City Clinical Hospital Research Articles

ANALYSIS OF PAIN TREATMENT IN SOME MEDICAL INSTITUTIONS IN KYIV THAT TREAT WOUNDED COMBATANTS

Summary. On the way to reducing the incidence of pain chronicity, it is first of all necessary to analyze the existing problem, prioritize and differentiate factors that can potentially improve the situation. By analyzing the pain management system of a medical institution, it is easy to track its effectiveness, especially when it comes to the wounded, because a certain percentage of such patients nevertheless continue treatment at the next stage through strategic medical evacuation. Studying the intensity of pain during strategic medical evacuation allows, to some extent, to assess the effectiveness of pain treatment. Objective. To study the intensity of pain in combatants after wounds in medical institutions of Kyiv. Methods. The results of pain treatment in 368 combatants after wounds in some Kyiv hospitals are presented. Pain intensity was assessed using the numerical pain scale (NPS). Results. The analysis data show that the highest pain intensity score on the WSS was in the Municipal Nonprofit Enterprise "Kyiv City Clinical Hospital No. 6" and averaged 5.7 points, which meets the criteria for moderate pain. In the Municipal Nonprofit Enterprise Kyiv City Clinical Hospital No. 1 of the Executive Body of the Kyiv City Council (Kyiv City State Administration), this indicator was 4.0 points, in the Municipal Nonprofit Enterprise Kyiv City Clinical Hospital No. 4 – 3, 3 points, at the Municipal Nonprofit Enterprise "Kyiv City Clinical Hospital of Emergency Care" – 3.0 points, at the Municipal Nonprofit Enterprise "Kyiv City Clinical Hospital No. 8" and the Municipal Nonprofit Enterprise "Oleksandrivska Clinical Hospital of Kyiv" – 2.5 points, at Feofaniya Clinical Hospital of the State Administration of Affairs – 2.3 points, and at the National Military Medical Clinical Center "Main Military Clinical Hospital" – 2.2 points. High-intensity pain was experienced in 5% of cases, moderate pain in 19%, mild pain in 74%, and no pain in 2% of cases. Conclusion. Pain management in some Kyiv hospitals treating wounded requires the introduction of new approaches, as better pain control during treatment and evacuation can potentially improve long-term treatment outcomes. Supplementing the healthcare system with a pain management system may be important given the war and the number of wounded.

Prediction of fatal cardiovascular events in patients with newly diagnosed non-small cell lung cancer

Aim. To study risk factors for fatal cardiovascular events in patients with non-small cell lung cancer over two years of standard treatment.Material and methods. This pilot retrospective non-randomized cohort study included 179 patients who were consecutively admitted to the chemotherapy department of City Clinical Hospital 1 from January to December 2020 with a confirmed diagnosis of non-small cell lung cancer based on the comprehensive examination and morphological verification according to the 2018 clinical guidelines on bronchial and lung cancer. Diagnosis and treatment of cardiovascular diseases were carried out according to national clinical guidelines. The follow-up period for non-small cell lung cancer and cardiovascular disease was 2 years. Logistic regression models were considered to assess the risk of cardiovascular death. The model accuracy was assessed by a cross-validation.Results. The best model in terms of the sensitivity and specificity sum according to a cross-validation was the model with the following explanatory variables: sex, cancer stage, platinum-based chemotherapy, etoposide, immunotherapy, surgical treatment. This model showed a sensitivity of 70,1% and a specificity of 82,1%.Conclusion. This approach is easy to implement and may optimize treatment for patients with non-small cell lung cancer.

Comparative assessment of venous congestion severity and hospitalization outcomes in patients with acute decompensated heart failure with preserved ejection fraction

Aim. To characterize the potental of additional paraclinical research methods (ultrasound, determination of body composition) for assessing the congestion severity in patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF) in the intensive care unit.Material and methods. We examined 82 patients with ADHFpEF aged from 50 to 85 years, who were hospitalized in the intensive care unit of the Veresaev City Clinical Hospital (Moscow). All patients underwent a standard clinical and laboratory examination, including determination of NT-proBNP, as well as echocardiography, chest radiography, bioimpedance analysis, Venous Excess Ultrasound (VExUS), lung ultrasound. Depending on the congestion degree visualized by VExUS, patients were divided into three groups.Results. The median levels of NT-proBNP, E/A and E/e', number of B-lines in one lung segment, ECW and TBW, and the diuretics' dose used in the hospital in pa tients with ADHFpEF and severe congestion were significantly higher. Signs of congestion obtained as a result of X-ray examination did not differ significantly between groups. In-hospital death was associated with higher values of NT-proBNP, E/A ratio, IVC diameter, number of B-lines in one lung segment, ECW and TBW. The odds of death in patients with VExUS Grade 3 increased 20,9 times compared to Grade 1 (95% CI: 1,125-387,688).Conclusion. Higher levels of NT-proBNP, the dose of diuretics used in the hospital, and ECW and TBW were associated with congestion severity. The severity of congestion assessed by VExUS and ECW/TBW are positively associated with inhospital mortality

