Bukovinian State Medical University Research Articles

ULTRASOUND CHARACTERISTICS OF THE DEVELOPMENT OF THE FETOPLACENTARY COMPLEX IN PREMIER PREGNANCY

The article is devoted to the study of ultrasound changes in the fetoplacental complex in the early gestational period in pregnant womenwith miscarriage. Placental insufficiency (PI) is a syndrome caused by morpho-functional changes and is the result of a complex responseof the fetus and placenta to various pathological conditions of the maternal body [1]. It is based on disorders of compensatory-adaptivemechanisms of the fetoplacental complex (FPC) at the molecular, cellular and tissue levels. Ultrasound fetometry and placentometry are very important methods for diagnosing the state of the fetoplacental complex and can be used from the early term. Many researchers identify a number of prognostically unfavourable ultrasound markers: low chorion attachment, especially with the appearance of areas of detachment, discrepancy between the size of the foetus and gestational age, lack of clear visualization of the embryo, especially its heartbeat. In pregnant women with a history of miscarriage it is important to identify early signs of placental dysfunction from the firsttrimester onwards and to provide adequate correction for this condition. For this situation it is important to create appropriate conditions for the development and growth of the placenta and its adequate functioning. Significant fetal abnormalities occur as early as the first trimester and have a significant impact on the further process of ontogenesis.Aims and objectives of the study. To assess the normal parameters of embryonic and extraembryonic formation and to evaluate theparticular features of the formation and development of the fetoplacental system during pregnancy in women with a history of miscarriage.Materials and Methods. We erformed a comprehensive ultrasonographic examination of 25 somatically healthy women with aphysiological gestational process (control group) between 5 - 40 weeks’ gestation and 25 pregnant women with a history of miscarriage (study group). The SONOACE 8800 GAI MT with a 3.5 to 7.5 MHz convex transducer was used in the study. The data were statistically processed using standard methods of mathematical analysis with the use of Student’s and Fisher’s criteria, standard and specialized computer programs. Paired correlation indices were used to study the nature and degree of correlation between different parameters. The scientific research was positively evaluated by the Bioethics Commission of the Bukovinian State Medical University (Protocol No. 4 of 6.12.2021).Results and their discussion. In the transvaginal examination, uncomplicated pregnancy is characterized by the mandatoryvisualization of the embryo in the fetal cavity with a diameter of 14 mm or more, corresponding to 6 weeks' gestation. From the time of embryo identification in our study, we measured the coccygeal-parietal size (CPS) and compared its values with gestational age. It was found that in 22 (88.0%) cases the embryo size corresponded to the calculated gestational age and the mean inner diameter of the fetal egg. In severe clinical manifestations of threatened miscarriage the most sensitive echographic sign was a decrease in the volume of the foetus, which is a marker of further adverse pregnancy course and outcome. However, when there was an isolated increase in myometrial tone in the absence of clinical manifestations of threatened abortion, there was predominantly an isolated reduction in amniotic cavityvolume, easily corrected by the administration of conventional antispasmodic therapy.The ultrasonic criteria for alterations in pregnancy were developed, including delay in embryo CTR by 2 weeks or more on ultrasound examination up to 9 weeks' gestation; bradycardia at 90 bpm or less up to 8-12 weeks' gestation; chorionic detachment withretrochorial hematoma formation (over 25 ml); tachycardia at over 200 bpm with clinical manifestations of spontaneous miscarriage; marked progressive decrease of amniotic cavity volume; severe polyhydramnios with a thick echopositive suspension in the amniotic cavity. The risk of spontaneous miscarriage and formation of placental insufficiency increases with the simultaneous detection of 2 or more echographic markers.Conclusions. On the basis of the above, it is possible to conclude on the need to conduct an ultrasound examination with an assessment of the echographic parameters of the formation and development of the embryo and extraembryonic structures in the first trimester in pregnant women with a history of miscarriage and a risk of developing placental insufficiency in the history in order toidentify markers of a complicated course of gestation and the and the subsequent choice of rational tactics of pregnancy management.

Training foreign citizens for taking exams needed for verification of diplomas in the graduates' home countries – as one of the types of educational and methodological work and a component of the educational process at BSMU

