Medicni perspektivi

The system of medical rehabilitation of the disabled people: experience of the leading EU and NATO countries

2025-06-26T14:14:01+03:00

Timeliness, purposefulness, patient centeredness, consistency, and continuity are the general principles of rehabilitation and the defining tasks of developed countries, especially in the context of ensuring the realization of the rights and opportunities of people with disabilities. The purpose of the study was to identify the features of medical rehabilitation systems for persons with disabilities in the leading EU and NATO countries that have experience in rehabilitating combatants and to substantiate proposals for improving the current system of medical rehabilitation in Ukraine. The study is based on the analysis of the conceptual principles of building rehabilitation systems in eight countries with developed democratic institutions, experience of military operations and belonging to classical models of social protection: Canada, France, Germany, Italy, Poland, Spain, the United Kingdom, the United States. The methods of comparative analysis, structural analysis, objectivity and consistency were used. The main results of the study are the identification of weaknesses of the Ukrainian medical rehabilitation system, such as fragmentation of service provision, lack of unified management coordination, insufficient information and uneven location of institutions. The advantages of foreign systems are analyzed: targeting medical rehabilitation, use of outsourcing, involvement of the community and volunteers, creation of competition between medical institutions, emphasis on mental rehabilitation, and use of sanatorium and resort facilities. It is proposed to create a single state body for coordinating medical services, develop a national roadmap for rehabilitation measures, encourage volunteers and expand the range of rehabilitation professions. The experience of the leading EU and NATO countries demonstrates the need for a systemic restructuring of medical rehabilitation in Ukraine through the introduction of modern approaches and methods aimed at improving the quality and accessibility of services. Successful implementation of foreign experience will create an effective national system capable of meeting the current challenges and needs of people with disabilities.

Medico-social rationale for the development of digital personnel potential in healthcare

2025-06-26T14:34:15+03:00

The digital transformation of the healthcare system is a key factor in improving the efficiency of medical services and sector management. One of the critical aspects of this transformation is the development of digital workforce potential, which includes the formation and enhancement of digital competencies among healthcare professionals. The aim of the study was to provide a medical and social justification and develop a conceptual model for the development of the digital potential of healthcare personnel to improve the sector's operational efficiency. A comprehensive approach was applied in the research, including a sociological survey of 162 healthcare professionals (practicing physicians, managers, and researchers), an analysis of strategic documents, the conceptual modeling method, and statistical analysis using standard tests conducted via Jupyter Notebook (https://jupyter.org). The findings indicate that the overall self-assessed level of digital competencies among healthcare professionals is moderate – 2.63 (95% CI 2.53-2.74) on a 5-point scale – suggesting potential for further growth. The highest competency level was recorded in general digital literacy, while the lowest was in digital tools and applications. Statistically significant differences were identified (p<0.001), as well as a positive correlation between the level of digital skills and the awareness of their importance for professional activities. The study identified the key stages in the cycle of forming, developing, and consolidating digital competencies among healthcare personnel while building digital human resource potential in healthcare. The most important stakeholder groups were also highlighted, with the top three, as identified by respondents, being: the Ministry of Health, higher medical education institutions, and healthcare institutions. Other key stakeholders include healthcare professionals and patients. Among the measures for developing digital competencies in healthcare personnel, respondents rated infrastructure development as the most significant at the systemic and organizational levels (over 40% of top ratings). A conceptual model for the digital potential of healthcare personnel in the healthcare system has been proposed. This model could serve as a foundation for developing further strategies in this area and contribute to achieving the primary goal of the sector – improving public health.

Study of affordability of pharmaceutical provision for type 2 diabetes therapy in Ukraine

2025-06-26T15:39:59+03:00

Increasing the availability and affordability of medical and pharmaceutical care to the population is the most important task of all levels of government. The purpose of the work is to study the affordability of glucose-lowering drugs for the treatment of type 2 diabetes in Ukraine. Research materials are: State Register of Medicinal Products and price of glucose-lowering drugs. Marketing, analytical, graphic and pharmacoeconomic analysis were used. On the pharmaceutical market of Ukraine 161 glucose-lowering drugs are registered, which contain 16 international non-proprietary names and 8 international non-proprietary names combinations. It was established that the cost of Defined Daily Dose for mono glucose-lowering drugs varies from UAH 1,1 for glibenclamide up to UAH 90,7 for liraglutide. Most of the Ukrainian-made and foreign drugs are highly affordable, but foreign preparations of modern groups are moderately affordable, only one foreign drug, Liraglutide, is unaffordable ratio. But the analysis of affovailability for pensioners only metformin (Ukrainian production), glibenclamide, gliclazide, and glimepiride are highly affordable, three of which are already subject to reimbursement. Modern glucose-lowering drugs, both of foreign and Ukrainian production, is scarcely affordable, which makes it practically impossible to use them in the majority of retirees with diabetes. Thus, the analysis showed that in order to implement modern treatment schemes for type 2 diabetes, which according to the current legislation can be used in Ukraine, it is necessary to expand the list of glucose-lowering drugs included in the reimbursement program. This will improve treatment results, which in turn will reduce the development of diabetes complications and improve the quality of life of patients.

Remediation strategies and systemic improvements in health care after COVID-19: an analysis of international practices in hospital financing

2025-06-27T11:43:33+03:00

During the coronavirus pandemic, health care systems worldwide encountered serious challenges. Many patients were hospitalized, and hospital sectors in numerous countries struggled to handle the crisis. The pandemic caused disruptions in health care delivery and heavily impacted hospital financing. The financial sustainability of hospitals differed among countries, depending on reliance on outpatient and elective services and other features. These gaps drove health organizations to develop new crisis management plans. This review analyzed changes in hospital financing during the pandemic in Poland, Bulgaria, the Czech Republic, Slovakia, Estonia, Latvia, Lithuania, and Georgia. We selected typical post-socialist nations in Central Europe that share similar geopolitical contexts and membership in the European Union, transitioning from centrally planned to market economies with distinct health financing models, as well as Georgia, which aims to become a member of the European Union. The aim of the present study is a comprehensive analysis of international practices of hospital sector financing under the conditions of the COVID-19 pandemic, based on a comparative analysis of crisis response mechanisms in eight countries, with an emphasis on identifying effective remediation strategies and systemic healthcare improvements in the context of financial sustainability, digitalization, and integration into the public health system. Comparing these countries reveals how they adapted to pandemic pressures, employed financial regulations, and addressed challenges, offering insights for similar health systems worldwide. The analysis indicates that the strength and structure of a country’s health financing, especially having an established diagnosis-related group system and comprehensive public health insurance, were crucial for managing the pandemic. Countries with robust systems, such as the Czech Republic, Poland, and Estonia, had better capacity to mobilize resources, adjust funding mechanisms, and support hospitals and staff. In contrast, countries with less well-funded structures, including Bulgaria, Latvia, and Georgia, experienced greater obstacles in their pandemic responses. Remediation of the public health sector within socio-ecological and socio-economic frameworks is essential. It covers a wide spectrum of pressing issues, proposing integrated solutions that safeguard health and improve social and environmental living conditions.

