Medicni perspektivi

Ear and skull base paraganglioma: review of literature

2024-12-26T12:19:11+02:00

The actuality of the research is determined by the lack of systemized information on the ear and skull base paraganglioma. Currently, from 500 to 1000 cases of paraganglioma or pheochromocyte are diagnosed in the United States of America annually. The combined morbidity of benign tumor forms is evaluated to be between 0.7 to 1.0 for 100000 people per year. Even though the results in understanding the nature of paraganglioma, as well as treatment thereof, are successful, the amount of literature on this topic only increases. The research aims to analyze study of the terminology, classification, diagnostics, and treatment of paraganglioma. Special attention was brought to the preoperative preparation and embolization of vessels, which supply blood to the tumor as well as to the problem of repeated bouts of glomangioma. The objective of the research is the selection of relative sources, argumentation analysis, and material systematization. For the analysis, 53 research articles were included. During the compilation of this study, such methods, as analysis, synthesis, information collection and systematization, and generalization, were used. In this article, various paraganglioma classifications, endoscopic treatment methods, other aspects of paraganglioma therapy, and diagnosis and treatment thereof, were presented. More and more researchers recommend individual and adapted approaches for each case with the inclusion of factors, related to the patient, including age, treatment goals, other infections, gene status, anatomical issues, caused by the tumor growth, its sizes, and other factors. This literature review focuses on ear and skull base paragangliomas, rare, usually benign, hyper-vascularized neuroendocrine tumors often treated surgically. Alternative treatments like cyber-knife, gamma-knife, and endoscopic approaches are also discussed, highlighting their efficacy for specific cases. The study emphasizes individualized treatment plans considering patient-specific factors, with stereotactic radiosurgery being a safe and effective option for many patients. Materials of the research can be used by doctors of various specializations to enrich their knowledge and for further study of paragangliomas of various localizations.

The mechanism of physical exercises increases heat shock protein 70 (HSP70) (a systematic review)

2024-12-26T13:19:42+02:00

This study aimed to analyze physical exercise in increasing the expression of heat shock protein 70 (HSP70). This research is a systematic review involving searches from journal databases such as Pubmed, Web of Science, and Science Direct. Before starting the search, the study determines inclusion and exclusion criteria. The inclusion criteria were articles that discussed oxidative stress, physical exercises, and heat shock protein 70 (HSP70), and were published over the last five years (2018-2023). Meanwhile, the articles were excluded if they were published in non-reputable journals or were not indexed by Scopus and Web of Science. A total of 3211 articles from the Science Direct, Pubmed, and Web of Science databases were initially identified. Among them, ten articles met the inclusion criteria and thus were selected and analyzed for this systematic review. For standard operations, this study follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) assessment. The results showed that physical exercises played a certain role in increasing HSP70 expression as a physiological reaction to exercises. The increase in HSP70 is good as it can reduce and prevent inflammation, which reduces cell damage due to physical stress. Additionally, HSP70 increases catalase and superoxide dismutase, the processes that can reduce reactive oxygen species (ROS) caused by physical exercises. This enzyme is also important in protein optimization based on requirements. Therefore, we recommend doing physical exercises to improve health and avoid degenerative diseases.

The effect of pharmaceutical composition based on L-carnitine on structural and functional features of rat placenta in the model of passive tobacco smoking

2024-12-26T13:37:06+02:00

Passive tobacco smoking in modern society is quite common phenomenon. Maternal smoking, including passive smoking, is one of the modifying risk factors for adverse pregnancy outcomes and is associated with disorders of the pregnant woman's reproductive system, including the development of placental dysfunction. The aim of this study was to investigate the effect of a pharmaceutical composition based on L-carnitine on the structural and functional features of the rat placenta in a model of passive tobacco smoking. The study was conducted on 40 nonlinear pregnant rats aged 6 months. Passive smoking modeling was performed from day 1 to day 20 of pregnancy. From the first day of gestation, daily for 20 days, rats were intragastrically administered a pharmaceutical composition based on L-carnitine at an effective dose of 25 mg/kg, and rats of the positive control group received the reference drug at a dose of 68 mg/kg. On the 20th day of pregnancy, the animals were withdrawn from the experiment to study the microstructure of the placenta and determine the level of sex hormones. Structural and functional changes in the rat placenta in the model of passive tobacco smoking were determined. The gravidoprotective effect of the pharmaceutical composition based on L-carnitine at a dose of 25 mg/kg in pregnant rats with a reproduced model of passive smoking was proved, which was manifested by a decrease in histomorphological and hormonal signs of fetoplacental insufficiency compared to the negative control. The gravidoprotective effect in rats treated with a pharmaceutical composition based on L-carnitine and exposed to passive smoking was manifested by a significant decrease in the severity of negative changes in the placental histological structure, which were recorded in animals from the passive smoking group, as evidenced by the following signs of increased width of the labyrinthine section normal width of the decidual membrane, no expansion of blood-filled lacunae, sufficient contact area of fetal and maternal vessels, no signs of thrombosis in maternal lacunae, the predominant number of fetal capillaries without signs of hemostasis with normal blood filling and wall thickness. The use of a pharmaceutical composition based on L-carnitine at a dose of 25 mg/kg in pregnant rats with a reproduced model of passive smoking reduces the damaging effect of cigarette combustion products on placental steroidogenesis. This is manifested by a less pronounced decrease in progesterone levels by 22.47% and free estriol by 55.48% compared to animals exposed to passive smoking, which almost corresponds to the activity of the reference drug at a dose of 68 mg/kg. The presence of a gravidoprotective effect of the pharmaceutical composition based on L-carnitine indicates the prospects for further pharmacological studies to prevent and treat the negative effects of fetoplacental insufficiency on the mother and fetus caused by placental hypoxia due to tobacco smoking.

The role of diet therapy in insulin resistance in women with polycystic ovary syndrome

2024-12-26T14:10:21+02:00

The purpose of the study is to substantiate, based on a review of literary sources, the effectiveness of various types of diet therapy as an initial method of treatment in women with polycystic ovary syndrome and insulin resistance, their effect on the normalization of the menstrual cycle, correction of metabolic disorders and reduction of the level of insulin resistance. From 2018 to 2024 40 articles were analyzed with key words: polycystic ovary syndrome (PCOS), insulin resistance, diet therapy, Mediterranean diet, ketogenic diet, low-carbohydrate diet, low-fat diet, Homeostasis model assessment (HOMA) according to which a review of the available literature was conducted in PubMed, National Library of Medicine, Medscape. The study did not include pregnant, lactating women who took hormonal therapy and/or insulin sensitizers during the last 2 months, had liver, kidney, and heart diseases that failed local treatment of hirsutism, with congenital hyperplasia of the adrenal glands, androgen-secreting tumors, Cushing's syndrome. A review and analysis of studies on the effects of a ketogenic diet for 12 weeks, in which 14 overweight women with a diagnosis of polycystic ovary syndrome, participated. 40 articles were studied using bibliographic and analytical methods. At the beginning of the study patients had HOMA-IR above 2.5, which confirms insulin resistance. After using ketogenic diet, a significant decrease in the level of glucose, insulin, and, therefore, the HOMA index was observed. There were significant changes in lipid profiles with a decrease in triglycerides, total cholesterol, and low-density lipoproteins along with increases in high-density lipoprotein. Anthropometric measurements revealed a weight loss of 8.78 kg and a significant decrease in the body mass index of 3.18. A study of 72 women with PCOS showed a superior efficacy of a Mediterranean diet (MED) combined with a low-carbohydrate (LC) diet versus a low-fat diet alone. In patients who used the combination of MED/LC diet, in 86.7% of cases, the regular menstrual cycle was restored, and pregnancy occurred.

