Kyiv City Research Articles

Renaming Kyiv’s Streets Amid the Russian War of Invasion: The Politics of History Between “Decommunization” and “Derussification”

The article undertakes a comparative thematic and narrative analysis of the trends in place name change in Kyiv (as published by the Kyiv City State Administration) during two periods: (1) between 2014 and the start of Russia’s full-scale invasion on 24 February 2022 and (2) between 24 February 2022 and the first anniversary of the Russian invasion in 2023. From 2014 to early 2023, 517 (about 17 percent) of Kyiv’s urbanonyms were changed. It is found that 58 percent of names changed during this entire time span belonged to the “Soviet nostalgic” narrative and 41 percent — to the narrative of the “Russian world”, while 1 percent were non-political. Before 24 February 2022, the “Soviet nostalgic” narrative was affected the most (88 percent of renamings), which reflects the phenomenon of “decommunization”; however, during the full-scale Russian invasion its share fell to 30 percent. In the period after 24 February 2022, the theme of “derussification” clearly dominated, with the share of removed names that represented the “Russian world” narrative increasing from 11 percent (before the full-scale invasion) to 69 percent. The largest proportion of newly minted toponyms in the period from 2014 to 2023 embody the “national Ukrainian” narrative (59 percent), while 35 percent invoke a “non-political” context and 6 percent are internationally-themed. The ongoing urbanonymic change, as analyzed in the article using Kyiv as a case study, has led to a radical transformation of the urban symbolic order in Ukraine. Ukraine is appropriating these spaces, displacing the Russian imperial legacy. The radicalization of this policy is a result of the Russian aggression; however, it reinforces an already existing trend. It is also an act of defiance, doing the opposite of what the aggressor may have planned or would have done, had Kyiv been captured. Thus the sad but stubborn irony is that the attempt to reintegrate Ukraine into the Russian imperial order has produced the exact opposite outcome — a fundamental rejection of the symbols of the “Russian world”.

RADIATION SITUATION IN THE CONTAMINATED TERRITORIES OF UKRAINE IN THE POST-CHORNOBYL PERIOD FROM 2013 TO 2022

Radiological tests analysis aimed to determine important issues regarding the safety of food products, feeds, medicinal herbs, etc., obtained from radioactively contaminated territories as a result of the accident at the Chornobyl nuclear power plant. The material for analysis was current documentation of the Regional State Laboratories of State Service of Ukraine on Food Safety and Consumers Protection in Zhytomyr, Volyn, Rivne, Chernihiv regions, Central Testing State Laboratory of State Service of Ukraine on Food Safety and Consumers Protection in Kyiv region and Kyiv city from 2013 to 2022. The analysis is conducted regarding contamination of food products, feeds, medicinal herbs, etc., with radionuclides 137Cs and 90Sr. The specialists of regional State Laboratories of State Service of Ukraine on Food Safety and Consumers Protection conducted 12 797 892 radiological tests, that showed 3 372 samples with higher than the permissible level content of 137Cs and 10 samples with higher than permissible level content of 90Sr. 137Cs is a main dose-forming radionuclide that has considerable influence on getting internal irradiation by population. There have been rare cases of contamination of food, feeds, and medicinal herbs with 90Sr. It was found that forest-based food (mushrooms, berries) – 62.1, milk – 22.7, meat of wild animals – 8.3, feeds – 1.8, and medicinal herbs – 0.8 had been mostly contaminated with 137Cs from the total number of samples with positive results for the specified period. Thus, analyzing the results of radiological tests over the past decade, it should be noted that even today, further radiological control of food products, feeds, etc. in radioactively contaminated territories is expedient and requires further implementation of anti-radiation protection actions established by current national legislation

ВИКОРИСТАННЯ РЕЗУЛЬТАТІВ РОБОТИ МЕТЕОРНОГО АПАРАТУРНО-ПРОГРАМНОГО КОМПЛЕКСУ В ОСВІТНЬОМУ ПРОЦЕСІ ЗІ СТУДЕНТАМИ ФІЗИКО-МАТЕМАТИЧНИХ СПЕЦІАЛЬНОСТЕЙ ЗАКЛАДІВ ВИЩОЇ ОСВІТИ

