Modern medical technology

Modern strategies for optimizing the management of patients with myocardial infarction and atrial fibrillation

2024-12-05T11:00:53+02:00

The aim of the study – to analyze and summarize information from the scientific literature on modern approaches to the management of patients with acute myocardial infarction and atrial fibrillation, as well as to identify promising directions for research in this category of patients.

Materials and methods. We searched in the scientometric systems of Google Scholar, PubMed, Cochrane Database, conducted a synthesis, comparison, generalization and system-structural analysis of modern scientific literary sources.

Results. The analysis of information in the modern scientific literature demonstrates that patients with combined cardiovascular pathology, in particular acute myocardial infarction with atrial fibrillation (AF), have a higher risk of mortality, a higher frequency of repeated cardiovascular events and a severe course of the underlying disease, which complicates the management of this category of patients. Despite all efforts to improve the AF management system, in the last decade the incidence of AF continues to grow, the age of patients is decreasing, the number of patients with two or more cardiovascular disease risk factors rises, which increases the frequency of AF-related complications. The use of mobile applications to solve clinical tasks in patients with AF has proven its effectiveness and is actively used in practice. Among the components of myocardial infarction and AF management, revascularization, drug treatment and rehabilitation have the highest level of evidence and significantly reduce mortality. It should be noted that existing rehabilitation protocols do not include restorative treatment programs for patients with combined cardiovascular pathology. Different rehabilitation strategies for myocardial infarction and atrial fibrillation create difficulties in managing these pathologies in combination.

Conclusions. Optimizing the management of patients with myocardial infarction and atrial fibrillation through the development of rehabilitation programs will help unify the approach to this category of patients. The use of telemedicine elements for rehabilitation treatment will expand the limits of patients’ access to cardiac rehabilitation resources, increase their adherence and improve treatment effectiveness.

The role of lactate in the body of martial artists during physical activity: a new look at the problem

2024-12-05T12:28:02+02:00

Aim. To conduct a modern semantic analysis of the results of our own research and literature data on the physiological significance of increased lactate level in skeletal muscles during physical activity in martial artists.

Materials and methods. This study used bibliosemantic, analytical, logical, and generalization methods. The bibliographic databases of life sciences and biomedical information MEDLINE, EMBASE, Medline (PubMed), Web of Science, and Cochrane Central were searched to find publications in English that matched the research keywords. The authors carried out an independent search and selection of articles, assessment of data quality, compliance of the presentation and interpretation with the main idea of the study, with the formation of the final list of references.

Results. For many years, the role of lactate in the formation of physical fatigue and delayed muscle soreness in martial artists and other athletes remained unknown. There has been a lot of speculation and competing concepts. Over the past 20 years, due to the successes of modern biochemistry, physiology, and molecular pharmacology, subtle molecular-biochemical mechanisms of delayed muscle soreness formation after muscle loading have been revealed. However, a holistic attitude to the role of lactate has not been formulated. We analyzed the results of modern studies, which showed that oxidative stress, inflammation, and a decrease in cytoprotective proteins, in particular HSP₇₀, but not the accumulation of lactate, are more important in the formation of delayed onset muscle soreness (DOMS).

Conclusions. Accumulation of lactate in muscle cells with its subsequent release into the bloodstream is considered to be much more positive than negative factor, and therefore the views on the increase of lactate content and its assessment as an enemy of athletes, including martial artists, should be reconsidered.

The importance of using mobile ultrasound devices in improving the quality and safety of emergency care, anesthesia and intensive care

2025-01-24T10:11:30+02:00

The aim of this review is to determine the role of ultrasound visualization in improving the safety and quality of anesthesia, intensive care and emergency medical care.

