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15
показниками до початку лкування (Р<0,05), але в перший мюяць покращення болю було бшьш достовiрним у груш мефенамшово! кислоти порiвняно з групою У11ех agnus-(3,8 проти 2,5; Р=0,0417). В обох групах спостерталося значне покращення якостi життя. Наприюнщ лiкування за допомогою Уйех agnus-castus сумарна оцiнка 8Б-12 становила 88,4±11,2 проти 94,8±10,2; Р=0,0300) i пiсля мефенамшово! кислоти -85,7±12,5 проти 92,5±11,2; Р=0,0354. Було з'ясовано, що вартiсть лiкування дисменоре! мефенамшовою кислотою була на 94,6% нижчою порiвняно з Vitex agnus-castus. Нашi результати показали, що у зменшенш важкостi дисменоре! у жiнок з вродженими аномалiями репродуктивного тракту, а також тдвищенш якостi життя, Vitex agnus-castus був настiльки ж ефективним, як i мефенамiнова кислота. Але використання мефенамово! кислоти в лкуванш дисменоре! е економiчно доцiльнiшим.
Ключовi слова: дисменорея, якiсть життя, Vitex agnus-castus, мефенамiнова кислота.
Стаття надшшла 20.03.19 р.
снизились в обеих группах по сравнению с показателями до начала лечения (Р<0,05), но в первый месяц улучшение боли было более достоверным в группе мефенаминовой кислоты по сравнению с группой Vitex agnus-castus (3,8 против 2,5; Р=0,0417). В обеих группах наблюдалось значительное улучшение качества жизни. В конце лечения с помощью Vitex agnus-castus суммарная оценка 8Б-12 составляла 88,4±11,2 против 94,8±10,2; Р=0,0300) и после мефенаминовой кислоты - 85,7±12,5 против 92,5±11,2; Р=0,0354. Было выяснено, что стоимость лечения дисменореи мефенаминовой кислотой была на 94,6% ниже по сравнению с Vitex agnus-castus. Наши результаты показали, что в уменьшении тяжести дисменореи у женщин с врожденными аномалиями репродуктивного тракта, а также повышении качества жизни, Vitex agnus-castus был столь же эффективным, как и мефенаминовая кислота. Но использование мефенамовой кислоты в лечении дисменореи является экономически целесообразнее.
Ключевые слова: дисменорея, качество жизни, Vitex agnus-castus, мефенаминовая кислота.
Рецензент Лiхачов В.К.
DOI 10.26724/2079-8334-2019-4-70-39-45 UDC 616.216-002-085-037: 004.4
O.O. Voloshan. S.M. Gri»orm. D.S. Demynnyk. G.P ku/in. 1 K.P lokes Kharkiv National Medical I niversily. Kharkiv 1 I krainian Medical Stomatological Academy. Poltava
PROSPECTS OF AN AUTOMATED COMPUTER SOFTWARE IMPLEMENTATION FOR PREDICTION OF COURSE AND TREATMENT IN PATIENTS WITH DIFFERENT FORMS OF ODONTOGENIC MAXILLARY SINUSITIS
e-mail: alexsurgery1990@gmail.com
It has been suggested to implement automated computer software for predicting the course and treatment in patients with various forms of odontogenic maxillary sinusitis (OMS) into clinical practice. The results of 153 patients' (prospective group) treatment were analyzed with the use of medical expert systems (MES), gender - age distribution, clinical - anamnestic data, type of surgery and comparative characteristics of complications with retrospective group. Reliable computer diagnoses were obtained, suggested by the MES, which coincided with the final clinical diagnoses in 97% of cases and individualized comprehensive treatment was applied to each clinical case. By means of MES, with regard to the prognosis of diagnosis and the comprehensive treatment variant, we have managed to reduce the proportion of actual complications depending on the clinical OMS form from 9, 22% (19 patients) to 2.6% (4 patients). The initial results analysis established the efficiency and prospects of using the automated "Easy-sinus 1.01" MES in the treatment of patients with various OMS forms.
Key words: odontogenic maxillary sinusitis, medical expert systems, diagnosis and treatment, computer-based disease prediction.
