Background. Atrial fibrillation (AF), one of the most prevalent cardiac arrhythmias, has a substantial global morbidity and mortality rate. According to recent research, the pathophysiology of AF may be significantly influenced by changes in the lipid profile, macrominerals, and trace elements. In order to shed light on any potential correlations and clarify them, this study compared the levels of lipid profile parameters, magnesium (Mg), calcium (Ca), specific trace elements and some other markers in serum of patients with AF compared to healthy individuals. Materials and methods. The measured markers include lipid profile (cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL)), macrominerals Mg, Ca and some trace elements — copper (Cu), chromium (Cr), selenium (Se), zinc (Zn), iron (Fe). The above markers were measured in 100 AF patients (50 males, 50 females) and 100 supposedly healthy subjects (50 males, 50 females). Results. Statistical data analysis revealed a significant elevation in serum levels of Cu and a decrease in Cr, Se, Zn, Fe, Mg, with non-significant differences in Ca in patients as compared to the control group and for both sexes. The study revealed a significant elevation in Cu levels in females versus males (P ≤ 0.05) and a significant decrease in Fe levels in females compared to males (P ≤ 0.05). In contrast, there was a significant elevation in the levels of cholesterol, TG, LDL-C and VLDL-C and a decrease in HDL-С in serum of patients with AF as compared to the control group for both sexes. Conclusions. There was no effect of sex on the studied markers except Fe, Cu.
Background. Armed conflicts have led to an increasing number of patients with retained metallic fragments, the surgical removal of which is often contraindicated due to high operative risks. These fragments may serve as a source of chronic lead exposure even in the absence of clinical symptoms, necessitating long-term medical surveillance. The role of primary care in coordinating such monitoring remains insufficiently explored. The purpose was to highlight the critical role of primary care in coordinating long-term monitoring in post-conflict patients who live with retained metallic fragments. Materials and methods. Due to the fragment’s high-risk anatomical location and the substantial potential for hemorrhagic and visceral complications, surgical removal was deemed contraindicated, and a conservative management strategy coordinated by a family physician was implemented, including periodic imaging surveillance to assess fragment stability and scheduled blood lead level (BLL) monitoring. Results. A structured active surveillance strategy was implemented. This included periodic imaging to assess fragment stability and annual BLL testing. The BLL was 2.2 µg/dL, remaining within the reference range (≤ 8.5 µg/dL) according to the private laboratory’s reference values. Conclusions. Retained fragments should be recognized as a potential source of chronic lead exposure, warranting proactive monitoring even in asymptomatic individuals. In post-conflict settings, primary care physicians play a pivotal role in ensuring continuity of care for patients with retained metallic fragments after acute surgical decision-making has concluded. Structured surveillance led by primary care may therefore represent a critical component of sustainable health system responses to armed conflict, particularly in countries facing large populations of veterans and former prisoners of war.
Non-erythematous forms of systemic tick-borne borreliosis, or Lyme disease (LD), are considered one of the most difficult to diagnose due to the lack of a pathognomonic (specific) marker of the disease — erythema migrans. In such a situation, the clinician should take into account the season, the patient’s residence or stay in a region endemic for LD, the possibility of an alimentary route of infection with Borrelia when consuming dairy products from sick domestic animals. The non-erythematous form of LD often proceeds as a common acute respiratory viral infection or flu and begins with the appearance of fever, weakness, headache, pain in muscles and joints. Sometimes the disease is masked as other pathologies: myocarditis, chorioretinitis, neurological disorders (facial nerve palsy, radiculopathy, meningoencephalitis), hepatitis. The appearance in a patient in a region endemic for tick activity of any symptoms without erythema migrans requires examination for LD, if these symptoms are not explained by other nosological forms. In order to identify specific antibody titers and assess their dynamics, serological blood testing is prescribed by the enzyme-linked immunosorbent assay, with a repeat after 2–4 weeks. The study of cerebrospinal fluid by polymerase chain reaction for the presence of Borrelia is diagnostically significant in cases of meningoencephalitis. Underestimation of the above-mentioned clinical and anamnestic data and laboratory criteria leads to diagnostic errors, delayed treatment and significantly increases the risk of developing chronic forms of the disease and complications.
