Zaporozhye Medical Journal

Predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction due to stenotic coronary artery disease

2025-01-28T09:02:20+02:00

Aim. To identify modifiable and non-modifiable risk factors for no-reflow syndrome in ST-segment elevation myocardial infarction (STEMI) patients undergoing reperfusion by balloon angioplasty.

Materials and methods. We analyzed 392 patients with STEMI who underwent percutaneous coronary intervention (PCI). The patients were divided into 2 groups based on the presence of no-reflow syndrome. Clinical data, laboratory results and instrumental findings were compared between the groups.

Results. A higher proportion of women has been observed among no-reflow patients compared to normal-flow group (33 % versus 22 %, p < 0.05). A lower hemoglobin level has been found in the study group as compared to that in the control group: 132 g/L and 136 g/L, respectively (p < 0.05). However, the same proportion of individuals with anemia has been documented in both groups (p = 0.79). Patients with no-reflow syndrome had lower glomerular filtration rate (GFR) compared to those in the normal-flow group – 61.1 mL/min/1.73 m² versus 67.9 mL/min/1.73 m² (p < 0.05). Additionally, GFR <60 mL/min/1.73 m² has been more common in the study group (48 %) than in the control group (35 %). Lesion types of an infarct-related artery in patients with no-reflow have been presented significantly more often as acute occlusion (78 % versus 65 %, p < 0.05) or thrombotic occlusion / subocclusion (6 % versus 1 %, p < 0.05). In the cases of impeded distal blood circulation during PCI, thrombus extraction was performed in 9 % of patients, compared to only 2 % in the normal blood flow group (p < 0.05). Female sex (OR 1.71 95 % CI 1.01–2.87), thrombus extraction (OR 4.24 95 % CI 1.49–12.05) and a patient belonging to the GFR <60 mL/min/1.73 m² category (OR 1.66 95 % CI 1.03–2.69) have been identified as the risk factors increasing the chances for developing no-reflow.

Conclusions. Female sex represents a non-modifiable risk factor for the development of no-reflow phenomenon. GFR <60 mL/min/1.73 m² is a significant modifiable risk factor. Characteristics of the infarct-related artery lesion, such as acute occlusion or thrombotic occlusion / subocclusion, are associated with an increased risk of no-reflow.

Practical experience and clinical results of reconstructive surgical correction of primary and secondary mitral regurgitation

2025-02-19T09:50:39+02:00

Mitral regurgitation (MR) is the most common valvular anomaly worldwide, affecting more than 2 % of the population. Mitral valve surgery is indicated in symptomatic patients with severe insufficiency and asymptomatic individuals with left ventricular systolic dysfunction, pulmonary hypertension, or atrial fibrillation.

Aim. Improving the immediate and long-term outcomes after cardiac surgery by demonstrating our own experience and analyzing the results of plastic correction for mitral regurgitation in patients with primary and secondary heart defects.

Materials and methods. A single-center retrospective observational study of clinical data on 107 consecutive patients with mitral valve insufficiency who underwent a surgery at Zaporizhzhia Regional Clinical Hospital between 01.01.2020 and 31.12.2024 was conducted. Depending on clinical and etiological factors, the structure of patients with MR was defined as follows: primary MR – 47.66 % (n = 51), secondary MR – 52.34 % (n = 56) cases. The mean age of patients was 62.2 ± 11.2 years. The studied patients had a sex distribution of 40 (37.38 %) female and 67 (62.62 %) male individuals.

Results. The length of stay in the intensive care unit was 4.6 ± 1.2 days. The total hospital length of stay was 17.4 ± 9.0 days. The hospital mortality rate for primary MR was 1.87 % (n = 2) and 7.48 % (n = 7) for secondary. At the time of discharge, 18.56 % (n = 18) of patients had no residual MR. In 51.54 % (n = 50) of patients, minimal (trivial) MR was detected, in 18.56 % (n = 18) – mild MR, and in 11.34 % (n = 11) – moderate MR. Thus, reconstructive plastic interventions on the MV were successfully performed in 90.65 % (n = 97) of patients. Freedom from reoperation in the early postoperative period was 100 %, freedom from moderate or severe MR in the early postoperative period was 88.66 % (86 out of 97 patients at the time of discharge).

