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.
Arterial hypertension (AH) is one of the leading contributors to the development of atherosclerotic cardiovascular disease; however, traditional risk assessment scales often fail to provide an accurate estimation of individual prognosis. Coronary artery calcification (CAC), detected by computed tomography (CT), is a highly specific marker of subclinical atherosclerosis and serves as a valuable tool for personalized cardiovascular risk stratification. Aim: to systematize and summarize current evidence from international clinical guidelines, recommendations, and scientific publications regarding the clinical use of coronary artery calcium assessment as a tool for personalized therapy and risk prediction in patients with arterial hypertension. Materials and methods. An analysis was conducted of international clinical guidelines, recommendations, and scientific publications indexed in the scientometric databases PubMed, Scopus, Web of Science, and Google Scholar. The following keywords were used: “arterial hypertension”, “dyslipidemia”, “coronary calcification”, “cardiovascular risk stratification”, “diabetes mellitus”, “cardiac computed tomography”, “primary prevention”, “screening of asymptomatic adults”. Results. Based on the analysis of the professional literature, the prognostic value of the calcium index (CI) has been confirmed, as well as the place of the test in modern international guidelines. The clinical applications of the CI encompass test indications, patient risk reclassification, guidance for initiating lipid-lowering therapy, and evaluation of aspirin use in primary prevention. The evolution of quantitative coronary calcium assessment methods has been reviewed, alongside technical considerations for CT scanning and specialized software-based data processing. The Agatston score has been highlighted as the standardized metric for quantifying CAC. Key advantages of the method include the absence of contrast agent requirement, low radiation exposure, and increasing availability. Acknowledged limitations of the test include inability to detect non-calcified (“soft”) plaques and limited suitability for serial monitoring of therapy efficacy. The prospects of mass screening using automated analysis of chest CT images and artificial intelligence for early detection of subclinical atherosclerosis as well as personalization of cardiovascular risk assessment with preventive measures have been proven. Conclusions. The detection of coronary calcification in patients with hypertension is a highly specific method for identifying subclinical atherosclerotic lesions with strong prognostic value for cardiovascular risk stratification and for a personalized approach to treatment and prevention.
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.
In recent years, the global medical and scientific community has continued to investigate COVID-19. Scientific attention, however, has shifted beyond the emergence of novel variants to include the development of postCOVID syndrome, which may occur in both adults and children. Aim. To characterize the features of development and clinical manifestations of post-COVID-19 syndrome in children based on an analysis of the scientific literature. Materials and methods. A narrative review of studies published between 2020 and 2025 retrieved from PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, UpToDate, and selected Ukrainian peer-reviewed journals was conducted. Eligible studies addressed clinical features, laboratory biomarkers, echocardiography and cardiac MRI findings, multisystem inflammatory syndrome in children (MIS-C), and coagulopathy in pediatric patients. Results. The reported prevalence of pediatric post-COVID-19 syndrome ranges from 4 % to 66 %. Among affected children, 10–27 % exhibit persistent symptoms 2–5 months after acute recovery. Common manifestations include fatigue, dyspnea, headache, cognitive complaints, anxiety, tachycardia, and sleep disturbance. Cardiac alterations were reported in 25–75 % of cases across included studies; findings encompass transient myocardial dysfunction, reduced left-ventricular ejection fraction, left ventricular dilatation, and arrhythmias. In MIS-C patients, NT-proBNP and troponin I elevations and systolic impairment are more pronounced compared to non-MIS-C post-COVID-19 cases. Coagulopathy is characterized by increased D-dimer and fibrinogen levels with a relatively low rate of overt thrombosis. Correlations among D-dimer, NT-proBNP, and ferritin levels highlight endothelial dysfunction as a central pathophysiologic driver. Conclusions. Pediatric post-COVID-19 syndrome is a multisystem entity dominated by endothelial-inflammatory mechanisms. NT-proBNP, D-dimer, and troponin I, together with echocardiography and cardiac MRI, are essential for risk stratification and long-term follow-up. Standardized monitoring protocols and long-term outcome studies are urgently needed.
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.
