Polski Merkuriusz Lekarski最新文献

Objective: .Aim: To investigate the pathomorphological changes in the terminal chorionic villi during COVID-19 in pregnant women.

Patients and methods: Materials and Methods: A total of 123 placentas were studied in cases of live term births (groups І) and antenatal asphyxia (groups ІІ). The subgroups were defined as follows: II.2 and I.2 (post-COVID interval of 1-4 weeks); I.1 and II.1 (5-16 weeks). Morphological and statistical research methods were applied.

Results: Results: Spherical structures resembling viral particles were identified in the placenta. In 100 % of the observations, damage to the microcirculatory bed of terminal villi was detected, manifested by cytoplasmic edema of endothelial cells, disruption of cell membranes, nuclear apoptosis and placentitis. With increasing duration of the post-COVID interval, a gradual restoration of endothelial functional activity was observed, evidenced by an increase in laminar microvilli and vesicles, as well as widening of the vascular lumen; whereas in cases of antenatal asphyxia, obliteration of the vascular lumen and stromal fibrosis were noted. A reduction in endothelial cell cytoplasmic edema and stromal edema of terminal chorionic villi was also observed.

Conclusion: Conclusions: The morphogenesis of placental dysfunction in cases of antenatal fetal asphyxia associated with immature protective mechanisms involves endothelial dysfunction, impaired microcirculation, inflammatory infiltration, stromal edema of terminal villi with a reduction in vascular lumen, and subsequent fibrosis. The detection of viral particles with increasing post-COVID interval suggests persistence of SARS-CoV-2, the long-term effects of which on vascular function and its role in the development of placental insufficiency require further investigation.

Objective: Aim: To investigate the role of serum vitamin D3 in the pathogenesis and diagnosis for hypothyroidism..

Patients and methods: Materials and Methods: Cross-sectional study was conducted at the Outpatient Analytics Center of Al-Nokhba and Al-Sadder Teaching Hospital, Najaf, Iraq, between October 2021 and February 2022. A total of two groups, Group I (49 hypothyroid patients; mean age 47.69±8.961 years) and Group II (49 healthy controls; mean age 47.43±9.89 years), were included. The estimation of serum T3, T4, TSH, calcium, and 25(OH) vitamin D levels was performed by GP1100 immunofluorescence quantitative analyzer. Serum Calcium levels were determined by the spectrophotometric method.

Results: Results: Hypothyroid patients had much lower serum 25(OH) vitamin D levels; mean value was 12.45±0.95 ng/ml whereas for controls it was 31.35±0.87 ng/ml (P<0.000). T3, T4, and calcium levels were also significantly low in the hypothyroid patients, as opposed to the high levels of TSH. The sensitivity and specificity of vitamin D3 in the diagnosis of hypothyroidism is 71% and 65% respectively.

Conclusion: Conclusions: This study underlines a strong association between hypothyroidism and low serum levels of vitamin D. The results support the notion that, in fact, vitamin D deficiency may be involved in the pathophysiology of hypothyroidism, thus indicating the significance of monitoring and correcting the status of this vitamin in such patients. Further studies should be directed to the casual pathways and therapeutic benefits of vitamin D supplementation.

Objective: Aim: To evaluate the possibility of using cataract phacoemulsification with simultaneous intraocular lens (IOL) implantation in patients with age-related cataract (ARC) combined with pseudoexfoliation syndrome (PES) as an algorithm for the pseudoexfoliation glaucoma (PEG) prevention..

Patients and methods: Materials and Methods: A retrospective case-control study was conducted using data from medical records of 610 outpatients (813 eyes) with ARC aged from 49 to 79 years (average age 69 ± 3 years). Group 1 included 488 patients (625 eyes) with ARC and PES, and Group 2 (control) included 122 patients (188 eyes) without signs of PES. Patients in both groups underwent ultrasonic phacoemulsification and IOL implantation.

Results: Results: Patients from Group 1 presented with less anterior chamber depth, a thicker lens, and higher intraocular pressure (IOP), as compared to Group 2. In patients with PES after cataract surgery, we observed a slight increase in IOP during the first week, followed by a significant decrease (by 3.1 mm Hg) during the next 3 months (vs. baseline; p<0,001). In patients without PES, a slow decrease in IOP (by 1,0 mm Hg) was observed during 3 months after surgery (vs. baseline; p<0,001). The cataract surgery favored an increase in anterior chamber depth by 45,2 % in patients with ARC and PES.