Introduction. The image of any education institution is formed by its graduates. The prestige of the higher education institution (HEI) itself depends on the success of young people who have graduated from it, on how far they can exercise the academic rights granted by the educational documents of their institutions, and whether they can get appropriate jobs.During the 6-year stage of undergraduate education foreign students studying at medical HEI of Ukraine, along with their Ukrainian fellow students, must take a series of unified state qualification exams that prove the level of their theoretical (USQE 1) and practical (USQE 2) training.But no less important for foreigners are examinations for verification of diplomas obtained from the Ukrainian HEI on their returning to the home country, the successful passing of which gives them the right to apply for postgraduate study and to start their own medical practice in their countries.Aim of the research. The aim of our research was to study the effectiveness of such type of educational and methodological work at the university as the training of foreign citizens for taking exams needed for verification of diplomas in the graduates’ home country (Republic of India).Methods and material. The study includes 1046 graduates of the Medical Faculty No. 3 of the Bukovinian State Medical University, natives of India, who successfully completed their studies during the years 2012-2021 and obtained diplomas in "General Medicine", with the educational and qualification level of "Specialist" (starting from the graduation year 2022 the programme subject area 222 "Medicine", degree of higher education - "Master’s Degree"). The subject of the study was the 1st attempt results of the above mentioned cohort of graduates on their returning to the home country and taking the state exam for the verification of the diplomas. The obtained results were processed by standard methods of variation statistics.Results. Starting from the academic year 2012-2013, the training course for the verification of diplomas by graduates from India was successfully launched on the university's distance learning server, and from the academic year 2013-2014 the control mode of the course was implemented; its passing was considered successful when the student solved more than 50% of the test tasks from the total of 300 test questions. Currently, this training course has about 25,000 test tasks from the main fields of theoretical and practical medicine. According to the received and processed data, when in 2011 only 12% of the graduates passed the MCI screening test on the first attempt, in 2015 this rate increased to 53%, and in 2018 reached 64.1%. This is one of the best results for the verification of diplomas of foreign medical graduates in India after their return to their home country from different countries of the world. Conclusions. Student-centred training courses significantly increase the effectiveness of the educational process when training foreign medical specialists. The implementation of the training courses for the MCI examination has made it possible to improve by several times the results of the verification of diplomas by BSMU graduates in their home country, the Republic of India.

Гормональна функція фетоплацентарного комплексу у вагітних при низькому розміщенні хоріона

Purpose - to analyze the hormonal function of the fetoplacental complex in pregnant women with normal and low-lying chorion. Materials and methods. 50 pregnant women with a low-lying chorion (main group) and 50 pregnant women with a position of the chorion in the body and fundus of the uterus (control group) were involved in the laboratory examination. All examined women of the main group were divided into 2 subgroups, depending on the period of gestation (25 women at 5-8 weeks of gestation and 25 women at 9-12 weeks of gestation). According to these terms, the control group was also divided (25 women at 5-8 weeks of gestation and 25 women at 9-12 weeks of gestation). During pregnancy in the І trimester of pregnancy, the content of hormones in blood serum was determined: estradiol, chorionic gonadotropin, placental lactogen, progesterone. Results. Conducted research on the level of hormones in the blood serum of pregnant women showed that the concentration of estradiol in the main group was reduced throughout the І trimester of pregnancy. In particular, the content of this hormone was lower compared to the control by 7.2% in 5-8 weeks of gestation (p˃0.05), and by 23.9% - in 9-12 weeks (p<0.05). The content of progesterone in pregnant women with low-lying chorion, on average, was lower compared to the control group by 10.9% in the period of 5-8 weeks of pregnancy (p<0.05) and by 21.0% in the period of 9-12 weeks (p<0.05). It was also established that the level of placental lactogen in the blood serum of pregnant women at 9-12 weeks of gestation in the main group was probably lower compared to the control (p<0.05). Analyzing the content of chorionic gonadotropin, it is noted its significant decrease during the entire early period of gestation in the main group compared to the control, respectively: at 5-8 weeks of gestation - 36990.0±210.0 mg/l and 43270.0±226.0 ml/l (p<0.05); at 9-12 weeks - 37194.0±395.0 mg/l and 54700.55±525.0 ml/l (р<0.05). Conclusions. Pregnant women with low-lying chorion in the early stages of gestation had a much slower increase in hormone levels and lag in quantitative indicators was observed compared to pregnant women in which the chorion was located in the fundus and body of the uterus. This is evidence of hormonal dysfunction of the placenta, and therefore, a marker of the developing of placental dysfunction. A decrease in the levels of hormones of the fetoplacental complex in pregnant women with low placentation is manifested by clinical signs of early placental dysfunction in the form of a threat of termination of pregnancy, partial detachment of the chorion in the early term, spontaneous miscarriage and lead to further progression of placental dysfunction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethic Committee of Bukovinian State Medical University. The informed consent of the patients was obtained for the conducting the studies. No conflict of interests was declared by the authors.

