Achievements of Clinical and Experimental Medicine
Scientific and practical journal aims to elucidate the actual problems of mechanisms of function of organism in health and illness, aspects of molecular and cell physiology and pathology, modelling of pathological processes, morphology and pathologic morphology, clinical and experimental data of diagnosis and treatment, peculiarities of internal medicine, actual problems of pediatric diseases, gynecology and obstetrics, surgery, transplantology, neurology and psychiatry, ecology, preclinical and clinical trials, etc. ISSN 2415-8836 (Online), ISSN 1811-2471 (Print)
ANALYSIS OF THE ASSORTMENT OF DIETARY SUPPLEMENTS FOR THE NORMALIZATION OF VISUAL FUNCTION
SUMMARY. Vision is essential for human activity, yet over 2.2 billion people worldwide face visual impairments, many of which are preventable. Digital screen exposure further exacerbates eye health issues. While treatment options exist, their cost makes prevention increasingly relevant. The use of plant-based dietary supplements offers a viable preventive strategy. Analyzing their assortment, composition, and dosage forms is key to improving quality control and guiding the development of effective products for visual function support. The aim – to investigate the pharmaceutical assortment of dietary supplements for the normalization of visual function. Material and Methods. The objects of the study were the directory of Compendium online and online resources such as Tabletki.ua and Apteki.ua. The study employed marketing analysis, graphical representation, logical generalization, and mathematical-statistical methods. Results. As of April 2025, the pharmaceutical assortment comprised 104 dietary supplements for the normalization of visual function. The analysis of the assortment revealed a predominance of domestically produced dietary supplements, accounting for 55.77 %. The leaders among them were Beauty and Health, LLC (10.34 %) and Elit-Pharm, LLC (8.61 %). Imported dietary supplements originated from 16 countries, with the highest shares coming from Germany and the United States (19.57 % each). The majority of dietary supplements had a multi-component composition (86.54 %). The most common dosage forms were capsules and tablets. Conclusions. The domestic pharmaceutical market of dietary supplements for the normalization of visual function has been analyzed. The results indicate a predominance of domestically produced products, a multi-component structure of the assortment, and a variety of dosage forms, highlighting the high potential for further research and development based on plant-derived raw materials.
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FEATURES OF THE INFLAMMATORY PROCESS IN RABBITS WITH MECHANICAL NON-PENETRATING CORNEAL INJURY AND ITS CORRECTION USING STEM CELLS
SUMMARY. Recent studies have demonstrated a significant role of neutrophil infiltration and activation of lipid peroxidation processes in the pathogenesis of corneal injury. The aim – to evaluate the dynamics of oxygen-dependent processes in the body and the NBT test as a marker of inflammation in rabbits with corneal injury, as well as the effectiveness of correction using mesenchymal stem cells. Material and Methods. Epithelial incisions were made in the upper part of the cornea using a trephine, followed by removal of the epithelium along with the anterior stromal layer. Local anesthesia was performed using 0.5 % Alcaine solution and 2 % lidocaine solution. For therapeutic correction, Corneregel and mesenchymal stem cells (MSCs) derived from the umbilical cord were used. In blood and corneal homogenates, concentrations of initial, intermediate, and final lipid peroxidation products were measured – reactive oxygen species (ROS), lipid hydroperoxides (LHP), thiobarbituric acid-reactive substances (TBARS), and Schiff bases (SB). Inflammatory activity was assessed using the nitroblue tetrazolium (NBT) test. Additionally, the reserve index (RI) and neutrophil activation coefficient (NAC) were calculated. Results. Mechanical corneal trauma in rabbits induced a rapid and intense local inflammatory response characterized by massive neutrophil infiltration and high production of lipid peroxidation products. A sharp but uneven increase in both spontaneous and induced NBT test values was observed, along with a simultaneous decrease in RI and NAC. Lipid peroxidation products increased primarily in the early stages, followed by partial reduction by day 28. The use of corrective agents was associated with a less pronounced increase in NBT test indicators, normalization of RI and NAC by the end of the experiment, and a significantly lower increase in lipid peroxidation products, which normalized by day 28. Combined use of Corneregel and MSCs showed the highest efficacy. Conclusions. Under conditions of mechanical corneal injury, the administration of mesenchymal stem cells effectively modulates the ocular immune response, reduces neutrophil activity and lipid peroxidation, thereby normalizing the level of inflammatory activity.
SURGICAL TACTICS AND RESULTS OF TREATMENT OF HEAD NEUROFIBROMAS: A CLINICAL EXPERIENCE
SUMMARY. The aim – to improve the effectiveness of surgical treatment of patients with head neurofibromas by systematizing clinical experience in treating such patients in the context of type 1 neurofibromatosis (NF1), with an emphasis on the choice of surgical tactics, reconstruction methods, and the use of innovative technologies, especially regarding the combination of surgical and medical approaches to improve functional and aesthetic results. Material and Methods. Current achievements and a clinical case of a patient with a head neurofibroma who underwent treatment at the Valikhnovski Surgery Institute were shown. Clinical examination, imaging methods (magnetic resonance imaging, Dopplerography), morphological confirmation, intraoperative neurophysiological monitoring, surgical methods (resection, microsurgery, laser ablation), reconstructive techniques (tissue expansion, free flaps), quality of life assessment, and statistical analysis of results at a p<0.05 level were presented. Results. Surgical intervention led to sustained improvement. The main complications included neurological deficits, recurrences, and reconstruction complications (expander extrusion, flap necrosis). The integration of 3D visualization, mitogen-activated protein kinase inhibitors (selumetinib), and personalized planning significantly improves treatment effectiveness. The presented clinical case demonstrates the successful application of a comprehensive approach with radical tumor removal, reconstruction of the defect with local tissues, and long-term remission without recurrence. Conclusions. Surgical treatment of head neurofibromas in patients with type 1 neurofibromatosis is an effective method that requires an individualized approach, taking into account the anatomical location and morphology of the tumor. Reconstructive interventions using tissue expansion and free flaps allow achieving high functional and aesthetic results even with large defects. The integration of intraoperative neuromonitoring, 3D visualization, and targeted therapy increases the safety of surgical interventions and expands the indications for the treatment of complex forms of neurofibromas. Prospects for further research include conducting multicenter prospective studies to standardize surgical tactics and reconstructive algorithms in patients with craniofacial neurofibromas, as well as studying the long-term effectiveness of combined treatment.
