Bogomolets National Medical University Research Articles

Результати застосування бактерій роду Bacillus spp. у вигляді спрея в лікуванні гострого вірусного тонзилофарингіту в дітей

Purpose - to determine the results of the use of bacteria of the genus Bacillus spp. in the form of a spray (Bioplasmix spray for throat) in the treatment of the children with acute tonsillopharyngitis. Materials and methods. An open, randomized, controlled, post-registration study was conducted among 60 children aged 3-17 years diagnosed with acute respiratory viral infection (ARVI), acute tonsillopharyngitis, who were treated in the clinic of pediatric infections of the Bogomolets National Medical University, Kyiv. Children were divided into two groups - main and control. The control group consisted of 30 children who received treatment in accordance with the local protocol for the diagnosis and treatment of acute respiratory viral infections and influenza, and the main group consisted of 30 children who received in addition to the protocol treatment the prophylactic and hygienic agent Bioplasmix throat spray 2-3 injections 3-4 times a day. Bacterial etiology of tonsillopharyngitis was excluded using the McIsaac diagnostic scale. The study involved children with acute viral tonsillopharyngitis, who had 0-2 points on this scale. The results of the pilot observation indicate a positive effect of the drug Bioplasmix Throat Spray on the course of acute viral tonsillopharyngitis in children. This effect was manifested by a reduction in the time of normalization of the main clinical symptoms, such as fever, sore throat and inflammation of the oropharyngeal mucosa. It should be noted that during the observation period, no adverse reactions were registered in patients who used Bioplasmix Throat Spray, which confirms the high safety profile of the drug and indicates its good tolerability. Conclusions. The use of probiotic bacteria Bacillus spp. (Bioplasmix throat spray) helps to reduce the viral load and eliminate the pathogen, destroy bacterial biofilms, antagonistically displace bacteria, in particular staphylococcus, facilitates the course of ARVI and accelerates the recovery of patients without the development of bacterial complications. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

TWO-YEAR ANESTHESIOLOGY AND INTENSIVE CARE INTERNSHIP PROGRAM EFFICACY AND THE WAR INFLUENCE ON IT

COVID-19 pandemic and full-scale Russia aggression in Ukraine have become a challenge for the medical schools. Internships in anesthesiology and intensive care in Ukraine is three times shorter, comparable with high-income countries. The aim of the study was to evaluate the efficacy of the internship training. A study was carried out at the department of surgery, anesthesiology and intensive care postgraduate education Bogomolets National Medical University named after O.O., Department of Surgery, Anesthesiology and Intensive Care Postgraduate Education. Among the most effective types of training, residents and teachers chose live practical classes, seminars and simulation trainings, self-study. The training efficacy of the Anesthesiology and Intensive Care internship program was acceptable for the anesthetic management of low-risk patients, but requires significant improvement for the anesthetic management of high-risk patients and the management of the critically ill.

Role of erosive and ulcerative gastric lesions in the development of hemorrhagic complications in liver cirrhosis

We present the results of the treatment of 135 patients with a hepatic form of portal hypertension (liver cirrhosis) that have been hospitalized in the clinic of the Department of Surgery No. 2 in Bogomolets National Medical University within the period from 2011 to 2020. The aim of our study was to reveal the factors of the development of erosive and ulcerative gastric lesions in liver cirrhosis and their role in the occurrence of hemorrhagic complications. Based on studies of the rheological properties of gastric mucus, it was found that one of the leading factors in the development of erosive and ulcerative stomach lesions in portal hypertension is increased transcapillary filtration in the edematous-ascitic stage of liver cirrhosis. As a result, portal stagnation and reduced colloid mucus-bicarbonate barrier of the stomach led to the development of actual gastric ulcers. Erosive and ulcerative lesions on a part of the gastric mucosa were found in 66 (48.9%) of patients with cirrhosis of the liver, and in 45.2% of cases (28 persons) they were complicated by gastric bleeding development. Pathogenetic treatment of gastric ulcer-erosive bleeding in portal hypertension, against the background of the use of endoscopic hemostasis, should be aimed at strengthening the protective properties of the mucous-bicarbonate barrier of the stomach. Successful results of surgical treatment were achieved in 64.3% of patients. The overall mortality in liver cirrhosis complicated by gastric bleeding from ulcerative lesions of the stomach was 21.4% (6 patients died), and postoperative mortality was 25% (2 patients died).

