The purpose of this work was to determine changes in endogenous intoxication indicators and C-reactive protein levels in experimental bacterial-immune periodontitis under the conditions of using acrylic and nylon bases of removable dentures. Experimental studies were conducted on clinically healthy male white rats weighing 150-200 g, which were kept in conditions that met the requirements of sanitation and good laboratory practice (GLP). Acrylic and nylon dentures were made for rats, and bacterial-immune periodontitis was simulated by injecting Staphylococcus aureus and Streptococcus hemolyticus in egg protein into periodontal tissue. The level of endogenous intoxication was assessed by the erythrocyte index, the middle molecular weight molecules were determined by spectrophotometer, and the level of C-reactive protein was determined by enzyme-linked immunosorbent assay. The data were processed using nonparametric statistical methods in STATISTICA 10.0. Characterizing the indicators of the erythrocyte intoxication index of the experimental model of periodontitis and against the background of prosthetics with nylon bases, it should be noted that the results obtained were higher (by 1.27 times; (p<0.001) than the control indicators, but lower than the data of animals without prosthetics (by 1.44 times; p<0.001) and with acrylic prostheses (by 1.24 times; p<0.001), respectively. The content of C-reactive protein after fixation of acrylic bases was significantly increased compared to the intact group (by 2.50 times; p<0.001). The obtained data also showed that the level of this protein was by 1.60 times higher (p<0.001) compared to the indicators in rats with bacterial-immune periodontitis without the use of removable acrylic structures. In the blood serum of rats with inflammatory periodontal disease and prosthetics with nylon bases, the level of C-reactive protein also increased significantly: it was by 1.91 times higher (p<0.001) compared to the control group and by 1.22 times (p<0.01) compared to animals with periodontitis on 30^th day without dentures. The use of different types of prosthetic bases in bacterial-immune inflammation of the periodontium affects the level of endogenous intoxication, reducing the dynamics of the inflammatory process in the periodontal complex. However, the use of acrylic bases contributes to an increase in the level of C-reactive protein, which indicates a more negative effect of acrylic plastics on the main mechanisms of inflammation in periodontal tissues.

Key words:  removable prosthetics, base materials, nylon prosthesis, acrylic prosthesis, periodontium, periodontitis, endogenous intoxication, C-reactive protein

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Look through:

Demkovych A.Ye. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0001-9823-4283

Poliukhovych Y.I. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0009-0007-4726-9372

Piasetska L.V. 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/0000-0002-5640-2258

Rosolovska S.O. I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
https://orcid.org/0000-0003-4768-3905

Demkovych A.Ye., Poliukhovych Y.I., Piasetska L.V., Rosolovska S.O. Development of endogenous intoxication and changes in the concentration of C-reactive protein in the blood in bacterial-immunoid periodontitis on the background of the use of prosthetic bases. Medicni perspektivi. 2025;30(4):4-11. 
DOI: https://doi.org/10.26641/2307-0404.2025.4.348272

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

The objective of the present study was to validate key mole­cular markers of bone tissue repair as indicators of osseointegration on systemic and local levels, and evaluate their trans­lational parallelism. This was achieved by comparing the configurational consistency of expression profiles between an experimental rat model and a pilot clinical investigation in human patients to synchronize systemic and local molecular responses. The hypothesis was that alumina-coated titanium implants would exhibit faster dynamics of angiogenic and osteogenic biomarkers, indicating accelerated osteoinduction, osteoconduction, and osseointegration compared with uncoated titanium. The pilot clinical study comprised the patients after total hip arthroplasty (n=6): three with uncoated titanium implants and three with alumina ceramics. Serum samples were collected from these patients in one and six months post-surgery. The experimental rat model comprised 160 Wistar females implanted with modified intrafemoral implants (seven surface types, including uncoated and alumina-coated titanium), with serum and peri-implant tissue samples collected in one, two, four, and eight weeks. Serum levels of vascular endothelial growth factor, bone morphogenetic protein 2, and osteoprotegerin were determined by enzyme-linked immunosorbent assay, while the corresponding local expression of vascular endothelial growth factor receptor, bone morphogenetic protein 2, and receptor activator of nuclear factor kappa-B was assessed by immunohistochemistry. The results demonstrated that alumina-coated implants induced an accelerated and synchronized molecular cascade in the rat model, which was qualitatively replicated in the clinical cohort. The systemic vascular endothelial growth factor peak manifested early, at one week in rats and one month in humans, and exhibited a strong parallelism with local microvessel density in the animal model, confirming rapid angiogenic activation. In both species, the expression of bone morphogenetic protein 2 increased earlier and to a greater extent in the alumina-coated groups, indicating more rapid osteoinduction. Local receptor activator of nuclear factor kappa-B activity demonstrated an early rise and a four-week peak in the groups with coated implants, consistent with controlled and timely bone remodelling. The study indicates that alumina coatings promote accelerated osseointegration by advancing the time course of healing, a conclusion supported by the observed translational parallelism of the investigated markers.

Key words: osteoinduction, osteoconduction, osseointegration, titanium implant, alumina, translational study, vascular-endothelial growth factor, receptor of vascular-endothelial growth factor, bone morphogenetic protein 2, osteoprotegerin/receptor activator of nuclear factor κB axis, enzyme-linked immunosorbent assay, bone remodeling, immunohistochemistry

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Look through:

Bondarenko O.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/0000-0002-9739-9219

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

Bondarenko N.S. Dnipro State Medical University, Dnipro, Ukraine

Bozhko A.G. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0002-1054-7574

Loskutov O.Ye. Dnipro State Medical University, Dnipro, Ukraine
https://orcid.org/0000-0003-0579-5642

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

Bondarenko O.O., Lievykh A.E., Bondarenko N.S., Bozhko A.G., Loskutov O.Ye., Shponka I.S. Expression of VEGF, BMP-2, and the OPG/RANK axis as indicators of osseointegration: a comparative clinical and experimental study of titanium implants with functional protective coatings. Medicni perspektivi. 2025;30(4):12-23. 
DOI: https://doi.org/10.26641/2307-0404.2025.4.348747

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

The review article presents modern ideas about the molecular and cellular mechanisms of brain damage in severe traumatic brain injury (TBI). The aim of the study is to analyze the pathophysiological links of primary and secondary brain damage in severe TBI in order to identify pathogenetically justified areas of intensive care. An electronic search was performed in PubMed and Google Scholar, the abstract database of scientific literature Scopus for the period 2001-2025. The search for information was carried out using the keywords: "traumatic brain injury", "cerebral metabolism", "excitotoxicity", "neuroinflammation", "metabolic crisis", "intensive care". Using bibliographic and analytical methods, 1128 sources were selected and processed, including evidence-based randomized trials, systematic reviews and others, 858 were selected and 83 of the most relevant sources were analyzed. It is fundamental to understand the fact that the pathological effect on the brain at the time of injury has not ended, but only begins, leading to secondary damage – the main point of application of the complex of intensive care for severe TBI. Since the prevention and limitation of the influence of secondary pathological factors can significantly improve the results of treatment of severe TBI. The main molecular and cellular links in the pathogenesis of severe traumatic brain injury are the development of energy deficiency, excitotoxicity with overload of nerve cells with calcium ions, hyperproduction of reactive oxygen species and nitric oxide, chronic neuroinflammation that activates microglia, which leads to the activation of signals of cellular death of nerve cells through necrosis, apoptosis and autophagy. A new concept of the development of metabolic crisis is presented, which complements our understanding of the pathophysiological mechanisms of brain damage in severe TBI. The concept of metabolic crisis, which differs from the mechanisms of ischemia, reshapes our understanding of secondary brain damage – the main point of application of the complex of intensive care for severe TBI. In which mitochondria play a central role and act as one of the main factors in determining the death or life of brain cells. Therefore, the development of neuroprotection trends for preventing and limiting the impact of secondary pathological factors can significantly improve the neurological outcomes of treatment of patients with severe TBI.

Key words: traumatic brain injury, cerebral metabolism, excitotoxicity, neuroinflammation, metabolic crisis, intensive care

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Tsarev A.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/0000-0002-2611-604X

Zhilyuk V.I. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0003-2259-0622

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

Bukreieva A.V. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0009-0006-5173-7055

Tsarev A.V., Zhilyuk V.I., Lievykh A.E., Bukreieva A.V. Severe traumatic brain injury: a modern understanding of the pathophysiological mechanisms of brain damage. Medicni perspektivi. 2025;30(4):24-35.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348754

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

Systemic inflammation and external respiration dysfunction lead to blood lipid profile shift. As the frequent concomitant pathology, hypothyroidism causes lipid metabolism deviations as well. In this study, we aimed to investigate lipid metabolism features in chronic obstructive pulmonary disease including the presence of concomitant hypothyroidism. A direct method for determining total cholesterol and high- and low-density lipoproteins in blood serum, an enzymatic method for determining triacylglycerols in serum, automatic counting of the absolute number of the peripheral blood monocytes by a hematology analyzer, a fluorescent immunoassay method for determining thyroid-stimulating hormone and free thyroxine in serum were used. All patients underwent postbroncho­dilator forced spirometry using a portable spirometer to obtain forced expiratory volume in the first second and forced vital capacity. There were assesed 65 patients with chronic obstructive pulmonary disease, 43 of them without con­comitant hypothyroidism (research group A), and the other 22 – with concomitant hypothyroidism (research group B); and 24 healthy controls. Comparing to controls, both research groups had significantly higher levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triacylglycerols (p<0.05 for each parameter). Research group B patients had significantly higher serum concentrations of total cholesterol, low-density lipoprotein cholesterol and triacylglycerols and lower – of high-density lipoprotein cholesterol (p<0.05 for each), compared with research group A. Forward stepwise regression analysis revealed that forced vital capacity decrease could be associated with total cholesterol content rise in all patients (p<0.001). We ascertained a negative correlation between total cholesterol level and forced expiratory volume during the first second, and also between total cholesterol level and forced vital capacity in both research groups (p<0.05). We also established a significant relationship between increased thyroid-stimulating hormone levels and increased total cholesterol concentrations based on stepwise regression analysis (p<0.001). A calculated monocytes-high density lipoprotein cholesterol ratio is perspective prognostic indicator of development of the final result of dyslipidemia – atherosclerosis, it was higher in the research group of patients with COPD and comorbidity (p<0.05). Investigation of blood lipid profile and the aforementioned index not only illustrates pathogenetic mutual burden of respiratory and thyroid pathologies, but also gives an opportunity to predict clinical parameters in chronic obstructive pulmonary disease patients like state of external ventilation function of lungs and cardiovascular risk.

Key words: chronic obstructive pulmonary disease, thyroid gland, thyroxine, thyroid-stimulating hormone, hypothyroidism, comorbidity, lipids, monocytes

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Kashul S.V. Bukovinian State Medical University, Chernivtsi, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0009-0006-7873-6466

Khukhlina O.S. Bukovinian State Medical University, Chernivtsi, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-1086-2785

Kashul S.V., Khukhlina O.S. Features of dyslipidemia in chronic obstructive pulmonary disease and its combination with concomitant hypothyroidism. Medicni perspektivi. 2025;30(4):36-45.
DOI: https://doi.org/10.26641/2307-0404.2025.4.348757

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

Cutaneous melanoma is a malignant tumor characterized by a high risk of both lymphatic and hematogenous metastasis, which represents a negative prognostic factor for affected patients. Although melanoma accounts for only approximately 1% of all skin cancer cases globally, it is responsible for more than 80% of skin cancer-related deaths due to delayed or inaccurate diagnosis. Given the increasing incidence of melanoma, particularly among individuals of Caucasian origin I-II, timely and accurate diagnosis is of critical importance. High-frequency ultrasound (HFUS) is a non-invasive and safe imaging modality that enables the assessment of tumor invasion depth and skin structure prior to surgical intervention. The aim of this study was to evaluate the diagnostic performance of high-frequency ultrasound using a 20-22 MHz probe for the preoperative visualization and assessment of cutaneous melanoma, through comparison with histopathological examination (HPE) data. Specifically, the study analyzed the effectiveness of a linear ultrasound probe with a frequency range of 10-22 MHz on the General Electric LOGIQ E R8 (USA) system, in comparison to the 22 MHz DUB Skinscanner (Germany), for determining tumor invasion depth. Additionally, the study established the statistical correlation between HFUS and histopathological findings, to justify the integration of HFUS into clinical diagnostic algorithms for melanoma as a non-invasive tool for preoperative assessment. A total of 90 patients with dermoscopically suspected melanoma were examined. The results of preoperative HFUS performed with two systems – GE LOGIQ E R8 (USA), using a linear transducer with a central frequency of 10-22 MHz, and the DUB Skinscanner (Germany), with a 22 MHz linear transducer were compared to histopathological data. Based on the results of the statistical analysis, the GE ultrasound system demonstrated a very high level of concordance with histopathological measurements, significantly outperforming the DUB device. These findings support the incorporation of high-frequency ultrasound into the diagnostic algorithm for patients with cutaneous melanoma as a non-invasive and informative method for preoperative evaluation.

