State Medical University Research Articles

КОЛИЧЕСТВЕННО-КАЧЕСТВЕННАЯ ХАРАКТЕРИСТИКА КРИСТАЛЛИЧЕСКОГО СТРОЕНИЯ РОТОВОЙ ЖИДКОСТИ ЧЕЛОВЕКА С ИСПОЛЬЗОВАНИЕМ ТЕОРИИ ФРАКТАЛОВ. ЧАСТЬ I

The subject of the study is a dried drop of human oral fluid (facies). The goal is to propose a method for quantitative characteristic for the crystalline structure of oral fluid using fractal theory. The task is to create a computer program to calculate the fractal dimension, the area of crystals; length and width of the axes of mixed human saliva crystals. Methodology. To create a computer program for quantitative description of the crystalline structure of the oral fluid facies. The program was created within the framework of cooperation between Omsk State Medical University and Omsk State Technical University. The program, called FracSquare, was developed using the Python programming language version 3.1 and the built-in libraries math, cv2 and plt, which implement algorithms for finding the Minkowski fractal dimension, searching and counting pixels located inside the desired object, as well as an algorithm for finding the hypotenuse. After installing on the computer and launching the program, you need to load a photo of the saliva facies and calculate the fractal dimension and crystal area by pressing the appropriate buttons; the result will appear on the screen in the form of numerical values. Results. The computer program FracSquare allows you to mathematically calculate the fractal dimension, the area of crystals, and also measure the length and width of the branches of human saliva crystals. These digital values provide a quantitative characterization of the crystalline pattern of the saliva facies. Conclusion. The operator receives accurate digital values using a developed computer program, on its basis he can objectively evaluate the microcrystalline pattern of the facies of human saliva in order to identify pathological processes occurring in the body. The indicator of these processes is oral fluid.

АНАЛИЗ ФАКТОРОВ РИСКА КСЕРОСТОМИИ И ЗДОРОВОГО ОБРАЗА ЖИЗНИ СТУДЕНТОВ СТОМАТОЛОГИЧЕСКОГО ФАКУЛЬТЕТА УРАЛЬСКОГО ГОСУДАРСТВЕННОГО МЕДИЦИНСКОГО УНИВЕРСИТЕТА

Subject. Xerostomia. Objectives. To analyze risk factors, to identify the incidence of xerostomia and a healthy lifestyle of students of the Faculty of Dentistry of the Ural State Medical University (USMU). Methodology. The work was carried out at the Department of Therapeutic Dentistry and Propaedeutics of Dental Diseases, at the Department of General Chemistry of USMU, at the Department of Controlled Systems Modeling of UrFU. The objects of the study were: a questionnaire consisting of two parts and volunteers – students of the Faculty of Dentistry of USMU. The first part of the questionnaire is based on the questionnaire "List of cases of xerostomia" modified by the authors of this study to 12 questions. The second part of the questionnaire (author's) consists of 29 questions on a healthy lifestyle (HLS), which also affect the development of xerostomia. Thus, the total number of questions in the questionnaire was 41. Statistical processing of the results was carried out on a personal computer using the Microsoft Excel 2007 application software package; the reliability of the differences was assessed by the Student's t-distribution using the Statistica 6.0 software package; the confidence interval for mathematical expectation M ± m was determined, where M is the sample average. The differences are considered. Conclusions. Students of the Faculty of Dentistry of USMU adhere to the rules aimed at maintaining the health of the oral cavity: they change their toothbrush (from 3 to 5 times a year – 85%), brush their teeth for at least three minutes (more than 48%) twice a day (77.7%) and use additional means of interdental hygiene (76.7%). 38% indicate dry lips. Dryness in the nose is emphasized by 14.1% of students. "Dry mouth is associated with elevated blood sugar", 2% of the study participants noted. It is advisable to investigate the problem of prevention of dental diseases, individual and professional oral hygiene programs, as well as regular general hygiene measures and the elimination of bad habits among students.

CHRONOTYPE AND DAILY FUNCTIONING OF PATIENTS WITH DIFFERENT MOTOR SUBTYPES OF PARKINSON DISEASE

Introduction. Sleep and circadian rhythm disturbances can occur at any stage of Parkinson disease (PD) and significantly affect quality of life. Chronotypes of patients with PD are associated with different phenotypes, in particular with the motor subtype. Thus, we hypothesized that patients with different motor subtypes of PD may have differences in the distribution of chronotypes and patterns of daily activity. Methods and materials. We conducted clinical research on the basis of the Centre for Parkinson Disease and Neurodegenerative Diseases of the Department of Neurological Diseases of Poltava State Medical University. PD was verified according to the recommendations of the International Movement Disorders and Parkinson's Disease Society. The motor subtype of PD was determined by the Stebbin method, which is based on the calculation of the Stebbins coefficient by the sum of the Unified PD Rating Scale scores. The examined patients were divided into 3 groups according to the motor subtype of PD: group 1 (n = 38) - patients with PD subtype with the predominance of postural instability and gait disorders (PIGD); group 2 (n = 26) - patients with PD subtype with the predominance of tremor and mixed subtype; control group (n = 30) - conditionally healthy individuals without CNS lesions. Circadian patterns were analyzed using the Munich Chronotype Questionnaire (MCTQ). Results. It was found that in PD patients sleep onset and time of getting out of bed was later (p<0.001 and p=0.042, respectively), sleep latency was longer (p<0.001), sleep duration was shorter (p=0.001), the mid-sleep corresponded to a later time (p<0.001). Patients with the PIGD subtype had a later time of getting out of bed (p=0.038), longer sleep inertia (p<0.001), shorter sleep duration (p<0.001), and later mid-sleep time (p=0.028). We have shown the tendency of patients with PD, mostly in the PIGD subtype, to later chronotypes (p<0.001). Light exposure indirectly moderately correlated with mid-sleep in all study groups. It was found that both the motor subtype (p<0.001) and the level of light exposure during the day (p<0.001) statistically significantly affect the mid-sleep. Conclusion. Thus, we have found that patients with PD differ from age-matched controls without neurodegenerative diseases by chronotype and circadian pattern of functioning. The motor subtype of the disease is associated with circadian differences, namely, the PIGD subtype is associated with shorter sleep duration, a predisposition to a later chronotype, and longer sleep inertia.

