ISSN 2409-9988 2016 N4(3) INTER COLLEGАS 2016 Vol. 3 No.4 OFFICIAL JOURNAL OF KHARKIV NATIONAL MEDICAL UNIVERSITY ISSN 2409-9988 EDITOR-IN-CHIEF: Vladimir Lesovoy, MD, PhD, professor, rector of KNMU EDITORIAL BOARD: Tetiana Ashcheulova, MD, PhD, professor, KNMU Valeriy Boyko, MD, PhD, professor, KNMU Olga Kovalyova, MD, PhD, professor, FESC, KNMU Volodymyr Korostiy, MD, PhD, professor, KNMU Vitalii Makarov, MD, PhD, professor, KNMU Olena Riga, MD, PhD, professor, KNMU Evhen Ryabokon, MD, PhD, professor, KNMU Igor Taraban, MD, PhD, professor, KNMU Iryna Tuchkina, MD, PhD, professor, KNMU Tetyana Chumachenko, MD, PhD, professor, KNMU Igor Zavgorodnii, MD, PhD, professor, KNMU Gulya Alimbayeva, MD, PhD, Associate professor, Kazakh National Medical University, Almaty, Kazakhstan Irina Böckelmann, MD, PhD, professor, Otto-von-Guericke-Universität, Magdeburg, Deutschland Ala Curteanu, MD, PhD, Associate professor, Mother And Child Institute, Chisinau, Moldova Igor Huk, MD, PhD, professor Vienna General Hospital, University Medical School, Vienna, Austria Birgitta Lytsy, MD, PhD, Uppsala University, Sweden Ed Maes, MD, PhD, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Gayane G. Melik-Andreasyan, MD, PhD, professor, Director of Research Institute of Epidemiology, Virology and Medical Parasitology after A.B.Alexanian, Yerevan, Armenia Branislav Milovanovic, MD, PhD, professor, University Hospital Bezanijska Kosa, Belgrade, Serbia Peter Nilsson, MD, PhD, professor, Lund University, Malmo, Sweden. Elmars Rancans, MD, PhD, professor, Riga Stradins University, Latvia Adam Rzechonek, MD, PhD, Associate professor, Wroclaw Medical University, Poland Milko Sirakov, MD, PhD, professor, President of European Association of Paediatric and Adolescent Gynaecology, Bulgary Arunas Valiulis, MD, PhD, professor, Clinic of Children's Diseases and Institute of Public Health, Vilnius University Medical Faculty, Vilnius, Lithuania DEPUTY EDITOR: Valeriy Myasoedov, MD, PhD, professor, vice-rector of KNMU ASSOCIATE EDITORS: Vitaliy Gargin, MD, PhD, professor, KNMU Volodimir Korobchanskiy, MD, PhD, professor, KNMU EXECUTIVE SECRETARY: Tetyana Chaychenko, MD, PhD, associate professor, KNMU Recommended for publishing by Scientific Council of Kharkiv National Medical University 22 - December - 2016 Correspondence address: 61022, Kharkiv, Nauki Avenue, 4 e-mail: collegas@ukr.net URL: http://inter.knmu.edu.ua/pub Periodicity: 4 times a year © Inter Collegas, 2016 mailto:collegas@ukr.net INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 152 ~ ISSN 2409-9988 Table of Contents HISTORY OF MEDICINE “WHITE RUSSIAN” DOCTORS IN CYPRUS: THE FATE OF SIX GRADUATES OF IMPERIAL KHARKOV UNIVERSITY (PART 2) PDF Ağayev E., Rusanov C. 154-162 CARDIAC SURGERY THE RESULTS OF SURGICAL REVASCULARIZATION IN PATIENTS WITH MULTI-VESSEL CORONARY DISEASE PDF Obeid M.A., Abdurakhmanov A.A., Mashrapov O.A., Ganiyev U.Sh. 163-165 PEDIATRICS CLINICAL CHARACTERISTICS OF CYSTIC FIBROSIS IN CHILDREN IN KHARKIV REGION PDF Klimenko V. A., Yanovskaya Y. A., Pasichnik Y. V. 166-169 EXERCISE TOLERANCE IN NORMAL WEIGHT, UN-DERWEIGHT, OVERWEIGHT AND OBESE ADOLESCENTS PDF Chaychenko T., Rybka O., Buginskaya N. 170-173 PSYCHOLOGICAL STATUS OF CHILDREN WITH DIFFERENT SOMATIC ABNORMALITIES AS A PREDICTOR OF CARDIOVAS- CULAR RISK PDF Gonchar M.O., Senatorova G.S., Chaychenko T.V., Muratov G.R., Tsura O.N., Chernenko L.N., Dril I.S., Rybka O.S., Omelchenko O.V. Telnova L.G., Bashkirova N.V. 174-179 NEUROLOGY COGNITIVE AND AFFECTIVE IMPAIRMENTS IN PATIENTS WITH TEMPORAL LOBE EPILEPSY PDF Sofilkanych N.V. 180-184 CEREBRAL HEMODYNAMICS AND CEREBROVASCU-LAR REACTIVITY IN PATIENTS WITH VERTEBRO-GENIC CERVI- COCRANIALGIA PDF Kalashnikov V.I. 185-189 http://inter.knmu.edu.ua/pub/article/view/46 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/46 http://inter.knmu.edu.ua/pub/article/viewFile/46/45 http://inter.knmu.edu.ua/pub/article/view/46 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/46 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/46 http://inter.knmu.edu.ua/pub/article/view/46 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 153 ~ ISSN 2409-9988 PSYCHIATRICS PSYCHOTHERAPEUTIC CORRECTION SYSTEM OF SOMATOGENIC DEPRESSIVE DISORDERS IN PATIENTS WITH CERE- BRAL STROKE PDF Mykhaylov V., Kozhyna H., Zdesenko I. 190-196 COMPLEX APPROACH TO REHABILITATION OF WOMEN WITH PARANOID SCHIZOPHRENIA PDF Korovina L. D., Kryshtal V. Ye. 197-200 PATHOLOGY THE POSSIBILITIES OF MUSEUM STUDYING OF VACTERL SYNDROME PDF Gargin V.V., Kurchanova Yu.V., Ivanteeva Yu.I. 201-205 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 http://inter.knmu.edu.ua/pub/article/view/45 http://inter.knmu.edu.ua/pub/article/viewFile/45/44 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 154 ~ ISSN 2409-9988 HISTORY OF MEDICINE Ağayev Elnur1, Rusanov Constantin2 “WHITE RUSSIAN” DOCTORS IN CYPRUS: THE FATE OF SIX GRADUATES OF IMPERIAL KHARKOV UNIVERSITY (PART 2) 1 European University of Lefke, Faculty of Arts Sciences, Department of History, Cyprus; 2 Independent reseacher, Kharkiv, Ukraine Abstract: The article discusses the fate of physicians who graduated the medical faculty of Kharkov University before 1917 and immigrated to Cyprus in 1920. For three of them the island became the second home. Apart from Pavel Smitten (we described his biography in the first part of the article), physicians Mark Freiman and Boris Vroblevskiy decided to live and work in Cyprus. The former had medical practice there, though in Kharkov he was engaged in real estate and became famous due to excavations of the city catacombs. Vroblevskiy worked in hospitals, supervised by Smitten, and after the death of the latter independently, until 1956. Three of the physicians were unable to find work in Cyprus, and in 1922 the British authority moved them from the refugee camps to Balcans. Sergey Kozentsov served as a surgeon in Kharkov Red Cross hospital for many years. Mkrtych Arevshatiants before immigrating worked in Tiflis City hospital; Alexey Ivanov served as a country doctor in Ukraine. After the departure from Cyprus Kozentsov lived in Dubrovnik, where he died in 1942. There is no information on the fate of the other two doctors who left Cyprus. KeyWords: Alexey Ivanov; Boris Vroblevskiy; Cyprus; graduates of medical faculty; Kharkov University; Mark Freiman; Mkrtych Avevshatiants; physicians; Sergey Kozentsov; White emigration. ——————————�—————————— INTRODUCTION As mentioned in the first part of this article, in May- July 1922, the British authorities forcibly evacuated the vast majority of «White Russian» refugees from Cyprus to the Balkans; also 7 of the 11 doctors were evicted, arrived on the island in the spring of 1920. Just as importantly, 3 out of 4 physicians who were granted permission to stay in Cyprus after 1922 [1] and who worked there for 20-30 years, were graduates of the medical faculty of Kharkov Imperial University. One of three former Kharkovites was Mark Isaakovich Freiman who left Russia on March 8, 1920 aboard the ship “Kherson” and arrived in the Cypriot port of Famasusta on March 22 [2]. He registered his medical dipoma and, after receiving permission, began to work as a doctor [3]. The reports in the press show that in November 1922 M.I.Freiman continued to work in Famagusta [4]. ———————————————— Corresponding Author: Rusanov Constantin, local historian, Kharkiv, Ukraine. E-mail: construsanov@yandex.ru History has preserved almost no other information about the life of Mark Freiman in Cyprus. It is only known that this native of Kharkov continued working on the island as a doctor in 1940 [5]. Although in the early 1930s, his name was not found in the lists of physicians in Cyprus published by the British administration [6] – perhaps Freiman at this time refused to provide medical service or left the island. Thus, we do not know when and where he finished his life journey. Mark Freiman, who was born in Kharkov in 1886, was the son (and heir) of a businessman, well-known in the city. In the official list of University students [7, p. 274] Mark's father is named “a retired Lieutenant of Jewish faith”. But we find a much fuller description in Freiman Senior’s obituary [8]: “Isaac Isidorovich Freiman, an outstanding Kharkov merchant, the Director and Head of Kharkоv offices of Tsintenhof manufactories, as well as of Joint Stock Compa- ny “Leonhardt Welker and Herbardt” died on the night of 24 June, 1912, in province of Livonia” The deceased was mailto:construsanov@yandex.ru INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 155 ~ ISSN 2409-9988 about 58 years old. In Kharkov I.I.Freiman owned three houses at No. 6, Sumskaya Street, on Rymarskaya Street near the Commercial club (former Kirsten house), and at No. 28, Rybnaya Street. Being a Jew, he volunteered in the army in the 1870s, and then was promoted to a Lieutenant and retired. The deceased left a widow, a son and three daughters”. Moreover, Mark's father served with distinction during the Russian-Turkish war of 1877-1878, and he was awarded the rank of an officer. In those days Russian Jews could receive it only in individual cases and by personal permis- sion of the Sovereign. Apart from the buildings, mentioned in the obituary, the Freimans also owned other houses in the city centre; most of them are still preserved today. Mark Freiman continued his education, staying away from the family business. At first he studied in the 3rd Kharkov gymnasium, and in 1904 he entered medical facul- ty of Kharkov Imperial University. During this period M.I.Freiman sometimes took care of patients. As in sum- mer of 1908, when he worked in the surgeon C.A.Isakovich’s “Hospital and Office for electro-, photo- and hydrotherapy” in the city of Vladikavkaz, and in 1909, during typhoid fever epidemic in Kharkov at the faculty of Internal Diseases of the University. The student Freiman was awarded the faculty gold medal for the essay “The value of various methods to determine blood pressure for clinics”. In 1910 he graduated from the university with the title of a specialist in internal medicine and in 1911 M.I.Freiman became a full member of Kharkov Medical Society [9]. The young doctor opened up a University career, but it turned out otherwise. Mark's father, suffering from arterial sclerosis and kidney disease, died suddenly, and the son had to assume the leadership of a newly initiated project, particularly the construction of a multistorey apartment house at No. 23, Rymarskaya Street. In 1914 the building was completed, and since then has embellished the historical center of Kharkov. Some doctors rented there the offices for their medical practice. For instance, Dr. Goldinger’s X-ray room was located there from 1915. Fig.1 “Freiman’s house” “Freiman’s house” as well as the name