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

Key words: obesity, disease model, metabolic syndrome, non-alcoholic fatty live disease, rats, monosodium glutamate, diet

1. Lin C, Chang Y, Cheng T, Lo K, Liu S, Yeh TL. The association between metabolically healthy obesity and risk of cancer: A systematic review and meta‐analysis of prospective cohort studies. Obesity Reviews. 2020Oct;21(10):e13049. doi: https://doi.org/10.1111/obr.13049
2. Prymachenko Obesity as a topical medical problem of the 21st century: a modern view on the disease of the humanity. The Medical and Ecological Problems. 2018;22(Issue 5-6):28-30. doi: https://doi.org/10.31718/mep.2018.22.5-6.07
3. Mongraw-ChaffinM, Foster MC, Ander­son CAM, Burke GL, Haq N, Kalyani RR, et  Metabo­lically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk. Journal of the American College of Cardiology [Internet]. 2018 May [cited 2019 Oct 20];71(17):1857-65. Available from: https://www.sciencedirect.com/science/article/pii/S073510971833496
4. Chernyshov [Metabolically healthy and un­healthy obesity: contemporary views on the main dif­ferences. Review]. Ukrainian Therapeutical Journal. 2022 Jun 30;1-2:78-86. Ukrainian. doi: http://doi.org/10.30978/UTJ2022-1-78
5. FullerT, Newberry Z, Nasir M, Tondt  Obesity. Primary Care: Clinics in Office Practice [Internet]. 2024 May 7 [cited 2024 Nov 15]. doi: https://doi.org/10.1016/j.pop.2024.04.007
6. Geetha V, Kumar GS. Concentrates from tender coconut water and coconut testa beneficially modulates tissue lipid profiles in high-fat fed rats. J Food Sci Technol. 2022 Apr;59(4):1649-57. doi: https://doi.org/10.1007/s13197-021-05178-2
7. Kravchun NO, Mysyura KV. [Overweight and obesity: state of the problem, associated diseases, pre­ventive measures]. Health of Ukraine [Internet]. 2016 [cited 2024 Nov 15];4(36). Ukrainian. Available from: https://health-ua.com/article/26142-nadlishkova-masa-tla-ta-ozhirnnya-stanproblemi-suputn-zahvoryuvannya-profla
8. The World Obesity Federation. History [Internet]. 2023 [cited 2024 Nov 15]. Available from: http://www.worldobesity.org/about/about-us/history
9. Mazur OY. [Experimental alimentary obesity in mature mat rats using the model of passive tobacco smo­king]. Morphologia. 2020 Oct 30;14(3):45-51. Ukrainian. doi: https://doi.org/10.26641/1997-9665.2020.3.45-51
10. Shutova NA. [Comparative characteristics of cur­rent experimental models of obesity. Mechanisms of the development of pathological processes and diseases and their pharmacological correction]. In: Proceedings of the II Scientific and Practical Internet Conference with International Participation; 2019 Nov 21; Kharkiv, Ukraine. 2019. p. 383-4. Ukrainian. Available from: https://repo.knmu.edu.ua/handle/123456789/25244
11. Khukhlina OS, Mandryk OE, Kotsiubiy­chuk ZYA, Rachynska IV, Molyn LR. [Main clinical and pathogenetic features of the comorbid course of non-alcoholic steatohepatitis, obesity and hypertension]. Zkem [Internet]. 2023 [cited 2024 Nov 15];(2):21-5. Ukrainian. Available from: https://ojs.tdmu.edu.ua/index.php/zdobutky-eks-med/article/view/13825
12. Molina-Molina E, Krawczyk M, Stachowska E, Lammert F, Portincasa P. Non-alcoholic fatty liver disease in non-obese individuals: Prevalence, pathogenesis and treatment. Clinics and Research in Hepatology and Gastro­enterology [Internet]. 2019 Jun [cited 2024 Nov 15]. Available from: https://www.sciencedirect.com/science/article/pii/S2210740119300956
13. Naumova LV, Naumova UO, Krytskyi TI. [Body mass index as a key factor of life experience and methods of its correction]. Zkem [Internet]. 2023 [cited 2024 Nov 15];(3):13-8. Ukrainian. Available from: https://ojs.tdmu.edu.ua/index.php/zdobutky-eks-med/article/view/14070
14. Knyazkova II. [On the issue of obesity in meno­pause]. Medicine of Ukraine. 2021 May 7;3(249):20-5. Ukrainian.
    doi: https://doi.org/10.37987/1997-9894.2021.3(249).238035
15. Sayehmiri K, Ahmadi I, Anvari E. Fructose Feeding and Hyperuricemia: a Systematic Review and Meta-Analysis. Clin Nutr Res. 2020 Apr 27;9(2):122-33. doi: https://doi.org/10.7762/cnr.2020.9.2.122
16. Mai BH, Yan L-J. The negative and detrimental effects of high fructose on the liver, with special reference to metabolic disorders. Diabetes Metab Syndr Obes. 2019;12:821-6. doi: https://doi.org/10.2147/DMSO.S198968
17. Klevanova V, Trzhetsynskiy S. [Antidiabetic acti­vity of blood burnet extract in high fructose fed insulin resistant rats]. Zsmueduua [Internet]. 2015 [cited 2024 Nov 15]. Ukrainian. Available from: http://dspace.zsmu.edu.ua/handle/123456789/8893
18. Zhang X, Zhang Y, Wang J, Wang S, Wang Y, Zhang H. High-fructose diet-induced metabolic syndrome in rats: a systematic review and meta-analysis. Nutr Metab (Lond). 2020;17:45. doi: https://doi.org/10.1186/s12986-020-00462-y
19. Zhao Y, Wang QY, Zeng LT, Wang JJ, Liu Z, Fan GQ, et Long-Term High-Fat High-Fructose Diet Induces Type 2 Diabetes in Rats through Oxidative Stress. Nutrients. 2022 May 24;14(11):2181. doi: https://doi.org/10.3390/nu14112181
20. Softic S, Gupta MK, Wang GX, Fujisaka S, O'Neill BT, Rao TN, et Divergent effects of glucose and fructose on hepatic lipogenesis and insulin signaling. J Clin Invest. 2017 Nov 1;127(11):4059-74. doi: https://doi.org/10.1172/JCI94585 Erratum in: J Clin Invest. 2018 Mar 1;128(3):1199. doi: https://doi.org/10.1172/JCI94585
21. SmithRL, Soeters MR, Wüst RCI, Hout­koo­per  Metabolic flexibility as an adaptation to energy resources and requirements in health and disease. Endocr Rev. 2018;39(4):489-517. doi: https://doi.org/10.1210/er.2017-00211
22. MamikuttyN, Thent Z, Sapri S, Sahruddin N, et  The establishment of metabolic syndrome model by induction of fructose drinking water in male Wistar rats. Biomed Res Int. 2014;2014:1-8. doi: https://doi.org/10.1155/2014/263897 
23. PreguiçaI, Alves A, Nunes S, Fernandes R, Go­mes P, Viana SD, et  Diet-induced rodent models of obesity-related metabolic disorders: A guide to a trans­lational perspective. Obes Rev. 2020;21(12):e13081. doi: https://doi.org/10.1111/obr.13081
24. KuceraO, Cervinkova  Experimental models of non-alcoholic fatty liver disease in rats. World J Gastroenterol. 2014;20(26):8364-78. doi: https://doi.org/10.3748/wjg.v20.i26.8364
25. Prymachenko [Obesity as a topical medical problem of the 21st century: a modern view on the disease of humanity]. The Medical and Ecological Problems. 2018;22(5-6):25-7. Ukrainian. doi: https://doi.org/10.31718/mep.2018.22.5-6.06
26. García-JaramilloM, Spooner MH, Löhr CV, Wong CP, Zhang W, Jump  Lipidomic and transcrip­tomic analysis of western diet-induced nonalcoholic steatohepatitis (NASH) in female Ldlr-/-mice. PLOS ONE. 2019;14(4):e0214387. doi: https://doi.org/10.1371/journal.pone.0214387
27. KonopelnyukVV, Pribytko IY, Tsyryuk OI, et  [Pathophysiology characteristics of the expe­ri­mental model of obesity in female rats induced neonatal  admi­nistration of monosodium glutamate]. ScienceRise: Biological Science. 2016 Nov 18;0(3(3)):14-8. Ukrainian.
    doi: https://doi.org/10.15587/2519-8025.2016.83570
28. Mazur [Experimental alimentary obesity in mature mat rats using the model of passive tobacco smo­king]. Morphologia. 2020 Oct 30;14(3):45-51. Ukrainian. doi: https://doi.org/10.26641/1997-9665.2020.3.45-51.
29. LalanzaJF, Caimari A, del Bas JM, Torregrosa D, Cigarroa I, Pallàs M, et  Effects of a post-weaning cafeteria diet in young rats: metabolic syndrome, reduced activity and low anxiety-like behaviour. PLoS One. 2014;9(1):e85049. doi: https://doi.org/10.1371/journal.pone.0085049
30. ReboucasEC, Leal S, Sa  Regulation of NPY and α-MSH expression by estradiol in the arcuate nucleus of Wistar female rats: a stereological study. UNIPRO. 2016;38:740-7. doi: https://doi.org/10.1080/01616412.2016.1203124
31. MarkhonNO, Mamchur VY, Zhilyuk VI, et  [Comparative analysis of experimental approaches in reproduction of metabolic syndrome]. Herald of Problems of Biology and Medicine. 2015;1(117):156-62. Ukrainian.
32. AlkhouriN, Dixon LJ, Feldstein  Lipoto­xicity in nonalcoholic fatty liver disease: not all lipids are created equal. Expert Rev Gastroenterol Hepatol. 2019;13(9):879-87. doi: https://doi.org/10.1080/17474124.2019.1657826
33. JensenT, Abdelmalek MF, Sullivan S, Na­deau KJ, Green M, Roncal C, et  Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-75. doi: https://doi.org/10.1016/j.jhep.2018.01.019
34. ZhongF, Zhou X, Xu J, Gao  Rodent models of nonalcoholic fatty liver disease. Digestion. 2020;101(5):522-35. doi: https://doi.org/10.1159/000501851
35. MatiasAM, Estevam WM, Coelho PM, Haese D, Kobi JBBS, Lima-Leopoldo AP, et al. Differential effects of high sugar, high lard or a combination of both on nutritional, hormonal and cardiovascular metabolic pro­files of rodents. Nutrients. 2018 Aug 11;10(8):1071. doi: https://doi.org/10.3390/nu10081071
36. MatiasAM, Coelho PM, Marques VB, dos San­tos L, de Assis ALEM, Nogueira BV, et  Hypercaloric diet models do not develop heart failure, but the excess sucrose promotes contractility dysfunction. PLoS One. 2020 Feb 7;15(2):e0228860. doi: https://doi.org/10.1371/journal.pone.0228860
37. NakamuraK, Miyoshi M, Ogawa  High-Fat, High-Sucrose Diet Leads to Obesity, Liver Steatosis, and Hyperglycemia in Mice. Sci Rep. 2021;11(1):8764. doi: https://doi.org/10.1038/s41598-021-87645-6
38. FarrellG, Schattenberg JM, Leclercq I, Yeh MM, Goldin R, Teoh N, et al. Mouse models of nonalcoholic steatohepatitis: toward optimization of their relevance to human nonalcoholic steatohepatitis. Hepatology (Bal­timore, Md). 2019 May 1;69(5):2241-57. doi: https://doi.org/10.1002/hep.30333
39. ChengHS, Ton SH, Phang SCW, Tan JBL, Abdul Kadir  Increased susceptibility of post-weaning rats on high-fat diet to metabolic syndrome. J Adv Res. 2017 Nov;8(6):743-52. doi: https://doi.org/10.1016/j.jare.2017.10.002
40. Eng JM, Estall JL. Diet-induced models of non-alcoholic fatty liver disease: food for thought on sugar, fat, and cholesterol. Cells.2021;10(7):1805. doi: https://doi.org/10.3390/cells10071805
41. LaskerS, Rahman MM, Parvez F, Zamila M, Miah P, Nahar K, et  High-fat diet-induced metabolic syn­drome and oxidative stress in obese rats are ameliorated by yogurt supplementation. Scientific Reports. 2019;9(1):20026. doi: https://doi.org/10.1038/s41598-019-56538-0 
42. KopchakNG, Pokotylo OS, Kukhtin MD, Ko­val  [The influence of iodine on the parameters of the blood lipid profile of rats of different ages with expe­rimental obesity]. Medical and Clinical Chemistry. 2017;19(4):123-8. Ukrainian. doi: https://doi.org/10.11603/mcch.2410-681X.2017.v0.i4.8437
43. AydosL, Aparecida do Amaral L, Serafim de Sou­za R, Jacobowski AC, Freitas dos Santos E, Rodrigues Mace­do  Nonalcoholic Fatty Liver Disease Induced by High-Fat Diet in C57bl/6 Models. Nutrients. 2019;11(12):3067. doi: https://doi.org/10.3390/nu11123067
44. SmithJ, Brown R, Johnson  Progesterone-indu­ced obesity in female mice: a model for studying metabolic dysregulation. Int J Obes (Lond). 2020;44(5):1123-32. doi: https://doi.org/10.1038/s41366-020-0581-z
45. DanielsSJ, Leeming DJ, Detlefsen S, Bruun MF, Hjuler ST, Henriksen K, et  Addition of trans fat and alcohol has divergent effects on atherogenic diet-induced liver injury in rodent models of steatohepatitis. Am J Physiol Gastrointest Liver Physiol. 2020;318(3):G410-G418. doi: https://doi.org/10.1152/ajpgi.00066.2019
46. Aleksandrov [Biochemical and immuno­logical parameters of rats under experimental model of progesterone-induced obesity. Qualifying scientific work on the rights of manuscripts]. 2019. 24 p. Ukrainian.
47. CarreresL, Jílková ZM, Vial G, Marche PN, De­caens T, Lerat  Modeling diet-induced NAFLD and NASH in rats: A comprehensive review. Biomedicines. 2021;9(4):378. doi: https://doi.org/10.3390/biomedicines9040378
48. MaslovaGS, Skrypnyk RI, Shcherbak OV, Skryp­nyk  [Model diet-induced steatohepatitis in rats: mor­phological and pathogenetic features]. Suchasna Hastro­eneterolohiya. 2020;2:11-7. Ukrainian. doi: https://doi.org/10.30978/MG-2020-2-11
49. FukudaA, Sasao M, Asakawa E, Narita S, Hisano, Suruga K, et  Dietary fat, cholesterol, and cholic acid affect the histopathologic severity of nonalcoholic steatohepatitis in Sprague-Dawley rats. Pathol Res Pract. 2019;215(11):152599. doi: https://doi.org/10.1016/j.prp.2019.152599
50. VatashchukMV, Demyanchuk OI, Bailyak  [Effects of alpha-ketoglutarate on glucose tolerance and visceral fat accumulation in mice fed a high-calorie cafeteria diet]. In: Basics Med Sci Endocrinol. Materials of the scientific and practical conference; 2021 Nov 18-19; Ivano-Frankivsk. Ivano-Frankivsk: IFNMU; 2021. р. 57-60. Ukrainian.
51. Gutiérrez-CuevasJ, Santos A, Armendariz-Borun­da J. Pathophysiological molecular mechanisms of obesity: A link between MAFLD and NASH with cardiovascular diseases. Int J Mol Sci. 2021 Oct 27;22(21):11629. doi: https://doi.org/10.3390/ijms222111629
52. de CastroJM, de Freitas JS, Stein DJ, de Ma­cedo IC, Caumo W, Torres  Transcranial Direct Current Stimulation (tDCS) promotes state-dependent effects on neuroinflammatory and behavioral parameters in rats chronically exposed to stress and a hyper-palatable diet. Neurochemical Research. 2023;48(10):3042-54. doi: https://doi.org/10.1007/s11064-023-03965-1
53. SuY, Wang T, Wu N, Li D, Fan X, Xu Z, et   Alpha-ketoglutarate extends Drosophila lifespan by inhibiting mTOR and activating AMPK. Aging. 2019 Jun 26;11(12):4183-97. doi: https://doi.org/10.18632/aging.102045
54. PivtorakVI, Sydorenko BV, Monastyrskyi VM, Pivtorak KV, Bulko  [Efficacy of an experimental model of non-alcoholic fatty liver disease based on a high-fat diet with cholesterol]. Svit Medytsyny ta Biolohii. 2022;2(80):222-6. Ukrainian. doi: https://doi.org/10.26724/2079-8334-2022-2-80-222-226
55. TavakoliR, Maleki MH, Vakili O, Taghizadeh M, Zal F, Shafiee  Bilirubin, once a toxin but now an antioxidant alleviating non-alcoholic fatty liver disease in an autophagy-dependent manner in high-fat diet-induced rats: a molecular and histopathological analysis. Res Pharm Sci. 2024 Jul;19(4):475-88. doi: https://doi.org/10.4103/RPS.RPS_53_24
56. Mateshuk-Vatseba LR, Garapko TV, Kyryk HA, Blyshchak NB, Prymachenko VI, Pidvalna UE, et al., inventors. [The method of modeling experimental ali­mentary obesity through the mediated effect of mono­sodium glutamate]. Patent of Ukraine for utility model u202002310. 2020 Sept 04. Ukrainian.

Look through:

Prymachenko V.I. Bogomolets National Medical University, Kyiv, Ukraine
e-mail:This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-2783-8546

Prymachenko V.I. Methods of modelling obesity in an animal experiment (analytical literature review). Medicni perspektivi. 2025;30(2):4-12.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333079

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

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

Key words: hippocampus, cerebellum, histopathology, repeated blast-induced neurotrauma, blast wave, rats  

1. Sachdeva T, Ganpule SG. Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge. Neurotrauma 2024 Mar 14;5(1):243-53. doi: https://doi.org/10.1089/neur.2024.0001
2. Dickerson MR, Murphy SF, Urban MJ, White Z, VandeVord PJ. Chronic Anxiety- and Depression-Like Behaviors Are Associated With Glial-Driven Pathology Following Repeated Blast Induced Neurotrauma. Front Behav  2021 Dec 10;15:787475. doi: https://doi.org/10.3389/fnbeh.2021.787475
3. Ravula AR, Rodriguez J, Younger D, Perumal V, Shao N, Rama Rao KV, et al. Animal model of repeated low-level blast traumatic brain injury displays acute and chronic neurobehavioral and neuropathological changes. Exp 2022 Mar;349:113938. doi: https://doi.org/10.1016/j.expneurol.2021.113938
4. Hubbard WB, Velmurugan GV, Brown EP, Sul­livan PG. Resilience of females to acute blood-brain barrier damage and anxiety behavior following mild blast traumatic brain injury. Acta Neuropathol Commun. 2022 Jun 27;10(1):93. doi: https://doi.org/10.1186/s40478-022-01395-8
5. Elder GA, Gama Sosa MA, De Gasperi R, Perez Garcia G, Perez GM, Abutarboush R, et al. The Neuro­vas­cular Unit as a Locus of Injury in Low-Level Blast-Induced Neurotrauma. Int J Mol Sci. 2024 Jan 17;25(2):1150. doi: https://doi.org/10.3390/ijms25021150
6. Kozlova YuV, Abdul-Ohly LV, Kosharnyi AV, Ky­tova IV, Korzachenko MA, inventors. [Device for studying the effect of the shock wave of an explosion on the body]. Ukraine patent U202100358. 2021 Mar 24. Ukrainian.
7. Bagriy MM, Dibrova VA, Popadynets OG, Gri­schuk MI. [Methods of morphological research]. Vinnitsa: Nova Knyha; 2016. 328 p. Ukranian.
8. Logsdon AF, Schindler AG, Meabon JS, Yagi M, Herbert MJ, Banks WA, et al. Nitric oxide synthase me­diates cerebellar dysfunction in mice exposed to repetitive blast-induced mild traumatic brain injury. Sci Rep. 2020 Jun 10;10(1):9420. doi: https://doi.org/10.1038/s41598-020-66113-7
9. Del Pilar C, Lebrón-Galán R, Pérez-Martín E, Pérez-Revuelta L, Ávila-Zarza CA, Alonso JR, et al. The Selective Loss of Purkinje Cells Induces Specific Pe­ripheral Immune Alterations. Front Cell Neurosci. 2021 Nov 30;15:773696. doi: https://doi.org/10.3389/fncel.2021.773696
10. Özen I, Mai H, De Maio A, Ruscher K, Micha­lettos G, Clausen F, et al. Purkinje cell vulnerability induced by diffuse traumatic brain injury is linked to disruption of long-range neuronal circuits. Acta Neuro­pathol 2022 Sep 5;10(1):129. doi: https://doi.org/10.1186/s40478-022-01435-3
11. Gama Sosa MA, De Gasperi R, Pryor D, Perez Garcia GS, Perez GM, Abutarboush R, et al. Low-level blast exposure induces chronic vascular remodeling, peri­vascular astrocytic degeneration and vascular-associated neuroinflammation. Acta Neuropathol Commun. 2021 Oct 15;9(1):167. doi: https://doi.org/10.1186/s40478-021-01269-5
12. Neale KJ, Reid HMO, Sousa B, McDonagh E, Morrison J, Shultz S, et al. Repeated mild traumatic brain injury causes sex-specific increases in cell proliferation and inflammation in juvenile rats. J Neuroinflammation. 2023 Oct 31;20(1):250. doi: https://doi.org/10.1186/s12974-023-02916-5
13. Prabhakar NK, Khan H, Grewal AK, Singh TG. Intervention of neuroinflammation in the traumatic brain injury trajectory: In vivo and clinical approaches. Int Immunopharmacol.2022 Jul;108:108902. doi: https://doi.org/10.1016/j.intimp.2022.108902
14. Wu A, Zhang J. Neuroinflammation, memory, and depression: new approaches to hippocampal neurogenesis. J 2023 Nov 27;20(1):283. doi: https://doi.org/10.1186/s12974-023-02964-x
15. Bryden DW, Tilghman JI, Hinds SR 2nd. Blast-Related Traumatic Brain Injury: Current Concepts andResearch Considerations. J Exp Neurosci. 2019 Sep 12;13:1179069519872213. doi: https://doi.org/10.1177/1179069519872213
16. Bell JD, Ai J, Chen Y, Baker AJ. Mild in vitro trauma induces rapid GluR2 endocytosis, robustly aug­ments calcium permeability and enhances susceptibility to secondary excitotoxic insult in cultured Purkinje cells. Brain.2007 Oct;130(10):2528-42. doi: https://doi.org/10.1093/brain/awm164
17. Godoy DA, Rubiano AM, Paranhos J, Robba C, Lazaridis C. Avoiding brain hypoxia in severe traumatic brain injury in settings with limited resources – A pa­thophysiological guide. J Crit Care. 2023 Jun;75:154260. doi: https://doi.org/10.1016/j.jcrc.2023.154260

Look through:

Chaban V.O. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-6002-5571

Kozlova Yu.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-1364-1910

Chaban V.O., Kozlova Yu.V. Repeated blast-induced neurotrauma: histopathological changes in the hippocampus and cerebellum of rats. Medicni perspektivi. 2025;30(2):13-19.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333132

Analyses of electromagnetic effects as colors of the vision analyzer

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

Key words: periodontitis, periodontal pathology, diabetes mellitus, bone metabolism markers, dental implantation, bone metabolism, surgical dentistry, maxillofacial surgery

1. American Diabetes Association Professional Practice Committee 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes care. 2024;47(Suppl 1):S20-S42. doi: https://doi.org/10.2337/dc24-S002
2. Khachatryan H, Hakobyan G. Diagnostic and prognostic value of indicators of markers of bone metabolism in type 2 diabetes mellitus patients with UV functionalised dental implants. Journal of stomatology, oral and maxillofacial surgery. 2023;124(6S):101608. doi: https://doi.org/10.1016/j.jormas.2023.101608
3. Marchand F, Raskin A, Dionnes-Hornes A, Bar­ry T, Dubois N, Valéro R, et al. Dental implants and diabetes: conditions for success. Diabetes & metabolism. 2012;38(1):14-9. doi: https://doi.org/10.1016/j.diabet.2011.10.002
4. Peled M, Ardekian L, Tagger-Green N, Gutma­cher Z, Machtei EE. Dental implants in patients with type 2 diabetes mellitus: a clinical study. Implant dentistry. 2003;12(2):116-22. doi: https://doi.org/10.1097/01.id.0000058307.79029.b1
5. Fuster-Torres MÁ, Peñarrocha-Diago M, Peñar­rocha-Oltra D, Peñarrocha-Diago M. Relationships bet­ween bone density values from cone beam computed tomography, maximum insertion torque, and resonance frequency analysis at implant placement: a pilot study. The International journal of oral & maxillofacial implants. 2011;26(5):1051-6.
6. Park CS, Kang SR, Kim JE, Huh KH, Lee SS, Heo MS, et al. Validation of bone mineral density measu­rement using quantitative CBCT image based on deep learning. Scientific 2023;13(1):11921. doi: https://doi.org/10.1038/s41598-023-38943-8
7. Al-Jamal MFJ, Al-Jumaily HA. Can the Bone Density Estimated by CBCT Predict the Primary Stability of Dental Implants? A New Measurement Protocol. The Journal of craniofacial surgery. 2021;32(2):e171-e174. doi: https://doi.org/10.1097/SCS.0000000000006991
8. Isoda K, Ayukawa Y, Tsukiyama Y, Sogo M, Matsushita Y, Koyano K. Relationship between the bone density estimated by cone-beam computed tomography and the primary stability of dental implants. Clinical oral implants research. 2012;23(7):832-6. doi: https://doi.org/10.1111/j.1600-0501.2011.02203.x
9. Massera D, Biggs ML, Walker MD, Mukamal KJ, Ix JH, Djousse L, et al. Biochemical Markers of Bone Tur­nover and Risk of Incident Diabetes in Older Women: The Cardiovascular Health Study. Diabetes care. 2018;41(9):1901-8. doi: https://doi.org/10.2337/dc18-0849
10. Zoch ML, Clemens TL, Riddle RC. New insights into the biology of osteocalcin. Bone. 2016;82:42-9. doi: https://doi.org/10.1016/j.bone.2015.05.046
11. Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, et al. Endocrine regulation of energy meta­bolism by the skeleton. Cell. 2007;130(3):456-69. doi: https://doi.org/10.1016/j.cell.2007.05.047
12. Motyl KJ, McCabe LR, Schwartz AV. Bone and glucose metabolism: a two-way street. Archives of bio­chemistry and biophysics. 2010;503(1):2-10. doi: https://doi.org/10.1016/j.abb.2010.07.030
13. Vimalraj S. Alkaline phosphatase: Structure, expres­sion and its function in bone mineralization. Gene. 2020;754:144855. doi: https://doi.org/10.1016/j.gene.2020.144855
14. Zhang Z, Nam HK, Crouch S, Hatch NE. Tissue Nonspecific Alkaline Phosphatase Function in Bone and Muscle Progenitor Cells: Control of Mitochondrial Respiration and ATP Production. International journal of molecular sciences. 2021;22(3):1140. doi: https://doi.org/10.3390/ijms22031140
15. Chen H, Li J, Wang Q. Associations between bone-alkaline phosphatase and bone mineral density in adults with and without diabetes. Medicine. 2018;97(17):e0432. doi: https://doi.org/10.1097/MD.0000000000010432
16. Al-Hariri M. Sweet Bones: The Pathogenesis of Bone Alteration in Diabetes. Journal of diabetes research. 2016;2016:6969040. doi: https://doi.org/10.1155/2016/6969040
17. Bergman A, Qureshi AR, Haarhaus M, Lind­holm B, Barany P, Heimburger O, et al. Total and bone-specific alkaline phosphatase are associated with bone mineral density over time in end-stage renal disease pa­tients starting dialysis. Journalof  2017;30(2):255-62. doi: https://doi.org/10.1007/s40620-016-0292-7
18. Lumachi F, Camozzi V, Tombolan V, Luisetto G. Bone mineral density, osteocalcin, and bone-specific alkaline phosphatase in patients with insulin-dependent diabetes mellitus. Annals of the New York Academy of Sciences. 2009;1173(Suppl 1):E64-E67. doi: https://doi.org/10.1111/j.1749-6632.2009.04955.x
19. Kuzniak NB, Boitsaniuk SI, Sukhovolets IO. [The use of biochemical markers of bone metabolism in dentistry]. Klinichna stomatolohiia. 2015;1:99-104. Ukrainian.
20. Williams C, Sapra A. Osteoporosis Markers. In: Statpearls Knowledge Base. StatPearls Publishing; 2023.
21. König D, Oesser S, Scharla S, Zdzieblik D, Gol­lhofer A. Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Study. Nutrients. 2018;10(1):97. doi: https://doi.org/10.3390/nu10010097
22. Roy M, Majid H, Khan P, Sharma N, Kohli S, Islam SU., et al. CTX-1 and TRACP-5b as biomarkers for osteoporosis risk in type 2 diabetes mellitus: a cross-sectional study. Journal of diabetes and metabolic disorders. 2024;23(2):2055-64. doi: https://doi.org/10.1007/s40200-024-01464-w
23. Chen X, Kang S, Bao Z. Effects of Glimepiride Combined with Recombinant Human Insulin Injection on Serum IGF-1, VEGF and TRACP-5b Oxidative Stress Levels in Patients with Type 2 Diabetes Mellitus. Evi­dence-based complementary and alternative medicine: eCAM. 2022;2022:4718087. doi: https://doi.org/10.1155/2022/4718087
24. Hygum K, Starup-Linde J, Harsløf T, Vester­gaard P, Langdahl BL. Mechanisms in endocrinology: Diabetes mellitus, a state of low bone turnover – a systematic review and meta-analysis. European journal of endocrinology. 2017;176(3):R137-R157. doi: https://doi.org/10.1530/EJE-16-0652
25. Klein KR, Walker CP, McFerren AL, Huffman H, Frohlich F, Buse JB. Carbohydrate Intake Prior to Oral Glucose Tolerance Testing. Journal of the Endocrine Society. 2021;5(5):bvab049. doi: https://doi.org/10.1210/jendso/bvab049
26. Aghaloo T, Pi-Anfruns J, Moshaverinia A, Sim D, Grogan T, Hadaya D. The Effects of Systemic Diseases and Medications on Implant Osseointegration: A Syste­matic Review. The International journal of oral & maxil­lofacial implants. 2019;34:s35-s49. doi: https://doi.org/10.11607/jomi.19suppl.g3
27. D'Ambrosio F, Amato A, Chiacchio A, Sisalli L, Giordano F. Do Systemic Diseases and Medications Influence Dental Implant Osseointegration and Dental Implant Health? An Umbrella Review. Dentistry journal. 2023;11(6):146. doi: https://doi.org/10.3390/dj11060146
28. Gudaryan OO, Mashchenko IS, Kucherenko TO. [Treatment of aggressive (rapidly progressing) generalized periodontitis using systemic enzyme therapy in combination with osteoinductive medicines]. Medychni perspektyvy.2020;25(3):144-52.  doi: https://doi.org/10.26641/2307-0404.2020.3.214852
29. Al-Asali M, Alqutaibi AY, Al-Sarem M, Saeed F. Deep learning-based approach for 3D bone segmentation and prediction of missing tooth region for dental implant planning. Scientific reports. 2024;14(1):13888. doi: https://doi.org/10.1038/s41598-024-64609-0
30. Zhang C, Fan L, Zhang S, Zhao J, Gu Y. Deep learning based dental implant failure prediction from periapical and panoramic films. Quantitative imaging in medicine and surgery. 2023;13(2):935-45. doi: https://doi.org/10.21037/qims-22-457
31. Melerowitz L, Sreenivasa S, Nachbar M, Stsefa­nenka A, Beck M, Senger C, et al. Design and evaluation of a deep learning-based automatic segmentation of maxillary and mandibular substructures using a 3D U-Net. Clinical and translational radiation oncology. 2024;47:100780. doi: https://doi.org/10.1016/j.ctro.2024.100780
32. Gudarian AA, Kucherenko TA. The state of bone metabolism in patients with different variants of the course of generalized periodontitis. Visnik problem biologii i meditsini.2020;3(157):314-18. doi: https://doi.org/10.29254/2077-4214-2020-3-157-314-318
33. Liu M, Kurimoto P, Zhang J, Niu QT, Stolina M, Dechow PC, et al. Sclerostin and DKK1 Inhibition Pre­serves and Augments Alveolar Bone Volume and Architecture in Rats with Alveolar Bone Loss. Journal of dental 2018;97(9):1031-8. doi: https://doi.org/10.1177/0022034518766874
34. Couto BADA, Fernandes JCH, Saavedra-Silva M, Roca H, Castilho RM, Fernandes GVO. Antisclerostin Ef­fect on Osseointegration and Bone Remodeling. J Clin Med. 2023 Feb 6;12(4):1294. doi: https://doi.org/10.3390/jcm12041294
35. Ominsky MS, Li C, Li X, Tan HL, Lee E, Bar­rero M, et al. Inhibition of sclerostin by monoclonal anti­body enhances bone healing and improves bone density and strength of nonfractured bones. J Bone Miner Res. 2011 May;26(5):1012-21. doi: https://doi.org/10.1002/jbmr.307
36. Taut AD, Jin Q, Chung JH, Galindo-Moreno P, Yi ES, Sugai JV, et al. Sclerostin antibody stimulates bone regeneration after experimental periodontitis. J Bone Miner Res. 2013 Nov;28(11):2347-56. doi: https://doi.org/10.1002/jbmr.1984
37. Virk MS, Alaee F, Tang H, Ominsky MS, Ke HZ, Lieberman JR. Systemic administration of sclerostin anti­body enhances bone repair in a critical-sized femoral defect in a rat model. J Bone Joint Surg Am. 2013 Apr 17;95(8):694-701. doi: https://doi.org/10.2106/JBJS.L.00285
38. Asokan AG, Jaganathan J, Philip R, Soman RR, Sebastian ST, Pullishery F. Evaluation of bone mineral density among type 2 diabetes mellitus patients in South Karnataka. J Nat Sci Biol Med. 2017 Jan-Jun;8(1):94-8. doi: https://doi.org/10.4103/0976-9668.198363
39. Kang KY, Hong YS, Park SH, Ju JH. Increased serum alkaline phosphatase levels correlate with high disease activity and low bone mineral density in patients with axial spondyloarthritis. Semin Arthritis Rheum. 2015 Oct;45(2):202-7. doi: https://doi.org/10.1016/j.semarthrit.2015.03.002
40. Kubihal S, Gupta Y, Goyal A, Kalaivani M, Tan­don N. Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes. Clin Endocrinol(Oxf). 2022 Apr;96(4):531-8. doi: https://doi.org/10.1111/cen.14641
41. Akalın A, Yorulmaz G, Alataş İÖ, Onbaşı K, Efe FB. Bone turnover markers and bone mineral density in patients with type 2 diabetes. The European Research Journal. 2023;9(2):301-8. doi: https://doi.org/10.18621/eurj.1085838