Key words: cutaneous melanoma, invasion depth, skin ultrasound diagnostics

1. Hryshchenko RV, Bohomolets OV, Stepanen­ko VI. [Benign and malignant (melanocytic and non-melanocytic) skin neoplasms: classification, clinical manifestations, diagnosis and treatment tactics]. Uk­rainskyi zhurnal dermatolohii, venerolohii, kosmetolohii. 2023;4:20. Ukrainian. doi: https://doi.org/10.30978/UJDVK2023-4-20
2. Glazer AM, Winkelmann RR, Farberg AS, et al. Digital dermoscopy for monitoring nevus evolution in children: a longitudinal study. JAMA Dermatol. 2020;156(9):976-82. doi: https://doi.org/10.1001/jamadermatol.2020.2430
3. Arnold M, Holterhues C, Hollestein LM, Coe­bergh JW, Nijsten T, Pukkala E, et al. Trends in incidence and predictions of cutaneous melanoma across Europe up to 2015. J Eur Acad Dermatol Venereol. 2014;28(9):1170-8. doi: https://doi.org/10.1111/jdv.12236
4. Crisan D, Crisan M, Badea R, et al. Ultrasono­graphic assessment of depth infiltration in melanoma and non-melanoma skin cancer. J Ultrasound Med. 2023;42(7):1609-16. doi: https://doi.org/10.1002/jum.16176
5. Bogomolets O, Rojczyk E, Hryshchenko R, Bogo­molets C, Berezkin O. Covid-19, leukemia, and secondary malignancies of the skin – is there a connection: a case report and literature analysis. Front Oncol. 2023;13:1265479. doi: https://doi.org/10.3389/fonc.2023.1265479
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12. Almuhanna N, Wortsman X, Wohlmuth-Wieser I, Kinoshita-Ise M, Alhusayen R. Overview of ultrasound imaging applications in dermatology. J Cutan Med Surg. 2021;25(5):521-9. doi: https://doi.org/10.1177/1203475421999326
13. Freschi G, Silvestri M, Russo T, et al. High-frequency ultrasound for preoperative melanoma thickness assessment: correlation with histopathology. Diagnostics (Basel).2022;12(10):2408. doi: https://doi.org/10.3390/diagnostics12102408
14. Jiyad Z, Palmer RA, Lear JT. Long-term risk of cutaneous squamous cell and basal cell carcinomas as­sociated with psoralen and ultraviolet A (PUVA) therapy: updated evidence from a cohort study. Br J Dermatol. 2022;186(3):487-94. doi: https://doi.org/10.1111/bjd.20815
15. Wortsman X. Top applications of dermatologic ultrasonography that can modify management. Ultra­sonography.2023;42(2):183-202. doi: https://doi.org/10.14366/usg.22130
16. Sellyn GE, Lopez AA, Ghosh S, Topf MC, Chen H, Tkaczyk E, et al. High-frequency ultrasound accuracy in preoperative cutaneous melanoma assessment: A meta-analysis. J Eur Acad Dermatol Venereol. 2025;39(1):86-96. doi: https://doi.org/10.1111/jdv.20179

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Hryshchenko R.V. Bohomolets National Medical University; Dr. Bogomolets Institute of Dermatology and Cosmetology, Kyiv, Ukraine, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-6582-3903

Bogomolets O.V.  Dr. Bogomolets Institute of Dermatology and Cosmetology, Kyiv, Ukraine
 https://orcid.org/0000-0001-7869-8443

Stepanenko V.I. Bohomolets 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/0000-0002-5824-8813

Chalyy K.O. Bohomolets 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/0000-0001-7077-0324

Hryshchenko R.V., Bogomolets O.V., Stepanenko V.I., Chalyy K.O. Diagnostic value of ultrasound examination of skin melanoma for selecting the optimal treatment tactics. Medicni perspektivi. 2025;30(4):46-53.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348763

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

Aim – to assess the influence of neoadjuvant chemotherapy (NAC) on nutritional status in breast cancer patients by analyzing changes in the prognostic nutritional index (PNI), serum albumin, and neutrophil-to-lymphocyte ratio (NLR) at standardized clinical time points. A retrospective study of 121 patients treated in 2008 and 2018 was conducted. Nutritional indicators were evaluated at baseline, before surgery, and seven days postoperatively. Baseline characteristics, including age, body mass index (BMI), albumin, NLR, and PNI1, did not differ significantly between groups. NAC significantly reduced preoperative PNI2 levels (48.70±6.73 vs. 51.61±3.99; p=0.0072), while no significant differences were found at baseline or postoperative PNI3 (p>0.05). A weak negative correlation was observed between age and PNI2 (r= -0.1817; p=0.0461). BMI, chemotherapy regimen, and treatment-related complications did not correlate with PNI values (p>0.05). Generalized Linear Model analysis showed no independent effect of treatment year, BMI, or NAC protocol on PNI1–PNI3, whereas albumin and NLR were significantly associated with PNI across all time points, consistent with the PNI formula. Analysis of the 2018 cohort confirmed a significant decrease in PNI2 among NAC patients (p=0.0076) with no postoperative differences (p=0.9916). The results indicate that NAC causes a transient decline in nutritional reserves confined to the pre-surgical period, emphasizing the need for targeted nutritional assessment and support during NAC in breast cancer care.

Key words: nutritional support, nutritional status, quality of life, breast cancer, neoadjuvant chemotherapy

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21. Killelea BK, Yang VQ, Mougalian S, Horo­witz NR, Pusztai L, Chagpar AB, et al. Neoadjuvant che­motherapy for breast cancer increases the rate of breast conservation: results from the National Cancer Database. Journal of the American College of Surgeons. 2015;220(6):1063-9. doi: https://doi.org/10.1016/j.jamcollsurg.2015.02.011
22. Schott AF, Hayes DF. Defining the Benefits of Neoadjuvant Chemotherapy for Breast Cancer. Journal of Clinical Oncology. 2012;30(15):1747-9. doi: https://doi.org/10.1200/JCO.2011.41.3161
23. Cortazar P, Zhang L, Untch M, Mehta K, Costan­tino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. The Lancet. 2014;384(9938):164-72. doi: https://doi.org/10.1016/S0140-6736(13)62422-8
24. Reza T, Grezenko H, Barker C, Bakht D, Faran N, Yahya NA, et al. Emotional stress and immune response in surgery: a psychoneuroimmunological perspective. Cu­reus. 2023 Nov 13;15(11):e48727. doi: https://doi.org/10.7759/cureus.48727
25. Kim TW, Ko RE, Na SJ, Chung CR, Choi KH, Park C-M, et al. Associations of albumin and nutritional index factors with delirium in patients admitted to the cardiac intensive care unit. Frontiers in Cardiovascular Medicine. 2023;10:1100160. doi: https://doi.org/10.3389/fcvm.2023.1100160
26. Chen C, Li Y, Zhou D, Yang Y, Zhang L, Wang X. Comparative predictive value of preoperative GNRI, PNI, and CONUT for postoperative delirium in geriatric abdominal surgery patients admitted to the ICU. Frontiers in Nutrition. 2025;12:1669159.  doi: https://doi.org/10.3389/fnut.2025.1669159

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Moroz O. Huazhong University of Science and Technology, Tongji Medical College, Tongji Hospital, Department of Thyroid and Breast Surgery, Wuhan, Hubei, China
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0003-4314-4939

Yin Q. Huazhong University of Science and Technology, Tongji Medical College, Tongji Hospital, Department of Thyroid and Breast Surgery, Wuhan, Hubei, China

Li X. Huazhong University of Science and Technology, Tongji Medical College, Tongji Hospital, Department of Thyroid and Breast Surgery, Wuhan, Hubei, China

Moroz O., Yin Q., Li X. Optimizing patient care protocols: importance of nutritional management as part of comprehensive breast cancer treatment. Medicni perspektivi. 2025;30(4):54-60.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348769

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

The article presents data from a clinical case that illustrates potential complications of COVID-19, in particular thrombotic phenomena in the skin and soft tissues, which can lead to necrosis even in the long term. Timely detection and comprehensive treatment provide a chance to avoid deep cicatricial facial deformities. The COVID-19 coronavirus infection, which has emerged in recent years, leads to a number of complications in various organs and systems, in the pathogenesis of which the determining factors are reduced immunity and circulatory disorders. Recently, there have been reports of complications in the maxillofacial region, such as osteonecrosis of the jaws, damage to the mucous membrane, cases of deformation of the facial bones, osteomyelitis, thrombosis of the cavernous sinuses, as well as a tendency to increase in the number of malignant tumors of the maxillofacial region. The aim of the work was to demonstrate a clinical case of facial skin necrosis in a patient who had COVID-19, to improve the diagnostic process, and raise awareness of possible rare complications of coronavirus infection. A clinical case of a patient who was admitted to the Department of Surgical Dentistry from the Intensive Care Unit with complaints of a facial wound that appeared after surgery for extensive swelling of the skin of the right half of the face is described. The COVID-19 test was positive. In a few days, the patient experienced progression of skin and subcutaneous fat necrosis, which led to a soft tissue defect. After the treatment, including surgical interventions and drug therapy, the patient's condition improved. The literature review also addressed the mechanisms of COVID-19 complications, including vasculitis, microthrombosis, and the effect on the immune system, which contribute to the development of necrotic changes. Timely diagnosis and adequate treatment of COVID-19 complications, especially rare manifestations such as skin necrosis, are important to prevent further progression of the pathological process and improve the prognosis for the patient. Close monitoring of patients who have had COVID-19, especially those with risk factors, is key to early detection and effective management of such complications. A 69-year-old patient was admitted to the Department of Surgical Dentistry from the Intensive Care Unit with complaints of a facial wound that developed following surgery for extensive swelling of the skin on the right side of the face. The COVID-19 test was positive. A few days after admission, despite ongoing antibacterial therapy, the wound became covered with extensive necrotic tissue without signs of spontaneous rejection. Due to the size of the affected area, a two-stage necrectomy was performed, followed by free skin grafting harvested from the anterior thigh. The postoperative period was uneventful, and the grafted skin flaps successfully integrated. The patient was discharged for continued follow-up under the care of a family doctor.

Key words: facial skin necrosis, COVID-19, plastic defect closure

1. Chakraborty SS, Malhotra A, Shah UA, Babu SR, Dandekar PB, Kumar DA, et al. Unusual case of a free anterolateral thigh flap partial necrosis in a COVID-19 positive young male following extremity reconstruction. Chinese Journal of Traumatology. 2023 Sep 1;26(05):308-10. doi: https://doi.org/10.1016/j.cjtee.2023.02.002
2. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020 Apr;295(1):202-7. doi: https://doi.org/10.1148/radiol.2020200230
3. Patel D, Louca C, Machuca Vargas C. Oral mani­festations of long COVID and the views of healthcare pro­fessionals. British Dental Journal. 2024 Jan 26;236(2):111-6. doi: https://doi.org/10.1038/s41415-023-6715-7
4. Lopez J, Mumtaz S, Amini A. Did the COVID-19 pandemic have an effect on oral cancer staging? A single-centre retrospective observational study. British Dental Journal. 2024 Feb;7:1-5. doi: https://doi.org/10.1038/s41415-024-7056-x
5. Magro C, Mulvey JJ, Berlin D, Nuovo G, Sal­vatore S, Harp J, et al. Complement associated micro­vascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Trans­lational2020 Jun 1;220:1-3. doi: https://doi.org/10.1016/j.trsl.2020.04.007
6. Prytula N, Fedotova I, Golbaum M. [The possi­bility of osteoporosis and avascular necrosis during the COVID-19 pandemic. A literature review]. Orthopaedics traumatology and prosthetics. 2022;1-2:118-22. Ukrainian. doi: https://doi.org/10.15674/0030-598720221-2118-122
7. Palou EY, Ramos MA, Cherenfant E, Duarte A, Fuentes-Barahona IC, Zambrano LI, et al. COVID-19 associated rhino-orbital mucormycosis complicated by gangrenous and bone necrosis – a case report from Honduras.2021 Jul 27;9(8):826. doi: https://doi.org/10.3390/vaccines9080826
8. Mañón VA, Balandran S, Young S, Wong M, Melville JC. COVID-associated avascular necrosis of the maxilla – A rare, new side effect of COVID-19. Journal of Oral and Maxillofacial Surgery. 2022 Jul 1;80(7):1254-9. doi: https://doi.org/10.1016/j.joms.2022.04.015
9. Burki T. Understanding variants of SARS-CoV-2. Lancet (London, England). 2021 Feb 4;397(10273):462. doi: https://doi.org/10.1016/S0140-6736(21)00298-1
10. Garcia-Beltran WF, Lam EC, Denis KS, Niti­do AD, Garcia ZH, Hauser BM, et al. Multiple SARS-CoV-2 variants escape neutralization by vaccine-induced humoral immunity. Cell. 2021 Apr 29;184(9):2372-83. doi: https://doi.org/10.1016/j.cell.2021.03.013
11. Farajzadeh S, Khalili M, Dehghani S, Babaie S, Fattah M, Abtahi‐Naeini B. Top 10 acral skin mani­festations associated with COVID‐19: A scoping review. Dermatologic2021 Nov;34(6):e15157. doi: https://doi.org/10.1016/j.cell.2021.03.013
12. Trotsky SM. [The role of SarS-CoV-2 genome mutation in the distribution of COVID-19 in Ukraine]. [dissertation]. Poltavskyi derzhavnyi medychnyi univer­sytet.Ukrainian. Available from: https://repository.pdmu.edu.ua/items/abedc949-fdbf-49e0-a435-0c2d0edfff02
13. Kulkarni P, Beeraka D, Tanwar M, Kim U, Gane­san RM, Saini P. Frontal osteomyelitis post-COVID-19 associated mucormycosis. Indian Journal of Ophthal­mology.2023 Jul 1;71(7):2906-10. doi: https://doi.org/10.4103/IJO.IJO_3117_22
14. Eghbali Zarch R, Hosseinzadeh P. COVID‐19 from the perspective of dentists: a case report and brief review of more than 170 cases. Dermatologic Therapy. 2021 Jan;34(1):e14717. doi: https://doi.org/10.1111/dth.14717

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Nahirnyi Ya.P.  I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
 https://orcid.org/0000-0002-1530-0271

Tverdokhlib N.O.  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/0000-0002-1247-2430

Stefaniv I.V.  I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
 https://orcid.org/0000-0003-1994-3802

Nahirnyi Ya.P., Tverdokhlib N.O., Stefaniv I.V. A case report of facial skin necrosis following COVID-19 infection. Medicni perspektivi. 2025;30(4):61-67.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348775

Side effects and hypersensitivity reactions to corticosteroids

Dysplastic nevi are the subject of debates between clinicians and pathologists. There is no standard diagnostic and treatment approach and this causes many disagreements. There is a need to study an immunohistochemical marker PTEN as a long-range diagnostic mechanism between early-stage melanoma and dysplastic nevi. A search for correlations between other markers (Ki-67, SOX-10, p16, PTEN) and dermatoscopic criteria was conducted. We observed 95 cases of clinically atypical melanocytic tumors in adult patients aged 18-65 years. We determined 13 dermatoscopic criteria that accompany atypical melanocytic formations such as structureless areas, irre­gular globules, atypical pigment network, gray dots, blotches, blue-white veil, negative pigment network, polymorphous vessels, “starburst” pattern, angulated lines, multiple colors, regression structures, pseudopods. During  the study all obtained lesions were removed with the following pathology and immunohistochemistry. The use of immunohistochemical markers made it possible to separate early melanomas (n=19) and other (benign) tumors (n=22) from the primary cohort of patients who, according to the results of pathology, had moderate or severe grade of dysplasia. The most common dermatoscopic feature were structureless areas combined with other mentioned signs. The presence of PTEN expression in benign melanocytic tumors and the absence of PTEN in a primary cutaneous melanoma confirms its role in melanoma pathogenesis. In melanoma, along with other markers, SOX-10 expression indicates aggressiveness, atypia, and archi­tectural disorders. Dysplastic nevi usually retain p16, which helps distinguish them from melanoma. The relatively low level of Ki-67 expression in dysplastic nevi is a criterion that helps to distinguish them from melanoma. We consider that application of this combination of immunohistochemical markers in routine practice can significantly improve the diagno­sis of dysplastic nevi and melanoma, especially for diagnostic collisions among superficial atypical melanocytic proli­ferations. Usage of the phosphatase and tensin homolog protein can be useful for diagnostic not only group of “thin mela­nomas” but for non-pigmented nodular melanomas and for secondary metastatic melanoma lesions with unknown primary tumors.

