Kharkiv National Medical University

Introduction and Importance The differential diagnoses of hypereosinophilia (HE) are diverse and may include parasitic infections, allergic or atopic diseases, and malignancies. The list of differentials for hypereosinophilia is diverse and a comprehensive workup can often be expensive. However, it is essential to identify the underlying cause and treat it rather than treating eosinophilia itself. Case presentation A 5-year-old male patient was referred to a pediatric hemato-oncologist for concerns of persistent hypereosinophilia, and the absolute eosinophil count (AEC) was greater than 1000 in three recent complete blood count with differentials. The child presented complaining of alternating waxing and waning right and left ankle and knee redness, hotness, pain, and decreased range of motion that occurred every 2 weeks, with associated lack of appetite, fatigue, constipation, and fever reaching 39°C. Clinical discussion Malignant eosinophilic infiltration of the bone marrow versus a parasitic infection was on top of the differential diagnoses. Presentations of HE suggesting organ system involvement include fever, weight loss, wheezing, cough, dysphagia, vomiting, lack of appetite, diarrhea, arthralgia, and myalgia. Conclusion Identifying the etiology of persistent hypereosinophilia can be challenging in the pediatric population and can have diverse presentations. The primary focus during initial HE assessment is on evaluating the severity of symptoms and potential organ damage. Major life-threatening diagnoses as malignancies and immune deficiencies must be ruled out first when the AEC is persistently elevated. Parasitic infections should be investigated according to the geographic endemicity.

Accumulating evidence suggests that manganese oxide nanoparticles (NPs) show multiple enzyme-mimicking antioxidant activities, which supports their potential in redox-targeting therapeutic strategies for diseases with impaired redox signaling. However, the systemic administration of any NP requires thorough hemocompatibility testing. In this study, we assessed the hemocompatibility of synthesized Mn3O4 NPs, identifying their ability to induce spontaneous hemolysis and eryptosis or impair osmotic fragility. Concentrations of up to 20 mg/L were found to be safe for erythrocytes. Eryptosis assays were shown to be more sensitive than hemolysis and osmotic fragility as markers of hemocompatibility for Mn3O4 NP testing. Flow cytometry- and confocal microscopy-based studies revealed that eryptosis induced by Mn3O4 NPs was accompanied by Ca²⁺ overload, altered redox homeostasis verified by enhanced intracellular reactive oxygen species (ROS) and reactive nitrogen species (RNS), and a decrease in the lipid order of cell membranes. Furthermore, Mn3O4 NP-induced eryptosis was calpain- and caspase-dependent.

Background. With a view of primary prevention of diseases common in the world, medical workers and educators can effectively work together within teaching valeological disciplines at higher education institutions. Medical information should be adapted for non-medical students using the methods of scaling, aggregation, balancing and system analysis. Their application requires studying the content of main topics of valeological disciplines, determining the boundaries of didactic adaptation and testing in different higher education establishments. Adaptation of medical information on risk factors for understanding by non-medical students has not been stu­died enough. Aim. To study the characteristics and interrelationships of risk factors of socially significant diseases for the didactic adaptation of the content of valeological disciplines. Materials and Methods. The bibliosemantic method, comparative method, and system ana­lysis method were used for the study. The analysis takes into account the experience of primary prevention of diseases and teaching valeological disciplines in higher education institutions in Ukraine and Germany. Results and Conclusions. The system of risk factors for diseases that are responsible for a significant number of deaths in most countries of the world is the subject of study of modern valeological disciplines. Medical research allows us to divide risk factors into controllable, conditio­nally controllable and uncontrollable. The impact of the first two groups of risk factors on health can be eliminated or significantly weakened by forming non-medical students’ valeological competence and adherence to a healthy lifestyle throughout life. The programs for primary prevention of socially significant diseases should include recommendations for quitting smoking, alcohol abuse, drug use, overeating, overfatigue, hypodynamia, or, conversely, extreme sports, and unprotected sex. Didactic adaptation of complex medical information is needed for valeological education of non-medical students. Its algorithms are analyzed in this article. Keywords: primary prophylaxis, preventable disease, controllable risk factors, healthy lifestyle, valeological competence, didactic adaptation.