of its owner re- mained in the history of Kharkov as when laying the under- ground service lines for this luxurious building the produc- tion workers unearthed ancient tunnels. Kharkov fortress which marked the beginning of the city was constructed on this very place in the 17th century [10]. Mark Freiman invited University historians and the finding was examined by a scientific board. City newspapers wrote articles re- garding the finding. So today M.I.Freiman is remembered in Kharkov as a person who unearthed medieval dungeons, not as a medical practitioner. That was why Freiman was listed in medical, urban, as well as in national directories [11, p. 464; 12, p. 501]. However, with the beginning of World War I Mark Isaa- kovich was drafted into the army as a doctor. M.I.Freiman served in the army. The message is preserved, stating that on 29 May, 1915 he arrived to Kharkov from the theater of military action with a large number of wounded soldiers [13]. There is no information on the life of the future White Russian Cypriot in the period of revolutions and Civil War. However, we can confidently say that in the summer of 1919 Mark Freiman was once again drafted into the army, this time in the Armed Forces of South Russia. The retreat of this army brought the doctor onto the board of “Kher- son” ship along with other refugees. INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 156 ~ ISSN 2409-9988 By circumstantial evidence it can be assumed that long before fleeing from the Bolsheviks M.I.Freiman shrewdly sold his estate in Kharkov and transferred the money to one of the Western banks. In any case, in Cyprus he clearly had the money without the need to earn a living. The most significant part of B.M.Vroblevskiy’s life, the youngest of six graduates of the medical faculty in Khar- kov, who arrived to Cyprus in 1920, took place, in contrast to M.I.Freiman, on the “Island of Aphrodite”. As P.N.Smitten (see the first part of this article), B.M.Vroblevskiy is remembered by the inhabitants of the region of Lefke for his health care service and for his prac- tice as a physician at a major U.S. mining company, Cyprus Mines Corporation (CMC). At the same time, only a little is known about his life before immigrating to Cyprus. Boris Mikhailovich Vroblevskiy was born in 1895 in the town of Shchigry, Kursk province, in the Orthodox family of an official. Boris fin- ished the 3rd Kharkov gymnasium and entered medical faculty of Kharkov Imperial University in 1913 [14, p.50]. Memoirs, written in 1945 in Paris [15] by his classmate at Kharkov gymnasium, P.V. Pashkov mention that 38 students graduated from the gymnasium in 1913 and they were “extremely brilliant in their success in sciences and in the number of received awards: 7 gold and 11 silver medals”. In autumn they entered high school, mainly Kharkov Uni- versity, but with the beginning of the World War I most of Pashkov’s classmates, united by a patriotic impulse, volun- tarily went to military schools, although they had an ex- emption from military service until the end of the Universi- ty course. Four of them, including Boris Vroblevskiy, be- came military doctors: “In spring of 1917 these four doctors graduated from the accelerated 4-years (instead of 5) course at medical faculty of Kharkov Imperial University with the rank of “zauryad vrach”. All four doctors served in the Black Sea Navy: Boris Vroblevskiy (senior physician at the battleship “Rostislav”, then the head of the medical regiment of the Don army during the Civil War), Vladimir Mal’tsev (at the battleship “Three hierarchs”), Egon Yatsunskiy (died in 1919) and Mikhail Popov (then in the civil service in Yugo- slavia)”. The fact that in autumn of 1917 Boris Vroblevskiy served as a doctor (however, as a junior one) on the above- mentioned ship, is testified by the literary sources [16]. Unfortunately, the evidence on B.M.Vroblevskiy’s supervi- sion of the medical service of the Don army (Armed Forces of South Russia) has not yet been found. But we know that the Civil War forever separated Boris Vroblevskiy and his older brother, also a doctor. Petr Mi- khailovich Vroblevskiy (born in 1885) graduated from medi- cal faculty of the same University in 1911, specializing in skin and venereal disease. Then he worked at Kharkov University under the guidance of Professor N.S.Bokarius. Having stayed in the country under the Bolsheviks, P.M.Vroblevskiy became a quite famous forensic doctor, authoring several publications in this field that are still referenced today. Petr Mikhailovich worked in Kharkov until at least 1935. The life of his younger brother turned out in a different way. Having arrived to Cyprus in spring of 1920, the immi- grant Vroblevskiy registered his medical diploma of Khar- kov Imperial University and started to work as a general practitioner [3]. There is information in a newspaper that in 1922 he worked in Margo village [4]. When in the early 1920s, P.N.Smitten was granted per- mission to open his own hospital in Nicosia (see the first part of this article), B.M.Vroblevskiy began working in this private healthcare institution [17, p.252]. Later, also under the charge of Smitten, B.M.Vroblevskiy served from 1932 in the CMC hospital in Pendayia. At first the head of hospital instructed Boris to conduct rehabilitation services for the employees of the company. But then B.M.Vroblevskiy became a full-fledged Smitten’s assistant in the field of obstetrics and gynecolo- gy. Boris Mikhailovich continued to work at the Pendaiya hospital after Smitten’s death in the 1940s and 1950s [18]. INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 157 ~ ISSN 2409-9988 Fig.2 Medical records of Dr. B.M.Vroblevskiy At the same time B.M.Vroblevskiy kept a private hospi- tal in Lefke. He rented a place in a building, built in the style of Ottoman architecture, which is now called “the House of the Pharmacist, Mr. Kemal”. A pharmacist’s son Kemal Bey, Mr. Feridun Kemal Feridun, reported the follow- ing (F.K.Feridun was born on 30.06.1952, living in Yedidal- ga. These information was quoted from an interview con- ducted on 09.04.2015.- E.A.): “My aunt, a pharmacist Mustafa Effendi’s daughter and Mrs. Ülfet, Beria Hami and uncle beha Hami constructed a house in Lefke. However, they could not live in this house since they took a loan from the bank and had to pay their debt. Dr. Vroblevksiy, a White Russian living in Lefke, work- ing in CMC and owning a private clinic, saw and liked the house and offered a rent that was not possible to refuse. The house had all the things that he asked for; the ground floor of the house had a big room for his clinic with the toilet and bathroom inside of the house as he wanted, as all the houses built in Lefke until that time had toilet and bathroom outside. Vroblevskiy found everything that he asked for in the building and rented the house for 10 liras and started to use it as a clinic”. Following the opening of his private hospital in Lefke, Vroblevskiy made good relations with the public, examined the residents and became the guardian of their wellbeing. Most probably because of such positive manners, he still had the same positive image. Harid Fedai, a Cypriot re- searcher and writer, who was examined by Vroblevskiy when he was a child, recalled the Russian doctor in Lefke as “his doctor Vroblevskiy” (Harid Fedai, born in 1930, from Lefke, living in Nicosia. This information was quoted from an interview conducted on 13.10.2012, and his letter sent to us on 17.02.2013.- E.A.): Fig.3 Dr. B.M.Vroblevskiy’s private hospital “In the beginning of 1920s, in 1930s and 1940s, there was a doctor Vroblevksiy, a White Russian, working in the hospital owned by the CMC located in Pendayia (now known as Cengiz Topel Hospital). Apart from his duty at this hospital, he had a clinic, where my mother took us whenever we would fall ill. The doctor was a middle-height, medium build, and good-humoured person. There was a phrase that he always repeated, “yes orayıd, kam burayıt, tam turayıt”. When- ever he would welcome the patients, he was using this phrase. Of course, as a child, I could not understand the meaning, and we did not ask him. Then I thought that it might be something ironic. We saw him drinking from his flask at every visit as he repeated, “yes orayıd, kam burayıt, tam turayıt”. He was squeezing something into his tea, which then I learnt that it was a lime. I then had the same tree in my garden in Lefke and had my tea as he did. Dr. Vroblevskiy learnt to speak Greek. He was talking INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 158 ~ ISSN 2409-9988 one by one. He was inserting a couple of Turkish words in between. He was smiling and humorous. He was always wearing his glasses above his nose”. One of Vroblevskiy’s significant contributions to the health care service in Lefke region was to encourage the residents to give birth in Pendayia hospital. He provided better conditions and facilities in the hospital, making the process of labor safer for women, and his initiatives paid back [19]: “Recently Dr. Vroblevskiy told us that 217 children were born in Pendayia hospital in 1951. This was the biggest number in the history of the hospital. Before the war, peo- ple were opposed to giving birth in hospitals, with the biggest number of birth of only 4 children born in hospital in 1927. The doctor indicated that since the women were informed about the benefits of giving birth in hospital, the number increased”. Dr. Vroblevskiy finally stated: “Since the hospital had all the required facilities, the wives of Cyprus Mines Corpo- ration workers understood that the hospital was the safest place to give birth”. Vroblevskiy resigned from the Pendayia hospital in 1953, after working for 20 years [20]. Then CMC newspaper announced about his intention to leave Cyprus: “Doctor Vroblevskiy is leaving Cyprus. He worked as a doctor in Cyprus since 1920 and he worked for the hospital owned by the mines corporation. Many of his friends are upset by the news and wish him good luck”. However, Vroblevskiy continued to work in Cyprus as a doctor also after the dismissal by the mining company, at least till 1956 [21]. We have not yet found any data regarding the subse- quent years of Vroblevskiy’s life. According to the infor- mation given by Behich Hasan (Behich Hasan was born in 1946, living in Doğancı. This information was quoted from an interview conducted on 15.02.2015.