Ternopil Regional Research Articles

Ternopil regional museums in the funds of the State Archive of Ternopil Region

The article highlights the activities of museum institutions of Ternopil Region based on the documents and materials of the State Archives of Ternopil Region. A brief description of the documents composition and a list of archival collections containing information on this issue are given. The current state of museum and archival affairs development allows numerous researchers, local lore researches and historians to find necessary information for writing scientific papers on various topics. Public interest in the historical past is growing every year, and museums, as specialized institutions, provide an opportunity to get acquainted with the artifacts of the past. Documents kept in state storage in the State Archives of Ternopil Region (hereinafter – the State Archives) allow us to better cover this issue. The emergence of this study is determined by the tasks of clarifying the content and composition of documents related to the activities of museum institutions in Ternopil and the region and stored in the State Archives. All of this together actualizes the research issues. The purpose of this study is to analyse the composition and content of the documents and materials of the State Archives related to the activities of museum institutions of Ternopil Region. The object of study is the activity of museum institutions of Ternopil Region since their foundation on the basis of documents of the national archival fond. The subject of the article is the documents of the State Archives concerning the work of museum institutions of Ternopil Region. A holistic study of the problem will allow to better highlight the activities of the museum institutions, and will give impetus to further research in this area. The work is the first to provide the most comprehensive analysis of the State Archives source base related to this issue, and this is the scientific novelty of the study. The scientific and practical value of the results and main ideas of study is that the analysed factual material, theoretical provisions and conclusions can be used in writing generalised works on the history of Ukraine, the history of museum affairs, in archival studies, historiographical and local history publications, in the preparation of relevant special courses, and in practical teaching. This study is an attempt to simplify the search for information for further researchers of Ternopil museums, local historians, and all those interested in the museum business of their native land.

IMPLEMENTATION OF THE DECISION TREE METHOD IN EXPERT ANALYSIS OF THE MEDICAL ERRORS IN OBSTETRIC PRACTICE

Aim: To identify expert patterns in cases of improper medical care in obstetric practice based on the analysis of the materials of judicial and investigative cases initiated against obstetrician-gynaecologists in cases of improper performance of their professional duties, using the decision tree method. Materials and methods: A retrospective review of all alleged medical malpractice cases (a total 350) between 2007 and 2016 handled at Ternopil Regional Bu¬reau of Forensic Medical Examination, Chernivtsi Regional Bureau of Forensic Medical Examination and Zhytomir Regional Bureau of Forensic Medical Examination (Ukraine) was performed. Results: Expert commissions confirmed various shortcomings and omissions in provision of medical care in 232 (72.0%) of the investigated cases. Obstetricians were involved in claims in 82 (23.4%) cases. Application of intelligent data processing technology "Data Mining" with the use of the decision tree method revealed that inadequacies with regard to the medical records (attribute usage 100%) were the most informative attribute in the expert assessment of inappropriate medical care in obstetrics. Defects in the provision of obstetric care with a probability (P = 0.71) occur simultaneously both at pre-hospital and hospital levels and with a high probability (P = 0.83) result in severe consequences. Conclusions: The use of modern technologies for data analysis and processing contributes to the formulation of mathematically substantiated statements that significantly enhance the reliability of expert opinions in cases of forensic medical examination attached to dereliction of duties by the medical practitioners.

THE FORMATION OF BOHDAN KHAVARIVSKYI AS PERSONALITY, SOCIAL, POLITICAL, CULTURAL AND EDUCATIONAL FIGURE (THE SECOND HALF OF THE 20TH CENTURY – THE BEGINNING OF THE 21ST CENTURY)

