Ministry of Healthcare (Ukraine)

Building a biobank network in developing countries is essential to foster genomic research and precision medicine for patients' benefit. However, there are serious barriers to establishing biobanks in low-income and middle-income countries (LMICs), including Ukraine. Here, we outline key barriers and essential milestones for the successful expansion of biobanks, genomic research and personalised medicine in Ukraine, drawing from the experience of other LMICs. A lack of legal and ethical governance in conjunction with limited awareness about biobanking and community distrust are the principal threats to establishing biobanks. The experiences of LMICs suggest that Ukraine urgently needs national guidelines covering ethical and legal aspects of biospecimen-related research. National guidelines must be consistent with international ethical recommendations for safeguarding participants' rights, welfare and privacy. Additionally, efforts to educate and engage physicians and patient communities are essential for achieving biobanking goals and benefits for precision medicine and future patients.

BACKGROUND:This cross-sectional survey study evaluates the influence of international observerships organised by the coalition of healthcare professionals from academic institutions-the Ukrainian Alliance for Medical Exchange and Development (UA-MED)-on the professional development, knowledge transfer and clinical practice improvement of Ukrainian healthcare professionals during the war. METHODS:A total of 263 international observerships were facilitated for 204 Ukrainian medical professionals across the institutions in the USA, Canada, Europe and Australia during 2022-2024. To assess the impact of these observerships, a survey was administered focusing on overall satisfaction, procedural knowledge gained and challenges faced when implementing new techniques on return. The primary outcome was the success score, defined as a composite score of implementing new procedures, initiating quality improvement projects and knowledge dissemination efforts. RESULTS:A total of 128 medical professionals from 45 Ukrainian institutions who completed 138 observerships in 27 institutions abroad participated in the survey (response rate of 62.7%). Observers varied by profession: surgeons (32.8%), radiation oncologists (14.8%), medical oncologists (11.7%), anaesthesiologists (11.7%) and others. Observerships lasted a median of 4 weeks; 74.1% included conference attendance. The average success and satisfaction scores were 6.5/10 and 9.3/10, respectively.The majority (92.7%) reported a shift in perception of how to practise medicine and 75.5% implemented new procedures on returning to Ukraine. Encouraged to disseminate knowledge, participants provided informal training to colleagues (67.3%), prepared presentations for their institutions (65.5%) and national conferences (32.7%), incorporated learnt materials into educational lectures (39.1%) and engaged in all the activities above (15.5%). CONCLUSIONS:The international observerships played an important role in enhancing the reported skills and knowledge of Ukrainian healthcare professionals during the war. Improvements were reported in clinical practice, medical education and the implementation of new procedures. The success of these observerships underscores the potential for similar programmes in other low-income and middle-income countries/upper-middle-income countries.

This study aimed to monitor risks of temperature excursions along vaccine distribution routes in Ukraine to identify weaknesses and recommend improvements. This cross-sectional study followed the World Health Organization’s temperature monitoring protocol. Vaccine shipments along randomly selected distribution routes were monitored using loggers, recording temperatures at 20 min intervals across all levels of the cold chain. The collected data were analysed to assess compliance with the recommended range and identify instances of heat and freeze exposure. A total of 72040.1 h were recorded from July 2024 to October 2024 across 48 distribution routes. The recorded temperature ranged from − 13.6 °C to + 28.4 °C. The level of compliance with the recommended temperature range varied by immunisation supply chain level and across facilities at a given level. The highest compliance ( 100

The article explores the theoretical and methodological principles of adaptive management of an agricultural enterprise’s economic potential amid modern challenges and the growing uncertainty of the external environment. It is evident that the transformation of the agricultural sector under the influence of globalization, digitalization, climate change, and military risks necessitates a shift from traditional management models to adaptive models that prioritize flexibility, rapid response, and the ability to self-recover. The essence of economic potential is defined as an integrated category comprising production and technical, material and resource, personnel, financial, information, innovation, and natural components that form the basis of the enterprise’s competitiveness. Special attention is paid to adaptive management mechanisms that provide for constant monitoring of the enterprise’s internal state, the introduction of innovative technologies, the optimization of resource use, and the development of human capital. It has been shown that the use of digital tools, in particular precision farming technologies, agromonitoring systems, and analytical platforms, improves the efficiency of management decisions and supports the transition from reactive to proactive management. The impact of martial law on agricultural enterprises’ operations is analyzed, including logistical constraints, resource shortages, personnel challenges, and financial pressures, highlighting the need for scenario planning and risk management systems. An approach to assessing an enterprise’s level of adaptation using an integral indicator is proposed, enabling the determination of its resistance to external shocks. It is evident that adaptive management of economic potential is a key factor in ensuring the competitiveness of an agricultural enterprise, as it contributes to the effective use of resources, increased productivity, and the formation of sustainable competitive advantages in the long term. Keywords: adaptive management, economic potential, agricultural enterprise, competitiveness, digitalization, risk management, sustainable development, resource potential.

Abstract Background and Aims Cardiovascular autonomic neuropathy (CAN) is a progressive complication of type 2 diabetes mellitus (T2DM), associated with oxidative stress and accumulation of advanced glycation end-products (AGEs). This study aimed to evaluate AGEs and glutathione (GSH) levels in T2DM patients with different stages of CAN: no CAN, early CAN, and established CAN. Materials and Methods We examined 79 subjects divided for three groups. The first group included 16 patients with T2DM without CAN (age—63.2 ± 10.9 years, BMI—32.7 ± 6.2, mean diabetes duration—6.7 ± 4.2 years, HbA1c—7.6% ± 1.6%, (data are presented as mean ± SD). The second group included 22 patients with T2DM with еarly CAN (1 abnormal autonomic test) (age 60,7 ± 12.6 years, BMI—30.8 ± 4.7, mean diabetes duration—6.8 ± 4.6 years, HbA1c -7.5% ± 1.8%). The third group included 41 patients with T2DM and established CAN (2 and more abnormal autonomic tests) (age—63.5 ± 9.3 years, BMI—31.3 ± 4.7, mean diabetes duration—7.7 ± 4.9 years HbA1c—7.3% ± 1.7 %). AGEs and GSH levels in the plasma were measured using standardized laboratory methods of fluorometry and spectrophotometry. CAN was diagnosed by standard battery of tests. Statistical analysis was performed using unpaired Student’s t-test (with Welch’s correction for unequal variances). Results We found a trend towards decreased GSH levels in patients with established CAN group compared to the еarly CAN group and to the no CAN group (1077.24 ± 104.11 µg/mLto 1109.51 ± 141.74 and to 1136.27 ± 98.83 respectively, P = .09). The highest AGEs levels were observed in the early CAN group (90.76 ± 19.8), though intergroup differences were not statistically significant (P > .05 for all comparisons). The established CAN group showed levels comparable to the no CAN group (85.64 ± 16.76 vs 84.0 ± 11.12). Conclusions Early CAN is associated with elevated AGEs levels, which may serve as a marker of initial metabolic dysregulation. CAN progression correlates with a declining GSH trend, supporting the role of oxidative stress in its pathogenesis. Further studies with larger cohorts and additional biomarkers are needed to validate these findings and explore clinical implications.