Prevalence of healthcare-associated infections and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine.

BACKGROUND: Healthcare-associated infections (HAIs) are among the most common adverse events in patient care, and account for substantial morbidity and mortality. AIM: To obtain the first estimates of the current prevalence of HAIs and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine. METHODS: Prospective surveillance was conducted from January 2014 to December 2016 in five acute care hospitals in Kyiv. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. FINDINGS: Among 53,884 patients, 3753 (7%) HAIs were observed. The most frequently reported HAIs were respiratory tract infections (pneumonia 19.4%, lower respiratory tract infections 4.1%), surgical site infections (19.6%), urinary tract infections (17.5%) and bloodstream infections (10.6%). Death during hospitalization was reported in 7.2% cases of HAI. The micro-organisms most frequently isolated from HAIs were Escherichia coli (15.9%), Staphylococcus aureus (14.8%), Enterococcus spp. (10.2%), Pseudomonas aeruginosa (8.9%) and Klebsiella spp. (8.9%). Meticillin resistance was reported in 28.2% of S. aureus, and 14.2% of enterococci were resistant to vancomycin. Overall, 35.1% of all Enterobacteriaceae were resistant to third-generation cephalosporins, with the highest resistance rates seen in K. pneumoniae (53.8%) and E. coli (32.1%). CONCLUSIONS: Infection control priorities in hospitals should include prevention of surgical site infections, pneumonia, bloodstream infections and urinary tract infections. These results may help to delineate the requirements for infection prevention and control in acute care hospitals.

[IDENTIFICATION OF A NEW DIAGNOSTIC MARKERS OF PROSTATIC CANCER, USING NOTI-MICROCHIPS].

The biopsy material specimens were investigated in 33 patients, examined for the prostatic cancer suspicion. In accordance to the morphological investigation data, in 15 patients a benign prostatic hyperplasia was verified, and in 18--pancreatic adenocarcinoma. NotI-Microchips of 180 clones of the third chromosome were used for determination of epigenetic changes. In 50 genes of the third chromosome a high rate of the methylation state changes (from 33 to 82%) was noted. Some changed genes take part in cancerogenesis (HMGB1L5, LRRC58, GPR149, DZIP1L, C3orf77, NUDT16) and in the prostatic gland cancer occurrence (BCL6, ITGA9, FBLN2, SOX2, LRRC3B etc.). Dependence of the genes methylation state from the clinic-morphological indices in patients with the prostatic gland cancer, including, the prostate-specific antigen level, the tumor differentiation degree in accordance to Gleason, was not established. Panel, consisting of 16 new potential markers for early and differentiated diagnosis of prostatic gland cancer, was identified: BHLHE40, FOXP1, LOC285205, ITGA9, CTDSPL, FGF12, LOC440944/SETD5, VHL, CLCN2, OSBPL10/ZNF860, LMCD1, FAM19A4, CAND2, MAP4, KY and LRRC58.

[DRAINLESS TRANSCUTANEOUS NEPHROLITHOTRIPSY. OUR FIRST EXPERIENCE].

Experience of performance of a drainless transcutaneous nephrolitotripsy (DTN) for renal concrements was summarized. In 245 patients mini­DTN was done, оperation was finished with the nephrostomic drain installation ­ in 224 (91.4%), and without such procedure ­ in 21 (8.6%), in these patients an ureteric JJ­stent was installed in antegrade fashion. Indications for the DTN performance were substantiated, the patients for such treatment were selected, peculiarities of the DTN performance are adduced. JJ­stents were removed from ureter on the 2­nd ­ 7­th postoperative day, and in some patients ­ in ambulatory setting. After the operation the patients with out nephrostomic drain needed anesthesia in twice rarely. DTN constitutes a secure procedure, which must be conducted by experienced surgeon, сomplient with all demands and criteria of renal transcutaneous surgery, what permits to reduce the pain syndrome severity in patients in the early postoperative period stationary state.

[[Peculiarities of transcutaneous nephrolithotripsy in the patient's position lying on the back].]

In 2014 - 2016 yrs transcutaneous nephrolithotripsy was performed in 245 patients for nephrolithiasis, of them in 228 (93.1%) - in position of patient lying on the abdomen (1st group), in 17 (6.9%) - lying on the back (2nd group) because of various concur- rent cardio-vascular and respiratory diseases present. Mini- transcutaneous nephro- lithotripsy was performed under regional epidural anesthesia in 224 (91.4%) patients, and under endotracheal narcosis - in 21 (8.6%). While conduction of mini- transcu- taneous nephrolithotripsy in position of patient lying on the back the operation duration is reducing, and it is possible to perform simultant endoscopic interventions (trans- ureteric, transcutaneous). Position of patient lying on the back while performing tran- scutaneous nephrolithotripsy in a complex with regional (epidural) anesthesia consti- tutes a relatively secure procedure. Hemodynamical and respiratory parameters are simply intraoperatively controlled, what is important for the patients, urologists and anesthesiologists. The complications rate and results of treatment are comparable with such while performing transcutaneous nephrolithotripsy in accordance to standard in position of patient lying on the abdomen.

Aberrant expression of selenium-containing glutathione peroxidases in clear cell renal cell carcinomas.