The article explores the role of ultrasound imaging in improving the quality and safety of diagnostics, analgesia, and intensive care, particularly in emergency conditions. The authors emphasize the importance of using portable ultrasound devices that enhance diagnostic accuracy and enable bedside or prehospital procedures. The study highlights the significance of ultrasound protocols, such as POCUS, FAST, eFAST, LUCI, and others which standardize diagnostics and invasive interventions. These protocols have proven to be effective in diagnosing shock states, pneumothorax, internal organ injuries, and critical complications. Ultrasound is also widely used to improve the safety of invasive procedures like central venous catheterization, regional nerve blocks, and epidural anesthesia. In children, ultrasound helps to reduce the number of complications during procedures due to its high accuracy of visualization. The authors point out that ultrasound is an important tool for monitoring the condition of patients with respiratory and heart failure, allowing for the prompt detection of pathological changes in the lungs and heart. In addition, the use of ultrasound examination significantly reduces the radiation exposure compared to X-rays and computerized tomography scans.

Despite significant progress, there are limitations related to the anatomical features of patients, the difficulty of finding acoustic windows, and the need for specialized training of doctors. Future developments include further standardization of protocols, improvement of ultrasound device capabilities, and the creation of international training programs.

Conclusions. Ultrasound visualization improves the quality of diagnosis, anesthesia and intensive care, significantly increases the accuracy and safety of invasive procedures. Using ultrasonic visualization methods can be problematic in cases where it is difficult to find an acoustic window. Further expansion of the use of the POCUS concept and integration of ultrasound into life support algorithms are related to the development of available compact, highly sensitive ultrasound devices suitable for prehospital diagnostics.

Association of early prognosis in patients with chronic heart failure with markers of renal tubulointerstitial dysfunction

2025-01-28T00:38:19+02:00

The glucose-potassium ratio (GPR) and serum sodium levels are robust indicators of renal metabolic and electrolyte imbalances. These markers can be used to assess the severity of cardiovascular disease and predict adverse outcomes. The renal tubulointerstitium plays a leading role in reabsorption of glucose, potassium, and sodium. In patients with chronic heart failure (CHF), not only the renal glomeruli but also tubulointerstitium is affected, that results in cardiorenal syndrome development. Consequently, alterations in GPR and serum sodium levels are expected in these patients. However, the prognostic value of these markers for predicting adverse cardiovascular events in patients with CHF remains insufficiently studied.

The aim. To investigate changes in the glucose-potassium ratio and serum sodium content in patients with chronic heart failure of ischemic origin and preserved left ventricular ejection fraction, and to determine their impact on adverse cardiovascular events during one year of follow-up.

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

Results. Univariate regression analysis demonstrated that an increase in the GPR above 1.1697 was associated with an 11.15-fold increase in the risk of adverse cardiovascular events at the end of the first year of follow up (95 % CI: 1.33–93.50, p = 0.0048). A decrease in serum sodium level below 142.2 mmol/L increased the risk of adverse events by 5.14 times (95 % CI: 1.0027–26.3538, p = 0.03). In a multivariate logistic regression model (p = 0.0019), the combination of elevated GPR and reduced serum sodium potentiated the relative risk of adverse cardiovascular events. GPR increased the risk 11.69-fold (95 % CI: 1.3538–100.9866, p = 0.025), while serum sodium contributed to a 5.45-fold increase (95 % CI: 1.0046–29.5986, p = 0.049).

Conclusions. The combination of elevated GPR and decreased serum sodium level in a multivariable logistic regression model (p = 0.0019) is a powerful prognostic tool for assessing the risk of adverse cardiovascular events in patients with CHF. These biomarkers provide valuable insights for early risk stratification and should be considered in the clinical management of CHF.

Preferences of choice between original and generic medicines: pharmaceutical support for patients with coronary heart disease and comorbid conditions

2024-12-13T11:13:48+02:00

Ukraine ranks fourth globally in mortality from coronary heart disease (CHD). The negative socio-economic impact of martial law is likely to exacerbate this situation. Therefore, the use of original and generic drugs in pharmacotherapy deserves special attention as it may affect the availability of medicines and adherence to treatment.

Aim. To study the influence of preferences of doctors, pharmacists, and patients regarding the use of original and generic medicines in the pharmacotherapy of CHD with comorbid conditions, to further identify factors affecting drug availability and patient adherence to treatment.

Materials and methods. We analysed the results of an anonymous online survey conducted with the help of Google Forms at the Department of Cardiology of the Shupyk National Healthcare University of Ukraine, from June to September 2024. Statistical, analytical, bibliographic methods, as well as synthesis, analysis, deduction, and induction techniques were used.