Оценка фовеальной гипоплазии у недоношенных детей как прогностический фактор формирования центрального зрения

Original article Assessment of foveal hypoplasia in premature infants as a prognostic factor in the formation of central vision R. Atamuradov, I.B. Astasheva, M.R. Guseva, V.V. Marenkov, Yu.A. Kyun, A.R. Baranova Pirogov Russian National Research Medical University, Moscow, Russian Federation Yudina City Clinical Hospital, Moscow, Russian Federation Morozov Children’s City Clinical Hospital, Moscow, Russian Federation Purpose. Assessment of foveal hypoplasia (FH) in premature infants as a prognostic factor in the formation of central vision. Material and methods. We’ve examined 61 patients (118 eyes) aged 8.83±3.5 years who were born prematurely (gestational age 24–34 weeks, birth weight 690–2,700 grams). Among the preterm infants, 22 (36%) had a history of spontaneous regression of retinopathy of prematurity (ROP), 31 (51%) had laser retinal photocoagulation for ROP and 8 (13%) preterm patients were without ROP. All children were assessed for the best corrected visual acuity (BCVA) according to the Sivtsev and Orlova tables, optical coherence tomography (OCT), and registration of visual evoked potentials (VEP). Results. We have noted 4 degrees of FH in preterm infants: 1st degree – no extrusion of plexiform layers, foveal depression is significant (BCVA on average 0.91±0.1); 2nd degree – mild foveal depression, no extrusion of plexiform layers (BCVA on average 0.83±0.2); 3rd degree – absence of foveal depression and extrusion of plexiform layers, elongation of photoreceptor outer segments and thickening of the outer nuclear layer were observed (BCVA on average 0.7±0.2); 4th degree – foveal depression, extrusion of plexiform layers and elongation of photoreceptor outer segments are absent, thickening of the inner nuclear layer is preserved (BCVA on average 0.4±0.2). A significant difference of BCVA from the norm was noted at 4th degree (p<0.05). Conclusion. Different degrees of FH have been identified, which can be used as a prognostic factor of visual acuity in premature infants. An uncorrectable decrease in visual acuity can be expected in children with 4th degree FH. Key words: foveal hypoplasia (FH), retinopathy of prematurity (ROP), optical coherence tomography (OCT), macula, visual evoked potentials (VEP)

Humoral immune response to shiga toxin 2 (Stx2) in children with escherichiosis with hemolytic-uremic syndrome

Shiga toxin-producing Escherichia coli (STEC) causes acute intestinal infections and also causes acute renal failure, especially in children. Shiga toxins (Stx) occupy a central place in the pathogenesis of hemolytic uremic syndrome (HUS) in Escherichiosis. The presented work analyzes the effectiveness of laboratory diagnostics of enterohemorrhagic escherichiosis in patients at the stage of manifestation of HUS and/or acute renal failure using microbiological, immunological research methods and PCR analysis. The study used clinical material from 30 patients in the pediatric intensive care unit of the St. Vladimir Children’s City Clinical Hospital in Moscow with symptoms of HUS aged from 8 months to 5 years. Blood sera from 20 healthy donors were used as control. As a result of PCR analysis, stx2 DNA was detected in 23.3% of cases. Bacteriological research made it possible to sow a pure culture of Escherichia coli O157:H7 in only 3.3% of cases. Since the development of HUS begins in patients with acute intestinal infection caused by Shiga toxin-producing microorganisms starting from the 5th day of the disease, when antibiotic therapy is already carried out, the bacteria can be completely destroyed, which makes it difficult to identify them by bacteriological methods, as well as to detect genes encoding Shiga toxin in PCR analysis. Typically, patients with HUS are admitted to the intensive care unit 5–7 days after the onset of the disease, when class G immunoglobulins specific to the pathogen are already beginning to circulate in the blood. In this regard, the use of immunological tests can be effective to confirm the diagnosis of STEC infection. In our studies, enzyme immunoassay allowed us to detect antibodies to Stx2A in 63.3% and to Stx2B in 43.3% of patients. Using immunoblotting, antibodies to Stx2A were detected in all sera obtained from patients and in 66.7% of cases to Stx2B. Immunoblot analysis was characterized by higher sensitivity for detecting antibodies to Stx2, however, due to the presence of an immunological layer among healthy people, it is preferable to use ELISA analysis. In healthy donors with antibodies to Stx2, the antibody titer was significantly lower than in patients. Laboratory confirmation of the diagnosis of STEC infection is difficult when conducting microbiological and molecular genetic studies, which is confirmed in this work. The effectiveness of laboratory diagnostics can be expanded by performing an ELISA aimed at detecting antibodies to Stx2A.