The work is a fragment of the research project "Nature, structure and treatment of major dental diseases ", state registration No. 0116U004975.
Expert systems (ES) began to be implemented in 1970s, but the interest in improving them has not waned over time. It is worth noting that in the medical field there have been developed more of them than in any other subject area [1]. Every year there appears information in the professional literature about the experience of artificial intelligence being successfully used to solve many responsible tasks in the diagnosis and treatment of patients with various diseases [2, 3, 4]. These Medical Expert Systems (MES) permit to: significantly improve the quality of health care institutions and their employees through organized medical information processing that will improve patient management and planning processes; to provide easier work of doctors in the simplified way of the obtained data analysis and by means of exchanging information with other systems [5, 11]. According to the literature, reliability of computer diagnostic software can reach up to 70-90% [1].
Nowadays in modern medical establishments it has become a quite widespread practice to use "sofisticated" information - search systems with integrated diagnostic capabilities, working on the principle of mathematical information processing [10]. The operational architectonics of such systems is based on the point calculation of certain indices and diagnostic criteria based on the analysis of subjective, objective and additional data [8]. The ultimate goal of using MES is to obtain reliable variants of diagnosis, to offer
© O.O. Voloshan, S.M. Grigorov, 2019
methods of treatment and to predict the course of the disease, etc. [9] The doctor's task in this case is to choose the correct variant of calculations and to determine individual complex treatment for the patient.
The literature review revealed a significant number of MES developed and implemented in the educational and clinical practice of general, social and folk medicine, part of which are produced in Ukraine (MYCIN- for diagnosing bacterial infection; ONCOCYN - to help in treatment of cancer patients; "Pregnancy 2.0" - for timely prognosis of premature birth; GUIDON - for teaching medical students about the choice of antibacterial drug for infectious patients; "IRIS" - iridology software; REPER - to help select homeopathic drugs, etc.).
While analyzing available literature, we have identified single MES in surgical dentistry (MES "Prognosis" - prediction of acute inflammatory processes of the maxillofacial area, 2012). Based on the world researchers' experience, the use of the above methods of diagnosis can significantly improve the treatment quality. In the field of our interests there is the possibility of using MES in patients with various forms of odontogenic maxillary sinusitis, which is one of the most common inflammatory pathologies in the maxillofacial area [7]. Thus, the literature review and clinical experience in the treatment of this category of patients prompted us to develop automated computer software for the course prediction and treatment of OMS.
The purpose of the study was to use automated computer software to predict the course and treatment of patients with OMS and the prospects of its implementation into clinical practice, to perform a comparative analysis of the treatment results in patients of the prospective and retrospective groups.
Materials and methods. Clinical bases for the study were the in-patient Department of Head and Neck Surgery of KNP KhOR "OKL" (noncommercial public utility enterprise of Kharkiv Regional Council "Regional Clinical Hospital"), Department of Surgical Dentistry and Maxillofacial Surgery of Kharkiv National Medical University, and Department of Biomedical Engineering of Kharkiv National University of Radio Electronics. Previously, with the help of a qualified expert group, composed of the problematic committee members on the specialty "Dentistry", a reliable database of the most informative diagnostic criteria was created and approved, the scoring coefficients assigned to each of them. The MES was applied in the treatment of 206 case histories of a retrospective group of inpatients treated in the 2014-2017 period. The results of these calculations have formed the basis for the diagnostic criteria of the automated computer software. The desired indices obtained with the MES have made a prognostic result: in 9.2% of clinical cases, the choice of surgery was not consistent with that predicted by the automated computer software, which could be due to the occurrence of 19 complications in patients [6]. We created the "Easy-Sinus 1.01" automated computer software for predicting the course and treatment of OMS, designed to improve the quality of diagnosis and treatment in various forms of odontogenic maxillary sinusitis (Copyright Certificate No. 91691 dated 19.08.2019). The system's capabilities include: 1) automated diagnosis; 2) identification of the risk group; 3) establishing the level of complications; 4) recommendations for optimized comprehensive treatment of the patient; 5) creation of the patient's personal electronic card. The program is designed using the ObjectPascal programming language, which is used to perform the necessary calculations.
