Experimental and Clinical Medicine

The relationship between serum galectin-3 levels and dysglycaemia in comorbid cardiometabolic pathology depending on heart failure phenotypes

K.M. Borovyk — 2025-12-31

In press

Background. Chronic Heart Failure (CHF) is an unfavourable pathology, the prevalence of which is increasing in patients with cardiometabolic pathology (Coronary Artery Disease (CAD), Type 2 Diabetes Mellitus (T2DM) and obesity). One of the key profibrotic biomarkers in this pathology is galectin-3, but its role in the development of dysglycaemia in comorbidity remains insufficiently studied.

Aim. To study the relationship between serum galectin-3 levels and carbohydrate metabolism indicators in patients with comorbid cardiometabolic pathology depending on the phenotype of chronic heart failure.

Materials and Methods. We examined 225 patients with CHF in CAD, divided into four groups and subgroups according to CHF phenotypes (CHF with preserved Ejection Fraction (CHFpEF); CHF with moderately reduced Ejection Fraction (CHFmEF); HF with reduced Ejection Fraction (HFrEF)). Group 1 included 75 patients with CAD, T2DM and obesity. Group 2 included 50 patients with CAD and T2DM. Group 3 included 50 patients with CAD and obesity. Group 4 included 50 patients with CAD without metabolic pathology. The control group consisted of 30 healthy individuals. Serum glucose, insulin, and glycated haemoglobin (HbA1c) levels were determined, and the HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) index was calculated. The level of galectin-3 was determined by immunoenzymatic method. Statistical analysis was performed using Fisher's criterion and Spearman's coefficient (p=0.05). The work was performed as part of the author's dissertation research.

Research Ethics. The study was carried out in accordance with the norms of WMA Declaration of Helsinki (1964–2024) and approved by the Bioethics Committee of Kharkiv National Medical University. All involved patients signed an informed consent.

Results. In Groups 1 and 2, a progressive deterioration in carbohydrate metabolism and an increase in galectin-3 were found in parallel with a decrease in Left Ventricular (LV) Ejection Fraction (EF). In Group 2, the HOMA-IR index in HFpEF was 264.8% higher than in HFpEF, and galectin-3 was 95.4% higher. Strong correlations were found between galectin-3 and HOMA-IR (r=0.72; p<0.05) and glucose (r=0.64; p<0.05). In Group 3, with a decrease in LVEF, only insulin (by 98.6%) and HOMA-IR increased, while HbA1c and galectin-3 levels did not change significantly. The correlation of galectin-3 was significant only with insulin (r=0.73; p<0.05).

Conclusions. Insulin resistance progresses most sensitively with a decrease in ejection fraction in metabolic disorders. The activation of galectin-3 as a mediator of fibrosis and dysglycaemia is closely associated with type 2 diabetes mellitus. The absence of a reliable correlation between galectin-3 and heart failure phenotypes in patients without type 2 diabetes mellitus emphasises the critical role of comorbid metabolic pathology in the progression of heart failure.

Keywords: therapy, сhronic heart failure, coronary artery disease, type 2 diabetes mellitus, obesity, galectin-3.

Optimization of diagnostic and therapeutic tactics for bile extravasation after the formation of biliary-digestive anastomoses based on prognostic modeling

D.S. Kozlov — 2025-12-31

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Background. Failure of biliary-digestive anastomoses with the development of bile extravasation remains a critical surgical complication associated with a high level of septic conditions and mortality. The lack of objective criteria for early differentiation of the severity of bile leakage necessitates the implementation of prognostic models to objectify surgical decision-making.

Aim. Development of a multifactorial mathematical model and clinical algorithm for early identification of the risk of progression of biliary extravasation in order to optimize the treatment strategy.

Materials and Methods. The results of treatment of 120 patients were analyzed by assessing diagnostic parameters, including the level of interleukin-6, the bilirubin gradient in the exudate, and the anatomical features of the biliary tree. Mathematical modeling and validation of the results were implemented using logistic regression analysis, construction of sigmoidal probability curves, and the bootstrap validation method with SPSS v.26.0 (IBM, USA). The work is a fragment of the research work of the Department of Surgery No.1 of the Kharkiv National Medical University "Development of diagnostic methods and open and minimally invasive technologies for the treatment of diseases and injuries of the thoracic and abdominal organs, vessels of the extremities in patients during wartime" (2024–2028), state registration number 0124U002908.

