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
Cognitive dysfunction is a frequent yet underrecognized complication of metabolic syndrome (MS), with important medical and social implications. Impairment of cognitive abilities in these patients can reduce quality of life and increase the long-term risk of dementia and social maladaptation. This study evaluated the prevalence and clinical features of cognitive disorders (CDs) in military personnel—combatants—diagnosed with MS. Eighty-two patients with MS (main group) and 40 patients with arterial hypertension (AH) without MS (control group) underwent comprehensive assessment, including
neuropsychological testing, biochemical analysis (lipid profile, glucose), blood pressure measurement, and statistical evaluation. Absence of cognitive impairment was significantly more frequent in the control group (χ2=11.7, p<0.01), whereas moderate CDs predominated in the MS group (χ2=4.2, p<0.05). The MS group demonstrated significantly lower performance across most neuropsychological measures, including screening scales, auditory-verbal memory, attention, processing speed, speech, and spatial orientation. Depression and anxiety scores correlated negatively with MMSE (r=–0.3, p<0.05) and positively with deficits in word memorization, naming, and attention tasks. Elevated triglycerides were associated with poorer attention and delayed recall (p<0.05), while low high-density lipoprotein (HDL) levels correlated with more errors in delayed reproduction (p<0.05). Findings indicate that in military personnel with MS, CDs are predominantly neurodynamic and, at present, do not result in complete social or domestic maladaptation. However, affected individuals remain at elevated risk for progression to severe cognitive impairment and dementia, underscoring the need for early detection and targeted preventive interventions.
Keywords: metabolic syndrome, cognitive disorders, metabolic disorders, hypertriglyceridemia, military personnel, combatants
Cardiovascular-kidney-metabolic syndrome (CKMS) is characterized by a vicious cycle where each pathogenic link exacerbates the others, contributing to progressive deterioration in cardiac function, renal performance, and metabolic stability. The study aimed to assess kidney, heart, and metabolic functions in chronic heart failure (CHF) patients and examine these charac- teristics in dependence on endogenous intoxication severity. A number of 110 CHF patients (main group, MG) and 90 patients without CHF (control group, CG) were studied. The MG had a median age of 69.9 years, with 74.5% male patients. Echocardiographic parameters, renal function markers, and endogenous intoxication indices were measured. CKMS subgroups were stratified by estimated glomerular filtration rate (eGFR): GFR1 (>90 mL/min/1.73 m2), GFR2 (60–90 mL/min/1.73 m2), and GFR3 (<60 mL/min/1.73 m2). MG patients exhibited significantly higher serum creatinine (97.7 μmol/L versus 72.8 μmol/L) and urea levels (7.1 mmol/L vs. 5.3 mmol/L), alongside lower eGFR (67.1 vs. 87.0 mL/min/1.73 m2) compared to CG (p<0.006). Survival analysis revealed a cumulative event-free survival rate of 60.8% in patients with eGFR <60 mL/min/1.73 m2 vs. 75.2% in those with eGFR >90 mL/min/1.73 m2 (p=0.04). Structural heart abnormalities, including reduced left ventricular ejection fraction and increased left ventricle end-diastolic diameter, correlated with declining eGFR levels. Body mass index was inversely related to eGFR and positively associated with adverse cardiac remodeling, hypertension, and metabolic dysregulation. Patients with eGFR <60 mL/min/1.73 m2 demonstrated more severe lipid abnormalities and systemic inflammation, reflected in elevated fibrinogen and middle-mass molecules. CKMS in CHF patients is characterized by impaired renal filtration, metabolic instability, and cardiac dysfunction. These changes correlate with systemic inflammation and endogenous intoxication, underscoring the need for integrated therapeutic strategies targeting these interrelated pathologies.
Keywords: cardiovascular-renal-metabolic syndrome, chronic heart failure, eGFR, endogenous intoxication, systemic inflammation