Medicine Today and Tomorrow

Model for predicting the progression of chronic heart failure of ischaemic origin against the background of concomitant metabolic pathology

K.M. Borovyk — 2025-12-31

In press

Background. Predicting the course of chronic heart failure (CHF) remains a challenging task, especially in the presence of comorbid metabolic disorders. Traditional prognostic tools, such as the Seattle Heart Failure Model (SHFM) and MAGGIC score, often do not take into account the specific impact of obesity and type 2 diabetes mellitus (T2DM), which can lead to the risk underestimation. This necessitates the search for new biomarkers to create more accurate risk stratification models in patients with polymorbidity.

Aim. To develop and internally validate a prognostic model for the risk of progression of chronic heart failure of ischaemic origin against the background of concomitant metabolic pathology such as type 2 diabetes mellitus and obesity.

Materials and Methods. The study was conducted on a cohort of 75 patients with CHF against the background of coronary artery disease with concomitant T2DM and obesity, examined twice with a frequency of one year. The diagnosis of CHF and concomitant pathology was verified in accordance with international and national standards. Biomarkers (NT-proBNP, GAS6, catestatin) were determined by enzyme-linked immunosorbent assay (ELISA).

Research Ethics. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Bioethics Committee of the Kharkiv National Medical University. All patients provided written informed consent to participate.

Results. The prognosis for CHF Functional Class (FС) deterioration within one year was calculated using binary logistic regression analysis with the method of sequential inclusion of parameters. The prognostic significance of individual indicators (NT-proBNP, GAS6, catestatin, insulin, nesfatin-1, and body mass index (BMI)) was assessed by ROC analysis to determine the optimal cut-off points and convert quantitative variables to binary (0/1). It was found that the most powerful prognostic factors were NT-proBNP at a level above 2347 pg/ml with the highest specificity (96.8%); BMI exceeding 32.47 kg/m2, which is a highly sensitive screening factor (92.8% sensitivity); catestatin at a level below 4.92 ng/ml – as a marker of a deficient cardioprotective mechanism, with high sensitivity (88.7%) and specificity (81.3%). Insulin levels above 32.18 mg/ml and GAS6 levels exceeding 23.48 ng/ml were also found to be significant independent predictors of CHF progression.

Conclusions. The developed integrative model effectively combines neurohumoral, metabolic, and inflammatory factors, allowing for personalised and accurate stratification of the risk of chronic heart failure progression in patients with comorbid obesity and type 2 diabetes mellitus.

Keywords: therapy, coronary artery disease, type 2 diabetes mellitus, obesity, GAS6, catestatin, nesfatin-1.

Aspects of psychosocial interaction between midwives and women with anxiety-phobic disorders in the perinatal period in war conditions

V.V. Obozna — 2025-12-31

In press

Background. The prolonged state of martial law in the country leads to an increase in anxiety-phobic disorders among the population. The highest percentage of this neurotic disorder is observed in children, pregnant women, and women in the postpartum period. Conditions of uncertainty, constant threat, and psychological burden have a negative impact on the psycho-emotional sphere of women in the perinatal period, which creates an additional need for maternity hospital nurses to provide comprehensive support to expectant mothers.

Aim. Analysis of the peculiarities of psychosocial interaction of midwives with women with anxiety-phobic disorders in the perinatal period during wartime and identification of current strategies for patient-healthcare professional interaction.

Materials and Methods. The study was conducted using systemic analysis, bibliosemantic and sociological methods. Scientific sources from PubMed, Medline, Scopus, Google Scholar, and Web of Science were reviewed. A survey of 20 women in the perinatal period residing in the Kharkiv region was conducted using the State-Trait Anxiety Inventory (STAI) via the Google-Forms platform. The study was conducted as a private initiative of the authors and did not receive grant funding.

Research Ethics. The study was conducted in compliance with the ethical standards of the Declaration of Helsinki of the World Medical Association (1964–2024), the international guidelines of CIOMS (Council for International Organizations of Medical Sciences) and ICH (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use), as well as Article 28 of the Constitution of Ukraine, Article 43 of the Law of Ukraine "Fundamentals of the Legislation of Ukraine on Health Care" (1992), and the Order of the Ministry of Health of Ukraine No.690 of September 23, 2009. The study participants provided informed consent to participate in the research.

Results. The survey using the State-Trait Anxiety Inventory (STAI) revealed a high level of anxiety in 15 (75 %) women, a moderate level in 4 (20 %), and a low level in 1 (5 %). Nine women had a diagnosed anxiety-phobic disorder, and 4 exhibited obvious symptoms of the disorder, indicating a high prevalence of this condition. We have systematized a strategy for psychosocial support and nursing care for such patients.