This article attempts to investigate the development of Bohdan Khavarivskyi as a philologist, teacher, archivist, local historian, artist, personality, public-political and cultural-educational figure in the second half of the 20th century and the beginning of the 21st century. This significant list of his interests testifies to this person's uniqueness, comprehensiveness, and talent. Based on the analysis of archival materials, it was found that the formation of B. Khavarivskyi took place in the traditions of family upbringing, his parents and teachers who encouraged him to draw, write poems, recite, and sing was an example to follow in childhood. Bohdan-Roman was a comprehensively gifted individual who could realize his talents later in life. His activities were traced during his studies at the philological faculty of Chernivtsi State University. He attended the literary studio named after Stepan Budny, designed and edited its handwritten newspapers "Sunny Clarinets" and "Vesely Ostap," and gave speeches at scientific conferences. Acquaintance with famous Ukrainian science and culture figures from Chernivtsi contributed to his formation as a mature personality with an active life position and deep national convictions. It has been proven that the beginnings of his pedagogical work were connected to his teaching activities in a rural school in the Ternopil region. Over time, Bohdan Khavarivskyi worked as an educator in the dormitory of Ternopil Technical School № 2. Also, as a teacher at Ternopil Special Vocational Technical School № 3. It was found that the center of the future writer's organization, a professional center of artists, free from the restrictions of the standards of socialist realism, was formed in this educational institution. Subsequently, he was a senior researcher at the Ternopil Regional State Archives, a teacher at the Ternopil State Pedagogical Institute, the head of the public education department of the Ternopil Regional Executive Committee, the director of the State Archives of the Ternopil Region. It is known that he thoroughly mastered the subjects he taught. He practiced original modern forms and teaching methods, involved pupils and students in Ukrainian and world cultural achievements, and worked in close contact with the Ternopil Art Gallery, the Ternopil Museum of Local History, and the creative organizations of the city. He organized fine art weeks and involved artists from Ternopil and Lviv in exhibitions of paintings and graphics.

Recurrence of bilateral polysegmental pneumonia associated with COVID-19 (clinical case)

COVID-19 (clinical case)We describe a clinical case of long-term follow-up of a patient who had experienced bilateral polysegmental pneumonia associated with COVID-19 twice within 16 months.Patient, 52 years old, resident of the countryside. He fell ill acutely on 01/06/2020. He turned to the rural outpatient clinic with a paramedic complaining of an increase in body temperature up to 39.0 °С, shortness of breath with little physical exertion, cough with massive sputum production. He began treatment at the regional hospital, later continued at the Ternopil Regional Phthisiopulmonology Medical Center. A clinical diagnosis was made — community-acquired bilateral polysegmental pneumonia, severe course, group III. COPD, group B (GOLD 2) infectious exacerbation. P I II, intoxication syndrome. After inpatient treatment, a partial improvement was clinically determined, and radiographically, the resorption of inhomogeneous infiltration, but an increase in matte consolidation fields. It was during this period that a lockdown was introduced in the country in connection with the COVID-19 pandemic. Considering certain clinical and, in particular, radiological features of the course of the disease in a patient, COVID-19 can be suspected, at that time a PCR test was not yet performed. Until August 2020, the patient received outpatient treatment and was observed by a family doctor at the place of residence. In August 2020, the patient underwent a follow-up examination. Clinical and radiological improvement was noted. But the condition deteriorated sharply in the second half of November 2020. From 11/27/2020 to 12/14/2020, he was treated at the regional CRH for COVID-19, PCR+, severe course of community-acquired bilateral pneumonia. On the control CT scan (December 30, 2020) — in dynamics from August 13, 2020, progression — an increase in the area of ​​the lesion. Treatment continued at the Ternopil Regional Phthisiopulmonological Medical Center, and after discharge on an outpatient basis. At the control examination (06/16/2021), in the dynamics from 12/30/2020, the resorption of fibrous seals, a decrease in the intensity of consolidation areas. Conclusion: CT picture of chronic fibrosing lung disease, resorption phase.The patient was diagnosed with bacterial-viral pneumonia, which clinically and radiologically resembled pneumonia associated with COVID-19. Clinical and radiographic findings showed improvement after 7 months of treatment. After 10 months from the date of the first detection of the disease, the patient was re-diagnosed with pneumonia associated with COVID-19. Long-term inpatient and outpatient treatment was carried out, as a result of which it was possible to achieve clinical and radiological stabilization of the process and resorption of changes in the lungs.

CLINICAL OUTCOMES OF REVERSAL OF HARTMANN’S PROCEDURE

Background. Reversal of Hartmann’s procedure (HP) is one of the most complex surgical interven­tions in abdominal surgery with high morbidity rates of up to 58% in the patients after HP and mortality of up to 3.6%. Objective. This was a retrospective observational study to analyze the Hartmann’s reversal (HR) outcomes. Methods. The study involved 31 patients (16 males and 15 females), average age 59.6±10.31 (range 26-80), who underwent HR at Ternopil Regional Hospital in 2010 - 2021. The reasons for the HP were: cancer in 20 (64.5%) cases, perforation of the diverticulum – 6 (19.3%), traumatic rupture – 3 (9.7%) and Crohn’s disease - 2 (6.4%) cases. Results. Median time from Hartmann’s procedure to reversal was 11.13±9.24 months (interval 3-38). Intraoperative time was 210.33±56.91 minutes (range 120-330). HR was performed in 30 (96.8 %) patients. Dense pelvic adhesions of the stump of the rectum was diagnosed in 13 (41.9%) patients. Hand-sewn anastomosis was performed for 22 (71%) patients, stapler anastomosis – 4 (12.9%), pull-through technique – 3 (9.7%) patients. AL occurred in 3 (9.7%) patients on the 15th, 23rd and 35th postoperative days. pseudomembranous colitis was diagnosed in 2 (6.4%) patients with AL. The mortality rate was 1 (3.3%) as a result of septic complications due to AL; this case was not operated by a colorectal surgeon due to administrative issue in the hospital. Conclusions. Hartmann’s reversal is still one of the most difficult operations in colorectal surgery with high incidence of postoperative complications. Sound selection of patients with low comorbidity and in suitable time period is crucial for successful HR.

