Introduction. Ovarian Insufficiency, characterized by a premature loss of ovarian function, presents a significant challenge for women, with limited effective treatments available. While widely used in other medical fields, platelet-rich plasma (PRP) therapy has recently emerged as a promising approach, offering potential for ovarian rejuvenation and improved fertility outcomes. The aim of the study. To develop a greater understanding of platelet-rich plasma therapy-enhanced ovarian rejuvenation as a promising approach towards ovarian insufficiency and fertility preservation. Materials and methods. An extensive review was conducted using PubMed, ScienceDirect, and Google Scholar databases, focusing on studies published between 2019 and 2024. Studies investigating PRP therapy for ovarian insufficiency and infertility in both human and animal models were analyzed to assess the mechanisms, efficacy, and safety profile. Results. PRP therapy enhances ovarian repair by increasing blood flow to ovarian tissue, inhibiting apoptosis of granulosa cells, and promoting cellular repair to restore hormonal balance. It is associated with increased (anti-mullerian hormone), decreased (follicle stimulating hormone), and higher antral follicular counts. PRP alleviates menopausal symptoms, restores regular menstrual cycles and improves embryo quality in in vitro fertilization. Animal models further support PRP’s role in ovarian tissue repair. Additionally, its use in polycystic ovarian syndrom, endometriosis, and intrauterine adhesions are under investigation. Conclusions. Overall, platelet-rich plasma therapy is a breakthrough in reproductive medicine for treating ovarian insufficiency, recurrent implantation failure, and menopausal symptoms, offering a non-invasive, cost-effective alternative with regenerative properties. While promising, optimal dosage, safety profile, and long-term health implications remain unclear. Large scale trials and follow-up studies post pregnancy are needed to standardize platelet-rich plasma use protocols. If standardized, platelet-rich plasma could play a vital role in fertility treatments for women in the future, potentially transforming the landscape of reproductive medicine.

Introduction. Subclinical hypothyroidism (SH) is a common borderline thyroid dysfunction characterized by elevated thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) and free triiodothyronine (FT3) levels. It frequently affects middle-aged individuals, particularly in iodine-deficient regions. While current clinical guidelines generally do not recommend levothyroxine therapy for SH, interest is growing in phytotherapeutic options with potential regulatory effects. The aim of the study. To assess the effectiveness of a three-month course of the herbal-vitamin complex "ThyroComplex" in middle-aged patients with SH living in an iodine-deficient area. Materials and methods. Twenty-nine patients aged 45-59 years, predominantly women, received "ThyroComplex" 1 capsule twice daily for three months. The preparation contains extracts of Potentilla alba, Rhodiola rosea, Feijoa sellowiana, and B-group vitamins. Before and after treatment, we evaluated subjective well-being using the SAN scale which includes categories of well-being, activity, mood, body mass index (BMI), serum TSH, FT4, FT3, antibodies to thyroperoxidase (anti-TPO), to thyroglobulin (anti-TG), and thyroglobulin (Tg). Results. BMI did not change significantly. A trend toward improvement was observed for well-being and activity (0.05 > р < 0.1), while mood showed a significant increase (from 3.84 ± 0.29 to 5.41 ± 0.46; p < 0.05). Thyroid parameters demonstrated a tendency toward lower TSH (from 4.83 ± 0.43 to 3.31 ± 0.35 mIU/mL; p < 0.09), significant increases in FT4, FT3, and reduction in anti-TPO levels (p < 0.05). Tg and anti-TG showed no significant changes. Conclusions. A three-month course of "ThyroComplex" in middle-aged patients with subclinical hypothyroidism was associated with significant improvements in mood, free thyroid hormone levels, and antibodies to thyroperoxidase, indicating potential beneficial effects of this phytotherapeutic approach.

