Vitaliy Tsymbaliuk

Background. Radioactive contamination of the northern districts of Zhytomyr Oblast with caesium-137 and strontium-90 persists to the present day, generating cumulative mutagenic and epigenetic burden on the developing organism of children. Despite four decades having elapsed since the disaster, no systematic analysis of the structure of neurological pathology in the affected districts, incorporating data from contemporary diagnostic methods, has been conducted to date. Purpose. To systematise data on the spectrum of neurological pathology in children from radioactively contaminated territories of Zhytomyr Oblast, to analyse the transformation of its structure, and to evaluate the role of chronic low-dose radiation exposure as a teratogenic and mutagenic factor within the framework of current neurobiological concepts. Materials and Methods. A systematic literature review was conducted using PubMed, Google Scholar, Cochrane Library, and the repository of the Vernadsky National Library of Ukraine, with a search depth spanning 1990–2025. Regional medical and statistical data, population-based data from the OMNI-Net congenital anomaly surveillance programme, and original clinical observations verified by diffusion tensor imaging tractography and whole-exome sequencing were additionally analysed. Results. The structure of neurological pathology in the contaminated territories has undergone substantial transformation over the past decade. Among congenital malformations of the central nervous system, anomalies of the posterior cranial fossa, corpus callosum, and hippocampus — structures particularly susceptible to chronic low-dose radiation exposure — have come to the fore, displacing neural tube defects and microcephaly. Concurrently, the pattern of referrals from affected territories is now dominated not by congenital structural anomalies but by neurodevelopmental disorders — autism spectrum disorders, epileptic and developmental encephalopathies. Precise statistical data in Ukraine are lacking: no epidemiological study of neurological disorders in children residing in radiation-contaminated zones has been conducted, and official registries capture only referrals rather than true disease prevalence. The presented clinical case illustrates the combined neuropathology typical of affected districts, comprising structural brain changes, epileptic encephalopathy, and neurodevelopmental impairment resulting from radiation-induced damage to major white matter tracts. Conclusions. Chronic low-dose radiation exposure remains a persisting determinant of neurological pathology formation in children from the affected territories. Neurodevelopmental disorders in young children from affected districts constitute an indication for comprehensive neurological investigation aimed at identifying their underlying cause. An urgent priority remains the establishment of a regional registry of neurodevelopmental disorders in children from radioactively contaminated territories.

The object of this study is the high-power UV radiation at different pulses and its effect on Bacillus anthracis spores. The destruction of pathogenic microorganisms at environmental objects is the key to sustainable epizootological well-being. The results of the study show that the effect of powerful pulses on the destruction of pathogenic microorganisms is achieved during a short series and even single exposures. In this case, a pulsed UV sterilizer based on a magnetoplasma compressor with a pulsed ultraviolet flux power of 3.6 MW with a wavelength of 185‒320 nm of ultraviolet radiation was used. The prospects for pulsed sterilization technology have been shown. As a result of laboratory tests, it was established that the elimination degree of spores of the test microorganism Bacillus anthracis CTI, applied to wooden plates, is lg 2.5; applied to plastic plates – lg 3.2, while the degree of death of spores applied to metal plates is lg 4.0. Based on the results, wood and plastic require more attention when choosing disinfection methods due to their lower efficiency in this context. The high resistance of spore microorganisms requires the use of high dose loads to neutralize the anthrax pathogen. The proposed disinfection methodology is relevant and can be used by veterinary medicine laboratories, livestock farms of various forms of ownership, the scientific community, and industrial enterprises manufacturing technological equipment. Further research should be aimed at devising and improving methods for combating pathogenic microorganisms and ensuring sustainable epizootic well-being

