Bioethical Research Articles

FUNCTIONAL STATE OF THE PINEAL GLAND IN WOMEN WITH THREATENED ABORTION IN THE FIRST TRIMESTER – FURTHER PROSPECTS OF PREGNANCY

Melatonin is an important hormone for normal pregnancy development, but the infl uence of serotonin remains poorlyunderstood. Low melatonin production can lead to spontaneous abortion by stimulating progesterone secretion and inhibiting prostaglandin synthesis. Melatonin has an eff ect on the induction and blocking of apoptosis of the villous cytotrophoblast and promotes the development of the syncytiotrophoblast. Analysis of the frequency of positive pregnancy showed a signifi cant impact on the course of pregnancy and childbirth, compliance with sleep and rest also contribute to a positive eff ect, but there is no general concept, which makes the subject relevant.The aim of the study. To evaluate the functional state of the pineal gland, in particular, the amount of melatonin and serotonin in the blood of pregnant women at 10-12 weeks of gestation with a threat of abortion, which was manifested by bloody discharge or formation of retrochorionic hematoma, and the consequences of pregnancy.Materials and methods. Two groups were formed: I main group – 40 pregnant women with a threat of abortion and formation of retrochorionic hematoma, II control group – 44 healthy pregnant women. Obstetric examination, enzyme- linked immunosorbent assay for determination of melatonin, serotonin, chorionic gonadotropin, and ultrasound were performed. Informed consent of pregnant women was obtained with adequate explanation of the purpose, objectives, methods and scope of laboratory and instrumental research methods. The study protocol was approved by the Commission on Biomedical Ethics of the Bukovinian State Medical University, 2015 (minutes of the Commission meeting No 2 from the 19.10.2023 year). The study was conducted in accordance with the basic provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Scientifi c Medical Research Involving Human Subjects (1964-2008), the Order of the Ministry of Health of Ukraine 690 of September 23, 2009 (as amended by the Order of the Ministry of Health of Ukraine 523 of July 12, 2012). Statistical analysis was performed using generally accepted methods of variance statistics. Reliability was assessed by Student’s t-test. Diff erences were considered signifi cant if the signifi cance level was p≤0.05. We also performed correlation analysis in Microsoft Excel, using the method of squares (Pearson’s method) to determine the correlation coeffi cient. The work is a fragment of the research work of the Department of Obstetrics and Gynecology, UDC 618.1-053.34 + 618.1-0536 /.8]. –07-084-08 «Prevention, diagnosis and treatment of disorders of the perinatal period and reproductive system of women and adolescent girls» (No. 201110Н, state registration number 0111U006499. The term of implementation is 02.2011-12.2015).Results of the study. According to the obtained results, retrochorionic hematoma up to 1 cm is detected three times more often than over 1 cm, while the level of melatonin is not signifi cantly lower, but with retrochorionic hematoma over 1 cm a signifi cant decrease is observed in cases of further normal pregnancy and childbirth. With further complications of pregnancy in retrochoroidal hematoma up to 1 cm, there is a signifi cant signifi cant decrease in melatonin (p ˂ 0.001), in contrast to retrochoroidal hematoma over 1 cm, where no signifi cant diff erence was found in the complicated course of pregnancy (p > 0.05). Serotonin levels were elevated in all subgroups regardless of hematoma size and subsequent pregnancy outcome. Conclusions. In case of threatened abortion in the fi rst trimester with formation of retrochorionic hematoma, the risk ofcomplicated pregnancy remains in 60.87 % of cases. Determination of pineal hormones revealed a signifi cant increase inserotonin with a simultaneous signifi cant decrease in melatonin, while maintaining a positive relationship between the hormones, indicating a disruption of melatonin synthesis in the central nervous system. This is confi rmed by the normal level of chorionic gonadotropin and the preservation of embryonic viability. Since the disruption of hormone formation in the pineal gland has been established, adherence to the recommendations for adequate rest may positively aff ect the further outcome of pregnancy and childbirth.

