Modern medical technology

Peculiarities of the composition of surface and groundwater in eastern Ukraine during the war: assessment of environmental and carcinogenic risks

O. O. Kovalov — 2025-06-25

Russia’s war against Ukraine has devastating humanitarian, social, economic and environmental consequences. To assess them, it is important to monitor environmental pollutants in the eastern regions of Ukraine. This study analyses the chemical composition of surface and groundwater near the frontline in Zaporizhzhia region and justifies the need to develop a state plan for the restoration of damaged areas.

Aim. To study the content of environmental toxins, organic compounds and heavy metals in surface and ground waters in the south-east of Ukraine near the frontline and to identify areas of high risk of pollution.

Materials and methods. During the period of 2024, 70 drinking water samples were collected and examined from the centralised water supply networks of the city of Zaporizhzhia of the Municipal Enterprise “Vodokanal” and Enterprise of State Criminal-Executive Service of Ukraine. Groundwater samples were taken by professional hydrogeologists on November 9, 2024, near Tarasivka village (geographical coordinates: 47°46′41′′N 35°26′36′′E / 47.77806°N 35.44333°E) and near Vilne village (geographical coordinates: 47.57286°N 32.61995°E) of Komyshuvakha village, Orikhiv district, Zaporizhzhia region, at a depth of 5, 14 and 190 meters. The water was not preserved and was delivered to the laboratory within a few hours. The chemical analysis was carried out in the laboratory of Ukrkhimanaliz LLC of the Center for Preventive Medicine of the State Administration of Affairs. The presence of heavy metals and organic compounds (50 indicators in total) was studied by atomic emission spectral, photometric, titrimetric, ionometric, colorimetric, chromatographic and calculation methods.

Results. Analysis of 70 samples of drinking water in Zaporizhzhia from the centralised water supply networks of the Municipal Enterprise “Vodokanal” and Enterprise of State Criminal-Executive Service of Ukraine showed that 67–96 % did not meet hygiene standards for trihalogen methanes. Chemical analysis of groundwater showed significant contamination of aquifers at the 5- and 14-meter levels near the frontline due to a significant increase in nitrate and aluminium content. The groundwater was characterized by high levels of salts, sulphates, calcium and magnesium. Such groundwater quality indicators may be related both to the natural features of the area, namely the chemical composition of the soil, and man-made factors caused by the hostilities. The high mineralisation and hardness of the water, and the excessive content of nitrates and heavy metals (aluminium) made the water unsuitable for drinking purposes. At a depth of 190 meters (interstitial water – artesian water), no chemical pollutants were detected, and the organoleptic, sanitary and toxicological indicators met the sanitary and hygienic requirements according to State Sanitary Rules and Norms 2.2.4-171-10 “Hygienic Requirements for Drinking Water Intended for Human Consumption”.

Conclusions. Drinking water from centralised water supply networks in Zaporizhzhia in 67–96 % of cases does not meet hygiene standards for trihalogen methanes. Groundwater in Zaporizhzhia region near the frontline at a depth of 5 and 14 meters is highly mineralised, containing high concentrations of nitrates and aluminium, making it unsuitable for drinking. The artesian water in this region does not contain pollutants of man-made and military origin, which indicates that the interlayer is not damaged, and this water is suitable for drinking. High levels of salt and general hardness of groundwater are associated with the geochemical features of the area. The high nitrate content and 1.4 times higher aluminium levels are the result of soil contamination in the area.

The impact of polypharmacy on adherence to pharmacotherapy for coronary heart disease with comorbid conditions: insights from the EUROASPIRE V observational study in Ukraine

M. M. Dolzhenko — 2025-06-25

It is known that coronary heart disease (CHD) is the leading cause of mortality among non-communicable diseases worldwide, including in Ukraine. The results of the EUROASPIRE V observational study showed an insufficient level of adherence to treatment in patients with CHD and comorbid conditions across European countries and in Ukraine. Conducting a retrospective analysis of the pharmacotherapy for CHD in patients with hypertension, dyslipidemia, atrial fibrillation, heart failure, type 2 diabetes mellitus, and chronic kidney disease regarding the content, number, and compatibility of prescribed drugs is relevant to determine the impact of polypharmacy on treatment adherence.

