Temporomandibular disorder (TMD) pain represents a multifactorial musculoskeletal condition, ranking as the second most common chronic pain condition after chronic low back pain. Contemporary research confirms its biopsychosocial nature, determined by genetic predisposition leading to central sensitization, and a wide spectrum of interacting psychosocial and physiological factors that shape the chronic orofacial pain syndrome. This article analyzes the role of genetic factors in the development and chronification of TMD pain. Key genetic markers identified include variations in the COMT gene (val158met, rs4680), which influence catechol-O-methyltransferase activity and regulate dopaminergic/adrenergic neurotransmission. Low-activity COMT alleles (met/met) correlate with heightened pain sensitivity, increased risk of pain chronification, and elevated anxiety. Polymorphisms in the ADRB2 (rs1042713) and HTR1A (rs6295) genes are associated with myofascial pain and allodynia. Variations in ADRB2 influence pain sensitivity linked to symptoms of somatization, depression, and anxiety — phenotypic characteristics commonly observed in individuals with generalized chronic pain and TMD. Studies, including the large-scale OPPERA project, demonstrate that genetic variations determine not only pain susceptibility but also treatment response. Specifically, carriers of minor alleles in COMT and OPRM1 exhibit poorer treatment outcomes, highlighting the need for a personalized approach in diagnosis and therapy. These findings underscore the complexity of the genetic architecture underlying Temporomandibular Disorder pain syndrome, necessitating further research and enhanced international collaboration to expand patient cohorts. Integrating genetic data into clinical practice could improve prediction of pain chronification, optimize treatment strategies, and develop preventive measures, thereby reducing the socioeconomic burden of the disease.

Determination of clinical characteristics of ischemic stroke (IS) in cancer patients is difficult due to the involvement of both traditional and cancer-associated mechanisms in stroke pathogenesis. To date, there are no clear diagnostic criteria for cancer-associated stroke, which is often one of the first clinical manifestations of the oncological process.

 The aim of the study — to research the clinical manifestations of ischemic stroke associated with cancer.

 Material and methods. A comparative analysis of 84 cases of IS with concomitant cancer (main group) and 239 cases of IS without cancer (comparison group) was performed. All patients were assessed for the severity of IS according to the NIHSS scale, stroke subtype according to TOAST, disease outcome, localization and size of the cerebral infarction territory according to neuroimaging data; presence of hemorrhagic transformation. The parameters of coagulation hemostasis (international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin index (PTI), fibrinogen, platelet count) were assessed at the time of admission to the hospital. The follow-up of patients in the main group was studied based on the data from outpatient cards in the RTMIS system, using a telephone survey of patients and their relatives 3 months and 1 year after the stroke.

Results. During the observation period, 2027 patients with ischemic stroke were hospitalized, of which 84 patients (the main group) were diagnosed with active stage cancer (4.14%). In the main group, 20 patients (23.8%) were diagnosed with cancer during hospitalization at the Regional Vascular Center due to ischemic stroke. The most common localization in the study group was colon cancer (19.04%). Lung cancer was diagnosed in 13.1%, bladder cancer — in 10.7%. According to the histological type, adenocarcinomas were most often detected — in 35 cases (41.6%). The median age in the main group was 69 years [65;75], in the comparison group — 65 years [58;72] (p < 0.001). In the main group of diseases, large-artery atherosclerosis (14.3% vs. 43.1%, respectively, p < 0.001) and cardioembolic stroke subtypes (14.3% vs. 30.5%, respectively, p = 0.004) were diagnosed less frequently. In the main group, there was a more frequent diagnosis of the IS subtype of other determined etiology (13.1% vs. 3.8%, respectively; p = 0.003) and of undetermined etiology according to TOAST (47.6% vs. 8.8%, respectively; p < 0.001). In the main group, in patients, compared with the consequence without cancer, multifocal infarctions that developed simultaneously in both carotid basins were more often diagnosed (9.5% vs. 2.5%, respectively, p = 0.011; OR = 4.09, 95% CI: 1.37–12.15). Upon admission to the hospital, the PTI values were higher in the main group of patients compared to patients without cancer (102.5 [84.0; 111.0] versus 87.7 [72.4; 99.0], p = 0.003). In patients with ischemic stroke, who were diagnosed with cancer in the RVC, higher fibrinogen and platelet levels were noted (p = 0.022 and p = 0.008). Mortality within 3 months after the suffered ischemic stroke in the group was 21.4% (18 patients), within a year — 42.9% (36 patients).

Conclusion. Cancer-associated coagulopathy probably plays a leading role in the development of ischemic stroke in cancer.