간호대학생의 생명의료윤리 원칙 인식에 대한 분석

Objectives This study was attempted to identify and systematically understand how nursing students perceive the principles of biomedical ethics.
 Methods Through an open questionnaire, first-year nursing students who took a biomedical ethics lecture for one semester were asked to choose the most important principle among the four principles of biomedical ethics and write the rationale for it. A total of 99 subjects were analyzed using the content analysis method.
 Results Among the four biomedical ethics principles, the importance distribution was shown in the order of prin-ciple of respect for autonomy(45.5%), principle of nonmaleficence(29.3%), principle of beneficence(20.2%), and principle of justice(5.0%), and 14 themes and 42 statements supporting the basis were revealed. There were a total of 15 statements on the principle of respect for autonomy, and 4 themes were included: inherent rights, right to choose, right to know, and right to be respected(45.5%). There were a total of 15 statements on the principle of nonmaleficence, including 4 themes: avoiding harm, minimizing suffering, basic duties, and licensing as a nurse(29.3%). There were a total of 9 statements on the principle of beneficence, and 4 themes were included: the role of medical personnel, use of professional knowledge, active help, and human well-being(20.2%). There were a total of 3 statements on the principle of justice, including 2 themes: establishment of standards and fair-ness(5.0%).
 Conclusions It was confirmed that the students showed an active attitude to solidify their moral values and to cul-tivate a sense of ethics. In the undergraduate curriculum, not teacher-centered lectures, but learner-centered bi-oethics education that reflects students' understanding and feedback should be provided.

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

CLINICAL AND PARACLINICAL FEATURES AND PATHOPHYSIOLOGICAL MECHANISMS OF DIGESTIVE SYSTEM DISORDERS IN PREMATURE INFANTS WITH PERINATAL PATHOLOGY

CLINICAL AND PARACLINICAL FEATURES AND PATHOPHYSIOLOGICAL MECHANISMS OF DIGESTIVE SYSTEM DISORDERS IN PREMATURE INFANTS WITH PERINATAL PATHOLOGY

Quality Assurance and Safety Culture in a Healthcare Organization

Patient care and quality management have as one of their primary focuses ensuring the safety of their patients. The four principles of biomedical ethics presented by Beauchamp and Childress are one quality management paradigm that emphasizes the importance of the patient. The Institute of Medicine's six improvement goals capture the essence of excellent medical treatment. Care, money, and health are the three pillars upon which the Institute for Healthcare Improvement's Triple Aim rests. The present review was written with the aforementioned contexts in mind, with the intention of highlighting the system's initiatives to address various efforts of enhancing quality and patient safety. We provide a reflective overview of healthcare legislation, policy, and regulation with special attention paid to the ideas of informed consent and informed refusal. This analysis also details the steps taken and regulations enforced by the administration and management to provide care that is focused on the individual patient. Finally, we discuss model policies like the Delivery System Reform Incentive Payment Program, which incorporates quality management frameworks, the Hospital-Acquired Conditions Reduction Program, which promotes patient safety, and the Hospital Readmissions Reduction Program, which aims to reduce hospital readmissions.

Dynamics of cognitive and neurophysiological functions of a person in the simulation of weightlessness in terrestrial conditions

Introduction. The authors have conducted a study of the influence of the conditions of 21-day antiorthostatic hypokinesia (AOSH) on the dynamics of neurophysiological reactions and cognitive functions of a person on the basis of Institute of Biomedical Problems, RAS, with the participation of six healthy male volunteers aged 24 to 40 years (30.7±5.4) who were in bed with hypokinesia in an antiorthostatic position with an angle of inclination –6° relative to the horizon.
 The study aims to determine the dynamics of neurophysiological reactions and cognitive functions of a person during a 21–day AOSH (–6°).
 Materials and methods. The researchers analyzed the dynamics of cognitive functions based on the results of performing complex dynamic tasks with elements of uncertainty from the CleverBalls software test block. The authors determined the dynamics of neurophysiological reactions by the relative dynamics index (RDI) of the relative power value (RPV) of all the studied ranges of the EEG spectrum. The experts carried out measurements of all indicators before the start of the study (Background), on the 3rd (1st session), 10th (2nd session), 17th (3rd session) and 21st (4th session) days, as well as 3 days after the end of the experiment — aftereffect (After).
 Results. Scientists have found an increase in inhibitory processes in the brain as a result of solving complex dynamic tasks with elements of uncertainty in the acute period (3 days) and in the aftereffect. After the acute period and before the end of the experiment, they observed the restoration of brain functions to the background level. An increase in the performance of complex dynamic tasks with elements of uncertainty (according to the indicators "Percentage of correct choice" and "Average harmonic click time") was observed from ten days to the aftereffect inclusive, which indicated, at least, the absence of a decrease in cognitive functions during the 21-day AOSH.
 Conclusion. At the end of the experiment, the authors noted a less pronounced increase in Delta and Theta activity than in the acute period, with a simultaneous decrease in Alpha and Beta activity, but at the same time, they did not observe a decrease in the success of cognitive tests.
 Ethics. The program of the experiment was approved at the section of the Scientific Council and approved by the Commission on Biomedical Ethics at the Institute of Biomedical Problems, RAS (Protocol No. 599 of 06.10.2021).