THE PECULIARITY OF MORPHOLOGICAL CHANGES IN LUNG BLOOD VESSELS AND TISSUES OF RATS DURING REPERFUSION OF THE SMALL INTESTINE AFTER PRELIMINARY MODELING OF ITS ACUTE OBSTRUCTION
SUMMARY. An important problem in acute intestinal obstruction is multiorgan failure, which is based on the phenomenon of "double blow", namely, due to the violation of the enteric and hepatic barriers, it manifests itself in the initiation of pulmonary dysfunction. The lungs are a target organ, including from the point of view of the mechanisms of bacterial translocation. The aim – to establish the features of the dynamics and sequence of morphological changes in the vessels and lung parenchyma during the reperfusion of small intestine after previous modeling of it acute obstruction. Material and Methods. The experiments were conducted on 54 outbred white laboratory male rats. Acute intestinal obstruction was simulated by ligation of the small intestine with a silk ligature 5 cm above the place of its confluence with the cecum. Restoration of the digestive tract patency was performed 48 hours after the start of the experiment. Histological sections were stained with hematoxylin and eosin, according to Weigert and Van Gieson. Results. In the course of the experiment on rats, it was found that the pulmonary artery in acute intestinal obstruction responds to a compensatory increase in resistance in the form of increased wall tone with narrowing of the lumen, as a response to hypovolemia, which naturally occurs in such cases. Bronchial arteries respond by increasing their throughput, which could also have a compensatory value, given the functionality of these vessels. Restoration of the patency of the digestive canal after a previous 48-hour occlusion initially does not lead to an improvement in blood circulation in the lungs and even a deepening of previously detected disorders was noted. Dilated bronchial arteries change the response to spasm, which may indicate similar mechanisms of influence on the vascular wall of the pulmonary and bronchial arteries. The reason for this may be a hemodynamic and oxygen double shock in the vessels of the small intestine. Changes in the blood vessels of the lungs are secondary in nature, possibly under the influence of hemodynamic factors, as well as additional toxic effects. Conclusions. Acute intestinal obstruction leads to a restructuring of the pulmonary blood flow, the nature and intensity of which depends on the duration of the pathological process and determines the degree of restructuring of the pulmonary vessels, which is manifested in a progressive decrease in their throughput in the form of wall thickening and lumen narrowing.
MOLECULAR HYDROGEN AS A MODULATOR OF OXIDATIVE STRESS AND INFLAMMATION IN DOXORUBICIN-INDUCED TOXICITY
SUMMARY. Doxorubicin is an effective anthracycline widely used in chemotherapy, but its clinical use is limited by toxic side effects, especially cardiotoxicity associated with oxidative stress and inflammation. Molecular hydrogen (H2) exhibits antioxidant and anti-inflammatory properties by selectively neutralizing hydroxyl radicals and peroxynitrite. The aim – to investigate the effect of molecular hydrogen-enriched water on oxidative stress and inflammation in doxorubicin-induced toxicity in rats. Material and Methods. The experiment was conducted on adult male rats randomized into four groups: control, doxorubicin (DOX), doxorubicin + hydrogen-enriched water (DOX+H2-water), and hydrogen-enriched water (H2-water). Intraperitoneal injections of doxorubicin were administered at a dose of 5 mg/kg, with a cumulative dose of 20 mg/kg. Rats were sacrificed on the 29th day of the experiment. Levels of pro-inflammatory cytokines (TNF-α, IL-1β), oxidative stress markers (MDA, 8-isoprostane, carbonyl groups), antioxidant enzyme activities (catalase, superoxide dismutase), and reduced glutathione content were measured. Results. Doxorubicin significantly increased the level of pro-inflammatory cytokines, enhanced oxidative stress and elevated lipid and protein peroxidation: increased levels of MDA, 8-isoprostane, and protein carbonyl groups were observed. At the same time, the suppression of activity of catalase, superoxide dismutase and reduced glutathione levels confirmed the inhibition of antioxidant defense. Consumption of hydrogen-enriched water reduced pro-inflammatory cytokines by 33–35%, decreased oxidative stress markers, and improved antioxidant defense. Consumption of hydrogen-enriched water did not cause deviations in indices compared to control group animals. Conclusions. Molecular hydrogen-enriched water effectively attenuates doxorubicin-induced oxidative stress and inflammation by modulating the pro-oxidant-antioxidant balance and cytokines profile. This approach is promising as an adjunct therapy to reduce anthracycline antibiotic toxicity without compromising antitumor efficacy. Further research into the mechanisms of molecular hydrogen action in clinical settings is recommended.
ACADEMIC PERFORMANCE OF MEDICAL STUDENTS AND THE IMPACT OF THE COVID-19 PANDEMIC: WHAT IS DECISIVE?
SUMMARY. Medical students’ education is commonly associated with stress, which is a prevalent problem affecting both psychological well-being and academic performance. This study aimed to investigate the impact of ethnicity, gender, and age on students’ academic performance during the first COVID-19 lockdown and after returning to the regular learning format. Material and Methods. The study involved 1st–6th year students of Ternopil National Medical University who, during the lockdown (March–May 2020), were isolated in dormitories (international students from India [group 1] and African countries [group 2]) or Ukrainian students who stayed at home [group 3]). Salivary cortisol levels and academic performance, based on the end-of-academic-year university average grade data in 2020 and 2021, were assessed. Results. A total of 769 students participated in the study, 399 [51.89 %] men and 370 [48.11 %] women, including 439 Indian [57.09 %], 290 African [37.71 %], and 40 Ukrainian students [5.20 %]. The mean age was 20.61±2.19 years (range 17–29), and subgroups were defined as 17–19, 20–24, and 25–29 years. Academic performance in 2021 was higher compared to 2020 among Indian and African students, while Ukrainian students showed the highest average grades, but with only a tendency for an increase. The same pattern was observed among women. The mean performance in the overall cohort was highest among students aged 25–29 years. In the 17–19 and 20–24 age groups, Ukrainian students had higher performance compared to Indian and African peers. However, among Ukrainian students aged 20–24, performance was lower than in the 17–19 age group (4.62±0.43 vs 4.26±0.30 in 2020, and 4.68±0.33 vs 4.40±0.28 in 2021). Overall, 62.03 % of participants had cortisol concentrations above the median, and 17.43 % exceeded the 95th percentile. Only Indian women had significantly higher cortisol levels compared to men of the same ethnic group. High cortisol levels were associated with significantly lower academic performance (except for Indian students). Among men, academic performance in 2021 was higher in Indian and African groups regardless of cortisol level. Among women from all countries, cortisol levels above the 95th percentile showed only a tendency toward improvement. Conclusions. Our study demonstrates that high-intensity stress caused by lockdown is associated with decreased academic performance and depends on ethnicity, gender (female), and age. Thus, sociocultural factors and the learning format have a significant impact on medical students’ academic success.
