It has long been known that the body’s response to various drugs, and thus the effectiveness of treatment, depends on the metabolic characteristics of each individual. But the study of genetic factors that affect chemical transformations in the body began only in the 20th century.
The paradigm of “treating the patient, not the disease” resulted in the concept of “personalized medicine”. The essence of personalized medicine is the individualization of drug therapy. The response to a drug, the optimal class of drug, its dose and mode of administration are determined, at least in part, by genetic determinants. Pharmacogenetics seeks to identify genes and their variants that determine the adequacy of pharmacotherapy and reduce the risk of side effects.
For a modern doctor, pharmacogenetics is a convenient and affordable tool to increase the effectiveness of evidence-based therapy for many diseases and, at the same time, reduce the likelihood of side effects. For a patient, pharmacogenetics means confidence that the drug prescribed by a doctor will act reliably and predictably, and will show maximum therapeutic effectiveness.
What needs to be done for this? Investigate the genetic information of a particular person regarding the genes that affect drug transport.
CSD LAB has long established itself as a progressive and innovative laboratory that implements modern diagnostic methods that should be useful to doctors for prescribing effective therapy. This spring, we created the Development and Innovation Department, which aims to develop diagnostic capabilities and medical science for their further implementation in the everyday life of the Ukrainian medical community.
From now on, the first pharmacogenetics services have been introduced in the list of CSD LAB laboratory diagnostics.
What pharmacogenetics tools are available in Ukraine today?
Currently, CSD LAB offers two tests that will allow individualizing the treatment of many diseases.
1. CYP2C9 (analysis of polymorphism of alleles *2, *3) and VKORC1 (analysis of G1639A polymorphism), determination of warfarin sensitivity, PCR, blood \ N
https://www.csdlab.ua/analyzes/farmakohenetka/cyp2c19-analiz-polimorfizmu-aleley-2-3-ta-vkorc1-analiz-polimorfizmu-g1639a
The test determines sensitivity to warfarin by detecting CYP2C9*2, CYP2C9*3 and VKORC1 G1639A mutations in human genomic DNA by real-time PCR.
The most common complication of warfarin therapy is bleeding, the risk of which can be reduced by 35%, and taking into account other factors (patient weight, prescription of other medications, etc.) – by 50%.
Warfarin is used for the treatment and prevention of deep vein thrombosis and pulmonary embolism, for the secondary prevention of myocardial infarction and prevention of thromboembolic complications (stroke or systemic embolism) after myocardial infarction, for the prevention of thromboembolic complications in patients with atrial fibrillation, heart disease or prosthetic heart valves, prevention of dynamic cerebrovascular disorders and stroke, and prevention of postoperative thrombosis.
2. CYP2C19 (analysis of allele polymorphism *2, *3, *17) PCR, blood \ N
https://www.csdlab.ua/analyzes/farmakohenetka/cyp2c19-analiz-polimorfizmu-aleley-2-3-17-plr-krov-n
This genetic test will allow you to determine the variations of the CYP2C19 gene (CYP2C19*2, CYP2C19*3 CYP2C19*17).
CYP2C19 is a clinically important enzyme involved in the biotransformation of a number of antidepressants, anticoagulants, and antimycotic drugs. For example, clopidogrel is a very effective antiplatelet drug whose action is based on irreversible inhibition of the platelet receptor P2RY12. However, in some patients, the therapeutic effect of the drug does not manifest itself, which is why it is necessary to change the drug, losing time in the patient’s treatment.
Why does this happen? The answer is simple: clopidogrel is a prodrug, which is activated by the cytochrome P450 complex, mainly CYP2C19. With a certain gene variant, this does not happen and the effectiveness of the drug is significantly reduced. In this case, you should choose another antiplatelet drug.
How to work with this?
The main goal of pharmacogenetics is to use the patient’s individual genetic information to inform and prescribe the most effective type and dose of drugs. Currently, targeted diagnostics and treatment of a patient can be determined according to the results of a study of his or her genetic profile, which makes pharmacotherapy for patients as effective, safe and affordable as possible.
However, personalized medicine is a relatively new area of medicine in general, and the new approach is to test patients for possible reactions to new drugs and to develop a treatment based on the test results.
In order to help Ukrainian doctors better understand pharmacogenetics, CSD LAB plans to hold a course of lectures on pharmacogenetics this fall.
In another video on the YouTube channel of the Kiev analytical center “Club of Experts”, the anesthesiologist of the medical group Adonis, Mariana Bolyuk, spoke about the main types of medical assistance in Ukraine, and also analyzed the specifics of the first pre-medical aid, including the algorithms of basic life support.
“Medical assistance in Ukraine at the moment, according to current legislation, is divided into emergency, primary, secondary (specialized), tertiary (highly specialized), palliative, medical rehabilitation,” Mariana Bolyuk pointed out.
The doctor emphasized that first aid is the implementation of basic medical measures to save lives, reduce human suffering in an emergency, and prevent possible complications.
“We, medical professionals, provide this assistance professionally, but it is important to remember that the ambulance may not always arrive on time at the scene. Therefore, knowing how to provide first aid to the victim before the arrival of the rescue services may be crucial to save his life,” Bolyuk emphasized.
She also spoke about the algorithm of basic actions that should be adhered to when providing first aid:
In turn, the founder of the Club of Experts, Maxim Urakin, emphasized that according to the UN, the total number of dead and injured as a result of war among the civilian population has already reached 25,671 people, of which 9,287 people died.