Distance learning technology in training competent master of dentistry under extreme conditions by evaluation of foreign students

The object of research: Masters of Dentistry professional training in Bogomolets National Medical University (Kyiv, Ukraine) with the distance learning technology
 Investigated problem: Educational process in extreme condition as pandemics and wars, possible ways to solve the problem how students and teachers cope with both challenges in Ukraine on the way of preparing competent doctor from the point of view of foreign students.
 The main scientific results: Preliminary data of medical university students from foreign countries - future masters in dentistry of the Bogomolets Medical University (Kyiv, Ukraine) survey, conducted in term April-November 2022 about their perceptions of online learning and teaching in extreme conditions as they experienced during lockdown in terms of COVID -19 outbreak and continuing russian`s aggressive war in Ukraine. Our findings from survey concern questions of student`s general view on online educational technology as well peculiarities of approaches in teaching we can use for acceptable in such extreme conditions educational outcome. We start discussion about some useful methodological approaches for distance education technology in extreme conditions.
 The area of practical use of the research results: Sharing with educational community our experience and features about distant learning in extreme conditions of dental students.

Obesity as an Additional Risk Factor for Thrombogenic Changes in Hemostasis in Hypertensive Patients with Non-Alcoholic Fatty Liver Disease

Introduction: Obesity due to the high proportion of visceral adipose tissue is often leads to hypertension (HT), non-alcoholic fatty liver disease (NAFLD). The risk of thrombogenic complications increases in the presence of NAFLD and HT. Considering the occurrence of prothrombotic changes in the blood in patients with NAFLD, HT and obesity, the combination of these diseases may be an additional risk of thrombosis. Methods: The research was conducted at the Bogomolets National Medical University, at Department Propaedeutics of Internal Medicine No 1. We examined 152 patients and 15 individuals for control group. Results: Mean platelet count was higher in obese patients by 6.4% (p<0.05). In patients with NAFLD without HT, platelet count was higher in the presence of obesity by 16% (p<0.05), we have seen an increase level of MPV in NAFLD patients with obesity. In the comorbid course of HT and NAFLD, aggregation of platelets stimulated by adrenaline was grown in case of obesity (18%; p<0.001) relatively to non-obese patients. In obese patients suffering from HT, these hemostasis changes were characterized by a tendency to accelerate coagulation. There was a reduction in prothrombin time (PT) time by 8.1%, a growth in fibrinogen by 25.8% (p<0.001) and soluble fibrin monomeric complexes (SFMC) by 4 times (p<0.001) in obesity. Conclusion: Obesity increases the thrombogenic activity of blood in both patients with HT and in patients with HT and NAFLD, both due to platelet and coagulation of hemostasis.

The Quality of Life of Patients after Conservative Treatment of Adolescent Idiopathic Scoliosis