Background. The relevance of social media addiction research is determined by rapid digitalization and the increasing integration of social networking platforms into the everyday lives of adolescents and young adults. During sensitive developmental periods of identity and self-esteem formation, this integration significantly increases the risk of polymorphic social media addiction with adverse psychological consequences. The aim of the study is to provide a theoretical justification and empirical investigation of polymorphic social media addiction as a psychological phenomenon and to determine its impact on psychosomatic risks in individuals with elevated levels of anxiety, as well as to identify the key psychological mechanisms underlying the development of addictive behavior and related psychosomatic health disorders. Materials and methods. A comprehensive battery of psychodiagnostic instruments (BSMAS, IAT, FOMO, DERS, INCOM, and DASS-21) was employed to provide a multidimensional assessment of social media addiction, capturing its behavioral, emotional, cognitive, motivational components, and also associations between addictive behavior, increased anxiety and psychosomatic risks. In line with DSM-5 and ICD-11 criteria, individuals with elevated anxiety levels, predominantly adolescents and university students, were classified as a high-risk group. The pilot study was conducted at the University Clinic of the Vinnytsia National Pirogov Memorial Medical University (clinical, educational, and research center). Results and conclusions. The results of the study indicate that polymorphic social media addiction has a systemic nature and encompasses behavioral, emotional, cognitive, motivational, physiological, and social levels of personality functioning. The identified profile of clinical well-being indicators substantiates the relevance of early diagnosis, prevention, and comprehensive psychocorrective interventions, particularly among adolescents and young people as high-risk groups. The empirical findings confirm that adolescents demonstrate greater vulnerability to polymorphic social media addiction, whereas among university students, the overall level of susceptibility is lower, but it still requires attention due to the existing stress background and the potential for professional-related online overinvolvement.
Background. Acute ischemic stroke remains one of the leading causes of mortality and disability worldwide. Metabolic disturbances, particularly diabetes mellitus and hyperglycemia, play a significant role in disease progression, as they are associated with more severe brain tissue injury and poorer clinical outcomes. Neuroimaging is a key tool for the early diagnosis of acute stroke and determining subsequent therapeutic strategies. The use of the ASPECTS and pc-ASPECTS enables objective assessment of morphological brain tissue changes and prediction of clinical course, highlighting the relevance of investigating the impact of carbohydrate metabolism disorders on the characteristics of ischemic stroke. Objective: to determine the features of neuroimaging changes in acute ischemic stroke depending on carbohydrate metabolism status. Materials and methods. A total of 124 patients with acute ischemic stroke were enrolled in this prospective study. According to glycemic status, they were divided into three groups: those with type 2 diabetes mellitus (n = 63), transient hyperglycemia (n = 31), and a control group without carbohydrate metabolism disorders (n = 30). The location of ischemic lesions and ischemic core volume were analyzed using the ASPECTS and pc-ASPECTS. Statistical processing was performed using the χ2 test; p < 0.05 was considered statistically significant. Results. The distribution of stroke according to vascular territories and arterial segments did not depend on glycemic status (p > 0.05). The middle cerebral artery territory was most frequently affected, with a predominance of distal M2 and M3 segments. Statistically significant differences were found in the ASPECTS among the groups (p < 0.001). The mean ASPECTS was highest in the transient hyperglycemia group (9.45), whereas lower values were found in patients with type 2 diabetes mellitus (8.40) and in the control group (8.50). Low ASPECTS (≤ 6 points) was predominantly observed in patients with type 2 diabetes mellitus. Conclusions. Glycemic status does not influence the topography of ischemic lesions but is associated with their volume. Chronic hyperglycemia in type 2 diabetes mellitus is linked to more pronounced early ischemic changes, whereas transient hyperglycemia is characterized by relatively more favorable neuroimaging parameters.
Despite the significant number of criminal proceedings initiated annually against healthcare professionals in Ukraine, clinicians remain insufficiently informed about the legal consequences of clinical and diagnostic failures. The article aims to familiarize clinicians with medical malpractice cases in anesthesiology and intensive care that resulted in severe adverse outcomes for patients and led to judicial verdicts. The article provides an analysis of court decisions from the Unified State Register of Court Decisions for the period 2011–2025, focusing on medical negligence involving anesthesiologists across various regions of Ukraine. Based on definite types of failures identified during anesthetic management or intensive care interventions, the authors present detailed case examples of harmful medical actions and their legal implications. Physicians who are aware of typical professional mistakes and their subsequent legal consequences might be better prepared to face and prevent medical errors.
