Multidisciplinary Medical Center Research Articles

The diagnostic value of cytokines in chronic glomerulonephritis in children

In modern clinical practice of pediatricians, the problem of timely adequate treatment of chronic glomerulonephritis (CGN) in children is of particular relevance, due to both the high prevalence of the disease and the severity of its course, the complexity of therapy and the ambiguity of the prognosis. Lesions of the urinary system in children are not only common, but also tend to grow, and often at an early age. Deterioration of the environmental background, toxic and allergic effects of drugs lead to damage primarily to the kidneys, which are the eliminating organ. The aim of the study was to study urocytokines to assess the immune response in children with HCG, depending on the association with cytomegalovirus infection. The study included 100 children aged 4-7 years, permanently residing in the Bukhara region of the Republic of Uzbekistan. At the time of the study, the patients were undergoing routine treatment in the Department of Pediatric Nephrology of the Bukhara Regional Children’s Multidisciplinary Medical Center. All children underwent general clinical (general blood test with leukoformula, general urine analysis, biochemical blood test with determination of urea, creatinine and cystatin C, immunological (TNFα, IL-18, MCP-1, IgM and IgG antibodies to cytomegalovirus infection (CMVI) in blood serum, IL-1β and IL-17A in urine) examination methods. Thus, it was found that the concentration of cystatin C in the blood serum was inversely proportional to the glomerular filtration rate in the kidneys – with a decrease in kidney function in sick children, a twofold increase was noted, that is, the accumulation of cystatin C in the blood. An increase in the concentration of IL-18 in serum and IL-1β in urine relative to the control group in CGN was an indicator of the severity of an autoimmune reaction, and a relatively low concentration of cytokines in both blood and urine in CGN with CMVI indicated suppression of the specific antiviral immunity of CMVI. It was found that an increase in serum MCP-1 by 1.4 times in group 1 and 2.9 times in group 2 of CGN with CMVI is an indicator of viral kidney damage. A significantly high concentration of IL-17A in urine in CGN with CMVI indicated local cytokine production in the kidneys and acted as an indicator of the prognosis of the outcome of CGN.

Assessment of metabolic indicators of the cardiovascular system in children with nephrotic syndrome

Objective: to evaluate the metabolic parameters of the cardiovascular system in nephrotic syndrome in children Material and methods: 110 children hospitalized with nephrotic syndrome in the nephrology department of the Samarkand Regional Children’s Multidisciplinary Medical Center were examined. Results: Renocardial syndrome with nephrotic syndrome develops in 64.8% of cases, the majority of patients are children 3-6 years of age (44.1%), with a predominance of boys (58.8%). In a cardiometric study in patients with nephrotic syndrome, renocardial syndrome is manifested by significant changes in metabolic and adaptation parameters: oxygen and lactate content - by 1.5 times, creatine phosphate - by 20%, tension index - by 4.8 times and vascular stiffness index - by 5.2 times. Conclusion: Deviation of cardiometry indicators in different age groups indicates a decrease in the intensity of blood circulation in organs and systems, indicating a significant load on the cardiovascular system in nephrotic syndrome.

Effective Communication As A Demanded Vector Of Development Of A Modern Medical Center

Competent communication between a doctor and a patient is one of the most important aspects of high-quality medical care. Effective communication helps improve the quality of consultations, increase patient satisfaction and preserve the emotional resources of specialists. We have developed and implemented a local educational module "Communication Skills with Patients" for employees of the multidisciplinary medical center "UMMC-Health". The center's development plan includes systematic training in effective communication in medicine for all specialists, which is more than 700 doctors and 400 nurses.

