Aim. To demonstrate the clinical heterogeneity of post-inflammatory interventricular septal injury and highlight the role of cardiac magnetic resonance (CMR) imaging in diagnosis and risk stratification. Materials and methods. A comparative analysis of myocardial changes was conducted in two young male servicemembers who developed significant cardiac manifestations following presumed inflammatory triggers (infection and trauma). Clinical evaluation included ECG, ambulatory rhythm monitoring, serum biomarkers, and CMR. Results. Both patients demonstrated preserved or only minimally elevated biomarkers, underscoring the limitations of laboratory screening alone. Case 1: a 40-year-old patient developed presyncope after pneumonia and blast-related trauma. Monitoring revealed high-grade atrioventricular block (Mobitz Type II). CMR identified focal intramural late gadolinium enhancement within the basal IVS, necessitating permanent pacemaker implantation. Case 2: a 39-year-old patient presented with acute dyspnea and fatigue after a viral infection. Despite a normal ECG, CMR revealed segmental fibrosis of the IVS with a moderately reduced left ventricular ejection fraction (45 %) without conduction disturbances. Conclusions. Post-inflammatory septal injury in young military personnel manifests across a broad clinical spectrum, ranging from malignant conduction failure to early-onset heart failure. These cases underscore the pivotal diagnostic value of CMR in detecting structural changes that remain occult on echocardiography. Early comprehensive evaluation and risk stratification are essential to prevent sudden cardiac death and preserve operational readiness.
Aim. To evaluate the effectiveness of surgical treatment for elderly and senile patients with acute malignant colonic obstruction using a differentiated approach to the choice of tactics based on the data of additional instrumental methods of examination. Materials and methods. The surgical treatment results of 122 patients aged 65–89 years with acute malignant colonic obstruction treated at the Surgical Department of the Municipal Non-Profit Enterprise “City Hospital No. 9” of the Zaporizhzhia City Council between 2022 and 2024 were analyzed. The diagnostic protocol included contrast-enhanced computed tomography, colonoscopy, plain abdominal radiography, abdominal ultrasonography, and intra-abdominal pressure measurement. Results. Computed tomography was performed as the gold standard of diagnosis and enabled precise identification of tumor location, degree of obstruction, lymph node involvement, and signs of intestinal ischemia (wall thickening, lack of contrast) as well as potential complications (perforation, abscess, peritonitis) in all patients examined. Colonoscopy confirmed tumor topography and provided histological verification of the diagnosis. Measurement of intra-abdominal pressure complemented the examination complex, correlating with abdominal hypertension severity. The use of minimally invasive methods (endoscopic stenting and laparoscopy) showed favorable treatment results, allowing effective elimination of the obstruction and, after stabilization of the condition, radical resection with primary anastomosis. Conclusions. Early multimodal diagnosis combined with an individualized surgical approach improves the effectiveness of treatment for older patients with acute malignant colonic obstruction. The use of minimally invasive techniques (stenting and laparoscopy) enables resection with primary anastomosis in a substantial proportion of patients, reduces stoma formation rates, and increases the quality of patients’ life.
Aim. To determine the expression patterns of p53 and annexin A5 in the cells of the basal magnocellular nucleus (BMN) of the rat brain following early neuroprotective intervention with citicoline, thiocetam, and recombinant HSF-1 in a rat model of colchicine-induced neurodegeneration. Materials and methods. The study involved 50 male Wistar rats divided into five groups (n = 10 each). Group 1 (control) received an intracerebroventricular (ICV) injection of 0.9 % NaCl solution. Animals in groups 2–5 received ICV colchicine. Group 2 served as the positive control (untreated pathology model). Groups 3–5 received citicoline, thiocetam, and HSF-1, respectively, for 14 consecutive days beginning the day after surgery. Subsequently, all rats were euthanized under thiopental sodium anesthesia, and the brains were harvested for histochemical and immunofluorescent analyses. Results. ICV colchicine caused loss of the neuronal component and an increase in glial cell number in the BMN. A two-week course of neuroprotective correction prevented these changes. Colchicine-induced neurodegeneration was also associated with an elevated number of p53- and Annexin A5-immunopositive cells in the BMN. Notably, administration of citicoline and HSF-1 resulted in a further pronounced increase in p53-positive neurons (by 60–70 % relative to the pathology group), whereas thiocetam caused a significantly increased number of annexin A5-immunopositive cells. Concurrently, all types of pathogenetic correction normalized the Corrected Total Cell Fluorescence (CTCF) of annexin A5+ cells to control levels. Conclusions. In the BMN of experimental animals on day 14 post-ICV colchicine injection, a decrease in neuronal density and an increase in glial density were observed compared to sham-operated rats. In contrast, in the groups receiving early administration of citicoline, thiocetam, or recombinant HSF-1, neuronal and glial density parameters remained at levels comparable to control animals. The highest CTCF values for annexin A5-positive cells were recorded in the colchicine group compared to both sham-operated and correction groups, with no statistically significant differences among the latter. At the same time, p53 CTCF values in the BMN across all experimental groups showed no statistically significant differences compared to the control or each other. While the total counts of p53- and annexin A5-positive cells in the colchicine group significantly exceeded those in sham-operated animals, this parameter in the correction groups varied according to the specific pharmacological agent used.