Look through:

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

Cherednyk D.O. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0009-0007-0199-2784

Gudarian O.O., Cherednyk D.O. Methods for studying the state of bone metabolism in patients with diabetes who require comprehensive total rehabilitation of the oral cavity through dental implantation. Medicni perspektivi. 2025;30(2):20-27. 
DOI: https://doi.org/10.26641/2307-0404.2025.2.333358

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

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

Key words: peroxisome proliferator-activated receptor gamma coactivator 1-alpha, physical exercises, mitochondrial, biogenesis

1. Lancet T. Diabetes: a defining disease of the 21st century. Lancet.2023;401(10394):2087. doi: https://doi.org/10.1016/S0140-6736(23)01296-5
2. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes pre­valence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: https://doi.org/10.1016/j.diabres.2021.109119
3. Ong KL, Stafford LK, McLaughlin SA, et al. Glo­bal, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet.2023;402(10397):203-34. doi: https://doi.org/10.1016/S0140-6736(23)01301-6
4. Khoramipour K, Hekmatikar AA, Sotvan H. An overview of Fatmax and MFO in exercise. Razi J Med Sci. 2020;27(3):49-59.
5. Orumiyehei A, Khoramipour K, Rezaei MH, et al. High-Intensity Interval Training-Induced Hippocampal Molecular Changes Associated with Improvement in Anxiety-like Behavior but Not Cognitive Function in Rats with Type 2 Diabetes. Brain Sci. 2022;12(10):1280. doi: https://doi.org/10.3390/brainsci12101280
6. Ebrahimnezhad N, Nayebifar S, Soltani Z, Khora­mipour K. High-intensity interval training reduced oxidative stress and apoptosis in the hippocampus of male rats with type 2 diabetes: The role of the PGC1α-Keap1-Nrf2 signaling pathway. Iran J Basic Med Sci. 2023;26(18):1313-9. doi: https://doi.org/10.22038/IJBMS.2023.70833.15387
7. Laura J. McMeekin, Stephanie N. Fox SMB and RMC. Dysregulation of PGC-1α-Dependent Transcrip­tional Programs in Neurological and Developmental Disorders: Therapeutic Challenges and Opportunities. Cells.2021 Feb 9;10(2):352.
   doi: https://doi.org/ 10.3390/cells10020352
8. Piccinin E, Villani G, Moschetta A. Metabolic aspects in NAFLD, NASH and hepatocellular carcinoma: the role of PGC1 coactivators. Nat Rev Gastroenterol Hepatol.2019;16(3):160-74. doi: https://doi.org/10.1038/s41575-018-0089-3
9. Dikalov SI, Dikalova AE. Crosstalk between Mito­chondrial Hyperacetylation and Oxidative Stress in Vascular Dysfunction and Hypertension. Antioxidants Redox Signal. 2019;31(10):710-21. doi https://doi.org/10.1089/ars.2018.7632
10. Wu L, Zhou M, Li T, et al. GLP-1 regulates exer­cise endurance and skeletal muscle remodeling via GLP-1R/AMPK pathway. Biochim Biophys Acta – Mol Cell Res. 2022;1869(9):119300. doi: https://doi.org/10.1016/j.bbamcr.2022.119300
11. Zhu N, Yan X, Li H. Clinical significance of serum pgc-1 alpha levels in diabetes mellitus with myocardial infarction patients and reduced ros-oxidative stress in diabetes mellitus with myocardial infarction model. Diabetes, Metab Syndr Obes. 2020;13:4041-9. doi: https://doi.org/10.2147/DMSO.S276163
12. Andrade C. Physical Exercise and Health, 4: the health care professional and patient's guide to under­standing what to do, how, and why-part 2. J Clin Psychiatry. 2023;84(6):23f15187. doi: https://doi.org/10.4088/jcp.23f15187
13. Marzuca-Nassr GN, Alegría-Molina A, SanMar­tín-Calísto Y, et al. Muscle mass and strength gains following resistance exercise training in older adults 65-75 years and older adults above 85 years. Int J Sport Nutr Exerc Metab. 2024;34(1):11-9. doi: https://doi.org/10.1123/ijsnem.2023-0087
14. Pinckard K, Baskin KK, Stanford KI. Effects of Exercise to Improve Cardiovascular Health. Front Cardiovasc 2019;6(6):1-12. doi: https://doi.org/10.3389/fcvm.2019.00069
15. Liu C, Wu X, Vulugundam G, Gokulnath P, Li G, Xiao J. Exercise promotes tissue regeneration: mecha­nisms involved and therapeutic scope. Sport Med – Open. 2023;9(1):27. doi https://doi.org/10.1186/s40798-023-00573-9
16. Little JP, Safdar A, Bishop D, Tarnopolsky MA, Gibala MJ. An acute bout of high-intensity interval trai­ning increases the nuclear abundance of PGC-1α and activates mitochondrial biogenesis in human skeletal muscle. Am J Physiol – Regul Integr Comp Physiol. 2011;300(6):1303-10. doi: https://doi.org/10.1152/ajpregu.00538.2010
17. Fernandes MSDS, Aidar FJ, da Silva Pedroza AA, et al. Effects of aerobic exercise training in oxidative metabolism and mitochondrial biogenesis markers on prefrontal cortex in obese mice. BMC Sports Sci Med Rehabil. 2022;14(1):1-8. doi  https://doi.org/10.1186/s13102-022-00607-x
18. Hejazi K, Attarzadeh Hosseini SR, Fathi M, Mo­saferi Ziaaldini M. The Regulation of the Concentrations of Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-Alpha and Sirtuin 1 Protein in the Soleus Muscle by Aerobic Exercise Training in Obese Wistar Rats. J Kermanshah Univ Med Sci. 2020;24(3):22-7. doi: https://doi.org/10.5812/jkums.101849
19. Gahramani M, Karbalaeifar S. Effect of eight weeks high intensity interval training on NRF-1, 2 and Tfam gene expressione levels in ST muscles in rats with myocardial infarction. Med J Tabriz Univ Med Sci Heal Serv. 2019;41(6):75-82. doi: https://doi.org/10.34172/mj.2020.009
20. Shirvani H, Rahmati-Ahmadabad S, Broom DR, Mirnejad R. Eccentric resistance training and β-hydroxy-β-methylbutyrate free acid affects muscle PGC-1α ex­pression and serum irisin, nesfatin-1 and resistin in rats. J Exp 2019;222(10):jeb198424. doi: https://doi.org/10.1242/jeb.198424
21. Hoseini Z, Behpour N, Hoseini R. Aerobic trai­ning with moderate or high doses of vitamin D improve liver enzymes, LXRα and PGC-1α levels in rats with T2DM. Sci 2024;14(1):1-11. doi: https://doi.org/10.1038/s41598-024-57023-z
22. Guo Y, Zhou F, Fan J, et al. Swimming alleviates myocardial fibrosis of type II diabetic rats through acti­vating miR-34a-mediated SIRT1/PGC-1α/FNDC5 signal pathway. PLoS 2024;19(9):1-24. doi: https://doi.org/10.1371/journal.pone.0310136
23. Ghadery B, Ghazalian F, Hosseini SA, Abed Na­tanzy H, Shamsoddini A. The effect of six weeks of high intensity interval training on enos and pgc-1α gene expres­sion in the heart tissue of male obese rats. Jundishapur J Heal 2020;12(2):1-5. doi: https://doi.org/10.5812/jjhs.100280
24. Shoghi E, Safari T, Parsi-Moud A, Mirzaei I, Rad NS, Chahkandi M. Effects of moderate intensity training and lithium on spatial learning and memory in a rat model: The role of SIRT3 and PGC1-α expression levels and brain-derived neurotropic factor. Exp Gerontol. 2024;191(Apr):112442. doi: https://doi.org/10.1016/j.exger.2024.112442
25. Sylviana N, Natalia C, Goenawan H, et al. Effect of short-term endurance exercise on Cox IV and PGC-1a mRNA expression levels in rat skeletal muscle. Biomed Pharmacol 2019;12(3):1309-16. doi: https://doi.org/10.13005/bpj/1759
26. Cho E, Jeong DY, Kim JG, Lee S. The acute effects of swimming exercise on PGC-1α-FNDC5/irisin-UCP1 expression in male C57bL/6J mice. Metabolites. 2021;11(2):1-11. doi: https://doi.org/10.3390/metabo11020111
27. Chou TJ, Lin LY, Lu CW, Hsu YJ, Huang CC, Huang KC. Effects of aerobic, resistance, and high-intensity interval training on thermogenic gene expression in white adipose tissue in high fat diet induced obese mice. Obes Res Clin Pract. 2024;18(1):64-72. doi: https://doi.org/10.1016/j.orcp.2024.01.003
28. Luo J, Tang C, Chen X, et al. Impacts of aerobic exercise on depression-like behaviors in chronic un­predictable mild stress mice and related factors in the AMPK/PGC-1α pathway. Int J Environ Res Public Health. 2020;17(6):2042. doi: https://doi.org/10.3390/ijerph17062042
29. Shelbayeh OA, Arroum T, Morris S, Busch KB. PGC-1 α is a master regulator of mitochondrial lifecycle and ROS stress response. Antioxidants. 2023;12(5):1075. doi: https://doi.org/10.3390/antiox12051075
30. Bost F, Kaminski L. The metabolic modulator PGC-1α in cancer. Am J Cancer Res. 2019;9(2):198-211. PMID: 30906622; PMCID: PMC6405967.
31. Wang F, Wang X, Liu Y, Zhang Z. Effects of Exercise-Induced ROS on the Pathophysiological Func­tions of Skeletal Muscle. Oxid Med Cell Longev. 2021 Oct 1;2021:3846122. doi: https://doi.org/10.1155/2021/3846122
32. Powers SK, Deminice R, Ozdemir M, Yoshi­hara T, Bomkamp MP, Hyatt H. Exercise-induced oxi­dative stress: Friend or foe? J Sport Heal Sci. 2020;9(5):415-25. doi: https://doi.org/10.1016/j.jshs.2020.04.001
33. Wibawa JC, Arifin MZ, Herawati L. Ascorbic acid drink after submaximal physical activity can maintain the superoxide dismutase levels in east java student regiment. Indian J Forensic Med Toxicol. 2021;15(3):3383-92. doi: https://doi.org/10.37506/ijfmt.v15i3.15824
34. Agostini F, Bisaglia M, Plotegher N. Linking ROS Levels to Autophagy: The Key Role of AMPK. Anti­oxidants.2023;12(7):1-14. doi: https://doi.org/10.3390/antiox12071406
35. Arhen BB, Renwick JRM, Zedic AK, et al. AMPK and PGC-α following maximal and supramaximal exercise in men and women: a randomized cross-over study. Appl PhysiolNutr  2024;49(4):526-38. doi: https://doi.org/10.1139/apnm-2023-0256
36. Parsamanesh N, Asghari A, Sardari S, et al. Res­veratrol and endothelial function: A literature review. Pharmacol 2021;170(Jun):105725. doi: https://doi.org/10.1016/j.phrs.2021.105725
37. Zhang Q, Lei YH, Zhou JP, et al. Role of PGC-1α in mitochondrial quality control in neurodegenerative diseases. Neurochem 2019;44(9):2031-43. doi: https://doi.org/10.1007/s11064-019-02858-6
38. Steinberg GR, Carling D. AMP-activated protein kinase: the current landscape for drug development. Nat RevDrug  2019;18(7):527-51. doi: https://doi.org/10.1038/s41573-019-0019-2
39. Mozaffaritabar S, Koltai E, Zhou L, et al. PGC-1α activation boosts exercise-dependent cellular response in the skeletal muscle. J Physiol Biochem. 2024;80(2):329-35. doi: https://doi.org/10.1007/s13105-024-01006-1
40. Radak Z, Suzuki K, Posa A, Petrovszky Z, Kol­tai E, Boldogh I. The systemic role of SIRT1 in exercise mediated adaptation. Redox Biol. 2020;35(Feb):101467. doi: https://doi.org/10.1016/j.redox.2020.101467
41. Xu R, Luo X, Ye X, et al. SIRT1/PGC-1α/PPAR-γ correlate with hypoxia-induced chemoresistance in non-small cell lung cancer. Front Oncol. 2021;11(Jul):1-15. doi: https://doi.org/10.3389/fonc.2021.682762
42. Maissan P, Mooij EJ, Barberis M. Sirtuins-mediated system-level regulation of mammalian tissues at the interface between metabolism and cell cycle: A systematic review. Biology (Basel). 2021;10(3):1-78. doi: https://doi.org/10.3390/biology10030194
43. Juan CG, Matchett KB, Davison GW. A syste­matic review and meta-analysis of the SIRT1 response to exercise. Sci 2023;13(1):1-14. doi: https://doi.org/10.1038/s41598-023-38843-x
44. Zhou L, Pinho R, Gu Y, Radak Z. The role of SIRT3 in exercise and aging. cells. 2022;11(16):2596. doi: https://doi.org/10.3390/cells11162596
45. Xu L, Li Y, Zhou L, et al. SIRT3 elicited an anti-warburg effect through HIF1α/PDK1/PDHA1 to inhibit cholangiocarcinoma tumorigenesis. Cancer Med. 2019;8(5):2380-91. doi: https://doi.org/10.1002/cam4.2089
46. Gao S, Yao W, Zhou R, Pei Z. Exercise training affects calcium ion transport by downregulating the CACNA2D1 protein to reduce hypertension-induced myocardial injury in mice. iScience. 2024;27(4):109351. doi: https://doi.org/10.1016/j.isci.2024.109351
47. Flück M, Sanchez C, Jacquemond V, et al. En­hanced capacity for CaMKII signaling mitigates calcium release related contractile fatigue with high intensity exercise. Biochim Biophys Acta – Mol Cell Res. 2024;1871(2):119610. doi: https://doi.org/10.1016/j.bbamcr.2023.119610
48. Bouviere J, Fortunato RS, Dupuy C, Werneck-De-castro JP, Carvalho DP, Louzada RA. Exercise-stimulated ros sensitive signaling pathways in skeletal muscle. Antioxidants. 2021;10(4):1-21. doi: https://doi.org/10.3390/antiox10040537
49. Folgueira C, Herrera-Melle L, López JA, et al. Re­modeling p38 signaling in muscle controls locomotor activity via IL-15. Sci Adv. 2024;10(33):1-18. doi: https://doi.org/10.1126/sciadv.adn5993
50. You W, Knoops K, Berendschot TTJM, et al. PGC-1a mediated mitochondrial biogenesis promotes recovery and survival of neuronal cells from cellular degeneration. Cell Death Discov. 2024;10(1):1-15. doi: https://doi.org/10.1038/s41420-024-01953-0

Look through:

Ayubi N. Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-5196-6636

Wibawa J.C. STKIP PGRI Trenggalek, Trenggalek, Jawa Timur, Indonesia

Rizki A.Z. Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia
https://orcid.org/0009-0006-7025-7209

Afandi A. Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia
https://orcid.org/0009-0009-7161-3852

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

Ayubi N., Wibawa J.C., Rizki A.Z., Afandi A., Callixte C. Physiological regulation of peroxisome proliferator-activated receptor-gamma coactivator 1 alpha in mitochondrial metabolism during physical exercises: a systematic review. Medicni perspektivi. 2025;30(2):27-37. 
DOI: https://doi.org/10.26641/2307-0404.2025.2.333361

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

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

Key words: Langerhans cells, dendritic cells, T-lymphocytes, abscessing perifolliculitis of the scalp, Hoffmann's disease, dissecting cellulitis of the scalp, abscessing and subluxing perifolliculitis of the scalp, cicatricial changes of the scalp, cicatricial alopecia, dermatology, trichology, hair diseases, skin pathomorphology, immunohistochemistry

1. Cuellar TA, Roh DS, Sampson CE. Dissecting cel­lulitis of the scalp: a review and case studies of surgical re­con­struction. Plast Reconstr Surg Glob Open. 2020;8(8):e3015. doi: https://doi.org/10.1097/GOX.0000000000003015
2. Melo DF, Lemes LR, Pirmez R, Duque-Estrada B. Trichoscopic stages of dissecting cellulitis: a potential complementary tool to clinical assessment. An Bras Dermatol.2020;95(4):514-17. doi: https://doi.org/10.1016/j.abd.2019.10.008 
3. Wu Q, Bu W, Zhang Q, Fang F. Therapeutic op­tions for perifolliculitis capitis abscedens et suffodens: A review. Dermatol 2022;35(10):e15763. doi: https://doi.org/10.1111/dth.15763
4. Abbas AK, Lichtman AH, Pillai S. Basic Immuno­logy. 7th Edition. Elsevier; 2023.
5. Ronchese F, Hilligan KL, Mayer JU. Dendritic cells and the skin environment. Current Opinion in Immunology. 2020;64:56-62. doi: https://doi.org/10.1016/j.coi.2020.03.006.
6. Mohamed A, Vella J, Turk MJ, Huang YH. Den­dritic cells instruct differentiation of tissue resident memory T cells in the skin to promote durable tumor immunity. J 2022;208(1):57.14. doi: https://doi.org/10.4049/jimmunol.208.Supp.57.14 
7. Dias de Oliveira NF, Santi CG, Maruta CW, Aoki V. Plasmacytoid dendritic cells in dermatology. An Bras 2021;96:76-81. doi: https://doi.org/10.1016/j.abd.2020.08.006
8. Scheib N, Tiemann J, Becker C, Probst HC, Ra­ker VK, Steinbrink K. The Dendritic Cell Dilemma in the Skin: Between Tolerance and Immunity. Front Immunol. 2022;13:929000. doi: https://doi.org/10.3389/fimmu.2022.929000
9. Sumpter TL, Balmert SC, Kaplan DH. Cutaneous immune responses mediated by dendritic cells and mast cells. JCI 2019;4(1):e123947. doi: https://doi.org/10.1172/jci.insight.123947 
10. Vareniuk IM, Dzerzhynskyi ME. [Methods of cyto-histological diagnosis]. Kyiv: Interservis; 2019. Ukrainian.
11. Nguyen T. Immunohistochemistry: A Technical Guide to Current Practices. Cambridge: Cambridge University Press; 2022.
12. Lombardo GP, Miller A, Aragona M, Messina E, Fumia A, Kuciel M, et al. Immunohistochemical Cha­rac­terization of Langerhans Cells in the Skin of Three Amphibian Species. Biology. 2024;13(4):210. doi: https://doi.org/10.3390/biology13040210
13. Strakhova OP, Androsov OI. [Statistical methods of processing the results of medical and biological re-search: educational and methodological manual]. Lviv: Vydavets Marchenko T.V.; 2021. Ukrainian.
14. Masson R, Jeong CY, Ma E, Crew AB, Fra­go­so NM, Shi VY, et al. Treatments for Dissecting Cellulitis of the Scalp: A Systematic Review and Treatment Algo­rithm. Dermatol Ther (Heidelb). 2023;13(11):2487-526. doi: https://doi.org/10.1007/s13555-023-01018-7
15. Poslavska OV, Statkevych OL, Sviatenko TV, Shponka IS. Pathomorphological analysis of the quali­tative composition of the inflammatory infiltrate around the pilosebaceous unit of the scalp in perifolliculitis capitis abscedens et suffodiens. Pathologia. 2025;22(1):33-40. doi: https://doi.org/10.14739/2310-1237.2025.1.314325

Look through:

Poslavska O.V. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-3133-8413

Statkevych O.L. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-2324-998X

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

Chekan S.M. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-7702-8912

Poslavska O.V., Statkevych O.L., Sviatenko T.V., Chekan S.M. Distribution of dendritic cells in the pilosebaceous unit of the scalp in subversive abscessing perifolliculitis of the scalp: immunomorphological aspects. Medicni perspektivi. 2025;30(2):38-45. 
DOI: https://doi.org/10.26641/2307-0404.2025.2.333366

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

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

Key words: cardiac amyloidosis, cardiomyopathy, myocardial hypertrophy, AL amyloidosis, heart failure, diagnostics, epidemiology

1. Maurer MS, Elliott P, Comenzo R, Semigran M, Rapezzi C. Addressing common questions encountered in the diagnosis and management of cardiac amyloidosis. Circulation.2017;135:1357-77. doi https://doi.org/10.1161/CIRCULATIONAHA.116.024438
2. Westin O, Butt JH, Gustafsson F, Schou M, Salo­mo M, Køber L, et al. Two Decades of Cardiac Amy­loidosis: A Danish Nationwide Study. JACC CardioOncol. 2021;3(4):522-33. doi: https://doi.org/10.1016/j.jaccao.2021.05.004
3. Gilstrap LG, Dominici F, Wang Y, El-Sady MS, Singh A, Di Carli MF, et al. Epidemiology of Cardiac Amyloidosis-Associated Heart Failure Hospitalizations Among Fee-for-Service Medicare Beneficiaries in the United States. Circ Heart Fail. 2019;12(6):e005407. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.118.005407 
4. Quock TP, Yan T, Chang E, Guthrie S, Bro­der MS. Epidemiology of AL amyloidosis: a real-world study using US claims data. Blood Adv. 2018;2:1046-53. doi: https://doi.org/10.1182/bloodadvances.2018016402
5. Ney S, Ihle P, Ruhnke T, Günster C, Michels G, Seuthe K, et al. Epidemiology of cardiac amyloidosis in Germany: a retrospective analysis from 2009 to 2018. Clin Res 2023;112(3):401-8. doi: https://doi.org/10.1007/s00392-022-02114-y 
6. Kyle RA, Linos A, Beard CM, et al. Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989. Blood. 1992;79(7):1817-22. doi: https://doi.org/10.1182/blood.V79.7.1817.1817
7. Ruberg FL. Cardiac Amyloidosis: A Zebra Hiding in Plain Sight? Circ Cardiovasc Imaging. 2017;10(3):e006186. doi: https://doi.org/10.1161/CIRCIMAGING.117.006186
8. Kieninger B, Eriksson M, Kandolf R, Schna­bel PA, Schönland S, Kristen AV, et al. Amyloid in endo­myocardial biopsies. Virchows Arch. 2010;456(5):523-32.
   doi: https://doi.org/10.1007/s00428-010-0909-5
9. Bonderman D, Pölzl G, Ablasser K, Agis H, Aschauer S, Auer-Grumbach M, et al. Diagnosis and treatment of cardiac amyloidosis: an interdisciplinary con­sensus statement. Wien Klin Wochenschr.
   2020;132(23-24):742-61.
   doi: https://doi.org/10.1007/s00508-020-01781-z
10. Erdogdua T, Uysala OK, Icena YK, Alicia G, Koca M, Ibrahim Halil Kurta IH. Increased EHRA score predicts atrial fibrillation recurrence in paroxysmal atrial fibrillation patients undergoing cryoablation. Ann Med Res.2024;31(2):94-100. doi: https://doi.org/10.5455/annalsmedres.2023.11.299
11. Garcia-Pavia P, Rapezzi C, Adler Y, Arad M, Basso C, Brucato A, et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. EurHeart  2021;42(16):1554-68. doi: https://doi.org/10.1093/eurheartj/ehab072 
12. Mishra P, Singh U, Pandey CM, Mishra P, Pan­dey G. Application of student's t-test, analysis of variance, and covariance. Ann Card Anaesth. 2019;22(4):407-11. doi: https://doi.org/10.4103/aca.ACA_94_19
13. Germain DP, Altarescu G, Barriales-Villa R, Mig­nani R, Pawlaczyk K, Pieruzzi F, et al. An expert con­sensus on practical clinical recommendations and guidance for patients with classic Fabry disease. Mol Genet Metab. 2022 Sep-Oct;137(1-2):49-61. doi: https://doi.org/10.1016/j.ymgme.2022.07.010
14. Castaño A, Narotsky DL, Hamid N, Khalique OK, Morgenstern R, DeLuca A, et al. Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing trans­catheter aortic valve replacement. Eur Heart J. 2017;38(38):2879-87. doi: https://doi.org/10.1093/eurheartj/ehx350
15. Porcari A, Bussani R, Merlo M, Varrà GG, Pa­gura L, Rozze D, et al. Incidence and Characterization of Concealed Cardiac Amyloidosis Among Unselected El­derly Patients Undergoing Post-mortem Examination. FrontCardiovasc  2021;8:749523. doi: https://doi.org/10.3389/fcvm.2021.749523
16. Maurizi N, Rella V, Fumagalli C, Salerno S, Cas­telletti S, Dagradi F, et al. Prevalence of cardiac amy­loidosis among adult patients referred to tertiary centres with an initial diagnosis of hypertrophic cardiomyopathy. IntJ  2020;300:191-5. doi: https://doi.org/10.1016/j.ijcard.2019.07.051 
17. Rubin J, Maurer MS. Cardiac Amyloidosis: Over­looked, Underappreciated, and Treatable. Annu Rev Med. 2020;71:203-19.
    doi: https://doi.org/10.1146/annurev-med-052918-020140
18. Arbelo E, Protonotarios A, Gimeno JR, Arbus­tini E, Barriales-Villa R, Basso C, et al. ESC Scientific Document Group. 2023 ESC Guidelines for the mana­gement of cardiomyopathies. Eur Heart J. 2023;44(37):3503-626. doi: https://doi.org/10.1093/eurheartj/ehad194
19. Mostbauer HV. [Cardiac amyloidosis]. Zdorovia Ukrainy. 2023;88(3):24-7. Ukrainian.
20. Muchtar E, Dispenzieri A, Magen H, Grogan M, Mauermann M, McPhail ED, et al. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med. 2021;289(3):268-92. doi: https://doi.org/10.1111/joim.13169
21. Fend F, Dogan A, Cook JR. Plasma cell neo­plasms and related entities-evolution in diagnosis and classification. Virchows Arch. 2023;482(1):163-77. doi: https://doi.org/10.1007/s00428-022-03431-3
22. Imperlini E, Gnecchi M, Rognoni P, Sabidò E, Ciuffreda MC, Palladini G, et al. Proteotoxicity in cardiac amyloidosis: amyloidogenic light chains affect the levels of intracellular proteins in human heart cells. Sci Rep. 2017;7(1):15661.
    doi: https://doi.org/10.1038/s41598-017-15424-3
23. Papathanasiou M, Schlender LS, Johnson VL, Wakili R. [Arrhythmias and amyloidosis]. Herzschrit­tmacherther Elektrophysiol. 2024;35(3):199-204. German. doi: https://doi.org/10.1007/s00399-024-01016-y
24. Chompoopong P, Mauermann ML, Siddiqi H, Pel­tier A. Amyloid Neuropathy: From Pathophysiology to Treatment in Light-Chain Amyloidosis and Hereditary Transthyretin Amyloidosis. Ann Neurol. 2024;96(3):423-40. doi: https://doi.org/10.1002/ana.26965

Look through:

Kozliuk A.S. SI “NSC “Strazhesko National Scientific Center of Cardiology and Regenerative Medicine of the NAMS of Ukraine”, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-3832-4134

Kozliuk A.S. Cardiomyopathies with left ventricular hypertrophy phenotype: prevalence of cardiac amyloidosis and clinical characteristics of patients. Medicni perspektivi. 2025;30(2):46-53.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333369

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

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

Key words: post-COVID syndrome, arterial hypertension, transforming growth factor β1

1. Bielecka E, Sielatycki P, Pietraszko P, et al. Ele­vated arterial blood pressure as a delayed complication following COVID-19 – A narrative review. Int J Mol Sci. 2024;25(3):1837. doi: https://doi.org/10.3390/ijms25031837
2. National Institute for Health and Care Research. NIHR themed review: living with COVID-19 [Internet]. 2020 [cited 2024 Dec 23]. Available from: https://evidence.nihr.ac.uk/themedreview/living-with-covid19/
3. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus [Internet]. 2021 [cited 2024 Dec 23]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1
4. World Health Organization. Post COVID-19 Condition (Long COVID) [Internet]. 2022 [cited 2024 Dec 23]. Available from: https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition
5. Kuriata O, Mytrokhina O, Kushnir Yu, et al. [Post-COVID syndrome: status of carbohydrate metabolism in patients with hypertension and stable ischemic heart disease]. Mizhnar endokrynol zhurn [Internet]. 2024;20(1):31-8.Ukrainian. doi: https://doi.org/10.22141/2224-0721.20.1.2024.1354
6. Cinar A, Gedikli O, Uyanik M, Terzi O. Eva­luation of Coronary Artery Calcium Score (CACS) in Dipper and Non-Dipper Hypertensive Patients with Moderate and High Cardiovascular Disease Risks. Medicina.2024;60(12):1999. doi: https://doi.org/10.3390/medicina60121999
7. Gemelli Against COVID-19 Post-Acute Care Study Group. Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res. 2020;32:1613-20. doi: https://doi.org/10.1007/s40520-020-01616-x
8. Strilchuk L. [Post- COVID syndrome: a new mul­tidisciplinary challenge]. Zdorovia Ukrainy. 2021;498(5):3.
9. Quinn KL, Lam GY, Walsh JF, et al. Cardio­vascular Considerations in the Management of People With Suspected Long COVID. Can J Cardiol. 2023;39(6):741-53. doi: https://doi.org/10.1016/j.cjca.2023.04.003
10. Kusumawardhani NY, Putra IC, Kamarullah W, et al. Cardiovascular disease in post-acute COVID-19 syndrome: a comprehensive review of pathophysiology and diagnosis approach. Rev Cardiovasc Med. 2023;24(1):28. doi: https://doi.org/10.31083/j.rcm2401028
11. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601-15. doi: https://doi.org/10.1038/s41591-021-01283-z
12. Wan Y, Shang J, Graham R, Baric RS, Lia F. Re­ceptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. 2020;94(7):e00127-20. doi: https://doi.org/10.1128/jvi.00127-20
13. Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease. Int J Cardiol [Internet]. 2020;309:70-7. doi: https://doi.org/10.1016/j.ijcard.2020.03.063
14. Ren LL, Li XJ, Duan TT, et al. Transforming growth factor-β signaling: From tissue fibrosis to therapeutic opportunities. Chem Biol Interact. 2023;369:110289. doi: https://doi.org/10.1016/j.cbi.2022.110289
15. Liu J, Tao Zhuang, Jingjiang Pi, et al. Endothelial forkhead box transcription factor P1 regulates pathological ca­rdiac remodeling through transforming growth factor-β1–en­dothelin-1 signal pathway. Circulation. 2019;140(8):665-80. doi: https://doi.org/10.1161/CIRCULATIONAHA.119.039767
16. Braga YL, do Carmo Neto JR, Franco PI, et al. The Influence of IL-11 on Cardiac Fibrosis in Experi­men­tal Models: A Systematic Review. J Cardiovasc Dev Dis. 2024;11(2):65. doi: https://doi.org/10.3390/jcdd11020065
17. Randell A, Daneshtalab N. Elastin microfibril interface–located protein 1, transforming growth factor beta, and implications on cardiovascular complications. J Am Soc Hypertens. 2017;11(7):437-48. doi: https://doi.org/10.1016/j.jash.2017.04.010
18. Li B, Khanna A, Sharma V, et al. TGF-β1 DNA Polymorphisms, Protein Levels, and Blood Pressure. Hypertension.1999;33(1):271-5. doi: https://doi.org/10.1161/01.HYP.33.1.271
19. Matsuki K, Hathaway CK, Lawrence MG, et al. The Role of Transforming Growth Factor β1 in the Regulation of Blood Pressure. Curr Hypertens Rev. 2014;10(4):223-38. doi: https://doi.org/10.2174/157340211004150319123313
20. Derhaschnig U, Shehata M, Herkner H, et al. In­creased levels of transforming growth factor-β1 in essential hypertension. AmJ  2002;15(3):207-11. doi: https://doi.org/10.1016/S0895-7061(01)02327-5
21. Zeng KF, Wang HJ, Deng B, et al. Ethyl ferulate suppresses post-myocardial infarction myocardial fibrosis by inhibiting transforming growth factor receptor 1. Phytomedicine.2023;121:155118. doi: https://doi.org/10.1016/j.phymed.2023.155118
22. Carod-Artal F. Post-COVID-19 syndrome: epide­miology, diagnostic criteria and pathogenic mechanisms involved. Rev 2021;72(11):384-96. doi: https://doi.org/10.33588/rn.7211.2021230
23. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). Eur Heart 2024;45(38):3912-4018. doi: https://doi.org/10.1093/eurheartj/ehae178.
24. Dubrov SO, Kovalenko VM, Vakaliuk IP, et al. [State Expert Center of the Ministry of Health of Ukraine. Clinical guideline based on evidence «Arterial hyper­tension» [Internet]. 2024 [cited 2024 Nov15]. Ukrainian. Available from: https://www.dec.gov.ua/mtd/arterialna-gipertenziya-2/
25. Hallek M, Adorjan K, Behrends U, et al. Post-COVID Syndrome. DTSCH Arztebl Int. 2023;120(4):48-55. doi: https://doi.org/10.3238/arztebl.m2022.0409
26. Yong SJ. Long COVID or post-COVID-19 synd­rome: putative pathophysiology, risk factors, and treat­ments. Infect 2021;53(10):737-54. doi: https://doi.org/10.1080/23744235.2021.1924397
27. Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney 2024;105(4S):117-314. doi: https://doi.org/10.1016/j.kint.2023.10.018
28. Makhanets L, Vinnychuk O, Hryhorkiv M. [Sta­tistics: Laboratory Workshop in STATISTICA 12: Tu­torial. Chernivtsi]. Chernivets nats un-t im. Yu. Fed­kovycha; 2023. 161 р. Ukrainian.
29. Scherer PE, Kirwan JP, Rosen CJ. Post-acute sequelae of COVID-19: a metabolic perspective. eLife. 2022;11:e78200. doi: https://doi.org/10.7554/eLife.78200
30. Al-Samerria S, Radovick S. The Role of Insulin-like Growth Factor-1 (IGF-1) in the Control of Neuro­endocrine Regulation of Growth. Cells. 2021;10(10):2664. doi: https://doi.org/10.3390/cells10102664
31. Kheirollahi V, Khadim A, Kiliaris G, et al. Trans­criptional Profiling of Insulin-like Growth Factor Signa­ling Components in Embryonic Lung Development and Idiopathic Pulmonary Fibrosis. Cells. 2022;11(12):1973. doi: https://doi.org/10.3390/cells11121973
32. Prlic MF, Brinar IV, Kos J, Dika Z, Ivandic E, Fucek M, et al. Serum Hepatocyte Growth Factor Concentration Correlates with Albuminuria in Individuals with Optimal Blood Pressure and Untreated Arterial Hypertension. Biomedicines.2024;12(10):2233. doi: https://doi.org/10.3390/biomedicines12102233
33. Prlic MF, Brinar IV, Kos J, et al. Serum Hepato­cyte Growth Factor Concentration Correlates with Albumi­nuria in Individuals with Optimal Blood Pressure and Untreated Arterial Hypertension. Biomedicines. 2024;12(10):2233. doi: https://doi.org/10.3390/biomedicines12102233
34. Frangogiannis NG. Transforming growth factor–β in tissue fibrosis. J Exp Med. 2020;217(3):e20190103. doi: https://doi.org/10.1084/jem.20190103
35. Kieć-Wilk B, Stolarz-Skrzypek K, Sliwa A, et al. Peripheral blood concentrations of TGFβ1, IGF-1 and bFGF and remodelling of the left ventricle and blood vesselsin hypertensive patients. Kardiol Pol. 2010;68(9):996-1002. PMID: 20859888
36. Liu Y, Lin Y, Huang X, et al. Association of serum transforming growth factor β1 with left ventricular hypertrophy in children with primary hypertension. Eur J Pediatr.2023;182:5439-46. doi: https://doi.org/10.1007/s00431-023-05219-2
37. Aula H, Skyttä T, Tuohinen S, et al. Transforming growth factor beta 1 levels predict echocardiographic changes at three years after adjuvant radiotherapy for breast cancer. Radiat 2019;14(1):155. doi: https://doi.org/10.1186/s13014-019-1366-1
38. Wang L, Wang HL, Liu TT, et al. TGF-Beta as a Master Regulator of Diabetic Nephropathy. J Mol Sci. 2021;22(15):7881. doi: https://doi.org/10.3390/ijms22157881
39. Liu H, Chen YG. The Interplay Between TGF-β Signaling and Cell Metabolism. Front Cell Dev Biol. 2022;10:2022. doi: https://doi.org/10.3389/fcell.2022.846723
40. Xiao Y, Wang Y, Ryu J, et al. Upregulated TGF-β1 contributes to hyperglycaemia in type 2 diabetes by poten­tiating glucagon signalling. Diabetologia. 2023;66:1142-55. doi: https://doi.org/10.1007/s00125-023-05889-5
41. Zhao L, Zou Y, Liu F. Transforming Growth Fac­tor-Beta1 in Diabetic Kidney Disease. Front Cell Dev Biol. 2020;8:2020. doi: https://doi.org/10.3389/fcell.2020.00187
42. [All-Ukrainian Association of Cardiologists of Ukraine. Recommendations of the All-Ukrainian Asso­ciation of Cardiologists of Ukraine on diagnosis, treatment and prevention of chronic heart failure. Pocket version [Internet]. 2024 [cited 2024 Dec 15]. Ukrainian. Available from: https://cardiohub.org.ua/wp-content/uploads/2024/09/Rekomendatsii-KHSN-A6-1.pdf
43. Azizi M. Aldosterone receptor antagonists Antagonistes du récepteur de l’aldostérone. Ann dEndo­crinologie. 2021;82(3-4):179-81. doi: https://doi.org/10.1016/j.ando.2020.03.009

