Relevance. Pemphigus vulgaris is a rare autoimmune bullous disease characterised by the formation of intraepithelial blisters and erosions. Often, the oral mucous membrane is the first and, for quite some time, the only area affected by this disease. The oral manifestation of the disease is often misdiagnosed as erythema multiforme, candidiasis, recurrent herpes simplex infection or common diseases, which results in errors in diagnosis, late referral to a dermatologist, and inappropriate treatment. Timely recognition of the lesion will affect the prognosis and quality of life of the patient. Aim. To generalise clinical manifestations of the oral cavity affected by pemphigus vulgaris, to analyse errors made when diagnosing at the stage of primary diagnosis, and to develop practical recommendations on the order of actions for physicians when suspected of pemphigus vulgaris. Materials and methods. A prospective clinical, descriptive analysis of 42 patients diagnosed with pemphigus vulgaris, who were treated at the dental medical centre, O.O. Bogomolets National Medical University, was conducted. The observation period covered 2018-2025. Clinical, cytological (Tzanck smear), and serological methods (ELISA for anti-Dsg1 and anti-Dsg3 antibodies) were used. The quality of life in patients was measured using of the SF-36v2 and DLQI questionnaires. Statistical analysis was performed using of the t-test, the Mann-Whitney test, and Spearman’s correlation analysis (p < 0.05). Results. Primary symptoms manifested as lesions of the oral mucous membrane in 83.3% of patients. In these cases, the differential diagnosis was difficult. The duration of the period between the first symptom and the diagnosis was 3.5 ± 0.6 months on average and was shorter in women than in men. At the time of referral, all patients had received incorrect diagnoses (candidiasis, erythema multiforme, recurrent herpes simplex infection) and inappropriate treatment. During the primary examination, acantholytic cells were detected by cytological examination in 47.6% of smears. When examining repeat cytological smear, it was found that acantholytic cells were present in 100% of cases. Serological testing confirmed the presence of anti-Dsg3 antibodies in all patients and anti-Dsg1 antibodies in 41.7%, which is consistent with the phenotype of the isolated and generalised forms. It was found that there was a direct correlation between the time of diagnostic uncertainty and the decline in quality of life (ρ = 0.62, p < 0.01). Practical significance. Prompt identification of solitary lesions on the oral mucosa together with the simultaneous use of cytological and serological techniques minimises the time for establishing the correct diagnosis, helps differentiate between the various types of pemphigus vulgaris and prevents further evolution of the disease. The suggested pattern of clinical actions can serve as a working guideline to dentists and otolaryngologists to facilitate the timely and accurate detection of disease and the timely referral of patients to the corresponding specialists. Conclusions. Oral manifestations of pemphigus vulgaris can manifest clinically as other pathologies and often lead to misdiagnosis and delayed diagnosis. Tzanck smear test is a very simple diagnostic tool and does not require special equipment, but this method should be performed together with serological research for a more accurate diagnosis of the disease, and as a result, better prognosis and higher quality of life of patients.
Relevance. The importance of the study is determined by the high prevalence of endometriosis among women of reproductive age and by the substantial negative effect of deep infiltrating endometriosis on the functional state of the pelvic organs, the quality of life of patients, and treatment outcomes. Despite the active development of minimally invasive gynaecological surgery, the choice of the optimal surgical approach for complex infiltrative forms of the disease remains debatable. An analysis of current scientific data on the effectiveness of robot-assisted and laparoscopic procedures is therefore especially relevant. Aim. To summarise current scientific data on the use of robot-assisted and laparoscopic surgical procedures in deep infiltrating endometriosis and to analyse their clinical outcomes and features of use in minimally invasive gynaecological surgery. Materials and methods. The study used methods of analysis, systematisation, and generalisation of current scientific sources devoted to the problem of surgical treatment of deep infiltrating endometriosis. The results of clinical studies, systematic reviews, and meta-analyses concerning the effectiveness and safety of robot-assisted and laparoscopic procedures were analysed. Approaches to analytical generalisation of perioperative indicators and clinical treatment outcomes were applied. Results. Current approaches to the surgical treatment of deep infiltrating endometriosis were examined, and the role of laparoscopic and robot-assisted technologies in minimally invasive gynaecological surgery was determined. A generalisation of scientific data indicated that laparoscopic procedures remain the main method of surgical treatment for this pathology, whereas robot-assisted technologies broaden the possibilities for performing complex operations in cases of deep tissue infiltration and involvement of adjacent pelvic organs. It was established that, according to perioperative indicators such as intraoperative blood loss, complication rate, and length of hospitalisation, the results of both approaches were similar in most studies. Robotic systems may provide improved visualisation of the surgical field and greater precision of manipulation during treatment of complex anatomical localisations of the pathological process. Conclusions. The analysis of the contemporary scientific sources indicated that the effectiveness of treatment for deep infiltrating endometriosis depends largely on the correct choice of surgical tactics and on individualisation of the surgical approach. Laparoscopic surgery remains the basic method of surgical treatment, whereas robot-assisted technologies should be used in complex clinical cases requiring high precision of surgical manipulation. The results obtained confirm the need for further accumulation of evidence on the long-term outcomes of different minimally invasive surgical technologies in deep infiltrating endometriosis.