Diagnosis and Prevention of Burnout in Teaching Physicians

The paper highlights the problem of professional burnout in higher education institutions, which is especially aggravated in the context of distance learning and quarantine restrictions. Because the professional burnout syndrome occurs in response to constant emotional stress. However, this process can be influenced. The purpose of the study was to determine the level of emotional burnout, factors and conditions that affect its occurrence and develop recommendations for its prevention. To diagnose the level of emotional burnout, a survey was conducted using the adapted methodology by V.V. Boyko. Three phases were considered: “tension”, “resistance”, “exhaustion”, and 12 symptoms of burnout were identified. Analysing the results of teachers of the Bukovinian State Medical University in the phase of «tension», the dominant symptom was «experiencing psycho-traumatic circumstances”; in the phase of “resistance” – “reduction of professional responsibilities”; in the “exhaustion” phase, the “personal detachment” prevailed. According to the study results, the majority of employees of the educational institution are in the “resistance” phase – 54%. According to gender characteristics, women are more likely to experience emotional burnout. At the age of 20-25, teachers are more susceptible to professional burnout syndrome due to their ambitions. Depending on the length of service, teachers with less than 5 years of experience have a predominant “tension” phase; among teachers with 5-10 and 20 years of experience, the “resistance” phase prevails. And teachers with more than 20 years of experience have an “exhaustion” phase. With this in mind, recommendations for the prevention of professional burnout have been developed. Namely: alternating work with rest, healthy sleep and walks in the fresh air, a variety of relaxation techniques and, certainly, spending time with family. The practical significance of identifying professional burnout among teachers of higher educational institutions is to conduct timely prevention and provide further recommendations for overcoming this syndrome, since the educational process and the atmosphere in the team directly depend on it

On the issue of teaching psychological and pedagogical disciplines at universities using immersive technologies

The use of immersive technology enables high-quality educational simulations. The immersive technology in the classroom initiative provides access to virtual, augmented, and mixed-reality simulations for students and faculty across the pedagogical spectrum. The Virtual Immersive Teaching and Learning Initiative contributes to a growing body of research in this area. Through research that compares traditional educational simulation methods with immersive methods, the findings from an experiment conducted among BSMU medical psychology students are presented. Until recently the teaching of any discipline was considered to be the mastering of the necessary theoretical and practical knowledge and skills by the students, but recently, with the development of science and the increase in the necessary amount of knowledge, it has become more and more important to provide students with an excellent theoretical basis for independent study of the subject, and this in distance conditions becomes possible thanks to technology and immersive learning. To confirm the working hypothesis, a qualitative survey of 34 students of the Bukovinian State Medical University, specialty “Medical Psychology” was conducted. A closed questionnaire survey of students helped to diagnose their deep learning needs and determine the effectiveness and feasibility of using immersive learning. In addition, the results of the survey made it possible to reveal students' opinions about the profile of the ideal teacher in the era of digital and immersive technologies. It turned out that the use of immersive learning for psychologists yields high results is perceived with enthusiasm by students and is a feasible element for the methodology of teaching a foreign language.

RESULTS OF APPLYING X-RAY INVESTIGATION METHODS IN PATIENTS AFTER BONE DEFECT RESTORATION BY OSTEOPLASTIC MATERIALS USING CELLULAR TECHNOLOGIES

The results of applying X-ray investigation methods to confirm effectiveness of the developed osteoplastic combination including multipotent mesenchymal stromal cells of adipose tissue, which was used to fill bone defects in operated patients, have been elusidated. Participants and methods. The study was conducted at the Department of Surgical Dentistry and Maxillofacial Surgery, Bukovinian State Medical University, Chernivtsi, Ukraine. To determine the density of bone tissue, CT scanning was done for 26 patients when replacing the bone defect with «Kolapan–L» (group A), for 28 people during the augmentation with an osteoplastic combination containing multipotent mesenchymal stromal cells of adipose tissue (group B), and for 25 patients where bone defect healing occurred spontaneously (group C). The study was conducted after the surgical operations (in 3-5-day, 3-, 6-, 12-month follow up period. We have found out the patients of group B who received the preparation «Kolapan–L» to fill bone defects in combination with multipotent mesenchymal stromal cells of adipose tissue and platelet-rich plasma demonstrate completed osteoregeneratis with newly formed bone tissue without granules of osteoplastic material in 6-8 months after the surgical intervention. In the patients of group A, who received the preparation «Kolapan–L» to replace bone defect, a complete osteoregeneration was observed in small and medium defects in 6-8 months, and more pronounced outcomes (more than 2.0 mm) were seen in 12-16 months. In the patients of group C (spontaneous healing), small bone defects were observed after 9-11 months the healing, while significant defects showed no complete tissues regeneration even in 12 month period. The results have demonstrated that in 12 month period, the patients of group B have the average density of osteoregenerate equalled 1036,69±55,53 HU that is 1.5 times and 1.8 times more than those values in the group A, p<0.01, and in the group B, p<0.05, p1<0.01, respectively.