Summary. Relevance. Health-related quality of life (HRQoL) is an important indicator of the treatment. Quality of life consists of functional, physical, emotional, social and spiritual states [1], and therefore has become a leading criterion in many researches, along with physical and economic factors. In the course of its development, the concept of quality of life has been correctly indicated as a parameter of the result in the recommendations of many medical societies [2].
 Objective: to assess the quality of life of patients with adolescent idiopathic scoliosis who were treated conservatively.
 Materials and Methods. The study included 54 patients who were treated at the clinic of the Department of Pediatric Surgery of the Bogomolets National Medical University in the period from 2015 to 2019. The mean age of the patients was 12.6 years (range 10 to 15 years), the mean Cobb angle was 24.8° (range 20° to 37°), and the mean torso angle was 7.2° (range 6° to 17°). All patients underwent conservative treatment with continuous use of the Cheneau corset [6]. Indicators of quality of life were studied using Brace Questionnaire (BrQ) [8] at the beginning and at the end of treatment. The minimum duration of conservative treatment was 2 years.
 Results. Patients with adolescent idiopathic scoliosis at the end of treatment had lower scores in all domains of BrQ. This difference was statistically significant for the mean overall BrQ score and for the domains of general health perception, physical functioning, emotional functioning, self esteem and aesthetics, bodily pain, and social functioning. Assessments in the domains of vitality and school activity were not significant.
 Conclusions. It was found that the quality of life immediately after the end of conservative treatment of adolescent idiopathic scoliosis in the Cheneau сorset is gradually improving. Due to limitations in the design of the study, this finding highlights the importance of measuring quality of life indicators to assess how patients with adolescent idiopathic scoliosis perceive the impact of their disease.

Experience of transanal hemorrhoidal dearterialization in the surgical treatment of grades II-IV hemorrhoids that bleeding

The aim of the work was to analyze the use of Transanal Hemorrhoidal Dearterialization (THD) in the surgical treatment of hemorrhoids of various degrees. The use of THD for complicated hemorrhoids in 514 patients for the period 2008–2021 was analyzed on the clinical basis of the Department of Surgery No.3 of the Bogomolets National Medical University (Ukraine). The average age of the patients was 39.1 years. 159 (30.9%) patients had grade II hemorrhoid, 299 (58.2%) – grade III, 56 (10.9%) – grade IV. All patients had manifestations of rectal bleeding and periodic prolapse of hemorrhoidal nodes, 75 (14.6%) patients had a pain syndrome associated with anal fissures, 19 (3.7%) patients underwent THD for recurrent (after performing other operations) hemorrhoids. No severe postoperative complications were observed. The average length of stay in the hospital was 1.3 days. The working capacity of the patients was restored after 3–5 days. Since 2015, THD has been performed according to the method updated by the authors, which was called Distal Doppler-controlled Dearterialization (DDD). We compared the results of performed THD before and after supplementing her DDD. When comparing THD before and after supplementing its DDD, a significant (p=0.00007) increase in the specific gravity of surgical interventions in stage III hemorrhoids while preserving the quality and duration of the postoperative course was revealed. Also, the number of THD in combination with surgery for chronic anal fissure, the number of operations for recurrent hemorrhoids increased significantly (p<0.05), which indicates the validity and effectiveness of the technique as an operation of choice in the surgical treatment of stage II–IV hemorrhoids. Application of the updated technique using DDD facilitates the performance of mucopexy, allows performing operations at later stages of complicated hemorrhoids. Keywords: proctology, THD, DDD, Doppler-controlled dearterialization.

Тактика хірургічного лікування вроджених деформацій хребта в дітей

Progress in spinal surgery during the second half of the twentieth century was made possible by a deeper study of the three-dimensional nature of the normal and pathological architecture of the spine. The problem of complex spinal deformities remains one of the most important in clinical vertebrology. In Ukraine, more than 9,000 children need surgery for scoliosis spinal deformities. Of these, more than 15% of children have congenital scoliosis deformities. Purpose - to conduct a retrospective analysis of the results of surgical treatment of congenital spinal deformities in children. Materials and methods. A retrospective analysis of the results of treatment of 36 patients (from 9 to 12 years) with congenital spinal deformities who received treatment at the Department of Pediatric Surgery of the Bogomolets National Medical University (National Children's Specialized Hospital «OHMATDYT», Kyiv) in the period from 2008 to 2018. Patients were divided into two groups: I (staged treatment) - 18 children who received treatment using halo-gravity traction (HGT), followed by spinal instrumentation; II (one-time treatment) - 18 children who underwent surgical correction with osteotomies (4-6 levels according to Ponte, VCR osteotomy at 1-2 levels). Results. Two groups of patients were studied. According to HGT, the main arc deformation improved to 55±25%. HGT - complications were observed in 12% (transient neurological disorders). In patients who underwent spinal instrumentation without prior traction complications were observed in 37% of patients (neurological transient disorders in the form of spinal cord dysfunction). In children with congenital spinal deformities, simultaneous implantation of the structure in comparison with staged treatment with HGT increases the risk of neurological deficits by 25%, HGT allows greater correction and adapt the spinal cord to further correction. Conclusions. In the surgical treatment of congenital spinal deformities, HGT reduces the risk of neurological complications, reduces the time of surgery and the amount of blood loss, allows us to get better results of correction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: halo-gravitational traction, scoliotic deformation, surgical treatment.

