National Academy Of Medical Sciences Research Articles

Infectious complications of external fixation in patients with polytrauma

Annotation. Among the main causes of mortality and in the structure of primary disability in Ukraine, the consequences of injuries consistently rank third, second only to cardiovascular and oncological diseases. The intensive use of implants in traumatology and orthopedics in the second half of the 20th century, along with significant advantages in the tactics of surgical treatment and further improvement of the quality of life of patients, also contributed to the emergence of infection. The purpose of our work was to determine the features of the occurrence and localization of the infectious process after external fixation as a result of polytrauma. An analysis of the treatment of 181 patients who were hospitalized in the Department of osteomyelitis surgery at the Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine was conducted. Statistical processing was carried out using the method of calculating the coefficient of the polychoric relationship indicator according to K. Pearson. As our study indicated, in 93.6% of patients with infectious complications of external fixation as a result of polytrauma, the pathological process was localized in the lower limb, which is associated with high-energy injuries inherent in multisystemic and multiorgan damage. Most often, the purulent process in patients with external fixation as a result of polytrauma was found in the lower third of the tibia (21.0%), the middle third of the tibia (17.9%) and the lower third of the femur (15.8%). Purulent complications in the area of the upper extremity in patients with external fixation as a result of polytrauma were observed four times less often than in patients with the same complications as a result of an isolated injury.

Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Annotation. The diagnosis of facial pain falls within the realm of professional competence for dentists, orthopedic dentists, ophthalmologists, otolaryngologists, neurosurgeons, neurologists, and physiotherapists. The complex and highly subjective nature of clinical symptoms often poses challenges for practitioners across these specialties. Consequently, a patient with facial pain may undergo multiple consultations with different specialists before a definitive diagnosis is established and effective treatment is provided. The aim of this study is to demonstrate a developed routing protocol for a patient with atypical facial pain through a clinical case. The stages of interdisciplinary simultaneous consultation, a comprehensive approach to diagnosis and treatment of patients with facial pain, and differential diagnosis are considered using the example of a clinical case of a 15-year-old female patient K., who presented to a dental surgeon with complaints of constant facial pain and a preliminary diagnosis of “Temporomandibular joint dysfunction. Impacted wisdom teeth 38 and 28”. The pain was constant, dull, deep, and piercing. She experienced decreased sensitivity in the lower lip and the anterior half of the tongue on the left side, as well as stuffiness and ringing in the left ear. Consultations with a neurologist and an orthopedic dentist were conducted, which led to the prescription of additional diagnostic methods: needle electromyography and magnetic resonance imaging of the brain. The article assesses the relevance and effectiveness of a multidisciplinary approach to the comprehensive diagnosis of facial pain syndrome, including a thorough history-taking by a dental practitioner, conclusions of a neurologist, and the results of additional diagnostic methods. Based on the electromyographic signs, the trigeminal nerve damage was detected, and a voluminous brain tumor causing compression of the trigeminal nerve and its peripheral endings was visualized on magnetic resonance tomography. Following the consultation with the dental surgeon, the patient was referred for further treatment to the A.P. Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine. Thus, interdisciplinary consultation is recognized as the basis for the comprehensive management of patients with atypical facial pain, requiring the involvement of a primary care physician - a dentist, who develops a routing protocol for timely diagnosis and effective treatment of these kind of patients.

Clinical Profile of Patients of Pelvic Organ Prolapse and Its Associated Factors.

Prolapse is among the most common indication for gynaecological surgery. It is difficult to estimate prevalence of pelvic organ prolapse even in developed countries due to lack of epidemiological studies. This study was done to find the prevalence, risk factors and common presenting complaints of women with pelvic organ prolapse. Women with pelvic organ prolapse visiting Paropakar Maternity and Women's Hospital during 4 months duration in 2021 were approached and after obtaining an informed consent, all the patient information on various risk factors and clinical profile(age,parity,body mass index,smoking etc.) for pelvic organ prolpase were collected in a pre-developed proforma. Pelvic Organ Prolapse was classified by Pelvic Organ Prolapse Quantification system. Data analysis was done using statistical package for the social sciences-25. Ethical approval was taken from Institutional Review Committee- National Academy of Medical Sciences. Out of 58 cases enrolled in the study, prevalence of pelvic organ prolapse was found to be 1.28%. Women belonging to age group ≥ 49 years was 91.4%. Bulge symptom was the most common presenting complain among the women, 98.3%. 50% of women (n=29) were grand multipara. 53.4% (n=31) of women had delivered their first baby before 20 years of age. Multiparity,vaginal birth and menopausal age were the common risk factors. Menopausal age, multi-parity, vaginal births, age at first vaginal delivery of less than 20 years were significant risk factors for development of prolapse. Bulge symptom was the most common presenting complaint. However,Smoking habit, overweight were not related to pelvic organ prolapse.

