Patients with cancer are at high risk of hemostatic disorders due to tumor-related mechanisms, antineoplastic therapy, and surgical interventions. Critical laboratory values (CVs) represent life-threatening conditions requiring immediate clinical response and are essential indicators of laboratory quality and patient safety.

To analyze the frequency, structure, and distribution of critical values of hemostasis parameters (APTT and fibrinogen) in the clinical diagnostic laboratory of an oncology center.

A retrospective study of the electronic CV registry was conducted for the period January-December 2025. Critical thresholds were defined according to SOPs and international recommendations. Data were analyzed by month, clinical ward, and type of hemostatic disorder. Comparative statistical analysis using the χ² test was performed. During the study period, a total of 48,326 coagulation tests were performed, including 27,418 APTT assays and 20,908 fibrinogen measurements. The overall frequency of critical values was 27.5 per 1,000 coagulation tests.

A total of 1,328 CVs were registered. The most frequent abnormalities were hypofibrinogenemia (<1.5 g/L) (60%), prolonged APTT (>78 s) (23%), and absent clot formation by APTT (10%). The distribution of CVs differed significantly across clinical departments (χ²(13)=726.51, p<0.001), with the highest burden observed in the hematobiochemistry department, ICU, and hematology wards. Extreme hypocoagulatory states (absence of clot formation by APTT or fibrinogen assays) accounted for 12% of all registered critical events, indicating a substantial proportion of patients at immediate risk of life-threatening hemorrhagic complications. Seasonal variation was statistically significant (χ²(10)=72.80, p<0.001), with peaks in March, July, and October.

Critical hemostasis abnormalities are highly prevalent in oncology patients and are predominantly associated with hypocoagulatory states. Implementation of a structured electronic CV reporting system enables rapid clinician notification, optimization of laboratory workflow, and improved patient safety in high-risk oncology settings.

To compare the efficacy and safety of doublet (capecitabine + cisplatin) and triplet (capecitabine + cisplatin + docetaxel) neoadjuvant chemotherapy (NACT) regimens in patients with locally advanced gastric cancer at a regional oncology center in Kazakhstan.

A prospective stratified randomized study included 107 patients with locally advanced gastric cancer. Patients were stratified by age, tumor location, and histological type/differentiation grade and then randomized in a 1:1 ratio to receive either capecitabine plus cisplatin or capecitabine plus cisplatin plus docetaxel. Tumor response was assessed using RECIST 1.1, pathological response was assessed in resected specimens, and toxicity was graded according to CTCAE v5.0.

The triplet regimen was associated with numerically higher rates of radiological partial response according to RECIST 1.1 (68.0% vs. 59.3%, p=0.423) and radical surgery among patients with partial response (91.7% vs. 78.1%, p=0.172). Pathological response was assessed in 58 patients who underwent radical gastrectomy. Pathological complete response (ypT0N0/TRG 1a) was observed in 2 patients in the triplet group and in none of the patients in the doublet group (0% vs. 6.1%, p=0.501). Favorable pathological regression (TRG 1a-1b) was more frequent after triplet therapy than after doublet therapy (24.2% vs. 12.0%, p=0.320). Grade III-IV neutropenia was more frequent in the triplet group (24.5% vs. 9.3%, p=0.041).

The triplet regimen showed a numerical efficacy advantage but was associated with increased hematologic toxicity, requiring careful monitoring. Treatment personalization based on histology and comorbidities is critical.

Small sample size, lack of survival data, and the need for multicenter validation.

As a major gastrointestinal malignancy, colon cancer (CC) demands more effective therapies. Gene therapy is an emerging promising strategy, and pyroptosis, a novel lytic cell death form, serves as a vital antitumor target, with Gasdermin D (GSDMD)-a key pore-forming protein in pyroptosis-showing anti-CC potential. We constructed an engineered attenuated Salmonella strain to deliver a GSDMD-expressing plasmid, and verified its therapeutic efficacy via in vitro and in vivo studies. In CC cell lines, the Salmonella vector upregulated GSDMD and cleaved caspase-1 (its upstream activator), inhibiting cell proliferation and inducing pyroptosis. In CC-bearing mice, the strain significantly suppressed tumor progression, reduced Ki67 expression, elevated intratumoral GSDMD and cleaved caspase-1 levels, and enhanced CD4⁺ and CD8⁺ T cell infiltration to boost antitumor immunity. This study suggests that attenuated Salmonella-mediated GSDMD delivery combats CC by triggering pyroptosis and stimulating antitumor immunity, laying a foundation for GSDMD-targeted gene therapeutics.

