Dnipropetrovsk Medical Academy Research Articles

Діагностика порушень діяльності центральної нервової системи в анестезіології та інтенсивній терапії за допомогою визначення когнітивної дисфункції

Оцінка вираженості порушень роботи нервової системи — важливий індикатор тяжкості критичного стану. Порушення когнітивних функцій є одними з ранніх проявів пригнічення діяльності нервової системи, тому заслуговують на особливу увагу лікарів-інтенсивістів. У клінічній практиці прийнято використовувати різні психофізіологічні тести та їх комбінації. У ДЗ «Дніпропетровська медична академія МОЗ України» дослідження когнітивних функцій у хворих, які знаходяться в критичному стані, проводиться вже протягом понад двох десятиліть. У статті описуються деякі результати цих досліджень. Висновок. Оцінка когнітивних функцій у хворих, які знаходяться в критичному стані, — важливий елемент моніторингу його тяжкості. Найбільш прийнятним у практичній анестезіології та інтенсивній терапії є використання шкали MMSE або MoCA в поєднанні з опитувальником CFQ.

Страницы истории: к 100-летнему юбилею Днепропетровской медицинской академии и истокам основания кафедры инфекционных болезней

История кафедры инфекционных болезней Днепропетровской медицинской академии начинается с 1927 г., когда тогда еще в Днепропетровском медицинском институте (основанном в 1916 г.) на базе городской инфекционной больницы профессором М.Б. Станишевской было начато преподавание инфекционных болезней как отдельной дисциплины. В 1937 г. кафедру инфекционных болезней возглавила ученица М.Б. Станишевской, достойная ее наследница, Е.Г. Попкова. Кандидатскую диссертацию «Об эпидемическом паротите и нейротропности этого вируса» она защитила в 1940 г. В этом монографическом исследовании впервые освещались вопросы паротита как инфекции, которая повреждает не только слюнные железы, но и центральную нерв­ную систему. В 1948 г. на должность заведующего кафедрой инфекционных болезней был избран известный инфекционист, доктор медицинских наук, профессор И.И. Левин. В 1950 г. профессор И.И. Левин одновременно возглавлял кафедру инфекционных болезней и основанную кафедру инфекционных болезней детского возраста. С 1952 г. в Днепропетровском медицинском институте существуют два самостоятельных подразделения: кафедра детских инфекционных болезней под руководством профессора Е.Г. Попковой и кафедра инфекционных болезней под руководством профессора И.И. Левина. В разные годы обе кафедры возглавляли такие выдающиеся ученые, как профессор А.И. Трипольская (1957–1978), профессор В.И. Бычкова (1978–1986), доцент Г.В. Левина (1956–1968), доцент И.В. Штырев (1968–1979), профессор Н.В. Беляева (1979–1994), профессор Л.Р. Шостакович-Корецкая (1994–2008), доцент Н.С. Суременко (1986–2008) и профессор Л.Р. Шостакович-Корецкая (с 2008 г. по настоящее время). Сотрудники кафедры принимают участие в работе съездов и конференций с устными и стендовыми докладами, которые в разные годы проходили в странах СНГ и Европы. В рамках гранта Американского фонда гражданских исследований и развития совместно с американскими коллегами выполнялись фундаментальные исследования по изучению генетических факторов, ответственных за резистентность Т-лимфоцитов к ВИЧ в условиях вертикальной трансмиссии от матери ребенку. Сегодня, празднуя 100-летний юбилей Днепропетровской медицинской академии Министерства здравоохранения Украины, стремясь идти в ногу со временем, помня корифеев медицины и нашей академии, почитая традиции кафедры, не забывая наших ветеранов, мы готовимся достойно встретить 90-летие кафедры инфекционных болезней в 2017 году.

Стан домінуючих мотивів навчання студентів на кафедрі пропедевтики педіатрії

На даний час проблема становлення висококваліфікованих фахівців набуває все більшого значення. Сучасне суспільство ставить до випускника вищого медичного навчального закладу особливі вимоги, серед яких важливе місце займають високий професіоналізм, активність, вміння співчувати, навички спілкування на основі взаєморозуміння, знання медичної етики і деонтології. Саме тому процес підготовки майбутніх фахівців в умовах сучасної освіти є досить складним процесом, який зумовлений багатьма чинниками. Проблема мотивації є однією з фундаментальних проблем навчання, а найважливішим параметром, який визначає ефективність процесу навчання студентів, є його особиста зацікавленість або мотивація навчання. В дослідженні брали участь студенти третього курсу Дніпропетровської медичної академії. У даній статті розглянуто сучасний стан проблеми навчально-професійної мотивації вітчизняних студентів і студентів-іноземців у процесі здійснення навчальної діяльності, а саме під час вивчення дисципліни «Пропедевтика педіатрії». Наведено результати дослідження основних, домінуючих мотивів навчання студентів третього курсу Дніпропетровської медичної академії, проведено аналіз домінуючих мотивів отримання вищої медичної освіти сучасними студентами, визначено ступінь їх важливості для кожного окремого студента. Виявлені відмінності в мотивах навчання вітчизняних студентів і студентів-іноземців. Результати дослідження основних груп мотивів професійної підготовки студентів і розподіл даних груп мотивів за ранговими значеннями можуть служити основою для подальшого дослідження, спрямованого на удосконалення процесу навчання і саморозвитку студентів, з урахуванням їх індивідуальних, особистісних якостей, рівня сформованості мотивів навчання.