Features of epileptic encephalopathy caused by SCN1A mutation

Background. The development and availability of genetic research open both new possibilities in the diagnosis of epileptic encephalopathies and require the search for correlations between detected pathological mutation and the clinical and instrumental examination of a child. In particular, seizure disorders in children in whom SCN1A has been detected cover a spectrum that varies from simple febrile seizures and mild generalized epilepsy with febrile seizures plus, which was first described in 2003, to severe myoclonic epilepsy in infancy (more commonly known as Dravet syndrome) or severe intractable childhood epilepsy with generalized tonic-clonic seizures. Materials and methods. In our study, we examined 4 children (2 boys and 2 girls) with clinical and instrumental signs of epileptic encephalopathy with resistant seizures who were treated in the psychoneurology department for children with perinatal pathology and orphan diseases of the SI “Lukyanova Institute of Pediatrics, Obstetrics and Gynecology named of the National Academy of Medical Sciences of Ukraine”. The average age of patients was 2.20 ± 1.55 years. In addition to the laboratory and instrumental examination, all children underwent a medical genetic analysis (whole exome sequencing or next-generation sequencing) and the mutation of the SCN1A gene was detected. Subsequently, the relationship between the obtained laboratory instrumental and clinical anamnestic data was analyzed using statistical research methods. Results. It should be noted that the onset of genetic disorders caused by SCN1A occurs at the age of 5.5–6 months. During the onset, focal clonic seizures predominate, mainly against the background of hyperthermia, which are later modified into generalized tonic-clonic, myoclonic ones, and even absences. In three of four cases, the epileptiform activity was focal, with a predominant localization in the fronto-central regions followed by generalization. In all children, taking into account the focal onset of attacks, therapy was started with the use of carbamazepine, which is contraindicated in children with this mutation. After analyzing our cases, we saw that the course of the disease and the resistance of attacks were more severe in girls. The study of this phenomenon requires observation of a larger number of children. Conclusions. In children with genetically determined epileptic encephalopathy caused by the SCN1A mutation, the onset of the disease occurs in the first half of life and is usually manifested itself by focal seizures. In children with SCN1A mutation, frontal localization of epileptiform activity prevails. Considering this feature of the disease and based on our own long-term observation of children with epileptic encephalopathies of early age, we would like to warn against the use of carbamazepines in this age group. The course of SCN1A epileptic encephalopathy (Dravet syndrome) is difficult, given the resistance of attacks and regression in the development of a child, and often requires the use of more than 2–3 antiepileptic drugs, but a correctly selected combination allows long-term remission to be achieved.

Assessment of computed tomography for the diagnosis of exudative and transudative pleural effusion

Introduction: The basic computed tomography (CT) characteristics of pleural effusion (PE) were analyzed, and the association between demographic factors and prominent CT findings with different types of PE was assessed. The individual CT characteristics and Light’s criteria for exudative PE were also evaluated. In addition, a cutoff for attenuation values of CT scans for exudative PE was determined. Methods: A cross-sectional study among 92 participants with PE was carried out at Bir Hospital, Kathmandu, Nepal. The χ2 test, logistic regression analysis, and diagnostic statistics were calculated. The ethical clearance was obtained from the institutional review committee of Institutional review board of National Academy of Medical Sciences (NAMS), Bir Hospital (Ref. 876/076/77). Results: The study examined 92 cases of PE, with 78.3% occurring in males and the majority affecting individuals aged 55–74 years old. Results showed that on CT scans, pleural thickening [odds ratio (OR): 13.89, 95% CI: 4.96–38.86, P < 0.05], pleural nodules (OR: 12.72, 95% CI: 2.64–61.18, P < 0.05) and loculations (OR: 13.46, 95% CI: 4.03–44.89, P < 0.05) were significantly associated with exudative PE. Of these, pleural nodules had the highest specificity (96.4%) and positive likelihood ratio (9), whereas pleural thickening had the highest sensitivity (70.3%). When using the criterion “pleural fluid Lactate Dehydrogenase concentration as positive if it was over two-thirds of the upper limit of normal serum Lactate Dehydrogenase,” the CT scan had a positive likelihood ratio of 22.52. The study also found that an attenuation value ≥9.70 HU could indicate an exudative PE (area under the curve: 0.80, 95% CI: 0.70–0.90, P < 0.05). Conclusion: The CT characteristics, such as pleural thickening, pleural nodules, and loculations, were more likely to be present in exudative PE. In addition, the attenuation values of PE could also determine its nature as either exudate or transudate, with an attenuation value of >9.70 HU indicating an exudative PE.

