Zaporozhye Medical Journal

A case of type 2 amiodarone-induced thyrotoxicosis

O. O. Soloviuk — 2024-05-31

Iodine-induced thyrotoxicosis (IIT) is an abnormal function of the thyroid gland towards increasing caused by excessive iodine intakes of the body. The main reasons for the development of IIT are effects of increased amounts of iodine in people with long-standing iodine deficiency, medical procedures with exposure to radiographic iodinated contrast media as well as long-term treatment with iodine-containing drugs, primarily amiodarone.

Aim: to describe an original practical case of the type 2 amiodarone-induced thyrotoxicosis development, to analyze the peculiarities of its clinical manifestations, to evaluate the possibilities for pharmacological correction of thyropathy, and to show the importance of the thyroid gland function systematic monitoring to prevent amiodarone-associated thyroid complications on the example of a particular patient taking antiarrhythmic therapy for a long time.

A 71-year-old patient S. was on inpatient treatment in the Endocrinology Department of MNE “Zaporizhzhia Regional Clinical Hospital” ZRC with diagnosed thyrotoxicosis based on complaints, laboratory and instrumental examinations, which was probably caused by long-term amiodarone treatment. A vitally important situation for the patient was the compression of mediastinal organs of unspecified genesis, which significantly complicated swallowing in the first place and impaired food passage into the stomach. Additional examinations using imaging methods were contraindicated due to thyrotoxicosis, since iodine-containing contrast agents could not be used. Surgical decompression of mediastinal organs was also not considered due to the presence of concomitant pathology which greatly increased the operative risk.

Treatment of thyrotoxicosis with the use of thyrostatic drugs in dynamics did not result in a significant decrease in serum levels of thyroid hormones. It was decided to prescribe glucocorticoids. The patient started prednisolone therapy at a dose of 30 mg per day. A week later, positive dynamics were obtained as a reduction in compression phenomena. The patient began to swallow normally and take food independently. According to the treatment regimen, the dose of prednisolone and methimazole was gradually reduced to maintenance. On the 17^th day of hospital stay, the patient was discharged for further treatment in an outpatient setting.

After 4 months, the patient was examined by an endocrinologist. A palpable decrease in the thyroid gland size was noted. There were no objective signs of thyrotoxicosis. Based on laboratory tests, TSH was 1.28 μIU/ml (0.38–4.31 μIU/ml), free T4 was 15.52 ng/dL (0.82–1.63 ng/dL). The patient was capable of eating independently and did not complain of swallowing disorders or other clinical manifestations of mediastinal compression. He continued to take prednisolone at a dose of 5 mg per day, tyrosol 5 mg per day.

Conclusions. Thus, the paper has described and analyzed the clinical case of the patient with type 2 amiodarone-induced thyrotoxicosis. Findings have indicated that cessation of amiodarone and management with glucocorticoids in view of ineffective thyrostatic treatment resulted in positive response to therapy of thyropathy in the patient. The importance of routine thyroid function monitoring to prevent amiodarone-induced thyroid complications of long-term antiarrhythmic therapy has also been shown.

The use of infrared thermography for abdominal gunshot wounds

I. V. Sobko — 2024-05-31

Aim. To determine the effectiveness of infrared thermography to identify tissue debris of parenchymal organs and in the wound edges of hollow organs to be removed as well as for the surgical treatment of gunshot wounds of the anterior abdominal wall.

Materials and methods. The results of the infrared thermography use in the provision of surgical care to 67 wounded at the second level of medical care in the conditions of the Forward Surgical Group of the Military Mobile Hospital were analyzed.

Results. Clinical examples and results of the infrared thermography use for the diagnosis and treatment of gunshot wounds of the abdominal wall soft tissues, injuries to parenchymal and hollow abdominal organs are presented.

Conclusions. Intraoperative infrared thermography allows to quickly assess the viability of the abdominal wall soft tissues, necrotic tissue margins of parenchymal organs, the state of blood supply to the walls of damaged hollow organs and their viability, thereby optimizing surgical tactics for abdominal gunshot wounds.

