MENSTRUAL DISORDER IN ADOLESCENTS DURING WAR.

OBJECTIVE: The aim: To investigate the peculiarities of menstrual cycle disorders in teenagers against the background of excessive stress in order to develop a scientifically based set of measures for their correction. PATIENTS AND METHODS: Materials and methods: 120 girls aged 9-18 who were in the war zone or became forced migrants were examined. Examination methods included anamnesis collection, assessment of psycho-emotional state, anthropometry, laboratory and instrumental studies. RESULTS: Results: It was found that the frequency of menstrual cycle disorders in the subjects was 65.8% (n = 79). Among menstrual cycle disorders: dysmenorrhea - 45.6% (n = 36), excessive menstruation - 27.8% (n = 22), secondary amenorrhea - 26.6% (n = 21). 71.7% (n = 86) of the examinees noted a change in eating behavior over the past few months. Almost half of these children had dyshormonal disorders or met the criteria of metabolic syndrome - 45.3% (n = 39). CONCLUSION: Conclusion: Timely detection and adequate correction of psycho-emotional and metabolic disorders in adolescent girls in stressful conditions contributes to the prevention of disorders of menstrual and reproductive function.

MEDICAL AND ECONOMIC ANALYSIS OF THE CHOICE OF THERAPEUTIC PLASMAPHERESIS METHOD TO OPTIMIZE THE TRANSFUSION CARE QUALITY.

OBJECTIVE: The aim: To analyze the medical and economic aspects of the manual and different types of automatic plasmapheresis (manual, automatic centrifugal, automatic membrane, plasmapheresis with plasma therapy and mixed) used for therapeutic purposes. PATIENTS AND METHODS: Materials and methods: The Baxter Auto-C, Haemonetics PCS2, Haemophenics, Baxter CPDA anticoagulant and saline, Baxter 16GA needles were used. Total protein was examined by the biuret method, hemoglobin by the Sally method, total bilirubin by the colorimetric photometric method, cell fragments by the Goryaev camera microscopy method; patient comfort - with a 10-point scale. Healthy blood donors participated in the study. Manual plasmapheresis was performed in 31 people, automatic plasmapheresis with centrifugal technology - 36 people, with membrane technology - 21 people, mixed technology - 36 people. RESULTS: Results: An analysis of the different technologies impact on hematological, psychological and medical and economic indicators was performed. Native hemoglobin was absent in the bloodstream and in the final plasma with all technologies. Bilirubin index was within normal limits. There were no cell fragments. It was proved the absence of significant differences in various technologies on hematological parameters. The lower level of patient comfort by manual plasmapheresis was established. CONCLUSION: Conclusion: All therapeutic plasmapheresis technologies have the same effect on the patient's blood hematological parameters and did not have a negative impact on the body by the indicators: hemolysis, the presence of cell fragments, patient discomfort and citrate reactions during the standard procedure of sampling 800 ml of plasma. The most effective are plasmapheresis machines with centrifugal technology by medical and economic parametres.

NEW MARKETING TOOLS IN THE BLOOD SERVICE TO OPTIMIZE QUALITY MANAGEMENT.

OBJECTIVE: The aim: To identify the main fears of donation among young people in the city and ways to eliminate these phobias with the help of modern marketing tools. PATIENTS AND METHODS: Materials and methods: It was conducted the questionnaire among Sumy State University students on donation fears. The questionnaire included questions about experience of donation, reason for non donation and age. After that a focus group among students who feared donation was organized. Participants were shown a 360 degree video recorded in the blood center and discussed how to donate blood after watching the video. RESULTS: Results: The main phobias were fear of becoming infected during the procedure (37.7%), fear of the procedure itself due to ignorance and misunderstanding of what to expect (14.0%), and fear of the needle, blood, and the discomfort possibility during the procedure (10.0%); 26.7% indicated that they could not be donors due to poor health, and 11.6% due to personal laziness. It was developed a 360o video, which demonstrates the blood donation process, showing the next steps with the selected blood in facilities. Its continues for 20 minutes. This video was shown in the focus group for ten non-donors with some donation fear. 60% of them reported a change from blood to a positive, which may indicate this tool's effectiveness. CONCLUSION: Conclusions: Due a 360o video some non-donor people can ensure safety, sterility of the process, reduce the fear of donation and further increase the likelihood of becoming regular donors.

Estimation to efficiency of the multifunction method оf endometriosis ovariеs treatment.

