HOLISTIC APPROACH IN COMMUNICATION SKILLS TEACHING OF MEDICAL STUDENTS.

OBJECTIVE: The aim: To analyze the relevance of communicative competence in medical practice and to choose the best pedagogical methods by improve communication skills in future doctors through the use of a holistic approach in teaching. PATIENTS AND METHODS: Materials and methods: Sociological, informational and analytical research methods were used in the research. CONCLUSION: Conclusions: The holistic direction in education promotes partnership between a student and a teacher, the achievement of mutual understanding and trust, better commitment and motivation to learn. The use of feedback forms helps to recognize and understand the needs and feelings of each student, work effectively with diversity, motivates the teacher to continuous self-development and self-improvement. Modern teaching methods such as working in small groups, Storytellling and role-play according to students are more valid in mastering the communicative competence of the future doctor.

The role of cytocin imbalance in the development of man infertility.

OBJECTIVE: The aim: Study of the clinical and pathogenetic role of IL-17, IL-35 and their correlation in the development of infertility in men with chronic ureoprostatitis. PATIENTS AND METHODS: Materials and methods: 82 male aged 20 to 40 were examined. The patients were divided into three groups: the first - 10 practically healthy men, in which the levels of IL-17 and IL-35 in semen were taken as normal; second - 33 infertile men with chronic urethroprostatitis; third - 39 fertile men with chronic urethroprostatitis. In addition to conventional clinical and laboratory (clinical blood and urine tests) studies, all men in semen were tested for IL-17 and IL-35 cytokine levels. RESULTS: Results: The levels of the studied cytokines were found to have opposite tendencies to shifts in the semen of men with chronic urethroprostatitis. The level of IL-17 in sperm increases and the level of IL-35 decreases. The IL-17/IL-35 index increases more strongly in men with impaired fertility. CONCLUSION: Conclusions: Increas IL-17 concentrations, decreas IL-35 levels and increas their correlation may be an indicator of infertility in men with chronic ureoprostatitis. Determining the IL-17 / IL-35 correlation in general clinical practice will allow to single out a group of men with a high likelihood of developing infertility for follow-up and treatment by a doctor of family medicine.

PATHOPHYSIOLOGICAL AND ATHOMORPHOLOGICAL ASPECTS OF RELAPSE OF VARICOSE VEINS AFTER ENDOVASCULAR LASER VEIN COAGULATION.

OBJECTIVE: The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the EVLC. PATIENTS AND METHODS: Materials and methods: In 173 patients with varicose veins of the lower extremities, the level of markers of endothelial dysfunction was determined: P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, adhesion molecules of type 1 vascular endothelium (sVCAM-1-soluble vascularcellularmolecula), circulating endothelial cells (CEC) before surgery (EVLC), on the 10th and 60th day of the postoperative period.At the same time, a morphological and electron microscopic examination of the state of the deep venous system in 31 patients with varicose vein disease of the lower extremities who died from acute heart failure, was performed. RESULTS: Results: Increased values of markers of endothelial dysfunction in patients with varicose veins of the lower extremitiesbefore surgery of EVLC were established. We found that, despite the operation, the parameters of endothelial dysfunction decrease, but in the remote postoperative period do not come to the norm. Morphological and electron microscopic studies of the deep vein wall revealed pathomorphological changes in all of their layers, especially the endothelial layer. At the heart of the development of endothelial dysfunction in the postoperative period, the leading role belongs to changes in mitochondria. CONCLUSION: Conclusions: 1. Based on our research, we can state that there are significant pathomorphological and pathophysiological changes in the deep venous system of the lower extremities in conditions of varicose vein disease. 2. The initiator of postoperative relapse of varicose veins are structural changes in the wall of deep veins with a violation of the integrity of the endothelial lining, contributing to the absorption of plasma and leukocyte contents from the blood stream in the interstitium, with the following pathological changes in the layers of deep veins.Such changes are the basis for the manifestations of endothelial dysfunction in the postoperative period.

Kallikrein-kinin system disbalance in chronic pancreatis in combination with metabolic syndrome.

