The Ukrainian Scientific Medical Youth Journal

Biomechanical aspects of mandibular fracture fragment fixation research

Olha Musiienko — 2026-06-30

Introduction. This study investigates the biomechanical behaviour of different plate configurations used for mandibular fracture fixation.

Aim. The aim of the study was to evaluate the biomechanical behaviour, stiffness, and stability of different plate configurations used for mandibular fracture fixation under axial loading.

Materials and Methods. Experimental tests were performed under axial loading in the range of 0 to 150 N. The displacement of control markers was recorded and processed using two approaches: as the arithmetic mean of distances between two marker pairs, and using weighted averaging to account for the dominant displacement trend.

Results. Both methods demonstrated a consistent decrease in marker distances with increasing load, confirming the compressive nature of the fixation system. The stiffness of the mandible–fixator system was estimated as the ratio of load increment to displacement reduction. The “2–3” configuration showed the highest stiffness values (≈1575 N/mm) but reduced stability and potential stress concentration near the screw–bone interface. The “3–2” configuration exhibited lower stiffness (≈964 N/mm) and greater micromovements, particularly in the mental region. The “butterfly” plate (“3–3”) provided an optimal balance of stiffness (≈1070 N/mm) and uniform load distribution, reducing torsional deformation and improving spatial stability.

Conclusions. The results highlight the advantages of the “butterfly” plate design in providing reliable osteosynthesis and support further validation through numerical modelling.

Gastrointestinal symptoms as comorbid manifestations of type 1 diabetes mellitus in children

Ihor Kovalchuk — 2026-06-30

Introduction. The incidence of type 1 diabetes mellitus among children and adolescents worldwide is characterized by significant variability, ranging from 5 to 50 new cases per 100,000 individuals under 20 years of age per year, with an average of approximately 14 cases per 100,000. The peak incidence occurs in the 10–14-year age group. After puberty, incidence rates decrease in young women but remain relatively high in young men under 20 years of age. Type 1 diabetes mellitus in childhood is a chronic autoimmune disease accompanied not only by impaired carbohydrate metabolism but also by damage to various organs and systems. Increasing attention is being paid to gastrointestinal disorders in children with type 1 diabetes, as these disorders may occur already in the early stages of the disease, even in the absence of classic microvascular and macrovascular complications.

Aim. The aim of the study was to assess the frequency and intensity of gastrointestinal symptoms in children with type 1 diabetes and to compare the clinical profile of gastrointestinal disorders with that of the control group.

Materials and Methods. The study was conducted as a comparative cross-sectional clinical study. It included 49 children with type 1 diabetes who were under observation in a specialized endocrinology department, as well as 49 children in the control group. The control group consisted of children without diabetes mellitus, chronic gastrointestinal diseases, acute infectious diseases at the time of examination, celiac disease, inflammatory bowel disease, or medication use that could affect the motility or function of the digestive system.

Results. In children with type 1 diabetes, gastrointestinal symptoms were significantly more frequent and more pronounced than in healthy peers, with significantly higher rates of reflux, abdominal pain, nausea, vomiting, diarrhea, and constipation observed in the diabetes group (all p<0.05). For several symptoms, median values were the same in both groups or equal to zero; however, the type 1 diabetes group had wider interquartile ranges, higher percentile values, and greater variability. The most pronounced intergroup differences were observed for pain, nausea, and diarrhea, which were characterized not only by higher frequency but also by greater intensity of manifestations. Individual upper and lower gastrointestinal symptoms in children with type 1 diabetes tended to occur in combination.

Conclusions. In children with type 1 diabetes, gastrointestinal symptoms are systemic and clinically significant. The results indicate an increased frequency and severity of symptoms from different parts of the gastrointestinal tract in children with type 1 diabetes.

Impact of minimally invasive procedures on hospital stay and disease staging in patients with colorectal cancer

Oleksandr Danylenko — 2026-06-30

Introduction. Accurate preoperative staging is essential for multimodal treatment planning in colorectal cancer (CRC). Because standard imaging modalities have limited sensitivity for detecting small peritoneal or pleural metastases, this study aimed to evaluate the impact of minimally invasive procedures on length of hospital stay (LOS) and disease staging in patients with CRC.

Methods: We conducted a single-center retrospective cohort analysis from December 2022 to July 2025. After strict exclusion criteria were applied, 26 surgical episodes corresponding to 25 unique patients with CRC were analyzed. Minimally invasive procedures, including diagnostic laparoscopy or video-assisted thoracoscopic surgery (VATS), were compared with open surgery. The primary outcome was LOS.

