Vinnytsia Regional Research Articles

Functional state of kidneys in patients with acute myocardial infarction

The aim. To assess the functional state of the kidneys in patients with acute myocardial infarction and to determine the effect of reduced glomerular filtration rate on the course of the disease.Material and methods. A retrospective analysis of 410 medical records of patients who were treated for STEMI in the department for patients with myocardial infarction of the Vinnytsia Regional Clinical Medical and Diagnostic Center for Cardiovascular Pathology in 2019 was conducted. All patients were hospitalized within 12 hours of the onset of pain, all patients underwent urgent revascularization of the infarct-related artery. The average age of the examined was 64.8±0.4 years. There were 263 men (64.1%), average age 60.8±0.2 years and 147 women (35.9%), average age 68.8±0.5 years. Results. It was found that the average level of creatinine was 101.5±2.2 μmol/l, no significant difference between men and women was found. The level of GFR was 64.8±1.1 ml/min/1.73m2 and was significantly lower among women than men (p<0.001). GFR ≥90 ml/min/1.73m2 was diagnosed in 31 patients (7.5%), no significant difference between men and women was established. GFR 60-89 ml/min/1.73m2 was found in 206 people (50.2%), significantly more often among men than among women (p<0.001). GFR of 30-59 ml/min/1.73m2 was established in 160 patients (39.1%), significantly more often among women than men (p<0.001). 11 people (2.7%) had GFR within 15-29 ml/min/1.73m2, no difference was noted between men and women. Significantly more patients with Killip III were in the II group (p<0.001), and with Killip IV (p<0.001). Among the medical records of the deceased that we analyzed were 28 patients (6.8%). A significantly larger number of patients who died were among patients with GFR less than 60 ml/min/1.73m2, namely 24 people (13.8%), p<0.001.Conclusions. It was established that in STEMI patients who underwent urgent revascularization, the average level of GFR was 64.8±1.1 ml/min/1.73m2. 173 people (42.2%) had a decrease in GFR of less than 60 ml/min/1.73m2. A decrease in GFR was significantly more often diagnosed in women than in men (p≤0.001), women were significantly older than men (p≤0.001). In the group of patients with GFR less than 60 ml/min/1.73m2, there were significantly more patients with hypertension for more than 10 years (p≤0.001) and diabetes for more than 10 years (p=0.067), there were significantly more people with peripheral artery disease (p=0.017). In the group of patients with STEMI and GFR less than 60 ml/min/1.73m2, significantly more HF of high gradations (Killip III-IV) were detected - in 36 people (20.7%). In-hospital mortality was significantly higher in patients with reduced GFR, 2% and 13.8%, respectively, p<0.001.

Formation of the Regional Political Elite of Vinnytsia Region

The article examines the process of regional political elite formation of Vinnytsia region in the context of Ukrainian state formation based on the analysis of the results of national and local elections held in the constituencies of Vinnytsia region, biographies of deputies from the region as well as deputies of Vinnytsia regional and city councils, heads of Vinnytsia regional state administration, heads of district state administrations and district councils of the region. The author provides the definition for the regional political elite and outlines the ways of its set up, offers the model of its modern structure for Vinnytsia region.Also, it was determined that at the beginning of the existence of an independent Ukraine, a key role in the formation of the new regional political elite was played by the people from the «nomenklatura» and former leaders of the Soviet enterprises. The obtained data confirms, that this social group was the main pool of recruitment of heads of Vinnytsia Regional State Administration and District State Administrations of Vinnytsia region until the mid-2000s, and the traditions they introduced into modern political culture influenced the formation of political and economic groups (clans) and the dominance of neopatrimonial relations in the interaction between different actors.As defined, people from different spheres of economic and socio-political life of the region participate in the formation of the modern regional political elite of Vinnytsia region. In particular, they are representatives of the economic elite (business owners, managers of private and state enterprises), party elite, elites of mass media and public organizations, and intellectual elite (heads and employees of science, education, medicine and culture). The tendency to increase the number of business representatives in these authorities while reducing the number of heads of state authorities, local governments and utilities was shown by the example of the Vinnytsia Regional Council of II, III, VII convocations and Vinnytsia City Council of VI and VII convocations; a consistently high level of the number of people from the intellectual elite in the regional and city councils was noted. Special attention is paid to the penetration of media and public sector figures into the power institutions as well as to their influence on the formation of the political agenda of the region.

Клінічний випадок чотириденного перекруту тератоми яєчника та вторинного апендициту в дитини

