> <p>&nbsp;<strong>The objective</strong> of the research was to evaluate the nutritional status of hemodialysis patients and the relationship between the nutritional status and muscle strength.</p> <p><strong>Materials and Methods.</strong> Sixty hemodialysis patients (38 males, 22 females) were chosen from among volunteers. Food consumption, biochemical values, anthropometric measurements, body composition, physical activity status, subjective global assessment, and handgrip strength in individuals were examined.</p> <p><strong>Results.</strong> According to subjective global assessment, 73.3% of patients were well-nourished, 26.7% of patients were moderately malnourished. In male patients, a moderate positive correlation was determined between handgrip strength and lean body mass (r=0.359, p&lt;0.05), albumin level (r=0.408, p&lt;0.05), energy intake (r=0.437, p&lt;0.05), protein intake (r=0.345, p&lt;0.05). In female patients, a moderate positive correlation was determined between handgrip strength and body weight (r=0.470, p&lt;0.05), body mass index (r=0.472, p&lt;0.05), triceps skinfold thickness (r=0.530, p&lt;0.05), mid-upper arm circumference (r=0.515, p&lt;0.05), mid-upper arm muscle circumference (r=0.557, p&lt;0.05), lean body mass (r=0.470, p&lt;0.05), body fat content (%) (r=0.588, p&lt;0.05), albumin level (r=0.565, p&lt;0.05).</p> <p><strong>Conclusions.</strong> Handgrip strength alongside with more than one method of food consumption, biochemical parameters, subjective global assessment, anthropometric measurements, and body composition should be used for assessing the nutritional status in hemodialysis patients.</p> Sevil Karahan Yılmaz Neslişah Rakıcıoğlu Copyright (c) 2020 Neslişah Rakıcıoğlu, Sevil Karahan Yılmaz 2020-09-28 2020-09-28 28 1 E202034 E202034 10.21802/gmj.2020.3.4 Antimicrobial Resistance Profile Among Major Bacterial Pathogens in Southern Babil, Iraq <p><strong>Background:</strong> At present, drug-resistant pathogens are considered one of the major increasing causes of morbidity and mortality around the world. The data on microorganisms' resistance assist define the best available treatment for patients. Therefore, this study aimed to screen the antimicrobial-resistant profile of different drugs in major clinical pathogens of urine, ear and wound infections.</p> <p><strong>Methods:</strong> This study was conducted in Al-Shomali General Hospital, Southern Babil, Iraq from October 2019 to May 2020. Totally 67 clinical specimens obtained from the wound, urine, and ear discharge collected from hospitalized patients as well as 30 healthy individuals participate in this study. Then, the standard microbiological methods carried outperformed to the isolated and identified bacterial species. Antimicrobial susceptibility tests were performed using different antimicrobial discs by applying the Kirby–Bauer disc diffusion method.</p> <p><strong>Results:</strong> Totally, 67 bacterial isolates were obtained from 44 (66%) female and 23 (34%) male patients. <em>Staphylococcus aureus</em> and <em>E. coli</em> were the most common predominant organisms. All isolates were showed a high rate of resistance to evaluated cephalosporins 100% and 87% to cefotaxime and ceftriaxone respectively, while very low resistance recorded in Aminoglycosides 22% and 12% to Gentamicin and amikacin, respectively.</p> <p><strong>Conclusion:</strong> These results suggest a constant screening for the detection of antibiotic resistance, as well as developing antimicrobial stewardship programs in Babil, Iraq. Moreover, these bacterial isolates have shown multidrug resistance, mainly to commonly administered drugs that could cause therapy ineffective. Therefore, in clinical use, appropriate treatment should be chosen based on the results obtained from antimicrobial susceptibility tests.</p> Falah Hasan AL-Khikani Copyright (c) 2020 Falah Hasan AL-Khikani 2020-09-28 2020-09-28 28 1 E202036 E202036 10.21802/gmj.2020.3.6 Abdominal Ascariasis: Where to Focus on Imaging Studies <p><strong>Objective</strong>: To assess the various presentations of abdominal ascariasis and their imaging features for developing a comprehensive radiological evaluation protocol.