Relevance. Myocardial infarction is accompanied by long-term functional, clinical, and psycho-emotional consequences, whereas insufficient accessibility of traditional centre-based cardiac rehabilitation programmes determines the need for evidence-based home-based, hybrid, and telerehabilitation models capable of supporting safe physical activity, self-management, and secondary prevention in the long-term rehabilitation period. Aim. To summarise the current evidence base on home-based cardiac rehabilitation after myocardial infarction and determine its effectiveness, safety, and prospects for use in the long-term rehabilitation period. Materials and methods. The study was prepared as an analytical narrative review with elements of a systematised search. Systematic reviews, meta-analyses, randomised controlled trials, cohort studies, scientific statements of professional societies, and clinical guidelines on exercise-based cardiac rehabilitation, home-based cardiac rehabilitation, cardiac telerehabilitation, mobile health technologies (mHealth), the maintenance phase, adherence to home-based physical exercises, kinesiophobia, psychological distress, and long-term self-management in patients after myocardial infarction were analysed. Results. Current evidences indicate that home-based cardiac rehabilitation can achieve outcomes comparable to those of centre-based cardiac rehabilitation programmes in clinically stable patients at low or moderate risk following myocardial infarction. The safety of the home-based model depends on appropriate patient selection, risk stratification, individualised exercise prescription, self-management training, regular professional feedback, and symptom-response algorithms – that is, structured rules for stopping or modifying physical exercise, contacting a specialist, or seeking emergency care when clinical signs of exercise intolerance appear. Telerehabilitation and mobile digital health technologies can improve accessibility, support self-management, and facilitate the monitoring of symptoms and physical activity. However, they should complement rather than replace a clinically structured cardiac rehabilitation programme. The greatest gap remains the long-term rehabilitation period, in which the maintenance of movement behaviour, adherence, psychological adaptation, overcoming kinesiophobia, self-efficacy, and social support become decisive. Conclusions. Home-based cardiac rehabilitation after myocardial infarction is a promising secondary prevention model for selected clinically stable patients, but its long-term effectiveness requires structured professional supervision, risk stratification, psychological-behavioural support, telerehabilitation or analogue self-management tools, and standardised assessment of functional, clinical, and behavioural outcomes.
Relevance. Hearing impairments in children negatively affect speech development, cognitive functions, learning and social adaptation, whereas the use of assistive technologies helps compensate for sensory deficits, improve speech perception and promote the child’s more effective integration into educational and social environments. Aim. To analysed recent scientific publications on assistive technologies for the rehabilitation of children with hearing impairments, with a focus on the effectiveness of their use in children with cochlear implants. Materials and methods. A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines, with the research question formulated using the PICO framework. Clearly defined inclusion criteria and a standardised search strategy were applied across PubMed, Scopus, and Web of Science databases covering the period from 2010 to 2025. Results. The analysis of 21 selected studies demonstrated that the use of assistive technologies is associated with improved speech perception, reduced negative effects of background noise, and increased academic engagement among children. The most pronounced effect was observed with the combined use of hearing aids or cochlear implant systems together with signal enhancement technologies (FM systems, induction loop systems), which improve the signal-to-noise ratio in challenging acoustic environments. The integration of multiple technological solutions contributes to individualised rehabilitation and enhances its functional effectiveness. Conclusions. Technological rehabilitation is a relevant and effective method for supporting patients with sensorineural hearing loss, ensuring restoration or improvement of sound and speech perception through hearing aids, cochlear implants, and sound amplification systems. The integration of assistive communication technologies enables children with hearing impairments to participate more actively in the educational process, social interactions, and daily life, thereby improving their quality of life and psychosocial well-being. The practical significance of the results lies in substantiating the early individualised use of assistive technologies in the rehabilitation of children with hearing impairments.
Relevance. Bacterial keratitis is one of the most common infectious diseases of the cornea and may lead to severe complications, persistent visual impairment, and disability. Aim. To investigate the levels of interleukin-6 and the tight junction protein zonula occludens-1 in the tear fluid of patients with bacterial keratitis according to the presence of type 2 diabetes mellitus and to assess their association with the clinical course and development of disease complications. Materials and methods. A prospective comparative multicentre cohort study involving 88 participants was conducted, including patients with bacterial keratitis with and without type 2 diabetes mellitus, as well as healthy controls. Concentrations of interleukin-6 and the tight junction protein zonula occludens-1 in tear fluid were determined using enzyme-linked immunosorbent assay (ELISA). Results. Significantly elevated concentrations of interleukin-6 and zonula occludens-1 were detected in patients with bacterial keratitis compared with the control group. The highest levels of both biomarkers were observed in patients with concomitant type 2 diabetes mellitus. The concentration of interleukin-6 in patients with bacterial keratitis without diabetes mellitus was 245 [170;390] pg/mL, whereas in patients with concomitant type 2 diabetes mellitus it reached 430 [310;610] pg/mL. The level of zonula occludens-1 was 6.8 [4.9;9.5] ng/mL and 9.6 [7.2;13.4] ng/mL, respectively. Statistically significant positive correlations were found between the levels of the investigated biomarkers and the thickness, width, and area of corneal infiltrates. The strongest correlations were observed between interleukin-6 concentration and infiltrate thickness (ρ = 0.74; p < 0.001), as well as between zonula occludens-1 level and infiltrate thickness (ρ = 0.76; p < 0.001) in patients with type 2 diabetes mellitus. Patients with infiltrate ulceration, delayed epithelialisation, and stromal opacity demonstrated significantly higher levels of both biomarkers compared with those without a complicated disease course. Conclusions. Bacterial keratitis is associated with increased levels of interleukin-6 and the tight junction protein zonula occludens-1 in tear fluid. The investigated biomarkers were associated with morphometric characteristics of corneal infiltrates and the development of clinical complications of the disease.
