Pain syndrome patterns and their characteristics in multiple sclerosis patients

Aim of the research is to analyze the patterns of pain syndromes and their characteristics in multiple sclerosis patients. Materials and Methods. A total of 104 multiple sclerosis patients complaining of pain during the last month were examined in Lviv Regional Multiple Sclerosis Center. We analyzed medical records, performed general medical and neurological examinations and compiled history of lifestyle, illness and pain. The VAS and PainDetect questionnaires were used to assess the characteristics of pain syndromes. The patients were asked to choose one of the 4 typical patterns of pain, which best described their feelings. Then the analysis of pain syndrome patterns and their characteristics was carried out. Results and Discussions. All 4 typical patterns of pain syndromes were registered in multiple sclerosis patients. However, only 26.92% of the participants experienced an intermittent pain pattern. The rest of patients suffered from patterns characterized by persistent pain. The evaluation of the patterns and their characteristics revealed typical features. The highest intensity of the severest and average pain during the last month was present in the patients suffering from constant pain with distinct attacks: 8.0 [7.0; 9.0] points (p<0.05) and 7.0 [5.0; 8.0] points (p<0.05), respectively. Persistent paroxysmal pain was more common in the multiple sclerosis patients with neuropathic pain (43.8±8.8% vs 20.4±5.8%, p<0.05). Irradiating pain is also characteristic to this pattern in 52.9±8.6% of patients (p<0.05). The head is the most common pain localization in the patients experiencing persistent pain with severe attacks - 82.4±9.2% of cases (p<0.05). Conclusions. Pain is a permanent symptom in a significant number of multiple sclerosis patients. It can have different patterns of progression. However, it has typical characteristics and their understanding will aid in the diagnosis, prognosis and treatment of pain syndromes in multiple sclerosis patients

Quality assessment of medical care according to data of annual reports (as exemplified by Urology Department of Municipal Non-profit Enterprise "Lviv Clinical Emergency Hospital")

Aim. The medical care quality remains one of the most pressing issues of the health care system, especially at the stage of reforming of the medical sector. Medical-statistical information comprising reporting forms is the basis for analyzing the status of medical care quality and incorporating management decisions to improve it. Material and Methods. The study was performed by the means of analysis of the annual reports of the Urology Department of Municipal Non-profit Enterprise "Lviv Clinical Emergency Hospital" over a ten-year period: from 2010 to 2019. Statistical analysis included the analysis of average and relative values, as well as the calculation of indicators of the dynamic range: growth rate and absolute increase. Results and Discussion. Analysis of the use of bed stock of the Urology Department of MNELCEH during 2010-2019 showed that the average quantity of inpatient days is 251.12-340.18 days per year. Inpatient turnover was in the range of 30.28-36.55 patients per year. The indicator of surgical activity increased by 5.4 percentage points (from 33.0% in 2010 to 38.4% in 2019). There was also a positive tendency of decrease of the duration of post-surgery stay of patients at the inpatient department of the Urology Department (from 9.25 in 2010 to 8.55 in 2019). During the study period of 2010-2019, the ratio of post-surgical complications remained relatively stable and did not exceed 5.1% (the indicator is in the range of 4.38% -5.09%). The analysis of the total mortality among all treated patients was in the range of 0.06%-0.65%. Conclusion. The indicators analyzed in the annual reports make it possible to identify the main problematic issues in the work of the department. In order to provide professional specialized care, quality and rational use of property and human resources, algorithms should be developed to increase treatment of patients with malignant tumors and urolithiasis at the department, as in recent years we could observe an outflow of patients with these diagnoses to other healthcare establishments. There is a need for individual analysis of the causes of post-surgical complications and mortality. These issues can be resolved by introducing clinical audit into the work of the department

The financial and economic results and the potentialities of training and advanced courses for doctors, dispensing chemists, and interns under conditions of the health care system reformation

