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Серцева недостатність є глобальною медико-соціальною проблемою, що постійно зростає та значно впливає на якість і тривалість життя, а також створює величезне економічне навантаження. Сучасні лабораторні дослідження набули ключового значення у веденні пацієнтів із СН, зокрема завдяки відкриттю натрійуретичних пептидів (BNP/NT-proBNP), які є основними маркерами діагностики, оцінки тяжкості та моніторингу ефективності терапії. Комплексний біохімічний аналіз крові, що включає електроліти, показники функції нирок і печінки, ліпідний спектр та маркери запалення, дозволяє виявити супутні патології та фактори, що обтяжують перебіг СН, як-от інсулінорезистентність. Ці дослідження є незамінними для індивідуального підбору лікування, прогнозування перебігу захворювання та своєчасної корекції терапії, оскільки повністю вилікувати СН наразі неможливо, але її прогресування можна сповільнити. Таким чином, інтегрований підхід до лабораторної діагностики є основою ефективного управління серцевою недостатністю.
Ключові слова: серцева недостатність, натрійуретичні пептиди, біомаркери

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