Volume 15 (2022): Issue 1 (June 2022)

Food safety is an essential and integral part of public health policies in developed countries. Canned foods play a significant role in modern human nutrition. Improving the safety of internal control in production is additional prevention of the potential risks of consuming contaminated food. The present study aims to perform a health assessment and medical analysis of the Internal Control System and a canning company’s Hazard Analysis and Critical Control Points (HACCP) plan. Our study also aimed to find potential mechanisms to increase the safety in producing this type of ready-to-eat foods and possible new approaches in avoiding and managing risks. An audit algorithm was developed to analyze the existing food safety systems in the enterprise to achieve the study’s goal. The algorithm was based on the Codex Alimentarius methodology, presented in the document “Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System. A medical analysis of the Internal Control System was performed, based on the prerequisite programs, technical documentation, and the company’s HACCP-plan. The analysis of the documentation and the critical remarks made can provide more reliable conditions for producing products safe for consumers’ health. The proposed corrections in the Good Hygiene Practices (GHP), the Good Manufacturing Practices (GMP), and the HACCP plan, mainly through adequately naming authentic hazards of a biological nature, are the basis for more professional verification of the processes and ensuring food safety.

Nursing research is a relatively new area of professional development that began firstly in the USA and made significant progress during the second half of the 19th century. Nursing research has made significant progress in European countries, mainly developed countries. This article aimed to review publications describing the evolution of nursing research, the directions of development, and best practices in the USA and Europe. Different databases were searched according to selected criteria, and a narrative literature review was conducted. Forty-two articles from the USA and Europe were identified and included as the most appropriate in the analysis, published in 22 journals. During the analysis, five basic directions of developing nursing research were identified - nursing research education, organizational structures for nursing research and collaboration with clinical professionals, research dissemination and journals, trends and priorities, and funding nursing research. To increase research capacity and respond to the growing research culture and the requirements of the scientific community, nursing research education is needed at every educational level. Establishing organizational structures has proved the importance of supporting and encouraging nurses to participate in and conduct studies. Funding research in teams is more likely to occur at any organization or centеr than looking for funding sources from individuals. Encouraging nurses and midwives to conduct research in clinical practice and publish results from scientific studies will help achieve sustainable implementation of evidence-based practice.

Cryptosporidiosis is a protozoan disease, usually asymptomatic. However, in some cases, the infection can progress to gastroenteritis and, more rarely, to colitis. Intensive studies on the biology of Cryptosporidium started in the 20th century after the outbreak of a major waterborne epidemic. The interest in this parasitosis increased after the WHO identified it as an opportunistic parasitosis - an indicator of AIDS. In this regard, the purpose of this article is to provide a scientific overview of this parasitosis, analyzing the state and development of modern research in a global and national aspect.

Surgical procedures of the retroperitoneum are often performed in gynecologic oncology surgery clinics. The most complex among them is paraaortic lymphadenectomy. It is generally performed in cases of bulky lymph nodes in ovarian carcinomas and sarcomas to achieve optimal cytoreduction. In the early stages of ovarian cancer, type II non-endometrioid endometrial cancer, and in advanced stages of cervical cancer, paraaortic lymphadenectomy is an integral part of staging. Moreover, the retroperitoneum is approached in cases of retroperitoneal gynecologic sarcomas. The largest vessels of the human body – the inferior vena cava and the abdominal aorta are localized in the retroperitoneum. Therefore, iatrogenic vessel injury during oncogynecological surgery is more likely to affect the inferior vena cava. Anatomical variations of the vein additionally increase the risk of vascular lesions. Therefore, surgeons should be aware of possible anatomical variations. The present article aimed to highlight the heterogeneity of anatomical variations of the inferior vena cava related to gynecologic oncology surgery. Embryogenesis of the vein and its variations are also discussed. Additionally, some anomalies of the ureter, associated with the embryogenesis of the inferior vena cava, are mentioned.

