Publishing House of Ivano-Frankivsk National Medical University
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A Rare Clinical Association of Type I Hereditary Angioedema and Acquired Epidermolysis Bullosa: A Case Report
Full text linkIntroduction. Both hereditary angioedema (HAE) and acquired epidermolysis bullosa (AEB) are extremely rare disorders, and their coexistence in a single patient is unique. Awareness of this exceptional association can aid in timely diagnosis and guide safe, individualized treatment strategies.
Case Report. We present a case of a 38-year-old female with co-occurring type I HAE, associated with a heterozygous SERPING1 variant c.425T>C (p.Leu142Ser) of uncertain significance previously reported in individuals with angioedema, and a rare autoimmune subepidermal blistering disorder mediated by autoantibodies against type VII collagen – AEB. Since adolescence, the patient had experienced recurrent limb edema and atypical dermatological manifestations, including macules, vesicles, and bullae, predominantly in areas exposed to mechanical stress and frequently resulting in scar formation. The disease course later progressed with an episode of acute laryngeal edema following a dental procedure. Laboratory evaluation confirmed a critically low level of C1-inhibitor and an almost complete depletion of C4 in plasma, indicating chronic activation of the classical complement pathway. Given the frequent exacerbations and severe clinical course, long-term prophylactic therapy with intravenous C1-INH (1,000 IU twice weekly) was initiated. This treatment regimen led to sustained clinical remission, resolution of angioedema episodes, notable improvement in dermatologic symptoms of AEB, and a substantial enhancement in overall quality of life.
Conclusions. The coexistence of HAE and AEB is exceptionally rare, with no prior cases identified. Complement dysregulation may link these conditions, underscoring the importance of considering autoimmune blistering disorders in HAE patients with atypical skin manifestations. This case highlights a potential role for complement-targeted therapies, warranting further clinical investigation
The Effect of Telehealth Based on Symptom Control and Rational Medication Use on Self-Efficacy, Anxiety-Depression, and Symptoms in Male Patients with COPD: A Quasi-Experimental Study
Full text linkIntroduction. Chronic obstructive pulmonary disease (COPD) is a critical global public health issue, imposing substantial physical, social, and economic burdens due to its symptoms and exacerbations. Telehealth has the potential to be applied for symptom management, monitoring medication adherence, and providing psychological support.
This study was carried out to determine the effect of telehealth based on symptom control and rational medication use on self-efficacy, anxiety-depression, symptoms, walking, and healthcare use outcomes in male patients with COPD.
Methods. A quasi-experimental design was used. The study examined 41 patients with COPD (the intervention group = 20, the control group = 21) treated at the Department of Chest Diseases, Buldan Chest Diseases State Hospital, Denizli, Türkiye. Data were collected at baseline and three months post-intervention using the COPD Self-Efficacy Scale, the COPD Assessment Test, the Hospital Anxiety Depression Scale, and the Six-Minute Walk Test. All participants received routine care. The patients in the intervention group were provided with a nurse-led program and telehealth for three months.
Results. A comparison of the baseline data for the two groups revealed a statistically significant difference in the incidence of respiratory hospitalizations (p = 0.009). Analysis of covariance adjusted for baseline results revealed statistically significant differences for the weather/environmental effect (p=0.011) and behavioral risk factors subscales (p = 0.017) of the COPD Self-Efficacy Scale, as well as dyspnea score after the Six-Minute Walk Test (p = 0.034) in the intervention group compared to the control group. No significant differences were observed between the groups in anxiety-depression, symptoms, and healthcare use (p > 0.05).
Conclusions. This study demonstrated that telehealth based on symptom control and rational medication use significantly affected post-walking dyspnea and partially improved COPD self-efficacy in male patients with COPD. Incorporating teamwork and device-based monitoring is recommended to enhance the effectiveness of telehealth interventions based on education and monitoring
Peculiarities of Oxidative Processes in the Tissues of the Dentioalveolar System under the Conditions of Zinc Deficiency Against the Background of Zinc- and Iodine-Deficient, High-Carbohydrate and High-Fat Diets in an Experiment
No full textAim. The present study aims to investigate experimentally the peculiarities of oxidative processes in the tissues of the dentition system, the effectiveness of the blood serum antioxidant system under the conditions of zinc deficiency against the background of zinc- and iodine-deficient, high-carbohydrate and high-fat diets.