Conclusions. Modern surgical repair techniques for mitral valve reconstruction demonstrate highly effective and safe treatment of patients with primary and secondary mitral insufficiency. Transthoracic echocardiography is the most common and necessary powerful imaging method for the diagnosis of mitral regurgitation.

Evaluation of long-term effectiveness of modified laparoscopic one-anastomosis gastric bypass in patients with morbid obesity

2025-01-28T08:57:22+02:00

Aim. To determine the long-term effectiveness of modified laparoscopic one-anastomosis gastric bypass in patients with morbid obesity.

Materials and methods. A total of 36 patients with morbid obesity who underwent a surgery from 2010 to 2019 were divided into two groups according to the surgical intervention type. Group 1 – 20 (55.6 %) patients who underwent laparoscopic one-anastomosis gastric bypass in the modification of the clinic, group 2 – 16 (44.4 %) patients who underwent the Roux-en-Y gastric bypass. The study included patients of both sexes, aged 18 to 60 years with a body mass index (BMI) of ≥40 kg/m². Patients with severe decompensated comorbidities, oncological diseases, and contraindications to laparoscopic interventions were excluded from the study. The results were evaluated at 1, 3, and 5 years. Anthropometric parameters were monitored dynamically; quality of life was assessed according to the Short Form 36 questionnaire, esophagoduodenoscopy with chromography and biopsy were performed to detect bile reflux. Statistical data were processed using the Statistica for Windows 13.0 software package.

Results. When analyzing the findings obtained, higher rates of weight loss in kilograms and percentage of excess and total body weight reduction during the entire follow-up period (p < 0.05) have been noted in group 1 patients. At the same time, the mean BMI had a statistical difference between the groups only 5 years after the surgery (p = 0.0487). The quality of patients’ life has been found to be significantly improved in both groups compared to that in the preoperative period, but without statistical significance in the long-term follow-up period. Bile reflux occurred in only 10 % of group 1 patients during the entire follow-up period (p > 0.05) with no signs of malignancies.

Conclusions. Laparoscopic one-anastomosis gastric bypass surgery modified in the clinic results in quick weight loss and significant improvements in quality of life in morbidity obese patients within 12 months after the surgery. Furthermore, the anti-reflux mechanism we developed is effective enough to prevent bile reflux.

Effectiveness of laparoendoscopic surgical treatment with single-site / single-incision laparoscopic surgery method in gynecological practice

2024-12-19T09:25:21+02:00

Laparoendoscopic single-site surgery (LESS) / single-incision laparoscopic surgery (SILS) is considered the effective minimally invasive laparoendoscopic method for solving gynecological problems.

The aim of the study was to clinically analyze and evaluate the main advantages and disadvantages of transumbilical LESS / SILS surgeries used in the surgical treatment of patients with tubo-ovarian pathologies.

Materials and methods. Depending on the tasks and the methods of examination and surgical treatment, patients were divided into 3 large groups: group I (comparison group I) patients underwent laparotomic surgical interventions on the pelvic organs; group II (comparison group II) patients were subjected to classical laparoscopic surgical treatment tactics, and group III (main group) patients underwent minimally invasive LESS / SILS surgeries.

Results. Pain intensity was statistically significantly lower measuring to 1.8 ± 0.1 cm on the Visual Analogue Scale in the postoperative period when applying LESS compared to other methods. The final analysis of intraumbilical scar on the Vancouver Scar Scale has revealed the highest cosmetic effect with a statistically significant score of 0.14 ± 0.08 6 months after LESS. In the long-term postoperative period, the least statistically significant complications have been observed after LESS / SILS with a rate of ventral hernia of 2.1 % and adhesions – 6.3 %.

Conclusions. The main advantages of LESS / SILS compared to laparotomy and laparoscopic surgeries are as follow: reduced blood loss, fewer postoperative complication rates, and faster recovery of patients in the early postoperative period. Since only a single incision is made, the pain sensation is minimal, and patients quicker return to usual daily activities. The main disadvantages of LESS are certain technical difficulties encountered during the procedure, as well as complications (conversion) observed during the intraoperative period. Since complications after LESS are minimal, this method is considered a more optimal approach for patients compared to classical laparoscopy. There is a need to optimize the application and functions of this method in clinical practice.

