Archive of clinical medicine最新文献

{"title":"Role of Computed Tomography in the Diagnosis of Ovarian Cancer","authors":"Anna Kryzhanivska, Roman Hrytsyk, Tetiana Teren, Yuriy Savchuk","doi":"10.21802/acm.2023.1.19","DOIUrl":"https://doi.org/10.21802/acm.2023.1.19","url":null,"abstract":"Introduction. Malignant formations in the ovaries remain a pressing issue in the field of oncology today. Ovarian cancer occupies one of the leading positions in terms of frequency (7th place) and mortality (4th place). The lack of symptoms during the course of the disease is explained by the fact that cancer cells primarily spread through the abdominal cavity, often leading to late-stage disease diagnosis. The prognosis of the disease depends on the stage of the disease, the level of tumor differentiation, the period of recurrence-free survival, and the size of the residual tumor after surgical treatment. Considering these factors, this disease remains of interest to researchers in terms of identifying new prognostic factors for the course of the disease and the possibility of influencing them. Methods. The study is based on the results of observing 139 patients with stage III-IV ovarian cancer. The study and evaluation included the peritoneal cancer index and overall survival. Results. An analysis of two groups of patients who received neoadjuvant chemotherapy/intraperitoneal chemotherapy and primary cytoreductive surgery was conducted. Peritoneal carcinomatosis was evaluated in the primary patients in the neoadjuvant chemotherapy/intraperitoneal chemotherapy group and the primary cytoreductive surgery group. The average peritoneal cancer index in the neoadjuvant chemotherapy/intraperitoneal chemotherapy group was 21.5 points, and in the primary cytoreductive surgery group, it was 14.3 points. Overall patient survival was calculated, according to the Kaplan-Meier curve, the median overall survival in the neoadjuvant chemotherapy/intraperitoneal chemotherapy group was 24 months, and in the primary cytoreductive surgery group, it was 25 months. Conclusions. The use of contrast-enhanced CT in patients with ovarian cancer is an informative method for diagnosing peritoneal carcinomatosis and allows for the correct diagnosis and planning of treatment tactics. Although interval cytoreductive surgery does not affect the overall survival of patients, it allows for optimal cytoreductive surgery in patients with advanced carcinomatosis.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Metabolic Disorders, Structural–Functional Changes of the Liver and Pancreas Against the Background of a High Calorie Carbohydrate and Fat Diets","authors":"Emilia Tsymbala, Nataliia Voronych-Semchenko, Mykhailo Pastukh","doi":"10.21802/acm.2023.1.18","DOIUrl":"https://doi.org/10.21802/acm.2023.1.18","url":null,"abstract":"Obesity becoms one of the most common pathologies, which is accompanied by a violation of energy metabolism in the body, increased accumulation of fat in tissues. The development of visceral obesity can develop against the background of a high calorie diet that is unbalanced in terms of carbohydrates and fats.
 The aim of the research: study of the hormonal-metabolic profile, structural-functional peculiarities of the liver and pancreas under the conditions of animals’ receiving high-carbohydrate or high-fat diets in dynamics.
 Research methods. The study was performed using sexually mature male rats receiving a standard food diet (control group) and received the high-carbohydrate or high-fat diets. Animals were removed out of the experiment during the 21st, 35th, 46th and 56th days of the study. Metabolic indices and functional markers of the hepatopancreatobiliary system were determined in the blood serum of experimental rats. Structural peculiarities of the liver and pancreas were studied using optical microscopy.