Overweight and comorbidity in patients with malignant tumors of the abdominal organs

The aim – to establish the clinical and pathogenetic significance of overweight and comorbidity in patients with malignant neoplasms (MN) of the abdominal cavity. Material and methods. The study was performed on the basis of the Chernivtsi Regional Clinical Oncology Centre and the Oncology Clinic of Bukovinian State Medical University and covered observation materials of 50 patients with intra-abdominal neoplasms. Among them, 35 individualsforming the main group were obese (body mass index ≥30), the rest formed the comparison group. Comorbidity index, risk complication ratio, confidence intervals, Fisher (P) and χ2 coefficients were calculated according to Yates and Pearson. Results. In the comparison group, comorbidities were detected in only 6 patients (40.0%), in the main group, comorbidities were detected in all patients. The value of the comorbidity index in the main group was 11.23±0.98 against 6.37±0.72 (P=0.005). The risk of complications increases significantly in the presence of obesity (OR+ 2.49, min-1.29, max-4.80). The term of hospitalization increases slightly (22.36±3.14 in the main group, against 16.73±2.50 in the comparison group, P=0.18). Conclusions. In patients with malignant neoplasms of the abdominal cavity, the risk of postoperative complications is 1.29-6.96 times higher than in the absence of obesity. The presence of obesity is a significant factor in aggravating the condition, prolongs the period of hospitalization of patients with malignant neoplasms, creates additional challenges for the oncologist.

Family medicine department – twenty years old

The organization of the work of the Department of Family Medicine of Bukovinian State Medical University for 20 years of its existence, its personnel potential, the specific characteristics of the educational and treatment process, its scientific achievements have been expounded.

Зниження маси тіла — наріжний камінь терапії метаболічного синдрому в підлітків

Актуальність. В останнє десятиліття активно обговорюється зв’язок метаболічного синдрому (МС) з ожирінням. Раннє виявлення порушення жирового обміну і лікування здорових підлітків є важливим компонентом первинної профілактики МС. Мета дослідження: вивчити клініко-епідеміологічну характеристику ожиріння у підлітків та встановити ефективність первинної профілактики МС. Матеріали та методи. У процесі дослідження було проаналізовано медичні форми 026/о «Медична карта дитини (для дошкільного та загальноосвітнього навчальних закладів)» 656 підлітків 16–18 років, які навчаються в коледжах ВДНЗ України «Буковинський державний медичний університет» упродовж 2014–2016 рр. За результатами аналізу була сформована група підлітків із надлишковою масою тіла та ожирінням із 50 осіб, які становили групу дослідження. Порушення жирового обміну верифікували з використанням перцентильних таблиць: індекс маси тіла у межах 85–95-го перцентилів оцінювався як надлишок маси, понад 95-го перцентиля — як ожиріння. Серед лабораторних показників аналізу підлягали рівні холестерину, гормонів щитоподібної залози, глюкози крові натще і після проведення глюкозотолерантного тесту, рівень еластази-1 в калі, а також результати додаткових інструментальних досліджень. Серед підлітків була сформована клінічна група із 20 осіб, яким проводився комплекс заходів, зокрема категоричне виключення з харчування рафінованих легкозасвоюваних вуглеводів, дозоване фізичне навантаження, корекція режиму дня. Результати. Аналіз даних медичної документації 656 підлітків встановив порушення фізичного розвитку у 50 (7,6 %) осіб, серед них надлишок маси тіла у 28 (56 %), ожиріння — у 22 (44 %). Клінічно у половини обстежених із надлишковою масою тіла та ожирінням визначалися ознаки гормонального дисбалансу (стрії, гіпергідроз, чорний акантоз, гіперкератоз, акне, гірсутизм, гінекомастія, жирна себорея). Підвищення артеріального тиску встановлено у 72,6 % підлітків. Різні варіанти порушення вуглеводного обміну встановлено у 42,7 % осіб. Майже у половини підлітків виявили зміни ліпідного спектра крові, у кожного сьомого виявлено порушення в системі гемокоагуляції, у 17,1 % підлітків відзначалося зниження функціональної активності підшлункової залози, що проявлялося зниженням еластази-1 в калі. Абсолютна більшість підлітків мали спадкову обтяженість щодо ожиріння, цукрового діабету 2-го типу та артеріальної гіпертензії. У 92,5 % підлітків із ожирінням визначені окремі компоненти МС. Поєднання ожиріння з одним із компонентів МС становить 56,4 %, з двома — 32,2 %, з трьома — 11,2 % випадків. Із 20 пацієнтів, які перебували в програмі, у 12 (60 %) осіб маса тіла нормалізувалася, у 8 (40 %) залишилось ожиріння. Ефективність програми підтверджена зниженням поширеності модифікованих факторів ризику: нераціонального харчування — на 13 %, куріння — на 6,9 %, порушення фізичної активності — на 25,2 %, підвищенням інформованості — на 54 %, зниженням компонентів МС (маса тіла — на 30 %, артеріальна гіпертензія — на 33,7 %, порушення вуглеводного обміну — на 20 %, дисліпопротеїнемія — на 33,3 %). Висновки. Порушення жирового обміну серед підлітків становить 7,6 %, зокрема надлишок маси тіла — 56 %, ожиріння — 44 %. Компоненти МС мають 92,5 % підлітків із ожирінням. Поєднання абдомінального ожиріння з одним із компонентів МС — 56,4 %, із двома — 32,2 %, із трьома — 11,2 % випадків. Ефективність запропонованої програми щодо зниження маси тіла становить 60 % і підтверджена зниженням поширеності модифікованих факторів ризику розвитку МС.

