10 research outputs found
ASPHYXIA AND DEVELOPMENTAL OUTCOME IN HIGH RISK INFANTS
Asphyxia is a risk factor that is very often related to neuro-developmental issues in high risk infants and equally affects preterm and term infants, however its outcome on the developed brain differs from the outcome on the preterm brain.In preterm infants, asphyxia usually exerts a hemorrhagic or ischaemic event and periventricular leukomalacia.In term infants, asphyxia leads to cerebral edema and atrophy of the brain, which may later lead to hypoxic ischaemic encephalopathy (HIE).The number of term infants with HIE who have survived is lower than those of preterm infants, while the percentage of term infants with HIE who have neuro-developmental issues is higher. Preemies face more problems in their motor development as a result of the brain damage, while term infants suffer from encephalopathy and their cognitive abilities are more affected.We have conducted a study about the effects that asphyxia has on the developmental outcomes in high risk infants. In our study, we did a longitudinal developmental follow-up of 30 high risk infants and an evaluation of their developmental outcome using the Griffiths Mental Development Scales, from the 4th month of life until the end of the 36th month. First, we found that high risk infants had a much lower developmental outcome than the control group during the trial. Finally, we found that asphyxia makes a difference in the developmental outcome of preterm infants without asphyxia who have a very low birth weight, the preterm infants with asphyxia, and the term infants with HIE-II
Zinc Status in Beta-Thalassemia Major
BACKGROUND: Zinc is one of the most important minerals incorporated in the enzymes of the human body. Zinc may be deficient in patients with the Ξ²-thalassemia major with possible adverse outcomes.
AIM: The purpose of this study was to assess the serum zinc status in Ξ²-thalassemia major patients in Duhok city.
PATIENTS, MATERIAL, AND METHODS: In this caseβcontrol study, 70 children with Ξ²-thalassemia major (2β12 years) of both genders were enrolled and were matched with 70 apparently healthy children for age and sex. A venous blood sample was obtained from each child for the measurement of serum zinc and serum ferritin levels at Jin Center in Duhok City between January 1 and June 30, 2017.
RESULTS: The mean serum zinc in the thalassemia patients (74.79 [Β±25.14] ΞΌg/dl) was significantly lower compared to the control group (93.61 [Β±15.12] ΞΌg/dl), (p = 0.0001). The serum zinc was not significantly different in thalassemia patients in terms of age, disease onset, gender, height, weight, body mass index, amount of blood transfusion, and type of chelation. There was a statistically significant correlation between serum zinc levels with a serum ferritin level of patients.
CONCLUSION: The study showed that thalassemia patients have significantly lower serum levels of zinc with no relation to medical factors
Deferasirox Effect on Serum Ferritin in Iraq Patients with Hemoglobinopathies: A Single Center Experience
BACKGROUND: The introduction of deferasirox as an oral iron chelator for hemoglobinopathies has been hailed by many as an important milestone in the management of iron overload in the latter disorders.
AIM: The objectives of the study were to evaluate the effectiveness of deferasirox in patients with hemoglobinopathies and to assess predictors of response.
METHODS: In this cross-sectional study, 160 patients diagnosed with hemoglobinopathies were included retrospectively from Jin hematology and oncology center in Duhok city, Iraqi Kurdistan. The Jin center offers patients with hemoglobinopathies clinical advice, examination, follow-up, treatment, and blood transfusions.
RESULTS: The median age of enrolled patients was 12 years (range 3β34 years), and included 86 females and 74 males. All patients were on deferasirox with a compliance rate of 77.5%. Furthermore, 32.3% were on concomitant deferoxamine at their last follow-up. After a median follow-up of 2.1 years (range 1β4 years), there was a mean reduction of serum ferritin level of β478.7 overall and β821.1 ng/ml in complaint patients (both being significant at p of 0.042 and 0.001, respectively). Univariate analysis revealed that older age at enrollment, and older age at starting therapy, and initial serum ferritin (>3000 ng/ml) were all significantly associated with more mean reduction in serum ferritin; while only the latter remained so by multivariate analysis (p = 0.04).