</p> <p><strong>Methods</strong>: Demographic and clinical profile of 84 patients with abdominal ascariasis was noted. Patients were divided into 2 groups with age less than 20 comprising Group A and those with age greater than 20 Group B. All the patients had a routine lab workup and a dedicated USG scan to look for objective evidence of intestinal or hepatobiliary ascariasis. Any history of previous intervention (cholecystectomy or ERCP) was also sought.</p> <p><strong>Results</strong>: Abdominal ascariasis is more common in females observed in 62% of our patients. Peripheral eosinophilia was observed in 70 (83%) patients. We had 74 (88%) patients with intestinal ascariasis with 2 patients having appendicular ascariasis. Biliary ascariasis was observed in 20 (24%) patients and pancreatic ductal ascariasis in 6 (7%) patients. We found peritoneal ascariasis in 1 (2%) pediatric patient and 2 (3%) patients in our study had ascariasis associated with the liver abscess. OCH was observed in 4 patients while 2 patients presented with worm cholecystitis.</p> <p><strong>Conclusion</strong>: Peripheral eosinophilia can be used to select patients in endemic regions for undergoing a dedicated USG scan. USG is the investigation of choice for both intestinal and hepatobiliary ascariasis. Worm migration is more common in adults and is especially prevalent in individuals with previous history of ERCP or cholecystectomy.</p> Jan Suhail Omair Shah Obaid Shah Jan Sarfaraz Irshad Mohuiddin Copyright (c) 2020 Jan Suhail, Omair Shah, Obaid Shah, Jan Sarfaraz, Irshad Mohuiddin 2020-09-28 2020-09-28 28 1 E202035 E202035 10.21802/gmj.2020.3.5 Role of Diffusion-Weighted and Chemical Shift Magnetic Resonance Imaging in Differentiation of Benign and Malignant Spinal Fractures <p>Atraumatic spinal compression fractures are common clinical problem. Differentiating benign osteoporotic fractures from pathological fractures due to malignant/metastatic lesions affects the management and prognoses in patients with known extraspinal malignancy. &nbsp;&nbsp; <strong>The objective</strong> of the research was to assess the role of conventional magnetic resonance imaging sequences with diffusion-weighted imaging and chemical-shift imaging in differentiating benign and malignant acute spinal compression fractures.</p> <p><strong>Materials and Methods. </strong>The study included 40 patients with acute spinal compression fractures. Patients were evaluated using magnetic resonance imaging with diffusion-weighted imaging and chemical-shift imaging to differentiate benign etiology from malignant one. The results obtained were compared with histopathological follow-up for 6 months for definite clinical diagnoses.</p> <p><strong>Results</strong>. No significant difference was noted in signal characteristics of benign and malignant fractures on T1, T2 and short-tau inversion recovery. However, posterior element involvement, soft tissue component and post-contrast enhancement were seen more frequently in malignant fractures (p&lt;0.05). On diffusion-weighted images, 77.8% of malignant fractures were hyperintense and 59.1% of benign fractures were hypointense (p&lt;0.05). The mean apparent diffusion coefficient value was 0.81 ± 0.19 for malignant and 1.24 ± 0.24 for benign fractures (p&lt;0.5). The mean signal intensity ratio for malignant fractures was 0.91 ± 0.125, whereas the signal intensity ratio for benign fractures was 0.64 ± 0.096 (p&lt;0.001).</p> <p><strong>Conclusions.</strong> Signal characteristics on T1, T2 and short-tau inversion recovery sequences do not differentiate benign from malignant fractures; however, posterior element involvement, soft tissue and post contrast enhancement help in differentiating the etiology. Diffusion-weighted imaging and apparent diffusion coefficient values, as well as using chemical shift imaging further improve the diagnostic accuracy of magnetic resonance imaging.