Zaporozhye Medical Journal

Naegleria fowleri as an infectious agent of primary amebic meningoencephalitis: morpho-biological properties of the pathogen, pathophysiology of meningoencephalitis, and clinical-diagnostic features (a literature review)

M. M. Martsev — 2025-11-07

Aim. To provide a comprehensive analysis of the morphobiological characteristics of Naegleria fowleri and summarize current data on the epidemiology, clinical course, diagnostic approaches, and therapeutic strategies for primary amebic meningoencephalitis (PAM).

Materials and methods. The review is based on scientific publications indexed in Web of Science, PubMed, Scopus, and Google Scholar from 1993 to 2025 with a focus on the past decade. It includes in vitro, in vivo and ex vivo studies, clinical reports, and epidemiological data.

Results. Naegleria fowleri is a thermophilic, free-living amoeba responsible for fulminant primary amebic meningoencephalitis, with a case-fatality rate exceeding 97 %. The trophozoite stage is the primary invasive form, capable of entering the brain via the olfactory nerves. Pathogenic mechanisms involve adhesion to the nasal mucosa, phagocytosis of neural cells, and secretion of metalloproteinases, proteases, and pore-forming proteins, contributing to blood-brain barrier disruption. The amoeba is believed to express actin-associated and integrin-like proteins that facilitate tissue invasion. Diagnostic tools include CSF microscopy, conventional and real-time PCR, LAMP, culture on non-nutrient agar with E. coli, and immunostaining techniques. Imaging (CT/MRI) supports diagnosis in cases with elevated intracranial pressure. Clinical evidence supports the efficacy of combination therapy including amphotericin B, miltefosine, fluconazole, rifampin, and azithromycin. However, treatment is complicated by poor central nervous system drug penetration and drug toxicity. Advances in nanocarrier-based delivery systems may improve outcomes.

Conclusions. Naegleria fowleri is a highly neuroinvasive facultative parasite with limited treatment options and poor prognosis. Early detection combined with aggressive, multi-drug therapy significantly improves survival. Future research should focus on novel diagnostic markers, therapeutic targets, drug delivery methods, and preventive strategies.

Antimicrobial resistance and genomic epidemiology of bacterial war-wound infections: Ukraine, 2014–2023

V. P. Kovalchuk — 2025-11-07

The aim of the study was to identify the dominant clonal lineages of pathogens causing combat wounds and to determine their antimicrobial resistance determinants for the purpose of optimizing antimicrobial drug administration in wartime.

Materials and methods. Microbiological monitoring of combat wound contents was carried out in patients of three medical hospitals in the central region of Ukraine during 2014–2023. Molecular genetic studies involving whole genome sequencing (WGS) of isolated cultures using Next-Generation Sequencing (NGS), followed by multilocus genotyping of genome sequences and gene identification, were performed at the Walter Reed Army Institute of Research (USA). Antibiotic sensitivity was determined using the disc diffusion method in accordance with the EUCAST recommendations.

Results. The results of bacteriological studies of combat wounds of the limbs and soft tissues of the torso during 2022 and 2023 have shown that A. baumannii (35.7 %), K. pneumoniae (20.7 %), and P. aeruginosa (14.9 %) were the most common organisms cultured. For A. baumannii, 95.6 % of isolates were multidrug-resistant (MDR), and 41.1 % were classified as extensively drug-resistant (XDR). Genome sequencing identified several high-risk international clones, including ST2, ST78 and ST1077, which carried the carbapenemase genes bla_OXA-23, bla_OXA-72and the 16S methyltransferase gene armA. Among the various strains of P. aeruginosa, isolates of globally distributed clonal lines ST235, ST357, ST773, and ST1047 have been identified.

The K. pneumoniae isolates belonged to five distinct clonal groups: ST395, ST307, ST147, ST39, and ST23. Most of these isolates carried carbapenemases and were classified as MDR and XDR.

Conclusions. This study analyzed bacterial pathogens from combat wounds in Ukraine (2014–2023), revealing a dominance of MDR/XDR Gram-negative organisms, primarily Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. Whole-genome sequencing identified the emergence of high-risk international clones (e. g. A. baumannii ST2, ST78, ST1077; P. aeruginosa ST235, ST357, ST773, ST1047; K. pneumoniae ST147, ST307, ST395), many carrying bla_OXA, bla_NDM, 16S rRNA methyltransferases and, in K. pneumoniae, hypervirulence markers. The findings underscore the close association between armed conflict and the amplification of antimicrobial resistance, driven by high antibiotic consumption, complex evacuation pathways, and nosocomial transmission in overstretched healthcare systems.

