Zaporozhye Medical Journal

A modern view on the role of single nucleotide polymorphism of human genes in the formation of unfavorable consequences of the new coronavirus disease (COVID-19)

Yu. Yu. Riabokon — 2024-10-04

Aim – to analyze the current literature on the role of single nucleotide polymorphism (SNP) of human genes in shaping the clinical course of the new coronavirus disease (COVID-19).

Results. Based on the results of the analysis and synthesis of the current literature on the role of SNP in shaping the clinical course and outcome of COVID-19, the clinical and prognostic significance of SNP of genes encoding receptors responsible for the penetration of SARS-CoV-2 into target cells has been demonstrated. The presence of the D-allele of the ACE gene (DD and ID genotypes) is associated with the highest risk of severe COVID-19, which makes it possible to offer it as an informative prognostic marker of COVID-19 severity. SNP of the TMPRSS2 co-receptor gene, known as the androgen responsive gene, at certain loci is prognostically important, as it leads to an increase in TMPRSS2 expression in men, which promotes virus fusion with the target cell membrane and has an unfavorable effect on the course of COVID-19 in men.

The data accumulated in the current literature on the clinical and prognostic value of SNP host genes encoding the immune response has also been analyzed. The role of HLA SNP genes, genes encoding innate immunity factors (TLR), as well as genes encoding pro-inflammatory cytokines (IL-6, TNF-α, etc.) and acute-phase inflammatory components (CRP) in the development of severe COVID-19 and the risk of death has been demonstrated. Attention has been paid to the determined role of SNP in the ACE gene in the development of pulmonary embolism in patients with severe COVID-19. The article has analyzed publications on the SNP role of host genes in the development of clinical events that are currently interpreted as long COVID. The prognostic role of the IL-10 gene SNP and its receptor gene in the formation of long-term consequences of the new coronavirus infection has been demonstrated.

Conclusions. SNP of host genes encoding receptors responsible for the entry of SARS-CoV-2 into target cells and SNP of genes encoding immune response have some prognostic value in assessing the risk of severe course and adverse effects of COVID-19. The accumulation of data on genetic risk factors for adverse outcomes of the new coronavirus disease will allow us to enhance the understanding of this infection pathogenesis, improve patient stratification and individualize therapeutic interventions.

Indications for heart transplantation: focus on advanced heart failure

V. F. Petrov — 2024-10-04

Heart failure is one of the most important medical and social problems. Despite recent successes in the treatment of this disease, which have been achieved with guideline-recommended medical treatment, some patients become insensitive to the interventions. Refractoriness to treatment recommended by the guidelines means that patients cannot hope for symptom relief or prolongation of life. These individuals develop the phase of advanced heart failure and have the worst survival rates compared to other stages of chronic heart failure. In the absence of contraindications, heart transplantation is indicated for this group of patients. In the recent years, organ transplantation has been legalized and the work of cadaver donation institutions has been organized in Ukraine. These changes helped to significantly increase the annual number of heart transplantations in the country.

The aim of the work is to systematize current knowledge about end-stage heart failure, to provide methods to timely diagnose advanced heart failure and indications for referral for heart transplantation.

At least every tenth patient with heart failure may deteriorate to the advanced stage. The article details clinical trajectories of patients with heart failure, and a particular emphasis has been given to refractory patients in accordance with present guidelines and recommendations. The main pathophysiological links and corresponding clinical manifestations of advanced heart failure have been outlined. The problems of life expectancy prognosing and possible predictors of refractoriness to the treatment recommended by the guidelines have been discussed. Current diagnostic criteria for advanced heart failure have been specified, including physical, laboratory and imaging methods of examination. The principles of differential diagnosis, especially between symptomatic and advanced heart failure, have been considered. Triggers for referring patients to a heart transplant center have been detailed. Current guidelines for heart transplantation related to advanced heart failure have been given.