CONCLUSIONS: Deferasirox was found to be effective in reducing the level of serum ferritin among this cohort of hemoglobinopathy patients, to a degree comparable to that reported in other studies worldwide. Furthermore, there were significant associations between the reduction of serum ferritin level and age, age at starting treatment, drug compliance, and the initial serum ferritin levels
Severe Encephalitis in Infant with COVID-19: A Case Report
BACKGROUND: Encephalitis is a serious condition that contains neurological dysfunction cause by inflammation of the brain tissue. Etiological factors for the occurrence of this condition include infectious and non-infectious causes.
CASE REPORT: We are presented 9-month-old infant referred to our clinic in convulsive status, fever, and disturbed consciousness. From anamnestic information, the infant has been febrile for 2 days with profuse vomiting initiating just before admission at the clinic. At the moment of admission in the clinic, the infant looked intoxicated with generalized tonic-clonic seizures, with shortness of breath and fever with a weakened reaction to painful stimuli. It was admitted in the Isolation Unit by the protocol of the clinic. Laboratory investigations were done. Due to the persistence of convulsive status, a computed tomography scan of the brain was performed with the finding of enlargement of the lateral ventricles, with intraventricular masses and pronounced internal hydrocephalus. The results of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from the infant were positive as well as the grandmother. The infant was intubated immediately and put on mechanical ventilation SIPPV.
CONCLUSION: Our case report could suggest that SARS-CoV-2 infection may cause severe clinical symptoms, neurological manifestations, and encephalitis in infants
Surgical Treatment of a Seven-Year-Old Boy with Refractory Epilepsy Due to Focal Cortical Dysplasia, Case Report
The most common developmental malformation encountered in patients with refractory epilepsy is Focal Cortical Dysplasia (FCD). Malformations of cortical development, in particular FCDs are identified in 20β25% of patients with focal epilepsy, and approximately 76% of these patients are supposed to suffer from drug-resistant epilepsy. A promising therapy option for these patients could be surgical treatment. We present a seven-year-old child with drug-resistant epilepsy, who underwent surgical treatment that had an excellent outcome. Throughout the period of five years, the index patient was admitted several times to the Department of Neurology at the University Pediatrics Clinic-Skopje. He was initially admitted at the age of two years, because of his first episode of febrile seizures accompanied by diarrhea. In the following period, during the hospitalization, febrile seizures also developed. CT findings showed a slight degree of front parietal cortical reduction, while the first MRI showed a slight dysmorphia at the frontal gyri, yet no focal abnormalities. The initial EEG revealed a bihemispheric epileptogenic focus. The reason for constant treatment alterations was drug-resistance. Although some encephalographic stabilization had been achieved, a full clinical response had never been obtained for a prolonged period. At the age of seven years, a pediatric epilepsy surgical team at the University School of MedicineβACIBADEM, Turkey, evaluated the patient. The conclusion of the team was that the child is a candidate for surgical treatment of epilepsy. The child underwent surgery at the age of eight years and has been seizure free since.Keywords: Focal Cortical Dysplasia, Epilepsy, Surgery
ΠΠ²Π°Π»ΡΠ°ΡΠΈΡΠ° Π½Π° ΠΏΠ΅Π΄ΠΈΡΠ°ΡΡΠΈΡΠΊΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΡΡΠ²Π΅Π½ΠΈΠ»Π΅Π½ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΡΠΊΠΈ Π°ΡΡΡΠΈΡ ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈ ΡΠΎ Π±ΠΈΠΎΠ»ΠΎΡΠΊΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ° Π’ΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± (Actemra)
Juvenile idiopathic arthritis (JIA) is the most common chronic disease in childhood. It manifests a heterogenic group of symptoms of arthritis, lasting at least 6 weeks and it appears before the age of 16. Patients who had no good therapeutic response to conventional therapy with Methotrexate were treated with biological therapy. The aim of this paper was to evaluate 9 patients who were receiving Tocilizumab at the Department of Rheumocardiology, University Clinic of Pediatric Diseases in Skopje. Materials and methods: Our study included 9 patients treated at our Department with biological therapy with Tocilizumab. Prior to initiation of the biological therapy, all patients underwent laboratory investigations, purified protein derivative (PPD) skin test for tuberculosis, X ray of the lungs and heart, and analysis of hepatitis markers. All patients were treated with amp. Actemra (tocilizumab) 8 mg/kg/tt i.v. Two of the patients had a severe form of the disease (one with severe systemic form and one with severe oligoarticular form of JIA). All presented patients had clinical remission of the disease. Conclusion: Therapy with tocilizumab in patients with juvenile idiopathic arthritis is a good therapeutic choice. The results obtained in our study have shown a significant therapeutic effect of tocilizumab even in severe forms of the disease.