Readmission for Morbidities among Postpartum Women in a Tertiary Hospital of Kathmandu

Background: Postpartum period is a critical stage where the majority of the maternal mortality occurs. Major obstetric morbidities during this period include postpartum haemorrhage, puerperal pyrexia, and sepsis, and pregnancy induced hypertension. The objective of this study was to find out the morbidities in postpartum women readmitted following discharge from the hospital after delivery. Methods: It was conducted as a hospital-based descriptive study at Paropakar Maternity and Women’s Hospital (PMWH), Thapathali, Kathmandu. Ethical clearance was obtained from Institutional Review Board (IRB) of National Academy of Medical Sciences (NAMS). The total population enumeration technique was used to collect the data for a period of three months. A Standard Performa containing socio demographic characteristics, causes of readmission, complications during pregnancy, time interval of readmission and outcome of readmission was prepared which include relevant points according to the objective of the study. Data analysis was done using the Statistical Package for Social Sciences 16. Descriptive statistics (frequency, percent, mean, standard deviation and range) were used to analyse the data. Results: The incidence of postpartum readmission was 1.0% of total deliveries with 58 women being readmitted. More than two-fifth (29, 43.9%) were readmitted due to abdominal and perineal wound infections followed by urinary tract infections (8, 12.1%). Hypertension, puerperal pyrexia, secondary postpartum haemorrhage were other conditions requiring readmission in postpartum period. Conclusion: The study concluded that the women were readmitted during their postpartum period for multiple causes, wound infection being the most common. The quality of postnatal care including proper examination before discharge is necessary to ensure reduction in the readmission rate.

"Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine": activities and achievements

The article provides a review of activities and achievements of the “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine” State Institution. In the article a history of the Institute, the main results of its scientific-research works for the last five years, an implementation of the research developments into public health practice, international liaisons of the Institute are described, a medical care to the population in peacetime and wartime, as well as the main prospective directions of scientific researches of the Institute are outlined. Key words: “Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine” SI, public health, scientific researches, neurology, psychiatry, narcology

Uncontrolled Diabetes Mellitus during Lockdown period of Covid 19 pandemic

Background: Nepal Government had declared a lockdown from 24th March till 21st July 2020 for prevention and control of spread of Covid 19 pandemic. This has made patients with diabetes mellitus unable to do their physical activity outside home, not able to visit physicians or healthcare workers on time, buy medicines on time, check blood sugar as scheduled. In this study we aimed to study the effect of lockdown on glycemic control of Diabetes patients. Methods: This study was done at National Academy of Medical sciences, Bir Hospital-Endocrine Unit outpatients department. After the ease of lockdown certain patients visited us with past and new reports of Blood glucose and HbA1c. We kept a record of variation of glycemic control, lack of physical activities, continuation of medications and daily food habits. Results: Total of 91 Diabetes Mellitus patients visited our OPD in 3 weeks period after lockdown was eased. 58% were Female and 42 % were Male. Only 7% of patients had good control of Diabetes, 32% had fairly controlled Diabetes and 61% had poorly controlled Diabetes in males. In females 3% had good control of Diabetes, 27% had fairly controlled and 70% had poorly controlled Diabetes. 46-65 age group in both male and female had uncontrolled blood sugar. Among males 49% had increased food habits, 32% had decreased physical activity and 10% of them left or decreased medicine. In similar among females 23% had increased food habits, 39% decreased physical activity, 38% had left or decreased medicines. Conclusion: Lockdown during Covid 19 pandemic had adverse effect on glycemic control of patients. This will lead to further complications of diabetes mellitus. Patients must do normal physical activities. They can do normal exercise inside their house and increase activities with family members in a small area, where possible. We must advice our patients to learn how to perform self glucose monitoring and self adjustment of Insulin and diet. Learning how to access to physicians, healthcare workers and pharmacist through telemedicine is very important during lockdown period.