Microbial landscape of periodontal pockets against local antibacterial therapy of chronic generalized periodontitis: a multicenter clinical trial

Background. A microbial nature of periodontitis requires an accurate analysis of the pathogenic potential of the periodontal pocket microflora thereby enabling correct diagnosis to be made and the most effective pharmacological agent to be selected for treating chronic periodontitis. Metronidazole demonstrates excellent results for anaerobic microorganisms in the periodontal pocket, whereas minocycline hydrochloride, moxifloxacin and amoxicillin/clavulanate are efficient for aerobic microorganisms. However, specialists find considerably relevant to analyze the correlations between specific bacterial associations in the periodontal pocket against local antibacterial therapy, as well as to track the contents of periodontal pockets long after antibacterial therapy. Therefore, a microbiological analysis of periodontal pocket contents is considered necessary in order to select and monitor the effectiveness of local antibacterial therapy.Objective. To evaluate the effectiveness of local antibacterial therapy for chronic generalized periodontitis by means of analysis of changes in the microbiological composition of periodontal pockets.Methods. The clinical trial involved 144 patients with chronic generalized periodontitis. The study included examination of patients and analysis of clinical data bases of the Department for General Practice Dentistry, Kuban State Medical University and the Dentistry Department, Stavropol State Medical University of the Ministry of Health of the Russian Federation. The trial included patients aged 30 to 60 with a diagnosis of chronic generalized periodontitis of different severity. All periodontitis patients were divided into 2 groups depending on the therapy: main and control groups. Each group had three subgroups depending on the severity of the pathologic process. The first subgroup of the control group (chronic generalized periodontitis of mild degree) consisted of 16 people (11.1%), the second subgroup (chronic generalized periodontitis of moderate degree) — 31 people (21.5%), the third subgroup (chronic generalized periodontitis of severe degree) — 7 people (4.9%). The first, second and third subgroups of the main group consisted of 28 (19.4%), 48 (33.3%) and 14 persons (9.7%) respectively. The severity of periodontitis was determined by the depth of the periodontal pocket, degree of bone resorption (according to x-ray examination), and pathologic tooth mobility. A local anti-inflammatory therapy for the patients of the control group included oral baths with propolis (15–20 drops of 10% propolis tincture diluted in 100 ml of warm water) 3 times a day for 7 days starting from the first visit. At the final stage of treatment after preliminary scaling and rootplaning, patients of the control group received antiseptic gel with 10% metronidazole and 2% chlorhexidine bigluconate to be injected into periodontal pockets with over 4 mm depth. Additionally, applications of adhesive dental films Diplene Denta L (with lincomycin) and Diplene Denta M (with metronidazole) were prescribed to be done in the home. In addition to the above-mentioned comprehensive therapy, patients of the main group received a single insufflation of minocycline hydrochloride microspheres into each periodontal pocket. The tools for the patients of the main group included plastic cannulas with minocycline hydrochloride microspheres in the form of powder in the tip of the cartridge, and a special syringe-insufflator. The technique of antibiotic insufflation into the periodontal pocket was preliminary trained on the model of jaws with the studied pathology. Statistical analysis of the results was performed using variance analysis in the Excel Microsoft Office 2016 (Microsoft, USA).Results. According to the systematic observation of the patients from the control group, periodic fluctuations in microbial population in the majority of pathologic pockets obtained a specific regularity: a decrease in the number of microorganisms on day 21 was followed by its increase in the subsequent period of observation after 30 and especially 60 days. According to the ongoing follow-up of the patients of the main group, fluctuations of microbial population in the majority of pathologic pockets obtained a certain regularity: a significant reduction in the number of microorganisms on day 21 was followed by its slight rise in the subsequent period of observation after 30 and a slight increase again in 60 days. Fluctuations in the number of microorganisms of periodontal pockets in the main group reveal their specific character: their number remained invariably lower than that of the control group throughout the observation period, while the total number of detected periodontopathogens decreased.Conclusion. The established correlations between the main indicators of microbiological status of periodontal pockets and the severity of chronic generalized periodontitis within different periods after the local therapy confirm the positive dynamics of treatment in the main group, where patients were insufflated with minocycline hydrochloride microspheres, proved by a change in the typology of microbial status of periodontal pockets and a number of periodontopathogenic microorganisms.

Experience of strategic sessions to improve the quality of lean technology implementation in medical organizations in Krasnodar Krai: a one-stage observational study

Background. Lean production is mainly focused on increasing value in processes and improving the quality of services provided. These principles are implemented in medical organizations within the framework of the national project “Healthcare” and the federal project “Development of the Primary Healthcare System”. Introduction of lean technologies at all levels of the organization can serve as a highly effective method of positive changes. In 2023, Kuban State Medical University, together with the Ministry of Health of Krasnodar Krai and the Regional Center for Primary Healthcare, held a strategic session aimed at identifying problematic processes in medical organizations of the region and jointly searching for ways to solve them. The session involved 73 primary healthcare organizations. Its results formed the basis for a study of the project activity of medical organizations. Objective. To analyze the current state of project activities of medical organizations in Krasnodar Krai to achieve a “new model” through the introduction of lean technologies.Methods. A one-stage observational study was carried out in two steps. The first step involved participant observation. Its results determined a set of tools to be compiled. The second step of the study included a questionnaire survey and analysis of information. The data obtained from the questionnaire survey and observation were coded, the distribution and frequency were identified using frequency analysis and calculation of mean values. The qualitative analysis of open-ended questions was additionally applied.Results. The analysis showed that the prevailing number of projects are aimed at forming and developing the availability of medical care for the population (50.6 %), including projects focused on inclusiveness and provision of medical care to low-mobility patients at home. It was also revealed that 42 projects in four areas are planned for implementation in 47 organizations using lean technology tools in 2024. The study showed that 91.49 % of projects failed to calculate financial efficiency and evaluate project results in monetary terms. Meanwhile, 8.51 % of those who carried out the efficiency calculations lacked an analysis methodology and revealed the superficiality of the calculations. Of all the participants, 53.19 % reported the need for help in organizing and implementing project activities, and 36.17 % of the participants had enough resources to cope on their own. The three most problematic processes requiring joint work with colleagues included “Reducing the wait times for healthcare in regional medical organizations,” “Registration of discounted prescriptions” and “Preventive medical examination and dispensary.”Conclusion. The experience of a strategic session at Kuban State Medical University proved to be effective in improving the quality of implementation of lean technologies in medical organizations of Krasnodar Krai. The study was instrumental in assessing the current state of the project activities of medical organizations to achieve a “new model” through the introduction of lean technologies, as well as in identifying the most common areas of project activities and the main problems. The performed analysis revealed a positive trend in improving the quality of work of medical organizations in Krasnodar Krai and disseminating the lean technologies in primary healthcare.

