COVID-19 may cause or worsen cardiac dysfunction and patients with preexisting cardiovascular disease, including heart failure (HF), have an increased risk of severe and fatal outcomes of COVID-19.

The study aimed to establish the role of soluble suppression of tumorigenesis-2 protein (sST2) and natriuretic peptide test (NT-proBNP) in predicting the severe course and in-hospital mortality of patients with COVID-19 and arterial hypertension (AH).

Methods: 109 inpatients with COVID-19 and AH who were treated at the "Lviv Emergency Hospital" were examined. The determination of sST2 and NTproBNP in blood serum were done using the ELISA method. The clinical endpoint was assessed during the hospitalization period (death, hospitalization in ICU, prolonged hospitalization). The risk of the final event development was calculated for the patients who reached the threshold sST2 concentrations, and, separately, based on the diagnostic values of the NT-proBNP indicator.

Results: The cut-off values of sST2 recommended for the diagnosis of HF in our study reached 25% of patients. The risk of final clinical points development in these patients was OR=9.0; 95% CI: 1.61; 50.3; p=0.0123. The level of NT-proBNP, which meets the criteria for the diagnosis of HF, was constant in only 9.0% of individuals (p=0.0461) and the risk of clinical events developing was equal to OR=4.69; 95% CI: 1.49; 14.8; p=0.0083.

Discussion: High concentrations of sST2 and NTproBNP were associated with a severe course and a higher risk of mortality in patients with COVID-19 and AH. The additional determination of sST2 significantly complements the capabilities of NT-proBNP in risk stratification and determination of prognosis.

Conclusion: Thus, sST2 and NTproBNP are highly informative predictors of HF development in hospitalized patients. Stratification of patients based on sST2 values, in addition to NTproBNP parameters, may provide further prognostic value compared to NT-proBNP levels in patients with COVID-19 and AH.

Calling the anatomically posterior ventricle “left” we must nevertheless keep in mind its expansion steals both left and posterior space, jeopardizing the potential trajectory of the stylet. Even if the drain entrance into the chest is safe, the enlarged ventricle will be prone to meet the needle inside the cavity.

Aim: to review information resources and analysis of the own experience on this problem for the provision of modern knowledge in the pathogenesis of the pathology, the latest diagnostic and treatment technologies, with consideration of the need to adhere to a single strategy in the management of patients with BA.
Materials and Methods: The analysis of the data regarding the results of existing studies evaluating the clinical benefit and safety of diagnostic and treatment methods in Biliary atresia.
Conclusions: BA is the leading cause of neonatal cholestasis development. Early diagnostics of BA, based on the complex evaluation of clinical-laboratory, instrumental and morphological signs of the pathology, has a significant meaning. Surgical correction during the first 2 months of life – the Kasai procedure, as well as dynamic post-surgery follow-up significantly prolong the life of children and allow postponing liver transplantation. The highest patient survival both at the first stage of treatment - conduction of the Kasai procedure and the stage of liver transplantation may be achieved by joined work of surgeons and pediatricians, which allows considering the whole row of possible problems. 

INTRODUCTION AND OBJECTIVE:

Access to renal transplantation in children with severe chronic kidney disease can be endangered in dangerous sociopolitical environments. Despite such challenges, we established the very first adult and pediatric renal transplantation program in Ukraine in 2021 during an ongoing war and the COVID-19 pandemic, which caused significant delays and difficulties, including disrupted supply chains and shortages of critical medical supplies and equipment and availability and access to transplant resources and personnel. Here, we describe our experience with establishing and conducting a pediatric renal transplantation program during wartime and a pandemic in Ukraine.

METHODS:

We conducted a retrospective cohort study of 20 pediatric patients who underwent renal transplantation between January 2021 and September 2023 at two large-volume pediatric care centers in Lviv. Due to Ukrainian laws, donations could not be taken from soldiers and military personnel or civilians who suffered due to hostilities. We managed immunosuppressive medications and antibiotic prophylaxis or treatment post-transplant, and nearly all patients were on dialysis prior to transplantation.

RESULTS:

Our program constituted 23% (189/821) of all transplants performed in Ukraine in the last three years, and we have expanded our efforts to Western Ukraine. The majority of our patients did not undergo native nephrectomy, and most patients were on dialysis prior to transplantation. Average age at the time of transplant was 12.6 +4.5 (years), and average length of time on dialysis was 18 months. Overall, 30-day graft survival was 95%. Two patients experienced acute rejection that was successfully managed medically, while one had graft thrombosis requiring nephrectomy on the day of surgery.

CONCLUSIONS:

Despite the challenges of establishing a renal transplantation program during wartime and the impact of COVID-19, we have successfully started a pediatric renal transplantation program in Ukraine with a 95% 30-day graft survival rate. Our efforts have constituted 23% of all transplants performed in Ukraine in the last three years, and we have expanded our program to Western Ukraine. Our experience highlights the importance of access to necessary care in challenging environments and the need for continued support and collaboration in these settings.

The patient suffered from a mild form of COVID-19 and was treated on an outpatient basis. According to the family doctor’s prescription, she took Azithromycin 500 mg a day per os for 6 days, and then Ceftriaxone 1.0 g twice a day i.m. for another 6 days. Diarrhea appeared on the 10th day of treatment up to 10-15 times a day, a month later - blood admixtures in the stool appeared. The result was negative. Data from colonoscopy and histological examination of the intestinal mucosa and the clinical picture showed nonspecific ulcerative colitis, moderately severe. The patient started treatment with Salofalk first at a dose of 2 mg and then 4 mg per day. Due to the insufficient clinical effect, the patient was additionally prescribed Budenofalk in a daily dose of 9 mg with a positive clinical effect