Accurate detection of botulinum neurotoxin (BoNT) requires assessing both its proteolytic SNARE-cleaving activity and its ability to inhibit synaptic transmission. While the mouse bioassay remains the traditional diagnostic standard, its prolonged turnaround time, limited reproducibility, and ethical constraints underscore the urgent need for advanced in vitro methodologies. Recent advances in analytical chemistry, stem-cell-derived neuronal platforms, and multi-omics profiling enable the development of sensitive systems that replicate BoNT’s molecular and functional mechanisms with greater precision than conventional in vivo models. Aim. To evaluate current methodologies for the diagnosis and functional analysis of botulinum neurotoxin and, synthesizing these findings, to propose a conceptual algorithmic model for comprehensive neurotoxin detection independent of in vivo methods. Materials and methods. A literature review was conducted utilizing the PubMed, Scopus, and Web of Science databases. Studies detailing molecular, cellular, multi-omics, and computational approaches to BoNT detection were included. The extracted data were synthesized across molecular, cellular, and systems-level domains to construct an integrated diagnostic model. Results. Modern diagnostic strategies increasingly surpass the mouse bioassay in terms of sensitivity, specificity, and mechanistic insight. SNARE-specific proteolytic profiling, notably Endopep-MS, enables precise detection of BoNT serotypes and their functional states by quantifying cleavage kinetics across a diverse array of substrates. Complementary human iPSC-derived neuronal platforms allow for direct functional assessment, revealing electrophysiological suppression, altered calcium signaling, and reporter-confirmed SNARE cleavage within living cells. Multi-omics analyses, including single-cell transcriptomics, epigenomics, and metabolomics, capture early stress signatures, serotype-specific responses, and determinants of neuronal susceptibility. Additional resolution is provided by receptor-binding kinetics and intracellular trafficking studies, which elucidate how serotype-dependent variations dictate overall toxicity. The integration of these molecular, cellular, and systems-level insights establishes the foundation for the ULTIMA-BoNT framework, a unified platform designed for high-precision BoNT detection. Conclusions. The convergence of proteolytic assays, physiologically relevant neuronal models, and multi-omics analytics presents a robust, reproducible, and ethically sustainable alternative to the mouse bioassay. This integrative approach not only provides profound mechanistic insights but also supports the predictive analysis of emerging BoNT variants.
The issue of mental health among students whose families are involved in military events, especially those whose close relatives are directly engaged in combat operations or reside in an area of active armed conflict, is becoming particularly relevant. The constant anticipation of danger to the lives of loved ones, emotional involvement, and empathetic experience of another person’s trauma creates conditions for the development of secondary traumatic stress (STS), which in its clinical manifestations is comparable to post-traumatic stress disorder. Aim. To investigate the characteristics of STS and chronic fatigue syndrome (CFS) in higher education students who reported having at least one close relative with a status related to participation in military operations or presence in a combat zone; to assess the intensity of emotional, cognitive, and somatic symptoms, as well as to analyze the relationship between indicators of secondary traumatization and the level of chronic fatigue. Materials and methods. Empirical data were collected via standardized questionnaires assessing STS and CFS (Fukuda criteria), administered to 75 higher education students in Ukraine (years 1–5). Analysis of the respondents’ academic profiles allowed classification into five primary fields of study. The majority of participants were enrolled in medical and pharmaceutical programs (53.2 %), with substantial representation from psychological and humanities disciplines (18.6 %) and rehabilitation-related programs (15.8 %). Students from the natural sciences and pedagogical fields accounted for 5.2 %, while the remaining 7.2 % were distributed across other specialties with lower individual representation. At the time of data collection, all participants (100 %) were residing within Ukraine. The survey was conducted via Google Forms web-based application. Statistical processing included Pearson’s correlation analysis with interpretation on the Chaddock scale and significance testing via Student’s t-test. The study conducted a systematic review of 13 national and international publications indexed in the Scopus and PubMed databases (search period: 2020–2025). Results. Of the 75 students surveyed, 68.0 % reported having close relatives involved in military operations or residing in the combat zone. These findings underscore the extensive familial exposure to the war among study participants and suggest an elevated vulnerability to STS, as well as to its associated psychophysiological sequelae. Regular obsessive thoughts about the possible suffering of relatives were reported by almost 70.0 % of respondents (options “sometimes” and “often” combined). Conclusions. A strong direct correlation was established between STS indicators and CFS (r = 0.70, p < 0.001), indicating the formation of a unified psychosomatic complex in students whose relatives are in the combat zone. These findings confirm the need for comprehensive rehabilitation programs that simultaneously address both psychological and physiological components of distress.