Results. The reliability of the influence of clinical efficacy and safety of drugs (χ² = 5.653, p = 0.017) on their choice in the pharmacotherapy of CHD with comorbidities for doctors 87.4 % [CI 95 % 87.400 ± 0.004, p < 0.0001], pharmacists 79.1 % [CI 95 % 79.10 ± 0.02, p < 0.0001] and patients 91.1 % [CI 95 % 91.100 ± 0.007, p < 0.0001] is determined in the study. The absence of certain drugs in the “Affordable Medicines” Reimbursement Program in Ukraine decreases interest among healthcare professionals in the program (χ², adjusted for plausibility = 4.011, p = 0.050) and negatively affects access to clinically effective and safe drugs for patients with CHD with comorbidities (χ² = 3.350, p = 0.067).

Conclusions. The preferences of choice of doctors, pharmacists, and patients between original and generic medicines are influenced by the clinical effectiveness and safety of the drugs. The absence of certain medicines that are recommended by clinical protocols and guidelines for managing CHD with comorbid conditions in the Reimbursement Program, reduces healthcare professionals’ engagement with the program and negatively affects the availability of effective pharmacotherapy and treatment adherence.

Regulation of the ratio of neurotransmitters and matrix metalloproteinases is a new strategy for secondary prevention of patients with multifocal atherosclerosis

2024-12-05T12:26:06+02:00

Multifocal atherosclerosis (MAS) remains one of the key problems of modern medicine, despite advances in primary and secondary prevention of myocardial infarction (MI) and ischemic stroke (IS). MAS worsens the prognosis and increases the risk of atherosclerotic plaque (AP) destabilization, especially under the influence of matrix metalloproteinases (MMPs). Activation of the sympatho-adrenal and serotonergic systems with the release of dopamine and serotonin also plays a significant role in the pathogenesis of this process, influencing the regulation of vascular tone and blood flow in various organs.

The aim of this study was to study the possibilities of normalizing the balance of serotonin and dopamine in patients with MAS to stabilize the atherosclerotic process and improve the regional hemodynamics of the heart, brain, and lower extremities.

Materials and methods. The study involved 54 men aged 60 to 90 years, including the first group (n = 26) patients with MAS with intermittent claudication, atherosclerotic encephalopathy and post-infarction cardiosclerosis; the second group (n = 28) patients with MAS who had IS, with concomitant atherosclerosis of the coronary and femoral arteries, and the control group – 18 people of comparable age. Examination: ankle-brachial index, Holter ECG monitoring, walking distance, dopplerography with determination of volumetric blood flow indicators. Blood levels of serotonin, dopamine, MMP-2 and MMP-9 were determined. Cognitive function was assessed using the Montreal scale. In addition, patients of both groups were prescribed cilostazol (50 mg twice a day), GABA – aminalon (250 mg twice a day) and atenolol (25 mg once a day).

Results. The results of the study showed significant disorders of hemodynamics and neurotransmitter balance in patients with MAS. We found a significant (p < 0.001) excess of serotonin in the blood serum, an increase of dopamine (p < 0.01) by 60–70 % more than in control group persons. The morning peak of a 5–7-fold increase in plasma serotonin levels is noteworthy. Levels of MMP-2 and MMP-9 were almost twice as high (p < 0.01) in patients who experienced IS or MI compared with the control group. After the addition of cilostazol, aminalon and atenolol to the basic therapy, we found a significant decrease in the ultra-high levels of serotonin in blood plasma (p < 0.001) and serum (p < 0.05). The levels of MMP-2 (p < 0.01) decreased, volumetric blood flow indicators improved in all three studied arteries (p < 0.05), the painless walking distance and maximum walking distance increased, and cognitive functions improved significantly (p < 0.05).

Conclusions. The proposed new strategy for secondary prevention of cardiovascular events in patients with MAS with a history of ischemic stroke or myocardial infarction is based on the correction of the imbalance of neurotransmitters serotonin and dopamine by adding to the basic therapy, according to the latest guidelines 2024, a complex of drugs – cilostazol, aminalon and atenolol.