ENDOVASCULAR ANGIOPLASTY FOR MULTI-LEVEL STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL-DISTAL ARTERIAL BED IN CASES OF STENOTIC-OCCLUSIVE PROCESS OF THE TIBIAL ARTERIES

Background. Occlusive-stenotic lesions of the lower extremity arteries are the second in the structure of cardiovascular diseases, after only coronary heart disease. Surgical treatment of patients with infrainguinal atherosclerotic lesions of the arterial segment is challenging in a number of cases. At the same time, revascularizing surgical interventions on the femoral-distal artery and especially on the tibial arteries in chronic critical ischemia is the only chance to avoid amputation of the lower limb. In this regard, the search and study of optimal methods of revascularizing surgery on the infrainguinal artery for stenotic-occlusive lesions of the arteries of the tibial segment is urgent.
 Objective. This study is aimed at promotion of endovascular and hybrid technology in cases of stenotic-occlusive process of the tibial arteries and choosing the optimal surgical treatment tactics in this case.
 Methods. Endovascular interventions of the femoral-distal arterial bed in cases of stenotic-occlusive process of the tibial arteries performed for 135 patients at the Department of Vascular and Cardiac Surgery of Ternopil Regional Clinical Hospital have been analysed.
 Results. In most cases, endovascular angioplasty of two tibial arteries in hybrid and endovascular methods of revascularization of multilevel atherosclerotic process of the femoral-distal arterial segment of the lower extremity prevents development of thrombosis in tibial segment and allows maintaining the patency of the reconstruction segment and preservation of the lower extremity in 97.57% and 93.44% of cases, respectively.
 Conclusions. Endovascular angioplasty of two tibial arteries provides a better result than angioplasty of one isolated tibial artery and allows maintaining the patency of the reconstructed segment for more than 90 percent compare to one isolated angioplasty.

THE REGIONAL TRENDS OF GLOBAL CLIMATE CHANGE IN THE TERNOPIL REGION

Climate change, its causes and consequences are an extremely relevant topic today. It is constantly discussed not only in the circles of scientific experts but also in almost all spheres of society because the modern economy is largely dependent on many climatic factors. Climate change is happening quite rapidly around the world as well as in Ukraine. Evidence of climate change is supported by numerous hydrometeorological observations, observations of the amount and intensity of precipitation, temperature indicators and their absolute and average values. These indicators allow us to determine climate change. Long-term monitoring of air temperature makes it possible to characterize the climate change trend and the extent of its spread. Ukraine has a large network of observation points that have their data expertly assessed by the Central Geophysical Observatory. We would like to point out that in recent decades the temperature in the region is continuing to rise based on the archival data from the Ternopil Regional Center for Hydrometeorology and the research of the Central Geophysical Observatory and the Ukrainian Research Hydrometeorological Institute under the Ministry for Emergencies and NAS of Ukraine.
 The average annual air temperature rises due to significant warming of summer and winter periods. Regarding the climatic norm, which was calculated from 1961 to 1990, in almost all warm months the temperature exceeds up to 4°C, and in the winter months it exceeds up to 6°C. Having analyzed the observations of the Ternopil Regional Center of Hydrometeorology from 1946 to 2021, we notice that until 1989 the average annual air temperature in the region was much lower than the climatic norm, which is +8,4°C. In the Ternopil region, 2019 was ranked first among the warmest years since 1946, its average temperature was + 10,1°C, which is 1.7°C higher than the climatic norm. According to the Kremenets meteorological station, the average annual air temperature was + 10,5°С in the northern areas. According to the Ternopil Civil Aviation Meteorological Station, the average annual temperature was +9,6°С in the central areas.
 The analysis of changes in precipitation over the study periods demonstrates that, depending on the region, the amount of precipitation is unevenly distributed. For example, in the northern districts of the Ternopil region, the number of years that exceed the annual average rainfall norm increases with each passing decade. The years with the highest precipitation for the entire period of our research were 2001, 2008 and 2012. A similar trend of increase in precipitation was not observed in the central areas of the region. The amount of precipitation throughout the period 1992-2020 was constantly changing between dry and wet years. Therefore, no steady growth trend has been recorded. According to the Ternopil Civil Aviation Meteorological Station, in the last decade, the amount of precipitation has decreased significantly. Throughout 2015-2020 the annual amount did not exceed 564 mm. Typical of the territory of our region is the predominance of summer over winter precipitation - almost 70% of the annual amount of precipitation falls in the summer season. Having analyzed the results of observations from 1992 to 2021, we note that throughout 1992-2011 a significant increase in precipitation compared to the climatic norm in July and August was observed. In the following years, the amount of precipitation in these months sharply decreased, which became one of the factors of hydrological drought.
 Key words: climate, climate change, climatic norm, Ternopil region.