Strategy for the Treatment of Newborns and Children in the First Year of Life with Malignant Tumors in the Moscow Multidisciplinary Medical Center

Strategy for the Treatment of Newborns and Children in the First Year of Life with Malignant Tumors in the Moscow Multidisciplinary Medical Center

LARYNGOPHARYNGEAL RECONSTRUCTION IN A PREGNANT WOMAN: A CLINICAL CASE

Relevance: Cancer in pregnancy is a very serious clinical condition that seriously affects women and their families, as well as the medical staff who provide care. Diagnostic and therapeutic solutions must balance the appropriate treatment with the risk to the fetus. In developed countries, cancer in pregnant women has become more common over the past 30 years due to an increase in the number of older women giving birth. Melanoma, lymphoma, leukemia, and cancers of the breast, cervix, ovaries, gastrointestinal tract, and genitourinary system are the most common malignant neoplasms in pregnant women. Head and neck cancers are rare in pregnancy. A total of 3 cases of locally advanced laryngopharyngeal cancer were recorded in patients aged 23 to 28 years in 2017-2023 at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. This article describes a case of advanced squamous cell carcinoma of the laryngeal region in a young pregnant woman and also discusses the diagnosis and treatment of head and neck cancer in pregnant women. The study aimed to describe a clinical case of squamous cell carcinoma of the larynx in a pregnant patient. Methods: The description of a clinical case presents data from laboratory, instrumental, and physical research methods of a pregnant patient with hypopharynx squamous cell carcinoma, who was examined, treated, and followed up at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. The patient was diagnosed with IVA laryngopharyngeal cancer T4aN2cM0. Grade III dysphagia. Laryngeal stenosis. Grade II cachexia” and received three courses of neoadjuvant polychemotherapy. Then, she underwent surgical intervention in the volume of laryngopharyngectomy and reconstructive surgery using a free radial flap and was administered adjuvant external beam radiation therapy. Results: The article presents the results of laryngopharyngectomy for locally advanced squamous cell carcinoma of the hypopharynx. The postoperative period was without complications, the patient was discharged 14 days after surgery in satisfactory condition and continued adjuvant radiation therapy. Conclusions: The reviewed clinical case demonstrates the importance of an integrated approach to treating laryngopharyngeal cancer, including effective reconstruction of postoperative defects using free fasciocutaneous flaps.

Diagnosis and treatment of retrorectal cystic hamartoma: clinical case

Background. Retrorectal tumors are a rare group of tumors that can be benign or malignant in origin; in most cases, they are asymptomatic. They mainly arise in the presacral space, which is limited by Waldeyer’s fascia posteriorly, the rectal fascia proper anteriorly, the ureters and lateral ligaments of the rectum laterally, the levator ani muscles and coccyx inferiorly, and the transition of the pelvic peritoneum between the second and third sacral segments superiorly. Magnetic resonance imaging (MRI) is crucial for diagnosis and surgical planning. Most retrorectal tumors require surgical treatment without preoperative biopsy. Here, we present a case of a retrorectal cystic hamartoma that was treated with surgery.Clinical case. Patient N., 45 years old, presented with suspected pelvic malformation. The patient reported experiencing pain in the sacrum area since May 2023, with no history of trauma. She sought medical help at a local polyclinic, where an ultrasound of the pelvic organs revealed a pelvic mass. The patient was then referred to an oncologist at the Multidisciplinary Clinical Medical Center “Medical City”. Physical examination showed no specific features, except upon rectal examination, where a non-displaced tumor measuring up to 2 cm was palpated along the posterior rectal wall. MRI of the pelvic organs confirmed the presence of a mass behind the lower ampullary rectum. Surgical treatment was subsequently performed, and the diagnosis of teratoma was confirmed through morphological and immunohistochemical studies.Conclusion. Early comprehensive diagnostics and an experienced surgical team are key factors for successful treatment of patients with retrorectal tumors.