Background. English-Medium Instruction (EMI) is a popular trend in modern higher education. Statistical data indicate a constant increase in the number of English-Taught Programmes (ETP) and courses, and Europe is the world leader in EMI implementation. Programmes in Medicine and Health Sciences are not included in the group of main ETPs in the world, European indicators of their number are lower than global, but they also demonstrate an increase in the number. Since these programmes were not described in detail, the aim of our work was to study the availability, distribution, and features of ETPs in Medicine and Health Sciences in Europe. Materials and Methods. Information from the websites of medical schools of the European Union/European Economic Area was studied using systematic analysis, comparative and bibliosemantic methods. The analysis covered 577 ETPs (160 higher education institutions from 26 countries where English has the status of a foreign language). Results. EMI in Medicine and Health Sciences has been implemented in two forms: single medium and partial (bilingual). The leader in the total number of completely ETPs is the Netherlands. The most common are Master programmes. Single-cycle programmes in medicine, dentistry and pharmacology are available in the Baltic countries, Central East Europe, South East Europe, South West Europe. Bachelor programmes in English are the smallest in number and are offered in selected countries. Bilingual programmes were found in Spain, Austria, Luxembourg, and Sweden. Conclusions. Teaching Medicine and Health Sciences in the medium of English is a common practice in the EU/EEA, but the choice of the type of teaching (single medium or bilingual) and the education level depend on the language policy of the country, the target group of students, and the internationalization strategy of a particular higher education institution. Keywords: English language, medium of instruction, English taught programme, higher education, medical higher education institution, Europe.

Introduction. During active hostilities, the issue of mental health in our society becomes very acute. The study of the mental health of military personnel participating in the war is particularly relevant. The purpose of the study was to investigate the psychopathological symptoms of disorders specifically related to the stress of war in combatants who were treated in different hospital departments. Methods. The study included 242 servicemen of the Armed Forces of Ukraine who were receiving treatment in different hospital departments. Psychodiagnostic assessment was conducted using the GAD-7, PHQ-9, PCL-5, PSS-SR questionnaires, and the DERS scale. Results. During the psychodiagnostics examination of servicemen treated in the hospital, anxiety-depressive syndrome was significantly more common in patients of the surgical unit, and post-communication syndrome in patients of the neurological unit. Adaptation disorder was found in almost a third of patients in all three departments. PTSD, anxiety disorder, personality and behavioral disorders were detected equally frequently in patients from different hospital departments. An analysis of the relationships between symptoms showed that anxiety-insomnia, post-traumatic and socially maladaptive syndromes were typical for servicemen treated in the therapeutic department, for patients in the neurological department – avoidant, depressive-anxious and insomnia-social syndromes, and for patients in the surgical department – acute traumatic, anxious-depressive and obsessive-avoidant syndromes. Conclusions. The identified peculiarities of symptoms and syndromes in patients of the therapeutic, neurological and surgical departments indicate the need for a differentiated approach to providing psychological assistance to servicemen undergoing treatment in a hospital, considering their underlying disease. The special vulnerability of neurological patients to the development of more severe psycho-emotional disorders is of great practical importance, as it indicates the need to develop specific protocols for psychological support for servicemen with neurological injuries.