Ethical review of preclinical research

The main goal of medicine has been and remains the desire to preserve the health of the population, increase human life expectancy and its quality. For those purposes, it is necessary to constantly improve treatment measures, create and introduce into medical practice new methods of therapy, innovative medicines, guided by strict rules of evidence of their high effectiveness and safety, study the mechanisms of physiological processes of a living organism in normal conditions and in pathology, the possibilities of correction and prevention of disease processes, and this means the need to conduct research, including those involving animals. The modern ethical and legal framework for research involving animals contains a requirement for mandatory examination of a research project by an ethical committee, monitoring its implementation, and analysis of the results. An ethics committee is a structure implemented into the research process to help researchers navigate the complex network of guidelines, rules and best practices, as well as the existing legal framework for conducting scientific research that guarantees quality results of work that do not violate these principles and restrictions. The local ethics committee is responsible for ensuring that research conducted in the territory under its supervision complies with modern ethical standards. This article presents the experience of the local ethics committee of the Kazan State Medical University in the ethical review of research projects involving animals, and substantiates the list and content of the requirements for documents submitted by the researcher for ethical review. The shortcomings identified in the preclinical research protocols submitted for examination were separately analyzed, and references were provided to the ethical and legal framework existing in the Russian Federation.

Relationship Between Sepsis Phenotypes and Treatment Characteristics of Patients with Viral and Bacterial Pneumonia

New subgroups of patients with severe community-acquired pneumonia (SCAP) are hardly predicted by the use of clinical covariates; clusterization may significantly improve diagnostic approaches and facilitate the adaptation of specific treatment modalities to patient’s individual characteristics.The aim of the study. To identify linking the sepsis phenotype in patients with SCAP and preferable treatment option to forecasting the outcome and improve treatment results.Materials and methods. Case histories of 664 of intensive care unit (ICU) patients with sepsis (2016–2023) from I. I. Mechnikov Northwestern State Medical University were analyzed. The study included 568 (85.5%) patients with viral SCAP (SCAPv group) and 96 (14.5%) patients with bacterial SCAP (SCAPb group). Sepsis phenotypes were identified using algorithm proposed by Seymour C.W. et al. In SCAP cases associated with COVID-19 infection (n=293, 51.6%) patients received genetically engineered biological therapy (GIBT). The study compared two cohorts of patients: those who received GIBT and did not receive GIBT. Data were statistically processed using the Statistica 10.0 and SPSS software packages.Results. Analysis revealed 4 sepsis phenotypes: α- (N=323, 48.6%); β- (N=128, 19.3%); γ- (N=87, 13.1%); δ - (N=126, 19%). The majority of SCAPv group patients — 295 (51.9%) — had α-phenotype of sepsis, while δ -phenotype prevailed in the SCAPb group — 53 (55.2%). The proportion of patients receiving GIBT and exhibiting α- sepsis phenotype dominated over other sepsis phenotypes: 61.8% of patientspossesed α- phenotype, whereas β-, γ- and δ -phenotypes were determined in 16% , 12.6%, and 9.6% of GIBT patients, respectivelty (P<0.05). The best effect of using monoclonal antibodies to interleukin-6 receptors as a GIBT was obtained in patients with the α-phenotype sepsis and COVID-19-associated SCAP: 87.5% favorable outcomes, P=0.0419. Rate of bacterial sepsis was significantly lower in patients with α- and δ -phenotypes of sepsis receiving GIBT vs those who did not receive this therapy: 12.71% vs 23.2% of patients with α-phenotype, P=0.0131; 25.0% vs 70.41% of patients with δ -phenotype, P=0.0254, respectively.Conclusion. Differences in sepsis phenotype between patients with viral or bacterial SCAP may stratify patients for different therapeutic management and more accurately predict potential complications and unfavorable outcome.

Serotonin blood level study, anxiety-depressive states indicators and patients life quality after laparoscopic treatment of gastroesophageal reflux disease

Nowadays effective treatment of gastroesophageal reflux disease (GERD) remains a difficult and still unsolved problem. The use of various antisecretory drugs in combination with surgical treatment does not allow to achieve a long lasting improvement of the quality of life and reliable prevention of complications. In this regard, special attention is paid to study humoral factors influencing the pathogenesis of GERD, data on which will improve the results of therapeutic and surgical treatment. It is promising to study the dynamics of serotonin after laparoscopic treatment of various types of GERD, especially in combination with dyspepsia, anxiety or depressive disorders, as well as the possibility of using drugs that affect the metabolism of this hormone to correct the above mentioned disorders and achieve long lasting recovery after laparoscopic fundoplication. The aim of the work was to study the dynamics of serotonin in the blood during laparoscopic total fundoplication and analyze the correlation of this hormone with the psychological well-being of patients before and after surgical treatment of GERD. Materials and methods. Laparoscopic fundoplication by Short Floppy Nissen modification was performed in 35 patients with GERD. There were 26 (74.3 %) women, 9 (25.7 %) men. Age – 55.3 ± 11.3. The comparison group consisted of 20 healthy volunteers (women – 14 (70.0 %); men – 6 (30.0 %), average age – 56.7 ± 10.6), who did not undergo surgery. The groups were comparable by gender and age. The studies were carried out in venous blood plasma, samples of which were maintained using standard methods and stored in a low-temperature freezer at a temperature of -80 °C. Tests for serotonin (Serotonin ELISA, RE59121, IBL) were studied on the immunoenzyme complex ImmunoChem-2100 (USA) of the Department of Clinical Laboratory Diagnostics in the Zaporizhzhia State Medical and Pharmaceutical University. The concentration of the last indicators was expressed in ng/ml. The presence of concomitant anxiety, depression and level of psychological well-being was assessed using the GAD-7, PHQ-9 and SF-36 questionnaires. Statistical assessment of the research results was carried out using the Statistica for Windows 13 software package (StatSoft Inc., No. JPZ804I382130ARCN10-J). Differences were considered statistically significant at p < 0.05. Results. The serotonin level in the blood of practically healthy people was 5.8 ± 1.5 ng/ml. In the main group serotonin values before surgical treatment were 3.1 ± 1.3 ng/ml. After surgical treatment the serotonin level increased to 5.4 ± 1.8 ng/ml and was not statistically different from the level of practically healthy patients. The dynamics of serotonin levels correspond to the dynamics of the patients number with signs of anxiety and depression before and after surgery in the main group, as well as the improvement in the psychological state of patients after surgery compared to preoperative data on the scales of the “psychological component” of SF-36 health questionnaire: Vitality (VT), Social Functioning (SF), Role-Emotional (RE), Mental Health (MH). Conclusions. Laparoscopic crurorrhaphy and fundoplication in the Short Floppy Nissen modification through the mechanism of serotonin helps to improve the psychological state of patients with GERD in the postoperative period, eliminate anxiety and depression, improve quality of life and achieve a lasting antireflux effect. The obtained dynamics of serotonin levels confirms its participation in the formation of behavioral reactions in GERD, helping to improve the results of surgical treatment.