 Results and discussion. As a result of the study, in animals that were on high calorie diet, a significant increase in the content of leptin and insulin was observed against the background of a decrease in the level of ghrelin in the blood serum of experimental rats during the 35th day of the experiment with the progression of the identified dyshormonal disorders until the 56th day. Such changes in the hormonal profile occurred against the background of an increase in the concentration of glucose in the blood serum, an increase in the content of glycosylated hemoglobin (HbA1c), an increase in the HOMA-IR insulin resistance index and body mass index (BMI). During the 21st day of the research, the activation of cytolytic processes (increased activity of alanine aminotransferase – ALT, aspartate aminotransferase – AST, gamma-glutamyl transpeptidase – GGT, α-amylase, alkaline phosphatase – AF) was revealed; they progressed until the end of the experiment. During the morphological examination of the liver and pancreas in animals under the conditions of a high-fat diet, pronounced fatty infiltration was observed. In the pancreas of animals receiving the high calorie diet, morphological changes are manifested by edematous processes and disruption of the vascular component, with greater dominance in the case of a high-fat diet.
 Conclusions. The animals’ being on high-carbohydrate and high-fat diets leads to the development of metabolic disorders, functional and structural changes in the liver and pancreas, which characterize the development of insulin resistance, obesity, and metabolic syndrome.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Lesson in a New Discussion Format – Clinical Case Discussion","authors":"Roman Yatsyshyn, Nataliia Cherniuk, Oksana Drohomeretska, Vira Vyshyvanyuk","doi":"10.21802/acm.2023.1.4","DOIUrl":"https://doi.org/10.21802/acm.2023.1.4","url":null,"abstract":"The exceptional availability of high-tech simulators is not enough to ensure the high quality of practical training of the future medical specialists. The main condition is the use of certain pedagogical technologies that ensure the continuity of the system of practice and improvement of practical skills and preparation for competent professional activity at all stages of the future doctor training.
 In recent years, there has been a clear trend to improve the methods of simulation technologies in medical education at the undergraduate stage of the future doctors’ training. At the same time, an important direction is the step-by-step analysis of clinical cases followed by an extended discussion (with the elements of debriefing) and the use of additional information in the form of separate information blocks with visualization. Only at this stage it is possible to practice communication skills, to understand the clinical route of the patient, as well as to discuss possible rehabilitation and preventive measures.
 The aim of this article is to share own experience of the implementation of a highly effective teaching method – the discussion of clinical cases, Clinical Case Discussion (CCD), which promotes the development of deep clinical thinking in students, the ability to practically apply knowledge in various fields of medicine, the performance of the applied differential diagnosis, and the formation of the real tactics of the diagnostic search and/or treatment of a specific patient on the example of this clinical case.
 Performance of a practical session in the new Clinical Case Discussion (CCD) format promotes the development of clinical thinking, allows students to systematize the material obtained and separate dominant signs (symptoms) from secondary ones, justify the appointment of laboratory and instrumental examination methods, verify the diagnosis and develop a number of rehabilitation measures. Active participation in the discussion of specialists of related specialties (depending on the topic of the clinical case and the primary manifestation of the disease) demonstrates the importance of interdisciplinary interaction and the ability to work in a team. The use in the process of clinical discussion of separate information blocks (with visualization) regarding important symptoms, as well as diseases with which it is necessary to perform differential diagnosis, contributes to analytical thinking, a syndromological systematized approach and the formation of a final diagnosis.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Philosophical and Methodological Challenges of Creativity","authors":"Nadiia Skrobach, Oksana Shapoval, Vira Vyshyvanyuk, Vitalii Petryna","doi":"10.21802/acm.2023.1.3","DOIUrl":"https://doi.org/10.21802/acm.2023.1.3","url":null,"abstract":"At all stages of its development, higher education considered the training of an educated specialist capable of improving their professional qualities, reproducing and expanding social experience, transforming the material conditions of society and its culture as well as accumulating and creating new values and knowledge as its main goal.
 At a certain stage, however, this social function of higher education – the formation and development of a creative personality of a specialist, became distorted, devalued, and lost its fundamental meaning. Higher education gradually began to lose its creative functions.
 The process of restructuring the political, spiritual, social, and economic life of society has posed new questions about the individual and the objective need for increasing the role of the creative personality.
 Studying the patterns of students’ thinking development, the peculiarities of their socialization under new conditions, and the realization of the creative abilities of the individual, while changing priorities and values, allows for predicting promising trends in the development of science, technology, and culture in the nearest future.
