Ukrainian Journal of Perinatology and Pediatrics

Clinical case of hyperfibrinolysis in a patient with biliary atresia

L.I. Faryna, M.V. Holovatiuk, D.S. Diehtiarova, O.S. Godik — Sat, 28 Mar 2026 00:00:00 +0200

Aim - to highlight the issues of diagnosis and treatment of hyperfibrinolysis in the postoperative period in a patient with biliary atresia.

Clinical case. Patient D., diagnosed with a congenital liver malformation, biliary atresia type 3 according to Kasai, underwent laparotomy with intraoperative cholangiography and portoenterostomy on a Roux loop (Kasai procedure). On the 6^th postoperative day, the patient presented with hemorrhagic impurities in the stools. Laboratory tests revealed a decrease in hemoglobin to 65 g/l. Endoscopy did not reveal the source of bleeding. Rotational thromboelastometry (ROTEM) detected hyperfibrinolysis. The patient was prescribed tranexamic acid in a loading dose of 10 mg/kg and a maintenance dose of 2.5 mg/kg/h. The results of a follow-up ROTEM revealed the effectiveness of tranexamic acid which was manifested by a decrease in maximum lysis in the EXTEM pathway. By the eighth day after the surgery, the patient's general condition had stabilized and he was transferred to the emergency surgery department.

Conclusions. Considering the features of the coagulation and fibrinolytic systems, in pediatric patients with liver failure, it is necessary to correct the hemostasis system disorders based on the results not only of standard (international normalized ratio, prothrombin time, activated partial thromboplastin time, fibrinogen) and specific (D-dimer, antithrombin III) coagulation parameters, but with using viscoelastic methods (ROTEM). The integration of the latter allows for timely intervention in the treatment strategy and improves its outcomes.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the child's parents to participate in the study.

The authors declare no conflict of interest.

The impact of stress induced by military conflict on morbidity level and adaptive capacity in children (аnalysis of current research data)

L.V. Kvashnina, I.M. Matviyenko, I.S. Maydan, T.B. Ignatova, L.A. Lutsenko — Sat, 28 Mar 2026 00:00:00 +0200

The active military conflict in Ukraine have developed an unprecedented humanitarian crisis, leading to mass displacement of the population not only within the country, but also beyond its borders. And the most vulnerable group from these refugees are children: chronic psychosocial stress has a systemic impact on the child's immature body what is leading to disrupt homeostasis and deplete adaptive reserves.

Aim - to analyze current scientific data on the impact of stress during open military conflict on key indicators of children's health: morbidity, cardiovascular and autonomic nervous system function, sleep quality, and psycho-emotional state.

Chronic psychosocial stress has been shown to have a systemic impact on the immature child's body, disrupting homeostasis and depleting adaptive reserves. Numeral meta-analyses demonstrate high levels of mental disorders and psychopathology in conflict’s victims, internally displaced persons, and refugees. Due to military conflicts in the world, about 10% of people who were involved in these events will have serious mental health problems in the future, and another 10% of people will have behavioral changes that will interfere with rational and effective functioning in society. All of these data, obtained in military conflict zones in other countries and regions, can be confidently extrapolated to the situation with Ukrainian children, which indicates the urgent need to implement screening programs and medical and social assistance for this category of children.

Conclusions. War stress and deprivation in childhood significantly increase the risk of development of cardiovascular and metabolic diseases in adulthood. The consequences of military conflict for children do not finish with the advent of peace. They form a “vicious cycle”: trauma leads to poor health and reduced educational achievement, and low socio-economic status in adulthood, which is a powerful risk factor for disease and premature mortality. Helping children in war is not only a humanitarian task, but also an investment in the long-term health and well-being of an entire generation.

The authors declare no conflict of interest.

Demographic crisis in Ukraine from the perspective of public health

O.E. Kolomiichuk, S.O. Dubrov — Sat, 28 Mar 2026 00:00:00 +0200

Aim - to analyze the transformation of the demographic situation in Ukraine in the pre-war period and after the onset of the war; to substantiate directions of state policy in the field of public health capable of reducing barriers to the realization of reproductive rights and contributing to the restoration of the population’s reproductive potential.