AIM: To find putative diagnostic markers for clear cell renal cell carcinomas (ccRCC). MATERIAL AND METHODS: Quantitative polymerase chain reaction (Q-PCR), bisulfite treatment, methylation-specific PCR, analysis on cBioPortal for Cancer Genomics. RESULTS: We have found that expression of GPX1, GPX3, and GPX4 genes was decreased in ccRCC. We have shown that the number of alanine (GCG) repeats at the amino terminus of the GPX1 protein is variable. It was reported earlier that an allele that possess 5 alanine repeats is associated with the increased cancer risk. According to the obtained data, the allele with the 5 alanine repeats was also present in a group of healthy donors. Moreover, the frequency of alleles with repeats was similar among ccRCC patients and healthy individuals. We found that decreased expression of GPXs genes was not associated with promoter methylation. To provide other explanation, an analysis on the gene copy number was performed. We have found the heterozygous deletions for GPX1 gene, amplification for GPX3 gene, and no change in gene copy number for GPX4. CONCLUSIONS: Our data support the hypothesis that GPX1, GPX3, and GPX4 genes may play a role in ccRCC cancerogenesis and therefore they might be considered as putative diagnostic markers for ccRCC.

[Endoscopic methods of urethral stenosis treatment in men]. / Endoskopichni metody likuvannia zvuzhennia sechivnyka u cholovikiv.

Results of treatment of 102 patients aged from 20 to 88 years for postoperative urethrostenosis were analyzed. Complex of investigations had included the analysis of complaints, data of anamnesis, instrumental methods, blood and urine analysis. Special urologic investigation had envisaged the revelation of the uresis disorders signs, conduction of radiologic, ultrasonic investigation, urophlowmetry. Optical urethrotomy, transurethral resection (TUR) of stenosis, bougienage were conducted depending on length of stenosis. In all patients independent controlled uresis was restored, signs of obstruction were eliminated. Introduction of miniinvasive methods of treatment in practice had promoted the lowering of operative intervention risk, the intra- and postoperative complications frequency, duration of intervention, had allowed to avoid performance of open operation, to improve quality of life.

[The immunohistochemical determination of p53 and of proliferating cell nuclear antigen in the epithelial nuclei of benign prostatic hyperplasia following the accident at the Chernobyl Atomic Electric Power Station]. / Imunohistokhimichne vyznachennia p53 ta proliferatyvnoho klitynnoho iadernohoantyhena v iadrakh epiteliiu dobroiakisnoï hiperplaziï peredmikhurovoï zalozy pislia avariï na ChAES.

With the purpose of studying into the morphogenesis and proliferous activity of the prostatic epithelium under a long-term exposure to low doses of ionizing radiation there have been conducted comparative histological and immunohistochemical (expression of p53 and proliferous cellular nuclear antigen-PCNA) investigations designed to study benign prostatic hyperplasia in patients living in those Ukraine territories affected by radionuclide contamination (group III), residents of Kiev (group II), and patients having been operated on before the Chernobyl accident, having constituted the control group I. It has been found out that the incidence of prostatic intraepithelial neoplasia (PIN), the level of nuclear expression of proteins p53 (in the PIN epithelium) and PCNA (in the epithelium of both benign prostatic hyperplasia and PIN) of patients in groups II and III are by far higher as compared with those in group I. The stroma of benign prostatic hyperplasia in patients of groups II and III was clearly different from that in the control group in that the former was characterized by apparent phenomena of hyalinosis, sclerosis, fibrosis, and extensive inflammatory infiltration, which changes can be explained by a long-term systematic exposure of prostatic tissue to low doses of ionizing radiation.

[The correlation of the hormonal and clinical effects in patients with prostatic cancer undergoing niftolid treatment in combination with low doses of synestrol]. / Koreliatsiia hormonal'nykh ta klinichnykh efektiv u khvorykh na rak peredmikhurovoï zalozy pry likuvanni niftolidom u poiednanni z malymy dozamy synestrolu.

Effects were studied of niftolide in tablets, 0.25 g on a three-times daily basis in combination with low doses of sinestrol, 5 mg intramuscularly within 24 h, on tumor growth, blood plasma content of luteinizing hormone (LH), testosterone (T) and testosterone-estradiol-binding globulin (TEBG) in 46 patients with prostate gland carcinoma, including seven patients with metastases. After treatment for three months, plasma T level decreased by 63%, that of LH by 53% whereas TEBG increased twice as much. The treatments were administered for as long as 10 months, with estrogen therapy being tapered to a dose of 3 mg daily. The above treatment schedule resulted in stabilization or partial regression of tumor growth in as many as 94.9% cases; also deserving to be noticed was improvement in the outflow of urine and alleviation of the pain syndrome. The clinical effect is believed to be due to pharmacological blockade of androgenic receptors in the tumor and its metastases as well as to antigonadotropic activity of estrogen and striking lowering of blood plasma free T.

[Radionuclide, ultrasonic and thermographic methods of examination in the differential diagnosis of acute pyelonephritis and diseases of the abdominal organs]. / Radionuklidnye ul'trazvukovye i termograficheskie metody issledovaniia v differentsial'noi diagnostike ostrogo pielonefrita i zabolevanii organov briushnoi polosti.

Based on the examination of 1050 patients the authors make a conclusion of great significance of renoscintigraphy, ultrasonic scanning and thermography for differential diagnostics of acute pyelonephritis, acute cholecystitis and pancreatitis.