Regulation of the non-steroid anti-inflammatory drug «Diclofenac sodium» in the air environment of populated places

2025-06-26T13:50:28+03:00

The most common group of drugs today are non-steroidal anti-inflammatory drugs, among which diclofenac sodium is one of the most widely used. It has a pronounced anti-inflammatory, analgesic and moderate antipyretic effect by inhibiting the synthesis of prostaglandins. This active pharmaceutical ingredient belongs to the second class of the Biopharmaceutical classification system, which has a high degree of permeability through biological membranes, which leads to the possibility of absorption of diclofenac sodium already in the stomach, thereby causing unwanted side and negative effects. Considering the large volumes of production and possible serious side effects of this active pharmaceutical ingredient, it is advisable to control the level of this substance in atmospheric air. The purpose of this work was to scientifically substantiate the hygienic regulation of diclofenac sodium in the atmospheric air of populated areas based on studies of the toxicological properties of this active pharmaceutical ingredient. Experimental animals (102 non-linear white mice, 136 non-linear white rats of both sexes, 60 short-haired mice) were divided into experimental and control groups of 6 individuals each. Based on the obtained indicators of lethality of experimental animals, using the method of probit analysis, the indicators of toxicity during acute exposure of the substance were determined – semi-lethal dose with a single intragastric administration of DL₅₀ for female rats (54.83 mg/kg), DL₅₀ for mice (550 mg/kg), DL₅₀ for rats-females (104.4 mg/kg), and CL₅₀ for male rats (243.11 mg/m³), CL₅₀ for mice (71.61 mg/m³). According to subchronic exposure, it was established that diclofenac sodium has supercumulative activity, since the cumulative coefficients for subacute administration to mice and rats are <1 (0.94 and 0.96, respectively). It was determined that this substance does not have a pronounced irritating effect on the mucous membrane of the eyes and does not exhibit allergenic properties. Does not cause sensitization of the body. It is shown that the possibility of developing acute poisoning from a single inhalation exposure to diclofenac sodium is unlikely, which is confirmed by the coefficient of the possibility of inhalation poisoning (СPIP=0.000032). In turn, the low value of the Lim_ch indicator (1.18 mg/m³) indicates the real danger of developing chronic inhalation poisoning with diclofenac sodium. Z_biol is 60.7, which indicates a significant sign of the ability to accumulate in the body. Expressed cumulative properties of this substance increase the risk of chronic poisoning. The maximum one-time maximum permissible concentration (MPC) in the atmospheric air of populated areas at the level of 0.03 mg/m³ was determined and substantiated. Thus, it is expedient to control and monitor the air environment during the production of medicinal products in order to prevent diclofenac sodium from entering the sanitary protection zones.

Search for biological mechanisms of toxic action of shoe glues: cell viability in vitro, albumin damage and free radical generation

2025-06-26T13:58:12+03:00

The combined use of cellular, extracellular research methods for studying the toxic effect of shoe glues is an additional tool for screening and assessing the potential risks of their use. The aim of the work was to investigate the mechanisms of the toxic effect of shoe glues at the cellular, molecular and biochemical levels. Rubber, polychloroprene and polyurethane shoe glues were used. Three experimental approaches were applied: measurement of survival of mammalian cells, a spectroscopic study of conformational changes of albumin, and a free radical measurement. Cytotoxicity testing was performed on murine fibroblasts Balb/c-3T3 line, human embryonic kidney cells HEK-293 and human keratinocytes of the HaCaT line treated for 24 and 72 hours with glues samples. A survival of treated cells was monitored using MTT-test. Changes in the spectral characteristics of albumin were monitored during exposure for 24 hours and 21 days with "fresh" and "dried" samples of glues. Content of free radicals was evaluated in the reaction with DPPH reagent. The cytotoxicity was increased with increasing exposure time, and depended on both the type of glue and the type of treated cells. The polyurethane glue demonstrated the most pronounced cytotoxic effect. Balb/c-3T3 fibroblasts were the most sensitive to the action of all types of glues, a reliable maximum increase in cell death was manifested in 72 hours exposure (28.9-19.1% of living cells).While cells of HEK-293 and НаСаТ lines were more resistant. At 24 hours contact, their viability was 99.12-79.22% and 99.0-56.9%, respectively. Increased exposure up to 72 hours reliably caused a decrease in the survival of these cell lines – 96.24-68.1% and 82.2-51.7%. The loss of the solvent didn’t affect the cytotoxic effect of the studied glues. Conformation changes in albumin were manifested during its long-term contact with both "fresh" and "dried" glues. Manifestations of the toxic effect of glues on biomolecules were increased in the sequence: rubber > polyurethane > polychloroprene. Shoe glues demonstrated an ability to generate free radicals in the sequence: rubber > polychloroprene > polyurethane. These manifestations were increased in a time period of 4 hours – 24 hours. That may create risks when they are used. The results can be used to determine the targets and mechanisms of the toxic effect of shoe glues and to obtain new knowledge in the field of research of industrial toxicants.

Methods of modelling obesity in an animal experiment (analytical literature review)

2025-06-19T15:22:00+03:00

The aim of the study was to explore the most effective experimental models of obesity that have been used over many years to study this condition in animals, as well as the models that most closely resemble obesity in humans. The article analyzes the current scientific literature regarding the use of various models to study the most pressing and widespread medical issue of today – obesity. A literature review and analytical analysis were conducted, along with a synthesis of data from scientific literature, which allowed for the examination of various obesity models most commonly used in experimental research by scientists. With the increase in body mass index and the onset of morbid obesity, pathological modifications are observed in all organs and systems of the human body: non-alcoholic fatty liver disease, metabolic syndrome, type 2 diabetes, insulin resistance, dyslipidemia, cardiovascular pathologies, various types of cancer of internal organs, mental disorders, and others. Experimental models of obesity in research animals allow for a deeper understanding of the development and progression of this disorder, which can expand current knowledge about the mechanisms underlying its formation, establish key pathomorphological manifestations, potential complications, and optimize new approaches to the diagnosis and treatment of obesity. However, in contemporary scientific literature, the question of improved and adequate selection of obesity models in animal studies remains open, with results that can be extrapolated to humans. To date, no single animal model can fully represent the entire spectrum of diseases and metabolic disorders associated with obesity in humans. Fatty liver disease represents a spectrum of continuous conditions associated with obesity: type 2 diabetes, insulin resistance, and hyperlipidemia. A significant amount of contemporary scientific literature documents researchers' studies on the progression from simple steatosis to non-alcoholic steatohepatitis, as well as to fibrosis and ultimately to hepatocellular carcinoma. Over the past 5-10 years, researchers have described the most commonly used animal models of fatty liver disease: genetic, chemical, dietary, and others. However, the mechanisms underlying the pathogenesis of obesity and related diseases remain not fully understood, and currently there are few available effective therapeutic approaches in the scientific literature. A large number of different animal models of obesity have been developed and described by researchers to study the pathophysiology of non-alcoholic fatty liver disease. Scientific sources highlight their advantages and disadvantages, as well as provide recommendations for researchers in selecting appropriate animal models.

Repeated blast-induced neurotrauma: histopathological changes in the hippocampus and cerebellum of rats

2025-06-20T12:29:19+03:00

Repeated blast-induced neurotrauma impairs the quality of life of military personnel and civilians who have suffered from repeated blast wave exposure. The aim was to study histopathological changes in the hippocampus and cerebellum of rats after repeated 3-fold blast wave exposure. The study was conducted on 40 male rats, randomly divided into control (n=5) and experimental groups (n=35). The experimental group of rats was divided into 5 animals for each observation period: 30 minutes, 1st, 3rd, 7th, 14th, 21st and 28th days, to track the dynamics of morphological changes. Animals of the experimental group were anesthetized with halothane and fixed on the abdomen so that the muzzle was at a distance of 5 cm from the device outlet. They were exposed to an excess pressure of 31.6±4.8 kPa. Then the animals were decapitated, the brain was removed, the hippocampus and cerebellum were separated, fixed and stained with hematoxylin-eosin according to the standard method. Light microscopy of the hippocampus demonstrated signs of karyopyknosis already 30 minutes after 3-fold exposure to the blast wave, as well as signs of perivascular and pericellular edema, and hypochromia of pyramidal cells. These signs intensified during all subsequent periods of observation. Light microscopy of the cerebellum demonstrated signs of pericellular edema in the Purkinje layer area 30 minutes after repeated exposure to the blast wave, which increased on the 1st and 3rd days, and then began to decrease. Hypochromia of Purkinje cells was observed throughout the entire period of observation of the experimental animals. On the 7th, 21st and 28th days, clearly visible signs of engorgement of the cerebellar blood vessels were observed. Thus, our morphological study showed that after 30 minutes, on the 1st, 3rd, 7th, 14th, 21st and 28th day after repeated exposure to a blast wave, primary and secondary brain changes were observed. In the hippocampus, signs of karyopyknosis and chromatolysis of pyramidal cells, as well as perivascular and pericellular edema were observed. In the cerebellum, hypochromia of Purkinje cells, pericellular edema in the Purkinje layer zone and hyperemia of blood vessels were detected. These changes can serve as biomarkers of traumatic disorders after 3-fold exposure to a blast wave.