Features of meteor fixation methods by organizing a network of corresponding observation points – permanently operating observation stations located on the territory of Ukraine with appropriate technical and software for basic and one-way observations of meteors in the radio range of electromagnetic wavelengths are presented, as well as the results of involving students in the analysis of work results meteor hardware and software complex, as a component of the Ukrainian meteor ob servation network. The principle of operation of a separate meteor hardware and softwar e complex for observing meteors in the radio range of electromagnetic waves using the method of direct scattering on meteor trails of signals from powerful FM radio broadcasting stations with the possibility of further processing and presentation of data by students of physical and mathematical specialties of higher education institutions is considered. The results of statistical data processing of meteor invasions and their graphic representation by students of physical and mathematical specialties are described. The seventh reception station in the city of Kyiv (student campus of NUBiP of Ukraine) – the seventh meteor hardware and software complex, as a component of the Ukrainian meteor observation network – has been put into operation.

Hypertensive supratentorial intracerebral hemorrhage: clinical picture, diagnosis, treatment

Background. The paper analyzed the severity and prevalence of hypertensive supratentorial intracerebral hemorrhages (ICH). This pathology is an urgent problem in the global health context, as it leads to severe consequences, including disability and death of patients. Recent discoveries and clinical guidelines provide physicians and researchers with new opportunities to improve clinical practice and improve the effectiveness of treatment for these complications. An increase in the number of cases of hypertensive supratentorial intracerebral hemorrhages and their impact on public health makes this problem extremely relevant in the field of medicine. Materials and methods. Two hundred and thirty-two patients with supratentorial intracerebral hemorrhages caused by hypertension were examined and treated in 2019–2020 at the Kyiv City Clinical Emergency Hospital. The average age of patients was 60 years: for men, it was 56 years, for women 69 years. They were observed during treatment in the hospital for up to 21 days. On the 21st day, the degree of disability was assessed. All patients underwent a neurological examination with an assessment of consciousness according to the Glasgow Coma Scale, Intracerebral Hemorrhage Score, Barthel index, modified Rankin scale, National Institutes of Health Stroke Scale (NIHSS). We have used neuroimaging methods (computed tomography, magnetic resonance angiography, if necessary). Clinical and laboratory studies were conducted. Results. It was found that 127 (57 %) patients had putaminal supratentorial hemorrhage, 24 (10 %) — thalamic, 34 (15 %) — subcortical (in the white matter of the cerebral hemispheres), 47 (20 %) — mixed. Seventy-seven (33 %) patients were hospitalized in a coma (Glasgow Coma Scale ≤ 8 points), 36 (16 %) in a sopor, 81 (35 %) in a stunned state, and 31 (13 %) patients were conscious. Patients over 60 years of age had ICH of deep localization, while young patients had cortical ones. Ninety-four surgical interventions were performed in 84 patients with lobar and lateral hematomas, as well as with breakthrough into the ventricular system (liquid drainage surgery). General mortality was 39.5 %, surgical — 46.4 %. Contraindications for surgical interventions were as follows: an existing severe coma, unstable hemodynamics, the need for constant administration of vasopressors, as well as severe comorbid conditions. Conclusions. It was found that the clinical picture of acute supratentorial intracerebral hemorrhages against the background of hypertension is characterized by polymorphic neurological symptoms according to the localization of the hematoma, its volume, cerebral edema, and intracranial hypertension. The results of the treatment of patients with hypertensive ICH indicate the need for early hospitalization, early computed tomography scan, and a differentiated approach to surgical removal of the hematoma. The favorable outcome of supratentorial ICH is more typical for patients with initial mild and moderate neurological symptoms in case of a hemorrhage volume of less than 30 cm3. The presence of blood breakthrough into the ventricular system increases the risk of death by 35 times.

