PhD, Pediatrician, neonatologist, doctoral candidate of the High School of Health and Social Sciences of St. Elizabeth in Bratislava, MBA - Master of Business Administration.
Authors: Krolak-Ulinska A., Dobrovanov. O.
Gram-negative bacteria pose a significant threat as pr... more Authors: Krolak-Ulinska A., Dobrovanov. O. Gram-negative bacteria pose a significant threat as primary agents of infection in septic shock, a condition with high mortality rates in intensive care patients. To combat this, chemists develop antibiotic drugs fortified with protective agents, such as carbapenemase inhibitors, to counter bacterial resistance mechanisms. This study aims to evaluate the clinical efficacy of two antibiotic combinations, imipenem/cilastatin/ relebactam (IMI/REL) and piperacillin/tazobactam (PIP/TAZ), in the treatment of septic shock caused by gram-negative bacteria. Seventeen patients diagnosed with septic shock were divided into Group 1 with IMI/ REL and Group 2 with PIP/TAZ. All patients received antishock treatment, renal replacement therapy, and ventilation. Bacteriological detection identified four gram-negative pathogens in biological samples, with further phenotyping and genotyping confirming resistance mechanisms. Both IMI/REL and PIP/TAZ exhibited notable resistance against Acinetobacter baumannii and Pseudomonas aeruginosa. Metallo- β-lactamases and class D carbapenem hydrolysing oxacillinase were detected in Acinetobacter baumannii. Therapy of IMI/REL and PIP/TAZ proved to be ineffectual in patients afflicted with these strains, leading to fatalities. The study highlights the ineffectiveness of IMI/REL and PIP/TAZ in treating septic shock caused by highly resistant gram-negative bacteria. The results of this study are crucial for guiding future clinical trials and strategic decisionmaking regarding the use of beta-lactam antibiotics combined with inhibitors. Keywords: Antishock treatment, Acinetobacter baumannii, antibiotic therapy, genotyping, clinical effectiveness.
Authors: Lisnyy I., Zakalska K., Dmytriiev D., Dobrovanov O., Sydorenko K., Horkavyi Y., Naumenko... more Authors: Lisnyy I., Zakalska K., Dmytriiev D., Dobrovanov O., Sydorenko K., Horkavyi Y., Naumenko A., Pikulskyi V., Yegorov I., Perkonos A., Balakhonov O., Vorobiov S., Prokopets A., Holovko V., Nesterenko O. Aim: Evaluation of the efficacy of intravenous lidocaine admi- nistration during surgical interventions in gynecologic oncolo- gy. Materials and Methods: A single-center randomized study. The study included 170 patients who underwent total hyste- rectomy or subtotal hysterectomy. The control group (Contr. Gr. ) received anesthesia based on fentanyl, propofol, and atracurium. The intravenous lidocaine administration group (ILA Gr. ) received 1 mg/kg/h lidocaine during anesthesia and 24 hs postoperatively. Final assessment: postoperative pain intensity (NRS), opioid requirement during surgery and posto- peratively, stress response assessment, and postoperative sleep quality. Results: 163 patients completed the study. Two patients in the IV lidocaine group and five patients in the control group were excluded from the analysis. At the time of surgery, the total fentanyl dose was 23 % lower in Contr. Gr. but the severity of the surgical stress response was more prominent in ILA Gr. ; blood glucose levels were 17 % higher in ILA Gr. at the end of surgery compared to Contr. Gr. In the postoperative period, pain intensity according to NRS was not statistically significan- tly different between the study groups 24 hs after surgery. The quality of sleep was better in ILA Gr. There were no significant differences in the dose of morphine for postoperative anesthe- sia between the study groups. Conclusions: Intravenous administration in the perioperative period in patients after gynecologic oncology surgeries did not improve the quality of perioperative anesthesia and did not significantly reduce the dose of opioid analgesics during anesthesia and within a day of the postoperative period (Tab. 2, Fig. 6, Ref. 37). KEY WORDS: intravenous lidocaine infusion, gynecologic on- cology surgery, pain, stress response.
Authors: Dobrovanov O., Topolsky I., Furkova K.
In an effort to help patients with COVID-19, vari... more Authors: Dobrovanov O., Topolsky I., Furkova K. In an effort to help patients with COVID-19, various treatment protocols have been developed and are constantly changing. Various antivirals and other potentially useful drugs (often "off label", without prior approval or testing) have been used in treatment. Currently, thanks to quick decisions regarding the treatment and prevention of the COVID-19 disease, it has been possible to stabilize the situation all over the world. The relatively rapid development of vaccines against SARS-CoV-2 with the aim of achieving collective immunity also has a large share in this. On the other hand, "quick decisions" contributed to the emergence of such problems as adverse effects of the drugs used. In the article, we want to draw the attention of the wider public to the other side of the treatment of the disease COVID-19, namely the possibility of iatrogeny, which significantly contributes to the emergence of post-covid syndrome and chronic pain. We place more emphasis on the importance of preventive measures than on the uncertain outcome of the treatment of the disease COVID-19. Key words: iatrogeny, chronic pain, co-morbidity, pain syndrome, pandemic COVID-19, SARS-CoV-2, post-covid syndrome
Authors: Semkovych Y., Dmytriiev D., Dobrovanov O.
Background. The aim of the study was to assess... more Authors: Semkovych Y., Dmytriiev D., Dobrovanov O. Background. The aim of the study was to assess changes in the serum CD40L level and its potential relationship with pain intensity in children after anterior abdominal wall surgery on the background of general anaesthesia and its combination with various RA techniques. Materials and methods. The study included 87 children who underwent anterior abdominal wall surgery using different analgesic techniques. All children were divided into 3 groups: Group I - 33 children - general anaesthesia using morphine; Group II - 27 children - general anaesthesia using the transversalis fascia plane block (TFPB); Group III - 27 children - general anaesthesia using the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection. Results. In Group I, 2 hours after surgery, the mean serum level of CD40L was 4,283 pg/ml, with a slight downward trend at discharge (UMann-Whitney=52.5; р=0.593). In Group II, the level of CD40L reduced significantly by 25.3% (UMann-Whitney=10.0; р=0.002); 24 hours after surgery, the level of CD40L reduced by 15.1% (UMann-Whitney= 26.0; р=0.20). At discharge, the level of CD40L in this group reduced significantly by 54.4% (UMann-Whitney=7.0; р=0.003). In Group III, during all observation periods, the mean serum level of CD40L was 4-7.6 times lower (UMann-Whitney=0.0; р=0.000) than corresponding levels in children of Group II. Conclusion. The indicators of CD40L signalling were found to increase in paediatric anterior abdominal wall surgeries. There was a close positive correlation between postsurgical pain intensity and CD40L serum levels. Single-injection TFBP+QLB-4 resulted in the lowest serum CD40L levels, an indicative of the lowest intensity of postsurgical pain. Clinical Trial registration. The study is a fragment of the research project “Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129 (Ivano-Frankivsk National Medical University). Keywords: regional analgesia, CD40L, postsurgical pain, children, pain management
Autors: Mayer A., Kucera A., Brychta I., Dobrovanov O., Vidiscak M.
Meckel's diverticulum (MD) i... more Autors: Mayer A., Kucera A., Brychta I., Dobrovanov O., Vidiscak M. Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its prevalence in the general population is 0.9-3.0%. Among the malignant neoplasms of MD, carcinoids and gastrointestinal stromal tumors are predominant. Adenocarcinomas account for less than 6.0% of all associated malignancies. We present a rare clinical case of a 67-year-old patient with gastric-type adenocarcinoma in MD, with metastatic foci in both lobes of the liver at diagnosis. This case demonstrates the diagnostic and therapeutic procedures that led to correct diagnosis and satisfactory treatment outcomes. This case emphasized the importance of using all the possibilities in the diagnosis and treatment and the necessity of cooperation with other experts in properly managing this disease. We also expressed an opinion about considering prophylactic resection of an intraoperatively discovered MD.
Authors: Nazarchuk O., Denysko T., Nagaichuk V., Chornopyschuk R., Nazarchuk H., Burkot V., Bobyr... more Authors: Nazarchuk O., Denysko T., Nagaichuk V., Chornopyschuk R., Nazarchuk H., Burkot V., Bobyr V., Dobrovanov O. The aim of this work was to study the antimicrobial activity of antiseptics against planktonic bacterial forms and biofilm formation of multidrug-resistant (MDR) clinical strains of K. pneumoniae isolated from infected wounds of patients with combat trauma during the war in Ukraine. Materials and Methods. The activity of antiseptics was determined against clinical antibiotic-resistant strains of K. pneumoniae (n=34). Clinical strains were isolated from patients with infectious complications of combat burn and shrapnel wounds of different localization, received during war conflict in Ukraine in the period since 24 of February to April of 2022. Results. Determining the activity of antiseptics against K. pneumoniae in planktonic form, high efficiency of the main surfactant active antiseptics was revealed. The highest activity against clinical strains of K. pneumoniae among the studied antiseptics from the group of quaternary ammonium compounds (QAC) was found in decamethoxine, miramistinand octenidine. IAA (index of antiseptic activity) values were highest (IAA >4) for the antiseptics decamethoxine (0.1%), octenidine (0.1%), and polyhexanide (0.1%). Conclusions. Determination of anti-biofilm forming activity showed that sub-bacteriostatic concentrations of chlorhexidine, decamethoxin, miramistin, octenidine, polyhexanide and povidone-iodineinhibited the formation of K. pneumoniae biofilms, but decamethoxine, polyhexanide and povidone-iodine had exhibited the most pronounced effect. Based on the analysis of all conducted studies, 0.1% and 0.02% decamethoxine, 0.01% miramistin, 0.05% chlorhexidine, 0.1% octenidine, 0.1% polyhexanide, 10% povidone-iodine are the effective agents against MDR clinical isolates of K. pneumoniae.
Authors: Semkovych Y., Dobrovanov O., Dmytriiev D.
Lek. Obzor, Bratislava: Herba, 2023, 72(10): 4... more Authors: Semkovych Y., Dobrovanov O., Dmytriiev D. Lek. Obzor, Bratislava: Herba, 2023, 72(10): 460-465. ISSN 0457-4214. The aim of the study was to evaluate the prevalence of chronic postsurgical pain in children three and six months after anterior abdominal wall surgery and to assess the use of different anesthetic approaches for its prevention. Materials and Methods. The study included 60 (35 boys and 25 girls) children at the age of 7 – 18 years who were treated at the surgical department and underwent anterior abdominal wall surgery. Group I – 30 children who were operated on under general anesthesia using the transversalis fascia plane block, combined with the quadratus lumborum block 4 via a single injection; Group II – 30 children who were operated on under general anesthesia using opioids. The assessment of acute pain and the quality of pain management was carried out by means of the Visual Analogue Scale (VAS), the Face, Legs, Activity, Cry, Consolability (FLACC) scale, the Behavioral Pain Scale. The DN-4 neuropathic pain diagnostic questionna- ire and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale were used to assess the presence of chronic or neuropathic pain. The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Differences were considered statistically significant at p < 0.05. The proportions were statistically compared by a z-test. Results. The analysis of the acute pain assessment scores in children revealed that children of Group II, while staying in the surgical department, had significantly higher FLACC and VAS scores as compared to those in Group I. On the first, second, and third days of hospital stay, pain intensity was greater in Group II (FLACC – 5.5 ± 0.22, 4.52 ± 0.14, 4.0 ± 0.16, VAS – 5.36 ± 0.18, 4.48 ± 0.16, 3.95 ± 0.11, respectively, p < 0.05) as compared to Group I (FLACC – 4.7 ± 0.17, 3.91 ± 0.28, 3.22 ± 0.22, VAS – 4.76 ± 0.28, 3.58 ± 0.28, 3.2 ± 0.36, respectively, р < 0.05) The analysis of questionnaires for chronic pain assessment in children (DN-4 questionnaire, LANSS pain scale) found that in Group II, the prevalence of chronic pain syndrome was greater (~20 %) as compared to Group I (9 %). Conclusions. The advantages of the transversalis fascia plane block and the ultrasound-guided quadratus lumborum block via a single injection include ease of administration, effective perioperative pain management, reduced need for opioid analgesics and non-steroidal anti-inflammatory drugs periope ratively, and a shortened length of hospital stay. KEY WORDS: acute postsurgical pain, chronic postsurgical pain, transversal fascia plane block, quadratus lumborum block, pain management, prevention.
Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I. and Vidiscak M.
Meckel’s diverticulum is... more Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I. and Vidiscak M. Meckel’s diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population of 0.9–3 %. Among the malignant neoplasms associated with Meckel’s diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage, with adenocarcinomas accounting for less than 6% of all associated malignancies. The authors present a rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel’s diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel’s diverticulum. Key words: adenocarcinoma, Meckel’s diverticulum, liver, metastases, treatment
Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I., Vidiscak M.