Disturbances in iron metabolism play a key role in the pathophysiology of chronic kidney disease (CKD), contributing to clinical complications, particularly the development of anemia. Evaluating the diagnostic utility of iron metabolism proteins in CKD patients, depending on disease progression, is of great significance both diagnostically and therapeutically. Aim: to evaluate the role of iron metabolism proteins in the pathogenesis of anemia and their clinical diagnostic value in patients with chronic kidney disease at both the conservative and terminal stages. Materials and methods. The study included patients with stage II–III CKD (conservative group) and terminal-stage CKD undergoing hemodialysis (terminal group), as well as healthy controls. Serum levels of hemoglobin, iron, erythropoietin, ferritin, transferrin, lactoferrin, ferroportin, hepcidin, and haptoglobin were analyzed. Results. In terminal-stage CKD, the concentrations of hemoglobin (22.1 %, p < 0.001 and 28.6 %, p = 0.001), erythropoietin (26.8 % and 32.5 %, p < 0.001), iron (18.3 %, p = 0.004 and 33.0 %, p < 0.001), TIBC (14.5 %, p < 0.001 and 17.3 %, p = 0.003), LIBC (14.4 %, p = 0.006 and 14.8 %, p = 0.039), and transferrin (11.3 %, p = 0.042 and 30.8 %, p = 0.008) were significantly lower in both men and women compared to the conservative group. In contrast, ferritin (2.3-fold and 2.1-fold, p < 0.001), hepcidin (82.2 % and 65.1 %, p < 0.001), ferroportin (50.0 % and 46.2 %, p < 0.001), and lactoferrin (2.2-fold and 87.5 %, p < 0.001) levels were significantly increased in the terminal stage group compared to the conservative group. Ferritin and hepcidin demonstrated the highest diagnostic performance in CKD, showing excellent sensitivity, specificity, and diagnostic efficiency. Lactoferrin and erythropoietin also showed strong diagnostic value, while ferroportin exhibited moderate diagnostic performance. Transferrin demonstrated the lowest diagnostic efficiency, indicating limited standalone clinical usefulness. Conclusions. This study demonstrates that functional iron deficiency in end-stage renal disease is mediated by systemic inflammation. These findings underscore the pivotal role of iron metabolism proteins in the pathogenesis of renal anemia and validate their clinical utility as diagnostic biomarkers and therapeutic targets.
Aim. To evaluate left ventricular myocardial structural remodeling in experimental type 1 diabetes mellitus (T1DM) and to assess the effects of L-arginine and N-acetyl-L-cysteine. Materials and methods. The study involved 47 male Wistar rats. Type 1 diabetes mellitus was induced by streptozotocin (45 mg/kg). From week 6, rats received L-arginine or N-acetyl-L-cysteine (1.5 g/kg). ImageJ software was used to analyze cardiomyocyte area, nucleo-cytoplasmic ratio, and cell density. Results. T1DM was found to cause pathological cardiomyocyte hypertrophy (area +17 %) alongside decreased cell density (-26 %) and suppression of the nuclear apparatus (nucleo-cytoplasmic ratio -10 %). L-arginine administration reduced perivascular infiltration but further decreased the nucleo-cytoplasmic ratio (-17 % compared to type 1 diabetes mellitus). N-acetyl-L-cysteine promoted nuclear area recovery (+34 % compared to type 1 diabetes mellitus) and stabilized cell density to control levels. Conclusions. Experimental type 1 diabetes mellitus leads to pathological left ventricular hypertrophy with significant cardiomyocyte loss and disturbance of morphometric characteristics of nuclei with a decrease in nuclear-cytoplasmic ratio. The use of L-arginine attenuates the severity of perivascular inflammatory infiltration and reduces the nuclear-cytoplasmic ratio but does not eliminate muscle fiber fragmentation and cellular heterogeneity. N-acetyl-L-cysteine reverses pathological hypertrophic changes and restores nuclear apparatus.
Aim. To identify informative clinical and prognostic risk factors for urinary tract inflammatory exacerbation in patients with urolithiasis (UL) after laser lithotripsy. Materials and methods. The study included 74 patients with UL who underwent laser lithotripsy using the holmium laser MultiPulse HoPlus (Germany) in fragmentation mode with a pulse energy of 1.2 J, a frequency of 20 Hz. Patients were divided into groups according to the presence of laboratory signs of urinary tract inflammation on the second postoperative day. Urinalysis for all patients was performed using an automated urine analyser, Laura Xl Erba (Germany). The obtained data were statistically processed with Statistica 13 for Windows (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. On the second day after laser lithotripsy, 48.6 % of patients with UL presented with laboratory signs of urinary tract inflammatory exacerbation, characterized by leukocyturia (100 %), elevated epithelial cell count (72.2 %), erythrocyturia (100 %), bacteriuria (88.9 %), and crystalluria (83.3 %). The signs of urinary tract inflammatory exacerbation were correlated with acute inflammatory indicators. Inflammatory changes on the second postoperative day were significantly more frequent in patients with comorbid diabetes mellitus (р = 0.03), chronic pyelonephritis in remission at the time of lithotripsy (р = 0.04) and their combination (р = 0.04). The duration of laser lithotripsy of ≥60 minutes was associated with a higher frequency of urinary tract inflammation (р = 0.01 in patients with UL on the second day after lithotripsy. The most informative independent prognostic risk factors for urinary tract inflammatory exacerbation in patients with UL on the second postoperative day were comorbid chronic pyelonephritis (p = 0.040) and lithotripsy duration ≥60 minutes (p = 0.016). Conclusions. Comorbid chronic pyelonephritis and lithotripsy duration ≥60 minutes are significant prognostic risk factors for urinary tract inflammatory exacerbation in patients with UL on the second day after laser lithotripsy.
