bluuebunny/crossref_metadata_2025 huggingface dataset:
Ketosis in pregnant women: causes, consequences, and correction
Authors: Medved V.I.
Published: July 2021

Background. Compared to 2013, in 2019 the number of pregnancies in Ukraine decreased by 32.7 %, so the value of each pregnancy and medical liability have proportionally increased. Because pregnancy is a ketogenic and diabetogenic condition, the issue of ketosis in pregnant women requires close medical attention.

Objective. To describe the causes, consequences and correction of ketosis in pregnant women.

Materials and methods. Analysis of literature sources on this issue.

Results and discussion. Ketosis of pregnant women is divided into diabetic and non-diabetic. The total prevalence of ketosis is 1.7-3.6 %. Risk factors for ketosis in pregnant women include starvation, dehydration, decreased blood buffer capacity, increased production of contrainsular hormones and stress. In addition, ketosis is facilitated by the fact that placenta produces placental lactogen (in late pregnancy – up to 1 g per day) – a powerful contrainsular hormone and ketogenic agent (via stimulating lipolysis in the liver). The development of ketosis is usually provoked by infections, acute diseases, and taking certain medications (glucocorticoids, adrenoblockers). In settings of ketoacidosis, the fetus develops bradycardia, hypoxia and distress, ante- and perinatal mortality increases. If the mother has ketosis with β-oxybutyrate in blood and keto acids in the amniotic fluid, it causes behavioral and intellectual disorders in the child. The links of ketosis pathogenesis include energy starvation due to poor nutrition and/or impaired insulin production, lipase activation with the formation of ketone bodies, protein breakdown, hyperglycemia development, and oxidative stress. The majority of cases of ketosis are diagnosed at the stage of decompensation. Polyatomic alcohol xylitol is one of the main means to eliminate ketosis. Xylitol (Xylate, “Yuria-Pharm”) promotes the formation of glycerophosphate in the pentose phosphate cycle, enhances glycogen production, reduces lipolysis, increases ATP level in liver, promotes insulin production, reduces lactate. The inclusion of Xylate (6-8 ml/kg of body weight for 3 days) into the ketosis therapy can significantly accelerate the elimination of ketosis. Xylate does not increase glucose levels and has nitrogen-sparing properties.

Conclusions. 1. Pregnancy is a ketogenic condition. 2. Ketoacidosis of pregnant women is associated with high perinatal losses. 3. Xylate has shown high antiketogenic activity and a number of additional beneficial effects.
Principles and rationale of infusion therapy in tuberculosis
Authors: Petrenko T.I.
Published: July 2021

Background. In 2018 7 million new cases of tuberculosis (TB) were registered, which is more than in previous years. Undoubtedly, TB is one of the most important threats to the public health globally. In developing countries, where there are no new TB drugs (TBD) and modern medical services, this threat is even more serious. Intravenous administration is an option to optimize the existing drug regimens, as it is accompanied by increased bioavailability.

Objective. To substantiate the rationality of infusion therapy in TB.

Materials and methods. Analysis of literature data on this topic; own study involving 106 patients with newly diagnosed infiltrative and disseminated pulmonary TB with bacterial excretion.

Results and discussion. The medical community is concerned not only about the increase in the TB incidence, but also about the increase in the number of drug resistance (DR) cases. Improper treatment is one of the causes of DR. In case of oral administration absorption disorders of the drug are possible in people with digestive system diseases, in addition, part of the drug is metabolized by passing through the liver. In contrast, intravenous drugs enter the superior vena cava system, right ventricle, and pulmonary arteries. In a number of patients’ subgroups, it is not possible to achieve a sufficient concentration of drugs in serum when taken orally for various reasons. In particular, these reasons include host organism factors (features of drug metabolism (fast acetylators are more likely to have DR than slow ones), malabsorption, drug clearance, inability of the drug to reach lung tissue) and mycobacteria factors (biofilm formation, drug resistance due to efflux pumps, metabolic status of the bacterium – division phase or sleep phase). These factors are considered to be the consequences of continuous oral administration of TBD. Achieving a high concentration of TBD in the source of infection due to intravenous administration allows to overcome the DR of mycobacteria. In the own study, oral (n=33) and intravenous (n=73) modes of TBD administration were compared. The groups were identical in age, sex, and TB stage. In the intravenous treatment group there was a significantly higher proportion of complete closure of the decay cavities (90.5 % vs. 60.4 % in the oral treatment group; p=0.04), as well as the significantly lower number of toxic reactions (14.3 % vs. 57.9 %; p=0.001) and poor tolerability of treatment (31 % vs. 57.9 %; p=0.04). On the background of intravenous therapy less fluoroquinolone DR was observed.