Aim. To determine the prevalence of polypharmacy and identify gaps in the rational use of drugs in patients with CHD and comorbid conditions, and to assess the subsequent impact on treatment adherence in the Ukrainian cohort of the EUROASPIRE V study.

Materials and methods. Medical data of patients with CHD and comorbid conditions who participated in the EUROASPIRE V observational study in Ukraine were analysed. Retrospective, statistical, clinical-epidemiological, frequency, ABC analysis, content analysis, comparison, and generalization methods were used.

Results. A significant effect of the number of prescribed drugs on treatment adherence was established (U = 4.895; Z-value = -2.793 without correction; Z-value = -2.844 adjusted). The level of significance (p) without correction was 0.0052 and with correction was 0.0045, indicating the need for the use of fixed combinations. The lack of compatibility among prescribed drugs (Z = 1.71; p = 0.086) in the pharmacotherapy of CHD with comorbid conditions was reliably confirmed, indicating insufficient compliance among doctors, patients, and pharmacists due to the lack of interprofessional interaction within multidisciplinary teams. The relationship between adherence to pharmacotherapy for CHD with comorbid conditions and sex characteristics was also investigated: χ² = 5.734; df = 1 (for groups of men and women); p ≈ 0.0167. Men (55 %) demonstrated greater adherence to treatment than women (45 %).

Conclusions. The prevalence of polypharmacy in the studied cohort of CHD patients with comorbid conditions was determined to be 76.47 % [CI 95 % 76.47 ± 0.03; p < 0.0001], which can be attributed to the predominantly complex drug model used in pharmacotherapy. The relationship between overall adherence to pharmacotherapy for CHD with comorbid conditions and the presence of drug interactions due to metabolism through the CYP450 isoenzyme 3A4 during the second visit of the studied cohort was reliably confirmed (χ² = 3.97; df = 1; p-value = 0.0462). However, there was a positive trend in the use of target doses of drugs after the correction of pharmacotherapy by the staff of the Department of Cardiology (1st visit – 27.57 % and 2nd visit – 13.57 %).

Emergency thyroidectomy for poorly controlled hyperthyroidism in the context of war in Ukraine

S. I. Savoliuk — 2025-06-25

The aim of the work is to analyze the results of surgical treatment of patients with hyperthyroidism (Graves’ disease, multinodular toxic goiter, solitary toxic adenomas) in patients who were observed during the period of hostilities in Ukraine.

Materials and methods. The retrospective study included 70 patients operated on for hyperthyroidism in the surgical clinic of the MNE “Kyiv City Clinical Hospital No. 8” during the period of military operations in 2022–2024. All patients underwent a comprehensive clinical and instrumental examination, an assessment of the clinical manifestations of the disease was carried out depending on the wartime migration, the nature of surgical treatment, and the immediate results of the postoperative period. Laryngeal dysfunction, hypocalcemia, hematoma, and bleeding were recorded. All samples of the removed thyroid glands underwent pathological analysis. Data analysis was performed using statistical methods.

Results. Observations of wartime patients showed that unstable, poorly controlled hyperthyroidism in Graves’ disease was more common in people from frontline regions and in evacuated patients. In our observations, 32 (45.7 %) patients required urgent surgery for poorly controlled hyperthyroidism. Planned surgery for well-controlled hyperthyroidism was performed in 38 (54.3 %) patients.

Conclusions. Surgical intervention is the method of choice for rapid final control of hyperthyroidism in Graves’ disease, multinodular toxic goiter, and toxic adenoma. During the period of military operations in Ukraine, patients with hyperthyroidism were predominantly Graves’ disease patients who could not achieve stable drug compensation of thyrotoxicosis, which was an indication for urgent thyroidectomy. Urgent surgical intervention for hyperthyroidism can be safely performed when using effective protocols for accelerated preoperative preparation.

