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Therapeutic Potential of CRISPR-Cas13 for RNA Virus Infections
Full text linkCRISPR-Cas13 is a groundbreaking RNA-targeting tool that has emerged as a promising solution for diagnosing and treating RNA viruses, including SARS-CoV-2, influenza, and HIV. By leveraging the CRISPR-Cas13 system, researchers can precisely target and cleave single-stranded RNA, thereby disrupting viral replication and enabling rapid molecular diagnostics. The CRISPR-Cas13 system boasts several advantages over traditional antiviral strategies, including exceptional specificity and sensitivity, rapid diagnostic capabilities, and potential for broad-spectrum antiviral activity. This technology has far-reaching implications for diagnosing and treating RNA viral infections, which pose significant global health threats due to their high mutation rates and resistance to conventional treatments. While CRISPR-Cas13 holds tremendous promise, there are challenges to be addressed, such as optimizing delivery methods to ensure efficient targeting of viral RNA and minimizing off-target effects. Experiments are also needed to fully elucidate the mechanism of RNA degradation by CRISPR-Cas13 and explore its use in treating diseases. Despite such limitations, promising prospects in practical applications, such as in the SHERLOCK and PAC-MAN systems, have already been demonstrated by CRISPR-Cas13. These innovative technologies have harnessed the power of CRISPR-Cas13 to detect and treat RNA viral infections, paving the way for developing novel diagnostic and therapeutic strategies
On-Going Russo-Ukrainian War and Advancing Forensic Medical Services: Addressing Critical Challenges
Full text linkRussia’s full-scale invasion of Ukraine, launched on February 24, 2022, has caused profound global disruptions, including social and humanitarian crises, economic instability, and significant geopolitical transformations. While these direct effects are widely discussed, indirect influences extend across multiple domains, such as legal frameworks, migration, media narratives, and public policy. Despite significant attention to political and humanitarian aspects, the impact on healthcare systems remains underexplored. In addition, forensic medical services, positioned at the intersection of healthcare and law, remain insufficiently addressed. Thus, this letter aims to draw attention to forensic medical services, discuss their key systemic limitations, propose a pilot education initiative, and outline essential steps to align practices with international standards
Effectiveness of Oral Nutrition Supplements in Older Patients: Evidence Versus Challenges
Full text linkThe increasing population of older adults imposes a significant burden and expenditures on healthcare services. Malnutrition is frequently associated with chronic diseases in older patients. Oral nutritional supplements (ONS) are crucial in managing malnutrition in older adults who need nutritional support. However, challenges related to low adherence may limit the effectiveness of ONS. This narrative review focuses on the difficulties associated with ONS use and the evidence regarding its efficacy in older patients. Studies have reported that ONS can be an effective strategy for nutritional interventions to prevent weight loss by supporting an increase in total food consumption. In addition, ONS have shown positive effects on walking speed and muscle strength in older adults. While the evidence for the positive impact of ONS on enhanced appetite, improved energy intake, and body weight in older patients at risk of malnutrition is well documented, concerns about inadequate consumption, taste and texture dissatisfaction, and low adherence have also been noted. Poor adherence to nutritional therapy may place older patients at risk of medical complications, rehospitalizations, and interruptions in nutritional care. Future qualitative and mixed-method research focused on improving the reporting and follow-up of ONS adherence and understanding the factors influencing acceptance in older patients will strengthen the existing literature and provide valuable guidance for healthcare teams in increasing adherence.
 
Unveiling the Silent Mass: Central Ossifying Fibroma of the Maxilla in an Edentulous Patient - A Case Report and Review of the Literature
Full text linkIntroduction. Ossifying fibroma is a rare, benign fibro-osseous lesion that primarily affects the mandible, with uncommon maxillary involvement. Diagnosing central ossifying fibroma (COF) in edentulous patients presents challenges due to the absence of dental-related symptoms. Herein, we present a rare case of COF in the maxilla of an edentulous patient, highlighting the diagnostic challenges, radiographic features, and surgical management.
Case Report. A 35-year-old female presented with a painless swelling in the right posterior maxilla, progressively enlarging over six months. Clinical examination revealed a bony-hard, non-tender lesion with well-defined margins. Radiographic evaluation showed a well-circumscribed, mixed-density lesion with a sclerotic border, suggesting COF. Histopathological analysis confirmed the diagnosis, revealing bony trabeculae within a cellular fibrous stroma. The lesion was surgically excised, and the patient recovered uneventfully.