Teratoma (from the Greek τέρατος - monster, ομα - tumor) is a tumor formed from monocytes, common location of which is the ovaries in females, testicles in males, sacrococcygeal area in children, as well as the brain. Teratoma of the ovary is one of the types of germinogenic tumors, which has synonyms of embryo, «parasitic fetus», «complex cell tumor», «mixed teratogenic neoplasm», «monodermoma». The aim - to analyze the clinical symptoms and diagnostic and treatment tactics for the combined pathology of the appendix and pelvic organs in girls, to draw the attention of the medical staff to the pathology called appendicular-genital syndrome. Clinical case. We observed torsion of the left uterine appendages in an 11-year-old girl, which caused diffuse serous-purulent peritonitis and secondary phlegmonous appendicitis. Thus, in this case, we can talk about the appendiсular-genital syndrome, which had its origin in the left appendages of the uterus as a result of organic damage and their twisting. Patient Hanna B., 11 years old, was hospitalized on January 25, 2021, in the surgical department № 1 of the Vinnytsia Regional Clinical Hospital with abdominal pain localized above the bosom, in the right and left iliac regions, which lasted for 4 days. During this period, there was also a rise in body temperature within subfebrile values. They were not treated independently. Until the moment of hospitalization, the girl had never had menstruation. The patient was operated on the day of admission to the emergency department due to the presence of the «acute abdomen» clinic. During the surgical intervention, the following findings were revealed: the left uterine appendages were black, swollen with under-capsular hemorrhages, which included a neoplasm with the dimensions and a hyperemic, swollen, injected appendix, which was mace-like thickened at the apex. In connection with the appearance of complications in the form of peritonitis and the development of secondary appendicitis, operative treatment had the following volume. Left tubovariectomy, appendectomy, sanitation and drainage of the abdominal cavity were performed. Conclusions. In case of suspicion of appendicular-genital syndrome, it is necessary to use a laparoscopic technique instead of an open one after carrying out pre-operative medical and diagnostic measures. It is laparoscopic surgery that has an advantage over appendictomous access in the right pubic region, because during laparoscopic intervention there is a wider field for examination of the pelvic cavity with the help of a camera. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Treatment of Bilateral Venous Thrombosis in a Patient with Aplasia of the Inferior Vena Cava

The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients.
 Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities.
 An objective examination revealed cyanosis and swelling of both lower extremities.
 A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein.
 The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended.
 After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis.
 Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.

Angiographic characteristics of patients with acute myocardial infarction complicated by acute high-grade heart failure

The aim of the work is to optimize local pharmacotherapy in the complex treatment of generalized periodontitis on the background of urolithiasis with the use of dental film.Material and methods. of the study was to evaluate the features of the angiographic picture among patients with acute myocardial infarction (AMI), which was complicated by acute heart failure (AHF). Materials and methods. This study is a retrospective analysis of 828 hospital charts of patients treated from STEMI in the Department of Myocardial Infarction of the Vinnytsia Regional Center of Cardiovascular Pathology. Two groups of patients were analyzed: group I (n = 699) patients with AMI without signs of high-grade acute heart failure (AHF) and group II (n = 129) patients with AMI complicated by high-grade AHF (Killip III and Killip IV).Results. Urgent coronary angiography (UCA) was performed for 456 (55.1%) patients, urgent revascularization was performed for 435 (52.5%) patients, for part of them - 403 (48.7%) patients were performed coronary artery stenting (CAS), for 18 (2, 2%) of them were performed thrombus aspiration, 2 (0.2%) of them were done angioplasty of the spacecraft without stent implantation. For 24 (2.9%) patients was carried out thrombolysis At the prehospital stage and 12 (1.4%) of them required further stenting of the spacecrafts in the coronary arteries. 21 (2.6%) patients did not require revascularization, according to the results of coronary angiography. In the general group of examined patients overwhelmed cases with a single vascular impression of CA 241 (52.8%) (p = 0.003). It was found that patients from group I had a single vascular 218 (57.2%) and double vascular - 105 (27.6%) damage of CA (p = 0.058) significantly more common, and 58 (15.2%) of investigated patients had multivascular damage of CA - which was less often among patients from group I. In the second group there was an even distribution of patients with single vascular 23 (30.7%), double vascular (28 (37.3%) and multivascular 24 (32.0%) damage of CA.

Порушення функції печінки в дітей раннього віку з позагоспітальною пневмонією: роль маркерів інфекційно-запального процесу

Today, pneumonia remains the leading cause of infant mortality and morbidity worldwide. Pneumonia increases inflammatory processes, accompanied by the activation of inflammatory mediators, and can provoke significant metabolic disorders in the body. Purpose - to determine liver dysfunction in young children with community-acquired pneumonia based on the study of markers of infectious-inflammatory process. Materials and methods. The results of clinical and laboratory examination of 338 children aged 1 month to 3 years with community-acquired pneumonia were analyzed. The children were hospitalized in the Infectious Diseases Boxed Department for Young Children of the Vinnytsia Regional Children’s Clinical Hospital. Verification of the diagnosis was made using the recommendations of the British Thoracic Society. All patients had pneumonia of varying severity, depending on which they were divided into two groups: group I - 129 children who were diagnosed with community-acquired pneumonia of moderate severity; group II - 209 patients with severe pneumonia. Comparison group - 40 healthy children. Results. Markers of infectious-inflammatory process were studied to determine the levels of pro-inflammatory cytokines - interleukin (IL-1, IL-6) and proteins of the acute phase of inflammation - C-reactive protein (CRP) and fibrinogen in the serum of young children with outpatients. Aminotransferase hyperenzymemia is closely correlated with the activity of the infectious-inflammatory process, which indicates a positive correlation between the level of IL-1 and ALT (rxy=+0.047) and AST (rxy=+0.111). At the same time, there is a negative correlation between the levels of IL-1, CRP and the activity of aminotransferases in blood plasma. Conclusions. It was found that the course of community-acquired pneumonia is accompanied by an increase in the serum of children with concentrations of IL-1 and IL-6 in parallel with the severity of the disease. The synthesis of pro-inflammatory cytokines stimulates the production of acute CRP, but reduces the concentration of fibrinogen in the blood of sick children. The identified links between the content of the studied cytokines at the systemic level and multidirectional changes in the acute phase of inflammation indicate a violation of the liver, where proteins are synthesized. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: cytokines, C-reactive protein, fibrinogen, alanine aminotransferase, aspartate aminotransferase, liver, community-acquired pneumonia, children, early age.