Varicose veins in the anterior accessory great saphenous vein system of the lower limb

V. I. Rusyn — 2025-06-25

Aim. In order to improve the results of the treatment of patients with varicose veins and to prevent the recurrence of the disease, a quantitative analysis of the types of varicose veins in the anterior accessory great saphenous vein (GSV) system should be carried out according to the source of their reflux.

Materials and methods. In the vascular department of the Transcarpathian regional hospital named after A. Novak in Uzhhorod, we treated 3000 patients with varicose veins of the subcutaneous veins of the lower extremities in 2018–2025. Varicose veins in the anterior accessory great saphenous vein system were noted in 111 (3.7 %) patients. Inclusion criterion for the study: diagnosis of varicose veins of the lower extremities with varicose veins in the anterior accessory GSV system was established using ultrasound examination of the superficial and deep veins of the iliofemoral segment. Exclusion criterion: the presence of concomitant serious diseases. In type I, the varicosed anterior accessory great saphenous vein flows into the GSV in its upper third, and in type II, the varicosed trunk is not connected with the GSV.

Results. Among patients with type I varicose veins in the system of the anterior accessory great saphenous vein 49 (55.1 %) patients, variant 3 was observed, which corresponded to classical varicose disease with a single dilation of the GSV and its tributaries. The second place was taken by 31 (34.8 %) patients with maximum dilation of the GSV, where the varicose GSV passes into the lateral vein, and distal to the GSV was not dilated. In type II varicose veins in the anterior accessory great saphenous vein system in 13.6 % of cases the source of reflux was incompetent perforating veins from the deep femoral vein, in 27.3 % – incompetent perforating veins connected to the common femoral vein. In more than 59.1 % of patients with type II varicose veins in the anterior accessory great saphenous vein system the source of reflux was the iliofemoral basin connected through the perforating veins of the inferior gluteal vein.

Conclusions. The optimal approach to the classification of varicose veins within the anterior accessory great saphenous vein system is based on the source of reflux. In the case of type I varicose veins in the anterior accessory great saphenous vein system, classical phlebectomy of the GSV is effective in any way. However, in the case of type II varicose veins in the anterior accessory great saphenous vein system, it is necessary to eliminate the perforating veins, which are the source of reflux from the iliofemoral segment.

Psoriasis associated with pruritus: variability of clinical manifestations spectrum, correlation analysis of psychopathological symptoms and their impact on quality of life

H. I. Makurina — 2025-06-25

The aim of the study is to determine the clinical and anamnestic characteristics of pruritus in psoriasis, as well as to analyse the spectrum of psychopathological symptoms and their impact on the quality of life in this cohort of individuals.

Materials and methods. The main group included patients with psoriasis accompanied by pruritus of varying intensity (n = 15) and patients with dermatosis without active pruritus (n = 15). The severity of skin lesions, intensity of itching, psychopathological aspects, and their impact on quality of life were assessed using questionnaires and psychodiagnostic methods.

Results. The area of skin lesions in both groups was assessed by the Psoriasis Area and Severity Index (PASI): for the main group, the median was 9.2 (7.5; 10.1), for the comparison group – 7.05 (5.95; 8.40), which demonstrated a statistically significant difference (p < 0.05). The intensity of pruritus assessed by visual analogue scale was significantly higher in the main group (mean 5.60 ± 0.21) compared to the comparison group (1.90 ± 0.27). Correlation analysis revealed that for patients with pruritus, obsessive-compulsive symptoms (r = 0.92, p < 0.05) play the greatest role in the psychopathological aspect of the disease, while in patients without pronounced itching, symptoms of interpersonal sensitivity dominated (r = 0.97, p < 0.05). The main group of patients with psoriatic skin lesions associated with pruritus demonstrated a moderate impact on their life activities with a median of 9.5 (9.5; 16.5). Those respondents with only dermatosis rated the impact on quality of life as slight discomfort – 3.0 (2.5; 5.5).

