Zaporozhye Medical Journal

Prevalence of newly diagnosed heart failure with preserved left ventricular ejection fraction in patients with arterial hypertension and type 2 diabetes mellitus according to different diagnostic algorithms

M. Yu. Kolesnyk — 2026-04-23

Chronic heart failure (CHF) is a common syndrome, in which heart failure with preserved left ventricular ejection fraction (HFpEF) predominates. The diagnosis of this particular phenotype of СHF currently remains challenging in medicine. Over the past ten years, scientific societies have developed and implemented modern diagnostic algorithms.

Aim. To assess the prevalence of HFpEF among patients with concurrent arterial hypertension and type 2 diabetes mellitus (T2DM) using various diagnostic algorithms.

Materials and methods. A study examined 90 individuals (mean age 61.61 ± 7.94 years) with arterial hypertension and T2DM who presented with dyspnea on moderate-intensity physical exertion and fatigue between 2022–2025. All participants underwent clinical and laboratory assessments, including NT-proBNP levels, 24-hour blood pressure monitoring, standard transthoracic and speckle-tracking echocardiography, as well as a diastolic stress test. HFpEF was evaluated using the European Society of Cardiology algorithm (ESC 2021), the H₂FPEF score (2018), the HFA-PEFF algorithm (2019), the European Association of Cardiovascular Imaging (EACVI, 2021) consensus-based score, and the American Society of Echocardiography guidelines (2025).

Results. The proportion of confirmed HFpEF diagnoses varied significantly across the scales, ranging from 8.9 % to 77.8 %. Disproved diagnoses ranged from 2.2 % to 86.7 %. A high proportion of indeterminate results was observed in specific scales, reaching up to 86.7 % and peaking at 100 % using the H₂FPEF score.

Conclusions. The estimated prevalence of HFpEF is highly dependent on the applied diagnostic algorithm. Evaluation of NT-proBNP levels significantly enhances diagnostic accuracy to identify HFpEF. In a cohort of patients with comorbid arterial hypertension and T2DM, the H₂FPEF and HFA-PEFF algorithms demonstrate limited diagnostic certainty, yielding a high percentage of indeterminate results.

Influence of smoking on cardiac structural and functional remodeling patterns in unstable angina and post-COVID-19 patients

Kh. M. Khamuliak — 2026-04-23

Aim. To assess the structural and functional myocardial characteristics in patients with unstable angina (UA) and post-COVID-19 syndrome (PACS), stratified by smoking status.

Materials and methods. The study included 147 patients with UA aged 35–76 years. Participants were divided into a PACS cohort (Group I, n = 88) and a non-PACS cohort (Group II, n = 59). Each group was further subdivided into smokers (subgroups IA and IIA) and non-smokers (subgroups IB and IIB). All patients underwent transthoracic echocardiography to evaluate standard structural and functional cardiac parameters. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were also quantified. Statistical analysis was performed using parametric and non-parametric tests, correlation analysis, and regression modeling.

Results. Patients with PACS demonstrated more pronounced cardiac remodeling compared to the non-PACS group, indicated by a lower left ventricular ejection fraction (LVEF) (50.48 ± 9.11 % (I) vs 53.15 ± 9.14 % (II), p < 0.05) and larger left atrial (LA) dimensions (4.09 ± 0.42 cm (I) vs 3.93 ± 0.48 cm (II), p < 0.05). The most unfavorable changes were observed in smokers with PACS, who exhibited the lowest LVEF values, higher left ventricular mass index, and elevated NT-proBNP levels. NT-proBNP concentration was significantly higher in the PACS group compared to patients without PACS (621.8 (370.0; 1500.0) ng/mL (I) vs 254.9 (92.0; 394.0) ng/mL (II), p < 0.005). Pathological patterns of left ventricular geometry, particularly eccentric hypertrophy, were more common among PACS patients, especially in smokers. Statistically significant correlations were found between smoking intensity, NT-proBNP levels, myocardial remodeling parameters, and hematological inflammatory markers. Linear regression analysis revealed a significant positive correlation between smoking intensity and elevated NT-proBNP levels.

Conclusions. Post-COVID-19 syndrome in patients with unstable angina is associated with moderate but significant cardiac structural and functional deterioration. Smoking substantially aggravates these changes, as evidenced by markedly elevated NT-proBNP levels and more pronounced echocardiographic signs of pathological myocardial remodeling.

