Ivano-Frankivsk Regional Research Articles

PREVALENCE OF CHRONIC PAIN AMONG CHILDREN OF THE PRECARPATHIAN REGION AFTER APPENDECTOMY: AN RETROSPECTIVE-PROSPECTIVE STUDY

As one of the leading causes of morbidity in children, chronic pain is a global challenge of public health. From 2004 to 2010, the number of children hospitalized for chronic pain increased by 831 %, particularly due to comorbidities. Over 1.7 million children suffer from moderate and severe pain.
 The study was aimed to determine the prevalence of chronic pain among children 7 to 18 years of age after appendectomies.
 Materials and Methods. One hundred and six children with acute appendicitis, peritonitis, who were treated at the Surgical Department, the Department of Anesthesiology and Intensive Care of CNE «Ivano-Frankivsk Regional Children’s Clinical Hospital» were observed. In the postoperative period, children were divided into the following groups: Group 1a included children 7 to 12 years of age with acute pain; Group 1b comprised children with acute pain at the age of 13 to 18 years; Group 2a included children 7 to 12 years of age with chronic pain; Group 2b comprised children with chronic pain at the age of 13 to 18 years.
 Results. The prevalence of chronic pain among children of the Precarpathian region was 19.81±0.21 %, with a male predominance. Patients with chronic pain required larger doses of fentanyl, analgin and paracetamol (p<0.05). Children with chronic pain had significantly higher FLACC and VAS scores as compared to children with acute pain (p<0.05). Discussion. The study confirmed the need for additional pain relief in children with chronic pain during the perioperative period without significant changes in pain scale indicators.
 Conclusions. Studying prognostic markers for chronic pain development, understanding the mechanisms of formation and application of modern therapeutic methods (regional analgesia) in managing chronic pain in children will prevent its occurrence, thereby reducing children and adolescents’ suffering.

CHARACTERISTICS OF CERTAIN INDICES OF MINERAL METABOLISM IN CHILDREN WITH KIDNEY CALCULI

The aim: To study the violations of bone density indices in patients with kidney calculi. Materials and methods: 175 children with different types of kidney calculi were examined and treated in Ivano-Frankivsk Regional Children’s Consultative Polyclinics and Hospital, from 2016 to 2019 inclusively. Comprehensive metabolic panel involved by means of generally accepted biochemical methods. Sonography of the urinary tract was carried out. Voiding cystourethrography and excretory urography were performed. Bone mineral density was evaluated by means of ultrasonic densitometry. Statistical processing of the obtained data was carried out according to standard methods of variation statistics. Results: In patients with kidney calculi, oxaluria and oxalate-calcium nephropathy (60.0% and 30.0%, p <0.05) occurred most frequently. Signs of syndrome of undifferentiated connective tissue dysplasia - postural malformation (50.0%), thoracic kyphosis (25.0%), and stigmas of dysembryogenesis (25.0%) were noticed. In the majority of children with oxalate-calcium nephropathy, levels of the bone alkaline and acid phosphatase isoenzymes in a blood serum were significantly high, indicating severity of the resorption and disorders in development of the bone tissue. In these children, decreased fraction of ionized calcium, hypomagniemia and hypophosphatemia were observed. Conclusions: Children with oxalate-calcium nephropathy are in group of risk for osteopenic syndrome.

Клінічний випадок легеневої бластоми в дитини як маскування негоспітальної пневмонії

Currently, the problem of diagnosing pleuropulmonary blastoma in children remains relevant, because this pathology often runs under the guise of other nosologies, including pneumonia, and is extremely difficult to diagnose. Currently there are no pathognomonic clinical symptoms, specific diagnostic criteria for this disease, almost 60% of patients have nonspecific symptoms. This article presents a rare clinical case of biphasic pulmonary blastoma in a child who was examined and treated at the Ivano-Frankivsk Regional Children's Clinikal Hospital Ivano-Frankivsk Regional Council. The main clinical manifestations, diagnosis and treatment of biphasic blastoma of the lungs in a child based on the observation of a 5-year-old girl who was hospitalized for acute abdominal pain, chest pain and cough. After clinical — laboratory and instrumental methods of examination, right-sided pneumonia and exudative pleurisy were diagnosed. The set of treatment measures did not give the expected positive effect, improving the patient's condition. Additional testing is required for suspected breast cancer. It has been established that the best method for verifying the diagnosis of pulmonary blastoma is multislice computed tomography with intravenous bolus contrast and immunohistochemical examination of the biopsy. The methods of treatment used in this case, including anti-inflammatory and polychemotherapy according to the scheme, the use of radical treatment at the National Cancer Institute in Kyiv — surgery right pneumonectomy with pericardial resection. The child is currently in stable remission for 4.5 years. The described clinical case demonstrates the difficulty of diagnosing lung blastoma in children due to the lack of typical clinical manifestations. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, pneumonia, blastoma, pulmonology, diagnosis, treatment.