Meckel's diverticulum is t... more Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I., Vidiscak M. Meckel's diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population of 0.9-3%. Of the malignant neoplasias of Meckel's diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage; the prevalence of adenocarcinomas is less than 6% of all associated malignancies. The authors present the rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel's diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel's diverticulum.
Authors: Nazarchuk O., Melnichenko M., Dmytriiev D., Bahniuk N., Levchenko B., Grebeniuk D., Duda... more Authors: Nazarchuk O., Melnichenko M., Dmytriiev D., Bahniuk N., Levchenko B., Grebeniuk D., Dudar A., Dobrovanov O. The aim of the study is to evaluate the dynamics of TLR-4 levels and microbial colonization in patients with infectious respiratory complications with different treatment strategies. Materials and Methods. 20 children in each group with different approaches to treatment - in the main observation group in the complex of antimicrobial treatment at the same time with empirically prescribed standard antibiotic therapy we used inhalation of quaternary ammonium compound (decamethoxine) through a nebulizer from the appearance of clinical signs of VAP, and the treatment of patients in the control group was carried out in accordance with generally accepted recommendations with the use of systemic antibacterial and symptomatic therapy. Results. It was found that the level of TLR-4 in the serum clearly correlates with the dynamics of the infectious process and the microbiological status of patients. Conclusions. The determination of the level of TLR-4 can serve as a diagnostic criterion for the development of severe bacterial disease and evaluate the effectiveness of the selected treatment regimen. Key words: VAP, children, toll-like receptors 4, quaternary ammonium compound, decamethoxine.
Dobrovanov O. Vitamíny – cesta k zdraviu. Abstrakty - XXXII. Getlíkov deň. Pediatria (Bratisl.) 2... more Dobrovanov O. Vitamíny – cesta k zdraviu. Abstrakty - XXXII. Getlíkov deň. Pediatria (Bratisl.) 2023; 18(2): 97-98. ISSN 1336-863X. DOI: 10.13140/RG.2.2.10881.63847 Vitamins are organic substances that every living organism needs. Although the body needs some vitamins only in trace amounts, it is very important that we have them regularly added to the body. Vitamins belong together with proteins, fats and carbohydrates to the basic components of food, in the human body they have the function of catalysts biochemical reactions. Our organism needs them for its existence, but it cannot make them as a rule synthesize, and therefore must obtain them from food. We call such nutrients essential. In ideally, we would need to replenish all the necessary vitamins quantities, a varied and varied diet should have been enough. However, this is not the reality for many people... You also have to think about the fact that every organism is unique and some groups of people they need more of some vitamins and less of others. For example, physically active people may need an increased amount of vitamins, pregnant women or smokers.
Open Access Macedonian Journal of Medical Sciences
BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care sys... more BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care system and clinical, medical, and social research. Untreated chronic pain in children increases the risk of developing mental disorders later in life. The pediatric QoL inventory 3.0 (PedsQL™) is one of the most valid and widely used tools for assessing pediatric QoL. AIM: The study was to assess QoL in children with chronic postsurgical pain 7 days, 3 months, and 6 months after surgery with different analgesic techniques by means of the PedsQL™ 3.0 Family Impact Module questionnaires. METHODS: Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council” were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic techniques. The patients were...
Open Access Macedonian Journal of Medical Sciences., 2023
Authors: Semkovych Y., Dmytriiev D., Dobrovanov O.
BACKGROUND: The concept of quality of life (Qo... more Authors: Semkovych Y., Dmytriiev D., Dobrovanov O. BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care system and clinical, medical, and social research. Untreated chronic pain in children increases the risk of developing mental disorders later in life. The pediatric QoL inventory 3.0 (PedsQL™) is one of the most valid and widely used tools for assessing pediatric QoL. AIM: The study was to assess QoL in children with chronic postsurgical pain 7 days, 3 months, and 6 months after surgery with different analgesic techniques by means of the PedsQL™ 3.0 Family Impact Module questionnaires. METHODS: Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise "Ivano-Frankivsk Regional Children's Clinical Hospital of Ivano-Frankivsk Regional Council" were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic techniques. The patients were asked to fill in the questionnaires repeatedly 3 and 6 months after hospital discharge. RESULTS: QoL in patients with chronic pain syndrome reduced significantly (p < 0.001) on the scales of physical functioning, emotional functioning, social functioning, cognitive functioning, communication, worry, daily activities, family relationships, as well as pediatric QoL summary score, parent QoL summary score, and family functioning summary score 3 and 6 months after surgery with conventional analgesic techniques. CONCLUSIONS: Chronic pain syndrome reduces QoL in children aged 7-18 years after anterior abdominal wall surgery by reducing their physical, emotional, social, and cognitive functioning. The myofascial block in conjunction with general anesthesia accelerates patient's recovery, relieves pain, and reduces emotional stress.
Authors: Dobrovanov O., Hrebik M.
The article points to modern ideas about the various causes of ... more Authors: Dobrovanov O., Hrebik M. The article points to modern ideas about the various causes of arrhythmias in children and adolescents. It also presents a working classification of arrhythmias based on their pathophysiological mechanisms, a brief diagnosis of arrhythmias including clinical criteria, various instrumental and ultrasound examination methods; described group of life-threatening arrhythmias, which are considered one of the main causes of sudden cardiac death. The characteristics of each type of life-threatening arrhythmia are listed at the end of the article. Treatment includes medical and surgical methods. Key words: children's ambulance, cardiac arrhythmias, life-threatening arrhythmias, diagnosis, treatment
Festival kazuistík z Pediatrie 2023, 16. ročník (Žilina, Holiday Inn Žilina****, 24.-25.03.2023).... more Festival kazuistík z Pediatrie 2023, 16. ročník (Žilina, Holiday Inn Žilina****, 24.-25.03.2023). Abstrakt book, 2023, s. 10-11. ISBN 978-80-972948-8-5.
Authors: Semenenko S., Semenenko A., Dobrovanov O., Saienko A., Semenenko N., Dmytriiev D., Konov... more Authors: Semenenko S., Semenenko A., Dobrovanov O., Saienko A., Semenenko N., Dmytriiev D., Konovalova N. Background: Currently, the problem of choosing an effective drug approach for cerebral protection in case of traumatic brain injury (TBI) remains poorly understood. The synthesis and development of new active molecules to treat brain disorders rely on an in-depth understanding of the pathophysiological mechanisms of brain disorders and the role of excessive activation of NMDA receptors. Clinical studies of cerebral protectors, specifically NMDA-receptor antagonists, show promising results for their use in treating TBIs. Materials and methods: A TBI rat model was used to investigate the effect of Ademol (2 mg/kg) given intravenously (IV) every 12 hours for eight days following the TBI. The control group and pseudo-operated animals received 0.9 % NaCl (2 mg/kg, IV). The comparison group received amantadine sulfate (5 mg/kg, IV). The efficiency and activity of these therapies were evaluated by measuring the protein S100 levels in each group. Results: Protein S100 levels in the groups with a TBI and treated with Ademol or amantadine sulfate were decreased by 50.8 and 39.9 %, respectively. Treatment of rats with severe TBI with Ademol was probably better than treatment of rats in the control group with saline and amantadine sulfate and better helped to reduce the growth of protein S 100 level, while Ademol exceeded the reference drug at 18.2 % (p < 0.05). Conclusion: Treatment of rats with severe traumatic brain injury with Ademol at a dose of 2 mg/kg (i/v) was probably better than treatment of rats in the control group with saline and amantadine sulfate.
Autors: Semenkovych Y., Semenkovych M., Synoverska O., Dobrovanov O.
Subcutaneous emphysema of t... more Autors: Semenkovych Y., Semenkovych M., Synoverska O., Dobrovanov O. Subcutaneous emphysema of the head, neck, and mediastinum occurs most commonly in head and neck surgery, tracheal and esophageal injuries, facial skeleton injuries, foreign bodies in the gastrointestinal tract and gastrointestinal neoplasms, pulmonary barotrauma during mechanical ventilation, and after dental procedures, which is extremely rare. The tooth preparation with a high-speed air turbine handpiece allows air to penetrate the mediastinum through the fascial spaces of the neck. Therefore, swelling of the face, neck, and upper body may often be misdiagnosed as an anaphylactic reaction to local or general anesthetics or other preparations used in dentistry. The paper presents a case of spontaneous pneumomediastinumand tension pneumothorax in a 2,5-year-old child after dental procedure. Dental treatment (extraction of 2 teeth, root canal filling of the mandibular right first molar) was carried out under general anesthesia. The early postoperative period was uneventful. In two hours, the parents with their child left private health care facility. Three hours after dental procedure, the parents noticed the child to develop an indurative edema of the right side of the face and neck, and immediately applied to the hospital. The therapy for angioedema was administered. Six hours after beginning therapy, there was observed a crepitation in the neck (circularly) and upper chest. The child was urgently transferred to the Department of Anesthesiology and Intensive Care of the Ivano-Frankivsk Regional Children’s Clinical Hospital. Pneumomediastinum was diagnosed via chest X-ray. Diagnostic bronchoscopy was performed under general anesthesia to exclude traumas to the laryngeal mucosa or injuries to the tracheobronchial tree. No visible local damage to the area examined was found. Drainage of the anterior mediastinum was performed emergently to save the child’s life. A control chest X-ray taken in two hours showed right-sided tension pneumothorax; the chest X-ray taken in four hours revealed left-sided spontaneous pneumothorax; the pleural cavities were drained using the Bülau-principle. Considering the increased cost of breathing and hypoxemia, the child was intubated and controlled mechanical ventilation was initiated. On the background of clinical improvement, the child was electively disintubated on the second day. The drainage tubes were removed from the pleural sinuses in 5 days. The control chest X-ray showed an improvement. The child was transferred to the Pulmonology Department and, on the 7th day of hospital stay, it was discharged home after recovery.
Authors: Dobrovanov O., Nazarchuk O., Dmytriieva K.
On the eve of the season of respiratory infec... more Authors: Dobrovanov O., Nazarchuk O., Dmytriieva K. On the eve of the season of respiratory infections, we would like to draw the attention of outpatient doctors to the fact that 80–90 percent of winter diseases affecting the nose, ears, throat and lungs are of viral origin. Improper and excessive consumption of antibiotics increases the risk of antibiotic resistance, and thus humanity enters the post-antibiotic era. The World Health Organization warns that the problems that antibiotic resistance could cause in the future can be compared to the spread of AIDS in the 1980s. The principles of rational use of antibiotics should always be based on the assumption that antibiotics are causal drugs, and their overuse very often leads to resistance, which negatively affects the entire population. Irrational antibiotic therapy can also lead to discomfort, worsening of acute and chronic pain. It is also important to know that in the post-antibiotic era, science has other options for fighting bacteria, such as vaccination, immunotherapy, and strengthening individual immunity. The correct attitude of doctors to the prevention of diseases and rational treatment with antibiotics can help reduce the resistance of bacterial strains, discomfort and pain.
Authors: Krolak-Ulinska A., Dobrovanov. O.
Gram-negative bacteria pose a significant threat as pr... more Authors: Krolak-Ulinska A., Dobrovanov. O. Gram-negative bacteria pose a significant threat as primary agents of infection in septic shock, a condition with high mortality rates in intensive care patients. To combat this, chemists develop antibiotic drugs fortified with protective agents, such as carbapenemase inhibitors, to counter bacterial resistance mechanisms. This study aims to evaluate the clinical efficacy of two antibiotic combinations, imipenem/cilastatin/ relebactam (IMI/REL) and piperacillin/tazobactam (PIP/TAZ), in the treatment of septic shock caused by gram-negative bacteria. Seventeen patients diagnosed with septic shock were divided into Group 1 with IMI/ REL and Group 2 with PIP/TAZ. All patients received antishock treatment, renal replacement therapy, and ventilation. Bacteriological detection identified four gram-negative pathogens in biological samples, with further phenotyping and genotyping confirming resistance mechanisms. Both IMI/REL and PIP/TAZ exhibited notable resistance against Acinetobacter baumannii and Pseudomonas aeruginosa. Metallo- β-lactamases and class D carbapenem hydrolysing oxacillinase were detected in Acinetobacter baumannii. Therapy of IMI/REL and PIP/TAZ proved to be ineffectual in patients afflicted with these strains, leading to fatalities. The study highlights the ineffectiveness of IMI/REL and PIP/TAZ in treating septic shock caused by highly resistant gram-negative bacteria. The results of this study are crucial for guiding future clinical trials and strategic decisionmaking regarding the use of beta-lactam antibiotics combined with inhibitors. Keywords: Antishock treatment, Acinetobacter baumannii, antibiotic therapy, genotyping, clinical effectiveness.