Ovarian cancer is not common, but it is still the fifth leading cause of death from malignant diseases among women worldwide. More than 200,000 women are diagnosed with ovarian cancer each year globally. Due to its asymptomatic course, most patients are diagnosed at a late stage. Therefore, ovarian cancer (OC) has the highest mortality among gynecological malignancies. Unfortunately, there is no adequate screening program for the early detection of ovarian cancer, and as a result, this diagnosis escapes clinicians. The protocol for early diagnosis of OC is currently a combination of elevated cancer antigen 125 (CA 125) and transvaginal ultrasonography (TVUS). However, it does not meet the necessary cost-effectiveness criteria and is therefore not recommended by any working group to screen ovarian cancer in the general population. The biomarkers with the highest informative value should be selected individually or combined in multi-biomarker panels from the many biomarkers strongly associated with OC. Numerous such panels of biomarkers and algorithms have been developed for the early diagnosis and differentiation of OC from other benign ovarian diseases. These panels or biomarkers need to be sufficiently reliable and show measurable changes in non-invasive samples obtained from patients with early-stage OC. Their reliability would significantly reduce mortality from this aggressive disease and improve the patient’s prognosis.

Cutaneous demodicosis (CD) is a pilosebaceous unit disease, overlapping clinically with other facial dermatoses, mainly rosacea, and acne. It is usually improved by acaricidal monotherapy. This study investigates the association of CD with metabolic disturbances. It was conducted with 141 patients with primary and secondary CD. The study investigated the correlation between CD and dyslipidemia based on disturbances in total cholesterol (TC) and Low-Density Lipoproteins (LDL) and between CD and impaired glucose tolerance, diagnosed with elevated fasting blood sugar levels, 120 minutes blood sugar levels in oral glucose tolerance test (OGTT) and the mathematically calculated Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index. The study results were verified with control groups. It was established that patients with CD do not show statistically significant deviations in serum lipoproteins compared with the control group. However, the patients with CD tended to have impaired glucose tolerance, demonstrated with elevated fasting glucose levels and elevated HOMA-IR, compared to the control group. Interestingly enough, the tendency towards prediabetes and diabetes was not confirmed by the 120 minutes blood glucose levels of the OGTT. The presented data confirm the need for testing impaired glucose tolerance in every patient with cutaneous demodicosis. Based on the presented evidence, it is recommended to perform the screening by evaluating fasting glucose levels and fasting insulin levels, followed by calculating the HOMA-IR index.

We present the applicability and cost-effectiveness of the large loop excision of the transformation zone (LLETZ) procedure in outpatient settings – anesthesia, postoperative pain, postoperative stay, and complications such as intraoperative bleeding, early postoperative bleeding, infection, late cervical canal stenosis, spotting, incomplete epithelialization, inadequate colposcopy). From Jan 1, 2017, to Jul 31, 2021, 189 patients underwent LLETZ at Medical Center “Prof. Kornovski”. The methodology includes the indications for performing the LLETZ procedure, the preparation of the patients, a description of the procedure, tools, technical parameters, the operation technique, and the postoperative period. We present the duration of the procedure; analgesics in terms of intraoperative bleeding; postoperative pain; postoperative stay; early postoperative complications (bleeding, infection); late postoperative complications (stenosis of the cervical canal, incomplete epithelialization, spotting before menstruation, and inadequate colposcopy). The LLETZ procedure is applicable in outpatient practice with low intra- and postoperative complications and minimum stay. Two main factors determine its cost efficiency in outpatient practice: the use of local anesthesia instead of general anesthesia requiring an anesthesiologist, anesthesiology nurse, anesthetic for short-term venous anesthesia, and the daily cost for an occupied bed – a financial factor in-hospital care versus the lack of daily cost per occupied bed in outpatient care.

