Zaporozhye Medical Journal

A case of an atypical course of rabies

V. V. Cherkaskyi — 2026-02-11

The aim of this study was to perform a clinical analysis of an atypical course of rabies in a 68-year-old female patient.

Materials and methods. A retrospective analysis of the medical records of the 68-year-old woman who died from the paralytic form of rabies was conducted. The patient was hospitalized at the Municipal Non-Profit Enterprise “Regional Infectious Diseases Clinical Hospital” of the Zaporizhzhia Regional Council from April 19 to April 29, 2024. The diagnosis of rabies was confirmed post-mortem by detection of rabies virus RNA in brain tissue using polymerase chain reaction (PCR), as well as by morphological verification of Babes–Negri inclusion bodies in the brain tissue.

Results. This clinical case describes an atypical (paralytic) form of rabies in the 68-year-old patient. The initial clinical presentation lacked classical manifestations such as agitation, aerophobia, and hydrophobia. The disease onset was characterized by flaccid paralysis, which progressively evolved into tetraparesis and other neurological signs indicative of encephalitic brain involvement. This atypical presentation significantly complicated the diagnostic process and resulted in the establishment of only symptomatic diagnoses during life. Suspicion of rabies arose only after clarification of the epidemiological history, which revealed that 2–3 months before the onset of symptoms the patient had been bitten by a dog of unknown vaccination status that died two days after the incident. Definitive confirmation of rabies was obtained during the post-mortem pathological examination through detection of rabies virus RNA in brain tissue using PCR and identification of Babes–Negri inclusion bodies. In our opinion, the most likely cause of infection and the atypical disease course was the administration of an incomplete course of post-exposure rabies prophylaxis. This observation highlights the critical importance of strict adherence to the anti-rabies prophylaxis protocols recommended by the World Health Organization.

Conclusions. This clinical case demonstrates that an atypical (paralytic) course of rabies may mimic other neurological syndromes, particularly in the absence of a clearly established epidemiological history. Such circumstances pose significant challenges to timely and accurate diagnosis. Incomplete post-exposure rabies prophylaxis was identified as the cause of the fatal outcome and is considered the probable reason for the atypical clinical course of the disease.

Clinical case of rifampicin-resistant tuberculous meningitis in a child: features of diagnosis, management and outcomes

Yu. V. Myronchuk — 2026-02-11

Aim: to demonstrate, based on an original clinical observation, the features of diagnosis, clinical management, and outcomes of rifampicin-resistant tuberculous meningitis in a child.

Materials and methods. A clinical case of rifampicin-resistant tuberculous meningitis in a child treated in the Pediatric Unit at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical and Pharmaceutical University, located at the Public Non-Profit Enterprise “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthisiology and Pulmonology” of the Zaporizhzhia Regional Council.

Results. A child was admitted to the Pediatric Unit from the pediatric intensive care unit (ICU) with a diagnosis of acute tuberculous meningitis. The diagnosis was confirmed by cerebrospinal fluid analysis using the Xpert MTB/RIF Ultra assay, which detected Mycobacterium tuberculosis resistant to the first-line antituberculous medication rifampicin. At the time of transfer, chest radiography revealed no pulmonary abnormalities. Brain magnetic resonance imaging showed no focal pathology. During further evaluation, the child’s mother was diagnosed with chemoresistant tuberculosis. The child received antituberculous and symptomatic therapy prescribed by a neurologist in the ICU for more than four months. During follow-up, chest computed tomography revealed disseminated pulmonary involvement. Following completion of treatment, the child was cured; however, epileptic syndrome developed, requiring lifelong therapy.

Conclusions. Delayed diagnosis of tuberculous meningitis in children is a major risk factor for disability. The clinical presentation is nonspecific, with manifestations typically occurring at later stages of the disease. Management requires combined antituberculous, hormonal, and symptomatic therapy and close cooperation among physicians of various specialties. Rapid and timely diagnosis, screening of at-risk groups, and effective treatment significantly improve prognosis and reduce mortality and disability.