Methods for studying the state of bone metabolism in patients with diabetes who require comprehensive total rehabilitation of the oral cavity through dental implantation

2025-06-23T12:56:48+03:00

Replacement of dentition defects using the dental implantation method is today one of the most common operations in the practice of a dentist-surgeon. The purpose of the study is to substantiate the choice of diagnostic methods for patients with type 2 diabetes mellitus, complicated by generalized periodontitis and diabetic osteopathy, who require dental implantation for total replacement of dentition defects. An electronic search was performed in PubMed and Google Scholar in the time interval 2003-2023. The study found 3728, selected 1170 and analyzed 24 sources, according to which the most optimal and expediently recommended research methods for the above group of patients were established. When processing information, the inclusion criteria were the study design, which included books and documents, clinical studies, meta-analysis, randomized controlled trial, review, systematic review, etc. The exclusion criteria were publications that did not meet the purpose of this review. The keywords used were “periodontitis”, “periodontal pathology”, “diabetes mellitus”, “bone metabolism markers”, “dental implantation”, “bone metabolism”, “surgical dentistry”, “maxillofacial surgery”. In patients without general somatic pathology, the results of implant treatment are quite predictable, however, the treatment of patients with type 2 diabetes mellitus may be compromised by a large number of complications, especially if they have generalized periodontitis and diabetic osteopathy. There is no consensus in the literature among researchers regarding the nature of the combined effect of the above pathology and various variants of generalized periodontitis on the features of bone metabolism and the results of dental implantation, especially in those patients who require total rehabilitation, which in turn requires a more detailed study of their effect on the osseointegration of implants. This is of particular importance for the development of new approaches to preoperative diagnostics of personalized determination of indications and contraindications for dental implantation in this category of patients. In contrast to X-ray studies, cone-beam computed tomography and dual-energy X-ray absorptiometry have a more sensitive response to changes in the rate of balance between the processes of bone resorption and osteosynthesis, which makes their clinical use valuable for monitoring in the preoperative period and predicting osseointegration after dental implantation, as well as for assessing the response to the prescribed treatment. Diagnostics and planning of surgical interventions in patients with type 2 diabetes mellitus cannot be similar to those used in somatically healthy patients.

Physiological regulation of peroxisome proliferator-activated receptor-gamma coactivator 1 alpha in mitochondrial metabolism during physical exercises: a systematic review

2025-06-23T13:35:02+03:00

This study aims to analyze in depth the mechanism of physical exercises in increasing the expression of PGC-1α (peroxisome proliferator-activated receptor gamma coactivator 1-alpha) as the most important part of mitochondrial biogenesis through a systematic review. Literature databases including PubMed, Web of Science, and Science Direct were searched for this systematic review study. The inclusion criteria for this study were articles published in the last five years. The articles discussed PGC-1α, exercises, and mitochondrial biogenesis. PubMed, Web of Science, and Science Direct databases were used to find 141 published articles. Finally, 13 articles that met the inclusion criteria were selected and analyzed for this systematic review. In this study, standard operating procedures were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Exercises have been shown to increase PGC-1α expression, according to this systematic review. Increased biogenesis in mitochondria may be triggered by increased PGC-1α expression, which helps in the energy production process. On the other hand, it is not yet clear about the ideal intensity and type of physical activity to increase PGC-1α. This provides recommendations for further exploration in future experimental studies.

Distribution of dendritic cells in the pilosebaceous unit of the scalp in subversive abscessing perifolliculitis of the scalp: immunomorphological aspects

2025-06-23T13:51:45+03:00

Abscessing perifolliculitis of the scalp (Hoffmann's disease) is a rare but serious chronic purulent-inflammatory disease of the hair follicles, which leads to the formation of deep abscesses, cicatricial alopecia and a significant decrease in the quality of life of patients. Our observations of the increase in cases allow us to state the relevance of this problem today and the need for additional, more thorough study of the pathology of the immune system underlying this pathological process. In the skin, one of the leading places among the cells that maintain local immune homeostasis and initiate protective innate and adaptive immune responses is occupied by Langerhans cells or the so-called dendritic cells of the epithelium. The aim of the work is to investigate the number and location of skin dendritic cells (separately subpopulations of Langerhans cells and dermal dendritic cells) in subacute abscessing perifolliculitis of the head, with special attention to damage to the structures of the pilosebaceous unit of the skin. Biopsy material from patients diagnosed with abscessing perifolliculitis of the head (Hoffmann's disease) who underwent examination and treatment at the medical center of the private enterprise “Dzerkalo”, Dnipro, Ukraine, was studied. All patients were male military personnel, whose age ranged from 20 to 51 years, the average age was 35.5±11.54 years. IHC was performed according to the TermoScientific (TS) protocols with primary antibodies to dendritic cells (CD1a, RTU). The Lab Vision Quanto (TS, USA) imaging system was used with the determination of the reaction using the DAB Quanto Chromogen (TS, USA) chromogen. Studies of the number and distribution of CD1a (+) cells (epidermal Langerhans cells and dermal dendritic cells) revealed significant differences in their accumulation and branching for the comparison groups. The greatest difference was demonstrated by areas of hair follicles where Langerhans cells were absent in the control group, namely in the internal root epithelial sheath, as well as in the hair dermal papilla (all p<0.05). In comparison, in abscessing perifolliculitis of the head, CD1a (+) cells actively accumulated in these areas with spread to areas around the sebaceous glands and muscles that lift the hair, with significant infiltration of all structures of the pilosebaceous unit and the surrounding dermis or hypodermis stroma. The average number of Langerhans cells among keratinocytes in the study group significantly exceeded the control group's indicators (26.07±11.51 cells compared to 6.02±11.51 cells, respectively (p<0.05)), and also demonstrated a wide network of branched processes. The stratified squamous epithelium in abscessing perifolliculitis of the head was characterized by acanthosis, hyperplasia, and increased mitotic activity. Accumulation of CD1a (+) cells in the internal root epithelial sheath and hair dermal papilla was observed only in the study group and was absent in the control group, (p<0.05). In the outer root epithelial sheath of pilosebaceous units around the hair follicle bud roller, the number of CD1a (+) cells in the study group significantly exceeded the control group (31.44±8.86 cells compared to 4.84±1.12 cells, respectively (p<0.05)), due to which T-lymphocyte infiltration with prolonged inflammatory damage and alopecia is probably maintained in this area. A statistically significantly higher density of infiltration by CD1a (+) dendritic cells in the area of the excretory ducts of the secretory departments of the sebaceous glands in the study group compared to the control group (17.87±11.65 cells compared to 6.24±2.05 cells, respectively (p<0.05)) due to excessive antigenic stimulation may be the cause of sebaceous gland hyperplasia. The increased density of antigen-presenting cells such as CD1a (+) dendritic cells among the inflammatory infiltrate of the dermis in PCAS compared to the control group (52.50±16.77 cells compared to 6.87±3.13 cells, respectively (p<0.05)) indicates the active migration of these motile cells and the predominance of effector mechanisms of the immune response around the pilosebaceous units of the scalp.