Analysis of central pontine myelinolysis in HIV-infected patients

Aim: to conduct a clinical and epidemiological analysis of cases of central pontine myelinolysis (CPM) in HIV-infected patients. Materials and methods. Four patients hospitalized in the infectious diseases department of No. 1 Clinic of the South Ural State Medical University were under dynamic observation. Results and its discussion. Four patients hospitalized in the infectious diseases department of Clinic No. 1 of the South Ural State Medical University were under dynamic observation. Patient management was carried out in accordance with current clinical recommendations for the provision of medical care to patients with HIV infection with a set of clinical and laboratory methods, including examination of lumbar puncture, its cytological and biochemical composition, determination of DNA of cytomegalovirus (CMV) and Epstein-Barr viruses (EBV) herpes simplex types 1 and 2, T. gondii, Cr. Neoformans, M. Tuberculosis, Cryptococcus neoformans, the presence of pathogens of bacterial infections. All patients underwent magnetic resonance imaging (MRI) of the brain. Conclusion. The process of demyelination of the central nervous system develops regardless of the level of CD4 lymphocytes and HIV viral load. The main method for verifying the diagnosis is MRI of the brain

Investigating the different forms of premenstrual syndrome in Kursk students

Background: Premenstrual Syndrome (PMS) is a complex of symptoms experienced by women before their menstrual period, which can significantly impact daily functioning and quality of life. While the prevalence of PMS varies globally, detailed studies on its manifestation among medical students are limited. This research aims to fill this gap by investigating the prevalence and types of PMS among female medical students at Kursk State Medical University. Methods and Materials: A descriptive cross-sectional study was conducted using a sample of 128 female medical students aged 18 to 25 years. Participants were surveyed using a validated PMS questionnaire, which classifies symptoms into four categories: psychological, behavioral, physical, and atypical. Data on demographic variables and lifestyle factors were also collected to explore potential correlations. Results: The study found that 84% of participants experienced some form of PMS, with 25% reporting severe symptoms. Psychological symptoms were the most prevalent, followed by physical, behavioral, and atypical symptoms. The incidence of PMS was higher among older students and those with less physical activity. Seasonal variations also influenced symptom severity, with winter months showing a higher incidence rate. Conclusion: The findings suggest a high prevalence of PMS among medical students at Kursk State Medical University, with significant impacts on their academic and personal lives. These results underscore the need for targeted educational programs and support systems to help manage PMS effectively. Further research is recommended to explore intervention strategies and to assess their efficacy in this population.

Statistical analysis of primary dysmenorrhea and mittelschmerz syndrome among female students of Kursk

Background: Primary dysmenorrhea and mittelschmerz syndrome represent significant gynecological challenges associated with the menstrual cycle, causing pain during menstruation and ovulation, respectively. These conditions not only cause physical discomfort but also psychological and social disturbances, impacting the quality of life of affected individuals. Understanding the prevalence and impact of these conditions among female students at Kursk State Medical University provides critical insights into their management. Methods and Materials: This cross-sectional study involved 100 female students who were not pregnant and were of reproductive age. Participants completed a detailed questionnaire that included the Wong-Baker Faces Pain Rating Scale to assess pain levels and documented their menstrual characteristics, pain symptoms, and associated lifestyle factors. Results: The majority (76%) of participants experienced a regular menstrual cycle length of 21-35 days, while 21% reported irregular cycles. Of those surveyed, 58% of American and 35% of African descent reported moderate pain due to dysmenorrhea, whereas a significant portion (38.5%) of Asian participants experienced severe pain. Mittelschmerz syndrome was generally less severe, with 88% reporting mild pain. The study also highlighted the influence of external factors such as stress, weather, and lifestyle on symptom severity. Conclusion: Primary dysmenorrhea and mittelschmerz syndrome are prevalent among the studied population, with significant variations in symptom intensity influenced by ethnic and lifestyle factors. The data underscore the necessity for tailored educational and medical interventions to alleviate the burden of these conditions. Future research should focus on longitudinal studies to track symptom progression and the effectiveness of different management strategies.

Anxiety, Stress and Depression in Overseas Medical Students and its Associated Factors: A Descriptive Cross-Sectional Study at Jalalabad State University, Jalalabad, Kyrgyzstan

Background: Stress can be described as a mental state of tension or be concerned brought on by an unpleasant circumstance. Stress is an ordinary human reaction that encourages us to face challenges and dangers in life. According to the WHO, four out of every five college students are contemplating or have attempted suicide. Medical education is considered as demanding because students undergo several psychological transformations. It is estimated that half of all significant adult psychiatric illnesses, including depression, begin before the age of fourteen. 75 % of college students do not seek help for mental health issues. (1)  Materials and Methods: A cross-sectional study was conducted in three months period of time from the month September till November 2023, among 150 students of various years at Jalalabad State Medical University using online Google forms. The study was conducted using DASS 21-item questionnaire to assess the level of stress, anxiety, and depression among students. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 22.0 software. Ethical approval was taken from the University.  Result: In the study 9% of people reported having a moderate to extremely severe degree of stress, anxiety 27.3% and depression was found among 4% respectively in students. Stress and study of year were substantially correlated. (p = 0.007). Anxiety and extracurricular activities were found to be significiant (p = 0.004). Extracurricular activities and depression were linked. (p = 0.029) and the type of family they belong to (p = 0.015). While stress and depression were shown to be uncommon among medical students, anxiety was found to be more common, which might be related to a variety of factors such as new environments, difficult subjects, complex terminology, etc.  Conclusion: It is important to highlight the points like financial issues, home sick, behaviour of teachers and friends etc would be the stressful elements that might lead to increase the psychological problem among medical student. Following research endeavors in this domain ought to endeavor to address these constraints. In any event, we believe that our results emphasize the necessity of putting policies in place to protect and, where appropriate, improve the mental health and general wellbeing of medical students.

CLINICAL DIAGNOSTIC ALGORITHMS OF ACTION IN THE PRACTICE OF A DOCTOR OF GENERAL PRACTICE – FAMILY MEDICINE DISEASES OF THE URINARY SYSTEM IN CHILDREN

Chronic kidney disease (CKD) is the presence of markers of pathological changes in the urinary system lasting more than 12 weeks, regardless of their cause. The number of cases in children with diseases of the urinary system has documented confi rmed chronic kidney disease according to the implemented regional registry of patients with CKD, but its signifi cant spread is observed. Early manifestations of CKD are often underestimated and not treated in time. CKD and chronic renal failure are not a narrowly defi ned nephrological problem. Nowadays, military aggression and the consequences of the 2019 coronavirus pandemic (COVID-19), which led to the destruction of standard ways (patient clinical routes) in the provision of medical care, the issue of providing medical care to children on the basis of evidence- based and personalized medicine is of particular relevance in Ukraine, which, according to the WHO strategy, should meet the needs and be safe,eff ective, timely and of appropriate quality. The introduction of innovations in pediatric practice in terms of standardization of medical care helps the physician to act eff ectively in specifi c clinical situations, avoiding ineff ective actions. Involvement of specialists of other specialties (general practitioners- family medicine, endocrinologists, urologists, cardiologists, pediatricians, ophthalmologists) in the management of CKD without coordination of cooperation to ensure the principle of continuity complicates the diagnostic and/or therapeutic support of the patient. Early diagnosis, proper management tactics of pediatric patients with diseases of the urinary system at the outpatient stage is an important component in the provision of integrated, patient- oriented medical care in the practice of a general practitioner- family medicine. The article highlights the clinical and diagnostic algorithms of action of a general practitioner- family medicine regarding the tactics ofmanagement of pediatric patients with the most common nephrological symptoms: leukocyturia (bacteriuria), proteinuria and erythrocyturia. The scientifi c research was carried out within the framework of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University. The research topics included: Research project on «Chronobiological and adaptive aspects and features of autonomic regulation in pathological conditions in children of diff erent age groups» (State registration number: 0122U002245, duration: 01.01.2022-31.12.2026).