Опыт дистанционного преподавания педиатрии студентам четвертого курса в медицинских вузах Украины в условиях пандемии COVID-19

Статья посвящена опыту дистанционного преподавания педиатрии студентам 4-го курса медицинского факультета на кафедре педиатрии 1 и медицинской генетики Днепропетровской медицинской академии в условиях карантина вследствие пандемии COVID-19. Внимание учебных заведений к дистанционному обучению повысилось в последнее время, благодаря внедрению дистанционного обучения стало возможным создавать учебные и научные источники, возможности которых в несколько раз превышают таковые бумажных носителей информации. Клинические кафедры медицинских вузов получили возможность распространить свой опыт в применении новейших информационных технологий и впервые ввести преподавание онлайн клинических дисциплин. В статье описан опыт подготовки и проведения практических занятий, изложения лекционного материала. Изложена динамика изменений нагрузки на преподавателей и студентов в процессе приобретения опыта дистанционного обучения. Описаны этапы подготовки учебных материалов, тестов и клинических задач для студентов. Рассмотрены возможности применения тестов базы КРОК-2 в процессе подготовки студентов к практическим занятиям. Представлены варианты проверки знаний, полученных студентами при подготовке к практическим занятиям. В статье подробно рассматриваются возможности проведения практических занятий и изложения лекционного материала на различных платформах, представленных в Интернете, возможности идентификации студентов, а также различные формы общения студента и преподавателя. Также уделено внимание порядку и методике принятия у студентов отработок занятий, которые были пропущены до времени объявления карантина. Кафедра педиатрии 1 и медицинской генетики также делится опытом проведения методических заседаний кафедры, работы студенческого научного кружка и мерами по воспитательной работе, которые могут иметь место в работе кафедры во время карантинных мер в условиях пандемии COVID-19.

Характеристика изменений показателей липидного и углеводного обменов у больных морбидным ожирением до и после оперативного лечения в зависимости от вида хирургического вмешательства

Актуальность. Ожирение — хроническое заболевание обмена веществ, которое прогрессирует при естественном течении, имеет определенный круг осложнений и высокую вероятность рецидива после окончания курса лечения. Связь ожирения с различными метаболическими нарушениями делает его одной из наиболее важных проблем здраво­охранения как для развитых стран, так и развивающихся стран. Цель: проанализировать динамику показателей липидного и углеводного обмена у больных с морбидным ожирением (МО) до и после билиопанкреатического шунтирования (БПШ) в модификации Hess — Marceau и продольной резекции желудка. Материалы и методы. Выборку исследования составили 82 пациента с МО и сопутствующим метаболическим синдромом (МС) в возрасте от 21 до 62 лет (средний возраст — 40,60 ± 1,09 года), которые были про­оперированы по данному поводу и находились в послеоперационном периоде под наблюдением в клинике «Гарвис», которая является базой кафедры хирургии 1 ГУ «Днепропетровская медицинская академия МЗ Украины», в течение от 2 до 3 и более лет после операции. Распределение больных по группам проводилось в зависимости от примененного способа хирургического лечения. І клиническую группу составили 30 (36,6 %) больных с БПШ в модификации Hess — Marceau; II группу — 52 (63,4 %) пациента с продольной резекцией желудка. У разного количества больных в обеих группах в течение срока наблюдения проводили определение характеристик липидного и углеводного обмена с применением общих практических и клинических методов. Оценку результатов снижения массы тела, изменения со стороны маркеров липидного и углеводного обмена проводили в динамике наблюдения — при первом визите на этапе предоперационной подготовки, через 3, 6, 12, 18, 24 и 36 месяцев после оперативного вмешательства. Результаты. Анализ динамики показателей МО после оперативного лечения показал общие тенденции к достоверному (от p < 0,01 до p < 0,001) уменьшению показателей массы тела и индекса массы тела (ИМТ) у пациентов всех клинических групп уже через 3 месяца от начала лечения. В I группе существенное снижение показателей происходило в течение 18 месяцев, а во II — в период 6–12 месяцев. Дислипидемические нарушения у больных с МО достоверно коррелировали с показателями избыточной массы тела с различной степенью достоверности (от р < 0,05 до р < 0,01). Результаты исследования показателей углеводного обмена накануне оперативного лечения свидетельствовали о наличии существенной взаимозависимости уровней С-пептида, инсулина и глюкозы в крови от ИМТ пациентов (от p < 0,01 до p < 0,001). В динамике исследования установлены тенденции к нормализации показателей липидного и углеводного обменов у пациентов обеих групп в течение 2 лет после бариатрического вмешательства с наибольшими изменениями в группе после БПШ уже после 3 и 6 месяцев. Выводы. Прямая корреляционная зависимость, установленная между показателями липидного и углеводного обменов с показателем ИМТ и избыточной массой, доказывала необходимость применения у этих больных оперативного лечения. Тенденции к нормализации показателей липидного и углеводного обменов у пациентов обеих групп в течение 2 лет после бариатрического вмешательства свидетельствовали о его эффективности.

