Modern medical technology

Choosing a class IC antiarrhythmic drug for the treatment of patients without structural heart disease: clinical advantages of the most common agents (literature review)

N. M. Sydorova, M. Yu. Kolesnyk — Thu, 25 Sep 2025 00:00:00 +0300

Aim: to analyze the pharmacological features and updated evidence-based medicine data of Class IC antiarrhythmic drug (AAD) ethacizine compared to propafenone to optimize the choice of treatment for cardiac arrhythmias in patients without structural heart disease.

Materials and methods. According to the purpose, a search was conducted for available scientific literature with an emphasis on publications of the last 5 years. We also analyzed scientific information on scientific platforms of the European Society of Cardiology (ESC 365) and the Association of Cardiologists of Ukraine.

Results. At first glance, Class IC AADs seem to be identical in the mechanism of action, which creates certain difficulties for practicing physicians when choosing AAD of this class for the treatment of arrhythmias in each specific case. Ethacizine and propafenone were chosen for comparison as the most frequently used Class IC AADs in our country. We presented data from studies comparing the efficacy and safety of the selected AADs with an emphasis on recent studies of ethacizine, as a less well-known AAD in Europe and globally. In addition, this article includes the main design features of new studies on real-world clinical use of Class IC AADs, including use as a “pill-in-the-pocket” for restoring sinus rhythm in patients with atrial fibrillation (ETERNITY study) and comparing the efficacy of propafenone and ethacizine in maintaining sinus rhythm in patients with paroxysmal and persistent forms of atrial fibrillation.

Conclusions. Propafenone and ethacizine have significant differences in pharmacological properties, specific contraindications, drug interactions, and evidence base, which can be considered to determine the optimal agent for a particular patient. The choice of the optimal Class IC AAD will depend on the presence and type of dysautonomia of the patient.

Laryngopharyngeal reflux: current perspectives and controversies

V. M. Kryshtal, O. V. Melnikova, O. V. Khorolets, O. V. Hancheva — Thu, 25 Sep 2025 00:00:00 +0300

The aim of this study is to systematize current concepts and describe key pathogenetic variants of laryngopharyngeal reflux formation based on the analysis of recent experimental research and clinical observations.

Materials and methods. The study examined pathogenetic mechanisms of laryngopharyngeal reflux (LPR) formation using methods of analysis, synthesis, and generalization of scientific data. The information base was formed through a systematic literature search in international scientometric databases, in particular PubMed, Scopus, Web of Science, and Google Scholar. A total of 90 sources were selected for further analysis according to criteria of scientific significance (high journal quartile, authors’ h-index, and statistical validity). The search strategy included the identification of the topic’s relevance, formulation of appropriate queries (laryngopharyngeal reflux, vagus reflex, autonomic nervous system, etc.), critically assessing the reliability of sources, comparing results between studies, and summarizing the data obtained.

Results. The literature review revealed that LPR is a multifactorial, complex, and poorly standardized syndrome with a wide range of nonspecific symptoms. Theoretical analysis identified four principal pathogenetic mechanisms of LPR: chemical (microaspiration and mucosal damage), neuro-reflex (hypersensitivity), muscular (laryngeal overload), and immunobiological (chronic inflammation and microbiota imbalance). LPR may result from esophageal motility disorders, sphincter dysfunction, neuroimmune and psychovegetative disturbances while its chronicity is promoted by central and peripheral sensitization, stress, genetic predisposition, and behavioral factors including obesity, smoking, diet, and medication. It was established that there is no universal diagnostic standard for LPR, and current diagnostic approaches remain complex and fragmented, relying largely on the exclusion of other pathologies and empirical treatment.

Conclusions. The complex and heterogeneous pathogenesis of laryngopharyngeal reflux accounts for its symptoms variability. Identification of distinct pathogenetic variants or typical phenotypes with specific clusters of morphological, structural, functional, biochemical, instrumental, and psychometric features will facilitate the development of highly effective integrative pharmacological treatment approaches.

Hypertensive disorders in pregnancy: current evidence, short-term and long-term outcomes

Thu, 25 Sep 2025 00:00:00 +0300

Hypertensive disorders during pregnancy remain a leading cause of maternal and perinatal morbidity and mortality worldwide and represent a significant challenge in contemporary obstetrics. Despite advances in diagnostics, treatment, and screening programs, their prevalence continues to rise, driven by sociodemographic and medical factors such as higher maternal age and increasing rates of comorbidities.

Aim: to analyze current scientific literature on the prevalence short-term and long-term outcomes of hypertensive disorders during pregnancy, with a particular focus on preeclampsia, and to identify promising strategies for prevention and postpartum follow-up in women affected by these complications.