Alternative ways to introduce resuscitation at the prehospital stage in emergency conditions

Annotation. Objective – carrying out a comparative assessment of the advantages and disadvantages of intravenous (IV) and intraosseous (IO) resuscitation, which are used by emergency and emergency teams in the Vinnytsia region. The work used statistical data of the Vinnytsia Regional Center for Emergency Medical Care and Disaster Medicine for the period 2019-2021, carry through content analysis of domestic and foreign scientific sources, applied biblio-semantic, analytical, and statistical methods for studying the use of intraosseous and intravenous methods in emergency cases. According to the Vinnytsia Regional Center for Emergency Medical Care and Disaster Medicine for the three years 2019-2021. we observe a low percentage of use of intraosseous access 0,2% - 0,1%, respectively. In the event of an accident in the patient's condition “without changes” a total of 786 injections were carried out both intravenously and intraosseously. In 2019, out of the total number, non-infusion therapy was performed in 71,0% of male patients and 11,1% of female patients, and 11,2% intraosseously only in male patients. Compared to 2020, only 0,3% intraosseously (2 female patients) and in 2021, no intraosseous resuscitation was performed at all. In a state of “deterioration” during an accident (road accident, etc.) for 2019, 87,5% of men and 12,5% of women were injected with drugs intravenously; for 2020, 50% for both males and 50% for females were infused intravenously; for 2021, 87,5% of men and 12,5% of women underwent intravenous resuscitation, intraosseous resuscitation was never performed, provided that the condition of patients worsened. And “death in the presence” occurred during resuscitation for 2019 88,8% (of which 77,7% for men and 11,1% for women) by intravenous access and 11.2 VC (males); for 2020 88,9% intravenously (of which 72,2% for men and 16,7% for women) and 11,1% intraosseously (of which 1 male and 1 female article); in 2021, 65,0% of intravenous access was performed for men and 25,0% for women, while no patient received intraosseous access. In case of a sudden illness, the percentage of intraosseous resuscitation in the state of “deterioration” was as follows: for the period 2019-2021. no intraosseous access was performed. In the state of “death in the presence” for 2019, intraosseous infusion was 3,4%; 2020 – 3,8%; 2021 – 1,9%. Thus, the intraosseous method has several undeniable advantages compared to the intravenous one, but in Ukraine, it is little used in the practice of mobile emergency medical teams with a syringe gun (connector – BLG), both considering the age characteristics: for adults (blue) and children (red color) and prescribed in the fundamental algorithms of clinical/modern protocols for the treatment of circulatory arrest due to insufficient practical and theoretical skills of medical personnel of emergency teams. The analysis of the use of intraosseous methods in emergency medical care gave impetus to conducting theoretical and practical classes for future doctors to master skills and reduce prehospital and early hospital mortality in patients with complement fixation reactions.

Мixed anxious and depressive reaction during adaptation disorder in participants during anti-terrorist operation

Adaptation disorder is caused by emotional and stressful factors. Stress - the state of tension of adaptation mechanisms. Since the war is still going on in our country, the military often has this nosology.
 These factors do not endanger a person's physical and mental health, but they do cause a pathological state of negative emotions that disrupts the adaptive response. Critical situations experienced by patients cause distress, which is experienced as grief, unhappiness, exhaustion and is accompanied by a violation of adaptation, control, prevents self-actualization of the individual.
 Thus, the occurrence of adaptation disorders (AD) in victims of the anti-terrorist operation (ATO), in people with extremely high personal anxiety, stress intensity, social situation in which he operates, personal characteristics of the victim and his biological vulnerability, with serious somatic diseases , disabled people, people who lost their parents in early childhood or lacked maternal care. Vulnerability to the disorder is also increased by premorbid burden of trauma.
 Clinical manifestations of patients with maladaptation were more often presented in the form of anxiety and depression. Mixed subvariant (anxiety-depressive) meets the diagnostic criteria of heading F 43.22 "Mixed anxiety and depressive reaction" and is characterized by a combination of clinical signs of two options in one patient.
 The article analyzes various psychological features of AD experience in combatants. It was found that 66.9% of soldiers out of 898 respondents who were demobilized from the ATO zone have pronounced anxiety and depressive symptoms of various degrees. The urgency of this issue is to determine the criteria for psychodiagnostics of the distribution of this condition, which is essential for the treatment of such patients.
 Purpose: to evaluate the algorithm of clinical psychodiagnostics of AD (F43) on the basis of research of clinical and psychopathological features and pathopsychological characteristics of patients affected by anti-terrorist operation. Mixed anxiety and depressive reaction (F 43.22).
 Materials and methods: On the basis of the municipal non-profit enterprise "Vinnytsia Regional Clinical Hospital of War Veterans of Vinnytsia Regional Council" (MNE "VRCHWV VRC"), for the period from 2016-2020 898 patients were examined, where the main research methods were: socio-demographic (questionnaire), clinical-anamnestic, clinical-psychopathological (clinical interview), psychodiagnostic, statistical.
 Results: In the course of this experimental study, the severity of emotional disorders in the study group was determined, data variability was determined and statistical and mathematical analysis of the survey results was performed. There was a significant correlation between indicators of situational, personal, general mental anxiety and depression by Pearson's correlation coefficients (P <0,01).
 Conclusions: AD occurs as a result of extraordinary events, as well as under the influence of stress, which does not reach an extraordinary or catastrophic level. The development of AD may be preceded by an acute stress reaction.
 Determining the clinical and psychopathological features of the predominant variants of adaptation disorders in the victims of the ATO is the basis for the development of new diagnostic algorithms and integrated approaches to the treatment of this contingent. With the timely detection of these symptoms, former combatants become less dangerous to others, thus having less traumatic impact on themselves and their families.
 A good prognosis correlates with the rapid development of symptoms, good social adaptation in premorbid, the presence of social support and the absence of concomitant mental and other diseases.