In order to provide the computer software's proper operation, the following conditions must be observed: consistent filling in general information about the patient (fig. 1); selection of appropriate subjective, objective individual parameters (fig. 2); data obtained by the additional methods of OMS patients study (fig. 3). After processing the above data, the calculation, indices analysis and formation of a reliable diagnosis variant and a comprehensive treatment proposal are carried out (fig. 4). The electronic
Fig. 1. Translate of original screen MES "Easy-Sinus 1.01" software window card is designed according to the with basic general information on the patient.
proposed form of MES.
In order to achieve this goal, we have analyzed and processed 153 case histories (clinical cases) using "Easy-Sinus 1.01" MES in the prospective group patients with various OMS forms, who were on inpatient treatment at the Department of Head and Neck Surgery of KNP KhOR OKL in 2017-2019. In
compliance with the treatment quality standards approved by the MOH of Ukraine, all patients were examined comprehensively, clinically and radiologically. Orthopantomogram and cone-beam computed tomography were used as the most informative radiographic methods of study.
In the previous study and at the stage of treatment for the purpose of diagnosis, definition of a risk group and obtaining a recommendation the above mentioned MES was applied. After processing the data, 3 groups of patients with clinical form of OMS were formed identically to the previous study of the retrospective group: 1. Acute OMS forms. 2. Chronic OMS forms. 3. Exacerbation of chronic OMS. Distribution of patients according to their gender and age (table 1), etiological factor according to the pathology form (table 2), type of surgical interventions (table 3) and comparative characteristics of complications in OMS patients depending on clinical forms in retrospective and prospective groups were carried out (table 4).
The MES correctness and capability to work by comparing its forecast data (predicting the diagnosis, suggesting a method of comprehensive treatment, identifying a risk group and potential complications development) and the actual treatment results have been determined.
The studies were performed in compliance with the basic provisions of the "Rules of Ethical Principles for Medical Research Involving Human Subjects", approved by the Declaration of Helsinki (19642013), ICH GCP (1996), EEC Directive No. 609 (dated 24.11.1986), Ministry of Health of Ukraine Decree No. 690 dated September 23, 2009, No. 944 dated December 14, 2009, No. 616 dated August 3, 2012.
Results of the study and their discussion. The results of 153 patients treatment using MES (fig. 2, 3, 4), distribution by gender - age, clinical - anamnestic data, type of surgery and comparative characteristics of complications have been analyzed compared to the retrospective group.
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Fig. 2. Translate of original screen MES "Easy-Sinus 1.01.Window for entering major complaints and changes in the patient's local status.
Fig. 3. Translate of original screen MES "Easy-Sinus 1.01. Downloading additional study methods and choosing the degree of changes.
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Final clinical diagnosis :
Exacerbation orchronic left sided adoiituL'enic calarrhal-polypous maxillary sinusitis. Radicular maxillary suppurated cyst iti the site of 26-27 teeth ÎCD-10: JÎ2.0
Medical procedures and surgery:
"Cystoiwomaxillary simisectomy with the causative tooth extraction 26,27 and plastic closure of the defect by local tissues, local and general medicinal therapy, physiotherapy".
Group of risk: Complications level predicted:
High High
Treatment ami labor reconsncndatioiis : Add tonal data : Electronic card
To be foltowed up aad treated by the demalsuijscon in the local out-patient ctmic .Oral cavily Ircatiitiil w;lh antiseptic solution 3 tints a day: Ptoteciive treatment regimen { physical overloads i.
Fig. 4. Translate of original screen MES "Easy-Sinus 1.01.Window for the diagnosis, treatment method, risk group, etc.
Ni:,il sinus rinsing with hypertonic saline twice a day for one week.
There were no significant changes in the gender - age aspect, women were more frequently diseased - 82 patients (53. 5%), men were slightly less frequently - 71 patients (46.4%) aged 25-44 years, that corresponds to 51% (according to the WHO classification).
