Diuretics are widely used to treat pathologies of various genesis. However, the development of side effects during their long-term use remains a problem of traditional treatment regimens. The search for diuretics that would be aimed at inhibiting a key target molecule that is involved in the regulation of salt or water balance in the kidney, and certainly have a low level of toxicity and side effects, is an urgent task for researchers. Our preliminary screening of substituted quinones using in silico and in vitro methodology identified a number of effective compounds that outperform or compete with diuretics. The compounds are not "classic" carbonic anhydrase II inhibitors, but the pronounced diuretic effect of a number of compounds requires additional explanation. Therefore, the aim of the work was to study the effect of substituted quinones on the excretory function of rat kidneys to assess the prospects of their further structural modification and use as potential diuretics. Considering the experimental data, it should be noted that compounds AVD-6, AVD-7, AVD-8 and AVD-9 have pronounced diuretic activity. Thus, according to indicators of ex­cretory indices of electrolytes, it is possible to note the predominant influence of compounds AVD-6, AVD-7, AVD-8 and AVD-9 on excretion of sodium, potassium and chlorine from the body. Compounds AVD-6, AVD-7, AVD-8 and AVD-9, in contrast to Hydrochlorothiazide, which blocks carbonic anhydrase in the proximal part of the convoluted tubules and accelerates the excretion of potassium with from the urine, have a much lower excretory index as for these ions. Thus, our conducted research made it possible to identify a new, little-known class of hybrid molecular structures, namely (N'-(4-[(aroyloxy)imi­no]cyclohexa-2,5-dien-1-ylidene) aroylhydrazides (AVD-6, AVD-7, AVD-8 and AVD-9), which, in addition to affecting the excretory function of the kidneys, have significant diuretic activity and are  potential diuretics. 

Key words: substituted quinones, diuretic activity, diuretic index, urinary electrolyte excretion

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Look through:

Sokolova K.V. Dnipro State Medical University, 9, Dnipro, 49044, Ukraine, 
e-mail: cat@dmu.edu.ua
https://orcid.org/0000-0001-5022-3227

Podpletnya O.A. Dnipro State Medical University, 9, Dnipro, 49044, Ukraine
https://orcid.org/0000-0003-4113-4665

Konovalova S.О. Donbas State Engineering Academy, Kramatorsk, Ukraine
http://orcid.org/0000-0003-3410-2550

Avdeenko A.P. Donbas State Engineering Academy, Kramatorsk, Ukraine
http://orcid.org/0000-0003-0549-2131

Kovalenko S.I. Oles Honchar Dnipro National University, Dnipro, Ukraine
https://orcid.org/0000-0001-8017-9108

Sokolova K.V., Podpletnya O.A., Konovalova S.О., Avdeenko A.P., Kovalenko S.I. Influence of substituted quinones on the excretory function of the rat kidney and evaluation of the prospects of their use as potential diuretics. Medicni perspektivi. 2024;29(2):4-10.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307457

The human visual analyzer is a high form of evolution. Some jellyfish can distinguish light and dark objects with sensitive cells. Squids, octopuses, and nautiluses from Cephalopods family have eyes with which they can see objects. Visual information is processed in the brain. In fishes, the visual analyzer evolved. Fishes living below 100 m depth inhabit a world with blue light. The authors consider the evolution of vision in these fishes due to the lowest absorption of blue and violet colors of electromagnetic waves from the optical spectrum. Subsequently, on land, in humans vision evolved towards the green color. Green is the most prevalent color on the land. In humans, three light-sensitive cones evolved – S, M, and L. S cones are most sensitive to blue, M – to green, and L – to red color in the spectrum. Some humans retain sensitivity of S to genetic changes and disorders. Additive color mi­xing is a high form of color perception in humans. The additive mixing of different colors achieves a new color in the human visual analyzer. Remarkably, different individuals perceive observed images in varying manners. Mixing neighboring colors on the spectrum gives one, two, or three colors. This process is estimated using graphical modeling. The graphical modeling with two colors allows for the creation of additive colors. One, two, or three additive colors can be obtained. The production of colors results from the light sensitivity of S, M, and L cones. An analysis that phy­sically demonstrates the mixing of green and red colors, resulting in the colors yellow or orange. When blue and red are mixed, the resulting colors are green, yellow, and orange is proposed. The additive mixing of blue and yellow gives green. The subjective nature of visual perception, influenced by the viewer’s heightened sensitivity to one of the colors, beco­mes evident in the presence of two colors. Notably, when the background is violet, the sensitivity of the blue cones diminishes.

Key words: colors, shades, additive mixing, electromagnetic waves, vision analyzer

1. Lienard MA, Valencia-Montoya WA, Pierce NE. Molecular advances to study the function, evolution, and spectral tuning of arthropod visual opsins. Philos Trans R Soc Lond B Biol Sci. 2022 Oct 24;377(1862):20210279. doi: https://doi.org/10.1098/rstb.2021.0279
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4. Sliney DH. What is light? The visible spectrum and beyond. Eye. 2016;30(2):222-9. doi: https://doi.org/10.1038/eye.2015.252
5. Nagane UP, Mulani AO, Moving object detection and tracking using Matlab. Journal of Science and Technology. 2021;6(1):2456-5660. doi: https://doi.org/10.46243/jst.2021.v6.i04
6. Patel B, Kanade P. Sustainable dyeing and prin­ting with natural colors vis-à-vis preparation of hygienic viscose rayon fabric. SM&T. 2019;22:e00116. doi: https://doi.org/10.1016/j.susmat.2019.e00116
7. Reda K, Szafir DA, Rainbows Revisited: Mode­ling Effective Colormap Design for Graphical Inference. IEEE Trans Vis Comput Graph. 2021;27(2):1032-42. doi: https://doi.org/10.1109/TVCG.2020.3030439
8. Pridmore RW. A new transformation of cone responcses to opponent color responses. Attention, Perception, & Psychophysics. 2021;83:1797-803. doi: https://doi.org/10.3758/s13414-020-02216-7
9. Levine JS, MacNichol EF. Color vision in fishes. Scientific 1982;246(2):140-9. doi: 10.1038/scientificamerican0282-140
10. Suryanto ME, Gilbert Audira G, Roldan MJM, Lai H-T, Hsiao C-D. Color perspectives in aquatic explo­ration: Unveiling innate color preferences and psychoactive responses in freshwater crayfish. Toxins. 2023;11(10):838. doi: https://doi.org/10.3390/toxics11100838
11. Ignatov I, Popova TP. Comparative spectral ana­lysis Octopus Vulgaris Cuvier, 1797, jellyfish and sea­water from Aegean Sea, Evia, Greece, Uttar Pradesh. Journalof  2023;44(24):119-33. doi: https://doi.org/10.56557/upjoz/2023/v44i243818
12. Altmann CS, Brachmann A, Redies C. Liking of art and the perception of color. J Exp Psychol: Hum Percept Perform. 2021;47(4):545-64. doi: https://doi.org/10.1037/xhp0000771
13. Hepschke JL, Martin PR, Fraser CL. Short-wave Sensitive (“Blue”) cone activation Is an aggravating factor for visual snow symptoms. 2021;12:697923. doi: https://doi.org/10.3389/fneur.2021.697923
14. Pridmore RW. Complementary colors: A litera­ture review. Color Res Appl. 2021;46:482-8. doi: https://doi.org/10.1002/col.22576
15. Ignatov I, Vanlyan K. Electromagnetic concep­tion of color vision in additive mixing of colors. Ap­plication in photography. Art and psychology. J Physiol Med Biophys. 2020;64:9-13. doi: http://dx.doi.org/10.7176/jmpb/64-02
16. Wissinger B, Baumann B, Buena-Atienza E, et al. The landscape of submicroscopic structural variants at the OPN1LW/OPN1MW gene cluster on Xq28 under­lying blue cone monochromicy. PNAS. 2022;119(27):e2115538119. doi: https://doi.org/10.1073/pnas.2115538119 
17. Andrews SS. Color: In light and waves Springer Cham. 2023:249-271.
    doi: https://doi.org/10.1007/978-3-031-24097-3_10
18. Krishnamoorthi A, Abady KK, Dhankhar D, et al. Ultrafast transient absorption spectra and kinetics of rod and cone visual pigments. Molecules. 2023;28(15):5829. doi: https://doi.org/10.3390/molecules28155829
19. Kim YL. Packer O, Pollreisz A, et al. Compa­rative connectomics reveals noncanonical wiring for color vision in the human foveal retina. PNAS. 2023;120(18):e2300545120. doi: https://doi.org/10.1073/pnas.2300545120

Look through:

Ignatov I. Scientific Research Center of Medical Biophysics, Sofia, Bulgaria, 
e-mail: mbioph@abv.bg

Popova T.P. University of Forestry, Faculty of Veterinary Medicine, Sofia, Bulgaria 

Ignatov I., Popova T.P. Graphical modeling of additive color mixing. Analyses of electromagnetic effects as colors of the vision analyzer. Medicni perspektivi. 2024;29(2):11-17.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307463

One of the actual problems of modern orthopedic dentistry is the development of optimal materials that, by their physical and chemical properties, would be most biocompatible with the mucous membrane of the oral cavity. The purpose of this work was to substantiate the use of base materials and acrylates for the manufacture of removable prostheses and to increase the effectiveness of orthopedic treatment of patients with complete or partial absence of teeth basing on the review of literary sources. A literature review was conducted using PubMed, Web of Science, SCOPUS, Google Scholar from 2019 to January 2024. There was no restriction on the date of publication or language. Searches were conducted according to MeSH (Medical Subject Headings) using the following search terms: "removable prosthetics", "removable prostheses", "dental base materials", "acrylates", "materials science", "adaptation". A total of 82 sources of literature were selected and processed during the primary analysis. After systematization of the selected information using general scientific methods, 70 most relevant sources remained. Exclusion criteria: publications that did not meet the purpose of this review, publication language other than English and Ukrainian. Used methods: bibliographic and analytical. The relation between the properties of the materials from which the prosthesis is made and the mucous membrane of the prosthetic bed was revealed, and the direct dependence of the quality of the prosthesis, the period of wearing, and the level of oral hygiene was determined. The base material must be easy to use so that the prosthesis can be manufactured and repaired without the use of a significant number of technological processes and equipment. The most common and popular material for manufacturing the bases of partial and complete removable prostheses are acrylates due to their low cost and the simplicity of the application technology, which does not require expensive equipment. The analysis of these literature sources showed that the percentage ratio of the composition of removable prostheses, which includes acrylic plastic, is more than 80%. However, except all existing advantages, they have a number of disadvantages. The main unsatisfactory quality of acrylic prostheses is their negative impact on the tissues of the prosthetic bed, which is reflected in the sensitivity of the mucous membrane and the phenomena of inflammation. Most often, this is manifested as a result of the reproduction of pathogenic microflora, which is concentrated on the surface of the base of the prosthesis. It is worth remembering that removable prostheses are inherently combined irritants that have a whole set of negative effects on the mucous membrane of the prosthetic bed, leading to its chronic inflammation. The above-described negative properties of acrylic plastic became the impetus for the creation of other types of materials. This problem is extremely urgent, and despite the serious resources spent on its elimination, so far no optimal way to increase not only the functionality and durability of the service, but also the safety of using removable orthopedic constructions has been found.

Key words: removable prosthesis, base materials, acrylic plastic, mucous membrane, material science, stomatitis, adaptation

1. Dobrovolskaya OV. [Dental implantation as a method of optimizing treatment of patients with complete dental teeth]. Ukrainian Dental Almanac. 2019;4:33-40. Ukrainian.
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3. Messias A, Nicolau P, Guerra F. Different interventions for rehabilitation of the edentulous maxilla with implant-supported prostheses: An overview of systematic reviews. Int J Prosthodont. 2021;34:63-84. doi: https://doi.org/10.11607/ijp.7162
4. Hasiuk P, Kindiy D, Radchuk V, Kindiy V, Dem­kovych A, Yarkoviy V. Biological compatibility of metal structures of dentures made from multiple melted alloys. Polski Merkuriusz Lekarski. 2022;50(296):114-7. Available from: http://repository.pdmu.edu.ua/bitstream/123456789/18107/1/Biological_compatibility_of_metal_structures.pdf
5. Carra MC, Rangé H, Swerts PJ, Tuand K, Van­damme K, Bouchard P. Effectiveness of implant-sup­ported fixed partial denture in patients with history of periodontitis: A systematic review and meta-analysis. J Clin 2022 Jun;49(24):208-23. doi: https://doi.org/10.1111/jcpe.13481
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7. Meira IA, Gama LT, Prado-Tozzi DA, Pin­heiro MA, Rodrigues Garcia RCM. Speech in implant-supported and removable complete denture wearers: A systematic review. J Prosthet Dent. 2022;128(6):1230-8. doi: https://doi.org/10.1016/j.prosdent.2021.03.006
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9. Gonсalves GSY, de Magalhaes KMF, Rocha EP, Dos Santos PH, Assuncao WG. Oralhealth-related quality of life and satisfaction in edentulous patients rehabilitated with implant-supported full dentures all-on-four concept: a systematic review. Clin Oral Investig. 2022;26(1):83-94. doi: https://doi.org/10.1007/s00784-021-04213-y
10. Goldstein G, Kapadia Y, Campbell S. Complete denture occlusion: Best evidence consensus statement. J Prosthodont.2021;30(s1):72-7. doi: https://doi.org/10.1111/jopr.13309
11. Araujo R, Zancopé K, Moreira R, Barreto T, Neves F. Mandibular implant-assisted removable partial denture – Kennedy Class I to Class III modification – Case series with masticatory performance and satisfaction evaluation. J Clin Exp Dent. 2023 Jan 1;1(15):71-8. doi: https://doi.org/10.4317/jced.59777
12. Techapiroontong S, Limpuangthip N, Tum­ras­vin W, Sirotamarat J. The impact ofpoor dental status and removable dental prosthesis quality on body composition, masticatoryperformance and oral health-related quality of life: a cross-sectional study in older adults. BMC Oral Health.2022;22(1):147. doi: https://doi.org/10.1186/s12903-022-02103-7
13. Makieiev V, Hunovsky Ya. The features of pa­tient adaptation to removable partial dentures based on the dynamic study of the mucous membrane condition of an oral cavity in the new functioning conditions. Actual Dentistry.2022;3-4:33-7.  doi: https://doi.org/10.33295/1992-576X-2022-3-33
14. Sylenko BYu, Dvornyk VM, Sylenko YuI. [The state of tissues of the prosthetic bed inpatients with prosthetic stomatitis during orthopedic treatment withpro­stheses modified with nanomaterials]. Ukrainian Dental Almanac.2021;(4):20-5.  doi: https://doi.org/10.31718/2409-0255.4.2021.04
15. Yanishen IV, Zapara PS, Fedotova OL, Khlis­tun NL, Saliya LG. Study ofhemodynamics of the mucous membrane of the prosthetic area atthe stages of treatment of patients with removable denturesaccording to the improved technique. Polish Med J. 2022;295:391-5.
16. Khilinich YeS, Nidzelsky MYa, Davydenko VYu, Kuznetsov VV, Davydenko GM. [Techniques to study indicators of temperature in foundation area and pressure onto the mucous membrane from removable laminar dentures]. Actual Problems of the Modern Medicine: Bulletin of Ukrainian Medical Stomatological Academy. 2019;4(19):73-6. doi: https://doi.org/10.31718/2077-1096.19.4.73
17. Sokolovska VM. [Modern methods to improve biocompatibility of removable dentures by applying ultrasound techniques]. Actual Problems of the Modern Medicine: Bulletin of Ukrainian Medical Stomatological Academy. 2020;3(20):73-6. doi: https://doi.org/10.31718/2077-1096.20.3.73
18. Demkovych A. Effects of flavonol quercetin on activity of lipid peroxide oxidation in experimental bacterial-immune periodontitis. Interventional Medi­cine   and Applied Science. 2019 Mar;11(1):55-9. doi: https://doi.org/10.1556/1646.10.2018.48
19. Bandrivsky Y, Bandrivska O, Bandrivska N, Be­denyuk O, Kuchyrka L, Zmarko I. Medication correction of themain clinical symptoms of generalized periodontitis in patients with different blood groups. Pharmacia. 2023;70(3):499-507. doi: https://doi.org/10.3897/pharmacia.70.e102850
20. Sokolova II, Kuznetsov RV, Chulak LD, Kiri­chek OV, Zverkhanovskyi OA. [Іnfluence of auxiliary groups of materials on productionquality removable ortho­pedic constructions of dental prosthesis (literature review)]. Experimental and Clinical Medicine. 2023;92(3):1-7. Ukr. doi: https://doi.org/10.35339/ekm.2023.92.3.skc
21. Matvieienko LM, Matvieienko RY, Fasto­vets OO. Effects of strontium ranelate on alveolar bone in rats with experimental diabetes mellitus. Wiadomości Lekarskie. 2022;75(1 Pt 2):151-5. Available from: https://repo.dma.dp.ua/7388/1/WLek202201201.pdf
22. Zapara PS. [Comparative evaluation of the quality of the recovery of chewing effectiveness, in the treatment of patients with removable orthopedic dentures made according to various laboratory technologies, based on data electro-myographic research]. Novini Stomatologii. 2019;2:50-4. Ukrainian. Available from: https://repo.knmu.edu.ua/bitstream/123456789/23574/1/%d0%97%d0%90%d0%9f%d0%90%d0%a0%d0%90_%d0%9d%d0%a1.pdf
23. Muluk S, Grover I. Aesthetics of claps in remo­vable partial denture – A literature review. International Journal of Advanced Dental Sciences and Technology. 2023;2(4):1-4. doi: https://doi.org/10.54105/ijadst.D1009.062422
24. Andrienko K.Y. [Analysis of clinical criteria for assessing quality of removable orthopedic appliances manufactured using doped packaging materials]. Actual Problems of the Modern Medicine: Bulletin of Ukrainian Medical Stomatological Academy. 2023;3(3):78-82. doi: https://doi.org/10.31718/2077-1096.23.3.78
25. Alhallak KR, Nankali A. 3D Printing techno­logies for removable dentures manufacturing: a review of potentials and challenges. Eur J Prosthodont Restor Dent. 2022 Feb 28;30(1):14-9. doi: https://doi.org/10.1922/EJPRD_2208Alhallak06
26. Schmutzler A, Rauch A, Nitschke I, Lethaus B, Hahnel S. Cleaning of removable dental prostheses – a systematic review. J Evid Based Dent Pract. 2021 Dec;21(4):101644. doi: https://doi.org/10.1016/j.jebdp.2021.101644
27. Peng PW, Hsu CY, Huang HY, Chao JC, Lee WF. Trueness of removable partial denture frame­works additively manufactured with selective laser melting. J Prosthet Dent. 2022;127(1):122-7. doi: https://doi.org/10.1016/j.prosdent.2020.06.035
28. Leybuk LV. [Dynamics of rheological properties of oral fluid in the course of their correction in patients with diabetes who use removable complete denture (RCD)]. Actual dentistry. 2020;1:100-2. Ukrainian. doi: https://doi.org/10.33295/1992-576X-2020-1-100
29. Yunizar MF, Watanabe M, Ichikawa T. Current development status of additive manufacturing techno­logies for fabricating removable partial denture frame­works: a literature review. Int J Comput Dent. 2022;25(1):57-70.
30. Khan AA, Fareed MA, Alshehri AH, Aldeg­heishem A, Alharthi R, Saadaldin SA, et al. Mechanical properties of the modified denture base materials and polymerization methods: a systematic review. Int J Mol Sci. 2022 May20;23(10):5737. doi: https://doi.org/10.3390/ijms23105737
31. RedushkoYuV, Dmytryshyn TM, Rozhko ОM. [Clinical condition of prosthetic bed tissues in patients who use different adhesive means to improve fixation of remo­vable dentures]. Actual dentistry. 2020;1:96-9. Ukrainian. doi: https://doi.org/10.33295/1992-576X-2020-1-96
32. RuzuddinovN, Ruzuddinov S, Voronov I, Altyn­bekov K, Ruzuddinova  Clinical classification of torus and effectiveness of two-layer bases in removable dentures. J Popul Ther Clin Pharmacol. 2022;29(3):87-93. doi: https://doi.org/10.47750/jptcp.2022.939
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Poliukhovych Yu.I.  I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0009-0007-4726-9372

