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

Key words: glomangioma, neurosurgery, tympanoplasty, embolization, rare tumors

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Abdrakhmanova D. Astana Medical University, Astana, Republic of Kazakhstan
e-mail: abdrakhmanovadina17@gmail.com
https://orcid.org/0000-0002-5688-5771

Niemczyk K. Medical University of Warsaw, Warsaw, Poland
https://orcid.org/0000-0003-2055-6615

Mukhamadieva G. Astana Medical University, Astana, Republic of Kazakhstan
https://orcid.org/0009-0001-0534-9995

Mustafin A. Astana Medical University, Astana, Republic of Kazakhstan
https://orcid.org/0000-0002-4278-5489

Papulova N. Astana Medical University, Astana, Republic of Kazakhstan
https://orcid.org/0000-0001-8375-2141

Abdrakhmanova D., Niemczyk K., Mukhamadieva G., Mustafin A., Papulova N. Ear and skull base paraganglioma: review of literature. Medicni perspektivi. 2024;29(4):4-13.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319156

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

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

Key words: HSP70, oxidative stress, physical exercises, inflammation, reactive oxygen species, catalase, superoxide dismutase  

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Look through:

Ayubi N. Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia,
e-mail: novadriayubi@unesa.ac.id
  https://orcid.org/0000-0002-5196-6636

Wibawa J.C. STKIP PGRI Trenggalek, Trenggalek, Jawa Timur, Indonesia
https://orcid.org/0000-0002-4667-5981

Callixte C. University of Rwanda, Kigali, Rwanda
https://orcid.org/0000-0002-9137-5515

Ayubi N., Wibawa J.C., Callixte C. The mechanism of physical exercises increases heat shock protein 70 (HSP70) (a systematic review). Medicni perspektivi. 2024;29(4):14-22.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319168

Analyses of electromagnetic effects as colors of the vision analyzer

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

Key words: passive tobacco smoking, fetoplacental insufficiency, gravidoprotective effect, pharmaceutical composition, L-carnitine, pregnancy, placenta, sex hormones

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Look through:

Volokhov I.V. SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"; National University of Pharmacy, Kharkiv, Ukraine, 
e-mail: chronos2000.org@gmail.com
https://orcid.org/0000-0001-6138-5889

Rybak V.A. National University of Pharmacy, Kharkiv, Ukraine 
https://orcid.org/0000-0001-7649-4287

Sergienko L.Yu. SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine", Kharkiv, Ukraine
https://orcid.org/0000-0002-1474-222X

Sokolova S.S. SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine", Kharkiv, Ukraine
https://orcid.org/0000-0001-7084-0011

Kustova S.P. SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine", Kharkiv, Ukraine
https://orcid.org/0000-0003-0964-5318

Volokhov I.V., Rybak V.A., Sergienko L.Yu., Sokolova S.S., Kustova S.P. The effect of pharmaceutical composition based on L-carnitine on structural and functional features of rat placenta in the model of passive tobacco smoking. Medicni perspektivi. 2024;29(4):23-38.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319172

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

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

Key words: polycystic ovary syndrome, insulin resistance, diet therapy, mediterranean diet, ketogenic diet, low-carbohydrate diet, low-fat diet, HOMA

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12. Markin LB, Korutko OO, Fartushok TV, Fartu­shok NV, Fedevych YuM, Dzhalilova EA,  et al. Asso­ciation of polycystic ovary syndrome with multiple health factors and adverse pregnancy outcomes. International Journalof  2023;19(2):137-42. doi: https://doi.org/10.22141/2224-0721.19.2.2023.1259 
13. Semenyna HB, Korytko OO. Effectiveness of vitex agnus castus extract in the primary dysmenorrhea. International Journal of Endocrinology. 2022;18(1);17-21. doi: https://doi.org/10.22141/2224-0721.18.1.2022.1141
14. MirabelliM, Chiefari E, Arcidiacono B, Corig­liano DM, Brunetti FS, Maggisano V, et al. Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases.  2020;12(4):1066. doi: https://doi.org/10.3390/nu12041066
15. Muscogiuri G, Barrea L, Laudisio D, Pugliese G, Salzano C, Savastano S, et al. The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide. J Transl Med. 2019;17(1):356. doi: https://doi.org/10.1186/s12967-019-2104-z
16. Caprio M, Infante M, Moriconi E, Armani A, Fab­bri A, Mantovani G, et al. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of endocrinology (SIE). J Endocrinol Invest. 2019;42(11):1365-86. doi: https://doi.org/10.1007/s40618-019-01061-2
17. Paoli A, Cancellara P, Pompei P, Moro T. Keto­genic diet and skeletal muscle hypertrophy: a frenemy relationship?J Hum  2019;68:233-47. doi: https://doi.org/10.2478/hukin-2019-0071
18. De Amicis R, Leone A, Lessa C, Foppiani A, Ra­vella S, Ravasenghi S, et al. Long-term effects of a classic ketogenic diet on ghrelin and leptin concentration: a 12-month prospective study in a cohort of Italian children and adults with GLUT1-deficiency syndrome and drug resistant Nutrients. 2019;11(8):1716. doi: https://doi.org/10.3390/nu11081716 
19. Hong SH, Choi KM. Sarcopenic Obesity, Insulin Re­sistance, and Their Implications in Cardiovascular and Meta­bolic Consequences. Int J Mol Sci. 2020 Jan 13;21(2):494. doi: https://doi.org/10.3390/ijms21020494
20. Soliman AR, Hegazy M, Ahmed RM, Abdel­ghaffar S, Gomaa M, Alwakil S, et al. Dietary recom­mendations for people with diabetes in special situations: a position statement report by Arabic Association for the Study of Diabetes and metabolism (AASD). J Health Popul Nutr.2024 Sep 3;43(1):139. doi: https://doi.org/10.1186/s41043-024-00619-y
21. Chen JH, Chen JY, Chen YC, Li WC. Sex dif­ference in the association between creatinine-to-cystatin C ratio and metabolic syndrome among Chinese adults. Front Endocrinol(Lausanne). 2024;15:1389295. doi: https://doi.org/10.3389/fendo.2024.1389295
22. Christensen S, Robinson K, Thomas S, Wil­liams DR. Dietary intake by patients taking GLP-1 and dual GIP/GLP-1 receptor agonists: A narrative review and discus­sion of research needs. Obes Pillars. 2024 Jul 25;11:100121. doi: https://doi.org/10.1016/j.obpill.2024.100121
23. Chen J, Jia S, Guo C, Fan Z, Yan W, Dong K. Research Progress on the Effect and Mechanism of Exercises Intervention on Sarcopenia Obesity. Clin Interv Aging.2024 Aug 8;19:1407-22. doi: https://doi.org/10.2147/CIA.S473083
24. Damanti S, Citterio L, Zagato L, Brioni E, Mag­naghi C, Simonini M, et al. Sarcopenic obesity and pre-sarcopenia contribute to frailty in community-dwelling Italian older people: data from the FRASNET study. BMC Geriatr.2024 Jul 31;24(1):638. doi: https://doi.org/10.1186/s12877-024-05216-6
25. Wang M, Tan Y, Shi Y, Wang X, Liao Z, Wei P. Diabetes and Sarcopenic Obesity: Pathogenesis, Diag­nosis, and Treatments. Front Endocrinol (Lausanne). 2020 Aug 25;11:568. doi: https://doi.org/10.3389/fendo.2020.00568
26. Diolintzi A, Panagiotakos DB, Sidossis LS. From Mediterranean diet to Mediterranean lifestyle: a narrative review. Public Health Nutr. 2019 Oct;22(14):2703-13. doi: https://doi.org/10.1017/S1368980019000612
27. Galan-Lopez P, Sanchez-Oliver AJ, Pihu M, Gís­ladóttír T, Domínguez R, Ries F. Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The Adoles Health Study. Nutrients. 2019 Dec 27;12(1):77. doi: https://doi.org/10.3390/nu12010077
28. American Diabetes Association. Lifestyle Mana­gement: Standards of Medical Care in Diabetes-2019. Diabetes 2019 Jan;42(Suppl 1):S46-S60. doi: https://doi.org/10.2337/dc19-S005
29. Jennings A, Berendsen AM, de Groot LCPGM, Fes­kens EJM, Brzozowska A, Sicinska E, et al. Medi­terranean-Sty­le Diet Improves Systolic Blood Pressure and Arterial Sti­ffness in Older Adults. Hypertension. 2019;73(3):578-86. doi:https://doi.org/10.1161/HYPERTENSIONAHA.118.12259
30. Kim H, Caulfield LE, Garcia-Larsen V, Stef­fen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. JAm Heart  2019 Aug 20;8(16):e012865. doi: https://doi.org/10.1161/JAHA.119.012865
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32. Brown TJ, Brainard J, Song F, Wang X, Abdelha­mid A, Hooper L, et al. Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;366:l4697. doi: https://doi.org/10.1136/bmj.l4697
33. Al-Ishaq RK, Abotaleb M, Kubatka P, Kajo K, Büsselberg D. Flavonoids and Their Anti-Diabetic Effects: Cellular Mechanisms and Effects to Improve Blood Sugar Levels. 2019;9(9):430. doi: https://doi.org/10.3390/biom9090430
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Look through:

Semenyna H.B. Danylo Halytsky Lviv Medical University, Lviv, Ukraine
https://orcid.org/0000-0003-2247-6731

Fartushok T.V. Danylo Halytsky Lviv Medical University, Lviv, Ukraine, 
e-mail: fartushok1@ukr.net
https://orcid.org/0000-0001-6571-0108

Fartushok N.V. HPEI “Lviv Medical University”, Lviv, Ukraine
https://orcid.org/0000-0003-2824-8473

Dumanchuk N.Ya. HPEI “Lviv Medical University”, Lviv, Ukraine
https://orcid.org/0009-0008-5006-8982

Yurchyshyn O.M. Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0002-0754-2983

Semenyna H.B., Fartushok T.V., Fartushok N.V., Dumanchuk N.Ya., Yurchyshyn O.M. The role of diet therapy in insulin resistance in women with polycystic ovary syndrome. Medicni perspektivi. 2024;29(4):39-47.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319179

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

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

Key words: molars, onlays, resin composite, ceramics, zirconium, finite element method, stress-strain states

1. Guerreiro E, Botelho J, Machado V, et al. Caries experience before and after COVID-19 restrictions: an observational study. J Clin Med. 2024;13:1164. doi: https://doi.org/10.3390/jcm13041164
2. Cadenaro M, Josic U, Maravi´c T, et al. Progress in dental adhesive materials. J Dent Res. 2023;102:254-62. doi: https://doi.org/10.1177/00220345221145673
3. Houdaifa R, Alzoubi H, Jamous I. Three-dimen­sional finite element analysis of worn molars with prosthetic crowns and onlays made of various materials. Cureus.2022;14(10):30240. doi: https://doi.org/10.7759/cureus.30240 
4. Țuculină MJ, Staicu AN, Munteanu MC, et al. Study on the restoration of class II carious cavities by virtual methods: simulation of mechanical behavior. Journal of functional biomaterials. 2023;14(7):354. doi: https://doi.org/10.3390/jfb14070354
5. Ouldyerou A, Mehboob H, Mehboob A, et al. Biomechanical performance of resin composite on dental tissue restoration: a finite element analysis. PloS one. 2023;18(12):0295582. doi: https://doi.org/10.1371/journal.pone.0295582
6. Dejak B, Młotkowski A. A comparison of mvM stress of inlays, onlays and endocrowns made from various materials and their bonding with molars in a computer simulation of mastication – FEA. Dental materials: official publication of the Academy of Dental Materials. 2020;36(7):854-64. doi: https://doi.org/10.1016/j.dental.2020.04.007
7. Grassi EDA, de Andrade GS, Tribst JPM, et al. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clinicaloral  2022;26(3):2513-26. doi: https://doi.org/10.1007/s00784-021-04219-6
8. Kim SY, Kim BS, Kim H, et al. Occlusal stress distribution and remaining crack propagation of a cracked tooth treated with different materials and designs: 3D finite element analysis. Dental materials: official publication of the Academy of Dental Materials. 2021;37(4):731-40. doi: https://doi.org/10.1016/j.dental.2021.01.020
9. Jung MK, Jeon MJ, Kim JH, et al. Comparison of the stress distribution in base materials and thicknesses in composite resin restorations. Heliyon. 2024;10(3):25040. doi: https://doi.org/10.1016/j.heliyon.2024.e25040
10. Alp Ş, Gulec Alagoz L, Ulusoy N. Effect of direct and indirect materials on stress distribution in class II MOD Restorations: A 3D-finite element analysis study. BioMed research international. 2020:2020:7435054. doi: https://doi.org/10.1155/2020/7435054
11. Yasin Gönder H, Mohammadi R, Harmankaya A, et al. Investigation of the effects of adhesive materials of different types and thicknesses on dental tissue stress via FEM analysis. BioMed research international. 2022:2022:8493909. doi: https://doi.org/10.1155/2022/8493909
12. Babaei B, Shouha P, Birman V, et al. The effect of dental restoration geometry and material properties on biomechanical behavior of a treated molar tooth: a 3D finite element analysis. Journal of the mechanical behavior ofbiomedical  2022;125:104892. doi: https://doi.org/10.1016/j.jmbbm.2021.104892
13. Malanchuk VO, Kryschuk MG, Kopchak AV. [Si­mulation computer modeling in maxillofacial surgery]. Kyiv: Vydavnychyi dim "Askaniia"; 2013. 231 p. Ukrainian.
14. Ryzhov OA, Penkin YuM. [Statistical methods of processing the results of medical and biological research]. Lviv: Magnoliia 2006; 2022. 160 p. Ukrainian.

Look through:

Sardykov Y.А. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0009-0006-9303-0074

Kryshchuk M.H. National Technical University of Ukraine “Igor Sikorsky Kyiv Polytechnic Institute”, Kyiv, Ukraine
https://orcid.org/0000-0002-0662-9147

Fastovets О.О. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: 503@dmu.edu.ua
https://orcid.org/0000-0002-2769-3244

Matvieienko R.Y. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-0888-3226

Sardykov Y.А., Kryshchuk M.H., Fastovets О.О., Matvieienko R.Y. Study results of the stress-strain states of the crown parts of molars restored with composite, ceramic and zirconium onlays. Medicni perspektivi. 2024;29(4):47-57. 
DOI: https://doi.org/10.26641/2307-0404.2024.4.319183