Background. The problem of surgical treatment for secondary peritonitis complicated by septic shock is the subject of constant discussions, as it is due to the difficulty in choosing an effective selective surgery and is accompanied by a significant number of complications and high mortality. The purpose was to analyze the features of the course of secondary peritonitis complicated by septic shock and to conduct a comparative analysis on the effectiveness of surgical management with the expansion of indications for the use of programmed relaparotomies with vacuum-assisted closure (VAC). Materials and methods. The work is based on the analysis of the results of surgical treatment of 42 patients with secondary peritonitis complicated by septic shock. Depending on the strategy, the patients were divided into 2 groups: group 1 (comparison, n = 19) and group 2 (main, n = 23) in which improved surgical strategy was used with the expansion of indications for programmed relaparotomies with VAC. Results. The results of the analysis on the structure of surgical diseases in patients with secondary peritonitis complicated by septic shock revealed a perforating complication as the cause of peritonitis in 9 (47.36 %) patients of the first group and 12 (52.17 %) patients of the second group. This was due to perforated gastric ulcer in 2 (10.53 %) patients of the first and 2 (8.69 %) patients of the second group. In almost every third (7 people (36.84 %)) participant of the first group and almost half (10 people (43.48 %) participants of the second group, peritonitis with septic shock was caused by perforation of intestinal tumors, and almost half of the patients in both groups had acute vascular insufficiency of intestine. Eight (42.11 %) patients of the first group and 10 (43.48 %) patients of the second group were operated with MPI of 21 to 29 points, and in almost every third (6 people (31.58 %) patient of the first and second groups (9 people (39.13 %), peritonitis course exceeded 29 points on MPI. Improvement of diagnostic and treatment strategy in patients of group 2 with secondary peritonitis complicated by septic shock by expanding indications for the use of laparoscopy allowed performing perforated gastric ulcer suturing in 2 cases, and the combined use of programmed relaparotomy with VAC contributed to the restoration of the digestive canal during their performance in 10 (43.48 %) patients. Conclusions. Improvement of diagnostic and treatment strategy in patients of group 2 with secondary peritonitis complicated by septic shock allowed reducing the number of postoperative complications by 19.91 % and postoperative mortality by 19.68 %.
Background. Segmental defects of the tibia (critical defect: more than 2 cm long and loss of more than 50 % of bone mass) are divided into primary (due to high-energy trauma) and secondary, as a result of radical resection of necrotic and infected bone fragments, resection of bone tumors, etc. Within the framework of biomechanical studies of modern fixators, great attention is paid to the development of structural parameters that influence the stability of the construct, such as rigidity, maximum stress values at the control points of the system and performance of the pin-bone interface. The purpose of the study was to investigate the stress-strain state of a model of the lower leg with a tibial defect with different options for its extra-articular osteosynthesis under the influence of a bending load acting in the sagittal plane. Materials and methods. A defect 5 cm long was modeled in the middle third of the tibia. Stabilization of the tibia with an external fixation device was studied with three options for inserting rods with a diameter of 8 mm at angles of 30, 60, and 90°. Results. Under the influence of bending load in the sagittal plane, insertion of fixing rods at an angle of 30° creates a maximum stress in the bone tissue of 13.4 and 9.4 MPa around distal pair of rods, around proximal one — of 8.4 and 6.6 MPa, respectively; at an angle of 60°, compared to the previous model, it causes an increase in the level of stresses in the bone tissue almost around all fixing rods. Change in the distribution of stresses on the fixing rods inserted at an angle of 90°: on rods 1 and 4, the stress level decreases to 48.4 and 28.0 MPa, respectively, which are the lowest indicators for all previous models. Conclusions. With a bending load acting on the limb in the sagittal plane, the most favorable option for minimizing stresses in the bone tissue is the installation of the external fixation device with the fixing rods inserted at an angle of 30°.
