Медичні перспективи

Exercise-induced changes in creatine kinase: a systematic review

2026-04-08T10:29:52+03:00

Creatine kinase (CK) is a key enzyme in cellular energy metabolism, playing a role in the regeneration of adenosine triphosphate through the phosphocreatine system, particularly in tissues with high energy demands such as skeletal muscle. Under normal conditions, CK is present within muscle cells, so its blood levels are relatively low. However, strenuous or unusual physical exercise especially with eccentric contractions can cause mechanical and metabolic stress that disrupts muscle fiber integrity and increases cell membrane permeability. Microdamage to the sarcolemma, accompanied by oxidative stress, inflammatory responses, and disruption of intracellular calcium homeostasis, are thought to cause the release of CK from muscle cells into the bloodstream. Although CK is widely used as a biomarker of exercise-induced muscle damage, its increased levels do not always correlate directly with the degree of muscle damage or functional impairment, so the exact mechanism of post-exercise CK release remains incompletely understood. The aim of this study was to determine the effect of physical exercise on increasing CK levels. We reviewed several literature databases, including Scopus, Pubmed, Web of Science, and Science Direct, for our systematic review investigation. The search was conducted for articles published between 2015-2025 that discussed physical exercise and CK. Using the Scopus, Web of Science, Pubmed, and Science Direct databases, 1,450 published publications were identified. For this systematic review, nine papers that met the inclusion criteria were selected and reviewed. This study evaluated the standard operating procedure using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Based on 9 reviewed papers it has been proven that physical exercise has been proven to increase CK levels significantly. Exercise-induced CK elevations serve as a valuable, albeit nonspecific, indicator of muscle damage. Understanding the variability in CK responses is critical to designing training and recovery programs for athletes in order to achieve optimal physical performance.

The impact of the robotic rehabilitation system with biological feedback "Omego Plus" on the functioning of patients with arthrogenic contractures of the joints of the lower extremities

2026-04-08T10:38:03+03:00

Under the ongoing military actions in Ukraine, the number of patients with limb injuries has increased significantly. Over 60% of personnel losses are associated with complications from musculoskeletal injuries, specifically arthrogenic contractures. The resistance of such conditions to standard therapy necessitates the search for innovative technological solutions, particularly robotic systems with biofeedback, such as the "Omego Plus" system. Purpose. To enhance the effectiveness of rehabilitation for patients with arthrogenic contractures of the lower limb joints through clinical and functional justification and the integration of the "Omego Plus" robotic system into the rehabilitation process. This randomized controlled trial included 60 patients (aged 20-53 years). The main group (n=30) received standard physical therapy (NICE-2022 protocol) supplemented with sessions on the "Omego Plus" system (60 min, 5 times per week for 6 weeks). The control group (n=30) followed the standard protocol only. The assessment was carried out in stages (at the beginning of the study, after 6 weeks, and 3 months after discharge). Effectiveness was evaluated using goniometry, Manual Muscle Testing (MMT), the Visual Analog Scale (VAS) for pain, and the 10-Meter Walk Test (10MWT). A statistically significant advantage was observed in the main group regarding the recovery of knee flexion to the functional norm (120 degree, p=0.0005) and a significant increase in the amplitude of ankle dorsiflexion (p=0.0008). Analysis of muscle strength revealed significantly higher absolute values in the main group at Visit 3 for the hip abductors (p=0.02) and internal rotators (p=0.04), indicating more effective motor unit recruitment by the "Omego Plus" robotic system with biofeedback. Gait speed dynamics according to the 10MWT confirmed a cumulative effect of the "Omego Plus" system: the intergroup advantage was established during the final assessment stage. The analgesic effect was most pronounced between the second and third visits (p<0.05), indicating the stability of the result and a reduction in central sensitization phenomena. The implementation of "Omego Plus" during the post-acute period ensures rapid recovery of mobility, a significant increase in muscle strength indicators, and sustained reduction of the pain syndrome. The results justify the integration of the "Omego Plus" robotic system to address existing "gaps" in the rehabilitation of patients with arthrogenic contractures.

The effect of muscle fatigue on playing performance and physical condition of futsal players

2026-04-08T10:47:04+03:00

This study investigates the impact of muscle fatigue on the physical condition and playing performance of futsal players, particularly focusing on decision-making, ball control, and technical skills under fatigue. Ten futsal players from Star Futsal Club (aged 17-25) participated in the study. Player performance was assessed using the Game Performance Evaluation Tool (GPET), which measured on-the-ball attacker and support actions, while physical condition was evaluated through shuttle run, 30-meter sprint, and vertical jump tests. The results showed a decline in performance after fatigue was induced. Specifically, the on-the-ball attacker score decreased from a pre-test mean of 81.00 to 71.75 post-test, and the support score dropped from 61.00 to 47.50. In terms of physical condition, the shuttle run time increased from a mean of 17.07 to 17.62 seconds, the 30-meter sprint time increased from 4.43 to 4.56 seconds, and vertical jump height decreased from 52.60 cm to 51.10 cm. Despite these observable declines, statistical analysis using paired samples t-tests revealed no significant differences: for player performance, t=5.353, df=1, p=0.118, and for physical condition, t=0.437, df=2, p=0.705. These findings suggest that muscle fatigue negatively impacts futsal players’ performance, particularly decision-making, speed, and technical execution, but the changes were not statistically significant, possibly due to the small sample size. The study highlights the importance of proper training load management and recovery strategies to optimize futsal performance. Further research with larger samples is needed to confirm these findings and better understand the effects of fatigue.

The effect of nutrition on tennis athlete performance: a systematic review

2026-04-08T11:00:11+03:00

Nutrition is crucial in improving athlete performance, and research on the relationship between nutrition and sport continues to grow. This article aims to investigate nutrition's influence on tennis athletes' performance through a systematic review approach. The main objective was to identify the types of food that are most influential in improving the performance of tennis athletes, as well as to evaluate their impact on physiological and psychological aspects. This study used a systematic review approach, following PRISMA guidelines. Databases such as PubMed, Scopus, and Web of Science were reviewed for articles published up to 2024, using keywords related to nutrition and tennis. Inclusion and exclusion criteria were set to select articles that fit the research topic. Data were then extracted, synthesized, and analyzed to produce significant findings in the context of nutrition's influence on tennis athletes' performance. Of the 500 articles identified, 44 met the inclusion criteria. The analysis concluded that nutrition is essential in enhancing a tennis athlete's performance. Carbohydrates, protein, and fat were shown to be vital sources of energy for tennis athletes, while vitamins and minerals play an essential role in recovery and optimal body function. Previous studies have also shown that proper diet and supplementation can significantly improve tennis athletes' stamina, strength, and recovery. This study confirms that proper nutrition is highly influential in improving the performance of tennis athletes. Optimizing carbohydrate, protein, fat, vitamin, and mineral intake can have significant physiological and psychological benefits such as stamina, strength, and recovery. These findings result in recommendations for a tennis athlete's diet tailored to individual needs. At the same time, further research is recommended to deepen the understanding of the relationship between nutrition and sports performance.