Key words: skin pathology, immunohistochemistry, dermatoscopy, dysplasia, melanoma

1. Drozdowski R, Spaccarelli N, Peters MS, Grant-Kels JM. Dysplastic nevus part I: Historical perspective, classification, and epidemiology. Journal of the Ame­ricanAcademy of Dermatology. 2023 Jan 1;88(1):1-10. doi: https://doi.org/10.1016/j.jaad.2022.04.068
2. Prokhach AV, Svyatenko TV, Hurtovyi VA. Der­matoscopic features of dysplastic nevi. Clinical and Pre­ventive2025 Jan 20;(1):25-30. doi:  https://doi.org/10.31612/2616-4868.1.2025.03
3. Svyatenko TV, Prokhach AV, Antoniuk S, Hurto­vyi V, Tereshkov D. MCATs: Case report of adnexal adenocarcinoma of not otherwise specified type. Clinical Case2023 Mar 1;11(3):e7097. doi: https://doi.org/10.1002/ccr3.7097
4. Xavier-Junior JCC, Ocanha‐Xavier JP. WHO (2018) Classification of Skin Tumors. The American Journal of Dermatopathology. 2019 Sep;41(9):699-700. doi: https://doi.org/10.1097/DAD.0000000000001446
5. BlueBooksOnline [Internet]. Who.int. 2025 [cited 2025 Feb 15].Availablefrom: https://tumourclassification.iarc.who.int/chaptercontent/64/45
6. Rosendahl C, Marozava A. Updated Edition. Scion Publishing Ltd., editor. [Internet]. The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury OX16 9UX, UK: Scion Publishing Limited. [cited 2025 Mar 11]. Availablefrom: https://scionpublishing.com/wp-content/uploads/2023/04/9781914961205_SC.pdf
7. Dysplastic/Atypical nevi – dermoscopedia [Inter­net]. Dermoscopedia.org. [cited 2025 Mar 11]. Available from: https://dermoscopedia.org/Dysplastic_/_Atypical_nevi
8. Wiedemeyer K, Hartschuh W, Brenn T. Dysplas­tic Nevi. Surgical Pathology Clinics. 2021 Jun;14(2):341-57. doi: https://doi.org//10.1016/j.path.2021.01.007
9. Mitsui H, Kiecker F, Shemer A, et al. Discrimina­tion of Dysplastic Nevi from Common Melanocytic Nevi by Cellular and Molecular Criteria. Journal of Investigative Dermatology.2016 Oct;136(10):2030-40. doi: https://doi.org/10.1016/j.jid.2015.11.035
10. Petkova L. Comparative analysis of BCL2, Cyclin D1, P53 and HMB45 expression in pigmented nevi and malignant melanoma of the skin, importance for diagnostic practice. Varna Medical Forum. 2021 Dec 14;10(2):94-4. doi: http://dx.doi.org/10.14748/vmf.v0i0.8157
11. Harvey NT, Peverall J, Acott N, et al. Correlation of FISH and PRAME Immunohistochemistry in Am­bi­guous Superficial Cutaneous Melanocytic Proliferations. The American Journal of Dermatopathology. 2021;43(12):913-20. doi: https://doi.org/10.1097/DAD.0000000000001951
12. Smalley KSM, Teer JK, Chen YA, et al. A Muta­tional Survey of Acral Nevi. JAMA dermatology. 2021 Jul 1;157(7):831-5. doi: https://doi.org/10.1001/jamadermatol.2021.0793
13. Hwang JC, Peacker BL, Lian CG, Russell-Gold­man EE, Cornejo CM, Vleugels FR, et al. Melanoma ari­sing from partially biopsied moderately dysplastic nevus. JAADCase 2025 Mar 7;59:89-93. doi: https://doi.org/10.1016/j.jdcr.2025.01.040
14. Fleming NH, Shaub AR, Bailey E, Swetter SM. Outcomes of surgical re-excision versus observation of severely dysplastic nevi: A single-institution, retrospective cohort study. Journal of the American Academy of Dermatology.2020 Jan;82(1):238-40. doi: https://doi.org/10.1016/j.jaad.2019.07.033
15. Cabrita R, Mitra S, Sanna A, et al. The Role of PTEN Loss in Immune Escape, Melanoma Prognosis andTherapy Response. Cancers. 2020 Mar 1;12(3):742. doi: https://doi.org/10.3390/cancers12030742
16. Valenti F, Falcone I, Ungania S, Desiderio F, Giacomini P, Bazzichetto C, et al. Precision Medicine and Melanoma: Multi-Omics Approaches to Monitoring the Immunotherapy Response. International Journal of Mole­cular2021 Jan 1;22(8):3837. doi: https://doi.org/10.3390/ijms22083837
17. Nishida N. Role of Oncogenic Pathways on the  Cancer Immunosuppressive Microenvironment and   its  Clinical Implications in Hepatocellular Carcinoma.   Cancers.  2021  Jul  21;13(15):3666. doi: https://doi.org/10.3390/cancers13153666
18. Fikrle T, Divisova B, Pizinger K. Clinical-dermo­scopic-histopathological correlations in collision skin tumours. Indian Journal of Dermatology. 2021;66(6):577. doi: https://doi.org/10.4103/ijd.ijd_938_20
19. Semsarian C, Ma T, Nickel B, et al. Do we need to rethink the diagnoses melanoma in situ and severely dysplastic naevus? British Journal of Dermatology. 2022;186(6):1030-2. doi: https://doi.org/10.1111/bjd.21010
20. Elmore JG, Barnhill RL, Elder DE, Longton GM, Pepe MS, Reisch LM, et al. Pathologists’ diagnosis of inva­sive melanoma and melanocytic proliferations: obser­ver accu­racy and reproducibility study. BMJ. 2017 Jun 28;357:j2813. doi: https://doi.org/10.1136/bmj.j2813 

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Prokhach A.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/0000-0001-8232-6204

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

Antoniuk S.V. Municipal non-profit company “Dnipro Regional Clinical Oncological Dispensary” , Dnipro, Ukraine
 https://orcid.org/0009-0006-8620-6238

Prokhach A.V., Svyatenko T.V., Antoniuk S.V. Dermatoscopic and immunohistochemical features of diagnostics of the dysplastic nevi. Medicni perspektivi. 2025;30(4):67-75.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348778

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

Peripheral vascular injury is still a serious pathology, even if the direct threat to life has already been overcome. Post-traumatic aneurysm is a rather rare phenomenon. The cause may be damage to the arteries of the limbs and blunt trauma, so the number of cases increases in wartime. Complications of aneurysms may include the formation of thrombosis, ischemia of the limb with trophic disorders with the need for amputation of the limb. The aim is to improve diagnostic algorithms, treatment results to reduce the recovery period in patients with limb injuries due to blast trauma, in whom aneurysms develop. We have considered and analyzed the features of diagnosis and surgical treatment of post-traumatic aneurysms of the arteries of the limbs based on 11 clinical cases as an example.Complications of aneurysms include rupture of the aneurysmal sac with profuse, life-threatening bleeding, thromboembolism, compression of the peripheral nerve with neuromuscular and sensory dysfunctions. An outbreak of infection and the development of phlegmon of the soft tissues surrounding the aneurysmal sac ("aneurysm suppuration") are possible. Most often, hemodynamic disorders and the formation of the "heart-artery-fistula-vein-heart" circulatory circuit bypassing the rest of the limb cause a steal syndrome and lead to limb ischemia. Simultaneous damage to the artery and vein leads to the formation of an arteriovenous fistula.Post-traumatic aneurysm of the peripheral arteries can lead to significant circulatory disorders, limb ischemia, neuropathy, and ultimately to trophic disorders of the limb. Radical surgical treatment of arteriovenous fistula guarantees improvement of systemic hemodynamics in the early postoperative period. Clinical observations indicate the need for further examination in patients with blunt trauma of the limbs.

Key words: limb injury,post-traumatic arterial aneurysms, surgical treatment, clinical cases

1. Nie S, Zhi K, Qu L. Research progress of tourni­quets and their application in the Russia-Ukraine Conflict. ChinJ 2025 Jan;28(1):1-6. doi: https://doi.org/10.1016/j.cjtee.2024.07.010
2. Compton C, Rhee R. Peripheral vascular trauma. Perspect Vasc Surg Endovasc Ther. 2005 Dec;17(4):297-307. doi: https://doi.org/10.1177/153100350501700404
3. Strafun SS, Laksha AM, Shypunov VG, et [Mi­stakes and complications of diagnosis and treatment of local hypertensive ischemic syndrome with gunshot inju­ries to the lower extremities]. Travma. 2019;20(4):105-12. Ukrainian. doi: https://doi.org/10.22141/1608-1706.4.20.2019.178754
4. Schmit-Neuerburg KP, Joka T. Principles of treatment and indications for surgery in severe multiple trauma. Acta Chir Belg. 1985 Jul-Aug;85(4):239-49. PMID: 4050256.
5. Khoroshun EM. [Key concepts and modern clas­sification of combat surgical trauma]. Klinichna khirurhia. 2022 Jul-Aug;89(7-8):73-87. doi: https://doi.org/10.26779/2522-1396.2022.7-8.736
6. Carey ME. Analysis of wounds incurred by U.S. Army Seventh Corps personnel treated in Corps hospitals during Operation Desert Storm, February 20 to March 10, 1991.J 1996;40(3):165-9. doi: https://doi.org/10.1097/00005373-199603001-00036
7. Richey SL. Tourniquets for the control of trauma­tic hemorrhage: a review of the literature. World J Emerg Surg.2007 Oct 24;2:28.
   doi: https://doi.org/10.1186/1749-7922-2-28
8. Khoroshun EM, Strafun SS, Shypilov SA, et al. [Tactics of Treatment of Tourniquet Syndrome after Gun­shot Wounds]. Terra orthopaedica. 2024;1;34-41. Uk­rainian. doi: https://doi.org/10.37647/2786-7595-2024-120-1-34-41
9. Masri BA, Eisen A, Duncan CP, McEwen JA. Tour­niquet-induced nerve compression injuries are caused by high pressure levels and gradients – a review of the evidence to guide safe surgical, pre-hospital and blood flow restric­tion BMC Biomed Eng. 2020 May 28;2:7. doi: https://doi.org/10.1186/s42490-020-00041-5
10. Rohovskyi VM, Shchepetov MV, Humeniuk KV, Hybalo RV. [Treatment of gunshot wounds of major arte­ries]. Kyiv: Knyha plius; 2022. 128 р. Ukrainian.
11. Zhao B, Zhang J, Ma J, Huang M, Li J, Ma X. Comparison of three different treatment methods for trau­matic and Iatrogenic peripheral artery pseudoaneurysms. Orthop2022 Jul;14(7):1404-12. doi: https://doi.org/10.1111/os.13315 
12. Maertens A, Tchoungui Ritz FJ, Poumellec MA, Camuzard O, Balaguer T. Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report. IntJSurg Case  2020;75:317-21. doi: https://doi.org/10.1016/j.ijscr.2020.09.029
13. Yingliang W, Hai Z, Wei Y, Shuguang J, Yao­wei B, Chaoyang W, et al. Management of traumatic peri­pheral artery pseudoaneurysm: A 10-year experience at a single center. Journal of Interventional Medicine. 2023;6(1):29-34. doi: https://doi.org/10.1016/j.jimed.2022.10.002
14. Khoroshun EM, Makarov VV, Nehoduiko VV, et al. [Problems of diagnosis and treatment of tourniquet syndrome in gunshot wounds of the upper and lower extremities]. Paediatric Surgery. 2023;3(80):83-91. Ukrainian. doi: https://doi.org/10.15574/PS.2023.80.83
15. Korol SO, Rohovskyi VM, Vovk MS, Schepe­tov MV, Honcharuk VS, Sivash YY, et al. [Features of complex surgical treatment of gunshot wounds of major vessels’ combat trauma]. Ukrainian journal of military medicine.2024;5(4):180-6. doi: https://doi.org/10.46847/ujmm.2024.4(5)-180
16. Chang J, Bhandari L, Messana J, et al. Manage­ment of Tourniquet-Related Nerve Injury (TRNI): A SystematicCureus. 2022;14(8):e27685. doi: https://doi.org/10.7759/cureus.27685
17. Cirocchi R, Prigorschi D, Properzi L, Mat­teuc­ci M, Duro F, Tebala GD, et al. Is the Use of Tourniquets More Advantageous than Other Bleeding Control Tech­niques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis. Medicina. 2025;61(1):93. doi: https://doi.org/10.3390/medicina61010093
18. Samarskyi IM, Khoroshun EM. [Provision of first medical aid for injuries of the limb large vessels in combat conditions. Post-tourniquet syndrome and its prevention]. Ukrainian journal of military medicine. 2023;4:50-5. Ukrainian. doi: https://doi.org/10.46847/ujmm.2023.2(4)

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Kryvoruchko I.A. Kharkiv National Medical University, Kharkiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-5525-701X

Honcharova N.M. Kharkiv National Medical University, Kharkiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-5031-7311

Kovbasa O.O. Private Higher Education Institution "Kharkiv Institute of Medicine and Biomedical Sciences", Kharkiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-8080-2166

Farzullaiev N.N. Kharkiv National Medical University, Kharkiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0009-0005-0543-518X

Kryvoruchko I.A., Honcharova N.M., Kovbasa O.O., Farzullaiev N.N. Features of diagnosis and treatment of post-traumatic aneurysms of the arteries of the limbs resulting from explosive injuries. Medicni perspektivi. 2025;30(4):75-86.
DOI: https://doi.org/10.26641/2307-0404.2025.4.348785

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

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder caused by the PIGA gene mutation. The major clinical manifestations include hemolytic anemia, signs of bone marrow dysfunction, and the presence of thrombosis, especially in atypical locations. PNH is classified by 3 types: classical, on the background of another blood disease, and subclinical. Making the diagnosis of PNH can be a difficult task due to the presence of clinical signs that are also characteristic of hemolytic and aplastic anemias, nephrotic syndrome, etc., which prolongs the time until the patient receives the appropriate treatment. The authors of the publication conducted a general review of the literature and an analysis of clinical cases of PNH in order to increase the awareness of specialists of various profiles in the diagnostics of rare diseases using the example of PNH. The article presents 3 clinical cases of different types of PNH. Patient A. was not finally examined and did not receive full treatment for 10 years, he was previously diagnosed with aplastic anemia, myelodysplastic syndrome, mesangial glomerulonephritis, received immunosuppressive therapy with partial effect. According to the data of the immunocytological study, the PNH clone was found, which made up 64.80% of erythrocytes, 94.73% of monocytes, and 97.82% of neutrophils. Reticulocytes made up 60‰, lactate dehydrogenase level was 1630 Units/L, there were no episodes of thrombosis. Patient G. was observed with a diagnosis of myelo­dysplastic syndrome: refractory anemia for 4 years, was examined for PNH after the loss of effect of erythropoietin therapy and the appearance of manifestations of hemolysis, which became more significant during the last year. A PNH clone was detected, which made up 17.83% of erythrocytes, 96.72% of monocytes, and 96.28% of neutrophils. Reticulocytes made up 127‰, bilirubin level – 28.74 mmol/l, lactate dehydrogenase – 1081.5 Units/L. Patient M. has been ill for several months with a pronounced cytopenic syndrome, and according to the bone marrow trepanobiopsy the hypocellular bone marrow was found out. According to the data of the immunocytological study, a reduction of CD55 and C59 expression was found out, which corresponds to PNH, as well as immunocytological signs of myelodysplastic syndrome. The final diagnosis of PNH was confirmed by molecular genetic study: a mutation in the PIGA gene was detected. The level of reticulocytes in this patient was 17‰, the level of bilirubin was 13.3 mmol/l, the level of lactate dehydrogenase was 232.2 Units/L, and there were no episodes of thrombosis. Conclusions. Patients A. and G. can be classified as patients with type 2 PNH. Patient M. can be classified as a patient with type 3 PNH due to the absence of signs of hemolysis and thrombosis in the presence of mutation in the PIGA gene on the background of MDS. The presented cases of PNH demonstrate the existing problems of diagnosing this rare disease. The variability of clinical manifestations, the lack of specific diagnostic criteria leads to late establishment of the correct diagnosis and, as a result, untimely treatment.

