City Clinical Hospital Research Articles

2020–2021 rhinovirus genetic diversity in Saint Petersburg

Introduction. Rhinoviruses represent one of the most common respiratory viruses and belong to the Picornoviridae family, genus Enterovirus, being divided into three types: A, B, C, which account for 169 types. Rhinoviruses predominate in autumn and spring periods, although they circulate throughout almost entire epidemic season. The rhinovirus genome is represented by a single-stranded 7.2 thousand base-long +RNA. According to the publications, the most common rhinovirus species is rhinovirus A (HRV-A), followed by rhinoviruses C (HRV-C) and finally rhinovirus B (HRV-B). The aim of our study was to define rhinovirus genetic diversity in Saint Petersburg . Materials and methods. The study was conducted at the Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza. Samples (smears from the nasopharynx and oropharynx) were delivered from the S.P. Botkin Clinical Infectious Diseases Hospital, St. Olga’s Children's City Hospital, N.F. Filatov Children's City Clinical Hospital No. 5. Outpatient samples were used as well. Samples received from December 2020 to October 2021 were analyzed. Detection of rhinoviruses was carried out by real-time PCR, typing — by Sanger sequencing, with primers developed by da Costa Souza L. et al. (2021). Results. According to total specimen testing, rhinoviruses comprise 3.2% total number of specimens tested. Of these, 71 rhinoviruses were typed, representing 17.03% total number of rhinovirus-positive specimens. The most common was HRV-A (55%), among which 21 types were found (the most common HRV-A46 is 13%, n = 5). HRV-B and HRV-C were found in equal numbers — 23% (n = 16) of each species out of total number of typed rhinoviruses. Among HRV-B, 8 types were found; the most common HRV-B06 comprised 33% (n = 5). Among HRV-C, 7 types were found (the most common types are HRV-C42, HRV-C32 and HRV-C15 — 19% each, n = 3). HRV-A was detected mainly in patients aged 18 to 65 years (57.5%, n = 23). HRV-B was detected only in adult patients (100%, n = 16). HRV-C was detected in children under 2 years of age (43.75%, n = 7) and adults aged 18–65 years (31.25%, n = 5). In some cases, HRV-A and HRV-C were associated with various respiratory tract syndromes such as acute nasopharyngitis, laryngotracheitis, obstructive bronchitis, and pneumonia. HRV-B was related to clinical manifestations of pneumonia in seven cases. Conclusion. Rhinovirus type A prevails in Saint Petersburg . Rhinoviruses can be associated with diverse respiratory tract syndromes.

Exploring Prognostically Significant Factors in COVID-19-Associated Pulmonary Fibrosis after Adaptive Lung Ventilation.

Research data on hospitalized coronavirus 2019 (COVID-19) survivors indicate the persistence of symptoms, radiological abnormalities, and physiological disorders months after the initial infection. Given the scale of the ongoing pandemic, a substantial number of patients with severe residual pulmonary fibrosis (PF) and oxygen dependence are anticipated. Currently, the search for risk factors associated with the development of fibrotic radiological abnormalities after moderate to severe COVID-19 is underway. Furthermore, the extent to which computed tomography (CT) data correlate with postdischarge symptoms and physical functions remains unclear. This study aimed to characterize patients experiencing persistent pulmonary consequences after hospital discharge. We examined clinical, radiological, and laboratory predictors of pulmonary fibrosis after COVID-19 infection. We retrospectively evaluated fibrosis-like lung changes and their prognostic factors in COVID-19 survivors. Our study included 77 patients with laboratory-confirmed COVID-19 who received inpatient treatment at City Clinical Hospital No. 1 in Almaty between November and December 2020. We assessed patients during the acute phase of the disease and again 6 to 8 months after discharge using high-resolution computed tomography (CT). Patients were classified into 2 cohorts based on semi-quantitative analysis of subsequently added tomograms-those with radiological fibrosis-like abnormalities (main group) and those who had recovered (control group). Parenchymal cords, irregular interfaces, reticulation, and traction bronchiectasis were common CT findings among all COVID-19 patients. Our study focused on patients who developed pulmonary fibrosis within 1 month after the onset of the disease. After 6 to 8 months, fibrosis-like lung changes persisted in 49.35% of patients (leading group), while 50.65% showed disease resolution (control group). Age, body mass index, high interleukin-6 (IL-6) levels, low IO levels, and the need for mechanical ventilation were identified as prognostic indicators for the persistence of pulmonary fibrosis. Our study revealed that pulmonary function can return to normal in over half of COVID-19 patients 8 months after infection onset. Despite advancements in COVID-19 treatment, there remains a significant knowledge gap in managing long-term effects, especially pulmonary fibrosis. Continued clinical trials and research on post COVID-19 fibrosis are essential to prevent early mortality due to the long-term impacts on these patients.

