Ukrainian Journal of Perinatology and Pediatrics

Reply of the author to “Stress hormone levels in women with infertility in the third year of the war in Ukraine”

O.O. Berestovyi — Fri, 28 Mar 2025 00:00:00 +0200

The consequences of hormonal changes under the influence of prolonged extreme stress indicate an alteration in the body's ability to cope with stress. Moreover, the transition-return-perception of potential stimuli (the final stage of folliculogenesis control) may resemble an acute response similar to the initial stage of the General Adaptation Syndrome.

Clinical features of 5-year-old girl with 22q11.2 deletion syndrome in a 5-year-old girl. To the 60th anniversary of the first description of DiGeorge syndrome

A.M. Antoshkina, N.I. Balatska — Fri, 28 Mar 2025 00:00:00 +0200

Since the article is devoted to the 60th anniversary of the definition of DiGeorge syndrome, it describes the biographical data of pediatric endocrinologist A.M. DiGeorge, the essential aspects of the syndrome's study, the main clinical presentation and diagnosis.

Aim - to reflect A.M. DiGeorge's important contribution to the current understanding of the syndrome and present a personal clinical observation of a child with 22q11.2 deletion syndrome.

Clinical case. A 5-year-old girl had such clinical symptoms as heart defects – multiple ventricular septal defects (Ø 10 mm perimembranous defect and Ø 2 mm apical muscular defect), secondary atrial septal defect, and high arterial hypertension; thymus aplasia was accompanied by moderate lymphopenia, reduced T-lymphocyte level, and decreased IgG level during the first two years of life (frequent viral respiratory diseases clinically manifested immunodeficiency); craniofacial dysmorphism; low levels of parathyroid hormone with normal levels of calcium in the blood; delayed speech development, dysarthria; cognitive deficit of mild degree. The diagnosis was confirmed by the FISH method. The peculiarities of the child's development and her laboratory and instrumental results are given in the dynamics of five years.

Conclusions. Over the past 60 years, there has been a significant transformation in the understanding of DiGeorge syndrome, which has gone from a congenital endocrine disease and primary immunodeficiency to a chromosomal anomaly (22q11.2 chromosome deletion syndrome) with multiorgan dysfunction. Nowadays, such patients need multidisciplinary and personalized management.

The study was conducted in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from the patients for conducting the study.

The authors declare no conflict of interest.

Complex sclerosing lesions of the mammary gland: clinical cases, diagnostic aspects

O.O. Karlova, O.O. Kyrylchuk, H.O. Halishyna — Fri, 28 Mar 2025 00:00:00 +0200

Aim - to clarify the clinical and diagnostic aspects of breast diseases in the clinical examination of patients

The study included 83 workers who were examined at the mammology centre in Kyiv. The average age of the examined 48.7±2.8. All patients underwent a comprehensive examination of the mammary glands, which included a general clinical examination, ultrasound, mammographic examination of the mammary glands, and, if necessary, morphological verification.

Clinical cases. The obtained analysis of clinical cases demonstrated: In 38% of patients, diagnosis was based on a complaint of a palpable mass in the breast, 11% of patients had pain, 51% were referred by their attending physicians for a routine breast examination. The lesions had the following ultrasound features: hypoechoic mass, spiculation and contour angulation; colour Doppler mapping showed perinodular blood flow in 47% of cases and avascular in 53%. According to the BIRADS descriptive system, the ultrasound examination was classified as category 5 in 87% of cases and category 4 in 23%. The MMG examination resulted in a conclusion similar to category 2. In 81% of cases, the histological stratification corresponded to radial breast scar, in 19% to lobular DCIS. Patients were offered surgical treatment

Conclusions. Screening of breast diseases, in particular, complex sclerosing breast diseases, should include examination of patients with the use of general clinical, ultrasound and mammography examinations.

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.

The safety and effectiveness of non-hormonal treatment in menopausal disorders

V.V. Lebedyuk — Fri, 28 Mar 2025 00:00:00 +0200

The use of non-hormonal therapy for the manifestations of CR will significantly improve the quality of life of women in the menopausal period due to its effectiveness and absence of side effects. It will also solve the issue of correcting menopausal disorders in women in whom menopausal hormone therapy is contraindicated.

Aim - to assess the safety and effectiveness of the herbal preparation Menoel® PLUS (EstroG-100®) in the treatment of menopausal disorders.

Materials and methods. The study involved 40 women of menopausal age with climacteric disorders. After confirmation of climacteric disorders in patients, they were distributed as follows: the Group I - 20 participants received MHT; the Group II included 20 women who received: the Subgroup IIA - 10 women: MHT and Menoel® PLUS; the Subgroup IIB - 10 women who had contraindications to MHT received Menoel® PLUS as monotherapy.