Non-pharmacological prevention of pregnancy complications in women with hypertension in the context of military operations in Ukraine

2024-12-05T14:18:40+02:00

Aim. To assess anxiety levels in pregnant women with hypertensive disorders (HDs) and the effectiveness of the developed complex non-drug relaxation measures in conditions of military operations in Ukraine.

Materials and methods. 170 pregnant women were examined during the period 2022–2024. At stage I, specialized psychometric testing was conducted using the Spielberger–Hanin scale and the Traumatic Event Impact Assessment Scale (IES-R) in two groups: 1 – pregnant women with HDs (n = 60); 2 – pregnant women without HDs (n = 60). At stage II, the relationship between pregnancy complications and the anxiety level in women with HDs was assessed. At stage III, the effectiveness of the developed complex non-drug treatment and prevention measures was assessed in both groups of pregnant women: 2D (n = 30) – in addition to drug therapy, non-drug methods were used, 2E (n = 20) – received standard drug therapy. Statistica 10 for Windows and Microsoft Excel 2016 programs were used for statistical processing of the results.

Results. Moderate and high levels of both trait and state anxiety have been documented in most examined individuals of both groups (95.0 % and 91.7 %) according to the Spielberger–Hanin scale. High levels of trait and state anxiety prevailed in patients with HDs, 56.7 % and 43.3 %, respectively, with a statistical advantage of trait anxiety, p < 0.05, which were additional stress factors. Assessment of the traumatic event impact (IES-R) on the intrusion subscale has revealed a predominance of high anxiety levels in both groups (40.0 %); the avoidance subscale: 56.7 % in group 1 vs. 51.7 % in group 2; the physiological arousal subscale: 35.0 % in group 1 vs. 15.0 % in group 2, p < 0.05. The findings have suggested that the psychological state of pregnant women in Ukraine was significantly affected by the socio-psychological background associated with military operations. After the implementation of the complex measures, the preeclampsia incidence was significantly decreased (13.3 %), the percentage of vaginal births was increased, and their duration was reduced. Normalization of sleep and lactation initiation have been observed. The percentage of women with persistent arterial hypertension in the postpartum period was lower in group 2D (46.7 %) as compared to group 2E (60.0 %).

Conclusions. A significant incidence of high anxiety levels in pregnant women in Ukraine has been revealed, that we believe to be associated with military operations in the area. Patients with hypertensive disorders are more prone to high anxiety levels, so these disorders can be considered additional stress factors. The proposed complex relaxation measures have demonstrated improved pregnancy outcomes, normalization of sleep and blood pressure after childbirth, and lactation initiation in pregnant women with arterial hypertension.

Analysis of the prevalence and sensitivity to antimycotic drugs of C. albicans strains in Bukovina during 2019–2023

2024-12-17T19:00:37+02:00

The aim of this work was to study the prevalence of C. albicans strains among patients with inflammatory processes of various localization during 2019–2023 years and to analyze dynamics in the sensitivity of these isolates to antifungal drugs.

Materials and methods. The study examined 608 strains of C. albicans: 161 strains isolated from the vaginal mucosa, 170 isolates – from the oral mucosa and tonsils, and 276 strains isolated from feces. A chromogenic medium was used for primary culture isolation, identification, and differentiation of Candida ssp. The sensitivity of all isolated strains to antifungal drugs (nystatin, amphotericin B, fluconazole, voriconazole, itraconazole, clotrimazole, econazole, miconazole, ketoconazole) was determined by the disk diffusion method according to the 2017 recommendations of the Clinical and Laboratory Standards Institute (CLSI).

