Untimely Treatment Research Articles

Varicella cellulitis in children (personal experience)

Annotation. The frequency of complications with varicella is 5-30%, and their level is much higher in patients with immunodeficiencies. In 8-50% of hospitalized children with varicella virus infection develop skin and soft tissue complications such as cellulitis, lymphadenitis, abscess, hysteria, toxicoderma. They are located on vulnerable parts of the body against the background of a state of anergy in a sick child, which is caused by the varicella virus. The aim is highlight clinical and diagnostic features and methods of treatment of varicella virus cellulitis in children based on own experience and according to literature sources. The high frequency of complications is associated with untimely detection of signs of inflammation and untimely treatment in case of secondary flora joining. The main etiological factors of superinfection are β-hemolytic streptococcus group A and staphylococcus aureus. Recently, cellulitis of the subcutaneous tissue is one of the most serious complications in patients with varicella virus infection. The clinical picture of this complication includes local and general manifestations. Local symptoms are accompanied by pronounced redness in the affected area, a significant increase in tissue volume due to swelling, intense, throbbing pain that worsens with touch or movement, the presence of purulent secretions from the affected area, compaction or softening of tissues at the site of the lesion, local hyperthermia. Treatment of varicella cellulitis involves a wide range of measures, which include: antibiotic therapy, drainage of purulent foci, symptomatic treatment, local treatment, supportive therapy, physiotherapy, observation and control. Before determining the optimal antibiotic, it is important to take into account the regional characteristics of the resistance of microorganisms and information about the typical causative agents of varicella cellulitis. Broad-spectrum antibiotics such as amoxicillin with clavulanic acid, ceftriaxone, clindamycin, or vancomycin are usually used for treatment. So, the main etiological factors causing complications in the form of necrotic cellulitis on the background of varicella virus are β-hemolytic streptococcus group A and Staphylococcus aureus. Diagnosis of varicella cellulitis includes a set of examination methods to confirm the diagnosis: daily examination of the child's body surface for inflammatory foci. The optimal treatment tactic is combined therapy (surgical and conservative treatment). Vaccination is recommended for children who are in risk groups – patients with oncology who receive cytostatics, corticosteroids; children with congenital and acquired immunodeficiencies.

MODERN PARAMETERS OF LABORATORY EXPRESS DIAGNOSTICS IN INTENSIVE NEUROLOGY AND NEUROSURGICAL PRACTICE IN PATIENTS WITH CRANIOCEREBRAL INJURIES

The parameters listed in the article show the huge path that laboratory express diagnosis of emergency conditions in neurology has taken over the past 50 years. And this is not the limit - new unique technologies appear. The range of measured and calculated parameters continues to expand, which makes it possible to more fully and adequately assess the condition of a critically ill patient. Thus, a timely and qualitative study of the gaseous composition of blood is important for carrying out differential diagnosis, prescribing adequate treatment and monitoring the therapy effectiveness. The aim of the study was to highlight the current parameters of laboratory rapid diagnostics in intensive neurology and neurosurgical practice in patients with traumatic brain injury. There are two situations that necessitate the development of rapid methods for monitoring hemostasis in the neurological intensive care unit and neurosurgical operating room: the need to immediately determine the concentration or biological effect of anticoagulants. Some areas of surgical intervention are associated with increased blood loss due to coagulopathy, which requires timely replacement therapy. A long process of determining hemostatic parameters by routine methods in a general laboratory leads to a delay in diagnosis and, as a result, untimely treatment. Quite a few express methods designed to obtain specific information about the hemostasis process are currently available in the operating room. If these monitoring methods are used correctly, the research results are reliable, so some researchers use them to develop algorithms for determining the need for transfusion of blood components. However, the development of new monitoring methods requires close collaboration with scientists specialized in hemostasis, plus quality control must be established. It is necessary to prove the positive effect of rapid diagnostic methods on the result to ensure the possibility of their wide application in various operations.