Research Ethics. The study was conducted in accordance with the main provisions of the Declaration of Helsinki of the World Medical Association (1964–2024). All patients signed a written informed consent for participation and processing of personal data.

Results. Key predictors of bile leak risk were identified, namely: anastomotic re-reconstruction, high strictures, hyperbilirubinemia > 100 μmol/l and hypoalbuminemia. The developed model demonstrated high predictive ability (AUC 0.94; sensitivity 89.3%; specificity 85.7%). The implementation of a three-stage algorithm allowed us to clearly distinguish treatment tactics between conservative management, minimally invasive decompression at an average risk level and urgent relaparotomy with the formation of a "guided fistula" at a high risk level.

Conclusions. The implementation of a three-level risk stratification system provided an objective choice between conservative tactics, minimally invasive interventions and relaparotomy. The use of interventional radiological techniques allowed us to avoid repeated operations and significantly improve treatment outcomes.

Keywords: surgery, biliodigestive anastomosis, bile leak, prognosis, minimally invasive interventions.

Prospects for the use of plant extracts for the treatment of wounds infected with poly-resistant pathogens

V.M. Holubnycha — 2025-12-31

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Background. The global spread of multi-drug resistant microorganisms has significantly complicated the treatment of bacterial infectious diseases in general and traumatic injuries in particular. Multi-drug resistant bacteria of the ESKAPE group pose a particular threat, which necessitates the search for alternative antimicrobial agents of natural origin.

Aim. Study the possibility of using alcoholic extracts of pomegranate peels and comfrey roots for the treatment of wounds infected with multi-drug resistant microorganisms of the ESKAPE group.

Materials and Methods. The antimicrobial activity of alcoholic extracts of pomegranate peels and comfrey root against multi-drug resistant microorganisms was studied using the agar diffusion spot method. The cytotoxicity of plant extracts was studied on human dermal fibroblast and osteosarcoma cell cultures in the resazurin assay. The overall toxicity of the extracts was determined on the in ovo model. Quail eggs (29 pieces) were divided into four groups: two – treated with pomegranate and comfrey extracts, one – with saline, and one – non-treated. Statistical analysis was performed using one-way ANOVA in GraphPad Prism 8.0 software, with significance set at p≤0.05. The study was carried out at the expense of grant support of the Ministry of Education and Science of Ukraine (state registration number 0124U000540).

Research Ethics. The studies were conducted in accordance with the "General Ethical Principles of Animal Experiments" (Kyiv, 2001), the World Medical Association Declaration of Helsinki (1964–2024) and with Sumy State University bioethics commission’s approval (Protocol No.1/02 of 02/18/2025).

Results. The alcoholic extract of pomegranate demonstrated effectiveness against all studied microorganisms and was non-toxic to cell cultures on the 1st day of observation at a dilution of 1:8. The alcoholic extract of comfrey demonstrated the absence of toxicity during 1, 3 and 5 days of observation and a moderate stimulating effect on cell culture at a dilution of 1:32. The general safety of pomegranate extract and the stimulating effect of comfrey extract were demonstrated in the in ovo model.

Conclusions. Alcoholic extracts of pomegranate peel and comfrey root are promising for complex therapy of ESKAPE-infected wounds: pomegranate extract exhibits antimicrobial activity, while comfrey extract stimulates MG63 and HDF cell proliferation without general toxicity, justifying their further evaluation.

Keywords: experimental medicine, antimicrobials, antibiotic-resistant microorganisms.

Dynamics of the manifestations of stress-associated disorders and their clinical correction in individuals who engaged in volunteer activities during the war

B.M. Sumariuk — 2025-12-31

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Background. Russia’s full-scale invasion of Ukraine has led to a significant increase in the psycho-emotional burden on the population, particularly on volunteers who experience prolonged stress and regularly encounter traumatic events. This significantly increases the risk of developing stress-associated mental disorders.

Aim. To evaluate the clinical effectiveness of a therapeutic and psychosocial program in reducing the severity of symptoms of stress-associated disorders among volunteers involved in wartime activities.