Cardiomyopathies with left ventricular hypertrophy phenotype: prevalence of cardiac amyloidosis and clinical characteristics of patients

2025-06-23T14:24:54+03:00

Cardiac amyloidosis was long considered a rare disease, primarily affecting the elderly. However, recent studies have demonstrated a higher prevalence, highlighting the need for further investigation, particularly in Ukraine, where data remain limited. The underdiagnosis of cardiac amyloidosis is primarily due to the low specificity of its clinical manifestations, which can mimic other cardiovascular diseases, particularly those presenting with a left ventricular hypertrophy phenotype. The aim of this study was to evaluate the prevalence and clinical characteristics of patients with cardiac amyloidosis among cardiomyopathies with the left ventricular hypertrophy phenotype, based on single-center data. This study was a retrospective analysis of medical records from the outpatient and inpatient departments of the SI “NSC “Strazhesko National Scientific Center of Cardiology and Regenerative Medicine of the NAMS of Ukraine” between 2020 and 2023. Data on subjective complaints, medical history, clinical examination findings, six-minute walk test results, and screening laboratory and instrumental evaluations were analyzed. Statistical analysis included confidence interval estimation, Pearson’s χ² test, one-way analysis of variance (ANOVA), and Tukey’s post hoc test. Data from 294 patients with left ventricular hypertrophy phenotypes were examined, including 177 cases (60.2%) of non-obstructive hypertrophic cardiomyopathy, 70 cases (23.8%) of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction, and 47 cases (16%) of cardiac amyloidosis. The true prevalence of cardiac amyloidosis among cardiomyopathies with a left ventricular hypertrophy phenotype was estimated at 16% (CI 95%: 7.44-24.56%). Patients with cardiac amyloidosis were characterized by older age (56.8±11.7 years, F=6.85, p≤0.01), presence of congestive heart failure in the medical history (45 cases, χ2=65.54, p≤0.001), reduced distance covered in the 6-minute walk test (248.3±131.6 meters, F=10.77, p<0.001), signs of congestion in the systemic circulation (89%, 42 cases, χ2=64.56, p<0.001), and decreased left ventricular ejection fraction (54.5±15.1%, F=11.71, p≤0.05) compared to both groups of hypertrophic cardiomyopathy. Extracardiac manifestations of cardiac amyloidosis included proteinuria (83%, 39 cases), neuropathy (59.6%, 28 cases), hepatomegaly (55.3%, 26 cases), skin involvement and bruising (34%, 16 cases), carpal tunnel syndrome (23.4%, 11 cases), macroglossia (19.1%, 9 cases), digestive disturbances (12.8%, 6 cases), weight loss (19.1%, 9 cases), and thrombotic events at various sites (14.9%, 7 cases). Thus, cardiac amyloidosis is an underrecognized pathology, accounting for 16% of cardiomyopathies with a left ventricular hypertrophy phenotype. Compared to non-obstructive and obstructive hypertrophic cardiomyopathy, these patients are characterized by older age, more severe systemic conditions, decreased left ventricular systolic function, and systemic extracardiac manifestations. Multicenter studies are required to determine the true prevalence of cardiac amyloidosis in Ukraine.

Transforming growth factor beta-1 in patients with hypertension who had COVID-19

2025-06-23T15:27:39+03:00

Post-covid syndrome is a multisystem disease. The totality of disorders of organs and systems, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes significant damage to human health for a long time, especially if the patient has comorbid pathology. Taking into account the concern about the impact of COVID-19 on the cardiovascular system, several mechanisms of the direct impact of SARS-CoV-2 on the specified system are considered. It should be noted that there is a limited number of studies on the observation of patients with post-covid syndrome. Today, the priority direction is the study of predictors of the adverse course of cardiovascular diseases, especially after COVID-19. Transforming growth factor β1 can be considered one of the potential markers of cardiovascular complications. The aim of our study was to evaluate the level of transforming growth factor β1 in patients with hypertension who had COVID-19. The cross-sectional study included 27 patients with hypertension after COVID-19. 16 patients with controlled hypertension (blood pressure 140/90 mm Hg) formed the first group. The second group was formed by 11 patients with uncontrolled hypertension (blood pressure ≥140/90 mm Hg). We determined the increased level of transforming growth factor β1 and its relationship with the glucose (r=0.38, p=0.049). The level of blood pressure control was associated with increasing age of patients, lower glomerular filtration rate (p<0.01), and worse glucose control (p<0.05). Thus, the data indicate that transforming growth factor β1 may be a possible factor inducing the development of cardiometabolic disorders in patients with hypertension after COVID-19.

Clinical efficacy and safety of high-dose ambroxol in the form of oromucosal spray in postnasal drip syndrome: results of a multicenter study in Ukraine

2025-06-23T15:36:52+03:00

Postnasal drip syndrome (PNDS) is one of the most common clinical conditions in the practice of otolaryngologists and family physicians, characterized by the drainage of mucous or mucopurulent secretions along the posterior wall of the pharynx and accompanied by rhinorrhea, nasal congestion, cough, and a feeling of irritation in the throat. Epidemiological studies show that approximately 20% of the adult population and 15% of children regularly suffer from manifestations of postnasal drip. The pathogenetic mechanisms of the development of PNDS are mucus hypersecretion, impaired rheological properties, dysfunction of mucociliary clearance, and local inflammation. The aim of our study was to clinically evaluate the efficacy and safety of different dosage regimens of the drug "Respx® Spray" (ambroxol) for postnasal drip on the background of common respiratory diseases. A large-scale prospective observational multicenter study was conducted, which included 1867 patients aged 12 to 65 years from 15 regions of Ukraine. The study lasted from September 2023 to March 2024. Patients had various respiratory diseases accompanied by postnasal drip: rhinopharyngitis (47.3%), acute rhinosinusitis (34.0%), vasomotor rhinitis (7.4%), tonsillopharyngitis (4.6%), acute tracheobronchitis (3.8%) and laryngitis/laryngotracheitis (2.9%). The effectiveness of the use was assessed by the dynamics of the intensity of postnasal drip on a 5-point scale at the beginning and on the 5-7th day of treatment. The safety of the drug was monitored by registering and analyzing adverse reactions. The results of the study showed a statistically significant decrease in the intensity of postnasal drip from 4.28±0.03 to 0.91±0.03 points on the 5th day of therapy (p<0.001). The highest efficiency was recorded with the dosage regimens of 4 sprays 4 times a day (decrease to 0.38±0.10 points) and 3 sprays 2 times a day (decrease to 0.60±0.15 points). Subjective assessment of the dynamics of symptoms by patients showed a rapid development of the therapeutic effect – already on the 2nd day of treatment, patients noted a moderate improvement (1.55±1.19 points), and on the 5th day a significant improvement was observed (4.66±0.99 points). The highest subjective improvement rates were recorded in patients with hypertrophic rhinitis (4.56±0.08 points) and tracheitis/acute bronchitis/acute tracheobronchitis (4.52±0.15 points). Overall satisfaction with the treatment was extremely high – 76.4% of patients rated it at 9-10 points on a 10-point scale, another 20.3% – at 7-8 points. Multivariate regression analysis revealed that the effectiveness of the treatment was significantly influenced by factors such as the dosage regimen (p<0.01), the initial intensity of the symptom (p<0.001) and the underlying disease (p<0.05). Non-serious adverse reactions were observed in only 1.2% of patients, which is a fairly low rate and indicates a good safety profile of the drug. The obtained data indicate that ambroxol in the form of a high-dose oromucosal spray is an effective and safe means for alleviating the manifestations of postnasal drip, ensuring high compliance and patient satisfaction. The choice of dosage regimen should be made taking into account the nature of the underlying disease and the initial intensity of postnasal drip syndrome. The safety of the preparation was monitored through registration and analysis of adverse reactions. The results of the study established a statistically significant reduction in the intensity of postnasal dripping from 4.28±0.03 to 0.91±0.03 points on the 5th day of therapy (p<0.001). The highest clinical efficacy was observed with dosing regimens of 4 jets 4 times a day (reduction to 0.38±0.10 points) and 3 jets 2 times a day (reduction to 0.60±0.15 points). Patients' subjective assessment of symptom dynamics indicated a rapid development of therapeutic effect – by the 2nd day of treatment, patients noted moderate improvement (1.55±1.19 points), and by the 5th day, significant improvement in condition was observed (4.66±0.99 points). The highest indicators of subjective improvement were recorded in patients with hypertrophic rhinitis (4.56±0.08 points) and tracheitis/acute bronchitis/acute tracheobronchitis (4.52±0.15 points). Overall treatment satisfaction was exceptionally high – 76.4% of patients rated it at 9-10 points on a 10-point scale, while another 20.3% gave it 7-8 points. Multivariate regression analysis revealed that treatment efficacy was significantly influenced by factors such as dosing regimen (p<0.01), baseline symptom intensity (p<0.001), and underlying disease (p<0.05). The obtained data indicate that ambroxol in the form of oromucosal spray is an effective and safe remedy for the treatment of postnasal syndrome of various etiologies, providing high compliance and patient satisfaction. The selection of dosing regimen should be tailored according to the nature of the underlying disease and the baseline intensity of the postnasal syndrome.