Materials and methods. The study was performed using 100 sexually mature rats (males) receiving a standard diet (control group), as well as zinc- and iodine-deficient, high-carbohydrate or high-fat diets. The protein and lipid peroxidation indices were determined in the soft tissues of the periodontium and in the blood serum of the animals. The antioxidant status was evaluated by measuring the activity of blood serum enzymes and the integral index F (catalase • SOD/TBK-AP) was calculated. The content of the nitrogen oxide metabolite nitrite-ion was also determined in the blood serum.
Results. Diet-induced zinc deficiency is accompanied by the activation of protein and lipid peroxidation processes in the mucous membrane of the alveolar process and the part reflecting the growth of products of oxidative modification of proteins (at 32.01% - twice), lipoperoxidation (diene conjugates – at 32.47% - 5.24-fold, TBK-active products – at 39.40% - 3.52-fold) compared to the control. Such changes were observed against the background of antioxidant imbalance: suppression of Cu, Zn-SOD (at 21.99-49.75%) and glutathione system enzymes (at 22.22-55.56%) against the background of catalase activation (more than twice), an increase in ceruloplasmin content (at 14.91-43.77%). The antioxidant potential is reduced by decreasing nitric oxide synthesis regardless of diet (at 25.96-46.97%). A close correlation relationship was identified between the integrated F index and the following: zinc content in the alveolar process, tooth root cementum, and erythrocyte mass.
Conclusions. Under the conditions of diet-induced zinc deficiency in the soft tissues of the periodontium, here is an activation of protein and lipid peroxidation processes against a background of antioxidant imbalance, and a reduction in nitric oxide synthesis. The development of oxidative stress contributes to the development of inflammatory processes, metabolic disorders, trophic disorders and is a risk factor for dental pathology
Visceral Adipose Tissue Radiodensity as a Potential Biomarker of Immunotherapy Efficacy in Metastatic Non-Small Cell Lung Cancer Patients
Full text linkIntroduction. Non-small cell lung cancer (NSCLC) remains a leading cause of cancer mortality worldwide. Immunotherapy with immune checkpoint inhibitors (ICIs) has improved clinical outcomes, yet predictive biomarkers of treatment efficacy are limited. Recent attention has turned to body composition, particularly adipose tissue characteristics, as potential prognostic indicators. While subcutaneous adipose tissue (SAT) has shown promise, the role of visceral adipose tissue (VAT) radiodensity remains unclear.
This study aimed to assess the prognostic significance of VAT radiodensity as a potential biomarker of ICI efficacy in patients with metastatic NSCLC.
Methods. A retrospective cohort study was conducted on 92 patients with metastatic NSCLC treated with ICIs. VAT radiodensity was measured using contrast-enhanced CT scans at the L3 vertebral level. Radiodensity was defined as the mean Hounsfield unit (HU) value within a 1 cm2 area of VAT. VAT radiodensity was analyzed as both a categorical and a continuous variable. Quartile ranges were as follows: Q1 (-150HU to -100HU), Q2 (-99HU to -91HU), Q3 (-90HU to -73HU), Q4 (-72HU to -50HU). Survival data were analyzed using Kaplan-Meier curves and Cox proportional hazards models adjusted for relevant clinicopathological covariates. A significance threshold of p < 0.05 was applied.
Results. The median overall survival was 15.9, 21.9, 20.1, and 14.2 months for quartiles Q1, Q2, Q3, and Q4, respectively (log-rank p = 0.6331). Multivariable Cox models showed no significant association between VAT radiodensity and NSCLC-specific mortality in categorical or continuous analyses (p > 0.05 across all models). However, PD-L1 expression ≥ 50% emerged as a strong independent predictor of reduced mortality risk (HR = 0.34; p < 0.001). A significant interaction between VAT radiodensity and PD-L1 status was observed (p < 0.001), suggesting possible modulation of immunotherapy response by metabolic factors. Restricted cubic spline analysis showed the non-linear association between mortality risk and VAT radiodensity in patients with metastatic NSCLC.