Key words: paroxysmal nocturnal hemoglobinuria, anemia, hematuria, hemolysis, myelodysplastic syndrome

1. Cançado RD, Araújo AS, Sandes AF, et al. Con­sensus statement for diagnosis and treatment of paroxys­mal nocturnal haemoglobinuria. Hematol Transfus Cell Ther. 2020;43(3):341-8. doi: https://doi.org/10.1016/j.htct.2020.06.006
2. Gurnari C, Awada H, Pagliuca S, et al. Paro­xysmal nocturnal hemoglobinuria-related thrombosis in the era of novel therapies: a 2043-patient-year analysis. Blood.144(2):125-6. doi: https://doi.org/10.1182/blood.2024023988
3. Dingli D, Maciejewski J, Larratt L, et al. Rela­tionship of paroxysmal nocturnal hemoglobinuria (PNH) granulocyte clone size to disease burden and risk of major vascular events in untreated patients: Results from the in­ter­national PNH Registry. Ann Hematol. 2023;102(7):1637-44.
   doi: https://doi.org/10.1007/s00277-023-05269-4
4. Kyselova O, Wagner O, Kotsubenko S. PB2692: Brief evaluation of the impact of the war on quality of life of ukrainian PNH patients. HemaSphere. 2023;7(S3):e471416f. doi: https://doi.org/doi.org/10.1097/01.HS9.0000977440.28886.a7
5. Kokoris S, Polyviou A, Evangelidis P, et al. Thrombosis in paroxysmal nocturnal hemoglobinuria (PNH): from pathogenesis to treatment. International Journal of Molecular Sciences. 2024;25(12104):1-24. doi: https://doi.org/doi.org/10.3390/ijms252212104
6. Colden MA, Kumar S, Munkhbileg B, Babu­shok DV. Insights into the emergence of paroxysmal noc­turnal hemoglobinuria. Front Immunol. 2022;12:830172. doi: https://doi.org/10.3389/fimmu.2021.830172
7. Goh YT, Yap ES, Tan CW, et al. Consensus re­com­mendations for optimising the diagnosis and treatment of paroxysmal nocturnal haemoglobinuria in Singapore. Ann Acad Med Singap. 2024;53(6):371-85. doi: https://doi.org/doi.org/10.47102/annals-acadmedsg.202475
8. Patriquin CJ, Kiss T, Caplan S, et al. How we treat paroxysmal nocturnal hemoglobinuria: A consensus sta­tement of the Canadian PNH network and review of the National Registry. Eur J Haematol. 2018:102(1):36-52. doi: https://doi.org/10.1111/ejh.13176
9. Babushok DV. When does a PNH clone have clinical significance? Hematology. 2021;2021(1):143-52. doi: https://doi.org/10.1182/hematology.2021000245
10. Wong RSM, Jang JH, Wong LLL, et al. Moni­toring and Treatment of Paroxysmal Nocturnal Hemo­globinuria in Patients with Aplastic Anemia in Asia: An Expert Consensus. Int J Mol Sci. 2024;25(12160):1-16. doi: https://doi.org/10.3390/ijms252212160
11. Bodó I, Amine I, Boban A, et al. Complement inhibition in paroxysmal nocturnal hemoglobinuria (PNH): A systematic review and expert opinion from Central Europe on special patient populations. Adv Ther. 2023;40(6):2752-72.
    doi: https://doi.org/10.1007/s12325-023-02510-4
12. Dezern AE, Borowitz MJ. ICCS/ESCCA Con­sensus Guidelines to detect GPI-deficient cells in Paro­xysmal Nocturnal Hemoglobinuria (PNH) and related Disorders Part 1 – Clinical Utility. Cytometry Part B. 2018;94B:16-22. doi: https://doi.org/10.1002/cyto.b.21608
13. Brodsky RA. How I treat paroxysmal nocturnal hemoglobinuria. Blood. 2021;137(10):1304-9. doi: https://doi.org/10.1182/blood.2019003812
14. Bektas M, Copley-Merriman C, Khan S, Sarda SP, Shammo JM. Paroxysmal nocturnal hemoglobinuria: Current treatments and unmet needs. J Manag Care Spec Pharm. 2020;26(12-b):14-20. doi: https://doi.org/10.18553/jmcp.2020.26.12-b.s14

Look through:

Zinoveva O.G. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0009-0006-9210-5716

Trushenko O.S. European Medical University, Dnipro, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-1719-1451

Usenko G.V. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0000-0003-4904-0188

Agafonova O.S. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0009-0006-7102-8889

Selina I.O. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0000-0001-7901-3127

Sydorenko I.V. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0009-0008-3171-9081

Kushnir M.D. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0009-0000-5187-8575

But N.O. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0000-0001-7184-924

Kusliy I.G. Municipal non-commercial enterprise "City Clinical Hospital No. 4" of the Dnipro City Council, Dnipro, Ukraine
 https://orcid.org/0009-0007-4536-5571

Zinoveva O.G., Trushenko O.S., Usenko G.V., Agafonova O.S., Selina I.O., Sydorenko I.V., Kushnir M.D., But N.O., Kusliy I.G. Paroxysmal nocturnal hemoglobinuria: clinical cases and diagnostic difficulties. Medicni perspektivi. 2025;30(4):87-92.
DOI: https://doi.org/10.26641/2307-0404.2025.4.348794

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

Thrombosis of a mechanical aortic valve prosthesis is a rare, yet potentially life-threatening complication that demands urgent recognition, rapid diagnostic evaluation, and immediate therapeutic intervention. We describe a detailed clinical case of a 52-year-old male patient who developed critical thrombosis of a mechanical aortic valve prosthesis despite maintaining an adequate and well-controlled anticoagulant regimen. The patient presented with profound hemodynamic instability, markedly reduced ejection fraction, and clinical manifestations consistent with acute decompensated heart failure. On physical and instrumental examination, his condition corresponded to ASA class IV, with a calculated surgical risk of EuroSCORE II=17.28%, indicating an extremely high perioperative mortality risk. Considering both the elevated risk of surgical re-intervention and the rapidly worsening heart failure, the multidisciplinary team decided to initiate systemic thrombolytic therapy as a life-saving alternative. Thrombolysis was performed according to an accelerated protocol using intravenous alteplase at a total dose of 100 mg. Within the first hour of infusion, echocardiography revealed a clear positive trend – restoration of leaflet mobility, a notable reduction in the transprosthetic gradient, and significant improvement in myo­cardial contractility. Subsequent management continued in the intensive care unit with careful hemodynamic and laboratory monitoring. The patient was discharged on the eighth day in a stable condition, free of complications. Follow-up echocardiography two months later confirmed normal and sustained function of the mechanical prosthesis. This case illustrates the high efficacy of systemic thrombolysis as a viable and guideline-supported (ESC/EACTS 2021, Class I, Level B) therapeutic option when surgical treatment is contraindicated or technically impossible.

Key words: prosthetic valve thrombosis, thrombolysis, mechanical aortic valve, ESC guidelines, high-risk surgery, case report

1. Roudaut R, Serri K, Lafitte S. Thrombosis of pros­thetic heart valves: diagnosis and therapeutic considera­tions. Heart.2007 Jan;93(1):137-42. doi: https://doi.org/10.1136/hrt.2005.071183
2. Özkan M, Gündüz S, et al. Thrombolysis or sur­gery in patients with obstructive prosthetic valve thrombosis. J Am Coll Cardiol. 2022;79(5):532-44. doi: https://doi.org/10.1016/j.jacc.2021.12.027
3. De Roeck F, Abdulmajid L, Haine S. Prosthetic aortic valve thrombosis complicated by left main coronary artery bifurcation embolism: Case report and review of literature. Cardiovascular Revascularization Medicine. 2021 Jul;28 Suppl:72-4. doi: https://doi.org/10.1016/j.carrev.2021.03.021
4. Chopard R, Meneveau N. Surgery versus throm­bolytic therapy for prosthetic valve thrombosis (review). J Am Heart Assoc. 2024;13(8):e035143. doi: https://doi.org/10.1161/JAHA.124.035143
5. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease.  European heart journal. 2022;43(7):561-632. doi: https://doi.org/10.1093/eurheartj/ehab395
6. Serban A, Dadarlat-Pop A, Achim A, et al. Diag­nosis of Left‑Sided Mechanical Prosthetic Valve Throm­bosis: A Pictorial Review. J Pers Med. 2023 Jun;13(6):967. doi: https://doi.org/10.3390/jpm13060967
7. Güner A, Kalçık M,∙Kalkan S,∙Özkan M. Manage­ment of Obstructive Prosthetic Heart Valve Thrombosis: Thrombolytic Therapy or Anticoagulation? The Canadian journal of cardiology. 2021;37(6):938.e7. doi: https://doi.org/10.1016/j.cjca.2021.01.026
8. Zoghbi WA, Jone P-N, Chamsi-Pasha MA,∙Chen T, Collins KA, et al. Guidelines for the evaluation of pro­sthetic valve function with cardiovascular imaging. J Am Soc Echocardiogr. 2024;37(4):355-420. doi: https://doi.org/10.1016/j.echo.2023.10.004
9. Nashef SAM, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-44. doi: https://doi.org/10.1093/ejcts/ezs043
10. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: https://doi.org/10.1093/eurheartj/ehab368
11. Seshagiri RD, Srinivasan KN, SathyamurthyI. Low-dose alteplase in prosthetic valve thrombosis. Indian Heart J. 2022;74(3):210-4. doi: https://doi.org/10.1016/j.ihjccr.2022.03.005
12. Amado-Rodríguez L, Rodríguez-Garcia R, Bel­lani G, Pham T, Fan E, Madotto F, et al. Mechanical venti­lation in cardiogenic pulmonary edema. J Intensive Care. 2022;10:13.
    doi: https://doi.org/10.1186/s40560-022-00648-x
13. Graham F, Dobbin S, Sooriyakanthan M, Tsang W. Evolving standards in prosthetic heart valve assessment. Struct Heart. 2024 Nov 30;9(4):100372. doi: https://doi.org/10.1016/j.shj.2024.100372

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Kipot A.O. The Heart Institute of the Ministry of Health of Ukraine, Kyiv; 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/0009-0003-4792-2133

Stetsyuk L.R. The Heart Institute of the Ministry of Health of Ukraine, Kyiv, Ukraine
 https://orcid.org/0009-0002-3286-4869

Todurov M.B. The Heart Institute of the Ministry of Health of Ukraine, Kyiv, Ukraine
 https://orcid.org/0009-0008-6299-8319

Todurov B.M. The Heart Institute of the Ministry of Health of Ukraine; Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
 https://orcid.org/0009-0000-2047-4447

Kipot A.O., Stetsyuk L.R., Todurov M.B., Todurov B.M. High-risk thrombosis of a mechanical aortic valve: successful thrombolysis as a bridge or an alternative to surgery. Medicni perspektivi. 2025;30(4):93-97.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348922

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

In connection with significant changes in the social policy of European countries, including Ukraine, regarding persons with disabilities and the need to prioritize not a “medical” but a “social” approach to the problem, given the elimination of the entire network of medical and social expert commissions (MSEC) in Ukraine, which were replaced by a new system for assessing a person’s daily functioning, a final analysis of the five-year activity of the medical and social expertise service was conducted. The study's purpose is to analyze statistical indicators of disability and the activities of medical and social expert commissions for 2020-2024. Primary statistical data obtained from regional entities implementing medical and social expertise (MSE) in Ukraine were collected and processed as part of a multi-year medical and statistical observation using reporting form No. 14 “Report on causes of disability, indications for medical, professional and social rehabilitation for 20__” (annual) (approved by order of the Ministry of Health of Ukraine dated July 10, 2007 No. 378, as amended). A continuous sample of all those initially examined by the MSEC and recognized as persons with disabilities from all regions of Ukraine who were examined by the MSEC of Ukraine for the period from 2020 to 2024 was analyzed. The following parameters were studied: the number of persons recognized as persons with disabilities in the country as a whole and by regions, the structure of disability by groups, the structure of disability by nosological forms. The epidemiological situation regarding primary disability in Ukraine during 2020-2024 remains unfavorable: there is an exponential growth in intensive and extensive indicators of all causes of disability of the population, disability of the population due to general diseases, childhood disability and disability of military personnel is rapidly increasing. The MSEC network available in 2024 was ineffective, part of the MSEC significantly reduced its expert activities, there are significant shortcomings in the objectivity of establishing disability groups and in the implementation of individual disability rehabilitation programs, preventive measures for persons with disabilities. Given the difficult socio-economic situation and martial law in Ukraine, there is an urgent need for systemic changes in the organizational model and mechanisms for expert establishment of disability for citizens of the country, as well as in the implementation of effective measures for the rehabilitation of persons with disabilities. It is advisable to continue in-depth epidemiological monitoring of primary disability in Ukraine by implementing electronic systems for collecting and statistical analysis of primary data using the electronic health care system of Ukraine. Due to the rapid growth of disability rates among military personnel, it is urgent to develop and implement a system of in-depth personalized epidemiological monitoring of disability and implement comprehensive prevention and rehabilitation measures (medical, labor, professional, social) among this category of Ukrainian citizens.