Gender and age related adverse effects of child’s hypoxic-ischemic encephalopathy

Introduction. Among the causes of childhood disability, the consequences of hypoxic-ischemic encephalopathy (HIE) transmitted in the neonatal period are the most significant. Annually in developed countries, 1-8 neonates per 1,000 are diagnosed with HIE. The incidence rate is twice as high in low- and middle-income countries. Among them, every 4th child with this diagnosis has adverse consequences of the disease sort of severe neurological pathologies such as epilepsy and cerebral palsy (CP). Researchers are particularly interested in the easy course of HIE and the ability to predict its consequences. Aim of the research. To establish the gender and age characteristics of the adverse effects of HIE in preschool children. Materials and methods. The study is prospective, carried out on all its stages in the neonatology center and the center of follow-up observation of Vinnytsia Regional Children's Clinical Hospital VOR, 214 children aged 0 to 6 years were examined. The prospective study included 174 children born full-term and in the neonatal period suffered HIE of various severity. Results. The results of follow-up were analyzed at 1, 3 and 6 years. The formation of disability had gender and age related features. Thus, among 23 children with disabilities, boys predominated - 16 (69.57%). With age, the number of children with disabilities increased from 14 (9.52%) in 1 year to 23 (15, 65%) in 3 years and remained unchanged at the age of 6 years. More than half of children had mental and language retardation at the age of 1. Thus, among 23 children with disabilities, boys predominated - 16 (69.57%). With age, the number of children with disabilities increased from 14 (9.52%) at 1 year of age to 23 (15.65%) among 3-agers and remained unchanged among 6-agers. More than half of children had mental and language retardation at the age of 1. As they reached the age of 6, their number decreased to 25% girls and 41.2% boys. Certainly, majority of these children were among patients with severe GIE in the neonatal period. 20 (13.61%) children had episyndrome at the age of 1 year, 11 (55.0%) of them - prevailing boys. For the children aged 3 with slight and moderate HIE, the diagnosis was disaffirmed. Among 6-olders with spasms boys prevailed. At the age of 6 years among children with convulsions significantly prevailed boys 12 (63.16%). Among concomitant pathologies of children with HIE consequences there prevailed anemia at the age of 3 years, found in 1 of 4 girls and 1 of 5 boys severe HIE history, ophthalmic diseases fou nd among 23.5% of boys in this group and bronchial asthma - among 9.52%. Child mortality with HIE in the neonatal period, in the first 6 years of life was 2.72%. Conclusions. The formation of adverse effects of HIE in children had gender and age characteristics. Boys predominated among children with disabilities, they were more likely to have mental and language retardation and episyndrome. With age, the number of children with adverse effects has decreased, with the exception of the disabled, whose number has increased. Key words: hypoxic-ischemic encephalopathy, disability, cerebral palsy, episyndrome, gender differences.

PREVALENCE, CLINICAL AND FUNCTIONAL CHARACTERISTICS OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMPLICATED BY ACUTE HEART FAILURE.

The aim: The study was designed to establish the prevalence of acute heart failure in patients with acute myocardial infarction, to determine the sex-age characteristics of acute myocardial infarction course in case of complications by acute heart failure of high classes (Killip III and Killip IV). Materials and methods: We analyzed medical records of inpatients of the myocardial infarction department of the municipal non-profit enterprise Vinnytsia Regional Center for Cardiovascular Pathology in 2019. The survey covered 828 medical records of patients with acute myocardial infarction, average age (64.6 ± 0.38), including 569 (64.7%) males and 311 (35.3%) females. Results: 129 (15.6%) patients with acute myocardial infarction were diagnosed high-class acute heart failure. Patients with high-class acute heart failure were statistically significantly elderly individuals of the average age (69.0 ± 1.3), (p <0.001), including 53.7% of males, and 46.3% (p <0.001) female patients. Patients with acute myocardial infarction complicated by acute heart failure were hospitalized within 2 hours of symptoms` onset with statistically significantly higher probability (p = 0.004). Patients with acute myocardial infarction complicated by acute high-class heart failure were statistically significantly more likely diagnosed with concomitant hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease than individuals with uncomplicated acute myocardial infarction. Acute myocardial infarction patients` mortality was 3.4%, while the one in patients with acute heart failure was 38% (p <0.001). Conclusions: Patients with complicated myocardial infarction are characterized by statistically significantly higher comorbidity and increased lethality.