Results. The incidence of C. albicans isolation from all studied biotopes had been increasing until 2022, whereas the number of isolations was statistically significantly higher in 2020 year compared to that in 2019 year: for strains isolated from the oral mucosa tφ = 1.67, p < 0.05; for vaginal isolates tφ = 2.66, p < 0.01; for fecal tφ = 2.76, p < 0.01. A statistically significant decrease in the isolation of C. albicans from all analyzed biotopes was noted in 2023. The dynamics of the isolated C. albicans strain sensitivity was barely related to the biotope of pathogen isolation. Among all the strains studied, sensitivity to nystatin remained high throughout the entire observation period, while it decreased to amphotericin B in 2020 (statistically significantly for vaginal isolates, tφ = 2.73, p < 0.01). The sensitivity of C. albicans strains to fluconazole and voriconazole was almost unchanged and did not relate to the biotope of pathogen isolation. Susceptibility to itraconazole was higher among all the strains (statistically significantly when comparing the data of 2021 and 2022: for oral strains tφ = 7.63 (p < 0.001); for vaginal tφ = 4.85 (p < 0.001); for fecal tφ = 7.97 (p < 0.001). The susceptibility of isolated C. albicans strains to clotrimazole, econazole, and ketoconazole was sharply decreased in 2020 with the onset of the SARS-CoV-2 pandemic (COVID-19), statistically significantly in most cases, and gradually increased to pre-epidemic levels in the years that followed.

Conclusions. The increase in the incidence of C. albicans isolation in 2020–2022 can be considered a trend for the initial period of the COVID-19 pandemic. At the same time, a substantial decrease, often statistically significant, in the isolated strain sensitivity to clotrimazole, econazole, ketoconazole and a gradual increase in this indicator the following year have been detected. The highest and almost constant sensitivity of the studied C. albicans strains was to nystatin, voriconazole, fluconazole, and it was the lowest to miconazole. Changes in the sensitivity of C. albicans strains to antifungal drugs require constant monitoring of this parameter.

Inadvertent perioperative hypothermia

2024-12-14T18:25:27+02:00

Inadvertent perioperative hypothermia (IPH) is a reduction in body temperature during the perioperative period defined as a loss in core temperature to below +36.0 °C. The development of hypothermia is associated with pharmacological blockade of thermoregulatory mechanisms, increased heat loss from a surgical wound, infusion of unwarmed solutions, low temperature in the operating room, and exposed surgical areas.

Aim: to analyze the issues of risk factors, pathophysiology, complications, prevention, and treatment of IPH based on literature sources.

Materials and methods. A search was carried out for scientific articles over the past 10 years in electronic databases of medical publications, in particular PubMed, Google Scholar, Scopus and Web of Science, using the keywords “hypothermia accidental”, “perioperative hypothermia”, “perioperative hypothermia management”, “perioperative period”, “perioperative medicine”, etc. For analysis, articles were selected that provided data on the impact of IPH on organs and systems, the causes of its development, complications and methods of prevention and treatment.

Results. IPH negatively effects numerous organs and systems of the body inhibiting coagulation and metabolism, reducing oxygen supply to tissues, increasing plasma catecholamine concentrations and the risk of cardiovascular complications, elevating the risk of postoperative wound infection, reducing cerebral metabolism, increasing the incidence of postoperative pain exacerbation, nausea and vomiting as compared to normothermic patients. The causes of hypothermia in the perioperative period can be low-temperature operating room environment, cold solutions, inhibition of thermoregulation by anesthetic drugs, prolonged exposure of body cavities and surgery duration. Heat loss during anesthesia causes a three-phase pattern of hypothermia. In the first phase, there is a rapid decrease in body temperature with peripheral vasodilation, in the second phase, the decrease becomes more gradual, followed by vasoconstriction, and the third phase occurs – “plateau” phase, when heat production and heat loss are balanced. Current principles of prevention and management of IPH include perioperative temperature regulation, measures to reduce heat loss by thermal insulation of the skin, active preoperative patient warming. Respect for these principles helps to reduce the number of blood transfusions, the risk of purulent-septic complications, the duration of mechanical ventilation as well as the intensive care unit and hospital length of stay.

Conclusions. Inadvertent perioperative hypothermia is a common condition linked to numerous risks for patients. Monitoring the patient’s body temperature and preventing the development of hypothermia are among the key perioperative concerns for anesthesiologists. To prevent inadvertent perioperative hypothermia, it is essential to follow the recommended temperature regime for patients at all perioperative stages. Particular attention should be paid to patients in medical emergencies requiring urgent surgical interventions.