Prediction of significant left ventricular myocardial fibrosis in patients with hypertrophic cardiomyopathy based on maximum wall thickness assessed by multiparametric cardiac MRI

M. S. Ishchenko — 2026-02-11

Hypertrophic cardiomyopathy (HCM) is the most common cardiomyopathy, characterized by left ventricular (LV) hypertrophy and associated with an increased risk of sudden cardiac death (SCD). One of the key morphological predictors of SCD is myocardial fibrosis, which is visualized on cardiac magnetic resonance (CMR) imaging using late gadolinium enhancement (LGE). An LGE extent of ≥15 % of LV mass significantly increases the risk of ventricular arrhythmias and SCD. A potential parameter for predicting this is the maximum LV wall thickness, which may correlate with the extent of myocardial fibrosis. However, this association remains a subject of scientific investigation, and it is the main focus of this study.

Aim. To assess the relationship and degree of correlation between maximum LV wall thickness and the presence of extensive myocardial fibrosis (LGE ≥15 %) detected by multiparametric CMR in patients with HCM.

Materials and methods. Data from 207 patients with confirmed HCM who underwent multiparametric CMR at the National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine between January and December 2024 were analyzed. Radiologists performed LV myocardial segmentation and quantified fibrosis, reporting LGE as a percentage of total LV mass. Patients were divided into two groups according to the degree of fibrosis: Group I – patients without extensive fibrosis (LGE <15 %) and Group II – patients with extensive fibrosis (LGE ≥15 %).

Results. The study included 207 patients with a mean age of 48.4 ± 12.9 years and a mean maximum LV wall thickness of 24.3 ± 5.5 mm. Extensive LV myocardial fibrosis (LGE >15 %) was detected in 35 patients (16.9 %), whereas 172 patients (83.1 %) had absent, mild, or moderate fibrosis. Patients with extensive fibrosis (Group II) had significantly greater maximum wall thickness (29.8 ± 5.5 mm) compared to Group I (23.2 ± 4.8 mm, p < 0.001). ROC curve analysis identified an optimal cutoff value of maximum LV wall thickness of 26 mm to detect extensive fibrosis, with a sensitivity of 83 %, specificity of 69 %, and an AUC of 0.823.

Conclusions. This study demonstrates a statistically significant correlation between maximum LV wall thickness and the presence of extensive myocardial fibrosis (LGE ≥15 %) in patients with HCM. This finding could be useful for assessing SCD risk when CMR is unavailable.

Clinical and laboratory characteristics of ST-segment-elevation acute coronary syndrome depending on body mass index

V. A. Kovalenko — 2026-02-11

Obesity is a critical risk factor for cardiovascular disease, specifically ST-segment elevation myocardial infarction (STEMI), and may influence clinical presentation, laboratory findings, and patient outcomes.

Aim. To identify clinical and laboratory features and evaluate the disease course in patients with acute coronary syndrome and ST segment elevation across different body mass index (BMI) categories.

Materials and methods. A non-randomized, open-label, prospective cohort study was conducted involving 120 patients with STEMI. Participants were categorized into three groups based on their BMI.

Results. In the obese group, a strong positive correlation was observed between troponin I levels and BMI (r = 0.632, t = 5.29, p < 0.001). A moderate correlation was found in the overweight group (r = 0.402, t = 2.86, p < 0.01). Furthermore, a statistically significant positive correlation between BMI and erythrocyte sedimentation rate (ESR) was identified in both the obese group (r = 0.663, t = 5.74, p < 0.001) and the overweight group (r = 0.312, t = 2.09, p = 0.042).

Conclusions. Obese patients demonstrated a more severe and clinically pronounced course of STEMI at the time of diagnosis and admission. Increased BMI was significantly associated with poorer STEMI outcomes, as evidenced by marked elevations in troponin I, ESR, respiratory rate, and heart rate in the obese cohort.

Insulin resistance as a systemic complication of chronic obstructive pulmonary disease

N. A. Sanina — 2026-02-11

The aim of this study is to examine the mechanisms of insulin resistance (IR) as a systemic complication in patients with chronic obstructive pulmonary disease (COPD) and to evaluate its prevalence in relation to disease severity, clinical characteristics, and standard therapy, specifically the use of inhaled corticosteroids (ICS).

