Smoking remains one of the most aggressive risk factors for cardiovascular disease (CVD), as smokers have been shown to have twice the risk of cardiovascular (CVD) mortality than non-smokers. Accordingly, quitting smoking in people even in the elderly is useful. Data from a metaanalysis showed that the increased CV risk in patients who got rid of this habit decreased over time. Another study found a directly proportional relationship between smoking and CVD: the more cigarettes smoked and the longer the history of smoking, the higher the risk of myocardial infarction (MI).

The authors of a meta-analysis of 12 cohort studies suggested that smoking cessation is closely related to a reduction in overall mortality. It was found that in patients who did not give up smoking after an MI, mortality increased significantly and amounted to 20%. The scientific results of another retrospective American study Partners YOUNGMI Registry showed that smoking cessation in young patients (< 50 years old) who underwent MI was reliably walking, therapeutic gymnastics (ThG), laser therapy for the associated with a decrease in total mortality and mortality from CV diseases by approximately 70-80%. And this, in turn, confisms the critical importance of smoking cessation in young patients after MI. Another convincing result was obtained in a 15-year follow-up of patients who underwent coronary bypass surgery. A study found that patients who smoked within 1 year after surgery had a risk of subsequent MI and reoperation more than twice as high as patients who quit smoking after surgery. Patients who continued to smoke 5 years after surgery had an even higher risk of MI and reoperation compared with patients who quit smoking after surgery and patients who had never smoked. It was also found that the risk of MI was similar among non-smokers and those who managed to quit smoking after surgery. In a meta-analysis of 20 studies, it was found that the effect of smoking cessation was prognostically more favorable than lowering cholesterol, in which the latter sometimes the greatest attention is focused.

Despite the fact that smoking necessity cessation in the process of cardiorehabilitation (CR) has been proven, little is known among the participants of CR about the factors associated with the patients’ refusal to quit smoking. That is why researchers have begun to study predictors of smoking cessation in order to improve and increase the effectiveness of cardiorehabilitation programs. The results of many studies have established variables that influence the process of quitting smoking, namely: the degree of tobacco dependence (number of cigarettes smoked per day, smoking history), number of previous attempts to quit smoking, gender, age, marital status and level of depression. However, the obtained scientific results of such studies are contradictory and require additional study to accurately determine the factors that are associated with the successful cessation of smoking by smoking patients after an acute coronary event at the stage of active completion of CR programs.

AIM

To establish socio-psychological and clinical predictors of smoking cessation at the stage of health-resort rehabilitation in patients who have recently suffered an acute coronary event.

MATERIALS AND METHODS

68 patients aged 42-68 years (average age 56.70±6.1 years) who underwent a cardiorehabilitation program in the rehabilitation department after heart diseases of the „Morshinkurort” health-resort complex after a recent heart attack (no more than 28 days ago) were examined. Depending on the smoking habit, all patients were divided into two groups. T he first (I) group included smoking patients who gave up smoking during the CR process (n=38, average age 57.10±6.73 years), the second (II) group – smokers who continued to smoke during the health-resort treatment (n=30, average age 56.58±5.74 years). The measures of the rehabilitation program were carried out according to the recommendations of the ESC working group on cardiorehabilitation and physical training. The CR program included dosed therapeutic walking, therapeutic gymnastics (ThG), laser therapy for the cubital vein, and optimal medical therapy (OMT). In order to quit smoking, all smoking patients were given individual counseling using the “5As” strategy, unmotivated smokers - the “5R” strategy in accordance with Order 746 dated 09/26/2012 “On the approval of Methodological recommendations for medical workers of health care institutions on providing medical and preventive care for persons who want to get rid of tobacco addiction”. The length of stay of all cardiac rehabilitation patients in the rehabilitation department was 24 days.

All CR participants were interviewed using the Fagerstman test to assess the degree of nicotine addiction. The smoking index (SI) was calculated according to the formula: (SI)=Ch*C/20, where Ch is the number of cigarettes smoked (per day), C is the smoking experience (years). All patients were also subjected to anthropometric measurements of body weight (m) using medical scales and height (h) to calculate BMI according to the formula: BMI = m/h2, where m is body weight (kg), h is height (m). The level of depression and anxiety was assessed using the HADS scale (The Hospital Anxiety and Depression Scale). All rehabilitation patients underwent biochemical blood analysis, echocardiography and physical stress tests at the start of the cardiorehabilitation process.

We also used the primary data of rehabilitation patients to conduct the study: age, sex, presence of concomitant diseases, cardiovascular risk and marital status. In the course of the study, all of the above indicators were used to synthesize a mathematical model for predicting the outcome of smoking cessation in patients with ACS using the binary logistic regression method. The conducted analysis made it possible to establish the factors affecting the outcome of smoking cessation and to calculate the probability of this event depending on the values of independent predictors.

RESULTS

During our calculations of binary logistic regression using the Wald exclusion method, 5 key parameters were determined that were statistically significant in terms of the influence on the process of smoking cessation in rehabilitation patients. T he coefficients of the selected binary logistic regression model are presented in the Table 1.

