Medicine Today and Tomorrow

Addressing key clinical issues during neoadjuvant polychemotherapy in patients with secondary-edematous breast cancer using magnetic resonance imaging

2025-12-08T19:08:57+02:00

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Background. Monitoring tumor regression and perifocal edema using Magnetic Resonance Imaging (MRI) is becoming crucial in NeoAdjuvant Chemotherapy (NAC) for Inflammatory Breast Cancer (IBC), as conventional imaging methods have low reliability for assessing treatment response.

Aim. To investigate the role of MRI in addressing key clinical issues during NAC in patients with IBC. The study aimed to determine the effectiveness of MRI in dynamically assessing the primary tumor and perifocal edema zone, which is essential for adjusting treatment strategies and predicting therapy response.

Materials and Methods. The study included 36 patients with IBC at stage T4bN0–3M0. MRI was performed before treatment and after NAC to evaluate tumor regression and perifocal edema. Statistical analysis was conducted using Statistica 14.0 (TIBCO Software Inc., USA) with non-parametric methods for small samples. Data are presented as Me (median). Results were compared between groups using the Wilcoxon test. Differences were considered statistically significant at p<0.05.

Research Ethics. The study was conducted in accordance with the ethical standards of the World Medical Association's Declaration of Helsinki (1964–2024), European Community Directive 86/609 on the participation of humans in biomedical research, and Order No.690 of the Ministry of Health of Ukraine dated September 23, 2009. Informed consent was obtained from all participants.

Results. Reduction of the edema zone on MRI after adding ranselex to NAC was significantly greater than without it (78.3% vs. 67.7%; p<0.05). Regression of the primary tumor in the ranselex group was also significantly higher (69.2% vs. 57.5%; p<0.05). Primary tumor regression was statistically significantly greater in the combination therapy group (69.2% vs. 57.5%; p<0.05). Dynamic contrast-enhanced MRI was effective in detecting residual tumor tissue after NAC, with a sensitivity of 92.8%, specificity of 82.0%, and overall accuracy of 85.6%.

Conclusions. The feasibility of using MRI as an effective tool for monitoring tumor regression and perifocal edema in IBC patients during NAC and for surgical planning has been confirmed. This enables timely adjustment of treatment regimens and increases the likelihood of treatment response.

Keywords: oncology, MRI, tumor regression, perifocal edema.

Structural dysfunctions and pathways of transformation of public prosthetics policy in Ukraine under martial law: An institutional-economic analysis

2025-12-25T13:46:16+02:00

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Background. The prosthetics system in Ukraine is in a deep crisis due to the full-scale war, which has shifted the priority to mass complex combat injuries, while exacerbating pre-war structural problems: the lack of national standards, a critical shortage of qualified personnel, and fragmented infrastructure. The emergence of high-tech charitable centers has created a precedent for a "two-speed" system, highlighting the need not for improvements but for a structural overhaul of the entire management system.

Aim. To determine the key determinants and effectiveness of public prosthetics policy in Ukraine under martial law, and to substantiate conceptual directions for systemic transformation aimed at creating a stable, fair, and quality model integrated into the national policy of barrier-free access.

Materials and Methods. The study employed a systemic approach, bibliosemantic, regulatory-legal, comparative, quantitative, and qualitative analysis. International (ISO, ISPO) and national standards for prosthetics and orthotics, national legislation, official statistical data, scientific publications, and reports were analyzed. The article provides a comparative analysis of the public policy on prosthetics in Ukraine and the institutionally stable model of the Republic of Lithuania.

Research Ethics. The work was conducted in compliance with the principles of academic integrity. All conclusions are based on the analysis of publicly available data and scientific publications with appropriate references. Since the research did not involve direct work with human subjects or the collection of personal data, approval from a bioethics committee was not required.

