MEDICAL AND SOCIAL ANALYSIS OF PATIENTS WHO DIED OF SARS-COV-2 IN THE SPECIALIZED INFECTIOUS DEPARTMENT OF THE CITY OF SUMY DURING THE FIRST WAVE OF THE EPIDEMIC.

OBJECTIVE: The aim of the article is to analyze demographic indicators, clinical symptoms, concomitant pathology, and the course of acute respiratory viral infection (ARVI) caused by SARS-CoV-2 in patients with a fatal outcome of the disease. PATIENTS AND METHODS: Materials and methods: To achieve the goal, a statistical method, an analytical method, and a method of retrospective analysis of the medical histories of patients with fatal cases who were hospitalized with a diagnosis of ARVI caused by SARS-CoV-2 were used. RESULTS: Results: Mortality among patients who were hospitalized with a diagnosis of ARVI caused by SARS-CoV-2 was 8.18 ± 2.17%. Among them, 62% were male and 38% were female. Cardiovascular pathology took first place in the structure of concomitant pathology of all age groups and accounted for 76%. Oncological diseases accounted for 62%, gastrointestinal diseases - 54%, endocrine diseases - 38%, and respiratory system diseases 23% of the total number of patients with fatal cases. CONCLUSION: Conclusions: Mortality from coronavirus infection in the period March - July 2020 among the male population was 62%, of which 13% - from the age group 18-45 years, 38% - from the age group 46-64 years, and 50% - patients 65 years old and older. Among the female population, the mortality rate was 38%, of which 20% were women in the age group 46-64% and 80% were 65 years and older. The presence of no-hospital polysegmental pneumonia as a complication of ARVI caused by SARS-CoV-2 was 62% among all age groups of the studied patients with fatal cases.

APPLICATION OF BEHAVIORAL ECONOMICS INSIGHTS TO INCREASE EFFECTIVENESS OF PUBLIC AWARENESS OF COVID-19.

OBJECTIVE: The aim: To determine the level of public awareness of COVID-19 and information needs, as well as level of public confidence in both official information on COVID-19 and to develop recommendations for communication policy on longer-term awareness in pandemic settings COVID-19, using principles of behavioral economics. PATIENTS AND METHODS: Materials and methods: 4 focus group interviews were conducted in residents of Ukraine, with a total quantity of 48 people aged 16-70 years questioned and an anonymous questionnaire was conducted in 1,700 respondents, representing the adult population aged 18 years and older from all over Ukraine. The representative error of the study with probability of 0.95 does not exceed 4%. The processing of questionnaires was carried out by SDU Center of Social Researches (SDUCSR) employees, using the OSA program. RESULTS: Results: 28.5% of respondents believe that politicians and media underestimate the danger of the COVID-19 epidemic, while other 28.1% believe that politicians and media adequately assess its danger. 18.9% of respondents are sure that the danger is exaggerated. As much as 24.5% of Ukrainian respondents could not decide on such assessment. The most common sources of information about disease/treatment are Internet and social media. Traditional media and relatives/acquaints who endured the COVID-19 also gain population`s confidence. A family doctor is the least popular source of information. 42.1% of respondents do not trust official information on the number of infected people and severity of the disease, and another 40% are not sure whether they should trust or not. Only 17.9% of respondents trust official information. CONCLUSION: Conclusions: Within informing the society about public health in conditions of a COVID-19 pandemic it is better to provide communication strategy for various target audiences: for youth which is inclined to underestimate threats of epidemic and obtains information on social networks; for people of a retirement age (as risk group) who lack information because they use only traditional media (mainly TV); for women who need psychological support to decrease in level of stress in the family more often and also to overcome the negative post-stressful situations (connected with the death of the family/relatives); for men who are inclined to neglect their own health, etc.; for the people who have endured COVID-19 to prevent possible reinfection in them.

MENINGO-ENCEPHALITIS IN A MIDDLE-AGED WOMAN HOSPITALIZED FOR COVID-19.

OBJECTIVE: The aim: To pay attention of clinicians to possible lesions of the central nervous system (encephalitis) in patients with COVID-19. PATIENTS AND METHODS: Case presentation: A 44-year-old woman was admitted to our clinic because of 2-month-history of mild fever, bilateral lower lobe pneumonia, respiratory failure, generalized weakness, and some neurologic symptoms. SARS-CoV-2 RNA was detected in nasopharyngeal swab. Chest CT demonstrated bilateral pulmonary poly segmental consolidations in the mid and lower zones. Focal hyper intensive abnormalities in various parts of the left hemisphere were found at MR brain imaging in T2WI, and T2 FLAIR mode. Cerebrospinal fluid (CSF) examination showed a white cell count of 31/uL (normal <5/uL), protein 0.73 g/L (0.15-0.45), and glucose 1.4 mmole/L (2.2-3.9). Standard CSF neuroviral PCR panel and PCR for SARS-CoV-2 were negative. She was treated with ganciclovir, and dexamethasone. Due to suspected tuberculosis meningitis (cytosis, decreased level of protein and glucose), she also received ex juvantibus a course of anti-TB therapy (isoniazid, kanamycin, and levofloxacin) and made a steady improvement. CONCLUSION: Conclusion: This case shows that SARS-CoV-2 in association with other pathogens may cause various lesions of the CNS accompanied by severe neurological manifestations in adults.