In the last decade, the Holmium Laser Enucleation of the Prostate (HoLEP) has become the new gold standard for surgical treatment of benign prostatic hyperplasia (BPH). This treatment has several modifications, and the latest one is en bloc (single piece) enucleation. This new method reduces the operative time and risk of early incontinence. The long-term effect is much better than transurethral resection of the prostate (TURP). We applied an effective method for treating benign prostatic hyperplasia with maximum safety, minimal hospital stays, short operative time, and minimal complications. We operated on 50 patients with BPH with a prostate volume between 30-120 cc. Transrectal ultrasound, uroflowmetry, PSA test, IPSS (International Prostate Symptom Score), residual urine, digital rectal examination, and laboratory blood and urine tests were performed preoperatively. We used Holmium laser (Auriga XL) 50 W, 600 μm fiber and morcellator (Richard Wolf PIRANHA). During the procedure, the laser’s operating power was 36 W. En bloc Holmium enucleation was performed in all patients, followed by morcellation of the prostatic tissue. The time for enucleation was 11-52 min, morcellation time - 1-10 min, the weight of the enucleated tissue - 15-100 g, enucleation efficiency - 0.67-3.03 g/min, postoperative catheterization time - 24-72h, and hospital stay was 1 to 3 days. One blood transfusion was required. There were no patients with postoperative incontinence or other complications. We conclude that еn bloc Holmium enucleation in BPH is an effective method of treatment that offers maximum performance combined with short operative time, shorter hospital stays, and minimal risk of complications. The learning curve requires at least twenty cases. The recommended prostate gland size for the initial trial should be between 50-60 cc. Starting with small-sized glands increases the risk of capsule perforation, and the enucleation plane is more difficult to find.

Bladder cancer is a heterogeneous disease in molecular, histological and clinical aspects. Treatment should also be considered from different angles - surgery, intravesical chemo- or immunotherapy, radiation therapy and lifestyle changes. Intravesical treatment of superficial bladder cancer with Еpirubicin or Bacillus Calmette-Guérin (BCG) is a continuation of surgical treatment to reduce or eliminate further recurrence.

One of the potential therapeutic agents for treating COVID-19 is favipiravir (FPV). This retrospective study compared the treatment of COVID-19 with (FVP group) or without (control group) favipiravir. Demographic characteristics and initial clinical indicators in the two groups were comparable. The level of oxygen saturation, respiratory rate, and prevalence of chest pain in the FVP group returned to normal significantly earlier (on the seventh day) compared to the control group (p<0.05). Improvement of patients’ condition in the FVP group occurred significantly earlier than in the control group (p <0.001). In conclusion, FVP treatment’s efficacy was higher than the control management strategy and established an individualized set of therapeutic agents. However, more detailed studies are needed to evaluate the efficacy of COVID-19 treatment with favipiravir fully.

Chronic pain syndrome is a severe condition that has been recently recognized, and many methods for treating it have been developed. We present a case of using a pudendal nerve block for treating chronic pain after Bartholin cyst removal. A 46-year-old female presented with chronic pain syndrome, lasting eight months following Bartholin cyst removal. Treatment with non-steroid anti-inflammatory drugs and opioids was unsuccessful, and pudendal nerve block was performed with dexamethasone and ropivacaine. The follow-up continued for a year, and no pain was reported. In cases of pudendal neuralgia, a peripheral pudendal nerve block is effective. Chronic pain syndrome is a complex problem, and a multidisciplinary approach is often required. This case represents the efficacy of pudendal nerve block in chronic pain syndrome after Bartholin cyst removal.

Hodgkin’s disease is one of the most common lymphomas in young people. In such cases, long-lasting hematological remissions are achievable using therapeutic regimens, including combined radiotherapy and chemotherapy. This publication aims to present clinical cases from our practice in patients with Hodgkin’s disease in whom the occurrence of second neoplasia is probably causally related to the treatment of Hodgkin’s lymphoma. We present two clinical cases of women with established secondary neoplasia (breast carcinoma, diffuse large B cell lymphoma) 20 years after treatment for Hodgkin’s disease had been completed. The probability of developing another neoplastic disease, leading to increased mortality in these patients, requires updating the recommendations for secondary prevention in oncology.