HYBRID VASCULAR APPROACH REDUCES THE INTENSIVE CARE UNIT STAY IN PATIENTS WITH CHRONICALLY THREATENING LIMB ISCHEMIA AND MULTILEVEL ATHEROSCLEROTIC LESIONS

Chronic limb-threatening ischemia represents the fi nal stage of atherosclerosis and is often associated with signifi cantcardiovascular morbidity leading to high mortality. The hybrid approach combines surgical and endovascular techniques toachieve maximal revascularization of multilevel atherosclerotic lesions in the lower limb, with a shorter procedure time and less trauma compared to the classical method. It is also expected to reduce the length of hospital stay.The aim of the study is to analyze the relationship between the hybrid approach and the length of stay in the intensive careunit (ICU) compared to the classical vascular surgical approach in patients with chronic limb-threatening ischemia, multilevel atherosclerosis and high anesthesiological risk. Another endpoint is to compare the total ventilation time in the two groups.Material and methods. The study compares ICU length of stay and total mechanical ventilation time between two groups –a prospective group (n=48) of patients treated with hybrid revascularization and a control group (n=50) treated with classicalvascular revascularization. Patients included had multi- level atherosclerotic lesions (aorta- iliac, femur- popliteal and outfl ow) and chronic limb-threatening ischemia (Fontaine Grade III and IV). A database was created with subsequent statistical analysis using «SPSS» software. Tests used: Chi-square, p-value, frequencies. The chi-squared test was considered valid if the test statistic is chi-squared distributed under the null hypothesis, specifi cally Pearson’s chi-squared test. If the null hypothesis that there are no diff erences between classes in the population is true, the test statistic calculated from the observations follows a χ2 frequency distribution. If the p-value is greater than alpha, then we have not rejectedthe null hypothesis and assume that there is no signifi cant diff erence between the two samples. We set the signifi cance level at 0.05. The study protocol was approved by the Commission on Biomedical Ethics of the Bukovinian State Medical University (minutes of the Commission meeting No 4 from the 19.12.2023 year). The theme of the complex research work «Development, justifi cation and implementation of new approaches to the diagnosis and treatment of some acute surgical diseases, prediction of their course and prevention of complications (state registration number: 0121U110501, terms of execution: 01.2021-12.0225).Results. ICU length of stay and total ventilation time were analyzed in the two groups. Both ICU and total ventilation timeswere shorter with statistical signifi cance in the hybrid approach group. Therefore, the use of hybrid revascularization contributes to an accelerated stabilization of the patient’s condition. Therefore, the use of the hybrid vascular approach contributes to an accelerated stabilization of the patient’s condition. This reduces the duration of treatment, the cost of treatment. So, hybrid vascular approach is a promising way to treat limb ischemia. This approach needs further implementation in practice. The novelty added by the manuscript to the already published scientifi c literature: Hybrid revascularization itself represents a relatively new type of treatment for patients with multilevel atherosclerotic lesions. The analysis of the length of stay in the intensive care unit of patients undergoing hybrid revascularization compared to classic surgical revascularization adds to the current literature.Conclusions. ICU length of stay for patients with chronic limb-threatening ischemia and multilevel atherosclerosis, as wellas total mechanical ventilation time, is shorter with statistical signifi cance when hybrid revascularization is used compared with traditional vascular surgery.

SOME FEATURES OF CELLULAR ENERGY SUPPLY OF THE BODY IN PREMATURE INFANTS WITH SEVERE FORMS OF PERINATAL PATHOLOGY

The nature of postnatal adaptation of newborns, their further growth, development, health status and quality of life largelydepend on the well-being of intrauterine development and maturity at birth. Premature birth under hypoxia causes signifi cant metabolic disorders in the body, is accompanied by a high risk of severe organ dysfunction, which requires in-depth research to clarify the features of intracellular metabolism in order to further improve methods of diagnosis and treatment of newborns with various forms of perinatal pathology.Aim of the research. To study the trends of changes in energy metabolism in premature infants with severe forms of perinatal pathology to investigate the possibility of using them as additional criteria of hypoxic damage to the body in conditions of morphological and functional immaturity.Materials and methods. Clinical and laboratory examinations were performed on 68 newborns with severe forms of perinatal pathology at the gestational age of 32 to 34 weeks; the comparison group consisted of 27 conditionally healthy newborns at the gestational age of 34 to 37 weeks. Inclusion criteria for the main study group: gestational age at birth from 32 to 34 weeks, clinical signs of severe perinatal pathology. Exclusion criteria: gestational age at birth < 32 and ≥ 37 weeks, diagnosed congenital malformations and septic conditions. The list of diseases was determined according to the International Classifi cation of Diseases, X Revision. The following blood serum laboratory parameters were studied: lactate level, glycerol-3-phosphate dehydrogenase (GPDH) (EC 1.1.99.5), succinate dehydrogenase (SDH), NADH dehydrogenase (NADH) (EC 1.6.5.3); the electron transport chain coeffi cient (ETC) was calculated. Laboratory studies were performed using micromethods. The study was conducted in accordance with the provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the Declaration of Helsinki of the World Medical Association (1964-2008), Order of the Ministry of Health of Ukraine No. 690 dated September 23, 2009 (as amended by Order of the Ministry of Health of Ukraine No. 523 dated July 12, 2012). Protocol of scientifi c research of the Biomedical Ethics Committee of BSMU dated September 12, 2015. Informed written consent was obtained from the parents of the patients before the study with an explanationof the purpose, objectives and methods of laboratory testing. Statistical processing of the results was performed using STATISTICA software (StatSoft Inc., USA, version 10). Comparison of quantitative indicators with normal distribution was performed using Student’s t-test, and the probability of diff erences was considered statistically signifi cant at p<0.05. The complex of studies was conducted within the framework of the planned research topics of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University: «Improvement of the areas of prognosis, diagnostics and treatment of perinatal pathology in newborns and infants, optimization of the schemes of catamenial observation and rehabilitation» (State registration No. 0115U002768, term of execution 01.2015-12.2019) and «Chronobiological and adaptive aspects and features of vegetative regulation in pathological conditions in children of diff erent age groups» (State registration No. 0122U002245, term of execution 01.2020-12.2024).Results. In newborns of the main group, in comparison with the control group, a signifi cant decrease in GFDH and SDHwas found, which indicates a signifi cant impairment of the activity of enzymes of the respiratory chain and explains the lack of oxygen absorption in the body at the cellular and tissue level, causing the severity of the condition of newborns. Determination of the level of GPDH and SDH in the dynamics of observation in children showed some improvement in these indicators. In the severe condition of newborns, a signifi cant increase in the NADPH index was found, with a further probable increase in its level in the dynamics of observation. Calculations of ETC coeffi cient in cord blood showed a signifi cant decrease of this indicator in comparison with the control group. The identifi ed disorders of intracellular energy metabolism under hypoxia indicate the expediency of conducting comprehensive scientifi c research to study the possibilities of appropriate pharmacological correction to improve the eff ectiveness of treatment of severe forms of perinatal pathology in premature infants.Conclusions: 1. The results of the study revealed a signifi cant decrease in GPDH and SDH at elevated levels of NADPH andETC coeffi cient, which confi rms the presence of signifi cant disturbances in intracellular energy metabolism and mitochondrial oxidation processes. 2. Timely detection of metabolic disorders with the determination of mitochondrial oxidation, in particular energy metabolism, is an important area for improving diagnostic measures in severe forms of perinatal pathology in preterm infants with hypoxic damage to the body in the pathogenesis.

