Zaporozhye Medical Journal

A case of progressive acute respiratory distress syndrome in a patient with coronavirus disease (COVID-19) and difficulties in its confirmation by instrumental diagnostic methods

2025-04-23T11:39:49+03:00

The aim of the study is to demonstrate the difficulties in instrumental diagnosis of acute respiratory distress syndrome (ARDS) in a patient with coronavirus disease (COVID-19) in the presence of certain clinical signs of its development and progression.

Results. We present a case of severe COVID-19 in a 79-year-old unvaccinated patient with comorbidities (stage II hypertension and psoriasis). The diagnosis of COVID-19 was confirmed by RNA detection with PCR; treatment was in accordance with the Order of the Ministry of Health of Ukraine No. 762. On the 3rd day of the disease, despite the presence of physical signs such as shortness of breath in the lower parts of the lungs and dry rales, as well as oxygen dependence, no pathology was detected by X-ray. The coronavirus disease course worsened during the period of hospital treatment, which was manifested by an increased supplemental oxygen requirement and the need to enhance the oxygen level and its partial pressure.

On the 9th day of hospitalization, the patient was transferred to the intensive care unit. Instrumental imaging methods (radiography and ultrasound examination of the lungs) were repeated, showing left-sided interstitial edema of the lung parenchyma with the formation of superficial consolidations, that progressively worsened. That same day, acute myocardial infarction was diagnosed. The level of consciousness decreased to 9 points on the Glasgow Coma Scale due to hypoxia, necessitating the patient’s transfer to mechanical ventilation. On the 24th day of hospitalization, the patient died due to the development of severe ARDS and acute myocardial infarction.

Conclusions. This clinical observation of an ARDS case in a patient with COVID-19 indicates that the emergence of this complication might occur without the typical radiological and sonographic signs of infiltrative lung injury. Alternatively, this could be attributed to the limitations of the equipment employed, while, conversely, the clinical manifestations might be influenced by the pathophysiological characteristics of ARDS development, prompting researchers to identify its distinct subphenotypes.

Intraoperative irradiation of transfused red blood cells during living donor liver transplantation using a portion of the liver

2025-04-23T11:36:54+03:00

Aim. To study the results of intraoperative irradiation of transfused erythrocytes during liver donor liver transplantation. To describe a clinical case of the intraoperatively irradiated erythrocyte use during liver donor liver transplantation in a patient with hepatocellular carcinoma and to evaluate the effectiveness of this approach in reducing postoperative complications.

Materials and methods. In this clinical case, a part of the liver was transplanted to the patient with hepatocellular carcinoma. During surgery, in order to avoid complications from massive whole blood transfusion, autologous erythrocyte mass was used after previous washing using a cell-saver machine and irradiation with a dose of 50 Gy performed on a linear accelerator.

Results. There were neither signs of acute respiratory failure, nor use of oxygen or continuous positive airway pressure therapy in the postoperative period. No indications for transfusion of foreign red blood cells were found as well as no signs of graft dysfunction were noted in the early postoperative period. The highest level of liver markers was observed laboratory in the late postoperative period.

Conclusions. The use of intraoperatively irradiated transfused red blood cells in liver transplantation for the recipient with hepatocellular carcinoma allowed for the prevention of postoperative complications associated with massive foreign blood transfusion such as acute respiratory failure or transfusion-related acute lung injury and early graft dysfunction. An optimal radiation dose is 50 Gy as a compromise between the need to ensure complete inactivation of tumor cells and preserve the functional properties of erythrocytes.

Terra firma-forme dermatosis (a clinical case)

2025-01-28T08:55:36+02:00

Terra firma-forme dermatosis (TFFD, Duncan’s dirty dermatosis) is a little-known skin disease with poorly understood etiology and pathogenesis. The true incidence and prevalence are unclear, and there are rather few publications on the disease. It is clinically characterized by skin hyperpigmentation with the formation of asymptomatic dirt-like plaques despite having good hygiene. Diagnosis is confirmed by lesion resolution after continuous applications of 70 % isopropyl alcohol. This is an ideal method for diagnosis and treatment, but lesions may recur.