- E.A.), Vroblevskiy was married to a British lady and lived in Karaman (former name Karmi), Kyrenia, where British people lived until 1980s. He died in those years and was buried in the UK. Three graduates of medical faculty of Kharkov Imperial University went from Cyprus to the Balkans in 1922. These doctors were not able to find work in their fields on the island. Or they probably did not want to spend the rest of their life among the non-Slavic population of Cyprus. In this sense, Serbia and Bulgaria were closer to former Khar- kovites with their languages similar to Russian. We were able to track the life path of one of them from the beginning to end. In his autobiography, written in 1906, Sergey Niko- laevich Kozentsov reported [22] that he was born on 9 February, 1881 in the city of Vasil’kov, Kiev province, in the Orthodox family. In 1899 after finishing a gymnasium in Elizavetgrad, Kherson province, S.N.Kozentsov entered medical faculty in Kharkov, graduating in May 1904 as a physician. After the graduation he began to work as an assistant in the surgical hospital of Kharkov branch of the All-Russian Red Cross Society. During the Russian-Japanese war of 1904-1905 Kozentsov, as well as Smitten (see the first part of our article), voluntarily went to the Far East. After returning to Kharkov in October 1905, he resumed his work at the same place. In 1906 S.N.Kozentsov joined Kharkov Medical Society and worked as a junior resident in Kharkov surgical hospital of the Red Cross till the revolu- tions of 1917 [12, p. 226; 23, p. 194]. Kozentsov was recommended to become a member of Kharkov Medical Society by M.I.Selikhov, the head doctor of Kharkov Red Cross Society, who also supervised the inpa- tient hospital of the Society from 1904. The surgical clinic with 9 wards, provided with water, gas and electricity was from 1898 located in a two-storey building on the corner of Vozneseniya (Ascension) Square and the homonymous street. The best Kharkov surgeons worked in the Red Cross hospital, sharing experience and skills with S.N.Kozentsov. INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 159 ~ ISSN 2409-9988 Fig.4 The building of Kharkov Red Cross hospital (up to 1912). In 1914 Kharkov Red Cross hospital moved to a new, much more spacious and well equipped building, located at the same place (at present it serves as Southern Railway hospital). Soon afterwards the World War I began. S.N.Kozentsov worked in Kharkov Red Cross hospital up to 1917; then the revolutions forever separated the doctor with his beloved place of work. Fig.5 The new building of Kharkov Red Cross hospi- tal, which was erected to 1914 (at the same place). S.N.Kozentsov suddenly became a senior doctor on a warship of the Black Sea Navy. His name appears at num- ber 24 on the list of officers of the battleship “Rostislav”, standing in 1917 at Odessa Harbor [16, 24]. We do not know where Kosentsov was during the Civil War. Probably he took the side of the White movement. And when in early 1920 it suffered defeat, the former doc- tor of Kharkov Red Cross was forced to emigrate. Most likely, he arrived in Cyprus on 22 March, 1920 on the ship “Kherson”, which was called the hospital ship [25, p. 1]. It is definitely known that in 1920 S.N.Kozentsov, as the other doctors-immigrants, registered his medical di- ploma in Famagusta [26] and had an opportunity to work in his field. It is entirely possibly that for some time he worked in Nicosia hospitals, under the guidance of another former Kharkovite, P.N.Smitten (see the first part of the article). However, apparently, Cyprus and the British administration were unsuited to Kozentsov, and in 1922 he left the island, preferring life in Dubrovnik, soon-to-be Yugoslavia. According to literary sources [27], S.N. Kozentsov “set- tled well” in this seaside town, as well as other “educated INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 160 ~ ISSN 2409-9988 and resourceful Russian people”. Engaged in medical prac- tice, he lived in exile more than 20 years. The doctor died during the World War II, surviving his wife Maria Mikhailov- na for a year. The couple was buried at the Orthodox cem- etery Boninovo in Dubrovnik. As for two other doctors, who studied in Kharkov, it is possible to tell with confidence only that in spring of 1920 they came by sea to Cyprus, and in autumn of 1922 they no longer lived on the island. M.Arevshatyants was one of them, having registered in Famagusta his diploma of Kharkov Imperial University and received permission to medical practice [3]. However, no information about his work as a doctor in Cyprus has been preserved. Only a little is known about his life before emi- grating from Russia. Mkrtych Arutyunovich Arevshatyants was born in 1884 in Armenian-Gregorian family in the city of New Bayazet (now Gavar) in Yerevan province. He fin- ished a gymnasium in Baku and entered medical faculty in Kharkov in 1906 [7, p.10]. M.A.Arevshatyants graduated from Kharkov Imperial University in 1912, and moved to the Transcaucasia, where he worked until the beginning of the war and revolutions. There is evidence that he served as a senior doctor of the city hospital in Tiflis (now Tbilisi) [12, p. 16; 28, p. 16]. We can assume that M.A.Arevshatyants served as a mili- tary doctor during World War I on the Caucasian front. However, it is clear that the Civil War forever severed Arevshatyants from his native Armenia, though the Bolshe- viks came there later than to the North Caucasus and the Crimea. Anyway, M.A.Arevshatyants did not stay long in Cyprus and spent the subsequent years in Yugoslavia, Bul- garia, or the Middle East, where the Armenian Diaspora has always held key positions. As for Alexey Ivanov, another graduate from medical faculty, Cypriot sources have not preserved more infor- mation than on Arevshatyants. And even less, because the note on registration of Ivanov’s medical diploma in Fama- gusta in 1920 did not specify the patronymic (middle) name of the Russian immigrant [26]. The surname “Ivanov” is very common in Russia. In the 1910s there were at least 10 doctors, called Alexey Ivanov with different middle names. It fell out that two of them graduated from Kharkov gymnasiums and entered Kharkov Imperial University in the same year, where both studied at the medical faculty [7, p.98]. One of them had the patronymic Georgievich and was born in the town of Slavyansk in 1883, in a noble family. Other one, Alexei Mikhailovich Ivanov, was born in 1884 in Kharkov, in the family of a Colonel. They both graduated from the University in 1910 and became rural (“zemskiy”) doctors [29, p. 167]: A.G.Ivanov worked in the village Zhyrkovka of Konstantinograd County (“uyezd”), Poltava province; A.M.Ivanov served in the settlement Shandrygal- ovo of Izyum “uyezd”, Kharkov province. With the beginning of the World War I, Alexei Mikhailo- vich Ivanov stayed in the same place of Kharkov province. Alexey Georgievich Ivanov moved to Gomel [12, p. 187], closer to the frontline (apparently, he was drafted into the Russian Imperial Army). As concerns the subsequent years of the two doctors with the name Alexey Ivanov, we can only say that they both no longer worked in the homeland under the Soviets, and that the path of one of them ran through Cyprus into exile and then to the Balkans. But who of them, Alexey Mikhailovich or Alexey Georgievich, we hardly know. At the best case, another former Kharkovite was also able to flee the Bolsheviks. At the worst, he was killed in the war, died of typhoid fever, was repressed by the Sovi- ets. But anyway the final point of his life remains un- known. In some respects the fate of the “bifurcated” doctor Alexey Ivanov is symbolic for dozens (maybe even hun- dreds) of students, graduates, professors and assistants of the medical faculty of the former Kharkov Imperial Univer- sity and for thousands of doctors of the former Russian Empire. CONCLUSIONS. White Russians, who were defeated in the Civil War in Russia, were forced to leave their homeland for fear of repressions, and settled in different countries of the world. One of these countries was Cyprus: in March-April INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 161 ~ ISSN 2409-9988 1920, the island took 1500-2000 refugees, soldiers and civilians, wounded and sick, women and children. Among them were officials and businessmen, doctors and priests, Christians and Muslims. All of them had no place in Bolshe- vik Russia. They lived in Cyprus, trying to rebuild their lives, until in 1922 the British authorities had evicted the Russian refugees to Bulgaria and Yugoslavia. Among the White Russians, who arrived to Cyprus, were a lot of doctors and nurses. We identified the names of 11 doctors, 6 of whom graduated from the medical faculty of Kharkov Imperial University, namely Pavel Smitten, Sergey Kozentsov, Alexey Ivanov, Mkrtich Arevshatyants, Mark Freiman and Boris Vroblevskiy. Doctors assisted their compatriots in the refugee camp, registered their diplomas in Cyprus, received permissions to medical practice, and treated the local residents until July 1922, when the White Russians were evicted to Bal- kans, including 7 of the 11 doctors. However, three former Kharkovites stayed on the island and for many years continued to treat its residents: Smit- ten (who left an outstanding mark in history), Vroblevskiy and Freiman. Today Cypriot community continues to remember these doctors with gratitude. The Cypriots have not forgotten the assistance provided to the local population by the graduates of Kharkov Imperial University. On the other hand, it is necessary to emphasize the fact that the students who graduated medical faculty in 1900-1917 received thorough training and skills (and some solid practical experience) in Kharkov. This allowed them, having left their homeland, not to be lost in the most diffi- cult conditions of life and to bring benefit to other people, even being in a foreign land. REFERENCES 1. The Cyprus Gazette (1923). №1561, 19 January, 25. 2. Volkov, S.V. (2014). Uchastniki Belogo dvizhenija v Rossii. Vtoraja baza dannyh. Alfavitnyj ukazatel', bukva F. 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Southern Region. June 26]. 9. Curriculum vitae M.I.Frejmana (1911). Protokol №9 zasedanija Har'kovskogo meditsinskogo obshhestva ot 12 marta 1911 g. // Har'kovskiy meditsnskiy zhurnal.- XI, 3, 52 [Curriculum vitae of M.I.Freiman (1911). Protocol №9 of the meeting of the Kharkov medical society of March 12, 1911 // Kharkov Medical Journal.- XI, 3, 52]. 10. Kovalev, A.G. (2015). Podzemnie sooruzhenie po ul. Rymarskoi. Istochnik – Internet resurs xt.ht›xtarticle…Podzemnoe-sooruzhenie-po…Rymarskoi. [Kovalev, A.G. (2015) Underground construction at Rymarskaya Str. Retrieved from xt.ht›xtarticle…Podzemnoe-sooruzhenie-po…Rymarskoi]; Kislyuk, K.V. (2015) Podzemnyi Har'kov i ego okrestnosti. Istochnik – Internet resurs podzemliu.kh.ua›article/kisliuk- podz-kharkov. [Kislyuk, K.V. (2015) Underground Kharkiv and its surroundings. Retrieved from podzemliu.kh.ua›article/kisliuk-podz-kharkov]. 11. Rossyjskyj meditsinskiy spisok na 1913 g. (1913). 