Hybrid Revascularization for Aorto-Iliac Occlusive Disease with Common Femoral Artery Involvement: Early Outcomes of a Single Centre.

To study the early outcomes of aorto-iliac occlusive disease with common femoral artery involvement by hybrid methods of revascularization - iliac stenting with femoral endarterectomy. We report the initial experiences of a single centre and discuss issues that arose. Ninety-eight critical limb ischaemia (CLI) patients with aorto-iliac occlusive lesions TASC-II C and D were treated using HR between January 2017 and September 2020 in the Ivano-Frankivsk Regional Clinical Hospital. Prospective data were recorded and analysed including demographics, technical success, 30-day and early patency outcomes, re-intervention, and death. The mean age of patients was 65 ± 7.2 years (61 men and 37 women). Using classification by TASC-II, 77% of the lesions were class D. Technical success was seen in 98% of patients. Two patients underwent a crossover femoro-femoral bypass due to failure to re-enter the true lumen of the aorta during endovascular lesion crossing. There were no deaths during the 30-day period. No re-interventions for thrombosis were needed. Additional delayed bypass procedures were required in 19 patients (19.3%) with distal occlusions and minor and major tissue loss. The overall complication rate was 16.3% (16 patients). The 30-day patency rate was 100%. The median follow-up period was 18 months (range 1-36 months) with a primary patency rate of 87.2%, and cumulative primary assisted and secondary patency rate of 93.4%. Four patients died during the study period. Hybrid revascularization is a safe and less traumatic method of managing aorto-iliac occlusive disease with common femoral artery involvement. Good early patency results and low major complication rates indicate that HR is an excellent alternative to traditional open surgery, especially for high-risk patients.

Starunya: from geological monument to nature UNESCO geopark

One of the natural wonders of Prykarpatya is the village Starunia – with embalmed in ozokerite and well-preserved carcasses of mammoths and hairy rhinos and an active mud volcano, will undoubtedly delight us with new exploratory discoveries in the field of geology, paleontology and archeology. It is possible that here, together with large fossil mammals of the Ice Age, the remains of hunters on them – our ancestors Cro-Magnons – could be preserved. This discovery would have, without the slightest exaggeration, an international dimension. Therefore, it is necessary to continue the comprehensive study of Starunia, to promote it among environmentalists, scientists, students and schoolchildren. All this develops a love for native nature, encourages the preservation of its unique objects and historical and cultural heritage.The preparation of "Starunia" for the UNESCO World Geoparks Network by specialists of the Ivano-Frankivsk National Technical University of Oil and Gas (IFNTUNG) in accordance with UNESCO requirements is highlighted by UNESCO Geoparks Program.According to these requirements to give the geological monument of nature "Starunia" the status of "geopark" it is necessary to study and give a standard description of all components of the environment: geological environment and endogeodynamic processes, relief (geomorphosphere) and dangerous exogeodynamic processes, hydro- and atmosphere, soil and plants cover, social environment, technosphere and their anthropogenic changes; assess the current environmental situation and develop environmental protection measures. This is not yet the case.In order to further study "Starunia" in IFNTUNG developed Regional Comprehensive Program for 2022–2023 "Starunia: from a natural monument to the geopark of the Ice Age", which was transferred to the Ivano-Frankivsk Regional State Administration and the Regional Council.Thus, the world-famous geological natural monument of national importance "Starunia" deserves a separate national program and shorter deadlines for its implementation, which would allow including "Starunia" in the world network of UNESCO geoparks.

Клиническое течение и распространенность ожирения в сочетании с дисфункцией сфинктера Одди по панкреатическому типу у подростков

