http://family-medicine.com.ua/issue/feed Family Medicine 2021-02-24T10:57:28+00:00 Александра alexandra@professional-event.com Open Journal Systems <p align="justify">The journal «Family medicine» was founded in 1999 to inform medical society about achievements, problems and prospects of family medicine development in Ukraine. From the beginning the journal promotes family medicine, describes the activities of Ukraine Association of Family Medicine, publishes the reviews of the global formation and evidence of advantages of the primary medical care organization based on principals of family medicine in different countries. Due to the constant participation of the Shupyk National Medical Academy of Postgraduate Education in journal development and significant personal efforts of the first chief editor of the journal – prominent Ukrainian scientist and teacher prof. Grygorii Lysenko, - «Family Medicine» publishes wide spectrum of the original researches and recommendations in different fields from the leaders of medical science of Ukraine. In short time the journal become the leading edition, not only for family physicians but also for a wide circle of other medical specialists in Ukraine. </p> http://family-medicine.com.ua/article/view/225454 Diagnostic Value of Heart-type Fatty Acid Binding Protein in Group of Patients with NSTEMI at the Time of Application for Medical Care 2021-02-24T09:29:59+00:00 Yevhen Sid yvsid_f@mail.net Oleksandr Kulbachuk kulbachuk@gmail.com <p>The relevance of the early detection of myocardial necrosis is due to the difficulties of differential diagnosis in the first hours of the development of acute coronary syndrome. Therefore, the doctors of the first contact, as before, are interested in an early cardiac marker and the presence of tests based on it. Heart fatty acid binding protein (h-FABP) is a cardiac marker that increases in the blood to diagnostic values after just one hour from the beginning of clinical manifestations.</p> <p><strong>The objective: </strong>to determine the diagnostic value of heart fatty acid binding protein in group of patients with NSTEMI.</p> <p><strong>Materials and methods. </strong>We examined 280 patients with STEMI, 91 patients with NSTEMI, 76 with stable angina pectoris. Blood samples were taken from all patients at the first contact to determine troponin I, a heart fatty acid binding protein and CPK-MB. Patients with NSTEMI were divided into three subgroups: the first – up to 3 hours from the onset of symptoms, the second – from 3 to 6, the third from 6 to 12. The level of heart fatty acid binding protein in plasma was determined by enzyme immunoassay.</p> <p><strong>Results. </strong>The early detection of AMI in people visiting primary care doctors with chest pain continues to be a challenge. Undoubtedly, cardiac troponins are the “gold standard” for the diagnosis of AMI, but early detection of these can give a negative result. The results of the studies show a high diagnostic efficacy of h-FABP in the early diagnosis of AMI, and it is superior in sensitivity (in the first hours from the onset of the disease) to cardiac troponins. So, for example, in the subgroup of patients with the onset of symptom manifestation up to 3 hours for h-FABP with a cut-off &gt;0,48 ng/ml, the sensitivity was 92.7 % and specificity was 97,3 % (AUC=0,99; 95 % CI AUC 0,942–0,998). In the same subgroup, troponin I had a specificity of &nbsp;22,0 %, with cut off &gt;0,84 ng/ml (AUC=0,71; 95 % CI AUC 0,615–0,787).</p> <p><strong>Conclusions. </strong>The level of cardiac protein that binds fatty acids is significantly increased in patients with acute myocardial infarction compared with stable coronary heart disease.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Yevhen Sid, Oleksandr Kulbachuk http://family-medicine.com.ua/article/view/225188 The Efficacy and Safety of Using a Combined Iron Supplement in Children with Community-acquired Pneumonia and Anemia 2021-02-21T20:53:15+00:00 Yurii Marushko iurii.marushko@gmail.com Tetiana Hyshchak tgischak@i.ua Olha Khomych khomychov@gmail.com <p>The article summarizes the own data and presents a scientific review of the medical literature devoted to the analysis of the problem of treatment of community-acquired pneumonia associated with anemia in children.</p> <p><strong>The objective:</strong> to optimize the treatment of community-acquired pneumonia associated with anemia in children.</p> <p><strong>Materials and methods.</strong> There were examined 100 children (53 girls and 47 boys) aged 9–17 years (the average age was 12.96 ± 0.07 years), who were treated for community-acquired pneumonia in the children’s clinical hospital No. 5 in Kiev. Children were divided into two groups: Group I – 70 patients with community-acquired pneumonia and normal levels of hemoglobin and erythrocytes; Group II – 30 children with pneumonia and anemia of the I – II stages.