Enzymes of the folate cycle participate in the process of remethylation of homocysteine (HC) to methionine, where folates are coenzymes for methyl transfer. The aim of the work was to identify the interrelationships of gene polymorphisms of associations between folate cycle enzyme gene polymorphisms and cardiometabolic risk factors such as increased serum homocysteine levels and folic acid deficiency in patients in the post-covid period. In 51 patients who suffered from COVID-19, a general clinical and laboratory examination, and assessment of serum homocysteine and folic acid concentrations by immunoenzymatic method was carried out. Polymorphisms of the genes: methylenetetrahydrofolate reductase (677C>T and 1298A>C), methionine synthase-reductase (66A>G) and methionine synthase (2756A>G) were determined by real time polymerase chain reaction. For each of the named polymorphisms, the examined patients were divided into 3 groups according to the nucleotide alleles in the corresponding position: 1) homozygous dominant, 2) heterozygous and 3) homozygous recessive. For the methylenetetrahydro­folatereductase gene at position 677, serum levels of homocysteine and folate did not differ between the groups 1 and 2 with genotypes 677 C/C (n=26) and 677C/T (n=21), (p>0.05); in group 3, the recessive genotype 677 T/T was found in only 4 people (8%), that did not allow comparison of indices. The distribution of patients into 3 groups according to the genotype of the same gene at position 1298 revealed that the recessive 1298 C/C mutation in group 3 (n=9) associated with an increased homocysteine level (19.56±1.89 μmol/l), versus 10.68±0.76 (p=0.012) and 11.63±1.25 μmol/l (p=0.013) in groups 1 and 2, with no difference in folate levels between groups. Group 3 differed by a higher degree of obesity, a higher frequency of hypertension disease and chronic heart failure (in 85% of patients in group 3, against 41 and 50% in groups 1 and 2), a higher number of platelets, a longer duration of hospitalization due to COVID-19, a higher level of D-dimer. The study of groups of patients, divided depending on the genotype of methioninesynthase reductase at position 66, showed that carriers of the recessive homozygous 66 G/G mutation (group 3, n=15) had increased serum homocysteine level (16.56±1.64 μmol/l) in comparison with individuals of group 1 (n=17) 66 A/A (10.28±1.17 μmol/l; p=0.004) and group 2 (n=19) 66 A/G (11.32±1.17 μmol/l, p=0.013). In group 3, a longer duration of hospitalization due to COVID-19 was noted (17.15±1.65 vs. 11.88±0.97 days, p=0.008), higher frequency of hypertension (67% vs. 35%) and heart failure (67% against 29%) compared to group 1. The use of a molecular genetic approach made it possible to establish that the presence of recessive mutations of the folate cycle genes is associated with a potential predisposition to hyperhomocysteinemia, thrombophilia, severe forms of cardiometabolic complications and coronavirus disease.

Key words: enzymes of the folate cycle, polymorphisms, recessive homozygous mutations, homocysteine, folic acid, cardiometabolic risk, coronavirus disease

1. Perła-Kaján J, Jakubowski H. COVID-19 and One-Carbon Metabolism. Int J MolSci. 2022 Apr;23(8):4181. doi: https://doi.org/10.3390/ijms23084181
2. Liu F, Chen J, Li Z, Meng X. Recent advances in epigenetics of age-related kidney diseases. Genes. 2022;13(5):796. doi: https://doi.org/10.3390/genes13050796
3. Kern B, Podkrajšek K, Kovač J, Šket R, Bizjan B, Tesovnik T, et al. The Role of epigenetic modifications in late complications in type 1 diabetes. Genes (Basel). 2022 Apr;13(4):705. doi: https://doi.org/10.3390/genes13040705
4. Andreichyn M, Nychyk N, Zavidniuk N, Yosyk Ya, Ishchuk I, Ivakhiv O. [COVID-19: epidemiology, clinic, diagnosis, treatment and prevention]. Infektsiini khvoroby. 2020;2(100):41-55. doi: https://doi.org/10.11603/1681-2727.2020.2.11285
5. Sun J, Jiang X, Zhao M, Ma L, Pei H, Liu N, et al. Association of Methylenetetrahydrofolate Reductase C677T Gene Polymorphisms with Mild Cognitive Impair­ment Susceptibility: A Systematic Review and Meta-Ana­lysis. Behav 2021;2021:2962792. doi: https://doi.org/10.1155/2021/2962792 
6. Raina JK, Panjaliya RK, Dogra V, Sharma S, Anupriya KP. Association of МТГФР and MS/MTR gene polymorphisms with congenital heart defects in North Indian population (Jammu and Kashmir): a case-control study encompassing meta-analysis and trial sequential analysis. BMC 2022 Apr 25;22(1):223. doi: https://doi.org/10.1186/s12887-022-03227-z
7. Ren ZJ, Zhang YP, Ren PW, Yang B, Deng S, Peng ZF, et al. Contribution of MTR A2756G poly­morphism and MTRR A66G polymorphism to the risk of idiopathic male infertility. Medicine (Baltimore). 2019 Dec;98(51):e18273. doi: https://doi.org/10.1097/MD.0000000000018273
8. Santilli F, Davì G, Patrono C. Homocysteine, me­thylenetetrahydrofolatereductase, folate status and athero­thrombosis: A mechanistic and clinical perspective. Vascul Pharmacol.2016 Mar;78:1-9. doi: https://doi.org/10.1016/j.vph.2015.06.009 
9. Ponti G, Pastorino L, Manfredini M, Ozben T, Oliva G, Kaleci S, et al. COVID‐19 spreading across world correlates with C677T allele of the methylenetetra­hydrofolate reductase gene prevalence. J Clin Lab Anal. 2021;35(7):e23798. doi: https://doi.org/10.1002/jcla.23798
10. Gogu AE, Jianu DC, Dumitrascu V, Ples H, Stroe AZ, et al. MTHFR Gene Polymorphisms and Car­diovascular Risk Factors, Clinical-Imagistic Features and Outcome in Cerebral Venous Sinus Thrombosis. Brain Sci. 2020;11(1):23. doi: https://doi.org/10.3390/brainsci11010023
11. Kovács E, Bereczky Z, Kerényi A, Laczik R, Na­gy V, Kovács DÁ, et al. Clinical /Investigation of Here­ditary and Acquired Thrombophilic Factors in Patients with Venous and Arterial Thromboembolism. Int J Gen Med. 2023 Nov 22;16:5425-37. doi: https://doi.org/10.2147/IJGM.S412551
12. Ponti G, Ruini C, Tomasi A. Homocysteine as a potential predictor of cardiovascular risk in patients with COVID‐19. Med  2020;143:109859.  doi: https://doi.org/10.1016/j.mehy.2020.109859
13. Si T, Zhang W, Fu X, Wang Y, Liu D, Wu Q. Reference intervals of homocysteine in apparently healthy Chinese Han ethnic adults. J Lab Med 2022;46(2):125-32. doi: https://doi.org/10.1515/labmed-2021-0135
14. Keskin O, Seremet Keskin A, Nilgün Seremet. Association between low serum folic acid and vitamin B12 levels with COVID-19 prognosis. Progr Nutr [Internet]. 2022 Sep. 27 [cited 2024 Mar 4];24(3):e2022104.
15. Abildgaard A, et al. Reference intervals for plas­ma vitamin B12 and plasma/serum methylmalonic acid in Danish children, adults and elderly. Clinica chimica acta; international journal of clinical chemistry. 2022;525:62-8. doi: https://doi.org/10.1016/j.cca.2021.12.015
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17. Golovanova IA, Belikova IV, Lyakhova NO. [Fun­damentals of medical statistics. Study guide for graduate stu­dents and clinical residents]. Poltava; 2017. 113 p. Ukrainian.

Look through:

Shuprovych A.A.  SI “V.P. Komissarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Science”, Kyiv, Ukraine, e-mail: angelaanat7070@gmail.com
https://orcid.org /0000-0002-7437-0309

Zinych O.V. SI “V.P. Komissarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Science”, Kyiv, Ukraine
https://orcid.org/0000-0002-0516-0148

Kushnareva N.M. SI “V.P. Komissarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Science”, Kyiv, Ukraine
https://orcid.org/0000-0002-5390-6784

Komisarenko K.P. "Adonis-Lab" medical center, "Top Clinic Denys" medical center, Kyiv, Ukraine
https://orcid.org/0000-0002-6318-755X

Shuprovych A.A., Zinych O.V., Kushnareva N.M., Komisarenko K.P. Study of the relationships of polymorphisms of the folate cycle genes with the levels of homocysteine and folic acid as risk factors of cardiovascular disorders in the post-covid period. Medicni perspektivi. 2024;29(3):4-11.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313071

Influence of substituted quinones on the excretory function of the rat kidney and evaluation of the prospects of their use as potential diuretics

Acute heat injury (AHI) is a serious condition caused by an excessive increase in body temperature, usually due to prolonged exposure to high environmental temperatures or intense physical activity in the heat. Without timely treatment, heat stroke can lead to severe damage to the central nervous system with cerebral edema, profound disturbances in the water-salt balance and internal organs, coma and death. Since the effectiveness of drugs for the treatment of thermal injuries has not been proven, the search for new thermoprotective agents with different mechanisms of action, in particular inhibitors of the arachidonic acid cascade, is urgent. In a preliminary screening study on the AHI model in rats, it was found that among cyclooxygenase (COX) inhibitors, the highly selective COX-2 inhibitor celecoxib and the analgesic-antipyretic para­cetamol are the most effective in preventing hyperthermia and improving the course of the recovery period. The purpose of this study was to determine the impact of the specified screening leaders on the functional state of the central nervous system, pain sensitivity and physical endurance in the recovery period of heat injury. The AHI model was reproduced on adult white male rats according to the previously proposed and validated method by means of a 30-minute exposure at +55°C. Animals were divided into 4 groups with 8 rats in each group: intact control, control pathology, paracetamol group and celecoxib group. Based on the results of the study, it was established that celecoxib exhibits a pronounced thermoprotective effect, probably improves the state of the central nervous system in terms of behavioral reactions and physical endurance of animals in the recovery period after acute heat injury. At the same time, paracetamol after acute heat injury does not have a distinct positive effect on the functional state of the central nervous system, moderately improves the physical endurance of rats and is inferior to celecoxib in all the studied parameters. These results open new opportunities for the development of approaches to the treatment of AHI and confirm the different effectiveness of the use of celecoxib and paracetamol in thermal injuries.

Key words: acute heat injury, cyclooxygenase inhibitors, celecoxib, paracetamol, central nervous system, pain sensitivity, physical endurance

1. Garcia CK, Renteria LI, Leite-Santos G, Leon LR, Laitano O. Exertional heat stroke: pathophysiology and risk factors. BMJ 2022 Oct 11;1(1):e000239. doi: https://doi.org/10.1136/bmjmed-2022-000239 
2. Stillman JH. Heat Waves, the New Normal: Sum­mertime Temperature Extremes Will Impact Animals, Ecosystems, and Human Communities. Physiology (Bethesda).2019 Mar 1;34(2):86-100. doi: https://doi.org/10.1152/physiol.00040.2018 
3. Périard JD, DeGroot D, Jay O. Exertional heat stroke in sport and the military: epidemiology and mitigation. Exp Physiol. 2022 Oct;107(10):1111-21. doi: https://doi.org/10.1113/EP090686
4. Kiatkitroj K, Arphorn S, Tangtong C, Maruo SJ, Ishimaru T. Risk factors associated with heat-related illness among sugarcane farmers in Thailand. Ind Health. 2022 Oct 1;60(5):447-58. doi: https://doi.org/10.2486/indhealth.2021-0161
5. How V, Singh S, Dang T, Fang Lee L, Guo HR. The effects of heat exposure on tropical farm workers in Malaysia: six-month physiological health monitoring. Int J Environ Health Res. 2023 Apr;33(4):413-29. doi: https://doi.org/10.1080/09603123.2022.2033706
6. Alari A, Letellier N, Benmarhnia T. Effect of dif­fe­rent heat wave timing on cardiovascular and respiratory mortality in France. Sci Total Environ. 2023 Sep 20;892:164543. doi: https://doi.org/10.1016/j.scitotenv.2023.164543
7. Bauman J, Spano S, Storkan M. Heat-Related Ill­nesses. Emerg Med Clin North Am. 2024 Aug;42(3):485-92. doi: https://doi.org/10.1016/j.emc.2024.02.010
8. Knapik JJ, Epstein Y. Exertional Heat Stroke: Pa­thophysiology, Epidemiology, Diagnosis, Treatment, and Prevention. J Spec Oper Med. 2019 Summer;19(2):108-16. doi: https://doi.org/10.55460/5P2Q-1MBQ
9. Sorensen C, Hess J. Treatment and Prevention of Heat-Related Illness. N Engl J Med. 2022;387(15):1404-13. doi: https://doi.org/10.1056/NEJMcp2210623
10. Chuykova P, Shtrygol’ S, Taran A, Yudkevych T, Lebedinets I, Oklei D. Acute heat trauma model in rats, gender-dependent thermoresistance, and screening of potential thermoprotectors. ScienceRise: Pharmaceutical Science. 2024 Apr;2(48):4-11. doi: https://doi.org/10.15587/2519-4852.2024.301620
11. Hock FJ, editor. Drug Discovery and Evaluation: Pharmacological Assays. B.: Springer Berlin Heidelberg; 2014. 2071 р.
12. Koval A, Shtrygol' S. 1-(5-Aetyl-3-methyl-6-phe­nyl-5h-[1,2,4]triazolo [3,4-b][1,3,4]thiadiazin-7-yl)-etha­none: dose-dependence of analgesic effect, lack of opioidergic mechanism of action, effect on behavioral reactionsand acute toxicity. Acta Medica Leopoliensia. 2023;29(3-4):192-203. doi: https://doi.org/10.25040/aml2023.3-4.192
13. Bonm AV, Elezgarai I, Gremel CM, Viray K, Bamford NS, Palmiter RD, et al. Control of exploration, motor coordination and amphetamine sensitization by cannabinoid CB1 receptors expressed in medium spiny neurons. Eur J Neurosci. 2021 Aug;54(3):4934-52. doi: https://doi.org/10.1111/ejn.15381
14. Karna SR, Kongara K, Singh PM, Chambers P, Lopez-Villalobos N. Evaluation of analgesic interaction between morphine, dexmedetomidine and maropitant using hot-plate and tail-flick tests in rats. Vet Anaesth Analg. 2019 Jul;46(4):476-82. doi: https://doi.org/10.1016/j.vaa.2018.12.009
15. Armario A. The forced swim test: Historical, conceptual and methodological considerations and its relationship with individual behavioral traits. Neurosci Biobehav Rev. 2021 Sep;128:74-86. doi: https://doi.org/10.1016/j.neubiorev.2021.06.014
16. Habibzadeh F. Data Distribution: Normal or Abnormal? Journal of Korean medical science. 2024 Jan 22;39(3):e35. doi: https://doi.org/10.3346/jkms.2024.39.e35
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21. Cruz JV, Rosa JMC, Kimani NM, Giuliatti S, Dos Santos CBR. The Role of Celecoxib as a Potential Inhibitor in the Treatment of Inflammatory Diseases – A Review. Curr Med Chem. 2022;29(17):3028-49. doi: https://doi.org/10.2174/0929867328666210910125229
22. Przybyła GW, Szychowski KA, Gmiński J. Para­cetamol – An old drug with new mechanisms of action. Clin Exp Pharmacol Physiol. 2021 Jan;48(1):3-19. doi: https://doi.org/10.1111/1440-1681.13392

Look through:

Chuikova P.O. National University of Pharmacy, Kharkiv, Ukraine
  https://orcid.org/0000-0002-9622-1566

Shtrygol’ S.Yu. National University of Pharmacy, Kharkiv, Ukraine, e-mail: shtrygol@ukr.net
https://orcid.org/0000-0001-7257-9048

Chuikova P.O., Shtrygol’ S.Yu. Effect of celecoxib and paracetamol on the functional state of the central nervous system, pain sensitivity, and physical endurance of rats with acute heat injury. Medicni perspektivi. 2024;29(3):11-19.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313072

Analyses of electromagnetic effects as colors of the vision analyzer

Plantar fasciitis (PF) is one of the most common causes of pain in the heel area, which is associated with the presence of inflammation in the plantar fascia and is most often localized in the medial part of the heel area. Extracorporeal shock wave therapy (ESWT) is a method of hardware treatment that has been used in orthopedics and traumatology for the past decades. One of the main diseases successfully treated with this method is plantar fasciitis. The aim of the work was to determine the effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis compared to other methods of conservative treatment based on the literature review. Research literary sources from scientific electronic databases PubMed, Medline and other sources of scientific and medical information were analyzed. A literature search was performed using search queries specifying the method under study and plantar fasciitis, namely: «Extracorporeal Shockwave Therapy», «Plantar Fasciitis», «Conservative Treatment», «Physiotherapy». During the search, 473 scien­tific articles devoted to the treatment of plantar fasciitis were selected. Given the large number of articles and the desire to present up-to-date data, the query was limited to the last 9 years (from 2015 to 2023) and 417 articles were selected. Articles devoted to other methods of treatment of PF (conservative and surgical) and articles devoted to the use of ESWT in orthopedic and traumatological diseases of other localizations were excluded from the search results. At the second stage of the search, articles devoted exclusively to the treatment of PF by the ESWT method were excluded, and sources comparing the effectiveness of ESWT treatment with other methods of conservative treatment were selected (31 articles). The main results – it was determined that extracorporeal shock wave therapy continues to remain one of the main methods of conservative treatment of PF, which has been used for the last decades. It has proven its high efficiency and safety in the treatment of PF. Compared with other methods of conservative treatment of PF, extracorporeal shock wave therapy remains one of the most effective, it is successfully used in the treatment of PF.