Динамічна оцінка поширеності та глікемічного контролю цукрового діабету I типу в дитячій популяції

Glycated hemoglobin (HbAc1) remains one of the most valuable methods of glycemic control among patients with diabetes mellitus (DM). Its target level in children and adolescents is ≤7% according to the recommendations of ISPAD (2018) and ≤7.5% – ADA (2020), but the presence of complications and labile course of type I diabetes mellitus (T1DM) in children and adolescents requires an individual approach to achieve optimal glycemic control. The level of glycated hemoglobin determines the risk of concomitant purulent-inflammatory diseases (PID) and the restoration of systemic homeostasis after the surgery. High HbAc1 levels during the last 90 days before the surgery significantly increase the length of hospital stay among adult patients. Currently, there are no published data on the level of glycemic control in children with T1DM in Vinnytsia region, which is extremely important in assessing the risk of complications and treatment outcomes of this population in a surgical department. Purpose – to analysis and assessment of the prevalence of T1DM and glycemic control among children with T1DM in Vinnytsia region in 2013, 2016 and 2017. Materials and methods. We carried a retrospective study to assess the prevalence of T1DM among the pediatric population of Vinnytsia region through the period from 2013 to 2017 by analyzing the reports of the Vinnytsia Regional Clinical Endocrinology Center and demographic data of the Main Department of Statistics in Vinnytsia Region, case histories of patients treated at Vinnytsia Regional Children’s Hospital. Number of patients with T1DM in 2013 was – 321, in 2016–358, in 2017–399 patients. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from parents to conduct the research. HbAc1 was used to assess glycemic control. The value of HbAc1 ≤7.5% was considered as optimal, &gt;7.5–9.0% – suboptimal, &gt;9.1% – poor. Patients with no HbAc1 available were excluded from further study. Fisher’s exact test was used to compare the groups. P-value ˂0.05 was considered statistically significant. Results. During the study period, there was an increase in the prevalence of T1DM in the pediatric population. Particularly, in 2013 this indicator was equal to – 1.08‰, in 2016 – 1.23‰, and in 2017 – 1.37‰ (p=0.1266; p=0.0015, compared to 2017, respectively), which corresponds to the estimated global trends. The primary incidence of T1DM in Vinnytsia region was: 0.017% in 2013, 0.015% in 2016, 0.022% in 2017, with the peak of the manifestation at the age of 6 and 10. Average indicators of glycemic control based on HbA1c were at the level of 8.73±1.82% in 2013, 8.60±1.52% in 2016, 8.85±1.88% in 2017, respectively. In 2013 glycemic control was assessed as optimal in 27.5% (88/319) of children, suboptimal – 37.5% (120/319), poor – 35% (111/319). In 2016 the number of patients with optimal HbAc1 decreased to 25% (83/336), suboptimal level was found in 41% (139/336), poor – in 34% (114/336), respectively. In 2017 the optimal level of HbAc1 was recorded in only 21% (68/329), suboptimal – in 41% (135/329), poor – in 38% (126/329), respectively. There is an increase in the number of patients with poor glycemic control and HbA1c exceeding 11% in 2017 (42/329) compared to the corresponding indicator in 2016 (24/336), p=0.0191. Clinical manifestations of poor glycemic control in the study population were acute complications (ketosis, ketoacidosis), which were accompanied by abdominal pain, nausea and vomiting and required treatment in the intensive care unit. Purulent-inflammatory diseases (PID) of the abdominal cavity in children with T1DM were accompanied by a combination of clinical and laboratory data of decompensation of T1DM, a significant increase in WBC and diffuse abdominal pain. Macroscopic and pathomorphological characteristics of the appendix and peritoneum corresponded to destructive forms of PID in the presence of a short period from the disease onset. The course of the postoperative period in children with PID of the abdominal cavity in the setting of T1DM was labile and required insulin correction. Conclusions. The prevalence of T1DM among children in Vinnytsia region is growing (1.08‰ – in 2013, in 1.37‰ – in 2017; p=0.0015). Glycemic control in this population is within suboptimal limits (&gt;7.5–9.0%) during the period from 2013 to 2017. As of 2017, more than a third of pediatric patients (38%) have poor glycemic control. The number of patients with HbA1c &gt;11% significantly increased in 2017 compared to 2016 (p=0.0191). The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: type I diabetes mellitus, glycemic control, glycated hemoglobin, children.