Results. A dynamic but contradictory model was identified: despite increased funding and the "money follows the patient" model, there is a concentration of funds among a limited number of centers. A "two-speed" system has formed with a critical technological gap between innovative charitable and technologically outdated state centers. A critical shortage of qualified personnel (approximately 220 specialists) and a significant wage gap between sectors were revealed. The monitoring system is limited to aggregated indicators, making it impossible to assess real quality.

Conclusions. Public prosthetics policy requires a transition from fragmented improvements to comprehensive reform. Its future effectiveness depends on ensuring financial sustainability through flexible multi-source planning, overcoming personnel shortages by creating a national system of education and certification according to international standards, and full integration into the National Barrier-Free Strategy until 2030. This will transform prosthetics from a medical service into a component of continuous medical-social rehabilitation and inclusion.

Keywords: healthcare organization, rehabilitation, disability, traumatology, martial law, barrier-free access.

Morphological study of the gastroprotective effect of a new tablet pharmaceutical composition based on a dry extract of Acorus calamus leaves with quercetin

2025-12-30T15:29:27+02:00

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Background. The high prevalence of gastric ulcer disease and other forms of gastric mucosal damage induced by glucocorticosteroids and non-steroidal anti-inflammatory drugs necessitates the search for new effective gastroprotective agents, particularly those based on herbal raw materials.

Aim. To evaluate the gastroprotective effect of a new pharmaceutical composition in tablet form based on dry sweet flag (Acorus calamus) leaf extract with quercetin ("Airtin") on a model of ethanol-prednisolone-induced gastric damage.

Materials and Methods. The study was conducted on 30 white outbred rats divided into 5 groups of 6 animals each: group 1 – intact control; group 2 – ethanol-prednisolone-induced damage without treatment; group 3 – dry sweet flag leaf extract "Airtin" 30 mg/kg and quercetin 5 mg/kg; group 4 – reference drug ("Vikair" 60 mg/kg); group 5 – reference drug (omeprazole 1.2 mg/kg). Preventive treatment was administered for 3 days before pathology induction and once after it. The state of the gastric mucosa (GM) was assessed by light microscopy of histological specimens stained with hematoxylin-eosin and by the Schiff method (PAS reaction). A semi-quantitative scoring system was used to evaluate the depth of lesions, stromal edema, hemorrhagic manifestations, and the intensity of mucoid secretion (PAS reaction). Statistical data processing was performed using Statistica 6.0 and MedStat 5.2 software with non-parametric criteria. State registration of the research topic 0114U000956.

Research Ethics. The work was performed in compliance with international and national bioethical principles, in particular the European Convention for the Protection of Vertebrate Animals used for Experimental and Other Scientific Purposes (Strasbourg, 1986), according to the protocol of the National University of Pharmacy (Kharkiv, Ukraine) Bioethics Commission.

Results. "Airtin" demonstrated a pronounced protective effect: 4 out of 6 animals in the group showed no signs of destructive-inflammatory process. The scores for lesion depth, stromal edema, and hemorrhages were significantly lower by 92%, 59%, and 73%, respectively, compared to the pathology control group (p≤0.05). The intensity of the PAS reaction was 72% of the intact control. "Omeprazole" also showed efficacy, reducing the analogous scores by 87%, 54%, and 33%. "Vikair" did not provide a significant improvement in morphological parameters.

Conclusions. The new pharmaceutical composition based on sweet flag leaf extract with quercetin reliably exhibits a gastroprotective effect, reducing destructive-inflammatory changes in the GM due to anti-inflammatory, antioxidant, membrane-stabilizing effects, and stimulation of mucus formation. Its activity is not inferior to omeprazole and exceeds the effectiveness of the "Vikair" drug, indicating the prospects for further research aimed at creating a new phytopreparation.

Keywords: phytotherapy, gastropathies, gastric ulceration, plant extracts, Acorus calamus, bioflavonoids, gastroprotection.