Prediction of coronary artery disease risk in patients with type 2 diabetes mellitus: a mathematical model

2025-06-24T09:45:59+03:00

Coronary artery disease (CAD) is one of the most prevalent and life-threatening complications in individuals with type 2 diabetes mellitus (T2DM). The aim of this study was to develop a mathematical model for predicting the risk of CAD in patients with T2DM. A total of 242 patients with T2DM, aged 30-80 years, were examined. The following parameters were analyzed: patient age, age at T2DM onset, disease duration, fasting glucose levels, glycated hemoglobin levels, lipid profile parameters, blood pressure, presence of diabetic complications, lifestyle factors, family history, and parental exposure to famine in 1932-1933. The predictive mathematical model for CAD development in T2DM patients was constructed using receiver operating characteristic (ROC) analysis and multiple logistic regression. ROC analysis identified the prognostic value of each of the eight key independent variables, which do not depend on the patient's current health status and can be considered independent at the time of CAD diagnosis. In the second phase of the study, a formula for calculating CAD probability was developed, incorporating the most informative variables with predictive significance. These included the patient’s age, T2DM duration, presence of chronic kidney disease, paternal history of T2DM, maternal famine exposure during pregnancy, rural residence, and patient sex. The developed formula was used to predict CAD risk, and its sensitivity, specificity, and diagnostic performance were evaluated. The model demonstrated high predictive accuracy (AUC=0.792 [0.734–0.842], chi-square =65.1; p<0.001). The probability of CAD development was determined with an accuracy of 72.3%, and the model’s predictive efficiency was 73.6%. The obtained results allowed us to establish statistically significant associations between the studied risk factors and CAD development in T2DM patients. Based on these findings, we have developed a mathematical model for predicting CAD risk in T2DM patients, which can be implemented in clinical practice.

Changes in the function of external breathing in patients who underwent lung decortication after post-pneumonic pleurisy

2025-06-24T10:08:32+03:00

This article explores changes in pulmonary function in patients who underwent lung decortication as a method of treating complications caused by post-pneumonic pleurisy. It is emphasized that complications such as post-pneumonic pleurisy may lead to the formation of pulmonary fibrosis, which results in a progressive decrease in the effectiveness of external respiratory function. The objective of this research was to assess the clinical effectiveness of surgical lung decortication in individuals with complicated post-pneumonic pleurisy during the early postoperative period based on comparative analysis of spirometric indicators measured both before and after the surgical procedure. A total of 36 patients who suffered from post-pneumonic pleurisy and underwent decortication were included in this study. The primary diagnostic tool used was spirometry. Pulmonary function tests were performed in full compliance with the guidelines of the European Respiratory Society, ensuring accuracy and consistency of results. Statistical analysis using the Wilcoxon test for dependent samples confirmed that decortication led to a statistically significant improvement (p<0.05) in ventilation performance. The procedure was especially effective for addressing restrictive ventilatory impairments caused by fibrotic changes in the pleura, which develop due to the complicated course of pleurisy. Indications for decortication included severe impairment of lung ventilation, radiological signs of fibrin adhesions, and failure of less invasive interventions such as pleural puncture. The operation enables to noticeably improve the quality of life of patients, achieved through the restoration of respiratory function and decrease of restrictive disorders already in early postoperative period: a 16% increase in forced vital capacity and a 13% improvement in forced expiratory volume in the first second. These outcomes correspond with those documented in international clinical studies, confirming the value and effectiveness of the procedure.

Experience of using psychological support for 6th year medical university students in conditions of high stress levels and reduced quality of life indicators

2025-06-24T10:17:12+03:00

Constant and excessive stress leads to psychological disorders in medical students, especially in ones of senior years of study. This creates problems with motivation to acquire knowledge, concentration, memorization of necessary information, an increase in the number of errors, the result of which can be a decrease in academic performance of a student of higher medical education. Student youth is the future of our country, therefore it is important to study the state of physical and psychological health of students and make every effort to improve their quality of life, especially in conditions of constant stress. The purpose of the study was to assess the level of anxiety and depression in students of the 6th year of a higher medical education institution, their quality of life, vitality and resilience, as well as to determine the directions of effective psychological support in conditions of constant stress. To achieve the goal, the quality of life was determined according to the SF-36 scale, the level of anxiety and depression – according to the HADS scale, the level of vitality - according to the S. Maddi "Test of Vitality" and resilience – according to the CD-RISC-10 technique. 61 students of the 6th year of the Dnipro State Medical University took part in the primary study. Among them, 42 students took part in psychological support during a 2-month cycle. According to the results of the study, it was found that the reduced level of quality of life was in mental health – MH=59.6±2.46), social functioning – SF=58.4±2.5), vital activity – V=53.7±2.46. According to the HADS anxiety and depression scales, it was determined that subclinical anxiety and depression syndrome occurred in 9 (14.8%) and 7 (11.4%) students, respectively, and high anxiety and depression scores (11 points and above) were diagnosed in 14 (23%) and 9 (14.8%) people. The integral index of vitality among students exceeded the average level in 25 (41.0% (81.7±1.0 points)) of students, its high indicators were in 21 (34.4% (100.8±1.59 points), and low in 15 (24.6% (57.3±2.64 points)) students, respectively. The level of resilience in all examined students was within 29.7±1.15, which is an average indicator. Psychological support provided to students had a positive effect on role-based physical functioning, as an indicator of quality of life, on the reduction of psychological tension, which improved attention, memory and sleep, reduced the anxiety response to sirens. Academic stress reduced students' quality of life and learning results. To overcome the stress associated with the state of war in the country, a psychological support program was developed and applied, the purpose of which was to influence the psycho-physiological and psycho-emotional state, correction of maladaptive thoughts and beliefs, educational activities. The presence of academic stress in students of higher education institutions requires further development of pedagogical methods and psychological counseling to improve learning and psychological health of students.

Burnout and depression in medical interns: causes, impact of war and coping strategies

2025-06-24T10:33:30+03:00

This article presents the findings of a study on the causes, impact of war and coping strategies for burnout and depression among medical interns. The study aimed to identify the factors contributing to burnout and depression in interns, the effects of war on these conditions, and respondents’ suggested strategies for managing them, to develop preventive and psychoeducational measures. The study involved 63 medical interns from the Dnipro State Medical University, undergoing training at the Department of Psychiatry, Narcology and Medical Psychology, and the Department of Pediatrics 3 and Neonatology. The interns were divided into two groups based on their specialty: "Psychiatry" (Group 1) – 31 individuals, and "Pediatrics" (Group 2) – 32 individuals. A psychodiagnostic method was employed, utilizing a custom-designed questionnaire inspired by a Medscape survey. The questionnaire focused on burnout and depression in medical interns during wartime and consisted of 21 questions structured into five clusters. The study revealed a high prevalence of symptoms of depression and burnout syndrome. Specifically, 51,6% of Group 1 and 56,3% of Group 2 reported such symptoms. War significantly impacted the psychological state of respondents, as reported by 67,7% of Group 1 and 96,9% of Group 2. Key factors included information overload, air raid alarms, and working with war-affected individuals. Female respondents were more likely to report a significant impact of war, while male respondents noted reduced attentiveness and irritability in workplace relationships. Approximately 22% of participants considered changing their profession due to burnout, with higher rates observed in Group 2 (34,4% versus 9,7%). The main coping strategies were communication with loved ones (68,3%) and creating a comfortable work environment (84,1%). However, some respondents, particularly from Group 1, resorted to isolation or psychoactive substance use (25,8%). Despite the prevalence of these issues, only 25,4% sought psychological help, with some avoiding disclosure due to stigma. The findings highlight the urgent need to develop targeted psychoeducational and preventive programs to address professional burnout and depression, particularly during wartime and in the post-war period.