Brain network mechanism of acupuncture for chronic spontaneous urticaria: a functional magnetic resonance imaging study protocol.

Chronic spontaneous urticaria (CSU) is a common skin condition that can significantly impact patients' quality of life. Although studies have demonstrated the efficacy of acupuncture in treating CSU, the underlying mechanisms remain unclear. Dysfunction within the brain's default mode network (DMN) represents a fundamental characteristic of central pathological changes associated with CSU. Therefore, it is hypothesized that improving brain network dysfunction could serve as a key mechanism through which acupuncture exerts its therapeutic effects. This study aims to provide evidence supporting this hypothesis. This study, a parallel, randomized, sham-controlled functional neuroimaging investigation will be conducted in China. We aim to enroll 50 patients with CSU and 25 healthy controls, distributing them evenly between the acupuncture and sham acupuncture groups in a 1:1 ratio. The total observation period will span 6 weeks, including 2 weeks designated for the baseline phase and 4 weeks allocated for the clinical treatment phase. Prior to treatment, all participants will undergo magnetic resonance scanning, clinical index detection, and microbiota collection. Following treatment, the patients with CSU will be retested for these indicators. Using resting-state functional connectivity (rsFC) analysis, dynamic Functional Connection (dFC) analysis, and brain microstate extraction technology combined with correlation analysis of microbiota and clinical indicators, the regulatory mechanism of acupuncture on the brain network of CSU will be evaluated from multiple dimensions. This trial was approved by the Biomedical Ethics Review Committee of the West China Hospital, Sichuan University (No. 2022-1255). Each participant will provide written informed consent to publish any potentially identifiable images or data.Clinical trial registrationhttps://www.chictr.org.cn/, identifier: ChiCTR2200064563.

Экологический сетевой подход в приложении к биоэтическим организационным структурам

The term ‘bioethics’ (in the narrow sense) or ‘biomedical ethics’ denotes medical ethics at the modern stage of development. Bioethics is currently institutionalized and falls under the responsibility of specialized organizational structures (bioethics commissions, ‘divine committees’, etc.). The article expounds the prospects of applying network structures to institutions and organizations dealing with bioethical issues and tasks (ethical aspects of reproductive technologies, biomedical experiments, organ transplantation, and bioethical education). With the principles of decentralization (‘multiple authority’) and ecology (an integrative approach to issues under study and integrity of a bioethical expert team), network structures promote creative and effective functioning of bioethical organizations. Nonetheless, the centralized hierarchies of traditional educational and research institutions are also expected to perform essential functions. A reasonable combination of network structures and hierarchies provides the latter with a new role: the hierarchies assess the activity of emergent network structures using competent experts and provide selective support (including financing) to the most effective among them.

The Effects of Gratitude Disposition and Nursing Professionalism on the Awareness of Biomedical Ethics Among Nursing Students

The Effects of Gratitude Disposition and Nursing Professionalism on the Awareness of Biomedical Ethics Among Nursing Students

Church and Liberal Healthcare: Need of Spiritual and Moral Education for Healthcare Workers