Young chronic obstructive lung disease or constrictive bronchiolitis: difficulties in differential diagnosis in the context of hostilities

2026-04-06T14:52:02+03:00

Confirmation of the diagnosis of chronic obstructive pulmonary disease (COPD) in young patients is a difficult but important challenge for respiratory physicians, as it is the key to prescribing the correct therapy and has an important medical and social role. The term “young COPD” is used in the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2026 GOLD Report to refer to patients with COPD aged 20-50 years. The aim of the study was to describe the features of the diagnosis of young COPD and to systematize the latest data on the differential diagnosis with obliterative bronchiolitis. We conducted a literature search on the relevant topics and keywords in the scientific databases PubMed, Google Scholar, Scopus and Web of Science. After a detailed analysis, 53 literature sources were selected and evaluated, 90% of which were published over the past 5 years and contained the most up-to-date information. It has been established that genetic factors prevail over the influence of environmental factors in the development of COPD in young patients, among which the most common cause is congenital alpha-1 antitrypsin deficiency. However, there is a growing trend of airway damage as a result of smoking modern devices for nicotine and tobacco use, such as new generations of e-cigarettes and tobacco heating devices, which are especially popular among youth. The diagnosis of COPD in people younger than 50 years can be considered if the patient has not only persistent post-bronchodilator obstruction, but also presents a long history of smoking (≥10 pack-years) and typical changes on computed tomography of the lungs (emphysema and abnormalities of small or large bronchi). In the context of active hostilities, an important competitive diagnosis in such patients is obliterative bronchiolitis. This disease is manifested by external compression and sometimes obliteration of bronchioles, and should be considered when five factors are combined, including an atypical young age for COPD, typical symptoms, persistent bronchial obstruction on spirometry, the formation of the “air trapping” symptom on computed tomography of the lungs, no signs of emphysema, and an anamnesis of inhalation of toxic substances. Thus, confirmation of the diagnosis of COPD in people under 50 years of age requires a comprehensive assessment of the patient's condition, which should include pulmonary function testing (spirometry), imaging studies (computed tomography of the lungs), and genetic testing (alpha-1 antitrypsin deficiency). Given that in the context of active hostilities related to the War for Independence of Ukraine, both military personnel and civilians may be exposed to significant negative effects of toxic and irritating substances on the respiratory system, obliterative bronchiolitis should be considered as a mandatory component of the differential diagnosis in young patients. To verify the diagnosis of obliterative bronchiolitis, computed tomography of the lungs and confirmation of inhalation of toxic substances are crucial. However, in certain clinical situations, only lung biopsy assessment can distinguish between these two diagnoses.

Complications of surgical treatment for esophageal leiomyoma: a case series

2026-04-06T15:11:59+03:00

Esophageal leiomyomas are the most common benign tumors of the esophagus. While surgical resection is the definitive treatment for symptomatic cases, it carries a risk of postoperative complications. This study presents a case series on the surgical management of esophageal leiomyomas, with a particular emphasis on postoperative complications and their management. This retrospective case series, conducted at the National Cancer Institute (Kyiv, Ukraine), analyzed patients who underwent surgical treatment for symptomatic esophageal leiomyoma between 2021 and 2024 and developed postoperative complications classified as Clavien-Dindo grade III or higher. Data were collected from medical records, including demographics, tumor characteristics, surgical details, postoperative course, complications, management strategies, and outcomes. The total number of observations was n=3. Three cases with Clavien-Dindo III-IV postoperative complications were analyzed. Complications included anastomotic leakage following Ivor Lewis esophagectomy (managed with endoscopic stenting and endoscopic vacuum therapy – EVT), esophageal perforation during enucleation leading to mediastinitis (managed with stenting and endoscopic vacuum therapy), and a complex case involving hemopericardium, post-cardiac arrest syndrome, peritonitis and diaphragmatic herniation requiring multiple reinterventions. Despite the severity of these complications, multidisciplinary management led to complete recovery of all patients. Histopathological evaluation confirmed benign leiomyoma in all cases. Surgical management of esophageal leiomyomas, particularly for large tumors, is often associated with significant postoperative complications. While minimally invasive techniques may reduce these risks, they do not eliminate them entirely. Endoscopic therapy plays a critical role in the non-surgical management of anastomotic leakage and esophageal perforation. Vigilant postoperative monitoring and a multidisciplinary approach are essential for achieving favorable outcomes in these complex cases.

Clinico-dermoscopic and histopathological correlations of benign melanocytic nevi of the skin as a basis for the choice of treatment and recurrence prevention (literature review)

2026-04-06T15:31:45+03:00

Benign melanocytic nevi are among the most common skin lesions and frequently require diagnostic and therapeutic interventions in dermatological practice. Despite the widespread implementation of dermoscopy, difficulties in the differential diagnosis of various clinico-morphological types of nevi and in the selection of optimal treatment strategies persist. Incomplete removal of pigmented lesions is associated with the development of the recurrent nevus phenomenon, scar formation, and diagnostically challenging pigmentation changes, highlighting the need for a comprehensive synthesis of current evidence on clinico-dermoscopic and histopathological correlations. The aim of the study was to analyze and substantiate current scientific data on the clinical, dermatoscopic, and pathomorphological features of various clinical and morphological forms of benign melanocytic skin nevi to justify the individualized choice of treatment method aimed at reducing the frequency of inverse nevus development, minimizing postoperative complications, and achieving optimal cosmetic results. The review was conducted as a narrative analytical with elements of a one structured search in accordance with PRISMA recommendations. Bibliographic, analytical, synthetic, and comparative methods, as well as data systematization and generalization techniques, were applied. The literature search was performed in the PubMed/MEDLINE and PubMed Central databases, covering the period from 2009 to 2025. A total of 312 publications were identified during the initial search. After duplicates removal, 268 records were screened, and 97 articles were selected based on title and abstract evaluation. Following full-text assessment, 54 publications were included in the final qualitative analysis. Inclusion criteria comprised review articles, clinical and clinico-morphological studies, as well as international consensus recommendations that reported data on dermoscopic and histopathological characteristics of benign melanocytic nevi and treatment methods. Exclusion criteria included isolated case reports without analytical synthesis, publications focused exclusively on melanoma, and studies without full-text availability. The keywords used were “melanocytic nevi,” “dermoscopy,” “histopathological correlations,” “recurrent nevus,” and “treatment methods.” The analysis demonstrated that dermoscopic patterns of benign melanocytic nevi reflect their underlying histopathological architecture and vary depending on patient age, lesion duration, and anatomical localization. A strong association was identified between specific dermoscopic features and the depth of melanocytic components, which is of critical importance for treatment selection. Partial removal techniques, including shave excision and ablative procedures, were associated with a higher risk of repigmentation and recurrent nevus development, whereas complete surgical excision provided the highest diagnostic reliability due to the possibility of primary histopathological verification, but it may be accompanied by a more pronounced scarring. The findings support the rationale for an individualized management strategy for benign melanocytic nevi based on the integration of clinical, dermoscopic, and histopathological data, aiming to reduce recurrence rates, minimize diagnostic uncertainty, and improve cosmetic outcomes.