Microbiological profile and antimicrobial resistance of mine-blast wounds in Ukraine: a single-center study

H. V. Filonenko — 2025-11-07

Infections resulting from combat wounds pose a significant challenge to modern medicine. Their unique polymicrobial nature, combined with massive tissue damage and the presence of foreign bodies, creates a favorable environment for the development of multidrug-resistant pathogens. The increasingly high level of antimicrobial resistance in the context of combat operations in Ukraine underscores the critical need for continuous epidemiological surveillance and adaptation of clinical protocols.

The aim of this study was to determine the species composition and antimicrobial resistance profile of causative agents of suppurative-inflammatory soft tissue diseases in patients with blast-related trauma who were treated at a tertiary medical facility.

Materials and methods. A prospective, single-center, observational study was conducted from January to May 2025 at the Kyiv Regional Clinical Hospital. A total of 276 wound samples were analyzed. The identification of microorganisms and testing of antibiotic sensitivity were performed according to the EUCAST methods and interpretation.

Results. Of the 276 samples, 86.6 % were positive. A total of 171 clinical strains were isolated, of which 58.5 % were Gram-negative and 38.2 % were Gram-positive microorganisms, and 2.3 % were fungi. The dominant etiological agent was Acinetobacter baumannii (21.6 %), followed by Klebsiella pneumoniae (13.5 %) and Proteus mirabilis (7.0 %). In A. baumannii, extremely high levels of resistance to carbapenems (imipenem – 83.8 %, meropenem – 73.0 %) and fluoroquinolones (94.6 %) were observed, while high sensitivity to colistin (100.0 %) and tobramycin (73.0 %) was maintained.

Conclusions. The local results obtained confirm the nationwide trend of the dominance of multidrug-resistant Gram-negative pathogens in combat wound infections. The detected high level of resistance to broad-spectrum drugs indicates a critical need for the optimization of empirical antibiotic therapy and the strengthening of infection prevention and control measures.

Efficacy of bacteriophages against Pseudomonas aeruginosa with diverse antibiotic resistance profiles

V. A. Poniatovskyi — 2025-11-07

With the rising prevalence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) strains of Pseudomonas aeruginosa, the development of alternative therapeutic approaches has become increasingly important. Among these, the use of bacteriophages represents a particularly promising strategy for the treatment of infections caused by multidrug-resistant pathogens.

The aim of this study was to isolate and characterize bacteriophages lytically active against P. aeruginosa, to determine their activity spectrum against clinical isolates, and to assess the potential of combining bacteriophages with antibiotics.

Materials and methods. The lytic activity of bacteriophages was tested against 23 clinical isolates of P. aeruginosa obtained from pediatric bloodstream infections, including strains carrying antibiotic resistance genes bla_NDM-1, bla_IMP, bla_VIM, and bla_TEM. Antimicrobial susceptibility of bacterial isolates was determined using the disk diffusion method according to EUCAST recommendations. Bacteriophages were isolated from wastewater samples collected in Kyiv. Lytic activity was evaluated by the Spot test and a modified agar overlay assay. Morphological characteristics were examined using transmission electron microscopy. Bacteriophage-antibiotic interactions were assessed by a modified disk diffusion method.

Results. Between 2021 and 2024, a total of 62 bacteriophages were isolated from wastewater, belonging to the Myoviridae-like, Siphoviridae-like, and Podoviridae-like morphotypes. Their lytic spectra varied considerably, ranging from narrow specificity (2–4 strains) to the ability to lyse more than 20 clinical bacterial isolates. Overall, 29.0 % of bacteriophages showed activity against multiple strains, and some isolates exhibited a broad host range, with specific lysis observed in up to 91.3 % of tested strains. Combination testing revealed a predominantly synergistic interaction between bacteriophages and β-lactam antibiotics, manifested by an increase in both plaque size and number.

Conclusions. The isolated bacteriophages demonstrated substantial variability in lytic activity and have potential applications in the treatment of infections caused by multidrug-resistant P. aeruginosa strains. The findings support the feasibility of establishing bacteriophage collections and applying combined bacteriophage-antibiotic therapies. Considering the current epidemiological situation in Ukraine, these results are of practical importance for the development of new antimicrobial strategies.

Erosion-related bleeding in combat-related extremity vascular trauma

Iu. Iu. Sivash — 2025-11-07

Combat-related extremity vascular injuries are among the most challenging in military surgery. These injuries are frequently associated with extensive soft-tissue loss and high levels of initial wound contaminations, which significantly increase the risk of erosion-related bleeding and limb loss. Erosion-related bleeding is one of the most dangerous complications following reconstructive procedures on major vessels; it directly affects limb preservation and patient survival, thus necessitating timely prevention and effective surgical control.