Quality of Life of Patients Who Have Suffered from Acute Cerebrovascular Accident (Investigation Based on EQ-5D-5L).

Acute cerebrovascular accident is known to be one of the main causes of morbidity, mortality, long-term disability, and disability in society. To investigate the quality of life of patients who have suffered from acute cerebrovascular accident (hereinafter ACVA) in stratified groups by age, gender, diagnosis, type (primary or secondary), and severity of a stroke, as well as undergoing rehabilitation. This research is a cross-sectional descriptive-analytical study. The main research method is a survey. Data collection was carried out in 2020 in Almaty of the Republic of Kazakhstan by inpatient doctors (City Clinical Hospital No. 5 of the Public Health Department of Almaty), engaged in the rehabilitation treatment of patients with acute cerebrovascular accident. The standardized questionnaire EQ-5D-5L was used to assess the quality of life due to health conditions. Data on the state of "mobility", "self-care", "daily activities", "pain", "anxiety", as well as data on self-assessment of health status (according to the EQ VAS scale) were analyzed using the Level Sum Scores (hereinafter LSS). The study involved 258 respondents who had a stroke. The survey was conducted 2 months after the respondents were discharged from the hospital. The average LSS index of patients who underwent ACVA was 10.2 (9.7±10.7). Significant differences in LSS levels ( P ≤ 0.001) were revealed by the severity of stroke and by the fact of rehabilitation. Differences in LSS levels by age, gender, diagnosis, and type of ACVA are insignificant (P > 0.05). The difference in health indicators of patients with primary and repeated strokes indicates the fact of deterioration in the quality of life with each subsequent stroke. The quality of life of patients with ACVA is associated with the fact of rehabilitation: low values of EQ VAS in the group of patients who did not undergo rehabilitation and high values of EQ VAS in those who underwent rehabilitation. After a stroke, the majority of patients tend to have a negative quality of life, mostly due to violations of the component "daily activities". The identified significant disparities in LSS and EQ VAS indicators further show that the quality of life varies among stratified groups. The kind (primary or secondary) and severity of the stroke, as well as the existence of rehabilitation, are indicators that impact the quality of life of patients who have had ACVA.

Experience in the treatment of isolated posttraumatic pancreatic injury complicated by the formation of pseudocysts in a 9-year-old child

The number of cases of traumatic pancreatic damage in children has increased by 1%2% over the last several decades, which is related to an increase in car accidents and the popularity of outdoor sports (cycling and scooter). A 9-year-old boy was admitted to Childrens City Clinical Hospital after being injured in a bicycle fall. The boy complained of pain in the upper abdomen and around the wound on the anterior abdominal wall when he was admitted. The victim was conscious during the examination, the abdomen was not bloated, soft, or uncomfortable on probing in the higher portions, and peritoneal symptoms were negative. An ultrasound examination of the abdominal organs revealed symptoms of pancreatic injury, including the creation of a hematoma up to 58 mL in size. The general blood test found leukocytosis (12.75 109/L) and an increase in amylase up to 1,664 U/L. Following preoperative preparation, a diagnostic laparoscopy was conducted, which included opening and draining the omental sac, as well as cleanliness and drainage of the abdominal cavity. The patient was given antimicrobial, hemostatic, infusion therapy, pancreatic secretion inhibitors, and food nutrition following the procedure. During the dynamics of the ultrasound examination, a pseudocyst of the pancreas with a volume of up to 22 mL was noted. The situation improved with treatment, the amylase indices reduced (271 U/L), and the child was discharged home 44 days a day. After 4.5 months, the cyst increased to 320 mL; therefore, during planned hospitalization, a laparotomy was performed with the imposition of pancreatocystojejunoanastomosis on the Roux-enabled loop. The postoperative time was uneventful, and the child was released from the hospital on the 14th day. The diagnosis was confirmed through laparoscopy, and the omental sac and abdominal cavity were sterilized before drainage. Constant monitoring of the ultrasound image of the pancreatoduodenal zone and the dynamics of amylase markers allowed for the identification and evaluation of posttraumatic changes in the pancreas. An increase in the volume of the pseudocyst served as an indication for the imposition of pancreatocystojejunoanastomosis on the Roux-en-Y loop.