Experience in managing patients with X-linked congenital retinoschisis

AIM: To describe the clinical manifestations and management experience of patients with X-linked congenital retinoschisis (XLRS).
 MATERIAL AND METHODS: The study was conducted in the ophthalmology department of the multidisciplinary clinical medical center Bonum (Yekaterinburg). Two brothers with XLRS were under observation. They underwent complete ophthalmological examinations, including electrophysiological examinations, optical coherence tomography (OCT), and fundus photoregistration. The mother refused genetic testing.
 RESULTS: Both siblings had early (up to 1 year) manifestations of central foveolamellar and peripheral bullous retinoschisis. The parents are phenotypically healthy, and the relatives have no hereditary eye diseases. The younger brother had a progressive peripheral retinoschisis and underwent barrier laser retinopexy; as a result, the progression stopped at the last examination. Acetazolamide 125 mg given orally daily for 4 weeks did not have a noticeable effect on the volume of bullous cavities. The older brother had been under observation for 4 years, and spontaneous closure of retinal cavities on the periphery in one eye and retinal detachment in the other after surgical treatment of retinoschisis were observed.
 CONCLUSION: Clinical cases of long-term follow-up of two brothers with XLRS are described. OCT is indicated to diagnose, assess the length and the state of the vitreoretinal interface, and monitor XLRS. Electroretignography is a specific and sensitive method for the complex diagnosis of XLRS. Barrier laser retinopexy is indicated for progressive peripheral retinoschisis. The efficacy and safety of carbonic anhydrase inhibitors in patients with XLRS require further study.

Assessment of the severity of ulcerative colitis: An effective pathway from invasive to non-invasive diagnosis

The purpose of the study is to study the Diagnostic and prognostic importance of TGF-β2 in patients with ulcerative colitis with different severity. The study received 82 patients with stasionar and outpatient treated ulcerative colitis in the Gastroenterology Department of Bukhara regional Multidisciplinary Medical Center during 2021-2023 and 20 health professionals as a control group. Patients were diagnosed with serum immunoferment analysis using IL-6 and TGF-β2, and its importance was studied. The results of the study showed an increase in IL-6 and a decrease in TGF-β2 in severe types of ulcerative colitis, and found that it could be used in diagnosis as a poor prognostic marker.

Features of the process of bone tissue regeneration in complex treatment of lower jaw injury

The article presents the results of a study of mandibular trauma, as well as treatment methods. Several methods for treatment, features of the process of bone tissue regeneration during complex treatment are discussed. In the period from 2008 to 2021, 231 patients with mandibular fractures who were treated in the department of the Bukhara Regional Multidisciplinary Medical Center were studied. All patients were divided into two groups: a comparison group (traditional treatment) and this group (treatment of complex pathologies). To make the correct diagnosis, modern methods of x-ray, microbiological and laboratory research were used. Analysis of the results of traditional and special treatment showed a clear advantage of the latter in terms of optimizing the process of bone tissue restoration in cases of damage to the lower jaw.

Assessment of the severity of ulcerative colitis: An effective pathway from invasive to non-invasive diagnosis

The purpose of the study is to study the Diagnostic and prognostic importance of TGF-β2 in patients with ulcerative colitis with different severity. The study received 82 patients with stasionar and outpatient treated ulcerative colitis in the Gastroenterology Department of Bukhara regional Multidisciplinary Medical Center during 2021-2023 and 20 health professionals as a control group. Patients were diagnosed with serum immunoferment analysis using IL-6 and TGF-β2, and its importance was studied. The results of the study showed an increase in IL-6 and a decrease in TGF-β2 in severe types of ulcerative colitis, and found that it could be used in diagnosis as a poor prognostic marker.

Nutritional status analysis in patients with ulcerative colitis

The study included 128 patients treated ulcerative colitis in the Gastroenterology Department of Bukhara regional Multidisciplinary Medical Center during 2021-2023 and 20 health professionals as a control group. Nutritional status has been studied in patients with ulcerative colitis on the basis of anthropometry. When nutritional indicators were analyzed in patients with ulcerative colitis, depending on the activity levels of the disease, it was noted that the incidence of the disease is obvious, that is, in the type of high activity, all indicators are relatively low.