The role of cardiac MRI in risk stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy

M. S. Ishchenko — 2024-05-31

Hypertrophic cardiomyopathy (HCM) is a prevalent genetic heart disease with a worldwide prevalence. Its estimated incidence in young individuals is approximately 1 case per 500 population. HCM in adults can be clinically diagnosed through visualization, either via 2D echocardiography or cardiac magnetic resonance (CMR) imaging, where the maximum thickness of any left ventricular (LV) segment, measured in end-diastolic phase, is 15 mm in the absence of other hypertrophy causes.

Aim. To demonstrate the role and diagnostic capabilities of CMR as a powerful diagnostic tool for detecting and evaluating sudden cardiac death (SCD) risk factors in patients with HCM.

Materials and methods. From January 2022 to September 2023, 236 CMR examinations were conducted and analyzed at the Diagnostic Radiology Department of Amosov National Institute of Cardiovascular Surgery in patients with suspected HCM. All examinations were performed on a magnetic resonance tomograph “Toshiba Vantage Titan 1.5T” until May 2023, and “Canon Vantage Orian 1.5T” from May to September 2023, with ECG and respiratory synchronization as well as intravenous injection of gadolinium-based contrast agent (Gadovist 1.0) at a dose of 0.1 mL/kg body weight. Statistical and mathematical data processing was performed by using the Statistica 6.0 (StatSoft Inc., USA) application package.

Results. The mean age of the examined patients was 41 ± 28 years, there were 142 male (60 %) and 94 (40 %) female patients. Symmetric non-obstructive HCM was identified in 39 patients (16.5 %) and 184 patients (78.0 %) had asymmetric obstructive HCM. Apical HCM was diagnosed in 4 patients (1.5 %), and midventricular HCM – in 9 patients (4.0 %) including one patient with a combination of midventricular and apical forms.

Risk factors for SCD were identified in 60 patients (25.4 %) with myocardial thickness exceeding 30 mm, 8 patients (3.3 %) with apical aneurysm, 4 patients (1.6 %) with reduced LV systolic function (LV ejection fraction <50 %), and 164 patients (69.4 %) with pathological late gadolinium enhancement.

Conclusions. CMR is a modern, high-precision and powerful diagnostic method that plays a key role in identifying and assessing SCD risk factors in patients with HCM. CMR helps to identify HCM patients at high SCD risk who may benefit from preventive measures such as implantable cardioverter-defibrillator therapy.

Levels of sST2 and NT-proBNP biomarkers in patients with acute coronary syndrome and subclinical hypothyroidism

N. B. Kuz — 2024-05-31

Aim. To evaluate the levels of soluble growth stimulator gene 2 (sST2) protein and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute coronary syndrome (ACS) depending on the presence of concomitant subclinical hypothyroidism (SH).

Materials and methods. 125 patients with ACS aged 36 to 81 years (mean age – 60.98 ± 0.81 years) were included in the study. All the patients were divided into two groups according to the state of thyroid function. Group I consisted of 51 patients (40.8 %) with SH (thyroid-stimulating hormone (TSH) level >4 μIU/mL), mean age – 62.51 ± 1.18 years; Group II – 74 patients (59.2 %) with normal thyroid function (TSH level 0.4–4.0 μIU/mL), mean age – 59.93 ± 1.08 years. The state of SH was diagnosed at a TSH level of >4.0 μIU/mL and a serum free thyroxine (FT4) level within the normal range.