Demkovych A.Ye. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine, e-mail: demkovushae@tdmu.edu.ua 
https://orcid.org/0000-0001-9823-4283

Bondarenko Yu.I.  I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0003-2681-5526

Shcherba V.V. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0002-1998-5183

Lebid O.I. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0002-6214-526X

Duda K.M. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0002-5570-9194

Poliukhovych Yu.I., Demkovych A.Ye., Bondarenko Yu.I., Shcherba V.V., Lebid O.I., Duda K.M. Characteristics of base materials and acrylates used in removable prosthetics in dental practice (review). Medicni perspektivi. 2024;29(2):18-26. 
DOI: https://doi.org/10.26641/2307-0404.2024.2.307464

Retention (delayed eruption) of the third molar is one of the most common pathologies in the outpatient practice of a dentist-surgeon. Such a pathology can very often be complicated by inflammatory diseases, such as pericoronitis, periostitis and other more serious diseases. Therefore, early warning and most gentle removal of the causative tooth determines the professionalism of the dental surgeon. A large number of indexes of difficulty of removal of the third molar have been proposed by different authors, but none of them is considered universal and optimal for different clinical cases. The level of complexity is most clearly characterized by a scale that takes into account not only radiological but also clinical and demographic indicators. Such scales exist in modification or in more recent literary sources. Having chosen the most clear and correct scale, it is possible for the surgeon to clearly assess the entire level of complexity and responsibility for surgical intervention on removing the third molar, thereby obtaining the most effective result, minimizing complications both during the operation and after a while. The purpose of the study: justification of the selection of the difficulty rating scale for the removal of the third molar of the lower jaw, depending on its position. The study analyzed and compared 18 basic scales of complexity that are most often used by surgeons before removing the impacted third molar of the lower jaw. Data sources that were used for the search were taken from Medline, PubMed, Google Scholar, Minerva library databases. Each of the difficulty scales was presented and translated into Ukrainian for convenient use in the practice of a dental surgeon. A general table was provided where a comparative analysis of the difficulty scales was made according to thirty parameters. It is shown that the Cosme Gay-Escoda C. scale has the most indicators for preoperative assessment of complexity. There are many difficulty scales for preoperative assessment for the removal of impacted third molars of the lower jaw. Some of them have radiological evaluation criteria, some have clinical criteria, and only the Pernumbuco index (2017), Zhang X. (2019), and Cosme Gay-Escoda C. (2022) scales also have demographic indicators. However, the latter has the largest number of criteria, according to which the difficulty of removing the third molar of the lower jaw is calculated. 

Key words: impacted third molar, impaction, atypical removal, complications

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41. Ku JK, Baik SH, Kim JY, Huh JK. Effect of a vertical incision on postoperative swelling after an impacted mandibular third molar extraction: two cases with split-mouth designed magnetic resonance imaging analysis. J Korean Assoc Oral Maxillofac Surg. 2023 Apr 30;49(2):91-5. doi: https://doi.org/10.5125/jkaoms.2023.49.2.91
42. Zhang X, Wang L, Gao Z, Li J, Shan Z. Develop­ment of a new index to assess the difficulty level of surgical removal of impacted mandibular third molars in an Asian population. J Oral Maxillofac Surg. 2019;77(7):1358.e1-1358.e8.
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44. Penarrocha M, Sanchis JM, Saez U, Gay Esco­da C, Bagan JV. Escala numerica de valoracion de la dificultad quirurgica en la extraccion de 190 terceros molars mandibu­lares incluidos. Arch Odontoestomatol. 2000;16(2):96-100.
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46. Gay-Escoda C, Sánchez-Torres A, Borrás-Fer­reres J, Valmaseda-Castellón E. Third molar surgical difculty scales: systematic review and preopera tive assessment form. Med Oral Patol Oral Cir Bucal. 2022;27(1):e68-76. doi: https://doi.org/10.4317/medoral.24951.
47. AAE Endodontic Case Difficulty Assessment Form and Guidelineshttps [Internet]. [cited 2024 Apr 07]. Available from: URL://www.aae.org/specialty/wp-content/uploads/sites/2/2022/01/CaseDifficultyAssessmentFormFINAL2022.pdf
48. Sánchez-Jorge MI, Cortés-Bretón-Brinkmann J, Acevedo-Ocaña R, Quispe-López N, Falahat F, Martín-Granizo R. Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualification in oral surgery and maxillofacial surgeons in a Spanish subpopulation. Med Oral  Patol Oral Cir Bucal. 2024 Mar 1;29(2):e263-e272. doi: https://doi.org/10.4317/medoral.26243 

Look through:

Gudarian O.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-5370-1570

Nekhanevуch Zh.M. Dnipro State Medical University, Dnipro, Ukraine,
e-mail: nekhanevichzh@gmail.com
https://orcid.org/0000-0003-2368-9579

Kycherenko T.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-6513-4662

Shepelya A.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0009-0005-3591-3429

Gudarian O.O., Nekhanevуch Zh.M., Kycherenko T.O., Shepelya A.V. Comparative assessment of difficulty scales for removal of the third molar of the lower jaw depending on its position. Medicni perspektivi. 2024;29(2):27-42.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307467

The Ukrainian system of medical and social expertise needs to revise its conceptual and methodological foundations in accordance with the realities of the current development of social sciences in the world and demand of the state regarding the modern understanding of disability. The purpose of the study was to analyze international experience and legislation on policy towards persons with disabilities and systematic approaches to the criteria of violation of functioning and the possibilities of determining the status of "person with disabilities" using the basic principles of the International Classification of Functioning (ICF), Impairment and Health to create optimal approaches to determining the criteria for disability in Ukraine. The study was based on the analysis of available scientific literature and legislative documents of developed countries on the understanding of the concept of "person with a disability". The scientometric databases used were Scopus, Web of Science, Google Scholar, and MedLine. Data from the official websites of the Political Department of the European Parliament, WHO, the United Nations, UNICEF, the World Bank. Аccording to the results of the study, it is determined that a single state body is responsible for determining the status of a person with a disability in sustainable development countries using a multidisciplinary approach. The author identifies 3 main components that most developed countries assess when determining disability: economic, medical and social. At the same time, the main criterion is decreased performance. It has been established that since 2022, Spain has completely switched to the criteria of the International Classification of Functioning in determining the signs of disability, basing the severity of a person's condition as a degree of disability on a percentage decrease in the person's functioning. Some European countries use selective categories of the ICF.

Key words: disability, impairment, medical and social expertise, international classification of functioning, recognition of the status of "person with disability"

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Look through:

Borysova I.S. Dnipro State Medical University, Dnipro, 49044, Ukraine, e-mail: doctorinnaborisova1@gmail.com
https://orcid.org/0000-0003-4703-6046

Borysova I.S. Analysis of the world experience on the approaches to the definition of disability: on the way to reforming the system of medical and social expertise. Medicni perspektivi. 2024;29(2):43-55. 
DOI: https://doi.org/10.26641/2307-0404.2024.2.307469

Patients with human papilloma virus associated oropharyngeal squamous cell carcinoma generally have better treatment outcomes and prognosis compared to those with non-papillomavirus-associated oropharyngeal squamous cell carcinoma. However, prognostic evaluation for non-papillomavirus-associated oropharyngeal squamous cell carcinoma remains a problem that could be solved through the molecular mechanisms of squamous cell carcinoma for the purpose of further development of target therapies. Detection of cyclin dependent kinase inhibitor 2a gene deletion in oropharyngeal squamous cell carcinomas can have clinical significance as it may serve as a prognostic marker and potentially guide treatment decisions. To investigate and analyze cyclin dependent kinase inhibitor 2a gene alterations in oropharyngeal squamous cell carcinoma comparing with clinical data (age of the patient, TNM stage), their histological features and occurrence of papillomavirus infection markers (p16 expression). Formalin-fixed and paraffin-embedded samples after transoral radical surgery of oropharyngeal tumors from 26 male patients with average age 57.35±10.33 years were studied. Histological, immunohistochemical analyses and fluorescent in-situ hybridization were performed to assess histological features, p16 expression, and cyclin dependent kinase inhibitor 2a gene gene abnor­malities respectively. Homozygous deletion of cyclin dependent kinase inhibitor 2a gene was statistically analyzed and compared with p16 expression, age, and occurrence of nodal metastases in investigated patients. Our study demonstrated that the patients with non-papillomavirus-oropharyngeal squamous cell carcinoma with cyclin dependent kinase inhibitor 2a gene homozygous deletion had the highest risk of the nodal metastases development. Our findings suggest that not only detection of the loss of p16 expression, but also the evaluation of homozygous cyclin dependent kinase inhibitor 2a gene deletion might be predictive of worse outcome specifically in oropharyngeal squamous cell carcinomas.

Key words: squamous cell carcinoma, oropharynx, p16, human papillomavirus, cyclin dependent kinase inhibitor 2a gene, hybridization in situ

1. Berdugo J, Rooper LM, Chiosea SI. RB1, p16, and Human Papillomavirus in Oropharyngeal Squamous Cell Carcinoma. Head Neck Pathol. 2021;15(4):1109-18. doi: https://doi.org/10.1007/s12105-021-01317-5
2. Preissner SH, Nahles S, Preissner S, Heiland M, Koerdt S. Influence of sex on survival rates of HPV-po­sitive oropharyngeal cancers. Front Oncol. 2022;12:917890. doi: https://doi.org/10.3389/fonc.2022.917890
3. Mylly M, Nissi L, Huusko T, et al. Epidemio­lo­gical Study of p16 Incidence in Head and Neck Squamous Cell Carcinoma 2005-2015 in a Representative Northern European Population. Cancers (Basel). 2022;14(22):5717. doi: https://doi.org/10.3390/cancers14225717
4. Lewis JS, Chernock RD, Ma XJ, Flanagan JJ, Luo Y, Gao G, et al. Partial p16 staining in oropha­ryngeal squamous cell carcinoma: extent and pattern correlate with human papillomavirus RNA status. Mod Pathol. 2012;25(9):1212-20. doi: https://doi.org/10.1038/modpathol.2012.79
5. Vazquez-Guillen JM, Palacios-Saucedo GC, Ala­nis-Valdez AY, et al. p16INK4a and pRb expression in laryngeal squamous cell carcinoma with and without infection by EBV or different genotypes of HPV: a retro­spective study. Infect Agents Cancer. 2023 Jul 11;18(1):43. doi: https://doi.org/10.1186/s13027-023-00514-x
6. Sivarajah S, Kostiuk M, Lindsay C, et al. EGFR as a biomarker of smoking status and survival in oropha­ryngeal squamous cell carcinoma. J of Otolaryngol - Head Neck Surg. 2019;48:1. doi: https://doi.org/10.1186/s40463-018-0323-6
7. Gadhikar MA, Zhang J, Shen L, et al. CDKN2A/p16 Deletion in Head and Neck Cancer Cells Is Associated with CDK2 Activation, Replication Stress, and Vulnerability to CHK1 Inhibition. Cancer Res. 2018;78(3):781-97. doi: https://doi.org/10.1158/0008-5472.CAN-17-2802
8. Aesif SW, Aubry MC, Yi ES, et al. Loss of p16INK4A Expression and Homozygous CDKN2A Dele­tion Are Associated with Worse Outcome and Younger Age in Thymic Carcinomas. J Thorac Oncol. 2017;12(5):860-71. doi: https://doi.org/10.1016/j.jtho.2017.01.028
9. Chen WS, Bindra RS, Mo A, et al. CDKN2A Copy Number Loss Is an Independent Prognostic Factor in HPV-Negative Head and Neck Squamous Cell Carcinoma. Front Oncol. 2018;8:95. doi: https://doi.org/10.3389/fonc.2018.00095
10. Buckley L, Jackett L, Clark J, Gupta R. HPV-related Oropharyngeal Carcinoma: A Review of Clinical and Pathologic Features With Emphasis on Updates in Clinical and Pathologic Staging. Adv Anat Pathol. 2018;25(3):180-8. doi: https://doi.org/10.1097/PAP.0000000000000179
11. Bancroft JD, Layton C. The hematoxylins and eosin. In: Suvarna SK, Layton C, Bancroft JD, editors. Bancroft's Theory and Practice of Histological Techniques. 8^thElsevier; 2019. p. 126-138. doi: https://doi.org/10.1016/B978-0-7020-6864-5.00010-4
12. de Ferreira C, Dufloth R, de Carvalho AC, et al. Correlation of p16 immunohistochemistry with clinical and epidemiological features in oropharyngeal squamous-cell carcinoma. PLoS One. 2021;16(6):e0253418. doi: https://doi.org/10.1371/journal.pone.0253418
13. Pessôa IA, Amorim CK, Ferreira WAS, et al. De­tection and Correlation of Single and Concomitant TP53, PTEN, and CDKN2A Alterations in Gliomas. Int J Mol Sci. 2019;20(11):2658. doi: https://doi.org/10.3390/ijms20112658
14. Grzechowiak I, Graś J, Szymańska D, et al. The Oncogenic Roles of PTTG1 and PTTG2 Genes and Pseudogene PTTG3P in Head and Neck Squamous Cell Carcinomas. Diagnostics (Basel). 2020;10(8):606. doi: https://doi.org/10.3390/diagnostics10080606
15. Moeckelmann N, Ebrahimi A, Tou YK, et al. Pro­gnostic implications of the 8th edition American Joint Committee on Cancer (AJCC) staging system in oral cavity squamous cell carcinoma. Oral Oncol. 2018;85:82-6. doi: https://doi.org/10.1016/j.oraloncology.2018.08.013

Look through:

Shponka I.S. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-7561-6489

Bondarenko O.O. Dnipro State Medical University, Dnipro, Ukraine, e-mail: olex.o.bondarenko@gmail.com
https://orcid.org/0000-0002-9739-9219

Kovtunenko O.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-0562-7684

Rakhmanov V.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-3200-6039

Shponka I.S., Bondarenko O.O., Kovtunenko O.V., Rakhmanov V.V. Deletion of cyclin dependent kinase inhibitor 2a gene as a marker of oropharyngeal carcinomas non-associated with human papillomavirus and its prognostic value. Medicni perspektivi. 2024;29(2):56-61.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307479

The study was aimed to determine of the most significant pathomorphological signs of severe hepatic encephalopathy (HE) in deceased cirrhotic patients with acute-on-chronic liver failure (ACLF) syndrome based on changes of the glioneuronal complex and the level of tissue ammonia. Using pathohistological, histochemical, and immunohistochemical methods, the cerebral cortex, thalamus, striatum, and cerebellum of 21 deceased patients with acutely decompensated liver cirrhosis with ACLF syndrome and HE Grade 3-4 were examined in comparison with control group, which included 30 deceased patients from acute cardiovascular failure. The study revealed that during HE Grade 3-4 as a component of ACLF, in all studied brain regions, there was a reliably (p<0.05) higher histochemical level of tissue ammonia (up to 500%), increased numbers (up to 215.69%) of apoptotic neurons (according to caspase-3), reduced (up to 119.60%) level of synaptophysin, increased expression of glutamine synthetase (up to 253.02%) and aquaporin-4 (up to 481.81%) associated by reduced (up to 296.81%) expression of glial fibrillary acidic protein in astrocytes, increased (up to 11-fold) numbers of Alzheimer type 2-astrocytes, expansion of perivascular and pericellular «edematous» spaces (up to 890.81%), increased numbers of amyloid bodies (up to 5-fold), increased area of immunopositive material of CD68+ microgliocytes (up to 114.78%) with an increase (up to 71.91%) in the proportion of CD68+ amoeboid microglia. The above-mentioned changes confirm that the loss of consciousness and other psychoneurological manifestations of severe HE Grade 3-4 are due to compound am­monia-associated changes in the components of the glioneuronal complex, namely: adaptive remodeling and dystro­phic changes in astrocytes, reduced synaptic transmission and apoptotic neuronal death, reactive changes in microglia with a small proportion of microgliocytes involved in phagocytosis, cytotoxic brain edema and dysfunction of the glymphatic system.