The transformation of the demographic situation was analyzed with an emphasis on the loss of, and opportunities for restoring, the reproductive potential of the population. It was substantiated that the decline in the birth rate under wartime conditions is not an isolated behavioral phenomenon, but rather the result of interrelated factors: forced migration, destruction of the infrastructure of healthcare facilities, deterioration of access to sexual and reproductive health (SRH) services, psychosocial stress, gender-based violence (GBV), and worsening social determinants of health. It was shown that the demographic crisis is exacerbated by excess mortality and disability among men of working age, territorial separation of partners, a decline in the number of women of reproductive age, and reduced household capacity to realize reproductive plans, which creates long-term risks for the reproductive potential of the population. Based on a comparative analysis of the experience of France, Poland, and Israel, it was demonstrated that a positive demographic effect in post-crisis and post-war conditions is achieved not through isolated financial incentives, but through a coordinated package of intersectoral policies. Priorities for Ukraine were proposed: transition from a natalist model to a model focused on reducing barriers to conscious parenthood; ensuring continuity of SRH and perinatal medical services; integration of mental health into SRH pathways; strengthening the system of response to GBV; development of assisted reproductive technology programs, including services for male and female veterans; consideration of the environmental consequences of war and the impact of social determinants; and services to support families at the community level.

Conclusions. From a public health perspective, sustainable demographic recovery is possible only through the combination of medical, social, housing, security, and economic interventions aimed not at mechanically stimulating birth rates, but at restoring the reproductive potential of the population.

The authors declare no conflict of interest.

Features of sensitization and clinical course of atopic dermatitis in children during the war in Ukraine

Sat, 28 Mar 2026 00:00:00 +0200

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, which affects 15% to 20% of children and 5% to 20% of adolescents. One of the key factors influencing the clinical course of AD and the further prognosis of the disease in children is sensitization to allergens, which can be specific trigger factors. War conditions impose significant additional risks regarding the development of sensitization and the severity of the disease.

Aim - to investigate the features of the clinical course and sensitization profile in children with AD during the war in Ukraine.

Materials and methods. A retrospective analysis of medical records of 62 children aged 5-17 years with a diagnosis of AD was conducted. Children were divided into two groups: before the war (group I, n=30), and after its onset (group II, n=32). The following parameters were analyzed: gender, age, severity of AD, sensitization profile, presence of concomitant diseases.

Results. Among the patients in group II, a significant decrease in the number of children with mild AD was observed, along with a tendency toward an increase in patients with moderate-severe disease (20.0% versus 40.62%). Furthermore, concomitant bronchial asthma was significantly more prevalent in this group (20.0% versus 52.0%). Sensitization to common allergens was determined in both groups with a tendency to an increase in sensitization to «internal» aeroallergens (house dust mites and mold) in children of group II, which was associated with the established unsatisfactory condition of bomb shelters.

Conclusions. The results indicate a deterioration in the course of AD in children during the war in Ukraine, an increase in cases of AD with concomitant asthma, an increase in the frequency of sensitization to aeroallergens of the «indoor environment», which may be associated with the unsatisfactory condition of bomb shelters. The obtained data indicate the need for further scientific research on the study of risk factors associated with the war in Ukraine.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

The authors declare no conflict of interest.

The effectiveness of intravenous administration of iron sucrose to parturient women with iron metabolism disorders after abdominal delivery

Iu.V. Davydova, A.Yu. Lymanska, O.M. Kravets, Iu.V. Landyak — Sat, 28 Mar 2026 00:00:00 +0200

Aim - to evaluate the effectiveness of treatment of iron metabolism disorders with iron sucrose in case of increased blood loss during cesarean section.

Materials and methods. The study included 156 women aged 22-38 years with an initial hemoglobin level of 92-105 g/l and intraoperative blood loss of 650-850 ml (≈0.6-0.8% of body weight). Of these, 62 women with hemoglobin in the 3^rd trimester of pregnancy 88-99 g/l (Group I), 62 women with hemoglobin 100-105 g/l (Group II). All women in groups I and II were administered iron saccharate (Sufer, Yuriya-Pharm) in the early postoperative period, Group III consisted of 32 parturient women with hemoglobin 88-99 g/l, who were prescribed ferrous sulfate 200 mg Fe²⁺ daily for 14 days.

