Introduction. The role of autonomic imbalance in maternal cardiac arrhythmia (CA) is still debatable. The objective of the study was to assess the relationship between maternal autonomic tone and CA in pregnant women. Materials and methods. The cross-sectional study was carried out among pregnant women admitted to Kharkiv Municipal Perinatal Center between 1 December 2015 and 31 July 2020. 117 patients at 28-36 weeks of gestation were enrolled. 20 of them had sinus rhythm and were included in Group I (control). In Group II, 55 pregnant women with CA and cardiovascular comorbidity were observed. 42 patients with idiopathic CA were monitored in Group III. The daily electrocardiogram and heart rate variability (HRV) were obtained. The density of ectopic beats (DEB) was defined as the percentage of ectopic to total beats. Results. The investigation of the HRV revealed heterogeneity in the groups of study. The enhanced sympathetic activity was determined in women with CA and structural heart disease. Pregnant women with idiopathic CA demonstrated a parasympathetic pattern of autonomic nervous regulation. The revealed relations between DEB and sympathetic or parasympathetic regulation demonstrate an increased sympathetic tone in patients with structural heart disease. In women with idiopathic CA, parasympathetic regulation played a significant role in the scenario of cardiac ectopy. Conclusions. The idiopathic CA could be the result of abnormally elevated parasympathetic regulation in the second half of pregnancy.

Introduction. The decrease in serum estrogens concentration at menopause disrupts the metabolic balance and leads to visceral obesity, which causes an increase in serum estradiol levels, through aromatase activity. Also, estrogen deficiency is a reason for the development of osteoporosis. The objective of the study was to investigate the serum estradiol levels and changes in bone alpha estrogen receptor expression in an experimental model of osteoporosis. Materials and methods. The study included 20 female Wistar rats at a reproductive age of two months, divided into two groups: group 1 (G1) – 10 ovariectomized rats, and group 2 (G2) –10 rats sham-operated. SPSS 20 software (SPSS, Inc., Chicago, IL, USA) was used for statistical analysis of the results. For the immunohistochemical study, the nonparametric test – Mann Whitney was used, by comparing the median values. Data were presented as mean ± standard deviation, with p < 0.05 as the limit for statistical significance. Results. All animals of G1 had weight gain compared to group G2. The results showed that the values of serum 17?-estradiol in rats of G1 statistically significant increased compared to G2 (p<0.05). The immunohistochemical analysis revealed no difference in estrogen receptor expression between the groups. The histological analysis of femur in rats from G1 showed pronounced osteoporosis. Conclusions. Ovariectomy led to the development of obesity, which caused an increase in serum estradiol levels, through aromatase activity. However, this increase of serum estradiol did not prevent osteoporosis.

Introduction. According to the European Association of Urology guidelines, flexible ureterorenoscopy is one of the treatment modalities for kidney stones less than 2 cm. Disposable flexible ureterorenoscopes are superior to reusable ones in terms of scope performance deterioration, damage repair costs and special gas-sterilization equipment. Despite the undeniable progress of disposable flexible ureterorenoscopes in everyday urological practice, the literature lacks a rich database on their technological design and clinical effectiveness. The objective of this paper is to present our experience in the management of kidney stones by a flexible disposable ureterorenoscope – WiScope™. Material and methods. Between the 1st of January 2020 –the 1st of January 2021, 76 patients with kidney stones were treated in our centre by flexible ureterorenoscopy and laser lithotripsy. The evaluation of demographics, efficacy and safety of the procedure was performed. Results. A successful procedure was recorded in 94.7% (72/76) of the patients. We evaluated the total stone-free rate 8 weeks after the intervention, which was 94.4% (70/72). The complications rate was 13.1% (10/76). No serious adverse events were observed. Conclusions. The use of flexible disposable ureterorenoscopes has proven a good efficacy and safety. WiScope™ is a comparable option among all available flexible disposable ureterorenoscopes, in terms of all basic characteristics.