The role of tumor-associated neutrophils in early luminal HER2-negative breast cancer progression

BACKGROUND: Luminal HER2-negative breast cancer is the most common type of tumor in women diagnosed with early-stage breast cancer. Stromal cells and immune cells in tumor microenvironment have been reported to play a significant role in cancer prognosis. The prognostic role of tumor-associated neutrophils in early breast cancer remains mostly unclear. AIM: To study predictive role tumor-associated neutrophils in early luminal HER2-negative breast cancer. MATERIALS AND METHODS: The dataset consisted of 60 patients with early luminal HER2-negative breast cancer treated in S.P. Botkin City Clinical Hospital (Moscow, Russia). We first estimated basic morphological signs: tumor size, tumor grade (by Nottingham Histologic Score), tumor-infiltrating lymphocytes, lymphovascular invasion, hormonal receptors status, proliferative index, regional lymph nodes status. The expression of intratumoral neutrophils was studied using immunohistochemistry with CD15. RESULTS: High tumor-associated neutrophils concentration was correlated with tumor size, high grade tumors, proliferative index, tumor-infiltrating lymphocytes, lymphovascular invasion and positive regional lymph nodes. CONCLUSION: Tumor-associated neutrophils predicted a worse prognosis in early luminal HER2-negative breast cancer.

Laparoscopic Removal of a Large Extraorgan Retroperitoneal Cyst

Introduction. Extraorgan cysts of the retroperitoneal space (ECRS) remain a challenge in terms of determining therapeutic and diagnostic tactics. In most cases, ECRS are asymptomatic, which explains their detection as an incidental finding during examinations or surgical interventions in the abdominal cavity and/or retroperitoneal space. The main method for treatment of true and formed false ECRS consists in surgery with both laparotomy and laparoscopic accesses. Materials and methods. Clinical case: patient M., female, 39 years old, addressed to one of the clinics in Ufa with complaints of periodic lower left abdominal pain. Based on the results of the examinations, a diagnosis was made of a large tumor of the left ovary, complicated by pain. Concomitant diagnosis: multinodular uterine myoma. Surgical treatment — conservative myomectomy — with laparotomy access was performed due to the large size of the neoplasm. Intraoperatively, in the left iliac region, a volumetric liquid formation measuring 20×15 cm, not associated with the ovary, was discovered retroperitoneally. After further examination, the patient was referred for surgical treatment for retroperitoneal tumor in the City Clinical Hospital No 21. Results and discussion. The surgery was performed laparoscopically. The duration of the surgical intervention accounted for 39 minutes. The postoperative period was reported to be uneventful. Drains were removed on the second day. The patient was discharged from hospital on the fifth day after surgery. Histological examination of the cyst wall revealed no epithelial lining; the wall consisted of fibrous tissue. In this clinical case, according to the results of histological examination, the structure of the cyst wall corresponds to the secondary type or false cysts due to no epithelial lining. Conclusion. In cases of extraorgan retroperitoneal cysts, laparoscopic excision is considered to be a safe and effective method with less postoperative pain and a shorter recovery period compared to open interventions.

Ворохобова Департамента здравоохранения города Москвы.

To reduce the workload of nursing staff, it is necessary to develop new approaches to the organization of work, new methods and forms of managing these personnel. Purpose of the study is to develop a system for the distribution of duties of non-medical personnel in order to improve the efficiency of medical organization functioning, basing on the example of the Vorohobov’s City Clinical Hospital № 67. The system will significantly reduce the workload of medical personnel, increase staff motivation and improve the quality of medical services provided. Material and methods. The features of the the Vorohobov’s City Clinical Hospital № 67 functioning, as well as the personnel reform carried out, contributing to the optimization of the activities of medical personnel, are considered. A quantitative analysis of the costs and structure of the nurses working time in the Vorohobov’s City Clinical Hospital № 67 was carried out on the basis of statistical accounting methods: an inventory of tasks and a survey of nurses in a separate building of the medical organization were performed. Results. It was revealed that the greatest time costs for performing labor operations that do not require medical qualifications during the working day fall on the nurses of treatment (procedure) room and dressing examination (bandaging room). Specific job responsibilities that can be delegated to non-medical staff have been identified. According to the results of a quantitative study, the modernization of labor organization principles in medical organizations on the example of the Vorohobov’s City Clinical Hospital № 67 consists in delegating labor operations, such as document handling and working with electronic resources, to non-medical personnel. Findings. The results of the study can be used by the management of medical organizations in the organization of labor and the distribution of the workload of medical and non-medical personnel to improve the quality of medical services provided.

