Ukrainian Military Medical Academy

BackgroundRetroperitoneal rectal injuries (RRIs) caused by combined military trauma represent a complex clinical challenge, especially in modern armed conflicts. Traditional management protocols have evolved significantly since World War II, emphasizing fecal diversion and presacral drainage. However, emerging evidence supports primary repair as a viable alternative for select cases. This study evaluates the efficacy of primary repair for RRIs among military trauma patients treated at a tertiary center.MethodsA retrospective cohort study was conducted at the National Cancer Institute, Kyiv, Ukraine, from February 2022 to March 2024. Patients with RRIs due to combined military trauma were analyzed, excluding isolated or intraperitoneal rectal injuries. Surgical interventions included primary repair, loop sigmoidostomy, presacral drainage, and rectal washout. Postoperative outcomes were assessed, including complication rates, hospital length of stay (LOS), and mortality. Statistical analyses included χ2, Fisher’s exact, t-tests, and logistic regression, with p<0.05 considered significant.ResultsTwelve patients met the inclusion criteria, with a median age of 33 years (IQR 27–40). Seven patients underwent primary repair, achieving an 85.7% success rate (χ2=10.89, p=0.001). Patients receiving primary repair experienced significantly shorter LOS (55 days, IQR 44–64 140 days, IQR 99–141, p=0.048) and lower complication rates (28.5% vs 80%, p=0.079). No mortality was reported. Loop sigmoidostomy showed a 66.6% success rate, while presacral drainage and rectal washout yielded limited efficacy, particularly in severe injuries.ConclusionPrimary repair may represent a viable and promising option for managing RRIs in selected patients with combined military trauma, potentially reducing LOS and postoperative complications compared to more invasive approaches. Nevertheless, given the limited sample size (n=12), these findings should be regarded as exploratory, underscoring the need for larger, prospective studies to confirm their validity.Level of evidenceIII-2 A comparative study with concurrent controls.

Background. The aim of the study is evaluate the quality and safety of the sedative effect of anesthesia in ambulant ophthalmic surgery by using continuous intravenous infusion of dexmedetomidine. Materials and Methods. Patients were randomized into groups by age (old people from 65 to 75 years old, old age 76 years, middle age, young people, children), by gender (men, women). The physical status of patients was assessed using the ASA scale and the dynamics of vegetatic activity by the Kerdo index. Sedation was assessed using the Richmond Sedation Scale RASS. Results. It was found that the difference in the frequency of adverse effects of the appointment of Dexmedetomidine clearly confirms the need to adjust the dose of Dexmedetomidine, depending on the state of the autonomic nervous system. The use of Dexmedetomidine according to the recommendations made it possible to achieve a safe level of sedation and eliminate side effects in ambulant ophthalmic surgery. Conclusions: Parenteral continuous infusion of Dexmedetomidine provides an effective level of sedation for ambulant ophthalmic surgery and maintaining patient-surgeon contact. Safety is confirmed by a low level of critical incidents, no respiratory depression at the target sedation level. The patency of the upper airways was better compared to previous experience with propofol

Objective – to assess the impact of an enhanced staged surgical management algorithm, stratified by levels of care, on postoperative complications and mortality in combat-related duodenal injuries. Materials and methods. This prospective study included 51 military personnel with gunshot-induced duodenal injuries. Patients were assigned to an experimental group (n=28) treated according to a newly developed algorithm and to a control group (n=23) managed with a conventional approach. The groups were comparable with respect to age, injury mechanism, duodenal injury severity, overall injury severity, and peritonitis characteristics. Both parametric and nonparametric methods were used in the statistical analyses. Results. Isolated duodenal injuries accounted for 13.7% of cases, while multiple injuries were present in 86.3%. In the experimental group, 82.1% of patients received staged care across levels II, III, and IV, with complex reconstructive and combined surgical interventions such as duodenal diverticulization with gastroenteroanastomosis, pancreaticoduodenectomy, and percutaneous transhepatic cholecystostomy (biliary decompression) primarily performed at level IV care following stabilization. In the control group, the staged model was implemented in only 26.1% of cases, while in the remaining cases, the main volume of surgical intervention was performed at level II care. A length of stay of less than 1 day at level II care was observed in 94% of the experimental group, compared with 5% of the control group (p=0.001). The experimental group demonstrated significantly lower rates of duodenal suture failure (7.1% vs. 52.2%, p=0.001), peritonitis (17.9% vs. 47.8%, p=0.022), sepsis (17.9% vs. 60.9%, p=0.002), and relaparotomies for recurrent peritonitis (14.2% vs. 60.9%, p=0.007). Mortality was 13.4% in the experimental group and 39.1% in the control group (p=0.043). The mean hospital stay was significantly shorter in the experimental group (18.2±7.1 days) compared to the control group (29.3±8.1 days; p &lt; 0.001). Conclusions. The enhanced staged surgical management algorithm for combat-related duodenal injuries significantly decreases the incidence of severe postoperative complications, relaparotomy rates, length of hospital stay, and mortality.

