bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Propaganda: Positioning Thomas Paine’s Common Sense in The Literature Of Revolution
Authors: Higham Dallin
Published: December 2018

In this article, I seek to define the status and role of Thomas Paine’s Common Sense as a historical document. I argue that although Paine’s influential pamphlet offers no original ideas and seems simply to reinforce existing trends, its layered text transcends the regurgitation of propaganda and extends to literary achievement in its reflection of social and economic conditions, its deliberate narrative style, and its usage of literary devices and culture references grounded in historical context. Consequently, my methodology is necessarily focused through literary discourse to achieve historical understanding of this key document from the American Revolution.
An American-Made Miracle: The Politicization of Penicillin During World War II
Authors: Herst Jordan
Published: December 2018

The discovery of penicillin by Alexander Fleming in 1928 revolutionized the way infections were treated. In the context of World War II, the government of the United States politicized the production and use of penicillin as yet another weapon to win the war. It was carefully rationed on the home front, while being used with reckless abandon in the treatment battle wounds and venereal diseases on the battlefield. Penicillin was described as a miracle drug that would be able to cure everyone, when in reality it was only being used to benefit the military and the American war effort, at the expense of civilian lives.
Predicting the Cooling Effect in Green Space Area Using Empirical Modeling in Bogor Agricultural University
Authors: Effendy Sobri , Sururi Ahmad
Published: December 2018

Green space area has contributed to increase atmospheric condition in surrounding area. Here we would like to test the cooling effect of small green area located in IPB campus Darmaga. We monitored air temperature at the morning (6 am) and afternoon (2 pm) for period March-June 2013 in three different sites in campus. Totally, we collected 658 observed data. Our results showed that partial shade area (PSA) and site were the most influenced factors that influence the cooling effect. It appears that the cooling effect is found until distance of 50 m from each monitoring site. The cooling effect varied among sites, but it is consistent that the maximum effect occurred during afternoon. Our analysis confirmed that PSA has contributed to the cooling effect until 28%. Other factors that contributed to the cooling effect were vegetation characteristics and geometric configuration of the canopy. Further, our findings revealed that greenspace area is valuable to minimize high temperature effect from traffic street.
MONTESQUİEU’NÜN İKLİM TEORİSİ
Authors: KARNIBÜYÜK Mustafa
Published: December 2018

Sosyal
bilimlerin ele aldığı konular son derece karmaşık, dinamik ve değişken olguları
içinde barındırır. Ele alınan olayları bilimsel bir çerçevede
değerlendirebilmek için üç unsura ihtiyaç vardır. Bu unsurlar; zaman, mekân ve
insandır. Bu unsurlardan biri eksik olduğunda bilimsel bir değerlendirme yapmak
mümkün değildir. Tarihsel olaylar genellikle zaman boyutunda ele alınmaktadır.
Mekân boyutu göz ardı edilmektedir. Ancak, olayların üzerinde gerçekleştiği
mekânın önemi fark edilmiş ve bazı önemli düşünürler tarafından da ele
alınmıştır. Ancak bu boyut ele alınırken daha somut bir ifade biçimi olan
coğrafya kavramı kullanılmıştır. Tarih boyunca sosyal olgular ile coğrafya
arasındaki ilişki düşünürlerin ilgisini çekmiştir. Antik Yunan’dan günümüze
kadar bu alanda pek çok düşünce geliştirilmiştir. Batı medeniyetinde bu
düşünceleri sistemli bir şekilde ortaya koyan Montesquieu olmuştur. Olgular
arasında nedensel bir ilişki olduğunu savunan Montesquieu, coğrafya ile sosyal
olgular arasındaki ilişkiyi de bu bağlamda kurmuştur. Coğrafi faktör olarak
iklimi öne çıkaran Montesquieu, iklimi geniş bir anlamda kullanarak “İklim
Teorisi”ni geliştirmiştir. Makalede Montesquieu’nün bu teorisinin siyaset
biliminin birtakım problemlerine verdiği cevaplar ele alınmıştır. Makalede
ayrıca bu cevaplar hakkında geçmişten günümüze bazı yazarların görüşlerine yer
verilmiştir. Makale sonucunda, teknolojik ilerleme ile birlikte göz ardı edilen
coğrafya faktörünün Siyaset bilimi çerçevesinde yeniden ele alınması gerektiği
sonucuna varılmıştır.
DUYGUSAL EMEK: ÖNCÜLLERİ VE ARDILLARI
Authors: EZİLMEZ Bilal
Published: December 2018

Duygusal emeğin yayılmasının temel faktörü, çalışanların, hizmet sunarken
işlerinde duygularını kendilerine göre kullanmaları konusunda özgür olmamaları,
bazı kurallara bağlı olmalarıdır. Bunun nedeni şudur ki, işletmeler
çalışanlardan işlerini belli duygularla ortaya koymalarını istemektedirler.
Bazı çalışanlar, bulundukları durumları yeniden değerlendirerek duygusal
durumlarını değiştirirler, bazıları ise bazı meslekler ve belirli sektörlerdeki
bazı şirketler için duygularını düzenleyebilir ve kontrol edebilir. Bu nedenle
bu çalışmanın amacı duygusal emek çalışmaları için gelecekteki değişkenleri
tahmin etmektir. Duygusal Emek stratejilerinin incelenmesi ve çalışanların
temel değerleri ile ilgili çalışma ortamı, duygu yönetimi, duygu düzenlemesi ve
duygusal emek bu çalışmada vurgulanan diğer özelliklerdir.
İliak arter girişimi için transpedal yaklaşım: Nadir bir olgu sunumu
Authors: Kaya Hakan
Published: December 2018