Phenotypes of early postoperative complications and dynamics of laboratory markers in infants after congenital heart defect correction

M. H. Melnychenko — 2026-04-23

The early postoperative period in infants following the correction of congenital heart defects is often accompanied by hemodynamic lability, systemic stress, and an acute-phase response, which may lead to transient organ dysfunction, particularly renal impairment.

Aim. To determine the phenotypes of early postoperative complications and the pattern of laboratory responses in infants after cardiac surgery.

Material and methods. A retrospective analysis of 101 infants aged 1 to 12 months who underwent cardiac surgery was performed. Postoperative complications were categorized using a syndromic (phenotypic) approach. Laboratory parameters before and after surgery were compared using a paired t-test; differences were considered statistically significant at p < 0.05.

Results. The profile of early postoperative complications was predominantly characterized by the cardiohemodynamic phenotype (94.06 %). A pulmonary vascular component was observed in 8.91 % of the patients and acted as a clinically significant modifier of the disease course. Conduction disturbances requiring pacing occurred in 2.97 %, and pericardial complications in 0.99 %. Laboratory dynamics corresponded to a triad of systemic changes: anemia / hemodilution (decreased hemoglobin and red blood cell count), a stress and acute-phase response (neutrophilia, lymphopenia, elevated erythrocyte sedimentation rate, and increased C-reactive protein), and renal stress (elevated creatinine with a trend toward increased urea). These pre- and postoperative differences were predominantly statistically significant (p < 0.05).

Conclusions. The leading early postoperative phenotype in infants after congenital heart defect correction is cardiohemodynamic instability (ICD I50.*; 94.06 %), which, in a subset of patients, co-occurs with a pulmonary vascular component (ICD I27.*; 8.91 %) and a laboratory triad of systemic responses (anemia / hemodilution, acute-phase reaction, and signs of renal stress). These findings support the prioritization of hemodynamic and perfusion control, alongside context-based monitoring of inflammatory markers and renal function, during the first 24–48 hours after surgery.

Clinical course of community-acquired pneumonia of coronavirus etiology in patients with metabolic dysfunction-associated steatotic liver disease

O. S. Khukhlina — 2026-04-23

Aim. To determine the clinical features of moderate community-acquired pneumonia (CAP) associated with COVID-19 in patients without comorbidities compared to those with comorbid metabolic dysfunction-associated steatotic liver disease (MASLD).

Material and methods. A retrospective analysis was performed including 200 hospitalized patients with moderate CAP associated with SARS-CoV-2. Two groups (n = 100 each) were defined: Group 1 included patients with CAP without liver comorbidity and with normal body weight; Group 2 comprised patients with CAP and comorbid MASLD associated with being overweight or having class I–II obesity.

Results. Patients in Group 2 demonstrated a significantly higher prevalence of intense chest pain (1.7-fold), fever (1.7-fold), anosmia (2.3-fold), sore throat with odynophagia (2.0-fold), and progressive inspiratory dyspnea (1.7-fold) compared to Group 1 (p < 0.05). Systemic and gastrointestinal symptoms were also more frequent in Group 2, including myalgia (4.2-fold), asthenia and headache (both 1.6-fold), syncope (2.5-fold), nausea (2.3-fold), and diarrhea (3.9-fold) (p < 0.05). Hyperthermia >38.5 °C (1.6-fold), tachycardia >90/min (2.0-fold), tachypnea >25/min (2.2-fold), and oxygen saturation (SpO₂) of 90–92 % (1.8-fold) were significantly more common in the comorbid group (p < 0.05). Laboratory findings in Group 2 revealed a higher incidence of leukopenia (52.0 % vs. 39.0 %), lymphopenia (77.0 % vs. 37.0 %, p < 0.05), and thrombocytopenia (61.0 % vs. 29.0 %, p < 0.05), alongside pronounced hyperfibrinogenemia and hyperferritinemia. Radiologically, Group 2 patients predominantly exhibited bilateral lung involvement (67.0 % vs. 38.0 %, p < 0.05), consolidation, ground-glass opacities, fibrotic changes, and pleuritis. Co-infections and superinfections were significantly more frequent in Group 2 (45.0 % vs. 18.0 %), with S. pneumoniae (27.0 %), K. pneumoniae (17.0 %), S. aureus (18.0 %), Aspergillus spp. (10.0 %), and Candida spp. (6.0 %) identified as the primary pathogens.