Background. Infertility remains a significant issue in reproductive medicine, and pregnancy following IVF requires specialised medical supervision due to differences in its course compared with physiological pregnancy. Aim. To determine the characteristics of pregnancy, labour, and neonatal outcomes in women whose pregnancies resulted from in vitro fertilisation. Materials and methods. A retrospective clinical and statistical analysis was conducted of 318 pregnancy and delivery records, as well as medical records of newborns of women whose pregnancies resulted from IVF (Group I), and 137 pregnancy and delivery records of women who conceived spontaneously (Group II). All patients received treatment and delivery care in the obstetric department of the multidisciplinary medical centre “Leleka” (Kyiv) during the period from 2020 to 2024. Results. Women in Group I were characterised by a higher incidence of moderate pre-eclampsia – 94 cases (29.6%), compared with 21 cases (15.3%) in Group II (p < 0.05), placental dysfunction – 198 cases (62.3%) versus 43 cases (31.4%) in Group II (p < 0.05), which was accompanied by foetal growth restriction – 99 cases (31.1%) compared with 19 cases (13.9%), abnormal amniotic fluid volume – 141 cases (44.3%) versus 14 cases (10.2%) in Group II (p < 0.05), and vaginitis – 177 cases (55.7%) compared with 29 cases (21.1%) in Group II (p < 0.05). The incidence of severe pre-eclampsia, 19 cases (5.9%) in Group I and 2 cases (2.1%) in Group II, showed no statistically significant difference (p > 0.05). Regarding the timing of delivery, women in Group I had a lower rate of term births – 186 cases (58.5%) compared with 107 cases (78.1%) in Group II (p < 0.05), against a background of an increased number of preterm births – 87 cases (27.4%) versus 14 cases (10.2%) (p < 0.05), and post-term births – 45 cases (14.1%) compared with 16 cases (11.7%) in Group II (p > 0.05). Within the structure of preterm births among women in Group I, 10 cases (3.1%) occurred at 22-27 weeks + 6 days. There was no significant difference in the number of preterm births at 28-33 weeks + 6 days (Group I – 26 cases (8.2%), Group II – 4 cases (2.9%), p > 0.05) or at 34-36 weeks + 6 days (Group I – 51 cases (16.0%), Group II – 10 cases (7.3%), p > 0.05). Analysis of labour demonstrated a higher incidence of abnormalities of labour activity among women in Group I – 94 cases (29.6%) compared with 19 cases (13.8%) in Group II (p < 0.05), mainly due to uterine inertia – 66 cases (20.7%) versus 7 cases (5.1%) (p < 0.05), with successful medical correction achieved in 59 cases (62.7%) in Group I and 16 cases (84.2%) in Group II (p < 0.05). Conclusions. During 2022-2024, the number of pregnancies and births following IVF increased by 56%, and their complicated course may be associated with obstetric history, impaired placentation, and the specific characteristics of pregnancy after IVF.
Relevance. Colorectal cancer (CRC) is one of the three most prevalent malignancies in terms of incidence and mortality, both in Ukraine and worldwide. Despite Ukraine’s healthcare financing reform, out-of-pocket payments by patients remain a significant concern. Aim. To compare the sociodemographic characteristics of patients receiving chemotherapy for CRC. This comparison was made according to whether they made OOPPs. Materials and methods. A total of 459 people took part in this cross-sectional study. Their sociodemographic characteristics, subjective assessments of healthcare accessibility, awareness and satisfaction were analysed. Respondents who made OOPPs were compared with those who did not using the χ² test and the Cochran-Armitage trend test in R with the EZR graphical user interface. Results. A statistically significant linear trend towards an increased frequency of OOPPs was observed. This was with increasing age (p = 0.026) and increasing settlement size (p = 0.029). However, the groups did not differ significantly in terms of sex, educational attainment, or income (p > 0.05). The likelihood of family members acknowledging payments was significantly higher than that of patients themselves (p = 0.001). Patients who made OOPPs were significantly more likely to postpone diagnosis or treatment than those who did not (21.8% versus 8.4%, p < 0.001). Patients who were better informed about services that were free of charge were less likely to make payments (p < 0.001), as shown by a strong linear trend. Patients who did not make OOPPs also reported a significantly higher level of satisfaction with the quality of care (p = 0.001). Conclusions. The study identified several factors that could potentially be used to prevent out-of-pocket payments (OOPPs). Respondents who received chemotherapy and incurred OOPPs were more likely to be aged 60 years or older, retired and living in a regional capital. They were significantly more likely to postpone a cancer diagnosis or treatment due to anticipated financial costs, which suggests that healthcare services are not easily accessible. These patients did not know that they could get chemotherapy for free and were less satisfied with its quality. No differences were identified in relation to sex, educational attainment, or income level.