Analysis of stroke incidence depending on changes in society and the external environment according to the data of the Mukachivo Central District Hospital for the years 2019, 2020, 2023, 2024

2026-01-17T20:55:55+02:00

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Background. Risk factors for stroke are traditionally divided into uncorrected (age, race, gender) and corrected (associated with adherence to a healthy lifestyle, timely treatment of pathology and perception of stress). Stress levels can increase due to extraordinary events of war and pandemics.

Aim. To conduct a comparative analysis of stroke incidence in the population of the Mukachevo District of Zakarpattia Region of Ukraine in the pre-COVID period, during the pandemic, as well as in the post-COVID period and times of russia's military aggression.

Materials and Methods. A retrospective analysis of medical records of inpatients and the register of patients of the municipal non-profit enterprise "St. Martin's Hospital" (Mukachevo Central District Hospital, Ukraine) was carried out. The 2,316 stroke patients included in the study were exposed to the following risk factors: usual, including controlled and uncontrolled (2019, Group I, 466 patients); ordinary and the impact of the COVID-19 pandemic (2020, Group II, 460 patients); ordinary, the impact of the pandemic and war (2023, Group III, 662 patients); ordinary and the impact of war (2024, Group IV, 728 patients). For the epidemiological calculation, Excel 2019 (Microsoft, USA) and SPSS Statistics 26.0 (IBM, USA) were used. The study was carried out as a private initiative of the authors, without additional funding.

Ethics. The study met the international ethical standards of the Helsinki Declaration of the World Medical Association (1964–2024).

Results. The stroke incidence remained stable in 2019 and 2020 (466 and 460 cases) with a predominance of males (54.1 % and 53.5 %) and the dominance of the ischemic type (80.3 % and 83.0 %). A sharp increase in the number of strokes was noted: 1.42 times compared to 2019 and 1.43 times compared to 2020 in 2023; and 1.56 and 1.58 times, respectively, in 2024. In 2023, an equalization of the stroke frequency between women and men was observed (49.7 % vs. 50.3 %). The largest increase was due to ischemic strokes.

Conclusions. The data obtained indicate no impact of the COVID-19 pandemic on the stroke incidence and a pronounced impact of wartime stress. A statistically significant (p<0.01) association between stroke risk and the psychotraumatic factor was demonstrated, confirmed by an increase in incidence in 2023 by 1.42 times compared to 2019 and by 1.43 times compared to 2020, and in 2024 by 1.56 and 1.58 times, respectively. An association between female sex and increased sensitivity to psychotraumatic factors was identified.

Keywords: social medicine, COVID-19 pandemic, stress, military aggression, ischemic stroke, hemorrhagic stroke.

Comprehensive analysis of the providence of oncogynecologists in the regions of Ukraine in 2015–2020, 2022 and 2023: Resource disparities, epidemiological consequences and management challenges in counteracting cervical cancer

2026-01-21T23:37:12+02:00

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Background. The incidence of Cervical Cancer (CC) among the female population of Ukraine remains consistently high. Uneven distribution of oncogynecologists across regions causes an uneven workload, which affects the effectiveness of medical care provision and early detection of oncopathology.

Aim. To analyze the dynamics of CC incidence in conjunction with the number of oncogynecologists in Ukraine in 2015–2020, 2022 and 2023 on a regional level.

Materials and Methods. Official statistical data on the number of oncogynecologists distributed across regions, as well as epidemiological data on CC cases, were analyzed. The analysis included five macroregions: Western, Southern, Northern, Eastern, and Central. The workload per oncogynecologist was calculated – the number of CC cases per one doctor in each region and each study year. Descriptive statistics and comparative analysis were used. Statistical data processing was performed using Excel 2019 (Microsoft, USA) software package. The study was conducted as a private initiative of the author, did not receive funding from grant programs, and the research topic was not officially registered with a state body.

Research Ethics. The study was based exclusively on aggregated open statistical data containing no personal information. In accordance with the standards of the World Medical Association's Declaration of Helsinki (1964–2024), additional ethical approval was not required.

