Zaporozhye Medical Journal

Justification of a price range for topical antifungal drugs based on patient preferences

Mon, 17 Feb 2025 00:00:00 +0200

The price factor is an important element when using a therapy management, that is complicated by the deterioration in the socio-economic situation of Ukrainians and the National Health Care system in the middle of war.

The aim is to examine patients’ willingness-to-pay for topical antifungal drugs (TAFDs) taking into account their differing consumer characteristics in order to justify the economic component in the development and pharmaceutical market introduction of national drugs and to formulate recommendations for improving the level of pharmaceutical care for patients with fungal skin diseases.

Materials and methods. The results of a sociological TAFDs’ consumer survey were used as the basic study material. In this study, the methods of information retrieval, summarizing, formalizing, questioning, van Westendorp’s Price Sensitivity Meter (PSM) were used. The respondent geography covered the Zaporizhzhia, Dnipropetrovsk, Cherkasy, Poltava, Ivano-Frankivsk, Kyiv, Odesa regions.

Results. A total group analysis of price sensitivity was conducted including 8 TAFDs with calculation of optimal (OPP), indifferent (IDP), minimum (MCP) and maximum (MEP) respondents’ willingness-to-pay prices. The same prices were subsequently calculated in the intra-group price analysis of respondents with different income levels and experience in drug therapy for fungal skin diseases. The cumulative distribution of respondents was graphed at three stages of the study calculations for the identified subgroups (64 graphs in total).

Conclusions. The van Westendorp’s Price Sensitivity Meter (PSM) has been used to examine patients’ willingness-to-pay for topical antifungal drugs considering their different consumer characteristics: final dosage form – gel, ointment, cream, solution, spray; combined / monocomponent. At the same time, opinion of patients with different levels of income and experience of drug therapy for fungal skin diseases has been sought. Based on the studies, the economic component and the promising form of a new antifungal drug for topical use (pharmacy or industrial production) – a spray or gel with a price in the range of UAH 181–230 have been justified.

Clinical characteristics and management of post-myocardial infarction patients with stable angina in the outpatient practice of Ukrainian cardiologists (GO-OD study)

O. M. Parkhomenko, M. Yu. Kolesnyk, O. A. Koval, S. A. Tykhonova — Mon, 17 Feb 2025 00:00:00 +0200

Aim. To identify the clinical and anamnestic characteristics and features of the stable angina management in patients with a history of myocardial infarction (MI) in the actual outpatient practice of Ukrainian cardiologists in order to determine the follow-up activities for optimizing and individualizing the treatment of this patient cohort.

Materials and methods. The non-interventional observational multicenter prospective study GO-OD enrolled 1529 patients with coronary artery disease, stable angina, 39.7 % of whom had a history of MI. The follow-up period for the study participants was 3 months. Physicians were instructed to continue monitoring and treatment of patients in accordance with routine practice and international guidelines. No additional diagnostic or monitoring procedures were performed. However, physicians could adjust therapy and provide recommendations for lifestyle modification.

Results. Among post-infarction patients, the proportion of young people, active smokers and men was significantly higher (p < 0.001). A positive family history of MI in first-degree relatives or sudden death in the patient’s father before 55 years of age have been identified to be more common in MI patients (p < 0.05), a positive family history of stroke has been found in the group of patients without MI (p < 0.001). Patients with MI had an average of 6 anginal attacks per week, and the need for short-acting nitroglycerin to relieve attacks was significantly higher than that in patients without MI. PCI was used more often for MI patients within up to 3 years post-MI, the proportion of CABG gained prevalence among patients over 3 years after MI. At the time of study enrollment, the patients mostly used beta-blockers, trimetazidine was the second most often prescribed. When optimizing antianginal therapy, trimetazidine therapy underwent the greatest modifications, the proportion of patients taking beta-blockers and calcium antagonists also increased, which resulted in a significant symptom alleviation in patients. Recommended highly intensive statin therapy was prescribed only to 44.2 % of patients and none of the patients received combined lipid-lowering therapy.