Watch and wait strategies offer organ preservation for selected patients with rectal cancer following neoadjuvant chemoradiotherapy (nCRT). Long-term outcomes following nCRT and total mesorectal excision (TME) provide important context for evaluating these approaches. We report regional surgical, pathological, and long-term oncological outcomes following nCRT and TME, with oncological outcomes stratified by treatment response.

A multicentre retrospective cohort study included patients with rectal cancer treated with curative-intent nCRT followed by TME across four Western Australian centres between 2006 and 2020. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were estimated using Kaplan-Meier methods. Local and metastatic recurrence were estimated using cumulative incidence functions, with death without the recurrence of interest treated as a competing event. Outcomes were stratified by baseline clinical stage, pathological stage, and American Joint Committee on Cancer (AJCC) tumour regression grade (TRG).

Among 573 patients, anastomotic leak occurred in 10.8% of patients with an anastomosis and an intended permanent stoma was formed in 31.9%. A pathological complete response occurred in 21.8%, and 3.1% had a positive circumferential resection margin. Five-year OS was 85.7%, CSS was 89.3% and DFS was 76.7%. The five-year cumulative incidences of local and metastatic recurrence were 3.4% and 16.5%, respectively. Baseline clinical stage was not associated with oncological outcomes, whereas pathological stage and AJCC TRG provided significant prognostic stratification. Five-year DFS was 92.2% for TRG 0% and 62.9% for TRG 3, with corresponding metastatic recurrence of 3.9% and 24.9%.

Long-course nCRT followed by TME achieved favourable long-term oncological outcomes. Pathological stage and AJCC TRG provided greater prognostic stratification than baseline clinical stage. These response-stratified estimates provide regional context for evaluating contemporary organ-preservation programmes.

In patients with chronic obstructive pulmonary disease (COPD), the correlations between inspiratory muscle weakness and some physiological factors were inconclusive. Understanding the relationship between these parameters may potentially be a screening tool for inspiratory muscle weakness. The purpose of this study was to evaluate the association between inspiratory muscle strength and functional capacity, dyspnea sensation, airway obstruction, lung hyperinflation, and peripheral muscle strength in patients with COPD.

A cross-sectional analytical study evaluated 40 patients with stable COPD. Patients underwent pulmonary function tests, maximal inspiratory and expiratory pressure (MIP, MEP) tests, handgrip strength measurement, and a six-minute walk test.

Forty male patients were included. Fifteen patients (37.5%) had inspiratory muscle weakness when using a cut-off point of 60 cmH₂O. Positive correlations were found between MIP and MEP (Pearson's correlation coefficient [r] = 0.489), six-minute walk distance (r = 0.504), and relative handgrip strength (r = 0.347). There was a negative correlation between MIP and residual volume/total lung capacity (RV/TLC) (r = -0.459). Regression analyses were performed after adjustment for age and forced expiratory volume in the first second (FEV₁) % predicted. Linear regression showed that MIP was associated with MEP (coefficient [β] = 0.37; 95% confidence interval [CI], 0.12-0.62) and peak expiratory flow (PEF) (β = 7.68; 95% CI, 2.50-12.81). Exploratory logistic regression showed an association between PEF and inspiratory muscle weakness (OR = 0.36; 95% CI 0.14-0.93); exploratory ROC analysis yielded an AUC of 0.81 (95% CI, 0.68-0.95).

A reduction in inspiratory muscle strength is related to lung hyperinflation, functional capacity, and peripheral muscle strength. Higher MIP was independently associated with higher MEP and PEF. After adjustment for age and FEV₁% predicted, PEF was significantly associated with inspiratory muscle weakness.

Individuals from regions affected by infectious disease outbreaks may be stigmatized because others hold negative mental images-or mental representations-of them. This study investigated whether such outbreaks lead to the formation of negative mental representations of residents in affected areas and explored the role of disease severity in this process. Study 1 revealed that during the early stages of the COVID-19 epidemic, the public's mental representations of residents from Wuhan were perceived as less attractive than those of Chengdu residents and associated with disgust and behavioural avoidance. However, differences disappeared after the restrictions of the epidemic were lifted. The results indicate that the COVID-19 outbreak triggered stigmatization of residents in Wuhan. In Study 2, disease severity and perceived threat were manipulated, and results show that participants formed less attractive face representations of residents from areas where severe infectious diseases broke out than those from areas affected by mild infectious diseases. This proved that the severity of infectious diseases affected the extent of stigmatization towards residents in outbreak areas. These results further our understanding of the mechanisms and factors underlying stigmatization associated with affected regions and may inform effective public health strategies to mitigate stigma and support disease control efforts.