We obtained reliable computer-based diagnoses, which were suggested by the MES, and coincided with the final clinical diagnosis in 97% of cases. It was found that, depending on the OMS form, exacerbation of chronic disease predominated in 72 clinical cases with catarrhal- polyposis (47%) and 39 cases with purulent-polyposis changes (25%). Less common pathology was chronic OMS - 29 clinical cases (18, 9%), acute OMS forms in this sample were found in fewer cases - 13 (8.5%) cases (table 1).
Table 1
Characterization of OMS patients by the etiological factors
Acute OMS forms Chronic OMS forms Chronic OMS
Etiological factor exacerbation Total
Serous Purulent Catarrhal-polyp. Purulent- polyp. of patients
MS perforation and foreign body 1 - - - - 1
MS perforation 1 - - - - 1
MS foreign body only, causative tooth extracted 1 - 1 4 4 10
Acute periodontitis 1 1 - 3 - 5
Chronic periodontitis - - - 5 - 5 153
Chronic periodontitis exacerbation 3 2 2 10 3 20
Suppurative radicular cyst 1 2 21 42 28 94
Radicular cyst - - 1 - - 1
MS fistula - - 4 8 4 16
Based on the MES-confirmed previous clinical diagnoses, individualized comprehensive treatment of patients was applied. Analysis of 153 (100%) surgical operations permitted to draw attention to the factors which the success of the patient's treatment outcome depends on - dependence on the form, stage of the disease and the method of carrying out the comprehensive treatment.
The most widespread procedures of the performed operations were established: "Cystomaxillary sinusotomy with extraction of the causative tooth with plastic closure of the defect by local tissues" in 53 patients (34.6%); "Cystonazomaxillary sinusotomy with the causative tooth extraction and plastic closure of the defect by local tissues" in 22 patients (14.4%).
The total summarized percentage of performed maxillary sinusotomies with the elimination of the above etiological factors by the single-stage method amounted to 55.6% (85 patients); nasomaxillary sinusotomies (with anastomosis) were performed in 22.8% (35 patients) and were also single-staged. The two-stage surgical treatment in different variations of the techniques amounted to the following figures: 5.2% (8 patients) had maxillary sinusotomies without nasomaxillary anastomosis, and 15.7% (24 patients) underwent an anastomosis application (table 2).
Table 2
Types of OMS surgical intervention in the prospective group patients (Total number 153 (100%))
Type of surgical intervention for patients with OMS: Number of surgical interventions
Maxillary sinusotomy with plastic closure of the defect (perforation and fistula) with local tissues. 8 (5.2 %)
Nasomaxillary sinusotomy with plastic closure of the defect (perforation and fistula) by local tissues. 5 (3.2 %)
Nasomaxillary sinusotomy with extraction of the causative tooth / teeth and plastic closure of the defect (here and on - with local tissues). 2 (1.3 %)
Maxillary sinusotomy with extraction of the causative tooth / teeth and plastic closure of the defect. 15 (9.8 %)
Cystomaxillary sinusotomy with extraction of the causative tooth / teeth and plastic closure of the defect. 53 (34.6 %)
Cystonasomaxillary sinusotomy with extraction of the causative tooth / teeth and plastic closure of the defect. 22 (14.4 %)
Maxillary sinusotomy with extraction of the causative tooth / teeth and the foreign body removal (filling material) and plastic closure of the defect. 6 (3.9 %)
Maxillary sinusotomy with the foreign body removal (filling material) and plastic closure of the defect. 2 (1.3 %)
Nasomaxillary sinusotomy with extraction of the causative tooth / teeth and the foreign body removal (filling material) and plastic closure of the defect. 2 (1.3 %)
Nasomaxillary sinusotomy with the foreign body removal (filling material) and plastic closure of the defect with local tissues. 4 (2.6 %)
Cystomaxillary sinusotomy with extraction of the causative tooth / teeth and MS catheterization. 1 (0.65 %)
Two-stage surgical intervention procedure: stage 1 - extraction of the causative tooth / teeth. Stage 2 -maxillary sinusotomy with plastic closure of the defect. 3 (1.9 %)
Two-stage surgical intervention procedure: stage 1 - extraction of the causative tooth, MS catheterization. Stage 2 - maxillary sinusotomy with plastic closure of the defect. 5(3.3 %)
