Current trends in the development of the Ukrainian education system provide a new approach to the organization of educational process. A doctor must know the algorithm of the diagnostic process and medical decision-making peculiarities underlying the making diagnosis. This requires constant improvement as the number of law cases has demonstrated that diagnostic errors are merely not due to physician’s insufficient medical qualification but often as a consequence of violation of the basic procedural laws. Studying the theory of medial diagnosis stimulates the development of clinical thinking. The purpose of this work was to systematize the main stages in making diagnosis and to outline the ways of their implementation through the interactive learning. The study involved the medical students of Zaporizhzhia State Medical University. The methodology included theoretical systematic analysis of scientific and methodological literature as well as own experience in applying interactive learning. The main motivating factor in the professional training organization should be focused on the professionally oriented use of material and fostering students’ own experience. Under these conditions, the importance of a semiotic approach to the diagnosis of diseases is increasing, i.e. the process of disease identification relies on the ability to catch and to recognise its signs. When making a diagnosis, the doctor has to rely on facts only. This is described as "clinical thinking." The interactive learning in the courses of various disciplines in the program of medical doctor training is being actively implemented at Zaporszhzhia State Medical University. It provides the opportunity for more pronounced pedagogical influence, which induces students to be more active in mastering the program, as well as to demonstrate creativity and research for solving various tasks in daily class practice. Deep understanding the theory of medical decision-making process and making diagnosis greatly contributes to clinical thinking.

Цель: изучить взаимосвязь между морфологическими показателями гломерулярного поражения почек и цистатином С (CysC) сыворотки крови у больных хроническим гломерулонефритом (ХТН) с сохраненной функцией почек, а также оценить терапевтическую коррекцию выявленных нарушений с помощью и АПФ рамиприла. Материалы и методы исследования. Обследован 81 больной с ХТН. Пациенты были разделены на 2 клинические группы: больные ХТН с артериальной гипертензией (АТ), ХТН без АТ. Средняя суточная доза рамиприла у больных ХТН с АТ составила 12,8 ± 5,6 мг, у пациентов с ХТН без АТ – 2,5 мг. Для анализа гломерулярного поражения почек у больных ХТН использовались данные нефробиопсий по следующим параметрам: пролиферация мезангиальных клеток, расширение мезангиального матрикса, гломерулосклероз, наличие фиброзных полумесяцев, утолщение капиллярных петель и/или их сращение с капсулой Боумена, утолщение и/или расщепление гломерулярной базальной мембраны, наличие экстракапиллярного компонента в просвете капсулы Боумена. Уровень Cys C в сыворотке крови определяли иммуноферментным методом. Результаты и обсуждение. Нами статистически подтверждена прямая связь между cysC крови и гло- мерулосклерозом (r = 0,85; р < 0,05). Установлено, что метод диагностики гломерулосклероза почек с помощью определения маркера cysC в сыворотке крови является высокочувствительным и специфичным, с эффективностью 96,55%. Выводы: сывороточный уровень cys C является чувствительным маркером гломерулосклероза почек у больных ХТН с диагностической эффективностью до 97%. Под влиянием 24-недельной терапии и АПФ рамиприлом у больных ХТН с наличием АТ и без наблюдается достоверное снижение маркеров поражения почек, в том числе и cysC сыворотки крови, что подтверждает нефропротекторное действие препарата.

