Polymorphic alleles in genes of folate metabolism are associated with such failures of female infertility like impaired ovulation or fertilisation; however, the data about the single gene polymorphisms in genes which code the enzymes of folate metabolism are controversial. This study aimed to analyse the correlation of polymorphic variants C677T (Ala222Val), A1298C (Glu429Ala) ofMTHFRgene and A66G (Ile22Met) ofMTRRgene with the oocytes’ maturation and early embryo development in women with unexplained infertility. DNA extraction was performed with extraction kits, real-time polymerase chain reaction was applied for single nucleotide polymorphisms determinations, gonadotropinreleasing hormone antagonists were used for controlled ovarian stimulation, obtained oocytes were fertilised by the method of intracytoplasmic sperm injection, early embryo developmentin vitrowas analysed according to the Istanbul Consensus, statistical hypotheses were tested at significance levels of 0.05 and 0.01. The part of good-quality cleavage stage embryos was statistically lower for infertile patients-carriers with mutant allele A1298C ofMTHFRgene in genotype (χ2crit.=18.0361, P=0.000022). A presence of mutant allele A66G ofMTRRgene led to decrease in the number of mature MII oocytes in women with unexplained infertility (χ2crit.=11.1469, P=0.000842). No correlations of studied polymorphisms ofMTHFRandMTRRgenes with total number of received oocytes, fertilisation rate and blastocysts formation rate were found out in studied group. Examination of polymorphic variants in genes of folate metabolism C677T (Ala222Val), A1298C (Glu429Ala) ofMTHFRgene and A66G (Ile22Met) ofMTRRgene could be included to the tests necessary for women with unexplained infertility

The aim of the study was a comprehensive investigation of the morphological and functional features of secondary deformities of the lip and nose in children after primary unilateral cheiloplasty and the identification of the key structural manifestations. The study was carried out in the Department of Plastic and Reconstructive Microsurgery of the National Children’s Specialised Hospital “Okhmatdyt” in Kyiv from 2023 to 2025, within which 57 children with unilateral clefts were examined, with assessment of the parameters of three anatomical zones (upper lip, nose and oral vestibule) in the long-term period after primary cheiloplasty performed in other medical institutions. As a result of the study, it was established that secondary postoperative changes in the nasolabial region were observed in all children (100%), among whom aesthetic deformities were detected in 57.9% and anatomical defects in 42.1%. Moderate forms of severity predominated (47.4%), whereas mild forms accounted for 31.6% and severe forms for 21.0%. The most frequent morphological changes of the upper lip were asymmetry of Cupid’s bow (80.7%), cicatricial changes (73.7%) and reduction of philtral height (66.7%), which were combined with impaired mobility in 50.9% of children. In the structure of the nose, asymmetry of the alae (77.2%), deformities of the columella (68.4%) and hypoplasia of the alar cartilage (63.1%) predominated. In the oral vestibule, common findings were reduction of depth (61.4%), scarring of the mucosa (70.2%) and oronasal communications (29.8%). A correlation was found between the severity of cicatricial changes and the reduction in vestibular depth (r=0.62; p=0.008), indicating the systemic nature of the secondary disturbances. The results obtained confirmed that secondary deformities of the nasolabial region after primary cheiloplasty are systemic in nature, with a predominance of aesthetic disturbances of moderate severity. The data can be used by surgeons, orthodontists, and speech therapists for planning reconstructive and rehabilitation interventions in children

