Archive of Clinical Medicine http://ojs.ifnmu.edu.ua/index.php/acm <p>The Journal of Research and Practice “Archive of Clinical Medicine” is a journal covering innovative research and practice in medicine. It publishes the results of original clinical research, review papers, case reports <span>and the results in sphere of medical education.</span></p><div class="page" title="Page 2"><div class="layoutArea"><div class="column"><p>The Journal is on the <a href="http://mon.gov.ua/activity/nauka/atestacziya-kadriv-vishhoyi-kvalifikacziyi/perelik-vidan/perelik-naukovix-faxovix-vidan.html" target="_blank">List of Specialized Editions</a> in which the main results of theses are allowed to be published (The Order of Ministry of Education and Science of Ukraine of 16.05.2016, No 515) </p></div></div></div><p><span>p-ISSN <span><strong>2312-7007 (<span lang="EN-GB">Ukrainian ed. Print)</span></strong></span></span></p><p><span>e-ISSN <strong><span lang="EN-US">2414-9853 (<strong><span lang="EN-GB">English ed. Online)</span></strong></span></strong></span></p> Ivano-Frankivsk National Medical University en-US Archive of Clinical Medicine 2312-7007 Authors who publish with this journal agree to the following terms:<br /><ol type="a"><li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="http://creativecommons.org/licenses/by/3.0/" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="http://opcit.eprints.org/oacitation-biblio.html" target="_new">The Effect of Open Access</a>).</li></ol> Clinical Effectiveness of Cardiocytoprotective Therapy in Patients with Acute Coronar Syndrome (ACS) – Myocardial Infarction (MI), Who Were Performed Balloon Angioplasty and Coronary Artery Stenting http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1027 <p>The aim of the study was to increase the efficiency of restorative treatment of patients with Acute Coronary Syndrome (Miocardial Infarction) by incorporating the protocol therapy for the course of parenteral use of L-arginine and L-carnitine (Tivorel).</p> <p>It has been determined that patients with ACS (MI) after percutaneous coronary intervention often develop reperfusion syndrome with manifestations of left ventricular insufficiency and rhythm disturbances. Substantial clinical and functional improvement was noted under the influence of standard medical treatment in patients of control group. At the same time postinfarction remodeling with systolic and diastolic function of the heart, with the development of heart failure syndrome and endothelial dysfunction of blood vessels, and also remained resistant to extrasystole therapy, progressed.</p> <p>Patients in the experimental group under the influence of complex medical treatment with the inclusion of L-arginine and L-carnitine marked a significant decrease in the frequency of violations of rhythm and conduction for the second day of observation, as well as a decrease in the manifestations of post-infarction remodeling of LV, which ultimately manifested a significant improvement in myocardial contractility (EF increased by 13%) and decreased diastolic dysfunction. Improvement of the inotropic function of the heart and a significant reduction in the frequency and severity of reperfusion arrhythmias was achieved precisely due to cardiometabolic effects of L-carnitine. In addition, in patients undergoing additional treatment with L-arginine and L-carnitine after 10 days of treatment, the activity of ET-1 was significantly lowered and the concentration of nitrogen oxide metabolites in the blood plasma increased and reach the level of healthy subjects (p&gt;0.05). So, they recovered the endothelial function of the vessels.</p> Mykola Shved Lesia Tsuglevych Svitlana Heryak ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-05-29 2019-05-29 25 1 10.21802/acm.2019.1.2 Modern View on the Problem of Treating Minor Dentition Defects with the Use of Zirconium Oxide Ceramic Resin-Bonded Prostheses http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1038 <p><strong>The objective </strong>of the research was to substantiate the effective method of treating minor dentition defects in the lateral and frontal areas considering anatomic features, functionality and aesthetic appearance of the prosthesis.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Materials and methods.</strong> A new approach to the problem of treating minor dentition defects with the use of zirconium oxide ceramic resin-bonded prostheses was proposed. The method of its manufacturing was described and the indications to the application were clearly explained. The comparative analysis with similar prostheses was conducted and the advantages of the proposed prosthesis were proved. Ceramic resin-bonded prosthesis allowed us to restore the dentition integrity in the presence of small bounded edentulous spaces in the lateral region and to provide high aesthetic qualities and bio-inertness of the prosthesis with maximum approximation to the physiological characteristics of natural teeth.</p> <p>&nbsp;&nbsp;&nbsp; <strong>Results. </strong>Thirty-eight patients with small bounded edentulous space in the lateral region were treated with the use of zirconium oxide resin-bonded prosthesis for 18 months. The obtained results of prosthetic treatment indicated that the proposed prosthesis provided an opportunity to restore the aesthetic appearance and integrity of the dentition, to prevent the occurrence of the deformations and to ensure the functionality of the dento-facial system.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </strong><strong>Conclusions.</strong> The framework made of zirconium oxide allowed us to significantly reduce the depth of hard dental tissue preparation resulting in a great aesthetic appearance thereby providing an opportunity to significantly expand the indications for use. The remote results of treatment indicated the absence of marginal coloration at the margin of indirect restoration and hard dental tissues, namely the marginal ridge, ensuring good aesthetics and functional integrity of the restorative construction.