Abstract
Background Disease and non-battle injuries (DNBI) often account for more military casualties than those from
combat wounds. The February 2022 Russian invasion of Ukraine has severely limited access to care in areas with
increasing patient care needs beyond combat injuries. The expansion of the draft resulted in an older military
population susceptible to musculoskeletal injuries, while trench warfare and harsh winters create conditions
conducive to cold weather injuries and infectious diseases. This study aims to assess the prevalence and scope of
DNBI in Ukraine.
Methods We conducted qualitative key informant interviews with Ukrainian military and civilian health care workers
from June 2023-February 2024 using an expanded version of the Global Trauma System Evaluation Tool which had
components focusing on DNBI. Thematic content analysis was used to derive key themes related to DNBI from
interviews.
Results We conducted 36 key informant interviews. Respondents described the wide range of DNBI that Ukrainian
soldiers are experiencing. Infectious disease, cold weather injuries, musculoskeletal injuries, sexual assault, and mental health emerged as prevalent concerns. Respondents described the critical shortage of resources and the high burden on military hospitals as barriers to the delivery of adequate care for DNBI.
Conclusions DNBI in Ukraine are directly related to the physical environment and the age and fitness of the military population. The troop shortage has resulted in soldiers with chronic illnesses returning to duty, while the physical environment limits prevention measures for weather-related injuries and infectious diseases. The complex healthcare challenges created by these factors highlight the importance of a military health system with the capacity to provide service members with the full spectrum of care beyond combat injuries.
Keywords Ukraine, Disease and Non-battle Injury, Conflict, Military Health

Introduction:
Ukraine’s health and trauma care system has been devastated by the Russian Federation’s invasion in 2022. Previous research shared insight of returned volunteers into changes in the system; however, as the war continues there is the need to understand how the observations of United States (U.S.) volunteers and Ukrainians working in healthcare in Ukraine may differ regarding perceptions of the trauma system’s current strengths and challenges.
Materials and Methods: We conducted structured interviews with U.S. healthcare or healthcare-adjacent returned volunteers and Ukrainian healthcare workers using the Ukraine Trauma System Assessment Tool Study Region Observation (TSAT SRO) Tool. Mean scores were calculated for each trauma system domain among both Ukrainian and U.S. groups. t-tests were used to determine if there were any statistical differences between these means among the 2 groups.
Results:
The overall score for the Ukraine trauma system combining scores from U.S. volunteers and Ukrainians was 1.89 out of a possible 3.00. The domains with the highest combined scores included Prehospital, Chemical, Biological, Radiological, Nuclear, and Explosive (score = 2.33), Prehospital Training (score = 2.25), and Definitive Care Facilities: Blood Product Use (score = 2.38). Domains with the lowest combined scores included Injury Prevention (score = 1.55), Definitive
Care Facilities: Disease and Non-Battle Injuries (DNBI) (score = 1.60), and Logistics and Supply (score = 1.55). U.S.
volunteers scored every domain lower compared to Ukrainian respondents. All differences between U.S. volunteers
and Ukrainian responses were statistically significant except Definitive Care Facilities: Telemedicine, Definitive Care
Facilities: Blood Product Use, and Definitive Care Facilities: DNBI.
Conclusions:
TSAT SRO component scoring from observations of U.S. volunteers and Ukrainian healthcare workers suggests the
current Ukrainian trauma system is in development. Domain scores differed between U.S. volunteers and Ukrainians; most were statistically significant, demonstrating the importance of including citizens of a nation versus only foreign healthcare workers in assessing a healthcare or trauma system

УДК: 616.69-008.1-06:616-001.45]-08

Combat injuries mostly cause post-traumatic stress disorder, which is accompanied by erectile dysfunction (ED), decreased sexual desire, premature ejaculation, etc. Neurotic mental disorders, blood vessel diseases, metabolic disor-ders, and partial androgen deficiency take precedence among the many pathological conditions preceding or compli-cating ED, especially for combatants.

The objective: optimization of treatment of psychogenic and mixed forms of ED in men with combat injuries.