Conclusion. This case highlights the importance of considering COF in maxillary swellings of edentulous patients, where delayed diagnosis is common. Advanced imaging and histopathology are crucial for accurate identification, and complete surgical excision ensures optimal outcomes
Epulis as a Manifestation of Periodontal Pathology: Clinical Case and Treatment
No full textEpulis is a clinical term that refers to a reactive localized proliferation of connective tissue in the gingiva, the specific histologic basis of which is not defined. Epulis can affect individuals of any gender and age, but is more common in women and young adults. Clinically, most epulis lesions look similar and are difficult to distinguish from other tumor-like lesions. Since a large number of gingival lesions are macroscopically similar to epulis, the literature has not yet defined an official classification of such lesions.
The aim of the work is to present a clinical case of giant cell epulis in a 25-year-old woman, which was removed by mucosal flap detachment and complete periosteum curettage and bone revision after two previous unsuccessful surgical interventions.
Woman A., 25 years old, complained of an aesthetic defect, namely, gingival enlargement between the 23rd and 24th teeth in the maxilla for 1 year. It is known from the anamnesis that 2 years ago, gingival enlargement in this area first appeared, which was removed by diathermocoagulation. After 6 months, there was a second gingival overgrowth, which was removed by surgical excision of soft tissue, but a few months later there was a recurrence. In the course of our treatment, we excised the growth by detaching the mucous flap from the palatal side, completely removing the granulation tissue in the interdental space up to the unaffected bone, followed by suturing the wound. The material was taken for histological examination, which resulted in the following diagnosis - giant cell epulis. The patient was prescribed accompanying medical treatment in the postoperative period and given recommendations for oral care. Dispensary observation for six months.Епуліс – це клінічний термін, який позначає реактивне локалізоване розростання сполучної тканини в яснах, специфічна гістологічна основа якого не визначена. Епуліс може вражати осіб будь-якої статі та віку, проте частіше зустрічається у жінок та молодих людей. Клінічно більшість уражень епулісу виглядають схоже і їх важко відрізнити від інших пухлиноподібних утворень. Оскільки велика кількість уражень ясен макроскопічно подібна на епуліси, в літературі досі не визначена офіційна класифікація таких уражень.
Мета роботи – висвітлити клінічний випадок гігантоклітинного епулісу у 25-річної жінки, який був видалений шляхом відшарування слизового клаптя та повним кюретажем окістя й ревізії кістки після двох попередніх невдалих хірургічних втручань.
Жінка А., 25 років, звернулася зі скаргами на естетичний дефект, а саме на збільшення ясен між 23 та 24 зубами на верхній щелепі протягом 1 року. З анамнезу відомо, що 2 роки тому вперше виникло збільшення ясен в цій ділянці, яке було вилучене шляхом діатермокоагуляції. Через 6 місяців відбулось повторне розростання ясен, яке видалили шляхом хірургічного висікання м’яких тканин, однак за декілька місяців відбувся рецидив. В ході проведеного нами лікування було висічено розростання шляхом відшарування слизового клаптя з піднебінної сторони, повного видалення грануляційної тканини у міжзубному проміжку аж до неураженої кістки, з подальшим ушиванням рани. Матеріал був взятий на гістологічне дослідження, за результатами якого поставлений наступний діагноз – гігантоклітинний епуліс. Призначено супровідне медикаментозне лікування в післяопераційний період та дано рекомендації щодо догляду за ротовою порожниною. Диспансерне спостереження протягом шести місяців.
Ключові слова: епуліс, доброякісне новоутворення, ротова порожнина. ясна, лікування епулісу, рецидив епулісу, пародонтологія
Age Dynamics of Content of Hydrogen Sulphide, Nitric Oxide Metabolites, Indicators of L-Arginine/Arginase System in the Oral Fluid
No full textAim. To examine age dynamics of content of hydrogen sulphide, nitric oxide metabolites, and indicators of L-arginine/arginase system in the oral fluid of practically healthy individuals of different age groups.
Methods: The study involved 103 patients divided into five age groups (18-89 years). The content of hydrogen sulphide, the sum of nitrites and nitrates, peroxynitrite concentration, L-arginine content and arginase activity were determined in the oral fluid. Statistical analysis was performed using Student’s t-test.
