Modern Treatment Protocols Research Articles

The comparative study between treatment with Cryoprecipitate and recombinant Factor VIII in Hemophilia in children

Introduction: Hemophilia A is a genetic disorder caused by a deficiency or absence of coagulation Factor VIII, leading to impaired blood clotting and prolonged bleeding, especially into joints and muscles. Without appropriate treatment, recurrent bleeding can result in chronic joint damage and disability. Traditionally, Cryoprecipitate, a blood product containing concentrated clotting factors, has been used to manage bleeding episodes in patients with Hemophilia A. However, with advancements in biotechnology, recombinant Factor VIII, a synthetic product, has become an alternative. Recombinant Factor VIII eliminates the risks associated with blood-derived products, such as viral transmission, and offers more consistent dosing and availability. Despite these advantages, recombinant therapies are significantly more expensive. This study seeks to compare the clinical efficacy, safety of Cryoprecipitate versus recombinant Factor VIII in pediatric patients with Hemophilia A, providing critical insights for optimal management strategies. Purpose: The purpose of this study is to compare the clinical outcomes, safety of Cryoprecipitate versus recombinant Factor VIII in the management of children diagnosed with Hemophilia A. Materials and methods: This retrospective study included 32 pediatric patients diagnosed with Hemophilia A, treated either with Cryoprecipitate or recombinant Factor VIII. Clinical data were collected on bleeding frequency, Factor VIII recovery. Statistical analyses were conducted to determine significant differences between the two groups. Results: The study demonstrated that treatment with recombinant Factor VIII resulted in significantly improved clinical outcomes compared to Cryoprecipitate. In the group treated with recombinant Factor VIII, patients required scheduled hospitalizations for routine follow-up and management, with no reports of acute bleeding episodes during these admissions. This contrasts sharply with the Cryoprecipitate group, where all hospitalizations were precipitated by acute bleeding events, necessitating urgent intervention. Conclusions: Recombinant Factor VIII demonstrates superior efficacy in managing Hemophilia A in children compared to Cryoprecipitate. Recombinant therapy provides better clinical outcomes, justifying its use in modern treatment protocols.

Improving Organizational Medical Care for Patients with Idiopathic Macular Hole: Impact on Quality of Life and Effectiveness of Modern Treatment Protocols

Background: IMH causes loss of central vision and it restricts the activities of a patient, therefore posing a threat to the patient’s quality of life. Modern developments in surgical interventions as well as the organization of medical care enhance the effectiveness of treatment while a detailed analysis of it is needed.Objective: Consequently, the purpose of this particular research is to examine organizational medical care among the specified population of patients with IMH, in regard to their quality of life and the efficacy of contemporary treatment regimens.Methods: To accomplish this, the current study applied narrative synthesis strategies and reviewed literature on IMH diagnosis, management for surgical solutions, and patient outcomes. This assessment encompassed previous and current therapy methods together with patient enlightenment and follow-up with impact on vision clarity and general quotient.Results: From the current review, it was evident that surgeons are now using facilities such as small-gauge vitrectomy and pharmaceutical substances including ocriplasmin, which enhance macular hole closure rates and near visual acuity levels. Teaching has been done to patients/clients and organized follow-ups as part of the organizational care to improve quality of life as perceived by patients from follow-up questionnaires representing a significant improvement in visual function and activities.Conclusion: This paper outlines that patients with IMH require a structured and coordinated, cross-professional approach to its management in conjunction with contemporary surgery revealing drastic enhancements to visual acuity levels and the overall wellbeing of a patient

Method of microbial decontamination of endodontic absorbent paper points: a randomised experimental study

Relevance. One of the challenges in endodontic treatment is preventing the presence or introduction of pathogenic flora into the root canal. Modern treatment protocols aim to maintain aseptic conditions throughout all stages of treatment. Before the final sealing of the root canal, it is dried using endodontic paper points (absorbers). Using previously opened packages of absorbers can pose a risk of contamination by environmental microorganisms.Purpose. This study aims to evaluate the effectiveness of microbial decontamination of endodontic absorbent paper points using various ultraviolet (UV) irradiation treatments.Materials and methods. The study used standard endodontic absorbent paper points, manufactured by compressing paper into cone shapes of various sizes, designed to remove residual moisture from the root canal. The experiment was conducted at the subdivisions of KubSMU of the Ministry of Health of Russia. During the study, absorbers were placed in a bactericidal UV chamber for 1, 3, and 7 days according to the study design. Subsequently, the paper points were immersed in nutrient media and incubated. Results were recorded daily by visually checking for signs of microbial growth (turbidity, sediment, flakes, and other changes in the media). Decontamination was considered complete in the absence of microbial growth in all test tubes. The comparison of the number of positive results was performed using the analysis of four-field contingency tables (comparison of percentage shares in two groups) using the Chi-square test with Yates' correction for independent groups and the McNemar test for dependent groups using Statistica 8.0 software (StatSoft, USA).Results. Analysis of the results from culturing the test samples in nutrient media confirms the safe use of endodontic absorbent paper points immediately after opening the commercial package. In the model used, microbial growth was observed in 22.2% of cases on various media. No positive results for bacterial or fungal contamination were found in samples after treatment. Comparison of the proportion of positive contamination results showed a statistically significant difference according to the McNemar test (p = 0.027). Similarly, a statistically significant difference in the proportions of positive contamination results was observed when comparing with the control group using the Chi-square test with Yates' correction for independent samples (p = 0.009).Conclusion. The study demonstrated that using a UV chamber for storing and decontaminating endodontic absorbent paper points is effective after just one day, significantly reducing the risk of microbial complications in endodontic treatment.