Materials and Methods. Within the overall study, 288 volunteers aged [18–60] years were examined. Among them, a clinical sample of individuals with neurotic and stress-associated mental disorders was formed (n=82). This article presents the results of the analysis of a subgroup of respondents with disorders of the F43 category. The analytical sample included 25 individuals. Depending on the type of intervention, they were divided into an experimental group (n=12), which received a comprehensive therapeutic and psychosocial program, and a control group (n=13), which received pharmacotherapy. Diagnostics were performed using the clinical-psychopathological method and psychodiagnostic tools: the Primary Care Post-Traumatic Stress Disorder (PTSD) Screen, PTSD Checklist (PCL) for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Impact of Event Scale – Revised (IES-R) The treatment program combined pharmacotherapy and a low-intensity psychological intervention "Problem Management+". Treatment effectiveness was assessed by the dynamics of psychometric indicators. The study was conducted within the framework of research projects with state registration numbers 0120U101503 and 0125U001434.

Research Ethics. The study was approved by the Commission on Biomedical Ethics of Bukovinian State Medical University (Protocol No.1 of September 15, 2022). All participants signed voluntary informed consent.

Results. In the experimental group, a statistically significant reduction in the severity of post-traumatic stress disorder symptoms was found across all scales, which persisted for three months after the completion of the intervention. In the control group, which received only pharmacotherapy, improvement was also observed, however it was less pronounced and less stable.

Conclusions. The comprehensive therapeutic-psychosocial program demonstrated high clinical effectiveness and can be recommended for integration into the system of assistance to volunteers. Its implementation contributes to increased psychological resilience and reduction of the risk of exacerbation of psychopathological symptoms.

Keywords: psychiatry, volunteers, psychosocial support, anxiety, post-traumatic stress disorder, stress.

Medico-social substantiation of a model for early detection and prevention of burnout syndrome in healthcare workers

R.O. Ivashchenko — 2025-12-31

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Background. Emotional Burnout Syndrome (EBS) among healthcare workers is a pressing public health issue that affects professional performance, patient safety, and healthcare system sustainability. Despite growing recognition, standardized early detection and prevention models remain underdeveloped in Ukraine.

Aim. To conduct medical and social research and develop a model for early detection and prevention of burnout syndrome among healthcare workers.

Materials & Methods. The study employed structural-functional modeling, synthesized from a literature review and empirical research conducted in 2021–2023. The study population comprised 483 healthcare professionals (study group, n=294; control group, n=189). An index-based approach was applied using integral indicators: Emotional Burnout Index (EBI), Stress Load Index (SLI), Support Index (SI), Access to Help Index (AHI), Learning Readiness Index (LRI), and Work Ability Index (WAI). Risk prediction was performed using Wald’s Sequential Probability Ratio Test. The model was validated via expert elicitation (12 experts) on a 10-point scale.

Research Ethics. The study was conducted in accordance with the World Medical Association Declaration of Helsinki (1964–2024). Ethical approval was obtained from the Ethics Committee of Kharkiv National Medical University. All participants provided written informed consent.

Results. Structural changes in burnout prevalence were observed: the proportion of individuals with EBI <40% decreased from 354.7‰ to 314.7‰, while those with EBI >70% increased from 191.9‰ to 231.9‰. Thirty risk factors were identified, with organizational-managerial determinants showing the strongest effect. Work ability among healthcare workers with burnout symptoms was low (mean WAI, [42.23±0.91]%). Access to help was limited (mean AHI, 59.18%), with the presence of specialized services significantly increasing the odds of high access (odds ratio, OR=43.56; p<0.001). A functional-structural model integrating screening, risk stratification, forecasting, and routing to assistance was developed and validated (mean overall score, [8.7±0.6] points).

Conclusions. The proposed model ensures standardized index-based screening, risk stratification, forecasting, formalized access to psychotherapeutic assistance, and monitoring of effectiveness, including work ability assessment. Implementation of the model corresponds to contemporary international approaches to mental health governance in the workplace.

Keywords: social medicine, emotional burnout syndrome, prevention, work ability.

Anxiolitic effect of cryopreserved placentar blood serum in a model of mild blast train injury

D.O. Salnykov — 2025-12-31

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Background. The significant prevalence of traumatic brain injury during armed conflicts and the insufficient effectiveness of existing treatment programs for victims necessitates the development of new therapeutic approaches.

Aim. To investigate the effect of cryopreserved human placental blood serum on the level of anxiety in mice with a model of mild blast-induced traumatic brain injury.