TO CHARACTERISTICS OF THE ETIOLOGICAL STRUCTURE AND ANTIBIOTIC SENSITIVITY PATHOGENSOF INFECTIOUS RESPIRATORY ORGANS IN NEWBORN AFTER ARTIFICIAL PULMONARY VENTILATION

Objective. The study of the etiological structure, properties of pathogens of the Vinnytsia National Medical University named after E. Pirogova, respiratory process in newborns who have underwent artificial mechanical lung ventilation (MLV) and their resistance to antibacterial agents is especially relevant in modern conditions, expands the search for new approaches to pathogens, improves treatment and reduces mortality from this pathology. The purpose of the study - to determine the etiological structure, sensitivity to antibiotics of the leading pathogens of the infectious process of the respiratory system in newborns who were on mechanical ventilation. Materials and methods. In total, the species composition of the leading microorganisms that colonized the airways of 180 newborns treated in the Neonatal Intensive Care Unit (VAITN) of Vinnytsia Regional Children’s Clinical Hospital (VRCCH) was studied in 2020. A total of 285 isolates of microorganisms were isolated. 62 patients who underwent mechanical ventilation were involved in a prospective microbiological study, 86 clinical strains of microorganisms were isolated. The susceptibility of microorganisms to 30 antibacterial agents was determined according to the generally accepted method (order of the Ministry of Health of Ukraine №167; recommendations). Research results. The etiological significance of opportunistic pathogens (Enterobacter cloacae - 29%, Staphylococcus aureus - 24.4%, Pseudomonas aeruginosa - 18.6%, Candida albicans) was proved in patients who were on mechanical ventilation in VAITN VRCCH in 2020 for pneumonia. Clinical strains of S. aureus are sensitive to vancomycin, oxacillin and clindamycin. Conclusions. Pathogens of the respiratory process in newborns who have been on mechanical ventilation, are resistant to a number of antibiotic drugs (cefepime, gentamicin amikacin, piperacillin).

Реабілітаційні заходи у хворих на ранніх стадіях коксартрозу після проведення артроскопії кульшового суглоба

Актуальність. Розробка програм реабілітації для хворих після оперативних втручань з використанням сучасних методів остеосинтезу — один із найважливіших напрямків розвитку сучасного відновного лікування хворих ортопедо-травматологічного профілю. Мета дослідження: розробити реабілітаційні заходи в комплексному лікуванні хворих на ранніх стадіях коксартрозу після проведення артроскопії кульшового суглоба. Матеріали та методи. Проведено аналіз лікування 95 хворих із остеоартрозом кульшового суглоба I–II ст., яким виконане артроскопічне оперативне втручання на базі травматологічного відділення Вінницької обласної лікарні ім. М.І. Пирогова та ДУ «Інститут травматології та ортопедії НАМН України» у період 2007–2016 рр. Результати. На основі комплексного обстеження хворих на ранніх стадіях коксартрозу після проведення артроскопії кульшового суглоба розроблені засоби реабілітації в комплексному лікуванні цієї категорії хворих. Запропоновані засоби відповідали терміну післяопераційного періоду, особливостям оперативного втручання під час виконання артроскопії кульшового суглоба та індивідуальним особливостям пацієнтів та дали можливість у 100 % хворих провести ефективне відновне лікування. Висновки. Впровадження запропонованих авторами засобів реабілітації дозволить проводити повноцінне диференційоване лікування та покращить ефективність надання медичної допомоги цій категорії хворих.

Опыт работы отдела репродуктивной эндокринологии Винницкого областного клинического высокоспециализированного эндокринологического центра

No abstract

Просторове обгрунтування лінійних параметрів біоптату в гістологічному дослідженні пігментних новоутворень шкіри у дітей

Usually the lower part of melanocyte nevi is at a depth of not more than 1–2 mm or more, which is typical for congenital nevi, as well as for large pigmented tumors that protrude significantly above the skin surface and have a pronounced intradermal part. Incomplete removal of pigmented nevi occurs during their superficial removal with insufficient capture of healthy tissues. When excision of pigmented nevi by acute method means in the vast majority of cases of incomplete removal can be avoided, and primarily because the suturing of the edges of the postoperative wound requires much deeper excision of tissues. Рurpose – to increase the effectiveness of surgical treatment of pigmented skin tumors in children by using a mathematical model. Materials and methods. The study was conducted on the basis of the oncohematology department of Vinnytsia Regional Children’s Clinical Hospital, a mathematical model for calculating the parameters of operational access was conducted on the Microsoft Excel platform. Results. Using the proposed mathematical model, the following parameters of the operating material were calculated: the area of the resection edges of the operating material; the area of the base of the operating material; the total area of morphological examination of the surface of the surgical material; determining the difference in the volume of surgical material to be histologically examined by different methods of its collection. In all cases, the tumor for three-dimensional histological examination was excised in the form of an ellipse with a safety zone (healthy tissue around the tumor). The surgical direction of the incision was formed with an inclination to the surface of the skin towards the tumor with the formation of an acute angle with it, while the upper part of the dermis was cut less than its lower part. This approach to the formation of the profile of the surgical wound improves the conditions for further reconstructive wound defect closure. Conclusions. Comparative mathematical calculation according to the proposed spatial geometric model of the biopsy in the form of a truncated elliptical cone convincingly shows an increase in the useful volume of surgical material in the planned histological examination compared with the cylindrical elliptical configuration of the biopsy due to involvement in the field of microscopic structures «residual structures» (processes) corresponding to melanocyte nevi, under the guise of which the development of the initial stages of melanoma may occur. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: children, melanocyte nevi, operative accesses.