ONTOGENETIC TRANSFORMATIONS OF BONES OF THE HUMAN ORBIT

Introduction. Elucidation of the sources of human orbital bones, clarifi cation of the sequence of their ossifi cation will allow to create a morphological basis for eff ective interpretation of the data of fetal condition monitoring, will contribute to early diagnosis of variants of the structure and possible malformations of the head, organ of vision and related structures.The aim of the study. The aim of this work was to fi nd out the sources of origin, the chronology of ossifi cation, the characteristics of age-related topographic and anatomical changes in the bones of the orbit.Material and methods. 18 series of histological sections of samples of human embryos and pre-fetuses at the age of 4-12 weeks of intrauterine development (4,0-80,0 mm parietal- coccygeal length) and samples of 12 fetuses at the age of 4-9 months of intrauterine development (130,0-450. 0 mm parietal- calcaneal length) using a complex of morphological research methods (anthropometry, morphometry, preparation of histological sections, dissection, three- dimensional reconstruction of series of histological sections and computer tomography, statistical analysis).The study was conducted in accordance with the main provisions of the European Union Convention on Human Rights andBiomedicine (1997), as well as the Helsinki Declaration on Ethical Principles of Medical Research Involving Human Subjects(1964-2008), EU Directive No. 609 (1986), Order of the Ministry of Health of Ukraine dated 23.09.2009 No. 690.The work was carried out within the framework of the initiative research work of the Department of Histology, Cytology andEmbryology of the Bukovinian State Medical University «Structural and functional peculiarities of tissues and organs in ontogenesis, regularities of variant, constitutional, sex and age-related and comparative human morphology». State registration number: 0121U110121. Deadlines: 01.2021-12.2025.The results. The fi rst signs of the appearance of ossifi cation centers around the main nervous and visceral contents of the rudiment of the orbit are determined in 6-week-old embryos in the form of seven cartilaginous bone models, and the fi rst centers of ossifi cation among the rudiments of bones participating in the formation of the orbit are found in the rudiment of the maxilla. In the 6th month of intrauterine development, the processes of ossifi cation of the frontal, sphenoid, ethmoid and maxillary bones begin. At the end of the 8th month of intrauterine development, due to the ossifi cation processes of the lesser wing of the sphenoid and frontal bones, the orbit acquires features of a defi nitive structure.From the beginning of the fetal period of human ontogenesis, ossifi cation of the structures of the sphenoid bone continues, which leads to morphological transformations of the orbit in 5-month fetuses – it is separated from the sphenopalatine and infratemporal fossa by a bone layer, the optic canal is formed, and in 6-month fetuses processes of ossifi cation of the frontal, sphenoid, ethmoid and maxillary bones, and Müller’s orbital muscle changes its structure into a fi brous one.The analysis of the age-related dynamics of the morphometric parameters of the orbit during the fetal period of intrauterine development made it possible to establish the peculiarities of changes in its diameter, circumference and area, which are expressed by mathematical functions: diameter of the orbit, mm = –0. 2285+0.4704*x; circumference of the orbit, mm = –0.2924+1.4595*x; area of the orbit, mm2 = –87.8597+8.0387*x, where x is the age of the human fetus in weeks.Conclusion. The critical periods of the development of the orbit are the 6th month of prenatal ontogenesis, during which there is an uneven growth rate of the horizontal size of the orbit in relation to the vertical one, and its shape returns to the mesoconchal, which was previously observed in fetuses, as well as the 8th month, during which the growth of all parameters of the orbit slows down due to intensive processes of organogenesis of its visceral structures.

HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL FEATURES OF DIFFERENTIATED TROPHOBLAST IN CHORIONIC VILLI OF THE PLACENTA IN PRETERM LABOR