Aim. To analyze a clinical case of terra firma-forme dermatosis (Duncan’s dirty dermatosis) in a child.

Results. Considering the disease rarity, the clinical case of terra firma-forme dermatosis (Duncan’s dirty dermatosis) in a 9-year-old boy with a comorbid allergic history is presented. The disease was possibly triggered by a complex effect (unhealthy diet, allergic anamnesis).

Conclusions. This presentation aims to capture attention to terra firma-forme dermatosis (Duncan’s dirty dermatosis). Inadequate awareness of this disease is the reason for worrying overdiagnosis. It is important to recognize this dermatosis to avoid irrational diagnostic and treatment procedures as well as to calm patients and family members. The paper is of interest to dermatovenereologists, pediatricians and general practitioners-family physicians.

From genotype to protein: how the 308 G/A polymorphism of the TNF-α gene is associated with TNF-α protein levels in patients with Hashimoto’s thyroiditis

2025-02-24T10:44:23+02:00

Aim. To study the 308 G/A polymorphism of the TNF-a gene and its influence on serum levels of TNF-a protein in patients with Hashimoto’s thyroiditis (HT) among the Azerbaijan population.

Materials and methods. The study was conducted at the Department of Biochemistry, Azerbaijan Medical University, between 2021 and 2023. The study enrolled 170 patients diagnosed with HT, and a comparison group consisting of 65 individuals without thyroid pathology or other diseases affecting the immune system. The presence of the TNF-α-308 G/A polymorphism (SNP rs1800629) was determined by the PCR-PDRF method and TNF-α protein serum levels were measured according to the standard ELISA protocol in both groups.

Results. The study on the 308 G/A polymorphism of the TNF-α gene has revealed 49.2 % of patients exhibited the G allele and 55.1 % – the A allele. The AG genotype has been found to be most prevalent in HT patients (57.9 %) being significantly higher than in the comparison group (21.7 % of individuals; p = 0.0006, χ² = 11.87, OR = 2.85, 95 % CI = 1.55–5.23). Furthermore, serum TNF-α levels have been shown to be significantly higher in HT patients (3.48 ± 1.32 pg/ml) as compared to the control group (2.31 ± 0.74 pg/ml) with statistical significance (p < 0.01).

Conclusions. The most prevalent AG genotype of the TNF-α gene 308 G/A polymorphism has been identified in patients diagnosed with Hashimoto’s thyroiditis. This polymorphism may serve as a genetic marker, indicating a predisposition to autoimmune thyroiditis among the Azerbaijan population. Furthermore, serum TNF-α protein levels have been found to be significantly elevated in patients with Hashimoto’s thyroiditis, which may be associated with the AG genotype of the 308 G/A TNF-α polymorphism.

Endoscopic management of large laterally spreading colorectal tumors (LSTs): a comparative study of techniques and outcomes

2025-05-14T12:53:45+03:00

Laterally spreading colorectal tumors (LSTs) are associated with a risk of high-grade dysplasia and potential malignant transformation. Endoscopic resection is the standard of care for non-invasive LSTs, with the choice of technique guided by lesion size, morphology, and recurrence risk. The most commonly employed methods include endoscopic mucosal resection (EMR), piecemeal EMR (pEMR), endoscopic submucosal dissection (ESD), and hybrid ESD. Comparative data on the safety and efficacy of these techniques remain limited.

Aim. To compare EMR, pEMR, ESD, and hybrid ESD with respect to complication rates (bleeding, perforation), recurrence, and influencing factors.

Materials and methods. In this single-center, retrospective-prospective study, 100 adult patients with non-invasive LSTs larger than 20 mm were enrolled. Lesions were assessed by expert endoscopists using image-enhanced endoscopy and standardized classifications to analyze surface pit patterns and vascular architecture. Endoscopic resection was then performed by EMR, pEMR, ESD, or hybrid ESD according to lesion size and morphology. Statistical analyses were conducted in “Statistica 13” using binary logistic regression (odds ratios with 95 % confidence intervals), Pearson’s correlation coefficient, and significance set at p < 0.05.