Досвід застосування пробіотика Bacillus clausii UBBC-07 при гострій водянистій діареї в дітей раннього віку в умовах стаціонарного відділення

Acute watery diarrhea in children remains an urgent problem in pediatrics due to its high prevalence and high mortality rates at an early age. Modern treatment protocols provide for a comprehensive approach to the treatment of patients. However, the main method of treatment of diarrhea - oral rehydration, does not allow for the stoppage of the progression of gastroenteritis, of the elimination of the imbalance of microflora and intestinal dysfunction. Such tasks can be solved thanks to the use of probiotics, which are recommended as a component of auxiliary therapy for children with acute infectious diarrhea. Purpose - to conduct a comprehensive clinical and epidemiological analysis of the results of the use of the spore-forming probiotic Bacillus clausii (B. clausii) strain UBBC-07 (Lactiale Germina) in the complex treatment of hospitalized young children with acute infectious watery diarrhea syndrome. Materials and methods. 85 children with acute infectious non-inflammatory diarrhea were comprehensively examined. 2 clinical groups were formed. The Group I - 50 hospitalized children (average age 3.1±0.4 years, the proportion of boys - 64.0%), who received 1 bottle of Lactiale Germina 1 time/day in complex treatment (5 ml=2×109 CFU B. clausii endospores). The Group II included 35 patients (average age 2.4±0.4 years (p>0.05), the share of boys - 54.3% (p>0.05)); who received standard treatment according to existing standards. According to the main clinical characteristics, the comparison groups can be considered comparable. Results. The analysis of the conducted studies established that the use of Lactial Germin increased the chances of a three-fold reduction in the frequency of bowel movements on the 4th day (absolute risk increase (ARI) - 27.0%, relative risk increase (RRI) - 34.6 (95% CI: 25.4-44.8) with the minimum number of patients who need to be treated to obtain a positive result (MNP) - 2.9 (95% CI: 0.5-8.6), led to the absence of the symptom of vomiting already for the 3rd day of inpatient treatment (ARI - 9.0%, RRI - 37.5 (95% CI: 28.0-47.7) with MNP - 2.7 (95% CI: 0.4-8.1), increased the chances of a lower need for long-term (≥3 days) parenteral rehydration (ARI - 12.9%, RRI - 13.7% (95% CI: 7.6-22.1) with MNP - 7.3 (95% CI: 2.9-14.3) and reduced the risk of needing to use antidiarrheal agents (relative risk - 3.2 (95% CI: 2.6-3.9) with an odds ratio - 7.1 (95% CI: 3,4-14,7)). Conclusions. Food supplement Lactiale Germina (probiotic strain B. clausii strain UBBC-07) in the complex treatment of children with acute watery diarrhea is effective and safe with good tolerability and rapid rates of clinical recovery. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The unique monoclonal antibodies and immunochemical assay for comprehensive determination of the cell-bound and soluble HER2 in different biological samples

The expression of the HER2 (human epidermal growth factor receptor 2) protein in cancer cells is a well-established cancer marker used for diagnostic and therapeutic purposes in modern treatment protocols, especially in breast cancer. The gold-standard immunohistochemical diagnostic methods with the specific anti-HER2 antibodies are utilized in the clinic to measure expression level of the membrane-bound receptor. However, a soluble extracellular domain (ECD) of HER2 is released to the extracellular matrix, thus the blood assays for HER2 measurements present an attractive way for HER2 level determination. There is a need for accurate and validated assays that can be used to correlate the concentration of the circulating HER2 protein with disease clinical manifestations. Here we describe two monoclonal antibodies binding HER2 with a unique sequence of the complementarity-determining regions that recognize HER2 ECD. Development and validation of the sandwich enzyme-linked immunosorbent assay (ELISA) for quantification of the soluble HER2 in a variety of biological samples is also presented. The assay provides HER2 quantitation within a concentrations range from 1.56 to 100 ng/ml with sensitivity at the level of 0.5 ng/ml that meets the expectations for measurements of HER2 in the blood and tumor tissue samples. The method presents satisfactory intra- and inter-assay precision and accuracy for immunochemical quantification of biomarkers in biological samples. The utility of the generated monoclonal anti-HER2 antibodies has been confirmed for use in the precise measurement of HER2 (both cell-bound and soluble) in several types of biological material, including serum, solid tumor tissue, and cell culture medium. Additionally, the developed immunochemical tools have a potential for HER2 detection, not only in a wide range of sample types but also independently of the sample storage/pre-processing, allowing for comprehensive HER2 analysis in tissue (IHC), cultured cells (immunofluorescence) and blood (ELISA).