</p> <p><strong>Results.</strong> During the study of the localization of the pathological process in the lungs, it was found that in children of group II compared with group I, bilateral lung damage was more common (33.3 % compared to 12.9 %; p &lt;0.05). The main indicators of peripheral blood in patients with community-acquired pneumonia and anemia were lower than in patients with community-acquired pneumonia. The clinical picture of community-acquired pneumonia with anemia and also there was analyzed the possibility of using a combined preparation of ferrous iron, manganese and copper for treatment.</p> <p><strong>Conclusion.</strong> It was found that in patients with community-acquired pneumonia and anemia, compared with patients with community-acquired pneumonia, there is a more widespread and severe inflammatory process in the lungs with prominent signs of intoxication. However, when using a medication of ferrous iron with trace elements, an improvement in indicators and the course of the disease is observed.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Yurii Marushko, Tetiana Hyshchak, Olha Khomych http://family-medicine.com.ua/article/view/225300 Thyroid Lesion as a Manifestation of Comorbidity in Patients with Diabetic Polyneyropathy 2021-02-23T07:50:01+00:00 Hennadii Chupryna gen7chupryna@gmail.com Viktoriia Dubynetska viktoria_md@ukr.net <p>The study of clinical and anamnestic and paraclinical characteristics, highlighting their dominant features in patients with DP and existing thyroid diseases occupies an important place in modern neuroendocrinology and requires more focused attention of clinicians.</p> <p><strong>The objective:</strong> to determine the leading clinical and laboratory-instrumental parameters in patients with DP and thyroid pathology, to analyze the mutual influence of neuroendocrine pathology on the patient’s somatoneurological condition.</p> <p><strong>Materials and methods.</strong> Was done a clinical examination of 64 patients with DP , in 27 (42 %) of them was diagnosed the comorbid thyroid pathology, in 37 (58 %) it was absent. All patients were divided into two groups: with DP in the background of type I, II DM and thyroid pathology (A) and with DP in the background of type I, II DM without thyroid pathology (B). During the examination of patients were used clinical-anamnestic, clinical-neurological, laboratory-instrumental, neurophysiological methods of examination. Pain characteristics were assessed using the McGill Pain Questionnaire (MPQ). Statistic calculation was done in MS Excel 2003 and using the package for statistical analysis STATISTICA 10.</p> <p><strong>Results.</strong> In patients of both groups comorbidly were dominated diseases of the cardiovascular system, in group A, increasingly was revealed gastrointestinal pathology. Polyneuritic disorders of sensitivity and autonomic-trophic disorders are more common in persons of group B, they have a higher frequency of comorbid pathology and longer duration of DM. In group A lack of Achilles and knee reflexes was recorded more often than in comparison group. In 18 (65 %) of the examined persons of group A was detected a fatty liver dystrophy by ultrasound scanning of the abdominal organs, which exceeds the number in group B – 13 (35 %). There is an inverse average dependence between the level of TSH and BMI (correlation coefficient = –0,65). The general index of pain rating (Pain Rating Index – PRI) in group A is higher (30,62±2,64 scores).</p> <p><strong>Conclusions.</strong> Among the thyroid diseases in the examined patients of group A hypothyroidism was most often detected, so 30 % of patients had a pronounced violation of lipid metabolism in the form of obesity, besides, in this group the number of people with type II DM was prevailed. The influence of thyroid pathology on the manifestations of DP is reflected in the intensification of neuropathic pain syndrome. There is also a significant effect on the metabolism of fats and carbohydrates, which aggravate and sometimes deepen the somatic condition of the patient.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Hennadii Chupryna, Viktoriia Dubynetska http://family-medicine.com.ua/article/view/225332 Influence of the Plant-citrate Complex on Indicators of Systemic Inflammation in Patients with Urolithiasis 2021-02-23T10:29:12+00:00 Olena Karpenko karpenko05.12@ukr.net Anna Petrova anna2311doc@ukr.net <p>Treatment of urolithiasis is a complex task of modern medicine. The search for non-invasive methods of treatment, prevention of relapses and complications, slowing down the development of renal failure is an urgent issue of our time. The study demonstrated a comprehensive analysis of indicators of systemic inflammation in patients with urolithiasis and the effectiveness of using the plant-citrate complex.