Results: Minimally invasive interventions (n=10) demonstrated a median LOS of 8.5 days (IQR, 5.2-13.0) versus 10.5 days (IQR, 7.0-18.0) for open surgery (p=0.289). Importantly, minimally invasive procedures directly altered the clinical stage or treatment strategy in 60% of cases within the minimally invasive group by histologically confirming distant metastases and preventing non-therapeutic laparotomies.

Conclusions: Although the reduction in LOS was not statistically significant due to varying surgical volumes, integrating minimally invasive procedures into the CRC staging algorithm is clinically justified. These procedures ensure precise staging and prevent unnecessary open surgical trauma.

Biochemical factors of wound healing: prospects and limitations of application in clinical practice

Nataliia Yavna — 2026-06-30

Introduction. The full-scale war in Ukraine has led to a significant number of wounded among both military personnel and civilians. Combat injuries often become chronic due to limited access to medical care and a high risk of wound infection. In addition, chronic wounds, particularly diabetic foot ulcers and venous ulcers, continue to represent a major healthcare problem because of their high prevalence. An imbalance of biochemical factors that regulate the process of wound healing at the stages of inflammation, angiogenesis, proliferation, and remodelling can contribute to the chronicity of wounds.

Aim. In this review, we analyse the role of biochemical regulators at different stages of tissue repair and consider the possibilities of integrating these data into clinical practice.

Materials and Methods. Approximately 50 literature sources were analysed. Articles from PubMed, Mendeley, and Europe PMC databases, as well as specialised Ukrainian journals, were used. We selected the most characteristic biochemical factors for each stage of tissue repair, as well as those with the greatest therapeutic potential.

Results. The following biochemical factors were examined: haemostatic components (thrombin and fibrin), inflammatory mediators (IL-10, MMPs/TIMPs), angiogenesis and proliferation regulators (VEGF, PDGF), gasotransmitters (H₂S), and extracellular matrix components (hyaluronic acid). Each group demonstrated therapeutic potential in experimental and, to a significantly lesser extent, in clinical settings.

Conclusions. However, the clinical application of these biomolecules is limited by molecular instability, dose-dependent risks, high cost, and a lack of standardisation. Therefore, optimisation of delivery systems and the conduct of high-quality clinical studies are required.

From sterile urine to dysbiotic ecosystem: The role of urobiome disruption in recurrent urinary tract infection

Antony Hamlin Joseph — 2026-06-30

Introduction. Recurrent urinary tract infections are best conceptualized as a disorder of microbial disequilibrium in which disruption of the normally protective urogenital ecosystem permits repeated pathogen establishment and persistence. Rather than representing isolated infectious episodes, recurrence reflects a failure of microbial homeostasis across interconnected niches, including the urinary tract, vagina, and gastrointestinal system. A defining feature of this condition is the decline of protective commensal organisms, particularly Lactobacillus species, accompanied by increased dominance of opportunistic uropathogens such as Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, and Proteus mirabilis, which collectively undermine colonization resistance and promote infection susceptibility.

Aim. The aim of this review is to characterize recurrent urinary tract infections as a manifestation of persistent microbial imbalance and adaptive pathogen survival, with particular attention to the role of the urogenital and gastrointestinal microbiome, biofilm formation, intracellular bacterial reservoirs, and microbiome-oriented therapeutic approaches.

Materials and Methods. This review summarizes current concepts regarding microbial disequilibrium, pathogen persistence mechanisms, antimicrobial-associated microbiome disruption, the gut–bladder axis, vaginal microbiota alterations, and emerging strategies aimed at restoring microbial equilibrium in recurrent urinary tract infections.

Results. This imbalance is often reinforced by repeated courses of antimicrobial therapy, which, while targeting acute infection, inadvertently deplete beneficial microbial populations, reduce ecological diversity, and select for resistant strains with enhanced survival capacity. Central to recurrence is the ability of pathogens to evade eradication through specialized persistence strategies. These include the development of biofilms that function as structured, matrix-enclosed communities with reduced metabolic activity and limited antibiotic accessibility, as well as intracellular bacterial reservoirs that enable pathogens to remain concealed within urothelial cells in a dormant state. Persister cells further contribute by adopting transiently inactive phenotypes that tolerate antimicrobial exposure and later repopulate once treatment pressure is removed. In parallel, the gastrointestinal tract acts as a continual source of uropathogens, facilitating reinfection through repeated transfer along the gut–bladder axis, while alterations in vaginal microbial composition—particularly those associated with hormonal changes—further compromise local defense mechanisms. Collectively, these processes create a self-sustaining cycle of microbial instability and infection recurrence.