Acute tonsillitis is a common disease with high clinical variability. Traditional approaches based on clinical scores (e.g., Centor) are often insufficient for accurately predicting individual outcomes. The aim of the study was to determine the significance of integrating clinical parameters and oropharyngeal microbial composition data to construct a predictive model for disease duration and symptom severity using the random forest method. Fifty-two patients with acute tonsillitis were examined. Bacteriological analysis of oropharyngeal swabs, clinical assessment using the Centor score, and rapid testing for streptococcal and viral infections were performed. Random forest and linear discriminant analysis models were constructed and compared. The random forest model demonstrated higher accuracy compared to linear discriminant analysis, especially for predicting pain intensity (overall accuracy 81.8% vs 55.0%). For disease duration, the accuracy of the random forest was 72.7% vs 75.0% for linear discriminant analysis. Feature importance analysis revealed that integrating microbiome indices (pathogen/commensal ratio – Pathogen_ratio) with the Centor clinical score significantly improved predictive ability. Disease duration was associated with bacterial aetiology (positive streptococcal test) and smoking status, while pain intensity correlated with microbial dysbiosis parameters. The combination of clinical and microbiological data in machine learning models improves the accuracy of disease progression prediction and can be used to develop personalised treatment approaches

The use of differing diagnostic terms by pathologists in their histopathological reports relating to tumours of the uterine cervix can affect the clinical decision-making of treating physicians or surgeons. A retrospective cross-sectional study was conducted with the aim of evaluating p16 expression in all cervical carcinomas diagnosed solely through cervical biopsies, following a review of their previous diagnoses. Any association between p16 expression and the age of the patient or previous diagnosis was also examined. The mean, median and mode ages in the study were 53±12.4, 60, and 65 years, respectively. In 70 out of 393 cervical biopsies (17.8%) were diagnosed cervical carcinomas. A significant inconsistency in the use of diagnostic terminology by pathologists was observed. Of the 53 cases submitted for p16 immunostaining, 50 cases (94.3%) were p16 positive, and 3 (5.7%) were negative. Moreover, 88.7% of cases were reclassified as squamous cell carcinoma, human papillomavirus-associated, 5.7% as squamous cell carcinoma, human papillomavirus-independent, and 5.7% as Adenocarcinoma, human papillomavirus-associated of the uterine cervix. A mean age at diagnosis of 65 years was not significantly associated; however, the previous categories of large cell non-keratinising and keratinising squamous cell carcinoma showed the highest p16 positivity (p < 0.001). The inclusion of p16 status in pathological reports would not only promote uniformity in histopathological reporting but also assist physicians and surgeons in determining the appropriate treatment approach, predictive value, and prognosis

Small intestine neuroendocrine tumours are becoming increasingly widespread, despite being a relatively rare condition. While abdominal computed tomography scans during routine check-up often detect small intestine neuroendocrine tumours, many cases are still diagnosed unexpectedly during emergency surgery. This subject is relevant because two rare conditions,situs inversus totalisand intestinal malrotation, can also affect the abdominal region thus misleading the diagnosis. The purpose of this study was to highlight the case of an acute onset of small bowel obstruction caused by neuroendocrine tumour with concomitant presence ofsitus inversus totalis.Situs inversus totalisusually stays asymptomatic, being discovered by chance during imaging, or manifests itself early in neonatal period with obstructive features or in old age as acute intestinal obstruction. However, this case is unique as the coexistence of situs inversus totalis and small intestine neuroendocrine tumours causing acute intestinal obstruction has not been previously reported in medical literature. The patient was diagnosed with a case ofsitus inversus totalis; when evaluated for cause of recurrent intestinal obstruction, the patient developed a fresh episode of acute intestinal obstruction while check-up was still ongoing and had to be taken up for emergency exploratory laparotomy. Patient underwent segmental small bowel resection and stapled side-to-side anastomosis. The real cause for recurrent obstructions was neuroendocrine tumour and not preoperatively presumed situs inversus totalis. Despite significant advancements in the treatment and management of small intestine neuroendocrine tumours, which improved patient outcomes, diagnosing these tumours continues to be a substantial challenge. This study aids in keeping a broader mindset on practical grounds, while concluding cause for intestinal obstruction in cases of multiple presumptions