RETROSPECTIVE ANALYSIS OF THE TREATMENT OF PURULENT CHOLANGITIS WITH BILIARY SEPSIS
SUMMARY. The treatment of purulent cholangitis with biliary sepsis is associated with high morbidity, serious complications and insufficient effectiveness of existing treatments. Improvement of therapeutic approaches and introduction of new therapies are extremely important for improving clinical outcomes and reducing mortality among patients. A comprehensive approach to treatment, including the use of modern antibacterial drugs, minimally invasive drainage methods and immunomodulatory therapy, is a promising area that requires further research and implementation in clinical practice. The aim – to analyze retrospectively the optimisation of minimally invasive treatment of biliary cholangitis complicated by biliary sepsis. Material and Methods. The observation group consisted of 60 patients diagnosed with purulent cholangitis with biliary sepsis. Patients were divided into two groups: Group I comprised 56.6 % of patients who underwent retrograde cholangiopancreatography (ERCP), Group II – 43.4 % of patients who underwent surgery without contrasting the extrahepatic bile ducts. Patients underwent clinical and instrumental studies. Results. In the analysis of laboratory parameters of group I after surgery, a significant increase in cytolysis markers was observed, which confirms the hepatotoxicity of the contrast agent. The general condition of patients and laboratory markers of the pathological process were monitored in the dynamics. In 24 hours after surgical treatment, an increase in hepatocyte cytolysis markers was observed, which is associated with the toxic effect of contrast on the liver parenchyma; the average values for cytolysis markers were as follows. When evaluating the laboratory data of patients in group II who did not undergo ERCP, significantly lower values of cytolysis markers were observed compared to patients in group I. Conclusion. The results of treatment of purulent cholangitis with biliary sepsis can reduce the number of bed days by excluding retrograde cholangiopancreatography (ERCP) from the diagnostic programme, which avoids the development of specific complications, both during and after its implementation, as well as avoiding the toxic effects of contrast on the patient’s liver parenchyma. And the use of a combination of Inositol, Vitamin B8 and Lipoic Acid complement and reinforce each other.
DEPENDENCE OF TICK TROPHIC ACTIVITY AND THEIR EPIDEMIOLOGICAL STATUS ON CHANGES IN CLIMATIC FACTORS IN THE COLD PODILLIA
Summary. Ixodes species Ixodes ricinus and Dermacentor reticulanus are increasingly attacking humans in search of a host. While feeding on blood, these arthropods are capable of transmitting many infectious agents to humans, including those that cause various forms of borreliosis, anaplasmosis, babesiosis, ehrlichiosis, etc. The frequency of their attacks generally depends on a number of conditions, primarily on the main climatic factors: temperature, relative humidity, precipitation, etc. Material and Methods. Ticks were identified using the optoelectronic system IMAGLAV-SEO. The epidemiological status of ticks was determined by PCR studies using the ROTOR-GENE-600 amplifier, 5-channel (Corbett Research, Australia), in real time with kits containing probes with fluorescent detection during each cycle. DNA/RNA extraction kits “RealBest Extraction 100” by VectorBest (Ukraine representative) were used. The most commonly used test systems were: “RealBest DNA Borrelia burgdorferi s.l.”, “RealBest DNA Anaplasma phagocytophilum/Ehrlichia muris/Ehrlichia chaffeensis”, DNA Borrelia miyamotoi, as well as “RealBest DNA Babesia species” and “RealBest RNA VKE” (Ukraine representative). Results. The highest frequency of attacks on humans, about 36.06 %, was in 2018, and the lowest in 2017, 29.86 %. In 2020-2024, out of 260 specimens of ticks studied, the largest share of ticks was in 2020 and 2021: 26.62 і 26.92 %. According to the results, the percentage of ticks carrying infectious agents increased sharply in 2020, 2023 and 2024 and amounted to 62.5, 40.42 and 57.77 %, respectively. In fact, in 2018, 2020 and 2021, when the frequency of tick attacks was highest, the highest average annual relative humidity and relatively low average annual temperature were observed. In 2018, 2020, 2023, and 2024, the highest percentage of infected ticks was observed at high average temperatures in these years. Conclusions. The distribution and development of ixodid ticks and pathogens in them largely depend on the main climatic factors: average annual temperature, relative humidity and precipitations.
CLINICAL AND LABORATORY DIFFERENCES IN PATIENTS WITH MULTIPLE MYELOMA DEPENDING ON RENAL FUNCTION
SUMMARY. Multiple myeloma (MM) is a malignant hematological disease characterized by clonal proliferation of pathological plasma cells in the bone marrow and excessive production of monoclonal immunoglobulin, known as M-gradient. The disease most commonly manifests as anemia, recurrent infections, and osteolytic lesions of the skeletal bones, which in turn leads to impaired function of organs and systems. Kidneys are often affected due to the deposition of light chains of immunoglobulins, hypercalcemia, or infiltration of kidney tissue by tumor cells. The aim – to compare the frequency of clinical manifestations and laboratory parameters of patients with MM and renal dysfunction (RD). Material and Methods. The study involved 105 patients with MM. Patients were divided according to their renal functional status, with the presence of renal dysfunction verified by the glomerular filtration rate (GFR): Group 1 – 80 patients with GFR > 60 mL/min/1.73m2 and Group 2 – 25 patients with GFR<60 mL/min/1.73m2. All patients underwent thorough collection of medical history and anamnesis, general clinical examinations, and laboratory tests. Comparison of the two groups was performed using the Mann-Whitney U test. Relative values were presented as percentages, and groups were compared using Pearson's chi-squared test. The significance level was set at p<0.05. Results. The study revealed that patients with MM and impaired renal function had a significantly higher incidence of dyspnea (56.0 % vs. 22.5 %, p<0.05) and diarrhea (72.0 % vs. 43.8 %, p<0.05) compared to patients without renal dysfunction (RD). In addition, this group of patients showed changes in laboratory parameters, including signs of anemia, elevated markers of inflammation, and impaired renal function. Specifically, patients with RD had lower levels of hemoglobin and albumin, as well as higher levels of β2-microglobulin, creatinine, and urea. Conclusions.The study clearly demonstrates that a decrease in GFR in patients with MM is associated with a worsening of the clinical picture, changes in blood parameters reflecting anemia and inflammation, and significant impairment of renal function, confirmed by changes in biochemical markers.
ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN PATIENTS WITH A HISTORY OF COVID-19: MYOCARDIAL PERFUSION RECOVERY AND CLINICAL COURSE FEATURES
SUMMARY. Acute ST-segment elevation myocardial infarction (STEMI) remains one of the leading causes of in-hospital mortality today. The priority in the treatment of such patients is the earliest possible initiation of reperfusion therapy aimed at restoring patency of the infarct-related coronary artery (IRA) through stent implantation. The clinical course of STEMI depends on the quality of myocardial perfusion recovery and the presence of patient's risk factors (RFs), among which a history of COVID-19 is receiving increasing attention. The aim – to assess the clinical course characteristics of STEMI in patients with a history of COVID-19, focusing on the effectiveness of myocardial perfusion restoration after IRA stenting, systemic inflammation activity, manifestations of heart failure, types of arrhythmias, and myocardial structural and functional parameters. Material and Methods. The study included 135 patients with STEMI who underwent percutaneous coronary intervention (PCI) with IRA stenting within 24 hours of symptom onset. Patients were divided into two groups: those with a prior history of COVID-19 (n=76) and those without this risk factor (n=59). Levels of C-reactive protein (CRP), fibrinogen (Fg), NT-proBNP, glomerular filtration rate (GFR), results of 24-hour electrocardiographic (ECG) monitoring, echocardiographic parameters, myocardial perfusion according to the Myocardial Blush Grade (MBG) scale, and left ventricular (LV) geometry were evaluated. Results. Complete coronary blood flow restoration (TIMI-3) was achieved in all patients. Optimal myocardial perfusion (MBG TIMI-3 = 3) was observed in approximately two-thirds of the cohort. Among patients with suboptimal myocardial perfusion recovery (MBG TIMI-3 ≤ 2), significantly higher levels of CRP, fibrinogen, and NT-proBNP were found, with statistically higher values in individuals with a history of COVID-19 compared to those without this risk factor. All patients showed mild renal dysfunction based on GFR values. Within 24 hours post-PCI, 24-hour ECG monitoring revealed frequent supraventricular and ventricular extrasystoles and tachycardia paroxysms, with a tendency toward more frequent supraventricular arrhythmias and longer episodes of ventricular tachycardia in prior COVID-19 patients. In patients with impaired myocardial perfusion, echocardiographic indicators of myocardial structure and function – such as increased end-diastolic diameter and reduced left ventricular ejection fraction (LVEF) – were more markedly altered compared to those with optimal perfusion. Notably, in patients with a history of COVID-19, LVEF tended to decline over time, whereas in those without this risk factor, it improved (p≥0.05). Pathological LV remodeling was more frequently observed in patients with a history of COVID-19. Conclusions. A history of coronavirus disease represents a significant risk factor for adverse outcomes in patients with STEMI. In this population, impaired myocardial perfusion is associated with heightened systemic inflammation, more severe manifestations of heart failure, a higher incidence of supraventricular arrhythmias, poorer structural and functional myocardial parameters, and an increased prevalence of pathological left ventricular remodeling.
ULTRAMICROSCOPIC ORGANIZATION OF THE KIDNEY FILTRATION BARRIER OF WHITE RATS AT NORMAL CONDITIONS AND UNDER EXPERIMENTAL TOXIC INFLUENCE OF TETRACHLOROMETHANE
SUMMARY. The toxic effect of xenobiotics on kidney function has long been a topical problem of experimental research. Xenobiotics can exert both direct and indirect effects on renal vessels and nephron structures. Carbon tetrachloride is quite often used as an experimental model for inducing hepatotoxicity in experimental animals and for a model of renal failure and nephrotoxicity. The aim – to establish the features of ultrastructural changes in the kidney filtration barrier under conditions of experimental toxic injury of rats with carbon tetrachloride. Material and Methods. The study was performed on sexually mature white male rats. Carbon tetrachloride was administered intragastrically every other day in the form of a 50% oil solution at a dose of 2 g/kg of animal body weight. The study was conducted in accordance with the European Convention for the Protection of Vertebrate Animals. On the second and seventh days from the start of carbon tetrachloride administration, the animals were removed from the experiment. The material for electron microscopic examination of the kidney was collected according to the generally accepted method. The state of functional activity of the kidneys was assessed by studying the dynamics of changes in the concentrations of creatinine and urea in the blood of animals. The obtained quantitative results were subjected to statistical processing using the STATISTICA 13 program. Results. The morphological state of the structures of the renal corpuscle of intact animals and submicroscopic changes in the structures of the filtration barrier of the kidneys of white rats under conditions of toxic damage by carbon tetrachloride of different duration were studied. Electron microscopy has shown that on the 2nd and 7th day after the start of carbon tetrachloride administration, significant destructive changes occur in the structural components of the nephron. During this period, the components of the renal filtration barrier are in a state of functional stress, which is the result of direct and indirect nephrotoxic effects on the kidney. Morphologically, this is evidenced by increased fenestration in the endothelium, local thickening of the basement membrane, and moderate hypertrophy of podocyte mitochondria. The dynamics of changes in the glomerular apparatus is closely related to changes in the capillary basement membrane, which, as the damaging factor affects it, thickens, becomes homogeneous, osmiophilic, and loses its three-layer structure. Podocytes and endothelium undergo dystrophy. The gaps between cytopodia are small or poorly visible. These changes cause a violation of the first stage of urine formation – filtration. Determinations of urea and creatinine levels in the blood of experimental animals after simulated carbon tetrachloride injury showed a significant increase in these indicators on the 2nd and 7th day of the experiment (p≤0.05). Conclusions. The obtained data indicate that experimental toxic injury of rats with carbon tetrachloride causes structural changes in the components of the renal filtration barrier, which reduces the functional capabilities of the kidneys.
STATE OF HORMONE HOMEOSTASIS IN PREGNANT WOMEN WITH PLACENTA DYSFUNCTION
SUMMARY. Violation of the structural and functional organization of the placenta is one of the leading causes of maternal and perinatal morbidity and mortality, according to various authors, its frequency varies from 10 % to 25 % among all pregnancies. A special place among these causes is occupied by post-covid syndrome and long-covid in pregnant women. Hormonal homeostasis, which is ensured by the close interaction of the hypothalamic-pituitary-ovarian and fetoplacental systems, plays a key role in maintaining pregnancy, ensuring normal fetal development and adapting the maternal organism to growing needs. The aim – to study the state of the fetoplacental complex in pregnant women based on the study of hormonal homeostasis. Material and Methods. We observed 110 pregnant women who were divided into three groups. Group I included 25 pregnant women with diagnosed placental dysfunction and fetal growth retardation (FGR) – estimated fetal weight less than the 10th percentile for this gestational age according to fetometry. Group II included 30 pregnant women with diagnosed placental dysfunction without fetal growth retardation with an increase in the resistance index (RI) and/or pulsatility index (PI) in the uterine arteries and/or umbilical artery according to Dopplerometry, which exceeded the 95th percentile for this gestational age. Group III included 30 pregnant women with placental dysfunction and post-covid syndrome (suffered coronavirus disease during pregnancy). Control group: 25 pregnant women with a physiological course of pregnancy without signs of obstetric complications. The following placental hormones were determined: progesterone (PG, nmol/l), estradiol (pmol/l), human placental lactogen (PL, mg/l), human chorionic gonadotropin (beta-hCG, mIU/ml). Statistical processing of the obtained data was carried out using Microsoft Excel spreadsheets and Statistica 10.0 software. Results. When examining pregnant women, the level of hCG in groups I, II and III was significantly lower than in the control. And at the same time, in the group of pregnant women with placental dysfunction and fetal growth retardation syndrome, it turned out to be the lowest compared to pregnant women in groups II and III. The concentration of PL at 32–34 weeks of pregnancy with fetal growth retardation on the background of placental dysfunction was almost 2 times lower than in the control, while in group II the level of PL was 1.6 times, and in group III – 1.8 times than in the control. Analyzing the obtained data on estriol, it can be noted that in group I this indicator was only 57 % of the control indicator, while in group II it was 78 % and in group III only 65 %, (P<0.05). Thus, at 32-34 weeks of pregnancy in the control group, the estriol level was 116.44±1.22 pmol/l, in group I – 66.02±1.06 pmol/l, (P<0.05), in group II – 91.46±1.84 pmol/l, (P<0.05) and 76.32±2.43 pmol/l in group III, which significantly differed from both group II and the control group. A similar trend was observed in the indicators of hCG and estriol. Similar dynamics were observed in group III. Thus, the indicators of PG in groups II and III were 76 % and 80 % of the values of the control group, (P<0.05). Conclusions. In pregnant women with placental dysfunction, statistically significant changes in the levels of progesterone, estradiol and placental lactogen are observed, which progress with the development of severe complications. Combined analysis of levels of (hCG, PL and estradiol can serve as a diagnostic criterion for an objective assessment of the condition of the fetus and allows to increase the accuracy of predicting the development of placental dysfunction and perinatal complications. Post-covid syndrome is one of the multifactorial causes of placental insufficiency and is accompanied by disorders in the hormone-producing function of the placenta.