Conclusion: Conclusions: Ultrasonic cataract phacoemulsification with IOL implantation in patients with PES leads to a significant decrease and stabilization of IOP in the long-term postoperative period (3-month follow-up), and may be an alternative method for the prevention of PEG development.

Objective: Aim: To provide a scientific rationale for various approaches to the practical application of individual motivation theories in order to develop a motivated medical workforce as the foundation for strengthening healthcare systems.

Patients and methods: Materials and Methods: Based on comparative analysis, as well as systematic and analytical approaches to understanding selected motivation theories - namely Maslow's Hierarchy of Needs, Herzberg's Two-Factor Theory, Adams's Equity Theory, Vroom's Expectancy Theory, and Deci and Ryan's Self-Determination Theory - the authors propose integrating these theories into managerial strategies.

Conclusion: Conclusions: A well-functioning healthcare workforce system requires not only a sufficient number of professionals but also effective motivation strategies based on various theories, such as those by Maslow, Herzberg, and Vroom, to enhance job satisfaction and retention. Understanding and applying these theories help managers create optimal working conditions, reduce turnover, improve service quality, and strengthen the healthcare system's overall efficiency and reputation.

Objective: Aim: To investigate the changes of the thymus structure under extracellular dehydration and after rehydration in model experiment.

Patients and methods: Materials and Methods: The study was conducted on 40 white male rats, divided into 4 groups of 10 animals each. 2 experimental groups were subjected to extracellular dehydration during 90 days. Following this period, one group was removed from the experiment and other one was switched to the vivarium's standard ration for 30 days (rehydration). The control groups of animals received the vivarium's standard ration throughout the 90 days and the 120 days respectively. The morphometric analysis, histological examination, immunohistochemical analysis were used.

Results: Results: 90 days extracellular dehydration leads to deformation of the thymocytes nuclei of rats, vacuolation or organelle destruction in cytoplasm, apoptosis and necrosis activation. The signs of stasis and thrombosis are present in thymic vessels. Functional thymus tissues replaced with connective and adipose tissues almost completely. After 30 days of rehydration reveals partial thymus restoration with lymphoid cell density increasing, with preserved morphological signs of cellular stress and structural remodelling, vascular abnormalities and incomplete restoration of thymus mass.

Conclusion: Conclusions: In the context of severe extracellular dehydration, profound the depletion of functional thymus tissue, its substitution with connective and adipose tissue, and the occlusion of blood vessels. The morphological structure of the thymus doesn't complete recover during 30 days readaptation period. This suggest the need for prolonged rehydration periods or more effective interventions to fully restore thymic structure and function.

This article presents the case of a 53-year-old patient who reported to the neurology emergency room because of painful swelling of the left side of the forehead, temple and parietal region that had been persisting for 4 days. In the interview, the patient is under constant cardiology care due to pharmacologically treated hypertension, additionally diagnosed with nephrolithiasis and left intercostal neuralgia as a result of chronic cough that had been persisting for 2 months. Neurological physical examination revealed slight facial asymmetry, with the left eyeball set deeper and the zygomatic bone less prominent on the left side. Noteworthy was the swelling of the soft tissues of the left side of the head, covering half of the forehead, temple and parietal region, without involvement of the back of the head or the right side. The patient underwent an imaging examination of the head using computed tomography (CT). Due to ambiguous changes in the bones of the skull cap, an extension of the diagnostics was ordered with magnetic resonance imaging (MRI). Very numerous osteolytic foci were found, which enhanced after contrast administration, scattered throughout the skull bone, and at least one foci in the spine - in the apex of the dentary tooth. The most probable origin of the changes was indicated as multiple myeloma, for differential diagnosis with other metastatic changes. The patient underwent a hematological consultation, during which a bone marrow aspirate and protein tests were taken. The histopathological result revealed numerous plasma cells and a monoclonal protein peak (M). A date was set for the patient to be admitted to the Hematology Department for further treatment.

Objective: Aim: The aim is to investigate the peculiarities of psychological trauma manifestation in police officers-combatants with different combat experience and to substantiate recommendations for their psychological rehabilitation based on the Gestalt approach.

Patients and methods: Materials and Methods: The research, conducted in 2023-2024, involved 69 male police officers-combatants with different combat experience: up to 1 year (Group A, n = 33) and more than 1 year (Group B, n = 36). Research methods: analysis and generalization, psycho-diagnostic, mathematical statistics.

Results: Results: It has been found that armed conflict participants with more combat experience had more pronounced symptoms of PTSD; the difference between the indicators of Groups A and B is significant (p ≤ 0.05). It has been found that the dominant type of response to a traumatic event in both groups of combatants is the protective mechanism of physiological arousal (63.6 % in Group A and 66.7 % in Group B). Practical recommendations for the psychological rehabilitation of combatants who suffered psychological trauma using Gestalt therapy have been proposed.