OBJECTIVE: Inroduction: Disbalance of kallikrein-kinin system, which is present in patients with chronic pancreatitis, is quite often associated with metabolic syndrome. The aim: to study and compare the status of kallicrein-kinin system in patients with chronic pancreatitis compared with patients with comorbidity of chronic pancreatitis and metabolic syndrome. PATIENTS AND METHODS: Materials and methods: All patients were divided into two groups: I group included 58 patients with chronic pancreatitis in combination with metabolic syndrome; IІ group included 32 patients with chronic pancreatitis. . Indicators of kallicrein-kinin system in blood plasma were determined by chromatographic method. Results and conclusions: Worse condition of kallicrein-kinin system was observed in patients with metabolic syndrome. Patients with chronic pancreatitis with comorbidity with metabolic syndrome established more pronounced activation of the system of general and specific proteolysis with statistically significantly higher rates of proteolytic activity of plasma, kallikrein, α1-protease inhibitor and kininase-II (p<0.05) relative to patients with chronic pancreatitis.

The effect of the proteolisis' system activity for the trophological status of patients with osteoarthrosis and excretory insufficiency of pancreas.

OBJECTIVE: Introduction:The excretory insufficiency of pancreas in patients with primary osteoarthrosis is formed at the comorbid pathologies and as a result of long-term treatment of osteoarthrosis using the non-steroidal anti-inflammatory drugs, steroids, chondroprotectors and chondrostimulators etc. The aim: to study the state of the proteolysis system and immune status, the presence and depth of the dysbiosis of colon in patients with primary osteoarthrosis against a violation of their excretory insufficiency of pancreas. PATIENTS AND METHODS: Materials and methods: There were 64 outpatients with primary OA (group 1) and 74 patients with primary OA in combination with diseases associated with EIP (group 2). The control group consisted of 30 healthy people.The age of the patients ranged from 29 to 74 years. The diagnosis of primary OA was established on the basis of unified diagnostic criteria, the X-ray stage of the primary OA, according to J. H. Kellgren and J. S. Lawrence. RESULTS: Results: It was proved that there is a deeper excitation of the excretory function of the pancreas in patient with osteoarthrosis and comorbid pathologies of the gastrointestinal tract with the excretory insufficiency of pancreas, as well as the presence of the excretory insufficiency of pancreas in patients with primary osteoarthrosis without the clinically available the excretory insufficiency of pancreas. In patients with primary osteoarthrosis that went through the isolation or in combination with the diseases accompanied by theexcretory insufficiency of pancreas, a statistically significant activation of the total proteolysis by the level of the proteolytic activity of the plasma was established. In group 2, dysbiotic changes were significantly deeper than in group 1. The obtained results indicate the presence of secondary immune deficiency in patients and non-specific activation of the humoral part of the immune system and the inflammatory process. CONCLUSION: Conclusion: Statistically more significant changes were observed in group 2, indicating the progression of the detected changes in comorbidity conditions.

combination effect of hypertonic disease with chronic pancreatitis on the processes maintain homeostasis.

OBJECTIVE: Introduction: Abnormalities comorbidity - a frequent phenomenon in medical practice. This determines the relevance of research processes maintaining homeostasis with a combination of various diseases. The aim of this study was to examine and compare the character of vegetative, antioxidant, kallikrein-kinin system and parameters of endogenous intoxication disorders in the patients with isolated essential hypertension and with combination of hypertonic disease and chronic pancreatitis. PATIENTS AND METHODS: Materials and Methods: Cardiointervalography was used in the research with definition of standard statistical and spectral heart rate variability. Determination of superoxide dismutase, glutathione, catalase, middle molecular peptides, total proteolytic activity of plasma by the hydrolysis of protamine sulfate, prekallikrein, kallikrein, α1 -proteinase inhibitor, α2 -macroglobulin and kininase II was conducted by laboratory methods. RESULTS: Results: Sympathicotonia with the moderate tension of adaptation processes, violation of antioxidant protection, kallikrein-kinin system and displays of endogenous intoxication were found in the patients with isolated hypertension. Reduction of sympathicotonia, reducing total power spectrum, increasing the share of humoral-metabolic effects on heart rate, tendency to asympathicotonia autonomic reactivity, lower levels of superoxide dismutase, glutathione, prekallikrein, α2 -macroglobulin, kininase II, higher levels of catalase, middle molecular peptides, total proteolytic activity of plasma kallikrein were observed upon accession the concomitant chronic pancreatitis. CONCLUSION: Conclusions: The signs of compensatory mechanisms disruption and increased autonomic nervous system imbalance with a decrease in ductility autonomous processes in the load were determined upon accession the concomitant chronic pancreatitis. The combination of pathologies also accompanied by more severe manifestations of endogenous intoxication, significant violations of antioxidant and kallikrein-kinin systems.