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

Key words: biofilms, antibiotic resistance, Quorum sensing, persisters

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2. Percival SL, McCarty SM, Lipsky B. Biofilms and wounds: an overview of the evidence. Advances in Wound Care.2015;7(4):373-81. doi: https://doi.org/10.1089/wound.2014.0557
3. Petrenko OM, Bezrodnyi BG, Bondarchuk OL. Study of the ability of causative agents of phlegmon of soft tissues to form biofilms. Surgery of Ukraine. 2016;1:85-9. Ukrainian.
4. Tkachuk N, Zelena L. [Biofilms of some anaerobic bacteria on the polyethylene terephthalate surface. In: In­ternational Conference on Biological Research and Ap­plied Science (IBRAS 2021). Advances in Microbio­logy, 2021 Jan 20-21, Karachi, Pakistan]. 2021. p. 88-90. Ukrainian. doi: https://doi.org/10.37962/IBRAS/2021/188-90
5. Vestby LK, Grønseth T, Simm R, Nesse LL. Bac­terial Biofilm and its Role in the Pathogenesis of Disease. Antibiotics.2020;9(2):59. doi: https://doi.org/10.3390/antibiotics9020059
6. European Union's action against antimicrobial resistance 2017 [Internet]. [cited 2024 Jun 15]. Available from:https://ec.europa.eu/health/amr/antimicrobial-resistance_en
7. Balko OI, Zelena LB, Kharkhota MA, Balko OB, Avdeeva LV. [The Quorum Sensing System in the Regu­lation of Pseudomonas аeruginosa Bacteriocinogenesis. In: Modern Infectious Diseases: Etiology, Epidemiology, Diagnosis, Treatment, Prevention, Biological Safety: Materials of the Scientific and Practical Conference Dedi­cated to the Memory of Academician L.V. Gromashevsky and the 25th anniversary of the National Academy of Medical Sciences of Ukraine, Kyiv, 2018 Oct 11-12]. Kyiv; 2018. р. 26-27. Ukrainian.
8. Vrynchanu NO, Dudikova DM, Grynchuk NI, Ne­dashkivska VV. [Biofilms. Current status and prospects of antimicrobial therapy]. Pharmacology and medicinal toxicology.2019;13(5):311-21.  doi: https://doi.org/10.33250/13.05.311
9. Ustinov VA. New WHO report on antibiotic resis­tance. Ukrainian medical journal. [Internet]. 2018 [cited 2024 Jun 15]. Available from: http://www.umj.com.ua/article/120095/novyj-dokladvoz-po-antibiotikorezistentnosti
10. Yovenko IA, Balaka IV. ["Antimicrobial Ste­ward­ship" program – a strategy of antimicrobial control in in­tensive care units in the era of antibiotic resistance]. Acute and urgent conditions in the doctor's practice. 2017;5-6(68-69):5-14. Ukrainian.
11. Billings N, Birjiniuk A, Samad TS, et al. Material properties of biofilms – a review of methods for under­standing permeability and mechanics. Reports on Progress in 2015;78(3):036601. doi: https://doi.org/10.1088/0034-4885/78/3/036601
12. Netzker T, Fischer J, Weber J, Mattern DJ, Kö­nig CC, Valiante V, et al. Microbial communication leading to the activation of silent fungal secondary metabolite gene clusters. Front Microbiol. 2015;6:299. doi: https://doi.org/10.3389/fmicb.2015.00299
13. Sutherland IW. The biofilm matrix – an immobilized but dynamic microbial environment. Trends in 2001;9(5):222-7. doi: https://doi.org/10.1016/S0966-842X(01)02012-1
14. Vorobei ES, Voronkova OS, Vinnikov AI. [Ba­cte­rial biofilms. Quorum Sensing – "Quorum sensing" in bacteria in biofilms]. Bulletin of Dnipropetrovsk Uni­versity. Biology. Ecology. 2012;1(Issue 20):13-22. doi: https://doi.org/10.15421/011202
15. Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Mea­sures, and Innovative Treatment. Micro­organisms.2023;11:1614. doi: https://doi.org/10.3390/microorganisms11061614
16. Xiao Y, Zou H, Li J, Song T, Lv W, Wang W, et al. Impact of quorum sensing signaling molecules in gram-negative bacteria on host cells: current understanding and future perspectives. Gut Microbes. 2022 Jan-Dec;14(1):2039048. doi: https://doi.org/10.1080/19490976.2022.2039048
17. Li YH, Tian X. Quorum sensing and bacterial social interactions in biofilms. Sensors. 2012;12(3):2519-38. doi: https://doi.org/10.3390/s120302519
18. Guo J, Yoshida K, Ikegame M, Okamura H. Quorum sensing molecule N-(3-oxododecanoyl)-l-homo­serine lactone: an all-rounder in mammalian cell modification. Journal of Oral Biosciences. 2020;62(1):16-29. doi: https://doi.org/10.1016/j.job.2020.01.001
19. Todosiichuk TS, Strelets TI, Konopatska SV. [Increasing the resistance of microbial pathogens as a factor in the development of new antiseptics]. Scientific News National technical University of Ukraine "Kyiv Polytechnic Institute". 2011;3:90-7. Ukrainian.
20. Siscar-Lewin S, Hube B, Brunke S. Antivirulence and avirulence genes in human pathogenic fungi. Virulence.2019 Dec;10(1):935-47. doi: https://doi.org/10.1080/21505594.2019.1688753
21. Madhusoodanan J. How persister bacteria evade antibiotics, prolong infections. Science Writer. 2022 Sept 29;119(41):e2215617119. doi: https://doi.org/10.1073/pnas.2215617119
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23. Niepa TH, Gilbert JL, Ren D. Controlling Pseudo­monas aeruginosa persister cells by weak electrochemical currents and synergistic effects with tobramycin. Biomaterials.2012;33(30):7356-65. doi: https://doi.org/10.1016/j.biomaterials.2012.06.092
24. Jiang Z, Wang Y, Bai S, Liao T, Qiu L. The phy­siological and ecological properties of bacterial persisters discovered from municipal sewage sludge and the potential risk. Environmental Research. 2022;205(1):112481. doi: https://doi.org/10.1016/j.envres.2021.112481
25. Zhang Y, Niu H, Gu J. Bacterial persisters: molecular mechanisms and therapeutic development. Signal Transduction and Targeted Therapy. 2024;9:174. doi: https://doi.org/10.1038/s41392-024-01866-5
26. Nicolau SE, Lewis К. The Role of Integration Host Factor in Escherichia coli Persister Formation. ASM Journals 2022;13(1):e03420-21. doi: https://doi.org/10.1128/mbio.03420-21
27. Imperi F, Leoni L, Visca P. Antivirulence activity of azithromycin in Pseudomonas aeruginosa. Frontiers in microbiology.2014;5:178. doi: http://dx.doi.org/10.3389/fmicb.2014.00178
28. Zhu L, Yang X, Fu X, Yang P, Lin X, Wang F, et al. Pheromone cCF10 inhibits the antibiotic persistence of Enterococcus faecalis by modulating energy meta­bolism.Front  2024 Jul 8;15:1408701. doi: https://doi.org/10.3389/fmicb.2024.1408701
29. Patel R, Soni M, Soyantar B, Shivangi S, Suta­riya S, Saraf M, et al. A clash of quorum sensing vs quorum sensing inhibitors: an overview and risk of resistance. Arch Microbiol. 2023 Mar 7;205(4):107. doi: https://doi.org/10.1007/s00203-023-03442-x
30. Rangel-Vega A, Bernstein LR, Mandujano-Tino­co EA, García-Contreras SJ, García-Contreras R. Drug re­purposing as an alternative for the treatment of recalcitrant bacterial infections. Front Microbiol. 2015 Apr 9;6:282. doi: https://dx.doi.org/10.3389/fmicb.2015.00282 

Look through:

Kuzminov B.P. Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine,
e-mail: kuzminovborys@gmail.com
https://orcid.org/0000-0002-8693-1046

Mazhak K.D. Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine
https://orcid.org/0000-0001-7776-8892

Kuzminov B.P., Mazhak K.D. Biofilm as a supracellular organization of pathogenic bacteria. Medicni perspektivi. 2024;29(4):58-65.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319186

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

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

Key words: sympathomimetic amines, toxicity, side effect, pseudoephedrine, energizers

1. Głowacka K, Anna WH. Pseudoephedrine-Bene­fits and Risks. International Journal of Molecular Sciences. 2021;22(10):5146. doi: https://doi.org/10.3390/ijms22105146
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3. Hussain L, Reddy V, Maani C. Physiology, Nora­drenergic Synapse. In: StatPearls [Internet]. Treasure Is­land (FL): StatPearls Publishing; 2024 [cited 2024 Aug 15]. Availablefrom: https://www.ncbi.nlm.nih.gov/books/NBK540977/
4. Brandon P, Bob B, John C, Fran D, Gerry Mc. Ef­ficiency of extraction and conversion of pseudoephedrine to methamphetamine from tamper-resistant and non-tamper-resistant formulations. Journal of Pharmaceutical andBiomedical  2018;156:16-22. doi: https://doi.org/10.1016/j.jpba.2018.04.016
5. Horowitz A, Frey D, Denault D. Sympathomi­me­tics. In: StatPearls [Internet]. Treasure Island (FL): Stat­Pearls Publishing; 2024 [cited 2024 Aug 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546597/
6. Lowry J, Brown J. Significance of the imi­dazoline receptors in toxicology. Clinical toxicology. 2014 Jun;52(5):454-69. doi: https://doi.org/10.3109/15563650.2014.898770
7. National Center for Biotechnology Information. PubChem Compound Summary for CID 7028 [Internet]. Pseudoephedrine.2024 [cited 2024 Aug 15]. Available from: https//pubchem.ncbi.nlm.nih.gov/compound/Pseudoephedrine
8. Laccourreye O, Werner A, Giroud JP, Couloig­ner V, Bonfils P, Bondon-Guitton E. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decon­gestants. European Annals of Otorhinolaryngology, Head andNeck  2015;132(1):31-4. doi: https://doi.org/10.1016/j.anorl.2014.11.001
9. Beck KR, Thompson GR. Odermatt, Drug-in­du­ced endocrine blood pressure elevation. Pharmacol Res. 2020;154:104311. doi: https://doi.org/10.1016/j.phrs.2019.104311
10. Ban J, Faeza A. The Effect of Pseudoephedrine (Sudafed) on Kinetic activity and histology of Livers and Kidneys in Albino Mice. Research Journal of Pharmacy and 2021;14(9):5015-8. doi: https://doi.org/10.52711/0974-360X.2021.00874  
11. io [Internet]. Available from: https://www.protocols.io/view/hematoxylin-amp-eosin-protocol-for-leica-st5020-au-x54v9mozqg3e/v1
12. Pawan M, Amandeep S, Krishika S, Pragati J, Chaudhary M, Chinmayee M, Poorvi UP. Ephedrine and Pseudoephedrine: A Comprehensive Review of Their Pharmacology and Clinical Applications. The JCHR. 2024;14:1447-55.
13. Ahmad S. Recent advances in Pharmacology and Toxicology of Phytopharmaceuticals. Asian J Pharm Res. 2017;7(4):222-4.
    doi: https://doi.org/10.5958/2231-5691.2017.00034.X
14. Goud MC, Ghazanfar SM. Nimesulide – A Drug to be Banned completely. Asian Journal of Pharmaceutical Research.2021;11(2):132-7. doi: https://doi.org/10.52711/2231-5691.2021.00025
15. Kumaraswamy G, Gandla L, Swetha K, Sutha­karan R, Ramesh Babu GA. Validated RP-HPLC Method for Simultaneous Estimation of Pseudoephedrine and Terfinadine in its Bulk and Pharmaceutical Dosage forms. Asian J Pharm Tech. 2014;4:(Iss 4):200-4.
16. Sohn JS, Choi J-S. Development and evaluation of pseudoephedrine hydrochloride abuse-deterrent for­mulations using thermal modified rice starch. International Journal of Biological Macromolecules. 2021;182:1248-58. doi: https://doi.org/10.1016/j.ijbiomac.2021.05.055
17. Chapman J, Goyal A, Azevedo AM. Spleno­me­galy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 15]. Availablefrom:https://www.ncbi.nlm.nih.gov/books/NBK430907/
18. Vaseeha Banu TS, Awdesh JV, Ansari MS. For­mulation and Evaluation of Transdermal Patches of Decongestant Drug. Research Journal of Pharmaceutical Dosage Forms and Technology. 2022;14(3):195-8. doi: https://doi.org/10.52711/0975-4377.2022.00031
19. Bitar Y. Separation and Assay of Three Anti-Cough Drugs Pseudoephedrine, Dextromethorphan and Chlorphe­niramine in Pharmaceutical Forms by using single RP-HPLC Method. Research J Pharm and Tech. 2020;13(2):831-9. doi: https://doi.org/10.5958/0974-360X.2020.00157.2
20. Waseem M, Bjerke S. Splenic Injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441993/

Look through:

Yasmin L. Alsaadi University of Baghdad, Al-Jadriya, Baghdad, Iraq
https://orcid.org/0009-0000-7501-2186

Bassam K. Abdul Ameer University of Baghdad, Al-Jadriya, Baghdad, Iraq
https://orcid.org/0009-0005-7510-7480

Ban Jasim Mohamad University of Baghdad, Al-Jadriya, Baghdad, Iraq, 
e-mail: banjasimmohamef@gmail.com
https://orcid.org/0000-0003-3025-6632

Faiza Kathum Omra University of Baghdad, Al-Jadriya, Baghdad, Iraq
https://orcid.org/0009-0002-9253-7202

Yasmin L. Alsaadi, Bassam K. Abdul Ameer, Ban Jasim Mohamad, Faiza Kathum Omra. The impact of Sudafed on spleen of albino mice. Medicni perspektivi. 2024;29(4):66-73.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319190

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

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

Key words: mandible/lower jaw, maxillofacial apparatus, bone tissue regeneration, collagen, lincomycin, osteoplastic materials, morphometric study

1. Xue N, Ding X, Huang R, et al. Bone tissue engi­neering in the treatment of bone defects. Pharmaceuticals. 2022;15:879. doi: https://doi.org/10.3390/ph15070879
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4. Tang T, Casagrande T, Mohammadpour P, Lan­dis W, Lievers B, Grandfield K. Characterization of hu­man trabecular bone across multiple length scales using a cor­relative approach combining X-ray tomography with LaserFIB and plasma FIB-SEM. Sci Rep. 2024;14(1):21604. doi: https://doi.org/10.1038/s41598-024-72739-8
5. Buss DJ, Kröger R, McKee MD, Reznikov N. Hierarchical organization of bone in three dimensions: A twist of twists. J Struct Biol X. 2021;6:100057. doi: https://doi.org/10.1016/j.yjsbx.2021.100057
6. Li Y, Liu Y, Li R, et al. Collagen-based bioma­te­rials for bone tissue engineering. Mater Des. 2021;210:110049. doi: https://doi.org/10.1016/j.matdes.2021.110049
7. Rico-Llanos GA, Borrego-González S, Moncayo-Donoso M, Becerra J, Visser R. Collagen type I bioma­terials as scaffolds for bone tissue engineering. Polymers. 2021;13(4):599. doi: https://doi.org/10.3390/polym13040599
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9. Gurumurthy B, Janorkar AV. Improvements in mechanical properties of collagen-based scaffolds for tissue engineering. Curr Opin Biomed Eng. 2020;17:100253. doi: https://doi.org/10.1016/j.cobme.2020.100253
10. Liu X, Zheng C, Luo X, Wang X, Jiang H. Recent advances of collagen-based biomaterials: Multi-hiera­rchical structure, modification and biomedical applica­tions. Mater Sci Eng C Mater Biol Appl. 2019;99:1509-22. doi: https://doi.org/10.1016/j.msec.2019.02.070
11. Revell CK, Jensen OE, Shearer T, et al. Collagen fibril assembly: New approaches to unanswered questions. Matrixbiology  2021;12:100079. doi: https://doi.org/10.1016/j.mbplus.2021.100079
12. Chao YH, Sun JS. Biomechanics of Skeletal Mus­cle and Tendon. In: Cheng CK, Woo SLY, eds. Frontiers in Orthopaedic Biomechanics. Springer, Singapore; 2020. p. 37-73. doi: https://doi.org/10.1007/978-981-15-3159-0_2
13. Fan L, Ren Y, Emmert S, et al. The use of col­lagen-based materials in bone tissue engineering. Int J Mol Sci. 2023;24(4):3744. doi: https://doi.org/10.3390/ijms24043744
14. Szwed-Georgiou A, Płociński P, Kupikowska-Stobba B, et al. Bioactive materials for bone regeneration: biomolecules and delivery systems. ACS Biomater Sci Eng.2023;9:5222-54. doi: https://doi.org/10.1021/acsbiomaterials.3c00609
15. Puyathorn N, Lertsuphotvanit N, Chantadee T, Pi­chayakorn W, Phaechamud T. Lincomycin HCl-loaded borneol-based in situ gel for periodontitis treatment. Gels. 2023;9(6):495. doi: https://doi.org/10.3390/gels9060495
16. Peng X, Cheng L, You Y, et al. Oral microbiota in human systematic diseases. Int J Oral Sci. 2022;14(1):14. doi: https://doi.org/10.1038/s41368-022-00163-7
17. Shah FA, Ruscsák K, Palmquist A. 50 years of scanning electron microscopy of bone – a comprehensive overview of the important discoveries made and insights gained into bone material properties in health, disease, and taphonomy.Bone  2019;7:15. doi: https://doi.org/10.1038/s41413-019-0053-z
18. Goldstein JI, Newbury DE, Michael JR, Ri­tchie NWM, Scott JHJ, Joy DC. Scanning electron micro­scopy and X-Ray microanalysis. New York, NY: Springer NewYork; 
    doi: https://doi.org/10.1007/978-1-4939-6676-9
19. Aescht E, Büchl-Zimmermann S, Burmester A, Dänhardt-Pfeiffer S, Desel C, Hamers C, et al. Romeis mikroskopische technik. Heidelberg: Spektrum AkademischerVerlag;  doi: https://doi.org/10.1007/978-3-8274-2254-5
20. Hruzieva TS, Lekhan VM, Ohniev VA, Haliien­ko LI, Kriachkova LV, Palamar BI, et al. [Biostatistics]. Vinnytsia: New Book; 2020. 384 p. Ukrainian.
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22. Directive 2010/63/EU of the European Parliament and of the Council of 22 September 2010 on the Protection of Animals Used for Scientific Purposes. Off J Eur Union. 2010;53(L276):33-79.
23. Albalooshy A, Duggal M, Vinall-Collier K, Drummond B, Day P. The outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries. Dent Traumatol. 2023;39(Suppl 1):40-9. doi: https://doi.org/10.1111/edt.12829
24. Hölzle F, Raith S, Winnand P, Modabber A. Mikrovaskuläre knöcherne rekonstruktion – neue technologien in planung und umsetzung. Die MKG-Chirurgie.2023;16(2):122-30. doi: https://doi.org/10.1007/s12285-023-00407-3
25. Lee CT, Tran D, Tsukiboshi Y, Min S, Kim SK, Ayilavarapu S, et al. Clinical efficacy of soft‐tissue augmentation on tissue preservation at immediate implant sites: A randomized controlled trial. J Clin Periodontol. 2023;50(7):1010-20. doi: https://doi.org/10.1111/jcpe.13816
26. Rodrigues MTV, Guillen GA, Macêdo FGC, Gou­lart DR, Nóia CF. Comparative effects of different mate­rials on alveolar preservation. J Oral Maxillofac Surg. 2023;81(2):213-23. doi: https://doi.org/10.1016/j.joms.2022.10.008
27. Vargas SM, Johnson TM, Pfaff AS, et al. Clinical protocol selection for alveolar ridge augmentation at sites exhibiting slight, moderate, and severe horizontal ridge deficiencies. Clin Adv Periodontics. 2023;13(3):174-96. doi: https://doi.org/10.1002/cap.10239
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Look through:

Chelpanova I.V. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine, e-mail: ilona.med75@gmail.com
https://orcid.org/0000-0001-5215-814X

Chelpanova I.V. Morphological characteristics of regeneration of the lower jaw bone in an experiment using natural collagen with lincomycin. Medicni perspektivi. 2024;29(4):73-83.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319201

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

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

Key words: placenta, COVID-19, SARS-CoV-2, pregnancy, chorionic villi 

1. Bonnet MP, Chantry AA. Placenta and utero­placental perfusion [Internet]. Oxford University Press eBooks. Oxford University Press; 2016 [cited 2024 Apr 30]. doi: https://doi.org/10.1093/med/9780198713333.003.0003
2. Turowski G, Vogel M. Re-view and view on matu­ration disorders in the placenta. APMIS. 2018 Jul;126(7):602-12. doi: https://doi.org/10.1111/apm.12858
3. Burton GJ. The Fine Structure of the Human Placental Villus as Revealed by Scanning Electron Micro­scopy. Scanning Microscopy. 1987;1(4):29.
4. Savchuk T. Pathomorphological changes of the placenta in the acute period of COVID-19 in pregnant women. Eastern Ukrainian Medical Journal. 2024 [cited 2024 Jun 30];12(2):323-34. doi: https://doi.org/10.21272/eumj.2024;12(2):323-334
5. Sara S, Peter L, Ajlana L, Matts O, Francisco ON, Jan W, et al. OP003. Placental perfusion in normal preg­nancy and in early and late preeclampsia: A magnetic resonance imaging study. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health. 2013 Apr;3(2):63. doi: https://doi.org/10.1016/j.preghy.2013.04.019
6. Wong YP, Khong TY, Tan GC. The Effects of COVID-19 on Placenta and Pregnancy: What Do We Know So Far? Diagnostics. 2021 Jan 8;11(1):94. doi: https://doi.org/10.3390/diagnostics11010094
7. Komine-Aizawa S, Takada K, Hayakawa S. Pla­cental barrier against COVID-19. Placenta. 2020 Sep;99:45-9. doi: https://doi.org/10.1016/j.placenta.2020.07.022
8. Foroozanfar E, Forouzanfar M, Farkhondeh T, Sa­marghandian S, Forouzanfar F. ACE2 as a Potential Target for Management of Novel Coronavirus (nCoV-2019). Curr Drug Discov Technol. 2021;18(6):e130921189567. doi: https://doi.org/10.2174/1570163817999201228215911
9. Stenton S, McPartland J, Shukla R, Turner K, Marton T, Hargitai B, et al. SARS-COV2 placentitis and pregnancy outcome: A multicentre experience during the Alpha and early Delta waves of coronavirus pandemic in England. eClinicalMedicine. 2022 May;47:101389. doi: https://doi.org/10.1016/j.eclinm.2022.101389
10. Savchuk TV. Pathomorphological changes of the placenta in antenatal asphyxia of the fetus associated with the coronavirus disease (COVID-19) in pregnant women. Reproductive health of woman. 2023 May 31;(3):44-51. doi: https://doi.org/10.30841/2708-8731.3.2023.283322
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12. Baergen RN, Heller DS. Placental Pathology in Covid-19 Positive Mothers: Preliminary Findings. Pe­diatric and Developmental Pathology. 2020 May 12;23(3):177-80. doi: https://doi.org/10.1177/1093526620925569
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Look through:

Savchuk T.V. Bogomolets National medical university, Kyiv, Ukraine,
e-mail: t.savchuk@nmu.ua
https://orcid.org/0000-0002-7218-0253

Savchuk T.V. Pathomorphological changes of the placenta in coronavirus disease (COVID-19) in pregnant women in the second and third trimesters of pregnancy. Medicni perspektivi. 2024;29(4):84-94.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319224 

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

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

Key words: hepatorenal syndrome, portal hypertension, liver cirrhosis, creatinine, spontaneous bacterial peritonitis, bleeding

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13. Thangaraj SR, Srinivasan M, Arzoun H, Tho­mas SS. A Systematic Review of the Emerging Treatment for Hepatorenal Syndrome With a Principal Focus on Terlipressin: A Recent FDA-Approved Drug. Cureus. 2023 Jul 24;15(7):e42367. doi: https://doi.org/10.7759/cureus.42367
14. Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020 Sep 14;370:m2687. doi: https://doi.org/10.1136/bmj.m2687
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Look through:

Tutchenko M.I. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0002-5050-6494

Besedinskyi M.S. Bogomolets National Medical University, Kyiv, Ukraine,
e-mail: mr.besedinsky@gmail.com
https://orcid.org/0009-0009-8618-1458

Aslanian S.A. Ukrainian Military Medical Academy, Kyiv, Ukraine
https://orcid.org/0000-0002-4122-775X

Kluzko I.V. Municipal non-profit enterprise “Vyshgorod Central District Hospital, Vyshhorod, Kyiv region, Ukraine
https://orcid.org/0000-0001-8253-9349

Rudyk D.V. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0001-9736-3614

Chub S.L. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0001-6489-7345

Tutchenko M.I., Besedinskyi M.S., Aslanian S.A., Kluzko I.V., Rudyk D.V., Chub S.L. Hepatorenal syndrome in decompensated portal hypertension. Medicni perspektivi. 2024;29(4):94-101.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319225Ж

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

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

Key words: chronic pancreatitis, chronic obstructive pulmonary disease, pancreatic fibrosis, collagen, echostructure of the pancreas

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    https://www.rese­archgate.net/profile/Yaroslav-Tsekhmister/publication/326271449_Posibnik_z_biostatistiki_analiz_rezultativ_medicnih_doslidzen_u_paketi_EZR_R-STATISTICS/­links/­5b436d09aca2728a0d664341/Posibnik-z-biostatistiki-analiz-rezultativ-medicnih-doslidzen-u-paketi-EZR-R-STATISTICS.pdf
20. Robinson SM, Rasch S, Beer S, Valantiene I, Mi­ckevicius A, Schlaipfer E, et al. Systemic inflammation contributes to impairment of quality of life in chronic pancreatitis. Sci Rep. 2019;9(1):7318. doi: https://doi.org/10.1038/s41598-019-43846-8
21. Kawahito S, Kitahata H, Oshita S. Problems asso­ciated with glucose toxicity: Role of hyperglycemia-indu­ced oxidative stress. World J Gastroenterol. 2009;15:4137-42. doi: https://dx.doi.org/10.3748/wjg.15.4137
22. Kong F, Pan Y, Wu D. Activation and Regulation of Pancreatic Stellate Cells in Chronic Pancreatic Fibrosis: A Potential Therapeutic Approach for Chronic Pan­creatitis. Biomedicines. 2024;12(1):108. doi: https://doi.org/10.3390/biomedicines12010108

Look through:

Dudka I.V. Bukovinian State Medical University, Chernivtsi, Ukraine, 
e-mail: dudka.inna@bsmu.edu.ua
https://orcid.org/0000-0001-9941-1878

Khukhlina O.S. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0002-1086-2785

Dudka T.V. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0001-8770-8164

Hryniuk O.Y. Bukovinian State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0002-7899-2287

Pavliuk V.O. Regional municipal non-profit enterprise «Chernivtsi Regional Children’s Clinical Hospital», Chernivtsi, Ukraine
https://orcid.org/0009-0003-6477-1584

Dudka I.V., Khukhlina O.S., Dudka T.V., Hryniuk O.Y., Pavliuk V.O. Features of pancreatic parenchyma fibrosis in the comorbid course of chronic pancreatitis and chronic obstructive pulmonary disease. Medicni perspektivi. 2024;29(4):101-108.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319237 

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

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

Key words: osteosynthesis, patients, infectious complications, osteomyelitis

1. Prada C, Marcano-Fernández FA, Schemitsch EH, et al. Timing and management of surgical site infections in patients with open fracture wounds: a fluid lavage of open wounds cohort secondary analysis. J Orthop Trauma. 2021;35:128-35. doi: https://doi.org/10.1097/BOT.0000000000001912
2. Depypere M, Morgenstern M, Kuehl R, Senne­ville E, Moriarty TF, Obremskey WT, et al. Pathogenesis and management of fracture-related infection. Clin Microbiol 2020 May;26(5):572-8. doi: https://doi.org/10.1016/j.cmi.2019.08.006
3. Foster AL, Moriarty TF, Trampuz A, Jaipra­kash A, Burch MA, Crawford R, et al. Fracture-related infection: current methods for prevention and treatment. Expert Rev Anti Infect Ther. 2020 Apr;18(4):307-21. doi: https://doi.org/10.1080/14787210.2020.1729740
4. Morgenstern M, Moriarty TF, Kuehl R, Ri­chards RG, McNally MA, Verhofstad MHJ, et al. Interna­tional survey among orthopaedic trauma surgeons: lack of a definition of fracture-related infection. Injury. 2018;49:491-6. doi: https://doi.org/10.1016/j.injury.2018.02.001
5. Mishra P, Pandey CM, Singh U, Keshri A, Saba­retnam M. Selection of appropriate statistical methods for data analysis. Ann Card Anaesth. 2019 Jul-Sep;22(3):297-301. doi: https://doi.org/10.4103/aca.ACA_248_18
6. Ma T, Lyu J, Ma J, Huang X, Chen K, Wang S, et al. Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study. BMC Musculoskelet Disord.2023 Feb 13;24(1):123. doi: https://doi.org/10.1186/s12891-023-06210-6
7. Onsea J, Pallay J, Depypere M, Moriarty TF, Van Lieshout EMM, Obremskey WT, et al. Intramedullary tis­sue cultures from the Reamer-Irrigator-Aspirator system for diagnosing fracture-related infection. J Orthop Res. 2021;39(2):281-90. doi: https://doi.org/10.1002/jor.24816
8. Moriarty TF, Schmid T, Post V, Samara E, Ka­tes S, Schwarz EM, et al. A large animal model for a failed two-stage revision of intramedullary nail-related infection by methicillin-resistant Staphylococcus aureus. Eur Cell Mater.2017 Aug 30;34:83-98. doi: https://doi.org/10.22203/eCM.v034a06
9. He SY, Yu B, Jiang N. Current Concepts of Fracture-Related Infection. Int J Clin Pract. 2023 Apr 25;2023:4839701. doi: https://doi.org/10.1155/2023/4839701
10. Govaert GAM, Kuehl R, Atkins BL, Trampuz A, Morgenstern M, Obremskey WT, et al. Diagnosing frac­ture-related infection: current concepts and recom­men­dations.J Orthop  2019;34(1):8-17. doi: https://doi.org/10.1097/BOT.0000000000001614
11. Mertens B, Van Daele R, Depypere M, Lagrou K, Debaveye Y, Wauters J, et al. Isavuconazole in the Treat­ment of Aspergillus fumigatus Fracture-Related Infection: Case Report and Literature Review. Antibiotics (Basel). 2022 Mar 5;11(3):344. doi: https://doi.org/10.3390/antibiotics11030344
12. Li J, Lai YX, Li MX, Chen XY, Zhou M, Wang WZ, et al. Repair of infected bone defect with clindamycin-tetrahedral DNA nanostructure complex-loaded 3D bioprinted hybrid scaffold. Chem Eng J. 2022;435:134855. doi: https://doi.org/10.1016/j.cej.2022.134855

Look through:

Tanasienko P.V. National Pirogov Memorial Medical University, Vinnytsya, Ukraine, 
e-mail: radix.vn@ukr.net
https://orcid.org/0000-0002-3064-5200

Kolov H.B. SI "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine", Kyiv,  Ukraine, e-mail: gennadiikolob@gmail.com
https://orcid.org/0000-0003-4191-1997

Tsokalo V.M. SI "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine", Kyiv,  Ukraine, e-mail: vasiliynv@gmail.com
https://orcid.org/0000-0002-9509-6337

Tanasienko P.V., Kolov H.B., Tsokalo V.M. Analysis of the terms of development of infectious complications in patients after osteosynthesis of long bones. Medicni perspektivi. 2024;29(4):109-116.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319302:

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

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

Key words: catamenial pneumothorax, diaphragm endometriosis, spontaneous pneumothorax, non-intubated video-assisted thoracic surgery, video-assisted thoracoscopic surgery, enhanced recovery after surgery

1. McCarthy C, Gupta N, Johnson SR, Yu JJ, McCormack FX. Lymphangioleiomyomatosis: pathoge­nesis, clinical features, diagnosis, and management. Lancet Respir 2021 Nov;9(11):1313-27. doi: https://doi.org/10.1016/S2213-2600(21)00228-9
2. Dos Santos VM, Dos Santos LAM. Catamenial pneumothorax: a rare condition. An Sist Sanit Navar. 2024 May 27;47(2):e1076. doi: https://doi.org/23938/ASSN.1076
3. Huan NC, Sidhu C, Thomas R. Pneumothorax: Clas­sification and Etiology. Clin Chest Med. 2021 Dec;42(4):711-27. doi: https://doi.org/1016/j.ccm.2021.08.007
4. Chen PH, Hung WT, Chen JS. Nonintubated Video – Assisted Thoracic Surgery for the Management of Primary and Secondary Spontaneous Pneumothorax. ThoracSurg  2020 Feb;30(1):15-24. doi: https://doi.org/10.1016/j.thorsurg.2019.08.001
5. Shigenobu T, Ohtsuka T, Yoshizu A. Risk factors for the recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery in patients younger than 40 J Thorac Dis. 2023 Jul 31;15(7):3783-90. doi: https://doi.org/10.21037/jtd-23-257
6. Opanasenko MS, Tereshkovych OV, Shala­hai SM, Konik BM, Shestakova D, Kalenychenko MI, et al. [Application of video-assisted lung volume reduction operations in bullous emphysema of the lungs in clinical practice]. Asthma and allergy. 2023;3:58-64. Ukrainian. doi: https://doi.org/10.31655/2307-3373-2023-3-58-64
7. Boiko VV, Haft KL, Nakonechnyi YeV, Shyli­na MV. [Videotracoscopic interference with bullous emphy­sema complicated by spontaneous pneumothorax]. Kharkiv Surgical School. 2019;3-4(96-97):59-63. Ukrainian. doi: https://doi.org/10.37699/2308-7005.3-4.2019.11
8. Kutluk AC, Kocaturk CI, Akin H, Erdogan S, Bi­len S, Karapinar K, et al. Which is the best minimal inva­sive approach for the treatment of spontaneous pneumo­thorax? Uniport, two, or three ports: a prospective rando­mized trial. Thorac Cardiovasc Surg. 2018;66:589-94. doi: https://doi.org/10.1055/s-0038-1629909
9. Pathak S, Caruana E, Chowdhry F. Should surgi­cal treatment of catamenial pneumothorax include dia­phragmatic repair? Interact Cardiovasc Thorac Surg. 2019 Dec 1;29(6):906-10. doi: https://doi.org/10.1093/icvts/ivz205
10. Sesma J, Álvarez M, Gálvez , Bolufer S, Lirio F, Mafé JJ, et al. Non-intubated VATS for the management in primary spontaneous pneumothorax. Video-assist Thorac Surg.2019;4:23. doi: https://doi.org/21037/vats.2019.09.02 
11. HwangJ, Seung Shin JS, Son JH, Min Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period. J Thorac Dis. 2018;10(3):1703-10. doi: https://doi.org/10.21037/jtd.2018.02.10
12. Guo Z, Yin W, Zhang X, Xu X, Liu H, Shao W, et al. Primary spontaneous pneumothorax: simultaneous treatment by bilateral non-intubated videothoracoscopy. Interactive CardioVascular and Thoracic Surgery. 2016;1:6. doi: https://doi.org/10.1093/icvts/ivw123
13. Li X, Wang X, Zhang H, Cheng H, Cao Q. Unila­teral single-port thoracoscopic surgery for bilateral pneu­mothorax or pulmonary bullae. Journal of Cardiothoracic Surgery. 2019;14:71.
    doi: https://doi.org/10.1186/s13019-019-0894-y
14. KohLY, Hwang  Anesthesia for Nonintubated Video-Assisted Thoracoscopic Surgery. J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1275-83. doi: https://doi.org/10.1053/j.jvca.2023.02.048
15. Gonzalez-RivasD, Bonome C, Fieira E, Ayme­rich H, Fernandez R, Delgado M, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? European Journal of Cardio-Thoracic Surgery. 2016;49:721-31. doi: https://doi.org/10.1093/ejcts/ezv136
16. Lantos J, Németh T, Barta Z, Szabó Z, Paróczai D, Varga E, et al. Pathophysiological Advantages of Spon­taneous Ventilation. Front Surg. 2022 Mar 14:9:822560. doi: https://doi.org/3389/fsurg.2022.822560
17. Chen Efficacy of intraoperative thoracoscopic intercostal nerve blocks in nonintubated and intubated video-assisted thoracic surgery. J Formos Med Assoc. 2024 Aug;123(8):920. doi: https://doi.org/10.1016/j.jfma.2024.01.008
18. Chiang X-H, Lin M-W. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indi­cation, Technique, and Prevention. Front Surg. 2021 Oct 26:8:769850. doi: https://doi.org/3389/fsurg.2021.769850
19. Fabo C, Oszlanyi A, Lantos J, Rarosi F, Hor­vath T, Barta Z, et al. Non-intubated Thoracoscopic Sur­gery-Tips and Tricks From Anesthesiological Aspects: A Mini Review. Front Surg. 2022 Feb 11;8:818456. doi: https://doi.org/3389/fsurg.2021.818456
20. Liu J, Cui F, Li S, Chen H, Shao W, Liang L, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov. 2015;22:123-30. doi: https://doi.org/10.1177/1553350614531662
21. Anile M, Vannucci J, Ferrante F, Bruno K, De Pao­lo D, Bassi M, et al. Non-Intubated Thoracic Surgery: Stand­points and Perspectives. Front Surg. 2022 Jul 01:9:937633. doi: https://doi.org/3389/fsurg.2022.937633
22. Yanik Current overview of awake, non-intu­bated, video-assisted thoracic surgery. Wideochir Inne Tech Maloinwazyjne. 2023 Sep;18(3):445-52. doi: https://doi.org/10.5114/wiitm.2023.128070
23. Elkhouly AG, Karamustafaoglu YA, Galvez C, Rao M, Lerut P, Grimonprez A, et al. Nonintubated versus intubated thoracoscopic bullectomy for primary spon­taneous pneumothorax: A multicenter propensity-matched analysis. Asian Cardiovasc Thorac Ann. 2022 Nov;30(9):1010-6. doi: https://doi.org/10.1177/02184923221129239
24. Kiss G. Technical Issues and Patient Safety in Nonin­tubated Thoracic Anesthesia. Thorac Surg Clin. 2020;30(1):1-13. doi: https://doi.org/10.1016/j.thorsurg.2019.09.001