Conclusions. Controlling the modifiable risk factors remains unsatisfactory among Ukrainian outpatients with angina and a history of MI. Despite prior coronary revascularization procedures, significant symptomatology in patients with angina and MI has been detected. Low therapy adherence has been documented in most patients. Fewer than half of patients with a history of MI receive the required doses of statins. Pharmacological therapy optimization through adjustment of hypolipidemic and antianginal medication dosages, and the inclusion of original trimetazidine at a dose of 80 mg once a day have resulted in a significantly reduced frequency of anginal attacks and improved quality of patients’ life.

The glucose-potassium ratio as a marker of adverse prognosis in patients with chronic heart failure

V. V. Syvolap, V. A. Lysenko — Mon, 17 Feb 2025 00:00:00 +0200

The glucose-potassium ratio (GPR) has previously proven its prognostic role in acute pathological conditions: ischemic and hemorrhagic strokes, aortic aneurysm and dissection, myocardial infarction. However, changes in the serum GPR in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction (HFpEF) remain unclear. It is known that tubulointerstitial injury occurs in patients with CHF. The renal tubulointerstitium plays a leading role in the reabsorption of glucose, potassium, and sodium. Therefore, impaired glucose-potassium ratio in patients with CHF is expected.

Aim. To examine changes in the glucose-potassium ratio in patients with ischemic HFpEF and to determine its impact on the short-term (1 year) prognosis.

Materials and methods. The study involved 57 patients (men – 43.9 % (n = 25); women – 56.1 % (n = 32)) with ischemic CHF, stage II A–B, NYHA FC II–IV, 49.1 % (n = 28) with sinus rhythm, and 50.9 % (n = 29) with atrial fibrillation (AF). Patients with sinus rhythm and AF were comparable in age (p = 0.968), height (p = 0.167), weight (p = 0.539), BMI (p = 0.774), body surface area (p = 0.296). The serum GPR was calculated as the serum glucose level divided by the serum potassium level. ROC analysis and logistic regression analysis were performed.

Results. According to the univariate regression model, an increase in the GPR above 1.1697 increased the number of adverse cardiovascular events by 11.15 times at the end of the 1st year of follow-up (95 % CI 1.33–93.50, p = 0.0048).

Conclusions. Chronic heart failure with preserved left ventricular ejection fraction is accompanied by impaired tubulointerstitial function, which is confirmed by an increase in the glucose-potassium ratio, and its increase above 1.1697 (sensitivity 88.9 %, specificity 60.8 %) is associated with 11.15 times (p = 0.0048) higher odds ratio of adverse cardiovascular events within a year.

Studying associative relations between left ventricular dysfunction and heart failure development in patients with acute coronary syndrome and clinical manifestation of COVID-19

D. V. Bondarets, K. V. Rudenko — Mon, 17 Feb 2025 00:00:00 +0200

The aim of the work: to determine associative relations between left ventricular dysfunction and heart failure development in patients with acute coronary syndrome and COVID-19.

Materials and methods. Patients with acute coronary syndrome and manifestation of COVID-19 were included in the study (n = 100). The material for the analysis was the data of echocardiography and coronary angiography. The study participants underwent myocardial revascularization.

Results. It has been found that ejection fraction before reperfusion was 2.4 % higher in the main group (p ≥ 0.05), and it was increased by an average of 1.2 % (p ≥ 0.05) after reperfusion. In the comparison group, the mean value of ejection fraction did not differ before and after reperfusion. A comparative analysis of ejection fraction after reperfusion has shown its increase by an average of 52.0 % in the main group and by 48.0 % in the comparison group, indicating the treatment effectiveness. The determined OR coefficients have indicated a 0.85-fold reduced heart failure risk in the comparison group (OR = 0.85; 95 % CI: 0.36–2.01, p = 0.8). A 0.78 times decreased heart failure risk has been revealed in patients with unchanged ejection fraction after reperfusion in the comparison group (OR = 0.78; 95 % CI: 0.26–2.31, p = 0.8), while it has been shown to be 1.47 times higher in those with decreased ejection fraction (OR = 1.47; 95 % CI: 0.57–3.79, p = 0.5).

Conclusions. The determined OR coefficients have demonstrated associative relations between a reduction in the heart failure risk in single-vessel (OR = 0.67; 95 % CI: 0.06–7.31, p = 0.5), two-vessel (OR = 0.40; 95 % CI: 0.01–10.17, p = 0.5) and multivessel (OR = 0.79; 95 % CI: 0.26–2.38, p = 0.8) coronary artery lesions after effective reperfusion in the comparison group. Associative relations between increased risk of heart failure have been established in single-vessel (OR = 4.67; 95 % CI: 0.29–90.01, p = 0.4) and multivessel (OR = 3.29; 95 % CI: 0.74–16.66, p = 0.01; χ² = 5.71) coronary artery lesions after ineffective revascularization.