Conclusions. Patients with psoriasis accompanied by severe pruritus, with a predominance of plaque form, have a more severe course of dermatosis, which is manifested by a higher PASI compared to patients with psoriasis without active itching. The psychodiagnostic assessment demonstrates the greatest influence of the group of obsessive-compulsive symptoms in the main group. The identified peculiarities of itching influence necessitate a better diagnosis of the pruriginous component and changes in approaches to personalized therapy for this group of patients.

Some aspects of the therapeutic effect of dental gel with IL-1β antagonist in experimental chronic generalized periodontitis

O. O. Dmytriieva — 2025-06-25

The aim of the current study was to evaluate the therapeutic efficacy of 1 % IL-1β antagonist dental gel by its effect on biomarkers of inflammation and cytoprotection under conditions of modelling chronic generalized periodontitis in rats.

Materials and methods. Chronic generalized periodontitis (CGP) was reproduced in Wistar rats weighing 180–210 g by 8-week administration of the prooxidant Delagil (chloroquine phosphate, 30 mg/kg) and addition of EDTA (2 %) to drinking water using a calcium-deficient peroxide diet with reduced chewing function. The studied pharmacological medications were administered after the development of CGP in rats for 30 days: 1 % oromucosal gel with IL-1β receptor antagonist (RAIL-1β, 1 mg/kg) locally using a dispenser; and the antioxidant Mexidol (250 mg/kg) intragastrically for 30 days. The condition of periodontal tissues and the effect of the studied medications on the levels of inflammatory markers IL-1β, tumour necrosis factor alpha (TNF-α), matrix metalloproteinase-2 (MMP-2) and markers of endogenous neuroprotection hypoxia-induced factor 1-alpha (HIF-1α) and heat shock proteins (HSP₇₀) were evaluated using enzyme-linked immunosorbent assay (ELISA).

Results. Modelling of CGP in rats by 8-week administration of the prooxidant Delagil and addition of EDTA to drinking water resulted in typical manifestations of the disease: bleeding, hyperaemia, and swelling of the gums; tooth mobility; formation of gingival pockets up to 8 mm against the background of increased levels of inflammation markers (TNF-α, IL-1β), and molecular markers (HIF-1α and HSP₇₀) in the blood indicated a homeostatic response of the periodontium to inflammation and subsequent hypoxia by an increase in the synthesis of HIF-1α and HSP₇₀. Course application of 1 % oromucosal gel with IL-1β receptor antagonist (1 μg/kg) to rats with CGP in a therapeutic regimen led to an improvement in the clinical picture of the disease: significant reduction in the size of the gingival pocket to 2.2 mm, and a significant reduction of bleeding and swelling against the background of lowering the levels of inflammatory markers in the blood: TNF-α – by 82 % (p < 0.05), metalloproteinase-2 – by 65 % (p < 0.05), and IL-1β – by 71.4 % (p < 0.05) compared to the group of untreated animals. Application of 1 % oromucosal gel with IL-1β receptor antagonist resulted in an increase in HIF-1α levels by 42 % (p < 0.05) in comparison to control indicators, and an increase in HSP₇₀ levels by 62.8 % compared to the control group, and in 2.4 times (p < 0.05) compared to the intact group that indicated a significant impact of IL-1β receptor antagonist on the HSP₇₀-dependent mechanisms of endogenous cytoprotection. Oromucosal gel with 1 % IL-1β receptor antagonist (1 μg/kg) was significantly superior to the reference drug Mexidol (250 mg/kg) in terms of its action on the studied parameters under conditions of CGP.

Conclusions. The obtained results substantiate the further in-depth pharmacological study of the new oromucosal gel with IL-1β receptor antagonist (1 μg/kg) for the purpose of clinical use in the treatment of generalized periodontitis. We have found that the use of IL-1β receptor antagonist in experimental CGP is more effective than Mexidol.