Analysis of the modern treatment protocols for complicated and uncomplicated infantile hemangiomas. Literature review and own data

Infantile hemangioma (IH), a benign tumor of the vascular endothelium, is the most common type of vascular pathology of the infant’s skin, which grows and significantly increases in size mostly during the first 12 months of a child's life. Statistics indicate that IH affects up to 10% of newborns and children aged <1 year. The proliferative activity of IHs during the first year of a child's life differs significantly and could mislead parents and doctors. Lack of timely treatment at an early stage leads to an increase in the size of the tumor and high risks of cosmetic defects. Thus, the proliferation of IH can cause a gross deformation of the skin and a dysfunction of nearby organs. Purpose - to analyze modern data on the treatment of patients with complicated and uncomplicated hemangiomas, to study international experience and compare it with own observations and own experience, and to improve patient treatment protocols. In this review, we analyzed 19 articles involving more than 2400 children with different types of IH, compared different treatment protocols, their outcomes, and complications, and demonstrated our methods, results, and clinical cases. It may be resumed that β-blockers are “first-line” drugs for local and systemic treatment of IHs, as they allow slowing of the proliferation and activating resorption of the tumor without cosmetic defects or complications. Treatment of IH in babies following modern treatment protocols should be carried out non-surgically, without operations, anesthesia, scars, or cosmetic defects. Ulceration is the most common complication of IHs and the result of the late start of the treatment and thus could be prevented by the timely beginning of the therapy. No conflict of interests was declared by the authors.

A Current Management Strategy for Children with Chronic Viral Hepatitis B, Based on International and National Guidelines.

Peculiarities of the course of chronic viral hepatitis B in children cause an important medical and social problem of health care, despite the implementation of modern treatment and prevention protocols. Pathogenetic mechanisms of the development and progression of viral hepatitis B infection, the presence of occult poorly diagnosed form, the impossibility of completely eliminating the virus and the specificity of the immune response in children are still not fully solved scientific problems. The aim of this review is to examine current strategies for the diagnosis and treatment of chronic hepatitis B in children, based on international and national guidelines. A detailed analysis of modern guidelines on the course and pathogenesis of viral hepatitis B infection confirms the fact that chronic hepatitis B is characterised by a complex interaction between the immune system of the virus and the patient, whose dynamic balance is not only responsible for the various phases of chronic viral hepatitis B infection but also leads to the result of antiviral treatment. Despite the introduction of vaccination of children against hepatitis B, the level of viral hepatitis B vaccination of children in Ukraine remains insufficient, which leads to the further spread of the infection. Currently available antiviral drugs can provide functional treatment of viral hepatitis B infection in a limited number of patients, but today's Ukrainian realities have caused a change in approach to the treatment and monitoring of patients, which may negatively affect the implementation of the key goals of the World Health Organization Global Strategy on the prevention, diagnosis and treatment of viral hepatitis.

Modern Treatment Protocols in the Management of Terrible Triad Elbow Injuries

Modern Treatment Protocols in the Management of Terrible Triad Elbow Injuries

Vasculitis, CA19-9, and Perineural Invasion Differentially Predict Response and Surgical Outcome in Pancreatic Ductal Adenocarcinoma

Curative intent treatment of pancreatic adenocarcinoma (PDAC) relies on surgical resection. Modern treatment protocols focus on optimizing neoadjuvant therapy to increase resectability and improve oncologic outcomes. To elucidate differences in outcomes, we investigated the relationship between neoadjuvant chemotherapy (NAC), either with or without stereotactic body radiation therapy (SBRT), and vascular inflammation, surgical outcomes, and the resultant transcriptomic changes. Clinical data were collected from patients with borderline resectable PDAC (clinical T3-T4N0-1) who underwent NAC or NAC-SBRT followed by curative intent resection between 2014 and 2019. Vascular structures on surgical specimens were histologically evaluated for vasculitis. RNA sequencing was used to evaluate differential gene expression and to generate enrichment maps. Multivariate analysis was used to analyze the relationship between patient characteristics and oncological outcome. In total, 46 patients met inclusion criteria (n=12 NAC, n=34 NAC-SBRT) with a median follow-up of 20.1 months. All patients underwent curative resection, with 91.3% achieving R0. There was no significant difference in patterns of failure, overall survival, or progression-free survival between NAC and NAC-SBRT groups. Patients with vasculitis had a lower median overall survival compared with those without (14.5 vs 28.3 months; hazard ratio, 12.96; 95% confidence interval, 3.55-47.28; P < .001). There was no significant correlation between inflammation and surgical complications or pathologic response. Neoadjuvant therapy did not have a significant effect on development of vasculitis (odds radio, 1.64 for NAC-SBRT; 95% confidence interval, 0.40-8.43; P=.52). Predictors of poor survival included perineural invasion and high baseline carbohydrate antigen 19-9 (CA19-9) (>191 U/mL). Patients with robust CA19-9 (>20% decrease) responses to neoadjuvant therapy had enrichment in immune response, chemotaxis, and cytotoxic T-cell and natural killer-cell proliferation. Vasculitis predicts for poor survival outcomes in patients with PDAC; NAC-SBRT did not increase the rate of vasculitis compared with NAC. Perineural invasion and CA19-9 remain strong prognosticators. Understanding and optimizing immune interactions remain a crucial hurdle in achieving response in pancreatic cancer.