Two-stage surgical intervention procedure: stage 1 - - MS catheterization. Stage 2 - Cystonasomaxillary sinusotomy with extraction of the causative tooth / resection of the tooth root apex. 13(8.5 %)
Two-stage surgical intervention procedure: stage 1 - - MS catheterization. Stage 2 - Nasomaxillary sinusotomy with plastic closure of the defect. 4(2.6 %)
Two-stage surgical intervention procedure: stage 1 - - MS catheterization. Stage 2 - Nasomaxillary sinusotomy with extraction of the causative tooth/ teeth, the foreign body removal and plastic closure of the defect. 7 (4.6 %)
Extraction of the causative tooth/ teeth and MS catheterization. 1(0.65 %)
With the use of MES, regarding prognosis of the diagnosis and the comprehensive treatment variant, we have managed to reduce the proportion of actual complications depending on the OMS clinical form from 9.22% (19 patients in the retrospective group) to 2.6% (4 patients in the prospective group) (table 3). The number of complications was: postoperative defect of the mucous-ossification flap in the site of plastic closure - 2 patients (1.3%), postoperative hematoma - 1 patient (0.65%) and MS recurrence -1 patient (0.65%). This was due to non-compliance and violation of the rehabilitation regimen.
Table 3
Comparative characteristics of complications in OMS patients depending on clinical forms in retrospective
and prospective groups
Retrospective group of OMS patients
Complicati-ons: Acute OMS forms Chronic OMS forms Chronic OMS exacerbation Total number of complications
Serous Purulent Catarr.- polyp. Purulent- polyp
Postoperative hematoma and soft tissue abscess - 2 - - 3 5 19
Phlegmons of soft facial tissues - 1 - - - 1
Postoperative defect of the mucous - ossification flap in the site of plastic closure 3 1 4 8
MS recurrence after treatment - 2 - 1 2 5
Prospective group of OMS patients.
Complications: Acute OMS forms Chronic OMS forms Chronic OMS exacerbation Total number of complications
Serous Purul ent Catarr.-pdyp. Purulent-pdyp.
Postoperative hematoma and soft tissue abscess - - - 1 1 4
Phlegmons of soft facial tissues - - - - - 0
Postoperative defect of the mucous - ossification flap in the site of plastic closure 1 1 2
MS recurrence after treatment - - - 1 - 1
In general, the methods we used to create this MES are consistent with the methods used by other authors. According to our findings were close to similar results that had S. Valizadeh et al. [10]. In their study computer software Logicon helps in automatically diagnosis of dentin caries in 88, 3 % of all clinical cases. The scientific results of E.Y Kim ( in review article of W.J. Park, J.B. Park ), showed a creating predictive model of toothache development with a fitness of about 80% that was derived [11]. Our results obtained as a percentage also coincide with the results of world researchers and stated that it is possible to improved accuracy reliable computer-based diagnoses in 97 % of all clinical cases by using the Easy-Sinus software. MES-proposed up to 90 % reliable variants for individualized comprehensive treatment that was obtained and applied that reduces the proportion of actual complications depending on the OMS clinical form to minimum.
The suggested "Easy-sinus 1.01" MES in our studies permitted us to: 1) obtain reliable computer-based diagnoses, which in 97% of clinical cases coincided with the final clinical ones in the treatment of patients with various OMS forms; 2) obtain and apply the MES-proposed reliable variants for individualized comprehensive treatment; 3) establish the level of complications risk: low - 13.7%, medium - 35.3%, high - 51%, which corresponded to the defined risk groups (low, medium, high); 4) reduce the proportion of actual complications depending on the OMS clinical form from 9.22% (19 patients, results of the retrospective group prognosis) to 2.6% (4 patients in the prospective group); 5) analyzing the initial results, the efficiency and prospects of using the automated "Easy-sinus 1.01" MES in the treatment of patients with various OMS forms were established, which meets the modern requirements for the provision of quality medical care.