Background. Platelets are highly sensitive to changes in the internal environment and play a key role in hemostasis, inflammation, and immune response. Burn injury is associated with significant alterations in platelet count and function, contributing to coagulopathy and adverse clinical outcomes. The purpose was to summarize current evidence on platelet hemostasis disorders in burn disease, with a focus on pathophysiology, biomarkers, and treatment approaches. Materials and methods. A literature search was conducted using CrossRef, Scopus, Google Scholar, and PubMed databases for the period from 2017 to 2026. The search strategy combined structured descriptive approaches with manual screening of relevant publications. Observational studies and reviews addressing platelet dysfunction in burn patients were included. Results. Thrombocytopenia in burn patients is primarily associated with increased platelet consumption and destruction due to inflammatory mediators, endothelial damage, and activation of coagulation pathways. Early decreases in fibrinogen may impair platelet aggregation. Several biomarkers demonstrate diagnostic and prognostic potential, including platelet count and its dynamics, mean platelet volume, platelet distribution width, immature platelet fraction, inflammatory markers (C-reactive protein, procalcitonin, interleukin-6), and coagulation parameters (D-dimer, fibrinogen, antithrombin III). Additional indicators include markers of endothelial dysfunction and organ failure. Severe thrombocytopenia (< 50 × 109/L) requires urgent clinical management. However, platelet transfusion in sepsis remains controversial due to potential risks such as hypercoagulability and thrombotic complications. Conclusions. Platelet dysfunction plays a central role in the pathogenesis of burn-related coagulopathy and sepsis. Further research is needed to improve diagnostic strategies and develop targeted therapies aimed at optimizing platelet function and reducing inflammation in burn patients.
Background. The conduct of modern warfare is significantly different from the world’s experience, which is related to new types of weapons. Treatment of victims with combat injury is very difficult. This is due to the destructive and complex influence of weapons, plasty of the massive defect and significant growth of antibiotic-resistant bacteria. It makes the application of physical methods the main part in treatment tactics. The purpose was to evaluate short-term results of the combined use of appropriate methods in the management of combat injury of the lower limb. Materials and methods. The study was based on the treatment outcomes of male patients with combat injury of the lower limb who underwent treatment at the Department of Surgery and Vascular Surgery from February 24, 2022, to August 20, 2025. Results. The mean age of patients was 27.95 ± 5.45 years. The mean number of using pulse lavage debridement — 2.90 ± 0.76 times. The average number of bandage changes with negative pressure wound therapy was 4.00 ± 0.83 times. Dermatoplasty was performed in 28.57 % cases, secondary suture closure — in 52.38 %, and 19.05 % of patients had their wounds healed by secondary intention. After rehabilitation, 33.3 % of patients returned to their duty. Conclusions. Combination of negative pressure wound therapy and pulse lavage system helped achieve adequate and high-quality debridement of affected areas, allowing for the preservation of significant tissue mass of traumatized limbs with the potential for further reconstruction and preparation for prosthetic fitting.
Background. Risk stratification in elderly patients and the choice of surgical strategy are performed with consideration of frailty, which is an independent risk factor for adverse outcomes after non-cardiac surgery. Comprehensive preoperative preparation of frail patients is part of prehabilitation programs that are actively being implemented in modern medical practice. Goals of study was to analyze the level of frailty in patients with concomitant cardiovascular disease undergoing elective non-cardiac surgery; to assess the relationship between frailty and clinical characteristics, instrumental and laboratory findings, perioperative course, and in-hospital mortality; consequently, to evaluate the role of frailty in preoperative risk stratification to improve postoperative outcomes. Materials and methods. Frailty was assessed preoperatively in 150 patients who underwent elective non-cardiac surgery and had concomitant cardiovascular pathology. Functional capacity, physical status according to the ASA classification, clinical risk factors, echocardiographic findings, 12-lead ECG dynamics, general clinical and biochemical blood parameters, and NT-proBNP levels were analyzed. Frailty was evaluated using the Clinical Frailty Scale. Results. Frailty was identified in 28 % of patients, two-thirds of whom were male. Frail patients demonstrated lower functional capacity and had a higher burden of comorbidities (diabetes mellitus, anemia, cardiovascular diseases, higher creatinine and transaminase levels) as well as a higher Revised Cardiac Risk Index. Most of them (81 %) were classified as ASA III. Frail patients commonly exhibited signs of left ventricular dysfunction (reduced ejection fraction, increased Tei index, shortened aortic ejection time, impaired diastolic relaxation) and remodeling (changes in geometry). They also had significantly higher levels of natriuretic peptide, higher mean heart rate, and a tendency toward QT interval prolongation. Frail patients had longer hospital stays, and 43 % required postoperative intensive care (compared to 6.5 % of non-frail patients). More than one-third were rehospitalized during the follow-up period. Half of the frail patients died (compared to 3.7 % in the non-frail group), with 75 % of deaths occurring during hospitalization; the mean time to death was 23.67 ± 2.44 days. Conclusions. Frailty is associated with reduced functional capacity, higher comorbidity burden, increased anesthetic risk, greater need for intensive care, longer hospital stay, and higher mortality. The Clinical Frailty Scale is an accessible and reliable tool for patient stratification, aimed at optimizing postoperative recovery, improving surgical outcomes, and enhancing the quality of medical care.