The aim of the study was to determine the incidence, risk factors, and features of surgical treatment of erosive bleeding in wounded patients with injuries to major limb vessels, and to assess the role of vacuum therapy in the prevention and management of this complication.

Materials and methods. A retrospective study was conducted on 85 military personnel with combat-related extremity vascular injuries treated at a Role IV military medical facility in Kyiv in 2022. Negative pressure wound therapy (NPWT) was applied in all cases as part of a comprehensive staged surgical treatment protocol. The variables analyzed included the incidence of erosion-related bleeding, its association with infectious complications, timing of hemorrhage onset, microbiological culture results, methods of surgical control, limb salvage, and mortality outcomes.

Results. Erosion-related bleeding occurred in 9 patients (13 %) with recurrent episodes (up to three events) in three cases. The complication was most frequently associated with a localized wound infection (n = 4) and sepsis (n = 3). The median time to onset of erosion-related bleeding was 18 days (range 6–29 days). Primary wound contamination was present in 57 % of patients. During the first week, Gram-positive organisms predominated (74 %), while by the third week, Gram-negative pathogens became dominant, primarily Acinetobacter baumannii (53 %) and Pseudomonas aeruginosa (15 %). Hemorrhage control techniques included autogenous vein grafts (n = 4), allograft replacements (n = 2), vessel ligations (n = 2), and vessel wall repair (n = 1). A secondary amputation was required in one patient, and no deaths were recorded. NPWT was used both before and after bleeding episodes to optimize wound conditions and prepare for definitive soft-tissue coverage.

Conclusions. Erosion-related bleeding remains a significant challenge in the management of combat-related extremity vascular injuries, especially in the presence of severe infection and sepsis. Key preventive measures include protecting vascular repairs from mechanical trauma and desiccation, early and appropriate use of NPWT, and timely definitive soft-tissue coverage.

Diagnostic and therapeutic tactics for patients with acute limb ischemia due to prolonged tourniquet application: a retrospective analysis and clinical outcomes

M. L. Golovakha — 2025-11-07

Patients with prolonged tourniquet application represent an understudied problem. The lack of clear national or international standards for care complicates the regulation of treatment tactics.

The aim of this study was to develop and evaluate an algorithm for the care of patients with acute lower limb ischemia caused by prolonged (>2 hours) tourniquet application.

Materials and methods. A retrospective analysis of 142 patients (mean age 36.71 ± 0.82 years) with isolated lower limb trauma and a tourniquet applied to the thigh for >2 hours was conducted at Communal Non-Profit Enterprise “Zaporizhzhia Regional Clinical Hospital” of Zaporizhzhia Regional Council from 2023 to July 2025. Patients were divided into two groups: a control group (2023, n = 64), who received unsystematic care, and a main group (from May 2024, n = 78), who were treated using the algorithm. These were further stratified into subgroups: A (2–4 hours), B (4–6 hours), and C (>6 hours). The algorithm was structured as follows: tourniquet removal at <2 hours; tourniquet removal after fasciotomy therapy at 2–4 hours; fasciotomy without relaxation, followed by muscle assessment (turgor, color, contractility, electrocoagulation), at >4 hours without contractures; amputation in cases of contractures. The analysis included a comparison of laboratory parameters (potassium, pH, and lactate) upon admission and 24–48 hours later, as well as amputation rates.

Results. Laboratory parameters upon admission did not correlate with ischemia time (p > 0.05). In subgroup B, the algorithm reduced the increase in potassium (0.20 mmol/L vs. 0.67 mmol/L, p = 0.02) and decreased the rate of delayed amputations (6.25 % vs. 44.4 %). The overall frequency of amputations was similar (50.00 % vs. 61.11 %), but the rate of primary amputations increased (43.8 % vs. 16.7 %), which led to a reduction in reperfusion complications.

Conclusions. The algorithm is effective in protracted conflicts with evacuation delays, allowing for the intraoperative assessment of muscles and avoiding unjustified reperfusion. It reduces delayed amputations and complications without increasing the overall frequency of amputations, highlighting the limitations of laboratory markers. The algorithm could form the basis of national guidelines but requires multicenter prospective validation.

Laparoscopy for combat-related abdominal trauma: a single center experience during the Ukrainian War of Independence

I. A. Lurin — 2025-11-07

Aim. To evaluate the feasibility, indications, and outcomes of laparoscopic surgery in hemodynamically stable combat casualties with abdominal trauma during the Ukrainian War of Independence.

