Англійською - Репозитарій

Features of diagnosis and opportunities for endoscopic treatment of a cervical esophageal cavernous hemangioma: a case report and review of literature

kaf_pedpropaedeutic — Wed, 07 Oct 2026 11:53:48 +0300

616.329-006.311.03-072.1-073.4:616-089.87

Esophageal hemangioma (EH) is an exceedingly rare benign vascular neoplasm, accoun-ting for less than 0.04 % of all endoscopic findings. Due to location and vascular nature, it poses significant diagnos-tic challenges and a high risk of life-threatening hemorrhage. Traditionally, surgical resection was the mainstay of treatment, but the paradigm has shifted toward minimally invasive endoscopic techniques at present. The purpose of the study was to highlight the importance of a multimodal diagnostic approach in differentiating rare EH from other subepithelial lesions, to demonstrate the feasibility, safety, and effectiveness of endoscopic submucosal dissection (ESD) for the treatment of a giant cavernous EH in the cervical esophagus and to provide an updated review of cur-rent diagnostic and therapeutic strategies based on recent clinical evidence. Case presentation. We report a clinical case of a 57-year-old female presenting with progressive dysphagia when drinking liquids. Endoscopy revealed a large soft elastic tuberculate cyanotic subepithelial mass on the posterior wall of the cervical esophagus, extending from 16 to 21 cm from the incisors (50 mm in length), which filled up to 2/3 of the esophageal lumen, flattened under pressure with the device and restored its shape. Endoscopic ultrasonography (EUS) confirmed a heterogeneous hypoechoic lesion within the submucosal layer with no active intralesional arterial blood flow. MSCT-angiography identified peripheral phleboliths, further supporting the diagnosis of a cavernous EH. The patient successfully under-went ESD. Despite the technical complexity, the lesion was resected en bloc without complications. Histopathology confirmed a cavernous hemangioma (ICD-O 9120/0). The patient was discharged on the second postoperative day. Conclusions. This case illustrates that advanced operative endoscopy, specifically ESD, is a safe and effective organ-preserving alternative to radical surgery for large EH, even in challenging anatomical locations such as the cervical esophagus. Multimodal imaging (EUS and MSCT) is crucial for accurate preoperative planning.

Evaluation of the effectiveness of Buteyko breathing in the comprehensive treatment of bronchial asthma in children

kaf_pedpropaedeutic — Wed, 07 Oct 2026 11:27:04 +0300

Aim: To evaluate the effectiveness of Buteyko breathing in the comprehensive treatment of bronchial asthma in school-age children.
Materials and Methods: The study included 48 children with bronchial asthma aged 12 to 18 years. The main group included children who received drug therapy for bronchial asthma in combination with Buteyko breathing (n=24). The comparison group consisted of children who received only drug therapy for bronchial asthma (n=24). The patients were followed up for one year during five scheduled visits at 3-month intervals.
At all visits, the dynamics of clinical symptoms and the results of the asthma control test were assessed. At the first and last visits, respiratory function andquality of life were evaluated.
Results: The study demonstrated improvement in quality of life and disease control in patients with bronchial asthma who, in addition to medication, used Buteyko breathing.
Conclusions: In patients with bronchial asthma who used Buteyko breathing along with medical treatment, asthma control improved after 3 months of treatment (p=0.01) and continued to increase during the year of observation more than in the comparison group (p<0.001). There was also a significant increase in the mean quality of life score in the main group after one year of treatment, in contrast to the comparison group (p<0.001). Assessment of respiratory function showed a significant increase in FEV1 in both groups after one year of treatment, without a statistically significant difference between the groups (p>0.05).