Conclusion: Conclusions: It has been found that the Gestalt approach allows solving the following tasks of working with psychological trauma: to help combatants realize and respond to traumatic experiences, to overcome existing traumas, to increase the adequacy of self-perception and self-esteem, to reduce anxiety, tension, emotional instability, and self-doubt in difficult life situations.

Objective: Aim: To determine the patterns of change in the cross-sectional area of the cerebellar vermis and the fourth ventricle during the fetal period of human ontogenesis and to analyze the dynamics of their interrelationship.

Patients and methods: Materials and Methods: The study was conducted using magnetic resonance imaging (MRI) scans of the human fetal brain obtained from open-access databases. Generalized images from the "Fetal Brain Atlas" (21-38 weeks of gestation) and MRI scans from the "Fetal Brain MRI from Stanford Lucile Packard Children's Hospital" database (20-39 weeks of gestation, n=20) were used. Morphometric analysis of mid-sagittal sections was performed using the Image Tool software. The cross-sectional areas of the cerebellar vermis and the fourth ventricle were measured, along with their relative values and ratios.

Results: Results: Between 21 and 38 weeks of gestation, the cross-sectional area of the cerebellar vermis increased steadily, whereas the fourth ventricle exhibited a biphasic growth pattern: relatively slow expansion until 30 weeks, followed by accelerated growth. The analysis of relative areas revealed that the growth rate of the cerebellum exceeded that of the fourth ventricle until 30-32 weeks, after which the fourth ventricle underwent rapid expansion, leading to an alignment of their relative values. The ratio of the fourth ventricle's area to that of the cerebellum ranged from 4.8% to 9.8%, showing minimal values at 25-28 weeks and rapid growth between 28 and 34 weeks of gestation.

Conclusion: Conclusions: The obtained data indicate changes in the proportional relationship between the cerebellum and the fourth ventricle throughout the fetal period of ontogenesis, reflecting the specific features of their morphogenesis. The proposed approach for assessing the interrelationship between these structures may be useful for analyzing both normal and abnormal hindbrain development during the prenatal period.

Objective: Aim: To conduct a forensic medical and legal analysis of cases of improper performance of professional duties by medical employees, including incorrect prescription of medical products..

Patients and methods: Materials and Methods: The article is based on the analysis of defects in the performance of professional duties by medical employees, particularly according to data from commission forensic medical examinations, as well as an analysis of international and national legal acts and national judicial practices of Ukraine. Dialectical, hermeneutic, comparative, analytical, synthetic, and system analysis research methods were used.

Results: Results: Although the total number of forensic medical examinations tends to decrease, these examinations remain the focus of attention in cases of improper performance of professional duties by medical employees. A more detailed analysis of cases involving violations of treatment strategies revealed instances of incorrect treatment method selection (whether conservative or surgical), along with cases of improper or unjustified prescription of medicinal products. Incorrect prescription of medical products is one significant way medical employees fail in their professional duties.

Conclusion: Conclusions: Understanding the general dynamics of forensic medical examinations is important, as it helps establish practical cause-and-effect relationships between the performance of professional duties by medical employees and adverse consequences for patients (including cases involving incorrect prescription of medical products).

Objective: Aim: To analyse the problems of implementing an individual's right to privacy in medical legal relations and to characterise the practice of the European Court of Human Rights (ECtHR).

Patients and methods: Materials and Methods: The methodological basis of the article is a set of methods and techniques of scientific knowledge. Methods of theoretical analysis, system-analytical and comparative-legal methods made it possible to characterise the problems of protecting the right of an individual to privacy in medical legal relations, taking into account the practice of the ECtHR.

Results: Results: The right to privacy in medical legal relations is a fundamental principle of the legal systems of the states parties to the European Convention. The right to privacy in medical legal relations is complex and forms part of the right to health. The ECtHR, in many of its decisions in the field of healthcare, has emphasised the existence of both negative and positive obligations of the state to ensure the right to respect for the private and family life of patients. States parties to the European Convention must not only refrain from unlawful interference, but also create mechanisms for the effective protection of patients'privacy, including the protection of confidential data.

Conclusion: Conclusions: The practice of the ECtHR in implementing an individual's right to privacy in medical legal relations is a dynamic source of law and contributes to the formation of uniform judicial practice in the context of protecting the rights, freedoms and interests of individuals in the field of healthcare.