Disability due to acute cerebral strokes in Ukraine over the period of 2014-2024 and features of dynamics under conditions of martial law

2026-04-07T10:44:55+03:00

Acute cerebral stroke is a disease that ranks among the leading causes of today's “non-infectious” epidemic, becoming a significant economic burden for global economies. The aim of the study was to investigate the dynamics of disability rates due to acute cerebral stroke and their features among the adult and working-age population in Ukraine under conditions of martial law. This work is fragment of the DSMU research project “Improvement of scientific and methodological approaches to determining the criteria for identifying signs of permanent disability, optimization of rehabilitation programs for patients and persons with disabilities”, No. 0124U005028, 2025-2028. Medical and social cases and referrals for medical and social examination (Form 088/o) of patients who were diagnosed with disability for the first time during the period of 2014-2024 were analyzed in accordance with ICD-10 codes: stroke (I 60 I 64), hemorrhagic stroke (I 60, I 61, I 62), ischemic stroke (I 63, I 64), and consequences of stroke (I 69). Statistical processing was performed using parametric and nonparametric statistical methods implemented in the STATISTICA 6.1 software package (StatSoftInc., serial number AGAR909E415822FA).The results of the study conducted over the last decade from 2013 to 2024 in Ukraine determined the dynamics of primary disability rates due to acute cerebral stroke. Among the adult and working-age population during 2011-2019, a stable dynamic of the indicator was found, which averaged 1.67 per 10,000 people, with a minimum level in 2020 – 1.3 and 1.7 per 10,000 people, respectively. The conclusions of the study are the identified characteristics of primary disability rates due to acute cerebral stroke ubder conditions of martial law. In 2022-2024, an increase in this indicator among both the adult and working-age population was identified, being approximately twice as compared to pre-war indicators.

Perceived quality of nursing education from a health systems perspective: a cross-sectional study of two universities in Albania

2026-04-07T10:59:47+03:00

Nursing students’ perceptions of educational quality – particularly the clinical learning environment (CLE) – are an early indicator of whether programs are producing graduates who feel ready for practice. This study aimed to describe nursing students’ perceived educational quality and clinical learning environment (CLE) in two Albanian universities, and to identify factors independently associated with low perceived preparedness for practice. In May 2025, a cross-sectional questionnaire was administered to 367 students at the department of medical technical sciences, University “Aleksandër Moisiu” of Durrës and the University “Eqrem Çabej” of Gjirokastra. Items covered staff availability, teaching quality and clinical skills, preparedness for practice, teaching approaches, and placement conditions. Domain scales were created (Cronbach’s α ≥0.70) and low preparedness was defined as a preparedness score below the sample median. In multivariable binary and ordinal logistic regression, limited availability of clinical supervisors/preceptors, poorer overall CLE quality, and lower exposure to simulation-based teaching were independently associated with low preparedness. Descriptively, around half of respondents reported that key CLE domains need improvement, including distance to clinical practice sites (52.0%), transportation (49.6%), availability of equipment and supplies (50.1%), quality of supervision (50.1%), and student assessment (51.0%). Clinical supervisors/preceptors were often available for 31.9% of students. Only 23.4% rated clinical supervisors/preceptors’ teaching quality as good. Simulation and role-play were among the least frequently used teaching approaches. Students’ responses indicate systematic gaps in clinical supervision capacity, placement logistics, and clinical learning infrastructure. Strengthening structured preceptorship, clinical site agreements, and skills-lab/simulation capacity are practical targets for quality improvement.

Prevalence of occupational burnout: a cross-section analysis across hospital nursing professionals

2026-04-07T11:09:46+03:00

This study aims to investigate the prevalence of occupational burnout among nursing professionals at Shkodra Regional Hospital and identify factors contributing to it. Specifically, the objectives include measuring the burnout rate within this population and analysing demographic and occupational factors that affect burnout levels. This cross-sectional, observational and analytical study used a semi-standardised questionnaire distributed to healthcare professionals over 7 months (September 2024 – March 2025) at the Shkodra Regional Hospital, Albania. The Excel file obtained from Microsoft software underwent statistical processing in SPSS version 26.0 software. The Maslach Burnout Inventory test was subjected to an evaluation of its reliability and consistency with the Cronbach alpha test. The alpha value was found to be 0.79. The level of significance adopted was p<0.05. The mean age among 131 nurses was 35.35±10.37, with a minimum to maximum age of 18-64 years old. Almost 38.2% of the participants belong to the 26-35 age group, which is considered to be a relatively young demographic one. Burnout prevalence turned to be relatively high – 68.9% for 95% CI (59.4-75.3), where 22.3% exhibited high levels of emotional exhaustion, 45.4% of cases high depersonalisation and low personal accomplishment domen in 92.3%. The phenomenon of depersonalization, in combination with two other areas, is worthy of consideration, with a p-value was found to be less than 0.05. It is noteworthy that the majority of these workers, 62.6%, are engaged in shift work with a frequency of 6-10 days per month. Burnout syndrome presented a correlation with sociodemographic factors (marital status, and monthly income) as well as some of the work-related factors (shift work system, weekly working hours, days on shift, work experience, etc). The findings of this study give us a relatively high prevalence of burnout syndrome among the participants (68.9%). We recommend rapid intervention with different policies or strategies that should improve the reduction of burnout among nursing staff. In order to facilitate recovery, it is essential to address burnout, recognise signs of excessive physical fatigue, seek support from colleagues and therapists, set boundaries, and prioritise self-care.