The importance of studying the histochemical and immunohistochemical features of the diff erentiated trophoblast in chorionic villi of the placenta in preterm labor is determined by the threatening nature of this condition for both mother and fetus, as well as its high prevalence and serious consequences for the health of both. The understanding of the damage to the trophoblast of chorionic villi in the placenta can be expanded by histochemical and immunohistochemical methods, which allow the assessment of the concentration of specifi c marker molecules in one way or another.Objective. To determine certain histochemical and immunohistochemical characteristics of proteins in the trophoblast of theintermediate and terminal chorionic villi of the placenta in preterm labor.Material and Methods. The obtained material (30 placentas from preterm deliveries and 30 placentas from normalpregnancies) was fi xed for 20-24 hours in 10 % neutral formalin solution buff ered in Lilly’s phosphate buff er. After tissue removal, the placental tissue was dehydrated in an ascending ethanol series and embedded in paraffi n at a temperature of approximately 58 °C. Serial histologic sections were cut at 5.0 μm thickness using an MS-2 sliding microtome. After deparaffi nization, histological sections were stained with hematoxylin and eosin, histochemical methods for total protein with bromophenol blue according to Bonhéme, and immunohistochemical techniques according to the manufacturer’s protocols (Dako, Denmark). In particular, immunohistochemical reactions were performed with monoclonal antibodies against trophoblast hormone- placental lactogen and placental alkaline phosphatase. Visualization of primary antibodies was performed using the Dako polymer visualization system with diaminobenzidine as chromogen (resulting in brown staining of the sites of studied antigens). In addition to the descriptive method of histopathologic research, computer morphometry of digital microphotographs of histologic sections was performed using a Delta Optical Evolution 100 microscope and an Olympus SP550UZ digital camera. Digital copies of the images were processed using a legitimate copy of the ImageJ v1.52f computer program developed for histometric studies (National Institutes of Health, USA). Specifi cally, the evaluation of staining intensity (optical density) was performed on digital microphotographs using the method of computer microdensitometry. For this purpose, a microprobe method was used to obtain a computer brightness value in an 8-bit analysis system with 256 gray levels – from black (0) to white (255).The obtained values were then transformed into relative optical density values (r.OD) by logarithmic transformation (naturallogarithm method). The relative optical density value ranges from 0 (absolute transparency of the object) to 1 (absolute opacity of the object). The obtained digital data were processed using statistical analysis methods. A legitimate copy of the statistical analysis computer program PAST v4.14 was used, with a preliminary check for normal distribution using the Shapiro- Wilk test. Since, according to this test, the hypothesis of normal distribution was not rejected for the statistical samples studied (at p=0.05), parametric methods of statistical analysis were applied: calculation of the mean and its standard error, Student’s t-test (two-tailed, unpaired). In addition, the non-parametric Mann- Whitney test was used for the reliability of the conclusions. The research was conducted as part of the scientifi c research project «Preservation and Restoration of Reproductive Health in Women and Girls with Obstetric and Gynecological Pathology» at the Department of Obstetrics and Gynecology of Bukovinian State Medical University (state registration number 0121U110020, duration 2021-2025).Results. Microscopic examination of histological sections stained with hematoxylin and eosin did not reveal any diff erencesin the structure of chorionic villus trophoblast in the placenta of preterm labor compared to normal pregnancy. However,histochemical and immunohistochemical methods of investigation revealed a number of features in the trophoblast of chorionic villi, where fundamental events related to substance exchange occur – intermediate immature, intermediate mature, terminal villi, including terminal «specialized villi».Conclusions. According to the obtained histochemical and immunohistochemical data, in preterm labor, compared to normalpregnancy, no changes are observed in the trophoblast of intermediate immature villi, while in intermediate mature and terminal villi, there is a decrease in histochemical staining for total protein and immunohistochemical staining for specifi c trophoblast proteins – placental lactogen hormone and placental alkaline phosphatase enzyme.

OBESITY IN CHILDREN AS A PREDICTOR OF THE DEVELOPMENT OF MYOPIA

Despite a suffi cient number of scientifi c studies devoted to the study of myopia risk factors, the infl uence of obesity on the degree of myopia risk in childhood has not been suffi ciently studied, which prompted us to study this issue using children as an example. The aim is to study the frequency and degree of myopia risk in overweight and obese children.Material and Methods. The sample of children for the study was formed step by step in the process of randomization. Thefi rst stage included a one-time epidemiological study of children aged 10-18 years during preventive examinations in schools of Chernivtsi and Chernivtsi region (1,035 persons). The primary screening included anthropometry and assessment of physical development. For detailed examination 205 persons were selected: with overweight (OW, 65 persons), with obesity (75 persons) and with normal body weight (65 persons, comparison group). The ophthalmologic examination included: visometry without and with correction, autorefractokeratometry before and after cycloplegia, biomicroscopy, ophthalmoscopy, optical biometry of the eye. To reveal the statistical diff erence between indicators in normally distributed groups, the Student’s t criterion of reliability was used, the degree of signifi cance – r. Comparison of groups on a qualitative basis was performed using Pearson’s χ2 test. Diff erences were considered statistically signifi cant at p <0.05.The research design and all methods used in this study were reviewed and approved by the Bioethics Committee of theBukovinian State Medical University (Protocol No. 10, dated 18.05.2002). The study was conducted within the research work «Early diagnosis, treatment and prevention of combined pathology of gastrointestinal tract and thyroid gland in children» (state registration number 0116U002937, implementation period 02.2016-11.2022).Results. The frequency of myopia in children with OW and obesity was signifi cantly higher than in children with average body weight (χ2 = 3.2, p < 0.05). Children with obesity and myopia were 2.7 times more likely to have diseases of the musculoskeletal system, 1.8 times more likely to have pathology of the autonomic nervous system, and 3.1 times more likely to have chronic diseases of the oropharynx than children in the control group. In all groups of children, the additional risk was greatest in children whose mother or father was myopic (49.6 and 41.3 %, respectively). Minimal additional risk was associated with a history of childhood infections (<1.6 %), helminthiasis (<3.9 %), nasal polyps (<3.4 %), adenoids (<2.4 %), and spinal cord injury at birth (<9.1 %). The odds ratio for the development of low myopia in the group with OW and obesity compared to the control group (normal weight) were 1.25 [95 % CI 0.56-2.82] and 0.88 [95 % CI 0.49-1. 58], for the development of moderate myopia – 1.22 [95 % CI 0.57-2.59] and 0.82 [95 % CI 0.46-1.49], respectively, and for the development of high myopia–1.37 [95 % CI 0.51-3.66] and 0.80 [95 % CI 0.49-2.09], respectively.Conclusion. The risk of myopia is higher in children with overweight and obesity, which emphasizes the importance andnecessity of taking into account the somatic condition of the child.

RENAL DYSFUNCTION IN PRETERM INFANTS WITH PERINATAL PATHOLOGY: RISK FACTORS, SENSITIVITY AND SPECIFICITY OF LABORATORY MARKERS OF DAMAGE