Introduction. The COVID-19 pandemic has caused enormous social and economic damage. A significant part of people who have contracted this infection have serious health problems. To prevent the long-term consequences of COVID-19, models for predicting the duration of treatment based on prognostic factors obtained at the beginning of the disease are needed. Materials and Methods. In 2020-2021, a survey of 832 patients with COVID-19 was conducted. With the help of computer programs Microsoft Excel 2021 and Statistica 12.0 Trial Version for Windows, the collected database was processed. The relationship between numerical predictors was investigated using Spearman's correlation, and between categorical indicators – gamma correlation. To predict the duration of the patient's treatment based on the initial clinical symptoms and signs, the tools of the Statistica 12.0 program "classification trees" were used. The model was built using the tool Data Mining – Trees/Partitioning – C&RT (Classification and Regression Tree). Results and Discussion. During the study period, it was established that the long-term treatment of patients with COVID-19 depends on age, concomitant diseases, shortness of breath, body temperature, chest pain, frequency of respiratory movements in 1 minute, pain in the heart area, average blood pressure and heart rate according to 1 minute. This is confirmed by a significant difference between the groups of patients who were treated for up to 30 days and 31 days and more, as well as established correlations. On the basis of the above-mentioned predictors, a decision-making algorithm was developed to determine the duration of patient treatment. Conclusions. Established interrelationships between clinical symptoms in patients with COVID-19 will allow timely detection of possible complications in patients. Implementation of a built decision-making model based on leading predictors will help doctors predict the duration of the infection and develop effective measures to prevent serious post-infection consequences.

Introduction. Numerous scientific papers have emphasised that COVID-19 should not be considered solely as an acute respiratory viral infection, as this disease can affect not only the respiratory system but also other organs and systems, exerting a complex effect on health and well-being, including the salivary glands and saliva. Considering that teeth are constantly bathed in saliva, the composition and properties of this oral fluid play a significant role in the onset and progression of dental caries, which created the prerequisites for our study. The purpose of the current study was to evaluate the impact of COVID-19 on the properties of oral fluid – particularly mineral potential and antimicrobial activity – in order to substantiate the risk of dental caries. Materials and Methods. In accordance with the aims and objectives of the study, 110 patients aged 18 to 35 years were examined and divided into two groups: patients with a history of COVID-19 confirmed by polymerase chain reaction (PCR) test (2 to 6 months prior) and conditionally healthy individuals. The first group was further divided into three subgroups according to the severity of COVID-19, classified by the WHO: mild, moderate, and severe. The objectives were to determine the mineral potential and antimicrobial activity of the oral fluid. Results. The observed changes in the concentration of calcium-phosphate compounds indicated an imbalance in the mineral metabolism of the oral fluid. The concentrations of calcium and phosphorus were directly associated with disease severity, decreasing progressively from the first to the third subgroup. The lowest values of calcium and phosphorus were recorded in patients of the third subgroup, measuring 1.08±0.034 mmol/L and 2.09±0.074 mmol/L, respectively, with a significant reduction in alkaline phosphatase activity (28.26±4.70 U/L) in this subgroup. The assessment of the antimicrobial activity of oral fluid revealed that microbial contamination of the oral cavity increased among patients with COVID-19. A pattern similar to that observed for mineral potential was noted in the third subgroup with severe disease, where urease activity was 0.148±0.013 U/mL and lysozyme activity was 77±11 µg/mL. As a result, the dysbiosis index significantly deviated from the normal value of 1, reaching 4.78±0.5, which, based on the interpretation, corresponded to a clinically subcompensated stage. Conclusions. Based on the conducted studies, it should be noted that patients with a history of COVID-19 are more susceptible to dental hard tissue caries due to a reduction in the natural protective and restorative mechanisms of enamel crystal structure.

Objective To analyze and synthesize the information available from five pivotal, large-scale, multicenter, observational studies (CHECK, OAI, FNIH Biomarkers Consortium, IMI-APPROACH, and MOST) focusing on knee osteoarthritis (OA), which can be used to elucidate disease progression, risk factors, and the effectiveness of potential interventions. Design For this narrative review, a comprehensive literature search and data extraction from official web pages and scientific databases were conducted to compare methodologies, in- and exclusion criteria, outcomes, and cohort characteristics across the studies. Thematic, comparative, and qualitative analyses were employed to identify trends, commonalities, and disparities among the findings. Results The studies collectively enhanced understanding of the onset and progression of knee OA, and in several of the studies, hip OA, emphasizing the importance of both systemic and local risk factors. Advanced imaging and biomarkers are important components in all the cohorts, with the goal of aiding early diagnosis and tracking disease progression. All cohorts evaluated unique markers generally not available in the other cohorts, while other factors overlap, suggesting possibilities for combining or cross-validating between cohorts. Conclusions The collaborative efforts of major OA research significantly advance our understanding of knee OA. These studies highlight the importance of a multifaceted approach, integrating advanced imaging, biomarkers, and longitudinal data to tackle the complexities of OA. By synthesizing findings and addressing knowledge gaps such as heterogeneity of patients and used measurements, and use of novel pain measures, future research can develop more effective diagnostic tools and treatments, ultimately enhancing the quality of life for OA patients.