Arteryel kan akımının yeniden
sağlanması, ayak koruyucu olarak kritik ayak iskemisi olan hastaların başlıca
önceliğidir. Son yıllarda, kardiyovasküler teknik ve becerilerdeki artışla ayak
korumak için daha fazla operasyon yapılmıştır. Ayak arter tıkanıklığında
antegrad girişimler, yaklaşık% 20 oranında başarısızlığa neden olur. Retrograd
yaklaşımlar ise genellikle diz ve diz altı arter tıkanıklıklarında uygulanır.
Çok seyrek olarak femoral arter tıkıanıklıklarında da retrograd yaklaşım
uygulanır. Bu vakada ise sağ external  iliak
arter çıkışından başlayıp popliteal artere kadar uzanan  tamamen  tıkanmış arter segmentine  sahip bir hastada  retrograd yaklaşımla başarılı bir rekanalizasyonun
sağlandığı çok daha nadir bir olgu sunulmaktadır.
Peyronie’s disease: new approaches and modern treatment methods
Authors: І. В. Попов
Published: December 2018

The article examines in detail the historical and etiopathological aspects of fibroplastic penile inducing, new data on the theory of the formation of fibrous plaques.The objective: To analyze the efficacy of conservative treatment of Peyronie’s disease in outpatient settings.Materials and methods. During the period 2012-2018 66 people aged between 20 and 70 years were examined and treated. Each patient has an individual approach when prescribing medicines, but all were given complex treatment with physiotherapeutic procedures.Results. After treatment, the algic syndrome was noted in 5 (7.6%) patients. Plaque size after treatment decreased in 48 (72.7%) of men. Complete plaque dissolution was achieved in 12 (18.1%) cases. Softening of cartilaginous plaques was effective in 29 (43.9%) men. In 25 (37.9%) men the angle of curvature of the penis decreased during erection, in no patient the angle of curvature in treatment increased. Most of all men worried about erectile function, which was improved in 28 (42.4%) patients. Patients with neurotic psychogenic disorders performed rational psychotherapy, explanations, with the appointment of sedatives and sedatives.Сonclusion. Qualitative treatment should be dynamic, take into account the clinical version, prescription of the disease, constitutional, immune, endocrine factors and personality of the patient, living conditions, professional activity, education, desire to be treated and financial condition.
12 years together. The experience of using Magic Staff Forte for the treatment of erektil dysfunktion ED
Authors: В. Г. Мігов  , В. В. Білоголовська
Published: December 2018

A five-year, prolonged-time study of patients with corporal venoocclusive dysfunction, for treatment of which was used by Magic Staff Forte, was performed with a frequency of 2 months twice a year at even intervals. The results show the effectiveness of the treatment schemes presented.
The role of ablative technologies in the treatment of small kidney tumors: an overview of the current state of the problem
Authors: С. В. Головко
Published: December 2018

The ablative treatment provides a minimally invasive model for the surgical removal of small kidney tumors, which reduces the risk and complications that are traditionally associated with open or laparoscopic partial nephrectomy. Among the main methods, the cold radiofrequency ablation is isolated; laparoscopic, percutaneous ablation; high intensity focused ultrasound.
Antioxidants in the treatment of male infertility
Authors: І. І. Горпинченко  , М. Г. Романюк  , П. В. Аксьонов  , Ю. Ф. Балацька  , М. М. Лисенко
Published: December 2018

The objective: the study was to determine the efficacy of the drugs containing L-carnitine (Novofertil and Novocarnitine) in certain cases of male infertility. The study is prospective and controlled.Materials and methods. One hundred patients (aged 20–40 years) with anamnesis of infertility with such parameters of spermogram – concentration 10–20×106/ml, total motility 10–30%, progressive motility <15%, atypical forms <70%, speed 10–30 μm/s, linearity <4. 86 patients completed the study. Patients received Novofertil therapy 1 capsule 2 times a day and Novocarnitine 1 vial 3.00 g ones per day or basic therapy (vitamins E and C, zinc, selenium); before the therapy was a 2-month washout period, then 2 months of Novofertil /base therapy, 2 months of followup, the next 2 months of cross therapy (basic therapy / Novofertil). The main parameters studied were spermogram parameters, in particular, motility.Results. Against the background of the use of Novofertil and Novocarnitine, there was a significant improvement in the parameters of total and progressive sperm motility, sperm concentration (compared with baseline). Improvement of motility was more pronounced in patients with worse motility rates, in particular <5 mln of progressively motile spermatozoa in the ejaculate and <2 million in ml.Conclusion. Based on a controlled study, the efficacy of Novofertil and Novocarnitineis effective in improving sperm quality, especially in groups with lower initial parameters.
Sonoelastographic predictors of men’s fertility in patients with primary left-side varicocele
Authors: Й. А. Наконечний  , Д. З. Воробець
Published: December 2018