Aim. To enhance the safety and efficacy of thermal ablation procedures in patients with chronic venous disease (CVD) of the lower limbs by developing a strategy for venous thromboembolism (VTE) prevention. Materials and methods. This single-center, prospective, open-label study included 420 consecutive patients with CVD (C2–C6). Participants underwent radiofrequency ablation (RFA, n = 206) or endovenous laser ablation (EVLA, n = 214). At the first stage, VTE risk stratification was conducted using the Caprini scale; at the second stage, the optimal thromboprophylaxis algorithm was selected. Patients were divided into two homogeneous groups. Group 1 (208 patients) received VTE prevention with standard elastic compression only, while Group 2 (212 patients) received prophylaxis based on the proposed algorithm. The incidence of postoperative VTE and bleeding complications was assessed. Results. According to VTE risk stratification, 23.6 % of patients were classified as low risk, 63.1 % as moderate risk, 9.0 % as high risk, 3.1 % as very high risk, and 1.2 % as the highest risk. Based on the second phase analysis, 12 patients (2.9 %) of Group 1 developed thrombotic complications during the early postoperative period: EHIT class II was diagnosed in 3 cases (0.7 %) after EVLA and in 2 cases (0.5 %) after RFA. Additionally, distal deep vein thrombosis (DVT) was detected in 7 patients (1.7 %) with high VTE risk on postoperative day 7: 3 after EVLA and 4 after RFA. Implementation of the proposed thromboprophylaxis strategy significantly reduced the total incidence of thrombotic complications compared to Group 1 (0.4 % vs. 2.9 %; p = 0.031). In Group 2, only one patient (0.4 %) with moderate VTE risk was diagnosed with distal DVT. Among 39 patients (18.3 %) who received prophylactic acetylsalicylic acid or rivaroxaban, a statistically significant increase in ecchymosis occurrence was observed (p = 0.018). Conclusions. Implementing a differentiated, risk-oriented thromboprophylaxis strategy significantly (p = 0.031) reduced the incidence of VTE from 2.9 % to 0.4 %, p = 0.031, without increasing the risk of clinically significant bleeding.
The aim of this study was to analyze temporal trends and regional distribution of nephrectomies within the spectrum of kidney and ureter surgery in Ukraine, including macro-regional and oblast-level characteristics in 2018–2023. Materials and methods. Data were obtained from the annual statistical reports of the Ministry of Health of Ukraine; indicators of inpatient medical care were analyzed for Ukraine as a whole, for five macro-regions (West, Central, North-East, South-East, South), individual oblasts, and Kyiv. Statistical analysis was performed with IBM SPSS Statistics usinng chi-square and Fisher’s exact tests; p < 0.05 was considered statistically significant. Results. Over the six-year study period, the total number of kidney and ureter surgeries increased, with the largest relative increase occurring in 2022–2023. The annual number of nephrectomies declined from 2020 to 2022 by 19 %, followed by an increase in 2023. The indications for nephrectomy shifted significantly: the proportions attributable to hydronephrosis and urolithiasis decreased (p < 0.05) in 2021–2023, and to malignant renal neoplasms in 2021 (p < 0.001), despite an otherwise stable proportion over 2018–2020 and 2022–2023. The proportions attributable to benign renal neoplasms and pyelonephritis increased from 2019 onward, with both groups reaching higher percentages in 2022–2023 than in 2018. In patients with nephrolithiasis, the absolute number of nephrectomies declined by 25 % between 2018 and 2023; during the same period, nephrectomies for pyelonephritis/pyelonephrosis increased by 200 % in absolute terms. Conclusions. Distinct temporal trends and regional variation in nephrectomy rates across Ukraine were identified for 2018–2023. These patterns are temporally consistent with the effects of the COVID-19 pandemic (2020–2021) and the ongoing armed conflict (from 2022) and are associated with a statistically significant increase in the proportions of nephrectomies performed in the Central, Western, and North-Eastern regions, accompanied by a decrease in the Southern regions and Kyiv (p < 0.001).