Results. Over 6 months of therapy, the indicators of psychological and somato-vegetative manifestations of the MRS scale significantly decreased in women using menopausal hormone therapy and Menoel® PLUS. The assessment of the mental tension index on the PSM-25 scale demonstrated that during 6 months of treatment, a clinically significant effect was obtained in the both groups, but in the Subgroup IIA it was more significant - already in 3 months the stress level decreased from 169.4±8.6 to 121.6±8.6 points, and in 6 months to 102±8.3 (p<0.05).

Conclusions. Non-hormonal drugs (Menoel® plus) can be used in combination with MHT for the treatment of climacteric disorders and are the only option for women with contraindications to estrogen or progestogen therapy.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Committee on bioethics and deontology of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the author.

SWOT-analysis of the maternal and child health service of Ukraine under martial law

Fri, 28 Mar 2025 00:00:00 +0200

According to experts, the Russian Federation's aggressive war against Ukraine, whose most vulnerable population groups are mothers and children, may become one of the bloodiest in modern history.

Aim - to analyze the activities of the maternal and child health service of Ukraine under martial law using SWOT-analysis.

Materials and methods. The research materials were data on the financial, economic, personnel, logistical and marketing potential of the maternal and child health service, the socio-economic situation and the regulatory framework during martial law in Ukraine. The methods of systematic approach, bibliosemantic, comparative analysis, and SWOT-analysis were used.

Results. The data of the analysis indicate the existence of the main opportunities and strengths of the maternal and child health service of Ukraine during martial law - favorable economic policy of the state, assistance from the international community and charitable institutions, introduction of a new financial mechanism in the medical field and increase in salaries of medical workers, uninterrupted functioning of the modern system of medical care for mothers and children, which meets the basic principles of the World Health Organization. Key obstacles to medical care for mothers and children during martial law were the unfavorable demographic and economic situation in the state, the lack of legislative definition of the priority of state policy on maternal and child health, the impact of adverse factors of military aggression on the state of medical care and health of mothers and children, and the lack of experience of medical personnel in martial law.

Conclusions. The SWOT-analysis of the state of medical care for mothers and children in Ukraine during military aggression is an effective tool for reducing and mitigating the negative effects of military aggression and making strategic, short-term and long-term management decisions to further improve medical care for mothers and children.

The authors declare that they have no conflicts of interest.

Optimization of the management tactics for women with fetal loss syndrome and high-risk thrombophilias in history at the preconception stage

O.A. Taran, S.V. Demianiuk — Fri, 28 Mar 2025 00:00:00 +0200

One of the most significant medico-social problems in modern obstetrics is the reduction of reproductive losses, which underlie pregnancy loss, with a prevalence of up to 55%, reaching 80% in the first trimester.

Aim - to evaluate the effectiveness of an optimized preconception preparation program using folates, a complex of vitamins, vitamin D, and L-arginine aspartate in women with fetal loss syndrome and high-risk thrombophilias in history.

Materials and methods. A prospective controlled clinical study was conducted involving 49 women aged 25 to 42 years with fetal loss syndrome and high-risk thrombophilias in history, divided into two groups. In the control group (n=26), the pre-gravid period was accompanied by standard management, whereas in the main group (n=23), in addition to enoxaparin and acetylsalicylic acid, additional therapy was administered, including folic acid preparations, a complex of vitamins and minerals with the biologically active fourth-generation folate – quatrefolic, vitamin D, and L-arginine aspartate. From the moment of the desired pregnancy diagnosis, the structure and frequency of pregnancy and childbirth complications were studied. Statistical data processing was performed using the SPSS 21 program.

Results. It was established that the administration of folates, a complex of vitamins, vitamin D, and L-arginine aspartate at the stage of comprehensive preconception preparation in women with fetal loss syndrome and high-risk thrombophilias in history is associated with a reduction in the frequency of threatened abortion, vitamin D deficiency, anemia during the first trimester, threatened miscarriage, de novo hypertensive disorders, placental dysfunction with fetal growth restriction in the second and third trimesters of pregnancy.

Conclusions. The proposed pre-gravid preparation and therapy tactics in women with fetal loss syndrome and high-risk thrombophilias in history demonstrated a tendency to increase the number of preserved desired pregnancies from 76.9% to 91.3%.

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.

No conflict of interest was declared by the authors.