Conclusions. VAT radiodensity was not an independent predictor of survival in metastatic NSCLC patients treated with ICIs. Nevertheless, its interaction with PD-L1 expression highlights a potential modifying role that warrants further exploration. These findings support the integration of VAT radiodensity into multivariable prognostic models rather than as a standalone biomarker
Viral-Bacterial Interactions: Mechanisms of Pathogenicity and Their Significance During the COVID-19 Pandemic
Full text linkEpidemic seasons of respiratory infections during the COVID-19 pandemic have been marked by the simultaneous circulation of multiple pathogens capable of infecting the human body. Investigating the altered pathogenicity of coexisting microorganisms and their influence on disease progression provides valuable insights for the development of effective therapeutic and preventive strategies against infectious processes. This article provides a comprehensive review of current literature on viral-bacterial interactions in the context of respiratory infections, their pathogenic mechanisms, and significance during the COVID-19 pandemic. It synthesizes recent findings on how SARS-CoV-2 influences mucosal immunity, facilitates secondary bacterial infections through immune modulation, and impacts disease severity and clinical outcomes in co-infected individuals. Special attention is given to the molecular and cellular pathways mediating virus-bacteria interactions, including host receptor modulation, cytokine and interferon response alterations, and disruptions to the respiratory and gastrointestinal microbiota. The epidemiological trends observed during the COVID-19 pandemic, including shifts in the prevalence of common respiratory pathogens and the emergence of new co-infection patterns, are also considered. Understanding the dynamic interplay between viral and bacterial pathogens is crucial for optimizing patient management, improving outcomes, and guiding effective public health interventions
Digital Transformation of Medical Education: the Role of Artificial Intelligence
No full textThis article analyzes the impact of the digital transformation of medical education, particularly the integration of artificial intelligence (AI), on the development of professional competencies among medical students. It has been found that the systematic implementation of AI in learning processes, knowledge assessment, and clinical training promotes the personalization of education and reduces the risk of medical errors. At the same time, a low level of awareness is noted among students pursuing higher medical education regarding the possibilities of AI, especially in the context of the practical application of these technologies in clinical activities.
The article presents data from cross-sectional surveys which show that although most students recognize the potential of AI, they also highlight ethical risks, the danger of reduced empathy, and the need for standardized approaches to teaching digital technologies. Updates to educational programs in line with current digital trends are proposed, including theoretical modules on Machine Learning, large language models (LLMs), and generative AI (GenAI), as well as practical training under the guidance of competent faculty. Emphasis is placed on the importance of developing international regulatory and legal frameworks to govern AI usage in medical education and clinical practice, ensuring algorithmic transparency and adherence to ethical principles.
It is concluded that the proper integration of AI in medical education will not only significantly improve the quality of training for future physicians and enhance the effectiveness of the learning process but will also provide graduates with competitive advantages in the rapidly evolving technological landscape.Ця стаття аналізує вплив цифрової трансформації медичної освіти, зокрема інтеграції штучного інтелекту (ШІ), на формування професійних компетентностей студентів-медиків. З’ясовано, що систематичне впровадження ШІ у навчальні процеси, оцінювання знань і клінічну підготовку сприяє персоналізації освіти та знижує ризик медичних помилок. Водночас серед студентів, які здобувають вищу медичну освіту, відзначено низький рівень обізнаності щодо можливостей ШІ, особливо в контексті практичного застосування цих технологій у клінічній діяльності.
У статті наводяться дані крос-секційних опитувань, що показують: попри те, що більшість студентів визнають потенціал ШІ, вони також виокремлюють етичні ризики, небезпеку зниження емпатії та потребу в стандартизованих підходах до викладання цифрових технологій. Пропонуються оновлення навчальних програм відповідно до сучасних цифрових тенденцій, зокрема включення теоретичних модулів зі сфери машинного навчання, великих мовних моделей (LLMs) і генеративного ШІ (GenAI), а також проведення практичних тренінгів під керівництвом компетентного викладацького складу. Наголошується на важливості розроблення міжнародної нормативно-правової бази щодо використання ШІ в медичній освіті та клінічній практиці, яка забезпечуватиме прозорість алгоритмів і дотримання етичних принципів.