The logistic regression model we created was statistically significant (G = 54.036 at p (χ2) < 0.00000) and the obtained Hosmer-Lemeshov (HL) value, which was 9.264 at a significance level of p>0.05 (p = 0.320), indicated about the high consistency of our model. In the logistic model we created, the influence of indicators (SI, HADS-T, BMI, marital status and the presence of concomitant diseases) on smoking cessation was 58.79% (Table 2).

Background. The 40-year-old patient developed headache, dyscoordination, imbalance, memory problems, fever, and somnolence. Two days after manifestation, the patient was hospitalized with an altered mental state (GCS of 12). No previous history of atrial fibrillation, persistent headache, migraine, drug abuse, autoimmune, or systemic inflammatory disorders. Results. CSF analysis revealed 10 WBC/μL with normal glucose and protein levels, no atypical cells or culture growth. No antibodies to TORCH infections or Borrelia were identified. CRP was elevated at 11.5 mg/dL, as well as ESR at 39 mm/hr, IgE at 1120.2 mU/L, and CD16+ NK cells in the blood, indicating inflammation. The rheumatologic workup was negative. Duplex ultrasound revealed bilateral resistive vertebral artery Doppler waveforms with no evident signs of atherosclerosis. Echocardiography was normal without valvular or septal pathology. The combination of multifocal middle-small caliber vessel stenotic changes, inflammatory signs, and no specific autoimmune antibodies is suggestive of primary CNS vasculitis. The patient was initiated with a short-term course of corticosteroids, long-term therapy with immunosuppressive drug, pentoxifylline, and antiplatelet drugs. During the 1-year follow-up, he responded to the therapy with clinical improvement and a radiologically stable state. Conclusions. The uniqueness of this clinical case is the coexistence of two clinically challenging disorders. The occlusion of the artery of Percheron, a rare anatomical variant of posterior cerebral perforator arteries 2, was caused by no less rare inflammatory neurological disease - primary CNS vasculitis.

 Keywords. Artery of Percheron, artery of Percheron territory infarct, bithalamic lesions, brainstem stroke syndromes, central nervous system vasculitis, posterior circulation infarction, posterior inferior cerebellar artery (PICA) infarct, superior cerebellar artery

UDC:  616.833-009.7

Background. Up to 50–80 % of military service members suffer from postamputation pain. Residual limb pain significantly postpones prosthetic surgery, recovery, employability, negatively impacts rehabilitation and military duty performance. 

The purpose was to study residual limb pain types in military personnel after traumatic amputation and efficacy of methods for their treatment. 

Materials and methods. A randomized cross-sectional study was performed of 231 military service members with residual limb pain after combat traumatic amputation, who underwent surgical treatment in tertiary and quaternary level military medical center between 2022 and 2024 amid full-scale war. 

Results. Somatic residual limb pain was observed in 36.36 % of enrolled patients, which was mainly caused by heterotopic ossification (30.74 %). 41.13 % of amputees experienced neuropathic pain due to neuromas. Pain syndrome in 22.51 % of patients resulted from both somatic causes and neuromas. Prosthesis-associated pain as a type of somatic pain was observed in 17.32 % of individuals. This study found that the persistence or recurrence of neuropathic pain among patients from the group of lidocaine-alcohol injection for painful neuromas was significantly lower (Pα = 0.013) at 6-month follow-up compared to the simple neuroma resection group. During 3 months after regenerative peripheral nerve interface, which was performed for 25 terminal neuromas, no pain recurrence was observed. 

Conclusions. It is important to assume the presence of one or both pain types in a patient with residual limb pain: somatic and/or neuropathic. Simple neuroma resections lead to an undesirably high reoperation rate — 21.79 ± 4.86 % of persistent painful neuromas. Lidocaine-alcohol injections are sufficiently simple and effective (8.70 ± 3.26 % of reinjections) in the treatment of neuropathic pain caused by terminal neuromas. Regenerative peripheral nerve interface is promising in the treatment and prevention of symptomatic neuroma. 

Keywords: postamputation pain; residual limb pain; stump pain; symptomatic neuroma; heterotopic ossification; neuroma resection; lidocaine-alcohol injection; regenerative peripheral nerve interface; prosthesis-associated pain

UDC: 618.19-009.7-085

More than 82 % of women of reproductive age note pain in the mammary gland. Every fifth woman feels severe pain (mastalgia) and swelling (mastodynia) in the mammary gland. Cyclic mastalgia is combined with hyperprolactinemia. Hyperprolactinemia occurs when dopamine does not suppress pituitary function enough to reduce prolactin release. Agni casti fructus, known for its dopaminergic activity, relieves pain and discomfort in the mammary glands. 50 patients were under observation. Only 10 % of patients felt mild pain, 32 % experienced moderate pain, 50 % assessed it as severe, and 8 % experienced extreme pain. After the treatment, the complete absence of pain was noted by 76 % of patients. The results of the conducted studies indicate a high efficiency of 76 % and the safety of using Agni casti fructus in treating mastalgia and mastodynia. The high efficiency in the treatment of mastalgia and mastodynia with the herbal medicine Agni casti fructus without the additional use of hormonal drugs can be explained by the fact that this drug normalizes the hormonal balance of a woman

УДК: 617.541-007.24-089.5-031.83-089.85]:616.153.45

Періопераційна стрес-реакція є динамічним процесом, на який впливають пацієнт-специфічні, хірургічні та анестезіологічні фактори.