The effect of prophylactic immune therapy in the III trimester on indicators of immune status in pregnant women with HCV infection

Yu.M. Zapopadna — Fri, 28 Mar 2025 00:00:00 +0200

Аim - to study the effect of prophylactic immune therapy in the III trimester on indicators of immune status in pregnant women with hepatitis C virus (HCV) infection for the prevention of vertical transmission of hepatitis C virus from mother to child.

Materials and methods. A prospective clinical and statistical analysis of the immune status at 28 and 36 weeks of pregnancy was conducted in 74 women with HCV infection, the Group I - 40 pregnant women who received recombinant interferon, the Group II - 34 pregnant women who did not receive it. The control group (CG) consisted of 30 healthy pregnant women. The immunological examination was carried out during 28-36 weeks of pregnancy and included: determination of the absolute and relative number of lymphocyte subpopulations CD3+ (T-lymphocytes), CD4+ (helper-inducers), CD8+ (suppressors), immunoregulatory index (IRI) - ratio of CD4+/CD8+, CD19+ (B-lymphocytes); determination of IgG, IgM, IgA levels; IFN-α content. Statistical processing of research results was carried out using standard programs "Microsoft Excel 5.0" and "Statistica 8.0"

Results. Indicators of the relative and absolute content of CD8+-lymphocytes at 36 weeks of pregnancy in women of the Group I were significantly lower than the corresponding indicators in the Group II and did not differ from similar indicators of the CG. After the first course of prophylactic interferon therapy in the Group I, the average level of IFN-α differed from the initial level and from the similar indicator of the CG. In the Group II, the indicators of IFN-α at 36 weeks of gestation remained at a low level and were significantly lower when compared with similar indicators the CG. The difference between the average indicators of IRI at 36 weeks of pregnancy in the Groups I and II was significant.

Conclusions. Іmmune therapy to pregnant women with HCV infection contributed to a decrease in CD8+ lymphocytes and an increase in IRI, as well as an increase in the level of IFN-α.

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 institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Ultrasound characteristics of perinatal complications in newborns from mothers who had COVID-19 during pregnancy

G.F. Medvedenko, B.A. Tarasyuk, O.M. Dziuba, G.O. Grebinichenko — Fri, 28 Mar 2025 00:00:00 +0200

Aim - to study ultrasound signs of perinatal complications in newborns born to mothers who suffered from COVID-19 during pregnancy.

Materials and methods. All pregnant women (140 women with a positive test for COVID-19 gave birth, from whom 142 children were born (2 dichorionic, diamniotic twins) of the main group and 103 children (3 dichorionic, diamniotic twins) of the control group) underwent a full ultrasound of the fetus with fetal echocardiography, as well as an assessment of the state of the uteroplacental and fetal blood flow in different vascular pools in the period of 11-39 weeks of pregnancy to determine the presence of signs of intrauterine infection, detection of accompanying pathology, structural changes in the placenta, the amount of amniotic fluid and the degree of hemodynamic disturbances in the fetoplacental system.

Results. 20 (14%) newborns required treatment in the intensive care unit and intensive care unit after delivery. Significant changes were registered in the structure of the placenta, vessels of the subchorionic space, which was accompanied by an increase in the amount of amniotic fluid (17.1% versus 8.0% in the control group). There was an increase in the percentage of fetuses with distress (18.6% vs. 8.0%) and fetal growth retardation syndrome (11.4% vs. 3.0%) compared to the control group. It should be noted that the risk of premature birth increased in the presence of fever, hypoxemia, severe respiratory disorders and increased amounts of amniotic fluid. In the main group of newborns, in comparison with the control group, respiratory distress syndrome, pneumonia, damage to the cardiovascular system were more often noted. At the same time, the percentage of congenital malformations practically did not differ in the main and control groups, on the basis of which it can be concluded that the SARS-CoV-2 virus does not cause the formation of congenital malformations associated with this disease. Thus, detection of ventriculodilatation, pyeloectasia , and expansion of intestinal loops were the basis for urgent ultrasound of newborns. Features detected during fetal echocardiography in fetuses from mothers of the main group, namely: dilatation of the right parts of the fetal heart, thickening of the walls of the ventricles due to the endocardium with an increase in its echogenicity, disturbances of the heart rhythm and conduction, hydropericardium indicated the probability of the presence of myocarditis.

Conclusions. A complex non-invasive ultrasound examination of fetuses and newborns, when mothers are infected with COVID-19, reveals manifestations of damage to the cardiovascular, digestive, urinary systems and brain structures. The most threatening condition is myocarditis of newborns.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent was obtained from the patients for conducting the study.