Results: With age (especially after 45 years), the content of nitric oxide metabolites in the oral fluid increases, toxic peroxynitrite accumulates. These changes are observed against the background of relative inertia of L-arginine/arginase system and a decrease the concentration of hydrogen sulphide in the advanced and senile people. The changes in the nitric oxide system may adversely affect the functioning of the system for regulation the vascular tone and immune response, the potential vulnerability of the tooth-jaw system to various diseases. The identified features may be associated with the development of nitroso-oxidative stress, which increases the risk of inflammatory processes occurrence in oral tissues, such as gingivitis and periodontitis, and may also characterise a change of the balance between the pathogenic and beneficial bacteria in the oral cavity that progresses with age.
Conclusions: The detected changes in the nitric oxide system and features of hydrogen sulphide synthesis may be important for understanding the age-related processes of aging in the organism and for developing the new approaches for prevention and treatment of dental diseases
Identification of Biomarkers for Early Diagnosis of Crush Syndrome
Full text linkIntroduction. In the aftermath of natural disasters, hospitals often face a surge of patients with emergency injuries, posing significant challenges to emergency medical response systems. Effective biomarkers are essential for patient follow-up, treatment, and prognosis prediction. Studies to date have attempted to identify indicators of crush syndrome. With this study, we aimed to add to the growing body of literature on this subject.
Methods. This single-center retrospective study analyzed 185 patients admitted with earthquake-related crush injuries between February and March 2023. They were compared with 1,065 patients who were also trapped during the earthquake but did not develop crush syndrome. Demographic, clinical, and laboratory data were utilized for the analysis.
Results. Patients with crush syndrome exhibited significantly higher levels of blood glucose, D-dimer, white blood cell count, hemoglobin, platelet count, absolute neutrophil count, absolute monocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and systemic inflammatory index compared to those without crush syndrome (p < 0.001). Additionally, they had a higher prevalence of upper extremity fractures, lower extremity fractures, pelvic fractures, abdominal trauma, chest trauma, lower extremity trauma, intracranial hemorrhage, pneumothorax, hemothorax, and intraabdominal bleeding (p < 0.001).
Conclusions. Systemic inflammatory indices and biochemical values can be valuable prognostic tools in managing patients after a disaster. Utilizing these indices may enhance the efficient allocation of hospital resources and enable rapid intervention for high-risk patients
Predictors of Fatal Outcomes in Cerebral Aneurysm Rupture
Full text linkIntroduction. Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and disability. Previous studies have reported a range of factors influencing in-hospital mortality after aSAH, sometimes with conflicting findings. This study aimed to identify predictors of fatal outcomes in ruptured cerebral aneurysms (CAs).
Methods. The study analyzed medical records of 421 patients with ruptured CAs. Data included demographics, clinical characteristics, comorbidities, CA size and location, intracranial and infectious complications, and conditions requiring tracheostomy.
Results. Conservative treatment increased the mortality risk fourfold (p < 0.001). Men treated conservatively had a 2.4-fold higher mortality risk (p = 0.039). Each additional hospital day reduced the mortality risk by a factor of 1.09 in microsurgically treated patients (p < 0.001) and by a factor of 1.15 in those receiving conservative treatment (p < 0.001). Preoperative recurrent hemorrhage was associated with a 2.3 times higher mortality risk in microsurgically treated patients (p = 0.003) and a 7.6 times higher risk in patients receiving conservative treatment (p < 0.001). In microsurgically treated patients, aneurysms in the anterior cerebral artery territory increased the mortality risk 2.3-fold (p = 0.007), while in conservatively treated patients, aneurysms in the middle cerebral artery territory increased it 3.3-fold (p = 0.044). A history of arterial hypertension was associated with a 1.83-fold lower risk of mortality among microsurgically treated patients (p = 0.042). Seizures at admission increased mortality fivefold in conservatively treated patients (p = 0.021), while headache at admission reduced mortality 2.2-fold in microsurgically (p = 0.037) and 3.26-fold in conservatively treated patients (p = 0.024). A higher WFNS grade was also a significant predictor of in-hospital mortality. Vasospasm tripled the mortality risk in microsurgically treated patients (p < 0.001). Regardless of treatment, pneumonia and conditions requiring tracheostomy increased mortality (p < 0.001). Surgery reduced mortality in patients with SAH and intraventricular hemorrhage or SAH and parenchymal hemorrhage, lowering the risk 5.15-fold (p = 0.03) and 8.7-fold (p = 0.01), respectively.