Materials and methods. We examined 151 patients with COPD (mean age 55.2 ± 8.8 years; 85.4 % men) and 40 control subjects without respiratory pathology. Fasting glucose, insulin, and glycated hemoglobin (HbA1c) levels were determined, and the HOMA-IR was calculated. All patients underwent spirometry; clinical data including smoking history, body mass index (BMI), disease duration, and ICS use were documented. Statistical analysis was performed using correlation and comparative methods.

Results. Patients with COPD demonstrated significantly higher levels of insulin (9.4 ± 1.8 mU/L vs. 8.3 ± 0.3 mU/L, p < 0.05), HbA1c (6.1 ± 0.3 % vs. 5.0 ± 0.4 %, p < 0.05), and HOMA-IR (2.2 ± 1.1 vs. 1.4 ± 0.1, p < 0.05) compared to the control group. IR (defined as HOMA-IR ≥ 2.5) was identified in 31.8 % of patients. HOMA-IR statistically significantly correlated with BMI (R = 0.4, p < 0.05) and showed a significant, albeit weak, association with COPD duration (R = 0.1, p < 0.01) and smoking history (R = 0.3, p < 0.05). Elevated HOMA-IR was accompanied by a significant increase in C-reactive protein levels (18.4 ± 3.9 mg/L vs. 7.6 ± 0.1 mg/L, p < 0.01), indicating the role of systemic inflammation in metabolic disturbances. Furthermore, a strong dose-dependent correlation was found between HOMA-IR and both the duration and dosage of ICS therapy (R = 0.7, p < 0.05), suggesting that long-term or high-dose ICS use may contribute to metabolic dysfunction.

Conclusions. Patients with COPD, even in the absence of concomitant diabetes mellitus, exhibit signs of dysglycemia and insulin resistance. Key risk factors include obesity, smoking, disease duration, and treatment with inhaled corticosteroids. Regular monitoring of HOMA-IR and HbA1c is recommended for the early detection of metabolic risks and timely adjustment of therapy.

Clinical and molecular characteristics of MET gene mutations in Azerbaijani patients with non-small cell lung cancer: a retrospective analysis

Sabina Ganbar Mehdizadeh — 2026-02-11

Lung cancer is the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) accounting for approximately 85 % of all cases. The MET proto-oncogene has emerged as a critical molecular target due to its involvement in cellular proliferation, motility, and metastasis. Among MET alterations, exon 14 skipping mutations have gained significant clinical relevance as actionable biomarkers in NSCLC.

Aim: to determine the frequency and clinical characteristics of MET gene mutations in Azerbaijani patients diagnosed with NSCLC, and to provide a detailed descriptive analysis of mutation-positive cases.

Materials and methods. This retrospective study included 187 patients with histologically confirmed NSCLC treated at the National Oncology Center (Baku, Azerbaijan) between 2014 and 2024. MET mutation analysis was performed on formalin-fixed paraffin-embedded (FFPE) tumor samples using real-time polymerase chain reaction (PCR) with Qiagen and EntroGen reagents. All detected mutations were subsequently validated using next-generation sequencing (NGS). Descriptive statistics were used due to the limited number of mutation-positive cases (n = 16).

Results. MET gene mutations were identified in 16 out of 187 patients, representing a prevalence of 8.6 %. The mean age of MET-positive patients was 66.5 years (range: 53–84), with a male predominance (81 %). Most patients presented with advanced-stage disease (stage III–IV: 93.7 %), and adenocarcinoma was the predominant histological subtype (93.7 %). The median overall survival was 598 days. Tobacco use was reported in 56 % of cases, and alcohol consumption in 19 %. Patients originated from diverse regions of Azerbaijan, with the majority residing in

Clinical and pathophysiological characteristics of hemodynamic alterations in patients with lower extremity varicose veins

M. V. Druzhkin — 2026-02-11

Chronic venous disease (CVD) of the lower extremities, specifically at the stage of chronic venous insufficiency, is a prevalent condition among adults characterized by a progressive clinical course and declining quality of life. This necessitates a detailed assessment of hemodynamic changes within the venous system.