Simulation of surface wastewater flow volume using the city of Kyiv as an example

Although observations of the negative impact of surface runoff on water quality in water bodies have a long history, the development of national regulations governing surface water quality took place only in 2022. Accordingly, the Law of Ukraine "On Water Drainage and Wastewater Treatment" was adopted, which entered into force in August 2023 and is part of the process of adapting Ukrainian legislation in the field of water drainage in accordance with Council of Europe Directive 91/271/EEC "On Urban Wastewater Treatment". The paper analyzes the problem of determining the volume of annual surface runoff to be cleaned at treatment facilities. Using the data of the hydrometeorological service on the maximum daily amount of precipitation of various types for the city of Kyiv, the dependences of the distribution of the probability of daily layers of precipitation, in the form of the total depth of precipitation and the total duration of precipitation, were obtained. The conclusion that the predominant volume of runoff is determined by microrains that have a high frequency of recurrence is confirmed. The problem of finding the ratio of precipitation and runoff in the regulatory documents of Ukraine is covered very primitively, which is why there is a need to determine the depth of runoff on a more advanced basis, taking into account infiltration, which is determined by the parameters of the filtration properties of soils. The effect of imperviousness on the drain layer is determined through simulations using the SWMM distributed model. The F/P parameter is proposed, which characterizes the volume of losses from the total amount of precipitation depending on the properties of the surface, namely waterproofness and filtration coefficient. The modeling made it possible to obtain the dependence of the F/P parameter on the filtration coefficient and the imperviousness of the catchment area. Calculations confirmed that the runoff in most cases is formed as a result of precipitation, the value of which exceeds 2.5 mm. For the city of Kyiv, the volume of surface wastewater runoff for the warm period of the year from an area of 1 ha was calculated depending on the soil filtration coefficient at 60% imperviousness. As a result of these studies, it is recommended that sewage treatment plants capture and treat rainwater with a probability of 70 to 90% of the total depth of precipitation that falls on the catchment area. At the same time, the value of the flow volume of surface wastewater must be confirmed by calculation.

Bird’s Consortium Ties with Parthenocissus inserta (A. Kern.) Fritsch., 1922 on the Example of Forest Parks and City Phytocenoses in Kyiv City (Ukraine)

Abstract Parthenocissus inserta (A. Kern.) Fritsch. adapts to living in the forests of Ukraine. The influence of P. inserta on native species and its consortial ties with representatives of the secondary ranges biota, in particular birds, has not been studied. The purpose of this study is to make an inventory of the consorts’ ornithocomplexes of P. inserta, to give a comparative analysis of topic and trophic consorts as a result of an introduced species’ participation in the transformation of habitat’s conditions. The material was collected from 2019 to 2022 in forest parks and urban green spaces of the Kyiv city. The bird distribution was determined by the standard method of counting birds at points. Exactly 12.2 ha of P. inserta plantations were surveyed. Trophic consortium relationships of P. inserta with 32 bird species and topic ones with six bird species were revealed. The species composition of consorts was higher in forest fragments than in urban plantations (26 and 21 species, respectively). In the ornithocomplexes of P. inserta consorts in forest biotopes, there was a smaller pressure of dominant species and a more evenly ranked distribution of species by abundance than in urbanized ones. The similarity of the consort’s species composition in urbanized and natural biotopes according to the Sorensen index was 0.64, in consorts 1 and 2 of the consortium concentres was 0.32, and in topic and trophic consorts was 0.27. According to the status of stay in the region, trophic consorts of P. inserta were mainly resident birds – 20 species (62.50%), wintering birds – six species (18.75%), and birds migrating through the region – six species of birds (18.75%). Among the topic consorts, there were four species of sedentary species and two species arriving for nesting. Principal component analysis revealed the largest positive relationship between P. inserta planting area and the number of consort bird species nesting (0.999) and feeding (0.889) on girlish vine plants. We predict that in the future, P. inserta will be more strongly woven into the matter cycle of the secondary range ecosystems. The study of consortial relationships between invasive plants and birds, taking into account the knowledge of the ecological characteristics of consort birds, will make it possible to more effectively prevent the spread of plants into natural biotopes.

Ruderal vegetation of Kyiv City. II. Class Artemisietea vulgaris

The article is a continuation of the study on ruderal vegetation of Kyiv City and provides summarized results of syntaxonomic research of the class Artemisietea vulgaris. We identified 14 associations and one derivative community belonging to three orders and four alliances. Using ordination and phytoindication analyses, the synmorphology of the communities, their ecological requirements, and habitat preferences were described. It has been shown that the vegetation of Artemisietea vulgaris is distributed throughout all districts of the city. According to ecological requirements, we found that main environmental gradients that determine the ordination of different types of stands of Artemisietea vulgaris within Kyiv City are thermoregime and light. The diversity of man-made habitats and regional environmental conditions appeared as the most important factors affecting the territorial differentiation of this vegetation type within the city. The contributed data can be used for strategic planning and practical implementation of measures for sustainable urban development and optimization of the urban environment.