Key words: hepatic encephalopathy, liver cirrhosis, neuropathology, immunohistochemistry, ammonia, Alzheimer type 2 astrocytes, ameboid microglia, amyloid bodies

1. Butterworth RF. Hepatic Encephalopathy in Cirrhosis: Pathology and Pathophysiology. Drugs. 2019 Feb;79(Suppl 1):17-21. doi: https://doi.org/10.1007/s40265-018-1017-0
2. Görg B, Karababa A, Häussinger D. Hepatic Encephalopathy and Astrocyte Senescence. J Clin Exp Hepatol. 2018 Sep;8(3):294-300. doi: https://doi.org/10.1016/j.jceh.2018.05.003
3. Elsherbini DMA, Ghoneim FM, El-Mancy EM, Ebrahim HA, El-Sherbiny M, El-Shafey M, et al. Astro­cytes profiling in acute hepatic encephalopathy: Possible enrolling of glial fibrillary acidic protein, tumor necrosis factor-alpha, inwardly rectifying potassium channel (Kir 4.1) and aquaporin-4 in rat cerebral cortex. Front Cell Neurosci. 2022 Aug 17;16:896172. doi: https://doi.org/10.3389/fncel.2022.896172
4. Shulyatnikova TV, Tumanskiy VO. Ammonia le­vel and Alzheimer type 2 astrocytes in the brain of deceased patients with liver cirrhosis of the varying degree. Pathologia. 2023 Apr 280;20(1):36-44. doi: https://doi.org/10.14739/2310-1237.2023.1.276453
5. Arroyo V, Moreau R, Jalan R. Acute-on-Chronic Liver Failure. N Engl J Med. 2020 May 28;382(22):2137-45. doi: https://doi.org/10.1056/NEJMra1914900
6. Engelmann C, Berg T. Clinical practice guidelines for acute-on-chronic liver failure: are we ready for reaching  global consensus? Hepatobiliary Surg Nutr. 2023 Apr 10;12(2):239-43. doi: https://doi.org/10.21037/hbsn-23-6
7. Zaccherini G, Weiss E, Moreau R. Acute-on-chro­nic liver failure: Definitions, pathophysiology and prin­ciples of treatment. JHEP Rep. 2020 Sep 2;3(1):100176. doi: https://doi.org/10.1016/j.jhepr.2020.100176
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Look through:

Shulyatnikova T.V. Zaporizhzhіa State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine, e-mail: shulyatnikova.tv@gmail.com
https://orcid.org/0000-0002-0196-9935

Tumanskiy V.O. Zaporizhzhіa State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
 https://orcid.org/0000-0001-8267-2350

Tumanska L.M. Zaporizhzhіa State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
https://orcid.org/0000-0001-5715-0040

Shulyatnikova T.V., Tumanskiy V.O., Tumanska L.M. Pathomorphology of severe Grade 3-4 hepatic encephalopathy in decompensated cirrhosis patients with acute-on-chronic liver failure. Medicni perspektivi. 2024;29(2):62-71.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307482

The aim of our work was to identify the relationship between platelet amino acid profile and cardiometabolic risk factors in patients with coronary heart disease and atrial fibrillation. 300 patients were examined, who were divided into 3 groups: the first (I) – 149 patients with coronary artery disease (CAD) and without arrhythmias, the second (II) – 123 patients with CAD and paroxysm of atrial fibrillation (AF) and the control group (CG) – 28 patients without CAD and arrhythmia. The platelets amino acid (AA) profile was determined by ion exchange liquid column chromatography. Cardiometabolic risk factors studied: total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), lipoprotein α (Lpα), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), C-reactive protein (CRP), interleukin-6 (IL-6), trimethylamine (TMA) and trimethylamine-N-oxide (TMAO). Significant increase of isoleucine (10.73%), leucine (12.63%) and decrease of threonine (23.05%), serine (5.06%), glycine (32.21%), valine (30.83%) levels in platelet AA profile was observed in patients with CAD and AF compared to patients with CAD without arrhythmias, p<0.05. Also, significant increase of apolipoprotein B (29.91%), CRP (40.93%), IL-6 (22.93%), TMA (16.13%) and TMAO (57.54%) and decrease of TMA/TMAO ratio (26.16%) was found in CAD with AF patients compared to CAD patients without arrhythmia, p<0.05. The highest number of correlations was found between platelets AA profile and TMA/TMAO ratio (total number =7), TC (total number =7) and fibrinogen levels (total number =6). In addition, most correlations were found between glycine (total =12), threonine (total =6), glutamate (total =6), valine (total =6), and cardiometabolic risk factors. The level of glycine in platelets is correlated with most cardiometabolic risk factors, such as: age (r=-0.305), BMI (r=-0.351), TC (r=-0.304), LDL (r=-0.348), ApoA1 (r=0.373 ), ApoB (r=-0.347), IL-6 (r=-0.315), TMAO (r=-0.654), TMA/TMAO ratio (r=0.688), prothrombin index (r=0.317), activated partial thromboplastin time (r=-0.365) and fibrinogen level (r=-0.396), p<0.05. So, in our work, the relationship between platelets AA profile and cardiometabolic risk factors in patients with CAD with AF was revealed. According to the results of the correlation analysis with known cardiometabolic risk factors, an important pathogenetic role of the glycine, threonine, valine and glutamate platelets levels in CAD and AF patients was revealed. 

Key words: coronary artery disease, atrial fibrillation, amino acids, blood platelets, cardiometabolic risk factors

1. Hindricks G, Potpara T, Dagres N, et al. ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). EuropeanHeart  2020;42:373498. doi: https://doi.org/10.1093/eurheartj/ehaa612
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3. Xu Y, Jiang H, Li L, Chen F, Liu Y, Zhou M, et al. Branched-Chain Amino Acid Catabolism Promotes Thrombosis Risk by Enhancing Tropomodulin-3 Pro­pionylation in Platelets. Circulation. 2020;142(1):49-64. doi: https://doi.org/10.1161/CIRCULATIONAHA.119.043581
4. Biswas S, Hilser JR, Woodward NC, Wang Z, Gukasyan J, Nemet I, et al. Effect of Genetic and Dietary Perturbation of Glycine Metabolism on Atherosclerosis in Humans and Mice. medRxiv [Preprint]. 2023 Dec 11:2023.12.08.23299748. doi: https://doi.org/10.1101/2023.12.08.23299748
5. Roşca AE, Vlădăreanu AM, Mirica R, Anghel-Timaru CM, Mititelu A, Popescu BO, et al. Taurine and Its Derivatives: Analysis of the Inhibitory Effect on Platelet Function and Their Antithrombotic Potential. Journal of clinical 2022;11(3):666. doi: https://doi.org/10.3390/jcm11030666
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8. Schmidt AF, Joshi R, Gordillo-Marañón M, Dre­nos F, Charoen P, Giambartolomei C, et al. Biomedical consequences of elevated cholesterol-containing lipopro­teins and apolipoproteins on cardiovascular and non-cardio­vascular outcomes. Communications medicine. 2023;3(1):9. doi: https://doi.org/10.1038/s43856-022-00234-0
9. Kamstrup PR. Lipoprotein(a) and Cardiovascular Disease. Clinical chemistry. 2021;67(1):154-66. doi: https://doi.org/10.1093/clinchem/hvaa247
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16. Bishop CA, Schulze MB, Klaus S, Weitkunat K. The branched-chain amino acids valine and leucine have differential effects on hepatic lipid metabolism. FASEB journal: official publication of the Federation of American Societies for Experimental Biology. 2020;34(7):9727-39. doi: https://doi.org/10.1096/fj.202000195R
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18. Tang Q, Tan P, Ma N, Ma X. Physiological Functions of Threonine in Animals: Beyond Nutrition Metabolism. Nutrients.2021;13(8):2592. doi: https://doi.org/10.3390/nu13082592
19. Yang H, Zhang C, Turkez H, Uhlen M, Boren J, Mardinoglu A. Revisiting the role of serine metabolism in hepatic lipogenesis. Nature metabolism. 2023;5(5):760-1. doi: https://doi.org/10.1038/s42255-023-00792-0
20. Li DH, Wu Q, Lan JS, Chen S, Huang YY, Wu LJ, et al. Plasma metabolites and risk of myocardial infarction: a bidirectional Mendelian randomization study. Journal of geriatric cardiology: JGC. 2024;21(2):219-31. doi: https://doi.org/10.26599/1671-5411.2024.02.002

Look through:

Melnychuk I.O. Bogomolets National Medical University, Kyiv, Ukraine,
e-mail: ira.merkulova45@gmail.com 
https://orcid.org/0000-0002-0659-1476

Melnychuk I.O. Conections between platelets amino acids profile and known cardiometabolic risk factors in patients with coronary artery disease and atrial fibrillation. Medicni perspektivi. 2024;29(2):72-79.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307572

Diabetes mellitus is a common disease followed by cardiovascular complications, it is a metabolic syndrome with multiple etiology that is characterized by chronic hyperglycemia. Hypertension is a serious health condition that is significantly associated with the risks of heart, brain, kidney, and other diseases. Glycosylated hemoglobin (HbA1c) is diagnostic means of diabetes when fasting (venous) glycemia figures are 126 mg/dl (7.0 mmol/l). The purpose of this study is to focus on the diagnosis, and the treatment of the population with diabetes, identifying the necessary targets to guarantee clinical efficacy. Managing diabetes is challenging, and smoking can complicate it. People with diabetes who smoke often need larger doses of insulin to keep their blood sugar near normal levels. To assess the amount of vitamin D bound to hemoglobin, the study analyzed a number of laboratory parameters in patients with type 2 diabetes. The importance of this study is the estimation of the amount of enzyme-linked immunosorbent vitamin D. Laboratory parameters of diabetic patients were divided into three categories based on increased levels of glycosylated hemoglobin. Vitamin D levels were analyzed in these categories with increased HbA1c values. The influence of smoking and hypertension on laboratory parameters of diabetic patients was analyzed. The observations were carried out in the form of a database, and the methods that allowed the results for all parameters were followed. The data on the homogeneity of the selected information groups cover 150 patients diagnosed with diabetes mellitus, 40.67% were men, 59.33% were women. Similarly, (in fasting patients), a high OGTT-2-hour glucose level, the hemoglobin test indicates [A1C(HbA1c)] level, cardiovascular disease, and serum vitamin D. Overall, 47.33% of the patients were deficient in vitamin D. Decreased levels of vitamin D were associated with increased levels of glycosylated hemoglobin, while 22% were deficient. As a result, 74.67% of tobacco users had hypertension. Vitamin D deficiency may increase in patients with diabetes, with increased levels of glycosylated hemoglobin.

Key words: vitamin D, glucose, smoking, hypertension

1. Pertseva NO, Moshenets KI. Definition of the dependence of QTc interval prolongation on glycemic control in patients with type 2 diabetes mellitus. Medicni perspektivi.2022;27(1):58-64. doi: https://doi.org/10.26641/2307-0404.2022.1.254326
2. Zinych O, Shuprovych A, Trofymenko O, Komi­sarenko K. The role of epigenetic modifications in the formation of heterogeneous phenotypes in diabetes mel­litus (a literature review). Medicni perspektivi. 2023;28(3):19-27. doi: https://doi.org/10.26641/2307-0404.2023.3.288928
3. Koval S, Snihurska I. Role of gut microbiota in the pathogenesis of type 2 diabetes mellitus (literature review). Medicni 2021;26(4):22-30. doi: https://doi.org/10.26641/2307-0404.2021.4.248064
4. Nikolaychuk M, Shostakovych-Koretskaya L, Bu­dayeva I, Biletska S. Influence of seasonality on vitamin D level in patients with HCV infection and healthy people. Medicni 2021;26(1):184-90. doi: https://doi.org/10.26641/2307-0404.2021.1.228000 
5. Pertseva NO, Gurzhiy OV, Moshenets KI. Depen­dence of heart rate variability on indicators of type 1 diabetes mellitus control. Medicni perspektivi. 2020;25(1):88-95. doi: https://doi.org/10.26641/2307-0404.2020.1.200406
6. Bartlomiej O, Maciej S, Przybylkowski A. The drug safety information in domestic medical literature. Current Issues in Pharmacy and Medical Sciences. 2022;35(3):111-5. doi: https://doi.org/10.2478/cipms-2022-0021
7. Ilkov O, Manko N, Bilous S, Didikin G, Klyu­chivska O, Dilay N, et al. Antibacterial and cytotoxic acti­vity of metronidazole and levofloxacin composites with silver nanoparticle. Current Issues in Pharmacy and Medical Sciences. 2021;34(4):224-8. doi: https://doi.org/10.2478/cipms-2021-0040
8. Malecha-Jedraszek A, Burska A, Matyjaszek-Matuszek B, Donica H. Serum leptin concentration in patients with type 2 diabetes. Current Issues in Pharmacy and Medical Sciences. 2015;28(4):236-40. doi: https://doi.org/10.1515/cipms-2015-0078
9. Omar SM, Musa IR, Abdelbagi O, Sharif ME, Adam I. The association between glycosylated hemoglobin and newly diagnosed hypertension in a non-diabetic Sudanese population: a cross-sectional study. BMC Cardiovasc Disord. 2022 May 10;22(1):208. doi: https://doi.org/10.1186/s12872-022-02649-y
10. Malviya V. Investigation of in-vitro antidiabetic study, antioxidant activity and anthelminthic property of various extracts of bitter cumin seeds: Antidiabetic Study, Antioxidant Activity, and Anthelminthic Property of Bitter  Cumin Seeds. Scopus Indexed [Internet]. 2023 Jul 31 [cited 2024 Feb 10];16(4):6855-74. doi: https://doi.org/10.37285/ijpsn.2023.16.4.3
11. Nuamchit T, Siriwittayawan D, Thitiwuthikiat P. The relationship between glycemic control and con­comitant hypertension on arterial stiffness in Type II Diabetes. Vasc Health Risk Manag. 2020;16:343. doi: https://doi.org/10.2147/VHRM.S265157  
12. Kassa A, Woldesemayat EM. Hypertension and diabetes mellitus among patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Int J Chronic Dis. 2019;2019:1-8. doi: https://doi.org/10.1155/2019/2509242
13. Au Yeung SL, Luo S, Schooling CM. The impact of glycated hemoglobin on risk of hypertension: a Mendelian randomization study using UK Biobank. J Hypertens.2020;38:38-44. doi: https://doi.org/10.1097/HJH.0000000000002210
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15. de Farias CB, Coelli S, Satler F, et al. Glycated hemoglobin and blood pressure levels in adults with type 2 diabetes: How many patients are on target? Can J Diabetes. 2021;45:334-40. doi: https://doi.org/10.1016/j.jcjd.2020.10.002
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18. Liu L, Zhen D, Fu S, Sun W, Li H, Zhao N, et al. Associations of the baseline level and change in glycosylated hemoglobin A1c with incident hypertension in non-diabetic individuals: A 3-year cohort study. Diabetol Metab Syndr. 2022;14(1):54. doi: https://doi.org/10.1186/s13098-022-00827-8

Look through:

Dreshaj Arber University of Pristina, Pristina, Republic of Kosovo
https://orcid.org/0000-0003-3309-9206

Dreshaj Altin University of Pristina, Pristina, Republic of Kosovo, e-mail: altin.dreshaj1@student.uni-pr.edu
https://orcid.org/0000-0003-1949-5261

Veseli D. University of Pristina, Pristina, Republic of Kosovo
https://orcid.org/0009-0008-3206-4339

Sinanaj D. University of Pristina, Pristina, Republic of Kosovo
https://orcid.org/0009-0007-3056-4279

Bresa A. University of Pristina, Pristina, Republic of Kosovo
https://orcid.org/0009-0007-4377-6908

Morina E. University of Pristina, Pristina, Republic of Kosovo
https://orcid.org/0009-0003-6455-1741

Dehari Sh. State University of Tetova, Tetova, Republic of North Macedonia
https://orcid.org/0000-0001-5204-453X

Dreshaj Arber, Dreshaj Altin, Veseli D, Sinanaj D., Bresa A., Morina E., Dehari Sh. Association between glycosylated hemoglobin and newly diagnosed hypertension in a non-diabetic kosovar population: a cross-sectional analysis. Medicni perspektivi. 2024;29(2):79-87.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307579

The aim of the study: to analyze the effect of improvement of glycemic control on heart rate variability changes in patients with type 1 diabetes against the background of insulin therapy correction and to predict this dynamics based on the parameters of continuous glucose monitoring. We examined 49 patients with the level of glycosylated hemoglobin ≥7% and <10% without late diabetic complications. The average age – 32.0 (21.5; 38.0) years, the average disease duration – 9.5 (5.0; 17.5) years. The study was based on the simultaneous registration of heart rate variability and continuous glucose monitoring before and 3 months after correction of insulin therapy. Logistic regression analysis and ROC-analysis were used to predict the changes. After 3 months, the patients had significant decrease in the level of glycosylated hemoglobin, glycose variability, and a decrease in the frequency of hypoglycemic episodes. Heart rate variability increased in 73.5% of persons. The presence of hypoglycemia, standard deviation of blood glucose levels and glomerular filtration rate after treatment turned out to be prognostic factors for the predicting improvement in heart rate variability (the proportion of correct prediction of the patient's actual belonging to one or another prognostic group was 76.39%). Based on the calculation of the theoretical values of the positive result probability using the logistic equation, a detailed scale for predicting changes in heart rhythm variability for type 1 diabetes patients was proposed: up to 0.07 – a low probability of a positive result; 0.07-0.29 – the probability of a positive result is below average; 0.29-0.51 – a moderate probability of a positive result; 0.51-0.90 – high probability of a positive result; more than 0.90 – a very high probability of a positive result. We found that improvement of glycemic control leads to an increase in both frequency and time characteristics of heart rate variability. The increase in the likelihood of improvement of heart rate variability in patients with type 1 diabetes was more likely to be associated with reduced glycose variability and fewer hypoglycemic episodes. We developed a predictive mathematical model of heart rate variability based on the continuous glucose monitoring parameters for type 1 diabetes with sensitivity of 88.0% and specificity 68.18%, AUC 0.739 (p=0.001).