ANAPHYLACTIC SHOCK IN CHILDREN CAUSED BY FOOD ALLERGENS: CURRENT APPROACHES TO DIAGNOSIS AND STANDARDS OF EMERGENCY CARE IN CLINICAL CASES АНАФІЛАКТИЧНИЙ ШОК У ДІТЕЙ, СПРИЧИНЕНИЙ ХАРЧОВИМИ АЛЕРГЕНАМИ: СУЧАСНІ ПІДХОДИ ДО ДІАГНОСТИКИ ТА СТАНДАРТИ

kaf_pedpropaedeutic — Wed, 07 Oct 2026 11:21:09 +0300

УДК: 616-056.3-001.36:613.26/.29]-07-083.9-053.2

Abstract. This article presents the current paradigm for the diagnosis and active management of patients with food allergies and anaphylaxis in pediatric practice. It analyzes the evolution of the WAO and EAACI 2025 clinical criteria, the specific “masks” of anaphylaxis in young children, and the elimination of strict time frames for symptom manifestation. A step-by-step algorithm for emergency care in accordance with the latest ERC 2025 recommendations (Pediatric Life Support), the principles of risk stratification for biphasic reactions, and the prospects for the use of nasal epinephrine are provided. The aim of this study is to analyze two clinical cases of patients with anaphylaxis and to find opportunities for developing food tolerance, taking into account current algorithms. Research materials and methods. Analysis of the patients` medical records and the results of clinical and laboratory tests. Research Results. A 4-year-old girl had two episodes of anaphylaxis (at the ages of 11 months and 1 year and 3 months of age) following the consumption of a lysozyme-containing lozenge and an egg, respectively. After a prolonged adhehernce to the elimination diet and oral provocation tests, treatment using the egg ladder method was initiated. The dynamics showed a decrease in the levels of specific antibodies to egg components: ovomucoid (Gal d 1) from 3.53 to 0.2 kU/L, ovalbumin (Gal d 2) from 9.47 to 1.59 kU/L, and
lysozyme (Gal d 4) from 9.9 to 1.81 kU/L. The child successfully began to tolerate eggs that had been thoroughly cooked. A 2-year-and-3-month-old boy suffered two episodes of anaphylaxis (at the ages of 8 months and 1 year and 3 months) following the consumption of dairy products. The results of molecular diagnostics revealed high levels of specific IgE to the major protein components of cow’s milk: α-lactalbumin (Bos d 4) — 37.45 kUA/L, β-lactoglobulin (Bos d 5) — 28.25 kUA/L, and casein (Bos d 6) — 32.45 kUA/L. Taking into account the patient’s medical history, clinical presentation, and laboratory test results, it was recommended to completely eliminate milk and all dairy products for at least six months. Conclusions. 1. Treating a patient with a history of food anaphylaxis allows for the identification of a “window of opportunity” to consider the reintroduction of the product, but this must be supported by an accurate diagnosis, supervision of an experienced team in a hospital setting, and only after an elimination period lasting at least 6 months. 2. Patients at high risk for anaphylaxis should
be provided with a first-line medication — epinephrine — and given clear instructions on actions to take.

У статті висвітлено сучасну парадигму діагностики та активного ведення пацієнтів із харчовою алергією й
анафілаксією у педіатричній практиці. Проаналізовано еволюцію клінічних критеріїв WAO та EAACI 2025 року, специфіку «масок» анафілаксії у дітей раннього віку та скасування жорстких часових рамок маніфестації. Наведено покроковий алгоритм невідкладної допомоги відповідно до найновіших рекомендацій ERC 2025 (Paediatric Life Support), принципи стратифікації ризику біфазних реакцій та перспективи використання назального адреналіну.
Мета дослідження проаналізувати два клінічні випадки пацієнтів з анафілаксією та пошук можливостей формування харчової толерантності, враховуючи сучасні алгоритми.
Матеріали та методи дослідження. Аналіз даних історій хвороби пацієнтів, результатів клінічних та лабораторних досліджень.
Результати дослідження. У дівчинки віком 4 роки було два випадки анафілаксії (11 місяців, 1 рік 3 місяці) після вживання льодяника з лізоцимом та після вживання яйця. Після тривалої елімінаційної дієти і проведених орально-провокаційних проб було розпочато лікування методом яєчної драбини. В динаміці состерігалося зменшення рівня специфічних антитіл до компонентів яйця: овомукоїд (Gal d 1) із 3,53 до 0,2 kU/L, овальбумін (Gal d 2) із 9,47 до 1,59 kU/L, лізоцим (Gal d 4) із 9,9 до 1,81 kU/L. Дитина успішно почала толерувати яйце з добрим рівнем термічної обробки. У хлопчика віком 2 роки 3 місяці зафіксовано два випадки анафілаксії (8 місяців, 1 рік 3 місяці) після вживання молочних продуктів. Результати проведеної
молекулярної діагностики дозволили виявити високі рівні специфічних IgE до основних білкових компонентів коров’ячого молока: α-лактальбуміну (Bos d 4) — 37,45 kUA/L, β-лактоглобуліну (Bos d 5) – 28,25 kUA/L та казеїну (Bos d 6) — 32,45 kUA/L. З урахуванням анамнестичних даних, клінічної картини та результатів лабораторного дослідження рекомендовано повністю виключити молоко та всі продукти щонайменше на шість місяців.
Висновки. 1. Лікування пацієнта з харчовою анафілаксією в анамнезі, дозволяє шукати «вікно можливостей» для перегляду питання повторного введення продукту, але все це повинно бути підкріплене точною діагностикою, супроводом досвідченої команди в умовах стаціонару та виключно після періоду елімінації, яка має тривати щонайменше 6 місяців.