Актуальность. Гастроэнтерологические проявления ожирения являются актуальной проблемой медицины вследствие взаимоотягощающего характера. Цель работы: изучить распространенность и клинические особенности течения у подростков с алиментарно-конституциональным ожирением и сопутствующей дисфункцией сфинктера Одди по панкреатическому типу и без данного сочетания. Материалы и методы. Обследованы 120 подростков с алиментарно-конституциональным ожирением в сочетании с дисфункцией сфинктера Одди по панкреатическому типу, которые находились на лечении в областной детской клинической больнице г. Ивано-Франковска за период с 2016 по 2019 год включительно. Больные подлежали комплексному обследованию в соответствии с современными протоколами диагностики и лечения. Результаты. Распространенность ожирения по Украине, по данным статистики, составляла 13,4 % на 1000 детского населения. Среди пациентов преобладали мальчики (70,0 и 30,0 %, р < 0,05). Продолжительность болезни у большинства детей с сочетанной патологией составила 6,0 ± 2,1 года, а в случае изолированного течения заболевания — 4,5 ± 3,1 года. К доминирующим факторам риска вовлечения поджелудочной железы в патологический процесс относились: генетическая предрасположенность (наличие ожирения или избыточной массы тела у одного или двух родителей), гиподинамия и нарушение рациона питания (преобладание мучных изделий и сладостей), реже — недостаточный питьевой режим. Среди клинических проявлений сочетанной патологии доминировала спастическая боль с локализацией в левом подреберье и продолжительностью несколько часов, которая плохо снималась спазмолитиками (75,0 и 25,0 %, c2 = 17,69, р < 0,05). Общий диспептический индекс (вздутие живота и понос) у детей с сочетанной патологией был выше, чем у остальных обследованных (5,01 ± 0,06 и 3,02 ± 0,04 балла, р < 0,05). Интоксикационный индекс за счет общей слабости был самым высоким в когорте детей с алиментарно-конституциональным ожирением и функциональным панкреатическим расстройством (7,02 ± 0,06 и 3,50 ± 0,02 балла, р < 0,05). Выводы. Ожирение часто сочетается с функциональной патологией поджелудочной железы, а отдельные клинико-лабораторные маркеры и факторы риска вовлечения поджелудочной железы в патологический процесс должны лечь в основу обновленных протоколов диагностики и лечения.

Хвороба Вільсона—Коновалова: гострий початок, перебіг, діагностика та лікування (клінічний випадок)

The article presents information on the main etiology and pathogenesis of Wilson–Konovalov disease, as hepato-lenticular degeneration associated with excessive accumulation of copper in body tissues due to an inherited autosomal recessive defect of a protein that transports copper. A rare case of the onset and course of the disease in a patient who was examined and treated at the Ivano-Frankivsk Regional Children's Clinical Hospital is described. The main focus is on the acute, atypical onset of the disease, in particular the signs of severe intoxication syndrome caused by manifestations of hepatic encephalopathy, steroid-induced diabetes, anemia of complex genesis, coronavirus disease, pyoderma. The difficulties of diagnosing the disease against the background of delayed manifestation of the main pathognomonic manifestations and the absence of reliable signs of the disease are shown. The clinical picture of this clinical case, features of the course are described, the indicators of the main clinical and laboratory research methods are given, the results of instrumental diagnostic methods and genetic examination methods are shown, both in laboratories of Ukraine and abroad, which confirmed the diagnosis of Wilson–Konovalov disease. The treatment of this clinical case is described in detail not only at the local level but also in the main leading research institution of Ukraine «OHMATDYT» and «National Institute of Surgery and Transplantology named after O.O. Shalimov». Recommendations for further observation and treatment of the child at the place of residence after orthotopic transplantation of the left lobe of the liver from a living family donor. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Wilson-Konovalov disease, etiology, pathogenesis, clinical picture, diagnosis, examination, treatment.

Ukrainian Regional Political Elite: Formation and Transformation of Identities and Values (A Case Study of Ivano-Frankivsk Region)

The article analyzes key factors facilitating the formation of diverse identities and values of the regional political elite at the stage of the establishment of Ukrainian state, as well as identifies the direction of their future transformation, including sociocultural and mental characteristics of the society, the phenomenon of the historical memory, the level of the development of socioeconomic relations, political regime, the level of the region’s and local best class’ integration into common national political processes. The analysis of the axiological characteristics of the main groups of political elite of the region (representatives of state authorities, deputies, party functionaries, entrepreneurs) allows to confirm the existence of a consensus inside Ivano-Frankivsk regional elite regarding the priority of state independence of Ukraine, that of democracy and liberal freedom, market relations, European vector of state development, formation of the civil society. At the same time, the highly dynamic level of correcting and changing political identities and value orientations, which were, as a rule, situation driven and caused mostly by external factors, points out that the “value portrait” of Ivano-Frankivsk regional political elite remains vague and not finalized.