Materials and methods. The study included the results of the examination and treatment of 136 men aged 20–53, partici-pants in combat operations with combat injuries, with sexual dysfunction and ED as the main complaint. According to the form of ED, patients were divided into two groups: Group 1 – patients with psychogenic ED after a combat injury (n=84); Group 2 – patients with ED of mixed genesis, included patients, participants in hostilities with endothelial dysfunction, metabolic syndrome, coronary heart disease, late hypogonadism (n=52). The treatment of all patients with sexual dysfunc-tion was carried out individually, depending on the etiopathogenesis of the main diseases and the combat trauma that led to it, as well as the development and course of the leading sexological syndromes, taking into account standardized protocols that allowed dividing patients by identity into groups and carrying our significant statistical calculations.

Results. It was shown that the treatment of men with psychogenic ED, which includes lifestyle modification, rational and explanatory psychotherapy, as well as the use of a PDE-5 inhibitor, such as sildenafil, leads to an increase in the mean IIEF-5 score from 10.8±0.9 (severe form of ED) to 19.6±1.7 (mild form of ED) (р<0.05). It is also advisable to use alpha-adreno-blockers that act on both peripheral and central adrenoceptors. In the treatment of patients with ED of mixed genesis, the best results are observed when androgen replacement therapy is performed with proven androgen deficiency; taking lipid-lowering therapy for persistent dyslipidemia; withdrawal of β-blocker, in cases where it is possible; changing the patient’s harmful life-style; conducting rational and clarifying psychotherapy and its potentiation by taking sildenafil. Such treatment leads to an increase in the average IIEF-5 score from 11.5±0.9 (moderate form of ED) to 17.8±1.6 (mild form of ED) (р<0.05).

Conclusions. The disorders of general and mental health, role functioning at the physical and emotional levels are the main disorders health-related quality of life with psychogenic ED. Lifestyle modification, along with rational and explana-tory psychotherapy, as well as the use of the PDE-5 inhibitor sildenafil, gives positive results. Patients with ED of mixed genesis have impaired general and mental health, physical and emotional functioning, and vital activity. The best treat-ment results are observed when androgen replacement therapy is carried out with proven androgen deficiency; taking lipid-lowering therapy for persistent dyslipidemia; withdrawal of β-blocker, in cases where it is possible; changing the patient’s harmful lifestyle; carrying out rational and clarifying psychotherapy and its potentiation by taking sildenafil.

UDC 616.36-004-06:612.015.11:616.24-008.4]-092

Background. Hepatopulmonary syndrome is one of the most dangerous syntropies in case of liver cirrhosis. Consequently, it is important to determine the role of oxidative stress, acid-base balance and ventila-tion-perfusion disorders as factors of hepatopulmonary syndrome development in cirrhotic patients.

Materials and methods. We included 44 cirrhotic patients with hepatopulmonary syndrome verified according to the patented. Method for diagnosing degrees of hepatopulmonary syndrome severity in patients with liver cirrhosis. In addition tothe traditional examinations, we determined the gas composition parameters in venous blood, acid-base balance parameters, catalase activity and malondialdehyde level in all the patients. The received material was processed on a personal computer using Excel 2010, Statistica 6.0, RStudio v. 1.1.442 and R Commander v. 2.4-4.

Results. Analysis of blood gas parameters revealed the reliability of the difference for PCO2(р = 0.03) depending on the class of liver cirrhosis severity. Also, with the liver cirrhosis severity increase, the malondialdehyde level increased,and catalase decreased. Moreover, significant inverse relationships between malondialdehyde content and PCO2(p = 0.039), HCO3(p = 0.039), TCO2(p = 0.036), Beb (p = 0.049), BEecf (p = 0.043) were found resulting in hypo-capnia and partiallycompensated metabolicacidosis.The found direct correlation between malondialdehyde level and AaDO2(p = 0.044) indicates the arteriovenous pulmonary shunts, ventilation-perfusion disorders. The absenceof catalase content changes can obviously be explained by the fact that its activity can be partially compensatory maintained.

Conclusions. In patients with hepatopulmonary syndrome, the peroxidation activity enhances with anincrease in the liver cirrhosis severity, resulting in the redox homeostasis imbalance, leading to the ventilation-per-fusion disorders and partially compensated metabolic acidosis.

Keywords: liver cirrhosis; hepatopulmonary syndrome; intrapulmonary vasodilatation; oxidative stress; metabolic acidosis