Introduction. Diagnosis of hyperaldosteronism (HD) makes it possible to prescribe specific treatment, which may include mineralocorticoid receptor antagonists, such as spironolactone and eplerenone contributing to improvement of the therapeutic complex. The aim of the study. To assess the plasma aldosterone concentration variations in stage II hypertension patients with comorbid chronic coronary disease, frequent ventricular extrasystoles and different clinical indicators. Materials and methods. We examined 120 stage II HD patients (34 (28.3 %) women and 86 (71.7 %) men aged 34 to 74 (mean age of the examined patients - 57.3 ± 0.9 years) with/and without concomitant chronic coronary insufficiency (CCI), frequent ventricular extrasystoles treated at the municipal institution "Vinnytsia Regional Medical and Diagnostic Center of Cardiovascular Pathology". The study was a randomized one with preliminary stratification by stage II HD diagnosis. The EDTA plasma aldosterone concentration (blood collected in EDTA tubes) was measured by enzyme-linked immunosorbent assay using a commercial kit "Aldosterone ELISA" (Dia Metra, Italy) according to the manufacturer’s instructions. The disease history was: HD - 8.6 ± 6.0, CCI - 4.8 ± 2.6, and arrhythmia - 3.5 ± 3.0 years. The majority (60.8 %, n = 73) of the examined patients had short hypertensive anamnesis not exceeding 10 years. 24.2 % (n = 29) of the patients had the history ranging from 10 to 15 years and only 15.0 % (n = 18) of the subjects had the history exceeding 15 years. Taking into account the diagnosis of concomitant CCI and frequent ventricular extrasystoles, the study was divided into four separate groups: 1-st one (n=30, mean age 52.1 ± 11.1) consisting of HD patients without concomitant CCI and ventricular extrasystoles, 2-nd one (n = 30, mean age 53.9 ± 7.7) included HD patients with frequent ventricular extrasystoles, 3-rd group (n = 30, mean age 61.7 ± 7.5) involved HD patients with concomitant CCI, and the 4-th group (n = 30, mean age 61.6 ± 8.1) consisted of HD patients with concomitant CCI and frequent ventricular extrasystoles. The obtained results were statistically processed by variational statistics methods using Microsoft Excel (2019) and Statistica 12.0 (Statsoft, USA). The values were presented as n (%) - absolute number (percentage) and M ± σ - mean value ± standard deviation of the mean. Results. We used the method of variational statistics to find out that plasma aldosterone concentration in the total cohort of patients (n = 120) varied from 42.8 to 285.0 pg/ml, with an average of 158.1 ± 55.5 pg/ml. Due to abnormal distribution of the indicator in the sample calculated by the Shapiro-Wilk test (W = 0.92, p = 0.04), the results were presented as median and interquartile range (25-th - 75-th percentiles), 152.5 pg/ml and 116.5 - 204.5 pg/ml, respectively. For analytical comparison, the aldosterone result was dichotomized around the median. The rounded median value (153.0 pg/ml) was taken to distinguish groups with relatively small (≤153.0 pg/ml) and relatively large marker content (>153.0 pg/ml) in the examined cohort of patients (hereinafter RSC and RLC). The results of the study show that the plasma aldosterone concentration in 50.0 %, 25.0 %, and remaining 25.0 % of patients was within the range of 116.5-204.5 pg/ml, less than 116.5 pg/ml and over 204.5 pg/ml, respectively. Conclusions. We established that stage II hypertension patients with/without concomitant chronic coronary disease and frequent ventricular extrasystoles (n=120) had the average plasma aldosterone concentration 158.1±55.5 pg/ml (median - 152.5, interquartile range 116.5 and 204.5 pg/ml, respectively). The rounded value of the median indicator (153.0 pg/ml) was taken to distinguish groups with relatively low (≤153.0 pg/ml) and a relatively high concentration of the marker (> 153.0 pg/ml) in the total cohort of patients. The obtained data suggest that significantly higher plasma aldosterone concentration was found in middle-aged and elderly patients compared to young patients, in case of hypertension history over 10 years, in patients with constitutional-alimentary obesity (body mass index >30.0 kg/m2), in groups of patients with concomitant chronic coronary disease, in patients diagnosed concomitant chronic coronary disease and frequent ventricular extrasystoles in the general sample of patients with stage C disease according to the Heart Failure Society of America. The association between aldosterone concentration and administration of such classes of medicines as Angiotensin-Converting Enzyme inhibitors, sartans, thiazide and thiazide-like diuretics, antiplatelet and antilipid agents, and the number of antihypertensive medicines was found.