CHANGING THE PARADIGM AND EXPANDING ACCESS TO ORTHOTICS
SUMMARY. Movement disorders of varying degrees and origins significantly affect the quality of life, limiting mobility, household independence, social activity, and often being accompanied by pain. In this context, orthotics is an important tool for improving the quality of life of people with motor disorders. The aim – to substantiate the need to rethink traditional approaches to orthotics, emphasizing the importance of a patient-centered approach, the introduction of modern technologies and advanced training of specialists. Material and Methods. Systematic analysis and synthesis of information from various sources to identify key issues and trends in the field of orthotics. The search was conducted in Medline databases (using the Pubmed interface). Results. Orthotics is not just a technical device, but an important element of comprehensive rehabilitation that opens up new opportunities for people with motor disabilities, helping them to achieve greater activity, independence and significantly improve their quality of life. Expanding access to quality orthoses is not only a medical necessity, but also an important social and economic one. When patients receive timely and adequate orthotic care, they can function better, integrate into society, and reduce the burden on the healthcare system. Orthoses help patients to feel more independent and fully-fledged members of society, which is an inalienable right of every human being. Conclusions. The rethinking of the orthotics paradigm should be based on the principles of patient-centeredness, active implementation of innovative technologies such as 3D printing and the latest materials, as well as advanced training and continuous professional development of specialists. Only a systematic approach that covers all the links - from education and production to legislative regulation - will create an effective and affordable orthotics system.
ORTHOTICS AND ASSISTIVE TECHNOLOGIES IN REHABILITATION AND GERIATRICS
SUMMARY. The article is devoted to the analysis of the role of orthosis and assistive technologies in the system of medical and social rehabilitation of people, primarily of elderly and senile age. In the context of global population aging and increasing life expectancy, the problem of maintaining functional independence of the elderly, preventing injuries, supporting self-care and social activity becomes particularly relevant. The aim – to investigate the effectiveness of approaches to implementing technical support tools into the geriatric care system, as well as to outline the prospects for using innovative solutions in the field of rehabilitation and care for the elderly. Material and Methods. The work reviews and systematizes the main types of orthoses used in geriatric practice – from supporting and stabilizing to dynamic orthopedic structures capable of improving the biomechanics of movements and compensating for the loss of muscle strength. Types of assistive technologies were analyzed: mechanical mobility devices, tools for performing daily household activities, digital and electronic health monitoring tools, as well as modern developments using sensors, 3D printing, and intelligent support systems. Results. The analysis revealed the advantages of using orthoses and assistive technologies in geriatric practice, inсluding: increased mobility, reduced risk of falls, optimized care, and reduced burden on medical staff and patient relatives. At the same time, a number of barriers have been identified that prevent the widespread implementation of orthoses and assistive technologies: economic difficulties, insufficient level of awareness, psychological unpreparedness of users, and lack of a multidisciplinary approach. Conclusions. The need to develop an integrated model of technical rehabilitation based on an individual approach, interdisciplinary interaction, innovative potential, and social responsibility has been formed.
ENDOTHELIAL DYSFUNCTION: PROBLEMATIC ISSUES OF DEFINITION AND CLASSIFICATION
SUMMARY. Endothelial dysfunction (ED) is a multifaceted pathophysiological condition underlying a wide range of cardiovascular and systemic diseases. The aim – to systematically analyze the evolution of approaches to defining endothelial dysfunction, identify their limitations, formulate a generalized functional definition that would reflect the modern understanding of the endothelium's role in pathology, and propose a new classification of ED capable of adapting to various clinical contexts and research objectives. Material and Methods. The study involved a systematic analysis of modern scientific literature concerning the definitions and classifications of endothelial dysfunction. Ten of the most influential definitions of ED found in peer-reviewed sources over the last two decades, as well as existing classifications, were analyzed. Results. Analysis of existing ED definitions revealed that most are based on reduced nitric oxide (NO) production and impaired vasodilation but have several limitations, including being focused on specific aspects or being highly specialized. A new, universal functional definition of ED was formulated: "a state in which the endothelium loses its ability to adequately respond to the physiological needs of the body by impairing the regulation of vascular tone, permeability, thromboreactivity, immune response, and metabolic activity". A generalized matrix classification of ED was also proposed, based on etiology, primary functional impairment, potential reversibility, stage of endothelial damage, and nature of response to functional tests. Conclusions. Endothelial dysfunction is a fundamental pathophysiological mechanism underlying many common diseases, yet the issues of its unified definition and comprehensive classification remain relevant. The proposed new functional definition and updated multi-level classification of ED have the potential to improve the understanding of its diverse manifestations, contribute to the standardization of scientific research, and optimize clinical practice.
ROBOT-ASSISTED SURGERY AS A COMPONENT OF THE IMPLEMENTATION OF MODERN MEDICAL TECHNOLOGIES IN THE HEALTH CARE OF UKRAINE.