REHABILITATION OF PATIENTS AFTER CARDIAC SURGERY

Background. Patients undergoing cardiac surgery are under a high risk of post-operative reductions in respiratory muscle strength and pulmonary function as well as lowered functional capacity. In-hospital physical inactivity and inappropriate rehabilitation increases the chances for development of these complications and affects patients’ future independence in daily routine. Cardiac rehabilitation is crucial in preventing complications and assisting the early function recovery. However, despite the evidences for its benefits and strong guideline recommendations, the uptake of cardiac rehabilitation remains poor. Objective. this study is aimed at promotion of cardiac rehabilitation and sharing successful experience of using it. Methods. Post-surgical treatment and rehabilitation of 387 patients with cardiovascular pathology in the Department of Vascular and Cardiac Surgery of Municipal Non-Commercial Enterprise “Ternopil Regional Clinical Hospital” of Ternopil Regional Council has been analysed. Results. The experience of successful post-surgical treatment and rehabilitation allowed establishing the basic approaches to perioperative management of patients with cardiovascular surgical pathology. Key principles include minimized ICU stay and artificial ventilation time, early verticalization and beginning of physical activities, early removed drainage tubes, tracheobronchial tree drainage, nutritional balance, lymphatic drainage massage, application of elastic jersey on the lower extremities, early transferring to the surgery ward and returning to the regular daily activities, circumstantial health education, complex work of a multidisciplinary team. Conclusions. This set of rehabilitation measures helps prevent complications after cardiac surgery as well as provide a faster patient’s daily routine.

Detection of serum antibodies to tick-borne and other infections in patients with lymphadenopathy

The aim was to determine the prevalence of serum antibodies to tick-borne pathogens and other infectious agents in patients with lymphadenopathy. Materials and methods. 68 patients with lymphadenopathy aged 20 to 63 years who received outpatient or inpatient treatment were followed up at Ternopil University Hospital and Ternopil Regional Clinical Dermatological and Venereological Dispensary. There were 41 women (60.3 %) and 27 men (39.7 %). Two-stage serological detection (ELISA and immunoblot) was used for diagnosis of Lyme borreliosis (LB). Indirect immunofluorescence, including the BIOCHIP multiplex indirect immunofluorescence technique, was used for serological identification of human granulocytic anaplasmosis (HGA) and other infectious diseases, which could be associated with lymphadenopathy. Results. In total, 45.6 % of 68 enrolled patients were positive for the presence of specific antibodies IgM and/or IgG against B. burgdorferi s. l. Further examination demonstrated the presence of specific serum anti-A. phagocytophilum antibodies IgM and/or IgG in 33 patients with lymphadenopathy. It was found that 24.2 % of involved patients were positive for the presence of at least one type of anti-A. phagocytophilum antibodies; 12.1 % had positive or intermediate results only for B. burgdorferi s. l.; 60.6 % of patients were positive for the presence of antibodies against both pathogens. 46.9 % of patients were seropositive for EBV-CA, 40.6 % – for Parainfluenza virus type 1, 37.5 % – for HHV-6, 34.4 % – for HSV-1, 31.3 % – for EBV-EA and Toxoplasma gondii, 6.3 % – for Coxsackievirus type A9 and HIV-2. Conclusions. One-third of all involved patients with lymphadenopathy were positive for antibodies to B. burgdorferi s. l., causa tive agent of Lyme borreliosis. Co-infection of Lyme borreliosis and human granulocytic anaplasmosis was established in more than half of the patients. Besides, specific antibodies to 18 causative agents of other infectious diseases were detected with varying rate. Almost half of positive results detected were the antibodies to parainfluenza virus type 1 and Epstein–Barr virus.