Biobanking in the hospital of a multidisciplinary research medical center as a potential for a wide research range. Part II. Specifics and first results of developing a described collection of biomaterial

In connection with the development of genetic and other types of research in translational medicine, collections containing a significant number of biospecimens and large data sets are required. Since in-depth examination of patients is most often carried out during hospitalization, the creation of collections based on electronic medical records (EMR) data is promising. In this regard, the project "Total biobanking in the hospital of the National Medical Research Center for Therapy and Preventive Medicine" was initiated, aimed at total biobanking of blood and related products from patients in inpatient departments and the creation of a unified system that combines information on biosamples, clinical and other types of data.Aim. To describe the collection of biospecimens collected within the project "Total biobanking in the hospital of the National Medical Research Center for Therapy and Preventive Medicine" for August 2023, and to analyze the process of biospecimen description.Material and methods. Recruitment of patients is carried out on the basis of inpatient departments of the National Medical Research Center for Therapy and Preventive Medicine, only if the patient signs informed consent. After blood is taken, the biomaterial enters the biobank, where sample preparation and storage is carried out, as well as data about each biosample is entered into a special FreezerPRO system. At the same time, clinical data about the patient is collected using EMR, which are combined in the Medialog medical information system.Results. A special software for data exchange between the medical information system and the biobank has been developed, which combines information about patients entering the Medialog medical information system and the FreezerPro biospecimen management system, which contains detailed information about biospecimens. As of August 25, 2023, biomaterial from 3996 patients was collected, which was accompanied by a detailed clinical summary. In particular, data is available on diagnoses (for 100% of patients), laboratory test data (100%), paraclinical data, in particular, electrocardiography (100%), echocardiography (76,8%), 24-hour Holter monitoring (59,8%), esophagogastroduodenoscopy (27,3%), etc. The most common diseases were hypertension (76,0%), atherosclerosis (69,9%), coronary artery disease (52,9%), arrhythmias (50,6%), diabetes (19,2%). In addition, 25,0% of patients had prior stenting.Conclusion. Total biobanking within the hospital of a multidisciplinary research medical center allows for the rapid and high-quality collection of biomaterial and related data. A collection of biospecimens with comprehensive and detailed clinical annotations has been collected. A primary analysis of the collection was carried, which showed that it can be used for a wide range of studies.

Biobanking in the hospital of a multidisciplinary research medical center as a potential for a wide research range. Part I. Organizational and methodological aspects

Aim. To develop an algorithm and manage total biobanking of samples of whole blood, serum and plasma of patients in the hospital of the National Medical Research Center for Therapy and Preventive Medicine in order to create a detailed biosample collection through the integration of electronic medical records and a biobank database.Material and methods. The study includes all patients admitted to the hospital of the National Medical Research Center for Therapy and Preventive Medicine in various departments who signed informed consent for biobanking. Clinical information is collected as part of patient examination and stored in electronic medical records in the Medialog medical information system. Biobanking of blood and related products is carried out in accordance with standard operating procedures. From each patient, 12 aliquots of serum and blood plasma are stored, as well as 1 tube of whole blood with ethylenediaminetetraacetic acid potassium salt. Information about biospecimens, patient identification numbers and storage location coordinates are contained in the biobank database.Results. An algorithm for total biobanking of biomaterial and data from inpatients has been developed and put into practice. This collection is associated with large biomedical data stored in a medical information system, laboratory information system and biobank. The combined databases make it possible to search for samples in the collection according to specified criteria.Conclusion. The collection developed can be used for a wide range of studies by forming patient samples according to the necessary criteria. The developed algorithm for total biobanking in a hospital can be used in various medical centers equipped with biobanks.

Analysis of treatment outcomes in patients with combat spinal column and spinal cord injuries

Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).

Long-term outcomes of laparoscopic sleeve gastrectomy in those with class I obesity: safety, efficacy, and quality of life.