Risk stratification of poor short-term prognosis in patients with high-risk pulmonary embolism

Background. Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. High-risk PE patients have more severe course of disease and poor prognosis. The question of additional factors which may be associated with prognosis in such patients remains poorly understood. The aim is to identify factors associated with mortality in high-risk PE patients and to determine contribution of these factors to the risk stratification of death. Materials and methods. A retrospective analysis of 635 medical cards of patients with PE diagnosis hospitalized in Kharkiv City Clinical Hospital 8 from January 1, 2017 to January 1, 2023 was conducted. The diagnosis was verified by multispiral computed tomography pulmonary angiography (CTPA) and/or by autopsy. Patients were divided into groups: group І — high-risk (113 — 17.8 %); group II — low-risk (522 — 82.2 %). Group I was divided into subgroups: IA — 63 (55.8 %) individuals, who were discharged from the hospital with improved status, IB — 50 (44.2 %) people, who died in hospital. Clinical, anamnestic, laboratory and instrumental parameters were measured. Statistical analysis was performed. Results. Patients from group I were older, there were more women among them. In subgroup ІВ, there are more women, more cases of obesity and deep vein thrombosis. Patients from group IB had lower blood oxygen saturation (SpO2) and systolic blood pressure (SBP), lower left ventricular ejection fraction (LVEF) measured by echocardiography. Bilateral segmental pulmonary embolism according to CTPA was more common in IB group. According to uni- and multivariate analysis, independent factors affecting in-hospital mortality in patients with high-risk PE were determined, among them: female gender, presence of bifurcation thrombus, lower SBP, SpO2, LVEF. Using the additional regression analysis, the formula for individual prediction of the risk of in-hospital mortality in high-risk PE patients was created. According to the receiver operating characteristic analysis, the sensitivity of the formula is 64.0 %, specificity is 92.1 %. The SBAFS (S — SpO2, B — Bifurcation thrombus, A — Arterial hypotension, F — left ventricular ejection Fraction, S — female Sex) score was formed, where the score of 2 or more indicates additional high risk of in-hospital mortality in high-risk PE patients. Conclusion. The high-risk PE patients who died during hospitalization had more cases of obesity, hypertension, lower SpO2, SBP, and LVEF, and there were more women among them. According to the multivariate logistic regression analysis, additional independent factors associated with in-hospital mortality in high-risk PE patients are female sex, thrombus in bifurcation of the pulmonary trunk, SpO2, SBP, LVEF. The formula for risk stratification of in-hospital death in high-risk PE patients was created and validated. The SBAFS score was formed to indicate additional high risk of in-hospital mortality in high-risk PE patients.

Prevention of endometriosis recurrence after surgical treatment

Introduction. The relevance of studying the mechanisms underlying the development of adenomyosis is determined not only by its high prevalence reaching 40% among reproductive aged women, but also by its association with unexplained infertility (60%), as well as woman’s quality of life impairment.Aim. To enhance efficiency of therapy after surgical treatment of endometriosis and minimize the risk of disease recurrence.Materials and methods. In a cohort prospective comparative study conducted on the basis of the gynecological department of the Inozemtsev City Clinical Hospital, 80 patients of reproductive age who underwent organ-preserving treatment for external genital endometriosis and nodular adenomyosis were included. Dienogest (Zafrilla) was prescribed to 65 patients at a dose of 2 mg/day (1 tablet) from day 2 after surgical treatment continuously for 6 months, taking into account contraindications to its use, 15 patients refused to take the drug in the postoperative period, and made up the control group.Results. The results of the study showed that after surgical treatment of external genital endometriosis and the nodular form of adenomyosis and the appointment of suppressive therapy with Zafrilla, after 3 months, the intensity of the pain syndrome was transformed according to the VAS, NRS, B&B scales by one step, and after 6 months it decreased to a slight (p < 0.05), which contributed to the improvement of the quality of life of patients based on the EHP-30 questionnaire. The long-term results of the study allow us to recommend the drug Zafrilla, with high compliance, good tolerance, a favorable safety profile, in order to reduce pain, the intensity of menstrual flow, and prevent recurrence of the disease based on 24 months of observation.Conclusion. An integrated approach to the treatment of external genital endometriosis and nodular adenomyosis, including surgical treatment and suppressive therapy with Zafrilla, made it possible to realize reproductive function in 48% of patients. Taking dienogest for 24 weeks provided effective relief of pain, alleviated the symptoms of the disease, as well as improved the quality of life and realized reproductive plans.

Postoperative complications in males with anorectal malformations depending on the surgical approach

