Zaporozhye Medical Journal

Impact of prior COVID-19 infection on cardiac surgery outcomes: optimal timing for valvular heart disease surgery

2025-07-01T10:23:01+00:00

The aim of this study was to evaluate the impact of prior COVID-19 infection on outcomes of surgery for valvular heart disease.

Materials and methods. The study included 200 patients with acquired valvular heart disease who underwent surgery at the National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during 2021–2024. The cohort was divided into two groups: the first consisted of patients with a confirmed history of COVID-19 before surgery (n = 100), and the second included patients with no COVID-19 history, hospitalized in the pre-pandemic period (2016–2019). For the post-COVID-19 group, disease severity, the time interval from recovery to surgery, and the clinical phase (pre- or postoperative infection) were considered. Outcomes compared between groups included the rate of postoperative complications (respiratory, renal, and cardiac failure), duration of intensive care stay, myocardial functional status, total hospitalization time, and 30-day mortality. Statistical analysis was conducted using the Student’s t test, χ² test, and Mann-Whitney U test with a significance level of p < 0.05. The examination integrates a retrospective analysis of clinical outcomes in patients who had recovered from COVID-19 before undergoing surgery with a review of current scientific literature. The study focused on determining the optimal timing for cardiac surgery post-recovery and comparing postoperative complication rates, hospitalization and intensive care durations, myocardial function, and 30-day mortality based on COVID-19 history.

Results. Patients with a history of COVID-19 had a significantly higher 30-day postoperative mortality rate (20 % vs. 2 %, p < 0.01), a greater need for mechanical ventilation exceeding 24 hours (27 % vs. 9 %), and longer intensive care unit stays. A marked increase in the frequency of acute heart failure (13 % vs. 4 %) was observed, while acute kidney injury occurred exclusively in the post-COVID-19 group. Among patients who underwent surgery less than 6 weeks after COVID-19, complication rates reached 50 %, with mortality exceeding 30 %. The most favorable outcomes were observed when surgery was performed no earlier than 8–12 weeks post-recovery. Postoperative SARS-CoV-2 infection was associated with a 60 % mortality rate, representing the highest risk in the entire cohort.

Conclusions. Previous COVID-19 infection is an independent risk factor for adverse outcomes following cardiac surgery. Patients with post-COVID-19 status are more likely to develop respiratory, cardiac, and renal complications and have a significantly increased mortality risk. Elective surgery should be deferred for at least 8 weeks following COVID-19, with 12 weeks or more being optimal. Postoperative COVID-19 infection significantly worsens prognosis, highlighting the importance of perioperative prevention. These findings underscore the need for risk stratification and a multidisciplinary approach in preparing post-COVID-19 patients for cardiac surgery.

Clinical outcomes of valve-sparing reconstructive surgery for ischemic mitral regurgitation: a 5-year single-center report and review of current global trends

2025-05-27T22:07:53+00:00

The presence of ischemic mitral regurgitation (MR) is associated with increased morbidity and mortality. Following acute myocardial infarction, the incidence of ischemic MR ranges from 17 % to 55 %. The optimal choice of surgical treatment for moderate and severe mitral valve (MV) insufficiency of ischemic origin remains a controversial issue for cardiologists and cardiac surgeons, despite the recommendations of current guidelines.

Aim. To enhance treatment outcomes for patients with ischemic MR by identifying the frequency and determinants of adverse postoperative events following sustained restoration of MV function over the long term.

Materials and methods. A single-center retrospective observational study was conducted, analyzing clinical data from 32 consecutive patients with MV insufficiency operated on at the Zaporizhzhia Regional Clinical Hospital from 01.01.2020 to 31.12.2024. The average postoperative observation period was 14.5 ± 5.9 months (minimum – 6, maximum – 24 months). The average age of the patients was 62.3 ± 7.1 years. By gender, the studied patients were distributed as follows: women – 7 (21.88 %), men – 25 (78.12 %).

Results. The mean ICU stay was 4.0 ± 2.2 days. The total length of hospital stay was 15.7 ± 4.8 days. The in-hospital mortality rate was 9.38 %. The most common cause of early mortality in the postoperative period was acute cardiovascular failure. At the time of discharge, 4 (13.8 %) patients had no residual MR. Minimal (trivial) MR was detected in 15 (51.72 %) patients, mild MR in 7 (24.14 %) patients, and moderate MR in 3 (10.35 %) patients. In the early postoperative period, there were no reoperations due to the progression of residual MR. In the long-term period, no fatalities were noted during the follow-up. Freedom from moderate and severe MR amounted to 80 % in the long-term postoperative period.