Results. Significant variability in workload between regions was identified. The highest workload was observed in the Southern and Northern regions in 2015–2017. The Western region demonstrated a stable number of oncogynecologists and a moderate workload despite high incidence. The Eastern region in 2023 had the lowest workload, which may be associated with the disruption of medical infrastructure due to the state of war. The Central region was characterized by stable incidence and staffing indicators, with a gradual decrease in the workload per doctor in recent years.

Conclusions. The conducted analysis allows for the identification of regions with critical staff overload, which require intervention to improve the accessibility of oncogynecological care.

Keywords: oncology, gynecology, regional analysis, staffing, physician workload, epidemiology.

Analysis of the relationship between nasal mucosa mucociliary clearance parameters and the duration and severity of nasal obstruction

2026-02-25T13:04:26+02:00

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Background. One of the common causes of cilia loss in the nasal mucosa is impaired aerodynamics within the nasal cavity. However, the mechanisms underlying the pathogenesis of functional changes in mucociliary clearance associated with impaired nasal aerodynamics remain controversial and poorly understood.

Aim. To identify and analyze the relationship between mucociliary clearance parameters of the nasal mucosa and the duration and degree of nasal obstruction, in order to assess the nature and severity of functional impairments in mucociliary transport.

Materials and Methods. A total of 196 patients with varying degrees of nasal obstruction accompanied by impaired respiratory and olfactory function, with disease duration ranging from 1 month to 5 years, were examined and divided into four groups. Clinical evaluation included assessment of complaints, medical history, otorhinolaryngological examination, rhinomanometry, olfactometry using the Sniffin’ Sticks test (Burghardt®, Germany), including threshold and identification subtests, and assessment of mucociliary clearance. Statistical data analysis was performed using Excel 2022 (Microsoft, USA). The study was conducted within the framework of research projects with state registration numbers 0122U200258 and 0125U001264.

Research Ethics. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki of the World Medical Association (1964–2024), the European Society Directive 86/609 on the participation of humans in biomedical research, and the Order of the Ministry of Health of Ukraine No.690 of September 23, 2009. All study participants provided informed consent.

Results. The most pronounced impairments of ciliary function were observed in patients of Group 3 (ciliary beat frequency (CBF) [6.8±2.2] Hz, saccharin test [34.7±3.3] min) and Group 1 (CBF [7.3±1.4] Hz, saccharin test [24.5±3.1] min), both of whom had severe nasal obstruction. In addition, patients in both groups exhibited marked olfactory dysfunction, reflected by an increased odour detection threshold ([4.1±1.3] points and [3.4±2.4] points, respectively). In patients of Groups 2 and 4, who had moderate and mild nasal obstruction, respectively, partial ciliary dysfunction was observed (CBF [7.6±3.1] Hz, saccharin test [18.0±2.4] min; and CBF [8.2±1.3] Hz, saccharin test [15.0±2.4] min, respectively). However, patients in Group 4 demonstrated marked olfactory dysfunction based on threshold and identification tests, in contrast to Group 2 patients, who showed a mild degree of dysosmia.

Conclusions. It has been determined that a pronounced correlation exists between nasal breathing indicators and the motility of ciliated cells, which directly impacts the functioning of mucociliary clearance.

Keywords: otorhinolaryngology, ciliated epithelium, respiratory disorders, olfactory dysfunction, COVID-19, rhinomanometry.

Regenerative cosmetology in dermatological practice: the use of exosomes and growth factors in skin regeneration

2026-03-03T01:05:04+02:00

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Background. Modern dermatology and cosmetology are actively implementing regenerative technologies for the treatment of skin diseases and correction of aesthetic problems. Exosomes and growth factors are promising bioactive components capable of stimulating the natural mechanisms of tissue regeneration. However, the issues of their optimal application and mechanisms of action at the cellular level remain insufficiently studied.