Changes of non-specific resistance in patients with postoperative peritonitis with abdominal sepsis

Purpose: to study changes in nonspecific resistance and cytokine regulation in patients with postoperative peritonitis with abdominal sepsisMaterials and methods. The clinic treated 456 patients with postoperative peritonitis who were treated in the surgery department of the municipal non-profit enterprise Regional Clinical Hospital of Ivano-Frankivsk Regional Council in the period from 2000 to 2021. Immunological studies were performed in 66 patients with varying severity of abdominal sepsis and its complications.Research results and their discussion. In patients with postoperative peritonitis with abdominal sepsis, the phagocytic index during the first week of hospital stay was in control. However, on the 10th-11th day, the phagocytic index decreased 1.6 times, which progressed until the end of the third week of treatment - on the 14th-21st day, the phagocytic index was 2.7 times smaller than the control. The phagocytic count in patients with PP with abdominal sepsis reached maximum values in the first day of the disease (3 ± 0.26). Later in the treatment process, this figure gradually decreased and on day 14-21 came to normal and amounted to 1.96 ± 0.10. The index of completeness of phagocytosis on the first day of the disease was1,59 ± 0,20. By 2-3 days it decreased by 1.44 ± 0.20 and returned to normal by 14-21 days. Circulating immune complexes were normalized by 5-7 days of the disease.

Prevention of postoperative peritonitis and its complications

Purpose: to develop a new method of lavage of the abdominal cavity in the experimental conditions.Materials and methods. We treated 456 patients with postoperative peritonitis who were on treatment in the surgery department of the municipal non-profit enterprise Regional Clinical Hospital of Ivano-Frankivsk Regional Council in the period from 2000 to 2021. Patients are divided into 2 groups. The retrospective group consisted of 212 patients, prospective - 244 patients.Research results and their discussion. The method of lavage of postoperative peritonitis was carried out as follows: during relaparotomy, after mechanical cleaning of the abdominal cavity from fecal masses, bile, blood clots, fibrin layers, the abdominal cavity washed twice with 2-3 l of 0.02% solution of decamethoxine at a temperature of 30-35 ° C. After removing the drug residues from the abdominal cavity, pour2 liters of solution for peritoneal dialysis Extranil at a temperature of370C, the active substance of which is icodextrin, not glucose, ie it is not a nutrient medium for microorganisms, but has antimicrobial action due to hyperosmolarity and exposure to hyperosmolarity and increases its adsorption properties. This is followed by drainage of the abdominal cavity from four points with polyvinyl chloride tubes, which are intimately fixed to the skin and blocked for 6 hours.

ЕФЕКТИВНІСТЬ ЗАСТОСУВАННЯ ПЛАВАННЯ ДЛЯ ВІДНОВЛЕННЯ ФУНКЦІОНАЛЬНОГО СТАНУ КАРДІОРЕСПІРАТОРНОЇ СИСТЕМИ ПІСЛЯ ПЕРЕНЕСЕНИХ ЗАПАЛЕНЬ ЛЕГЕНЬ

Мета. Встановити вплив занять плаванням на відновлення функціональних резервів кардіореспіраторної системи після перенесених запальних захворювань легень. Методи. У дослідженні взяли участь 50 осіб (12 жінок і 38 чоловіків, середній вік 42,01±1,29 років) після завершення стаціонарного лікування з приводу запальних захворювань легень в пульмонологічному відділенні Івано-Франківського обласного фтизіопульмонологічного центру. За погодженням з лікуючими лікарями вони були скеровані у санаторії “Алмаз” і “Кристал (м. Трускавець) де основним групам (ОГ) у кількості 25 осіб чоловічої і 6 жіночої статі було створено умови для щоденних занять плаванням протягом 18 днів. Тривалість кожного заняття складала 45 хвилин, а обсяг фізичного навантаження – 400–800 м при ЧСС 120-140 уд/хв. Контрольні групи протягом перебування в санаторії плавання не використовували. Для оцінки основних показників функції зовнішнього дихання використовувався комп’ютерний спірометр Mіcrospіro HІ-501. Визначення загальної фізичної працездатності здійснювали за допомогою проби Джеймса. Обстеження здійснювали двічі (до початку і після завершення циклу занять плаванням). Результати. Порівняльний аналіз змін середніх значень дихального об’єму і життєвої ємності легень контрольної й основної групи чоловіків свідчить про те, що в основній групі ці показники зовнішнього дихання перевищують дані групи контролю на 10,9% і 4,0% відповідно (р<0,05). Аналіз засвідчує, Щодо жінок, то величини дихального об’єму та життєвої ємності легень основної групи наприкінці занять зросли у порівнянні з групою контролю на 5,0% і 12,4% відповідно. Вірогідні зміни виявлені також і в показниках хвилинного об’ємудихання, форсованого об’єму дихання та пікової швидкості видиху як у чоловіків, так і в жінок. Висновок. Застосування плавання у відновному періоді осіб, які перенесли запальні захворювання дихальної системи забезпечує нормалізацію функціонування як дихальної, так і серцево-судинної системи, що опосередковано свідчить про нормалізацію механізмів нейрогуморальної регуляції функцій організму.Ключові слова: плавання, запальні захворювання легень, функціональний стан.