Conclusions. The presence of MASLD is associated with a more severe clinical course of COVID-19-related CAP. Patients with MASLD exhibit more pronounced respiratory and systemic manifestations, significant immune disturbances, higher rates of secondary co-infections, and more extensive bilateral radiological lung involvement (p < 0.05).

Association between leptin, lipid metabolism, and bone remodeling markers in men with type 2 diabetes mellitus

Sain Safarova — 2026-04-23

Type 2 diabetes mellitus (T2DM) is associated with disturbances in bone metabolism that may increase fracture risk, even in the presence of normal or high bone mineral density (BMD). Dyslipidemia and elevated leptin levels, both common in T2DM, considered potential contributors to impaired bone remodeling, particularly in men, where skeletal responses to metabolic disturbances remain insufficiently understood.

Aim. To evaluate associations between serum leptin levels, lipid metabolism parameters, and markers of bone turnover in men with T2DM.

Materials and methods. A cross-sectional study included 62 men with T2DM (aged 50–65 years) and 58 age-matched non-diabetic controls. Laboratory assessments included HbA1c, insulin, leptin, testosterone, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, lipid profile, and bone turnover markers (P1NP, β-CTX). BMD at the lumbar spine and proximal femur was measured by dual X-ray absorptiometry (DXA). Insulin resistance was evaluated using HOMA-IR. Correlations were analyzed using Spearman’s rank test.

Results. Men with T2DM had higher BMI (29.8 kg/m² vs. 26.7 kg/m², p = 0.006), elevated leptin (15.2 ng/mL vs. 11.2 ng/mL, p = 0.003), dyslipidemia (increased triglycerides and LDL-C, decreased HDL-C), and lower 25(OH)D levels (16.8 ng/mL vs. 21.6 ng/mL, p = 0.007) compared to controls. Bone formation marker P1NP was significantly reduced (35.4 ng/mL vs. 43.9 ng/mL, p = 0.009), while resorption marker β-CTX was increased (0.44 ng/mL vs. 0.37 ng/mL, p = 0.042) in T2DM group. BMD was significantly lower at the lumbar spine and total hip (p < 0.05). Leptin levels were correlated positively with BMI and HOMA-IR, while triglycerides were negatively correlated with P1NP (r = -0.218, p = 0.023).

Conclusions. This study demonstrates that men with T2DM exhibited significant associations between dyslipidemia, hyperleptinemia, and altered bone metabolism. These metabolic abnormalities were linked to reduced bone mineral density, most notably at the lumbar spine and proximal femur. The results suggest that lipid and hormonal imbalances may contribute to poor bone health in T2DM, highlighting the need for careful skeletal assessment and targeted preventive approaches in this group.

Immunohistochemical characterization of the proliferative activity in epithelial and stromal cells of distal colonic polyps

A. V. Husarova — 2026-04-23

Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide. Colonic polyps are known to be potential precursors to CRC. Evaluating cellular proliferative activity across various polyp types and normal mucosa is essential for understanding the early stages of colorectal carcinogenesis. Ki-67 expression serves as a reliable biomarker of proliferative activity.

Aim. To investigate Ki-67 expression patterns in the epithelial and stromal cells of tubular adenomas and hyperplastic polyps of the distal colon.

Materials and methods. Pathohistological and immunohistochemical (IHC) analyses were performed on biopsy specimens from 139 patients (age range: 22–81 years). The cohort included 68 patients with tubular adenomas of the distal colon, 56 with hyperplastic polyps, and 15 controls (age range: 22–72 years) with normal distal colonic mucosa.