Chorioamnionitis: clinical, anamnestic and molecular-genetic parallels

Aim: to determine clinical, anamnestic and molecular-genetic parallels in emergence of clinical chorioamnionitis (CA) and severe forms of intrauterine infections (IUI) in high-risk pregnant women.Materials and Methods. A single-center prospective cohort comparative case-control study was conducted by examining 58 pregnant female patients aged 18 to 42 years with a verified CA diagnosis during pregnancy and childbirth at different gestation stages (main group), and 35 age-matched pregnant women with uncomplicated pregnancy and no significant extragenital pathology, aggravated factors of obstetric and gynecological history and risk factors for developing CA (control group), observed and performed a delivery in Yudin City Clinical Hospital. All women underwent clinical, anamnestic, laboratory, instrumental and molecular-genetic examitation. We studied the polymorphism of genes FCGR2A (Fc fragment of immunoglobulin G receptor IIa), IFN-γ (interferon gamma), IL-10 (interleukin-10), IL-6 (interleukin-6) and MBL2 (mannose binding lectin 2) to determine their role in assessing a risk of maternal and neonatal infection.Results. Among the patients with developed clinical CA vs. control subjects, more of them had a history of abortion and miscarriages (17.24 %), comorbid with chronic arterial hypertension (13.79 %), previous surgical interventions (27.59 %), as well as chronic inflammatory diseases (chronic tonsillitis, bronchitis, pyelonephritis, sinusitis; 27.59 % vs. 17.14 %). In addition to risk factors directly related to the infectious and inflammatory unfavorable background, they also had a significantly higher rate of obstetric complications: moderate preeclampsia – 6 (10.34 %) cases, threat of miscarriage or premature birth – 14 (24.14 %) cases vs. 1 (2.86 %) case in control group (p = 0.007), polyhydramnions – 4 (6.9 %) cases, placental insufficiency – 6 (10.34 %) cases. The frequency of premature rupture of membranes was 31.03 % in women with CA. Questionable cardiotocography (CTG) type was found in 24 (41.38 %) women with CA vs. 4 (11.4 3%) women without CA (p = 0.003), the pathological CTG type was observed only in women with CA. In the group with clinical CA and neonatal IUI, the combination of genotypes AG rs1801274 FCGR2A, ТT rs2430561 (IFN-γ)+874, GC rs1800795 (IL-6)-174 occurs in 80.65 % (25/31), whereas in women without severe neonatal IUI – in 37.04 % (10/27) (odds ratio (OR) =7.08; 95 % confidence interval (CI) = 2.166–23.166). In addition, the combination of alleles TT rs2430561 (IFN-γ)+874, GC+CC rs1800795 (IL-6)-174, AA rs1800450 MBL2 codon 54 was detected in 60.86 % (62/102) vs. 47.52 % (370/778) in main and control group (OR = 11.667; 95 % CI = 2.842–47.886), respectively.Conclusion. The study data evidence about importance of identifying genes for developing CA and neonatal septic complications to optimize and personalize management of high-risk patients (premature birth, infections during pregnancy, premature rupture of membranes).

Clinical and epidemiological analysis of intestinal infections in a children's infectious diseases hospital, experience in using the PEWS scale

Purpose of the work: to conduct a clinical-epidemiological analysis of intestinal infections in a pediatric infectious diseases hospital and the effectiveness of the PEWS scale.Materials and methods: a retrospective study was conducted at the Moscow City Clinical Hospital «Communarka» and City Clinical Hospital No. 1 in the pediatric infectious disease departments from June 1, 2023, to August 31, 2023. Laboratory, clinical, and anamnestic data were obtained from the medical information system «EMIAS» and the laboratory information system (LIS) «ALISA». The study analyzed 838 medical records of children with acute respiratory infections.Results: when conducting a statistical analysis of indicators in two groups (group 1 — PEWS ≥ 3 points, recorded at least once during the entire period of hospitalization, group 2 — PEWS from 1 to 2 points, recorded at least once during hospitalization period) no significant differences were observed in terms of etiology, age, day of illness, blood test results, and length of hospital stay. All patients had a moderate form of acute respiratory infection, however, patients with PEWS ≥ 3 points required increased attention from medical staff and had a higher risk of deterioration without additional medical intervention, with the most significant risk in predicting deterioration being related to changes in the cardiovascular system. All children were discharged home in satisfactory condition with PEWS = 0.Conclusion: In our conducted research, for the first time in the Russian Federation, the experience of using the PEWS scale in pediatric practice for patients with gastrointestinal infections was applied with the aim of early detection of the risk of clinical deterioration. It can be assumed that the most significant risk in predicting deterioration in the condition of a child with acute gastrointestinal infection, as well as with acute respiratory infection, is predominantly due to disturbances in the cardiovascular system.

