Background. Acute cerebrovascular accidents remain one of the leading causes of mortality and long-term disability. Current therapeutic approaches do not provide sufficient control of neuroinflammation, which necessitates the search for effective corrective strategies. A promising direction involves the use of mesenchymal stem cells (MSCs) in combination with antioxidants, particularly resveratrol, which potentiates the neuroprotective properties of MSCs. Aim: to investigate the dynamics of cytokine concentration changes during the acute and early recovery periods of experimental ischemic stroke under the influence of MSCs and their combination with resveratrol. Materials and methods. A model of focal cerebral ischemia was reproduced according to the E.Z. Longa et al. method (1989). Serum levels of pro-inflammatory (IL-1β, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10, TGF-β1) cytokines, as well as β-endorphin, were determined using ELISA. Animals were divided into three groups: no treatment, MSCs, and combined MSCs + resveratrol therapy. Corrective interventions were administered once daily. Results. MSC monotherapy produced a moderate decrease in pro- and partially anti-inflammatory cytokines during the acute and early recovery phases. Combined therapy resulted in a statistically significant and more pronounced reduction in IL-1β, IL-6, TNF-α, TGF-β1, and β-endorphin levels, indicating suppression of cytokine cascade hyperactivation and normalization of the immune microenvironment. Conclusion. Combined treatment with MSCs and resveratrol provides substantially greater attenuation of the neuroinflammatory response compared with monotherapy. The findings support the potential of a combined cell-based and antioxidant approach for limiting secondary ischemic damage and creating favorable conditions for neurorepair.

Background. Nitric oxide (NO) plays a key pathophysiological role in the development of diabetic retinopathy (DR), as it determines the state of endothelial dysfunction and causes numerous damaging mechanisms. Aim: to determine the content of NO and endothelial NO-synthase (eNOS) in DR and the possibility of their use as diagnostic and prognostic markers of its progression. Materials and methods. 136 patients with type 2 diabetes mellitus were examined, who were divided into groups: 1st – with non-proliferative (NPDR, 60 eyes), 2nd – with preproliferative DR (PPDR; 42 eyes) and 3rd – with proliferative DR (PDR; 34 eyes). Patients were examined and treated for 2 years. The blood NO content was determined by a biochemical method using the end products of its metabolism (NOx) using Griess reagent. The blood eNOS content was determined by an enzyme-linked immunosorbent assay. The analysis of the results was carried out in the EZR v.1.54 package (Austria). Results. In patients with DR, an increase in the blood NOx content was found (1.3-1.4 times; p<0.001) compared to the control group without diabetes. The NOx content at different stages of DR did not differ (p>0.05). The blood eNOS content by stages of DR significantly and progressively decreased, in NPDR it was 1.5 times lower than the control level, in PPDR – 1.6 times and in PDR – 3.7 times (p<0.001). The content of eNOS in NPDR and PDR did not differ statistically significantly from each other (p>0.05), but was higher than that in patients with PDR (by 2.3-2.4 times; p<0.05). The NOx content was correlated with systolic (r=-0.632) and diastolic (r=-0.506) pressure, glycated hemoglobin (r=0.216;), cholesterol and lipoproteins levels. The eNOS content was correlated with fasting glycemia (r=-0.257), central retinal thickness (r=-0.401) and volume (r=-0.391), glycated hemoglobin (r=-0.683), cholesterol and lipoproteins levels. The NOx cut-off level for DR in type 2 diabetes was determined, which was 4.88 μmol/l (prognostic sensitivity – 89.7%, specificity – 100%). The cut-off level of eNOS for NPDR/PPDR was less than 300 pg/ml, for PDR – less than 104.5 pg/ml (prognostic accuracy – 90.1%). The risk of DR progression after 2 years was inversely related to the blood eNOS content (p<0.001; OR=0.16; 95% CI 0.08-0.31). Conclusion. Thus, it was established that an increase in the NOx blood content can be considered a biomarker of DR in type 2 diabetes, and the eNOS blood content is a biomarker of DR and its progression.