Results. Distal colonic polyps were characterized by moderate epithelial cell proliferation (Me = 61.38 % (49.28; 70.38) for tubular adenomas; Me = 35.26 % (4.37; 45.23) for hyperplastic polyps) and low level of stromal cell proliferation (Me = 10.51 % (1.08; 15.57) for tubular adenomas; Me = 2.84 % (0.70; 5.45) for hyperplastic polyps). Direct correlations were observed between the degree of dysplasia and Ki-67 expression levels in both epithelial (γ = 0.79) and stromal cells (γ = 0.61). The spatial distribution of Ki-67-positive cells demonstrated distinct patterns: in normal mucosa and hyperplastic polyps, proliferation was primarily confined to the lower and middle thirds of the crypts. In contrast, tubular adenomas with low-grade dysplasia exhibited an even distribution, while those with high-grade dysplasia showed a predominant localization in the upper and middle thirds of the crypts.

Conclusions. The findings indicate that evaluating Ki-67 expression in both the epithelial and stromal compartments of distal colonic polyps is a valuable tool for assessing malignancy risk. This marker may serve as a supplementary pathohistological criterion for the evaluation of precancerous lesions.

Clinical effectiveness of a topical IL-1 receptor antagonist (IL-1ra) in the comprehensive treatment of chronic generalized periodontitis

O. O. Dmytriieva — 2026-04-23

Chronic generalized periodontitis (CGP) is a widespread inflammatory and destructive disease of periodontal tissues that leads to progressive destruction of supporting structures of the teeth and tooth loss. One of the key mediators of the inflammatory response in periodontal tissues is interleukin-1 (IL-1), which plays a significant role in the activation of osteoclastic bone resorption and progression of periodontal inflammation.

Aim. To evaluate the efficacy of anakinra (IL-1ra) as part of complex therapy for moderate chronic generalized periodontitis in comparison with standard treatment and therapy using choline salicylate.

Materials and methods. The study included 87 patients with moderate chronic generalized periodontitis. Patients were divided into three groups: group I – standard periodontal therapy (n = 34); group II – standard therapy combined with a drug, Anakinra (a recombinant human IL-1ra; n = 31); group III – standard therapy combined with choline salicylate gel (n = 22). The following clinical parameters were evaluated: probing pocket depth (PPD), papillary bleeding index (PBI), hygiene index (HI), Ramfjord index, Miller tooth mobility index, PMA index, and Fuchs index. Examinations were performed before treatment and after 30 and 90 days. Radiological assessment of periodontal bone structures was performed using cone-beam computed tomography (CBCT).

Results. All treatment groups demonstrated statistically significant improvement in periodontal clinical indices after therapy. The most pronounced changes were observed in group II with the use of IL-1ra. After 90 days of treatment, PPD decreased from 3.89 ± 0.11 mm to 1.99 ± 0.03 mm, PBI by 30.1 %, HI by 53.5 %, Miller mobility index by 61.5 %, and PMA index by 57.4 %. CBCT analysis demonstrated stabilization of alveolar bone parameters in patients receiving the IL-1 receptor antagonist.

Conclusions. The addition of an IL-1 receptor antagonist to the comprehensive treatment of chronic generalized periodontitis is associated with greater improvements in clinical and radiological outcomes compared with standard therapy and the use of choline salicylate.

Vestibular dysfunction in patients with sensorineural hearing loss following acoustic barotrauma

O. Ye. Dubenko — 2026-04-23

The ongoing war in Ukraine has led to an increased incidence of sensorineural hearing loss (SNHL) resulting from acoustic trauma caused by firearms or explosions among both military personnel and civilians. This type of trauma is a significant contributing factor to the rising disability rates associated with impaired auditory and vestibular functions.

Aim. To determine the frequency and characteristics of vestibular dysfunction in patients with SNHL resulting from acoustic trauma.

Materials and methods. A total of 52 patients with SNHL due to acoustic trauma were examined, including 32 with acute and 20 with chronic forms of the condition. The study protocol comprised neurological, somatic, and otoneurological examinations, as well as audiological evaluation (pure-tone audiometry), brain neuroimaging, and stabilometry.

Results. Patient complaints included hearing loss, tinnitus, dizziness, headache, general fatigue, gait instability, ear fullness, and nausea. A correlation analysis between hearing thresholds and stabilometric indicators revealed a positive correlation with the Romberg coefficient for oscillation trajectory length at high frequencies (R = 0.407, p = 0.022921) and with the Romberg coefficient for sagittal oscillation amplitude at medium frequencies (R = 0.493, p = 0.004874). In patients with chronic SNHL, the integral hearing threshold (averaged across all frequencies) significantly correlated with maximum oscillation amplitudes in the frontal (R = 0.622, p = 0.004452) and sagittal planes (R = 0.572, p = 0.010530) under eyes-open conditions. Three key phenomena were identified in this group: the dominance of frontal instability, the role of the speech frequency range as a marker of decompensation, and the formation of a stable pathological pattern of lateralized instability.

