ON THE ISSUE OF TREATMENT OF SEVERE TRAUMATIC BRAIN INJURY IN THE ELDERLY AND SENILE

Проведено исследование клинического течения очаговых травм головного мозга у больных пожилого и старческого возраста. Проведен анализ лечения больных в возрасте 60-82 лет(основная группа) и 18-59 лет(контрольная). Для исключения влияния взаимного отягощения отобраны больные только с изолированными внутримозговыми повреждениями. Результаты исследования показали, что очаговые повреждения головного мозга у лиц пожилого и старческого возраста относится к тяжелым травмам центральной системы с неблагоприятным прогнозом. Этому способствует не только травмирующий фактор и его воздействие на мозговую ткань, но и вторичные нарушения мозгового кровообращения вокруг патологического очага, вследствие первичного атеросклеротического поражения сосудов головного мозга. The clinical course of focal brain injuries in elderly and senile patients was studied. The analysis of treatment of patients aged 60-82 years (main group) and 18-59 years (control). To exclude the influence of mutual burden, patients with isolated intracerebral injuries were selected. The results of the study showed that focal brain damage in the elderly and senile age refers to severe injuries of the Central system with an unfavorable prognosis. This contributes not only to the traumatic factor and its impact on brain tissue, but also secondary disorders of cerebral circulation around the pathological focus, due to the primary atherosclerotic lesions of the cerebral vessels.

Influence of Genetic Factors on Immunopathogenesis and Clinical Phenotypes of ANCA-associated Vasculitis

The review presents the recent data on assumed risk factors for the development of ANCA-associated vasculitis (AAV), among which environmental factors, such as climatic, chemical, etc., are of particular interest of researchers. Controversial opinions of various authors on the role of individual causative agents of infectious diseases in the development of AAV are analyzed. The review pays special attention to scientific data on the influence of variants of the structure of genes encoding various components of the immune system on the development of the pathogenetic process of AAV. Up-to-date information on the association of single-nucleotide polymorphisms (SNPs) with the course, risk of development and the likelihood of AAV recurrence is indicated, the most associated of which are genes encoding proteins of the main histocompatibility complex (HLA), a toll-like receptors (TLR`s), as well as an inhibitor of serine proteinases-alpha-antitrypsin (AAT). The analysis of scientific publications describing the molecular mechanism of the development of a pathological focus that forms the conditions for the synthesis of PR3ANCA and MPOANCA complexes characteristic of AAV has been carried out. The data of a number of foreign studies on the relationship of individual SNPs associated with the features of the course of granulomatosis with polyangiitis, microscopic polyangiitis, as well as eosinophilic granulomatosis with polyangiitis are presented and summarized. The review presents current AAV treatment regimens and promising directions for the development of medical care for patients.

Automatic segmentation of the borders of the pathological focus in the macular area of the retina to calculate the area of the pathological focus

Optical coherence tomography (OCT) is a modern, non-contact method of diagnostic examination that enables the visualization of various tissues of the human eye in a cross-sectional view at the microscopic level with the required morphological information. The software pre-installed in such devices contains many different tools for analyzing scans and has almost all the functionality necessary for the doctor to make a correct diagnosis. However, as time passes, more and more advanced methods of analyzing the images appear, which actualizes new tasks of developing additional software that can supplement and expand the functionality of the diagnostic equipment. This paper proposes an algorithm for automatic segmentation of the borders of a pathological focus in the macular area of the retina to calculate the area of the pathological focus, which together with other algorithms for analysis of morphometric parameters of the human eye, which are still under development, will be used for more accurate diagnosis of the stage of age-related macular degeneration.

Forms of infectious complications after use of metal foreign bodies of the auricle and determination of the ability of detected microorganisms to biofilm formation

Ear or nose are quite vulnerable to foreign bodies. Foreign bodies cause various side effects in the body. A special category consists of foreign bodies that are introduced for aesthetic purposes, in particular piercing products. Decoration implanted in the tissues of the ear or nose is a foreign body and is a field of increased contamination and reproduction of pathogenic and opportunistic microorganisms. The aim of the study was to determine the infectious forms of complications that occurred after prolonged use of metal foreign bodies and to study the ability of biofilms by microorganisms isolated from the pathological contents of the foreign body of the auricle. 93 patients who applied to the ENT department of Kharkiv Regional Hospital for complications after implantation of metal foreign bodies and 10 people, control group, which had no foreign bodies, and were randomly selected from healthy individuals, were examined, to determine the qualitative composition of the microbiocenosis of the auricle skin. The material for the study was pathological discharge from a foreign body of the auricle. The microbiological study was performed using MICRO-LA-TEST identification kits. Studies of the formation of biofilms were studied by determining the ability of bacterial strains to adhere to the surface of polystyrene. The obtained cultures were washed with suspension media individual for each family of bacteria. The optical density of bacterial suspensions was measured using a microplate reader "MultiskanEX" (type 355). Statistical analysis of the obtained data was performed using MSExcel, Statisica 10 software. As a result of the conducted researches the dependence between the development of infectious complications of the auricle in the presence of metal foreign bodies and the microbiocenosis of the pathological focus was revealed. The study allowed to establish the structure of the microbial landscape of the skin of the auricle in the area of the metal foreign body, to determine the dominant forms of complications of infectious origin, after prolonged use of metal foreign bodies and to study the ability to form biofilms by microorganisms from different metals. The ability of various types of microorganisms to form biofilms when using products from different types of metals has been studied. It is established that the use of metal foreign bodies made of silver and gold reduces the risk of purulent-inflammatory process. It is proved that the optical density of biofilms of most microorganisms isolated from the pathological contents of the area of foreign bodies made of silver and gold is significantly lower than when using steel and titanium products.