Вплив додаткової нейропротекції Гліатиліном на перебіг септичного процесу і вираженість енцефалопатії в структурі синдрому поліорганної недостатності

Актуальність. Сепсис, як реакція організму на інфекцію, включає такий етап розвитку, як синдром поліорганної недостатності (СПОН). Мозкова дисфункція в 70 % випадків є одним з перших симптомів сепсис-асоційованого СПОН, ще до клінічних проявів в інших системах життєзабезпечення. Сепсис-асоційована енцефалопатія — мультифокальне порушення функцій головного мозку за умови наявності інфекції, що супроводжується проявами системного запалення, але без клінічних і лабораторних доказів прямої причетності інфекції до пошкодження головного мозку. Залежно від критеріїв, покладених в основу діагностики, церебральна дисфункція-недостатність може бути виявлена в усіх хворих із сепсисом. Ступінь її вираженості корелює зі зростанням тяжкості септичного процесу. Сепсис-асоційована дисфункція-недостатність може бути незалежним предиктором летального кінця. Тяжкість церебральної дисфункції-недостатності коливається від летаргії і/або дезорієнтації до коми. Мета: вивчення впливу терапії відповідно до головних положень «Міжнародного керівництва з інтенсивної терапії сепсису та септичного шоку: 2016» із додатковою нейропротекцією Гліатиліном на перебіг септичного процесу й вираженість енцефалопатії в структурі синдрому поліорганної недостатності. Матеріали та методи. За період 2010–2015 рр. нами проведено контрольоване проспективне рандомізоване когортне дослідження на клінічній базі кафедри анестезіології та інтенсивної терапії ДЗ «Дніпропетровська медична академія МОЗ України» і на базі відділення інтенсивної терапії сепсису КП «Дніпропетровська обласна клінічна лікарня ім. І.І. Мечникова» ДОР». У дослідження було включено 22 пацієнти. У всіх хворих було проведено рутинні лабораторні дослідження для визначення рівня клінічних і біохімічних маркерів системного запалення й органних дисфункцій за шкалами SOFA і LIFE. Для оцінки стану свідомості використовували шкалу коми Глазго. Концентрацію цитокінів (фактор некрозу пухлини α, інтерлейкін-1, інтерлейкін-4, інтерферон α) у сироватці крові вивчали імуноферментним методом. Базисна інтенсивна терапія здійснювалася відповідно до основних положень «Міжнародного керівництва з інтенсивної терапії сепсису та септичного шоку: 2016» з додатковим використанням нейропротекторного препарату Гліатиліну (холіну альфосцерат) 1000–3000 мг на добу внутрішньовенно, розчиненого в 0,9% розчині натрію хлориду, протягом 5–10 днів. Дослідження показників проводилося в чотири етапи: на 1-шу, 3-тю, 5-ту, 7-му добу. Результати. Узагальнюючи результати дослідження, можливо сказати, що на п’яту й сьому добу були відсутні клінічні прояви синдрому системної запальної відповіді в понад 75 % хворих; зменшилася тяжкість стану за APACHE II на 72,5 і 74,5 % (p < 0,001) і ступінь вираженості синдрому поліорганної недостатності за SOFA в 9 разів (p < 0,001) відповідно до етапів дослідження. Церебральна недостатність, оцінена за шкалою коми Глазго, становила 15 балів на п’яту й сьому добу дослідження, що відповідало стану ясної свідомості в понад 75 % хворих. Зазначене спостерігалося на тлі тенденції до збалансованості активності прозапальних і протизапальних ланок цитокінової системи, про що свідчили максимальні значення фактора некрозу пухлини α та інтерферону α на п’яту добу спостереження при зниженні концентрації інтерлейкіну-1 на 55,8 % щодо фону. Прогнозована летальність у пацієнтів другої групи становила 51 %, фактична летальність — 7,5 %. Отже, шляхом проведення даного варіанта інтенсивної терапії вдалося знизити передбачувану летальність на 43,5 %.

