УДК 616.12:612-001]:355(091) 

Вступ. До найскладніших сучасних проблем військової медицини належать питання діагностики, надання невідкладної допомоги та хірургічного лікування поранених з ураженнями серця та перикарда.
Мета. Вивчити структурно-функціональні особливості серця у поранених для прогнозування віддалених посттравматичних міокардіодистрофій.
Матеріали та методи. Аналіз наукової літератури проведений у базі Pubmed та у вітчизняній літературі. Описовий матеріал проілюстрований клінічним випадком.
Результати. За даними літератури, ураження серця під час та після бойової травми край різноманітні, їх можна поділити на безпосередні (відкриті та закриті) та віддалені посттравматичні. Для діагностики найбільш складними є закриті тупі травми серця (струс серця, забій серця, розрив серця
зовнішній чи внутрішній з гемоперикардом, тампонадою серця, гемотораксом), що може спричиняти стан гібернації чи оглушення міокарда на тлі його набряку, викликати зміни ендокарда та перикарда, аритмії, у тому числі життєво небезпечні, гострий розрив серця, розшарування чи розрив аорти. Аналіз клінічного випадку свідчить, що саме порушення електрофізіологічних процесів та формування дисфункції міокарду можна вважати проявом посттравматичної міокардіодистрофії токсично-запального характеру у віддалений період важкої церебральної травми.
Висновки. Віддалені посттравматичні міокардіодистрофії токсично-запального характеру зумовлені активацією запалення та ендотоксикозу, гіпоксією та метаболічними змінами з процесами апоптозу кардіоміоцитів, що ілюструє клінічний випадок.

UDC 378.1.096:616

The introduction of innovative teaching technologies in higher medical education contributes to its intensification, effective implementation of the acquired knowledge into practice, formation of clinical thinking, and development of practical skills and abilities. It is ensured by the joint work of the student, who is at the centre of the educational process, and an experienced teacher who uses innovative methods. The study aimed to analyse the use of innovative methods in clinical departments of higher education institutions. The analytical method of literature data and the comparative method of comparing with one's own clinical and teaching experience were used. Game methods have become essential nowadays in the context of distance or blended learning. The advantage of a clinical game is the expansion of knowledge and experience of participants who learn to interact, make quick and correct decisions, evaluate their effectiveness and consequences, and have the opportunity to correct mistakes. The teacher can change the context, tasks, logistics of instrumental and laboratory examinations, and management tactics. The effective work of the teacher, the skilful use of innovative technologies, and the quality of the presentation of the material affect the student's interest in learning. Evaluating student mistakes that do not harm the patient or worsen their condition is important. There are games with a change of context, examination results, sudden development of an emergency, and a game with incomplete data that the participant has to model. The clinical game can be adapted for both classroom and distance learning; it can be based on data from real patients. Thus, innovative technologies of the educational process, including simulation ones, promote active independent learning, the development of practical skills and abilities, and the formation of clinical thinking. The clinical game is a creative method of teaching that expands the knowledge and experience of participants, has an educational function, brings them closer to future practical work and can be used in various forms of education.

Introduction. Recommendations for the use of the Mediterranean diet apply to many nosologies, which made it expedient to consider the principles of such nutrition and adherence to it for patients with high cardiovascular risk.
Objectives. In order to evaluate the nature of the diet of patients with high cardiovascular risk and their adherence to the Mediterranean diet, the principles of the diet were described according to the data from the Pubmed database. Adherence to and compliance with the principles of Mediterranean diet in patients with high cardiovascular risk were determined according to the Food Questionnaire in 29 outpatients with stable chronic forms of coronary heart disease and arterial hypertension: 18 men, 11 women aged 55.72±2.59 years with excessive body weight; the results were processed by the methods of variational statistics.
Results. The Mediterranean diet is recommended for patients with high cardiovascular risk, excess body weight, steatotic liver disease, inflammatory bowel diseases, autoimmune changes in the thyroid gland, dementia, chronic obstructive pulmonary diseases, and oncological processes. It is based on grains, cereals, vegetables and fruits, beans, nuts, and seeds; a small amount of meat, eggs, fish, and poultry; olive oil and moderate daily consumption of cheeses and yogurts. According to the Food Questionnaire, patients with a high cardiovascular risk are not sufficiently aware of the principles of this diet, do not fully follow the recommendations for replacing fats with extra virgin olive oil, do not consume enough fish, vegetables, fruits, nuts, whole grain pasta and hard cereals. In addition, they tend to consume meat, soft cereals, ordinary types of bread and pasta, sweets, carbonated beverages, beer, and spirits in excessive
amounts or too often.

Liver steatosis, the earliest stage of metabolic-associated non-alcoholic fatty liver disease (MAFLD), is the most common form of liver damage. However, the specific immune response linked to this condition remains poorly understood. This study aimed to assess immune system parameters and their relationships in patients with cardiorheumatic diseases who also have metabolic-associated liver steatosis (MALS). A total of 53 patients were included in the study: 32.07% had ischemic heart disease, 39.62% had haemorrhagic vasculitis, and 28.31% had rheumatic fever. Various immune parameters were measured, including different lymphocyte subtypes, immunoglobulin levels, immune complexes, complement components, and phagocyte activity. In patients with MALS, immune disturbances were characterized by significant shifts in B-cell activity, elevated immune-effector indices, increased small immune complexes, and complement component levels. Low-affinity B-cells emerged as central in immune system interactions, showing significant correlations with various immune cells, such
as T-cells, T-suppressors, NK cells, and IL-2 receptor-bearing T-cells, as well as with the immunoeffector index. Key immune mechanisms associated with MALS included activation of the humoral immune response, the complement system, immune complex formation, and enhanced antibacterial activity in phagocytes.

The aim: To evaluate the structural changes of the brain in relation to the formation of cognitive disorders (CD) in patients with arrhythmias

Materialsand methods: 147 patients with different clinical forms arrhythmias against the background of ischemic heart disease were examine. At the first stage, all patients with arrhythmias assessed cognitive functions. At the second stage, patients were distributed divided into two groups: the main group patients with CD, control – patients without CD. These groups underwent computed tomography examination of the brain.

Results:CD were established in 83% patients with arrhythmias. Mild CD were more often diagnosed in patients with persistent form of atrial fibrillation (AF), severe CD – in patients with permanent form of AF and atrioventricular blockade ІI-III degrees. Neuroimaging changes were found in 73.8% patients with CD and in 36% patients without CD. They were manifested by atrophic changes of the cortex, internal hydrocephalus, a decrease in the density of the brain sub- stance of the periventricular area. In patients with CD, compared to patients without CD, showed lacunar foci with predominant localization in the parietal and frontal lobes of the brain, periventricular and subcortical leukoaraiosis. Multiple correlations were established between CD and structural changes of the brain.

Conclusions: The increase in the severity of CD in patients with arrhythmias is associated with atrophic changes at the cortical-subcortical level, accompanied by the phenomena of internal hydrocephalus, periventricular and subcortical LA, lacunar foci, with a predominant localization in the frontal-temporal-occipital lobes, in the visual hump and basal ganglia of both cerebral hemispheres.