Purpose. The article examines the current state of physical and mental health among Ukrainian youth under martial law, as well as the level of their awareness regarding the principles of a healthy lifestyle. Results. The prevalence of harmful habits among young people—such as smoking, alcohol consumption, drug use, and substance abuse—is analyzed, along with the factors contributing to their emergence. Special attention is given to the impact of leisure activities on the formation of behavioral patterns among youth during wartime. The role of social and educational work in preventing deviant behavior is emphasized. The study utilizes official statistics from the Ministry of Health of Ukraine, the National Social Service, and data from medical and social rehabilitation centers for the years 2022–2025. Conclusions. The study reveals significant challenges in maintaining the physical, mental, and social health of Ukrainian youth during wartime. Analysis of official statistics from the Ministry of Health of Ukraine, the National Social Service, and medical-social centers from 2022–2025 indicates a deterioration in health indicators among young people, primarily due to increased psycho-emotional stress, an unstable social environment, and the spread of deviant behaviors. Practical recommendations are provided to enhance the effectiveness of preventive and educational work with youth, aimed at preserving and strengthening their health.

For a long time, ventilator-associated pneumonia (VAP) remains a common hospital-acquired infection, but its diagnosis and treatment require constant updating. The objective: to determine the features of the clinical course, diagnostics and treatment of VAP in wounded military personnel. Materials and methods. 47 wounded persons with VAP who were undergoing inpatient treatment at the National Military Medical Clinical Center “The Main Military Clinical Hospital” from April 2022 to September 2024 were examined. The inclusion criteria for patients in the study were: 1) the presence of an injury; 2) the presence of an X-ray confirmed diagnosis of VAP; 3) being on mechanical ventilation (MV). The exclusion criteria: clinical and X-ray signs that require differential diagnosis with diseases of specific etiology (tuberculosis). Patients were divided into two randomized groups: 1st group – 22 servicemen with “early” VAP, and 2nd group – 25 servicemen with “late” VAP. The following indicators were analyzed: type of injury and its severity, time of onset – early or late, duration of the patient’s stay on MV, evaluation of the results of general clinical research methods, bacteriological examination of sputum, data from chest X-rays, results of laboratory and instrumental examination methods, effectiveness of antibiotic therapy. Results. The study of the distribution of patients by the nature of the injurious factor showed that the main type of injury in both groups was mine-explosive trauma – 78.3% (18 people) and 84.0% (21 patients), respectively, and gunshot and shrapnel injuries were observed in a significantly smaller number of patients. In both groups, bilateral lung damage prevailed: 77.3% – in 1st group and 80.0% – in 2nd group. In the case of unilateral localization of VAP, polysegmental infiltration was detected, which was complicated by abscessation in 20.0% of cases, and exudative pleurisy – in 13.7%. The majority of patients in both groups had thoraco-abdominal trauma combined with open craniocerebral trauma and thoraco-skeletal trauma combined with non-penetrating traumatic brain injury. All wounded persons with VAP had a high level of C-reactive protein without significant differences between groups – 96.5 ± 0.5 mg/L – in 1st group and 102.1 ± 0.4 mg/L – in 2nd group, respectively (p &gt; 0.05). Serum concentration of procalcitonin was significantly higher in 2nd group and was 4.07 ± 0.05 ng/mL (p &lt; 0.05), which can be as an additional marker to the CPIS scale in establishing the diagnosis of VAP. Analysis of the factors of VAP development showed a high percentage of detection of a combination of highly pathogenic pathogens with a significant difference between the groups (p &lt; 0.05, χ2 = 11.8): 64.0% – in 2nd group and 27.3% – in 1st group. In 2nd group, a significant percentage of strains of Pseudomonas aeruginosa, Acinetobacter, Proteus mirabilis, Klebsiella pneumoniae were detected. Conclusions. A comprehensive clinical and functional examination of wounded servicemen with VAP showed that the development of hospital infection occurs against the background of massive multiple and combined wounds involving many body systems. The etiological factors of VAP are highly virulent and multidrug-resistant microorganisms – primarily Acinetobacter, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae and various types of mixed infections. The isolated pathogens are characterized by multidrug resistance to antibacterial drugs, retaining sensitivity only to colistimethate sodium, cefoperazone/sulbactam, and amikacin. Taking into account the severity of the course, late onset, and high virulence of the pathogens, the initial empirical antibiotic therapy included two broad-spectrum drugs that have anti-cyanopneusin activity and affect Gram-negative microorganisms.

