Risk assessment of intrauterine infection in pregnant women with chronic hepatitis B

Purpose — to develop a method for predicting intrauterine fetal infection in pregnant women with CHB, infected and uninfected HIV, which provides the high accuracy of prognosis, is simple and accessible in practice and is achieved by analyzing multiple risk factors for mother-to-fetus transmission. Materials and methods. The course and consequences of pregnancy were analyzed in 211 women with chronic hepatitis B (CHB), not infected with HIV and in 18 — with CHB infected with HIV. The replicative activity of the virus and the activity of the inflammatory process in the liver were evaluated. We studied the dynamics of indicators depending on the trimester of pregnancy, the degree of immunosuppression caused by HIV. The frequency of risk factors was determined by «case-control» studies, and the frequency of identified risk factors was calculated in the groups of mothers in whom CHB was transmitted to the child and in those in which it did not occur. The degree of influence of individual risk factors was determined by the value of relative risk (RR), determined by their 95% confidence interval (95% CI), the reliability of the results (p) according to the Student's t-test. Differences at p<0.05 were considered probable. Results. It is established that risk factors that contribute to intrauterine infection of the fetus are: maternal — viral load HBV >105 copies/ml in the third trimester, HIV infection, immunosuppression caused by HIV (CD4+ Т-lymphocytes <500 cells/μL), low adherence to antiretroviral therapy, maternal bad habits; fetal — intrauterine growth restriction, fetal distress; obstetric — premature placental abruption, preterm delivery, placental dysfunction, prolonged anhydrous interval, prelabor rupture of membranes. In pregnant women with CHB, each risk factor was assessed in points depending on the RR: those factors whose relative risk was highest — 5 points, those whose score was lower — 4 and 3 points, respectively, and those whose score was the lowest — in 2 points. In order to predict the risk of fetal infection, a working prognostic chart with a score from 2 to 5 was developed. It was found that the risk of HBV infection in women with HIV-negative status is high with a score of 19–34, moderate — at 18–11, low — <10 points. In women with HIV-positive status — high risk of fetal intrauterine infection at a score of 24–46, moderate — at 13–23, low — <12 points. Conclusions. The use of the proposed prognostic map in the practice of medical institutions with a score of total risk factors for each pregnant woman will facilitate early prediction of fetal infection in pregnant women with CHB, taking into account their HIV status, which will allow to diagnose timely congenital infections and provides outpatient observation for these children. 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 all 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: pregnant women, chronic hepatitis B, co-HIV infection, risk factors for intrauterine infection of the fetus.

Colposcopic and cytological parallels in pregnant women with a history of infertility of various genesis