Conclusions. In patients with acoustic trauma-induced SNHL, there is a clear positive correlation between hearing threshold shifts and the severity of the vestibular deficit. Stabilometric parameters show higher Romberg coefficient values, indicating that these patients rely more heavily on visual input to maintain postural balance.

Research on depression, anxiety, post-traumatic stress and sleep disturbances among civilian and military populations during the war in Ukraine

V. V. Ogorenko — 2026-04-23

Aim. To determine the characteristics of depression, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbances among civilian and military populations during the war in Ukraine.

Materials and methods. The study included 81 civilians (63 women and 18 men), predominantly residents of frontline regions, and 25 military personnel (all men). The survey was conducted in March 2025. The following standardized questionnaires were used: PHQ-9, GAD-7, PSQI, PC-PTSD-5.

Results. Median depression scores corresponded to a moderate level among civilians and a mild level among military personnel, while anxiety levels in both groups were within the mild range. The median PTSD screening score indicated the absence of clinically significant symptoms; however, the global sleep quality index in both groups fell within the range of poor sleep quality. No statistically significant differences were found between civilians and military personnel in levels of depression, anxiety, PTSD symptoms, or overall sleep quality. Among civilians, women and unmarried participants demonstrated higher levels of depression, anxiety, and PTSD symptoms. Analysis of sleep components revealed shorter sleep duration in military personnel, whereas civilians exhibited more pronounced daytime dysfunction. In civilians, clinically significant depression was associated with an increased risk of poor sleep quality (RR = 1.98; OR = 9.39; p < 0.01), and PTSD symptoms were associated with higher relative risk and odds of poor sleep (RR = 1.49; OR = 5.11; p < 0.05). No statistically significant predictors of poor sleep quality were identified among military personnel. Significant positive correlations between depression, anxiety, PTSD symptoms, and sleep quality were observed in both groups.

Conclusions. No statistically significant differences in depression, anxiety, PTSD symptoms, or sleep disturbances were identified between civilian and military populations during wartime. Social and demographic factors influenced psycho-emotional status only among civilians, with higher levels of depression, anxiety, and PTSD symptoms observed in women and unmarried individuals. Military personnel exhibited shorter sleep duration, whereas civilians demonstrated more pronounced daytime dysfunction. Depression and PTSD symptoms were the primary factors associated with poor sleep quality among civilians.

Individual aggressiveness of contemporary Ukrainian medical students during the early years of training

I. V. Husakova — 2026-04-23

The ongoing War for the Independence of Ukraine turns aggression into a survival tool, resulting in social withdrawal and persistent psychological distress, which influences the level of aggressiveness among modern Ukrainian medical students.

The aim of the study was to assess the degree of aggressiveness in junior medical students (1^st and 2^nd years) accounting for their mental health problems like stress, depression, and anxiety.

Material and methods. The Buss–Durkee Hostility Inventory (BDHI-75) and DASS21 questionnaire (Ukrainian versions) were used in psychological testing of 257 preclinical medical students who volunteered to participate in the testing (males – 112, females – 145). The test scores were processed statistically using the statistical analysis package “data analysis” in Microsoft Excel. The classic data analysis tools used included descriptive statistics, correlation, t-test, and histogram.

Results. Contemporary Ukrainian junior medical students (MS1 and MS2) demonstrated low aggressiveness (60.31 ± 3.05 %) often combined with high hostility (47.08 ± 3.11 %). Male students scored significantly higher in physical assault than females (p < 0.001), while females exhibited higher verbal aggression (p < 0.05) and irritability (p < 0.001). Moreover, medical students demonstrated elevated anxiety (66.02 ± 2.96 %), stress (59.77 ± 3.06 %), and a tendency toward depression (48.05 ± 3.05 %). Stress and anxiety levels were substantially higher among females compared male students (р < 0.001 for both parameters). Statistically significant positive correlations of weak-to-moderate magnitude were found between BDHI-75 subscales (indirect aggression, irritation, resentment, feeling guilty, hostility index) and DASS-21 scores (anxiety, depression, stress).