Medical university experiences regarding emergency remote teaching (ERT): Evidence from Ukraine

The study's main aim is to examine the opportunities and challenges of Emergency Remote Teaching (ERT), focusing on the students of O.O. Bogomolets National Medical University during COVID-19 pandemic. In order to conduct the study, an ex-post facto design of the quantitative research method was employed. Data were collected through a survey from 120 students and 15 teachers. For that, an instrument was developed to collect the responses related to face-to-face learning and online learning. The results reveal various technological, pedagogical, and social challenges. This study intends to examine the students' and teachers' experience of emergency remote teaching ERT in the wake of the COVID-19 Pandemic, especially Ukrainian university students. This study aims to know the advantages and disadvantages of online learning with individuals' demographics, interests, and satisfaction. This research assists in developing new techniques of education by focusing on the pros and cons of any methodology.

DEVELOPMENT OF KYIV SOCIAL AND HYGIENIC SCIENTIFIC SCHOOL IN INDEPENDENT UKRAINE

The aim of the work is to study the processes of development of the Kyiv Social and Hygienic Scientific School during the period of Ukraine’s independency, it’s contribution to the development of medical and social research and development of the health care system.
 Materials and methods. Published scientific papers and reports were used like sources of information. The methodology was based on the using of historical-bibliographic and information-analytical methods.
 Results. Since 1991, a new stage of development of the Kyiv Social and Hygiene Scientific School has been started, closely connected with the state-forming processes in the country. Important scientific tasks of the representatives of this school were the scientific substantiation of the new national health care system, preparation of modern specialists in the sphere of social medicine and health care organization, optimization of organization and management of medical services, development of public health system, etc. Department of Social Medicine and Health Care of Bogomolets National Medical University later was transformed into the Department of Social Medicine and Public Health and continue the traditions according previous years in the development of scientific and educational direction in social medicine and health care organization, filled it with modern content. Members of the school became developers of a number of important strategic and program documents on development of the field, including concepts, state programs, national plans. They actively worked on forming the regulatory and legal base of health care. The department, as a scientific and methodological center of educational process implementation in medical and social direction, has carried out development of new modern educational programs on social medicine, public health and their educational and methodical support. The staff members of the department are developers of educational standards and programs.
 The pedagogical staff of the department headed the work on writing and publishing a number of new national editions and educational manuals to provide teaching of specialized educational disciplines. Over time, the Department’s graduates have joined to the groups of other scientific and educational institutions, which contributed to the expansion and progressive development of the Kyiv Social and Hygiene Scientific School. Active preparation of new personnel of social workers for scientific and educational institutions and practical health care was carried out. International cooperation, cooperation of school representatives with WHO, WHO/Europe and other international healthcare organizations have been strong developed.
 Conclusion. The repairing of Ukraine's independence marked the beginning of a new stage in the development of the Kyiv Social and Hygienic Scientific School, which continues nowadays. It is characterized by active transformation and internationalization of medical, social, scientific and educational trends in health care in the context of building a new national health care system, scientific support of reforms, preparation of a new modern constellation of social hygienists, creation of new and strengthening existing schools and development of international cooperation.