Conclusions. Advanced heart failure is the progression of heart failure due to refractoriness to treatment. Diagnostic criteria for advanced heart failure have been developed relatively recently. This diagnosis requires an utmost understanding of pathophysiology and skills to examine cardiac patients using modern tools. Due to the extremely unfavorable prognosis, diagnosis of advanced heart failure is an absolute indication for referral to a heart transplant center.

Perimenopause period and menopause: cardiovascular and metabolic risks

V. H. Siusiuka — 2024-10-04

The number of mature and elderly women is increasing all over the world. According to the World Health Organization, in most countries of the world, the life expectancy of women after the age of 50 ranges from 27 to 32 years. Thus, approximately one third of a woman’s life is lived after menopause.

Aim. To analyze and summarize scientific data on cardiovascular and metabolic risks in perimenopausal and menopausal women based on the use of scientometric databases.

Menopause should be considered as a risk factor for the development of cardiovascular diseases (CVDs), which triggers a whole cascade of pathological changes in a woman’s body, including the development of arterial hypertension, dyslipidemia, abdominal obesity, insulin resistance, an increased sympathoadrenal tone, endothelial function disorders, and inflammatory vascular reactions. CVD is known to be the leading cause of death among postmenopausal women associated with the loss of estrogenic protective effect on the cardiovascular system. Women with premature menopause have a 33 % higher risk of heart failure and a 9 % higher risk of atrial fibrillation.

Metabolic syndrome is more common in postmenopausal women than in premenopausal women. It is defined as a cluster of disorders characterized by impaired glucose metabolism, high blood pressure, central obesity, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and triglycerides. It is the activity of low-density lipoproteins and an increase in the level of triglycerides that have serious consequences in the etiology of cardiovascular diseases and the development of atherosclerosis.

Osteoporosis ranks fourth among non-communicable diseases after CVD, cancer and diabetes. Estrogen deficiency during menopause results in increased osteoclast resorptive activity, while osteoblast function remains relatively constant, ultimately resulting in bone loss. In the first postmenopausal years, a woman can lose up to 9–35 % of bone mass, postmenopausal osteoporosis affects between one third to a half of all women.

Conclusions. Menopause is a difficult period in a woman’s life, during which the risk of developing cardiovascular diseases and metabolic disorders increases, as well as almost all somatic diseases are exacerbated. Therefore, proper assessment of such risks is mandatory to improve long-term CVD outcomes. Given this, it is the interdisciplinary interaction that is central to early detection of symptoms and diagnosis of climacteric disorders for the timely prescription of treatment. Physicians working with this contingent of women should apply a comprehensive approach to health care and quality of life preservation during the menopause transition, menopause and postmenopause.

Effect of adhesives on the sensitivity of dental tissues

I. L. Diudina — 2024-10-04

Currently, the issue of increased dentin sensitivity after operations for hard dental tissue preparation during the therapeutic treatment of the carious process, as well as during orthopedic treatment of various types with non-removable dentures, has retained its relevance. Pain management is the prevention of postoperative complication development and ensures high-quality treatment results.

Aim. The purpose of the literature review in this paper was to draw specialists’ attention to the use of low-solvent adhesive systems of various types to manage postoperative sensitivity of hard dental tissues.

Materials and methods. More than 30 literature sources focused on studying action mechanisms of known generations of dental adhesive systems and their effects on changes in postoperative sensitivity of dental hard tissues as a result of a high-quality protective film formation on the dentin surface have been analyzed.

Results. The use of various adhesive systems to reduce postoperative sensitivity of soft tissues with the formation of a high-quality protective film on the dentin surface that seals the dentinal tubules is of great importance for obtaining qualitative treatment results and increasing its effectiveness. However, various reactive substances (solvents, acetone), which are components of most adhesives, have a strong impact on their quality and significantly reduce the indications for their use.

Conclusions. Thus, studying the action mechanisms of adhesives on dental tissues, searching for the formulation of new adhesive systems with a lower solvent content would expand the indications for their use as therapeutic and prophylactic drugs to reduce pain sensitivity of hard dental tissues after preparation.