The authors declare no conflict of interest.

Vitamin D deficiency and its association with fetal growth restriction in pregnant women

I.V. Poladych, S.O. Avramenko — Fri, 28 Mar 2025 00:00:00 +0200

Vitamin D deficiency is common among pregnant women and is associated with an increased risk of obstetric complications, particularly fetal growth restriction (FGR). The main pathogenetic mechanism of FGR is impaired transplacental nutrient transport due to vascular dysfunction and decreased expression of vitamin D receptors (VDR).

Aim - to determine serum vitamin D levels in pregnant women and evaluate its role in the development of FGR.

Materials and methods. A total of 140 pregnant women were examined: 90 with vitamin D deficiency and FGR (main group), and 50 with optimal 25(OH)D levels and a physiological course of pregnancy (control group). Serum levels of 25(OH)D, parathyroid hormone (PTH), calcium, and phosphorus were assessed. VDR expression in the placenta was evaluated by immunohistochemistry. Placental blood flow was assessed using Doppler ultrasonography, and fetal status was evaluated by ultrasound. Statistical analysis was performed using MedStat v.5.2 and EZR v.3.4.1, with a significance level of p<0.05.

Results. The mean serum 25(OH)D level in the main group was 15.2±5.1 ng/mL, compared to 30.5±7.4 ng/mL in the control group. Elevated PTH levels (62.3±9.5 pg/mL), decreased calcium and phosphorus concentrations, and reduced placental VDR expression were observed in the main group. These changes were associated with impaired placental blood flow (increased pulsatility and resistance indices in the umbilical artery) and the development of FGR.

Conclusions. Vitamin D deficiency contributes to the development of FGR through disruption of calcium-phosphorus metabolism, downregulation of VDR expression, and placental vascular dysfunction. Timely assessment and correction of vitamin D levels in pregnancy are essential for the prevention of adverse perinatal outcomes.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all participants.

The author declares no conflict of interest.

Stress hormone levels in women with infertility in the third year of the war in Ukraine

O.O. Berestovyi, A.R. Syzonenko, V.O. Berestovyi, D.O. Govsieiev — Fri, 28 Mar 2025 00:00:00 +0200

This paper examines the impact of chronic stress caused by the war in Ukraine on the development of mental disorders and impaired reproductive health in women. The study is based on hormonal factors, particularly prolactin and cortisol, in the context of the general adaptation syndrome. War conditions create unique stress effects that disrupt the functioning of the nervous, endocrine, and immune systems. Analysis of changes in hormonal balance is essential to understanding nature's adaptation.

The study aimed to analyze the relationship between prolactin and cortisol levels in women with infertility who are under the psychological and emotional impact of war in Ukraine.

Materials and methods. The research was conducted using statistical data on air raid alarms and three separate measurements of prolactin and cortisol levels in 23 patients with infertility.

Results. Within 108 days of research, 268 airstrikes were announced, causing anxiety over a total duration of 45,873 minutes, with an average duration of 171.2 minutes and a median of 80.5 minutes. The mean prolactin levels were 10.41±0.87, 14.34±1.57, and 20.54±5.24, while cortisol levels were 9.36±1.15, 8.49±0.80, and 9.35±1.71. Baseline prolactin levels correlated with cortisol.

Conclusion. The data obtained indicate normalization or reduction of prolactin and cortisol levels, which may suggest the development of stress resistance in patients with infertility or their presence in the second stage of the general adaptation syndrome. The results emphasize the need to revise traditional paradigms of hormonal regulation, stress factors, and infertility.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Treatment features of recurrent vulvovaginal candidiasis on the basis of papillomavirus infection

A.B. Boiko, A.A. Suchanova, S.Y. Savchenko, V.V. Konoplyanko, S.V. Dudka — Fri, 28 Mar 2025 00:00:00 +0200

Aim - evaluation of effectiveness of vaginal suppositories containing boric acid and centella asiatica (Centella asiatica) for treatment in recurrent vulvovaginal candidiasis (RVVC) on the basis of papillomavirus infection.

Materials and methods. The effectiveness of vaginal suppositories containing boric acid and centella asiatica (Centella asiatica) in treatment of RVVC in patients with papillomavirus infection was carried out. The study included 38 patients of the "Nova Medical" medical center (Vasylkiv) with RVVC, who had 3-5 repeated VVC episodes during the last year, on the basis of papillomavirus infection (confirmed by PCR). All patients received vaginal suppositories in the treatment regimen during 14 days. Statistical analysis was performed using the SPSS Statistics software (Statistica 6.0). Differences at p<0.05 are considered statistically significant.