Conclusions. 1. Intravenous therapy in patients with pulmonary TB is more effective than standard in terms of closure of the decay cavities. 2. Intravenous therapy is accompanied by significantly less toxicity and better tolerability. 3. Intravenous TB therapy is less likely to provoke the development of DR.
Malabsorption syndromes in patients with tuberculosis as a cause of ineffective treatment: how to diagnose and overcome?
Authors: Butov D.O.
Published: July 2021

Background. Impaired drug absorption is one of the reasons of the ineffectiveness of tuberculosis (TB) treatment. Malabsorption syndrome (MS) is a clinical syndrome that occurs due to the impaired digestive and transport function of the small intestine and is characterized by impaired absorption of nutrients, vitamins, microelements and drugs from the digestive tract. MS accompanies the following pathological conditions: pancreatic diseases, cholestasis, inflammatory bowel diseases, autoimmune enteropathies, diabetes mellitus, amyloidosis, hyperthyroidism, atrophic gastritis, HIV/AIDS, infections and parasitosis of the digestive system, alcoholism, and TB.

Objective. To describe the ways to overcome the influence of MS on TB treatment.

Materials and methods. Analysis of literature data on this topic.

Results and discussion. MS can worsen the treatment of all forms of TB, especially severe. The latter include tuberculous meningitis, disseminated TB, miliary TB, caseous pneumonia, and infiltrative TB. Causes of death from severe forms of TB include untimely diagnosis, lack of thorough differential diagnosis, insufficient intensity of therapy, decreased maximum concentration of oral forms of anti-TB drugs (ATBD) in blood. The latter often occurs in severe forms of TB and in case of co-infection with TB and HIV/AIDS. Injectable forms of the drugs are recommended by the World Health Organization to increase the effectiveness of TB meningitis treatment. The American Thoracic Society and the American Society of Infectious Diseases also recommend the use of intravenous ATBD in patients with impaired absorption. Most patients receiving oral ATBD have extremely low plasma concentrations of these drugs. This is probably due to a decrease in the functional area of intestinal absorption in patients with TB. Indications for intravenous ATBD include severe forms of TB, the presence of severe disorders of the digestive system and severe comorbidities, TB with multiple and widespread resistance to ATBD, pre- and postoperative periods, low adherence to therapy. The intensive phase of therapy and the patient’s preference may be the additional indications. Studies show that intravenous ATBD is associated with significantly better survival than oral, in the absence of an increase in the number of side effects. The advantages of intravenous administration also include 100 % bioavailability, 100 % controllability of treatment, intensification of therapy, overcoming and preventing the development of resistance of mycobacteria, reducing the risk of adverse reactions, improving the tolerability of chemotherapy.

Conclusions. 1. Impaired drug absorption is one of the reasons for the ineffectiveness of TB treatment. 2. MS can worsen the treatment of all forms of TB, especially severe. 3. In patients with malabsorption it is recommended to use intravenous ATBD. 4. Intravenous ATBD is associated with significantly better survival than oral, in the absence of an increase in the number of side effects.
Evaluation of the effectiveness of the pharmacotherapy scheme “TRIO” in patients with chronic arterial insufficiency of IIb-III degree
Authors: Petrushenko V.V.
Published: July 2021

Background. Occlusive peripheral arterial disease (OPAD) of the lower extremities is a pathological condition; its pathogenetic substrate is an obstruction or narrowing of the lumen of peripheral vessels of various calibres. About 200 million people worldwide suffer from OPAD. The incidence and severity of the disease increase with age. Patients with diabetes are 2-4 times more likely to develop OPAD than those without diabetes. Smoking increases the risk of OPAD by 2.5 times.

Objective. To evaluate the effectiveness of the pharmacotherapy regimen “TRIO” in patients with chronic arterial insufficiency of IIb-III degree.

Materials and methods. The study included 45 people with confirmed OPAD of the lower extremities and chronic arterial insufficiency of IIb-III degree (62.2 % males, 37.8 % females, mean age – 61 years). Patients in the experimental group (n=20) were prescribed a “TRIO” scheme, which included: 1) a multicomponent isoosmolar solution containing Ringer’s lactate and pentoxifylline (200 ml per day); 2) multicomponent hyperosmolar solution containing sorbitol and sodium lactate (400 ml per day); 3) a solution of L-arginine hydrochloride (100 ml per day). Comparison group was treated by the solution 2 (200 ml per day) and solution 3 (100 ml per day) only. The effectiveness criteria included the distance of painless walking, the intensity of pain according to the visual-analogue scale (VAS), ankle brachial index, and peripheral oxygen saturation.

Results and discussion. In the experimental group there was a shorter length of hospital stay (7.9±0.97 days vs. 9.8±1.63 days in the comparison group) and better dynamics of painless walking distance (1st day – 47.50±30.54 m, 7th day – 126.25±72.16 m, in the comparison group: 1st day – 49.00±27.73 m, 7th day – 54.20±33.59 m). Pain syndrome according to VAS also decreased more markedly in the experimental group: from 5.35±1.81 points on day 1 to 3.25±1.68 points on day 7 (in the comparison group – from 5.32±1.63 points on day 1 to 4.80±1.53 points on day 7). There was no significant difference in the ankle brachial index. Peripheral oxygen saturation increased more markedly in the experimental group (from 75.50±7.10 % on day 1 to 90.65±5.07 % on day 7) than in the control group (from 75.72±6.55 % on day 1 to 79.48±6.91 % on day 7).