Comparative effect of dapoxetine and venlafaxine in the treatment of premature ejaculation in men injured as a result of hostilities

2026-04-07T11:27:24+03:00

Premature ejaculation is one of the most common male sexual disorders and occurs with a frequency of 21-33% in various populations. The etiology of premature ejaculation is practically not established, although it is a fairly common type of sexual dysfunction. According to various data, sexual dysfunction occurs in 49.1-80% veterans of combat-actions with post-traumatic stress disorder. Premature ejaculation can interfere with sexual satisfaction, leading to a reduced quality of life for men and their partners. It has been shown that serotonin reuptake inhibitors may be the drugs of choice in the treatment of premature ejaculation. The aim of the work was to improve methods of treating sexual dysfunction accompanied by premature ejaculation in men injured as a result of hostilities. 56 men injured as a result of hostilities with sexual dysfunction and complaints of premature ejaculation were examined. Patients were divided into two groups depending on the selected selective serotonin reuptake inhibitors – venlafaxine (n=24) and dapoxetine (n=32) which they had been receiving for at least 1.5 months. After treatment with both serotonin reuptake inhibitors, reactive and personality anxiety symptoms objectively decreased, as assessed by the Spielberger-Hanan scale. Treatment with venlafaxine and paroxetine resulted in a significant reduction in depressive symptoms in men with premature ejaculation. They turned out to be relatively balanced drugs with satisfactory efficacy and relatively few side effects. However, venlafaxine, compared to dapoxetine, produced 2.1 times fewer side effects and 20% fewer relapses. The average duration of sexual intercourse after treatment with both drugs positively correlated with the overall improvement of sexual function according to the IIEF-5 scale (r=0.70; p<0.05 for the first group; r=0.85; p<0.05 for the second group). An inverse correlation was found between the average duration of sexual intercourse and the score of anxiety symptoms on the Spielberger-Hanin scale in patients of both study groups (r= -0.69; p<0.05 for the first group; r= -0.68; p<0.05 for the second group). Although dapoxetine is considered the “gold standard” among serotonin reuptake inhibitors for the treatment of premature ejaculation, the drug is used by the patient only on demand, and other drugs in this group, which are antidepressants, may have a more positive effect on patients with depression and concomitant premature ejaculation, who have suffered as a result of hostilities. The study demonstrates that the neurotransmitter serotonin plays a key role in the modulation of ejaculation, as the use of its reuptake inhibitors, in particular dapoxetine and venlafaxine, contributes to an increase in intravaginal latency time to ejaculation.

Microbial skin infection with an unusual course in an immunocompetent woman: analysis of a clinical case

2026-04-07T11:42:11+03:00

We analyzed the clinical case of recurrent infection of the skin in a hospitalized 20-year-old immunocompetent patient female with pustular rash, feverishness and debilitating weakness. The aim of the work was to improve the diagnosis and treatment of infectious skin diseases based on the analysis of this clinical case of recurrent microbial skin infection on the background of atopic dermatitis in an immunocompetent woman. The diagnosis was based on clinical examination, microbiological studies (bacteriological culture of scrapings from the rash elements), laboratory blood tests, and assessment of the effectiveness of antibacterial therapy. Upon admission to the hospital, complaints of a rash located on the face, scalp, and neck, with a feeling of mild pain and itching, as well as a fever within 38º-38.5ºC, and general weakness. The patient was diagnosed with a mixed infection of Streptococcus agalactiae, Staphylococcus aureus, and later Enterococcus faecalis. Initial treatment with cefazolin for 8 days was effective, however, 5 days after the end of the course, the rash relapsed, which was accompanied by increased itching, an increase in body temperature to 37.5ºC, as well as the deterioration of the emotional state, which required the use of a reserve antibiotic – linezolid, and, taking into account atopic dermatitis, a short (5-day) course of systemic corticosteroids was prescribed. During 10 days of treatment, the patient's condition improved, there were no new rashes, the blisters healed and became crusted, itching decreased, and the general and emotional state normalized. However, a week after the end of the course of systemic treatment, the patient again had new elements of the rash. Treatment was continued on an outpatient basis. This clinical case demonstrates that microbial skin infections in non-immunocompromised patients can be severe in the presence of additional risk factors such as atopic dermatitis and occupational exposure. Valid microbiological studies are critical for effective selection of antibiotic therapy. It is recommended that microbial infections of the skin and subcutaneous tissue be included in the national infectious disease registration system for monitoring the effectiveness of treatment and prevention.

Molecular-neurovascular mechanisms of metal implant hypersensitivity as a cause of osteosynthesis failure and delayed bone union: a clinical case study

2026-04-07T11:53:01+03:00

Metal hypersensitivity is a rare but clinically significant cause of aseptic inflammation and delayed bone union after osteosynthesis. The release of nickel, cobalt, and chromium ions from metal implants induces a T-lymphocyte–mediated delayed-type immune response, which leads to chronic inflammation, endothelial dysfunction, and suppression of osteogenesis. Differentiation of metal-induced hypersensitivity from infectious complications or mechanical instability remains a challenging diagnostic task in orthopedic practice. The aim of the study was to analyze a clinical case of chronic hypersensitivity to a metal implant after tibial osteosynthesis and to identify clinical and diagnostic features linking immune-mediated inflammation with delayed bone union. A retrospective analysis of a clinical case of a patient after tibial osteosynthesis using metal plates was performed. The clinical course, laboratory inflammatory markers, and serial radiographic examinations were evaluated to exclude infection and mechanical fixation failure. The postoperative course was characterized by persistent edema, hyperemia, recurrent seropurulent exudation, and chronic pain in the absence of laboratory signs of bacterial infection. Radiography revealed a lack of progression in bone callus formation despite stable implant fixation. Eight months after surgery, removal of the metal construct led to rapid regression of inflammation, reduction of pain syndrome, and restoration of radiological signs of bone union. Chronic hypersensitivity to metal implants is an underestimated cause of aseptic inflammation and delayed fracture healing. Persistent local inflammatory manifestations without signs of infection, combined with the absence of radiological progression of bone union, should prompt evaluation of a metal-induced immune reaction. Timely implant removal contributes to the restoration of osteogenic balance and bone consolidation.