The state of lipid metabolism in patients with acute coronary syndrome and chronic kidney disease depending on glomerular filtration rate and smoking factor

O. V. Yadzhyn — 2024-10-04

Aim. To study the features of lipid metabolism disorders in patients with acute coronary syndrome (ACS), depending on glomerular filtration rate (GFR) and smoking factor.

Materials and methods. The study included 142 ACS patients (mean age – 59.66 ± 0.78 years). All the patients were divided into two groups according to GFR. Group I comprised 57 individuals with GFR <60 ml/min/1.73 m²; Group II – 85 persons with GFR ≥60 ml/min/1.73 m². Patients of each group were divided into two subgroups based on smoking status: A – smokers (IA, IIA) and B – non-smokers (IB, IIB). The main serum parameters of lipid metabolism were determined: total cholesterol (TC), low-density lipoprotein cholesterol (LDL cholesterol), high-density lipoprotein cholesterol (HDL cholesterol), triglycerides (TG), non-high-density lipoprotein cholesterol (non-HDL cholesterol).

Results. As compared to Group II, Group I have demonstrated significantly higher (by 21–31 %) mean LDL cholesterol (p < 0.01) and non-HDL cholesterol (p < 0.01); higher (by 11–18 %) TC (p < 0.01) and TG (p < 0.05); lower HDL cholesterol (p < 0.05). The results of the subgroup study (based on the smoking status) have shown 22–36 % higher TC, LDL cholesterol, TG, non-HDL cholesterol and 11–16 % lower HDL cholesterol in smokers (IA, IIA) as compared to those in non-smokers (IB, IIB). The study of the smoker subgroups has revealed 13–23 % higher mean TC, LDL cholesterol, and non-HDL cholesterol in Subgroup IA compared to those in Subgroup IIA. The examined patients with lipid profiles different from the reference values were divided into groups. So, up to 18–22 % more individuals with higher LDL cholesterol and lower HDL cholesterol as compared to reference values were in Group I compared to Group II; in the smoker subgroups (IA, IIA), in comparison to non-smoker ones (IB, IIB), there were up to 19–37 % more individuals with higher TC, TG, compared to reference values; in the subgroup of smokers, i.e. in Subgroup IA compared with Subgroup IIA, there were up to 21–24 % more individuals with lower HDL cholesterol and higher non-HDL cholesterol compared with reference values. A correlation analysis has revealed a moderate inverse correlation between TC, LDL cholesterol, non-HDL cholesterol and GFR in Group I and Group II. Moderate and strong inverse correlations between TC, LDL cholesterol, TG, non-HDL cholesterol values and GFR have been found in subgroups of smokers (IA, IIA) and non-smokers (IB, IIB). In addition, in Subgroups IA and IIA, a moderate direct correlation between pro-atherogenic lipid fractions and smoking index has been found.

Conclusions. Patients with GFR <60 ml/min/1.73 m², compared to those with GFR ≥60 ml/min/1.73 m², have been revealed with significantly higher levels of pro-atherogenic lipid fractions – LDL cholesterol, non-HDL cholesterol – by 21–31 %, TC, TG – by 11–18 %; and lower levels of HDL cholesterol. Regardless of GFR, in each of the two subgroups of smokers (IA, IIA), compared to non-smokers (IB, IIB), there was a significant increase in the levels of TC, LDL cholesterol, TG, non-HDL cholesterol (by up to 11–36 %) and a decrease in HDL cholesterol. The most obvious pro-atherogenic changes in the lipid spectrum were detected in patients with GFR < 60 ml/min/1.73 m² and smoking factor (IA).

Features of cardiac remodeling and GDF 15 and NTproBNP levels in patients with heart failure and preserved ejection fraction depending on the history of myocardial infarction

Ya. V. Zemlianyi — 2024-10-04

Aim. To determine the relationships between serum concentrations of growth and differentiation factor 15 (GDF 15) and NTproBNP and features of heart remodeling in patients with heart failure and preserved ejection fraction (HFPEF) depending on the history of Q-myocardial infarction (MI).