2. Пацієнти з високим ризиком анафілаксії мають бути забезпечені препаратом першої лінії – адреналіном і мати чіткі інструкції щодо дій.

IgG N-Glycan Profiles in Mothers and Infants Postpartum in the Context of Maternal Obesity and Gestational Diabetes

kaf_pedpropaedeutic — Wed, 07 Oct 2026 11:11:10 +0300

This study explored IgG N-glycosylation pattern differences in maternal and infant serum in the context of gestational diabetes mellitus (GDM). Serum samples from 15 mother– infant pairs were collected at 12 weeks postpartum and categorized according to maternal body mass index (BMI) and GDM status. The N-glycosylation patterns of the isolated IgG pools were analyzed by capillary electrophoresis with laser-induced fluorescence
detection (CE-LIF). Descriptive comparison of the relative area percentage of IgG N-glycan structures revealed differences between the groups. Comparison of the maternal and infant sialo-form/neutral-form ratio (SF/NF) of the N-glycans suggested differences between control mothers and their children, as well as between obese mothers and their children. The maternal SF/NF ratio of IgG varied between the obese and normal-weight GDM mothers. The SF/NF ratios of IgG from the infants showed variation between infants of control mothers and infants of obese mothers, between infants of obese and infants of obese GDM mothers, and between infants of GDM with normal-weight and GDM with obese mothers. The observed differences in maternal and infant IgG N-glycosylation profiles suggest potentially selective placental transfer mechanisms.

Maternal and perinatal outcomes during successive and overlapping crises in Ukraine, 2019–2024: a nationwide population-based ecological study

kaf_pedpropaedeutic — Fri, 02 Oct 2026 11:45:40 +0300

Ukraine has experienced overlapping shocks from the COVID-19 pandemic and a full-scale war, with
potential impacts on maternal and perinatal health. We examined national-level changes in these outcomes
between 2019 and 2024.
In this population-based ecological study, publicly available Ministry of Health data were analysed to
examine trends in deliveries, births, and maternal and perinatal outcomes. Changes were assessed using
pairwise comparisons, absolute risk differences, and effect sizes. Annual estimates were compared with prepandemic, preceding-year, and wartime estimates. Deliveries and births declined by approximately 40%, predominantly during the first wartime year. Between 2019 and 2024 (298,066 and 176,842 deliveries, respectively), the prevalence of diabetes in pregnancy increased from 0.88% (n = 2634) to 2.66% (n = 4707), hypertensive disorders from 3.80% (n = 11,332) to 5.45% (n = 9633), severe postpartum haemorrhage from 0.36% (n = 1070) to 0.53% (n = 941). Among 302,190 and 179,192 births, respectively, preterm births increased from 5.59% (n = 16,907) to 6.25% (n = 11,195), very low birthweights from 1.05% (n = 3184) to 1.29% (n = 2305), and extremely low birthweights from 0.44% (n = 1335) to 0.60% (n = 1068). Pregnancy-related and perinatal mortality, particularly stillbirths, were higher during the second year of the pandemic but not during wartime. Early neonatal mortality did not change throughout. Overlapping crises were associated with fewer births and increased maternal morbidity. Although pregnancy-related and perinatal mortality increased during the pandemic, their relative stability during wartime may suggest preservation of maternal and newborn services, potentially supported by international assistance. Continued support for maternal and neonatal healthcare services remains important in crisis-affected settings. No funding was received.