Key words: type I diabetes, heart rate variability, glucose control, vago-sympathetic balance 

1. Deka B, Deka D. Nonlinear analysis of heart rate variability signals in meditative state: a review and perspective. Biomed Eng Online. 2023;22(1):35. doi: https://doi.org/10.1186/s12938-023-01100-3
2. Siepmann M, Weidner K, Petrowski K, Siep­mann T. Heart rate variability: a measure of cardiovascular health and possible therapeutic target in dysautonomic mental and neurological disorders. Appl psychophysiol biofeedback.2022;47(4):273-87. doi: https://doi.org/10.1007/s10484-022-09572-0
3. Shkala LV. [Heart damage in diabetes]. Simeina medytsyna. 2022;1-2:81-4. Ukrainian. doi: https://doi.org/10.30841/2307-5112.1-2.2022.260509
4. Hajdu M, Garmpis K, Vértes V, Vorobcsuk-Var­ga N, Molnár GA, Hejjel L, et al. Determinants of the heart rate variability in type 1 diabetes mellitus. Front Endocri­nol (Lausanne). 2023;14:1247054. doi: https://doi.org/10.3389/fendo.2023.1247054
5. Duque A, Mediano MFF, De Lorenzo A, Rodri­gues LF. Cardiovascular autonomic neuropathy in dia­betes: Pathophysiology, clinical assessment and im­plications. World J Diabetes. 2021;12(6):855-67. doi: https://doi.org/10.4239/wjd.v12.i6.855
6. Zhou Z, Sun B, Huang S, Zhu C, Bian M. Gly­cemic variability: adverse clinical outcomes and how to improve it? Cardiovasc Diabetol. 2020;19(1):102. doi: https://doi.org/10.1186/s12933-020-01085-6
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17. Sztanek F, Jebelovszki É, Gaszner B, Zrínyi M, Páll D, Kempler P, et al. [Diagnosis of diabetic cardiac auto­nomic neuropathy]. Orv Hetil. 2019 Sep;160(35):1366-75. Hungarian. doi: https://doi.org/10.1556/650.2019.31491
18. Jayachandra S, Kodidala SR. A study of heart rate variability in diabetic mellitus patients. International journal of endocrinology (Ukraine). 2022;18(3):153-6. doi: https://doi.org/10.22141/2224-0721.18.3.2022.1162

Look through:

Pertseva N.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-5828-6270

Moshenets K.I. Dnipro State Medical University, Dnipro, Ukraine, e-mail: k.moshenets@gmail.com
https://orcid.org/0000-0002-9953-0081

Pertseva N.O., Moshenets K.I. Predicting the dynamics of heart rate variability in patients with type 1 diabetes against improving glycemic control. Medicni perspektivi. 2024;29(2):87-94. DOI: https://doi.org/10.26641/2307-0404.2024.2.307585

The relevance of the topic under study is due to the fact that patients receiving large or repeated doses of corticosteroids often suffer from hypersensitivity reactions or side effects from taking this category of drugs. As a result, this poses a serious problem for healthcare authorities, as the scientific understanding of this phenomenon is still at an early stage. The purpose of study is to comprehensively disclose the various types of mechanisms underlying corticosteroid hypersensitivity, as well as to develop recom­mendations for more accurate methods of diagnosis, treatment, and prevention of this reaction. To achieve this goal, this theoretical study used various methods, including analysis, deduction, abstraction and generalization, and the method of synthesis. The results of the study underscore the broad spectrum of applications for corticosteroid drugs in medicine, highlighting their systemic effects and potential for side effects and hypersensitivity reactions across various bodily systems. These adverse reactions encompass hyperglycemia, hypertension, respiratory issues, visual impairments, skin conditions like contact dermatitis, bone tissue complications, and behavioral disorders, notably in children. Administering cortico­steroids in COVID-19 treatment necessitates caution due to the potential for life-threatening immediate hypersensitivity reactions, which may be mistaken for disease progression. The results and conclusions of this study, which were formed using the above methods, may lead to a more accurate diagnosis of hypersensitivity to drugs such as corticosteroids, and may also contribute to the development of effective preventive measures. This study is of practical importance for dermato­lo­gists, allergists and immunologists, as well as researchers working in the field of rheumatology, allergology and immunology.

Key words: side effects, taking drugs, safety, patch test, corticosteroids, hypersensitivity

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Look through:

Lisiecka M.Z. National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland,
e-mail: mariazofialisiecka@gmail.com
https://orcid.org/0009-0003-9543-509X

Lisiecka M.Z. Side effects and hypersensitivity reactions to corticosteroids. Medicni perspektivi. 2024;29(2):95-104.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307587

The aim of the study was to analyse the microbial profile of the urinary tract infections (UTIs) due to urolithiases and to study susceptibility to antibiotics in its causative agents. The main method of the research was bacteriological. Antimicrobial susceptibility testing was conducted by serial microdilution assay in accordance with recommendations of the European committee on antimicrobial susceptibility testing (EUCAST). For present study 128 unique urine samples were collected from patients with UTIs associated with urolithiasis. Among all collected specimens, 78% (n=100) gave clinically signi­ficant growth. Among all examined participants, 88.9% of women (64/72) and 64.3% of men (36/56) had confirmed UTI; in the study, female/male ratio was 1.4 (χ2=9.76; p<0.05). Microorganisms identified in our study predominantly belon­ged to Bacteria (93.4%), and yeasts of Candida genus comprised only 6.6%. Among all, 66.1% were representatives of Enterobacterales (n=80), particularly, Escherichia coli (38.0%), Klebsiella oxytoca (15.7%), Klebsiella pneumoniae (2.5%), Enterobacter cloacae (5.8%), Proteus mirabilis (4.1%). Isolates of Pseudomonas aeruginosa comprised 3.3%. Among gram-positive isolates, Staphylococcus spp. (14.1%) and Enterococcus spp. (9.9%) were identified. Regarding female/male distribution, the biggest proportion of gram-positive bacteria were isolated from women, statistically significant results were obtained for sex distribution of S. saprophyticus (p<0.05). Antimicrobial susceptibility of Enterobacterales was variable, and the best results were obtained for carbapenems, novel antibiotics (cefiderocol, ceftolozane-tazobactam and ceftazidime-avibactam), aminoglycosides and tigecycline. There were 9 isolates with pro­duction of carbapenemases and resistant to all relevant β-lactam antibiotics. All isolated Staphylococcus spp. were β-lactamase producers, one isolate of S. saprophyticus demonstrated methicillin-resistance. To summarise, there is an ongoing outbreak of multidrug-resistant infections in Ukraine and causative agents of UTIs are among the most important contributors. Availability of data on the local antimicrobial susceptibility profile may guide the informed decision making in etiotropic treatment, therefore, contribute to global efforts in rational drug use and fight the resistance escalation.

Key words: urinary tract infections, urolithiasis, antimicrobial resistance, bacteria, local susceptibility profile

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Look through:

Barannik K.S. Dnipro State Medical University, Dnipro, Ukraine, e-mail: k.barannik1984@gmail.com
https://orcid.org/0000-0002-1009-4990

Ishchenko O.V. Dnipro State Medical University, Dnipro, Ukraine, e-mail: med.oksana2017@gmail.com
https://orcid.org/0000-0001-7677-5062

Duka R.V. Dnipro State Medical University, Dnipro, Ukraine, e-mail: rusduka@gmail.com
https://orcid.org/0000-0003-3962-8746

Molchanov R.M. Dnipro State Medical University, Dnipro, Ukraine, e-mail: rob_molch@yahoo.com
https://orcid.org/0000-0002-9589-8364

Stepanskyi D.O. Dnipro State Medical University, Dnipro, Ukraine, e-mail: dstepanskiy@gmail.com
https://orcid.org/0000-0001-6350-8176

Barannik K.S., Ishchenko O.V., Duka R.V., Molchanov R.M., Stepanskyi D.O. Microbiological profile and antimicrobial susceptibility of bacteria associated with urinary tract infections in Ukrainian adults. Medicni perspektivi. 2024;29(2):105-111.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307596

Among the diseases of the colon, diverticular disease occupies one of the leading positions, the frequency of which is currently 1.2 cases per 1000 people. Complications in this condition develop in 5% of cases and account for 3-5% of all patients with acute abdominal diseases. Surgical intervention is required in 15% to 30% of such patients. The mortality rate after surgical treatment of acute complications of the diverticular disease remains high, ranging from 7% to 25%. The purpose of our study was to compare the outcomes in the treatment of patients with acute destructive diverticulitis of the colon using traditional surgical treatment versus minimally invasive technologies. In the study, 114 patients diagnosed with acute destructive diverticulitis were examined. Group I consisted of 56 patients who underwent initial surgical interventions employing minimally invasive methods like laparoscopy, laparoscopic-assisted techniques, or percutaneous drainage guided by ultrasound. Group II comprised 58 patients who underwent the first surgical intervention through laparotomy access. The data of our study show that the overall proportion of patients with complications was higher in Group II – 20 (34.5%) compared to 6 (10.1%) in Group I (p=0.005). The application of diverse surgical methods did not notably impact the mortality rate, with 6 (10.3%) fatalities in Group II compared to 2 (3.6%) in Group I (p=0.2). Stoma creation was more frequent in Group II, in 40 (67%) patients, whereas in Group I, the occurrence of stomas was lower, in 15 (25.9%) cases. The average period to stoma closure was 5 months in Group II and 2 months in Group I. There was observed a decrease in the time of urgent surgery from 143±13.5 minutes in Group II to 65.7±15.2 minutes in Group I (p<0.01) and the duration of the first hospitalization from 14.2±1.8 days to 5.6±0.7 days, accordingly (p<0.01). When dealing with primary anastomosis or severe peritonitis, utilizing a laparoscope for dynamic laparoscopy allows for real-time monitoring of the abdominal cavity and early identification of complications, eliminating the need for scheduled laparostomy. The research data demonstrate that, while not affecting mortality, minimally invasive methods have several significant advantages, including a reduction in the number of complications, a decrease in the proportion of patients with stomas, a reduction in the time to reconstructive surgery, and a decrease in the duration of urgent surgery and the length of hospitalization.

Key words: colonic diverticulitis, treatment of acute diverticulitis, treatment of acute peritonitis, laparoscopy

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2. Strate LL, Morris AM. Epidemiology, pathophy­siology, and treatment of diverticulitis. Gastroenterology. 2019;156(5):1282-98. doi: https://doi.org/10.1053/j.gastro.2018.12.033
3. Gregori M, Cassini D, Depalma N, Miccini M, Ma­noochehri F, Baldazzi GA. Laparoscopic lavage and drainage for Hinchey III diverticulitis: review of technical aspects.Updates  2019 Jun;71(2):237-46. doi: https://doi.org/10.1007/s13304-018-0576-7
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5. Shaprynskyi VO, Taheiev VR, Stukan SS, Cher­nychenko OI. [Diagnostic and treatment of diverticular disease of the colon]. Klinichna ta profilaktychna medytsyna.2023;1(23):21-5.  doi: https://doi.org/10.31612/2616-4868.1(23).2023.03
6. Lambrichts DPV, Bolkenstein HE, van der Does DCHE, Dieleman D, Crolla RMPH, Dekker JWT, et al. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg. 2019 Mar;106(4):458-66. doi: https://doi.org/10.1002/bjs.11129
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9. Schultz JK, Azhar N, Binda GA, Barbara G, Bion­do S, Boermeester MA, et al. European Society of Colo­proctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis. 2020 Sep;22(Suppl 2):5-28. doi: https://doi.org/10.1111/codi.15140
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15. Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, et al. Colonic diverticular disease. Nat RevDis  2020;6(1):1-23. doi: https://doi.org/10.1038/s41572-020-0153-5
16. You H, Sweeny A, Cooper ML, Von Papen M, Innes J. The management of diverticulitis: a review of the guidelines.Med J  2019;211(9):421-7. doi: https://doi.org/10.5694/mja2.50276 
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18. Haida YaI, Herasymenko OS, Yenin RV, Kashta­lian MA, Kvasnevskyi YeA, Koshykov MO, et al., in­ven­tors; Viiskovo-medychnyi klinichnyi tsentr Pivdennoho rehionu m. Odesa, assignee. [Laparoport for performing dynamic laparoscopy for combat injuries of the abdomen]. Patent of Ukraine №u 201901071. 2019 Apr 25. Ukrainian.
19. Mali J, Mentula P, Leppäniemi A, et al. Determi­nants of treatment and outcomes of diverticular abscesses. World Journal of Emergency Surgeryvolume. 2019;14:31. doi: https://doi.org/10.1186/s13017-019-0250-5
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Look through:

Tymchuk O.B. Military Medical Clinical Centre of East Region, Dnipro, Ukraine, e-mail: gutsulbigmirnet@gmail.com
https://orcid.org/0000-0003-2794-3749

Malinovskyi S.L. Dnipro State Medical University, Dnipro, Ukraine, e-mail: proct.surg@gmail.com
https://orcid.org/0000-0002-5554-836X

Tymchuk O.B., Malinovskyi S.L. Results of surgical treatment of patients with acute destructive diverticulitis of the colon using minimally invasive technologies. Medicni perspektivi. 2024;29(2):112-122.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307599

Aim – to study the altruistic values of o group of nursing, midwifery, and physiotherapy students, and how these values evolved throughout academic years and across study programs. The study used a descriptive correlational design. The data were collected from students in the bachelor’s degree programs in nursing, midwifery, and physiotherapy, and in the master's degree program in health psychology (students in this program have completed bachelor’s degrees in nursing, midwifery, or physiotherapy). The Faculty of Natural Sciences at the University of Shkodra “Luigi Gurakuqi”, Albania offers bachelor’s degree programs in nursing, midwifery, physio­therapy and a professional master's degree in health psychology. During the academic year 2022-2023, the number of active students was 756. A total of 457 students participated in this study: 175 from the nursing program, 130 from the midwifery program, 107 from the physiotherapy program, and 45 from master program. Data were collected from December 1, 2022, through January 31, 2023, with an online questionnaire. Two tools were used in this study: a demographic questionnaire and the Altruism Scale used by Űmmet and colleagues. The mean score on the Altruism Scale was 2.9±0.78. A one-way ANOVA revealed that there was a difference in mean altruism score between at least two groups (F (3, 452) = [3.232], p=0.02). Tukey’s HSD Test for multiple comparisons found out that the mean value of altruism was different between the bachelor students in nursing and bachelor students in physiotherapy (p=0.011, 95% CI = [0.0498, 0.5448]). Compared to others, bachelor students in nursing had higher level of altruism and bachelor students in physiotherapy had lower level of altruism. Conclusions: The results showed that it is precisely the feeling of altruism that people have, which made them choose nursing as a profession. Since altruism is so important for the nursing profession, topics related to altruism should be included in nursing curricula.