Increased Intra-Abdominal Pressure as One of the Links in the Pathogenesis of Secondary Diffuse Purulent Peritonitis

Aim: to present literature data on the importance of intra-abdominal hypertension in the pathogenesis of peritonitis. Key points. Secondary purulent peritonitis is a severe and fairly common form of abdominal infection with high mortality. According to statistics, hospitalization of patients with signs of local or diffuse peritonitis is more than 15 % among patients with acute surgical pathologies. One of the factors in the development of complications and an unfavorable prognosis for this disease is increased intra-abdominal pressure. To measure this indicator, a Foley catheter inserted into the bladder is used in medical practice. According to reference values, the optimal level of intra-abdominal pressure does not exceed 5 mmHg. A persistent increase in pressure of 12 mmHg and above indicates the development of intra-abdominal hypertension. An increase in the level of intra-abdominal pressure indicates the progression of the inflammatory destructive process in the abdominal cavity and contributes to the development of multiple organ failure with subsequent fatal outcome with untimely treatment. With an indicator exceeding 20 mmHg, there is a risk of developing abdominal compartment syndrome. This condition is characterized by increased pressure in two or more anatomical areas, which leads to decreased blood flow and subsequent tissue hypoxia. Intra-abdominal hypertension also increases the risk of developing postoperative peritonitis in patients who have undergone laparotomy. Conclusion. To predict the course of secondary diffuse purulent peritonitis, reduce the risk of complications and mortality, it is necessary to focus on measuring intra-abdominal pressure as a mandatory manipulation in surgical patients. Despite its general availability and ease of implementation, this technique allows assessing the severity of organ dysfunctions.

Features of diagnosis of incomplete Kawasaki disease in young children. A clinical case of Kawasaki disease with the formation of giant coronary artery aneurysms

Kawasaki disease (KD) is a mucocutaneous lymphonodular syndrome, a vasculitis of unknown etiology that mainly affects children under the age of 5 years. Today, KD is the most common cause of acquired heart disease in children in developed countries. Given the absence of pathognomonic diagnosis of the disease, the diagnosis is based solely on the identification of clinical signs and the exclusion of other clinically similar diseases. Timely therapy with intravenous immunoglobulin has significantly reduced the incidence of complications, such as coronary artery aneurysms, from 25 to ≈ 4 %. The long-term prognosis of the disease depends on the initial and current level of coronary artery damage. Patients with coronary artery aneurysms remain at high risk of developing myocardial ischaemia due to thrombosis and stenosis of the coronary arteries, which can occur in case of untimely treatment for KD. Therefore, the life of these patients depends on lifelong thromboprophylaxis and timely diagnosis of stenosis. The article presents a clinical case of incomplete Kawasaki disease, which was complica­ted by the development of giant coronary artery aneurysms.

Efficacy of Abhrakadi Yogam in Managing Type II Diabetes Mellitus

Diabetes mellitus is a metabolic disorder mainly characterized by elevated blood sugar level or hyperglycemia. Type 2 Diabetes Mellitus (T2DM) is the most common form, accounting for about 90% of the total diabetic population and is a major cause of morbidity and mortality. The condition mainly occurs from insulin resistance and relative deficiency in insulin secretion. The condition hampers the patient’s quality of life with symptoms of polyuria, polyphagia, polydipsia, fatigue, weight loss, etc. Type 2 Diabetes Mellitus can be managed effectively in the initial phases with proper medication and lifestyle modification. The untimely treatment, chronicity of insulin resistance, and hyperglycemia can cause damage to multiple organs. In Ayurveda, the descriptions of Avaranajanya Madhumeha, which is a Medovahasrothodushti Vikara can be compared with T2DM as both seem analogous in etiopathogenesis and clinical features.
 The present study aims to evaluate the efficacy of Abhrakadi Yogam in managing Type II Diabetes Mellitus. The study was a consecutive case series done on an OPD basis. The study was conducted on ten subjects newly diagnosed with Type 2 Diabetes Mellitus, in whom Abhrakadi Yogam, 4gm thrice daily before food along with honey as Anupana was given for 90 days and 30 days follow up. Assessment was done on 0th, 91st and 121st day with subjective and objective parameters. All drugs possess Tridoshahara property which helps in controlling all the Doshas. The Deepana, Pachana, Lekhana, Vatanulomana and Rasayana properties of the trial drug helped in Amapachana, Kleda Shoshana, Medohara and Srothoshodhana, restoring Dhatu Sthirata thereby improving quality of life of patients. After treatment significant improvement was observed in assessment parameters. The study showed significant clinical efficacy and safety of the trial drug.