Conclusions. Nursing care for women in the perinatal period requires comprehensive provision of psycho-emotional support, as a significant proportion of patients have an increased level of anxiety, which is a clinically significant risk factor for the development of anxiety-phobic disorders.

Keywords: obstetrics, nursing, medical support, stress disorders, neurotic disorders, pregnancy.

Integration of positron emission tomography and computed tomography data with high-resolution neurovisualization for personalized surgical planning for drug-resistant epilepsy in children

O. Oliinichenko — 2025-12-31

In press

Background. Drug-resistant epilepsy in children remains one of the most challenging problems in pediatric neurology, as the lack of seizure control after drug treatment requires early detection of the epileptogenic zone and precise preoperative planning. Integration of Positron Emission Tomography with 18F-FluoroDeoxyGlucose and Computed Tomography (18F-FDG PET/CT) and high-resolution neuroimaging opens new possibilities for a personalized approach.

Aim. To assess the diagnostic and prognostic value of an integrated approach combining positron emission tomography with 18F-fluorodeoxyglucose and computed tomography and high-resolution neuroimaging data in detecting and localizing the epileptogenic zone for personalized surgical planning in children with drug-resistant epilepsy.

Materials and Methods. A retrospective analysis of 150 outpatient charts of children aged 1 to 17 years at the Nuclear Medicine Center of the Kyiv City Clinical Oncology Center in 2021–2023 was conducted. Patients were divided into four age groups. Data from ElectroEncephaloGrams (EEG), high-resolution Magnetic Resonance Imaging (MRI), and 18F-FDG PET/CT were compared.

Research Ethics. The study was conducted with the written consent of the children's parents, in compliance with the provisions of the World Medical Association Declaration of Helsinki (1964–2024).

Results. Structural changes in the brain by MRI were detected in 43.3 % of the examined, and metabolic disorders by PET/CT were detected in 68.7 % of the children, including cases with negative MRI results. Quantitative analysis using the CortexID 3.2 software complex (GE Healthcare, USA) proved to be an effective tool for objectifying the results of PET/CT. This increases the reproducibility of the results and contributes to the personalized choice of surgical tactics. Correlation analysis showed a reliable relationship between the zones of hypometabolism by PET/CT and focal epileptic activity by EEG (r=+0.577; p<0.05), as well as between the localization of hypometabolism and structural changes by MRI (r=+0.251; p<0.05), which confirms the complementary nature of the methods in the diagnosis of the epileptogenic zone.

Conclusions. The obtained data confirm that PET/CT with 18F-FDG is a highly sensitive method for detecting epileptogenic foci in children, in particular in cases of "MRI-negative" epilepsy and is a key stage in personalized planning of neurosurgical interventions in children with drug-resistant epilepsy.

Keywords: medical radiology, pediatrics, epileptogenic zone, neuroimaging.

Detailed analysis of risk factors for development and progression of cervical caries of teeth in young patients

I.I. Zabolotna — 2025-12-31

In press

Background. Today dental caries remains the main reason for seeing a dentist.

Aim. The aim of the study was to identify Risk Factors (RF) for Cervical Caries (CC) of teeth in young patients, their detailing and analysis.

Materials & Methods. There were examined 272 patients (mean age 24.3±6.9 years) whose biophysical parameters of Oral Fluid (OF) and level of personal anxiety were determined. Data on potential RF were collected using a questionnaire. To assess the strength of the correlation between the studied factors and the outcome, there was used the indicator of Odds Ratio (OR), for which the 95% Confidence Interval (95% CI) was determined. Univariate and multivariate logistic regression analysis were used to identify RF. The work was carried out within the framework of the dissertation research of the first author.

Research Ethics. The research was carried out based on the principles of World Medical Association Declaration of Helsinki (1964–2024), Order of the Ministry of Health of Ukraine No.690 of September 23, 2009, the conclusion of Bioethics Commission of Donetsk National Medical University No.43 of January 21, 2021. All participants gave a written informed consent in the study.

Results. Independent RF of development of CC of teeth were determined as salivary flow rate less than 0.5 ml/min, buffer capacity of OF less than 6.5 arb. u.; pathological type of bite and shortened frenulum of tongue; habit of adding lemon to tea; clinical markers occlusal abrasion and cracks in tooth enamel. Factors-modifiers of development of CC of teeth were average daily consumption of more than 0.25 portions of acidic foods and more than one glass of green tea; high level of personal anxiety; musculoskeletal dysfunction of temporomandibular joint lasting more than a year. Consumption of fruit in an average amount of 2.5 pieces and more than one cup of coffee per day had OR<1 that indicates their potential protective effect. The existence of confounding was determined for predictor "frequency of tооth brushing" more than twice a day. Independent RF of progression of CC of teeth were presence of three or more malpositioned teeth and a history of digestive diseases. However, in univariate analysis, both variables showed wide CI indicating instability of assessment.