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Реферати
ПЕРСПЕКТИВИ ВПРОВАДЖЕННЯ АВТОМАТИЗОВАНОГО ПРОГРАМНОГО ЗАБЕЗПЕЧЕННЯ ДЛЯ ПРОГНОЗУВАННЯ ПЕРЕБ1ГУ ТА Л1КУВАННЯ ПАЦ1€НТ1В З Р1ЗНОМАН1ТНИМИ ФОРМАМИ ОДОНТОГЕННОГО ВЕРХНЬОЩЕЛЕПНОГО
СИНУСИТУ Волошан О. О., Григоров С.М., Дем'яник Д. С., Рузш Г.П., Локес К.П.
Запропоновано впровадження в клшчну практику автоматизовано! комп'ютерно! програми прогнозування переб^ захворювання та л^вання пащен™ з рiзноманiтними формами одонтогенного
верхньощелепного синуситу (ОВС). Проведено аналiз результата л^вання 153 пащенив (проспективно! групи) з використанням медично! експертно! системи (МЕС), розпод^ за гендерно - вковими, клшжо -
ПЕРСПЕКТИВЫ ВНЕДРЕНИЯ АВТОМАТИЗИРОВАННОГО ПРОГРАММНОГО ОБЕСПЕЧЕНИЯ ДЛЯ ПРОГНОЗИРОВАНИЯ
ТЕЧЕНИЯ И ЛЕЧЕНИЯ ПАЦИЕНТОВ С РАЗНЫМИ ФОРМАМИ ОДОНТОГЕННОГО ВЕРХНЕЧЕЛЮСТНОГО СИНУСИТА Волошан А.А., Григоров С.М., Демяник Д.С., Рузин Г.П., Локес К.П. Предложено внедрение в клиническую практику автоматизированной компьютерной программы
прогнозирования течения заболевания и лечения пациентов с разнообразными формами одонтогенного верхнечелюстного синусита (ОВС). Проведен анализ результатов лечения 153 пациентов (проспективной группы) с использованием медицинской экспертной системы (МЭС), распределения по гендерно - возрастным, клинико - анамнестическим данным,
анамнестичними даними, типу хiрургiчних втручань i порiвняльноï характеристики ускладнень з ретроспективною групою. Отримано правдоподiбнi комп'ютернi дiагнози, яю були запропонованi МЕМ, збтаися з заключними клiнiчними дiагнозами в 97%, що в подальшому дозволило застосувати шдивщуайзоване комплексне лiкування в кожному з клшчних випадюв. За допомогою застосування МЕС для прогнозування дiагнозу i варiантiв комплексного л^вання вдалося знизити питому вагу фактичних ускладнень в залежносп вiд клiнiчноï форми ОВС з 9,22% (19 пащентсв) до 2,6% (4 пащента). Аналiз вихiдних результатiв встановив ефектившсть i перспективнiсть застосування автоматизованоï МЕС «Easy- sinus 1.01» в ткуванш пащенлв з рiзними формами ОВС.
Kto40bî слова: одонтогенний верхньощелепний синусит, медичш експертнi системи, дiагностика i л^вання, комп'ютерне прогнозування захворювання.
Стаття надшшла 20.05.2019 р.
типу хирургических вмешательств и сравнительной характеристики осложнений с ретроспективной группой. Полученные правдоподобные компьютерные диагнозы, которые были предложены МЭС, совпали с заключительными клиническими диагнозами в 97% , что в последующем позволило применить индивидуализированное комплексное лечение в каждом из клинических случаев. С помощью применения МЭС по прогнозированию диагноза и варианта комплексного лечения удалось снизить удельный вес фактических осложнений в зависимости от клинической формы ОВС с 9, 22% (19 пациентов) до 2,6% (4 пациента). Анализ исходных результатов, установил эффективность и перспективность применения автоматизированной МЭС « Easy- sinus 1.01 » в лечении пациентов с различными формами ОВС.
Ключевые слова: одонтогенный верхнечелюстной синусит, медицинские экспертные системы, диагностика и лечение, компьютерное прогнозирование заболевания.