Aim. to forecast the economic effect of potentialities of the Departments subordinated to the Faculty of Advanced (postgraduate) studies that deals with training of interns and tuition relating to advanced and re-training (refresher) courses for specialists. Materials and Methods. The research was carried out on the basis of actual indices of the Faculty of Advanced (postgraduate) studies at Danylo Halytsky Lviv National Medical University during 2014-2018 years. The statistical methods, structural-and-logical analysis and systemic approach were used. Results and Discussion. The number of individuals who underwent (on contract terms) the primary specialization at the Departments subordinated to the Faculty of Advanced (postgraduate) studies with regard to 29 specialties was established. The financial income, 13 million 668 thousand and 74 hryvnyas, to the special fund for the first year of interns' education was forecast. The feasibility of this forecast may become valid if the maximum possible number of applicants to the internship will be enrolled (on contract terms) regarding the specialties of eligible type. As it is forecast, the largest amount of fees for the first year of studies (29,54%), will be provided by the interns-dentists, while the smallest share in the structure of income (20,01%) will be paid by the interns who are specialized in different surgical profiles. The education at the Advanced Courses and the re-training of the maximum possible number of students of the Faculty of Advanced (postgraduate) studies, on contract terms, will provide the maximum possible income, which is 10 million 826 thousand and 33 hryvnyas; 28,67% out of them are fees for the education from the students of surgery type; 42,01% are fees from the students of therapy type, and 29,32% are fees from the students of medico-prophylactic type, organization and management of Health Care and dispensing chemists. Conclusions. The computation of the maximal loading (amount of work) at the Departments dealing with the interns' training and advanced courses for doctors and dispensing chemists is of significant practical importance for the evaluation of the potentialities of the Departments subordinated to the Faculty of Advanced (postgraduate) studies as to conducting the primary specialization, advanced courses, and re-training of specialists. This is imposed in the finances as well, primarily in the money receipts from interns' training and advanced courses and re-training of specialists on contract terms (at the expense of natural and juridical persons)

Results of clinical and additional examination methods in the treatment of localized periodontitis

Aim. The study aims at enhancing the therapeutic effect and reducing the duration of treatment by using a solution of titanium dioxide in ozonated distilled water for antiseptic treatment of periodontal tissues. Material and Methods. Treatment results of local inflammatory changes of periodontal tissues in 128 patients (73 female, 55 male aged 21-65 years) were analyzed and classified by the severity of periodontal disease as: gingivitis, primary and moderate periodontitis. Schemes of medical actions differed in pharmacotherapy. In order to ascertain the most effective approach, the results of conventional and developed treatment complexes were compared. Results and Discussion. Digital indicators of the periodontal tissues condition following treatment presented common positive dynamic in all patients. However, significantly better results were obtained by using the developed method. According to the dynamics of bleeding index values, the proposed treatment regimens allow achieving more effective control over the inflammatory process. Digital indicators of hygiene showed that a better effect was reached after the suggested method - the dynamics of reducing the depth of periodontal pockets demonstrated clearer and statistically better results. Changes in the pH of the gingival fluid in a severe inflammatory condition indicated a considerable improvement after using the suggested treating method. X-ray data demonstrated the stability of digital values in the observation groups before and after treatment, which was interpreted as a sufficient control of destructive processes. Conclusion. Mathematical analysis of the presented data demonstrates the benefits of the developed method for the treatment of periodontal diseases, especially in non-surgical treatment regimens. The performed research confirms greater effectiveness of the therapeutic method in initial lesions, and thus it proves the efficiency of complex control for preventive purposes

relationship between circadian rhythm and severity of psoriasis and obesity

The research aim is to identify the correlation between circadian rhythm in terms of changes in the chronotype of human working capacity and severity of psoriasis progression, obesity, and the disease impact on the quality of patients' life. Materials and Methods. The research focuses on the determination of the PASI, BMI, DIAG indexes and a patient's chronotype of working capacity. Results and Discussion. The results of the correlation analysis showed a very high negative correlation between chronotype of patients' working capacity and BMI. They also demonstrated a high negative correlation between PASI and DIAG indicators and chronotype of patients' working capacity. Conclusions. The circadian rhythm changes to the evening chronotype of human working capacity contribute to psoriasis worsening, weight gain, and negative impact of the disease on the quality of patients' life.