Case Report: Still’s Disease in an 11-Month-Old Child

kaf_pedpropaedeutic — Thu, 24 Sep 2026 20:42:28 +0300

Systemic Juvenile Idiopathic Arthritis (sJIA, Still’s disease) in children was first described by George Frederick
Still in 1896 in Great Britain. In 1971 E.G. Bywaters identified and described in detail the adult form-the
so-called adult-onset Still’s disease. This was an important step in distinguishing between children’s and
adults’ manifestations of the disease, and since then the world literature has clearly differentiated juvenile
and adult forms, although modern recommendations (EULAR/PReS 2024) treat them as a single spectrum-
Still’s disease. sJIA is a rare systemic inflammatory disease, diagnosed based on clinical signs and supported by laboratory and instrumental findings; it remains a diagnosis of exclusion. In the treatment strategy for sJIA, nonsteroidal anti‑inflammatory drugs and glucocorticosteroids are widely used for anti‑inflammatory, antipyretic and analgesic purposes. Recent clinical trials have shown positive results in the use of new pharmacotherapeutic
agents, such as monoclonal antibodies and anti-interleukin drugs. The optimal therapeutic strategy is the early
use of interleukins (IL-1 or IL-6 inhibitors) in combination with glucocorticoids and immunosuppressants
(e.g., cyclosporine A, methotrexate) in severe cases or in Macrophage Activation Syndrome (MAS).
The prognosis of sJIA varies among different children: some patients recover completely after a certain
time, some have a relapsing course with alternating periods of exacerbation and remission, and about half
of the patients have a long‑term course of the disease. This article presents a clinical case of sJIA in an
eleven‑month‑old child.

Musculoskeletal anatomy education perspectives

kaf_normanatomy — Fri, 28 Aug 2026 20:47:53 +0300

Musculoskeletal (MSK) anatomy education is a critical foundation for developing competency among radiologists, physiatrists, rheumatologists, and orthopedic surgeons. However, current undergraduate medical curricula often exhibit significant deficiencies in instructional hours, integration of diverse teaching modalities, and clinical relevance. This narrative review synthesizes recent evidence (March 2021–March 2026) identified through a targeted search of Medline, Embase, and Scopus, with an emphasis on consensus guidelines, validation studies, and clinically focused publications related to MSK anatomy, imaging modalities (ultrasound, magnetic resonance imaging, computed tomography), and curriculum design for medical students in relevant specialties. Multimodal interventions, including cadaveric dissection, radiological anatomy, case-based rheumatologic and rehabilitation modules, and technology-enhanced platforms such as 3D virtual models and AI-driven adaptive learning, have been associated with improvements in knowledge retention, spatial reasoning, diagnostic accuracy, and procedural confidence compared with didactic instruction alone. Persistent knowledge gaps undermine interpretive proficiency in MSK imaging, including the identification of synovitis and enthesopathy, and are linked to reduced clinical preparedness. Objective assessments reveal suboptimal performance despite completion of conventional preclinical training. Cadaveric dissection fosters practical skills and ethical professionalism, while early integration of imaging connects theoretical morphology with three-dimensional relational understanding and pathological
correlations in MSK and rheumatic diseases. Implementation frameworks recommend phased rollouts that incorporate stakeholder needs assessments, faculty development through train-the-trainer models, resource reallocation for pointof-care ultrasound and virtual reality, and strategies to address barriers, such as grants for low-resource settings and modularization to reduce curricular congestion. These evidence-based approaches support scalable reforms that produce MSK-literate clinicians prepared for precision diagnostics and interventional practice