Predictive value of the Elixhauser comorbidity index in assessing the risk of coronavirus disease (COVID-19) mortality in patients with pneumonia

I. O. Kuliesh, O. V. Riabokon, K. V. Kalashnyk — Mon, 17 Feb 2025 00:00:00 +0200

Aim. To determine the spectrum of comorbid pathology and to find out the prognostic value of the Elixhauser Comorbidity Index (ECI) in assessing the risk of death from coronavirus disease (COVID-19) in patients with pneumonia.

Material and methods. The study included 123 patients with COVID-19 with pneumonia who were examined and treated according to the Order of the Ministry of Health of Ukraine of 28.03.2020 No. 722. Depending on the disease outcome, the patients were divided into groups: 77 patients who recovered and 46 patients who died. The ECI was calculated for all the patients. Statistical processing of the data was performed using Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J).

Results. In patients with COVID-19 and pneumonia, comorbid conditions were most often represented by chronic cardiovascular disease (63.4 %), obesity (28.5 %), endocrine pathology (26.0 %) and discirculatory encephalopathy (23.6 %). Among patients with a fatal outcome, coronary heart disease with cardiac arrhythmias, obesity, endocrine diseases, primarily diabetes mellitus, and discirculatory encephalopathy were more common (p < 0.05) as compared to patients who recovered. Among the comorbidities integrated into the ECI, the most commonly diagnosed comorbidities in COVID-19 patients with pneumonia were hypertension (58.5 %), congestive heart failure (33.3 %), obesity (28.5 %), neurodegenerative disorders (23.6 %), and diabetes, both without (13.8 %) and with chronic complications (7.7 %). The following ECI components were more common in patients with COVID-19 pneumonia who died as a result of COVID-19 than in patients who recovered: congestive heart failure (p = 0.008), cardiac arrhythmias (p = 0.001), neurodegenerative disorders (p = 0.0003), diabetes mellitus (p = 0.004) including diabetes without chronic complications (p = 0.01), and obesity (p = 0.04). The ECI score in patients with a fatal outcome was 2.2 times higher (p < 0.05) than that in patients with COVID-19 pneumonia who recovered. The ECI >7 was predictive of the likelihood of COVID-19 death in patients with pneumonia (AUC = 0.656, p = 0.002).

Conclusions. The frequency of chronic comorbidities in patients with COVID-19 and pneumonia has been determined taking into account the ECI components. The prognostic significance of the ECI score >7 in assessing the risk of fatal outcome has been established.

Impairment of renal reserve filtration capacity in stage II–III chronic obstructive pulmonary disease under conditions of syntropy with stage II essential hypertension

S. Ya. Dotsenko, L. S. Akimova — Mon, 17 Feb 2025 00:00:00 +0200

The aim of the study: to examine the state of functional renal reserve in patients with stage II–III chronic obstructive pulmonary disease (COPD) and stage II essential hypertension (EH).

Materials and methods. 60 patients were examined and divided into 3 clinical groups: group 1 – 15 patients with stage II EH (mean age 52.87 ± 1.36 years; male / female ratio 73.33 % / 26.67 %); group 2 – 15 patients with stage III–III COPD (mean age 48.01 ± 2.75 years; male / female ratio 86.67 % / 13.33 %); group 3 – 30 patients with stage II–III COPD and comorbid stage II EH with arterial hypertension stage I–III (23 men and 7 women, mean age 57.49 ± 2.39 years), without evidence for another clinically significant concomitant pathology and who did not receive regular antihypertensive therapy. All the groups were comparable in sex distribution and demographic parameters. Data indicating the presence of clinically significant kidney disease in these individuals was not revealed by comprehensive clinical, laboratory and instrumental examination results.

