Chronic endometritis and endometriosis: is there an interrelationship?

Background. Chronic endometritis and endometriosis have a lot in common. Both diseases are long-term inflammatory processes, with definitively unspecified etiological factors and pathogenetic mechanisms that negatively affect fertility and may cause pelvic pain or abnormal uterine bleeding. The issue of effective and timely diagnosis of chronic endometritis remains open due to the lack of specific clinical symptoms and clinical examination data. Assessment of current scientific evidence of the interrelationship between endometriosis and chronic endometritis. Materials and methods. A systematic search of scientific medical information has been conducted in English-language databases: MEDLINE, Scopus, Web of Science, Medline, The Cochrane Library, PubMed. Results. According to the review of various scientific studies that have recently been conducted, it has been found that patients with endometriosis statistically have a significantly higher risk of developing chronic endometritis by 1.3-2.5 times than women without endometriosis. Using a histological endometrial study and detection of CD138, chronic endometritis was found in 52.94 % of women in the endometriosis group and in 27.02 % of patients in the endometriosis-free group; the rate was significantly higher in the endometriosis group than in the control group (p = 0.0311). Moreover, 76% of women with endometriosis showed inflammatory processes of pelvic organs (compared to the control group, where inflammation was found in 38.4 % of women, p < 0.0001). Conclusions. Patients with endometritis demonstrate a positive correlation with development of endometriosis. Given the inability to establish a causal relationship between endometriosis and chronic endometritis, extended diagnosis is necessary to eliminate chronic endometritis, especially if women have abnormal uterine bleeding or chronic pelvic pain. The combination of histological and immunohistochemical endometrial examination methods has shown its effectiveness in timely diagnosis of chronic endometritis. Identifying and adequately treating this condition will help avoid unnecessary surgery.

Forensic and pharmaceutical research on the impact of drugs on the safety, life and health of road users within the organization of pharmaceutical business, drug technology, pharmaceutical and medical law in Ukraine

Background. Around the world, drug-related road traffic accidents are one of the leading causes of injury and death among road users. Traffic safety is a system that includes the following components: a person – a person's health condition – the use of dangerous drugs of different classification and legal groups – adverse drug reactions – a vehicle – a road. The share of road traffic accidents under the influence of drugs is more than 75 %, they are also the most socially dangerous, because they have grave consequences, cause irreparable harm to the health and death of the victims. The purpose of the study was to analyze the achievements of forensic and pharmaceutical researches in Ukraine on the impact of drugs on the safety, life and health of road users within the framework of the organization of pharmaceutical business, drug technology, pharmaceutical and medical law in a retrospective aspect. Materials and methods. The materials of the imperative research were legislative, regulatory and legal documents; materials of the formation of the scientific school of forensic pharmacy; scientific publications on the topic of the article; Internet resources, sources of scientific literature. To achieve the set goals, the methods of forensic and pharmaceutical, regulatory, documentary, bibliographic, comparative, historical and graphic analysis were used. Results. The experience of the countries of the world in the prophylaxis and prevention of road traffic accidents under the influence of drugs was analyzed. The causes and conditions for the occurrence and consequences of road traffic accidents are multifactorial in nature and are associated with the victims (driver - pedestrian), vehicle, road conditions, and the use of psychoactive drugs. A system of organizational, regulatory and preventive measures has been developed to provide first medical aid to victims of a road traffic accident. Shown that there is a need for scientifically grounded organizational and legal, clinical and pharmacological, forensic pharmaceutical and socio-economic studies on causal relationships between adverse reactions due to the use of drugs of various classification and legal groups, traffic safety and road traffic accidents. For the first time in Ukraine, a mathematical model was proposed to establish the effect of psychoactive drugs on the driver's condition when driving a vehicle, depending on the calculation of the stopping path of the car in accordance with the selected speed and a decrease in the driver's response. The structure of road traffic accidents under the influence of psychoactive drugs has been investigated. Conclusions. A classification of first-aid kits for providing first medical aid to victims of road traffic accidents was proposed, which made it possible to substantiate the need to improve them both in qualitative and quantitative composition, depending on the type of vehicle and the likelihood of an accident with serious consequences. Recommendations were proposed for providing information on the possibility of obtaining medical care and the signal-calling system on the roads, marking the packages of psychoactive drugs with a special mark in the form of a red triangle. The need for further forensic pharmaceutical research has been proven.