У статті проаналізовано основні результати виконання у 2024 р. Програми спільної діяльності Національної академії медичних наук України та Національної академії педагогічних наук України на 2023-2025 роки, обговорені на засіданні Президії НАПН України 23 січня 2025 р. Співпраця двох академій у межах реалізації Програми спільної діяльності актуалізована кризовими реаліями воєнного стану в країні, їх тяжкими наслідками для життя, здоров’я та розвитку українського суспільства, завданнями для відновлення людського потенціалу держави, збереження його фізичного та психічного здоров’я.Охарактеризовано основні результати виконання запланованих Програмою заходів співпраці, серед яких розроблення нормативного та науково-методичного забезпечення, зокрема щодо впровадження результатів досліджень з проблем медичної психології, застосування психотерапевтичних технологій у наданні допомоги постраждалим із проявами посттравматичного стресового розладу, подолання травмівного досвіду військовослужбовців та їхніх родин, організації навчання військових з інвалідністю, популяризації здорового способу життя серед дітей і підлітків, розроблення дитячо-орієнтованих програм з психічного здоров’я і психосоціальної підтримки, вивчення ментального здоров’я українців в кризових умовах воєнного стану та ін. Наведено основні спільні науково-практичні заходи, проведені вченими академій з метою популяризації і широкого впровадження результатів наукових досліджень.Окреслено перспективні завдання, що потребують подальшого вирішення у рамках спільної діяльності НАМН України та НАПН України. Зокрема, щодо розширення співпраці вчених академій у спільних робочих групах з розроблення і реалізації державної політики з питань охорони життя та здоров’я дітей та молоді; здійснення спільних проєктів і програм, спрямованих на науково-інформаційне забезпечення науковців і практиків освітянської галузі з питань формування здорового способу життя в дітей та підлітків; обмін результатами досліджень з проблем здоров’язбережувальної діяльності, психологічної підтримки різних категорій населення в умовах воєнного стану та ін.

The Department of Psychoneurology for Children with Perinatal Pathology and Orphan Diseases at the SI “Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine” has a multidisciplinary team which provides care to children with orphan diseases from all over Ukraine. Thanks to modern methods of clinical, instrumental and genetic diagnostics, it is possible to establish a definitive diagnosis. Aim - to provide a literature review and a clinical case of a child with pathogenic variants of the ARID family genes, which, in particular, lead to the development of Coffin-Circe syndrome (CCS), autism spectrum disorder and intellectual disability, as well as the development of nervous system tumors in children. The article presents a clinical case of a child with a rare disease - CCS, which is part of the ARID gene mutation spectrum. The general clinical and neurological examination, electroencephalographic sleep monitoring, magnetic resonance imaging, whole-exome sequencing, and pathological examination were performed. The difficulty of diagnosis was that a child with skin manifestations of phacomatosis was diagnosed with subependymal giant cell astrocytoma (SGСA) by magnetic resonance imaging, but there were no mutations characteristic of tuberous sclerosis (TSC1, TSC2). Pathologically, the patient was confirmed to have grade I SGСA according to the World Health Organization classification. Two pathogenic mutations of the ARID1A gene in the compound heterozygous state were detected by whole-exome sequencing. After combining the combined clinical and instrumental signs, the diagnosis of CCS with grade I SGСA was established. Conclusions. The disorders caused by ARID1A and ARID1B mutations belong to a spectrum that includes syndromic and non-syndromic cases of intellectual disability, autism spectrum disorder, and CCS with or without a variety of somatic and neurological symptoms, and are grouped under the general term “ARID-related disorders”. Only a thorough medical history, clinical examination, and modern methods of instrumental and genetic diagnostics can make a diagnosis. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors. У відділенні психоневрології для дітей із перинатальною патологією та орфанними захворюваннями ДУ «Інститут педіатрії акушерства і гінекології імені академіка О.М. Лук’янової НАМН України» створено мультидисциплінарну команду, яка надає допомогу дітям з орфанними захворюваннями з усієї України. Завдяки сучасним методам клінічної, інструментальної та генетичної діагностики вдається встановити остаточний діагноз. Мета - навести огляд літератури та клінічний кейс дитини з патогенними варіантами генів родини ARID, які, зокрема, призводять до розвитку синдрому Коффіна-Сіріса (КСС), розладу аутистичного спектра та інтелектуальної недостатності, а також до розвитку пухлин нервової системи в дітей. Наведено клінічний випадок дитини з рідкісним захворюванням - КСС, що входить до спектра мутації гена ARID. Застосовано загальноклінічний і неврологічний огляд, електроенцефалографічний моніторинг сну, магнітно-резонансну томографію, повноекзомне секвенування, патогістологічне дослідження. Складність діагностики полягала в тому, що в дитини зі шкірними проявами факоматозу діагностовано за допомогою магнітно-резонансної томографії субепендимальну гігантоклітинну астроцитому (СЕГА), проте не виявлено мутацій, характерних для туберозного склерозу (TSC1, TSC2). Патоморфологічно підтверджено СЕГА I ст. за класифікацією Всесвітньої організації охорони здоров’я. Методом повноекзомного секвенування виявлено дві патогенні мутації гена ARID1A у компаунд гетерозиготному стані. Після об’єднання сукупних клінічних та інструментальних ознак встановлено діагноз - «КСС із СЕГА І ст.». Висновки. Розлади, спричинені мутаціями ARID1A та ARID1B, належать до спектра, що включає синдромальні та несиндромальні випадки інтелектуальної недостатності, розладу аутистичного спектра і КСС із різним поєднанням соматичних і неврологічних симптомів або без них, та об’єднуються під загальним терміном «розлади, пов’язані з ARID». Тільки ґрунтовне вивчення анамнезу, клінічний...

Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds.

Reproductive health problems are attracting the attention of biomedical scientists in connection with changes in the environment. Climate change in the direction of rising temperatures is an urgent threat to human health with negative long-term effects. Under conditions of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature newborns. The priority to reduce the negative health effects of climate change is to identify most sensitive risk groups to the negative impacts of climate change on health, which include pregnant women and newborns. The strategy to prevent and reduce changes in reproductive health is based on the recognition of global warming as a risk factor that contributes to the growth of premature birth and the associated adverse effects of pregnancy.

Objective: the objective of this study was to retrospectively analyze the change in the surgical strategy (SS) of brachial plexus injuries (BPI), the outcomes of different SS and the factors that influenced the establishing process of a new SS in a single surgical centre in Kyiv, Ukraine. Materials and Methods. 148 patients (mean age 29.5) received 76 neurolysis (N), 14 grafting (G) and 58 nerve transfer (NT) surgeries after a mean 7.4 months following BPI. 29 patients received NT of n. phrenicus, 7 –ulnar nerve fascicles, 9 – lateral pectoral nerve, 7 – medial pectoral nerve to musculocutaneous nerve aimed to restore active elbow flexion. Six other patients received NT of ipsilateral extraplexal motor nerves. The follow-up period included neurological examination (MRC Scale), electromyographic examination and angular deviation in the elbow joint during recovered active elbow flexion. 148 patients were retrospectively divided into two groups A (102 patients, received surgeries from surgical team #1) and B (46 patients, received surgeries from surgical team #2). The SS used in each group and its change with time was analyzed during the 6-year span. Results. 41 patients (70.7%) showed recovery of effective power (Ep) (M4-5) of biceps brachii muscle (BB) after NT. 14 patients (18.4%) showed recovery of Ep of BB after N. 4 patients (28.6%) showed recovery of Ep of BB after G. Overall Group A patients received 55 NT, Group B – 3 NT. The number of NT among Group A patients increased in 2013-2019 from 31% to 100% with overall efficacy of NT increased from 50% to 83%. Conclusions. SS of BPI changed only for Group A patients – N was completely replaced by NT in 2019. For Group B patients N remained SS of choice. The establishing of new SS was influenced by four factors (time, anatomy of injury, donor nerves, radiological findings). The factors being processed, allowed us to define optimal time, effective donors and non-reliability of radiology at BPI. We state that it is only matter of own experience, based on the thorough analysis of the technique, that brings positive outcomes after new SS has been adopted.