Conclusions. Consequently, effective management requires a shift away from pathogen elimination alone toward strategies that restore and maintain microbial equilibrium. Interventions such as targeted probiotics, hormonal therapies, dietary modulation, and emerging microbiome-based approaches aim to reinforce beneficial microbial communities and enhance host resistance. Nonetheless, variability in clinical response highlights the need for improved mechanistic understanding and standardized therapeutic frameworks. In this context, recurrent urinary tract infection should be regarded as a manifestation of persistent ecological disruption and adaptive microbial survival, necessitating comprehensive approaches that address both microbial composition and functional resilience.

Genetic Determinants of the Response to Acute Massive Blood Loss as a Factor in Planning Evacuation Measures in Field Conditions

Myroslava Salo — 2026-06-30

Introduction. Acute massive blood loss and hemorrhagic shock remain major challenges for modern military medicine, accounting for over 90% of preventable battlefield deaths. Traditional methods of monitoring vital signs often prove ineffective in compensated conditions, when blood pressure and heart rate remain stable until sudden decompensation and the loss of more than 40% of circulating blood volume (CBV).

Aim. This study aimed to systematize data on genetic markers that determine individual tolerance to hypovolemia and to justify their integration into digital predictive monitoring systems to optimize evacuation logistics.

Methods. The study methodology included a comprehensive analysis of scientific publications from the PubMed, Scopus, and Google Scholar databases published between 2020 and 2026, as well as a review of current Tactical Combat Casualty Care (TCCC) clinical guidelines.

Results. The analysis revealed that the population of soldiers is heterogeneous in terms of compensatory capacity, with groups demonstrating high tolerance (HT) and low tolerance (LT) identified. The genetic determinants of this distribution include polymorphisms in genes of the renin-angiotensin-aldosterone system (RAAS), specifically variations in angiotensin-converting enzyme (ACE) and angiotensin II receptor type 1 (AGTR1).

Conclusions. The limitations of using genetic data in field conditions are discussed, and it is argued that the integration of molecular markers into tactical medicine is possible only after large-scale clinical validation and currently represents a promising theoretical direction for the development of long-term care protocols.

Influence of cultivation conditions and genetic engineering methods on Phaeodactylum tricornutum biomass growth and high-value metabolites content

Nikita Nechyporuk — 2026-06-30

Introduction. The modern pharmaceutical industry is increasingly shifting from chemical synthesis to bio-oriented technologies, creating demand for new sustainable sources of biologically active substances. The diatom microalga Phaeodactylum tricornutum has emerged as a promising cellular biofactory due to its ease of cultivation, high growth rates, metabolic versatility, and the availability of reproducible protocols for genetic transformation and cryopreservation.

Aim. This narrative review aims to summarise the influence of cultivation conditions and genetic engineering methods on biomass yield and the production of both native high-value metabolites, including eicosapentaenoic acid, fucoxanthin, and chrysolaminarin, and non-native compounds, such as recombinant proteins and cannabinoid precursors, in Phaeodactylum tricornutum for pharmaceutical biotechnology.

Materials and Methods. This narrative review analysed data on cultivation conditions, culture media composition, temperature and light regimes, genetic engineering approaches, and preclinical and clinical evidence related to Phaeodactylum tricornutum and its biotechnological applications.

Results. The key findings indicate that biomass growth and metabolite accumulation are strongly dependent on the composition of culture media, including nitrogen, phosphorus, and silicates, as well as temperature and light regimes. For example, nitrogen starvation increases lipid content but reduces phenolic compounds and carotenoids, whereas higher phosphate levels enhance both biomass production and fucoxanthin accumulation. Two-stage cultivation strategies help mitigate the trade-off between biomass productivity and stress-induced metabolite yield. Genetic engineering approaches, including the overexpression of endogenous genes, the introduction of plant transcription factors, clustered regularly interspaced short palindromic repeats interference, and epigenetic editing using human fat mass and obesity-associated protein demethylase, have successfully increased the yields of native lipids, eicosapentaenoic acid, and fucoxanthin without compromising biomass growth. Furthermore, Phaeodactylum tricornutum has been engineered to produce non-native compounds of pharmaceutical interest, including recombinant vaccine antigens, such as hepatitis B surface antigen and salmon alphavirus antigen, as well as cannabinoid precursors, such as olivetolic acid and cannabigerolic acid. However, cannabinoid production remains at an early experimental stage. Preclinical and clinical studies confirm the safety, bioavailability, and anti-inflammatory effects of Phaeodactylum tricornutum biomass, while fucoxanthin shows promise against inflammatory and neurodegenerative diseases.