Look through:

Tkalich V.V.  Kyiv City Hospital No. 17, Kyiv, Ukraine, 
e-mail: airmj23@ukr.net
https://orcid.org/0000-0001-7696-8403

Nedilia Yu.V.  Kyiv City Hospital No. 17, Kyiv, Ukraine, 
e-mail: nedilyay@ukr.net
https://orcid.org/0009-0005-5860-3204

Borysova V.I.  Kyiv City Hospital No. 17, Kyiv, Ukraine, 
e-mail: v-borisova@ukr.net
https://orcid.org/0009-0009-2999-4196

Galiiev O.V.  Kyiv City Hospital No. 17, Kyiv, Ukraine, 
e-mail: galiev@ukr.net
https://orcid.org/0009-0006-5634-5704

Savoliuk S.I. Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine,
e-mail: savoluk@meta.ua
https://orcid.org/0000-0002-8988-5866

Tkalich V.V., Nedilia Yu.V., Borysova V.I., Galiiev O.V., Savoliuk S.I. Spontaneous pneumothorax: intubated or non-intubated surgery? Medicni perspektivi. 2024;29(4):117-125. DOI: https://doi.org/10.26641/2307-0404.2024.4.319308

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

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

Key words: artificial lung ventilation, intensive care, risks and complications, clinical scenario, new technologies and equipment, high-flow nasal oxygen therapy

1. Chandel A, Patolia S, Brown AW, Collins AC, Sahjwani D, Khangoora V, et al. High-flow nasal cannula therapy in COVID-19: Using the ROX index to predict success.Respir  2021;66(6):909-19. doi: https://doi.org/10.4187/respcare.08631
2. Lukianchuk VD, Hordiichuk DO, Shevchuk OO. Key links in pathogenesis of respiratory failure in COVID-19 and pharmacological correction. Bulletin of Medical andBiological  2022;4(2):62-74. doi: https://doi.org/10.11603/bmbr.2706-6290.2022.2.13082
3. Romanyuk LB, Volch I, Kravets NY, Pyat­kovskyi T, Zahrychuk OM. Retrospective analysis of gender-age structure and comorbid pathology of patients with viral and bacterial pneumonia associated with COVID-19. International Journal of Medicine and Medical Research. 2021;7(2):15-9. doi: https://doi.org/10.11603/ijmmr.2413-6077.2021.2.12675
4. Chen L, Liu P, Gao H, Sun B, Chao D, Wang F, et al. Inhalation of nitric oxide in the treatment of severe acute respiratory syndrome: A rescue trial in Beijing. Clin Infect Dis. 2004;39(10):1531-5. doi: https://doi.org/10.1086/425357
5. Takeshita Y, Terada J, Hirasawa Y, Kinoshita T, Tajima H, Koshikawa K, et al. High-flow nasal cannula oxygen therapy in hypoxic patients with COVID-19 pneu­monia: A retrospective cohort study confirming the utility of respiratory rate index. Respir Investig. 2022;60(1):146-53. doi: https://doi.org/10.1016/j.resinv.2021.10.005
6. Maitra S, Som A, Bhattacharjee S, Arora MK, Baidya DK. Comparison of high flow nasal oxygen therapy with conventional oxygen therapy and noninvasive mechanical ventilation in adult patients with acute hypo­xemic respiratory failure: A meta-analysis and systematic review. J Crit Care. 2016;35:138-44. doi: https://doi.org/10.1016/j.jcrc.2016.05.013
7. Hui DS, Chow BK, Lo T, Tsang OT, Ko FW, Ng SS, et al. Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks. Eur Respir J. 2019;53(4):1802339. doi: https://doi.org/10.1183/13993003.02339-2018
8. Pasillas-Lépine W, Tuffet S, Soussen C, Me­kont­so-Dessap A, Carteaux G. A novel method for noninvasive esti­mation of respiratory effort during pressure support ventila­tion. Biomed. Signal Process Control. 2024;93:106176. doi: https://doi.org/10.1016/j.bspc.2024.106176
9. Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, et al. Extracorporeal membrane oxyge­nation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir Med. 2020;8(11):1121-31. doi: https://doi.org/10.1016/S2213-2600(20)30328-3
10. Bertini P, Guarracino F, Falcone M, Nardelli P, Landoni G, Nocci M, et al. ECMO in COVID-19 patients: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2022;36(8):2700-6. doi: https://doi.org/10.1053/j.jvca.2021.11.006
11. Arentz M, Yim E, Klaff L, Lokhandwala S, Rie­do FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. JAMA. 2020;323(16):1612-4. doi: https://doi.org/10.1001/jama.2020.4326
12. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. COVID-19 in critically ill patients in the Seattle region – Case series. N Engl J Med. 2020;382(21):2012-22. doi: https://doi.org/10.1056/NEJMoa2004500
13. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-81. doi: https://doi.org/10.1001/jama.2020.5394
14. Xie J, Tong Z, Guan X, Du B, Qiu H. Clinical cha­racteristics of patients who died of coronavirus disease 2019 in China. JAMA Netw Open. 2020;3(4):e205619. doi: https://doi.org/10.1001/jamanetworkopen.2020.5619
15. Iwashyna TJ, Boehman A, Capecelatro J, Cohn AM, Cooke JM, Costa DK, et al. Variation in aerosol production across oxygen delivery devices in sponta­neously breathing human subjects. medRxiv [Internet]. 2020 Apr 20 [cited 2024 Sept 11]. doi: https://doi.org/10.1101/2020.04.15.20066688
16. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: Dif­ferent respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099-102. doi: https://doi.org/10.1007/s00134-020-06033-2
17. Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. COVID-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020;201(10):1299-300. doi: https://doi.org/10.1164/rccm.202003-0817LE
18. Karagiannidis C, Mostert C, Hentschker C, Vo­shaar T, Malzahn J, Schillinger G, et al. Case characte­ristics, resource use, and outcomes of 10021 patients with COVID-19 admitted to 920 German hospitals: An observational study. Lancet Respir Med. 2020;8(9):853-62. doi: https://doi.org/10.1016/S2213-2600(20)30316-7
19. Wu Z, McGoogan JM. Characteristics of and im­portant lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. doi: https://doi.org/10.1001/jama.2020.2648
20. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving sepsis campaign: Gui­delines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854-87. doi: https://doi.org/10.1007/s00134-020-06022-5
21. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.doi: https://doi.org/10.1016/S0140-6736(20)30183-5
22. Martinez MA. Compounds with therapeutic po­tential against novel respiratory 2019 coronavirus. Antimicrob Agents Chemother. 2020;64(5):e00399-20. doi: https://doi.org/10.1128/AAC.00399-20
23. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan  YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7:4. doi: https://doi.org/10.1186/s40779-020-0233-6
24. Carsetti A, Paciarini AD, Marini B, Pantanetti S, Adrario E, Donati A. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care. 2020;24(1):225. doi: https://doi.org/10.1186/s13054-020-02956-w
25. Li L, Li R, Wu Z, Yang X, Zhao M, Liu J, et al. Therapeutic strategies for critically ill patients with COVID-19. Ann Intensive Care. 2020;10(1):45.doi: https://doi.org/10.1186/s13613-020-00661-z
26. Shang J, Ye G, Shi K, Wan Y, Luo C, Aihara H, et al. Structural basis of receptor recognition by SARS-CoV-2. Nature. 2020;581(7807):221-4. doi: https://doi.org/10.1038/s41586-020-2179-y 

Look through:

Mirsaliyev M. Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan, 
e-mail: mirkhoshimmir12@gmail.com
https://orcid.org/0000-0001-5166-6169

Kashikova K. Caspian International School of Medicine, Almaty, Republic of Kazakhstan
https://orcid.org/0000-0001-6523-1684

Zholdybayeva A. Caspian International School of Medicine, Almaty, Republic of Kazakhstan
https://orcid.org/0000-0002-1332-574X

Mirsaliyev M., Kashikova K., Zholdybayeva A. Respiratory support of patients with pneumonia in the context of the COVID-19 pandemic. Medicni perspektivi. 2024;29(4):126-135.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319322

Side effects and hypersensitivity reactions to corticosteroids

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

Key words: bacterial vaginosis, vaginal microbiota, postmenopausal age, genitourinary menopausal syndrome, anti- recurrence therapy, probiotics, hormone therapy

1. Aggarwal N, Meeta M, Chawla N. Menopause ma­nagement: A manual for primary care practitioners and nurse practitioners. J Midlife Health. 2022 Jul;13(Suppl 1):S2-S51. doi: https://doi.org/10.4103/jmh.jmh_85_22
2. Vaskiv ОV, Grigorenko А, Horbatiuk ОG, Shat­kovska AS, Binkovska АN. Peculiarities of hormonal ho­meostasis in perimenopausal and postmenopausal women with menopausal disorders. Biomedical and Biosocial Anthropology.2019;35:43-7. doi: https://doi.org/10.31393/bba35-2019-07
3. [Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care "Menopausal disorders and other disorders in the peri­menopausal period"]. [Internet]. 2022 [cited 2024 Aug 15]. Ukrainian. Availablefrom: https://www.dec.gov.ua/wp-content/uploads/2022/06/37474-n_1039_17_06_2022_ dod.pdf 
4. Nappi RE, Martini E, Cucinella L, Martella S, Tiranini L, Inzoli A, et al. Addressing Vulvovaginal At­rophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front Endocrinol (Lausanne).2019 Aug 21;10:561. doi: https://doi.org/10.3389/fendo.2019.00561  
5. Park MG, Cho S, Oh MM. Menopausal Changes in the Microbiome-A Review Focused on the Geni­tourinary Microbiome. Diagnostics (Basel). 2023 Mar 21;13(6):1193. doi: https://doi.org/10.3390/diagnostics13061193
6. Sarmento ACA, Costa APF, Vieira-Baptista P, Gi­raldo PC, Eleutério JJr, Gonçalves AK. Genitourinary Syndrome of Menopause: Epidemiology, Physiopa­thology, Clinical Manifestation and Diagnostic. Front Reprod 2021 Nov 15;3:779398. doi: https://doi.org/10.3389/frph.2021.779398
7. Kim S, Seo H, Rahim MA, Lee S, Kim YS, Song HY. Changes in the Microbiome of Vaginal Fluid after Menopause in Korean Women. J Microbiol Biotechnol.2021;31:1490-500. doi: https://doi.org/10.4014/jmb.2106.06022
8. Ribeiro AE, Monteiro NES, Moraes AVG, Costa-Paiva LH, Pedro AO. Can the use of probiotics in association with isoflavone improve the symptoms of  genitourinary syndrome of menopause? Results from  a randomized controlled trial. 2018;26:643-52. doi: https://doi.org/10.1097/GME.0000000000001279
9. Cagnacci A, Xholli A, Sclauzero M, Venier M, Palma F, Gambacciani M, et al. Vaginal atrophy across the menopausal age: results from the ANGEL study. Climacteric.2019 Feb;22(1):85-9. doi: https://doi.org/10.1080/13697137.2018.1529748
10. Phillips NA, Bachmann GA. The genitourinary syndrome of menopause. 2021;28:579-88. doi: https://doi.org/10.1097/GME.0000000000001728
11. Coudray MS, Madhivanan P. Bacterial vaginosis-A brief synopsis of the literature. Eur J Obstet Gynecol Reprod 2020 Feb;245:143-8. doi: https://doi.org/10.1016/j.ejogrb.2019.12.035
12. Stewart LL, Vodstrcil LA, Coombe J, Brad­shaw CS, Hocking JS. Prevalence of bacterial vaginosis in postmenopausal women: a systematic review and meta-analysis.Sex Health. 2022;19(1):17-26. doi: https://doi.org/10.1071/SH21083
13. Muhleisen AL, Herbst-Kralovetz MM. Meno­pause and the vaginal microbiome. Maturitas. 2016;91:42-50. doi: https://doi.org/10.1016/j.maturitas.2016.05.015
14. [Standard of care. Abnormal vaginal discharge]. [Internet]. 2022 [cited 2024 Aug 15]. Ukrainian. Available from:https://moz.gov.ua/uploads/8/42485-dn_2264_15122022_dod.pdf
15. Javed A, Parvaiz F, Manzoor S. Bacterial vagi­nosis: An insight into the prevalence, alternative treatments regimen and it's associated resistance patterns. Microb Pathog.2019 Feb;127:21-30. doi: https://doi.org/10.1016/j.micpath.2018.11.046
16. Ostafiichuk S, Polishchuk I, Perkhulyn O, KusaO, Henyk N, et al. Microbiological аssessment of Glycyrrhizic Acid affectiveness in bacterial vaginosis – a co­mparative study. Galician medical journal. 2022;29(4):E202243. doi: https://doi.org/10.21802/gmj.2022.4.3
17. Workowski KA, BachmannLH, Chan PA, John­ston CM, Muzny CA, Park I, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi: https://doi.org/10.15585/mmwr.rr7004a1   
18. Unlü C, Donders G. Use of lactobacilli and estriol combination in the treatment of disturbed vaginal ecosystem: a review. J Turk Ger Gynecol Assoc. 2011 Dec 1;12(4):239-46. doi: https://doi.org/10.5152/jtgga.2011.57
19. Horbunova OV. [Bacterial vaginosis: modern approaches to treatment]. Novosty medytsyny y farmatsyy. Reproduktolohyya. Akusherstvo. Hynekolohyya. Urolo­hyya [Internet]. 2018 [cited 2024 Aug 15];671. Ukrainian. Availablefrom:
    http://www.mif-ua.com/archive/article/46650
20. Liu H-F, Yi N. A systematic review and meta-ana­lysis on the efficacy of probiotics for bacterial vaginosis. Europ Rev Medic Pharmacol Scien. 2022;26:90-8. doi: https://doi.org/10.26355/eurrev_202201_27752
21. Wu S, Hugerth LW, Schuppe-Koistinen I. The right bug in the right place: opportunities for bacterial vaginosis treatment. Biofilms Microbiomes. 2022;8:34. doi: https://doi.org/10.1038/s41522-022-00295-y
22. Geng L, Huang W, Jiang S, Zheng Y, Zhou Y, Zhou Y, et al. Effect of Menopausal Hormone Therapy on the Vaginal Microbiota and Genitourinary Syndrome of Menopause in Chinese Menopausal Women. Frontiers in Microbiology.2020;11:590877. doi: https://doi.org/10.3389/fmicb.2020.590877
23. Serhiychuk MH. [The structure of a bacterial cell and methods of its research]. Kyiv: Fitosotsiotsentr; 2001. 232 р. Ukrainian.
24. Horokhovatskyi VO, Hadetska SV. [Statistical processing and data analysis in structural image classification methods]. Kharkiv: FOPPanov A.N., 2020. 128 р. Ukrainian.
25. Amabebe E, Anumba DOC. The Vaginal Micro­environment: The Physiologic Role of Lactobacilli. Front Med(Lausanne). 2018 Jun 13;5:181. doi: https://doi.org/10.3389/fmed.2018.00181
26. Lyu J, Gao M, Zhao S, Liu X, Zhao X, Zou Y, et From whole genomes to probiotic candidates: A study of potential lactobacilli strains selection for vaginitis treatment. Heliyon. 2024 Apr 30;10(9):e30495. doi: https://doi.org/10.1016/j.heliyon.2024.e30495
27. Choi SI, Won G, Kim Y, Kang CH, Kim GH. Lacto­bacilli Strain Mixture Alleviates Bacterial Vaginosis through Antibacterial and Antagonistic Activity in Gard­nerella vaginalis-Infected C57BL/6 Mice. Micro­orga­nisms. 2022 Feb 20;10(2):471. doi: https://doi.org/10.3390/microorganisms10020471  
28. Liu P, Lu Y, Li R, Chen X. Use of probiotic lacto­bacilli in the treatment of vaginal infections: In vitro and in vivo Front Cell Infect Microbiol. 2023 Apr 3;13:1153894. doi: https://doi.org/10.3389/fcimb.2023.1153894
29. Srinivasan S, Hua X, Wu MC, Proll S, Valint DJ, Reed SD, et al. Impact of Topical Interventions on the Vaginal Microbiota and Metabolome in Postmenopausal Women: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2022;5(3):e225032. doi: https://doi.org/10.1001/jamanetworkopen.2022.5032
30. Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020;19:5. doi: https://doi.org/10.1186/s12941-020-0347-4
31. Mueck AO, Ruan X, Prasauskas V, Grob P, Ort­mann O. Treatment of vaginal atrophy with estriol and lactobacilli combination: a clinical review. Climacteric. 2018 Apr;21(2):140-7. doi: https://doi.org/10.1080/13697137.2017.1421923