Aim. To identify the clinical and pathophysiological features of hemodynamic changes prior to surgery and determine their association with the clinical class of the disease.

Materials and methods. The study included 139 patients (aged 18–75 years) with CVD classes C3–C6 (CEAP classification). Patients were divided into three groups with subgroups based on the treatment method. Assessment included clinical examination, duplex scanning (measuring diameters of the saphenofemoral and saphenopopliteal junctions (SFJ and SPJ), great and small saphenous veins (GSV and SSV), tributaries, and perforators). Disease severity was evaluated using the Venous Clinical Severity Score (VCSS), and quality of life using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). Statistical analysis utilized Student’s t-test and Pearson correlation coefficient (r).

Results. A statistically significant direct correlation was found between higher CEAP clinical classes and worsening CIVIQ-20 and VCSS scores (p < 0.05). Duplex ultrasound revealed a strong positive correlation between disease progression and increased diameters of the GSV, SSV, SFJ, and SPJ, as well as a greater number and size of tributaries and perforators with pathological reflux. The number of affected anatomical segments in the superficial venous system also increased with disease severity.

Conclusions. Combined analysis of duplex data, CIVIQ-20, and VCSS is critical for optimal surgical decision-making. Future studies should prioritize elucidating the biochemical mechanisms underlying CVD progression and assessing the long-term outcomes associated with various surgical approaches.

Influence of joint line obliquity on morphological parameters of the knee joint in osteoarthritis

R. I. Blonskyi — 2026-02-11

Aim. To characterize the morphological parameters of the knee joint in medial osteoarthritis (OA), accounting for joint line obliquity (JLO) as assessed by a method proposed by the author (mJLO).

Materials and methods. A total of 100 standard weight-bearing anteroposterior knee radiographs from 70 patients with medial knee OA were analyzed. The following radiographic parameters were evaluated: anatomical lateral distal femoral angle (aLDFA), anatomical medial proximal tibial angle (aMPTA), femorotibial angle (FTA), joint line convergence angle (JLCA), joint line obliquity (JLO), and mJLO. Values of mJLO <177° were defined as apex distal (AD), 177–183° as apex neutral (AN), and >183° as apex proximal (AP). Statistical significance was set at p ≤ 0.05.

Results. AD was identified in 72 cases (72.0 %), AN in 25 (25.0 %), and AP in 3 (3.0 %). The mean mJLO values were: AD 172.13 ± 4.15°, AN 178.92 ± 1.53°, and AP 187.33 ± 2.52° (p < 0.00001). The corresponding values for other parameters were: FTA: AD – 175.90 ± 5.08°, AN – 179.58 ± 5.68°, AP – 185.00 ± 3.00° (p = 0.003); aLDFA: AD – 83.33 ± 2.75°, AN – 85.82 ± 2.37°, AP – 86.33 ± 3.06° (p = 0.0003); aMPTA: AD – 82.80 ± 3.28°, AN – 87.10 ± 2.50°, AP – 95.00 ± 2.65° (p < 0.00001); JLCA: AD – 4.41 ± 1.39°, AN – 3.72 ± 0.99°, AP – 3.50 ± 1.32° (p = 0.08); JLO: AD – 0.83 ± 3.52°, AN – 3.50 ± 4.15°, AP – 4.00 ± 1.00° (p = 0.009). Higher mJLO values (characteristic of the AP phenotype) positively correlated with increased FTA (τ = +0.21, p = 0.002), aLDFA (τ = +0.53, p < 0.0000001), and aMPTA (τ = +0.56, p < 0.0000001), while negatively correlating with JLCA (τ = -0.18, p = 0.007). The likelihood of the AD phenotype was significantly increased in patients with aLDFA 79–83° (OR = 3.86; 95 % CI: 1.51–11.10; p = 0.004), aMPTA ≤84° (OR = 15.35; 95 % CI: 5.05–61.75; p < 0.001), JLCA ≥4.1° (OR = 4.04; 95 % CI: 1.52–12.47; p = 0.004), and JLO <0° (OR = 3.69; 95 % CI: 1.31–12.62; p = 0.01). Conversely, the AN phenotype was more probable in patients with aLDFA ≥84° (OR = 5.56, CI (2.06–17.31), p = 0.0005), aMPTA 85–90° (OR = 4.13, CI (1.65-10.90), p = 0.002), aMPTA ≥91° (OR = 5.30, CI (1.46–20.93), p = 0.01), JLCA 2,1–4,0° (OR = 3.42, CI (1.32–9.90), p = 0.01), JLO >0° (OR = 3.03, CI (1.07–10.41), p = 0.04).