Рецензент Аветиков Д. С.
DOI 10.26724/2079-8334-2019-4-70-45-49 УДК 616-06:616-079.66:122:167.7:167.2
В. I. Воронов, А.О. Гинрм. мок, Л.В. Мороз, 1.В. Воронова
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СУДОВО-МЕДИЧНА КВАЛ1Ф1КАЦ1Я МЕХАН1ЧНО1 ТРАВМИ У КОМБ1НАЦП З 1НФЕКЦ1еЮ ПРАВЦЯ В ТРАВМАТИЧНО-1НФЕКЦ1ЙНОМУ ПРОЦЕС1
e-mail: slavavt48@ukr.net
Вщома роль Cl. tetanus, який обтяжуе травматичний процес механiчного ушкодження оргашзму у випадках наявностi та активiзащI в рановому каналi iнфекцii правця. Таке комбшоване тiлесне ушкодження потребуе визначення судово-медично! квалiфiкацii ступеня тяжкост травми з урахуванням впливу Cl. tetanus. Експертш пiдсумки щодо квалiфiкацii механiчноi травми, яка обтяжена захворюванням правцем, нерiдко викликають суперечливi дискусп. З метою вирiшення завдання судово-медично! експертизи (СМЕ) щодо квалiфiкацii комбiнованоi травми запропонованi методи ретроспективного причинно-системного моделювання причинно! залежностi травматично-iнфекцiйного процесу та метод квазiформальноi репродукцii модельованих об'екпв. Показано на прикладi моделi залежностi травматично-iнфекцiйного процесу, що об'ект Cl. tetanus машфестуе в оргашзмЦ як патогенно дiючий збудник, i, таким чином, детермiнуе захворювання на правець. Разом с тим, доведено, що шфекцшний процес утворюеться в непередбачуваному час пiсля занесення спор Cl. tetani в органiзм через пошкоджену шкiру. Таким чином, визначено, що судово-медична квалiфiкацiя ступеня тяжкост комбiнованоi травми (механiчного ушкодження шюри та iнфекцii правця) не може бути конкретизована в певний час. Отримаш результати причинно-системного аналiзу дозволяють удосконалити iнформативнi рекомендацii судово-медичним експертам вщносно встановлення квалiфiкацii ступеня тяжкост механiчного ушкодження, яке комбiновано з шфекщею правця.
Ключовi слова: об'ект Cl. tetanus, залежшсть травматичного процесу, залежшсть iнфекцiйного процесу, комбiнована травматично-шфекцшна залежнiсть, методологiя причинно-системного комбiнованого патолопчного процесу.
Робота е фрагментом НДР «Судово-медична di^Hocmum мехашчног травми з використанням технологiчних систем обробки цифрових зображень», № державноi реестрацн 0114U004132.
Патогенез утворення посттравматичного правця вщображае ланцюг взаемопов'язаних систем залежносп ¡з включенням об'екпв (фактор1в) мехаично^' травми, збудника, екзотоксину, анабюзу в рановому канат, клшчних ознак ураження центральноi нервовоi системи. У практищ судово-медичноi експертизи (СМЕ) залежносп в комбшованому ланцюгу травматично-шфекцшного процесу дослщжуються експертом шляхом лопчних операцш ретроспективного моделювання з метою визначення детермiнуючоI взаемодп патогенетичних фактор1в травмування та шфшування правцем. Релевантшсть вказаних об'екпв дослщжують судово-медичний експерт та експерт-шфекцюшст з цшлю виршення завдань слщства щодо каузальних (причинно-умовних) оцшок обставин подш.
Судово-медичш об'екти темпорального травматичного процесу утворюють м1ж собою причинш, умовш залежносп, зв'язки сташв. Проблема каузальних оцшок об'екпв СМЕ полягае в складносн щентифшацп причинного або умовного !х статусу. Це обумовлено недостатньо розробленою методолопю д1агностики причинних та умовних детермшанпв. Тому об'екти СМЕ та
© В.Т. Воронов, А.О. Гаврилюк, 2019