</p> <p><strong>The objective: </strong>to conduct a clinical assessment of systemic inflammation in patients with urolithiasis, to determine the effectiveness of the use of the plant-citrate complex of the drug Uriklar on the indicators of systemic inflammation.</p> <p><strong>Materials and methods. </strong>There were examined 52 (55.6 %) patients with urolithiasis, which were divided into two groups: Group I (main group) – 32 patients with urolithiasis who received the herbal citrate complex and Group II (comparison group) – 20 patients with urolithiasis. The control group included 20 almost healthy individuals. All patients underwent clinical and laboratory tests: general and biochemical blood tests to determine the parameters of iron metabolism, lipid profile, CRP, determination of the levels of cytokines in the blood, blood pressure, body mass index.</p> <p><strong>Results. </strong>The results of this study demonstrate the development of systemic inflammation in patients with urolithiasis, determined by a decrease in GFR. Against the background of the treatment with Uriklar, a decrease in the levels of pro-inflammatory cytokines, CRP and ferritin is observed, which indicates the anti-inflammatory properties of the drug.</p> <p><strong>Conclusion. </strong>Such properties of the plant-citrate complex are pathogenetically substantiated and can be recommended for urolithiasis, which, along with the therapeutic properties, allows to obtain the provision of metaphylaxis of urolithiasis and to slow down the rate of development of chronic kidney disease.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Olena Karpenko, Anna Petrova http://family-medicine.com.ua/article/view/225345 Analysis of the Pancreas Functional Capacity at the Comorbidity of Chronic Pancreatitis with Diabetes Mellitus Type 2 2021-02-23T11:27:08+00:00 Liliia Babynets lilyababinets@gmail.com Halyna Sasyk hmsasyk_f@mail.net <p>The diagnosis, treatment and rehabilitation of patients with chronic pancreatitis (CP) with concomitant diabetes mellitus (DM), whose incidence is increasing.</p> <p><strong>The objective</strong><strong>: </strong>was to investigate the state of functional capacity of the pancreas in patients with comorbidity of chronic pancreatitis and diabetes type 2.</p> <p><strong>Materials and methods. </strong>137 patients with CP with and without concomitant diabetes mellitus were studied: the main group consisted of 112 outpatients with CP in combination with diabetes mellitus in the phase of stable or unstable remission, the comparison group – 25 patients with isolated CP, and the control group – 30 healthy individuals. Verification of diagnoses and determination of the pancreas functional capacity parameters was carried out according to generally accepted world standards.</p> <p><strong>Results</strong><strong>. </strong>In comorbidity, exocrine insufficiency (ExI) was significantly more severe than in the group of patients with isolated CP in the content of fecal α-elastase, which corresponded to the medium and mild degrees of ExI respectively, and the coprogram score – respectively (5,60±0,10) and (3,89±0,16) points (p&lt;0,05). We found a significant predominance of patients with comorbidity relative to that with an isolated course of CP among those who had mild (22,6 % vs. 11,7 %) and moderate (50,1 % vs. 3,7 %) degree of ExI in the complete absence of severe pancreas ExI in isolated CP against 5.1 % of such patients with CP and diabetes mellitus type 2. A statistically significant higher content of HbA1c in patients with CP with concomitant diabetes was found in relation to the group of patients with isolated CP (7,71±0,16 % vs. (5,66±0,10 %), glucose – respectively (28,89±0,33 mmol/l against 5,27±0,11 mmol/l), the level of the HOMA index – 3,29±0,07 against 1,63±0,09 (p&lt;0,05), which confirmed the presence of IR in patients with pancreas endocrine insufficiency in the cohort of subjects, and also proved that these patients have diabetes type 2. Evaluation of the ultrasound score of the structure of the software proved that in comorbidity with diabetes mellitus, this figure is higher and corresponds to a severe degree, while in isolated CP of the studied patients – the average severity (6,25±0,67) points against (3,89±0,78) points.</p> <p><strong>Conclusion. </strong>The distribution by index and severity of patients acording M-ANNHEIM in points statistically significantly proved that the comorbidity of CP and diabetes mellitus was dominated by patients with moderate (72,2 % vs. 24,0 %) and severe CP severity (17,0 % against 8,0 %), and in isolated CP – dominated by patients with moderate severity (64,0 % vs. 4,5 %), patients with severe were more in the group of comorbid patients (6,3 % vs. 4,0 %).