The review focuses on the laboratory and pathogenetic aspects of preeclampsia, one of the most clinically significant and life-threatening obstetric complications, characterized by multiorgan maternal dysfunction resulting from specific vascular and hemostatic changes. The aim of the study was to review and critically analyze peer-reviewed publications on coagulation changes in preeclampsia in electronic scientometric databases, including PubMed, Web of Science, Scopus, and Google Scholar. Materials and methods. A search was conducted for scientific publications using the following queries: “preeclampsia hemostasis abnormalities”, “preeclampsia coagulation disorders pathogenesis”, “coagulation changes in pregnancy”, “preeclampsia mechanisms”, “preeclampsia epidemiology global prevalence”, “endothelial dysfunction and coagulation in preeclampsia”. A retrospective analysis of scientific literature from the past 7 years was conducted using searches in major scientometric databases. Following abstract screening and full-text review, 60 relevant publications were selected. Publication trends on key hemostasis parameters in preeclampsia were tracked in both English and Ukrainian literature, applying “systematic review” filters. Results. The study revealed a consistent year-on-year increase in publications addressing these search terms across major scientific databases. Disorders of hemostasis play a pivotal role in preeclampsia pathogenesis; thus, evaluating key parameters (platelet count, fibrinogen levels, prothrombin time) enables elucidation of hypercoagulability mechanisms, quantification of endothelial injury, and identification of links between placental hypoperfusion, microthrombosis, and systemic hemostatic alterations. Diagnostic criteria for preeclampsia were established per leading international and Ukrainian guidelines. The analysis highlighted several unresolved challenges in investigating fibrinolysis and coagulation activation markers that warrant further comprehensive research. Conclusions. Analysis of key parameters of hemostasis in preeclampsia facilitates understanding of its pathogenetic mechanisms, contributes to early diagnosis and risk stratification, and enables assessment of the risk of maternal and perinatal complications.
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.
Dyslipidemia is a pathological condition characterized by abnormal concentrations of lipids and lipoproteins in blood plasma, including increased levels of total cholesterol, low-density lipoproteins, and triglycerides, decreased levels of high-density lipoproteins, or a combination thereof. Dyslipidemias can be primary (genetically determined) or secondary, resulting from other diseases or environmental factors, and represent one of the key modifiable risk factors for atherosclerosis and cardiovascular disease. Aim. To analyze current evidence on dietary recommendations for dyslipidemia and evaluate their effectiveness in correcting the lipid profile. Materials and methods. A search was conducted in PubMed, Embase, ResearchGate, Crossref databases using the following keywords: dyslipidemia, cardiometabolic disorders, metabolic syndrome, cardiovascular diseases, dietary nutrition, lipid biomarkers and lifestyle. Results. Given the growing prevalence of cardiometabolic disorders, dietary interventions that effectively reduce these risks are gaining importance. Alongside pharmacological therapy, dietary correction and lifestyle modification are recommended as first-line measures. Thus, incorporating specific bioactive food compounds with proven cardioprotective properties into the diet has demonstrated meaningful clinical benefit. The strongest evidence for dyslipidemia correction supports the Mediterranean diet, a high-fiber diet, an anti-inflammatory diet, and plant-based dietary patterns, etc. The Mediterranean diet, rich in fruits, nuts and olive oil, vegetables, legumes, whole grains, with moderate consumption of fish and poultry and limited intake of red and processed meat has shown positive effects on cardiometabolic outcomes. Through its content of soluble and insoluble fiber, monounsaturated fatty acids (oleic acid), polyunsaturated fatty acids including omega-3, polyphenols (oleuropein, resveratrol), phytosterols, flavonoids, catechins, and carotenoids, it exhibits anti-inflammatory and antioxidant properties, improves serum lipid levels and insulin sensitivity, and lowers blood pressure. Conclusions. Dietary interventions represent the first line of non-pharmacological lipid profile correction. Evidence supports the effectiveness of reducing saturated and trans-fat intake while increasing the proportion of unsaturated fatty acids, particularly mono- and polyunsaturated fatty acids. The Mediterranean and DASH dietary patterns, combined with weight control, regular physical activity, and lifestyle modification, provide the greatest positive effect on the lipid profile.
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.
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.
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 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.