Aim. To analyze the mechanisms of action of exosomes and growth factors at the cellular level and evaluate the effectiveness of their use in cosmetology procedures and treatment of dermatological diseases.

Materials and Methods. Bibliosemantic and comparative methods were used. Scientific publications for the period 2018–2024 in PubMed, Scopus, and Web of Science databases were analyzed using the following keywords exosomes, growth factors, skin regeneration, wound healing, mesenchymal stem cells, microneedling, laser resurfacing. An analysis of scientific research on the mechanisms of action of exosomes and growth factors at the cellular level, their effect on tissue regeneration, and application in cosmetology procedures was carried out. The results of clinical cases of the use of exosomes and growth factors in laser resurfacing, microneedling, post-acne therapy, and couperose were studied. The study was conducted as a private initiative of the author and did not receive grant support.

Research Ethics. For the analysis, those sources were selected in which compliance with the ethical standards of research was indicated.

Results. It has been established that the use of exosomes and growth factors in dermatology promotes the activation of skin regeneration processes by stimulating fibroblast proliferation, collagen synthesis, angiogenesis, reducing inflammation, and restoring the skin barrier function. The effectiveness of using these bioactive components in the treatment of atopic dermatitis, hyperpigmentation, post-inflammatory erythema, and for accelerating wound healing has been shown. Prospects for the use of exosomes and growth factors in the complex therapy of dermatological pathologies are considered.

Conclusions. Exosomes and growth factors are promising components for use in regenerative cosmetology and dermatology. They demonstrate high efficiency in skin regeneration after damage and in the treatment of various dermatological diseases. Further research is needed to standardize protocols for their use and study long-term results.

Keywords: microneedling, laser resurfacing, atopic dermatitis, post-acne, angiogenesis.

Comparative assessment of the physicochemical and clinical-technological properties of a new acrylic-free plastic for removable denture bases

2026-03-20T05:12:33+02:00

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Background. A significant disadvantage of dental acrylic base materials is the presence of residual methyl methacrylate monomer. In this regard, it is important to develop alternative acrylic-free base materials with increased biocompatibility and improved performance properties.

Aim. To conduct a comparative analysis of the properties of a new self-curing acrylic-free base plastic (BAP) and its analogues based on a generalised quality indicator.

Materials and Methods. Laboratory tests of base plastic samples were conducted in accordance with international standard ISO 20795–1:2013. Physical, chemical, clinical and technological indicators were determined. A comparative analysis in the qualimetric assessment system involved determining qualimetric indicators: relative standardised and qualimetric coefficients and a generalised quality indicator. The results were processed and analysed using methods of variational statistics, including the calculation of the mean value, mean square deviation and standard error of the mean. The comparison of mean values was performed using Student's t-test. The study was conducted as a private initiative of the authors, without additional funding or state registration of the research topic.

Research Ethics. All materials are approved for medical use in Ukraine in accordance with the Technical Regulations for Medical Devices, approved by Resolution of the Cabinet of Ministers of Ukraine No.753 of October 02, 2013, and comply with the requirements of Medical Device Regulation (European Union) 2017/745 and International Organization for Standardization (ISO) 10993 standards. The study was performed in vitro without the involvement of humans or laboratory animals.

Results. All materials studied met the requirements of ISO 20795–1:2013. The proposed acrylic-free plastic was characterised by the absence of residual monomer, low water absorption and solubility, and optimal clinical and technological properties. The generalised quality index was 14.164 and 4.477 bits, respectively.

Conclusions. The developed acrylic-free plastic demonstrates a high level of biocompatibility and can be recommended for the manufacture of bases for removable dentures.

Keywords: dentistry, base plastics, composite materials, residual monomer, multifactorial qualimetric analysis.