Post-COVID syndrome has emerged as a major global health issue characterized by long-lasting psychoneurological symptoms, including cognitive impairment, anxiety, depression, sleep disturbances, and fatigue. These symptoms can persist regardless of the severity of the initial SARS-CoV-2 infection and often result in long-term functional limitations. The purpose of this review was to summarize current evidence on psychoneurological therapeutic approaches used to manage post-COVID syndrome and evaluate their clinical effectiveness.

A structured literature review was conducted using PubMed, Scopus, MEDLINE, and Google Scholar. Eligible studies included randomized controlled trials, observational studies, and clinical reports published up to 2024 that examined pharmacological, psychotherapeutic, physical, complementary, or neuromodulation-based treatments for adults with persistent psychoneurological symptoms after COVID-19. The review followed standard ethical practices for narrative reviews; no new human or animal data were collected, and therefore ethical approval or CTRI registration was not required. Findings were synthesized narratively by therapy category.

The review identified consistent evidence supporting the efficacy of multiple therapeutic modalities. Pharmacological agents including SSRIs, SNRIs, anxiolytics, and nootropics reduced anxiety, depression, and cognitive dysfunction. Psychotherapeutic methods such as cognitive behavioral therapy, psychodynamic therapy, and mindfulness-based interventions improved emotional regulation and coping. Physical rehabilitation, aerobic exercise, and breathing practices enhanced endurance and reduced fatigue. Complementary approaches (e.g., acupuncture, massage) provided additional symptom relief. Neuromodulation techniques, including transcranial magnetic stimulation and electroconvulsive therapy, demonstrated benefits in treatment-resistant cases.

Psychoneurological therapy for post-COVID syndrome requires a multimodal approach that integrates pharmacological, psychological, physical, and neuromodulatory interventions. Current evidence suggests that individualized, combined strategies are most effective for improving cognitive, emotional, and functional outcomes. Further research is needed to optimize treatment protocols and evaluate long-term effectiveness.

To evaluate the clinical efficacy and rate of inflammatory process regression using the YAMIK-3 sinus catheter combined with low-frequency ultrasound (LFUS) and ozone/NO technologies in the treatment of acute purulent hemisinusitis (APHS).

A prospective controlled clinical study enrolled 51 patients with confirmed APHS. The main group (n=25) received YAMIK-3 sinus drainage with instillation of ozone/NO-enriched physiological saline followed by combined LFUS and ozone/NO mucosal exposure. The control group (n=26) received YAMIK-3 drainage with 0.01% Miramistin instillation. Clinical symptoms, videoendoscopic findings, microbiological cultures, endogenous intoxication markers (tyrosine-containing peptides [TCP] and tryptophan-containing peptides [TrCP]), and radiological sinus pneumatisation were assessed before and after treatment.

Sterile post-treatment cultures were achieved in 23/25 (92.0%) of main-group patients versus 20/26 (76.9%) of controls. Pathological exudate clearance occurred 3.0±0.8 days earlier and pain/mucosal oedema resolved 2.4±0.3 days earlier in the main group. Plasma TCP and TrCP concentrations, elevated 2.6-fold before treatment, normalised following combined therapy. Complete sinus pneumatisation at 3 months was achieved in 100% of main-group patients versus 88.5% of controls. Hospital stay was reduced by approximately three days. No treatment-related adverse events were observed in either group. The combined use of YAMIK-3, LFUS, and ozone/NO technologies represents a highly effective and well-tolerated treatment strategy for APHS.

The COVID-19 pandemic had a significant impact on public health systems both globally and in Georgia. It highlighted the importance of health system preparedness, risk communication, governance mechanisms, population behavior, and access to healthcare services. Despite the growing body of international evidence, a comprehensive assessment of the determinants of COVID-19 and the associated public health challenges in Georgia remains limited.

The aim of this study was to assess the determinants of COVID-19 among the population of Georgia and to identify the social, behavioral, and governance-related factors influencing the effectiveness of pandemic management.

