Introduction. Unfortunately, no one is immune from the unlawful actions or inactions of medical professionals. Some prefer to solve the problem with public outcries and hysteria, while others exercise their constitutional right to judicial protection. The effectiveness of each of these approaches is a topic for lengthy discussion. The Ministry of Health offers an out-of-court alternative to address the issue – directing complaints to authorized bodies and individuals. The Ministry considers this method to be more effective and, most importantly, faster in restoring violated rights, which plays a crucial role for every patient. Even if the operation of your healthcare facility is perfectly organized, you may still receive complaints from patients. Properly receiving these complaints and navigating the relevant legislation is almost an art. Objective. To integrate patient complaints review with monitoring and improving the quality of both medical care and the operation of healthcare facilities. Materials and methods. The study employs statistical, medical-epidemiological methods, and survey techniques. An analysis of the Ministry of Health’s citizen complaint database for 2013, 2018, and 2022 was conducted. Results. It was found that over the study period, the number of citizen complaints regarding the provision of medical care in Ukraine significantly increased. The number of complaints in 2022 compared to 2013 grew by 7.4%. The main issues of citizen complaints concern the provision of medical care (23.4%), staffing issues (14.6%), referrals to medical and sanitary expert commissions and medical advisory commissions (12.9%), and unlawful actions by healthcare workers (7.7%). The results confirm the necessity for developing and implementing scientific preventive technologies aimed at improving the organization of citizen complaint handling at the regional level, with further implementation in the operation of healthcare facilities. Conclusion. It was found that optimizing complaint handling requires the implementation of a new model for organizing work with citizens regarding their complaints. This model will ensure that complaints are reviewed substantively, entered into a unified complaint register, with feedback and monitoring of patient satisfaction taken into account.
Relevance. The epidemiological significance of varicella (chickenpox) stems from its extremely high contagiousness and widespread prevalence among the general population. In terms of incidence rates globally, it is surpassed only by influenza and other acute respiratory viral infections (ARVIs). Contrary to the common misconception of varicella being a "benign childhood illness," it annually leads to substantial medical and socioeconomic burdens. The relevance of the disease is underscored by its widespread prevalence. According to WHO data, approximately 140 million cases of varicella are registered worldwide annually, of which 4.2 million result in complications requiring hospitalization and approximately 4,200 are fatal. Chickenpox (CP) remains a significant socio-economic burden, ranking third in economic losses among infectious diseases. During 2024-2025, an increase in severe cases has been observed among adults, who face a 10-20 times higher mortality risk than children, primarily due to visceral dissemination and VZV-induced hepatitis. Visceral disseminated VZV (VD-VZV) results from the haematogenous spread of the virus from the primary entry site or skin lesions to internal organs. Large-scale surveys indicate that liver involvement occurs in 44% of systemic dissemination cases, making hepatitis the second most common visceral manifestation after pneumonitis (56%). Objective.The aim of this study is to present a case report of CP complicated by hepatitis. Materials and Methods. A clinical case of a 34-year-old patient hospitalized with a clinical presentation of varicella complicated by acute hepatitis is described. The diagnosis was based on clinical findings, biochemical and serological blood tests, and ultrasonography. A systematic analysis of scientific publications, official reports, and recommendations from international organizations (EUCALB, CDC, ECDC) from 2013 to 2025 was conducted. Both original studies and systematic reviews and meta-analyses were analyzed. Results. This report describes a case of CP in a 34-year-old male, complicated by moderate acute hepatitis. A key feature of the case was "biochemical dissociation" – marked cytolysis despite normal bilirubin levels. Comprehensive treatment combining valaciclovir and ademetionine likely resulted in clinical and biochemical recovery by day 24. The rising frequency of visceral complications in adults necessitates high clinical suspicion of varicella-zoster virus (VZV) hepatitis in patients presenting with atypical abdominal pain and severe intoxication. Prompt antiviral therapy and the implementation of routine vaccination are essential strategies for reducing hospitalizations and preventing fatal outcomes. Conclusions. This clinical case highlights the severity of varicella infection in adults, complicated by acute hepatitis exhibiting characteristic "biochemical dissociation" (marked cytolysis alongside normal bilirubin levels). Combined therapy with valaciclovir and ademetionine likely accelerated clinical and laboratory recovery. The increasing incidence of visceral complications warrants high clinical vigilance for VZV-induced hepatitis in adult patients presenting with severe duration or abdominal syndrome. Early administration of antiviral therapy and the expansion of vaccination coverage are pivotal for preventing life-threatening outcomes and reducing hospitalization rates.
Introduction. In recent years, the physiological role of hydrogen sulfide (H2S) has been recognized, and evidence has emerged that this endogenous gaseous molecule can modulate inflammatory processes. Many studies have shown that H2S donors reduce edema formation and leukocyte adhesion to vascular endothelium, as well as suppress the synthesis of pro-inflammatory cytokines. The aim of the work was to determine the effect of the hydrogen sulfide donor NaHS and the selective COX-2 inhibitor on nitric oxide metabolism, pro- and antioxidant balance, and the concentration of sulfide anions in the periodontal soft tissues of rats under conditions of modeling of systemic inflammatory response syndrome. Materials and methods. The experiment was performed on 30 sexually mature male rats weighing 190–220 g. The oxidative-nitrosative stress indices and the hydrogen sulfide content in the soft periodontal tissues of rats were evaluated under the conditions of oral administration of 18 mg/kg nimesulide and intraperitoneal administration of 5 mg/kg NaHS and their combination against the background of systemic inflammatory response syndrome. Results. Under the conditions of administration of the hydrogen sulfide donor NaHS and the selective COX-2 inhibitor nimesulide against the background of systemic inflammatory response syndrome in the periodontal soft tissues of rats, the total activity of NO-synthase decreased by 1.52 times, inducible NO-synthase by 1.65 times, catalase by 1.06 times, superoxide anion radical production by 1.28 times, and the activity of constitutive NO-synthase increased by 1.15 times, arginase by 1.15 times, the concentration of peroxynitrite by 1.56 times, malondialdehyde by 3.32 times, as well as the content of OMP by 3.96 times and the concentration of sulfide anions by 3.11 times in relation to the control group of animals (Р < 0.05). Conclusions. The combined administration of NaHS and the selective COX-2 inhibitor nimesulide under conditions of systemic inflammatory response syndrome modeling has a synergistic stimulating effect on the formation of peroxynitrite and hydrogen sulfide in the periodontal soft tissues of rats, which may be a consequence of the influence of the hydrogen sulfide donor NaHS.