Effect of an endotoxicosis on the vegetative status of patients with chronic pancreatitis

Background. One of the defining typical clinical and pathogenetic syndromes of the formation and severity of chronic pancreatitis (CP) are the syndromes of endogenous intoxication (SEI) and autonomic (vegetative) dysfunction (VD). We did not find any studies of hematological indices of inflammation and intoxication, and especially in comparison with the parameters of vegetative status in CP, which motivated us to conduct this research work. The purpose of the study was to establish the relationship between hematological indices of inflammation and intoxication and the parameters of the autonomic status of patients with chronic pancreatitis. Materials and methods. We examined 69 patients diagnosed with CP who were treated as out-patient. The following hematological indices were determined: leukocyte intoxication index (LII), adaptation index (IA) with subsequent determination of the type of nonspecific adaptive response, lymphocyte-granulocyte index (ILG). The correlations of LII with the parameters of psycho-emotional state (neuroticism, reactive (RA) and personal (PA) anxiety according to the Eisenk, Spielberger-Khanin questionnaires), VD according to the Wayne questionnaire, and the duration of the disease were studied. Results. 63% of patients with chronic pancreatitis were diagnosed with endogenous intoxication of mild and moderate severity according to the Kalf-Khalif index, which makes it necessary to use drugs aimed at its correction. Significant correlations were established between LII and personal anxiety (direct weak r = 0.23, p <0.05), neuroticism (direct moderate force r = 0.41, p <0.05), autonomic dysfunction (direct weak r = 0,1, p <0,05), duration of the disease (direct weak r = 0,15, p <0,05), structural condition of the pancreas by ultrasound manifestations in points (direct weak r = 0.29, p <0.05), the level of α-amylase of the pancreas (direct medium strength r = 0.30, p <0.05). The obtained results proved the presence of significant interactions between the parameters of inflammation and endotoxicosis with indicators of autonomic status and the state of the pancreas. This makes it necessary to prescribe anti-inflammatory and vegetotropic drugs to patients with CP to enhance protocol treatment. Conclusions. Among patients with CP, favorable adaptive reactions were observed in only 36% of subjects, adverse - in 25%, intermediate - in 39%, and the average value of the adaptation index was - 0.48 ± 0.18, which corresponds to the upper limit of the orientation reaction. This motivates additional prescription of vegetotropic and adaptogenic drugs to such patients with CP. Only in 10% of patients with chronic pancreatitis the general immune response has no deviations from the adequate immune response, in 48% of subjects there is an inability of the immune system to complete inflammation, in 42% - the predominance of autoimmune intoxication, which requires enhanced anti-inflammatory therapy.

Analysis of the gestational period and perinatal outcomes in women after surgical treatment of the cervix

Background. The purpose was to conduct a comparative analysis of the course of pregnancy and perinatal outcomes in women who underwent treatment of the cervix using various organ preserving surgical methods. Material and methods. We examined 250 women of reproductive age who underwent excision or ablative treatment of the cervix before pregnancy. The subjects were divided into five groups depending on the cervix treatment method. The study used general clinical examination protocols outlined in the regulations № 417 and № 676 issued by the Ministry of Health of Ukraine. The results. The most frequent complications of pregnancy in the patients with cervical surgery were: threatened abortion, threatened of preterm birth, anemia, low placentation, placental dysfunction, and low levels of amniotic fluid. Childbirth complications in women who underwent excision or ablation treatment of the cervix before pregnancy predominantly consisted of labor abnormalities, premature amniotic sac rupture, fetal distress, tears of the cervix and perineum. Among the complications of the postpartum period, there were isolated cases of subinvolution of the uterus, lochiometers, metroendometritis, and lactostasis. There were no cases of intrapartum and early neonatal mortality among the newborns. Conclusions. Given the high frequency of gestational and postpartum complications in women after organ-sparing surgical treatment of the cervix, it is necessary to choose the least harmful approach. The lowest incidence of complications during pregnancy, intra and postnatal periods was observed in the women who underwent laser vaporization and radio-wave ablation.