Association between Serum Brain-derived Neurotrophic Factor and 25-OH Vitamin D Levels with Vitamin D Receptors Gene Polymorphism (rs2228570) in Patients with Autoimmune Thyroiditis and Hypothyroidism

BACKGROUND: Different polymorphisms in Vitamin D receptors (VDRs) have an important role in autoimmune thyroiditis (AIT) risk. Hashimoto’s thyroiditis (HT) is the most recurrent autoimmune thyroid disorder. Patients with HT may suffer from cognitive impairment brain-derived neurotrophic factor (BDNF) which has been identified as an important growth factor that is involved in learning and memory. AIM: This study examined the linkage of VDR gene polymorphism (rs2228570) with blood serum levels of BDNF and 25-OH Vitamin D in thyroid pathology of patients in the West Ukrainian population. METHODS: This research is a case–control study was performed in HSEEU “Bukovinian State Medical University,” Chernivtsi Regional Endocrinology Center, and I. Horbachevsky Ternopil National Medical University, Ukraine, from September 2017 to December 2020. The study involved a total of 153 patients with post-operative hypothyroidism, hypothyroidism induced by AIT, and patients with both AIT and elevated serum antibodies anti-thyroglobulin (anti-Tg) and anti-thyroid peroxidase. BDNF levels in the sera of the patients and healthy individuals were quantified using enzyme-linked immunosorbent assay (ELISA) with highly sensitive Human BDNF ELISA Kit. Genotyping of the VDR (rs2228570) gene polymorphism using TaqMan probes and TaqMan Genotyping Master Mix (4371355) on CFX96™ Real-Time Polymerase Chain Reaction (PCR) Detection System (Bio-Rad Laboratories, Inc., USA). PCR for TaqMan genotyping was carried out according to the kit instructions (Applied Biosystems, USA). RESULTS: Our study revealed a significant decrease in the BDNF level in the study group in carriers of the AA and AG genotypes by 1.58 and 2.39 times, corresponding, compared with carriers of the AA genotype in the control group. Concurrently, there was no significant difference in the BDNF level between different genotypes of VDR rs2228570 in the research group. In our study, analysis of the correlation between serum BDNF levels and 25-OH Vitamin D concentration shows a moderate direct relationship (r = 0.4) between BDNF and 25-OH Vitamin D (p = 0.006). CONCLUSIONS: The rs2228570 VDR polymorphism is not a risk factor for decreased serum BDNF levels. At the same time, our study found a moderate direct relationship between serum BDNF levels and 25-OH Vitamin D.

Comparative characteristics of regional morbidity of malignant neoplasms of the abdominal cavity and other localizations considering certain determining factors

The aim – To carry out a comparative statistical and epidemiological analysis of the incidence of malignant neoplasms (MN) of the abdominal cavity and other localizations in the Bukovyna region and possible determining factors.Material and methods. The study was performed on the basis of RMNE "Chernivtsi Regional Clinical Oncology Center" and the Oncology Clinic of Bukovinian State Medical University and covers observation materials and statistical reports of 21259 cases of MN of various localization. Indicators were calculated using Access and Excel software packages based on the Microsoft Office environment.Results. Among all MN of different localization, neoplasms of abdominal organs make up about a third (32.4%), or 37.1% of those diagnosed with MN for the first time, they are distinguished by a significant proportion of III-IV stages and relatively high mortality. In comparison with neoplasms of other localization, the MN of the abdominal organs is common, exceeding at least twice the number of MN of the skin and breast. High mortality was observed in the esophagus (72.4%), stomach (56.2%), hepatobiliary system, and pancreas (67.5-71.4%).Conclusions. MNs of abdominal organs occupy an important place in the general structure of new growths of various localization. MN data are characterized by high mortality rates and insufficient effectiveness of treatment, which requires additional studies.