The increased attention of the Orthodox Church to issues of medical education in our country was the result of the fact that in the 1990s it once again became one of the most active forces in our society. The connection between the church and the medical community, which goes back to a time when the doctoring of the mind and bodily health was in fact the work of the same people, cannot leave the church indifferent to the professional formation of healthcare workers. The Soviet era saw the forced de-Christianization of the medical profession and measures taken to abolish medical ethics rooted in the Hippocratic Oath and the Gospel commandments. The restoration of dialogue between church and medicine began after the collapse of the Soviet state, but it is still insufficiently regular. Currently, factors complicating this dialogue are liberal medical legislation and capitalist economies in health care. The former, by legalizing abortion, artificial insemination, and sterilization, absolves the doctor of moral responsibility in matters concerning the management of human life; the latter encourages him to view his profession not as a service, but as a means of making money from other people’s suffering. If the dialogue between church and medicine were to be carried on permanently within the walls of medical schools, it would strengthen the spiritual and moral foundations of the medical profession, upon which it has always existed. One of the most significant forms of this dialogue should undoubtedly be the teaching of biomedical ethics, which should be grounded in modern theology and the values of traditional spiritual cultures of Russia.

Global Warming, Air Pollution and Health

A new field of biomedical ethics is opening up, concerning what should be done to reduce the direct and indirect impacts of greenhouse gas emissions on human health. Some of these impacts could be described as ‘direct’, in the form of fatalities and illnesses due to the increasingly frequent heatwaves in many countries of recent years, ascribable to anthropogenic climate change. Other impacts are mediated through the air pollution that results from emissions from vehicles in the form of a cocktail of carbon oxides including carbon monoxide, nitrogen dioxide and particulates. Most of the world’s cities have streets with unsafe pollution levels, and one child’s death in Britain has been officially ascribed to air pollution (BBC 2020). This presentation aims to validate the above claims about the impacts of emissions on health, and to suggest remedies. The early phasing out of vehicles powered by internal combustion engines is the ultimate remedy for the latter set of impacts, while the urgent replacement of energy generated from fossil-fuel sources with renewable energy is the best way to remediate the former set. More immediate remedies for air pollution include restricting the use of roads and streets in urbanised areas by vehicles to bicycles and light vehicles with small engines. Medical and nursing education should include the diagnosis and treatment of pulmonary conditions resulting from increased levels of carbon oxides, nitrogen oxides and particulates. Medical and nursing practice should focus on the early identification of vulnerable adults and children at risk from air pollution, and warnings against walking, running or cycling along the most polluted thoroughfares.

연명의료결정제도 연구 동향 분석: 주제범위 문헌고찰*

This scoping review examines the “System for Decisions to Forgo Life-Sustaining Treatment” in Korea from 2018 to 2022 and is based on an analysis of 285 research studies, published in either domestic or international journals. Of the articles examined, 164 (57.5%) focused on issues related to health science, while 121 (42.5%) addressed ethical and legal aspects of the system. Articles in the former category of health science focused on advance care plans, contemplation on death, decision-making, end-of-life care, biomedical ethics, and psychosocial factors. Articles in the latter category of the ethical and legal aspects of the system focused on legal challenges, the right to self-determination, death with dignity, surrogate decision-making, contemplation of death, biomedical ethics, and legal frameworks. To ensure the system’s stable integration into society during this transitional period, it is crucial to continuously assess its operation in clinical settings. Efforts to establish a societal consensus on dignified end-of-life experiences and to conduct future multidisciplinary research should persist.

Navigating the Ethical Landmines of ChatGPT: Implications of Intelligent Chatbots in Plastic Surgery Clinical Practice.

ChatGPT is a cutting-edge language model developed by OpenAI with the potential to impact all facets of plastic surgery from research to clinical practice. New applications for ChatGPT are emerging at a rapid pace in both the scientific literature and popular media. It is important for clinicians to understand the capabilities and limitations of these tools before patient-facing implementation. In this article, the authors explore some of the technical details behind ChatGPT: what it is, and what it is not. As with any emerging technology, attention should be given to the ethical and health equity implications of this technology on our plastic surgery patients. The authors explore these concerns within the framework of the foundational principles of biomedical ethics: patient autonomy, nonmaleficence, beneficence, and justice. ChatGPT and similar intelligent conversation agents have incredible promise in the field of plastic surgery but should be used cautiously and sparingly in their current form. To protect patients, it is imperative that societal guidelines for the safe use of this rapidly developing technology are developed.

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection.