The main burden of neonatal morbidity in critically ill preterm infants, despite signifi cant achievements and rapid development of care technologies, is most often associated with neonatal sepsis, perinatal asphyxia and the development of multiple organ failure syndrome. As a component of this syndrome, newborns with combined perinatal pathology in the early neonatal period manifest severe renal dysfunction up to acute kidney injury, which is closely correlated with increased mortality. The incidence of acute kidney injury in critically ill preterm infants varies widely, ranging from 25 to 77 % according to diff erent neonatal data. A major problem in the fi eld of neonatal nephrology is the lack of uniform approaches for the diagnosis of moderate and severe renal dysfunction at the subclinical stage, which would allow the timely formation of risk groups and the optimization of interventional strategies.Aim of the study. To analyze the data on clinical characteristics, risk factors, and results of additional paraclinicalexaminations in preterm infants with gestational age of 34-36/6 weeks who had severe and moderate perinatal pathology during the early neonatal period.Material and methods. A comprehensive study of 91 premature infants with moderate and severe perinatal pathology wasconducted, of which group I consisted of 30 children with severe perinatal pathology at 34-36/6 weeks’ gestation, group II – 30 children with moderate perinatal pathology at 34-36/6 weeks’ gestation; group III (control) consisted of 31 conditionally healthy premature infants at 34-36/6 weeks’ gestation.The diagnosis of acute kidney injury in neonates in the comparison groups was made according to the International Criteriafor Kidney Disease: Improving Global Outcomes as modifi ed by J. G. Jetton and D. J. Askenazi (2015). The international scaleNeonatal Multiple Organ Dysfunction Score was used to assess the severity of multiorgan dysfunction in perinatal pathology.The eff ectiveness of therapeutic interventions was assessed using the international scale Neonatal Therapeutic Intervention Scoring Scale, and the severity of the patient’s condition in dynamics was assessed using the neonatal scale Score for Neonatal Acute Physiology.Methods of laboratory research. The study of the biochemical spectrum of urine in children of the observation groups,in particular, the determination of the level of markers of kidney damage – alpha-1-microglobulin, beta-2-microglobulin,microalbumin, cystatin C was carried out on the basis of the problematic research laboratory of the Bukovinian State Medical University of the Ministry of Health of Ukraine using the automatic analyzer «ACCENT-200» and «ACCENT-200 II CEN». Urine was collected on the 3rd day of life (between 48-72 hours of life), in sterile disposable containers, in the amount of at least 5 ml.At the same time, a blood sample for cystatin C determination was taken in the amount of 0.5-1.0 ml, in accordance with the rules of asepsis and antisepsis in disposable sterile tubes. A turbodimensional immunoassay was used to determine the concentration of cystatin C and urinary microalbumin. Determination of alpha-1-microglobulin was performed using an ACCENT-200 automated analyzer by measuring agglutination by change in absorbance (572 nm), with actual concentration determined by interpolation from a calibration curve constructed using calibrators of known concentration. The concentration of beta-2-microglobulin in urine was determined by the method of competitive chemiluminescence analysis.The studies were conducted in accordance with the basic provisions of GCP (1996), the Convention of the Council of Europeon Human Rights and Biomedicine (April 4, 1997), the World Medical Association Declaration of Helsinki on Ethical Principlesfor Research Involving Human Subjects (1964-2008), Order of the Ministry of Health of Ukraine No. 690 of September 23, 2009 (as amended by Order of the Ministry of Health of Ukraine No. 523 of July 12, 2012).Statistical analysis of the results was performed using Statistica 10 software (StatSoft Inc., USA, 2010), MedCalc software(version 16.1) with calculation of chi-squared, odds ratio (OR), 95 % confi dence interval (CI), statistically signifi cant diff erences between the study groups were considered at a value of p<0.005. Receiver operating characteristic (ROC) curves, area under ROC (AUROC), sensitivity (SN), and specifi city (SP) were analyzed using MedCalc software (version 16.1). The research work was carried out within the framework of research of the Department of Pediatrics, Neonatology andPerinatal Medicine of the Bukovinian State Medical University: Research project «Improvement of directions of prognostication, diagnosis and treatment of perinatal pathology in newborns and infants, optimization of schemes of catamnestic observation and rehabilitation» (State registration number 0115U002768, term of implementation 2015-2019); Research project «Chronobiological and adaptive aspects and features of vegetative regulation in pathological conditions in children of diff erent age groups» (State registration number 0122U002245, term of implementation 2020-2024).Study results. The data obtained showed statistically signifi cant associations between the risk of severe renal dysfunctionand a number of antenatal and postnatal factors that adversely aff ect the course of the early neonatal period. These included fetal distress during pregnancy and delivery, emergency cesarean section, risk of spontaneous abortion and preterm birth, and impaired fetal- placental blood fl ow. Statistically signifi cant associations with the development of moderate and severe renal dysfunction are associated with a burdened history of maternal extragenital pathology, namely cardiovascular, urinary system, and anemia (p<0.005). The structure of perinatal pathology in preterm infants is often combined and diffi cult to diagnose.A signifi cant proportion of newborns had clinical manifestations of multiple organ failure syndrome, including signs of renal dysfunction. Therefore, it is expedient to study a set of the latest potential biomarkers of renal dysfunction, such as cystatin C, alpha-1-microglobulin, beta-2-microglobulin and microalbumin, in order to create an appropriate prognostic model and timely form risk groups among this category of children.
 Conclusions. The basis for the development of moderate and severe renal dysfunction in premature infants with perinatalpathology is polyetiology against the background of morphological and functional immaturity of the body, which has a clearrelationship with gestational age and birth weight. The compensatory and adaptive properties of the «immature» kidneys at birth are limited, which, in the presence of combined pathology, plays a signifi cant role in shaping the severity of the course of the disease. Early prognosis and diagnosis of renal dysfunction in the early stages of its development makes it possible to improve the quality and eff ectiveness of medical care and improve treatment outcomes.

Early “Red Flags” in hospitalized patients with COVID-19

Relevance. Among the studies during the COVID-19 pandemic, a special role is played by studies examining the prognostic value of clinical, laboratory and instrumental markers in patients. Biomarkers with absolute sensitivity and specificity for predicting the outcome of a new coronavirus infection have not been identified yet.Aim: To identify early clinical and laboratory predictors of severity and mortality in hospitalized patients with COVID-19 and to evaluate the effectiveness of the pharmacotherapy in outpatient and early hospital settings.Methodology and research methods. A retrospective, comparative study was carried out. Medical data from 745 adult patients with COVID-19, hospitalized in the respiratory hospital of the Siberian State Medical University (Tomsk) from 05/16/2020 to 09/30/2020 were included. The main group consists of patients who were discharged from the hospital. The comparison group included patients with a fatal outcome of the disease.Results. The group of deceased patients was characterized by older age and a greater number of comorbid diseases (р < 0.0001), the presence of pneumonia during the year preceding COVID-19 (р < 0.0001) and risk factors for the development of Pseudomonas aeruginosa infection (р < 0.005). Early admission to the hospital (р = 0.0110), severe dyspnea (р < 0.0001) with a decrease in oxygen saturation below reference values (р < 0.0001) are also associated with the risk of a fatal outcome. Anosmia was significantly more common in the group of surviving patients.The number of platelets, the absolute number of lymphocytes, amounts of total protein, albumin (р < 0.0001), sodium (р = 0.0013) in the first 48 hours of hospitalization in the main group were significantly higher. The number of leukocytes (p = 0.0078), neutrophils (p < 0.0001), neutrophil-lymphocyte ratio (p < 0.0001), concentrations of glucose, aspartate aminotransferase, urea, creatinine, C-reactive protein and lactate dehydrogenase were significantly lower in the main group. Serum procalcitonin levels > 0.5 ng/ml were 5 times higher in deceased patients during early period of hospitalization.Conclusion. Clinical, anamnestic and laboratory factors were identified through this study. These factors may be useful in the early period of hospitalization for accurate assessment of risks of severe ill, effective disease management and reduction of mortality in hospitalized patients with COVID-19.