Results. Functional renal reserve (FRR) in patients with COPD + EH was significantly lower by 3.79 times (p < 0.05) compared to that in otherwise healthy individuals, while the basal glomerular filtration rate (GFR) did not differ significantly between these groups. In EH monopathology, the FRR level was 2.11 times (p < 0.05) lower than that in the control group. In COPD comorbid with EH, almost 5/6 patients showed signs of renal dysfunction in the form of impaired renal reserve ability to proportionally increase GFR, indicating the progression of nephron hyperfiltration processes. According to the Pearson’s chi-squared test, adverse disorders of pulmonary respiratory function were significantly more common (decreased Tiffeneau index (χ² = 6.13, p = 0.013)) as well as cases of microalbuminuria combined with elevated renal interlobar artery resistance (RI ILRA >1.05 RU) (χ²= 13.64, p < 0.001) in COPD patients with EH in the lower quartile of the FRR index, indicating the possible parallelism in certain pathological processes and abnormal autoregulatory mechanisms of glomerular filtration in combination of COPD and EH.

Conclusions. In patients with comorbid stage II–III COPD and stage II EH, manifestations of intraglomerular hypertension and hyperfiltration progression are associated with more severe clinical symptoms and the degree of “pressure load” according to the results of 24-hour ambulatory blood pressure monitoring, as evidenced by the presence of statistically significant correlations between FRR values, on the one hand, and the COPD Assessment Test scores and daytime systolic blood pressure load index (r = +0.55 and -0.63, p < 0.05 for all cases), on the other, confirming important relationships between impaired intrarenal hemodynamic processes and some prognostic factors in COPD combined with EH.

Metabolic disorders and their impact on retinal blood flow in patients with age-related macular degeneration and diabetes mellitus: data from optical coherence tomography angiography

N. S. Lutsenko, T. S. Kyrylova — Mon, 17 Feb 2025 00:00:00 +0200

Aim – to examine the impact of metabolic disorders on retinal blood flow in patients with age-related macular degeneration (AMD) and diabetes mellitus using optical coherence tomography angiography (OCT-A).

Materials and methods. The study included 98 eyes (62 patients) with early dry AMD. OCT-A examinations assessed retinal blood flow density in different areas with manual segmentation to define superficial (SCP), intermediate (ICP), and deep (DCP) capillary plexuses. Laboratory tests evaluated glucose and lipid profiles and homocysteine. Morphometric measurements were also conducted: waist circumference (WC) and body mass index (BMI). Patients were grouped based on carbohydrate metabolism impairment: Group 1 (no abnormalities), Group 2 (insulin resistance (IR)), and Group 3 (type 2 diabetes mellitus (DM)).

Results. The study has identified higher glucose levels in the type 2 DM group (10.67 ± 5.11 mmol/L, p = 0.05) and elevated HOMA index in both IR (4.48 ± 2.17, p = 0.03) and diabetes groups (4.89 ± 1.13, p = 0.04). Homocysteine levels were lower in DM patients (6.36 ± 2.57 µMol/L, p = 0.02). No significant differences have been found in lipid profiles or morphometric parameters (p > 0.05). WC and BMI were strongly correlated with reduced blood flow in the SCP middle / far periphery (r = -0.747, p = 0.001). Elevated blood glucose (r = -0.606, p = 0.017) and HOMA index (r = -0.664, p = 0.013) were associated with reduced macular blood flow in the SCP macular region. Triglycerides have shown the most significant negative effect on the blood flow, especially in the SCP macular area (r = -0.883, p = 0.0001). Homocysteine and cholesterol have also been linked to reduced blood flow in the DCP, while high-density lipoprotein has been found to be protective.

Conclusions. The results suggest that glucose metabolism abnormalities, IR, and elevated lipid and homocysteine levels significantly impair retinal blood flow, particularly in the macula and peripheral regions, emphasizing the importance of metabolic control in patients with AMD and DM.

The role of visceral hypersensitivity and cortisol levels in the development of intestinal dysfunction in coexisting hypothyroidism

V. H. Mishchuk, H. V. Kozinchuk, O. Z. Venhrovych, U. P. Shalamai — Mon, 17 Feb 2025 00:00:00 +0200

The increasing dysfunction of the thyroid gland, particularly hypothyroidism, and its multifaceted effects on the gastrointestinal tract, such as potential changes in hormonal receptor sensitivity, neuromuscular disorders, and myopathy caused by infiltration of the colonic wall, lead to impaired bowel function. Although constipation remains the most common gastrointestinal complaint in hypothyroidism, hypomotility may contribute to excessive bacterial growth in the small intestine and the development of diarrhea.