Look through:

Ostafiichuk S.O. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, 
e-mail: svitlana.ostafijchuk@gmail.com
https://orcid.org/0000-0001-8301-814X

Drogomyretska N.V. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
https://orcid.org/0000-0002-7371-2450

Kusa O.M. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
https://orcid.org/0000-0002-8881-3756

Neiko O.V. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
https://orcid.org/0000-0003-2408-2664

Levitsky I.V. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
https://orcid.org/0000-0001-6197-1730

Kinash N.M. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
https://orcid.org/0000-0002-2094-6026

Ostafiichuk S.O., Drogomyretska N.V., Kusa O.M., Neiko O.V., Levitsky I.V., Kinash N.M. Optimization of treatment and prevention of recurrences of bacterial vaginosis in postmenopausal women. Medicni perspektivi. 2024;29(4):136-145.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319326

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

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

Key words: endometrial polyps, endometrial hyperplasia,  endometrial neoplasms, benign tumors, malignant transformation, diagnostics, immunohistochemistry

1. DreislerE, Kjer  Management of endometrial hyperplasia and polyps. Maturitas. 2019;124:64-7. doi: https://doi.org/10.1016/j.maturitas.2019.04.036
2. NijkangNP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. doi: https://doi.org/10.1177/2050312119848247
3. Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio Sardo A, Carugno J. Endometrial polyps. An evi­dence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol. 2021;260:70-7. doi: https://doi.org/10.1016/j.ejogrb.2021.03.017
4. Khaskhachikh DA, Potapov VO, Poslavska OV. [Immunohistochemical characteristics of endometrium hyperplasia in comparison with secretory endometrium]. Morphologia. 2023;17(2):66-74. Ukrainian. doi: https://doi.org/10.26641/1997-9665.2023.2.66-74
5. Chapel DB, Howitt BE, Sholl LM, Dal Cin P, Nucci MR. Atypical uterine polyps show morphologic and molecular overlap with mullerian adenosarcoma but follow a benign clinical course. Mod Pathol. 2022;35(1):106-16. doi: https://doi.org/10.1038/s41379-021-00946-z
6. Yang JH, Yang PK, Chen MJ, Chen SU, Yang YS. Management of endometrial polyps incidentally diagnosed during IVF: a case-control study. Reprod Biomed Online. 2017;34(3):285-90. doi: https://doi.org/10.1016/j.rbmo.2016.12.012
7. Venturella R, Miele G, Cefalì K, Lico D, D'Ales­sandro P, Arduino B, et al. Subcutaneous Progesterone for Endometrial Polyps in Premenopausal Women: A Preli­minary Retrospective Analysis. J Minim Invasive Gynecol. 2019;26(1):143-7. doi: https://doi.org/10.1016/j.jmig.2018.04.023
8. Cetin F, Kayar İ, Birge Ö, Goc G. Malignancy risk factors based on endometrial polyp. BMC Womens Health. 2024;24(1):567.
   doi: https://doi.org/10.1186/s12905-024-03406-3
9. Shen Y, Feng W, Yang J, Yi J. Effect of Hystero­scopic Polypectomy Combined with Mirena Placement on Postoperative Adverse Reactions and Recurrence Rate of Endometrial Polyps: Based on a Large-Sample, Single-Center, Retrospective Cohort Study. Biomed Res Int. 2022;2022:1232495. doi: https://doi.org/10.1155/2022/1232495
10. Xu J, Rao X, Lu W, Xie X, Wang X, Li X. Nonin­vasive Predictor for Premalignant and Cancerous Lesions in Endometrial Polyps Diagnosed by Ultrasound. Front Oncol. 2022;11:812033. doi: https://doi.org/10.3389/fonc.2021.812033
11. Chou AJ, Bing RS, Ding DC. Endometrial Atypi­cal Hyperplasia and Risk of Endometrial Cancer. Diagno­stics. 2024;14(22):2471. doi: https://doi.org/10.3390/diagnostics14222471
12. Vareniuk IM, Dzerzhynskyi ME. [Methods of cy­to-histological diagnosis: study guide]. Kyiv; 2019. Ukrainian.
13. Nguyen T. Immunohistochemistry: A Technical Guide to Current Practices. Cambridge: Cambridge University Press; 2022.
14. Lucas E, Niu S, Aguilar M, Molberg K, Carrick K, Rivera-Colon G, et al. Utility of a PAX2, PTEN, and β-ca­tenin Panel in the Diagnosis of Atypical Hyperpla­sia/Endometrioid Intraepithelial Neoplasia in Endometrial Polyps. Am J Surg Pathol. 2023;47(9):1019-26. doi: https://doi.org/10.1097/PAS.0000000000002076
15. Patrizi L, Ticconi C, Borelli B, Finocchiaro S, Chiaramonte C, Sesti F, et al. Clinical significance of endo­metrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery. BMC Womens Health. 2022;22(1):106. doi: https://doi.org/10.1186/s12905-022-01682-5
16. Lu L, Luo J, Deng J, Huang C, Li C. Polycystic ovary syndrome is associated with a higher risk of prema­lignant and malignant endometrial polyps in premeno­pausal women: a retrospective study in a tertiary teaching  hospital. BMC Womens Health. 2023;23(1):127. doi: https://doi.org/10.1186/s12905-023-02269-4
17. Uglietti A, Buggio L, Farella M, Chiaffarino F, Dridi D, Vercellini P, et al. The risk of malignancy in ute­rine polyps: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;237:48-56. doi: https://doi.org/10.1016/j.ejogrb.2019.04.009
18. Li X, Wang F, Chen M, Ling L, Zhao F, Peng D. The association between endometrial polyps and insulin resistance from the expression of PI3K and AKT proteins perspective. BMC Womens Health. 2024;24(1):366. doi: https://doi.org/10.1186/s12905-024-03218-5
19. Jose AA, Daniel M, Phansalkar MD. Hysteropa­thological Correlation in Abnormal Uterine Bleeding in a Tertiary Care Hospital in South India. J Obstet Gynaecol India. 2024;74(2):150-7. doi: https://doi.org/10.1007/s13224-023-01888-z
20. Xu J, Rao X, Lu W, Xie X, Wang X, Li X. Nonin­vasive Predictor for Premalignant and Cancerous Lesions in Endometrial Polyps Diagnosed by Ultrasound. Front Oncol. 2022;11:812033. doi: https://doi.org/10.3389/fonc.2021.812033
21. Antomonov M Yu. [Mathematical processing and analysis of biomedical data]. Kyiv: MIC "Medinform"; 2018. 579 р. Ukrainian. 

Look through:

Poslavska O.V. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: alexandra.poslavskaya@gmail.com
https://orcid.org/0000-0002-3133-8413

Khaskhachykh D.A. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: docdhas@gmail.com
https://orcid.org/0000-0001-5097-6667

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

Potapov V.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-7498-7416

Poslavska O.V., Khaskhachykh D.A., Shponka I.S., Potapov V.O. The significance of the immunohistochemical method in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia. Medicni perspektivi. 2024;29(4):145-156.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319330

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

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

Key words: mental health, information, psycho-emotional state, anxiety, depression, resources, joy

1. Ali RN, Rubin H, Sarkar S. Countering the poten­tial re-emergence of a deadly infectious disease-Infor­mation warfare, identifying strategic threats, launching countermeasures. PLoS One. 2021;16(8):e0256014. doi: https://doi.org/10.1371/journal.pone.0256014
2. Muresanu IA, Grad DA, Muresanu DF, Dob­ran SA, Hapca E, Strilciuc S, et al. Evaluation of post-traumatic stress disorder (PTSD) and related comorbidities in clinical studies. Journal of Medicine and Life Science. 2022;15(4):436-42. doi: https://doi.org/10.25122/jml-2022-0120
3. Talishinsky E. [Information and psychological war­fare in the context of the war between Azerbaijan and Armenia]. Eminak. 2023;4(44):231-47. Ukrainian. doi: https://doi.org/10.33782/eminak2023.4(44).684
4. Bartzik M, Bentrup A, Hill S, Bley M, von Hir­schhausen E, Krause G, et al. Care for Joy: Evaluation of a Humor Intervention and Its Effects on Stress, Flow Experience, Work Enjoyment, and Meaningfulness of Work. Frontiers in Public Health. 2021;9:667821. doi: https://doi.org/10.3389/fpubh.2021.667821
5. Whitehead B, Torossian E. Older adults’ expe­rience of the COVID-19 pandemic: a mixed-methods ana­lysis of stresses and joys. The Gerontologist. 2021;61(1):36-47. doi: https://doi.org/10.1093/geront/gnaa126
6. Fischer F, Peifer C, Scheel T. Editorial: Cross-Dis­ciplinary Perspectives on the Relationship Between Humor and Health: Theoretical Foundations, Empirical Evidence and Implications. Frontiers in Public Health. 2021;9:774353. doi: https://doi.org/10.3389/fpubh.2021.774353
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8. Hrytsiuk IM, Mahdysiuk LI. [Research methods in various fields of practical psychology]. Lutsk: Vezha-Druk; 2022. 248 р. Ukrainian.
9. Sytnyk OA. [Survey of the patient in the activity of a physical therapist]. Sumy: Sumskyi derzhavnyi univer­sytet; 2023. 72 р. Ukrainian.
10. [Questionnaire for current functioning]. [Internet]. [cited 2024 Mar 16]. Ukrainian. Available from: https://www.rdc.org.ua/download/methodological-develop­ments/Questionnaire%20for%20current%20functioning.pdf
11. [Questionnaire “Presence of joy in your life”]. [Internet]. [cited 2024 Mar 16]. Ukrainian. Available from: https://www.rdc.org.ua/download/methodological-deve­lopments/Questionnaire%20of%20Joy%20in%20Your%20Life.pdf
12. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow 2013;48(3):452-58. doi: https://doi.org/10.1038/bmt.2012.244
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14. 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;19(8):e7698. doi:  https://doi.org/10.5867/medwave.2019.08.7698
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17. Danilyan OG, Dzeban AP, Hetman YA, Kalynov­skyi YYu. Features of information war in the media space in the conditions of russian aggression against Ukraine. Cogito. 2023;15(3):55-71.
18. Hordiichuk O, Halapsis A, Kozlovets M. How the information warfare turns into full-scale military aggres­sion: the experience of Ukraine. 2023;16:345-62. doi: https://doi.org/10.14746/ps.2023.1.25
19. Bakhramova AA. Causes and manifestations of aggressive behavior in adolescence. Journal for Educators, Teachersand  2023;14(3):513-20. doi: https://doi.org/10.47750/jett.2023.14.03.062
20. Tatayeva R, Ossadchaya E, Sarculova S, Sem­bayeva Z, Koigeldinova S. Psychosomatic Aspects of The Development of Comorbid Pathology: A Review. Medical journal of the Islamic Republic of Iran. 2022;36(1):1160-8. doi: https://doi.org/10.47176/mjiri.36.152
21. Beller J. Age-period-cohort analysis of depression trends: are depressive symptoms increasing across gene­rations in Germany? European Journal of Ageing. 2022;19(4):1493-505. doi: https://doi.org/10.1007/s10433-022-00732-z
22. Bielikova N, Indyka S, Tsos A, Vaschuk L. [Quality of Life in War-Affected Population]. Fizychne vykhovannia, sport i kultura zdorovia u suchasnomu suspilstvi.2022;1(57):3-9.  doi: https://doi.org/10.29038/2220-7481-2022-01-03-09
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25. McGinty G, Fox R, Roberts B, Makhashvili N, Javakhishvili JD, Hyland P. Post-traumatic Stress Disor­der, Complex Post-traumatic Stress Disorder, and Coping Styles among Internally Displaced Ukrainians. Journal of Lossand  2023;28(7):571-87. doi: https://doi.org/10.1080/15325024.2023.2217002
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Look through:

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

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., Serdyuk I.A. The current state of functioning and resourcefulness of individuals during turbulent times. Medicni perspektivi. 2024;29(4):157-167.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319334

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

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

Key words: somatoform disorders, anxiety, depression, sleep disorders, quality of life, alexithymia

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4. Yang X, Luo J, Wang P, He Y, Wang C, Yang L, et al. Characteristics and economic burden of patients with somatoform disorders in Chinese general hospitals: a multi­center cross-sectional study. Ann Gen Psychiatry 2023;22:30. doi: https://doi.org/10.1186/s12991-023-00457-y
5. Wu C-S, Chen T-T, Liao S-C, Huang W-C, Huang W-L. Clinical outcomes, medical costs, and medi­cation usage patterns of different somatic symptom disorders and functional somatic syndromes: a population-based study in Taiwan. Psychol Med 2024;54:1452-60. doi: https://doi.org/10.1017/S0033291723003355
6. Challa SA, Graziano R, Strasshofer DR, Whi­te KS, Sayuk GS, Bruce SE. Perceived sleep quality mediates the relationship between posttraumatic stress and somatic symptoms. Psychol Trauma 2022;14:1080-8. doi: https://doi.org/10.1037/tra0000561
7. Ducroizet A, Zimianti I, Golder D, Hearne K, Ed­wards M, Nielsen G, et al. Functional neurological disor­der: Clinical manifestations and comorbidities; an online survey. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia 2023;110:116-25. doi: https://doi.org/10.1016/j.jocn.2023.02.014
8. Zborovskyi O, Kozhyna H, Symonian V, Ko­zhyn M, Serhiienko O, Tabachnikova V, et al. [Clinical phenomenology of somatoform disorders and assessment of the quality of life of patients in the zone of Operations of the United Forces and internally displaced persons]. Medytsyna sohodni i zavtra. 2021;90:74-80. Ukrainian. doi: https://doi.org/10.35339/msz.2021.90.4.zks
9. Khomitskyi MY, Kondratenko MY. [Personality profile characteristics of patients with somatoform and an­xiety-phobic disorders with phenomena of reduced criti­cality]. Zaporizkyi medychnyi zhurnal. 2023;25:215-9. Ukrainian.
   doi: https://doi.org/10.14739/2310-1210.2023.3.265368
10. Ogorenko В, Shornikov А. [Sleep disorders and quality of life of medical students during martial law]. Psykhosomatychna medytsyna ta zahalna praktyka. 2023;8:e0801439. doi: https://doi.org/10.26766/pmgp.v8i2.439
11. Liashchenko YV, Yuryeva LM. [The influence of the sleep disturbances on the quality of patients` life with anxiety-depressive disorders of neurotic and organic ge­nesis]. Psykhiatriia, nevrolohiia ta medychna psykholohiia. 2021:25-31. doi: https://doi.org/10.26565/2312-5675-2021-18-01
12. The Universal Declaration on Bioethics and Hu­man Rights. International Social Science Journal. 2005;57:745-53. doi: https://doi.org/10.1111/j.1468-2451.2005.00592.x
13. World Medical Association. World Medical Asso­ciation Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310:2191-4. doi: https://doi.org/10.1001/jama.2013.281053
14. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research.1989;28:193-213. doi: https://doi.org/10.1016/0165-1781(89)90047-4
15. Beck AT, Steer RA, Brown GK. BDI-II, Beck depression inventory: manual. 2nd ed. San Antonio, Tex.: Boston: Psychological Corp.; Harcourt Brace; 1996.
16. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34:601-8. doi: https://doi.org/10.1093/sleep/34.5.601
17. Vasylets VV, Shapoval II, Shalkovskyi YeI, Kle­ban­ska AO, Stanislavchuk MA. [Cross-cultural adaptation ukrai­nian language version Toronto alexithymia scale TAS-20: approbation in patients with ankylosing spon­dylitis]. Ukrain­skyi Revmatolohichnyi Zhurnal. 2023;1(91):1-7. doi:https://doi.org/10.32471/rheumatology.2707-6970.91.17556
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19. Skapinakis P. Spielberger State-Trait Anxiety Inventory. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: SpringerNetherlands;  p. 6261-4. doi: https://doi.org/10.1007/978-94-007-0753-5_2825
20. Ivanchuk М, Polishchuk О. [Features of statistical analysis of medical-psychological research]. Psykhosoma­tychna medytsyna ta zahalna praktyka. 2020;5:e0504255. Ukrainian. doi: https://doi.org/10.26766/pmgp.v5i3.255
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    doi: https://doi.org/10.1136/gpsych-2022-100942
25. Behm AC, Hüsing P, Löwe B, Toussaint A. Persistence rate of DSM-5 somatic symptom disorder: 4-year follow-up in patients from a psychosomatic outpatient clinic.Compr  2021;110:152265. doi: https://doi.org/10.1016/j.comppsych.2021.152265
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Look through:

Ogorenko V.V. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: 604@dmu.edu.ua
https://orcid.org/0000-0003-0549-4292

Makarova I.I. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0009-0001-1426-5398

Shornikov A.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-8196-9128

Ogorenko V.V., Makarova I.I., Shornikov A.V. Quality of life prognosis in patients with somatoform disorders with sleep disorders. Medicni perspektivi. 2024;29(4):167-175.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319337

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

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

Key words: cerebral venous thrombosis, depression, comorbidities, outcomes, scoping review

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2. Coutinho JM, van de Munckhof A, Aguiar de Sousa D, Poli S, Aaron S, Arauz A, et Reducing the global burden of cerebral venous thrombosis: An international research agenda. Int J Stroke [Internet]. 2024 [cited 2024 Sep1];19:599-610. doi: https://doi.org/10.1177/17474930241242266
3. Aguiar de Sousa D, Lucas Neto L. Advances in Cerebral Venous Thrombosis. Stroke [Internet]. 2024 [cited2024 Sep 1];55:2169-72. doi: https://doi.org/10.1161/STROKEAHA.123.044266
4. Quealy JB. Mechanical Thrombectomy for Asep­tic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic Review. Clin Neuroradiol [Internet].2024 [cited 2024 Sep 1];34:451-63. doi: https://doi.org/10.1007/s00062-023-01373-0
5. Sriram S, Asokan K, Thomas TS. Study on the Health Related Quality of Life of Patients with Ischemic stroke.IOSR J Pharm Biol  2015;10:45-52. doi: https://doi.org/10.9790/3008-10134552
6. Hackett ML, Pickles K. Part I: frequency of dep­ression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke [Internet].2014 [cited 2024 Sep 1];9:1017-25. doi: https://doi.org/10.1111/ijs.12357
7. Thorat N, Onkarappa SA, Karkal RN. Depression and quality of life after cerebral venous sinus thrombosis. J Neurol Sci [Internet]. 2019 [cited 2024 Oct 20];405:70-1. doi: https://doi.org/10.1016/j.jns.2019.10.351
8. Rosovsky RP, Mezue K, Gharios C, Civieri G, Cardeiro A, Zureigat H, et al. Anxiety and depression are associated with heightened risk of incident deep veinthrombosis: Mediation through stress-related neural   Am J Hematol. 2024;99(10):1927-38. doi: https://doi.org/10.1002/ajh.27427
9. Jørgensen H, Horváth-Puhó E, Laugesen K, Bræk­kan SK, Hansen J-B, Sørensen HT. Venous throm­boem­bolism and risk of depression: a population-based cohort study. J Thromb Haemost [Internet]. 2023 [cited2024 Sep 2];21:953-62. doi: https://doi.org/10.1016/j.jtha.2022.12.006
10. Li H-Y, Wang L-H, Wang J, Wang Y-B, Wang H-S. Causal association between major depressive disorder and venous thromboembolism: a bidirectional mendelian randomization study. Front Genet [Internet]. 2024 [cited 2024 Sep 2];15:1383333. doi: https://doi.org/10.3389/fgene.2024.1383333
11. Takeshima M, Ishikawa H, Umeta Y, Kudoh M, Umakoshi A, Yoshizawa K, et al. Prevalence of Asy­mp­tomatic Venous Thromboembolism in Depressive Inpa­tients. Neuropsychiatr Dis Treat [Internet]. 2020 [cited 2024 Sep 2];16:579-87. doi: https://doi.org/10.2147/NDT.S243308
12. Medeiros GC, Roy D, Kontos N, Beach SR. Post-stroke depression: A 2020 updated review. Gen Hosp Psychiatry.2020;66:70-80. doi: https://doi.org/10.1016/j.genhosppsych.2020.06.011
13. Ashorobi D, Ameer MA, Fernandez R. Throm­bosis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Sep 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK538430/
14. Idiculla PS, Gurala D, Palanisamy M, Vijayaku­mar R, Dhandapani S, Nagarajan E. Cerebral Venous Thrombosis: A Comprehensive Review. Eur Neurol [Internet].2020 [cited 2024 Sep 2];83:369-79. doi: https://doi.org/10.1159/000509802
15. Patwardhan A, Gupta M, Philip M, Ranga­rajan A, Joshi T, Alladi S, et al. Clinicoradiological Features and Long-term Cognitive and Functional Out­come in Patients with Deep Cerebral Venous Thrombosis. Ann Indian Acad Neurol [Internet]. 2024 [cited2024 Sep 7];27:34. doi: https://doi.org/10.4103/aian.aian_792_23
16. Meher R, Aghoram R, Narayan S, Done I, Bala­chandran M, Jain S, et Journal of Cardiovascular Di­sease Research. Long-term outcomes of patients with cerebral venous sinus thrombosis from tamil nadu. J Cardiovasc Dis Res. 2024;15:793-804.
17. Teixeira JMS. Quality of Life after Cerebral Venous Thrombosis. U.Porto. Repositorio aberto [Inter­net].2023 [cited 2024 Sep 7]. Available from:  https://repositorio-aberto.up.pt/handle/10216/150322 
18. Malone M, Ritchie D, Okonoboh P, Ebrahim A. An Atypical Presentation of Cerebral Venous Sinus Thro­mbosis in a 19-Year-Old Woman. Consultant. 2023;63:1-8. doi: https://doi.org/10.25270/con.2023.08.000001
19. Pleșa FC, Jijie A, Toma GS, Ranetti AE, Ma­nole AM, Rotaru R, et al. Challenges in Cerebral Venous Thrombosis Management-Case Reports and Short Lite­rature Review. Life Basel Switz. 2023;13:334. doi: https://doi.org/10.3390/life13020334
20. Benerji T, Bandla S, Parvathaneni KM. Depres­sion in a case of cerebral venous sinus thrombosis. Arch Ment Health [Internet]. 2023 [cited 2024 Sep 7];24:149. doi: https://doi.org/10.4103/amh.amh_68_22
21. Saroja AO, Thorat NN, Naik KR. Depression and Quality of Life after Cerebral Venous Sinus Thrombosis. Ann Indian Acad Neurol [Internet]. 2020 [cited 2024 Sep 7];23:487-90. doi: https://doi.org/10.4103/aian.AIAN_191_19
22. Hiltunen S. Cerebral venous thrombosis: clinical characteristics and factors affecting outcome. Helsinki: Helsingin yliopisto; 2018.
23. Lindgren E, Jood K, Tatlisumak T. Vocational outcome in cerebral venous thrombosis: Long-term follow-up study. Acta Neurol Scand [Internet]. 2018 [cited 2024 Sep 7];137:299-307. doi: https://doi.org/10.1111/ane.12875
24. Hiltunen S, Putaala J, Haapaniemi E, Tatlisu­mak T. Long-term outcome after cerebral venous throm­bosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients. J Neurol.2016;263:477-84. doi: https://doi.org/10.1007/s00415-015-7996-9
25. Iannacchero R, Costa A, Sergi A, Squillace A, Vescio G, Cannistrà U. Diagnosis and treatment of heada­che probably attributed to cerebral venous sinus throm­bosis. Clin Manag Issues [Internet]. 2014 [cited 2024 Sep 7];8:97-101. doi: https://doi.org/10.7175/cmi.v8i4.966
26. Bugnicourt J-M, Guegan-Massardier E, Rous­sel M, Martinaud O, Canaple S, Triquenot-Bagan A, Wallon D, La­my C, Leclercq C, Hannequin D, et al. Cognitive impairment after cerebral venous thrombosis: a two-center study. J Neurol.2013;260:1324-31. doi: https://doi.org/10.1007/s00415-012-6799-5
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33. Amadio P, Sandrini L, Zarà M, Barbieri SS, Iera­ci A. NADPH-oxidases as potential pharmacological targets for thrombosis and depression comorbidity. Redox Biol.2024;70:103060. doi: https://doi.org/10.1016/j.redox.2024.103060
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35. Nieuwsma JA, Pepper CM, Maack DJ, Birgen­heir DG. Indigenous perspectives on depression in rural regions of India and the United States. Transcult Psychiatry.2011;48:539-68. doi: https://doi.org/10.1177/1363461511419274
36. Bhattacharya A, Camacho D, Kimberly LL, Lu­kens EP. Women's Experiences and Perceptions of Depression in India: A Metaethnography. Qual Health Res. 2019;29:80-95. doi: https://doi.org/10.1177/1049732318811702
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Look through:

Feras M. Almarshad  Shaqra University, College of Medicine, Department of Medicine, Shaqra, Saudi Arabia, 
e-mail: falmarshad@su.edu.sa
https://orcid.org/0000-0002-9468-1489

Dushad Ram Cerebral  Shaqra University, College of Medicine, Department of Medicine, Shaqra, Saudi Arabia,
e-mail:dushadram@su.edu.sa
https://orcid.org/0000-0003-4908-5407

Feras M. Almarshad, Dushad Ram Cerebral venous thrombosis and depression: a scoping review. Medicni perspektivi. 2024;29(4):175-184.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319342

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

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

Key words: disability, military personnel, large-scale military invasion

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4. Ipatov AV, Moroz OM, Golyk VA, Perepe­li­chna RYa, et al. [Main indicators of disability and activity of medical and social expert commissions of Ukraine for 2014: analytical and informational guide]. Dnipro, 2015. 167 p. Ukrainian.
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11. Ipatov AV, Moroz OM, Khanyukova IY, et al. [Main indicators of disability and activity of me­dical and social expert commissions of Ukraine for 2021: ana­lytical and informational guide]. Dnipro; 2022. 188 p. Ukrainian.
12. Kyrychenko AG, Khanyukova IY, Hondu­len­ko NO, Sanina NA. [Main indicators of disability and activity of medical and social expert commissions of Ukraine for 2022: analytical and informational guide]. Dnipro; 2023. 188 p. Ukrainian.
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16. Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 [Internet]. 2022 [cited 2024 Feb 15]. Available from: https://www.congress.gov/bill/117th-congress/­senate-bill/3373/text
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Look through:

Khanyukova I.Y. SI “Ukrainian State Research Institute of Medical and Social Problems of Disability Ministry of Health of Ukraine”, Dnipro, Ukraine, e-mail: khanyukova.inna@gmail.com
https://orcid.org/0000-0002-1760-0913

Hondulenko N.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-5683-7836

Sanina N.A. Dnipro State Medical University, Dnipro, Ukraine,
e-mail: nataliyasanina@gmail.com
https://orcid.org/0000-0001-6603-0219

Khanyukova I.Y., Hondulenko N.O., Sanina N.A. Disability of military personnel in Ukraine for 2014-2022. Medicni perspektivi. 2024;29(4):184-192.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319362

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

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

Key words: Parkinson's disease, deep brain stimulation, radiofrequency destruction

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15. Kostyuk KR, Popov AO, Medvedev YuM, Zinke­vich YaP, Shevelyov MM, Dichko SM. [The first expe­rience of using deep brain stimulation in the treatment of Parkinson's disease in Ukraine]. Ukrainian Neurological Journal. 2013;(4):36-43. Ukrainian.
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    doi: https://doi.org/10.3233/JPD-212879
33. Kennis M, Hale EW, Hemendinger E, Davis R, Ojemann SG, Strom L, et Suicide in Deep Brain Stimulation for Parkinson’s Disease: A Retrospective Case-Control Study. J Park Dis. 2023 May;13(3):415-9. doi: https://doi.org/10.3233/JPD-225049
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35. Hacker M, Cannard G, Turchan M, Meystedt J, Da­vis T, Phibbs F, et al. Early subthalamic nucleus deep brain stimulation in Parkinson’s disease reduces long-term medi­cation costs. Clin Neurol Neurosurg. 2021 Nov;210:106976. doi: https://doi.org/10.1016/j.clineuro.2021.106976
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    doi: https://doi.org/10.1038/s41467-021-23311-9
43. Hacker M, Cannard G, Turchan M, Meystedt J, Davis T, Phibbs F, et al. Early subthalamic nucleus deep brain stimulation in Parkinson’s disease reduces long-term medication costs. Clin Neurol Neurosurg. 2021 Nov;210:106976. doi: https://doi.org/10.1016/j.clineuro.2021.106976
44. Spindler P, Alzoobi Y, Kühn AA, Faust K, Schneider GH, Vajkoczy P. Deep brain stimulation for Parkinson’s disease-related postural abnormalities: a systematic review and meta-analysis. Neurosurg Rev. 2022 Oct;45(5):3083-92. doi: https://doi.org/10.1007/s10143-022-01830-3
45. Mahlknecht P, Foltynie T, Limousin P, Poewe W. How Does Deep Brain Stimulation Change the Course of Parkinson’s Disease? Mov Disord Off J Mov Disord Soc. 2022 Aug;37(8):1581-92. doi: https://doi.org/10.1002/mds.29052

Look through:

Kostiuk K.R. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, 
e-mail: kostiuk.neuro@gmail.com
https://orcid.org/0000-0002-3277-5025

Lisianyi A.O. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, 
e-mail: neuroliandri@gmail.com
https://orcid.org/0000-0002-4245-2377

Medvediev Yu.M. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, 
e-mail: stereomed@gmail.com
https://orcid.org/0000-0002-9999-8813

Popov A.O. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, 
e-mail: popovandriy@gmail.com
https://orcid.org/0000-0001-9741-2711

Cheburakhin V.V. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, 
e-mail: dr.cheburakhin@gmail.com
https://orcid.org/0000-0002-6820-5673

Buniakin V.M. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine, 
e-mail: bunyakin.slava@gmail.com
https://orcid.org/0000-0001-8643-1693

Tevzadze D.A. State Institution “Romodanov Neurosurgery Institute”, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine,
e-mail: pawtod22@gmail.com
https://orcid.org/0000-0002-5298-2179

Kostiuk K.R., Lisianyi A.O., Medvediev Yu.M., Popov A.O., Cheburakhin V.V., Buniakin V.M., Tevzadze D.A. Prospects for the use of deep brain stimulation in the treatment of Parkinson's disease in Ukraine. Medicni perspektivi. 2024;29(4):193-207.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319368

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

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

Key words: coordinated rehabilitation, stroke, interprofessional collaboration, patient recovery, quality of life, rehabilitation strategy