Clinical, pathogenetic and prognostic significance of vascular endothelial growth factor content in the blood serum of patients with coronavirus disease (COVID-19) with pneumonia in relation to the parameters of immune inflammation and haemostasis in assessing the risk of death

2025-01-24T10:42:34+02:00

Aim. To find out the clinical, pathogenetic and prognostic significance of vascular endothelial growth factor in the blood serum of patients with coronavirus disease with pneumonia in relation to the parameters of immune inflammation and haemostasis in assessing the risk of death.

Material and methods. We examined 123 patients with coronavirus disease (COVID-19) with pneumonia. Laboratory examination of patients was carried out in accordance with the Order of the Ministry of Health of Ukraine of 28.03.2020 No. 722. The patients were divided into groups depending on the outcome of the disease: 77 patients who recovered and 46 patients who died. The content of vascular endothelial growth factor (VEGF) (total form) in the blood serum was determined by enzyme-linked immunosorbent assay (Immuno-Biological Laboratories Co., Ltd., Japan). Statistical data processing was performed in the program “Statistica for Windows 13”.

Results. It was found that in patients with coronavirus disease with pneumonia, the level of increase in serum VEGF (total form) was associated with the outcome of the disease. When patients were hospitalised on day 9.0 [7.0; 12.0] of illness, a serum VEGF level >32.04 pg/ml (AUC = 0.842, p < 0.001) indicated a high risk of adverse outcome, and after 7 days of treatment, with a VEGF level >58.79 pg/ml (AUC = 0.899, p < 0.001), there was a high probability of death. The correlation between the development of thrombotic complications and the level of VEGF increase in the blood serum both at the time of hospitalisation (gamma +0.32, p < 0.05) and after 7 days of treatment (gamma +0.37, p < 0.05) was established. The occurrence of thrombotic complications was more frequent in patients with a fatal outcome than in patients who had recovered (18.4 times, p = 0.000001). The level of VEGF in the blood serum >51.91 pg/ml (AUC = 0.680, p = 0.019) was prognostic of the risk of developing thrombotic complications only in the dynamics after 7 days of hospital treatment. The clinicopathogenetic role of increased serum VEGF in the progression of the disease in patients with COVID-19 pneumonia was demonstrated by statistically significant correlations.

Conclusions. In patients with COVID-19 pneumonia, VEGF (total form) level elevation in serum is associated with the risk of death. The threshold levels of VEGF, which are informative for prognosing the risk of unfavourable disease course at different follow-up periods, have been established.

Safety and efficacy of apixaban in patients with glomerulonephritis and nephrotic syndrome: a prospective longitudinal cohort study

2025-01-24T10:41:41+02:00

Aim. Assessment of the efficacy and safety of apixaban in preventing thromboembolic complications in patients with nephrotic syndrome caused by primary glomerulonephritis.

Materials and methods. We conducted a prospective longitudinal cohort study involving 125 patients with glomerulonephritis and nephrotic syndrome. According to the inclusion criteria, patients had to be over 18 years of age, diagnosed with nephrotic syndrome within the last month, and have an estimated glomerular filtration rate greater than 60 ml/min/1.73 m². The study population was divided into two cohorts for comparison: one group (62 patients) received prophylactic anticoagulation with warfarin, while the other group (63 patients) was administered apixaban at a dose of 5 mg twice daily. The observation period was 6 months.

Results. During the observation period, no thromboembolic events were reported in either group, indicating the effectiveness of both treatments. However, minor bleeding events were significantly more frequent in the warfarin group than in the apixaban group (p = 0.003). These findings suggest that apixaban is associated with a lower risk of bleeding while maintaining effective thromboembolic prevention.

Conclusions. This study highlights that apixaban is a potentially better alternative to warfarin for thromboprophylaxis in patients with nephrotic syndrome and glomerulonephritis, particularly in those at high thromboembolic risk. Further randomized controlled trials are recommended to confirm these findings and optimize anticoagulation strategies for this population.