Conclusions. Early surgical intervention is recommended to improve the long-term treatment results of ischemic MR. Durable restoration of mitral valve function can be achieved with low perioperative mortality and favorable long-term survival. In late stages of severe MR, replacement of the MV is recommended instead of surgical repair.

The effect of smoking cessation on lipid metabolism in patients after coronary artery bypass grafting

2025-06-10T13:30:53+00:00

Aim. The study aimed to comparatively assess lipid metabolism in patients with ischemic heart disease (IHD) before and after coronary artery bypass grafting (CABG) and to evaluate the smoking factor and effects of smoking cessation.

Materials and methods. A total of 122 patients with IHD and indications for CABG were examined (101 men, 21 women; mean age 62.4 ± 0.7 years, range 40–83 years). The patients were divided into two groups: Group I (45 patients <60 years) and Group II (77 patients ≥60 years). Within each group, patients were further divided into subgroups based on smoking status: current smokers (Subgroups IA (n = 28, mean age 55.2 ± 0.9) and IIA (n = 18, mean age 65.0 ± 0.8)) and non-smokers (Subgroups IB (n = 17, mean age 55.2 ± 1.3) and IIB (n = 59, mean age 67.1 ± 0.6)). Lipid metabolism parameters were evaluated at two time points: prior to CABG and six months post-surgery. All patients received statin therapy throughout the study period and those identified as smokers ceased smoking prior to undergoing CABG.

Results. Among smokers (Subgroups IA and IIA), mean levels of proatherogenic lipids were 1.2 to 1.5 times higher, and HDL-C levels were markedly reduced, compared to non-smokers (Subgroups IB and IIB). At 6 months post-CABG, a more pronounced positive change in the lipid profile was observed in Subgroups IA and IIA: LDL-C levels decreased by 47.3 % and 40.7 %, respectively; non-HDL-C by 28.2 % and 24.1 %; and TG by 44.7 % and 29.3 %. In non-smokers, the improvement was less pronounced. At baseline, the proportion of individuals achieving target lipid levels was significantly lower among smokers, regardless of age (p < 0.05): LDL-C <1.4 mmol/L was observed in 46.4 % of Subgroup IA patients compared to 70.6 % in Subgroup IB patients; TG <1.7 mmol/L was achieved by 10.7 % of patients in IA compared to 23.5 % in IB. No individuals in Subgroup IA had target HDL-C or non-HDL-C levels at baseline, whereas these proportions were 29.4 % and 17.7 % in Subgroup IB, respectively. After 6 months, target levels for LDL-C, TG (IA, IIA), and non-HDL-C (IIA) were achieved by 90–100 % of patients (p < 0.05), while the changes in Subgroups IB and IIB were less pronounced.

Conclusions. Among patients with indications for CABG, baseline analysis revealed significantly elevated mean levels of proatherogenic lipids and low HDL-C levels among smokers, as well as the highest proportion of patients failing to achieve target lipid levels, despite prior statin therapy. The most pronounced improvement in lipid metabolism at 6 months was documented among the patients who ceased smoking. These findings suggest that smoking cessation enhances the hypolipidemic effect of statin therapy.

Regulation of the autonomic nervous system in older adults with accelerated respiratory system aging: effectiveness of breathing training with positive end-expiratory pressure

2025-07-01T10:32:23+00:00

Aim. To evaluate the effectiveness of breathing training with positive end-expiratory pressure (PEEP) on the autonomic nervous system in older adults with accelerated respiratory system aging.

Materials and methods. Ninety-four older adults aged 60–74 years were examined, including 45 with physiological aging and 49 with accelerated aging of the respiratory system. Participants with accelerated respiratory aging were divided into three groups: 16 underwent breathing training without PEEP (0 cm H₂O), 17 with PEEP of 5 cm H₂O, and 16 with PEEP of 10 cm H₂O. The autonomic nervous system was assessed at baseline and after completing the breathing training program.

Results. Older adults with accelerated respiratory system aging showed reduced high-frequency (HF) power and an increased low-frequency / high-frequency (LF/HF) ratio. In this group, HF power was inversely correlated with the functional age of the respiratory system (r = -0.33, p < 0.05) and oxygen saturation (SpO₂; r = -0.29, p < 0.05). Breathing training with PEEP increased SpO₂ and HF power while reducing the LF/HF ratio. However, increasing PEEP from 5 cm H₂O to 10 cm H₂O did not improve the effectiveness of the training.