Conclusions. 1. Administration of the pharmacotherapy scheme “TRIO” allows to improve the indicators of the functional state of the vascular bed in patients with chronic arterial insufficiency of IIb-III degree. 2. Manifestations of improvement included lengthening of the distance of painless walking, increase of peripheral blood oxygen saturation, and reduction of the pain severity.
eHealth as a united information space for doctors and patients
Authors: Vasyliev V.S.
Published: July 2021

Background. The national primary healthcare system (PHS) includes 1939 institutions, 27.7 million patients, 24,607 doctors, 1122 pharmacies and 9395 pharmacists. The eHealth informational space was created to coordinate the work of the PHS.

Objective. To describe the features and functioning of the eHealth informational space.

Materials and methods. Analysis of the current situation regarding the work of eHealth.

Results and discussion. An important function of eHealth is the transition to electronic prescriptions and electronic referrals to specialists under the medical guarantee program. Adopted in 2020 budget of this program amounted to 72 billion UAH, which was allocated to primary care, secondary, tertiary, emergency and palliative care, medical care for children, medical care for pregnancy and childbirth, medical rehabilitation. In total, UAH 1758 billion was spent on the diagnosis and treatment of oncological diseases, of which 80.7 % – on diagnosis and chemotherapy, and 29.3 % – on the diagnosis and radiation treatment. The eHealth system provides the cooperation between the Ministry of Health of Ukraine, the National Health Service of Ukraine and medical institutions with medical information systems. Benefits of the united informational system include the elimination of paperwork, creating a united medical card of each patient, online registration for a doctor’s consultation, eliminating the possibility of drug receipt falsification, increasing the availability of telemedicine consultations, improving communication between healthcare professionals, planning and monitoring of strategic procurement. If the patient uses a smartphone, this informational space allows him to transmit his data (for example, the results of blood pressure measurements) through a mobile application to the telemedicine platform with their subsequent analysis and correction of prescriptions. Additional opportunities of the informational space include monitoring of drugs’ side effects, educational programs for doctors, and the possibility of creating professional communities.

Conclusions. 1. The eHealth system enables Ukrainian doctors and patients to use electronic prescriptions and electronic referrals to the specialists. 2. Benefits of this informational system include the elimination of paperwork, the creation of a united medical card of each patient, online registration for a doctor’s consultation, improved communication between health professionals, improved planning of strategic procurement, etc. 3. The eHealth system includes a number of useful services for both doctor and patient.
Pleural empyema from the point of view of a thoracic surgeon
Authors: Sokolov V.V.
Published: July 2021

Background. Pleural empyema (PE) is the presence of pus in the pleural cavity. The causes of PE include the diseases of adjacent organs (75 %), direct contamination of the pleural cavity during injuries or operations (20 %), and hematogenous dissemination of infection (5 %).

Objective. To describe the modern views on the treatment of EP.

Materials and methods. Analysis of literature sources on this topic.

Results and discussion. Radiography, computed tomography, and ultrasound can be used to diagnose PE. To detect PE, radiography should always be performed in two projections, paying special attention to the posterior sinus and the space above the diaphragm. Computed tomography shows pleural layers’ separation and a “pregnant woman” symptom. Ultrasound can distinguish fluid, pleural thickening and pulmonary infiltration, as well as determine the optimal point for puncture. The ultimate goals of PE treatment include the obliteration of the pleural cavity or creating conditions for the formation of a sterile residual cavity. In case of acute PE, drainage, washing, and antibiotic therapy are applied; correction of concomitant diseases is carried out. Drainage of the pleural cavity should be preceded by a puncture of the pleural cavity to obtain pathological contents. The appearance and odor of the fluid obtained by puncture are the most important indicators of the pathology. Drainage can be performed at the point where the pus was obtained, or in the VII-VIII hypochondrium along the posterior axillary line. Drains from polyvinylchloride with a diameter of 6-8 mm are applied. The length depends on the task. Videothoracoscopy is a modern method of treating PE. This method is minimally invasive, removes fibrin and pus, destroys adhesions, connects cavities and provides drainage at the optimal point. To wash the pleural cavity, it is advisable to use decamethoxine or povidone-iodine. With regard to antibiotic therapy, levofloxacin or third-generation cephalosporins are used in combination with an antianaerobic drug, or carbapenems or glycopeptides.

Conclusions. 1. PE is often a secondary infectious process caused by adjacent structures’ infection. 2. Pleural cavity sanitation during videothoracoscopy and drainage are the main methods of PE treatment. 3. Antibiotic therapy and pleural lavage are integral components of PE treatment.
Organoprotection in patients with COVID-19
Authors: Tashchuk V.K.
Published: July 2021

Background. Treatment of chronic coronary syndrome (CCS) includes the elimination of acute ischemic pain, prevention of ischemic pain, symptomatic treatment, and influence on the prognosis. The health of patients with CCS during their lifetime is affected by the diet, climate, medication, exposure to toxic substances, and now the COVID-19 epidemic.

Objective. To describe the available options of cardioprotection and metabolic therapy.

Materials and methods. Analysis of literature data on this topic and own research “Smart ECG”.