</p> Iryna Kumgyr Zinoviy Ozhogan ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-05-30 2019-05-30 25 1 10.21802/acm.2019.1.4 Clinical Features, Course and Indicators of Endothelial Function and Systemic Immune-Inflammatory Response in Patients with Chronic Coronary Artery Disease Depending on Affected Coronary Artery Number http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1041 <p>In Ukraine, cardiovascular diseases are the leading cause of morbidity and rank second among primary diseases. Nowadays the most common cardiovascular disease is coronary artery disease that accounts for 33.7% of total cardiovascular pathology cases.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The objective</strong> of the research was to study clinical manifestations and indicators of endothelial function and immune-inflammatory response in the patients with coronary artery disease, heart failure with preserved left ventricular ejection fraction depending on affected coronary artery number.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Materials and methods. </strong>The study included 62 patients with chronic coronary artery disease, heart failure with preserved left ventricular ejection fraction who underwent coronary artery stenting. Among the examined patients, males prevailed – 52 (83.9%) individuals. All the patients were randomized according to the number of the affected coronary arteries and divided into two groups. Clinical manifestations were studied; the patients’ quality of life was assessed; the functional state of the myocardium was determined according to the six-minute walk test; the indicators of endothelial dysfunction were analyzed by endothelin-l level; the indicators of immune inflammatory response were analyzed by serum levels of C-reactive protein and tumor necrosis factor.&nbsp;</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Results. </strong>In the examined patients, the clinical course did not depend on the number of the affected coronary arteries; however, to reduce the incidence of cardiac pain, the patients with multivessel coronary artery disease received 2±0.1 extra nitroglycerin tablets.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conclusions. </strong>Quality of life and physical well-being were better in the patients with single-vessel coronary artery disease (p&lt;0.05). Myocardial functional reserves were lower in the patients with multivessel coronary artery disease (p&lt;0.05), while the intensity of immune inflammation and endothelial dysfunction reduced in case of multivessel coronary artery disease that confirmed a strong correlation between the indicators of tumor necrosis factor and endothelin-l.</p> Iryna Kupnovytska Nelia Romanyshyn ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-06-02 2019-06-02 25 1 10.21802/acm.2019.1.5 Peculiarities of the Course and Provision of Medical Care to Patients with Acute Coronary Syndrome in the Precarpathian Region http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1052 <p><strong>Abstract</strong><strong>.</strong> Cardiovascular diseases are the first ones in mortality among other diseases. Particular attention should be paid to patients after acute coronary syndrome, since their quality of life, the possibility of restoration of work capacity.</p> <p><strong>Objective of the research.</strong> To evaluate indicators of medical care provision for patients with acute coronary syndrome in the Precarpathian region.</p> <p><strong>Materials and methods.</strong> The medical-geographical indicators, data of the local registry (2014-2018) included clinical and objective parameters, peculiarities of the course, rehabilitation and treatment of patients with acute coronary syndrome.</p> <p><strong>Results</strong><strong>.</strong> The peculiarities of the course of acute coronary syndrome, clinical characteristics of patients depend on the form of IHD and the applied method of ACS treatment. There is an increase of the number of PCI performance and the reduction of TLT, the percentage of admission of patients up to 2 hours remains low. The increase of PCI performed in the districts of the region in the dynamics from 2014 to 2018 has been determined, as well as the geographical peculiarities of the Ivano-Frankivsk region. The percentage of patients’ undergoing rehabilitation after acute coronary syndrome remains low.</p> <p><strong>Conclusions</strong><strong>.</strong> The Precarpathian region has a number peculiarities that are related to the location of the region. Taking into account the characteristics will contribute to the improvement of the organizational model of medical care provision in the region.</p> Roksolana Nesterak ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-06-03 2019-06-03 25 1 10.21802/acm.2019.1.6 Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1036 <p>Echocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period.</p> <p><strong>The</strong> <strong>objective</strong> of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period.</p> <p><strong>Materials</strong> <strong>and</strong> <strong>methods. </strong>There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender.</p> <p><strong>Results. </strong>The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling.</p> <p><strong>Conclusions</strong><strong>. </strong>Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well.&nbsp;</p> Khrystyna Levandovska ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-06-30 2019-06-30 25 1 10.21802/acm.2019.1.7 Optimization of the Prediction of Arterial Hypertension Development in the Patients with Type 2 Diabetes Mellitus on the Background of Undifferentiated Connective Tissue Dysplasia http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1048 <p>In recent years, disorders of connective tissue metabolism that are involved in the pathogenesis of many diseases have attracted increasing attention. They are of particular importance in the presence of connective tissue dysplasia. Undifferentiated forms, being a frequent component of comorbid pathology, are quite widespread among the general population. Among comorbidities, arterial hypertension, diabetes mellitus and undifferentiated connective tissue dysplasia in various combinations are more often observed.</p> <p>&nbsp;</p> <p><strong>The objective of the research </strong>was to determine the prognostic significance of undifferentiated connective tissue dysplasia in the development of arterial hypertension in the patients with type 2 diabetes mellitus.