Objective Increasing access to quality, evidence-based mental health treatments, including psychotherapy, is a global priority. Knowledge of factors associated with delivery settings is critical to ensure that new practices are appropriate and effectively adapted for novel settings. Understanding perceived needs for training and interest in ongoing education is one key factor. This qualitative study aimed to identify perspectives on contemporary evidence-based psychotherapies, perceived needs for mental health training, and existing barriers and facilitators to provision of mental health services in community clinics in Ukraine. Purposive and snowball sampling was used to recruit 18 physicians and psychologists employed in community clinics in Kyiv. A combination of free-listing and semi-structured interviews was used to collect data, which were thematically coded using emergent coding. Results Findings from this study indicated that participants recognize a need for improved mental health knowledge and training, as well as suggested interest and openness to learning short-term, structured psychological interventions. Additional barriers and existing strengths described by participants provide insight into possible factors that may impact future trainings in and implementation of modern mental health approaches.

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MATERIALS AND METHODS. Preliminary clinical and morphological analysis of a group of patients with various post-COVID complications and with surgical treatment was performed. For the period 2020-2021 in the clinic of thoracic surgery of the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” 12 patients were treated who had coronavirus disease (COVID-19) in anamnesis and underwent surgery for COVID-19 complications. RESULTS AND DISCUSSION. Data on the type of surgery, X-ray conclusion and preliminary clinical diagnoses of patients with post-COVID pulmonary complications are presented. At the time of surgical treatment, according to clinical data, 4 (22.2 %) patients were diagnosed with lung abscess, 4 (22.2 %) patients had a disseminated process in the lungs of unclear origin, 2 (11.0 %) – a solitary formation of the lung, one (5.5 %, respectively) observation – spontaneous pneumothorax and suspected tumor of the lung. The results of the histopathological conclusion on the operative material and the final clinical diagnosis in the group of patients with atypical lung lesions after COVID-19 are presented. The results of histopathological examination showed that after 3 months and more after recovery from COVID-19 in some patients there are persistent pathological changes in lung tissue of various characters, and quantitatively among them prevail cases of various pathologies associated with damage to the vascular bed of the lungs. CONCLUSIONS. In most cases of pulmonary complications after suffering COVID-19, preliminary clinical diagnoses did not fully correspond to the identified pathological process. Morphological examination of the operative material of patients with a history of COVID-19 and postcocious complications associated with the lungs, found that vascular pulmonary pathology predominates: persistent microvasculitis of small blood vessels, pulmonary infarction, metacarpal metaplasia, secondary vascular malformation.

THORACIC SURGICAL TREATMENT IN PATIENTS WITH CORONAVIRUS INFECTION M. S. Opanasenko, B. M. Konik, S. M. Belokon, O. V. Tereshkovich, S. M. Shalagai, L. I. Levanda, M. I. Kalinichenko, V. I. Lysenko, M. U. Shamrai, A. M. Stepanyuk, O. D. Shestakova Abstract Aim. To familiarize physicians of different specialties with thoracic pathology in patients with coronavirus infection (COVID-19). Materials and methods. Since the beginning of the COVID-19 pandemic 63 patients were treated at the department of surgical treatment of tuberculosis and NLD, complicated by purulent-septic infections: 47 (74.6%) — with various complications of coronavirus infection, and 16 (25.4%) — COVID-19 and conditions, requiring thoracic surgery, not associated with COVID-19. Results. Pleural empyema was the most common bacterial complication — 18 (28.5%) cases. Only 6 (9.5%) patients were diagnosed with broncho-pleural fistula, while 12 (19.6%) patients already had a functioning broncho-pleural fistula at the stage of hospitalization. In 15 (23.8%) patients, the destructive cavities remained on admission, and only 3 (4.7%) had isolated pleural empyema without destruction of pulmonary parenchyma (complete scarring of abscesses). 17 (26.9%) patients with empyema underwent videothoracoscopic (VATS) drainage of the pleural cavity with polydrainage and the use of long-term active aspiration in the postoperative period. In 1 (1.5%) case, due to the extremely severe condition of the patient, only drainage of both pleural cavities was performed. 1 (1.5%) patient with bilateral pleural empyema died of progressive respiratory and cardiovascular failure. Nonspecific exudative pleurisy was diagnosed in 8 (12.6%) patients after coronavirus infection. Spontaneous pneumothorax without development of pleural empyema was diagnosed in 7 (11.1%) patients and in 3 (4.7%) cases pneumo hemothorax occurred. in 2 (3.1%) cases there was a need for parietal pleurectomy (there was a significant area of detachment of the visceral pleura and the impossibility of imposing intracorporeal sutures). All patients were discharged from the hospital with recovery. 6 (9,5 %) patients with necrotizing pneumonia comprised a challenging group of patients with large, treatment-resistant cavities. In 4 (6.3%) cases antibacterial therapy was ineffective, so transthoracic cavity drainage was performed. All 6 patients underwent radical resection interventions following long pre-operative period: 3 (4.7%) cases - pleurolobectomy, 2 (3.1%) — sublobar resection and 1 (1.5%) - resection of the 6th segment of right lung). Conclusions. Pulmonary purulent-destructive COVID-19 complications may occur much more rarely if timely treatment was used. Videothoracoscopic intervention is a preferred option of treatment of these conditions. Key words: COVID-19, thoracic pathology pneumohemothorax, pleurodesis. Ukr. Pulmonol. J. 2021;29(3):31–35:

Відеоасистовані резекції частки легеніДУ «Національний інститут фтизіатрії і пульмонології імені Ф.Г. Яновського НАМН України», м. Київ Відеоасистовані (VATS) лобектомії виконуються з використанням ендоскопічних інструментів на основі степлер-техніки та загальнохірургічних елементів. Пріоритет надається виконанню типових резекцій з роздільною обробкою елементів кореня частки (артерій, вен, бронха).Матеріали і методи. За останні 5 років (з 2014 по 2018) у відділенні торакальної хірургії і інвазивних методів діагностики ДУ «Національний інститут фтизіатрії і пульмонології імені Ф. Г. Яновського НАМН України» було виконано 36 VATS-резекцій частки легені. Усі 36 (100,0%) VATS-резекцій проводилися при використанні бронхіальної інтубації контрлатеральної легені. Мініторакотомний розріз був не більше 8 см. Обробка елементів кореня частки виконувалась із застосуванням ендоскопічних зшивальних апаратів на основі степлер-техніки, інтраопераційно виконувалася механічна френікотрипсія.Результати. Інтраопераційні ускладнення були діагностовані у 2 (5,6%) пацієнтів. У 1 (2,8%) хворого була проведена конверсія в широку торакотомію із зупинкою кровотечі. Загальний рівень післяопераційних ускладнень склав 5 (13,9%) спостережень. Середня тривалість резекційних оперативних втручань становила 188,4±73,6 хв, а середня інтраопераційна крововтрата -86,1±154,1 мл. Середня тривалість лікування у післяопераційному періоді склала 29,2±14,1 дня.Висновки. VATS-резекції частки легені є малотравматичними і перспективними методами лікування, що забезпечують анатомічне препарування елементів кореня частки легені. Їх можна розглядати як альтернативу відкритій лобектомії. Широкому використанню даного методу перешкоджає виразний фіброз кореня легені і злуковий процес внаслідок тривалого запального процесу і медикаментозного лікування, а також вартість ендоскопічних інструментів.