Prediction of Living Status for Breast Cancer Patients Using Machine Learning

Due to reasons such as diet, living habits, and genes, etc., breast cancer has gradually become a common high mortality disease and is not limited to women. Many patients suffer from terrible illness or even death due to untimely treatment or incorrect prediction of tumors. This study has 500 observations in total through utilizing the combination of oversampling and undersampling. What’s more, by using advanced machine learning, the method of recursive feature elimination and random forest, this research constructs a model and select four types of protein content in the body and age as the most relevant features in predicting patients’ living status. The model has a relative high accuracy 98.052% and can provide physicians relative accurate information to give targeted treatment. It also can be utilized as a warning to remind patients of their current physical condition. Early treatment and accurate diagnosis can significantly improve patient survival rates.

Comparative analysis of the results of multispiral computed tomography using color mapping and magnetic resonance imaging in the diagnosis of acute hematogenous osteomyelitis in children

BACKGROUND: Although acute hematogenous osteomyelitis is considered a fairly well-studied disease, several articles emphasize that the frequency of diagnostic errors remains quite high. The clinical presentation of acute hematogenous osteomyelitis largely depends on its reactivity and localization. The latter has features of the clinical course in children of different age groups. Osteomyelitis can be difficult to detect because of the variability and nonspecificity of symptoms and physical and laboratory parameters. Rapid diagnosis is crucial for successful disease outcomes because untimely treatment increases the number of complications. Therefore, visualization should be aimed at early diagnosis and, ultimately, successful treatment.
 AIM: This study aimed to evaluate the informative value of magnetic resonance imaging and multispiral computed tomography (MSCT) in the diagnosis of the intramedullary phase of acute hematogenous osteomyelitis as its earliest stage.
 MATERIALS AND METHODS: Thirty patients suspected with acute hematogenous osteomyelitis underwent magnetic resonance imaging and MSCT using color mapping techniques and X-ray density assessment. At the final stage of the diagnostic algorithm, osteotonometry was performed. The contents of the bone marrow canal were taken for microbiological and bacteriological studies.
 RESULTS: In the intramedullary phase of acute hematogenous osteomyelitis, magnetic resonance imaging and MSCT revealed signs of bone marrow edema in 96% of the cases. The sensitivity of magnetic resonance imaging was 96%, the same as that of MSCT; however, the specificity was significantly lower than that of MSCT using the color mapping method and X-ray density assessment, which was 67% and 83%, respectively (p 0.05).
 DISCUSSION: In recent years, the role of computed tomography in the diagnosis of acute hematogenous osteomyelitis has received considerable recognition in pediatric surgical practice, and MSCT with color mapping and X-ray density assessment in the diagnosis of acute hematogenous osteomyelitis in children has been used relatively recently. Simultaneously, many researchers have reported the high informativeness of MSCT in the diagnosis of acute hematogenous osteomyelitis.
 CONCLUSIONS: The intramedullary phase of acute hematogenous osteomyelitis according to magnetic resonance imaging and MSCT indicates bone marrow edema as its earliest stage. According to the data of the present study, MSCT using color mapping and X-ray density assessment has high specificity and can be used with MRI as the main method for diagnosing the intramedullary phase of acute hematogenous osteomyelitis.

Current issues in the diagnostics of hip dysplasia in newborns in the regions of the Russian Federation

BACKGROUND:Early diagnostics of hip dysplasia in newborns are important medical and social problems because untimely treatment of these children leads to severe irreversible pathological disorders of the hip joint, dysplastic coxarthrosis, and consequently disability. Anamnesis data of patients from the Department of Hip Pathology of H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery show that late diagnoses of the dysplastic pathology of the hip joint are not rare, which does not tend to decrease in number.
 AIM:To identify and analyze the causes of the late diagnosis of dysplastic hip joint pathology in newborns in the Russian Federation.
 MATERIALS AND METHODS:Statistical data from 64 regions of the Russian Federation were collected and analyzed to study the causes of untimely diagnosis of dysplastic hip joint pathology in newborns.
 RESULTS:According to the information received, 3,456,207 children were born in 64 regions of the Russian Federation between 2019 and 2021. Of these children, 108,737 (3.1%) were diagnosed with hip dysplastic pathology of varying severity (acetabular dysplasia, subluxation, and dislocation), and 3,943 cases (3.6%) had untimely diagnosis.
 CONCLUSIONS: Late diagnosis is primarily caused by the untimely appearance of patients for ultrasound screening and initial examination by an orthopedist. The secondary reason is the understaffing of medical organizations with specialists–orthopedists and specialists in Doppler ultrasound examination. To reduce the number of cases of late diagnosed or missed dysplastic hip pathologies and improve the quality of orthopedic care for children in the Russian Federation, strengthening health education must be recommended among parents and staff of medical organizations with orthopedic and ultrasound specialists.