Traumatic brain injury complicated by extracerebral disorders is an important cause of morbidity and mortality worldwide. Acute lung injury develops in approximately 20-25% of patients with traumatic brain injury. However, the relationships between post-traumatic pathomorphological manifestations, clinical features, and the severity of traumatic brain injury remain insufficiently studied. Objective. The aim of our experimental study was to investigate the morphological changes in the lungs of experimental animals along the brain-lung axis following moderate closed traumatic brain injury. Materials and Methods. A model of closed traumatic brain injury was reproduced in adult outbred white rats, followed by histological examination of lung tissue at 3, 24, and 72 hours after brain injury. Results. The study demonstrated progressive pathomorphological changes in the pulmonary microcirculation and parenchyma at different stages of the post-traumatic period. These changes included hyperemia and diapedetic hemorrhages, impairment of the vascular wall structure, altered blood rheological properties manifested by erythrocyte stasis and sludge formation, separation of blood cells from plasma, interstitial edema, inflammatory changes with perivascular and peribronchial lymphocytic infiltrates, localized emphysematous lesions of the lung tissue combined with atelectatic and dystelectatic changes in the respiratory portion of the pulmonary parenchyma, as well as dystrophic and degenerative changes in alveolocytes. An increase in the relative area of atelectasis and the thickness of the interalveolar septa, together with decreased alveolar, arteriolar, and hemocapillary diameters, indicated progressive hypoxic disorders and a worsening prognosis following closed traumatic brain injury. Conclusions. The key morphological features of acute lung injury following closed traumatic brain injury include interstitial and alveolar edema, alveolocyte injury, pulmonary congestion, alveolar hemorrhages, atelectasis and dystelectasis, and signs of inflammation. Collectively, these changes can be interpreted as a manifestation of acute respiratory distress syndrome in rats.
Background. According to the American Heart Association, coronary artery disease is found in a significant share of people over 60 years old, and in Ukraine it remains one of the leading causes of mortality—approximately 650 cases per 100,000 population. Most coronary artery bypass grafting (CABG) procedures are performed using cardiopulmonary bypass (CPB), which may increase the risk of complications. In this regard, we aimed to evaluate the effectiveness of lidocaine as part of a multimodal analgesia regimen during such procedures. Objective. To analyze the impact of lidocaine administration on the level of surgical stress in patients undergoing CABG with CPB by assessing fluctuations in lactate, glucose, and the pro-inflammatory cytokine IL-6. Materials and Methods. The study is based on the results of examination of 100 patients with coronary artery disease (50 patients in Group 1 — without the use of lidocaine in the multimodal anesthesia scheme; 50 patients in Group 2 — with lidocaine). All underwent CABG with cardiopulmonary bypass. Indicators were recorded at the following stages: 1)before initiation of CPB; 2) after cessation of CPB; 3) on the last day in the intensive care unit. Results and Discussion. Before the start of surgery, hemodynamic indicators suggested stable overall condition. The duration of surgery in Group 2 (with lidocaine) was shorter by 9.95% compared to Group 1 (p=0.01); anesthesia duration decreased by 8.94% (p=0.02), and CPB duration decreased by 20.06% (p=0.0003). The fentanyl dose (µg/kg/min) in Group 2 was lower by 7.3% (p=0.03), and the amount of propofol (mg) was lower by 27.8% (p=0.0002). The total dose of dobutamine in Group 2 was lower by 25.08% (p=0.02). A significant difference was also observed in the level of the pro-inflammatory cytokine IL-6. By the end of CPB, its level in Group 2 was lower by 74.4% compared to Group 1 (p=0.008). The difference in lactate level was also statistically significant — by the end of perfusion it was lower by 11.16% (p=0.04) than in the group without lidocaine. On the last day in the intensive care unit, glucose levels in Group 2 were lower by 9% compared to Group 1 (p=0.02). Duration of mechanical ventilation decreased by 27.8% (p=0.0003), and norepinephrine dosage was lower by 44.1% (p=0.03). Conclusions. In the lidocaine group, a lower requirement for Fentanyl and Propofol was observed, as well as lower values of certain early postoperative parameters, including glucose levels, duration of mechanical ventilation, and the dose of Norepinephrine. Differences in the duration of surgery, anesthesia, cardiopulmonary bypass, and intraoperative requirement for Dobutamine should be interpreted as associations rather than definitive evidence of a direct causal effect of lidocaine. To conclusively confirm the obtained results, larger prospective studies with clearly defined randomization, comprehensive inclusion and exclusion criteria, as well as correlation analysis and multivariable statistical adjustment are warranted.