Association of serum uric acid with albuminuria in type 2 diabetic patients with comorbid obesity and/or essential arterial hypertension

Abstract. Decompensation of diabetes mellitus type 2 (T2DM), duration of the disease, level of proteinuria, obesity and essential arterial hypertension (AH) play the main role in the development and progress of diabetic nephropathy.
 The present study aimed to analyze the level of serum uric acid in type 2 diabetic patients with comorbid overweight/obesity and AH and to find its possible correlations with lipid panel data and urinary albumin excretion.
 Methods. 579 medical records of type 2 diabetic patients treated at the Endocrinological department of the municipal non-profit enterprise "Ternopil University Hospital" of Ternopil Regional Council (Ternopil) in 2018-2019 years were analyzed.
 Results. The analysis of renal panel data of type 2 diabetic patients with comorbid overweight/obesity and AH found out that only serum levels of urea and uric acid were statistically different in the patients with only T2DM and comorbid course of T2DM. Herewith the maximal changes were established for serum uric acid level, which in type 2 diabetic patients with comorbid obesity exceeded by 175.9 % data of only T2DM patients. Moreover, it was established a significant direct relationship between serum uric acid level and BMI and dyslipidemia in both groups of type 2 diabetic patients - with comorbid obesity and with comorbid obesity and AH. At the same time, a significant direct association between serum uric acid level and albuminuria was established only in type 2 diabetic patients with comorbid obesity and AH.
 Conclusions. Our retrospective study indicates that serum uric acid level is markedly elevated and positively associated with albuminuria in type 2 diabetic patients with comorbid obesity and AH and can be used as a biomarker allowing further risk stratification for development and/or progress of diabetic nephropathy in this cohort of the patients.

ECOLOGICAL AND STATISTICAL ANALYSIS OF MAIN ASPECTS OF FORESTRY MANAGEMENT OF TERNOPIL REGION

In the context of growing anthropogenic impact on forest ecosystems, there is a need to control the use of this valuable natural resource. Ternopil region has a unique natural potential. A large area of the region is covered with forests, the main share of which is occupied by deciduous species. Ecological and statistical study of the main aspects of forestry in Ternopil region, identification of major trends is one of the priorities, as forests cover about 14% of the region, and conservation, reproduction and expansion of forests is a necessary prerequisite for planning environmental measures. The aim of the work is to conduct an ecological and statistical analysis of the main aspects of forestry in the Ternopil region in 2016–2020 and to identify the main patterns. Methodology. The research was conducted on the basis of information collection methods and statistical data analysis methods. All calculations were performed by using Microsoft Excel and Microcal Origin (version 6). The research used data from the Ministry of Environmental Protection and Natural Resources of Ukraine in Ternopil region (environmental passport), Ternopil Regional State Administration, Ternopil Regional Department of Forestry and Hunting for 2016–2020 years. Scientific novelty. Based on the conducted ecological and statistical study of the main aspects of forestry management of Ternopil region in 2016–2020, a clear trend to reduce the volume of deforestation from forestry activities. The nature of the functions allows to predict the decline in the future of these indicators. The same trend is characteristic of the volume of areas of reforestation. As for the volume of areas for afforestation, they are characterized by a tendency to increase over the entire study period. In addition, based on the nature of the function for this indicator, we predict its further growth. Conclusions. It has been established that there is a clear downward trend in the volume of deforestation in the Ternopil region and the volume of deforestation from forest activities related to logging. The volume of reforestation works also decreased annually, there is a tendency to increase the area of afforestation.