Procedure for assessing rehabilitation measures for military personnel with skin injuries caused by thermobaric and incendiary weapons after reconstructive plastic surgery

2026-04-07T12:42:06+03:00

The recovery of Ukrainian Armed Forces servicemen after skin injuries caused by ammunition containing incendiary and thermobaric mixtures (white phosphorus, thermite, ethylene-based, propylene-based, and others) is a complex process that requires a comprehensive approach. Such injuries cause deep burns, leading to significant tissue damage and even loss of functionality in the affected parts of the body. Surgical intervention is only the first step on the road to recovery. Postoperative rehabilitation, which includes a complex of medical, physiotherapeutic and psychological measures, is key to achieving functional and aesthetic results and the full return of the serviceman to his duties. Assessing the effectiveness of these measures is a multifaceted process that requires the analysis of various indicators: physiological, psychological, functional and social. Despite the widespread use of multidimensional comparative analysis methods to evaluate such complex systems, most of them have a significant drawback – the assumption that each indicator is equally important. This limits the accuracy and objectivity of selecting the best rehabilitation programme, as different aspects of the patient's condition have unequal effects on their overall combat capability. The purpose of the article is to justify and describe the procedure for evaluating rehabilitation measures for military personnel with skin injuries caused by thermobaric and incendiary weapons after reconstructive plastic surgery. The study analysed the results of the application of rehabilitation programmes in 122 servicemen of the Ukrainian Armed Forces (men aged 25 to 58) who underwent reconstructive and plastic surgery after skin injuries caused by thermobaric and incendiary weapons. An algorithm for evaluation using the minimum distance method is proposed. This algorithm includes the selection of indicators, the formation of a reference object, data standardisation, and the calculation of the integral distance, modified by integrating weight coefficients. The weights reflect the relative importance of each indicator, allowing priority to be given to those aspects that are most critical for restoring combat capability. The study was conducted in accordance with the principles of bioethics and using standard software for statistical data processing. Analysis of the rehabilitation results of 122 servicemen confirmed that there are statistically significant differences between the compared rehabilitation programmes in terms of key clinical and functional indicators, such as time, aesthetic outcome (p<0.001) and functional recovery (p<0.001). The use of an improved method of multidimensional comparative analysis with the integration of weighting coefficients allowed for a more accurate ranking of programme effectiveness compared to the traditional approach. This justification is key to the objective selection of optimal rehabilitation techniques. The proposed improved method of multidimensional comparative analysis is an effective tool for the objective evaluation and comparison of rehabilitation programmes. Using three programmes as examples, their ranking was established based on the weighted distance to the benchmark: programme B was recognised as the best (R_B^w=0), programme C as intermediate (R_C^w=0.254), and programme A as the worst (R_A^w=0.34). The implementation of this method will optimize rehabilitation protocols and accelerate the restoration of military personnel's functional capacity, ensuring their full return to duty.

Clinical efficacy and safety of Flamidase in the treatment of lumbar pain: results of a multicenter observational comparative study in Ukraine

2026-04-07T13:55:17+03:00

Pain in the lumbar region (lumbalgia) is one of the leading causes of temporary disability among the economically active population worldwide, including Ukraine. Nonsteroidal anti-inflammatory drugs remain the first-line treatment for vertebrogenic pain syndromes, providing analgesic and anti-inflammatory effects, but their use is limited by gastrointestinal disorders. Flamidase is a combination drug based on potassium diclofenac and paracetamol, which also contains the enzyme serratiopeptidase. This combination achieves a synergistic effect: paracetamol enhances the analgesic effect of potassium diclofenac, reducing the need to increase the dose of the nonsteroidal anti-inflammatory drug, while serratiopeptidase provides additional anti-inflammatory and anti-edema effects. The aim of the study was to evaluate the efficacy and safety of the combination drug Flamidase (potassium diclofenac, paracetamol, serratiopeptidase) compared to sodium diclofenac in the treatment of acute lower back pain (lumbago, lumbosciatica). A comparative prospective multicenter observational study was conducted involving 157 patients from 15 regions of Ukraine. Participants were divided into 4 groups depending on the nosology and the drug used: lumbago-Diclofenac (n=29), lumbosciatica-Diclofenac (n=49), lumbago-Flamidase (n=25), lumbosciatica-Flamidase (n=54). Efficacy was assessed based on the dynamics of pain syndrome from days 1 to 7 of treatment, safety was assessed based on the activity of transaminase enzymes (ALT, AST) in blood plasma, as well as subjective manifestations of side effects (nausea, abdominal pain, etc.). Both diclofenac sodium and Flamidase are effective in reducing the intensity of low back pain, with Flamidase significantly superior to diclofenac in terms of the severity and speed of the analgesic effect (especially in the nociceptive component). The average reduction in pain intensity (ΔVAS) over 7 days of treatment was 5.76 points in the Flamidase group versus 4.12 points in the diclofenac sodium group, which is statistically significant (p<0.05). In patients with lumbago, ΔVAS was 6.12 points (Flamidase) versus 4,48 points (diclofenac). In patients with lumbosciatica, it was 5.39 points (Flamidase) versus 3.76 points (diclofenac). The median VAS on the 7th day of treatment was 0 points in the Flamidase group versus 2 points in the diclofenac group. In terms of safety, diclofenac sodium is also slightly inferior to Flamidase, reliably (but clinically insignificantly) increasing ALT and AST activity, while no statistically significant difference between the drugs in terms of their effect on the stomach was verified: gastrointestinal side effects were observed in 15% of patients on diclofenac and 11% on Flamidase. Flamidase demonstrates better efficacy and safety compared to diclofenac sodium in the treatment of acute low back pain, especially in the presence of a nociceptive component. The combined action of potassium diclofenac, paracetamol, and seratopeptidase provides a pronounced analgesic effect without creating additional gastric and hepatobiliary risks for the patient. The results obtained indicate that the combination drug Flamidase may be an effective option for pharmacotherapy of acute low back pain. Further randomized controlled trials with a longer follow-up period are needed to confirm these results.