The objective: to increase treatment efficiency of men with primary left-sided varicocele by investigating the sonoelastography criteria for testicular damages.Materials and methods. Qualitative compression elastography were included into the examination complex of 214 men, aged from 18 to 33 years, with a primary, grade II–III, left-side varicocele before and during the follow up, 3 months after the laparoscopic varicocelectomy.Results. Left testicle elastogram with – OS >2 points, Se = 98,6 [96–99,7] and Sp = 80 [59,3–93,2] can be uased as prognostic predictors of testicles lesions at varicocele II–III. For this parameter, we received a high probability of a negative test result of 0,018 [0,006–0,05] and the mediocre positive – 4,93 [2,3–10,8] with an indicative positive predictive value of 97,7 [94,7–99,2] and negative test results – 87 [65,8–97,4]. Among the sonological parameters, the strongest correlation between the varicose veins diameter of the spermatic cord was observed at rest and during the Valsalva maneuver – 0,89; p<0,05. The strongest, in particular, high density, was the probable correlation between the duration of retrograde flow in varicose veins of the spermatic cord during the Valsalva maneuver with an absolute number of sperm in ejaculate -0,88; p<0.05. According to the elastographic picture of the left testicle in men with varicocele II–III the highest probable inverse correlation bond of moderate density was recorded with an absolute number of sperm in ejaculate -0,6; p<0,05.Conclusions. Elastography expedient to use as a screening method of complex ultrasound examination for detecting testicular lesions, as well as, for monitoring the efficacy of varicoсelectomy which restores the elasticity of the testicular tissue.
Chronic treat pain syndrome
Authors: Ю. М. Гурженко  , В. В. Спиридоненко
Published: December 2018

In the article the main aspects of etiology, pathogenesis, clinic, diagnostics and treatment of chronic pelvic pain syndrome are given.
Alternative to antibiotic-associated complications from the digestive tract after treatment of urological diseases (Review)
Authors: В. В. Спиридоненко
Published: December 2018

The use of a modern enterosorbent with a prebiotic component (a combination of lignin, lactulose and microcrystalline cellulose) in urological practice helps prevent the development of complications of antibiotic therapy in the treatment of urogenital infections.
Etiotropic medicamental prophylaxis of early postoperative complications in patients with benign prostatic hyperplasia infected Trichomonas vaginalis
Authors: С. П. Пасєчніков  , В. С. Грицай  , С. В. Нашеда  , А. С. Глєбов
Published: December 2018

The objective: analysis of postoperative complications after transvesical prostatectomy in patients with benign prostatic hyperplasia infected with Trichomonas vaginalis.Materials and methods. Comparative analysis of postoperative complications in 320 patients after transvesical prostatectomy.Results. The study in patients infected with Trichomonas vaginalis percentage of infectious and inflammatory complications is higher in comparison with a group not infected.Conclusion. The use of ornidazole as causal prophylaxis, in infected patients, has reduced the incidence of infectious and inflammatory complications in 2.1 times and long or profuse gross hematuria in 2,4 times.
Pathomorphological features of the inflammatory process of the tissues of the prostate cancer and benign prostatic hyperplasia in patients, depending on the infectious agents of sexually transmitted diseases
Authors: А. М. Романенко  , С. П. Пасєчніков  , В. М. Григоренко  , В. С. Грицай  , А. С. Глєбов  , О. В. Кравченко
Published: December 2018

The objective: the detection of pathomorphological features of the inflammatory process in the intraoperatively removed prostate tissue of the prostate cancer patients (RPZ) and benign prostatic hyperplasia (BPH) depending on the infectious agents of sexually transmitted diseases.Materials and methods. 317 patients aged 42 to 83 years (mean 62 years) were examined, of which 122 patients with RPD had undergone radical prostatectomy and 195 patients with BPH - prostatectomy.Results. The obtained results suggest that the pronounced degree of inflammatory process occurs only in patients with prostate cancer infected with sexually transmitted diseases pathogens, whereas in noninfected, predominant light stomach or a lack of inflammation and pronounced degree is not determined at below. Patients with prostate cancer are more likely to have symptoms of severe inflammation, areas of the tumor beyond the tumor and poorly differentiated tumors.Conclusion. The established facts require further in-depth study of this problem in order to better understand the etiopathogenesis and improve treatment and prophylaxis of prostate tumors.
The use of herbal drug Canephron® N in ambulatory meta-prevention of uratolysis
Authors: Ф. І. Костєв  , Л. І. Красилюк  , Р. В. Бахчієв  , Є. Л. Лісак  , М. В. Новиков
Published: December 2018

The objective: was to assess the efficacy and safety of Canephron® N in the metaphysics of urate urolithiasis.Materials and methods. In this single-center, prospective, openlabel, non-randomized, controlled, parallel study, 60 patients with urethra-urethritis urolithiasis (39 men and 21 women) who underwent disintegration/dislocation of concrements, were divided into two groups. In the main group, patients complied with the general preventive measures for liquids and nutrition recommended by the EAU, and Canephron® N was used in standard dosages for 6 months.Results. The daily diuresis, uric acid levels of blood and urine, the level of magnesium in urine, and the rate of recurrence of urolithiasis in both groups were evaluated.Conclusion. It was found that the use of Canephron® N with the purpose of secondary prevention of uratogenic urolithiasis causes a significant decrease in the factors of urine lithogenicity: a decrease in the concentration of uric acid in urine, an increase in daily diuresis and a change in urine pH to physiologically optimal amounts, contributes to a significant increase in the concentration of Mg + ions in urine, reduces the rate of relapse of urethane lithiasis in stone formation compared with standard secondary prevention of IBD in 3.8 times.
Results of researches of the functional state of the lower urinary tract and distal colonies with neurogenic pathology
Authors: С. О. Возіанов  , М. П. Захараш  , П. В. Чабанов  , Ю. М. Захараш  , Н. А. Севастьянова  , В. Ю. Угаров  , А. С. Репринцева
Published: December 2018