SUMMARY. The aim – to analyze the prospects for the implementation and development of robotic surgery (robot-assisted surgery), which is a high-tech method of treating various pathologies of the population of Ukraine in the current conditions. Material and Methods. The work uses the bibliosemantic method and methods of content and structural-logical analysis. Results. In modern realities, the role of technology in the medical field is extremely important, in particular in surgical practice and physical rehabilitation, which is a component of recovery after surgical treatment. Technological achievements in various fields of medical activity open up new horizons for providing more effective methods of restoring body functions and improving the quality of life of military personnel and civilians who need rehabilitation after surgical interventions, the consequences of mine and explosive injuries, gunshot wounds of various genesis and localization, or chronic diseases. It is especially important to study the experience of Western countries in using technologies to improve surgical methods, physical rehabilitation of victims and determine possible prospects for the implementation of innovative methods in Ukraine. Technologies such as robotics, VAC-wound therapy, VR (virtual reality), artificial intelligence (AI), etc., open up wide opportunities for improving the process of surgical treatment and physical recovery of military and civilian casualties as a result of hostilities on the territory of Ukraine in the war with Russia. Robotic surgery, also known as robot-assisted surgery, is an innovative technology that has changed the global surgical direction. The use of robots has made it possible to achieve an unprecedented level of accuracy and flexibility in surgical manipulations. In this article, we will consider the numerous advantages and disadvantages of robotic surgery, as well as future prospects for its implementation in Ukrainian medicine. Conclusions. The emergence of advanced surgical techniques and technologies for performing modern surgical interventions, which allow to accelerate the recovery process of patients, is positive. However, surgical intervention is only the first stage of their recovery, therefore it is advisable to involve modern methods and means of physical therapy for the convalescence of the profile group of patients.
MODERN VISION AND PRACTICAL ASPECTS OF THE NEUROPLASTICITY MECHANISM IN REHABILITATION
SUMMARY. Neuroplasticity is a key mechanism for restoring function after nervous system damage. Modern rehabilitation is based on the principle that the nervous system is able to change and adapt - and this can be stimulated by special interventions. The aim – to summarize the current understanding of the biological basis and mechanisms of neuroplasticity, as well as to highlight their role in the recovery of the nervous system during rehabilitation. Material and Methods. The methods of systematic analysis and generalization of data from the literature, in particular from the PubMed database, were used. The biological bases, cellular and neurophysiological mechanisms of neuroplasticity, as well as the principles of its use in rehabilitation are covered. Results. The study of how synaptic plasticity occurs and how it is modified during certain time windows of development will provide key information about how the brain develops. Furthermore, a better understanding of how synaptic modifications occur during learning and memory and/or development may help to shape and improve the effectiveness of current protocols in the early stages of learning. Rehabilitation interventions (motor activity, training, stimulation) activate synaptic plasticity, neurogenesis, axon regeneration, and the release of neurotrophic factors. These changes increase the adaptability and compensatory capacity of the nervous system. The modern approach emphasizes the importance of an individualized rehabilitation strategy that maximizes the neuroplasticity of a particular patient. Studies have shown that neurorehabilitation itself can be considered as a part of neuroplasticity or as a means of enhancing it, thus establishing a symbiotic relationship between them. Conclusions. The modern view of the problem of neuroplasticity is not just a theoretical basis, but the main tool that should be actively used to restore the patient. Rehabilitation should be “adjusted” to these mechanisms in order to maximize the result.
COMPARATIVE CHARACTERISTICS OF HORMONAL INDICATORS IN INFERTILE WOMEN WITH POLYCYSTIC OVARY SYNDROME AND METABOLIC SYNDROME
Summary. Polycystic ovary syndrome (PCOS) is a leading cause of endocrine infertility. A distinct clinical subgroup includes women with PCOS combined with metabolic syndrome, characterized by more pronounced metabolic and hormonal disturbances, which may complicate infertility management and treatment response. Therefore, the aim of this study was to investigate the hormonal profile and identify clinically significant hormonal markers with diagnostic and prognostic value in patients with PCOS and metabolic syndrome, to better predict reproductive function and optimize assisted reproductive technology (ART) protocols in these patients. Material and Methods. A retrospective comparative analysis was conducted to assess the hormonal profile by measuring serum levels of key sex hormones (FSH, LH, LH/FSH ratio, prolactin, estradiol, total and free testosterone, progesterone, anti-Müllerian hormone (AMH)) based on clinical and laboratory data from reproductive-age women with various forms of infertility. Results. Women with PCOS exhibited a characteristic hormonal imbalance: elevated levels of LH, prolactin, total and free testosterone, and increased LH/FSH ratio alongside decreased levels of FSH, estradiol, and progesterone. These changes correspond to impaired ovulatory function and folliculogenesis, which are typical features of this pathology. Conclusions. The coexistence of PCOS and metabolic syndrome exacerbates hormonal disturbances, promoting hyperandrogenism and anovulation. The obtained data support the necessity of comprehensive hormonal assessment when selecting treatment strategies, especially in the context of ART.
ATRIAL FIBRILLATION IN PATIENT WITH PREEXCITATION (CASE REPORT)
SUMMARY. Ventricular pre-excitation is a cardiac disorder characterized by the presence of an accessory pathway that bypasses the atrioventricular node, which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death due to rapid atrial fibrillation conduction. Early identification of ventricular pre-excitation and proper risk stratification are crucial for determining the most appropriate management strategy and ensuring the safety of these individuals. The aim – to demonstrate the peculiarities of electrocardiographic diagnosis of atrial fibrillation in a patient with preexcitation, to substantiate the importance of timely diagnosis and treatment. Material and Methods. Literature publications covering the mechanisms of development and aspects of diagnosis of tachyarrhythmias in patients with preexcitation were analyzed and a clinical case of atrial fibrillation in a patient with Wolff–Parkinson–White syndrome was presented. Results. A 26-year-old male patient presented to the emergency room with atrial fibrillation and evidence of preexcitation on a 12-lead electrocardiogram. Cardioversion was performed, resulting in a successful restoration of sinus rhythm. The ECG in sinus rhythm revealed persistent preexcitation. The patient was scheduled for an electrophysiological study and radiofrequency ablation. Conclusions. Atrial fibrillation becomes a potentially fatal arrhythmia in the presence of pre-excitation, as rapid ventricular activation can lead to ventricular fibrillation. Recognizing preexcitation is very important for early treatment. Non-invasive tools such as resting electrocardiograms, ambulatory ECG monitoring, and exercise stress tests are commonly used for this purpose, although their interpretation can sometimes be difficult. Early stratification and management of patients with Wolff-Parkinson-White syndrome is important to reduce the risk of atrial fibrillation and sudden cardiac death. Radiofrequency ablation is an effective treatment for such patients.