X-ray diagnostics of gunshot wounds of main vessels of the limbs: theoretical analysis

The analysis of damage to the main vessels of the limbs was considered for the formation of further organizational and tactical instructions for the provision of emergency medical care at the stages of evacuation of the injured to specialized wartime departments. It was determined that with the help of MSCT-angiography, signs of damage to main vessels can be accurately diagnosed, and additional information about damage to bone structures, neighbouring organs and tissues can be obtained. It is emphasized that MSCT is an effective and accurate method in the assessment of clinically significant arterial injuries of the lower extremities in case of gunshot injury. It was noted that timely diagnosis of vessels gunshot wounds can contribute to the preservation of the functionality of the limbs and the life of patients, reducing the risk of bleeding, infections and other complications. It was noted that the correct medical decisions, in particular, the correct diagnosis of gunshot injuries to blood vessels will help doctors make informed decisions regarding emergency surgical care, the choice of treatment methods and preoperative preparation.
 The aim. The aim of the work is the theoretical substantiation of gunshot injuries of the main vessels of the limbs and the definition of practical diagnostic methods.
 Materials and methods: analysis of theoretical sources, comparison, induction of isolated analytical data. The study was conducted based on the database of the State institution "National Institute of Cardiovascular Surgery named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine".
 Results. It was determined that with the help of MSCT-angiography, signs of damage to main vessels can be accurately diagnosed, and additional information about damage to bone structures, neighboring organs and tissues can be obtained.
 Conclusions. Radiological diagnosis of gunshot injuries of the main vessels of the limbs demonstrates the importance of using radiological diagnostics in the detection and analysis of vascular injuries in gunshot injuries of the extremities. The study confirms the high efficiency of this method, its accuracy and reliability in determining the nature of damage. In addition, radiological diagnostics allows timely and accurate determination of the extent and nature of injuries, which is important for making informed clinical decisions and providing adequate medical care to the injured

Smart-Systems for Precision Agriculture, Environmental Protection and Healthcare

Appearance of innovative tools of informatics in the world is determined by development of information-communication technology, microelectronics, sensor and biosensor technologies. Spreading of these technologies on precision agriculture, environmental protection and health care gives opportunity to create smart fields, gardens, greenhouses, forests and parks, and also smart health monitors, which estimate the health state of person as in rehabilitation, so in emergency situations. Results of research of authors in the development of new information technologies and creation of main components of the smart systems for different purposes on this base are shows in this paper. Main requirements for knowledge bank for precision agriculture and ecological monitoring are defined. Main principles of creating knowledge bank on base of requirements are proposed. The typical smart system models and their development stages are considered. Structure of wireless multilevel networks for the estimation of state of biological objects of different origin and their nodes are described. Developed sensor networks and smart systems for agriculture are considered. Structure of proposed smart system for agriculture and ecological monitoring is given. Approaches for chlorophyll fluorescence induction curves analysis are studied. Results of network testing for the estimation of the autonomous work time of network nodes and possible errors are given. Wireless sensor network and smart system for remote medical monitoring are described. Diagnostic smart systems for estimation of quality of life are considered. Medical communicator, computer device on base of tablet computer, was used for their development. The short form of Survey Instrument (SF-36) for life quality estimation and abnormal uterine bleeding questionnaire, which was developed in State Scientific Institution "Center for Innovative Medical Technologies of the National Academy of Sciences of Ukraine", were embedded in communicator. STEPS questionnaire which was designed for epidemiological monitoring of the prevalence of noncommunicable diseases and their risk factors in the target subpopulations could be added to communicator. Development of smart systems for estimation of quality of life and prevalence of noncommunicable diseases was made in cooperation with R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology NAS of Ukraine (department of research management and innovation), Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Center for Innovative Medical Technologies of the National Academy of Sciences of the Ukraine. Keywords: wireless sensor network, precision agriculture, chlorophyll fluorescence induction, express-diagnostics of plant state, quality of life, SF-36.

Method for calculating the integrated biological age of a human

Abstract. Integral biological age (BA) encompasses a holistic assessment of an individual's overall physiological state, taking into account various biological markers that may contribute to the ageing process. This article presents a novel method for determining the integral biological age, a comprehensive measure that considers multiple biological markers and factors to assess an individual's ageing process. We will delve into the various components and biomarkers utilized in our method, including cardiorespiratory and musculoskeletal systems functionality, and other molecular markers associated with ageing. By combining these diverse indicators, we create an integrated framework that provides a holistic view of an individual's ageing trajectory. The study included 124 practically healthy people aged from 20 to 90 years, who were examined at the «D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine». People with pathologies of the cardiovascular, respiratory, endocrine and central nervous systems, chronic liver and kidney diseases, and pathologies of the hematopoietic system were excluded from the analysis. We recorded 74 indicators characterizing different body systems: hearing, cardiovascular, respiratory, and musculoskeletal systems, as well as autonomic regulation and metabolism. To build a model of integral BA, indicators of each of the systems that have the highest correlation with age were selected. An important selection criterion was the low cross-correlation of these indicators. The use of step-by-step multiple regression made it possible to select the most informative indicators and obtain an equation that relates the age of the subjects with a number of indicators of the main body systems. The resulting calculation formula includes 11 indicators characterizing different body systems. The coefficient of determination of the model R2 was 0.738, indicating the high accuracy of the created model. The mean absolute error of age calculation was 5.34±3.99 years. After correcting the systematic error of the regression equation, the average absolute error in calculating the age was 4.72±3.25 years. The rate of ageing was estimated as the difference between BA and CA. If this difference exceeds the value of the model error, a conclusion can be made about accelerated ageing. Thus, the method for assessing the rate of ageing developed by us has high accuracy and can be used to assess the risk of developing age-dependent pathology. The implementation of the proposed method will allow not only to identify people with the risk of developing pathology but also to assess the effectiveness of treatment, prophylactic and rehabilitation measures. Keywords: integral biological age; method calculation; cardiovascular; respiratory; musculoskeletal systems; metabolism; human