Look through:

Kuryata O.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-7642-0077

Mytrokhina O.S. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-6485-4329

Stadnyk O.I. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-8253-5524

Kuryata O.V., Mytrokhina O.S., Stadnyk O.I. Transforming growth factor beta-1 in patients with hypertension who had COVID-19. Medicni perspektivi. 2025;30(2):53-60.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333373

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

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

Key words: postnasal drip syndrome, ambroxol, oromucosal spray, postnasal dripping, rhinosinusitis, rhinopharyngitis, efficacy, safety, multicenter study

1. Babchenko NV, Dieieva YuV, Konovalov SE, Motailo OV. [Expression indicators of mucopoly­sac­charides MUC 5AC and MUC 1 in the nasal mucosa in patients with postnasal drip syndrome and nasal septum curvature]. Klinichna ta profilaktychna medytsyna. 2024;(2):43-8. doi: https://doi.org/10.31612/2616-4868.2.2024.06
2. Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol.2020;146:721-67. doi: https://doi.org/10.1016/j.jaci.2020.07.007
3. Sanu A, Eccles R. Postnasal drip syndrome. Two hundred years of controversy between UK and USA. Rhinology. 2008;46(2):86-91.
4. Krajewska J, Zub K, Słowikowski A, Zatoński T. Chronic rhinosinusitis in cystic fibrosis: a review of therapeutic options. Eur Arch Otorhinolaryngol. 2022:1-24. doi: https://doi.org/10.1007/s00405-021-06875-6
5. Kumar A, Sharma S, Singh P, et al. Comparison of different formulations of mucolytics in post-nasal drip: a network meta-analysis. Eur Respir J. 2024;63:2302544. doi: https://doi.org/10.1183/13993003.02544-2023
6. Trykhlib V, Zadorozhna V, Tkachuk S, Palatna L, Operchuk N. The Incidence of Acute Upper Respiratory Infections of Multiple or Uncertain Localization in Ukrainian Children. Actual Infectology. 2016;(3.12):83-92. doi: https://doi.org/10.22141/2312-413x.3.12.2016.81720
7. Naumenko OM, Zabolotnyi DI, Dieieva YuV, Za­bo­lotna DD. [Features of the clinical course of acute rhi­nosinusitis in COVID-19]. Pohlyad otorynolarynholoha. II Scientific and Practical Conference; 2021. Ukrainian. Availablefrom: http://ir.librarynmu.com/bitstream/123456789/8230/1/Особливості%20клінічного.pdf
8. Scaglione F, Petrini O. Mucoactive Agents in the Therapy of Upper Respiratory Airways Infections: Fair to Describe Them Just as Mucoactive? Clin Med Insights Ear Nose 2019;12. doi: https://doi.org/10.1177/1179550618821930
9. Paleari D, Rossi GA, Nicolini G, Olivieri D. Ambroxol: a multifaceted molecule with additional therapeutic potentials in respiratory disorders of childhood. Expert Opin Drug Discov. 2011;6(11):1203-14. doi: https://doi.org/10.1517/17460441.2011.629646
10. Weiser T. Ambroxol: a CNS drug? CNS Neurosci Ther.2008;14(1):17-24. doi: https://doi.org/10.1111/j.1527-3458.2007.00032.x
11. Malerba M, Ragnoli B. Ambroxol in the 21st century: pharmacological and clinical update. Expert Opin DrugMetab  2019;12:1-10. doi: https://doi.org/10.1080/17425255.2019.1670168
12. Beeh KM, Beier J, Esperester A, Paul LD. Antiin­flammatory properties of ambroxol. Eur J Med Res. 2008;13:557-62.
13. Zhang ZQ, Wu QQ, Huang XM, Lu H. Prevention of respiratory distress syndrome in preterm infants by antenatal ambroxol: a meta-analysis of randomized controlled trials. Am J Perinatol. 2023;30:529-36. doi: https://doi.org/10.1055/s-0032-1329188
14. Kantar A, Klimek L, Cazan D, Sperl A, Sent U, Mesquita M. An overview of efficacy and safety of am­broxol for the treatment of acute and chronic respiratory diseases with a special regard to children. Multidiscip Respir 2020;15(1):511. doi: https://doi.org/10.4081/mrm.2020.511
15. Cheng X, Xie Q, Sun Y. Advances in nano­ma­terial-based targeted drug delivery systems. Front Bioeng Biotechnol.2023;11:1177151. doi: https://doi.org/10.3389/fbioe.2023.1177151
16. Collins JC, Moles RJ. Management of respiratory disorders and the pharmacist's role: Cough, colds, and sore throats and allergies (including eyes). Encyclopedia of pharmacy practice and clinical pharmacy. 2019:282. doi: https://doi.org/10.1016/B978-0-12-812735-3.00510-0
17. de Mey C, Patel J, Lakha DR, Richter E, Koelsch S. Efficacy and Safety of an Oral Ambroxol Spray in the Treatment of Acute Uncomplicated Sore Throat. DrugRes (Stuttg). 2015;65(12):658-67. doi: https://doi.org/10.1055/s-0035-1547229
18. Chenot JF, Weber P, Friede T. Efficacy of Am­broxol lozenges for pharyngitis: a meta-analysis. BMC Fam 2014;15:45.
    doi: https://doi.org/10.1186/1471-2296-15-45
19. Brahmeshwar Mishra, Juhi Singh. Novel drug deli­very systems and significance in respiratory diseases. In: Tar­geting Chronic Inflammatory Lung Diseases Using Advanced Drug Delivery Systems. Academic Press; 2020. p. 57-95. doi: https://doi.org/10.1016/B978-0-12-820658-4.00004-2
20. Doulaptsi M, Prokopakis E, Seys S, Pugin B, Steelant B, Hellings P. Visual analogue scale for sino-nasal symptoms severity correlates with sino-nasal outcome test 22: paving the way for a simple outcome tool of CRS burden. Clin Transl Allergy. 2018;8:32. doi: https://doi.org/10.1186/s13601-018-0219-6
21. Butcher NJ, Monsour A, Mew EJ, et al. Guidelines for Reporting Outcomes in Trial Reports: The CONSORT-Outcomes 2022 Extension. JAMA. 2022;328(22):2252-2264. doi: https://doi.org/10.1001/jama.2022.21022
22. Walther C, Döring K, Schmidtke M. Comparative in vitro analysis of inhibition of rhinovirus and influenza virus replication by mucoactive secretolytic agents and plant extracts. BMC Complement Med Ther. 2020;20:380. doi: https://doi.org/10.1186/s12906-020-03173-2
23. Cheng L, Liu M, Wang R, Cao S, Li R, Su B, et al. Ambroxol hydrochloride spray (Luo Runchang®) in the treatment of acute respiratory infectious diseases: a pro­spective, multicenter, open label, randomized controlled study.Front  2024;12:1380189. doi: https://doi.org/10.3389/fped.2024.1380189
24. Alkotaji M. Azithromycin and ambroxol as po­tential pharmacotherapy for SARS-CoV-2. Int J Antimicrob 2020;56:106192. doi: https://doi.org/10.1016/j.ijantimicag.2020.106192
25. Nakahari T, Suzuki C, Kawaguchi K, Hosogi S, Tanaka S, Asano S, et al. Ambroxol-Enhanced Frequency and Amplitude of Beating Cilia Controlled by a Voltage-Gated Ca2+ Channel, Cav1.2, via pHi Increase and [Cl−]i Decrease in the Lung Airway Epithelial Cells of Mice. Int J Mol Sci. 2023;24:16976. doi: https://doi.org/10.3390/ijms242316976

Look through:

Deeva Yu.V. Bogomolets National Medical University, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-0552-1254

Fomin S.F. Poltava region, Ukraine
https://orcid.org/0009-0004-8109-1289

Kuznetsova O.V. Poltava region, Ukraine
https://orcid.org/0009-0009-8251-9933

Tsyba L.L. Sumy region, Ukraine
https://orcid.org/0009-0006-8000-0642

Lavrova N.P. Mykolaev, Ukraine
https://orcid.org/0009-0005-9792-2873

Deeva Yu.V., co-authors (42). Clinical efficacy and safety of high-dose ambroxol in the form of oromucosal spray in postnasal drip syndrome: results of a multicenter study in Ukraine. Medicni perspektivi. 2025;30(2):61-77.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333376

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

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

Key words: type 2 diabetes mellitus, coronary artery disease, mathematical model

1. Seo DH, Kim M, Suh YJ, Cho Y, Ahn SH, Hong S, et al. Association between age at diagnosis of type 2 diabetes and cardiovascular morbidity and mortality risks: A nationwide population-based study. Diabetes Res Clin 2024;208:111098. doi: https://doi.org/10.1016/j.diabres.2024.111098
2. Huang L, Wu P, Zhang Y, Lin Y, Shen X, Zhao F, et Relationship between onset age of type 2 diabetes mellitus and vascular complications based on propensity score matching analysis. J Diabetes Investig. 2022;13(6):1062-72. doi: https://doi.org/10.1111/jdi.13763
3. Kim SM, Lee G, Choi S, Kim K, Jeong SM, Son JS, et Association of early-onset diabetes, pre­diabetes, and early glycaemic recovery with the risk of all-cause and cardiovascular mortality. Diabetologia. 2020;63(11):2305-14. doi: https://doi.org/10.1007/s00125-020-05252-y
4. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension.J  2013;31(7):1281-9. doi: https://doi.org/10.1097/01.hjh.0000431740.32696.cc
5. Goodarzi MO, Rotter JI. Genetics insights in the relationship between type 2 diab etes and coronary heart disease.Circ  2020;126(11):1326-40. doi: https://doi.org/10.1161/CIRCRESAHA.120.317103
6. Ye Y, Han J, Jiang W, Natarajan P, Zhao H. Interac­tions between enhanced polygenic risk scores and lifestyle for cardiovascular disease, diabetes, and lipid levels. Circulation: Genomic and Precision Medicine. 2021;14(1):e003128. doi: https://doi.org/10.1161/CIRCGEN.120.003128
7. Polemiti E, Baudry J, Kuxhaus O, Jäger S, Berg­mann MM, Weikert C, et BMI and BMI change fol­lowing incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study. Diabetologia. 2021;64(5):1084-96. doi: https://doi.org/10.1007/s00125-021-05367-x
8. Nanayakkara N, Curtis AJ, Heritier S, Ga­dows­ki AM, Pavkov ME, Kenealy T, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia.2021;64(2):275-87. doi: https://doi.org/10.1007/s00125-020-05319-w
9. Sattar N, Rawshani A, Franzén S, Rawshani A, Svensson AM, Rosengren A, et al. Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks. Circulation. 2019 May 7;139(19):2228-37. doi https://doi.org/10.1161/CIRCULATIONAHA.118.037885
10. de Jong M, Woodward M, Peters SAE. Duration of diabetes and the risk of major cardiovascular events in women and men: a prospective cohort study of UK biobank participants. Diabetes Res Clin Pract. 2022;188:109899. doi: https://doi.org/10.1016/j.diabres.2022.109899
11. Huang JX, Liao YF, Li YM. Clinical features and microvascular complications risk factors of early-onset type 2 diabetes mellitus. Curr Med Sci. 2019;39(5):754-8. doi: https://doi.org/10.1007/s11596-019-2102-7
12. Endothelial Dysfunction and Diabetic Cardio­myopathy. Front Endocrinol. 2022;13:851941. doi: https://doi.org/10.3389/fendo.2022.851941
13. Saienko YaA, Pysaruk AV, Koshel NM, Man­kovskyi BM. [Clinico-demographic characteristics of patients with type 2 diabetes mellitus of different age groups and their relationship with the risk of developing cardiovascular complications]. 2024;29(3):240-6. Ukrainian. doi: https://doi.org/10.22141/2224-0439
14. [All-Ukrainian Association of Cardiologists of Ukraine. Recommendations of the All-Ukrainian As­sociation of Cardiologists of Ukraine on the diagnosis, treatment and prevention of chronic heart failure]. [Internet]. 2024 [cited 2025 Feb 5]. Ukrainian. Available from:https://cardiocongress.org.ua/wp-content/uploads/2024/09/Рекомендації-ХСН-А6-1.pdf
15. Chronic Kidney Disease in the Older Adult Patient with Diabetes. J Clin Med. 2024;13(2):348. doi: https://doi.org/10.3390/jcm13020348
16. Saienko YaA, Pysaruk AV, Koshel NM, Man­kovskyi BM. [The relationship between chronic kidney disease and cardiovascular pathology in patients with type2 diabetes of different ages]. Ukrainian J Cardiol. 2024;31(5):21-30.  doi: https://doi.org/10.31928/2664-4479-2024.5.2130
17. Ye Y, Chen X, Han J, Jiang W, Natarajan P, Zhao H. Interactions Between Enhanced Polygenic Risk Scores and Lifestyle for Cardiovascular Disease, Diabetes, and Lipid Levels. Circulation: Genomic and Precision Medicine.2021;14(1):e003128. doi: https://doi.org/10.1161/CIRCGEN.120.003128
18. Vaiserman AM, Khalangot ND, Pisaruk AV, Me­khova LV, Kolyada AK, Kutsenko KY, et al. Predis­posi­tion to type II diabetes among those residents of Ukraine whose prenatal development coincided with the famine of 1932-1933.Adv  2011;1:362-6. doi: https://doi.org/10.1134/S2079057011040163
19. Zong JC, Hengjinda P. Early Prediction of Coro­nary Artery Disease (CAD) by Machine Learning Method – A Co­mparative Study. J Artif Intell Capsule Netw. 2021;3(1):17-33. doi: https://doi.org/10.1007/s00125-020-05362-7
20. Hassanzad M, Hajian-Tilaki K. Methods of determining optimal cut-point of diagnostic biomarkers with application of clinical data in ROC analysis: an update review. BMC Med Res Methodol. 2024;24:84. doi: https://doi.org/10.1186/s12874-024-02198-2
21. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117-S314. doi: https://doi.org/10.1016/j.kint.2023.10.018
22. ESC Guidelines on Chronic Coronary Syndromes. Eur Heart J. 2024;45(1):ehae177. doi: https://doi.org/10.1093/eurheartj/ehae177

Look through:

Saienko Y.A. D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-1953-1066

Koshel N.M. D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0003-1429-2326

Pysaruk A.V. D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0001-5522-0172

Mankovsky B.M. D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0001-8289-3604

Saienko Y.A., Koshel N.M., Pysaruk A.V., Mankovsky B.M. Prediction of coronary artery disease risk in patients with type 2 diabetes mellitus: a mathematical model. Medicni perspektivi. 2025;30(2):78-90.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333436

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

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

Key words: decortication, pleurisy, pleural effusion, functions of external respiration

1. Koshak YuF. [Analysis of results of surgical treatment of patients with tuberculous pleural empyema]. Achievements of clinical and experimental medicine. 2020;1:106-12. Ukrainian. doi: https://doi.org/10.11603/1811-2471.2020.v.i1.11077
2. Madhi S, Boudaya MS, Attig YB, Rammeh M, Souissi F, Dhou AB, et al. Video-assisted thoracoscopic surgery for pleural decortication in empyema. European Respiratory Journal. 2024;64(Suppl 68):PA3159. doi: https://doi.org/10.1183/13993003.congress-2024.PA3159
3. Dokhan AL, Ibrahim IM, Hagag M. Video-assis­ted thoracoscopic surgery versus open decortication in chronic pleural empyema. The Egyptian cardiothoracic surgeon. 2022;4(4):68-72. doi: https://doi.org/10.35810/ects.v4i4.222
4. Makarov VV, Tsivenko ОІ. [Early complications by patients with decortications of lung in empyema pleural: causes, methods of prevention]. World Science. 2020;4(56):24-8. doi: https://doi.org/10.31435/rsglobal_ws/30042020/7020
5. Kondov G, Colanceski R, Kondova Topuzovska I, Spirovski Z, Caeva Jovkovska B, Kokareva A, et al. Analysis of lung function test in patients with pleural empyema treated with thoracotomy and decortication. Prilozi. 2011;12:259-71.
6. Özer КВ, Tükel M, Özdemir A, Cesur EE, De­mirhan R. The Effects of Pleural Decortication on Respiratory Functions of the Patients with Pleural Em­pyema. South Clin Ist Euras. 2018;29(2):99-104. doi: https://doi.org/10.14744/scie.2018.85866
7. Elsheikh A, Bhatnagar M, Rahman NM. Diagno­sis and management of pleural infection. Breathe. 2023;19(4):230146. doi: https://doi.org/10.1183/20734735.0146-2023
8. Cheikhrouhou T, Dhaou MB, Elleuch A, Hbaieb M, Zouari M, et al. The thoracoscopic approach in the mana­gement of parapneumonic pleural effusion in children. J Pulmonol Respir Res. 2022;6:025-9. doi: https://doi.org/10.29328/journal.jprr.1001041
9. Duzhyi ID. [Features of the diagnosis of pleural diseases: monograph]. 2 ed. Sumy: Sumy State University; 2021. 716 p. Ukrainian.
10. Roberts ME, Rahman NM, Maskell NA, Bibby AC, Blyth KG, Corcoran P, et al. British Thoracic Society Gui­deline for pleural disease. Thorax. 2023;78(Suppl 3);s1-s42. doi: https://doi.org/10.1136/thorax-2022-219784
11. Savenkov YuF. [Rational phthisiosurgery]. Dnip­ro: Dmitrieva G.V.; 2022. 115 p. Russian.
12. Gokce M, Okur E, Baysungur V, Ergene G, Sevil­gen G, Halezeroglu S. Lung decortication for chronic empyaema: effects on pulmonary function and thoracic asymmetry in the late period. Eur J Cardiothorac Surg. 2009;36:754-8. doi: https://doi.org/10.1016/j.ejcts.2009.04.043
13. Abraham SV, Chikkahonnaiah P. Change in pul­monary function following decortication for chronic pleural empyema. Turk Thorac J. 2020;21(1):27-31. doi: https://doi.org/10.5152/TurkThoracJ.2019.180146
14. Rai SP, Kaul SK, Tripathi RK, Bhattacharya D, Kashyap M. Decortication in chronic pleural empyema. Lung 2006;23:100-2. doi: https://doi.org/10.4103/0970-2113.44399
15. Ryzhov OA, Penkin YuM. [Statistical methods of processing the results of medical and biological research]. Magnolia; 2022. 160 p. Ukrainian.
16. Bhatnagar M, Najib NC, Rahman NM, Stan­ton AE. Front-door thoracic ultrasound in patients with community-acquired pneumonia to diagnose and predict pleural infection – a prospective study. ERJ Open Research. 2024;10(4):00662-2023. doi: https://doi.org/10.1183/23120541.00662-2023

Look through:

Duka R.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-3962-8746

Bilov O.V. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-8076-6871

Duka M.V. MNE “City Clinical Hospital No. 16” of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0009-0006-5004-5161

Duka R.V., Bilov O.V., Duka M.V. Changes in the function of external breathing in patients who underwent lung decortication after post-pneumonic pleurisy. Medicni perspektivi. 2025;30(2):91-97.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333439

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

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

Key words: decortication, pleurisy, pleural effusion, functions of external respiration

1. Babych MS. [Personal and academic stress in students receiving higher education in a different specialty]. Kyiv: Natsionalnyi linhvistychnyi universytet; 2023. 74 p. Ukrainian.
2. Schwabe L, Wolf OT. Timing matters: Temporal dynamics of stress effects on memory retrieval. Cogn AffectBehav  2014;14(3):1041-8. doi: https://doi.org/10.3758/s13415-014-0256-0
3. Liu Q, Liu Y, Leng X, Han J, Xia F, Chen H. Impact of Chronic Stress on Attention Control: Evidence from Behavioral and Event-Related Potential Analyses. Neurosci 2020;36(11):1395-410. doi: https://doi.org/10.1007/s12264-020-00549-9
4. Lukasik КМ, Waris О, Soveri А, Lehtonen М, Laine M. The Relationship of Anxiety and Stress With Working Memory Performance in a Large Non-depressed Sample. Front Psychol Sec Cognition. 2019;10:4. doi: https://doi.org/10.3389/fpsyg.2019.00004
5. Deng Y, Cherian J, Khan NUN, Kumari K, Sial MS, Comite U, et al. Family and Academic Stress and Their Impact on Students' Depression Level and Academic Performance.Front  2022;13:869337. doi: https://doi.org/10.3389/fpsyt.2022.869337
6. Barbayannis G, Bandari M, Zheng X, Baqueri­zo H, Pecor KW, Ming X. Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19. Front Psychol. 2022;13:886344. doi: https://doi.org/10.3389/fpsyg.2022.886344/
7. Akanpaadgi Е, Binpimbu F, Naalu Kuuyelleh E. The impact of stress on students’ academic performance. J Educational 2023;2(1):60-7. doi: https://doi.org/10.56773/ejer.v2i1.17
8. Solis AC, Lotufo-Neto F. Predictors of quality of life in Brazilian medical students: a systematic review and meta-analysis. Braz J Psychiatry. 2019 Nov-Dec;41(6):556-67.
   doi: https://doi.org/10.1590/1516-4446-2018-0116
9. Ramón-Arbués E, Echániz-Serrano E, Martínez-Abadía B, Antón-Solanas I, Cobos-Rincón A, Santolalla-Arnedo I, et al. Predictors of the Quality of Life of University Students: A Cross-Sectional Study. Int JEnviron Res Public Health. 2022;19(19):12043. doi: https://doi.org/10.3390/ijerph191912043
10. Omodaka Y, Sato T. The Quality of Life of Students With Difficulties Accessing Support. Inquiry. 2023;60:469580231159728. doi: https://doi.org/10.1177/00469580231159728
11. Kordunova N, Mudrak I, Dmytriiuk N. [Features of vitality and adaptability of students in crisis situations]. Psychological Prospects Journal. 2021;38:96-109. Ukrainian. doi: https://doi.org/10.29038/2227-1376-2021-38-96-109
12. Noreen A, Iqbal N, Hassan B, Ali SA. Rela­tionship between psychological distress, quality of life and resilience among medical and non-medical students. J Pak Med 2021;71(9):2181-5. doi: https://doi.org/10.47391/JPMA.04-611
13. Fechenko YuI, Mostovoy YuM, Babiychuk YuV. [The procedure of adaptation of international quality of life questionnaire MOS SF-36 in Ukraine. The experience of administration in asthma patient]. Ukrainskiy pulmono­logichniy Journal. 2002;3:9-11. Ukrainian.
14. Zlivko VL, Lukomska CO, Fedan OV. [Psycho­diagnostics of personality in life crisis situations]. Kyiv: Pedagogichna dumka; 2016. 219 р. Ukrainian.
15. Kolesnichenko OS. [Applied psychodiagnostics in the National Guard of Ukraine]. Kharkiv: NANGU; 2020. 338 р. Ukrainian.
16. Kireeva ZO, Odnostalko OS, Biron BV. [Psycho­metric analysis of the adapted version of the resilience scale]. 2020;14:110-6. Ukrainian. doi: https://doi.org/10.32843/2663- 5208.2020.14.17 
17. Panok VG, Rybalka VV, Shandruk SK, et al. [Me­thods of psychological support of participants in the educational process in wartime conditions: practical manual]. Kyiv: UNMC of practical psychology and social work; 2023. 212 р. Ukrainian.
18. Moskalenko VF, Gulchiy OP, Golubchikov MV. [Biostatistics]. Kyiv: Knyga Plus; 2009. 217 р. Ukrainian.
19. Korda M, Shulhai A, Shevchuk O, Shulhai O, Shulhai A-M. Psychological well-being and academic performance of Ukrainian medical students under the burder of war: a cross-sectional study. Front Public Health. 2025 Jan 6;12:1457026. doi: https://doi.org/10.3389/fpubh.2024.1457026
20. Dzeruzhynska N, Gindych A. [Research on the mental health of students affected by war: comorbidity, quality of life and effective therapeutic approaches]. Psychosomatic medicine and general practice [Internet]. 2025[cited 2024 Dec 17];10(1).  doi: https://doi.org/10.26766/pmgp.v10i1.596
21. Chachko SL, Travinina EI. [Experience of pro­longed traumatic stress of war by higher education stu­dents]. Scien­tific notes of the Tavria National University named V.I. Ver­nandsky. Psychology. 2024;35(74)(3):67-75. Ukrainian.
    doi: https://doi.org/10.32782/2709-3093/2024.3/10
22. Sholubka T. [Content-organizational aspects of building a program for the formation of psychological resilience of students in war conditions]. Bulletin of Lviv University. Psychological Sciences. 2023;Issue 17:73-82. doi: https://doi.org/10.30970/PS.2023.19.9
23. Moskalets VP, Fedyk OV. [Psychological re­silien­ce of students in the conditions of the criminal war of Mus­covy against Ukraine]. Slobozhanskyi scientific bulletin. Ser.: Psychology; 2024;1:116-25. Ukrainian. doi: https://doi.org/10.32782/psyspu/2024.1.21

Look through:

Khanyukov O.O. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-4146-0110

Krotova V.Yu. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-2517-435X

Panina S.S. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-1080-7185

Khramtsova V.V. State institution "Ukrainian State Institute of Medical and Social Problems of Disability Ministry of Public Health of Ukraine", Dnipro, Ukraine
https://orcid.org/0000-0001-7007-249711

Yegorov K.Yu. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0002-4524-1014

Shchukina O.S. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-9543-1545

Khanyukov O.O., Krotova V.Yu., Panina S.S., Khramtsova V.V., Yegorov K.Yu., Shchukina O.S. Experience of using psychological support for 6th year medical university students in conditions of high stress levels and reduced quality of life indicators. Medicni perspektivi. 2025;30(2):97-107.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333441

Side effects and hypersensitivity reactions to corticosteroids

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

Key words: burnout, depression, intern doctor, war, coping

1. Khan R, Hodges BD, Martimianakis MA. Con­structing "Burnout": A Critical Discourse Analysis of Burnout in Postgraduate Medical Education. Acad Med. 2023Nov 1;98(11S):S116-S122. doi: https://doi.org/10.1097/ACM.0000000000005358
2. Khatab Z, Hanna K, Rofaeil A, Wang C, Maung R, Yousef GM. Pathologist workload, burnout, and wellness: connecting the dots. Crit Rev Clin Lab Sci. 2024 Jun;61(4):254-74. doi: https://doi.org/10.1080/10408363.2023.2285284
3. Kramuschke M, Renner A, Kersting A. [Burnout: Symptoms, diagnostics and treatment approaches]. Ner­venarzt.2024 May;95(5):484-93.  doi: https://doi.org/10.1007/s00115-024-01649-x  
4. Vinkers CH, Schaafsma FG. Burnout urgently needs robust research. Nature. 2021 Apr;592(7853):188. doi: https://doi.org/10.1038/d41586-021-00896-1
5. Panse N, Panse S, Ravi S, Mankar H, Ka­ranjkar A, Sahasrabudhe P. Burnout among Plastic Sur­gery Residents in India: An Observational Study. Indian J Plast 2020 Dec;53(3):387-93. doi: https://doi.org/10.1055/s-0040-1719238 
6. Smoktunowicz E, Lesnierowska M, Cieslak R, et al. Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial. Trials. 2019;20(338):1-12.
   doi: https://doi.org/10.1186/s13063-019-3401-9
7. Rotstein S, Hudaib AR, Facey A, Kulkarni J. Psy­chiatrist burnout: a meta-analysis of Maslach Burnout Inventory means. Australas Psychiatry. 2019 Jun;27(3):249-54. doi: https://doi.org/10.1177/1039856219833800
8. Zhang XJ, Song Y, Jiang T, Ding N, Shi TY. Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine(Baltimore). 2020 Jun 26;99(26):e20992. doi: https://doi.org/10.1097/MD.0000000000020992 
9. Yang S, Tan GKJ, Sim K, Lim LJH, Tan BYQ, Kanneganti A, et al. Stress and burnout amongst mental health professionals in Singapore during Covid-19 endemicity. PLoS One. 2024 Jan 11;19(1):e0296798. doi: https://doi.org/10.1371/journal.pone.0296798
10. Negri L, Cilia S, Falautano M, Grobberio M, Nic­colai C, Pattini M, et al. Job satisfaction among physicians and nurses involved in the management of multiple sclerosis: the role of happiness and meaning at work. Neurol 2022 Mar;43(3):1903-10. doi: https://doi.org/10.1007/s10072-021-05520-8
11. Tsybuliak N, Suchikova Y, Shevchenko L, Popo­va A, Kovachev S, Hurenko O. Burnout dynamic among Ukrainian academic staff during the war. Sci Rep. 2023 Oct20;13(1):17975. doi: https://doi.org/10.1038/s41598-023-45229-6  
12. The Universal Declaration on Bioethics and Human Rights. International Social Science Journal. 2005;57(186):745-53.
    doi: https://doi.org/10.1111/j.1468-2451.2005.00592.x
13. World Medical Association. World Medical Asso­ciation Declaration of Helsinki. JAMA. 2013;310(20):2191-4. doi: https://doi.org/10.1001/jama.2013.281053
14. Cataldo R, Arancibia M, Stojanova J, Papu­zinski C. General concepts in biostatistics and clinical epidemiology: Observational studies with cross-sectional and ecological designs. 2019 Sep 25;19(8):e7698. doi: https://doi.org/10.5867/medwave.2019.08.7698
15. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018 Sep 18;320(11):1131-50. doi: https://doi.org/10.1001/jama.2018.12777
16. De Hert S. Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local Reg Anesth.2020 Oct 28;13:171-83. doi: https://doi.org/10.2147/LRA.S240564
17. du Prel JB, Koscec Bjelajac A, Franić Z, Hen­ftling L, Brborović H, Schernhammer E, et al. The Rela­tionship Between Work-Related Stress and Depression: A Scoping Review. Public Health Rev. 2024 May 1;45:1606968. doi: https://doi.org/10.3389/phrs.2024.1606968
18. De Hert S. Burnout in Healthcare Workers: Pre­valence, Impact and Preventative Strategies. Local Reg Anesth.2020 Oct 28;13:171-83. doi: https://doi.org/10.2147/LRA.S240564
19. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide [Internet]. [cited 2025 Feb 20].Available from: https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460
20. Sanfilippo F, Palumbo GJ, Noto A, Pennisi S, Mi­neri M, Vasile F, et al. Prevalence of burnout among intensive care physicians: a systematic review. Rev Bras Ter 2020 Jul-Sep;32(3):458-67. doi: https://doi.org/10.5935/0103-507X.20200076
21. Al-Youbi RA, Jan MM. Burnout syndrome in pe­diatric practice. Oman Med J. 2013 Jul;28(4):252-4. doi: https://doi.org/10.5001/omj.2013.71
22. Rivas-García A, Míguez-Navarro MC, Ferrero-García-Loygorri C, Marañón R, Vázquez-López P; en rep­resentación del Grupo para el estudio del Burnout de la Red de Investigación de la Sociedad española de Urgencias Pediátricas (RISeuP-SPERG). Burnout syndrome in paediatricians working in paediatric emergency care set­tings. Prevalence and associated factors: a multilevel analysis. An Pediatr (Engl Ed). 2023 Feb;98(2):119-28. doi: https://doi.org/10.1016/j.anpede.2023.01.004
23. Jagannath G. Burnout syndrome in healthcare pro­fessionals. Telangana J Psychiatry. 2020;6(2):105-9. doi: https://doi.org/10.18231/j.tjp.2020.023