Introduction. Late complications of myocardial infarction (MI) are important causes of re-hospitalization and mortality in patients with type 2 diabetes mellitus (DM). The objective of the study was to predict the development of late complications after MI in type 2 DM patients, to improve the quality of diagnostic tests for this group of patients. Material and methods. A total of 109 patients with type 2 DM after MI was divided into two groups: the study group (n = 74) and the validation group (n = 35). The levels of adropin and C1q/tumour necrosis factor-related protein 3 (CTRP 3) were measured by enzyme-linked immunosorbent assay. The model for predicting late complications of MI was calculated using binary logistic regression. Results. The median age of patients was 61.0 (54.5 – 67.0) years and 68.8% were male. Mathematical model components on the 14th day of follow-up were qualitative adropin, qualitative CTRP3, total cholesterol (TC), triglycerides (TG), ejection fraction (EF), low-density lipoprotein (LDL), left atrium (LA). The model attained the highest under the receiver operating characteristic curve for predicting late MI complications in the study and control groups (0.949 and 0.966, respectively), with the highest diagnostic accuracy in both groups (94.6% and 97.1%, respectively). Conclusions. This study has shown that the integral assessment of adropin, CTRP 3, TC, TG, EF, LDL, LA, measured on the 14th day after MI in type 2 DM patients who underwent percutaneous coronary intervention (PCI), could predict late complications of MI after PCI.

Introduction. Cutaneous metastases are usually observed in end-stage cancers. In some cases, the diagnosis of skin metastases is not clinically evident. New studies have found that serological markers, such as fibrinogen and lactate dehydrogenase (LDH), represent predictive factors of cutaneous metastases and could be used in the follow-up. The objective of our study was to evaluate these two markers (fibrinogen and LDH) and to find if there are any correlation between different parameters such as patients’ age, dimensions, and type of the tumour, as well as local complications. Materials and methods. We conducted a retrospective study on 56 patients with cutaneous metastases. We analysed different parameters of patients who underwent skin biopsies or surgical excision, such as age, number, diameter, localization or complications, type of primary neoplasia, other internal organ malignancies, as well as serological levels of LDH and fibrinogen. Results. The study included patients with various types of malignant tumours, most of them with melanoma, followed by different types of adenocarcinomas and leiomyosarcoma. Our cohort also included some rare cases of uterine cervix adenocarcinoma metastases, renal cell metastases and pancreatic metastases. Regarding the serological markers, we identified that fibrinogen correlates with the diameter of the skin nodules, LDH correlates with the age of the patients diagnosed with melanoma, and the two serological parameters correlate with one another. Conclusions. Fibrinogen and LDH can be considered poor prognostic factors for patients with melanoma metastases. As the two markers correlate with one another and with some of the analysed parameters, they could, in the future, be useful to better estimate the malignant disease outcome.

Introduction. Probiotics are well-known adjuvants, used as complementary therapeutic agents in health (e.g. gastrointestinal or metabolic) disorders, considering their beneficial role on gut microbiota, and their support in immunity. The objective of the study was to evaluate the impact of probiotic supplementation on abundance of Bacteroides spp. in intestinal microbiome of patients with Crohn’s disease (CD). Materials and methods. The comparative evaluation was conducted over a 6-month period, on 49 subjects diagnosed with CD, who were separated into two groups, as follows: the study group (probiotics associated with allopathic treatment) and the control group (only allopathic treatment). All patients were evaluated at baseline and at 6 months. Demographic characteristics, associated pathology, and the evolution of intestinal microbiome and faecal pH were followed. Results. In this research, the microbiome of patients with CD showed changes in the abundance of bacterial species. The combination of probiotic treatment led to the following changes: Escherichia coli (from 5.77x107 to 4.15x107, p=0.006) and Enterobacter spp. (from 1.92x104 to 1.17x104, p=0.009) values decreased significantly and Faecalibacterium prausnitzii (from 3.73x108 to 4.55x108, p=0.003), Bifidobacterium spp. (from 4.76x106 to 4.92x106, p<0.001 and Bacteroides spp. (from 4.68x107 to 4.80x107, p=0.012) values increased significantly; the pH value increased significantly at 6 months (from 6.30 to 6.59, p=0.043). Conclusions. Treatment with the selected probiotic led to changes in the composition of beneficial microbial communities in patients with CD.