Conclusions. In conclusion, Phaeodactylum tricornutum represents a controllable and versatile platform for pharmaceutical biotechnology. However, challenges related to strain stability, scalability, downstream processing costs, and regulatory frameworks must be addressed before its widespread industrial application.

Modern Challenges in Rational Pharmacotherapy Design: The Multifaceted Role of Color in the Development and Application of Solid Dosage Forms

Zoryana Kurylo — 2026-06-30

Introduction. In the paradigm of rational pharmacotherapy, the visual attributes of solid dosage forms (SDFs), particularly their color, emerge as a complex factor influencing both physicochemical stability and treatment safety.

Aim. The aim of this research was to systematize scientific data on the role of SDF color in ensuring photostability, accurate identification, excipient safety, and improving medication adherence.

Materials and Methods. Based on the PRISMA methodology, a systematic analysis of scientific literature for the period 2024–2026 was conducted using PubMed, Scopus, Web of Science, and Google Scholar databases, covering the screening of 989 publications and a critical review of 35 source materials.

Results. It was established that the directional hemispherical reflectance (DHR) parameters of the SDF coating determine its photoprotective attributes, preventing active substance degradation. Color differentiation of doses serves as an effective tool to minimize Look-Alike, Sound-Alike (LASA) errors, thereby enhancing patient safety in cases of polypharmacy. The current regulatory status of titanium dioxide (TiO₂, E171) was evaluated according to EMA and EFSA documents, alongside the technological prospects of implementing natural plant and microbial pigments. The impact of color semantic resonance on shaping patient expectations and modulating placebo/nocebo effects was reviewed.

Conclusions. Therefore, a justified choice of color palette at the preformulation stage is an essential element of patient-centric design of SDFs to optimize storage conditions and support proper medication adherence.

Clinical Case of Rendu–Osler Syndrome: The Role of Pharmaceutical Care in Optimizing Pharmacotherapy

Yelyzaveta Yevdokymova — 2026-06-30

Introduction. Rendu-Osler syndrome, also known as hereditary hemorrhagic telangiectasia, is an orphan genetic disorder characterized by multisystem vascular involvement and recurrent bleeding, most commonly epistaxis. Frequent nosebleeds can lead to chronic iron-deficiency anemia and significantly impair patients' quality of life.

Aim. This study aimed to substantiate the role of pharmaceutical care in ensuring rational and safe use of medications based on a clinical case of Rendu-Osler syndrome.

Materials and Methods. A retrospective analysis of a patient's medical records for Rendu-Osler syndrome for the period 2022-2025 was conducted using the case method. A clinical and pharmaceutical analysis of the prescribed pharmacotherapy was conducted, along with an assessment of potential drug interactions using the DrugBank Online database and a retrospective review of literature sources in PubMed and Cochrane Library.

Results. The patient presented with recurrent episodes of epistaxis, anemic syndrome, and the need for interventional treatment. The use of tranexamic acid contributed to a reduction in the intensity and frequency of nosebleeds. The clinical and pharmaceutical analysis helped identify potential risks of drug interactions and formulate recommendations to improve the safety of pharmacotherapy, including monitoring of coagulation parameters and iron status with the possibility of iron deficiency correction.

Conclusions. The presented clinical case demonstrates the importance of a comprehensive approach to managing patients with Rendu-Osler syndrome. Pharmaceutical care, which encompasses clinical and pharmaceutical analysis of pharmacotherapy, safety monitoring, and patient education, is an essential tool for optimizing treatment and improving clinical outcomes.

Clinical case of treatment of a patient with a gunshot wound and a massive osteo-soft tissue defect of the calcaneal region

Viktoriia Pohorila — 2026-06-30

Introduction. Injuries of the heel region associated with combined bone and soft-tissue defects represent a significant challenge in reconstructive surgery due to the high risk of infectious complications and loss of the limb’s weight-bearing function.

Aim. We present a clinical case of staged treatment of a military patient with a gunshot injury to the left foot, a comminuted calcaneal fracture, and a massive bone and soft-tissue defect.

Materials and Methods. During the first stage, surgical debridement of the wound, eradication of the infectious focus, and implantation of a gentamicin-loaded polymethylmethacrylate (PMMA) spacer were performed to achieve local infection control and preserve the volume of the bone defect. Following stabilization of the local wound condition, soft-tissue reconstruction was carried out using a reverse sural flap, with subsequent closure of the donor site using a split-thickness skin graft.