Study results of the stress-strain states of the crown parts of molars restored with composite, ceramic and zirconium onlays

2024-12-26T14:22:51+02:00

The relevance of the research is determined by the significant need for effective restorative treatment of caries decayed teeth. The purpose of the study is comparison of the stress-strain states in simulated models of non-homogeneous composite structural elements for typical geometric characteristics of onlays made of composite, ceramic, and zirconium dioxide in the restoration of the decayed mandibular molar. Computer simulation models of biomechanical systems were obtained by digital scanning of the mandibular molar in STEP format. Control was carried out in the form of numerical characteristics and graphical visualization in the EXOCAD program. The numerical method of finite elements, information technologies and program codes of the ANSYS Workbench 12.1 system were used to solve applied problems of biomechanics. After testing the developed discrete models, they were checked for adequacy and coincidence of numerical results in areas of high voltage gradients using the tools and methods of the ANSYS 12.1 code system. The maximum displacements, gradients, and amplitudes of the Mises-equivalent stress in the structural elements of each biomechanical system were evaluated. The stress values were calculated using the method of linear scaling of the results of the numerical solution of the boundary value problems of the theory of elasticity for small deformations to correspond to the functional force load of the mandibular molar of 100 N. The estimated values of the coefficients of the strength reserve of the structural elements were calculated as the ratio of the strength limit values to the maximum calculated values of the Mises-equivalent stress, scaled by a coefficient of 10 for a force load of 100 N. It was established that the largest voltage gradients are registered at the border of the cement layer. However, the nature of force transmission, as well as stress distribution, was different for different structural materials. The maximum stress was observed in the model with a composite onlay in the local area of the surface of the force load in the cement layer. For the ceramic onlay, the maximum stress was found on the lower support surface of contact with the onlay, where its values were 1.4 times higher than on other surfaces. The analysis of the zones of maximum stress for the zirconium onlay revealed their predominant localization in the center of its occlusal surface and in the zone of change in its spatial configuration at the border with cement. The highest stress values, along with the lowest coefficients of safety margin, were found for the molar model restored with a composite onlay, which indicated the lowest endurance of this material to functional load. While the zirconium onlay provided optimal stress distribution and it was characterized by the largest safety factor, which makes this method the most acceptable for molar restoration. The obtained results should be taken into account when choosing a material for the prosthetics of lateral teeth with onlays.

Biofilm as a supracellular organization of pathogenic bacteria

2024-12-26T14:44:06+02:00

The high frequency of resistance to antibiotics among bacterial clinical isolates necessitates the discovery of new targets for suppressing the pathogenicity of microbes without stimulating their resistance. The studied sources suggest that this can be achieved by targeting the determinants of virulence. The search for new active substances with anti-biofilm activity based on the analysis of literature data on the structure of bacterial biofilms, mechanisms of their resistance to antimicrobial agents was the purpose of this work. An electronic search was conducted in Medline (PubMed interface), Scopus, and Web of Science between 2011 and July, 2024 using the keywords: biofilms, antibiotic resistance, Quorum sensing, persisters. 30 sources were selected, 85 were processed. The subject of the search was: microbial landscape of hospital strains of microorganisms, biofilm formation by microorganisms – pathogens of infectious diseases, regulation of virulence factors in bacterial biofilm. Studies of recent years have established that many pathogenic bacteria produce signal molecules for cellular communication. This signaling system is called Quorum sensing (QS) and it depends on the density of the bacterial population and is mediated by signaling molecules called pheromones or autoinducers (AI). Bacteria use QS to regulate activities and behavior including competence, conjugation, symbiosis, virulence, motility, sporulation, antibiotic production and biofilm formation. Researches aimed at bacterial communicative signals and suppressing QS demonstrate a fundamental approach to forming competitive microbial communication. The search, synthesis, and development of drugs based on modified autoinducers of various natures can lead to a breakthrough in the field of antibacterial therapy of infectious diseases, as well as surgical purulent postoperative complications. The processed literature describes a number of hypotheses regarding the participation of "toxin-antitoxin" systems that control the growth and metabolism of bacteria in the stimulation of the formation of persister cells. The simultaneous acquisition of resistance to many antibacterial factors, including physico-chemical ones, is suggested. Therefore, there is an increased attention of scientists to the study of the anti-biofilm effect of new compounds and drugs capable of influencing energy or metabolic processes in cells, as well as substances that do not require a metabolically active target. The review illustrates general modern approaches to the use of QS chains in pathogenic bacteria as new therapeutic targets.

The impact of Sudafed on spleen of albino mice

2024-12-26T14:57:22+02:00

Pseudoephedrine (PSE), often known as Sudafed, belongs to a class of medications known as sympathomimetic amines, which affect the digestive system, respiratory system, and cardiovascular system. This drug has a long history of medical use; it is helpful in treating symptoms of the common cold and flu, sinusitis, asthma, and bronchitis. Due to its central nervous system (CNS) stimulant properties and structural similarity to amphetamine, it is also used for non-medical purposes such as doping agent, to increase focus, and as a substance that gets rid of exhaustion and drowsiness. Nevertheless only a few studies, backed up its impact on solid abdominal organs. The aim of this task is to investigate the effect of some dosages of PSE medication on the histology of albino mice's spleens. The current study included 18 albino mice grouped into 2 groups: control (3 mice), and acute group (15 mice). The acute group was further divided into five subcategories with 3 mice in each, and the animals received a single intraperitoneal injection of 0.3 ml of each of the following concentrations of drug for 24 hours: 500 mg/kg, 250 mg/kg, 125 mg/kg, 62.52 mg/kg, and 31.24 mg/kg. After the mentioned period, the mice of all subgroups were sacrificed and the spleens were removed, processed, sectioned and stained for histological analysis. Results showed that the amount of PSE administered at 500 mg/kg caused considerable sago spleen, numerous amyloid depositions in peripheral zone, sinusoidal red pulp congestion, and hyperplasia inside the germinal center. While less powerful effects or no detectable pathological alterations were seen at lower doses (125, 62.52, and 31.24 mg/Kg). This investigation demonstrated some pathological effects of this drug on spleen of albino mice at higher doses as compared to lower doses and control which recommends the use of minimal doses of PSE to avoid its adverse effects.