BACKGROUND: Anorectal abnormalities occur in 1:1,500 to 1:5,000 live births. There is still no agreement on the best surgical procedure for treating some types of anorectal abnormalities in males. Anorectoplasty could be performed using the posterior sagittal approach and using laparoscopic techniques.
 AIM: To assess the risk of postoperative complications and determine their specificity in males with anorectal malformations, depending on the surgery approach.
 MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Male patients with anorectal malformations who had surgical correction of anorectal malformation by posterior sagittal (group I) or laparoscopic-assisted anorectoplasty (group II) at the age of up to 1 yr at the N.F. Filatov Childrens City Clinical Hospital from 2008 to 2022. Postoperative and intraoperative problems and the number of surgical interventions that had to be redone to correct issues were noted.
 RESULTS: Of the 33 patients in group I, 18 (55%) had anorectal malformations with bulbar fistula, 12 (36%) had anorectal malformations without fistula, and three (9%) had a prostatic fistula. Group II included 99 patients, with 53 (54%) having anorectal malformations with prostatic fistula, 30 (30%) having anorectal malformations with bulbar fistula, nine (9%) having anorectal malformations with bladder neck fistula, and seven (7%) having anorectal malformations without a fistula. The incidence of intraoperative and postoperative complications was statistically significantly higher in children after posterior sagittal anorectoplasty than laparoscopic-assisted anorectoplasty: I, 19 (58%) versus II, 33 (33%); p = 0.014. The number of redo surgical interventions to correct complications did not differ significantly between the studied groups: I, 8 (24%) versus II, 26 (26%); p = 0.819. The incidence of urethral damage was identified with posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I, 4 (12%) versus II, 0 (0%); p 0.001. We found no differences in postoperative complications between laparoscopic-assisted and posterior sagittal anorectoplasty.
 CONCLUSIONS: The results define laparoscopic-assisted anorectoplasty as a viable and promising method that does not have specific postoperative complications if it is technically correctly performed. It is necessary to develop clear criteria for rectum mobilization and the volume of rectourethral fistula dissection during laparoscopic-assisted surgery to reduce the risks of postoperative problems and repeat surgery.

Clinical Observation of Acute Intestinal Obstruction Caused by Giant Granulosa Cell Tumour of the Ovary

Ovarian granulosa cell tumours (OGCT) are non-epithelial neoplasms of the ovaries and belong to the group of granulosa-stromal tumours. The most likely source of these tumours’ development is granulosis of the primordial follicles of the ovary as a result of hormonal imbalance.
 The aim of the study is to represent a clinical observation of acute intestinal obstruction caused by a giant ovarian granulosa cell macrofollicular tumour.
 A woman, aged 52 years, medical history № 2579, was admitted to the surgical department of Communal Non-Profit Enterprise (CNPE) City Clinical Hospital (CCH) № 1 in Ivano-Frankivsk as an urgent patient with complaints of nausea, vomiting, delayed passage of flatus and defecation, general malaise, abdominal distention. During the laboratory and instrumental examination, a giant tumour of the abdominal cavity was revealed; it has led to the compression of internal organs and the development of small- and large-intestinal obstruction. The operation was performed: middle-median laparoscopy, removal of a giant cyst of the right ovary. Complete hysterectomy with appendages, drainage of the abdominal cavity were also performed.
 During the operation, a giant tumour with dimensions of 65x70x50 cm, of dense but elastic consistency, pale-pink in color, with multiple chambers of different diameters filled with cloudy, yellow liquid was revealed. The removed uterus with appendages and a large omentum were also given for pathological examination. Pathohistological examination results included: 15824-8- granulosa-cell ovarian tumour; 15815-7- uterus - plethora; 15818-20-ovary - white bodies, fallopian tube - chronic salpingitis; 15812-4- omentum - focal hemorrhages. The postoperative period was uneventful, the patient was referred to a gynecologist-oncologist for consultation and treatment.

Provision of specialized medical care to patients in a modern inpatient polyclinic complex

The article is devoted to the analysis of medical and economic standards of medical rehabilitation of patients with complicated and un[1]complicated fractures of the mandible. The structure of therapeutic measures for the treatment of fractures of the mandible in the hospital, complications of fractures of the mandible were studied. The results of the analysis of medical documentation of 550 patients with fractures of the mandible and their complications who sought medical help in Maxillofacial hospital for war veterans, Pirogov City Clinical Hospital №1 for the period from 2006 to 2021 are presented.

Comparative characteristics of pneumonia caused by <i>Mycoplasma pneumoniae</i> in children