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Parizh: Voenno-istoricheskaja biblioteka «Voennoy byli». 102. 15. [Pashkov, P.V. (1970) Memories of cadet of Alexeev’s Military school. June 1 – October 1, 1915.- Paris: Military- historical library «Military True Stories». 102. 15]. 16. Mel'nikov, R.M. (2006). Eskadrennyi bronenosets «Rostislav» (1893-1920). Sankt-Peterburg: Izdatel’ M.A.Leonov. 68 s. [Mel’nikov, R.M. (2006). Squadron battleship «Rostislav» (1893-1920). Saint-Petersburg: Published by M.A.Leonov. 68 p.]. 17. Lavender, D.S. (1962). The Story of the Cyprus Mines Corporation. San Marino, California: Huntington Library. 387 p. 18. The Cyprus Gazette (1947). №3288, 6 February, 57; (1950). №3479, 26 January, 82; (1951). №3540, 24 January, 27; (1952). №3600, 23 January, 46; (1953). №3669, 28 January, 35. 19. Hastahane Doğumları Çok Artmıştır [Hospital Births Significantly Increased] (1952). CMC Welfare News. 1 (2, 10 January). 1. 20. Şirketin Hastahanesi ve Tıbbiye Dairesi [Hospital and Medical Department of Company]; Doctor Vroblevski İşden Çekiliyor [Doctor Vroblevski Leaving Business] (1953). CMC Welfare News. 1 (2, 10 January). 1, 4]. 21. The Cyprus Gazette (1954). №3730, 28 January, 37; (1955). №3805, 27 January, 33. 22. Curriculum vitae S.N.Kozentsova (1906) // Protokol nauchnogo i chrezvychajnogo zasedaniya Har'kovskogo meditsinskogo obshhestva ot 13-go maya 1906 goda. Har'- kov, 58. [Curriculum vitae of S.N.Kozentsov (1906). Protocol of scientific and emergency meeting of the Kharkov Medical Society on May 13, 1906. Kharkov, 58]. 23. Rossiyskiy meditsinskiy spisok na 1909 g. (1909). S.- Peterburg: Upravlenie Glavnogo vrachebnogo inspektora Ministerstva vnutrennih del. [Russian medical list on 1909. (1909). St. Petersburg: Office of the Chief medical inspector of the Ministry of Internal Affairs]. 24. Klassnye meditsinskie chiny Chernomorskogo flota (2007). Istochnik - Internet-resurs wap.kortic.borda.ru/?1- 17-90-00000022-000-0-0. [Top-level medical officials of the Black Sea Navy (2007). Retrieved from wap.kortic.borda.ru/?1-17-90-00000022-000-0-0]. 25. Doklad o polozhenii russkih bezhentsev, poselennyh na o. Kipre. Gosudarstvennyj arhiv Rossijskoj Federacii (1917- 1924). Fond P-5924, opis’ 2, edinitsa hraneniya 146. [Report on the conditions of Russian refugees who settled on the island of Cyprus. State Archive of the Russian Federation (1917-1924). Fund P-5924, list 2, the storage unit 146]. 26. The Cyprus Gazette (1920). №1438, 6 August, 314. 27. Bulatova, E.O. (2011). Valentinov den'. Istochnik - Internet-resurs samlib.ru/b/bulatowa_e_o/009valentine_day.shtml. [Bulatova, E.O. (2011). Valentine's day. Retrieved from samlib.ru/b/bulatowa_e_o/009valentine_day.shtml]. 28. Rossiyskiy meditsinskiy spisok na 1914 g. (1914). S.- Peterburg: Upravlenie Glavnogo vrachebnogo inspektora Ministerstva vnutrennih del. [Russian medical list on 1914. (1914). St. Petersburg: Office of the Chief medical inspector of the Ministry of Internal Affairs]. 29. Rossiyskiy meditsinskiy spisok na 1912 g. (1912). S.- Peterburg: Upravlenie Glavnogo vrachebnogo inspektora Ministerstva vnutrennih del. [Russian medical list on 1912. (1912). St. Petersburg: Office of the Chief medical inspector of the Ministry of Internal Affairs]. Received: 17-Sep.– 2016 Accepted: 28-Nov.- 2016 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 163 ~ ISSN 2409-9988 CARDIAC SURGERY OBEID M.A., ABDURAKHMANOV A.A., MASHRAPOV O.A., GANIYEV U.SH. THE RESULTS OF SURGICAL REVASCULARIZATION IN PATIENTS WITH MULTI-VESSEL CORONARY DISEASE Republican Research Center For Emergency Medicine, Tashkent, Uzbekistan Abstract: Multi-vessel coronary artery disease constitutes 30 to 60 % of morbidity of coronary heart disease (CHD). Surgical revascularization in patients with multi-vessel coronary artery disease is still a challenge. To evaluate the immediate results of hospital period: 30-day hospital mortality, postoperative complications and outcomes at 1 year follow-up the retrospective study was performed. We analyzed 90 patients with history of coronary artery disease who underwent coronary artery bypass grafting (CABG) surgery in 2014 by using the method of continuous sampling on the basis of a computer database of cardiac surgery department. It was established, that surgical revascularization in patients with multi-vessel coronary disease can bring complete revascularization, eliminate signs of stenocardia, improve the quality of life and exercise tolerance in most patients in the 30-day period, and in 1 year after surgery. KeyWords: coronary artery disease, coronary artery bypass grafting, postoperative complications and outcomes ——————————�—————————— INTRODUCTION Multi-vessel coronary artery disease, which is charac- terized by the disease of two or more coronary arteries, has recently become increasingly common, and according to various reports constitutes 30 to 60 % of morbidity of coronary heart disease (CHD). Surgical revascularization in patients with multi-vessel coronary artery disease is still a challenge. Although coronary artery bypass grafting (CABG) is the standard surgical revascularization in multi-vessel disease, improved techniques of interventional cardiology and the use of drug-eluting stents helped to increase them in patients with multi-vessel coronary artery disorders. According to several randomized trials percutaneous inter- ventional (PCI) procedures are accompanied by a lower incidence of postoperative and neurological complications. However, the frequency of revascularization after stenting is significantly higher than after CABG during the first year after the intervention. ———————————————— Corresponding Author: Abdusalom Abdurakhmanov, MD, PhD, Republican Research Center For Emergency Medicine, Tashkent, Uzbekistan. E- mail: ab.abdurakhmanov@yandex.com The one of the largest multicenter randomized trial - ARTS trial (Arterial Revascularization Therapy Study), which included 1205 patients, showed that the angina recurrence and the need for repeated revascularization one year after the PCI were observed more frequently than in patients after CABG: the need for repeated revasculari- zation was 3.1% among diabetic patients after surgery, and 22.3% after stenting (p <0.001). In our study we have ana- lyzed the results of direct CABG, including early postopera- tive complications and mortality, as well as outcomes with- in 30 days and one year. 2 PURPOSES, SUBJECTS and METHODS: 2.1 Purpose To evaluate the immediate results of hospital period: 30-day hospital mortality, postoperative complications and outcomes at 1 year follow-up after surgical revascularization in patients with multi-vessel coronary disease. 2.2 Subjects & Methods Our retrospective study involved 90 patients with history of mailto:ab.abdurakhmanov@yandex.com INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 164 ~ ISSN 2409-9988 coronary artery disease who underwent CABG surgery in 2014 at the Republican Research Center for Emergency Medicine. We used the method of continuous sampling on the basis of a computer database of cardiac surgery department. Conflict of interests There is no conflict of interests. 3 RESULTS AND DISCUSSION Data on demographic and clinical characteristics are shown in Table 1. Table 1 Demographic and clinical characteristics of patients Baseline characteristics Abs.value (%) Age 56.04±0.9 Gender: x Male 69 (76.7%) x Female 21 (23.3%) The duration of the disease for over one year 75 (83.3%) Duration of disease less than one year 15 (26.7%) Diabetes 61 (67.8%) Unstable stenocardia 85 (94.4%) Acute myocardial infarction 5 (5.6%) The average age of the patients was 56.04 ± 0. 9 years, among them 23.3 % of women and 76.7 % of men. The duration of the disease less than 1 year was observed in 26.7 % of patients and 83.3 % of patients had disease duration greater than one year. Diabetes mellitus was diagnosed in 67.8% of patients. The majority of patients were diagnosed with unstable stenocardia (94.4%); and 5.6% of patients underwent surgery under emergency indications secondary to acute myocardial infarction. Surgical access in all the cases was provided by a median sternotomy. Shunting index was 3.1. In 8 (8.9 %) cases we used heart-lung machine; the remaining 82 (91.1 %) of patients were operated off-pump (OPCAB). In 39 (43.3 %) cases, the left internal thoracic artery was used for grafting of the left anterior descending artery, and in one patient, the left and right internal thoracic artery were used. Types of interventions are presented in Table 2. Table 2 Types of surgical intervention Characteristics Abs.value (%) Bypass grafting of 2 vessels 17 (18.9%) Bypass grafting of 3 vessels 46 (51.1%) Bypass grafting of 4 vessels 26 (28.9%) Bypass grafting of 5 vessels 1 (1.1%) Operation via cardiopulmonary bypass 8 (8.9%) Operation via OPCAB technology 82 (91.1%) We evaluated the immediate results of hospital period: 30-day hospital mortality, postoperative complications and outcomes at 1 year follow-up. Hospital mortality was 3.3% (3/90). The cause of mortality in all three cases was acute heart failure - 3, due to the initial severity of the disease, all patients underwent surgery with cardiopulmonary bypass. Postoperative complications were observed in 9 (10%) patients. The types of complications are presented in Table 3. Table 3 The types of post-operative complications Complications Abs. value (%) Heart failure 2 (2.2%) Neurological complications (stroke) 1 (1.1%) Postoperative bleeding 2 (2.2%) Wound complications: 4 (4.4%) x Sternal dehiscense 1 (1.1%) x Superficial wound infection 2 (2.2%) x Purulent mediastinitis 1 (1.1%) Among non-fatal complications, prevailing complications associated with post-operative wound infection were ob- served in 4 (4.4%) patients. Postoperative bleeding in the early postoperative period was diagnosed in 2 (2.2%) pa- tients, and only in 1 case resternotomy was necessary to identify the source and achieve hemostasis. Cardiac complications (heart failure requiring long-term inotropes) were observed in 2 (2.2%) cases. In INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 165 ~ ISSN 2409-9988 one case (1.1%) with postmedical history of acute stroke, an operation using heart-lung machine resulted in deterio- ration of clinical signs. The duration of stay in the ICU after surgery was 2.4±0.5. The duration of postoperative period in the clinic was 7.8±0.9 days. During one year follow up there were no cases of angina recurrence. The majority of patients (95.6%) were consid- ered as the first functional class according to Canadian stenocardia classification, the rest (4.4%) were assessed as the second functional class. The patients who underwent surgery were found to have improved exercise tolerance, all patients after surgery were considered the second class of NYHA functional classification and within a year after surgery 83.3% have improved their physical tolerance. 