Характеристика харчування українських підлітків з ознаками метаболічного синдрому

One of the most important issues of modern medical science is the metabolic syndrome, the origins of which begin in childhood and adolescence. Purpose: To study the dietary peculiarities of Ukrainian adolescents with obesity and to identify the eating dis-orders on the background of metabolic syndrome. A survey on the nutrition of Ukrainian adolescents was conducted on the base of Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine. As a result, a sample of 200 adolescents with obesity (age 14 – 18 years: 100 boys and 100 girls) was formed. Thus, irregular and unbalanced diet naturally causes digestive disorders, abnormalities in eating behavior and contributes to the formation of comorbid pathologies such as obesity and metabolic syndrome. Adolescents with obesity experienced sig-nificant zinc and magnesium deficiency in the body.

PROFILE OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19 INFECTION

Background: COVID-19 infection has shown to be a multi-system disease and kidneys are commonly affected. AKI is the main risk factor for mortality in COVID-19 infection. There is limited data on Covid-19 infection and kidney involvement among the Nepalese population. Hence this study aims to describe the prevalence, risk factors, and outcomes in the setting of Covid-19 infection and acute kidney injury. Methods: This was a hospital-based cross-sectional study conducted at the National Academy of Medical Sciences (NAMS), Bir Hospital, Kathmandu, Nepal from January 2021 to June 2021. Ethical approval was obtained from the Institutional Review Board, NAMS (Reference number: 452/2077/78) Convenience sampling method was used. Data obtained was entered in MS Excel 2010 and statistical analysis was done by SPSS version 21. Results: Out of 101 patients, 73(72%) were male and 28(28%) were female. The mean age of the total study participants was 51.50 years. The prevalence of AKI among patients with COVID-19 in the ICU and ward of Bir Hospital was found to be 13.9%. A statistically significant association between liver disease and AKI with p-value of 0.018 was observed. The majority of death i.e., 57.14% was for KDIGO stage 3 patients. 3(100%) patients requiring renal replacement observed mortality. Conclusions: CLD, higher KDIGO staging of AKI, and the need for renal replacement therapy have been associated with mortality in patients with COVID-19 infections.

Neurodevelopmental Manifestations and Birth Defects in Prader-Willi Syndrome: Findings from a Study in Western Ukraine

Prader-Willi syndrome (PWS) is a genetic disease characterized by mental retardation, as well as autism spectrum disorders, obesity and mood disorders. The aim of our study was to research a spectrum of genetic heterogenity and different clinical neurodevelopmental manifestations. Materials and methods: clinical, molecular, genetic and psychological methods were used. We observed 9 children (5 boys and 4 girls) with Prader-Willi syndrome from Lviv and Ivano-Frankivsk regions (Western Ukraine) who were diagnosed and followed-up at the Institute of Hereditary Pathology, National Academy of Medical Sciences of Ukraine, Lviv, for 4 years (2019–2022) and underwent molecular genetic testing. The ages of children ranged from 1 month to 7 years, with the mean value amounting to 3.6 years of age. Results: Our study revealed that 6 (66.7%) out of 9 children with PWS had birth defects. At ultrasound during pregnancy, we observed certain clinical features of the fetus, including fetal intrauterine development delay –5 (55.5%), and higher nuchal translucency measurement – 3 (33.3%). According to the checklist of autism spectrum disorders (CASD), 3 of the examined children with autism syndrome were at risk and required further monitoring, while 5 children scored 18-20 points, which indicated the presence of autistic spectrum and required in-depth monitoring during diagnosis. Stereotypical and repetitive play as a manifestation of problems with social interaction was observed in 3 boys with PWS. In our study, parents had no complaints about aggressive behavior in children with this syndrome. Conclusions: In cases if the children have signs of autism or developmental delay, they should undergo genetic counseling.