Key words: statistical indicators, disability, rehabilitation, medical and social examination

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14. Kyrychenko AG, Khaniukova IY, Hondu­len­ko NO, Sanina NA. [Main indicators of disability and activity of medical and social expert commissions of Ukraine for 2023: analytical and informational guide] [Internet]. Dnipro: Aktsent; 2024 [cited 2025 Jun 25]. 133 p. Ukrainian. Available from: https://drive.google.com/­file/d/1fP8TD7K5HpsPjzWCwyZIC9xQgRcExf03/view
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16. Antomonov MY. [Mathematical processing and analysis of medical and biological data]. Kyiv; 2018. 579 p. Ukrainian.
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Varyvonchyk D.V. State Institution "Ukrainian State Research Institute of Medical and Social Problems of Disability of the Ministry of Health of Ukraine", Dnipro, Ukraine 
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0003-2107-6269

Khanyukova I.Y. State Institution "Ukrainian State Research Institute of Medical and Social Problems of Disability of the Ministry of Health of Ukraine", Dnipro, Ukraine 
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-1760-0913

Hondulenko N.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/0000-0001-5683-7836

Varyvonchyk D.V., Khanyukova I.Y., Hondulenko N.O. Analysis of the dynamics of primary disability in Ukraine and the implementation of rehabilitation measures for persons with disabilities (2020-2024). Medicni perspektivi. 2025;30(4):97-115.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348953

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

Sexually transmitted infections (STIs) continue to pose a significant global health burden, particularly among young adults aged 18-24 years, including university students. These infections can lead to serious reproductive and sexual health complications, yet knowledge gaps, inconsistent protective behaviors, and limited access to health education and services persist in this demographic. University students are at increased risk due to a combination of behavioral, cultural, and systemic factors. This study aimed to evaluate STI-related knowledge, attitudes and practices among health-science students enrolled at the University of Medicine, Tirana (FTMS/FMD) and University “Aleksandër Moisiu” of Durrës, Albania. A descriptive cross-sectional survey was carried out in May 2025 among 475 students enrolled in Bachelor and Master-level programs at two universities: The University of Medicine in Tirana and University “Aleksandër Moisiu” of Durrës. Participants completed a psychometrically validated self-administered questionnaire. The tool measured multiple dimensions including knowledge about STIs transmission and prevention, attitudes toward condom use and counseling, and self-reported sexual practices. Descriptive statistics and chi-square tests were used to analyze the data, while thematic analysis was applied to open-ended responses. Findings revealed that while awareness was high – 83.4% of students recognized that STIs may cause female infertility and 74.1% identified male infertility risk – only 26.3% reported using any form of contraception and condom use was reported by only a small minority of students. A large proportion of both female (58.9%) and male (60.6%) students did not use any birth control method. The data also indicated a strong gender disparity in responsibility and knowledge related to reproductive risks. A notable 6.6% of female respondents reported a history of abortion, highlighting possible consequences of inconsistent contraceptive use and limited access to sexual health counseling. In conclusion, although general awareness regarding STIs is present, significant gaps in protective practices remain. There is a critical need for targeted, gender-sensitive, and skills-based sexual health education programs that address the knowledge-behavior disconnect and promote youth-friendly services. These efforts must be embedded within university systems to foster a supportive environment for behavioral change and improved reproductive health outcomes.

Key words: sexually transmitted infections, university students, sexually transmitted infections knowledge, contraceptive use, condom use, Albania, sexual health education

1. World Health Organization. Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022-2030 [Internet]. Geneva: WHO; 2023 [cited 2025 Nov 7]. Available from: https://www.who.int/publications/i/item/9789240053779
2. Liu R, Xu K, Zhang X, Cheng F, Gao  L, Xu J. HIV‑Related Knowledge and Sexual Behaviors among Teenagers: Implications for Public Health Interventions. Children (Basel). 2023;10(7):1198. doi: https://doi.org/10.3390/children10071198
3. World Health Organization. Consolidated guide­lines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations [Internet]. Geneva: WHO; 2022 [cited 2025 Nov 7]. Available from: https://www.who.int/publications/i/item/9789240052390
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6. Capraș R-D, Telecan T, Crețeanu R, Crivii C-B, Badea A-F, Cordoș A-A, et al. Knowledge, attitudes, and behaviors regarding sexually transmitted infections  among Romanian medical students: a cross-sectional study. Healthcare (Basel). 2025;13(10):1120. doi: https://doi.org/10.1186/s41182-025-00737-1
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8. Gabrani J, Merkuri L, Cela K, Rugia I. Utili­zation of sexual and reproductive health services among Albanian uni­versity students. Eur J Public Health. 2025;35(Suppl 4):ckaf161.1029. doi: https://doi.org/10.1093/eurpub/ckaf161.1029.
9. Burazeri G, Roshi E, Tavanxhi N, Rrumbullaku L, Dasho E. Knowledge and attitude of undergraduate students towards sexually transmitted infections in Tirana, Albania. Croat Med J. 2003;44(1):86-91. PMID: 12590435
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18. Lederer AM, King MH, Sovak MA, Kim S. Col­lege students and sexually transmitted infection risk: a review of the recent literature. Health Educ J. 2021;80(1):6-17. doi: https://doi.org/10.1177/0017896920959091
19. Subbarao NT, Akhilesh A. Knowledge and attitu­de about sexually transmitted infections other than HIV among college students. Indian J Sex Transm Dis AIDS. 2017;38(1):10-14. doi: https://doi.org/10.4103/0253‑7184.196888
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22. Subotic S, Vukomanovic V, Djukic S, Radevic S, Radovanovic S, Radulovic D, Boricic K, Andjelkovic J, Tosic Pajic J, Simic Vukomanovic I. Differences regar­ding knowledge of sexually transmitted infections, sexual habits, and behavior between university students of medical and non‑medical professions in Serbia. Front Public Health. 2022 Jan 13;9:692461. PMID: 35111707; PMCID: PMC8802719. doi: https://doi.org/10.3389/fpubh.2021.692461

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Bimi Indrit  University “Aleksandër Moisiu” , Durrës, Albania
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0003-2143-8012

Bara Silvana University of Medicine, Tirana, Tirana, Albania
 https://orcid.org/0000-0001-7911-7305

Stroni Gentian University of Medicine, Tirana, Tirana, Albania
 https://orcid.org/0009-0008-9436-2163

Ramosaçaj Ergys University of Medicine, Tirana, Tirana, Albania
 https://orcid.org/0000-0003-0758-4793

Bimi Daniela  “Queen Geraldina” Maternity Hospital, Tirana, Albania
 https://orcid.org/0009-0008-9440-1118

Bimi Indrit, Bara Silvana, Stroni Gentian, Ramosaçaj Ergys, Bimi Daniela. Knowledge, attitudes and practices on sexually transmitted infections among university students in Albania. Medicni perspektivi. 2025;30(4):116-124. DOI: https://doi.org/10.26641/2307-0404.2025.4.348957

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

The article is devoted to studying the nature and extent of the burden on the Ukrainian healthcare system under martial law, particularly in connection with the disability of both civilians of various age groups and military personnel. The aim of the study was to assess the burden on the healthcare system associated with all classes of diseases and disorders of the musculoskeletal system and connective tissue in the adult and child population of Ukraine as a whole and in the Vinnytsia region, as well as to analyze its changes in the period 2021-2024. Based on an analysis of secondary official statistical data from the Public Health Center of the Ministry of Health of Ukraine. It has been established that the level and structure of hospital morbidity in Ukraine during 2021-2024 reflects general global trends. It has been confirmed that diseases of the musculoskeletal system and connective tissue constitute a significant proportion of the burden on the inpatient healthcare system in Ukraine. The study also found that diseases of the musculoskeletal system and connective tissue occupy one of the leading places in the structure of disability among the adult population, indicating their significant contribution to the loss of working capacity and the need for long-term treatment and rehabilitation. At the same time, diseases of the musculoskeletal system and connective tissue are not among the leading causes, but are consistently present in the structure of child disability. The increase in hospitalizations and surgical interventions against the backdrop of a decrease in the number of doctors in 2024 indicates an increased burden on the human resources of the healthcare system, particularly in the field of surgical and orthopedic-traumatological care. The results obtained indicate the need to take into account diseases of the musculoskeletal system and connective tissue when planning the volume of inpatient care, rehabilitation services, and resource provision, especially in conditions of martial law.

Key words: disability, hospitalizing, diseases of musculoskeletal system and connective tissue, use of healthcare system resources

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12. Koval VM, Kryvoviaz OV, Kudria VV. [Asses­sment of the state of pharmaceutical aid dynamics in Ukraine and the Republic of Poland in the context of the economic accessibility of reimbursable medicines and medical goods for the population]. Achievements of Clinical and Experimental Medicine. 2024 Oct. 24;(3):5-12. Ukrainian. doi: https://doi.org/10.11603/1811-2471.2024.v.i3.14703
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14. Ferrari Alize J, Santomauro DF, Aali Ai, et al. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global  Burden of Disease Study 2021. The Lancet. 2024 Apr 17;403(10440):2133-61. doi: https://doi.org/10.1016/S0140-6736(24)00757-8
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19. Gill TK, Manasi MM, Lyn MM, et al. Global, regional, and national burden of other musculoskeletal disorders, 1990-2020, and projections to 2050: a syste­matic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology 2024 Apr 17;5(11):e670–e682. doi: https://doi.org/10.1016/S2665-9913(23)00232-1
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Kryvoviaz O.V. National Pirogov Memorial Medical University, Vinnytsya, Vinnytsia, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-5441-1903

Koval V.M. National Pirogov Memorial Medical University, Vinnytsya, Vinnytsia, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-9324-209X

Kryvoviaz S.O. Khmelnytskyi National University, Khmelnytskyi, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-6599-1392

Kryvoviaz O.V., Koval V.M., Kryvoviaz S.O. The burden on the healthcare system of Ukraine under martial law, taking into account the contribution of musculoskeletal and connective tissue diseases. Medicni perspektivi. 2025;30(4):125-133. DOI: https://doi.org/10.26641/2307-0404.2025.4.348970

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

Iron deficiency  anemia (IDA) is a common nutritional disorder in young children, associated with impaired cognitive, physical, and immune development. This study aimed to evaluate hematological, immunological, and nutritional parameters in children with IDA, determine the incidence of respiratory tract infections in IDA and assess the impact of iron supplementation therapy (IST). A prospective observational cohort study was conducted on 123 children aged 6 months to 5 years (95 term children with IDA and control group included 28 practically healthy children) between 2019-2020 at the National Center for Hematology and Transfusion in Baku, Azerbaijan. Laboratory assessments included hematological parameters, iron status markers, and immune system analysis using flow cytometry and ELISA. Hemoglobin (HgB), red blood cell (RBC) count, mean cor­puscular volume (MCV), and ferritin levels were significantly lower in children with IDA compared to the control group (p<0.001), while total iron binding capacity (TIBC) and unsaturated iron binding capacity (UIBC) were elevated. Nutri­tional analysis revealed a significant deficiency in iron-rich food intake among children with IDA (p<0.050), with low socio-economic status and maternal education identified as key risk factors (p<0.001). Immune system evaluation showed significantly lower interferon gamma (IFN-γ) and interleukin-2 (IL-2) levels (p<0.001) and higher tumor necrosis factor alpha (TNF-α) levels (p=0.003), indicating compromised cellular immunity. The incidence of acute respiratory viral infections and pneumonia was significantly higher in children with IDA (p<0.050). IST over 8-16 weeks led to significant improvements in hematological and immune parameters, with a notable reduction in infection rates (p<0.001). It was proven the negative impact of IDA on immune function and its association with increased susceptibility to infections. IST effectively restores immune function and reduces infection incidence, emphasizing the importance of early diagnosis and intervention in pediatric IDA management.

Key words: iron deficiency anemia, cytokine profiles, iron supplementation therapy, respiratory infections, nutritional status

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2. Mantadakis E, Chatzimichael E, Zikidou P. Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diag­nosis and Therapy. Mediterr J Hematol Infect Dis. 2020 Jul 1;12(1):e2020041. doi: https://doi.org/10.4084/MJHID.2020.041
3. Akand N, Sarkar PK, Alam J, Mollah AH, Kam­ruzzaman, Tahura S, et al. Anemia: a Risk Factor for Acute Lower Respiratory Tract Infection in Children under 5 years of age. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2021 Sept;20(Iss 9, Ser 2):33-40. doi: https://doi.org/10.9790/0853-2009023340
4. Cronin SJF, Woolf CJ, Weiss G and Pennin­ger JM. The Role of Iron Regulation in Immunometabo­lism and Immune-Related Disease. Front. Mol. Biosci. 2019;6:116. doi: https://doi.org/10.3389/fmolb.2019.00116/
5. Siller A, Seekircher L, Schmidt D, Tschiderer L, Willeit P, Schennach H, et al. XN-1000 Hematology Ana­lyzer as an Alternative to Flow Cytometry for Measuring Residual Cells in Blood Components. Ann Lab Med. 2025;45(4):437-49. doi https://doi.org/10.3343/alm.2024.0448
6. Tabacco A, Moda E, Tarli P, Neri P. An improved, highly sensitive method for the determination of serum iron using chromazurol B. Clin Chim Acta. 1981;114(2-3):287-90. doi: https://doi.org/10.1016/0009-8981(81)90404-6
7. Mahesha HB. Estimation of Protein by Biuret Method. Structure Biology [Internet]. 2012 [cited 2025 Jun 01]. Availablefrom: https://www.researchgate.net/publication/329699625
8. Shankar G, Cohen DA. Enhanced cytokine detec­tion by a novel cell culture-based ELISA. J Immunoassay. 1997 Nov;18(4):371-88. doi: https://doi.org/10.1080/01971529708005828
9. Kutner MH, Nachtsheim CJ, Neter J, Li W. Ap­plied Linear Statistical Models. 5th Edition. [Internet]. McGraw-Hill/Irwin; 2005[cited 2025 Jun 01]. Available from: https://ru.scribd.com/document/906591963/Applied-Linear-Statistical-Models-5th-Edition-Michael-H-Kutner-latest-pdf-2025
10. Shouse AN, LaPorte KM, Malek TR. Interleukin-2 signaling in the regulation of T cell biology in autoim­munity and cancer. Immunity. 2024 Mar 12;57(3):414-28. doi: https://doi.org/10.1016/j.immuni.2024.02.001
11. Chibanda Y, Brookes M, Churchill D, Al-Hassi H. The Ferritin, Hepcidin and Cytokines Link in the Diagno­ses of Iron Deficiency Anaemia during Pregnancy: A Re­view. International Journal of Molecular Sciences. 2023;24(17):13323. doi http://doi.org/10.3390/ijms241713323
12. Orozco Valencia A, Camargo Knirsch M, Sua­vinho Ferro E, Antonio Stephano M. Interleukin-2 as im­munotherapeutic in the autoimmune diseases. Int Immu­nopharmacol.2020 Apr;81:106296. doi: https://doi.org/10.1016/j.intimp.2020.106296
13. Anani M, El-Kelany A, Hashem A, Mona Sala­mal M. Interleukin-2 gene expression and its relation to red blood cell indices and T lymphocytes in anemic Egyptian children: a case–control study. The Egyptian Journal of Haematology. 2021;46(1):29. doi: https://doi.org/10.4103/ejh.ejh_36_20
14. Bendickova K, Fric J. Roles of IL-2 in bridging adaptive and innate immunity, and as a tool for cellular immunotherapy. J Leukoc Biol. 2020 Jul;108(1):427-37. doi: https://doi.org/10.1002/JLB.5MIR0420-055R
15. Giannessi F, Percario Z, Lombardi V, Sabatini A, Sacchi A, Lisi V, et al. Macrophages treated with inter­ferons induce different responses in lymphocytes via extracellular vesicles. iScience. 2024 May 10;27(6):109960. doi: https://doi.org/10.1016/j.isci.2024.109960
16. Abuga KM, Rockett KA, Muriuki JM, Koch O, Nairz M, Sirugo G, et al. Interferon-gamma polymor­phisms and risk of iron deficiency and anaemia in Gambian Wellcome Open Res. 2020 Jun 2;5:40. doi: https://doi.org/10.12688/wellcomeopenres.15750.2
17. Berg V, Modak M, Brell J, Puck A, et al. Iron Deprivation in Human T Cells Induces Nonproli­ferating Accessory Helper Cells. Imm unoho­rizons. 2020;4(4):165-77. doi: https://doi.org/10.4049/immunohorizons.2000003
18. Abreu R, Essler L, Giri P, Quinn F. Interferon-gamma promotes iron export in human macrophages to limit intracellular bacterial replication. PLoS One. 2020 Dec 8;15(12):e0240949. doi: https://doi.org/10.1371/journal.pone.0240949