Materials and methods. The study was performed on the basis of the Cardiology Department of the Municipal non-profit Enterprise “City Hospital of Urgent and Emergency Medical Care” of Zaporizhzhia City Council. 72 patients (mean age 62.1 ± 1.7 years) with HFPEF after MI were enrolled. The patients were divided into two groups depending on the time of previous MI. The patients were examined using two-dimensional echocardiography on a MyLab50 device (Esaote, Italy) according to the recommendations of the American Society of Echocardiography. Serum concentrations of GDF 15 and NTproBNP were measured by enzyme immunoassay using Elabscience reagent kits (USA).

Results. In the 1^st and 2^nd groups of patients who suffered MI within a year, a significant increase in GDF 15 has been found (by 66.1 % and 74.7 %, respectively; p < 0.05) compared to the control group. The level of GDF 15 was significantly higher (by 41.8 %, p < 0.05) in the group of patients who had MI over a one-to-two-year period as compared to those who had MI within one year. The serum concentration of NTproBNP was also significantly higher in HFPEF groups compared to the control group (by 84.7 % and 87.2 %, respectively, p < 0.05). In the 2^nd group of patients with the history of MI between 1 and 2 years, a significant increase in end-systolic volume (by 11.8 %, p < 0.05), end-diastolic volume (by 22.3 %, p < 0.05), left ventricular myocardial mass index (by 19.1 %, p < 0.05) and the E/e’ ratio (by 20.9 %, p < 0.05) has been revealed as compared to the 1st patient group. A strong direct correlation has been shown between the time of MI occurrence and the concentration of GDF 15 (r = 0.58, p < 0.05), the interventricular septum thickness at diastole (r = 0.61, p < 0.05) and the left ventricular myocardial mass index (r = 0.63, p < 0.05), GDF 15 and E/e’ (r = 0.37, p < 0.05), GDF 15 and the left atrial volume index (r = 0.41, p < 0.05), GDF 15 and NTproBNP (r = 0.56, p < 0.05).

Conclusions. Progression of left ventricular myocardial hypertrophy and diastolic dysfunction with dilatation of the heart chambers has been observed in HFPEF patients with a longer history of MI. The time period of MI in patients with HFPEF was associated with the serum concentration of GDF 15, the interventricular septum thickness and the mass index of the left ventricular myocardium. The serum concentration of GDF 15 was significantly correlated with the deterioration of the left ventricular diastolic function, such as an increase in the E/e’ ratio and the left atrial volume index.

Cardiorenal interactions in patients with juvenile idiopathic arthritis

L. F. Bohmat — 2024-10-04

As early as the first stages of rheumatic diseases in children, a number of pathological changes occur with the involvement of many organs and systems in the process. In children with juvenile idiopathic arthritis (JIA), decreased adaptability of the cardiovascular system is detected in 17.0–20.0 % of cases. 36.9 % of children with JIA develop renal lesions. Thus, inflammation underlies the interaction between pathological mechanisms of renal and heart failure in patients with rheumatic diseases.

The aim of the work is to identify the characteristics of the interaction between main morphofunctional parameters of the cardiovascular system and kidneys in children with JIA, and the factors that give rise to the formation and worsening of these disorders.

Materials and methods. 152 patients aged 13.42 ± 0.22 years with JIA were examined. Renal functions were examined based on the levels of creatinine, urea, albuminuria, urine specific gravity, glomerular filtration rate. To determine the morphofunctional parameters of the heart, ultrasound examinations of both left and right ventricles were performed.