Surgical Reconstruction of Mitral-Tricuspid Insufficiency Combined with Biatriomegaly in Marfan Syndrome

The aim. To analyze the results of introduction of complex reconstruction of the left and right parts of the heart in Marfan syndrome combined with mitral-tricuspid insufficiency, biatriomegaly and left ventriculomegaly.
 Materials and methods. As an example of this pathology, we present our observation. Female patient T., 24 years old, was examined and treated from 7/27/2022 to 8/17/2022 at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a diagnosis: Marfan syndrome. Stage IV mitral-tricuspid insufficiency. Biatriomegaly. High pulmonary hypertension. Permanent form of atrial fibrillation (for 10 years, since 2011). IIB heart failure with left ventriculomegaly with reduced left ventricular ejection fraction. NYHA functional class IV+. The patient underwent surgery in the following volume: mitral valve replacement with full preservation of the valve apparatus + tricuspid valve plasty with the imposition of a support ring + triangular plasty of the left atrium with its partial resection + resection of the right atrium.
 Results. Within 4 months after surgery, echocardiographic parameters showed significant decrease in the volume of the left ventricle, the diameters of both atria. In addition, there was a significant decrease in the level of N-terminal pro-brain natriuretic peptide and manifestations of heart failure.
 Conclusion. Taking into account the initial serious condition of the patient with Marfan syndrome and advanced mitral-tricuspid heart disease, left ventriculomegaly with a reduced left ventricular ejection fraction, biatriomegaly (left atrium 7.2 cm, right atrium 6.5 cm), permanent form of atrial fibrillation, complex reconstruction of the left and right parts of the heart leads to an improvement in the functional state of the myocardium.

Experience of Surgical Treatment of Complex Forms of Ebstein’s Anomaly through the Method of Hemodynamic Correction

Ebstein’s anomaly (EA) is a rare and complex congenital heart disease, with a prevalence of 4 to 7 cases per 100,000 live births. At this stage of the development of EA surgery, significant progress has been made in our understanding and treatment of EA, but the question of the tactics of treating complex forms, especially in the period of infancy and early childhood, remains open. Due to significant phenotypic heterogeneity, the treatment of EA varies greatly from patient to patient and depends on many factors that require a comprehensive approach. The choice of the method of surgical correction directly depends on the anatomical features: the degree of dysplasia, rotation and displacement of the tricuspid valve, the degree of atrialization of the right ventricle, the combination with other congenital heart diseases, and the severity of hemodynamic disorders.
 The aim. To evaluate perioperative characteristics in patients with complex forms of EA, immediate and long-term results after hemodynamic correction.
 Materials and methods. In the period from 1996 to 2022, at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, one and a half ventricle repair was performed in 18 patients with complex forms of EA. There were 12 (67%) male patients, 6 (33%) female patients. The median age of the patients at the time of surgery was 30 months [3.5; 312]. The main diagnostic method in determining the defect and assessing the immediate and remote results was echocardiography and probing of the heart cavities. In order to qualitatively evaluate the perioperative, immediate and long-term results to determine the optimal tactics and terms of surgical intervention, prevention of possible complications, all the patients were divided into two age groups: I group up to 2.5 years including 9 patients (50%), II group older than 2.5 years including 9 patients (50%).
 Results. In the postoperative period, 2 (11%) deaths were noted in both groups. In all the deceased patients, the cause of death was acute heart failure and acute respiratory failure. The analysis of the postoperative period showed normal results in such a cohort of highly complex patients of both groups, but a more stable course was noted among patients of the I group, as indicated by statistically significant values for the duration of mechanical ventilation, stay in the intensive care unit, stay in the hospital, the average dose of sympathomimetic support and its duration, the total duration of exudation in the comparison groups.
 An uncomplicated course of the early postoperative period was observed in 8 (44%) patients. The remaining 10 (56%) patients of both groups had: I group, 3 (33%) patients: 7 complications; II group, 5 (55%) patients: 13 complications. In 5 patients (2 patients in I group and 3 patients in II group), attention-grabbing acute heart failure was observed, which required high doses and long-term sympathomimetic support, and in 2 patients caused death. The average observation period was 45 months [6; 190]. No deaths were observed during the observation period among 13 (72%) patients of both groups, contact was lost with 3 (17%) patients. There were no violations in the functioning of the right ventricle, but the recovery of the systolic function of the left ventricle occurred only in 8 (44%) patients.
 Tricuspid insufficiency was minimal in 5 (28%) patients, moderate in 6 (33%), severe in 2 (11%) patients.
 Conclusions. Determining the tactics of treatment of complex forms of EA is a serious problem in patients of various ages, especially in newborns and infants, due to pronounced dilatation and systolic dysfunction of the left ventricle, a sharp decrease in systemic output due to changes in the geometry of the left ventricle. The technique of hemiventricular correction shows very promising results and may become the technique of choice for patients with severe forms of EA and pronounced right ventricular insufficiency.