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Najafova V.A. Azerbaijan State Advanced Training Institute For Doctors named for A. Aliev, Department of Pediatrics, Baku, Republic of Azerbaijan
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-8736-7953

Mammadova R.Y. Azerbaijan State Advanced Training Institute For Doctors named for A. Aliev, Department of Pediatrics, Baku, Republic of Azerbaijan
 https://orcid.org/0009-0008-8635-9925

Garayeva S.Z. Azerbaijan Medical University, Department of Children Diseases, Baku, Republic of Azerbaijan
 https://orcid.org/0000-0002-3325-1047

Najafova V.A., Mammadova R.Y., Garayeva S.Z. The impact of iron deficiency anemia on cytokine profiles and respiratory infections in children: a single-center study. Medicni perspektivi. 2025;30(4):134-142.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348337

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

War certainly always creates socio-stressful conditions, causes significant damage to mental health and creates obstacles to the comprehensive development of children, one of which is anxiety. Therefore, identifying the risks of developing anxiety in children and adolescents will contribute to early intervention and prevention of negative consequences, the implementation of appropriate restorative measures to strengthen and preserve mental health. The aim of the study was to identify key factors associated with the development of anxiety in children and adolescents living in Ukraine during the period of active hostilities. The study involved 489 individuals aged 8 to 18 who experienced a traumatic event during the full-scale invasion in Ukraine. Demographic variables of respondents were collected using the “School-age Child Integration Questionnaire.” To measure the level of anxiety and other manifestations of a neurotic state (in particular, sleep disturbances, autonomic disorders, behavioral disorders, signs of depression and asthenia), the “Children's Neurosis Questionnaire” by V. Siedniev was used. The results of univariate regression analysis showed that the main factors that increase the risk of anxiety in children and adolescents who experienced acute stress during the war, are: female gender, age, feeling of discomfort in the family, lack of a favorable model of family relationships to inherit, limited circle of friends at school, misunderstanding of their own positive character traits, doubts about negative character traits. The results of multivariate analysis revealed the following independent predictors of the anxiety development: female gender, age, feeling of discomfort in the family, lack of a favorable model of family relationships to inherit, misunderstanding of their own positive character traits, doubts about negative character traits, fear of terrible dreams, fear of animals and fairy-tale characters. A predictive model has been developed that allows, with sufficient accuracy: sensitivity (67.4%; 95% CI 56.7% – 77%) and specificity (71%; 95% CI 66.3% – 75.4%), to assess the risk of developing anxiety in children and adolescents. This ensures early detection of disorders and the formation of a clear plan of recovery measures, which must necessarily include a family-oriented approach.

Key words: mental health, psycho-emotional state, anxiety factors, neurotic manifestations, fears, clinical psychology

1. Misiura O, Sova V, Anopriienko O, Sudyka O, Mer­kotan A, Khajtovych M. [The emotional state of Ukrainian children affected by military factors in the oc­cupied territory]. Medychna nauka Ukrainy. 2022;18(3):60-5. doi: https://doi.org/10.32345/2664-4738.3.2022.09
2. Waddoups AB, Yoshikawa H, Strouf K. Develop­mental Effects of Parent-Child Separation. Annu Rev Dev Psychol.2019;1:387-410. doi: https://doi.org/10.1146/annurev-devpsych-121318-085142
3. Bürgin D, Anagnostopoulos D, Board and Policy Division of ESCAP, Vitiello B, Sukale T, Schmid M, et al. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry. 2022;31(6):845-53.
   doi: https://doi.org/10.1007/s00787-022-01974-z
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5. Slone M, Peer A. Children's reactions to war, armed conflict and displacement: resilience in a social climate of support. Curr Psychiatry Rep. 2021;23(11):76. doi: https://doi.org/10.1007/s11920-021-01283-3
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Kabantseva A.V. State Non-profit Enterprise “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-7678-6052

Panchenko O.A. State Non-profit Enterprise “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
 https://orcid.org/0000-0001-9673-6685

Guryanov V.H. State Non-profit Enterprise “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”; Bohomolets National Medical University, Kyiv, Ukraine
 https://orcid.org/0000-0001-8509-6301

Serdyuk I.A. State Non-profit Enterprise “Scientific and Practical Medical Rehabilitation and Diagnostic Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-9840-7340https://orcid.org/0000-0001-9840-7340

Kabantseva A.V., Panchenko O.A., Guryanov V.H., Serdyuk I.A. Risks of anxiety evelopment in children and adolescents under the social-stressful conditions of war. Medicni perspektivi. 2025;30(4):143-151.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348344

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

Obesity is a medical condition characterized by the accumulation of excess fat in the body, which can increase the risk of various chronic diseases such as type 2 diabetes, hypertension, and heart disease. Obesity also correlates with an increase in metabolic syndrome diseases that have a negative impact on human health. The prevalence of obesity continues to increase globally, including in develo­ping countries, along with changes in diet and lifestyle. Genetic, environmental, and behavioral factors play an important role in the development of obesity. The impact is not only limited to physical health, but also includes psychological and social aspects. Therefore, it is important to immediately address this problem. Irisin is one of the hormones that plays a major role in reducing obesity rates. The purpose of this study was to determine how physical exercise can increase the expression of the irisin hormone. For this study, a number of journal databases were searched, such as Pubmed, Embase, Science Direct, Web of Science, and Scopus. This study considered various variables, including research on physical activity and the irisin hormone published in journals in the last five years. The analysis included only publications from reputable scientific journals that met the established inclusion criteria, namely: the studies had to involve human participants, and the interventions had to consist of physical exercise. Using databases from Pubmed, Science Direct, Embase, Web of Science, and Scopus, 104 publications were found. Approximately ten carefully selected publications discussed the need for a syste­matic review analysis. The standard operating procedure for the investigation was developed using – preferred re­porting items for systematic reviews and meta-analyses (PRISMA). The results of the systematic review showed an increase in irisin expression during physical activity. The limitation of this review only concerned the effect of physical activity on the irisin hormone. The best dose given during physical exercise to increase irisin expression is still not fully understood, there­fore it is important to conduct further studies that discuss an adequate and optimal dose of physical activity to increase irisin.

Key words: physical exercise, irisin, health, obesity

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Pembayun N.S.R.  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/0000-0001-6816-8705

Wibawa J.C. STKIP PGRI Trenggalek, Trenggalek, Jawa Timur, Indonesia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-4667-5981

Lobo J.  Bulacan State University, Malolos, Bulacan, Philippines
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-2553-467X

Ardha M.A.A.  Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia
 https://orcid.org/0000-0002-9192-2072

Nurhasan  Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia
 https://orcid.org/0000-0003-2790-5777

Hartati S.C.Y.  Universitas Negeri Surabaya, Surabaya, Jawa Timur, Indonesia
 http://orcid.org/0009-0004-5698-9185

Komaini A. Universitas Negeri Padang, Prof. Dr. Hamka str., kec. Padang Utara, Padang, Sumatera Barat, Indonesia
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0002-2955-0175

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

Pembayun N.S.R., Wibawa J.C., Lobo J., Ardha M.A.A., Nurhasan, Hartati S.C.Y., Komaini A., Ayubi N. Increased secretion of irisin hormone during physical exercise: a systematic review. Medicni perspektivi. 2025;30(4):152-161.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348350

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

Effectiveness of existing methods of therapy for functional impairment due to upper limb dysfunction in patients with visuospatial neglect due to acute cerebral stroke remains uncertain. This requires the search for new methods of occupational therapy interventions, in particular, taking into account the capabilities of virtual reality technologies. The aim of this study was to evaluate the therapeutic effect of virtual reality technology on the state of visuospatial perception, fine and gross motor function of the upper extremities, cognitive functions and limitations activities of daily living in patients with neglect due to cerebral stroke. In the study 47 patients (there were 7 people dropped out of the study based on the results of the application of exclusion criteria), 10 women and 30 men, aged from 23 to 86 years old (mean age was 63.3 (13.2) years) were included. All patients were assessed for the state of visuospatial perception, cognitive function, motor and sensory functions, and activity limitations at the beginning and at the end of rehabilitation. At the first stage during 2023-2024, 18 patients were included in the study and assigned a standardized rehabilitation program. In the second phase, during 2024-2025, 22 patients participated in the study and were assigned  an author's occupational therapy program using the Arm-Therapy-System Diego, the effect of which is based on the use of virtual reality technology. All patients were assigned 3 hours of rehabilitation interventions per day for 14 days. The application of the program using virtual reality technology showed 31.3% greater efficiency in restoring the level of cognitive functions according to the Montreal Cognitive Assessment, 68.4% better efficiency in restoring large motor functions according to the "Box and Blocks" test, 40.2% better dynamics according to the sensorimotor state of the upper limb according to the Fugl-Meyer assessment of motor recovery after stroke (p<0.05), 25.0% less manifestations of visuospatial neglect according to the tests of dividing lines in half and drawing stars, which together contributed to a better restoration of the level of independent activity when performing everyday tasks according to the Barthel Index (p<0.05) as compared to standard therapy. The predominant effectiveness of the developed author's program using virtual reality technology in improving fine motor skills of the upper limb according to the Nine-Hole Peg Test (p>0.05) compared to the standard therapy program was not established. Thus, the use of virtual reality technology is promising for restoring the functioning of the upper limb in patients with the consequences of cerebral stroke and impaired visual-spatial perception.

Key words: stroke, visuospatial neglect, rehabilitation, occupational therapy, virtual reality, functioning, disability, quality of life

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Look through:

Totska A.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/0009-0001-7169-3022

Mokhna V.S.  Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0001-6009-6110

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

Tsizh L.M. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0003-4891-4058

Avramenko V.V. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0009-0008-1278-7732

Totska A.V., Mokhna V.S., Somilo O.V., Tsizh L.M., Avramenko V.V. Effectiveness of virtual reality technology in the rehabilitation of patients with visuospatial neglect due to cerebral stroke. Medicni perspektivi. 2025;30(4):161-170.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348366

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

The aim of this study was to analyze the human resource needs, and engagement of rehabilitation professionals within the healthcare system of Ukraine. Data on the professional education, training, and employment of rehabilitation professionals in Ukraine were obtained through requests to the Unified State Electronic Database on Education for the period 2015-2025 (as of September 2025) and the Electronic Healthcare System of the National Health Service of Ukraine (as of March 2025). Additional information on human resource in healthcare facilities at different levels was collected through direct information requests and an online survey. The assessment was conducted using indicators of admission and graduation in the specialty “Therapy and Rehabilitation,” the licensed capacity of the specialty, the titles of educational programs and their academic and teaching support; as well as healthcare facilities contracted with the National Health Service of Ukraine and the employment of rehabilitation professionals, including their number and occupied positions (physical therapists, occupational therapists, physical therapy assistants, occupational therapy assistants, and physicians of physical and rehabilitation medicine), their education, and continuing professional development. As of November 2025, education in the specialty “Therapy and Rehabilitation” was provided by 72 higher education institutions. Based on admission-graduation indicators, only approximately a half of bachelor graduates proceeded to master’s level education. A significant increase in the number of enrolments to educational programmes related to physical therapy and occupational therapy was observed during 2023-2025. As of March 2025, the specialization cycle “Physical Therapy and Occupational Therapy” was implemented in 18 colleges/universities, which accounted for 42% (1,767 persons) of employed physical therapy assistants and 39% (1,052 persons) of occupational therapy assistants. The specialization cycles “Speech and Language Therapy” and “Prosthetics and Orthotics” were introduced in 2024-2025. The specialization “Physical and Rehabilitation Medicine” was completed by 5,754 individuals during 2019-2025 through specialization cycles and by 146 individuals through the internship program. Analysis demonstrates a pronounced imbalance between the different regions of Ukraine regarding both their contribution to education of the rehabilitation workforce and the subsequent employment of such professionals within the healthcare system. Analysis of the number of physical therapists and occupational therapists per 10,000 of population indicates a low level in almost all regions. The volume of staff turnover remains consistently high across all analysed rehabilitation professions, with the greatest numbers observed among occupational therapists. It was established that 71% to 80% of rehabilitation professionals in each group are employed in only one position. On average, 20-34% of such professionals combine two or more positions within the same institution, while for physicians of physical and rehabilitation medicine this proportion reaches 52%. Thus, the key challenges in ensuring adequate human resources in the rehabilitation system of healthcare and their employment include uneven quality of professional education, barriers to entry into the profession and retention within the healthcare system, and unjustified multiple job holding. The obtained results demonstrate the need for a revised, integrated state policy on rehabilitation workforce planning, which should take into account not only quantitative indicators of admission, graduation, and employment, but also forecast data, the quality of educational programs, actual labour market demand, demographic and regional factors, and motivational mechanisms for attracting and retaining personnel in professional education and the rehabilitation system.

Key words: rehabilitation, personnel, resources, healthcare, professional education, specialization, employment, planning

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Look through:

Tymruk-Skoropad K.A. TRUE Initiative.Trauma Rehabilitation for Ukraine (Patients of Ukraine Charitable Foundation), Kyiv; Ivan Bobersky Lviv State University of Physical Culture, Lviv, Ukraine, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-8152-0435

Martynova N.O. Belgian agency for international cooperation Enabel, Kyiv, Ukraine
 https://orcid.org/0009-0003-4007-5787

Boichuk A.Yu. TRUE Initiative.Trauma Rehabilitation for Ukraine (Patients of Ukraine Charitable Foundation), Kyiv, Ukraine
 https://orcid.org/0009-0003-6928-9885

Kolesnikov B.Yu. TRUE Initiative.Trauma Rehabilitation for Ukraine (Patients of Ukraine Charitable Foundation), Kyiv, Ukraine
 https://orcid.org/0009-0005-4159-7979

Yezhova O.O. Sumy State University, Sumy, Ukraine 
 https://orcid.org/0000-0002-8916-4575

Pampukha A.V. TRUE Initiative.Trauma Rehabilitation for Ukraine (Patients of Ukraine Charitable Foundation), Kyiv, Ukraine
 https://orcid.org/0009-0008-5918-4779

Prytherch H. Swiss Tropical and Public Health Institute, Allschwil; University of Basel, Basel, Switzerland
 https://orcid.org/0000-0002-6999-5718

Tymruk-Skoropad K.A., Martynova N.O., Boichuk A.Yu., Kolesnikov B.Yu., Yezhova O.O., Pampukha A.V., Prytherch H. Human resource provision in the rehabilitation system of Ukraine’s healthcare sector. Medicni perspektivi. 2025;30(4):171-183.
DOI: https://doi.org/10.26641/2307-0404.2025.4.348369

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

The full-scale war in Ukraine has led to a humanitarian crisis and has placed a significant burden on the healthcare system, particularly in the fields of traumatology, rehabilitation, and medical support for disabled people. From 2022 to 2024, more than 90,000 amputations were documented in Ukraine, most amputations are of the lower limbs, which created an increased demand for modern healthcare and rehabilitation products. Particularly important became ensuring proper stump care – a key component of the amputation recovery process, which is often underestimated. The aim of this study was the scientific substantiation, development, and testing of the composition of a semisolid medicinal formulation based on modern excipients and active pharmaceutical ingredients (glucosamine hydrochloride, miramistin, dexpanthenol, vitamin D) for stump care after amputation. To achieve this goal, a comprehensive study of the physico-chemical and structure-mechanical properties of the developed samples was carried out, as well as an evaluation of their pharmacological (reparative) effectiveness using scar tensile strength as a parameter in a linear incision wound model. It was established that the emulsifier content significantly affects the structure-mechanical and adhesive properties of creams intended for stump care. The best ratio of parameters was observed in the sample containing 5% emulsifier. The bioadhesion of creams decreases under the influence of electrolytes. The most pharmacologically effective were prototype formulations with glucosamine hydrochloride alone and in combination with miramistin, which outperformed the comparison drug (gel Pantestin-Darnitsa) in a model of a linear cut wound in rats. These formulations produced a statistically significant increase in scar tensile strength, while gel Pantestin-Darnitsa was at the trend level. It was shown that variations in the content of emulsifier, glycerin, and silicone components significantly influence the structural-mechanical, microstructural, and bioadhesive properties of the formulation. Samples with the optimal ratio of these components demonstrated high stability, uniform microstructure, and a sufficient level of skin adhesion, for instance, under conditions that simulate skin perspiration. Thus, a promising formulation has been obtained, which can be further used in preclinical and clinical studies and implemented into stump care practice for patients after lower limb amputations.