Morphological characteristics of regeneration of the lower jaw bone in an experiment using natural collagen with lincomycin

2024-12-26T15:35:29+02:00

This study aimed to investigate the dynamic changes in the histomorphological architecture of bone-ceramic regeneration following the transplantation of natural collagen combined with lincomycin into an experimental defect of the rabbit mandible. 45 adult male rabbits aged 6-7 months and weighing 2.5-3 kg were used for the study. 20 animals were in control group and 20 animals in experimental. An additional 5 intact animals were used to study the normal structure of bone tissue in the studied area of the lower jaw. The control group consisted of animals with a bone defect that healed under a blood clot. The experimental group consisted of rabbits with the bone defect filled with natural collagen, with simultaneous intramuscular injections of lincomycin at a dose of 12 mg/kg body weight once a day for 6 days (Col-C-lincomycin). Post-traumatic bone tissue status within the defect area was monitored for 84 days. Ultrastructural changes were studied using scanning electron microscopy. To determine changes in the composition in the bone regeneration, three parameters were calculated – the relative volume of: 1) bone tissue, 2) osteoplastic material and 3) connective tissue in the bone regeneration. The data were analyzed using the Student's t-test, and a difference at p<0.05 was considered statistically significant. The research of the surface topography of the experimental bone defect in the rabbit mandible, following the implantation of Col-C material in combination with lincomycin, revealed numerous regenerative changes that occurred after injury and correlated with the dynamic changes in the relative volume of bone tissue, osteoplastic material, and connective tissue within the regeneration. Morphometric analysis of the relative volume of the constituent components of the regeneration in the experimental defect revealed a phased nature of the dynamics of the observed changes. The osteocyte lacuno-canalicular system that formed after material implantation acquired characteristics of typical structure. Foci of incomplete osteogenesis were not visualized. Unlike the control group, after the application of Col-C material in combination with lincomycin, the majority of osteons in the regeneration near the outer bone plate did not differ from the typical structure of the maternal bone in terms of both its structure and geometry.

EBV-associated lymphoadenopathy in a child

2024-12-27T14:58:47+02:00

Lymphadenopathy is observed in 55% of children under the age of 10 years and the most often it has a bacterial or viral etiology, but it also can manifest as lymphoproliferative diseases or lymphomas. Lymphoproliferative diseases are characterized by uncontrolled growth of lymphocytes with the development of monoclonal lymphocytosis, lymphadenopathy and bone marrow infiltration. Since the Epstein-Barr virus (EBV) has oncogenic potential, it is essential for doctors to be vigilant about generalized persistent lymphadenopathy on the background of chronic persistent Epstein-Barr infection. The purpose of the article is to increase the awareness of doctors of various specialties about the risk of developing EBV-associated lymphoproliferative diseases in children with generalized persistent lymphadenopathy using the example of a clinical case discussion. The article describes a clinical case of a 14-year-old patient with persistent lymphadenopathy on the background of chronic Epstein-Barr infection. Immunohistochemical study of the lymph node biopsy revealed reactive hyperplasia with expressed immune blast transformation, the presence of CD30-positive cells while excluding Hodgkin lymphoma. It is recommended to involve a multidisciplinary team to prescribe appropriate antiviral therapy, regularly monitor the clinical course, dynamics of laboratory and immunological indicators. The result of the study is the recommendation to repeat biopsy in the absence of positive dynamics in patients with persistent Epstein-Barr infection and lymphadenopathy.

Syphilitic aortitis: from the past to the present (view of a dermatovenerologist)

2024-12-27T15:22:12+02:00

In order to improve the diagnosis and treatment of syphilitic aortitis, an analysis of known data on the clinical manifestations, course and diagnosis of this pathology was conducted, illustrating our own observations with the subsequent implementation of recommendations in clinical practice. The problem of syphilitic aortitis - the most frequent manifestation of late syphilis - was considered. Current data on clinical manifestations, possibilities and problems of diagnosing this pathology were presented. Modern methods of serological research used in the diagnosis of syphilitic aortitis were analyzed in detail; the course, complications and prognosis of this pathology were separately considered. All these aspects were illustrated by our own observations of clinical cases of syphilitic aortitis, which are of interest due to their rarity in clinical practice and demonstrate the importance of correct diagnosis and appropriate treatment. Serological tests for syphilis, ultrasound examination of the heart, extracardiac vessels and internal organs; X-ray examinations were used when examining patients. It was concluded that lesions of the cardiovascular system are currently among the most common forms of visceral syphilis. Syphilitic aortitis with symptoms of cardiovascular damage, which are caused by aortic valve insufficiency, narrowing of the ascending coronary arteries, aneurysmal dilatation of the ascending part and aortic arch, occurs in the late stages of syphilitic infection. Even in patients with syphilis who have been treated in the past with penicillin drugs, cardiovascular damage may occur, namely aortitis with aortic valve insufficiency. The most informative methods for detecting late cardiovascular damage are: enzyme-linked immunosorbent assay, passive hemagglutination reaction, immunoblotting and computed tomography of the heart and echocardiography. Special attention is paid to the fact that the uniqueness of the above observations lies in the fact that complicated forms of aortitis began to occur more often and also in treated syphilis patients who had previously been treated with water-soluble penicillin. Aortitis also occurs against the background of seroconversion (positivity) of non-treponemal tests, which were previously negative after treatment.

Local anesthetic systemic toxicity after brachial plexus block with ropivacaine: a case report

2024-12-27T15:31:41+02:00

The aim of this article is presentation of clinical case of local anesthetic systemic toxicity (LAST). Local anesthetic systemic toxicity is a rare but life-threatening complication. Ropivacaine is widely used for the regional blocks and rarely leads to the development of LAST. LAST may develop due to intravascular injection or high dose of ropivacaine. We present the case of 48-year-old-female (ASA I, 56 kg, and 165 cm), who underwent surgery on the right shoulder under brachial plexus block. Brachial plexus nerve block was performed by interscalene access with introduction of 40 ml of 0.75% ropivacaine (300 mg). Twenty minutes after the injection, complete sensory/motor block was achieved. Twenty-five minutes after the injection, the patient complained of numbness in the tongue, tinnitus and dizziness. During this time, her blood pressure was 132/83 mmHg, heart rate 82 beats/min. oxygen saturation 97%. No changes were observed on the ECG. Suspecting ropivacaine-induced toxicity, 50 mg of thiopental sodium followed by 2 mg of midazolam were administered for seizure prophylaxis, and supplemental oxygen was given via face mask. Patient’s state improved in 10 minutes. Ten minutes later 20% intralipid emulsion bolus during 2-3 min was administered followed by continuous infusion at a dose of0.25 ml/kg/min. Against clinical stablility and consciousness of the patient, decision was made to proceed with surgery, which was uneventful. Implementation of preventive measures can decrease the possibility for development of complications and emergency treatment can safe patient’s health and life. Preventive measures should include implementation of ultrasound nerve location guidance, individual calculation of local anesthetic dose, taking into account sex, weight, and physical status of a patient.

Pathomorphological changes of the placenta in coronavirus disease (COVID-19) in pregnant women in the second and third trimesters of pregnancy

