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The Modern Aspects of Acute Heart Failure Management
Get PDFAcute heart failure (AHF) is one the most common causes of morbidity and mortality. The prognosis of patients admitted with AHF remains dismal, with over 20% experiencing recurrent HF admission and over 20% dying during the first year after initial admission.The purpose of this study was to provide contemporary perspective for hospital management of AHF within the context of the most recent data and to provide guidance, based on expert opinions, to practicing physicians and other healthcare professionals. Material and methods: In this paper we reviewed of current updated European Cardiology Society (ESC) HF guideline (2016) and modern trials for AHF from Medscape database. Results: Diuretics are the main medications in the treatment of patients with AHF and signs of fluid overload and congestion. Intravenous vasodilators are the second most used agent in AHF. Their use was shown to be associated with lower mortality, and a delay in administration was associated with a higher mortality.Use of an inotropic medications (such as dopamine, dobutamine, milrinone, levosimendan, epinephrine, norepenephrine) should be reserved for patients with a severe reduction in cardiac output resulting in compromised vital organ perfusion, which occurs most often in hypotensive AHF. Conclusion: Acute heart failure is a life-threatening medical condition, which needs emergency management for death prevention
Our Experience in Treatment of Testicular Torsion in Children
Get PDFThe objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with testicular torsion and to improve the process of providing specialized care.Materials and methods. The study included 141 boys with testicular torsion. 133 patients underwent emergency surgery, 8 patients underwent manual detorsion.Results. Treatment was successful in 88 patients; in 53 cases, orchiectomy was performed.Conclusion. Personal observations and the analysis of the literature on testicular torsion in boys indicate the need for early diagnosis and immediate surgery
Cardiorehabilitation of Patients with Acute Coronary Syndrome Who Were Performed Coronary Arteries Revascularization
Get PDFIn patients with acute coronary syndrome who were performed coronary arteries’ revascularization, in the postoperative period disorders of hemodynamics and heart rate variability often develop. The aim of our work was to optimize the cardiac rehabilitation of such patients by individualization of physical activity depending on the state of systolic and diastolic left ventricular dysfunction and heart rate variability. 40 patients with acute coronary syndrome and coronary artery revascularization were included into the experimental group. The control group consisted of 20 patients of the same age, clinical and laboratory manifestations of ACS who were treated according to the protocol of Ministry of Health of Ukraine. In both groups of patients clinical efficacy of cardiac rehabilitation process was evaluated according to the dynamics of clinical symptoms, systolic and diastolic left ventricular function and heart rate variability. In patients with acute coronary syndrome and coronary artery revascularization in the initial state the clinical and laboratory signs of myocardial ischemia disappear, but subclinical and clinical manifestations of heart failure remain. During the first month of training, the original accelerated cardiac rehabilitation program leads to the decrease of systolic and diastolic signs of cardiac dysfunction and improves heart rate variability, which significantly improves the quality of life of these patients. For monitoring the efficacy and safety of the performance of cardiac rehabilitation program in patients with acute coronary syndrome and coronary artery revascularization, in addition to conventional methods (determination of heart rate, blood pressure, 6-minute test), it is useful to diagnose subclinical stage of heart failure by examination of systolic, diastolic function and vegetative regulation
Small Cell Variant of Renal Oncocytoma – a Case Report of Unusual Histopathologic Entity
Get PDFRenal oncocytoma (RO) accounts for 3–7% of all renal cells tumors. It typically consistes of large eosinophilic cells (oncocytes) with abundant cytoplasm, which constitute the crucial diagnostic feature. In 2001, the Czeck authors first described an unusual small cell variant of RO and untill now, only a few reports of such cases have been published. In the current article, the author presents an additional new case. 40-year old male with macroscopic hematuria as a clinical symptom was diagnosed to have solitary tumor in the upper third of the right kidney. He underwent a nephrectomy. On light microscopy, the tumor was predominantly composed of uniform small cells („oncoblasts“) with scant cytoplasm, hyperchromic nuclei and high nuclear-to-cytoplasmic ratio. In addition, it also contained characteristic oncocytes typical for oncocytoma. Tumor was strongly immunoreactive for EMA, sporadically positive for CK7 and negative for RCC antigen, vimentin, S100, WT1, chromogranin and synaptophysin. Proliferative activity did not exceed 1% and mitotic activity was virtually absent. No necrosis or aggressive growth features were found. The spectrum of histopathologic and immunohistochemical findings was consistent with a diagnosis of small cell variant of RO. The author focus on histopathological aspects and differential diagnostic pitfalls of this unique lesion.