Key words: plantar fasciitis, extracorporeal shock wave therapy, comparison, conservative treatment, physiotherapy

1. Tseng WC, Chen YC, Lee TM, Chen WS. Plantar Fasciitis: An Updated Review. J Med Ultrasound. 2023;6;31(4):268-74. doi: https://doi.org/10.4103/jmu.jmu_2_23
2. Auersperg V, Trieb K. Extracorporeal shock wave therapy: an update. EFORT Open Rev. 2020;26;5(10):584-92. doi: https://doi.org/10.1302/2058-5241.5.190067
3. Charles R, Fang L, Zhu R, Wang J. The effecti­veness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis. Front Immunol. 2023;14:1193835. doi: https://doi.org/10.3389/fimmu.2023.1193835 
4. Melese H, Alamer A, Getie K, Nigussie F, Ayhualem S. Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials. Disabil Rehabil. 2022;44(18):5007-14. doi: https://doi.org/10.1080/09638288.2021.1928775 
5. Tognolo L, Giordani F, Biz C, Bernini A, Rug­gieri P, Stecco C, et al. Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial. Eur J Phys Rehabil Med. 2022;58(1):85-93. doi: https://doi.org/10.23736/s1973-9087.21.06814-3
6. Kapusta J, Domżalski M. Long Term Effec­ti­veness of ESWT in Plantar Fasciitis in Amateur Runners. J Clin Med. 2022;24;11(23):6926. doi: https://doi.org/10.3390/jcm11236926
7. Giordani F, Bernini A, Müller-Ehrenberg H, Stec­co C, Masiero S. A global approach for plantar fasciitis with extracorporeal shockwaves treatment. Eur J Transl Myol. 2019;29(3):8372. doi: https://doi.org/10.4081/ejtm.2019.8372
8. Nazim BT, Seow D, Vig KS. Extracorporeal Sho­ckwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis. J Am Podiatr Med Assoc. 2022;112(3):118-91. doi: https://doi.org/10.7547/18-191
9. De la Corte-Rodríguez H, Román-Belmonte JM, Rodríguez-Damiani BA, Vázquez-Sasot A, Rodríguez-Mer­chán EC. Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review. Healthcare (Basel). 2023;26;11(21):2830. doi: https://doi.org/10.3390/healthcare11212830
10. Li T, Lv H, Lin T. Comparison of efficacy of eight treatments for plantar fasciitis: A network meta-analysis. J Cell Physiol. 2018;234(1):860-70. doi: https://doi.org/10.1002/jcp.26907
11. Akınoğlu B, Köse N. A comparison of the acute effects of radial extracorporeal shockwave therapy, ultra­sound therapy, and exercise therapy in plantar fasciitis. J Exerc Rehabil. 2018;14(2):306-12. doi: https://doi.org/10.12965/jer.1836048.024
12. Sun K, Zhou H, Jiang W. Extracorporeal shock wave therapy versus other therapeutic methods for chro­nic plantar fasciitis. Foot Ankle Surg. 2020;26(1):33-8. doi: https://doi.org/10.1016/j.fas.2018.11.002
13. Erden T, Toker B, Cengiz O, Ince B, Asci S, Top­rak A. Outcome of Corticosteroid Injections, Extra­corporeal Shock Wave Therapy, and Radiofrequency Thermal Lesioning for Chronic Plantar Fasciitis. Foot Ankle Int. 2021;42(1):69-75. doi: https://doi.org/10.1177/1071100720949469
14. Yapici F, Gur V, Sari IF, Karakose R, Tardus I, Ucpunar HJ. which treatment method is better in the treatment of chronic plantar fasciitis: corticosteroid injection, extracorporeal shock wave therapy, or radio­frequency thermal lesioning? Am Podiatr Med Assoc. 2023;113(5):21-049. doi: https://doi.org/10.7547/21-049
15. Yinilmez Sanmak ÖD, Geler Külcü D, Mesci N, Altunok EÇ. Comparison of effects of low-level laser the­rapy and extracorporeal shock wave therapy in plan­tar fasciitis treatment: A randomized, prospective, single-blind clinical study. Turk J Phys Med Rehabil. 2018;65(2):184-90. doi: https://doi.org/10.5606/tftrd.2019.3528
16. Akinoglu B, Köse N, Kirdi N, Yakut Y. Compa­rison of the Acute Effect of Radial Shock Wave Therapy and Ultrasound Therapy in the Treatment of Plan­tar Fasciitis: A Randomized Controlled Study. Pain Med. 2017;18(12):2443-52. doi: https://doi.org/10.1093/pm/pnx113
17. Koz G, Kamanli A, Kaban N, Harman H. Effica­cies of extracorporeal shockwave therapy and low-level laser therapy in patients with plantar fasciitis. Foot Ankle Surg. 2023;29(3):223-7. doi: https://doi.org/10.1016/j.fas.2023.01.009
18. Timurtaş E, Çinar E, Selçuk Н, Avci EE, Batar S, Demirbüken İ, et al. Polat MG. Extracorporeal shock wave therapy versus low level laser therapy in the treatment of plantar fasciitis: a randomized controlled trial. J Am Podiatr Med Assoc. 2022;20:1-27. doi: https://doi.org/10.7547/22-095
19. Al-Siyabi Z, Karam M, Al-Hajri E, Alsaif A, Ala­zemi M, Aldubaikhi AA. extracorporeal shockwave thera­py versus ultrasound therapy for plantar fasciitis: a syste­matic review and meta-analysis. 2022;14(1):e20871. doi: https://doi.org/10.7759/cureus.20871
20. Li S, Wang K, Sun H, Luo X, Wang P, Fang S, et al. Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(50):e13687. doi: https://doi.org/10.1097/MD.0000000000013687
21. Xu D, Jiang W, Huang D, Hu X, Wang Y, Li H, et al. Comparison Between Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection for Plantar Fasciitis. Foot Ankle Int. 2020;41(2):200-5. doi: https://doi.org/10.1177/1071100719891111
22. Mishra BN, Poudel RR, Banskota B, Shrestha BK, Banskota AK. Effectiveness of extra-corporeal shock wave therapy (ESWT) vs methylprednisolone injections in plantar fasciitis. J Clin Orthop Trauma. 2019;10(2):401-5. doi: https://doi.org/10.1016/j.jcot.2018.02.011
23. Eslamian F, Shakouri SK, Jahanjoo F, Hajiali­loo M, Notghi F. Extra corporeal shock wave therapy versus local corticosteroid injection in the treatment of chronic plantar fasciitis, a single blinded randomized clinical trial. Pain Med. 2016;17(9):1722-31. doi: https://doi.org/10.1093/pm/pnw113
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Ovchynnikov O.M. Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine, e-mail: mydisser83@gmail.com
https://orcid.org/0009-0006-4486-5163

Bludova M.O. Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
https://orcid.org/0009-0003-9977-3854

Merkulova T.V. Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine; Kharkiv National Medical University, Kharkiv, Ukraine, e-mail: tv.merkulova@knmu.edu.ua
https://orcid.org/0000-0003-2362-9226

Ovchynnikov O.M., Bludova M.O., Merkulova T.V. Effectiveness of extracorporeal shock wave therapy in comparison with other methods of treatment of patients with plantar fasciitis: literature review. Medicni perspektivi. 2024;29(3):20-26. 
DOI: https://doi.org/10.26641/2307-0404.2024.3.313479

Characteristics of base materials and acrylates used in removable prosthetics in dental practice (review)

Alveolar tissue diseases cause the appearance of dentition defects, thereby reducing the patients' work capacity and quality of life. The purpose of this research was to investigate, modern views on the etiology of periodontitis and the role of microbial persistence in the development of inflammatory processes of periodontal complex basing on a review of literary sources. Literature review was conducted using PubMed, Web of Science, Scopus, Google Scholar from 2018 to March 2024. There were no restrictions on the date of publication or the language of scientific sources. Searches were conducted according to MeSH (Medical Subject Headings) with using the following search terms: "periodontitis", "oral mucosa", "gums", "dental plaque", "periodontium", "traumatic occlusion", "microorganisms". In total, during the initial analysis 82 literary sources were selected and processed, after further systematization of the selected information using general scientific methods, 70 of them remained. Used methods: bibliographic and analytical. Generalized perio­dontitis is a chronic inflammatory-dystrophic process that occurs as a result of various factors. In the pathogenesis of this disease, the key role is played by the inflammatory process, which is a complex interaction of microcirculatory, he­matological and connective tissue reactions to the lesion. Local (exogenic) and general (endogenic) causative factors are distinguished. The main factors that cause pathological changes in periodontium are bacterial biofilm, traumatic occlusion and various anatomical anomalies. Dental plaque occupies a special and main place among the causes of periodontitis. At present, leading pathogenetic links in the development of the inflammation in the periodontium, in par­ticular, the disruption of free radical oxidation, the processes of peroxide oxidation of lipids and proteins, the disorder of the functional state of the antioxidant system, the formation of oxidative stress, as well as the humoral link of adaptive immune protection and cytokinesis, have not been sufficiently studied. There is no doubt about the role of the microbial factor in the etiology of periodontal diseases, but the penetration of microbes into the periodontium does not always lead to the development of the disease, because the organism has a number of protective mechanisms that counteract the development of inflammation.

Key words: periodontitis, oral mucosa, gums, dental plaque, periodontium, traumatic occlusion, microorganisms

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Marfiian O.V.  I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0009-0007-7782-8278

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

Yaremchuk O.Z. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0001-5951-1137

Marfiian O.V., Demkovych A.Ye., Bondarenko Yu.I., Yaremchuk O.Z. Modern views on the etiology and role of microbial persistence in the development of inflammatory processes in the periodontal complex (review). Medicni perspektivi. 2024;29(3):27-35.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313482

Comparative assessment of difficulty scales for removal of the third molar of the lower jaw depending on its position

Unprofessional behaviour in the workplace, such as bullying, harassment, and discrimination, remains common in the cardiothoracic surgery unit. Despite its prevalence, there is little consensus on what constitutes unprofessional behaviour in the workplace of a cardiothoracic surgeon. In this review, we aim to narrow down the definition of unprofessional behaviour among cardiothoracic surgeons, identify its prevalence and the factors contributing to it, as well as explore potential preventive and support measures. We searched the MEDLINE and Web of Science databases (2000-2022), focusing on publications within psychology, medicine, general surgery, and cardiothoracic surgery for inclusion in a focused review. The current review identified 89 papers that highlight the complexity of defining unprofessional behaviour and its prevalence in cardiothoracic surgery units. Psychosocial professional challenges, hierarchical relationships within the medical team, and a high-stress environment may prompt unprofessional behaviour, which can manifest in both overt and covert actions. Such behaviour negatively impacts medical services for patients, the psycho-emotional state of employees, and the overall functioning of the medical institution. The most effective support measures are characterized by being proactive, anticipating potential problems before they occur. Unprofessional behaviour should be considered an organizational concern, not merely an issue between individual team members. This perspective is essential for fostering a healthy work environment. The leaders of cardiothoracic surgery, given their high status and authority, play a pivotal role in this regard; their focus on inclusiveness of employees with lower status or responsibility is crucial for promoting a culture of psychosocial safety. This culture should be characterized by trust, honesty, and mutual respect, ensuring that every team member feels valued and respected. By prioritizing these values, leaders can minimize the risk of unprofessional behaviour, ultimately leading to an improvement in the quality of medical services for patients, an improvement in the psycho-emotional state of employees and the functioning of the organization as a whole.

Key words: bullying, discrimination, harassment, cardiothoracic surgery

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Look through:

Sydorenko A.Yu. Aarhus University, Aarhus C, Denmark; Bogomolets National Medical University, Kyiv, Ukraine, e-mail: sydorenko_anast@ukr.net
https://orcid.org/0000-0002-1650-126X

Spindler H. Aarhus University, Aarhus C, Denmark
https://orcid.org/0000-0002-7098-5699

Sydorenko A.Yu., Spindler H. Promoting a culture of respect in cardiothoracic surgery: navigating challenges in understanding unethical behaviour. Medicni perspektivi. 2024;29(3):36-47. 
DOI: https://doi.org/10.26641/2307-0404.2024.3.313484

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

The aim of the work was to evaluate the pharmacological effects and therapeutic potential of individual compounds and extracts of B. monnieri based on the analysis of data from scientific periodicals regarding chemical composition and biological action. Theoretically significant were the studies of the materials of the scientific-metric database PubMed and Google Scholar over the last five years regarding the chemical composition and biological action of extracts based on B. monnieri and their individual components. The search query was carried out by the Latin name of the plant, with the exception of publications related to botanical research. In separate PubChem searches, names of individual phytocompounds were used to establish structure and distribution in plants. The SuperPred web server was used to predict therapeutic potential. The authors analyzed the chemical composition of the extracts, presented the structural and pharmacological characteristics of bacosides and their aglycones: bacosin and juubogenin, cucurbitacin E, loliolide, betulinic and asiatic acids and the flavonoid oroxindin. The mechanism of action of bacoside on β-amyloid is characterized and illustrated. Using machine learning, the prospects for using the main compounds of bacopa to create drugs were calculated taking into account the ATC classification, their biological effects and alternative plant sources were given. Experimental animal studies of whole aqueous or ethanolic extracts of B. monnieri have been found to support a cognitive enhancement effect. The extract was not toxic to humans. Numerous clinical trials show the effectiveness of the use of extracts in the treatment of anhedonia, depression, Alzheimer's disease, Parkinson's disease, dementia and hyperactivity. An analysis of clinical studies in Ukraine shows that drugs based on B. monnieri can be used in the complex treatment of cognitive impairment associated with dyscirculatory encephalopathy in adults and perinatal CNS damage in children. Considering the amphiphilicity of bacosides and the non-toxicity of extracts, they can be involved in the development of various dosage forms with a wide range of therapeutic applications. Further study of the pharmacological action of B. monnieri and the development of drug technology for solid and liquid dosage forms based on it are promising.

Key words: Bacopa monnieri, phytocompounds, bacosides, nootropic properties, cognitive disorders

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Look through:

Nikitina O.O. Kyiv National University of Technologies and Design, Kyiv, Ukraine, e-mail: nikitinap1046@gmail.com
https://orcid.org/0000-0001-6994-4294

Tsyba D.S. Kyiv National University of Technologies and Design, Kyiv, Ukraine, e-mail: tsyba2002@gmail.com
https://orcid.org/0009-0001-9881-5990

Nikitina O.O., Tsyba D.S. Therapeutic potential of phytocompounds of Bacopa monnieri (L.) Wettst (literature review). Medicni perspektivi. 2024;29(3):48-58.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313488

Deletion of cyclin dependent kinase inhibitor 2a gene as a marker of oropharyngeal carcinomas non-associated with human papillomavirus and its prognostic value

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demo­graphic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs.

Key words: arterial fibrillation, coronavirus disease, arterial hypertension, systemic nflammation, thrombosis, bleeding, heart failure

1. Gunawardene MA, Willems S. Atrial fibrillation progression and the importance of early treatment for improving clinical outcomes. Europace. 2022;24(2):1122-8. doi: http://doi.org/10.1093/europace/euab257
2. Donniacuo M, De Angelis A, Rafaniello C, Cian­flone E, Paolisso P, Torella D, et al. COVID-19 and atrial fibrillation: Intercepting lines. Front Cardiovasc Med. 2023;10(1):1-8. doi: http://doi.org/10.3389/fcvm.2023.1093053
3. Gupta A, Madhavan M, Sehgal K, Nair N, Ma­hajan S, Sehrawat T, et al. Extrapulmonary manifestations of COVID-19. 2020;26(7):1017-32. doi: http://doi.org/10.1038/s41591-020-0968-3
4. Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, et. al. Attributes and predictors of long COVID. 2021;27(4):626-31. doi: http://doi.org/10.1038/s41591-021-01292-y
5. Barron E, Bakhai C, Kar P. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol. 2020;8(1):813-22. doi: http://doi.org/10.1016/S2213-8587(20)30272-2
6. Sychov OS, Stasyshena OV. [The influence of a transferred infection of COVID-19 on the development of atrial fibrillation and changes in its course depending on clinical and anamnestic data]. Ukrainskyi kardiolohichnyi zhurnal. 2023;30(5-6):31-9. Ukrainian. doi: https://doi.org/10.31928/2664-4479-2023.5-6.3139
7. Mohammad M, Emin M, Bhutta A, Gul EH, Voor­hees E, Afzal MR. Cardiac arrhythmias associated with COVID-19 infection: state of the art review. Expert Rev Cardiovasc Ther. 2021;19(10):881-9. doi: https://doi.org/10.1080/14779072.2021.1997589
8. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retro­spective cohort study. Lancet. 2020;395(10229):1054-62. doi: https://doi.org/10.1016/S0140-6736(20)30566-3
9. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guide­lines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi: https://doi.org/10.1093/eurheartj/ehaa612
10. Ibdah R, Obeidat O, Khader Y, Al-Nusair J, Abu­surrah O, Obeidat A, et al. Validation of CHA2DS2 VASc Score Predictability of Stroke and Systemic Embolization in a Middle Eastern Population with AF: The Jordan Atrial Fibrillation (JoFib) Study. Vasc Health Risk Manag. 2023;19(1):255-64. doi: https://doi.org/10.2147/VHRM.S404575
11. Abowali H, Pacifico A, Erdinc B, Elkholy K, Bur­khanova U, Aroriode T, et al. Assessment of Bleeding Risk in Hospitalized COVID-19 Patients: A Tertiary Hospital Experience during the Pandemic in a Predominant Mino­rity Population—Bleeding Risk Factors in COVID-19 Patients. J Clin Med. 2022;11(1):27-54. doi: https://doi.org/10.3390/jcm11102754
12. Sweatt K, Garvey WT, Martins C. Strengths and Limitations of BMI in the Diagnosis of Obesity: What is the Path Forward? Curr Obes Rep. 2024;13(3):584-95. doi: https://doi.org/10.1007/s13679-024-00580-1
13. McElroy E, Herrett E, Patel K, Piehlmaier DM, Gessa GD, et al. Living alone and mental health: parallel analyses in UK longitudinal population surveys and ele­ctronic health records prior to and during the COVID-19 pandemic. BMJ Ment Health. 2023;26(1):300842. doi: https://doi.org/10.1136/bmjment-2023-300842
14. Huseynov A, Akin I, Duerschmied D, Scharf RE. Cardiac Arrhythmias in Post-COVID Syndrome: Preva­lence, Pathology, Diagnosis, and Treatment. Viruses. 2023;15(2):389. doi: https://doi.org/10.3390/v15020389
15. Yong SJ. Long COVID or post-COVID-19 synd­rome: putativepathophysiology, risk factors, and treat­ments. Infect Dis (Lond). 2021;53(10):737-54. doi: https://doi.org/10.1080/23744235.2021.1924397
16. Thompson EJ, Williams DM, Walker AJ, Mit­chell RE, Niedzwiedz CL, Yang TC, et al. Long COVID burden and risk factors in 10 UK longitudinalstudies and electronichealthrecords. Nat Commun. 2022;13(1):3528. doi: https://doi.org/10.1038/s41467-022-30836-0
17. Al-Aly Z, Xie Y, Bowe B. High-dimensional cha­racterization of post-acute sequelae of COVID-19. Nature. 2021;594(7862):259-64. doi: https://doi.org/10.1038/s41586-021-03553-9

Look through:

Sychov O.S. SI “National Scientific Center “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine, e-mail: os.sychov@gmail.com 
https://orcid.org/0000-0001-8432-7403

Stasyshena O.V. SI “National Scientific Center “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine, e-mail: oksana.stasushena1990@gmail.com
https://orcid.org/0000-0002-2992-4640

Sychov O.S., Stasyshena O.V. Clinical course of atrial fibrillation in patients who experienced coronavirus disease (COVID-19): results of a 6-month follow-up. Medicni perspektivi. 2024;29(3):59-67.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313515

Deletion of cyclin dependent kinase inhibitor 2a gene as a marker of oropharyngeal carcinomas non-associated with human papillomavirus and its prognostic value

Reperfusion therapy in myocardial infarction patients with acute ST-segment elevation significantly reduced the frequency of ventricular tachycardia and ventricular fibrillation, however, such arrhythmias still occur in 6-8% of patients, posing a threat to their lives.The aim of the study was to determine the nature of ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention, and their prognostic value regarding the development of complications during the inpatient treatment phase. The study involved 82 individuals (mean age: 62,4±10,2 years; male: 69,23 (58,6-78,92)%, female: 30,77 (21,08-41,4)%). Within 24 hours after the infarct-related artery stenting, all patients underwent a 24-hour Holter ECG monitoring.  The course of the disease was analyzed based on the presence of risk factors such as hypertension, diabetes mellitus, past COVID-19, and obesity. Ventricular rhythm disturbances were represented mainly by premature contractions. They occurred significantly more frequently in patients with arterial hypertension (883,71 (96,0; 986.0); p=0,02; p=0,03; p=0,02, compared to patients with a history of COVID-19, diabetes, and obesity, respectively) and in those with past COVID-19 (711,3 (125,0; 846,5); p=0,01; p=0,04, compared to indi­viduals with diabetes and obesity, respectively). Isolated premature ventricular complexes, pairs, triplets were recorded, and in individuals with arterial hypertension and past COVID-19 “runs” of ventricular extrasystoles and episodes of nonsustained monomorphic and even polymorphic ventricular tachycardia, such as Torsades de Pointes, (under the condition of combined risk factors) were noted; predominantly in these patients during the hospital phase such сom­plications as ventricular fibrillation and asystole,with sudden cardiac arrest developed. The obtained results is an evidence of electrical myocardial instability and indicate that myocardial infarction patients with acute ST-segment elevation, in addition to myocardial revascularization, require optimization of pharmacological treatment. The use of intravenous beta-blockers as part of complex treatment prevented the occurrence of life-threatening ventricular arrhythmias during the inpatient treatment phase.