DEVELOPMENT OF METHODOLOGY AND TOOLS FOR REGULAR MONITORING, ASSESSMENT OF THE QUALITY OF WORK OF THE ELECTRONIC HEALTHCARE SYSTEM AND IMPROVEMENT OF THE WORK OF EXISTING SERVICES

Introduction. Medical information systems have become an important tool in the complex of providing medical care. They allow storing the patient's medical data, analyzing information at many levels, and using modern electronic and telemedicine technologies. The glossary of the concept of health care informatization defines a medical information system as a type of system characterized by a complex of methodological principles, technical means, management algorithms designed for the collection, storage, analysis, forecasting and transmission of medical information in health care institutions.
 The aim: To analyze the level of satisfaction of medical workers regarding the functioning of the electronic health care system and medical information systems in all areas of medical activity, by evaluating the data of the electronic questionnaire.
 Materials and methods: A group of 213 user experts from 11 regions of Ukraine and the city of Kyiv was formed to assess the overall quality of the electronic health care system. Informational, analytical-statistical, graphic, and system analysis methods were applied.
 Results. The information entered into the medical information systems is subsequently widely used by doctors, other medical personnel, patients, and the administration of the health care facility. However, numerous functional deficiencies, and user wishes were identified. Assessing them will contribute to the improvement of e-Health.
 Conclusions: Medical information systems (MIS) have become an integral attribute of the practical activity of all doctors. The development of MIS in Ukraine continues in intensive and extensive ways. The first MIS were autonomous and responded to local clinical and administrative needs. The problems of the country's health care management can be corrected through the wide and rational use of MIS, their integration into a single electronic system. This will make it possible to analyze medical data at the level of the country, region, institution and thus be able to apply the correct management decisions. Informatization of health care is a global trend, and in Ukraine it is developing at an unusually fast pace. Therefore, the assessment of convenience, efficiency, and interoperability of MIS should become a permanent tool for monitoring and prompt response by both doctors and health care managers. Medical workers are quite satisfied with the functioning of medical information systems in Ukraine, but the issues between technical solutions and practical use of the application remain unresolved.

PARAMETRIC ANALYSIS OF NATURAL AIR EXCHANGE IN MULTI-APARTMENT RESIDENTIAL BUILDINGS

Most multi-apartment residential buildings built in the 20th century in Central and Eastern Europe do not meet modern energy efficiency requirements. The main part of the thermal energy consumed by buildings is used to heat the supply air from outside, which is the largest share in the energy balance of buildings. The purpose of this research is a parametric analysis of influencing factors on the frequency of air exchange in the room and an experimental study of the concentration of CO2 in a typical apartment. The object of the study is a one-room apartment in a family-type dormitory in the city of Kyiv. The dormitory has ducted natural ventilation. In the work, experimental measurements of the concentration of carbon dioxide were carried out in the premises of the living room, kitchen, corridor of the apartment and in the ventilation channel in the summer period. The indicator gas method was used to measure the air exchange rate. During air infiltration, the average rate of air exchange in the absence of people in the apartment in the living room was 2.41 h-1, in the corridor - 2.34 h-1, in the kitchen - 0.57 h-1. Under exfiltration conditions, the average values were lower: living room – 0.24 h-1, corridor – 0.94 h-1, kitchen – 0.52 h-1. The dependence between wind directions and the phenomena of infiltration and exfiltration in the premises of the apartment was recorded. As a result of the research, it was established that the most influential parameter of the change in the concentration of CO2 in the room is the release from people's breath. It follows from the simulation results that to ensure the regulatory level of CO2 concentration is not higher 1500 ppm, it is necessary to observe the air exchange in the considered room not lower than the level of 1.51 h-1 for conditions when 2 people are constantly in the room That is, the mass balance of CO2, which takes into account the number of inhabitants, can be an attractive alternative method for predicting the intensity of ventilation of a building.