The aim is to study the role of visceral hypersensitivity and cortisol levels in patients with intestinal dysfunction in coexisting hypothyroidism and in those with constipation or diarrhea without thyroid dysfunction.

Materials and methods. A total of 41 patients with hypothyroidism were examined, of whom 24 were diagnosed with persistent constipation and 17 with diarrhea, along with 36 patients with irritable bowel syndrome (IBS) (control group), of whom 22 had constipation and 14 had diarrhea. In all the patients, visceral hypersensitivity was assessed using the Visceral Sensitivity Index (VSI), and serum cortisol levels were measured by enzyme-linked immunosorbent assay (ELISA) using commercial kits from Sanguin (USA). Fecal calprotectin levels were assessed with the Human CALPE (Calprotectin) ELISA KIT by Elabscienсe (USA).

Results. VSI was higher in patients with hypothyroidism and diarrhea and scored 66.0 (61.0; 68.0) points. In individuals with IBS and diarrhea without thyroid dysfunction, VSI was 58.0 (54.0; 62.0) points. Meanwhile, VSI was 65.0 (60.0; 69.0) points in patients with constipation due to hypothyroidism, whereas in IBS patients without thyroid dysfunction, it was significantly lower – 24.0 (22.0; 26.0) points (p < 0.05). In the control group without bowel and thyroid pathology, VSI scored 15.0 (12.0; 18.0) points. The serum cortisol level in patients with hypothyroidism and diarrhea was 305.41 (270.24; 309.3) nmol/L, while in patients with IBS and diarrhea without thyroid dysfunction, it was 211.0 (205.0; 222.5) nmol/L. In patients with constipation due to hypothyroidism, the serum cortisol level was 310.625 (308.440; 337.285) nmol/L, whereas in IBS patients with constipation, it was 178.0 (172.0; 187.5) nmol/L. For healthy individuals, the cortisol level was 158.0 (152.0; 167.5) nmol/L. A direct correlation has been found between a high degree of visceral sensitivity and cortisol levels in patients with hypothyroidism and constipation, as well as an inverse correlation in patients with hypothyroidism and diarrhea. The obtained data may indicate a shift towards hypersensitivity and the development of symptoms characteristic of IBS.

Conclusions. Visceral hypersensitivity is observed both in cases of diarrhea developing against the background of hypothyroidism and in irritable bowel syndrome with a similar clinical presentation. At the same time, in cases of constipation associated with hypothyroidism, hypersensitivity is also present but tends to be less pronounced in IBS with constipation. Patients with hypothyroidism, regardless of the presence of constipation or diarrhoea, have an increase in blood cortisol levels, while in some variants of IBS, they do not differ significantly from those of healthy individuals. A direct correlation was found between a high degree of visceral hypersensitivity and cortisol levels in hypothyroid patients with constipation and the opposite in hypothyroid patients with diarrhoea.

Prognostic value of serum zinc concentration determination in young children during the course of infectious diarrhea

V. V. Pechuhina, O. V. Usachova — Mon, 17 Feb 2025 00:00:00 +0200

Aim. To develop a model for predicting the course of infectious diarrhea (ID) in young children based on the determination of serum zinc (Zn) concentration influence on the clinical scores of these patients.

Materials and methods. The study included 99 children aged between 1 and 36 months who were hospitalized with a diagnosis of acute intestinal infection within the first three days of the disease onset. Serum Zn levels were determined by the colorimetric method. Non-parametric statistical methods were used to process the obtained data, since the distribution of indicators did not correspond to the normal one. A correlation analysis with the Spearman correlation coefficient (r) calculation was used to determine the influence of serum Zn concentrations on the ID course. A regression analysis then followed selecting the preferred version of the regression equation in each particular case, ranked according to the value of the determination coefficient R².

Results. A decrease in serum Zn concentrations was found in 22 (22.22 %) children of the examined group. Low serum Zn concentrations on the 1^st and 3^rd days of treatment were associated with a higher frequency of loose stools on the 7^th day of hospitalization (r = -0.68 and r = -0.51, respectively; p < 0.05). We have constructed a pairwise linear regression model according to which the duration of diarrhea in patients with ID can be determined if the serum Zn level on the 1^st hospitalization day is known. The relationship found can be estimated by the paired linear regression equation: y = 0.5638x + 10.348, where y – is the duration of diarrhea (days), x – is the serum Zn concentration (μmol/l) on the 1^st hospitalization day. The model determination coefficient R² = 0.5 (p ˂ 0.001) was considered statistically significant. From this equation it follows that diarrhea lasts more than 5 days with a serum Zn concentration below 9.8 μmol/l.