 An important methodological principle that should be embedded in the center of educational policy during the predicted period is the recognition that the progress of any society is measured by the ability to realize the essential capacities of individuals, their degrees of freedom, moral self-improvement, personal development, and the movement of society towards a new historical form of humanism.
 An individual in society should be free and retain the freedom of conscience, thought, skills, profession choice, cultural interests, aspirations, and priorities.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peculiarities of Arteriovenous Prosthesis Functioning in Patients on Hemodialysis","authors":"Vladyslav Semchenko, Oleh Popadyuk, Oleh Legun","doi":"10.21802/acm.2023.1.17","DOIUrl":"https://doi.org/10.21802/acm.2023.1.17","url":null,"abstract":"Long-term and proper functioning of vascular access is necessary for renal replacement therapy in patients with chronic kidney disease (CKD). If it is impossible to form an arteriovenous fistula due to a pathologically changed structure of the vascular wall of peripheral arteries and veins, an arteriovenous prosthesis of various locations is implanted to form a permanent vascular access. However, the problem of long-term use of arteriovenous prostheses remains relevant, in particular, due to the prevalence of hemodynamic disorders, such as thrombosis, stenoses, and pseudoaneurysms.
 The aim of the study was a retrospective analysis of hemodynamic disorders and peculiarities of the use of arteriovenous prostheses as permanent vascular access in patients undergoing hemodialysis therapy.
 There were analyzed 586 medical records of inpatients and 103 discharge epicrisis of outpatients of the intensive nephrology department. Out of the 467 primary permanent vascular accesses formed for renal replacement therapy, 391 (83.72%) ones – were native arteriovenous fistulas (AVF) and 76 (16.27%) – were arteriovenous prostheses (AVP).
 It was found that the increase in the frequency of initial uncorrected and corrected primary loss of vascular access for AVF is the greatest during the first year of use and amounts to 35.53% and 26.32% of cases, respectively. Instead, the greatest increase in secondary loss of patency is observed during the first six months of using prostheses, which corresponds to 10.53% of patients. It is worth paying attention to the problem of concomitant pathology, in particular diabetes mellitus, arterial hypertension, calcification disease, which directly affect the state of the vascular wall and the functioning effectiveness of the vascular access. The obtained results indicate the necessity to review and supplement the existing methods of prevention of hemodynamic disorders of AVF during the first 6-12 months of their use in order to improve the quality of patients’ lives.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Antioxidant Correction on Structural and Functional Changes of the Thyroid Gland in Case of Experimental Iodine Deficient Hypothyroidism","authors":"Oksana Tuchak, Ihor Luchko, Nadiia Pobigun, Iryna Dubkovetska","doi":"10.21802/acm.2023.1.9","DOIUrl":"https://doi.org/10.21802/acm.2023.1.9","url":null,"abstract":"Experimental iodine deficient hypothyroidism is manifested by an increase the activity of oxidative processes and a decrease the indicators of antioxidant defense of blood, which is accompanied by the appearance of destructive changes in the tissues of thyroid gland. The comparative analysis of the obtained results confirms the advantage of α-tocopherol using in the complex with potassium iodide for the correction of hypothyroidism, antioxidant imbalance and structural changes of the thyroid gland.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of the Endodontic Treatment Efficiency of the Maxillary First Molars Using Differentiated Instrumental Preparation of the Apical Part and Additional Sealing of Root Canal Orifices","authors":"Nataliya Kobryn, Vitalii Hereliuk","doi":"10.21802/acm.2023.1.2","DOIUrl":"https://doi.org/10.21802/acm.2023.1.2","url":null,"abstract":"Introduction. Endodontic treatment of maxillary first molars (MFMs) is very challenging due to the anatomical complexity of root canals which makes it difficult to do the proper cleaning, shaping, and obturation.&#x0D; Aim was to study the effectiveness of a proposed endodontic treatment of maxillary first molars, compared to the traditional method, in patients with and without concomitant generalized periodontitis.