Results. The mean patient age was 64.59 ± 10.89 years. LSTs were granular in 66 % of cases and non-granular in 34 %. Mean lesion size was greatest for ESD (46.6 ± 16.18 mm) and smallest for EMR (21.07 ± 2.49 mm); pEMR and hybrid ESD averaged 33.47 ± 15.20 mm and 38.64 ± 13.62 mm, respectively. Intraoperative perforation occurred in 20 % of ESD cases versus 0 % with EMR / pEMR (OR 0.065, p = 0.021, 95 % CI: 0.0034–1.2500 / OR 0.051, p = 0.008, 95 % CI: 0.0027–0.9700) and 9.09 % with hybrid ESD. Intraoperative bleeding was significantly more frequent during hybrid ESD (36.36 %) compared to pEMR (2.78 %; OR 0.12, p = 0.008, 95 % CI: 0.021 0.690), en bloc EMR (3.57 %; OR 0.091, p = 0.008, 95 % CI: 0.012–0.680), and ESD (4.00 %; OR 0.10, p = 0.013, 95 % CI: 0.014–0.770). Hybrid ESD had a higher recurrence rate (27.27 %) than EMR (0.00 %; OR 0.043, p = 0.007, 95 % CI: 0.002–0.910) and ESD (4.00 %; OR 0.15, p = 0.047, 95 % CI: 0.019–1.170); pEMR recurrence was 11.11 %. A weak positive correlation was observed between recurrence and tubulovillous adenoma morphology (r = 0.233, p = 0.02) and rectal location (r = 0.281, p = 0.005). All complications and recurrences were successfully managed endoscopically.

Conclusions. EMR, pEMR, and ESD are safe and effective for resecting large LSTs, though ESD has a higher risk of intraoperative perforation. Given the elevated rates of recurrence and intraoperative bleeding with hybrid ESD, further investigation of this technique is warranted. Recurrences are more frequent following resection of tubulovillous adenomas and when lesions are located in the rectum.

Analysis of treatment outcomes using various surgical technologies for lumbar intervertebral disc herniation complicated by segmental instability

2024-12-05T15:26:47+02:00

Aim. To compare the outcomes of surgical treatment using open and endoscopic techniques for patients with lumbar disc herniation complicated with segmental instability.

Materials and methods. The study analyzed the results of surgical treatment in 96 patients who underwent surgery for lumbar intervertebral disc herniation associated with segmental instability. All the patients were treated in the Department of Minimally Invasive and Laser Neurosurgery at the State Institution “Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine” (Kyiv) and at the Medical Center “Endoclinic” (Rivne) from 2021 to 2024.

Results. In patients who underwent intralaminar hernia removal with a subsequent transpedicular system fixation, pain was reduced from 10.80 ± 1.40 to 4.50 ± 1.40 points in the early postoperative period, to 2.20 ± 0.80 points after 6 months, and to 1.80 ± 0.23 points after 1 year. According to the McBurney scale, positive results were achieved in 93.02 % of cases. As defined by the NPS, in patients who underwent endoscopic techniques, the pain syndrome regressed from 10.20 ± 0.19 to 2.56 ± 0.09 points in the early postoperative period, to 1.12 ± 0.10 points after 6 months, and to 0.50 ± 0.03 points after 1 year. In the endoscopic group, a decrease in the mean blood loss and average operation time was attained (130.0 ± 0.5 ml, 2.0 ± 0.7 hours), in contrast to the group with intralaminar removing the herniated disc followed by the transpedicular system fixation (260.0 ± 0.3 ml, 3.0 ± 0.5 hours). Thus, modern UBE-TLIF surgical technologies have certain advantages compared to traditional techniques and can be recommended for greater use.