Materials and Methods. Human placental blood was obtained from the umbilical vein of postpartum placenta weeks of gestation with a physiological course of pregnancy. Experiments were conducted on 6-month-old mice. Human placental blood was obtained from the umbilical vein of postpartum placenta 38–40 weeks of gestation with a physiological course of pregnancy. Experiments were conducted on 6-month-old mice. Statistical analysis of the obtained experimental data was performed by analysis of variance using the software package "StatGraphics Plus 2.1" (Statgraphics Technologies, Inc., USA). The study was carried out within the framework of the scientific project "Cryotechnologies in overcoming the consequences of combat blast-induced brain injury", state registration number 0125U000872.

Research Ethics. Human placental blood was obtained with informed consent of parturient women in compliance with the principles of the World Medical Association Declaration of Helsinki (1964–2024). All manipulations with animals were carried out in accordance with the "General Principles of Animal Experiments" adopted by the First National Congress on Bioethics (Kyiv, 2001) and consistent with the provisions of the "Convention of the Council of Europe for the Protection of Laboratory Animals" (ETS 123, 1986).

Results. Analysis of the obtained data proves that mild blast-induced craniocerebral trauma leads to increased anxiety in mice. Conducting a 5-day course of injections of cryopreserved or cryosublimated cord blood serum in the first days after the injury reduces pathological anxiety of experimental animals, which demonstrated a lower percentage of the total time spent in the closed arms of the maze, lower coefficients of preference for visiting and staying in the closed arms of the maze, a longer average duration of one episode of staying on the platform between the arms of the maze and higher exploratory activity. Cryosublimated cord blood serum was not inferior in activity to cryopreserved

Conclusions. The revealed anxiolytic effect of the use of cryopreserved, cryosublimated placental blood serum allows us to consider it as a promising means of overcoming increased anxiety – a pathological consequence of mild blast-induced craniocerebral trauma.

Keywords: neurology, placental blood serum, cryopreservation, mild traumatic brain injury, anxiety, elevated plus maze test, anxiolytic activity.

Erythrocyte photomodification in discrete plasmapheresis as a detoxification method in acute pleural empyema

V.V. Boyko — 2025-12-31

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Background. Acute pleural empyema is a severe disease accompanied by high systemic intoxication, metabolic disturbances, and purulent septic complications. Conventional therapy – antibiotics, pleural drainage, and infusions – may be insufficient due to accumulation of toxins and disruption of homeostasis. While extracorporeal methods such as plasmapheresis appear promising, classic approaches are limited by substantial losses of plasma proteins and immune components. Photomodification of erythrocytes may enhance detoxification and stimulate tissue repair processes.

Aim. To assess the clinical efficacy, safety, and impact on tissue repair of three variants of detoxifying hemocorrection: Therapeutic Plasma Exchange (TPE), TPE with Partial Photomodification of Erythrocytes (TPE-PPE), and Small Volume TPE with Full Photomodification of Erythrocytes (SV-TPE-FPE) in patients with acute pleural empyema.

Materials and Methods. A total of 105 patients with acute nonspecific pleural empyema treated at the Institute of General and Emergency Surgery (2008–2024) were enrolled. Patients were stratified into four groups: control (standard therapy), TPE, TPE-PPE, and SV-TPE-FPE. Apheresis procedures were performed every other day. Efficacy was monitored via clinical parameters (body temperature, duration of fever, severity of condition), complications, and morphological changes. Statistical analysis was carried out using variation statistics and Student's t-test, with Bonferroni correction for multiple comparisons. The study was carried out as a private initiative of the authors, without grant support or state registration of the topic.

Research Ethics. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki (1964–2024) and approved by the Ethics Committee of the Educational and Scientific Medical Institute of National Technical University "Kharkiv Polytechnic Institute" (Protocol No.2 dated October 13, 2023). Written informed consent for the use of clinical data in scientific research was obtained from all patients, with adherence to the principles of confidentiality and voluntary participation.

Results. The SV-TPE-FPE group demonstrated the best clinical dynamics: maximal body temperature decreased to 37.1°C, and the fever period was shortest (mean ≈ 18 days). The complication rate in this group was significantly lower than in other groups: fewer purulent septic complications and a reduced need for surgical interventions. No deaths were recorded in the SV-TPE-FPE group. Morphologically, there was the largest proportion of spontaneous scarring of pleural cavities in this group, suggesting activation of reparative processes.