Електроміографічне обгрунтування доцільності застосування міорелаксуючих шин технології EXOCAD при лікуванні дисфункції скронево-нижньощелепних суглобів

The purpose of the study was to study and comparatively analyze the nature and degree of changes in electromyographic activity of the main and auxiliary chewing muscles in patients with temporomandibular joint dysfunction before and after the use of treatment with myorelaxant splints. Materials and methods. Five-year study on the basis of Stomatological Medical Center of Bogomolets National Medical University of patients with temporomandibular joint dysfunction (274 people) was conduscted. The general analysis provided 1024 detailed electromyograms before, after and at the stages of treatment of patients with temporomandibular joint dysfunction. Results and discussion. The results and conclusions of the analysis of the effectiveness of the treatment with the use of myorelaxant splints in the treatment of temporomandibular joint dysfunction indicate an increase in the quality of treatment of this pathology in patients and a reduction in the period of achievement of the result. The results obtained after 12 months indicate that the effectiveness of treatment of patients of control group I (with the lowest intensity of symptoms of temporomandibular joint dysfunction) reached 89.1±1.3%; control group II – up to 78.3±1.3%; control group III – 77.3±1.3%. In general, a study of the state of temporomandibular joint, complex clinical and paraclinic diagnosis, modern orthopedic treatment and prevention of musculoskeletal dysfunction of the temporomandibular joints were carried out. Based on the obtained data, the effectiveness of this algorithm of complex diagnosis, treatment and prevention of musculoskeletal dysfunction of temporomandibular joint was developed, clinically implemented and evaluated. Also, the data obtained as a result of the study by the authors were the basis for finding and correcting new methods and algorithms for diagnosing and treating pathology. The original author's concept of the pathogenesis of muscular-articular dysfunction of temporomandibular joint, used in the study and scientifically substantiated by the authors, united all existing theories of the development of this disease. The multifactorial analysis revealed an increase (p <0.001) of the risk of not achieving the effect of treatment by reducing pain syndrome with an increase in scores on the Bayers scale before treatment, odds ratio = 1.6 (95% of BI 1.4–1.9) for each point of growth score (when standardizing on three other risk factors). An increase (p=0.002) of the risk of not achieving the effect of treatment by reducing pain syndrome with an increase in the asymmetry of the indicator J_MM_A_max, Index Bayers (visual analogue scale) = 1.08 (95% BI 1.03–1.12) for each point exceeding the value of the indicator for the left half above the right (when standardizing on three other risk factors). Also, an increase (p= 0.049) of the risk of not achieving the effect of treatment for a decrease in pain syndrome with an increase in the asymmetry of the J_MM_A_mean indicator, odds ratio = 1.28 (95% of BI 1.00–1.65) for each point exceeding the value of the indicator for the left side above the right side (when standardizing on three other risk factors) was found. Conclusion. Such a thorough approach to the implemented model of diagnosis and treatment of patients with temporomandibular joint dysfunction and a synchronized complex of studies and treatment of this pathology, developed in accordance with it, provided an opportunity to assess qualitative and quantitative changes in the link of the chewing apparatus and the central link of the corresponding functional biosystem that ensure the formation and implementation of the main functions of the temporomandibular joint

Experience in implementation of the new elective course “Actual problems of pharmacy education"

Objective. The paper focuses on the description of the new elective course “Actual problems of pharmacy education”, which was offered during the fall semester 2021/2022 academic year for first-year pharmacy foreign students at Bogomolets National Medical University. The detailed information about the organization of lectures and seminars are presented. Methods. The model of flipped class was chosen to teaching the proposed elective course. The attitude of students to the elective course was assessed by using post-course surveys. Results. Most of students reported that they would recommend this elective course to other students. Overall, students felt that the course was engaging, interesting and informative. Students’ attitudes also were positive toward the teaching style − flipped classroom. Conclusions. Most students earned grades of A and C. This high level of the students’ performance confirms that the elective course was successfully conducted achieving the desired learning outcomes.