The state of the cervix was studied in pregnant women with a history of infertility of various genesis by colposcopic and cytological research methods. The data obtained indicate an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility, compared with pregnant women who had endocrine infertility. Purpose — to determine the relationship between the nature and severity of colpocoscopic and cytological changes in the cervix in pregnant women who had a history of infertility. Materials and methods. 101 women were examined: 14 pregnant women with a history of endocrine infertility, group 1; 27 pregnant women with a history of tuboperitoneal infertility — group 2; 40 pregnant women, had combined infertility — group 3, 20 healthy pregnant women with no history of infertility — group 4. Methods for assessing the state of the cervix in pregnant women — video colposcopic and cytological (on glass). Results. Normal cytological changes (NILM) were found: in group 1–8 (57.2%), in group 2 — in 15 (55.6%), in group 3 — in 23 (57.5%), in group 4, 14 (70.0%) pregnant women. Benign cytological and ASCUS signs were: in group 1 — in 5 (35.7%), in group 2 — in 6 (22.2%), in group 3 — in 10 (25.0%), in group 4 — in 5 (25%) patients. Precancer (LSIL+HSIL): in group 1 — in 1 (7.1%), in group 2 — in 6 (22.2%), in group III — in 9 (22.5%) women, and in group 4, no precancers were found cytologically. Normal colposcopic signs (stratified squamous epithelium) were found: in group 3 — in 11 (27.5%), in group 2 — in 8 (29.6%), and in group 1 — in 7 (50.0%) pregnant women. And benign colposcopic changes (ectopia, open glands, Nabotovi cysts, deciduosis): in group 3 — in 19 (47.5%), in group 2 — in 16 (59.3%), in group 1 — in 6 (42.9%), in group 4 — in 5 (35.7%) patients. Our data indicate that precancers during colposcopy occurred: in group 3 — in 9 (22.5%), in group 2 — in 3 (11.1%), in group 1 — in 1 (7.1%), in group 4 — in 1 (5.0%) women. No colposcopic signs of invasive growth were found in any of the groups. Conclusions. The study revealed an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility. A fairly high percentage of precancerous conditions of the cervix in group 2 — in 6 (22.2%) and in group 3 — in 9 (22.5%) women indicates that in the presence of Human papillomavirus (HPV) and other genital infections and with increasing age, the probability self-elimination of the papilloma virus is reduced. After long-term infertility treatment, all pregnant women must undergo a colposcopic examination at the first visit to the antenatal clinic, in addition to taking a cytological smear. If LSIL and HSIL are found in this category of women, colposcopic and cytological control once every 3 months during pregnancy with mandatory HPV PCR HCR. 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 all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: pathology of the cervix, pregnancy after infertility, video colposcopy, cytology.

Functional capabilities of the heart rate depending on the characteristics of homeostasis among primary-school-age children

One of the most common diseases of the cardiovascular system is cardiac arrhythmias. Assessment of the heart rate is one of the obligatory methods of pediatric examination and its deviation from the age norm may indicate a change in the child's health and be one of the first manifestations of the disease. Heart rhythm disturbances accompany various diseases, namely: congenital heart defects, cardiomyopathies, rheumatic and infectious diseases, intoxication, vegetative crises, endocrine diseases, diseases of the nervous system and others. Most often, in children's practice, it is not always possible to establish the cause of heart rhythm disturbances, as well as to classify the presence of organic or functional disorders without conducting morphological studies. Purpose — to study the features of heart rhythm and the state of the autonomic nervous system (ANS) among the children of primary school age with sinus bradycardia. Materials and methods. Children of primary school age with sinus bradycardia were examined (210 children). All children underwent: clinical examination, ECG at rest and after exercise, daily monitoring of ECG and heart rate, echocardiography, cardiointervalography with spectral analysis of heart rate. Results. Assessment of the cardiovascular system among children with bradycardia revealed the following features: 80.0% of children had no complaints, 68.0% of children at the age of 6–7 years and 55.0% of children at the age of 8–10 years had moderate bradycardia, 32.0% of children at the age of 6–7 years and 45.0% of children at the age of 8–10 years had significant bradycardia. After the exercise test, 71.0% of children still had bradycardia, which is typical for children at the age of 9–10 years and 29.0% of children had an acceleration of heart rate above the age norm. Holter monitoring revealed the following cardiac arrhythmias: sinus rhythm driver migration, ectopic rhythm, sinoatrial block, 2 grade atrioventricular block, atrial extrasystole and ventricular extrasystole. Different duration of sinoatrial pauses was detected: in the range from 1300–1400 ms among the most children (78.0%) to 1700–1800 ms among 1.8% of children. Data from spectral analysis of sinus rhythm showed the predominance of parasympathetic nervous system tone among the 84.0% of children, asympathicotonic (40.5%) and normal (44.9%) autonomic reactivity. Conclusions. Examination of the children of the primary school age revealed sinus bradycardia and bradyarrhythmia among the 80.7% of children. Bradyarrhythmia is typical for children at the age of 6–7 years, bradycardia — for children at the age of 9–10 years. Spectral analysis of the ANS showed an imbalance in the regulation of sinus rhythm: the predominance of the parasympathetic link, regardless of the initial state of the ANS and the violation of adaptive mechanisms. According to Holter monitoring, the duration of pauses is longer than normal for the given age (more than 1300 ms) indicates sinus node dysfunction and requires closer monitoring due to the risk of developing sinus node weakness syndrome and other threatening conditions in later life. 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 all 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: children, bradycardia, bradyarrhythmia, vegetative homeostasis.