Risk factors of local recurrence and distant metastasis and manifestations of toxicity during chemoradiation treatment of cervical cancer patients

Relevance. Cervical cancer remains one of the most common malignancies in women worldwide, despite declining mortality rates due to large-scale screening programs and increased use of the human papillomavirus vaccine in Western countries. Although chemoradiotherapy has been recognized as the standard therapy for patients with locally advanced carcinoma, one-third of patients experience recurrence, and the effect of its treatment is far from satisfactory. In addition, factors affecting prognosis for patients with cervical cancer remain controversial. In connection with the above, research devoted to the analysis of the long-term clinical consequences of cervical cancer treatment and the search for prognostic factors remains extremely relevant.
 The purpose of the work is to determine the risk factors of local and distant metastasis and manifestations of toxicity during chemoradiation treatment of cervical cancer patients.
 Materials and methods. Paper case histories of non-operated patients with locally disseminated сervical cancer (stages 2B–4А) who underwent special treatment in the clinic of the institute in the period 1999–2020 were selected from the archive of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» for inclusion in the electronic database. The selection criterion was either a follow-up period of more than 1 year, or a tracked recurrence of the disease within a period of up to 1 year. The end of observation was considered either the death of the patient, or the appearance of oncological consequences of the disease, or withdrawal from observation for unknown reasons (censored observations). The WizWhy package of the Data Mining category was used to conduct the research and propose hypotheses, followed by hypothesis testing by non-parametric statistical methods using the STATISTICA and SPSS general-purpose software package. Non-parametric methods were used – Pearson’s chi-squared test and the Mann–Whitney U-test.
 Results and discussion. A number of parameters and factors that have predictive properties regarding the risk of the appearance of oncological consequences of treatment in the future have been identified. The main immediate and remote consequences of chemoradiation treatment of patients and remote somatic consequences of combined treatment were analyzed.
 Conclusions. Catamnetic data of «processed» case histories, provided they are processed by appropriate mathematical methods, are a potential source for obtaining new non-obvious knowledge. In particular, the correct analytical approach to the processing of formalized medical history data made it possible to find a number of risk factors for local and distant metastasis and manifestations of toxicity during chemoradiation treatment of non-operated patients with locally disseminated cervical cancer, which creates the basis for the development of proposals for adjusting antitumor therapy and individualized patient support.