Characteristics of anesthetic management in elderly patients with frailty syndrome

2024-12-17T23:34:44+02:00

The increase in the proportion of elderly people has led to a proportional increase in geriatric patients undergoing surgical treatment. Elderly patients often develop geriatric syndromes, one of which is the frailty syndrome.

Aim. Based on the analysis of scientific literature, to emphasize the specifics of anesthetic care for surgeries in patients with frailty syndrome.

Materials and methods. To achieve the goal, a search and analysis of full-text articles in the PubMed, Web of Science, Google Scholar, Scopus databases was conducted using the key terms “frailty syndrome” and “anesthesia”, including randomized controlled trials and meta-analyses and covering English- and Ukrainian-language publications over the past 10 years (from September 2014 to September 2024). A total of 390 publications were selected and analyzed.

Results. Currently, more than 20 different tools for assessing frailty are known in the literature. The most suitable for preoperative assessment were the Clinical Frailty Scale, the FRAIL scale, and the most informative was the Comprehensive Geriatric Assessment. Strictly controlled general anesthesia with extended monitoring and continuous adjustment of almost all organ functions should be considered for most frail patients when choosing an anesthesia method. Aging affects the pharmacokinetics and pharmacodynamics of drugs. The dosage of most modern anesthetic agents should be reduced by 25–75 % in patients with senile frailty. In the postoperative period, rational analgesia and cardiorespiratory monitoring should be provided.

Conclusions. The anesthetic management plan should include a detailed preoperative assessment, selection of the optimal method of intraoperative analgesia, structured intraoperative procedures, and a course of postoperative treatment with adequate pain relief. Optimal perioperative management of patients with frailty syndrome requires close interdisciplinary, interprofessional, and interdisciplinary collaboration to minimize adverse postoperative outcomes.

Dental caries as a common dental disease: prevalence and association with gastrointestinal pathology in children (a literature review)

2025-02-19T09:55:55+02:00

Dental caries is the most widespread dental disease, with a prevalence among the pediatric population worldwide ranging from 39.6 % to 75.43 %, and an intensity of 0.89–3.40 teeth. In Ukraine, the prevalence of dental caries varies from 42 % to 96 %, with an intensity of carious lesions ranging from 0.07 to 6.50 teeth. Higher rates of dental caries have been observed in children with somatic diseases, which contribute to the formation of deficient dental hard tissue structure, reduced enamel resistance, and favorable conditions for caries development.

The aim of the study: to examine and analyze the data on the prevalence of dental caries in permanent teeth in children with chronic gastrointestinal tract (GIT) diseases based on Ukrainian and foreign scientific research.

Materials and methods. The bibliosemantic method was applied to study the issue of dental hard tissue diseases in children with GIT disorders. Results of Ukrainian and foreign studies from available electronic resources such as PubMed, Scopus, Web of Science, and Google Scholar for the period 1990–2024 were analyzed.

Results. A review of thematic scientific sources indicates on increasing in the prevalence of GIT diseases among children of different ages, with a clear trend toward the “rejuvenation” of these diseases globally and in Ukraine particularly. Significantly higher rates of dental caries were identified in children with these somatic pathologies compared to healthy children, with a predominance of subcompensated and decompensated forms, complicated caries, and reduced enamel. Diverse perspectives were observed regarding the impact of H. pylori on the formation of dental caries. In addition to caries, enamel hypoplasia and erosion of dental hard tissues were noted in children with GIT diseases.

Conclusions. According to the literature, there is a trend of GIT disease increasing prevalence among the pediatric population in Ukraine, especially among children under one year old (an increase of 13.0 %) and adolescents (an increase of 73.7 %). In children with GIT disorders, the prevalence of dental caries, as reported in the literature, ranges from 61.54 % to 100.00 %, with an intensity of 3.31 to 8.96 teeth. Contradictory data regarding the relationship between GIT diseases and dental caries, including the influence of H. pylori on the formation of caries-susceptible enamel, underscores the relevance and importance of further research on this issue.