The work presents data on the diagnosis and differentiation of states of psychomotor agitation. It is emphasized that this condition is quite common and develops in acute mental disorders, intoxications, somatic and neurological diseases, and stressful influences. The clinical picture of agitation is characterized by significant acuteness, severity, and intensity of symptoms with a dominance of impaired consciousness, psychotic disorders, aggression, affective, and severe behavioral deviation. Such conditions are dangerous for both the patient and those around them. In psychiatric practice, the following variants of psychomotor agitation are encountered: hallucinatory-delusional, depressive (melancholic), manic, catatonic, hebephrenic, amentive, epileptic, choreiform, hysterical, psychopathic, panic, erethic. Psychomotor agitation that develops in disorders due to alcohol and drug use also has certain characteristics. The article presents the states of psychomotor agitation of the indicated variants, which are important for timely diagnosis and differentiation when providing emergency care for patients. Help to patients with psychomotor agitation is provided not only by psychiatrists and narcologists but also by doctors of other specialties who contact such peoples in outpatient clinics and in hospitals. Information is given that today in all countries, there is a significant gap in the ability to provide specialized care for people with mental, neurological and substance use disorders. To address this problem in treatment, the World Health Organization developed the Mental Health Gap Action Programme, which is being actively implemented in Ukraine. Due to the importance of unifying approaches to providing care, information is given on the assessment and management of agitation states in accordance with the provisions of this programme. Depending on which type of agitation is diagnosed, recommendations are given for management using both non-drug de-escalation methods and therapy with the prescription of psychotropic medications.
Background. Hepatorenal syndrome (HRS) developing in the setting of decompensated portal hypertension (PH) is characterized by progressive renal failure, elevated serum creatinine levels, and worsening oliguria. HRS occurs in approximately one-third of patients with Child-Pugh class C liver cirrhosis. The purpose was to optimize early diagnosis and treatment, as well as to identify risk factors for the development of HRS and associated mortality. Materials and methods. A total of 126 medical records of patients with decompensated PH treated at the Kyiv City Emergency Hospital and the Department of Surgery, Dental Faculty, Bogomolets National Medical University, between 2022 and 2024 were analyzed. HRS was diagnosed in 51 (40.5 %) cases. Diagnostic criteria included an increase in serum creatinine > 150 µmol/L (1.69 mg/dL) or ≥ 26.5 µmol/L (0.3 mg/dL) within 48 hours in the presence of oliguria and absence of other signs of intrinsic renal injury, particularly hematuria. Patients were divided into two groups. The first group included 24 (47.1 %) patients in whom HRS and community-acquired spontaneous bacterial peritonitis (SBP) were diagnosed within the first 24 hours, and a restrictive transfusion strategy was applied. The second group comprised 27 (52.9 %) participants in whom HRS and nosocomial SBP were diagnosed on days 3–5 of hospitalization, and a liberal transfusion strategy was used. The impact of transfusion strategy, ascites severity, and SBP as mutually aggravating factors in HRS development was assessed. Results. Analysis showed that the combination of large-volume ascites, SBP, and a liberal transfusion strategy forms an unfavorable prognostic complex associated with a significantly increased risk of mortality. HRS development was more frequently associated with large-volume ascites (70.8 %), nosocomial SBP (37.0 %), and a liberal transfusion strategy (52.9 %). Among 126 patients, 27 (21.4 %) underwent surgery. In the postoperative period, HRS developed in 1 (4.2 %) patient in the first group and in 2 (7.4 %) patients in the second group. Overall mortality was 74.5 % (n = 38), with 14 deaths (58.3 %) in the first group and 24 (88.9 %) in the second group (p = 0.03). According to ROC analysis, the model demonstrated high predictive performance for mortality (AUC = 0.909; 95% CI 0.831–0.987), confirming strong discriminative ability for risk stratification in patients with HRS. Conclusions. HRS is a severe complication of decompensated PH associated with high mortality. A liberal transfusion strategy, severe ascites, and SBP increase the risk of its development and progression. Early monitoring of urine output and serum creatinine levels is critical for timely diagnosis, prevention, and management of HRS.