Results. All patients before treatment had inflammatory changes of the vaginal and cervical epithelium with the confirmed candidal nature: minor reaction - 28.9%, moderate - 63.2% and severe - 7.9%. The data obtained after using vaginal suppositories containing boric acid and centella asiatica (Centella asiatica) demonstrate a significant reduction in hyperemia of the vulvovaginal zone - 84.2% and -10.5% - slight hyperemia after treatment and the disappearance of microcracks (p<0.05). The colposcopic features indicates a significant decrease in the severity of the inflammatory process of the vagina and exocervix - 86.8% (p<0.05). Microscopic examination indicates 100% presence of candidal infection before treatment versus 13.2% after treatment. (p<0.05).

Conclusions. Vulvovaginal candidiasis occurs in 59.4% of patients with papillomavirus infection. Combination of boric acid and centella asiatica (Centella asiatica) shows significant effectiveness of treatment RVVC. Clinical recovery was a total of 89.4%. Microbiological recovery was 86.8%. (p<0.05). The occurrence of repeated relapses after treatment did not have statistical significance, 13.2% of asymptomatic carriers of candidal infection required an extension of course up to 8 weeks.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Сommittee on bioethics and deontology of these institutions. Informed consent of the patients was obtained for the study.

No conflict of interests was declared by the authors.

Study of possibilities to improve the effectiveness of stress urinary incontinence treatment in menopausal women with an implanted TVT-O sling

K.I. Bohadelnikova, K.V. Chaika, O.I. Yatsyna, V.O. Rud, V.A. Shamrai — Fri, 28 Mar 2025 00:00:00 +0200

The issue of urinary disorders in postmenopausal women is receiving significant attention due to its negative impact on quality of life, social activity, and the risk of emotional and sexual dysfunction.

Aim: to investigate the potential for improving medium- and long-term outcomes of sling procedures for stress urinary incontinence using the transobturator placement of a prolene loop (TVT-Obturator, Tension-Free Vaginal Tape - Obturator, TVT-O) in combination with local estrogen therapy in postmenopausal women.

Materials and methods. A comparative study was conducted to evaluate the immediate and long-term outcomes of sling procedures for surgical correction of stress urinary incontinence in menopausal women. The study included two representative groups. Group I (n=28): Patients underwent free synthetic loop plasty (TVT) for stress urinary incontinence. Group II (n=30): Patients underwent TVT-O and received a course of natural and semi-synthetic estrogens (promestriene). Statistical data analysis was performed using SPSS 21.

Results. Two years post-surgery, patients in Group I had a significantly higher frequency of urgency and urge incontinence episodes compared to women in Group II. Additionally, the reduction in urinary incontinence episodes by ≥50% from baseline was significantly greater in Group II. At the two-year follow-up, a significantly higher number of women in Group II had a negative cough test and lower average pad weight. Moreover, the mean UDI-6 (Urogenital Distress Inventory) score in this group was significantly lower compared to Group I, indicating a more pronounced reduction in stress urinary incontinence symptoms.

Conclusions. The results of a two-year follow-up of menopausal patients after surgical treatment of stress urinary incontinence demonstrated that TVT-O surgery, in combination with a postoperative course of natural and semi-synthetic estrogen therapy (promestriene), is statistically significantly more effective than TVT surgery alone.

No conflict of interest was declared by the authors.

Impact of chronic alcohol use on the psychosocial and emotional well-being of women of fertile age with chronic inflammatory diseases caused by sexually transmitted infections

Vl.V. Podolskyi, V.V. Podolskyi, Y.M. Rybinskyі — Fri, 28 Mar 2025 00:00:00 +0200

Chronic alcohol use poses significant risks to women’s psychosocial and emotional health, particularly among those of reproductive age. The interplay of societal norms, gender dynamics, and adverse socio-economic conditions exacerbates these vulnerabilities. This study investigates the psychogenic and socio-environmental factors influencing alcohol dependence and its psychological consequences.

Aim - to assess the impact of chronic alcohol use on the psychological state, interpersonal relationships, and social adaptation of women of reproductive age, emphasizing gender-sensitive and socio-cultural considerations.

Materials and methods. A clinical study was conducted on two groups of women of reproductive age with varying patterns of alcohol use: episodic and chronic. The study involved 120 women of reproductive age, usually in the age range of 18 to 45 years, who were evenly divided into two groups. The first group consisted of 60 women who consumed alcohol episodically, and the second group included 60 women with chronic alcohol consumption. Psychological assessments included the Leary Interpersonal Test and Lüscher Color Test. Data on interpersonal behavior, stress levels, and adaptive functioning were quantitatively analyzed, highlighting correlations with socio-economic and family dynamics.