Key words: acute myocardial infarction with ST-segment elevation, risk factors, primary percutaneous coronary intervention, daily electrocardiogram monitoring, ventricular arrhythmias, prognostic value

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2. Badiuk NV, Hrebenyk MV. [Cardiac arrhythmias in patients with acute myocardial ischemia, which deve­loped on the background of comorbid hypertension and diabetes]. Bulletin of Medical and Biological Research. 2021;1:5-9. Ukrainian. doi: https://doi.org/10.11603/bmbr.2706-6290.2021.1.11789
3. Makino T, Ichikawa T, Amino M, Nakamura M, Koshikawa M, Motoike Y, et al. Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome-TWIST study. Ann Noninvasive Electrocardiol. 2023;28(6):e13069. doi: https://doi.org/10.1111/anec.13069
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5. Liang JJ, Fender EA, Cha Y-M, Lennon RJ, Pra­sad A, Barsness GW. Long-term outcomes in survivors of early ventricular arrhythmias after acute st-elevation and non–st-elevation myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol. 2016;117(5):709-13. doi: https://doi.org/10.1016/j.amjcard.2015.12.002
6. Masuda M, Nakatani D, Hikoso S, Suna S, Usa­mi M, Matsumoto S. Clinical impact of ventricular tachy­cardia and/or fibrillation during the acute phase of acute myocardial infarction on in-hospital and 5-year mortality rates in the percutaneous coronary intervention era. Circ J. 2016;80(7):1539-47.
   doi: https://doi.org/10.1253/circj.CJ-16-0183
7. Mehta RH, Yu J, Piccini JP, Tcheng JE, Far­kouh ME, Reiffel J. Prognostic significance of postpro­cedural sustained ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention (from the horizons-ami trial). Am J Cardiol. 2012;109(6):805-12. doi: https://doi.org/10.1016/j.amjcard.2011.10.043
8. Khederlou H, Azimi Pirsaraei SV, Rabbani E, Motedayen M. Correlations between cardiovascular risk factors and ventricular arrhythmias following primary percutaneous coronary intervention in patients with st-elevation myocardial infarction. J Tehran Heart Cent. 2023;2(18):122-8. doi: https://doi.org/10.18502/jthc.v18i2.13322
9. Deshmukh T, Kovoor JG, Byth K, Chow CK, Zaman S, Chong JH, et al. Influence of standard modi­fiable risk factors on ventricular tachycardia after myocardial infarction. Front Cardiovasc Med. 2023;24:10. doi: https://doi.org/10.3389/fcvm.2023.1283382
10. Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, et al. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace. 2019;21(10):1603-4. doi: https://doi.org/10.1093/europace/euz163
11. Frampton J, Ortengren AR, Zeitler EP. Аrrhy­thmias after acute myocardial infarction. Yale J Biol Med. 2023;96(1):83-94. doi: https://doi.org/10.59249/LSWK8578
12. Nalliah CJ, Zaman S, Narayan A, Sullivan J, Ko­voor P. Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias. EP 2014;16(7):1053-60. doi: https://doi.org/10.1093/europace/eut307
13. Pandozi C, Mariani MV, Chimenti C, Maest­rini V, Filomena D, Magnocavallo M, et al. The scar: the wind in the perfect storm-insights into the mysterious living tissue originating ventricular arrhythmias. J Interv Card Electrophysiol. 2023;66(1):27-38. doi: https://doi.org/10.1007/s10840-021-01104-w
14. Zhao BH, Ruze A, Zhao L, Li QL, Tang J, Xiefu­kaiti N, et al. The role and mechanisms of microvascular damage in the ischemic myocardium. Cell Mol Life Sci. 2023;80(11):341.
    doi: https://doi.org/10.1007/s00018-023-04998-z
15. Faxén J, Xu H, Evans M, Jernberg T, Szummer K, Carrero JJ. Potassium levels and risk of in-hospital arrhythmias and mortality in patients admitted with suspected acute coronary syndrome. Int J Cardiol. 2019;1(274):52-8. doi: https://doi.org/10.1016/j.ijcard.2018.09.099
16. Podolecki TS, Lenarczyk RK, Kowalczyk JP, Jed­rzejczyk-Patej EK, Chodor PK, Mazurek MH, et al. Risk stratification for complex ventricular arrhythmia compli­cating ST-segment elevation myocardial infarction. Coron Artery 2018;29(8):681-6. doi: https://doi.org/10.1097/MCA.0000000000000662
17. Xu X, Wang Z, Yang J, Fan X, Yang Y. Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord. 2024;24(1):218. doi: https://doi.org/10.1186/s12872-024-03889-w
18. Piers S, Wijnmaalen A, Borleffs C, van Huls, van Taxis C, Thijssen J, et al. Early reperfusion therapy affects inducibility, cycle length, and occurrence of ventricular tachycardia late after myocardial infarction. Circ Arrhythm Electrophysiol.2011;4(2):195-201. doi: https://doi.org/10.1161/CIRCEP.110.959213
19. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). European Heart Journal. 2022;43(40):3997-4126. doi: https://doi.org/10.1093/eurheartj/ehac262
20. Gorenek B, et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace. 2019;21(10):1518. doi: https://doi.org/10.1093/europace/euz242
21. Majidi M, Kosinski AS, Al-Khatib SM, Lem­mert ME, Smolders L, van Weert A, et al. Reperfusion ventricular arrhythmia 'bursts' predict larger infarct size despite TIMI 3 flow restoration with primary angioplasty for anterior ST-elevation myocardial infarction. Eur Heart J.2009;7(30):757-64. doi: https://doi.org/10.1093/eurheartj/ehp005
22. Sau A, Kaura A, Ahmed A, Patel KK, Li X, Mul­la A, et al. Prognostic significance of ventricular arhyth­mias in 13 444 patients with acute coronary syndrome: a retrospective cohort study based on routine clinical data (NIHR health informatics collaborative VA-ACS study). J Am Heart Assoc. 2022;11(6):e024260. doi: https://doi.org/10.1161/JAHA.121.024260
23. Kovoor JG, Deshmukh T, von Huben A, Mar­sch­ner SL, Byth K, Chow CK, et al. Optimizing electrophy­siology studies to prevent sudden cardiac death after myocardial infarction. Europace. 2023;25(7):219. doi: https://doi.org/10.1093/europace/euad219
24. Deshmukh T, Zaman S, Narayan A, Kovoor P. Duration of inducible ventricular tachycardia early after st-segment-elevation myocardial infarction and its impact on mortality and ventricular tachycardia recurrence. J Am Heart Assoc. 2020;9(13):e015204. doi: https://doi.org/10.1161/JAHA.119.015204
25. Terkelsen CJ, Sørensen JT, Kaltoft AK, Niel­sen SS, Thuesen L, Bøtker HE, et al. Prevalence and significance of accelerated idioventricular rhythm in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol.2009;104(12):1641. doi: https://doi.org/10.1016/j.amjcard.2009.07.037
26. Rymer JA, Wegermann ZK, Wang TY, Li S, Smi­lowitz NR, Wilson BH, et al. Ventricular arrhythmias after primary percutaneous coronary intervention for STEMI. JAMA New Open. 2024;7(5):e2410288. doi: https://doi.org/10.1001/jamanetworkopen.2024.10288
27. Chang H, Chen E, Zhu T, Liu J, Chen C. Commu­nication regarding the myocardial ischemia/reperfusion and cognitive impairment: a narrative literature review. J Alzheimers 2024;4(97):1545-70. doi: https://doi.org/10.3233/JAD-230886
28. Silva RR, Magalhães CJ, Silva RD, Tavares de Albuquerque AL, Montenegro ST, Alencar Neto JN. Ac­celerated idioventricular rhythm as anginous substrate in elderly: Report of an unprecedented case. HeartRhythm Case 2023;10(3):217-21. doi: https://doi.org/10.1016/j.hrcr.2023.12.014
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30. Neely JG, Hartman JM, Forsen JW Jr, Wal­lace MS. Tutorials in clinical research: VII. Understanding comparative statistics (contrast) — part B: application of T-test, Mann-Whitney U, and chi-square. Laryngoscope. 2010;10(113):1719-25. doi: https://doi.org/10.1097/00005537-200310000-00011

Look through:

Bahan U.R. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine, e-mail: ulyana.bagan@gmail.com
https://orcid.org/0000-0002-5790-2705

Kovalchuk R.A. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
https://orcid.org/0000-0001-6093-0689

Svitlyk H.V. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
https://orcid.org/0000-0002-1083-3204

Bahan U.R., Kovalchuk R.A., Svitlyk H.V. Ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention and their prognostic value. Medicni perspektivi. 2024;29(3):68-77.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313516

Pathomorphology of severe Grade 3-4 hepatic encephalopathy in decompensated cirrhosis patients with acute-on-chronic liver failure

Combined thoracic and abdominal trauma is considered one of the most severe in the structure of polytrauma, which causes a high frequency of complications – 33-72% and a mortality rate of up to 34%. The purpose of the study was to ensure the quality of the provision of medical services to victims with combined abdominal and thoracic trauma, through clinical assessment of the most significant symptoms and systematization of their manifestations aimed at justifying diagnostic and treatment measures. We conducted a prospective analysis of clinical manifestations in 44 victims with combined abdominal and thoracic trauma, who were treated at the city clinical hospital 16 of Dnipro in the period from 2019 to 2023. The average age of the victims was 41.5±2.4 years, men predominated – 40 (90.9%) people. In 40 (90.9%) victims, only 2 anatomical sites were damaged, 3 anatomical sites were damaged in 3 (6.8%) victims, 4 or more anatomical sites were damaged in 1 (2.3%) injured person. All victims were operated on. Multiple injuries of abdominal organs were observed in 14 (31.2%) victims. Among the injuries of the chest cavity, the most common cause was a lung contusion – 36.4% of cases. Exclusion criteria from the study were craniocerebral injury and contusion or injury to the heart as components of a combined injury. Also, the study did not include victims who received resuscitation measures during admission or at the stage of emergency care. Collection of complaints and anamnesis, examination, palpation, percussion and auscultation were used as research methods. The obtained information made it possible to determine the sequence of use of hardware and instrumental diagnostic methods. For better systematization of clinical symptoms, the latter were divided into three components – abdominal, thoracic and hemodynamic. The most frequent complaint was pain in the abdomen and in the chest area, respectively 75.6% and 82.9%. In the structure of the hemodynamic component, the victims most often complained of a feeling of general weakness – 73.2%. The accuracy of the symptoms detected during the diagnosis of damage to the abdominal organs ranged from 6.8% (Kulenkampf's symptom) to 93.2% pain of the abdominal wall. The diagnostic accuracy of Rozanov's symptom, which indicated damage to the spleen was 68.2%. Despite the fact, that such a symptom as pain during palpation of the chest occurred in 81.8% of victims, its diagnostic efficiency remains quite low – 54.5%. On the other hand, such a symptom as bone crepitation, with an accuracy of 95.5%, allowed us to assert the presence of rib fractures in the victims and hint at the probability of injury to the chest or abdominal organs, which we observed in 44.4% and 88.9% of cases, respectively. Damage to the lungs was also ascertained due to the sufficiently high diagnostic accuracy of the auscultatory symptom – weakening of breathing – 70.5%. Hypotension below 90 mm Hg. (45%; 50%), tachycardia (81.8%; 59.1%) and pallor of the skin (56.8%; 65.9%) showed sufficiently high diagnostic accuracy during the diagnosis of possible intraabdominal and intrapleural bleeding, respectively. The combination of damage to the organs of the abdominal and thoracic cavities was characterized by multifaceted clinical manifestations and signs of multisymptoms. Most of the symptoms taken separately had low accuracy regarding the presence or absence of a certain intracavitary post-traumatic pathology (from 6.8% to 43.2%); however, the combination of several of them indicated the multiplicity of damage to the organs of the abdominal cavity (from 41.7% to 100%). The best diagnostic accuracy was shown by Rozanov's symptoms – 68.2%, which indicated damage to the spleen and crepitation of rib fragments – 95.5%, as well as auscultatory weakening of breathing – 70.5%, which indicated lung damage.

Key words: clinical symptoms, combined trauma, injury, diagnostic accuracy

1. Leenellett E, Rieves A. Occult abdominal trauma. Emergency Medicine Clinics of North America. 2021 Nov;39(4):795-806. doi: https://doi.org/10.1016/j.emc.2021.07.009
2. Tang A, Chehab M, Ditillo M, Asmar S, Khur­rum M, Douglas M, et al. Regionalization of trauma care by operative experience: Does the volume of emergent laparotomy matter? Journal of Trauma and Acute Care Surgery. 2020 Sept 14;90(1):11-20. doi: https://doi.org/10.1097/TA.0000000000002911
3. Hietbrink F, Smeeing D, Karhof S, Jonkers HF, Houwert M, van Wessem K, et al. Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization. World Journal of Emergency Surgery. 2019 Aug 14;14(1):40. doi: https://doi.org/10.1186/s13017-019-0257-y
4. Klygunenko OM, Krishtafor DA, Yovenko IO. In­fluence of qualitative and quantitative changes of blood replacement on manifestations of multiple organ dys­function syndrome in multiple trauma. Emergency medicine.2022 Jan 27;(5.84):91-9. doi: https://doi.org/10.22141/2224-0586.5.84.2017.109366 
5. Trutyak IR, Zarutskyi YL, Trutyak RI, Kali­novich NR, Obaranets OV. [Polytrauma and combined trauma: what is common and what are the differences?] Trauma.2019;20(5):97-101.  doi: https://doi.org/10.22141/1608-1706.5.20.2019.185563
6. Shojaee M, Sabzghabaei A, Heidari A. Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department. Chin J Traumatol. 2020 Jun;23(3):145-8. doi: https://doi.org/10.1016/j.cjtee.2020.03.003
7. Girard E, Jegousso Q, Boussat B, François P, Age­ron F-X, Letoublon C, et al. Preventable deaths in a French regional trauma system: A six-year analysis of severe trau­ma mortality. Journal of Visceral Surgery. 2019 Feb;156(1):10-6. doi: https://doi.org/10.1016/j.jviscsurg.2018.05.002
8. Hogia MO. [Structure of abdominal injury and its consequences]. J VN Karazin Khark Nat Univ. Ser.: Med. 2021 Jun 30;42. Ukrainian. doi: https://doi.org/10.26565/2313-6693-2021-42-05
9. Antomonov MYu. [Mathematical processing and analysis of medical and biological data]. 2nd ed. Kyiv: Medinform; 2017. 578 р. Ukrainian.
10. Boyko OV, Volkova YuV, Zamiatin PM, Lit­vi­shko VO, Tkachuk OYu. Zamiatin DP. [Diagnosis of post-traumatic disorders according to laboratory and instrumental research data in patients with combined thoracic trauma (lite­rature review)]. Kharkiv surgical school. 2020;5-6:55-60. Uk­rainian. doi: https://doi.org/10.37699/2308-7005.5-6.2020.10
11. Zaporozhan SY, Khomenko VS. [Abdominal in­jury (literature review)]. Hospital surgery. Journal named by L.Ya. Kovalchuk. 2020;4:99-107. Ukrainian. doi: https://doi.org/10.11603/2414-4533.2020.4.11793

Look through:

Chaika V.O. Dnipro State Medical University, Dnipro, Ukraine,
e-mail: chich321@gmail.com
https://orcid.org/0000-0002-0516-6224

Karpenko S.I. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0009-0001-1423-7477

Zavizion E.M. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0009-0002-4448-2243

Chaika V.O., Karpenko S.I., Zavizion E.M. Clinical symptoms of combined abdominal and thoracic trauma in peacetime. Medicni perspektivi. 2024;29(3):78-84.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313518

Conections between platelets amino acids profile and known cardiometabolic risk factors in patients with coronary artery disease and atrial fibrillation

The goal of the study was to improve the outcomes of surgical care and treatment for patients with combat-related abdominal injuries at different levels of medical support during combat operations by using abdominal vacuum therapy as a component of Damage Control Surgery tactics.  At the II level of combat medical support within the Damage Control Surgery tactics, abdominal vacuum therapy was applied to 75 wounded male combatants with a combat abdominal injury, aged 37.4±8.3 years (main group). The comparison group consisted of 87 wounded patients aged 37.5±10.2 years, operated on using Damage Control Surgery tactics with drainage of the abdominal cavity and suturing of the skin only. 40.0% of the wounded in the main group and 46.0% of the comparison group were admitted with signs of traumatic shock of various degrees. According to the AdTS scale, 78.7% of the wounded in the main group were admitted in a serious condition, 21.3% – in an extremely serious condition; in the comparison group, 74.7% were in severe condition, 25.3% were in extremely severe condition. In 57.3% of the wounded of the main group, abdominal vacuum therapy was carried out in the irrigation-flow mode. 24.0% used standard bandages for abdominal vacuum therapy, 76.0% used partially improvised ones. The level of negative pressure was set in the range of 40-125 mm Hg in constant mode. Intra-abdominal pressure was measured by a standard method (through the bladder) at admission and after surgery. The assessment of the state of the abdominal cavity in the I and III phases of Damage Control Surgery was carried out according to the Abdominal Cavity Index scale – an integral assessment expressed in points based on factors that can be assessed visually during surgery. The volume of surgical interventions in the 1st phase of the Damage Control Surgery tactic depended on the nature of the damage to the abdominal organs and the condition of the wounded. After the completion of Phase I of Damage Control Surgery tactics, all wounded were evacuated by road medical transport and medical helicopters to the next level of medical support, with abdominal vacuum therapy during evacuation in the main group and Damage Control Resuscitation measures. Under the effect of abdominal vacuum therapy, the reduction of intra-abdominal pressure in the main group was pronounced (Δ=9.2; p<0.01) than in the comparison group (Δ=6.1; p<0.01). Abdominal vacuum therapy during the II phase of the Damage Control Surgery tactic made it possible to clean the abdominal cavity better (p<0.0001) than in the comparison group and provided better preparation for the implementation of the III phase of this tactic. As a result, reliable protection from external factors, active prevention of intra-abdominal pressure and rehabilitation of the abdominal cavity during the application of abdominal vacuum therapy during the II phase of Damage Control Surgery tactics in the main group of wounded after obstructive resections of the small intestine in the I phase made it possible to completely abandon terminal stomas in the III phase (in the comparison group – 5) in favor of the formation of small bowel intestinal anastomoses, and during obstructive colon resections, the number of terminal colostomas in the main group was reduced to 50.0% (in the comparison group -90.9%, р=0.004), also in favor of the formation anastomoses, which significantly improved the functional results of providing assistance to the wounded with a combat abdominal injury. The use of abdominal vacuum therapy during phases I-II of the Damage Control Surgery (DCS) tactics allows for the optimization of the scope of surgical interventions in phase III of Damage Control Surgery and significantly improves the functional outcomes of surgical care and treatment for patients with combat abdominal injuries at various levels of medical support during combat operations.