Results. According to the fatigue assessment, women in all groups felt fatigue after abdominal delivery. In Group II, the fatigue index on day 2 was much lower than in Groups I and III. A rapid recovery of hemoglobin and ferritin was observed in Groups I and II 48 hours after drug administration, but the indicators of Group II reflected a faster rate of recovery of iron metabolism in contrast to the retention of increased fatigue in women in Group III, which lasted longer and was more pronounced.

Conclusions. Early use of intravenous iron sucrose in combination with anemia and moderate blood loss after cesarean section promotes accelerated recovery of hemoglobin and iron stores, reduces clinical manifestations of posthemorrhagic syndrome and reduces the frequency of blood transfusions.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Evaluation of the application of the intensive neurophysiological rehabilitation system in children with nervous system disorders who lived in regions affected by hostilities

Yu.G. Antypkin, L.G. Kyrylova, O.O. Miroshnykov, A.M. Kuzan — Sat, 28 Mar 2026 00:00:00 +0200

Factors of prolonged martial law in Ukraine significantly worsen the condition of children with neurological disorders, making it relevant to evaluate the effectiveness of rehabilitation systems in this vulnerable group.

Aim - to evaluate the application of the Intensive Neurophysiological Rehabilitation System (INRS) according to the method of Academician V.I. Kozyavkin in children with neurological disorders from Ukrainian regions affected by hostilities, through the analysis of changes in gross motor functions, muscle tone, and psycho-emotional state.

Materials and methods. A retrospective analysis of 257 discharge summaries from medical records of children aged 1–18 years who underwent a course of INRS from January to October 2025 was conducted. The included children had diseases of the nervous system and resided in regions affected by hostilities. Descriptive statistics, Gross Motor Function Classification System (GMFCS), Modified Ashworth Scale for muscle tone assessment, Manual Ability Classification System (MACS), as well as evaluations of psycho-emotional state and speech were used.

Results. Overall clinical improvement was recorded in 96.9% of children (249 out of 257) with an average course duration of only 10 days. Reduction of muscle tone was observed in 71.2%, increase in the range of active movements - in 74.3%, and improvement of gross motor functions - in 41.2% of patients. Improvement in speech and psycho-emotional state was noted in 36.6% of children. This study enabled the evaluation of the Intensive Neurophysiological Rehabilitation System (INRS) specifically in a cohort of children who lived in areas affected by military actions.

Conclusions. The Intensive Neurophysiological Rehabilitation System according to the method of Academician V.I. Kozyavkin contributes to the recovery of motor, cognitive, and psycho-emotional functions in children with organic lesions of the central nervous system under conditions of prolonged military stress. The results substantiate the need to expand access to INRS for children from affected regions and to include this method in the standards of rehabilitation for children with nervous system disorders in conditions of martial law.

The authors declare no conflict of interest.

Relationship between PAPP-A levels, placental morphometric parameters, and perinatal outcomes in pregnant women with fetoplacental insufficiency

U.M. Siracli — Sat, 28 Mar 2026 00:00:00 +0200

Fetal growth restriction (FGR) and fetoplacental insufficiency (FPI) are major complications of pregnancy associated with adverse perinatal outcomes. Pregnancy-associated plasma protein A (PAPP-A) and placental morphometry have been proposed as potential predictors of fetal growth and neonatal health.

Aim - to evaluate the relationship between first-trimester PAPP-A, placental morphometry, and neonatal outcomes in pregnancies complicated by FPI and FGR, and to assess their predictive value for monitoring intrauterine growth.

Materials and methods. A prospective cohort study was conducted between 2023 and 2025. The study included 42 deliveries from women aged 20-40 years with FPI and FGR. Maternal and neonatal data were collected. Placental morphometry and PAPP-A were analyzed for correlation with neonatal outcomes. Statistical analyses included mean ± standard deviations, ranges, 95% confidence intervals, t-tests, analysis of variance (ANOVA), and Pearson/Spearman correlation coefficients.