The urgency of the problem of community-acquired pneumonia in children is due to the high incidence rate. In the etiological structure of bacterial pneumonia, Streptococcus pneumoniae and Mycoplasma pneumonia (Mp) prevail.Purpose: to identify clinical, laboratory and instrumental features of mycoplasmal pneumonia in children.Materials and methods. A retrospective, single-center cohort study of 266 case histories of children aged 4 months to 17 years who were in Children’s City Clinical Hospital No. 9 in 2019 with a referral diagnosis of pneumonia was carried out. To verify the diagnosis of pneumonia, the method of chest X-ray was used, for the etiological diagnosis, the method of PCR swabs from the nasopharynx, ELISA for the detection of antibodies of the IgM and IgG classes was used. Results. The diagnosis of pneumonia was confirmed in 190 children. The diagnosis of pneumonia caused by M. pneumoniae (MpP) was established in 76 (40%) children, they made up the 1st group. The remaining 114 (60%) children with community-acquired pneumonia of another etiology (CAP) made up the 2nd group – comparisons. The diagnosis of MpP was confirmed in 46 (60.5%) children by the detection of IgM, in 12 (15.8%) by the detection of Mp genetic material, and in 18 (23.7%) by positive both IgM and PCR. The median age of children in the group with MpP was 9.6 years, in the comparison group – 4 years (p<0.01). Significantly more often MpP occurs in children aged 11–17 years (p < 0.01), and CAP – up to 7 years (p < 0.01). With MpP, catarrhal phenomena in the form of hyperemia of the oropharynx, nasal congestion, and unproductive cough are observed less frequently than with CAP. With MpP, rales in the lungs are heard more often than with CAP, they are significantly more often wet (p<0.01). Respiratory failure and dyspnea are less common in MpP than in CAP. Bilateral lesions and lesions of the upper lobe of the lungs are more often detected in MpP, and in CAP – right-sided lesions. In the general blood test, leukocytosis, incl. above 15 thousand/µl, as well as leukopenia below 4 thousand/µl were significantly more frequent in the group of patients with CAP (p<0.01). Conclusion. No clear clinical and laboratory criteria for mycoplasmal etiology of pneumonia have been obtained, which dictates the need for laboratory confirmation for the choice of therapy tactics.

Opportunities to improve the prognosis of the course of COVID-19 for at-risk patients

To evaluate the efficacy and safety of a combination of virus neutralizing monoclonal antibodies in the treatment of patients with confirmed COVID-19 and risk factors for disease progression and severe disease course. The study was carried out in the Sokolniki temporary hospital of the Inozemtsev City Clinical Hospital. A retrospective comparative case-control study included 400 patients hospitalized for confirmed COVID-19 infection from November 01, 2022 to March 31, 2023. Patients were divided into two groups depending on the treatment given: the first control group (n=200) and the second group (n=200), where patients received a single intramuscular injection of tixagevimab + cilgavimab within the first days of hospitalization. When analyzing the concomitant pathology, C-reactive protein level and CT scans at the time of hospitalization, it was revealed that patients in the tixagevimab + cilgavimab treatment group were more severe compared to the control group. On the 2nd day of hospitalization, there was a decrease in the level of C-reactive protein in the control group by 36.2%, in the group receiving tixagevimab + cilgavimab - by 45.2%; p<0.05. Standard treatment was supplemented with antibacterial therapy in 47 (23.5%) patients of the first group and in 32 (16.0%) patients of the second group, which was due to the accession of bacterial infection; p<0.05. Significant differences were found in the duration of hospitalization, which averaged 8.0±0.21 bed-days in group 1 and 6.4±0.13 (p<0.05) bed-days in group 2. No adverse reactions to intramuscular injection of tixagevimab + cilgavimab were detected. The use of a combination of neutralizing monoclonal antibodies in patients with COVID-19 reduce the average bed-day in hospitalization of patients with comorbid pathology and/or immunodeficiencies and high risk of progression of infection.

Clinical observation of patients with fractures of the proximal humerus bone in Kazakhstan

Background: Treatment of patients with fractures of the proximal humerus remains an urgent problem of modern traumatology and orthopedics. The aim of this work was to study the results of surgical treatment of patients with proximal humerus fractures in which plates with angular stability of screws were used for osteosynthesis.Materials and methods: Thirty six patients aged 18 to 75 years with fractures of the proximal humerus, ,were observed after treated in the polytrauma department of the City Clinical Hospital No. 4 in Almaty, Kazakhstan during the period from August 2019 to December 2021. There were12 men (33.4%) and 24 women (66.6%). According to the C.S., Neer patients were distributed as follows: two-part patients - 17 (47.2%), three-part patients - 11 (30.6%), four-partpatients-5(13.9%), fracture-dislocations of the humerus head-3 (8.3% ). Most of the patients applied before 3 days after injury (53.0%).Results: Positive treatment results were achieved in most cases with two and three fragmentary fractures and in those operated early (from 3 to 7 days) after injury. Plates with angular stability of the screws provided excellent and good treatment results in 69.5%, and a satisfactory result in 16.7%. The unsatisfactory results of treatment were 13.8%, and the incidence of postoperative complications was 19.4%.Conclusions: Performing stable osteosynthesis in three- to four-fragment fractures and fracture-dislocations of the humerus head is technically a difficult operation. A study of our material and literature has shown that the incidence of complications after extra-cortical osteosynthesis of the humerus is associated not only with the surgical technique of implant placement, but also with the nature of the damage, including osteoporosis, osteonecrosis, and pathology of bone tissue regeneration.