Look through:

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

Mavropulo T.K. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0001-9351-3080

Borysova I.S. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-4703-6046

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

Nikolenko A.Ye. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-5523-8858

Plekhanova T.M. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-9243-5399

Ogorenko V.V., Mavropulo T.K., Borysova I.S., Shusterman T.Y., Nikolenko A.Ye., Plekhanova T.M. Burnout and depression in medical interns: causes, impact of war and coping strategies. Medicni perspektivi. 2025;30(2):108-119.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333442

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

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

Key words: human papillomavirus, HPV, vaccine, vaccination, immunization, public health, healthcare

1. Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV Infection Among Females in the United States. JAMA. 2007 Feb 28;297(8):813. doi: https://doi.org/10.1001/jama.297.8.813
2. Smith JS, Gilbert PA, Melendy A, Rana RK, Pi­menta JM. Age-Specific Prevalence of Human Papillo­mavirus Infection in Males: A Global Review. Journal of Adolescent 2011 Jun;48(6):540-52. doi: https://doi.org/10.1016/j.jadohealth.2011.03.010
3. Winer RL, Feng Q, Hughes JP, O’Reilly S, Ki­viat NB, Koutsky LA. Risk of Female Human Papilloma­virus Acquisition Associated with First Male Sex Partner. JInfect  2008 Jan 15;197(2):279-82. doi: https://doi.org/10.1086/524875
4. Baandrup L, Blomberg M, Dehlendorff C, Sand C, Andersen KK, Kjaer SK. Significant Decrease in the Inci­dence of Genital Warts in Young Danish Women After Implementation of a National Human Papillomavirus Vac­cination Program. Sex Transm Dis. 2013 Feb;40(2):130-5. doi: https://doi.org/10.1097/OLQ.0b013e31827bd66b
5. Chaturvedi AK. Beyond Cervical Cancer: Burden of Other HPV-Related Cancers Among Men and Women. Journal of Adolescent Health. 2010 Apr;46(4):S20-6. doi: https://doi.org/10.1016/j.jadohealth.2010.01.016
6. Giuliano AR, Anic G, Nyitray AG. Epidemiology and pathology of HPV disease in males. Gynecol Oncol. 2010 May;117(2):S15-9. doi: https://doi.org/10.1016/j.ygyno.2010.01.026
7. Giuliano AR, Palefsky JM, Goldstone S, Mo­rei­ra ED, Penny ME, Aranda C, et al. Efficacy of Quadri­valent HPV Vaccine against HPV Infection and Disease in Males. New England Journal of Medicine. 2011 Feb 3;364(5):401-11. doi: https://doi.org/10.1056/NEJMoa0909537
8. Hariri S, Markowitz LE, Dunne EF, Unger ER. Po­pulation Impact of HPV Vaccines: Summary of Early Evidence. Journal of Adolescent Health. 2013 Dec;53(6):679-82. doi: https://doi.org/10.1016/j.jadohealth.2013.09.018
9. Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006 Aug;24:S11-25. doi: https://doi.org/10.1016/j.vaccine.2006.05.111
10. Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Dat­ta SD, McQuillan GM, et al. Prevalence of Sexually Trans­mitted Infections Among Female Adolescents Aged 14 to 19 in the United States. Pediatrics. 2009 Dec 1;124(6):1505-12. doi: https://doi.org/10.1542/peds.2009-0674
11. Giuliano AR, Lu B, Nielson CM, Flores R, Pa­penfuss MR, Lee J, et al. Age‐Specific Prevalence, Inci­dence, and Duration of Human Papillomavirus Infections in a Cohort of 290 US Men. J Infect Dis. 2008 Sep 15;198(6):827-35. doi: https://doi.org/10.1086/591095
12. Etter DJ, Zimet GD, Rickert VI. Human papil­lomavirus vaccine in adolescent women. Curr Opin Obstet Gynecol.2012 Oct;24(5):305-10. doi: https://doi.org/10.1097/GCO.0b013e3283567005
13. Fisher WA. Understanding Human Papilloma­virus Vaccine Uptake. Vaccine. 2012 Nov;30:F149-56. doi: https://doi.org/10.1016/j.vaccine.2012.04.107
14. Stupiansky NW, Alexander AB, Zimet GD. Hu­man papillomavirus vaccine and men. Curr Opin Infect Dis.2012 Feb;25(1):86-91. doi: https://doi.org/10.1097/QCO.0b013e32834ed5be
15. Markowitz LE. dvisory Committee on Immu­nization Practices (ACIP). Quadrivalent Human Papil­lomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2007;2(56):1-24. doi: https://doi.org/10.1037/e601292007-001
16. Dunne EF; MLE; CHCCRSMGJUER. Recom­mendations on the Use of Quadrivalent Human Papillo­mavirus Vaccine in Males – Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60(50):1705-8. PMID: 22189893
17. Curtis CR YDJJDCSSMJHS. National and State Vaccination Coverage Among Adolescents Aged 13-17 years – United States, 2012. MMWR Morb Mortal Wkly Rep. 2013 Aug 30;62(34):685-93. PMID: 23985496.
18. Nolan KM, Seaton B, Antonello J, Zhang Y, Cook L, Delfino K, et al. Development and Validation of Two Optimized Multiplexed Serologic Assays for the 9-Valent Human Papillomavirus Vaccine Types. mSphere. 2023 Apr 20;8(2):e0096221. doi: https://doi.org/10.1128/msphere.00962-21
19. Borah P, Kim S, Xiao X, Lee DKL. Correcting misinformation using theory-driven messages: HPV vaccine misperceptions, information seeking, and the moderating role of reflection. Atl J Commun. 2022 May 27;30(3):316-31. doi: https://doi.org/10.1080/15456870.2021.1912046
20. Adekanmbi V, Sokale I, Guo F, Ngo J, Hoang TN, Hsu CD, et al. Human Papillomavirus Vaccination and Human Papillomavirus–Related Cancer Rates. JAMA Netw Open.2024 Sep 5;7(9):e2431807. doi: https://doi.org/10.1001/jamanetworkopen.2024.31807
21. Dorji T, Nopsopon T, Tamang ST, Pongpirul K. Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis. Ecli­nicalMe­dicine.2021 Apr;34:100836. doi: https://doi.org/10.1016/j.eclinm.2021.100836
22. Dykens JA, Peterson CE, Holt HK, Harper DM. Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally. Front Public Health.2023 Feb 21;11:1067299. doi: https://doi.org/10.3389/fpubh.2023.1067299
23. Athanasiou A, Bowden S, Paraskevaidi M, Foto­poulou C, Martin-Hirsch P, Paraskevaidis E, et al. HPV vaccination and cancer prevention. Best Pract Res Clin Obstet 2020 May;65:109-24. doi: https://doi.org/10.1016/j.bpobgyn.2020.02.009
24. Pojani E, Bozo S, Capparelli E, Hoxha B. Cer­vical Cancer and HPV vaccination: Insights into know­ledge, attitudes, and practices among Albanian women. Vaccine 2025 Jan;22:100594. doi: https://doi.org/10.1016/j.jvacx.2024.100594
25. Merkuri L, Kamberi F, Qorri E, Shapo L. Asses­sment of the Albanian University female students’ know­ledge, attitudes, and practices on cervical cancer. The Journal of Infection in Developing Countries. 2023 Apr 30;17(04):534-41. doi: https://doi.org/10.3855/jidc.18121
26. Bakiri F, Abazi E, Lika M. Albanian Male Stu­dents Perception and Knowledge of Human Papilloma­virus (HPV). Journal of Biological Studies. 2023 Dec 31;6(4):273-81. doi: https://doi.org/10.62400/jbs.v6i4.8727
27. Shin MB, Sloan KE, Martinez B, Soto C, Baez­conde-Garbanati L, Unger JB, et al. Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis. BMC Public Health. 2023 Mar 22;23(1):545. doi: https://doi.org/10.1186/s12889-023-15318-2
28. Kennedy J. Vaccine Hesitancy: A Growing Concern. Pediatric Drugs. 2020 Apr 19;22(2):105-11. doi: https://doi.org/10.1007/s40272-020-00385-4
29. Kong WY, Oh NL, Kennedy KL, Carlson RB, Liu A, Ozawa S, et al. Identifying Healthcare Profes­sionals With Lower Human Papillomavirus (HPV) Vac­cine Recommendation Quality: A Systematic Review. Journal of Adolescent Health. 2024 May;74(5):868-77. doi: https://doi.org/10.1016/j.jadohealth.2023.11.016
30. Vahabi M, Mishra G, Pimple S, Wong JPH, Khan M, Prakash V, et al. Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study. BMC Public Health. 2023 Apr 11;23(1):671. doi: https://doi.org/10.1186/s12889-023-15602-1
31. ICO/IARC Information Centre on HPV and Cancer. Albania. Human Papillomavirus and Related Cancers. Fact Sheet 2023 [Internet]. 2023 Mar 10 [cited 2025 Jan 11].Available from: https://hpvcentre.net/statistics/reports/ALB.pdf
32. Beavis AL, Krishnamoorthi MS, Adler S, Fles­zar LG, Moran MB, Rositch AF. Contemporary provider perspectives on how to address HPV vaccine hesitancy in the US: A qualitative study. Vaccine X. 2024 Oct;20:100533. doi: https://doi.org/10.1016/j.jvacx.2024.100533

Look through:

Shabani Zamira University of Shkodra “Luigj Gurakuqi” Faculty of Natural Sciences, Shkoder, Albania
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-8021-5391

Haxhija Edona University of Shkodra “Luigj Gurakuqi” Faculty of Natural Sciences, Shkoder, Albania
https://orcid.org/0000-0002-9454-8485

Pjetri Emiljano University of Shkodra “Luigj Gurakuqi” Faculty of Natural Sciences, Shkoder, Albania
https://orcid.org/0009-0004-7299-0346

Shala Irena University of Shkodra “Luigj Gurakuqi” Faculty of Natural Sciences, Shkoder, Albania
https://orcid.org/0000-0002-3726-6115

Bushati Nevila University of Shkodra “Luigj Gurakuqi” Faculty of Natural Sciences, Shkoder, Albania
https://orcid.org/0000-0001-7913-9088

Malevija Amela University of Shkodra “Luigj Gurakuqi” Faculty of Natural Sciences, Shkoder, Albania
https://orcid.org/0009-0005-6314-0355

Shabani Zamira, Haxhija Edona, Pjetri Emiljano, Shala Irena, Bushati Nevila, Malevija Amela. The situation with vaccination in Shkodra region after the first year of implementation of human papillomavirus vaccine. Medicni perspektivi. 2025;30(2):120-127.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333445

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

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

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

1. Palomo M, Youssef L, Ramos A, Torramade-Moix S, Moreno-Castaño AB, Martinez-Sanchez J, et al. Differences and similarities in endothelial and angiogenic profiles of preeclampsia and COVID-19 in pregnancy. American Journal of Obstetrics and Gynecology. 2022 Aug;227(2):277.e1-16. doi: https://doi.org/10.1016/j.ajog.2022.03.048
2. Naeh A, Berezowsky A, Yudin MH, Dhalla IA, Berger H. Preeclampsia-Like Syndrome in a Pregnant Patient With Coronavirus Disease 2019 (COVID-19). 2022 Feb 1;44(2):193-5. doi: https://doi.org/10.1016/j.jogc.2021.09.015
3. Erez O, Romero R, Jung E, Chaemsaithong P, Bosco M, Suksai M, et al. Preeclampsia and eclampsia: the conceptual evolution of a syndrome. American Journal of Obstetrics and Gynecology. 2022 Feb;226(2):S786-803. doi: https://doi.org/10.1016/j.ajog.2021.12.001
4. Sankar KD, Bhanu PS, Kiran S, Ramakrishna BA, Shanthi V. Vasculosyncytial membrane in relation to syn­cytial knots complicates the placenta in preeclampsia: a histo­morphometrical study. Anat Cell Biol. 2012 Jun;45(2):86-91. doi: https://doi.org/10.5115/acb.2012.45.2.86
5. Shaw LJ, Patel K, Lala-Trindade A, Feltovich H, Vieira L, Kontorovich A, et al. Pathophysiology of Pree­clampsia-Induced Vascular Dysfunction and Implications for Subclinical Myocardial Damage and Heart Failure. JACC: 2024 Jun;3(6):100980. doi: https://doi.org/10.1016/j.jacadv.2024.100980
6. Serrano B, Bonacina E, Garcia-Ruiz I, Men­do­za M, Garcia-Manau P, Garcia-Aguilar P, et al. Confirma­tion of preeclampsia-like syndrome induced by severe COVID-19: an observational study. American Journal of Obstetrics & Gynecology MFM. 2023 Jan;5(1):100760. doi: https://doi.org/10.1016/j.ajogmf.2022.100760
7. Mendoza M, Garcia‐Ruiz I, Maiz N, Rodo C, Gar­cia‐Manau P, Serrano B, et al. Pre‐eclampsia‐like synd­rome induced by severe COVID‐19: a prospective obser­vational study. BJOG: An International Journal of Obstetrics & Gynaecology. 2020 Jun 21;127(11):1374-80. doi: https://doi.org/10.1111/1471-0528.16339
8. Turpin CA, Sakyi SA, Owiredu WK, Eph­raim RKD, Anto EO. Association between adverse preg­nancy outcome and imbalance in angiogenic regulators and oxidative stress biomarkers in gestational hypertension and preeclampsia. BMC Pregnancy and Childbirth. 2015 Aug 25;15(1):189. doi: https://doi.org/10.1186/s12884-015-0624-y
9. Kreutz R, Algharably EAEH, Azizi M, Dobro­wolski P, Guzik T, Januszewicz A, et al. Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19. Cardiovascular Research. 2020 Aug 1;116(10):1688-99. doi: https://doi.org/10.1093/cvr/cvaa097
10. Gheblawi M, Wang K, Viveiros A, Nguyen Q, Zhong JC, et al. Angiotensin Converting En­zyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System. Circulation Research. 2020 May 8;126(10):1456-74. doi: https://doi.org/10.1161/CIRCRESAHA.120.317015
11. Deanfield JE, Halcox JP, Rabelink TJ. En­do­thelial Function and Dysfunction. Circulation. 2007 Mar 13;115(10):1285-95. doi: https://doi.org/10.1161/CIRCULATIONAHA.106.652859
12. Gychka SG, Brelidze TI, Kuchyn IL, Sav­chuk TV, Nikolaienko SI, Zhezhera VM, et al. Placental vascular remodeling in pregnant women with COVID-19. PLOS 2022 Jul 29;17(7):e0268591. doi: https://doi.org/10.1371/journal.pone.0268591
13. Savchuk T, Malysheva T, Vaslovych V, Chernen­ko O, Leshchenko I, Gychka S. Pathomorphological chan­ges of the placenta in the acute period of coronavirus disease 2019 (COVID-19) at 37–41 weeks of gestation. Proc Shevchenko Sci Soc Med Sci [Internet]. 2024 Dec 24 [cited2025 Jan 8];76(2). doi: https://doi.org/10.25040/ntsh2024.02.12
14. Nunes PR, Mattioli SV, Sandrim VC. NLRP3 Acti­vation and Its Relationship to Endothelial Dysfunction and Oxidative Stress: Implications for Preeclampsia and Phar­macological Interventions. Cells. 2021 Nov 1;10(11):2828. doi: https://doi.org/10.3390/cells10112828
15. Savchuck TV, Gychka SG, Leshchenko IV. Pa­tho­morphological changes of the placenta in coronavirus disease (COVID 19). Patologìâ. 2021 Aug 20;18(2):128-35.doi: https://doi.org/10.14739/2310-1237.2021.2.231461
16. 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
17. Savchuk T. Pathomorphological changes of the placenta in coronavirus disease (COVID-19) in pregnant women at 19-32 weeks of gestation. Proceeding of the Shevchenko Scientific Society. Medical Sciences [Internet]. 2024 Jun 28 [cited 2024 Jun 30];73(1). doi: https://doi.org/10.25040/ntsh2024.01
18. Savchuk T. Pathomorphological changes of the placenta in the acute period of COVID-19 in pregnant women. Eastern Ukrainian Medical Journal [Internet]. 2024 Jun 24 [cited 2024 Jun 30];12(2):323-34. doi: https://doi.org/10.21272/eumj.2024;12(2):323-334
19. Savchuk TV. 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
20. Aeffner F, Zarella MD, Buchbinder N, Bui MM, Goodman MR, Hartman DJ, et al. Introduction to Digital Image Analysis in Whole-slide Imaging: A White Paper from the Digital Pathology Association. Journal of patho­logy informatics [Internet]. 2019;10(1):9. doi: https://doi.org/10.4103/jpi.jpi_82_18
21. Savchuk TV, Leshchenko IV, inventors; Bogo­molets National medical university (UA), assignee. [Method for quantitative determination of delayed placental maturation]. Patent Ukraine u202400917. 2024 Dec 18. Ukrainian.
22. Shackelford C, Long G, Wolf J, Okerberg C, Herbert R. Qualitative and Quantitative Analysis of Non­neoplastic Lesions in Toxicology Studies. Toxicologic Pathology. 2002 Jan;30(1):93-6. doi: https://doi.org/10.1080/01926230252824761
23. Kruskal WH, Wallis WA. Use of Ranks in One-Criterion Variance Analysis. Journal of the American Sta­tistical Association. 1952;47(260):583-621. doi: https://doi.org/10.1080/01621459.1952.10483441
24. Sharps MC, Hayes DJL, Lee S, Zou Z, Brady CA, Almoghrabi Y, et al. A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection. Placenta. 2020 Nov;101:13-29. doi: https://doi.org/10.1016/j.placenta.2020.08.018
25. Turyanytsya SМ, Korchins’ka OO, Sabova АV, Baloga OА, Petrov VO. Influence of SARS-CoV-2 acute respiratory viral disease on pregnancy and childbirth. Reproductive health of woman. 2021 Apr 1;2:15-8. doi: https://doi.org/10.30841/2708-8731.2.2021.232515
26. Yamada S, Asakura H. Coagulopathy and Fibri­nolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination. International Journal of Molecular Sciences. 2022 Mar 19;23(6):3338. doi: https://doi.org/10.3390/ijms23063338
27. Garg R, Agarwal R, Yadav D, Singh S, Kumar H, Bhardwaj R. Histopathological Changes in Placenta of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) Infection and Maternal and Perinatal Outcome in COVID-19. J Obstet Gynaecol India. 2023 Feb;73(1):44-50. doi: https://doi.org/10.1007/s13224-022-01666-3
28. Bodnarchuk ОV. [Тhe metabolic aspects of pree­clampsia development]. Collection of scientific papers of the Association of Obstetricians and Gynecologists of Ukraine. 2022 Sep 21;1(49):5-15. Ukrainian.
    doi: https://doi.org/10.35278/2664-0767.1(49).2022.266320
29. Burton GJ. The Fine Structure of the Human Placental Villus as Revealed by Scanning Electron Micro­scopy. Scanning Microscopy. 1987;1(4):29

Look through:

Savchuk T.V. Bogomolets National medical university, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-7218-0253

Leshchenko I.V. Bogomolets National medical university, Kyiv, Ukraine
https://orcid.org/0000-0001-8239-256X

Savchuk T.V., Leshchenko I.V. Coronavirus disease 2019 (COVID-19) or preeclampsia: pathomorphological differential diagnosis of placental changes. Medicni perspektivi. 2025;30(2):128-139.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333460

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

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

Key words: chromosomal abnormalities, acute myeloid leukemias, diagnosis making, relapse

1. Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of haematolymphoid tumors: myeloid and histiocytic/den­dritic neoplasms. Leukemia. 2022 June;36(7):1703-19. doi: http://doi.org/10.1038/s41375-022-01613-1
2. Mrozek K, Heerema NA, Bloomfield CD. Cytoge­netics in acute leukemia. Blood Rev. 2004 Jun;18(2):115-36. doi: http://doi.org/10.1016/S0268-960X(03)00040-7
3. Desai RH, Zandvakili N, Bohlander S. Dissecting the genetic and non-genetic heterogeneity of acute myeloid leukemia using next-generation sequencing and in vivo models.Cancer (Basel). 2022 Apr;14(9):2182. doi: http://doi.org/10.3390/cancers14092182
4. Acute myeloid leukemia. NCCN Clinical Practice Guidelines in Oncology. NCCN Evidence Blocks. Ver­sion 3. 2024 [Internet]. 2024 [cited 2025 Mar 16]. Availablefrom: http://www.nccn.org/professionals/physician_gls/pdf/  
5. Thol F, Ganser A. Treatment of relapsed acute mye­loid leukemia. Curr Treat Options Oncol. 2020 Jun;21(8):66. doi: http://doi.org/10.1007/s11864-020-00765-5
6. Hackl H, Astanina K, Wieser R. Molecular and genetic alterations associated with therapy resistance and relapse of acute myeloid leukemia. Journal of hematology & 2017 Feb;10(1):51. doi: http://doi.org/10.1186/s13045-017-0416-0
7. [Acute myeloid leukemia. Evidence-based clinical guidelines. Ministry of Health of Ukraine]. [Internet]. 2023 [cited 2025 Mar 16]. Ukrainian. Available from: https://www.dec.gov.ua/wp-content/uploads/2023/10/2023_kn-gml.pdf
8. SilvaM, Leeuw N, Mann K, et al. European guidelines for constitutional cytogenomic analysis. Euro­pean Journal of Human Genetics. 2018 Jan;27(1):16. doi: http://doi.org/10.1038/s41431-018-0244-x
9. McGowan-Jordan J, Hastings RJ, Moore S. An International System for Human Cytogenomic Nomen­clature: Karger AG, Basel; 2020. 163 p.
10. Arber DA, Orazi A, Hasserjian R, et al. Inter­national Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data. Blood. 2022 Sep;140(11):1200-28. doi: https://doi.org/10.1182/blood.2022015850
11. Kurzer JH, Weinberg OK. Updates in molecular genetics of acute myeloid leukemia. Seminars in diagnostic pathology.2023 May;40(3):140-51. doi: https://doi.org/10.1053/j.semdp.2023.04.002
12. Anelli L, Pasciolla C, Zagaria A, et al. Monosomal karyotype in myeloid neoplasias a literature review. Onco Targets 2017 Apr;10:2163-71. doi: http://doi.org/10.2147/OTT.S133937
13. Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med. 2022 Dec;70(8):1759-70. doi: https://doi.org/10.1136/jim-2022-002479
14. White NM, Balasubramaniam T, Nayak R, Bar­nett AG. An observational analysis of the trope "A p-value of< 0.05 was considered statistically significant" and other cut-and-paste statistical methods. PLo SOne. 2022;17(3):e0264360. doi: https://doi.org/10.1371/journal.pone.0264360
15. Mrozek K, Eisfeld A, Kohlschmidt J, et al. Com­plex karyotype in de novo acute myeluod leukemia: typical and atypical subtypes differ molecularly and clinically. Leukemia.2019 Jul;33(7):1620-34. doi: http://doi.org/10.1038/s41375-019-0390-3
16. Ansar Z, Alam H, Shariq M, et al. Acute myeloid leukemia with hyperdiopoidy. AMP case report. CAP TODAY [Inretnet]. 2024 Mar [cited 2025 Mar 16]:1-3. Availablefrom: https://www.amp.org/AMP/assets/File/clinical-practice/0324_26-27_AMPcase-Ansar-reprint_HiRes.pdf?pass=98
17. Yeh W, Tirado C. Hypodiploidy in AML. J Assoc Genet Technol. 2021;47(3):122-6. PMID: 34491230

Look through:

Andreieva S.V. SI “National Research Center for radiation medicine, hematology and oncology of the national academy of medical science of Ukraine”, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-3029-4444

Korets K.V. SI “National Research Center for radiation medicine, hematology and oncology of the national academy of medical science of Ukraine”, Kyiv, Ukraine
https://orcid.org/0000-0001-6519-8626

Skorokhod I.M. Limited Liability Company «Institute of medical molecular diagnostics», Kyiv, Ukraine
https://orcid.org/0000-0002-2219-5713

Hartovska I.R. Municipal Non-Profit Enterprise of the Kyiv Regional Council "Kyiv Regional Oncology Dispensary", Kyiv, Ukraine
https://orcid.org/0000-0002-8283-429X

Melnyk U.I. Municipal Non-Profit Enterprise "Kyiv City Clinical Hospital No. 9", Kyiv, Ukraine
https://orcid.org/0009-0006-7026-7669

Andreieva S.V., Korets K.V., Skorokhod I.M., Hartovska I.R., Melnyk U.I. Comparative characteristics of quantitative and structural chromosome abnormalities at the time of diagnosis and in relapses of acute myeloid leukemias. Medicni perspektivi. 2025;30(2):140-148.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333463

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

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

Key words: emollients, skin diseases, homeostasis, lipids, humans

1. Schrader A, Siefken W, Kueper T, Breitenbach U, Gatermann C, Sperling G, et al. Effects of glyceryl glucoside on AQP3 expression, barrier function and hydration of human skin. Skin Pharmacology and Physiology.2012;25(4):192-9. doi: https://doi.org/10.1159/000338190 
2. Basson R, Baguneid M, Foden P, Al Kredly R, Bayat A. Functional testing of a skin topical formulation in vivo: Objective and quantitative evaluation in human skin scarring using a double-blind volunteer study with Sequential Punch Biopsies. Advances in Wound Care. 2019 May;8(5):208-19. doi: https://doi.org/10.1089/wound.2018.0864
3. Draelos ZD. A clinical evaluation of the com­parable efficacy of hyaluronic acid-based foam and ceramide-containing emulsion cream in the treatment of mild-to-moderate atopic dermatitis. Journal of Cosmetic Dermatology. 2011 Sept;10(3):185-8. doi: https://doi.org/10.1111/j.1473-2165.2011.00568.x
4. van Smeden J, Janssens M, Kaye EC, Caspers PJ, Lavrijsen AP, Vreeken RJ, et al. The importance of free fatty acid chain length for the skin barrier function in atopic eczema patients. Experimental Dermatology. 2013 Dec 30;23(1):45-52. doi: https://doi.org/10.1111/exd.12293
5. Green M, Feschuk AM, Kashetsky N, Mai­bach HI. “Normal” tewl‐how can it be defined? A systematic review. Experimental Dermatology. 2022 Jul 31;31(10):1618-31. doi: https://doi.org/10.1111/exd.14635
6. Glatz M, Jo J-H, Kennedy EA, Polley EC, Seg­re JA, Simpson EL, et al. Emollient use alters skin barrier and microbes in infants at risk for developing atopic dermatitis. PLOS ONE. 2018 Feb 28;13(2):e0192443. doi: https://doi.org/10.1371/journal.pone.0192443
7. Lee H-J, Kim M. Skin barrier function and the microbiome. International Journal of Molecular Sciences. 2022 Oct 28;23(21):13071. doi: https://doi.org/10.3390/ijms232113071
8. Danby SG, Chalmers J, Brown K, Williams HC, Cork MJ. A functional mechanistic study of the effect of emollients on the structure and function of the Skin Barrier. British Journal of Dermatology. 2016 Aug 23;175(5):1011-9. doi: https://doi.org/10.1111/bjd.14684
9. Vaillant L, Georgescou G, Rivollier C, Delarue A. Combined effects of glycerol and petrolatum in an emollient cream: A randomized, double‐blind, crossover study in healthy volunteers with Dry Skin. Journal of Cosmetic Dermatology. 2019 Sept 18;19(6):1399-403. doi: https://doi.org/10.1111/jocd.13163
10. Chuberre B, Araviiskaia E, Bieber T, Barbaud A. Mi­neral oils and waxes in cosmetics: An overview mainly based on the current European regulations and the safety profile of these compounds. Journal of the European Aca­de­my of Dermatology and Venereology. 2019 ;33(S7):5-14. doi: https://doi.org/10.1111/jdv.15946
11. Ogorzałek M, Klimaszewska E, Mirowski M, Ku­lawik-Pióro A, Margula K, Tomasiuk R. Natural or syn­thetic emollients? Physicochemical properties of body oils in relation to selected parameters of epidermal barrier function. Appl 2024;14(7):2783. doi: https://doi.org/10.3390/app14072783  
12. Monteiro R, Nikam V, Dandakeri S, Bhat R. Tran­sepidermal water loss in psoriasis: A case-control study. Indian Dermatology Online Journal. 2019;10(3):267. doi: https://doi.org/10.4103/idoj.idoj_180_18
13. Pereira G, Fernandes C, Dhawan V, Dixit V. Pre­paration and development of nanoemulsion for skin moisturizing. In: Nanotechnology for the Preparation of Cosmetics Using Plant-Based Extracts. 2022. р. 27-47. doi: https://doi.org/10.1016/b978-0-12-822967-5.00008-4
14. Mawazi SM, Ann J, Othman N, Khan J, Alo­layan SO, Al thagfan SS, et al. A review of moisturizers; history, preparation, characterization and applications. Cosmetics. 2022 Jun 9;9(3):61. doi: https://doi.org/10.3390/cosmetics9030061
15. Armstrong J, Rosinski NK, Fial A, Ansah S, Hag­lund K. Emollients to prevent eczema in high-risk infants. MCN: The American Journal of Maternal/Child Nursing. 2022 May;47(3):122-9. doi: https://doi.org/10.1097/nmc.0000000000000809
16. Blanks KJ, Musaba MW, Ren L, Burgoine K, Mukunya D, Clarke A, et al. Neonatal emollient therapy and massage practices in Africa: A scoping review. International Health. 2023 Jul 22;16(2):152-64. doi: https://doi.org/10.1093/inthealth/ihad052
17. Techasatian L, Kiatchoosakun P. Effects of an emollient application on newborn skin from birth for prevention of atopic dermatitis: A randomized controlled study in Thai neonates. Journal of the European Academy of Dermatology and Venereology. 2021;36(1):76-83. doi: https://doi.org/10.1111/jdv.17675
18. Mehling A, Haake H‐M, Poly W. Differential deposition of emollients from tripartite formulation sys­tems. International Journal of Cosmetic Science. 2010 Mar 3;32(2):117-26. doi: https://doi.org/10.1111/j.1468-2494.2009.00546.x
19. Schoenfelder H, Liu Y, Lunter DJ. Systematic in­vestigation of factors, such as the impact of emulsifiers, which influence the measurement of skin barrier integrity by in-vitro trans-epidermal water loss (TEWL). Interna­tional Journal of Pharmaceutics. 2023 May;638:122930. doi: https://doi.org/10.1016/j.ijpharm.2023.122930
20. Leoty-Okombi S, Gillaizeau F, Leuillet S, Douil­lard B, Le Fresne-Languille S, Carton T, et al. Effect of sodium lauryl sulfate (SLS) applied as a patch on human skin physiology and its microbiota. Cosmetics. 2021 Jan 6;8(1):6. doi: https://doi.org/10.3390/cosmetics8010006
21. Ruiz PS, Serafini MR, Alves IA, Novoa DM. Re­cent progress in self-emulsifying drug delivery systems: A systematic patent review (2011-2020). Critical Re­views^TM in Therapeutic Drug Carrier Systems. 2022;39(2):1-77. doi: https://doi.org/10.1615/critrevtherdrugcarriersyst.2021038490
22. Schoenfelder H, Wiedemann Y, Lunter DJ. Deve­lopment and characterization of topical formulation for maintenance therapy containing Sorbitan monostearate with and without peg‐100‐stearate. Int J Cosmet Sci. 2025 Apr;47(2):223-33. doi: https://doi.org/10.1111/ics.13023
23. Sherif G, Naguib Y, Mady F, Khaled K. Po­lyethylene Glycol: Properties, applications, and chal­lenges. Journal of advanced Biomedical and Pharma­ceutical Sciences. 2023 Dec 21;0(0):26-36. doi: https://doi.org/10.21608/jabps.2023.241685.1205
24. Fu J, Wu E, Li G, Wang B, Zhan C. Anti-PEG antibodies: Current situation and countermeasures. Nano Today. 2024 Apr;55:102163. doi: https://doi.org/10.1016/j.nantod.2024.102163
25. Liu L, Zeng L, Gao L, Zeng J, Lu J. Ozone therapy for skin diseases: Cellular and Molecular Mechanisms. International Wound Journal. 2022 Dec 16;20(6):2376-85. doi: https://doi.org/10.1111/iwj.14060
26. Pham Le Khanh H, Nemes D, Rusznyák Á, Ujhelyi Z, Fehér P, Fenyvesi F, et al. Comparative in­vestigation of cellular effects of polyethylene glycol (PEG) derivatives. Polymers. 2022 Jan 11;14(2):279. doi: https://doi.org/10.3390/polym14020279
27. Hirano A, Goto M, Mitsui T, Hashimoto-Ha­chiya A, Tsuji G, Furue M. Antioxidant artemisia princeps extract enhances the expression of filaggrin and loricrin via the ahr/OVOL1 pathway. International Journal of Molecular Sciences. 2017 Sept 11;18(9):1948. doi: https://doi.org/10.3390/ijms18091948
28. Maroto-Morales D, Montero-Vilchez T, Arias-Santiago S. Study of skin barrier function in psoriasis: The impact of Emollients. Life. 2021 Jul 4;11(7):651. doi: https://doi.org/10.3390/life11070651
29. Ryczaj K, Dumycz K, Spiewak R, Feleszko W. Contact allergens in moisturizers in preventative emollient therapy – A systematic review. Clinical and Translational Allergy. 2022 Jun 5;12(6):e12150. doi: https://doi.org/10.1002/clt2.12150
30. Akdeniz M, Gabriel S, Lichterfeld-Kottner A, Blu­me-Peytavi U, Kottner J. Transepidermal water loss in healthy adults: A systematic review and meta-analysis update. British Journal of Dermatology. 2018 Sept 9;179(5):1049-55. doi: https://doi.org/10.1111/bjd.17025
31. Kang S-Y, Um J-Y, Chung B-Y, Lee S-Y, Park J-S, Kim J-C, et al. Moisturizer in patients with inflam­matory skin diseases. Medicina. 2022 Jul 1;58(7):888. doi: https://doi.org/10.3390/medicina58070888
32. Roso A, Kern C, Cambos S, Garcia C. Diversity Challenge in skin care: Adaptations of a simple emulsion for efficient moisturization across multiple geographies. Applied Sciences. 2023 Dec 12;13(24):13175. doi: https://doi.org/10.3390/app132413175
33. Rajkumar J, Chandan N, Lio P, Shi V. The skin barrier and moisturization: Function, disruption, and mechanisms of repair. Skin Pharmacology and Physiology. 2023;36(4):174-85. doi: https://doi.org/10.1159/000534136
34. Jung Y-O, Jeong H, Cho Y, Lee E-O, Jang H-W, Kim J, et al. Lysates of a probiotic, lactobacillus rham­nosus, can improve skin barrier function in a reconstructed human epidermis model. International Journal of Mole­cular Sciences. 2019 Sept 2;20(17):4289. doi: https://doi.org/10.3390/ijms20174289
35. Kouassi M-C, Grisel M, Gore E. Multifunctional active ingredient-based delivery systems for skincare formulations: A Review. Colloids and Surfaces B Biointerfaces. 2022 Sept;217:112676. doi: https://doi.org/10.1016/j.colsurfb.2022.112676
36. Jung S-W, Park GH, Kim E, Yoo KM, Kim HW, Lee JS, et al. Rosmarinic acid, as an NHE1 activator, decreases skin surface ph and improves the skin barrier function. International Journal of Molecular Sciences. 2022 Mar 31;23(7):3910. doi: https://doi.org/10.3390/ijms23073910
37. Sounouvou HT, Lechanteur A, Piel G, Evrard B. Silicones in dermatological topical drug formulation: Overview and advances. International Journal of Pharmaceutics. 2022 Sept;625:122111. doi: https://doi.org/10.1016/j.ijpharm.2022.122111
38. Eskens O, Amin S. Challenges and effective routes for formulating and delivery of epidermal growth factors in skin care. International Journal of Cosmetic Science. 2021 Jan 15;43(2):123-30. doi: https://doi.org/10.1111/ics.12685
39. Stefanov SR, Andonova VY. Lipid Nanoparti­culate Drug Delivery Systems: Recent advances in the treatment of skin disorders. Pharmaceuticals. 2021 Oct 26;14(11):1083. doi: https://doi.org/10.3390/ph14111083
40. Kouassi M-C, Grisel M, Gore E. Multifunctional active ingredient-based delivery systems for skincare formulations: A Review. Colloids and Surfaces B Biointerfaces. 2022 Sept;217:112676. doi: https://doi.org/10.1016/j.colsurfb.2022.112676
41. Barradas TN, de Holanda e Silva KG. Nanoemul­sions of essential oils to improve solubility, stability and permeability: A Review. Environmental Chemistry Letters. 2020 Nov 23;19(2):1153-71. doi: https://doi.org/10.1007/s10311-020-01142-2