</p> Waseem Ahmed Sheikh Feroze A Shaheen Nasir Ahmad Lone Srabjit S Chhiber Rumana Hamid Makhdoomi Copyright (c) 2020 Waseem Ahmed Sheikh, Feroze A Shaheen, Nasir Ahmad Lone, Srabjit S Chhiber, Rumana Hamid Makhdoomi 2020-09-28 2020-09-28 28 1 E202037 E202037 10.21802/gmj.2020.3.7 Study of Salivary Stress Factor Activity in Patients with Diabetes Mellitus During the Period of Adaptation to Complete Removable Laminar Dentures <p>Diabetes mellitus is referred to as non-communicable epidemic of the 21<sup>st</sup> century and the fight against diabetes is one of medical and social challenges. One of its complications is damage to periodontal tissues that is accompanied by tooth loss. Any removable denture is a foreign body being a stress factor for the oral cavity.</p> <p><strong>The objective</strong> of the research was to study dynamic changes in the activity of stress factor indicators, namely salivary cortisol, glucose and alpha-amylase levels in diabetic patients after prosthodontic treatment with complete removable laminar dentures.</p> <p><strong>Materials and Methods. </strong>For this study, patients at the age of 45 to 74 years were divided into two groups: Group I included 52 edentulous patients with type 2 diabetes mellitus who were treated with acrylic resin complete removable laminar dentures; Group II comprised 52 edentulous patients without endocrine pathology who were treated with acrylic resin complete removable laminar dentures as well. Saliva served as the study material. The enzyme-linked immunosorbent assay was used to determine salivary cortisol levels. Glucose concentration in saliva was determined by a unified enzymatic method. Alpha-amylase activity was determined by the enzymatic colorimetric method.</p> <p><strong>Results. </strong>According to the research results, before prosthodontic treatment, salivary cortisol levels of patients with diabetes mellitus were 2.4 times higher as compared to patients without somatic pathology. In phase I of adaptation to complete removable laminar dentures, in patients with diabetes mellitus, salivary cortisol concentration increased drastically by 1.4 times as compared to the indicator before prosthodontic treatment (5.61±0.83 ng/ml vs. 4.02±0.65 ng/ml, p&lt;0.01), while in the group of patients without endocrine pathology, cortisol levels increased by 1.2 times; salivary glucose level of patients with diabetes mellitus increased by 1.3 times, while in patients without endocrine pathology, it increased by 1.1 times; in patients of Group I, salivary alpha-amylase levels increased by 1.2 times, while in patients of Group II, salivary alpha-amylase concentration increased by 1.05 times.</p> <p><strong>Conclusions</strong>. In patients with diabetes mellitus, changes in saliva composition indicate a significant reduction in the adaptation mechanisms, that complicates and significantly prolongs the period of adaptation to complete removable laminar dentures.</p> Lyubov Leybyuk Mykola Rozhko Olena Rozhko Copyright (c) 2020 Lyubov Leybyuk, Mykola Rozhko, Olena Rozhko 2020-09-28 2020-09-28 28 1 E202038 E202038 10.21802/gmj.2020.3.8 Clinical Manifestations of Periodontal Tissue Diseases in Patients with Rheumatoid Arthritis Who Live in Anthropogenically Loaded Areas <p>The <strong>objective</strong> of the study is to clinically assess the condition of periodontal tissues in patients with rheumatoid arthritis, living in anthropogenically loaded and environmentally friendly areas and in people with generalized periodontitis without concomitant somatic diseases.</p> <p><strong>Materials and methods.</strong> There were examined 137 patients, including 82 patients with generalized periodontitis of the I degree (subgroups A) and the II degree (subgroups B) with rheumatoid arthritis, living in anthropogenically loaded areas (group I), environmentally friendly areas (group II) and without concomitant somatic diseases living in environmentally friendly areas (group III). Control group – included 18 healthy people.</p> <p>Periodontal tissues were evaluated according to the indices: Greene-Vermillion, PMA, periodontal index offered by Russel and the depth of periodontal pockets.&nbsp;</p> <p><strong>Results.</strong> Women (80%) dominated in each group, patients with generalized periodontitis of the II degree of severity dominated, too.