Aim. To determine the characteristics of depression, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbances among civilian and military populations during the war in Ukraine. Materials and methods. The study included 81 civilians (63 women and 18 men), predominantly residents of frontline regions, and 25 military personnel (all men). The survey was conducted in March 2025. The following standardized questionnaires were used: PHQ-9, GAD-7, PSQI, PC-PTSD-5. Results. Median depression scores corresponded to a moderate level among civilians and a mild level among military personnel, while anxiety levels in both groups were within the mild range. The median PTSD screening score indicated the absence of clinically significant symptoms; however, the global sleep quality index in both groups fell within the range of poor sleep quality. No statistically significant differences were found between civilians and military personnel in levels of depression, anxiety, PTSD symptoms, or overall sleep quality. Among civilians, women and unmarried participants demonstrated higher levels of depression, anxiety, and PTSD symptoms. Analysis of sleep components revealed shorter sleep duration in military personnel, whereas civilians exhibited more pronounced daytime dysfunction. In civilians, clinically significant depression was associated with an increased risk of poor sleep quality (RR = 1.98; OR = 9.39; p < 0.01), and PTSD symptoms were associated with higher relative risk and odds of poor sleep (RR = 1.49; OR = 5.11; p < 0.05). No statistically significant predictors of poor sleep quality were identified among military personnel. Significant positive correlations between depression, anxiety, PTSD symptoms, and sleep quality were observed in both groups. Conclusions. No statistically significant differences in depression, anxiety, PTSD symptoms, or sleep disturbances were identified between civilian and military populations during wartime. Social and demographic factors influenced psycho-emotional status only among civilians, with higher levels of depression, anxiety, and PTSD symptoms observed in women and unmarried individuals. Military personnel exhibited shorter sleep duration, whereas civilians demonstrated more pronounced daytime dysfunction. Depression and PTSD symptoms were the primary factors associated with poor sleep quality among civilians.
Preeclampsia (PE) complicates 2 % to 8 % of pregnancies and remains the leading cause of perinatal maternal and neonatal mortality worldwide. Early identification of high-risk pregnancies allows for the reduction of complications and the implementation of preventive measures. Aim. To assess the current state of research on early biomarkers of PE, analyze their prognostic value, and determine the prospects for implementation in clinical practice. Materials and methods. The article analyzes the current state of research regarding early biomarkers of PE, analyze their diagnostic accuracy, and determine the prospects for their integration into routine clinical practice. A systematic review (incorporating meta-analysis elements) of publications was conducted covering the period from 2000 to 30.06.2024. Databases searched included PubMed / MEDLINE, Embase, Scopus, Web of Science and Cochrane Library; additionally, Google Scholar (first 200 results), ClinicalTrials.gov and ProQuest Dissertations & Theses. MeSH / Emtree and free keywords were used: preeclampsia, biomarker, placental growth factor, PlGF, sFlt-1, sFlt-1/PlGF, PP-13, PAPP-A, microRNA, first trimester, prediction, screening. Human studies (prospective / retrospective cohorts, case-control), systematic reviews and meta-analyses that evaluated biomarkers in the I–II trimesters were included; cases, works without primary data and studies with n < 10 were excluded. The presented data substantiate the role of biomarker combinations in increasing the accuracy of early diagnosis, and the prospects for their implementation in clinical practice are discussed. Results. The synthesis of data confirms a consistent early decrease in PlGF and an increase in sFlt-1 in pregnant women who subsequently develop PE. The sFlt-1/PlGF ratio emerged as the most robust predictor. Pooled diagnostic performance indices were: PlGF – sensitivity ~78 %, specificity ~85 %; sFlt-1 – sensitivity ~82 %, specificity ~80 %; sFlt-1/PlGF – sensitivity ~85 %, specificity ~88 %. The main limitations include population heterogeneity, differences in laboratory methods, and the absence of universally standardized cutoff values for different gestational ages. Conclusions. PlGF, sFlt-1 and their ratios are promising early markers for PE screening. To facilitate clinical implementation, there is an urgent need for standardization of laboratory methods, identification of clinically validated thresholds, development of affordable rapid tests, and large multicenter validation studies. Integrating these biomarkers with clinical risk factors remains the most effective strategy for early-onset PE prediction.
