Vol 30, No 1 (2026): SURGERY

Relevance. Post-infarction aneurysm of the left ventricle significantly reduces the length and quality of life of patients. The results of comparisons of different methods for surgical restoration of the left ventricle are ambiguous and often contradictory, complicating the choice of an effective treatment strategy and the ability to objectively assess the survival prospects of such patients. The aim of the meta-analysis is to assess the one-year survival of patients after surgical reconstruction of the left ventricle, to determine the functional class of heart failure, and to study the morphological and functional characteristics of the heart. A comparative analysis of the results of the meta-analytic assessment of patient survival after left ventricle reconstruction using the DOR (SAVER) method will be performed in comparison with other treatment methods. Materials and Methods. As a result of a systematic search in two specialized databases (PubMed, Google Scholar), 1,875 articles were selected. A total of 15 studies were included in the final analysis. The total number of patients in these studies was 1,089. To objectify the assessment of the effectiveness of different surgical approaches, two patient groups were formed. The first group underwent only surgical reconstruction of the left ventricle using the Dor procedure or surgical anterior ventricular endocardial restoration (SAVER); the second group received other methods of surgical ventricular reconstruction, depending on the surgical feasibility. Results. The mean age of the examined patients was 62.1 (95% CI: 60.2-64.1) years. The study included 56% (95% CI: 42-69) men. Anterior aneurysm occurred in 87% (95% CI: 74-99) of patients. The mean EuroSCORE value corresponded to 9.7% (95% CI: 7.3-12.1). Before the operation, the patients had a high functional class of heart failure according to NYHA [3 functional class (95% CI: 2.82-3.1)], low left ventricular ejection fraction [31.3% (95% CI: 29.2-33.3)], dilation of the heart chambers [EDVI - 131.7 mL/m2 (95% CI: 113.1-150.2)]. Meta-analysis of the difference in mean values of ejection fraction in patients before and 1 year after surgery showed an increase of 10.1% (95% CI: 8.01-12.1, p < 0.001). Meta-analysis of the difference in mean values of EDVI and NYHA functional class of heart failure in patients before and 1 year after surgery showed a decrease of 38.8 ml/m2 (95% CI: 28.1-49.6, p < 0.001) and 1.52 (95% CI: 1.3-1.8, p < 0.001), respectively. Conclusion. The meta-analysis showed that one year after surgery, survival rates are 94%, with statistically significant increases in ejection fraction and decreases in functional class of heart failure according to the NYHA scale. The studies did not reveal significant differences in patient survival and clinical outcomes one year after operations performed using different surgical methods. The results indicate the effectiveness of left ventricular surgical reconstruction, providing prolonged improvement in patients’ functional status. However, it should be noted that there was significant heterogeneity among the studies.

Relevance. Globally, there are now 32.53 million hernia cases, up from about 23.92 million during the previous 3 decades. Many authors lack statistical knowledge, which could jeopardize healthcare. The aim was to use artificial intelligence as a statistical technique to assess the potential effects of AdhesixTM self-gripping mesh implants, HertraTM mesh implants, and LintexTM glue-fixed mesh implants on the outcomes of inguinal hernia patients who underwent open inguinal hernia repair in Lichtenstein. Materials and Methods. We performed 120 Liechtenstein-compliant inguinal hernia repair procedures on three evenly split patient groups (n = 40) using AdhesixTM, HertraTM, and LintexTM mesh implants. The parameters for comparison were the time-frame of the procedure, hospital-stays, challenges afterwards surgery, and issues that arose during the brief follow-up. Results and Discussion. Patients of the first group were hospitalized for shorter periods of time than those in the second and third groups (group A-4.9 bed /day, group B-4.9.5 bed /day, and group C-4.95 bed /day), with no statistically significant differences. Patients in the first group experience a significantly shorter procedure time, followed by those in the second and third groups (27.8 min, 31.4 min, and 38.9 min respectively). Unlike the third group, which included 3 patients with postoperative discomfort and 1 with postoperative seroma formation, the first and second groups’ postoperative hospitalization stays were free of complications. In contrast to the third group’s 2 patients who experienced mesh migration and hernia recurrence, the first and second groups’ patients experienced no complications during the short-term follow-up. Conclusion. Compared to LintexTM mesh implants, the operative times using AdhesixTM and HertraTM are significantly shorter with no post-operative complications or hernia recurrence.