ASPECTS OF THE ORIGIN AND DEVELOPMENT OF NOSOCOMIAL INFECTIONS IN PATIENTS WITH PANCREAS LESIONS
SUMMARY. Traditionally, hospital-acquired infections include those infectious diseases that develop in a medical institution 48 or more hours after a patient’s hospitalization during treatment or during discharge. Today, there is an increase in these pathologies in various countries, regardless of their level of economic development. The prevalence of hospital-acquired infections is 5.1–11.6 % for low-income countries and 5.7–19.7 % for middle-income countries. The aim – to analyze the scientific literature on the frequency, etiology, pathogenesis, features of the clinical course, and possibilities for preventing the occurrence of nosocomial infections in pancreatic diseases. Main content. The most vulnerable category is the category of patients who are inpatients, as they have a more severe clinical condition (which necessitated their hospitalization), and they have a higher risk of contamination by representatives of multi-resistant hospital flora. Acute and chronic pancreatitis are common somatic pathologies that worsen the nutritional status of the patient. This makes it advisable to consider the mutually aggravating elements of the pathogenesis of nosocomial infections in patients with pancreatic lesions. Conclusions. Structural and functional disorders of the pancreas during its acute or chronic inflammation, as well as the influence of factors contributing to its development, explain the predisposition of this category of hospitalized patients to the occurrence of nosocomial infections, which requires further optimization of treatment and prevention methods for these pathological conditions.
THE MICROBIOME AS A SYSTEMIC REGULATOR OF HUMAN HEALTH: CURRENT CONCEPTS AND PERSPECTIVES
Summary. This article highlights the evolutionary and functional aspects of the microbiota and its importance for human health, particularly in the context of systemic regulation. The aim – to summarise current data on the importance of the microbiome in maintaining human body homeostasis, in particular the gut microbiome, and to assess the impact of different microbiota biotopes on physiological processes. Material and Methods. To achieve this goal, we performed a systematic analysis of the scientific literature on the formation of the human microbiota during ontogeny and its role in the regulation of physiological processes. The information search was carried out using scientometric databases and electronic platforms such as PubMed, Medline, Scopus, Medscape and Google Scholar. Modern scientific sources covering evolutionary, structural and functional aspects of the human microbiome were included in the analysis. A systematic analytical approach was used to summarise the data obtained. Results. The article looks at how the human microbiome has evolved and how it works. It discusses how microbiota formation during ontogenesis affects physiological processes. It focuses on the gut microbiome as a unique ecosystem that stabilises the body's internal environment, affecting metabolic, immune and neurohumoral processes. It also considers other biotopes, such as the skin, oral cavity, lungs, placenta and female reproductive system, which are important in maintaining the body's homeostasis. It emphasises that even organs that were previously sterile may contain microbiome communities with functional significance. Conclusions.The human microbiome, especially the gut microbiome, plays a key role in maintaining health by interacting with the immune, metabolic and neurohumoral systems of the body. Maintaining its balance is essential for disease prevention and maintaining the body's physiological balance. Modern methods of metagenomics and metabolomics allow us to better understand how the microbiome interacts with the body, which opens up new perspectives for medical practice.
EFFECTIVENESS OF BRACING IN ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS): A SYSTEMATIC REVIEW
SUMMARY. The aim – to conduct a systematic review of the evidence base regarding the effectiveness of bracing therapy in patients with adolescent idiopathic scoliosis (AIS), with a focus on slowing progression and the potential for curve reduction. Material and Methods. A systematic review and comparative analysis of scientific publications and literature over the past five years was conducted using the PubMed database. The analysis focused on studies in the fields of prosthetics and orthotics, rehabilitation, and orthopedics that investigated the efficacy of bracing in AIS patients. Publications were included if they contained data on curve progression dynamics, surgical intervention rates, brace wear duration and protocols, and clinical or radiological treatment outcomes. Key inclusion criteria were clearly defined AIS populations, the use of conservative treatment involving bracing, and the presence of controlled or prospective data. Results. The review confirmed that brace treatment – particularly with the Chêneau brace – is the most effective conservative intervention for adolescent idiopathic scoliosis. It has been shown to significantly slow or even halt the progression of spinal curvature. Treatment success is strongly influenced by brace wear compliance, individual customization, and patient adherence. Other methods, such as physiotherapy, electrical stimulation, or the use of soft or night-time braces, were found to be considerably less effective compared to rigid, custom-made orthoses. The psychosocial impact of long-term brace use on adolescents was also noted as a significant factor affecting quality of life and remains a priority for further research. Conclusions. Chêneau bracing represents the most evidence-based and effective conservative treatment for AIS to date. Further research in this field may optimize bracing strategies, minimize complications, reduce the need for surgical intervention, and contribute to the development of clear clinical protocols for the non-operative management of adolescent idiopathic scoliosis.
OCULAR MANIFESTATIONS OF LYME BORRELIOSIS: CURRENT STATE AND FUTURE PERSPECTIVES
SUMMARY. The aim – to systematize current knowledge on ophthalmological complications of Lyme borreliosis, focusing on non-rheumatogenic forms, their prevalence, clinical manifestations, diagnostic methods, treatment approaches, preventive measures, and prospects for improving the diagnosis and therapy of ocular pathologies, particularly in endemic regions. Material and Methods. A review of scientific literature was conducted, including epidemiological reports, clinical studies, laboratory and instrumental diagnostic methods, as well as strategies for the treatment and prevention of ocular complications in Lyme borreliosis. Data were sourced from PubMed, Scopus, Web of Science, and reports from the U.S. Centers for Disease Control and Prevention (CDC) and the Public Health Center of the Ministry of Health of Ukraine. Special attention was given to non-rheumatogenic forms associated with Borrelia garinii and their manifestations in Ukraine. Results. Lyme borreliosis is the leading tick-borne infection in the Northern Hemisphere, with an annual incidence of 20–200 per 100,000 people in Europe and up to 476,000 cases in the USA. In Ukraine, an increase in cases has been noted, particularly in western regions. Ocular complications, such as conjunctivitis, uveitis, keratitis, and optic neuritis, are rare but more frequent in neuroborreliosis associated with B. garinii. Diagnosis is challenging due to the low sensitivity of serological tests and the non-specific nature of symptoms. Treatment involves antibiotics (ceftriaxone, doxycycline), steroids, and mydriatics, but chronicity and side effects, such as the Jarisch-Herxheimer reaction, complicate therapy. Prevention focuses on avoiding tick bites and early tick removal. Conclusions. Ocular manifestations of Lyme borreliosis, particularly non-rheumatogenic forms, may impact vision, but their association with the disease requires further clinical investigation. Current diagnostic and therapeutic methods have limitations, highlighting the need for new tools, such as multiplex tests, and a multidisciplinary approach. For Ukraine, as an endemic region, key priorities include raising awareness among healthcare professionals and improving access to modern technologies for early detection and effective treatment.