Development of forensic and pharmaceutical researches within the organization of pharmaceutical business, drug technology and pharmaceutical law in Ukraine concerning the turnover of controlled drugs and substances

Background. In recent years, the COVID-19 pandemic has spread and is developing in all countries of the world without exception, affecting not only medical and pharmaceutical, but also social, economic, toxicological and criminal aspects. In such conditions, it is of great importance in the field of healthcare and the pharmaceutical industry of Ukraine to improve the system of legal relations "doctor-patient-pharmacist", based solely on the principles of pharmaceutical and medical law. Among the components of medical and pharmaceutical law there is forensic pharmacy, which studies the causes of offenses in the field of healthcare. The purpose of the study was to analyze history of formation and development of forensic and pharmaceutical researches in Ukraine within the organization of pharmaceutical business, drug technology and pharmaceutical law. Materials and methods. Legislative and regulatory documents were used in the study; scientific publications in the field of "forensic pharmacy"; Internet resources. Normative and legal, documentary, historical, bibliographic, forensic and pharmaceutical, comparative and graphic methods of analysis were used. Results. Forensic pharmacy in the world as a scientific field is known and developed since 1946. The article covers the period of 1990-2004. Prominent scientists of Ukraine were of great importance in the formation of forensic pharmacy. The formation of forensic pharmacy began with the generalization of forensic and pharmaceutical practice in historical retrospect "from police chemistry to forensic chemical and pharmaceutical examination – from forensic pharmacy to pharmaceutical law and medical law" with the support of prof. Chernykh V.P. In the period of 1997-2003, the development of forensic pharmacy took place by improving the regulatory and legal support of the control and licensing system of circulation of medicines. Trends in the prevalence of diseases involving uncontrolled and irrational use and abuse of surfactants have been identified. The causal links between drug addiction, substance abuse and crime have been investigated. The interpretation of "potent", "poisonous" substances in the regulations of Ukraine have been improved. It is substantiated that the main indicator of classifying drugs as "potent" and "poisonous" substance is a forensic criterion that qualifies the consequences of irrational use of drugs by severity of injuries: from mild, moderate to severe injuries, or those that caused fatalities. At the next stage (2003-2004) the scientific and theoretical generalization and the new approach to the decision of a problem which is connected with development of scientifically-based principles of optimization of system of the state control over circulation of narcotic drugs, psychotropic substances and precursors were studied. The possibility of participation of a pharmacy specialist (pharmacist-forensic scientist) at the stages of: investigation, pre-trial investigation in forensic chemical and pharmaceutical studies of physical evidence and participation as a forensic expert in a criminal case in court has been researched. Conclusions. It is substantiated that the formation of forensic and pharmaceutical researches within the organization of pharmaceutical business, drug technology and pharmaceutical law in Ukraine has taken place. Further forensic pharmaceutical research needed to harmonize domestic legislation, international human rights standards in the field of health care, legal regulation of the pharmaceutical market and the medical services market.

Dentists satisfaction with professional activities

Background. Supporting the health personnel satisfaction of with their professional activities and motivating them to work is a means of effective human resource management. The patient's health and the quality of life associated with it depends on the motivation and satisfaction with the professional activity of the health specialists. The satisfaction as a characteristic of organizational culture differs among physicians of different specialties. The purpose of the study: to determine the level of satisfaction with the professional activities of dentists of institutions providing highly specialized dental care. Materials and methods. The author's structured questionnaires were used, completed by 110 dentists from three regional dental care institutions. Methods: sociological; medical and statistical; logical structure analysis; generalizations. Results. In general, dentists highly rated satisfaction with their professional activities on a 5-point scale: 4.6 ± 0.5 points – doctors of the Сommunal Non-profit Company (CNC) "Zhytomyr Regional Dental Medical Association"; 4.2 ± 0.4 points – doctors of the CNC of the Kharkiv Regional Council "Regional Dental Clinic"; 4.3 ± 0.9 points – doctors of the CNC "Chernihiv Regional Dental Clinic of the Chernihiv Regional Council". However, the respondents of the CNC "Chernihiv Regional Dental Clinic of the Chernihiv Regional Council" expressed only partial satisfaction with the opportunity to improve their qualifications at the workplace, the state of the provision of drugs, consumables and evidence-based technologies, the level of wages (range of estimates 3.5 ± 0.9 – 3, 7 ± 1.1 points). It was found that the lowest satisfaction scores of dentists of all institutions concerned professional relations with colleagues of the polyclinics structural units where they work, with the administration, and with doctors of other health care institutions: doctors' assessments, depending on the institutions, varied, respectively, within 4, 2 ± 0.4 – 4.4 ± 0.7 points, 4.4 ± 0.5 – 4.5 ± 0.5 points, 4.0 ± 1.0 – 4.4 ± 0.7 points. Conclusions. General assessments of satisfaction with the professional activities of dentists are high, but the professional relations of dentists need to be improved, improvement is the state of resource provision of institutions and opportunities for professional development; increases – salary. This information can be used to make management decisions to strengthen the organizational culture of healthcare institutions by improving personnel management.