Зроблено висновок, що належна інтеграція ШІ в медичну освіту не лише істотно покращить якість підготовки майбутніх лікарів і підвищить ефективність навчального процесу, а й надасть випускникам конкурентні переваги в умовах стрімкого технологічного розвитку
ПРОФІЛАКТИКА ЗАХВОРЮВАНЬ РОТОВОЇ ПОРОЖНИНИ В ПРАКТИЦІ ЛІКАРІВ-СТОМАТОЛОГІВ
No full textDental diseases are the most widespread non-communicable diseases. Although most of them are preventable, they remain a significant population health challenge, a serious public health problem, and an economic burden globally.
The aim of the study: To study the use of routine technologies for the oral cavity diseases prevention by dentists.
Materials and methods: A retrospective cross-section study was conducted. During 2024, 152 dentists in Ivano-Frankivsk region were surveyed according to the original author's program.
Research results: It was found that dentists do not pay enough attention to the prevention of oncological diseases of the maxillofacial area. They do not properly screen the oral mucosa (50.0%) and lymph nodes of the head and neck (78.9%), do not advise patients on the regularity and necessity of preventive visits to the dentist (55.9%), most of them do not have information materials on these issues in their facilities or on their social media pages. It was established that dentists do not sufficiently advise their patients on the frequency and technique of brushing their teeth (54.6%) and the choice of oral hygiene products (48.0%), not all of them regularly undergo preventive dental check-ups (13.8%) and do not take into account modern guidelines when choosing oral hygiene products (26.3-72.4%).
Conclusions: More attention should be paid to the prevention of dental diseases in the practice and educational programs for dentists.Резюме. Стоматологічні захворювання є найбільш поширеними неінфекційними хворобами. Хоча більшості з них можна запобігти, вони залишаються суттєвим викликом популяційного здоров’я, вагомою проблемою громадського здоров’я та економічного тягаря загалом.
Мета дослідження: вивчення частоти використання лікарями-стоматологами технологій профілактики захворювань ротової порожнини.
Матеріали і методи: Провели ретроспективне крос-секційне дослідження. Впродовж 2024 року за оригінальною авторською програмою опитали 152 лікарів-стоматологів Івано-Франківської області.
Результати дослідження: Встановлено, що лікарі-стоматологи не приділяють достатньо уваги профілактиці онкологічних захворювань щелепно-лицевої ділянки: не проводять належним чином скринінгові обстеження слизової оболонки ротової порожнини (50,0%) та лімфатичних вузлів голови і шиї (78,9%), не надають порад пацієнтам щодо частоти і необхідності профілактичних візитів до лікаря-стоматолога (55,9%), у більшості не розташовують у своїх закладах чи на їх сторінках в соцмережах інформаційних матеріалів з цих питань. З’ясовано, що лікарі-стоматологи не достатньо консультують своїх пацієнтів стосовно частоти та методики чищення зубів (54,6%), вибору засобів гігієни порожнини рота (48,0%), не всі з них самі регулярно проходять профілактичні стоматологічні огляди (13,8%) і не враховують сучасні рекомендації при виборі засобів догляду за ротовою порожниною (26,3-72,4%).
Висновки: Необхідно більше уваги приділяти профілактиці стоматологічних захворювань в практичній діяльності та програмах підготовки лікарів-стоматологів.
Ключові слова: стоматологічне здоров’я, організація медичної допомоги, профілактика захворювань, профілактика раку, громадське здоров’я, доступність стоматологічної допомоги
Cardiovascular Morphological Changes in Metabolic and Endocrine Disorders: A Narrative Review
No full textMetabolic and endocrine disorders profoundly influence cardiovascular morphology through complex mechanisms that converge on endothelial dysfunction. This review synthesises current evidence on structural alterations of the endocardium and arterial system under conditions such as hypertension, diabetes mellitus, metabolic syndrome, and hypothyroidism. Particular attention is given to the endothelium as an active regulator of vascular tone, haemostasis, inflammatory balance, and extracellular matrix dynamics. Chronic metabolic stress, oxidative injury, and dysregulated hormonal signalling drive endothelial-to-mesenchymal transition, smooth muscle cell phenotypic switching, collagen accumulation, and loss of vascular compliance. These processes underlie arterial wall thickening, microvascular rarefaction, endomyocardial fibrosis, and maladaptive myocardial remodelling. Distinct morphological patterns are highlighted across metabolic and endocrine states, including myxedematous changes in hypothyroidism, interstitial fibrosis in diabetes, and hypertrophic vascular remodelling in hypertension. By integrating histological, ultrastructural, and pathogenetic data, this narrative review underscores endothelial dysfunction as a unifying mechanism linking systemic disturbances to cardiovascular pathology. Recognition of these pathways not only advances morphofunctional understanding but also identifies early diagnostic markers and therapeutic targets in cardiometabolic disease
Effects of Ethanolic Ruta Graveolens L. Extracts on In Vitro Postantibiotic Effect of Erythromycin in MLS-Resistant Staphylococci
No full textIntroduction. Ruta graveolens L. (R. graveolens) is a rich source of biologically active compounds with antimicrobial and antibiotic-potentiating properties; however, its impact on the duration of the postantibiotic effect (PAE) remains unclear.