A GENIUS WHO UNITES GENERATIONS: MEDICAL SHEVCHENKIANA 2026

kaf_normanatomy — Fri, 28 Aug 2026 20:24:27 +0300

The events of this year’s Medical Shevchenkiana, organised by the Medical Commission of the Shevchenko Scientific Society and Danylo Halytsky Lviv National Medical University, brought together the scientific conference “Our Soul Does Not Die, Our Will Does Not Die. Shevchenko as a Phenomenon” and the formal Academic Ceremony “The Influence of the Kobzar’s Literary Heritage on the Work of Contemporaries and Descendants.”
On March 4, in the reading hall of the Scientific Library of Danylo Halytsky Lviv National Medical University, participants discussed the significance and contemporary relevance of Taras Shevchenko’s prophetic words in today’s world. The speakers included Marta Nadraga, Director of the Library, Candidate of Historical Sciences and Senior Researcher; Professor Zoryana Masna, Head of the Medical Commission of the Shevchenko Scientific
Society; Zoryana Ivankiv, Head of the Ivan and Yurii Lypa Club of the Ukrainian Medical Society; Professor Lidiia Boichyshyn, Deputy Head of the Shevchenko Scientific Society; Nataliia Hirna, Candidate of Historical Sciences and Associate Professor; and Taras Kobza, military physician, veteran of the Russian-Ukrainian War, and Associate Professor. The key event of the meeting was the presentation of the bibliographic index “Medical Professionals
and Medicine in the Life of Taras Shevchenko” (authors: Svitlana Vasilieva and Olena Kril; edited by Marta Nadraga).
Sophia Loda, a student of the Andrei Krupynsky Lviv Medical Academy, and Oksana Savitska, bandura player, laureate of international and all-Ukrainian competitions, member of the National Kobzar Union of Ukraine, and soloist of the Myroslav Skoryk Lviv National Philharmonic – delighted participants and guests with performances of the Great Kobzar’s finest poetic and musical works. On March 12, a large audience gathered in the conference hall of the Dental Medical Centre of Danylo Halytsky Lviv National Medical University for the formal Academic Ceremony “The Influence of the Kobzar’s Legacy on the Work of Contemporaries and Descendants.”
Guests were welcomed by Head of the Medical Commission of the Shevchenko Scientific Society, Professor Zoryana Masna, and its President, Academician Roman Kushnir. Art historian Roksoliana Kozak, Director of the Ivan Trush Art Memorial Museum, spoke about visions of Shevchenko in Trush’s work, while an unconventional perspective on the legacy of the Great Kobzar was offered by the amateur arts ensembles of Danylo Halytsky
Lviv National Medical University: the People’s Choral Ensemble “Musy Hippocrata,” the Ukrainian Jazz Orchestra “Medicus,” and the People’s Dance Ensemble “Horytsvit” named after Zenon Kolobych. The visual highlight of the Ceremony was a live painting performance by Associate Professor of the Department of Infectious Diseases Olena Zubach, who, drawing inspiration from Shevchenko’s verse, painted “Mallows” – a symbol of home and
Ukrainian identity – in real time.

The influence of cardiovascular risk factors and depressive disorders on endothelial function in patients undergoing cardiac rehabilitation

kaf_rehabilitationmed_fpge — Mon, 24 Aug 2026 13:38:48 +0300

ABSTRACT

Aim: To investigate the impact of cardiovascular risk factors and depressive symptoms on endothelial function in patients undergoing ambulatory cardiac rehabilitation.

Materials and Methods: The study included 98 patients (63 men and 35 women, mean age 49±6 years), who were divided into two groups: Group I – patients with stage I–II arterial hypertension (n=53), and Group II – patients without hypertension (n=45). Endothelial function was assessed using flow-mediated dilation (FMD) of the brachial artery via ultrasound (Samsung H-60, 7 MHz linear probe). The presence and severity of depression were assessed using the HADS scale. All patients completed a structured outpatient cardiac rehabilitation program including aerobic training, psychological support, pharmacological therapy, nutritional counseling, and educational sessions.