Conclusions. Small volume TPE with full photomodification of erythrocytes (SV-TPE-FPE) appears to be a promising method for treating acute pleural empyema, combining effective detoxification with activation of repair and reduced complication rates with no fatal outcomes in the studied sample. These findings support incorporating photomodified erythrocytes into comprehensive therapy, but further multicenter randomized studies are required to validate these results.

Keywords: surgery, purulent diseases of the pleura, laboratory diagnostic.

Multidisciplinary outpatient cardiac rehabilitation system as an effective model for restoring and maintaining cardiovascular health

O.Yu. Sierkov — 2025-12-31

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Background. Cardiovascular diseases are the leading cause of death worldwide. The effectiveness of outpatient multidisciplinary cardiac rehabilitation in Ukraine requires evidence-based justification.

Aim. To evaluate the effectiveness of a multidisciplinary outpatient cardiac rehabilitation model for patients with cardiovascular disease based on physical performance, hemodynamic status, body mass index, psycho-emotional state, and treatment adherence compared with standard outpatient follow-up.

Materials and Materials. A multidisciplinary outpatient cardiac rehabilitation model was developed. A total of 120 patients were examined and randomized equally into a multidisciplinary group and a control group. The multidisciplinary group received a structured cardiac rehabilitation programme. The control group remained under standard outpatient follow-up. The following methods for controlling exercise intensity were used: heart rate reserve, percentage of peak heart rate, exercise intensity in metabolic equivalents, and subjective assessment of exertion using the Borg scale. Statistical analysis was performed using Student’s t-test for group comparisons; data are presented as M ± SD. Calculations were carried out using Statistica 8.0 (Statsoft, USA). The study was conducted as a private initiative of the authors, without grant support or state registration of the research topic.

Research Ethics. The study was conducted in accordance with the principles of the World Medical Association’s Declaration of Helsinki (1964–2024) and Order No.690 of the Ministry of Health of Ukraine of September 23, 2009. The study protocol was approved by the Bioethics Committee of the Uzhhorod National University. All patients provided written informed consent to participate in the study.

Results. After 12 weeks, the multidisciplinary group achieved a statistically significant greater increase in MET compared with the control group: from [4.3±0.6] relative units (RU) to [6.1±0.8] RU, compared with [4.2±0.7] RU to [5.0±0.9] r.u. (p<0.001); a reduction in systolic blood pressure: from [142±12] mmHg to [130±10] mmHg versus from [143±11] mmHg to [136±11] mmHg (p=0.002); reduction in anxiety on the HADS-A scale: from [10.2±3.1] points to [6.5±2.4] points versus from [9.8±2.9] points to [8.7±2.8] points (p<0.001) and in depression on the HADS-D scale: from [8.7±2.7] points to [5.2±2.0] points versus from [8.4±2.8] points to [7.6±2.4] points (p<0.001). Adherence to treatment increased to 89% in the multidisciplinary group compared with 75% in the control group (p<0.001).

Conclusions. The results showed that cardiac rehabilitation with multidisciplinary support and full support of the multimodal clinical model is an effective means of managing patients' health at the outpatient observation point.

Keywords: physiotherapy and rehabilitation, myocardial infarction, personalised medicine, cardioprotective factors, physical activity, training intensity.

HIV infection in Ukraine amid full-scale war: Epidemiological situation, legal regulation, and prospects for prevention and vaccination

V.G. Nesterenko — 2025-12-31

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Background. HIV infection remains one of the most serious medical and social problems of our time: by the end of 2025, there were 40.9 million people living with HIV worldwide, and in Ukraine 129,802 people were under medical supervision (316.6 per 100,000 population). The Ukrainian epidemic has specific features – the dominance of the parenteral transmission route and a close link with injecting drug use – while the full-scale war creates additional challenges for HIV prevention, diagnosis and treatment.

Aim. To analyse the epidemiological situation of HIV/AIDS in Ukraine in comparison with global and European trends, to characterise the legal and regulatory framework counteracting the epidemic, and to assess current approaches to the prevention and treatment of HIV infection under conditions of full-scale war.

Materials and Methods. The theoretical research was carried out using bibliosemantic and comparative methods, descriptive statistics, system analysis, as a private initiative of the authors, without grant support and state registration of the topic. Data from UNAIDS, the European Centre for Disease Prevention and Control (ECDC), and the Public Health Center of the Ministry of Health of Ukraine for 1986–2024, together with relevant scientific publications, were used.