Conclusions. Morphological parameters of the knee joint in medial osteoarthritis patients significantly differ based on mJLO values.

Complex regional pain syndrome as a complication following total knee arthroplasty: clinical significance and impact on functional outcomes

O. M. Sulima — 2026-02-11

Aim. To evaluate the impact of complex regional pain syndrome (CRPS) on outcomes following primary and revision total knee arthroplasty (TKA). The study assesses the incidence, clinical manifestations, and functional consequences of CRPS, while evaluating current diagnostic and treatment approaches and the need for standardization.

Materials and methods. A systematic scientific review was conducted, covering literature from PubMed, Scopus, and Web of Science published between 2015 and 2025. Inclusion criteria focused on studies of adult patients undergoing TKA who developed CRPS diagnosed by IASP or Budapest criteria. The analysis targeted incidence, clinical manifestations, risk factors, diagnostic approaches, treatment efficacy, and impact on rehabilitation outcomes.

Results. CRPS remains a significant complication of TKA, with a reported incidence of approximately 0.2–2.0 % after primary procedures and 2–5 % following revision surgery. Clinical presentation is characterized by refractory pain, vasomotor dysfunction, and restricted range of motion, leading to significantly lower WOMAC and SF-36 scores and prolonged rehabilitation compared to uncomplicated TKA. Diagnosis remains challenging due to the lack of standardized early-detection protocols and symptom overlap with other complications, and underutilization of international diagnostic criteria. While multimodal management (pharmacotherapy, physiotherapy, and interventional techniques) is effective, its success is highly dependent on early initiation. High-quality evidence regarding CRPS in the specific context of revision TKA remains limited.

Conclusions. CRPS adversely affects functional outcomes after TKA, with higher prevalence observed in revision cases. The absence of standardized preventive measures and optimized therapeutic regimens highlights an urgent need for personalized rehabilitation strategies and the implementation of international diagnostic criteria in routine clinical practice. Further research is needed to establish precise diagnostic criteria, effective prevention strategies, and personalized therapeutic and rehabilitation approaches.

Orthopedic treatment of dentition defect in frontal division with compensated form of pathological attrition by adhesive dental bridge

I. V. Yanishen — 2026-02-11

In pathological attrition, teeth change the anatomical shape of the crown part of the teeth and the character of the mastication pressure distribution on the cutting and chewing surfaces. Dentition defects accompany this process and need the use of adhesive dental bridge (ADB), which is more suited to modern biotechnological requirements.

Aim. To statistically analyze the dimensions of the oral surfaces of the anterior teeth in patients with a compensated form of pathological attrition, and to evaluate the potential applicability of these teeth as abutment elements for ADB.

Materials and methods. We selected 30 patients (18 men and 12 women) aged 35–55 years with first-degree (attrition up to 1/3 of crown height) or second-degree (attrition up to 2/3 of crown height). From these, we formed two groups of 15 patients each. A third control group comprised 15 patients with intact dentition and physiological occlusion. We used a mathematical model from prior work for rational planning of ADB abutments in specific patients.

Results. The examination results of 45 patients (270 teeth) conducted on models allowed us to determine the oral surface area of the anterior teeth, depending on the degree of pathological attrition.