Relevance. Postoperative ventral hernias (POVH) remain a significant surgical challenge, characterized by remodeling of the musculoaponeurotic layer of the anterior abdominal wall and loss of functional integrity. Computed tomography (CT) texture analysis enables an objective assessment of tissue microarchitecture, facilitates the identification of structural changes, and optimizes preoperative planning and surgical decision-making. Aim. To evaluate structural changes in the musculoaponeurotic layer of the anterior abdominal wall in healthy individuals and patients with W2 and W3 POVH using texture analysis, identify intergroup differences, and determine the topographic-anatomical characteristics of affected tissues. Materials and Methods. This study included 90 patients (30 without hernias, 30 with W2-POVH, 30 with W3-POVH) examined between 2020 and 2024. All patients underwent multislice computed tomography (MSCT), and axial slices were segmented using Roboflow. The resulting masks were analyzed for texture characteristics, including brightness (mean_gray), contrast (contrast), correlation (correlation), kurtosis (kurtosis_gray), skewness (skewness_gray), standard deviation (std_gray), LBP, wavelet analysis, and gabor filtering. Statistical analysis included ANOVA, the Kruskal-Wallis test, and Tukey’s post-hoc analysis. Results and Discussion. Texture analysis revealed significant differences in Wavelet and Gabor response (p < 0.0001). Group 2 exhibited marked structural alterations, while Groups 1 and 3 demonstrated similar tissue characteristics (p > 0.05), suggesting adaptive remodeling in patients with severe hernia defects. Further, Group 2 showed significant changes in contrast (p < 0.0001), correlation (p < 0.0001), and kurtosis (p = 0.001), while brightness (mean_gray) and homogeneity (homogeneity) did not differ significantly (p > 0.05). Conclusion. The most pronounced structural disorganization was observed in W2-POVH patients, indicating morphofunctional instability. In contrast, W3-POVH patients exhibited adaptive changes, suggesting compensatory remodeling. These findings confirm the progressive nature of morphological changes in POVH and highlight the importance of texture analysis for personalized surgical planning.

Relevance. Monomorphic maculopapular cutaneous mastocytosis (mMPCM) is a rare and diagnostically challenging form of cutaneous mastocytosis, often mimicking other pigmentary and papular dermatoses. The increasing incidence of mMPCM and the complexity of its differential diagnosis underscore the need for effective, non-invasive diagnostic methods. The aim of the study was to evaluate the dermoscopic features of mMPCM and compare them with findings from optical coherence tomography (OCT) and histopathological criteria, aiming to establish a non-invasive diagnostic algorithm. Materials and Methods. The study included 30 patients aged 14-30 years with mMPCM, observed at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Russia from 2022 to 2024. All patients underwent clinical examination, dermoscopy, and, in selected cases, OCT imaging. Dermoscopic and OCT findings were systematically compared with histopathological results from skin biopsies. Results and Discussion. Dermoscopic examination of mMPCM lesions revealed increased yellow-brown pigmentation, preservation of skin appendages, unchanged vellus hairs, pigment pseudonetwork, and a weakly expressed asymmetric vascular pattern. Darier’s sign was more frequently detected under dermoscopy than on clinical examination. OCT imaging visualized clusters of mast cells as round or oval low-intensity signal zones, most often located in the reticular dermis, corresponding to histological mast cell infiltrates. The combination of dermoscopy and OCT allowed differentiation of mMPCM from other subtypes of cutaneous mastocytosis based on the depth and distribution of infiltrates. Notably, non-invasive methods provided valuable information for diagnosis and monitoring, reducing the need for routine biopsies. Conclusion. Integrating dermoscopy and OCT into the diagnostic workflow for mMPCM offers informative, non-invasive alternative to traditional histopathology, facilitating early and accurate diagnosis as well as monitoring of disease dynamics and therapeutic efficacy. This study is among the first to systematically compare dermoscopic and OCT findings with histopathological features in mMPCM, highlighting the unique diagnostic potential of these non-invasive techniques for rare forms of cutaneous mastocytosis.

