EFFECTIVENESS OF HEPATOPROTECTOR IN THE COMPLEX CORRECTION OF CLINICAL MANIFESTATIONS OF CHRONIC PANCREATITIS AND TYPE 2 DIABETES MELLITUS COMORBIDITY.

OBJECTIVE: The aim: To investigate the effectiveness of complex protocol treatment with the additional inclusion of a course of the sublingual form of hepatoprotector on the clinical manifestations of patients with chronic pancreatitis in combination with type 2 diabetes mellitus. PATIENTS AND METHODS: Materials and methods: We studied 57 outpatients with chronic pancreatitis in the phase of stable or unstable remission in combination with diabetes mellitus in the phase of stable or unstable remission. Two groups were formed according to randomization principles to study the effectiveness of the proposed correction programs: 1stgroup (30 patients) took protocol treatment for one month, 2nd group (27 patients) - received protocol treatment with a course of hepatoprotector. RESULTS: Results: It was found the results of the impact of two treatment programs on some clinical symptoms and syndromes in patients with chronic pancreatitis. Positive dynamics of clinical symptoms/syndromes were found in both groups of patients, but the therapeutic effect in the 2nd group was more significant. Analysis of the dynamics of the Quality of Life parameters on the scales of a specialized gastroenterological questionnaire under the influence of two treatment programs found statistically significant (p<0.05) changes in the group with the inclusion of hepatoprotector for treatment for all parameters in contrast to the group of protocol treatment, where statistically significant changes on three scales (abdominal pain, gastric reflux, and dyspepsia). CONCLUSION: Conclusions: It is proved that the proposed inclusion in the protocol treatment of a combination of CP and DM2 course of sublingual a demethion in eledtoan increase in its effectiveness in the correction of abdominal pain - by 8.2%, dyspepsia - by 17.8%, constipation - by 7.4% , diarrhea - by 12.9%, astheno-neurotic - by 21.5%, allergic - by 15.9%, autonomic - by 20.1% (p<0.05). Found higher efficacy of treatment with the in clusion of a demethion in relation to that in the group of PL on the dynamics of the parameters of the scales of the GSRS questionnaire by a total of 13.7%, p <0.01: abdominal pain decreased by 22.6% vs. 16.7%, gastricreflux - by 34.7% against 16.9% (p <0.05), diarrhea - by 23.9% against 8.2% (p<0.001), constipation - by 20.6% against 5.9% (0.01), dyspepsia - by 32.4% against 17.9% (p <0.01), respectively. It proved the feasibility of using sublingual demethion in the complex rehabilitation treatment of patients with comorbidity of CP and diabetes mellitus in order to correct clinical symptoms.

HOLISTIC APPROACH IN COMMUNICATION SKILLS TEACHING OF MEDICAL STUDENTS.

OBJECTIVE: The aim: To analyze the relevance of communicative competence in medical practice and to choose the best pedagogical methods by improve communication skills in future doctors through the use of a holistic approach in teaching. PATIENTS AND METHODS: Materials and methods: Sociological, informational and analytical research methods were used in the research. CONCLUSION: Conclusions: The holistic direction in education promotes partnership between a student and a teacher, the achievement of mutual understanding and trust, better commitment and motivation to learn. The use of feedback forms helps to recognize and understand the needs and feelings of each student, work effectively with diversity, motivates the teacher to continuous self-development and self-improvement. Modern teaching methods such as working in small groups, Storytellling and role-play according to students are more valid in mastering the communicative competence of the future doctor.

THE INFLUENCE OF EXOCRINE PANCREATIC INSUFFICIENCY IN THE FORMATION OF OSTEOPENIA IN PATIENTS WITH PRIMARY OSTEOARTHRITIS.

OBJECTIVE: The aim: Make complex study of bone density in patients with primary osteoarthritis and exocrine pancreatic insufficiency and patients with primary osteoarthritis without exocrine pancreatic insufficiency. PATIENTS AND METHODS: Materials and methods: There were examined 140 patients with primary osteoarthritis without exocrine pancreatic insufficiency and combination osteoarthritis and exocrine pancreatic insufficiency. Diagnosis of osteoarthritis was based on diagnostic X-Ray criteria - according to J.H. Kellgren and J.S. Lawrence. The level of exocrine pancreatic insufficiency was based on result of Elisa test. State of mineral bone density was examined by using dual-photon densitometry. RESULTS: Results: It was established that there was a progressive, statistical, significant increase of mineral density of bone tissue in the 1-st group patients with osteoarthritis. Patients in the 2-nd group, with osteoarthritis in the comorbidity with exocrine pancreatic insufficiency, the densitogram rates were statistically significantly lower than in patients in the 1-st group. CONCLUSION: Conclusions: The changes of bone tissue can be explained by the formation of trophological insufficiency as a result of exocrine pancreatic insufficiency. One of the symptoms of trophic failure is bone and mineral changes, in particular, the decrease of bone density.

The role of cytocin imbalance in the development of man infertility.