2024-12-26T18:41:31+02:00

Despite the severity of the course of COVID-19 in pregnant women, COVID-19 remains a risk factor for perinatal losses. The aim of the study was to determine the pathomorphological changes in the placenta in pregnant women with COVID-19 during the second and third trimesters of gestation in cases of live birth and antenatal fetal asphyxia. Placentas of pregnant women with COVID-19 were examined: in cases of live birth (n=122; Group I), in cases of antenatal fetal asphyxia (n=27; Group II), and in a comparison group (n=40). Macroscopic, microscopic, immunohistochemical, morphometric, and statistical methods were used. Subgroups: I.1 (n=49) – COVID-19 in the mother at 19-34 weeks of gestation and I.2 (n=34) – at 35-40 weeks. Placentas in antenatal fetal asphyxia, depending on the duration of the post-COVID interval (the time interval from the diagnosis of COVID-19 to delivery), were divided into subgroups – II.1 (n=8) and II.2 (n=19). In subgroup II.1, the post-COVID interval was 5-17 weeks; in II.2 – 1-4 weeks. In the acute phase of the disease, placentas predominantly showed congestion, thrombosis, hemorrhages, and placentitis – 100% (95% CI: 94.5%-100%). An increase in the number of syncytial nodules was found in subgroup I.2: 12.7 [11; 14] compared to 5.8 [5; 7] in the control group, p<0.0001. A decrease in the number of terminal villi was observed in subgroups I.1 and II.1 – 16.3 [10; 25]; 10.3 [8; 12] respectively; p<0.0001, compared to 25.4 [20; 30] in the comparison group. All cases of COVID-19 in the mother were accompanied by edema of the stromal tissue of the terminal villi of the chorion, which led to a decrease in the percentage of blood vessels in the terminal villi: in subgroup I.2 – 29.4 [25.6; 34.2]; II.1 – 16.5 [10.34; 24.37], and II.2 – 14.71 [10.1; 19.4] compared to 67.6 [58.78; 73.7] in the comparison group; p<0.0001. Proliferative changes in the wall of arterioles with subsequent arteriosclerosis were observed exclusively in subgroups I.1 and II.1 – 28.6% (95% CI: 16.6%-42.3%) and 100% (95% CI: 78.6%-100%) respectively. Pathomorphological changes in the placenta in COVID-19 during pregnancy are associated with the timing of infection and the phases of the inflammatory process, with an increase in the duration of the post-COVID interval – exudation (placentitis, edema of chorionic villi), proliferation followed by fibrosis. Factors that disrupt placental perfusion in the acute phase of COVID-19 include edema of the villous stroma, narrowing of the capillary lumen in the terminal chorionic villi, and the intervillous space. Compensatory mechanisms of the mature placenta include the appearance of a large number of syncytial bridges to increase the intervillous space and focal inflammation. Arteriolosclerosis, obliteration of the intervillous space, and hypoplasia of the terminal villi caused by SARS-CoV-2 damage to stem and semi-stem villi during COVID-19 in the second trimester of pregnancy are mechanisms of chronic placental insufficiency and a risk factor for intrauterine fetal hypoxia.

Hepatorenal syndrome in decompensated portal hypertension

2024-12-26T18:55:44+02:00

Hepatorenal syndrome is the development of kidney failure in patients with decompensated chronic diseases with portal hypertension. This study aimed to search for optimal methods of early diagnostics, therapeutic approaches and establishment of lethality causes in hepatorenal syndrome. The research presents the outcomes of treatment of 192 patients diagnosed with hepatorenal syndrome and undergoing inpatient care at the Municipal non-profit enterprise “Kyiv City Clinical Emergency Hospital” and the Clinic of the Department of Surgery of the Dental Faculty of the Bogomolets National Medical University between 2018 and 2023. Renal dysfunction and increased creatinine were detected in 192 (43.9%) out of 437 patients with decompensated portal hypertension, who were subsequently divided into two groups based on the degree of decompensation. The first group, comprising 57 (29.7%) patients, fell into class B according to the Child-Pugh scale and had <30 points according to the MELD scale. The second group consisted of 135 (70.3%) patients classified as class C and ≥30 points according to the MELD scale. In the treatment of hepatorenal syndrome, as well as in order to ensure an euvolemic state and prevent circulatory dysfunction, after therapeutic paracentesis, an infusion of 20% albumin solution at the rate of 6-8 g/l of evacuated ascites was used. The appointment of terlipsin in patients with portal hypertension complicated by bleeding in the presence of hepatorenal syndrome had a double effect in the form of a constrictor effect aimed both at stopping bleeding and at changing the splanchnic blood flow, which contributes to the improvement of kidney function. Stopping bleeding, eliminating the infectious factor in ascitic fluid, reducing intra-abdominal pressure, correcting biochemical parameters, and optimizing intra-abdominal blood flow were components of the treatment of hepatorenal syndrome. Depending on the combination of the number and severity of complications of portal hypertension, the number of unsatisfactory treatment results also increased. The total mortality in the development of hepatorenal syndrome was 80.2%. The primary criterion for diagnosing hepatorenal syndrome is the control of diuresis and its daily decline, coupled with an increase in creatinine levels exceeding 30 mmol/l within 48 hours.Varicose bleeding, severe ascites accompanied by intra-abdominal hypertension, and spontaneous bacterial peritonitis serve both as triggering factors for hepatorenal syndrome development and increase mortality rates.

Features of pancreatic parenchyma fibrosis in the comorbid course of chronic pancreatitis and chronic obstructive pulmonary disease

2024-12-26T19:37:57+02:00

Under the conditions of chronic obstructive pulmonary disease (COPD), chronic pancreatitis (CP) progresses with the development of exocrine pancreatic insufficiency (EPI), which occurs when the active area of the acinar epithelium decreases as a result of the inflammatory process and fibrosis of the organ. The objective of the study was to study the peculiarities of the processes of the pancreas tissue fibrosis in patients with chronic pancreatitis in case of comorbidity with chronic obstructive pulmonary disease. A prospective cohort study was conducted with the analysis of inpatients’ medical records of 305 patients. The first group of patients consisted of 96 people with an isolated course of CP, the second group consisted of 116 patients with CP with comorbid COPD, the third group consisted of 93 patients with isolated COPD. The comparison group consisted of 30 practically healthy persons. The study also used data from a clinical blood analysis, a biochemical study of the content of markers of the syndrome of deviation of the pancreas enzymes in the blood, the content of elastase-1 in feces, ultrasonographic examination of abdominal organs, changes in the carbohydrate-protein components of the extracellular matrix, the state of collagenolytic activity of the blood plasma. In patients with CP in the exacerbation phase without comorbid pathology, as well as with comorbid COPD and isolated COPD, a significant activation of fibrosing reactions was established: activation of collagen synthesis was registered as an indicator of an increase in the content of protein-bound oxyproline (PBOP) in the blood: in patients of the 1st group – 1.7 times, patients of the 2nd group – 2.1 times and 3rd group – 2.3 times (p<0.05). The specified direction of changes is confirmed by the indicator of the content of type IV collagen in the blood, which increased in comparison with the indicator in practically healthy persons, respectively, in patients of groups 1, 2, 3 – by 1.4 times, 2.4 and 2.5 times (p<0.05), i.e. maximally in patients with COPD and with comorbidity of CP with COPD. In patients with a comorbid course of CP and COPD, a correlational interdependence was established between the indicators of the state of the protein components of the connective tissue of the extracellular matrix of the pancreas (PBOP) and hyperamylasemia (r=0.32, p<0.05), the intensity of endotoxicosis (r=0, 37, p<0.05), the level of glycemia (r=0.45, p<0.05), and the inverse relationship between the content of elastase-1 in feces (r=-0.33, p<0.05 ), insulinemia (r=-0.46, p<0.05), which indicates the interdependence of these changes and their role in the pathogenesis of the progression of chronic pancreatitis. Correlation relationship between the parameter of ultrasonographic histography of the pancreas – L, which indicates the degree of the pancreas fibrosis, and the content of type IV collagen in the blood (r=0.54, p<0.05), the content of PBOP in the blood (r=0.46, p<0.05), hexosamines (r=0.38, p<0.05) points to the biochemical mechanisms of the pancreas fibrosis and opens up prospects for developing the ways of pathogenetic correction and prevention of CP progression in comorbidity with COPD.