Multifocal Tuberculosis with Pre-Extensive Drug Resistance (Clinical Case)

We present our own observation of the multifocal tuberculosis with pre-extensive drug resistance (pre-XDR-TB) development in a patient who was treated in the pulmonary tuberculosis department No. 2 of the Zaporizh­zhia’ regional phthisio-pulmonology clinical treatment and diagnostic center. Multifocal pre-XDR-TB developed in the patient 2.5 months after the initial diagnosis of destructive disseminated pulmonary tuberculosis. The patient was treated during 2 months with deforming arthrosis, which turned out to be tuberculosis of the left knee joint until the specified changes in the lungs were detected, which indicates its late diagnosis. The patient was not tested for HIV infection when tuberculosis was detected in the primary care, and after 2.5 months it was firstly found and accompanied by severe immunosuppression (CD4 lympho­cytes count was 94 cells). This fact also indicates a late diagnosis of HIV infection. As a result of untimely diagnosis and treatment of disseminated pulmonary tuberculosis in the pre-XDR-TB patient with combined HIV infection, there was a rapid generalization of a specific process with the development of multifocal tuberculosis involving not only the bronchopulmonary system, but also the left eye (focal chorioretinitis), the heart (exudative pericarditis), brain (meningoencephalitis) and the left knee joint. The presented clinical case also shows the irresponsibility of the patient to his healthy and the poor work of the family doctor in explaining to the patient the importance of timely tuberculosis treatment. Thus, in the described clinical case, a late-diagnosed HIV infection with severe immunosuppression may have been the trigger for the development of multifocal tuberculosis with extensive drug resistance in the patient and untimely treatment of disseminated pulmonary tuberculosis led to rapid generalization of the specific process. More responsible work of family doctors with tuberculosis patients is also necessary. Therefore, timely diagnosis of multifocal tuberculosis and the earliest appointment of antimycobacterial therapy will allow not only to achieve positive results in treatment, but also to prevent the complications’ development.

A Web-Based Intervention to Address Risk Factors for Maternal Morbidity and Mortality (MAMA LOVE): Development and Evaluation Study.

Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation's worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool's initial prototype. Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals.

18F-FDG PET/CT Image Deep Learning Predicts Colon Cancer Survival.

Colon cancer is a type of cancer that begins in the large intestine. In the process of efficacy evaluation, postoperative recurrence prediction and metastasis monitoring of colon cancer, traditional medical image analysis methods are highly dependent on the personal ability of the doctors. In the process of patient treatment, it not only increases the workload and work pressure for doctors, but also has some problems with traditional medical image analysis methods. Moreover, the traditional medical image analysis methods have problems such as insufficient prediction accuracy, slow prediction speed, and the risk of errors in prediction. When analyzing 18F-FDG PET/CT images by traditional medical image analysis methods, it is easy to cause problems such as untimely treatment plans and errors in diagnosis, which will adversely affect the survival of colon cancer patients. Although 18F-FDG PET/CT images have certain advantages in image clarity and accuracy compared with traditional medical imaging methods, the analysis method based on 18F-FDG PET/CT images also has certain effects in predicting the survival of colon cancer patients, but there are still many shortcomings: the 18F-FDG PET/CT image analysis method overly relies on the technical advantages of 8F-FDG PET/CT images; in the analysis and prediction of image data, it has not gotten rid of the dependence on the personal medical quality of the doctors; traditional medical image analysis methods are still used when analyzing and predicting images; there is no breakthrough in image analysis effects. In order to solve these problems, this paper combined deep learning theory, using three algorithms of the improved RBM algorithm, image feature extraction method based on deep learning, and regression neural network to analyze and predict 18F-FDG PET/CT images, and applied some algorithms to analyze and predict 18F-FDG PET/CT images, and also established a deep learning-based 18F-FDG PET/CT image survival analysis prediction model. Four aspects survival prediction accuracy, survival prediction speed, survival prediction precision, and physician satisfaction were studied through this model. The research results have shown that compared with traditional medical image analysis methods, the prediction accuracy of 18F-FDG PET/CT image survival analysis prediction model based on deep learning is improved by 0.83%, and the prediction speed is improved by 3.42%, as well as the prediction precision increased by 6.13%. The research results show that the deep learning-based 18F-FDG PET/CT image survival analysis prediction model established in this paper is of great significance to improve the survival rate of colon cancer patients, and also promotes the development of the medical industry.