Results. In children with JIA, the functional parameters of the kidneys almost do not differ from those of the control group, with the exception of albuminuria, which is significantly higher in children of the main group and increases with the process activity progression. Morphofunctional analysis of the cardiac parameters has shown a decrease in the stroke volume of the left ventricle (51.83 ± 1.57 ml against 57.86 ± 2.54 ml, р < 0.05) with preserved ejection fraction and a significant increase in the right ventricle volumes both diastolic (34.54 ± 1.51 ml against 22.45 ± 2.11 ml, p < 0.001) and systolic (19.15 ± 0.96 ml against 10.18 ± 1.14 ml, p < 0.001), as well as stroke volume (15.39 ± 0.84 ml against 12.21 ± 1.05 ml, p < 0.01), with a significant decrease in its ejection fraction (45.04 ± 1.44 % against 56.06 ± 1.59 %, p < 0.001).

Conclusions. Renal functional parameters are within normal values, but the level of albuminuria is significantly higher and increases with the process activity progression in children with JIA. The morphofunctional parameters of the left ventricle correspond to the control ones, but there is an increase in the right ventricle volume with a significant decrease in its ejection fraction. A decrease in the myocardial pumping function of the right ventricle is accompanied by a decrease in renal blood supply which leads to the development of cardiorenal syndrome type 5 in JIA children.

The specificity of iNOS expression indicators in the basal magnocellular nucleus of rats under early pathogenetic correction in experimental neurodestruction

M. V. Danukalo — 2024-10-04

Aim. To characterize iNOS expression indicators in the basal magnocellular nucleus of rats during early pathogenetic correction of neurodegeneration induced by intracerebroventricular colchicine administration.

Materials and methods. The study was conducted using 50 male Wistar rats aged 10–11 months, which were divided into 5 experimental groups (n = 10). The control animals (group 1) were administered a 0.9 % NaCl solution intracerebroventricularly, while the other experimental group rats (groups 2–5) received a colchicine solution in the same manner. The following day, the animals from groups 3–5 were initiated early pathogenetic correction with citicoline (group 3), thiocetam (group 4), and HSF-1 (group 5) lasting 14 days. All the experimental animals (groups 1–5) were then euthanized with sodium thiopental, and their brains were extracted for histochemical, immunofluorescent, and biochemical examinations.

Results. The study has demonstrated that intracerebroventricular administration of colchicine to rats was accompanied by morphological signs of neurodegeneration in the basal magnocellular nucleus and characterized by a significantly smaller area of chromaffin substance in the neurons of this structure by 39 % as compared to the control animals. At the same time, early pathogenetic correction of colchicine-induced neurodegeneration was associated with significantly larger values of Nissl substance area of the basal magnocellular nucleus neurons compared to the corresponding values in animals that did not receive the correction. Additionally, the nitrite level in the brain homogenates of rats administered colchicine without correction (group 2) exceeded the control (group 1) by almost 7 times, while the indicators in experimental groups 3, 4, and 5 exceeded it by 3.5, 2.9, and 3.8 times, respectively. However, no statistical differences were found between the control group and the correction groups in terms of nitrite content. Evaluating the expression of iNOS (the area of immunopositive cells and corrected total cell fluorescence, CTCF) in the basal magnocellular nucleus of the experimental rats it has been shown that the area was most affected in group 5 (HSF-1 correction), exceeding the control parameter by 18.9 %, group 3 (citicoline correction) by 14.7 %, and group 4 (thiocetam correction) by 17.1 %, with no statistical differences compared to group 2 (colchicine administration without correction). Meanwhile, the CTCF of iNOS+-cells in the basal magnocellular nucleus of the experimental animals was the highest in group 2 significantly exceeding the corresponding parameters in the control and correction groups. No significant differences were found between the control and correction groups in this parameter. Additionally, it is noteworthy that intracerebroventricular administration of colchicine to rats, compared to control animals, was associated with a significant double the number of iNOS+ cells in the basal magnocellular nucleus. However, early pathogenetic correction in groups 3-5 did not significantly affect the number of iNOS+ cells in the studied structure, as this parameter did not statistically differ from group 2, although significantly exceeding the corresponding parameter in the control group (group 1).