Materials and methods. A literature search was conducted in PubMed, Scopus, Web of Science, Medline, and UpToDate using the keywords: hypertensive disorders in pregnancy, gestational hypertension, preeclampsia, eclampsia, long-term outcomes, short-term outcomes, maternal cardiovascular risk, offspring, neurodevelopment, postpartum follow-up, cardiovascular prevention. Publications from 2020–2025 were prioritized. The review included systematic reviews, meta-analyses, cohort studies, and clinical guidelines. After exclusions, 70 publications meeting the criteria for relevance, evidence level, and clinical significance were analysed.

Results. The review summarizes the main clinical forms of hypertensive disorders during pregnancy – gestational hypertension, preeclampsia, and eclampsia – and highlights an upward trend in prevalence, particularly for gestational hypertension. The impact of the COVID-19 pandemic on incidence patterns is noted. Reported long-term maternal consequences – including cardiovascular, metabolic, and neurological disorders – as well as for their children, who may experience neurodevelopmental and psycho-emotional disturbances.

Conclusions. Hypertensive disorders during pregnancy carry substantial short- and long-term health risks for both mother and child. Women with a history of these conditions require structured postpartum follow-up and targeted preventive measures. Children born from such pregnancies may face elevated cardiovascular and neurodevelopmental risks, warranting ongoing monitoring. Implementation of early risk identification, patient education, and a multidisciplinary preventive approach is essential for reducing adverse outcomes.

Rare embryonal tumor of the central nervous system in newborns: case report and comparative clinical analysis

A. S. Panina, P. V. Kuzyk, T. V. Savchuk, V. A. Zhovnir, A. Zh. Sadykova — Thu, 25 Sep 2025 00:00:00 +0300

Aim: to conduct a clinical and morphological analysis of a case of central nervous system (CNS) embryonic tumor not otherwise specified (NOS) and to determine its key pathogenetic features.

Materials and methods. A retrospective analysis was conducted of an autopsy case involving a deceased premature female neonate diagnosed with a CNS embryonal tumor, NOS. The material was obtained from the Division of Pathological Anatomy of the National Specialized Children’s Hospital “Ohmatdyt” of the Ministry of Health of Ukraine. The morphological diagnosis was established based on macroscopic and microscopic examination.

Results. The findings indicate an intrauterine origin of the CNS embryonal tumor NOS and the presence of characteristic morphological features that correlate with aggressive tumor behavior, including multiple necroses, hemorrhages, and pseudorosettes formations composed of poorly differentiated cells. The study emphasizes the importance of fetal magnetic resonance imaging in complex cases of prenatal hydrocephalus as a diagnostic tool and for determining further pregnancy management strategies.

Conclusions. The presented case highlights the need for an interdisciplinary approach to the diagnosis and care of newborns with CNS embryonal tumors and the creation of prognostic models for delivery outcomes in the presence of this pathology.

Experience in improving the results of treating scalp defects using the FUE method with DHI

O. A. Hyndych — Thu, 25 Sep 2025 00:00:00 +0300

Aim. Improvement of scalp defect treatment results using hair transplantation technology by follicular unit extraction and direct hair implantation methods.

Materials and methods. A 50-year-old patient complained of multifocal post-burn alopecia of the scalp and left eyebrow. Hair restoration was performed using hair transplantation using the FUE (Follicular Unit Extraction) method with DHI (Direct Hair Implantation). The results were evaluated using an objective criterion (percentage of hair engraftment), as well as the subjective criterion of patient satisfaction with the result using a total score scale (Likert scale), which was adapted according to the tasks of the work.

Results. The final result was evaluated one year after hair transplantation. The patient noted an acceptable result (4 points). A second session of hair transplantation was performed in the intervals between the already grown grafts to achieve a uniform effect.

Conclusions. Hair transplantation can be used to restore scalp hair in cases where the use of local flaps and tissue extension is limited (multifocal scarring and postoperative alopecia), as well as a secondary procedure after primary closure of the defect with non-vascularized skin grafts or distance flaps. FUE hair transplant with DHI allows you to restore the natural angle and direction of hair growth, even in aesthetically difficult areas such as the front hairline, crown, eyebrows, and achieve hair growth density that is almost identical to natural.

Analysis of apoptosis-associated proteins expression in the basal magnocellular nucleus of rats under experimental neurodegeneration

M. V. Danukalo, Yu. M. Kolesnyk — Thu, 25 Sep 2025 00:00:00 +0300

The aim. To expand current understanding of the expression characteristics of p53 and Annexin A5, as well as the nature of their correlations in the basal magnocellular nucleus (BMN) of rats undergoing colchicine-induced neurodegeneration.