Authors: Lisnyy I., Zakalska K., Dmytriiev D., Dobrovanov O., Sydorenko K., Horkavyi Y., Naumenko... more Authors: Lisnyy I., Zakalska K., Dmytriiev D., Dobrovanov O., Sydorenko K., Horkavyi Y., Naumenko A., Pikulskyi V., Yegorov I., Perkonos A., Balakhonov O., Vorobiov S., Prokopets A., Holovko V., Nesterenko O. Aim: Evaluation of the efficacy of intravenous lidocaine admi- nistration during surgical interventions in gynecologic oncolo- gy. Materials and Methods: A single-center randomized study. The study included 170 patients who underwent total hyste- rectomy or subtotal hysterectomy. The control group (Contr. Gr. ) received anesthesia based on fentanyl, propofol, and atracurium. The intravenous lidocaine administration group (ILA Gr. ) received 1 mg/kg/h lidocaine during anesthesia and 24 hs postoperatively. Final assessment: postoperative pain intensity (NRS), opioid requirement during surgery and posto- peratively, stress response assessment, and postoperative sleep quality. Results: 163 patients completed the study. Two patients in the IV lidocaine group and five patients in the control group were excluded from the analysis. At the time of surgery, the total fentanyl dose was 23 % lower in Contr. Gr. but the severity of the surgical stress response was more prominent in ILA Gr. ; blood glucose levels were 17 % higher in ILA Gr. at the end of surgery compared to Contr. Gr. In the postoperative period, pain intensity according to NRS was not statistically significan- tly different between the study groups 24 hs after surgery. The quality of sleep was better in ILA Gr. There were no significant differences in the dose of morphine for postoperative anesthe- sia between the study groups. Conclusions: Intravenous administration in the perioperative period in patients after gynecologic oncology surgeries did not improve the quality of perioperative anesthesia and did not significantly reduce the dose of opioid analgesics during anesthesia and within a day of the postoperative period (Tab. 2, Fig. 6, Ref. 37). KEY WORDS: intravenous lidocaine infusion, gynecologic on- cology surgery, pain, stress response.
Authors: Dobrovanov O., Topolsky I., Furkova K.
In an effort to help patients with COVID-19, vari... more Authors: Dobrovanov O., Topolsky I., Furkova K. In an effort to help patients with COVID-19, various treatment protocols have been developed and are constantly changing. Various antivirals and other potentially useful drugs (often "off label", without prior approval or testing) have been used in treatment. Currently, thanks to quick decisions regarding the treatment and prevention of the COVID-19 disease, it has been possible to stabilize the situation all over the world. The relatively rapid development of vaccines against SARS-CoV-2 with the aim of achieving collective immunity also has a large share in this. On the other hand, "quick decisions" contributed to the emergence of such problems as adverse effects of the drugs used. In the article, we want to draw the attention of the wider public to the other side of the treatment of the disease COVID-19, namely the possibility of iatrogeny, which significantly contributes to the emergence of post-covid syndrome and chronic pain. We place more emphasis on the importance of preventive measures than on the uncertain outcome of the treatment of the disease COVID-19. Key words: iatrogeny, chronic pain, co-morbidity, pain syndrome, pandemic COVID-19, SARS-CoV-2, post-covid syndrome
Authors: Semkovych Y., Dmytriiev D., Dobrovanov O.
Background. The aim of the study was to assess... more Authors: Semkovych Y., Dmytriiev D., Dobrovanov O. Background. The aim of the study was to assess changes in the serum CD40L level and its potential relationship with pain intensity in children after anterior abdominal wall surgery on the background of general anaesthesia and its combination with various RA techniques. Materials and methods. The study included 87 children who underwent anterior abdominal wall surgery using different analgesic techniques. All children were divided into 3 groups: Group I - 33 children - general anaesthesia using morphine; Group II - 27 children - general anaesthesia using the transversalis fascia plane block (TFPB); Group III - 27 children - general anaesthesia using the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection. Results. In Group I, 2 hours after surgery, the mean serum level of CD40L was 4,283 pg/ml, with a slight downward trend at discharge (UMann-Whitney=52.5; р=0.593). In Group II, the level of CD40L reduced significantly by 25.3% (UMann-Whitney=10.0; р=0.002); 24 hours after surgery, the level of CD40L reduced by 15.1% (UMann-Whitney= 26.0; р=0.20). At discharge, the level of CD40L in this group reduced significantly by 54.4% (UMann-Whitney=7.0; р=0.003). In Group III, during all observation periods, the mean serum level of CD40L was 4-7.6 times lower (UMann-Whitney=0.0; р=0.000) than corresponding levels in children of Group II. Conclusion. The indicators of CD40L signalling were found to increase in paediatric anterior abdominal wall surgeries. There was a close positive correlation between postsurgical pain intensity and CD40L serum levels. Single-injection TFBP+QLB-4 resulted in the lowest serum CD40L levels, an indicative of the lowest intensity of postsurgical pain. Clinical Trial registration. The study is a fragment of the research project “Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129 (Ivano-Frankivsk National Medical University). Keywords: regional analgesia, CD40L, postsurgical pain, children, pain management
Autors: Mayer A., Kucera A., Brychta I., Dobrovanov O., Vidiscak M.
Meckel's diverticulum (MD) i... more Autors: Mayer A., Kucera A., Brychta I., Dobrovanov O., Vidiscak M. Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its prevalence in the general population is 0.9-3.0%. Among the malignant neoplasms of MD, carcinoids and gastrointestinal stromal tumors are predominant. Adenocarcinomas account for less than 6.0% of all associated malignancies. We present a rare clinical case of a 67-year-old patient with gastric-type adenocarcinoma in MD, with metastatic foci in both lobes of the liver at diagnosis. This case demonstrates the diagnostic and therapeutic procedures that led to correct diagnosis and satisfactory treatment outcomes. This case emphasized the importance of using all the possibilities in the diagnosis and treatment and the necessity of cooperation with other experts in properly managing this disease. We also expressed an opinion about considering prophylactic resection of an intraoperatively discovered MD.
Authors: Nazarchuk O., Denysko T., Nagaichuk V., Chornopyschuk R., Nazarchuk H., Burkot V., Bobyr... more Authors: Nazarchuk O., Denysko T., Nagaichuk V., Chornopyschuk R., Nazarchuk H., Burkot V., Bobyr V., Dobrovanov O. The aim of this work was to study the antimicrobial activity of antiseptics against planktonic bacterial forms and biofilm formation of multidrug-resistant (MDR) clinical strains of K. pneumoniae isolated from infected wounds of patients with combat trauma during the war in Ukraine. Materials and Methods. The activity of antiseptics was determined against clinical antibiotic-resistant strains of K. pneumoniae (n=34). Clinical strains were isolated from patients with infectious complications of combat burn and shrapnel wounds of different localization, received during war conflict in Ukraine in the period since 24 of February to April of 2022. Results. Determining the activity of antiseptics against K. pneumoniae in planktonic form, high efficiency of the main surfactant active antiseptics was revealed. The highest activity against clinical strains of K. pneumoniae among the studied antiseptics from the group of quaternary ammonium compounds (QAC) was found in decamethoxine, miramistinand octenidine. IAA (index of antiseptic activity) values were highest (IAA >4) for the antiseptics decamethoxine (0.1%), octenidine (0.1%), and polyhexanide (0.1%). Conclusions. Determination of anti-biofilm forming activity showed that sub-bacteriostatic concentrations of chlorhexidine, decamethoxin, miramistin, octenidine, polyhexanide and povidone-iodineinhibited the formation of K. pneumoniae biofilms, but decamethoxine, polyhexanide and povidone-iodine had exhibited the most pronounced effect. Based on the analysis of all conducted studies, 0.1% and 0.02% decamethoxine, 0.01% miramistin, 0.05% chlorhexidine, 0.1% octenidine, 0.1% polyhexanide, 10% povidone-iodine are the effective agents against MDR clinical isolates of K. pneumoniae.
Authors: Semkovych Y., Dobrovanov O., Dmytriiev D.
Lek. Obzor, Bratislava: Herba, 2023, 72(10): 4... more Authors: Semkovych Y., Dobrovanov O., Dmytriiev D. Lek. Obzor, Bratislava: Herba, 2023, 72(10): 460-465. ISSN 0457-4214. The aim of the study was to evaluate the prevalence of chronic postsurgical pain in children three and six months after anterior abdominal wall surgery and to assess the use of different anesthetic approaches for its prevention. Materials and Methods. The study included 60 (35 boys and 25 girls) children at the age of 7 – 18 years who were treated at the surgical department and underwent anterior abdominal wall surgery. Group I – 30 children who were operated on under general anesthesia using the transversalis fascia plane block, combined with the quadratus lumborum block 4 via a single injection; Group II – 30 children who were operated on under general anesthesia using opioids. The assessment of acute pain and the quality of pain management was carried out by means of the Visual Analogue Scale (VAS), the Face, Legs, Activity, Cry, Consolability (FLACC) scale, the Behavioral Pain Scale. The DN-4 neuropathic pain diagnostic questionna- ire and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale were used to assess the presence of chronic or neuropathic pain. The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Differences were considered statistically significant at p < 0.05. The proportions were statistically compared by a z-test. Results. The analysis of the acute pain assessment scores in children revealed that children of Group II, while staying in the surgical department, had significantly higher FLACC and VAS scores as compared to those in Group I. On the first, second, and third days of hospital stay, pain intensity was greater in Group II (FLACC – 5.5 ± 0.22, 4.52 ± 0.14, 4.0 ± 0.16, VAS – 5.36 ± 0.18, 4.48 ± 0.16, 3.95 ± 0.11, respectively, p < 0.05) as compared to Group I (FLACC – 4.7 ± 0.17, 3.91 ± 0.28, 3.22 ± 0.22, VAS – 4.76 ± 0.28, 3.58 ± 0.28, 3.2 ± 0.36, respectively, р < 0.05) The analysis of questionnaires for chronic pain assessment in children (DN-4 questionnaire, LANSS pain scale) found that in Group II, the prevalence of chronic pain syndrome was greater (~20 %) as compared to Group I (9 %). Conclusions. The advantages of the transversalis fascia plane block and the ultrasound-guided quadratus lumborum block via a single injection include ease of administration, effective perioperative pain management, reduced need for opioid analgesics and non-steroidal anti-inflammatory drugs periope ratively, and a shortened length of hospital stay. KEY WORDS: acute postsurgical pain, chronic postsurgical pain, transversal fascia plane block, quadratus lumborum block, pain management, prevention.
Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I. and Vidiscak M.
Meckel’s diverticulum is... more Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I. and Vidiscak M. Meckel’s diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population of 0.9–3 %. Among the malignant neoplasms associated with Meckel’s diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage, with adenocarcinomas accounting for less than 6% of all associated malignancies. The authors present a rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel’s diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel’s diverticulum. Key words: adenocarcinoma, Meckel’s diverticulum, liver, metastases, treatment
Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I., Vidiscak M.
Meckel's diverticulum is t... more Authors: Mayer A., Kuchera A., Dobrovanov O., Brychta I., Vidiscak M. Meckel's diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population of 0.9-3%. Of the malignant neoplasias of Meckel's diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage; the prevalence of adenocarcinomas is less than 6% of all associated malignancies. The authors present the rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel's diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel's diverticulum.
Authors: Nazarchuk O., Melnichenko M., Dmytriiev D., Bahniuk N., Levchenko B., Grebeniuk D., Duda... more Authors: Nazarchuk O., Melnichenko M., Dmytriiev D., Bahniuk N., Levchenko B., Grebeniuk D., Dudar A., Dobrovanov O. The aim of the study is to evaluate the dynamics of TLR-4 levels and microbial colonization in patients with infectious respiratory complications with different treatment strategies. Materials and Methods. 20 children in each group with different approaches to treatment - in the main observation group in the complex of antimicrobial treatment at the same time with empirically prescribed standard antibiotic therapy we used inhalation of quaternary ammonium compound (decamethoxine) through a nebulizer from the appearance of clinical signs of VAP, and the treatment of patients in the control group was carried out in accordance with generally accepted recommendations with the use of systemic antibacterial and symptomatic therapy. Results. It was found that the level of TLR-4 in the serum clearly correlates with the dynamics of the infectious process and the microbiological status of patients. Conclusions. The determination of the level of TLR-4 can serve as a diagnostic criterion for the development of severe bacterial disease and evaluate the effectiveness of the selected treatment regimen. Key words: VAP, children, toll-like receptors 4, quaternary ammonium compound, decamethoxine.