INSULIN RESISTANCE IN PATIENTS WITH PANCREATIC AND COLORECTAL CANCER DIAGNOSED AGAINST THE BACKGROUND OF TYPE 2 DIABETES MELLITUS

The aim of the study was to investigate insulin resistance in patients with pancreatic and colorectal cancer diagnosed in people with type 2 diabetes.
 Materials and methods. 64 patients were examined. They were divided into the following groups: group I – healthy people (control group) (n = 16); group II – patients with type 2 diabetes without cancer (n = 28); group IIIa – patients with type 2 diabetes with pancreatic cancer (n = 10), group IIIb – patients with type 2 diabetes with colorectal cancer (n = 10). The study involved patients from specialized departments of the Ivano-Frankivsk Regional Hospital and the Precarpathian Clinical Oncology Center.
 Blood insulin levels were determined by enzyme-linked immunosorbent assay, using Insulin ELISA diagnostic kits, EIA-2935. Fasting blood glucose was determined by glucose oxidase method. Compensation for diabetes was assessed by the level of glycated hemoglobin (HbA1c) and determined by ion exchange chromatography. Data analysis was performed using Statistica 12.0 (StatSoft Inc., USA). Differences between the values in the comparison groups were determined by Student’s t-test and were considered significant at P < 0.05.
 Results. Patients with type 2 diabetes who were diagnosed with pancreatic cancer or colorectal cancer were older, compared with patients with type 2 diabetes without cancer (P < 0.05). Obesity was diagnosed in patients with colorectal cancer of group IIIb, their BMI was higher in comparison with patients of group IIIa who suffered from pancreatic cancer (P < 0.05). BMI in patients of group IIIa was lower than in control group (P < 0.05), in patients of group II (P < 0.05) and in patients of group IIIb with colorectal cancer (P < 0.05).
 Compared with patients of group II, patients with pancreatic and colorectal cancer had significantly lower insulin levels (P < 0.05), but significantly higher fasting blood glucose levels (P < 0.05). Insulin resistance according to the HOMA-IR index (> 3.0) was detected in both types of cancer. The HOMA-IR index in patients with pancreatic cancer was significantly lower than in patients of group II (P < 0.05). The level of HbA1c in patients with type 2 diabetes without cancer and in patients with cancer diagnosed on the background of diabetes did not differ significantly (P > 0.05).
 Prior to cancer detection, the same number of patients (50.0%) received metformin-free therapy in both the pancreatic cancer group and the colorectal cancer group. However, the duration of diabetes in patients with pancreatic cancer was 2.90 ± 2.60 years and was significantly shorter than in patients with colorectal cancer 9.70 ± 5.66 (P < 0.05). 80.0% of patients in group IIIa had a history of diabetes less than 5 years, and 80.0% of patients in group IIIb – more than 5 years.
 Conclusions:
 
 In patients with type 2 diabetes mellitus with pancreatic cancer, as well as in patients with colorectal cancer, insulin resistance was detected by the HOMA-IR index, which depended on the combined effect of insulin and hyperglycemia in patients with colorectal cancer and on the fasting blood glucose in patients with pancreatic cancer.
 The absence of hyperinsulinemia, the short duration of type 2 diabetes in patients with pancreatic cancer may be indirect evidence of cancer induced pancreatogenic diabetes (T3cDM) in the majority of patients of this group.
 For elderly patients with newly diagnosed diabetes mellitus without obesity, without hyperinsulinemia, screening for pancreatic cancer is recommended.

INFLUENCE OF COMPLEX TREATMENT WITH MAGNESIUM AND POTASSIUM SALTS OF GLUCONIC ACID, EPLERENONE AND RIVAROXABAN ON DYNAMICS OF INDICATORS OF ISCHEMIA AND MYOCARDIAL REMODELING IN PATIENTS WITH CHRONIC HEART FAILURE AFTER MYOCARDIAL INFARCTION

The aim: To increase the treatment effectiveness of CHF patients after MI with stenting by using magnesium and potassium salts of gluconic acid, eplerenone, and rivaroxaban in complex therapy. Materials and methods: The research was performed at the premises of Ivano-Frankivsk Regional Clinical Cardiology Centre, Ukraine. 84 patients with CHF after past MI were examined. Results and conclusions: A more pronounced anti-ischemic effect has been linked to the use of combination therapy with rivaroxaban on the background of basic therapy (BT) in patients with CHF after MI, compared with the use of magnesium and potassium salts of gluconic acid or eplerenone. The use of eplerenone in the complex treatment of these patients on the background of BT has been proven to provide a pronounced reverse remodeling of the left myocardium in the postinfarction period.