IMPLEMENTATION OF THE CONCEPT OF STEM EDUCATION IN THE SYSTEM OF QUALIFICATION DEVELOPMENT OF PEDAGOGICAL EMPLOYEES

The concept of STEM-education today is the subject of research and interest among educators-practitioners, as a way to implement reforms in the field of education and improve teaching methods of natural sciences and mathematics. The article describes the method of organizing professional development of teachers within the STEM field and their continuing education at the Ternopil Regional Municipal Institute of Postgraduate Pedagogical Education. Foreign and domestic approaches and concepts of STEM implementation in educational institutions are analyzed. In order to study and adapt the model of STEM-education as an approach to integrated learning in educational activities, an analytical study was conducted. The SWOT-analysis allowed to determine the hierarchy of positioning opportunities and threats of STEM education in the relevant matrices and to identify strategies for using strengths to realize opportunities and prevent threats, as well as to identify recommendations for the implementation of these strategies. The educational environment is analyzed and the system of measures for the development of STEM-competencies of teachers in the period of professional development is proposed. The proposed model provides a combination of formal (training sessions with STEM elements provided by the curriculum), non-formal (events in educational and research institutions) and informal education (self-education, scientific contacts, unscheduled casual conversations about STEM-education). The emphasis is placed on the fact that the implementation and development of STEM-education requires the preparation of an appropriate learning environment and improvement of the pedagogical system. An effective way to test the effectiveness of innovation in the education system is an experiment or research work. There was described for the formative stage of the innovative educational experiment of the regional level on the topic of “ECO-school” for the formation of environmentally safe STEM-educational environment in educational institutions of Ternopil region.

Borelis Pro phytomedicine for the complex treatment of Lyme borreliosis in children

IntroductionLyme disease, also known as Lyme borreliosis (LB) (tick (Ixodes)borne borreliosis) is a transmissible, natural-focal disease characterized by damage of the skin, nervous system, heart.Material and methodsUnder observation were 68 children – residents of Ternopil region, who applied to Ternopil Regional Children Hospital, and whose age range was 8–17 years. Two schemes of complex treatment of patients were tested: the 1st – patients received Doxycycline (Unidox Solutab®), tablets 100 mg, 10 pcs. 2 time/day after meals for 14 days at a dose 4 mg/ kg; the 2nd – patients received the treatment regimen like the 1st group and phytomedicine “Boreliss pro” capsules, 28.56g, 60 pcs. (Duo Life Boreliss Pro., Poland) 1 capsule 2 time/day after meals for 14 days.ResultsResults showed that was significantly (p < 0.05) lower severity of LB in patients who received antibacterial therapy in combination with doxycycline hydrochloride and phytomedicine “Boreliss pro” (1 caps. 2 times/day, after meals), compared with individuals in another group, on the 30th day after treatment. Complex therapy of patients by phytomedicine “Boreliss pro” causes a decrease of pro-inflammatory levels of cytokines IL-1β in the serum.ConclusionsComprehensive treatment of patients with an erythematous form of LB by phytomedicine “Boreliss pro” contributes to a significantly (p < 0.05) faster disappearance of clinical manifestations of LB, shortening the duration of doxycycline hydrochloride use, and reducing the likelihood of side effects from this drug.

Bolovi u trbuhu kod bolesnice s rekurentnom malarijom – prikaz slučaja

Currently the majority of malaria cases in Europe are imported by international travellers and immigrants. Typical clinical signs of malaria are recurrent fever, hepatosplenomegaly and haemolytic anaemia. Abdominal pain is not a specific clinical sign of malaria. We present a clinical case of three-day malaria in a 17-year-old Indian citizen who was admitted to the Ternopil Regional Children’s Hospital with fever and severe abdominal pain. The peculiarity of this case was the presence of fever and severe abdominal pain at the onset of the disease, which led to admission of the patient to surgical department and delayed correct diagnosis. Careful, thoro- ugh case history is one of the key points on the way to the accurate diagnosis. There is a need to increase the physicians’ awareness of malaria in patients with abdominal pain who have come from malaria endemic countries.

Comparative characteristics of the epidemiological situation of chemoresistant tuberculosis in Germany and Ukraine