Bortezomib and quercetin as effective modulators of lipopolysaccharide-induced systemic inflammatory response and metabolic disorders

Ye. O. Morhun — 2025-06-25

Aim. This study aimed to evaluate the effects of combined administration of bortezomib and quercetin on serum ceruloplasmin levels, carbohydrate and lipid metabolism parameters, and secondary products of lipid peroxidation in a lipopolysaccharide (LPS)-induced rat model.

Materials and methods. Systemic inflammatory response (SIR) was modeled in male Wistar rats by intraperitoneal administration of Salmonella typhi LPS. Rats were divided into groups: intact controls, LPS-induced SIR, and SIR groups treated with bortezomib, quercetin, or their combination. Serum ceruloplasmin, glucose, lipid profiles, nitric oxide synthase (NOS) activity, and thiobarbituric acid-reactive substances (TBARS) levels were measured. Biochemical analyses were conducted using validated spectrophotometric and enzymatic methods.

Results. Combined administration of bortezomib and quercetin showed superior efficacy in mitigating SIR markers and metabolic disruptions compared to individual treatments. Serum ceruloplasmin levels, a marker of acute-phase reaction, were normalized, indicating robust anti-inflammatory effects. Hyperglycemia associated with SIR was significantly reduced, with glucose levels returning to baseline in the combined treatment group. Lipid profile analysis revealed a marked increase in high-density lipoprotein cholesterol and reductions in very low-density lipoprotein cholesterol and triglycerides, demonstrating improved lipid metabolism. Oxidative and nitrosative stress markers, including TBARS and inducible NOS activity, were significantly lower in the combined treatment group. Enhanced constitutive NOS activity and arginase levels further supported the restoration of nitric oxide metabolism.

Conclusions. The dual administration of bortezomib and quercetin is an example of a synergistic approach to managing SIR and its metabolic consequences. This combination effectively targets both inflammatory (NF-κB inhibition) and oxidative stress (Nrf2 activation) pathways, providing better therapeutic results compared to monotherapy. These findings suggest potential clinical application of the combined use of bortezomib and quercetin in conditions characterized by chronic inflammation and metabolic disturbances.

Analysis of the effectiveness of extracorporeal shock wave therapy in the treatment of orthopedic foot diseases at the current stage (literature review)

O. M. Ovchynnikov — 2025-06-25

Extracorporeal shock wave therapy (ESWT) continues to be a procedure with broad indications for use in orthopedic diseases, including the foot. One of the most common orthopedic diseases of the foot is plantar fasciitis and Achilles tendon tendinopathy. In recent years, the number of articles on tendinopathies has increased, and one of the most popular areas of research is diseases of the musculoskeletal system.

The aim of the study was to analyse the data from the current literature for review, to identify orthopedic diseases of the foot for the treatment of which the method of extracorporeal shock wave therapy was used, and to determine the effectiveness of the ESWT method for each of the diseases.

Material and methods. Literature sources from the scientometric electronic databases PubMed, Medline, Scopus, and Web of Science were selected and analysed. The search queries “ESWT”, “extracorporeal shock wave therapy” were used for the search. There were no language restrictions on the search for studies. The following information was extracted from each selected publication: study title, list of authors, year of publication, basic information about the study (type of study, number of patients), treatment parameters, duration of treatment, evaluation period, and study results. Articles from the last 5 years, i. e. from 2020 to 2024 inclusive, were separated from the selected articles.

Results. Based on the search results, 1771 scientific articles were selected. An analysis of the selected articles was conducted, orthopedic diseases of the foot were identified in the treatment of which extracorporeal shock wave therapy was used, and the effectiveness of the procedure itself for each disease was assessed. As a result, 36 articles were selected, which were used for the final analysis of the literature. The selected articles were distributed by the type of foot diseases in which the ESWT method was used. According to the search data, ESWT was used in the treatment of plantar fasciitis, Achilles tendon tendinopathy, and plantar fibromatosis.

Conclusions. According to the literature, extracorporeal shock wave therapy has been used in the treatment of plantar fasciitis, Achilles tendon tendinopathy, plantar fibromatosis, and partial damage to Achilles tendon. Extracorporeal shock wave therapy remains a relevant and effective method of treatment for the most common foot diseases.