Background. With the active implementation of robotic surgery and enhanced recovery after surgery (ERAS) protocols, optimisation of perioperative patient management has become increasingly important. One of the key factors influencing the speed of emergence, the possibility of early mobilisation, and the length of hospital stay is the choice of general anaesthesia. Despite the widespread use of both inhalational anaesthesia with sevoflurane and total intravenous anaesthesia (TIVA) with propofol, data on their comparative effects on postoperative recovery following robot-assisted procedures remain limited. The purpose was to perform a comparative evaluation of postoperative recovery parameters in patients undergoing robotic surgeries depending on the type of anaesthesia. Materials and methods. The study was conducted between 2022 and 2024 and included 81 patients who underwent robot-assisted surgical procedures using the da Vinci system. Patients were divided into two groups according to the anaesthetic technique: group 1 — inhalational anaesthesia with sevoflurane (n = 45) and group 2 — TIVA with propofol (n = 36). The groups were comparable in terms of demographic characteristics and anaesthesiological risk according to the ASA classification. Early postoperative recovery parameters were assessed, including time to extubation, time to mobilisation, length of stay in the intensive care unit, and total hospital stay. Statistical analysis was performed using non-parametric methods, with p < 0.05 considered statistically significant. Results. The duration of surgery was significantly longer in the TIVA group compared to the inhalational anaesthesia group (6 h [4; 5] vs 5 h [4; 5], p < 0.01). The most pronounced differences between the groups were observed in early postoperative recovery outcomes. Patients receiving sevoflurane had a significantly shorter time to extubation (6 min [5; 7] vs 18 min [16; 19], p < 0.01) and earlier postoperative mobilisation (10 h [9; 10] vs 12.5 h [12; 14], p < 0.01). In addition, the length of stay in the intensive care unit (18 h [16; 19] vs 20.5 h [19.8; 22], p < 0.01) and total hospital stay (7 days [7; 7] vs 8 days [8; 9], p < 0.01) were significantly shorter in the sevoflurane group. Conclusions. Inhalational anaesthesia with sevoflurane during robot-assisted surgical procedures provides significantly faster early postoperative recovery compared to TIVA with propofol. It is associated with reduced time to extubation, early mobilization, reduced length of stay in the intensive care unit, and overall hospitalization. The obtained results indicate the appropriateness of using sevoflurane as the anaesthetic technique of choice for robot-assisted surgical procedures, as it aligns with ERAS principles, offering important organisational and economic advantages.
Background. Acute pancreatitis is characterized by marked clinical heterogeneity, while severe forms are associated with organ failure, necrosis, and infectious complications. The gut-pancreas axis has become increasingly important for understanding disease progression, because dysbiosis, intestinal barrier dysfunction, and bacterial translocation may amplify systemic inflammation and worsen clinical outcomes. Objective: to summarize current evidence on the gut microbiota as a therapeutic target in acute pancreatitis and to assess the clinical value of microbiota approaches. Materials and methods. A narrative review with critical evidence synthesis was performed. The literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar, with additional manual screening of reference lists from key publications and current guidelines. Clinical studies, systematic reviews, and relevant experimental reports addressing dysbiosis, intestinal barrier dysfunction, microbial metabolites, and microbiota-oriented interventions in acute pancreatitis were analyzed. Results. Available evidence indicates that dysbiosis in acute pancreatitis is not a secondary phenomenon but can act as a modifier of disease severity through effects on intestinal barrier integrity, inflammatory signaling, and the risk of infectious complications. Clinical and multi-omics studies have demonstrated reduced microbial diversity, depletion of butyrate-producing bacteria, enrichment of opportunistic taxa, and microbiome signatures associated with more severe disease. Early oral or enteral feeding currently appears to be the most evidence-based and safest microbiota-oriented strategy because it helps preserve mucosal barrier function. In contrast, data on probiotics, prebiotics, synbiotics, and postbiotic approaches remain heterogeneous, and their use in predicted severe or severe acute pancreatitis requires caution. Fecal and washed microbiota transplantation are promising, but current evidence is still limited to early clinical experience and low-level studies. Conclusions. Gut microbiota is a promising therapeutic target in acute pancreatitis; however, clinical implementation of microbiota-oriented interventions requires standardization, more precise patient stratification, and further well-designed studies.