BASIC PRINCIPLES OF BEHAVIORAL ECONOMICS AND PROSPECTS FOR THEIR APPLICATION IN THE PUBLIC HEALTH SYSTEM.

Behavioral economics is a branch of economic theory that studies the influence of psychological factors on people's decisions in various life situations. At the same time, much attention is paid to situations where people behave differently than predicted by classical economic theory with its assumption of rationality and selfishness. Interesting possibility of application of behavioral economic in various spheres of human life and society, for example, reforms introducing, insurance system, public health and medicine (healthy living, disease prevention, following-up to the doctor's recommendations, improving the quality of care, etc.).

A rural-based medical and sociological study on the results of the primary care reform.

OBJECTIVE: The aim: To study the results of a medical and sociological research as to the attitude of rural population in amalgamated hromadas (AH), i.e. united territorial communities, of Sumy region to the results of primary care reform. PATIENTS AND METHODS: Materials and methods: The form of research - a survey with closed questionnaire. The study was conducted on a specially designed three-tier quota sample, which was calculated allowing for the territorial and socio-demographic indicators. A total of 320 respondents residing in the specified rural communities (hromadas) were surveyed with quota sampling. The theoretical sampling error makes 3%. The questionnaires were processed by the laboratory staff with the help of the "OСA" program. RESULTS: Results: Among the surveyed in Nyzhniosyrovatska AH (amalgamated hromada), 23.5% of the population emphasized that their authorities neglected medical problems, while in Bezdrytska AH this indicator was 6.7%, as evidenced by the difference in the industry financing from own assets (274 thousand less than in Bezdrytska AH). The survey revealed that in the communities where the population knows their family doctors better and trusts them, the satisfaction with the quality of medical care and the attitude to prophylaxis (prevention) is much higher. CONCLUSION: Conclusions: A significant part of the population demonstrates a low level of awareness of the course of the reforms, their goals and objectives. The specified trends may indicate a lack of communication or distortion of information on the implementation of medical reform. It is an information support that is one of the key instruments for effective introduction of medical reform. At the local level, this function is assigned to a family doctor who becomes a determining factor not only for providing medical services to patients, but also for communication, keeping the population informed and prophylaxis.

Subacute enterovirus-associated encephalitis in a young adult coinfected with borrelia burgdorferI.

OBJECTIVE: The aim: To pay attention of clinicians to sterile encephalitis in adults, which in fact may be caused by EVs. RESULTS: Results: A young woman was admitted to our clinic because of 3-month-history of mild fever, left-sided soft facial paralysis, and generalized weakness. MR brain imaging in T2W, FLAIR, and T1W mode showed focal hyper intensive abnormalities in various parts of the left hemisphere. EV RNA was detected in the patient's CSF on admission. IgM class antibodies to B.burgdorferi were present in the blood. Antibiotics and ribavirin have been administrated with a good effect. CONCLUSION: Conclusion: This case shows that EV infection may cause brainstem encephalitis accompanied by severe neurological manifestations in adults.

Epstein-barr virus-associated encephalitis in a case-series of more than 40 patients.

OBJECTIVE: Introduction: Epstein-Barr virus (EBV) infection can present with neurologic manifestations including encephalitis, aseptic meningitis, Guillain-Barre syndrome, and many others. Most reported cases have been in children. Little is known about EBV encephalitis in adults. The aim: To describe the clinical presentations, investigational findings, management and outcome of adult patients with EBV encephalitis. PATIENTS AND METHODS: Materials and methods: This report conducted a retrospective review of all cases of EBV-associated encephalitis compiled in the Kyiv's referral hospital from January 2016 to December 2017. RESULTS: Review: Out of 226 adult patients hospitalized with acute encephalitis during the study period, 48 (21.2%) were identified as having evidence of EBV-infection: convincing EBV serology and/or positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) in patients that had no bacterial cause of encephalitis. EBV monoinfection was registered in 24 (50%) patients. Mixed herpesvirus infection with one to four viruses in addition to EBV was detected in the rest. The most common symptoms were fever, confusion, headache, focal neurological deficits, vestibulo-ataxic disorders. CSF cytosis, content of protein and glucose were close to normal. Magnetic resonance imaging (MRI) showed focal (28/58.3%) and diffuse (15/31.3%) changes of the brain parenchymal. All patients got antiviral medication: ganciclovir, valganciclovir or valaciclovir, as a rule. Outcome: 26 (54%) patients recovered without any disabling sequela, 21 (44%) patients with remaining preservations were transferred to a convalescence facility. One patient, which condition worsened against the background of the therapy, were moved to an intensive care unit. No patient died. CONCLUSION: Conclusions: CNS infection with EBV only and as a mixed infection is common in Ukraine. Presentation of EBV-infection is non-specific, both as MR imaging, sometimes reminding of HSV-1 infection. Prognosis of the disease is favorable.