Obesity is a predictor of the development of acute coronary syndrome with ST segment elevation and is realised through increased apoptotic processes. The objective of the study was to evaluate the relationship between body mass index, troponin I as a specific marker of myocardial necrosis and adipose-dependent non-specific markers in patients with acute coronary syndrome with ST segment elevation affected by obesity. An open-label longitudinal comparative cohort study was conducted involving 120 patients with acute coronary syndrome with ST segment elevation, stratified by body mass index into three groups. The levels of troponin I, leptin and caspase-9 (ELISA method) were determined, followed by the use of statistical research methods. In obese patients, a significant increase in the levels of caspase-9 (62.40 ± 3.8 ng/mL) and leptin (57.27 ± 4.1 ng/mL) was found compared to the overweight groups (45.27 ± 2.26 ng/mL and 36.60 ± 2.9 ng/mL) and controls (38.08 ± 2.1 ng/mL and 28.92 ± 2.5 ng/mL; p < 0.001). In group 2, there was a nearly linear relationship between leptin and caspase-9 (r=0.999; p<0.001) and a moderate correlation of troponin I with body mass index (r = 0.632; p < 0.001) and with leptin (r = 0.316; p < 0.05). With increasing body mass index in patients with ST-elevation myocardial infarction, there is an increased correlation between leptin, caspase-9, and troponin I, which promotes the activation of the adipokine-apoptosis-necrosis sequential cascade. Leptin-dependent activation of apoptosis may be one of the key mechanisms of metabolically mediated myocardial damage. The obtained results support the use of leptin and caspase-9 as additional risk stratification markers in acute coronary syndrome

The increasing prevalence of type 2 diabetes mellitus complicated by diabetic foot syndrome and the prescription of high-cost medicines, which are not included in treatment protocols, significantly raise healthcare expenditures and worsen patient outcomes, making the optimisation of pharmacotherapy both a clinical and economic priority. The purpose of this study was to evaluate the rationality of pharmacotherapy for patients with diabetic foot syndrome using an integrated frequency/ABC/VEN analysis. The study applied frequency analysis to assess prescription patterns ATC-classification, ABC-analysis to classify medicines by expenditure levels, and VEN-analysis to determine their therapeutic importance based on national and international treatment guidelines recommendations for type 2 diabetes mellitus. The results demonstrated that etiological and pathogenetic therapies approaches predominated in clinical practice. Antidiabetic agents accounted for the largest share of prescriptions (23%), while antibiotics were essential for managing infectious complications. The integrated frequency/ABC/VEN-analyses revealed that “essential” medicines (44.19%) predominated over “vital” (23.26%) and “non-essential” categories (32.56%), indicating the insufficiently rational prescribing practices in accordance with treatment recommendations. However, a high share of healthcare expenditures was concentrated in a group of high-cost medicines (34.89%), suggesting suboptimal allocation of healthcare resources. The results also highlighted the importance of evidence-based antibiotic selection due to the growing risk of antimicrobial resistance. The study provided a foundation for improving the economic efficiency of pharmacotherapy in patients with diabetic foot syndrome by supporting rational prescribing, optimisation of healthcare expenditures, and the promotion of cost-effective Ukrainian medicines alternatives

Tobacco use provokes the development of numerous pathological changes in the oral mucosa, from inflammatory processes to precancerous conditions and malignant neoplasms, which requires a comprehensive forensic medical assessment to establish cause-and-effect relationships in the investigation of cases of occupational pathology and compensation for harm to health. The study was aimed at summarising existing scientific data on the clinical and forensic features of oral lesions caused by tobacco use and determining the role of dentists in conducting forensic examinations of such cases. A systematic analysis of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 methodology, with a search in international databases. The results of the analysis revealed three categories of lesions with maximum forensic value: erythroplakia (severe dysplasia/carcinoma in situ), leukoplakia with epithelial dysplasia, and submucosal fibrosis with stromal hyalinisation due to the high risk of malignancy. An aetiological relationship was established between tobacco use and the pathogenesis of lesions through biochemical (decrease in glutathione and albumin), immunohistochemical (expression of SERPINA6, SERPINF1, p16), and molecular (microRNA-21) markers. Epidemiological data showed mucosal lesions in 60.1% of tobacco users, with submucous fibrosis (110 cases, 27.5%) and leukoplakia (102 cases, 25.5%) dominating the 400 surveyed. A gradation system for assessing the severity from mild (5-15% disability) to severe (40-100%, persistent dysfunction) was developed, which provides a legal qualification of lesions. Comparative analysis showed a functional differentiation of the competencies of forensic medical experts and dentists, which justified the need for interdisciplinary integration in the examination of tobacco-related lesions. Morphological characteristics of lesions of forensic significance were systematised, and criteria for assessing the severity of tobacco-associated mucosal changes were determined. The necessity of integrating dental knowledge into forensic medical practice and involving dentists in conducting an expert examination in cases of oral pathology associated with tobacco use was substantiated