Key words: abdominal VAC-therapy, DCS tactics, combat abdominal trauma 

1. Skoroplit SM, Mykhnevich KG, Zamyatin PM, Khoroshun EM, Borodai VO, Tertyshny SV, et al. [Featu­res of modern combat trauma and the organization of medical care]. Kharkivska khirurhichna shkola. 2022 Dec 30;6:51-3. doi: https://doi.org/10.37699/2308-7005.6.2022.10
2. Zarutskyi YaL, Klishevych BA, Poleizjaev GO. [Combat closed abdominal trauma, diagnosis and treatment at the stages of medical and evacuation support]. Viiskova medytsyna Ukrainy. 2019;19(3):46-55.
3. Polovyi VP, Railyanu SI, Palyanitsa AS, Chepe­ga IG. [Application of "damage control" tactics in surgical treatment of victims with severe abdominal trauma]. Shpytalna khirurhiia. 2020;(3),63-9. doi: https://doi.org/10.11603/2414-4533.2020.3.11463
4. Boychak MP, Yurchenko BV, Moshkivskyi VM, Fe­dorova OO. Development of the principles of treatment of patients with gunshot wounds according to the modern strategy of Damage Control Resuscitation. Ukrainskyi zhurnal viiskovoi medytsyny. 2022;2(3):120-8. Ukrainian. doi: https://doi.org/10.46847/ujmm.2022.2(3)-120
5. Rotondo MF, Schwab CW, McGonigal MD, Phil­lips GR, Fruchterman TM, Kauder DR. “Damage control”: an approach for improved survival in exsanguinating pene­trating abdominal injury. Journal Trauma. 1993;35(3):375-82. doi: https://doi.org/10.1097/00005373-1993000-00008
6. Hirshberg A, Walden R. Damage Control for ab­dominal trauma. Surgical Clinics of North America. 1997;4(77):813-20.
   doi: https://doi.org/10.1016/S0039-6109(05)70586-7
7. Volpin G, Pfeifer R, Saveski J, Hasani I, Co­hen M, Pape HC. Damage control orthopaedics in po­lytraumatized patients – current concepts. Journal of Clinical Orthopaedics and Trauma. 2021;12(1):72-82. doi: https://doi.org/10.1016/j.jcot.2020.10.018
8. Coccolini F, Montori G, Ceresoli M, Catena F, Ivatury R, Sugrue M, et. al. IROA: International Register of Open Abdomen, preliminary results. World Journal of Emergency Surgery. 2017;(12):10. doi: https://doi.org/10.1186/s13017-017-0123-8 
9. Roberts DJ, Bobrovitz N, Zygun DA, Kirkpat­rick AW, Ball CG, Faris PD. Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review. World Journal of Emergency Surgery. 2021;16(1):10. doi: https://doi.org/10.1186/s13017-021-00352
10. Pfeifer R, Pape HC. Trends in nomenclature to describe concepts in trauma patients: time for stan­dardization. Injury.2020;51(11):2353-5. doi: https://doi.org/10.1016/j.injury.2020.10.061
11. Padar M, Reintam BA, Talving P, Lipping E, Star­kopf J. Abdominal Compartment Syndrome: Improving Outcomes With A Multidisciplinary Approach – A Nar­rative Review. J Multidiscip Healthc. 2019;12:1061-74. doi: https://doi.org/10.2147/JMDH.S205608
12. Pape HC, Halvachizadeh S, Leenen L, Velma­hos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. Injury. 2019;50(10):1656-70. doi: https://doi.org/10.1016/j.injury.2019.09.021
13. Loftus TJ, Efron PA, Bala TM, Rosenthal MD, Croft CA, Walters MS, et al. The impact of standardized protocol implementation for surgical damage control and temporary abdominal closure after emergent laparotomy. J Trauma Acute Care Surg. 2019;86:670-8. doi: https://doi.org/10.1097/TA.0000000000002170
14. Roberts DJ, Leppäniemi A, Tolonen M, Men­tula P, Björck M, Kirkpatrick AW, et al. The open abdo­men in trauma, acute care, and vascular and endovascular surgery: comprehensive, expert, narrative review. BJS Open.2023;7(5):zrad084. doi: https://doi.org/10.1093/bjsopen/zrad084
15. Fernández Treatment of Complex Thoracic and Abdominal Trauma Patients: A Review of Literature and Negative Pressure Wound Therapy Treatment Options. Advances in Wound Care. 2023;13(8):1-8. doi: https://doi.org/10.1089/wound.2023.0113
16. Zarutskyi YaL, Aslanyan SA, Zhovtonozhko OI, Oliynyk YuM, Forostyany PP, Honcharuk VS, et al. [Ana­tomic-functional scale for assessing the severity of injury in the wounded with thoraco-abdominal injuries in the conditions of the Joint Forces Operation]. Clinical surgery. 2020;87(1-2):3-7. doi: https://doi.org/10.26779/2522-1396.2020.1-2.03
17. Savelyev VS, Gelfand BR, Filimonov MI, Poda­chin PV, Sergeeva NA. [Criteria for choosing effective tactics for surgical treatment of widespread peritonitis]. Annals of Surgery. 2013;2:48-54. Russian.
18. Antomonov MJ, Korobeinikov GV, Hmel­nyts­ka IV, Harkovliuk-Balakina NV. [Mathematical methods of processing and modeling the results of experimental research: a study guide]. Kyiv: Olimpiiska literatura; 2021. 216 p. Ukrainian.
19. Crumley C. Abdominal Negative Pressure Wound Therapy Devices for Management of the Open Abdomen: A Technologic Analysis. Journal of Wound, Ostomy and Continence Nursing. 2022;49(2):124-7. doi: https://doi.org/10.1097/WON.0000000000000862
20. Fernandez LG, Sibaja Alvarez P, Kaplan MJ, et al. Application of Negative Pressure Wound Therapy with Instillation and Dwell Time of the Open Abdomen: Initial Experience. Cureus.2019;11(9):e5667. doi: https://doi.org/10.7759/cureus.5667
21. KocaaslanFND, Ozkan MC, Akdeniz Z, Sa­cak B, Erol B, Yuksel M, et al. Use of abdominal negative pres­sure wound therapy in different indi­ca­tions: a case series. Journal of Wound Care. 2019;28:4. doi: https://doi.org/10.12968/jowc.2019.28.4.240
22. MansoorJ, Ellahi I, Junaid Z, Habib A, Ilyas Clinical evaluation of improvised gauze-based negative pressure wound therapy in military wounds. International Wound Journal. 2013;12(50):559-63. doi: https://doi.org/10.1111/iwj.12164
23. Alhan D, Şahin I, Güzey S, Aykan A, Zor F, Öz­türk S, et al. Staged repair of severe open abdomens due to high-energy gunshot injuries with early vacuum pack and delayed tissue expansion and dual-sided meshes. Turkish Journal of Trauma and Emergency Surgery. 2015;21(6):457-62. doi: https://doi.org/10.5505/tjtes.2015.05942

Look through:

Aslanyan S.A. Ukrainian Military Medical Academy, Kyiv, Ukraine, e-mail: sergeyaslanyan@ukr.net
https://orcid.org/0000-0002-4122-775X

Bily V.Ya. Ukrainian Military Medical Academy, Kyiv, Ukraine, e-mail: volodymyr.bilyi27@gmail.com 
https://orcid.org/0009-0002-5731-7159

Sobko I.V. Ukrainian Military Medical Academy, Kyiv, Ukraine, e-mail: sobko.i@ukr.net
https://orcid.org/0009-0003-9177-0237

Davidyuk M.M. Ukrainian Military Medical Academy, Kyiv, Ukraine, e-mail: mykola.davidyk93@gmail.com
https://orcid.org/0009-0003-2941-1524

Aslanyan S.A., Bily V.Ya., Sobko I.V., Davidyuk M.M. Abdominal vacuum therapy is a component of DAMAGE CONTROL SURGERY tactics for combat trauma to the abdomen. Medicni perspektivi. 2024;29(3):85-96.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313568

Association between glycosylated hemoglobin and newly diagnosed hypertension in a non-diabetic kosovar population: a cross-sectional analysis

The main purpose of this work was to investigate the possibility of detecting respiratory diseases in audio recordings of lung auscultation using modern deep learning tools, as well as to explore the possibility of using data augmentation by generating synthetic spectral representations of audio samples. The ICBHI (International Conference on Biomedical and Health Informatics) dataset was used for training, validation and augmentation. The dataset includes lung auscultations of 126 different subjects, there are a total of 920 sounds, of which 810 have signs of chronic diseases, 75 of non-chronic diseases and 35 with no pathology. The stage of data preprocessing includes discretization to 4kHz frequency, as well as filtering of frequency bands that do not carry information value for the task. In the next step, each sample was transformed into a frequency spectrum and Melspectrograms were generated. To solve the problem of class imbalance, the required number of synthetic spectrograms generated by convolutional variation autoencoders was added. At the stage of building the model, the methods of classical convolutional neural networks were used. The quality of the obtained algorithm was evaluated using a 10-fold cross-validation. Also, to assess the generalization of the proposed method, experiments were performed with the split of audio recordings into training and test sets using patient grouping. Qualitative evaluation of the model was performed using sensitivity, specificity, F1-score and Cohen’s kappa. A score of 98.45% F1-score was achieved for the 5-class classification problem which can contribute to the development of ways to synthesize and augment sensitive medical data. In addition, a cons of existing methods in the generalization of the obtained predictions were revealed, which opens the way for further research in the direction of clinical respiratory diseases detection.

Key words: pulmonary diseases, lung sounds, deep learning, convolutional neural network, conditional variational auto encoder

1. Abbas A, Fahim A. An automated computerized auscultation and diagnostic system for pulmonary diseases. JMed  2010;34:1149-55. doi: https://doi.org/10.1007/s10916-009-9334-1
2. Fraiwan L, Hassanin O, Fraiwan M, Khassa­wneh B, Ibnian AM, Alkhodari M. Automatic identifi­cation of respiratory diseases from stethoscopic lung sound signals using ensemble classifiers. Biocybern Biomed Eng. 2021;41(1):1-14. doi: https://doi.org/10.1016/j.bbe.2020.11.003
3. Fraiwan M, Fraiwan L, Alkhodari M, Hassanin O. Recognition of pulmonary diseases from lung sounds using convolutional neural networks and long short-term me­mory. J Ambient Intell Humaniz Comput. 2021;13(10):1-13. doi: https://doi.org/10.1007/s12652-021-03184-y
4. Gibson GJ, Loddenkemper R, Lundback B, Sibil­le Y. Respiratory health and disease in Europe: The new European lung white book. Eur Respir J. 2013;42(3):559-63. doi: https://doi.org/10.1183/09031936.00105513
5. Kim Y, Hyon Y, Jung SS, Lee S, Yoo G, Chung C, et al. Respiratory sound classification for crackles, wheezes, and rhonchi in the clinical field using deep learning. Sci 2021;11(1):1-11. doi: https://doi.org/10.1038/s41598-021-96724-7
6. Kingma DP, Welling M. Stochastic gradient vb and the variational auto-encoder. In: Second International Conference on Learning Representations. 2014. p. 121.
7. Lema GF, Berhe YW, Gebrezgi AH, Getu AA. Evidence-based perioperative management of a child with upper respiratory tract infections (urtis) undergoing electi­ve surgery: A systematic review. Int J Surg Open. 2018;12:17-24. doi: https://doi.org/10.1016/j.ijso.2018.05.002
8. Ma Y, Xu X, Li Y. LungRN+ NL: An improved adventitious lung sound classification using non-local block resnet neural network with mixup data augmen­tation. In:Interspeech;  doi: https://doi.org/10.21437/Interspeech.2020-2487
9. Minami K, Lu H, Kim H, Mabu S, Hirano Y, Kido S. Automatic classification of large-scale respi­ratory sound dataset based on convolutional neural net­work. In: 2019 19th International Conference on Control, Automation and Systems (ICCAS). 2019. p. 804-7. doi: https://doi.org/10.23919/ICCAS47443.2019.8971689
10. Monaco A, Amoroso N, Bellantuono L, Panta­leo E, Tangaro S, Bellotti R. Multi-time-scale features for accurate respiratory sound classification. Appl Sci. 2020;10(23):8606. doi: https://doi.org/10.3390/app10238606
11. Pham L, Phan H, Palaniappan R, Mertins A, McLoughlin I. Cnn-moe based framework for classifi­cation of respiratory anomalies and lung disease detection. IEEE J Biomed Health Inform. 2021;25(8):2938-47. doi: https://doi.org/10.1109/JBHI.2021.3064237
12. Priftis KN, Hadjileontiadis LJ, Everard ML. BreathSpringer; 2018. 319 р. doi: https://doi.org/10.1007/978-3-319-71824-8
13. Reyes B, Charleston-Villalobos S, Gonza´lez-Ca­marena R, Aljama-Corrales T. Assessment of time–fre­quency representation techniques for thoracic sounds analysis. Comput Methods Programs Biomed. 2014;114(3):276-90. doi: https://doi.org/10.1016/j.cmpb.2014.02.016
14. Rocha BM, Filos D, Mendes L, Serbes G, Ulu­kaya S, Kahya YP, et al. An open access database for the evaluation of respiratory sound classification algorithms. Physiol Meas. 2019;40(3):035001. doi: https://doi.org/10.1088/1361-6579/ab03ea
15. Sarkar M, Bhardwaz R, Madabhavi I, Modi M. Physical signs in patients with chronic obstructive pul­monary disease. Lung India. 2019;36(1):38-47. doi: https://doi.org/10.4103/lungindia.lungindia_145_18
16. Tasar B, Yaman O, Tuncer T. Accurate respiratory sound classification model based on piccolo pattern. Appl Acoust. 2022;188:108589. doi: https://doi.org/10.1016/j.apacoust.2021.108589
17. Wu YS, Liao CH, Yuan SM. Automatic auscul­tation classification of abnormal lung sounds in critical patients through deep learning models. In: 2020 3rd IEEE International Conference on Knowledge Innovation and Invention. 2020. p. 9-11. doi: https://doi.org/10.1109/ICKII50300.2020.9318880 

Look through:

Panaskin D.V. Ihor Sikorsky Kyiv polytechnic institute, Kyiv, Ukraine, e-mail: denys_panaskin@edu.cn.ua
https://orcid.org/0009-0008-2867-5399

Stirenko S.H. Ihor Sikorsky Kyiv polytechnic institute, Kyiv, Ukraine, e-mail: sergiy_stirenko@edu.cn.ua 
https://orcid.org/0009-0003-2674-3590

Babko D.S. Ihor Sikorsky Kyiv polytechnic institute, Kyiv, Ukraine, e-mail: dmytro_babko@edu.cn.ua
https://orcid.org/0009-0006-5829-1906

Panaskin D.V., Stirenko S.H., Babko D.S. Respiratory disease detection in lung auscultation with convolutional neural networks and CVAE augmentation. Medicni perspektivi. 2024;29(3):96-107. DOI: https://doi.org/10.26641/2307-0404.2024.3.313569

Predicting the dynamics of heart rate variability in patients with type 1 diabetes against improving glycemic control

The aim of the study is to identify and evaluate the general immunological reactivity of patients with COVID-19 and its relationship with gene polymorphism, severity of the clinical course of the disease and combination with comorbidities. A cohort study was conducted involving 204 patients with COVID-19 diagnosed with community-acquired pneumonia of mild, moderate, and severe degrees who also had comorbidities: endocrinopathies (46 patients), cardiovascular diseases (82 patients), and comorbidities of the ENT organs, connective tissue, gastrointestinal tract, chronic kidney disease (CKD), which were grouped into the group "other comorbidities (76 patients). Among the patients there were 51.97% (106) women and 48.03% (98) men. The average age of patients was 55.93±8.75 years. The polymorphism of the NOS3 (rs2070744), FGB (rs1800790) and TMPRSS2 (rs12329760) genes was determined by real-time polymerase chain reaction (qualitative determination). The overall immunological reactivity was detected and evaluated based on the analysis of 14 integral leukocyte indices: leukocyte shift index, absolute leukocyte count/erythrocyte sedimentation rate (ESR) ratio index, lymphocyte-granulocyte index, lymphocyte index, immunological resistance and reactivity index, and others. The overall immunological reactivity of the body of patients with coronavirus infection increases in the presence of the wild-type T-allele of the eNOS gene (rs2070744) in the patient's genotype, especially the CC genotype, by 21.98-57.89% (p≤0.029-0.001), against the background of a decrease in the index of nonspecific reactivity and the ratio of agranulocytes to ESR – by 23.0 (p=0.039) and 15.74% (p=0.044), indicating the onset of specific immunological reactions in the active infectious process. Carriers of the mutational A-allele of the FGB gene (rs1800790) and the TT genotype of the TMPRSS2 gene (rs12329760) showed higher immune reactivity and resistance, which was significantly confirmed by the level of increase in immune reactivity by 6.31-17.21% (p=0.007) and 22.05-35.78% (p≤0.06-0.004), respectively, against the background of a slightly higher rate of allergy (especially in owners of the AG genotype of the FGB gene – by 68.18%, PAG=0.017), a higher ratio of agranulocytes and ESR – by 18.30-21.84% (p≤0.008-0.007) and 19.46-31.07% (p=0.023), with a higher ratio of lymphocytes and eosinophils – by 13.35-19.20% (p≤0.002-0.001). The influence of the wild-type T-allele of the eNOS gene (rs2070744), the A-allele of the FGB gene (rs1800790) and the TT genotype of the TMPRSS2 gene (rs12329760) on the immunological reactivity of the body of a patient with coronavirus infection was revealed.

Key words: COVID-19, immunological reactivity, immune resistance, genotype, comorbidities

1. Azkur AK, Akdis M, Azkur D, Sokolowska M, van de Veen W, Brüggen MC, et al. Immune response to SARS‐CoV‐2 and mechanisms of immunopathological changes in COVID‐19. Allergy. 2020 Jul;75(7):1564-81. doi: https://doi.org/10.1111/all.14364
2. Paces J, Strizova Z, Danie SM, Cerny J. COVID-19 and the immune system. Physiological research. 2020;69(3):379. doi: https://doi.org/10.33549/physiolres.934492
3. Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses. Cell Death & Differentiation. 2020;27(5):1451-4. doi: https://doi.org/10.1038/s41418-020-0530-3
4. Siracusano G, Pastori C, Lopalco L. Humoral im­mune responses in COVID-19 patients: a window on the state of the art. Frontiers in immunology. 2020;11:551868. doi: https://doi.org/10.3389/fimmu.2020.01049
5. Mortaz E, Tabarsi P, Varahram M, Folkerts G, Adcock IM. The immune response and immunopathology of COVID-19. Frontiers in immunology. 2020;11:558378. doi: https://doi.org/10.3389/fimmu.2020.02037
6. Ravindran R, McReynolds C, Yang J, Ham­mock BD, Ikram A, Ali A, et al. Immune response dyna­mics in COVID-19 patients to SARS-CoV-2 and other human coronaviruses. PloS one. 2021;16(7):e0254367. doi: https://doi.org/10.1371/journal.pone.0254367
7. Boechat JL, Chora I, Morais A, Delgado L. The im­mune response to SARS-CoV-2 and COVID-19 im­muno­pa­thology–current perspectives. Pulmonology. 2021;27(5):423-37. doi: https://doi.org/10.1016/j.pulmoe.2021.03.008
8. Jafarzadeh A, Jafarzadeh S, Nozari P, Mokhtari P, Nemati M. Lymphopenia an important immunological ab­normality in patients with COVID‐19: possible mecha­nisms. Scandinavian journal of immunology. 2021;93(2):e12967. doi: https://doi.org/10.1111/sji.12967
9. Oliveira DS, Medeiros NI, Gomes JA. Immune res­ponse in COVID-19: What do we currently know? Microbial pathogenesis. 2020;148:104484. doi: https://doi.org/10.1016/j.micpath.2020.104484
10. Sydorchuk lP, Syrota BS, Sydorchuk AR, Ge­rush OV, Muzyka NY, Sheremet MI, et al. Clinical mar­kers of immune disorders in the pathogenesis of Esche­richia coli enteritis. Arch Balk Med Union. 2019;54(1):89-96. doi: https://doi.org/10.31688/ABMU.2019.54.1.1
11. Moody R, Wilson K, Flanagan KL, Jawo­rows­ki A, Plebanski M. Adaptive immunity and the risk of autoreactivity in COVID-19. International journal of molecular sciences. 2021;22(16):8965. doi: https://doi.org/10.3390/ijms22168965
12. Schön MP, Berking C, Biedermann T, Buhl T, Er­penbeck L, Eyerich K, et al. COVID‐19 and immuno­logical regulations-from basic and translational aspects to clinical implications. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2020;18(8):795-807. doi:  https://doi.org/10.1111/ddg.14169
13. Elshazli RM, Toraih EA, Elgaml A, El-Mo­wafy M, El-Mesery M, Amin MN, Diagnostic and prog­nostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PloS one. 2020;15(8):e0238160. doi: https://doi.org/10.1371/journal.pone.0238160
14. Sydorchuk A, Sydorchuk L, Gutnitska A, Va­syuk V, Tkachuk O, Dzhuryak V, et al. The role of NOS3 (rs2070744) and GNB3 (rs5443) genes’ polymorphisms in endothelial dysfunction pathway and carotid intima-media thickness in hypertensive patients. General Physiology & Biophysics. 2023;42(2):179-90. doi: https://doi.org/10.4149/gpb_2022060
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16. [Medical care standards "Coronavirus disease (COVID-19)". Approved by Order No. 722 of the Ministry of Health of Ukraine dated March 28, 2020]. [Internet]. 2020 [cited 2024 Mar 2024]. Ukrainian. Available from: https://www.dec.gov.ua/wp/content/uploads/2022/02/2020_722_standart_covid_19.pdf
17. CDC 24/7: saving lives, protecting people. Pre­vention Actions to Use at All COVID-19 Community Le­vels [Internet]. Center for Disease Control and Prevention. 2023 [cited 2024 Mar 2024]. Available from:  https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
18. Artika IM, Dewi YP, Nainggolan IM, Siregar JE, Antonjaya U. Real-Time Polymerase Chain Reaction: Current Techniques, Applications, and Role in COVID-19 Diagnosis. Genes (Basel). 2022 Dec 16;13(12):2387. doi: https://doi.org/10.3390/genes13122387
19. Usul E, Şan İ, Bekgöz B, Şahin A. Role of hema­tological parameters in COVID-19 patients in the emer­gency room. Biomark Med. 2020 Sep;14(13):1207-15. doi: https://doi.org/10.2217/bmm-2020-0317
20. Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med. 2022 Dec;70(8):1759-70.
    doi: https://doi.org/10.1136/jim-2022-002479
21. Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, et al. Changes of hematological and im­muno­logical parameters in COVID-19 patients. Int J Hematol. 2020 Oct;112(4):553-9. doi: https://doi.org/10.1007/s12185-020-02930-w
22. Birindelli S, Tarkowski MS, Gallucci M, Schiu­ma M, Covizzi A, Lewkowicz P, et al. Definition of the immune parameters related to COVID-19 severity. Fron­tiers in Immunology. 2022;13:850846. doi: https://doi.org/10.3389/fimmu.2022.850846
23. Qin R, He L, Yang Z, Jia N, Chen R, Xie J, et al. Identification of parameters representative of immune dysfunction in patients with severe and fatal COVID-19 infection: a systematic review and meta-analysis. Clinical Reviews in Allergy & Immunology. 2023;64(1):33-65. doi: https://doi.org/10.1007/s12016-021-08908-8
24. Chatterjee S, Nalla LV, Sharma M, Sharma N, Singh AA, Malim FM, et al. Association of COVID-19 with comorbidities: an update. ACS Pharmacology & Translational Science. 2023;6(3):334-54. doi: https://doi.org/10.1021/acsptsci.2c00181
25. Kamyshnyi A, Krynytska I, Matskevych V, Maru­shchak M, Lushchak O. Arterial hypertension as a risk comorbidity associated with COVID-19 pathology. Inter­national journal of hypertension. 2020 Dec 4:2020:8019360. doi: https://doi.org/10.1155/2020/8019360
26. Fishchuk L, Rossokha Z, Pokhylko V, Cher­niavs­ka Y, Dubitska O, Vershyhora V, et al. NOS3 (rs61722009) gene variants testing in prediction of COVID-19 pneumonia severity. Nitric Oxide. 2023;134:44-8. doi: https://doi.org/10.1016/j.niox.2023.04.002
27. Stopsack KH, Mucci LA, Antonarakis ES, Nel­son PS, Kantoff PW. TMPRSS2 and COVID-19: Seren­dipity or Opportunity for Intervention?. Cancer discovery. 2020;10(6):779-82.
    doi: https://doi.org/10.1158/2159-8290.CD-20-0451
28. Rezaei-Tavirani M, Nejad MR, Arjmand B, Tavi­rani SR, Razzaghi M, Mansouri V. Fibrinogen dysre­gulation is a prominent process in fatal conditions of COVID-19 infection; a proteomic analysis. Archives of  Academic Emergency Medicine. 2021;9(1):e26. doi: https://doi.org/10.22037/aaem.v9i1.1128
29. Sur S, Khatun M, Steele R, Isbell TS, Ray R, Ray RB. Exosomes from COVID-19 patients carry te­nascin-C and fibrinogen-β in triggering inflammatory signals in cells of distant organ. International Journal of Molecular Sciences. 2021;22(6):3184. doi: https://doi.org/10.3390/ijms22063184