Conclusions. Early pathogenetically substantiated correction with citicoline, thiocetam, and HSF-1 in colchicine-induced neurodegeneration in the basal magnocellular nucleus of experimental rats is accompanied by an increase in the area of chromaffin substance compared to rats that received intracerebroventricular colchicine without correction, as well as a reduction in nitrite levels in brain homogenates to the control level (sham-operated animals). In the basal magnocellular nucleus of experimental rats, under the influence of early pathogenetically substantiated correction of experimental neurodegeneration, iNOS expression indicators (area of immunopositive cells and CTCF) vary depending on the neuroprotectant used. The number of iNOS+ cells in the basal magnocellular nucleus of experimental rats in the correction groups does not change compared to the group that received intracerebroventricular colchicine without correction and is statistically higher than the corresponding indicator in the control rats.

Approaches to evaluation of neurocognitive profile in patients with residual schizophrenia depending on a history of cerebral stroke

D. M. Safonov — 2024-10-04

Cerebral stroke consequence assessment in patients with residual schizophrenia is a complex clinical scenario questioning both diagnostic and therapeutic strategies.

Aim. To assess the structure of neurocognitive dysfunctions in patients with residual schizophrenia with pronounced negative symptoms depending on a history of cerebral stroke.

Materials and methods. In the period of 2020–2023, a clinical examination of 47 patients of Zaporizhzhia Regional Clinical Psychiatric Hospital and Veselovsky Psychoneurological Boarding School with a diagnosis of residual schizophrenia (ICD-10: F20.5) was carried out. Study groups were formed: G1 – 9 patients with residual schizophrenia and the history of cerebral stroke; G2 – 36 patients with residual schizophrenia without the history of cerebral stroke.

Results. The DSM-5 neurocognitive functioning assessment system was used in the study, based on which a protocol for rapid testing of neurocognitive functions adapted for patients with residual schizophrenia was developed. The group of patients with the history of cerebral stroke has demonstrated lower results in attention allocation (p ≤ 0.05). This group has also shown relatively poor results in planning (p ≤ 0.05), error correction (p ≤ 0.05), inhibition (p ≤ 0.05) and flexibility (p ≤ 0.05). As concerning verbal ability, worse results of expressive speech (p ≤ 0.05), grammar and syntax (p ≤ 0.05) have been revealed in the group of patients with the history of cerebral stroke. In terms of perceptual-motor functions, the gnosis task has been performed worse (p ≤ 0.05) by the group of patients with the history of cerebral stroke. Differences in emotion recognition and theory of mind were insignificant between groups.

Conclusions. An original neurocognitive function assessment protocol adapted for the Ukrainian-speaking patient population with residual schizophrenia has been developed. The patient population with residual schizophrenia and the history of cerebral stroke or without it has been examined with the use of the developed protocol for the assessment of neurocognitive functions. According to the obtained results, patients with residual schizophrenia and the history of cerebral stroke have demonstrated worse cognitive performance compared to those without the history of stroke.

Pattern of IgM and IgG changes depending on the pathological process duration in patients with autoimmune thyroiditis

R. R. Rahimova — 2024-10-04

The aim of the study was to find out the pattern of IgM and IgG changes in patients with autoimmune thyroiditis depending on the pathological process duration.

Materials and methods. A single-center cross-sectional study with randomization elements enrolled 170 patients with autoimmune thyroiditis, and 65 patients without thyroid pathology or other autoimmune diseases were assigned to sex- and age-matched comparison group (p = 0.6155 and p = 0.3093, respectively). The patients were classified according to thyroid status parameters into subclinical and manifest groups. All study participants were examined on IgM and IgG levels based not only on the clinical form of the disease, but also on the disease duration (up to 5 years and more than 5 years). The control group comprised 65 healthy individuals, including 26 men and 39 women (mean age 38.7 ± 10.8 years).