Academic maladaptation of international students: psycho-emotional disturbances, social factors, and approaches to correction (literature review)

2025-12-24T17:06:14+02:00

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Background. The increase in the number of international students in Ukrainian higher education institutions against the backdrop of globalization brings the problem of their academic maladaptation to the forefront. This condition, caused by the difficulty of adapting to new academic, socio-cultural, and living realities, manifests as a complex of psychophysiological disturbances that seriously threaten academic success and mental health. In the current conditions of socio-economic uncertainty, it requires in-depth study and the development of practical intervention measures.

Aim. To systematize scientific data on the clinical-psychological structure of academic maladaptation among international students, analyze its key determinants, and, based on a literature review, formulate comprehensive approaches to its psycho-correction and prevention. Систематизувати наукові дані щодо клініко-психологічної структури навчальної дезадаптації іноземних студентів, проаналізувати її ключові детермінанти та на основі огляду літератури сформулювати комплексні підходи до її психокорекції та профілактики.

Materials and Methods. A systematic review and analysis of current domestic and international scientific sources on the research topic were conducted. Methods of theoretical analysis, synthesis, and generalization were used to identify the main components of maladaptation, risk factors, and protective mechanisms.

Research Ethics. Sources describing studies conducted in compliance with ethical rules were analyzed.

Results. It was established that the academic maladaptation of international students is a multicomponent state, the obligatory elements of which include psychoemotional disturbances (anxiety, emotional instability), somatovegetative imbalance, dyssomnia disorders, and social anxiety. The main predictors of maladaptation development include language and cultural barriers, lack of social support, difficulties in interpersonal interaction, financial instability, and academic overload. Social support has been identified as a key factor mitigating stress impact and promoting adaptation. The negative impact of disruptions in life regime on the functional state of students was also revealed.

Conclusions. Effectively overcoming the academic maladaptation of international students requires a comprehensive, integrated approach that combines individual psychological correction aimed at developing adaptive coping strategies and increasing stress resistance with organizational-environmental measures. The latter should include social integration programs, tutor support, creating an inclusive educational environment, and teaching self-regulation skills. The implementation of such measures is a guarantee of not only improving the academic results and psychological well-being of international students but also enhancing the international image of Ukrainian higher education as a whole.

Keywords: psychiatry, medical psychology, social anxiety, somatovegetative imbalance, psycho-correction, social support.

A modern view of the problem of endometriosis from a genetic point of view (literature review)

2026-01-17T20:22:40+02:00

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Background. Endometriosis ranks third in the structure of gynecological morbidity, occurs in [5–10]% of women of reproductive age and is a relevant problem of today due to the increase in the frequency and prevalence of the pathological process. It is accompanied by a violation of menstrual function, reproductive health, pain syndrome, reduces the quality of life of women.

Aim. To analyze foreign literary sources and study the problem of endometriosis from a genetic point of view at the present stage.

Materials and Methods. The study was carried out using the bibliosemantic method and the method of system analysis. The study was conducted as a private initiative of the authors.

Research Ethics. Studies were selected for the review, the performers of which adhered to ethical standards. The study did not require informed consent and approval of ethics committees.

Results. The prevalence of endometriosis worldwide reaches 10% among women of reproductive age (190 million people according to the World Bank's 2017 population estimates). The incidence of confirmed endometriosis is [187.0–298.0] cases per 100,000 women over the age of 15. The peak of the rate falls in the 25–34 age group ([380.6–417.0] cases per 100,000 people). The literature indicates data on a tendency for this pathological process to increase and, accordingly, for the cost of treating endometriosis to rise in many countries around the world. Research proves the intrauterine influence of the synthetic estrogen diethylstilbestrol on the development of endometriosis as a result of disrupted fetal estrogen receptor expression. The development of endometriosis can be caused by early menarche, menstrual cycles shorter than 26 days in late adolescence and reproductive age, tall height of adult women, excessive consumption of trans-unsaturated fats, red meat, exposure to chemicals (polychlorinated biphenyls, dioxin), and night work. Genetic factors in the pathogenesis of endometriosis include disorders of cell adhesion, cell migration, angiogenesis, and inflammatory and hormonal metabolic pathways. Most epigenetic studies are focused on the methylation of DeoxyriboNucleic Acid (DNA). Examples of replicated epigenetic changes are DNA hypermethylation and the silencing of endometrial genes that are normally expressed during the secretory phase of the menstrual cycle, which affects the proliferation and invasion of endometrial cells into surrounding tissues.