The situation with vaccination in Shkodra region after the first year of implementation of human papillomavirus vaccine

2025-06-24T10:49:31+03:00

Human papillomavirus (HPV) is a common sexually transmitted infection with potentially serious health consequences, including anogenital and oropharyngeal cancers and genital warts. In 2022, Albania implemented an HPV vaccination program for girls aged 13-20 years, offering a single dose of the bivalent or quadrivalent vaccine. This study aims to evaluate the status of HPV vaccination in the Shkodra region after its first year of implementation and explore reasons for non-vaccination. This retrospective study collected data from official vaccination registers at health centers in the Shkodra region for the period 2022-2023. Additionally, face-to-face interviews were conducted with nurses responsible for administering vaccinations (vaccinators) and with parents present at the centers. Quantitative data were obtained and validated by the Chief Vaccination Office in the Epidemiology Sector at the Local Health Care Unit in Shkodra. A simple descriptive and comparative method was employed. Data for this study were gathered from two main sources: official vaccination records and interviews conducted with nurses and parents. Quantitative data were processed and analyzed using Microsoft Office Excel 2010. The vaccination coverage plan aimed to vaccinate 812 girls, with 67% (n=546) from urban areas and 33% (n=266) from rural areas. Overall, vaccination coverage was 51% (n=412 girls). Coverage was higher in rural areas (72.6%, n=193 girls) than in urban areas (40%, n=219 girls). This study highlights the challenges and successes of the HPV vaccination program in the Shkodra region during its first year of implementation. Vaccination coverage was higher in rural areas (72.6%) compared to urban areas (40%). Key barriers to vaccine uptake included parental refusal, lack of information, and fear of side effects.

Coronavirus disease 2019 (COVID-19) or preeclampsia: pathomorphological differential diagnosis of placental changes

2025-06-24T13:00:35+03:00

Coronavirus disease 2019 (COVID-19) and preeclampsia (PE) have shared clinical and pathological manifestations, creating a diagnostic challenge. The aim of the study was to identify pathomorphological changes in the placenta that are diagnostically significant for COVID-19 and preeclampsia. We studied the placenta in full-term pregnancies with maternal COVID-19 (Group I, n=80; Subgroup I.1 – COVID-19 at 19–34 weeks of gestation, n=48; Subgroup I.2 – COVID-19 at 35–40 weeks, n=32), the placenta in cases of preeclampsia (PE, n=30) – Group II (Subgroup II.1 – with mild PE; Subgroup II.2 – with moderate and severe PE), and the placenta in the comparison group, n=40. Macroscopic, microscopic, immunohistochemical, morphometric, and statistical methods were used. Placentae in the main groups were characterized by circulatory disorders. Placentitis was present exclusively in Group I. Arteriolosclerosis with vascular lumen obliteration was predominantly detected in Group II and was associated with arteriolar wall hyalinosis: Subgroup II.1 – 75% (95% CI: 49.5%–93.5%), Subgroup II.2 – 100% (95% CI: 87.3%–100%) compared to 25% (95% CI: 13.6%–38.4%) in Subgroup I.1, where it was caused by the proliferation of smooth muscle cells in the arteriolar wall followed by fibrosis, and was not observed in Subgroup I.2. A reduction in the number of terminal chorionic villi was observed in Subgroup I.1 and Subgroup II.2: 16.6 [10; 25] and 12.8 [12; 14], respectively. This was attributed to delayed villous maturation caused by vascular damage in the stem villi. The placenta in Subgroup I.2 was characterized by stromal edema of terminal villi, which led to external compression of the vessels, resulting in a reduced percentage of vessels within the villi – 26.9% [20.9%; 35.6%]. The reduction in vessel percentage in Group II.2 – 29.0% [25.6%; 34.2%] was associated with fibrosis of the chorionic villous stroma. These indicators significantly differed (p<0.0001) from Group I.1 and II.1: 45.2% [40.9%; 48.3%] and 57.6% [50.2%; 64.1%], respectively, and from the comparison group: 67.8% [58.78%; 73.7%]. Compensatory changes, such as an increase in syncytial knots, were observed in Subgroup I.2 and Subgroup II.1, with densities of 12.8 [11; 14] and 9.1 [8; 10], respectively, compared to 5.7 [5; 7] in the comparison group. A reduction in the percentage of the intervillous space was observed in Subgroup I.2 and Subgroup II.1: 26.0% [20.7%; 33.8%] and 29.2% [18.9%; 42.2%], respectively, versus 44.9% [40.5%; 49.6%] in the comparison group; p<0.0001. Placentitis is the main pathomorphological difference in placental changes in COVID-19 compared to preeclampsia. Pathomorphological changes in the placenta during the acute phase of COVID-19 and in mild preeclampsia, despite differences in disease pathogenesis, shared common features: microcirculatory disturbances and an increased number of syncytial knots as a compensatory response to reduced intervillous space (caused by villous stromal edema in COVID-19 and angiomatous changes in terminal villi in preeclampsia). Placental changes in moderate and severe preeclampsia, characterized by infarctions, arteriolosclerosis, and delayed villous maturation (distal villous hypoplasia), were similar to changes observed in COVID-19 in the second trimester of pregnancy.

Comparative characteristics of quantitative and structural chromosome abnormalities at the time of diagnosis and in relapses of acute myeloid leukemias

2025-06-24T13:19:36+03:00

Acute myeloid leukemias (AML) are a heterogeneous group of neoplasms of hematopoietic tissue, to determine the subtypes of which cytomorphological and cytochemical methods, immunophenotyping, cytogenetic and molecular genetic studies are carried out. Numerous genetic studies have identified criteria for diagnosis and prognosis of the course of the disease, which play a decisive role in the algorithms for stratifying clinical risk groups, which in turn contributes to the choice of optimal treatment tactics. However, the effectiveness of chemotherapy may lose its importance due to the lack of response to therapy and the development of relapses. The aim of the work was to establish ways to form resistance to therapy by comparing the features of quantitative and structural chromosome abnormalities at the time of diagnosis and in relapse of AML. Karyotyping was performed on bone marrow cells of 14 patients at the time of diagnosis of AML, sex ratio 1.0:1.0, mean age 44.0±3.6 years and 9 patients in relapsed disease: sex ratio 1.0:0.8, mean age 31.0±5.9 years. The analysis of the results included a comparison of the features of karyotype formation by clone structure, assessment of clones in relation to ploidy, balanced and unbalanced structural rearrangements and the frequency of chromosome involvement in such rearrangements. Subsequently, the formation of the stages of clonal chromosome abnormalities evolution was reconstructed and the frequencies of the cytogenetic prognosis groups were compared. As a result of the studies, the heterogeneity of quantitative (monosomies, trisomies) and structural balanced (translocations, inversions, insertions) and unbalanced chromosome abnormalities (deletions, isochromosomes, additional material of unknown origin, marker chromosomes) were determined, both in diagnosis and in relapse of AML. Mosaic karyotypes were almost three times more likely to occur in relapses than at the time of diagnosis (100% vs. 35.7%). At the time of diagnosis, an increased percentage of hyperdiploid clones (28.6%) was registered due to trisomies of chromosomes 2, 8×2, 13, 19, 20 and complex karyotypes (21.4%); chromosome 17 (20.8%) was more often involved in structural rearrangements, the group of intermediate cytogenetic prognosis dominated (57.1%). In relapses, chromosomes 8 and 9 were more often involved in structural rearrangements (17.6% each) and the group of unfavorable cytogenetic prognosis dominated (55.6%).