Вступ. Гострий інфаркт міокарда з елевацією сегмента ST (ST-elevation myocardial infarction – STEMI) супроводжується летальними наслідками, безпосередньою причиною яких доволі часто є аритмії. Мета. З’ясувати характер аритмій у пацієнтів із гострим інфарктом міокарда після первинного крізьшкірного коронарного втручання зі стентуванням інфарктасоційованої вінцевої артерії з різною ефективністю відновлення міокардіяльної перфузії та коморбідними ураженнями. Матеріяли й методи. У дослідженні взяли участь 155 пацієнтів зі STEMI, після первинного крізьшкірного коронарного втручання (ККВ) зі стентуванням інфарктасоційованої вінцевої артерії (ІАВА), яким упродовж 24 год після імплантації стента проводили добовий моніторинг електрокардіограми (ЕКГ). До групи 1 увійшли 92 пацієнти з повним відновленням епікардіяльного кровоплину (TIMI 3) та міокардіяльної перфузії (MBG = 3) до групи 2 – 63 пацієнти з недостатнім відновленням мікроперфузії (TIMI 3, MBG ≤ 2). Результати. Під час добового моніторингу ЕКГ у пацієнтів обох груп реєстрували надшлуночкові та шлуночкові аритмії. У пацієнтів групи 2 (MBG ≤ 2), порівняно з хворими групи 1 (MBG = 3), спостерігали тенденцію до частішої появи суправентрикулярних екстрасистол, в т. ч. парних, їхніх триплетів, епізодів бі-, тригеміній і суправентрикулярних тахікардій. У пацієнтів групи 2 достовірно частіше реєстрували шлуночкові екстрасистоли – ізольовані (p = 0,030), «R на T» (p = 0,010), триплети (р = 0,020), бігемінії (р = 0,022). Порушення ритму переважали у хворих із перенесеним COVID-19 і артеріальною гіпертензією. Висновки. У пацієнтів зі STEMI після стентування інфарктасоційованої вінцевої артерії з повним відновленням епікардіяльного кровоплину (TIMI 3) і мікроваскулярної перфузії міокарда (MBG = 3) реєстрували надшлуночкові та шлуночкові аритмії, які у випадку MBG ≤ 2 є частішими та потенційно загрозливішими для життя. Перенесений COVID-19 і артеріяльна гіпертензія є несприятливими чинниками щодо виникнення аритмій у ранній післяінфарктний період.

Introduction. The long-term impact of balloon pulmonary angioplasty (BPA) on cardiac activity, especially on the electrocardiographic (ECG) picture, is poorly studied, despite its use in well-established therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the study. To investigate the electrocardiography changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension and to determine whether these changes can serve as reliable indicators of treatment effectiveness and long‑term prognosis Materials and methods. A systematic search of PubMed, MEDLINE, and Google Scholar was conducted for publications between 2000 and 2024. Eligible studies included clinical trials, cohort studies, and retrospective analyses reporting quantitative ECG outcomes in CTEPH patients after BPA. 16 studies involving 1,200 patients were included. Data on ECG changes, hemodynamic parameters, and functional outcomes were synthesized narratively. Results. Patients demonstrated significant improvement in ECG parameters: QRS axis normalization in 60.0 %, regression of right ventricular hypertrophy (RVH) with loss of the qR pattern in lead V1 in 75.0 %, and resolution of p-pulmonale and T‑wave inversion in right precordial leads. These changes correlated with a reduction in mean pulmonary arterial pressure (mPAP) from 38.0 ± 11.0 mmHg to 20.0 ± 4.0 mmHg (p < 0.05) and improved six‑minute walk distance (p < 0.01). No long‑term adverse ECG changes attributable to BPA were reported. Conclusions. Balloon pulmonary angioplasty leads to significant electrocardiography improvements in patients with chronic thromboembolic pulmonary hypertension, reflecting better ventricular function and reduced pulmonary artery pressure. Post‑balloon pulmonary angioplasty electrocardiography monitoring represents a cost‑effective, non‑invasive tool for evaluating treatment effectiveness and guiding patient care. Larger prospective studies are required to standardise electrocardiography criteria and confirm their prognostic value.