1. ATLAS.ti: The #1 software for qualitative data analysis. ATLAS.ti Scientific Software Development GmbH [Internet]. 2024 [cited 2024 Feb 12]. Available from: https://atlasti.com
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5. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Asso­ciation/Ame­rican Stroke Association. Stroke. 2013 May 7;44(7):2064-89. doi: https://doi.org/10.1161/STR.0b013e318296aeca
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8. The top 10 causes of death. World Health Orga­nization [Internet]. 2024 [cited 2024 Feb 12]. Available from:https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
9. Kendall E, Muenchberger H, Catalano T. The move towards community-based rehabilitation in indu­strialised countries: Are we equipped for the challenge? Disability and Rehabilitation. 2009 Nov 11;31(26):2164-73. doi: https://doi.org/10.3109/09638280902939734
10. Juckett LA, Wengerd LR, Faieta J, Griffin CE. Evidence-Based Practice Implementation in Stroke Reha­bilitation: A Scoping Review of Barriers and Facilitators. The American Journal of Occupational Therapy. 2020 Jan 1;74(1):7401205050p1-7401205050p14. doi: https://doi.org/10.5014/ajot.2020.035485
11. Vacková J. [Social work in the system of coor­dinated rehabilitation: for clients after acquired brain injury (especially stroke) with special attention to intervention from the perspective of social work, physiotherapy, occupational therapy and other selected professions]. Praha: Grada Publishing; 2020. Czech.
12. Sarzyńska-Długosz I. An optimal model of long-term post-stroke care. Frontiers in Neurology. 2023 Mar 23;14:1129516. doi: https://doi.org/10.3389/fneur.2023.1129516
13. Martins SCO, Secchi TL, Molina C, Nogueira R. Editorial: Development of stroke systems of care across the globe. Frontiers in Neurology. 2023 Sep 26;14:1292036. doi: https://doi.org/10.3389/fneur.2023.1292036
14. Thomas E, Magilvy JK. Qualitative Rigor or Research Validity in Qualitative Research. Journal for Specialists in Pediatric Nursing. 2011;16(2):151-5. doi: https://doi.org/10.1111/j.1744-6155.2011.00283.x
15. Holloway I, Galvin KM. Qualitative research in nursing and healthcare. 4th ed. Wiley; 2017.
16. Maxwell Qualitative Research Design: an In­teractive Approach. 3rd ed. Vol. 41. Thousand Oaks: Sage Publications; 2013.
17. Tong A, Sainsbury P, Craig J. Consolidated cri­teria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care.2007 Sep 16;19(6):349-57. doi: https://doi.org/10.1093/intqhc/mzm042
18. Siddiqui A. SWOT Analysis (or SWOT Matrix) Tool as a Strategic Planning and Management Technique in the Health Care Industry and Its Advantages. Bio­medical Journal of Scientific, Technical Research. 2021 Nov 29;40(2):1-8. doi: https://doi.org/10.26717/BJSTR.2021.40.006419
19. Mahak C, Manisha N, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of Utilization of Rehabilitation Services among Stroke Survivors. Journal of Neurosciences in Rural Practice. 2019 Sep 2;09(04):461-7. doi: https://doi.org/10.4103/jnrp.jnrp_25_18
20. Schwamm LH, Pancioli A, Acker JE, Gold­stein LB, Zorowitz RD, Shephard TJ, et Recommen­dations for the Establishment of Stroke Systems of Care. Stroke. 2005;36(3):690-703. doi: https://doi.org/10.1161/01.STR.0000158165.42884.4F  
21. Lewinter M, Mikkelsen S. Patients' experience of rehabilitation after stroke. Disability and Rehabilitation. 2009 Jul 28;17(1):3-9.doi: https://doi.org/10.3109/09638289509166621
22. Zwygart-Stauffacher M, Lindquist R, Savik K. De­velopment of Health Care Delivery Systems That Are Sen­sitive to the Needs of Stroke Survivors and Their Caregivers. Nursing Administration Quarterly. 2000;24(3):33-42. doi: https://doi.org/10.1097/00006216-200004000-00006
23. Nugraha B, Defi I, Yolanda R, Warliani M, Bi­ben V, Jennie J, et al. Describing community-based rehabi­litation services in Indonesia by using The International Classification of Service Organization in Rehabili­tation 2.0. Journal of Rehabilitation 2021;53(3):jrm00166. doi: https://doi.org/10.2340/16501977-2804
24. Lamontagne ME, Richards C, Azzaria L, Rosa-Goulet M, Clément L, Pelletier F. Perspective of patients and caregivers about stroke rehabilitation: the Quebec experience. Topics in Stroke Rehabilitation. 2019 Jan 2;26(1):39-48. doi: https://doi.org/10.1080/10749357.2018.1534453
25. Abu Saydah H, Turabi R, Sackley C, Moffatt F. Stroke Survivor’s Satisfaction and Experience with Re­ha­bilitation Services: A Qualitative Systematic Review. Journal of Clinical Medicine. 2023;12(16):5413. doi: https://doi.org/10.3390/jcm12165413
26. Mahak C, Manisha N, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of Utilization of Rehabilitation Services among Stroke Survivors. Journal of Neurosciences in Rural Practice. 2019 Sep 2;09(04):461-7. doi: https://doi.org/10.4103/jnrp.jnrp_25_18
27. Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Stu­dies. Archives of Physical Medicine and Rehabilitation. 2015;96(9):1698-1708.e10.doi: https://doi.org/10.1016/j.apmr.2015.03.017
28. Kusec A, Milosevich E, Williams OA, Chiu EG, Watson P, Carrick C, et al. Long-term psychological out­comes following stroke: The OX-CHRONIC study. BMC Neurol.2023 Nov 30;23(1):426. doi: https://doi.org/10.1186/s12883-023-03463-5
29. Stark S, Keglovits M, Arbesman M, Lieberman D. Effect of Home Modification Interventions on the Par­ticipation of Community-Dwelling Adults With Health Conditions: A Systematic Review. The American Journal ofOccupational  2017 Mar 1;71(2):7102290010p1-7102290010p11.doi: https://doi.org/10.5014/ajot.2017.018887
30. König J, Slepičková V. [Rehabilitation pathway of a patient after a stroke]. [Internet]. CMP Journal. 2022 [cited 2024 Feb 12];4(1):14-21. Czech. Available from: https://www.prolekare.cz/casopisy/cmp-journal/2022-1-30/rehabilitacni-cesta-pacienta-po-prodelane-cmp-131428
31. Mountain A, Patrice Lindsay M, Teasell R, Sal­bach NM, de Jong A, Foley N, et al. Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part Two. International Journal of Stroke. 2020;15(7):789-806. doi: https://doi.org/10.1177/1747493019897847
32. Ranford J, Asiello J, Cloutier A, Cortina K, Thor­ne H, Erler KS, et al. Interdisciplinary Stroke Recovery Research: The Perspective of Occupational Therapists in Acute Care. Frontiers in Neurology. 2019 Dec 17;10:1327. doi: https://doi.org/10.3389/fneur.2019.01327 

Look through:

Shuranova L. University of South Bohemia, České Budějovice, Czech Republic, 
e-mail: shural00@zsf.jcu.cz
https://orcid.org/0000-0002-5611-0490

Vacková J. University of South Bohemia, České Budějovice, Czech Republic
https://orcid.org/0000-0002-0241-1052

Rimárová K. Pavol Jozef Šafárik University in Košice, Institute of Public Health and Hygiene, Košice, Slovak Republic
https://orcid.org/0000-0003-4364-0553

Hryshchuk A. SI "Luhansk Taras Shevchenko National University", Educational and Research Institute of Natural and Agrarian Sciences, Lubny, Poltava region, Ukraine 
https://orcid.org/0000-0002-4608-337X

Shuranova L., Vacková J., Rimárová K., Hryshchuk A. Effective strategies for coordinated rehabilitation. Medicni perspektivi. 2024;29(4):207-218.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319375

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

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

Key words: HIV infection, mycoses of the skin and its applications, nosological structure, antiretroviral therapy, correlation

1. [Statistics on HIV/AIDS. Public Health Center of the Ministry of Health of Ukraine]. [Internet]. 2023 [cited 2024 Aug 07]. Available from: https://phc.org.ua/kontrol-zakhvoryuvan/vilsnid/statistika-z-vilsnidu
2. Boyd MA, Boffito M, Castagna A, Estrada V. Ra­pid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps. HIV Med. 2019;20(3):3-11. doi:  https://doi.org/10.1111/hiv.12708
3. Kawashima A, Uemura H, Oka S. Skin lesions of disseminated histoplasmosis resembling Kaposi’s sar­coma. Am J Trop Med Hyg. 2023;108(3):459. doi: https://doi.org/10.4269/ajtmh.22-0459
4. Carnovale S, Relloso MS, Bendezu K, Scra­vo­ni R, Daneri GL, Grzona E. Impact of acquired immuno­deficiency in dermatomycosis. Cases and Controls Study. Interamerican Journal of Heath Sciences. 2021 Oct:73-9. doi: https://doi.org/10.59471/ijhsc20212
5. Parija SC. Systemic mycoses and opportunistic in­fections. In: Textbook of Microbiology and Immuno­logy. Singapore: Springer Nature Singapore; 2023. p. 973-1002. doi: https://doi.org/10.1007/978-981-19-3315-8_67
6. Hay RJ. Superficial mycoses. In: Hunter's Tropical Medicine and Emerging Infectious Diseases. Elsevier; 2020. p. 648-52.
   doi: https://doi.org/10.1016/B978-0-323-55512-8.00082-X
7. Shen YZ, Liu W, Pan WH, Huang SZ, Wang CY, Song YX, et al. Mycoses in HIV/AIDS patients. In: Muco­cutaneous Manifestations of HIV/AIDS: Early Diagnostic Clues. p. 1-35.
   doi: https://doi.org/10.1007/978-981-15-5467-4_1
8. Sidikovych UO, Kalandarovych KM. Skin condi­tion in patients with HIV infection. Probl Suchasn Nauky Osvity. 2022;4:60-3.
9. Koffi D, Bonouman IV, Toure AO, Kouadjo F, N’gou MR, Sylla K, et al. Estimates of serious fungal in­fection burden in Côte d’Ivoire and country health profile. JMed  2021;31(1):101086. doi: https://doi.org/10.1016/j.mycmed.2020.101086
10. Ma Y, Wang X, Li R. Cutaneous and subcuta­neous fungal infections: recent developments on host–fungus interactions. Curr Opin Microbiol. 2021;62:93-102. doi: https://doi.org/10.1016/j.mib.2021.05.005
11. Bhopal RS. Concepts of epidemiology: integrating the ideas, theories, principles, and methods of epidemio­logy. Oxford: Oxford University Press; 2016. 480 p. doi: https://doi.org/10.1093/med/9780198739685.001.0001
12. Gruzeva TS, Lekhan VM, Ohniev VA, et al. [Bio­statystyka: pidruchnyk]. Vinnytsia: Nova Knyha; 2020. 384 p. Ukrainian.
13. NCSS Statistical Software. Chi-Square Test for Independence [Internet]. Kaysville, Utah: NCSS, LLC. [cited 2024 Aug 7]. Available from: https://www.ncss.com
14. Serra N, Kajita M, Matchita K, et al. Continuity correction of Pearson’s chi-square test in 2x2 contingency tables: A mini-review on recent development. Epidemiol Biostat Public Health. 2019;16(2):e13059-1-e13059-4. doi: https://doi.org/10.2427/13059
15. Dzhurabaeva M, Anvarova E, Sultanov S, Masa­virov S, Mukhamedov K, Uteshev M, et al. [Epidemio­logy, etiopathogenesis, diagnosis, and treatment of visceral mycosis in patients with tuberculosis/HIV coinfection]. Int JPharm  2021;13(2):834-42. Ukrainian. doi: https://doi.org/10.31838/ijpr/2021.13.02.133
16. Nedoboi PM, Nedoboi PB. [Skin lesions in HIV-infected patients]. Klin Immunol Alergol Infektol. 2011;1(40):34-7. Ukrainian.
17. [On the approval of standards of medical care "HIV infection". Order of the Ministry of Health of Uk­raine No. 2092 dated 2022 Nov 16]. [Internet]. 2022 [cited 2024 Aug 7]. Available from: https://moz.gov.ua/article/ministry-orders/nakaz-moz-ukraini-vid-16112022--2092-pro-zatverdzhennja-standartiv-medichnoi-dopomogi-vil-infekcija
18. Ginter-Hanselmayer G, Nenoff P. Clinically relevant mycoses dermatomycoses. In: Clinically Rele­vant Mycoses. A Practical Approach; 2019. p. 145-76. doi: https://doi.org/10.1007/978-3-319-92300-0_10

Look through:

Moskaliuk V.D. Bukovyna State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0002-4104-8153

Kravchuk I.I. Bukovyna State Medical University, Chernivtsi, Ukraine,
e-mail: kravchukir0@gmail.com
https://orcid.org/0000-0002-1193-6176

Randiuk Yu.O. Bukovyna State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0003-2154-8115

Balaniuk I.V. Bukovyna State Medical University, Chernivtsi, Ukraine
https://orcid.org/0000-0003-1146-4065

Moskaliuk V.D., Kravchuk I.I., Randiuk Yu.O., Balaniuk I.V. Structure of mycoses of the skin and its appendices in HIV-infected patients. Medicni perspektivi. 2024;29(4):218-226.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319383

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

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

Key words: error management, algorithm of management decisions, deviations in appointment lists, reducing the number of errors when prescribing medicines

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3. Valencia Quintero AF, Amariles P, Rojas He­nao N, Granados J. [Medication errors in pediatrics]. Andes Pediatr. 2021 Apr;92(2):288-97. Spanish. doi: https://doi.org/10.32641/andespediatr.v92i2.1357
4. Rodziewicz TL, Houseman B, Hipskind JE. Medi­cal Error Reduction and Prevention. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023[cited 2024 Feb 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/29763131/ 
5. Tariq RA, Vashisht R, Sinha A, Scherbak Y. Me­dication Dispensing Errors And Prevention. In: Stat­Pearls [Internet]. Treasure Island (FL): StatPearls Pub­lishing; 2023[cited 2024 Feb 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/30085607/ 
6. Rozhdestvenska AO. [Medical errors in the prac­tice of a district therapist. The phenomenon of bioethics and biosafety as an indicator of the state of medical science: materials of the abstract conference dedicated to the founder of bioethics V.R. Potter, February 19, 2019, Kharkiv]. Kharkiv; 2019. р. 52-53. Ukrainian. Available from: https://repo.knmu.edu.ua/handle/123456789/23651
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14. [DSTU IWA 1:2007. Quality management sys­tems. Guidelines for improving processes in healthcare organizations: IWA 1:2005, IDT; entered into force on 01-01-2008]. Kyiv: Derzhspozhivstandard of Ukraine; 2008. 83 p. Ukrainian.
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17. Nemchenko AS, Babenko MM, Nazarkina VM, Ko­syachenko KL. [Modern models of public management in the system of healthcare and pharmacy. In: Social pharmacy: state, problems and prospects: materials of the 8th interna­tional scientific and practical remote con­ference, Kharkіv, 2023 Apr 27]. [Internet]. Kharkiv; 2023 [cited 2024 Feb 20]. 81 p. Available from: https://socpharm.nuph.edu.ua/wp-content/blogs.dir/10/files/­2023/05/sotsialna-farmatsiia_materialy-2023.pdf 
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.
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27. Kenawy AS, Kett V. The impact of electro­nic prescription on reducing medication errors in an Egyp­tian outpatient clinic. Int J Med Inform. 2019 Jul;127:80-7. doi: https://doi.org/10.1016/j.ijmedinf.2019.04.005
28. Laher AE, Enyuma CO, Gerber L, Buchanan S, Adam A, Richards GA. Medication Errors at a Tertiary Hospital Intensive Care Unit. Cureus. 2021;13(12):e20374. doi: https://doi.org/10.7759/cureus.2037 

Look through:

Zalyhina Ye.V. Dnipro State Medical University; LLC "Endotechnomed", surgical clinic "Garvis",  Dnipro, Ukraine,
e-mail: avis.rara@hotmail.com
http://orcid.org/0000-0002-0478-5664

Zalyhina Ye.V. Improvement of the management system of the pharmaceutical service of the health care institution. Medicni perspektivi. 2024;29(4):227-236.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319393

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

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

Key words: patent monopoly, “evergreen” patents, medicines, unfair competition, intellectual property, wartime conditions