РОЗВИТОК ТА ФУНКЦІОНУВАННЯ РИНКУ МЕДИЧНИХ ПОСЛУГ В УМОВАХ ГЛОБАЛІЗАЦІЇ ТА ІНТЕГРАЦІЇ

The article reveals significant globalization trends of the world market of medical services and unites them into four groups: political (functioning of international organizations, activities of interstate non-governmental organizations and charitable foundations, exit of intellectual property rights protection procedures to the global level), economic (liberalization of trade in medical services , monopolization of the world pharmaceutical market by TNCs, formation of medical clusters), technological (intensification of information exchange, use of international standards of medical care, development of modern treatment methods, medical technologies and equipment) and social (international migration of medical specialists, internationalization of medical education, spread global epidemics). It was determined that these trends have a mostly positive impact on the development of the world market of medical services. One notes that the maximum possible use of the advantages of international cooperation to improve the quality of medical services, the transfer of innovative technologies, the acquisition and development of modern equipment and medicines, the introduction of modern treatment protocols with the simultaneous minimization of the negative consequences of globalization processes must be taken into account when developing strategic plans for transformation and development sphere of health care of Ukraine. The article identifies the negative manifestations of globalization: bureaucratic decision-making process by international organizations, stagnation of national health care systems as a result of the liberalization of trade in medical services, an increase in the general level of drug prices due to a significant level of monopolization of the international pharmaceutical market, a decrease in the number of the working population and shortages qualified workers as a result of labor migration and the internationalization of higher education, the emergence of economic and social crises due to the spread of infectious diseases, the need for significant amounts of investment for the introduction of modern technologies. One identifies the measures to minimize globalization risks: creating optimal conditions for the productive work of medical workers (salary, equipping workplaces, improving qualifications, protecting intellectual property rights, stimulating research and innovation), preventing stagnation in the field of health care by ensuring a constant flow of investment funds (insurance funds of state and non-state institutions, international grants, international cooperation programs, funds of charitable funds), constant improvement of the response system to natural and man-made emergencies.

Practical recommendations for the treatment of patients with breast cancer (article 2)

Background. Breast cancer is one of the most widespread malignant diseases among women in the world. For the last few years, its rate has constituted about 20% of all tumor diseases in women. The annual standardized morbidity growth rate in Ukraine was 1,8% in the last decade. The cumulative risk of breast cancer development is 5,4% given that the life duration is 74 years. Treatment of patients with breast cancer. The treatment must be planned by several medical specialists including a surgical oncologist, a radiation therapist, a chemotherapist, and, if possible, a pathologist. This will allow local and systematic tumor therapy methods to be combined in the best way possible.&#x0D; Purpose – to systematize, generalize, and present the research data on modern approaches to diagnostic measures, movement of patients, and sequence of treatment approaches for locally advanced and metastatic breast cancer from the perspective of the Ukrainian healthcare system. Materials and methods. The article covers modern full-text publications, screening, and treatment protocols of patients with breast cancer, which were obtained from international and domestic sources and databases (e-catalog of Vernadsky National Library of Ukraine, Web of Science, Core Collection, Pubmed).&#x0D; Results. Місцево-поширений первинно-неоперабельний інвазивний рак грудної залози РГЗ, в тому числі інфільтративно-набрякова форма є первинно неоперабельними і вимагають призначення медикаментозної терапії на першому етапі лікування. Locally advanced primarily inoperable invasive breast cancer, including infiltrativeedematous form, is primarily inoperable and requires the prescription of drug therapy at the first stage of the treatment. Triple-negative and HER-2-dependent tumors also require presurgical drug therapy. Local treatment (surgery, radiation therapy) at the first stage is not indicated. The main goal of drug therapy in primarily inoperable forms of breast cancer is the reduction in the size of the tumor in order to achieve an operable condition. Presurgical drug therapy in primarily inoperable forms of breast cancer is carried out under the same rules as in primarily operable ones. Therapy of isolated local recurrences is aimed at full recovery and must be performed similarly to the treatment of primary tumor and involve necessary diagnostic and treatment methods (the diagrams are given in article 1). The treatment of advanced, disseminated breast cancer is palliative and intended to improve the quality of life and increase its duration. The main treatment method for metastatic disease is drug therapy. There is no single treatment standard for metastatic breast cancer. Selection of the drug therapy option is performed taking into account biological markers and clinical-anamnestic features of the patient. On the condition that individual approaches to the treatment of patients with breast cancer are used, the following improvements are quite possible: an increase in both recurrence-free and overall survival, a decrease in the number of complications and toxic manifestations, better compliance of the patients and improvement of their life quality. Systematization and individualization of treatment regimens, depending on the stage of the tumor process and biological features of the tumor, allow the practicing physician to plan and predict the types and the sequence of antitumor therapy.&#x0D; Conclusions. The deepening of our knowledge of breast cancer pathogenesis will contribute to the deeper implementation of individual approaches to the treatment of patients with this pathology. Continuous search will certainly lead to the appearance of new groups of drugs which may change the existing standards of treatment. The use of new pathogenetically relevant methods of biological, hormonal, and target therapy in the modern standards of treatment will allow both recurrence-free and overall survival of the patients to be increased.

