Навчально-науковий медичний інститут (НН МІ)
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Item Condition of fetures and newborns from women with infertility treated with assisted reproductive technologies and with concomitant intrahepatic cholestasis(Aluna Publishing, 2021) Ekom Nsed, E.N.; Boichuk, O.H.; Heryak, S.M.; Нікітіна, Ірина Миколаївна; Никитина, Ирина Николаевна; Nikitina, Iryna Mykolaivna; Khmil, S.V.; Myhovych, V.V.The aim: Improving the effects of pregnancy on the fetus and newborn through early diagnosis and timely comprehensive therapy of pregnant women with intrahepatic cholestasis. Materials and methods: We have conducted a complex examination of 60 women who got pregnant owing to assisted reproductive technologies, with concomitant intrahepatic cholestasis, and 20 practically healthy women with a physiological course of pregnancy and labor (reference group), aged between 18 and 42. The research did not involve pregnant women with chronic liver diseases, viral hepatitis, skin diseases. Womens who underwent the suggested complex drug therapy with Ursofalc, L-arginine and Omega 3, with peroral administration for 14 days according to the following scheme: Ursofalc – 250 mg once a day, L-arginine – 5 ml 3 times a day, Omega 3 – 1 capsule a day. The complex examination of pregnant women with IHC was conducted before and after treatment. We analyzed the data of anamnesis, carried out anthropometric measurements, clinical biochemical examinations of the women with IHC, including the measurement of the levels of alanine aminotransferase, aspartate aminotransferase, total and direct bilirubin, total and placental alkaline phosphatase, leucine aminopeptidase, 5’-nucleotidase, cholic, deoxycholic and chenodeoxycholic acids as wells as their total level. Results: Almost 40 % of women with intrahepatic cholestasis gave birth to babies with asphyxia, including severe one in 11.1 % of cases, 1/3 of the newborns were premature, 40% had signs of hypotrophy, and 66.7 % experienced a disturbed course of early neonatal adaptation. There was also a higher level of perinatal mortality. The newborns from women who had undergone the suggested complex therapy presented no cases of hypotrophy, prenatal infection or cerebral circulation disorder. Conclusions: Thus, functional hepatic disorders in women with infertility play a certain role in the carrying of pregnancy after ART, in the development of pregnancy complications and adverse consequences for women and their newborns. The conducted research shows that early diagnosis and timely complex therapy of pregnant women with intrahepatic cholestasis makes it possible to influence the pathogenesis of perinatal complications and improve the consequences of pregnancy for the fetus and the newborn.Item Lung ultrasound during COVID-19 pandemics: why, how and when?(Aluna Publishing, 2021) Pronyuk, K.O.; Kondratiuk, L.O.; Vysotskyi, A.D.; Golubovska, O.A.; Нікітіна, Ірина Миколаївна; Никитина, Ирина Николаевна; Nikitina, Iryna MykolaivnaThe aim: To optimize diagnostic of pathological processes in lungs affected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for confirmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinflammatory cytokines – IL-6, CRP, procalcitonin, ferritin. Diagnosis was confirmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound findings were recorded numerically based on scales. Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process affecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19.Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. Conclusions: Grading of ultrasonographic findings in the lungs was sufficient for both initial assessment with identification of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisionsItem The state of reproductive health of women with hyperproliferative pathology of the endometrium(Aluna Publishing, 2021) Нікітіна, Ірина Миколаївна; Никитина, Ирина Николаевна; Nikitina, Iryna Mykolaivna; Horban, N.Ye.; Микитин, Ксенія Вадимівна; Микитин, Ксения Вадимовна; Mykytyn, Kseniia Vadymivna; Kondratiuk, K.O.; Сміян, Світлана Анатоліївна; Смиян, Светлана Анатольевна; Smiian, Svitlana Anatoliivna; Калашник, Наталія Володимирівна; Калашник, Наталия Владимировна; Kalashnyk, Nataliia Volodymyrivna; Gerevich, N.V.The aim: To study and analyze the dynamics of women’s reproductive health in Ukraine as a factor in population reproduction and to study the features of menstrual disorders in Ukraine in 2010-2019. In women of reproductive age with hyperproliferative pathology of the endometrium without atypia. Materials and methods: A descriptive epidemiological study was conducted using data from the departmental statistical reporting of the Ministry of Health of Ukraine on the number of cases of gynecological pathology for 2010–2019. The peculiarities of menstrual function in patients of reproductive age with atypical hyperproliferative pathology of the endometrium were studied. We examined 84 patients of the gynecological department of the Sumy Regional Clinical Perinatal Center with a diagnosis of hyperproliferative pathology of the endometrium without atypia, who sought medical help during 2017-2020 for hyperplastic processes of the endometrium in reproductive age (18 to 49 years). All patients were divided into three groups, up to group I women with endometrial hyperplasia without atypia (HGE) (n = 30); Group II – patients diagnosed with endometrial polyps (n = 30); group III included patients with combined hyperproliferative pathology (uterine