Look through:

Brunina L. Turība University, Riga, Latvia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0009-0002-0051-1030

Brunina L. Bridging the gap: evaluating emollients and emulsifiers in dermatology for long-term skin health and barrier recovery. Medicni perspektivi. 2025;30(2):149-155.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333650

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

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

Key words: mine-explosive trauma, gunshot trauma, traumatic injuries, bleeding

1. Tin D, Barten DG, Granholm F, Kovtonyuk P, Burkle FM, Ciottone GR. Hybrid warfare and counter-terrorism medicine. European Journal of Trauma and Emergency Surgery. 2023;2:583-93. doi: https://doi.org/10.1007/s00068-023-02230-y
2. Jarrassier A, Py N, de Rocquigny G, Raux M, Lasocki S, Dubost C, et al. Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review. Anaesthesia Critical Care & Pain Medicine. 2024 Jul 30;43(5):101409. doi: https://doi.org/10.1016/j.accpm.2024.101409
3. Spagnolello O, Gatti S, Shahir MAA, Afzali MF, Portella G, Baiardo Redaelli M. Civilian war victims in Afghanistan: five-year report from the Kabul EMERGENCY NGO hospital. European Journal of Trauma and Emergency Surgery. 2022 Nov 30;49(3):1401-5. doi: https://doi.org/10.1007/s00068-022-02137-0
4. Kuchyn I, Horoshko V. Chronic pain in patients with gunshot wounds. BMC Anesthesiol. 2023;23(1):47. doi: https://doi.org/10.1186/s12871-023-02005-3
5. Wightman JM, Springer BL, Pickett JR. Blast injury management for operators and tactical emergency medical support providers. The Tactical Edge [In­ternet]. 2018 [cited 2025 Mar 07];(Fall):74-8. Available from: https://www.researchgate.net/publication/361594434_Blast_injury_management_for_operators_and_TEMS_providers
6. Kobayashi L, Coimbra R, Goes AMO Jr, et al. American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries. J Trauma Acute Care Surg. 2020;89(6):1183-96. doi: https://doi.org/10.1097/TA.0000000000002967
7. Alarhayem AQ, Cohn SM, Cantu-Nunez O, Eas­tridge BJ, Rasmussen TE. Impact of time to repair on outcomes in patients with lower extremity arterial injuries. J Vasc Surg. 2019;69(5):1519-23. doi: https://doi.org/10.1016/j.jvs.2018.07.075
8. [On approval of the procedures for providing first aid to persons in emergency conditions. Order of the Ministry of Health of Ukraine dated 2022 Mar 9  441]. [Internet]. 2022 [cited 2025 Mar 07]. Ukrainian. Available from: https://zakon.rada.gov.ua/laws/show/z0356-22#Text
9. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008;64(2):295-9. doi: https://doi.org/10.1097/TA.0b013e318163b875
10. Khomenko IP, Korol SO, Khalik SV, Shapo­va­lov VY, Yenin RV, Нerasimenko OS, Tertyshnyі SV. Cli­nical and Epidemiological analysis of the structure of combat surgical injury during Antiterrorist operation “Clinical and Epidemiological Analysis of the Structure of Combat Surgical Injury During Antiterrorist Operation. Joint Forces Operation. Ukrainian Journal of Military Medicine. 2021;2(2):5-13. doi: https://doi.org/10.46847/ujmm.2021.2(2)-005
11. Trentzsch H, Goossen K, Prediger B, Schwei­gkofler U, Hilbert-Carius P, Hanken H, et al. Stop the bleed “ – Prehospital bleeding control in patients with mul­tiple and/or severe injuries – A systematic review and clinical practice guideline – A systematic review and clinical practice guideline. European Journal of Trauma  and Emergency Surgery. 2025 Feb 5;51(1):92. doi: https://doi.org/10.1007/s00068-024-02726-1
12. O'Banion LA, Dirks R, Saldana-Ruiz N, et al. Contemporary outcomes of traumatic popliteal artery injury repair from the popliteal scoring assessment for vascular extremity injury in trauma study. J Vasc Surg. 2021;74(5):1573-80.e2. doi: https://doi.org/10.1016/j.jvs.2021.04.064
13. Patel JA, White JM, White PW, Rich NM, Ras­mussen TE. A contemporary, 7-year analysis of vascular injury from the war in Afghanistan. J Vasc Surg. 2018;68(6):1872-9. doi: https://doi.org/10.1016/j.jvs.2018.04.038
14. Danford JR, Reyes F, Gurney JM, Smith JP, Stin­ner DJ. Optimizing Advanced Trauma Life Support (ATLS®) to Maximize Readiness. Mil Med. 2024 Aug 30;189(9-10):e2206-10. doi: https://doi.org/10.1093/milmed/usae073
15. Pape HC, Lefering R, Butcher N, et al. The defi­nition of polytrauma revisited: An international consensus process and proposal of the new 'Berlin definition. J Trauma Acute Care Surg. 2014;77(5):780-6. doi: https://doi.org/10.1097/TA.0000000000000453
16. Chen Y, Liu Z, Zhang P, Huang W. [Consistency of injury severity scores in patients with severe trauma]. Medical and health technology. 2024;56(1):157-60. Chinese. doi: https://doi.org/10.19723/j.issn.1671-167X.2024.01.024
17. Hardy BM, Varghese A, Adams MJ, Ennin­ghorst N, Balogh ZJ. The outcomes of the most severe polytrauma patients: a systematic review of the use of high ISS cutoffs for performance measurement. Eur J Trauma Emerg Surg. 2024;50(4):1305-12. doi: https://doi.org/10.1007/s00068-023-02409-3 

Look through:

Denysiuk M.V. Bogomolets National Medical University, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-2811-8046

Dubrov S.O. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0002-2471-3377

Poniatovska H.B. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0001-7224-4213 

Lianskorunskyi V.M. Bogomolets National Medical University, Kyiv, Ukraine
https://orcid.org/0000-0002-1288-0688

Denysiuk M.V., Dubrov S.O., Poniatovska H.B., Lianskorunskyi V.M. Analysis of the structure and features of traumatic injuries in victims with combat trauma. Medicni perspektivi. 2025;30(2):156-163. DOI: https://doi.org/10.26641/2307-0404.2025.2.333655

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

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

Key words: clinical-economic analysis, ABC-analysis, postoperative period, hip joint, endoprosthetics, financial costs

1. Jerrhag D, Englund M, Karlsson MK, Rosen­gren BE. Epidemiology and time trends of distal forearm fractures in adults – a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord. 2017;18(1):240. doi: https://doi.org/10.1186/s12891-017-1596-z
2. Loskutov OYe, Oliinyk OE, Loskutov OO, Syne­hubov DA. [Development of national joint endoprosthesis (results of 30-year research)]. Transplantatsiia ta shtuchni organy. 2021;2:37-50. Ukrainian. doi: https://doi.org/10.30702/transpaorg/10_21.2710/0437-50/451.30(477)
3. Turchin VM, Loskutov OYe, Savynska OYu. [On the optimal choice of hip joint implant]. Issues of applied mathematics and mathematical modeling. 2020;20:163-74. Ukrainian. doi: https://doi.org/10.15421/322016
4. Dudko S, Kusz D, Kopeć K, Wojciechowski P, Kwiatkowska K, Niemiec D. Pseudotumor as a Com­plication of Total Hip Replacement. Ortop Traumatol Rehabil.2022 Aug 31;24(4):273-80. doi: https://doi.org/10.5604/01.3001.0015.9991
5. Yakovlieva LV, Bezditko NV, Herasymova OO, Mishchenko OYa, Karbusheva IV, Tkachova OV, et al. [Pharmacoeconomics: a textbook for university students]. Vinnytsia: NOVA KNYHA; 2009. 208 р. Ukrainian.
6. Ubohov SH, Trokhymchuk VV, Todorova VI, Za­horiy VA. Process model of the pharmaceutical inte­grated management systems. Wiadomości Lekarskie. 2019;72(2):201-8. doi: https://doi.org/10.36740/WLek201902112
7. Hruzieva TS, Lekhan VM, Ohniev VA, Ha­liien­ko LI, Kriachkova LV, Palamar BI, et al. [Biostatistics]. 2020. 384 p. Ukrainian.
8. Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, et al. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Di­seases Undergoing Elective Total Hip or Total Knee Arthro­plasty. Arthritis Care Res (Hoboken). 2022 Sep;74(9):1399-408. doi: https://doi.org/10.1002/acr.24893
9. Khalid T, Ben-Shlomo Y, Bertram W, Culli­ford L, Henderson EJ, Jepson M, et al. Prehabilitation for frail patients undergoing hip and knee replacement in the UK: Joint PREP feasibility study for a randomised controlled trial. BMJ Open. 2024 Sep 17;14(9):e084678. doi: https://doi.org/10.1136/bmjopen-2024-084678

Look through:

Brodska E.V. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0009-0004-7141-6625

Makarenko O.V. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-8730-1081

Dronov S.M. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-7495-2835

Brodska E.V., Makarenko O.V., Dronov S.M. Clinical and economic analysis of the prescription of drugs for postoperative support of total hip arthroplasty. Medicni perspektivi. 2025;30(2):164-170. DOI: https://doi.org/10.26641/2307-0404.2025.2.333657

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

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

Key words: biocompatibility, individual sensitivity, material intolerance, tests

1. Schmalz G, Watts DC, Darvell BW. Dental ma­terials science: research, testing and standards. Dent Mater. 2021;37(3):379-81. doi: https://doi.org/10.1016/j.dental.2021.01.027
2. Arakelyan M, Spagnuolo G, Iaculli F, Diko­pova N, Antoshin A, Timashev P, et al. Minimization of adverse effects associated with dental alloys. Materials (Basel). 2022;15(21):7476. doi: https://doi.org/10.3390/ma15217476
3. Bousquet J, Pfaar O, Agache I, Bedbrook A, Ak­dis CA, Canonica GW, et al. ARIA‐EAACI care pathways for allergen immunotherapy in respiratory allergy. Clinical and Translational Allergy. 2021;11(4):e12014. doi: http://dx.doi.org/10.1002/clt2.12014
4. Domic I, Budmir J, Novak I, Mravak-Stipetic M, Lugovic-Mihic L. Assessment of allergies to food and addi­tives in patients with angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reac­tions, and perioral dermatitis. Acta Clin Croat. 2021;60(2):276-81. doi: https://doi.org/10.20471/acc.2021.60.02.14
5. Schmalz G, Jakubovics N, Schwendicke F. Nor­mative approaches for oral health: standards, specifi­cations, and guidelines. J Dent Res. 2022;101(5):489-94. doi: https://doi.org/10.1177/00220345211049695
6. Budimir J, Mravak-Stipetic M, Bulat V, Fercek I, Japundzic I, Lugovic-Mihic L. Allergic reactions in oral and perioral diseases-what do allergy skin test results show? Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127(1):40-8. doi: https://doi.org/10.1016/j.oooo.2018.08.001
7. Itoh E, Furumura M, Furue M. Rate of actual metal allergy prior to dental treatment in subjects complaining of possible metal allergy. Asian Pac J Allergy Immunol. 2020;38(3):186-9. doi: https://doi.org/10.12932/ap-241018-0425
8. Gryzodub DV, Gryzodub VI, Gryzodub YeV, vy­nakhidnyky; Kharkivska medychna akademiia pisliadyp­lomnoi osvity MOZ Ukrainy, patentovlasnyk. [Method for determining individual sensitivity to dental materials]. Patent Ukrainy No. 91624. 2014.04.10. Ukrainian.
9. Fletcher R, Harrison W, Crighton A. Dental mate­rial allergies and oral soft tissue reactions. Br Dent J. 2022;232(9):620-25.
   doi: https://doi.org/10.1038/s41415-022-4195-9
10. Sokolovska V, Tsvetkova N, Davydenko V, Pysa­renko O, Tarashevska Y. Dental rehabilitation of a patient with a decrease in bite height due to pathological abrasion of hard tooth tissues (clinical case). Medicni Perspektivi. 2024;(29):245-53.
    doi: https://doi.org/10.26641/2307-0404.2024.2.307778
11. Sokolovska V, Tsvetkova N. [Displays of un­bea­rab­leness of stomatological materials are in cavity of mouth (clinical case)]. Ukr Dent Alm. 2022;4:48-52. Ukrainian.
    doi: https://doi.org/10.31718/2409-0255.4.2022.08
12. Alarcon-Sanchez MA, Heboyan A, Fernan­des GVO, Castro-Alarcon N, Romero-Castro NS. Poten­tial impact of prosthetic biomaterials on the periodontium: a comprehensive review. Molecules. 2023;28(3):1075. doi: https://doi.org/10.3390/molecules28031075
13. Forkel S, Schubert S, Corvin L, Heine G, Lang CCV, Oppel E, et al. Contact allergies to dental ma­terials in patients. Br J Dermatol. 2024;190(6):895-903. doi: https://doi.org/10.1093/bjd/ljad525
14. Müller-Heupt LK, Schiegnitz E, Kaya S, Jacobi-Gresser E, Kämmerer PW, Al-Nawas B. Diagnostic tests for titanium hypersensitivity in implant dentistry: a sys­tematic review of the literature. Int J Implant Dent. 2022;8(1):29. doi: https://doi.org/10.1186/s40729-022-00428-0
15. Sousa‐Pinto B, Sa‐Sousa A, Vieira RJ, Amaral R, Klimek L, Czarlewski W, et al. Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK‐air® real‐world data. Allergy. 2022;77(9):2699-711. doi: http://dx.doi.org/10.1111/all.15275
16. Can A, Karabacak DE, Yalcin BK, Demir S, Buyukozturk S, Colakoglu B, et al. How important is patch testing with dental materials in real-life clinical practice? AllergyAsthma  2023;44(2):136-44. doi: https://doi.org/10.2500/aap.2023.44.220074
17. Lugovic-Mihic L, Ilic I, Budimir J, Pondeljak N, Mravak Stipetic M. Common allergies and allergens in oral and perioral diseases. Acta Clin Croat. 2020;59(2):318-28. doi: https://doi.org/10.20471/acc.2020.59.02.16
18. Forkel S, Schubert S, Corvin L, Heine G, Lang CCV, Oppel E, et al. Contact allergies to dental materials in patients. Br J Dermatol. 2024;190(6):895-903. doi: https://doi.org/10.1093/bjd/ljad525
19. Bacchi A, Cesar PF. Advances in ceramics for dental applications. Dent Clin North Am. 2022 Oct;66(4):591-602. doi: https://doi.org/10.1016/j.cden.2022.05.007
20. Muntian LM, Kulyhin OB. [Dynamics of bio­physical and biochemical changes in oral fluid parameters during orthopedic treatment of patients with fixed dentures and their prognostic significance]. Novyny stomatolohii. 2010;1:47-51. Ukrainian.
21. Zemelka-Wiacek M. Metal Allergy: State-of-the-art mechanisms, biomarkers, hypersensitivity to implants. JClin  2022;11(23):6971. doi: https://doi.org/10.3390/jcm11236971
22. Kilic K, Koc AN, Tekinsen FF, Yildiz P, Kilic D, Zararsiz G, et al. Assessment of Candida species colo­nization and denture-related stomatitis in barand locator-retained overdentures. J Oral Implantol. 2014;40(5):549-56. doi: https://doi.org/10.1563/AAID-JOI-D-12-00048
23. Brown A, Mandelberg NJ, Munoz-Mendoza D, Palys V, Schalock PC, Mogilner A, et al. Allergy consi­derations in implanted neuromodulation devices. Neuro­modulation. 2021;24(8):1307-16. doi: https://doi.org/10.1111/ner.13332
24. Grizodub DV. [Analysis of the frequency of soma­tic complications in patients with intolerance to con­structional dental materials and with fixed bridge pro­stheses]. Problemy bezperervnoi medychnoi osvity ta nauky. 2019;(1):64-7. Ukrainian.

Look through:

Davydenko V.Yu. Poltava state medical university, Poltava, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-4231-7343

Davydenko H.M. Poltava state medical university, Poltava, Ukraine
https://orcid.org/0000-0001-6219-2376

Sokolovska V.M. Poltava state medical university, Poltava, Ukraine
https://orcid.org/0000-0002-8944-5828

Khilinich Ye.S. Poltava state medical university, Poltava, Ukraine
https://orcid.org/0000-0001-7970-944X

Tarashevska Yu.Ye. Poltava state medical university, Poltava, Ukraine
https://orcid.org/0000-0003-2983-1708

Davydenko V.Yu., Davydenko H.M., Sokolovska V.M., Khilinich Ye.S., Tarashevska Yu.Ye. Rehabilitation of a patient with manifistations of intolerance to dental materials in the oral cavity (clinical case). Medicni perspektivi. 2025;30(2):171-179.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333658

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

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

Key words: youth sports medicine, physiological adaptation, growth and development, cardiovascular response, musculoskeletal development, neuromuscular adaptation, training safety

1. LloydRS, Faigenbaum AD, Stone MH, Meyer GD, Gregory D, Myer GD, et al. Position statement on youth resistance training: the 2014 International Consensus. Br J Sports Med. 2014;48(7):498-505. doi: https://doi.org/10.1136/bjsports-2013-093614
2. GranacherU, Lesinski M, Büsch D, Muehl­bauer T, Prieske O, Puta C, et al. Effects of resistance trai­ning in youth athletes on muscular fitness and athletic performance: a conceptual model for long-term athlete development. Front  2016;7:164. doi: https://doi.org/10.3389/fphys.2016.00164
3. BehmDG, Young JD, Whitten JHD, Reid JC, Quigley PJ, Low J, et al. Effectiveness of traditional strength vs. power training on muscle strength, power and speed with youth: a systematic review and meta-analysis. Front  2017;8:423. doi: https://doi.org/10.3389/fphys.2017.00423
4. Ford P, De Ste Croix M, Lloyd R, Meyers R, Moosavi M, Oliver J, et al. The long-term athlete develop­ment model: physiological evidence and application. J Sports 2011;29(4):389-402. doi: https://doi.org/10.1080/02640414.2010.536849
5. Malina RM, Rogol AD, Cumming SP, Coelho e Silva MJ, Figueiredo AJ. Biological maturation of youth athletes: assessment and implications. Br J Sports Med. 2015;49(13):852-9.
   doi: https://doi.org/10.1136/bjsports-2015-094623
6. Myer GD, Faigenbaum AD, Ford KR, Best TM, Bergeron MF, Hewett TE. When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth? Curr Sports Med Rep. 2011;10(3):155-66. doi: https://doi.org/10.1249/JSR.0b013e31821b1442
7. Fort-Vanmeerhaeghe A, Romero-Rodriguez D, Lloyd RS, Kushner A, Myer GD. Integrative neuromus­cu­lar training in youth athletes. Part II: Strategies to prevent injuries and improve performance. Strength Cond J. 2016;38(4):9-27. doi: https://doi.org/10.1519/SSC.0000000000000229
8. Lesinski M, Prieske O, Granacher U. Effects and dose-response relationships of resistance training on phy­sical performance in youth athletes: a systematic review and meta-analysis. Br J Sports Med. 2016;50(13):781-95. doi: https://doi.org/10.1136/bjsports-2015-095497
9. Faigenbaum AD, Lloyd RS, MacDonald J, Myer GD. Citius, Altius, Fortius: beneficial effects of resistance training for young athletes. Br J Sports Med. 2016;50(1):3-7.
   doi: https://doi.org/10.1136/bjsports-2015-094621
10. Bergeron MF, Mountjoy M, ArmstrongN, Chia M, Côté J, Emery CA, et al. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med. 2015;49(13):843-51. doi: https://doi.org/10.1136/bjsports-2015-094962
11. Moran J, Sandercock GR, Ramírez-Campillo R, Meylan C, Collison J, Parry DA. A meta-analysis of maturation-related variation in adolescent boy athletes' adaptations to short-term resistance training. J Sports Sci. 2017;35(11):1041-51. doi: https://doi.org/10.1080/02640414.2016.1209306
12. Lubans DR, Morgan PJ, Cliff DP, Barnett LM, Okely AD. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med.2010;40(12):1019-35. doi: https://doi.org/10.2165/11536850-000000000-00000
13. Brownlee TE, O'Boyle A, Morgans R, Morton JP, Erskine RM, Drust B. Training duration may not be a predisposing factor in potential maladaptations in talent development programmes. Int J Sports Sci Coach. 2018;13(5):674-8. doi: https://doi.org/10.1177/1747954118758744
14. Haugen TA, Tønnessen E, Seiler S. Speed and countermovement-jump characteristics of elite female soccer players, 1995-2010. Int J Sports Physiol Perform. 2014;9(5):906-13.
    doi: https://doi.org/10.1123/ijspp.2013-0096
15. Deprez D, Fransen J, Boone J, Lenoir M, Philip­paerts R, Vaeyens R. Characteristics of high-level youth soccer players: variation by playing position. J Sports Sci. 2015;33(3):243-54. doi: https://doi.org/10.1080/02640414.2014.934707
16. Rössler R, Junge A, Bizzini M, Verhagen E, Cho­miak J, Fünten K, et al. A multinational cluster randomised controlled trial to assess the efficacy of '11+ Kids'. Sports Med.2018;48(6):1493-504. doi: https://doi.org/10.1007/s40279-017-0834-8
17. Read PJ, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. Neuromuscular risk factors for knee and ankle ligament injuries in male youth soccer players. Sports Med. 2016;46(8):1059-66.
    doi: https://doi.org/10.1007/s40279-016-0479-z
18. Bahr R. Why screening tests to predict injury do not work and probably never will...: a critical review. Br J Sports 2016;50(13):776-80. doi: https://doi.org/10.1136/bjsports-2016-096256
19. Seifert L, Button C, Davids K. Key properties of expert movement systems in sport. Sports Med. 2013;43(3):167-78.
    doi: https://doi.org/10.1007/s40279-012-0006-9
20. Meylan C, Cronin J, Oliver J, Hughes M. Talent identification in soccer: The role of maturity status on physical, physiological and technical characteristics. Int J SportsSci  2010;5(4):571-92. doi: https://doi.org/10.1260/1747-9541.5.4.571
21. Williams AM, Ford PR. Expertise and expert performance in sport. Int Rev Sport Exerc Psychol. 2008;1(1):4-18. doi: https://doi.org/10.1080/17509840701836867
22. Jaakkola T, Yli-Piipari S, Huotari P, Watt A, Liukkonen J. Fundamental movement skills and physical fitness as predictors of physical activity: A 6-year follow-up study. Scand J Med Sci Sports. 2016;26(1):74-81. doi: https://doi.org/10.1111/sms.12407
23. Vandorpe B, Vandendriessche J, Vaeyens R, Pion J, Lefevre J, Philippaerts R, et al. Factors discrimi­nating gymnasts by competitive level. Int J Sports Med. 2011;32(8):591-7.
    doi: https://doi.org/10.1055/s-0031-1275300
24. McKeown I, Taylor‐McKeown K, Woods C, Ball N. Athletic ability assessment: a movement asses­sment protocol for athletes. Int J Sports Phys Ther. 2014;9(7):862-73. PMID: 25540702
25. Radnor JM, Oliver JL, Waugh CM, Myer GD, Moore IS, Lloyd RS. The influence of growth and matu­ration on stretch-shortening cycle function in youth. Sports Med.2018;48(1):57-71. doi: https://doi.org/10.1007/s40279-017-0785-0
26. Fort-Vanmeerhaeghe A, Romero-Rodriguez D, Montalvo AM, Kiefer AW, Lloyd RS, Myer GD. Integ­rative neuromuscular training and injury prevention in youth athletes. Part I: Identifying risk factors. Strength Cond 2016;38(3):36-48. doi: https://doi.org/10.1519/SSC.0000000000000229
27. Chaouachi A, Hammami R, Kaabi S, Chamari K, Drinkwater EJ, Behm DG. Olympic weightlifting and plyometric training with children provides similar or greater performance improvements than traditional resistance training. J Strength Cond Res. 2014;28(6):1483-96. doi: https://doi.org/10.1519/JSC.0000000000000305
28. Pichardo AW, Oliver JL, Harrison CB, Maul­der PS, Lloyd RS. Integrating models of long-term athletic development to maximize the physical development of youth. Int J Sports Sci Coach. 2018;13(6):1189-99. doi: https://doi.org/10.1177/1747954118785487
29. O'Connor D, Larkin P, Williams AM. What lear­ning environments help improve decision-making? Phys EducSport  2017;22(6):647-60. doi: https://doi.org/10.1080/17408989.2017.1294678
30. Balyi I, Way R, Higgs C. Long-term athlete development. Champaign, IL: Human Kinetics; 2013. ISBN: 978-0736092180
31. Lloyd RS, Oliver JL, Faigenbaum AD, Howard R, De Ste Croix MB, Williams CA, et al. Long-term athletic development, part 1: a pathway for all youth. J Strength Cond 2015;29(5):1439-50. doi: https://doi.org/10.1519/JSC.0000000000000756
32. McKay D, Broderick C, Steinbeck K. The adoles­cent athlete: a developmental approach to injury risk. PediatrExerc  2016;28(4):488-500. doi: https://doi.org/10.1123/pes.2016-0021
33. Faigenbaum AD, Myer GD. Resistance training among young athletes: safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi: https://doi.org/10.1136/bjsm.2009.068098
34. Moran J, Sandercock G, Rumpf MC, Parry DA. Variation in responses to sprint training in male youth athletes: a meta-analysis. Int J Sports Med. 2017;38(1):1-11. doi: https://doi.org/10.1055/s-0042-114526
35. Smith JJ, Eather N, Morgan PJ, Plotnikoff RC, Fai­genbaum AD, Lubans DR. The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sports Med. 2014;44(9):1209-23. doi: https://doi.org/10.1007/s40279-014-0196-4
36. Gabbett TJ, Whyte DG, Hartwig TB, Wescom­be H, Naughton GA. The relationship between workloads, physical performance, injury and illness in adolescent male football players. Sports Med. 2014;44(7):989-1003. doi: https://doi.org/10.1007/s40279-014-0179-5
37. Young WB, Dawson B, Henry GJ. Agility and change-of-direction speed are independent skills: im­plications for training for agility in invasion sports. Int J SportsSci  2015;10(1):159-69. doi: https://doi.org/10.1260/1747-9541.10.1.159
38. Opstoel K, Pion J, Elferink-Gemser M, Hart­man E, Willemse B, Philippaerts R, et al. Anthropometric characteristics, physical fitness and motor coordination of 9 to 11 year old children participating in a wide range of sports. PloS 2015;10(5):e0126282. doi: https://doi.org/10.1371/journal.pone.0126282
39. Lloyd RS, Oliver JL, Hughes MG, Williams CA. The influence of chronological age on periods of acce­lerated adaptation of stretch-shortening cycle performance in pre and post-pubescent boys. J Strength Cond Res. 2011;25(7):1889-97. doi: https://doi.org/10.1519/JSC.0b013e3181e7faa8
40. Viru A, Loko J, Harro M, Volver A, Laaneots L, Viru M. Critical periods in the development of perfor­mance capacity during childhood and adolescence. Eur J Phys 1999;4(1):75-119. doi: https://doi.org/10.1080/1740898990040107
41. Castagna C, Manzi V, Impellizzeri F, Weston M, Álvarez J. Relationship between endurance field tests and match performance in young soccer players. J Strength Cond Res. 2010;24(12):3227-33. doi: https://doi.org/10.1519/jsc.0b013e3181e72709
42. Dridi R. Regular soccer training improves pul­monary diffusion capacity in 6 to 10 year old boys. BMC Sports Sci Med Rehabil.2023;15(1):146. doi: https://doi.org/10.1186/s13102-023-00757-6
43. Lechner S, Ammar A, Boukhris O, Trabelsi K, Glenn J, SchwarzJ, et al. Monitoring training load in youth soccer players: effects of a six-week preparatory training program. Biol  2023;40(1):63-75. doi: https://doi.org/10.5114/biolsport.2023.112094
44. Machado Mapping talent pathways: a compa­rative study of developmental activities and practice structure in Brazilian and Spanish U-18 elite youth male soccer players. Int J Sports Sci Coach. 2024;19(5):2006-15. doi: https://doi.org/10.1177/17479541241241487
45. MarshallD, Lopatina E, Lacny S, Emery  Eco­nomic impact study: neuromuscular training reduces the burden of injuries and costs compared to standard warm-up in youth soccer. Br J Sports Med. 2016;50(22):1388-93. doi: https://doi.org/10.1136/bjsports-2015-095666
46. ReadP, Oliver J, De Ste Croix M, Myer G, Lloyd  A review of field-based assessments of neuro­muscular control and their utility in male youth soccer players. J Strength Cond Res. 2019;33(1):283-99. doi: https://doi.org/10.1519/jsc.0000000000002069
47. SogiY, Hagiwara Y, Yabe Y, Sekiguchi T, Mom­ma H, Tsuchiya M, et  Association between trunk pain and lower extremity pain among youth soccer players: a cross-sectional study. BMC Sports Sci Med Rehabil. 2018;10(1):13.
    doi: https://doi.org/10.1186/s13102-018-0102-8
48. UnnithanV, Beaumont A, Rowland T, George K, Sculthorpe N, Lord R, et al. Left ventricular responses during exercise in highly trained youth athletes: echocar­diographic insights on function and adaptation. J Cardio­vasc Dev  2022;9(12):438. doi: https://doi.org/10.3390/jcdd9120438
49. Jovanović Prevalence of potential risk of eating disorders among young, unprofessional European athletes: results of the Erasmus+ project SCAED. Front Nutr. 2024;11:1398464. doi: https://doi.org/10.3389/fnut.2024.1398464
50. TadesseT, Asmamaw A, H/Mariam S, Edo  A survey of contextual factors and psychological needs sa­tisfaction as correlates of youth athletes' developmental outcomes in the Ethiopian sports academy context. BMC Sports Sci Med Rehabil. 2022;14(1):156. doi: https://doi.org/10.1186/s13102-022-00545-8
51. DiCesareC, Montalvo A, Foss K, Thomas S, Ford K, Hewett T, et al. Lower extremity biomechanics are altered across maturation in sport-specialized female adolescent athletes. Front Pediatr. 2019;7:268. doi: https://doi.org/10.3389/fped.2019.00268
52. JacobssonJ, Bergin D, Timpka T, Nyce J, Dahl­ström Ö. Injuries in youth track and field are perceived to have multiple‐level causes that call for ecological (holistic‐developmental) interventions: a national sporting commu­nity perceptions and experiences. Scand J Med Sci Sports. 2017;28(1):348-55. doi: https://doi.org/10.1111/sms.12929
53. Xiao S. Characteristics and prevention of sports injuries in taekwondo training. Rev Bras Med Esporte. 2022;28(1):37-9. doi: https://doi.org/10.1590/1517-8692202228012021_0436