Results. Gestational age ranged from 30⁺⁴ to 40⁺⁶ weeks. Preterm deliveries (<37 weeks) were less frequent and associated with lower birth weight (LBW) and Apgar scores. The mean birth weight was 3280±417 g, mean neonatal length 50.8±2.9 cm, mean placental volume 70.9±36.5 cm³, and mean PAPP-A 0.92±0.70 MoM. Reduced PAPP-A (<0.5 MoM) was associated with LBW (<2900 g) and smaller placental volume, whereas elevated PAPP-A (>1.5 MoM) corresponded to higher birth weight (>3700 g) and larger placental volume. PAPP-A positively correlated with birth weight and placental volume. Increased placental volume was also associated with greater neonatal length and mass.

Conclusion. PAPP-A levels and placental morphometric characteristics are significant predictors of fetal growth and neonatal outcomes in pregnancies complicated by FPI and FGR.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the patients was obtained for conducting the studies.

The author declares the absence of conflict of interests.

Conceptual model of an infection prevention and control program at the health facility level: prospects for integrating programs and health services

A.V. Aleksandrin — Sat, 28 Mar 2026 00:00:00 +0200

The existence of a functional infection control program is one of the strategic directions of the global strategy for infection control of the World Health Organization. The invasion of the Russian Federation in Ukraine has created new challenges for health care facilities, in particular the destruction of infrastructure and has exacerbated the issue of antimicrobial resistance. To address these complex challenges, the recommended models for building a program on IPC at the level of health care facilities are not fully satisfactory

Aim - the development, scientific substantiation and coordination of key structural components of the conceptual model of the IPC program in healthcare institutions in Ukraine.to study the prerequisites for the creation, scientific substantiation and coordination of key structural components of the conceptual model of the national IPC program in Ukraine.

Materials and methods. The study was conducted in 2024-2025 using systemic, bibliosemantic, sociological and expert-analytical approaches. At the first stage, a review of international and national sources was carried out to analyze modern approaches to building IPC systems. The second stage included 20 in-depth interviews with national experts, which allowed to clarify the context of the development of IPC programs in healthcare institutions and determine their structural elements. The third stage involved a questionnaire survey of 116 specialists using the expert consensus method (agreement threshold ≥75%).

Results. It was found that existing models do not take into account the specific challenges of Ukraine, including water supply, sanitation, energy supply and antimicrobial resistance. A four-level conceptual model of the IPC was formed: 1) water supply, sanitation and hygiene; 2) standard measures; 3) additional measures; 4) integrated antimicrobial stewardship program. The model was supported by more than 80% of the surveyed experts.

Conclusions. Based on the results of the work, it was possible to formulate and substantiate a conceptual model of the IPC program in healthcare facilities in Ukraine, which includes structural levels: Water supply, sanitation and hygiene; Standard infection control measures; Additional infection control measures; Antimicrobial stewardship program.

The authors declare no conflict of interest.

Etiological factors of the formation of retrochorial hematomas in the first trimester of pregnancy

T.G. Romanenko, L.Y. Staselovych, H.M. Zhaloba — Sat, 28 Mar 2026 00:00:00 +0200

Aim - to establish the etiological factors of the formation of RCH in the first trimester of pregnancy in order to reduce the frequency of their occurrence.

Materials and methods. Clinical observation was conducted in 164 pregnant women (main group, МG) with RCH who were undergoing examination and treatment and 48 pregnant women (control group, CG) who did not have RCH in the first trimester of pregnancy, for the period from 2022 to 2024. A clinical and statistical analysis of somatic, gynecological and reproductive anamnesis was conducted in 212 pregnant women to clarify the etiological factors of the development of RCH in them; the following anamnesis was collected: reproductive, gynecological, somatic, thrombotic (personal and family).