Results. The treatment resulted in complete coverage of the defect, preservation of flap viability, and creation of favorable conditions for subsequent bone reconstruction.

Conclusions. This case demonstrates the effectiveness of a staged reconstructive approach combining a PMMA spacer and a reverse sural flap for the management of complex traumatic heel defects and preparation of the patient for the next stage of bone defect reconstruction.

Clinical case of warfarin use in a patient with cardiovascular pathology

Mavluda Qadamova — 2026-06-30

Introduction. The use of warfarin in patients with mechanical heart valve prostheses is an important component of thromboembolic prevention; however, it is associated with clinically significant drug interactions and hemorrhagic complications. Particular attention should be paid to patients with comorbid cardiovascular diseases receiving combined antithrombotic therapy.

Aim. The aim of this study was to substantiate the importance of clinical and pharmaceutical support in warfarin therapy in a patient with a mechanical mitral valve prosthesis.

Materials and Methods. A retrospective analysis of the medical records of a 52-year-old patient with chronic rheumatic heart disease after mitral valve replacement was performed. Clinical and pharmaceutical analysis of pharmacotherapy, assessment of international normalized ratio (INR) dynamics, and evaluation of potential interactions of warfarin with acetylsalicylic acid, omeprazole, and atorvastatin were carried out.

Results. INR fluctuations within the range of 1.8–3.14 required warfarin dose adjustment. The most clinically significant interaction was identified between warfarin and acetylsalicylic acid, which increased the risk of hemorrhagic complications. Regular INR monitoring allowed stabilization of hemostatic parameters and improvement of the patient’s clinical condition.

Conclusions. This clinical case illustrates the importance of individualized anticoagulant therapy and clinical and pharmaceutical monitoring to ensure treatment safety in patients receiving warfarin.

Dementia with Lewy bodies: a clinical case study on the differential diagnosis of atypical parkinsonism

Yaroslava Petrashevska — 2026-06-30

Introduction. Parkinsonism and dementia pose a significant challenge to modern society, as medicine can only offer symptomatic treatment, which may be more effective when diagnosed at the early stages of progression. To date, successfully performing a differential diagnosis of atypical parkinsonism syndrome and establishing the correct diagnosis remains a challenging task, particularly given limited diagnostic resources.

Aim. The aim of the study was to conduct a differential diagnosis of atypical parkinsonism based on consensus international criteria, using the example of a clinical case of dementia with Lewy bodies, and to demonstrate the diagnostic and therapeutic process using clinical, neuroimaging, electrophysiological and neuropsychological criteria.

Materials and methods. We present a clinical case of a 75-year-old patient with atypical parkinsonism. Informed consent for publication has been obtained. The following were performed: neurological examination, neuropsychological testing (Mini-Mental State Examination, Montreal Cognitive Assessment), magnetic resonance imaging of the brain with assessment of atrophy (Global Cortical Atrophy scale), electroencephalography, and a levodopa test. The diagnosis was established in accordance with the criteria of the International Society for Parkinson’s Disease and Movement Disorders, as well as the consensus on Lewy body dementia. The duration of follow-up was 6 months.

Results. The efficacy of treatment with cholinesterase inhibitors, anti-Parkinson’s drugs and melatonin was assessed. A stepwise differential diagnosis of atypical parkinsonism was performed. Initially, a diagnosis of multiple system atrophy of the parkinsonian subtype was established on the basis of oligo-bradykinesia, plastic hypertonia, limb ataxia and a poor response to the levodopa test. However, the detection of recurrent episodes of cognitive fluctuations to the level of moderate dementia (MMSE 19–20 points) and persistent visual hallucinations, which are exclusion criteria for multiple system atrophy, led to a revision of the diagnosis. Clinically probable dementia with Lewy bodies was established, presenting with all four core features: cognitive fluctuations, visual hallucinations, clinically probable behavioural disturbances during rapid eye movement (REM) sleep, and parkinsonism. Combination therapy with rivastigmine (3 mg in the morning, 1.5 mg at night), amantadine (100 mg/day), levodopa retard (100/25 mg/day) and melatonin (10 mg) resulted in significant clinical improvement: a reduction in the frequency of cognitive-hallucinatory fluctuations to once every 2–3 months, improved cognitive function (MMSE 22 points), reduced muscle rigidity and restoration of partial self-care.