Gender-related differences and its effects on ureteroscopy success

Introduction. The prevalence of urinary stone disease (USD) historically considered a predominantly male disease. It has been rising over the last several decades with the rate of increase being higher among females. However, factors such as stone localisation, size, and density are usually analysed in postureteroscopic complications, and reports on gender-specific differences in the treatment of USD are scarce.Objective. To investigate the impact of gender differences on treatment success, intraoperative and postoperative complications in patients undergoing ureteroscopy.Materials &amp; methods. A total of 300 patients with USD, who were performed ureteroscopic interventions in the period from September 2021 to November 2022 in Yudin City Clinical Hospital. Depending on gender, patients were divided into two groups — 194 (64.7%) men and 106 (35.3%) women. Recurrent USD was observed in 71 (36.6%) cases in Group I and in 45 (42.5%) cases in Group II, with an average recurrence time of 4.3 and 6.3 years, respectively. Male and female patients have had stone location in the upper third in 14.4% and 18.9% of cases, in the middle third in 18% and 6.6% (p = 0.005), in the lower third in 36 .1% and 49.1% (p = 0.04), in the intramural ureter in 28.9% and 21.7%, and in several localisations in 2.6% and 3.8% of cases, respectively.Results. The duration of surgery did not differ in both groups and composed 41.6 minutes. Internal ureteral stent placement was in 37 (19.1%) male patients and in 14 (13.2%) female patients. Based on specialised postureteroscopic lesion scales such as PULS and Satava, the percentage of complications in Groups I and II was 2.1 and 2.8 and 4.1 and 9.4 (p = 0.03) respectively.Conclusion. The development of acute renal colic in women with patients less intensity than in the male group leads to hospitalisation in the delayed period. In female patients, the number of postureteroscopic complications has higher rates due to the size and density of the stone and its location.

Медико-социальная значимость заболеваний периферической нервной системы на примере карпального туннельного синдрома.

Peripheral nerve diseases are one of the socially significant problems in the healthcare system of the Russian Federation. Effective care for patients suffering from these diseases is an important task for healthcare, as so as they are accompanied by prolonged disability. However, at present we do not have data that could fully demonstrate the medico-social and medico-economic aspects of carpal tunnel syndrome (CTS) and other peripheral nerve diseases in the Russian Federation. The aim of the study is to improve the quality of medical care for patients with carpal tunnel syndrome based on the analysis of statistical data of patients operated on for this pathology in the S. P. Botkin City Clinical Hospital. Material and methods. The patients in the study were all adult men and women who underwent surgical treatment of CTS at S. P. Botkin City Clinical Hospital in the period from 2016 to 2022. The sources of information about the treated patients were the information of medical information systems used in the hospital in different years. Statistical and visualization tools of the Microsoft® Excel® spreadsheet were used to obtain descriptive statistics and present data graphically. Results. In the S. P. Botkin City Clinical Hospital, which is the clinical base of the Department of neurosurgery of the Russian Medical Academy of Continuous Professional Education, in the period from 2016 to 2022, 692 surgical interventions were performed for patients with CTS. The analysis of statistical data has shown results comparable with the available literature data, however, a distinctive feature is an extremely long history of the disease before surgical treatment. Conclusions. Currently, in our country, there is an underestimation of the importance of peripheral nerve diseases, therefore, their separate statistical accounting in the structure of neurological morbidity is extremely important. Another important task is a multidisciplinary approach that provides high-quality medical care to patients with this pathology.