A retrospective analysis of MS/MS screening for IEM in high-risk areas

Inborn errors of metabolism (IEM) can lead to severe motor and neurological developmental disorders and even disability and death in children due to untimely treatment. In this study, we used tandem mass spectrometry (MS/MS) for primary screening and recall of those with positive primary screening for rescreening. Further diagnosis was based on biochemical tests, imaging and clinical presentation as well as accurate genetic testing using multi-gene panel with high-throughput sequencing of 130 IEM-related genes. The screening population was 16,207 newborns born between July 1, 2019, and December 31, 2021. Based on the results, 8 newborns were diagnosed with IEM, constituting a detection rate of 1:2,026. Phenylketonuria was the most common form of IEM. In addition, seven genes associated with IEM were detected in these eight patients. All eight patients received standardized treatment starting in the neonatal period, and the follow-up results showed good growth and development. Therefore, our study suggests that MS/MS rescreening for IEM pathogenic variants in high-risk areas, combined with a sequencing validation strategy, can be highly effective in the early detection of affected children. This strategy, combined with early intervention, can be effective in preventing neonatal morbidity and improving population quality.

A Case of Severe Somatized Depression in a Young Adult: Diagnostic Challenges

IntroductionDepressive disorders in adolescence and young adulthood have always been and remain an urgent problem due to their fairly high prevalence among the population, serious difficulties in diagnosis and untimely treatment. Timely diagnosis and adequate treatment can have a powerful impact on the future life of a person in a positive context. This process requires both standardized mechanisms, and an individual detailed study of each case, as the future of the individual depends on it.ObjectivesA young adult M., 20 years old, a university student, from a socially prosperous family, approached us.Main complaints: headaches that have been going on for almost 4 years. Pains did not depend on loads, both physical and mental, were of various characteristic and different localization. Non-steroidal anti-inflammatory drugs, as well as anti-migraine drugs, have little effect on the pathological experiences.MethodsOur main method of examination was clinical interview. In the complex assessment detailed neurological and ophtalmological examination included.ResultsThe parents referred patient for a medical examination about a year ago, because they noticed persistent mydriasis in him. During the year, the patient underwent a detailed examination (consultations of a therapist, endocrinologist, neurologist, ophthalmologist, MRI, EEG, dopplerography). Doctors expressed various assumptions about the diagnosis, because all the studies did not reveal any pathology that could explain the indicated complaints and mydriasis.During the initial interview, a high level of intelligence and knowledge was revealed, as well as a sufficient ability to learn. Examining the emotional-volitional sphere, a slight level of emotional instability, mild irritability, anhedonia and a slight degree of hypobulia (which can be explained by long-lasting and persistent pathological somatic experiences in the form of headaches) were found. Incomplete Protopopov’s triad was revealed.The patient was referred for repeated neurological and ophthalmological examination. Specialists with a high qualification level discovered the A. Athanassio symptom in him.He was diagnosed with recurrent depressive disorder, a current episode of severe depression with somatic symptoms, and appropriate treatment was prescribed.Conclusions1. Depressive disorders in adolescence and young adulthood require special attention from specialists of all medical specialties.2. The need for a detailed medical examination and modern neuroimaging methods is beyond doubt.3. Psychiatric examination cannot be limited to assessment of mental status only, and assessment of Protopopov’s triad should be part of psychiatric examination.4. Neurological and ophthalmological examination must necessarily include an assessment of neuro-ophthalmological symptoms.5. Individual selection of treatment should be carried out by a psychiatrist.Sorry to say, Professor Mykola Pityk died 27.12.2020Disclosure of InterestNone Declared