SURGICAL OPTIONS FOR NONPARASITIC SPLENIC CYSTS

Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen,clinically, they may be asymptomatic. Their classification includes two basic groups: the true cysts or primary cysts and false or pseudo cysts based on the presence or absence of an epithelial lining. The need for surgery of nonparasitic cysts is due to the development of complications: suppuration, hemorrhage into the cavity of the cyst and its rupture. Historically, the conventional surgical method was splenectomy, however, complete removal of the organ, especially at a young age, often led to life-threatening infectious complications. Spleen-preserving surgeryis considered to be analternative to classicalsplenectomy: partial resection of the spleen and fenestration with excisionof extra-hepaticcyst wall. However, as clinical practice has shown, these methods can be effectively used exclusively for the treatment of superficial cysts, and during the operation the ruptures of the capsule of the pathological focus with bleeding are observed. According to the general tendency in surgery to reduce the traumatization all patients were worked up with an ultrasound and X-Ray examination of the abdomen to look for the size and location of the splenic cysts. These operations include: drainage with sclerosing of the cyst and deepithelialization with superselective arterial embolization of the feeding vascular pedicle of the pathological focus. The study of these techniques revealed their weak points: the recurrence rate of cysts after sclerosis was 30-50%, and the use of embolizing agents in 50% of cases is complicated by ischemia of an organ segment with possible formation of an infarction zone in the early postoperative period. Nowadays the most promising method is considered to be a microwave ablation. Its thermal effect creates coagulation necrosis of the pathological focus and surrounding tissues with minimal toxic effects. This approach decidedly requires further research.

Promoting psychological well-being in doctoral students: a qualitative study adopting a positive psychology perspective

Purpose Concerns about psychological well-being (PWB) in doctoral students have grown in recent years. The purpose of this study was to explore qualitatively doctoral students’ perceptions of factors that promoted their PWB during the doctoral journey. Design/methodology/approach Nine recent doctoral graduates at an English university participated in the study. Participants recalled their experience and PWB during the doctoral journey via a life grid and semi-structured interview. The life grids were visually inspected to identify high points in PWB whilst the interview data were analysed thematically. Findings The analysis produced the following seven themes representing factors that participants described during periods of better PWB: accomplishments; intrinsic rewards; self-efficacy; comprehension and understanding; supervisor support; wider support network; and self-care and lifestyle. Originality/value By adopting a positive psychology approach and exploring qualitatively factors that promoted PWB in doctoral students, this study offers an alternative perspective to research on doctoral student well-being, which has largely adopted a pathological focus. As such, the study demonstrates the utility of approaching research on doctoral students’ PWB from a positive psychology perspective. Findings are discussed in relation to the extant literature, and future directions for research are outlined.

Relationships between morphological indicators of the tibia and soft tissues lesions and some biochemical blood indicators in patients with traumatic osteomyelitis

Aim. Research aim was to find statistical differences of biochemical indicators of blood and morphometric indicators of crural tissue lesion and relationships between them in patients with traumatic osteomyelitis of the tibia with trophic disturbances in extremity. Material and methods. The work material includes data from 28 patients with traumatic osteomyelitis which was combined with trophic tissue disturbances of different manifestation degree. The levels of procalcitonin, lactate dehydrogenase and acetylcholinesterase of blood serum were estimated. In crural tissues quantitative biochemical, gradual morphometric indicators, frequencies of occurrence of different manifestation degree cases and relationships “clinic – biochemistry – pathomorphology” were defined histologically. Results. Average values of procalcitonin, lactate dehydrogenase and acetylcholinesterase in patients with traumatic osteomyelitis of the tibia, combined with trophic disturbances in crural tissues, are significantly higher, than average values of these indicators in intact donors. In the majority of the patients with chronic traumatic osteomyelitis in crural tissues pathological changes were found out, which by clinical estimations are considered as trophic disturbances. They represent a combination of discirculatory, ischemic-necro­tic, exsudative, productive-inflammatory, and also reparative processes which in total create a composite picture of complex lesion and can persist for many years. As closest relations, according to values of association coefficient, concerning certain biochemical indicators, can be noted such clinical indicators: “degree of bone fragments non-consolidation” and “severity of trophic disturbances in bone tissue (by clinical estimation)”, concerning defined morphometric indicators – such biochemical indicators: “level of procalcitonin” and “level of lactate dehydrogenase” in blood serum. Among morphometric lesion indicators the closest relations concerning biochemical indicators were revealed: in bones – “the form of the pathological focus of traumatic osteomyelitis” and “presence of sequesters”, in soft tissues – “exsudative inflammation in internal membrane of a focus capsule”. Conclusions. In chronic traumatic osteomyelitis combined with trophic disturbances of crural tissues, there are relationships between some clinical, biochemical and morphological indicators of the extremity tissues condition. A deviation of metabolism indicators from norm can serve as biochemical markers in definition of severity degree and efficiency of treatment in patients.