Relevance. Psychosomatic disorders represent a significant medical and biological problem, as their development is linked to the chronic activation of stress-mediating systems, in particular the hypothalamic-pituitary-adrenal axis and immuno-inflammatory mechanisms, which contribute to the development and progression of somatic pathology. Despite a considerable body of research, the pathogenesis of psychosomatic disorders requires an integrative synthesis that takes into account the interaction of neuroendocrine, immunoinflammatory and metabolic mechanisms, in particular neuroinflammation, glucocorticoid resistance, activation of the kynurenine pathway and gut dysbiosis. The relevance of this study stems from the need to systematise these data and develop a comprehensive pathogenetic model that can serve as a basis for improving the diagnosis and treatment of psychosomatic disorders. Aim. To systematise current scientific data on the psychoneuroimmunological mechanisms underlying the development of stress-induced mental and psychosomatic disorders by analysing the neuroendocrine, immuno-inflammatory, neurotransmitter and microbiome changes that arise under the influence of chronic stress and contribute to the development of psychosomatic pathology. Materials and methods. The study involved a narrative analysis of current scientific publications in the PubMed, PMC and Scopus databases for the period 2015-2025 (187 identified, 26 included in the final analysis). Methods of systematic analysis, generalisation and comparison of scientific data were employed. Results. This study systematises an integrative approach to the pathogenesis of psychosomatic disorders, uniting neuroendocrine, immune, metabolic and microbiome mechanisms into a single, interconnected cascade. Key points of convergence (the hypothalamic-pituitary-adrenal axis, indoleamine 2,3-dioxygenase 1, neuroinflammation) have been identified, and the concept of a pathological “vicious circle” that drives the chronicity of the process has been substantiated. It has been shown that chronic stress, via glucocorticoid resistance, neuroinflammation and kynurenine metabolism, forms a self-reinforcing pathological cycle, which underlies the chronicity of psychosomatic disorders. Conclusions. Psychosomatic pathology should be regarded as a systemic, multifactorial process in which the interaction of neuroendocrine, immune and microbiome regulation plays a key role. Practical value. The findings presented here can be used to deepen the understanding of the pathogenesis of psychosomatic diseases and to identify promising therapeutic targets.
Relevance. Worldwide, people recognise kidney transplantation as the standard treatment for end-stage kidney failure. However, impaired graft function frequently complicates the early postoperative period. The most common causes of early dysfunction are acute tubular necrosis and acute rejection. These conditions are difficult to distinguish from one another because they have similar clinical manifestations and routine monitoring methods are limited. Aim. To describe the evidence relating to the diagnostic accuracy and capabilities of dynamic renal scintigraphy with 99mTc-DTPA in distinguishing acute tubular necrosis from renal allograft rejection. Materials and methods. To identify relevant publications, searches were conducted in the international databases PubMed, Scopus, Web of Science and Google Scholar, with a focus on the period from January 2020 to January 2026. The analysis included studies that looked at how 99mTc-DTPA scintigraphy is used in adult kidney transplant patients. This was confirmed by either a biopsy or by checking the patient’s progress over time. This review is limited by the fact that no formal risk-of-bias assessment was performed. A total of 22 sources were included in the final analysis. The comprehensiveness of the global evidence included in this review may have been affected by the fact that it was limited to English- and Ukrainian-language publications. Results. Analysis of the literature indicates that the key criterion for scintigraphic differentiation is assessing the relationship between graft perfusion and function. Acute tubular necrosis is characterised by a dissociation phenomenon, with preserved perfusion despite reduced excretory function. In contrast, acute rejection is accompanied by a parallel deterioration in haemodynamics and function caused by increased vascular resistance. Using semi-automated quantitative parameters, particularly the Hilson and Kirchner indices, has been shown to strongly correlate with biopsy findings. According to the available literature, this method has a sensitivity of 98% for diagnosing acute tubular necrosis and 87% for detecting acute rejection. Even in cases of reduced graft function, 99mTc-DTPA is the optimal radiopharmaceutical for the routine assessment of perfusion indices thanks to its cost-effectiveness. Conclusions. Dynamic renal scintigraphy with 99mTc-DTPA is an effective non-invasive diagnostic method. It enables haemodynamic abnormalities in the allograft to be detected at the preclinical stage. Quantitative perfusion indices provide an objective basis for the diagnostic process, allow reliable differentiation between ischaemic and immunological complications, and minimise the need for invasive procedures. This facilitates the timely selection of an appropriate treatment strategy.