Metabolic alterations in men with coronary artery disease and concomitant prostate cancer and possibilities of their correction in statin-intolerant patients

2026-04-07T14:27:06+03:00

Numerous studies suggest an increased frequency of dyslipidemia and metabolic disorders in patients with prostate adenocarcinoma. The aim was to evaluate lipid profile, insulin resistance level in men with coronary artery disease and concomitant prostate cancer and impact of ursodeoxycholic acid on these indicators in complex therapy. Study included 48 men with coronary artery disease and prostate adenocarcinoma. The lipid profile, insulin resistance, testosterone level were determined in all of patients. The level of insulin, C-reactive protein were determined by immune-enzyme analysis. 1st group (n=22) was made up by statin-intolerant patients treated with ursodeoxycholic acid during 60 days in addition to standard therapy; 2nd group (n=26) – by statin-intolerant patients treated with standard regimen. The levels of triglycerides, low density lipoprotein-cholesterol and apolipoprotein-B in men with coronary artery disease and prostate adenocarcinoma were significantly higher than those in control group (p<0.001). The complex therapy with ursodeoxycholic acid resulted in significant decrease in the level of total cholesterol by 17.6% (p<0.001), triglycerides by 21.6% (p<0.001), low density lipoprotein-cholesterol by 25.2% (p<0.001), apolipoprotein-B by 12.9% (p<0.001), HOMA index level by 19.4% (p=0.001), median insulin level by 22.9% (p=0.002). Men with coronary artery disease and concomitant prostate cancer are characterized by increased levels of triglycerides, low density lipoprotein-cholesterol, insulin resistance and decreased apolipoprotein-B associated with low testosterone level. Complex treatment with ursodeoxycholic acid in these patients contributed to significant lipid level improvement and additional decrease of insulin resistance.

GAS6 protein and lipid metabolism dysfunction: a potential biomarker for risk stratification in patients with ischaemic chronic heart failure and metabolic disorders

2026-04-07T14:58:18+03:00

Chronic heart failure (CHF) remains a critical problem, the relevance of which is growing against the background of cardiometabolic polymorbidity. Comorbid conditions such as type 2 diabetes mellitus (T2DM) and obesity have common pathogenetic mechanisms that accelerate myocardial remodelling and fibrosis. The GAS6 (Growth Arrest-Specific 6) protein, as a ligand for the TAM family of receptors, is a central regulator of inflammation, cell survival, and vascular remodelling. Establishing a link between GAS6 levels and specific lipid metabolism disorders in the context of CHF is critical for improving risk stratification. The aim of the study was to investigate the activity of GAS6 protein and its relationship with lipid metabolism indicators in patients with ischaemic CHF, as well as to determine its potential prognostic value for risk stratification depending on the presence of concomitant metabolic pathology. The study included 225 patients with ischemic CHF and 30 healthy individuals (control group). The patients were divided into 4 groups: Group 1 (n=75) – coronary artery disease (CAD) + T2DM + obesity; Group 2 (n=50) – CAD + T2DM; Group 3 (n=50) – CAD + obesity; Group 4 (n=50) – CAD without metabolic pathology. Lipid metabolism indicators (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), atherogenicity coefficient (AC)) and serum GAS6 levels (using the ELISA kit Cusabio, USA) were determined. Spearman's rank correlation coefficient was used to determine correlations, with a critical significance level of p<0.05. According to the results of the study, the GAS6 protein content was highest in Group 1 (31.64±18.71 ng/ml), exceeding the control values by 66.3% (p<0.001), which indicates the cumulative effect of combined pathology. GAS6 levels in Group 3 and Group 2 were significantly higher than the control (by 41.8% and 31.1% , respectively). When analysing the correlations in Group 1, strong and significant positive correlations were found between GAS6 and BMI (r=0.68) and proatherogenic lipid metabolism fractions (LDL-C (r=0.54), VLDL-C (r=0.51), TG (r=0.47)). GAS6 is a sensitive marker, the activation of which is closely associated with the number and type of concomitant metabolic disorders. The established strong direct relationship between GAS6 and BMI and proatherogenic lipid fractions confirms that this protein is a powerful biochemical mediator that reflects the degree of dyslipidaemia and exacerbates atherosclerosis processes in patients with cardiometabolic polymorbidity. The level of GAS6 can serve as an important diagnostic and prognostic marker for early stratification of patients with ischaemic heart failure.

The uncertainties in radiation therapy planning

2026-04-07T15:20:31+03:00

The quality of radiation therapy has significantly improved due to the introduction of new irradiation sources, advanced delivery techniques, and modern three-dimensional treatment planning. However, the level of radiation-induced damage remains considerable, necessitating an assessment of the accuracy of tools responsible for image generation and dose calculation. The aim of the study was to identify potential uncertainties arising from the use of the TOSHIBA Asteion Super 4 computed tomography software and the planning systems of the Elekta Synergy linear accelerator (Elekta Limited), as well as to determine approaches for reducing these uncertainties. Twenty-eight patient radiotherapy plans carried out on the Elekta Synergy accelerator within the past four years were subjected to analysis. To evaluate image parameters, computed tomography data with a slice reconstruction thickness of 1.5 mm processed using the eFilm software were analysed. Pixel size, the number of pixels within a selected region, area, and optical density of various image segments were measured. Dose-planning uncertainties were estimated in the Monaco Treatment Planning System software based on absorbed-dose values in regions with minimal optical density inside the irradiation target contours, in the black-background cavities within the object, and outside the external body contour at various distances. The analysis revealed incorrect determination of image geometric parameters by eFilm, with an error of 8-15%. Optical-density values in the black background ranged from –1000 HU near the object boundary to -834 HU at greater distances. Significant variations in absorbed dose were observed in low-density regions: under identical conditions, dose values ranged from 0.0 Gy to 15.4 Gy. At a distance of 4 mm from the outer contour, an optical density of -1001 HU corresponded to a dose of 5.9 Gy, increasing with proximity to the contour. These findings indicate that errors in DICOM-image formation and dose calculation may introduce substantial uncertainties affecting treatment-planning accuracy and therapeutic outcomes. Improving computed tomography (CT) image-processing software and radiotherapy planning systems is considered a promising approach to reducing such uncertainties.

Altruism levels of medical students: a comparative perspective

2026-04-08T09:59:51+03:00

This study aims to compare the altruism levels of medical faculty students with other students and to understand the reasons for the decline of altruism in the medical profession. The sample consists of a total of 454 university students, comprising 309 females and 145 males, selected through random sampling from the faculties of medicine, education, and engineering. Data on altruism were obtained using the Altruism Scale, a Likert-type measurement tool that measures four sub-dimensions: family, social, helpful, and responsibility. The results revealed that medical students had significantly lower total altruism scores compared to both education and engineering students. This difference emerged most prominently in the "helpful" and "responsibility" sub-dimensions and could not be explained by demographic factors such as age and gender, or personality traits like extroversion. Furthermore, the findings showed that medical students already begin their education with a low level of altruism, and these levels remain statistically low without significant change throughout the preclinical years. The study concluded that the low altruism in medical students is not a result of an educational "erosion" of initially high ideals, but rather stems from structural factors. It is suggested that the student selection system for medical schools, which is highly competitive and based solely on multiple-choice tests, prioritizes academic achievement over humanistic values and thereby selects students who are motivated by status and career security rather than a desire to help. Additionally, the theory-heavy, competitive, and patient-distant preclinical educational environment fails to nurture or develop altruistic values. These findings challenge the dominant erosion narrative and indicate that a fundamental re-evaluation of student selection criteria and the educational curriculum is necessary to actively select for and cultivate altruism, a core value of the medical profession. It is recommended that longitudinal studies be conducted to follow students into their clinical years to observe further developments.