Relevance. It is been currently known that viruses rewire the metabolic machinery host’s cell to promote successful viral replication via reprogramming host energy flows, resource, metabolic tools and further, the reorganization of cellular structures. Recent studies indicate that the human immunodeficiency virus significantly reduces the number of peroxisomes in infected cells. However, there is still no clear understanding of the reasons for this apparent HIV intervention. The aim of the study was to confirm the hypothesis about the causes of the decrease in the number of peroxisomes in HIV infection. In this study, changes in several hematological markers of peroxisomal metabolism were assessed in connection with data on the unique role of these organelles in the catabolism of the amino acid L-lysine, the level of which correlates with the level of viral RNA in the blood plasma of HIV-infected individuals. Materials and Methods. A study was conducted on the levels of total cholesterol, catalase, L-lysine, and its derivative L-carnitine among HIV-infected individuals (controllers and patients with rapidly progressive disease) in comparison with similar indicators in cohorts of HIV-infected patients and healthy individuals. Results and Discussion. The study confirms the presence of significant differences in plasma levels of markers associated with peroxisomal metabolism, such as catalase, cholesterol, and the amino acid L-lysine, in the compared groups of HIV controllers and patients with rapidly progressing disease. The most negative changes in peroxisomal markers were detected among patients with accelerated HIV disease progression and, to a lesser extent, in individuals from the overall cohort. Conclusion. The results of this study indicate that HIV interference with host peroxisome biogenesis is accompanied by a concomitant dysregulation of peroxisomal enzyme systems and L-lysine-related substrates. Virus-induced reprogramming of the catabolism of this essential amino acid indirectly confirms the hypothesis of a key role of L-lysine in the HIV life cycle and is a factor in the successful implementation of the reproductive strategy of the human immunodeficiency virus.

Relevance. The excessive use of antibiotics is a public health issue that has hampered poor and middle-income nations and is linked to rising healthcare expenses and antimicrobial resistance, which is regarded as an important risk to world health. In addition, resistance raises expenses, prolongs hospital stays for patients, and causes mortality. Defined daily dose (DDD) represents the average adult daily maintenance dose of a specific drug applied according to its primary indication. Antibiotic use density is expressed as defined daily doses/ 100 patient-days. Aim. The aim of this study is to evaluate the pattern of usage of antibiotics and to find out antibiotic use density in trauma intensive care unit (ICU). Materials and Methods. In this prospective observational study prescription data of 100 consecutive patients at admission into the trauma ICU was audited. Patients of all age of either gender admitted in the trauma ICU during the study period, which have been prescribed with antibiotics. The study was conducted over a period of eight months from August 2022 March 2023. During this period, all the included patients were followed up for their entire duration of stay in trauma ICU. Results and Discussion. The prescriptions of 100 consecutive patients admitted into the ICU were analyzed. On analyzing comorbidities it was noted that 79% were affected with contusions in brain/ intracerebral hemorrhage/ subdural hematoma followed by 5% with pnumothorax. According to DDD/100 bed days in our study piperacillin+tazobactam (10.64), cefoperazone+sulbactam (5.21), amikacin (7.5), vancomycin (3.2) and linezolid (3.2) were most consumed drugs in trauma ICU patients. Conclusion. Present study results conclude that overuse of antibiotics can cause antibiotic resistance, increased duration of stay in hospitals and reason of mortality.