Intestinal microbiome: basics of diagnostics for maintaining health

2025-02-06T09:25:03+02:00

Aim. To examine the impact of the gut microbiome on human health, as well as modern methods of its diagnosis, determining the role of modern diagnostic tests as a tool for assessing the microbiota state and its importance in personalized medicine.

Materials and methods. A literature search was conducted in scientometric databases, including PubMed, Scopus, Web of Science, and Google Scholar, using the keywords: gut microbiome, microbiota diagnostics, GA-map dysbiosis test, fecal microbiota. The analysis included over 30 sources from specialized scientific literature.

Results. The article covers the role of gut microbiome diagnostics in maintaining human health by presenting a comprehensive analysis of modern diagnostic methods, their comparative advantages and disadvantages, with a focus on the GA-map dysbiosis test as an innovative standardized approach. The authors review the historical context, dating all the way back to the Hippocrates’ views, and trace the evolution of microbiome studies to modern technological advances. Particular attention is paid to key aspects of microbiome composition, including recent changes in the nomenclature of bacterial phyla and the issues of various diagnostic method standardization.

The article discusses the stages of development and clinical validation of the GA-map diagnostic test, emphasizing its advantages in providing standardized and reproducible results. The clinical application and interpretation of the test results are analyzed, demonstrating the importance of the test for personalized medicine approaches. The study reinforces the importance of understanding the gut microbiota for disease prevention and treatment, suggesting that standardized diagnostic methods such as GA-map could significantly improve clinical outcomes.

Conclusions. The importance of maintaining microbiota balance for disease prevention has been emphasized. The GA-map dysbiosis test has demonstrated high accuracy and reproducibility allowing physicians to develop individualized nutrition and treatment recommendations and making it a key tool in modern medicine aimed at a personalized therapeutic approach.

Sarcoidosis as a diagnostic challenge – a case report

2024-12-05T14:24:16+02:00

Sarcoidosis is considered a disease of unknown etiology which usually affects several organs and systems of the body and is manifested by the development of non-caseous granulomas. It is predominantly a multisystemic granulomatous disease that most often affects the respiratory and lymphatic systems, but varies clinically from patient to patient, making it difficult to diagnose correctly. The diagnosis is based on clinical and radiological data, the results of the sarcoidosis biomarker examinations, confirmed by the histological picture of non-caseous epithelioid cell granulomas. The use of modern instrumental methods of examination such as magnetic resonance imaging, high-resolution computed tomography, 18F-fluorodeoxyglucose-positron emission tomography has significantly improved the diagnosis of sarcoidosis.

Aim. The purpose of this paper is to present a clinical case of pulmonary sarcoidosis with atypical initial origin needed for additional differentiation and specific confirmation of the diagnosis.

Materials and methods. Diagnostic and differential diagnostic procedures were provided for a 24-year-old patient at the Therapeutic Department of the Regional Hospital of War Veterans (Chernivtsi, Ukraine). Complete examination included general clinical, laboratory and instrumental testing. Results of the clinical data were analyzed in dynamics, clinical diagnosis was confirmed by specific biomarkers, imagine tests and transbronchial lung biopsy with histology.

Results. The authors have presented the case of the 24-year-old man with atypical sarcoidosis associated with vertebrogenic thoraco-lumbalgia and persistent severe pain syndrome. He was admitted due to fever, increased temperature up to 37.2–37.4 °C, headache, muscular thoracic spine pain, unexplained general intoxication. He had a history of nephrectomy and mine-explosive injury. His specific objective findings were negative, but some nonspecific inflammatory biomarkers were imbalanced. Respiratory and inflammatory manifestations worsened in several days after admission that led to further diagnostic search and raised suspicion of sarcoidosis. Given the nonspecific clinical presentation and laboratory findings, the diagnosis needed a confirmation by chest computed tomography, sarcoidosis biomarkers and transbronchial lung biopsy with histology.

Conclusions. Thus, this case illustrates that even classic pulmonary sarcoidosis may started atypically, and diagnostic procedure requires extensive differentiation and specific confirmation by using modern diagnostic tools.