ΠΡΠ²Π΅Π½ΠΈΠ»Π½ΠΈΠΎΡ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΡΠΊΠΈ Π°ΡΡΡΠΈΡ Π΅ Π½Π°ΡΡΠ΅ΡΡΠ° ΡΠΎΡΠΌΠ° Π½Π° Ρ
ΡΠΎΠ½ΠΈΡΠ½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°ΡΠ΅ Π²ΠΎ Π΄Π΅ΡΡΠΊΠ°ΡΠ° Π²ΠΎΠ·ΡΠ°ΡΡ, ΠΊΠΎΠ΅ ΡΠ΅ ΠΌΠ°Π½ΠΈΡΠ΅ΡΡΠΈΡΠ° ΡΠΎ Ρ
Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π° Π³ΡΡΠΏΠ° Π½Π° ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ Π½Π° Π°ΡΡΡΠΈΡ ΠΊΠΎΠΈΡΡΠΎ ΡΡΠ°Π°Ρ Π½Π°ΡΠΌΠ°Π»ΠΊΡ 6 Π½Π΅Π΄Π΅Π»ΠΈ, Π° ΡΠ΅ ΠΏΠΎΡΠ°Π²ΠΈΠ»Π΅ ΠΏΡΠ΅Π΄ 16-Π³ΠΎΠ΄ΠΈΡΠ½Π° Π²ΠΎΠ·ΡΠ°ΡΡ. ΠΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ ΠΊΠΎΠΈ Π½Π΅ Π΄Π°Π΄ΠΎΠ° Π΄ΠΎΠ±Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡΠΊΠΈ ΠΎΠ΄Π³ΠΎΠ²ΠΎΡ Π½Π° ΠΊΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½Π°ΡΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ° ΡΠΎ ΠΠ΅ΡΠΎΡΡΠ΅ΠΊΡΠ°Ρ, Π±Π΅Π° ΠΏΡΠ΅ΡΡΠ»Π΅Π½ΠΈ Π½Π° Π±ΠΈΠΎΠ»ΠΎΡΠΊΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ°. Π¦Π΅Π»ΡΠ° Π½Π° ΠΎΠ²Π°Π° ΡΡΡΠ΄ΠΈΡΠ° Π±Π΅ΡΠ΅ Π΄Π° ΠΈΠ·Π²ΡΡΠΈ Π΅Π²Π°Π»ΡΠ°ΡΠΈΡΠ° Π½Π° 9 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΊΠΎΠΈ ΠΏΡΠΈΠΌΠ°Π° ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± Π½Π° ΠΠ΄Π΄Π΅Π»ΠΎΡ Π·Π° ΡΠ΅ΡΠΌΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ° Π½Π° Π£Π½ΠΈΠ²Π΅ΡΠ·ΠΈΡΠ΅ΡΡΠΊΠ°ΡΠ° ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ° Π·Π° Π΄Π΅ΡΡΠΊΠΈ Π±ΠΎΠ»Π΅ΡΡΠΈ Π²ΠΎ Π‘ΠΊΠΎΠΏΡΠ΅. ΠΠ°ΡΠ΅ΡΠΈΡΠ°Π»ΠΈ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΠΎ Π½Π°ΡΠ°ΡΠ° ΡΡΡΠ΄ΠΈΡΠ° Π±Π΅Π° Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈ 9 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈ Π½Π° Π½Π°ΡΠΈΠΎΡ ΠΠ΄Π΄Π΅Π» ΡΠΎ Π’ΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± Π²ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΎΠ΄ 2010-2020 Π³ΠΎΠ΄ΠΈΠ½Π°. ΠΠ°Ρ ΡΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΏΡΠ΅Π΄ Π·Π°ΠΏΠΎΡΠ½ΡΠ²Π°ΡΠ΅ Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ°ΡΠ° Π±Π΅Π° Π½Π°ΠΏΡΠ°Π²Π΅Π½ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΡΠΊΠΈ ΠΈΡΠ»Π΅Π΄ΡΠ²Π°ΡΠ°, ΠΏΡΠΎΡΠΈΡΡΠ΅Π½ ΠΏΡΠΎΡΠ΅ΠΈΠ½ΡΠΊΠΈ Π΄Π΅ΡΠΈΠ²Π°ΡΠΈΠ²Π΅Π½ ΠΊΠΎΠΆΠ΅Π½ ΡΠ΅ΡΡ Π·Π° ΡΡΠ±Π΅ΡΠΊΡΠ»ΠΎΠ·Π° (ΠΠΠ), Π ΠΠ Π½Π° Π³ΡΠ°Π΄ΠΈΡΠ΅, ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ Π·Π° Ρ
Π΅ΠΏΠ°ΡΠΈΡ. Π‘ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π±Π΅Π° ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈ ΡΠΎ Π°ΠΌΠΏ. ΠΠΊΡΠ΅ΠΌΡΠ° 8ΠΌΠ³/ΠΊΠ³/ΡΡ ΠΈ.Π². ΠΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΈΠΌΠ°Π° ΡΠ΅ΡΠΊΠ° ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠ° ΠΏΡΠ΅Π·Π΅Π½ΡΠ°ΡΠΈΡΠ° Π½Π° ΡΡΠ²Π΅Π½ΠΈΠ»Π΅Π½ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΡΠΊΠΈ Π°ΡΡΡΠΈΡ (ΠΏΡΠ²ΠΈΠΎΡ ΡΠΎ ΡΠ΅ΡΠΊΠ° ΡΠΈΡΡΠ΅ΠΌΡΠΊΠ° ΡΠΎΡΠΌΠ° Π½Π° Π±ΠΎΠ»Π΅ΡΡΠ°, Π° Π²ΡΠΎΡΠΈΠΎΡ ΡΠΎ ΡΠ΅ΡΠΊΠ° ΠΎΠ»ΠΈΠ³ΠΎΠ°ΡΡΠΈΠΊΡΠ»Π°ΡΠ½Π° ΡΠΎΡΠΌΠ°). ΠΠ°Ρ ΡΠΈΡΠ΅ ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π½Π°ΡΡΠ°Π½Π° ΡΠ΅ΠΌΠΈΡΠΈΡΠ° Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠ°ΡΠ° ΡΠ»ΠΈΠΊΠ° ΠΏΠΎ ΡΠΏΡΠΎΠ²Π΅Π΄ΡΠ²Π°ΡΠ΅ Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ°ΡΠ°. ΠΠ°ΠΊΠ»ΡΡΠΎΠΊ: ΠΠΈΠΎΠ»ΠΎΡΠΊΠ°ΡΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡΠ° ΡΠΎ ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ ΡΠΎ ΡΡΠ²Π΅Π½ΠΈΠ»Π΅Π½ ΠΈΠ΄ΠΈΠΎΠΏΠ°ΡΡΠΊΠΈ Π°ΡΡΡΠΈΡ Π΅ Π΄ΠΎΠ±Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡΠΊΠΈ ΠΈΠ·Π±ΠΎΡ. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΏΠΎΠΊΠ°ΠΆΠ°Π° ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ΅Π½ ΡΠ΅ΡΠ°ΠΏΠΈΡΠΊΠΈ Π΅ΡΠ΅ΠΊΡ Π΄ΡΡΠΈ ΠΈ ΠΊΠ°Ρ ΠΏΠΎΡΠ΅ΡΠΊΠΈΡΠ΅ ΠΎΠ±Π»ΠΈΡΠΈ Π½Π° Π±ΠΎΠ»Π΅ΡΡΠ°
First-line therapy in atypical hemolytic uremic syndrome: consideration on infants with a poor prognosis.