Key words: stump, a soft medicine, cream, miramistin, glucosamine hydrochloride, texture profile analysis, pharmacological screening

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19. Yakovleva LV, Kovalyova YO, Kovalyov VV, Saleyman AI. [Experimental study of the reparative and anti-inflammatory activity of “Filetol” ointment]. News of Pharmacy [Internet]. 2010 [cited 2025 Aug 14];1:59-61. Ukrainian. Available from: http://dspace.nuph.edu.ua/handle/123456789/742
20. Festing MF, Altman DG. Guidelines for the design and statistical analysis of experiments using laboratory animals. ILAR J.2002;43(4);244-58. Erratum in: ILAR J. 2005;46(3):320. doi: https://doi.org/10.1093/ilar.43.4.244
21. Bishara AJ, Li J, Conley C. Informal versus formal judgment of statistical models: The case of normality assumptions. Psychonomic Bulletin &amp; Review. 2021 Mar 3;28(4):1164-82. doi: https://doi.org/doi:10.3758/s13423-021-01879-z
22. Mijaljica D, Townley JP, Klionsky DJ, Spada F, Lai M. The Origin, Intricate Nature, and Role of the Skin Surface pH (pHSS) in Barrier Integrity, Eczema, and Psoriasis.2025;12(1):24. doi: https://doi.org/10.3390/cosmetics12010024 
23. Reddy V. Evaluation of in vitro stability studies on nutraceuticals in oral solid dosage forms with special reference to glucosamine. Int J Pharm Sci Rev Res. 2014;25(2):54-9.
    doi: https://doi.org/10.7897/2230-8407.04854
24. Osmanov A, Farooq Z, Richardson MD, Den­ning DW. The antiseptic Miramistin: a review of its comparative in vitro and clinical activity. FEMS Microbiol Rev.2020;44(4):399-417. doi: https://doi.org/10.1093/femsre/fuaa012
25. Marcondes H, Sari M, Mota Ferreira L, Cruz L. The use of natural gums to produce nano-based hydrogels and films for topical application. International Journal of Pharmaceutics.2022 Oct;626:122166. doi: https://doi.org/doi:10.1016/j.ijpharm.2022.122166
26. McCarty MF. Glucosamine for wound healing. Medical1996 Oct;47(4):273-5. doi: https://doi.org/doi:10.1016/s0306-9877(96)90066-3
27. Bissett DL. Glucosamine: An ingredient with skin and other benefits. Journal of Cosmetic Dermatology. 2006 Dec;5(4):309-15. doi: https://doi.org/doi:10.1111/j.1473-2165.2006.00277.x
28. Voloshchuk NI, Yukhymchuk AV, Shtryhol SIu. [Morphological changes in the skin of male and female rats under acute cold injury and correction with glucosamine hydrochloride]. Morphology. 2023;17(4):6-13. Ukrainian. doi: https://doi.org/doi:10.26641/1997-9665.2023.4.6-13
29. Fernández-Rojas B, Gómez-Sierra T, Medina-Campos ON, Hernández-Juárez J, Hernández-Cruz PA, Gallegos-Velasco IB, et al. Antioxidant activity of glu­cosamine and its effects on ROS production, Nrf2, and O-glcnac expression in HMEC-1 cells. Current Research in Toxicology.2023;5:100128. doi: https://doi.org/doi:10.1016/j.crtox.2023.100128
30. Wu Y, Gong Y, Ma Y, Zhao Q, Fu R, Zhang X, et al. Effects of vitaminD status on cutaneous wound healing through modulation of EMT and ECM. The Journal of Nutritional Biochemistry. 2024 Dec;134:109733. doi: https://doi.org/doi:10.1016/j.jnutbio.2024.109733
31. Bikle DD. Role of vitamin D and calcium sig­naling in epidermal wound healing. Journal of Endo­crinological Investigation. 2022 Aug 13;46(2):205-12. doi: https://doi.org/doi:10.1007/s40618-022-01893-5

Look through:

Ruban O.A. National university of pharmacy, Kharkiv, Ukraine
 https://orcid.org/0000-0002-2456-8210

Shtrygol’ S.Yu. National university of pharmacy, Kharkiv, Ukraine
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0001-7257-9048

Kovalevska I.V. National university of pharmacy, Kharkiv, Ukraine
 https://orcid.org/0000-0001-5610-83343

Slipchenko H.D. National university of pharmacy, Kharkiv, Ukraine
 https://orcid.org/0000-0002-5494-335X

Maslii Y.S. Lithuanian University of Health Sciences, Kaunas, Lithuania
 https://orcid.org/0000-0002-8968-0262

Herbina N.A. Lithuanian University of Health Sciences, Kaunas, Lithuania
 https://orcid.org/0000-0001-9826-7552

Ivaniuk O.I. National university of pharmacy, Kharkiv, Ukraine

Hutorka M.O. National university of pharmacy, Kharkiv, Ukraine
 https://orcid.org/0009-0007-2503-5073

Kyrylov D.K. National university of pharmacy, Kharkiv, Ukraine
 https://orcid.org/0009-0000-6212-8235

Meklenburtsev O.D. National university of pharmacy, Kharkiv, Ukraine
 https://orcid.org/0009-0004-7750-8520

Ruban O.A., Shtrygol’ S.Yu., Kovalevska I.V., Slipchenko H.D., Maslii Y.S., Herbina N.A., Ivaniuk O.I., Hutorka M.O., Kyrylov D.K., Meklenburtsev O.D. Physicochemical and wound tensile-strength studies in the development of a cream formulation for application during the acute and post-acute rehabilitation phases following limb amputation. Medicni perspektivi. 2025;30(4):184-198.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348296

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

Pharmacists play an important role in the treatment of cough, which is a frequent complaint when seeking medical help and in 30-40% of cases is the main reason for a visit to the pharmacy. The aim of the study was to identify using a questionnaire, the level of awareness, practical approaches and difficulties faced by pharmacists when recommending medicines for the treatment of cough.The study was qualitative, descriptive in nature and was conducted in the form of an anonymous voluntary survey using a structured online survey in Google form. The instrument was a questionnaire with 20 questions (closed and semi-open type), developed by the author based on literature sources and clinical guidelines. The participants were 42 pharmacists from pharmacies in the city of Dnipro. The survey lasted one calendar month.According to the results of the study, pharmacists demonstrate a sufficient level of knowledge about the causes of cough, tactics for selecting over-the-counter drugs, indications for their use and general recommendations for patients, which indicates proper training of specialists in basic issues of pharmaceutical counseling. At the same time, a number of problematic aspects were identified: insufficient knowledge about drug interactions, incomplete information of patients about the features of the use of over-the-counter drugs and untimely referral of pharmacy visitors to a doctor. Such gaps increase the risk of irrational use of drugs and negatively affect the results of treatment.The conclusions emphasize the feasibility of implementing additional training measures for pharmacists, in particular cases with role-modeling of clinical situations, which will increase practical competence, optimize pharmaceutical care and reduce cases of unjustified prescription of antibiotics by specialists.

Key words: cough, pharmacist, pharmaceutical care, pharmacotherapy

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4. Arboleda Forero V, Cruzate Hernández JP, Yepes Restrepo M, Higuita-Gutiérrez LF. Antibiotic Self-Medi­cation Patterns and Associated Factors in the Context of COVID-19, Medellín, Colombia: A Survey Based Cross Sectional Study. Patient Prefer Adherence. 2023;17:3057-66. doi: https://doi.org/10.2147/PPA.S434030
5. Tkachenko NO, Demchenko VO, Litvinenko OV. [Research on topical issues of self-medication among young people]. Topical issues of pharmaceutical and medical science and practice. 2024;17(3):46. Ukrainian. doi: https://doi.org/10.14739/2409-2932.2024.3.307771
6. Iakovlieva L, Bahlai T. Study of awareness of pharmacy employees in Ukraine with the problem of antibiotics resistance. Eureka: HS. 2020 Nov 29;6:108-16. doi: https://doi.org/10.21303/2504-5679.2020.001530
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8. Morice AH, Fontana GA, Sovijarvi AR, Pisto­lesi M, Chung KF, Widdicombe J. Task Force. The diagno­sis and management of chronic cough. European Respiratory2004;24(3):481-92. doi: https://doi.org/10.1183/09031936.04.00027804  
9. Irwin RS, French CL, Chang AB, Altman KW. Clas­sification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panelChest. 2018;153(1):196-209. doi: https://doi.org/10.1016/j.chest.2017.10.016
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17. Nazaryan L, Barseghyan A, Rayisyan M, Begla­ryan M, Simonyan M. Evaluating consumer self-medica­tion practices, pharmaceutical care services, and pharmacy selection: a quantitative study. BMC Health Services Research.2024 Jan 3;24(1):10. doi: https://doi.org/10.1186/s12913-023-10471-1
18. Micallef R, Reem Kayyal R. Why we should create uniform pharmacy education requirements across different countries: A review of current requirements and the need for global regulator input. Currents in Pharmacy Teachingand 2020;12(5):499-503. doi: https://doi.org/10.1016/j.cptl.2020.01.004
19. Tkachuk O, Deineka A, Nesteruk T. [Current trends in training specialists in the pharmaceutical industry through the prism of deontological and professional standards]. Social Work and Education. 2024;11(1):74-82. Ukrainian. doi: https://doi.org/10.25128/2520-6230.24.1.6
20. Ballaram S, Perumal-Pillay V, Suleman F. A sco­ping review of continuing education models and statutory requirements for pharmacists globally. BMC Med Educ. 2024 Mar 27;24(1):343. doi: https://doi.org/10.1186/s12909-024-05322-4
21. Kardos P, Beeh KM, Sent U, Bissmann G. Impact of guideline awareness on the counseling of patients with acute cough among general practitioners and pharmacy personnel.PloS 2021 Aug 5;16(8):e0254086. doi: https://doi.org/10.1371/journal.pone.0254086
22. Sezerano M-L, Niyonkuru E. Self-medication with antibiotics: A pervasive risk factor for antibiotic resistance and public health concerns. International Journal of Science and Research Archive, 2024;13(02):2362-73. doi: https://doi.org/10.30574/ijsra.2024.13.2.2377
23. Kallio S, Eskola T, Airaksinen M, Pohjanoksa-Mäntylä M. Identifying Gaps in Community Pharmacists’ Competence in Medication Risk Management in Routine Dispensing.Innov 2021 Feb 11;12(1). doi: https://doi.org/10.24926/iip.v1
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27. Kanaan S, Dabbous M, Akel M, Lteif R, Rahal M, Sakr F. Game-based learning in pharmacy education: A syste­matic reviewand narrative synthesis. Pharmacy Education. 2023;23(1):629-39. doi: https://doi.org/10.46542/pe.2023.231.629639
28. Denzin NK, Lincoln YS. The SAGE Handbook of Qualitative Research. 5th ed. SAGE Publishing; 2018.

Look through:

Kaidash S.P.  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/0000-0002-3210-3560

Sokolova K.V. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0001-5022-3227

Sliesarchuk V.Yu. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0001-8777-1243

Potapova T.M. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0003-0184-3571

Kaidash S.P., Sokolova K.V., Sliesarchuk V.Yu., Potapova T.M. Research on the awareness of pharmacists regarding the rational use of medicines in providing pharmaceutical care for patients with cough of various genesis. Medicni perspektivi. 2025;30(4):199-212.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348306

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

Strengthening the prevention of noncommunicable diseases at the regional level is gaining particular relevance under current socio-economic and security challenges that affect the resilience of the public health system. Aim to assess the effectiveness of regional noncommunicable diseases prevention programs using the Dnipropetrovsk region as an example, with consideration of current socio-economic challenges. A descriptive study with a retrospective analysis of programmatic and regulatory documents as well as secondary statistical and epidemiological data from international and national open sources was conducted. The information base included data from the WHO Global Health Observatory, the WHO European Health for All database, the Institute for Health Metrics and Evaluation, the State Statistics Service of Ukraine, the National Health Service of Ukraine analytical dashboards, the Public Health Atlas of Ukraine, documents of the Ministry of Health of Ukraine, and more than 70 scientific publications, of which 18 were selected for detailed analysis. A bibliosemantic approach, content analysis of strategic documents, analysis of the regulatory framework, descriptive and analytical statistics were applied using Microsoft Excel and R (version 4.3.1). Results. In 2021, the premature mortality rate from major noncommunicable diseases (cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, including chronic obstructive pulmonary disease and bronchial asthma) in Ukraine was 24.8%, substantially exceeding the average rate in the European Region (15.6%). In Dnipropetrovsk region, premature mortality rates among those aged 30-59 were higher than the national average: by 12.9% for men from cerebrovascular diseases, by 24.1% for women, and by 12.3% for breast cancer. At the same time, the region demonstrated a 54.4% lower rate of premature mortality from diabetes compared with the national average, indicating the potential of effective preventive interventions. The analysis revealed a gap between declared prevention priorities and actual outcomes, driven by limited evidence, insufficient resource allocation, and the impact of the war. Conclusions. Optimization of regional noncommunicable disease prevention in Ukraine requires a revision of priorities with a focus on evidence-based and cost-effective interventions, the implementation of digital monitoring systems, and the integration of socio-economic and security considerations.

