The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

14-25

Authors: Mariana Iskiv, Natalia Lukyanenko

Annotation: The prevalence of microbial inflammatory diseases of the urinary system, according to epidemiological studies, is 29.0 per 1000 children. Over the past decades, an unfavourable tendency towards an increase in the pediatric population of chronic pathology has been observed, treatment complicated by a significant pathomorphosis of the disease. Aim of the research: analysis of the frequency of birth defects in the development of organs of the urinary system, as a visceral marker of violation of the fibrillogenase, in children with different variants of pyelonephritis. Materials and methods: 148 children with pyelonephritis from 3 to 18 years were examined. According to the results of catamnestic observation, they were divided into 2 groups: I - 92 people, children with pyelonephritis, in which catamnesis was diagnosed 3 or more episodes of recurrence of pyelonephritis in 2 years, II - 56 children with pyelonephritis, in which for 2 years no relapse of the disease was noted. The control group consisted of 65 somatically healthy children of the same age. All children had a routine comprehensive clinical and laboratory examination and clinical and laboratory markers of fibrillogenic disorder (phenotypic signs of undifferentiated connective tissue dysplasia (UCTD), excretion of oxyproline with urine) were established. Results: In children with recurrent pyelonephritis, phenotypic signs of undifferentiated connective tissue dysplasia. For this purpose, the activity of endothelin-1 fraction, alkaline phosphatase and serum creatine phosphokinase, excretion of creatinine and glycosaminoglycans with daily urine in children with pyelonephritis was studied. On average, the level of endothelin-1 in blood plasma in practically all children in group I was significantly higher (1.815±0.03 fmol/l, q=0.92, p≤0.01) more than in the 10th time, than in children with APN (0.179±0.02 fmol/l, q=0.78 p≤0.01) and healthy children (0.077±0.01 fmol/l, q=0.03). Conclusions: In children with recurrent pyelonephritis, compared with the data of children with acute non-recurrent pyelonephritis, phenotypic signs of undifferentiated dysplasia of connective tissue were significantly more marked. Thus, the negative role of UCTD in the course of pyelonephritis in children has been confirmed. It has been shown that UCTD in children with pyelonephritis is manifested not only by phenotypic features, but also by visceral, such as BD US, which leads to the chronization of the process with frequent relapses.

33-38

Authors: Yana Kolesnyk

Objectives. The article presents the results of research on the definition of criteria for predicting the adverse course of infectious mononucleosis (IM) in children on the basis of the structural organization of lymphocytes of blood. Materials and methods. There were 68 children aged three to fifteen years suffering from IM under supervision. The diagnosis of IM was verified by PCR (detection of EBV DNA in the blood) and ELISA (anti-EBV Ig M and Ig G). The biophysical organization of the cytoplasmic membrane of lymphocytes was determined by the method of electron paramagnetic resonance (EPR) of spin probes using the method of additional broadening at microwave parameters 9.39 gHz, amplitude of high-frequency modulation 1 gauge, magnetic field scan time 200 sec, time constants 0.1 milliseconds (ms). Microviscosity of the intracellular environment of lymphocytes was determined by the mobility parameter of a water-soluble probe (nickel ferricyanide), which easily penetrates into the cytoplasm and in combination with extracellular paramagnetic ions, allows to evaluate the microviscosity of intracellular contents in relative units (r.u.). Results. According to the results of observations, it is established that at the stages of manifestation of the disease there are pronounced violations of the biophysical organization of the structure of lymphocytes in the form of a decrease of viscosity and elastic properties of intracellular content and cytoplasmic membrane of lymphocytes. It was characterized by the fact that the average values of the penetration rate of the electron paramagnetic resonance of the spin probe (PR EPR s.p) in patients of both groups were significantly higher than the normative ones. In the group with smooth course, they exceeded the norm by 1.5 times, and in patients with prolonged course by 1.8 times, and the values of the microviscosity of intracellular contents (MIC) were significantly reduced compared to the control - by 22.1% in patients with a smooth course of the disease and 25.1% - with a prolonged course of IM. Conclusions. In patients with prolonged course of IM these disorders were more pronounced than in the smooth course of the disease. In the period of convalescence, the indicators of the biophysical organization of the structure of lymphocytes of patients with a smooth course of IM did not differ from the norm, and in patients with a prolonged course of the disease, their reliable deviation was revealed.