The clinical role of daily blood pressure monitoring for the management of patients at the ambulatory stage

O. S. Kulbachuk — 2025-06-25

The aim of the work is to analyze and evaluate the clinical role of daily blood pressure monitoring for the management of patients with arterial hypertension.

Materials and methods. We analyzed the scientometric databases Scopus, Web of Science, PubMed and conducted a retrospective analysis of literature sources for 2019–2024. The most relevant sources on this topic were selected for analysis. Based on the review of article abstracts and their full text, 29 sources were selected.

Results. Blood pressure (BP) measured by the method of ambulatory blood pressure monitoring (ABPM) provides prognostic information about cardiovascular disease to a greater extent than “office blood pressure” and is more associated with predicting cardiovascular risk. The most clinically important are 24-hour and nighttime BP levels, while other BP indices, in addition to 24-hour and nighttime BP levels, contribute little to risk stratification or treatment of hypertension. ABPM provides a more physiologically accurate measurement of “true” blood pressure and its changes during the day. In most cases, values are considered normal if the 24-hour average BP is 130/80 mm Hg or less, daytime BP is 135/85 mm Hg or less, or nighttime BP is 120/70 mm Hg or less. The European guidelines for the treatment of hypertension support the use of out-of-office BP measurements to confirm the diagnosis of hypertension and to identify hypertension phenotypes such as “white coat” hypertension and masked hypertension. White-coat hypertension is associated with an increased long-term risk of persistent hypertension and mortality, so patients at high risk of cardiovascular disease should be treated with pharmacological therapy along with nonpharmacological approaches. Masked hypertension carries a risk, adjusted for many factors, almost equivalent to resistant hypertension. There are 3 subtypes: masked effect, masked hypertension, and masked uncontrolled hypertension. It is advisable to consider pharmacologic treatment in patients with masked hypertension after treating risk factors such as obesity, diabetes, alcohol consumption, smoking, and stress.

Conclusions. The main contribution of ABPM to the diagnosis and treatment of hypertension is the cross-classification between office and ambulatory BP measurement. Current data suggest that 24-hour ABPM should be an integral part of the management of patients with hypertension.

A case of successful intensive care of severe sepsis in a newborn child

M. Yu. Kurochkin — 2025-06-25

Neonatal sepsis remains one of the key problems of perinatal medicine.

Aim of the study. To acquaint practitioners with the case of successful complex intensive care in a newborn child with severe sepsis using discrete plasmapheresis.

Materials and methods. The child was treated in the Department of Anaesthesiology and Intensive Care of Newborns of Zaporizhzhia City Children’s Hospital No. 5. The child underwent clinical and biochemical blood tests, microbiological, X-ray and ultrasound examinations using the hospital’s equipment.

Results. In a premature baby, the postoperative period after hernia repair was complicated by the development of necrotising enterocolitis. The child’s condition was close to critical due to the progression of toxemia, water and electrolyte disorders, acid-base imbalance, development of peritonitis, and multiple organ failure syndrome. For the purpose of extracorporeal detoxification, a discrete plasmapheresis session was performed. In order to sanitise the inflammation focus, the child’s abdominal cavity was drained from the left and right sides for washing with antiseptic solutions. After that, the child’s condition was stabilised, and an extended surgery with balanced multimodal anesthesia and neuroaxial block was performed. In post-operative period caudal blocks were performed twice daily. A second session of discrete plasmapheresis was conducted. Subsequently, immunosupplementation therapy, full parenteral nutrition, and combined antibacterial therapy according to the de-escalation principle were performed. The child’s condition was positive due to the complete regression of intoxication, intestinal paresis, and multiple organ failure. The result of complex intensive care using extracorporeal detoxification methods was positive.

Conclusions. The integration of extracorporeal detoxification methods into the comprehensive intensive treatment of severe sepsis in a newborn, in combination with de-escalation antibiotic therapy and immune replacement therapy, is likely to improve treatment outcomes.