The possibilities of diagnostic radiology for the primary identification of spleen abscesses

The issue on the differential diagnosis of formations of purulent-inflammatory etiology and the choice of treatment method taking into account the visual picture does not lose its relevance. Ultrasound (US) is not less crucial than computed tomography (CT) for the primary diagnosis of spleen abscesses. This article presents clinical observations of patients with suspected spleen abscesses admitted to the emergency room of the Novosibirsk City Clinical Hospital No. 1 with emergency indications for 2017–2022. All patients underwent ultrasound with Philips Affiniti 70G, Mindray M9, and General Electric Logiq P6 devices. While performing ultrasound in In-mode, attention was paid to the main signs: localization (in the parenchyma, subcapsular), quantity, contours (wall thickness), the nature of the abscess contents, dimensions (volume calculated according to the formula for irregularly shaped formations, A × B × C × 0.52), the presence or absence of effusion in pockets the spleen. The formations were classified by volume into small (up to 50 ml), medium (50–100 ml) and large (more than 100 ml). The main ultrasound signs in the seroscale mode have been determined. The presented clinical observations illustrate the possibilities of ultrasound for deciding on the method of treatment: for primary diagnosis (including emergency), it was possible to determine the presence of formations of purulent- inflammatory etiology, to determine the localization, the main signs in which minimally invasive treatment was effective (formed abscess of "medium" volume). Surgical abdominal treatment was preferable in the presence of multiple abscesses (without a formed capsule) of small size.

Functional state of the kidneys in patients with acute coronary syndrome against the background of newly identified disorders of carbohydrate metabolism: a multidisciplinary problem

ABSTRACT Background Determining the relationship between cardiovascular risks, carbohydrate metabolism disorders, and renal dysfunction can help in creating new tools for their management and for better interaction of specialists in a multidisciplinary team. The purpose of this study was to determine the functional state of the kidneys and carbohydrate metabolism in patients with acute coronary syndrome without a history of such disorders. Methods 200 patients of the cardiology department of the City Clinical Hospital No. 7 in Almaty were examined using laboratory diagnostics and subsequent statistical data processing. Results Acute coronary syndrome develops in 63% of cases against the background of previous disorders of carbohydrate metabolism – prediabetes (45.5%) and type 2 diabetes mellitus (17.5%). In this group of patients, in the presence of disorders of carbohydrate metabolism, in all cases, it is accompanied by acute renal damage. It was noted that diabetes mellitus in newly diagnosed patients actually had a certain duration and occurred much earlier than cardiovascular complications – this was evidenced by an increased level of glycated hemoglobin. Conclusions Such results indicate the need for early diagnosis of cardio-reno-metabolic syndrome in patients with cardiovascular complications, as well as timely administration of drugs that simultaneously have antidiabetic, cardio- and nephroprotective effects.

Meteoropathy: myth or reality? Assessment of the relationship between cardiovascular diseases and weather conditions according to data from a Moscow hospital

Many patients and some doctors associate the worsening of cardiovascular diseases with meteoropathy (changes in atmospheric pressure and air temperature). Opinion about lack of weather influence on the increase in overall morbidity and the lack of related research data indicate the need to study the relationship between cardiovascular diseases and meteorological conditions.Aim. To assess the prevalence of hospitalizations with symptomatic increases in blood pressure (BP), atrial fibrillation (AF), and decompensated heart failure (HF) in a Moscow hospital depending on meteorological conditions.Material and methods. This retrospective analysis of the number of emergency hospitalizations of patients with symptomatic increases in blood pressure, AF, and decompensated HF in Moscow City Clinical Hospital № 24 was carried out in the period from October 1, 2018 to September 30, 2019. Information from the website www.weather.com was used as a source of meteorological data. The following indicators were assessed daily: daytime air temperature (t), nighttime air temperature, maximum diurnal air temperature variation, atmospheric pressure, maximum diurnal atmospheric pressure variation, amount of precipitation. To assess statistical significance, the Mann-Whitney and Kruskal-Wallis tests were used. A correlation analysis was carried out, and a prognostic model was created using multiple linear regression.Results. During the period from October 1, 2018 to September 30, 2019, 4354 patients were hospitalized at City Clinical Hospital № 24 with symptomatic BP increase and/or AF and/or decompensated HF. The highest number of hospitalizations occurred in November, December and January. The median number of admissions per day was 12 patients. When comparing the mean number of patients admitted to the hospital per day, depending on day- and nighttime air temperature, following statistically significant differences were obtained (p<0,001): with day- and nighttime air temperature ≥0о C, the number of admissions was less compared to sub-zero temperatures. Significant inverse correlations were established between the number of patients hospitalized with symptomatic BP increase, AF and HF per day, with air temperature at night (correlation coefficient r=-0,339; p<0,001), air t during the day (r=-0,316; p<0,001), temperature difference over 48 hours (r=-0,205; p<0,001); direct correlations with atmospheric pressure (r=0,106; p=0,044) and its changes (r=0,115; p=0,028) were identified. All identified relationships were of moderate strength. According to prognostic model, only nighttime air temperature turned out to be a significant indicator associated with the hospitalization rate per day. With a decrease in air temperature at night for every 7,5о C <0, one more patient is expected to be hospitalized with a symptomatic BP increase, decompensated HF, or paroxysmal AF.Conclusion. Negative air temperature in a metropolis is associated with an increase in hospitalizations for symptomatic BP increase, AF or decompensated HF. Atmospheric pressure and precipitation do not affect these conditions.