Results. In the group of patients with ACS and SH (I), significantly higher mean levels of sST2 and NT-proBNP have been found compared to patients without thyroid dysfunction (II), 46.6 (27.9; 57.7) ng/ml (I) vs. 29.9 (22.0; 38.5) ng/ml (II), p = 0.001 and 173.0 (103.4; 1005.1) ng/l (I) vs. 95.9 (71.8; 178.6) ng/l (II), p = 0.0001, respectively. Among patients with ACS and SH (I), the sST2 level of 35–70 ng/ml was 1.94 times more often, and sST2 >70 ng/ml was 2.28 times more often as compared to those in patients with ACS without thyroid dysfunction (II), 22.74 % (47.06 ± 6.99 % (I) vs. 24.32 ± 4.99 % (II), p = 0.008) and 15.81 % (21.57 ± 5.76 % (I) vs. 9.46 ± 3.40 % (II), p < 0.05), respectively. The study on NT-proBNP levels in ACS patients with SH (I) has revealed a 75.67 % significantly higher proportion of individuals with NT-proBNP levels > 600 ng/L (33.33 ± 6.60 % (I)) as compared to ACS patients with normal thyroid function (II) (8.11 ± 3.17 % (II), p = 0.001). The level of NT-proBNP <125 ng/l has been detected 2.31 times more often in the group of ACS patients with normal thyroid function (II) compared to that in ACS patients with SH (I), by 36.06 % (63.51 ± 5.60 % (II) vs. 27.45 ± 6.25 % (I), p = 0.00002). A significant strong positive correlation has been found in the group of ACS patients with SH (I) (correlation coefficient (r) = 0.775, p < 0.001) in assessing the relationship between the mean levels of sST2 and NT-proBNP. In the group of ACS patients with normal thyroid function (II), a moderate correlation has been found between the mean levels of sST2 and NT-proBNP (r = 0.678, p < 0.001).

Conclusions. In the group of ACS patients with moderately reduced thyroid function (SH), significantly higher mean levels of sST2 and NT-proBNP and significantly higher percentage of individuals with sST2 levels ≥ 35 ng/mL, NT-proBNP >600 ng/L have been detected compared to the group of ACS patients with normal thyroid function. These results may indicate a higher risk of development, progression and complications of heart failure due to a higher probability of myocardial fibrosis and subsequent left ventricular remodeling in ACS patients with SH. The significant strong positive correlation has been found between the mean levels of sST2 and NT-proBNP in the group of ACS patients with SH (I) (r = 0.775, p < 0.001). In the group of ACS patients with normal thyroid function (II), the correlation between the mean levels of sST2 and NT-proBNP was less pronounced (r = 0.678, p < 0.001). Combined assessment of these biomarkers may be more informative for the diagnosis and prognosis of heart failure in ACS patients with concomitant thyroid dysfunction than measurements of individual biomarkers. In particular, the simultaneous increase in sST2 and NT-proBNP above reference values allows to identify a very high-risk group for heart failure occurrence and progression in ACS patients.

Diagnostic value of lung ultrasonographic parameters in predicting outcomes of coronavirus disease 2019 (COVID-19) in oxygen-dependent patients requiring intensive care unit treatment

K. V. Kalashnyk — 2024-05-31

The aim – to determine the diagnostic value of lung ultrasound parameters in predicting outcomes of coronavirus disease 2019 (COVID-19) in oxygen-dependent patients requiring intensive care unit treatment.

Materials and methods. We examined 105 patients with COVID-19 who needed supplemental oxygen and were treated in the Department of Anesthesiology and Intensive Care. The age of patients ranged between 39 and 80 years, 63 participants were male and 42 – female. To determine the diagnostic value of lung ultrasound parameters in predicting the severe course of COVID-19 in oxygen-dependent patients, they were divided into groups: Group I – recovered patients (n = 39); Group II – patients with a fatal outcome (n = 66). In all the patients, the diagnosis of COVID-19 was confirmed by RNA-SARS-CoV-2 detection in nasopharyngeal swab specimens. The patients were examined and treated according to the Protocol of the Ministry of Health of Ukraine. The lung ultrasound protocol used in the study included 14 lung examination zones and a score of lung tissue infiltration degree from 0 to 3 points. Statistical processing of the data was performed with Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J).