Risk-Adapted Target Delineation for Breast Cancer: Controversies and Considerations

The advent of computed tomography–based planning coupled with modern tools for target delineation and hypofractionated treatment schedules has increased efficiency and throughput for patients with breast cancer. While the benefit of adjuvant radiation therapy (RT) in reducing locoregional recurrences is established, disentangling local versus regional recurrence risks with modern treatment protocols has become an area of active research to de-escalate treatment. Delineation guidelines for nodal regions either attempt to replicate results of conventional RT techniques by translating bony landmarks to clinical target volumes or use landmarks based on the fact that lymphatic channels run along the vasculature. Because direct comparisons of both approaches are implausible, mapping studies of nodal recurrences have reported on the proportion of nodes included in these delineation guidelines, and larger, bony, landmark-based guidelines appear intuitively appealing for patients with unfavorable risk factors. A pooled analysis of these studies is reported here, along with literature supporting the exclusion of the true chest wall from postmastectomy/breast-conserving surgery clinical target volumes and the selective (versus routine) use of bolus during postmastectomy RT. The risk-adapted approach suggested here accounts for the risk of recurrence as well as toxicity and endorses nuanced target volume delineation rather than a one-size-fits-all approach.

Splenic injury during colonoscopy: modern treatment approach and splenic salvage.

Splenic injury is a rare complication of colonoscopy, estimated to occur in 0.020 to 0.034% of procedures, with a 30-day mortality of 3.6% (1-3). Of the three major severe adverse events during colonoscopy (perforation, bleeding, and splenic injury), splenic injury has the highest mortality but is rarest (1). The spleen is attached to the colonic splenic flexure by the splenocolic ligament, suggesting that manipulation of the colon during colonoscopy may cause direct tension or impaction on the spleen and splenic hilum as the mechanism of injury (2,3). Patients typically present within 24 hours of colonoscopy with severe abdominal pain and peritonism, and may be haemodynamically unstable (2). The majority of published cases of high-grade splenic injury due to colonoscopy have been managed with splenectomy (2,3), however smaller numbers have been managed with embolization and conservative measures (3). Modern treatment options for splenic injury due to colonoscopy can be classified into con- servative, endovascular, and surgical management (3). Conservative management involves inpatient moni- toring, with analgesia, intravenous fluids, and blood transfusion (2,3). Endovascular treatment is splenic artery embolization, typically with deployment of coils into the splenic artery proximal to the splenic hilum or into a single splenic artery branch in cases with an isolated focal injury (2-4). Surgical management is principally laparotomic splenectomy (2,3). In modern treatment protocols, splenectomy is usually reserved for unstable patients who require emergent laparotomy (4). Given the similarity in mechanism between splenic injuries due to blunt trauma and those due to colonoscopy, it may be helpful to conceptualize splenic injuries due to colonoscopy according to the American Association for the Surgery of Trauma (AAST) grading system (5). After institutional ethical approval, electronic medical records over a 10-year period (2012-2022) were searched to identify all patients treated for splenic injury due to colonoscopy, with the following inclusion criteria: • Splenic laceration diagnosed on computed tomography (CT). Colonoscopy within 72 hours of CT diagnosis. • Absence of blunt external traumatic incident between colonoscopy and diagnosis. Patient demographic information, past surgical history, colonoscopy indication, splenic injury grading, treatment and outcome data were analysed. Two males and 3 females were included, with median age of 63 years (range: 40-72), and four had undergone previous abdominal surgery (Table 1) (Figure 1). AAST injury grades were II to V. One patient with an AAST II injury was treated conservatively without requiring embolization or splenectomy. Three patients with AAST III-V injuries were treated primarily with splenic artery embolization, with one patient undergoing splenectomy 2 weeks later due to increased haematoma on CT. One patient with AAST III injury was treated conservatively but then underwent splenectomy 6 days later due to clinical rebleeding. All patients in the cohort survived, and 3 of 5 achieved splenic salvage. The spleen has important immune and non-immune functions, as the main filter of blood-borne pathogens, antigens, and red blood cells and patients post- splenectomy have increased life-long risk of infection(6). Embolization preserves splenic function via collateral arterial supply and splenectomy may therefore be best reserved for patients who require emergent laparotomy or where conservative and endovascular management have failed. In the present cohort, 3 of 5 patients were able to avoid splenectomy, higher than in previous published reports (47-69% splenectomy rate) (2,3). The higher splenectomy and mortality rates in previous reports may be due to publication bias favouring severe cases. As a rare complication of colonoscopy, splenic injury requires prompt diagnosis and management to minimize mortality. All patients in the present cohort survived, 3 of 5 with splenic salvage. A treatment protocol utilizing conservative management for low-grade injuries and embolization for high-grade injuries may optimise rates of splenic salvage with long-term public health benefits. This paper has not been presented previously at a conference and is not under consideration by any other journal for publication. The authors have no conflicts of interest to declare. This research was not supported by any funding.