COVID-19 was initially considered a primary respiratory disorder associated with various short- and long-term complications, affecting many patients and imposing a significant burden. Patients who have dementia are especially vulnerable to the SARS-CoV2 infection, which is associated with an increased risk for neuropsychiatric complications. These patients need a unique approach to managing ethical issues related to the COVID-19 pandemic, including autonomy, veracity, non-maleficence, justice, compassion, and dignity. The latter is one of the most elusive and misunderstood concepts in medical ethics and is extremely important in debates surrounding the proper management of patients with dementia. However, it is often left out of ethical analysis, as most clinicians, when debating issues associated with clinical practice, often evaluate only the "classical" principles of biomedical ethics. In this article, we aim to assess the unique features of dignity in treating this group of patients during the COVID-19 pandemic. We will briefly analyze dignity as a bioethical concept. We will further explore its principal axes, namely compassion, creating a humane and purposeful environment, employing persuasion to meet the person's essential needs, exerting a certain degree of mild restraint to meet the person's critical needs, minimizing harm in terminal care, and justice, through the lens of people who had dementia during the COVID-19 pandemic. Applying this principle in clinical practice requires significant commitment from all healthcare workers. New approaches to the analysis of dignity, such as through the Ring Theory of Personhood, may facilitate its understanding by practitioners and aid its implementation in populations with multiple vulnerabilities, such as dementia patients, during an infectious outbreak that generates significant social and medical changes.

Проблемные зоны современного дискурса об эвтаназии. Этический аспект

The article analyzes the ethical problems that arise in the process of discourse on voluntary departure from life, examines the ethical aspects of existing views on euthanasia. It is noted that adherence to the principles and rules of biomedical ethics is of particular importance when making decisions regarding the end of life. The paper presents the relationship between the characteristics of modern society and hedonistic tendencies, determined when choosing the value orientations of young people who have chosen medicine as their future profession. In this regard, it is necessary to discuss issues related to the ethical aspects of euthanasia at interdisciplinary platforms in the professional community of representatives of medicine, philosophy, law and religious organizations. The author comes to the conclusion that following the norms of morality in the activities of a doctor, determined by the centuries-old achievements of philosophical thought, predetermines the trajectory of his professional activity in terms of the duty he performs.

Legal thanatology and the right to death: problems and prospects for studying somatic human rights

The article examines the somatic rights of a person through the prism of «discourse of death». Emphasis is placed on the problems of legal thanatology as a science about death. Philosophical, religious and cultural differences in concepts and definition of human death. It is noted that an important component of medical thanatology is the concept of thanatogenesis – the causes and mechanisms of the onset of death, a set of interdependent pathological processes that lead to the onset of clinical or biological death. Knowledge of the basic patterns of thanatogenesis and detection of changes that trigger the process of thanatogenesis are necessary for timely and adequate correction of critical conditions that occur in patients. The time of death of a person is the moment of his brain death or his biological death (irreversible death of a person). Brain death can occur with complete and irreversible cessation of all its functions, which is registered with a working heart and artificial ventilation of the lungs. The methodology for diagnosing death is not related to the concept that there are different types of death. Loss of cardiovascular and respiratory function can lead to death only when ischemia and anoxia are prolonged enough to cause irreversible brain damage. Legal thanatology should be considered as an independent direction in modern jurisprudence within the framework of general theoretical jurisprudence. It is related to medical bioethics, medical law, and, from this point of view, it identifies the gaps that exist in jurisprudence and medicine and, if possible, eliminates them. Legal thanatology is a kind of «bridge» and «filter» of achievements in the field of medicine and legal science, which further helps law to «go hand in hand» with medicine. It was concluded that in the conditions of an increase in the number of donor centers, the extreme ethical importance of diagnosing brain death determines the need for high accuracy, speed and safety of its establishment. The above data show that the problem of brain death, as before, remains an open scientific problem. The concept of brain death continues to develop, refine, and improve. Any new circumstances (clinical observations, scientific facts) have to be tested again and again as arguments in defense of life or in defense of death. Key words: human rights, right to death, somatic rights, legal thanatology, death, human body, time of death, brain death.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Awareness and Perception About Research Ethics and Misconduct Among the Teaching Staff of Health Colleges, Jazan University, Saudi Arabia.