Dobrovanov O. Vitamíny – cesta k zdraviu. Abstrakty - XXXII. Getlíkov deň. Pediatria (Bratisl.) 2... more Dobrovanov O. Vitamíny – cesta k zdraviu. Abstrakty - XXXII. Getlíkov deň. Pediatria (Bratisl.) 2023; 18(2): 97-98. ISSN 1336-863X. DOI: 10.13140/RG.2.2.10881.63847 Vitamins are organic substances that every living organism needs. Although the body needs some vitamins only in trace amounts, it is very important that we have them regularly added to the body. Vitamins belong together with proteins, fats and carbohydrates to the basic components of food, in the human body they have the function of catalysts biochemical reactions. Our organism needs them for its existence, but it cannot make them as a rule synthesize, and therefore must obtain them from food. We call such nutrients essential. In ideally, we would need to replenish all the necessary vitamins quantities, a varied and varied diet should have been enough. However, this is not the reality for many people... You also have to think about the fact that every organism is unique and some groups of people they need more of some vitamins and less of others. For example, physically active people may need an increased amount of vitamins, pregnant women or smokers.
Open Access Macedonian Journal of Medical Sciences
BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care sys... more BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care system and clinical, medical, and social research. Untreated chronic pain in children increases the risk of developing mental disorders later in life. The pediatric QoL inventory 3.0 (PedsQL™) is one of the most valid and widely used tools for assessing pediatric QoL. AIM: The study was to assess QoL in children with chronic postsurgical pain 7 days, 3 months, and 6 months after surgery with different analgesic techniques by means of the PedsQL™ 3.0 Family Impact Module questionnaires. METHODS: Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council” were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic techniques. The patients were...
Open Access Macedonian Journal of Medical Sciences., 2023
Authors: Semkovych Y., Dmytriiev D., Dobrovanov O.
BACKGROUND: The concept of quality of life (Qo... more Authors: Semkovych Y., Dmytriiev D., Dobrovanov O. BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care system and clinical, medical, and social research. Untreated chronic pain in children increases the risk of developing mental disorders later in life. The pediatric QoL inventory 3.0 (PedsQL™) is one of the most valid and widely used tools for assessing pediatric QoL. AIM: The study was to assess QoL in children with chronic postsurgical pain 7 days, 3 months, and 6 months after surgery with different analgesic techniques by means of the PedsQL™ 3.0 Family Impact Module questionnaires. METHODS: Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise "Ivano-Frankivsk Regional Children's Clinical Hospital of Ivano-Frankivsk Regional Council" were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic techniques. The patients were asked to fill in the questionnaires repeatedly 3 and 6 months after hospital discharge. RESULTS: QoL in patients with chronic pain syndrome reduced significantly (p < 0.001) on the scales of physical functioning, emotional functioning, social functioning, cognitive functioning, communication, worry, daily activities, family relationships, as well as pediatric QoL summary score, parent QoL summary score, and family functioning summary score 3 and 6 months after surgery with conventional analgesic techniques. CONCLUSIONS: Chronic pain syndrome reduces QoL in children aged 7-18 years after anterior abdominal wall surgery by reducing their physical, emotional, social, and cognitive functioning. The myofascial block in conjunction with general anesthesia accelerates patient's recovery, relieves pain, and reduces emotional stress.
Authors: Dobrovanov O., Hrebik M.
The article points to modern ideas about the various causes of ... more Authors: Dobrovanov O., Hrebik M. The article points to modern ideas about the various causes of arrhythmias in children and adolescents. It also presents a working classification of arrhythmias based on their pathophysiological mechanisms, a brief diagnosis of arrhythmias including clinical criteria, various instrumental and ultrasound examination methods; described group of life-threatening arrhythmias, which are considered one of the main causes of sudden cardiac death. The characteristics of each type of life-threatening arrhythmia are listed at the end of the article. Treatment includes medical and surgical methods. Key words: children's ambulance, cardiac arrhythmias, life-threatening arrhythmias, diagnosis, treatment
Festival kazuistík z Pediatrie 2023, 16. ročník (Žilina, Holiday Inn Žilina****, 24.-25.03.2023).... more Festival kazuistík z Pediatrie 2023, 16. ročník (Žilina, Holiday Inn Žilina****, 24.-25.03.2023). Abstrakt book, 2023, s. 10-11. ISBN 978-80-972948-8-5.
Authors: Semenenko S., Semenenko A., Dobrovanov O., Saienko A., Semenenko N., Dmytriiev D., Konov... more Authors: Semenenko S., Semenenko A., Dobrovanov O., Saienko A., Semenenko N., Dmytriiev D., Konovalova N. Background: Currently, the problem of choosing an effective drug approach for cerebral protection in case of traumatic brain injury (TBI) remains poorly understood. The synthesis and development of new active molecules to treat brain disorders rely on an in-depth understanding of the pathophysiological mechanisms of brain disorders and the role of excessive activation of NMDA receptors. Clinical studies of cerebral protectors, specifically NMDA-receptor antagonists, show promising results for their use in treating TBIs. Materials and methods: A TBI rat model was used to investigate the effect of Ademol (2 mg/kg) given intravenously (IV) every 12 hours for eight days following the TBI. The control group and pseudo-operated animals received 0.9 % NaCl (2 mg/kg, IV). The comparison group received amantadine sulfate (5 mg/kg, IV). The efficiency and activity of these therapies were evaluated by measuring the protein S100 levels in each group. Results: Protein S100 levels in the groups with a TBI and treated with Ademol or amantadine sulfate were decreased by 50.8 and 39.9 %, respectively. Treatment of rats with severe TBI with Ademol was probably better than treatment of rats in the control group with saline and amantadine sulfate and better helped to reduce the growth of protein S 100 level, while Ademol exceeded the reference drug at 18.2 % (p < 0.05). Conclusion: Treatment of rats with severe traumatic brain injury with Ademol at a dose of 2 mg/kg (i/v) was probably better than treatment of rats in the control group with saline and amantadine sulfate.
Autors: Semenkovych Y., Semenkovych M., Synoverska O., Dobrovanov O.
Subcutaneous emphysema of t... more Autors: Semenkovych Y., Semenkovych M., Synoverska O., Dobrovanov O. Subcutaneous emphysema of the head, neck, and mediastinum occurs most commonly in head and neck surgery, tracheal and esophageal injuries, facial skeleton injuries, foreign bodies in the gastrointestinal tract and gastrointestinal neoplasms, pulmonary barotrauma during mechanical ventilation, and after dental procedures, which is extremely rare. The tooth preparation with a high-speed air turbine handpiece allows air to penetrate the mediastinum through the fascial spaces of the neck. Therefore, swelling of the face, neck, and upper body may often be misdiagnosed as an anaphylactic reaction to local or general anesthetics or other preparations used in dentistry. The paper presents a case of spontaneous pneumomediastinumand tension pneumothorax in a 2,5-year-old child after dental procedure. Dental treatment (extraction of 2 teeth, root canal filling of the mandibular right first molar) was carried out under general anesthesia. The early postoperative period was uneventful. In two hours, the parents with their child left private health care facility. Three hours after dental procedure, the parents noticed the child to develop an indurative edema of the right side of the face and neck, and immediately applied to the hospital. The therapy for angioedema was administered. Six hours after beginning therapy, there was observed a crepitation in the neck (circularly) and upper chest. The child was urgently transferred to the Department of Anesthesiology and Intensive Care of the Ivano-Frankivsk Regional Children’s Clinical Hospital. Pneumomediastinum was diagnosed via chest X-ray. Diagnostic bronchoscopy was performed under general anesthesia to exclude traumas to the laryngeal mucosa or injuries to the tracheobronchial tree. No visible local damage to the area examined was found. Drainage of the anterior mediastinum was performed emergently to save the child’s life. A control chest X-ray taken in two hours showed right-sided tension pneumothorax; the chest X-ray taken in four hours revealed left-sided spontaneous pneumothorax; the pleural cavities were drained using the Bülau-principle. Considering the increased cost of breathing and hypoxemia, the child was intubated and controlled mechanical ventilation was initiated. On the background of clinical improvement, the child was electively disintubated on the second day. The drainage tubes were removed from the pleural sinuses in 5 days. The control chest X-ray showed an improvement. The child was transferred to the Pulmonology Department and, on the 7th day of hospital stay, it was discharged home after recovery.
Authors: Dobrovanov O., Nazarchuk O., Dmytriieva K.
On the eve of the season of respiratory infec... more Authors: Dobrovanov O., Nazarchuk O., Dmytriieva K. On the eve of the season of respiratory infections, we would like to draw the attention of outpatient doctors to the fact that 80–90 percent of winter diseases affecting the nose, ears, throat and lungs are of viral origin. Improper and excessive consumption of antibiotics increases the risk of antibiotic resistance, and thus humanity enters the post-antibiotic era. The World Health Organization warns that the problems that antibiotic resistance could cause in the future can be compared to the spread of AIDS in the 1980s. The principles of rational use of antibiotics should always be based on the assumption that antibiotics are causal drugs, and their overuse very often leads to resistance, which negatively affects the entire population. Irrational antibiotic therapy can also lead to discomfort, worsening of acute and chronic pain. It is also important to know that in the post-antibiotic era, science has other options for fighting bacteria, such as vaccination, immunotherapy, and strengthening individual immunity. The correct attitude of doctors to the prevention of diseases and rational treatment with antibiotics can help reduce the resistance of bacterial strains, discomfort and pain.
Autors: Konoplitskyi V., Dmytriiev D., Sidoryk M., Dobrovanov O., Vidiscak M.
Objective: Rare di... more Autors: Konoplitskyi V., Dmytriiev D., Sidoryk M., Dobrovanov O., Vidiscak M. Objective: Rare disease Background: The conflict in Ukraine during the past year has resulted in increased deaths and injuries to soldiers and civilians from military weapons and large and small caliber firearms. Unlike clinicians in some Western countries, until recently, clinicians working in Ukraine hospitals had little experience managing patients with gunshot wounds. Case Report: A 16-year-old boy was admitted as an emergency following a gunshot wound to the back of the neck from a Makarov pistol. The gun was reported to have been fired at a distance of more than 15 cm. Imaging showed the 9-mm bullet hit the cervical spine, causing nerve root involvement at C4 to C7, traveled upwards, and lodged in the left posterior maxilla. On examination, the patient had facial asymmetry and paralysis of the left shoulder, arm, hand, and wrist and was in pain and shock. Intubation and emergency surgery were performed, with the removal of a 9×18-mm bullet shell from the pterygopalatine fossa, deep to the infratemporal fossa, and posterior to the maxilla. The patient underwent postoperative physical therapy and continues to improve his physical function. Conclusions: This report has shown the importance of immediate evaluation of gunshot wounds so that surgery can be planned and performed rapidly, with a view to postoperative recovery and active physical therapy.
Autors: Kovacova D., Dobrovanov O.
Lymphadenopathy in children is a common finding but often a di... more Autors: Kovacova D., Dobrovanov O. Lymphadenopathy in children is a common finding but often a diagnostic problem for the physician. Seventy percent of all lymphadenopathies are localized and of these, more than 50% are located in the head and neck region. Reactive hyperplasia due to infectious stimulation is the most common cause of lymphadenopathy in childhood. Since lymphadenopathy is a nonspecific clinical manifestation of various diseases, differential diagnosis should cover a wide spectrum of diseases. Key words: cause, childhood, diagnosis, differential lymphadenopathy
18. medzinárodná vedecko-odborná konferencia SPOLUPRÁCA POMÁHAJÚCICH PROFESIÍ POĽSKO – ČESKO – SLOVENSKÉ ŠTÚDIE, 2023
Authors: Dobrovanov Oleksandr, Richard Bárta
Introduction: In an effort to help patients with COV... more Authors: Dobrovanov Oleksandr, Richard Bárta Introduction: In an effort to help patients with COVID-19, various treatment protocols havebeen developed and are constantly changing. Various antivirals and other potentially usefuldrugs (often "off label", without prior approval or testing) have been used in treatment. Thanksto quick decisions, it was possible to stabilize the situation with the pandemic all over the world.The relatively rapid development of vaccines against SARS-CoV-2 with the aim of achievingcollective immunity also has a large share in this. On the other hand, "quick decisions"contributed to the emergence of such problems as adverse effects of the drugs used.Focus: In the post, we want to draw the attention of the wider public to the other side of thetreatment of the disease COVID-19, namely the possibility of iatrogeny, which significantlycontributes to the emergence of post-covid syndrome and chronic pain. We place moreemphasis on the importance of preventive measures than on the uncertain outcome of thetreatment of the disease COVID-19.