Class I obesity carries significant morbidity and mortality risk similar to higher grades of obesity, and persons with class I obesity have a high risk of progression to class II and III obesity. While bariatric surgery has made strides in safety and efficacy, it remains inaccessible for persons with class I obesity (body mass index [BMI] of 30-35 kg/m2). To assess safety, weight loss durability, co-morbidity resolution, and quality of life after laparoscopic sleeve gastrectomy (LSG) in persons with class I obesity. Multidisciplinary medical center that specializes in obesity management. A longitudinal prospective single-surgeon registry was queried for data pertaining to persons with class I obesity who underwent primary LSG. Primary endpoint was weight loss. Secondary endpoints included change in obesity-related co-morbidities, adverse events, and post hoc analysis of symptoms of gastroesophageal reflux disease (GERD) and Bariatric Analysis and Reporting Outcome System results. Follow-up was divided into short- (1-3 yr), intermediate- (4-7 yr), and long-term (8-12 yr). We evaluated percent excess weight loss (%EWL) using linear mixed models adjusting for age, sex, years since operation, and baseline BMI. Least-squares means estimates and 95% confidence intervals (CI) were generated. Of 13,863 bariatric procedures, a total of 1851 patients were included. Mean baseline BMI, age, and male:female ratio were 32.6 ± 2.1 kg/m2, 33.7 ± 9.2 years, and 1:5, respectively. Adjusted mean %EWL (95% CI) at short-, intermediate-, and long-term follow-up were 111% (95% CI, 91%-131%), 110% (95% CI, 89%-131%), and 141% (95% CI, 57%-225%), respectively. Of 195 patients with type 2 diabetes, 59% experienced complete remission, and of 168 patients with hypertension, 43% experienced complete remission. Being on oral antidiabetes medication was a significant predictor of sustained remission compared with being on insulin or combination therapy (P < .001). Sixty-nine patients had symptoms of GERD before surgery, which improved in 55 (79.7%). Thirty-three patients developed de novo symptoms of GERD. The average Bariatric Analysis and Reporting Outcome System score was 4.5 ± 1.7, with 83% of participants rating their quality of life after surgery as good, very good, or excellent. Those with class I obesity who undergo LSG experience normalization of weight, sustained remission of co-morbidity, and good quality of life without significant risk of morbidity or mortality.

Outpatient-Polyclinic Register of the Multidisciplinary Medical Center (TERRA): general characteristics and first results

Aim. To describe the experience of creating the Outpatient-Polyclinic Register of the Multi-specialty Medical Center (TERRA) and the first results of the study.Material and methods. The TERRA registry included 32264 patients (age 44,0±15,3 years; 32,2% men) who applied to the multidisciplinary medical center from January 1, 2018 to December 31, 2021. Information from electronic outpatient records was evaluated. The data of patients with/without cardiovascular diseases (CVDs) in those who applied to general practitioners, cardiologists and other specialists, those with and without coronavirus disease 2019 (COVID-19) were compared.Results. There were 26,8% of patients with CVDs, while with ≥2 CVD — 8,1%, with CVD and/or chronic non-cardiac disease — 54,1%, their combination — 26%. Among those who consulted cardiologists, general practitioners and doctors of other specialties, hypertension was most often recorded — 64,8; 34,9 and 18,6%, coronary artery disease — 15,1, 6,2 and 3,2%, while from chronic non-cardiac diseases — diseases of the digestive system (64,4; 58,0 and 33,7%), kidneys (29,8; 24,9 and 13,2%), respiratory organs (28,4; 23,8 and 12,6%). The proportion of COVID-19 survivors was 8.2%, in patients with and without CVD — 14,8 and 5,1%, respectively (p&lt;0,001). The proportion of CVD cases among survivors and non-survivors of COVID-19 was 58,0% and 25,2%, respectively (p&lt;0,001). In addition, 88% of patients with CVDs consulted a cardiologist or general practitioner, of which 42% were observed by them together.Conclusion. The majority of patients at the multidisciplinary medical center had CVDs and chronic non-cardiac diseases, and more than a quarter had a combination of both. Patients with CVDs were more likely to have chronic non-cardiac diseases (2,2 times) and a history of COVID-19 (2,9 times). Among patients with a history of COVID-19, there was a higher proportion of cases of CVDs (by 2,3 times) and chronic non-cardiac pathology (by 1,8 times). Almost half of patients with CVD were observed jointly by a cardiologist and a general practitioner.

Laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra

Introduction. The most common treatment option for prostate cancer is radical prostatectomy, which involves the removal of the prostate itself and the prostatic urethra in a single block, followed by the formation of a vesicourethral anastomosis. This approach is fraught with postoperative complications, such as urinary incontinence and strictures of anastomosis. In this sense, the clinic's staff faced the question of the possibility of a urethral-sparing variant of operative benefit for a certain category of patients.Objective. To assess the possibility of performing radical prostatectomy with sparing of the proximal prostatic urethra in the laparoscopic version, its advantages, and disadvantages.Materials &amp; methods. From 2021 to 2022, 18 successful laparoscopic operations were performed using this technique at the St. Luke Clinical Multidisciplinary Medical Centre. Patients were selected according to the above criteria. In the preoperative period, patients underwent a standard examination in accordance with guidelines, including a blood test for prostate-specific antigen (PSA), ultrasound, magnetic resonance imaging (MRI) with 3D-modelling, data from a multifocal prostate biopsy, the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF), the Quality of Life (QoL) index due to urinary disorders, assessment by the Partin’s nomogram. Intraoperative ratios, early and late postoperative complications, length of hospital stay, day of catheter removal, and time to complete urethral recovery were evaluated to study the effectiveness of this surgery type. PSA testing, uroflowmetry with post-void residual urine measurement and IPSS questionnaire were carried out one month after surgery.Results. There was an improvement in all measurements one month after surgery: median values of the mean urine flow rate increased by 1.7 ml/s, median values of the max urine flow rate increased by 3.7 ml/s, the IPSS decreased by 12 points.Conclusion. Based on the results of the study, clinical observations, and statistical analysis of the data obtained, it can be concluded that laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra is the preferred surgical option for this pathology, due to its organ-preserving nature.

Voices from a Multidisciplinary Healthcare Center: Understanding Barriers in Gender-Affirming Care-A Qualitative Exploration.

When seeking gender-affirming care, trans* and gender-diverse individuals often describe experiencing barriers. However, a deeper understanding of what constitutes such barriers is generally lacking. The present research sought to better understand the barriers trans* and gender-diverse individuals experienced, and their effects, when seeking gender-affirming care in the Netherlands. Qualitative interviews were conducted with trans* and gender-diverse individuals who sought care at a Dutch multidisciplinary medical center. Twenty-one participants were included, of which 12 identified as (trans) male, six identified as (trans) female, one as trans*, and one as gender-nonconforming (GNC)/non-binary. The interviews were mostly conducted at the homes of the participants and lasted between 55 min and 156 min (mean = 85 min). Following data collection and transcription, the interviews were analyzed using axial coding and thematic analysis. A total of 1361 codes were extracted, which could be classified into four themes describing barriers: lack of continuity: organizational and institutional factors (ncodes = 546), patient-staff dynamics (ncodes = 480), inadequate information and support (ncodes = 210), and lack of autonomy in decision making (ncodes = 125). Within our study, trans* and gender-diverse individuals described encountering multiple and diverse barriers when seeking gender-affirming care in the Netherlands. Future studies are needed to evaluate whether individualized care, the decentralization of care, and the use of decision aids can improve the experienced barriers of trans* and gender-diverse individuals seeking gender-affirming care within the Dutch healthcare system.