The aim: to examine the relations between morphological tubulointerstitial (TIT) parameters of kidney damage and neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) of blood serum in patients with chronic glomerulonephritis (CGN) with saved renal function, and to estimate the therapeutic correction of identified changes using ACE inhibitor ramipril.. Materials and methods. The study included 81 patients with CGN. Patients were divided into 2 clinical groups: CGN patients with arterial hypertension (AH), CGN without AH. The average daily dose of ramipril in patients with AH was 12,8 ± 5,6 mg, in patients without hypertension – 2,5 mg. We used kidney biopsy data for the analysis of renal damage on the following parameters: dystrophic and necrotic changes in tubular epithelium, thickening and/or cleavage of tubular basement membrane, presence ofcellular infiltration, interstitial fibrosis (IF). The level of NGAL and IL-18 in serum were determined by ELISA. Results. We statistically confirmed a direct link between blood NGAL and IF (r=+0,65;p<0,05), blood IL-18 and dystrophic changes in tubular epithelium (r=+0,81;p<0,05). It was established that the kidney IF diagnostic using NGAL determination in serum is highly sensitive and specific, with an efficiency of 95,3 %, and dystrophic changes in tubular epithelium via serum IL-18 – 96,6 %. Conclusion: serum levels of NGAL and IL-18 are sensitive markers of kidney TIT damage in patients with CGN with diagnostic efficiency up to 97 %. Under the influence of 24 weeks treatment with an ACE inhibitor ramipril we observed a significant decrease in levels of markers of kidney TIT damage, that confirmed nephroprotective effect of the drug.

Abstract. According to current presentations, primary AL-amyloidosis (AL-A) and multiple myeloma, associated and not associated with AL-A, are considered as a part of uniform β-lymphocytic dislocation that is characterized by proliferation of abnormal clone of plasma or β-cells in the bone marrow with excess production of monoclonal immunoglobulins. Objective: to describe our own observations of patients with AL-A, which is an example of complexity of the disease diagnostics, due to the polymorphism of clinical picture and need for immunological verification. It was presented 2 cases of late AL-A diagnostics. Amyloid depositing in different organs determined the diversity of clinical manifestations. AL-A had a consistently progressive character with the gradual involvement of various organs and systems. Results: case 1 demonstrated AL-A with damage of kidneys, heart, liver, spleen, lungs, pleura and subsequent development of ischemic stroke. In the second case AL-amyloidosis with damage of heart, kidneys, lungs, tongue and skin was diagnosed. The severity of the patient's condition was due to severe nephrotic syndrome. AL-A is a serious disease that leads to a lethal end if treatment is not timely. Our observations demonstrate the complexity of AL-A diagnostics, which requires the collaboration of doctors of various profiles. Modern morphological diagnostics of amyloidosis involves not only detection but also mandatory amyloid typing, which determines further therapeutic tactics. Diagnostics of AL-A diagnosis should be based on the morphological study results. The final diagnosis of amyloidosis is established after congolic masses detecting. Biopsy of the affected organ is the most effective diagnostic method. When there is a nephrotic syndrome, kidney biopsy is most appropriate, because amyloid will be detected in 80% of AL-A. The most effective method for AL-A typing is an immunohistological study using the immunoglobulin light chains antisera.

Current trends in the development of the Ukrainian education system require reconsidering some aspects in the educational process and provide some new approach to improve the existing standards: from passing on the ready-for-use knowledge towards creating conditions for dialogue and active interaction with students. At present, interactive education is one of the up-to-date directions of the pedagogical process. Another issue that is still challenging is how to keep students motivated. Therefore, faculty staff should keep the finger on the pulse of events, i.e. to reconsider or update time-tested techniques as well as to implement new ones. The purpose of this work was to evaluate the effectiveness of interactive technologies as a way to motivate students to be actively engaged into learning. Material and methods. Students of Zaporizhzhya State Medical University were the subjects of the study. The methods applied included theoretical analysis of relevant scientific and methodological literature and own experience in applying interactive techniques. Results and discussion. Zaporizhzhya State Medical University has a broad experience in implementing interactive technologies in different disciplines through the undergraduate education. Their applying enhances pedagogical influence and thus inciting students to active research and learning work, contributes to development of creative environment, and promotes research approaches for solving various tasks during classes. The main goals in conducting interactive lectures and practical classes are not only representing the information, but involving students into co-operation. In our opinion, introduction of interactive techniques in practical classes facilitate individual and / or group work of students. This is a promising area in learning that can considerably improve the quality of education and completely meets the present-day demands in terms of education. Conclusion: wide introduction of interactive technologies in the pedagogical process creates the opportunity to diversify the classes in different disciplines, builds up comfortable conditions for learning, helps to keep students actively engaged and motivated that makes this approach desirable for both students and teachers.