Кафедра внутрішніх та професійних хвороб
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Browsing Кафедра внутрішніх та професійних хвороб by Subject "2023а"
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Item Crush syndrome. The amount of assistance at the stages of medical evacuation : methodical instructions for the 5th year students to the practical class(2023-09) Мартовицький, Дмитро Володимирович; Шелест, Борис Олексійович; Садовенко, Ольга Леонідівна; Брек, Валерія Василівна; Прохоренко, Василь Леонтійович; Бабічева, Олександра Олександрівна; Martovytskyi, Dmytro; Shelest, Borys; Sadovenko, O.; Brek, Valeria; Prokhorenko, V.; Babicheva, O.Syndrome of traumatic prolonged rhabdomyolysis, compression (STS, crash syndrome, crushing syndrome, traumatic limb compression syndrome, crushing syndrome, compression syndrome, release syndrome, Bywaters syndrome, myorenal syndrome, myoglobinuric nephrosis, ischemic muscle necrosis, etc.) – the body's reaction to endotoxicosis, which develops as a result of ischemic damage to tissues as a result of their mechanical compression, a severe pathological condition that occurs as a result of closed damage to significant areas of soft tissues under the influence of a large and long-lasting mechanical force; which is accompanied by a complex of specific pathological disorders: shock, heart rhythm disorders, acute kidney damage. The syndrome of prolonged tissue compression is a critical condition that has not yet been sufficiently studied, especially if the release of the compressed limbs is delayed. Obvious scenarios are accidents in mines, tunnels, traffic accidents, accidents, earthquakes and building collapses, terrorist acts. In each of these scenarios, the release can take a long time, usually due to technical issues.Item Emergencies. Providing therapeutic care in life-threatening conditions at the stages of medical evacuation : methodical instructions for the 5th year students to the practical class(2023-09) Мартовицький, Дмитро Володимирович; Шелест, Борис Олексійович; Садовенко, Ольга Леонідівна; Брек, Валерія Василівна; Прохоренко, Василь Леонтійович; Бабічева, Олександра Олександрівна; Martovytskyi, Dmytro; Shelest, Borys; Sadovenko, O.; Brek, Valeria; Prokhorenko, V.; Babicheva, O.Providing emergency aid on the battlefield is the main guarantee of saving the life of the wounded. The analysis of the causes of the death of servicemen during hostilities shows that a significant part of them could be saved if timely and high-quality first aid was provided. This number ranges from 9 to 25 % (wars in Iraq and Afghanistan). The main causes of death of 80–90 % of such wounded were massive blood loss and shock. At the same time, the localization of wounds in 48 % of cases – in the trunk, in 31 % – in the upper and lower limbs, in 21 % – in the neck or groin areas, where the main blood vessels are located. The scope of providing medical aid on the battlefield depends on the tactical situation, the nature of the injuries received, the level of theoretical knowledge and practical skills of the person who first comes into contact with the wounded, and the medical equipment and medical supplies available to him. The development of the system of providing medical care in the armed forces of NATO countries led to a gradual change in the approach to the treatment of the wounded on the battlefield and created the prerequisites for the emergence of the concept of Tactical Combat Casualty Care.Item Exercise-induced desaturation as an independent predictor of the occupational chronic obstructive pulmonary disease course in combination with hypertension(2023-05) Melenevych, Anastasiia; Kapustnik, Valeriy; Shelest, BorysWe found a significantly greater drop in the level of oxygen saturation (SpO2) during the 6-minute walk test (6MWT) in comorbid pathology compared to isolated COPD 62 (4,14±1,44 % vs. 3,39±1,31 %, p<0,05). Exercise-induced desaturation (EID), a 4 % drop in SpO2 during the 6MWT from the initial value, occurred significantly more often in comorbid pathology – in 56,5 % of patients, compared to 48,4 % in the isolated COPD group. In comorbid patients with EID, a significant (p<0,001) increase in pro-inflammatory interleukin (IL)-18 (3296,24 (2356,03; 3978,92) pg/ml vs. 2256,30 (1980,88; 2738,86) was found) pg/ml) and a decrease in anti-inflammatory IL-10 (61,12 (48,34; 79,63) pg/ml vs. 106,35 (89,45; 126,97) pg/ml) compared to patients without EID, which indicates a greater imbalance in the formation of the inflammatory response. EID in patients of the main group was associated with an increase in the right ventricular (RV) wall thickness (5,58±0,57 mm vs. 5,22±0,61, p<0,05), growth of the right atrium diameter (39,79±2,27 mm vs. 35,83±5,02 mm, p<0.05) and a decrease in the RV diameter (27,10±2,22 mm vs. 28,37±2,40 mm, p<0.05) in comparison with comorbid patients without EID. Patients with chronic obstructive pulmonary disease (COPD) and , hypertension (HT) with EID have more pronounced signs of RV pressure overload. Receiver-operating characteristic (ROC) analysis revealed the prognostic significance (p<0,001) of IL-18 level more than 3063,7 pg/ml (with a sensitivity of 61,5 % and a specificity of 90 %, area under the ROC curve (AUC) – 0,736) and the IL-18/IL-10 ratio value more than 39,9 (with a sensitivity of 76,9 % and a specificity of 83,3 %, AUC – 0,791) for EID in COPD patients combined with HT.Item Gender differences in exercise capacity and left ventricular geometry among patients with comorbid pathology – hypertension with chronic obstructive pulmonary disease(2023-09) Melenevych, AnastasiiaHypertension (HT) and chronic obstructive pulmonary disease (COPD) are one of the most common comorbid pathologies associated with the risk of cardiovascular events. As long as the ejection fraction (EF) remains preserved, it is quite challenging to establish signs of heart failure. Dyspnea and exercise intolerance in COPD can mask reduced heart function, especially in hypertensive patients. Our aim was to assess gender differences in exercise capacity using 6-min walk test (6MWT) and left ventricular (LV) geometry among patients with HT and COPD. We found that dyspnea level before and after the 6MWT, drop in SpO2 during the 6MWT as well as the distance walked in the 6MWT showed no significant (p > 0,05) gender differences. LV systolic function was preserved in all patients (EF > 55 %). LV diastolic function echocardiographic parameters didn’t show significant differences between men and women. At the same time, we found that all women had unfavorable types of LV geometry (concentric and eccentric hypertrophy), concentric hypertrophy was predominated. All four types of LV geometry were found among men. Thus, despite the lack of differences in clinical and functional data by gender, the predominance of LV concentric hypertrophy in women was reliably established among the patients with HT and COPD.Item Impact of right ventricular diastolic function on exercise tolerance in patients with chronic obstructive pulmonary disease and hypertension(2023-07) Melenevych, AnastasiiaWe evaluated the impact of right ventricular (RV) diastolic function on exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) and hypertension (HT). Analysis of RV diastolic function showed reduced early RV filling (p<0.05) and the ratio between early RV filling (E-wave) and late RV filling (A-wave) (E/A ratio) (p=0.007), elevated E-wave deceleration time (p<0.05) and isovolumic relaxation time (p<0.05) in the COPD with HT compared to the isolated COPD patients. It indicates a more pronounced relaxation disturbances and increased RV stiffness in patients with COPD combined with HT. We found RV diastolic dysfunction in the majority of comorbid patients – 78,2%, impaired relaxation (Grade I) was the predominant grade (50.7%), pseudo-normalized (Grade II) diastolic function was determined in 27,5%. In the isolated COPD group, normal diastolic function predominated (58.1%), pseudo-normalized - was less common (12,9%). Restricted (Grade III) RV diastolic dysfunction was not registered in our patients. Among patients with COPD and hypertension significant differences (p<0.05) were found in exercise tolerance parameters between patients with normal RV diastolic function (n=15) and RV diastolic dysfunction (n=54): the 6-min walk distance - 393.2±14.61 m vs. 380.69±13.85 m; exercise-induced dyspnea (Borg scale) - 3.4±0.63 vs. 3.98±1.0; exercise-induced oxygen desaturation - 3.4±1.3 vs. 4.35±1.42%. In the isolated COPD group reliable distinctions (p<0.05) were found in exercise tolerance parameters between patients with normal RV diastolic function (n=18) and RV diastolic dysfunction (n=13): the 6-min walk distance - 402.06±17.75 m vs. 386.85±17.6 m; exercise-induced dyspnea (Borg scale) -3.22±0.65 vs. 3.92±0.95. There was no significant difference in exercise-induced oxygen desaturation between COPD patients with normal RV diastolic function and RV diastolic dysfunction. Thus, RV diastolic dysfunction contributes to exercise intolerance and exercise-induced oxygen desaturation in patients with COPD and HT.Item A modern view on hyperkalemia’s management(2023-10) Melenevych, Anastasiia; Dwivedi, AnanyaThe study demonstrated that sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) have dominated the management of hyperkalemia over 6 decades after being approved by the United States Food and Drug Administration (FDA) in 1958 because of their long term effi cacy but due to their affi liation with gastrointestinal side effects their usage has been insubstantial or limited. Earlier SPS was thought to work effectively for constipation along with sorbitol but later FDA found it to be causing colonic necrosis and increased mortality. CPS was useful in patients with high sodium load but there were cases with increased vascular calcifi cation. So, eventually in 2009, the FDA prohibited their long-term use for hyperkalemia. The shortcomings led to the development of “new generation” potassium binders including - patiromer and sodium-zirconium cyclosilicate (SZC / ZS-9). In clinical studies patiromer was found to be well tolerated and reduced hyperkalemia in patients with diabetes mellitus, chronic kidney disease, heart failure, hypertension to enhance cardiovascular and renal outcomes and also in patients on renin-angiotensin-aldosterone system inhibitors (RAASi) therapy. Cochrane reviews were conducted three times (2005, 2015, and 2020) for comparison of “old generation” potassium binders with the new generation” potassium binders however, from the point of view of safety, preference was given to the “new generation” potassium binders.Item Which patient characteristics are associated with exerciseinduced desaturation in COPD combined with hypertension?(2023-10) Melenevych, AnastasiiaWe analyzed associations between various patient characteristics and exercise-induced desaturation in chronic obstructive pulmonary disease (COPD) combined with hypertension. We found that the male sex, dyspnea, fatigue, the distance walked in the 6-min walk test, BODE index, quality of life (assessed using a Clinical COPD Questionnaire) are associated with exercise-induced desaturation in patients with COPD combined with hypertension stage II.