18. medzinárodná vedecko-odborná konferencia SPOLUPRÁCA POMÁHAJÚCICH PROFESIÍ POĽSKO – ČESKO – SLOVENSKÉ ŠTÚDIE, 2023
Authors: Bárta Richard, Dobrovanov Oleksandr
Introduction: The paper will introduce the issue of ... more Authors: Bárta Richard, Dobrovanov Oleksandr Introduction: The paper will introduce the issue of domestic violence against women and the possibilities of assistance from the perspective of social work. Focus: The main objective of our research was to explore the issue of domestic violence against women and the possibilities of assistance from a social work perspective. We set ourselves partial goals, to find out what forms of domestic violence the participants suffered from, to find out what was the trigger for domestic violence, to find out under what circumstances they left the aggressor, to find out who they asked for help, to find out how professional help was provided. Material and Methods: It consists of interviews with six women from the Košice region. All women have been victims of domestic violence and each of them is the mother of a minor child(s). We chose interview as the method. The interviews were conducted individually, there was a personal meeting with each of the women. The women answered the questions asked. The entire course of the conversations was recorded on a dictaphone, and subsequently these answers were transcribed into text form. Results: We found that every woman can be a victim of domestic violence, regardless of age, occupation, education or social status. Leaving the aggressor is not easy. Domestic violence leaves consequences not only on victims of domestic violence, but also on minor children. Conclusion: Through our work, we have demonstrated that it is essential to address the issue of domestic violence against women and the possibilities of assistance from a social work perspective.
The authors compare the effectiveness and sensitivity of prenatal and postnatal sonographic diagn... more The authors compare the effectiveness and sensitivity of prenatal and postnatal sonographic diagnosis of congenital kidneys malformations, underline the importance of postnatal diagnosis in the Slovak Republic.
Autors: Shul'ga D.I., Lojko E.E., Sasjuk A.I., Dobrovanov O.
A new surgical technique is offered... more Autors: Shul'ga D.I., Lojko E.E., Sasjuk A.I., Dobrovanov O. A new surgical technique is offered correct reliably the congenital pectus carinatum (I-III degrees) in children, to reduce significantly the surgical traumatism and to improve the cosmetic results.
Погорілий В.В., Кукуруза Ю.П., Шульга Д.І., Лойко Є.Є., Фомін О.О., Зябченко І.С., Федчишин О.П.,... more Погорілий В.В., Кукуруза Ю.П., Шульга Д.І., Лойко Є.Є., Фомін О.О., Зябченко І.С., Федчишин О.П., Доброванов О.Є., Сасюк А.І., Череповський В.В. Збірник наукових праць XV з’їзду ортопедів-травматологів України (Abstract book of XV congress of orthopaedists and traumatologists of Ukraine). м. Дніпропетровськ, 16-18 вересня, 2010.
Каблукова Е.К., Сторожук И.В., Шаламай М.А., Доброванов А.Е., Кондратюк Л.В. Матеріали науково-пр... more Каблукова Е.К., Сторожук И.В., Шаламай М.А., Доброванов А.Е., Кондратюк Л.В. Матеріали науково-практичної конференції з міждународною участю “Функціональні розлади травлення у дітей раннього віку, їх профілактика та лікування”, 16-17 березня, м. Київ, 2006.
Сторожук И.В., Шаламай М.А., Доброванов А.Е., Сауленко Т.А., Однорогова Г.Г.
Актуальні питання ст... more Сторожук И.В., Шаламай М.А., Доброванов А.Е., Сауленко Т.А., Однорогова Г.Г. Актуальні питання стратегії, тактики застосування та дослідження антибіотиків, антисептиків, дезінфекантів. 9-10 листопада, 2006. Вінниця.
Zborník abstraktov Festival Kazuistík z pediatrie 2021. , 2021
Zborník abstraktov Festival Kazuistík z pediatrie 2021. (1.-2. október 2021, Žilina, Slovensko): ... more Zborník abstraktov Festival Kazuistík z pediatrie 2021. (1.-2. október 2021, Žilina, Slovensko): s. 8-9. ISBN 978-80-972948-4-7
Autors: Krčméry V., Hricák V., Lišková A., Dobrovanov O., Bernadič M.
ISBN 978-80-8229-029-8.
V... more Autors: Krčméry V., Hricák V., Lišková A., Dobrovanov O., Bernadič M. ISBN 978-80-8229-029-8.
Venovanie
Venujeme pamiatke prof. MUDr. Vladimíra Krčméryho, DrSc., FRSP, FACP, FRCP, Dr. h. c. mult. (23.7.1960 - 20.12.2022), iniciátora, autora a editora piatich vydaní Manuálu - tabelária antimikróbnej terapie v SR (1969), ako poďakovanie za vzor obetavého lekára, vedca a učiteľa, organizátora medicíny nielen na Slovensku, za dlhoročnú odbornú a vedeckú spoluprácu na mnohých projektoch, za spoluprácu s vydavateľstvom Herba, za dlhoročné rozsiahle humanitárne, charitatívne a misijné aktivity v prospech ľudí v krízových životných situáciách na celom svete. Za to, že za splnením aj nesplniteľných cieľov vždy šiel s nádejou, odhodlaním a modlitbou v srdci...
Autor: Oleksandr Dobrovanov, ISBN 978-80-8229-026-7
Kniha „Vitamíny – cesta k vášmu zdraviu“ vyda... more Autor: Oleksandr Dobrovanov, ISBN 978-80-8229-026-7 Kniha „Vitamíny – cesta k vášmu zdraviu“ vydavateľstva HERBA (www.shopherba.sk) je napísaná v zaujímavej forme tak, aby bola pochopiteľná a použiteľná nielen pre odbornú, ale aj pre laickú verejnosť. Na začiatku opisu každého vitamínu sú obrázky s krátkou charakteristikou vitamínu, jeho biologickou úlohou, príznakmi deficitu, dennou potrebou a rizikovými prejavmi deficitu. Opísané aj zdroje potravín, ktoré obsahujú ten-ktorý vitamín. Informácie podané z dnešného moderného pohľadu. Mottom knihy je Hippokratov citát „Nech potraviny sú tvojimi liekmi, nie lieky tvojou potravou“. Kniha harmonicky doplňuje moderný pohľad na Pediatriu a medzeru v literatúre, nakoľko doteraz v Slovenskej odbornej pediatrickej literatúre vitamíny neboli spomínané samostatne, ale len v rámci niektorých súvisiacich s nimi ochorení.
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Gram-negative bacteria pose a significant threat as primary agents of infection in septic shock, a condition with high mortality rates in intensive care patients. To combat this, chemists develop antibiotic drugs
fortified with protective agents, such as carbapenemase inhibitors, to counter bacterial resistance mechanisms. This study aims to evaluate the clinical efficacy of two antibiotic combinations, imipenem/cilastatin/
relebactam (IMI/REL) and piperacillin/tazobactam (PIP/TAZ), in the treatment of septic shock caused by gram-negative bacteria. Seventeen patients diagnosed with septic shock were divided into Group 1 with IMI/
REL and Group 2 with PIP/TAZ. All patients received antishock treatment, renal replacement therapy, and ventilation. Bacteriological detection identified four gram-negative pathogens in biological samples,
with further phenotyping and genotyping confirming resistance mechanisms. Both IMI/REL and PIP/TAZ exhibited notable resistance against Acinetobacter baumannii and Pseudomonas aeruginosa. Metallo-
β-lactamases and class D carbapenem hydrolysing oxacillinase were detected in Acinetobacter baumannii. Therapy of IMI/REL and PIP/TAZ proved to be ineffectual in patients afflicted with these strains,
leading to fatalities. The study highlights the ineffectiveness of IMI/REL and PIP/TAZ in treating septic shock caused by highly resistant gram-negative bacteria. The results of this study are crucial for guiding future clinical trials and strategic decisionmaking regarding the use of beta-lactam antibiotics combined with inhibitors.
Keywords: Antishock treatment, Acinetobacter baumannii, antibiotic therapy, genotyping, clinical effectiveness.
Aim: Evaluation of the efficacy of intravenous lidocaine admi-
nistration during surgical interventions in gynecologic oncolo-
gy.
Materials and Methods: A single-center randomized study.
The study included 170 patients who underwent total hyste-
rectomy or subtotal hysterectomy. The control group (Contr.
Gr. ) received anesthesia based on fentanyl, propofol, and
atracurium. The intravenous lidocaine administration group
(ILA Gr. ) received 1 mg/kg/h lidocaine during anesthesia and
24 hs postoperatively. Final assessment: postoperative pain
intensity (NRS), opioid requirement during surgery and posto-
peratively, stress response assessment, and postoperative
sleep quality.
Results: 163 patients completed the study. Two patients in the
IV lidocaine group and five patients in the control group were
excluded from the analysis. At the time of surgery, the total
fentanyl dose was 23 % lower in Contr. Gr. but the severity of
the surgical stress response was more prominent in ILA Gr. ;
blood glucose levels were 17 % higher in ILA Gr. at the end of
surgery compared to Contr. Gr. In the postoperative period,
pain intensity according to NRS was not statistically significan-
tly different between the study groups 24 hs after surgery. The
quality of sleep was better in ILA Gr. There were no significant
differences in the dose of morphine for postoperative anesthe-
sia between the study groups.
Conclusions: Intravenous administration in the perioperative
period in patients after gynecologic oncology surgeries did
not improve the quality of perioperative anesthesia and did not
significantly reduce the dose of opioid analgesics during
anesthesia and within a day of the postoperative period (Tab.
2, Fig. 6, Ref. 37).
KEY WORDS: intravenous lidocaine infusion, gynecologic on-
cology surgery, pain, stress response.
In an effort to help patients with COVID-19, various treatment protocols have been developed and are constantly changing. Various antivirals and other potentially useful drugs (often "off label", without prior approval or testing) have been used in treatment. Currently, thanks to quick decisions regarding the treatment and prevention of the COVID-19 disease, it has been possible to stabilize the situation all over the world. The relatively rapid development of vaccines against SARS-CoV-2 with the aim of achieving collective immunity also has a large share in this. On the other hand, "quick decisions" contributed to the emergence of such problems as adverse effects of the drugs used. In the article, we want to draw the attention of the wider public to the other side of the treatment of the disease COVID-19, namely the possibility of iatrogeny, which significantly contributes to the emergence of post-covid syndrome and chronic pain. We place more emphasis on the importance of preventive measures than on the uncertain outcome of the treatment of the disease COVID-19.
Key words: iatrogeny, chronic pain, co-morbidity, pain syndrome, pandemic COVID-19, SARS-CoV-2, post-covid syndrome
Background. The aim of the study was to assess changes in the serum CD40L level and its potential relationship with pain intensity in children after anterior abdominal wall surgery on the background of general anaesthesia and its combination with various RA techniques.
Materials and methods. The study included 87 children who underwent anterior abdominal wall surgery using different analgesic techniques. All children were divided into 3 groups: Group I - 33 children - general anaesthesia using morphine; Group II - 27 children - general anaesthesia using the transversalis fascia plane block (TFPB); Group III - 27 children - general anaesthesia using the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection.
Results. In Group I, 2 hours after surgery, the mean serum level of CD40L was 4,283 pg/ml, with a slight downward trend at discharge (UMann-Whitney=52.5; р=0.593). In Group II, the level of CD40L reduced significantly by 25.3% (UMann-Whitney=10.0; р=0.002); 24 hours after surgery, the level of CD40L reduced by 15.1% (UMann-Whitney= 26.0; р=0.20). At discharge, the level of CD40L in this group reduced significantly by 54.4% (UMann-Whitney=7.0; р=0.003). In Group III, during all observation periods, the mean serum level of CD40L was 4-7.6 times lower (UMann-Whitney=0.0; р=0.000) than corresponding levels in children of Group II.
Conclusion. The indicators of CD40L signalling were found to increase in paediatric anterior abdominal wall surgeries. There was a close positive correlation between postsurgical pain intensity and CD40L serum levels. Single-injection TFBP+QLB-4 resulted in the lowest serum CD40L levels, an indicative of the lowest intensity of postsurgical pain.
Clinical Trial registration. The study is a fragment of the research project “Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129 (Ivano-Frankivsk National Medical University).
Keywords: regional analgesia, CD40L, postsurgical pain, children, pain management
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its prevalence in the general population is 0.9-3.0%. Among the malignant neoplasms of MD, carcinoids and gastrointestinal stromal tumors are predominant. Adenocarcinomas account for less than 6.0% of all associated malignancies. We present a rare clinical case of a 67-year-old patient with gastric-type adenocarcinoma in MD, with metastatic foci in both lobes of the liver at diagnosis. This case demonstrates the diagnostic and therapeutic procedures that led to correct diagnosis and satisfactory treatment outcomes. This case emphasized the importance of using all the possibilities in the diagnosis and treatment and the necessity of cooperation with other experts in properly managing this disease. We also expressed an opinion about considering prophylactic resection of an intraoperatively discovered MD.