Results. In oxygen-dependent patients with severe COVID-19 and a fatal outcome, infiltrative changes in the lung parenchyma were more severe based on the lung ultrasound total score both at the time of admission (p < 0.01) and after 5 days of treatment (p < 0.01). The cutoff score of ≥19 at the time of hospitalization (AUC = 0.753, p < 0.01; sensitivity – 76.9 %, specificity – 68.2 %) and ≥17 after 5 days of treatment (AUC = 0.799, p < 0.01; sensitivity – 71.4 %, specificity – 92.1 %) had a prognostic value for assessing the risk of death in oxygen-dependent patients with severe COVID-19. A lung ultrasound score >19 at the time of admission increased the risk of death by 2.96 times (RR = 2.96, 95 % CI 1.43–2.87, p < 0.001). Lung ultrasound found pleural effusion only in oxygen-dependent COVID-19 patients who died. In the treatment dynamics after 5 days, the rate of pleural effusion detection in this group of patients was three times increased (from 9.1 % to 27.3 %, p < 0.01).

Conclusions. The study has revealed the diagnostic value of lung ultrasound parameters in predicting outcomes of COVID-19 in oxygen-dependent patients requiring intensive care unit treatment. Cutoffs of the total score characterizing the degree of lung tissue infiltration have been determined, that allowing to assert a high probability for a lethal outcome of the disease.

Quality of life as a measure of the single-step dental implantation effectiveness

Ye. Yu. Njezhencev — 2024-05-31

Aim. The study aims to examine the quality-of-life dynamics in patients after single-step dental implantation depending on the technique of its implementation.

Materials and methods. The study included 51 patients who underwent single-step dental implantation. Depending on the dental implantation technique, the patients were divided into two groups: the study group consisted of 25 patients who underwent implant placement in the preliminary prepared bed with a post-extraction socket grafting using Sensobone xenograft, followed by a formation of soft-tissue cuff reinforced with a bone grafting material (Sensobone xenograft and free connective tissue autograft were placed on the soft tissue area) with subsequent fixation of a temporary crown. The comparison group included 26 patients who underwent implant placement in the preliminary prepared bed with a post-extraction socket grafting using Sensobone xenograft, followed by the Sensobone xenograft placement on the soft tissue area and a temporary crown fixation. To assess the quality of life (QOL), the patients were asked to fill out the OHIP-14 questionnaire before the implantation, three months and one year after the implantation. The study results were processed using the statistical licensed software package Statistica, version 13 (Copyright 1984-2018 TIBCO Software Inc. All rights reserved. License No. JPZ804I382130ARCN10-J).

Results. Problems with one or two teeth in patients requiring dental implantation led to limited QOL difficulties, reflected in the overall increase in the OHIP-14 total score. Patients in both groups had unsatisfactory QOL before implantation that was associated with a significant increase in almost all OHIP-14 items, which was significantly depended on the number of implants placed in a patient. In both groups, poor QOL was mainly due to psychosocial aspects, a physical factor, and a lower life satisfaction caused by dental problems. It has been found that a significant increase in the QOL level to a satisfactory state was seen as early as 3 months after the implantation in both groups. However, QOL was better in the study group than in the comparison group, as was evidenced by a 12 % significantly lower OHIP-14 total score. One year after implantation, the study group patients reported the OHIP-14 total score of 8.5 ± 0.8 indicating good QOL. In the comparison group, this index was 14.2 ± 0.8 showing satisfactory QOL. Normalization of QOL in the study group patients was due to the restoration of physical condition, pain relief, normalization of psychosocial state, and increased feeling of satisfaction with their life. Some patients in the comparison group reported continuing problems with physical and psychosocial disorders.

Conclusions. Single-step dental implantation is a significant factor influencing the improvement of QOL in patients. QOL is an important measure of the single-step dental implantation effectiveness. The use of a soft tissue cuff reinforced with bone grafting material allows achieving good QOL compared to the use of a bone grafting material matrix alone (due to a higher aesthetic result), since QOL remains satisfactory after the same time.