Analysis of the terms of development of infectious complications in patients after osteosynthesis of long bones

2024-12-27T10:05:59+02:00

Determination of the influence of the timing of infectious complications in patients after osteosynthesis of long bones and its influence on the course of the infectious process. An analysis of the treatment of 207 patients with infectious complications after osteosynthesis of long bones, who were treated at the "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" from 2013 to 2017 was made. The first group included 148 patients who developed infectious complications after osteosynthesis of long bones with a plate. The second group included 59 patients who developed infectious complications after osteosynthesis of long bones with a blocking intramedullary rod. In 51.5% of patients of the first group after closed fractures, infectious complications were detected in the first 6 weeks after surgery. In 43.7% of patients of this group, manifestations of the inflammatory process occurred in the period from 6 weeks to 1 year. In 4.9% of patients of the first group, the infectious process (in the form of a fistula) did not occur acutely, but after one year after osteosynthesis. In 62.2% of patients after osteosynthesis as a result of an open fracture, the first manifestations of the infectious process appeared in the first 6 weeks after the operation. In 35.6% of patients of this cohort, the infectious process occurred within 6 weeks to 1 year after the surgical intervention. In 43.2% of patients of the second group, the first manifestations of infection began immediately after the operation in the form of non-healing of the postoperative wound, and in another 24.3% – in the first 6 weeks after the intervention. In 32.4% of patients in this cohort, an infectious process occurred more than a year after the intervention against the background of a consolidated fracture and a stable fixator. After BIOS with rod as a result of open fractures, in 72.7% of patients, the infectious process began immediately after the operation in the form of non-healing of the postoperative wound, and in another 27.3% – in the first 6 weeks after the intervention. The terms of the infection after osteosynthesis and its type reliably affect the development of complications in the injured person and have an indirect effect on their development. The structure of infectious complications is different depending on the time of occurrence and the type of osteosynthesis used to treat patients. In all observation groups, the infectious process localized in the tibia, which has both anatomical reasons and reasons related to the blood supply of this segment, was detected the most often.

Spontaneous pneumothorax: intubated or non-intubated surgery?

2024-12-27T10:22:37+02:00

The aim of our clinical study was to justify and implement non-intubated video assisted thoracic surgery as a part of enhanced recovery after surgery pathway in treatment of spontaneous pneumothorax. Data of 150 patients who underwent surgical treatment were retrospectively analyzed. Among them group 1 of 75 patients underwent video-assisted thoracoscopic surgery (VATS) and group 2 of 75 patients underwent non-intubated VATS surgical treatment. All patients underwent atypical resection of the lung and pleural abrasion, diaphragm augmentation with mesh if diaphragm endometriosis was suspected. The perioperative data, short-term outcomes and recurrence rates of these two groups were compared. The two groups had comparable demographic, perioperative investigations, fluid infusions during surgery, the volume of surgery intraoperatively, blood loss, time for chest drain removal, length of stay in the hospital and the rate of complications. There were no conversions to thoracotomy or intubated general anaesthesia, no mortality. The peak end-tidal carbon dioxide was significantly higher in the non-intubated group than in the intubated group (mean: 48±8.6 vs 34±6.2 mmHg, p<0.001). The mean follow-up was 20.2±3.9 months in the non-intubated group and 24.7±4.2 months in the intubated group (p>0.05). Chest tube duration was 4.11 days in group 1 and 3.76 days in group 2. The recurrence rate of pneumothorax after surgery was 4% in both groups. Nnon-intubated video-assisted thoracic surgery for spontaneous pneumothorax could be considered a feasible, safe and effective method of treatment, even with mesh diaphragm augmentation, in cases of catamenial pneumothorax and can be a part of Enhanced Recovery After Surgery pathway. Continious follow-up and additional clinical investigations are supposed to validate the profits of the suggested approach.

Respiratory support of patients with pneumonia in the context of the COVID-19 pandemic

2024-12-27T11:03:38+02:00

The purpose of this study is to evaluate and analyse existing methods of supporting individuals suffering from pneumonia due to the coronavirus infection, as well as to find new ones. The following methods were used in a randomised controlled trial: artificial lung ventilation (ALV), non-invasive ventilation, oxygen therapy using oxygen masks and nasal cannulas, penetrating ventilation with high oxygen flow, high-flow nasal oxygen therapy; advantages and disadvantages of such methods. The analysis of a sample of 200 patients aged 18-80 years, among whom there were both women and men with different levels of severity of the disease, was carried out. The study showed that the use of penetrating ventilation with high oxygen flow significantly improves blood oxygenation and reduces the requirement for lung intubation and ALV. However, minimally invasive respiratory support and oxygen treatment have also proven to be effective methods of respiratory support. When using non-invasive ventilation and penetrating ventilation with high oxygen flow, higher survival rates and shorter hospital stay were observed in patients with pneumonia caused by coronavirus infection, compared with the use of ALV. The study revealed that the use of artificial respiration may result in more severe adverse effects, such as lung barotrauma, so it is recommended to use it only in the absence of other effective methods of respiratory support. Thus, the results of the study emphasise the need for an individual approach when choosing a method of respiratory support in patients with pneumonia caused by coronavirus infection, and also confirm the effectiveness of minimally invasive respiratory aid and high-flow oxygen penetrating ventilation in the treatment of this pathology.

Optimization of treatment and prevention of recurrences of bacterial vaginosis in postmenopausal women

2024-12-27T11:14:59+02:00

The study aimed to improve the effectiveness of treatment and prevention of recurrences of bacterial vaginosis (BV) in postmenopausal women. 87 women with BV aged 50 to 65 who received a course of antibacterial therapy with control clinical and laboratory recovery were examined. In the future, two groups were selected: the first group (42 women) received probiotics in suppositories (live lactobacillus strains L. aktobacillus plantarum 8P-A3 or L. plantarum 38, or L. fermentum 90T-C4, or L. fermentum 39) vaginally 2 times a day for 10 days. Women of the second group (45 patients) received probiotics vaginally once a day for 20 days and a suppository with estriol 0.5 mg vaginally once a day for 2 weeks, and then 2 times a week for 3 months. Evaluation of effectiveness was carried out after 3 and 6 months. A gynecological examination, determination of the pH reaction of vaginal contents, aminotest, microscopy of vaginal smears, bacteriological cultures on nutrient media for the determination of facultatively anaerobic bacteria, Gardnerella vaginalis, quantitative analysis of vaginal microflora, species composition and frequency of lactobacilli were performed. In the women of the first group, the risk of recurrence of the laboratory criteria of BV increases after 3 months: an increase in the pH of the vaginal contents by 1.2 times (p<0.05), the appearance of a positive aminotest in 38.1% of patients, the presence of Gardnerella vaginalis in 26.2% women with a pathological number of 10⁴-10⁵CFU/ml, regression of the pool of lactobacilli with worsening of the situation and the appearance of clinical manifestations of the disease after 6 months. In the second group, there was a decrease in cases of recovery of laboratory markers after 3 months and clinical and laboratory criteria of BV after 6 months. The study proves the necessity of determining the laboratory criteria for the diagnosis of BV in dynamics 3 months after the main course of antimicrobial therapy in women without a clinical picture of recurrence. The effectiveness of intravaginal use of probiotics and vaginal estriol at a dose of 0.5 mg for the treatment and prevention of BV recurrences in postmenopausal women with a long course has been shown (4 months).