The algorithm for providing paliative care by general practitioners - family doctors

Background. In Ukraine, as in the rest of the world, the majority of people who face life-threatening or life-limiting illnesses and who need palliative care are at home [1]. It is estimated that palliative care is needed in 40–60 % of all deaths [2]. According to the State Statistics Service of Ukraine, 616 840 persons died in 2020 [3], respectively, approximately 250 to 370 thousand patients needed palliative care in Ukraine. The management of patients throughout the progression/development of the disease and the final phase of life is assigned to the doctors who are closest to the patient – general practitioners – family doctors. The main goal of palliative care is to ensure the most attainable quality of life for patients. At the same time, the doctor must determine in a timely manner when the volume of palliative care provided exclusively from a general practitioner – family doctor is not enough and in a timely manner to involve specialized palliative care services. Purpose of the research: to develop an algorithm for the providing of palliative care by gene­ral practitioners – family doctors with the definition of patients for whom the volume of palliative care goes beyond primary health care. Materials and methods. The current legal framework governing the provision of palliative care by general practitioners – family doctors, scientific literature, questionnaires of sociological research of patients (n = 25). Methods of system analysis, synthesis, abstraction, sociological and medical-statistical methods were used. Results. The current orders of the Ministry of Health of Ukraine and sectoral standards for the provision of medical care, which are guided by general practitioners – family doctors in the provision of palliative care, were studied and the lack of consistency in the implementation of the norms determined by different standards was revealed. It was found that the use of tools to determine the level of quality of life (QOL) as the main purpose of palliative care is not proposed. The duty of the general practitioner – family doctor is the timely involvement of specialized services in the provision of palliative care. At the same time, there is no specific indicator or criterion that may indicate an insufficient provision of palliative care at the level of primary health care. Questionnaires have been proposed for determining the QOL of patients (EORTC QLQ-C30) and self-assessment of depression (PHQ-9). It has been shown that indicators of less than 50 points on the functional scales of the EORTC QLQ-C30 questionnaire and / or 10 or more points on the PHQ-9 depression scale are evidence of the need to accompany the patient by a psychologist, clergyman and social worker, that is the basis for the involvement of a multidisciplinary team of mobile palliative care. A unified algorithm of actions for the provision of palliative care by general practitioners – family doctors has been developed. Conclusions. To ensure the implementation of the rules and regulations defined for general practitioners – family doctors by various regulatory documents, instructions and sectoral standards, it is necessary to introduce an algorithm (unified scheme) of doctor's actions in the provision of palliative care. Therefore, general practitioners – family doctors need to timely apply an algorithm for identifying patients for whom the provision of palliative care provided exclusively by general practitioners – family doctors is insufficient and to establish interaction with mobile palliative services.

The topicality of regulatory of general practitioners-family doctors activity regarding of palliative care patients the quality of life the determination and assessment