Significance of changes in general clinical analysis of blood and thyroid status in people with neoplasm of the thyroid gland

Background. One of the major challenges of modern medicine is prevention and early detection of diseases, especially malignant tumors, since the stage does influence the prognosis and treatment costs. Thyroid involvement is currently one of the leading endocrine disorders in terms of overall morbidity and prevalence in the world. Thyroid cancer is one of the localizations, which being timely detected and properly treated, has a favorable prognosis, when 20–30-year survival rate exceeds 90 %. Therefore, the search for simple, minimally invasive, but highly informative techniques for optimizing the algorithms for diagnosis, differential diagnosis and monitoring of this disease remains a priority.
 Purpose – to determine and substantiate the diagnostic value of comprehensive assessment of the thyroid status and full blood count values in patients with thyroid nodules.
 Materials and methods. The study involved 60 patients with thyroid nodules, which according to ultrasonography (US) of the thyroid were classified as TR-4 category of thyroid nodules, TIRADS scale (4–6 points, suspected malignant thyroid changes). The examination included the following: questionnaire, ultrasound examination with fine-needle aspiration puncture biopsy, cytological examination, counting the thyroid hormone concentration, full blood count. The study was carried out at the premises of State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”.
 Results. Assessment of thyroid status of patients with thyroid nodules showed a significant correlation between the severity of thyroid malignancy and TSH levels (according to Kruskal – Wallis test, H = 7.30, p < 0.05), FT4 (H = 17.64, p < 0.001) and FT3 (H = 12.41, p < 0.01). Patients of Group I with benign thyroid process showed significant (p < 0.05) decrease in total hemoglobin along with significantly frequent (p < 0.05) microcytic anemia. According to the studies, Group II had a significant (p < 0.05) decrease in total platelet count and plateletcrit, as well as an increased average platelet volume and the percentage of large platelets compared to Group I. The blood values in malignant thyroid process (Group III) are characterized by increased levels of leukocytes and the proportion of eosinophils and basophils in the leukocyte formula compared to Group II (p < 0.05).
 Conclusions. The outcomes of comprehensive assessment of thyroid status and full blood count values in patients with thyroid nodules can be used in preoperative diagnosis as a differential prognostic tool to assess their malignant potential.

Analysis of the krok1 and histology subtests dynamics of students of Dnipropetrovsk medical academy

Оbjective control of the level of knowledge in medical universities is the basis for guaranteeing the quality of education. There are a lot of examples of universal systems designed to evaluate medical students in different countries, including USMLE, IFOM and others; particularly in Ukraine Krok 1 licensed exam is conducted since 2005. Results of Krok 1 are also used for ranking medical universities at the national level. The purpose of our work was to conduct a comparative analysis of the results of the licensing exam Krok 1, in particular, a histology subtest, among students of specialties 221 “Dentistry” and 222 “Medicine” and different languages of education (Ukrainian, Russian, English) in Dnipropetrovsk medical academy. We have revealed that all the analyzed contingents of students (DMA as well as Ukrainian) in the majority of observation periods from 2014 to 2019 had lower average results on histology compared to average Krok 1 results. This could be explained by low quota of histological tests for students of specialty 222 “Medicine” which is 4-6%, and absence of the threshold level for doing each particular subject. These conditions do not motivate students of the third course to recollect a complicated discipline that ended more than a year ago. Another problem is in the content of anchor questions in Krok 1 booklets: the number of such questions are distributed unevenly among booklets of different years and different languages of study. As a result, students with different languages of study are put in unequal conditions. In addition, the variation in the number of anchor tests from year to year, the lack of a declared quota of such tests disorients students and makes it difficult to develop algorithms for preparing for Krok 1.

Justifications for differentiated approach in correction of some changes of the immunologic disorders in patients with rapidly progressing generalized parodontitis with different drug susceptibility of the parodontal bacteria

Rapidly progressing generalized perio­dontitis (RPGP) still remains an extremely important medical problem, despite certain achievements in solving most of the issues of etiology, pathogenesis and treatment. The study included 102 patients with rapidly progressing periodontitis of I-II and II-III degrees of severity, with ineffective and inconsistent results of previous treatment who were examined and treated in the clinic of the Department of Surgical Dentistry, Periodontics and Implantology of the SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine». On the basis of the diagnostic and therapeutic measures carried out, it was established that, in patients with rapidly progressing generalized periodontitis, the formation of various drug sensitivity in periodontopathogenic microorganisms to protocol antibacterial therapy is closely associated with immunological protocol diseases. The presence of drug-resistant bacteria in the periodontal tissues is combined with a more pronounced immunodeficiency in the mechanisms of systemic and local protection than when the lesions are colonized by drug-sensitive periodontal microorganisms. The revealed features of immunity disorders in patients with RPGP with drug-resistant infection to conventional antibiotic therapy are manifested by a decrease in CD3+ lymphocytes, cells with cytostatic activity (CD4+, CD16+) expressing receptors for the activation of lymphocytes CD25+, HLA-DR and apoptosis CD95+), against the background of a slight increase in CD20+, CD116+, CD54+, significant inhibition of the synthesis of SIgA, IgM, α-INF, γ-INF; a pronounced increase in the production of pro-inflammatory cytokines IL-1β and TNF-α. The need for a differentiated approach in the correction of immunological disorders in patients with RPGP depending on the detected sensitivity and resistance of periodontal pathogenic bacteria to the protocol generally accepted antibacterial therapy has been clearly proved; this provides a faster relief of the infectious and inflammatory process (on average on 3.6±0.2 day) in more than 90% of cases, normalization of the parameters of immunological reactivity in 93.3% of the observed and stable clinical remission of the disease.