</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Liliia Babynets, Halyna Sasyk http://family-medicine.com.ua/article/view/225349 Rational Pharmacotherapy in Case of Exacerbation of the Primary Low Back Pain 2021-02-23T11:41:17+00:00 Oleksandr Burianov kaftraum@ukr.net Taras Omelchenko tnomelchenko@gmail.com Volodymyr Volodymyr kaftaum@ukr.net Myroslav Myroslav kaftaum@ukr.net Volodymyr Lianskorunskyi kaftaum@ukr.net <p>Low back pain (LBP) is one of the most common causes of orthopedic disability in people under 45 years of age. Primary LBP accounts for more than 90 % of all cases. The main objectives of treatment are to slow the progression of the degenerative process, reduce the intensity of inflammation and pain, increase functional activity and quality of life of patients. The solution of the set tasks is impossible without effective complex influence on numerous links of pathogenesis of degenerative-dystrophic and inflammatory process and ensuring safety at treatment.</p> <p><strong>The objective: </strong>to evaluate the clinical effectiveness of complex conservative treatment of primary LBP with the use of the drug Alsokam (meloxicam) in patients with uncomplicated forms of degenerative-dystrophic lesions of the spine in the period of exacerbation.</p> <p><strong>Materials and methods. </strong>A non-randomized, prospective comparative clinical study in two parallel groups involved 30 patients with exacerbation of LBP on the background of uncomplicated forms of degenerative-dystrophic lesions of the spine (osteochondrosis, spondyloarthritis). The mean age of patients was 40±7,2 years. There were 12 (40 %) female patients and 18 (60 %) male patients. The main group consisted of 15 patients who were prescribed the drug Alsokam (meloxicam) at a dose of 15 mg 1 time per day intramuscularly for 7 days. The control group consisted of 15 patients who received diclofenac sodium at a traditional daily dose of 75 mg intramuscularly once daily for 7 days during the same treatment period. In both groups, tolperisone 150 mg 3 times a day and B vitamins were also used for 10 15 days. Outcome evaluation parameters included: Visual analog pain scale (VAS), Huskisson; assessment of the patient’s functional status on the Roland-Morris scale (RDQ-24); accounting for side effects and adverse events in the observation groups.</p> <p><strong>Results. </strong>In both groups, a significant decrease in the intensity of the pain syndrome was observed in the assessment of pain by VAS, but no statistically significant difference was observed between the observation groups (p=0,312). The analysis of the results of the evaluation of RDQ-24 also showed an increase in functional capacity in both groups, but without a significant difference between the groups of clinical observation (p=0,302). Analysis of the number of undesirable side effects in the observation groups showed a significantly lower frequency in patients of the main group with a high statistical probability (p&lt;0,01).</p> <p><strong>Conclusions. </strong>The results of a clinical study showed the effectiveness of meloxicam (Alsokam) in the complex conservative treatment of patients with primary LBP in the period of exacerbation, which correlates with the effect of diclofenac sodium in the average daily dose. The nature and frequency of adverse reactions in the main and comparator groups showed that meloxicam in Alsocam has a significantly higher safety profile compared to diclofenac sodium, and its use in complex treatment regimens for patients with primary LBP syndrome reduces the risk of NSAIDs gastropathies.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Oleksandr Burianov, Taras Omelchenko, Volodymyr Chornyi, Myroslav Vakulych, Volodymyr Lianskorunskyi http://family-medicine.com.ua/article/view/225448 Topical Issues in Diagnosis of Coagulopathies and Prevention of Thromboembolic Complications of Atrial Fibrillation in Patients with Liver Cirrhosis 2021-02-24T08:24:47+00:00 Volodymyr Chernyavsky vvch1979@gmail.com Alina Baylo alinabajlo@gmail.com <p>Nowadays the comorbid pathology of liver cirrhosis and atrial fibrillation has been widely discussed and reported in the literature in the light of recent findings from the study of the effectiveness and safety of anticoagulants in this category of patients. The review is devoted to summarizing the existing data on the comorbid course of these diseases from the point of view of the impact of bleeding and thrombosis on the quality of life and mortality of patients and the possibility of using new methods of diagnosis and prevention of these complications.</p> <p>The purpose of the review is to focus the attention of physicians and researches on the relevance and prevalence of comorbid course of liver cirrhosis and atrial fibrillation, their complications, and discuss the benefits and possibilities of applying global methods of hemostasis assessment and anticoagulants in clinical practice.