The significance of the immunohistochemical method in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia

2024-12-27T11:28:05+02:00

The article explores the role of immunohistochemical methods in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia. Endometrial polyps are a widespread pathology among women of reproductive age, frequently accompanied by hyperplastic tissue changes. The aim of the work was to investigate the expression of diagnostic markers in endometrial polyps, which may be manifestations of local endometrial hyperplasia, with the aim of improving differential diagnosis in their atypia.. The research material consisted of histological samples from 37 patients aged 38 to 52 with abnormal uterine bleeding, treated at a clinical hospital in Dnipro. The methods included histological tissue analysis, immunohistochemical studies using a panel of antibodies, and statistical data analysis. Antibodies targeting markers such as ER, PR, PAX-2, PAX-8, PTEN, Ki-67, p16, and p53 were used to evaluate proliferative activity and the degree of tissue atypia. The results showed that polyps associated with atypical hyperplasia are characterized by complex morphological changes, including abnormal glandular architecture, stromal atypia, and increased mitotic activity in both glandular and stromal components. Epithelial differentiation of tubal, mucinous, or mixed types was frequently observed. More than half of the cases exhibited partial atypical changes, while diffuse atypia was noted in fewer instances. The control group of glandular-fibrous polyps with hyperplasia without atypia demonstrated low mitotic activity and no cellular atypia. Immunohistochemical studies confirmed the high sensitivity of markers in identifying pathological changes, particularly in diagnostically challenging cases. The conclusions emphasize that immunohistochemistry is an effective tool for detecting endometrial atypia, and the diagnosis of atypical polyps should be based on a comprehensive analysis of morphological and molecular changes. Polyps associated with hyperplasia and atypia require further observation due to the risk of recurrence and potential malignant transformation. Utilizing markers such as PAX-2, PTEN, and Ki-67 enhances diagnostic accuracy. Additional studies are needed to develop more reliable risk stratification models.

The current state of functioning and resourcefulness of individuals during turbulent times

2024-12-27T11:37:01+02:00

The purpose of the work was a study of the current functioning and resourcefulness of the adult population of Ukraine among different age groups amidst turbulent changes. Conducted by the State Institution "Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine," the study surveyed 1216 respondents residing in eastern, central, and western Ukraine. Methodological basis of the study was observation, interviews, questionnaires, and testing. The study examined topical aspects of turbulent changes on respondents, their current psycho-emotional state, information needs, sources of information, daily functioning, subjective assessment of life quality, presence of anxiety, depression, aggression, and the role of joy as a source of resilience during wartime in Ukraine. The results of the study showed that people in late adulthood were more likely to be anxious about hostilities and the socio-economic situation in the country compared to young adults (p<0.001). Furthermore, the study found a positive correlation between age and the percentage of people reporting high anxiety about the country's socio-economic situation (p<0.001). These worrying situations resulted in changes in daily functioning, particularly chronic daytime fatigue and drowsiness (p=0.069), feelings of dissatisfaction with oneself (p=0.223), manifestations of aggression towards oneself (p=0.603) and loved ones (p=0.148). Interestingly, early adulthood individuals showed more aggression towards other people compared to late adulthood individuals (p=0.013). The study also showed that feelings of joy serve as a resource for coping with war trauma and are an important indicator of mental health.

Quality of life prognosis in patients with somatoform disorders with sleep disorders

2024-12-27T11:46:13+02:00

In recent years, the impact of psychotraumatic factors has been increasing, leading to an increased prevalence of psychogenic disorders. Patients with somatoform disorders place a significant burden on the healthcare system. Depending on the diagnostic approach, the prevalence of somatoform disorders ranges from 0.8% to 34%, with nearly half of the patients experiencing sleep disorders. The study aimed to determine the quality of life in patients with somatoform disorders combined with sleep disorders and to identify factors influencing its formation. A total of 120 individuals with somatoform disorders combined with sleep disorders were examined. A comprehensive assessment of the patient’s condition was conducted, including clinical-anamnestic, clinical-psychopathological, and psychodiagnostic examinations, supplemented by the use of psychometric scales (Pittsburgh Sleep Quality Index, Beck Depression Inventory, Insomnia Severity Index, Toronto Alexithymia Scale-20, Integrative Quality of Life Questionnaire, and Spielberger Anxiety Scale). It was found that only 51 out of 120 patients who completed the study had a sufficient level of quality of life. Patients with sufficient quality of life demonstrated lower levels of depression, insomnia severity, and quality of life and its components, but higher levels of personal anxiety. Analyzing categorical indicators, significant differences were also identified in the presence of depression, anxiety, alexithymia, and severe insomnia. As a result of the study, it was established that predictors of quality of life are the severity of sleep disorders and the presence of alexithymia and severe insomnia before the start of treatment. The multiple logistic regression model demonstrated the highest discriminatory ability (AUC 0.872 (95% CI 0.799–0.926)), with predictors of insufficient quality of life including sleep latency, personal anxiety, and depression before the intervention, as well as the presence of severe insomnia after intervention. The combination of these predictors increases the chances of having a low quality of life level by 17.6 times. The study’s results served as the basis for developing individualized therapeutic and corrective strategies in sleep disorders treatment in patients with somatoform disorders and sleep disturbances.

Cerebral venous thrombosis and depression: a scoping review

2024-12-27T11:53:37+02:00

Cerebral venous thrombosis is a rare condition involving thrombus formation in the venous sinuses of the brain, leading to impaired venous drainage, increased intracranial pressure, and brain damage. Depression frequently accompanies cerebral venous thrombosis patients with varying prevalence and characteristics across studies. This scoping review aims to synthesize current evidence on the prevalence and characteristics of depression among cerebral venous thrombosis patients, identify patterns of sinus involvement, and assess the impact on clinical and psychiatric outcomes. This study searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar databases for case reports, retrospective studies, and clinical trials published within the last 20 years in articles related to depression and cerebral vein thrombosis. This review covered demographics, clinical characteristics, structural involvement, and outcomes. The prevalence of depression in patients with cerebral venous thrombosis ranged from 13% to 58.4%, influenced by factors such as pattern of venous sinus involvement, other body systemic involvement, and individual characteristics. Patients were predominantly younger to middle-aged adults, with a significant female predominance. Common comorbidities were anemia, hyperhomocysteinemia, migraines, and hypertension. Most patients had favorable outcomes; however, persistent residual symptoms and variable clinical presentations were also noted, affecting long-term quality of life. The review highlights the need for standardized assessments and a multidisciplinary approach to cerebral venous thrombosis management, addressing both neurological and psychiatric aspects. Further research with larger, standardized studies is necessary to better understand the relationship between cerebral venous thrombosis and depression and to improve patient outcomes.