Dynamics of the abdominal organs malignant tumors regional morbidity, taking into account certain factors

The aim of the work is to determine the dynamics of the incidence of malignant neoplasms of the abdominal cavity in the Bukovina region and possible determinants. Material and methods. The study was performed on the basis of RMNE "Chernivtsi Regional Clinical Oncology Center" and Clinic of Oncology of Bukovinian State Medical University and covers observation materials during 2015-2019 and statistical reporting on 102,247 cases of tumors of various localizations. The indicators were calculated using Access and Excel software packages based on the Microsoft Office environment. The results. The total number of malignant neoplasms of different localizations is relatively stable throughout the study period and ranged from 19903 to 21259 cases per year (average 20449.4±508.2 registered during the year). Neoplasms of the abdominal cavity are about the third of the total number of tumors of different localization with a certain tendency to grow. The distribution of patients with neoplasms of the abdominal cavity by stages of development is relatively uniform, despite significant variations in different localizations of tumors. Conclusions. A significant part of tumors of the abdominal cavity is diagnosed in the late (III-IV) stages of the pathological process, which leads to a decrease in the effectiveness of treatment. Significant differences in the clinical and epidemiological characteristics of neoplasms of various abdominal organs have been identified, which requires further study.

Self-assessment of inters on the efficiency of online preparation for the licensed integrated exam "Krok 3. General medical training" in a pandemic COVID-19 (analysis results of anonymous survey)

An anonymous survey of interns of the specialty "Pediatrics" on the quality of training interns for the licensed integrated exam "KROK 3. General medical training" at the Department of Pediatrics and Children's Infectious Diseases of Bukovinian State Medical University was conducted using the google form.The main purpose of the survey was to assess the effectiveness of training interns for the licensed test exam "KROK 3. General medical training" in the context of distance learning. It is shown that interns positively assess the quality of training in a distance form for passing this exam. Most interns point to the effectiveness of consultations of teachers and experts of creating tests in preparation for the exam. According to 60.0% of interns, the most effective component of preparation for the LIE "KROK 3. General medical training" was training on the program of the module "Emergencies", 25.0% noted thematic consultations conducted by teachers of the department immediately before the exam, and according to 15.0% of respondents, the best component was preparation for rector's tests. The most useful and informative for interns were consultations on emergencies in pediatrics (50.0% of responses), neurology and psychiatry (20.0%), cardiology (15.0%) and radiation medicine (15.0%).

OSTEOPLASTIC PROPERTIES OF MULTIPOTENT MESENCHYMAL STROMAL CELLS OF ADIPOSE TISSUE

The aim: Determining the ability of samples based on MMSC – AT differentiating in the osteogenic direction. Materials and methods: The study was conducting at Bukovinian State Medical University, Chernivtsi, Ukraine. Adipose tissue samples were obtaining from the neck of 60 experimental animals (white Wistar rats). Multipotent mesenchymal stromal cells of adipose tissue were obtained by grinding adipose tissue of rats in 0.1% collagenase 1A . Alkaline phosphatase activity was assessing by using the Alkaline Phosphatase Detection Kit (Sigma, USA) according to the manufacturer’s protocol. Osteopontin gene expression was determining by immunocytochemical method. To determine the mRNA used the PCR method, which is associated with reverse transcription (RT-PCR) in the area of quantification of gene expression to the marker BGP. Results: On the 21st day of observations, the expression of mRNA encoding the BGP gene decreased in samples № 1 and № 3 to 35,800 ± 420.0 copies and to 35,000 ± 400.0 copies, p1<0.01, p>0.05. Also was observing growth of copies of the BGP gene in samples № 2 and № 4 in 2.1, р<0.01 and 2.2 times, р-р2<0.05, relative to the data in sample № 1. Conclusions: Comparative study of osteoplastic properties samples MMSC-AT showed that a larger number of cells differentiate into the osteoblasts in samples containing MMSC-AT + PRP (№ 2) and MMSC-AT + PRP + «Kolapan» (№ 4). This has been proven higher alkaline phosphatase activity, higher levels osteopontin expression, and higher levels BGP gene expression.

TEACHING OF MEDICAL PARASITOLOGY AT BUKOVINIAN STATE MEDICAL UNIVERSITY

Parasitic infestations account for a significant percentage of overall morbidity andmortality. In this regard, the problem of parasitic pathology often occurs in the practiceof physicians, which necessitates an increase in the level of professional training ofphysicians. It is necessary to expand the knowledge of health professionals not onlyabout the clinical symptoms, diagnosis and treatment of infestations, but also about theepidemiological features and life cycles of parasites that underlie the development of themethods for the prevention of parasitic diseases.The aim of the work is to analyze the peculiarities of teaching medical parasitologyto the first-year students of the Higher State Educational Establishment of Ukraine“Bukovinian State Medical University” in order to improve teaching methods in thetraining of doctors.Conclusion. Teaching medical parasitology includes lectures, practical classes,independent work of students, conducting two final modular tests, which includecomputer testing, theoretical questions, practical skills. The peculiarity of the study ofmedical parasitology is the use of a large amount of visual material: tables, diagrams,illustrations, photographs, microslides and museum specimens.