Look through:

Sokolenko M.O. Bukovinian State Medical University, Chernivtsi, Ukraine, e-mail: sokolenko_maks@ukr.net
https://orcid.org/0000-0002-7150-7146

Sydorchuk L.P. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0001-9279-9531

Sokolenko L.S. Pavlo Tychyna Uman State Pedagogical University, Uman, Cherkasy region, Ukraine, e-mail: post@udpu.edu.ua
https://orcid.org/0000-0002-1285-1596

Sokolenko A.A. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0003-0010-2771

Sokolenko M.O., Sydorchuk L.P., Sokolenko L.S., Sokolenko A.A. General immunologic reactivity of patients with COVID-19 and its relation to gene polymorphism, severity of clinical course of the disease and combination with comorbidities. Medicni perspektivi. 2024;29(3):108-117.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313570

Side effects and hypersensitivity reactions to corticosteroids

Diabetic kidney disease (DKD) is the leading cause of end-stage renal failure. Evidence indicates gender differences in the progression of this disease. This study aimed to determine gender differences in prevalence and identify gender-associated risk factors contributing to the development of diabetic kidney disease in individuals with type 2 diabetes mellitus (T2DM). The cross-sectional study included 132 patients with T2DM ranging in age from 50 to 65 years. Subjects were stratified by sex (80 women and 52 men). Gender differences have been studied in relation to the incidence and prevalence of DKD, their phenotypes and clinical manifestations, and several risk factors that have different effects on both sexes. The outcome of clinical kidney function assessment showed that 70% subjects were diagnosed with DKD (71% of women and 67% of men). The study indicated an association between the duration of T2DM and urinary albumin levels, as well as between arterial hypertension and triglyceride levels, which are independent risk factors for DKD development. Notably, older women with T2DM have a higher prevalence of DKD than older men. The albuminuric component of DKD was more frequently observed in men. Additionally, men were more likely to have adverse risk factors, including dyslipidemia, lower high-density lipoprotein cholesterol, and glomerular filtration rate, which are factors involved in the mechanisms of DKD. In summary, the results indicate that: 1) women with type 2 diabetes mellitus are at a higher risk of developing a normoalbuminuric phenotype of diabetic kidney disease, while men are at a higher risk of developing an albuminuric phenotype of diabetic kidney disease leading to renal failure and end-stage renal disease; 2) gender differences are most noticeable among older adults and may have significant implications for the development of more effective diagnostic and treatment methods for diabetic kidney disease, tailored to individual needs.

Key words: diabetic kidney disease, diabetes mellitus type 2, gender

1. Xia L, Cheng L, Jiang T, et al. Estimation of the pre­valence of type 2 diabetes in combination with diabetic kidney disease and identification of the associated factors in patients attending primary hospitals in Anhui Province, China. J Inter­national Medical Research. 2021;49(10):3000605211051225. doi: https://doi.org/10.1177/03000605211051225
2. Huang JX, Liao YF, Li YM. Clinical features and microvascular complications risk factors of early-onset type 2 diabetes mellitus. Current Medical Science. 2019;39(5):754-8.
   doi: https://doi.org/10.1007/s11596-019-2102-7
3. Deng L, Li W, Xu G. Update on pathogenesis and diagnosis flow of normoalbuminuric diabetes with renal in­su­f­ficiency. Euro Journal of Medical Research. 2021;26(1):144. doi: https://doi.org/10.1186/s40001-021-00612-9
4. Fritz J, Brozek W, Concin H, et al. The association of excess body weight with risk of ESKD is mediated through insulin resistance, hypertension, and hyperu­ricemia. Journal of the American Society of Nephrology. 2022;33(7):1377-89. doi: https://doi.org/10.1681/ASN.2021091263
5. Bae EH, Lim SY, Kim B, et al. Effects of blood pressure according to age on end-stage renal disease deve­lopment in patients with diabetes: a nationwide population-based cohort study. Hypertension. 2022;79(8):1765-76. doi: https://doi.org/10.1161/HYPERTENSIONAHA.121.18881
6. Sabbatini AR, Kararigas G. Estrogen-related me­chanisms in sex differences of hypertension and target organ damage. Biology of Sex Differences. 2020;11(1):31. doi: https://doi.org/10.1186/s13293-020-00306-7
7. Bensken WP, Ho VP, Pieracci FM. Basic Intro­duction to Statistics in Medicine, Part 2: Comparing Data. Surg Infect (Larchmt). 2021;22(6):597-603. doi: https://doi.org/10.1089/sur.2020.430
8. Piani F, Melena I, Tommerdahl KL, et al. Sexrelated differences in diabetic kidney disease: A review on the mechanisms and potential therapeutic implications. Journal of Diabetes Complications. 2021;35(4):107841. doi: https://doi.org/10.1016/j.jdiacomp.2020.107841
9. Giandalia A, Giuffrida AE, Gembillo G, et al. Gen­der differences in diabetic kidney disease: focus on hormonal, genetic and clinical factors. International J Molec Sciences. 2021;22(11):5808. doi: https://doi.org/10.3390/ijms22115808
10. Menendez-Castro C, Cordasic N, Fahlbusch FB, et al. Sex differences in long-term kidney fibrosis fol­lowing neonatal nephron loss during ongoing nephro­genesis. Molecular and Cellular Pediatrics. 2023;10(1):8. doi: https://doi.org/10.1186/s40348-023-00164-4
11. Rajabi S, Saberi S, Najafipour H, et al. Interaction of estradiol and renin-angiotensin system with mic­roRNAs-21 and -29 in renal fibrosis: focus on TGF-β/smad signaling pathway. Molecular Biology Reports. 2024;51(1):137. doi: https://doi.org/10.1007/s11033-023-09127-4
12. Schexnayder CD, Agbahiwe S, Emelogu O. Burnt out? The phenomenon of type 2 diabetes mellitus in end-stage renal disease. Federal Practitioner. 2020;37(12):580-5. doi: https://doi.org/10.12788/fp.0076
13. Xu AR, Jin Q, Shen Z, et al. Association between the risk of hypertension and triglyceride glucose index in Chinese regions: a systematic review and dose-response meta-analysis of a regional update. Front Cardiovascular Medicine. 2023;10:1242035. doi: https://doi.org/10.3389/fcvm.2023.1242035
14. Swartling O, Rydell H, Stendahl M, et al. CKD Pro­gression and mortality among men and women: a nationwide study in Sweden. Am J Kidney Dis. 2021;78(2):190-9. doi: https://doi.org/10.1053/j.ajkd.2020.11.026
15. Wang K, Xu W, Zha B, et al. Fibrinogen to albu­min ratio as an independent risk factor for type 2 diabetic kidney disease. Diabetes Metab Syndr Obes. 2021;14:4557-67. doi: https://doi.org/10.2147/DMSO.S337986
16. Bernstein SR, Kelleher C, Khalil RA. Gender-ba­sed research underscores sex differences in biological pro­cesses, clinical disorders and pharmacological interven­tions. Biochemical Pharmacology. 2023;215:115737. doi: https://doi.org/10.1016/j.bcp.2023.115737
17. Christofides EA, Desai N. Optimal early diagnosis and monitoring of diabetic kidney disease in type 2 diabetes mellitus: addressing the barriers to albuminuria testing. Journal of Primary Care and Community Health. 2021;12:21501327211003683. doi: https://doi.org/10.1177/21501327211003683
18. Li S, Li N, Li L, Zhan J. Sex difference in the asso­ciation between serum versican and albuminuria in patients with type 2 diabetes mellitus. Diabetes, Metabolic Synd­rome and Obesity. 2023;16:3631-9. doi: https://doi.org/10.2147/DMSO.S434287

Look through:

Safarova S.S.  Azerbaijan Medical University, Baku, Republic of Azerbaijan, e-mail: dr.safarovas@gmail.com
https://orcid.org/0000-0002-7131-3878

Safarova S.S. Gender-associated features in diabetic kidney disease. Medicni perspektivi. 2024;29(3):118-122.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313578

Microbiological profile and antimicrobial susceptibility of bacteria associated with urinary tract infections in Ukrainian adults

The aim of the work was to investigate the dynamics of endothelial markers in patients with arterial hypertension with different cardiovascular risk under the influence of the prescribed treatment during a year of observation. The first group (with a moderate risk of cardiovascular events) included 48 patients with arterial hypertension (AH). The second group consisted of 54 patients with hypertension and a high risk of cardiovascular events, namely type 2 diabetes. Each group of patients was randomized into two subgroups by blood pressure (BP) medication. In patients of subgroup 1a (n=29) and subgroup 2a (n=35) – the main subgroups – the therapy necessarily included the angiotensin II receptor antagonist losartan potas­sium in a dosage of 50-150 mg/day, depending on the blood pressure level. Patients of subgroup 1b (n=19) and subgroup 2b (n=19) – comparison subgroups were treated with antihypertensive drugs of other first-line groups according to the data of the unified clinical protocol for the treatment of hypertension. According to the ROC analysis, it was determined that the dynamics of endothelin-1 (ET-1) indicators after 9 and 12 months of therapy (a decrease of 12% or more from the initial level) can predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity and specificity – 85% (95% CI 62.1-96.6%) and 92.9% (95% CI 76.5-98.9%), respectively. A decrease in the level of Willebrand factor (fV) by 23% or more due to such a treatment time can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 75% (95% CI 50.9-91.2%), specificity – 100% (95% CI 87.5-100%). According to the given data, both in the group with moderate and with high cardiovascular risk, there is a relationship between endothelial dysfunction (ED) and the duration of hypertension, indicators of the lipid spectrum and abdominal obesity – factors that increase the viscous resistance of the blood circulation, as well as platelet hyperactivity in the bloodstream. We have also established that according to the dynamics of ET-1 indicators after 9 and 12 months of therapy (decrease by 27% or more from the initial level), it is possible to predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity – 81.8% (95% CI 59.7-94.7%), specificity – 90.6% (95% CI 75-97.9%). A decrease in the level of fV by 24.5% or more after a year of treatment can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 68.2% (95% CI 45.1-86.1%), specificity – 71.9% (95% CI 53.3-86.2%). The obtained results testify to the dominant role of type 2 diabetes as a factor in platelet disorders of hemostasis. Taking into account the positive dynamics of the above-mentioned markers of ED during the year of treatment, their relationship with the reduction of blood pressure, indicators of the lipid spectrum and abdominal obesity, it should be noted the positive effect of angiotensin II receptor blockers (BRA II) as endothelioprotective drugs. Considering the irrefutable literary data about the absence of thrombomodulin in the blood stream, even its insignificant appearance indicates the presence of endothelial dysfunction. Determining the state and dynamics of changes in endothelial function under the influence of prescribed therapy will make it possible to improve the diagnosis of endothelial function disorders and increase the effectiveness of treatment of patients with hypertension and various cardiovascular risks.

Key words: arterial hypertension, endothelial dysfunction, cardiovascular risk, Diabetes Mellitus type 2, endothelin-1, thrombomodulin, von Willebrand factor

1. Mancia G, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Journal of Hypertension. 2023;41(12):1874-2071. doi: https://doi.org/10.1097/HJH.0000000000003480
2. Guanghong J, Sowers J. Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease. Hypertension.2021;78(1):1197-205. doi: https://doi.org/10.1161/HYPERTENSIONAHA.121.17981 
3. Jankowich M, Choudhary G. Endothelin-1 levels and cardiovascular events. Trends Cardiovasc Med. 2020 Jan;30(1):1-8. doi: https://doi.org/10.1016/j.tcm.2019.01.007
4. Lancellotti S, Sacco M, Basso M, Cristofaro R. Mechanochemistry of von Willebrand factor.Bio­mo­lecular 2019;10(1):194-208. doi: https://doi.org/10.1515/bmc-2019-0022
5. Giri H, Cai X, Panicker SR, Biswas I, Rezaie AR. Thrombomodulin Regulation of Mitogen-Activated Pro­tein Kinases. Int J Mol Sci. 2019 Apr 15;20(8):1851. doi: https://doi.org/10.3390/ijms20081851
6. Pertseva NO, Chub DI. [Peculiarities of the daily blood pressure profile in patients with diabetes depending on endothelial dysfunction]. International Journal of Endocrinology.2018;14(2):131-7.  doi: https://doi.org/10.22141/2224-0721.14.2.2018.130556
7. Yang Q, Wijerathne H, Langston JC, Kiani MF, Kilpatrick LE. Emerging Approaches to Understanding Microvascular Endothelial Heterogeneity: A Roadmap for Developing Anti-Inflammatory Therapeutics. International Journal of Molecular Sciences. 2021;22(15):7770. doi: https://doi.org/10.3390/ijms2215777
8. Gerych MS, Sinyavska OO. [Mathematical statis­tics: a study guide]. Uzhhorod; 2021. 146 p. Ukrainian.
9. Flack J, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med.2020 Apr;30(3):160-4. doi: https://doi.org/10.1016/j.tcm.2019.05.003
10. Drożdż D, Drożdż M, Wójcik M. Endothelial dys­function as a factor leading to arterial hypertension. Pediatric Nephrology. 2023;38(9):2973-85. doi: https://doi.org/10.1007/s00467-022-05802-z 

Look through:

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

Turlyun T.S. Dnipro State Medical University, Dnipro, Ukraine, e-mail: turlyunt@gmail.com
https://orcid.org/0000-0001-5208-9121

Sanina N.A. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-6603-0219

Pertseva N.O., Turlyun T.S., Sanina N.A. Dynamics of endothelial function in patients with arterial hypertension with different cardiovascular risk against the background of antihypertensive therapy. Medicni perspektivi. 2024;29(3):123-128.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313592

Results of surgical treatment of patients with acute destructive diverticulitis of the colon using minimally invasive technologies

The number of patients with oral lichen planus (OLP) has increased due to the raise of aggressive forms of the disease (erosive, ulcerative and hyperkeratotic forms) with a possible risk of malignancy. There are isolated researches which indicate a genetic determinism to OLP, but more often these conclusions are based on insufficiently adequate and out of date methods, which make it impossible to correctly interpret the obtained data. The aim was to identify a genetical predisposition with a programmed risk to the oral lichen planus. The main group – 278 patients with the OLP (aged 26-65 years). The control group – 298 people (blood donors) who didn’t have dental diseases, as well as diseases of internal organs and systems. The groups were homogeneous by gender and age. In our research we used such methods: clinical, radiological, immunogenetic, statistical methods were used. The erosive form of OLP was associated with 0(I) group in 54.2±0.4% of cases, while the hyperkeratotic form was associated with group 0(I) only in 28.7±1.8% of cases. B(ІІІ) and AB(ІB) groups were less often associated with the erosive form of OLP and were observed in 17.3±0.1% and 2.0±0.1% of cases, respectively. The integration of A(ІІ) group in the erosive form of OLP was 30.5±0.1%, but the indicator was higher than in individuals with B(III) and AB(IV) groups. Hyperkeratotic form of OLP was more often observed in A(II) carriers than in 0(I) and was 44.1±0.1% versus 28.7±1.8%, respectively. With blood group B (ІІІ), the relationship with OLP is not traced. Correlative relationship with erythrocyte blood antigens of the ABO system in patients with oral lichen planus was established. Risk groups for the development of erosive and hyperkeratotic forms of lichen planus in patients with gastrointestinal tract pathology O(I)>A(II)>B(III) – with erosive form and A(II)>O(I)>B(III)) – with hyperkeratosis. 

Key words: oral mucosa, oral lichen planus, erythrocyte blood systems, genetic determinism, occlusal correlation of the jaws

1. Nicolas-Rodriguez E, Pons-Fuster E, López-Jor­net P. Diagnostic Infrared Thermography of the Tongue and Taste Perception in Patients with Oral Lichen Planus: Case-Control Study. J Clin Med. 2024 Jan 12;13(2):435. doi: https://doi.org/10.3390/jcm13020435
2. Jalenques I, Lauron S, Almon S, Pereira B, D'In­can M, Rondepierre F. Prevalence and Odds of Signs of Depression and Anxiety in Patients with Lichen Planus: Systematic Review and Meta-analyses. Acta Derm Venereol.2020 Nov 24;100(18):adv00330. doi: https://doi.org/10.2340/00015555-3660
3. Birckel E, Lipsker D, Cribier B. [Efficacy of pho­topheresis in the treatment of erosive lichen planus: A ret­ros­pective study]. Ann Dermatol Venereol. 2020 Feb;147(2):86-92. doi: https://doi.org/10.1016/j.annder.2019.02.011
4. Louisy A, Humbert E, Samimi M. Oral Lichen Planus: An Update on Diagnosis and Management. Am J Clin 2024 Jan;25(1):35-53. doi:  https://doi.org/10.1007/s40257-023-00814-3
5. González-Moles MÁ, Ruiz-Ávila I, González-Ruiz L, et al. Malignant transformation risk of oral lichen planus: a systematic review and comprehensive meta-analysis.Oral  2019;96:121-130. doi: https://doi.org/10.1016/j.oraloncology.2019.07.012
6. Jalenques I, Lauron S, Almon S, Pereira B, D'In­can M, Rondepierre F. Prevalence and Odds of Signs of Depression and Anxiety in Patients with Lichen Planus: Systematic Review and Meta-analyses. Acta Derm Venereol.2020 Nov 24;100(18):adv00330. doi: https://doi.org/10.2340/00015555-3660
7. Simons G, Caplan J, DiSantostefanoRL, Veld­wijk J, Englbrecht M, Bywall KS, et al. Systematic review of quantitative preference studies of treatments for rheu­matoid arthritis among patients and at-risk populations. Arthritis Res  2022 Feb 22;24(1):55. doi: https://doi.org/10.1186/s13075-021-02707-4
8. Keller LM, Lombardi T. Gingival lichen planus: A clinical and pathological study. J Stomatol Oral Maxillofac Surg.2023 Feb;124(1S):101354. doi: https://doi.org/10.1016/j.jormas.2022.101354
9. De Porras-Carrique T, González-Moles MÁ, War­nakulasuriya S, Ramos-García P. Depression, anxiety, and stress in oral lichen planus: a systematic review and meta-analysis. Clin Oral Investig. 2022 Feb;26(2):1391-408. doi: https://doi.org/10.1007/s00784-021-04114-0
10. Kim TJ, Kim YG, Jung W, Jang S, Ko HG, Park CH, et al. Non-Coding RNAs as Potential Targets for Diagnosis and Treatment of Oral Lichen Planus: A Narrative Biomolecules. 2023 Nov 13;13(11):1646. doi: https://doi.org/10.3390/biom13111646
11. Philipone EM, Peters SM. Ulcerative and Inflam­matory Lesions of the Oral Mucosa. Oral Maxillofac Surg ClinNorth  2023 May;35(2):219-26. doi: https://doi.org/10.1016/j.coms.2022.10.001
12. Antonenko M, Palamarchuk S, Reshetnyk L, She­melko M, Palamarchuk M. Vitamin D3 and the system of oxidative stress-antioxidant protection in the pathogenesis and treatment of generalized parodontitis associated with anorexia nervosa.  International Journal of Medical Den­tistry [Internet]. 2023 Jan-Mar [cited 17 Dec 2023];(1):45-53. Available from: https://ijmd.ro/2023/vitamin-d3-and-the-system-of-oxidative-stress-antioxidant-protection-in-the-pathogenesis-and-treatment-of-generalized-parodontitis-associated-with-anorexia-nervosa/
13. Proschenko AM, Proschenko NS, Shemelko ML, Reshetnyk LL, Chervonna NV, Sorokina KO. Assessment of the quality of treatment of patients with functional disorders of the dento-magular apparatus combined with dentoalveolar form of deep bite. Clin and prev med. [Internet]. 2024 Jun 17 [cited 17 Dec 2023];(4):26-32. Availablefrom: https://cp-medical.com/index.php/jour­nal/article/view/418
    doi: https://doi.org/10.31612/2616-4868.4.2024.04
14. Shirobokov VP. [Medical microbiology, virology, immunology: a text book for English-speaking students of higher medical schools]. Vinnytsia: Nova Knyha; 2019. 744 p. Ukrainian.
15. Hruzieva TS, Lekhan VM, Ohniev VA, Ha­liien­ko LI, Kriachkova LV, Palamar BI, et al. [Biostatistics]. Vinnytsia: New Book; 2020. 384 p. Ukrainian.