</p> <p>This article examines the main pathophysiological aspects of «rebalanced hemostasis» theory in liver coagulopathies, its effect on the onset of bleeding and thrombotic events, and considering the clinical benefit of the use of anticoagulants. The disadvantages of traditional coagulation assessment tests compared to the benefits of thromboelastometry (ROTEM) and thromboelastography (TEG), general fulfilling principles and evaluation of their indicators are discussed. Existing research findings on the safety and efficacy of warfarin and direct oral anticoagulants in patients with liver cirrhosis and atrial fibrillation compared with no treatment are highlighted.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Volodymyr Chernyavsky, Alina Baylo http://family-medicine.com.ua/article/view/225452 Evaluation of Pancreatotropic and Joint Efficiency of Intracellular Systemic Enzyme in Osteoarthritis 2021-02-24T09:10:12+00:00 Liliia Babynets lilyababinets@gmail.com Iryna Halabitska irynkagal@gmail.com <p>Despite the advances of modern evidence-based medicine, the treatment of osteoarthritis (OA) remains a complex and unresolved issue. Of course, modification of the patient’s lifestyle improves the condition of a patient with osteoarthritis, but the management of a patient with osteoarthritis without drug therapy, which is mostly symptomatic, is almost impossible.</p> <p><strong>The objective: </strong>was to investigate the effectiveness of intracellular systemic enzyme in the complex therapy of patients with primary OA in comorbidity with exocrine pancreatic insufficiency for the correction of pathological processes developing in patients.</p> <p><strong>Materials and methods. </strong>69 patients with primary OA in comorbidity with exocrine pancreatic insufficiency were examined. The diagnosis of OA was established on the basis of diagnostic criteria of the American College of Rheumatologists (ACR, 2018), the European Association of Rheumatologists (European League Against Rheumatism, EULAR, 2018). American Academy of Orthopedic Surgeons (AAOS, 2018), International Society for the Study of OA (OARSI, 2019). Examination of the joints included examination, palpation, and objective assessment of pain. OA symptoms were also assessed by Leken index and the Harris test. To assess the state of exocrine pancreatic insufficiency, the content of fecal α-elastase was determined and the coprogram was evaluated. Patients were divided into two groups: the 1st group received treatment of primary OA according to international recommendations, the 2nd group additionally received an enzymatic drug.</p> <p><strong>Results. </strong>After the treatment, patients of the 1st group showed a statistically significant tendency to deterioration of fecal α-elastase and coprogram (p&lt;0,05), in the 2nd group there was a statistically significant improvement of these indicators (p&lt;0,05). There was also a statistically significant improvement in the course of primary OA in both study groups (p&lt;0,05), but in the 2nd group the therapeutic effect was statistically significantly more significant (p&lt;0,05).</p> <p><strong>Conclusions. </strong>There was a statistically significant positive dynamics of exocrine pancreatic insufficiency and course of primary OA in the 2<sup>nd</sup> group compared to those in the 1st after treatment (p&lt;0,05), which indicates the feasibility of using the enzyme drug in the treatment of patients with primary OA in comorbidity with exocrine pancreatic insufficiency.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Liliia Babynets, Iryna Halabitska http://family-medicine.com.ua/article/view/225468 Efficacy and Safety for Use Desloratadine in Children with Allergic Conditions (Literature Review, Own Research) 2021-02-24T10:42:47+00:00 Yurii Marushko pediatrics.postgrad@nmu.ua Olha Khomych pediatrics.postgrad@nmu.ua <p>According to scientists, more than 20 thousand allergens are known and their number is constantly increasing. Therefore, children’s allergy remains one of the urgent problems of modern medicine, since allergic diseases in adults in most cases begin from childhood.</p> <p>The article summarizes our own data and presents a scientific review of the medical literature, which is devoted to the analysis of the problem of treatment of allergic diseases with desloratadine in children. Nowdays there is a significant prevalence of allergic conditions in children. We analyzed the effect of desloratadine on the course of allergic diseases in children. The analyzed literature review showed a high safety profile of the drug desloratadine. Also we presented the personal data of desloratadine therapy for seasonal allergic rhinitis in children.