Surgical treatment of patients with postoperative perianal scar deformities and concurrent rectal fistulas

Perianal scar deformity is referred to as a scar or deformity in the perianal area, with or without extension to the anal canal. It frequently occurs after surgical treatment for acute purulent necrotic diseases and is associated with the formation of fistulas in the scar. Objective — to evaluate the experience of the proctology department in the treatment of postoperative perianal scar deformities and concurrent rectal fistulas using one‑stage combined plastic surgery. Materials and methods. A prospective, non‑randomized study was carried out at the proctology department of the Kyiv City Clinical Hospital No. 18 to evaluate the treatment outcomes for postoperative perianal scar deformities and concurrent fistulas in the scar using one‑stage combined plastic surgery. A total of 34 patients were treated from January 2021 to February 2023, with an average age of 41.85±7.81 years. All patients had a history of surgical treatment of purulent‑necrotic perineal diseases. The observation period ranged from 1 to 6 months. Preoperative and postoperative data were collected to analyze the duration of surgery, the incidence of complications, the duration of hospitalization and rehabilitation. Results. All 34 patients underwent one‑stage combined plastic surgery, which included a combination of anoplasty or sphincteroplasty and flap plastic surgery. The size of the scar deformity was important when choosing a wound closure method, as 3 (8.82%) patients had a small lesion (up to 2 cm2), 20 (58.82%) had a moderate lesion (from 2 to 6 cm2), and 11 (32.36%) had a widespread lesion of the perianal area (more than 6 cm2). The type of rectal fistula was also taken into account: a simple fistula was observed in 26 (76.47%) patients, and a complex fistula in 8 (23.53%). The average duration of the operation was 90.41±13.48 min, and the patient’s hospitalization period was 5.88±1.41 days. Postoperative complications were observed in 3 patients (8.82%). Conclusions. Our findings demonstrate that, in the majority of patients, a single‑stage excision of postoperative perianal scar deformities and concurrent fistulas combined with skin grafting allows for the preservation of normal anal function and satisfactory cosmetic and functional outcomes.

Work disability due to cardiovascular diseases in newly diagnosed patients in Ukraine during the first year of the war (2022) compared to prior nine years (2013-2021)

Aim: Cardiovascular diseases (CVDs) are a significant problem in Ukraine, accounting for over 60% of all deaths in the country. It is expected that the ongoing Russian aggression will augment this problem. The study aimed to analyze the trends of work disability due to CVDs in newly-diagnosed patients between 2013 and 2022.Methods: This retrospective study included data obtained from the official document “Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation” commissioned by the Ministry of Health of Ukraine. The data on disability due to CVD were obtained from 24 regions and the city of Kyiv for 2013-2022.Results: Between 2013 and 2022, the average incidence of work disability due to CVD per 10000 working-age individuals was 9.86. Among these disabilities, cerebrovascular diseases accounted for the highest proportion, followed by ischemic heart disease (IHD). The incidence of CVD-related primary disabilities displayed a variable upward trend over the observed period, with cerebrovascular diseases and hypertensive diseases showing clear upward trends. Compared to 2021, in the year 2022 (corresponding to the beginning of the Russian aggression) an 20% increase has been observed for CVDs, while for cerebrovascular diseases, IHD, hypertensive disease, acute rheumatic fever, and chronic rheumatic heart disease the increase was 20%, 18%, 22%, and 14%, respectively. The CVD-related work disability varied substantially in different regions of Ukraine.Conclusions: During the first year of the war in Ukraine (the year 2022) there was an increase in primary disability due to CVD compared to the period between 2013 and 2021. This may be associated with war-related psychosocial factors and global impact on CVD. The regions in southwestern parts of Ukraine proved to be especially prone to this increase requiring special attention.