Ischemic stroke (IS) is one of the leading causes of disability. Most cases of this disease are caused by modifiable metabolic risk factors associated with obesity. However, the effect of body composition on the functional status of patients who have suffered an IS has not been determined.

 Purpose of the study. To assess the effect of muscle and adipose tissue on the functional status and cognitive impairment in patients after IS.

 Material and methods. The study included 65 patients who had suffered an IS (age 62.9 ± 2.1 years) and 43 volunteers — the control group (age 63 ± 5 years). Depending on the severity of functional impairment after stroke (Modified Rankin Scale), the study group was divided into 2 subgroups. Subgroup 1 included 35 patients with no or mild limitations of life activities, and subgroup 2 included 30 patients with severe limitations. All patients underwent an assessment of daily activity (Barthel index), cognitive testing, anthropometric data and bioimpedancemetry parameters.

 Results. Compared with the control group, patients after IS showed an increase in parameters reflecting the state of adipose tissue, and the results of assessing cognitive functions and muscle mass were lower. In patients who had undergone IS, obesity was noted in 46% of cases, and a decrease in skeletal muscle mass was observed in 93%. In patients with obesity, the Barthel index values   were lower than in those without it (90 ± 7 vs 95 ± 6, p = 0.005). The body mass index (BMI) and visceral fat area (VFA) values were higher in the presence of disability (31.8 ± 1.5 vs. 28.4 ± 1.9 kg/cm²; p = 0.003; 177 [158;192] vs. 141 [122;156] cm², p = 0.005). A threshold value of VFA (168.5 cm²) was determined, the excess of which serves as a marker for identifying severe functional limitations. The results of assessing cognitive functions in patients were associated with the value of the skeletal muscle index (men r = 0.487, p = 0.001; women r = 0.596, p = 0.007).

 Conclusion. Visceral obesity accompanies more severe post-stroke limitations of life activities. Cognitive impairment in individuals who have suffered a stroke is associated with the state of muscle mass. An increase in the VFA from 168.5 cm² can serve as a marker of major functional limitations in patients who have suffered a stroke.

The purpose of this study was to verify predictors of the cognitive impairment (CI) development and progression in patients in recovery period after ischemic stroke (IS) using discriminant analysis.

 Material and methods. 192 patients underwent IS were examined. To assess the degree of CI on the 14th day and in 6 months after the IS development CDR scale was applied. The relationship with CDR (correlation coefficient, r) and predictive ability (ML, information gain, p.g.) was analyzed in relation to 28 parameters: demographic characteristics, comorbidity, clinical, immunological and instrumental indicators.

 Results. Deterioration of cognitive function was found in 34.5% of cases (development in 15.2%, progression in 19.3%). Significant correlations (p < 0.05) with CDR and predictive ability (p < 0.001) were found for comorbidity ( r = 0.620; p.g. = 0.431), age (r = 0.320; p.g. = 0.204), CXCL10 (r = 0.322; p.g. = 0.341), CXCL1 (r = 0.333; p.g. = 0.304) and CCL2 (r = 0.440; p.g. = 0.124) concentrations.

 Conclusion. Polymorbidity, age, and levels of cytokines CXCL10, CXCL1, and CCL2 were found to be most relevant to the development and progression of CI in the recovery period of IS. For better understanding of the structure and dynamics of post-stroke CI large-scale researches assessing data from extended neuropsychological testing and aspects of drug therapy consistent with current recommendations for the cognitive impairment treatment are required.

Introduction. High morbidity of ischemic stroke (IS) in modern time of the cardiovascular complications (CVC) risk factors population management strategy application of determines the need to improve the prevention model.

 Purpose of the research: to develop a competence-based prevention model of IS in the “elderly patient — patients’ family” system at the primary health care (PHC) level and to evaluate its effectiveness.

 Material and methods. А retrospective, multicenter research was in 2021–2024. Objects of the research: patients (n = 233), average age 66 ± 8.7 years, with chronic cardiovascular diseases (CVD) and risk factors of IS; family members of patients (n = 233): group A (n = 114) — aged 40–60 years and group B (n = 119) — aged over 60 years. The subject of the research is the clinical organizational processes of the competency-based prevention model of IS and the medical social effectiveness of the model, including the coverage of preventive medical examinations, the achievement of final clinical cardiovascular points (IS, myocardial infarction (MI), death from CVC). The follow-up period is 36 months. Research methods: content analysis, statistical, comparative analysis, mathematical, clinical organizational modeling.