</p> <p>The literature data presented in the article and our own experience allow us to conclude that allergic conditions remain an urgent problem in clinical medicine, and the use of antihistamines, in particular desloratadine, increases the effectiveness of allergy therapy and accelerates the recovery and disappearance of symptoms.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Yurii Marushko, Olha Khomych http://family-medicine.com.ua/article/view/225460 Factor of Basic Pharmacologic Therapy in DSME Applying 2021-02-24T10:06:41+00:00 Larysa Matіukha mlarysa@gmail.com Bohdan Smal bohdansmal@gmail.com <p><strong>The objective</strong><strong>: </strong>to investigate the influence of the scheme of basic pharmacologic therapy on the dynamics of carbohydrate and lipid metabolism in a group of patients with type 2 diabetes on the background of the use of group DSME.</p> <p><strong>Materials and methods. </strong>The study was performed on the basis of the Department of Family Medicine and Outpatient Care within the territorial boundaries of the Kyiv agglomeration. The study included 117 patients with type 2 diabetes. The study group of patients was randomly divided into a groups of classroom training (38 people), a group of remote training (39 people) and a control group (40 people), which did not receive additional training load. Subsequently, patients from the study groups took the appropriate course in classroom (outpatient) or remote (using Skype video conferencing) formats. The education of patients methodically and meaningfully complied with the consensus recommendations of the American Diabetes Association, the American Association of Diabetes Educators and the Academy of Nutrition and Dietetics. Subsequently, the relevant indicators of diabetes were monitored at 3 and 12 months after the start of the study and the correlation of their dynamics with the basic scheme of pharmacologic therapy ts and its change during the observation period was analyzed.</p> <p><strong>Results. </strong>During the observation period, changes in the scheme of hypoglycemic and hypolipidemic therapy were made in 10 (8,5 %) and 20 (17,0 %) patients. It should be noted that the relevant changes were bilateral, both in the direction of simplification and in the direction of intensification of drug therapy regimens. Analysis of the ratio of 3- and 12-month dynamics of carbohydrate and lipid metabolism and the scheme of hypoglycemic and hypolipidemic therapy in all study groups did not reveal a significant correlation.</p> <p><strong>Conclusions. </strong>There is no significant correlation between the basic scheme of hypoglycemic and hypolipidemic therapy with the dynamics of carbohydrate and lipid metabolism at the stages of 3- and 12-month check-points. The lack of influence of the pharmacologic therapy scheme on the positive dynamics of diabetes mellitus emphasizes the importance of group DSME in patients with type 2 diabetes mellitus as a separate independent factor of improving of the disease.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Larysa Matіukha, Bohdan Smal http://family-medicine.com.ua/article/view/225464 The Outcomes of an Improved Treatment of Patients with Type 2 Diabetes and Non-alcoholic Fatty Liver Disease 2021-02-24T10:30:13+00:00 Halyna Mykhalchyshyn G.mykhalchyshyn@gmail.com <p>Nowadays we notice the increase of cases that combine type two diabetes mellitus, and nonalcoholic fatty liver disease. As a result, the course of disease aggravates. The pathogenesis, diagnoses and treatment of NAFLD remain unclear.</p> <p><strong>The objective: </strong>of our study is to determine the clinical efficacy of an improved therapeutic measures set in patients with type 2 diabetes and NAFLD.</p> <p><strong>Materials and methods. </strong>We’ve examined 132 patients with type 2 diabetes mellitus and NAFLD. All patients gave their consent to participate in the study. They also received all necessary nutrition and workout recommendations. We split the patients into two groups. First group patients (n=37) received antihyperglycemic drugs (metformin, gliclazide or glimepiride). Patients of the second group (n=95) additionally received DPP-4 inhibitors (saxagliptin or sitagliptin), atorvastatin, and the multiprobiotic. Patients of the second group were divided into 2 subgroups: 2A group with standard level of transaminases, and 2B group with an increased level of transaminases accordingly.</p> <p><strong>Results. </strong>Improved set of therapeutic measures revealed distinctively positive effect on the dynamics of clinical manifestation of lesions of the hepatobiliary system in patients with diabetes. There were no such changes in another group. Under the influence of complex treatment in the second group of patients, the functional state of liver improved due to a significant decrease of ALT, AST, TG and VLDL levels in the blood serum. Size of the liver decreased, liver stiffness indicators improved according to shear wave elastography data.