Seizure syndrome is one of the most common and complex neurological complications in patients with acute brain injuries, particularly following stroke and traumatic brain injury. This complication significantly worsens clinical outcomes, increases the risk of mortality, and prolongs patients’ length of stay in the intensive care unit. This study aimed to determine the frequency of seizure syndrome in patients with stroke and traumatic brain injury, to analyse the main causes of its development, and to evaluate the efficacy and safety of antiepileptic therapy in order to improve treatment approaches and clinical outcomes. A comprehensive literature review was conducted using 50 relevant scientific publications from PubMed, Scopus, Web of Science and Google Scholar databases. The selection was carried out in accordance with PRISMA guidelines and included studies with clearly defined patient populations with stroke or traumatic brain injury, data on seizure frequency, antiepileptic drug use, and statistically analysed results published in peer reviewed journals. Published studies indicated that seizure syndrome occurs in approximately 15%- 30% of patients after stroke and in 20%-40% of individuals with traumatic brain injury. Early seizures (within the first seven days) are consistently reported in approximately 7% of patients after stroke and are associated with a poorer prognosis. The literature review identified multifactorial pathophysiological mechanisms, including primary structural brain tissue damage, secondary metabolic disorders, neuroinflammation, and an imbalance of neurotransmitter systems. Data from numerous studies demonstrated a high efficacy of modern antiepileptic therapy – particularly levetiracetam and lorazepam – estimated at 70%-85% with a favourable safety profile. The binding of levetiracetam to synaptic vesicle protein 2A is widely regarded as a key mechanism of seizure control, while lorazepam remains a first-line drug for the acute management of seizures due to its enhancement of GABAergic transmission

Dyslipidaemia, a major contributor to cardiovascular diseases, necessitates multifaceted treatment strategies. This study aimed to evaluate the effectiveness of combined therapy – including probiotics, lifestyle modifications, and dietary recommendations – in managing dyslipidaemia and its impact on gut microbiota composition. A total of 168 patients with dyslipidaemia were enrolled and categorised according to cardiovascular risk using the SCORE scale. Group 1 included low-risk patients, while Group 2 comprised moderate-risk patients who also received simvastatin. Both groups were prescribed a 12-week probiotic regimen containing Lactobacillus acidophilus LA-5 and Bifidobacterium lactis BB-12, alongside recommendations for physical activity and cholesterollowering diets. Comprehensive assessments of lipid profiles and gut microbiota composition were conducted before and after treatment. The results demonstrated significant improvements in lipid profiles in both groups. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels decreased, while high-density lipoprotein cholesterol levels increased. Statistical analysis showed that the differences in the percentage reductions of lipid profile parameters between the two groups were not statistically significant (p > 0.05), confirming the potential impact of probiotic therapy on lipid levels. Analysis of the gut microbiota revealed an increase in Bacteroidetes, and reductions in Firmicutes and Actinobacteria, along with a notable improvement in the Firmicutes/Bacteroidetes ratio, indicating restored microbial balance. This study highlighted the potential of probiotics as an effective adjunct in the management of dyslipidaemia, capable of complementing – or even reducing dependence on – statin therapy. The findings support the integration of microbiota-targeted therapies into personalised treatment strategies for dyslipidaemia