The article presents the results of studies of the functional state of the lower urinary tract and distal colon sections in neurogenic pathology. It has been established that electromyographic, urodynamic studies reflect the functional state of the urinary tract and distal colon, are an objective criterion for diagnosis, study of the causes and pathophysiological mechanisms of the formation of a combined pathology; clinically, electromyographically, urodynamically, four main groups of patients with neurogenic pathology of the lower urinary tract and distal colon are distinguished. The results obtained were the basis for substantiating the principles of a differentiated approach to the treatment of patients.
Clinical and laboratory assessment of efficiency of the use of Gistafen in complex therapy for patients with itching dermatoses
Authors: В. І. Величко  , Г. О. Данильчук  , Я. І. Венгер
Published: December 2018

The objective: is to study the effect of the antihistamine Gistafen on the dynamics of the clinical picture and laboratory parameters of patients with itching dermatoses, and to assess its acceptability.Materials and methods. Sixty patients with itching dermatoses aged 18 to 65 years were examined. All patients were divided into two representative groups. Patients of the control group along with standard therapy, corresponding to the established diagnosis, took an antihistamine – loratadine. Patients of the main group received an antihistamine Gistafen. Duration of prescribing – 14 days.Results. As a result of the investigation, it was revealed that patients of the main group, in comparison with the control group, had the decrease of clinical symptoms in a short period of time, the level of serotonin decreased, the activity of diaminoxidase increased, and patients quality of life improved significantly.Conclusion. The use of Gistafen is an effective treatment for patients with itching dermatoses, as it provides an evident antipruritic effect, rapid relief of clinical symptoms according to the Dermatological index of scale of symptoms, significantly improves their quality of life according to DQLI scale.
The role of home monitoring of blood pressure in evaluating the susceptibility to drugs for treatment essential hypertension
Authors: І. С. Лисий  , В. В. Саморукова  , В. О. Збітнєва  , О. Б. Волошина  , Т. О. Дичко  , О. Р. Дукова
Published: December 2018

The objective: analysis of the informative value of home blood pressure monitoring (BP) in comparison with complex monitoring of blood pressure (daily, office and home) in determining sensitivity to antihypertensive drugs.Materials and methods. An open prospective comparative study was conducted with the participation of 120 patients aged 45-74 with essential stage II arterial hypertension (AH). Most patients have a high risk of cardiovascular and cerebrovascular complications. The average duration of hypertension was 8.3±2.4 years. The average level of systolic blood pressure was 162.4±5.5 mm Hg, the diastolic blood pressure was 103.3±4.8 mm Hg. All patients were examined according to the Unified Protocol, identifying the risks of cardiovascular and cerebrovascular complications.Results. In the article, the informative value of home blood pressure monitoring was determined in comparison with the complex monitoring of blood pressure (daily, office and home) in determining sensitivity to antihypertensive drugs.The conclusion. The analysis shows that home monitoring of blood pressure (BP) by informative value is not inferior to complex AO monitoring, but it brings less inconvenience to the patient. Due to certain limitations in the use of daily monitoring of blood pressure or complex monitoring of blood pressure, home monitoring of blood pressure can be recommended as a less informative method in determining sensitivity to antihypertensive drugs in the practice of a family doctor.
The importance of laboratory medicine in the family doctor practice at the stage of the primary health care reform
Authors: Є. Х. Заремба  , О. О. Ястремська  , О. В. Заремба-Федчишин  , О. В. Заремба
Published: December 2018

The article highlights the results of the research of the problem of laboratory support of family doctors in Ukraine, the ways of bringing modern analytical technologies to the needs of doctors, and the importance of introducing standardization of the preanalytic phase of laboratory research into practice for improving the quality of medical care provision to the population, which will contribute to the reform of the health care system. The results of the study are shaped into the knowledge system.
Cardiovascular risk stratification and renal functional reserve in patients with essentials hypertension
Authors: Л. В. Хіміон  , Л. С. Тимощук  , М. О. Рибицька  , О. Б. Шадрін
Published: December 2018