ORIGINS OF THE PEOPLE'S MOVEMENT OF UKRAINE – IVANO-FRANKIVSK REGIONAL CULTURAL AND SCIENTIFIC SOCIETY “RUKH”

The purpose of the research is to analyze the first independent public organizations of the Ukrainian SSR and the contribution to the state building on the example of Ivano-Frankivsk Regional Cultural and Scientific Society (CSS) “Movement” (“Rukh” – (“Malyi Rukh”)) in the historical context, the revival of democratic processes in the region on the Ukrainian national soil, the cooperation with similar organizations in other cities of the UkSSR, the USSR and the diaspora. The research methodology is based on the fundamental principles of objectivity and historicism, which provide for the consideration of individual phenomena and processes in their development and a close connection with the system of relevant social relations. The historical facts have been considered against the background of the political processes, which imply the use of the comparative analysis method, owing to which, there has been clarified the essence of many significant events for the Ukrainian socio-political thought of this period. The scientific novelty consists in the fact that on the basis of the available press of that period, as well as previously unpublished sources from the archives of Ivano-Frankivsk National Organization of People's Movement of Ukraine (AIFNOPMU), the attempt was made to realize the process of forming socio-political organizations of the Ukrainian SSR, which by large-scale protests, formed the political consciousness and national pride. The Conclusions. A national democratic revival in Ukraine during the late 1980-ies took place by creating centers of socio-political organizations according to the scheme “from the bottom – upwards”. Clubs, unions, committees, circles, associations, societies, parties complemented each other and inscribed the golden core in the national progress and functioned for the Ukrainian statehood. Numerous culturological “informal” associations, which began functioning in the Ukrainian SSR during the second half of the 1980-ies, set themselves one of the most important tasks – the revival of the Ukrainian culture, language, education and the state. Among culturological “informal” associations Ivano-Frankivsk Regional CSS “Movement” (“Rukh” (“Malyi Rukh”)) stood out – a new type of organization – the state type in form and spirit. The historical merit of Ivano-Frankivsk regional CSS “Movement” (“Rukh”) consists in the fact that this organization in a classical form and under its own name (which spread to all-Ukrainian), was formed by the public and was one of the sources (forerunners) of People's Movement (Narodnyi Rukh) of Ukraine at the end of 1987. Ivano-Frankivsk regional CSS “Movement” (“Rukh”) worked actively with societies in most regions of the UkSSR, the republics of the USSR and the diaspora. The organization arose as a result of a public need and on the initiative of its founders, despite the obstacles made by the party-state apparatus. The “Rukh members” used various forms and methods of a political struggle, from popularizing the Ukrainian customs and traditions to mass political protests. They worked selflessly and sacrificially to restore the Ukrainian state. As a result of the elections on March 4, 1990 to the Verkhovna Rada of the Ukrainian SSR and the local Soviets of People's Deputies together with other national democratic organizations, the Society eliminated the communist regime from power and initiated decommunization processes. In the majority of the regions of Ukraine, these processes intensified only during recent years, but in Ivano-Frankivsk (Lviv and Ternopil regions) these processes took place during the beginning of the 1990-ies.

Modern views at the morbidity and course of Henoch-Schönlein purpura in children: a literature review

The article presents data on the prevalence, etiology, pathogenesis and clinical features of hemorrhagic vasculitis in children, based on the modern scientific literature. The aim of the study was to establish frequency and features of Henoch-Schonlein purpura course in children over the past decade. Materials and methods. Scientific and metric systems Google Scholar, PubMed, CyberLeninka, Cochrane database for the period of 2015–2019 were searched, using the keywords “hemorrhagic vasculitis”, “IgA-аssociated vasculitis”, “acute respiratory infections”, “bacterial infections”, “etiology and pathogenesis”, “clinics”. The frequency of the disease in the population was also analyzed, according to the data of the initial presentation at the inpatient and polyclinic of the Ivano-Frankivsk Regional Children's Clinical Hospital of the Ivano-Frankivsk Regional Council, for the period between 2015 and 2019 respectively. Conclusion. It was established that hemorrhagic vasculitis is the most common in childhood, and is diagnosed approximately in 50 % of cases. The disease is triggered mostly by the genetic, infectious and non-identified factors. The authours have distinguished such pathogenic links as glycosylation disorders of immunoglobulin A, the accumulation of circulating immune complexes, resulting in specific inflammation and blood clotting disorders with subsequent development of thrombosis. There are following clinical findings for hemorrhagic vasculitis: palpable purpura, diffuse abdominal pain, accumulation of IgA (confirmed by biopsy of any organ); arthritis or arthralgia; kidney damage (hematuria and/or proteinuria). These data need to be clarified, and further clinical, cohort, and prospective studies should be conducted.