</p> <p><strong>Materials and methods.</strong> To determine the prognostic significance of undifferentiated connective tissue dysplasia in the development of arterial hypertension, there was conducted an analysis of hospital discharge reports received by the patients with type 2 diabetes mellitus duration of at least 2 years who were treated two to five years ago. The predictive significance of the factors selected for the analysis was determined through applying the regression analysis using a logistic regression model, the Wald test.</p> <p><strong>Results. </strong>The test for coincidence of the predicted and observed values revealed that the specificity of the regression model was 87.2%, while its sensitivity was 89.7%. The overall predictability was 88.5%.</p> <p><strong>Conclusions. </strong>These are quite high indicators that allow us to apply the proposed model to detect the patients with type 2 diabetes mellitus being at high risk of arterial hypertension.</p> Liudmyla Sherstiuk ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-06-30 2019-06-30 25 1 10.21802/acm.2019.1.8 Morphometric Characteristics and Features of Metachronous Breast Cancer http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1042 <p>An important morphological criterion for the development of the degree of malignancy of breast cancer is the change in the structure of cell nuclei. At the same time, both the morphometric parameters of metachronous breast cancer and their connection with the molecular biological characteristics of these tumors are currently unknown.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The objective</strong> of the research was to identify metachronous malignant disease in the patients with breast cancer.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Materials and methods. </strong>The study is based on a retrospective analysis of tumors in 63 patients with breast cancer, who developed uterine cancer or ovarian cancer within 5 years after diagnosis of breast cancer. All the patients received treatment at the Ivano-Frankivsk Regional Clinical Oncology Center. The criterion for selecting patients in the study was the presence of gynecologic cancer after the treatment of breast cancer. The age of patients with breast cancer involved in the study ranged from 24 to 83 years, averaging 56.8±1.5 years.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Results and discussion. </strong>The maximum values ​​of the perimeter, radius, and area of ​​cell nuclei (19.21±0.7, 3.05±0.4 and 36.3±0.9, respectively) were observed in tumors of the patients with metachronous breast cancer. <br> The improvement of the perimeter, radius, and area of ​​tumor cell nuclei in the patients with metachronous breast cancer was associated with an increase in the size of the tumors and the presence of metastases in regional lymph nodes.</p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conclusions. </strong>The morphometric sign of the high risk of developing metachronous breast cancer is the increase in the perimeter, radius, and cell nucleus area on the background of increased proliferative activity of low-grade cancer in the presence of large tumors and metastases in regional lymph nodes.</p> Iryna Dyakiv Anna Kryzhanivska ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-06-30 2019-06-30 25 1 10.21802/acm.2019.1.9 Effeciency of Initial-I Stage Generalized Periodontitis Treatment Among Medical University Students According to Indicators of Oral Cavity Prooxidant-antioxidant System http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1032 <p>Periodontal diseases are one of the most important problems in dentistry, due to its very high dissemination. Inflammatory processes in periodontal tissues are more common among young people, which, in the future, without adequate treatment lead to irreversible changes in structure of cellular bone. This causes development of new effective therapeutic complexes aimed at eliminating etiopathogenetic factors development of periodontal tissues inflammatory diseases and the targeted influence on the pathological processes in these tissues.</p> <p><strong>The objective of the study</strong> was to analyze the efficiency of suggested initial-I stage generalized periodontitis treatment among second-year students of medical university.</p> <p><strong>Materials and methods. </strong>To achieve this goal, we examined and treated 50 students with initial-I stage of generalized periodontitis without somatic pathology, which were divided into two groups, depending on treatment method. First group included 25 students who received advanced treatment; second group included 25 students, who received usual treatment. Control group consisted of 20 clinically healthy students. The state of oral cavity prooxidant-antioxidant system was determined by the level of malone dialdehyde (MDA), diene conjugates (DK), superoxide dismutase (SOD) activity, glutathione-S-transferase (G-ST), and the activity of glutathione peroxidase (GPO).</p> <p><strong>Results and discussion. </strong>Periodontal diseases, namely, initial-I stage of GP, are accompanied by an imbalance of oral cavity prooxidant-antioxidant system indicators. This is confirmed by an increase number of MDA and DK (p&lt;0.001), and a decrease in SOD, G-ST, GPO (p&lt;0.001) compared to clinically healthy students.</p> <p><strong>Conclusions. </strong>The results of GP treatment in first group were significantly better in relation to the second one (p&lt;0.05), indicating the effectiveness of the proposed advanced treatment of initial-I stage of GP.</p> Tetiana Pavliuk Mykola Rozhko ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-06-30 2019-06-30 25 1 10.21802/acm.2019.1.3 Improvement of Students’ Training Level in Higher Educational Institutions http://ojs.ifnmu.edu.ua/index.php/acm/article/view/1022 <p><strong>Objective:</strong> to determine the effective factors of impact on the internal motivation stimulation for students’ study.</p> Nataliia Tymochko ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-05-28 2019-05-28 25 1 10.21802/acm.2019.1.1