How to Teach Students Mastering Practical Skills Without Stress by the Example of Fourth-Year Dental Students
Get PDFThe article presents the results of the experimental study devoted to stress prevention in the course of directed formation of practical knowledge and skills in students. Since all the students constantly suffer from chronic constructive stress, the traditional system of acquiring knowledge and skills becomes time-consuming. There is a low assimilation of the material by students due to a lack of understanding of their tasks.The objective of the study was to increase the efficiency of mastering practical skills in therapeutic dentistry considering the students’ psycho-emotional state.Materials and methods. There were formed 2 groups of fourth-year students studying in different groups who attended the course of periodontology. In Group I (35 students), the teacher explained the specific purpose and benefits of manual removal of dental deposits using Gracey curettes and provided a specific manipulation scheme. The teacher slowly demonstrated each action: the instrument and the specific tooth for which it is used. Then, the students were offered to independently remove dental deposits according to the scheme. 34 students of Group II learned traditional removal of dental deposits using Gracey curettes. The teacher explained the manipulation, and, then, slowly demonstrated it on dental moulage. Afterwards, students independently performed the manipulation. We compared the success of mastering practical skills by students and developing an automatic skill.Results. 34 students of Group I (97.1%) removed dental deposits properly on the first try, and after 10 identical manipulations, all students of Group I developed an automatic skill. In Group II, only 44.1% of students (15 individuals) developed an automatic skill after performing 10 identical manipulations. It should be noted that the main students’ actions in this group were accompanied by a considerable number of mistakes; students incorrectly selected dental tools for removing the deposits, and the teacher spent a lot of time correcting these mistakes.Conclusions. The proposed method is an effective means of directed formation of manual action complex in students. The creation of action schemes for specific manipulation allows us to simplify the learning process reducing the time for the formation of automatic skills in students
The Prospect of Cluster Analysis’ Use to Obtain the New Scientific Results at the Example of Urotheliocytes’ Study in Experimental Diabetic Cystopathy
Get PDFDuring the experiment on 70 adult male rats of the Wistar line the priority mechanisms of development of streptotrozotocin diabetic cystopathy were determined. It’s morphometrically and statistically proved that the imbalance of the systemic mechanisms of the functioning of the transitional epithelium of the bladder starts from the first stages of the development of diabetic cystopathy and is not restored to the end of the experiment; it is associated with a violation of the structural and functional balance between the uroletocytes of clusters 4 and 1 and clusters 2 and 3, as well as with a loss of urothelial bladder of morphological stratification.The general pathological processes accompanying the diabetic cystopathy of a bladder development were revealed. According to the results of histological, morphometric, ultrastructural methods, biochemical studies of blood and urine, determination of water balance and cluster analysis, the main systemic and non-systemic factors that cause the development of these pathological processes were established
An Evaluation of the Metabolic Profile in Total Thyroidectomy
Get PDFAim: To investigate the relationship between metabolic parameters and thyroid hormone changes which occur in patients treated with thyroid replacement therapy following total thyroidectomy. Material and Method: The study comprised 30 patients who underwent total thyroidectomy. Evaluations were made preoperatively and after 6 and 12 months postoperatively. Body mass index was calculated by recording height and weight of all patients, waist size was measured, arterial blood pressure was measured with a sphyngomanometer on the right arm after 10 mins of rest. Peripheral blood samples were taken after 12-hour fasting for the evaluation of low density lipoprotein, high density lipoprotein, total cholesterol, triglyceride, fasting glucose, fasting insulin, thyroid stimulating hormone, free T3, free T4, C-reactive protein, and haemoglobin A1c values.Results: In the postoperative 1-year follow-up, a significant increase was determined in total