Research Ethics. The study was conducted without the participation of patients, so it did not require the approval of the ethics committee.

Results. Five periods of development of the global and Ukrainian epidemics were identified; incidence in Ukraine peaked in 2010–2014 (compared with the mid-1990s worldwide), attributable to the delayed development of the epidemic among people who inject drugs. The multi-tiered legal framework was characterised (the Constitution of Ukraine, Law No. 1972-XII, orders of the Ministry of Health), together with Ukraine's international obligations (UN declarations, the State Strategy until 2030, the "95-95-95" target). Differentiated approaches to prevention for the general population, young people ("Vybir", "Programme 15", "Learning to Live Together"), and key populations (harm reduction, pre-exposure prophylaxis) were systematised. As of February 2025, 118,444 Ukrainians living with HIV were receiving antiretroviral therapy. Prospects for HIV vaccine development were summarised based on studies published in 2025–2026 (mRNA platforms, DNA origami, the MVA.HIVconsvX vaccine).

Conclusions. The Ukrainian HIV/AIDS epidemic exhibits significant national specificity and requires a differentiated preventive approach. Despite the challenges of the war, Ukraine's healthcare system has shown resilience in ensuring access to treatment, and progress in vaccine development gives grounds for cautious optimism about controlling the epidemic.

Keywords: health care management, social medicine, AIDS, antiretroviral therapy, pre-exposure prophylaxis.

Adaptive role of the thyroid system in low triiodothyronine syndrome: immunometabolic mechanisms, clinical significance and rehabilitation perspectives (literature review, part 2)

O.M. Biletska — 2025-12-31

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Background. Low triiodothyronine syndrome (LT₃S) is a common manifestation of severe non-thyroidal conditions (trauma, infections, ischemic and oncological processes) associated with a systemic inflammatory response dominated by innate immune mechanisms, particularly phagocytosis. Traditionally regarded as an energy-conserving mechanism, it is now understood to reflect adaptive changes in thyroid metabolism related to immune regulation, prompting a reassessment of its clinical significance.

Aim. To systematize current knowledge on the pathophysiological mechanisms of adaptive changes in the thyroid system in non-thyroidal conditions with systemic inflammation and their clinical significance.

Materials and Methods. The study employed systematic analysis and bibliosemantic synthesis of scientific sources. The review is based on publications from 2015–2025 indexed in PubMed, Scopus, ScienceDirect, EMBASE, MEDLINE, the Cochrane Library, and Google Scholar. Peer-reviewed review, clinical, and experimental studies in Ukrainian and English were included. The study was conducted as a private initiative of the authors, without grant support and state registration of the scientific topic.

Research Ethics. Only publications meeting current bioethical standards were included.

Results. Alterations in thyroid metabolism in non-thyroidal conditions with systemic inflammation should be interpreted not only as an energy-conserving response but as an immune-mediated adaptive remodeling. These changes redistribute energy and micronutrients toward innate immune cells, particularly phagocytes, and clinically manifest as LT₃S. From a systems perspective, they correspond to the concept of a functional dominant. However, there is no unified clinical consensus regarding their therapeutic correction.

Conclusions. LT₃S should be considered a clinical and laboratory manifestation of adaptive changes in thyroid metabolism in non-thyroidal conditions with systemic inflammation. These changes are immune-mediated and aimed at supporting the functional activity of innate immune cells. The lack of consistent correction strategies underscores the need for further research and integration of these concepts into a unified pathophysiological model.

Keywords: rehabilitation medicine, non-thyroidal illness, thyroid hormones, thyroxine, cytokines, phagocytosis.

Comprehensive assessment of brain metabolic asymmetry based on positron emission tomography with computed tomography in children with drug-resistant epilepsy (literature review)

P.O. Korol — 2025-12-31

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Background. Drug-Resistant Epilepsy (DRE) in the pediatric population remains a challenging diagnostic problem, as traditional neuroimaging methods do not always reflect functional changes in the brain. The use of Positron Emission Tomography with 18F-FluoroDeoxyGlucose in combination with Computed Tomography (18F-FDG PET/CT) opens up new possibilities for the early detection of epileptogenic zones through quantitative assessment of metabolic asymmetry.