Key words: altruism, students, nurse, midwifery, physiotherapy

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7. Hampton D, Heath J, Rayens MK. Strengthening Professional Values of Doctoral-Level Nursing Students. SAGE Open Nurs. 2022;8:23779608221126359. doi: https://doi:10.1177/23779608221126359
8. Manzur E, Olavarrieta S. The 9-SRA scale: A simplified 9-items version of the SRA scale to assess altruism. Sustainability. 2021 Jun 22;13(13):6999. doi: https://doi.org/10.3390/su13136999
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13. Marynissen K, Spurrier B. Becoming the 'good doctor': medical students' views on altruism and profes­sional identity. MedEdPublish. 2018;7:52. doi: https://doi:10.15694/mep.2018.0000052.1
14. Jonasson HI, Ingason HT. Using altruism in project management education: How ‘Doing Good’im­pacts student motivation. Project Leadership and Society. 2022;3:100038. doi: https://doi:10.1016/j.plas.2021.100038
15. Gusar I, Tokić A, Lovrić R. Psychometric Ana­lysis of the Professional Identity Questionnaires in Croatian Nursing Student Context. SAGE Open Nurs. 2021;7:23779608211044600. doi: https://doi:10.1177/23779608211044600
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23. Ümmet D, Ekşi H, Otrar M. Altruism scale deve­lop­ment study. J of Values Education. 2013;11(26):301-
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27. Akman O, Çinar F. Effects of nursing students' altruism and compassion levels on care behaviors. Gevher Nesibe Journal of Medical and Health Sciences. 2020;5(9):123-33. doi: https://doi.org/10.46648/gnj.150
28. Gol I. Nursing students' attitudes towards the nur­sing profession in relation to their altruism levels. Interna­tional Journal of Caring Sciences. 2018 May 1;11(2):663-71.
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Look through:

Kraja J. University of Shkodra “Luigj Gurakuqi”,  Shkoder, Albania, e-mail: julian.kraja@unishk.edu.al
https://orcid.org/0000-0001-6694-394X

Fresku E. University of Shkodra “Luigj Gurakuqi”,  Shkoder, Albania, e-mail: edra.fresku@unishk.edu.al
https://orcid.org/0000-0003-1333-8986

Xhakollari L. University of Shkodra “Luigj Gurakuqi”,  Shkoder, Albania, e-mail: lediana.xhakollari@unishk.edu.al
https://orcid.org/0000-0001-6552-4364

Kraja J., Fresku E., Xhakollari L. Altruistic values among students of Nursing, Midwifery, Physiotherapy, and Health Psychology: a cross-sectional study. Medicni perspektivi. 2024;29(2):123-132.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307603

Underweight or overweight in children and adolescents is a serious public health problem. Self-perception is an important factor in promoting health, especially during adolescence. The purpose of this study is to assess the characteristics of self-perception of children with low body weight, normal body weight, overweight and obesity. This study was conducted in Kharkiv secondary schools in November 2021. The total number of participants was 14,853, of which 8,290 were girls and 6,563 were boys, aged 10-17 years. Using an online questionnaire, adolescents indicated their body weight and height, and also assessed their own health preserving activities. Diagnosis of  being underweight, overweight and obesity was carried out in accordance with World Health Organization (WHO) standards. Body self-esteem was assessed using the following questions: “What do you think about your body?”; “How satisfied are you with your health?”; “How satisfied are you with yourself?”; “How can you assess your own health?”. According to the results of the examination based on BMI, it was found that 63.1±2.4% of adolescents have normal body weight. Overweight was detected in 12.3±1.1%, obesity – in 2.4±0.5%. 17.4±1.3% of participants were underweight, and 4.8±0.7% had body mass deficit. By their own assessment, 75.0% of children considered themselves to have “normal” body weight, another 15.0% considered their weight “more than normal,” and about 10.0% of adolescents considered themselves “lean.” Among boys, 61.0% had normal body weight. About 16.5% of boys were considered overweight, and 3.8% of boys were obese. Insufficient body weight was found in 14.08% of respondents, and 4.6% had big body mass deficit.  Among girls, the percentage of participants with normal body weight was 64.8%. 8.95% of participants were considered overweight, 1.35% were obese. Almost 20.0% were underweight; a large deficiency was detected in 5.0% of girls. In order to carry out health promotion activities among schoolchildren, the sexual characteristics of self-perception of one's own body and health problems among adolescents should be taken into account. Boys were almost twice as more satisfied with themselves and their health than girls, regardless of how they perceived their body (p<0.01). The number of boys with overweight and obesity was twice as high as girls (20.0% vs. 10.0%). At the same time, almost one in four girls and one in five boys were underweight and/or had body mass deficit. The systematic collection and analysis of data on the health-preserving behavior of adolescents is an important component of the development and creation of health care programs for the children's population of Ukraine.

Key words: self-perception, adolescents, body-mass index, underweight, overweight, obesity, promotion of health, physical development

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13. Avdiievska OH, Danylenko HM. Correction of the Nutrition Status of Young Elementary School Children as a Prevention of Metabolic Syndrome. Ukrainian Journal of Pediatric Endocrinology. 2019;2:32-38. doi: https://doi.org/10.30978/UJPE2019-2-32
14. Chernyakova GM, Merkulova TV. Features of Physical Development of Schoolchildren in Modern Con­ditions. Ukrainian Journal of Pediatric Endocrinology. 2021;3(31):46-51.
15. Zelinska NB, Gryshchenko KV, Globa YV. Ty­pe 2 Diabetes in Children and Adolescents Worldwide and in Ukraine. Ukrainian Journal of Pediatric Endocrinology. 2021;1:4-16. doi: https://doi.org/10.30978/UJPE2021-1-4
16. Holstein BE, Andersen A, Damsgaard MT, Mad­sen KR, Pedersen TP. Underweight among adoles­cents in Denmark: prevalence, trends (1998–2018), and association of underweight with socioeconomic status. Family Practice.2022 May 28;39(3):413-9. doi: https://doi.org/10.1093/fampra/cmab134
17. Frolova TV, Osman NS. Structural and Functional State of Bone Tissue in Children During the Period of the Second Growth Spurt. Modern Pediatrics. Ukraine. 2022;1(121):31-5. doi: https://doi.org/10.15574/SP.2022.121.31
18. Garrido-Miguel M, Martínez-Vizcaíno V, Oli­veira A, et al. Prevalence and trends of underweight in European children and adolescents: a systematic review and meta-analysis. Eur J Nutr. 2021;60:3611-24. doi: https://doi.org/10.1007/s00394-021-02540-0
19. Creese H, Saxena S, Nicholls D, Pascual San­chez A, Hargreaves D. The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study. EClinicalMedicine. 2023;60:101992. doi: https://doi.org/10.1016/j.eclinm.2023.101992

Look through:

Cherniakova G.M. "Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
е-mail: anna.chernyakova@iozdp.org.ua
https://orcid.org/0000-0002-3960-2485

Avdiievska O.H. "Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine,
e-mail: olenaavdііevska@gmaіl.com 
https://orcid.org/0000-0001-5764-5254

Danylenko H.M. "Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine,
e-mail: danylenko@iozdp.org.ua
https://orcid.org/0000-0001-7086-2720

Cherniakova G.M., Avdiievska O.H., Danylenko H.M. Assessment of adolescent physical development using body mass index and body self-perception. Medicni perspektivi. 2024;29(2):133-142.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307607

The period of compulsory school attendance is a mentally very challenging period for children in foster care, which can be impacted by complex developmental trauma stemming from the child's experience in foster care with cumulative and chronic traumatic events in his/her biological family. These events have taken place over a long period of time in interpersonal relationships usually related to caregivers, in the form of abandonment of the child by the caregiver, changing caregivers, lack of safe space and necessary support for the child from the family and school, and/or deficiencies in the provision of coordinated health and social care for both the child and the foster parents. The paper presents research findings supported by a statistical analysis of health and school difficulties in children in foster care related to their school attendance. The purpose of the research was to support the quality and coordination of services of non-profit organizations providing social, health and educational services to foster families and their children during school attendance to support the school success and well-being of children. The study was implemented as part of a dissertation at the University of South Bohemia in České Budějovice in the Czech Republic on the topic of promotion of the health, social and psychological well-being of school-aged children in the context of their school and family environment. The authors carried out a questionnaire survey in the Czech Republic among a selected sample of respondents, who were foster parents of children aged 6 to 15 attending primary school in the Pardubice Region. In a total sample of 102 respondents, we identified two different groups. One group – 64 respondents with healthy children and another group – 38 respondents with children with health difficulties. The aim of the research was to compare the assessments of the intensity of school difficulties of children in foster care in groups of respondents with or without a child with health difficulties or mental illness in their foster care. The hypothesis of a difference in assessments of school difficulties in children with/without health difficulties was formulated and statistically tested (H₀: ratings of the intensity of difficulties are the same in both groups). Statistical testing of the hypothesis utilised the non-parametric Mann-Whitney test with the test results being significant at the level of significance p<0.05. Correlation was observed for each difficulty and exploratory cluster analysis shows their interrelationships. The study results according to the foster parents' assessment show a high intensity of difficulties of school-aged children in foster care in their inclusion in the classroom in establishing relationships with classmates (p-value =0.9), in a negative attitude towards learning and lack of motivation to learn (p-value =0.7) experiencing nervousness, internal tension and staying focused when learning. In addition, when comparing the groups of respondents with healthy children and children who have health difficulties/mental illness, there was a statistically significantly higher intensity of difficulties in the group of respondents with children with health difficulties when doing prep work for the classes (p-value =0.00075). 

Key words: health problems, mental health, foster care, school, schoolchild, school obstacles

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Look through:

Faltová B. University of South Bohemia, Faculty of Health and Social Sciences, České Budějovice, Czech Republic, e-mail: Barbora.Faltova@upce.cz
https://orcid.org/0000-0002-0030-697X

Mojžíšová A. University of South Bohemia, Faculty of Health and Social Sciences, České Budějovice, Czech Republic
https://orcid.org/0000-0001-8549-1424

Holá J. University of Pardubice, Faculty of Health Studies, Pardubice, Czech Republic
https://orcid.org/0000-0003-2671-0855

Shuranová L. University of South Bohemia, Faculty of Health and Social Sciences, České Budějovice, Czech Republic
https://orcid.org/0000-0002-5611-0490

Čermák Z. University of Pardubice, Faculty of Arts and Philosophy, Pardubice, Czech Republic
https://orcid.org/0000-0003-3489-8069

Faltová B., Mojžíšová A., Holá J., Shuranová L., Čermák Z. Health and school difficulties of children in foster care in the experience of their foster parents. Medicni perspektivi. 2024;29(2):143-151.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307609

In recent years, there has been an increase in the incidence of morbidity associated with digestive organ pathology in the pediatric population. The oral cavity is the digestive tract opening, sharing a common ectodermal origin with it. The changes in the cytogram of the oral mucous membranes can signal about exacerbation of pathological processes in the gastrointestinal tract. The aim of this work: to identify the features of gingival cellular composition in school-age patients with chronic gastritis and duodenitis in order to improve diagnostic methods at the disease stages. Examinations of the gingival cytogram in children aged 12-17 years with chronic gastritis and duodenitis (27 individuals with the disease in acute stage, 30 – in remission) were carried out. The control group included 28 children who did not have any somatic pathology by the results of the examination. For cytological examination, imprint smears from the gingival vestibular surface of the upper and lower jaws were made. The smears were fixed and stained by the May-Grunwald Pappenheim method, and then examined using a microscope with an im­mersion system. The percentage of epithelial cells and connective tissue cells  was calculated per 100 cells. The number of pathologically altered epithelial cells was determined: with vacuolated cytoplasm, with nucleus deformation. In children with chronic gastritis and duodenitis disorders in the gingival cellular composition with a predominance of dystrophic components were found, that was manifested by a decrease in the proportion of epithelial cells at terminal stages of differentiation, an increase in the proportion of cells with cytopathological phenomena, polymorphonuclear leukocytes and lymphocytes. Changes in the cytogram were especially expressed in the phase of disease exacerbation. Knowing the phases of the wound process, based on the timing and sequence of the cellular ensembles seen in the cytogram, it is possible to control the disease periods, and timely apply measures to prevent exacerbations. This diag­nostic method is especially indicated for children who have relative and absolute contraindications for fibroesogastroduodenoscopy.

Key words: cytogram, epitheliocytes, gingiva, diagnostics, chronic gastritis, duodenitis  

1. Sdravou K, Emmanouilidou-Fotoulaki E, Mitaki­dou MR, Printza A, Evangeliou A, Fotoulaki M. Children with diseases of the upper gastrointestinal tract are more likely to develop feeding problems. Ann Gastroenterol. 2019 May-Jun;32(3):217-33. doi: https://doi.org/10.20524/aog.2019.0348
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Look through:

Romanenko Ye.G. European Medical University” LLC , Dnipro, Ukraine, e-mail: helenromanenko2017@gmail.com
https://orcid.org/0000-0001-9524-4187

Komskyi M.P. European Medical University” LLC , Dnipro, Ukraine
https://orcid.org/0000-0002-5717-9473

Titov O.H. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-5971-5014

Bureha I.Y. European Medical University” LLC , Dnipro, Ukraine
https://orcid.org/0000-0001-6425-4286

Khotimska Yu.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-0161-1191

Lavreniuk Ya.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-6293-9203

Alieksieienko V.V. European Medical University” LLC , Dnipro, Ukraine
https://orcid.org/0009-0006-8512-8506

Holub A.V. European Medical University” LLC , Dnipro, Ukraine
https://orcid.org/0009-0009-0417-6322

Romanenko Ye.G., Komskyi M.P., Titov O.H., Bureha I.Y., Khotimska Yu.V., Lavreniuk Ya.V., Alieksieienko V.V., Holub A.V. Diagnostic value of the gingival cytogram in school-age children suffering from chronic gastritis and duodenitis. Medicni perspektivi. 2024;29(2):151-158. DOI: https://doi.org/10.26641/2307-0404.2024.2.307612

Objective of the research was to find out the effectiveness of the use of osteoplastic materials based on the multipotent mesenchymal stromal cells of the adipose tissue during surgical treatment for restoration of bone defects in dental patients. The clinical material included examination of 79 patients who underwent replacement of bone defects of the alveolar processes and/or an alveolar part of the appropriate jaw by means of different osteoplastic materials and their combinations or without their application (the control group). Acid phosphatase activity in the oral fluid of patients was determined by means of the unified “end point” method. Alkaline phosphatase activity in the oral fluid was determined using a set of reagents produced by the company “Filisit-Diagnostika” (Ukraine). Oral fluid mineralization index (MI) of patients was calculated according to the ratio of enzymatic activity of alkaline phosphatase (ALP) to acid phosphatase (AP) according to the formula: MI=ALP/AP. Histological material was taken at the stage of installation of a dental implant. It was established that the use of a composition based on multipotent mesenchymal stromal cells of adipose tissue, platelet-enriched blood plasma and bone tissue substitute containing hydroxyapatite contributes to the improvement of regenerative processes in the bone tissue of the jaws, which is confirmed by a 28.68% decrease in acid phosphatase activity, an increase by 25, 97% of alkaline phosphatase activity in the oral fluid of group B patients and, accordingly, a 77.08% increase in the ratio of alkaline to acid phosphatase. According to the results of histological studies and phase-contrast microscopy, after 6-8 months of observation, in patients of group B, the areas of jaw defects were filled with newly formed bone tissue, identical to native bone, and the resulting trepanobioptas had the structure of cancellous bone with osteoblastic elements forming a chain around osteoid tissue. Having analyzed the results of biochemical and histological studies it was established that application of an osteoplastic composition based on the multipotent mesenchymal stromal cells of the adipose tissue, bone tissue substitute with hydroxyapatite and platelet-rich plasma allows restoration of bone defects of the alveolar processes and an alveolar part of the appropriate jaw in shorter terms. The method is an optimal alternative to traditional osteoplastic materials to be used in modern dental practice and dental implantation.

Key words: multipotent mesenchymal stromal cells, hydroxyapatite, bone defect, patient, dentistry

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9. Al-Obaidi MM, Al-Bayaty FH, Al Batran R, Ibra­him OE, Daher AM. Ellagic Acid Increases Osteocalcin and Alkaline Phosphatase After Tooth Extraction in Nicotinic-Treated Rats. Curr Pharm Des. 2016;22(16):2403-10. doi: https://doi.org/10.2174/138161282216160428002842
10. Skrypa OL, Bandrivsky YL. Determining the fre­quency of functional disorders of the TMJ in patients with mandible fractures depending on the location. Wiadomości Lekarskie.2020;73(2):245-9. doi: https://doi.org/10.36740/WLek202002107
11. Chen Q, Cai J, Li X, Song A, Guo H, Sun Q, et al. Progranulin Promotes Regeneration of Inflammatory Periodontal Bone Defect in Rats via Anti-inflammation, Osteoclastogenic Inhibition, and Osteogenic Promotion. Inflammation.2019 Feb;42(1):221-34. doi: https://doi.org/10.1007/s10753-018-0886-4
12. Pilawski I, Tulu US, Ticha P, Schüpbach P, Trax­ler H, Xu Q, et al. Interspecies Comparison of Alveolar Bone Biology, Part I: Morphology and Physiology of Pristine Bone.    JDR Clin Trans Res. 2020:2380084420936979. doi: https://doi.org/10.1177/2380084420936979
13. Bandrivsky YL, Bandrivska OO, Shkrebnyuk RY, Dyryk VT. Prevalence of the generalized periodontitis in patients with different groups blood in depending on age and periodontal biotype. Wiad Lek. 2020;73(1):119-22. doi: https://doi.org/10.36740/WLek202001123
14. Meza-Zepeda LA, Noer A, Dahl JA, Micci F, Myklebost O, Collas P. High-resolution analysis of genetic stability of human adipose tissue stem cells cultured to senescence. J Cell Mol Med. 2018 Apr;12(2):553-63. doi: https://doi.org/10.1111/j.1582-4934.2007.00146x
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16. Bandrivsky Y, Bandrivska O, Gnid R, Minko L, Shevchuk M. Indicators of markers of bone metabolism in patients with generalized periodontitis depending on blood  group. Arch Balk Med Union. 2019;54(1):72-7. doi: https://doi.org/10.31688/ABMU.2019.54.1.10
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19. Wankhade UD, Shen M, Kolhe R, Fulzele S. Ad­vances in adipose-derived stem cell isolation, characte­rization, and application in regenerative tissue engineering. Stem Cells Int. 2016;2016:3206807. doi: https://doi.org/10.1155/2016/3206807

Look through:

Bambuliak А.V. Bukovinian State Medical University, Chernivtsi, Ukraine, e-mail: bambuljak.andrij@bsmu.edu.ua
https://orcid.org/0000-0002-6383-9327

Kuzniak N.B. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0002-4020-7597

Lopushniak L.Y. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0001-8362-406X

Dronyk І.І. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0001-8382-4379

Myhal О.О. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
https://orcid.org/0000-0001-8000-8827

Bambuliak А.V., Kuzniak N.B., Lopushniak L.Y., Dronyk І.І., Myhal О.О. Results of biochemical and histological studies after restoration of bone defects using cellular technologies in dental patients. Medicni perspektivi. 2024;29(2):159-167. DOI: https://doi.org/10.26641/2307-0404.2024.2.307615

In the literature, there are not enough studies that reflect the role and place of tissue and microbial sensitization in patients with generalized parodontitis (GP) associated with rheumatoid arthritis (RA). In our opinion, the research of these components will help to better understand the etiopathogenetic mechanisms of development of GP against the background of RA, which will improve the formation of preventive and therapeutic measures for this disease treatment. The purpose of the research was to determine the location and integration features of tissue and microbial sensitization in the pathogenesis of generalized parodontitis associated  with rheumatoid arthritis. Immunological studies were carried out in 335 people, who were divided into 4 groups: Group 1 – the main – consisted of 136 patients with GP on the background of RA; Group 2 – control – 71 people with GP without signs of RA; Group 3 – comparison – 128 people without GP, but with diseases of the musculoskeletal system not related to RA and Group 4 – 30 practically healthy people. To determine microbial and tissue sensitization, we used inhibition reaction of migrating lymphocytes with microbial antigens of streptococci and staphylococci, tissue antigens (bone and synovial). A high frequency of microbial sensitization to streptococcal and staphylococcal antigens was established in patients with GP on the background of RA and in patients with GP without signs of RA. The parodontal focus turned out to be an active focus of microbial sensitization in patients with GP associated  with RA and in patients with GP without signs of RA. Established sensitization to bone antigen in a small number of patients (27-33%) with GP, which was significantly more frequent (61-80%) in patients with GP associated  with RA, indicates that in the latter, allergy is to a greater extent due to tissue systemic damage to connective tissue than GP. However, a certain allergy to bone tissue in GP may indicate the inclusion of an immune component in the pathogenesis of GP. The presence of microbial and tissue sensitization in patients with GP and RA indicates that similar and cross antigens of streptococcal and staphylococcal microorganisms with connective tissue are a potential trigger for the development of both GP and RA, which is a reason to consider GP and RA comorbid diseases with similar pathogenetic mechanisms of development.