cholesterol, low-density protein and triglyceride levels, which are related to cardiovascular risk, but no significant change was determined in high density protein levels. In addition, a significant increase was determined in the postoperative trend of both systolic and diastolic arterial blood pressures compared to the preoperative values.Conclusion: Although euthyroid was achieved with follow-up of thyroid functions in the patients who underwent bilateral total thyroidectomy, it was found that there could be changes in metabolic parameters. Therefore, with close monitoring of the metabolic profile of these patients, it can be recommended that lifestyle changes are made when medical intervention is insufficient
Innovative Approaches to Teaching Professionally Oriented Disciplines “Organization and Economics of Pharmacy”, “Management and Marketing in Pharmacy”
Get PDFThe article presents pedagogical innovations in teaching professionally oriented disciplines “Organization and Economics of Pharmacy”, “Management and Marketing in Pharmacy” at the Department of Organization and Economics of Pharmacy and Technology of Drugs of the Ivano-Frankivsk National Medical University, namely: innovative approaches to practical classes with the elements of business games, training in mini-groups, problematic question discussion; extraordinary defense of term papers and the 4-step monitoring of knowledge, abilities and skills required for future pharmacy professionals. The outlined innovations of classroom interactive training are aimed at involving the entire academic group of students in group discussions, teaching them to substantiate their thoughts, developing the abilities to make joint management decisions and bear responsibility for their fulfillment – these are the qualities, which are constantly improving when studying the disciplines “Organization and Economics of Pharmacy”, “Management and Marketing in Pharmacy”
Peculiarities of the Upper Lip Morphogenesis and Its Relation to Facial Development
Get PDFAn appreciation of the fundamental principles associated with the development of the craniofacial structures is essential for attaining competency within the fields of facial surgery, dentistry and pediatrics.The objective of this literature review was to highlight the main stages and precise time ranges of human upper lip development, as well as to elucidate the fundamental mechanisms of normal morphogenesis and possible congenital malformations.The structures of the head and neck arise from the lateral portion of the neural tube, which forms five pairs of branchial arches. Recent studies have identified various molecular pathways (including Bmp, Fgf and Shh signaling) and genetic mechanisms in human face development. Primordial structures of the upper lip begin to appear early within the 6th week of ontogenesis; their development involves a number of highly coordinated, genetically programmed ontogenetic mechanisms that include growth and expansion of the facial prominences, programmed cell death, active fusion and breakdown of the epithelial seam between the initially freely maxillary, medial nasal, and lateral nasal processes. Defects of epithelial and mesenchymal fusion during upper lip formation result in orofacial cleft. Further research should be directed to studying normal ontogenesis at the molecular and topographical levels with the determination of critical periods, time ranges and developmental stages that are sensitive to teratogens.
Eccrine Porocarcinoma: A Case Report of a Rare Skin Malignancy (Dermatopathologic View)
Get PDFEccrine porocarcinoma is extremely rare malignant skin adnexal tumor histogenetically derived from the sweat gland ducts and acrosyringium. The authors described a 66-year-old woman, who was diagnosed to have a malignant cutaneous neoplasia arising in the lateral side of the right shin. The lesion displayed exophytic growth with central ulceration, it was rounded and well-defined having 25 mm in diameter. Microscopically, it exhibited a mixture of atypical basaloid and clear cell population arranged in solid-nodular fashion, that grew out from the epidermis and infiltrated the corium. Ductal formations were sporadically present as well. Tumor was immunohistochemically positive for HMWCK, CK7, EMA, weakly positive for pCEA and negative for mCEA and BerEP4. The spectrum of histomorphologic and immunophenotypic findings favored a diagnosis of primary eccrine porocarcinoma. Having made the retrospective analysis, the authors found only this single one biopsy-proven case of EP during the last seven years suggesting exclusive diagnosis in a routine dermatopathologic practice