4 CONCLUSIONS Surgical revascularization in patients with multi-vessel coronary disease can bring complete revascularization, eliminate signs of stenocardia, improve the quality of life and exercise tolerance in most patients in the 30-day period, and in 1 year after surgery. REFERENCES 1 Abu-Omar Y., Taggart DP. (2009). The present status of off-pump coronary artery bypass grafting. Eur J Cardiothorac Sur, 36: 312–21. 2 Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T et al. (2011). Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am CollCardiol, 57:538–45. 3 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al. (2011). 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation,124: e652–735. 4 Kim W.S., Lee J., Lee Y.T., Sung K., Yang J.H., Jun T.G. et al. (2008). Total arterial revascularization in triple- vessel disease with off-pump and aortic no-touch technique. Ann ThoracSurg, 86:1861–5. 5 Lev-Ran O., Loberman D., Matsa M., Pevni D., Nesher N., Mohr R. et al. (2004). Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. Ann ThoracSurg, 77:102–7. 6 Park S.J., Kim Y.H., Park D.W., Yun S.C., Ahn J.M., Song H.G. et al. (2011). Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med, 364:1718–27. 7 Puskas J.D., Kilgo P.D., Lattouf O.M., Thourani V.H., Cooper W.A., Vassiliades T.A. et al. (2008). Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann ThoracSurg, 86:1139– 46. 8 Vallely M.P., Potger K., McMillan D., Hemli J.M., Brady P.W., Brereton R.J. et al. (2008). Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery. Heart Lung Circ;17:299–304. Received: 10-Nov. – 2016 Accepted: 20-Dec. - 2016 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 166 ~ ISSN 2409-9988 PEDIATRICS V. A. Klimenko1, Y. A. Yanovskaya1, Y. V. Pasichnik2 CLINICAL CHARACTERISTICS OF CYSTIC FIBROSIS IN CHILDREN IN KHARKIV REGION Kharkiv National Medical University1, Kharkiv Regional Children’s Clinical Hospital No. 1 2, Ukraine Abstract: The article deals with the study of clinical and paraclinic peculiarities of CF (including respiratory tract microbiocenosis) in children in Kharkiv region. The study also involves the assessment of microbiological status correlation in patients with CF and the disease incidence. The study implied examination of 30 children with cystic fibrosis. They underwent clinical, paraclinical (bacteriological examination of sputum and epithelial lining fluid, chest X-ray, CT scan of lungs) examination. Clinical and paraclinic (bacteriological examination of sputum and epithelial lining fluid, chest X-ray, CT scan of lungs) examination was performed. The study showed that CF severity in patients was associated with chronic P. aeruginosa and B. cepacia infection. None of the patients in Kharkiv region was found to have any of pathognomonic respiratory causative microorganisms, such as M. Tuberculosis and non-tuberculous micobacteria, H. influenza, Ralstonia picketi, and P. Aeruginosa infection was not identified which can be the evidence of insufficient laboratory diagnosis. KeyWords: cystiс fibrosis, children, microflora. ——————————�—————————— INTRODUCTION Cystic fibrosis (CF) is one of the most frequent le- thal genetic disorders of autosomal recessive nature. The assumed prevalence of CF in Ukraine is one case per 2.300 of newborns. CF patients’ life expectancy worldwide is 38 years. It is unknown for Ukraine, but the age of the oldest member of Kharkiv CF Association is 35 years [1, 2, 7]. CF develops in mutation of gene, coding the cystic fibrosis transmembrane conductance regulator – CFTR, which is in the sevenths human chromosome. In respiratory CFTR defect results in high bronchial mucous viscosity, mucociliary clearance decrease and development of chron- ic bronchopulmonary infection from the first months of child’s life. Damage of respiratory tract in CF is the main cause of death [3, 4, 5, 8]. ———————————————— Corresponding Author: Viktoriia Klymenko, MD, PhD, Professor, Head of the Depart- ment of Fundamentals of Pediatrics No.2, Kharkiv National Medical University, Ukraine. E-mail: klymenkoviktoriia@gmail.com The basic respiratory tract microflora in CF is Staphylo- coccus aureus (S. aureus) in the initial period, then Hae- mophilus influenza (H. Influenza) and Pseudomonas aeru- ginosa (P. aeruginosa). In recent years, the role of Burkholderia cepacia (B. Cepacia), Nontuberculous myco- bacteria, Stenotrofomonas maltophilia (S. Maltophilia), Alcaligenes xylosoxidans (A. xylosoxidans), Аspergillus sp. and others has increased. CF clinical presentation and prediction are significantly defined by bacterial composition of the respiratory tract. Thus, trials with mice demonstrated that combined infec- tion, induced by P. aeruginosa and B. Cepacia, enhances virulence properties of causative agents and all the ani- mals die within one day. Mutual virulence enhancement of P. aeruginosa and B. cepacia bacteria in vivo provides the possibility of mutual use of the “Quorum sensing” system components by closely related bacteria. There is evidence that over 80% of clinical isolates of B. cepacia are able to form a biofilm and colonize the tissue surface, to form permanent infection reservoirs in hospital environment, and this contributes to bacteria persistence to eradication by phagocytes and elimination in antibiotic therapy. In mailto:klymenkoviktoriia@gmail.com INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 167 ~ ISSN 2409-9988 each country and region, the data on microbial flora and resistance in children with CF are different, and this is related to differences in CF genotype in population, in antibacterial therapy algorithms, drug availability, eco- nomic condition and national peculiarities [6, 9, and 10]. 2 PURPOSES, SUBJECTS and METHODS: 2.1 Purpose 1. To study clinical and paraclinic peculiarities of CF in children (including respiratory tract microbiocenosis) in Kharkiv region. 2. To define correlations of microbiological status in patients with CF with the disease morbidity. 2.2 Subjects & Methods The study involved examination of 30 children with CF at the Pulmonology Department of Regional Children’s Clinical Hospital No. 1. Of them, 23 children (12 boys and 11 girls) with CF underwent complete physical examination in 2014. Clinical and paraclinic (bacteriological examination of sputum and epithelial lining fluid, chest X- ray, CT scan of lungs) examination was performed. In statistical analysis of paraclinic data (bacteriological studies, tomography) for increase of study informative value, we analyzed the findings, received not only in MHCI RCCH No. 1, but the data from records, made in other Kharkiv clinics for the last 5 years. Chronic colonization of P. Aeruginosa was determined in two-fold identification of causative microorganism in bacterial inoculation during 6 months. Statistical data processing was performed using MS Excel and Statgraphics-5 software. The study was conducted in accordance with basic ethic and legal principles of European Convention for the Protection of Vertebrate Animals (Strasbourg, March 18, 1986), EEC Directive for the Protection of Vertebrate Animals (Strasbourg, November 24, 1986), ІСН GСP (2008), GLР (2002) and national regulations. Conflict of interests There is no conflict of interests. 3 RESULTS AND DISCUSSION Prenatal CF diagnosis was made in 2 (8.7± 5.9) % of children, 12 (52.1±10.4) % of children were diagnosed in the first year of life, 10 (43±10.1)% – in preschool period, 1 (4 %) child was diagnosed at early school age. The main clinical CF signs included symptoms of bronchopulmonary and gastrointestinal impairment, as well as nutritional disorders. The following presentation was observed in bronchopulmonary abnormalities: chronic cough with viscous sputum discharge, airways obstruction, radiologic abnormalities in lungs (bronchiectasis, infiltration, pneumosclerosis); nasal polyps, maxillary sinus conditions; drumstick fingers and watch-glass nails symptoms. The group of patients with severe CF included 8 children (4 boys and 4 girls). In the group of patients with severe CF: prenatal diagnosis of the main condition was determined in 1 (12.5±6.7)% child, at the age under 1 year – in 7 (87.5 ± 6.9)% children. The following main clinical signs in the group of patients with the severe disease were observed: chronic pancreatic deficiency – in 8 (100 %) children, diffuse pulmonary fibrosis – 8 (100%), extensive bronchiectasis – 6 (75±15)%, chronic obstructive bronchitis – 5 (62.5±10)%, chronic II stage respiratory insufficiency – 6 (75±15)%, I stage pulmonary hypertension was observed in 5 (62.5±10)% children. The patients were found to have such complications of the main condition as cirrhosis, macronodular type, portal hypertension (1 patient); allergic bronchopulmonary aspergillosis (1 child); extensive subcutaneous emphysema (1 child). The following CF-specific respiratory pathogens were detected in sputum culture in 23 children, who were treated in the Pulmonology Regional Children’s Clinical Hospital No. 1. 23 in 2014: P. aeruginosa – in 13 (56.5 ± 10.3)% of children, in (80.9 ± 8.1)% of cases large colony INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 168 ~ ISSN 2409-9988 growth was observed, with moderate growth in (19.1 ± 8.1)%; S. aureus – in 10 (43.4 ± 10.3)% of patients, B. cepacia in (13 ± 7) % of patients, S. maltrophilia – in 1 (4 %), Acinetobacter – in 1 (4 %), A. xylosoxidans – in 2 (8 %), Candida – in 16 (70 ± 9.5)% of children. More than in 2/3 cases chronic lung infections was induced by association of microorganisms rather than by pure culture, in most cases – by more than three microorganism species. The most frequent association involved combination of P. aeruginosa + S. aureus in (22 ± 8.6)% of patients, and P. аeruginosa + B. cepacia in (13 ± 7)% of patients. Except P. Aeruginosa, 4% of patients were found to have such nonfermentative gram-negative microorganisms as S. maltophilia. In the group of patients with severe conditions chronic P. Aeruginosa colonization was observed in 8 (100 %) children, in 4 (50 ± 17,6)% of them – together with S. aureus, S. maltrophilia (1), Acinetobacter (1), A. xylosoxidans (2), B. cepacia complex – in 3 (37,5 ± 17,1) %. The earliest age of the observed chronic colonization was 6 months. Comparison of microbiological status in patients with moderate and severe CF is presented in Table 1. Table 1. Respiratory microbiological status of patients with moderate and severe cystic fibrosis Causative agents Severity Severe, n=8, n (%) Moderate, n=15, n (%) Pseudomonas aeruginosa 8 (100)* 4 (27 ± 11.4) Pseudomonas aeruginosa resistent 4 (50 ± 17.7)* 0 Staphylococcus aureus 4 (50 ± 17.7) 7 (47 ± 12.9) Stenotrophomonas maltrophilia 1 (13 ± 11.9) 0 Acinetobacter 1 (13 ± 11.9) 0 Alcaligenes xylosoxidans 2 (25 ± 15.3) 0 Bulkholderia cepacia complex 3 (37 ± 17.1)* 0 Note: * - differences in the incidence of causative microorganisms in the groups are statistically significant (р < 0.05). Thus, P. aeruginosa, B. Cepacia were significantly more frequent in the group of patients with severe CF. Determination of these infections in CF patients’ sputum may be the adverse prognostic factor for the disease severity. Multi-drug resistant strains of P. Aeruginosa were observed in the groups of patients with severe CF in 50% and significantly more frequent, than in the group of children with moderate severity. Candida was determined in 16 (70%) children. Our data are slightly different from the data received by Moscow N. I. Kapranov CF center, where S. aureus was determined in 64.1 % of cases, P. aeruginosa in 64% and B. cepacia – in 48.9% of patients. In Moscow CF center B. cepacia was observed significantly more often, and this may be related to the improved diagnosis of this pathogen [3, 4, 10]. Comparing our findings to the data of the world CF centers we should mention that the USA Registry takes into account not only the frequency of the above listed microorganisms, but H. influenza, multi-drug resistant strains of S. aureus and P. Aeruginosa are considered separately. The Registry of Great Britain monitors the plating of fungi of Aspergillus fumigatus species from the respiratory tract. The French Registry involves information about patients, discharging M. Tuberculosis from their airways. Non-tuberculous micobacteria are plated in 7.1% cases in Israel. Perhaps, the facilities of Kharkiv region clinics do now provide a possibility of accurate identification of these pathogens [3, 4, 10]. Additionally, in Kharkiv region mucoid and non-mucoid strains of pseudomonas infection are not types, such pathogen, as Ralstonia picketi, described in CF is not defined; none of the laboratories defines the level of antibodies to P. Aeruginosa, and this is necessary to determine the infection condition, period/phase of the disease, and to define the antibacterial therapy algorithm. Thus, Lee at al., 2003 determined 4 patient’s conditions dependable on P. aeruginosa introduction of infection: 1. Chronic infection – in determination of P. aeru- ginosa in more than 50% of sputum culture and presence of INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 169 ~ ISSN 2409-9988 increased titer of precipitating antibodies to P.aeruginosa. 2. Intermittent infection – in determination of P. ae- ruginosa in 50% examinations during one year in normal titers of precipitating antibodies to P.aeruginosa. 3. Absence of infection – when the patient, infected by P. Aeruginosa, has no determined causative microorgan- ism in bacteriologic sputum in the course of 12 months. 4. Never infected – P. aeruginosa has never been de- termined in sputum, and there are no antibodies. The abovementioned problems with laboratory diagnos- tics of the infection complicates the work of the clinicians, and is the objective prerequisite for diagnostic errors and incorrect approach to prescription of antibacterial therapy of pseudomonas infection in children with CF. 4 CONCLUSIONS 1. CF severity in patients is associated with chronic infection by P. aeruginosa and B. cepacia. 2. None of the patients in Kharkiv region was found to have any of pathognomonic respiratory causative microorganisms, such as M. Tuberculosis and non- tuberculous micobacteria, H. influenza, Ralstonia picketi, and P. Aeruginosa infection was not identified, which is the evidence of insufficient laboratory diagnosis. 3. It is necessary to improve laboratory diagnosis for determination of respiratory pathogens and their susceptibility to increase the quality of medical care for children with CF and substantiated prescription of antibacterial therapy. REFERENCES 1. Gorinova, U.V., Simonova, U.V., Tomilova, A.U., Roslavtseva, E.A. (2013). Algoritm posindromnoj kompleksnoj terapii pri mukoviscidoze u detej: sovremennyj podhod [The algorithm is complex therapy in cystic fibrosis in children: modern approach]. Voprosy sovremennoj pediatrii, 5, 30-38. 2. Ivkina, S.S., Krivitskaya, L.V., Latoho, T.A. (2015). Mukoviscidoz u detej [Cystic fibrosis in children]. Problemy zdorov'ja i jekologii, 4(46), 6-10. 3. Kapranova, N.I., Kashirskaya, N.U. (2014). Mukoviscidoz [Cystic fibrosis]. Medpraktika. 672p. 4. Kapranova, N.I., Kashirskaya, N.U. (2014). Sovremennye farmakoterapevticheskie podhody k lecheniju mukoviscidoza [Current pharmacological approaches to the treatment of cystic fibrosis]. Farmateka, 3, 38-43. 5. Manovitskaya, N.V., Harevich, O.N., Borodina, G.L. (2014). Sposob opredelenija tjazhesti kliniko- funkcional'nogo sostojanija pacientov s mukoviscidozom [The method for determining the severity of the clinical and functional status of patients with cystic fibrosis]. Medicinskij zhurnal, 1(47), 87-89. 6. Shahinian, I.A., Kapranova, N.I., Chernuha, M.U. (2010). Mikrobnyj pezazh nizhnih dyhatel'nyh putej u razlichnyh vozrastnyh grupp detej, bol'nyh mukoviscidozom [Microbial landscape of the lower respiratory tract disease in different age groups of children with cystic fibrosis]. ZHMEI, 1, 15-20. 7. Ilchenko, S.I., Ivanus, S.G. (2014). Suchasnі problemi dіagnostiki ta osoblivostі klіnіchnogo perebіgu mukovіscidozu u hvorih dіtej mіsta Dnіpropetrovs'ka [Modern problems of diagnosis and clinical course of cystic fibrosis patients at children of Dnepropetrovsk]. Molodij vchenij, 6(09), 148-52. 8. Elkins, M., Dentice, R. (2012). Timing of hypertonic saline inhalation for cystic fibrosis. Cochr. Database Syst. Rev., 2: CD008816. 9. Rabin H. R., Butler S. M., Wohl, M. E. B., Geller, D. E., Colin, A. A., Schidlow, D. V. (2004). Pulmonary exacerbations in cystic fibrosis. Pediatr. Pulmonol., 37, 400-406. 10. Tramper-Stranders, G.A., van der Ent, C.K., Molin, S., Yang, L., Hansen, S.K., Rau, M.H., Ciofu, O., Ohansen, H.K., Wolfs, T.F. (2012). Initial Pseudomonas aeruginosa infection in patients with cystic fibrosis: characteristics of eradicated and persistent isolates. Clin. Microbiol. Infect., 18(6), 567-74. Received: 02-Nov. – 2016 Accepted: 18-Dec. - 2016 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 170 ~ ISSN 2409-9988 PEDIATRICS Chaychenko T., Rybka O., Buginskaya N. EXERCISE TOLERANCE IN NORMAL WEIGHT, UN- DERWEIGHT, OVERWEIGHT AND OBESE ADOLESCENTS Kharkiv National Medical University, Ukraine Abstract: Lack of physical activity negatively impacts weight management programs effectiveness, even with the strictest dietary recommendations. In the context of the obesity epidemic, associated with the cardiovascular risk development, assessment of exercise tolerance in adolescents with different body composition assumes special significance. The examination of 64 normal weight, underweight, overweight and obese adolescents has been performed with anthropometric investigation, study of physical activity level by NHANES and exercise tolerance by multistage treadmill protocol. We established that normal weight children tolerate exercise better than underweight and overweight despite of the same physical activity level. Exercising for persons involved in of body mass correction programs must be adjusted to the potential cardiovascular complications, last longer with the less load in the boost and must be conducted under the relevant specialist control. KeyWords: adolescents, body mass index, physical activity, exercise tolerance ——————————�—————————— INTRODUCTION 2 PURPOSES, SUBJECTS AND METHODS: The WHO Global Strategy on Ending Childhood Obesity (ECHO) includes a complex of measures at various levels from individual to socio-political one. Physical activity in this strategy plays a key role as the only way of energy expenditures [1]. Physical activity level in children is in- versely proportional to the metabolic status [2]. Converse- ly, an adequate fitness reduces the cardiometabolic risk [3]. Obesity related cardiovascular disorders (hypertension, myocardial hypertrophy, remodeling) significantly limit the intensity of physical activity [4]. That’s why a comparative analysis of exercise tolerance in children with different body composition it is necessary. ———————————————— Corresponding Author: Tetyana Chaychenko, MD, PhD, Professor of Department of Pediatrics No.1 and Neonatology, Kharkiv National Medical University, Ukraine. E-mail: tatyana.chaychenko@gmail.com 2.1 Purpose The aim of the study was to improve effectiveness and safety of weight management programs in adolescents by assessment of exercise tolerance in children with different body mass. 2.2 Subjects & Methods 64 normal weight, underweight, overweight and obese (mean age 13,56+2,47 years) were examined. Grouping was done by the body mass index (BMI) Z-score: gr.S (skinny, underweight with BMI less than -1,0 SD, n=6), gr.0 (normal weight with BMI + 1,0 SD, n=12), gr.1 (overweight with BMI +1,1-2,0 SD, n=14), gr.2 (obese with BMI +2,1–3,0 SD, n=18), gr.3 (obese with BMI more than + 3,0 SD, n=14). Anthropometric examination included measurement of height, body mass, waist circumference and skin folds in standard positions. Abdominal fat predisposition assessed by the waist to height ratio (WHR) [5]. Body fat and lean body mass were calculated [6]. The physical activity readyness (PAR) assessed on the recommendations of NHANES, 2014 [7]. Multistage treadmill protocol (Bruce) mailto:tatyana.chaychenko@gmail.com INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 171 ~ ISSN 2409-9988 used for exercise tolerance assessment with further analysis of cardiovascular parameters: resting heart rate (HRr), maximal heart rate (HRm), resting and maximal systolic and diastolic blood pressure (SBPr, SBPm, DBPr, DBPm respectively). Maximal predicted heart rate (MPHR) was calculated by Tanaka formula and HRm in patient was compared with MPHR as a percent of it (%MPHR) [8]. Oxygen consumption calculated by ACSM formula to study cardiorespiratory fitness level [9]. The results were analyzed using Stat Soft Statistica 10. Quantitative variables were described as means + SD, qualitative variables were described as percentages. Differences between groups were established by ANOVA and Mann-Whitney U test. Reported P-values are two-tailed and P-values <0,05 were considered to be statistically significant. Conflict of interests There is no conflict of interests. 