Algorithm of adenoiditis treatment in adults, depending on the pharyngeal tonsil hypertrophy stage.

OBJECTIVE: Introduction: Implementation of the endoscopic technologies while the upper airways diseases gave opportunity to diagnose the adenoid vegetation in adults. The aim: Тo offer effective algorithm of curing adults for adenoiditis, depending on the degree of pharyngeal tonsil hypertrophy. PATIENTS AND METHODS: Materials and methods: 43 patients aged 18 - 55 with hypertrophy of pharyngeal tonsil were examined. Depending on the degree of hypertrophy three clinical groups of patients was created: the first one receiving only conservative treatment, the second one receiving conservative therapy and radiowaveradiation coagulation with the apparatus "SURGITRON" and the third one receiving the endoscopic shave adenotomy. Statistical processing of the received data was made in the programs «Exсel¼ and «STATISTICA 6.0¼. Data rows were checked for the normality with the help of Shapiro-Wilk statistical criteria (small sample) and Kolmohorov-Smirnov (large sample). Checking of the dispersion uniformity was done by Leneva criteria. During the comparison of the rows criteria of Student and Wilkokson for the non-paired, Kolmogorov-Smirnov were used. RESULTS: Results: During the re-examination of patients who received only conservative therapy treatment in a month endoscopic signs adenoiditis were distinguished and a year later percentage of relapse was higher than in patients with complex treatment. After shave adenotomy adenoiditis recurrence was not observed. CONCLUSION: Conclusions: While treatment of the patients with the pharyngeal tonsil hypertrophy of the 1 and 2 degree conservative therapy is possible. Addition into the scheme of conservative treatment RWCAV actually reduces quantity of adenoiditis recurrence and allows fast recovery. Treatment of patients with the pharyngeal tonsil hypertrophy of 3 degree, in context of contraindication absence requires surgical treatment (adenotomy) in 100% of cases.

Development of informational-communicative system, created to improve medical help for family medicine doctors.

OBJECTIVE: Introduction: Today mobile health`s protection service has no concrete meaning. As an research object it was called mHealth and named by Global observatory of electronic health`s protection as "Doctor and social health practice that can be supported by any mobile units (mobile phones or smartphones), units for patient`s health control, personal computers and other units of non-wired communication". An active usage of SMS in programs for patients` cure regimen keeping was quiet predictable. Mobile and electronic units only begin their development in medical sphere. Thus, to solve all health`s protection system reformation problems a special memorandum about cooperation in creating E-Health system in Ukraine was signed. The aim: Development of ICS for monitoring and non-infection ill patients` informing system optimization as a first level of medical help. PATIENTS AND METHODS: Materials and methods: During research, we used systematical approach, meta-analysis, informational-analytical systems` schemes projection, expositive modeling. Developing the backend (server part of the site), we used next technologies: 1) the Apache web server; 2) programming language PHP; 3) Yii 2 PHP Framework. In the frontend developing were used the following technologies (client part of the site): 1) Bootstrap 3; 2) Vue JS Framework. RESULTS: Results and conclusions: Created duo-channel system "doctor-patient" and "patient-doctor" will allow usual doctors of family medicine (DFM) take the interactive dispensary cure and avoid uncontrolled illness progress. Doctor will monitor basic physical data of patient`s health and curing process. The main goal is to create automatic system to allow doctor regularly write periodical or non-periodical notifications, get patients` questioning answers and spread information between doctor and patient; that will optimize work of DFMs.

Identification of human herpesvirus 7 in the cerebrospinal fluid of adult ukrainian with relapsing-remitting multiple sclerosis. A case study.

OBJECTIVE: Introduction: In this study, we investigated the possible involvement of Human herpesvirus 7 in multiple sclerosis. The aim: To contribute to clarifying the controversy on the association between Human Herpesviruses 7 (HHV-7) and multiple sclerosis (MS) studying patient with relapsing-remitting MS (RRMS). PATIENTS AND METHODS: Case study: Young female admitted to adult tertiary referral, infectious diseases hospital, Kyiv, Ukraine, with signs of a focal neurological deficit. Meningeal symptoms were not detected. The preadmission illness lasted some years. Clinical diagnosis was relapsing-remitting multiple sclerosis (RRMS). On admission, general condition was of moderate severity. She has a mild fever, confusion, speech and coordination disorders, dizziness, worsening of memory, inability to walk (inferior paraparesis). Focal lesions were detected on MRI scan. The spinal fluid contained oligoclonal IgG-chains and HHV-7 DNA. After two weeks of intensive antiviral treatment, the patient's condition improved significantly,the function of the lower limbs recovered almost completely, and she was discharged home. CONCLUSION: Conclusion: Here we present a comprehensive clinical, radiological and virological analysis of the HHV-7-associated case of multiple sclerosis.