Minimally invasive method of surgical treatment of Peyronie's disease

Objective. To improve the results of surgical treatment of Peyronie's disease. Materials and methods. 20 patients with Peyronie's disease aged 22 to 60 were treated in the urological departments of the Private Clinical Hospital “Russian Railways Medicine” and Astrakhan City Clinical Hospital No. 3 named after. C.M. Kirov. A method of surgical treatment of Peyronie's disease using a shortening technique without opening the tunica albuginea includes the application of a pressure tourniquet to the base of the penis, puncture of the cavernous bodies, injection of sterile saline into them until an erection is achieved, determination of the angle of curvature of the penis, removal of the tourniquet and surgery to eliminate curvature of the penis. Results. Neither postoperative complications nor formation of hematomas were observed. The patients were discharged on the 4th day in satisfactory condition. 1.5 years` observation showed no progression of angular deformation of the penis which could impede sexual intercourse. The mobility of the skin of the penis was preserved. Conclusions. In addition to the correction of penile deformity, our method eliminates the need for extensive incisions and preserves the physiological functions of the penis. As a result of using this surgical method, the following goals are achieved: minimal trauma to tissues in the surgical area, absence of scar processes in the plastic area and preservation of the skin of the penis mobility, absence of pronounced postoperative tissue edema, no need to drain the wound, reduction of the duration of the operation and minimal blood loss, short postoperative and rehabilitation period.

Comparative analysis of robot-assisted and laparoscopic operations in oncogynecology

Aim. To determine the advantages and disadvantages of laparoscopic (LS) and robot-assisted (RA) surgery in oncogynecological operations.Materials and methods. 282 clinical cases were retrospectively analyzed. The patients were treated in oncogynecological department No. 70 of the CS.P. Botkin City Clinical Hospital, Moscow Healthcare Department for endometrial cancer of stages IA–II, cervical cancer in situ and IA1 stages or atypical endometrial hyperplasia in the period from February 2020 to September 2022, among them 74 patients were operated with Da Vinci robotic units (models Si and Xi) and 208 using laparoscopy. The standard volumes of surgical treatment, depending on the clinical diagnosis, were: hysterectomy, hysterectomy with pelvic lymphadenectomy, hysterectomy with pelvic and retroperitoneal lumbar lymphadenectomy. To compare the technical characteristics of minimally invasive operations and the condition of patients in the intra- and postoperative periods in each group, data on the duration of operations, body mass index, age, intra- and postoperative complications, as well as the number of postoperative hospital bed-days were analyzed.Results. When comparing the average duration of operations by time, a statistically significant difference was obtained. Thus, LS hysterectomy was performed 43 minutes faster on average than RA (74.2 minutes versus 117 minutes) (p <0.001). When performing pelvic lymphadenectomy, the average duration of RA operations was 28 minutes longer than LS operations (142 minutes versus 170 minutes), and when adding the retroperitoneal lymphadenectomy stage, the average duration of RA operations was 128 minutes longer than LS operations.Conclusion. At this stage of technology development in surgery, LS operations have a number of advantages over RA ones in numerous ways. LS operations demonstrate statistically significantly shorter execution time, fewer perioperative complications, as well as a more controlled environment in the operating field. In the long term, RA surgery has serious potential and is currently at an early stage of its development. A real and sober assessment of its characteristics will determine the right direction for the development of this technology in the future.