Conclusions. The use of endoscopic surgical interventions for patients with lumbar intervertebral disc herniation complicated by segmental instability allows for minimal surgical trauma, reduced blood loss, a shorter hospital stay, lower risk of postoperative complications, and significantly shortened rehabilitation time.

Albumin treatment of critical conditions on the example of pre-eclampsia

2025-02-11T12:51:35+02:00

Despite the well-documented physicochemical and pharmacodynamic properties of albumin solutions and the availability of clinical guidelines for their use in critical conditions, several aspects of their application, particularly in the context of pre-eclampsia, remain a matter of clinical debate.

Aim: to ascertain the effect of intravenous human albumin solution on the inflammatory process activity in the postpartum period in women with pre-eclampsia.

Materials and methods. 60 women aged 18 to 40 years in the third trimester of pregnancy complicated by moderate or severe pre-eclampsia were assigned to 2 groups of 30 patients each according to the prespecified inclusion and exclusion criteria. Group I patients were given a standard therapy after delivery. Group II patients were treated with the same therapy combined with continuous infusions of 20 % albumin solution (8 ml/h – on day 1; 4 ml/h – on days 2 and 3) and furosemide (0.05 mg/kg/h – on day 1; 0.025 mg/kg/h – on days 2 and 3) for 72 hours. Serum concentrations of interleukins (IL)-6 and IL-10 were measured, and the IL-6 / IL-10 ratio (inflammation index) was calculated before the onset of labor, and on days 1 and 3 of the postpartum period.

Results. The analysis has shown the inflammatory index of 120 % higher the normal in the third trimester of uncomplicated pregnancy, indicating a slight prenatal increase in inflammatory processes. Moderate or severe pre-eclampsia in the same period has been found to be accompanied by significantly increased IL-6/IL-10 ratios by 523.3–570.0 %, showing the significant activation of inflammatory processes. The use of albumin infusion in combination with low doses of furosemide according to the method developed by us has proven the possibility to correct the inflammatory process activity. So, with infusions on the 1st day postpartum, the IL-6 / IL-10 ratio was decreased and exceeded the norm for non-pregnant women by 866.7 % versus 1696.7 % in Group 1 women. On the 3rd day after childbirth, the inflammatory index exceeded the norm by only 116.7 % with intravenous albumin, while in Group 1 (control), it remained 730.0 % higher than the norm.

Conclusions. Intravenous combination of albumin solution with furosemide in the postpartum period according to the authors’ method has helped to significantly reduce the inflammatory index in parturient women with pre-eclampsia.

Risk factor analysis and etiological pathogen spectrum for urinary tract infection in children

2025-04-23T11:28:30+03:00

The problem of urinary tract infection (UTI) in children remains relevant in modern pediatrics, pediatric nephrology, and urology, despite the large number of works focused on this issue studies.

Aim. To analyze the potential predictors of development and examine the etiological spectrum of pathogens for urinary tract infection in children.

Materials and methods. Medical documentation of 238 children aged 1 to 14 years was analyzed. Children were divided into two groups: I – children with UTI (n = 140), II – children without UTI (n = 98). The patient group inclusion criteria for children with UTI met the recommendations of the European Society of Pediatric Urology. Urine culture for microbial flora and antibiotic sensitivity were performed according to standard methods.

Results. UTIs occurred in 32.7 % of boys and 26.1 % of girls. The most frequent UTIs were registered in the 1–3 years age group (54.3 %). Sex-specifics of UTIs were noted, varying depending on age: at the age of 1–3 years, girls were 1.3 times more likely to have UTIs than boys (95 % CI: 0.8–2.5); at the age of 4–7 years, boys were 1.4 times more likely to have UTIs (95 % CI: 0.9–3.4) than girls. Most common in children were vesicoureteral reflux (passive 34.5 % and active 19.2 %), cryptorchidism (12.1 %), and pyelectasia (10.3 %). According to the results of questioning, a positive family history of nephro-urological diseases was found in 35.7 % of patients. Age, heredity, neurogenic bladder, duration and number of hospitalizations, anomaly, congenital defect, constipation, intestinal dysbacteriosis, and anemia were identified as factors influencing UTI in children (p < 0.05), while factors such as sex, place of residence, seasonality, and diabetes mellitus had no significant effect. Gram-negative bacterial flora was predominantly identified including Escherichia coli in both observation groups, Klebsiella oxytoca and Acinetobacter baumannii were isolated more often than other microorganisms.