Organization-methodological aspects of teaching interns the tactic of treatment of patients with acute abdominal surgical pathology

Objective. To improve the mastering of treatment tactics of patients with acute surgical abdominal pathology by interns of the specialty "Surgery".Material and methods. We performed an analysis of the effectiveness of the education-methodological process in interns of the specialty "Surgery" for mastering the surgical tactics of treatment of patients with acute surgical abdominal pathology at the Department of General Surgery of Bukovinian State Medical University during 2017-2020 years.Results. Optimization of intern training was carried out due to the introduction of modern minimally invasive methods of surgical interventions and the latest highly informative diagnostic and prognostic criteria for the complicated course of acute surgical abdominal pathology. The effectiveness of training is improved through the use of modern interactive technologies, for assessing the knowledge of interns the method of discussion polling is preferred.Conclusion. Perfect mastery of modern minimally invasive methods of interventional treatment, understanding of their place and significance is an important component of effective learning of treatment tactics of acute surgical abdominal pathology by interns in the specialty "Surgery".

Challenges and benefits of integrating online learning in higher education in a pandemicof COVID-19

Objective — to assess peculiarities of distant learning integration in higher educational institutions in the context of the COVID-19 pandemic.Materials and methods. More than 50 literature sources were included to the study. 20 of them were chosen for detailed investigation. Data of use of online educational methods in departments of phthisiology and pulmonology of Kharkiv National Medical University and Bukovinian State Medical University were used.Results and discussion. To provide the asynchronous part of distance learning, the Department of Phthisiology and Pulmonology of Kharkiv National Medical University created distance courses on the Moodle platform. The courses were built in accordance with the topic plans of the department. Study materials on the topic were presented in various formats: files, web pages, videos, links to Internet resources, etc., test tasks were developed for each topic. In addition, lecture presentations with text accompaniment were added to online resources.At the Department of Phthisiology and Pulmonology of Bukovinian State Medical University (BSMU), training sessions have been started online in accordance with the orders of the BSMU: «On the introduction of quarantine at the University» No. 129-Adm. of 03/12/2020 and «On the approval of instructions for teachers for conducting training sessions online using the videoconferencing service» No. 130-Adm. from 12.03.2020. Final modular controls and state exams were provided in online distance learning. Chernivtsi region was in the red zone of quarantine measures until September 21. Thus, the educational process at the BSMU was carried out exclusively in a distance form using the videoconference service. The Google Hangouts Meet service — https://meet.google.com — was selected for online training sessions. To schedule online training sessions using the Google Hangouts Meet video conferencing service, the Google Calendar service — https://calendar.google.com — was used.Conclusions. Despite a number of problems in the implementation of online learning technologies, such as insufficient technical provision, imperfect knowledge of the methodology of modern digital skills by participants in the educational process, the need for a quick change in approaches to continuous teaching in the context of the COVID-19 pandemic has become a powerful impetus in the development and implementation of information-communication technologies in education, which in the future may have positive consequences for improving the quality of education, increasing student motivation and their satisfaction with the educational process.

Distance learning as an alternative to continuing educationin the context of the COVID-19 pandemic

Objective — to assess the problem and benefits of distance learning as an alternative to continuing education in medical schools of III—IV levels of accreditation in the COVID-19 pandemic.Materials and methods. Test access to full-text and abstract databases was used, a meta-analysis of modern literature sources was conducted, some of which were selected for more detailed coverage, as well as data on the experience of online teaching methods using at the Department of Phthisiology and Pulmonology of Bukovinian State Medical University. Results and discussion. Google Hangouts Meet (https://meet.google.com) has been selected for online training. The Google Calendar service — https://calendar.google.com — is used to create a training schedule online using the Google Hangouts Meet video conference service. In the educational process during the distance learning at the departments various complexes of educational and methodical support of educational disciplines with elements of explanatory-illustrative and problem-based learning are used. In the control of knowledge during distance learning, the following methods of pedagogical control are used: test, written control (for example, writing answers to questions in a chat to the teacher via Internet technology or student communication via chat with the teacher and group); oral (for example, the use of audio and video conferencing). This method allows you to solve the problem of personal control of knowledge, because in distance learning there may be a situation that the student solves the problem with help of another person. To increase the effectiveness of control of knowledge and skills of students at distance learning it is necessary to use a set of different types and methods of pedagogical control.Conclusions. A new form of distance learning in the modern realities of the COVID-19 pandemic online has been successfully implemented and its implementation continues. A significant disadvantage of such training is the dependence of effective online classes on the established network of Internet communication and the quality of technical support.