Conclusions. Key mortality predictors include male sex, hospital stay duration, extent of hemorrhage, preoperative recurrent hemorrhage, CA location, seizures, absence of headache, a higher WFNS grade, vasospasm, pneumonia, and conditions requiring tracheostomy
Risks of the Insulin Resistance Development in Conditions of Pre- and Postnatal Iodine Deficiency
No full textThe aim of the article is to study the peculiarities of carbohydrate metabolism in rats in pre- and postnatal iodine deficiency, with a gender-based analysis.
Materials and methods. The indices of thyroid homeostasis and carbohydrate metabolism were determined in animals born after natural mating from rats being on an iodine-deficient diet for at least two months from the moment they’ve reached a weight of 150±15 g, and throughout the gestational period of females (prenatal iodine deficiency) being on a diet with a limited iodine content from birth, and in rats that were on such a diet for two months at sexual maturity (postnatal iodine deficiency). The animals in the control group were fed according to a standard vivarium diet.
Results. The experimental animals exhibited hypothyroid dysfunction, accompanied by more significant disturbances of the pituitary-thyroid axis under conditions of prenatal iodine deficiency. In both males and females being on an iodine-deficient diet in the second generation, there was observed an increase in fasting serum glucose levels at 27% and 18% (p<0.05), glycated haemoglobin in whole blood – at 18% and 16% (p<0.05), and HOMA-IR index – at 46% and 27% (p<0.05), compared to control values. Under the conditions of postnatal iodine deficiency, there was observed a tendency towards an increase in serum glucose and, to a greater extent, glycated haemoglobin in whole blood. The findings of this study suggest a high risk of developing insulin resistance, particularly in conditions of congenital iodine deprivation in animals, irrespective of gender.
Conclusions. The maintenance of rats on an iodine-deficient diet over two generations is accompanied by the development of hypothyroid dysfunction concomitant with the development of insulin resistance (characterised by hyperglycaemia, hyperinsulinaemia, an increase in glycated haemoglobin and HOMA-IR index in relation to the control data)
Effectiveness and safety of tumescent anesthesia in the comprehensive management of patients with chronic venous disease of the lower extremities
No full textAim. To improve the efficacy of analgesia and reduce the incidence of complications associated with tumescent anesthesia (ТА) during various stages of surgical interventions in patients with chronic venous disease (CVD) of the lower extremities by identifying the optimal technical parameters for its administration.
Materials and Methods. A single-center, open-label, non-randomized, prospective study was conducted from 2019 to 2024 and included 591 consecutive patients with clinical manifestations of CVD (C2–C6 according to the CEAP classification). TA was administered using a modified Klein solution under continuous ultrasound guidance at a flow rate of 50 mL/min. The primary endpoint of the study was to evaluate the technical characteristics of TA and the effectiveness of the proposed technique for analgesia during radiofrequency ablation (RFA). The secondary endpoint was to assess the safety of TA and the incidence of complications.
Results. A total of 620 lower extremities underwent RFA; 92.7% involved the great saphenous vein (GSV) and 7.3% the small saphenous vein (SSV). Concomitant miniphlebectomy was performed in 85.5% of cases. The mean volume of tumescent solution per centimeter of treated vein was 12.5 mL/cm for the GSV and 13 mL/cm for the SSV. No statistically significant differences were observed between procedures performed as isolated truncal ablation and those combined with miniphlebectomy; however, bilateral procedures demonstrated a statistically significant difference in solution volume (p < 0.05). The perioperative VAS score was 1.9 ± 1.7 cm for isolated RFA and 2.9 ± 1.8 cm for combined treatment with miniphlebectomy, with no significant differences between the groups. Pain scores decreased to 1.2 ± 1.3 cm within 48 hours and increased to 0.68 ± 1.1 cm on postoperative day 7. TA-related complications included ecchymosis in 15.8% of cases and transient paresthesia in 0.7%. No allergic reactions or thermal skin injuries were observed.
Conclusions. The use of tumescent anesthesia with a modified solution and the proposed technique demonstrates a high safety profile and provides effective analgesia, enabling comprehensive treatment of patients with chronic venous disease of the lower extremities while avoiding the need for general or spinal anesthesia