Results. Women with chronic alcohol use exhibited higher levels of psychological stress, depression, and social disintegration compared to those with episodic use. Key findings include elevated rates of depression (90%), asthenic-vegetative syndrome (50%), and maladaptive interpersonal behaviors. Chronic users demonstrated significant socio-professional declines, including loss of employment and family stability. The findings underscore the compounded impact of social stigma, early exposure to risky behaviors, and negative familial environments.

Conclusions. Chronic alcohol use significantly affects women's mental health, leading to stress, maladaptation, and strained interpersonal relationships. Effective interventions must incorporate gender-sensitive approaches, addressing societal stigmatization, providing psychological support, and fostering socio-economic stability to mitigate the impact of alcohol use.

The authors declare no conflict of interest.

The influence of ERAS recommendation implementation in surgical treatment of spontaneous pneumothorax in women

Fri, 28 Mar 2025 00:00:00 +0200

Spontaneous pneumothorax sometimes is life threatening condition which accounts from 1.2 to 15.4 cases per 100,000 of the women per year.

Aim: to analysis of results after implementation of ERAS protocols in treatment of spontaneous pneumothorax in women of different age groups for optimizing the tactic of treatment

Materials and methods. Prospective study was performed on 80 patients, age 22-62 years with spontaneous pneumothorax, were divided on 2 groups. In control group (n=40) standard perioperative treatment was performed, in main group (n=40) uniportal non-intubated video-assisted thoracic surgery with multimodal analgesia techniques and implemented ERAS components by our team. The analysis of effectiveness of different components of ERAS in preoperative, intraoperative, postoperative phases were compared in two groups. Statistic analysis was performed with «SPSS 21» program.

Results. It was established that time to decision for surgical treatment, surgery during first 48 hours from admission, not applying premedication, surgery during mensis, prophylaxis of postoperative nausea and vomiting, applying of BIS-monitoring, warming patient through the whole perioperative time, postoperative pain, time for first meal after surgery, early mobilization, number of postoperative chest X-rays before chest drain removal were statistically significant.

Conclusions. Proposed and implemented ERAS recommendations in treatment of spontaneous pneumothorax in women reduced the time to discharge criteria by 3.47 days and the length of hospital stay by 3.42 days.

No conflict of interest was declared by the authors.

Assessment of physical development indicators of preterm infants of the Carpathian region at the stage of catamnestic observation

Fri, 28 Mar 2025 00:00:00 +0200

Aim - to analyze the features of physical development of prematurely born children who were under follow-up observation during the first year of the life for early detection of deviations and their timely correction.

Materials and methods. 29 Medical records of follow-up observation of prematurely born children aged from 0 up to 12 months were processed. All prematurely born children were divided into three groups at birth: with low weight - 1500-2500 g, with very low weight - 1000-1499 g and with extremely low weight - less than 1000 g. Physical development was assessed once a month according to body weight, head circumference and body length conserning the age. The obtained data were statistically processed using Microsoft Office Excel.

Results. It was established that in 1 year the body weight in the groups I, II and III increased by 5, 6, 9 times, respectively. Head circumference during the first year in the all groups corresponded to gestational age. The increase of body length in the groups I, II and III at the age of 1 year was 1.6, 1.8, 1.9 times, respectively. The highest growth rates in the first year of the life in terms of body weight, head circumference and body length were observed in premature children in the groups III and II. “Growth graphs” showed that 93.1% of premature children had physical development below average.

Conclusions. Physical development in 93.1% of premature children was between the 9th and 25th percentiles and corresponded to gestational age. Children with extremely low and low birth weight had more intensive growth in terms of basic indicators of physical development.

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 institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Course features of IgA-associated vasculitis in children at the present stage

I.S. Lembryk, P.Z. Buiak, T.V. Shatynska, O.O. Tsytsiura, O.V. Zhyliak — Fri, 28 Mar 2025 00:00:00 +0200

IgA-associated vasculitis belongs to primary systemic vasculitides, and its frequency makes 3-27 cases per 100,000 children.

Aim - to establish the course features of IgA-associated vasculitis in children.

Materials and methods. 50 medical records of hospitalized patients who were treated at the Communal Non-Profit Enterprise "Ivano-Frankivsk Regional Children's Clinical Hospital of the Ivano-Frankivsk Regional Council" for IgA-associated vasculitis between 2015 and 2019 were analyzed. And 57 patients, aged 3 to 18 years, who were undergoing inpatient treatment between 2019 and 2024 were examined. The Group I includes 71 (66.4%) patients with IgA-vasculitis, associated with acute respiratory diseases. The Group II includes 36 (33.6%) patients with manifestation of illness after allergic reactions.