The ongoing War for the Independence of Ukraine turns aggression into a survival tool, resulting in social withdrawal and persistent psychological distress, which influences the level of aggressiveness among modern Ukrainian medical students. The aim of the study was to assess the degree of aggressiveness in junior medical students (1st and 2nd years) accounting for their mental health problems like stress, depression, and anxiety. Material and methods. The Buss–Durkee Hostility Inventory (BDHI-75) and DASS21 questionnaire (Ukrainian versions) were used in psychological testing of 257 preclinical medical students who volunteered to participate in the testing (males – 112, females – 145). The test scores were processed statistically using the statistical analysis package “data analysis” in Microsoft Excel. The classic data analysis tools used included descriptive statistics, correlation, t-test, and histogram. Results. Contemporary Ukrainian junior medical students (MS1 and MS2) demonstrated low aggressiveness (60.31 ± 3.05 %) often combined with high hostility (47.08 ± 3.11 %). Male students scored significantly higher in physical assault than females (p < 0.001), while females exhibited higher verbal aggression (p < 0.05) and irritability (p < 0.001). Moreover, medical students demonstrated elevated anxiety (66.02 ± 2.96 %), stress (59.77 ± 3.06 %), and a tendency toward depression (48.05 ± 3.05 %). Stress and anxiety levels were substantially higher among females compared male students (р < 0.001 for both parameters). Statistically significant positive correlations of weak-to-moderate magnitude were found between BDHI-75 subscales (indirect aggression, irritation, resentment, feeling guilty, hostility index) and DASS-21 scores (anxiety, depression, stress). Conclusions. The “low aggression, high hostility” profile typical of modern Ukrainian medical students reflects deep-seated negative affect, which may predispose individuals to repressed anger, stress internalization, and potential somatic health consequences. Given this psychological profile and the widespread prevalence of stress, depression, and anxiety, Ukrainian medical students require systemic psychological support within the medical university setting.
Aim of the study. To evaluate the reliability of assessing characteristic odor intensity, specifically alcohol, during forensic medical examinations of cadavers without signs of decomposition. Materials and methods. A total of 43 cadavers of various ages and sexes were examined at the Department of Forensic Medical Examination of the State Specialized Institution “Kharkiv Regional Bureau of Forensic Medical Examination” between December 2024 and March 2025. Inclusion criteria: the presence of a perceptible alcohol odor, the absence of putrefactive changes, and a detectable concentration of ethyl alcohol in the blood or urine confirmed by gas chromatography. A preliminary blind test involving 12 participants was conducted to validate the observers’ ability to recognize odors from alcoholic beverages of different concentrations. During autopsy, an empirical conditional scale (ranging from 0 ‰ to 5 ‰) was utilized to quantify odor intensity. Statistical analysis was performed using Microsoft Excel and included Pearson (r) and Spearman (ρ) correlation coefficients, with significance testing performed using the χ2 test and p-values (p < 0.05). The null hypothesis assumed no significant correlation between objective ethanol concentration and perceived odor intensity. Results. In the overall sample, a weak positive correlation was identified between odor intensity and blood alcohol concentration (r = 0.195, ρ = 0.215). Subgroup analysis based on odor localization revealed correlations ranging from moderate negative (abdominal cavity) to moderate positive (thoracic cavity, cranial cavity, and combined localizations). Analysis of urine ethanol levels showed a consistent pattern: a weak positive correlation in the general cohort and moderate positive or negative correlations depending on the site of odor assessment. Statistically significant results (p < 0.05) were predominantly observed in larger subgroups. Conclusions. The identified correlations suggest that alcohol odor intensity serves only as a subjective and approximate indicator. It cannot replace the quantitative laboratory determination of ethanol in biological fluids due to the significant number of confounding factors influencing olfactory perception. These findings underscore the necessity for further research to determine the standardized value of olfactory evaluation in forensic practice.
The ongoing war in Ukraine has led to an increased incidence of sensorineural hearing loss (SNHL) resulting from acoustic trauma caused by firearms or explosions among both military personnel and civilians. This type of trauma is a significant contributing factor to the rising disability rates associated with impaired auditory and vestibular functions. Aim. To determine the frequency and characteristics of vestibular dysfunction in patients with SNHL resulting from acoustic trauma. Materials and methods. A total of 52 patients with SNHL due to acoustic trauma were examined, including 32 with acute and 20 with chronic forms of the condition. The study protocol comprised neurological, somatic, and otoneurological examinations, as well as audiological evaluation (pure-tone audiometry), brain neuroimaging, and stabilometry. Results. Patient complaints included hearing loss, tinnitus, dizziness, headache, general fatigue, gait instability, ear fullness, and nausea. A correlation analysis between hearing thresholds and stabilometric indicators revealed a positive correlation with the Romberg coefficient for oscillation trajectory length at high frequencies (R = 0.407, p = 0.022921) and with the Romberg coefficient for sagittal oscillation amplitude at medium frequencies (R = 0.493, p = 0.004874). In patients with chronic SNHL, the integral hearing threshold (averaged across all frequencies) significantly correlated with maximum oscillation amplitudes in the frontal (R = 0.622, p = 0.004452) and sagittal planes (R = 0.572, p = 0.010530) under eyes-open conditions. Three key phenomena were identified in this group: the dominance of frontal instability, the role of the speech frequency range as a marker of decompensation, and the formation of a stable pathological pattern of lateralized instability. Conclusions. In patients with acoustic trauma-induced SNHL, there is a clear positive correlation between hearing threshold shifts and the severity of the vestibular deficit. Stabilometric parameters show higher Romberg coefficient values, indicating that these patients rely more heavily on visual input to maintain postural balance.
Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide. Colonic polyps are known to be potential precursors to CRC. Evaluating cellular proliferative activity across various polyp types and normal mucosa is essential for understanding the early stages of colorectal carcinogenesis. Ki-67 expression serves as a reliable biomarker of proliferative activity. Aim. To investigate Ki-67 expression patterns in the epithelial and stromal cells of tubular adenomas and hyperplastic polyps of the distal colon. Materials and methods. Pathohistological and immunohistochemical (IHC) analyses were performed on biopsy specimens from 139 patients (age range: 22–81 years). The cohort included 68 patients with tubular adenomas of the distal colon, 56 with hyperplastic polyps, and 15 controls (age range: 22–72 years) with normal distal colonic mucosa. Results. Distal colonic polyps were characterized by moderate epithelial cell proliferation (Me = 61.38 % (49.28; 70.38) for tubular adenomas; Me = 35.26 % (4.37; 45.23) for hyperplastic polyps) and low level of stromal cell proliferation (Me = 10.51 % (1.08; 15.57) for tubular adenomas; Me = 2.84 % (0.70; 5.45) for hyperplastic polyps). Direct correlations were observed between the degree of dysplasia and Ki-67 expression levels in both epithelial (γ = 0.79) and stromal cells (γ = 0.61). The spatial distribution of Ki-67-positive cells demonstrated distinct patterns: in normal mucosa and hyperplastic polyps, proliferation was primarily confined to the lower and middle thirds of the crypts. In contrast, tubular adenomas with low-grade dysplasia exhibited an even distribution, while those with high-grade dysplasia showed a predominant localization in the upper and middle thirds of the crypts. Conclusions. The findings indicate that evaluating Ki-67 expression in both the epithelial and stromal compartments of distal colonic polyps is a valuable tool for assessing malignancy risk. This marker may serve as a supplementary pathohistological criterion for the evaluation of precancerous lesions.
Aim. To assess the structural and functional myocardial characteristics in patients with unstable angina (UA) and post-COVID-19 syndrome (PACS), stratified by smoking status. Materials and methods. The study included 147 patients with UA aged 35–76 years. Participants were divided into a PACS cohort (Group I, n = 88) and a non-PACS cohort (Group II, n = 59). Each group was further subdivided into smokers (subgroups IA and IIA) and non-smokers (subgroups IB and IIB). All patients underwent transthoracic echocardiography to evaluate standard structural and functional cardiac parameters. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were also quantified. Statistical analysis was performed using parametric and non-parametric tests, correlation analysis, and regression modeling. Results. Patients with PACS demonstrated more pronounced cardiac remodeling compared to the non-PACS group, indicated by a lower left ventricular ejection fraction (LVEF) (50.48 ± 9.11 % (I) vs 53.15 ± 9.14 % (II), p < 0.05) and larger left atrial (LA) dimensions (4.09 ± 0.42 cm (I) vs 3.93 ± 0.48 cm (II), p < 0.05). The most unfavorable changes were observed in smokers with PACS, who exhibited the lowest LVEF values, higher left ventricular mass index, and elevated NT-proBNP levels. NT-proBNP concentration was significantly higher in the PACS group compared to patients without PACS (621.8 (370.0; 1500.0) ng/mL (I) vs 254.9 (92.0; 394.0) ng/mL (II), p < 0.005). Pathological patterns of left ventricular geometry, particularly eccentric hypertrophy, were more common among PACS patients, especially in smokers. Statistically significant correlations were found between smoking intensity, NT-proBNP levels, myocardial remodeling parameters, and hematological inflammatory markers. Linear regression analysis revealed a significant positive correlation between smoking intensity and elevated NT-proBNP levels. Conclusions. Post-COVID-19 syndrome in patients with unstable angina is associated with moderate but significant cardiac structural and functional deterioration. Smoking substantially aggravates these changes, as evidenced by markedly elevated NT-proBNP levels and more pronounced echocardiographic signs of pathological myocardial remodeling.