Results and discussion. A significant number of the foreign scientists’ papers have been devoted to the problems of the excessive release of free radicals, mitochondrial DNA damage, reduction of ATP content and cardiocytoprotection. Even the short-term ischemia depletes ATP depots and slows their recovery. Metabolic therapy is able to protect cardiomyocytes from the hypoxic death due to the mismatch of energy production by mitochondria to the energy needs of the cell. According to the results of the own study “Smart ECG”, L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) activates parasympathetic regulation in stable angina, reducing the risk of adverse events. Vascular, immunomodulatory, antioxidant and cytoprotective properties of L-carnitine and L-arginine make their use reasonable for COVID-19.

Conclusions. 1. Metabolic therapy is an important component of the treatment of CCS. 2. L-carnitine and L-arginine have the pronounced vascular, immunomodulatory, antioxidant and cytoprotective properties. 3. It is reasonable to use these drugs during an epidemic of COVID-19.
Options of severe preeclampsia treatment
Authors: Tkachenko R.O.
Published: July 2021

Background. Preeclampsia (PE) occurs in 2-8 % of all pregnancies. Every day 210 women die from PE, and neonatal losses are even greater (1380 children per day). Fatal complications of severe PE include cerebral hemorrhage, cerebral edema, pulmonary edema, placental abruption, adrenal hemorrhage, dissecting aortic aneurysm, HELLP syndrome, disseminated intravascular coagulation syndrome. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE.

Objective. To describe the options of severe PE treatment.

Materials and methods. Analysis of literature data on this issue.

Results and discussion. The pathogenesis of PE is based on total damage to the vascular endothelium, which leads to an increase in its permeability, including for albumin molecules. Plasma protein loss is accompanied by a drop in oncotic blood pressure and fluid leakage into the interstitial space. Thus, in patients with PE there is an associated disturbance of fluid and electrolyte balance: along with intravascular dehydration there is extravascular hyperhydration. Infusion therapy (IT) allows to overcome this imbalance and to increase the colloid-osmotic pressure. According to modern views, a restricted IT regimen improves the effects of PE treatment. There are two ways to correct this disorder: an increase in oncotic blood pressure due to infusion of albumin (indicated in case of blood albumin levels <25 g/L) and the administration of osmotically active drugs, such as Reosorbilact (“Yuria-Pharm”). The latter option prevents the loss of fluid from the vascular bed and promotes its return to the vessels from the intercellular space. The total fluid volume should be limited to physiological needs, taking into account pathological losses (not more than 1 ml/kg/h). The maximum IT volume should not exceed 800 ml per day. The drugs of choice for IT before delivery are balanced isotonic saline solutions and solutions containing 6 % sorbitol. Fresh-frozen plasma is not recommended for the correction of colloid-oncotic pressure. Influence on the redistribution of fluid in the interstitial space without the introduction of significant volumes of infusion solutions is the main principle of low-volume IT. Recommendations for the administration of Reosorbilact comply with this principle. The low osmolarity of Reosorbilact and its ability to improve the osmotic properties of blood justify the use of this drug in women with PE.

Conclusions. 1. PE occurs in 2-8 % of all pregnancies. 2. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE. 3. Restricted IT mode improves the consequences of PE treatment. 4. Osmotically active drugs (Reosorbilact) are prescribed for this purpose.
Tranexamic acid for upper gastrointestinal bleeding
Authors: Fenger-Eriksen C.
Published: July 2021

Background. In patients with trauma and significant bleeding or risk of significant bleeding it is advised to administer tranexamic acid (TXA) intravenously as early as possible at a loading dose of 1 g for 10 minutes, followed by 1 g for 8 hours. The effectiveness of TXA has been proven in various pathological conditions in large trials. TXA has been shown to reduce the need for blood transfusions.

Objective. To describe the use of TXA for upper gastrointestinal tract (GIT) bleeding.

Materials and methods. Analysis of literature sources on this topic.

Results and discussion. The mechanism of TXA action is to inhibit plasminogen activation and reduce fibrin degradation, however, its features are not clear. With the use of TXA, the strength of the blood clot and its resistance to lysis increases. The use of TXA in gastrointestinal bleeding was analyzed in the Cochrane Review (2012) of seven randomized controlled trials involving 1,654 patients. TXA was compared with placebo, lansoprazole or cimetidine. There was a lower mortality in the TXA group, however, after taking into account possible bias, this trend did not persist. A randomized placebo-controlled study of HALT-IT included 12,009 patients with gastrointestinal bleeding who were prescribed TXA (loading dose of 1+3 g for 24 hours) or placebo. The primary endpoint was death from bleeding within 5 days. There were no differences in mortality or re-bleeding. The TXA group had a higher frequency of deep vein thrombosis and pulmonary embolism. One of the reasons for the lack of benefits of TXA in gastrointestinal bleeding is that the onset of such bleeding is difficult to detect immediately, and to achieve the effect of TXA as early as possible administration is necessary. In this case, >80 % of patients sought medical help >3 hours after the onset of bleeding. In addition, in 50 % of patients, the bleeding was due to esophageal varices due to liver disease. It is known that most coagulation factors are synthesized in the liver, so liver failure is a common cause of coagulopathies. When the liver is affected, the levels of vitamin-K-dependent procoagulants (coagulation factors II, VII, IX and X), coagulation factor V, as well as anticoagulants (proteins C and S, antithrombin) decrease. Levels of fibrinogen and acute phase proteins remain normal or increase. In case of liver failure, hyperfibrinolysis occurs and at the same time the risk of thrombosis increases significantly. In such patients there is a decrease in hemostatic blood reserve. In general, contraindications to the use of TXA include severe renal failure, seizures, disseminated intravascular coagulation without bleeding, arterial or venous thromboembolism, active bleeding from the upper urinary tract.