FEATURES OF PAIN SYNDROME IN THE LUMBAR REGION AMID INFLAMMATORY GYNECOLOGICAL DISEASES

Проведен анализ особенностей развития болевого синдрома в нижних отделах спины, в проекции поясничного отдела позвоночника на фоне неспецифических воспалительных заболеваний придатков матки (НВЗПМ) у 148 женщин, находившихся на амбулаторном лечении в гинекологическом отделении поликлиники №5 г. Алматы в 2019-2020 г.г. Установлено, что у 79 (53,4±4,1%) из них отмечался болевой синдром в нижней части спины и сопутствующие ему скованность и ограничение подвижности поясничного отдела позвоночника на фоне обострения НВЗПМ.Критериями для анализа являлись динамика клинической симптоматики НВЗПМ и болевого синдрома с учетом его локализации на фоне проводимого лечения. При этом было проведено сравнение результатов, зафиксированных при поступлении и через 14 суток после начала лечения НВЗПМ. Перспективным представляется продолжить исследования и оценить влияние спинально-генитального рефлекса на течение первичного патологического очага в придатках матки. The development of the features of pain syndrome in the lower back, in the projection of the lumbar spine amid nonspecific inflammatory diseases of the uterine appendages (NIDUA) in 148 women who were on outpatient treatment in the gynecological department of polyclinic # 5 in Almaty in 2019-2020 were analized. It was found that 79 (53.4 ± 4.1%) of them had pain in the lower back and concomitant stiffness and limitation of the mobility of the lumbar spine amid exacerbation of NIDUA. The analysis criteria were the dynamics of the clinical symptomatology of NIDUA and pain syndrome, taking into account its localization amid treatment. At the same time, a comparison was made between the results recorded at admission and 14 days after the start of the NIDUA treatment. It seems promising to continue research and assess the impact of the spinal-genital reflex on the course of the primary pathological focus in the uterine appendages.

The first experience of applying laser ablation in patients with benign tumors, tumor-like and inflammatory diseases of the skeleton

The researchers discuss the first experience of treating 9 pediatric patients with osteoid osteoma (3), primary chronic osteomyelitis (4) and aneurysmal cysts (2). Selected patients had complex treatment which included unloading of the diseased segment of the skeleton and laser ablation of the pathological focus. Laser ablation was done with medical laser «AZOR-ALM», emitting light at wavelength 1.55 μm. Registration certificate No. RZN 2015/2720 of Roszdravnadzor. Manufacturer – LLC «AZOR» (Moscow). Small tumors and inflammatory diseases of the skeleton were surgically treated with high-level laser light in the computed tomography room. Patients with lesions of lower extremities and pelvis previously had spinal anesthesia. If a pathologic focus was located in bones of upper extremities, regional brachial plexus blockage was preferable. In all cases, positive outcomes were seen. Follow-up lasted for 6 months.

SURGICAL TREATMENT OF COMPLICATED FORMS OF ERYSIPELAS

Purpose of the study. The goal of the article is to find out the frequency of complicated forms of erysipelas among the general population of the disease and to determine the main directions for their surgical treatment. Materials and methods. 114 case histories of patients who were hospitalized in the center of purulent-septic surgery of the Non-profit municipal enterprise «City Hospital № 3» in Zaporozhye for the period 2019–2020 were analyzed retrospectively and prospectively. Results. It was found that most often the focus was localized on the upper and lower extremities. In the complex treatment of patients with surgical forms of erysipelas, the main place belongs to antibiotic therapy (ABT) and early surgical treatment of the area of the pathological process. Determination of the level of procalcitonin in blood serum makes it possible to assess the progression of the inflammatory process and is a sensitive test for the effectiveness of treatment. Conclusions. The incidence of complicated forms of erysipelas requiring surgery in the general population was 78,9%. Patients with circular erysipelas need the most extensive surgery, when it is necessary to perform an autopsy within the area of inflammation with longitudinal and transverse wavy autopsies throughout the pathological focus. Determination of the level of procalcitonin in blood serum makes it possible to assess the progress of the process and is a sensitive test for the effectiveness of treatment. Keywords: surgical forms of erysipelas, procalcitonin.