STRUCTURE OF TRAUMATIC INJURIES AND EXPERIENCE IN THE TREATMENT OF THE WOUNDED PATIENTS, AS A RESULT OF HOSTILITIES IN THE FIRST DAYS OF RUSSIA’S ATTACK ON UKRAINE

Introduction. All the gunshot wounds are of high-energy. Gunshot and blast injuries, in most cases, are multiple, varying in depth and area of the wound surface. From the first day of the full-scale invasion of Russian troops (February 24, 2022), many victims of hostilities on the right bank of the Dnipro river in Kyiv were hospitalized in our hospital, which is one of the clinical bases of the Department of Anesthesiology and Intensive Care of the Bogomolets National Medical University. Dozens of wounded patients needed simultaneous interventions, and the presence of only 5 operating tables in the facility did not prevent the provision of appropriate qualified medical care to 6-8 critical patients at the same time.
 The goal of the work. To determine the structure and severity of traumatic injuries received as a result of hostilities.
 Materials and methods. In the study a prospective analysis of 89 patients who were injured in hostilities for the period from February 24 and March 3 2022, and were hospitalized in one of the clinical bases of the Department of Anesthesiology and Intensive Care of the Bogomolets National Medical University was conducted.
 Results and discussion. Lesions of one anatomical area occurred in 54 people (60.7%), lesions of two or more anatomical areas – in 35 people (39.3%). Most injured patients – 61 (68.5%), required from 2 to 6 surgeries, which was due to damage to various anatomical areas or the need for phased surgical interventions, including the use of damage-control surgery. Of the 66 patients with limb and pelvic bone injuries, mine explosions or gunshot fractures of the long bones of arms and legs, 41 were injured, and all were treated on an orthopedic basis. Damage-control surgery for injuries of abdominal organs was used in 5 wounded patients. In two patients, damage-control surgery was used for injuries of the pleural cavity. 9 patients (10.1%) of the 89 hospitalized with traumatic injuries received as a result of hostilities died.
 Conclusion. Extremities and pelvic bones injuries dominate in the structure of combat injuries – 66 (43.7%) patients; chest injuries were in 31 (20.5%) patients; head and neck injuries in 27 (17.9%) patients; abdominal solid organs and pelvic organs injuries in 19 (12.6%) patients; facial injuries in 8 (5.3%) patients. Damage of two or more anatomical areas occurred in 39.3% of patients affected by the hostilities. Most of the wounded patients – 68.5%, required from 2 to 6 surgeries.

The experience of designing a single information and educational environment of the university "NMU Digital"

The publication considers theoretical and practical approaches to the design and creation of a single information and educational environment of the Bogomolets National Medical University. The main factors that were taken into account in the development of information and educational environment of the university are identified and substantiated. The basic educational and methodical resources that ensure the functioning of the information and educational environment of modern Medical (Pharmaceutical) Higher Educational Establishment (M(P)HEE) are given. The peculiarities of the educational process at the university are analyzed and the scheme of interaction of the educational-methodical department with the faculties of the university is given.A model of information and educational environment of the Bogomolets National Medical University "NMU Digital". The list of works related to the educational process performed by the structural units of the university in the automated control system is highlighted. The main advantages of use and functionality of the automated control system, electronic document management system and distance learning platform are revealed and analyzed. The results of an online survey of research and teaching staff and students of different faculties on determining the level of digital orientation are analyzed.

SCIENTIFIC-PRACTICAL CONFERENCE WITH INTERNATIONAL PARTICIPATION FOR THE WORLD HEALTH DAY 2022

Venue of the conference - Bogomolets National Medical University, Kyiv, Ukraine The date of the conference has been postponed from April 5, 2022 to the fall of 2022 due to the martial law in the country.

SIMULATION TRAINING AND VIRTUAL PATIENTS AS A COMPONENT OF CLASSROOM TRAINING OF FUTURE DOCTORS UNDER COVID-19 CONDITIONS.