Results: Patients with hypertension (Group I) demonstrated significantly lower endothelium-dependent and endothelium-independent vasodilation compared to Group II (p<0.05). Clinically significant depression was observed in 35% of hypertensive patients at baseline and in 11% of patients in Group II. After rehabilitation, no cases of clinically significant depression were observed in either group, with affected patients shifting to the subclinical depression category. No statistically significant correlation was found between the severity of depressive symptoms and endothelial function parameters.

Conclusions: The presence of hypertension is associated with impaired endothelial function and a higher prevalence of depressive symptoms. A comprehensive outpatient cardiac rehabilitation program, integrating physical, psychological, pharmacological, nutritional, and educational interventions, contributed to a significant reduction in depressive symptoms and improvement in patients’ psychoemotional status. These findings support the inclusion of psychosocial interventions in routine cardiovascular care.

KEYWORDS: cardiac rehabilitation; endothelial dysfunction; arterial hypertension; depression; cardiovascular risk factors

FREQUENCY OF COMPLICATIONS AND LESIONS OF ORGANS/SYSTEMS IN PULMONARY TUBERCULOSIS AMONG HIV-PATIENTS

kaf_phthisiology — Mon, 29 Jun 2026 11:42:04 +0300

Objective: To study the frequency of complications and organ/system involvement in pulmonary tuberculosis in the context of HIV/AIDS infection.
Materials and Methods. We analyzed medical data from 103 patients with pulmonary tuberculosis that
developed in the setting of HIV/AIDS infection. The patients were divided into groups: drug- sensitive pulmonary tuberculosis (DS-PTB) – 42 patients who excreted Mycobacterium tuberculosis (MBT) strains sensitive to anti- mycobacterial drugs (AMD); and drug-resistant pulmonary tuberculosis (DR-PTB) – 61 patients with resistant MBT strains. Data from the period 2020–2024 were analyzed. To study the frequency of complications and organ/system involvement, the results of laboratory tests, abdominal ultrasound, computed tomography of the chest and abdominal organs, and consultations with specialized physicians were taken into account.
Microbiological detection of MBT included molecular genetic testing, microscopy and culture methods, and drug susceptibility testing of MBT strains to anti-mycobacterial drugs. HIV/AIDS infection was diagnosed using rapid tests, and viral load was determined by polymerase chain reaction. Microsoft Excel software was used for statistical analysis of the results.
Results and Discussion. In both study groups, men predominated by 1.5 times, aged over 30 to 50 years. A severe condition at admission was noted in 23.8% of patients with DS-PTB and 9.8% with DR-PTB. The average hospital stay for DS-PTB was (23.1 ± 2.1) bed-days, and for DR-PTB – (61.7 ± 4.5). In DR-PTB/HIV, miliary tuberculosis predominated 1.7 times more often, and infiltrative pulmonary tuberculosis – 2.0 times more often. In DS-PTB/HIV, an increased frequency of disseminated pulmonary tuberculosis was observed. Patients with DR-PTB reported pronounced intoxication and cachexia twice as often compared to those with DSPTB. In both groups, sepsis, pericarditis, and spontaneous pneumothorax were diagnosed with nearly equal frequency. Respiratory failure was
detected 1.5 times more often in DR-PTB, while chronic obstructive bronchitis was 1.7 times more frequent in DS-PTB. In both groups, chronic hepatitis, liver cirrhosis, ascites, and toxic liver damage were noted. In DR-PTB, chronic hepatitis B, nervous system involvement, and eye disorders were observed twice as often as in DS-PTB.
Conclusions. Drug-resistant pulmonary tuberculosis in the context of HIV/AIDS infection had a significantly more severe course due to the development of multiple organ failure. These changes in the combined
TB/HIV/AIDS condition contributed to disability in 24.4% (10) of patients with drug-sensitive TB/HIV and in 55.7% (34) of patients with drug-resistant TB/HIV.
Keywords: HIV/AIDS/TB co-infection, complications, organ involvement, systems.