FETAL ANATOMICAL VARIABILITY OF STRUCTURES IN INFRAHYOID AREA

When performing myoplastic operations and surgical interventions on the thyroid gland, trachea and esophagus, information on the variant anatomy of the infrahyoid muscles, the features of their innervation and blood supply are of great clinical importance. Moreover, when additional muscles are attached to the thyroid gland, intraoperative bleeding can occur resulting in hematoma and tissue scarring in the postoperative period. There are fragmentary data in the literature on the variants of the structure and topography of the human infrahyoid area muscles. The specificity of branching nerves and blood vessels, their vascular-nervous relationships in a separate part of the sternohyoid, sternothyroid, thyrohyoid, and omohyoid muscles should be taken into account when performing rational incisions in the neck, moving both the flaps and the above muscles in plastic surgery. The purpose of study was to establish the anatomical variability and features of innervation and blood supply of the infrahyoid muscles of the neck in human foetuses of 4 – 10 gestational months age. Material and methods. The study was performed on 36 human foetuses, whose parieto-coccygeal length was 81.0 – 375.0 mm, without visible signs of anatomical abnormalities or anomalies in the cervical region. Thin sections of the structures from the anterior and lateral parts of the neck were prepared under the control of binocular magnifier, vascular injection technique, and morphometry. Foetal preparations weighing over 500.0 g were studied directly at Chernivtsi Regional Paediatric Pathological Bureau. Foetal preparations were taken from the Museum of M.G. Turkevich Human Anatomy Department, Bukovinian State Medical University. Results and discussion. The study demonstrated anatomical variability of the infrahyoid area muscles during the foetal period of human ontogenesis. Human foetuses were mainly found to have loose extending intramuscular branching of the nerves of the cervical loop in the infrahyoid muscles. The only exception is the inferior belly of the omohyoid muscle, where main nerve branching is found out. The distribution of nerves in the thickness of the infrahyoid muscles is uneven. Macroscopic examination revealed the smallest number of nerve branches was found within the middle third of the sternohyoid and upper third of the sternothyroid muscles. Arteries and nerves enter the sternothyroid and thyrohyoid muscles through the anterior surface, and the omohyoid and sternohyoid muscles enter mainly through the posterior surface of these muscles. The infrahyoid muscles are characterized by the main form of intramuscular branching of the arteries. The data on the peculiarities of intramuscular branching of arteries and nerves in the infrahyoid muscles we obtained, as well as the variant anatomy of the infrahyoid area muscles must be taken into account when performing a surgical access to the neck, or when operating on in the anterior cervical region, in particular myoplastic and reconstructive operations, in order to avoid muscle injuries.

DEVELOPMENTAL PECULIARITIES OF TOPOGRAPHIC MORPHOLOGY OF CERVICAL FASCIA AND CELLULAR SPACES IN ANTERIOR AND LATERAL CERVICAL REGIONS IN HUMAN FETUSES

In-depth study of the peculiarities of the morphological, topographic and anatomical relationships between fascia, muscles, vessels, nerves, cellular spaces and organs of other parts of the human body requires applying an appropriate methodology of morphological research. According to some researchers, the superficial, pretracheal, and prevertebral plates of the cervical fascia develop depending on the origin and morphogenesis of the respective groups of neck muscles. Obtaining data on the development of topographic morphology of the cervical fascia and interfascial cellular spaces of the anterior and lateral areas of the neck during the fetal period of human ontogenesis is an important area of fetal anatomy and surgery and can be used for age comparison. The purpose of the study was to clarify the peculiarities of the development of the topographic morphology in the cervical fascia and interfascial cellular spaces of the anterior and lateral areas of the neck in human fetuses of 4-10 months of gestation. The study was performed on 75 human fetuses of 81.0-375.0 mm parietal coccygeal length without external signs of anatomical abnormalities or developmental anomalies of the cervical region by preparing microscopic slides of organs and structures of the anterior and lateral areas of the neck. The samples taken from fetuses weighing more than 500.0 g were investigated directly at the Chernivtsi Regional Paediatric Pathological Bureau according to the association agreement. The material was also taken from the M.G. Turkevich Museum of the Human Anatomy Department, Bukovinian State Medical University. The macroscopic and microscopic investigation of the cervical region in human fetuses of 4-7 months revealed thin, semitranslucent plates of the cervical fascia: superficial, middle (pretracheal) and deep (prevertebral). In fetuses of 8-10 months in the anterior area of the neck, the plates of the cervical fascia were clearly seen and shiny. Subcutaneous, or superficial, and intracervical fascias were fascias propria of the neck, and having no clear boundaries passed into adjacent areas. In the fetal period of human ontogenesis the interfascial cellular spaces of the anterior and lateral areas of the neck develop including suprapectoral, anterovisceral, extravisceral, antescalenous, interscalenous cellular spaces and sheath of vascular-nervous bundles of the neck. During the fetal period of human ontogenesis, there is a pronounced variation in the development and location of the plates of the cervical fascia. The authors of this study state that the research and result publication have no conflicts regarding commercial or financial relations, relations with organizations and/or individuals who may have been related to the study.