Look through:

Proschenko A.M. Bogomolets National Medical University, Kyiv, Ukraine 
https://orcid.org/0000-0003-0847-1408

Proschenko N.S. Bogomolets National Medical University, Kyiv, Ukraine 
https://orcid.org/0000-0001-7317-6590

Zelinskaya N.A. Bogomolets National Medical University, Kyiv, Ukraine 
https://orcid.org/0000-0003-0383-349X

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

Chervonna N.V. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0003-4499-5399

Bida O.V. Bogomolets National Medical University, Kyiv, Ukraine 
https://orcid.org/0000-0002-6038-6545

Proschenko A.M., Proschenko N.S., Zelinskaya N.A., Reshetnyk L.L., Chervonna N.V., Bida O.V. Peculiarities of the format of genetic blood systems in patients with oral lichen planus. Medicni perspektivi. 2024;29(3):128-137.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313595

Altruistic values among students of Nursing, Midwifery, Physiotherapy, and Health Psychology: a cross-sectional study

Multiple sclerosis is a chronic autoimmune inflammatory disease that affects the brain and spinal cord. The most common form of this disease according to the type of its course is relapsing-remitting multiple sclerosis. Comorbidity in multiple sclerosis is an urgent problem of modern neurology, since it can influence such factors as the time of diagnosis, the rate of disease progression and the rate of patient disability, the number of exacerbations and the patient’s quality of life. The purpose of the work was to study and characterize comorbidity in patients with relapsing multiple sclerosis. To conduct this study 105 patients with a diagnosis of relapsing-remitting multiple sclerosis were enrolled. All patients were assessed using the Multiple Sclerosis Neurological Disability Severity Scale (EDSS). Study participants were divided into two groups – Group 1 and Group 2 – based on EDSS scores. Separately, study participants were divided into groups based on the principle of receiving pain-modifying therapy. In the 1st study group, concomitant diseases were in 57 (78.1%) patients, in the 2nd group – in 100% (p=0.010). In patients who did not receive pain-modifying therapy, 57 (98.3%) of those examined had concomitant diseases, in those who received such treatment – in 32 (68.1%), which was statistically significantly less (p<0.001). In the first place in terms of the frequency of concomitant pathology among all examined patients were diseases of the gastrointestinal tract, which also dominated in the 1st and 2nd observation groups, in the second place – diseases of the urinary system, in the third place – eye diseases, and in the last place, by the frequency of concomitant diseases – cardiovascular diseases. Comorbidity in multiple sclerosis is an extremely relevant problem in modern neurology due to its significant impact on the clinical picture of the disease, its course and the degree of disability of the patient. Digestive system disease is one of the most common comorbid conditions in multiple sclerosis. The number of patients with comorbid conditions is higher among patients with a moderate degree of disability and among patients not taking disease-modifying therapy, but the relationship between the degree of disability, treatment and comorbid conditions requires further study.

Key words: comorbidity, relapsing-remitting multiple sclerosis, disability, concomitant diseases

1. Somilo OV, Makarov SO, Kalbus OI, Soro­kin AV. [Anxiety and depression in patients with multiple sclerosis]. Medicni perspektivi. 2023;28(2):106-11. Ukrainian. doi: https://doi.org/10.26641/2307-0404.2023.2.283349
2. Dobson R, Giovannoni G. Autoimmune disease in people with multiple sclerosis and their relatives: a syste­matic review and meta-analysis. J Neurol. 2013;260:1272-85. doi: https://doi.org/10.1007/s00415-012-6790-1
3. Gascoyne CR, Simpson S, Chen J, van der Mei I, Marck CH. Modifiable factors associated with depression and anxiety in multiple sclerosis. Acta Neurol Scand. 2019;140:204-11. doi: https://doi.org/10.1111/ane.13132
4. Ge F, Huo Z, Li C, et al. Lung cancer risk in pa­tients with multiple sclerosis: a mendelian randomization analysis. Mult Scler Relat Disord. 2021;51:102927. doi: https://doi.org/10.1016/j.msard.2021.102927
5. Grytten N, Myhr KM, Celius EG, et al. Risk of cancer among multiple sclerosis patients, siblings, and population controls: a prospective cohort study. Mult Scler. 2020;26(12):1569-80. doi: https://doi.org/10.1177/1352458519877244
6. Kosmidou M, Katsanos AH, Katsanos KH, et al. Multiple sclerosis and inflammatory bowel diseases: a sys­tematic review and meta-analysis. J Neurol. 2017;264:254-9. doi: https://doi.org/10.1007/s00415-016-8340-8
7. Kurtzke JF. Rating neurologic impairment in mul­tiple sclerosis: An expanded disability status scale (EDSS). Neurology.1983;33(11):1444. doi: https://doi.org/10.1212/WNL.33.11.1444
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10. Marrie RA, Tremlett H, Kingwell E, et al. Dispa­rities in management and outcomes of myocardial in­farction in multiple sclerosis: a matched cohort study. MultipleSclerosis  2020;26(12):1560-8. doi: https://doi.org/10.1177/1352458519876038
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12. Ogino M, Shiozawa A, Ota H, et al. Treatment and comorbidities of multiple sclerosis in an employed popu­lation in Japan: analysis of health claims data. Neurode­generativeDis  2018;8(2):97-103.  doi: https://doi.org/10.2217/nmt-2017-0047
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Look through:

Somilo O.V. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0003-4429-8884

Makarov S.O. Dnipro State Medical University, Dnipro, Ukraine, e-mail: makarov295062@gmail.com
https://orcid.org/0000-0002-3106-9727

Kalbus O.I. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-0796-4825

Somilo O.V., Makarov S.O., Kalbus O.I. Comorbidity in in patients with relapsing-remitting multiple sclerosis. Medicni perspektivi. 2024;29(3):137-143.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313600

Assessment of adolescent physical development using body mass index and body self-perception

The article presents the study results of resiliency modalities and the content of psychoeducational measures for higher education seekers in war conditions. The purpose of the study was to increase the effectiveness and to balance resiliency modalities use by higher education seekers in war conditions while using psycho-educational measures. 174 seekers of higher education were examined, including 144 students of the 4th-6th year of the medical faculty and the faculty of medicine and pharmacy of the Dnipro State Medical University, specializing in 222 «Medicine» (main group) and 30 students of the 4th-5th year of the metallurgical and electro-metallurgical faculties of the Ukrainian State University of Science and Technology (comparison group). A psy­chodiagnostic method using the resource-oriented model of stress resiliency "BASIC Ph" was employed. The first stage involved a statistical analysis of resiliency modalities and their average scores in both groups. In all participants of the main group, it was found that the highest average score was registered in the resiliency modality “Cognitive strategy”. The lowest score was observed for the “Social support” modality. In all participants of the comparison group, it was found that the “Cognitive strategy” modality, as in the main group, had a clear advantage over other modalities, and the lowest score was already observed for the “Emotions” modality. These results formed the basis for creating psychoeducational measures for stress resiliency among higher education seekers in wartime. Psychoeducation for higher education seekers was conducted from September to November 2023, including lectures and individual conversations upon request. The «BASIC Ph» model of stress resiliency was utilized as a framework for determining optimal human resource utilization during crises, with six modalities forming individual style of resiliency. It is crucial to identify dominant modalities and develop those that are less effective. The identified stress resiliency modalities provided a conceptual basis for developing of psychoeducational measures to enhance their effective and balanced use in war situations among higher education seekers. During psychoeducational work with higher education seekers, their resiliency models were analyzed, interpreted, and balanced. Study results should be taken into account in psychological support efforts for higher education seekers in war and post-war time.

Key words: psychoeducation, higher education seekers, resiliency, resources, modalities, war

1. Riad A, Drobov A, Krobot M, Antalová N, Alka­saby MA, Peřina A, et al. Mental Health Burden of the Russian-Ukrainian War 2022 (RUW-22): Anxiety and Depression Levels among Young Adults in Central Europe. Int J Environ Res Public Health. 2022 Jul 9;19(14):8418. doi: https://doi.org/10.3390/ijerph19148418
2. Gardani M, Bradford DRR, Russell K, Allan S, Beat­tie L, Ellis JG, et al. A systematic review and meta-analysis of poor sleep, insomnia symptoms and stress in undergra­duate Sleep Med Rev. 2022 Feb;61:101565. doi: https://doi.org/10.1016/j.smrv.2021.101565
3. van Voren R, Andreescu C. Ukrainian Mental Health – A Report From the War. Am J Geriatr Psychiatry. 2022 Aug;30(8):940-3. doi: https://doi.org/10.1016/j.jagp.2022.04.004
4. Danese A, Martsenkovskyi D. Editorial: Measu­ring and Buffering the Mental Health Impact of the War in Ukraine in Young People. J Am Acad Child Adolesc Psychiatry.2023 Mar;62(3):294-6. doi: https://doi.org/10.1016/j.jaac.2022.11.001
5. Lahad M. From victim to victor: The development of the BASIC PH model of coping and resiliency. Traumatology. 2017;23:27-34. doi: https://doi.org/10.1037/trm0000105
6. Ohorenko VV, Nikolenko AI, Shusterman TI, Ko­kashynskyi VO. [Resource-oriented model of stress mana­gement in higher education students in war conditions]. Medicni perspektivi. 2023;28(3):94-109. Ukrainian. doi: https://doi.org/10.26641/2307-0404.2023.3.289204
7. Ang WHD, Shorey S, Hoo MXY, Chew HSJ, Lau Y. The role of resilience in higher education: A meta-ethnographic analysis of students' experiences. J Prof Nurs. 2021 Nov-Dec;37(6):1092-109. doi: https://doi.org/10.1016/j.profnurs.2021.08.010
8. The Universal Declaration on Bioethics and Human Rights. International Social Science Journal. 2005;57(186):745-53.
   doi: https://doi.org/10.1111/j.1468-2451.2005.00592.x
9. World Medical Association Declaration of Hel­sinki. 2013;310(20):2191. doi: https://doi.org/10.1001/jama.2013.281053
10. Cataldo R, Arancibia M, Stojanova J, Papu­zin­ski C. General concepts in biostatistics and clinical epi­demiology: Observational studies with cross-sectional and ecological designs. Medwave. 2019 Sep 25;19(8):e7698. doi: https://doi.org/10.5867/medwave.2019.08.7698

Look through:

Ogorenko V.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-0549-4292

Nikolenko A.E. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-5523-8858

Shusterman T.Y. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-5422-1624

Kokashynskyi V.O. Dnipro State Medical University, Dnipro, Ukraine, e-mail: viltord.koka16@gmail.com
https://orcid.org/0000-0002-6191-3757

Khotimska A.B. Charitable organization «Charitable Foundation Resolute Hearts», Dnipro, Ukraine
https://orcid.org/0009-0005-8806-7713

Koren M.H. Municipal Enterprise "Dnipropetrovsk multidisciplinary clinical hospital for the provision of psychiatric care" Dnipropetrovsk Regional Council”, Dnipro, Ukraine
https://orcid.org/0009-0009-7072-3494

Ogorenko V.V., Nikolenko A.E., Shusterman T.Y., Kokashynskyi V.O., Khotimska A.B., Koren M.H. Psychoeducation of higher education seekers with using of the resource-oriented model of stress resiliency in war conditions. Medicni perspektivi. 2024;29(3):144-150.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313660

Health and school difficulties of children in foster care in the experience of their foster parents

Dental caries is one of the most common health problems. The aim of the research was to study the spectrum of microbiota, which is part of the dental biofilm, and its biological properties. The study involved 90 participants of the study group and 20 of the control group. Dental plaque and saliva were used as principal clinical specimens. The main research method was bacteriological. All samples from study participants were positive for microbiota. At the initial collection of material, 395 unique isolates were obtained: 338 from patients with caries and 57 from healthy volunteers. The microbiocenosis of the oral cavity associated with the development of caries contained such eudodominants as Streptococcus mutans, Peptostreptococcus spp., Fusobacterium spp., Prevotella spp. and dominants Streptococcus pyogenes, Enterobacterales, Prevotella spp. and Candida albicans. In contrast the eudominants of the healthy oral cavity were microorganisms with known commensal properties, in particular Streptococcus salivarius, Aerococcus viridans, Veillonella spp. After the dental treatment, significant shifts in the taxonomic composition of the dental biofilm were observed. Therefore, the composition of the oral cavity microbiocenosis in participants who underwent restoration of the dental crown defects with zirconium inserts approached patients to the healthy cohort participants. The eudodominants of the oral microbiocenosis of the participants who underwent direct restoration were S. mitis, Peptostreptococcus spp. and Veillonella spp. In zirconium restoration, the commensals S. salivarius and A. viridans were eudodominants. The obtained isolates of opportunists possessed high virulence properties. Streptococcus spp. cultures were sensitive to norfloxacin screening in only 28.6% of cases. Among cultures of the genus Staphylococcus, 23.8% were methicillin resistant. Representatives of Enterobacterales had chemotherapeutic sensitivity that varied significantly depending on the group of antimicrobial agents. Using disks with phenylboronic acid, ethylenediaminetetraacetic acid and cloxacillin, it was established that Klebsiella spp. were producers of class A carbapenemases (n=3) and contained AmpC (n=3). Carbapenemases were also produced by at least 65.2% of the studied cultures of non-fermenting gram-negative microorganisms. In our study, all obtained isolates were also endowed with the ability to form a biofilm. Therefore, microbiological research in dentistry should be considered as one of the objective methods for assessment of health of the oral cavity and will also have advantages in choosing a method of correcting defects of dental crown parts and in some cases, making an informed decision about the prescription of antimicrobial treatment.

Key words: bacteria, fungi, microbiological study, microbiota, microbiocenosis, resistance, biofilms, adhesiveness

1. Giacaman RA, Fernández CE, Muñoz-Sando­val C, León S, García-Manríquez N, Echeverría C, et al. Understanding dental caries as a non-communicable and behavioral disease: Management implications. Front Oral Health.2022;3:64479. doi: https://doi.org/10.3389/froh.2022.764479
2. Thanetchaloempong W, Koontongkaew S, Utis­pan K. Fixed Orthodontic Treatment Increases Carioge­nicity and Virulence Gene Expression in Dental Biofilm. J Clin 2022;11(19):5860. doi: https://doi.org/10.3390/jcm11195860 
3. Spatafora G, Li Y, He X, Cowan A, Tanner ACR. The Evolving Microbiome of Dental Caries. Micro­organisms.2024;12(1):121. doi: https://doi.org/10.3390/microorganisms12010121 
4. Trottini M, Campus G, Corridore D, Cocco F, Cagetti MG, Vigo MI, et al. Assessing the Predictive Performance of Probabilistic Caries Risk Assessment Models: The Importance of Calibration. Caries Res. 2020;54(3):258-65. doi: https://doi.org/10.1159/000507276
5. Carroll CK, Pfaller AM. Manual of Clinical Mic­ro­biology, 4 Volume Set. 13-st ed. ASM Books; 2023. 3456 p.
6. Efimenko AO, Ishchenko OV. [Features of micro­biological research in dental practice]. Perspektyvy ta innovatsiyi nauky. 2023;14(32):969-86. Ukrainian. doi: https://doi.org/10.52058/2786-4952-2023-14(32)-969-986
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8. Ishchenko OV, Plotnikova MM, Stolye­to­va YuYu, Sharun OV, Stepanskyi DO. [The influence of different concentrations of pectin on the adhesive properties of clinical isolates obtained from patients with cystic fibrosis.] Vistnyk problem biolohiyi i medytsyny. 2020;1(155):137-40. doi: https://doi.org/10.29254/2077-4214-2020-1-155-137-140
9. Toc DA, Csapai A, Popa F, Popa C, Pascalau V, et al. Easy and Affordable: A New Method for the Studying of Bacterial Biofilm Formation. Cells. 2022;11(24):4119. doi: https://doi.org/10.3390/cells11244119
10. Ryzhov OA, Penkin YuM. [Statistical methods of processing the results of medical and biological research]. Magnolia; 2022. 160 p. Ukrainian.
11. Zhang L, Chen X, Ren B, Zhou X, Cheng L. Heli­cobacter pylori in the Oral Cavity: Current Evidence and Potential Survival Strategies. Int J Mol Sci.2022 Nov 7;23(21):13646. doi: https://doi.org/10.3390/ijms232113646  
12. Zhu Y, Wang Y, Zhang S, Li J, Li X, Ying, et al. Association of polymicrobial interactions with dental caries development and prevention. Front Microbiol. 2023;14:1237596. doi: https://doi.org/10.3389/fmicb.2023.1237596
13. Lei L, Long L, Yang X, Qiu Y, Zeng Y, Hu T, et al. The VicRK Two-component system regulates Strepto­coccus mutans virulence. Curr Issues Mol Biol. 2019;32:167-200. doi: https://doi.org/10.21775/cimb.032.167
14. Acet Ö, Erdönmez D, Acet B, Odabaşı M. N-acyl homoserine lactone molecules assisted quorum sensing: Effects consequences and monitoring of bacteria talking inreal life. Arch Microbiol. 2021;203:3739-49. doi: https://doi.org/10.1007/s00203-021-02381-9
15. Lu Y, Lin Y, Li M, He J. Roles of Streptococcus mutans-Candida albicans interaction in early childhood caries: a literature review. Front Cell Infect Microbiol. 2023 May 16;13:1151532.
    doi: https://doi.org/10.3389/fcimb.2023.1151532
16. Li Y, Huang S, Du J, Wu M, Huang X. Current and prospective therapeutic strategies: tackling Candida albicans and Streptococcus mutans cross-kingdom biofilm.Front Cell Infect Microbiol. 2023;13:1106231. doi: https://doi.org/10.3389/fcimb.2023.1106231
17. Kim HE, Liu Y, Dhall A, Bawazir M, Koo H, Hwang G. Synergism of Streptococcus mutans and Can­dida albicans Reinforces Biofilm Maturation and Acidogenicity in Saliva: An In Vitro Study. Front Cell Infect 2021 Feb 19;10:623980. doi: https://doi.org/10.3389/fcimb.2020.623980   
18. Contaldo M, Lucchese A, Lajolo C, Rupe C, Di Stasio D, Romano A, et al. The Oral Microbiota Changes in Orthodontic Patients and Effects on Oral Health: An Overview.J Clin  2021;10(4):780. doi: https://doi.org/10.3390/jcm10040780
19. Ionescu AC, Hahnel S, Delvecchio P, Ilie N, Moldovan M, Zambelli V, et al. Microbiological models for accelerated development of secondary caries in vitro. J Dent.2022;127:104333. doi: https://doi.org/10.1016/j.jdent.2022.104333
20. Bollen C, Hakobayan G, Jörgens M. One-piece versus two-piece ceramic dental implants. Br Dent J. 2024;236(5):383-7.
    doi: https://doi.org/10.1038/s41415-024-7123-3
21. D’Ambrosio F, Santella B, Di Palo MP, Giorda­no F, Lo Giudice R. Characterization of the Oral Mic­robiome in Wearers of Fixed and Removable Implant or Non-Implant-Supported Prostheses in Healthy and Pathological Oral Conditions: A Narrative Review. Micro­organisms.2023;11(4):1041. doi: https://doi.org/10.3390/microorganisms11041041
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24. Kiros A, Saravanan M, Niguse S, Gebreg­ziab­her D, Kahsay G, Dhandapani R, et al. Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Fac­tors among Dental Caries-Suspected Patients Attending the Ayder Comprehensive Specialized Hospital and Private Dental Clinic in Mekelle, Northern Ethiopia. Biomed Res Int.2022;2022:3463472. doi: https://doi.org/10.1155/2022/3463472
25. Philips OO, Timothy O, Charlse II, Osa­muyi­men I. Susceptibility Pattern of Bacterial Isolates from Dental Caries Patients Attending Clinic at Irrua Specialist Teaching Hospital, Irrua, Nigeria. J Biomed Res Environ Sci. 2021;2(9):784-9. doi: https://doi.org/10.37871/jbres1311

Look through:

Sardykov Ye.A. Dnipro State Medical University, Dnipro, Ukraine, e-mail: eugenesea2021@gmail.com
https://orcid.org/0009-0006-9303-0074

Ishchenko O.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-7677-5062

Fastovets O.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-2769-3244

Sardykov Ye.A., Ishchenko O.V., Fastovets O.O. Oral microbiocenosis state under different approaches of replacing dental crown defects. Medicni perspektivi. 2024;29(3):151-161.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313603

Diagnostic value of the gingival cytogram in school-age children suffering from chronic gastritis and duodenitis

Purpose – to evaluate the demographic and clinical characteristics and treatment efficiency of patients by vitrectomy due to retinal detachment against the background of combined eye pathologies. The observation was conducted in the Clinic of Educational Surgery of the Azerbaijan State Medical Institute named after A. Aliyev. The case histories of 500 patients diagnosed with retinal detachment against the background of combined eye pathologies were studied by random sampling, 197 of whom underwent vitrectomy. Data on the demographic and clinical characteristics of these patients were collected. Before the operation, visual acuity and intraocular pressure were assessed. Information on registered complications after the operation, the results of optical coherence tomography on day 10 after treatment, as well as visual acuity indicators were provided for in the observation program and obtained in a standard manner for all patients. The obtained results were processed statistically using the "data analysis" package of the Excel program. The collected data were grouped by variants of features, the specific weight of each group and subgroup in the aggregate was calculated. The obtained data showed that in 197 (34.9±2.2%) patients with retinal detachment against the background of combined pathologies who underwent vitrectomy, the gender difference was not significant. The overwhelming majority of patients were admitted for treatment with a great delay. Basically, combined pathologies of the cornea (16.2%), lens (45.2%) and vitreous body (5.3%) prevailed. Combined eye pathologies in patients with retinal detachment during vitrectomy are often complicated by choroidal rupture (4.1%), increased intraocular pressure (7.6%), diplopia (3.6%), hemophthalmos (2.5%) and cataract (22.8%). The main etiologic factors of retinal detachment against the background of combined eye pathologies are myopia (50.3%), eye injuries (30.9%).