Conclusions. 1. TXA is effective for most types of bleedings, however, there are some exceptions. 2. One should remember the side effects of TXA and follow the recommended method of administration. 3. TXA is not suitable for the treatment of gastrointestinal bleeding.
Intoxication syndrome in the practice of internist
Authors: Halushko O.A.
Published: July 2021

Background. Intoxication syndrome (IS) is one of the most common syndromes in the medical practice, but its exact scientific outline has not yet been established. This is due to a variety of toxic factors, a large polymorphism of symptoms, and complex interactions between the processes of toxin production and detoxification.

Objective. To describe the main features of IS and its treatment.

Materials and methods. Analysis of literature sources on this issue.

Results and discussion. The morphological basis of IS is the subcellular interaction between the toxin and the receptor. IS develops if the toxins’ entry or formation outweigh their elimination. Intoxications are divided into exogenous and endogenous. The diagnostic criteria for exogenous intoxications are the contact of the patient with the substance that caused the intoxication and the corresponding damage to the organs. Exogenous intoxications have a clear clinical picture, and the introduction of specific antidotes or antitoxins is the best treatment. In turn, endogenous IS is mediated by the accumulation of bacterial endotoxins, excess amounts of physiological metabolic products, biologically active substances and mediators. Natural ways of detoxification include metabolism, excretion and immune mechanisms. Infusion detoxification (IDT) with a significant load by crystalloids and multicomponent drugs is a mandatory treatment for both exogenous and endogenous IP. In most cases, the volume of infusion should be 25-35 ml/kg body weight. Requirements for the ideal drug for detoxification include hypervolemia, improving microcirculation and rheological properties of blood, correction of electrolyte disorders and disorders of acid-base balance, increase of diuresis and peristalsis. All these effects are typical for Reosorbilact (“Yuria-Pharm”). In general, the IDT program may include classical and balanced crystalloids (800-1500 ml), Reosorbilact (600-800 ml), specialized solutions (100-200 ml), and symptomatic drugs. The optimal duration of treatment with Reosorbilact is 7 days.

Conclusions. 1. Exact scientific characteristics of IS are still missing. 2. IDT is the mandatory method of treatment of exogenous and endogenous IS. 3. Reosorbilact is the main component of IDT in any IP, as it affects the main links of the pathogenesis of the latter.
Treatment of trophic ulcers of the lower extremities
Authors: Cherniak V.A.
Published: July 2021

Background. In 50 % of cases trophic ulcers (TU) are caused by chronic venous insufficiency, in 10 % – by arterial insufficiency, in 5 % – by disorders of nerve trophic. Treatment of ischemic TU includes conservative and surgical tactics, wound dressings, pain management, use of hydrogel dressings, antibacterial therapy, measures to improve blood circulation.

Objective. To describe the treatment of TU of the lower extremities.

Materials and methods. Analysis of literature data on this issue.

Results and discussion. The pathogenesis of chronic venous ulcers includes persistent venous hypertension and microcirculation disorders. Varicose veins, postthrombotic disease and congenital vascular malformations are the main causes of such ulcers. In postthrombotic disease affecting the veins of the lower extremities in patients with severe symptoms, surgery (femoro-femoral or femoro-caval bypass), percutaneous endovascular recanalization (stenting, balloon angioplasty), combined surgical-endovenous desobliteration, transposition of the segmentary vein valves and relocation of autoveins may be considered. After the operations on veins, surgical interventions for TU are performed. Antibiotic therapy (Leflocin, “Yuria-Pharm”, 500 mg intravenously once before surgery), topical antiseptic Dekasan (“Yuria-Pharm”) and skin disinfectant Gorosten (“Yuria-Pharm”) are used to accompany interventions for postthrombotic disease. Vasodilation disorders, which are one of the links in the TU pathogenesis, are the result of endothelial dysfunction and nitric oxide (NO) deficiency. To eliminate these factors, L-arginine (Tivortin, “Yuria-Pharm”) is used. Tivortin catalyzes the synthesis of NO in endothelial cells, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium, prevents the formation and progression of atherosclerotic plaques. In the treatment of lower extremity ischemia and TU, it is advisable to use the infusion therapy scheme “TRIO”: Reosorbilact 400 ml + Latren 400 ml + Tivortin 100 ml (“Yuria-Pharm”).

Conclusions. 1. Minimally invasive methods are effective and minimally traumatic option of TU treatment, which should actively displace open methods. 2. Conservative TU treatment includes the microcirculation improvement, the use of antiseptics, strengthening of the vascular wall, antibacterial and rheological support.
Personalized oncology as a global uniting aim of clinical experience, unified protocols and modern technologies on the way to the victory against neoplastic processes
Authors: Herasymenko O.V.
Published: July 2021

Background. According to the prognoses, by 2025 the global cancer incidence will increase to 24 million cases per year, and mortality – up to 16 million cases. The annual growth rate of tumors number exceeds the growth rate of global population, which justifies the feasibility of improving the diagnosis, treatment and prevention of these diseases.