The article is devoted to the role of renal functional reserve (RFR) in essentials hypertension (EH) in the diagnosis of early kidney damage. Particular attention is paid to the effect of cardiovascular (CV) complications on RFR.The objective: to assess the functional state of the kidneys in patients with EH I stage and different total risk of CV complications.Materials and methods. The study involved 80 people with the established diagnosis EH of I stage of the I–II grade according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 8], in age from 18 to 60 years (women – 28 (35%), the average age is 40,1 (35,0–56,0) years, men – 57 (71%), average age – 40,2 (37,0–53,0) years. The average duration of EH stage I was 3,5 (1,2–5,0) years. Non-inclusion criteria were acute infectious diseases, symptomatic arterial hypertension, valvular heart disease, cardiac rhythm disturbances, chronic heart failure, chronic kidney disease, diabetes mellitus, coronary heart disease. Patients at the time of inclusion in the study did not take antihypertensive therapy. All patients underwent a comprehensive examination: a history, clinical examination and body anthropometric measurements (height, weight, waist and hip circumference and waist-to-thigh ratio (WTR)), complete blood count and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile, cystatin C), albumincreatinine ratio (ACR) in urine, ABPM, ECG, Echo-CG, ultrasound of carotid arteries, ophthalmoscopy. A risk factor count was used to assess the overall risk of CV complications in hypertension. In addition, RFR was determined the method water and salt load (under patentUkraine42,860) [1]. Statistical analysis of the results was carried out on a computer using the Microsoft Excel 2016 software package and IBM SPSS Statistics (version 21,USA).Results. When stratifying the risk, it was found that 56% of patients had a high risk, 20% of patients had an average risk and 24% had low risk of developing CV complications. In this case, high risk patients had 3–5 risk factors, the average – less than 3 risk factors, and patients with low risk had 1–2 or had no risk factors at all. Of all the risk factors most often met dyslipidemia, male sex, abdominal obesity and family history of premature CVD. In the course of the study, it was clear that even in patients with a low risk of CV complications, kidney damage was noted in the form of a reduced and depleted RFR.Conclusions. An important study of renal damage in EH I stage is the definition of a functional renal reserve. In patients with even a low risk of CV complications in EH I stage, a reduced and depleted RFR is defined. The most commonly depleted RFR was detected in patients with a high risk of developing CV complications.
Clinical features of neurologic disturbances in patients with multiple sclerosis and acute acute disseminated encephalomielitis in the aspect of comorbidity
Authors: Г. М. Чуприна  , Н. К. Свиридова  , А. І. Галуша
Published: December 2018

Multiple sclerosis (MS) is a degenerative disease of the nervous system, whose pathological mechanisms are based on the progressive demyelinating lesion, primarily the CNS.The objective: to determine the nature of neurologic symptoms in MS patients and acute disseminated encephalomyelitis (ADEM), to clarify their characteristics in terms of comorbidity.Materials and methods. In a neurological examination of 216 MS patients with different course forms, we scored a score of FS1–FS7 (FS – Functional System scale according to J. Kurtzke, 1983), the level of disability (EDSS) was determined.Results. Symptoms associated with pyramidal, cerebellar function disorders, sensitivity, cerebral functions were the most frequent symptoms in the examined MS patients, whereas the most common symptoms in the examined patients with the consequences of the ADEM were those associated with disorders of the brainstem and cranial nerves, pyramidal, cerebellar, cerebral functions.Conclusions. In patients with ADEM, under conditions of a monophasic course of the disease, the comorbidity is not as pronounced as in MS, especially with prolonged course.
Pathogenetic aspects of chronic pancreatitis in comorbidity with diabetes mellitus (kallikrein-kinin disbalance and endotoxicosis)
Authors: Л. С. Бабінець  , У. М. Захарчук  , С. Р. Підручна  , Н. О. Шевченко  , Г. М. Сасик  , О. С. Земляк  , Г. В. Адамів
Published: December 2018

The kinin-kallikrein system and endogenous intoxication play an important role in the course of chronic pancreatitis (CP) with concomitant diabetes mellitus.The objective: of our work was to investigate the effect of diabetes mellitus on the parameters of the kinin-kallikrein system and endotoxicosis in patients with CP.Materials and methods. The study involved 112 patients with CP that were divided into 2 groups: I group – 35 patients with CP without diabetes; II group – 77 patients with CP with concomitant diabetes. The comparison group included 20 healthy individuals who did not have any complaints from the digestive tract.Results. A statistically significant increase in the factor of immune genesis in patients with CP with diabetes was found, in comparison with patients with CP and control group (p<0.05).Conclusions. A statistically significant activation of proteolytic activity, increase of the proteolytic enzyme of the kallikrein, decrease of the prekallikrein level, increase of the α1-proteinase inhibitor and α2-macroglobulin levels and decrease of the kininase-II activity, an increase in endotoxicosis in patients with CP with concomitant diabetes (p<0,05) compared to patients with only CP have been proved. It revealed the complicating role of diabetes mellitus in the disorder of the calicreatin-kinin system and endogenous intoxication in the presence of a comorbid course of it with chronic pancreatitis, which must be taken into account in the formation of therapeutic tactics.
Multiple pregnancy in contemporary obstetrics (Review of the literature)
Authors: А. В. Ткаченко
Published: December 2018

The aim of this review was to study, analyze and summurise the data of world literature and our own scientific achievements in the problem of multiple pregnancy, antenatal care for women with twins, perinatal care of fetuses, rational approaches to the tactics and the method of delivery of such patients in particular. The results of literature overview of multicentered clinical trials and their meta-analysis in the leading professional scientific resorces about frequency and prevalence of the most common obstetrical, perinatal and neonatal complications in multiple pregnancies, as well as existing methods of their prognosis, diagnosis, prevention and treatment were studied. The implementation of these data and evidence based clinical approaches with proven efficacy in management of women with multiple pregnancy will help to reduce the rate of obstetrical complications, its severity, and may improve perinatal outcomes as the main goal.
Cardiohemodynamic and renal function in patients with chronic heart failure with hypertension and atrial fibrillation
Authors: О. В. Курята  , Мухаммад Мухаммад  , О. С. Митрохіна
Published: December 2018