Materials and methods. This study was conducted on 30 male Wistar rats. Neurodegeneration was induced in the group of animals (n = 10) via intracerebroventricular administration of colchicine. The comparison groups included intact rats (n = 10) and sham-operated rats (n = 10), the latter receiving an intracerebroventricular injection of 0.9 % NaCl instead of colchicine. Subsequently, the animals were euthanized with sodium thiopental, and their brains were collected for immunofluorescent analysis of p53 and Annexin A5 expression. The data obtained were analyzed statistically.

Results. The intensity of p53-positive cell fluorescence within the studied brain structure did not significantly differ between experimental groups. In contrast, the corrected total cell fluorescence of Annexin A5-positive cells in the BMN was significantly higher in colchicine-treated rats – by 24.2 % and 46.9 % – compared to intact and sham-operated animals, respectively. Evaluation of the colocalization degree between p53 and Annexin A5 immunoreactive materials with the nuclear stain DAPI in BMN cells demonstrated a low level of colocalization for both markers. However, compared to the neurodegeneration group, the intact and sham-operated animals showed statistically significant differences in this parameter for both p53-positive and Annexin A5-positive cells. Assessing the number of immunopositive cells, colchicine administration resulted in nearly a threefold increase in p53⁺ cells compared to intact animals and an approximately two-and-a-half-fold increase compared to sham-operated animals. Regarding Annexin A5⁺ cells, their number nearly doubled compared to both comparison groups. Colchicine treatment also led to a nearly threefold increase in p53⁺ cells and a twofold increase in Annexin A5⁺ cells compared to controls.

Conclusions. In the basal magnocellular nucleus of rats subjected to intracerebroventricular colchicine administration, a statistically significant increase in corrected total cell fluorescence values for Annexin A5-positive cells – but not for p53-positive cells – was observed compared to intact and sham-operated animals. Additionally, there was a significant increase in the number of both p53-positive and Annexin A5-positive neurons. Moreover, p53-positive cells in the BMN of colchicine-treated rats exhibited a higher degree of colocalization with DAPI compared to the comparison groups. Importantly, no correlation was found between the fluorescence intensity of Annexin A5-positive cells and the degree of DAPI colocalization with p53 in the neurons of the BMN under conditions of colchicine-induced neurodegeneration.

The role of X-ray densitometry in diagnosing calcium metabolism disorders in patients after bariatric surgery

I. M. Todurov, O. O. Kalashnikov, V. P. Yushchenko, A. A. Hrynevych — Thu, 25 Sep 2025 00:00:00 +0300

Obesity and bariatric surgery are global medical challenges; however, they are associated with the risk of developing calcium metabolism disorders, which may lead to osteopathies and fractures. Dual-energy X-ray absorptiometry (DXA) plays a key role in the detection of such disorders.

Aim: to analyze the role of X-ray densitometry in diagnosing calcium metabolism disorders in patients after bariatric surgery.

Materials and methods. A retrospective study was conducted on 31 obese patients after bariatric surgery: sleeve gastrectomy (SG) (n = 14) and biliopancreatic diversion with duodenal switch (BPD-DS) (n = 17). Anthropometric data, levels of ionized calcium, 25(OH)D, and parathyroid hormone (PTH), as well as bone mineral density indicators assessed by DXA, were evaluated. Statistical analysis was performed using SPSS version 23.

Results. At an average of 40.7 ± 11.4 months postoperatively, all patients were found to have vitamin D deficiency and secondary hyperparathyroidism. The T-score in the BPD-DS group (-1.77 ± 0.9) was significantly lower than in the SG group (0.47 ± 1.26) (p < 0.001). Osteopathies were more frequently observed after BPD-DS: osteopenia was found in 58.8 % of patients and osteoporosis in 17.6 %. A strong inverse correlation was identified between PTH levels and T-score (rs = -0.71, p = 0.001), highlighting the influence of hyperparathyroidism on the reduction of bone mineral density.

Conclusions. DXA is a highly effective method for diagnosing calcium metabolism disorders after bariatric surgery, enabling the detection of early forms of osteopathies. Patients after BPD-DS have a higher risk of osteopenia and osteoporosis compared to patients after SG. X-ray densitometry combined with laboratory monitoring of calcium-phosphorus metabolism should become a standard part of follow-up to ensure timely detection and prevention of complications.

Assessment of occupational risks from exposure to suspended ultrafine particles of industrial aerosol for workers of a metallurgical enterprise

L. P. Sharavara, N. M. Dmytrukha, I. M. Andrusyshyna — Thu, 25 Sep 2025 00:00:00 +0300

Aim. To assess occupational risks from exposure to suspended ultrafine particles of industrial aerosol for workers of a metallurgical enterprise.