BackgroundAtypical hemolytic uremic syndrome (aHUS) is a rare and heterogeneous disorder. The first line treatment of aHUS is plasma therapy, but in the past few years, the recommendations have changed greatly with the advent of eculizumab, a humanized monoclonal anti C5-antibody. Although recent recommendations suggest using it as a primary treatment for aHUS, important questions have arisen about the necessity of immediate use of eculizumab in all cases. We aimed to draw attention to a specific subgroup of aHUS patients with rapid disease progression and high mortality, in whom plasma therapy may not be feasible.MethodsWe present three pediatric patients of acute complement-mediated HUS with a fatal outcome. Classical and alternative complement pathway activity, levels of complement factors C3, C4, H, B and I, as well as of anti-factor H autoantibody and of ADAMTS13 activity were determined. The coding regions of CFH, CFI, CD46, THBD, CFB and C3 genes were sequenced and the copy number of CFI, CD46, CFH and related genes were analyzed.ResultsWe found severe activation and consumption of complement components in these patients, furthermore, in one patient we identified a previously not reported mutation in CFH (Ser722Stop), supporting the diagnosis of complement-mediated HUS. These patients were not responsive to the FFP therapy, and all cases had fatal outcome.ConclusionTaking the heterogeneity and the variable prognosis of atypical HUS into account, we suggest that the immediate use of eculizumab should be considered as first-line therapy in certain small children with complement dysregulation
Collodion phenotype remains a challenge for neonatologists: A rare case of selfβhealing collodion baby
Abstract We report a unique case of selfβhealing collodion baby (CB) that was successfully managed despite the risk of potentially serious complications. Selfβhealing CB is a rare and distinct outcome of collodion phenotype occurring in approximately 10% of the cases. The outcome depends on the initial assessment and adequate multidisciplinary approach
OΠ΄Π½ΠΎΡΠΎΡ ΠΏΠΎΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΡΠΎ Π½Π° ΡΠ΅ΡΡΠΌΡΠΊΠΈΠΎΡ ΠΏΡΠΎΠΊΠ°Π»ΡΠΈΡΠΎΠ½ΠΈΠ½ ΠΈ Ρ-ΡΠ΅Π°ΠΊΡΠΈΠ²Π΅Π½ ΠΏΡΠΎΡΠ΅ΠΈΠ½ ΠΊΠ°Ρ Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ ΡΠ΅ΠΏΡΠ° ΠΏΡΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ Π²ΠΈΠ΄ΠΎΠ²ΠΈ Π½Π° ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½Π° ΠΏΠΎΠ΄Π΄ΡΡΠΊΠ° Π²ΠΎ Π΅Π΄ΠΈΠ½ΠΈΡΠ°ΡΠ° Π·Π° ΠΈΠ½ΡΠ΅Π½Π·ΠΈΠ²Π½Π° Π½Π΅Π³Π° ΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΡΠ°
Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive Care Unit at the University Clinic of Pediatrics β Skopje in the period between December 2018 and Πanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ββof PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37Β±53.79) ββwere measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ββof PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia and proven sepsis, p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.