Results. A slight decrease in IgM levels was observed in patients with subclinical form and longer disease duration, which was 1.5 (1.5; 1.7) g/l with the disease duration of up to 5 years and 1.4 (1.2; 1.4) g/l with the disease duration of more than 5 years, while there were no differences in IgM levels in patients with manifest form with longer disease duration. IgG concentrations were statistically significantly higher in both clinical groups of patients with the disease duration of up to 5 years compared to those in patients with the disease duration of more than 5 years (13 (11; 14) g/l up to 5 years and 11 (10; 12) g/l more than 5 years in subclinical group, p < 0.05); 13 (12; 14) g/l up to 5 years and 12 (10; 15) g/l more than 5 years in manifest group, p < 0.05).

Conclusions. A downward trend in IgG concentrations is noted with the disease progression and longer duration, while IgM levels are uninformative.

The spectrum of pathogens and their resistance in patients with malignant liver and biliary tract tumors with biliary obstruction after extensive liver resections

V. P. Romaniuk — 2024-10-04

The aim of the study to assess the resistance of infectious complication pathogens to antibacterial drugs in patients after major liver resection (MLR) with or without biliary obstruction.

Material and methods. A total of 105 patients were assigned to 2 groups: group 1 consisted of 53 patients (7 – with hepatocellular carcinoma (HCC), 28 – with cholangiocarcinoma (CC), 18 – with metastases of colorectal cancer) with biliary obstruction; group 2 – 52 patients (25, 10 and 17, respectively) without biliary obstruction.

Results. A microbiological examination of urine, blood, sputum, bile, pharyngeal and wound samples was performed after MLR.

Conclusions. Patients with HCC and CC with biliary obstruction after MLR had infectious complications in 100.0 % of cases, patients without biliary obstruction – in 25.7%; Gram-positive microorganisms were statistically significantly more often isolated from them: Enterococcus faecalis in 17.1 % (р_1,2 = 0.01); gram-negative microorganisms: Escherichia coli in 5.7 % (р_1,2 = 0.05), hemolytic Escherichia coli in 5.7 % (р_1,2 = 0.05), Pseudomonas aeruginosa in 5.7 % (р_1,2 = 0.05); fungi in 8.6 % (р_1,2 = 0.04); significantly more often, Enterococcus faecalis was isolated from blood in 5.7 % (р_1,2 = 0.05), Enterococcus faecium – from urine in 8.6 % (р_1,2 = 0.05), Candida albicans – from wounds in 5.7 % (р_1,2 = 0.05) and sputum in 8.6 % (р_1,2 = 0.02).

Pelvic small intestine reservoirs of a new type

V. M. Melnyk — 2024-10-04

Aim. To improve the results of surgical treatment for patients with severe non-cancerous diseases of the colon by developing and implementing the new type of pelvic small intestine reservoirs.

Materials and methods. A new type of pelvic small intestine reservoirs has been developed and introduced into clinical practice to improve processes of intestinal digestion, absorption, anal retention after radical surgery for ulcerative colitis, Crohn’s disease with total colon involvement, familial adenomatous polyposis. Each of the reservoirs has been adapted to anatomical relationships between the small intestine and the debuccalized surgical anal canal depending on a radical surgery extent and a functional state of the small intestine. Pelvic small intestine reservoirs of a new type were used in 39 patients of the main study group, 21 (53.8 %) men and 18 (46.2 %) women. The patients’ age ranged from 21 to 43 years. The comparison group consisted of 42 patients. The patient groups were identical in terms of sex, age, diagnosis and complications of the underlying disease. Patients in the comparison group differed in that they underwent the well-known “J”-shaped pelvic small intestine reservoir procedures.