</p> <p>&nbsp;The highest depth of periodontal pockets was 5.02±0.11 mm in the IB subgroup and differed significantly from this figure in the IIB subgroup 1.07-fold (p<sub>IB-IIB</sub>&lt;0.05) and from that in the IIIB subgroup 1.2-fold (p<sub>IB-II</sub><sub>I</sub><sub>B</sub>&lt;0.001). The value of the Greene-Vermilion index in patients with GP of the I degree of development in all subgroups A corresponded to “unsatisfactory”. In patients with GP of the II degree of development, the state of hygiene corresponded to “bad” in subgroups IB, IIB and was 3.04±0.11 points (p<sub>IB-IIB</sub>˂0.01, p<sub>IB-II</sub><sub>I</sub><sub>B</sub>˂0.001, p<sub>IB-</sub><sub>K</sub>˂0.001); 2,63 ± 0.07 points (p<sub>I</sub><sub>I</sub><sub>B-IB</sub>˂0.01, p<sub>I</sub><sub>I</sub><sub>B-I</sub><sub>II</sub><sub>B</sub>˂0.001, p<sub>I</sub><sub>I</sub><sub>B-</sub><sub>K</sub>˂0.001), in ІІІB – “unsatisfactory”. According to the indicators of the PMA index in patients with GP of the I degree of severity, we’ve found the average severity degree of gingivitis (within the range of 43.25±2.02 – 48.06±1.46%) and severe degree of gingivitis in patients with the GP of the II degree &gt;50 %. The highest indicator of periodontal index was found in the IB subgroup – 6.16±0.10 points (p<sub>IB-I</sub><sub>I</sub><sub>B</sub>˂0.01, p<sub>IB-I</sub><sub>II</sub><sub>B</sub>˂0.001, p<sub>IB-</sub><sub>K</sub>˂0.001), which indicated a severe form of periodontitis.</p> <p><strong>Conclusion.</strong> Most often, GP in patients with RA was diagnosed in women, most of whom were patients with GP of the II degree (most in group I – 69.04%). The highest depth of periodontal pockets was 5.02±0.11 mm in the IB subgroup. The performed clinical and index assessment of periodontal tissues in patients of three groups indicates a more severe course of GP of the I and II degree in patients with rheumatoid arthritis living in anthropogenically loaded areas (IA, IB subgroups).</p> Khristina Kovalyshyn Mykola Rozhko Copyright (c) 2020 Khristina Kovalyshyn, Mykola Rozhko 2020-09-28 2020-09-28 28 1 E2020310 E2020310 10.21802/gmj.2020.3.10 About Some Aspects of Teaching Foreign Students in the Discipline "History of Medicine" <p><strong>The objective </strong>of the research was to study the opinion of the first-year students of the Faculty of Foreign Citizens Training of the Ivano-Frankivsk National Medical University on some aspects of teaching the discipline "History of Medicine" to determine its areas for improvement.</p> <p><strong>Materials and methods.</strong> According to the author's program, a survey of 239 first-year students of Ivano-Frankivsk National Medical University was conducted. They came from 10 countries, studiyng the specialty "Medicine". The results of research were mainly categorical (qualitative) data. Therefore, calculation of each factor rates per 100 respondents, standard errors of rates, and Chi-Square Test (χ<sup>2</sup>) for comparing group differences have been used for statistical data analysis. The methods that have been mainly used are sociological, medical and statistical.</p> <p><strong>Results.</strong> The research found that the absolutely majority of students are from India (81.2%) and about 59.0% of respondents profess Hinduism (59.0%), but the shares of Muslims (21.3%) and Christians (17.6%) are also significant.There are 65.7% males vs. 34.3% of females among the respondents, which is obviously due to religious, cultural and national stereotypes of different countries (p &lt; 0.001). The results of secondary education, with which foreign students entered university, were quite high. Almost 86.7% of surveyed first-year-students noted the high level of lectures on the subject "History of Medicine", pointing to their informativeness, accessibility, interesting and illustrative manner of presenting the material.</p> <p><strong>Conclusion. </strong>It was found that among foreign first-year students studying at the IFNMU, predominated males (65.7%), aged from 19 to 21 years of (62.3%), with a high basic level of secondary education (66.9%). It was also shown that 91.7% of respondents are satisfied with the level of teaching "History of Medicine" and manner of presentation lecture material (86.7%).