• To assess the population's knowledge, attitudes, and practices (KAP) regarding COVID-19 in Georgia. • To evaluate the social, demographic, and behavioral determinants associated with the COVID-19 pandemic. • To assess public perceptions of government regulations, risk communication, and public health interventions. • To identify the factors influencing the effectiveness of COVID-19 pandemic management.

A quantitative, analytical, population-based cross-sectional study was conducted to assess knowledge, attitudes, and practices (KAP) related to the COVID-19 pandemic, as well as the social, behavioral, and governance determinants of COVID-19 among the population of Georgia. The target population comprised adults aged 18 years and older who were permanent residents of Georgia. The minimum required sample size was calculated using OpenEpi (Version 3.01) with a 95% confidence level, a 5% margin of error, and an assumed population proportion of 50%, resulting in a minimum sample of 384 participants. A total of 386 respondents were included in the study. A multistage stratified sampling design was employed. In the first stage, Georgia was stratified into 11 geographical strata (Tbilisi and 10 administrative regions). The sample was allocated proportionally to population size (Probability Proportional to Size, PPS) based on the official 2024 population statistics published by the National Statistics Office of Georgia (Geostat). Population data processing and regional sample allocation were performed using IBM SPSS Statistics version 23.0. In the second stage, each region was further stratified into urban and rural areas. A sampling frame was developed for each stratum, based on which municipalities and settlements were selected. The number of respondents was allocated according to a predefined fieldwork plan, ensuring the representativeness of all regions of Georgia as well as both urban and rural populations. Data were collected using a structured electronic questionnaire. Statistical analyses were performed using IBM SPSS Statistics version 23.0. Descriptive statistics included absolute and relative frequencies, means, and standard deviations. Associations between categorical variables were assessed using Pearson's chi-square test, while multivariable logistic regression analysis was used to identify independent factors associated with the study outcomes. Statistical significance was defined as a p-value<0.05.

The study demonstrated that population knowledge, perceptions of government regulations, the effectiveness of risk communication, attitudes toward COVID-19 vaccination, and the use of digital health services varied significantly according to age, educational level, and region of residence. Statistically significant associations were identified between previous COVID-19 infection and post-COVID condition, as well as between public trust and sources of health information. The findings also highlighted both the strengths and the challenges of the public health system, particularly in relation to pandemic preparedness, risk communication, and health system resilience.

The findings indicate that the effective management of the COVID-19 pandemic in Georgia was strongly influenced by population awareness, evidence-based governance, effective risk communication, and the organizational capacity of the health system. The evidence generated by this study provides important implications for strengthening public health policy and enhancing national preparedness for future pandemics and other public health emergencies.

Pediatric COVID-19 generally has a milder clinical course than adult disease, although hematological, inflammatory, hepatic, coagulation-related, and renal laboratory abnormalities may accompany infection. White blood cell (WBC) and platelet (PLT) counts are routinely available hematological measures; however, the relationship between combined WBC/PLT profiles and broader laboratory patterns in pediatric COVID-19 remains incompletely characterized. This study aimed to compare selected laboratory parameters among pediatric patients with COVID-19, stratified according to predefined WBC and platelet profiles.

This retrospective, laboratory-based comparative study included 142 pediatric patients with RT-PCR-confirmed COVID-19 from the Adjara region of Georgia between 2020 and 2021. Patients were classified as WBC+PLT-N/CT (reference; n=94), WBC+PLT-H (n=16), WBC-H (n=3), or PLT-H (n=29). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), D-dimer, ferritin, and creatinine were evaluated. The WBC+PLT-H and PLT-H groups were compared separately with the reference group using two-sided independent-samples Welch's t-tests. The WBC-H subgroup was analyzed descriptively because of its very small size. Analyses were exploratory and were not adjusted for age or multiple comparisons.

The overall mean age was 5.71±5.36 years, with both platelet-elevated groups being younger on average than the reference group. Compared with the reference group, the WBC+PLT-H group had higher CRP (16.71±9.17 vs 11.38±6.98 mg/L; p=0.0396) and lower creatinine (58.93±10.20 vs 68.09±15.91 µmol/L; p=0.0052). The PLT-H group had higher ALT (27.29±22.37 vs 18.60±6.65 U/L; p=0.0479). No other comparison met the nominal p<0.05 threshold.

Combined WBC/platelet profiles were associated with different laboratory patterns in pediatric COVID-19. These exploratory findings warrant confirmation in larger pediatric cohorts using appropriately age-adjusted analyses.