Background. Purulent-inflammatory lesions of the skin and soft tissues remain one of the most common pathologies in surgical practice, accounting for up to 35% of hospitalizations and up to 60% of outpatient visits. Their treatment is often complicated by the chronicity of the process, resistance to antibiotics and a high risk of patient disability. Despite positive clinical results, morphological aspects of wound healing have not been studied sufficiently. Aim: to evaluate the clinical effectiveness of application sorbent and bacteriophage (Piophage) in the treatment of purulent wounds in an experimental model, by comparative analysis of pathohistological changes and dynamics of the main phases of the wound process (cleansing, granulation, epithelialization, complete healing) in Wistar rats in comparison with local treatment with hypertonic sodium chloride solution and Levomikol ointment. Methods. The experiment was conducted on 40 white Wistar rats aged 3–4 months, weighing 180–220 g, which were kept under standard conditions of the vivarium of the P.L. Shupyk National University of Health Care of Ukraine. Modeling of purulent inflammation was carried out by subcutaneous injection of 1 ml of bacterial suspension prepared from rat feces, containing E. coli, S. epidermidis and E. faecalis in appropriate concentrations. Morphological changes were studied at different stages of the wound process. Animals were divided into three groups. Group IA (n=17) - treatment with an experimental sorbent based on aerosil and tinidazole and lidocaine immobilized on its matrix; group IB (n=13) - use of the bacteriophage preparation "Piophage" which includes specific bacteriophages at a concentration of not less than 1×105 phage particles for these types of microorganisms. Group II (n=10) performed modeling of the inflammatory process according to the specified method, made an incision at the site of bacterial solution injection, introduced sorbent and sutured the wound tightly with an aseptic dressing. Results. In group IA, the fastest wound healing was observed. In group IB, epidermization was lower, mainly at the edges of the wound. In group II, minimal signs of repair, preservation of inflammation. Morphological and immunohistochemical dynamics confirmed the superiority of the application sorbent over bacteriophage and traditional treatment. Conclusions. The application sorbent provides the fastest and most complete regeneration of purulent wounds, surpassing bacteriophage and traditional treatment in all phases of healing.

Background. Neuropathic pain is a debilitating pain syndrome that underlies phantom pain, in particular - due to combat trauma. Phantom neuropathic pain affects 45-85% of patients who have undergone limb amputations or spinal cord injury. Less than half of patients manage to achieve significant pain relief with pregabalin, gabapentin, duloxetine and tricyclic antidepressants. Taking opioid drugs is accompanied by many undesirable side effects. Aim: to review current data on the possibility of using cannabinoids in the treatment of patients with chronic neuropathic pain. Materials and methods. Analysis of data presented in PubMed, using the keywords “neuropathic pain”, “cannabinoids”, “efficacy”, “safety”. Results. The bioavailability of the main psychoactive component of marijuana, delta-9-tetrahydrocannabinol (THC), orally is only 6% (due to intensive presystemic metabolism in the intestinal wall and the influence of drug transporters P-gp and BCRP), while when smoked it is 25%, and when inhaled it is 10–35%. The pharmacokinetics of another significant component, cannabidiol (CBD), do not differ significantly. Therefore, when cannabis is inhaled, acute pain is relieved, while orally it provides a long-lasting effect, which is advisable to use for constant pain. The THC/CBD ratio in the drug and a gradual increase in its dose are of great importance. An anonymous survey of 227 patients with traumatic spinal cord injury showed that in 87.9%, cannabis reduced the intensity of neuropathic pain by more than 30%. The majority of participants (83.3%) indicated that they had replaced their analgesic medications (including opioids and gabapentinoids) with cannabis. The number of patients needed to treat to achieve a 30% pain reduction is 2.9-3.2 when using medium or low doses of cannabis. Conclusion. Medical cannabis preparations have proven their effectiveness for the correction of neuropathic pain, their effectiveness corresponds to the effectiveness of opioids, while the risk of adverse reactions is significantly lower. It is necessary to take into account the features of the clinical course of the disease and the pharmacokinetics of cannabinoids to choose the route of administration, the initial dose and the rate of dose titration to increase the effectiveness of therapy and minimize the risk of side effects.

Background. Nutrition knowledge is a potential tool for improving disease management in multiple sclerosis (MS). Understanding how patients perceive and utilize dietary advice is crucial for optimizing support strategies to improve MS disease course management. Aim: To evaluate patient satisfaction with dietary advice, explore dietary awareness and the need for tailored educational materials. Materials and methods. A total of 52 patients diagnosed with multiple sclerosis (MS) participated in this single-center survey-based cross-sectional study. Data were collected through structured online questionnaires from MS patients receiving treatment at Kyiv City Clinical Hospital №4 in Ukraine between November 2024 to January 2025, and descriptive statistics were calculated. Results. A total of 59 patients were invited to participate in the survey, with 7 declining to participate. The median age was 36 (IQR: 29-42). The group included 38 (65,4%) inpatient and 14 (34,6%) outpatient participants, with 65,4% being female. Patients were categorized as having relapsing-remitting (86.5%), primary progressive (9.6%), secondary progressive (3.9%) forms of MS. A majority (70.6%) considered nutrition recommendations important, while 49% initiated the primary dialogue about nutrition with physicians, and 67.4% sought information online. Satisfaction with online resources averaged 3.7/5 (n=30), compared to 3.6/5 (n=23) for information provided by physicians. Conclusion. This study indicates moderate satisfaction with dietary information from online and physicians-provided sources, underscoring a necessity for improvement. Patients with MS value nutrition in disease management and express interest in receiving evidence-based guidance, highlighting the need for better educational materials.