Conclusions. The “low aggression, high hostility” profile typical of modern Ukrainian medical students reflects deep-seated negative affect, which may predispose individuals to repressed anger, stress internalization, and potential somatic health consequences. Given this psychological profile and the widespread prevalence of stress, depression, and anxiety, Ukrainian medical students require systemic psychological support within the medical university setting.

Assessment of alcohol odor intensity as an indicator of ethanol concentration in cadavers without signs of decomposition: a correlational analysis

O. V. Shcherbak — 2026-04-23

Aim of the study. To evaluate the reliability of assessing characteristic odor intensity, specifically alcohol, during forensic medical examinations of cadavers without signs of decomposition.

Materials and methods. A total of 43 cadavers of various ages and sexes were examined at the Department of Forensic Medical Examination of the State Specialized Institution “Kharkiv Regional Bureau of Forensic Medical Examination” between December 2024 and March 2025. Inclusion criteria: the presence of a perceptible alcohol odor, the absence of putrefactive changes, and a detectable concentration of ethyl alcohol in the blood or urine confirmed by gas chromatography. A preliminary blind test involving 12 participants was conducted to validate the observers’ ability to recognize odors from alcoholic beverages of different concentrations. During autopsy, an empirical conditional scale (ranging from 0 ‰ to 5 ‰) was utilized to quantify odor intensity. Statistical analysis was performed using Microsoft Excel and included Pearson (r) and Spearman (ρ) correlation coefficients, with significance testing performed using the χ² test and p-values (p < 0.05). The null hypothesis assumed no significant correlation between objective ethanol concentration and perceived odor intensity.

Results. In the overall sample, a weak positive correlation was identified between odor intensity and blood alcohol concentration (r = 0.195, ρ = 0.215). Subgroup analysis based on odor localization revealed correlations ranging from moderate negative (abdominal cavity) to moderate positive (thoracic cavity, cranial cavity, and combined localizations). Analysis of urine ethanol levels showed a consistent pattern: a weak positive correlation in the general cohort and moderate positive or negative correlations depending on the site of odor assessment. Statistically significant results (p < 0.05) were predominantly observed in larger subgroups.

Conclusions. The identified correlations suggest that alcohol odor intensity serves only as a subjective and approximate indicator. It cannot replace the quantitative laboratory determination of ethanol in biological fluids due to the significant number of confounding factors influencing olfactory perception. These findings underscore the necessity for further research to determine the standardized value of olfactory evaluation in forensic practice.

The role of pulmonary arterial stiffness in the progression of chronic obstructive pulmonary disease: a literature review

S. Ya. Dotsenko — 2026-04-23

Aim: to systematize data on the clinical, diagnostic, and prognostic significance of pulmonary arterial stiffness (PAS) in chronic obstructive pulmonary disease (COPD) and to elucidate its pathogenetic role in pulmonary arterial hypertension (PAH) and right ventricular dysfunction.

Materials and methods. An analysis of scientific research results published from 2015 to 2026 was conducted. Sources for the analysis were selected based on an information search in the PubMed, Google Scholar, Scopus, and Web of Science scientometric databases using the following keywords: “chronic obstructive pulmonary disease”, “pulmonary artery stiffness”, “pulmonary hypertension”, “right ventricular failure”, and “cardiovascular events” (plus Ukrainian equivalents).

Results. It has been found that PAS emerged early in COPD, preceding emphysema or significant airflow obstruction. The progression of PAS correlates with emphysema severity, lung hyperinflation, and bronchial obstruction, predicting disease severity, exacerbation frequency, and cardiovascular mortality. Loss of pulmonary artery compliance drove early right ventricular dysfunction, even with moderate PAH.

Conclusions. PAS in COPD serves as a valuable diagnostic marker of early remodeling within the pulmonary circulation. Assessing PAS parameters offers substantial diagnostic and prognostic value for tailoring patient management.

The influence of war on pregnancy and childbirth in female service members and internally displaced women

V. V. Babaian — 2026-04-23

Aim: to synthesize existing scientific literature to evaluate the impact of war and military conflict on the course of pregnancy and childbirth among female service members and internally displaced women.