Relevance. The relevance of the study lies in the need to clarify the role of DNA repair mechanisms and genomic stress in the pathogenesis of diabetic retinopathy for the search for new therapeutic targets. Aim. To determine the expression of PMS2 and p53 proteins in the retinal tissues of rats with experimental diabetic retinopathy (DR) and to assess the effects of insulin and the cellular protein kinase blocker sorafenib. Materials and methods. The study was performed on 50 male Wistar rats. Diabetes mellitus was modelled by a single intraperitoneal injection of streptozotocin (50 mg/kg). After 7 days, animals with persistent hyperglycaemia were randomised into groups: no treatment, insulin treatment, and combined treatment with insulin and sorafenib. Animals were withdrawn from the experiment after 7 days, 28 days, and 3 months. Immunohistochemical examination was performed using antibodies against PMS2 and p53. The proportion of immunopositive cells was determined per 100 cells in 5 fields of view. Results. In intact animals, PMS2 and p53 immunoreactivity was minimal. During the development of experimental DR, the number of positively stained cells progressively increased. PMS2-positive cells were localised mainly in the ganglion cell layer and plexiform layers of the retina, whereas p53-positive cells were more strongly associated with the vascular bed. Treatment with insulin and sorafenib was accompanied by increased expression of both markers, with the most pronounced effect after combined administration of the drugs. After 3 months, combined therapy increased the proportion of PMS2-positive cells 2.5-fold and p53-positive cells 3.5-fold compared with the control group (p < 0.05). Conclusions. The development of experimental DR is accompanied by activation of the PMS2- and p53-associated cellular response to DNA damage in retinal tissues. Increased PMS2 expression during treatment with insulin and sorafenib may reflect activation of MMR-associated reparative and adaptive mechanisms. The results support considering PMS2 as a promising marker of genomic stress in diabetic retinopathy.
Relevance. Antimicrobial stewardship (AMS) programmes have become an important strategy for optimising antibiotic use and combating antimicrobial resistance in surgical practice. Aim. To evaluate the impact of implementing an AMS on antibiotic consumption in an inpatient surgical department. Materials and methods. A retrospective analysis of antimicrobial consumption was conducted in the surgical department of a university hospital between 2023 and 2025. Consumption was assessed using the defined daily dose (DDD) and DDD per 100 bed-days, with analysis of the prescribing structure according to the WHO AWaRe classification. Results. Despite an almost fivefold increase in the total volume of antibiotics used, from 558.1 to 2,387.0 DDD, due to a substantial expansion of surgical services, including the treatment of patients with combat-related injuries, the intensity of antibiotic consumption decreased from 33.5 to 6.8 DDD per 100 bed-days. The proportion of Access group antibiotics increased from 5.8% to 57.3%, whereas the proportion of Reserve group antibiotics declined from 82.6% to 4.7%, indicating a more appropriate pattern of use. A marked reduction was observed in the prescribing of third-generation cephalosporins (particularly ceftriaxone, which is classified as a Reserve antibiotic according to the national healthcare standard), as well as other Reserve antibiotics, including colistin and tigecycline. The use of carbapenems and fluoroquinolones also decreased, while the use of aminoglycosides, metronidazole, and clindamycin, all of which belong to the Access group, increased. Practical significance. The implementation of a comprehensive AMS resulted in more rational antibiotic use, optimisation of prescribing patterns in accordance with the AWaRe classification, and a reduction in the intensity of antibiotic consumption, confirming the effectiveness of a multidisciplinary approach involving a clinical pharmacist in the inpatient surgical setting.
Relevance. Scoliosis in children is a common orthopaedic condition that may be accompanied by progressive spinal deformity, impaired function of internal organs and a reduced quality of life. Early detection of postural abnormalities at the primary care level is crucial for timely treatment and the prevention of complications. Aim. To analyse current approaches to the early detection of scoliosis in children and to assess the importance of routine screening at the primary care level based on a clinical case. Materials and methods. An analysis of current scientific literature was conducted, along with a clinical analysis of a case of idiopathic scoliosis in an adolescent. The following were assessed: medical history, clinical manifestations, results of laboratory and instrumental diagnostic tests, the progression of the condition, and the effectiveness of treatment and rehabilitation measures. Results. The presented clinical case demonstrates the progression of spinal deformity in the child, despite the systematic implementation of conservative treatment, which necessitated surgical correction. It has been established that scoliosis in children may be accompanied by multisystem manifestations, which emphasises the need for a multidisciplinary approach involving a paediatrician, orthopaedic surgeon, neurologist, cardiologist and other specialists to ensure comprehensive diagnosis, treatment and rehabilitation. The critical importance of the timely detection of early clinical signs of scoliosis at the primary care level has been demonstrated, as this enables the prevention of the progression of the deformity and the development of complications. Practical significance. It is recommended that the results of this study be applied in the clinical practice of primary care specialists – paediatricians and general practitioners – for the early detection of scoliosis and the timely referral of children for specialist assessment.