3 RESULTS AND DISCUSSION There was no gender and age difference between groups (р>0,05) while BMI was gradually growing together with abdominal adiposity and sum of skinfolds (and body fat relevantly). Lean body mass in underweight is less comparatively to normal weight. It could be indirect confirmation that underweight are not athletes (Table 1). There was no difference in basic cardiovascular parameters in groups (SBP, DBP, and HR). SBP and DBP were similar in skinny, normal weight and overweight, but high in all obese subjects. Resting HR did not reveal any difference in groups. Anyway, there was no significant difference in groups between maximal predicted heart rate and chronotropic reserve. The physical activity level was significantly reduced only in the gr.3 and different in others (where, regardless of BMI, children reported that were moderately active more than 1 hour per day). Normal weight children reached the maximal speed (106.22 + 22.55 m/s) during exercise load, while the results of overweight and underweight were compared to each other. The lowest speed of movement as well as the smallest incline (10.23 + 5.41%) were registered in children with the highest BMI. Maximal oxygen consumption was also highest in normal weights and decreased in underweight and overweight with minimal result in heaviest ones. Maximal oxygen consumption to body mass gradually decreasing from group to group. At the same time, oxygen consumption referred to the lean body mass is same at. gr.S, gr.0 and gr.1 but it is reduced compared to them in obese. Moreover, in obese with a BMI +>3SD the named parameter is twice lower than in those with a BMI + 2-3 SD. Thus, oxygen consumption (as a percentage of the predicted value) is identified a progressive decreasing from group to group. However, value is statistically reduced in obese and underweight. The respiratory parameters (by the peak expiratory flow , PEF) were not changed in groups as well as oxygen saturation before, during and after the load. The total distance passed during exercise boost was the longest in normal weight, gradually decreased in excess body mass and statistically lower in underweight. The same about exercise duration in groups. Metabolic equivalent of exercising is decreasing while growing BMI. This means that at the same physical load in obese causes fewer calories burn out comparatively to underweight, normal weight and overweight. Summarizing the data we can conclude, that normal weight children tolerate exercise better than underweight and overweight, physical activity for persons involved in of body mass correction programs must be adjusted to the potential cardiovascular complications, last longer with the less load in the boost and must be conducted under the relevant specialist control. 4 CONCLUSIONS 1. Fitness is reduced in both excess and deficiency of body weight despite of the same physical activity level. This is reflected by passage of the smaller distance with less tolerance to slope of surface and training time. INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 172 ~ ISSN 2409-9988 Table 1. Basic anthropometric parameters of groups and exercise tolerance markers in adolescents with different body mass Parameter Gr.S Gr.0 Gr.1 Gr.2 Gr.3 P Mean SD Mean SD Mean SD Mean SD Mean SD Basic anthropometric parameters Z – BMI -1,61 0,46 -0,20 0,29 1,47 0,29 2,60 0,24 3,38 0,26 S0, S1, S2, S3, 1-2, 23, 13 Z – height -0,78 1,22 -0,29 1,19 0,95 2,00 0,64 0,91 0,54 0,93 WHR 0,34 0,18 0,35 0,05 0,53 0,05 0,56 0,03 0,68 0,15 S1, S2, S3, 1-2, 23, 13 Skin fold, cm 21,33 29,57 41,18 42,29 118,29 42,29 154,28 33,02 181,62 28,94 S0, S1, S2, S3, 1-2, 23, 13 Fat, % 19,64 5,80 27,04 4,49 37,97 4,49 41,75 2,89 43,93 2,41 S0, S1, S2, S3, 1-2, 23, 13 Lean mass, kg 29,46 8,98 40,90 12,54 37,50 12,54 48,91 10,69 58,89 11,21 S0, S1, S2, S3, 1-2, 23, 13 Exercise tolerance parameters SBPr, mm Hg 101,83 4,49 109,09 10,44 110,71 13,34 114,33 13,50 117,46 18,03 DBPr, mm Hg 63,33 6,06 70,45 8,50 69,71 8,65 75,28 11,65 76,85 12,11 HRr, mm Hg 70,50 6,02 74,64 10,50 77,64 12,70 79,67 11,58 84,46 11,87 SBPm, mm Hg 120,17 7,63 127,00 12,73 132,79 16,00 150,06 24,11 153,46 33,00 S1, S2, S3, 02, 03, 12 DBPm, mm Hg 72,50 7,58 80,00 8,94 80,71 12,06 90,28 10,02 93,85 21,83 S1, S2, S3, 02, 03, 12 HRm, mm Hg 142,17 18,71 135,55 25,35 127,86 32,09 116,89 27,85 129,46 27,34 MPH, bpm 199,95 2,41 197,69 1,26 199,00 1,90 198,36 1,88 198,25 1,63 % MPH 71,08 9,20 68,52 12,53 64,32 16,47 58,92 14,05 65,34 14,05 Chronotropic index 29,12 0,00 40,94 0,00 36,36 23,70 25,26 26,80 38,69 29,61 PAR 3,33 1,86 2,36 1,69 3,79 1,76 3,11 1,28 1,62 1,39 13, 23, S3 V max, m/sec 79,51 19,23 106,23 22,56 85,57 21,96 91,56 21,16 65,97 21,46 S0, S1, S2, S3, 12, 23, 13 Incline max, % 14,33 2,66 15,27 1,62 14,43 2,24 14,78 2,07 10,23 5,42 S3, 23, 13 VO2max, ml/min/kg 29,96 7,97 39,60 8,62 32,04 8,62 34,30 8,33 22,57 10,45 S0, S1, S2, S3, 12, 23, 13 METmax, kcal/min 12,33 4,00 16,27 3,76 10,98 3,34 11,71 3,42 7,46 3,63 S0, S1, S2, S3, 12, 23, 13 VO2 l/min 2,47 0,80 3,25 0,75 2,20 0,67 2,37 0,68 1,53 0,77 Duration, min 12,33 2,80 16,73 3,44 13,71 2,95 13,69 2,70 9,85 4,58 S0, S1, S2, S3, 12, 23, 13 Distance, m 545,00 135,90 990,00 291,38 657,14 230,70 745,00 254,03 469,23 286,75 S0, S1, S2, S3, 12, 23, 13 VO2, l/min/kg 0,08 0,04 0,07 0,03 0,04 0,02 0,03 0,01 0,02 0,01 01, 12, 23, 13, 02, 03, S1, S2, S3 VO2, l/min/kg of lean 0,08 0,04 0,08 0,04 0,06 0,03 0,05 0,02 0,03 0,02 13, 23, 02, 03, S2, S3 Observed VO2max, ml/min/kg 79,77 40,36 66,33 29,97 39,39 17,39 28,70 11,82 15,44 10,20 01, 12, 23, 13, 02, 03, S1, S2, S3 Predicted VO2 max, ml/min/kg 45,52 4,98 43,00 4,18 44,28 6,56 40,58 5,96 34,58 4,83 23, 13, 03, S3 % of Predicted VO2 max 66,17 17,64 92,56 21,01 74,08 24,14 85,42 20,91 64,25 27,75 S0, 23, 03, S3 PEF0, l/min 441,67 73,60 485,45 96,06 412,86 96,51 407,22 121,26 386,92 139,55 PEFmax, l/min 458,33 106,85 495,45 121,36 400,71 111,32 430,00 146,69 392,31 139,71 Sa O2, % 98,33 11,34 98,80 3,79 100,60 2,99 99,14 2,85 99,33 1,97 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 173 ~ ISSN 2409-9988 2. In terms of cardiorespiratory fitness, the most unfavorable is the reduction of oxygen consumption, as normalized to total body weight so to the lean mass. Obese children are prone to hypertension after the exercise boost and, relevantly to the acute events. 3. Than heavier child than fewer calories burn out could be triggered by the same physical load, which should be taken into account when forecasting effective weight loss under the influence of exercising. REFERENCES 1. Interim report of the Commission on Ending Childhood Obesity. World Health Organization 2015. Available from URL: http://www.who.int/end-childhood- obesity/commission-ending-childhood-obesity-interim- report.pdf?ua=1. 2. Parrett, A.L., Valentine, R.J., Arngrímsson, S.A., Castelli, D.M., Evans, E.M. (2011). Adiposity and aerobic fitness are associated with metabolic disease risk in children. ApplPhysiolNutrMetab, 36(1):72-9. doi: 10.1139/H10-083. 3. Brouwer, S.I., Stolk, R.P., Liem, E.T., Lemmink, K.A., Corpeleijn, E. (2013). The role of fitness in the association between fatness and cardiometabolic risk from childhood to adolescence. Pediatr Diabetes, 14(1):57-65. doi: 10.1111/j.1399-5448.2012.00893. 4. Friedemann, C., Heneghan, C., Mahtani, K., Thompson, M., Perera, R., Ward, A.M. (2012). Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ, 345:e4759 5. Barclay, L., Lie, D. (2010). Waist-to-height ratio may predict cardiometabolic risk in normal-weight children CME. BMC Pediatr, 10: 73. 6. Luft, V.M. (2010) Trofolohycheskyy status: kryteryy otsenky y dyahnostyky narushenyy pytanyya [Trophological status: criteria for the evaluation and diagnosis of eating disorders]. SPb., 74 p. 7. National health and nutrition examination survey (2014). Cardiovascular fitness procedures manual. 255 p. 8. Tanaka, H., Monahan, K.D., Seals, D.R. (2001). Age- predicted maximal heart rate revisited. J Am CollCardiol, 37(1):153-6. 9. Glass, S., Gregory, B. (2007). ACSM’s Metabolic Calculations Handbook. Lippincott Williams & Wilkins, Baltimore, 25–74 p. Received: 13-Oct. – 2016 Accepted: 16-Dec. - 2016 INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 174 ~ ISSN 2409-9988 PEDIATRICS Gonchar M.O., Senatorova G.S., Chaychenko T.V., Muratov G.R., Tsura O.N., Chernenko L.N., Dril I.S., Rybka O.S., Omelchenko O.V. Telnova L.G., Bashkirova N.V. 2 PSYCHOLOGICAL STATUS OF CHILDREN WITH DIF- FERENT SOMATIC ABNORMALITIES AS A PREDIC- TOR OF CARDIOVASCULAR RISK Kharkiv National Medical University1, Kharkiv Regional Children’s Clinical Hospital 2, Ukraine Abstract: Psychological status of children with different somatic abnormalities was assessed with the Beck-Youth questionnaire. Psychological profile of children with different somatic abnormalities is not identical which requires obligatory evaluation. The study showed that it is necessary to provide the assessment of psychological state at all stages of management of children with chronic diseases, and provide them with timely psychological assistance. Changes in inner psychological state of the child will potentially give a possibility to provide better treatment in this group of children and prevent recurrence. KeyWords: psychological status, somatic abnormalities, children. ——————————�—————————— INTRODUCTION Formation of physically and mentally healthy personali- ty capable of effective adaptation to the changeable living conditions is important as early as at children's age. Self- assessment plays an essential part as one of the most im- portant indices of individual and personal development [1]. Researchers consider that even a disease caused by physical factors can be a source of emotional stress [2, 3]. However, prolonged stress leads to psycho-physiological impairment. Psychological factors can affect the course of a disease and its outcome. Thus, it is reasonable to study somatic abnormalities in relation to psychological factors. Psychological factors can be triggers intensifying the dis- ease, or modulators influencing its course [4]. ———————————————— Corresponding Author: Oksana Tsura, MD, PhD, Assistant of Professor of Depart- ment of Pediatrics No.1 and Neonatology, Kharkiv National Medical University, Ukraine. E-mail: cyuoksana@yandex.ru The most potentially threatening fact is that according to the WHO, the level of suicide cases is closely associated with mental disorders, and its number (including individu- als with somatic abnormalities) is steadily increasing [5]. Self-esteem has an impact on behavior, activity and de- velopment of a child, his relationship with other people, to a certain extent forming regulative and protective func- tions of an organism. The importance of investigating the features of personality development and, in particular, self-esteem in this group of children, is determined by the fact that childhood morbidity has been increasing recently and as a consequence there is a problem with the assess- ment of development in children with chronic somatic abnormalities [6]. The Beck Anxiety Inventory (BAI) is