Materials and methods. We conducted a descriptive-comparative analysis focused on the reproductive outcomes of female service members and internally displaced women during wartime. The study was based on a systematic review and synthesis of current scientific literature to identify the primary factors through which hostilities influence maternal health. The research utilized methods of searching, comparative analysis, generalization, and synthesis of peer-reviewed data.

Results. The analysis indicates that women and children bear a disproportionate burden during armed conflicts. Most maternal and neonatal deaths in war zones are indirect, resulting from untreated diseases, malnutrition, pregnancy complications, and the collapse of healthcare infrastructure. Inadequate or absent antenatal care for internally displaced women is significantly associated with an increased risk of complications during pregnancy and delivery. This cohort exhibits higher rates of preterm birth and low birth weight, alongside an elevated risk of maternal mortality. Due to the destruction of medical facilities and shortages of personnel and essential medications, systemic obstetric assistance is often unavailable. Consequently, some women resort to unskilled birth attendants or remain entirely without medical support. Among Ukrainian female service members, the gynecological pathology profile is dominated by stress-induced disorders and pelvic inflammatory diseases. These conditions are often exacerbated by insufficient awareness regarding the prevention of sexually transmitted infections in field conditions.

Conclusions. Military conflict and displacement exert a profoundly negative influence on female reproductive health and obstetric outcomes. Given the increasing number of women in the military and the veteran population, it is crucial to address the unique reproductive health needs of this demographic to improve medical care and long-term quality of life. In combat zones, the rising rate of unassisted births significantly escalates the risk of maternal and neonatal mortality. Priority must be given to organizing specialized medical care in extreme conditions, focusing on systematic pregnancy monitoring, emergency obstetric care, and comprehensive postpartum support.

Early markers of preeclampsia: a current state, analysis, and clinical implementation prospects

G. I. Ishchenko — 2026-04-23

Preeclampsia (PE) complicates 2 % to 8 % of pregnancies and remains the leading cause of perinatal maternal and neonatal mortality worldwide. Early identification of high-risk pregnancies allows for the reduction of complications and the implementation of preventive measures.

Aim. To assess the current state of research on early biomarkers of PE, analyze their prognostic value, and determine the prospects for implementation in clinical practice.

Materials and methods. The article analyzes the current state of research regarding early biomarkers of PE, analyze their diagnostic accuracy, and determine the prospects for their integration into routine clinical practice. A systematic review (incorporating meta-analysis elements) of publications was conducted covering the period from 2000 to 30.06.2024. Databases searched included PubMed / MEDLINE, Embase, Scopus, Web of Science and Cochrane Library; additionally, Google Scholar (first 200 results), ClinicalTrials.gov and ProQuest Dissertations & Theses. MeSH / Emtree and free keywords were used: preeclampsia, biomarker, placental growth factor, PlGF, sFlt-1, sFlt-1/PlGF, PP-13, PAPP-A, microRNA, first trimester, prediction, screening. Human studies (prospective / retrospective cohorts, case-control), systematic reviews and meta-analyses that evaluated biomarkers in the I–II trimesters were included; cases, works without primary data and studies with n < 10 were excluded. The presented data substantiate the role of biomarker combinations in increasing the accuracy of early diagnosis, and the prospects for their implementation in clinical practice are discussed.

Results. The synthesis of data confirms a consistent early decrease in PlGF and an increase in sFlt-1 in pregnant women who subsequently develop PE. The sFlt-1/PlGF ratio emerged as the most robust predictor. Pooled diagnostic performance indices were: PlGF – sensitivity ~78 %, specificity ~85 %; sFlt-1 – sensitivity ~82 %, specificity ~80 %; sFlt-1/PlGF – sensitivity ~85 %, specificity ~88 %. The main limitations include population heterogeneity, differences in laboratory methods, and the absence of universally standardized cutoff values for different gestational ages.

Conclusions. PlGF, sFlt-1 and their ratios are promising early markers for PE screening. To facilitate clinical implementation, there is an urgent need for standardization of laboratory methods, identification of clinically validated thresholds, development of affordable rapid tests, and large multicenter validation studies. Integrating these biomarkers with clinical risk factors remains the most effective strategy for early-onset PE prediction.