Results. Course features of vasculitis in patients of the Group I are as follows: age from 4 to 7 years (40.0% and 10.0%), duration of the disease before admission to the hospital - 14.0±2.5; male gender (71.0% and 29.0%). In patients of the Group I, the most common clinical form is articular (45.0%), while in the patients of the Group II, cutaneous (61.0%) form prevails accordingly. Kidney damage occurs in 10.0% patients of the Group I.

Conclusions. The prevalence of IgA-associated vasculitis in the Ivano-Frankivsk region coincides with similar data for Ukraine (8.0-12.0 cases per 100,000 children). The most meaningful signs in patients of the Group I includes: age, the duration of the illness before admission to the hospital, and gender features. The most common clinical form in the Group I patients is articular (45.0%), while in patients of the Group II - cutaneous (61.0%).

No conflict of interests was declared by the authors.

Improving microcirculation as a factor in the recovery of comorbid patients after surgical interventions

Iu.V. Davydova, A.Yu. Lymanska, І.G. Kryvorchuk — Fri, 28 Mar 2025 00:00:00 +0200

Aim - to study the need to optimize microcirculatory perfusion according to the literature and our own experience in order to reduce postoperative complications and speed up the recovery of surgical patients.

Perioperative recovery in comorbid patients helps prevent complications after surgery, including reducing the risk of respiratory and cardiovascular complications. However, even after optimizing macrohemodynamic parameters, some patients develop microcirculatory dysfunction, which is associated with a higher incidence of postoperative complications. Surgical intervention is a regional trauma and also causes regional microcirculatory impairment. Elevated lactate levels and a high incidence of postoperative organ damage indicate that microcirculation may be impaired in surgical patients. Stress hyperglycemia has been identified as an independent risk factor for increased mortality Potentially adverse effects of hyperinsulinemia can be corrected by the administration of polyhydric alcohols (polyols), among which xylitol occupies an important place. Correction of iron deficiency in the intensive care unit with biomarker signs of tissue hypoxia (decreased hepcidin) leads to the restoration of microcirculation and improved survival of these patients. Hyperosmolar solutions contribute to fluid moderation of the flow of fluid from the intercellular space into the vascular bed, which leads to improved microcirculation and tissue perfusion, and also has a diuretic effect and the removal of excess fluid volume.

Conclusions. The ultimate goal of hemodynamic management is the optimization of microcirculatory perfusion. Considering the multifunctionality of Reosorbilact, namely the presence of hemodynamic action, pronounced detoxification effect, improvement of microcirculation and rheology, correcting water-salt and acid-base balance, it is recommended to use it as a balanced solution to improve microcirculation in various surgical pathologies. The iron saccharate preparation Sufer allows you to fill the iron depot as quickly as possible and significantly reduce the negative impact of hemic and hypoxic hypoxia, in particular on the microcirculatory bed, by improving tissue respiration and, as a result, improving microcirculation in the area of surgical intervention, which, in turn, is the key to wound healing per prima. The introduction of the drug Xylat to patients after non-cardiosurgical interventions leads to the correction of stress hyperglycemia, a decrease in the severity of postoperative asthenia and motivates patients to an early motor regimen.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Obstetric aspects of diseases of the hepatobiliary system

A.B. Рrуlutska, L.I. Martynova, О.L. Kisilenko, T.А. Tsema, D.О. Govsіeіev — Fri, 28 Mar 2025 00:00:00 +0200

The aim is to analyze the data of modern literature on etiopathogenetic factors, diagnosis, and treatment of diseases of the hepatobiliary system in pregnant women in order to improve the tactics of pregnancy, childbirth, and the postpartum period in such women in order to reduce complications in both the mother and child.

The relevance of the problem of hepatobiliary system diseases throughout the world is described. The etiopathogenetic factors that cause the occurrence of the disease are considered. Attention is focused on the complications caused by diseases of the hepatobiliary system in pregnant women. The effectiveness of methods for diagnosing and treating pregnant women with diseases of the hepatobiliary system is analyzed. The impact of diseases of the hepatobiliary system on the course of pregnancy and childbirth is considered, in particular, the risk of miscarriage, gestosis, premature birth, placental complications, fetal hypoxia, postpartum hemorrhage, and other obstetric problems.