Aim. To summarize current data on the comprehensive assessment of brain metabolic asymmetry using positron emission tomography with 18F-fluorodeoxyglucose in combination with computed tomography in children with drug-resistant epilepsy and to determine scientifically-based parameters for its assessment.

Materials and Methods. The study used methods of theoretical generalization, analysis, and synthesis of results, bibliosemantic method. The search for works was conducted in the scientometric databases Scopus, Web of Science, PubMed and Google Scholar. This study was conducted as a private initiative by the author.

Research Ethics. During the study, publications were selected, the authors of which adhered to modern bioethical standards.

Results. The study showed that metabolic asymmetry of the brain is a quantitatively measurable, statistically significant marker of epileptogenic focus activity. Metabolic asymmetry correlates with neuroontogenetic markers and the localization of the epileptogenic focus, which is of practical importance for planning more targeted surgical procedures. The combination of PET/CT with neuroimaging methods yielded more stable and repeatable results in identifying areas with impaired metabolism compared to each method alone. The results indicate the potential for using metabolic asymmetry as an additional biomarker for selecting candidates for surgical interventions, as well as for monitoring the effectiveness and prognosis of surgical treatment of DRE in children. It complements structural imaging methods and neuropsychological assessments, facilitating a personalized approach to each patient and improving the effectiveness of surgical treatment of children with DRE.

Conclusions. 18F-FDG PET/CT is a reliable tool for quantitative assessment of brain metabolic asymmetry in children with DRE. The asymmetry index can serve as an objective biomarker for the lateralization of the epileptogenic zone and the prognosis of treatment effectiveness. Standardization of analysis methods and the creation of age-referenced databases are key conditions for increasing the clinical value of PET/CT in pediatric practice.

Keywords: medical radiology, pediatrics, neuroimaging, asymmetry index, epileptogenic focus.

Mother, child, microbiome: the health triangle

Yu.V. Karpushenko — 2025-12-31

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Background. In recent years, the pediatric population has experienced a significant increase in the number of diseases, with their profile increasingly corresponding to the "adult type". Only [3–5]% of high school‑age children in Ukraine can be considered healthy. Children’s health is influenced by a number of harmful environmental factors, infections, and stress. The foundations of a child’s health are laid long before birth. Long‑term health programming continues up to the age of 2–3 years, when the gut microbiome is formed, which modulates metabolism, behavioural reactions, and the function of the immune and nervous systems. Data on the gut microbiome are numerous but insufficiently systematised.

Aim. To analyse modern scientific sources on the impact of nutrition on the formation of the child’s microbiome as a factor of long‑term health programming.

Materials and Methods. The study was conducted using the bibliosemantic method and systemic analysis. A search for scientific sources was performed in the scientometric databases PubMed, Scopus, Web of Science, Google Scholar, and Wiley Online Library for the period 2015–2026. A total of 121 sources were included in the analysis. The study was carried out within the framework of the research project of the paediatric departments of Kharkiv National Medical University "Medical and Biological Aspects of Adaptation of Children with Somatic Pathology in Modern Conditions" (2023–2026), state registration number 0123U101768.

Research Ethics. Only literature sources describing studies whose authors adhered to modern bioethical standards were selected.

Results. Analysis of the sources showed that balanced, adequate nutrition during pregnancy and in the early stages of a child’s life plays a key role in the formation of the child’s intestinal microbiota, which is an important factor in healthy physical and neuropsychic development and contributes to the formation and maturation of the immune system. Maternal nutrition during pregnancy and the child’s nutrition in the first years of life can disrupt this process. Improper formation of the gut microbiome can negatively affect the child’s physical development and the occurrence of metabolic, cardiovascular, autoimmune, allergic and neurodegenerative diseases, as well as type 2 diabetes, even in adulthood. Breastfeeding, timely introduction of complementary feeding, and the use of nutritional interventions can help create a healthy microbiota in the child from birth and thereby "program" long‑term health.

Conclusions. The formation of a healthy microbiome is crucial for the development of targeted nutritional interventions aimed at improving health throughout the lifespan.

Keywords: pediatrics and neonatology, child nutrition, maternal nutrition, microbiocenosis, health programming, pediatric nutrition.