The aim of this work was to study the antimicrobial activity of antiseptics against planktonic bacterial forms and biofilm formation of multidrug-resistant (MDR) clinical strains of K. pneumoniae isolated from infected wounds of patients with combat trauma during the war in Ukraine.
Materials and Methods. The activity of antiseptics was determined against clinical antibiotic-resistant strains of K. pneumoniae (n=34). Clinical strains were isolated from patients with infectious complications of combat burn and shrapnel wounds of different localization, received during war conflict in Ukraine in the period since 24 of February to April of 2022.
Results. Determining the activity of antiseptics against K. pneumoniae in planktonic form, high efficiency of the main surfactant active antiseptics was revealed. The highest activity against clinical strains of K. pneumoniae among the studied antiseptics from the group of quaternary ammonium compounds (QAC) was found in decamethoxine, miramistinand octenidine. IAA (index of antiseptic activity) values were highest (IAA >4) for the antiseptics decamethoxine (0.1%), octenidine (0.1%), and polyhexanide (0.1%).
Conclusions. Determination of anti-biofilm forming activity showed that sub-bacteriostatic concentrations of chlorhexidine, decamethoxin, miramistin, octenidine, polyhexanide and povidone-iodineinhibited the formation of K. pneumoniae biofilms, but decamethoxine, polyhexanide and povidone-iodine had exhibited the most pronounced effect. Based on the analysis of all conducted studies, 0.1% and 0.02% decamethoxine, 0.01% miramistin, 0.05% chlorhexidine, 0.1% octenidine, 0.1% polyhexanide, 10% povidone-iodine are the effective agents against MDR clinical isolates of K. pneumoniae.
Lek. Obzor, Bratislava: Herba, 2023, 72(10): 460-465. ISSN 0457-4214.
The aim of the study was to evaluate the prevalence of chronic postsurgical pain in children three and six months after anterior abdominal wall surgery and to assess the use of different anesthetic approaches for its prevention.
Materials and Methods. The study included 60 (35 boys and 25 girls) children at the age of 7 – 18 years who were treated at the surgical department and underwent anterior abdominal wall surgery. Group I – 30 children who were operated on under general anesthesia using the transversalis fascia plane block, combined with the quadratus lumborum block 4 via a single injection; Group II – 30 children who were operated on under general anesthesia using opioids. The assessment of acute pain and the quality of pain management was carried out by means of the Visual Analogue Scale (VAS), the Face, Legs, Activity, Cry, Consolability (FLACC) scale, the Behavioral Pain Scale. The DN-4 neuropathic pain diagnostic questionna- ire and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale were used to assess the presence of chronic or neuropathic pain. The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Differences were considered statistically significant at p < 0.05. The proportions were statistically compared by a z-test. Results. The analysis of the acute pain assessment scores in children revealed that children of Group II, while staying in the surgical department, had significantly higher FLACC and VAS scores as compared to those in Group I. On the first, second, and third days of hospital stay, pain intensity was greater in Group II (FLACC – 5.5 ± 0.22, 4.52 ± 0.14, 4.0 ± 0.16, VAS – 5.36 ± 0.18, 4.48 ± 0.16, 3.95 ± 0.11, respectively, p < 0.05) as compared to Group I (FLACC – 4.7 ± 0.17, 3.91 ± 0.28, 3.22 ± 0.22, VAS – 4.76 ± 0.28, 3.58 ± 0.28, 3.2 ± 0.36, respectively, р < 0.05) The analysis of questionnaires for chronic pain assessment in children (DN-4 questionnaire, LANSS pain scale) found that in Group II, the prevalence of chronic pain syndrome was greater (~20 %) as compared to Group I (9 %).
Conclusions. The advantages of the transversalis fascia plane block and the ultrasound-guided quadratus lumborum block via a single injection include ease of administration, effective perioperative pain management, reduced need for opioid analgesics and non-steroidal anti-inflammatory drugs periope ratively, and a shortened length of hospital stay.
KEY WORDS: acute postsurgical pain, chronic postsurgical pain, transversal fascia plane block, quadratus lumborum block, pain management, prevention.
Meckel’s diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population
of 0.9–3 %. Among the malignant neoplasms associated with Meckel’s diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage, with adenocarcinomas accounting for less than 6% of all associated malignancies. The authors present a rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel’s diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel’s diverticulum.
Key words: adenocarcinoma, Meckel’s diverticulum, liver, metastases, treatment
Meckel's diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population of 0.9-3%. Of the malignant neoplasias of Meckel's diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage; the prevalence of adenocarcinomas is less than 6% of all associated malignancies. The authors present the rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel's diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel's diverticulum.
The aim of the study is to evaluate the dynamics of TLR-4 levels and microbial colonization in patients with infectious respiratory complications with different treatment strategies.
Materials and Methods. 20 children in each group with different approaches to treatment - in the main observation group in the complex of antimicrobial treatment at the same time with empirically prescribed standard antibiotic therapy we used inhalation of quaternary ammonium compound (decamethoxine) through a nebulizer from the appearance of clinical signs of VAP, and the treatment of patients in the control group was carried out in accordance with generally accepted recommendations with the use of systemic antibacterial and symptomatic therapy.
Results. It was found that the level of TLR-4 in the serum clearly correlates with the dynamics of the infectious process and the microbiological status of patients.
Conclusions. The determination of the level of TLR-4 can serve as a diagnostic criterion for the development of severe bacterial disease and evaluate the effectiveness of the selected treatment regimen.
Key words: VAP, children, toll-like receptors 4, quaternary ammonium compound, decamethoxine.
Vitamins are organic substances that every living organism needs. Although the body needs some vitamins only in trace amounts, it is very important that we have them regularly added to the body. Vitamins belong together with proteins, fats and carbohydrates to the basic components of food, in the human body they have the function of catalysts biochemical reactions. Our organism needs them for its existence, but it cannot make them as a rule synthesize, and therefore must obtain them from food. We call such nutrients essential. In ideally, we would need to replenish all the necessary vitamins quantities, a varied and varied diet should have been enough. However, this is not the reality for many people...
You also have to think about the fact that every organism is unique and some groups of people they need more of some vitamins and less of others. For example, physically active people may need an increased amount of vitamins, pregnant women or smokers.
BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care system and clinical, medical, and social research. Untreated chronic pain in children increases the risk of developing mental disorders later in life. The pediatric QoL inventory 3.0 (PedsQL™) is one of the most valid and widely used tools for assessing pediatric QoL. AIM: The study was to assess QoL in children with chronic postsurgical pain 7 days, 3 months, and 6 months after surgery with different analgesic techniques by means of the PedsQL™ 3.0 Family Impact Module questionnaires. METHODS: Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise "Ivano-Frankivsk Regional Children's Clinical Hospital of Ivano-Frankivsk Regional Council" were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic techniques. The patients were asked to fill in the questionnaires repeatedly 3 and 6 months after hospital discharge. RESULTS: QoL in patients with chronic pain syndrome reduced significantly (p < 0.001) on the scales of physical functioning, emotional functioning, social functioning, cognitive functioning, communication, worry, daily activities, family relationships, as well as pediatric QoL summary score, parent QoL summary score, and family functioning summary score 3 and 6 months after surgery with conventional analgesic techniques. CONCLUSIONS: Chronic pain syndrome reduces QoL in children aged 7-18 years after anterior abdominal wall surgery by reducing their physical, emotional, social, and cognitive functioning. The myofascial block in conjunction with general anesthesia accelerates patient's recovery, relieves pain, and reduces emotional stress.
The article points to modern ideas about the various causes of arrhythmias in children and adolescents. It also presents a working classification of arrhythmias based on their pathophysiological mechanisms, a brief diagnosis of arrhythmias including clinical criteria, various instrumental and ultrasound examination methods; described group of life-threatening arrhythmias, which are considered one of the main causes of sudden cardiac death. The characteristics of each type of life-threatening arrhythmia are listed at the end of the article. Treatment includes medical and surgical methods.
Key words: children's ambulance, cardiac arrhythmias, life-threatening arrhythmias, diagnosis, treatment
Background: Currently, the problem of choosing an effective drug approach for cerebral protection in case of traumatic brain injury (TBI) remains poorly understood. The synthesis and development of new active molecules to treat brain disorders rely on an in-depth understanding of the pathophysiological mechanisms of brain disorders and the role of excessive activation of NMDA receptors. Clinical studies of cerebral protectors, specifically NMDA-receptor antagonists, show promising results for their use in treating TBIs. Materials and methods: A TBI rat model was used to investigate the effect of Ademol (2 mg/kg) given intravenously (IV) every 12 hours for eight days following the TBI. The control group and pseudo-operated animals received 0.9 % NaCl (2 mg/kg, IV). The comparison group received amantadine sulfate (5 mg/kg, IV). The efficiency and activity of these therapies were evaluated by measuring the protein S100 levels in each group. Results: Protein S100 levels in the groups with a TBI and treated with Ademol or amantadine sulfate were decreased by 50.8 and 39.9 %, respectively. Treatment of rats with severe TBI with Ademol was probably better than treatment of rats in the control group with saline and amantadine sulfate and better helped to reduce the growth of protein S 100 level, while Ademol exceeded the reference drug at 18.2 % (p < 0.05). Conclusion: Treatment of rats with severe traumatic brain injury with Ademol at a dose of 2 mg/kg (i/v) was probably better than treatment of rats in the control group with saline and amantadine sulfate.
Subcutaneous emphysema of the head, neck, and mediastinum occurs most commonly in head and neck surgery, tracheal and esophageal injuries, facial skeleton injuries, foreign bodies in the gastrointestinal tract and gastrointestinal neoplasms, pulmonary barotrauma during mechanical ventilation, and after dental procedures, which is extremely rare. The tooth preparation with a high-speed air turbine handpiece allows air to penetrate the mediastinum through the fascial spaces of the neck. Therefore, swelling of the face, neck, and upper body may often be misdiagnosed as an anaphylactic reaction to local or general anesthetics or other preparations used in dentistry. The paper presents a case of spontaneous pneumomediastinumand tension pneumothorax in a 2,5-year-old child after dental procedure. Dental treatment (extraction of 2 teeth, root canal filling of the mandibular right first molar) was carried out under general anesthesia. The early postoperative period was uneventful. In two hours, the parents with their child left private health care facility. Three hours after dental procedure, the parents noticed the child to develop an indurative edema of the right side of the face and neck, and immediately applied to the hospital. The therapy for angioedema was administered. Six hours after beginning therapy, there was observed a crepitation in the neck (circularly) and upper chest. The child was urgently transferred to the Department of Anesthesiology and Intensive Care of the Ivano-Frankivsk Regional Children’s Clinical Hospital. Pneumomediastinum was diagnosed via chest X-ray. Diagnostic bronchoscopy was performed under general anesthesia to exclude traumas to the laryngeal mucosa or injuries to the tracheobronchial tree. No visible local damage to the area examined was found. Drainage of the anterior mediastinum was performed emergently to save the child’s life. A control chest X-ray taken in two hours showed right-sided tension pneumothorax; the chest X-ray taken in four hours revealed left-sided spontaneous pneumothorax; the pleural cavities were drained using the Bülau-principle. Considering the increased cost of breathing and hypoxemia, the child was intubated and controlled mechanical ventilation was initiated. On the background of clinical improvement, the child was electively disintubated on the second day. The drainage tubes were removed from the pleural sinuses in 5 days. The control chest X-ray showed an improvement. The child was transferred to the Pulmonology Department and, on the 7th day of hospital stay, it was discharged home after recovery.
On the eve of the season of respiratory infections, we would like to draw the attention of outpatient doctors to the fact that 80–90 percent of winter diseases affecting the nose, ears, throat and lungs are of viral origin. Improper and excessive consumption of antibiotics increases the risk of antibiotic resistance, and thus humanity enters the post-antibiotic era. The World Health Organization warns that the problems that antibiotic resistance could cause in the future can be compared to the spread of AIDS in the 1980s. The principles of rational use of antibiotics should always be based on the assumption that antibiotics are causal drugs, and their overuse very often leads to resistance, which negatively affects the entire population. Irrational antibiotic therapy can also lead to discomfort, worsening of acute and chronic pain. It is also important to know that in the post-antibiotic era, science has other options for fighting bacteria, such as vaccination, immunotherapy, and strengthening individual immunity. The correct attitude of doctors to the prevention of diseases and rational treatment with antibiotics can help reduce the resistance of bacterial strains, discomfort and pain.