Conclusions. Every fifth child was diagnosed with serum Zn deficiency. Decreased serum Zn concentrations below reference values on the 1^st day of treatment affected the diarrheal syndrome duration being associated with its period of more than 5 days. To predict the duration of diarrheal syndrome in young children, the formula y = 0.5638х + 10.348, where y is the duration of diarrhea (days), x is the serum Zn concentration on the 1^st day of hospitalization (μmol/l), should be used.

Justification and implementation of the multimodal general anesthesia model for elective cesarean section into clinical practice

A. A. Padalko, H. A. Dziuba — Mon, 17 Feb 2025 00:00:00 +0200

General anesthesia for cesarean section serves as a reserve method and is used in cases when neuraxial anesthesia is contraindicated. Its total usage frequency accounts for approximately 20 % of all anesthetic techniques. Today, in medical practice, there is no unified general anesthesia protocol for obstetric patients. There are two main unresolved issues of general anesthesia for cesarean section: accidental awareness in patients during surgery (1:670 cases) and a manifest neuro-endocrine stress response of the body to surgical trauma.

Aim. To comparatively assess the efficacy of the conventional total intravenous anesthesia technique with mechanical ventilation and multimodal general anesthesia.

Materials and methods. In total, 60 cases of elective cesarean sections were analyzed. Patients were randomized into two groups of 30 individuals each. Group 1 (control group) received standard total intravenous anesthesia with mechanical ventilation. Group 2 (study group) received multimodal general anesthesia with additional adjuvants, including intravenous forms of paracetamol (1000 mg) and clonidine (100 µg), administered 30 minutes prior to surgery. Perioperative monitoring was carried out according to the recommendations of the American Association of Anesthesiologists with additional control of the bispectral index and levels of stress-induced substances (glucose, cortisol). The analysis included the newborn assessment on the Apgar scale, the measurement of umbilical cord blood gases, the evaluation of postoperative recovery and maternal satisfaction with anesthesia. For statistical analysis, unpaired two-tailed Student’s t-test was used to compare differences between normally distributed data and the Mann–Whitney U-test – when data were not normally distributed.

Results. Mean baseline characteristics have shown no statistically significant differences between the two groups (p > 0.05). At all planned stages of the scientific work, statistically significant differences (p < 0.001) were found in the examined indicators between the two groups: mean arterial pressure; heart rate; bispectral index; Apgar scores at 1 and 5 minutes; umbilical cord blood gas composition; blood glucose and cortisol levels. It has been noted that the postoperative period was better in Group 2 patients (p < 0.001): patient recovery time, length of intensive care unit stay, patient satisfaction with anesthesia).

Conclusions. Based on the results obtained, multimodal general anesthesia with adjuvants such as clonidine and acetaminophen administered prior to elective cesarean sections provides statistically significant advantages over the standard method of general anesthesia. The multimodal general anesthesia approach allows to improve the stability of hemodynamics, reduce the stress-induced response, ensure a better condition of newborns and quicker postoperative recovery.

Comprehensive assessment of the long-term stressful event impacts on the mental health of medical students

Mon, 17 Feb 2025 00:00:00 +0200

The aim of the study was to examine the impact of long-term exposure to stressful events (the COVID-19 pandemic and prolonged martial law) on the mental health of medical students.

Material and methods. The study was conducted among 4^th–5^th-year education applicants at Dnipro State Medical University (DSMU), specialty 222 “Medicine”. Group 1 consisted of 67 students examined in 2019, and Group 2 comprised 61 students examined in 2024. Clinical-anamnestic, clinical-psychopathological and psychodiagnostic examinations were conducted. The following psychometric scales were used: PHQ-9 health questionnaire, Dutch Eating Behavior Questionnaire (DEBQ), State-Trait Anxiety Inventory (STAI; C. D. Spielberger, Y. L. Hanin), Michigan Alcoholism Screening Test (MAST), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q).