Results. Among 212 pregnant women, infertility was detected in 45 (21.2%): in 38 (23.2%) in pregnant МG and in 7 (14.6%) in CG. Early pregnancy loss was significantly more often noted in the anamnesis in pregnant МG - 26 (15.8%) cases versus 4 (8.4%) in CG. Uterine leiomyoma was significantly more often observed in pregnant МG - 15 (9.1%) cases versus 3 (6.3%) in CG; the frequency of chronic endometritis in pregnant women in the МG was 40 (24.4%) cases versus 5 (10.4%) cases in the CG, which is significantly lower. The high frequency of uterine cavity wall scraping in the anamnesis in both studied groups - in 86 pregnant women (52.4%) in the МG and in 11 pregnant women (22.9%) in the CG. Weight and body mass index (BMI) were significantly lower in pregnant МG.

Conclusions. The etiological factors of retrochorial hematomas were: antiphospholipid syndrome in 11.6% of cases, congenital thrombophilia in 16.5% of cases, infectious-inflammatory factor in 53.7% of cases, uterine developmental anomalies in 2.4% of cases, unspecified causes in 15.8% of cases.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work.

The authors declare no conflict of interest.

Endometrial polyps: impact on reproductive function and clinical aspects

A.J. Parvana — Sat, 28 Mar 2026 00:00:00 +0200

Endometrial polyps (EP) are among the most common benign intrauterine lesions and may significantly affect female reproductive function. Despite their prevalence, clinical features, impact on fertility, and optimal management strategies remain insufficiently studied, particularly in postmenopausal women.

Aim - to evaluate the influence of EP on reproductive function and to assess their clinical characteristics, localization, and management in women of reproductive and postmenopausal age.

Materials and methods. A prospective comparative clinical study was conducted, involving 114 women aged 20-70 years with histologically confirmed EP. The Control group included 54 healthy women of reproductive age. Diagnostic methods included transvaginal ultrasound (TVUS), sonohysterography, and office hysteroscopy with targeted biopsy. Polypectomy was performed using mechanical or electromechanical resection techniques.

Results. Office hysteroscopy demonstrated high diagnostic and therapeutic efficiency, allowing removal of small EP (<20 mm) in outpatient settings, while larger EP required in-hospital electromechanical resection. Most EP were single (76.8%), small to medium-sized (≤2 cm, 79.3%), and localized mainly on the posterior and lateral uterine walls. Histologically, EP were predominantly glandular-fibrous (59.8%) or glandular (37.8%), with 2.4% being adenomatous (atypical). The majority of postmenopausal EP were asymptomatic (67.1%). No significant intraoperative complications were reported. Organ-preserving surgical techniques were effective and safe, with polypectomy success rates exceeding 96%.

Conclusions. EP in postmenopausal women are often asymptomatic, highlighting the importance of early detection via TVUS and hysteroscopy. Office hysteroscopy enables minimally invasive, effective treatment of small EP, whereas larger EP require electromechanical resection. A combined imaging and histological evaluation optimize patient management, reduces the risk of recurrence, and supports preservation of reproductive and gynecological health.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the patients was obtained for conducting the studies.

The author declares the absence of conflict of interests.

Vascular growth factors as diagnostic markers of preeclampsia severity and duration of pregnancy prolongation in women giving birth for the first time

А.V. Chernov, А.V. Serbeniuk — Sat, 28 Mar 2026 00:00:00 +0200

Aim - to determine the role of vascular growth factors in the development and progression of preeclampsia (PE) in women giving birth for the first time, to optimize obstetric tactics in this category of pregnant women.

Materials and methods. 101 pregnancy histories from 28 to 40 weeks in women with preeclampsia giving birth for the first time were analyzed. Group I - 40 pregnant women with moderate preeclampsia, group II - 36 pregnant women with severe preeclampsia, control group (CG) - 25 pregnant women the physiological course of this pregnancy. The study of the content of sFlt-1 (soluble FMS-like tyrosine kinase-1), PlGF proteins (placental growth factor) and soluble endoglin (Seng) was carried out by the method of immuno-enzyme analysis.