Key words: retinal detachment, vitrectomy, ocular pathology, demography

1. Sindal MD, Gondhale HP, Srivastav K. Clinical profile: and outcomes of rhegmatogenous retinal deta­chment related to trauma in pediatric population. Can J Ophthalmol.2021;56(4):231-6. doi: https://doi.org/10.1016/j.jcjo.2020.12.001
2. Lakshmi J, Faraz J, Reddy L. Clinical profile of patients presenting with rhegmatogenous retinal deta­chment. Med Pulse International Journal of Ophthal­mology.2017;3(3):87-91. doi: https://doi.org/10.26611/10093311
3. Awan MA, Hussain Z, Shaheen ZS, et al. Ef­ficacy and safety profile of 25-Gauge Pars Plana vitrectomy in rhegmatogenous retinal detachment in Pakistan: A multicenter retrospective study. Cureus. 2022 Mar 24;14(3):23437. doi: https://doi.org/10.7759/cureus.23437
4. Sung J, Lee M, Won Y, et al. Clinical cha­racteristics and prognosis of total rhegmatogenous retinal detachment: a matched case-control Study. BMC Ophthalmology.2020;20:286. doi: https://doi.org/10.1186/s12886-020-01560-4
5. Shchukin AD. Modern extrascleral surgery in the treatment of rhegmatogenous retinal detachment: asses­sment of the effectiveness of application and functional results. Ophthalmological Bulletin. 2019;12(4):23-8. doi: https://doi.org/10.17816/OV18780
6. Arevalo F, Ong S, Sulaiman M. Retinal deta­chment: Vitrectomy, bucle, or both? Retina today. 2022;April:17-78.
7. Zgolli H, Mabrouk S, Khayrallah O. Prognostic factors for visual recovery in idiopathic rhegmatogenous retinal detachment: a prospective Study of 90 patients. La Tunisie Medicale. 2021;99(10):972-9. PMID: 35288898. PMCID: PMC8972183.
8. Chang JS, Smiddy W. Cost-effectivenes of retinal detachment repair. Ophthalmology. 2014;12(4):946-51. doi: https://doi.org/10.1016/j.ophtha.2013.11.003
9. Liao L, Zhy X. Advances in the treatment of rhegmatogenous retinal detachment. Int J Ophthalmology. 2019;12(4):660-7. doi: https://doi.org/10.18240/ijo.2019.04.22
10. Lv Z, Li Y, Wu Y. Surgical complications of pri­mary rhegmatogenous retinal detachment: a meta-analysis. PLOS 2015;10(3):0116493. doi: https://doi.org/10.1371/journal.pone.0116493
11. Bai Y, Song Q, Liu J. Vitrectomy for complicated retinal detachment without the use of perfluorocarbon liquid: a real-word date and retrospective study. Opthalmol Ther. 2022;11:857-68. doi: https://doi.org/10.1007/s40123-022-00479-x

Look through:

Ismailov G.M. Azerbaijan State Medical Institute named after A.Aliyev, Baku, Republic of Azerbaijan
e-mail: doc.nasibova.esmira@gmail.com

Ismailov G.M. Demographic and clinical characteristics and effectiveness of treatment of patients with combined ocular pathologies by vitrectomy due to retinal detachment. Medicni perspektivi. 2024;29(3):162-166.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313666

Results of biochemical and histological studies after restoration of bone defects using cellular technologies in dental patients

People with long-term physical disabilities also suffer from different types and nature of tumors as well as general population. Unfortunately, the information about the frequency of these diseases among the specified contingent is very deficient. The objectives of the study were to determine the incidence of benign and malignant neoplasia among the adults and elderly with physical disabilities and to indicate the risk factors for the appearance and development of tumors in this population. In this descriptive survey, 186 people, living in the largest home on the Balkan Peninsula for adults and elderly people with long-term physical disabilities were studied in 2021. 82.79% of the residents were over 51 years of age and almost all of them are inhabited by two residents. 42.47% of the respondents were men and 57.52% – women. Data on the demographic characteristics of the respondents, including their personal lifestyle and self-reported diagnosis of presence and/or history of a tumor formation, were collected through a semi-structured interview. The verification of the collected information about the incidence of benign and malignant lesions among adults with physical disabilities was carried out by means of the application of the second research method – content analysis based on the medical records. For processing and analysis of the collected data, it was used statistical software – IBM SPSS Statistics V21.0. The results showed a significantly high rate in the prevalence of tumor formations in the sample – 24.19%. The pre-cancerous formations have the highest incidence among residents – 42.22% with the most common variant – chronic form of cholecystitis combined with cholelithiasis (37.77%). Prostatic hyperplasia and uterine leiomyoma are the leading benign lesions in male residents – 11.11%, in female respondents – 11.11% respectively. The predominant form of cancer is breast carcinoma – 8.88%. The research found a high prevalence of tumor formations among adult patients with long-term physical disabilities. The harmful impact of a number of behavioral habits and health determinants significantly contributes to this negative tendency.

Key words: tumor formations, incidence, people with long-term physical disabilities

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Look through:

S. Alekova Todorova Trakia University, Stara Zagora, Bulgaria, e-mail: sevdalina.alekova@abv.bg
https://orcid.org/0000-0002-0443-5891

S. Alekova Todorova The incidence of benign and malignant tumors among adults with long-term physical disabilities. Medicni perspektivi. 2024;29(3):166-175.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313671

Indicative features of tissue and microbial sensitization in the pathogenesis of generalized parodontitis associated with rheumatoid arthritis

Transcranial direct current stimulation (tDCS) in the treatment of post-traumatic stress disorder (PTSD) is used to strengthen the inhibitory control of amygdala activity. However, there are still limited meta-analytic studies examining different tDCS protocols on core PTSD symptoms and the relationship between stimulation parameters and effect size. The objective is to investigate the effectiveness of such an intervention, which is a complex combination of a psychotherapy program with tDCS in the treatment of patients with PTSD and mild traumatic brain injury (mTBI) by assessing their level of functioning. 329 veterans (PTSD (n=109), mTBI (n=112), PTSD + mTBI (n=108) were examined using WHODAS 2.0. Standardized treatment was provided as well as psy­chotherapeutic intervention - a combination of psychoeducation with motivational interviewing and acceptance and commitment therapy for PTSD and tDCS. Clinical targets of therapy in the PTSD group were symptoms of intrusion, avoidance, hyperactivation and protocol of tDCS was dorsolateral prefrontal cortex arousing stimulation. In PTSD + TBI group clinical targets were neurocognitive symptoms, intrusion symptoms, avoidance, hyperactivation and tDCT protocol was motor cortex-supraorbital area inhibitory stimulation. The targest for TBI group was neurocognitive symptoms and tDCS protocol was occipital region exciting stimulation. The long-term effectiveness and the impact on neuroplasticity processes allow considering transcranial direct current stimulation as a promising method of neurorehabilitation of patients with a combination of posttraumatic stress disorder and mild traumatic brain injury. 

Key words: posttraumatic stress disorder, traumatic brain injury, functioning, veteran, neuroimaging studies transcranial direct current stimulation

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16. Abellaneda-Pérez K, Vaqué-Alcázar L, Perellón-Alfonso R, Bargalló N, Kuo MF, Pascual-Leone A, et al. Differential tDCS and tACS Effects on Working Memory-Related Neural Activity and Resting-State Connectivity. Front Neurosci. 2020 Jan 17;13:1440. doi: https://doi.org/10.3389/fnins.2019.01440
17. Zaninotto AL, El-Hagrassy MM, Green JR, Babo M, Paglioni VM, Benute GG, et al. Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery A systematic review. Dement Neuropsychol. 2019;13(2):2-179. doi: https://doi.org/10.1590/1980-57642018dn13-020005
18. Bajbouj M, Aust S, Spies J, Herrera-Melendez AL, Mayer SV, Peters M, et al. PsychotherapyPlus: augmen­ta­tion of cognitive behavioral therapy (CBT) with prefrontal transcranial direct current stimulation (tDCS) in major depressive disorder-study design and methodology of a multicenter double-blind randomized placebo-control­led trial. Eur Arch Psychiatry Clin Neurosci. 2018 Dec;268(8):797-808. doi: https://doi.org/10.1007/s00406-017-0859-x
19. Ines K, Violante R, Zimmerman K, Leech R, Hampshire A, Patel MC, et al. Investigating the interaction between white matter and brain state on tDCS-induced changes in brain network activity. Brain Stimulation. 2021;14(5):1261-70. doi: https://doi.org/10.1016/j.brs.2021.08.004
20. Dubreuil-Vall L, Chau P, Ruffini G, Widge AS, Camprodon JA. tDCS to the left DLPFC modulates cog­nitive and physiological correlates of executive function in a state-dependent manner. Brain Stimul. 2019 Nov-Dec; 12(6):1456-63. doi: https://doi.org/10.1016/j.brs.2019.06.006
21. Li ML, Violante IR, Leech R, Ross E, Hampshi­re A, Opitz A, et al. Brain state and polarity dependent modulation of brain networks by transcranial direct current stimulation. Hum Brain Mapp. 2018;40(3):904-915. doi: https://doi.org/10.1002/hbm.24420
22. Zaninotto AL, El-Hagrassy MM, Green JR, Babo M, Paglioni VM, Benute GG, et al. Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review. Dement Neuropsychol. 2019 Apr-Jun;13(2):172-9. doi: https://doi.org/10.1590/1980-57642018dn13-020005
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Look through:

Smashna O.Y. Ternopil National Medical University named after I.Ya. Horbachevskyi, Ministry of Health of Ukraine, Ternopil, Ukraine, e-mail: osmashna@gmail.com
https://orcid.org/0000-0001-6595-2940

Smashna O.Y. Transcranial electrical stimulation in post-traumatic stress disorder and brain injury: possibilities of tuning neuronal networks. Medicni perspektivi. 2024;29(3):175-183.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313673

Study of the neuroprotective properties of metformin in rats with type 2 diabetes mellitus and brain injury induced by intracerebral hemorrhage

Rehabilitation and psychological support are becoming today's most urgent issues due to russian armed aggression. These needs will be long-lasting and increasingly significant. Since 2023, the Program of Medical Guarantees in Ukraine has been expanded regarding rehabilitation assistance. Additionally, volumes of the state-commissioned training of bachelors and masters in the speciality of "Therapy and rehabilitation" have been increased. It is well known that the quality of specialists trained by higher educational institutions largely depends on the motives behind the career choice. Knowledge about a student's socio-demographic status and his/her motivations to become a physical therapy and occupational therapy specialist can help understand future challenges and opportunities for the profession's development. This information can aid in elaborating strategies to promote the profession in the educational services market and to attract more applicants to choose the speciality 227 "Therapy and rehabilitation". The research aimed to compose the socio-demographic characteristics of the applicant for training in the speciality 227 "Therapy and rehabilitation", to investigate the motivational aspects of career choice and to establish the factors significant for motivation formation. To achieve this goal, a voluntary anonymous survey of 39 domestic applicants enrolled to complete the bachelor's degree program in speciality 227 "Therapy and rehabilitation" at Dnipro State Medical University was conducted. It was determined that the contingent of applicants is represented mainly by persons aged 16-18 (74%) with an active life position (90%). Additionally, most are familiar with the specifics of medical professions (62%) and have had previous personal or professional contact with physical therapy and occupational therapy (78%). The future career decision was mostly independent (84%), conscious, and influenced by the balance of internal and external motivational factors. It was typically made one to two years before taking degree course (72%). The primary motives for choosing the speciality 227 "Therapy and rehabilitation" while understanding its demand in today's conditions by applicants (82%) were "interest in medical science" (95%), "the desire to help others" (95%), "the opportunity to obtain a prestigious profession" (90%), "possibility of guaranteed employment" (90%) and "material interest/financial independence" (87%). Future specialists are aware of the importance of controlled acquisition of knowledge and skills (90%), the need for daily independent work (80%), and the significance of gaining practical experience during training (95%). They aim to achieve professionalism (59%), enhance communication skills (31%), build endurance (31%), and cultivate persistence (28%) and empathy (28%). Most applicants entering the speciality 227 "Therapy and rehabilitation" are goal-oriented, highly motivated, and prepared for rigorous study, which is the key to developing into competent and competitive specialists.

Key words: applicants survey, career choice, motivation, therapy and rehabilitation, physical therapy, occupational therapy, medical education

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Look through:

Zakharov S.V. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0002-2278-5692

Nekhanevych O.B. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0003-0307-784X

Rusakova O.O. Dnipro State Medical University, Dnipro, Ukraine 
https://orcid.org/0000-0002-5097-1185

Smolianova O.V. Dnipro State Medical University, Dnipro, Ukraine, e-mail: smolyanova.ukr@gmail.com
https://orcid.org/0000-0002-8654-381X

Zakharov S.V., Nekhanevych O.B., Rusakova O.O., Smolianova O.V. Socio-demographic portrait of the applicant and the main motives for choosing the "Therapy and rehabilitation" speciality. Medicni perspektivi. 2024;29(3):183-192.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313675

Study of the neuroprotective properties of metformin in rats with type 2 diabetes mellitus and brain injury induced by intracerebral hemorrhage

The aim of the investigation is the toxicological characterization and analysis of the danger criteria of the insecticide metofluthrin with an assessment of the carcinogenic risk to health caused by chronic inhalation exposure to the substance at the level of the maximum possible concentrations in the air environment of human life. The analysis of scientific reports of the US Environmental Protection Agency (US EPA) and the European Chemicals Agency (ECHA) on the toxicological properties of metofluthrin was carried out. The assessment of the risk of the development of carcinogenic effects due to chronic inhalation exposure to metofluthrin was carried out taking into account the average daily dose of the substance that can enter the human body during the natural life span (LADD) and the carcinogenic potential factor (SF) in accordance with domestic guidelines. Classification of levels of carcinogenic risk was carried out using domestic and international approaches. It was established that the limiting criteria for the danger of metofluthrin are the average lethal concentration in air (LC₅₀ =1080 mg/m³) and the size of the zone of chronic action (Z_ch=7.46), which characterizes the danger of occurrence of chronic intoxication due to long-term inhalation exposure. According to these indicators, metofluthrin is classified as a dangerous substance (hazard class 2). The key effects of the toxic action of metofluthrin are determined – neurotoxicity, hepatotoxicity and nephrotoxicity. The threshold non-genotoxic oncogenic potential of metofluthrin according to the phenobarbital type was established. Individual carcinogenic risk under different scenarios of chronic inhalation exposure to metofluthrin was calculated. The substance concentration of 3.54 mg/m³ leads to a high level of risk (1.5×10^-3), which is considered unacceptable for production conditions and the population. At concentrations of 0.28 mg/m³ and 1.0 mg/m³, the risk is estimated as average and acceptable for production conditions (1.1-4.1×10^-4). The risk of exposure to a concentration of 0.14 mg/m³ is classified as low and acceptable for the population (5.7×10^-5). Thus, the results obtained in the study indicate that such concentrations of metofluthrin in the air as 0.14 – 0.28 – 1.0 mg/m³ are safe for human health, subject to compliance with medical and sanitary regulations at the stage of production and application of insecticides based on metofluthrin as prescribed.

Key words: metofluthrin, toxicological assessment, hazard criteria, carcinogenic risk, air environment  

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Look through:

Yastrub T.O. 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: tatyanayastrub@gmail.com
https://orcid.org/0000-0002-5084-3773

Kravchuk O.P. SE "L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine", Kyiv, Ukraine
https://orcid.org/0000-0003-3608-5555

Basanets A.V. SE "L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine", Kyiv, Ukraine
https://orcid.org/0000-0001-8236-4251

Yastrub A.M. SE "L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine", Kyiv, Ukraine
https://orcid.org/0000-0003-2674-5265

Shabalkov D.O. SE "L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine", Kyiv, Ukraine
https://orcid.org/0009-0006-2599-8454

Yastrub T.O., Kravchuk O.P., Basanets A.V., Yastrub A.M., Shabalkov D.O. Toxicological characterization of the insecticide metofluthrin and assessment of the carcinogenic risk to human health due to its chronic inhalation effect. Medicni perspektivi. 2024;29(3):193-204. DOI: https://doi.org/10.26641/2307-0404.2024.3.313676

Peculiarities of the blood system of animals under the conditions of consumption of drinking water containing chlorates

The timeframe for evacuating the wounded is a critical factor that largely determines the fate of a wounded soldier. Even at the initial stage of the war waged by the russian federation against Ukraine, there were almost no frontline ambulances, and there was a critical shortage of ambulances. At present, despite significant efforts to provide the Armed Forces of Ukraine with weapons and military equipment, as well as material and technical means, including medical equipment and property, in particular through international technical assistance, the problem of the lack of the required number of specialised medical evacuation vehicles has not been fully resolved. From this point of view, the issue of correct formulation of requirements for the rational composition and specially equipped various types of vehicles (including sanitary transporters, ambulances), including general use, the system of evacuation of the wounded, and determining the possibility of its further improvement through the methodological apparatus is relevant. The purpose of the article is to present a methodological approach to determining the main parameters of the system of evacuation of the wounded of an operational group of troops with the involvement of various types of transport. The formation of a model of the casualty evacuation system as a mass service network (MSN) will minimise the time spent waiting for medical care by wounded personnel, determine the rational composition of forces and means of the tactical casualty evacuation system. To model the system and processes of evacuation of the wounded from the battlefield during hostilities, including their transportation to medical facilities located in the depths of the third logistics zone, the mathematical apparatus of the theory of mass service was used. In particular, we are talking about the devices of queuing systems (QS) and MSN. The existing system of military evacuation of the wounded and sick is a four-tier system in which all wounded with moderate and severe severity are evacuated. Based on this, the system of evacuation of the wounded can be represented as an MSN, which has a number of features. First of all, this MSN is an open queuing network (OQN), i.e. the flow of requests to enter the network is unlimited, homogeneous and comes from an external independent source. As a result of the calculations, data were obtained on the values of network parameters (average number of applications in queues – 119.47 applications/hour, average number of applications in the network – 158.53 applications/hour, average waiting time for applications in queues for service – 11.95 hours, average time of application stay in the network – 15.85 hours) and the parameters of each QS operating in the MSN – transmission coefficient, incoming flow intensity, load factor, average number of busy channels, average number of applications per QS, average queue length, average waiting time for an application in the service queue, average time for an application to stay in the QS. Analysing the calculated data, from the point of view of creating a rational OQN, the casualty evacuation system achieves maximum efficiency when its productivity in processing the incoming flow of requests is maximised, and the minimum values of such parameters as the number of requests for service in the queue and the number of service channels operating in the network are minimal.