Objective. Describe the main features of personalized oncology.

Materials and methods. Analysis of regulatory documents and literature sources on this topic.

Results and discussion. In their work Ukrainian oncologists are guided by the domestic documents and the documents of international societies. Personalization of treatment involves taking into account such characteristics of the disease as its stage, morphological affiliation of cells and molecular genetic characteristics of the tumor, as well as such patient characteristics as sex, age, general somatic status, comorbidities, and place of residence. Personalized medicine is a set of methods for diagnosis, treatment and prevention of pathological conditions, based on the individual characteristics of the patient (genetic, epigenetic, transcriptomic, proteomic, metagenomic markers, phenotypic features). For the introduction of personalized medicine into oncology it is necessary to use the molecular genetic profiling of the tumor, to assess the risks with the help of several specialists, to involve the patient in decision-making regarding treatment and diagnostic measures. The main tools for the widespread introduction of personalized medicine include qualified specialists, laboratories of pharmacogenetics and pharmacokinetics, the formation of competencies in health care providers and the development of personalized pharmacy. The main result is the widespread implementation of treatment programs using personalized protocols with targeted delivery of the drug to the appropriate targets, taking into account the state of the body of the particular patient at the specific time.

Conclusions. 1. The incidence of cancer is steadily growing. 2. Personification of treatment involves taking into account the stage of the disease, morphological affiliation of cells and molecular genetic characteristics of the tumor, as well as individual characteristics of the patient. 3. For the introduction of personalized medicine in oncology it is necessary to use molecular genetic profiling of the tumor, to assess the risks with the help of several specialists, to involve the patient in decision-making regarding treatment and diagnostic measures.
Rheo-STAT project. New options of the intoxication syndrome therapy from the point of view of the evidence: accent on pneumonia
Authors: Thi Hoa Dinh , Beridze S.
Published: July 2021

Background. Pneumonia is a widespread disease and an often cause of hospitalizations both in Vietnam and Georgia. The supportive treatment of pneumonias includes the respiratory support, the support of fluid and electrolyte balance, parenteral nutrition and some additional drugs (analgesics, corticosteroids, inotropes). Rheo-STAT study is an interventional open-label randomized controlled study of Reosorbilact (“Yuria-Pharm”) effectiveness in pneumonia treatment. The study was held in 7 countries (Ukraine, Moldova, Georgia, Vietnam, Kazakhstan, Kyrgyzstan, Uzbekistan).

Objective. To assess Reosorbilact effectiveness in the elimination of the intoxication syndrome.

Materials and methods. 628 adult patients with sepsis, peritonitis, pneumonias and burns took part in this study. The pneumonia subgroup included 150 people (62 % males, mean age – 41.3 years, 33 % had some concomitant diseases). Inclusion criteria were the following: age – 18-60 years, community-acquired pneumonia and antibiotic therapy, administered not later than after 48 hours after the disease beginning, at least IV class according to PSI/PORT index, the presence of informed consent, baseline level of SOFA points ≥2. The assessment according to the SOFA scale on the 3rd day of treatment in comparison to the baseline level was the primary endpoint. Secondary endpoints included the change of mean result according to other scales (APACHE II, SAPS II, MODS, PSI/PORT, CURB-65) and changes of biochemical, immunological and integral markers of endogenous intoxication.

Results and discussion. Infusion therapy with the help of Reosorbilact (200-400 ml per day) led to the increase of circulating blood volume and to the decrease of total infusion volume without any risk of volume overload. Lactate – one of the Reosorbilact components – did not increase the endogenous lactate level, which testifies a high safety. Inclusion of Reosorbilact into the combined treatment in 3 days led to the body temperature decrease from 39.37 to 36.77 °С, heart rate decrease from 105.27 to 77.81 bpm, leucocytes amount – from 9.38 to 6.64×109/L. Blood oxygenation also increased at the 3rd day of treatment, and PSI/PORT index decreased from 101.47 to 49.07. Pulmonary edema or pleural effusion were not revealed in any patients.

Conclusions. 1. Pneumonia is a widespread disease, which often requires hospitalization. 2. Infusion therapy with the help of Reosorbilact increases the circulating blood volume without a risk of volume overload. 3. Inclusion of Reosorbilact into the combined treatment of pneumonia in 3 days leads to the decrease of body temperature, heart rate, leucocyte amount and to the increase of blood oxigenation.
Procedural sedation – a patient’s whim or a necessity?
Authors: Domoratskyi O.E.
Published: July 2021

Background. Procedural sedation (PS) is a condition that allows patients to avoid discomfort when undergoing certain painful manipulations on the background of stable hemodynamics and respiration and maintaining the ability to respond adequately to verbal commands or tactile stimulation. PS is most often used in dentistry, maxillofacial surgery, endoscopy, ophthalmology, otorhinolaryngology.

Objective. Describe the main features of the PS.

Materials and methods. Analysis of literature data on this topic.