GENESIS OF TRAUMA IN PATIENTS WITH LONG BONE FRACTURES COMPLICATED UNDER COVID-19

Traumatology is one of the branches of medicine that cannot suspend its activities, despite the danger of the COVID-19 epidemic. Treatment of skeletal bone fractures in patients with COVID-19, given the novelty of this problem, is one of the most difficult tasks of modern traumatology and orthopaedics. Bone fractures against the background of COVID-19 are characterized not only by high mortality and disability, but also by unpredictable progression. The aim of our study was to study the impact of the mechanism of occurrence and traumatogenesis of long bone fractures in patients with COVID-19. To carry out the research tasks, we formed a retrospective study array, which consisted of 289 cases of skeletal bone fractures, which were treated at the "Kyiv City Clinical Hospital of Emergency Medical Care" from March 2020 to February 2021. The main mechanism of injury in patients with skeletal bone fractures against COVID-19 was a fall from a height, which was observed 1.5 times more often than in the pre-war period. There was a 10% reduction in high-energy injury mechanisms such as falls from height and direct impact during the epidemic period, and an almost 10% increase in low-energy compression injury mechanisms. Among the patients of the main group, the combination of lighter mechanisms of injury such as falling and compression was more often detected, in contrast to the patients of the control group, where more high-energy mechanisms of trauma from a fall and a direct blow prevailed. During the COVID-19 epidemic, domestic injuries as a cause of fractures increased sharply and the specific gravity of road accidents decreased sharply, which is associated with epidemic restrictions. During the period of the COVID-19 epidemic, industrial injuries significantly decreased, while criminal and combined injuries remained at the same level as before the epidemic.

A MODERN VIEW OF THE PSYCHOSOMATIC CONSEQUENCES OF THE COVID-19 PANDEMIC

This text is the thesis of the VI scientific and practical conference with international participation "Psychosomatic medicine: science and practice". Which will take place on November 2-3, 2023 in the city of Kyiv.

Experience in the design and construction of service facilities located at ‏transport hubs

The article analyzes the latest research, experience in the design and construction of transport interchanges. The main trends and directions of the architectural and planning solution of the service facilities located in them have been identified. The formation of service facilities is influenced by the dynamics of the development of nearby districts and residential areas, the urban development situation, and social and economic conditions. Direct interdependence is observed - provided the population increases in the adjacent residential areas and the production potential of local industrial enterprises increases several times, while the traffic load of the relevant transport arteries, transfer stations and transport junctions and nodes increases. Transport interchanges and stations of the city of Kyiv, Ukraine were analyzed. One of the largest transport intersections was found to be located in the East: in China (Beijing, Shanghai), South Korea (Seoul), Japan (Tokyo, Kyoto). The classification is given depending on the functional load, location in the city system, annual volume of passengers, type of service by size (small, medium, large); type of volumetric-spatial solution. The main principles of the formation of volumetric and spatial solutions are formulated. In the development of the planning structure, the following main functional blocks were identified: transport and transport arteries; storage areas and platforms; communications and transitions (vertical and horizontal, transitions, stairs, elevators, escalators); service of regular and rest transit passengers; trade and entertainment; "intercepting" parking lots and city public transport stops. There are three main types of planning configuration of junctions and landfills, determined in particular by the shape of the plots under construction and the urban planning situation.

Changes in the financing of medical institutions of Ukraine and the efficiency of using their assets

The purpose of the study is to analyze the transformational changes that have taken place in the financing of the health care sector and the availability and regional distribution of assets of health care enterprises. The study is based on data from the Ministry of Finance, the Ministry of Health of Ukraine and the National Health Service of Ukraine.The article analyzes the expenditures of the Consolidated Budget of Ukraine and health care expenditures. It was determined that after the start of the medical reform, there was a trend towards an increase in the share of health care costs in the total expenditure part of the Consolidated Budget of Ukraine.Based on the analysis of the data of the National Health Service of Ukraine, the number and distribution of costs among medical providers according to the level of medical care were determined. The presence and distribution of the medical industry’s assets among hospitals in the regions of Ukraine were analyzed. It was found that, during 2022, enterprises in the healthcare sector of Ukraine significantly increased their assets.To assess the effectiveness of the industry’s use of assets, the indicator of “return on assets” of health care facilities based on the amount of payments from the National Health Service of Ukraine for the provided medical services was used. The amount of payment per patient was analyzed based on the number of declarations signed by patients. The influence of the migration factor as a result of the war on the activities of health care institutions was determined.Conclusions were made regarding the need for a more even distribution of assets of the medical industry to increase the efficiency of their use. The city of Kyiv’s medical assets need more complete use.Based on the results of the study, conclusions were made about the positive impact of the implementation of the reform on the financing of the medical industry. It was noted that further research in this area can be aimed at identifying factors influencing the effectiveness of the use of the assets of Ukraine’s medical institutions and finding reserves for increasing the efficiency of their use.It is emphasized that when making calculations, standard approaches to evaluating efficiency should be transformed, taking into account the specifics of the medical field so that they can adequately reflect the industry’s economic situation.
 JEL classification: H51, I18