&#x0D; Methods. Endodontic treatment of 176 maxillary first molars was carried out according to the traditional method and proposed one, which included a differentiated approach to the instrumental preparation of the apical part of the root canal, and additional sealing of the root canals orifices using glass-ionomer cement. Obturation was conducted by lateral compaction of gutta-percha, combined with zinc-oxide-eugenol (ZOE) sealer and sealer based on epoxy resins. The effectiveness of endodontic treatment was evaluated based on the radiological comparison of the index, area of periapical destruction, and optical density of treated teeth roots immediately after, in 6 and 12 months.&#x0D; Results. In 12 months after the endodontic treatment in the subgroups where the proposed technique was used, in patients with chronic apical periodontitis, better positive dynamics of the % increase in densitometric indicators, % increase of ​​periapical bone destruction, and the decrease of PAI were noted. The % increase of the ​​destruction area in the subgroup with the proposed treatment in combination with ZOE sealer was (79.21±2.41) %, that characterizes the decrease in the area from 14.03±0.7 mm2 to 2.65±0.26 mm2. It was established that the index of endodontic treatment effectiveness is significantly lower in patients with generalized periodontitis of 2nd degree, compared to patients with healthy periodontium(p<0.05).&#x0D; Conclusions. It was established that the combination of the proposed method of treatment and ZOE sealer showed high effectiveness of endodontic treatment, due to the radiological picture in 12 months. It was found that there can be a possible negative effect of tooth mobility on the prognosis of endodontic treatment.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"237 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Morphological Parallels in the Etiopathogenesis of Secretory Otitis Media","authors":"Vasyl Popovych, Ostap Orishchak","doi":"10.21802/acm.2023.1.11","DOIUrl":"https://doi.org/10.21802/acm.2023.1.11","url":null,"abstract":"Introduction. According to global statistics, secretory otitis media (SOM) ranks first among middle ear infections. This pathology is believed to be characteristic of the pediatric population; however, recent global statistics indicate an increase in the percentage of SOM cases among the adult population. Information about adult-onset SOM varies, with no consensus on the causes of its occurrence. Diverse clinical presentation of the condition, often unsatisfactory treatment outcomes, and a high percentage of recurrences have necessitated a more in-depth study of the etiological factors associated with adult-onset SOM.&#x0D; The objective of the research was to determine clinical and morphological parallels in the etiopathogenesis of adult-onset SOM as well as to establish the relationship between the clinical, otoscopic, and endoscopic presentations and pathomorphological changes in the tubal tonsils in these patients.&#x0D; Materials and Methods. Sixty-eight (38 men and 30 women) patients with SOM at the age of 18 to 65 years were examined. Fifty-three patients were diagnosed with unilateral pathological process, while in 15 individuals, bilateral SOM was observed. All the patients underwent a comprehensive assessment of their complaints, collection of their medical history, and a full ear, nose, and throat examination using conventional methods, optical techniques, video endoscopy of the nasopharynx and tubal tonsils, and otomicroscopy. In 15 patients, to exclude a malignant process, tissue samples from the tubal tonsils were taken for pathological examination.&#x0D; Results. One of the causes of adult-onset SOM could be pathomorphological changes in the tubal tonsils, specifically their inflammation, hypertrophy, and in some cases, tumours. The clinical course and stages of SOM development depend on the duration of auditory tube obstruction. Inflammation of the tubal tonsils usually results in catarrhal and serous SOM, while hypertrophy or hyperplasia of the tubal tonsils is observed in patients with mucous SOM.&#x0D; Conclusions. Pathomorphological changes in the tubal tonsils have been established as one of the reasons for developing SOM in adults. Both the clinical presentation of SOM and the stage of its progression depends on the type of pathomorphological changes, their localization (upper or lower pole), and the duration of auditory tube obstruction. A prolonged, recurrent, and treatment-resistant course of SOM may be associated with hypertrophy of the tubal tonsil or tumours. Clinical and morphological parallels identified by us will enable timely utilization of effective etiopathogenetic treatment of SOM and prevent the occurrence of complications.