Alternative methods in the management of preeclampsia. Analytical inspection

There are many alternative drugs for the prevention and treatment of preeclampsia in the new research. This drugs can effect on the underlying pathophysiology of the disease: oxidative stress, antiangiogenic factors, as well as angiotensin, nitric oxide and various parts of the inflammatory process. Thus, they affect the disease of the placenta or endothelium. The proposed treatments are currently undergoing preclinical and clinical trials. Pravastatin was of the greatest interest among all the proposed therapeutic agents. It has pleiotropic effect, i.e. affects multiple molecular targets against preeclampsia. Proton pump inhibitors, metformin, and sulfasalazine are other drugs that have preclinical evidence of multiple molecular actions that may address the pathophysiology of preeclampsia. Currently, these molecules are also in clinical trials. Many natural compounds for the treatment of preeclampsia, such as plant extracts and trace elements, are being researched to identify the potential in anti-inflammatory or antioxidant activity. Monoclonal antibodies are another direction is new molecular-oriented strategies. They are targeting tumor necrosis factor alpha, placental growth factor and short interfering RNA technology to inhibit the expression of soluble fms-like tyrosine kinase-1 or angiotensinogen. Folic acid, nitric oxide donors (such as L-arginine), recombinant antithrombin III, and immunogenic digoxin antigen and melatonin are other treatment approaches that have been tested in humans (ranging from single-group studies to phase III trials that have been completed or are ongoing). The series of cases demonstrated that removal of circulating soluble fms-like tyrosine kinase-1 can help stabilize the disease and prolong pregnancy. Monoclonal antibodies such as eculizumab (a complement inhibitor) may have therapeutic potential. Thus, the identified alternative drugs in the treatment and prevention of preeclampsia create the potential to improve maternal health and pregnancy. No conflict of interests was declared by the author. Key words: preeclampsia, pregnancy, pravastatin, metformin, sulfalazine

Optimization of pneumonia complex therapy in children with acute respiratory diseases

Purpose — to improve the pathogenetic treatment of pneumonia in children with recurrent acute respiratory infections by combining of protocol therapy with a drug has antioxidant, antihypoxic and organoprotective effects. Materials and methods. The analysis of the results of clinical, laboratory and instrumental methods of examination of children with pneumonia at the age of 3–8 years which have recurrent acute respiratory infections has performed. Children have had received standard protocol treatment of pneumonia and combination with a drug has antioxidant, antihypoxic and organoprotective effects. Results. Optimization the protocol treatment of pneumonia in children with recurrent acute respiratory infections by supplementing pathogenetic therapy with this drug made possible to improve the efficiency of treatment, what confirmed by the rapid regression of clinical manifestations of pneumonia (intoxication — to 1.9±0.04 days, cough — to 2.1±0.08 days, respiratory failure — to 1.7±0.08 days, shortness of breath — to 1.3±0.04 days, disorders of microcirculation and hemodynamics — to 2.1±0.05 and 1.8, respectively ± 0.09 days). This approach calls the decrease of percentage of children with pneumonic infiltration according to the control X-ray examination of the lungs — to 30.0%, myocardial hypoxia according to the ECG results — 20.0%, which made possible to reduce the duration of the course of antibiotic therapy to 2.0±0.04 days, inpatient treatment — to 2.2±0.08 bed-days. The positive dynamics laboratories values, clinical signs and instrumental methods of examination of such children occurred due to an increasing levels of glutathione reductase and glutathione transferase in the blood serum to 4 and 3 times, respectively, and a decreasing the content of glutathione peroxidase and gamma$glutamyl transpeptidase to 2.6 and 1.6 times. Conclusions. Supplement the protocol therapy of pneumonia in children with recurrent acute respiratory infections with a drug has antioxidant, antihypoxic and organoprotective effects promoted a rapid regression of clinical manifestations due to the improvement of the functional activity of the oxidative system of glutathione, which made possible to reduce the duration of the course of antibiotic therapy and inpatient treatment. 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 all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: children with recurrent acute respiratory infections, pneumonia, treatment.