Results and discussion. Risk groups during PS include patients with cardiovascular decompensation, morbid obesity, obstructive sleep apnea, grade III-IV chronic renal failure, liver decompensation, as well as age over 70. The conditions for safe PS are as follows: all medical staff are trained to provide cardiorespiratory resuscitation; there is a constant quick access to resuscitation equipment; a routine pre-procedure assessment of the patient’s condition (especially the upper respiratory tract) was carried out; pre-procedure fasting was prescribed; careful monitoring of the patient’s condition is provided. The main scales for sedation assessment include Ramsay Sedation Scale, Sedation Agitation Scale, Motor Activity Assessment Scale, Vancouver Interactive and Calmness Scale, Richmond Agitation-Sedation Scale, Adaptation to Intensive Care Environment, Minnesota Sedation Assessment Tool. Midazolam, propofol, dexmedetomidine can be used for PS. Minimal sedation (anxiolysis) is a medical condition in which the patient responds normally to voice commands. Cognitive function and coordination in this condition may be impaired, however, cardiorespiratory function remains unchanged. Such sedation is prescribed in traumatology, maxillofacial surgery, urology, gynecology, plastic surgery. Moderate sedation is a medical suppression of consciousness in which the patient responds to voice commands accompanied by light tactile stimulation. Adequate respiration and functioning of the cardiovascular system is maintained. Diazepam/sibazone, midazolam, dexmedetomidine are prescribed for this purpose. The latter is recommended for fiber-optic intubation in a state of complete consciousness. The dangers of PS include passive aspiration and ventilation disorders, which leads to hypoxia and hypercapnia. Caution should be taken with propofol due to the possible development of respiratory depression and hemodynamics, pain in the vein during administration. Dexmedetomidine does not cause respiratory depression, however, this does not eliminate the need for monitoring.

Conclusions. 1. Adequate sedation during surgery is a logical component of the intervention if the regional methods of anesthesia are applicated. 2. Sedation outside the operating room will account for more and more of the use of anesthetics. 3. There is a need for clear regulation of PS. 4. When choosing a drug one should take into account the purpose of its administration, curability of complications, comfort and safety of the patient.
An Integrated Approach for Table Detection and Structure Recognition
Authors: Phan Hai-Hong
Published: July 2021

Detecting and identifying the table structure is an important issue in document digitization. Although there have been many great strides based on current deep learning techniques, table structure identification is still a difficult and difficult problem, especially when solving the problem of digitizing text in practice. The paper proposes a solution to digitize table documents based on the Cascade R-CNN HRNet network to detect, classify tables and integrate image processing algorithms to improve table data identification results. The proposed algorithm proved effective on real data - the hydrometeorological station record book contains tables including simple and complex structures tables with over 98% accuracy.
The Role of Purchasing Decisions Mediating Product Quality, Price Perception, and Brand Image on Customer Satisfaction of Kopi Janji Jiwa
Authors: Rivai Janes , Zulfitri
Published: July 2021

This research study analyses and determines the role of purchasing decisions mediating product quality, price perception, and brand image on Kopi Harapan Jiwa's customer satisfaction. The population in this study were customers of Kopi Janji Jiwa 135 respondents. The use of samples with purposive sampling technique and target customers who have bought or consumed Kopi Janji Jiwa. Stages in data analysis with a structural equation model on partial least squares to see the effect of exogenous variables on endogenous variables. The structural model is known to moderate purchasing decisions, while customer satisfaction has a strong influence. The predictive capability is large, and the model performance between the structural and measurement models is in a good category. According to hypothesis testing, it was found that product quality and price perception did not significantly affect purchasing decisions, but the brand image had a significant influence on purchasing decisions. Product quality and price perception were found to significantly affect customer satisfaction while purchasing decisions were found to have no significant effect. The brand image was found not to have a significant effect on customer satisfaction. Meanwhile, purchasing decisions found a significant influence. In purchasing decisions, there is a significant influence on customer satisfaction.
Performance Evaluation of Equity Funds: 2017-2019
Authors: Sianipar Rivandi Uchok Imanuel , Mulyana Bambang , Pramudena Sri Marti
Published: July 2021

Mutual funds are said to perform very well if they can provide a higher rate of return and minimize risk. This study aims to find out if the performance of stock mutual funds has a better performance than the market as a comparison (JCI) using sharpe and jensen methods and to find out if there is a difference in the rating of stock mutual fund performance measurement results between sharpe method and Jensen method.The analysis results using Sharpe method and Jensen method show that 30 mutual funds have a good performance where the performance value of stock mutual funds from sharpe and jensen method is above the average market value (JCI). The result of Sharpe method in 2017 shows that the best performing stock mutual fund is Batavia Stock Fund Optimal Stock Fund. In 2018 and 2019, the best performance was the Sucorivest Maxi Fund, while the result of Jensen's method in 2017, the best performing stock mutual fund was the Sucorivest Maxi Fund. In 2018, it showed the best performance, namely Trim Kapital Equity Fund. The Bahana Trailblazer Fund occupied the highest performance value in 2019. However, each equity fund will experience a change in its rating every year. For the best mutual funds in this research year.
Historia de las profesoras rurales en Cundinamarca-Colombia (1950-1970) : dirigentes de los campesinos, para el desenvolvimiento de la economía y la agricultura.
Authors: Rojas Pinzón Nataly Ginnette , Campos Ferreira Nilce Vieira
Published: July 2021