PHARMACOLOGICAL ASPECTS OF THE POTENTIAL FOR PATHOGENETIC PHYTOTHERAPY OF UTERINE FIBROIDS
Summary. Uterine fibroids are among the most common benign tumors of the female reproductive system worldwide. The disease is often asymptomatic and is frequently diagnosed incidentally during preventive clinical examinations. Currently, the incidence of uterine fibroids among women aged 50 and older is around 70–80 %. Uterine fibroids are now the most common indication for hysterectomy globally. The aim – to analyze the literature data regarding the pathogenesis and treatment of uterine fibroids using both conventional and phytotherapeutic methods. To summarize recommendations on the use of medicinal plants with various mechanisms of action to address the pathogenetic chains of disease development. To evaluate the prospects of phytotherapy in fibroid treatment. Material and Methods. Domestic and foreign literature sources were analyzed concerning the pathogenesis of fibroid development, pharmacological treatment options, and the use of medicinal plants in managing this pathology. The research method used was literature review. Results. Based on the literature review, the following medicinal plants demonstrate the greatest pharmacotherapeutic potential for conservative treatment of uterine fibroids due to their choleretic, anti-inflammatory, uterotonic, antiestrogenic, and sedative effects. These primarily include infusions and decoctions of Helichrysum arenarium (sandy everlasting), Achillea millefolium (common yarrow), Capsella bursa-pastoris (shepherd’s purse), Echium vulgare (viper’s bugloss), Leonurus cardiaca (motherwort), and others. In our opinion, it is rational to combine plants from different pharmacological groups targeting various pathogenetic mechanisms of fibroid development, taking into account the form of the disease. Conclusions. Considering the multifactorial pathogenesis of uterine fibroids, even with modern advancements in surgical and therapeutic treatment methods, the use of medicinal plants and their rational combinations tailored to the individual characteristics of a patient’s condition and comorbidities can be effective and beneficial. It is evident that, for the effective and safe use of phytotherapy (not only for fibroids), a more thorough study of the pharmacology of active compounds in medicinal plant raw materials is required – especially those that have been traditionally used in folk medicine for treating "women’s diseases." A wise saying holds that there are no useless plants – only those that are yet to be studied.
REPRODUCTIVE FUNCTION IN MEN WITH EPILEPSY: STATE OF THE PROBLEM
Summary. Epilepsy is a chronic brain disease characterized by a persistent tendency to convulsions, as well as neurobiological, cognitive, psychological and social consequences of their recurrence. The results of recent epidemiological studies indicate that approximately 50% of infertility cases are associated with male factors. The aim – to analyze data in the published literature on the antiepileptic drugs (AEDs) effect on male reproductive function. Material and Methods. The available information resources of the Internet, foreign professional publications, and the medical database MEDLINE/PubMed over the past 20 years were analyzed. The method of information retrieval and the method of analytical and comparative analysis were used. Results. According to the studies, 38–71 % of men with epilepsy have sexual dysfunction, and fertility rates are 30–50 % lower than in healthy individuals. In this group, erectile dysfunction, anorgasmia and lack of spontaneous night erection are significantly more often diagnosed. There are two causes of reproductive toxicity in epilepsy: the use of AEDs and the negative impact of the disease. The data from both experimental and clinical studies on the impact of various AEDs (valproate, carbamazepine, lamotrigine, levitiraceptam, topiramate, oxycarbazepine) on male reproductive function were analyzed. Conclusions. Intensity of the AEDs impact on male reproductive function depends on the mechanism of action of the antiepileptic drug, its dose and duration of therapy. There is a disproportion in the number of studies on the effect of certain AEDs. Based on the analysis of experimental and clinical studies, the drugs of lower risk are oxcarbazepine, levetiracetam, and lamotrigine.
OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH BRONCHIAL ASTHMA
SUMMARY. According to statistics, approximately 936 million adults worldwide between the ages of 30 and 69 are affected by obstructive sleep apnea (OSA), with nearly 425 million individuals suffering from moderate to severe forms of the condition. These figures highlight the significant burden OSA places on healthcare systems and emphasize the need to develop effective diagnostic and treatment strategies to reduce its negative impact. The aim – to analyze current scientific data on the pathophysiological mechanisms, mutual influence, and clinical features of the combined course of OSA and bronchial asthma (BA). Material and Methods. A search was conducted in the PubMed, Scopus, and Web of Science databases among publications from the last 10 years (2015–2025) using the keywords: "obstructive sleep apnea," "bronchial asthma," "comorbidity". Results. The comorbidity of BA and OSA represents a significant clinical challenge due to their shared pathophysiological pathways. Systemic inflammation and oxidative stress are the main pathogenic links in the mutual aggravation of these conditions. The course of OSA in patients with BA is significantly influenced by obesity, gastroesophageal reflux disease, arterial hypertension, and allergic rhinitis, which commonly accompany both conditions. Identifying OSA in patients with BA can lead to more effective treatment strategies and improved overall asthma control. A personalized approach to managing patients with OSA and BA is essential for achieving optimal clinical outcomes and enhancing patients’ quality of life. Conclusions. Clinicians should carefully assess the presence of symptoms that may indicate OSA in patients with BA. Special attention should also be paid to comorbid conditions that are predictors of OSA development in this patient group, particularly obesity, gastroesophageal reflux disease, and resistant arterial hypertension. The use of screening tools to assess the risk of OSA in asthma patients can increase the effectiveness of medical care and improve clinical outcomes.
CYCLIC VOMITING SYNDROME IN CHILDREN (A REVIEW BASED ON THE 2025 RECOMMENDATIONS OF THE NORTH AMERICAN SOCIETY FOR PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION)
SUMMARY. Cyclic vomiting syndrome (CVS) is one of the functional gastrointestinal disorders that, according to the literature, affects approximately 2 % of children. It is traditionally considered a pediatric condition associated with migraine, yet it is frequently underdiagnosed and ineffectively treated, even after diagnosis is confirmed. The primary characteristic of CVS is the stereotypical, recurrent pattern of episodes involving intense nausea and vomiting that last from several hours to several days, with complete symptom resolution between episodes. Therefore, diagnosis is primarily clinical. Management of acute CVS episodes aims to alleviate symptoms, reduce episode duration, and prevent dehydration and hospitalization. Treatment also includes appropriate counseling on healthy lifestyle practices, development of individualized management plans, and prophylactic pharmacotherapy. The aim – to analyze evidence-based recommendations developed to replace previous consensus-based expert guidelines and to support patients and clinicians in the management of pediatric CVS. Material and Methods. This review utilized published results from recent scientific studies on the diagnosis of CVS in pediatric patients. The article is a synthesis of the analyzed sources and the authors expert opinion. Results. In 2025, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) developed evidence-based guidelines for the management of pediatric CVS. These were based on systematic reviews and assessment of the quality of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Through the application of this structured methodology by a multidisciplinary team, a comprehensive document was created that integrates both clinical experience and scientific evidence. This aims to assist clinicians and their patients in timely diagnosis, effective treatment, and improved quality of life. Conclusion. The NASPGHAN guidelines emphasize a combination of non-pharmacological and pharmacological strategies, with a focus on early intervention and prevention. This article is intended for a broad audience of healthcare professionals who encounter children with CVS, and it includes a detailed clinical profile, diagnostic criteria, and an analysis of current treatment approaches.