&nbsp;</p> Nataliia Stytsiuk Copyright (c) 2020 Nataliia Stytsiuk 2020-09-28 2020-09-28 28 1 E202039 E202039 10.21802/gmj.2020.3.9 Non-Invasive Mechanical Ventilation in Children with Previous Unsuccessful Weaning from Respiratory Therapy <p><strong>The </strong><strong>objective</strong> of the research was to establish the impact of diaphragm-protective mechanical ventilation on the rate of successful weaning from invasive and non-invasive mechanical ventilation in children with acute respiratory failure.</p> <p><strong>Materials and </strong><strong>M</strong><strong>ethods.</strong> We conducted a prospective, observational cohort study. Seventy-eight patients were randomly divided into 2 groups: patients of Group I received lung-protective mechanical ventilation; patients of Group II received diaphragm-protective + lung-protective mechanical ventilation. For age-specific data analysis, patients were divided into age subgroups: the 1<sup>st</sup> subgroup included children being 1 to 12 months old; the 2<sup>nd</sup> age subgroup comprised children being 12 to 36 months old. We started respiratory support in both groups with invasive mechanical ventilation and when patients met the criteria, we weaned them. We confirmed successful weaning, when patients had no need to be mechanically ventilated within next 48 hours, otherwise, they were intubated again. Before the second trial to wean, patients in Group I were simply extubated, while patients in Group II received non-invasive mechanical ventilation. The primary endpoint was the rate of successful weaning from mechanical ventilation in the first trial. The secondary outcomes were complications, namely reintubation rate, tracheostomy rate and death.</p> <p><strong>Results</strong>. We found a significant difference in the primary outcome for the 1<sup>st</sup> age subgroup: there were 72.4% in Group I vs. 52.6% in Group II successfully weaned patients (p=0.04). No significant difference in the primary outcome was observed in the 2<sup>nd</sup> age subgroup: there were 80% in Group I vs. 82.3% in Group II successfully weaned patients (p=0.78). There were significant differences in the secondary outcomes between groups in the 1<sup>st</sup> age subgroup, namely reintubation rate was seen in 9.1% patients of Group I vs. 36.8% patients of Group II (p=0.05); death happened in 18.2% cases in Group I vs. no cases in Group II (p=0.01). There were no differences in tracheostomy rate in the 1<sup>st</sup> age subgroup and there were no differences in the &nbsp;secondary outcomes between groups in 2<sup>nd</sup> age subgroup.</p> <p><strong>Conclusions</strong>. Diaphragm-protective mechanical ventilation significantly reduced the incidence of successful weaning from invasive mechanical ventilation; however, it increased the incidence of successful weaning from non-invasive mechanical ventilation, and, significantly decreased the mortality rate in the 1<sup>st</sup> age subgroup, while in the 2<sup>nd</sup> age subgroup, it had no impact on the incidence of successful weaning from invasive mechanical ventilation and mortality rate.</p> Olha Filyk Copyright (c) 2020 Olha Filyk 2020-09-28 2020-09-28 28 1 E2020311 E2020311 10.21802/gmj.2020.3.11 Primary aggressive chondroblastoma of the tibia <p align="justify">Chondroblastoma is a primary bone tumor in children, adolescents and young adults, which accounts for 1% of all bone tumors. Epiphyseal or epiphysometaphyseal localization, this lesion usually develops from secondary ossification centers close to the knee, shoulder and hip. Although chondroblastoma is a nonaggressive benign tumor, it can very rarely show a locally aggressive character or a malignant transformation or even metastases. We describe a histologically proven case of an aggressive, primary chondroblastoma of the tibia invading soft tissue in a 22-year-old girl.</p> Reda Badaoui Amine Elmaqrout Mohamed Boussaidan Jalal Mekaoui Jalal Boukhriss Bouchaib Chafry Driss Benchaba Mostapha Boussouga Copyright (c) 2020 Reda Badaoui, Amine Elmaqrout, Mohamed Boussaidan, Jalal Mekaoui, Jalal Boukhriss, Bouchaib Chafry, Driss Benchaba, Mostapha Boussouga 2020-06-30 2020-06-30 28 1 E202021 E202021 10.21802/gmj.2020.2.1