The objective: to determine the influence of irbesartan on cardiohe modynamic and renal function in patients with chronic heart failure with preserved systolic function (CHF PF) with hypertension and atrial fibrillation (AF).Patients and methods. 31 patients with CHF NYHA I III class with preserved systolic function (mean age 68,63 [45,00;85,00] years) were enrolled.Results. Echocardiographic parameters and 6 min walk test were performed in all patients, the creatinine levels were determined in the serum and glomerular filtration rate (GFR) was calculated by CKD EPI for all patients as well. Irbesartan was administered to all patients.Conclusion. The treatment with irbesartan of CHF PF patients with hypertension and AF has contributed to the improvement of FC, improvement of 6 min walk test results and to effective control of blood pressure. The drug showed good tolerance and safety. The deterioration of the kidney function in patients with CHF did not result in significant changes of cardiohemodynamics. The use of irbesartan contributed toward increase of GFR with the positive effect in patients with renal insufficiency (GFR <60≥30 ml/min/1,73 m2).  Therefore, the irbesartan may be the drug of choice in these patients.
The metabolism of connective tissue risk faсtors effect in patients with unstable angina
Authors: Є. Х. Заремба  , О. О. Капустинський  , О. С. Капустинська
Published: December 2018

The objective: to study the impact of known risk factors for coronary heart disease and atherosclerosis connective tissue metabolism in patients with unstable angina.Patients and methods. The influence of known risk factors of coronary artery disease and atherosclerosis metabolism of connective tissue (CT) in patients with unstable angina. The study involved 90 patients with unstable angina (mean age of patients was 62,33±1,27 years). Depending on the metabolism and CT in accordance with the tasks patients were divided into 3 groups: Group 1 – with reduced trans  forming growth factor в1 (TGF β-1) and oxyproline normal levels of urine; Group 2 – with normal TGF β-1 and high rate oxyproline urine; Group 3 – with increased TGF β-1 and normal urinary hydroxyproline.Results. Patients of group 1 risk factors of destabilization of atherosclerotic plaque is part of obesity and smoking. Smoking triggers a slowdown in Article anabolic processes – reducing TFR β-1. Development of complications of coronary patients in group 2 with increased catabolism of collagen provoke excessive physical activity and hypertension. Patients 3rd group to destabilize atherosclerotic plaques often results in a high degree of blood pressure and age over 65 years.Conclusion. An important stage of clinical examination was study of the metabolism of connective tissue based screening to determine the level of transforming growth factor в1 and general oxyproline urine
Continuing education as one of the priority methods of postgraduate study: prospects and problems of implementation in the family medicine
Authors: Л. В. Глушко  , Х. С. Симчич  , С. В. Федоров  , В. Т. Рудник  , І. В. Козлова  , Т. Ю. Гавриш  , Н. З. Позур  , Т. І. Маковецька  , А. В. Симчич
Published: December 2018

The article emphasizes the priority of continuing education in a family doctor’s professional development and training. Current issues of  continuing education as a strategic and prospective direction in postgraduate education development are indicated. The attention is paid to the impact of continuing education on doctor’s professional development in terms of World Federation of Medical Education. The development of postgraduate education according to the concept of higher medical education in Ukraine and the National Doctrine is also determined. The basic trends of study in Europe and Ukraine, major development directions, prospects and problems of professional education for family doctors are presented. Characteristic features of continuing education, major means and ways of implementation within postgraduate education are indicated. The attention of the medical community is drawn to the issues of continuing education in Ukraine. The existing system of family doctor’s training at the Department of  Therapy and Family Medicine of Postgraduate Education as well as stages of organizational approach to the study of family doctors in the Carpathian region is analyzed.Ways to overcome the problems and the approach of continuing education to international standards are determined. It has been concluded that knowledge gained during continuous postgraduate education and medical practice as well as increase in motivation for continuous renewal and mastering practical skills obtained with experience will be the foundation of successful family doctor’s practice and decisive fac tor in the development of family medicine in general. There are many unsolved issues on the way to improve the system of postgraduate professional education in Ukraine and the Department of Therapy and Family Medicine. Therefore, permanent search for new advanced methods of family doctors’ professional development with the involve  ment of the latest teaching methods and advanced technologies taking into account healthcare system features in the country in general and in the Carpathian region in particular in the period of its reforming is necessary.
Analysis of emergency/urgent medical aid challenges for the working-age-generated population in the case of a hypertensive crisis in a megacity
Authors: Л. Ф. Матюха  , Г. О. Слабкий  , О. О. Тарнавська  , Л. Г. Матвієць  , Н. В. Малютіна
Published: December 2018