Conclusion. This case presents a classic example of Lewy body dementia with all four diagnostic features, but illustrates the typical difficulties arising from the overlap in the manifestations of synucleinopathies. The early onset of cognitive fluctuations, hallucinations and behavioural disturbances during rapid eye movement sleep, combined with resistant parkinsonism, creates a highly specific pattern of Lewy body dementia, even in the presence of ataxia and autonomic dysfunction.

Differential diagnosis and management of patients with abdominal manifestations of hyponatremia

Viktoriia Harasymchuk — 2026-06-30

Introduction. Hyponatremia is one of the most common electrolyte disorders in clinical practice and may present with a wide range of manifestations, from asymptomatic cases to severe neurological and gastrointestinal disturbances. Decreased serum sodium (Na⁺) levels can impair intestinal motility and lead to the development of intestinal pseudo-obstruction, creating significant diagnostic challenges.

Aim. This study analyzes the clinical features of hyponatremia with abdominal manifestations based on clinical cases and summarizes current literature data regarding the development of intestinal pseudo-obstruction in this electrolyte imbalance.

Materials and Methods. Two clinical cases of patients with severe hyponatremia accompanied by neurological symptoms and impaired intestinal motility with features of intestinal pseudo-obstruction were analyzed. Laboratory and instrumental investigations allowed exclusion of surgical pathology and established the association between clinical manifestations and severe electrolyte imbalance.

Results. Timely diagnosis and correction of hyponatremia resulted in regression of clinical symptoms and restoration of intestinal function.

Conclusions. The presented clinical cases emphasize the importance of assessing serum electrolyte levels in patients with abdominal symptoms and the need for differential diagnosis with acute surgical pathology of the abdominal organs.

Fever of unknown origin in a patient undergoing maintenance therapy for B-cell lymphoma

Sophia Moloshtan — 2026-06-30

Abstract

Introduction. Patients with B-cell lymphomas are at high risk for developing infectious complications due to secondary hypogammaglobulinemia, immunosuppressive therapy, and prolonged use of central venous access. In this patient population, bacteremias are often associated with catheter-related infections and may be caused by non-fermenting Gram-negative microorganisms with inherent antibiotic resistance, which complicates the selection of empirical therapy.

Aim. The aim of this study was to analyze the clinical features, diagnostic approaches, and treatment strategies for bacteremia caused by Stenotrophomonas maltophilia in a patient with B-cell lymphoma receiving maintenance anti-CD20 therapy, with an assessment of the role of the port system as a possible source of infection.

Materials and Methods. A clinical case of bacteremia in a patient with B-cell lymphoma receiving maintenance anti-CD20 therapy and prolonged central venous access was analyzed. Clinical manifestations, laboratory markers of systemic inflammation, blood culture results, antibiotic susceptibility testing, empirical and adjusted antibacterial therapy, and clinical dynamics after central venous catheter removal were assessed.

Results. The clinical course was characterized by fever without a clearly defined primary site of infection and elevated laboratory markers of systemic inflammation. Blood culture revealed Stenotrophomonas maltophilia, and antibiotic susceptibility testing was performed. Empirical broad-spectrum antibiotic therapy was ineffective due to the pathogen’s inherent resistance. Following adjustment of antibiotic therapy based on the antibiotic susceptibility test results and removal of the central venous catheter, clinical improvement and normalization of laboratory parameters were observed.

Conclusions. This case demonstrates the clinical significance of Stenotrophomonas maltophilia as an opportunistic pathogen in oncohematology patients and underscores the importance of an individualized approach to treating bloodstream infections in this patient population.

Guillain-Barré syndrome complicated by acute flaccid tetraplegia: a clinical case

Tetiana Tereshchenko — 2026-06-30

Introduction. Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy characterized by autoimmune damage to peripheral nerve myelin sheaths or axons. Its clinical significance is driven by the risk of rapid ascending paralysis, respiratory failure, and high disability rates (20–30%). In pediatrics, diagnosis is often challenged by atypical presentation, particularly a severe pain syndrome mimicking somatic conditions.

Aim. This study aims to analyze the diagnostic and management characteristics of a 5-year-old patient with rapidly progressive GBS within 48 hours, complicated by acute flaccid tetraplegia.

Materials and Methods. The clinical case of a 5-year-old patient with rapidly progressive Guillain-Barré syndrome was analyzed. The diagnostic assessment included evaluation of clinical neurological findings, cerebrospinal fluid analysis, and electroneuromyography (ENMG).