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9. [On the protection of the interests of individuals in the field of intellectual property during the martial law introduced in connection with the armed aggression of the Russian Federation against Ukraine. Law of Ukraine 2022 Apr 13 No. 2174-IX]. [Internet]. 2022 [cited 2024 Jul 15]. Available from: https://zakon.rada.gov.ua/laws/show/2174-20#Text  
10. [Draft Law on Amendments to the Law of Ukraine "On the Protection of the Interests of Individuals in the Field of Intellectual Property During the Martial Law Introduced in Connection with the Armed Aggression of the Russian Federation Against Ukraine" regarding the renewal of certain periods of registration and validity of intellectual property rights. Citizen’s electronic cabinet]. [Internet]. 2024 May 01 [cited2024 Jul 15].  Available from:https://itd.rada.gov.ua/billInfo/Bills/Card/44118
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26. Kochkina N. War as a Catalyst: Ukraine’s Inspi­ring Narrative for “Made In Ukraine” Pharmaceuticals in the German Market. Access to Justice in Eastern Europe. 2023;6(4):1-27.
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27. Kodynets A, Doroshenko O, Volynets I, Doro­zhko G, Petrenko V, Belitsky V. Supplementary protection of intellectual property rights for medicines. Medicni Perspektivi.2023;28(3):180-9. doi: https://doi.org/10.26641/2307-0404.2023.3.289223
28. Kovacs S, Hawes S, Maley S, Mosites E, Wong L, Stergachis A. Technologies for detecting falsified and substandard drugs in low and middle-income countries. PloS 2014;9(3):e90601. doi: https://doi.org/10.1371/journal.pone.0090601
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30. Lietzan E. The Evergreening Myth. Cato Institute [Internet].2020 [cited 2024 Jul 22]. Available from: https://www.cato.org/regulation/fall-2020/evergreening-myth
31. Moir HVJ. Pharmaceutical Patents and Ever­greening. In: Bonadio E, Goold P, eds. The Cambridge Handbook of Investment-Driven Intellectual Property. Cambridge Law Handbooks, Cambridge University Press; 2023. p. 133-52.
32. Patent Database Exposes Pharma’s Pricey “Ever­green” Strategy. UC Law San Francisco (Formerly UC Hastings). [Internet]. 2020 Sep 24 [cited 2024 Jul 22]. Availablefrom: https://www.uclawsf.edu/2020/09/24/patent-drug-database/
33. Patent pool. Wikipedia, the free encyclopedia [Internet]. 2024 [cited 2024 Jul 22]. Available from: https://en.wikipedia.org/wiki/Patent_pool
34. Pope C. What is the cost of Sovaldi? Why is it so expensive? Drugs.com. [Internet]. 2024 May 14 [cited 2024 Jul 15].Available from: https://www.drugs.com/medical-answers/cost-sovaldi-ex­pensive-3538358/#:~:text=Sovaldi%20is%20expe­nsive.&amp;text=This%20means%20a%2012-week,with%20other%20treatments,%20never%20alone
35. Promoting Access to Medical Technologies and Innovation. 2nd Ed. WIPO Publications; 2021. 21 р.
36. Promoting Access to Medical Technologies and Innovation. Intersections between public health, intel­lec­tual property and trade. WIPO Publications; 2012. 259 р.
37. Rader R. Are Patents Monopolies or Not? Part II: Residual Bias and Misnomers. IPWatchdog.com. Patents & Intellectual Property Law [Internet]. 2024 May 27 [cited 2024 Jul 15].Available from:https://ipwatchdog.com/2024/05/27/patents-monopolies-not-part-ii-residual-bias-misnomers/id=176900/
38. Top national pharma markets by market share 2022. Statista [Internet]. 2023 May 22 [cited 2024 Jul 15]. Availablefrom:https://www.statista.com/statistics/245473/market-share-of-the-leading-10-global-pharmaceutical-markets/ 
39. Topic: Global pharmaceutical industry. Statista [Internet]. 2024 Jan 10 [cited 2024 Jul 15]. Available from:https://www.statista.com/topics/1764/global-pharmaceutical-industry/#topicOverview
40. Uncertainty Remains More Than One Year After the FTC Announces New “Unfair Methods of Compe­tition” Policy. White & Case LLP [Internet]. 2024 Jan 31 [cited 2024 Jul 15]. Available from: https://www.whitecase.com/insight-alert/uncertainty-remains-more-one-year-after-ftc-announces-new-unfair-methods-competition

Look through:

Kodynets A.O. Taras Shevchenko National University of Kyiv; Intellectual Property Scientific Research Institute of National Academy of Legal Sciences of Ukraine, Kyiv, Ukraine,  e-mail: a_kodynets@ukr.net
https://orcid.org/0000-0002-0954-1474

Doroshenko O.F. Intellectual Property Scientific Research Institute of National Academy of Legal Sciences of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0002-2542-2328

Volynets I.P. Intellectual Property Scientific Research Institute of National Academy of Legal Sciences of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0002-2029-2165

Dorozhko G.K. Intellectual Property Scientific Research Institute of National Academy of Legal Sciences of Ukraine, Kyiv, Ukraine, e-mail: alfeddor@gmail.com
https://orcid.org/0000-0001-6506-3203

Petrenko V.O. Ukrainian State University of Science and Technologies, Institute of Industrial and Business Technologies, Dnipro, Ukraine, e-mail: petrenko_v@email.ua
https://orcid.org/0000-0001-5017-1674

Belitsky V.V. Dnipro State Medical University, Dnipro, Ukraine,
e-mail: Vyacheslav.Belitsky@gmail.com
https://orcid.org/0000-0002-2841-7372

Kodynets A.O., Doroshenko O.F., Volynets I.P., Dorozhko G.K., Petrenko V.O., Belitsky V.V. Abuse of patent rights for pharmaceuticals in wartime conditions. Medicni perspektivi. 2024;29(4):237-246.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319395

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

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

Key words: confidential information, cyberattacks, cybersecurity, eHealth system, European legal sources

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7. EU4Health Program 2021-2027 – a Vision for a Healthier European Union. n.d. Public Health [Internet]. 2021 [cited 2024 Jan 26]. Available from: https://health.ec.europa.eu/funding/eu4health-programme-2021-2027-vision-healthier-european-union_en
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9. Global strategy on digital health 2020-2025. Geneva: World Health Organization; 2021.
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11. [The first medical institutions joined the pilot of the eHealth system. 2017. Ministry of Health of Ukraine]. [Internet]. 2017 Jun 20 [cited 2024 Jan 24]. Ukrainian. Available from: https://web.archive.org/web/20210910003045/https://moz.gov.ua/article/news/pershi-medichni-zakladi-doluchilisja-do-pilotu-systems-ehealth
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Look through:

Parfonova I. Kharkiv National Medical University, Kharkiv, Ukraine, 
e-mail: Managerhnmi@proton.me
https://orcid.org/0000-0002-7049-4312

Zinchenko O. V.N. Karazin Kharkiv National University, Kharkiv, Ukraine,
e-mail: alekca.98@ukr.net
https://orcid.org/0000-0003-1623-957X

Parfonova I., Zinchenko O. Cybersecurity enhancement in the field of eHealth  system development in Ukraine. Medicni perspektivi. 2024;29(4):247-256.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319402

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

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

Key words: Epstein-Barr virus infection, oncogenic potential, lymphoproliferative disorder, CD30-cells, lymphadenopathy, children

1. Urbas OV, Vovk ZV, Holodnykh OA, Alek­seieva UI, Ivanenko AL. A clinical case of manifestation of primary immunodeficiency diagnosed before as Burkitt’s lymphoma. Modern Pediatrics. 2023;4(132):104-10. doi: https://doi.org/10.15574/SP.2023.132.104
2. Campo E, Jaffe ES, Cook JR, Quintanilla-Marti­nez L, Swerdlow SH, Anderson KC, et al. The Interna­tional Consensus Classification of Mature Lymphoid Neo­plasms: a report from the Clinical Advisory Committee. Blood. 2022 Sep 15;140(11):1229-53. doi: https://doi.org/10.1182/blood.2022015851
3. Riaz IB, Faridi W, Patnaik MM, Abraham RS. (2019). A Systematic Review on Predisposition to Lym­phoid (B and T cell) Neoplasias in Patients With Primary Immuno­deficiencies and Immune Dysregulatory Disorders (Inborn Errors of Immunity). Front Immunol. 2019 Apr 16;10:777. doi: https://doi.org/10.3389/fimmu.2019.00777
4. Forbes LR, Eckstein OS, Gulati N, Peckham-Gre­gory EC, Ozuah NW, Lubega J, et al. Genetic errors of immu­nity distinguish pediatric nonmalignant lymphopro­liferative disorders. J Allergy Clin Immunol. 2022 Feb;149(2):758-66. doi: https://doi.org/10.1016/j.jaci.2021.07.015
5. LeBoeuf NR, McDermott S, Harris NL. Case 5-2015 – A 69-Year-Old Woman with Recurrent Skin Le­sions after Treatment for Lymphoma. N Engl J Med. 2015 Feb 12;372:650-9. doi: https://doi.org/10.1056/NEJMcpc1314241
6. Chen C, Gu YD, Geskin LJ. A Review of Prima­ry Cutaneous CD30+ Lymphoproliferative Disorders. Hematol Oncol Clin North Am. 2019 Feb;33(1):121-34. doi: https://doi.org/10.1016/j.hoc.2018.08.003
7. Cui D, Zhang Y, Chen L, Du H, Zheng B, Huang M, et al. CD30 plays a role in T-dependent immune response and T cell proliferation. FASEB J. 2024 Jan;38(1):e23365. doi: https://doi.org/10.1096/fj.202301747RR
8. Weniger MA, Tiacci E, Schneider S, Arnolds J, Rüschenbaum S, Duppach J, et al. Human CD30+ B cells represent a unique subset related to Hodgkin lymphoma cells. J Clin Invest. 2018;128(7):2996-3007. doi: https://doi.org/10.1172/JCI95993
9. Kartan S, Johnson WT, Sokol K, Alpdogan O, Gru AA, Nikbakht N, et al. The spectrum of CD30+ T cell lymphoproliferative disorders in the skin. Chin Clin Oncol. 2019;8(1):3. doi: https://doi.org/10.21037/cco.2019.01.04
10. Shi JH, Sun SC. Tumor Necrosis Factor Receptor-Associated Factor Regulation of Nuclear Factor κB and Mitogen-Activated Protein Kinase Pathways. Front Immunol. 2018 Aug 9;9:1849. doi: https://doi.org/10.3389/fimmu.2018.01849
11. Vrzalikova K, Pugh M, Mundo L, Murray P. The contribution of ebv to the pathogenesis of classical hodgkin lymphoma. Ann Lymphoma. 2021;5:30: doi: https://doi.org/10.21037/aol-21-8
12. Andersen O, Ernberg I, Hedström AK. Treatment options for Epstain-Barr viruses related disorder of the Central nervous system. Infection and Drug Resistance. 2023;16:4599-620. doi: https://doi.org/10.2147/IDR.S375624
13. Classic Hodgkin lymphoma. Ottawa Atlas of Pathology [Internet]. [cited 2024 Mar 15]. Available from: https://www.pathologyatlas.ca/galleries/hematolymphoid/classic-hodgkin-lymphoma/#foobox-1/17/classic-hodgkins-lymphoma-lymphocyte-rich-high-HRS-cells-mumified-cell.jpg
14. Reactive lymphadenopathy. Ottawa Atlas of Pathology [Internet]. [cited 2024 Mar 15]. Available from: https://www.pathologyatlas.ca/galleries/hematolymphoid/reactive-lymphadenopathy/#foobox-1/1/reactive-lymph-node-low.jpg

Look through:

Mateiko Н.B. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, е-mail: gmateiko@ifnmu.edu.ua
https://orcid.org/0000-0003-4512-4552

Hlushko U.A. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, е-mail: uhlushko@ifnmu.edu.ua
https://orcid.org/0000-0003-4044-766X

Nesterova T.V. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, е-mail: tnesterova@ifnmu.edu.ua
https://orcid.org/0009-0007-0982-1090

Antoniuk L.V. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, е-mail: luantoniuk@ifnmu.edu.ua
https://orcid.org/0009-0006-0561-4732

Horbal N.B. Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine, е-mail: nhorbal@ifnmu.edu.ua
https://orcid.org/0000-0003-0198-6126

Mateiko Н.B., Hlushko U.A., Nesterova T.V., Antoniuk L.V., Horbal N.B. EBV-associated lymphoadenopathy in a child. Medicni perspektivi. 2024;29(4):257-264.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319403

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

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

Key words: clinic, complication, diagnosis, syphilitic aortitis

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2. Roberts WC, Ko JM, Vowels TJ. Natural history of syphilitic aortitis. Am J Cardiol. 2009 Dec 1;104(11):1578-87. doi: https://doi.org/10.1016/j.amjcard.2009.07.031
3. Fedotov VP. [Syphilis of the cardiovascular system. Clinical lecture]. Dermatovenerology. Cosmeto­logy. Sexopathology. 2017;1-4:94-111. Russian.
4. Bai L, Wang M, Peng Y. Syphilitic Aortitis Cau­sing Severe Bilateral Coronary Ostial Stenosis. JACC Cardiovasc Interv. 2021 Apr 12;14(7):e65-e67. doi: https://doi.org/10.1016/j.jcin.2021.01.023
5. Cocora M, Nechifor D, Lazar MA, Mornos A. Im­pending Aortic Rupture in a Patient with Syphilitic Aortitis. Vasc Health Risk Manag. 2021 May;25(17):255-8. doi: https://doi.org/10.2147/VHRM.S289455
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7. Makhdumi M, Roberts WC. Combined Cardio­vas­cu­lar Syphilis and Aortic Valve Stenosis (Due to a Con­geni­tally Unicuspid Valve). Am J Cardiol. 2022 Jun 1(172):144-5. doi: https://doi.org/10.1016/j.amjcard.2022.02.020
8. Miller SA, Ladich ER. Syphilitic Aortitis. N Engl J Med. 2022 May19;386(20):e55. doi: https://doi.org/10.1056/NEJMicm2110835
9. Peeling RW, Mabey D, Chen XS, Garcia PJ. Sy­philis. Lancet. 2023 Jul 22;402(10398):336-46. doi: https://doi.org/10.1016/S0140-6736(22)02348-0
10. Ramchandani MS, Cannon CA, Marra CM. Sy­philis: A Modern Resurgence. Infect Dis Clin North Am. 2023 Jun;37(2):195-222. doi: https://doi.org/10.1016/j.idc.2023.02.006
11. Roberts WC, Moore AJ, Roberts CS. Syphilitic aortitis: still a current common cause of aneurysm of the tubular portion of ascending aorta. Cardiovasc Pathol. 2020 May-Jun;46:107175. doi: https://doi.org/10.1016/j.carpath.2019.107175
12. Tang T, Wu C, Wang Z, Wei J, Zhang D, Sheng W. Treatment of syphilitic aortitis with coronary artery bypass grafting and "open" stent placement. J Int Med Res. 2023 Oct;51(10):3000605231204496. doi: https://doi.org/10.1177/03000605231204496
13. Uehara H, Okuyama M, Oe Y, Yoshimura T, Gunji T. Tertiary Cardiovascular Syphilis Presenting as Aortic Regurgitation, Aortitis, Thrombus, and Coronary Artery Occlusion, Requiring Percutaneous Coronary Inter­vention. Am J Case Rep. 2023 Sep 22;24:e941070. doi: https://doi.org/10.12659/AJCR.941070
14. Xiao B, Liu L, Peng Y, Kang Z, Guo Y. Cardio­vascular syphilis treated with transcatheter aortic valve replacement. J Card Surg. 2022 Apr;37(4):1083-6. doi: https://doi.org/10.1111/jocs.16286
15. Zakharov SV, Zakharov VK, Gorbuntsov VV. Features of biochemical indices and content of enzymes in the serum of syphilis patients with viral hepatites B and C in the course of treatment. Medicni Perspektivi. 2021;26(3):107-13.
    doi: https://doi.org/10.26641/2307-0404.2021.3.241971
16. Vega J, Gonzalez D, Yankovic W, Oroz J, Gua­man R, Castro N. [Thoracic aortic aneurysm. Natural history, diagnosis and management]. Revista chilena de cardiología. 2014;33(2):127-35. Espanol. doi: https://doi.org/4067/S0718- 85602014000200007
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Look through:

Zakharov S.V. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: zakharov@dmu.edu.ua
https://orcid.org/0000-0002-2278-5692

Svyatenko T.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-4303-2937

Zakharov V.K. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-5140-4417

Gorbuntsov V.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-7752-0993

Pohrebniak L.A. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-3458-9995

Zakharov S.V., Svyatenko T.V., Zakharov V.K., Gorbuntsov V.V., Pohrebniak L.A. Syphilitic aortitis: from the past to the present (view of a dermatovenerologist). Medicni perspektivi. 2024;29(4):264-271.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319405

Orthodontic and orthopedic rehabilitation of adult patients with congenital cleft lip and palate (clinical case)

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

Key words: regional nerve blocks, local anesthetic systemic toxicity, ropivacaine

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Look through:

Tutunnyk A.G. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: 410_05@dmu.edu.ua
https://orcid.org/0000-0003-0594-0889

Mynka N.V. Dnipro State Medical University, Dnipro, Ukraine, 
e-mail: nice.barannik@ukr.net
https://orcid.org/0000-0001-5024-911X

Kobelyatskyy U.U. Dnipro State Medical University, Dnipro, Ukraine,
e-mail: kobeliatsky@ukr.net
https://orcid.org/0000-0002-8504-6125

Tutunnyk A.G., Mynka N.V., Kobelyatskyy U.U. Local anesthetic systemic toxicity after brachial plexus block with ropivacaine: a case report. Medicni perspektivi. 2024;29(4):272-276.
DOI: https://doi.org/10.26641/2307-0404.2024.4.319406

Orthodontic and orthopedic rehabilitation of adult patients with congenital cleft lip and palate (clinical case)