Conclusions. Despite modern diagnostics and pharmacological means, the problem of managing pregnancy, childbirth, and the postpartum period in pregnant women with diseases of the hepatobiliary system remains complex and is the cause of complications of both pregnancy and childbirth, leading to the impaired condition of newborns and subsequent development of children, and most importantly remains the cause of maternal and perinatal morbidity and mortality. The presented results of the studies emphasize the need to optimize the tactics of managing pregnancy, childbirth, and the postpartum period in pregnant women with diseases of the hepatobiliary system.

No conflict of interest was declared by the authors.

Atopic dermatitis in children

Fri, 28 Mar 2025 00:00:00 +0200

Aim: review of current data from scientific medical literature on the prevalence, genetic features, etiopathogenesis, approaches to diagnosis and treatment of atopic dermatitis in children.

Atopic dermatitis (AD) affects 15% to 20% of children and 5% to 20% of adolescents and is the most common chronic relapsing inflammatory skin disease in children with severe pruritus. In recent years, the incidence of AD has increased 2-3 times in industrialized countries and varies depending on the geographical region. The manifestation of AD is realized in the interaction of genetic and environmental factors. Mutations in the filaggrin gene lead to a violation of the skin barrier function and an increase in the transdermal transfer of allergens and are a significant genetic factor that contributes to the formation of both AD and AD combined with asthma in children. The severity of the course of AD depends on the intestinal microbiota, the presence of food sensitization, and food allergy. The diagnosis of AD is established on the basis of criteria Hanifin and Rajka (three main and three additional) and the British group of experts. According to the criteria of the British group, the presence of the main criterion (itching of the skin in the last 6 months) and three or more secondary criteria (onset of symptoms before the age of 2 years; damage to the flexural areas of the skin in the anamnesis; general dryness of the skin; other atopic diseases) is necessary to establish the diagnosis of AD in the anamnesis of the child or parents, siblings; dermatitis of flexural areas of the skin). Depending on the age of the child, there are baby (from birth to 2 years), childhood (2-12 years), and adolescent (from 12 years) forms of AD. For the treatment of AD in children, a step-by-step approach is used, which is based on the severity of the course of AD, using emollients, various strengths of topical glucocorticosteroids, calcineurin inhibitors, in case of a refractory course, systemic immunosuppressive therapy and biological drugs.

Conclusions. A timely diagnosis and individually selected treatment will allow parents and children to cope with the disease, avoid complications of AD and other psychosocial problems.

No conflict of interest was declared by the authors.

Modern ideas about the phenomenon of spontaneous regression of hemangiomas in children

K.V. Polkovnikova, V.S. Konoplitskyi, L.V. Fomina, Yu.Ye. Korobko — Fri, 28 Mar 2025 00:00:00 +0200

Hemangioma is the most common tumor in the newborn period, which is a benign vascular growth that consists of densely located capillaries represented by endothelial cells and pericytes, in the form of a lobular pattern with the presence of mast cells.

Aim - to highlight the current views on the peculiarities of the phenomenon of spontaneous regression in children with superficial hemangioma, the diagnosis and treatment of heart diseases according to the literature sources and personal experience.

The analysis of modern literary sources confirms the fact that if the involution of infantile hemangiomas did not take place before 5-6 years, its complete regression should not be expected; only 4-10% of capillary hemangiomas undergo spontaneous regression and only in full-term children, and cavernous and combined neoplasms do not regress. Considering the uncertainty of the prognosis of the course of hemangiomas in children, their unpredictable involutional behavior, possible residual degenerative skin changes and other complications in the process of spontaneous regression, early treatment of the pathology has gained consensus. When choosing a method of treating infantile hemangiomas, it is necessary to critically evaluate the effectiveness of the treatment method, its side effects, and the possibility of permanent cosmetic defects. Based on such potential limitations, domestic specialists proposed an algorithm for the treatment of infantile hemangiomas. The article presents two clinical cases that convincingly prove the absence of spontaneous involution in these patients, and the futile waiting for it and the lack of early treatment led to the need for surgical intervention due to the complicated course of the pathological process, with certain cosmetic losses.

Conclusions. Taking into account the analysis of literature sources, which testify to a small percentage of infantile hemangiomas, which are prone to the tendency of their complete reverse development or have statistical uncertainty in this matter, and the possibility of certain complications and cosmetic losses in the process of spontaneous involution, the choice of treatment tactics should be individual. if necessary, as early as possible, which has a decisive influence on improving the quality of life of patients in the process of their growth.

The study was conducted in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from the patients for conducting the study.

The authors declare no conflict of interest.