In his lecture for first-year medical students in the early 20th century, the prominent scientist Vasyl Yakovych Danylevskyi shared his views on medical education and its reform with future physicians. The author noted that while ancient medicine had a mystical character, the training of 20th century physicians was conducted exclusively through intellectual means. However, according to Danylevskyi, such training remained imperfect and was closely tied to school education. In this case, the primary task of school education was to develop the capacity for serious systematic work, intellectual growth, and discipline necessary for higher education. Until the 1860s, teaching at medical faculties followed old, unchanged curricula. Then young scholars brought a fresh stream of European science thanks to the 1863 University Statute, which granted broad autonomy to universities for improving young doctors' training. However, the negative impact of the subsequent 1884 University Statute nullified previous achievements in medical education development. The medical faculty proved more sensitive than others to the increased role of the school district trustee and university rector, who was now appointed by the Minister of Public Education. Of course, real power lies in people, not in statutes, declarations, or circulars. Give a good statute to people unprepared for the task, and there will be no order. It's not just the seed that affects germination, but also the soil where it's sown. Therefore, the main task of higher education is to select worthy candidates for departments who could reform medical education. We must abandon the illusion of creating any perfectly correct reforms while ignoring real-life conditions, traditions, skills and preparation of participants with their domestic and psychological characteristics. Keywords: medical faculty, statute, physician training.

In India, Gender-Based Violence (GBV) continues to be a significant issue affecting women across all sectors, including healthcare. This violence is driven mainly by the societal norms of patriarchy as well as systematic inequalities that have numerous and devastating effects on the social life of women, leading to psychological trauma, poorer health outcomes in underserved communities, and loss of trust in the healthcare system. There have been several legal frameworks, such as the Protection Human Rights Act, the Sexual Harassment of Women at Workplace Act, and the Protection of Women from Domestic Violence Act. Despite these initiatives, gaps still exist, mainly in enforcing and reducing the cultural stigmas contributing to the ongoing vulnerability of female healthcare professionals. By strengthening security measures and educating the public on gender sensitivity while empowering female healthcare workers, GBV may be mitigated. This paper highlights the urgency for a comprehensive and intensive approach towards ensuring a safer environment for women in healthcare to work and thrive in India. Cultural shifts, legal enforcement, and continuous advocacy efforts are also required.

Purpose There is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches. Methods This retrospective study included 257 patients who underwent LIFT (136 patients) or MAF (121 patients) for de novo and cryptoglandular TPAF between July 2018 and July 2021. Recurrent fistulas were clinically and radiologically detected using MRI. Postoperative incontinence was evaluated using the Wexner score and anorectal manometry. Logistic regression analysis was used to detect the risks of recurrence and incontinence. Results The median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant (P = 0.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively (P = 0.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; P = 0.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; P = 0.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; P = 0.013). A low Charlson comorbidity index score (≤ 5) (OR, 0.68; 95% CI, 0.47 to 0.99; P = 0.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; P = 0.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; P = 0.04). Conclusions The healing rates of MAF and LIFT procedures did not differ significantly; however, continence was significantly better after MAF. MAF should be added to the guidelines as a good option for the treatment of TPAF in elderly patients. Trial registration The study was registered as a clinical trial www.clinicaltrials.gov (NCT06616662).