This study aimed to evaluate, in vitro, the PAE duration of erythromycin in staphylococcal strains with different MLS (macrolides, lincosamides, and streptogramin B) resistance phenotypes and to assess the impact of 70% and 90% ethanolic R. graveolens extracts on this parameter.
Methods. Three control strains of staphylococcal skin isolates with different MLS resistance phenotypes, inducible (D), constitutive (Neg), and resistant (R), were used in this study. The minimum inhibitory concentrations of erythromycin and ethanolic R. graveolens extracts (70% and 90%) were determined using the broth microdilution method. Bacterial growth was monitored spectrophotometrically in microplates, and the lag phase, log phase, and PAE values were assessed.
Results. The duration of the erythromycin PAE differed among staphylococcal strains exhibiting different MLS resistance phenotypes. The most extended PAE duration was observed in the tested strain with an inducible phenotype (7.3 ± 0.75 hours). An intermediate mean PAE duration (3.76 ± 0.4 hours) was observed for the strain with complete resistance to the MLS group of antibiotics. The erythromycin PAE was not detected in the strain with the Neg phenotype. Seventy percent R. graveolens extract modified the lag phase and prolonged the erythromycin PAE duration in a phenotype-dependent manner. In contrast, 90% R. graveolens extract did not show a potentiating effect compared to 70% R. graveolens extract.
Conclusions. Combinations of erythromycin with subinhibitory concentrations of 70% R. graveolens extract modified the lag phase and prolonged erythromycin PAE in a resistance phenotype-dependent manner. The most pronounced effect of 70% R. graveolens extract was observed in strains with the D and R MLS resistance phenotypes. Moreover, 90% R. graveolens extract did not potentiate erythromycin activity against MLS-resistant staphylococci
Between Malignancy and Infection: The Diagnostic Challenge of Tuberculous Cervical Lymhadenomegaly – A Case Report
No full textIntroduction. Tuberculous (TB) lymphadenitis is the most frequent extrapulmonary manifestation of Mycobacterium tuberculosis infection, with predominant involvement of the cervical lymph nodes (LN). Bilateral LN enlargement in elderly patients, especially in the presence of a thyroid nodule, may closely mimic malignant disease. This case highlights the diagnostic challenge of distinguishing TB from metastatic thyroid carcinoma and contributes to literature by emphasizing the role of minimally invasive and molecular techniques in diagnosis.
Case report. An 83-year-old female was admitted with progressive bilateral cervical swelling, pain, and systemic symptoms, including weight loss, fatigue, and night sweats. Physical examination revealed bilateral cervical lymphadenopathy and a palpable thyroid nodule. Laboratory studies showed microcytic anemia, leukopenia, and subclinical hypothyroidism. Computed tomography demonstrated bilateral cervical and mesenteric lymphadenopathy, right pleural effusion with pulmonary consolidation, and splenomegaly. Fine-needle aspiration (FNA) of a cervical LN revealed granulomatous inflammation, while polymerase chain reaction (PCR) confirmed Mycobacterium tuberculosis. Cytological evaluation of the thyroid nodule was benign. A final diagnosis of disseminated extrapulmonary TB (EPTB) with LNs, pleural, and probable thyroid involvement was established. The patient was referred to a specialized tuberculosis clinic for further management, but follow-up data were not available.
Conclusion. This case illustrates the diagnostic complexity of EPTB, particularly when concurrent thyroid pathology is present. In such patients, TB may be clinically and radiologically indistinguishable from metastatic malignancy. FNA combined with molecular testing significantly enhances diagnostic accuracy, reducing the need for excisional biopsy