Conclusions. From the point of view of the evolution of the disease phenotype, endometriosis is taking on new shapes. The development and course of the disease depends on highly organized influences with generalizing properties – the constitution, its components, somatotype. Such levels of organization include genetic, i.e. deterministic, and environmental factors that play a leading role in the phenotypic implementation of the genetic basis within the normal reaction.

Keywords: gynecology, endometrial disease, reproductive-age women, women's infertility, risk factors, quality of life.

Combined technique of lower eyelid reconstruction using a rotational upper eyelid flap, cartilage and mucosal grafts: a clinical case of functional and aesthetic restoration

2026-01-24T20:23:10+02:00

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Background. Reconstruction of large lower eyelid defects is a complex problem that requires simultaneous restoration of the structural framework, lacrimal drainage function, and an aesthetically acceptable appearance. Combining these goals remains a challenge in reconstructive surgery.

Aim. To evaluate the effectiveness of a combined two-stage technique for lower eyelid reconstruction using a rotational flap from the upper eyelid, autografts of oral mucosa and cartilage, for functional and aesthetic restoration in a patient with a complex post-oncological defect.

Materials and Methods. The paper presents a clinical case of reconstruction in a 38-year-old female patient with a complete absence of the lateral part of the lower eyelid. The technique involved two stages: 1) reconstruction of the posterior lamella with an oral mucosal graft and coverage of the defect with a rotational Tripier myocutaneous flap from the upper eyelid; 2) after 6 months – restoration of the lower eyelid framework using cartilage grafts from the nasal tip and palate, combined with simultaneous rhinoplasty and blepharoplasty of the contralateral eyelid. Results were assessed based on eyelid height, tear film status (Schirmer's test, fluorescein staining), ability for complete closure, and the patient's subjective satisfaction. This work was conducted as part of the dissertation research "Optimization of the method selection for surgical correction of the periorbital zone" (2025–2029).

Research Ethics. The study complies with the principles of the World Medical Association's Declaration of Helsinki (1964–2024). Informed consent was obtained from the patient for the treatment, participation in the scientific study, and publication of clinical materials and images.

Results. After completing the reconstruction, full functional restoration was achieved: eyelid height and position were normalized, complete closure of the palpebral fissure was restored, and symptoms of dry eye were eliminated (the patient discontinued the use of artificial tears). Schirmer's test showed normal tear production. The aesthetic result was rated by the patient as 9/10 and confirmed by an independent expert evaluation.

Conclusions. The proposed combined two-stage technique, integrating a rotational flap, mucosal and cartilage grafts, is an effective approach for comprehensive functional and aesthetic restoration of complex lower eyelid defects. The method allows for the recreation of anatomical structure, ensures stability of the eyelid margin, and achieves a high level of patient satisfaction.

Keywords: plastic surgery, myocutaneous flap, complex eyelid defect.

Treatment and rehabilitation of a patient with multiple fractures of the lower legs and feet after blast injury: a clinical case

2026-01-30T21:09:27+02:00

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Background. Optimization of combat surgical trauma management, particularly timely amputation and subsequent prosthetics, is a relevant task of wartime medicine.

Aim. To analyze the full cycle of treatment and rehabilitation of a patient with severe combined blast injury of both lower limbs using a clinical case example, focusing on a multidisciplinary approach and quality of life assessment.