Conclusions. The predominant pathogen in the development of pediatric urinary tract infections is Escherichia coli. Identification of UTI microbiological spectrum will allow for rapid and rational initiation of empirical antibacterial therapy. Independent risk factors for UTI development should be considered when developing strategic guidelines for prevention, early diagnosis, and treatment approaches.

Mental state of medical students three years into the war

2025-05-01T14:34:22+03:00

The aim of the study was to assess the mental health status of higher medical education students three years into the war in Ukraine.

Materials and methods. 104 students were interviewed at Dnipro State Medical University from February 24 to March 2, 2025, coinciding with the third anniversary of the martial law implementation in Ukraine. The Patient Health Questionnaire (PHQ-9) was used to identify depressive symptoms, while anxiety levels were assessed using the Generalized Anxiety Disorder Scale (GAD-7). Sleep quality components, such as feeling rested after waking, difficulty falling asleep, problems maintaining deep sleep as well as physical and mental components of health-related quality of life (QOL) were evaluated using the visual analog scale.

Results. The study has revealed that 61.5 % of medical students experienced anxiety of varying severity; 39.4 % had clinically significant anxiety, and 18.3 % reported severe anxiety. At the same time, 18.3 % of students exhibited pronounced functional impairment (≥8 points). Depressive symptoms of any severity were present in 76.9 % of respondents; 39.4 % had clinically significant depression, and 19.2 % had severe depression. Difficulty falling asleep was reported by 57.0 % of students, mostly of mild-to-moderate severity; 49 % experienced disturbed deep sleep, with 12.0 % reporting severe disturbances. The majority of students expressed dissatisfaction with sleep quality: 33.0 % reported moderate dissatisfaction, and 23.0 % indicated significant rest disturbance. Moreover, only 38.0 % of respondents reported no impairment in the mental component and 54.0 % – in the physical component of QOL.

Conclusions. Ensuring the psychological resilience of medical students in Ukraine is critically important. Psychological support should focus not only on managing anxiety, depression, and sleep disorders but also on improving health-related quality of life to enhance overall resilience.

Memory changes in rats following repeated blast-induced neurotrauma

2025-06-05T14:09:03+03:00

Aim. To determine the characteristics of memory changes in associative and spatial memory in the dynamics of repeated blast-induced neurotrauma (rBINT) in rats.

Materials and methods. The study was conducted on 36 sexually mature male rats, in accordance with the current legislation on the humane treatment of animals. The selected rats were randomly divided into 2 groups for assessment using the conditioned passive avoidance response (CPAR) test (I) and the Barnes maze (II). In each of these groups, three subgroups were formed: Experimental – subjected to 3-fold exposure to a blast wave with an excess pressure of 31.6 ± 4.8 kPa; Control – exposed only to halothane and fixation; Intact. The study was conducted on the 1st, 3rd, 7th, 14th, 21st and 28th days after the blast wave exposure.

Results. Experimental reproduction of rBINT on the 1st, 3rd, 7th, 14th, 21st day showed a significant decrease in the time spent by rats in the light compartment in the CPAR test as compared to the control and intact groups, indicating a deterioration in associative memory. The study using the Barnes maze demonstrated significantly increased latency to find the target hole and the number of errors in experimental animals throughout the observation period as compared to the control and intact groups, indicating a deterioration in spatial memory.