Background. There is currently limited evidence on the effective management of intensive care for infective endocarditis (IE), including specific clinical signs that indicate a poor prognosis, as well as prognostic tools that are effective in identifying high-risk patients. Aim: Evaluate the effectiveness of using a severity assessment system in patients with infective endocarditis complicated by acute heart failure in the perioperative stage. Materials and methods. The study included clinical data of 75 patients with IE complicated by preoperative acute heart failure (AHF), who were hospitalised at the State Institution ‘Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine’ from 01.01.2019 to 01.01.2023. At the perioperative stage, clinical and biochemical parameters were assessed and scores were calculated according to the sepsis-associated organ dysfunction score. Results. The median calculated preoperative APACHE II score was 14 points (11;19). In our study, 23 patients (30.7%) belonged to the group with scores from 15 to 19. Surgical intervention under conditions of artificial circulation was performed in 72 (96.0%) cases. At the preoperative stage, hospital mortality was 3 (4.0%) patients with IE complicated by preoperative AHF. The median calculated APACHE II score on the first day of the postoperative period was 11 points (6;13). The distribution of patients based on the APACHE II scale was analysed. The largest number - 12 (16.7%) - of patients had a score of 13 on the APACHE II scale. The largest cohort at this stage was made up of patients with scores from ‘4’ to ‘9’ - 42 (58.3%) cases. In-hospital mortality in the surgical treatment of IE complicated by AHF was 10 (13.9%) cases. Conclusions. A balanced preoperative assessment of the risks of cardiac surgery will allow modifying the tactics of perioperative management of patients with IE complicated by preoperative AHF.

Background. Fibrotic changes as manifestations of a systemic process in the human body are found in a wide range of diseases of the bronchopulmonary system. The genetic component of the process of lung tissue fibrosis, which involves genes of the platelet-derived growth factor (PDGF) family, plays an important role in the clinical course of lung diseases and the formation of isolated consequences, in particular, the development of respiratory failure, which significantly complicates the quality of life of patients. Aim: To determine the role of PDGF family genes in the formation of fibrotic changes in normal and lung pathology, to analyze the ways of correcting the detected disorders. Materials and methods. The article uses the bibliographic method, summarizes scientific publications presented in PubMed and Google Scholar. Results. The literature review presents structural features of PDGF family genes and their receptors (PDGFR). The role of PDGF genes in the processes of physiological development of the lungs, their participation in the mechanisms of the formation of pathological processes accompanied by fibrosis of lung tissue (viral infections, interstitial lung diseases, bronchial asthma) was analyzed. The effectiveness of the use of modern drugs that affect signaling pathways involving genes of the PDGF family and their receptors PDGFR as predictors of the formation of fibrotic changes in lung tissue was evaluated. Conclusion. Genes of the PDGF family play an important role both in the processes of lung development in the neonatal period and in the development of fibrotic changes in lung tissue in a wide range of diseases (viral infections, interstitial lung diseases, bronchial asthma). The introduction into treatment of drugs that affect signaling pathways involving the genes of the PDGF family and the use of tyrosine kinase inhibitors to correct the functioning of PDGFR receptors leads to a reduction in the progression of fibrotic changes in the lung tissue and is one of the modern strategic directions in the treatment of this group of diseases.