Advantages of multi-target scintigraphy in the diagnosis of kidney cancer

Background. There has been a recent increase in the incidence of kidney cancer, which is explained not only by the improvement in the diagnosis of neoplasms but also by a true increase in the incidence of renal cell cancer. This led to the need for in-depth study and solution of the following problem: to prove the benefits of multi-target scintigraphy for the assessment of the functional capacity of kidneys in establishing the diagnosis of kidney cancer and early detection of secondary lesion of the skeleton during the primary full examination of the patient, as well as in monitoring of the disease.&#x0D; Purpose. For the first time to prove diagnostic significance of a multi-target scintigraphic examination with a radiopharmaceutical drug with renal and osteotropic kinetics, in the form of a sequential combination of dynamic renal scintigraphy and osteoscintigraphy (as one diagnostic examination) in the early detection of secondary lesion of the bones of the skeleton and simultaneous determination of the functional capacity of kidneys in the pre-treatment period and in monitoring of the course of kidney cancer.&#x0D; Materials and methods. Dynamic renal scintigraphy and subsequent (within the next 3 hours) osteoscintigraphy with 99mTc-methylenediphosphonic acid (99mТс-MDP) (activity of 370–740 MBq) were performed on the SPECT-1 gamma camera «AMCRIS-H Limited» (Ukrainian-American enterprise) with computer software «Spect Work» (Ukraine) at the premises of the Department of Radiology and Radiation Medicine of Bogomolets National Medical University in the Department of Radionuclide Diagnostics of communal non-commercial enterprise&#x0D; «Kyiv City Clinical Hospital No.18». 20 patients with a morphologically established diagnosis of kidney cancer, aged from 38 to 68 years, were examined before the full diagnosis was established according to TNMx. As a control group, 8 patients with ultrasonography-confirmed cystic lesions of the kidneys were examined.&#x0D; Results. Using a radiopharmaceutical drug with renal and osteotropic kinetics in the form of a simultaneous sequential combination of dynamic renal scintigraphy and osteoscintigraphy (as one diagnostic examination) allowed us to assess the degree of deterioration of the filtering and excretory capacity of the kidneys regardless of the origin of the expansive process. The results of dynamic renal scintigraphy with 99mТс-MDP made it possible to assess functional capacity of the kidneys no worse than specific renal imaging agents in subsequently given possibility to determine secondary lesion of the bones of the skeleton in osteoscintigraphy. We established indicators of development of renal compensation process and subsequent decompensation process of the contralateral kidney. It was especially noticeable when analyzing the asymmetry of the fixation of the radiopharmaceutical in the functioning kidney parenchyma, depending on the degree of the disease progression.&#x0D; 20 patients with kidney cancer underwent osteoscintigraphy for the complete diagnosis to be established according to TNM. The following changes were detected: the presence of heterogeneous focal (17,8% of the cases) and multifocal (7,1% of the cases) distribution of the radiopharmaceutical.&#x0D; Conclusions. Performing a multi-target scintigraphy with 99mТс-MDP (phosphates) in malignant process in the kidney allows the functional capacity of the kidneys and the presence of the secondary lesion of the bones to be assessed in one exami- nation. Besides reducing radiation burden on the patient (one examination instead of two), it is also economically beneficial.

Surgical approaches to the treatment of complicated ulcers of the stomach and duodenum

Surgical treatment of combined complications of peptic ulcer disease of the stomach and duodenum currently remains a complex and not fully resolved problem in abdominal surgery. Algorithms, surgical approaches and tactics of surgical treatment of patients with multiple combined complications have not been developed. The relative number of patients with a combination of complications has increased and is accompanied by significant mortality. The aim was to improve the results of surgical treatment of complicated gastroduodenal ulcers. The presented materials are the results of the analysis of the surgical treatment of patients with complicated gastroduodenal ulcer for the period from 2000 to 2022, which was carried out on the basis of the Kyiv City Clinical Hospital No.12 (Gastro Intestinal Bleeding Center of the city of Kyiv). 395 patients operated on for complicated gastroduodenal ulcers (combination of 2 or more complications) were analyzed. By time period, all patients were divided into 2 periods: group A (2000–2014) – 209 patients, group B (2015–2022) – 186 patients. Of which 299 (75.7%) patients had a combination of two complications in different combinations, 88 (22.3%) patients had a combination of three complications, and the remaining 8 (2.3%) had four complications. Gastrointestinal bleeding was observed in 164 (41.5%) of 395 patients, and ulcer perforation complications were observed in 353 (89.4%) patients. 352 (89.1%) emergency operations were performed, 43 (10.9%) early-term operations. The use of modern measures of endoscopic hemostasis made it possible to operate on patients with EDP, and their share increased 2.6 times (from 13 (6.2%) to 30 (16.1%)) and made it possible to perform radical operations in most cases (from 174 (83.2%) to 182 (97.8%)) both organ-preserving and organ-sparing. The total mortality in group A was 21 cases per 209 patients (10.1%), and in group B it decreased to 12 cases per 186 operated (6.5%). The highest rate of complications and mortality is associated with gastric resection – 42.9% (3 out of 7 patients). The lowest rate of mortality was among patients who underwent OSO, 3.3% (8 out of 245 operated on). Keywords: complicated gastroduodenal ulcer, perforation, bleeding, stenosis, penetration, early delayed period.