Introduction. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease frequently associated with cardiac lesion. Aim of the study. To elucidate the prognostic power of clinical predictors of syntropical cardiac lesions in patients with systemic lupus erythematosus. Materials and methods. The study included 118 patients with SLE and cardiac manifestations, most of whom were young women. Patients were stratified according to the presence of SLE-associated cardiac lesion. Data were analyzed using Excel; statistical significance was defined as p < 0.050. An association was considered confirmed if the association coefficient is ≥0.50 or the contingency coefficient is ≥0.30. Results. The study identified the predictive power of clinical indicators and determined that the most informative constellation for detecting mitral valve insufficiency was "joint pain + new skin rash + accentuated second heart sound over the aortic area" with an absolute risk (AR) 93.75 %, for mitral leaflet thickening the optimal constellation was "dyspnea + sensation of irregular heartbeats" (AR 69.23 %), for pericardial effusion it was "joint pain + diminished heart soundsv (AR 33.33 %), for myocarditis the best constellation was "palpitations + systolic murmur at the cardiac apex" (AR 55.17 %). No predictive constellation was found for endocarditis. Conclusions. For each syntropical cardiac lesion in patients with systemic lupus erythematosus, the clinical predictors or their constellations that have optimal prognostic strength, have been elucidated.

Introduction. Breast cancer (BC) remains one of the most common malignant neoplasms worldwide. Mutations in certain genes are the cause of 5.0-10.0 % of all cases of BC, therefore, timely genetic diagnostics can allow for effective prevention, the selection of targeted therapy, and the assessment of the prognosis of the disease. The aim of the study. Determination of the significance of genetic testing in patients with breast cancer based on the analysis of published research results for choosing their treatment and prevention strategies. Materials and methods. The search and analysis for literary sources was carried out among publications in open databases PubMed/MEDLINE, SCOPUS, WEB of SCIENCE and related to the keywords: breast cancer, genetic research, treatment, prevention. Results. The study highlights the shift from focusing on BRCA1/2 genes to the use of comprehensive multigene panels, as well as the role of genetic diagnostics in selecting personalized treatment and prevention strategies for breast cancer. The interpretation of genetic study results is emphasized, with a focus on the use of tests such as Oncotype DX, MammaPrint, Prosigna, and others, which help predict the benefit of chemotherapy and assess the risk of breast cancer recurrence. The article briefly reviews the latest diagnostic technologies, such as multigene panels and liquid biopsy. Examples of targeted therapies based on BRCA1/2 and other gene mutations are described. Conclusions. Genetic testing in women with breast cancer or with a heavy family history allows to identify "risk groups", determining the tactics and strategy of adjuvant treatment, and choosing preventive measures. The use of PARP, HER2, etc. inhibitors when detecting inherited gene mutations in the adjuvant treatment of breast cancer allows for effective personalization of treatment and prevention strategies, improving the prognosis, quality, and life expectancy of patients.

Introduction. Hemorrhagic transformation (HT) is an undesirable complication of ischemic stroke, leading to a significant increase in the duration of hospital stay and a higher rate of mortality due to cerebral infarction. To broaden the knowledge of physicians across various specialties regarding the latest etiological, pathogenetic, and diagnostic algorithms for HT during postgraduate training, it is essential to assess their existing foundational understanding of this complication. The aim of the study. To assess the knowledge of practicing physicians of various specialties regarding hemorrhagic transformation of ischemic stroke. Materials and methods. A survey was conducted among 96 physicians of various specialties (mean age 36.9 ± 11.0 years). Participants were asked to select one of 3-5 proposed answers to five questions concerning the definition, pathophysiology, risk factors, and diagnostic methods of hemorrhagic transformation in patients with ischemic stroke. Results. During postgraduate training of specialists involved in the diagnosis and management of ischemic stroke, it is necessary to provide a more comprehensive coverage of the causal factors and the pathogenetic model of hemorrhagic transformation. Conclusions. During postgraduate training of specialists involved in the diagnosis and treatment of ischemic strokes, it is necessary to more broadly cover the issues of causal mechanisms of occurrence and pathogenetic model of hemorrhagic transformation.