The study presents the results of research on the biochemical parameters of blood serum (including total protein, urea, total lipoproteins, creatinine, activities of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase), as well as the physicochemical properties of muscle tissue in young pigs of the Large White breed of foreign origin, and the calculation of correlations between key quantitative traits. The research was conducted in agricultural enterprises of the Dnipropetrovsk region, at the Research Center for Biosafety and Environmental Control of Agro-Industrial Complex (AIC) Resources of the Dnipro State Agrarian and Economic University, at “Globynskyi Meat Processing Plant” LLC in the Poltava region, in the zootechnical analysis laboratory of the Institute of Pig Breeding and Agro-Industrial Production of NAAS, and the animal husbandry laboratory of the State Institution “Institute of Grain Crops” of NAAS. It was established that the biochemical parameters of the blood serum of young pigs of the Large White breed from the controlled population are within the physiological range for clinically healthy animals. The study of the longissimus dorsi muscle in the general animal sample showed the following values: water-holding capacity – 59.83 ± 0.855 %, active acidity (pH) – 5.63 ± 0.029 units, tenderness – 9.41 ± 0.143 s, color intensity – 71.57 ± 2.215 ext. units × 1000; cooking loss – 21.25 ± 0.404 %. Deviations from the minimum requirements for high-quality meat were: –7.17 % for water-holding capacity, –13.77 % for color intensity, and –16.04 % for tenderness. The proportion of longissimus dorsi muscle samples of high quality was: 12.0 % for water-holding capacity, 16 % for color intensity, and 12 % for tenderness. Statistically significant pairwise correlation coefficients were established between the following trait pairs: pH of the longissimus dorsi × alanine aminotransferase (ALT) activity in serum (r = +0.435, tr = 2.37); water-holding capacity of the longissimus dorsi × urea content in serum (r = –0.405, tr = 2.17); water-holding capacity × total lipoprotein content in serum (r = +0.562, tr = 3.33); color intensity × urea content in serum (r = –0.394, tr = 2.10); color intensity × alkaline phosphatase (ALP) activity in serum (r = –0.520, tr = 2.98); cooking loss × aspartate aminotransferase (AST) activity (r = +0.439, tr = 2.39); cooking loss × alanine aminotransferase (ALT) activity in serum (r = +0.404, tr = 2.16).

Introduction. The war in Ukraine has exacerbated the humanitarian crisis and severely damaged the healthcare infrastructure, which had already been weakened in recent years by the COVID-19 pandemic, creating a new threat to the fight against tuberculosis. The incidence of tuberculosis within the Armed Forces has increased, mirroring the broader trends of rising tuberculosis rates across Ukraine.Problem Statement. In light of the difficult epidemic situation with tuberculosis globally, in Ukraine, and within its Armed Forces, the issues of diagnosis, treatment, and prevention of tuberculosis have become extremely urgent.Purpose. The aim of this study is to analyze the specific developments in tuberculosis infection among military personnel and the need for the implementation of innovative measures for its prevention, early diagnosis, and treatment. Materials and Methods. The materials for this study included reports on tuberculosis incidence from 2017 to 2023 among servicemen within the administrative territorial zones of responsibility, as determined by the Regional Sanitary and Epidemiological Department of the Command of the Medical Forces of the Armed Forces of Ukraine. Analytical and epidemiological methods, as well as mathematical modeling techniques, have been applied.Results. The relationship between the increase in tuberculosis incidence among the servicemen of the Armed Forces of Ukraine and the armed aggression by the Russian Federation was highlighted. From 2021 to 2023, a sharp increase in military personnel illness rates was observed, rising from 0.2‰ to 1.82‰. The morbidity ratio in 2023 compared to 2022 was 170.09%. The predicted incidence rate for 2024 is 1.42‰ (unfavorable).Conclusions. Ensuring effective treatment for tuberculosis, particularly multi-drug resistant forms, through the use of innovative early diagnosis methods, is one of the primary objectives for domestic medicine. Additionally, identifying cofactors contributing to tuberculosis development remains a crucial task.

Analyzing the security situation in Europe, especially using methods of comparison, classification, as well as the real time method, and relying on statistical and factual data, the article identifies the dominant challenges and threats that currently affect the effectiveness of defense and security strategies in European countries. It is proven that against the background of deglobalization processes, the international system is degrading and fragmenting; in the course of the fierce confrontation between democracy and various authoritarianisms, alternativeversions of the world order are being formed; European nationalisms are strengthening, that, by distancing themselves from helping Ukraine, the victim of russian aggression, in their own way ensure the legitimacy of the russian dictator, ignoring the prospects of the russian army’s invasion of their own territory. In addition, the instability of the security situation in Europe is caused by the change of presidential power in the USA and the uncertainty of the policy of the Donald Trump’s administration regarding Euro-Atlantic cooperation, NATO, as well as the not yet fully understood degree of “understanding of russian” by the American president, and, accordingly, his role in ultimately taming the aggressor country, or vice versa - deepening the “understanding” of russian neo-imperialism, racism and ignoring war crimes.