</p> <p><strong>Conclusions. </strong>Combined therapy, which includes DPP-4 inhibitors, statins and multiperiodic is effective in the treatment of patients with type two diabetes and nonalcoholic fatty liver disease.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Halyna Mykhalchyshyn http://family-medicine.com.ua/article/view/225199 USA Got the Rights to the Drug Arlevert® 2021-02-22T07:56:24+00:00 Yevhenii Andreyev yvandreyev_f@mail.net <p>Міжнародна компанія Castle Creek Pharmaceuticals (США), яка спеціалізується на розробці інноваційних засобів для лікування пацієнтів із патологією голови та шиї, дерматологічними захворюваннями, а також іншими клінічними станами, отримала від компанії Hennig Arzneimittel GmbH &amp; Co. KG (Німеччина) ексклюзивні права на використання препарату Арлеверт® у Сполучених Штатах Америки.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Yevhenii Andreyev http://family-medicine.com.ua/article/view/224988 Anxious-depressive Pathology in the Structure of Adaptation Disorders (Clinics, Diagnosis, Therapy) 2021-02-18T09:13:19+00:00 Nataliia Maruta mscience@ukr.net Viktoriia Fedchenko vfedchenko83@ukr.net <p><strong>The objective:</strong> evaluation of the effectiveness of the drug Giacintia (escitalopram) – coated tablets, 10 mg in the treatment of patients with anxiety and depressive symptoms in the structure of adaptation disorders.</p> <p><strong>Materials and methods.</strong> The study involved 38 patients with adaptive disorders, mixed anxiety-depressive response to ICD-10 (F 43.22). All patients received Giacintia at a dose of 10 mg per day, due to the sufficient therapeutic effect of this dosage. A comprehensive approach was used, which included methods: clinical and psychopathological; psychodiagnostic, based on the scale «Questionnaire of severity of psychopathological symptoms» (Symptom Check List-90-Revised – SCL-90-R), hospital scale of anxiety and depression (HADS) and the scale of social adaptation Sheehan (SDS); methods of mathematical statistics.</p> <p><strong>Results.</strong> Peculiarities of patients’ clinical condition and its dynamics were assessed before treatment (day 1), during therapy (day 14), and after treatment (day 90). As a result of Giacintia therapy, a significant improvement in the mental state of patients was found. When studying the regression of psychopathological symptoms, the positive dynamics of depressive disorders in this category of persons was observed by the end of the second week of therapy, and on the part of anxious – up to 21 days of therapy. Examination of patients at the end of the 90-day course of Giacintia treatment revealed a significant reduction in all previously recorded symptoms of anxiety and depression compared with baseline (p&lt;0.05). On the SCL-90-R scale, on day 14 of therapy, patients showed a significant decrease in obsessive-compulsive symptoms, signs of paranoia (suspicion), hostility (feelings of anger), depressive symptoms, and phobic anxiety. Subsequently, there was a significant decrease in existing psychopathological symptoms and a probable decrease in all scales on day 90 of therapy with the studied antidepressant (t≥2,3477). At the time of the final assessment, the indicator on the scale of depression decreased to 0,52 points, and on the scale of anxiety – to 0,56 points, which indicates a reduction in clinically = pronounced anxiety and depressive symptoms. According to the HADS scale at the initial assessment of clinical and psychopathological manifestations of anxiety and depression, clinically expressed symptoms of anxiety were registered in 71,05 % of individuals (mean score – 15,00±2,39 points), subclinical – in 28,95 % of individuals (mean score – 8,82±0,75 points). At the same time, clinically pronounced symptoms of depression were registered in 81,58 % of individuals (mean score – 15,23±2,33 points), subclinical – in 18,42 % of individuals (mean score – 8,43±0,53 points). A significant decrease in the percentage of clinically pronounced manifestations of depressive symptoms was registered on day 14 of therapy (57,89 % of individuals, p&lt;0,05). At the time of the final HADS assessment, clinically significant symptoms of anxiety and depression were completely reduced in the study group and were represented only by subclinical manifestations in 13,16 % of patients and 11,43 % of patients, respectively.</p> <p><strong>Conclusions.</strong> The results of the study showed high efficacy and good tolerability of the drug Giacintia in the treatment of anxiety and depressive symptoms in the structure of adaptation disorders. Giacintia has not only a balanced pronounced thymoanaleptic effect, but also provides increased professional, social and family activity and improves the quality of life of patients in general. Especially important is the good tolerability of the drug confirmed by the study, the unstable transient nature of adverse events, their insignificant severity, which is a significant advantage in the formation of patients’ commitment to treatment and achieving a deeper and more lasting therapeutic effect. Thus, the use of Giacintia can successfully overcome adaptation disorders and prevent their transformation into chronic conditions.