ORGANIZATION OF TREATMENT OF OSTEOARTHRITIS OF THE KNEE JOINT

According to modern ideas, the treatment of osteoarthritis should be comprehensive and include a combination of non-drug methods. In addition, routing patients for non-pharmacological treatment is a difficult problem. In addition, doctors of all specialties who, to a greater or lesser extent, are engaged in the treatment of osteoarthritis (therapists, surgeons, rheumatologists, neurologists) widely use local forms of glucocorticoids in the treatment of osteoarthritis. At the same time, many doctors are guided by outdated recommendations for the management of patients with osteoarthritis. Such a monodisciplinarian approach in the treatment of osteoarthritis of the knee joint, coupled with the patient's routing defects, has a number of significant drawbacks, namely, the lack of timely and adequate therapy of the disease based on a convincing evidence base, which ultimately leads to the progression of joint damage, the development of persistent health disorders and limitations of the patient's vital activity. We have analyzed domestic and foreign literature to identify the shortcomings of osteoarthritis treatment, as well as to understand what concepts need to be changed in the structure of the organization of treatment of osteoarthritis of the knee joint. Among the shortcomings of the existing system of care for patients with osteoarthritis of the knee joint, it should be noted the almost complete absence of dispensary monitoring of patients with pathology of the musculoskeletal system in outpatient clinics. In modern conditions of a market economy, an important aspect of the activities of healthcare institutions is the cost of a particular type of treatment, since the heads of medical institutions are forced to think about financing the organization. This situation leads to the fact that inpatient conservative treatment of osteoarthritis of the knee joint in therapeutic departments is unprofitable for a medical institution due to cheap CHI rates. On an outpatient appointment, doctors do not in all cases manage to reliably establish a diagnosis and make a plan for further treatment of the patient. The lack of continuity in the diagnosis and treatment of osteoarthritis of the knee joint leads to a high frequency of the establishment of the disease at late stages, untimely treatment and the development of pronounced persistent structural and functional disorders of the joints, which can only be compensated by radical surgical methods of treatment. On the other hand, primary care physicians (therapists and surgeons) have limited time to receive a patient, which does not allow for a full physical examination necessary for differential diagnosis of joint syndrome, especially considering that most patients with osteoarthritis have concomitant pathology that also requires attention. It should be noted that the shortcomings in the organization of treatment of patients with osteoarthritis of the knee joint are characteristic not only for the Russian Federation, but also for other European countries and the USA. In foreign countries, osteoarthritis is mainly treated in primary health care institutions, and the main role in this case belongs to the therapist (general practitioner). Thus, it can be stated that today the system of organization of treatment of osteoarthritis of the knee joint is imperfect. Outpatient orthopedic care is provided mainly by non-core specialists.

Complicated Course of Cystous and Tumor-Like Ovarian Formations in Adolescents

The article presents the data of our own studies of patients with cystic and tumor-like formations of the ovaries in a complicated course of the disease. Difficulties in the differential diagnosis of this pathology leads to diagnostic and tactical errors, which further leads to dysfunction of the reproductive organs and irreversible consequences in the reproductive health of patients in case of untimely treatment. A comprehensive study of the features of the course of cystic and tumor-like ovarian formations, the development of diagnostic criteria, will help determine the tactics of timely treatment of this pathology, which in turn will affect the prognosis of the disease, and will also contribute to solving this problem in women of different age periods.

Vehicle Crash Detection using YOLO Algorithm

Car accidents cause a large number of deaths and disabilities every day, a certain proportion of which result from untimely treatment and secondary accidents. To some extent, automatic car accident detection can shorten response time of rescue agencies and vehicles around accidents to improve rescue efficiency and traffic safety level. —Road Accidents, a very common reason of tragic deaths and many times the victim dies due to non-reporting of such accidents to the proper authority. Since the accident was not reported the lack of emergency medical care results in death. We live in an era of technology where we are moving towards making the city, A Smart City. A smart city with smart AI based traffic monitoring and reporting mechanism can help providing medical emergencies in real time and this would result in saving lots of life. Traditional Traffic systems are equipped with IP cameras and sensors, and are already installed in most part of the city to monitor and control traffic. These systems are able to generate traffic tickets automatically. In this paper we are proposing a more advanced traffic monitoring system which can identify and detect moving objects such are cars, bikes etc in live camera feeds and detect collision of these moving objects and immediately send emergency alerts to the nearby authority for them to take necessary actions.