Type 2 diabetes mellitus (T2DM) is associated with disturbances in bone metabolism that may increase fracture risk, even in the presence of normal or high bone mineral density (BMD). Dyslipidemia and elevated leptin levels, both common in T2DM, considered potential contributors to impaired bone remodeling, particularly in men, where skeletal responses to metabolic disturbances remain insufficiently understood. Aim. To evaluate associations between serum leptin levels, lipid metabolism parameters, and markers of bone turnover in men with T2DM. Materials and methods. A cross-sectional study included 62 men with T2DM (aged 50–65 years) and 58 age-matched non-diabetic controls. Laboratory assessments included HbA1c, insulin, leptin, testosterone, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, lipid profile, and bone turnover markers (P1NP, β-CTX). BMD at the lumbar spine and proximal femur was measured by dual X-ray absorptiometry (DXA). Insulin resistance was evaluated using HOMA-IR. Correlations were analyzed using Spearman’s rank test. Results. Men with T2DM had higher BMI (29.8 kg/m2 vs. 26.7 kg/m2, p = 0.006), elevated leptin (15.2 ng/mL vs. 11.2 ng/mL, p = 0.003), dyslipidemia (increased triglycerides and LDL-C, decreased HDL-C), and lower 25(OH)D levels (16.8 ng/mL vs. 21.6 ng/mL, p = 0.007) compared to controls. Bone formation marker P1NP was significantly reduced (35.4 ng/mL vs. 43.9 ng/mL, p = 0.009), while resorption marker β-CTX was increased (0.44 ng/mL vs. 0.37 ng/mL, p = 0.042) in T2DM group. BMD was significantly lower at the lumbar spine and total hip (p < 0.05). Leptin levels were correlated positively with BMI and HOMA-IR, while triglycerides were negatively correlated with P1NP (r = -0.218, p = 0.023). Conclusions. This study demonstrates that men with T2DM exhibited significant associations between dyslipidemia, hyperleptinemia, and altered bone metabolism. These metabolic abnormalities were linked to reduced bone mineral density, most notably at the lumbar spine and proximal femur. The results suggest that lipid and hormonal imbalances may contribute to poor bone health in T2DM, highlighting the need for careful skeletal assessment and targeted preventive approaches in this group.
Chronic heart failure (CHF) is a common syndrome, in which heart failure with preserved left ventricular ejection fraction (HFpEF) predominates. The diagnosis of this particular phenotype of СHF currently remains challenging in medicine. Over the past ten years, scientific societies have developed and implemented modern diagnostic algorithms. Aim. To assess the prevalence of HFpEF among patients with concurrent arterial hypertension and type 2 diabetes mellitus (T2DM) using various diagnostic algorithms. Materials and methods. A study examined 90 individuals (mean age 61.61 ± 7.94 years) with arterial hypertension and T2DM who presented with dyspnea on moderate-intensity physical exertion and fatigue between 2022–2025. All participants underwent clinical and laboratory assessments, including NT-proBNP levels, 24-hour blood pressure monitoring, standard transthoracic and speckle-tracking echocardiography, as well as a diastolic stress test. HFpEF was evaluated using the European Society of Cardiology algorithm (ESC 2021), the H2FPEF score (2018), the HFA-PEFF algorithm (2019), the European Association of Cardiovascular Imaging (EACVI, 2021) consensus-based score, and the American Society of Echocardiography guidelines (2025). Results. The proportion of confirmed HFpEF diagnoses varied significantly across the scales, ranging from 8.9 % to 77.8 %. Disproved diagnoses ranged from 2.2 % to 86.7 %. A high proportion of indeterminate results was observed in specific scales, reaching up to 86.7 % and peaking at 100 % using the H2FPEF score. Conclusions. The estimated prevalence of HFpEF is highly dependent on the applied diagnostic algorithm. Evaluation of NT-proBNP levels significantly enhances diagnostic accuracy to identify HFpEF. In a cohort of patients with comorbid arterial hypertension and T2DM, the H2FPEF and HFA-PEFF algorithms demonstrate limited diagnostic certainty, yielding a high percentage of indeterminate results.
Chronic generalized periodontitis (CGP) is a widespread inflammatory and destructive disease of periodontal tissues that leads to progressive destruction of supporting structures of the teeth and tooth loss. One of the key mediators of the inflammatory response in periodontal tissues is interleukin-1 (IL-1), which plays a significant role in the activation of osteoclastic bone resorption and progression of periodontal inflammation. Aim. To evaluate the efficacy of anakinra (IL-1ra) as part of complex therapy for moderate chronic generalized periodontitis in comparison with standard treatment and therapy using choline salicylate. Materials and methods. The study included 87 patients with moderate chronic generalized periodontitis. Patients were divided into three groups: group I – standard periodontal therapy (n = 34); group II – standard therapy combined with a drug, Anakinra (a recombinant human IL-1ra; n = 31); group III – standard therapy combined with choline salicylate gel (n = 22). The following clinical parameters were evaluated: probing pocket depth (PPD), papillary bleeding index (PBI), hygiene index (HI), Ramfjord index, Miller tooth mobility index, PMA index, and Fuchs index. Examinations were performed before treatment and after 30 and 90 days. Radiological assessment of periodontal bone structures was performed using cone-beam computed tomography (CBCT). Results. All treatment groups demonstrated statistically significant improvement in periodontal clinical indices after therapy. The most pronounced changes were observed in group II with the use of IL-1ra. After 90 days of treatment, PPD decreased from 3.89 ± 0.11 mm to 1.99 ± 0.03 mm, PBI by 30.1 %, HI by 53.5 %, Miller mobility index by 61.5 %, and PMA index by 57.4 %. CBCT analysis demonstrated stabilization of alveolar bone parameters in patients receiving the IL-1 receptor antagonist. Conclusions. The addition of an IL-1 receptor antagonist to the comprehensive treatment of chronic generalized periodontitis is associated with greater improvements in clinical and radiological outcomes compared with standard therapy and the use of choline salicylate.