Conclusions. In older adults with accelerated respiratory aging, parasympathetic activity decreases, and sympathetic activity increases. Changes in parasympathetic activity of the autonomic nervous system in this group are associated with the functional age of the respiratory system and pulmonary gas exchange. Breathing training with PEEP increases vagal activity and reduces sympathetic dominance. However, the magnitude of this effect is independent of the PEEP level.

Suspended ultrafine particles of industrial aerosol as a non-carcinogenic hazard factor for workers of a machine-building enterprise

2025-05-14T13:29:30+00:00

Aim. To evaluate the non-carcinogenic hazard posed by exposure to suspended ultrafine industrial aerosol particles among workers of a machine-building enterprise.

Materials and methods. The content of suspended ultrafine particles was analyzed using a scanning spectrometer NanoScan 3910. The chemical composition was assessed by optical emission spectrometry with inductively coupled plasma. To assess adverse non-carcinogenic effects, hazard quotients (HQs) were calculated, and the risk level was determined depending on the suspended particle using the proposed new methodology.

Results. The study has revealed that suspended particles comprised chemical elements with varying densities. Based on this, HQs were calculated and ranked for workers at the machine-building enterprise. HQs from the impact of suspended ultrafine particles with a density ≥6 kg/m³: 4.88 – for furnace operators, 4.44 – for welders, 2.63 – for cutters, 2.16 – for grinders. HQs from the impact of suspended ultrafine particles with a density ≤6 kg/m³: 2.44 – for furnace operators, 2.22 – for welders, 1.32 – for cutters, 1.08 – for grinders.

According to the proposed methodology, for furnace operators, particles of 11 nm and 15 nm posed the greatest hazard. For manual electric welders, 11 nm particles were critical, as well as larger particles in the range 64–154 nm. Grinders faced the highest risk from exposure to particles of 15–48 nm, while for cutters, the most dangerous were particles of 48 nm and larger ones in the range 154–205 nm.

Conclusions. The calculated hazard quotients for suspended ultrafine particles exceeded safe limits at all workplaces, which is not within acceptable parameters given the high probability of harmful effects. According to the proposed methodology, hazard levels were determined for each workplace based on particle size to guide the implementation of targeted preventive measures.

Psychodynamics and coping in rapid response healthcare personnel: an observational cross-sectional study with analytical components

2025-07-11T08:36:51+00:00

Currently, the training of Rapid Response Teams (RRTs) primarily focuses on mastering professional action protocols. However, the ability to effectively implement these protocols in high-stress professional situations remains a challenge that specialists frequently address without adequate support.

The aim of this study was to assess the psychological status of RRT personnel to identify their coping strategies and rate of adaptation to stressful conditions.

Materials and methods. The study involved 381 participants (284 women and 97 men). An observational cross-sectional study with analytical components was conducted. RRT personnel were examined before 1 PM on a non-working day. The assessment was performed using the automated system, “Psychological Safety of the Individual”. The frequency of COPE strategy use was quantified.

Results. Three distinct temperament profiles were identified among RRT personnel: individuals with a low level of activity (Group 1), those with heightened emotional-volitional involvement (Group 3), and those with average profiles (Groups 2 and 4). Group 1 individuals exhibited high self-control but lower openness to emotional support. Group 3 demonstrated higher levels of emotionality, flexibility, and the ability to utilize external resources. Groups 2 and 4 showed limited capacity for active stress coping, particularly regarding situation acceptance and the use of social support. Statistically significant differences in coping strategies highlight the necessity of an individualized approach in the psychological training of personnel.

Conclusions. The psychological effectiveness of RRT personnel is influenced by the interplay between temperament types and coping behaviors. The highest stress resilience was found among individuals with active problem-oriented strategies and the ability to engage external resources. The least adaptive group demonstrated low self-acceptance and confidence. These findings underscore the importance of considering these factors during professional selection and training.

Congenital Morgagni–Larrey diaphragmatic hernia in a child associated with hypoplasia of the muscular layer of the right diaphragmatic dome (a clinical case)

2025-07-01T10:31:20+00:00

A rare variant of dysontogenesis of the embryonic diaphragm in children is Morgagni–Larrey hernia and hypoplasia of the muscular layer of the diaphragm. The low frequency of these malformations, which ranges from 1 : 2000 to 1 : 4000 newborns, and the nonspecific clinical manifestations of the disease explain the limited experience of specific specialists in diagnostics, features of surgical treatment, and early postoperative rehabilitation of children with these anomalies.

Aim. To analyze the features of the clinical course, diagnosis, and surgical treatment of a rare diaphragmatic malformation in a child, Morgagni–Larrey hernia combined with hypoplasia of the right diaphragmatic dome, using an original case as an example.