Key words: medical and evacuation support, Medical Forces of the Armed Forces of Ukraine, evacuation of the wounded, evacuation transport, parameters of the evacuation system, war, model

1. Job Profile: Healthcare Management Mana­ger. Best College [Internet]. 2022 Jul[cited 2022 Mar 17]. Availablefrom: https://www.bestcolleges.com/healthcare/healthcare-risk-management-manager-job/
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Look through:

Hutchenko K.S. Central Research Institute of the Armed Forces of Ukraine, Kyiv, Ukraine, e-mail: dr.gutches@ukr.net 
https://orcid.org/0009-0008-6377-7745

Kozachuk V.L. Central Research Institute of the Armed Forces of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0002-0207-7461

Hutchenko O.A. Central Research Institute of the Armed Forces of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0001-5918-1545

Movchan O.M. Central Research Institute of the Armed Forces of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0001-5245-7051

Tymkiv O.A. Central Research Institute of the Armed Forces of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0002-2248-382X

Hrom V.A. Central Research Institute of the Armed Forces of Ukraine, Kyiv, Ukraine
https://orcid.org/0009-0009-5415-9758

Hutchenko K.S., Kozachuk V.L., Hutchenko O.A., Movchan O.M., Tymkiv O.A., Hrom V.A. Methodical approach to determining the main parameters of the evacuation system for the wounded with the use of different types of transport. Medicni perspektivi. 2024;29(3):205-212.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313682

On the issue of creating an algorithm for assessing safety culture in modern healthcare institutions

Among the various forms of quality control of the provision of medical care, self-control and internal control of the quality of medical services are the most effective and significant. Currently, there is no comprehensive information technology and algorithm for recording data on the provision of medical services and determining their quality. The goal is to develop and analyze the effectiveness of business processes and an algorithm for quality control of the performance of medical services in a surgical health care institution by establishing their daily accounting in the information system, control of indicators characterizing the safety and quality of their performance, as well as an opportunity to assess the dynamics changes in indicators for making management decisions. In the study, an analysis of literary sources was carried out, business processes were formulated, and on the materials of a retrospective analysis algorithms for the use of information technologies were developed based on the methods of generalization, comparison, content analysis, system-analytical and logical analysis, a graphic analysis was performed to increase the clarity of the presentation of the material. The research was approved by the Biomedical Ethics Committee. For the first time, as a result of the work of the internal quality commission, daily and summarized forms of reports on the work of the medical center, which have five sections are obtained. The statistical indicators of the operation of the surgical unit for any period are fixed, formed in an automated mode and analyzed. Clinical data characterizing all prescribed procedures applied are subject to analysis, and the results provide an opportunity to isolate from the records the disorders and complications reflected in the reports. The quality control of the use of antibiotics, the frequency of their use for preventive and therapeutic purposes is also carried out. The section that contains multivariate epidemiological control of the work of the treatment facility, as well as the section that shows the quality of medical record keeping and patient care is important. Together with the inpatient chart, e-mails of medical appointments are analyzed, patient falls are recorded, appointments and monitoring of patient care, pain assessment after surgery, allergic reactions are recorded, as well as a retrospective audit of the charts regarding the justification of the appointment of antimicrobial therapy. Control of patient safety and the quality of the provided medical services requires constant verification of their implementation and paying attention to be up to standards, the occurrence of deviations and complications. The application of a specially developed algorithm based on information technologies, aimed at daily accounting of medical services and obtaining data on deviations in their application, makes it possible to make urgent management decisions and influence the improvement of the qualifications of personnel who provide such services.

Key words: informatization of processes, administration, safety, quality of medical services in surgical hospitals 

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   doi: https://doi.org/10.1186/s12941-019-0325-x
8. Baur D, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with anti­bioticresistant bacteria and Clostridium difficile infection: A systematic review and meta-analysis. Lancet infect dis. 2017 Sep;17(9):990-1001. doi: https://doi.org/10.1016/S1473-3099(17)30325-0
9. Cai Y, et al. A multidisciplinary antimicrobial ste­wardship programme safely decreases the duration of broadspectrum antibioticprescription in Singaporean adult renal patients. Int J Antimicrob Agents. 2016 Jan;47(1):91-6. doi: https://doi.org/10.1016/j.ijantimicag.2015.10.021
10. De With K, et al. Strategies to enhance rational use of antibiotics in hospital: A guideline by the German Society for Infectious Diseases. Infection. 2016 Jun;44(3):395-439. doi: https://doi.org/10.1007/s15010-016-0885-z
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12. Rennert-May E, et al. Clinical practice guidelines for creating an acute care hospital-based antimicrobial stewardship program: A systematic review. Am Jinfect Control.2019 Aug;47(8):979-93. doi: https://doi.org/10.1016/j.ajic.2019.02.010
13. Antomonov MYu. [Mathematical processing and analysis of medical and biological data]. 2-ed., Kyiv: MITs “Mininform”; 2018. 579 p. Ukrainian.

Look through:

Bereznytskyi Ya.S. Dnipro State Medical University; LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine, е-mail: y.bereznitsky@garvis.com.ua
http://orcid.org/0000-0003-2968-7443

Bereznytskyi V.Ya. LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine

Hudoshyna O.V. Department of Quality Control of Medical Care of the Ministry of Health of Ukraine, Kyiv, Ukraine, e-mail: moz@moz.gov.ua
http://orcid.org/0000-0003-1901-0818

Chuhrienko N.D. Dnipro State Medical University, Dnipro, Ukraine
http://orcid.org/0000-0003-2101-3882

Bereznytska G.V. LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine

Zalyhina Ye.V. Dnipro State Medical University; LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine
http://orcid.org/0000-0002-0478-5664

Dianova Yu.B. LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine

Rynska E.A. LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine

Ksykevich L.N. LLC "Endotechnomed" (surgical clinic "Garvis"), Dnipro, Ukraine

Bereznytskyi Ya.S., Bereznytskyi V.Ya., Hudoshyna O.V., Chuhrienko N.D., Bereznytska G.V., Zalyhina Ye.V., Dianova Yu.B., Rynska E.A., Ksykevich L.N. Informatization of the processes of administration of the quality of medical services in surgical hospitals. Medicni perspektivi. 2024;29(3):213-225.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313685

Optimization and standardization of the work of a health care facility during a chemical accident

Uterine lipoleiomyoma is one of the variants of uterine leiomyoma, which is histologically represented by the presence of mature fat and smooth muscle cells. The relevance of the coverage of this clinical case is determined by the extreme rarity of the development of uterine lipoleiomyoma in women of reproductive age. The purpose of this work was to record this clinical case in the world statistics of lipoleiomyoma, to evaluate methods of diagnosis and differential diagnosis, to determine the role of early diagnosis of uterine lipoleioma in the subsequent tactics and scope of surgical treatment. Data from the medical records of a 41-year-old inpatient were analyzed. In addition to the generally accepted clinical and biochemical methods of blood and urine examination, electrocardiogram, ultrasound examination of the pelvic organs, the level of ovarian tumor markers in the blood (CA 125, HE4 and the ROMA index) was determined. The diagnosis of the disease was based on the data of pathohistological and immunohistochemical studies. Based on the results of a review of the medical literature, analysis of articles obtained as a result of a search of PubMed, SCOPUS, Web of Science, MedScape databases, the current state of the problem is highlighted, literary data related to the incidence, features of the clinical course, diagnosis and treatment of uterine lipoleiomyoma are summarized. The clinical case presented in the article demonstrates an incidental finding of a uterine lipoleiomyoma in a woman of reproductive age, measuring 30x25x20 cm, originated subserously from the body and cervix of the uterus, in the area of its isthmus. Under this condition, it occupied the entire Douglas space, the area of the sacro-uterine ligaments and the parietal peritoneum, intimately adjacent to the sigmoid and rectum, to the ureters and iliac vessels. The peculiarity of this clinical case is that sonographically uterine lipoleiomyoma was hidden under the "mask" of a dermoid cyst of the right ovary. Macroscopically, it differed from a typical lipoleiomyoma by the purple-bluish color of its outer surface and soot-colored, fine-lobed spongy structure on the section. The diagnosis of uterine lipoleiomyoma was verified only on the basis of pathohistological and immuno­histochemical research. Microscopically, the lipoleiomyoma had a mesenchymal structure with a pronounced vascular component and consisted of mitotically inactive bundles of smooth muscle cells and mature adipocytes. Im­munohistochemically, a positive reaction for caldesmon, desmin, smooth muscle actin alpha of tumor cells and for S.100 (DAKO, polyclonal) fatty cells was detected, which confirmed the hypothesis of direct transformation of smooth muscle cells existing in the leiomyoma of the uterus into fatty cells. This clinical case should complement the global statistical indicators of diagnosis of uterine lipoleiomyoma in women of reproductive age. Lipoleiomyoma should be considered as the primary diagnosis in case of detection of a large uterine tumor in women with excess body weight and be removed immediately after diagnosis, otherwise it is impossible to exclude its malignancy. For the planned diagnosis of neoplasms of the female genital organs, preference should be given to non-invasive research methods: magnetic resonance or computer tomography with contrast enhancement. The problem of these tumors lies in their unpredictable histogenesis, the unexpected presence of fat in the microscopic structure, and in the visual similarity to sarcomas. Verification of the diagnosis is carried out on the basis of pathohistological and immunohistochemical studies of the tumor preparation. Uterine lipoleioma can have a purplie-bluish color and develop by a broad base from the body and cervix of the uterus, as a result of "lipomatous" metaplasia of the uterine leiomyoma existing in a woman. Regular preventive examinations of women of all ages are crucial for timely detection of this rare neoplasm.

Key words: lipoleiomyoma, leiomyoma, mesenchymoma, uterus, ovarian dermoid cyst, laparoscopy

1. Alsaif JM, Alali ZS, Elsharkawy T, Ahmed A. Uterine Lipoleiomyoma: A Case Report and Review of Literature. 2021 Dec 9;13(12):e20297. doi: https://doi.org/10.7759/cureus.20297
2. Kim YS, Lee JH. A case report of pelviscopic resection of lipoleiomyoma originating from the uterine cervix in a postmenopausal woman. Medicine (Baltimore). 2022 Sep 30;101(39):e30665. doi: https://doi.org/10.1097/MD.0000000000030665
3. Virk SK, Lopez E, Pardo KM, Gonzalez AM. Incidental Finding of a Lipoleiomyoma During Robotic Inguinal Hernia Repair: A Case Report. Cureus. 2023 Jun 19;15(6):e40635. doi: https://doi.org/10.7759/cureus.40635
4. Saraf P, Thirunavukkarasu B, Kathuria P, So­lanki V. Lipoleiomyoma: incidental finding in a postme­nopausal woman. International journal of gynecological cancer.2021;31(7):1092-4. doi: https://doi.org/10.1136/ijgc-2021-002657
5. Li Y, et al. HMGA2-mediated tumorigenesis through angiogenesis in leiomyoma. Fertility and sterility. 2020;114(5):1085-96. doi: https://doi.org/10.1016/j.fertnstert.2020.05.036
6. Yuan Y, Chen L, Zhao T, Yu M. Pathogenesis, diagnosis and treatment of uterine lipoleiomyoma: A review. Biomedicine & pharmacotherapy. 2021;142:112013. doi: https://doi.org/10.1016/j.biopha.2021.112013
7. Akbulut M, Soysal ME, Duzcan SE. Giant lipo­leiomyoma of the uterine corpus. Archives of gynecology and 2008;278:291-93. doi: https://doi.org/10.1007/s00404-008-0580-0
8. Bosoteanu M, et al. A Case of Giant Mesenchymal Uterine Tumor: Lipoleiomyoma. The American journal of case 2022;23:e934913. doi: https://doi.org/10.12659/AJCR.934913
9. Rampersad FS, et al. Uterine Lipoleiomyoma Presenting With Pelvic Pain in a Post-Menopausal Woman. 2021;13(5):e14929. doi: https://doi.org/10.7759/cureus.14929
10. Schaefer SL, et Large intraperitoneal lipoleio­myoma in a pre-menopausal woman: a case report. World journal of surgical oncology. 2021;19(1):144. doi: https://doi.org/10.1186/s12957-021-02256-9
11. Carvalho JF, Morgado A, Ribeiro MF, Oliveira C. Imaging diagnosis of an uterine lipoleiomyoma, a rare entity. Acta radiológica portuguesa. 2014;26(102):55-7.
12. Jamoulle JF, Brisbois D. L’image du mois. Le lipoléiomyome: une tumeur rare de l’utérus. Revue medi­cale de Liege. 2020;75(3):137-9.
13. Rasmussen T, Sanchirico P, Pfeiffer D. Uterine Lipoleiomyoma in the Context of Adenocarcinoma. Journal of clinical imaging science. 2020;10:82. doi: https://doi.org/10.25259/JCIS_204_2020
14. Sun D, Yang P, Liu Y, Yu G. Fallopian tube lipo­leiomyoma with degeneration: a case report and literature review. International journal of clinical and experimental pathology. 2020;13(8):2163-8.
15. Schaberg K. Mesenchymal tumors of the Uterus [Internet]. 2023 [cited 2023 Oct 24]. Available from: https://schaberg.faculty.ucdavis.edu/wp-content/uploads/sites/604/2023/06/Uterus-Mesenchymal.pdf
16. Munro MG. Endometrial ablation. Best practice & research. Clinical obstetrics & gynaecology. 2018;46:120-39. doi: https://doi.org/10.1016/j.bpobgyn.2017.10.003
17. Braganza JS, et al. Recurrent Large Extrauterine Lipoleiomyoma in a Postmenopausal Woman: A Case Report. 2023;15(8):e43193. doi: https://doi.org/10.7759/cureus.43193
18. Palicelli A, et al. Lipoleiomyomas of the Uterine Cervix: A New Series including the First Recurrent Case and the First Systematic Literature Review. Journal of personalized 2022;12(11):1852. doi: https://doi.org/10.3390/jpm12111852
19. Oh MH, et al. A case of retroperitoneal lipoleio­myoma. Journal of Korean medical science. 2001;16(2):250-2. doi: https://doi.org/10.3346/jkms.2001.16.2.250
20. Scurry JP, Carey MP, Targett CS, Dowling JP. Soft tissue lipoleiomyoma. Pathology. 2021;23(4):360-2. doi: https://doi.org/10.3109/00313029109063606
21. Reyna-Villasmil E, Rondon-Tapia M, Torres-Cepeda D. Uterine lipoleiomyoma. Revista Peruana de Ginecologíaand  2022;68(3):1-5. doi: https://doi.org/10.31403/rpgo.v68i2438
22. Wilke S, Benson J, Roller L. Uterine lipoleio­myoma: Case report and review of the literature. Radiology case reports. 2022;17(3):954-8. doi: https://doi.org/10.1016/j.radcr.2022.01.012
23. Park S, et al. Imaging uterine lipoleiomyomas: A case series and review of the literature. Heliyon. 2023;9(5):e15970. doi: https://doi.org/10.1016/j.heliyon.2023.e15970
24. Kaur M, Sadashiva H, Madakshira MG. Lipoleio­myoma: Egg-yolk in the uterus. Medical journal, Armed Forces India. 2022;78(3):371-2. doi: https://doi.org/10.1016/j.mjafi.2021.10.004
25. Limaiem F, Halouani A, Ben Aissia N. Laparo­scopic resection of a uterine lipoleiomyoma. Clinical case reports. 2023;11:e6878. doi: https://doi.org/10.1002/ccr3.6878
26. Alrasheed RK, Elhassan MA, Murad MA. Lipo­leiomyoma with bizarre nuclei and abundant mast cells. Cureus. 2023;15(6):e40361. doi: https://doi.org/10.7759/cureus.40361
27. Nishikawa S, et al. Characteristic of Concurrent Uterine Lipoleiomyoma and Hemangioma by Algorithm of Candidate Biomarkers for Uterine Mesenchymal Tumor. Diagnostics. 2022;12(10):2468. doi: https://doi.org/10.3390/diagnostics12102468
28. Orlova YuA, et al. Pathogenetic role of macro­phage colony-stimulating factor (csf-1) in predicting endometrioid disease. Wiadomości Lekarskie. 2021;74(8):1939-44. doi: https://doi.org/10.36740/WLek202108128
29. Orlova YuA, et al. Aseptic inflammation as the essential link in the pathogenesis of endometrioid disease. Medicni perspektivi. 2023;28(3):55-61. doi: https://doi.org/10.26641/2307-0404.2023.3.288961
30. Resta L, Maiorano E, Piscitelli D, Botticella MA. Li­pomatous tumors of the uterus. Clinico-pathological features of 10 cases with immunocytochemical study of histogenesis. Pathology, research and practice. 1994;190(4):378-83. doi: https://doi.org/10.1016/S0344-0338(11)80410-3

Look through:

Talash V.V. Poltava State Medical University, Poltava, Ukraine

Palyokha Ya.V. CE “Perinatal center of II level of the Poltava city council”, Poltava, Ukraine, e-maіl: roddom-poltava@ukr.net

Gromova A.M. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0003-1829-5399

Talash V.V. Poltava State Medical University, Poltava, Ukraine, e-maіl: viktorya.talash@gmail.com

Martynenko V.B. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0001-7465-0215

Prylutska N.O. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0009-0003-7378-1530

Mityunina N.I. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0009-0001-9662-8681

Talash V.V., Palyokha Ya.V., Gromova A.M., Talash V.V., Martynenko V.B., Prylutska N.O., Mityunina N.I. Lipoleiomyoma of the uterus in a woman of reproductive age (clinical case). Medicni perspektivi. 2024;29(3):226-234. DOI: https://doi.org/10.26641/2307-0404.2024.3.313686

Сlinical case of funicular myelosis in combination with a concomitant genetic predisposition to folate cycle disorder

The purpose of the work was to analyze a clinical case of the course of war trauma and present the experience of providing comprehensive medical and psychological clinical rehabilitation to a patient who suffered as a result of a terrorist attack. Patient D., 65 years old, sustained a mine-blast injury (MBI) of the right upper limb during shelling. The optimal restoration of the functions of the upper injured limb and the patient's health (physical, somatic, mental) was carried out according to the algorithm of comprehensive medical and psychological clinical rehabilitation. As a result of the course of comprehensive medical and psychological clinical rehabilitation, significant positive dynamics was observed, including a decrease in edematous, painful, and inflammatory syndromes. The range of motion in the right upper limb and cervical-thoracic spine increased. Supination and pronation of the right hand became better and less painful (from 8 to 2 points), movement in the fingers of the right hand increased and became more steady, a clear pulsation appeared in the area of the skin defect on the right forearm, regression of pain in the elbow and shoulder joints on the right was noted, and the patient began to walk without a mobilization bandage. The course of rehabilitation helped to reduce anxiety (from -1.82 to 0.85), asthenic symptoms (from 0.48 to 3.71), obsessive-phobic symptoms (from -1.96 to 1.74), and autonomic disorders (from -0.83 to 2.03). Low cortisol levels (61 nmol/l) against acute stress indicated the development of post-traumatic stress disorder. Upon completion of the rehabilitation course, cortisol levels rose to a healthy level (246 nmol/l), indicating the effectiveness of the process of restoring the psychophysiological state and adapting to a stressful situation. War trauma is a complex and severe condition that requires an integrated approach to treatment and rehabilitation, covering not only physical but also psychological and social aspects of patients' health.

Key words: military operations in Ukraine, neuropathy, post-traumatic stress disorder, clinical psychology, anxiety, stress, cortisol

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Panchenko O.A. SI “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine, e-mail: rdckonst@ukr.net
https://orcid.org/0000-0001-9673-6685

Kabantseva A.V. SI “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
https://orcid.org/0000-0001-7678-6052

Zhogina O.O. SI “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
https://orcid.org/0009-0007-3420-9581

Serdyuk I.A. SI “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
https://orcid.org/0000-0001-9840-7340

Panchenko O.A., Kabantseva A.V., Zhogina O.O., Serdyuk I.A. Comprehensive Medical and Psychological Rehabilitation in War Trauma (clinical case). Medicni perspektivi. 2024;29(3):235-244.
DOI: https://doi.org/10.26641/2307-0404.2024.3.313425

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