The objective: to investigate and analyze the emergency/urgent medical care calls for the working-age population on the hypertensive crisis (GC) more than once a year and to study the state of supervision of this category of population at the level of primary care.Materials and methods. In the course of the study, a retrospective quantitative analysis of the emergency (EMD) and emergency (NDC) medical care for the working-age population with a GC aged 18-60 in the Pechersk and Darnytsky districts of Kyiv in 2015 was conducted.Results. The article presents the results of the retrospective analysis of emergency medical care outlets in the Pechersk and Darnytskyi districts of the city ofKyiv to the working-age population for the hypertensive crisis. It is established that their number is respectively 855 and 6203, which is 2,87% and 8,24% of total number of calls. For servicing all calls of emergency medical care to the working-age population with hypertensive crises, 178 169,43 UAH of public funds were spent in both districts. During the research, it was found that in 22,54% of the Pechersk and 18,84% of Darnytskyi districts, during the provision of emergency and emergency medical care, the diagnosis of arterial hypertension was established for the first time, 48,0% of them in Pechersk and 52,84% in the Darnytskyi districts used to seek medical assistance from general practitioners-family physicians.Conclusion. It was shown that 42,96% of the outpatient medical cards in Pechersk and 54,24% in Darnytskyi district did not contain information on the volume of emergency care provided to patients with a sharp increase in blood pressure, as well as the referral of his patient to the primary link.
Acute abdominal pain in the practice of a general practitioner – family medicine
Authors: В. Б. Гощинський  , Л. С. Бабінець  , Б. О. Мігенько  , І. О. Боровик  , В. М. Творко  , С. С. Рябоконь
Published: December 2018

Diagnostic errors in the prehospital stage of the examination of a patient with abdominal pain are evidenced by the fact that: 20% – errors from imperfect knowledge; 50% – errors from non-compliance with the rules of clinical examination of a patient; 30% – errors related to the patient’s severe condition. The article lists the main pathologies included in the term “acute abdomen”, a diagnostic strategy for determination and differentiation of abdominal pain in the work of a general practitioner – family medicine.
Endothelial dysfunction in the pathogenesis of arterial hypertension and the progression of atherosclerosis
Authors: С. Г. Пузік
Published: December 2018

The article presents a modern view of the endothelium and main functions supporting the physiology of the vascular and homeostasis for the normal functioning of the cardiovascular system. An analysis of studies on the formation of endothelial dysfunction and effect on the formation a pathological cascade of cardiovascular events is carried out. The mechanisms of formation endothelial dysfunction involved in inflammation, progression of atherosclerosis and the possibility of modern diagnosis of vascular remodeling are presented. An analysis of the release of nitric oxide, which influences the formation of endothelial dysfunction in arterial hypertension, is carried out.
Intergenerational differences in prevalence and association with survival rates of major cardiovascular risk factors
Authors: В. Ю. Жарінова  , І. С. Шаповаленко  , Ж. С. Бутинець
Published: December 2018

The objective: determination of the prevalence of major cardiovascular risk factors (CVRF) and their association with the survival rate of cardiovascular disease (CVD) among generations 1905–1924 and 1925–1944 years of birth.Materials and methods. 384 patient case histories were analyzed from 1905 to 1944 with ischemic heart disease (IHD). According to the year of birth, the patients were divided into 2 groups: 1 group – born in the period 1905–1924 («pre-war» generation), 2 group – from 1925–1944 (a generation of «front-line soldiers»). The diagnosis was established on the basis of examinations, in accordance with the current recommendations for the diagnosis of IHD.Results. There are significant intergroup differences in the frequency and structure of arterial hypertension in the pre-war generation group, the incidence of arterial hypertension (AH) was 64,1%, of which 54,6% is isolated systolic hypertension (ISAH). In the frontline group, the AH frequency reached 74,1%, and ISAG accounted for only 27%. When analyzing the average of low density lipoprotein (LDL) values in the first and second generations, there were no significant differences. However, gender analysis revealed that in both groups of women, the average level of LDL was higher than that of men. The prevalence of elevated LDL in the first generation is higher (98,68%) than in 2 generations (94,12%) (р>0,05). The prevalence of the increased level of glucose in the 1st generation is 4,4%, while in the 2nd generation it increases to 20,6% (p=0,0001). Although the diagnosis of diabetes mellitus is 1,94% in the 1st group and 3,68% in the second group, which indicates a significant increase in the cases of violation of carbohydrate metabolism in the 2nd generation.Conclusion. Also, with a detailed gender analysis within the group, attention is drawn to the distribution of overweight and obese individuals: if in the 1st generation of overweight men there was more (68,85%) than with obesity (31,15%), and women with increased body weight was 40,38%, with obesity 59,62%, then in 2 generations 61,8% of men were overweight and only 37% obese. In women, a mirror trend was observed – 36,1% were overweight and 63,9% were obese. These CWR factors were associated with various indicators of life. in the first generation there was no dependence of survival on the presence of individual CVR factors; in the second, survival was significantly lower in patients with obesity and hypertension.
Retrospective assessment of patients with arterial hypertension who used emergency medical services in a mega-city, in accordance with the requirements of the UCPMC «Arterial hypertension»
Authors: О. О. Тарнавська  , Л. Ф. Матюха
Published: December 2018