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Naloxone Induced Flash Pulmonary Edema: A Case Report","authors":"Kaazim Hasan, Andrew Kirk","doi":"10.21802/acm.2023.1.1","DOIUrl":"https://doi.org/10.21802/acm.2023.1.1","url":null,"abstract":"We present the case of a 26 year old patient with a medical history significant for mild intermittent asthma that developed marked respiratory distress after naloxone administration. EMS was called to the patient’s home after the patient was found unresponsive there. She later endorsed taking a single Ecstasy pill which she had obtained off the street. The patient had an initial excellent response to naloxone, demonstrating a rapid return to her baseline mental status. Within the hour however she developed profound hypoxia, tachypnea, and tachycardia with evidence of acute pulmonary edema on chest x-ray and bedside ultrasound. Her clinical deterioration led to intubation and later ECMO cannulation, however she was eventually discharged home in stable condition after an approximately 3.5 week hospital course. We believe the patient’s presentation is best explained by naloxone induced pulmonary edema, a phenomenon that has been described in the literature previously. However, her preceding ingestion, delayed development of profound cardiomyopathy, and sputum cultures positive for S. pneumoniae provide a broad differential for the patient’s dramatic presentation. &#x0D; Keywords: Naloxone; acute respiratory distress syndrome; toxic overdose; ECMO","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Natural, Preformed Physical Factors in Patients with Type 2 Diabetes Mellitus with the Metabolic Syndrome on the Compensation of Carbohydrate Metabolism According to the Results of Continuous Glucose Level Monitoring","authors":"Taras Romaniv, Nadiya Skrypnyk","doi":"10.21802/acm.2023.1.5","DOIUrl":"https://doi.org/10.21802/acm.2023.1.5","url":null,"abstract":"In recent years, rehabilitative and preventive areas of medicine have become relevant. Restorative treatment and rehabilitation with the use of complex resort therapy in patients with type 2 diabetes have been relevant in recent years. The purpose of our study was to investigate the variability of glycemia in patients with type 2 diabetes mellitus with MS under the influence of natural and preformed physical factors at the sanatorium of SPK \"Morshinkurort\" in Morshin. Continuous glucose monitoring (CGM) was performed using the Metronic Guardian Connect system in 48 patients with type 2 diabetes and MS for an average of 14 days before and after treatment. Daily monitoring of blood glucose was carried out using the \"Metronic\" device. We used traditional indicators of glycemia variability according to the recommendations of the American Diabetes Association. All patients with type 2 diabetes and MS had signs of abdominal obesity, which was evidenced by an increase not only in BMI, but also in OT. Their waist circumference was 112.06±5.59 in men and 107.64±2.46 in women. After the course of treatment, the NOMA IR index decreased by 3 times (p<0.05). The content of fasting insulin in the blood after 3 months of treatment probably decreased by 45%, which indicates a significant contribution of sanatorium-spa therapy in overcoming hyperinsulinemia and insulin resistance in general. For optimal diabetes control, in addition to HbA1c, we must consider CGM and % Time in range (TIR) ​​(time in target range). TIR: (3.9–10.0 mmol/l) in the studied patients before treatment was 53.30±5.90% and significantly differed from patients after treatment - 72.53±7.41% (p < 0.05 ) (with a norm of >70%). TIR should be used as a target point as an indicator of glycemic control in routine clinical practice. Under the influence of natural and preformed physical factors in the conditions of the \"Morshinkurort\" medical center in Morshyn, in patients with type 2 diabetes with MS, the variability of glycemia according to CGM data is likely to decrease, which makes it possible to achieve strategic goals and criteria for the effectiveness of treatment of diabetes. CGM plays an important role in evaluating the effectiveness and safety of treatment, including the prevention of hypoglycemia.","PeriodicalId":489563,"journal":{"name":"Archive of clinical medicine","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}