Relevance. Non-carious cervical lesions of teeth remain the second reason for contacting the dentist after tooth decay and its complications. Aim. To determine predictors of the occurrence and progression of wedge-shaped defect (WSD) and erosion (E) of tooth enamel in young patients. Materials and methods. 272 patients (mean age 24.3 ± 6.9 years) were examined, in which potential predictors were collected during the examination and questionnaire method. To analyse the strength of the association between the factors and the outcome, the odds ratio (OR) was used within a 95% confidence interval (CI). Univariate and multivariate logistic regression analysis was used to determine the predictors. Results. Independent predictors of WSD were salivation rate less than 0.5 mL/min, hygiene habit of applying pressure to the toothbrush, age of 25 and older, the presence of gingival recession and tooth extraction. Latent predictors of WSD development were oral fluid pH (OF) values less than 6.9 C.U., behavioural factors, clinical markers. Potentially protective variables were variables with OR < 1: duration of brushing teeth for three minutes or more, consumption of yoghurt and bananas. Confounding was identified for the “fruit consumption” predictor. Independent predictors of the occurrence of enamel E were the presence of occlusal tooth wear and enamel cracks; modifier factors – OF pH values less than 6.9 C.U., and the habit of brushing teeth before breakfast. However, the broad CI determined for all predictors of the appearance of enamel E in univariate logistic regression analysis, and a small number of observations, indicate the prematurity of the results and the need for their confirmation. Most predictors of the progression of non-carious cervical lesions of teeth were latent and had broad CI in univariate logistic regression analysis, indicating evaluation instability and requiring further studies in larger samples. Conclusions. The use of the logistic regression analysis method determined statistically independent and hidden predictors that are recommended to be considered in the diagnosis and preparation of a treatment plan for non-carious cervical lesions lesions of teeth in young patients.
Relevance. Ukraine’s integration into the European Union requires the harmonisation of national legislation with European standards. One of the priority areas is the improvement of the system of medical and sanitary standards for hazardous substances in ambient air. Unlike the EU Member States and the United States, where the regulation of carcinogens is based on a risk-oriented approach that allows for an acceptable level of risk and the periodic revision of limits, the maximum permissible concentrations (MPCs) of carcinogens in Ukraine have traditionally been established on the basis of toxicological experiments without mandatory subsequent review. Aim. To analyse the compliance of the current Ukrainian medical and sanitary (hygienic) standards for carcinogenic substances in the ambient air of populated areas with international standards. Materials and methods. The Ukrainian regulatory framework governing carcinogenic substances in ambient air, EU legislation and directives, US standards, and the recommendations of the International Agency for Research on Cancer were examined. Results. A comparative assessment of the current Ukrainian standards for carcinogenic substances was carried out to determine their compliance with internationally accepted carcinogenic risk levels (1 × 10⁻⁴) and reference concentrations. Hygienic standards for 45 substances with established carcinogenic potential were analysed. It was found that the current standards for 34 substances do not comply with international requirements. An improved system of standards is proposed, incorporating annual average concentrations for the assessment of chronic exposure and daily average concentrations for the assessment of acute exposure. Conclusions. The need to harmonise the Ukrainian system of medical and sanitary regulation of carcinogens with international standards has been demonstrated. The introduction of a risk-oriented approach based on an acceptable risk level (1 × 10⁻⁴), the differentiation of standards according to averaging periods (annual average and daily average concentrations), and the regular revision of the regulatory framework in accordance with current toxicological and epidemiological evidence are scientifically substantiated.
Relevance. Patients with type 2 diabetes mellitus are at high risk of severe COVID-19, multiple organ failure, and death. Despite the introduction of direct-acting antiviral agents, including molnupiravir, some patients may still experience an unfavourable outcome despite early initiation of treatment, highlighting the need for further investigation. Aim. To evaluate the course of COVID-19 in a patient with type 2 diabetes mellitus using a clinical case and to analyse the possible reasons for the unfavourable outcome despite the timely administration of molnupiravir. Materials and methods. A retrospective descriptive case study was conducted. The course of COVID-19 was analysed in a 56-year-old woman with type 2 diabetes mellitus who received antiviral therapy with molnupiravir from the fourth day of illness. Clinical manifestations, laboratory and instrumental findings, treatment characteristics, and the possible causes of the unfavourable outcome were assessed. Results. The illness began with moderately severe respiratory symptoms and a low-grade fever. On hospital admission, signs of decompensated diabetes mellitus were identified, including hyperglycaemia (14.7 mmol/L), ketonuria (3+). Also elevated C-reactive protein (CRP) level of 91.5 mg/L and lymphopenia were revealed. Although there were no clinical and radiological signs of pneumonia on admission, the patient’s condition deteriorated rapidly, with the development of metabolic acidosis, diabetic ketoacidotic coma, bilateral polysegmental pneumonia, acute respiratory distress syndrome, and multiple organ failure. Early administration of molnupiravir did not prevent a fatal outcome. Conclusions. This clinical case demonstrates that, in patients with decompensated diabetes mellitus, COVID-19 may progress rapidly to a critical condition even in the absence of signs of pulmonary involvement at the early period of the disease. One of the key factors contributing to the poor prognosis was likely metabolic decompensation associated with ketoacidosis and a systemic inflammatory response. COVID-19 vaccination did not prevent the fatal outcome in this patient. The effectiveness of antiviral therapy for COVID-19 depends not only on the timely initiation of treatment but also on the degree of control of underlying comorbidities and the early correction of metabolic disordes. The clinical effectiveness of molnupiravir may depend on the SARS-CoV-2 variant, the baseline viral load, and individual patient peculiarities. Specialised molecular genetic studies are required to assess the potential role of antiviral resistance.