Reconfiguring interpretive bias in smokers: an integrated approach combining identity and contextual interventions

2026-04-08T10:18:07+03:00

Smoking-related interpretive bias, a core aspect of cognitive distortion in addiction, remains poorly understood regarding its specific characteristics and underlying activation mechanisms. This study addressed this gap through three sub studies exploring the intrinsic properties of smokers’ interpretive bias, the role of smoker identity, and the moderating effect of cognitive load. The Ambiguous Scenario Test was employed to assess interpretive bias. Results revealed that smokers exhibited significantly higher levels of smoking related interpretive bias compared to nonsmokers. Furthermore, smokers with a strong smoker identity displayed more pronounced bias than those with a weak identity. Importantly, the predictive influence of smoker identity on this bias diminished as cognitive load increased, indicating that cognitive resources modulate the identity bias relationship. These findings suggest that sufficient cognitive capacity is necessary for smoker identity to effectively activate associated interpretive biases. By clarifying the core features of smoking-related interpretive bias, identifying smoker identity as a key contributor, and demonstrating cognitive load’s moderating role, this research advances theoretical understanding of cognitive bias components and triggering mechanisms in smokers. The results also hold practical implications for developing targeted interventions aimed at disrupting maladaptive cognitive processes in smoking behavior.

Comparison approahes to children’s caries treatment among ukrainian dental students and dentists

2026-04-06T14:31:55+03:00

Selecting the non-operative or operative method of caries treatment is crucial for saving affected teeth. This article aims to investigate the diagnosis and treatment methods of caries lesions in children which preferred by the students and dentists from Poltava city, and to explore factors influencing their treatment approaches. The research tool was standard anonymous survey modified by the authors, which composed of three clinical scenarios and questions about diagnosis and treatment of carious lesions and collected data on gender and length of dental service (assistance for students). The fourth- and fifth-year dental students from Poltava state medical university (PSMU) and the dentists from government-owned and private clinics in Poltava were interviewed. Statistical analysis of the results was performed using descriptive statistics and Pearson's chi-square test. Among the students, 2.7% believed that radiographs estimate the true depth of a proximal carious lesion compared with clinical findings, and 66.1% of the dentists agreed with this statement (p<0.05). 66.9% of the students and 84.75% of the dentists answered that it would take less than 6 months for an approximal lesion to progress from outer enamel to dentin (p<0.05). 56.25% of the students and 77.97% of the dentists (p<0.05) diagnosed an enamel caries (ICDAS 2-3) in the first clinical scenario. For the first clinical scenario, choice of treatment method depended on student's length of dental assistance (p<0.05). 42.36% of the students and 55.93% of the dentists (p<0.05) diagnosed enamel caries in the second clinical scenario. In both clinical scenarios, dentists predominantly chose operative treatment methods (66.09% and 78.82%), which was significantly higher than the rates observed among students (43.06% and 47.02%; p<0.001). 56.5% of the students and 59.32% of the dentists chose immediate operative treatment for an occlusal carious lesion confined by enamel in the third clinical scenario. The surveyed students did not place sufficient importance to radiographs in diagnosis of proximal lesions. Instead, students length of dental assistance was a major factor influencing their treatment decisions for enamel caries. The majority of surveyed dentists disagreed with current recommendations for treatment of enamel lesions, preferring operative intervention to a non-operative approach. This suggests that academic institutions should make conservative and restorative dentistry a priority area.

Evaluation of the effectiveness of treatment of primary sclerosing cholangitis and autoimmune sclerosing cholangitis in children and adolescents

2026-04-07T15:33:28+03:00

Primary sclerosing cholangitis and autoimmune sclerosing cholangitis in children are rare chronic liver diseases characterized by progressive bile duct damage, fibrogenesis, and a risk of developing biliary cirrhosis. Autoimmune sclerosing cholangitis is considered a distinct pediatric phenotype of primary sclerosing cholangitis, combining clinical and morphological features of both autoimmune hepatitis and sclerosing cholangitis. Despite similar immunopathogenetic mechanisms, these diseases differ significantly in clinical course, therapeutic response, and long-term prognosis. The overall effectiveness of treatment remains suboptimal, which may be related to the ongoing progression of bile duct fibrosis even under therapy. Lack of biochemical response within the first 6-12 months is considered an unfavorable prognostic factor and should be regarded as an indication for treatment escalation or transition to alternative therapeutic strategies. Evaluation of treatment efficacy is essential for timely decision-making regarding therapeutic adjustments. The aim of this study was to evaluate the effectiveness of treatment in children with primary sclerosing cholangitis and autoimmune sclerosing cholangitis over a 12-month period based on the dynamics of biochemical response, liver stiffness measurements assessed by elastography, and the SCOPE prognostic index. A total of 56 children aged 2 to 18 years, who underwent evaluation and treatment between 2016 and 2024 at a pediatric hepatology department, were included in the study: 38 with autoimmune sclerosing cholangitis and 18 with primary sclerosing cholangitis. Patients in the first group received combined immunosuppressive therapy, while those in the second group were treated with ursodeoxycholic acid. After 12 months of treatment, complete biochemical response was achieved in 47% and 67% of children, respectively (p=0.27), and normalization of gamma-glutamyltransferase in 63% and 83% (p=0.21). The prognostic index significantly decreased in both groups, while liver stiffness reduction was statistically significant only in children with autoimmune sclerosing cholangitis (p=0.002). These findings indicate partial treatment effectiveness and highlight the importance of comprehensive monitoring to support timely modification of therapeutic strategies.