The aim: To present and substantiate the theoretical and applied aspects of the organization of simulation training for higher education applicants in the field of health care based on the analysis and generalization of the experience of the Bogomolets National Medical University. Materials and methods: To perform the set tasks, the following theoretical and empirical methods of scientific research were used: system analysis; comparison and generalization; bibliosemantic method; the analysis and simulation methods. Results: The experience of organizing simulation training for higher education students in the field of health care was analyzed and summarized. There have been investigated the functional capabilities of the most common "virtual patient" modeling systems for the formation of the practical component of the future doctors' professional competence. Finally, the features of the organization of the educational process at a medical university in classroom, mixed (classroom-distance) and synchronous (hybrid) forms of education during the period of quarantine restrictions have been described. Conclusions: A technology for conducting an objective structured practical (clinical) exam has been developed. It helps to standardize the procedure for checking the level formation of the clinical professional competence of a future doctor in accordance with the requirements the standard of higher medical education. It is shown that the use of simulation training and modeling systems "virtual patient" in the preparation of future healthcare professionals increases the effectiveness of training, the interest of students and interns, motivating them to develop the necessary components of the future doctor's professional competence.

Досвід надання стоматологічної допомоги в умовах військового стану

Relevance. The state of war had a significant impact on the provision of medical care to the population of Ukraine. Considering that dental care is one of its highly specialized types, the events in the country were fully reflected in it as well. The aim of the study. Summarize and analyze the experience of outpatient dental reception of patients in the conditions of the Dental Medical Center, which is a structural unit of the University Clinic of Bogomolets National Medical University, during the martial law period. Materials and methods. A retrospective analysis of 4,308 medical histories of persons who sought dental care at the Dental Medical Center of Bogomolets National Medical University within two months from the moment martial law was declared in Ukraine (February 28, 2022–April 30, 2022). The results. The work of the Dental Medical Center of Bogomolets National Medical University was restored practically from the first days of the declaration of martial law in Ukraine. For the period from 28.02 to of 30.04.2022 4,308 patients were admitted by the staff of the Dental Medical Center, of which 1,713 (39.8 %) were servicemen of the Armed Forces of Ukraine and soldiers of the Territorial Defense. Conclusions. The experience of organizing and conducting an outpatient dental appointment in the conditions of martial law, on the one hand, highlighted the problems of dental care for soldiers and conscripts before the start of a full-scale invasion, and on the other hand, it allowed to develop recommendations regarding the algorithm of the operation of a medical institution in extreme conditions. Key words: martial law, Dental Medical Center, emergency care, servicemen of the Armed Forces of Ukraine and soldiers of the Territorial Defense.

Insulin resistance in the ХХІ century: multimodal approach to assessing causes and effective correction

In a broad sense, insulin resistance (IR) is the impairment of the biological response of target tissues to insulin stimulation. IR plays a leading role in the development of metabolic syndrome, the global prevalence of which continues to grow, despite the significant efforts of medical systems. The multicomponent nature of metabolic syndrome implies its complex and heterogeneous pathogenesis, knowledge about which is annually updated with new details as a result of scientific research.This review systematizes the results of recent studies on risk factors and pathogenetic links in the development of IR, prospects and existing experience of using these data in clinical practice with an emphasis on assessing the level of melatonin and vitamin D. The issue of timely and reliable laboratory confirmation of IR is relevant not only for endocrinologists, but also for specialists in almost all areas. In clinical use apart from indirect methods of IR-assessment like HOMA-IR, there is an informative test intact proinsulin.Recently, the increasing attention of researchers is attracted by such factors of the development of IR as vitamin D deficiency and disturbances in chrono- and biorhythms. Today, their role in the pathogenesis of IR can be considered proven, which makes it possible to consider vitamin D and melatonin as therapeutic agents in an integrated approach to the prevention and correction of IR. Statistical analysis of the research results of the “DILA” Medical Laboratory and clinical data provided by the Department of Endocrinology of the O.O. Bogomolets National Medical University also showed an association of vitamin D and melatonin levels with IR.Thus, a review of scientific sources over the last 5 years clearly demonstrates the growing urgency of the problem of IR and metabolic syndrome, the need to reconsider their management from assessing traditional etiopathogenetic factors (alimentary) to taking into account the maximum spectrum of genetic aspects and exogenous impacts. An important place among the latter belongs to an objective assessment of the vitamin D and melatonin levels for adequate pharmacological correction.