Gram-negative bacteria pose a significant threat as primary agents of infection in septic shock, a condition with high mortality rates in intensive care patients. To combat this, chemists develop antibiotic drugs
fortified with protective agents, such as carbapenemase inhibitors, to counter bacterial resistance mechanisms. This study aims to evaluate the clinical efficacy of two antibiotic combinations, imipenem/cilastatin/
relebactam (IMI/REL) and piperacillin/tazobactam (PIP/TAZ), in the treatment of septic shock caused by gram-negative bacteria. Seventeen patients diagnosed with septic shock were divided into Group 1 with IMI/
REL and Group 2 with PIP/TAZ. All patients received antishock treatment, renal replacement therapy, and ventilation. Bacteriological detection identified four gram-negative pathogens in biological samples,
with further phenotyping and genotyping confirming resistance mechanisms. Both IMI/REL and PIP/TAZ exhibited notable resistance against Acinetobacter baumannii and Pseudomonas aeruginosa. Metallo-
β-lactamases and class D carbapenem hydrolysing oxacillinase were detected in Acinetobacter baumannii. Therapy of IMI/REL and PIP/TAZ proved to be ineffectual in patients afflicted with these strains,
leading to fatalities. The study highlights the ineffectiveness of IMI/REL and PIP/TAZ in treating septic shock caused by highly resistant gram-negative bacteria. The results of this study are crucial for guiding future clinical trials and strategic decisionmaking regarding the use of beta-lactam antibiotics combined with inhibitors.
Keywords: Antishock treatment, Acinetobacter baumannii, antibiotic therapy, genotyping, clinical effectiveness.
Aim: Evaluation of the efficacy of intravenous lidocaine admi-
nistration during surgical interventions in gynecologic oncolo-
gy.
Materials and Methods: A single-center randomized study.
The study included 170 patients who underwent total hyste-
rectomy or subtotal hysterectomy. The control group (Contr.
Gr. ) received anesthesia based on fentanyl, propofol, and
atracurium. The intravenous lidocaine administration group
(ILA Gr. ) received 1 mg/kg/h lidocaine during anesthesia and
24 hs postoperatively. Final assessment: postoperative pain
intensity (NRS), opioid requirement during surgery and posto-
peratively, stress response assessment, and postoperative
sleep quality.
Results: 163 patients completed the study. Two patients in the
IV lidocaine group and five patients in the control group were
excluded from the analysis. At the time of surgery, the total
fentanyl dose was 23 % lower in Contr. Gr. but the severity of
the surgical stress response was more prominent in ILA Gr. ;
blood glucose levels were 17 % higher in ILA Gr. at the end of
surgery compared to Contr. Gr. In the postoperative period,
pain intensity according to NRS was not statistically significan-
tly different between the study groups 24 hs after surgery. The
quality of sleep was better in ILA Gr. There were no significant
differences in the dose of morphine for postoperative anesthe-
sia between the study groups.
Conclusions: Intravenous administration in the perioperative
period in patients after gynecologic oncology surgeries did
not improve the quality of perioperative anesthesia and did not
significantly reduce the dose of opioid analgesics during
anesthesia and within a day of the postoperative period (Tab.
2, Fig. 6, Ref. 37).
KEY WORDS: intravenous lidocaine infusion, gynecologic on-
cology surgery, pain, stress response.
In an effort to help patients with COVID-19, various treatment protocols have been developed and are constantly changing. Various antivirals and other potentially useful drugs (often "off label", without prior approval or testing) have been used in treatment. Currently, thanks to quick decisions regarding the treatment and prevention of the COVID-19 disease, it has been possible to stabilize the situation all over the world. The relatively rapid development of vaccines against SARS-CoV-2 with the aim of achieving collective immunity also has a large share in this. On the other hand, "quick decisions" contributed to the emergence of such problems as adverse effects of the drugs used. In the article, we want to draw the attention of the wider public to the other side of the treatment of the disease COVID-19, namely the possibility of iatrogeny, which significantly contributes to the emergence of post-covid syndrome and chronic pain. We place more emphasis on the importance of preventive measures than on the uncertain outcome of the treatment of the disease COVID-19.
Key words: iatrogeny, chronic pain, co-morbidity, pain syndrome, pandemic COVID-19, SARS-CoV-2, post-covid syndrome
Background. The aim of the study was to assess changes in the serum CD40L level and its potential relationship with pain intensity in children after anterior abdominal wall surgery on the background of general anaesthesia and its combination with various RA techniques.
Materials and methods. The study included 87 children who underwent anterior abdominal wall surgery using different analgesic techniques. All children were divided into 3 groups: Group I - 33 children - general anaesthesia using morphine; Group II - 27 children - general anaesthesia using the transversalis fascia plane block (TFPB); Group III - 27 children - general anaesthesia using the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection.
Results. In Group I, 2 hours after surgery, the mean serum level of CD40L was 4,283 pg/ml, with a slight downward trend at discharge (UMann-Whitney=52.5; р=0.593). In Group II, the level of CD40L reduced significantly by 25.3% (UMann-Whitney=10.0; р=0.002); 24 hours after surgery, the level of CD40L reduced by 15.1% (UMann-Whitney= 26.0; р=0.20). At discharge, the level of CD40L in this group reduced significantly by 54.4% (UMann-Whitney=7.0; р=0.003). In Group III, during all observation periods, the mean serum level of CD40L was 4-7.6 times lower (UMann-Whitney=0.0; р=0.000) than corresponding levels in children of Group II.
Conclusion. The indicators of CD40L signalling were found to increase in paediatric anterior abdominal wall surgeries. There was a close positive correlation between postsurgical pain intensity and CD40L serum levels. Single-injection TFBP+QLB-4 resulted in the lowest serum CD40L levels, an indicative of the lowest intensity of postsurgical pain.
Clinical Trial registration. The study is a fragment of the research project “Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129 (Ivano-Frankivsk National Medical University).
Keywords: regional analgesia, CD40L, postsurgical pain, children, pain management
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its prevalence in the general population is 0.9-3.0%. Among the malignant neoplasms of MD, carcinoids and gastrointestinal stromal tumors are predominant. Adenocarcinomas account for less than 6.0% of all associated malignancies. We present a rare clinical case of a 67-year-old patient with gastric-type adenocarcinoma in MD, with metastatic foci in both lobes of the liver at diagnosis. This case demonstrates the diagnostic and therapeutic procedures that led to correct diagnosis and satisfactory treatment outcomes. This case emphasized the importance of using all the possibilities in the diagnosis and treatment and the necessity of cooperation with other experts in properly managing this disease. We also expressed an opinion about considering prophylactic resection of an intraoperatively discovered MD.
The aim of this work was to study the antimicrobial activity of antiseptics against planktonic bacterial forms and biofilm formation of multidrug-resistant (MDR) clinical strains of K. pneumoniae isolated from infected wounds of patients with combat trauma during the war in Ukraine.
Materials and Methods. The activity of antiseptics was determined against clinical antibiotic-resistant strains of K. pneumoniae (n=34). Clinical strains were isolated from patients with infectious complications of combat burn and shrapnel wounds of different localization, received during war conflict in Ukraine in the period since 24 of February to April of 2022.
Results. Determining the activity of antiseptics against K. pneumoniae in planktonic form, high efficiency of the main surfactant active antiseptics was revealed. The highest activity against clinical strains of K. pneumoniae among the studied antiseptics from the group of quaternary ammonium compounds (QAC) was found in decamethoxine, miramistinand octenidine. IAA (index of antiseptic activity) values were highest (IAA >4) for the antiseptics decamethoxine (0.1%), octenidine (0.1%), and polyhexanide (0.1%).
Conclusions. Determination of anti-biofilm forming activity showed that sub-bacteriostatic concentrations of chlorhexidine, decamethoxin, miramistin, octenidine, polyhexanide and povidone-iodineinhibited the formation of K. pneumoniae biofilms, but decamethoxine, polyhexanide and povidone-iodine had exhibited the most pronounced effect. Based on the analysis of all conducted studies, 0.1% and 0.02% decamethoxine, 0.01% miramistin, 0.05% chlorhexidine, 0.1% octenidine, 0.1% polyhexanide, 10% povidone-iodine are the effective agents against MDR clinical isolates of K. pneumoniae.
Lek. Obzor, Bratislava: Herba, 2023, 72(10): 460-465. ISSN 0457-4214.
The aim of the study was to evaluate the prevalence of chronic postsurgical pain in children three and six months after anterior abdominal wall surgery and to assess the use of different anesthetic approaches for its prevention.
Materials and Methods. The study included 60 (35 boys and 25 girls) children at the age of 7 – 18 years who were treated at the surgical department and underwent anterior abdominal wall surgery. Group I – 30 children who were operated on under general anesthesia using the transversalis fascia plane block, combined with the quadratus lumborum block 4 via a single injection; Group II – 30 children who were operated on under general anesthesia using opioids. The assessment of acute pain and the quality of pain management was carried out by means of the Visual Analogue Scale (VAS), the Face, Legs, Activity, Cry, Consolability (FLACC) scale, the Behavioral Pain Scale. The DN-4 neuropathic pain diagnostic questionna- ire and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale were used to assess the presence of chronic or neuropathic pain. The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Differences were considered statistically significant at p < 0.05. The proportions were statistically compared by a z-test. Results. The analysis of the acute pain assessment scores in children revealed that children of Group II, while staying in the surgical department, had significantly higher FLACC and VAS scores as compared to those in Group I. On the first, second, and third days of hospital stay, pain intensity was greater in Group II (FLACC – 5.5 ± 0.22, 4.52 ± 0.14, 4.0 ± 0.16, VAS – 5.36 ± 0.18, 4.48 ± 0.16, 3.95 ± 0.11, respectively, p < 0.05) as compared to Group I (FLACC – 4.7 ± 0.17, 3.91 ± 0.28, 3.22 ± 0.22, VAS – 4.76 ± 0.28, 3.58 ± 0.28, 3.2 ± 0.36, respectively, р < 0.05) The analysis of questionnaires for chronic pain assessment in children (DN-4 questionnaire, LANSS pain scale) found that in Group II, the prevalence of chronic pain syndrome was greater (~20 %) as compared to Group I (9 %).
Conclusions. The advantages of the transversalis fascia plane block and the ultrasound-guided quadratus lumborum block via a single injection include ease of administration, effective perioperative pain management, reduced need for opioid analgesics and non-steroidal anti-inflammatory drugs periope ratively, and a shortened length of hospital stay.
KEY WORDS: acute postsurgical pain, chronic postsurgical pain, transversal fascia plane block, quadratus lumborum block, pain management, prevention.
Meckel’s diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population
of 0.9–3 %. Among the malignant neoplasms associated with Meckel’s diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage, with adenocarcinomas accounting for less than 6% of all associated malignancies. The authors present a rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel’s diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel’s diverticulum.
Key words: adenocarcinoma, Meckel’s diverticulum, liver, metastases, treatment
Meckel's diverticulum is the most common congenital anomaly within the gastrointestinal tract, with a prevalence in the general population of 0.9-3%. Of the malignant neoplasias of Meckel's diverticulum, carcinoids and gastrointestinal stromal tumors predominate in percentage; the prevalence of adenocarcinomas is less than 6% of all associated malignancies. The authors present the rare case report of a 67-year-old patient with gastric-type adenocarcinoma in Meckel's diverticulum, with metastatic foci in both lobes of the liver at the time of diagnosis. The case demonstrates diagnostic and therapeutic procedures that led to a correct diagnosis and a satisfactory treatment outcome. They emphasize the importance of using all the possibilities of diagnosis and treatment as well as the necessity of cooperation with other experts in the proper management of this disease, they express an opinion about considering prophylactic resection of intraoperatively detected Meckel's diverticulum.
The aim of the study is to evaluate the dynamics of TLR-4 levels and microbial colonization in patients with infectious respiratory complications with different treatment strategies.
Materials and Methods. 20 children in each group with different approaches to treatment - in the main observation group in the complex of antimicrobial treatment at the same time with empirically prescribed standard antibiotic therapy we used inhalation of quaternary ammonium compound (decamethoxine) through a nebulizer from the appearance of clinical signs of VAP, and the treatment of patients in the control group was carried out in accordance with generally accepted recommendations with the use of systemic antibacterial and symptomatic therapy.
Results. It was found that the level of TLR-4 in the serum clearly correlates with the dynamics of the infectious process and the microbiological status of patients.
Conclusions. The determination of the level of TLR-4 can serve as a diagnostic criterion for the development of severe bacterial disease and evaluate the effectiveness of the selected treatment regimen.
Key words: VAP, children, toll-like receptors 4, quaternary ammonium compound, decamethoxine.
Vitamins are organic substances that every living organism needs. Although the body needs some vitamins only in trace amounts, it is very important that we have them regularly added to the body. Vitamins belong together with proteins, fats and carbohydrates to the basic components of food, in the human body they have the function of catalysts biochemical reactions. Our organism needs them for its existence, but it cannot make them as a rule synthesize, and therefore must obtain them from food. We call such nutrients essential. In ideally, we would need to replenish all the necessary vitamins quantities, a varied and varied diet should have been enough. However, this is not the reality for many people...