Reimplantation of the left renal vein in case of nutcracker syndrome: a 25-year experience of one center

I.I. Kobza — 2024-05-31

The aim was to assess the long-term outcomes of the left renal vein reimplantation in case of nutcracker syndrome.

Materials and methods. The study included 56 patients with critical stenosis of the left renal vein who underwent left renal vein reimplantation from May 1999 to August 2023. 10 patients were operated on between 1999 and 2013, that provided an opportunity to study long-term outcomes in the period from 7 to 21 years (a retrospective part). 46 patients underwent the surgery between 2018 and 2023 (a prospective part).

Results. According to the long-term outcome analysis of the left renal vein reimplantation conducted in the period from 3 months to 21 years, all the patients reported a gradual regression of clinical symptoms, namely, resolution of pain syndrome, hematuria, proteinuria, erectile dysfunction, dyspeptic phenomena. Ultrasonography detected a statistically significant increase in the left renal vein diameter from 1.90 ± 0.87 mm to 7.50 ± 0.76 mm (p = 0.0123) in the aorto-mesenteric segment after the surgery and a statistically significant decrease in the peak systolic velocity from 187.30 ± 2.95 cm/sec to 38.70 ± 0.76 cm/sec (p = 0.0178) in this area. A statistically significant decrease in the left gonadal vein diameter from 6.60 ± 1.30 to 4.20 ± 0.84 mm (p = 0.0118) after the surgery was noted and a decrease in the left kidney parenchymal thickness from 2.20 ± 0.46 to 1.60 ± 0.54 mm (p = 0.0123) was observed.

Conclusions. Reimplantation of the left renal vein has been proven to be an effective treatment for critical stenosis of the left renal vein.

Assessment of the risk factors for the development and morphological types of posterior subcapsular cataract using optical coherence tomography

N. S. Lutsenko — 2024-05-31

Aim. To analyze the risk factors for the development of posterior subcapsular cataract in patients with different morphological changes using anterior segment optical coherence tomography.

Materials and methods. A prospective clinical study on the risk factors for posterior subcapsular cataract was conducted during 2020–2022. The study involved 296 patients (512 eyes). The morphological type of the posterior capsule was evaluated using anterior segment optical coherence tomography (AS OCT), Optovue RTVue 100 XR Avanti (Optovue Inc., USA).

Results. Significant differences have been found between the first and second types of morphological changes in the posterior lens capsule in diabetes mellitus, long-term steroid use and myopia (χ² = 68.01, р ≤ 0.0001), as well as between the second and third types of posterior capsule changes in myopia (χ² = 16.97, р ≤ 0.0001). In the third type of morphological changes in the posterior lens capsule, mainly hereditary risk factors for the development of capsule opacification have been identified, namely, a history of retinitis pigmentosa in 77.8 % of cases, congenital myopia – in 22.2 %.

Conclusions. Defining the morphological type of posterior capsule opacities coupled with studying the etiology of the process provide new knowledge concerning the prediction of visual functions and the phacoemulsification technique for posterior subcapsular cataract.

Physiological characteristics of reproductive-age patients with female sexual dysfunction and endometriosis (a comparison of clinical and laboratory parameters in different study groups)

O. I. Kryzhanovska — 2024-05-31

Endometriosis is an estrogen-dependent inflammatory disease that affects 5–10 % of reproductive-age women. About two-thirds of women with endometriosis have sexual dysfunction caused by dyspareunia, which negatively affects the quality of life and mental health of a woman.

The aim of the study is to identify differences in clinical and laboratory parameters in study groups of reproductive-age female patients with the aim of obtaining information about specifics of the female sexual dysfunction (FSD) development in women with endometriosis.

Materials and methods. The examination results of the hormonal profile, sexual functional index and other laboratory markers were analyzed in 130 women of active reproductive age: Group I (n = 100) – the main group – women with manifestations of FSD including subgroup IA (n = 70) – women with FSD and external genital endometriosis and IB subgroup (n = 30) – women with FSD alone; Group II (n = 30) – healthy women.