RETROSPECTIVE ANALYSIS OF MEDICAL CHARTS OF PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME

Background. Antiphospholipid attracts the attention of clinicians in various fields of medicine. This pathology is characterized by a triad of clinical and laboratory signs: recurrent venous or arterial thrombosis with localization in any part of the bloodstream, obstetric pathology in the form of primary premature pregnancy and intrauterine death of the fetus with hematological disorders (thrombocytopenia, hemolytic anemia).&#x0D; Aim: to conduct a retrospective analysis of medical records of patients with antiphospholipid syndrome.&#x0D; Materials and methods. A retrospective analysis of outpatient/inpatient medical records of 54 patients with the main diagnosis: antiphospholipid syndrome between 2016 and 2021, who were examined and treated in the rheumatology department of the Multidisciplinary Medical Center of Odesa National Medical University, was conducted. The diagnosis of antiphospholipid syndrome was established according to the recommendations of EULAR (2019), Order of the Ministry of Health of Ukraine dated October 8, 2007 No. 626 "Clinical protocol for providing medical care to patients with Antiphospholipid Syndrome" and Order of the Ministry of Health of Ukraine No. 22 dated January 20, 2015. "Clinical protocol for providing medical care to patients with immune diseases."&#x0D; Results. In the general group of patients, the duration of this pathology at the time of the study ranged from 1 to 10 years. It was established that the number of appeals in connection with exacerbation of antiphospholipid syndrome depended on age and had probable differences. It was also noted that the total number of concomitant pathologies was correlated with the number of appeals regarding exacerbation of antiphospholipid syndrome. It was revealed that arthralgia and polyarthritis were most often detected in male patients aged 20-44 against the background of antiphospholipid syndrome, and skin manifestations in men aged 45-59. In women of the age group of 20-44 years, on the background of the diagnosed antiphospholipid syndrome, skin manifestations in the form of reticular liver, arthralgia and polyarthritis, as well as cardiovascular disorders, were most often noted. In women aged 45-59, arthralgia and polyarthritis and disorders of the cardiovascular system.&#x0D; Using the method of collecting anamnestic data and the results of clinical laboratory examination, in accordance with current medical care protocols and diagnostic criteria for antiphospholipid syndrome, a retrospective analysis confirms the fact that antiphospholipid syndrome occurs 5 times more often in women than in men.

Evaluation of Kidney Functioning in Children with Renal Complications During COVID-19 Pandemic: A Retrospective Observational Cohort Clinical Study

Background. An increase in a quantity of children with acute renal insufficiency associated with infectious diseases, including COVID-19 is a growing problem in nephrology. Such insufficiency is often expressed in pyelonephritis. Due to a lack of specific signs or obvious clinical symptoms and their correct interpretation, acute renal insufficiency against the background of COVID-19 is first identified in the period of steady worsening of the kidney functioning. An accurate non-invasive diagnostic test is yet to be fully developed, therefore, determination of the mechanisms of complications is considered to be challenging and can contribute to the formation of irreversible renal injury.Objective — to determine and evaluate characteristics of the renal status in children with acute pyelonephritis against the background of COVID-19.Methods. A retrospective observational cohort clinical study of 65 children with acute pyelonephritis was carried out. The study also included a control group of 20 healthy children, who were observed during routine health checkup. The patients were observed at the Nephrology Unit, Samarkand Regional Pediatric Multidisciplinary Medical Center, Uzbekistan. Laboratory examination was carried out on the basis of Clinical Diagnostic Laboratory, Samarkand Regional Pediatric Multidisciplinary Medical Center, Uzbekistan, and Laboratory of Innova Clinic, Uzbekistan. The study was conducted from January 2021 to December 2022 and involved participants with the history of COVID-19 before treatment. Thus, two cohorts were formed: group 1 comprised 30 children with acute pyelonephritis and without a history of COVID-19; group 2 consisted of 35 patients with acute pyelonephritis against the background of COVID-19. In order to evaluate the renal status, examination of the glomeruli, proximal and distal tubules was carried out. The study included investigation of “urinary syndrome” indicators — leukocyturia of neutrophil origin, microhematuria, proteinuria, and bacteriuria. The obtained laboratory data were analyzed using variance and given in SI System — the International System of Units. The calculations were carried out using StatPlus 7 (AnalystSoft Inc., USA).Results. Renal function is decreased in an acute period due to reduced functionality of concentration and distal tubule, which were more significantly affected in group 2. Inflammatory changes in the renal tissue due to the toxic effects of coronavirus infection underlie the abnormalities detected. The history of COVID-19 is reckoned from the date of admission and ranges from 3 weeks to 2 months. Renal insufficiency in children with COVID-19 history is manifested irrespective of their clinical polymorphism, due to impairment of its tubular structures (reabsorption, acidogenesis and ammoniogenesis, osmotic concentration) and glomerular filtration. A statistically significant reduction in acidogenesis (p = 0.001) was recorded in patients with acute COVID-associated pyelonephritis.Conclusion. Children with COVID-19 respiratory symptoms require monitoring their renal functions for early diagnosis and treatment. Long-term monitoring of patients with isolated urinary syndrome in the acute period is needed to detect the underlying renal disease.