Background. The study included determination of the levels of some parameters and antioxidants in serum of patients with coronary artery disease (CAD) compared to healthy people aiming at clarifying the relation among these changes. The measured parameters include: malondialdehyde (MDA), glutathione (GSH), vitamin C, uric acid, total protein, albumin, globulin and some trace elements (chromium (Cr) and selenium (Se)). Materials and methods. Serum MDA, GSH, vitamin C, uric acid, total protein, albumin, globulin, Cr and Se were measured in 100 CAD patients (50 male, 50 female) and 100 supposedly healthy subjects (50 male, 50 female). Results. Statistical data analysis revealed a significant elevation in the serum levels of MDA and uric acid in patients with CAD compared to control group. The study also showed a significant decrease in the levels of GSH, Cr and Se in serum of patients as compared to control group and for both sexes. On the other hand, a significant decrease was observed in vitamin C, total protein, albumin, with no significant differences in serum globulin in patients versus control group and for both sexes. Conclusions. There was no effect of sex on the studied parameters except uric acid.
Background. Studies on the mechanisms of metabolic syndrome formation under the influence of low temperatures, the pathogenesis of necrosis, cellular and molecular mechanisms of inflammation in widespread local and severe general cold injury require further research. The purpose of the work was to identify clinical and experimental parallels between general and local cold injury and to clarify the pathogenesis and mechanisms of cold illness formation, taking into account systemic anti-inflammatory response syndromes. Materials and methods. Experimental studies were conducted on six-month-old white Wistar rats weighing 250–270 g, as well as on four-month-old Chinchilla rabbits weighing 2000–2100 g, in accordance with the provisions of the European Convention for the Protection of Vertebrate Animals Used for Experimental and Other Scientific Purposes. A total of 80 rats and 20 rabbits were involved. The experiments were conducted using intramuscular ketamine anesthesia. Clinical studies included observations of 712 patients with general and local cold injury aged 21 to 77 years. The control group consisted of 30 practically healthy individuals aged 20 to 65 years. Results. Pathohistological and histochemical studies in animals, and the results of thanatological studies (56 deceased people) revealed certain signs of the damaging effect of cold on internal organs in case of general cold injury and widespread local lesions, which led to the formation of multiple organ failure and death. Significant disturbances in microcirculation and oxygen transport function of erythrocytes were detected with impaired oxygen utilization, which subsequently led to dysfunction of internal organs and the development of multiple organ failure syndrome. The causes of mortality in those who died from cold injury indicate an insufficient assessment of the damaging effects of cold in the early stages of the injury when using traditional cold injury treatment technology. Conclusions. The results obtained indicate that development of metabolic syndrome of systemic inflammatory response with severe general hypothermia of the body combined with trauma and widespread local damage by low temperatures, with pathological changes in organs and systems, should be considered as manifestations of cold illness. In the dynamics of its pathogenesis and clinical course, stages of shock, toxemia, septic toxemia, septic complications in the form of multiple organ dysfunction syndrome, multiple organ failure syndrome, and sepsis can be identified.