Conclusions. The mean occlusal surface areas of upper and lower jaw teeth have been identified. Based on clinical and laboratory experiments, this made it possible to plan the supporting elements of ADB for patients with a horizontal form of pathological dental attrition.

Physical activity, sleep quality, and mental health among university students during wartime: findings from a mediation study

Kh. Ya. Abrahamovych — 2026-02-11

Aim. To assess physical activity, sleep quality, and the mental health status of students during wartime, to explore their interrelationships, and to examine the mediating role of sleep quality.

Materials and methods. A cross-sectional study was conducted among 245 first- to third-year students of State Non-Profit Enterprise “Danylo Halytsky Lviv National Medical University”aged 18–24 years (mean age 19.15 ± 0.95 years; 25 % males, 75 % females). Validated Ukrainian versions of standardized instruments were used: Perceived Stress Scale-14 (PSS-14, stress), Hospital Anxiety and Depression Scale (HADS, anxiety and depressive symptoms), Pittsburgh Sleep Quality Index (PSQI, sleep quality), and International Physical Activity Questionnaire – Long Form (IPAQ-LF, physical activity). Statistical analysis included descriptive statistics, Student’s t-test, one-way ANOVA, χ² test, Pearson’s correlation, and mediation analysis (Hayes’ PROCESS Macro, model 4, with 5000 bootstrap resamples).

Results. Most students reported moderate stress scores (74.3 %). Elevated anxiety levels (HADS) were found in 38.8 % of participants, while increased depressive symptoms were observed in 7.3 %. Sleep disturbances (PSQI >5) were found in 64.1 % of students, with the most affected components being daytime dysfunction, sleep latency, and dissatisfaction with sleep quality. A high level of physical activity was observed in 73.9 % of students. Sleep quality showed a strong correlation with depressive symptoms (r = 0.473, p < 0.001), a moderate correlation with anxiety (r = 0.373, p < 0.001), and a weak correlation with stress scores (r = 0.230, p < 0.001). Physical activity was not directly associated with stress or anxiety but was significantly correlated with better sleep quality (r = -0.253, p < 0.001). Mediation analysis demonstrated that the effect of physical activity on depressive symptoms (β = -0.120; 95 % CI: -0.177 to -0.062) and anxiety (β = -0.097; 95 % CI: -0.147 to -0.050) was fully mediated by sleep quality, whereas for stress only partial mediation was observed (β = -0.059; 95 % CI: -0.106 to -0.020).

Conclusions. Students during wartime exhibited a high prevalence of mental health issues combined with frequent sleep disturbances. Despite a generally high level of physical activity, sleep quality emerged as the key predictor and mediator of stress, anxiety, and depressive symptoms. These findings highlight the need for integrated programs that address both physical activity and sleep hygiene to safeguard students’ mental health in wartime conditions.

Positive and negative effects of monosodium glutamate on morphofunctional characteristics of the pancreas (an analytical literature review)

M. Yu. Kochmar — 2026-02-11

Monosodium glutamate (MSG) is widely used as a flavor enhancer in the food industry; however, its effects on the pancreas remain insufficiently studied. Experimental animal studies and clinical observations regarding the potential toxicity of this substance have yielded varying results depending on the organ systems involved and the administered dose.

Aim: to highlight the specific effects of monosodium glutamate on the pancreas of rats of different ages, based on the analysis of relevant scientific literature.

Materials and methods. This review summarizes and analyzes scientific studies published between 2015 and 2025, selected through systematic searches in established scientific databases, including PubMed, Google Scholar, Scopus, Web of Science. The following keywords and their combinations were used: monosodium glutamate, pancreas, white rats, food additive, metabolism.

Results. The analyzed literature confirms the significant clinical and research relevance of this topic, given the extensive use of MSG in the food industry. Experimental studies consistently demonstrate the dose-dependent negative effects of MSG administration on the pancreas in animals of various age groups. However, clinical findings regarding the effects of dietary MSG exposure in humans remain inconsistent and inconclusive.