ASSESSMENT OF REFLECTIVE LEARNING STRATEGIES IN PEDIATRIC SURGERY COURSE AT MEDICAL UNIVERSITY

The article is aimed at studying medical students’ reflective strategies for learning the Pediatric Surgery course at medical university. We used a modified version of the Motivated Strategies for Learning questionnaire (Soemantri et al., 2018), which has four subscales: self-orientation, critical thinking, self-regulation, and feedback seeking. The self-orientation component deals with students’ perceptions on their self-efficacy and internal motivation. The participants were fourty-six 5-th year medical students from the Bogomolets National Medical University, Kyiv, Ukraine. The survey was held in May 2021 when the students finished their spring semester in the online mode. We observed the prevalence of high and moderate levels in all the variables, but the indicators of Feedback seeking are lower which can be explained by the specificities of online learning. The authors propose methodological recommendations for educators how to create an environment for reflective learning to develop students’ reflective skills and employ alternative assessment strategies in the classroom.

ASSESSMENT LEVEL OF PHYSICAL ACTIVITY AND PSYCHO-EMOTIONAL HEALTH STATUS OF THE BOGOMOLETS NATIONAL MEDICAL UNIVERSITY STUDENTS UNDER CONDITIONS OF DISTANCE LEARNING ORGANIZATION

deterioration of epidemiological situation in the country and educational institutions due to the spread of coronavirus infection prompted the government to change the educational process and move it to distance learning. Psychological support and assistance of future doctors are critical, as, in our country, there is a growing shortage of medical staff, namely doctors, during the COVID-19 pandemic. One way to solve the above problems is to study students of higher medical institutes (SHMI) views on the transition to distance learning, which is essential to identify weaknesses and issues in the higher medical institutions of our country and to purposefully take measures to improve the pedagogical process based on identified needs. The aim of our research includes assessment of the level of physical activity and psycho-emotional health of the higher medical education seekers' of the healthcare field specialty 222 medicine using distance education under quarantine conditions (additional psycho-emotional impact) and establish ways for improving it with a combination of distance education and different psycho-emotional impact. A survey was conducted among 155 Bogomolets National Medical University SHMI of the 1st and 2nd year of study. Developed by us questionnaire have included questions about the assessment of the educational process organization (at the classroom and at "distance"), SHMI routine (work and leisure), namely amount of their spending time for sports and on the gadget use. Significant attention had been given to SHMI assessment of their health, psycho-emotional state, and level of adaptation during the study. During processing results of the motor activity study of surveyed SHMI had been revealed an insufficient level of motor activity. Thus, only 14% of SHMI do morning gymnastics, 29% of respondents go in for sports three times a week. We also found that a significant proportion of respondents have not enough duration of night sleep, which negatively affects the study's success and potentially worsens their health. Analysis of the surveyed SHMI work and rest schedule shows that most SHMI sleep at night on weekdays for 6 to 7 hours (72%). 25% of respondents have a sleep duration of up to 5 hours and only 3% of respondents have slept more than 9 hours. However, chronic insomnia can gradually lead not only to diseases but also to disorders such as, decreasing concentration memory impairment, reduce performance and work efficiency. Significant mental and psycho-emotional overload during distance education requires establishing of physiological day regime.
 Assessment of the functional state of SHMI allows timely attention and identifies certain risk groups among SHMI. Currently, distance education is developing rapidly due to quarantine restrictions, the rapid development of the Internet, and the constant improvement of communication methods. Therefore, it is essential to improve the effective organization of distance education in terms of providing SHMI with the required level of knowledge and paying due attention to problem issues.