Introduction. Up to date, various mobile medical apps were proposed, including digital platforms for diagnoses of speech impairment. The review aims to assess the effectiveness of mobile health (m-Health) platforms for patients with speech and voice disorders. Material and methods. We conducted a systematic review of studies published between 2008 and 2021. 234 articles from PubMed, Web of Science, and Cochrane Library databases were pre-selected for the review. Only articles related to the use of medical applications for smartphones, tablets, or computer devices studies were included in the analysis. Results. A total of 111 full-text articles were assessed for eligibility, and 37 were included in this study. The selected reports cover research on the use of mobile applications for therapy, rehabilitation assistance, and diagnoses. In terms of application, mobile apps have been developed for patients (children and adults) with speech disorders caused by autism, neuro-developmental speech impairment, Parkinson’s disease, aphasia, voice disorders, etc. Conclusions. The analysis showed that the m-Health market offers various mobile applications for persons with speech impairments (as an adjuvant tool for therapy and rehabilitation). Despite the existence of a range of m-Health applications for patients with speech disorders, there is a need for further large-scale studies aimed at studying their effectiveness, safety, and reliability.

Dengue is estimated to be the most common mosquito- borne disease globally, affecting mainly tropical and subtropical countries. It has been identified as a disease of the future, due to persistent trends in urbanization of societies, scarce water resources and changes in the environment. The four dengue virus serotypes cause from the usual mild illness to a potentially fatal syndrome associated with increased vascular permeability. The unique antigenic and biological properties of the virus have made it difficult to develop vaccines. The authors have analysed “Dengvaxia“, the only licensed vaccine with partial efficacy (it protects most of the people, but makes others more susceptible to serious diseases) and complex performance. The impact of these results on the future of the dengue vaccines is discussed.

Introduction. The coronavirus disease 2019 (COVID-19) pandemic has constrained healthcare units to reorganize hospital departments, substantially reducing their capacity to perform oncology-related surgeries. Despite the efforts to reduce the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization, COVID-19 has complicated the recovery of many surgical patients. Our objective was to assess the impact of SARS-CoV-2 infection on the postoperative evolution of patients with pancreatic surgery. Cases presentation. We present four patients with pancreaticoduodenectomy for malignant disease, operated in our hepato-biliary-pancreatic surgery department, who presented COVID-19 in the postoperative period, despite initial negative screening. 10% of patients who had pancreaticoduodenectomies were subsequently detected with minimal, moderate to severe forms of COVID-19 in the postoperative period, which led to an extension of the hospitalization period, in some cases, by up to five weeks. Conclusions. The side effects of COVID-19 pandemic are yet to have reached their limits. Pancreaticoduodenectomy is a complex surgery with high morbidity rates, but during the COVID-19 pandemics it has become more challenging.

Introduction. Neoplastic microenvironment represents a frequently studied subject in numerous studies. Angiogenesis, as a part of it, is a prognostic factor and a therapeutic target in several neoplastic diseases. Cases presentation. We describe the angiogenetic process in a small series of extra gastrointestinal stromal tumours (EGISTs) and corelate it with the proliferation index. We retrospectively searched our institutions databases for EGIST cases. The resulting data were reviewed by two pathologists. Immu nohistochemistry (IHC) was performed to highlight the vascular structure of the tumours and determine the proliferative index using ki67 staining. Subsequently, the whole slide scanned digital images were used to assess micro vessel density and vascular surface. Statistical analysis of measurements data yielded a negative correlation between the tumour proliferative index and vascular surface normalized to examined surface of the tumour (r=-0.5506 and p=0.0051). A correlation between micro vessel density and proliferative index of the tumour could not be established in our series (p =0.035). Conclusions. Highly proliferative EGISTs have a reduced micro vessel surface compared to low grade tumours, possibly due to a limited development rate of the angiogenesis during the tumours’ growth. Due to the rarity of this sarcoma, our study is limited by the small number of cases, as well as by the preanalytical procedures performed on the tissue that may alter the vascular area in different manners. Further studies on larger series are needed to confirm our results and to investigate other morphological parameters, to assess the utility of anti-angiogenic therapies.