Bacterial vaginosis and vulvovaginal candidiasis in women of reproductive age with overweight and obesity

In a review article of literary sources, domestic, foreign authors and their own research, modern views are highlighted, often problems and debatable, the prevalence of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) among women with overweight and obesity, women of reproductive age. Vulvovaginal candidiasis (VVC) It ranks second among all vaginal infections and is one of the most common mental reasons for women to visit a gynecologist. Obesity and overweight play an important negative role in gynecological and obstetric practice. There has been a significant increase in C. albicans non-albicans in overweight women of reproductive age, and has a negative effect on the reproductive health of women. The article presents the results of a comparative study on the clinical and laboratory effectiveness of local therapy for bacterial vaginosis and IHC in overweight women. Against the background of metabolic disorders, there is an increase in the frequency of infectious pathology of the urogenital tract. Numerous literature data indicate that fungi of the city of Candida are part of various microbial associations and an important factor in their active growth is the deficiency of lactobacilli that produce H2O2. Data on bacterial vaginosis and vulvovaginal candidiasis, development and role of metabolic disorders in the pathogenesis of BV and VVC are presented. Increasing the effectiveness of local treatment of disorders of the vaginal biocenosis in women with overweight and obesity by using individualized dietary nutrition, means of correcting the intestinal biocenosis and metabolic therapy, an integrated approach to the therapy of women of reproductive age showed more effective results. It has been found that overweight and obesity negatively affect the reproductive system of women. Irregular menstrual cycles, secondary amenorrhea, infertility, endometrial hyperplastic processes are often associated with overweight and obesity. In many cases, BV is combined with intestinal dysbiosis. In this case, vaginosis can be considered as a manifestation of a systemic dysbiotic process, affects not only the microbiota of the genitourinary system, but also the endogenous microflora in various cavities of the macroorganism, provided that it is influenced by any exogenous and endogenous factors. No conflict of interest was declared by the author. Key words: bacterial vaginosis, vulvovaginal candidiasis, overweight, obesity.

The level of sanitary and hygienic knowledge on oral hygiene in teenagers and young adults who smoke

Numerous studies in recent years have shown that the prevalence of dental disease, periodontal tissue and dental anomalies remains high among children, despite the development and implementation of new prevention and treatment regimens. Thus, the prevalence of dental caries in children in the period of temporary occlusion reaches 80–90%, in the period of permanent occlusion — 70–80%. The prevalence of chronic catarrhal gingivitis in children 12–15 years of age is 70–80%, reaching 95–98% in some regions, and localized and generalized periodontitis – 4.1–16.4%. It is known that the pathogenesis of dental diseases is closely related to the presence of a bad habit — smoking, mostly there is a strict correlation between the intensity and experience of smoking and the emergence and development of pathological changes in various organs and systems, including the oral cavity. Maintaining proper oral hygiene is an important factor influencing the occurrence of periodontal disease. It is known that the formation of oral care skills is formed in childhood, so the study of oral hygiene and the level of hygienic knowledge in adolescents with healthy periodontitis and catarrhal gingivitis in order to further develop a scheme of preventive measures remains one of the most important areas of pediatric dentistry. Purpose — to study the level of hygienic oral care and knowledge in teenagers and young adults who smoke. Materials and methods. The level of knowledge on the observance of individual oral hygiene in 87 people aged 15 to 24 years was studied. The main group included 40 adolescents and young people who smoked, in the comparison group we included 47 people of the same age without a bad habit of smoking. Results. It was found that the majority of all respondents have information on how to properly care for the hygiene of RP, respectively 67.54±3.75% — in the main group, 72.78±4.81% — in the comparison group. However, not all respondents have the full amount of information, as indicated by 23.43±7.51% of adolescents and young people in the main group and 17.86±6.42%. In addition, the individual assessment of their own oral care skills according to the respondents revealed that not all respondents regularly oral care. In the main group only 59.56±4.61% indicated regular oral care, which was 1.4 times less than in the comparison group 81.42±5.73% (p<0.001). Conclusions. It is necessary to conduct additional hygienic training, mandatory reinformation on the risks of dental diseases, in order to form a system of sustainable understanding and awareness of the need for adolescents and young people to observe individual oral hygiene. Particular attention should be paid to aspects of the emergence and rooting of bad habits, namely the bad habit of smoking, both traditional and alternative types of smoking, which adversely affects somatic and dental health, because it is known that without smoking it is impossible to achieve sustainable and long-term results of treatment and prevention measures. 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 all 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: teenager, young adult, oral hygiene, smoking.