OBJECTIVE: The aim: Study of the clinical and pathogenetic role of IL-17, IL-35 and their correlation in the development of infertility in men with chronic ureoprostatitis. PATIENTS AND METHODS: Materials and methods: 82 male aged 20 to 40 were examined. The patients were divided into three groups: the first - 10 practically healthy men, in which the levels of IL-17 and IL-35 in semen were taken as normal; second - 33 infertile men with chronic urethroprostatitis; third - 39 fertile men with chronic urethroprostatitis. In addition to conventional clinical and laboratory (clinical blood and urine tests) studies, all men in semen were tested for IL-17 and IL-35 cytokine levels. RESULTS: Results: The levels of the studied cytokines were found to have opposite tendencies to shifts in the semen of men with chronic urethroprostatitis. The level of IL-17 in sperm increases and the level of IL-35 decreases. The IL-17/IL-35 index increases more strongly in men with impaired fertility. CONCLUSION: Conclusions: Increas IL-17 concentrations, decreas IL-35 levels and increas their correlation may be an indicator of infertility in men with chronic ureoprostatitis. Determining the IL-17 / IL-35 correlation in general clinical practice will allow to single out a group of men with a high likelihood of developing infertility for follow-up and treatment by a doctor of family medicine.

The effect of the proteolisis' system activity for the trophological status of patients with osteoarthrosis and excretory insufficiency of pancreas.

OBJECTIVE: Introduction:The excretory insufficiency of pancreas in patients with primary osteoarthrosis is formed at the comorbid pathologies and as a result of long-term treatment of osteoarthrosis using the non-steroidal anti-inflammatory drugs, steroids, chondroprotectors and chondrostimulators etc. The aim: to study the state of the proteolysis system and immune status, the presence and depth of the dysbiosis of colon in patients with primary osteoarthrosis against a violation of their excretory insufficiency of pancreas. PATIENTS AND METHODS: Materials and methods: There were 64 outpatients with primary OA (group 1) and 74 patients with primary OA in combination with diseases associated with EIP (group 2). The control group consisted of 30 healthy people.The age of the patients ranged from 29 to 74 years. The diagnosis of primary OA was established on the basis of unified diagnostic criteria, the X-ray stage of the primary OA, according to J. H. Kellgren and J. S. Lawrence. RESULTS: Results: It was proved that there is a deeper excitation of the excretory function of the pancreas in patient with osteoarthrosis and comorbid pathologies of the gastrointestinal tract with the excretory insufficiency of pancreas, as well as the presence of the excretory insufficiency of pancreas in patients with primary osteoarthrosis without the clinically available the excretory insufficiency of pancreas. In patients with primary osteoarthrosis that went through the isolation or in combination with the diseases accompanied by theexcretory insufficiency of pancreas, a statistically significant activation of the total proteolysis by the level of the proteolytic activity of the plasma was established. In group 2, dysbiotic changes were significantly deeper than in group 1. The obtained results indicate the presence of secondary immune deficiency in patients and non-specific activation of the humoral part of the immune system and the inflammatory process. CONCLUSION: Conclusion: Statistically more significant changes were observed in group 2, indicating the progression of the detected changes in comorbidity conditions.

combination effect of hypertonic disease with chronic pancreatitis on the processes maintain homeostasis.

OBJECTIVE: Introduction: Abnormalities comorbidity - a frequent phenomenon in medical practice. This determines the relevance of research processes maintaining homeostasis with a combination of various diseases. The aim of this study was to examine and compare the character of vegetative, antioxidant, kallikrein-kinin system and parameters of endogenous intoxication disorders in the patients with isolated essential hypertension and with combination of hypertonic disease and chronic pancreatitis. PATIENTS AND METHODS: Materials and Methods: Cardiointervalography was used in the research with definition of standard statistical and spectral heart rate variability. Determination of superoxide dismutase, glutathione, catalase, middle molecular peptides, total proteolytic activity of plasma by the hydrolysis of protamine sulfate, prekallikrein, kallikrein, α1 -proteinase inhibitor, α2 -macroglobulin and kininase II was conducted by laboratory methods. RESULTS: Results: Sympathicotonia with the moderate tension of adaptation processes, violation of antioxidant protection, kallikrein-kinin system and displays of endogenous intoxication were found in the patients with isolated hypertension. Reduction of sympathicotonia, reducing total power spectrum, increasing the share of humoral-metabolic effects on heart rate, tendency to asympathicotonia autonomic reactivity, lower levels of superoxide dismutase, glutathione, prekallikrein, α2 -macroglobulin, kininase II, higher levels of catalase, middle molecular peptides, total proteolytic activity of plasma kallikrein were observed upon accession the concomitant chronic pancreatitis. CONCLUSION: Conclusions: The signs of compensatory mechanisms disruption and increased autonomic nervous system imbalance with a decrease in ductility autonomous processes in the load were determined upon accession the concomitant chronic pancreatitis. The combination of pathologies also accompanied by more severe manifestations of endogenous intoxication, significant violations of antioxidant and kallikrein-kinin systems.