Pharmacology of treatment of vascular diseases with the help of endothelioprotectors

Background. Endothelioprotectors (EP) are a group of drugs with different pathogenetic mechanisms of action that prevent disruption and/or restore the structural and functional properties of vascular endothelium. EP are mainly used in the treatment and prevention of cardiovascular and cerebrovascular diseases and their complications.
 Objective. To describe the role of EP in modern therapy of vascular diseases on the example of L-arginine (Tivortin, “Yuria-Pharm”).
 Materials and methods. Analysis of literature data on this topic.
 Results and discussion. The endothelium can be considered as a separate organ that regulates the work of blood vessels. Nitric oxide (NO) is the main signaling molecule of the endothelium. In humans, NO is produced from L-arginine. The latter is a conditionally essential amino acid, which means that it is synthesized in sufficient quantities only in perfectly healthy adults. Arginine is practically not synthesized in children under 5 years of age and in persons over 50 years of age. The main food sources of arginine are meat (pork, poultry), chocolate, soybeans, however, nutrition may not always provide the necessary need for L-arginine. The effects of NO include decreased intracellular calcium, smooth muscle cell relaxation, and vasodilation. As a result, the total peripheral vascular resistance and blood pressure decrease. One of the leading negative factors affecting the heart and blood vessels is hypercholesterolemia, which disrupts the production and release of NO. An improvement in endothelium-dependent vasodilation and a reduction in the size of atherosclerotic plaques with L-arginine have been demonstrated in a rabbit model with hypercholesterolemia. Endothelial dysfunction is an important concept in modern cardiology and medical science. Its main manifestation is a decrease in the NO bioavailability, so in order to eliminate endothelial dysfunction, EP are prescribed. The ideal EP should have such properties as a pronounced cardio- and cerebroprotective effect, rapid onset of action, no side effects, and low cost. L-arginine (Tivortin) is one of the best known EP. It can be used in the treatment of chronic heart failure to increase exercise tolerance. Tivortin supplies the depleted endothelium with a substrate for NO synthesis, facilitating cell function. Tivortin can be used not only in cardiological patients. The research of V.V. Bezugla et al. (2017) showed that Tivortin aspartate for oral administration improves the general and special performance of athletes in cyclic and strength sports, as well as reduces the severity of psychophysiological stress. In addition, the neuro-rehabilitation properties of Tivortin are demonstrated, which justifies its feasibility in the treatment and prevention of stroke. In the study of M.M. Sunychuk et al. (2014) the inclusion of Tivortin (100 ml infusion once a day from the 4th day after stroke for 10-14 days) in the complex therapy contributed to a more positive dynamics of assessments on the NIHSS, Bartel and Rankin scales than the use of standard therapy only. Improvement of the cerebral blood flow with the use of Tivortin is shown in other scientific papers (Mankovsky B.N. et al., 2014). The beneficial effect of L-arginine on the course of hypertension has also been proven (West S.G. et al., 2005). Studies conducted at the Department of Pharmacology and Clinical Pharmacology of the Dnipropetrovsk Medical Academy confirmed the cardiotropic and vasotropic properties of L-arginine.
 Conclusions. 1. NO – the main signaling molecule of the endothelium – is produced from L-arginine, the production of which almost stops after 50 y. o. 2. EP supply the endothelium with a substrate for NO synthesis, facilitating its function. 3. L-arginine (Tivortin, “Yuria-Pharm”) improves clinical, laboratory and functional parameters in patients with cardiovascular and cerebrovascular diseases.

Retrospective Analysis and Current State of Experimental Models of Blast-induced Trauma