Disability of military personnel in Ukraine for 2014-2022

2024-12-27T12:49:42+02:00

In connection with the military operations in our country, initially in the form of the Anti-Terrorist Operation (ATO), 2018 – the Joint Forces Operation (JFO), and from February 24, 2022 in the form of a large-scale invasion of the RF (Russian Federation), which led to changes in the life of the entire country, there was a need for new approaches to medical and social examination and collection of statistical information on disability and rehabilitation of military personnel. The study aims to investigate the dynamics and features of military personnel's disabilities from 2014 to 2022. By the method of a continuous sample of all participants of ATO/JFO in Ukraine examined for the first time by medical and social expert commissions of Ukraine from 2014 to 2022 (a total of 40,209 cases) was conducted. For that, the study's authors developed a separate form of statistical reporting, entitled: "Report on the causes of disability, indications for medical, professional and social rehabilitation of ATO participants for _____ year." Generally accepted methods of mathematical descriptive statistics were used for processing. Up to and including 2019, there was an annual increase in the level of primary disability among ATO/JFO participants despite the downward trend in disability rates in Ukraine as a whole. In 2020, the level of disability of ATO/JFO participants decreased slightly, but in 2021 and 2022, it increased again. According to the severity of disability, persons with disabilities of the third group prevailed (59.9% of those examined). More than half of those first recognized as disabled were identified as such not due to traumatic injuries but for other reasons, mainly due to cardiovascular diseases (32.4%). Brain traumas and traumatic injuries of the limbs prevailed among the injuries. As for rehabilitation services, the most requested were medical services, including restorative treatment, reconstructive surgery, and orthotics. The rate of primary disability of servicemen between 2014 and 2022 gradually increased, with a slight “dip” in 2020, and given the intensity of hostilities, further increases in the number of persons with war-related disabilities can be predicted. According to the structure of disability groups, most military personnel are persons with disabilities of the third group (58.8%). Most identified as disabled (62.5%) received disabilities because of diseases, not traumas. The leading causes of non-traumatic disability among military personnel are cardiovascular diseases (32.4%), musculoskeletal diseases (8.7%), and mental and behavioral disorders (8.3%).

Prospects for the use of deep brain stimulation in the treatment of Parkinson's disease in Ukraine

2024-12-27T12:58:23+02:00

Aim of the study – evaluation of the results of various methods of surgical treatment of Parkinson's disease depending on the clinical manifestations and stage of the disease. The study included 566 patients with Parkinson's disease (PD), comprising 201 (35.5%) women and 365 (64.5%) men, aged 30 to 79 years (mean age 52.9±8.8 years). Radiofrequency (RF) destruction of the subcortical nuclei was performed on 522 patients: 392 underwent unilateral thalamotomy, 50 underwent bilateral thalamotomy, 36 underwent unilateral pallidotomy, 2 underwent bilateral pallidotomy, 30 underwent thalamotomy combined with contralateral pallidotomy, and 12 underwent thalamotomy combined with contralateral subthalamic nucleus (STN) destruction. Additionally, neurostimulation surgery was performed on 37 patients, and combined surgical interventions (stereotactic RF destruction and deep brain stimulation (DBS) system implantation) were performed on 7 patients. Postoperative follow-up ranged from 1 to 16 years (mean follow-up 5.2±0.9 years). One year after RF unilateral thalamotomy, tremor abolishing or significant regression was observed in 374 out of 392 patients (95.4%). Rigidity regressed in 278 out of 314 patients (88.5%) who had it before operation. Postoperative complications from unilateral thalamotomy occurred in 18 patients (4.6%). Following staged bilateral thalamotomy, tremor regression was observed in 48 out of 50 patients (96.0%) and motor fluctuations (MF) regressed in 15 out of 28 patients (53.6%). The rate of surgical complications was higher after bilateral thalamotomy (8.0%) compared to unilateral thalamotomy. After unilateral and staged bilateral pallidotomy, tremor and rigidity regression were achieved in more than two-thirds of operated patients, and levodopa-induced dyskinesias (LID) stopped in over 80% of cases. The best outcomes for alleviating motor symptoms were observed in patients who underwent DBS treatment. Staged bilateral RF ablation can be considered an alternative surgical treatment for a highly selected group of patients.

Effective strategies for coordinated rehabilitation

2024-12-27T13:12:09+02:00

Rehabilitation of stroke patients is a complex process that requires coordination between healthcare professionals, patients and their families. This study aims to develop strategies to optimize coordinated care and rehabilitation in order to improve patients' quality of life and facilitate their return to normal life. The main objective is to examine the implementation of coordinated care and rehabilitation before, during and after hospital discharge. The study was conducted within the framework of the project GAJU 066/2022/S, approved by the Ethics Commission (number 6/2022). A qualitative approach was used, with semi-structured interviews with healthcare professionals involved in the rehabilitation of patients after stroke as the main method of data collection. The study involved 143 professionals from different hospitals, including doctors, physiotherapists, occupational therapists, psychologists, social workers and nurses. The data were analysed using ATLAS.ti software and different coding strategies [1]. Based on the information obtained, a SWOT analysis was conducted, the results of which were used to propose process optimization. It helped to identify key strengths, weaknesses, opportunities and threats to coordinated rehabilitation. The results indicate the need to improve cooperation between professionals and increase the availability of coordinated rehabilitation services. Key challenges include insufficient support and awareness of patients and their families, limited access to home-based rehabilitation services, and insufficient coordination between health and social service providers. Recommended strategies include improving interprofessional communication, expanding access to home-based services, increasing financial support, improving education of patients and their families, and introducing a system for monitoring the quality of services provided.

Structure of mycoses of the skin and its appendices in HIV-infected patients

2024-12-27T13:35:39+02:00

The spread of HIV infection is one of the most pressing problems of modern health care. The purpose of the work is to analyze the structure of the disease on the surface of the skin and its appendages by the nosological forms in HIV-infected persons and to establish a possible correlation between the presence of fungal lesions. The data obtained from 801 patients who sought medical help at the «Chernivtsi Regional Medical Center for Socially Significant Diseases» for the period from 2018 to 2023 were analyzed. The diagnosis of HIV infection was established according to the International Classification of Diseases of the 10th revision (ICD-10) and verified by the detection of specific serological and molecular biological markers of HIV. Mycological examination included microscopy of pathological material and cultural diagnosis. Analysing the structure of the disease it was found that skin mycoses and its appendages were detected in 334 (41,7%) HIV-infected patients. The main part of such patients – 237 (71%) – did not receive antiretroviral therapy (ART). Accordingly, dermatomycosis was detected in only 97 people (29%) who were adherent to ART. The relative risk method confirms the assessment of the effect of ART on the frequency of combined forms of mycosis – RR=0.608, which indicates the obvious rarity of the event (mycosis of the skin and its appendages), compared to the group that did not receive ART. A statistically significant direct relationship was established between the presence of a fungal skin lesion and its applications and indicators of HIV load in the blood – r=0.421...0.460 at p<0.001, as well as the duration of HIV infection – r=0.573...0.611 at p<0.01 . In addition, there is a clear positive correlation of medium strength between the duration of HIV infection and the level of viremia – r=0.388...0.427 at p<0.01, as well as an inverse weak relationship with the number of CD4+-lymphocytes – r=-0.105. ..-0.204 at p<0.05. The number of CD4+-lymphocytes was expected to be in an inverse correlation of medium strength with the HIV load (r=-0.618...-0.682, p<0.01). The relative risk of the development of mycoses of the skin and its applications in HIV-infected patients under the condition of antiretroviral therapy is only 0.262 (0.225-0.298), which indicates an obvious rarity of the event, compared to the group that did not receive antiretroviral therapy. The majority of HIV-infected patients (62.3%) have a combination of several nosological forms of mycosis of the skin and its applications. A strong inverse relationship between the probability of developing combined forms of mycoses and receiving antiretroviral therapy was revealed – r=-0.719...-0.806 at p<0.001. In the absence of antiretroviral therapy, a statistically significant direct relationship was established between the presence of fungal lesions of the skin and its appendages and indicators of HIV load in the blood, as well as the duration of HIV infection.