Results. In group I pregnant women, the level of sFlt-1 was 36124.6±4820.2 pg/ml, which is significantly lower than in group II pregnant women - 54826.4±442.2 pg/ml and significantly higher than in group II pregnant women - 3299.4±144.2 pg/ml, respectively. The level of sEng in groups I and II was significantly higher than in CG 69940±1234.2 pg/ml, 92580±1784.4 pg/ml versus 5440±684.6 pg/ml, respectively. The level of endoglin in group I was 69940±1234.2 pg/ml, significantly lower than that of pregnant women in group II - 92580±1784.4 pg/ml. The level of PlGF in group I was 64.8±4.6 pg/ml and group II was 48.2±4.2 pg/ml, significantly lower than that of CG - 428.8±46.2 pg/ml. In group I, the level of PlGF was 64.8±4.6 pg/ml, significantly higher than that of group II - 48.2±4.2 pg/ml. The angiogenic coefficient (sFlt-1/PlGF) from 28 to 34 weeks in group I is 557.47±42.8, which is significantly lower than group II - 1137.47±62.2 and significantly higher than СG - 7.69±2.2.

Conclusions. For pregnant women with preeclampsia who give birth for the first time, the development of an imbalance of angiogenic growth factors with a predominance of antiangiogenic and a deficiency of proangiogenic agents is characteristic. With high values of the sFlt-1/PlGF ratio, it is not possible to prolong pregnancy for a long time due to the progression of PE and/or deterioration of the fetal condition.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper.

The authors declare no conflict of interest.

Calcium and ıron metabolism in children with major beta-thalassemia

G.E. Hamidova, G.I. Azizova, I.J. Shahverdiyeva, G.A. Jafarova — Sat, 28 Mar 2026 00:00:00 +0200

Beta-thalassemia major (β-TM) is an inherited blood disorder characterized by ineffective erythropoiesis and chronic anemia, which often necessitates blood transfusions. Beyond iron overload, disturbances in calcium and phosphorus metabolism contribute significantly to skeletal complications in these patients.

Aim. This study investigates the relationship between iron and bone metabolism markers in children with β-TM to optimize the correction of iron overload and related complications.

Material and methods. A cohort of 30 children aged 6-11 years with β-TM, receiving regular blood transfusions, was compared to 25 age-matched healthy controls (control group). Blood samples were analyzed for markers of calcium and phosphorus metabolism, including serum calcium, phosphorus, vitamin D, and fibroblast growth factor 23 (FGF-23) levels, along with iron metabolism markers such as ferritin, hepcidin, and ferroportin.

Results. Significant findings include elevated serum ferritin and iron levels in β-TM patients, along with a decrease in hepcidin (p<0.001). Vitamin D deficiency (p<0.001) was observed, correlating with increased FGF-23 levels (p<0.05). These findings suggest a reciprocal relationship between calcium and phosphorus, and iron metabolism in β-TM.

Conclusion. The results highlight the critical interplay between iron and bone metabolism in β-TM. FGF-23 could serve as a key marker for bone metabolism disturbances, and the regulation of hepcidin and ferroportin may offer insights into managing iron overload and related complications.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the patients was obtained for conducting the studies.

The authors declare no conflict of interest.

Polymorphism of the LEPR gene in children with hypothalamic obesity

O.V. Bolshova, M.O. Ryznychuk, T.M. Malinovska, D.A. Kvachenyuk — Sat, 28 Mar 2026 00:00:00 +0200

Childhood obesity is a complex multifactorial condition that develops under the influence of genetic, epigenetic, and environmental factors. Leptin, a hormone produced by adipocytes, plays a crucial role in the regulation of energy balance and exerts its effects through the leptin receptor (LEPR), which is primarily expressed in the hypothalamus.

Aim - to evaluate the impact of the LEPR gene Q223R (rs1137101) polymorphism on the risk of developing hypothalamic obesity in children.

Materials and methods. The study included 36 children with hypothalamic obesity aged 14.53 ± 2.24 years. Body weight, body mass index, and HOMA-IR index were assessed according to international standards. Genotyping of the LEPR Q223R (rs1137101) polymorphism was performed using the polymerase chain reaction followed by restriction fragment length analysis. Statistical processing was carried out in Microsoft Excel, calculating genotype and allele frequencies as well as odds ratios (OR).