Materials and methods. The study of the content of suspended particles was carried out at the workplaces of metallurgical production workers using a portable scanning spectrometer Nanoscan 3910 (USA). Their chemical composition was studied by optical emission spectrometry with inductively coupled plasma (OES-ICP) on the device “Optima 2100 DV” manufactured by “PerkinElmer” (USA). Based on the results obtained, carcinogenic and non-carcinogenic risks were calculated.

Results. It was established, that in the air of the working area of the open-hearth furnace steelworker, the total numerical concentration of suspended particles was 6.9 × 10⁴(4.0 × 10⁴; 8.0 × 10⁴) particles/cm³, in the air of the working area of the blast furnace – 5.1 × 10⁴ (4.5 × 10⁴; 7.8 × 10⁴), in the air of the sinter plant working area – 2.4 × 10⁴ (2.1 × 104; 5.1 × 10⁴). All indicators exceeded the total numerical concentration of suspended particles of control workers and were statistically significantly higher (p ˂ 0.001). The composition of suspended particles included Si, Al, P, Fe, Ca, Mg, Cr and Ni, which is due to the type of technological process. Exceedances of hygienic standards was observed for P, Cr and Ni. The calculated carcinogenic risk indicators for workers from exposure to chromium and nickel were high. The hazard coefficients from exposure to suspended particles with element densities >6 kg/m³ and <6 kg/m³ for an open-hearth furnace steelworker were HQ = 3.15 and HQ = 1.57, for a blast furnace worker – HQ = 2.54 and HQ = 1.27, for a sinter plant worker – HQ = 3.15 and HQ = 1.57, respectively. The greatest non-carcinogenic risk was caused by particles up to 64 nm in size. The risk excess factor at the workplace of an open-hearth furnace steelworker, compared with workers in the control group, was 224.8 times, at the workplace of a blast furnace worker – 61.9 times, and at the workplace of a sinter plant worker – 12.9 times.

Conclusions. During the production of sinter, cast iron and steel, suspended particles of combined chemical composition are formed at the workplaces of workers. The obtained carcinogenic risk values from exposure to chromium and nickel for all workers were high. The hazard coefficients from exposure to suspended particles for almost all workers exceeded unit, that can be considered unacceptable. The greatest risk, depending on the size, for all workers was posed by the smallest particles (≤64 nm).

Apixaban in glomerulonephritis with nephrotic syndrome: thromboprophylaxis and pleiotropic effects in a prospective cohort study

Thu, 25 Sep 2025 00:00:00 +0300

Aim: to assess the efficacy and safety of apixaban in preventing thromboembolic complications in patients with nephrotic syndrome (NS) due to primary glomerulonephritis, and to investigate its potential anti-inflammatory and antifibrotic effects.

Materials and methods. A prospective longitudinal cohort study included 85 adult patients with newly diagnosed NS and estimated glomerular filtration rate >60 mL/min/1.73 m². Patients were divided into two groups: 42 received warfarin and 43 received apixaban (5 mg twice daily). The follow-up period was 6 months. IL-6, TNFα, and TGF-β1 were measured in serum and urine at baseline, 1 month, and 6 months.

Results. No thromboembolic events occurred in either group. Minor bleeding events were significantly more common in the warfarin group (p = 0.01), confirming apixaban’s better safety profile. After 6 months, the apixaban group showed a more pronounced decrease in IL-6, TNFα, and TGF-β1 levels in both serum and urine compared to the warfarin group (p < 0.05), suggesting anti-inflammatory and antifibrotic effects potentially associated with protease-activated receptor pathway modulation.

Conclusions. Apixaban ensures safe and effective thromboprophylaxis in NS with possible additional benefits in reducing inflammation and fibrosis. Further studies are needed to confirm these effects and define its role in nephrology.

Mechanical circulatory support in patients in cardiogenenic shock

V. H. Tanskyi — Thu, 25 Sep 2025 00:00:00 +0300

Cardiogenic shock in acute myocardial infarction is a life-threatening syndrome characterized by systemic hypoperfusion that can rapidly progress to multiple organ failure and death. There are various mechanical circulatory support devices and configurations available to support patients, each with unique pathophysiological characteristics.

The aim. To investigate the effectiveness and causes of adverse outcomes of extracorporeal membrane oxygenation in the treatment of patients with cardiogenic shock.

Materials and methods. Between January 2024 and December 2024, 11 patients underwent venous-arterial extracorporeal membrane oxygenation in the state of cardiogenic shock at the Kovel-ECMO hospital district.

Results The survival rate was 72.0 % (8 patients). The successful cannulation rate was 100 %. The median cannulation time was 15 minutes. The median time before extracorporeal membrane oxygenation was 54 minutes. The median age was 50 years, and 100 % were male.

Conclusions. When using temporary mechanical circulatory support in patients with cardiogenic shock, a positive result was obtained in 72.0 % of patients.