RISK FACTORS OF POSTOPERATIVE COMPLICATIONS DEVELOPMENT IN PATIENTS WITH RECTAL CANCER

Rectal cancer remains one of the most pressing problems today. Despite the development of technologies that can stage the disease and the use of modern treatment protocols, there is no continuous linear improvement in patient survival. The various concepts proposed for the treatment of colorectal cancer do not lead to a statistically significant improvement in overall survival. This may be due to the variability of the concepts of rectal cancer treatment, including the choice of a short or long course of neoadjuvant therapy, a standard regimen or total neoadjuvant therapy, surgery or "watch and wait" tactics. The likelihood of developing surgical complications, especially in cases of neoadjuvant treatment, also remains high, despite the development of minimally invasive accesses and the use of suturing devices, which in turn can lead to poor survival, local recurrence, and disability in patients. Understanding different concepts and strategies for treating patients with rectal cancer, systematically assessing various risk factors for postoperative complications, and modifying them individually can improve not only local outcomes but also overall survival of rectal cancer patients. Several studies have shown that the use of neoadjuvant chemotherapy in patients with rectal cancer significantly increases the risk of postoperative complications, although it reduces the likelihood of local and long-term recurrence. Therefore, given that neoadjuvant therapy is usually a mandatory step in treatment, further research should be conducted on the effects of different doses and regimens, and there is an urgent need to study other modified risk factors for postoperative complications, including BMI, stapler use, size stitching circular apparatus and others. Only in-depth study and accumulation of more data will allow you to more effectively choose the right treatment tactics that will increase life expectancy and reduce the disability of patients with rectal cancer. Thus, despite the great advances in understanding the treatment of rectal cancer, the application of the concept of combination therapy and the development of technical equipment, there are still several controversial issues that require detailed study. In particular, this applies to neoadjuvant chemotherapy, and a detailed study of the timing and different courses of radiation therapy, to ensure maximum effectiveness and reduce the risk of complications. This can be achieved only with the use of an individualized approach to the treatment of patients. The aim of the study is to assess the impact of various risk factors for postoperative complications, including anastomotic failure in patients receiving neoadjuvant chemotherapy. A research and analysis of PubMED publications for 2015-2022 has been made, which provided data on the use of neoadjuvant therapy in patients with rectal cancer and assessed risk factors for postoperative complications. The search queries included "rectal cancer", "anastomosis failure", "neoadjuvant therapy", "risk factors", and "survival of rectal cancer patients". Analysis of treatment and postoperative surgical complications in patients with adenocarcinoma of the rectum stage I-III in the Precarpatian clinical oncological centre during 2019-2022 was performed.

Dermatological toxicity of acute lymphoblastic leukemia treatment by protocol ALL IC-BFM 2002