Intramedullary stabilization of dislocated clavicle fractures with a compression rod

Despite the favorable prognosis of conservative treatment for clavicle fractures, unsatisfactory consequences reach 10–30 % cases. Surgical methods of treatment for dislocated clavicle fractures, such as osteosynthesis with a plate or an elastic titanium rod, are mostly used in practice. The disadvantage of the latter is the possible migration of the implant with perforation of the skin. The purpose was to study the effectiveness of an intramedullary rod, improved by us, for osteosynthesis of dislocated clavicle fractures type OTA 15A and OTA 15B according to the AO/ASIF classification. The essence of the improvement was the possibility of closed minimally invasive intramedullary osteosynthesis of the clavicle body, with a simplified technique of the surgical intervention itself, prevention of implant migration. The latter was achieved by the fact that one of the ends of the rod had a drill, which eliminated the need for predrilling the medullary cavity of the clavicle to insert the rod, and its opposite end had a thread onto which a nut is screwed to achieve compression between the clavicular fragments. Forty-two patients with closed dislocated clavicle fractures were under supervision in the clinic of traumatology and orthopedics of Kyiv City Clinical Hospital 6. They underwent intramedullary osteosynthesis for clavicle fractures with an improved compressing rod (closed in 28 cases, open in 14) under regional anesthesia. In dyna-mics of the postoperative period, a clinical and radiological examination was performed, the severity of the pain syndrome and the function of the upper limb were assessed according to the visual analog scale (VAS), Disability of Arm, Shoulder and Hand (DASH). As shown by the results of X-ray examinations, the average period of clavicle fracture union was 10.1 ± 1.4 weeks (range 8–12 weeks). During the observation of the patients, favorable dynamics on the VAS and DASH were noted; by the end of the study (12 months after the operation), the functional capabilities of the upper limb on the DASH corresponded to 1.54 ± 0.84 points, VAS score was 9.60 ± 2.11 points. The improved construction of the intramedullary rod for osteosynthesis of dislocated clavicle fractures of the OTA 15A and OTA 15B type can be recommended for use in practice, as it has demonstrated favorable clinical, radiological, and functional outcomes.

Clinical Case of Rare Genetic Disorder (Proud Syndrome) in a Child

Background. Proud syndrome is rare inherited disease with X-linked inheritance associated with mutations in the homeobox gene ARX. Typical clinical signs of this syndrome are severe mental retardation, intractable epilepsy, agenesis (dysgenesis) of corpus callosum. Less common features are genital abnormalities, microcephaly, facial dysmorphia, and skeletal malformations. Clinical case description. The article describes the clinical findings of Proud syndrome in girl A., admitted to Children’s City Clinical Hospital No. 1 in Nizhny Novgorod. The girl was born without asphyxia at term through natural vaginal delivery after the first uneventful pregnancy. Body weight at birth was 2600 g. The genealogical history is burdened by the presence of epilepsy in girl’s father relatives. There were no deviations in psychomotor skills development before disease onset. Hemi-convulsive seizures (switching sides) have appeared at the age of 6 months. These attacks had status course and were resistant to anticonvulsant therapy. Neuroimaging has revealed agenesis of corpus callosum. Regression of psychomotor development, new behavioral disorders (stereotypes and auto-aggression), hyperexcitability, and sleep disorders were observed in dynamics. The diagnosis of Proud syndrome was confirmed by identification of probably pathogenic mutation in the ARX gene (c.1111C>T, p. Arg 371*64). The features of anticonvulsant management were demonstrated in the patient. Conclusion. This clinical case presents typical clinical picture of Proud syndrome. The disease is non-curable. Such patients should be administered with syndromic therapy: constant anticonvulsant therapy, correction of behavioral disorders (classes with specialist on mental defects), neurologist, epileptologist, psychiatrist observations. Parental examination is crucial ARX mutation search in order to determine the prognosis for further child-bearing (parents refused to perform genetic study at the time of article writing).

Central Retinal Vein Occlusion as the Debut of a Chronic Myeloproliferative Neoplasm

Introduction. Most retinal vascular diseases are associated with systemic risk factors such as hypertension, diabetes mellitus, age and smoking. However, in their absence, further examination is required to identify possible hematological disorders.Purpose. Improve the diagnostic and management scheme for patients with occlusion of the central retinal vein or its branches.Materials and methods. A clinical case of the onset of polycythemia vera with the central retinal vein occlusion is described. As part of the study, a molecular genetic analysis was carried out to identify the driver mutation JAK2V617F in peripheral blood as a screening diagnosis of Ph-negative chronic myeloproliferative neoplasms (CMN), a cytological, cytogenetic study of bone marrow aspirate and a morphological study of bone marrow trephine biopsy.Results. A mutant allele of the JAK2V617F gene with a diagnostically significant allele load of 14.61 % was determined in a patient hospitalized in the ophthalmology department with a diagnosis of central retinal vein occlusion (CRVO) of the right eye. The patient was referred for further examination to the Moscow City Hematology Center of Botkin City Clinical Hospital, where, aſter examination, the diagnosis was established: True polycythemia.Discussion. CMN are a group of tumor diseases of hematopoietic tissue characterized by malignant transformation of bone marrow stem cells with their subsequent clonal proliferation. Cytogenetic and molecular genetic disorders play a significant role in the pathogenesis of chronic CMN. True polycythemia, essential thrombocytemia, primary myelofibrosis belong to the group of classical Ph-negative CMP, Thrombotic, vascular and hemorrhagic complications are the most common causes of death in patients with this pathology.Conclusion. Previously, various ophthalmological manifestations and symptoms have been described in patients with CMN. The observed complications are diverse and oſten secondary to the pathognomonic hematological disorders for these diseases. It is worth considering the clinical value of molecular genetic analysis to detect the JAK2V617F mutation in patients with central retinal vein occlusion for early diagnosis of CMN and timely administration of appropriate therapy.