Despite adopting biomedical research ethics rules, regulations, and statements, unethical behavior is pervasive and frequently reported. This study assessed the perception and awareness of research Ethics and Misconduct among the Teaching Staff of Health Colleges at Jazan University, southwest Saudi Arabia. This research aimed to assess the awareness and perception of research ethics and misconduct among the teaching staff of the health colleges at Jazan University in southwest Saudi Arabia. Observational cross-sectional study targeted 424 faculty members randomly chosen from health-related colleges at Jazan University. A structured questionnaire was used to collect data using a web-based survey. The overall level of knowledge about medical ethics indicated that more than half of respondents (57.8%) had a good level of knowledge, 23.4% had a fair level of knowledge, and only 18.4% had poor knowledge. The Saudi National Committee on Bioethics was only known by 49.5% of the study participants. In addition, just 48.3% of respondents knew Saudi Arabia's national standards of ethics and principles for conducting scientific research. The knowledge of research ethics was found to be significantly (P<0.05) higher in participants with higher academic positions, such as professors, MD degree holders, and participants with more extensive work experience. About 48.2% reported that the severity of penalties for scientific misconduct would highly affect scientific integrity, and 74.3% found that their understanding of rules and procedures related to scientific misconduct has a very high effect on scientific integrity. Poor knowledge of research ethics is typically associated with an individual's academic job title, as "lecturer" showed a lower level of knowledge in comparison to other job titles. Even though about 50% of participants in the study had a good understanding of research ethics, it's crucial to ensure that all faculty members have a universal understanding. Therefore, it's essential to implement an appropriate research ethics training program.

ANALYSIS OF THE RISK OF RECURRENT WHEEZING IN CHILDREN WITH BRONCHIOLITIS BASED ON THE WEIBULL MATHEMATICAL MODEL

Given the frequency of recurrent wheezing (up to 50 % of cases) in young children during the first year after bronchiolitis, the assessment of the prognostic value of diagnostic biological markers of bronchiolitis requires special attention.According to modern concepts, mast cells, eosinophils, play a significant role in the pathogenesis of bronchiolitis, with degranulation of which the release of cationic proteins (eosinophilic cationic protein (ECP), eosinophil-derived neurotoxin (EDN)) and molecular mediators, namely vascular cell adhesion molecule-1 (VCAM-1), which is a regulator of leukocyte adhesion and transendothelial migration. That is why VCAM-1, ECP and EDN are discussed as important prognostic markers in assessing the risk of recurrent wheezing in children with bronchiolitis.The aim of the study. To analyze the risk factors for recurrent wheezing in children with bronchiolitis, considering allergic history, the influence of external factors (passive smoking, place of residence), levels of VCAM-1, ECP, EDN in the blood serum.Material and Methods. This article is a part of the research work of the Department of Paediatrics No. 1 of Vinnytsia National Medical University named after M.I. Pyrohov on the topic "Optimization of diagnosis and treatment of somatic pathology in children", state registration No. 0115U007075.A clinical examination of 67 infants was carried out. The main group consisted of 34 children with bronchiolitis without a complicated allergic history. The comparison group consisted of 33 children with bronchiolitis who had a burdened allergic history. The average age of the children in the main group was 8.4±1.6 months, and 6.2±1.4 months in the comparison group. The analytical component of the study was based on parametric survival models (Weibull and generalized Gamma models). The analysis of Weibull models was performed in the statistical packages of analytical system R for Mac OS X FAQ, Version 3.1.0 2014-04-10, R. app 1.64 based on the Mac OS X 10.9 platform, 64-bit Intel Core i7 architecture.The study was approved by the Commission on Biomedical Ethics for compliance with the moral and legal rules for conducting medical research at Vinnytsia National Medical University named after M.I. Pyrohov. It was established that the research does not contradict the basic bioethical norms and meets the principles of compliance with the basic provisions of the GCP (1996), the Council of Europe Convention on Human Rights and Biomedicine (04.04.1997), WMA Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects (1964-2008) and Order of the Ministry of Health of Ukraine No. 690 of 23.09.2009 (as amended by Order of the Ministry of Health of Ukraine No. 523 of 12.07.2012). All patients were informed about the purpose and possible consequences of the research procedures. All patients signed an informed written consent to participate in the study prior to the procedure.Results of the study. The risks of recurrent wheezing in children with bronchiolitis according to the Weibull model were allergic history ( β=1,996) mixed feeding, and to an even greater extent artificial feeding ( β=7,832 and β=8,337). High serum levels of ECP β=5,03, EDN β=0,182 and VCAM-1 β=0,0254 are reliable markers of increased risk of recurrent wheezing in children with bronchiolitis. Living in rural areas ( β=-5,8) significantly reduces the risk of recurrent wheezing in children with bronchiolitis compared to children living in urban areas β=0.0162).Conclusions. 1. The levels of VCAM-1, ECP and EDN in the blood serum were recognized as reliable markers for the prognosis of recurrent vesicitis in children with bronchiolitis. The level of EDN ≤ 7 ng/ml in the blood serum is a prognostic marker for the risk of recurrent wheezing in children with bronchiolitis.2. The hypothesis that artificial feeding in children with bronchiolitis with a complicated allergic history confirms and significantly increases the risk of recurrent vesicitis in children with bronchiolitis. The hypothesis about the role of passive smoking exposure in a significant increase in the risk of recurrent wheezing in children with bronchiolitis was confirmed only for patients with EDN levels not exceeding 7 ng/ml in the blood serum.