Results. The developed model is based on the competence activity of doctors in identifying and modifying CVC risk factors. ALL patients had a “very high” risk of CVC, including IS and MI, amounting to 16–47% for women and 26-51% for men. Among family members of patients in group A, a “high” risk of CVC was in 67.5% of the subjects; “medium” — in 10.5% and “low” — in 21.9%. All family members of patients in group B had a “high” risk of CVC, amounting to 36-42% for men and 24–30% for women. The coverage of patients and their family members with medical examinations and preventive check-ups was 100% during 36 months of follow-up. The endpoints of clinical cardiovascular events were not reached in 97.2% of patients and 100% of their family members.

Conclusion. Сompetency-based CVС prevention at the primary care level contributes to the medical social effectiveness of the developed model in the “elderly patient-patients family” system and the prevention of IS and mortality of patients and their family members from CVC, regardless of personal cardiovascular risk.

Introduction. The prevalence of sinus of Valsalva aneurysm (SOVA) in the general population is up to 0.09%, and among all congenital heart defects from 0.1 to 3.5%. One of the complications of this pathology is the development of cerebral embolism.

 Aim. To present a clinical case of ischemic stroke in a young patient with a rare cardiac pathology.

 Material and methods. The article presents a description of a clinical case of the development of ischemic stroke due to cerebral embolism from a thrombosed SOVA. A review of all published cases on the clinical significance of SOVA thrombosis in the development of stroke was conducted, and the PubMed database of medical and biological publications was analyzed.

Results. A 19-years old patient without chronic diseases or bad habits was hospitalized at the vascular center for thrombectomy from the right middle cerebral artery. After successful reperfusion therapy, a diagnostic search was initiated. Transthoracic echocardiography revealed thrombosis of SOVA. During anticoagulant therapy, control transesophageal echocardiography demonstrated thrombus lysis. The patient underwent delayed resection of the SOVA.

Conclusion. The study of the problem of embolic complications against the background of SOVA is low due to the extremely rare prevalence of this anomaly. Echocardiography is a key method for primary visualization of SOVA and its dynamic monitoring. There are no regulated tactics for managing patients with SOVA thrombosis.

The aim of the study was to investigate the effectiveness of including cytoflavin in the complex outpatient therapy of patients with post-COVID syndrome.

 Materials and methods: the results of outpatient treatment of 106 patients (49 men and 57 women, average age 52.4 ± 5.2 years) with post-COVID syndrome were analyzed. In addition to standard clinical and laboratory observation, the HADS scale was used to assess the severity of anxiety and depression, and the general clinical impression — CGI-S. Spirometry, Stange, and Genchi tests were used to assess the state of the respiratory system. Patients were randomly divided into two groups comparable in gender and age. The examination was carried out before the start of treatment and after the end of the course of therapy (on the 30th day). In the main group (I, n = 56), in addition to standard drug therapy, psychotherapy, exercise therapy and vacuum therapy on the thoracic and lumbar spine, cytoflavin was prescribed: 20.0 ml intravenously by drip in 200 ml of 0.9% sodium chloride solution for 10 days, then 2 tablets 2 times a day for 20 days. Patients in the comparison group (II, n = 50) received 10.0 ml of placebo diluted in 200.0 ml of 0.9% sodium chloride solution daily by intravenous drip, followed by taking the tablet form of vitamin B12 1 tablet 1 time per day for 20 days.

Results: the inclusion of cytoflavin contributed to a more pronounced positive dynamics of clinical indicators (“chest pain” — 6 times in Group 1 and 2.2 times in the comparison group, “headaches” — 7 and 3 times, respectively, and “tachycardia” — 5.2 and 3 times, respectively (p < 0.01). Spirometry also revealed a more pronounced positive dynamics of external respiration indicators: deeper and slower breathing, relatively high ventilation reserve indicators, a longer time during the Stange and Gench tests. Against this background, a decrease in the level of anxiety and depression (according to the HADS scale) was noted: the frequency of recording atypical depressive symptoms decreased according to the “anxiety” indicator by almost 9 times in the main group and only 2.5 times in the comparison group, according to the “clinical depression” indicator — 12.5 and 5.5 times, respectively (p < 0.01). As a result, the majority (90.9%) of patients who received in the therapy scheme cytoflavin, the treatment was recognized as effective (according to the CGI scale).

 Conclusion. Тhe results obtained, along with good tolerability of the drug, allow us to recommend its use in outpatient complex therapy of patients with post-covid syndrome.

The article presents a clinical observation of the treatment of severe combined trauma in a 12-year-old child. Due to the presence of brainstem disorders and prolonged impairment of consciousness after surgical treatment and two weeks after the injury, a solution of cytoflavin (20 ml/day) was used intravenously by drip (off  label) in the conservative treatment regimen with a positive effect. The neuroprotector cytoflavin may have a positive effect in children with severe TBI not only during the “therapeutic window” period, but also later. The results obtained may serve as a basis for further research.