Background. Recently, scientific publications on various aspects of the problem of recurrent respiratory infections in preschool children have paid increasing attention to identifying influential factors contributing to frequent episodes of acute respiratory infections (ARI). In particular, these factors include significant deviations in children's physical development from standard values. Aim: to find out the relationship between the frequency of ARI episodes in children aged 60-83 months and their basic anthropometric indicators. Materials and methods. A total of 71 children (44 boys and 27 girls) aged 60-83 months, undergoing inpatient treatment on ARI, were involved in the clinical study. The number of ARI episodes during the previous year of their life was taken into account. Additionally, two integral indices of ARI recurrence, specifically the infection index (InI) and resistance index (RI), were calculated. The basic indicators of physical development were assessed in the children, including: 1) body weight; 2) body length; 3) body surface area; 4) body mass index; 5) chest circumference (CC); 6) integral index of dolichostenomelia. For the comparative analysis of the results obtained, the current standards of physical development indicators for children from the World Health Organization were used. The statistical processing of the digital data was performed with IBM SPSS Statistics 28 licensed software. Results. Rank correlation analysis and cross-tabulation did not demonstrate any interdependence between InI and RI, on the one hand, and the anthropometric indicators considered, on the other hand. Meanwhile, there was a very strong direct correlation between InI and RI (ρ=0.983; p<0.001; 95% CI: 0.972-0.989) in the examined children. Linear regression analysis revealed the dependence of InI and RI on CC size (p<0.001). At that, the degree of the impact of CC size on these clinical indices was almost the same, constituting 7.7% and 7.5%, respectively. Conclusion. Thus, according to the data obtained, the contribution of СС size to the susceptibility of children aged 60-83 months to recurrent respiratory infections among other potential risk factors is insignificant. However, given the widely recognized diversity of mentioned factors, the result deserves due attention. This should be accounted while developing the final integrated model for predicting the frequency of ARI episodes in preschool children.

Background. Individual genetic features can influence to formation of structural and functional changes in organs during EH and encourage the search for biological markers of the state of the myocardium and conclusions about their diagnostic effectiveness. Aim: to improve the early diagnosis of changes in the structure and function of the myocardium and the formation of prerequisites for chronic heart failure (CHF) in women with EH carriers of various polymorphic variants of the LGALS-3 gene (rs2274273), based on galectin-3 plasma level. Materials and methods. 180 postmenopausal women, average age 57,34±0,45, residents of the Podillya region of Ukraine were examined. The main group included 113 women with EH, of which 62 people had EH II, 51 people - EH with CHF C stage according to the ESH 2023 classification. The control group included 67 women without signs of cardiovascular pathology. In addition to the general clinical examination, the research used the enzyme immunoassay method to determine the level of galectin-3 in blood plasma, genotyping of the LGALS3 gene (rs2274273) by means of polymerase chain reaction, and ultrasound of the heart. The statistical processing of the obtained results was carried out using the package of statistical programs SPSS, STATISTICA v. 10.0. Using the MedCalc Software Ltd. Odds ratio calculator (https://www.medcalc.org/calc/odds_ratio.php) the conformity of the frequency distribution of genotypes in the studied population to the Hardy-Weinberg equilibrium was checked and calculated the odds ratio (OR) of the development of left ventricular myocardial hypertrophy (LVH) and CHF on the background of EH. The threshold levels of galectin-3 in blood plasma for the diagnosis of LVH and CHF were calculated using the ROC analysis method. Results. During study the frequency distribution of genotype variants of the galectin-3 gene (rs2274273) among women residents of the Podillya region of Ukraine, it was found that both in people without cardiovascular pathology and in patients with EH II and EH III, the GA genotype predominates, although there is a significant difference between the frequency of occurrence genotypes GA and GG are not noted (p>0.05). The AA genotype variant is significantly less frequent than both the GA and GG genotypes (p<0.01). The frequency distribution of genotype variants corresponds to the Hardy-Weinberg equilibrium. Moreover, the ratio between genotypes in patients of different stages of EH does not reliably differ from that in the control group. However, in EH complicated by CHF among patients with LVEF < 50% A allele carriers significantly predominate compared to GG homozygotes (79.31%, n=23 vs. 20.69%, n=6). In patients with EH, it was found that the concentration of galectin-3 in blood plasma in carriers of the A allele is significantly higher than in carriers of the GG genotype: EH without CHF - 16.82±0.54 ng/ml vs. 12.82±0.54 ng/ml (p<0.01); EH with CHF – 35.70±1.53 ng/ml vs. 25.39±1.38 ng/ml (p<0.001). The threshold levels of galectin-3 plasma concentrations, which indicate the presence of LVH and CHF, are significantly higher in carriers of the A allele than in carriers of the GG genotype. Conclusion. The carriers of the A allele of the LGALS3 gene (rs2274273) have a greater chance of developing CHF with a LVEF < 50% (OR 4.60; 95% CI 1.35 - 15.73 z statistic 2.43 p<0.01 χ2=6 .28; p=0.0122) and correspondingly higher levels of galectin-3 in blood plasma compared to carriers of the GG genotype.