Синдром Пруне–Беллі: випадки з клінічної практики

Objective: to acquaint doctors of various specialties with clinical course, early diagnostics, and treatment strategy for a rare congenital anomaly — Prune Belly syndrome in children. Materials and methods. Inpatient medical records of municipal non-profit enterprise «Ivano-Frankivsk Regional Children's Clinical Hospital» of Ivano-Frankivsk Regional Council. Results. The paper presents the clinical course of a rare congenital anomaly — Prune Belly syndrome in two children. The disease occurs chiefly among boys manifesting itself as multiple congenital malformations including deficiency or aplasia of abdominal muscles, congenital anomalies of the kidneys and urinary tract (hydronephrosis, megaureter, hydroureter, megacystis, vesicoureteral reflux), bilateral cryptorchidism. In addition, Prune Belly syndrome can coexist with urethral pathology, as well as skeletal, cardiovascular, respiratory, gastrointestinal malformations. Conclusion. Modern views on the development, clinical course, and diagnosis of a rare congenital disease with multiple organ malformations — Prune Belly syndrome have been presented for doctors of various specialties. Prenatal diagnosis, detection of potential congenital malformations after birth allows selecting the correct algorithm for monitoring vital organ functions, syndromic treatment and making timely decision on internal organ transplantation. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of municipal non+profit enterprise «Ivano-Frankivsk Regional Children's Clinical Hospital» of Ivano-Frankivsk Regional Council. The informed consent to participate in the research study was obtained from all the children's parents. Conflict of Interest. The authors declare they have no conflict of interest. Key words: children, Prune Belly syndrome, diagnosis, therapy.

VІ МІЖНАРОДНА НАУКОВО-ПРАКТИЧНА КОНФЕРЕНЦІЯ «НАУКОВА ЕЛІТА У РОЗВИТКУ ДЕРЖАВ»

Стаття присвячена VІ Міжнародній науково-практичній конференції «Наукова еліта у розвитку держав», яка відбулася 25-26 вересня 2020 р. з нагоди Дня позашкілля. Цьогоріч захід відзначився двома особливостями — проведенням у режимі онлайн і найбільшим числом учасників — понад 1000 осіб. Метою конференції було обговорення стратегічних питань розвитку освіти і науки, розширення міжнародного партнерства. Основні напрями роботи: наукова еліта і позашкільна освіта у розвитку держав, наукова еліта і соціально-гуманітарний розвиток держав, наукова еліта і економіко-правовий розвиток держав, наукова еліта і туристсько-краєзнавчий та екологічний розвиток держав, наукова еліта і Мала академія наук України. Організаторами конференції виступили: Комітет Верховної Ради України з питань освіти, науки та інновацій, Міністерство освіти і науки України, Національна академія педагогічних наук України, Національний педагогічний університет імені М.П. Драгоманова, Міжнародна асоціація позашкільної освіти, Національний центр «Мала академія наук України», Інститут екології економіки і права, Івано-Франківський обласний державний центр туризму і краєзнавства учнівської молоді. Серед учасників конференції були науково-педагогічні та педагогічні працівники закладів освіти, вчені, представники законодавчої і виконавчої влади, засобів масової інформації, громадськості України та інших держав.