OBJECTIVE: The aim: The aim of the study was to improve the results of treatment of patients with endometriosis by using a combination method of therapy. PATIENTS AND METHODS: Materials and methods: For two years, 136 women of reproductive age who underwent laparoscopic surgeries for ovarian endometriosis were monitored: Group I (n = 24) did not receive any hormonal treatment in the perioperative period; Group II (n = 32) - received gonadotropin-releasing hormone agonists within 3 months after surgery; Group III (n = 80) prior to laparoscopic removal of the ovarian cyst used gonadotropin-releasing hormone agonists - Triptorelin 3.75 mg intramuscularly for 2 months, as well as three months after surgery. The control group consisted of 30 healthy women of reproductive age with regular menstrual periods. All patients underwent transvaginal ultrasound, counting the number of antral follicles before and after treatment. Serum hormone levels (FSH, prolactin, thyrotropic hormone, anti-Mullerian hormone, inhibin B) were determined by enzyme-linked immunosorbent assay on Cobas e-411 analyzer (Roche Diagnostics, Switzerland) on day 2-3 of the menstrual cycle and on day 2-3 of the first menstrual period after the end of treatment. Laparoscopic removal of the cyst was performed with exfoliation of the cyst, hemostasis on the wound surface of the bed of the cyst was performed with a bipolar electrocoagulator. Bipolar coagulation and resection of the ovarian tissue with no potential was used during surgical treatment of the ovaries, which made it possible to preserve the intact portion of the ovary as much as possible. RESULTS: Results: Analysis of ovarian reserve indices, namely number of antral foliculs, number of antral follicles, AMG, and inhibin B levels in all examined patients with ovarian endometriomas were significantly lower than those of the control group before the start of treatment: in the ovarian endometrial group group 1.26 times (p <0.01), inhibin B - 1.5 times (p <0.01), the number of antral follicles - 1.2 times (p <0.01), due to the development dystrophic changes of the follicular apparatus due to prolonged compression, hypoxia, fibrosis in the ovaries. Patients who planned pregnancy were advised to have an active sexual life before menstruation was restored. In 23 (46.9%) of 49 patients who had reproductive plans, pregnancy occurred without first menstruation after a course of gonadotropin-releasing hormone agonists, 12 (24.5%) women became pregnant during the first three menstrual cycles. Extracorporeal fertilization was recommended for women who did not have pregnancy within 6 months of surgery. For two years in women who did not plan pregnancy, recurrence of endometriosis was not observed. CONCLUSION: Conclusions: The combination of laparoscopic treatment with gonadotropin-releasing hormone agonists in patients with endometriosis with infertility allowed to restore reproductive function in 71.4% of women, which indicates the effectiveness of the treatment method used. In addition, it helps to achieve lasting remission and addresses the socio-social problems of women's health and maternity.

Methods of preventive intervention in women with multiple pregnancies in non-assymptomic circulation.

OBJECTIVE: The aim: The purpose of the study is a comparative evaluating the effectiveness of using the different methods of treatment of miscarriage in multiple pregnancies taking into account the condition of the cervix. PATIENTS AND METHODS: Materials and methods: 86 pregnant women with diarrheal twins were monitored. On the basis of studying the premorbid background, somatic and reproductive history, features of the gestational period, leading antenatal risk factors for the development of complications in multiple pregnancies were identified. With the help of transvaginal cervicometry the prognostic ultrasound criteria of the condition of the cervix and its obstructive capacity in case of premature birth are investigated. RESULTS: Results: In the event of uncomplicated pregnancy multiple birth is characterized by a gradual shortening of the cervix in dynamics from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm by 20 weeks, from 37.7 ± 4.1 mm to 30.2 ± 3.9 mm to 30 weeks, to 21.1 ± 3.1 mm to 37 weeks. In the period of 25-27 weeks, the appearance of a V-shaped opening of the uterine cervix in half of the women was observed, which remained until the end of gestation. Shortening of the cervix was the most significant in patients with the risk of abortion who received only tocolytic therapy. In the 2nd trimester revealed a V- or U-shaped opening of the cervical canal. In pregnant women at risk who had an obstetric pessary, a decrease in the length of the cervix was found, which was similar to the rate of its shortening in uncomplicated multiple pregnancies. The condition of the cervix in the presence of a pessary before delivery probably did not differ from the condition of the cervix with the normal course of multiple pregnancies. CONCLUSION: Conclusions: Pregnant women with uncomplicated multiple pregnancies revealed a decrease in the length of the cervix with an increase in gestation. At the end of pregnancy, the internal jaws acquired a predominantly Y-shape. In pregnant women with the risk of pregnancy termination who received tocolytic therapy, the cervix was the shortest. In late gestation, V- and U-shaped internal jaws were observed. Changes in the cervix after the placement of obstetric pessaries are similar to changes in uncomplicated pregnancy.