Results. Women with endometriosis combined with FSD (IA) exhibited a reproductive hormonal profile different from that in women with FSD (IB), which was seen by a significant difference in follicle-stimulating hormone (FSH), estradiol, free testosterone and dehydroepiandrosterone sulfate values (p = 0.001, p = 0.039, p = 0.035 and p = 0.035, respectively). Vitamin D deficiency and hyperhomocysteinemia, the presence of antibodies to thyroperoxidase and functional hyperprolactinemia have been detected in all the women with FSD signs, regardless of the concomitant endometriosis presence. Post-hoc analysis (Mann–Whitney test) has shown that the mean scores for all categories of the Female Sexual Function Index (FSFI) questionnaire were statistically significantly higher in Group IA patients compared to those in Group II patients (p < 0.001).

Conclusions. The hormonal profile of women with endometriosis is characterized by increased levels of FSH, estradiol, free testosterone and dehydroepiandrosterone sulfate as compared to that in women with FSD alone, however it does not prevent the development of FSD signs in them and is accompanied by different indicators of the FSFI domains.

Dynamics of c-kit immunopositive pancreatic beta cells influenced by exogenous factors or endogenous pathology

T. V. Ivanenko — 2024-06-05

Mechanisms of beta-endocrinocyte differentiation involving c-kit may be associated with a number of processes, including signaling pathways and regulatory mechanisms. Such factors as activation of the c-kit signaling pathway, an increase or decrease in cell proliferation and survival, regulation of differentiation gene programs and stem cells are important in controlling self-preservation and regulating the cellular number and types, that are differentiated being impacted by intermittent hypoxic hypoxia, hypertension and diabetes mellitus.

The aim of the work is to determine the dynamics of c-kit proliferative factor in beta cells under an exogenous influence (intermittent hypoxic hypoxia) and endogenous pathology (arterial hypertension and diabetes mellitus).

Materials and methods. The study was conducted using 15 white Wistar rats and 5 spontaneously hypertensive rats (SHR), which were divided into 4 groups of 5 animals each. Group 1 – control (intact) rats, group 2 – animals with experimental diabetes mellitus, group 3 – rats with hereditary arterial hypertension (SHR), group 4 – animals exposed to the effect of intermittent hypoxic hypoxia. At the end of the experiment, the animals were euthanized, organs were harvested and processed, serial histological pancreatic sections 5 µm thick were deparaffinized and retrieved. Insulin and c-kit⁺ beta progenitor cells were detected by the immunofluorescence method using antibodies. Immunofluorescent reactions were studied using an AxioImager-M2 fluorescence microscope.

Results. The quantitative indicator of beta cells was almost 6 times decreased in rats with diabetes mellitus. Concentrations of insulin in animals of this group were increased compared to intact animals and the marker of proliferative activity was decreased without changes in the percentage of c-kit-immunopositive beta cells. The course of hereditary arterial hypertension in SHR was accompanied by an 8-fold decrease in the number of beta cells per 1 cm², an increase in insulin in beta cells as compared to the animals of both intact and experimental diabetes groups. Regarding the c-kit expression in beta cells, it was significantly reduced only in the group of intact animals and the number of c-kit-immunopositive beta cells was almost 2.8 times decreased.

In the experimental group of animals exposed to hypoxic hypoxia, the number of beta cells per measurement unit was significantly increased, the concentration of insulin in beta cells was increased as compared to the intact animals, but lower than that in rats with diabetes and hypertension. The marker of proliferative activity c-kit was decreased compared to both intact and diabetic animals. As for the number of c-kit-immunopositive beta cells, it did not differ statistically from that in intact and diabetic animals, but was higher than that in SHR.