Key words: rheumatoid arthritis, generalized periodontitis, reaction of inhibition of migrating leukocytes, tissue allergy, streptococcus antigen, staphylococcus antigen, synovial antigen

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Proschenko A.M. Bogomolets National Medical University, Kyiv, Ukraine, e-mail: andrey.proschenko@gmail.com
 https://orcid.org/0000-0003-0847-1408

Proschenko N.S. Bogomolets National Medical University, Kyiv, Ukraine, e-mail: khrolnina@gmail.com
https://orcid.org/0000-0001-7317-6590

Reshetnyk L.L. Bogomolets National Medical University, Kyiv, Ukraine, e-mail: reshetnik.lujdmila@gmail.com
https://orcid.org/0000-0001-9295-7800

Zelinskaya N.A. Bogomolets National Medical University, Kyiv, Ukraine, e-mail: viktor03148@gmail.com
https://orcid.org/0000-0003-0383-349X

Chervonna N.V. Bogomolets National Medical University, Kyiv, Ukraine, e-mail: Interesantemasymas@gmail.com
https://orcid.org/0000-0003-4499-5399

Melnychyk Т.А. Bogomolets National Medical University, Kyiv, Ukraine, e-mail: Ta-mel@ukr.net 
https://orcid.org/0000-0002-1588-1619

Proschenko A.M., Proschenko N.S., Reshetnyk L.L., Zelinskaya N.A., Chervonna N.V., Melnychyk Т.А. Indicative features of tissue and microbial sensitization in the pathogenesis of generalized parodontitis associated with rheumatoid arthritis. Medicni perspektivi. 2024;29(2):168-174.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307620

The aim of this study was to study the effect of metformin (Met) on the formation of the conditional passive avoidance skills, markers of neurogenesis and oxidative stress in the brain of rats with acute intracerebral hemorrhage (ICH) in the setting of streptozotocin-nicotinamide-induced diabetes. Type 2 diabetes mellitus (T2DM) was induced in rats via the intraperitoneal injection of streptozotocin (STZ) and nicotinamide (NA), ICH – by microinjection of bacterial collagenase into the striatum. Rats were randomly divided into four groups: 1 – intact animals (n=8), 2 – T2DM (n=9); 3 – T2DM+ICH (n=7); 4 – T2DM+ICH+Met (n=7). The passive avoidance test was used to evaluate behavioural activity. Advanced oxidation protein products (AOPP) and lactate were measured by spectrophotometry, advanced glycation end products (AGEs) by quantitative fluorescence, level of 8-hydroxy-2-deoxyguanosine (8-OHdG) was assessed by enzyme-linked immunosorbent assay (ELISA). Histopathological examination was performed using general histological staining techniques and immunohistochemical methods for assessment of expression of endothelial NO-synthase (eNOS), Growth Associated Protein 43 (GAP43), Hypoxia-inducible factor 1-alpha (HIF-1α), neural cadherine (N-cadherine) and vascular endothelial cadherine (VE-cadherine). In this study, metformin had nootropic (anti-amnestic) activity and decreased oxidative stress markers (AGEs, AOPPs and 8-OHdG) levels by 29.1% (p<0.001), 24.9% (p<0.015) and 29.3% (p<0.05) respectively, which indicates its positive impact on the course of free radical oxidation reactions intensified by both diabetes and intracerebral hemorrhage. The study provides additional information on neuroprotective properties of metformin and the emphasizes possibility of using metformin in diabetic patients at risk of hemorrhagic stroke. Considering the increase in VE-cadherin expression by the drug, it is possible to predict its positive effect on the function of blood-brain barrier. This study may serve as a reference for the feasibility of studying the clinical efficacy of metformin under these conditions.

Key words: type 2 diabetes mellitus, intracerebral haemorrhage, metformin, neuroprotection, oxidative stress

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54. Zhyliuk V, Lievykh A, Shevtsova A, Tka­chenko V, Kharchenko Y. The impact of perindopril and metformin on the markers of endothelial dysfunction in rats with acute intracerebral hemorrhage and type 2 diabetes mellitus. Medicni 2021;26(4):15-22. doi: https://doi.org/10.26641/2307-0404.2021.4.248055
55. Alnaaim SA, Al-Kuraishy HM, Al-Gareeb AI, Ali NH, Alexiou A, Papadakis M, et al. New insights on the potential anti-epileptic effect of metformin: Mecha­nistic pathway. J Cell Mol Med. 2023;27(24):3953-65. doi: https://doi.org/10.1111/jcmm.17965 

Look through:

Holubiev V.L. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0009-0006-9574-7140

Oberemok M.H. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0009-0006-7042-7933

Tkachenko V.A. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0003-2231-2913

Kharchenko Yu.V. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0002-4136-3495

Bondarenko O.O. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0002-9739-9219

Lievykh A.E. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0002-0615-5092

Zhyliuk V.I. Dnipro State Medical University, Dnipro, Ukraine, e-mail: vzhyliuk@gmail.com
https://orcid.org/0000-0003-2259-0622

Holubiev V.L., Oberemok M.H., Tkachenko V.A., Kharchenko Yu.V., Bondarenko O.O., Lievykh A.E., Zhyliuk V.I. Study of the neuroprotective properties of metformin in rats with type 2 diabetes mellitus and brain injury induced by intracerebral hemorrhage. Medicni perspektivi. 2024;29(2):174-186.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307690

In modern conditions, providing the population with high-quality drinking water is becoming an increasingly urgent hygienic, scientific, technical, and social problem. Chlorine dioxide can be an alternative reagent for disinfecting drinking water. However, as with chlorine, dangerous by-products, particularly chlorites and chlorates are formed. The processes of development of morphofunctional changes in homeostasis remain insufficiently studied in this aspect. The objective is to determine the nature and peculiarities of changes in hematological indicators in the blood of animals due to the chronic impact of various concentrations of chlorates in drinking water to establish criteria for the hygienic assessment of their adverse effects on the body. The test animals were given drinking water with different concentrations of chlorates daily for 6 months: group 1 – control, group 2 – chlorates at a dose of 0.2 mg/dm³, group 3 – chlorates at a dose of 0.7 mg/dm³, and group 4 – chlorates at a dose of 1.2 mg/dm³. Evaluating the results of experimental studies, it should be noted that the most pronounced changes are observed in groups of animals that received chlorates in concentrations of 0.7 and 1.2 mg/dm³: a gradual decrease in the absolute number of leukocytes, the absolute and relative number of lymphocytes, relative to the indicators of the control group can be observed. In groups of animals that received chlorates in concentrations of 0.7 and 1.2 mg/dm³, a decrease in the absolute number of erythrocytes was observed during the 90 days of the experiment. It was established that the severity of the effects depended on the dose of chlorates and the time of exposure. Thus, the nature and features of changes in hematological indicators in the body of experimental animals during a chronic sanitary-toxicological experiment under the influence of chlorates in drinking water may indicate that chlorates affect the indicators of the blood system, being the indirect signs of disorders of other functional systems in the body, namely – slowing of redox reactions, hypoxic manifestations, reduction and weakening of the immune response and reactivity, etc. 

Key words: drinking water, chlorine dioxide, chlorates, quality of drinking water, hematological indicators

1. Prokopov VO, Lypovetska OB, Kulish TV, Kos­tiuk VA. [Hazardous chlorites in drinking water: formation and removal using chlorine dioxide in water treatment technology]. Dovkillia ta zdorovia. 2023;1(106):43-50. doi: https://doi.org/10.32402/dovkil2023.01.043
2. Mokiienko AV, Bondarchuk OY, Spasonova LM. [Justification of the safety of chlorites and chlorates as derivatives of chlorine dioxide in the purification and di­sinfection of drinking water. In: Clean water. Fundamental, applied and industrial aspects: materials of the VII International Scientific and Practical Conference (Kyiv, 2023 Nov 9-10)]. Kyiv; 2023. p. 118-21. Ukrainian.
3. Evlampidou I, Font-Ribera L, Rojas-Rueda D, Gracia-Lavedan E, Costet N, Pearce N, et al. Trihalo­methanes in Drinking Water and Bladder Cancer Burden in the European Union. Environmental Health Pers­pectives.2020;128(1):17001. doi: https://doi.org/10.1289/EHP4495
4. Padhi RK, Subramanian S, Satpathy KK. Forma­tion, Distribution, and Speciation of DBPs (THMs, HAAs, ClO2 - , and ClO3 - ) during Treatment of Different Source Water with Chlorine and Chlorine Dioxide. Chemosphere. 2019;218:540-550. doi: https://doi.org/10.1016/j.chemosphere.2018.11.100
5. Dettori M, Azara A, Loria E, Piana A, Masia MD. Population distrust of drinking water safety. Community outrage analysis, prediction and management. Int J Environ Res Publ Health. 2019;16(6):1004. doi: https://doi.org/10.3390/ijerph16061004
6. Directive (EU) 2020/2184 of the European Parliament and of the Council of 16 December 2020 on the quality of water intended for human consumption (recast) [Internet]. 2020 [cited 2024 Feb 12]. Available from: http://data.europa.eu/eli/dir/2020/2184/oj
7. [European Convention on the Protection of Vertebrate Animals Used for Experiments or for Other Scientific Purposes dated March 18, 1986, No. 994_137]. [Internet]. 1986 [cited 2024 Feb 12]. Available from: http://zakon.rada.gov.ua/laws/show/994_137
8. [The procedure for carrying out experiments and experiments on animals by scientific institutions. Approved by the Order of the Ministry of Education and Science, Youth and Sports of Ukraine 03.01.2012 No. 249]. [Internet]. 2012 [cited 2024 Feb 12]. Available from: http://zakon.rada.gov.ua/laws/show/z0416-12
9. [DSanPiN 2.2.4-171-10. Hygienic requirements for drinking water intended for human consumption]. Kyiv: MOZ Ukrainy, 2012. 55 p.
10. [On the approval of the State sanitary norms and rules "Safety indicators and certain indicators of the quality of drinking water in conditions of martial law and emergency situations of a different nature". Order of the Ministry of Health of Ukraine dated 2022 Apr 22, No. 683]. [Internet]. 2022 [cited 2024 Feb 12]. Ukrainian. Available from: https://zakon.rada.gov.ua/laws/show/z0564-22#Text
11. Antomonov MY, Korobeinikov HV, Khmel­nytska IV, Kharkovliuk-Balakina NV. [Mathematical me­thods of processing and modeling the results of expe­rimental studies]. Kyiv: NUFVSU «Olimpiiska lit.»; 2021. 216 р. Ukrainian.
12. Оzdemir K. Chlorine and Chlorine Dioxide Oxi­dation of Natural Organic Matter in Water Treatment Plants. Environment Protection Engineering. 2020;46(4):87-97. doi: https://doi.org/10.37190/epe200407
13. Zhong Yu, Wenhui Gan, Ye Du, et al. Disin­fection byproducts and their toxicity in wastewater effluents treated by the mixing oxidant of ClO2/Cl2. Water Research.2019;162:471-81. doi: https://doi.org/10.1016/j.watres.2019.07.012
14. Meng-Yuan Xu, Yi-Li Lin, Tian-Yang Zhang, et al. Chlorine dioxide-based oxidation processes for water purification: A review. Journal of Hazardous Materials. 2022;436:129-95. doi: https://doi.org/10.1016/j.jhazmat.2022.129195
15. Srivastav A, Patel N, Chaudhary V. Disinfection by-products in drinking water: occurrence, toxicity and abatement. Environmental Pollution. 2020;267:115474. doi: https://doi.org/10.1016/j.envpol.2020.115474

Look through:

Kravchun T.E. SI «O.M.Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
https://orcid.org/0000-0002-2553-9796

Tomashevskaya L.A. SI «O.M.Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine, e-mail: tomashewskaya@ukr.net
https://orcid.org/0000-0002-0674-7848

Prokopov V.A. SI «O.M.Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
https://orcid.org/0000-0002-1611-8930

Kulish T.V. SI «O.M.Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
https://orcid.org/0009-0009-9658-2570

Tsytsyruk V.S. SI «O.M.Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
https://orcid.org/0009-0006-0315-7750

Kravchun T.E., Tomashevskaya L.A., Prokopov V.A., Kulish T.V., Tsytsyruk V.S. Peculiarities of the blood system of animals under the conditions of consumption of drinking water containing chlorates. Medicni perspektivi. 2024;29(2):187-193. DOI: https://doi.org/10.26641/2307-0404.2024.2.307693

Healthcare iшnstitutions with a high culture of patient safety are characterized by the appropriate level of mutual trust of employees, a general understanding of the importance of patient safety issues, the presence of an effective system of preventive measures to ensure the safety of both medical personnel and the patient, which has been implemented. Moreover, maintaining a high safety culture requires an understanding of certain norms of behavior and attitude towards the patient from the stand point of ensuring his maximum safety, which contributes to compliance with treatment standards and the development of safe behavior. The aim of the study was to create and scientifically substantiate an algorithm for analytical assessment of the level of safety culture in modern healthcare institutions.The research was conducted on the basis of the Dental Medical Center of Bogomolets National Medical University. Hygienic and medical-sociological methods and methods of expert assessment and statistical analysis were used in the work. Expert assessment maps of the leading components of safety culture served as the material of the conducted research. The organizational and target structure of the scientific work provided for the determination of the structural features of the leading components of safety culture and the development of a scoring scale for their assessment, the implementation of an expert evaluation of the specified components and the establishment of the degree of consistency of the opinions of experts, the calculation of the weighting coefficients of the influence of various components on the formation of a certain level of safety culture and the justification of objective statistical approaches to assessing the level of safety culture. In the course of the conducted research, a high degree of consistency of experts’opinions was revealed and the values of weighting coefficient swere calculated, which made it possible to develop generalized formulas for determining the values of indicators of the level of safety culture provision in modern healthcare institutions from the standpoint of assessing the degree of influence on the level of safety culture of the leading characteristics of dangerous actions of a person (doctor, specialist, etc.) (Component No. 1), identifying the degree of influence on the level of safety culture of both strengths and weaknesses in creating a safe medical environment (Component No. 2) and establishing the degree of influence on the level of safety culture of dangerous production factors inherent for medical environment (Component No. 3). It is sub­stantiated that the process of creating an algorithm for analytical assessment of the level of safety culture in modern healthcare institutions should involve the implementation of the following stages: establishing the degree of expression of the leading indicators that are components of each of its main components, using special scales (1ststage), determining the values indicators of ensuring the level of patient safety culture for each of the components using the appropriate generalized formulas (2^ndstage), evaluation and meaningful interpretation of the values of indicators of the level of safety culture based on quantitative criteria (3^rdstage), determination of collective, group or personalized, according to the content, strategies application of preventive measures aimed at increasing the level of safety culture in each specific case (4^thstage).