Materials and Methods. A clinical case of treatment of a 42-year-old serviceman with open comminuted fractures of both lower leg bones and feet, as well as blast injury to the chest and abdomen, is presented. Clinical examination data, radiological studies, and dynamic observation were used. The patient's condition was assessed using the Glasgow Coma Scale. Treatment effectiveness and quality of life were evaluated using the Ukrainian version of the standardized EuroQol EQ-5D-5L questionnaire. The study did not receive targeted support in the form of grants from public or private foundations, it was carried out as a private initiative of the authors.

Research Ethics. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki (1964–2024). The patient provided informed voluntary consent for the use of his anonymized medical data for scientific analysis and publication. The research algorithm and methods were approved by the local ethics commission.

Results. The initial treatment strategy included intensive therapy, antibiotic prophylaxis, primary surgical debridement, VAC (Vacuum-Assisted Closure) therapy, and osteosynthesis with external fixation devices. On day 18, a purulent complication (S. aureus) developed, with a predicted unfavorable outcome for preserving the right limb. After discussion with the patient, amputation of the right lower leg was performed. Rehabilitation at a specialized center included physiotherapy, therapeutic exercises, orthotic support for the left limb, and prosthetic fitting for the right. Assessment with the EQ-5D-5L on day 134 showed significant limitations (profile 21212, index 8), while after 12 months, significant improvement was recorded (profile 11110, index 4).

Conclusions. This clinical case demonstrates that the success in managing severe blast injuries is based on a multidisciplinary approach, timely application of modern surgical technologies (VAC therapy, external fixation), timely and justified decision-making for amputation when the prognosis is unfavorable, and subsequent comprehensive rehabilitation with prosthetics. This algorithm allows not only saving the patient's life but also ensuring a high level of functional recovery and quality of life.

Keywords: orthopedics and traumatology, combat surgical trauma, amputation, quality of life, EQ-5D, medical rehabilitation.

Evolution of medical pedagogy in Ukrainian lands (lecture)

2025-12-01T13:44:30+02:00

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Background. The relevance of this study lies in the need for a comprehensive analysis of the historical stages of the formation and development of medical pedagogy in Ukrainian lands, reflecting the continuity of the educational tradition in 10^th–20^th century. It allows comprehension of contemporary educational paradigms and the determination of their historical conditioning.

Aim. The retrospective analysis of the evolution of medical pedagogy in the territory of Ukraine from 10^th to the early 20^th century.

Materials and Methods. The authors used a complex of general scientific and special methods: historical method, which provided a chronological analysis of events and stages; the systemic method for considering medical pedagogy as a holistic, dynamic system; and the comparative-historical method for juxtaposing educational approaches from different periods. The study was carried out as a private initiative of the authors, did not receive funding from grant programmes, and the research topic has not been formally registered with a state body.

Research Ethics. The research was conducted in compliance with the ethical norms of academic integrity: mandatory citation of information sources, ensuring the objectivity of the presentation of historical facts, and proper referencing of the works of predecessors.

Results. It is established that approaches to treatment and teaching, linked to monastic and folk medicine, were laid down as early as the Kyivan period. It is proven that the KMA first institutionalized the teaching of medical disciplines, elevating it to a qualitatively new level of the European university tradition. It is emphasized that the second half of the 19^th and the early 20^th century saw the modernization of medical education. The founding of the KhWMI (1910) is highlighted as a key result of this modernization establishing new pedagogical standards oriented towards clinical practice and scientific activity.

Conclusions. The evolution of medical pedagogy in Ukrainian lands in the researched period is a complex but continuous process, characterized by the transition from empirical knowledge to institutionalized university education. The authors investigated markers of this evolution for the further development of national medical science and pedagogy.

Keywords: medical pedagogy, Kyiv Mohyla Academy, Kharkiv Women's Medical Institute, medical education, history of medicine.

Requirements for the design of manuscripts of scientific articles of journals of the Kharkiv National Medical University (in force from 2 July 2025)

2025-12-31T00:30:03+02:00