Aspects of hypofractionation in modern radiation oncology

Background. In the modern world, the incidence of cancer diseases is rapidly increasing and is the second most common cause of death. This is preconditioned by the quantitative growth of the senior and elderly population, as well as the growth of the main risk factors for cancer, which is related to the socio-economic development of society. About half of cancer cases require radiation therapy (RT) as a component of multimodal treatment, therefore its improvement, namely the introduction of hypofractionated radiation regimens, is considered today as one of the most effective ways to increase availability of oncological care and optimize the use of health care system resources.
 Purpose. To find out clinical and medico-social advantages of the hypofractionated approach in radiation oncology in order to optimize the functioning of the health care system by increasing availability of treatment for cancer patients. To highlight the importance of hypofractionated RT in terms of evidence-based medicine for the most common oncological pathology and in neuro-oncology. To demonstrate the influence of the COVID-19 pandemic on the implementation of hypofractionated RT. To present our own experience of using hypofractionated radiation regimens in patients with glioblastoma (GB).
 Materials and methods. MEDLINE (Pubmed), EMBASE (Ovid), Web of Science (Web of Knowledge) databases were used to search for literature. The search was performed in the English-language sources with the following keywords: «Radiation», «Hypofractionation radiotherapy», «Hypofractionated radiotherapy», «Hypofractionated irradiation»; «Breast cancer»; «Prostate cancer»; «Lung cancer»; «Glioblastoma», COVID-19. Systematic reviews, meta-analyses, randomized controlled trials and retrospective clinical trials were reviewed in full. The primary sources were backreferenced to identify additional relevant studies related to hypofractionated radiation treatment regimens. The last date of the search is 05.25.2023. The authors’ own experience of the hypofractionated approach in the adjuvant radiation treatment of patients with GB is presented briefly, as a reflection of the relevance of the authors’ practical experience to the provisions of the narrative review, based on the results of a retrospective single-center non-randomized study conducted at the State Institution «Romodanov Neurosurgery Institute National Academy of Medical Sciences of Ukraine» in 2014–2020. The oncological results of 110 (69.2%) patients of the hypofractionated RT group (15 fractions, single fraction dose (SFD) 3.5 Gy, total fraction dose (TFD) 52.5 Gy) and 49 (30.8%) patients of the standard RT group (30 fractions, RVD 2.0 Gy, SVD 60.0 Gy) were compared. RT was performed with Trilogy linear accelerator (USA) (6 MeV) using the intensity-modulated radiotherapy method (IMRT). Overall survival (OS) and recurrence-free survival (RFS) in the groups were analyzed.
 Results and discussion. Hypofractionated approaches, which allow to significantly decrease the duration of radiation treatment, have clinical, medical and social advantages, including: increased comfort for a patient; reduction of the workload on staff and technological equipment of medical facilities; reduction of the cost of treatment. The introduction of hypofractionated RT allows to increase access to cancer care at the global level, reducing disparity in the results of treatment of cancer patients between low- and middle-income countries and the countries with high income level. Hypofractionated radiation regimens are included in the clinical guidelines of professional associations, as for the most common forms of cancer and for malignant brain tumors, and represent the standard of treatment for particular clinical cases. Our experience of using the hypofractionated radiation regimen is based on the adjuvant radiation treatment of 110 patients with GB and in terms of clinical results is a relevant concept presented in a narrative review. The analysis showed no statistical difference between the groups of standard fractionation and hypofractionated RT in OS (Logrank test p = 0.06757) and RFS (Logrank test p = 0.43374). In the hypofractionation group, with an observation time median of 22.3 months, the OS median was 16.5 (95% CI 14.1–18.8) months; median RFS was 9.0 (95% CI 8.0–10.0) months. In the standard radiation regimen group, with a median of observation time of 24.4 months, the median OS was 15.0 (95% CI 14.1–17.1) months; median RFS is 9.0 (95% CI 9.0–10.0) months.
 Conclusion. Development and implementation of the measures designed to optimize the use of resources of medical facilities of Ukraine is a necessary condition for maintaining high-quality care for cancer patients in the conditions of full-scale military aggression, which has been ongoing since February 24, 2022. Increased application of hypofractionated approaches in radiation oncology can be considered as a potential tool for optimization of the use of resources of the healthcare system of Ukraine and enhancing public health.

Clinical and diagnostic observation of primary lymphoma of the central nervous system

Background. Lymphoma of the central nervous system (CNS), both primary and secondary, is a rare but very aggressive type of non-Hodgkin’s lymphoma. Primary CNS lymphoma (PCNSL) refers to cases confined to the CNS parenchyma, dura mater, leptomeninges, cranial nerves, and spinal cord or intraocular region. The prognosis of PCNSL has been very dismal with an overall survival of 1.5 months without treatment and a 5-year survival rate of 30%. Due to the introduction of high-dose methotrexatebased chemotherapy regimens, there has been substantial progress in treating patients with lymphomas of the CNS, leading to improved survival. Diagnosis and differential diagnosis of PCNSL can often cause complications because it may have similar clinical and radiological signs with some other tumors, primarily with high-grade gliomas and metastatic lesion of the CNS. Stereotactic biopsy remains the main diagnostic method.
 Purpose – to investigate the complexity of the diagnostic and therapeutic process in PCNSL on the example of a clinical case.
 Materials and methods. Clinical observation of patient K., 59 years old, who underwent examination and inpatient treatment at the Department of Radiation Pathology and Palliative Care of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» regarding multifocal lesions of the brain (volumetric formations of the white matter of the left hemisphere of the brain).
 Results and discussion. In this clinical case, the presence of multiple volumetric white matter formations of the left hemisphere of the brain in the frontal and temporal lobes of the brain with pronounced perifocal edema, mass effect and signal amplification from the described formations after the administration of a contrast agent in the patient in magnetic resonance imaging allowed us to assume metastatic lesion of the central nervous system. However, a comprehensive examination made it possible to exclude the presence of primary cancer, as well as an infectious lesion of the brain. The diagnosis of primary non-Hodgkin’s diffuse large B-cell lymphoma with damage to the central nervous system was established only after the neurosurgical removal of one of the neoplasms with the conduction of pathohistological and immunohistochemical studies.
 Conclusion. Multifocal brain injury often causes difficulties in diagnosis. Magnetic resonance imaging using T1, T2 and Flair imaging, although very important for the diagnosis of PCNSL, is not always specific. Timely cerebral biopsy with immunohistochemical examination remains the method of choice for verification of the pathological process, which is necessary for the correct treatment.

Oleksandr Oleksijovych Kostrub

The article is dedicated to the head of the Department of Sports and Ballet Trauma of the State Institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine", doctor of medical sciences, professor, doctor of the highest qualification category O. O. Kostrub.