Look through:

Grygus I. National University of Water and Environmental Engineering, Rivne, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-2856-8514

Grynova M. Poltava V. G. Korolenko National Pedagogical University, Poltava, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-3912-9023

Gamma T. National University of Water and Environmental Engineering, Rivne, Ukraine
https://orcid.org/0000-0001-9295-3375

Hodlevskyi P. National University of Water and Environmental Engineering, Rivne, Ukraine
https://orcid.org/0000-0001-8655-4546

Zukow W. Nicolaus Copernicus University, Torun, Poland
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-7675-6117

Grygus I., Grynova M., Gamma T., Hodlevskyi P., Zukow W. Physiological adaptations and functional changes in young soccer players' organisms aged 11-14 years following a 12-week specialized training program: a sports medicine perspective. Medicni perspektivi. 2025;30(2):180-189.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333676

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

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

Key words: health resilience, endogenous response, motor activity of athletes

1. [WHO. Physical activity and health. Global report on physical activity]. [Intenet]. 2022 [cited 2025 Apr 12]. Ukrainian. Available from: https://resources.physio-pedia.com/uk/resource/global-status-report-on-physical-activity-2022-uk/
2. Nikitina LP. [Biological and medical aspects of a healthy lifestyle]. Zaporizhzhia: ZDMU; 2021. p. 50-65. Ukrainian.
3. Yuzyk O, Honcharuk V, Pelekh Y, Bilanych L, Sirenko P, Voitovych I, et al. Research on Generative Arti­ficial Intelligence Technologies in Education: Oppor­tunities, Challenges, and Ethical Aspects. BRAIN Broad Research in Artificial Intelligence and Neuroscience. 2025;16(Supl 1):139-51. doi: https://doi.org/10.70594/brain/16.S1/12
4. Dyachenko PA, Kurhanska VO, Dyachenko AG, Smiianova OI. A rural-based medical and sociological stu­dy on the results of the primary care reform. Wiadomosci Lekarskie.2020;73(5):963-6. doi: https://doi.org/10.36740/WLek202005123 
5. Ivakhniuk TV, Holubnycha VM, Smiianov VA, Rudenko LA, Smiianov YV. Basic principles of behavioral economics and prospects for their application in the public health system. Wiadomosci Lekarskie. 2020;73(9):2036-41. doi: https://doi.org/10.36740/WLek202009231
6. Kohl HW, Murray TD. Foundations of Physical Ac­tivity and Public Health. Human Kinetics; 2021. р. 50-65.
7. Krustrup P, Mohr M, Nybo L, Jensen JM, Niel­sen JJ, Bangsbo J. The Yo-Yo IR2 test: physiological response, reliability, and application to elite soccer. Med Sci Sports Exerc. 2006 Sep;38(9):1666-73. doi: https://doi.org/10.1249/01.mss.0000227538.20799.08
8. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An Ecological Approach to Creating Active Living Communities. Annual Review of Public Health. 2006;27:297-322. doi: https://doi.org/10.1146/annurev.publhealth.27.021405.102100
9. Sartorius N. The Meanings of Health and its Pro­motion. Croat Med J. 2006 Aug;47(4):662-4. PMID: 16909464; PMCID: PMC2080455. Functional Training and Flexibility: Modern Approaches. Cambridge: Cam­bridge University Press; 2020. р. 112-8.
10. Sirenko PO, Storozhenko IP, Žīdens J, Zuša A, Yuzyk OP, Lietuviete D, et al. Functional testing of the lower extremity muscles. Medicni perspektivi. 2023;28(2):150-63.
    doi: https://doi.org/10.26641/2307-0404.2023.2.283388
11. Sirenko PO, Istomin AH, Sirenko RR, Khorka­vyi BV, Rybchych IE. Special and preventive exercises for hamstring muscles in the training process of experienced football players. Pedagogy of Physical Culture and Sports, 2022;26(5):344-52. doi: https://doi.org/10.15561/26649837.2022.0509
12. Hampel FR. The Influence Curve and Its Rolein Robust Estimation. Journal of the American Statistical Association. 1974;69(346):383-93. doi: https://doi.org/10.1080/01621459.1974.10482962
13. Wilcoxon F. Individual comparis ons by ranking methods. Biometrics. 1945;1(6):80-83. doi: https://doi.org/10.2307/3001968
14. Mann HB, Whitney DR. On a test of whether one of two random variablesis stochastically larger than the other. The Annals of Mathematical Statistics. 1947;18(1):50-60. doi: https://doi.org/10.1214/aoms/1177730491
15. Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples). Biometrika. 1965;52(3/4):591-611. doi: https://doi.org/10.1093/biomet/52.3-4.591
16. Yuzyk O, Pelekh Y, Voitovych I, Pavlova N, Briukhovetska I, Sirenko P, et al. Peculiarities of Profes­sional Training of Informatics and Mathematics Teachers at Universities in Poland and Ukraine. In: Štarchoň P, Fedushko S, Gubíniová K, editors. Data-Centric Business and Applications. Lecture Notes on Data Engineering and Communications Technologies. Springer, Cham; 2024. doi: https://doi.org/10.1007/978-3-031-62213-7_1
17. Smith J. Training Principles for Athletes. Oxford: Oxford University Press; 2018. р. 150-67.
18. Warburton DER, Nicol CW, Bredin SS. Health Benefits of Physical Activity. CMAJ. 2006;174(6):801-9. doi: https://doi.org/10.1503/cmaj.051351

Look through:

Sirenko P.O. Rīga Stradiņš University, Rīga, Latvia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-2787-6497

Storozhenko I.P. State Biotechnological University, Kharkiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-7344-242X

Sirenko R.R. Private higher education institution "Lviv medical university", Lviv, Ukraine
e-mail:This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-9100-4709

Yuzyk O.P. Rivne State University of the Humanities, Rivne, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-9586-6015

Kindrat V.K. Rivne State University of the Humanities, Rivne, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
htths://orcid.org/0000-0002-7475-3385

Lietuviete D. Clinic Aiwa, Riga, Latvia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0009-0000-2821-3559

Kolesnyk T.V. Shupyk National University of Health Care, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-4849-5615

Sirenko P.O., Storozhenko I.P., Sirenko R.R., Yuzyk O.P., Kindrat V.K., Lietuviete D., Kolesnyk T.V. Resilience of individual health and endogenous response to determinants of motor activity of athletes. Medicni perspektivi. 2025;30(2):190-203.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333679

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

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

Key words: diclofenac sodium, nonsteroidal anti-inflammatory drugs, toxicological studies, regulation, atmospheric air

1. ICH hаrmonised guideline biopharmaceutics clas­sification system – based biowaivers M9. Final version Adopted on 20 November 2019 [Internet]. 2019 [cited 2024 May 06].Available from: https://database.ich.org/sites/default/files/M9_Guideline_Step4_2019_1116.pdf 
2. Imai T, Hazama K, Kosuge Y, Suzuki S, Oot­suka S. Preventive effect of rebamipide on NSAID-induced lower gastrointestinal tract injury using FAERS and JADER. Scientific reports. 2022;12(1):2631. doi: https://doi.org/10.1038/s41598-022-06611-y
3. Bocci G, Oprea TI, Benet LZ. State of the Art and Uses for the Biopharmaceutics Drug Disposition Clas­sification System (BDDCS): New Additions, Revisions, and Citation References. AAPS J. 2022 Feb 23;24(2):37. doi: https://doi.org/10.1208/s12248-022-00687-0
4. Erhirhie EO, Ihekwereme CP, Ilodigwe EE. Ad­vances in acute toxicity testing: strengths, weaknesses and regulatory acceptance. Interdiscip Toxicol. 2018;11(1):5-12. doi: https://doi.org/10.2478/intox-2018-0001
5. Vohra F, Raut A. Comparative efficacy, safety, and tolerability of diclofenac and aceclofenacin muscu­loskeletal pain management: A systematic review. Indian J of 2019;30(1):1-69. doi: https://doi.org/10.4103/0970-5333.173431
6. Yehudina ED. [Nonsteroidal anti-inflammatory drugs: evidence of effectiveness, facts, myths]. Neurology aspects of treatment. 2021;3:20-1. Ukrainian.
7. [On the approval of state medical and sanitary standards for the permissible content of chemical and biological substances in the atmospheric air of populated areas. Order of the Ministry of Health of Ukraine dated 2024 May 10 No. 813] [Internet]. 2024 [cited 2024 Jul 14]. Ukrainian.Available from: https://zakon.rada.gov.ua/laws/show/z0763-24#Text 
8. UNEP/WHO – United Nations Environment Pro­gramme/World Health Organization. State-of-the-Science of Endocrine Disrupting Chemicals [Internet]. 2012 [cited 2024 Oct 10].Available from: https://www.unep.org/resources/publication/state-science-endocrine-disputing-chemicals-ipcp-2012
9. Diclofenac (sodium salt). Safety data sheet. Cayman chemical [Internet]. 2022 [cited 2024 May 24]. Availablefrom: https://cdn.caymanchem.com/cdn/msds/70680m.pdf 
10. Panchal N, Kaur M, Tharmatt A, Thakur S, Jain SK. Development, Characterization and Evaluation of Parenteral Formulation of Diclofenac Sodium. AAPS PharmSciTech.2020;21(6):219. doi: https://doi.org/10.1208/s12249-020-01729-6
11. Diclofenac sodium. National Library of Medicine. National Center for Biotechnology Information [Internet]. 2022 [cited 2024 May 24]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Diclofenac-sodium  
12. [On approval of guidelines  "Justification  of  the  maximum permissible concentrations of drugs in the air of the  working  area  and  the  atmospheric  air  of  populated areas". Order of the MH of Ukraine dated 2005 Oct 21   544]. [Internet] 2005 [cited 2024 Jun 22]. Ukrainian. Available from: https://zakon.rada.gov.ua/rada/show/v0544282-05#Text 
13. Smith AJ. Guidelines for planning and conducting  high-quality research and testing on animals. Lab Anim Res. 2020 Jul 10;36:21. doi: https://doi.org/10.1186/s42826-020-00054-0
14. Eyme KM, Carvalho L, Badr CE. Intranasal deli­very of experimental compounds in orthotopic brain tumor mouse models. STAR Protocols. 2021;2(1):100290. doi: https://doi.org/10.1016/j.xpro.2020.100290
15. Halmi MI, Rahim MB, Othman AR. Estimation of LC50 and its Confidence Interval for the Effect of Ferrous Sulphate on Catla catla. JEMAT. 2018;6(1):21-3. doi: https://doi.org/10.54987/jemat.v6i1.402
16. Novosad NV. [Laboratory animals and technique of biological experiment]. Zaporizhzhia: ZNU; 2011. 85 р. Ukrainian.
17. Lim KS, et al. A method for the evaluation of cumulation and tolerance by the determination of acute and subchronic median effective doses. Arch Intern Phar­macodyn Ther. 1961;130:336-42.
18. Antomonov MYu. [Mathematical processing and analysis of medical and biological data]. Кyiv: MYCz "Medynform"; 2018. 579 р. Ukrainian.
19. Kim HS, Kang GH, Yang MJ, Ahn HJ, Han SC, Hwang JH. Toxicity of diclofenac sodium salt in Yucatan minipigs (Sus scrofa) following 4 weeks of daily intra­muscular administration. Toxicol Rep. 2021 Feb 26;8:557-570. doi: https://doi.org/10.1016/j.toxrep.2021.02.022
20. Nikolaieva YI, Hlavachek DO. [Study of acute toxicity parameters of Diclofenac sodium by different methods of administration]. Bulletin of the Vinnytsia National Medical University. 2023;27(4):548-53. Ukrai­nian. doi: https://doi.org/10.31393/reports-vnmedical-2023-27(4)-02
21. Patel JH, Thanagari BS, Fefar DT, Prajapati KS, Jivani BM, Thakor KB, et al. Haemato-biochemical altera­tions induced by diclofenac sodium toxicity in Swiss albino mice. Vet World. 2012;5(7):417-9. doi: https://doi.org/10.5455/vetworld.2012.417-419

Look through:

Nikolaieva Ya.Yu. State Institution "Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-4031-9967

Nikolaieva Ya.Yu. Regulation of the non-steroid anti-inflammatory drug «Diclofenac sodium» in the air environment of populated places. Medicni perspektivi. 2025;30(2):204-212.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333685

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

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

Key words: shoe glues, in vitro method, cytotoxicity, conformational changes of albumin, radicals activity

1. Kuzminov BP, Lototska-Dudyk UB. [Occupa­tio­nal factors and their influence on the health of workers of shoe productions]. Ukrainian journal of occupational health. 2016;1(46):74-83.  doi: https://doi.org/10.33573/ujoh2016.01.074
2. Lukács J, Präßler J, Gebhardt M, Elsner P. Adhe­sives and Glues. In: Kanerva’s Occupational Dermatology. Springer; 2020. р. 891-900. doi: https://doi.org/10.1007/978-3-319-68617-2_59
3. Orgiles-Calpena ME, Aran-Ais F, Torro-Pa­lau AM, et al. Adhesives in the footwear industry: a critical review. Rev Adhesion Adhesives. 2019;7(1):69-91. doi: https://doi.org/10.7569/RAA.2019.097303
4. Lototska-Dudyk UB. [Research of the assortment of shoes glues and their components as potential harmful factors of the production environment of footwear industry]. Aktualni problemy profilaktychnoi medytsyny. 2020;20:151-61. Ukrainian.
5. Heuser VD, de Andrade VM, da Silva J, Erdt­mann B. Comparison of genetic damage in Brazilian foot­wear-workers exposed to solvent-based or water-based adhesive. Mutat 2005;583(1):85-94. doi: https://doi.org/10.1016/j.mrgentox.2005.03.002
6. Domanski W, Makles Z. [Chemical hazards when working with solvent-based adhesives]. Medicina pracy. 2012;63(1):31-8. Polish.
7. Savira YM, Tejamaya MB, Putri AA. A case study: Chemical health risk assessment in three footwear small industries in Bogor-Indonesia year 2019. Gaceta Sanitaria.2021;35(2):374-8. doi: https://doi.org/10.1016/j.gaceta.2021.10.054
8. Umicevic N, Kotur-Stevuljevic J, Paleksic V, et al. Liver function alterations among workers in the shoe industry due to combined low-level exposure to organic solvents. Drug Chem Toxicol. 2022;45(4):1907-14. doi: https://doi.org/10.1080/01480545.2021.1894703
9. Cozigou G, Crozier J, Hendriksen C, et al. The European Partnership for Alternative Approaches to Animal Testing (EPAA): promoting alternative methods in Europe and beyond. J Am Assoc Lab Anim Sci. 2015;54(2):209-13.PMID: 25836968; PMCID: PMC4382626.
10. Zazulyak TS. [Theoretical and applied aspects of the application of alternative methods of toxicity research in the implementation of hygienic regulation of chemical factors of production]. Experimental and clinical physiology and biochemistry. 2019;88(4):73-81. Uk­rainian. doi: https://doi.org/10.25040/ecpb2019.04.073
11. Dmytrukha NM. [Аpplication of alternative in vitro test models for assessing the toxicity of heavy metal compounds]. Actual problems of preventive medicine. 2023;26:27-36. Ukrainian. doi: https://doi.org/10.32782/2786-9067-2023-26-3
12. Maestri E. The 3Rs principle in animal expe­rimentation: A legal review of the state of the art in Europe and the case in Italy. BioTech (Basel). 2021;10(2):9. doi: https://doi.org/10.3390/biotech10020009
13. Laroche C, Annys E, Bender H, et al. Finding synergies for the 3Rs - repeated dose toxicity testing: Report from an EPAA Partners' Forum. Regul Toxicol Pharmacol.2019;108:104470. doi: https://doi.org/10.1016/j.yrtph.2019.104470  
14. Tolosa L, Donato MT, Gómez-Lechón MJ. Gene­ral cytotoxicity assessment by means of the MTT assay. Protocols in vitro hepatocyte research. 2015;1250:333-48. doi: https://doi.org/10.1007/978-1-4939-2074-7_26
15. Singhal A, Saini U, Chopra B, et al. UV-Visible Spectroscopy: A review on its pharmaceutical and bio-allied sciences applications. Current Pharmaceutical Analysis.2024;20(3):161-77. doi: https://doi.org/10.2174/0115734129300562240408042614
16. Kedare SB, Singh RP. Genesis and development of DPPH method of antioxidant assay. J Food Sci Technol. 2011;48(4):412-22.
    doi: https://doi.org/10.1007/s13197-011-0251-1
17. Antomonov MYu. [Mathematical processing and analysis of medical and biological data]. Кyiv: Me­dynform; 2018. 579 p. Ukrainian.
18. Caloni F, De Angelis I, Hartung T. Replacement of animal testing by integrated approaches to testing and assessment (IATA): a call for in vivitrosi. Arch Toxicol. 2022;96(7):1935-50.
    doi: https://doi.org/10.1007/s00204-022-03299-x
19. Han P, Li X, Yang J, et al. Advancing toxicity predictions: a review on in vitro to in vivo extrapolation in next-generation risk assessment. Environ Health (Wash). 2024;2(7):499-513. doi: https://doi.org/10.1021/envhealth.4c00043
20. Trachtenberg IM, Dmytrukha NM. [Industrial to­xicology: main directions, results and prospects of scientific activity]. Ukrainian journal of occupational health. 2019;15(2):87-101.  doi: https://doi.org/10.33573/ujoh2019.02.087
21. Croute F, Poinsot J, Gaubin Y, et al. Volatile organic compounds cytotoxicity and expression of HSP72, HSP90 and GRP78 stress proteins in cultured human cells. BiochimBiophys  2002;1591(1-3):147-55. doi: https://doi.org/10.1016/s0167-4889(02)00271-9
22. Wu Sh, Li F, Wang M, et al. Cytotoxicity of eight organic solvents towards Balb/3T3 and 293T Cells. In: 5th International Conference on Bioinformatics and Biome­dical Engineering. 2011. р. 1-4. doi: https://doi.org/10.1109/icbbe.2011.5781580
23. Grzęda D, Węgrzyk G, Nowak A, et al. Cytotoxic properties of polyurethane foams for biomedical appli­cations as a function of isocyanate index. Polymers. 2023;15(12):2754. doi: https://doi.org/10.3390/polym15122754  
24. Khan Z, Ali SA. Isocyanate induces cytotoxicity via activation of phosphorylated alpha synuclein protein, nitrosative stress, and apoptotic pathway in Parkinson's disease model-SHSY-5Y cells. Neurol Res. 2023;45(7):676-87. doi: https://doi.org/10.1080/01616412.2023.2181919
25. Boyer JC, Taylor LW, Nylander-French LA. Via­bi­lity of cultured human skin cells treated with 1,6-hexa­methylene diisocyanate monomer and its oligomer isocya­nurate in different culture media. Sci Rep. 2021;11:23804.
    doi: https://doi.org/10.1038/s41598-021-02811-0
26. Schuppe-Koistinen I. Molecular profiling and prediction of toxicity. ATLA. 2001;29(30):287-9.
27. Hongzhao X, Qiaomei S, Wenjing W, et al. Study of conformational and functional changes caused by binding of environmental pollutant tonalide to human serum albumin. Chemosphere. 2021;270:129431. doi: https://doi.org/10.1016/j.chemosphere.2020.129431
28. Peng J, Yu Zh, Yifan Zh, et al. Probing the toxic interactions between polyvinyl chloride microplastics and human serum albumin by multispectroscopic techniques. SciTotal  2020;734:139219. doi: https://doi.org/10.1016/j.scitotenv.2020.139219   
29. Shasha L, Long S, Mei S, et al. Influence of para-substituted benzaldehyde derivatives with different push/pull electron strength groups on the conformation of human serum albumin and toxicological effects in zebrafish. Int J Biol Macromol. 2024;266(1):131246. doi: https://doi.org/10.1016/j.ijbiomac.2024.131246
30. Amal SA, Hussein Mohgah Sh, et al. Antioxidants in of shoe-makers exposed to organic solvents. Journal of Applied Sciences Research. 2008;4(9):1107-17.
31. Gulcin I, Saleh H. DPPH radical scavenging assay. Processes. 2023;11(8):2248. doi: https://doi.org/10.3390/pr11082248

Look through:

Lototska-Dudyk U.B. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-7587-8457

Kuzminov B.P. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
https://orcid.org/0000-0002-8693-1046

Lototska L.B. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
https://orcid.org/0000-0002-2690-1793

Klyuchivska O.Yu. Institute of cell biology of the NAS of Ukraine, Lviv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-8657-5945

Stoika R.S. Institute of cell biology of the NAS of Ukraine, Lviv, Ukraine
https://orcid.org/0000-0001-5719-2187

Lototska-Dudyk U.B., Kuzminov B.P., Lototska L.B., Klyuchivska O.Yu., Stoika R.S. Search for biological mechanisms of toxic action of shoe glues: cell viability in vitro, albumin damage and free radical generation. Medicni perspektivi. 2025;30(2):212-221.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333689

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

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

Key words: medical rehabilitation system, persons with disabilities, EU countries, NATO countries, war, peacekeeping operations