Spinal cord injury as a component of polytrauma in road accident victims

Background. Road traffic injury remains one of the most serious and complex types of human injury both in Ukraine and around the world. The purpose of the research: to determine the location and extent of spinal cord injuries as a component of polytrauma as a result of a road accident. Materials and methods. We formed a study array of 298 victims with spinal cord injuries from the array of road accident victims (1,696 people) who were treated in the emergency medical care hospital of the city of Kyiv, the emergency medical care hospital of the city of Chernivtsi, and three central district hospitals of the Kyiv region in 2020–2021. Formation of the research array was carried out by the method of irreversible randomization using the technology of random numbers. The selection criterion for inclusion in the study was the presence of spinal cord injury in road accident victims. At the same time, verification of the nature of the damage was determined at this stage of the study only by clinical and anatomical features, namely, the cervical spine, the thoracic spine and the lumbar spine. Results. It was established that 87.25 % receive damage to one part of the spine. Damage to all parts of the spine in road accidents occurs in 1.68 %. Among the combination of injuries of the spine, the combination of injuries of the thoracic and lumbar parts has the largest specific weight. Spinal cord injury occurs most often in drivers 37.05 %, the least common in pedestrians 30.82 %. According to the NISS, 51.02 % of victims receive a mild spinal cord injury, 39.99 % of victims receive a severe spinal cord injury. In victims with a severity of 25 points, damage to the cervical spine has the largest specific weight of 40.29 %, the smallest is the thoracic section of 28.70 %. In drivers and passengers, the cervical spine is most often damaged, 53.85 and 48.91 %, respectively. In pedestrians, the lumbar spine is most often injured, 47.19 %. The coefficient of combination of damage to several sections of the spine at the same time for drivers and passengers is 1.14, and for pedestrians — 1.6. Conclusions. Spine injuries occur in 17.98 % of victims of traffic accidents. Most often, the cervical spine is damaged in 46.64 %, thoracic — in 32.55 %, and lumbar — in 35.23 % of those injured as a result of traffic accidents.

STUDY OF FIRE LOCATION TIME IN HIGH-STORY BUILDINGS IN CITIES OF UKRAINE

The effectiveness of extinguishing a fire depends on the speed of arrival of fire and rescue units at the scene and the time it will take to deliver the "first" barrel (extinguishing agent) to the location. The rapid supply of fire extinguishing agent gives a chance to localize and then eliminate the fire in the initial phase, although the result depends significantly on the action in the "first minutes of the fire". The urban settlements into appropriate groups based on population and territory using methods of cluster analysis were divided. One settlement was selected from each group of cities, and then data on fires for the period of 2020 was processed. The statistical data obtained from the operational coordination centers of the State Emergency Service of Ukraine in the cities of Kyiv, Kharkiv, Poltava, and Berdyansk, which characterize the process of extinguishing fires, namely the time of arrival of fire and rescue units at the scene of the fire, the time of localization of the fire and the area of the fire, were analyzed. Statistical data were selected only for high-rise buildings. The interrelationship of the following parameters was established: burning area, building floor, time of fire localization. The obtained static data indicate that the area of fire and the time of localization increases on average from 3.5 to 6 times. The result of the data analysis provides a clear understanding of the need to improve the available means and methods (tactics) of extinguishing fires in multi-story buildings. We proposed to use the Typhoon-10 impulse fire extinguisher, which has been converted into a pneumatic gun for the discrete delivery of fire extinguishing substances placed in a special container, as the basis of firefighting tactics in multi-story buildings. Discrete delivery of fire-extinguishing substances in a container allows to reduce the time of localization of fires in multi-story buildings due to the efficiency of deployment of the installation and accurate delivery through the window opening directly to the center of the fire.

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.

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.
 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.
 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
 «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.
 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.
 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.
 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.

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.