TRAINING OF INTERNS IN SURGERY: TODAY’S FEATURES

Summary. The aim: To find the most effective methods of training interns in surgery under conditions of martial law restrictions at the Department of General and Emergency Surgery of the National University of Health of Ukraine named after P.L. Shupika.&#x0D; Main part. Training for surgical interns was organized in a mixed format, that is, theoretical disciplines in an online format; and the acquisition of practical skills, the study of which requires access to the patient in an offline format. Distance education was conducted in the remote conference system on the Zoom Video Communications platform, and exchange resources using the cloud services of the Google platform were used. The mailing was carried out via Viber messengers, cellular communication. The educational material fully corresponded to the approved curriculum according to the internship program for intern doctors and the specialty “Surgery”. The content of the lecture material was presented as a PDF presentation. Seminar classes were conducted in the format of an online webinar, the results of test tasks and situational tasks were analyzed. Practical classes were limited to independent study of video materials of educational videos and operations. An interview, Viber messengers, chat, and e-mail were used for the final control of knowledge. In order to master the practical skills of operative interventions, interns in surgery were involved in the treatment process of the departments of the surgical clinical base of the department of the multidisciplinary city clinical hospital No. 6.&#x0D; Conclusions. The optimal ways of learning in the intramural cycle of internships in surgery in a mixed form in martial law conditions are a combination of teaching the theoretical part in an online format and acquiring practical skills in mastering surgical interventions through the integration of interns in an off-line format into practical activities in surgical departments of the clinical base of the Department of General and Emergency Surgery of of the National University of Health of Ukraine named after P.L. Shupika.

Periprosthetic infection after total hip arthroplasty in polytrauma victims

Infectious complications during endoprosthesis of large joints are one of the urgent medical and socio-economic problems of modern orthopedics and traumatology. The purpose of the study was to improve the results of treatment of periprosthetic infection in patients after total hip arthroplasty as a result of polytrauma by determining the features of the course and diagnosing it in this category of patients. To carry out the study, a retrospective analysis of 87 cases of periprosthetic infection was conducted in patients undergoing inpatient treatment at the Kyiv City Clinical Hospital of Emergency Medical Care for the period 2012–2020 and divided into observation and control groups. Іn the first group, acute postoperative periprosthetic infection (up to 4 weeks) was detected in 33 victims, which was 71.7% of the group. In the second group, this type of periprosthetic infection was detected in 23 victims, which was 56.1% of the group. Late chronic infection (from 4 weeks to 1 year) among the victims of the first group was found in 10 patients, which was 21.7% of the group. In the second group, there were 11 patients with late periprosthetic infection, which was 24.4% of the group. All patients participating in the study were divided into observation and control groups. Periprosthetic infection after total hip arthroplasty in polytrauma victims develops more often in the early stages, up to 4 weeks. In addition to gram-positive cocci, the causes of periprosthetic infection are often gram-negative enterobacteria, which indicates the prevalence of the endogenous route of infection in this category of patients. Among the etiological factors of periprosthetic infection after total hip arthroplasty in polytrauma victims, Acinetobacter spp. is quite often found, which is a consequence of long-term use of invasive methods of treatment and monitoring performed on the patient during the treatment of traumatic injuries. Keywords: large joints, arthroplasty, microorganisms, complications, multiple trauma.

Blepharorrhaphy in the complex treatment of the anterior eye diseases

Introduction. Blepharorrhaphy (BR) is an operation aimed at reducing the size or complete closure of the eye slit, a technically simple and proven technique used in the treatment of patients with various diseases of the eye accessory apparatus, eyeball and orbit. But to date, there are no clear criteria for choosing the type of operation (temporary or permanent, the latter is full or partial) and evaluating its effectiveness.The purpose of the study: to evaluate the effectiveness of the use of blepharorrhaphy various types in the complex treatment of the eye anterior part diseases.Material and methods. The analysis of case histories and outpatient records of patients who underwent blepharorrhaphy surgery in the ophthalmological department of the City Clinical Hospital No. 2 named after Dr. F.Kh. Gral’ in Perm in 2020–2021 was carried out.Results. 42 partial blepharorrhaphy surgeries were performed, including temporary suture and non-bloody permanent ones in 30 patients in 35 eyes. The type of BR and the period for which the stitches were applied were determined individually depending on the severity of the lesion. At the same time, the cornea was coated with the “Alloplant” material for the conjunctiva and cornea. All patients were divided into 4 groups depending on the etiology of the pathological process. According to the indications the BR was repeated. The analysis of treatment results was carried out within each group in the early postoperative and long-term periods.Conclusions. The effectiveness of blepharorrhaphy was assessed by the possibility of preserving the eye as an organ, it was possible in 94%. The preserved eyes needed further rehabilitation. The choice of one or another type of operation should depend on a number of conditions and the approach in each case should be strictly individual.

Modern possibilities for correcting of severe iron deficiency anemia during pregnancy

An analytical review of literature data on modern methods of treatment of pregnant patients with severe iron deficiency anemia (IDA) was carried out. The authors present their own data on the results of treatment of severe IDA in two pregnant patients who were in the Department of Pregnancy Pathology of the Gomel City Clinical Hospital №3 in October – November 2022. Literature data on the high effectiveness of treatment of pregnant patients with severe IDA by intravenous infusion of iron carboxymaltosate in a dose of 1000 mg . The absence of immediate adverse side effects and complications of pregnancy makes it reasonable to use this drug in the 2nd and 3rd trimesters in the complex treatment of IDA.