Material and methods. A retrospective observational study included 238 hemodynamically stable patients with combat-related abdominal trauma treated at the Zaporizhzhia Military Hospital between 2022 and 2025. Medical records, operative protocols, imaging examinations (e-FAST, computed tomography), and intraoperative documentation were analyzed.

Results. Laparoscopic procedures performed included diagnostic laparoscopy (n = 78), foreign body removal (n = 60), hemostasis (n = 23), diaphragmatic repair (n = 19), hollow viscus suturing (n = 15), splenectomy (n = 5), and colectomy / colostomy (n = 12). Conversion to laparotomy was required in 28 cases (11.8 %), while secondary laparotomy was needed in 5 patients due to missed bowel injuries, intra-abdominal abscess, ileus, or bleeding. The best outcomes were achieved in American Association for the Surgery of Trauma (AAST) grade I–II injuries. Advanced bowel resections were technically complex requiring further validation for routine use. Barbed suture-based closure improved safety and efficiency in diaphragmatic and hollow viscus repair.

Conclusions. Laparoscopy appears to be a safe and effective option for selected hemodynamically stable patients with abdominal combat trauma. It reduces rates of unnecessary laparotomies, postoperative complications, and recovery time, facilitating faster return of soldiers to duty. Complex bowel resections require further validation before routine implementation in military trauma surgery.

Experience in the comprehensive management of gunshot shrapnel wounds of soft tissues at various locations

S. M. Zavhorodnii — 2025-11-07

Aim. To develop a comprehensive strategy for the treatment of isolated gunshot shrapnel wounds of soft tissues at various locations.

Materials and methods. This study analyzed outcomes in 5,000 patients of working age (18–49 years) treated for isolated gunshot and shrapnel soft-tissue wounds at hospitals in Zaporizhzhia and the Zaporizhzhia Military Hospital between March 2022 and June 2025. The injuries were predominantly localized in the lower extremities (67.06 %), less frequently in the upper extremities (25.14 %) and trunk (7.78 %). Different treatment approaches were applied: platelet-rich plasma (PRP) in combination with delayed primary sutures (DPS) or early secondary closure (ESC), modified autodermoplasty, and local or free flap reconstructions.

Results. PRP combined with suturing was applied in 3851 cases (77.02 %): DPC in 2394 (47.88 %) and ESC in 1457 (29.14 %). The complication rates were 7.81 % with DPC and 8.86 % with ESC, while the average hospital stay was 16.0 ± 3.1 and 22.0 ± 2.2 days, respectively. In 1149 cases (22.98 %), plastic techniques were required: modified autodermoplasty in 953 (19.06 %) and flap reconstructions in 196 (3.92 %). These methods enabled the closure of extensive defects but were associated with higher complication rates (25.6–67.9 %) and longer hospital stays (23.0–36.8 days).

Conclusions. The use of PRP in combination with delayed primary or early secondary closure is the most effective and safe treatment strategy for small, isolated gunshot shrapnel wounds of soft tissues, ensuring low complication rates and faster functional recovery. Autodermoplasty and flap techniques remain the methods of choice for large and deep defects but require advanced surgical expertise and are associated with longer rehabilitation.

Application of the frozen elephant trunk technique in surgical correction for complex pathology of the ascending aorta, aortic arch, and descending thoracic aorta

V. I. Kravchenko — 2025-11-07

Aim: to summarize the current experience in correcting complex pathology of the ascending aorta, aortic arch, and descending thoracic aorta using the frozen elephant trunk technique.

Materials and methods. This study describes the technique and presents the outcomes of the first 42 operations involving prosthetic replacement of the ascending aorta, aortic arch, supra-aortic vessels, and descending thoracic aorta using the frozen elephant trunk technique. These procedures were performed by the staff of the Department of Surgical Treatment of Aortic Pathology at National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine, during the period from 2020 to 2025. All patients underwent a procedure involving complete replacement of the ascending aorta and arch with supra-aortic vessel reimplantation aorta using the stabilized elephant trunk technique as the first stage of reconstruction for aortic arch pathology.

Results. Hospital mortality rate was 9.5 % (4 patients). Causes of death included acute cerebrovascular accident in 1 case, acute respiratory failure in 1 case, and multiple organ failure in 2 cases. Two patients required delayed re-exploration for tamponade on postoperative days 2–3 due to bleeding. Persistent lower paraplegia was observed in 3 patients; however, in 2 cases, intensive rehabilitation enabled full recovery of motor function. Renal failure requiring dialysis was observed in 5 patients. One patient underwent re-thoracotomy for postoperative bleeding. Prolonged mechanical ventilation (>2 days) was necessary in 6 patients. Following the first-stage procedure, endovascular repair (TEVAR) of the aortic arch and descending thoracic aorta was performed in 3 (7.1 %) patients within a period ranging from 14 days to 3 years after the initial operation to stabilize the descending thoracic aorta and promote true lumen remodeling following dissection. All endovascular procedures were completed without complications.