Combat pathology, particularly mine-blast injury is the main cause of military casualties. In our country, as a factor of destabilization, are widely used terrorist attacks using explosive devices of different capacities. Blast injury over 60% is cause of military casualties during armed conflicts. It is known that the condition for the formation of air-shock wave is creating waves of pressure, which is distributed at supersonic speed as possible with pulsed gas explosion and expansion of compression ambient air. The brain, chest, abdomen, and bladder are the most sensitive parts of the human body to blast. But the pathogenesis, diagnosis, treatment and rehabilitation of post-traumatic explosion-induced disorders, namely, neurodegenerative complications psychosomatic, cognitive impairment, currently not fully understood and are not clear enough for an adequate therapy. The purpose of the study was to analyze the advantages and disadvantages of experimental models of blast-induced injury and to improve method and compressed air-driven shock tube. Material and methods. We used the following methods: analysis and evaluation of experimental models of explosion-induced injury by scientific publications, monographs and invention obtained in stages patent information search in the library collection of the State institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine" (October 2019), a retrospective search of the literature database PubMed (February 2020). Results and discussion. A retrospective analysis of the number of literary sources on the experimental reproduction of explosive trauma has shown a high interest of a large circle of scientists in the last decade. A qualitative study of scientific publications has shown a wide range of physical characteristics of an experimental shock wave, methods and devices for simulating an explosive injury. The absence of a standardized model of explosive injury with characteristics as close as possible to real circumstances creates conditions for the implementation of our own proposals. Conclusion. This work presents a tested modified experimental model for reproducing an air shock wave under laboratory conditions, which makes it possible to study the features of the course of an explosive injury of various organs and organ systems at various periods after injury

LEARNING FRENCH BY TEACHERS OF THE DNIPROPETROVSK MEDICAL ACADEMY: A CHALLENGE AND PROSPECTS

In the framework of this article, we focus on the features of teaching/learning of French language for special purposes by teachers of the Dnipropetrovsk Medical Academy: the diversity of the public (age, previous experience of learning foreign languages, specialization), specific need, etc. Then, we will focus on the difficulties that the teacher and students encounter while learning French for special purposes, on ways and methods to overcome the obstacles that impede the achievement of the objectives.
 French for special purposes has certain features that all teachers must know to make this type of courses successful.
 Specific needs are one of the main characteristics of the FOS audience. The audience mentioned above does not want to learn French, but French for professional activities. For example, teachers of the Dnipropetrovsk Medical Academy aim to teach their subjects in French to French-speaking foreign students so that the learning process is as clear to them as possible, and so that the latter have the opportunity to master professional terminology in their native language. .
 Any FOS program developer must take into account the difficulties faced by a specialized audience (limited time, classes after work, the need to move to the place of training, etc.). Awareness of these obstacles helps to find solutions to overcome the above problems. Our research aims to offer solutions to overcome difficulties of all kinds, providing the possibility of distance learning. From our experience in this field, it seems to us quite possible, even effective, to offer it remotely, provided we take a common approach.

Discussion questions about the role of a lecture in the process of teaching the discipline "Propaedeutics of pediatrics" in the context of modern medical education

An important task of the modern high school of Ukraine is the comprehensive improvement of the educational process, based on the best achievements of the world and national didactics. A lecture always took the leading place among the large list of forms and methods of study in higher education. However, in the context of higher education reform, the issue of the relevance of a lecture as an integral part of the educational process is being actively discussed. The purpose of the study was to determine the importance and role of a lecture in the teaching of the discipline of pediatrics in modern medical education. 593 students of the third year of study at the Dnipropetrovsk Medical Academy were anonymously questioned, among them: 377 respondents - domestic students, 170 - foreign English-speaking students and 46 - foreign Russian-speaking students. The results show that for most domestic and foreign third-year students, lectures are a compulsory form of study, and lectures on of pediatrics are quite informative and necessary. In addition, the students highly appreciated the work of the teaching staff on the development of lectures and the level of presentation of the lecture material at the Department of Propaedeutics of Pediatric Diseases. The most frequent suggestions of both domestic and foreign students to improve the effectiveness of lectures were: to increase the number of lectures and educational information in them; cite more clinical examples from the practitioner's own experience; increase the number of videos during the class. Therefore, a lecture in the modern conditions of national higher medical education should remain the leading and necessary form of organization of the educational process. Teachers need to take into account the individual characteristics and needs of students to improve the effectiveness of the lecture material

THE RESULTS OF IMPLEMENTATION OF THE UNIFIED STATE QUALIFICATION EXAMINATION OF PHARMACY STUDENTS AT DNIPROPETROVSK MEDICAL ACADEMY

The article analyzes the results of the Unified State Qualification Examination (USQE) implementation in order to assess the pharmacy students’ education level during the Krok-1 licensed integrated examination and to compare these results with the national indicators.
 Considering that for the first time in 2019 a new qualitative assessment method of students’ knowledge has been introduced in Ukraine, both Ukrainian and foreign third year pharmacy students have had the USQ examination at Dnipropetrovsk Medical Academy (DMA), which included two components: Krok-1 licensed integrated examination and professional English. The analysis of the obtained results has revealed some shortcomings of the student training program and drawn an attention to the solution to these problematic issues.
 This comprehensive assessment of the pharmacy students’ profile knowledge allows us to identify the training programs’ shortcomings and provides an opportunity to increase the effectiveness of study at the academy in order to integrate Ukrainian specialists in the world medicine.