1. Garg A, Skempes D, Bickenbach J. Legal and Regulatory Approaches to Rehabilitation Planning: A Concise Overview of Current Laws and Policies Ad­dressing Access to Rehabilitation in Five European Countries. International Journal of Environmental Re­search and Public Health. 2020 Jun 18;17(12):4363. doi: https://doi.org/10.3390/ijerph17124363
2. Barth CA, Wladis A, Blake C, Bhandarkar P, O’Sullivan C. Users of rehabilitation services in 14 countries and territories affected by conflict. 1988–2018. Bulletin of the World Health Organization. 2020 Jul 8;98(9):599-614. doi: https://doi.org/10.2471/blt.19.249060
3. Iravani M, Riahi L, Abdi K, et al. A Comparative Study of the Rehabilitation Services Systems for People With Disabilities. Journal of Rehabilitation. 2021 Jan 1;21(4):544-63. doi:https://doi.org/10.32598/rj.21.4.3225.1   
4. Smarżewska D, Wereda WS, Jończyk JA. Asses­sment of the Health Care System in Poland and Other OECD Countries Using the Hellwig Method. International Journal of Environmental Research and Public Health. 2022 Dec 13;19(24):16733. doi: https://doi.org/10.3390/ijerph192416733
5. Duarte Cuervo C. Conflicto armado, paz y terapia ocupacional en Colombia: recorridos y desafíos. Cadernos Brasileiros de Terapia Ocupacional. 2023;31(spe):e3514. doi: https://doi.org/10.1590/2526-8910.ctoao273435143
6. Berlinets IA. [Foreign experience in the field of medical rehabilitation: prospects of use in Ukraine]. Derzhavne upravlinnya: udoskonalennya ta rozvytok [Internet]. 2019 Apr 25 [cited 2024 Sep 18];(4). Ukrainian. doi: https://doi.org/10.32702/2307-2156-2019.4.100 Available from: http://www.dy.nayka.com.ua/?op=1&z=1416
7. Kondratenko OO. International experience in ensuring state social protection of war veterans. State and Regions [Internet]. 2018 [cited 2024 Sep 18];1(61):102-6. Available from: http://pa.stateandregions.zp.ua/eng/archive/1_2018/20.pdf
8. Deshko L, Kostenko Y, Koval I, Mikhailina T, Oliinyk O. The right to health: Ukraine's international obligations and financial activity of public authorities in the context of reforming the national healthcare system. Georgian Med News [Internet]. 2020 Jul [cited 2024 Sep 18];1(304-305):177-82. Available from: https://pubmed.ncbi.nlm.nih.gov/32965271/
9. Deshko L, Vasylchenko O, Sherbak I, Galai V, Medvid A. Ukraine's international liabilities on initiation of measures for public health protection and the role of local authorities in implementation of health care policy. Georgian Med News [Internet]. 2021 [cited 2024 Sep 18];(312):163-8. Available from: https://pubmed.ncbi.nlm.nih.gov/33964846/
10. Thomson C, Mader M, Münchow F, Reifler J, Schoen H. European public opinion: united in supporting Ukraine divided on the future of NATO. International Affairs.2023 Nov 6;99(6):2485-500. doi: https://doi.org/10.1093/ia/iiad241
11. Nazarko Y, Iliashko O, Kaminska N. Implemen­tation of the right to health care in the countries of the European Union. Wiad Lek. 2019 [cited 2024 Sep 18];72(7):1337-42. doi: https://doi.org/10.36740/WLek201907120
12. Ivanishyn-Hayduchok L, Shapovalova V, Shapo­valov V. ICD-11: Organizational and Legal, Medical and Pharmaceutical, Social and Economic Issues of Imple­mentation of the Program of State Guarantees of Medical Care in 2022 in Ukraine, based on The Fundamental Principles of the European Union. SSP Modern Pharmacy and Medicine. 2022 Jun 24;2(2):1-14. doi:https://doi.org/10.53933/sspmpm.v2i2.53 
13. Muliar G, Zhuravel Y, Muzyka A, Cherniak O, Kachynska M, Orlovska I. International and legal, regional and specialized medical standards in the health care sector: experience of Ukraine. Georgian medical news. 2022 Feb;323:167-74. PMID: 35271491
14. Roser M, Ritchie H, Ortiz-Ospina E. Democracy index. Our World in Data [Internet]. 2024 May 22 [cited 2024 Sep 16]. Available from: https://ourworldindata.org/grapher/democracy-index-eiu?tab=table
15. Latysheva O, Yevtushenko M, Pronin S, Budo­viy M. Social Protection of the State: the Essence. Models and Features of Security. Herald of the Economic Sciences of Ukraine. 2020;2(39):95-104. doi: https://doi.org/10.37405/1729-7206.2020.2(39).95-104
16. Melkonyan AG. Specificity and features of func­tioning of Western public governance models. Public Administration and Governance. 2020;15:11-5. doi: https://doi.org/10.32843/2663-5240-2020-15-2
17. United Nations Office for Disaster Risk Reduction. 2023 Global Survey Report on Persons with Disabilities and Disasters [Internet]. 2023 Oct 11 [cited 2024 Sep 18]. Available from: https://reliefweb.int/report/world/2023-global-survey-report-persons-disabilities-and-disasters
18. Alanazi AM, Almutairi AM, Aldhahi MI, Alo­taibi TF, AbuNurah HY, Olayan LH, et al. The Intersec­tion of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs, Healthcare. 2023 Jan 30;11(3):389. doi: https://doi.org/10.3390/healthcare11030389
19. Frontera WR, DeGroote W, Ghaffar A, Axen I, Ehab Azim M, Battistella L, et al. Importance of Health Policy and Systems Research for Strengthening Reha­bilitation in Health Systems: A Call to Action to Accelerate Progress. Advances in Rehabilitation Science and Practice [Internet]. 2023 Nov 23 [cited 2024 Sep 16];4. doi: https://doi.org/10.3389/fresc.2023.1303135
20. United Nations. Convention on the Rights of Persons with Disabilities [Internet]. 2006 Dec 13 [cited 2024 Sep 16]. Available from: https://www.ohchr.org/en/instruments-mechanisms/­instrumentsconvention-rights-personsdisabilities
21. World Health Organization. Strengthening reha­bilitation in health systems. Executive board. 152nd ses­sion EB152(10) [Internet]. 2023 Feb 2 [cited 2024 Sep 16]. Available from: https://apps.who.int/gb/ebwha/pdf_files/­EB152/B152(10)-en.pdf
22. World Health Organization. Strengthening rehabi­litation in health systems. Seventy-sixth world health assembly WHA76.6 [Internet]. 2023 May 30 [cited 2024 Sep 16]. Available from: https://apps.who.int/gb/eb­wha/pdf_files/WHA76/A76_R6-en.pdf
23. Musenyente E, Han ML, Knigge M. Implemen­tation of UN Convention on the Rights of Persons with Disabilities in public and private schools in three districts of Uganda. African Journal of Disability. 2022 Oct 27;11:908. doi: https://doi.org/10.4102/ajod.v11i0.908
24. Fortune N, Madden RH, Clifton S. Health and Ac­cess to Health Services for People with Disability in Aus­tralia: Data and Data Gaps. International Journal of Environ­mental Research and Public Health. 2021 Nov 8;18(21):11705. doi: https://doi.org/10.3390/ijerph182111705
25. Stavert J. The CRPD and mental health law reform in Scotland. International Journal of Law and Psychiatry. 2024 May;94:101991. doi: https://doi.org/10.1016/j.ijlp.2024.101991
26. Ministry of Veterans Affairs of Ukraine. Analy­tical information based on data from the Ministry of Veterans Affairs of Ukraine [Internet]. 2022 [cited 2024 Sep 18]. Available from: https://data.mva.gov.ua/?fbclid=IwAR2OWnHkc9i1eRcNxWI4T6gvQz61X7A3tEqQP5-FOYeYoPcaq0EBNRyXSYI
27. Ipatov AV, Moroz OM, Golik VA, Perepe­lych­na RY, Khanyukova IY, Korobkin YI, et al. [Key indi­cators of disability and activities of medical-social expert commissions of Ukraine for 2015: analytical and infor­mational reference book]. Dnipro: Accent PP; 2016. 162 p. Ukrainian.
28. Ipatov AV, Moroz OM, Khanyukova IYa, et al. [Key indicators of disability and activities of medical and social expert commissions of Ukraine for 2018: analytical and informational reference book]. Dnipro: Accent PP; 2019. 180 p. Ukrainian.
29. Ipatov AV, Moroz OM, Khanyukova IYa, Kuz­mina LV, Ulyanova AM. [Key indicators of disability and activities of medical and social expert commissions of Ukraine for 2021: analytical and informational reference book]. Dnipro: Accent PP; 2022. 188 p. Ukrainian.
30. Ipatov AV, Moroz OM, Khanyukova IuA, Gondu­lenko NO, Sanina NA, Ulyanova AM. [Key indicators of disability and activities of medical and social expert commissions of Ukraine for 2020: analytical and informational reference book]. Dnipro: Aktsent PP; 2021. 188 p. Ukrainian.
31. [Social Protection of the Population of Ukraine. Statistical Yearbook]. Kyiv; 2019. 123 p. Ukrainian.
32. [Social Protection of the Population of Ukraine. Statistical Yearbook for 2019]. Kyiv; 2020. 115 p. Ukrainian.
33. [Social Protection of the Population of Ukraine. Statistical Yearbook for 2020]. Kyiv; 2021. 121 p. Ukrainian.
34. [Social Protection of the Population of Ukraine. Statistical Yearbook for 2022]. Kyiv; 2023. 116 p. Ukrainian.
35. [Social Protection of the Population of Ukraine. Statistical Yearbook]. Kyiv; 2018. 121 p. Ukrainian.
36. [Social Protection of the Population of Ukraine. Statistical Yearbook]. Kyiv; 2017. 122 p. Ukrainian.
37. [Social Protection of the Population of Ukraine. Statistical Yearbook]. Kyiv; 2016. 124 p. Ukrainian.
38. [Social Protection of the Population of Ukraine. Statistical Yearbook]. Kyiv; 2015. 124 p. Ukrainian.
39. Shevchuk VI, Yavorovenko OB, Belyaeva NM, Kurylenko IV. Medical Rehabilitation System and Its Quality Control in Developed Countries of The World. Wiadomości 2020;73(9):2040-3. doi: https://doi.org/10.36740/wlek202009227
40. Light Joints Physiotherapy. Military Rehabili­tation: A Short UK Defense History [Internet]. 2022 Jun 21 [cited 2024 Sep 18]. Available from: https://www.linkedin.com/pulse/military-rehabilitation-short-uk-defence-history-
41. Osborne A, McGill A, Kiernan MD. Pathways into Mental Health Services for UK Veterans [Internet]. 2021 Mar [cited 2024 Sep 18]. Available from: https://covenantfund.org.uk/wp-content/uploads/2021/03/2021-Pathways_into_Mental_Health_Services_for_UK_Veterans.pdf
42. Aitken D, Kinane C. An Evaluation of Veteran-Led Peer Support Services for UK Veterans with Complex Mental Health Needs. Journal of Veterans Studies. 2024;10(1):76-84. doi: https://doi.org/10.21061/jvs.v10i1.480
43. [Spanish Society of Rehabilitation and Physical Medicine (SERMEF). Inpatient rehabilitation care is one of the greatest shortcomings in the Spanish healthcare system]. [Internet]. 2024 Mar 23 [cited 2024 Sep 18]. Spanish. Available from: https://www.sermef.es/la-atencion-rehabilitadora-en-regimen-hospitalaria-es-una-de-las-mayores-carencias-de-la-sanidad-espanola/
44. European Observatory on Health Systems and Policies. Spain: Country Health Profile 2023 [Internet]. 2023 [cited 2024 Sep 18]. Available from: https://eurohealthobservatory.who.int/publications/m/spain-country-health-profile-2023
45. Citarella A, Sánchez Iglesias AI, González Bal­lester S, Gentil Gutiérrez AA, Maldonado Briegas JJ, Vicente Castro F, et al. Being disabled persons in Spain: policies, stakeholders and services. Revista INFAD de Psicología International Journal of Developmental and Educational Psychology. 2020 Jun 29;1(1):507-16. doi: https://doi.org/10.17060/ijodaep.2020.n1.v1.1869
46. European Commission. Spain: Country Health Profile 2023 [Internet]. 2023 [cited 2024 Sep 17]. Available from: https://health.ec.europa.eu/document/download/2d9493b1-3e86-4d30-b603-1e6f6503284c_en?filename=2023_chp_es_english_0.pdf
47. [Ministry of Defense. Order DEF/83/2016, of January 25, establishing the Office for Disability Assis­tance in the Armed Forces. Official State Gazette]. [Internet]. 2016 Feb 2 [cited 2024 Sep 18]. Spanish. Available from: https://www.boe.es/buscar/act.php?id=BOE-A-2016-955
48. Ministerodella Salute. Riabilitazione [Internet]. Rome: Ministerodella Salute; 2024 [cited 2024 Sep 18]. Available from: https://www.salute.gov.it/portale/lea/dettaglioContenutiLea.jsp?lingua=italiano&id=4720&area=Lea&menu=ospedaliera
49. General Inspectorate of Military Medical Ser­vices. Italian Republic. Military Medicine Worldwide [Internet]. 2024 Jan 31 [cited 2024 Sep 18]. Available from: https://military-medicine.com/almanac/67-italian-republic.html
50. Caminsky NG, Wong EG. Trauma systems in Canada: striving for quality across an expansive landmass. Emergency and Critical Care Medicine. 2023 Sep;3(3):89-93. doi: https://doi.org/10.1097/ec9.0000000000000102
51. Canadian Institute for Health Information. National Rehabilitation Reporting System Privacy Impact Assessment. 2022 [Internet]. 2022 [cited 2024 Sep 18]. Available from: https://www.cihi.ca/sites/default/files/document/national-rehab-reporting-system-pia-en.pdf
52. Standing Committee on National Defense. Cana­dian Armed Forces Health Care and Transition Services [Internet]. 2023 Nov [cited 2024 Sep 18]. Available from: https://www.ourcommons.ca/Content/Committee/441/NDDN/Reports/RP12673550/nddnrp06/nddnrp06-e.pdf
53. Tien H. The Canadian Forces trauma care system. Canadian Journal of Surgery. 2011 Dec 1;54(6):S112-7. doi: https://doi.org/10.1503/cjs.025311
54. Gerdes N, Zwingmann C, Jäckel WH. The system of rehabilitation in Germany. Rehabilitation (Stuttg) [Internet]. 2001 [cited 2024 Sep 12];40(5):317-25. Available from: https://www.researchgate.net/publication/239572127_The_system_of_rehabilitation_in_Germany
55. Perreau E. Financing of Care Services for Persons with Disabilities: Fact Sheet Germany. European As­sociation of Service Providers for Persons with Disabilities [Internet]. 2020 [cited 2024 Sep 16]. Available from: https://easpd.eu/fileadmin/user_upload/Publications/EAS_008-21_factsheet_financing_care_services_DE_v2.pdf
56. Rehabilitation for soldiers. REHACARE [In­ternet]. [cited 2024 Sep 16]. Available from: https://www.rehacare.com/en/business/rehabilitation-for-soldiers
57. Kosycarz E. Rehabilitation in the Polish health system and its financing methods. Finance [Internet]. 2018 [cited2024 Sep 12];1(11):161-75. doi: https://doi.org/10.24425/finanse.2018.125398
58. [National Health Fund. Annex No. 1: Description of the POZ PLUS pilot program. Białystok]. [Internet]. 2017 [cited 2024 Sep 16]. Polish. Available from: https://www.nfz-bialystok.pl/wp-content/uploads/2017/06/Zał.-1_Opispilotażu.docx
59. Organisation for Economic Co-operation and De­velopment (OECD). France. Country Health Profile 2023 [Internet]. 2023 Dec 15 [cited 2024 Sep 16].
    Available from: https://www.oecd.org/en/publications/france-country-health-profile-2023_07c48f9f-en.html 
60. Centre des Liaisons Européennes et Internationales de SécuritéSociale (CLEISS). The French health care system [Internet]. 2021 [cited 2024 Sep 16]. Available from: https://www.cleiss.fr/particuliers/venir/soins/ue/systeme-de-sante-en-france_en.html
61. [France Ministry of the Armed Forces. Order of December 20, 2021 on the organization of the armed forces health service]. [Internet]. 2021 Dec 20 [cited 2024 Sep 16]. French. Available from: https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000044553939
62. Smolinski G, Licina D. After the Trauma: The Role of Rehabilitation Medicine in U.S. DoD Global Health Engagement. Military Medicine. 2022 Oct 14;188(1-2):3-5. doi: https://doi.org/10.1093/milmed/usac302
63. Number of veterans in the United States in 2022, by service-connected disability status [Internet]. 2024 [cited 2024 Sep 16]. Available from: https://www.statista.com/statistics/250316/us-veterans-by-disability-status/
64. Kamenov K, Mills JA, Chatterji S, Cieza A. Needs and unmet needs for rehabilitation services: a scoping review. Disability and Rehabilitation. 2018 Jan 5;41(10):1227-37. doi: https://doi.org/10.1080/09638288.2017.1422036
65. The Lancet. Prioritising disability in universal health coverage. The Lancet. 2019 Jul;394(10194):187. doi: https://doi.org/10.1016/s0140-6736(19)31638-1
66. Negrini S, Kiekens C, Heinemann AW, Özça­kar L, Frontera WR. Prioritizing people with disabilities implies furthering rehabilitation. The Lancet. 2020 Jan;395(10218):111. doi:https://doi.org/10.1016/s0140-6736(19)32623-6
67. Bressi F, Rogliani R. Health policies and reha­bilitation. Giornale Italiano di Medicina Riabilitativa [Internet]. 2023 Dec [cited 2024 Sep 16];39(4). Available from: https://springerhealthcare.it/mr/archivio/politiche-sanitarie-e-riabilitazione/
68. World Population by Country in 2021 [Internet]. 2024 [cited 2024 Sep 16]. Available from: https://database.earth/population/by-country/2021
69. Federal Statistical Office of Germany. Key table: Gross domestic product (GDP). current prices [Internet]. 2024 [cited 2024 Sep 16]. Available from: https://www.destatis.de/EN/Themes/Countries-Regions/International-Statistics/Data-Topic/Tables/BasicData_GDP.html
70. World Bank. Current health expenditure (% of GDP) [Internet]. 2024 [cited 2024Sep 16]. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS 
71. Hospital beds by function and type of care [Internet]. 2024 [cited 2024Sep 16]. Available from: https://ec.europa.eu/eurostat/databrowser/view/hlth_rs_bds1/bookmark/table?lang=en&bookmarkId=13462546-495b-4885-88e9-06087c90e3f4 
72. Community hospital beds per 1.000 U.S. population from 2000 to 2022 [Internet]. 2024 [cited 2024Sep 16]. Available from: https://www.statista.com/statistics/184546/community-hospital-beds-per-1000-population-in-the-us/ 
73. Density of hospital beds in Canada from 1976 to 2021 [Internet]. 2024 [cited 2024Sep 16]. Available from: https://www.statista.com/statistics/831668/density-of-hospital-beds-canada/
74. Number of hospital beds in the United Kingdom (UK) from 2000 to 2022 [Internet]. 2024 [cited 2024Sep 16]. Available from: https://www.statista.com/statistics/473264/number-of-hospital-beds-in-the-united-kingdom-uk/
75. [Center for Medical Statistics of the Ministry of Health of Ukraine. Health indicators and utilization of healthcare resources in Ukraine (general). 2022]. [In­ternet]. 2022 [cited 2024Sep 16]. Ukrainian. Available from: http://medstat.gov.ua/im/upload/DOV_1_ZAG-2021.zip  
76. World Health Organization. Density of physicians (per 10 000 population) [Internet]. 2024 [cited 2024Sep 16]. Available from: https://data.who.int/indicators/i/CCCEBB2/217795A#disclaimer-maps
77. Number of nurses per 1.000 inhabitants in selected countries worldwide [Internet]. 2024 [cited 2024Sep 16]. Available from: https://www.statista.com/statistics/283124/selected-countries-nurses-per-1-000-inhabitants/ 
78. Statistics Canada. Canadian Survey on Disability. 2017 to 2022 [Internet]. 2023Dec 1 [cited 2024 Sep 16]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/231201/dq231201b-eng.htm 
79. Disability in the U.S.: statistics and facts [Internet]. 2024 [cited 2024 Sep 16]. Available from: https://www.statista.com/topics/4380/disability-in-the-us/#topicOverview
80. Kirk-WadeE, Stiebahl S, Wong  UK disability statistics: prevalence and life experiences. House of Com­mons Library [Internet]. 2024 Oct 2 [cited 2024 Sep 16]. Available from: https://researchbriefings.files.parliament.uk/documents/CBP-9602/CBP-9602.pdf 
81. [Convention on the Rights of Persons with Disabilities]. [Internet]. 2006 [cited 2024Sep 16]. Ukrai­nian. Available from: https://zakon.rada.gov.ua/laws/show/995_g71#Text 
82. [Ministry of Health of Ukraine. International Clas­sification of Functioning. Disability and Health (ICF)]. [Internet]. [cited 2024Jan 18]. Ukrainian. Available from: https://moz.gov.ua/uk/mkf
83. PoliakovaO, Petrusha S, Bayda  Analytical Re­port: Access to Rehabilitation Services for Adults and Chil­dren with Disabilities [Internet]. 2023 [cited 2024 Jan 18]. Ukrainian. Available from: https://naiu.org.ua/wp-content/uploads/2023/06/NAPD_2003_EN.pdf
84. Nagoriyanskii Improvement of public admi­nistration of the medical rehabilitation system as an in­tegral part of public health policy. Clinical and Preventive Medicine. 2021 Jun 25;(2):63-9. doi: https://doi.org/10.31612/2616-4868.2(16).2021.08
85. RomaniukP, Semigina  Ukrainian health care system and its chances for successful transition from Soviet  legacies. Globalization and Health [Internet]. 2018 Nov 23;14(1):116. doi: https://doi.org/10.1186/s12992-018-0439-5  
86. HavlovskyOD, Holovanova IA, Khorosh MV, Tovstyak  The importance of research on the dynamics of disability in Ukraine among the participants of the war to determine volume of medical assistance and rehabilitation. Clinical and Preventive Medicine. 2019 Oct 17;(3-4):22-30. doi: https://doi.org/10.31612/2616-4868.3(9).2019.03 
87. MarunychVV, Shevchuk VI, Yavorovenko  [Methodological manual on rehabilitation of persons with disabilities. Manual]. Vinnytsia: O. Vlasiuk; 2006. 212 p. Ukrainian.
88. StriukovVV, Grynko TV, Krupskyi OP, Va­zov  Current state and strategic directions of de­velopment of state management of nursing education in Ukraine. Medicni perspektivi. 2022 Mar 30;27(1):174-83. doi: https://doi.org/10.26641/2307-0404.2022.1.254469  
89. Parovyshnyk OV. [Ensuring the rights of persons with disabilities in Ukraine: theoretical and practical foundations of administrative and legal regulation]. Kharkiv: Pravo; 2016. 264 p.
90. [Assessment of the system of disability limitation and rehabilitation in Ukraine. Summary of the WHO Consultative Mission Report – International Society of Physical and Rehabilitation Medicine]. Ukrainskyi Visnyk Medyko-Sotsialnoi Ekspertyzy [Internet]. 2016 [cited 2024 Feb 1];(1):21-5. Available from: http://www.irbis-nbuv.gov.ua/cgi-bin/irbis_nbuv/cgiirbis_64.exe?C21COM=2&I21DBN=UJRN&P21DBN=UJRN&IMAGE_FILE_DOWNLOAD=1&Image_file_name=PDF/ujmse_2016_1_8.pdf
91. Bogdanov SG. [Government mechanism of organization of medical rehabilitation system in Ukraine]. Public Administration and Governance in Ukraine. 2020;(16):40-5. Ukrainian. doi: https://doi.org/10.32843/2663-5240- 2020-16-7
92. National Health Service of Ukraine. Contracts for medical care under the program of medical guarantees [Internet]. 2024 Jan 5 [cited 2024 Feb 1]. Available from: https://edata.e-health.gov.ua/e-data/dashboard/pmg-contracts
93. Analytical report on the provision of rehabilitation services for adults and children with disabilities. All-Ukrainian Public Association "National Assembly of People with Disabilities of Ukraine" within the project "Response and Recovery with the Needs of People with Disabilities under the Leadership and Coordination of Organizations of Persons with Disabilities", funded by the European Disability Forum and Christian Blind Mission (CBM) [Internet]. 2023 May 30 [cited 2024 Feb 1]. Available from: https://naiu.org.ua/wp-content/uploads/2023/07/2023_NAIU_AnaliticalReport-Rehabilitation_v02-1.pdf

Look through:

Ozerniuk H.V. Odesa Politechnic National University, Odesa, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-5030-6356

Balan O.S. Odesa Politechnic National University, Odesa, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-6711-5687

Prokopenko O. Estonian Entrepreneurship University of Applied Sciences, Tallinn, Estonia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-1362-478X

Stasiuk Yu.M. Oles Honchar Dnipro National University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-6644-8658

Krupskyi O.P. Oles Honchar Dnipro National University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-1086-9274

Ozerniuk H.V., Balan O.S., Prokopenko O., Stasiuk Yu.M., Krupskyi O.P. The system of medical rehabilitation of the disabled people: experience of the leading EU and NATO countries. Medicni perspektivi. 2025;30(2):222-234.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333692

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

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

Key words: efficiency of the health care system, digitalization, management, health workforce, competencies, conceptual model

1. Robertsone G, Lapiņa I. Digital transformation as a catalyst for sustainability and open innovation. Journal of Open Innovation: Technology, Market, and Complexity. 2023 Mar 1;9(1):100017. doi: https://doi.org/10.1016/j.joitmc.2023.100017
2. Odone A, Buttigieg S, Ricciardi W, Azzopardi-Mus­cat N, Staines A. Public health digitalization in Europe: EUPHA vision, action and role in digital public health. Euro­pean Journal of Public Health. 2019 Oct 1;29(Suppl 3):28-35. doi: https://doi.org/10.1093/eurpub/ckz161
3. Ziadlou D. Strategies during digital transformation to make progress in achievement of sustainable deve­lopment by 2030. Leadership in Health Services. 2021 Jun 25;34(4):375-91. doi: https://doi.org/10.1108/LHS-08-2020-0056
4. Trenerry B, Chng S, Wang Y, Suhaila ZS, Lim SS, Lu HY, et al. Preparing Workplaces for Digital Transformation: An Integrative Review and Framework of Multi-Level Factors. Frontiers in Psychology. 2021 Mar 23;12:620766. doi: https://doi.org/10.3389/fpsyg.2021.620766
5. Golinelli D, Boetto E, Carullo G, Nuzzolese AG, Landini MP, Fantini MP. Adoption of Digital Techno­logies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature. Journal of Medical Internet Research. 2020 Nov 6;22(11):e22280. doi: https://doi.org/10.2196/22280
6. Health system performance assessment: A frame­work for policy analysis. Copenhagen (Denmark): Euro­pean Observatory on Health Systems and Policies. [Internet]. 2022 [cited 2025 Jan 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK590192/
7. Sharma A, Harrington RA, McClellan MB, Tura­khia MP, Eapen ZJ, Steinhubl S, et al. Using Digital Health Technology to Better Generate Evidence and Deliver Evidence-Based Care. Journal of the American College of Cardiology. 2018 Jun 12;71(23):2680-90. doi: https://doi.org/10.1016/j.jacc.2018.03.523
8. Avagyan A, Minasyan E, Khachatryan H, Gevor­gyan S. Possible Process Optimization: Innovative Digital Health Implementation Models. In: Kozlakidis Z, Mura­dyan A, Sargsyan K, editors. Digitalization of Medicine in Low- and Middle-Income Countries: Paradigm Changes in Healthcare and Biomedical Research. Cham: Springer InternationalPublishing;  p. 103-23. doi: https://doi.org/10.1007/978-3-031-62332-5_10
9. Librarian I. Developing Competencies and Pro­fessional Standards for Health Promotion Capacity Building in Europe. The CompHP Project Handbooks [Internet]. [cited 2025 Jan 18]. Available from: https://www.hrhresourcecenter.org/node/4546.html
10. Chukwu E, Mechael P, Edelman JK, Layer E. State of digital health 2023. Global Digital Health Monitor [Internet]. 2023 [cited 2025 Jan 18]. Available from: https://digitalhealthmonitor.org/stateofdigitalhealth23
11. Long LA, Pariyo G, Kallander K. Digital Techno­logies for Health Workforce Development in Low- and Middle-Income Countries: A Scoping Review. Global Health: Science and Practice. 2018 Oct 10;6(Suppl 1):S41-S48. doi: https://doi.org/10.9745/GHSP-D-18-00167
12. Brommeyer M, Liang Z. A Systematic Approach in Developing Management Workforce Readiness for Digital Health Transformation in Healthcare. International Journal of Environmental Research and Public Health. 2022 Jan;19(21):13843. doi: https://doi.org/10.3390/ijerph192113843
13. Adeniran IA, Efunniyi CP, Osundare OS, Abhuli­men AO. Data-driven decision-making in healthcare: Improving patient outcomes through predictive modeling. International Journal of Scholarly Research in Mul­tidisciplinary Studies. 2024 Aug 30;5(1):059-67. doi: https://doi.org/10.56781/ijsrms.2024.5.1.0040
14. Future of digital health systems: report on the WHO symposium on the future of digital health systems in the European region: Copenhagen, Denmark, 6-8 February 2019. World Health Organization. Regional Office for Europe [Internet]. 2019 [cited 2025 Jan 10]. Available from: https://iris.who.int/handle/10665/329032
15. Digital Health in the European Region: the ongoing journey to commitment and transformation. World Health Organization. Regional Office for Europe [Internet]. 2023 [cited 2025 Mar 18]. Available from: https://iris.who.int/handle/10665/372051
16. Rajan D, Rohrer K, Koch K, Kunjumen T, Dial­lo K, Berumen AV, et al. Health system performance assessment: A framework for policy analysis. European Observatory on Health Systems and Policies. Resource generation [Internet]. 2022 [cited 2025 Jan 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK590195/
17. Data and digital health in the WHO European Region in 2023: a year in review. World Health Orga­nization [Internet]. 2024 [cited 2025 Mar 18]. Available from: https://iris.who.int/handle/10665/375768
18. Health and care workforce in Europe: time to act. World Health Organization. Regional Office for Europe. World Health Organization [Internet]. 2022 [cited 2025 Mar 18]. Available from: https://iris.who.int/handle/10665/362379
19. Langins M, Borgermans L. Strengthening a com­petent health workforce for the provision of coordina­ted/integrated health services: working document [Inter­net]. 2015 [cited 2025 Jan 10]. Available from: https://iris.who.int/handle/10665/362099
20. [Digital Competence Framework for Healthcare Workers of Ukraine. Version 1.0]. [Internet]. 2023 [cited 2025 Mar 18]. Ukrainian. Available from: https://cutt.ly/ue4RmmzV
21. [On the Approval of Priority Directions for the Development of the Healthcare Sector for 2023-2025. Order Ministry of Health of Ukraine 2022 Oct 07 No. 1832]. Ministerstvo okhorony zdorovia Ukrainy [In­ternet]. 2022 [cited 2025 Jan 10]. Ukrainian. Available from: https://zakon.rada.gov.ua/go/v1832282-22
22. [On the Approval of the Strategy for the Deve­lopment of the Healthcare System Until 2030 and the Operational Action Plan for Its Implementation in 2025–2027. Ordinance Cabinet of Ministers of Ukraine of 2025 Jan 17 No. 34-r, Kyiv]. [Internet]. 2025 [cited 2025 Jan 10]. Ukrainian. Available from: https://www.kmu.gov.ua/npas/pro-skhvalennia-stratehii-rozvytku-systemy-okhorony-zdorovia-na-period-do-2030-roku-ta-zatverdzhennia-operatsiinoho-planu-zakhodiv-z-ii-realizatsii-u-20252027-rokakh-34r-170125
23. Saigí-Rubió F, Romeu T, Encuentra EH, Gui­tert M, Andrés E, Reixach E. Design, Implementation, and Analysis of an Assessment and Accreditation Model to Evaluate a Digital Competence Framework for Health Professi onals: Mixed Methods Study. JMIR Medical Education.2024 Oct 17;10(1):e53462. doi: https://doi.org/10.2196/53462
24. Hautz SC, Hoffmann M, Exadaktylos AK, Hautz WE, Sauter TC. Digital competencies in medical education in Switzerland: an overview of the current situation. GMS Journal for Medical Education. 2020 Nov 16;37(6):Doc62. doi: https://doi.org/10.3205/zma001355
25. Simon KI, Kriachkova LV, Zakharov SV, Zait­sev VV. [Using digital competencies to develop leadership and management potential in higher medical education students]. Klinichna ta profilaktychna medytsyna. 2024 May 8;(3):115-24. Ukrainian. doi: https://doi.org/10.31612/2616-4868.3.2024.14
26. Kriachkova LV, Simon KI, Borvinko EV, Seme­nova LS. [Using digital competencies to develop lea­dership and management potential in higher medical edu­cation students]. Klinichna ta profilaktychna medytsyna. 2022;2(20):73-80. doi: https://doi.org/10.31612/2616-4868.2(20).2022.09
27. Kriachkova LV, Korobko MIu. [Involvement of different stakeholder groups in ensuring children’s dental public health: analysis and perspectives]. Klinichna ta profilaktychna medytsyna. 2024 Mar 15;(1):79-86. Ukrai­nian. doi: https://doi.org/10.31612/2616-4868.1.2024.10
28. Lang TA, Secic M. How to Report Statistics in Medicine: Annotated Guidelines for Authors , Editors, and Reviewers. ACP Press; 2006. 512 p.
29. Mainz A, Nitsche J, Weirauch V, Meister S. Mea­su­ring the Digital Competence of Health Professionals: Scoping Review. JMIR Medical Education. 2024 Mar 29;10:e55737. doi: https://doi.org/10.2196/55737
30. Mauro M, Noto G, Prenestini A, Sarto F. Digital transformation in healthcare: Assessing the role of digital technologies for managerial support processes. Techno­lo­gical Forecasting and Social Change. 2024 Dec 1;209:123781. doi: https://doi.org/10.1016/j.techfore.2024.123781
31. Stoumpos AI, Kitsios F, Talias MA. Digital Trans­formation in Healthcare: Technology Acceptance and Its Applications. International Journal of Environmental Research and Public Health. 2023 Feb 15;20(4):3407. doi: https://doi.org/10.3390/ijerph20043407
32. Zettelmann A, Cano JA. How Change Mana­gement Activates Digital Transformation in Healthcare [Internet]. HealthManagement.org. 2024 May 24 [cited 2025 Mar 18];24(2):101-3. Available from: https://healthmanagement.org/c/healthmanagement/IssueArticle/how-change-management-activates-digital-transformation-in-healthcare
33. Global strategy on digital health 2020-2025. World Health Organization [Internet]. 2021 [cited 2025 Mar 18]. 50 p. Available from: https://www.who.int/publications/i/item/9789240020924
34. Konopik J, Blunck D. Development of an Evi­dence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review. Journal of Medical Internet Research. 2023 Jun 8;25:e41512. doi: https://doi.org/10.2196/41512
35. Abernethy A, Adams L, Barrett M, et al. The Pro­mise of Digital Health: Then, Now, and the Future. NAM Perspectives.2022 Jun 27;2022:10.31478/202206e. doi: https://doi.org/10.31478/202206e
36. [About the approval of the plan for approaching the implementation of the concept for the development of electronic health care. Cabinet of Ministers of Ukraine. Order of 2021 Sept 29, No. 1175-r, Kyiv]. [Internet]. 2021 [cited 2025 Mar 18]. Ukrainian. Available from: https://zakon.rada.gov.ua/go/1175-2021-р
37. Bonny S, Cahlikova T. Evaluating the effects of collaborative governance: Case of a digital education project. Evaluation and Program Planning. 2024 Nov 30;109:102522. doi: https://doi.org/10.1016/j.evalprogplan.2024.102522
38. Tortorella GL, Fogliatto FS, Espôsto KF, Mac Cawley AF, Vassolo R, Tlapa D, et al. Healthcare costs’ reduction through the integration of Health­ca­re 4.0 technologies in developing economies. Total Quality Management & Business Excellence. 2022 Feb 17;33(3-4):467-87.
    doi: https://doi.org/10.1080/14783363.2020.1861934
39. Kakale MA. Of digital transformation in the healthcare (systematic review of the current state of the literature). Health and Technology. 2024 Jan 1;14(1):35-50. doi: https://doi.org/10.1007/s12553-023-00803-w
40. Canfell OJ, Woods L, Meshkat Y, Krivit J, Guna­shanhar B, Slade C, et al. The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis. Journal of Medical Internet Research. 2024 Mar 11;26:e47715. doi: https://doi.org/10.2196/47715
41. Simon KI. [Approaches to Assessing the Com­pliance of Healthcare Institution Websites with Modern Digital Standards]. Intermedical journal. 2024 Nov 28;(2):161-6.
    doi: https://doi.org/10.32782/2786-7684/2024-2-28
42. Alanazi AT. Digital Leadership: Attributes of Mo­dern Healthcare Leaders. Cureus. 2022 Feb 7;14(2):e21969. doi: https://doi.org/10.7759/cureus.21969

Look through:

Kriachkova L.V. Dnipro State Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-7635-2609

Simon K.I. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-4155-5873

Kriachkova L.V., Simon K.I. Medico-social rationale for the development of digital personnel potential in healthcare. Medicni perspektivi. 2025;30(2):234-246.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333698

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

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

Key words: affordability, diabetes melitus, glucose-lowering drugs, reimbursement, solvency adequacy ratio, pharmacoeconomic research

1. Diabetes Atlas. International diabetes federation. 10th edition [Internet]. [cited 2024 Mar 01]. Available from:http://www.diabetesatlas.org  
2. Ozawa S, Higgins CR, Yemeke TT, Nwokike JI, Evans L, Hajjou M, et al. Importance of medicine quality in achieving universal health coverage. PLoS One. 2020;15(7):e0232966. doi: https://doi.org/10.1371/journal.pone.0232966
3. Huang Y, Jiang Y, Zhang L, Mao W, van Bo­ven JFM, Postma MJ, et al. Availability, use, and afforda­bility of medicines in urban China under universal health coverage: an empirical study in Hangzhou and Baoji. BMC healthservices  2018;18(1):218. doi: https://doi.org/10.1186/s12913-018-2993-1
4. Onarheim KH, Sisay MM, Gizaw M, Mo­land KM, Norheim OF, Miljeteig I. Selling my sheep to pay for medicines-household priorities and coping strategies in a setting without universal health coverage. BMC health services research. 2018;18(1):153. doi: https://doi.org/10.1186/s12913-018-2943-y  
5. Chow CK, Ramasundarahettige C, Hu W, Alha­bib K, Avezum A, Cheng X, et al. Availability and affor­dability of essential medicines for diabetes across high-income, middle-income, and low-income countries: A prospective epidemiological study. Lancet Diabetes Endocrinol.2018;6:798-808. doi: https://doi.org/10.1016/S2213-8587(18)30233-X
6. Nguyen TN, Yusuf S, Chow CK. Availability and Affordability of Medicines for Diabetes and Cardio­vascular Disease across Countries: Information Learned from the Prospective Urban Rural Epidemiological Study. Diabetology.2022;3(1):236-45. doi: https://doi.org/10.3390/diabetology3010014
7. Nemchenko A, Nazarkyna V. [Improvement of mo­dern approaches to reference pricing for insulin preparations]. Farmatsevtychnyi zhurnal. 2020;5:23-33. Ukrainian. doi: https://doi.org/32352/0367-3057.5.20.03
8. Chumak І. [Intensification of therapyof type 2 diabetes according to modern guidelines]. Diabetology, Thyroidology, Metabolic disorders. 2021;1:53. Ukrainian.
9. [Solvency adequacy ratio]. [Internet]. [cited 2024 Mar 01]. Ukrainian. Available from: https://www.pharmencyclopedia.com.ua/article/8076/koeficiyent-adekvatnosti-platospromozhnosti
10. Zaliska O, Maksymovych N, Zabolotnya Z, Za­lisky B. [Analysis of the list and availability of medicines used for the treatment of atopic dermatitis in Ukraine]. Farmatsevtychnyi Zhurnal. 2022;77(2):25-37. Ukrainian. doi: https://doi.org/10.32352/0367-3057.2.22.03
11. Yakovleva L, Matyashova N, Stalna O. [Analysis of the assortment and economic availability of means affecting the structure and mineralization of bones pre­sented on the pharmaceutical market of Ukraine]. Farmatsevtychnyi Zhurnal.2018;1-2:5-11. Ukrainian. doi: https://doi.org/10.32352/0367-3057.1-2.18.01
12. [Analysis of the treatment system and calculation of economic losses from diabetes in Ukraine]. Kyiv; 2020. 30 p. Ukrainian.
13. Chekman IS, Bondur VV, Klymenko OV. [Com­bined pharmacotherapy of type 2 diabetes]. Ratsionalna farmakoterapiia. 2016;2(39):25-31. Ukrainian.
14. American Diabetes Association. Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(1):S1-S2. doi: https://doi.org/10.2337/dc21-Sint
15. Kovalevska IV, Ruban OA, Yevtushenko OM. [Researches of the assortment of drugs for the treatment of diabetes II type оn the pharmaceutical market of Ukraine]. Farmatsevtychnyi Zhurnal. 2019;2:13-23. Ukrainian. doi: https://doi.org/10.32352/0367-3057.2.19.02
16. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes. Diabetes 2022;45(1):125-43. doi: https://doi.org/10.2337/dc22-S009
17. [On approval of the list of medicines and medical products for free and (or) discounted outpatient provision of certain categories of citizens of the Republic of Kazakhstan with certain diseases (conditions)]. [Internet]. [cited 2024 Mar 01]. Kazakh. Available from: https://adilet.zan.kz/kaz/docs/V2100023885

Look through:

Vlasenko I.O. Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
е-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-5530-4189

Gladyshev V.V. Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
е-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. 
https://orcid.org/0000-0001-5935-4856

Zaliska О.M. Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
е-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-1845-7909

Davtian L.L. Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
https://orcid.org/0000-0001-7827-2418

Vlasenko I.O., Gladyshev V.V., Zaliska О.M., Davtian L.L. Study of affordability of pharmaceutical provision for type 2 diabetes therapy in Ukraine. Medicni perspektivi. 2025;30(2):247-254.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333711

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

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

Key words: COVID-19 pandemic, health financing system, financial sustainability, public health sector, remediation, health development strategy