49-55

Authors: Mariia Matvieienko, Nadegda Baranova, Serhei Matvieienko, Tetiana Kozlova, Alona Gryshchenko, Arora Sukesh

Objective of the research is to assess the likelihood of complications in the acute and early periods of Traumatic Disease (TD) and primary condition and reserve capability of hemodynamic and homeostasis in patients with polytrauma. Materials and methods. A retrospective study was carried out on 32 patients suffering from polytrauma. The group of the study included patients with the severity of injury according to the Injury Severity Score (ISS) more than 25 points and on a scale APACHE II 10-25 points at the time of admission. The estimated blood loss was 30-40% of blood volume (BV). The individual assessment of blood loss was calculated by Moor. Results. The study of 20 (62.5%) men, 12 (37.5%) women aged 18 to 60 years old (35.22 ± 12.66) were done. The mechanical ventilation was performed for 30 patients (93.75%), and 2 patients (6.25%) required oxygen therapy 5 lit per min for 3 days. The duration of mechanical ventilation was in 10 patients - up to 1 day, 8 patients - up to 3 days and at 12 - more than 3 days. Among 12 patients, who used AMV more than 3 days, 10 patients were tracheostomy in 3d day and 2 patients were extubated on 4th day. Among the patients examined thirty patients (93.7%) had posthemorrhagic anemia during first day of injury. Infectious complications like purulent tracheobronchitis and pneumonia were observed in 14 (43.75%) patients. The local infectious complications (abscesses, festering wounds) occurred in 5 (15.6%) patients and bedsores in 3 (9,375%) patients. The catheterization of the bladder lead to the development of urinary tract infection in 3 patients (9,3%). Conclusion. The most problematic category of victims includes patients with injuries several anatomical regions. Pneumonia, anemia, urinary tract infection and local infectious complications were considered as the most common complications of acute and early periods TD. The factors that influenced the probability of a high degree of complications were AMV, the thoracic component of the injury, more massive blood loss, long-term catheterization of the bladder.

63-71

Authors: Nataliya Veresnyuk

Objectives. The effect of the unicornuate uterus on the reproductive health and quality of life of woman has been analyzed. Materials and methods. The study included 26 patients with unicornuate uterus aged 25 to 42 years and 20 women without gynecological pathology. Diagnosis of uterine abnomalies was based on patient complaints, medical history and life history, as well as clinical and laboratory and instrumental examinations. The severity of dysmenorrhea was determined using a visual analogue pain scale, women's quality of life was assessed using a short SF-12 health questionnaire. Results. The average age of the surveyed women was 30.2 ± 3.9 years. All patients with unicornuete uterus by subclasses were distributed as follows: subclass U4a (unicornuate uterus with rudimentary cavity) – 69.2% of patients, subclass U4b (unicornuate uterus without rudimentary cavity in the contralateral horn or with its aplasia) – 30.8%. In all patients was confirmed normal karyotype – 46XX. The combination of a unicornuate uterus with a defect of the urinary system (aplasia, doubling, or kidney dystopia) occurred in 23.1% of women. It has been found that in women with unicornuate uterus, clinical symptoms in 76.9% of cases are accompanied by dysmenorrhea. The unicornuate uterus in 69.2% of cases causes negative reproductive outcomes, among which 26.9% – early spontaneous abortions, 11.5% – ectopic pregnancy. In 46.2% of cases the unicornuate uterus is combined with other gynecological pathology, whereby the incidence of concomitant gynecologic pathology is significantly more frequent in U4a patients than in the U4b subclass (˂0.01). The severity of dysmenorrhea in the main group was 5.8 ± 1.8 points (the difference was significant compared with the control group, p = 0.0032). Conclusions. Due to the low physical subunit, the unicornuate uterus significantly impairs the quality of life of women, which was significantly lower in the group of patients with unicornuate uterus compared to the control group (total SF-12 score: 85.4 ± 11.2 vs. 95.8 ± 12.1; p = 0.002).

79-95

Authors: Yevgenia Shargorodska

Congenital heart defects are a heterogeneous group of diseases that occur as isolation or a part of multiple birth defects, gene disorders or chromosomal abnormalities. Chromosomal abnormalities and its underlying syndromes are the cause of 6 to 36% of cases of congenital heart defects. Monogenic etiology is proven in about 8% of cases, and the main group - about 90% of the congenital heart defects is the result of an unfavorable combination of genetic predisposition and external factors. The causes of early neonatal infant mortality are dominated by incompatible birth defects: almost 26% of perinatal and neonatal deaths are associated with congenital child pathology. Heart defects compose about 30% of all birth defects. They rank first place among the diseases that lead to perinatal mortality and early disability. World statistics show that the incidence of birth defects in the world is 9 per 1000 newborns, in Europe - 8/1000, which is 4 times more frequent than neural tube defects and 6 times higher than chromosomal abnormalities. In Ukraine, about 5,000 children with congenital heart defects are born each year, and the total number of those children on dispensary records reaches more than 45,000. Knowledge about the prevalence of birth defects in the region is needed to develop new information markers of the risk of congenital pathology of the circulatory system for women of reproductive age. Data on the incidence of congenital heart defects of fetuses and newborns in the region will allow the creation of a database for follow-up studies, which will facilitate the timely identification of pregnant women at risk. This will improve the prognosis of pregnancy, reduce the level of perinatal pathology, which will have a significant medical and social effect. The data obtained will allow to create preconditions for improvement of approaches to the definition of risk groups of perinatal pathology, perfection of specialized care for pregnant women with risk of congenital heart defects of the fetus.