RESEARCH COMPETENCY AT THE UNDERGRADUATE LEVEL OF HIGHER EDUCATION

The aim of the article is to provide a justification for the introduction of “research competency” concept and to describe the ways of its formation among students of higher medical institution, based on the experience of the Students' Scientific Society (SSS) work at the Department of Internal Medicine 3 of State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”. The need to implement the research competency in the medical students training is substantiated in this article on the base of current legislation of Ukraine and today's requirements. A SSS work at a clinical department is analysed as one of the possible ways of the research competency acquisition, with the aspects that contributes to the development of the desired skills as well as those that may impede its mastery. Research work is a powerful impetus to the motivation to learn, as it directs students to scientific research. During working at SSS, students learn how to make a literary search, critically assimilate and assess of primary research literature and formulate a scientific problem, which require solution. At next step, they choose and apply the appropriate research methods that could be used in solving this problem. And finally, participants comprehend the statistics and process the obtained data followed by their scientific papers presentation in literary scientific sources or conferences. The work at SSS helps graduates be more competitive in today's job market as it brings up and cultivates professionally required qualities, including teamwork, ability to manage time and workload properly, an understanding of medical ethics and a range of communication skills. Currently, working in a SSS remains one of the best available options for introduction of the research competency in the training of the medical students, but it does not provide complete involvement of all undergraduate students, as required by the law of Ukraine.

The study of the neurotropic activity of the pyrrolopyrimidin-4-ones rearrangement products under the action of phosphorus oxychloride

Aim. To synthesize the annelated 4-aminopyridines and study the biological activity of one of products.Results and discussion. In the laboratory of the Research Institute of Biomedical Problems of the Dnipropetrovsk Medical Academy the studies of the effect of 2,3,3-trimethyl-2,3,5,6,7,8-hexahydro-1H-pyrrolo[3,4-b]quinolin-9-amine on the neuroactivity in the “open field” model have been conducted. According to the results of the experiment it has been found that in two hours after the administration of the oil solution of the compound the indices of the motor activity of mice are significantly reduced.Experimental part. 2,3,3-Trimethyl-2,3,5,6,7,8-hexahydro-1H-pyrrolo[3,4-b]quinolin-9-amine and 2,3,6,7,7-pentamethyl-6,7-dihydro-5H-pyrrolo[3,4-b]pyridin-4-amine were obtained by the rearrangement of the corresponding pyrrolopyrimidin-4-ones under the action of the excess of phosphorus oxychloride in toluene. The initial pyrrolopyrimidin-4-ones were synthesized by the condensation of 4-amino-1,2,2-trimethyl-2,5-dihydro-1H-pyrrole-3-carbonitrile with ketones. The structure of all compounds obtained was confirmed by 1H NMR-spectroscopy, mass spectrometry and elemental analysis.Conclusions. The neurotropic activity has been detected for the oil solution of 2,3,3-trimethyl-2,3,5,6,7,8-hexahydro-1H-pyrrolo[3,4-b]quinolin-9-amine on the “open field” model. It has been found that the aqueous solution of this compound does not exhibit the neurotropic activity regardless of the administered dose. Taking into account the presence of the neurotropic activity further research in this field is a promising way to search novel bioactive molecules among 4-aminopyridine derivatives, which are structural analogs of the drug Tacrine. Received: 26.12.2019Revised: 20.01.2020Accepted: 27.02.2020

ДО ПИТАННЯ ВПРОВАДЖЕННЯ ЛІЦЕНЗІЙНОГО ІНТЕГРОВАНОГО ІСПИТУ З МЕДИЦИНИ У ЗАКЛАДАХ ВИЩОЇ ОСВІТИ УКРАЇНИ

Introduction. The entry of the Ukrainian state into the European educational space, bringing in line domestic educational standards of future medical profe-?sionals’ training to European ones led to the reform of higher medical education, expanding the content of educational programs, introducing new methods and technologies of teaching students and improving forms of cooperation of teachers and students in medical establishments of higher education. In this regard, the Ministry of Health of Ukraine decided to introduce a licensed integrated exam for students of medicalestablishments of higher education, which aimed to identify not only the level of training of graduates of domestic medical establishments, but also to compare their training with European and world levels.The purpose of the article is to reveal the history of the introduction of a licensed integrated medical exam in Ukraine, the content of the system of students’ training for it, the positive aspects and shortcomings of the first experience of this form of state certification in various medical establishments of higher education. Methods. During the work on the article the following main research methods were used: analysis, synthesis, comparison, generalization, descriptive. Results. The history of the introduction of the licensed integrated exam in medicine in Ukraine during the end of the 20th – the first quarter of the 21st century in Ukraine is revealed in the article. The sites of the Ministry of Health of Ukraine and the Testing Center at the Ministry of Health of Ukraine, which contain state documents on the feasibility of the system of implementation of a licensed integrated medical exam; information about the experiment in some medical etablishments of higher education of Ukraine and the first experience of implementing licensed state certification in medical universities, schools, colleges and academies in the Ukrainian state are presented and analyzed. It was established that the experiment was initially conducted in some establishments of higher education since 1996 with further discussion of its results, and in 1998 the licensed integrated exam has become mandatory for all medical establishments of higher education of Ukraine that train specialists in “Medicine” and “Pharmacy”. Since 2000 it has become mandatory for specialists in “Dentistry”, and since 2004 exams have become mandatory for interns and in 2007 they have become mandatory for interns-dentists. Particular attention is paid to the content, structure and stages of implementation of this exam, analysis of the first results of its implementation and assessment of training for the exam by teachers and students of Ukrainian medical establishments of higher education. A comparative description of the methods of training, organization of the exam, information material for it, forms of independent training for the exam of students in medical establishments of higher education of different levels of accreditation is given. The experience of teachers’ work at such medical establishments of higher education as Bukovynian State Medical University, Vinnytsia National Medical University named after M.I. Pyrohov, Zaporizhzhia State Medical University, Ternopil State Medical University named after Ivan Horbachevsky, Kharkiv National University of Pharmacy, Zhytomyr Institute of Nursing, Dnipropetrovsk Medical Academy and others. Originality. The experience of introduction of the licensed integrated examination in medical estab-?ishments of higher education of Ukraine of different levels of accreditation is systematized for the first time.