Background. Access to palliative care and symptom relief for patients with incurable and serious illnesses remains a pressing issue for the health systems of many countries around the world. It is estimated that more than 40 million patients with serious illnesses and life-threatening and limiting conditions require palliative care (PC) each year. Most of the patients requiring PC are at home, so PC that can alleviate most of the suffering of the patient and his family is provided by general practitioners. Settling the regulatory framework is an important factor in providing quality palliative care. The purpose of the study: to propose amendments to the regulatory documents governing the provision of palliative care to determine and assess the quality of life of patients. Materials and methods. Scientific literature, WHO documents, EORTC QLQ-C30 questionnaire and patient survey results (n = 219). We used the method of system analysis, synthesis, sociological and medical-statistical. Results. We analyzed literature sources regarding a patient-family-centered approach in the health care system. We studied the WHO recommendations for determining the quality of life (QOL) of patients. We identified a gap in the current documents regulating the provision of PC in assessing the QOL of patients. As a result of involving patients (n = 219) in self-assessment of the QOL using the EORTC QLQ-C30 questionnaire and further ensuring the subjective needs of patients, an improvement in their QOL was established. It was proposed to amend the orders of the Ministry of Health of Ukraine, regulating the provision of primary medical care and PС, in order to achieve the main goal of this type of medical care - to ensure the maximum achievable QOL. Conclusions. 1. It has been shown that the regulatory framework for the provision of PС regulates the provision of the most attainable QOL of the patient as the main goal of this type of medical care. However, the use of funds for determining the level of QOL and its components by doctors when providing PС on an outpatient basis, including at home, is not not regulated by law. 2. It has been proven that the use of the EORTC QLQ-C30 questionnaire to determine the QOL of patients receiving PС allows assessing their general and psycho-emotional state, as well as the level of the patient's functioning from his subjective point of view. This ensures the patient's partnership in a multidisciplinary team, his responsibility and participation in the treatment. At the same time, the key need of the patient to be involved in decision-making on diagnostics and the choice of treatment methods in accordance with personal beliefs and expectations is satisfied. 3. It is necessary to amend the order of the Ministry of Health of Ukraine dated 04.06.2020 No. 1308 "On improving the organization of the provision of palliative care in Ukraine" on the procedure for providing PC and the order of the Ministry of Health of Ukraine dated 03.19.2018 No. 504 "On approval of the Procedure for the provision of primary health care" according to the list medical services for the provision of primary health care in terms of using questionnaires to determine QOL and achieve the main goals of PC.

The results of teachers' awareness about visual impairment prevention among school-age children study

Background. According to the Center for Medical Statistics of the Ministry of Health of Ukraine, the number of children with ophthalmic diseases has increased significantly over the last decade. The purpose of the study was to determine the awareness of teachers of secondary schools (schools, lyceums) on the problem of visual impairment among schoolchildren with the identification of their willingness to participate in preventive measures. Materials and methods. The materials of the study were the results of a sociological survey of teachers of schools and lyceums in Ukraine (a total of 6215 questionnaires were subject to analysis). We used the method of sociological research and methods of medical statistics, in particular to calculate the representativeness and reliability of the survey results. The study complied with modern European requirements for anonymity; each of the respondents was involved in the survey only after prior oral voluntary consent. The results revealed a lack of awareness of teachers in the prevention of visual impairment among schoolchildren, their willingness to participate in prevention activities and the high need for information support for modern prevention technologies. The majority of respondents supported the need to introduce regular vision testing in childhood, including in the framework of the relevant state prevention program. Conclusions. The majority of teachers (99.40 ± 0.10 %) supporting the expediency of introducing regular vision testing in children, (97.38 ± 0.20 %) support the introduction of a state prevention program to preserve vision from childhood. Based on the results of the study, promising for further research is the study of the possibility of involving teachers in preventive measures and participation in comprehensive programs for the prevention of ophthalmic pathology among students. It is also important to find effective ways of information support for educators on modern prevention technologies, risk factors for the formation of visual impairments in schoolchildren in order to prevent the formation of stigma against children with visual impairments and disorders in their environment.

Experience of world academic science as a landmark of medical science development in Ukraine

Background. The previous millennium was marked by the rapid development of scientific and technological progress, the widespread implementation of the results of scientific research. The purpose of our work was a retrospective study of global approaches and historical preconditions for the formation of academic science in different countries, the experience of effective organization of scientific research to develop proposals for its improvement, taking into account the peculiarities of medical academic science in Ukraine. Materials and methods. In the course of the research the methods of semantic analysis of scientific documents, methods of structural-logical analysis, content analysis were used. Results. Historical and modern aspects of academic science formation in different countries of the world were analyzed. Particular attention was paid to the peculiarities of the development of medical academic science with the assessment of the most effective systems of its organization. In Ukraine, national interests require immediate and effective measures aimed at preserving and effectively using existing scientific potential. Specific mechanisms for ensuring proper scientific substantiation of the formation and implementation of state policy in all spheres of public life need to be identified. Conclusions. Improving the system of organization of medical academic science in Ukraine should take into account the results of the emergence and development of academic science, both in Ukraine and in developed countries. The results of the study of international experience testified to the historical expediency and effectiveness of the development of academic medical science. Funding for medical science, which has become a cornerstone of transformation, must be differentiated, this is the mixed model is the most common in the world-basic funding using public funds with the possibility of grant support on a competitive basis. Such a mechanism for the efficient use of public resources will create conditions for stimulating priority and innovative research.