Objective — to compare the epidemiological situation of chemoresistant tuberculosis in Germany and Ukraine, in addition analyzing the nature and features of chemoresistant tuberculosis in 192 patients treated at the Ternopil Regional TB Dispensary Ukraine during 2017—2018.
 Materials and methods. In order to study the comparative characteristics of the epidemiological situation with chemoresistant tuberculosis in Germany and Ukraine, modern literature sources were used with the search query «epidemiological situation with chemoresistant tuberculosis in Germany», «epidemiological situation with chemoresistant tuberculosis in Ukraine». Separatelly a retrospective cohort study was conducted. The nature and features of the course of chemoresistant tuberculosis in 192 patients who were treated in the Ternopil Regional TB Dispensary during 2017—2018 were analyzed. 
 Results and discussion. Analysis of literature sources showed that multidrug resistant Tuberculosis (MDR-TB) is relatively seldom in Germany with around 100 cases annually. Overall, the epidemiological situation of MDR-TB has been stable since the beginning of the statistical recording of the disease in 2002. In 2013, the highest proportion of MDR TB was registered at 3.3 %. Detailed analysis of notifi cation data shows that the tuberculosis situation in Germany is mainly influenced by migratory movements and demographic changes in the population. Despite the positive overall epidemiological trend with decreasing incidence rates, however, the burden of TB in Ukraine remains significant. According to the latest WHO estimates for 2018, TB incidence in the country(new cases and relapses) is the 4th highest among 53 countries of the WHO European Region.To address the situation, reduce TB prevalence, scale up TB early detection and diagnosis, and ensure effective treatment, Ukraine adopted, in 2019, the 2020–2023 State Strategy for Development of Anti-Tuberculosis Care for the Population.The analysis performed of 192 patients of the MDR/XDR-TB Cohort from the TB-Dispensary Hospital in Ternopil (Ukraine) from 2017—2018, showed that the resistanse of mycobacteria to anti-TB drugs was dominated by cases of MDR-TB — 57.3 %. Among patients first diagnosed were 52.6 %, relapses were 46.4 %. Destruction in the lungs was detected in 71.9 %. 111 patients (57.8 %) had treatment success, and 81 (42.2 %) had poor treatment outcomes or were lost to follow-up.
 Conclusions. The epidemiological situation of tuberculosis in Germany is stable and improving. Despite the positive overall epidemiological trend, the burden of TB in Ukraine remains significant. In 2018, TB incidence in the country (new cases and relapses) was 80 per 100 thousands population. In Ukraine during the period (2015—2018), the proportion of «pre-XDR» and XDR cases increased from 47.4 to 51.3 %. Among patients with chemoresistant tuberculosis, MR TB predominates (57.3 %), with destruction in the lungs and only 57.8% are effectively treated.

Prevalence of premature birth in conditions of global warming

The dynamics and likely associative link between global warming and the prevalence of preterm births in Ukraine over the years 2009-2018 was studied. to form modern ideas about the prognosis and prevention of this pathology. Data on medical care for pregnant women, mothers and parturients and adverse effects of pregnancy on preterm birth (form 21) for the period 2009-2018 were obtained from the municipal non-profit enterprise "Ternopil Regional Center of Public Health of Ternopil Regional Council". The correlation between the number of premature births per 100 births according to the average annual air temperature according to the Global Historical Climatology Network from the US Department of Ocean and Atmospheric Research in the climatically homogeneous regions of Ukraine was estimated. Predictive analysis of time series was performed by the method of integrated auto-regression of the moving average (ARIMA). The model error was estimated by calculating the absolute percentage error of the mean (MAPE). Statistical processing of materials was performed using programs Statistica 6.0 (StatSoft, USA) and open statistical package "R". The study meets modern requirements of moral and ethical standards regarding the provisions of legislative acts of Ukraine. Analysis of these reports of women's counseling shows an increase in the average number of preterm births from 2.88 per 100 births in the total number of births in Ukraine – 491445 in 2009 to 3.33, per 100 births in the total number of 309191 in 2018, which testifies to a significant increase in premature births in our country. Since 2009, there has been an annual, varying degree of increase in average annual air temperature in Ukraine. As a result of the correlation analysis, a significant strong direct correlation was established between the average level of premature birth and the average annual air temperature in Ukraine (r=0.84, p<0.05). Regression analysis revealed a significant increase in the number of premature births (per 100 births) in 1, 2, 5, 6, 7, 8 and 10 climatically homogeneous regions and a tendency to increase in, respectively, 3, 4, 9, 11 and 12 climatically homoge­neous regions of Ukraine. Based on the analysis of data on the average annual air temperature in Ukraine for 2009-2018, the average annual air temperature in Ukraine is projected to increase by 0.3 ° С in 3 years (MAPE <10%, p<0.05). The annual number of premature births is expected to increase (cases per 100 births) in 3 years by 0.4 cases per 100 births (MAPE <10%, p <0.05). In the context of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature infants. Strong correlations have been established between the annual number of premature births and the average annual air temperature in Ukraine. Regression models of preterm birth showed a significant increase in 1, 2, 5, 6, 7, 8, and 10 cli­matically homogeneous regions and a tendency to increase in 3, 4, 9, 11 and 12 climatically homogeneous regions. The annual number of premature births in Ukraine is projected to increase by 2023 by 20 cases per 100 births compared to 2018. The strategy for preventing premature births and related adverse effects of pregnancy should include the identification of global warming as a risk factor for increasing level of this pathology.