</p> 2020-12-21T00:00:00+00:00 Copyright (c) 2020 Nataliia Maruta, Viktoriia Fedchenko http://family-medicine.com.ua/article/view/225186 I International Congress «From Birth to Maturity: Interdisciplinary Approach in Preserving Human Health» (April 3-5, 2020) 2021-02-21T20:30:32+00:00 Serhii Shurpyak soshurpyak_f@mail.net 2020-12-21T00:00:00+00:00 Copyright (c) 2020 Serhii Shurpyak http://family-medicine.com.ua/article/view/224822 Rehabilitation of Rheumatic Patients in Primary Care 2021-02-16T10:19:22+00:00 Liudmyla Khimion ludmilahimion@hotmail.com Oleksandr Burianov kaftraum@ukr.net Oksana Yashchenko yashchenkoo@ukr.net Svitlana Danylyuk svdan62@gmail.com Tetiana Sytyuk sytuktanya@ukr.net Nataliia Kicha kicha0514@gmail.com <p>The evidence base for use of different rehabilitation programs is discussed in the article. The most effective approaches to the rehabilitation organization and patients education are presented together with the different types of physical rehabilitation, ergotherapy and physical activities useful for the development of the maximum functional ability and social integration of rheumatic patients. The positive impact of the motivational interview in work with rheumatic patients, the results of the clinical studies on evaluation of the patients education influence on their functional abilities and psychologic status; recommendations on ortheses use are discussed in the article.</p> <p>The recommendations of the leading international expert groups about exercises, physiotherapy, ergotherapy prescribing to the patients with rheumatoid arthritis, osteoarthritis and connective tissue systemic diseases are given; the attention is drown to the methods of evaluation of patients physical status; patients education about energy saving technologies use for maximum possible functional and physical loads and patients autonomy at hom aend social life realization.</p> <p>Implementation of the given rehabilitation algorithms can help to realize holistic patient-centered approach, improve patients quality of life and functional capacity.</p> 2020-12-21T00:00:00+00:00 Copyright (c) 2020 Liudmyla Khimion, Oleksandr Burianov, Oksana Yashchenko, Svitlana Danylyuk, Tetiana Sytyuk, Nataliia Kicha http://family-medicine.com.ua/article/view/225470 Parameters of Quality of Life and Metabolic Disorders in Women Who Underwent on Hysterectomy with Uterine Myoma 2021-02-24T10:57:28+00:00 Olha Proshchenko proshchenko777@gmail.com Borys Ventskivsky bmventskivsky_f@mail.net Iryna Ventskivska ventskivska@gmail.com <p>Today, there are more and more reports of an increase in the proportion of patients with uterine fibroids (up to 45 %), in whom hysterectomy (HE) remains the only radical method of recovery. Over the past decades, views on this operation have changed significantly. HE and its influence on somatic and psychological status, psychogenic changes and vegetative-neurotic manifestations associated with postoperative acute circulatory ischemia of ovarian tissue have become the subject of scientific exchange in many discussion panels.<br>The article presents data from an experimental psychological study, assessment of the severity of urogenital dysfunction using the standardized POP-Q system, characteristics of quality of life parameters, indicators of carbohydrate and lipid metabolism both at the stage of preoperative followup and within 12 months, 3 and 5 years after surgery. in 80 women of reproductive age with uterine fibroids who underwent vaginal hysterectomy.<br>The comparison group included 60 patients with abdominal hysterectomy. As a result of the studies carried out using experimental psychological methods, the dominance of asthenic, anxiety and depressive disorders should be noted. The most common symptoms were decreased performance, mood, emotional lability, dyssomnia, decreased memory and concentration.<br>The study of the parameters of the quality of life made it possible to note the lowest indicators in the older age category of the main group, low levels of parameters were recorded in relation to «physical» and «sexual health», the sphere of interpersonal relationships suffered less.<br>After GE, an increase in body mass index, systolic and diastolic blood pressure, an increase in proinsulin and HOMA index, as well as very low density lipoprotein cholesterol and an atherogenic index were recorded.</p> 2021-03-15T00:00:00+00:00 Copyright (c) 2020 Olha Proshchenko, Borys Ventskivsky, Iryna Ventskivska