Results. The case presented with acute, severe muscle pain, leading to an initial misdiagnosis of generalized myositis and an 11-day delay in specific immunotherapy. The diagnosis was established based on clinical findings, including total areflexia and flaccid tetraplegia, and ENMG signs of acute inflammatory demyelinating polyradiculoneuropathy. Early cerebrospinal fluid analysis did not reveal classic albuminocytological dissociation, which did not contradict the diagnosis at the early stages. The primary specific treatment consisted of intravenous immunoglobulin (IVIG) at a total dose of 2 g/kg. Glucocorticoids were administered as a short pulse course solely for managing severe refractory pain and systemic inflammatory response. Comprehensive therapy and intensive care monitoring led to significant clinical improvement: the patient regained the ability to sit independently and walk with support.

Conclusions. This case emphasizes the critical need for prompt neurological evaluation in children presenting with acute limb pain and highlights the high efficacy of IVIG.

Management of a Patient with Metabolic Dysfunction-Associated Steatotic Liver Disease and Periodontitis

Yaroslav Makovei — 2026-06-30

Abstract.

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently recognized as a multicomponent systemic pathology extending far beyond isolated hepatobiliary impairment. MASLD serves as a hepatic manifestation of metabolic syndrome and is pathogenetically linked to an elevated risk of type 2 diabetes mellitus progression, abdominal obesity, atherogenic dyslipidemia, cardiovascular complications, and chronic low-grade systemic inflammation. The comorbid course of MASLD and generalized periodontitis is of particular clinical and scientific interest. Both pathological states share common pathogenetic pathways, where tissue insulin resistance, systemic oxidative stress, proinflammatory cytokine imbalance, endothelial dysfunction, and mutual aggravation due to the persistence of a chronic oral infection focus play a pivotal role.

Aim. The aim of this study is to demonstrate the features of non-invasive diagnostics and multidisciplinary management in a young patient presenting with a combination of MASLD, type 2 diabetes mellitus, obesity, and chronic periodontitis.

Materials and Methods. The article analyzes a clinical case of a 34-year-old patient S. referred by a dentist due to the aggressive course of periodontitis. Physical examination revealed signs of class I obesity. Laboratory monitoring demonstrated insulin resistance, subcompensated type 2 diabetes mellitus under baseline therapy, pronounced atherogenic dyslipidemia, and biochemical signs of cytolytic syndrome. Utilizing quantitative ultrasound fat fraction (UDFF) and shear wave elastography (pSWE), moderate liver steatosis was diagnosed in the absence of significant fibrotic changes (stage F0). The form of MASLD was verified as steatohepatitis based on the persistent activity of liver enzymes over time and the exclusion of other etiological factors.

Results. A detailed periodontal examination and instrumental-radiological evaluation of the dental status confirmed severe alveolar bone destruction, pronounced pathological tooth mobility, and poor oral hygiene, fulfilling the criteria for stage IV, grade C periodontitis. Given the presence of type 2 diabetes mellitus, obesity, MASLD, and critically elevated LDL levels, which stratify the patient into a very high cardiovascular risk category, high-intensity statin therapy was reasonably incorporated into the treatment regimen to achieve target lipid parameters in accordance with current cardiometabolic guidelines.

Conclusions. This case emphasizes the necessity of early proactive screening for liver steatosis and fibrosis in patients with periodontitis and metabolic disorders, even at a young age. Multidisciplinary collaboration among a dentist, general practitioner, endocrinologist, and ultrasound specialist represents a fundamental prerequisite for the timely detection of MASLD and the prevention of comorbid complications.

Metastatic Relapse of Ewing Sarcoma with Parietal Bone Involvement and Intracranial Extension Following Euro-Ewing 2012 Protocol and Left Transfemoral Amputation

Vladyslava Bespalova — 2026-06-30

Introduction. Ewing sarcoma is a highly aggressive malignant bone tumor associated with a high risk of relapse and metastatic spread, whereas skull and intracranial involvement remains rare and clinically challenging.

Aim. The aim of this case report is to describe a late metastatic relapse of Ewing sarcoma presenting as a right parietal bone metastasis with intracranial extension 2.9 years after completion of Euro-Ewing 2012 protocol treatment and left transfemoral amputation, and to discuss implications for individualized post-remission surveillance.

Materials and Methods. An 11-year-old patient initially achieved complete clinical remission after multimodal treatment for Ewing sarcoma of the left lower limb; however, due to emergency evacuation and subsequent treatment abroad after the beginning of the full-scale invasion of Ukraine, primary diagnostic documentation was limited, and regular surveillance imaging during remission was not performed according to the available history. In August 2025, the patient was admitted with persistent fever without an identifiable infectious source and subsequently developed a painless right parietal mass with headache. Brain CT and MRI revealed osteolytic destruction of the right parietal bone with a paraosseous soft-tissue component and intracranial parameningeal extension, while histopathological examination confirmed metastatic Ewing sarcoma.