Background. Venous stroke resulted from cerebral venous thrombosis represents a rare but clinically significant subtype of stroke, characterized by substantial clinical variability, atypical or subacute onset, and often leading to a delay in establishing the correct diagnosis. Aim: to analyze clinical manifestations of venous stroke based on illustrative clinical cases and to integrate them with current international evidence. Materials and methods. A descriptive analysis of two clinical cases of venous stroke was performed. Clinical, neuroimaging and laboratory data were interpreted in the context of contemporary international guidelines and large-scale cohort studies. Results. Two clinical cases of venous stroke (cerebral venous thrombosis) were analyzed in female patients aged 57 and 70 years, characterized by marked clinical heterogeneity and an atypical course. In both cases, disease onset was subacute or acute, with non-specific clinical manifestations and no clear correspondence between the lesions and arterial vascular territories. In the first patient, the predominant symptom was progressively worsening headache accompanied by visual disturbances, with minimal focal neurological deficit, consistent with a subacute pseudotumorous presentation. In the second case, the disease had an acute onset with a cortical symptom in the form of motor aphasia, which clinically mimicked an arterial ischemic stroke. Neuroimaging using magnetic resonance imaging and magnetic resonance venography in both patients revealed venous infarctions without a clear arterial territorial distribution, thereby confirming the diagnosis of venous stroke. Both cases were managed conservatively with anticoagulant therapy, without neurological deterioration, resulting in clinical stabilization and a favorable functional outcome. Conclusions. Venous stroke demonstrates substantial clinical variability and often mimics arterial cerebrovascular events. Early recognition of atypical symptoms and appropriate neuroimaging are essential for favorable outcomes.
Background. Empirically adopted and widely used “liberal” fluid therapy strategies are associated with fluid overload, hyperchloremic acidosis, and acute kidney injury. In contrast, individualized fluid therapy based on the patient’s hemodynamic phenotype, using small boluses, frequent reassessment, and clearly defined safety limits, may improve clinical outcomes. Objective: to analyze the current evidence base on optimizing fluid therapy in intensive care and perioperative medicine, with a focus on the rational selection of solutions using an “osmotic driver”, and to structure clinical decision-making according to the stepwise ПОІНТ (profile-orientation-infusion-load-targeting) fluid therapy strategy, including the development of algorithms and key performance indicators for clinical implementation and audit. Materials and methods. This article is based on a review of scientific literature, including a bibliosemantic analysis of the current state of the problem, an evaluation of the major established concepts of fluid therapy, and an assessment of contemporary trends in the rational selection of solutions from the available therapeutic armamentarium. Based on the identified patterns in the principal scientific views, the authors formulated their own perspective on potential ways to improve fluid therapy through the development of the patient-oriented ПОІНТ strategy. The theoretical and methodological framework of the study also incorporated a logical-structural approach and content analysis. Scientific publications from 2018 to 2025 were studied. The review covered the literature identified through the main keywords relevant to the topic of the article. No meta-analysis was planned because of the heterogeneity of endpoints. Results. Three stratification layers were described: by clinical problem, specialty, and nosology. The principles of fluid selection were defined as follows: balanced solutions as the default option; 0.9% NaCl for limited indications only; colloids/albumin selectively; glucose-containing solutions not for resuscitation; hyperosmolar solutions as “osmotic drivers” to enhance an existing fluid therapy regimen. Indications, dosing, and monitoring parameters for the “osmotic driver” were also outlined. In addition, visual tools (a decision tree and a scenario matrix) and an implementation package (4D/ROSE) were developed. Conclusions. The ПОІНТ strategy formalizes the individualization of fluid therapy and supports clearly defined patient safety boundaries.
Sufentanil is a synthetic opioid with high lipophilicity and selective affinity for the μ1 sub-population of opioid receptors, which defines its place in the cardiac anaesthesiologist’s pharmacological arsenal. This review systematises current evidence on sufentanil pharmacokinetics, dosing in on-pump and off-pump (off-pump coronary artery bypass — OPCAB) cardiac surgeries, haemodynamic effects, ventricular-arterial coupling, myocardial protection, fast-track protocols and the safety profile. As a clinical illustration, own experience of using sufentanil as the principal opioid component of anaesthesia is presented: a series of 20 patients with coronary artery disease who underwent coronary artery bypass grafting — 18 off-pump (OPCAB) and 2 on-pump. The mean time from the endof surgery to extubation was 2.6 ± 1.1 h, consistent with fast-track cardiac anaesthesia criteria; no reintubations or haemodynamic complications were recorded. Sufentanil provides reliable haemodynamic stability compatible with early extubation, contributes toan improved early postoperative course and demonstrates a favourable balance of efficacy and safety compared with fentanyl and remifentanil.