Results. The number of postoperative complications was statistically significantly higher in patients of the comparison group due to acute and chronic complications, 33.2 % and 10.4 %, respectively. Indicators of intestinal digestion, absorption and anal retention were statistically significantly better in the majority of patients of the study group. The number of patients with I (mild) degree of pathological post-colectomy syndrome was significantly higher in the study group, and the number of patients with diarrheal syndrome and secondary anal incontinence syndrome was significantly lower. Positive results after the introduction of a new type of pelvic small intestine reservoirs were obtained by applying the following basic principles of their formation: the use of only known factors of physiological delay in the passage of contents through the small intestine, preservation of the small intestine wall anatomical integrity, location of the small intestine reservoir at a certain distance from the upper border of the rectal sphincters, as well as the reasonable expediency of choosing a method of forming the pelvic small intestine reservoir depending on the patient’s anatomy.

Conclusions. The use of physiological factors of delayed passage of the contents in the small intestine, small intestine wall anatomical integrity preservation in the formation of pelvic small intestine reservoirs of the new type, the reservoir location at a certain distance from the upper border of the rectal sphincters has resulted in significant improvements in the functions of intestinal digestion, absorption, and anal retention. Practical application of the new type of pelvic small intestine reservoirs has helped to significantly decrease the incidence of postoperative complications from 33.2 % to 10.4 %, increase the number of patients with post-colectomy syndrome of the I (mild) degree from 47.4 % to 86.4 %, reduce the number of patients with diarrheal syndrome from 55.3 % to 8.1 %, and secondary anal incontinence syndrome from 36.8 % to 5.4 %.

Prosthetic valve thrombosis in a patient secondary to COVID-19: a case report

L. V. Rasputina — 2024-10-04

A well-known and dangerous complication of COVID-19 infection is the development of hypercoagulation, which leads to thrombosis of various localization. Therefore, the problem of anticoagulant therapy was widely discussed during the first months of the pandemic and continues to be relevant. At the same time, concomitant cardiac pathology is associated with a more severe course of COVID-19 and higher risks of complications and mortality. Therefore, patients who underwent cardiac surgery require special attention. Individuals with prosthetic metal heart valves must constantly receive anticoagulant therapy, however, the literature describes cases of intracardiac thrombotic complications despite anticoagulation during COVID-19 infection. Currently, there are no randomized studies on this issue, and only individual clinical cases provide this information.

The aim of the work was to describe a clinical case of thrombosis at the left ventricular apex during COVID-19 infection in a patient with a prosthetic aortic valve who received adequate warfarin therapy and to compare the tactics of patient management and therapeutic outcomes with other clinical cases.

Materials and methods. The patient was followed-up after aortic valve replacement for 2 years. During the visits, a general clinical examination, laboratory examinations – clinical blood test, blood glucose, urea, creatinine, bilirubin, INR, NT-proBNP, echocardiography were performed.

Results. The patient with a congenital heart defect, a condition after aortic valve replacement, mitral and tricuspid valve annuloplasty (15.03.2022) due to bicuspid aortic valve, combined aortic defect with predominance of stage III-IV regurgitation; stage III secondary arterial hypertension; chronic heart failure IIA, functional class III, stage C, reduced systolic left ventricular function; a two-chamber pacemaker due to complete AV blockade; paroxysmal atrial flutter presented to a cardiologist with worsening shortness of breath and weakness one month after a moderate COVID-19 infection. The patient received bisoprolol 5 mg, amiodarone 200 mg, spironolactone 50 mg, perindopril 8 mg, warfarin 5 mg, INR was carefully controlled, at presentation – 3.7. Echocardiography revealed a left ventricular apex thrombus, a decrease in left ventricular ejection fraction (LVEF) from 46 % to 38 %. Aspirin 75 mg/day, torasemide 10 mg/day, dapagliflozin 10 mg/day, and metabolic therapy were added to the treatment. After 1 month, the patient’s condition improved, no thrombus was detected in the left ventricular cavity, LVEF increased to 46 %.

Conclusions. This case demonstrates the problem of careful cardiovascular system state monitoring in patients with prosthetic valves during and after COVID-19, since symptoms of heart cavity or valve thrombosis, worsening heart failure can be mistakenly considered as signs of a viral infection or respiratory failure.