Kharkiv Regional Clinical Psychiatric Hospital No 3

Tuberculosis (TB) burden concentrates in low-income settings and remains the leading global cause of death from a single infectious agent, despite that it is preventable and treatable. TB-associated lung diseases (TBALD), a broad range of respiratory abnormalities which can start before or during a TB episode, may increase morbidity. TBALD may persist after successful completion of TB treatment as post-TB lung disease (PTLD). PTLD varies in severity and is characterised by persistent respiratory symptoms and lung impairment that can significantly impact social activities, health-related quality of life, and long-term survival. Risk factors for PTLD include increasing age, smoking, HIV infection, delayed diagnosis, and poor socioeconomic conditions.Action to limit PTLD may be taken before TB develops through TB screening, early diagnosis and TB preventive treatment, during treatment of TB, and upon its completion. Early detection, clinical assessment, and tailored management (including smoking cessation, immunisation, addressing respiratory comorbidities, pulmonary rehabilitation and social protection) can mitigate impairment and disability. Healthcare providers and national programmes play a vital role through clinical follow-up, patient education, and integration of TBALD care into broader health and social protection services. Sustained funding and research are crucial for this and to develop new tools to enhance care.

Background. Timely diagnosis is important for the patientʼs quality of life and prevents serious complications, taking into account the presence of comorbidities in the patient. Despite certain similaritie Muscle pain can be caused by many factors and can be a manifestation of various diseases: infectious, endocrinological, rheumatological, etc. Myopathies have certain differences in different pathologies and impair the patientʼs quality of life. Timely diagnosis is important for preventing serious complications, especially considering the comorbid course of several diseases in a patient. The prognosis for working capacity is unfavorable. Usually, patients are disabled in group II or even group I. Quality of life depends on systematic long-term treatment. Overall, the prognosis is unfavorable. Purpose – to describe a clinical case of dermatopolymyositis with antisynthetase syndrome against the background of hypothyroid myopathy in autoimmune thyroiditis. Materials and methods. A retrospective analysis of data from a patient with comorbid dermatopolymyositis with antisynthetase syndrome against the background of hypothyroid myopathy was performed. The study was conducted using the following methods: collection of complaints and medical history of the patient, objective examination data, instrumental and laboratory examination methods, consultations with related specialists (endocrinologist, hematologist, gastroenterologist). Results. A clinical case of a 31-year-old female patient with primary manifestations of polyarthritis is described. Further examinations (high levels of Creatine Phosphokinase, Aspartate Aminotransferase, alanine aminotransferasepositive autoantibodies, data of electroneuromyography, capillaroscopy) The final diagnosis was dermatopolymyositis with antisynthetase syndrome against a background of hypothyroid myopathy in autoimmune thyroiditis. In accordance with the American College of Rheumatology / European League Against Rheumatism recommendations, combination therapy (thyroid hormone replacement therapy and mycophenolate mofetil) was prescribed, which led to clinical and laboratory remission and improved the patientʼs quality of life. Conclusions. This clinical case confirms the complexity and demonstrates the importance of considering the comorbid course of inflammatory and endocrine myopathies. Timely comprehensive diagnosis and treatment ensure improvement in the patientʼs clinical condition and quality of life.

<bold>Background:</bold> COPD exacerbations (Es) increase the risk of cardiovascular (CV) events and future Es, necessitating improved cardiopulmonary risk prediction. We aimed to evaluate the role of natriuretic peptides (NPs) in improving risk prediction and proactive management of COPD patients without overt heart failure (HF). <bold>Methods:</bold> We searched PubMed, Google Scholar for articles published from 2015 to 2025. After deduplication, 158 titles and abstracts were screened. 15 observational studies and 1 RCT were included. <bold>Results:</bold> Brain NP (BNP) and N-terminal pro-BNP (NT-proBNP) are valuable biomarkers for identifying COPD patients at high risk of adverse events and death, even without a prior CV history. Factors contributing to increased BNP/NT-proBNP include previously unrecognized HF, severe airway obstruction, chronic hypoxia, hyperinflation, Es, and pulmonary hypertension (PH). 1 SD increase in baseline NT-proBNP linked to a 13% rise in the risk of Es. FEV₁ is inversely related to NT-proBNP. A rapid decline in FEV₁ predicts a 4-fold increase in the risk of HF within a year. Lower levels of α1-antitrypsin are associated with higher levels of BNP. BNP gene polymorphisms linked with COPD, complicated with PH. Increased midregional proatrial NP indicates the risk of osteoporotic fractures. Treatment with nebulized salbutamol increased NT-proBNP levels. Decreased PaCO₂ during noninvasive positive pressure ventilation is linked to lower proBNP levels. Irbesartan and hydrochlorothiazide reduced NT-proBNP in Es. <bold>Conclusions:</bold> NPs are promising biomarkers that can enhance clinical decision-making and proactive management in COPD patients when used alongside other diagnostic tools.