1. COVID-19: Impact of the pandemic on healthcare delivery. The third of five BMA reports. [Internet]. 2024 Sep 18 [cited 2025 Jan 14]. Available from: https://www.bma.org.uk/advice-and-support/covid-19/what-the-bma-is-doing/covid-19-impact-of-the-pandemic-on-healthcare-delivery#heading_bc72014323af4e31990d37ce4b3cef63
2. Haldane V, De Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27:964-80. doi: https://doi.org/10.1038/s41591-021-01381-y
3. Pujolar G, Oliver-Anglès A, Vargas I, Váz­quez ML. Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review. Int J Environ ResPublic  2022;19(3):1749. doi: https://doi.org/10.3390/ijerph19031749
4. Ranney ML, Griffeth V, Jha AK. Critical supply shortages – The need for ventilators and personal pro­tective equipment during the COVID-19 pandemic. N EnglJ  2020;382:1181-3. doi: https://doi.org/10.1056/NEJMp2006141
5. Benatar M, Fregonese F, Muiruri C. COVID-19-related healthcare impacts: An uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Moza­mbique, 2017-2020. BMJ Glob Health. 2022;7(4):e007878. doi: https://doi.org/10.1136/bmjgh-2021-007878
6. Lippi G, Plebani M. The Critical Role of Labora­tory Medicine during Coronavirus Disease 2019 (COVID-19) and Other Viral Outbreaks. Clinical Chemistry and Laboratory 2020;58:1063-9. doi: https://doi.org/10.1515/cclm-2020-0240
7. Paltiel AD, Zheng A, Zheng A. Assessment of SARS-CoV-2screening strategies. JAMA. 2020;324(2):140-1. doi: https://doi.org/10.1001/jamanetworkopen.2020.16818
8. Cohen J, van der Meulen Rodgers Y. Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Prev Med. 2020;141:106263. doi: https://doi.org/10.1016/j.ypmed.2020.106263
9. Kaye AD, Okeagu CN, Pham AD, Silva RA, Hur­ley JJ, Arron BL, et al. Economic impact of COVID-19 pandemic on healthcare facilities and systems: Interna­tional perspectives. Best Pract Res Clin Anaesthesiol. 2021;35(3):293-306. doi: https://doi.org/10.1016/j.bpa.2020.11.009
10. Khullar D, Bond AM, Schpero WL. COVID-19 and the financial health of US hospitals. JAMA. 2020;323(21):2127. doi: https://doi.org/10.1001/jama.2020.6269
11. Sharashenidze A. Analysis of COVID-19 Hospital Services Financing Practices (Based on the Examples of Austria and Germany) (in Georgian). Economics. 2022;105(03):159-64. doi: https://doi.org/10.36962/ecs105/3/2022-159
12. Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community 2020 Nov;74(11):964-8. doi: https://doi.org/10.1136/jech-2020-214401
13. Ala A, Wilder J, Jonassaint NL, Coffin CS, Bra­dy C, Reynolds A, et al. COVID-19 and the Uncovering of Health Care Disparities in the United States, United Kingdom and Canada: Call to Action. Hepatol Commun. 2021 Oct;5(10):1791-800. doi: https://doi.org/10.1002/hep4.1790
14. Miszczyńska K, Miszczynski PM. Measuring the efficiency of the healthcare sector in Poland–a window-DEA evaluation. Int J Prod Perform Manag. 2021;71(7):2743-70. doi:https://doi.org/10.1108/IJPPM-06-2020-0276
15. Łyszczarz B, Abdi Z. Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions. Healthcare(Basel). 2021;9(12):1750. doi: https://doi.org/10.3390/healthcare9121750
16. Global Health Expenditure Database [Internet]. 2023 Apr 03 [cited 2025 Jan 14]. Available from: https://ghdx.healthdata.org/record/who-global-health-expenditure-database
17. European Commission [Internet]. 2020 Jan 29 [cited2025 Jan 14]. Available from: https://ec.europa.eu/­commission/presscorner/detail/en/ip_20_124
18. Sowada C, Sagan A, Kowalska-Bobko I, Ma­retso A. Poland: Health system summary. WHO [Internet]. 2022 [cited 2025 Jan 14]. Available from:https://iris.who.int/bitstream/handle/10665/365287/9789289059275-eng.pdf?sequence=1
19. European Commission. State of Health in the EU: Poland country health profile 2020 [Internet]. 2023 [cited 2025 Jan 14].Available from: https://ec.europa.eu/health/state/country_profiles_en
20. Krzeczewski B, Hassan C. Health models – Fi­nancing and effects: A comparative study of the models in Poland and Italy. Finanse i Prawo Finansowe [Internet]. 2024 Feb 27 [cited 2025 Jan 14]. Available from: https://api.semanticscholar.org/CorpusID:268138098
21. Czechia – Public Health – European Commission [Internet]. 2023 [cited 2025 Jan 14]. Available from: https://ec.europa.eu/health/state/country_profiles_en
22. Health at a Glance 2021: OECD Indicators. OECD Publishing, Paris [Internet]. 2021 Nov 9 [cited 2025 Jan 14]. Availablefrom: https://www.oecd.org/en/publications/health-at-a-glance-2021_ae3016b9-en.html
23. Bryndová L, Šlegerová L, Votápková J, Hrobon P, Shuftan N, Spranger A. Czechia: Health System Review. Health Syst Transit. 2023 Mar;25(1):1-216.
24. World Health Organization. World health statistics 2023: Monitoring health for the SDGs, Sustainable Development Goals [Internet]. 2023 May 19 [cited 2025 Jan 14].Available from: https://www.who.int/publications/i/item/9789240074323
25. Country Health Profiles 2023. OECD [Internet]. 2024 Feb 06 [cited 2025 Jan 14]. Available from: https://web-archive.oecd.org/temp/2024-02-06/455310-country-health-profiles-eu.htm
26. Ministry of Health of the Slovak Republic [Internet]. [cited 2025 Jan 14]. Available from: https://www.health.gov.sk/?minister-of-health-eng-verzia
27. Dimova A, Rohova M, Koeva S, Atanasova E, Koeva-Dimitrova L, Kostadinova T, et al. Bulgaria: Health System Summary. WHO Regional Office for Europe [Internet]. 2022 Jul [cited 2025 Jan 14]. Available from: https://iris.who.int/handle/10665/365286
28. OECD Economics Outlook. Volume 2023, Is­sue 1. A long unwinding road. OECD [Internet]. 2023 Jun 07 [cited 2025 Jan 14]. Available from: https://www.oecd.org/en/publications/oecd-economic-outlook/volume-2023/issue-1_ce188438-en.html
29. Living and working in Europe 2021 [Internet]. 2022 May 09 [cited 2025 Jan 14]. Available from: https://www.eurofound.europa.eu/en/publications/2022/living-and-working-europe-2021
30. World Health Organization. Out-of-pocket spen­ding on health in Europe: Monitoring policies and progress [Internet]. 2024 [cited 2025 Jan 14]. Available from: https://gateway.euro.who.int/en/indicators/h2020_29-out-of-pocket-expenditures/#id=17097
31. World Health Organization. European Health Information Gateway. Bulgaria – statistical data [Internet].2024 [cited 2025 Jan 14]. Available from: https://gateway.euro.who.int/en/country-profiles/bulgaria/
32. Behmane D, Dudele A, Villerusa A, Misins J, Kla­vina K, Mozgis D, et al. Latvia: Health system review. Health Syst Transit. 2019;21(4):1-165. PMID: 32863240.
33. World Bank. Georgia: Health sector reform [Internet]. 2022 [cited 2025 Jan 14]. Available from:https://documents1.worldbank.org/curated/en/099802505242216398/pdf/IDU07bfac40d035c20431a0bc1b0755ced4057df.pdf
34. TBC Capital. Overview of Healthcare sector in Georgia [Internet]. 2023 Jul [cited 2025 Jan 14]. Available from:https://tbccapital.ge/static/file/202307072806-healthcare-eng.pdf
35. Indicators of Health Care, 2022. Geostat [Internet]. 2022[cited 2025 Jan 14]. Available from: https://www.geostat.ge/en/single-news/2900/indicators-of-health-care-2022
36. COVID-19 Health System Response. WHO EUROHEALTH [Internet]. 2020 [cited 2025 Jan 14]. Avai­lablefrom: https://iris.who.int/bitstream/hand­le/10665/­336263/Eurohealth-26-2-2020-eng.pdf?sequence=1
37. Sastry S, Basu A. How to Have (Critical) Method in a Pandemic: Outlining a Culture-Centered Approach to Health Discourse Analysis. Frontiers in Communica­tion[Internet]. 2020 Oct [cited 2025 Jan 14];14;5. doi: https://doi.org/10.3389/fcomm.2020.585954
38. Balan O, Shepel M, Savelich L. Healthcare Insti­tution Manager’s Deontological Culture as a Component of the Professional Image. Economics: time realities. 2022 Dec 27;6(64):14-24. doi: https://doi.org/10.15276/etr.06.2022.2
39. Vazov R, Kanazireva R, Grynko TV, Krup­skyi OP. Strategies for Healthcare Disaster Management in the Context of Technology Innovation: the Case of Bul­garia. Medychni perspektyvy. 2024 Jun 28;29(2):215-28. doi: https://doi.org/10.26641/2307-0404.2024.2.307703
40. Krishnan K, Lin Y, Prewitt KRM, Potter DA. Multidisciplinary Approach to Brain Fog and Related Persisting Symptoms Post COVID-19. Journal of Health Service 2022 Feb;48(1):31-8. doi: https://doi.org/10.1007/s42843-022-00056-7
41. Intraprise Health. 5 steps to creating a healthcare risk remediation plan [Internet]. [cited 2025 Jan 14]. Available from: https://intraprisehealth.com
42. Lypynska O, Sviridova S, Balan O. The quality of providing medical services through the prism of management decisions. Economic journal Odessa poly­technic 2023 Aug 30;3(25):119-26. doi: https://doi.org/10.15276/ej.03.2023.13
43. Chakraborty S, Raut RD, Rofin TM, Chakra­borty S. A comprehensive and systematic review of multi-criteria decision-making methods and applications in healthcare. Healthcare Analytics. 2023 Dec;4:100232. doi: https://doi.org/10.1016/j.health.2023.100232
44. Cherniavska T, Cherniavskyi B, Sanikidze T, Sha­rashenidze A, Tortladze M, Buleishvili M. Optimization of medical logistics with bee colony algorithms in emer­gency, military conflict and post-war remediation settings [Internet]. In: Shakhovska N, Jiao J, Izonin I, Chretien S, editors. Proceedings of the 7th International Conference on Informatics & Data-Driven Medicine (IDDM 2024); 2024 Nov 14-16; Birmingham, United Kingdom. Aachen: CEUR-WS.org; 2024 [cited 2025 Apr 16]. p. 220-235. Available from: https://ceur-ws.org/Vol-3892/paper16.pdf
45. Cherniavska T, Cherniavskyi B. Architecture-Oriented Agent-Based Model (AOAM) for Optimizing Transport Evacuation Management and Emergency Medical Assistance in the Context of the War in Ukraine: Challenges and Prospects [Internet]. In: Shakhovska N, Jiao J, Izonin I, Chretien S, editors. Proceedings of the 7th International Conference on Informatics & Data-Driven Medicine (IDDM 2024); 2024 Nov 14-16; Birmingham, United Kingdom. Aachen: CEUR-WS.org; 2024 [cited 2025 Apr 16]. p. 319-336. Available from:  https://ceur-ws.org/Vol-3892/paper21.pdf

Look through:

Sharashenidze A. Georgian Technical University, Tbilisi, Georgia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
http://orcid.org/0009-0008-8289-1850

Cherniavskyi B. University of Applied Science in Konin, Konin, Poland
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
http://orcid.org/0000-0001-9174-6139

Buleishvili M. European University, Tbilisi, Georgia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0009-0004-2657-8473

Sanikidze T. Tbilisi State Medical University, Tbilisi, Georgia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
http://orcid.org/0000-0003-1618-5276

Krasnikova N. Oles Honchar Dnipro National University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-6484-2050

Sharashenidze A., Cherniavskyi B., Buleishvili M., Sanikidze T., Krasnikova N. Remediation strategies and systemic improvements in health care after COVID-19: an analysis of international practices in hospital financing. Medicni perspektivi. 2025;30(2):255-271.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333807

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

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

Key words: pseudoaneurysm of the thoracic aorta, surgical treatment, surgical technique

1. Gouveia E Melo R, Silva Duarte G, Lopes A, Al­ves M, Caldeira D, Fernandes E Fernandes R, et al. Incidence and Prevalence of Thoracic Aortic Aneurysms: A Systematic Review and Meta-analysis of Population-Based Studies. Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):1-16. doi: https://doi.org/10.1053/j.semtcvs.2021.02.029
2. Atik FA, Navia JL, Svensson LG, Vega PR, Feng J, Brizzio ME, et al. Surgical treatment of pseudo­aneurysm of the thoracic aorta. J Thorac Cardiovasc Surg. 2006 Aug;132(2):379-85. doi: https://doi.org/10.1016/j.jtcvs.2006.03.052
3. Aebert H, Birnbaum DE. Tuberculous pseudoa­neurysms of the aortic arch. J Thorac Cardiovasc Surg. 2003 Feb;125(2):411-2. doi: https://doi.org/10.1067/mtc.2003.130
4. Katsumata T, Moorjani N, Vaccari G, Westaby S. Mediastinal false aneurysm after thoracic aortic surgery. Ann Thorac Surg. 2000 Aug;70(2):547-52. doi: https://doi.org/10.1016/S0003-4975(00)01300-X
5. Kang T, Kang MJ. Aortic pseudoaneurysm mis­diagnosed as lung cancer on unenhanced CT: a case report. Shanghai 2024;8(23):1-5. doi: https://doi.org/10.21037/shc-24-17
6. Takahara Y, Nishiki K, Nakase K, Mizuno S. Rup­tured pseudoaneurysm of the thoracic aorta mimicking lung cancer: A case report. Thorac Cancer. 2021;12(5):685-9. doi: https://doi.org/10.1111/1759-7714.13783
7. Sleem M, Abdelsalam M, Hafiz S, Yusuf A, Ngoc D, Nguyen C. Ruptured thoracic aortic aneurysm secondary to syphilitic aortitis: a case report. Chest. 2024;166(4):3048-9. doi: https://doi.org/10.1016/j.chest.2024.06.1836
8. Sousa J, Oliveira-Pinto J, Soares T, Lachat M, Tei­xeira J. Symptomatic Distal Anastomotic Pseudo-aneurysm After the Bentall Procedure Successfully Trea­ted by Supra-aortic Trunk Debranching and Zone 0 Thoracic Endovascular Aneurysm Repair. EJVES Vasc Forum. 2020 Jan 8;47:90-6. doi: https://doi.org/10.1016/j.ejvssr.2019.12.003
9. Basu R, Zhang J, Zaheer S, Grimm J, Szeto W, Kalapatapu V. Ascending aorta thoracic endovascular aortic repair for infected pseudoaneurysm. J Vasc Surg Cases Innov Tech. 2022 Mar 9;8(2):244-7. doi: https://doi.org/10.1016/j.jvscit.2022.02.005
10. Recicarova S, Jonak M, Netuka I. Comprehensive multi-modality treatment of thoracic aorta pseudoaneu­rysms: a single-center experience. Gen Thorac Cardiovasc Surg. 2024;72:387-94. doi: https://doi.org/10.1007/s11748-023-01986-9

Look through:

Romaniuk T.V. Municipalnon-profitenterprise «Ternopil Regional Clinical Hospital» Ternopil City Council; I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-9279-3711

Moroz V.S. Municipalnon-profitenterprise «Ternopil Regional Clinical Hospital» Ternopil City Council, Ternopil, Ukraine
https://orcid.org/0009-0002-5925-2694

Lekan R.Io. Municipalnon-profitenterprise «Ternopil Regional Clinical Hospital» Ternopil City Council, Ternopil, Ukraine
https://orcid.org/0000-0002-5969-9886

Romaniuk T.V., Moroz V.S. Lekan R.Io. Pseudoaneurysm of the thoracic aorta (clinical case). Medicni perspektivi. 2025;30(2):272-277.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333827

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

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

Key words: systemic lupus erythematosus, lupus crisis, lupus nephritis, renal failure

1. Hoi A, Igel T, Mok CC, Arnaud L. Systemic lupus erythematosus. Lancet. 2024;403(10441):2326-38. doi: https://doi.org/10.1016/S0140-6736(24)00398-2
2. Kant S, Kronbichler A, Sharma P, Geetha D. Ad­vances in Understanding of Pathogenesis and Treatment of Immune-Mediated Kidney Disease: A Review. Am J Kidney Dis. 2022;79(4):582-600. doi: https://doi.org/10.1053/j.ajkd.2021.07.019
3. Ameer MA, Chaudhry H, Mushtaq J, Khan OS, Babar M, Hashim T, et al. Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management. Cureus. 2022;14(10):e30330. doi: https://doi.org/10.7759/cureus.30330
4. Siegel CH, Sammaritano LR. Systemic Lupus Erythematosus: A Review. JAMA. 2024;331(17):1480-91. doi: https://doi.org/10.1001/jama.2024.2315
5. Davidenko K. [Lupus nephritis: diagnosis and treatment]. Ukr Med J [Internet]. 2019 [cited 2024 Dec 13];5(133 Pt 1):1-3. Ukrainian. Available from: https://umj.com.ua/uk/publikatsia-162408-vovchakovij-nefrit-diagnostika-ta-likuvannya
6. Protsenko HO, Dubas VV. [Systemic lupus ery­thematosus: the state of the problem in Ukraine and the world]. Ukr J Rheumatol. 2020;4(82):25-34. Ukrainian. doi: https://doi.org/10.32471/rheumatology.2707-6970.82.15749
7. Christou EAA, Banos A, Kosmara D, Bert­sias GK, Boumpas DT. Sexual dimorphism in SLE: above and beyond sex hormones. Lupus. 2019;28(1):3-10. doi: https://doi.org/10.1177/0961203318815768
8. Dzhus MB, Ivashkivskyi OI, Karasevska TA, Potomka RA, Novytska AL, Mikuksts VYa, et al. [Soft tissue calcifications in systemic lupus erythematosus. A clinical case and literature review]. Ukr J Rheumatol. 2021;1(83):64-73. Ukrainian. doi: https://doi.org/10.32471/rheumatology.2707-6970.83.16006
9. Protsenko HO, Dubas VV, Uzun SV, Tso­ka­lo YaV, Zbarashchenko-Hasan MI. [Cutaneous manifesta­tions in systemic lupus erythematosus (a case report)]. Ukr J Rheumatol. 2020;4(82):25-34. Ukrainian. doi: https://doi.org/10.32471/rheumatology.2707-6970.91.17654
10. Gilcrease W, Manfredi L, Sciascia S, Ricceri F. From Multimorbidity to Network Medicine in Patients with Rheumatic Diseases. Rheumatol Ther. 2025 Feb;12(1):1-24.
    doi: https://doi.org/10.1007/s40744-024-00724-8
11. Zhdan VM, Tkachenko MV, Babanina MYu, Volchenko HV, Kitura YeM, Ivanytskyi IV. [Insulin resistance in systemic lupus erythematosus]. Family medicine. European practices. 2024;2:49-54. Ukrainian. doi: https://doi.org/10.30841/2786-720X.2.2024.307530
12. Baumann P, Völkl A, Bäuerle M, Schmidmaier R, Oduncu FS. Aplastic crisis as primary manifestation of systemic lupus erythematosus. Onkologie. 2011;34(8-9):452-4. doi: https://doi.org/10.1159/000331069
13. Ungprasert P, Chowdhary VR, Davis MD, Ma­kol A. Autoimmune myelofibrosis with pancytopenia as a presenting manifestation of systemic lupus erythematosus responsive to mycophenolate mofetil. Lupus. 2016;25(4):427-30. doi: https://doi.org/10.1177/0961203315615221
14. Piga M, Arnaud L. The Main Challenges in Sys­temic Lupus Erythematosus: Where Do We Stand? J Clin Med. 2021;10(2):243. doi: https://doi.org/10.3390/jcm10020243
15. Hailu GT, Hussen SU, Getachew S, Berha AB. Management practice and treatment outcomes of adult patients with Lupus Nephritis at the Renal Clinic of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Nephrol. 2022;23(1):214. doi: https://doi.org/10.1186/s12882-022-02846-z
16. Anders HJ, Saxena R, Zhao MH, Parodis I, Sal­mon JE, Mohan C. Lupus nephritis. Nat Rev Dis Primers. 2020;6(1):7.
    doi: https://doi.org/10.1038/s41572-019-0141-9
17. Wallace ZS, Naden RP, Chari S, Choi HK, Della-Torre E, Dicaire JF, et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease. Ann Rheum Dis. 2020;79(1):77-87. doi: https://doi.org/10.1136/annrheumdis-2019-216561
18. Heikki Ju. [Guideline 00446. Systemic lupus erythematosus (SLE)]. [Internet]. 2017 [cited 2024 Dec 13]. 17 p. Ukrainian. Available from: http://guidelines.moz.gov.ua/documents/2918
19. Kostopoulou M, Fanouriakis A, Cheema K, Bo­letis J, Bertsias G, Jayne D, et al. Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations. RMD Open. 2020;6(2):e001263.
    doi: https://doi.org/10.1136/rmdopen-2020-001263
20. Fanouriakis A, Kostopoulou M, Cheema K, An­ders HJ, Aringer M, Bajema I, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis. 2020;79(6):713-23. doi: https://doi.org/10.1136/annrheumdis-2020-216924
21. [KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases]. Kidneys. 2021;10(4):201-28. Ukrainian. doi: https://doi.org/10.22141/2307-1257.10.4.2021.247896С
22. Fanouriakis A, Kostopoulou M, Andersen J, Arin­ger M, Arnaud L, Bae SC, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024;83(1):15-29. doi: https://doi.org/10.1136/ard-2023-224762
23. [KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis]. Kidneys. 2024;13(1):18-25. Ukrainian. doi: https://doi.org/10.22141/2307-1257.13.1.2024.437
24. Ivanov DD. [Chronic kidney disease: differential tactics of renoprotection]. Ukr Med J [Internet]. 2018 [cited 2024 Dec 13];2(124):1-5. Ukrainian. Available from: https://umj.com.ua/uk/publikatsia-124335-hronichna-hvoroba-nirok-diferentsijna-taktika-renoprotektsiyi
25. Siniscalchi С, Rossetti P, Carolla G, Micco P, Stella A, Riva M. A review on management of antiphos­pholipid syndrome in clinical practice. Ital J Med. 2023;17(2):1649. doi: https://doi.org/10.4081/itjm.2023.1649
26. Тaran OI. [Thrombotic thrombocytopenic micro­angiopathy]. Kidneys. 2022;2(4):66-9. Ukrainian. doi: https://doi.org/10.22141/2307-1257.0.2.04.2013.85358
27. Kobeliatskyi YuYu. [Intensive care of haemo­lytic uremic syndrome in pregnant women]. Surg. Orthop. Traumatol. Int care [Internet]. 2021 [cited 2024 Dec 23];2(45):14-5. Ukrainian. Available from: https://health-ua.com/multimedia/6/5/8/2/0/1624020515.pdf
28. Herrinton LJ, Liu L, Goldfien R, Michaels MA, Tran TN. Risk of Serious Infection for Patients with Systemic Lupus Erythematosus Starting Glucocorticoids with or without Antimalarials. J Rheumatol. 2016;43(8):1503-9. doi: https://doi.org/10.3899/jrheum.150671
29. Shuba NM. [Emergency conditions in patients with rheumatic diseases: modern approaches to treatment]. Ukr J Rheumatol [Internet]. 2009 [cited 2024 Dec 13];3(37):41-8. Ukrainian. Available from: https://www.rheumatology.kiev.ua/wp/wp-content/uploads/magazine/37/41.pdf
30. Kiss E, Tarr T, Soltész P, Szegedi G. [Crisis states in systemic lupus erythematosus]. Orv Hetil. 2006;147(51):2469-73. Hungarian.
31. Kovalenko VM, Rekalov DH, Yatsyshchyn RI, Holovach IYu, Stanislavchuk MA, Ter-Vartanian SKh, et al. [Systemic lupus erythematosus. Clinical guidelines]. Kyiv; 2020. 76 p. Ukrainian.
32. Katerenchuk IP, Tkachenko LA, Yarmola TI, Ta­lash VV. Microscopic polyangiitis – a view of the problem through the lens of a nephrologist. Wiad Lek. 2021;74(4):1024-31. doi: https://doi.org/10.36740/WLek202104140
33. Yarmola TI, Gutsalenko OO, Katerenchuk IP, Tka­chenko LA, Kostrikova YА, Talash VV. Microscopic polyangiitis hiding behind the mask of COVID-19: A case series and minireview. Ukr J Nephrol Dial. 2023;2(78):5-21. doi: https://doi.org/10.31450/ukrjnd.2(78).2023.02
34. Hsu T, Nguyen P, Petronic-Rosic V. A case of systemic lupus erythematosus with cutaneous granu­lomatous vasculitis. JAAD Case Rep. 2022;21:93-6. doi: https://doi.org/10.1016/j.jdcr.2022.01.006
35. Botero B JD, Bernal-Macías S, Celis P CA, Las­so A JI, Rodríguez J, Arias Álvarez L, et al. Systemic lupus erythematosus/ANCA-associated vasculitis overlap: An explanation for atypical lupus manifestation. Lupus. 2022;31(4):495-9. doi: https://doi.org/10.1177/09612033221084519
36. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheu­matology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151-9. doi: https://doi.org/10.1136/annrheumdis-2018-214819
37. Abrahamovych UO, Abrahamovych OO, Tsyha­nyk LV, Farmaha ML, Synenkyi OV. [A Method to Determine Functional Class of Systemic Lupus Erythe­matosus in Patients]. World Sci. 2020;2(5(57):10-9. Ukrainian. doi: https://doi.org/10.31435/rsglobal_ws/31052020/7076
38. National Kidney Foundation. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis. 2012;60(5):850-86. doi: https://doi.org/10.1053/j.ajkd.2012.07.005
39. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl [Internet]. 2012 [cited 2024 Sept 11];3(1):1-150. Available from: https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf
40. Yu C, Li P, Dang X, Zhang X, Mao Y, Chen X. Lupus nephritis: new progress in diagnosis and treatment. J 2022;132:102871. doi: https://doi.org/10.1016/j.jaut.2022.102871
41. Julkunen H. Guideline 00446. Systemic lupus erythematosus (SLE) [Internet]. 2017 [updated 2017 Jul 31; cited 2024 Dec 13]. Available from: https://guidelines.moz.gov.ua/documents/3299
42. Kato K, Kawamura T, Terashima R, Tsuchiya Y, Takahashi Y, Kasai K, et al. A Case of Systemic Lupus Erythematosus/Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Overlap Syndrome with Dissociated Pathological and Immunological Findings. Case Rep Nephrol.2020;2020:5698708. doi: https://doi.org/10.1155/2020/5698708
43. Rossi GP, Bisogni V, Rossitto G, Maiolino G, Ce­sari M, Zhu R, et al. Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension. High Blood Press Cardiovasc Prev. 2020;27(6):547-60. doi: https://doi.org/10.1007/s40292-020-00415-9
44. Soyuöz A, Karadağ Ö, Karaağaç T, Kılıç L, Bil­gen ŞA, Özcebe Oİ. Therapeutic plasma exchange for refractory SLE: A comparison of outcomes between different sub-phenotypes. Eur J Rheumatol. 2018;5(1):32-6. doi: https://doi.org/10.5152/eurjrheum.2017.17088
45. Unger T, Borghi C, Charchar F, Khan NA, Poul­ter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension.2020;75(6):1334-57. doi: https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
46. Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3):559-69. doi:https://doi.org/10.1016/j.kint.2020.10.026
47. Kaidashev I, Shlykova O, Izmailova O, Toru­bara O, Yushchenko Y, Tyshkovska T, et al. Host gene variability and SARS-CoV-2 infection: A review article. Heliyon.2021;7(8):e07863. doi: https://doi.org/10.1016/j.heliyon.2021.e07863
48. Honkanen E. [Guideline 00225. Acute kidney in­jury]. [Internet]. 2017 [cited 2024 Sept 11]. 9 p. Ukrainian. Availablefrom: https//guidelines.moz.gov.ua/documents/3113
49. Tarasenko SO, Dubrov SO, Suslov HH. [Diag­nostic criteria for disseminated intravascular coagulation syndrome and sepsis-induced coagulopathy]. Pain, Anaesth & Int Care. 2021;2(95):25-38. doi: https://doi.org/10.25284/2519-2078.2(95).2021.238302
50. Yaremenko OB, Sydorova AO. [Hemophagocytic syndrome in a patient with paniculitis: a case report]. Ukr J 2021;2(84):1-5. Ukrainian. doi: https://doi.org/10.32471/rheumatology.2707-6970.84.16101
51. Driouach S, Mounir A, Elkhader S, Zinebi A, Moud­den MK. [Pancytopenia secondary to autoimmune myelofibrosis revealing a male case of systemic lupus]. Ann Biol Clin (Paris). 2019;77(3):327-30. French. doi: https://doi.org/10.1684/abc.2019.1443
52. Protsenko HO, Dubas VV. [Analysis of delayed diagnosis in systemic lupus erythematosus]. Ukr J Rheumatol.2022;1(87):1-6.  doi: https://doi.org/10.32471/rheumatology.2707-6970.87.16747
53. Solhjoo M, Goyal A, Chauhan K. Drug-Induced Lupus Erythematosus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [updated 2023 Apr 3; cited 2024 Nov 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441889
54. Aaltonen S. [Guideline 00229. Glomerulo­nephrites]. [Internet]. 2017 [updated 2017 May 22; cited 2024 Dec 13]. Ukrainian. Availablefrom: https://guidelines.moz.gov.ua/documents/3117
55. Ahn SS, Yoon T, Song JJ, Park YB, Lee SW. Serum adipokine profiles in patients with microscopic polyangiitis and granulomatosis with polyangiitis: An exploratory analysis. PLoS One. 2021;16(7):e0254226. doi: https://doi.org/10.1371/journal.pone.0254226
56. Banos A, Thomas K, Garantziotis P, Filia A, Malis­sovas N, Pieta A, et al. The genomic landscape of ANCA-associated vasculitis: Distinct transcriptional signatures, molecular endotypes and comparison with sys­temic lupus erythematosus. Front Immunol. 2023;14:1072598. doi: https://doi.org/10.3389/fimmu.2023.1072598
57. Khil J, Nguyen TM, Troxell ML, Zheng S. Sys­temic Lupus Erythematosus and ANCA-Associated Vas­culitis Overlap Syndrome: A Case Report. Kidney Med. 2022;4(11):100544. doi: https://doi.org/10.1016/j.xkme.2022.100544
58. Borzykh O, Belan O, Mormol I, Avramenko Y, Іengalychev T, Markina T. Characteristics of the course of leucocytoclastic vasculitis with skin lesions. analysis of clinical cases. Med and Ecol Probl. 2023;27(1-2):35-41. doi: https://doi.org/10.31718/mep.2023.27.1-2.07
59. Mucke J, Aringer M. [EULAR recommendations 2023 on the treatment of systemic lupus erythematosus-Implications for treatment in Germany]. Z Rheumatol. 2024;83(6):431-8. doi: https://doi.org/10.1007/s00393-024-01544-5
60. Velichuk A. [Systemic lupus erythematosus. A clinical case]. In: Topical issues of clinical medicine: Collection of materials of the All-Ukrainian scientific and practical conference of interns; 2023 May 25; Poltava, UA [Internet]. Poltava; 2023 [cited 2024 Oct 3]. p. 103-4. Ukrainian. Available from: https://repository.pdmu.edu.ua/handle/123456789/21453
61. Mormol I, Borzykh O, Gerasymenko N, Esanu C, Ozarchuk L. [Lesions of the hematopoietic system in a patient with systemic lupus erythematosus and the effectiveness of treatment with mycophenolate mofetil]. Med and Ecol Probl. 2022;26(5-6):7-10. Ukrainian. doi: https://doi.org/10.31718/mep.2022.26.5-6.02
62. Newman K, Owlia MB, El-Hemaidi I, Akhtari M. Management of immune cytopenias in patients with systemic lupus erythematosus – Old and new. Autoimmun Rev.2013;12(7):784-91. doi: https://doi.org/10.1016/j.autrev.2013.02.001 
63. Shoenfeld Y, Zandman-Goddard G, Levy Y. Com­ment on published article in Lupus: Autoimmune myelofibrosis with pancytopenia as a presenting ma­nifestation of systemic lupus erythematosus responsive to mycophenolate mofetil; IVIG in myelofibrosis in SLE. Lupus.2017;26(2):224. doi: https://doi.org/10.1177/0961203316662725
64. Wibowo T, Kawada S, Ishida Y, Yoshimine Y, Ishikawa N, Kawamoto K, et al. Autoimmune myelo­fibrosis associated with systemic lupus erythematosus: a case report. Mod Rheumatol Case Rep. 2020;4(1):28-33. doi: https://doi.org/10.1080/24725625.2019.1650697
65. Üsküdar Cansu D, Üsküdar Teke H, Işiksoy S, Korkmaz C. Bone marow as a target organ of systemic lupus erythematosus: analysis of cases with myelofibrosis. IntJ Rheum  2018;21(5):1049-59. doi: https://doi.org/10.1111/1756-185X.13308
66. Putra RS, Najirman. Treatment of Systemic Lupus Erythematosus with Anti SSA and SSB Positive Preg­nancies. Biosmed.2022;6(3):1523-9. doi: https://doi.org/10.37275/bsm.v6i3.470
67. Joy GM, Arbiv OA, Wong CK, Lok SD, Ad­derley NA, Dobosz KM, et al. Prevalence, imaging pat­terns and risk factors of interstitial lung disease in connective tissue disease: a systematic review and meta-analysis. Eur Respir Rev. 2023;32(167):220210. doi: https://doi.org/10.1183/16000617.0210-2022
68. Kanapathy A, Nik Jaafar NR, Shaharir SS, Chan LF, Rozita M, Ch'ng SS. Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia. Lupus. 2019;28(7):854-61. doi: https://doi.org/10.1177/0961203319852153
69. Koliadenko DI, Yaremenko OB, Nahirna MI. [Neu­ropsychiatric manifestations in patients with systemic lupus erythematosus: prevalence, clinical and laboratory as­sociations]. Ukr J Rheumatol. 2023;1(91):1-7. Ukrainian. doi: https://doi.org/10.32471/rheumatology.2707-6970.91.17688
70. Abrahamovych U, Abrahamovych О, Nadashke­vich О, Farmaha М, Kobak L. Pathogenetic Association of Digestive System Lesions with Systemic Lupus Erythematosus: Characteristics and Prevalence. PMGP. 2020;5(1):e0501225. doi: https://doi.org/10.26766/pmgp.v5i1.225
71. Fanouriakis A, Kostopoulou M, Alunno A, Arin­ger M, Bajema I, Boletis JN, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus Annals of the Rheumatic Diseases. Ann Rheum Dis. 2019;78(6):736-45. doi: https://doi.org/10.1136/annrheumdis-2019-215089
72. Prokhorov EV, Borysova TP. [Features of the current course and therapy of systemic lupus erythe­matosus in children and adolescents]. Child Health. 2007;2(5):60-6. Russian.
73. Furie R, Rovin BH, Houssiau F, Malvar A, Teng YKO, Contreras G, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J 2020;383(12):1117-28. doi: https://doi.org/10.1056/NEJMoa2001180
74. Fanouriakis A, Bertsias G, Boumpas DT. Res­ponse to: 'Hydroxychloroquine is neutral in risk of chronic kidney disease in patients with systemic lupus erythe­matosus' by Wu et al. Ann Rheum Dis. 2022;81(5):e76. doi: https://doi.org/10.1136/annrheumdis-2020-217804

Look through:

Talash V.V. Poltava State Medical University, Poltava, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-5700-557X

Katerenchuk I.P. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0003-3765-4895

Kostrikova Yu.A. Poltava State Medical University, Poltava, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-8675-8896

Yarmola T.I. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0002-7428-0223

Hutsalenko O.O. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0001-8313-3201

Pustovoyt H.L. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0001-6879-8088

Tkachenko L.A. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0001-9356-6385

Mokhnachev O.V. Poltava State Medical University, Poltava, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-4247-6926

Rustamіan S.T. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0003-4348-6365

Talash V.V. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0001-7758-767X

Sarychev L.P. Poltava State Medical University, Poltava, Ukraine
https://orcid.org/0000-0003-3257-4845

Savchenko R.B. Poltava State Medical University, Poltava, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-9790-8821

Talash V.V., Katerenchuk I.P., Kostrikova Yu.A., Yarmola T.I., Нutsalenko O.O., Pustovoyt Н.L., Tkachenko L.A., Mokhnachev O.V., Rustamіan S.T., Talash V.V., Sarychev L.P., Savchenko R.B. Systemic lupus erythematosus as a multidisciplinary problem (clinical case). Medicni perspektivi. 2025;30(2):278-292.
DOI: https://doi.org/10.26641/2307-0404.2025.2.333835

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