Key words: safety culture, algorithm for assessing, health care institutions, patients

1. Hospital Survey on Patient Safety Culture: 2018 User Database Report. Agency for Healthcare Research and Quality U.S. AHRQ Publication No. 18-0025-EF [Internet]. [cited 2023 May 01]. Available from: https://www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/2018hospitalsops­report.рdf
2. NHS Patient Safety Strategy. Safer culture, safer systems, safer patients [Internet]. 2019 [cited 2023 May 01]. Available from: https://www.england.nhs.uk/wpcontent/­uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf
3. NHS Patient Safety Strategy: 2021 update [Internet]. 2021 [cited 2023 May 01]. Available from: https://www.england.nhs.uk/wpcontent/uploads/2021/02/B0225-NHS-Patient-Safety-Strategy-update-Feb-2021-Final-v2.pdf
4. Healthcare Safety Culture: A Seven-Step Success Framework. Health Catalyst [Internet]. 2019 [cited 2023 May 01]. Available from: https://www.healthca­talyst.com/insights/safetyculture-healthcare-7-step-framework/
5. Patient Safety Fact File [Internet]. Geneva: World Health Organization; 2019 [cited 2023 May 01]. Available from: https://www.who.int/features/factfiles/patient_sa­fety/patient-safety-fact-file.pdf?ua=1/
6. Yavorovskyi OP, Ryhan MM, Naumenko OM, Skaletskyi YuM, Hychka SH, Ivanko OV, et al. [Patient safety culture in domestic hospitals (message 1)]. Me­dicni perspektivi. 2021;26(3):179-87. Ukrainian. doi: https://doi.org/10.26641/2307-0404.2021.3.242257
7. Yavorovskyi OP, Ryhan MM, Naumenko OM, Skaletskyi YuM, Hychka SH, Ivanko OV, et al. [Compa­ra­tive analysis of safety culture in domestic and foreign hospitals and enterprises of other fields of activity (mes­sage 2)]. Medicni perspektivi. 2021;26(4):153-60. Uk­rai­nian. doi: https://doi.org/10.26641/2307-0404.2021.4.248210
8. Patient Safety Indicators. AHRQ Pub. No. 15-M053-4-EF [Internet]. 2015 [cited 2023 May 01]. Avai­lable from: https://www.qualityindicators.ahrq.gov/­Downloads/Modules/PSI/V50/PSI_Brochure.pdf
9. Nordin A, Wilde-Larsson В, Nordström G, Thean­der K. Swedish Hospital Survey on Patient Safety Culture – Psychometric properties and health care staff’s perception. Open Journal of Nursing. 2013;3:41-50. doi: https://doi.org/10.4236/ojn.2013.38A006
10. State of Health in the EU Sweden Country Health Profile 2017. OECD. European Observatory on Health Systems and Policies [Internet]. 2017 [cited 2023 May 01];20. Available from: https://www.euro.who.int/_data/assets/­pdf_file/00 12/355998/Health-Profile-Sweden-Eng.pdf.ua
11. Antomonov MYu. [Mathematical processing and analysis of medical and biological data]. Kyiv: MYTs “Medinform”; 2018. 579 p. Russian.
12. [On the approval of the Concept of reforming the labour protection management system in Ukraine and the approval of the plan of measures for its implementation. Order of the Cabinet of Ministers of Ukraine dated 2018 Dec 12 No. 989-r]. [Internet]. 2018 [cited 2023 May 01]. Ukrainian. Available from: https://zakon.rada.gov.ua/­laws/show/989-2018-%D1%80#Text
13. Hudson P. Implementing a safety culture in a major multi-national. Safety Science [Internet]. 2007 Jul [cited 2023 May 01];45(6):697-722. doi: https://doi.org/10.1016/j.ssci.2007.04.005

Look through:

Yavorovsky O.P. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0002-4573-8039

Serheta I.V. National Pirogov Memorial Medical University, Vinnytsya, Ukraine
https://orcid.org/0000-0002-4439-3833

Brukhno R.P. Bogomolets National Medical University, Kyiv, Ukraine, e-mail:bruhnoroman@ukr.net
https://orcid.org/0000-0002-6666-397X

Skaletskyi Yu.M. SI “O.M. Marzeіev Institute for Public Health of the NAMS of Ukraine”, Kyiv, Ukraine
https://orcid.org/0000-0001-7527-6827

Chopchyk V.D. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0002-5581-0372

Varyvonchyk D.V. Shupyk National University of Health of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0003-2107-6269

Zenkina V.I. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0001-5125-6557

Yavorovsky O.P., Serheta I.V., Brukhno R.P., Skaletskyi Yu.M., Chopchyk V.D.,Varyvonchyk D.V., Zenkina V.I. On the issue of creating an algorithm for assessing safety culture in modern healthcare institutions. Medicni perspektivi. 2024;29(2):194-205.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307698

During the years of war, as a result of aviation and missile attacks, a significant number of health care facilities in various regions of Ukraine were destroyed, and the complexity and intensity of their work increased significantly. If the readiness of hospitals and their employees to treat gunshot and explosive injuries is established, in the case of mass destruction of chemically hazardous enterprises and the threat of the enemy using weapons of mass destruction, including chemical weapons, there is a need for special training of health care facilities to work in the in conditions of chemical threats. The aim of the work was justification of the development and set of measures for the implementation of standard operating procedures in the event of a chemical incident. The legal documents and recommendations of the Ministry of Health of Ukraine, management of the World Health Organization and the Red Cross on the topic of the study were used. The research methods: bibliosemantic, analytical, modeling were applied. It is established that the special management group, which includes representatives of various services, is of decisive impor­tance in the effective management of a health care facility during a chemical incident: administration; communication department; security department; management of nurses and the department of infection control; human resources department; pharmacy; intensive care unit; department of engineering maintenance and repair; laboratory; kitchen; laundry; cleaning service and waste management. The most important measures of response to a chemical incident that ensure the safety of medical personnel and patients are the organization of a triage zone and a decontamination area for chemically affected persons. Based on the above, to prepare a health care facility for work during a chemical incident, it is necessary to develop a response plan, which consists of special administrative and management decisions and provides for regular staff training.

Key words: chemical incident, standard operating procedure, health care facility

1. WHO Response to the Ukraine Crisis: Fourth quarter bulletin: October-December 2023 [Internet]. [cited 2023 Nov 28]. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2024-6172-45937-73504
2. Ukraine: civilian casualty update 24 October 2022. News. Geneva: Office of the High Commissioner for Human Rights [Internet]. 2022 [cited 2023 Nov 28]. Available from: https://www.ohchr.org/en/news/2022/10/ukrainecivilian-casualty-update-24-october-2022
3. Ukraine refugee situation: 19 October 2022. Ope­rational Data Portal. Geneva: United Nations High Com­missioner for Refugees [Internet]. 2022 [cited 2023 Nov 28]. Available from: https://data.unhcr.org/en/situations/ukraine
4. [On Approval of the Decree of the President of Ukraine "On the Introduction of Martial Law in Ukraine". Law of Ukraine No. 2102-IX dated 2022 Feb 24]. [In­ternet]. 2022 [cited 2023 Nov 28]. Ukrainian. Available from: https://zakon.rada.gov.ua/laws/show/2102-20#Text
5. [Medical triage during the mass influx of victims at the early hospital stage. Order of the Ministry of Health of Ukraine No. 368 dated 2022 Feb 24]. [Internet]. 2022 [cited 2023 Nov 28]. Ukrainian. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-24022022--368-pro-zatverdzhennja-standartu-ekstrenoi-medichnoi-dopomogi-medichne-sortuvannja-pri-masovomu-nadhodzhenni-postrazhdalih-na-rannomu-gospitalnomu-etapi 
6. [On the approval of Methodological recom­mendations for the decontamination of victims as a result of the action of chemical, radiation factors and biological agents. Order of the Ministry of Health of Ukraine No. 322 dated 2011 May 27]. [Internet]. 2011 [cited 2023 Nov 28]. Ukrainian. Available from: https://zakononline.com.ua/documents/show/79070___79070
7. [On the approval of Temporary measures in health care institutions to ensure their readiness to provide medical care to victims of the military aggression of the Russian Federation against Ukraine. Order of the Ministry of Health of Ukraine No. 374 dated 2022 Feb 24]. [Internet] 2022 [cited 2023 Nov 28]. Ukrainian. Available from: https://zakon.rada.gov.ua/rada/show/v0374282-22#Text
8. [On the approval of Methodological recom­mendations for the organization of emergency medical care for victims of the effects of chemical agents during the evacuation stages. Order of the Ministry of Health of Ukraine No. 478 dated 2022 Mar 13]. [Internet] 2022 [cited 2023 Nov 28]. Ukrainian. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-13032022--478-pro-zatverdzhennja-metodichnih-rekomendacij-schodo-organizacii-nadannja-ekstrenoi-medichnoi-dopomogi-postrazhdalim-vnaslidok-dii-himichnih-agentiv-na-etapah-evakuacii
9. World Health Organization. Regional Office for Europe. Strengthening health-system emergency prepa­redness: toolkit for assessing health-system capacity for crisis management: part 2: assessment form. Regional Office for Europe [Internet]. 2012 [cited 2023 Nov 28]. Available from: https://iris.who.int/handle/10665/352568
10. World Health Organization. European Regional Office. Hospital Emergency Preparedness Assessment Checklist: Emergency response assistance for hospital administrators and emergency responders [Internet]. 2011 [cited 2023 Nov 28]. Available from: https://iris.who.int/handle/10665/349464   
11. World Health Organization. Regional Office for Europe. Hospital readiness checklist for COVID-19 interim version 2020 Feb 24 [Internet]. 2020 [cited 2023 Nov 28]. Available from: https://iris.who.int/handle/10665/333973  
12. World Health Organization. Initial clinical ma­nagement of patients exposed to chemical weapons: in­terim guidance document [Internet]. 2014 [cited 2023 Nov 28]. Available from: https://www.who.int/publications/i/item/initial-clinical-management-of-patients-exposed-to-chemical-weapons-interim-guidance-document
13. Guideline for the pre-hospital management of persons contaminated with chemical agents during armed conflict and other violence. International Committee of the Red Cross [Internet]. Geneva, Switzerland. 2019 [cited 2023 Nov 28]. Available from: https://www.icrc.org/en/­publication/4414-guidelines-pre-hospital-management-persons-contaminated-chemical-agent-during-armed

Look through:

Hudoshyna O.V. Ministry of Health of Ukraine, Kyiv, Ukraine, e-mail: hudoshyna@gmail.com
https://orcid.org/0000-0003-1901-0818

Kurdil N.V. SE “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine”, Kyiv, Ukraine, e-mail: kurdil_nv@ukr.net
https://orcid.org/0000-0001-7726-503X

Hudoshyna O.V., Kurdil N.V. Optimization and standardization of the work of a health care facility during a chemical accident. Medicni perspektivi. 2024;29(2):205-215.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307700

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems. 

Key words: healthcare disaster management, e-health, telemedicine, strategies for healthcare

1. Abid SK, Chan SW, Sulaiman N, Bhatti U, Na­zir U. Present and Future of Artificial Intelligence in Disaster Management. In: 2023 International Conference on Engineering Management of Communication and Technology (EMCTECH), 2023 Oct 16 [Internet]. 2023 [cited2023 Dec 13]. doi: http://dx.doi.org/10.1109/emctech58502.2023.10296991 
2. AlHinai YS. Disaster management digitally trans­formed: Exploring the impact and key determinants from the UK national disaster management experience. International Journal of Disaster Risk Reduction. 2020 Dec;51:101851. doi:https://doi.org/10.1016/j.ijdrr.2020.101851
3. Amjad A, Kordel P, Fernandes G. A Review on In­novation in Healthcare Sector (Telehealth) through Artifi­cial Intelligence. Sustainability. 2023 Apr 14;15(8):6655. doi:https://doi.org/10.3390/su15086655
4. Azarmi S, Sharififar S, Pishgooie AH, Khan­keh HR, Hejrypour SZ. Hospital disaster risk management improving strategies: A systematic review study. American Journal of Disaster Medicine. 2022 Mar 1;17(1):75-89. doi: https://doi.org/10.5055/ajdm.2022.0421
5. Baharun R, Mi TJ, Streimikiene D, Mardani A, Sha­keel J, Nitsenko VS. Innovation in healthcare perfor­mance among private brand’s healthcare services in small and me­dium-sized enterprises (SMEs). Acta Polytechnica Hun­garica  [Internet]. 2019 Aug 21 [cited 2023 Dec 13];16(5). doi: https://doi.org/10.12700/aph.16.5.2019.5.9
6. Bala H, Venkatesh V, Venkatraman S, Bates J. If the Worst Happens: Five Strategies for Developing and Leveraging Information Technology-Enabled Disaster Response in Healthcare. IEEE Journal of Biomedical and   Health Informatics. 2016 Nov;20(6):1545-51. doi: https://doi.org/10.1109/jbhi.2015.2477371
7. Behrens DA, Rauner MS, Sommersguter-Reich­mann M. Why Resilience in Health Care Systems is More than Coping with Disasters: Implications for Health Care Policy. Schmalenbach Journal of Business Research. 2022 Apr 8;74(4):465-95. doi: https://doi.org/10.1007/s41471-022-00132-0
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9. Bogodistov Y, Moormann J, Sibbel R, Krup­skyi O, von Hanstein M, Grytsenko S. Bedeutung des Pro­zessreifegrads für die Patientenorientierung im Gesund­heitswesen. Gesundheitsökonomie & Qualitätsmana­gement.2019 Jul 29;25(01):37-42. doi: https://doi.org/10.1055/a-0965-8373 
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Look through:

Vazov R. Faculty of Economics and Business Administration, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria, e-mail: vazov.rado@gmail.com 
https://orcid.org/0000-0003-3322-7060

Kanazireva R. Faculty of Economics and Business Administration, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria, e-mail: rayakan@yahoo.com
https://orcid.org/0000-0002-5438-0286

Grynko T.V. Oles Honchar Dnipro National University, Dnipro, Ukraine, e-mail: greisy25@gmail.com
https://orcid.org/0000-0002-7882-4523

Krupskyi O.P. Oles Honchar Dnipro National University, Dnipro, Ukraine,
e-mail: krupskyy71@gmail.com
http://orcid.org/0000-0002-1086-9274

Vazov R., Kanazireva R., Grynko T.V., Krupskyi O.P. Strategies for Healthcare Disaster Management in the Context of Technology Innovation: the Case of Bulgaria. Medicni perspektivi. 2024;29(2):215-228.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307703

Funicular myelosis (sub­acute combined degeneration) is a disease characterized by the development of degeneration of the posterior and lateral cords of the spinal cord. Funicular myelosis is a neurological complication of vitamin B₁₂ deficiency, which occurs as a result of reduced intake of vitamin B₁₂ with food, malabsorption, in connection with taking some drugs (metformin, proton pump inhibitors, and nitrous oxide), with invasion by Diphyllobothrium latum. The disease is usually characterized by the presence of paresthesias, the development of sensitive ataxia, and impaired gait. The aim of the work was to demon­strate a clinical case of funicular myelosis in a young patient in order to improve the diagnostic process, paying attention to the genetic profile and identifying a concomitant predisposition to folate cycle disorder. A clinical case of funicular myelosis in a 39-year-old woman is described. The patient came to the neurology department with complaints of numbness in the upper and lower limbs, periodic shooting pains along the spine when the head is tilted forward. During the neurological examination, the following was observed: a decrease in vibrational, muscle-joint, discrimination sensitivity in the upper limbs, paresthesias in the distal parts of the limbs, and sensitive ataxia. According to the results of the magnetic resonance imaging (MRI) of the spinal cord, a lesion of the posterior cords on the long segment (C2-Th1) was found, which corresponds to the subacute degeneration of the spinal cord, which arose due to the deficiency of holotranscobalamin (active B₁₂). The patient received appropriate treatment and was discharged home. Subsequently, the patient was found to have a concomitant genetic predisposition to folate cycle disorder and the development of thrombophilia. A year later, the woman again came to the neurological department. We carried out a repeated examination, evaluation of the results of the MRI of the cervical spine and other examinations in dynamics. According to the results of the literature analysis, additional markers for the diagnosis of funicular myelosis (in particular, homocysteine), the causes of hyper­homocysteinemia and its effects on the body were described. Timely detection and treatment of vitamin B₁₂ deficiency is quite important, since in severe cases the development of spastic paraplegia is possible. Recovery of lost functions depends on the extent of spinal cord damage and the duration of the disease. If anemia is observed together with neurological symptoms, it is necessary to be especially attentive to possible funicular myelosis and to carry out appropriate diagnostic searches. And when detecting hyperhomocysteinemia, it is advisable to take into account other factors that can cause an increase in the level of homocysteine, in addition to a deficiency of vitamins B₆, B₁₂ and folic acid.

Key words: funicular myelosis, B₁₂ deficiency anemia, thrombophilia, folate cycle, homocysteine, methylenetetrahydrofolate reductase gene mutation

1. Niklewicz A, Smith AD, Smith A, et al. The importance of vitamin B₁₂ for individuals choosing plant-based diets. Eur J Nutr. 2023;62(3):1551-9. doi: https://doi.org/10.1007/s00394-022-03025-4
2. Al-Awami HM, Raja A, Soos MP. Physiology, Gastric Intrinsic Factor. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 14]. PMID: 31536261. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546655/
3. Rustgi SD, Bijlani P, Shah SC. Autoimmune gas­tritis, with or without pernicious anemia: Epidemiology, risk factors, and clinical management. Therapeutic Ad­vances in Gastroenterology. 2021;14:175628482110387. doi: https://doi.org/10.1177/17562848211038771
4. Gu L, Fu R, Chen P, et al. In Terms of Nutrition, the Most Suitable Method for Bariatric Surgery: Lapa­roscopic Sleeve Gastrectomy or Roux-en-Y Gastric By­pass? A Systematic Review and Meta-analysis. Obes Surg. 2020;30(5):2003-14.
   doi: https://doi.org/10.1007/s11695-020-04488-2
5. Martín-Masot R, Nestares MT, Diaz-Castro J, et al. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients.2019;11(11):2557. doi: https://doi.org/10.3390/nu11112557 
6. Sharma K, Wijarnpreecha K, Merrell N. Diphyllo­bothrium latum Mimicking Subacute Appendicitis. Gastro­enterology 2018;11(3):235-7. doi: https://doi.org/10.14740/gr989w
7. Miller JW. Proton Pump Inhibitors, H2-Receptor Antagonists, Metformin, and Vitamin B-12 Deficiency: Clinical Implications. Adv Nutr. 2018;9(4):511S-518S. doi: https://doi.org/10.1093/advances/nmy023
8. Infante M, Leoni M, Caprio M, Fabbri A. Long-term metformin therapy and vitamin B₁₂ deficiency: Anassociation to bear in mind. World J Diabetes. 2021;12(7):916-31. doi: https://doi.org/10.4239/wjd.v12.i7.916
9. Choi C, Kim T, Park KD, Lim OK, Lee JK. Sub­acute Combined Degeneration Caused by Nitrous Oxide Intoxication: A Report of Two Cases. Ann Rehabil Med. 2019;43(4):530-4. doi: https://doi.org/10.5535/arm.2019.43.4.530
10. Means R, Fairfield K. Clinical manifestations and diagnosis of vitamin B₁₂ and folate deficiency [Internet]. 2023[cited 2024 Jan 15]. Available from: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-vitamin-b12-and-folate-deficiency?search=subacute%20degeneration%20of%20cord&topicRef=5093&source=see_link#H708835024
11. Rosenson R, Smith C, Bauer K. Overview of ho­mocysteine [Internet]. 2023 [cited 2024 Jan 15]. Availablefrom: https://www.uptodate.com/contents/overview-of-homocysteine?search=hyperhomocysteinemia&topicRef=1120&source=see_link
12. Qudsiya Z, De Jesus O. Subacute Combined Degeneration of the Spinal Cord. In: StatPearls [In­ternet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 14]. PMID:32644742. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559316/
13. Bähr M, Frotscher M, Duus P. Duus’ topical diag­nosis in neurology: Anatomy, physiology, signs, symp­toms. Stuttgart: Thieme; 2019.
14. Tinelli C, Di Pino A, Ficulle E, Marcelli S, Feli­gioni M. Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies. Front Nutr. 2019;6:49. doi: https://doi.org/10.3389/fnut.2019.00049