Clinical case of sharp bowel obstruction during pregnancy for a patient with an extracorporal impregnation and large intergenic interval

The great importance in the development of acute intestinal obstruction (AIO) is the change in intestinal kinetics during pregnancy. In pregnant women, the rhythmic function of the intestine slows down due to an increase in the threshold of excitability of its receptors to biologically active substances. The article provides an overview of modern literary sources on the problem of acute intestinal obstruction in pregnant women. According to foreign literature sources, the incidence of intestinal obstruction in pregnant women is 1:3600–1:66000, and complications of diseases of the digestive system rank 4th among the causes of maternal mortality during pregnancy — 9%. According to domestic scientific sources, the frequency with which intestinal obstruction occurs in pregnant women is 1:40000–1:50000 births, mortality reaches 35–50%, stillbirth — 60–75%. The development of the disease is caused by physiological changes in the body of a pregnant woman. With increasing gestational age there are changes in the anatomical arrangement of the abdominal organs. From the second trimester of pregnancy, the uterus extends beyond the pelvis and gradually occupies the entire abdominal cavity. The increase in the size of the uterus due to hypertrophy and hyperplasia of muscle fibers, amniotic fluid, fetal growth, leads to increased intraabdominal pressure, displacement of the small intestine and lumbar colon up, thereby creating conditions for compression of intestinal loops, nodules, development. The modern classification, clinic, diagnostics and methods of treatment of this surgical pathology are presented. The author presents his own clinical case of acute intestinal obstruction in a 51-year-old pregnant woman with the sixth desired pregnancy, which occurred as a result of assisted reproductive technologies and a large intergenetic interval. Both surgeon and obstetrician-gynecologist treat intestinal obstruction in pregnant women. Conservative treatment is carried out simultaneously with diagnostic procedures. No effect of conservative therapy for 2 hours is an indication for surgery. The main purpose of surgery is to eliminate the causes of intestinal obstruction and restore bowel function. The scope of surgery is determined in each case individually and depends on the type of AIO and the age of the disease. The chosen tactics of the preoperative period, the volume of surgery, anesthesia and adequate management of the postoperative period can cure acute surgical pathology, maintain the desired pregnancy, avoid the development of obstetric and surgical purulent-septic complications. 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 interest was declared by the authors. Key words: sharp bowel obstruction, pregnancy, extracorporal impregnation, large intergenic interval.