Results. In children with hypothalamic obesity, the proportion of heterozygous A/G genotype was 1.6 times higher than in healthy children with normal nutritional status and no comorbidities (OR=2,89), while the homozygous A/A genotype occurred less frequently (OR=0,15). The G allele was more common in children with hypothalamic obesity (pG=0.5694), but the association was not statistically significant (OR=1.21). The genotype distribution conformed to Hardy-Weinberg equilibrium.

Conclusions. The LEPR Q223R (rs1137101) polymorphism is associated with an increased risk of hypothalamic obesity in children, particularly among carriers of the heterozygous A/G genotype. The G allele may serve as a potential genetic marker of susceptibility to energy homeostasis disruption in hypothalamic dysfunction. These findings emphasize the importance of considering the clinical context when interpreting the role of genetic variants in the pathogenesis of obesity.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies.

The authors declare no conflict of interest.

Modification of the Kasai portoenterostomy in biliary atresia and its impact on treatment outcomes

H.V. Kurylo — Sat, 28 Mar 2026 00:00:00 +0200

Biliary atresia (BA) is a severe progressive cholangiopathy of infancy that, without timely surgical treatment, leads to end-stage liver failure. Despite the widespread use of the Kasai portoenterostomy, postoperative cholangitis and other related complications remain the major causes of native liver loss.

Aim - to evaluate the impact of modified portoenterostomy (MPE) on surgical outcomes in patients with BA and to determine its clinical advantages with classical Kasai portoenterostomy (CPE).

Materials and methods. A retrospective non-randomized single-center study was conducted involving 63 patients with BA who underwent surgery at less than 60 days of age. CPE was performed in 24 patients and MPE in 39. Preoperative assessment included clinical and laboratory evaluation, ultrasound examination, liver biopsy, and intraoperative cholangiography. The incidence of postoperative cholangitis and bile leakage, duration of drainage, rate of bilirubin normalization, and native liver survival were assessed.

Results. The incidence of postoperative cholangitis was significantly lower in the MPE group than in the CPE group (1.3±0.6 vs. 2.1±0.8 episodes per patient). Bile leakage occurred less frequently after MPE (7.7% vs. 25.0%). Drainage duration was shorter in the MPE group (6.8±1.9 vs. 9.2±2.1 days). There was also a trend toward faster bilirubin normalization (54±9 vs. 62±10 days) and higher native liver survival (61.5% vs. 45.8%).

Conclusions. Modified portoenterostomy reduced the incidence of postoperative cholangitis and bile leakage, shortened drainage duration, and demonstrated a tendency toward improved long-term outcomes in patients with biliary atresia.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the specified institution. The informed consent of the patients was obtained from the patients’ parents.

The author declares no conflict of interest.

Changes in the psycho-emotional state of adolescents with acute respiratory infections during the war in Ukraine

I.O. Mityuryayeva-Korniyko, T.D. Klets, O.M. Odayskyi — Sat, 28 Mar 2026 00:00:00 +0200

Studying the correlation between the severity of acute respiratory infections (ARIs) and manifestations of psychological maladaptation in adolescents at the epicenter of military conflict is a strategically important task for developing integrated programs of medical and psychological support for this age group.

Aim - to determine the specific impact of long-term war-related stress on the course of acute respiratory infections (ARIs) in adolescents (aged 10-18) in Ukraine by assessing the frequency of prior recurrent respiratory infections (RRIs) and the severity of current symptoms.

Materials and methods. A total of 123 adolescents with ARIs were examined. The infectious history over the preceding year, current disease severity (WURSS-21 scale), bronchitis symptoms (BSS scale), and markers of stress disorders were analyzed. Statistical analysis was performed using non-parametric methods (Mann-Whitney U test, Spearman’s rank correlation (r), and Benjamini-Hochberg correction (P_{adj})).

Results. Psycho-emotional distress was identified in 92.6–100.0% of adolescents, regardless of their immunological history. The war factor obliterates the impact of past ARI frequency on patients' current psycho-emotional status (P_{adj}>0.05). However, a critical dependence on the severity of the current illness was established: moderate ARI was associated with a statistically significant increase in scores on the aggression and anger scales (P_{adj}=0.0052) compared to a mild course, indicating acute emotional decompensation. Correlation analysis confirmed a direct, moderate relationship between somatic symptoms and the destabilization of the emotional and sleep spheres: loss of appetite and eating disorders (r=0.491; p<0.001), as well as sputum production and abdominal pain (r=0.331; p<0.001).