COVID-19 IN NEWBORNS: OWN EXPERIENCE ON THE EXAMPLE OF CLINICAL CASES

Introduction. Currently, there is controversial information regarding the epidemiologic characteristics and severity of COVID-19 in pregnant women and newborns. Most researchers report the same severity of disease in pregnant and non-pregnant women, and a milder course of disease in the neonatal period, with the possibility of critical illness in some infants. Ideas about the possibility of transmission of SARS-CoV-2 to a newborn have changed. Since intrauterine transmission of the novel coronavirus is currently considered rare, COVID-19 in newborns is usually associated with postnatal transmission of the virus.The aim of the work was to analyze the epidemiologic and clinical features of the COVID-19 in newborns based on the analysis of clinical cases.Material and methods. On 2020, at the beginning of the COVID-19 pandemic, 11 newborns were admitted to the infectious diseases departments of Chernivtsi Regional Children's Clinical Hospital, 9 children were referred from home by a family physician, and 2 children were transferred from maternity care facilities. Diagnosis was confirmed by PCR-RT detection of SARS-CoV-2 RNA in nasal/oropharyngeal swabs.The research was conducted in accordance with the principles of bioethics, the conclusion of the Commission on Biomedical Ethics of the Bukovinian State Medical University on the observance of moral and legal rules for conducting medical-scientific research, Protocol No. 6 dated March 16, 2023.The research was carried out within the framework of scientific and research activity of the Department of Pediatrics and Infectious Diseases of Children of the Bukovinian State Medical University "Modern epidemiological, clinical-paraclinical and diagnostic features of the most common inflammatory infectious and non-infectious diseases in children", state registration number: 0122U002208.Results. The analysis of the epidemiologic data allowed to identify an intrafamilial source of infection in all identified cases (in one case the source of infection could not be identified), in most cases it was the mother, in one case the source of infection was the father and the grandmother. In most families there are older siblings who could serve as a potential additional source of infection, but respiratory symptoms in siblings were identified in one third of the families.In the late neonatal period, cases of horizontal virus transmission were characterized by mild symptoms of upper respiratory tract infection as acute nasopharyngitis, one case - as a mixture with secretory diarrhea. COVID-19 in another child was accompanied by acute gastroenteritis and moderate dehydration. The clinical picture of coronavirus infection in the remaining third of cases was characterized by lower respiratory tract infection as acute tracheobronchitis, acute obstructive bronchitis and bronchiolitis.Two infants were transferred from the maternity hospital after delivery because of COVID-19 maternal symptoms and SARS-CoV-2 RNA detection in the infants' nasal/oropharyngeal swabs on the first day of life. These children were asymptomatic with no clinical or laboratory evidence of an infectious-inflammatory process during observation.Conclusions. The presence of an exclusively family source of infection can be considered an epidemiological feature of COVID-19 in the neonatal period. In the case of horizontal transmission of the SARS-CoV-2 virus in newborns, the disease COVID-19 in most cases proceeds as mild upper respiratory tract infection, less often – as lower respiratory tract infection and/or secretory diarrhea. In the case of maternal COVID-19 disease before childbirth the vertical and/or antenatal infection mode and the subsequent asymptomatic neonatal COVID-19 cannot be denied.