The article presents the results of a retrospective analysis of outpatient cards (form 025/o), which repeatedly caused emergency medical care (EMC) for acute blood pressure increase (BP), according to the requirements of the UCPMC «Arterial Hypertension». It was found that the management of patients by family doctors does not fully comply with the requirements of this protocol, in particular, the doctor’s recommendation for a home BP measurement and diary keeping was recorded in 28.83% outpatient cards of patients in the Pechersky district and in 26.80% of Darnitskiy district. It was revealed that the primary care physician practically does not monitor the home blood pressure measurement, does not take into account the importance of motivated counseling about the risk factors for further monitoring of patients with hypertension.The objective: was to conduct a retrospective assessment of outpatient cards of patients using NMD services for acute blood pressure elevation in a megapolis environment for compliance with their introduction of the Unified Clinical Protocol (ACP) «Arterial Hypertension» approved by the Order of the Ministry of Health of Ukraine from 24.05.2012 No. 384.Materials and methods. In the course of the study, a retrospective analysis of outpatient charts of patients of working age (aged 18-60) was conducted with a sharp increase in blood pressure, which was provided by the HMD more than once a year in two districts of the city of Kiev. The method of mechanical selection was used to analyze every fifth outpatient card from all the challenges of AMD to patients with a sharp increase in BP of working age. So, 142 outpatient cards in the Pechersky district and 1178 in the Darnytskyi district were analyzed for compliance with the necessary volume of medical services by general practitioners by family physicians (SP-SL) in accordance with the UCPMC «Arterial hypertension».Results. According to the records in outpatient cards, the first line of prescription drugs are first-line drugs: ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, β-adrenoblockers, thiazide diuretics. Combined therapy was prescribed to 28.40% of patients in the middle age of the Pechersky district and 32.15% of the Darnitskiy district. At the same time, attention is drawn to the irregularity of patients visiting doctors, and hence the uncontrolled use of prescribed treatment.Conclusion. It was established that 22.00% of patients with acute blood pressure increase in Pechersky and 44.57% in Darnytskyi district received emergency medical services on a number of occasions, and subsequently did not apply to a primary care physician. When analyzing outpatient cards, it was established that the necessary actions in accordance with the UCPMC «Arterial hypertension» were carried out by the doctors in full.
Situations and indications for specialist training and undergraduate teaching at status in Europe
Authors: F. Carelli
Published: December 2018

This paper presents an excursus from Alma Ata Declaration on Family Medicine, through the Documents, Statements that EURACT (European Academy of Teachers in Family Medicine) has produced to strengthen Family Medicine in Europe, mainly as undergraduate and specialist training teaching and continuing medical education and professional development. Here is presented just the history of these documents, also some political and national ones to defend Family Medicine from dismantling dangers always at the corner.Some parts of these documents are descripted in detail, some are indicated to push to read them on EURACT and WONCA websites.The aim is the enforce Family Medicine everywhere in Europe, been supported by these key documents.
Foundation of algorithm of medical and psychological support of adolescents with primary arterial hypertension
Authors: О. М. Місюра  , М. В. Хайтович  , Н. М. Кухта  , Л. І. Місюра  , С. Д. Максименко
Published: December 2018

The objective: of this work was to identify the frequency of increased anxiety, depression and alexithymia in adolescents with primary hypertension and to develop an algorithm for their medical and psychological support.Materials and methods. 91 children (21 girls and 70 boys) aged 10 to 17 y.o. (on average 14,65±1,52 y.o.) were examined. Diagnosis was verified by 24-hour blood pressure monitoring using monitors ABM-04 (Meditech,Hungary). Two groups were formed: I – 60 adolescents (11 girls and 49 boys) with stable and labile arterial hypertension and II – 31 adolescents (10 girls and 21 boys) – control group. Psychological study included identification of state and trait anxiety by Spielberger-Khanin test, alexithymia – using Toronto Alexithymia Scale, depression – by Zung Self-Rating depression scale.Results. Moderate statr anxiety was noted in 50%, and high – in 28.6% adolescents with primary  hypertension; moderate and high trait anxiety respectively in 59,8% and 35,7%; alexithymia and risk of alexithymia – respectively in 21,4% and 31%, depression only 2,4%. On average, these emotional characteristisc did not differ from those of the control group. Taking into account the given and results of previous researches, the algorithm of medical and psychological support of adolescents with primary hypertension was developed and introduced.Conclusion. In the majority of adolescents with primary hypertension, there is anxiety and/or high anxiety that requires psychological correction.
Endothelial dysfunction and renal functional in patients with chronic heart failure with atrial fibrillation
Authors: О. В. Курята  , М. Мухаммад  , О. С. Митрохіна
Published: December 2018

The objective: we aimed to evaluate the relationship between endothelial dysfunction and renal functional in patients with chronic heart failure (CHF) with atrial fibrillation (AF).Materials and methods. 57 patients with CHF NYHA II-III class and preserved left ventricular ejection fraction (LVEF >45%), mean – 60,34 [45, 88]%) aged 45 to 85 years (mean age – 65,49 [45, 85] years) were enrolled. Among 58 patients, more than 65% had endothelial dysfunction.Results. Flow-mediated dilation (FMD) was assessed during reactive hyperemia in all patients, the serum creatinine level was determined and the glomerular filtration rate (GFR) was calculated by CKD-EPI formula.Conclusion. The FMD in patients with CHF with AF was higher by 8,23% than without AF. Deterioration of the renal functional in patients with CHF did not cause significant changes of FMD, however, the presence of AF increased the decrease in FMD (by 13,72%) with a decrease in GFR.