Швидка нейтралізація травмуючих гіпертермічних чинників ушкодження при опіках у дітей на етапах само-, взаємо- та першої долікарської допомоги

Occupying a leading position in the structure of general injuries, burn injuries in children remain an urgent issue of combustiology in particular and medicine in general. At the same time, many issues related to the organization of first aid to such patients still remain unregulated. To this end, a study aimed at conducting a comparative analysis of the clinical effectiveness of emergency care for children with burn injuries, including the use of the suggested algorithm, was conducted. Materials and methods. 153 cases of burn injuries with boiling water of IIab–III degree on the area of 10–40% of the body surface in children aged from 8 months to 16 years, who were treated at the Clinical Center for Thermal Injury and Plastic Surgery of the Municipal Non-profit Enterprise «Vinnytsia Regional Pirogov Clinical Hospital Vinnytsya Regional Council» in the period of 2015–2020 were analyzed. All patients underwent comprehensive diagnosis and treatment including surgery. Depending on the nature of first aid, children were divided into two groups: patients of the main group (n=97) underwent prompt neutralization of the traumatic effects of exogenous hyperthermic factors on the injured areas from the moment the injury was sustained. Childrenin the control group (n=56) sought help on the 5th–14th day after the injury. The duration of prompt neutralization did not exceed 15 minutes or was not performed at all. It was often combined with the irrational use of pharmacological agents and folk remedies. Results. Comparative analysis of the course of the disease in children of the main group and the comparison group reliably confirmed the benefits of prompt neutralization of traumatic effects of hyperthermic exogenous and endogenous damage factors in burn injuries manifested by a more favorable course of the disease, faster improvement, lower local and systemic inflammatory response, shorter hospital stay with less occurrence of various complications, repeated surgical interventions, better aesthetic and functional results. Conclusions. The obtained results objectively confirmed the importance and effectiveness of the suggested system of organization of care for children with burn injuries, especially at the stages of self-help, mutual assistance and first aid. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: burn injuries, children, first aid, traumatic hyperthermic agents, neutralization.

CLINICAL CASES OF BULLOUS EPIDERMOLYSIS IN NEWBORNS

Summary. Hereditary bullous epidermolysis (BE) is a group of genetically and clinically heterogeneous diseases characterized by the formation of blisters and erosion due to injury on the skin and mucous membranes. Different forms of BE can be accompanied by various extracutaneous complications, such as blisters and erosion on the cornea and mucous membranes, stenoses and strictures of the respiratory system, gastrointestinal tract, urinary system, muscular dystrophy, and malignant tumors.&#x0D; Hereditary bullous epidermolysis is divided into three types, depending on the level of blister formation: simple, borderline, and dystrophic. Simple BE is characterized by the stratification of epidermis due to the keratinocyte cytolysis. Borderline BE means that blisters are formed at the border of the epidermis and dermis due to the splitting of the lamina of the basement membrane (lamina lucida), while dystrophic BE has blisters that are formed under the dense plate of the basement membrane (lamina densa), which exfoliates the dermis.&#x0D; Currently, mutations have been identified in more than 10 genes encoding the structural proteins of keratinocytes and the basal membrane of the skin and mucous membranes. A common feature of these proteins is their involvement in the formation of strong bonds between the epithelium and the basement membrane. The nature of the mutations and their localization determine the severity of the clinical manifestations of BE. Mutation information is a prerequisite for effective medical and genetic counseling, prenatal and preimplantation DNA diagnosis.&#x0D; Therefore diagnosis and prescribing appropriate treatment and follow-up care is an important task for neonatologists and pediatric dermatologists. As manifestations of hereditary BE are numerous, a specialized center is required for optimal care, where multidisciplinary care will be provided (neonatologists, pediatric surgeons, pediatric dermatologists, etc.).&#x0D; The purpose of clinical observation is to pay attention of specialists to this rare disease, and to present 2 clinical cases of bullous epidermolysis in newborns who were admitted to the anesthesiology and intensive care unit of newborns of Vinnytsia Regional Children's Clinical Hospital almost at the same time.