Conclusions. Radical surgical correction of aortic arch aneurysm or dissection involving supra-aortic vessels or disruption of the anatomical integrity of the arch is feasible using the stabilized elephant trunk technique. Advances in preoperative diagnostics, surgical techniques, optimization of cerebral, spinal, and visceral organ protection, and the availability of hybrid / endovascular approaches have enabled successful treatment of complex pathology involving the ascending aorta, arch, and descending thoracic aorta. The initial outcomes were satisfactory, with a hospital mortality rate of 9.5 % (4 out of 42).

Open surgical repair of abdominal aortic aneurysms and dissecting aneurysms in patients with coronary artery disease: a single-center experience

I. I. Zhekov — 2025-11-07

Aim. To summarize the experience of pre- and postoperative management of patients with abdominal aortic aneurysms or dissections associated with coronary artery disease (CAD), and to evaluate the effectiveness of open surgical repair combined with myocardial revascularization based on a single specialized center’s clinical experience.

Materials and methods. The study included 75 patients (100.0 %) with infrarenal abdominal aortic aneurysms. Patients were initially divided into subgroup A (non-dissecting aneurysm) and subgroup B (dissecting aneurysm). All patients were then further stratified into three groups: Group 1 (comparison group) included patients without a diagnosed CAD; Group 2 consisted of patients with CAD who had previously undergone stenting or coronary artery bypass grafting (CABG) / off-pump coronary artery bypass (OPCAB); and Group 3 comprised patients with CAD who, during the same hospitalization, underwent surgical correction of both CAD and abdominal aortic aneurysm.

Results. Most patients who underwent myocardial revascularization (Groups 2 and 3) had multivessel coronary artery disease (MVCAD), confirmed by coronary ventriculography (CVG). Triple-vessel disease was observed in 78.9 % of patients, double-vessel disease in 15.8 %, and significant left main coronary artery stenosis (≥70 %) in 5.3 %. Patients who underwent CABG / OPCAB had an average ICU stay of 59.89 ± 20.20 hours, with a mean mechanical ventilation (MV) duration of 5.00 ± 2.40 hours. In the same group, after abdominal aortic aneurysm correction, the average ICU stay was 78.92 ± 53.93 hours, and the mean MV duration was 7.58 ± 6.71 hours. The overall complication rate was the highest in Group 1 (37.84 %), where the most extensive reconstructive procedures were performed. The highest postoperative in-hospital mortality was also observed in Group 1 in 4 (10.81 %) cases.

Conclusions. Myocardial revascularization should take priority over aortic reconstruction. This approach minimizes the risk of ischemic complications and allows for a safe transition to the next stage of treatment. A comparative analysis of the three clinical groups showed the worst outcomes in patients without prior revascularization, statistically confirming the effectiveness of a comprehensive treatment strategy (p < 0.05).

Assessment of the regenerative capacity of the remnant liver lobe in livng-related donors after right hemihepatectomy

I. O. Kotenko — 2025-11-07

Donor right hepatectomy is the standard method of graft procurement in living-related donors. Donor safety depends on adequate regeneration of the remnant liver. Studying the patterns of parenchymal regeneration and functional liver reserve in this category of patients has important clinical significance.

Aim. To evaluate the regenerative capacity of the remnant liver in living-related donors after right hepatectomy.

Materials and methods. A prospective study was conducted including 50 living liver donors who underwent right hepatectomy. Liver volumes were assessed using CT volumetry preoperatively and on postoperative days 14 and 90. The study was conducted in accordance with the principles of the Declaration of Helsinki. The protocol was approved by the institutional bioethics committee, and informed consent was obtained from all participants

Results. The mean remnant liver volume was 448.7 ± 93.9 ml preoperatively, 833.0 ± 176.1 ml on day 14, and 943.2 ± 160.3 ml on day 90. A statistically significant increase was observed on both day 14 and day 90 (p < 0.001). The increase relative to baseline was +85.6 % at day 14 and +110.2 % at day 90.

Conclusions. The liver of living donors demonstrates a high regenerative potential after right hepatectomy, with restoration of adequate parenchymal volume within the first three months postoperatively.