Conclusions. Based on the available literature, there is a distinct need for comprehensive investigations into the systemic effects of MSG, particularly focusing on the pancreas. The presence of glutamate receptors and transporters in the pancreas suggests that this organ is a direct target for MSG action.

The association between hepatobiliary system pathology and oral cavity status

A. I. Babiachok — 2026-02-11

Aim: to determine the relationship between hepatobiliary system (HBS) pathology and oral health status based on a synthesis of professional literature.

Materials and methods. A bibliosemantic analysis was performed on research results from Ukrainian and international professional literature indexed in PubMed, Scopus, Web of Science, and Google Scholar. The search utilized keywords: hepatobiliary system, liver diseases, biliary tract diseases, dental caries, periodontitis, and oral mucosal diseases.

Results. The study indicates that pathological changes in the hepatobiliary complex disrupt numerous vital systemic processes. Existing research has explored the development of hepatorenal, hepatoencephalic, hepatopulmonary, dermatological, and cardiovascular syndromes associated with HBS pathology. The authors have identified a significant influence of hepatobiliary diseases on the development of oral conditions, specifically affecting the periodontium, oral mucosa, salivary glands, and dental hard tissues. Furthermore, periodontitis is increasingly recognized as a risk factor that may contribute to the progression of hepatobiliary pathology. Evidence confirms a bidirectional correlation between HBS disorders and oral tissue health.

Conclusions. Impairment of hepatic metabolic functions, including protein synthesis, accumulation, and distribution, as well as hormone and vitamin regulation and the activation of pro-inflammatory processes, negatively impacts various organ systems. It has been established that microbiome alterations observed in periodontitis play a significant role in the pathogenesis of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Hepatobiliary pathology impairs the regeneration of both connective tissue and bone structures within the oral cavity. Clinical and experimental data also confirm that viral hepatitis is frequently accompanied by pathological changes in the salivary glands.

Laparoscopy for the management of penetrating and blunt abdominal trauma (a systematic review)

Iu. O. Mikheiev — 2026-02-11

The role of diagnostic and therapeutic laparoscopy in abdominal trauma has expanded over the last decade, but indications, safety, and comparative effectiveness versus laparotomy remain debated. Recent data, including large multicentre cohorts and updated meta-analyses, justify a focused synthesis.

Aim. To systematically review contemporary evidence on the effectiveness and safety of laparoscopy for the management of penetrating and blunt abdominal trauma, including case reports published over the last five years.

Materials and methods. Following PRISMA 2020 guidance, we searched PubMed / MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar. We included prospective/retrospective clinical studies and case series evaluating laparoscopy in abdominal trauma. Primary outcomes included non-therapeutic laparotomy (NTL) rates, missed injuries, complications, conversion rates, length of stay (LOS), and mortality. Risk of bias was assessed using ROBINS-I for non-randomized studies and descriptive appraisal for case reports.

Results. The search has identified two recent systematic reviews / meta-analyses on abdominal trauma (one blunt-specific, one mixed blunt/penetrating), several cohort / propensity-matched studies (including large registry analyses), and multiple single-center series and case reports published during 2020–2025. Laparoscopy in hemodynamically stable trauma patients consistently reduced NTL (19 % absolute reduction in a large single-center series) and postoperative complications and shortened LOS compared with laparotomy, without increasing missed injuries or mortality. Multicenter registry data for blunt trauma and recent retrospective cohorts showed that laparoscopic intervention in selected patients did not increase in-hospital mortality and was associated with acceptable conversion and complication rates. Case reports and small series document successful laparoscopic management of complex injuries (diaphragmatic rupture, hollow viscus injuries, colon trauma, post-traumatic hernias) in both blunt and penetrating mechanisms, with low morbidity in carefully selected patients.

Conclusions. The accumulated evidence strongly supports the role of laparoscopy in the management of penetrating and blunt abdominal trauma in hemodynamically stable patients. The use of laparoscopy in trauma management significantly reduces the rate of non-therapeutic laparotomies and postoperative complications and shortens hospital stays. Laparoscopy for abdominal trauma maintains very low rates of missed injuries and mortality when applied with strict patient selection and surgeon expertise.