El objetivo del artículo es investigar el contexto rural de Colombia y, a partir de eso, analizar cómo fueron creadas las escuelas normales rurales en Cundinamarca, cuáles fueron los modelos de formación utilizados, y los decretos y leyes que marcaron la educación entre los años de 1950 a 1970. Para conocer el contexto y las transformaciones educacionales colombianas, el texto encuentra fundamentos en la Misión Rural del Departamento Nacional de Planeación de Colombia y las memorias de los ministros de Educación. Las memorias eran escritas durante los años de gobierno y en ellas podemos identificar diferentes aspectos, entre ellos: el surgimiento de las escuelas rurales, los modelos formativos de esas escuelas y como fueron instruidas las profesoras para ejercer; eso nos permite proceder a un análisis exacto considerando algunos avances, retrocesos y problemáticas en el modelo de educación colombiano, bien como factores económicos, políticos, sociales y culturales que influenciaron la educación rural en ese periodo. Destacamos que la formación de profesoras rurales cundinamarquesas se encontraba relacionada con los contextos socioculturales, su experiencia y las reformas institucionales, que luego se convirtieron en aspectos esenciales para el proceso de formación, orientación y capacitación de ellas.
Indicaciones de la drospirenona más allá de la anticoncepción.
Authors: Espitia De La Hoz Franklin José
Published: July 2021

Introducción: la drospirenona es una progestina de tercera generación, derivada de la espironolactona; la cual goza de actividad anti-mineralocorticoide y antiandrogénica, además de una alta eficacia anticonceptiva. El objetivo de esta revisión consistió en evaluar la efectividad y seguridad de la drospirenona, más allá de sus efectos anticonceptivos. Métodos: se hizo una revisión sistemática de la literatura en las bases de datos electrónicas (Medline vía PubMed, Central, CINAHL, Cochrane Database of Systematic Reviews (plataforma Wiley), entre otras), a través de términos de búsqueda libres y estandarizados. Los desenlaces evaluados incluyeron tratamiento de la endometriosis, síndrome de ovario poliquístico, sangrado uterino disfuncional, síndrome premenstrual y terapia de reemplazo hormonal, así como los efectos adversos. La búsqueda se limitó a artículos y revisiones bibliográficas publicadas a partir de 1990 hasta el 2020, en inglés y español. Resultados: se incluyeron 48 publicaciones. La drospirenona demostró ser eficaz y segura en el tratamiento de condiciones ginecológicas frecuentes como: la endometriosis, síndrome de ovario poliquístico (SOP), sangrado uterino disfuncional, síndrome premenstrual y en la terapia de reemplazo hormonal. Se observó una baja frecuencia de efectos adversos. Conclusiones: la drospirenona es eficaz y segura para el tratamiento de algunas afecciones ginecológicas de frecuente consulta en la práctica diaria, con ventajas adicionales en su régimen 24/4, además de escasa presencia de efectos adversos. Se requiere mayor evidencia más allá de la anticoncepción, para promover su recomendación e indicaciones en la práctica clínica.
MODIFICATION OF SEPARATE RATIO TYPE EXPONENTIAL ESTIMATOR: A POST-STRATIFICATION APPROACH
Authors: Rabiu Adam , Abubakar Yahaya  , Muhammad Abdulkarim
Published: July 2021

In this research, modification of separate ratio type exponential estimator introduced in an earlier study is proposed. Expressions for the bias and mean square error (MSE) of the proposed estimator up to first degree of approximation are derived. The optimum value of the constant which minimize the MSE of the suggested estimator is also obtained. In the same vein, efficiency comparisons between the proposed estimator and some related existing ones under the case of post-stratification is conducted. Empirical studies have been conducted to demonstrate the efficiencies of the suggested estimators over other considered estimators. The proposed MSE and Percentage Relative Efficiency (PRE) were used to evaluate the achievement of the modified estimator.
EFFECTS OF BANDITRY ON RUMINANT ANIMAL PRODUCTION IN KATSINA STATE
Authors: Aruwayo Adebayo , Adeola Segun S. , Adeleke R. A.
Published: July 2021

Ruminant animal production has recently come under a big threat due to the challenges of insecurity. This study was conducted to assess the effect of banditry on ruminant animal production in Katsina state. Using a two-stage sampling procedure,   60 ruminant animal farmers (keeping cattle, sheep and goats) in the state were selected for the study. In the first stage, three livestock markets from each of the state agricultural zones namely: Mai’dua, Charanchi and Sheme markets were purposively selected based on the volume of ruminant animal sold there. The use of livestock markets was because of the difficulty of accessing the famers in their homes due to the prevalent security challenges in the study area. In the second stage, 60 questionnaires were randomly distributed to ruminant animal producers identified in the markets. However, only 44 were used due to incomplete information. The information gathered was analyzed using descriptive statistics. The study revealed that 66% of the respondent were within the age of 41-60 years, married (93%) and educated (57%). Similarly, majority of the respondents (64%) have large families. According to the study, the most prominent system of production used was Semi-intensive (29%) and forage was the major source of feed (70%). The study concluded that banditry has significantly reduced the ruminant production in the study area with untold negative effect on their standard of living and that government should improve security in the study area