Key words: noncommunicable diseases, prevention, effectiveness, regional analysis, public health, health policy

1. Ganju A, Goulart AC, Ray A, Majumdar A, Jef­fers BW, Llamosa G, et al. Systemic Solutions for Addres­sing Non-Communicable Diseases in Low- and Middle-Income Countries. J Multidiscip Healthc. 2020;13:693-707. doi: https://doi.org/10.2147/JMDH.S252300
2. Noncommunicable diseases progress monitor 2022. Geneva: World Health Organization [Internet]; 2022 [cited 2025 Apr 9]. 225 p. Available from: https://www.who.int/publications/i/item/9789240047761
3. Avoidable mortality, risk factors and policies for tackling noncommunicable diseases – leveraging data for impact: monitoring commitments in the WHO European Region ahead of the Fourth United Nations High-Level Meeting. Copenhagen: WHO Regional Office for Europe [Internet]; 2025 [cited 2025 Apr 9]. 52 p. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2025-12445-52219-80271
4. Global Burden of Disease Collaborative Net­work. Global Burden of Disease Study 2019 (GBD 2019) Re­sults. Seattle (WA): Institute for Health Metrics and Evaluation (IHME) [Internet]; 2020 [cited 2025 Apr 9]. Availablefrom:
   https://vizhub.healthdata.org/gbd-results/
5. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy de­composition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2100-32. doi: https://doi.org/10.1016/S0140-6736(24)00367-2
6. Myroniuk I, Slabkyi H, Shcherbinska O, Bilak-Lukianchuk V. [Consequences of the war with the Russian Federation for public health in Ukraine]. Reproduktyvne zdorovia2022;(8):26-31. Ukrainian. doi: https://doi.org/10.30841/2708-8731.8.2022.273291
7. Hruzdieva TS, Lekhan VM, Ohniev VA, et al. [Biostatistics]. Vinnytsia: Nova Knyha; 2020 [ci­ted 2025 Apr 9]. 381 p. Ukrainian. Available from: https://library.pdpu.edu.ua/images/2021/medbook/36.pdf
8. van Haaren P, Hernandez AM, Berger A. The EU's support for the global Sustainable Development Agenda: how to accelerate progress until 2030. In: Ha­cke­nesch C, Keijzer N, Koch S, editors. The European Union's global role in a changing world: challenges and oppor­tunities for the new leadership [Internet]. Bonn: German Institute of Development and Sustainability (IDOS); 2024 [cited 2025 Apr 9]. p. 66-69. Available from: https://www.ssoar.info/ssoar/bitstream/handle/document/97045/ssoar-2024-haaren_et_al-The_EUs_support_for_the.pdf?sequence=3&isAllowed=y
9. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020 [Internet]. Geneva: World Health Organization; 2013 [cited 2025 Apr 9]. Available from: https://iris.who.int/handle/10665/94384
10. World Health Organization. Discussion Paper on the development of an implementation roadmap 2023-2030 for the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2030 [Internet]. Geneva: World Health Organization; 2021 [cited 2025 Apr 9]. Available from: https://cdn.who.int/media/docs/default-source/documents/health-topics/non-communicable-diseases/eb150---who-discussion-paper-on-ncd-roadmap-development-(20-aug-2021)---for-web.pdf?sfvrsn=58b8c366_17&download=true
11. Cabinet of Ministers of Ukraine. [On approval of the National Action Plan for Non-Communicable Diseases to achieve global sustainable development goals] [Internet]. Kyiv: CMU; 2018 [cited 2025 Apr 9]. Ukrai­nian. Available from: https://www.kmu.gov.ua/npas/pro-zatverdzhennya-nacionalnogo-planu-zahodiv-shchodo-neinfekcijnih-zahvoryuvan-dlya-dosyagnennya-globalnih-cilej-stalogo-rozvitku
12. United Nations Development Programme in Ukraine. [Sustainable Development Goals: Objectives and Indicators]. [Internet]. 2017 [cited 2025 Apr 9]. Ukrainian. Available from: https://www.undp.org/sites/g/files/zskgke326/files/migration/ua/SDG-leaflet-ukr_F.pdf
13. Semenov VV, Kryachkova LV. Incidence and mortality of the most socially significant cancer types in Dnipropetrovsk region in 2009-2019. Intermedical Journal.2024;(2):135-40. doi: https://doi.org/10.32782/2786-7684/2024-2-23
14. Kriachkova LV, Krotova LO, Valchuk SI. [Arte­rial hypertension: leading chronic non-communicable disease and priority challenge for public health system]. In: Hushchuk IV, Topishko NP, editors. [Public health system in Ukraine and EU countries: realities, transformation, development vectors, perspectives]. Riga: Baltija Pub­lishing;p. 479-95. Ukrainian. doi: https://doi.org/10.30525/978-9934-26-358-8-26
15. Kriachkova L, Krotova V, Krotova L, Zaiar­skyi M. [Study of awareness and autonomy of patients for public health needs (on the example of a cross-sectional study of people with arterial hypertension in Dnipro)]. Klinichna ta profilaktychna medytsyna. 2022;(2):88-95. Ukrainian. doi: https://doi.org/10.31612/2616-4868.2(20).2022.11
16. STEPS study: prevalence of risk factors for non_­communicable diseases in Ukraine in 2019. Copenhagen: WHO Regional Office for Europe [Internet]; 2020 [ci­ted 2025 Apr 9]. 88 p. Available from: https://ukraine.un.org/sites/default/files/2020-11/WHO-EURO-2020-1468-41218-56060-eng.pdf
17. Vaughan K, Khudonazarov D, Kurylo I. [Ukraine-Swiss project "Act for Health". Prevention of noncom­municable diseases: assessment of investment feasibility in Ukraine]. [Internet]. Basel: Swiss Tropical and Public Health Institute; 2021 [cited 2025 Apr 9]. Ukrainian. Available from: https://www.actforhealth.in.ua/materialy/profilaktika-neinfekciynih-zahvoryuvan-ocinka-docilnosti-investiciy-v-ukrayini
18. WHO Health Evidence Network Synthesis Reports. Copenhagen: WHO Regional Office for Europe [Internet]. 2015 [cited 2025 Apr 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK379477/
19. WHO package of essential noncommunicable (PEN) disease interventions for primary health care. Geneva: World Health Organization [Internet]; 2020 [ci­ted 2025 Apr 9]. 77 p. Available from: https://www.who.int/publications/i/item/who-package-of-essential-noncommunicable-(pen)-disease-interventions-for-primary-health-care

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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

Semenov V.V. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0000-0003-3363-0159

Ustymchuk O.V. Dnipro State Medical University, Dnipro, Ukraine
 https://orcid.org/0009-0006-1401-1757

Kriachkova L.V., Semenov V.V., Ustymchuk O.V. Effectiveness of noncommunicable disease prevention in the regional context: current challenges and prospects. Medicni perspektivi. 2025;30(4):213-223.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348713

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

Efficient patient logistics crucial for optimizing healthcare delivery; however, many German hospitals continue to encounter significant challenges in process management and scheduling. The purpose of this study was to address existing gaps in patient logistics by conducting a systematic observation of workflows in German hospitals and developing a practical framework for optimization. To achieve this, the study set out to: (1) identify specific inefficiencies in emergency department operations, surgical scheduling, and interdepartmental coordination; (2) evaluate the applicability of Lean Management and Six Sigma principles in addressing these inefficiencies; and (3) propose a centralized scheduling model as a structural solution for enhancing coordination and resource allocation across departments. Employing a mixed-methods design, the research involved a six-month observation of workflows in three urban hospitals, focusing on emergency department operations, surgical unit scheduling, and interdepartmental coordination. Additionally, qualitative data were gathered through structured interviews with 25 hospital staff members. Data collection lasted six months, from January to June 2023. The analysis incorporated principles of Lean Management and Six Sigma to assess current inefficiencies and explore potential improvements. The study identified critical issues such as triage delays averaging 45 minutes, persistently high bed occupancy rates (95%), and delays in 25% of scheduled elective surgeries. To address these inefficiencies, a new framework was proposed that combines Lean and Six Sigma methodologies. The implementation of dynamic scheduling algorithms led to a 67% reduction in elective surgery delays, while predictive analytics significantly improved bed allocation efficiency. The research highlights the underexplored potential of digital tools and standardized protocols in streamlining patient logistics. However, the study also revealed key barriers to effective process optimization, including fragmented communication between departments, lack of centralized scheduling systems, staff resistance to workflow changes, and insufficient integration of real-time data. These findings emphasize that techno­logical improvements must be supported by organizational change management and systemic coordination to achieve sustainable enhancements in hospital efficiency. Key recommendations include the adoption of predictive analytics, integration of dynamic scheduling systems, and formalization of interdepartmental communication standards. By offering context-specific insights for German healthcare institutions, this study contributes to the broader discourse on healthcare logistics and provides practical strategies for improving patient flow, reducing costs, and enhancing overall care quality.

Key words: patient logistics, process management, dynamic scheduling, predictive analytics, hospital efficiency, Lean Six Sigma

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Zeiler J. Comenius University Bratislava, Faculty of Management, Bratislava, Slovak Republic
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0009-0005-6466-6543

Strazovska L. Comenius University Bratislava, Faculty of Management, Bratislava, Slovak Republic
 https://orcid.org/0000-0002-0632-7165

Zeiler J., Strazovska L. Enhancing hospital efficiency in Germany: Process management and scheduling innovations in patient logistics. Medicni perspektivi. 2025;30(4):223-237.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348716

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

Changes in the political and economic situation in the Kyrgyz Republic in the 90s of the XX century, to a certain degree, had an impact on the health of the population as related to the availability and quality of medical care, especially at the primary level. Naturally, the indicator of the disease prevalence and incidence of the population is one of the most important parameters of the effectiveness of health resource provision, planning of medical care and preventive measures for specific age and social groups. The purpose of the study was to assess the level of the disease prevalence and incidence of the urban population of the Bishkek megacity in comparison with the national level. Data on the disease prevalence and incidence of the population of the Bishkek city population were from the Electronic Health Center of the Ministry of Health of the Kyrgyz Republic for the period 1989-2019 and were compared with the national level. Analytical, statistical and comparative analysis methods were used and data processed with the MS Excel 2021 and SPSS-16 software packages. There is definitely a multidirectional dynamics of the disease prevalence and incidence of the population of the entire country and the city Bishkek during the observation period 1989-2019. However, the disease prevalence in absolute figures shows an increasing growth rate tendency 6.2% (1999) to 5.7% (2009) and 7.0% (2019) and a decline in the relative indicator -5,4%, -5,0% and -10.8% respectively. Bishkek’s absolute numbers fell sharply in 1999 (-30,6%), and 2009 saw an increase of up to 637 252 cases (+56%) and 2019 (926845 or +45,4%) and was similar by the relative number per 100,000 population: +42,5%,+41,8%, +17,3% respectively, which indicates the general increased load on the urban health care system. The disease incidence revealed fluctuations in absolute values and per 100,000 population both in the entire country and Bishkek, with decreasing tendencies by 1999 and an increase in subsequent decades, especially in the group of children and adolescents. In the gender aspect, there is a decrease in the disease morbidity in men and growth in women against the background of variations observed in disease incidence indicators by age groups. The results obtained indicate the uneven dynamics of morbidity in different age and social groups of the urban population compared with the national values. The observed increase in population morbidity in the Bishkek megacity largely correlates with the increasing population size and the state of the city's primary health care network, as well as staffing. At the same time, differences are seen in the gender aspect for the entire country: among men, the incidence was decreasing, while among women there were growing tendencies, and on the contrary, in Bishkek there was a general trend of increasing morbidity among all categories of the population. The presented results indicate the problems of organizing primary health care in the whole country and in Bishkek, especially for the male population, related to healthcare access and shortcomings in the organization of preventive work. Thus, the dynamics of the disease prevalence and incidence in the population of the entire country and the metropolitan area demonstrates multidirectional tendencies, showing shortcomings in the planning and implementation of national programs aimed at strengthening and improving the primary health care system. Overall, this indicates the need to review strategies and approaches to ensure more effective healthcare management.

Key words: primary health care, incidence, prevalence, age groups, urban population, Kyrgyzstan, Bishkek, time trends

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Naizabekova S.D.  S.B. Daniyarov Kyrgyz State Medical Institute for Retraining and Continuing Education; Academic consortium “The International University of Kyrgyzstan”, Bishkek, Kyrgyz Republic
е-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0003-1581-9935

Kurmanova A.R.  S.B. Daniyarov Kyrgyz State Medical Institute for Retraining and Continuing Education, Bishkek, Kyrgyz Republic
 https://orcid.org/0009-0001-9424-4182

Baitova G.M.  S.B. Daniyarov Kyrgyz State Medical Institute for Retraining and Continuing Education; Academic consortium “The International University of Kyrgyzstan”, Bishkek, Kyrgyz Republic
 https://orcid.org/0009-0000-5409-571X

Naizabekova S.D., Kurmanova A.R., Baitova G.M. Trends in the disease prevalence and incidence in the population of the city Bishkek and the Kyrgyz Republic. Medicni perspektivi. 2025;30(4):238-249.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348726

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

The purpose of the study is to characterize the cumulative exposure and quantify the risk of specific effects of insecticidal pesticides of different chemical classes on the nervous system when they enter the body simultaneously with apples at the level of approved maximum residue levels. By literature data, inactive and minimal dose levels of abamectin, emamectin benzoate, milbemectin, alpha-cypermethrin and acetamiprid for their specific effects on the nervous system were established. Domestic reference values – acceptable daily doses, maximum residue levels of insecticides in apples were studied and their comparative characteristics were carried out with those established in the European Union. A comparative characteristic for the daily exposure of the studied insecticides in apples when they enter the children and adults’ bodies according to the scenario of maximum residue levels is carried out. It was found that acetamiprid (0.00026/0.0001 mg/kg bw (body weight) for children 2-6 years/adults, respectively) is characterized by the highest level of exposure for which the maximum residue level is approved – 0.05 mg/kg. The greatest contribution to the risk of cumulative alimentary effects is made by abamectin (65.8-66.4%), for which the lowest permissible daily dose (0.0002 mg/kg) is justified. The determined risk parameters from cumulative alimentary exposure are within accep­ table values (hazard index <1, total exposure margin >100). It was found that the cumulative effect per unit of body weight for children is higher compared to adults. It is shown that the effect of a mixture of the studied substances when they are taken with apples in the maximum permissible quantities will not lead to adverse health consequences for different age groups of the population (adults and children 2-6 years), in particular, the effect on nervous system. The results obtained indicate that the reference values of the studied insecticides approved in Ukraine will ensure safety for the health of consumers when they enter the body with apples. Recommendations are given on the need to take into account processing factors in food production technology and baby food hygiene.

Key words: pesticides, neurotoxic effects, residues in food products, cumulative dietary risk

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Yastrub A.M. SE “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety Ministry of Health of Ukraine”, Kyiv, Ukraine, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 https://orcid.org/0000-0003-2674-5265

Zhminko P.H. SE “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety Ministry of Health of Ukraine”, Kyiv, Ukraine
 https://orcid.org/0000-0001-7314-9947

Yastrub T.O. SE “L.I. Medved’s Research Center of Preventive Toxicology, Food and Chemical Safety Ministry of Health of Ukraine”, Kyiv, Ukraine
 https://orcid.org/0000-0002-5084-3773

Yastrub A.M., Zhminko P.H., Yastrub T.O. Characterization of cumulative exposure and risk assessment of specific effects of pesticide impact on the nervous system during their simultaneous intake with apples into the human body. Medicni perspektivi. 2025;30(4):250-259.
DOI:https://doi.org/10.26641/2307-0404.2025.4.348734

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