№2, 2025, volume 21

Objective: to evaluate the features of myocardial revascularization in patients with acute coronary syndrome (ACS) in the post-COVID period. Material and methods. A total of 114 patients with ACS and a history of new coronavirus infection (NCI) (group 1). The comparison group included 111 patients with ACS without a history of NCI (group 2). All patients in both groups underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting on the first day. Results. A significant difference between the groups was noted in the frequency of PTCA with stenting, taking into account the age aspect: for patients in the age group over 65 years: p=0.031, relative risk (RR) 0.717 ([95% confidence intervals — Cl 0.518-0.991]). ACS in the post-COVID period was associated with damage to the right coronary artery (p<0.001, RR 1.629 [95% Cl 1.251-2.120]) and statistically significantly increased the risk of developing reperfusion syndrome, namely the occurrence of cardiogenic shock on the operating table (p=0.023, RR 1.553 [95% Cl 1.162-2.075]), AV blocks (p=0.034, RR 1.775 [95% Cl 1.322-2.383]) and bradycardia (p=0.021, RR 1.707 [95% Cl 1.280-2.276]). Conclusion. Patients with ACS in the post-COVID period more often experience manifestations of reperfusion syndrome after revascularization compared to patients without previous NCI.

Objective: to reveal the frequency of hemostasis and folate cycle gene polymorphisms in stable coronary heart disease (CHD) patients based on the severity of COVID-19 during the acute phase. Material and methods. During the study, 416 patients with stable CHD who had previously experienced COVID-19 with documented severity were examined for hemostasis and folate cycle gene polymorphisms. The severity of COVID-19 was used to categorize patients into two groups: the first group included patients with mild cases (n=203), while the second group comprised patients with moderate severity (n=213). The evaluation included the following genetic variants: 20210 G>A of the F2 gene, 1691 G>A of the F5 gene, 807 ОТ of the ITGA2 gene, 10976 G>A of the F7 gene, 1298 A>C of the MTHFR gene, 66 A>G of the MTRR gene, 2756 A>G of the MTR gene, 677 ОТ of the MTHFR gene, 455 G>Aof the FGB gene, 103 G>T of the F13A1 gene, 6755G>4G of the SERPINE1 (PAI-1) gene, and 1565 T>C of the ITGB3 gene. These polymorphisms likely contribute to a more severe course of COVID-19 in patients with CHD. Results. The presence of the heterozygous FGB: 455 G>A polymorphism and the ITGB3: 1565 T>C CC genotype may contribute to more severe COVID-19 progression in patients with CHD. Conversely, the CC genotype of the 807 ОТ polymorphism of the ITGA2 gene was associated with protection against more severe forms of the disease in the analyzed sample. Conclusion. Polymorphisms 455 G>Aof the FGB gene and 1565 T>C of the ITGB3 gene can be considered potential markers for detecting and predicting a more severe course of COVID-19 in patients with CHD.

The article presents a clinical case of the development of a massive paradoxical embolism during the removal of a large vestibular schwannoma. The clinical case demonstrates one of the complications that occur during neurosurgical operations performed in the patient's sitting positionln this clinical case, against the background of an air embolism of cerebral vessels, multiple foci of cerebral ischemia formed, which are of interest mainly due to the cortical localization of the formed multiple foci, which determined the rapid regression of gross postoperative neurological deficit.

Objective: to compare the outcomes of surgical plasty of bone defects of various localization with block allografts or spongy bone powder for distal humerus fractures. Material and methods. The study included 56 patients with comminuted distal humerus fractures divided into 3 groups based on the bone defect location and 2 subgroups based to the replacement method used for them. The functional outcomes were evaluated based on the indicators of the Broberg and Morrey scale, pain was evaluated based on the Visual Analogue Scale. Results. The amplitude of flexion-extension movements of the elbow joint in patients with defects of the medial column reached 90±5° (p=0.04) 1.5 months after surgical plasty with a block allograft and 75±6° with the use of spongiosus allograft. 3 months after surgical block graft surgery, the strength and pain in elbow joint for defects in the central zone reached 80±2 points (p=0.01), lateral — 82±3 points (p=0.01) and medial epicondyles — 88±4 points (p=0.03). Conclusion. The plasty of the defect with a block allograft in distal humerus fractures increases the multiplane range of motion in 1.5 months after the surgery for the medial column defects, improves strength and flexion-extensional range of motion, reduces pain in 3 months after the surgery for the bone defects in the medial, lateral or central metaphyseal areas.