Conclusions. In wartime conditions, acute respiratory pathology in adolescents acts as a biological detonator of latent distress, transforming a somatic problem into affective decompensation. The psychosomatic response exhibits a two-tier structure: the baseline level is a hidden somatized profile (irritability, sleep/eating disorders, headache). Under the influence of infectious intoxication and aggravated somatic status (moderate ARI, bronchitis), this latent pattern decompensates, triggering a phase of asthenic hyperexcitability (anger, aggression) with a risk of further development of post-viral depression.

The study was conducted in accordance with the principles of the Declaration of Helsinki.

The authors declare no conflict of interest.

Current trends in the teaching of pathomorphology in medical universities: a comparative analysis of Ukrainian and European educational standards

Sat, 28 Mar 2026 00:00:00 +0200

Pathomorphology remains a fundamental component of medical education, providing an essential understanding of the structural basis of disease and fostering clinical reasoning skills. In modern medical education in both Ukraine and Europe, curricula are being transformed in line with the principles of a competency-based approach, requiring revision of content, teaching methods, and learning formats. The relevance of this study lies in the need to harmonize Ukrainian educational standards with European frameworks, identify strengths and weaknesses of national medical training, and implement innovative technologies in the teaching of morphological disciplines. The COVID-19 pandemic and the ongoing war have accelerated the digital transformation of medical education, particularly through distance learning, virtual microscopy, interactive case studies, and simulation-based methods.

Aim - to conduct a comparative analysis of approaches to teaching pathomorphology in medical universities of Ukraine and the European Union, to assess the compliance of Ukrainian curricula with international standards, and to develop recommendations for modernization.

Comparative, content, expert evaluation, system-structural, and descriptive statistical methods were applied. European universities operate within clearly defined competency frameworks encompassing knowledge, practical skills, communication abilities, and clinicopathological integration. Digital pathology, simulation training, and e-learning platforms play a crucial role. In Ukraine, pathomorphology has a strong theoretical foundation, but limited integration of digital tools and practical training. The main challenges include excessive theoretical focus, lack of interactive learning, and absence of unified assessment criteria for practical skills.

Conclusions. Modernization of pathomorphology teaching in Ukraine should involve the introduction of virtual microscopy, creation of a national competency framework aligned with European standards, updating course content with molecular pathology and digital medicine, development of simulation technologies, and expansion of academic mobility. These steps will enhance medical education quality and promote integration of Ukrainian pathology schools into the European educational space.

The authors declare that there is no conflict of interest.

Methodological approaches to the prevention of preeclampsia in high-risk pregnant women in perinatal practice

Sat, 28 Mar 2026 00:00:00 +0200

Preeclampsia is one of the most common and severe complications of pregnancy, which makes a significant contribution to the structure of maternal and perinatal morbidity and mortality. Despite the improvement of clinical protocols for pregnancy management, the frequency of severe forms of preeclampsia remains consistently high, especially among high-risk pregnant women.

Aim - to substantiate and systematize modern methodological approaches to the prevention of preeclampsia in high-risk pregnant women for their implementation in the practice of perinatal institutions.

This study was based on the analysis of international clinical recommendations (FIGO, ACOG, NICE), national pregnancy management protocols, as well as the results of randomized clinical trials and meta-analyses published in leading professional publications over the past 10 years. The methods of systematic analysis, generalization and expert assessment were applied. Based on the analysis of international and national recommendations, a step-by-step algorithm of preventive measures is proposed, which is aimed at the early identification of risk groups, optimization of drug and non-drug prevention, as well as the reduction of adverse perinatal outcomes.

Conclusions. The proposed methodological approaches to the prevention of preeclampsia in high-risk pregnant women of high risk contribute to reducing the frequency of severe forms of the disease and improving perinatal outcomes. Early identification of risk factors and step-by-step prevention is an integral part of modern perinatal care.

The authors declare that there is no conflict of interest.