Bridging the gap: evaluating emollients and emulsifiers in dermatology for long-term skin health and barrier recovery

2025-06-26T10:25:58+03:00

This study addresses the significant gap in existing literature regarding the long-term effects of emollients and emulsifiers on skin health to systematically evaluate the impact of these substances on Trans-Epidermal Water Loss (TEWL) and skin barrier functions across various skin conditions. The main aim of this research is to evaluate the effects of commonly used emollients and emulsifiers on skin barrier function across different skin conditions to provide insights that will contribute to the development of optimized skincare formulations for individuals with compromised skin barriers. A literature search was conducted across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar, using targeted search strings to gather relevant studies published over the last 20 years. The inclusion criteria focused on peer-reviewed studies that provided empirical data on the effects of emollients and emulsifiers on TEWL and skin barrier functions, specifically in human subjects. A total of 88 articles were initially identified, with 41 meeting the strict inclusion criteria after quality assessment using Joanna Briggs Institute checklists. The review revealed varied effects of emollients and emulsifiers on skin health. Natural oils were found to enhance skin barrier functions and reduce TEWL, whereas synthetic emollients raised concerns about their occlusive properties and potential to worsen skin conditions over time. Emulsifiers showed dual effects; some exacerbated TEWL in normal skin but reduced it in damaged skin, highlighting the complexity of their interaction with skin barrier components. The findings emphasize the need for standardized research methodologies and long-term studies to better understand the mechanisms by which emollients and emulsifiers influence skin health, particularly regarding TEWL measurement techniques while products do exhibit dual behavior and scientific evidence should guide the selection of emulsifiers and emollients in skincare products to ensure both efficacy and long-term safety as well as the special assessment of the safer alternative what support both human health and environmental sustainability.

Analysis of the structure and features of traumatic injuries in victims with combat trauma

2025-06-26T10:44:33+03:00

The aim of this study was to determine the structure and characteristics of traumatic injuries in patients with mine-blast and gunshot wounds, serving as a basis for developing a comprehensive approach to medical care. The study included 127 individuals with combat-related injuries who received treatment at a healthcare facility between February 24, 2022, and October 30, 2023. Medical records, including case histories and reporting forms, were analyzed. The structure and localization of injuries, types of trauma, and the frequency of combined and multiple injuries were assessed. Statistical analysis was performed using MS Office Excel (2010) and STATISTICA v.6.1 (Statsoft Inc., USA). In this study, the nature of traumatic injuries in hospitalized patients with mine-blast and gunshot wounds was analyzed. Results: 45.7% of patients sustained combined or multiple injuries, while 54.3% had injuries limited to a single anatomical region. The most common injury traumas of were the chest (18.9%), head and neck (16.5%), and abdomen (14.2%). Penetrating wounds to the chest and head were often associated with more severe consequences, such as pneumohemothorax and traumatic brain injuries. In mine-blast injuries, non-penetrating trauma predominated, in particular injuries of the extremities and pelvic bones, observed in 80 patients. A significant proportion of patients also experienced bleeding, exceeding 750 ml, which led to hemorrhagic shock in 63.6% of cases. The overall mortality rate was 13.4%, with most deaths occurring in the early stages of treatment, primarily due to the severity of injuries and the development of purulent-septic complications. Combat trauma is predominantly associated with mine-explosive mechanisms, characterized by a high frequency of multiple and combined injuries, significantly complicating the provision of medical care and necessitating a multidisciplinary approach.

Clinical and economic analysis of the prescription of drugs for postoperative support of total hip arthroplasty

2025-06-26T11:02:18+03:00

A well-founded choice of means of medical support for patients after total hip arthroplasty and rational use of financial resources for this purpose allow to achieve the maximum possible socio-economic effect in the future. Its methodological basis is made up of clinical and economic concepts based on the concepts of cost (price, expenses) and clinical effectiveness of the intervention (treatment results). The aim of the study was to determine the financial component of medical support in the postoperative period of total hip arthroplasty using ABC/VEN analysis (Vital Essential Non-essential). In the current study, the ranking of medical products when conducting both ABC/VEN analysis was carried out by the number of prescriptions. The number of prescriptions is a more indicative approach, as it demonstrates the real frequency of drug use in practice, the relevance and demand for specific medications in real-world conditions, allowing for a more accurate determination of priority drugs for clinical use and, accordingly, providing a more relevant and practical assessment of drug needs. The number of observations (n), minimum and maximum values (min – max) were used to describe the variables, quantitative data were presented as the arithmetic mean and standard deviation. Qualitative data - in the format n (%). Results - analysis of prescriptions from medical records of patients with dysplastic coxarthrosis revealed that 6548 prescriptions were made for 367 people during the study period. The results of the integrated ABC/VEN analysis showed that in the context of the most costly group “A”, the main financial resources were spent on providing long-term antithrombotic therapy to prevent pulmonary embolism and lower limb vein thrombosis, the total amount for 2754 prescriptions (42.1% of all prescriptions) was 1,745,478.90 UAH. Less costly (group “B”, 2351 prescriptions) were drugs prescribed for antibiotic prophylaxis of infectious complications. In general, the costs of drugs in group “B” (35.9% of all prescriptions) amounted to 552,820.30 UAH, which corresponded to 21.6% of the financial costs for medical support of patients after TEP. The least expensive group "C" consisted mostly of secondary category N means, which accounted for 17.9% (1173 out of 6548) of the total number of prescriptions and accounted for 6.7% (171,986.75 out of 2,559,353.23 UAH) of the total amount of expenses. «Vital» category V means in this analysis group accounted for 4.1% (270 out of 6548) of all prescriptions, and the expenses for them were 3.5% (89,067.28 out of 2,559,353.23 UAH). The share of financial expenses for these means amounted to half (52.8%) of the total budget for medical support of patients after total hip arthroplasty, which in monetary equivalent was 1,350,380.53 UAH. The leading positions in terms of costs were occupied by vital category V drugs – the synthetic selective inhibitor of activated factor X fondaparinux (“Arixtra”) and the competitive reversible direct thrombin inhibitor dabigatran etexilate (“Pradaxa”), the share of prescriptions of which was 89.4% and 82.3%, respectively.

Rehabilitation of a patient with manifestations of intolerance to dental materials in the oral cavity (clinical case)

2025-06-26T11:12:31+03:00

Significant achievements in modern dental materials science, improvements in all-ceramic technologies, microprosthetics, and inert removable prosthetics have not eliminated the relevance of assessing the biocompatibility of dental construction materials with the tissues of the prosthetic bed. Currently, almost 47% of the global population suffers from food, drugs, various materials, and chemical compounds intolerances. Aim of the study – to present a clinical case of intolerance to structural materials, and to demonstrate the prediction and prevention of their adverse effects on the whole organism through biocompatibility testing with the tissues of the prosthetic bed. A 62-years-old male patient sought prosthodontic care with complaints of pain, bleeding, redness, and swelling at the sites where metal-ceramic crowns contacted the oral mucosa, along with itching, burning sensations, and halitosis. Approximately two weeks after fixing the bridge prostheses, skin rashes appeared on the neck, accompanied by itching and tingling sensations. Given that the patient associated symptom onset with the fixation of full-cast metal-ceramic bridges, and based on the clinical picture in the oral cavity and results of epicutaneous patch testing, a diagnosis was established: “Intolerance to dental materials. Localized periodontitis complicated by Kennedy Class II, Subclass 2 maxillary and Class I, Subclass 1 mandibular edentulous areas. Masticatory efficiency loss according to Agapov – 84%.” Due to positive patch test results and clinical findings, removal of the metal-ceramic constructions from the oral cavity was deemed necessary. After extraction of all mobile teeth and their destroyed roots, it was planned to restore the edentulous spaces with zirconia bridge prostheses and fabricate clasp dentures based on polyamide for both jaws.