Look through:

Shulga O.D. Municipal enterprise “Volyn Regional Clinical Hospital”; Lesya Ukrainka Volyn National University, Lutsk, Ukraine, e-mail: shulgaolga@ukr.net
https://orcid.org/0000-0002-4513-9028

Popko E.A. Municipal enterprise “Volyn Regional Clinical Hospital”, Lutsk, Ukraine
https://orcid.org/0000-0002-1537-940X

Chabanova A.S. Municipal enterprise “Volyn Regional Clinical Hospital”, Lutsk, Ukraine
https://orcid.org/0000-0002-2378-0770

Kotsiuba O.G. Municipal enterprise “Volyn Regional Clinical Hospital”, Lutsk, Ukraine
https://orcid.org/0000-0002-6278-0466

Hussain Q. “Ukrainian-German Laboratory”, Lutsk, Ukraine
https://orcid.org/0000-0002-0730-5312

Shulga O.D., Popko E.A., Chabanova A.S., Kotsiuba O.G., Hussain Q. Сlinical case of funicular myelosis in combination with a concomitant genetic predisposition to folate cycle disorder. Medicni perspektivi. 2024;29(2):229-236. DOI: https://doi.org/10.26641/2307-0404.2024.2.307773

Congenital cleft lip, alveolar process, hard and soft palate are common anomalies of the development of human organs and in terms of frequency occupy one of the first places among other defects of the human body. The clinical study and treatment of cleft lip and palate, malocclusions that accompany this defect have always been of great interest in orthodontics and orthopedic dentistry. This is due to the fact that malocclusions in this group of patients are complex and difficult to treat, as morphological changes are combined with significant functional disorders. The aim of the work was to demonstrate a clinical case of orthodontic and orthopedic rehabilitation of patients with congenital bilateral cleft lip and palate after cheilouranoplasty. A clinical case of a complex treatment of a 25-year-old female patient with bilateral cleft lip, alveolar process, hard and soft palate after cheilouranoplasty performed in childhood is presented. During the clinical examination, an irregular shape of the upper dentition was established due to its sharp narrowing and alveolar shortening in the area of canines and first premolars. A deep reverse bite was formed, a false progeny with a sagittal fissure of up to 10 mm, bilateral vestibular crossbite, contact on the first and second molars of the upper and lower jaws was observed, adentia 12, 22, 23. With a sharp narrowing of the upper dentition at the first stage of orthodontic treatment, Nord's apparatus was used. At the second stage, the brace technique was applied, namely, the straight arch technique. After expanding, lengthening the upper dentition, creating space for missing teeth, reducing the size of the lower dentition by removing 34, 44, the patient continued treatment at the orthopedic department. At an appointment with an orthopedic dentist, after an objective and subjective examination, according to Kennedy the patient was diagnosed as III class, I subclass of the upper jaw. Defects of the alveolar process of the upper jaw, formed as a result of adentia, connection of the oral cavity with the nasal cavity in places of non-union of the alveolar process were established. In this clinical situation, the manufacturing of a complete esthetic-cosmetic structure, namely a metal-ceramic dental bridge with obturating parts is indicated. Thus, the demonstrated clinical case can be considered as one of the methods of a complex orthodontic and orthopedic rehabilitation of adult patients with congenital cleft lip, alveolar process and palate.

Key words: congenital clefts, orthodontic treatment, brace technique, orthopedic treatment, aesthetic structures

1. Vyas T, Gupta P, Kumar S, Gupta R, Gupta T, Singh HP. Cleft of lip and palate: a review. J Family Med Prim Care. 2020 Jun 30;9(6):2621-5. doi: https://doi.org/10.4103/jfmpc.jfmpc_472_20
2. Oliinyk AY, Oliinyk HV. [Features of dentoal­veolar deformities in patients with congenital cleft lip and palate (literature review)]. Klinichna stomatolohiia. 2020;4:45-54. doi: https://doi.org/10.11603/2311-9624.2019.4.10881
3. Oliynyk AYu. [Characteristic features of the for­mation and dynamics of upper jaw dentition in patients with left-sided transverse congenital clefts after surgery]. Naukovyi visnyk Uzhhorodskoho universytetu: Ser.: Medytsyna. 2016;1(53):111-7. Ukrainian. doi: https://doi.org/10.24061/2413-0737.XIX.4.76.2015.228
4. Krezel JD, Friel T, Waia S, Clark P, Taylor PD. Prosthetic rehabilitation of a repaired cleft palate with use of a two-part hinged magnet retained removable prosthesis. J 2021;30(5):454-7. doi: https://doi.org/10.1111/jopr.13353
5. Bhutiani N, Tripathi T, Verma M, Bhandari PS, Rai P. Assessment of treatment outcome of presurgical nasoalveolar molding in patients with cleft lip and palate and its postsurgical stability. Cleft Palate Craniofac J. 2020 Jun;57(6):700-6. doi: https://doi.org/10.1177/1055665620906293
6. Mancini L, Gibson TL, Grayson BH, Shetye PR. Orthodontic treatment in adolescents with cleft lip and palate. Semin 2017;23(3):295-304. doi: https://doi.org/10.1053/j.sodo.2017.05.005
7. Yelins’ka AM, Akimov OY, Kostenko VO. Role of AP-1 transcriptional factor in development of oxidative and nitrosative stress in periodontal tissues during systemic inflammatory response. Ukr Biochem J. 2019;91(1):80-5. doi: https://doi.org/10.15407/ubj91.01.080
8. Halych LV, Halych LВ. Impact of malocclusion of II1 according to Angle’s classification method on facial esthetics. Wiad 2021;74(7):1600-4. doi: https://doi.org/10.36740/WLek202107109
9. Makarova OM, Semeniaka MV, Balia HM, Kuroie­dova VD. [Orthodontic and orthopedic rehabilitation of pa­tients with nonunions of the upper lip, alveolar process, hard and soft palate]. Ukr Stomat almanakh. 2018;4:55-9. Ukr.
10. Makieiev VF, Oliinyk AIu. [Orthopedic rehabili­ta­tion of patients with congenital clefts of the upper lip and palate by different kinds of prosthetic constructions using own dentition deformations]. Novyny stomatolohii. 2017;3:43-50. Ukrainian.

Look through:

Halych L.B. Poltava State Medical University, Poltava, Ukraine, e-mail: galich.poltava@gmail.com
http://orcid.org/0000-0001-9649-9675

Kuroyedova V.D. Poltava State Medical University, Poltava, Ukraine
http://orcid.org/0000-0003-1847-6931

Tsvetkova N.V. Poltava State Medical University, Poltava, Ukraine
http://orcid.org/0000-0003-1153-529X

Halych L.V. Sumy State University Medical Institute, Sumy, Ukraine
http://orcid.org/0000-0002-8454-6427

Halych L.B., Kuroyedova V.D., Tsvetkova N.V., Halych L.V. Orthodontic and orthopedic rehabilitation of adult patients with congenital cleft lip and palate (clinical case). Medicni perspektivi. 2024;29(2):237-245.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307777

At the present stage of diagnostics and treatment of dental diseases, morphofunctional disorders of the dento-maxillary system associated with a decrease in the height of occlusion are becoming more common. In the scientific literature, this pathological condition is described under the name "occlusion" that decreases. The reasons that cause it include partial or complete loss of teeth, irrational prosthetics and untimely restoration of dentition defects, doctors' mistakes in the restructuring of the masticatory apparatus, and a generalized form of pathological abrasion of hard tooth tissues. The purpose of the study – demonstration of a clinical case of pathological abrasion of hard tissues of teeth with a decrease in bite height, complicated by defects in the dentition. Patient S., 47 years old, applied for orthopedic help with complaints of anatomical deformity, significant abration of teeth on the upper and lower jaws, increased sensitivity to various types of irritants, partial absence of teeth, impaired masticatory function, periodic clicking in the temporomandibular joint, aesthetic and phonetic defects. Based on the data obtained, we established the following diagnosis: generalized form of pathological abrasion of hard teeth tissues, subcompensated form of reduced bite height, complicated by defects in the dentition of the upper jaw – class I according to the Kenedy classification, lower jaw – class III according to the Kenedy classification. The loss of chewing efficiency according to Agapov was 68%. Patient S. was recommended a two-stage orthopedic treatment, which involves preliminary separation of the bite with the help of individual vinyl mouth guards which  have an increasing thickness of 2, 4 and 6 mm, made for the lower jaw.The planned treatment period with each of the muscle relaxant splints will be 2 months. Subsequently, 15, 14, 13, 12, 11, 21, 22, 23, 24 will be restored with one-piece metal crowns with ceramic cladding, and the final defects in the lateral areas will be restored with a clasp prosthesis with a locking system of fixation. The included defect of the lateral part of the lower jaw is planned to be restored with a metal-ceramic bridge-like prosthesis with a support on 47, 45, 44, and the worn-out hard tooth tissues will be completely restored with photopolymer material. In patients with a reduction in bite height of more than 2 mm, it is advisable to carry out treatment in two stages. At the first stage, we normalize the occlusal height and rebuild the function of the masticatory muscles. At the second stage, we provide rational prosthetics. Orthopedic rehabilitation with myorelaxing splints of increasing thickness makes it possible to correctly rebuild myostatic reflexes and prevent functional disorders in the TMJ. Any case of complex treatment of patients with a decrease in bite height due to pathological abrasion of  the hard tooth tissues deserves the attention of both scientists and dentists in practical health care.

Key words: pathological abrasion, occlusal height, masticatory muscles, temporomandibular joint, myorelaxing splint 

1. Alwadai GS, Roberts G, Ungar PS, González-Cabezas C, Lippert F, Diefenderfer KE, et al. Monitoring of simulated occlusal tooth wear by objective outcome measures. J 2020;102:103467. doi: https://doi.org/10.1016/j.jdent.2020.103467
2. Goldstein G, Goodacre C, MacGregor K. Occlusal vertical dimension: best evidence consensus statement. J Prosthodont. 2021;30(S1):12-9. doi: https://doi.org/10.1111/jopr.13315
3. Dvornyk VM. [Analysis of the causes of declining occlusion, clinical signs and the need of the population for the treatment of this pathology]. Svit medytsyny ta biolohii. 2008;2:21-3. Ukrainain.
4. Shen YF, Wei MC, Li HP, Pan YH, Hong HH, Chen CC, et al. Vertical dimension of occlusion related to mandibular movement during swallowing. Biomed J. 2021;44(2):217-22. doi: https://doi.org/10.1016/j.bj.2019.12.006
5. Bartlett D, O'Toole S. Tooth wear and aging. Aust Dent J. 2019;64(1):S59-S62. doi: https://doi.org/10.1111/adj.12681
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Look through:

Sokolovska V.M. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0002-8944-5828

Tsvetkova N.V. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0003-1153-529X

Davydenko V.Y. Poltava State Medical University, Poltava, Ukraine, e-mail: v.davydenko@pdmu.edu.ua 
https://orcid.org/0000-0002-4231-7343

Pysarenko O.A. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0002-6104-6745

Tarashevska Y.E. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0003-2983-1708

Sokolovska V.M., Tsvetkova N.V., Davydenko V.Y., Pysarenko O.A., Tarashevska Y.E. Dental rehabilitation of a patient with a decrease in bite height due to pathological abrasion of hard tooth tissues (clinical case). Medicni perspektivi. 2024;29(2):245-253.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307778

Gottron's carcinoid papillomatosis of the skin is a rare and little-studied disease. The number of available scientific publications does not exceed several dozens, in Ukraine, in the last ten years, 2 works devoted to this pathology have been published. However, in parallel with the increase in diagnostic capabilities in a multidisciplinary hospital, there are periodically cases of establishing a diagnosis: Gottron's carcinoid papillomatosis of the skin. The lack of a clear understanding of the diagnostic and treatment algorithm creates additional difficulties in the treatment of Gottron's carcinoid papillomatosis of the skin. The course and features of this disease, namely: the presence of various concomitant pathologies, duration and unsatisfactory results of treatment, low patient compliance, etc., make its study relevant. This prompts a more detailed study and analysis of cases of successful treatment. The purpose of our work was to analyze a clinical case of treatment of Gottron's carcinoid papillomatosis of the skin in a multidisciplinary hospital using a multidisciplinary team approach, as well as to summarize the data related to the incidence, features of the clinical course and treatment of this disease given in scientific publications. A clinical case of successful treatment of a patient with Gottron's carcinoid papillomatosis of the skin is presented, a model of the interaction of a vascular surgeon at the stage of restoring the patency of the main arteries and preservation of the limb, a surgeon of the purulent-septicsurgery department at the stage of local and systemic treatment, a pathologist at the diagnostic and post operative stage, and a dermatologist for improvement of topical exposure and ambulatory monitoring is shown. Therefore, the analysis of this clinical case convincingly testifies to the successful capabilities of a multidisciplinary hospital in the treatment of Gottron's carcinoid papillomatosis of the skin, which can be taken into account when determining the treatment tactics of this disease. Coverage of this and similar cases in scientific publications of this rare disease will improve clinician awareness and treatment outcomes.

Key words: Gottron's carcinoid papillomatosis of the skin, surgical treatment, wound process

1. Gottron HA, Nykolowsky W. Pseudokanzerose. Dermatologieund Venerologie. 1963;4:312-28.
2. Torre J. ChronicWounds [Internet]. Medscape. 2021 [cited 2024 Jan 12]. Available from: https://emedicine.medscape.com/article/1298452-overview#a4
3. Shreya K, Gupta P, Asati DP, Verma P. Eponyms in dermatology linked to Gottron. Indian J Dermatol Venereol Leprol. 2023;89:620-1. doi: https://doi.org/10.25259/IJDVL_309_2022
4. Slesarenko SV, Nor NM, Tsigankov KV. [Surgi­cal treatment of gottron’s carcinoide papillomatosis of the skin. Case study]. Surgery of Ukraine. 2018;2:82-5. Ukrainian. doi: https://doi.org/10.30978/SU2018282
5. Fernandez-Flores A, Cassarino DS. Gottron papu­les show histopathologic features of localized lymphe­dema. The American Journal of Dermatopathology. 2017;39:518-23. doi: https://doi.org/10.1097/DAD.0000000000000701
6. Lytynska TО, Demchenko OV. [Gottron’s carci­noid papillomatosis of skin (features of clinical course, diagnosis and treatment, own clinical observation)]. Ukrai­nian journal of dermatology, venereology, cosmetology. 2021;1(80):5-20. Ukrainian. doi: https://doi.org/10.30978/UJDVK2021-1-15
7. Schoenberg E, Ho B, Ma L, Sander I. AB011. A Gottron’s papule mimicker: an unusual presentation of porokeratosis plantaris Palmaris et disseminata. Ann Transl Med. 2021;9(5):AB011. doi: https://doi.org/10.21037/atm.2021.AB011
8. Kosulnikov SO, Biesiedin OM, Kisilevsky DO, Sokolov OV, Tarnapolsky SO, Kravcheno KV. [Treatment experience of chronic leg ulcers of different genesis]. 2022;2:46-53. Ukrainian. doi: https://doi.org/10.11603/2414-4533.2022.2.13046
9. Wang W-Y, Cheng S-T. Sleeve Signand Inverse Gottron’s Papulesin Anti-MDA5 Dermatomyositis. New England Journal of 2023;389(11):1032. doi: https://doi.org/10.1056/NEJMicm2301354
10. Anjani G, Govindarajan S, Sudhakar M, Chaud­hary H, Rawat A, Jindal AK. Catch the thief by its marks: inverse Gottron papules, interstitiallung disease, anti MDA-5 antibody positivity in juvenile dermatomyositis. Rheumatology. 2021 Feb;60(2):e56-e58. doi: https://doi.org/10.1093/rheumatology/keaa433

Look through:

Biesiedin O.M. Municipalnon-profitenterprise «City Clinical Hospital No. 4» Dnipro City Council, Dnipro, Ukraine, e-mail: bam-86@ukr.net
https://orcid.org/0000-0002-3349-9747

Shkuropat V.M. Municipalnon-profitenterprise «City Clinical Hospital No. 4» Dnipro City Council, Dnipro, Ukraine
https://orcid.org/0009-0005-9142-6561

Tsygankov K.V. Municipalnon-profitenterprise «City Clinical Hospital No. 4» Dnipro City Council, Dnipro, Ukraine
https://orcid.org/0000-0002-1536-4021

Hrytsenko P.O. Dnipro State Medical University, Dnipro, Ukraine,  e-mail: po.hrytsenko@gmail.com
https://orcid.org/0000-0002-9965-8608

Biletska S.V. Medical Center ”Unimed”, Krakow, Poland, e-mail: biletskasv@gmail.com
https://orcid.org/0000-0002-4031-9310

Biesiedin O.M., Shkuropat V.M., Tsygankov K.V., Hrytsenko P.O., Biletska S.V. Gottron's carcinoid papillomatosis of the skin (сlinical case). Medicni perspektivi. 2024;29(2):254-259.
DOI: https://doi.org/10.26641/2307-0404.2024.2.307783