Condition assessment of infants born to mothers with urinary diseases

The research aim is to study factors of perinatal complications among women with diseases of the urinary system on the basis of retrospective analysis of their newborns' condition. Materials and Methods. A total of 160 women with urinary diseases were selected for the study in Lviv Regional Clinical Hospital from 2014 to 2017. We studied the development of infants born to women with a clinical diagnosis of "Diseases of the urinary system". The newborns' gestational age at birth, anthropometric indicators, and condition assessment on the Apgar scale were analyzed. The obtained indicators were compared with similar parameters in the control group of healthy women that had given birth to live children in the same maternity department during the same period of time. Results and Discussion. We analyzed the condition of infants born to 130 women with urinary diseases. 68 of them were hospitalized with pyelonephritis, and 62 - with chronic pyelonephritis. The control group included 30 healthy female patients. The gestation age analysis showed that the number of preterm babies was higher in the group of infants born to mothers with acute pyelonephritis - 13 cases (10.0%) and even much higher in the group of mothers with chronic pyelonephritis - 25 cases (19.2%). These results were compared with the data obtained from the control group in which 30 full-term babies (100.0%) were born, (p <0.05). In the group of women with acute pyelonephritis, the majority of infants were born with the body weight more than 2500.0 g - 55 cases (42.3%), and 13 (10.0%) infants with the birth weight less than 2500.0 g. The mothers with chronic pyelonephritis gave birth to infants with the body weight less than 2500.0 g in 37 cases studied (28.5%). There was also a significant number of low birth weight newborns in this group - 25 cases (19.2%). In the control group, all 30 babies (100.0%) were born healthy weighing over 2500.0 g. Infants receiving less than 7 points on the Apgar scale were born to women with acute pyelonephritis in 15 cases (11.5%) and to mothers with chronic pyelonephritis in 25 cases (19.2%). In the group of healthy women, all newborns' condition was satisfactory. Conclusions. Women with urinary pathology are confirmed to be at risk of perinatal complications. The research has revealed the significant differences in gestational age, birth weight, and the Apgar score among infants born to women in the main and control groups (p<0.05). The infants whose mothers suffered from urinary pathology were often born prematurely: 13 (10.0%) - to mothers with acute pyelonephritis and 25 (19.2%) - to mothers with chronic pyelonephritis. At the same time the infants in the control group were born healthy (100.0%). Therefore, women with urinary pathology are recommended to be included in the "risk group" for perinatal complications.

Voluntary medical insurance in Ukraine: state and prospects of development

Aim. The paper analyzes the state of the voluntary medical insurance in Ukraine and identifies the tendencies of its development. Material and Methods. The research was conducted on the basis of consolidated reporting data of the National Commission for State Regulation of Financial Services Markets using statistical methods, structural-logical analysis and systematic approach. Results and Discussion. According to the results of the study, the permanent health insurance is a dominant segment in the market of voluntary medical insurance in Ukraine; however the medical expenses insurance shows a steady upward trend. During the study period, the number of concluded contracts by type of medical insurance increased by 3.1 times. The increase in contracts on health insurance against disease turned out to be the most significant: in 2019, 4.7 times more contracts were concluded than in 2015. The dominance of corporate medical insurance in the segment of the market of permanent health insurance was established, while the insurance premiums made by individuals prevailed in the segment of health insurance against disease and medical expenses insurance. When studying the level of payments under voluntary medical insurance contracts, it was found that the highest level of payments had been recorded for permanent health insurance (56.95% - 62.12%). In the result of analyzing the level of reinsurance in the voluntary medical insurance market, a reduction in the ratio of insurance premiums transferred to non-resident reinsurers was established. On the basis of which it can be affirmed that the inwards reinsurance in Ukraine is being formed. The formation of the inwards reinsurance market in Ukraine has significant prospects, as it will ensure the attraction of funds into the national economy and promote integration into the international reinsurance space. Conclusions. The development tendencies study of the voluntary medical insurance is of practical importance for assessing and increasing the competitiveness of the medical insurance market in Ukraine