There was made the analysis of wound ballistics of modern expansive bullets in comparison with shell bullets on 25 blocks of ballistic plasticine (ROMA PLASTILINA No. 1, Ballistic Testing Backing Material), made in the USA, in which one shot from an AKS-74 automatic firearm and carbine ZBROYAR Z-10 with an optical sight was fired. The bullet speed was the highest in 5.45x39 caliber cartridge with a V-max bullet. – 1185 m/s, low in the bullet caliber cartridge .308 Win with a bullet SP, – 664 m/s. The difference is significant at the level of significance α=0.05. In terms of the size of the entrance hole, the largest is from the bullet of cartridge .308 Win with a bullet SP – 10.0 cm, the smallest - from the bullet "PS" with a steel core 5.45x39 mm, cartridge sample of the year 1974 (7H6) – 1.2 cm. The difference is significant at the level of significance α=0.05. In the expansive bullet of type "V-Max" of shortgun cartridge of caliber 5.45x39 mm, the size of the entrance hole was 9.1 cm, with asterial shape having radial gaps and turned edges of ballistic plasticine on the outside. All cartridges with expansive bullets did not have an exit hole after the shot. The dimensions of the formed residual cavity were the largest after firing with .308 Win caliber cartridge with a bullet SP – 25.0x5.0 cm., the smallest – bullet of a military caliber cartridge of 5.45x39 mm (7H6) – 6.0x4.0 cm. The difference is significant at significance level α=0.05. The shape and character of the residual cavity in ballistic plasticine was significant for all expansive bullets, in contrast to the bullet of a military cartridge 5.45x39 mm (7H6), where no such changes are detected. The considerable signs of expansion properties and deformation of the bullet in the form of a "flower of death" were identified in the bullet of caliber cartridge .308 Win with a bullet SP, other bullets with expansive properties showed significant fragmentation, with the location of fragments both in the residual cavity and outside its borders at different distances. Expansive bullets differ significantly at the level of significance α=0.05. The low flight speed of bullets (m/s) of .308 Win caliber cartridges with bullets BTHP and SP is due to their structure, weight, and caliber. Bullet of type V-max with cartridge 5.45x39 mm has the highest speed – 1185 m/s, and due to its design has significant expansive properties. Common to expansive bullets is a entrance hole, the blind nature of the lesion with the presence of a large residual cavity, which is due to kinetic energy return 114.37 E, J/mm2 inside the object of lesion. Fragmentation of expansion bullets occurs inside an object with fragments located at different distances. A .308 Win caliber cartridge with SP bullet causes deformation of s bullet by the type of "death flower" causing significant damage.