a measure for classi- fying levels of anxiety as a reaction to stress factors, more often of social-psychological type. The BAI focuses on so- matic symptoms of anxiety developed to differentiate anxiety from depression. The Beck Depression Inventory (BDI) is used for quanti- fying such symptoms as anxiety, phobias, somatic com- plaints and behavioral disorders, grief, irritability. The specific signs of psychotic depression in children are hallu- cinations and delirium, more frequently occurring in teen- INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 175 ~ ISSN 2409-9988 agers. These symptoms, lasting at least 2 weeks through- out the most part of day, lead to suffering and social mal- adjustment of the child. The Beck Anger Inventory (BANI) is used to assess the level of anger which is an emotional state which arises spontaneously or in response to behavior of other people as defense reaction from real or mental disturbance of its psychological / physical borders. The Beck Disruptive Behavior Inventory (BDBI) identifies behavior associated with aggression presenting physical or psychological threat to others. Aggression can take differ- ent forms and is diagnosed as persistence, assertiveness. The definition of "malignant" aggression is a hidden inten- tion directed to offense or as the imagination of violence and destruction, for infliction of harm to other person who does not wish such action. It is accompanied by emotional conditions of hatred, rage, anger and hostility. Obesity is not a disease in literal word meaning, but ra- ther a physiological condition which is presented by ex- treme result of continual tendency [7]. At the same time development of obesity is associated with potential cardio- vascular risk which is the leading factor of morbidity of adult population in the world [8]. Excessive calories intake, mainly sedentary lifestyle and psychological factors are main triggers of obesity develop- ment. Social-psychological factors include external triggers inducing the increased consumption and low rates of lipid- carbohydrate substances burning [9]. The role of psycho- logical factors in the development of obesity is related to low self-assessment [10], frustration, anxiety [11] and depression [12], leading to disturbances of feeding behav- ior in children [13]. According to modern literature, functional relationship between psychological status and characteristics of breath- ing in children are not well understood [14]. Nevertheless the available data suggest that bronchial asthma as a chronic disease capable to incapacitate the patient, is accompanied by the development of somatic-psychological dysfunction that can influence the course of the disease [15]. Leading researchers believe that bronchial asthma development in children is to a great extent related to chronic stress which has various clinical, metabolic, psy- chological manifestations and can influence the course of the underlying disease [16]. The problem of the relationship of psychological and somatic triggers, their influence on the course of somatic abnormalities in children is currently under study because pain and dyspeptic syndromes in chronic gastroenterologi- cal disorders deteriorate psychological condition of the child and his personal characteristics [17]. Thus, in the context of pathogenic features of various somatic abnormalities children should undergo comprehen- sive assessment of psychosocial dysfunction necessary for early prognosis of complications, elaboration of differenti- ated approach to treatment and rehabilitation of patients. 2 PURPOSES, SUBJECTS and METHODS: 2.1 Purpose Evaluation of psychological status in children with different somatic abnormalities as a predictor of cardiovascular risk. 2.2 Subjects & Methods The study involved 350 children aged 4-17 years with different somatic abnormalities. The inspected children were divided into groups: group 1 included 66 children with chronic gastrointestinal pathologies, group 2 – 150 children with excessive body weight and obesity, group 3 – 21 children with acute bronchopulmonary diseases, group 4 – 25 children with bronchial asthma, group 5 – 88 children with chronic diseases of kidneys. The comparison group was formed by average population values in Kharkiv region [18]. The level of psychological stress was assessed by the Beck Youth Questionnaire (in translation) and BSCI assessment – self-concept, the BAI – anxiety, BDI – depression, BANI – anger, BDBI – aggressive behavior. All the data were processed by methods of variation statistics and correlation analysis by "EXCEL" and "STATISTICA 7.0" software. Conflict of interests There is no conflict of interests. INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 176 ~ ISSN 2409-9988 3 RESULTS AND DISCUSSION The results of examination of children with different somatic abnormalities are presented in Table 1. As the data suggest, when compared to the recommended authors of the questionnaire, the results of the examination of teenagers in Kharkov region correlate with the regulatory level of American and European students of appropriate age and gender. The study also involved correlation analysis to establish the relationship between psychological indices which evidently demonstrated (p <0.01), that self-esteem in teenagers in Kharkov region negatively correlated with the level of anxiety (r = - 0.21), depression (r = - 0.41) and deviant behavior (r = - 0.29), anxiety levels were positively associated with the severity of depression (r = 0.58) and anger (r = 0.52), but follow-up level of depression was positively associated with deviant behavior (r = 0.62) and anger (r = 0.74) (Table. 2). As shown in the presented correlation matrix self- esteem in adolescents significantly (p <0.01) negatively correlated with the severity of anxiety, depression and deviant behavior, anxiety levels positively correlated with depression and anger, and the level of depression was also considerably associated with deviant behavior and anger. That connection was expressed by source for the general population and may be considered as a basis for further considerations. especially if they fully agree with the published data on features of teenagers’ behavior. Mental disorders accompany different diseases and their development is not a direct result of psychological deviations, but is quite closely connected with features of the course. Thus, we will consider the results concerning children with different somatic states. Teenagers with obesity have a registered possible increase of anxiety levels and depression given a decreased self-esteem. Most children with asthma (84.0 ± 5.0%) were found to suffer from instability and disorientation in psychosomatic stress, while 28.5 ± 3.8% group 1 patients had impaired emotional state. The average level of anxiety in group 2 was 40.0 ± 3.0% vs. 14.3 ± 2.7% in group 1. The highest level of anxiety in children with asthma was 32.0 ± 4.5%, compared to 9.5 ± 2.6% in group 1. Self-esteem in children with respiratory diseases was identified as reduced, normal or high. Decreased self- esteem was observed in 64.0 ± 5.5% of children with asthma in group 1 of children with low self-esteem; normal in 28.0 ± 2.5% and 71.4 ± 3.1%; high in 8.0 ± 1.5% of children with asthma and in 28.6 ± 4.2% of group 1 patients. Signs of depression were detected in 12 ± 1.5% of group 2 children. As for children with chronic gastroenterological disorders, average level of anger was observed in 60 (91%) of children, slightly increased in 3 (4.5%) children, moderately elevated in 2 (3%) children and significantly increased in 1 (1.5 %) child. Among the surveyed children the average level of depression was identified in 52 (78.9%), slightly increased in 9 (13.6%), moderately increased in 4 (6%), significantly increased in one child (1.5%). Assessment of anxiety level showed average rate in 49 (74.4%), slightly increased in 5 (7.6%), moderately elevated in 12 (18%); significantly increased level of anxiety was not found. Significantly elevated levels of aggressive behavior was observed in 3 (4.5%) children, the vast majority of patients – 53 (80%) were shown to have an average level of aggressive behavior; a slight increase was observed in 9 (13.6%) and moderately increased in one child (1 5%). Comparative analysis showed that self-esteem was low in all the children with chronic diseases and obesity, a condition that is not accompanied by any pain or limita- tions in physical activity, the rate was the lowest. The level of anxiety was significantly increased in obesity (and more) as well as in asthma and chronic kidney diseases. An interesting fact is that increased level of anger and aggres- sion with a predisposition to deviant behavior was identi- fied only in children with chronic kidney diseases. INTER COLLEGAS, VOL. 3, No. 4 (2016) ~ 177 ~ ISSN 2409-9988 Table 1. Psychological profile of children with various somatic abnormalities (in points) Group Self-esteem Anxiety Depression Anger Aggression Standards questionnaire Beck-Youth, (45-55)* (< 55) (< 55) (< 55) (< 55) The average value in the population, n=582 0 46.34 + 8.05 48.61 + 8.48 47.53 + 8.40 46.22 + 8.49 50.85 + 9.56 Chronic GIT problems, n = 66 1 43.36 + 9.14 46.86 + 13.28 45.12 + 8.35 42.06 + 2.14 47.08 + 6.25 Overweight and obesity, n = 150 2 38.19 + 6.28 61.77 + 10.31 47.57 +10.5 47.08 + 7.7 49.03 + 9.99 Acute bronchopulmonary diseases, n = 21 3 55.80 + 6.40 37.61 + 3.01 44.20 +6.95 44.20 + 9.12 46.83 + 7.54 Аsthma, n=25 4 41.20 + 9.80 50.52 + 12.30 49.73 + 8.31 44.66 + 6.82 49.66 + 9.12 Chronic kidney disease, n=88 5 39.19 + 4.27 50.62 + 2.34 50.57 + 9.76 52.86 + 11.82 53.85 + 11.82 Note: * - differences in the incidence of causative microorganisms in the groups are statistically significant (р < 0.05). Table 2 Correlation matrix of psychological parameters in the population of teenagers in Kharkiv region (r) Self-esteem Anxiety Depression Anger Deviant behavior self-esteem - 0.2050 - 0.4164 - 0.2464 - 0.2951 anxiety p=0.000 p=0.00 p=0.000 p=0.000 depression - 0.2050 0.5801 0.5244 0.3252 anger p= 0.000 p=0.00 p=0.00 p=0.000 deviant behavior - 0.4164 0.5801 0.7405 0.6206 self-esteem p=0.00 p=0.00 p=0.00 p=0.00 anxiety - 0.2464 0.5244 0.7405 0.6679 depression p = 0.000 p=0.00 p=0.00 p=0.00 anger - 0.2951 0.3252 0.6206 0.6679 p=.000 p=0.000 p=0.00 p=0.00 INTER COLLEGAS, VOL. 3, No. 3 (2016) ~ 178 ~ ISSN 2409-9988 INTER COLLEGAS © 2010 http://inter.knmu.edu.ua 4 CONCLUSIONS 1. Psychological profile of children with different somatic abnormalities is not identical requiring obligatory evaluation. 2. Teenagers with obesity were found to have significantly increased levels of anxiety and depression secondary to low self-esteem. 3. 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