TREATMENT OF SIMPLE CHRONIC INSTABILITY OF THE ELBOW JOINT

Simple chronic instability of the elbow joint is one of the urgent problems in modern traumatology due to the fact that the standard tactics of managing patients with traumatic injuries of the elbow joint due to dislocation, which amounts to its elimination, immobilization of the upper limb and subsequent development of movements in the joint, most often does not take into account damage to specific soft tissue structures. With untimely treatment for qualified help, with late or unsuccessful attempts to eliminate dislocation of the bones of the forearm, less often with chronic traumatization of the ligamentous apparatus of the elbow joint during some types of occupation, one of the most unpleasant complications may form, namely, chronic instability. This article discusses the main types of chronic instability of the elbow joint, analyzes approaches to the management of patients with simple chronic instability. Despite the not very high occurrence of this pathology, the effectiveness of modern surgical treatment options aimed at reconstruction of the ligamentous apparatus of the elbow joint, the percentage of unsatisfactory results of treatment of simple chronic recurrent and persistent instability of the elbow joint remains high.

A case of brucellosis-induced Guillain\u2013Barre syndrome

BackgroundGuillain–Barre syndrome (GBS) is a rare neurological complication of brucellosis, and neurobrucellosis is the most common, but they have many similarities in clinical manifestations. Many clinicians are accustomed to merely explaining the manifestations of nervous system involvement with neurobrucellosis, but they ignore the possibility of GBS, and this leads to misdiagnosis, untimely treatment, and serious consequences.Case presentationA 55-year-old male patient was admitted to The First Affiliated Hospital of Harbin Medical University for intermittent fever, fatigue, and waist pain more than three months. Brucellosis was diagnosed from the blood test. Although anti-brucella treatment was given at the time of diagnosis, the disease continued to progress. At the time of the cerebrospinal fluid systematic physical examination and the neuroelectrophysiological test, acute motor sensory axonal neuropathy was diagnosed. The patient was given immediately administered immunoglobulin therapy. After three months of systemic treatment, the patient's muscle strength of the distal limbs gradually recovered. The numbness of the limbs eased slowly, and urination function and respiratory function returned to normal. He could sit by himself.ConclusionsThe possibility of GBS should be closely monitored for when a brucellosis patient shows typical clinical manifestations of progressive muscle weakness, protein-cell separation of the cerebral spinal fluid, and typical demyelinating sensorimotor polyneuropathy.

Соціально-демографічна криза в Україні внаслідок війни: стан, наслідки та шляхи подолання

The article is devoted to the study of the demographic situation that developed in Ukraine during the full-scale invasion of the Russian Federation. The authors revealed the demographic problems caused by Russia's military aggression and determined the prospects of the main indicators. The demographic situation is an integral indicator of the country's social development, which reflects its economic, social-psychological and moral state. It has been determined that the war entails an increase in the mortality rate, a decrease in the birth rate, and a deterioration in the state of health, in particular due to stress, untimely treatment, and the unavailability of quality medical care.

РИНОК ПРАЦІ УКРАЇНИ В УМОВАХ ВІЙНИ

Basic aspects of functioning of labour-market in the conditions of war are reflected in the article. Basic factors that always influenced on forming of labour-market are examined, namely: amount of population, level of GDP, unemployment and employment rate, the level of wages and incomes of the population, as well as indicators of population poverty, the index of business activity, the number of jobs, etc. A lot of attention is paid to the analysis of the demographic factor, as it affects the formation and functioning of the labor market. After all, as a result of the war with Russia, Ukrainians will already be reduced by millions, since the war entails an increase in the death rate, a decrease in the birth rate, a deterioration in health, in particular due to stress, untimely treatment and the unavailability of quality medical care, and of course population migration. In addition, the demographic impact of the war is significant not only during the war, but also during the following decades. The history of the development of the Ukrainian labor market is analyzed separately, because even before the start of hostilities and the pandemic, a high supply of labor was formed in Ukraine with low payment for its services, which was also accompanied by the actual degradation of the workforce. A detailed analysis of supply and demand in the labor market was also carried out. Thus, the analysis showed that the offer on the labor market in Ukraine already in April 2022 entered the stage of adaptation, and therefore the market began to resume its activity. The article also examines various studies of the level of unemployment in Ukraine, which made it possible to form the main trends in the labor market of Ukraine during the war. The payment of labor services, namely the wages of employees, as an integral component of the labor market, is also analyzed. It was determined that in some regions the drop in wages reaches more than 50%, therefore a detailed analysis of wages by month and by region was carried out. The question of the state's reaction to a shock on the labor market is also considered. That is, help for the unemployed, jobs and affairs during the war.