Π‘Π΅ΠΏΡΠ°ΡΠ° ΠΊΠ°Ρ Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ΅Π½ Π΄ΠΈΡΡΡΠ΅Ρ ΡΠΈΠ½Π΄ΡΠΎΠΌ (Π ΠΠ‘) ΠΈ Π°ΡΡΠΈΠΊΡΠΈΡΠ° Π΅ ΠΆΠΈΠ²ΠΎΡΠΎΠ·Π°Π³ΡΠΎΠ·ΡΠ²Π°ΡΠΊΠ° ΡΠΎΡΡΠΎΡΠ±Π° ΠΈ ΡΓ¨ ΡΡΡΠ΅ ΠΏΡΠ΅ΡΡΡΠ°Π²ΡΠ²Π° Π²Π°ΠΆΠ½Π° ΠΏΡΠΈΡΠΈΠ½Π° Π·Π° ΠΌΠΎΡΡΠ°Π»ΠΈΡΠ΅Ρ ΠΈ ΠΌΠΎΡΠ±ΠΈΠ΄ΠΈΡΠ΅Ρ. Π¦Π΅Π»ΡΠ° Π½Π° ΠΎΠ²Π°Π° ΡΡΡΠ΄ΠΈΡΠ° Π±Π΅ΡΠ΅ Π΄Π° ΡΠ΅ ΠΏΡΠΎΡΠ΅Π½Π°Ρ ΠΏΡΠ΅Π΄Π²ΠΈΠ΄ΡΠ²Π°ΡΠΊΠΈΡΠ΅ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ Π½Π° ΠΏΡΠΎΠΊΠ°Π»ΡΠΈΡΠΎΠ½ΠΈΠ½ΠΎΡ (ΠΠ¦Π’) ΠΊΠ°ΠΊΠΎ ΡΠ°Π½ Π΄ΠΈΡΠ°Π³Π½ΠΎΡΡΠΈΡΠΊΠΈ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠΊΠΈ Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΌΠ°ΡΠΊΠ΅Ρ Π·Π° ΡΠ΅ΠΏΡΠ° ΠΊΠ°Ρ Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π ΠΠ‘ ΠΈ Π°ΡΡΠΈΠΊΡΠΈΡΠ°. Π‘ΡΡΠ΄ΠΈΡΠ°ΡΠ° Π±Π΅ΡΠ΅ Π΄ΠΈΠ·Π°ΡΠ½ΠΈΡΠ°Π½Π° ΠΊΠ°ΠΊΠΎ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½Π° ΠΈ ΠΈΡΠΏΠΈΡΠ°Π²ΠΌΠ΅ 110 Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ°, Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ Π²ΠΎ ΠΠ΄ΠΈΠ½ΠΈΡΠ°ΡΠ° Π·Π° ΠΈΠ½ΡΠ΅Π½Π·ΠΈΠ²Π½Π° Π½Π΅Π³Π° ΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΡΠ° (ΠΠΠΠ’), ΠΏΡΠΈ Π£Π½ΠΈΠ²Π΅ΡΠ·ΠΈΡΠ΅ΡΡΠΊΠ°ΡΠ° ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ° Π·Π° Π΄Π΅ΡΡΠΊΠΈ Π±ΠΎΠ»Π΅ΡΡΠΈ - Π‘ΠΊΠΎΠΏΡΠ΅, Π²ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄ΠΎΡ ΠΎΠ΄ Π΄Π΅ΠΊΠ΅ΠΌΠ²ΡΠΈ 2018 Π΄ΠΎ ΡΠ°Π½ΡΠ°ΡΠΈ 2021 Π³ΠΎΠ΄ΠΈΠ½Π°. ΠΠΈΠ²ΠΎΡΠΎ Π½Π° ΠΏΡΠΎΠΊΠ°Π»ΡΠΈΡΠΎΠ½ΠΈΠ½ Π±Π΅ΡΠ΅ ΠΌΠ΅ΡΠ΅Π½ΠΎ ΡΠΎ ΠΊΠΎΡΠΈΡΡΠ΅ΡΠ΅ Π½Π° ΠΈΠΌΡΠ½ΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°ΡΠΊΠΈΠΎΡ ΡΠΈΡΡΠ΅ΠΌ ΠΠΈΠ΄Π°Ρ Π±Π°Π·ΠΈΡΠ°Π½ Π½Π° ΠΠΠ€Π ΠΌΠ΅ΡΠΎΠ΄ΠΎΡ. ΠΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ°ΡΠ° ΡΠΎ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ° Π±Π΅Π° ΠΏΠΎΠ΄Π΅Π»Π΅Π½ΠΈ Π²ΠΎ Π΄Π²Π΅ Π³ΡΡΠΏΠΈ. ΠΠΎ ΠΏΡΠ²Π°ΡΠ° Π³ΡΡΠΏΠ° Π±Π΅Π° Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ 55 Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π ΠΠ‘ ΠΈ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ°, Π° Π²ΠΎ Π²ΡΠΎΡΠ°ΡΠ° Π³ΡΡΠΏΠ° 55 Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π°ΡΡΠΈΠΊΡΠΈΡΠ° ΠΈ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ°. Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠΊΠ°ΡΠ° Π°Π½Π°Π»ΠΈΠ·Π° ΠΏΠΎΡΠ²ΡΠ΄ΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ Π½Π° ΠΠ¦Π’ Π²ΠΎ Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈΠΎΡ ΠΏΠ΅ΡΠΈΠΎΠ΄ Π²ΠΎ ΠΏΡΠ²Π°ΡΠ° Π³ΡΡΠΏΠ° Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π ΠΠ‘ ΠΈ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ°, p<0,001. ΠΠ°ΡΠ²ΠΈΡΠΎΠΊΠΈΡΠ΅ ΠΏΡΠΎΡΠ΅ΡΠ½ΠΈ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ (40,37Β±53,79) Π±Π΅Π° ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½ΠΈ Π·Π° Π²ΡΠ΅ΠΌΠ΅ Π½Π° ΠΏΡΠΈΠ΅ΠΌΠΎΡ ΡΠΎ Π²ΠΈΡΠΎΠΊ ΠΏΠΈΠΊ Π²ΠΎ ΡΠΏΠΎΡΠ΅Π΄Π±Π° ΡΠΎ Π²ΡΠΎΡΠ°ΡΠ° Π³ΡΡΠΏΠ° Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π°ΡΡΠΈΠΊΡΠΈΡΠ° ΠΈ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ°. Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠΊΠ°ΡΠ° Π°Π½Π°Π»ΠΈΠ·Π° ΠΏΠΎΡΠ²ΡΠ΄ΠΈ ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½ΠΎ ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ Π½Π° ΠΠ¦Π’ Π²ΠΎ Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈΠΎΡ Π²ΡΠ΅ΠΌΠ΅Π½ΡΠΊΠΈ ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΊΠ°Ρ ΠΏΡΠ²Π°ΡΠ° Π³ΡΡΠΏΠ° Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π ΠΠ‘ ΠΈ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ° ΡΠΎ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠΊΠ° Π²Π΅Π½ΡΠΈΠ»Π°ΡΠΈΡΠ° (ΠΠ) ΠΈ bubble ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π΅Π½ ΠΏΡΠΈΡΠΈΡΠΎΠΊ Π½Π° Π΄ΠΈΡΠ½ΠΈΡΠ΅ ΠΏΠ°ΡΠΈΡΡΠ° (ΠΠ¦ΠΠΠ), ΡΠΏΠΎΡΠ΅Π΄Π΅Π½ΠΎ ΡΠΎ Π²ΡΠΎΡΠ°ΡΠ° Π³ΡΡΠΏΠ° Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π°ΡΡΠΈΠΊΡΠΈΡΠ° ΠΈ Π΄ΠΎΠΊΠ°ΠΆΠ°Π½Π° ΡΠ΅ΠΏΡΠ°, p<0,001. ΠΠ¦Π’ Π΅ Π²Π΅ΡΡΠ²Π°ΡΠΊΠΈ ΠΌΠ°ΡΠΊΠ΅Ρ Π·Π° ΡΠ΅ΠΏΡΠ° ΠΊΠ°Ρ Π½ΠΎΠ²ΠΎΡΠΎΠ΄Π΅Π½ΡΠΈΡΠ° ΡΠΎ Π ΠΠ‘, ΠΊΠΎΡ ΡΠ° Π½Π°Π΄ΠΎΠΏΠΎΠ»Π½ΡΠ²Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠ°ΡΠ° ΠΏΡΠ΅Π·Π΅Π½ΡΠ°ΡΠΈΡΠ° ΠΈ ΡΡΡΠΈΠ½ΡΠΊΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΊΠΎΠΈ ΡΠΊΠ°ΠΆΡΠ²Π°Π°Ρ Π½Π° ΡΠ΅ΡΠΊΠ° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡΠ° Π·Π° Π²ΡΠ΅ΠΌΠ΅ Π½Π° Ρ
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