Results. Systemic staging demonstrated additional metastatic lesions in the left iliac bone and segment S5 of the right lung. Second-line treatment included high-dose ifosfamide-based chemotherapy, peripheral blood stem cell mobilization and collection, surgical resection of the cranial metastasis, and high-dose chemotherapy with autologous stem cell transplantation followed by referral for consolidative radiotherapy. After two cycles of chemotherapy, partial response was achieved according to RECIST 1.1 criteria, with reduction of the cranial, iliac, and pulmonary lesions; subsequent imaging showed complete regression of the pulmonary metastasis and stabilization of the iliac bone lesion. The cranial metastasis was resected with R0 margins, although isolated tumor cell elements were identified on the dural surface.

Conclusions. This case illustrates that Ewing sarcoma may relapse after a prolonged remission period with atypical cranial and intracranial involvement and may initially present with nonspecific symptoms. Current follow-up strategies mainly focus on the primary site and chest imaging and may fail to detect rare metastatic localizations at an early stage. Brain MRI should not be interpreted as a routine requirement for all survivors; rather, it may be considered in selected patients with neurological symptoms, cranial complaints, unexplained fever without an identifiable source, or other high-risk clinical features. Further prospective studies are required to define standardized indications for neuroimaging during long-term follow-up of Ewing sarcoma survivors.

Pharmacological Correction of Severe Acute Pancreatitis with Pancreatogenic Diabetes Mellitus

Hanna Salivon — 2026-06-30

Introduction. Acute pancreatitis (AP) is a complex pathology in emergency abdominal surgery associated with a high risk of systemic complications. The severe course of the disease is accompanied by pancreatic necrosis, systemic inflammatory response syndrome, and multiple organ failure. The metabolic consequences of massive destructive pancreatic damage often lead to the development of secondary pancreatogenic diabetes mellitus (type 3c), which manifests as profound insular insufficiency and critical hyperglycemia, significantly limiting therapeutic options and contributing to polypharmacy.

Aim. The aim of this study was to analyze the clinical and pharmacological features of managing a patient with severe acute pancreatitis, pancreatic necrosis, and secondary pancreatogenic diabetes mellitus based on a clinical case.

Materials and Methods. This paper presents a retrospective analysis of the medical history of a 60-year-old patient A. with severe AP. The severity of the condition was verified according to the 2012 Atlanta classification criteria by the presence of local destructive complications and transient renal dysfunction (serum creatinine 150 μmol/L). The comprehensive diagnosis included severe acute pancreatitis, focal pancreatic necrosis, splenic vein occlusion, cholangitis, reactive hepatitis, and subcompensated pancreatogenic diabetes mellitus. Abdominal CT confirmed focal changes in the gland and the presence of heterogeneous fluid collections. Upon admission, the glycemia level reached 20.9 mmol/L, and leukocytosis was 13.4 × 10⁹/L.

Results. Pharmacotherapy in the intensive care unit included infusion detoxification (Sterofundin, Reosorbilact) and antibacterial coverage of the necrosis zones (ciprofloxacin, metronidazole), which was associated with a decrease in leukocytosis to 4.0 × 10⁹/L by the seventh day. Pancreatic secretion was suppressed with omeprazole and dalargin. To improve blood rheological properties and prevent thrombosis, given a fibrinogen level of 11.5 g/L, sodium enoxaparin and pentoxifylline were utilized. During the conservative treatment phase, due to an increase in transaminases (ALT 53 U/L, AST 72 U/L), hepatoprotectors (arginine glutamate, alpha-lipoic acid) were prescribed. Special attention was paid to the correction of carbohydrate metabolism. Due to the high risk of euglycemic diabetic ketoacidosis, glycemic control in the acute period was provided by insulin therapy. The administration of the SGLT2 inhibitor dapagliflozin at a dose of 10 mg/day was performed extremely cautiously only after the resolution of acute renal dysfunction (creatinine reduction to 102 μmol/L on the third day), stabilization of overall hemodynamics, restoration of hydration balance, and the patient's transition to oral nutrition.

Conclusions. The described clinical case demonstrates the successful implementation of an individualized pharmacological strategy; however, proving the isolated efficacy of specific agents, such as dalargin or hepatoprotectors, is limited by the scope of a single observation. The use of SGLT2 inhibitors in the acute period of pancreatic necrosis cannot be considered a routine recommendation and requires dynamic monitoring of electrolytes, renal function, and acid-base status.