Principles of medullary thyroid cancer staging according to AJCC TNM 8th edition

Aim. The research aims at analyzing the main changes in classification of medullary thyroid cancer and outlining the principles of staging according to modern studies. Material and Methods. Specific scientific articles for the period of 2009-2019 referring to the principles and rules of the TNM classification process, as well as recommendations of the TNM committees of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (IUAC) were selected for the analysis. The basic principles of classification and staging for 8th edition of TNM, as well as changes that have taken place in comparison with 7th edition of TNM It were defined. Results and Discussion. Medullary thyroid cancer accounts for 1-2 percent in the structure of cancers of the thyroid gland, however it is associated with a high mortality rate compared to highly differentiated forms of thyroid cancer. The main radical method of treatment is an adequate volume of surgical intervention, which is determined on the basis of proper staging, the use of visualization methods and the practical experience of doctors. The 7th edition of the TNM was introduced to the scientific society in 2009. It has been 10 years since a new version of the 8th edition based on the new data in evidence-based medicine appeared. It included numerous changes and additions, namely for medullary thyroid cancer. The following research suggests a detailed review and analysis of the basic principles of the staging and classification of medullary thyroid cancer for AJCC TNM-8 in order to improve the diagnosis and treatment of patients with the mentioned above disease. Conclusions. The use of modern principles of classification and staging of medullary thyroid cancer in clinical practice promotes choosing the adequate treatment method and estimating the patient's prognosis. In addition, further improvement of the staging system by TNM-committee and cancer registers depends on the presence of detailed information on additional "parameters for collection and further evaluation" in medical documentation.

Anticonvulsive potential of cardiac glycosides under conditions of pentilentetrazole-induced seizures in mice: comparative study

Aim. The research provides a comparative analysis of the possible anticonvulsant action of different cardiac glycosides, namely: digoxin, lanatoside C, strophanthin G and corglycone. In addition, it detrmines the leading medication among the abovementioned ones by dose-dependence of its anticonvulsant action. Material and Methods. The research was performed on 66 random-bred albino male mice. The anticonvulsant effect of cardiac glycosides was studied in a baseline model of pentylenetetrazole-induced seizures. The first series of experiment evaluated the effect of cardiac glycosides on the course of model seizures in comparable doses of approximately 1/10 LD50 for the corresponding drug: digoxin, lanatoside C and strophanthin G - at a dose of 0.8 mg/kg; corglycone - at a dose of 1 mg/kg. The second series of experiments used the drug-leader, which was digoxin, in a wide dose range from 0.2 to 1.6 mg/kg. Digoxin, strophanthin G and corglycone were administered subcutaneously for 15 minutes, lanatoside C - intragastrically for 30 minutes before the induction of experimental seizures. Convulsive agent - pentylenetetrazole in the form of an aqueous solution was administered to animals subcutaneously at a dose of 80 mg/kg. Results and Discussion. Digoxin at a dose of 0.8 mg/kg under conditions of pentylenetetrazole-induced seizures shows a pronounced anticonvulsant activity: it is the only one among the studied cardiac glycosides that probably reduces lethality. In addition, digoxin prolongs the latency period of the first attacks, and reduces the number of clonic-tonic paroxysms in 1 mouse. Moderate anticonvulsant properties of lanatoside C were found both by a statistically significant decrease in the number of clonic-tonic seizures in 1 mouse, and by a significant reduction in the duration of the convulsive period. Although strophanthin G is unlikely to affect lethality, it moderately reduces the severity of pentylenetetrazole-induced seizures in mice, as evidenced by a statistically significant prolongation of the latency period of the first seizures, as well as a decrease in the number of clonic-tonic seizures in 1 mouse and the duration of seizures. Prophylactic administration of corglycone only prolongs the latency period of seizures and significantly reduces the number of clonic-tonic seizures in 1 mouse. The results of the dose-dependence study of digoxin anticonvulsant action show a clear anticonvulsant potential of this cardiac glycoside in a wide range of doses - from 0.2 to 1.6 mg/kg - with a maximum effect at a dose of 0.8 mg/kg. Conclusions. It was found that cardiac glycosides have a different severity of anticonvulsant effect: the most powerful anticonvulsant effect is due to digoxin, lanatoside C and strophanthin G have moderate properties, and the least pronounced effect is characteristic to corglycone. In addition, it was determined that digoxin exhibits anticonvulsant properties in a wide range of doses, and has the most pronounced anticonvulsant effect at a dose of 0.8 mg/kg. The obtained results substantiate the expediency of further in-depth study of digoxin as an anticonvulsant medicine.