Aim. To assess systemic levels of CD95 (Fas) and ICAM-1 (CD54) in patients with secondary neovascular glaucoma (NVG), to determine the relationship with the severity of iris rubeosis and the iridocorneal angle, and to evaluate the role of endothelial apoptosis in neovascular remodelling of the anterior segment of the eye. Materials and methods. A single-centre cross-sectional study included 186 eyes with secondary NVG (96 associated with proliferative diabetic retinopathy and 90 following retinal vein occlusion) and 34 eyes in the control group. The severity of rubeosis was assessed using the Weiss grading scale. CD95 and ICAM-1 levels in peripheral blood were measured using an immunocytochemical method. Results. In patients with NVG, CD95 and ICAM-1 levels were significantly higher compared with controls (p < 0.001). Both markers positively correlated with the severity of rubeosis according to Weiss (CD95: rs = 0.46; ICAM-1: rs = 0.45; p < 0.001) and with intraocular pressure. In a multivariable ordinal logistic regression model, CD95 and ICAM-1 remained independently associated with more severe rubeosis after adjustment for aetiology and intraocular pressure (CD95: OR = 2.31; 95% CI 1.27-4.18; p = 0.006; ICAM-1: OR = 2.48; 95% CI 1.56-3.95; p < 0.001). ROC analysis demonstrated moderate discriminative ability of the markers for detecting clinically significant rubeosis (Weiss ≥ II): AUC = 0.729 for CD95 and AUC = 0.730 for ICAM-1. Cut-off values were 687 cells/µL and 542 cells/µL, respectively. Conclusions. CD95 (Fas) and ICAM-1 (CD54) are associated with the severity of rubeosis in secondary NVG and may serve as systemic biomarkers for neovascular remodelling and risk stratification of disease progression.
Relevance. Under modern biological, chemical, radiological, and other threats to public health, improvement of the system for developing and maintaining the competence of rapid response teams of the Centres for Disease Control and Prevention becomes particularly important. Aim. To identify the main problems in developing and maintaining professional competence and to substantiate directions for its improvement based on an analysis of regulatory support and the results of a survey of specialists from rapid response teams of the Centres for Disease Control and Prevention. Materials and methods. Bibliosemantic, information-analytical, and sociological methods, together with descriptive statistics, were used in the work. The sociological stage of the study involved an anonymous questionnaire survey of specialists from rapid response teams (RRTs) of the Centres for Disease Control and Prevention (CDCPs) to assess the current training system, experience of participation in emergency response, and directions for its improvement. Regulatory documents, educational and certificate programmes, electronic resources, and the results of sociological studies on the training and activity of RRTs of CDCPs were analysed. Results. It was established that the competence system of RRTs of CDCPs should include cognitive, operational-technological, communicative, digital, and personal-motivational components. The key competences include emergency response, epidemiological investigation, risk assessment, laboratory diagnostics, interagency interaction, and public information. Competence is maintained through continuous learning, training, updating of the regulatory framework, resource provision, readiness monitoring, and international cooperation. According to the results of the questionnaire survey, 47.0% of respondents indicated the need to strengthen practical training, and 48.5% had experience of responding to public health emergencies. The need to develop psychological training, improve the integrated competence-based approach, and train personnel to work with modern material and technical support was also determined. Conclusions. The results obtained indicate the need to strengthen the practical and psychological components of training for RRT personnel of CDCPs, develop practice-oriented forms of learning, and regularly practise emergency response algorithms. Professional competence should be maintained by combining continuous professional development, readiness monitoring, interagency drills, and international cooperation. The certificate programme “Emergency Preparedness, Response and Management” can be considered an effective instrument of professional development, as it combines a competence-based approach, practical training, training in response to chemical, biological, radiological, and nuclear threats, and the development of interagency interaction skills.