A rare finding on the fundus or “dancing” retina: a clinical case

2025-01-24T10:27:03+02:00

Aim. To attract the attention of ophthalmologists to the possibilities of optic coherence tomography (OCT) in the differential diagnosis of the retinal peripheral mass by detecting its pulsation.

Materials and methods. A 47-year-old female patient has been under observation since 2021 for primary open-angle glaucoma (stage 1a, left eye) and moderate myopia in both eyes. She has been wearing glasses since childhood and receives preservative-free latanoprost for intraocular pressure control. Regular examinations every six months include tonometry, ophthalmoscopy, perimetry, and OCT / OCT angiography (OCTA) imaging for monitoring glaucoma progression and retinal health. The Cross Line mode was used for B-scans focused on vortex vein ampullae, with video recordings capturing dynamic retinal and choroidal changes.

Results. The patient complained of “lightning” and a floating spot in front of the left eye, and a thorough examination of the central and peripheral retina was performed. The OCT and OCTA examinations of the central retina revealed thinning of the ganglion cell layer and peripapillary nerve fiber layer in the upper-temporal sector, a decrease in the density of blood vessels, which corresponds to the initial signs of glaucoma. The OCT-B scan of the peripheral area at the level of the ophthalmoscopic grayish radiating focus revealed a convex change in the retinal profile, a homogeneous hyporeflective cavity with clear borders in the choroid, without changes in the retinal layers and subretinal fluid. Rhythmic retinal pulsations synchronized with the heart rate were observed. The differential diagnosis included choroidal metastases, melanoma, lymphoma, hemangioma, nevus, and varicose dilation of the vortex vein ampulla, the latter diagnosis being confirmed.

Conclusions. Varicose dilation of the vortex vein ampulla is a rare condition that mimics benign and malignant retinal diseases, requiring differential diagnosis, where OCT is useful for identifying morphological and dynamic changes, with recognition of retinal fluctuation as the final diagnostic criterion.

First experience of laparoscopic colon resection with primary anastomosis for combat-related thoracoabdominal trauma with through-and-through colon injury

2025-01-24T10:33:44+02:00

Aim: to demonstrate the possibilities and advantages of laparoscopic surgery in combat-related abdominal penetrating trauma with colon injury.

Materials and methods. This case report presents the first experience of laparoscopic colon resection with primary anastomosis for combat-related thoracoabdominal trauma with through-and-through colon injury. A 47-year-old serviceman sustained an explosive penetrating thoracoabdominal injury (dropping explosives from a drone) operated 10 hours after. Initial management at Role 2 included chest tube drainage, surgical debridement, and wound sealing of the chest. CT: penetrating gunshot wound with internal and external damage to the lower lobe of the left lung, perforation of the diaphragm on the left, and transverse colon perforation with a retained metal fragment, pneumoperitoneum, drained hemopneumothorax, and a gunshot fracture of the posterior third of the 5^th left rib. Exploratory laparoscopy revealed no free fluid in the abdominal cavity. Surgery: the diaphragmatic perforation was sutured with a 3-0 V-loc barbed suture, the segment of the transverse colon was resected using two Endo-GIA 60 linear staplers according to the severity of injury (AAST Grade 3) and non-viable edges of colon wound. To ensure mobility, a side-to-side antiperistaltic anastomosis was performed using an Endo-GIA 60 stapler (blue cartridge). The anastomosis site was reinforced with a single-layer 3-0 V-loc suture. The procedure was completed with abdominal drainage and port site closure.

Results. Postoperative recovery was without complications. The abdominal drain was removed on the 2^nd day, and the pleural drain on the 5^th day after the control CT scan. Follow-up after 1.5 month – returned to military service. Our case demonstrates that laparoscopic surgery can be a useful option for combat-related colon injuries when tissue damage is minimal and the patient’s condition is stable. The absence of massive hemoperitoneum and contamination confirms the feasibility of primary repair or anastomosis.

Conclusions. Laparoscopic surgery for combat-related penetrating abdominal trauma with colon injuries is feasible and safe in stable patients. If there are no multiple colon injuries or significant contamination, primary repair or stapled anastomosis is a suitable option.