Predictive models of high risk of heart failure, atherosclerotic diseases and CKD in patients with type 2 diabetes mellitus

Due to the high prevalence of complications from the cardiovascular system and kidneys in patients with type 2 diabetes mellitus (DM) already in the early stages of the disease, it is interesting to identify predictors that could be used for early diagnosis and prevention of cardio-renal complications in patients with type 2 diabetes.Objective: to develop prognostic models for the development of ASCVD, CHF, and CKD in patients with type 2 diabetes, identifying predictors and determining the contribution of each factor in the development of these diseases.Material and methods: A one-time observational study was conducted on a sample of patients hospitalized in the endocrinology department of the State Budgetary Healthcare Institution of the City Clinical Hospital named after V.P. Demikhov. Statistical analysis was carried out using Jamovi and IBM SPSS Statistics 23 (IBM. USA). Differences were considered statistically significant at p <0.05. The construction of a prognostic model of the probability of a certain outcome was carried out using the logistic regression method with reverse stepwise exclusion of collinear factors, calculation of the odds ratio (OR) and 95% confidence interval (CI).Results: The study included 1150 patients with type 2 diabetes, whose median age was 65 [57;74] years, median BMI - 31.2 [26.3; 35.8] kg/m2. According to logistic regression analysis, the most significant factors associated with the development of ASCVD in the population of patients with type 2 diabetes were: duration of diabetes more than 10 years (OR 4.16 (95% CI: 3.01-5.76) (p>0.001) ) and hypertension (OR 3.92 (95% CI: 2.17-7.08). Age over 60 years (OR 2.12 (95% CI: 1.46-3.06) (p>0.001), male gender (OR 1.61 95% CI: 1.14-2.26) (p>0.006)). Predictors increasing the likelihood of CHF were: patient age over 60 years (OR 4.05 (95% CI: 2). .70-6.06), (p>0.001)), previous MI (OR 3.71 (95%(2.58-5.33), p<0.001), presence of AF 2.93 (OR 2.93 (95 % CI: 1.79-4.78), p<0.001), hypertension (OR 2.45 (95% CI: 1.29-4.65), p<0.006) and female gender (OR 1.58 ( 95% 1.09-2.28), p<0.014). Factors increasing the odds of CKD were: age over 60 years (OR 2.36 (95% CI: 1.61-3.47), p <0.001), the presence of CHF was associated with an increase in the odds of CKD by 1.86 times (p <0.001), previous MI by 1.55 times (p<0.008), female gender by 1.62 times (p<0.004) and diabetes duration of more than 10 years by 1.44 times (p>0.037).Conclusion: The universal predictors of the development of cardiorenal complications in patients with type 2 diabetes were: age over 60 years and hypertension. Predictors of the development of ASCVD, in addition to universal ones, were: duration of diabetes and male gender; the likelihood of developing CHF increased in patients with a history of myocardial infarction, the presence of AF, and in females. The presence of obesity increased the chances of developing CHF, but was not associated with ASCVD and CKD. The odds of developing HF were similar regardless of the duration of diabetes, while the duration of diabetes was closely associated with the development of ASCVD and renal dysfunction. The following factors were associated with the development of CKD: duration of diabetes, female gender, history of CVD and female gender.

Key aspects of developing standard operating procedures

In modern medical practice, standard operating procedures play a crucial role in ensuring quality medical care. The development and implementation of effective SOPs require a systematic approach and active participation of medical personnel. This article discusses the stages of developing standard operating procedures and outlines the fundamental principles of developing SOPs in healthcare institutions. Drawing on the successful experience of a State Budgetary Healthcare Institution «City Clinical Hospital №52 of the Moscow City Health Department», the authors highlight key aspects and provide recommendations based on practical experience for the implementation of standard procedures to enhance the efficiency and safety of medical care. The authors analyze the importance of standardizing processes in healthcare and discuss the key stages of creating and implementing SOPs, including forming professional teams, engaging experts, and justifying the legislative framework. The research findings can be valuable for methodologists, senior nurses, and healthcare institution leaders seeking to improve the quality of medical care through the systematization and standardization of operating procedures.