Clinical case. A 13-year-old boy K., who was undergoing inpatient treatment in the surgical department of Zaporizhzhia Regional Children’s Clinical Hospital, was diagnosed with a large congenital hernia of the anterior part of the right diaphragmatic dome based on clinical complaints and results of laboratory and instrumental examinations. Following a comprehensive clinical and laboratory evaluation, the child underwent surgery, including right-sided anterolateral thoracotomy, plastic repair of the right diaphragmatic dome, removal of the congenital Morgagni–Larrey hernia with defect repair using a polypropylene anti-adhesive mesh (Peters Surgical, France), and pleural cavity drainage using the Bülau technique. Intraoperatively, a large congenital hernia of the anterior diaphragm (measuring 17 × 15 × 12 cm) and hypoplasia of the right diaphragmatic dome muscular part were identified. The hernial sac contents were adherent to the greater omentum. Postoperative diagnosis: congenital diaphragmatic defects, including hypoplasia of the right diaphragmatic dome and Morgagni–Larrey hernia. The postoperative period was uneventful with the wound healing by primary intention. Pleural cavity drainage was removed on day 3, and the patient was discharged home on day 10. Follow-up examinations at 6 months and 1 year revealed the patient remained asymptomatic with no complaints or functional impairments.

Conclusions. Morgagni–Larrey diaphragmatic hernia combined with hypoplasia of the right diaphragmatic dome remained asymptomatic in the patient for an extended period. The gradual increase in hernia size led to compression of the right lung and nonspecific clinical manifestations, including coughing attacks. The most effective diagnostic method, beyond chest radiography, was computed tomography. The transthoracic surgical approach was the most appropriate, enabling the elimination of the significant hernial process and plastic repair of the right diaphragmatic dome.

Diagnostic considerations for cat-scratch disease illustrated by clinical examples

2025-07-11T10:47:53+00:00

Cat-scratch disease (CSD) is one of the most common causes of chronic lymphadenopathy in children. The ratio of typical to atypical systemic forms of felinosis is 6 : 1. Human infection typically occurs as a result of a bite or scratch from cats, and less often from dogs and rodents. The main causative agent of CSD is Bartonella henselae.

Aim. To demonstrate the features of the disease course and the diagnostic challenges of cat-scratch disease by presenting two clinical cases in children.

Materials and methods. Two clinical examples of typical and atypical forms of cat scratch disease in children are presented. The presence of IgM to Bartonella henselae, confirmed the diagnosis of cat scratch disease.

Results. Typical and atypical clinical signs and stages of CSD differential diagnosis between diseases accompanied by similar symptoms, namely bacterial lymphadenitis, sepsis, lymphonodular form of toxoplasmosis, systemic inflammatory disease, have been demonstrated.

Conclusions. CSD should be considered a potential cause of isolated lymphadenitis in children. When a patient presents with a fever of unknown origin, unilateral lymphadenopathy, and inflammatory changes in complete blood count, the differential diagnosis should include not only oncohematological diseases, lymph node tuberculosis, systemic inflammatory diseases, but also CSD.

Successful carotid endarterectomy in a patient with factor XII deficiency (Hageman disease): a case report

2025-04-23T11:32:00+00:00

Aim. To present the first documented case of successful carotid endarterectomy in a patient with severe Factor XII deficiency and analyze the features of perioperative management.

Materials and methods. We report a case of a 70-year-old male with critical left internal carotid artery stenosis (90 %) and incidentally discovered severe Factor XII deficiency (activity 0.1 %, activated partial thromboplastin time (aPTT) 235.0 seconds) during preoperative screening. A comprehensive differential diagnosis of prolonged aPTT was performed, including measurement of intrinsic coagulation factor activities and immunological testing. Classical carotid endarterectomy under local anesthesia was performed using a standard perioperative thromboprophylaxis protocol.

Results. The surgery and postoperative period were uneventful with a blood loss of 150 ml. Standard thromboprophylaxis was administered using unfractionated heparin intraoperatively and low molecular weight heparin postoperatively. At 3-month follow-up, ultrasound confirmed satisfactory reconstruction with normal flow parameters.

Conclusions. Isolated factor XII deficiency is not a contraindication for carotid endarterectomy when proper preoperative diagnosis is established, and standard perioperative protocols are followed. A multidisciplinary approach involving a hematologist is essential for successful management of such patients.

Actual issues of medical and environmental aspects of climate change

2025-06-05T14:13:14+00:00

The aim is to analyze the primary directions of international policy addressing the impact of climate change on population health and to evaluate the feasibility of developing security mechanisms.