Background. Аcute lymphoblastic leukemia (ALL) in children is not only the most common but also potentially curable disease in 8590% cases. The other side of high effectiveness of modern treatment protocols their toxicity. Inspite of skin and mucosal toxicity is not a life threatening condition, it requires a supportive care to prevent infectious complications, which prolong hospitalization, administration of antibacterial, antifungal and in some cases antiviral drugs.&#x0D; Aim. To study skin and mucosal toxicity in patients with ALL, treated by ALL IC-BFM 2002 protocol.&#x0D; Materials and methods. One hundred and nineteen pediatric patients with primary diagnosed ALL were enrolled the study. All the patients were treated by ALL IC-BFM 2002 protocol. Toxicity assessment was performed on each step by the scale of National Cancer Institute (NCI) USA, 2d version.&#x0D; Results. The most often variants of skin and mucosal toxicity during ALL IC-BFM 2002 protocol were found on protocol mM/M, based on high-dosed methotrexate. In 42.1% stomatitis 2st. was diagnosed on methotrexate dose 5000 mg/m2, 3st. 15.8%, 4st. 5,3%. Methotrexate dosed 2000 mg/m2 coused stomatitis 3 st. in 6.3%, in other patients stomatitis was 12st. Exfoliative dermatitis was in 1 (1%) case with prolonged methotrexate elimination. Block polychemotherapy used in high risk group of patients was complicated with stomatitis 34 st. in 90%. In 20% naso-gastral catheter was performed and in 25% used partial/hole parenteral nutrition support. Alopecia was reversible and observed in 100% patients. Protocols I, II and maintenance treatment were free of clinically significant skin and mucosal toxicity.&#x0D; Conclusion. The skin and mucosal toxicity profile of ALL IC-BFM 2002 protocol was tolerable. Hole volume of supportive care, preventing and treatment of dermatological toxicity of chemotherapy can prevent of severe skin and mucosal toxicity (soft tissue infections, sepsis, metabolic disorders).

The Epidemiological Tuberculosis Situation in the Russian Penitentiary System: Main Trends and Challenges

The article describes the current tuberculosis epidemiological situation in institutions of the penitentiary system including the combination of tuberculosis and HIV infection. The epidemic consequences of increased coverage of people living with HIV infection (PLHIV) with antiretroviral therapy (ART) were analyzed. By 2020, tuberculosis incidence dropped to 621 per 100,000. Tuberculosis mortality dropped to 6.8 per 100,000. The incidence of tuberculosis among PLHIV decreased from 3,490.6 per 100,000 population in 2014 to 2,014.2 per 100,000 population in 2020, while coverage of PLHIV with ART increased from 21.7 to 89.6%. The proportion of TB patients among PLHIV decreased from 10.4% in 2014 to 7.2% in 2020. The proportion of PLHIV among newly diagnosed TB patients remained high (34.4% in 2020). The prevalence of multiple drug resistant tuberculosis decreased to 557.6 per 100,000. Thus, in 2020, the epidemiological tuberculosis situation in the Russian penitentiary institutions continued to improve. The strategy to increase coverage of PLHIV with ART proved to be effective for prevention of tuberculosis in penitentiary settings. Multiple drug resistant tuberculosis presents a serious problem which forms the grounds for introduction of modern treatment protocols with innovative drugs to the Russian penitentiary institutions.

QOL-13. Impact of hearing loss on neuropsychological functioning in children treated for medulloblastoma: A report from the Children’s Oncology Group (COG)

BACKGROUND/OBJECTIVE: We prospectively examined neuropsychological outcomes and ototoxicity in children with average-risk medulloblastoma. METHODS: Eligible patients included those treated on COG protocol ACNS0331 who completed audiograms at end of therapy or one-year off-therapy, and neuropsychological assessments between 2- and 5-years post-diagnosis. Conventional pure-tone audiometric evaluations (0.25-8kHz) were assigned an ototoxicity grade based on the International Society of Pediatric Oncology (SIOP) grading scale. Grade for the better hearing ear was used for analyses. Participants were divided into two groups: SIOP grade≥3 hearing loss (HL) versus SIOP grade<3. Cutoff score of 60 on BASC-2 was used to dichotomize parent-reported anxiety and depression scores as ‘low’ or ‘high’. RESULTS: Data were available for 113 children (66% male; 86% white), aged 3.0-18.5 at diagnosis (Mean=9.1). One-quarter (24.8%, n=28) had at least moderate HL (≥ SIOP grade 2), and 12.3% (n=14) had severe HL (≥ SIOP grade 3). After controlling for radiation exposure and age, children with severe HL showed significantly higher levels of anxiety (OR=5.9, 95%CI 1.3-26.0, p=0.0195) and borderline differences in depression (OR=4.0, 95%CI 1.0-16.5, p=0.0563), but no differences in cognitive functioning when compared to other participants. When moderate and severe HL were combined in exploratory analyses, significantly greater anxiety (OR=9.0, 95%CI 2.1-37.4, p=.0027) and depression (OR=4.6, 95%CI 1.3-15.7, p=.0165) were observed. CONCLUSIONS: Survivors of pediatric medulloblastoma with moderate to severe HL evidenced greater psychosocial, but not neurocognitive, difficulties compared to those with no or mild HL. It may be that modern treatment protocols generally preserve cognitive functioning such that associations between HL and cognitive impairment are no longer significant. It is also possible that neurocognitive risk associated with HL may not manifest until survivors are further from diagnosis. In contrast, survivors with HL may be at greater risk for negative psychosocial adjustment, suggesting that increased monitoring of mental health outcomes is warranted.