Conclusions. The development of experimental diabetes in Wistar rats and hereditary hypertension in SHR results in a significant decrease in the specific density of beta cells in the pancreas in contrast to the effect of multiple-day hypoxic training, which stimulates an increase in the density of insulin-synthesizing endocrinocytes. Experimental conditions, diabetes mellitus, hypertension and adaptation to hypoxia, are accompanied by an increase in insulin and a decrease in the c-kit expression in beta cells. However, the number of c-kit-immunopositive beta cells in the pancreatic islets significantly decreases only with the development of hereditary arterial hypertension.

Long-term sequelae of coronavirus disease: long COVID-19 and cardiovascular outcomes (a literature review)

A. V. Hovornyan — 2024-05-31

The COVID-19 pandemic has serious global implications for the healthcare system and economy. Although the recovery rate has increased significantly and the morbidity rate has decreased, long-term consequences, particularly cardiovascular, have come to the fore and become a global problem. As a result, in 2021, at the WHO level, the concept of “long-term COVID” was introduced, including more than 100 already described symptoms in patients for at least 3 months after initial recovery. At the same time, the clinical symptoms are not specific, strategies for the treatment of such disorders have not been worked out, and measures to detect and/or prevent the development of these complications have not been organized.

The aim: to summarize the available data and modern views on the long-term cardiovascular effects of COVID-19, to reveal probable causes and risk factors for their development, as well as to analyze the presented information on the pathogenetic mechanisms of cardiovascular consequences after coronavirus disease.

The literature data analysis has shown that SARS-CoV-2 viral persistence in the human body, reactivation of other viral agents, immune system dysregulation, autoimmunization development as well as the occurrence of microvascular thrombosis and endothelial dysfunction are among the pathogenetic mechanisms of long COVID. Although all these findings represent theoretical concepts regarding the pathogenesis of the long-term consequences of coronavirus disease, complementing and interacting with each other, at the moment, there is no formulated uniform explanation for the development of long-term effects of COVID-19. Also, large-scale studies point to the need for special attention to cardiovascular consequences of COVID-19. Among those already described in the literature are myocarditis, pericarditis, heart failure, arterial hypertension, arrhythmias, pulmonary embolism, cerebrovascular disorders, and cardiomyopathy. Given the prevalence of cardiovascular diseases and their impact on mortality, such processes have become a serious threat to the global healthcare system in the context of the COVID-19 pandemic.

Conclusions. The available information on the causes and mechanisms of the long-term COVID development has been analyzed, and COVID-related cardiovascular disorders described in patients after recovery from acute coronavirus disease have been examined in detail. The study on this issue is extremely important since only by understanding the association between COVID-19 and cardiovascular diseases, studying pathogenetic mechanisms and identifying risk factors, it is possible to improve the prevention and treatment as well as to take control over cardiovascular consequences of COVID-19 at the global level.

Brain natriuretic peptide: diagnostic and prognostic value in chronic heart failure (a literature review)

O. O. Sakovych — 2024-05-31

The increase in the prevalence of cardiovascular disease has caused a rapid increase in the risk of developing heart failure. For many years, chronic heart failure (CHF) has occupied one of the leading positions in the structure of cardiac and all-cause mortality worldwide, resulting in not only negative social, but also economic effects. To optimize the timely detection of this pathological condition, laboratory biomarker-based diagnostics of heart dysfunction is widely used along with echocardiographic examination. Brain natriuretic peptide (BNP) is currently considered one of the most well-known and informative biochemical markers in heart failure.

The aim of the work was to cover the results of current scientific research according to the principles of evidence-based medicine regarding the use of BNP and its precursor NT-proBNP for the diagnosis of CHF, prognosis and monitoring of the treatment effectiveness. To achieve this goal, an analysis of literary sources published in scientometric databases such as ScienceDirect, Web of Science, Google Scholar, PubMed, Scopus for the period 2013–2024 was carried out.