Методика визначення ступеня радикалізму видалення пігментних невусів шкіри у дітей

Nevi are benign melanocytic tumors. Congenital melanocytic nevus is detected at birth or shortly after birth in 1% of infants. The nevus cells of simple nevican spread into the deep layers of the dermis. So incompletely excised nevus cells may at times continue to grow when the conventional excising technique is applied. A small pigment focus may therewith be detectable in the presence of a scar. These foci usually repeat the histological pattern of the primary nevus without any signs of malignization. The article presents an analysis of the data surgical approaches in the treatment nevus of the dermis. There are ways of improving surgical method of treatment of primary tumor based on research in the field of microarchitectonics of the skin. The aim: to increase the effectiveness of determining the degree of radicalism of removal of pigmental nevi in children, taking into account the thickness of the hypoderma in different anatomical areas of the body. Materials and methods of research. The work was carried out on the basis of the department of oncohematology of Vinnytsia Regional Children’s Clinical Hospital in the period from 2018 to 2020. Clinical distribution of features of surgical interventions in pigmented skin nevi involved analysis of data of medi cal cards of patients (120 documents). The age of patients of both sexes was between 3 and 16 years old. Patients with localization of pigmented neoplasms in different areas of the extremities (68 observations) and the trunk (52 children) were subject to analysis. Conclusions. The proposed methodology for determining the radicalism of removing pigmented skin nevi by mathematically calculating the ratios of the areas of the removed tissues at the skin level and at the level of aponeurosis, taking into account the thickness of the hypoderma in different parts of the body, allow you to clearly calculate the individual parameters of the operating wound. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: children, surgical treatment, nevus, skin, primary tumor.

Errors in the diagnosis of syphilitic infection

Annotation. Syphilis remains one of the infections of particular concern worldwide, being one of the most important medical and social problems. Scientists' reports and WHO data show an increase in the incidence of sexually transmitted diseases. Syphilitic infection is still a pressing problem in Ukraine. Because syphilis facilitates the transmission of HIV and STIs, a comprehensive model for the prevention of HIV, STIs, and syphilis at the same time is needed. This requires the health authorities to strengthen treatment and prevention measures, among which an important role is to improve the skills of doctors in modern clinics and early diagnosis of luteal infection. Mistakes made by doctors are one of the reasons for the spread of infection, the development of severe, often disabling lesions of the patient’s internal organs and nervous system. The purpose of the work is to improve the diagnosis of syphilitic infection, which contributes to the effective fight against the spread of syphilis in Ukraine. 4 cases of syphilis in patients who applied to the Vinnytsia Regional Clinical Dermatological and Venereological Dispensary and were consulted by the staff of the Department of Dermatology and Venereal Diseases of National Pirogov Memorial Medical University, Vinnytsya, they were verified the diagnosis of syphilis and received specific treatment. During the examination of patients with syphilis with clinical manifestations of infection by doctors of various profiles in 14% of patients, the true disease remained undiagnosed. The analysis of diagnostic errors of syphilis in the primary period, when patients with classic manifestations of syphilitic infection visited 4–6 doctors of different profiles. The errors made by doctors were divided as follows: dermatovenereologists – 21%, surgeons – 26%, obstetricians and gynecologists – 22%, physicians – 19%, oncologists, dentists and other specialists – 12%. Thus, timely diagnosis of syphilitic infection is one of the most important points in a set of national measures to combat this infection.

Мотивація і працездатність медичних працівників сфери охорони психічного здоров’я як предиктор їхнього психологічного благополуччя

Objective: We defined the internal and external motivation features, performed a differential assessment of the states of reduced working capacity in medical workers of the Vinnytsia O.I. Yushchenko Regional Clinical Psychoneurological Hospital, Vinnytsia Regional Council (Communal Non-Profit Enterprise) and developed the preventive measures. Materials and methods: 224 medical workers (15.2% of males and 84.8% of females) of the Clinical Psychoneurologic Hospital (Communal Non-Profit Enterprise) took part in the study. 38.8% of the doctors, 61.2% of the nurses took part in the survey. The length of service in the professional activity was (19.7+12.3) years among doctors and (15.5+11.1) years among nurses. The average age of the doctors made up (44.6+12.2) years, nurses – (37.2+11.4) years. We carried out a survey on the motivation of the professional activity of doctors and nurses by the methodology of K. Zamfir in the modification of A. Rean and a study based on the technique of A. Leonov, S. Velichkovskaya regarding the differential assessment of the states of reduced working capacity (DOSR) of workers of health care institutions. To calculate the arithmetic mean, standard arithmetic mean error, we processed the results with the help of the Statistica 6.1 for Windows licensed standardized package. In the study, we used the analysis of the work of domestic and foreign scientific sources, biblio-semantic, analytical, and statistical research methods. Results: The data of the survey of the psychoneurologic hospital medical workers regarding doctors' internal and external motivation and nurses' professional activity are presented in the article. Three types of motivation and the motivation complexes in healthcare workers were determined, the following classification of motivational factors were used: «motivators» and «context factors», or «hygienic factors», which provoke negative stress affecting the quality of medical care. Analysis of the survey data shows that the external negative motivation exceeds the external positive one in male doctors and female nurses – (3.2+0.8) and (3.0+1.2) points, respectively. That’s why these medical workers have a decrease in their interest in work, lack of striving for career growth, lack of self-perception, and an indifference to work, to patients, which can negatively affect the quality of medical care and interpersonal relationships the team and at home. The questionnaire results regarding the differential assessment of the states of the reduced working capacity of the psychoneurologic hospital workers have been analyzed. The results demonstrate a high level of oversaturation index in female doctors - 3.2% and female nurses - 1.6% and a high degree of fatigue - 4.8% and 3.9%, respectively, which can be assessed as a pre-disease state in women. The preventive measures to overcome these states and to improve the psychosocial environment for the quality performance of the professional duties and satisfaction with the work are proposed.