body polyps and endometrial hyperplasia without atypia) (n = 24). Results: As a result of the conducted systematic analysis it was established: the higher the prevalence of PMC, the higher the frequency of diseases of the genitourinary system and some gynecological diseases. This is confirmed by the calculated coefficients of correlation of the prevalence of PMC with the frequency of diseases of the genitourinary system (r = 0.75, p<0.001), salpingitis (r = 0.63, p<0.001) and endometriosis (r = 0.42, p<0, 05). The assessment of the relative risk of gynecological diseases has shown that the greatest attention needs to be paid to improving the diagnosis of infertility and endometriosis, as well as the prevention and treatment of salpingitis and uterine cancer. When women with menstrual disorders go to the gynecologist, it is necessary to pay attention to the presence of hyperproliferative pathology, and if women have other chronic diseases, offer rehabilitation of these foci, which can further have a positive effect on reproductive health. Conclusions: The highest rates of menstrual irregularities were found in women with endometrial hyperplasia without atypia and a combination diffuse hyperplasia with endometrial polyps in contrast to patients with only endometrial polyps. Menstrual irregularities can be considered as a marker and indicator of dysfunction of the genitourinary system and the presence of a hyperproliferative process at the prehospital stage.Item Estimation of relative risk of development and informativeness of diagnostic methods of hyperproliferative processes of endometrium(Aluna Publishing, 2020) Boychuk, A.V.; Vereshchahina, T.V.; Нікітіна, Ірина Миколаївна; Никитина, Ирина Николаевна; Nikitina, Iryna MykolaivnaThe aim: To conduct a comparative analysis of the results of ultrasound and hysteroscopic examinations with further histopathological findings and the clinical and anamnestic features of patients with hyperproliferative pathology in order to determine the etiopathogenetic mechanisms of the development of endometrial pathological processes. Materials and methods: We studied 119 medical records of patients of the Gynecological Department of Minipal Non-Commercial Enterprise “Ternopil Municipal City Hospital No. 2”, who applied for medical assistance because of benign endometrial hyperplasia in the reproductive age with a verified diagnosis of “uterine polyp” during 2017–2018. The control group consisted of 30 patients of the same age group, with menstrual disorders with no signs of hyperplastic processes of endometrium. With the consent of the patients, they were treated with diagnostic hysteroscopy in order to study evacuated material from the uterus. The results of the histological study confirmed the absence of signs of hyperplastic processes of endometrium. The results of diagnostic methods were evaluated by comparing the material’s histological data with the results of ultrasound and hysteroresectoscopy. Results: Taking into account the results of our research, women with hyperplastic processes of endometrium have the risk of the pathology of the nervous system is in 2.71 times higher (OR=2.71, CI–0.88: 8.33), cardiovascular pathology—in 2.04 (OR=2.04, CI–0.57:7.34), vascular diseases of the lower extremities—in 1.81 times (OR=1.81, CI–0.21:15.32) compared with the control group. While the risk of pathology of the urinary system and organs of vision is only—OR=0.48, CI–0.11:2.03 and OR=0.75, CI–0.08:7.48, respectively. Analyzing the results of the study using ultrasound examination, it was found that endometrial polyposis in combination with uterine leiomyoma was not detected in 3 women (15%), while all the results of hysteroscopy were confirmed by histopathological studies. When the endometrial hyperplastic processes were combined with adenomyosis— according to ultrasound examination a false positive result was obtained in 2 patients (13.3%), and in a hysteroscopic study we determined –1 false positive result. In patients the diagnosis of “endometrial polyp” according to the results of hysteroscopy was not confirmed in 2 women (2 false positive results 2.99%) and in 5 cases of ultrasound examination (5 false negative results 7.46%). The use of ultrasound examinations in patients with endometrial hyperplastic changes, according to our data, made it possible to identify pathology in 88.39% of cases, while the information content of the hysteroscopy was 98.21% (p<0.001). Conclusions: Thus, the results of the subjective examination of patients in the gynecological department: complaints, anamnestic data on gynecological and extragenital pathology should be used to identify etiopathogenetic factors and the formation of risk groups for the occurrence of hyperplastic processes of endometrium. Women with cervical erosion, uterine myoma and episodes of herpetic rash on the mucous membranes in past medical history have a higher likelihood of hyperplastic processes of endometrium. The vast majority of patients (63.87%) with polyps of the body of the uterus have a combined hyperproliferative pathology, which requires an individual approach to planning the scope of diagnostic examination and the choice of treatment method. Visualization of endometrium with hysteroscopy is more informative than ultrasound for diagnosing hyperproliferative processes, including uterine polyps. Hysteroscopic polypectomy has a high level of both clinical and economic benefits as well as diagnostic value in patients with hyperplastic processes of endometrium.