Пацієнти з цукровим діабетом (ЦД) знаходяться в центрі уваги з ранніх стадій пандемії COVID‑19, оскільки епідеміологічні дані показують, що вони схильні до підвищеного ризику важких клінічних наслідків. Водночас як глобальна пандемія COVID‑19 продовжує розвиватися, стає все більш очевидним, що зв’язок між COVID‑19 і ЦД є складною патофізіологічною взаємодією. Наслідки COVID‑19 важчі в пацієнтів із ЦД, який здатний прискорити виникнення гострих метаболічних ускладнень, таких як діабетичний кетоацидоз і гіперглікемія. Механізми, які лежать в основі цих зв’язків залишаються нез’ясованими, але вони, очевидно, включають рецептор ангіотензинперетворюючого ферменту 2 (АПФ2), сайт зв’язування для коронавірусу 2 важкого гострого респіраторного синдрому (SARS-CoV‑2), що експресується в ключових метаболічних органах, зокрема, у β-клітинах підшлункової залози (ПШЗ). Потенційно тропізм SARS-CoV‑2 до β-клітин може призвести до пошкодження клітин і порушення секреції інсуліну, викликаючи гіперглікемію і кетоацидоз. Розуміння двонапрямної взаємодії між ЦД і COVID‑19 буде мати вирішальне значення для профілактики та лікування пацієнтів із ЦД. Наявні епідеміологічні дані про COVID‑19 не підтверджують гіпотезу про те, що пацієнти з ЦД схильні до підвищеного ризику інфікування порівняно із загальною популяцією. На сьогодні встановлено, що декомпенсований ЦД є незалежним чинником, який обтяжує перебіг коронавірусної інфекції та вірогідно підвищує ризики фатального наслідку захворювання. В огляді представлена квінтесенція еволюції поглядів патогенетичних і клінічних аспектів розуміння механізмів цього патологічного тандему, а також терапевтичних стратегій лікування пацієнтів із COVID‑19 і ЦД. Оскільки захворюваність на ЦД продовжує зростати в усьому світі, наразі, більш ніж коли-небудь, профілактика ЦД та боротьба з ним повинні стати пріоритетом систем охорони здоров’я всіх країн світу.

The dynamics and likely associative link between global warming and the prevalence of preterm births in Ukraine over the years 2009-2018 was studied. to form modern ideas about the prognosis and prevention of this pathology. Data on medical care for pregnant women, mothers and parturients and adverse effects of pregnancy on preterm birth (form 21) for the period 2009-2018 were obtained from the municipal non-profit enterprise "Ternopil Regional Center of Public Health of Ternopil Regional Council". The correlation between the number of premature births per 100 births according to the average annual air temperature according to the Global Historical Climatology Network from the US Department of Ocean and Atmospheric Research in the climatically homogeneous regions of Ukraine was estimated. Predictive analysis of time series was performed by the method of integrated auto-regression of the moving average (ARIMA). The model error was estimated by calculating the absolute percentage error of the mean (MAPE). Statistical processing of materials was performed using programs Statistica 6.0 (StatSoft, USA) and open statistical package "R". The study meets modern requirements of moral and ethical standards regarding the provisions of legislative acts of Ukraine. Analysis of these reports of women's counseling shows an increase in the average number of preterm births from 2.88 per 100 births in the total number of births in Ukraine – 491445 in 2009 to 3.33, per 100 births in the total number of 309191 in 2018, which testifies to a significant increase in premature births in our country. Since 2009, there has been an annual, varying degree of increase in average annual air temperature in Ukraine. As a result of the correlation analysis, a significant strong direct correlation was established between the average level of premature birth and the average annual air temperature in Ukraine (r=0.84, p<0.05). Regression analysis revealed a significant increase in the number of premature births (per 100 births) in 1, 2, 5, 6, 7, 8 and 10 climatically homogeneous regions and a tendency to increase in, respectively, 3, 4, 9, 11 and 12 climatically homoge­neous regions of Ukraine. Based on the analysis of data on the average annual air temperature in Ukraine for 2009-2018, the average annual air temperature in Ukraine is projected to increase by 0.3 ° С in 3 years (MAPE <10%, p<0.05). The annual number of premature births is expected to increase (cases per 100 births) in 3 years by 0.4 cases per 100 births (MAPE <10%, p <0.05). In the context of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature infants. Strong correlations have been established between the annual number of premature births and the average annual air temperature in Ukraine. Regression models of preterm birth showed a significant increase in 1, 2, 5, 6, 7, 8, and 10 cli­matically homogeneous regions and a tendency to increase in 3, 4, 9, 11 and 12 climatically homogeneous regions. The annual number of premature births in Ukraine is projected to increase by 2023 by 20 cases per 100 births compared to 2018. The strategy for preventing premature births and related adverse effects of pregnancy should include the identification of global warming as a risk factor for increasing level of this pathology.