Nutritional problems and factors of forming the health of children of the first year

Evaluation of the type of nutrition, which is one of the important components that ensure the physical growth, development and health of a child in the first year of life, and that forms metabolic processes at an older age, has been the subject of research and discussion of domestic and foreign scientists over the past decades. Purpose — to study the influence of the nature of feeding on the incidence and physical development of infants. Materials and methods. During the year, 250 children (118 girls and 132 boys) of the first year of life were under observation, who received various types of feeding (breast milk and milk formulas, differing in composition). The main (I) group (n=130) included children (62 girls and 68 boys) who were breastfed; and in the comparison group — children receiving artificial feeding: in group II (n=60) (27 girls and 33 boys) received a standard mixture with a prebiotic; in group III (n=60) (29 girls and 31 boys) — a standard mixture without a prebiotic. Physical development was assessed according to the generally accepted measurement technique in terms of absolute values, monthly increases in anthropometric indicators and mass-growth indices. Outpatient records of children, protocols of examination of a 1-year-old child were studied (accounting and reporting documentation was analyzed). The criteria for inclusion in the main group of infants were: breastfeeding for at least 9 months; the age of children from up to 1 year of age. The second comparison group included children who were fed mixed with the addition of probiotic means. Results. In girls of the second group, who were artificially fed with the addition of a probiotic — 7100.0±95.9 g, the weight gain in the first year of life was significantly higher than the weight gain of girls who received breast milk and standard formula — 6671.0±72.6 g and 6733.3±91.8 g, respectively. Despite the fact that there were no significant differences in the medians of body weight and height in children of the main group and the comparison groups, it was found that children in the main group were overweight/obese at 12 months had two or more times less indicators than children who received artificial nutrition. Children who are breastfed began to sit independently much earlier, on average 7.6±0.05 months after birth, and children of the other two groups who are bottle-fed, on average, 8.0±0.13 and 8.1±0.12 months, respectively (p<0.05). When studying the structure of the most common diseases of children in the first year of life, depending on the type of feeding, it was revealed that the greatest percentage both in group I (group) and in group II (claim) are children with acute intestinal infections — in group I (group 1)) group in 7.7±2.34% of children, in subgroup II (claim) in 11.7±2.93% of children (p=0.3905). Conclusions. The results obtained indicate a positive effect of breastfeeding on anthropometric indicators and the formation of basic skills in young children. The incidence of infectious diseases (ARI and OCI) revealed in children who received breast milk, compared with children who are bottle-fed, indicates that breastfeeding has the ability to create conditions for reducing the incidence of diseases in young children. 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 all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: types of feeding, physical development, motor skills, morbidity, children under 1 year old.

Assessment of the state of personal and situational anxiety and indicators of stress-implementing and stress-limiting systems of the organism as marker efficiency the antenatal preparation

As a result of research conducted on the basis of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova NAMS of Ukraine», the issue of the transcranial electrostimulation introduction in preparation for partnership labor was shown. Purpose — to study the features of changes in the state of personal and situational anxiety, stress-implementing and stress-limiting systems of the body in healthy women depending on the method of prenatal training. Materials and methods. 120 somatically healthy women without severe extragenital and obstetric pathology with a physiological course of singleton pregnancy were examined. In the first group — 45 women set up for partner childbirth, the second group also included 45 patients who underwent a course of transcranial electrical stimulation (TES) of mesodiencephalic structures of the brain in comprehensive preparation for partner childbirth. The control group included 30 women who did not receive prenatal training, did not have individual support in childbirth and were tuned to traditional methods of pain relief as needed. Results. Following the results of the determination of pain rate in the dynamic of the TES procedure, a progressive growth of the pain tolerance threshold was recorded with the subsequent stabilization of this value after the 5th procedure of electrical stimulation. Methods of psychophysical preparation for childbirth using transcranial electrostimulation and partner support made it possible to reduce medical induced pain relief during childbirth, which is what the data we obtained indicate. Conclusions. The use of TES in complex prenatal preparation for partner labor allows to achieve and maintain a stable psycho-emotional adaptation of pregnant women and increases the tolerance of the consonant to labor pain without additional medication load, which helps to make more physiological course of labor. 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: labor, prenatal preparation, transcranial electrostimulation, pain threshold, anesthesia, partnership labor.