Conclusions. Experimental modeling of repeated blast-induced neurotrauma in rats has revealed a significant decrease in associative memory within the first 14 days after the exposure with partial recovery from day 21 to 28. Spatial memory remained impaired throughout the observation period, as evidenced by increased time to locate the hidden platform and the number of errors in the Barnes maze. The detected impairments suggest the impact of the blast wave on cognitive functions, and could be associated with hippocampal pathologies, neuroinflammation, and prefrontal cortex dysfunction.

A cardiometabolic patient and microbiota

2025-01-28T08:58:54+02:00

Aim: to determine associations between the microbiota and a cardiometabolic patient’s condition and to identify key mechanisms of the microbiota influence on the cardiovascular system and metabolic profile based on summarizing the scientific literature.

Material and methods. A descriptive-comparative analysis was performed to study associations between cardiometabolic patient’s condition and microbiota. The work was based on a substantive review of modern scientific literature, which allowed us to identify key aspects of this interaction and its impact on metabolic and cardiovascular processes. To achieve the goal, the following research methods were used: search method, comparative analysis, methods of generalization and synthesis.

Results. The article presents the study results indicating the pathology development such as abdominal obesity, diabetes mellitus, atherosclerosis, and arterial hypertension induced by disturbances in the microbiota composition (dysbiosis). Studying the probiotic and prebiotic effects provides perspectives to correct dysbiosis and improve the intestinal microflora functions. Probiotics, such as Lactobacilli and Bifidobacteria, are capable of microbiota balance normalization, reducing the risk for cardiovascular complications, as well as improving lipid metabolism and reinforcing the intestinal barrier function. Prebiotics help stimulate the beneficial bacteria colonization and the production of key metabolites such as short-chain fatty acids.

Conclusions. The intestinal microbiota has been shown to play a key role in the development and progression of numerous pathological conditions, such as cardiovascular disease, obesity, diabetes mellitus, atherosclerosis, and hypertension. Its effects are mediated by mechanisms, including intestinal wall permeability variations, pro-inflammatory process activation, and metabolic activity alterations. One of the important factors is a decreased count of microorganisms that produce short-chain fatty acids, resulting in impaired metabolism and an increased risk for cardiometabolic diseases.

Genital ulcer disease: current challenges and perspectives

2025-02-19T09:48:14+02:00

Aim. To analyze the role of etiological factors of genital ulcer disease based on data from professional literature and to develop proposals for improving diagnostic algorithms, as well as a syndromic approach to treatment and prevention, in particular, regarding current trends in world medical practice.

Materials and methods. Full-text articles were searched and analyzed in Google Scholar, Scopus, PubMed, and Web of Science databases. The search was performed using the following key terms: genital ulcer disease, genital herpes, syphilis, chancroid, lymphogranuloma venereum, donovanosis. Statistical data from the European Center for Disease Prevention and Control and the Centers for Disease Control and Prevention in the United States were also used.

Results. The World Health Organization pays considerable attention to sexually transmitted diseases and more specifically discusses the effective management and treatment of genital ulcers. The main causes of genital ulcers are infections caused by five major pathogens: herpes simplex virus type 2, syphilis, chancroid, donovanosis and lymphogranuloma venereum. According to recent studies, herpes simplex virus type 2 and syphilis remain the leading pathogens among infections that cause genital ulcers, but their role differs depending on the region and socioeconomic factors. The most important among these pathogens are herpes viruses due to the ability to cause recurrent and lifelong infection that are perhaps the main cause of genital ulcers. Infections such as chancroid and donovanosis are gradually decreasing in prevalence even in regions where they were more common in the past owing to changes in sexual behavior and improved access to modern means of prevention.

Conclusions. For effective treatment and diagnosis of genital ulcer disease and associated asymptomatic urogenital infections, it is important to improve diagnostic algorithms that will allow to identify the causative agents accurately and apply a comprehensive approach to treatment. An important area is the development of vaccines that will provide long-term immunity against major pathogens, in particular herpes simplex viruses and lymphogranuloma venereum, and thus will help to increase the protection of populations as well as reduce recurrences and antimicrobial resistance.