Conclusions. The combination of logistic regression analysis methods allowed to distinguish between independent and latent predictors as well as to identify potentially protective factors and a confounding factor.

Keywords: dentistry, dental biofilm, dietary habits, oral fluid.

Physical therapy for children with cerebral palsy: The use of traditional techniques and innovative rehabilitation approaches in the correction of motor dysfunctions (literature review)

V. Hnatyuk — 2025-12-31

In press

Background. Cerebral palsy remains one of the leading causes of persistent motor impairment in childhood and necessitates long-term, evidence-based physical therapy. Despite the widespread use of traditional rehabilitation methods, current clinical practice is characterized by substantial variability in approaches and insufficient standardization of interventions, which highlights the need for a comparative analysis of their effectiveness from the perspective of evidence-based medicine.

Aim. To review contemporary scientific sources on the use of traditional and modern physical therapy approaches in children with cerebral palsy.

Materials and Methods. The study was conducted using bibliosemantic and comparative methods. A search for scientific sources was conducted in the scientometric databases PubMed, Scopus, Web of Science, and Google Scholar for the years 2016–2025. A total of 21 sources were included in the analysis. The study was conducted as a private initiative of the authors and did not receive grant funding.

Research Ethics. During the study, literature sources were selected that describe research conducted by authors who adhered to modern bioethical standards.

Results. Analysis of the sources showed that traditional physical therapy methods, including neurodevelopmental therapy, general functional exercises, and sitting and gait training, provide a basic correction of motor impairments. At the same time, they are characterized by moderate effectiveness and a high dependence on intervention intensity and individualized application. The analysis also showed that traditional and modern physical therapy approaches differ primarily in their mechanisms of action, intervention structure, intensity, demands on child participation, and sets of functional goals. In the included studies, modern technology-assisted or intensive programs were more often associated with improvements in selected functional outcomes; however, direct comparison of their effectiveness with traditional approaches is methodologically limited because of the heterogeneity of study designs, samples, intervention duration, and outcome assessment methods.

Conclusions. The most promising rehabilitation programs are those that combine traditional and innovative physical therapy methods with an emphasis on intensity and repeated motor practice.

Keywords: physical therapy, pediatrics, motor disorders, rehabilitation, evidence-based medicine.

Clinical physiology of childhood as the basis for the development of students' medical competencies

T.S. Lagodych — 2025-12-31

In press

Background. Nowadays, the healthcare system needs trained highly qualified pediatricians. The formation of professional competencies of future pediatricians is ensured through the integration of theoretical knowledge with clinical practice. The main areas of study include the acquisition and systematization of knowledge about the age-related physiological characteristics of children, the development of skills in clinical examination, diagnostics and communication with the patient and his family, as well as monitoring, interpretation of laboratory and functional data, compliance with the principles of safety, ethics and informed consent.

Aim. To determine the role of knowledge in clinical physiology of childhood in the process of forming medical competencies of students.

Materials and Methods. The study was conducted using systemic analysis and bibliosemantic method.

Research Ethics. The study was conducted without patient participation, so it did not require approval by an ethics committee.

Results. During the work, the necessity of the course "Clinical Physiology of the Child" for the formation of medical competencies in the field of knowledge 22 "Health Care" of future doctors specializing in 228 "Pediatrics" was substantiated. This course was introduced into the practice of higher medical education at the Bogomolets National Medical University in the Department of Physiology. The program of the discipline was developed as an educational component of the second year of study in accordance with the working curriculum for the training of specialists at the master's level of higher medical education. The aim of this course is to provide academic training in fundamental disciplines for further mastery of clinical sciences and to prepare graduates for professional activity as pediatricians in the relevant primary position by acquiring general and special competencies.

Conclusions. Clinical physiology of childhood helps students identify age-related features of physiology and adaptive mechanisms, which is important for early diagnosis, monitoring, and prevention of diseases in children. Thanks to the introduction of modern educational technologies and the latest achievements in the practice of teaching elective courses, namely "Clinical Physiology of Children" as an elective component of training, it is possible to improve the medical competencies of students, future pediatricians.

Keywords: teaching issues, pediatrician, teaching methodology, academic training.

Requirements for the design of manuscripts of scientific articles of journals of the Kharkiv National Medical University

2025-10-01