Improvement of the management system of the pharmaceutical service of the health care institution

2024-12-27T14:14:18+02:00

When providing medical care, harm to patients' health associated with the use of drugs occurs in 10-40% of cases. The issue of ensuring safety in the field of health care is a global problem. The relevance of the problem of improving the quality of pharmaceutical care and estimating the costs of medical care requires research. The purpose of the work is the formation of principles for improving pharmaceutical management in a health care institution by monitoring and analyzing prescription errors at all stages of drug use. The study was conducted on the basis of LLC "Endotechnomed", surgical clinic "Garvis" in the period 01.09.2019-29.02.2024 and was approved by the commission on biomedical ethics. The bibliographic method and retrospective analysis were used. In the study, the level of errors in appointment lists was calculated, their dynamics and relationship with the costs of medical care for the corresponding period were analyzed. The method of increasing the interval was used, and statistical significance was checked using the non-parametric Mann-Whitney test. The non-parametric method of Spearman's rank correlation is used to determine the characteristics of the relationship between the level of errors in appointment lists and the amount of drug costs for one patient. Statistical processing of the results was carried out using the methods of descriptive and analytical statistics using the integrated Jupyter Notebook development environment. A value of p<0.05 was considered statistically significant when testing all statistical hypotheses. The level of errors over 4.5 years significantly (p<0.002) decreased by 78.44% compared to the initial value (from 139.62‰ to 30.10‰), which was at the global level (10%). These indicators confirm the results of research by Chinese scientists, who prove that properly organized work in an inpatient medical institution can reduce the frequency of errors when prescribing drugs from 6.94% to 1.96%. A statistically significant negative rank correlation of average strength was observed between the amount of expenses for medical care of one patient and the level of errors in prescribing medicines for the considered period (r= -0.49; 95% CI (-0.67)–(-0.26); p<0.001), which contradicts the generally accepted notion and, according to the authors, is related to the uniqueness of the situation during the considered period (first the pandemic, then the war). Therefore, it can be concluded that the introduction of new approaches to control the prescription of medicines led to a significant (p<0.002) reduction in the level of errors in appointment lists over 4.5 years by 78.44% compared to the initial value; the higher level of errors in appointment lists corresponds to lower costs for medical care, which is a consequence of the unstable situation on the drug market during the pandemic and the war in Ukraine; the improvement of pharmaceutical service management processes was directed to the following areas of work: planning, control, implementation and functioning of the information system, personnel management, performance evaluation, involvement of interested parties for the formation and implementation of decisions.

Abuse of patent rights for pharmaceuticals in wartime conditions

2024-12-27T14:22:57+02:00

The article addresses the issue of patent rights abuse in relation to pharmaceuticals during wartime conditions. The aim of the study is to summarize the problems of patent rights abuse in the national legislation, identify ways to resolve them, and formulate conclusions to reduce such abuses. The study employs general scientific and specialized methods of scientific cognition, including dialectical, formal-logical, system-structural, comparative-legal methods, as well as modeling, analysis, and synthesis. Together, these methods facilitated the organization, planning, and execution of the research. The information search covered the period from 2001 to 2024. The study is based on scientific publications from databases and search engines (PubMed, JAMA, Scopus, Springer, BMC, Oxford Academic, Cairn.info), international and domestic legal acts, statistical studies of international organizations (Precedence Research, Statista, Proxima Research), patents on inventions related to pharmaceuticals, court rulings, and the recommendations of international and domestic experts. The inclusion criteria for materials were scientific articles, legal acts, court rulings, and analytical reviews related to pharmaceutical patent rights, patent monopoly abuses, "evergreening" patents, and unfair competition in the pharmaceutical industry. The following search queries were used: "abuse of patent rights on pharmaceuticals," "patent monopoly in the pharmaceutical industry," "evergreening patents," "unfair competition in the pharmaceutical market," and "intellectual property in wartime conditions." Exclusion criteria included sources unrelated to the legal regulation of pharmaceutical patents, materials not directly connected with patent rights, and publications that did not meet scientific standards and credibility. It has been determined that patent monopolies can lead to higher drug prices, the prevention of generic drug production, import dependency, reduced competitiveness, and other consequences. Additionally, the creation of "evergreening" patents affects competitive relations, representing a form of unfair competition. Examples of patent monopolies in pharmaceuticals owned by major global pharmaceutical companies (Gilead, Merck Sharp & Dohme Corp., etc.) were examined. Attention is drawn to the problematic aspects of legislative implementation to strengthen the protection of individuals’ interests in the field of intellectual property during martial law, which leads to misinterpretation and implementation of relevant provisions and requires updating. Court cases of pharmaceutical companies regarding the artificial maintenance of patent monopolies and the blocking of generic drugs entering the Ukrainian market were analyzed. The need for updating and improving the legislative mechanism for regulating the validity of invention patents has been emphasized.

Cybersecurity enhancement in the field of eHealth system development in Ukraine

2024-12-27T14:52:06+02:00

Today, more than ever, cybersecurity issues are crucial in all industries and sectors, yet healthcare remains the most vulnerable. This work aims to analyze the state of cybersecurity in the most successful European countries and to outline the main steps for strengthening cybersecurity in Ukraine's electronic healthcare system. A review of literature on electronic healthcare and cybersecurity in Europe and Ukraine was conducted using Web of Science, SCOPUS, Google Scholar, and legislative databases from each of the analyzed European countries, covering a total of 49 sources from 2020 to 2024. The search was conducted using scientific terms such as “eHealth system”, “cyberattack”, “cybersecurity”, “medical information systems”, “EU4 Health”, “electronic healthcare”, “digital healthcare services”, “Ministry of Health”, “confidential information”, “legislative framework”. A total of 83 sources were initially selected and reviewed. After systematizing the gathered information, 55 of the most relevant sources were retained. Exclusion criteria included publications that did not align with the purpose of this review. The methods used included bibliographic, analytical, and forecasting. The analytical method was applied to compare Ukraine’s approach to ensuring cybersecurity in electronic healthcare with those of countries such as Estonia, Germany, France, and the United Kingdom, allowing the identification of key differences and potential improvements for Ukraine's system. Additionally, the forecasting method was used to assess future initiatives and plans in eHealth cybersecurity that should be implemented to further develop Ukraine’s protective systems. First, a clear concept of “cybersecurity of electronic healthcare” was formulated, identifying its key components. Second, the establishment of a regulatory framework was proposed to detail the aspects of cybersecurity in electronic healthcare, including guidelines and methods for supporting and improving protection systems in medical institutions. It is recommended to incorporate these provisions into the laws “On Cybersecurity” and “Fundamentals of Ukrainian Legislation on Healthcare” to enhance the effectiveness of cybersecurity measures in healthcare. Thirdly, we analyze the effectiveness of the most common cybersecurity tools and provide recommendations for their use in Ukraine: introducing regular backups for all medical systems, setting up firewalls, centralized IDS/IPS systems, mandatory data encryption, enhanced VPN authentication, automated threat monitoring systems, and engaging experts to ensure comprehensive cybersecurity of medical institutions. This will help to preserve significant amounts of confidential information and ensure the possibility of recovering lost data. The need to adapt the best European practices to the special conditions in Ukraine to work confidently in the face of potential and real threats was emphasized, which will allow timely response to new challenges and ensure cybersecurity.