Materials and methods. This study employed a bibliographic, bibliosemantic, and analytical approach. Data were sourced from international databases, including the WHO, EU, PubMed, E-library, Research4Life, ResearchGate, Google Scholar.

Results. The health impacts of climate change are increasingly recognized globally. These effects vary across populations, influenced by factors such as geography, socioeconomic status, and cultural context. Increasing intensity, frequency, and duration of heat waves contribute to significant heat stress in living organisms. Epidemiological studies have shown a correlation between heat waves and elevated morbidity and mortality rates. Recent research highlights the mechanisms linking climate change and air pollution to immune system alterations, resulting in a rise in allergic diseases and asthma. Numerous studies address the challenges of food and water safety exacerbated by climate change. Evidence confirms the influence of climate change on cardiovascular pathology, neurological disorders, mental health, children’s morbidity, age-related vulnerability, and the spread of transmissible diseases. Climate change is having a significant impact on children’s respiratory health. These factors collectively increase the financial burden on healthcare systems.

Conclusions. The analysis and findings underscore the necessity of an integrated approach to evaluate the impact of climate change on health. Such an approach is essential for devising effective strategies to mitigate adverse effects and safeguard human life.

Impact of methylenetetrahydrofolate reductase gene polymorphism on cancer and thalassemia incidence

2025-04-23T11:35:10+00:00

The aim of this study is to assess the risk of cancer and thalassemia development in patients carrying methylenetetrahydrofolate reductase (MTHFR) gene polymorphism. The study emphasizes the role of folate deficiency in methionine metabolism, a process known to affect the immune system and coagulation, potentially influencing tumor development and complications associated with thalassemia.

Material and methods. This review article examines existing research on the association between MTHFR gene polymorphisms and their potential link to cancer and thalassemia. A comprehensive literature search was conducted using databases such as PubMed, Google Scholar, and other reputable scientific sources, with a focus on studies published since 2010. Only those studies that investigated the relationship between MTHFR polymorphisms, hypercoagulability, and immune function, and that provided sufficient statistical data, were included in the analysis.

Results. MTHFR gene polymorphism directly affects all processes related to methionine metabolism. Folate deficiency negatively impacts the synthesis of proteins involved in the anticoagulant system and the synthesis of genetic material for rapidly proliferating cells, leading to anemia, thrombocytopenia, and lymphocytosis. On one hand, a decrease in the activity of actively proliferating cells may seem beneficial in tumor treatment. However, the negative impact of folate deficiency on the immune system, particularly T-cells, creates favorable conditions for tumor escape and immune surveillance failure. The association between MTHFR gene polymorphism and complications related to a hypercoagulable state in patients with thalassemia remains controversial: some scientists report a statistically significant relationship, while others largely refute this claim.

Conclusions. MTHFR gene polymorphism may influence the risk of cancer and thalassemia through its effects on folate metabolism, immune function, and coagulation. Further studies are needed to clarify the relationship between MTHFR gene polymorphism, hypercoagulability, and immune system dysfunction in these conditions.

Varicocele: historical background, anatomical features, and prerequisites for development

2025-05-14T12:44:06+00:00

Varicocele, an abnormal enlargement of the pampiniform venous plexus in the scrotum. This paper provides an overview of important information on the historical aspects, anatomical structure of the testicular vascular system, and hemodynamic prerequisites for the development of varicocele.

The aim of this study is to analyze scientific papers focused on the anatomical and etiopathogenetic features of varicocele.

Materials and methods. This paper is a literature review (PubMed, Scopus, Embase) describing the history of varicocele investigation, anatomical features of the testicular venous system, and the hemodynamic prerequisites of the pathology.

Results. In elective pediatric surgery, varicocele is one of the most common pathologies among boys over the age of 10, with a prevalence of 14–20 %. However, the pathophysiology of varicocele and the optimal treatment approach remain subjects of ongoing debate. Nonetheless, all research on the origins and treatment of varicocele contributes to a growing knowledge base. The authors, relying on scientific studies, anatomical knowledge, and surgical experience, describe the historical background of the disease, the anatomical prerequisites, and the causes of varicocele development in children.

The paper highlights the anatomical features of testicular blood supply and the hemodynamic conditions for the development of varicocele, which partially elucidate the disease’s etiopathogenesis and serve as a step toward optimizing the choice of surgical treatment method.

Conclusions. Varicocele as a pathology has been known since ancient times, and approaches to its treatment have evolved over the centuries. Disruptions in the embryogenesis of the venous system, venous valve insufficiency, and arteriovenous conflicts are key factors in the development of varicocele. Understanding these anatomical features is crucial for selecting the appropriate surgical approach and improving treatment effectiveness.