Objective: to evaluate the relationship between blood clotting factor activity and the closure of full-thickness macular holes after surgical intervention using autologous conditioned plasma (ACP). Material and methods. A single-center retrospective cohort study was conducted involving 62 patients (62 eyes) with primary full-thickness macular holes. Patients underwent treatment: microinvasive subtotal vitrectomy with removal of epiretinal and internal limiting membranes, application of ACP, and airtamponade. Patients were divided into two groups: the main group (31 patients with coagulogram abnormalities) and the control group (31 patients with normal coagulogram parameters). Results. Surgical outcomes showed recurrence in 85.7% of cases in the main group versus 14.3% in controls (p=0.005). Among recurrence cases, 83.3% had prolonged prothrombin time (p=0.042) and 75.0% had reduced fibrinogen levels (p=0.049). Conclusion. Abnormalities in the coagulogram may be a risk factor for failure to close the macular rupture with ACP mass. Relapse was detected 6 times more often with an increase in prothrombin time, as well as with a decrease in fibrinogen below 2.0 g/L in the blood of patients.

Objective: to develop an effective prognostic model for the development of metabolic syndrome (MS) in women during early postmenopause. Material and methods. The case — control study included 82 early postmenopausal women. Group 1 consisted of 35 women with MS, group 2-47 women without MS. The research methods included the collection of medical history in a specially designed form, analysis of medical information from outpatient records, anthropometry and laboratory studies, assessment of the severity of menopausal syndrome by a modified menopausal index (MMI). Results. In patients with MS, compared with the control group, index HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), the visceral adiposity index and MMI were significantly higher (p<0.001, p<0.001 and p=0.003, respectively), while the levels of follicle-stimulating hormone (p=0.008) and prolactin (p=0.011) were lower. Using the method of multiple logistic regression, a screening model has been developed to assess the likelihood of MS in women, including 5 parameters: somatic comorbidity, visceral adiposity index, MMI, levels of follicle-stimulating hormone and prolactin. The ROC curve was used to build the model. The area under the ROC curve (AUC) of the model was 0.909; 95% confidence interval 0.835-0.984 (sensitivity — 87.1 %, specificity — 78.6%). Conclusion. A prognostic model of the development of metabolic syndrome in women during early postmenopause has been developed, which helps identify patients with increased cardiometabolic risk, which will allow timely initiation of personalized preventive and treatment measures.

A clinical case of a rare orbital lesion with mucormycosis, which developed against the background of odontogenic osteomyelitis in a patient with diabetes mellitus, is presented. A comprehensive approach, including antifungal therapy, surgical interventions and correction of carbohydrate metabolism, made it possible to localize the infection and stabilize the patient's condition; however, vision in the right eye could not be restored.

Objective: to evaluate the olfactory function and olfactory fissure (OF) parameters in patients with varying severity of chronic polypous rhinosinusitis (CRSwNP) symptoms. Material and methods. A total of 50 patients with CRSwNP (mean age 44,5 [36,2; 55,0] years) were examined: group 1 (n=12)— patients with mild CRSwNP symptoms (total SNOT-22 score 8-20 points), group 2 (n=38)— with moderate and severe CRSwNP symptoms (total score over 21). A questionnaire was administered using Sino-Nasal Outcome Test, Sniffin' Sticks Screening Test-12, Questionnaire of Olfactory Disorders — Negative Statements and computed tomography of the paranasal sinuses was performed. Results. According to Sniffin' Sticks Screening Test-12, olfactory function was impaired in 91.7% of patients in group 1 (33.4% — hyposmia, 58.3% — anosmia), and in 94.7% of patients in group 2 (71.1% — hyposmia, 23.6% — anosmia). According to Questionnaire of Olfactory Disorders — Negative Statements, the total score in group 1 was 19.0 [5.0; 19.0], and in group 2-7.5 [6.0; 13.0]; (p=0.053). The volume of the OF in patients in groups 1 and 2 was 21.0 [20.0; 24.0] and 7.5 [6.0; 13.0] mm3, respectively, but the nature of the differences revealed was statistically insignificant (p=0,053). The density of the OF in group 1 was-100 [-192.5; —9] HU units, in group 2------149.5 [-302.3; 68.3] HU units (p=0.958). Conclusion. Olfactory function was impaired equally often regardless of the severity of CRSwNP symptoms. The volume of the OF in patients with moderate and severe CRSwNP symptoms was 3 times smaller than in CRSwNP with mild symptoms. The density of the OF was comparable with different severity of CRSwNP symptoms.