Introduction. Clinical and diagnostic approaches to the detection and treatment of perilymphatic fistulas (PLF) have remained controversial in modern otolaryngology for the past five decades. The main approaches in the patient treatment protocol are the identification of PLF, the time of its detection, and the timeliness of treatment. Aim. To evaluate the clinical and functional outcomes of treatment in patients with unilateral sudden and acute sensorineural hearing loss, fluctuating and sensorineural deafness, as well as perilymphatic fistulas by assessing the effectiveness of minimally invasive diagnostic tympanotomy with one-step labyrinthine window plastic surgery. Materials and methods. Analysis of long-term follow-up treatment outcomes of 37 patients with PLF in labyrinth windows areas who underwent surgery (minimally invasive otomicrosurgical intervention with optimal combined microscopic and endoscopic visualization and closure of the affected area) in 2016–2020 was conducted. The perilymphatic fistula was repaired using a free connective tissue-fat flap with additional sealing of the labyrinthine windows area with fragments of gelaspon soaked with dexamethasone solution. In follow-up all patients were examined by otomicroscopy, pure tone threshold audiometry, impedancemetry, vestibulometry, temporal bones CT scans and magnetic resonance imaging of the brain. Results. The long-term follow-up period is composed of 18–24 months. The absence of dizziness after our treatment approach was noted in 28 patients (76 %). In 22 patients (59 %), stable values of improved bone conduction sound perception thresholds were determined at all studied frequencies within 18–24 months after surgical treatment. The average threshold values for bone-conducted sounds were (26.05±6.2) dB. The decrease in air conduction perception thresholds had more pronounced values at frequencies of 500 Hz – 2 kHz. Fluctuating hearing loss persisted in 6 (16 %) patients. In 7 (19 %) patients, hearing at the studied frequencies improved within 5–10 dB, however, instability and uncertainty were noted when walking in the dark. Two patients had no improvement in hearing either in the immediate or long-term follow-up period. Conclusions. Thus, timely diagnostic determination and treatment with PLF closure ensures improvement of vestibular and auditory function with obtaining a positive stable clinical and functional result in the dynamics of the postoperative period.

The present paper aims to provide an overview of the use of biologically active components derived from mineral, synthetic, phyto-, and organic sources in the development of local hemostatic agents. The study highlights the historical and contemporary use of these agents in medical practice, and examines the scientific evidence supporting their efficacy. Hemostasis, the process of stopping bleeding, is a critical component of surgical and medical procedures. Local hemostatic agents are widely used to achieve hemostasis in a targeted and controlled manner, thereby minimizing the risk of complications associated with bleeding. The use of biologically active components derived from various sources, including minerals, synthetic materials, plants, and organic compounds, has a long history in the development of hemostatic agents. These components can act through various mechanisms, such as inducing platelet aggregation, activating the coagulation cascade, or promoting the formation of blood clots. Recent advances in biotechnology and nanotechnology have led to the development of novel hemostatic agents with improved properties, such as enhanced biocompatibility, targeted delivery, and controlled release. These agents have the potential to revolutionize hemostasis in surgical and medical procedures, and improve patient outcomes. Overall, the study highlights the importance of biologically active components derived from mineral, synthetic, phyto-, and organic sources in the development of local hemostatic agents. The review of historical and contemporary use of these agents underscores their continued relevance in medical practice, while recent advances in technology offer exciting new possibilities for future development. After a thorough review of domestic and foreign literature, the development team used adsorbing materials from biologically active components of mineral, synthetic, phyto-, and organic origin to create a hemostatic powder known as "PLANTOR." The active components of PLANTOR include aerosol, carrageenan of a special brand, and a specific mixture of medicinal vegetable oils, which have a special sorption effect. Due to the well-selected composition of the product, PLANTOR forms a blood clot in the wound through a biophysical process of liquid absorption. Notably, PLANTOR does not contain procoagulant minerals or nanoparticles that could remain in the human body, and therefore does not belong to means with a chemical or biochemical mechanism of action. Based on the above, it is possible to recommend the hemostatic agent-powder "PLANTOR" of the trade mark "PLANTOR tm" and "Dr. Sokolovskiy R" of the manufacturer "Medpro Nutraceuticals" (Latvia) by order of LLC "Plantor" (Ukraine, Dnipro), the author and owner of the developed technology of the hemostatic agent - powder "PLANTOR" (TU U 20.4-44827581-001:2022) as an auxiliary means of revitalization, local coagulation, treated wound surfaces during emergency medical care for external bleeding.