Collaborative professional development in school-based occupational therapy for autistic students (literature review)

S.I. Neshko — 2025-12-31

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Background. Teaching students with autism spectrum disorders in mainstream classrooms exposes school staff to high risks of professional burnout during pedagogical stress. While traditional school-based occupational therapy focuses primarily on direct, individual student interventions, contemporary international research indicates an institutional paradigm shift toward collaborative consultation, multi-tiered systems of support, and professional coaching for teachers.

Aim. To investigate professional development programs designed by occupational therapists to train school staff in working with students with autism spectrum disorders.

Materials and Methods. The study was conducted using bibliosemantic and comparative methods, as well as systems analysis. A literature search was performed in PubMed and Google Scholar covering the period from 2001 to 2023. The research was carried out as a private academic initiative of the authors, without external grant funding or state registration of the topic.

Research Ethics. For the literature review, studies whose authors adhered to bioethical standards were selected.

Results. Data analysis revealed a critical need for teacher training in working with students with autism spectrum disorders to develop staff-safe behavioral strategies. Evaluation of such models indicates a need for a transition from direct individual help to collaborative consultation models, which reduces teacher burnout and isolation and improves the educational process. Data from quasi-experimental pilot studies demonstrate that short-term, structured occupational performance coaching combined with specialized workshops provides a statistically significant improvement in teachers’ perception of their effectiveness (Wilcoxon Z=–3.30, p=0.001) and clinical-educational satisfaction (Z=–3.31, p=0.001). These data validate coaching as a powerful mechanism to enhance professional self-efficacy.

Conclusions. Implementing multi-tiered and collaborative coaching strategies in the school environment creates a sustainable, hierarchical support framework that prioritizes universal communicative and protective solutions. Since school-based occupational therapy is not yet institutionalized within the Ukrainian educational system, international experience can be used to create conceptually scalable models for local educational policy-makers to optimize interdisciplinary cooperation.

Keywords: autism spectrum disorder, inclusive education, school-based occupational therapy, teacher coaching, multi-tiered systems of support, professional development.

Physical rehabilitation of military personnel with combat injuries: modernization of approaches and methodological solutions in the context of long-term functional recovery (literature review)

I.M. Lutsenko — 2025-12-31

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Background. The article considers a comprehensive analysis of modern and innovative approaches to physical rehabilitation of military personnel injured in combat operations in the context of post-war recovery.

Aim. To identify effective methods of physical rehabilitation for military personnel with combat injuries, assess their potential for functional recovery, and outline directions for improving rehabilitation programmes in Ukraine with consideration of international experience.

Materials and Methods. The study was conducted using methods of content analysis, comparative analysis, structural-functional analysis of scientific literature cited for 2019–2025 in the databases PubMed, Medline, Web of Science, Scopus, Cochrane Library, and Rehabilitation Reference Centre. This study was conducted as a private initiative by the authors, without grant funding or official registration of the research topic.

Research Ethics. During the work, studies were selected whose authors adhered to ethical standards.

Results. An analysis of scientific literature indicates that prolonged use of traditional approaches often leads to overload, depletion of adaptive resources, the development of dysfunctional overtraining, and delayed neuromuscular recovery. Against this background, the latest technologies – kinesiotherapy, mechanotherapy, electrical stimulation, sensory retraining, biomechanical modelling, and integrative multisystem approaches – are promising, but their effectiveness depends on the personalisation of interventions. Analysis of the experiences the European Union (EU) and NATO (North Atlantic Treaty Organization) countries indicates the need to transition to integrated rehabilitation protocols that account for injury complexes, psychophysiological changes, and social factors. As part of the study, a model of comprehensive physical rehabilitation for military personnel was developed, combining modern recovery technologies, individualised therapy, and a systemic interagency approach. It was established that the success of the rehabilitation of wounded military personnel in the post-war period depends not only on the degree of medical innovation but also on the healthcare system's ability to adapt quickly to new challenges.

Conclusions. The effectiveness of physical rehabilitation for military personnel with combat injuries is determined not only by the set of methods used, but also by the quality of personalization, continuity of the patient pathway, access to modern technologies, availability of a trained team, and interagency coordination. For Ukraine, priorities include standardizing assessment, developing rehabilitation centres of different levels, integrating physical, psychological, and social support, and introducing transparent criteria for programme effectiveness.

Keywords: functional independence, neuromuscular adaptation, remote monitoring, assistive technologies, interdisciplinary coordination, evidence-based protocols.

Requirements for the design of manuscripts of scientific articles in journals of Kharkiv National Medical University

2025-12-31