The article continues the series of lectures by the outstanding Kharkiv scientist with a world name, Vasyl Yakovych Danylevskyi. In it, the scientist notes that in the second half of the last century, the doctor's horizons expanded significantly with the realization of the need for social service in medicine. In order to take into account, the patient's social ties for his diagnosis and treatment, the doctor needs knowledge in the field of sociology, psychology, economics, other sciences and fields of knowledge. A large crowd is dangerous if its psyche is set on destruction. The doctor's public service also concerns epidemiology, occupational hygiene, forensic examination, school hygiene, social psychology and psychiatry. The doctor's competence is necessary and can be useful for assessing art, literature, the adequacy of worldview and religious views. Psychohygiene, according to the scientist, can prevent symptoms of degeneration in the field of fine arts and literature before they affect the mental state of unbalanced natures and immature intellects. For some people, the convenience and comfort of city life led to moral weakness and degradation, and social bustle to a psychopathic personality. People with mental disorders seek everything very exciting and irritating in works of literature and art. The usual level of pleasure in the refined is already hardly acceptable for them. In contrast to the influence of the urban "superculture", a doctor can recommend restoring a person's tolerance to the social environment and his recovery through physical labor, strict discipline, endurance, and patience in rural conditions. The scientist's ideas, show the connections between physiological processes and mental functions, emotions and social behavior, describe the reasons and forms of the doctor's social service. The lecture substantiates duties of every doctor to be a social hygienist in matters of disease prevention. Keywords: social psychology, evolutionary psychology, art, personality.

This paper explores the role of collaboration between families and schools in enhancing the effectiveness of the Social, Emotional and Ethical Learning programme (SEE Learning) in the nationwide educational pilot in Ukraine. It emphasises the importance of a systems approach, particularly through the integration of School-Based Family Counselling (SBFC), to strengthen partnerships between schools and families. These partnerships are crucial for promoting students’ social-emotional development, academic achievements and overall well-being and resiliency. The study uses feedback from 723 students, 203 teachers and 718 parents across schools involved in the SEE Learning pilot. The research also incorporates findings from the OECD Survey on Social and Emotional Skills (SSES), in which 528 students from 18 SEE Learning pilot schools participated alongside 4,823 students from 194 schools from across Ukraine. The paper concludes with practical recommendations for improving communication and collaboration between educators and parents in implementing social-emotional learning programmes. It highlights the benefits of the SBFC model, which integrates the efforts of schools and families to address students’ emotional and psychological needs, offering significant potential to enhance the effectiveness of social-emotional learning programmes.

Aim The purpose of this study is to analyze the correlations of pro-inflammatory cytokines and β2-microglobulin with indicators of changes in the functional state of kidneys in patients with diabetic nephropathy, to determine different degrees of chronic renal failure. Material and methods 80 patients with type 1 and type 2 diabetes, complicated by diabetic nephropathy, at different levels of the functional state of the kidneys were examined. Results It has been shown that the level of tumor necrosis factor α (TNFα) in the blood of patients with diabetic nephropathy (DN) is increased already with sufficient kidney function, decreases with chronic renal failure (CRF) of the I degree and reaches maximum values with CRF of the II and III degrees. which indicates the degree of progression of fibroplastic and sclerotic processes in the kidneys with DN. The level of interleukin-1α (IL-1α) in the blood of patients with DN begins to decrease with sufficient kidney function, increases with CRF of the II degree, but remains below the values of the control group and is minimal in patients with CRF of the III degree, which reflects a decrease in the intensity of the acute-phase inflammatory process in the development of CRF. Conclusions The development and progression of CRF is accompanied by an increase in the excretion of β2-microglobulin in the urine in parallel with changes in the cytokine profile in the blood.