Growth hormone deficiency in childhood brain tumors and acute lymphoblastic leukemia survivors

Thanks to modern treatment protocols, childhood cancer survivors (CCS) are a very fast-growing population nowadays. Cancer therapy inevitably leads to different late adverse effects, where endocrine disorders are highly prevalent, including growth hormone deficiency (GHD) which is the most common endocrine outcome after cancer treatment in childhood and contributes to impaired growth. Short stature is a big issue, which leads to problems in psychological and social adaptation of patients and reduces their quality of life. Impact of GH treatment on various physiological processes and global outcome of CCS is of great interest. Several studies have demonstrated an influence of GH and IGF-1 on the development/tumour growth, cell proliferation. In this regard, the issue of increasing the risk of cancer recurrence and/or the development of secondary neoplasms in CCS, causes a lot of controversy and is the subject of continuous evaluation. In this review, we went through the available data on the prevalence and pathogenesis of GHD following chemo- and radiotherapy, in particular after treatment of brain tumors and acute lymphoblastic leukaemia in childhood. In addition, here we discuss the existing problems in the diagnosis of GHD, the safety of GH replacement therapy, as well as the treatment algorithm of the GHD in adults.

Debunking the myths of acute hyperkalemia treatment

The article provides an overview of the world data on modern approaches to the treatment of patients with hyperkalemia according to the principles of evidence-based medicine. Hyperkalemia is a common and potentially fatal condition that affects millions of people throughout their lives. Despite the prevalence and severity of this condition, there are no consensus recommendations for the treatment of hyperkalemia. The authors noted that a standard approach would likely improve outcomes. Further complicating the situation is that there is not even a universal definition of hyperkalemia. Historically, approaches to the treatment of acute hyperkalemia have been based on three concepts: «stabilization» of the cardiac depolarization threshold, intracellular displacement of serum potassium, and elimination of total potassium in the body. The urgency of these actions is often determined by ECG findings, as life-threatening dysrhythmias can occur over a wide range of serum potassium concentrations. Because of the difficult nature of prospectively assessing a life-threatening condition, many of these ideas have been entrenched for generations despite a lack of evidence to support them. Objective. To review information sources devoted to modern approaches to the management of patients with acute hyperkalemia, modern diagnostics, modern treatment protocols in order to establish optimal methods of treatment of patients, prevention of complications and early recovery and development of recommendations in Ukrainian. The article provides a brief overview of the most significant errors encountered in emergency care in hyperkalemia, reviews the currently available literature and discusses the practical aspects of several methods of hyperkalemia treatment. Misconceptions and disagreements about its treatment have led to controversial treatment strategies. The article reviews four of the most common myths and provides recommendations based on the interpretation of the available data. At the end of each section, recommendations from open sources are provided to help emergency physicians, internists, nephrologists, and anesthesiologists make safe and effective choices in the treatment of acute hyperkalemia. Conclusion. Hyperkalemia is a common and potentially life-threatening electrolyte disorder. Misconceptions and disagreements about its treatment have led to controversial treatment strategies. This article reviews four of the most common myths and provides recommendations based on the interpretation of the available evidence. We recommend that clinicians continue to evaluate the available evidence and make treatment decisions based on the balance between the potential benefits and harms of each of these interventions.

Кожные проявления первичных иммунодефицитных состояний

Primary immune deficiency diseases (PIDDs) are a group of severe genetically determined diseases caused by a disorder of the immunity links: humoral and cell-mediated links, phagocytosis, complement system. PIDDs are characterized by severe atypical recurrent infections, as well as autoimmune and oncological processes. In the case of clinical symptoms, skin manifestations in PIDDs allow to suspect the presence of congenital disorders of immunity. There is a technique in laboratory diagnostics of PIDDs, that determines a decrease in the number of T- and B-lymphocytes based on measuring the levels of TREC (T-cell Receptor Excision Circle) and KREC (Kappa-deleting Recombination Excision Circle), which are by-products of recombination of T- and B-cell receptor genes. TREC and KREC levels can be assessed using a reagent kit for quantifying TREC and KREC DNA by PCR in real time. The analysis can be conducted using both whole blood and DNA obtained from dried blood stains collected during the national newborn screening program. Today, quantitative analysis of TREC and KREC in dried blood stains on newborn screening cards is becoming the method of choice for newborn screening of PIDDs. The inclusion of the PIDDs diagnosis in the federal newborn screening program will allow detecting disorders of the immune system before their clinical manifestations, which will allow to apply modern treatment protocols, reduce disability and ensure high patient survival. KEYWORDS: TREC, KREC, PIDDs, newborn screening, PCR, immunity, early diagnosis. FOR CITATION: Churyukina E.V., Kudlay D.A. Skin manifestations of primary immune deficiency diseases. Russian Medical Inquiry. 2022;6(2):98–104 (in Russ.). DOI: 10.32364/2587-6821-2022-6-2-98-104