SURGICAL PREVENTION AND TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM IN PATIENTS OPERATED ON THYROID GLAND

Abstract. Thyroid gland (TG) diseases are among the most common and occupy the second place in the structure of endocrine system diseases after diabetes mellitus. The main method of TG disease treatment remains the surgical one. With the increase in the incidence of various forms of TG pathology, the number of surgeries increases including the ones performed at non-specialized in-patient facilities leading to an increase in the frequency of postoperative complications.
 One of the most common specific complications after surgeries on TG is postoperative hypoparathyroidism (PHPT). It occupies a special place considering the severity of manifestations and the difficulty in prevention. It is usually caused by trauma or parathyroid glands (PTG) removal, their blood supply disturbance, as well as the development of fibrosis at the surgery site in the long term.
 Therefore, the improvement of existing technologies and the development of new approaches to surgeries in case of TG diseases are relevant today. The most common method of postoperative hypoparathyroidism (PHPT) surgical prevention is precision nature of surgical manipulations with careful adhering to tactical and technical requirements for the operator: identify parathyroid glands (PTG) timely, mobilize gently, and keep their blood supply. However, it is often impossible to keep PTG intact structurally and without ischemia due to the small sizes of PTG and their vessels, anatomical and embryological features of these organs localization, the consistency and color similarity with fatty tissue, lymph nodes.
 The objective of the research was to develop and evaluate the algorithm of prevention and treatment of postoperative hypoparathyroidism (PHPT) based on determining parathyroid glands (PTG) viability and the use of antihypoxant-antioxidant therapy in the postoperative period. The research was based on the results of a comprehensive examination and treatment of 60 patients who were operated for thyroid gland diseases. The patients underwent inpatient treatment at the surgical department of Ivano-Frankivsk Central City Clinical Hospital and Ivano-Frankivsk Regional Oncology Center from 2017 to 2020.
 We proposed an algorithm for surgical prevention and treatment of PHPT during thyroid gland surgeries which consisted in the following. We performed a visual assessment of PTG intraoperatively and evaluated each gland from 0 to 3 points according to the degree of its viability affection.
 If the gland was evaluated at 0-2 points, we left it, since there was a high probability of maintaining its function. If it was evaluated at 3 points, its autotransplantation was performed. Cytoflavin drug was applied in a dose of 10 ml per 200 0.9% NaCl intravenously once a day during 7 days in the postoperative period for the purpose of antihypoxant-antioxidant therapy.
 2 groups of patients were formed in order to evaluate the effectiveness of the algorithm. Each group consisted of 30 people. Patients of Group I underwent surgery on thyroid gland according to generally accepted rules. Patients of Group II underwent interventions according to the above-mentioned algorithm.
 The use of our proposed algorithm (intraoperative assessment of PTG viability and antihypoxant-antioxidant therapy in the postoperative period) significantly reduces the frequency of permanent PHP justifying indications to its application.

Analysis of Commission Forensic-medical Examinations performed in Cases Concerning the Responsibility of Surgical Professional Doctors

The objective of the research was the analysis of the structure of the commission of forensic medical examinations concerning professional offenses of medical professionals of the surgical profile according to the data of the Ivano-Frankivsk Regional Bureau of Forensic Medical Expertise for the period 2015-2019.
 Materials and methods. The material of the study were the annual reports of the Ivano-Frankivsk Regional Bureau of Forensic Medical Expertise (Commission Department) and criminal case materials. Obtained data were processed using Microsoft Exel, Statistica 6.0. 
 Results. It was found that forensic medical examinations in case of improper performance of professional duties by medical workers accounted for a relatively small part 71 (14.3%) of the total forensic medical expertise. After the performed analysis, it was found that the doctors made diagnostic, therapeutic, organizational-tactical, deontological and combined errors that had a direct (29%) or indirect (26%) connection with the onset of death or adverse effects on the patient’s health. In 45% of cases, there was no correlation between the doctor’s actions and the occurrence of adverse effects for the patient.
 Conclusions. The number of cases for improper performance of professional duties by medical workers is significantly higher in surgeons and obstetricians-gynecologists than in doctors of therapeutic profile. Every year, the complexity of commission forensic medical examinations in case of improper performance of professional duties by medical workers increases. This is due to the increasing complexity of surgical interventions and instrumental examination methods, as well as the increasing legal literacy of the population.

Modern View on the Problem of Bronchial Asthma Comorbidity

We have examined 40 patients with bronchial asthma (BA) based at the municipal non-profit enterprise "Ivano-Frankivsk Regional Phthisiopulmonology Center of the Ivano-Frankivsk Regional Council" (Center for Pulmonary Diseases). The patients were randomized into two groups: Group I (17) involved patients with BA, Group II included (23) patients suffering from BA with obesity. The goal of the research work was to analyze the manifestations of clinical symptomatology, manageability of BA, state of pulmonary function, level of leptin in relation to mono- or polymorbidity. The research findings show the decrease in asthma manageability level in patients with combined pathology, particularly BA + obesity + gastroesophageal reflux disease (GERD), significant negative correlation (r=-0.95, p<0.001) between FEV1 and ACQ-5 data in patients suffering from BA with obesity and GERD. The frequency of nocturnal asthma attacks, heartburn, and sleep disorders tended to increase in patients with comorbid conditions. Features of changes in the concentration of leptin depending on the detected pathology is characterized by the following data. The level of leptin in patients with BA with and without obesity is 4.82 times higher as compared to patients with combined pathology (45.28 ± 10.42 ng/ml), and is significantly different (p<0.05) from the indices observed in patients with normal body weight (9.40 ± 1.52 ng/ml).