Conclusions. BNP and NT-proBNP have been found to be informative markers for the early diagnosis of chronic heart failure and can also be recommended for dynamic assessment of patients’ condition and the effectiveness of their treatment. It is proposed to continue the research on clarifying the threshold diagnostic levels of the biomarkers in patients with chronic heart failure and comorbid conditions such as type 2 diabetes mellitus, obesity, as well as in consideration of their sex, age, racial and ethnic characteristics, which in the future would promote the optimization of timely diagnosis, selection of appropriate treatment and improvement of further prognosis.

The significance of melatonin as one of the signaling substrates in the expression of psychopathological disorders in the late period after traumatic brain injury

M. O. Ovcharenko — 2024-05-31

Aim. To discuss the functional properties of melatonin which plays a key role in the expression of psychopathological disorders following traumatic brain injury (TBI).

The influence of melatonin on neurochemical changes, which may lead to various mental disorders, has been analyzed. Specifically, its impact on asthenia, cognitive impairments, emotional instability, and insomnia, which are among the main symptoms accompanying TBI in the chronic phase, has been examined. The importance of studies on melatonin as a neurotransmitter and its role in the circadian rhythm regulation, which is often impaired as a consequence of TBI, has been emphasized. The mechanisms underlying these disorders may be related to dysfunction of the hypothalamus and interhemispheric interactions. Melatonin may influence the recovery processes after TBI, reducing inflammation and providing optimal conditions for tissue regeneration. It opens up new possibilities for the development of therapy aimed at reducing the impact of trauma consequences on patients. Earlier studies have also indicated the option of using melatonin as an antioxidant, which can protect brain tissue from further damage caused by recovery processes after injury.

Studies on pharmacological modulation of the melatonin system could be useful for developing new methods for treatment and prevention of mental disorders associated with TBI. Examining the action of melatonin receptor antagonists and agonists can help to choose optimal treatment strategies aimed at correcting disorders arising as a result of trauma. It holds promise for faster and more complete recovery of mental health in TBI patients.

Conclusions. Considering the significance of melatonin in regulation of physiological processes, further studies may enrich understanding of its role, ensuring the development of more effective treatment methods. Given the safe profile of melatonin and its availability as a supplement, supportive studies in this direction have the potential to positively impact clinical practice.

Accelerated biological ageing as a complication of cancer therapy

O. O. Kovalov — 2024-05-31

Aim. The paper aimed to update the study on accelerated biological aging as a complication of cancer therapy with a focus on diagnosing and prognosing the disease course.

The authors independently searched scientific literature for the systematic review within databases PubMed, Scopus and Cochrane in the period from 2018 to 2024, using combinations of keywords “cancer”, “biological aging”, “replicative aging”, “antitumor therapy”, “markers of cellular senescence”, “coronary artery calcium” and selected full-text publications written in English and Ukrainian with level 1–3 evidence.

People affected by cancer grow old faster. This could be related to malignant growth biology as well as to methods of anticancer therapy received. Cytostatics, targeted, hormonal and immune drugs damage not only malignant, but also benign cells, which leads to violations of replication with sustained cell cycle arrest and other phenotypic signs – macromolecular damage, metabolic changes, production of a specific senescence-associated secretome. Clinically, this is manifested by reduced work capacity, weakness, chronic organ dysfunction, cardiovascular disorders, progression of coronary atherosclerosis, hypertension, diabetes, dyslipidemia, sarcopenia, cognitive disorders, a de novo development of tumors and premature death. Biological markers of cellular senescence include the expression of lipofuscin, Ki67, p21 WAF1/Cip1 or p16 INK4a. A clinical marker of aging is the deposition of calcium salts within coronary arteries based on the Agatston score detected using multidetector computed tomography.

Conclusions. A better understanding of the cancer consequences associated with accelerated biological aging might suggest new therapeutic strategies and improve the quality of life among cancer survivors. Rehabilitation measures through changes in diet, caloric restriction, aerobic exercises and pharmacological senolytic therapy should be a part of a patient’s daily routine after completion of radical cancer treatment.