Results. The data obtained have shown a statistically significant difference in alcohol screening indicators between the two groups of examinees. According to the questionnaire, students surveyed in 2024 have reported consuming less alcohol. In general, the findings from both groups have revealed normal weight, restrained and emotional eating behavior (EB) traits, absence of alcoholism, and a moderate level of the quality of life index (QOL). However, mild depression, a tendency towards externalizing EB, and a moderate level of trait anxiety have been found among the examinees. The statistical analysis results have shown a weak effect of high trait anxiety (0.135) on the development of clinically significant depression. An analysis of relative risks and odds ratios has found increased relative risks and odds ratios for poor QOL indices and clinically significant depression among individuals examined in 2024 based on a several-fold increase in these values for the indicator “High trait anxiety”.

Conclusions. Our study has demonstrated an increased strength of associations between factors (emotional eating, high trait anxiety) that influenced the onset of clinically significant depression and an increase in relative risks and odds ratios of its development among the students surveyed in 2024. A small effect of long-term stressful events (the COVID-19 pandemic and prolonged martial law) on the factors of clinically significant depression has been found. In such extreme conditions, medical students of DSMU have demonstrated a high level of stress resilience in the conditions of long-term exposure to extreme stressful events, which was confirmed by our study results revealing no significant deterioration in the mental health and quality of life in 2024 student sample compared to 2019 one.

Expert evaluation of priority areas for implementation of medical and pharmaceutical technologies in Ukraine

M. M. Babenko, K. L. Kosiachenko — Mon, 17 Feb 2025 00:00:00 +0200

Aim. To analyze survey results of healthcare (НС) professionals on the status, problems and prospects of implementing medical and pharmaceutical technologies in Ukraine and their proper appraisal.

Materials and methods. A comprehensive sociological study was conducted via an online survey using Google forms (September – December 2023). Two questionnaires were developed and tested for this purpose, one for public administration professionals and another for health technology assessment (HTA) specialists. Respondents were selected by purposive sampling based on their managerial experience, education, and professional qualifications. In total, 164 НС system managers of different levels and 77 HTA specialists were enrolled in the study. The methods of system analysis, mathematical and statistical, generalization, comparison, descriptive, and graphical were used to process and interpret the results.

Results. Based on current scientific concepts and regulatory requirements, medical and pharmaceutical technologies include various methods, procedures, systems or tools applied in the field of HC for treatment, diagnosis, prevention, medical rehabilitation and palliative care. The WHO also defines HC technologies as public health measures and interventions at the population level (such as vaccination, screening), targeted programs, and treatment standards (protocols, guidelines). The modern НТА methodology as a scientific and practical concept is now developing quite dynamically in the world and has specific features of implementation in different countries.

Conclusions. Since НТА is an internationally recognized tool to support effective management decision-making, a comparison between НТА specialist and НС manager opinions on the status, problems and prospects of НТА implementation in Ukraine has been important in the study. The respondents have reported the formation of a professional environment, improvement of legislation, international cooperation, infrastructure development and capacity building as the most probable scenario for the НТА implementation in Ukraine.

Visualization of coronary artery calcification and its impact on percutaneous coronary intervention procedure (a literature review)

V. O. Hubka, Yu. M. Vailo, A. M. Materukhin, A. L. Makarenkov — Mon, 17 Feb 2025 00:00:00 +0200

In general, the phenomenon of vascular calcification is quite common and might pose considerable impediments for vascular, cardiovascular and endovascular surgeons, as well as for interventional cardiologists when performing surgical manipulations during the treatment of patients with coronary artery disease (CAD) or peripheral atherosclerosis. A high degree of coronary artery (CA) calcification is independently associated with an increased risk of major cardiovascular events after percutaneous coronary intervention (PCI).

The aim of the work is to analyze modern professional literature, summarize information and add to our ideas about the impact of CA calcification and methods of its visualization on the PCI technical aspects.