Physiological adaptations and functional changes in young soccer players' organisms aged 11-14 years following a 12-week specialized training program: a sports medicine perspective

2025-06-26T12:59:00+03:00

This study investigated the physiological adaptations and functional consequences of a 12-week specialized training program in youth soccer players, focusing on musculoskeletal development, cardiorespiratory responses, and neuromuscular adaptations during the critical growth period of 11-14 years. Sixty male youth soccer players (mean age: 12.5±1.2 years; height: 156.3±8.7 cm; weight: 45.8±7.2 kg) underwent comprehensive medical screening before randomization to experimental (n=30) or control (n=30) groups. Initial screening included growth plate assessment and cardiovascular fitness testing. The intervention included continuous monitoring of physiological parameters including heart rate variability, oxygen consumption, blood lactate levels, and musculoskeletal development markers. Weekly medical monitoring assessed recovery markers and growth indicators to ensure safe adaptation to training loads. The experimental group showed significant physiological adaptations (p<0.001): resting heart rate decreased by 8.4% (95% CI: 6.2-10.6%), peak oxygen consumption increased by 12.3% (95% CI: 9.8-14.8%), bone density improved by 6.2%, muscle mass increased by 8.5%, neuromuscular coordination improved by 24.3% (95% CI: 20.1-28.5%), and recovery time between high-intensity efforts improved by 42%. Growth plate safety markers remained within normal ranges throughout the intervention. The 12-week program produced significant positive physiological adaptations in youth athletes without compromising growth patterns. The study establishes evidence-based guidelines for safe training prescription during crucial developmental periods, emphasizing the importance of medical monitoring in youth sports. These findings contribute to sports medicine protocols for youth athlete development, demonstrating that properly structured training can enhance physiological development while maintaining growth safety parameters.

Resilience of individual health and endogenous response to determinants of motor activity of athletes

2025-06-26T13:21:06+03:00

The issue of specialized multicomponent studies of defining the functional state of the organism under the influence of personalized factors of external influence in sport is not sufficiently studied in the scientific and methodological literature. It needs to be expanded and supplemented. The aim of the study was to determine the resilience of an individual's health and the components of the endogenous response to the determinants of athlets's motor activity. The study involved 15 experienced football players, whose average age was 25.47±4.66 years.To achieve this goal, based on the analysis of scientific and methodological literature and the questionnaire, we identified the factors of exogenous influence and the main determinants of motor activity of athletes. An additional specialized questionnaire was conducted to assess the personalized general state of health. According to the previous diagnostic data and on the basis of empirical components, a programme for the development of certain motor qualities (general, power endurance) as a specialized training was developed, which was coordinated with the training process of athletes. Before the beginning of the formed programme the testing of the background assessment of development of aerobic functional capabilities was carried out. In the context of the research the programme with the use of certain determinants of motor activity was implemented. We repeatedly tested the development of aerobic capabilities, determined the resilience of an individual's health and the impact of the research block of exogenous agents on the state of the cardiovascular and muscular systems. We also used a repeated questionnaire to assess the general state of health and health resilience of the individual. We determined the conditions for the implementation and effectiveness of the use of determinants of motor activity as exogenous factors of influence on the health resilience of an individual. Specialized questionnaires and protocols have been created to determine the priority personalized factors of exogenous influence and the operational state of the organism. Based on the data obtained, a programme for the development of motor skills was developed and scientifically and methodically regulated. A systematic assessment of the functional state of athlets on the basis of test models and statistical processing unit was carried out. Defining determinants of motor activity of athletes, resilience of health of an individual and specialized methods of assessment of influence of exogenous factors requires statistically confirmed efficiency of the offered methods in the structure of experimental and research check of their use. The methodology for applying an individual programme for the development of functional capabilities of the motor systems of the body of athletes has been established and substantiated. The effectiveness of the influence of exogenous means on the state of functional systems of the organism in the direction of general and power endurance is statistically substantiated. The positive influence on the general state of health (according to the questionnaire, monitoring of heart rate and intensity of movement, analysis of graphic images built on the obtained indicators) is established.

Pseudoaneurysm of the thoracic aorta (clinical case)

2025-06-27T12:49:50+03:00

The purpose of the work is to publicize a complex clinical case of the disease – pseudoaneurysm of the thoracic aorta, based on the results of the patient's examination and treatment. Analysis of surgical treatment tactics, description of applied surgical techniques during radical surgery, the results of a clinical study of a patient with a thoracic aortic pseudoaneurysm are presented. For this purpose, echocardioscopy, coronary angiography, contrast-enhanced computed tomography, general clinical laboratory tests, and microbiological examination of biological fluids and tissues were used. Based on the diagnostic data, the primary clinical diagnosis was established: Ischemic heart disease. Stable angina pectoris, functional class III, post-infarction cardiosclerosis with hypokinesis of the posterior wall of the middle and basal segments of the left ventricle. Polytopic supraventricular extrasystole of the type of bigeminia and trigeminia. Hypertensive disease of the 2nd stage, 3rd stage. Thoracic aortic aneurysm. CHF IIa stage. A clinical case of surgical treatment of thoracic aortic pseudoaneurysm is described: the course of primary surgical treatment of thoracic aortic aneurysm (Supracoronary prosthesis of the ascending aorta, aortic valve revision. CABG (Ao-PDA) in conditions of artificial blood circulation), postoperative observation, as well as the prerequisites for the occurrence of thoracic aortic pseudoaneurysm. The course of this complication is directly described, with a description of the course of surgical treatment: Resternotomy. Elimination of prosthetic pseudoaneurysm of the ascending aorta. Plastic surgery of the distal anastomosis and plastic surgery of a linear rupture of the right ventricle in conditions of complete circulatory arrest (18°C, 38 min.), as well as the features of the postoperative period after it. Conclusions have been made that may help prevent the occurrence of thoracic aortic pseudoaneurysm and treat it more effectively. In particular, its infection was established as a factor in the cause of the defect of the distal anastomosis of the prosthesis. The described surgical technical method of peripheral cannulation with artificial blood circulation, with heart drainage, with cold arrest up to 18°C, within 38 minutes allowed to quickly localize the pseudoaneurysm of the thoracic aorta, bleeding from the defect of the distal anastomosis of the prosthesis, which occurred during resternotomy; to perform the main stage of surgical intervention – elimination of prosthetic pseudoaneurysm of the ascending aorta, plastic surgery of the distal anastomosis and plastic surgery of the linear rupture of the right ventricle.

Systemic lupus erythematosus as a multidisciplinary problem (clinical case)

2025-06-27T13:28:39+03:00

Systemic lupus erythematosus (SLE) is a prognostically unfavorable systemic connective tissue disease with heterogeneous clinical manifestations, development of complications, and an unpredictable wave-like course, which complicates the diagnosis of this pathology. The relevance of this clinical case is determined by a number of features: the debut of SLE with isolated kidney damage, an 11-year delay in the date of diagnosis, and the occurrence of an extremely rare complication – lupus crisis (LC), which became fatal for the patient. The aim of the work: to analyze a clinical case as unique in terms of the features of the debut and clinical course of systemic lupus erythematosus, which has become a multidisciplinary problem, to highlight the reasons for the delay in diagnosis verification, to assess, in dynamics, the effectiveness of the prescribed treatment and to report on the development of a multiorgan lupus crisis. The article analyzes data from the medical documents of a 31-year-old inpatient. An illustrative clinical case of SLE, which debuted with glomerulonephritis at the age of 16, 11 years before the appearance of specific clinical symptoms that met the criteria of the American College of Rheumatology and the European League Against Rheumatism 2019, is presented. The level of immunological indicators specific for SLE – antinuclear antibodies to double-stranded deoxyribonucleic acid increased in the patient in 2023, i.e. 4 years later. The patient’s refusal of nephro biopsy, starting from the debut of the disease and from pathogenetic therapy at the stage of diagnosis and during the next 4 years. led to increased SLE activity, frequent relapses with the development of polymorbid pathology and, incompatible with life, multiorgan lupus crisis. The article describes in detail the dynamics of clinical manifestations of SLE and LC. The stages of diagnostic search, features of differential diagnosis and treatment of SLE and LC are discussed on the example of a clinical case. Based on the results of a review of the medical literature, analysis of articles, databases PubMed, SCOPUS, Web of Science, MedScape, the current state of the problem is highlighted, literature data on the incidence, features of the clinical course, diagnosis and treatment of SLE, its complications are summarized. The description of the clinical case, analysis of the literature is an addition to modern information about the possible clinical manifestations and consequences of SLE with the development of a severe, extremely rare complication – lupus crisis.