Мета – оцінити стрес-відповіді при корекції лійкоподібної деформації грудної клітки за Nuss в умовах комбінації загальної анестезії з різними реґіонарними блокадами.

Матеріали та методи. Обсерваційне проспективне дослідження включало 60 підлітків (хлопчики/дівчатка=47/13), які перенесли операцію Nuss для корекції лійкоподібної деформації грудної клітки в умовах комбінації загальної анестезії з різними реґіонарними блокадами. Пацієнти рандомізовані в три групи залежно від методу реґіонарного знеболювання (по 20 осіб у кожній групі): стандартна епідуральна анестезія (СЕА) на рівні Th5–Th8, висока епідуральна анестезія (ВЕА) на рівні Th2–Th3, білатеральна паравертебральна анестезія (ПВА) на рівні Th5–Th8. Рівні кортизолу та глюкози в сироватці крові визначені на трьох етапах: 1-й – вихідний рівень до операції, 2-й – під час травматичного моменту операції (повертання коригувальної пластини), 3-й – після операції.

Результати. Середнє значення кортизолу сироватки серед усіх пацієнтів перед операцією становило 342,4 [282,1–415,0] нмоль/л (медіана – 25–75% процентилі). Під час ротації пластини кортизол знизився до 223,1 [174,9–282,3] нмоль/л (p<0,000001). Після операції та прокидання від наркозу кортизол сироватки становив у середньому 279,6 [216,7–312,6] нмоль/л (p<0,000001 порівняно з вихідним рівнем до операції). На травматичному етапі операції кортизол сироватки був нижчим порівняно з вихідним рівнем до операції в групі СЕА на 41%, у групі ВЕА – на 30%, у групі ПВА – на 31%. Після операції та наркозу кортизол залишався нижчим за вихідний рівень у групі СЕА на 28%, у групі ВЕА – на 20%, у групі ПВА – на 26%. Середній рівень глікемії серед усіх пацієнтів до операції становив 4,62 [4,01–5,05] ммоль/л. Під час операції глікемія значно знизилась до 4,05 [3,86–4,62] ммоль/л (p=0,00018). Після операції глікемія повернулася до вихідного рівня 4,24 [4,09–4,99] ммоль/л (p=0,7). Під час операції глікемія знизилася порівняно з вихідним рівнем у групі СЕА на 11%, у групі ВЕА і ПВА – на 5%. Динаміка кортизолу та глюкози сироватки була схожою у всіх групах зі статистично незначною міжгруповою відмінністю на всіх етапах.

Висновки. Рівні кортизолу та глюкози в сироватці крові під час операції Nuss для корекції лійкоподібної грудної клітки у підлітків в умовах комбінації загальної анестезії з епідуральною та паравертебральною блокадами значно знизилися порівняно з вихідним рівнем до операції. Після закінчення операції глікемія повернулася до вихідного рівня, кортизол дещо підвищився, але залишався нижчим за вихідний рівень. Ці зміни стресмаркерів були більш виразними в групі СЕА на рівні Th5–Th8, ніж у групах ВЕА на рівні Th2–Th3 та ПВА.

Автор заявляє про відсутність конфлікту інтересів.

Results. The average serum cortisol level among all patients before surgery was 342.4 [282.1–415.0] nmol/L. At stage 2 the plasma cortisol decreased up to 223.1 [174.9–282.3] nmol/L (p<0.000001). After the surgery and anesthesia finished the average plasma cortisol was 279.6 [216.7–312.6] nmol/L (p<0.000001 vs baseline). During surgery serum cortisol decreased in group SEA by 41%, in group HEA – by 30%, and in group PVA – by 31% compared with baseline levels. After surgery, the serum cortisol was lower than baseline measurements in group SEA by 28%, in group HEA – by 20%, and in group PVA – by 26%. The average baseline glycemia among all patients before surgery was 4.62 [4.01–5.05] mmol/L. At stage 2 glycemia decreased significantly up to 4.05 [3.86–4.62] mmol/L (p=0.00018). After the surgery finished the average serum glucose among all patients was 4.24 [4.09–4.99] mmol/L (p=0.7). At stage 2 serum glucose decreased in group SEA by 11%, in groups HEA and PVA – by 5% compared with the baseline level. The dynamics of serum cortisol and glycemia were similar in all groups with statistically insignificant intergroup differences at all three stages.

Conclusions. Serum cortisol and glycemia during the Nuss procedure under the combination of general anesthesia with regional blocks decreased significantly. After surgery finished glycemia returned to baseline level, but serum cortisol was lower than baseline measurement. The changes in serum cortisol and glycemia were more pronounced in patients under standard epidural analgesia in Th5–Th8 compared with the high epidural in Th2–Th3 and paravertebral blocks.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study.