You also have to think about the fact that every organism is unique and some groups of people they need more of some vitamins and less of others. For example, physically active people may need an increased amount of vitamins, pregnant women or smokers.
BACKGROUND: The concept of quality of life (QoL) is today an integral part of the health-care system and clinical, medical, and social research. Untreated chronic pain in children increases the risk of developing mental disorders later in life. The pediatric QoL inventory 3.0 (PedsQL™) is one of the most valid and widely used tools for assessing pediatric QoL. AIM: The study was to assess QoL in children with chronic postsurgical pain 7 days, 3 months, and 6 months after surgery with different analgesic techniques by means of the PedsQL™ 3.0 Family Impact Module questionnaires. METHODS: Following the inclusion and exclusion criteria, a total of 80 children undergoing treatment at the surgical department of a Communal Non-Profit Enterprise "Ivano-Frankivsk Regional Children's Clinical Hospital of Ivano-Frankivsk Regional Council" were enrolled in the study. Among them, 60 children underwent anterior abdominal wall surgery with various types of anesthetic techniques. The patients were asked to fill in the questionnaires repeatedly 3 and 6 months after hospital discharge. RESULTS: QoL in patients with chronic pain syndrome reduced significantly (p < 0.001) on the scales of physical functioning, emotional functioning, social functioning, cognitive functioning, communication, worry, daily activities, family relationships, as well as pediatric QoL summary score, parent QoL summary score, and family functioning summary score 3 and 6 months after surgery with conventional analgesic techniques. CONCLUSIONS: Chronic pain syndrome reduces QoL in children aged 7-18 years after anterior abdominal wall surgery by reducing their physical, emotional, social, and cognitive functioning. The myofascial block in conjunction with general anesthesia accelerates patient's recovery, relieves pain, and reduces emotional stress.
The article points to modern ideas about the various causes of arrhythmias in children and adolescents. It also presents a working classification of arrhythmias based on their pathophysiological mechanisms, a brief diagnosis of arrhythmias including clinical criteria, various instrumental and ultrasound examination methods; described group of life-threatening arrhythmias, which are considered one of the main causes of sudden cardiac death. The characteristics of each type of life-threatening arrhythmia are listed at the end of the article. Treatment includes medical and surgical methods.
Key words: children's ambulance, cardiac arrhythmias, life-threatening arrhythmias, diagnosis, treatment
Background: Currently, the problem of choosing an effective drug approach for cerebral protection in case of traumatic brain injury (TBI) remains poorly understood. The synthesis and development of new active molecules to treat brain disorders rely on an in-depth understanding of the pathophysiological mechanisms of brain disorders and the role of excessive activation of NMDA receptors. Clinical studies of cerebral protectors, specifically NMDA-receptor antagonists, show promising results for their use in treating TBIs. Materials and methods: A TBI rat model was used to investigate the effect of Ademol (2 mg/kg) given intravenously (IV) every 12 hours for eight days following the TBI. The control group and pseudo-operated animals received 0.9 % NaCl (2 mg/kg, IV). The comparison group received amantadine sulfate (5 mg/kg, IV). The efficiency and activity of these therapies were evaluated by measuring the protein S100 levels in each group. Results: Protein S100 levels in the groups with a TBI and treated with Ademol or amantadine sulfate were decreased by 50.8 and 39.9 %, respectively. Treatment of rats with severe TBI with Ademol was probably better than treatment of rats in the control group with saline and amantadine sulfate and better helped to reduce the growth of protein S 100 level, while Ademol exceeded the reference drug at 18.2 % (p < 0.05). Conclusion: Treatment of rats with severe traumatic brain injury with Ademol at a dose of 2 mg/kg (i/v) was probably better than treatment of rats in the control group with saline and amantadine sulfate.
Subcutaneous emphysema of the head, neck, and mediastinum occurs most commonly in head and neck surgery, tracheal and esophageal injuries, facial skeleton injuries, foreign bodies in the gastrointestinal tract and gastrointestinal neoplasms, pulmonary barotrauma during mechanical ventilation, and after dental procedures, which is extremely rare. The tooth preparation with a high-speed air turbine handpiece allows air to penetrate the mediastinum through the fascial spaces of the neck. Therefore, swelling of the face, neck, and upper body may often be misdiagnosed as an anaphylactic reaction to local or general anesthetics or other preparations used in dentistry. The paper presents a case of spontaneous pneumomediastinumand tension pneumothorax in a 2,5-year-old child after dental procedure. Dental treatment (extraction of 2 teeth, root canal filling of the mandibular right first molar) was carried out under general anesthesia. The early postoperative period was uneventful. In two hours, the parents with their child left private health care facility. Three hours after dental procedure, the parents noticed the child to develop an indurative edema of the right side of the face and neck, and immediately applied to the hospital. The therapy for angioedema was administered. Six hours after beginning therapy, there was observed a crepitation in the neck (circularly) and upper chest. The child was urgently transferred to the Department of Anesthesiology and Intensive Care of the Ivano-Frankivsk Regional Children’s Clinical Hospital. Pneumomediastinum was diagnosed via chest X-ray. Diagnostic bronchoscopy was performed under general anesthesia to exclude traumas to the laryngeal mucosa or injuries to the tracheobronchial tree. No visible local damage to the area examined was found. Drainage of the anterior mediastinum was performed emergently to save the child’s life. A control chest X-ray taken in two hours showed right-sided tension pneumothorax; the chest X-ray taken in four hours revealed left-sided spontaneous pneumothorax; the pleural cavities were drained using the Bülau-principle. Considering the increased cost of breathing and hypoxemia, the child was intubated and controlled mechanical ventilation was initiated. On the background of clinical improvement, the child was electively disintubated on the second day. The drainage tubes were removed from the pleural sinuses in 5 days. The control chest X-ray showed an improvement. The child was transferred to the Pulmonology Department and, on the 7th day of hospital stay, it was discharged home after recovery.
On the eve of the season of respiratory infections, we would like to draw the attention of outpatient doctors to the fact that 80–90 percent of winter diseases affecting the nose, ears, throat and lungs are of viral origin. Improper and excessive consumption of antibiotics increases the risk of antibiotic resistance, and thus humanity enters the post-antibiotic era. The World Health Organization warns that the problems that antibiotic resistance could cause in the future can be compared to the spread of AIDS in the 1980s. The principles of rational use of antibiotics should always be based on the assumption that antibiotics are causal drugs, and their overuse very often leads to resistance, which negatively affects the entire population. Irrational antibiotic therapy can also lead to discomfort, worsening of acute and chronic pain. It is also important to know that in the post-antibiotic era, science has other options for fighting bacteria, such as vaccination, immunotherapy, and strengthening individual immunity. The correct attitude of doctors to the prevention of diseases and rational treatment with antibiotics can help reduce the resistance of bacterial strains, discomfort and pain.
Objective: Rare disease Background: The conflict in Ukraine during the past year has resulted in increased deaths and injuries to soldiers and civilians from military weapons and large and small caliber firearms. Unlike clinicians in some Western countries, until recently, clinicians working in Ukraine hospitals had little experience managing patients with gunshot wounds. Case Report: A 16-year-old boy was admitted as an emergency following a gunshot wound to the back of the neck from a Makarov pistol. The gun was reported to have been fired at a distance of more than 15 cm. Imaging showed the 9-mm bullet hit the cervical spine, causing nerve root involvement at C4 to C7, traveled upwards, and lodged in the left posterior maxilla. On examination, the patient had facial asymmetry and paralysis of the left shoulder, arm, hand, and wrist and was in pain and shock. Intubation and emergency surgery were performed, with the removal of a 9×18-mm bullet shell from the pterygopalatine fossa, deep to the infratemporal fossa, and posterior to the maxilla. The patient underwent postoperative physical therapy and continues to improve his physical function. Conclusions: This report has shown the importance of immediate evaluation of gunshot wounds so that surgery can be planned and performed rapidly, with a view to postoperative recovery and active physical therapy.
Lymphadenopathy in children is a common finding but often a diagnostic problem for the physician. Seventy percent of all lymphadenopathies are localized and of these, more than 50% are located in the head and neck region. Reactive hyperplasia due to infectious stimulation is the most common cause of lymphadenopathy in childhood. Since lymphadenopathy is a nonspecific clinical manifestation of various diseases, differential diagnosis should cover a wide spectrum of diseases.
Key words: cause, childhood, diagnosis, differential lymphadenopathy
Introduction: In an effort to help patients with COVID-19, various treatment protocols havebeen developed and are constantly changing. Various antivirals and other potentially usefuldrugs (often "off label", without prior approval or testing) have been used in treatment. Thanksto quick decisions, it was possible to stabilize the situation with the pandemic all over the world.The relatively rapid development of vaccines against SARS-CoV-2 with the aim of achievingcollective immunity also has a large share in this. On the other hand, "quick decisions"contributed to the emergence of such problems as adverse effects of the drugs used.Focus: In the post, we want to draw the attention of the wider public to the other side of thetreatment of the disease COVID-19, namely the possibility of iatrogeny, which significantlycontributes to the emergence of post-covid syndrome and chronic pain. We place moreemphasis on the importance of preventive measures than on the uncertain outcome of thetreatment of the disease COVID-19.
Introduction: The paper will introduce the issue of domestic violence against women and the possibilities of assistance from the perspective of social work. Focus: The main objective of our research was to explore the issue of domestic violence against women and the possibilities of assistance from a social work perspective. We set ourselves partial goals, to find out what forms of domestic violence the participants suffered from, to find out what was the trigger for domestic violence, to find out under what circumstances they left the aggressor, to find out who they asked for help, to find out how professional help was provided. Material and Methods: It consists of interviews with six women from the Košice region. All women have been victims of domestic violence and each of them is the mother of a minor child(s). We chose interview as the method. The interviews were conducted individually, there was a personal meeting with each of the women. The women answered the questions asked. The entire course of the conversations was recorded on a dictaphone, and subsequently these answers were transcribed into text form. Results: We found that every woman can be a victim of domestic violence, regardless of age, occupation, education or social status. Leaving the aggressor is not easy. Domestic violence leaves consequences not only on victims of domestic violence, but also on minor children. Conclusion: Through our work, we have demonstrated that it is essential to address the issue of domestic violence against women and the possibilities of assistance from a social work perspective.
A new surgical technique is offered correct reliably the congenital pectus carinatum (I-III degrees) in children, to reduce significantly the surgical traumatism and to improve the cosmetic results.
Актуальні питання стратегії, тактики застосування та дослідження антибіотиків, антисептиків, дезінфекантів. 9-10 листопада, 2006. Вінниця.
ISBN 978-80-8229-029-8.
Venovanie
Venujeme pamiatke prof. MUDr. Vladimíra Krčméryho, DrSc., FRSP, FACP, FRCP, Dr. h. c. mult. (23.7.1960 - 20.12.2022), iniciátora, autora a editora piatich vydaní Manuálu - tabelária antimikróbnej terapie v SR (1969), ako poďakovanie za vzor obetavého lekára, vedca a učiteľa, organizátora medicíny nielen na Slovensku, za dlhoročnú odbornú a vedeckú spoluprácu na mnohých projektoch, za spoluprácu s vydavateľstvom Herba, za dlhoročné rozsiahle humanitárne, charitatívne a misijné aktivity v prospech ľudí v krízových životných situáciách na celom svete. Za to, že za splnením aj nesplniteľných cieľov vždy šiel s nádejou, odhodlaním a modlitbou v srdci...
Marián Bernadič, odborný redaktor a spoluautor
Kniha „Vitamíny – cesta k vášmu zdraviu“ vydavateľstva HERBA (www.shopherba.sk) je napísaná v zaujímavej forme tak, aby bola pochopiteľná a použiteľná nielen pre odbornú, ale aj pre laickú verejnosť. Na začiatku opisu každého vitamínu sú obrázky s krátkou charakteristikou vitamínu, jeho biologickou úlohou, príznakmi deficitu, dennou potrebou a rizikovými prejavmi deficitu. Opísané aj zdroje potravín, ktoré obsahujú ten-ktorý vitamín. Informácie podané z dnešného moderného pohľadu. Mottom knihy je Hippokratov citát „Nech potraviny sú tvojimi liekmi, nie lieky tvojou potravou“. Kniha harmonicky doplňuje moderný pohľad na Pediatriu a medzeru v literatúre, nakoľko doteraz v Slovenskej odbornej pediatrickej literatúre vitamíny neboli spomínané samostatne, ale len v rámci niektorých súvisiacich s nimi ochorení.