Випадок гострого нейробореліозу у хлопчика шкільного віку

Наведено клінічний випадок гострої мікст-інфекції, асоційованої з анаплазмою і Borrelia burgdorferi (ПЛР ДНК+), первинно-дисемінованим ураженням центральної нервової системи, нейробореліозом, у хлопчика 11 років, який був госпіталізований у неврологічне відділення Тернопільської обласної дитячої клінічної лікарні зі скаргами на біль голови розпираючого характеру після сну. В анамнезі був укус кліща за 4 тижні до початку хвороби. Недуга перебігала з вираженою цефалгією за відсутності підвищення температури в дебюті, наявністю у неврологічному статусі загальномозкової симптоматики за відсутності клінічно вогнищевого неврологічного дефекту на фоні спричиненої мікст-інфекції (бореліозу та анаплазмозу).

Клінічний випадок укусу змії в дівчинки шкільного віку

Ми наводимо клінічний випадок укусу змії в дівчинки 8 років, яка була госпіталізована в реанімаційне відділення Тернопільської обласної дитячої клінічної лікарні. Особливістю наведеного клінічного випадку є домінування больового синдрому та виражений лімфостаз у місці укусу, відсутність системного ураження. Необхідно підвищити настороженість населення щодо можливих укусів змій. Особливо небезпечними є укуси для дітей у зв’язку з тим, що вони багато часу проводять босоніж на відкритому повітрі.

Синдром Стивенса — Джонсона у подростка: диагностика и лечение (клинический случай)

Авторами представлен клинический случай синдрома Стивенса — Джонсона у подростка, жителя Тернопольской области, который был госпитализирован в реанимационное отделение Тернопольской областной детской клинической больницы. Особенностью данного клинического случая является то, что у пациента была тяжелая форма токсического эпидермального некролиза, который сопровождался лихорадкой, поражением кожи, симптомом Никольского. У мальчика развился характерный кожный синдром, сопровождающийся формированием пузырей на коже, эрозий на слизистых. Парентеральное введение преднизолона из расчета 10 мг/кг на фоне поддержания водного, электролитного и белкового баланса привело к выраженному положительному эффекту и снизило риск ухудшения состояния больного.

Reorganization of the structural elements of the venous wall in oncogenic pathology

The objective: an identification of changes and reorganization of structural elements of the venous wall, their correlation with cancer processes in the organism; the establishment of the relationship between structural changes in the wall of the venous vessels and thrombosis, with the following complications; the determination of the necessity of the preventive measures to avoid complications. Materials and methods. Histological, submicroscopic and polarization data of the research of the veins of the hind limbs of 12 sexually mature nonlinear male rats weighing 170–180 g on the 30th day of chronic neoplastic intoxication were analyzed. A retrospective analysis of the autopsy protocols of cancer patients (n=54), the largest incidences – pulmonary embolism, during 2014-2018 in the Ternopil Regional Clinical Oncology Center was performed. The average age of women who died was 61.93±1.51 years and 62.44±2.61 years – for men.Results. As a result of morphological examination of the veins of the hind limbs of rats with experimental neoplastic intoxication revealed mainly submicroscopic reorganization of endothelial cells and their desquamation, as well as platelet aggregation that can be one of the links in the pathogenesis of thrombosis.According to a retrospective analysis of the autopsy protocols, the proportion of pulmonary embolism was higher among women (61.1 %) than men (38.9 %). The structure of oncopathology in this group of patients: bronchial and lung cancer (18.5 %); neoplasms of the uterine body (22.2 %); rectum cancer (13.0 %), colon cancer (7.4 %), rectosigmoid junction cancer (5.6 %); bladder cancer (9.3 %); gastric cancer (7.4 %); ovarian cancer (7.4 %); prostate cancer (5.6 %); thyroid cancer (1.8 %); pancreatic cancer (1.8 %). In all cases of autopsy phlebothrombosis of the deep veins of the leg and thigh with impaired blood flow caused by occlusion by blood clots of various manifestations of the structural organization was revealed. In five cases, fresh red blood clots were found, which were closely connected with the intima by fibrin threads, in five other cases – red blood clots were freely located in the lumen of the vein, swelling of all layers of the vein, fibrous structure and diffuse neutrophil infiltration were found. In the remaining 44 cases, vein occlusion was detected by already organized thrombi with signs of fibrosis, recanalization, and revascularization.Conclusions. The study of the morphology of rat hind limb veins with experimental neoplastic intoxication mainly revealed changes in the shape, structure and function of endotheliocytes, their desquamation and changes in all three layers of the venous wall as well as platelet ligation. The relationship between the presence of changes in the venous wall as a result of cancer and the formation of thrombosis was found. The number of thromboembolic complications emphasizes the necessity to prevent thrombosis in cancer patients.