Simulation as a tool for strengthening the preparedness of Ukraine’s public health system to threats: challenges and prospects

2026-04-08T12:46:18+03:00

The public health system of Ukraine operates under a combination of military threats, intensive migration processes, transformation of the social environment, and increasing risks of biological, chemical, and technological incidents. Under these conditions, traditional educational and managerial approaches are limited in their capacity to ensure preparedness for complex crisis situations and do not allow for a comprehensive assessment of the system’s ability to respond in a coordinated manner. In response to these challenges, simulation technologies are increasingly considered as a tool that integrates workforce training with the testing of managerial decisions and intersectoral coordination in a safe environment. The aim of this study is a conceptual and analytical synthesis of contemporary approaches to the use of simulation technologies in public health and the development of an applied framework for their integration to enhance the preparedness and functional resilience of the national public health system of Ukraine to modern and combined threats. The analysis was based on peer-reviewed scientific publications, international methodological guidelines, and strategic documents retrieved from international scientific databases and official resources of leading international institutions, primarily covering the period from 2018 to 2025. The study substantiates the relevance of considering simulation technologies not only as an educational tool but as a component of ensuring systemic preparedness and functional resilience in public health. The main areas of application of simulations are systematized, including emergency response, testing of public policies, crisis communication, and intersectoral coordination. The role of medical universities as an institutional foundation for the development of simulation-based training is summarized, and key barriers to implementation are identified, including infrastructural, regulatory, and methodological constraints. Based on the analytical synthesis, strategic directions for the development of simulation technologies in the public health system of Ukraine are formulated, the implementation of which is considered a prerequisite for strengthening system preparedness for current and future threats.

Trends in the abuse of patent rights for medicinal products in the United States (review)

2026-04-08T11:12:15+03:00

The article provides a systematic analysis of scholarly publications addressing contemporary trends in the abuse of patent rights in the pharmaceutical sector of the United States, with particular emphasis on the mechanisms for implementing “evergreen” patent strategies and their economic and legal consequences. The purpose of the study was to conduct a systematic review of the scientific literature on trends in the abuse of patent rights in the U.S. pharmaceutical sector, focusing on the mechanisms of “evergreen” patent strategies, their economic and legal implications, and possible directions for improving regulatory policy. To achieve this objective, a systematic literature review methodology was applied in accordance with the PRISMA guidelines, in combination with general scientific and special research methods, including the systemic-structural, dialectical, formal-logical, and comparative legal approaches, as well as methods of analysis and synthesis. The use of these methods made it possible to assess the current state of patent regulation in the United States, identify legal instruments for extending patent monopolies, and analyze their impact on the availability of generic and/or biosimilar medicines. The empirical basis of the study consisted of scientific publications, analytical and statistical reports indexed in PubMed, JAMA, Scopus, Springer, BMC, and Oxford Academic, reports and forecasts of international organizations (DrugPatentWatch, ProClinical, PhRMA, Statista), as well as official documents of the United States Patent and Trademark Office (USPTO), the TRIPS Agreement, and U.S. patent legislation (the U.S. Patent Act and the Hatch–Waxman Act). Out of 286 identified publications, 40 sources published between 2008 and 2025 were included in the qualitative analysis. Inclusion criteria comprised sources containing data on pharmaceutical patent protection, “evergreen” patent strategies, economic consequences, and access to medical technologies. Sources lacking a direct connection to the subject of the study or failing to meet scientific reliability standards were excluded. The results of the study demonstrate that U.S. pharmaceutical companies systematically employ multi-layered patent strategies aimed at prolonging market exclusivity beyond the expiration of the basic patent term, increasing drug prices, and restricting access to therapy for consumers. At the same time, empirical evidence confirms that patent expiration creates conditions for intensified market competition and a reduction in generic drug prices by 30–50% within the first years following market entry. The study emphasizes the need to improve regulatory mechanisms within U.S. patent law, including limiting “evergreen” practices and ensuring greater transparency of market processes. A forecast of structural changes in the U.S. pharmaceutical market for the period 2025-2029 is provided, associated with the expiration of key patents for original medicines, and approaches are proposed to achieve a balance between the interests of innovative development and societal needs for affordable medicines.

Risk analysis in the production of hard capsules under the conditional name “Praziquantel plus” using the Ishikawa diagram method

2026-04-08T11:29:14+03:00

This article explores the application of the Ishikawa (cause-and-effect) diagram as a risk analysis tool within a pharmaceutical quality system for the production of hard capsules under the code name "Praziquantel Plus". Aligned with the standards of ISO 9001, ICH Q10, and GMP, the study demonstrates how this method systematically identifies and analyzes potential risks across key production categories. The research provides a tailored Ishikawa diagram that facilitates the identification of critical parameters, supports process optimization, and enhances the overall quality assurance system for this specific medicinal product. The aim of the research was to analyze the risks in the production of hard capsules under the conditional name “Praziquantel Plus” using the Ishikawa diagram. The study was based on the analysis of a model industrial process for the production of Praziquantel Plus hard capsules. The materials for the risk analysis were the technological regulations, specifications for raw materials and finished product, as well as the requirements of GMP/ICH standards. The study employed a systematic approach to risk assessment in accordance with ICH Q9 guidelines. The primary methodology is centered on the construction of the Ishikawa diagram. The study is based on a systems approach, brainstorming, cluster analysis and cause-and-effect analysis. A comprehensive Ishikawa diagram was developed, structured around six primary risk categories for pharmaceutical production: raw materials, production process, equipment, personnel, premises, and quality control. Critical risk factors were identified and prioritized. The most significant risks were found to be associated with: a) the quality of active pharmaceutical ingredients and excipients (e.g., inconsistency in quantitative content, impurities); b) critical stages of the technological process (e.g., weighing accuracy, mixture homogeneity, capsule filling flowability); and c) the specifics of pharmaceutical equipment qualification and operation. Detailed risk assessment tables were created for both raw materials and the technological process, outlining potential failures, their consequences, and proposed precautionary measures to mitigate each risk (e.g., enhanced incoming quality control, process validation, equipment calibration). An adapted, product-specific Ishikawa diagram was proposed for the industrial-scale production of “Praziquantel Plus”. This diagram details first- and second-order subcategories within the main "bones," reflecting the unique aspects of scaling up from laboratory to commercial manufacturing. The Ishikawa diagram method proves to be an effective and structured tool for pre-emptive risk identification in pharmaceutical process development and scale-up, aligning with GMP and ICH Q9/Q10 requirements. The study successfully mapped and systematized the key risk categories and their interrelations for the production of “Praziquantel Plus” hard capsules, providing a visual and analytical framework for quality management. The proposed tailored diagram and risk tables serve as a practical foundation for implementing preventive actions, optimizing the technological process, and conducting root-cause analysis of potential defects, thereby strengthening the overall Pharmaceutical Quality System for this product.