Introduction. Depending on neuroendocrine differentiation, the prostate cancer is divided into two major groups: primary neuroendocrine prostate tumour (carcinoid, small-cell, and large-cell neuroendocrine carcinoma) or as a focal tumour in conventional adenocarcinoma. Large-cell neuroendocrine carcinoma of the prostate is very rare. Case presentation. A 72-year-old man was diagnosed with a high-grade adenocarcinoma Gleason 9 (4 + 5) by needle biopsy and subsequently, after prostatectomy, with a large-cell neuroendocrine carcinoma without areas of prostatic adenocarcinoma. The patient was prescribed chemotherapy (etoposide and cisplatin) with subsequent radiation therapy by a Tumour Board. For the last 5 months, he is in partial remission. Conclusions. An extremely rare case of primary large-cell neuroendocrine carcinoma of the prostate has been reported. Prostate needle biopsy may omit neuroendocrine carcinomas. In low-grade prostate cancer, especially diagnosed by needle biopsy, the inclusion of neuroendocrine markers is recommended to exclude neuroendocrine tumours. A broad panel of immunohistochemistry markers, including E-26 transformation- specific related gene (ERG), can rule out metastatic neuroendocrine carcinomas of the prostate.

Introduction. Worldwide, cardiovascular diseases represent the first cause of morbidity and mortality. The genetic contribution in this pathology is heterogenous, and the microenvironment-genes interactions (mediated by epigenetic mechanisms) influence the prevalence of the diseases. The objective of the study was to find the micro ribonucleic acids (miRNAs) that alter gene expression in endothelial progenitor cells, to reveal the regulation mechanisms involved and to clarify the function of miRNAs in endothelial cell differentiation, that may facilitate the improvement of angiogenesis and stem cell-based therapies in cardiovascular disease. Material and methods. The differentiation of endothelial progenitor cells from amniotic fluid stem cells was done by using endothelial specific media, followed by characterization with Real-time PCR, flow-cytometry, LDL-uptake assay, and Matrigel network formation. PCR array was used to analyse the expression of 84 miRNAs to identify molecular markers for certain stem cells and/or specific stem cell differentiation processes. Results. The results obtained using PCR array technique showed a significantly increased expression for miRNA-106b-5p, miRNA-155-5p, miRNA-126-3p, miRNA- 22-3p and a decrease in miRNA-let7e-5p expression, miRNA125a –5p, miRNA-125b-5p, miRNA-92a-3p. Conclusions. Upregulation or antagonization of certain circulating miRNAs may represent promising therapeutic strategies in the cardiovascular diseases management. Furthermore, establishing the role of circulating miRNAs as biomarkers and independent predictors of cardiovascular disease outcome, correlated with the medical and surgical treatment, could improve the patients’ lifespan.

The digital transformation of healthcare services is a hot topic during the coronavirus disease 2019 (COVID-19) pandemic. To limit the spreading of the severe acute respiratory coronavirus 2 (SARS-CoV-2), in a short period of time an accelerated digitalization took place in many societies. The direct, physical interaction between doctors and patients was replaced by digital types of communication and examination, to avoid the patients’ exposure to the risk of infection in healthcare facilities or during their travel to hospitals or medical offices. Telemedicine was introduced as an alternative option, being reimbursed for consultations and remote monitoring of patients with different pathologies. The role of the digital healthcare services when the pandemic will end and will eventually, transform in endemic in certain areas and populations is unclear now.

Introduction. Herpes simplex virus type 2 (HSV-2) is recognized as one of the most common causes of aseptic meningitis, that is also a well-known complication of genital herpes. We report a case of recurrent HSV-2 meningitis without genital lesions, but with simultaneous skin lesions that were a clue for diagnosis. Case presentation. A 21-year-old man had two episodes of aseptic meningitis in 2019 and 2021, respectively. During both episodes, the neurological manifestations were preceded by recurrent herpetic skin lesions on the right arm. HSV-2 deoxyribonucleic acid (DNA) was detected in the spinal fluid only in the first episode. However, due to the possibility that the lesions and simultaneous episodes of meningitis were caused by HSV-2, systemic acyclovir was initiated. Each time, the treatment was followed by rapid symptoms’ resolution. After the second episode, the patient was put on indefinite suppressive therapy with valacyclovir. Conclusions. Recurrent skin lesions can suggest the probability of HSV-2 etiology of concomitant meningitis and justify the initiation of acyclovir. In all confirmed meningitis cases with HSV-2, counseling on this genital infection and the possibility of sexual spread should be considered.