Relevance. Diabetic nephropathy significantly impairs patients’ quality of life, leads to loss of working capacity, and is associated with high mortality. Current scientific trends demonstrate a transition from a conventional approach focused solely on normalising blood glucose levels towards developing comprehensive preventive strategies that block pathogenetic mechanisms directly at the molecular level. Aim. To investigate the impact of the protein kinase inhibitor sorafenib on the histological structure of the kidney in a model of type 2 diabetes mellitus and during treatment. Materials and methods. An experimental study was conducted on laboratory rats to model diabetes using a hypercaloric, high-fat diet for 150 days, followed by the induction of diabetes mellitus with streptozotocin. The animals were divided into the following experimental groups and subgroups: Group I: normal-calorie diet. Group II: diabetes modelling comprising subgroups IIa (placebo treatment), IIb (sorafenib treatment), IIc (insulin treatment) and IId (combined insulin and sorafenib treatment). Treatment following the induction of diabetes lasted for 30 days. The animals’ kidneys were then examined using general histological and morphometric methods. Paraffin sections were stained with haematoxylin and eosin. The areas of the renal corpuscles and glomeruli, as well as the cell density within the glomeruli, were measured. Results. Animals in the experimental subgroups IIa, IIb and IIc exhibited moderate changes that predominantly affected the glomeruli. This was manifested by an increase in the glomerular area compared to that of intact animals. Animals in subgroup IIa were more frequently characterised by the presence of both obliterated and dilated capillaries. These capillaries were found within the glomerular loops. In animals in subgroups IIb and IIc, enlargement of the glomeruli was accompanied by dilatation of the capillary loops. The histological structure and morphometric parameters of the renal glomeruli in animals in subgroup IId were similar to those observed in group I. The morphological changes identified in subgroups IIa, IIb and IIc are characteristic of the early stages of diabetic nephropathy, indicating compression of the capillaries due to mesangial expansion and excessive dilatation of other capillaries as a result of hyperfiltration. Conclusions. Using the protein kinase inhibitor sorafenib alongside the standard insulin therapy regimen prevented the development of the renal glomerular lesions characteristic of diabetic nephropathy.
Relevance. This study addresses the issue of rehabilitation for military personnel with lumbar disc herniation, which poses a critical challenge due to high levels of physical exertion and combat stress. Aim. To investigate the effectiveness of manual therapy as a means of correcting the psychoemotional state and improving the quality of life of such patients within a long rehabilitation cycle. Materials and methods. The study involved 30 military personnel (23 men and 7 women), randomised into two groups: basic (manual therapy + exercise (MT)) and control (exercise only + sham mobilisation (EX)). The assessment was performed using a number of tools: the McGill-Melzack Pain Questionnaire (pain), the HADS (anxiety/depression), the Tampa Scale of Kinesiophobia (kinesiophobia), the PCS (pain catastrophisation), and the Nottingham Health Profile (quality of life). Patients’ condition was assessed in three stages: before treatment (T1), after a 5-week course (T2), and after three months of follow-up (T3). Results. At baseline, the groups were homogeneous, although the MT group had higher levels of pain and catastrophisation. After the course (T2), both cohorts showed significant progress: in the MT group, pain intensity halved and quality of life improved by 64.1% (compared to 36.8% in EX). Only the MT group had a statistically significant reduction in anxiety and depression (49.2%) with a high effect size (0.432). Furthermore, in this group, the effect size for reducing pain catastrophisation (0.571) was twice that of the EX group (0.256). However, at the T3 stage, different trajectories were found: in the MT group, partial regression of results occurred, while the EX group showed a prolongation of the effect with a stable improvement in quality of life by 54.8%. Therefore, manual therapy is effective for rapid psychoemotional stabilisation, and physical exercises are effective for maintaining a long-lasting analgesic result. Conclusions. Manual therapy is an effective tool in the comprehensive rehabilitation of service personnel, as it not only helps to reduce the intensity of pain but also successfully overcomes psychological barriers, such as fear of movement and depressive states. To achieve the most sustainable functional well-being, it is recommended to integrate manual techniques into long-term physical training programmes.
Relevance. Depression is one of the leading causes of disability worldwide, and a significant proportion of patients suffer from treatment-resistant forms of the disorder. An innovative approach involves the use of ketamine and esketamine, which are capable of inducing a “window of neuroplasticity” – a period of enhanced synaptogenesis and the formation of new neural connections. Theoretically, this increased neuroplasticity may contribute to the improvement of not only mental but also motor and sensorimotor functions, which is critically important for neurological rehabilitation following brain injuries, strokes, and other CNS lesions. Aim. To conduct a systematic review of the available scientific literature on the effects of ketamine and esketamine on neuroplasticity and neurological functions, with a particular focus on assessing their potential for use in neurological rehabilitation following various CNS injuries. Materials and methods. A systematic search of the scientific literature was conducted in leading databases (PubMed, Cochrane Library, NICE, APA PsycInfo, CANMAT, UpToDate), focusing on studies from the past 20 years. The review included clinical trials, experimental animal studies (modelling acute CNS injuries), as well as systematic reviews and meta-analyses. The collected data were synthesised using a descriptive method. Results. The systematic review did not identify any clinical studies that directly evaluated the use of ketamine or esketamine to enhance the effectiveness of human neurological rehabilitation programmes specifically due to their neuroplastic effects. On the other hand, preclinical data in animal models (traumatic brain injury and ischemic stroke) convincingly demonstrate that these drugs reduce neuroinflammation, excitotoxicity, and oxidative stress. Furthermore, they support structural neuroplasticity and positively correlate with improvements in sensorimotor and behavioural outcomes. Conclusions. Ketamine and esketamine are promising candidates for use as adjunctive agents in neurological rehabilitation programmes. However, there is currently insufficient clinical evidence to formulate official recommendations. Well-designed randomised controlled trials with long-term follow-up and standardised assessment of functional outcomes are needed to confirm their efficacy and safety.