Since the second half of the 20th century, various methods that allow for visualization of СA plaque calcification have been developed and introduced into clinical practice. These techniques vary in their potential due to type and technical parameters of the radiation source, possibilities of using specialized software, automation of image analysis, etc. Currently, the methods of intravascular imaging, intravascular ultrasound (IVUS) and optical coherence tomography (OCT), are the most informative for visualization of CA calcification and can help interventionalists when performing PCI to identify and evaluate calcified lesions, to determine the indications and choose an optimal type of device for calcium modification, directing appropriate stent or balloon sizing; to detect signs of suboptimal stent implantation providing control over possible periprocedural complications. In addition, the deposition of such morphological substrate as calcium within coronary atherosclerotic lesions is a predictor of insufficient stent expansion during PCI, which in turn can cause thrombosis and in-stent restenosis. CA lesion preparation before stent implantation involves using specialized angiographic balloons or atherectomy devices. Applying these methods of calcium modification contributes to the compliance of the calcified plaque causing fractures beyond or within the stent, ensures optimal final stent expansion and reduces the risks of possible long-term consequences. Furthermore, other periprocedural difficulties and problems may arise during PCI of calcified CA lesions: increased probability of technical failure due to the impossibility of passing the target lesion with instruments, intimal dissection, wall perforation, distal embolization, etc.

Conclusions. CA calcification is a complex issue for an interventional cardiologist during CA stenting, which certainly complicates the PCI procedure and requires a specialist not only theoretical knowledge, but also practical skills in using a wide range of interventional tools and techniques. There are modern methods of identifying calcified CA lesion and its quantitative assessment. Among them are methods of intravascular visualization – IVUS and OCT, which are used directly in a catheterization laboratory during PCI. They provide the amplest opportunities and the most advanced capabilities for determining the morphological substrate of the affected CA area and allow an interventionist to plan PCI and adjust its real-time implementation at different stages of the procedure. The use of intracoronary imaging methods gives more opportunities to improve PCI outcomes.

The role of anticoagulants in the treatment of community-acquired pneumonia in patients combined with coronavirus infection

I. M. Fushtei, V. O. Mochonyi, O. V. Soloviov — Mon, 17 Feb 2025 00:00:00 +0200

The review article focuses on the role of anticoagulants in the treatment of community-acquired pneumonia in patients combined with coronavirus infection. Considerable research interest in determining the role of anticoagulants, especially heparin, in COVID-19 patients is related to their positive effect on the disease course. Apart from well-known anticoagulant effects of unfractionated and low-molecular-weight heparins, they possess excellent pleiotropic properties. Although recommended, standard pharmacological thromboprophylaxis for hospitalized patients is debatable as there is still an issue regarding regimens and dosage in critically ill patients with pneumonia combined with COVID-19.

Aim. To define the role of anticoagulants in the treatment of community-acquired pneumonia in patients combined with coronavirus infection.

Materials and methods. Scientometric databases (PubMed, Web of Science and Scopus) were searched to retrospectively analyze literary sources focused on the specified issue selecting the most relevant ones for the period 2020–2024. Following evaluation of abstracts and full texts, 41 sources were retrieved.

Results. The pathogenesis of coagulopathy associated with COVID-19 is complex. It involves macrophage activation, the onset of “cytokine storm”, increased platelet adhesion and endothelial dysfunction, ultimately activating the intrinsic and extrinsic coagulation pathways. There is an increased risk of thromboembolism associated with COVID-19, and prophylactic anticoagulation improves outcomes in hospitalized patients. The problem for physicians is to decide which anticoagulant and how to start anticoagulation. Anticoagulant selection should take into consideration not only biochemical and coagulation parameters, such as elevated D-dimer, fibrinogen, and low antithrombin, which are the targets of this therapy. It is also extremely important to take into account bleeding risks, as massive bleeding can occur in 2.3 % of all patients, even when using standard doses for thromboprophylaxis. The use of anticoagulants such as heparin and vitamin K antagonists in COVID-19 patients is a challenging issue that depends on the balance between therapeutic benefit and potential risk avoidance. Therefore, thromboprophylaxis is indispensable for hospitalized patients with COVID-19.

Conclusions. Thus, the literature analysis has shown anticoagulant therapy as an integral component in the treatment of community-acquired pneumonia in patients combined with coronavirus infection for thromboprophylaxis. Heparin has been found to have a high therapeutic potential in patients with community-acquired pneumonia combined with coronavirus infection, but the bleeding risk should be weighed up. Enoxaparin is proved to be a safer anticoagulant option compared to heparin, but it may be not sufficiently effective in patients with community-acquired pneumonia combined with coronavirus infection.