Oral piercing is a new challenge in the dentistry.

The number of the young adults undergoing oral piercing is increasing worldwide. Oral piercing leads to numerous complications, and it is possible that the incidence of complications may increase as the prevalence of oral piercing rises in Ukraine. However, not everyone is aware of its potential risks, local and systemic complications shortly after, or long after the piercing procedure. Dentists should educate patients with oral piercing or those who plan to have this type of body art performed about potential side effects and possible oral, dental, and systemic complications. However, data related to these complications in Ukrainian literature are limited. The purpose of this study – to assess the potential complications of the oral piercing; and to analyze awareness about the actual health risks linked to the practice of oral piercing by dental students. This study includes 37 cases of oral piercing in 36 young women attending the department of therapeutic dentistry of Dnipropetrovsk medical academy with and without complaints. The average subjects age was 22,3 years. Patients were examined clinically and radiographically. 200 students of Dnipropetrovsk medical academy answered a questionnaire about oral piercing knowledge. Immediate complications of oral piercing included pain (58.3% of cases), oedema (47,2%) and bleeding (11.1%) as the most representative. Prolong time of piercing wearing is associated with a greater prevalence of complications. Dental fractures or fissures (35,1%), gingival recession (29,7%) and mucosal atrophy (21,6%) are the most representative. The accumulation of dental plaque and calculus on piercing elements (43,2%) was an additional risk of infection. The results of the survey showed a high level (85,4%) of awareness of dental students about local oral piercing risks. At the same time, dental students (50,6%) are not sufficiently aware of the risk of piercing on developing systemic complications. Approximately 60% of dental students do not have a negative attitude towards the new practice of oral piercing.

Dnipro Pharmacology School: a 100 years’ journey (to the centenial of the department of pharmacology and clinical pharmacology of Dnipropetrovsk medical academy). Part I: 1918-1943.

Dnipro Pharmacology School: a 100 years’ journey (to the centenial of the department of pharmacology and clinical pharmacology of Dnipropetrovsk medical academy). Part I: 1918-1943.

Perception of the educational environment by foreign students of medical and dental faculties of the Dnepropetrovsk Medical Academy.

Background. Favorable educational environment is the key to successful adaptation of both domestic and foreign students to the requirements of modern training programs. The perception by students of the educational environment requires constant study, since it reflects the internal processes taking place in the student's environment, which characterizes the learning process as a whole. Objective. This investigation was aimed at studying the perception by foreign students of medical and dental faculties of 1st and 2d courses of the Dnipropetrovsk Medical Academy educational environment. Methods. As a method was used Dundee Ready Education Environment Measure (DREEM). DREEM is a questionnaire consisting of 50 statements. All questions are subdivided into five categories: students' perception of learning or learning; teacher perception of pupils or teaching; academic self-perception; educational atmosphere and social self-perception of students. Results. The study involved 200 foreign students. The mean total DREEM score of the educational environment was 139/200 (70%) and the majority of students had positive rather than negative perceptions, which can be regarded as quite good conditions of the educational process. Students rated academic self-perception as high –23.8 / 32 (74%). No less appreciated was the perception of learning –34.7 / 48 (72%). The perception of the educational atmosphere –32.6 / 48 (68%) and the perception of teaching –29.9 / 44 (68%) students rated equally and well above average, but social self-perception was reduced –18.5 / 28 (66% ). Conclusion. The survey made it possible to assess the perception of the educational environment by foreign medical students of 1 and 2 courses of the Dnipropetrovsk Medical Academy. The educational environment was characterized by the students as positive in general, but with certain disadvantages. Analysis of scores according to all criteria can serve as a basis for the correction of teaching methods, relations between teachers and students, which will contribute to the improvement of the educational process.