Background. Toxoplasmosis mainly affects immunocompromised individuals, but there are certain gender characteristics that may influence the course of toxoplasmic encephalitis (TE) in HIV-infected men and women. The purpose was to analyze the gender characteristics of TE in HIV-infected patients. Materials and methods. A retrospective analysis of the gender characteristics of the TE course was performed in 23 HIV-infected patients. The gender composition was almost the same: 11 (47.8 %) men and 12 (52.2 %) women. The average age of patients was 37.50 ± 0.38 years. The average number of CD4+ lymphocytes was 102.5 ± 21.2 cells/μl, and the HIV RNA load in plasma at the diagnosis of TE was 292,773.8 ± 113,180 copies/ml. Results. Analysis of the gender characteristics of the clinical course of TE in HIV-infected patients showed that there were significant differences between the groups in a number of clinical signs. Thus, nausea (p &lt; 0.01), speech impairment (p &lt; 0.01) and confusion or loss of consciousness (p &lt; 0.05) were more often detected in men, while fever (p &lt; 0.05), headache (p &lt; 0.05), memory impairment (p &lt; 0.05), hearing loss (p &lt; 0.05), visual impairment (p &lt; 0.05) and facial asymmetry (p &lt; 0.05) were significantly more often diagnosed among women. When studying possible factors that contribute to the occurrence of TE in HIV-infected patients (CD4+ content and IgG level to T. gondii), it was found that the body of men is less resistant to toxoplasmic invasion compared to women. Therefore, TE develops in them even against the background of high CD4+ lymphocytes and low activity of toxoplasmic invasion. The body of women is more resistant, and TE develops against the background of a very low content of CD4+ lymphocytes and high activity of toxoplasmic invasion. Conclusions. Thus, compared to women, clinical manifestations indicating local brain lesions were significantly more often diagnosed in men, while cognitive and mental disorders were significantly more common among women. TE in women develops on the background of a very low CD4+ count (≤ 10 cells) and a high (≥ 401 IU/ml) level of IgG to T. gondii, which causes a more severe clinical course of the disease compared to men.

We present own experience of two years of screening for chromosomal abnormalities in the first trimester under conditions of limited capacity due to military status. To assess the risk of chromosomal abnormalities in the fetus, we used the pregnant woman age, anamnesis, ultrasound markers. Biochemical studies were extremely limited due. The risks were calculated at the FMF software (2.8.1) without biochemical markers. During this period, 351 pregnant women were examined. There were 81 women aged 35 years and older(23.1%). The multiple pregnancies -8(2.3%). 99.7% of the women were Caucasian. Previous Tr. 21-1,1%. NT>3,5mm -1,1%, NT>95‰ –2,2%, NT<5‰ –1,7%. Abnormal NB– 0,8%. Abnormal TR–0,3%. Total PI DV–349, mean=-0,010, Std. dev.=0,0637. Anatomical abnormalities –1,95% (fetal edema, CNS, cardiac, abdominal wall, bone abnormalities, diaphragmal hernia). Based on the distribution of maternal age, it was expected that the study population contained 1.2 cases of Tr 21 and approximately the same number of other chromosomal abnormalities. The calculated risk was 1:100 or more in 4(1.1%) cases. These pregnant women underwent invasive PD or postnatal karyotype determination. Only 1 fetus (0.28%) with an enlarged NT(>3.5 mm) and multiple malformations, which was aborted at 13 weeks' gestation, had Tr18 determined postnatally. Other fetuses with identified anatomical anomalies did not have chromosomal abnormalities. All other pregnancies were no verified fetuses with Tr 21,13,18. In settings with limited capacity and resources (when both technical and time resources are limited), performing an ultrasound scan at 11 - 13 weeks together with risk assessment (without wasting time on additional visits and the impossibility of biochemical screening) significantly improves coverage and provides optimal information on risk groups to determine further management tactics. The calculations obtained in the surveyed population were adjusted to the postnatal results, i.e. we did not observe any missed cases of Tr 21, 13, 18 during the two years of the study.

Our previous 3-period crossover study in healthy volunteers comparing the pharmacokinetics of nalbuphine nasal spray Apain with parenteral nalbuphine solution demonstrated high bioavailability of the nasal spray and close similarity of pharmacokinetic profiles after intranasal and intramuscular administration, especially within 30 min postdose. The aim of the present study was a noninferiority assessment of nalbuphine nasal spray vs. intramuscular injection for pain relief in postoperative patients. Ninety orthopaedic and traumatology patients were enrolled in this double-blind, randomized study of the effectiveness and tolerance of a single 10.5mg dose of nalbuphine nasal spray vs. 10mg intramuscular injection. The summed pain intensity difference (SPID0-6) calculated using visual analogue scale scores was the primary study endpoint. Of 90 subjects enrolled, the per-protocol efficacy population comprised 79 patients; 6 patients in the reference group and 5 patients in the test group were excluded due to remedication. The mean values of study endpoints with 95% confidence interval were as follows in reference and test groups, respectively: SPID0-6= 228.08 (205.73-250.43) vs. 248.73 9 (225.83-271.63), time to pain relief onset =0.28 h (0.25-0.31) vs. 0.27 h (0.25-0.29), duration of analgesia =5.55 h (5.17-5.93) vs. 5.51 h (5.10-5.92), area under the curve = 119.30 (91.17-147.43) vs. 99.81 (74.52-107.10). No statistically significant differences were revealed. Nalbuphine nasal spray Apain has been proven to be a safe, noninvasive alternative to intramuscular nalbuphine to relieve severe postoperative pain. Designed for self-administration and dose-adjusting, the noncontrolled opioid analgesic nalbuphine spray can be used for patient-controlled analgesia in out-of-hospital, field and home settings.