Introduction. Basal cell carcinoma in most cases remains localized in the superficial layers of the skin, without penetrating into deeper tissues. Invasion of underlying structures such as muscle, cartilage, and even bone is extremely rare but clinically significant. Such situations are of particular interest among specialists, because they demonstrate the potential of a tumor to grow aggressively under certain conditions. Invasion of basal cell carcinoma in the sternum is extremely rare, but leads to serious clinical consequences. Such a lesion is accompanied by an increased risk of pathological fractures due to the anatomical features of the bone, a pronounced pain syndrome, a violation of the integrity of the chest, which causes disorders of the respiratory function. In addition, open "bare" areas of osteonecrosis and osteolysis create favorable conditions for the attachment of secondary infection, which greatly complicates of the disease. The aim of the study. To describe the clinical diagnosis and palliative treatment of atypical basalioma of the anterior chest wall complicated by secondary osteomyelitis of the sternum. Materials and methods. A complex, practical-oriented, analytical-descriptive study of the clinical case of patient K., 74 years old, hospitalized on April 21, 2025 at the 4th hospital of the Lviv Territorial Medical Association No. 2, was conducted. A rare case of infiltrative growth of basal cell carcinoma of the chest wall complicated by secondary osteomyelitis of the sternum with its pathological fracture is diagnosed. A thorough clinical, laboratory, microbiological and instrumental examination was carried out. Microbiologically identified Arcanobacterium, etc; features of the therapeutic strategy are considered. An information search of the literature was performed through the search engines Yahoo, Bing and Google, as well as in the specialized professional databases PubMed and Medline using the key terms: basal cell carcinoma, complications, sternal osteomyelitis, Arcanobacterium, complex treatment, sequestrnecrectomy, antibacterial therapy. Results. This article presents a rare clinical case of invasive basal cell carcinoma (basalioma) involving the sternum, complicated by osteomyelitis and pathological fracture, and discusses the therapeutic approach in a patient with severe comorbidities. Following primary excision and histopathological verification of tumor morphology, the patient received standard courses of radiotherapy and polychemotherapy. Sternal fracture and osteomyelitis secondary to basalioma represent exceptionally rare complications that demand a multidisciplinary and comprehensive management strategy. Although basal cell carcinoma is typically superficial, it may exhibit an invasive course with direct involvement of bony structures. Several necrectomies and sequestrnecrectomies were performed, erosive bleeding was stopped, and fragments of the sternum were stabilized. During repeated surgical debridements, despite the presence of sluggish granulation tissue, bacteriological cultures from the sternal defect revealed Corynebacterium striatum (10⁸), Arcanobacterium haemolyticum (10⁷), Pseudomonas aeruginosa (10⁷), E. coli (10⁶), and MRSA. Based on antimicrobial susceptibility testing, systemic therapy with linezolid, a broad-spectrum antibiotic, was initiated, achieving effective infection control. The presence of multidrug-resistant mixed infection necessitated rigorous microbiological monitoring and individualized antibiotic therapy. In palliative patients, even partial improvement in functional status and infection control possesses considerable clinical value, enabling preparation for potential radical intervention. This case shows the tumor’s capacity for aggressive progression under certain conditions, including long-standing disease, immunodeficiency, protein-energy malnutrition, or inadequate management. Sequential surgical debridement with concurrent chest wall stabilization proved critical for infection control, respiratory improvement, pain relief, and wound healing. The presented case is a atypical example of the invasive course of basal cell carcinoma with deep sternal bone involvement, pathological fracture, and chronic osteomyelitis caused by Arcanobacterium and other pathogens. It broadens current take on the possible clinical spectrum of basal cell carcinoma and highlights the significance of a multidisciplinary strategy that includes oncologists, surgeons, infectious disease specialists, and microbiologists. Conclusions. Basal cell carcinoma, usually has superficial manifestations, sometimes shows an invasive course, which can lead to damage to bone structures, including front chest wall. Pathological fracture of the sternum and osteomyelitis caused by basal cell carcinoma are extremely rare complications that require complex treatment methods. A multidrug-resistant infection caused by a mixed microflora requires accurate microbiological monitoring and personalized antibiotic therapy. Staged surgical treatment of the wound along with chest stabilization played a critical role in controlling the infection and promoting wound healing. In palliative patients, staged necrotectomies and sequestrnectomies, which determine even a partial improvement of the general and functional condition, effective infection control are extremely important, as they can improve the prognosis and open the possibility for more radical interventions.