Background Myelodysplastic Syndrome (MDS) is a devastating hematologic malignancy associated with advanced age. Diabetes Mellitus (DM) is one of the most common morbidities worldwide, with metformin serving as the first line therapy for several decades. However, the potential association between previous metformin use and the risk of developing MDS remains uncertain. Methods This cross-sectional study addressed the possible association between prior metformin use in DM patients and the subsequent development of MDS. Results Data from 54,869 DM patients was retrieved from their medical records from a tertiary medical center. Of these, 20,318 patients had been exposed at some point in time to metformin, with 133 (0.7%) subsequently developing MDS. In contrast, among 34,551 DM patients with no prior exposure to metformin, only 154 (0.4%) developed MDS later in life. The Odds Ratio (OR) for MDS development amongst metformin users compared to the entire study population was 1.48 (95% CI 1.17–1.86; p = 0.001). A multivariate analysis adjusting for gender, age, congestive heart failure and chronic kidney disease, past exposure to metformin remained an independent risk factor for MDS development (OR = 1.6, 95% CI 1.26–2.03; p < 0.001). Conclusion Previous exposure to metformin amongst DM patients is associated with an increased risk for MDS development later in life. This is a preliminary, cross-sectional study that show that larger studies in variable MDS patient populations are warranted.

Glucocorticoid-induced osteoporosis (GIOP) is a bone metabolic disorder caused by glucocorticoid (GC) use. It is one of the leading causes of secondary osteoporosis, increasing the risk of low-energy fractures, disability, and mortality. Although limited studies on GIOP epidemiology and treatment have been conducted in Ukraine, there were no national guidelines for its management. The aim was to create national guideline for the GIOP diagnosis, prevention, and treatment based on a comprehensive review of modern literature to enhance awareness within Ukraine’s medical community, improve disease management, and reduce its socio-economic impact. An Expert Group comprising 18 leading Ukrainian scientists from various fields was created for guideline development. A review of modern literature on GIOP epidemiology, risk factors, diagnosis, prevention, treatment, and monitoring was conducted. Evidence synthesis followed the GRADE methodology, and the quality of recommendations was critically evaluated using the AGREE II tool. The guideline comprises 12 statements covering GIOP screening, diagnosis, prevention, and treatment. We highlight the need to raise awareness among healthcare providers and patients about the potential effects of GC therapy. Also, we outline approaches to clinical assessment of osteoporotic fracture risk in GC users and detail diagnostic and therapeutic methods currently available in Ukraine for managing GIOP. The first Ukrainian national GIOP guideline is critical for healthcare providers across specialities. Endorsed by the Board of the Ukrainian Association of Osteoporosis, it is recommended for use in routine clinical practice to enhance patient outcomes and mitigate the disease’s impact.

Toroidal/ring structures are a common feature in a wide variety of astrophysical objects, including dusty tori in active galactic nuclei (AGNs), rings in galaxies, protoplanetary disks, and others. The matter distribution in such structures is not homogeneous and can be flattened by self-gravity or become elongated in the vertical direction, as is the case with obscuring tori in AGNs. This led us to consider the more general case of the gravitational potential of an inhomogeneous torus with an elliptical cross-section. We begin by showing that the outer potential of a homogeneous elliptical torus can be effectively approximated with less than 1% error by the potentials of two infinitely thin rings with a minor correction term. These two rings have masses each equal to half the total mass of the torus. The most notable feature is that each such infinitely thin ring is positioned at precisely the halfway point between the center and the focus of the elliptical cross-section, regardless of the torus’ other parameters. The result, which holds for both oblate and prolate geometries, allows us to find a new expression to handle the outer potential of an inhomogeneous torus with an elliptical cross-section. The confocal density distribution is a special case. We have found that the outer potential of such a torus is only weakly dependent on the density distribution law. Consequently, even for the confocal inhomogeneous case, the outer potential is well represented by two infinitely thin rings. This approach simplifies problems of dynamics and allows for the analysis of the results of N-body simulations for the systems consisting of toroidal structures. For completeness, we have derived the expressions for the components of the external force exerted by a homogeneous torus with an elliptical cross-section, both for the exact form of the potential and for our approximation by two infinitely thin rings. Comparison of the two shows that our model fits the true trend of the force well.