“It should be noted that the real number of victims may be significantly higher, as many cases of death or injury have not yet been confirmed, and information from some areas where hostilities continue comes with a delay,” Maxim Urakin stressed.
In the expert’s opinion, journalists and media workers are among the main risk groups, as their professional activity is associated with the possibility of getting into an emergency.
“For this reason, in June, the ‘Club of Experts’ introduced an initiative to train media representatives in the basics of providing primary medical aid. And the first seminar-practical training has already taken place,” Urakin concluded.
Watch more in detail in the video on the YouTube channel “Club of Experts”:
You can subscribe to the Club of Experts channel here: https://www.youtube.com/@ExpertsClub
CLUB_EXPERTS, FIRST_AID, MEDICAL_AID, MEDICINE, URAKIN, АДОНИС, БОЛЮК
“In August 2022, we entered the premises of the first building of our all-Ukrainian clinic for the first time. In October, renovation work began here and in April, after a record 5 months, we opened the doors of the first building of the Superhumans Center,” the statement reads.
“Superhumans is not just a clinic, not just a network of clinics, it’s a philosophy and rightly so. The rebuilding of a country begins with the rebuilding of each individual, military or civilian. Child or adult. And when we see the creation of such a center, we see the creation of a place of strength,” said First Lady Elena Zelenskaya, the center’s ambassador, at the opening.
“For me, it’s a personal obligation, my way of giving thanks to those we win. The military and civilians who paid for our country’s freedom with their own health will receive at Superhumans the most advanced technology, the best medical expertise from around the world, an individualized itinerary – everything they need to get back to active life,” said Superhumans co-founder Andrew Stavnitzer.
“We are honored to be part of this extraordinary effort to help world-class Ukrainians who have been terribly injured in this war – they are truly ‘Superhumans.’ Russia’s full-scale invasion of Ukraine is a war against civilians.
Many men, women, and children will lose life or limb, even long after the war is over, due to the sheer number of mines in large parts of Ukraine. This center is a step toward giving Ukrainians a chance to rebuild their lives and their country,” said Howard G. Buffett, chairman and CEO of the Howard G. Buffett Foundation.
The Superhumans Center is a comprehensive medical facility that will prosthetically treat and rehabilitate patients, primarily those who have been injured as a result of Russian aggression.
The first phase of the center, a prosthetic workshop and part of the rehabilitation center, were opened April 14. According to Vladimir Golovatsky, deputy medical center, more than sixty medical specialists will work in the center. Annually about 3 thousand patients will be treated there.
Investment in the launch of the Superhumans rehabilitation medical center in Lviv is estimated at $54 million, Superhumans CEO Olga Rudneva said earlier.
The first stage of the project includes repairs of premises, purchase of equipment, a year of medical team salaries and purchase of materials for prosthetics.
The second and third phases include the launch of all the buildings of the hospital, the start of the educational center on the basis of Superhumans, and expansion to other regions of Ukraine, in particular, to Kharkiv.
The project has already been supported by the Howard Buffett Foundation, the Richard Branson Virgin Unite Foundation, Cargill, Payoneer, Freedom Finance, Loro Piano, Mastercard, SD Capital and others.
A memorandum of cooperation was signed between Superhumans and the Ministry of Health. Health Minister Viktor Lyashko noted that the joint goal is to provide Ukrainians who suffered war injuries with the world’s best expertise.
Ottobock, a German manufacturer of technologies for manufacturing various types of prostheses, orthoses and exoskeletons, is working with the Superhumans project to launch a laboratory for the production of prostheses. Ossur, a leading manufacturer of bionic and other prostheses from Iceland, is also advising the team on starting its own production of prostheses.
The project is being created at the initiative of Ukrainian businessman Andrei Stavnitser. Another of its founders is Philip Grushko.
CSD LAB medical laboratory is opening partner laboratory offices in the front-line regions of Ukraine.
The company told Interfax-Ukraine news agency that, in particular, CSD LAB is opening laboratories on their basis together with medical centers.
“We opened partner laboratory offices in the frontline regions of Slavyansk, Kramatorsk and Konstantinovka (Donetsk region),” the company specified.
CSD LAB reported that the company opened more than 15 lab offices together with partners during the war, including three in Ternopil, offices in Dnipro, Khmelnytsky, Drohobych, Kamyanets-Podilsky, Ivano-Frankivsk, Lutsk, Chernivtsi, Chernomorsk, Slavyansk, Kramatorsk and Konstantinivka.
Currently there are over 70 laboratory offices and biomaterial collection points in the network all over Ukraine.
CSD LAB – one of the leading laboratories in Ukraine, provides more than 1500 tests – from general blood analysis to determination of genetic disorders in the tumor by NGS method. For 12 years CSD LAB has been one of the largest pathomorphological laboratories in Eastern Europe.
CSD LAB unites six laboratories: pathomorphology, cytomorphology, oncohematology, microbiology, clinical diagnostic laboratory and molecular genetics center. Every year it conducts more than 1.5 million tests.
Production facilities and modern high-tech equipment are located in Kiev and Lviv on a total area of more than 5 thousand square meters, as well as in Moldova and Georgia.
The largest private clinics in Ukraine expect that the health insurance sector will recover, despite its significant decline due to the war, have restructured their work with insurance companies.
According to the assessment of the medical group of companies (MGC) “Adonis”, the volume of the health insurance market by the equation with 2021 decreased by 30-40%.
“In 2022, Adonis MGC has been loyal to working with insurance companies. We met our obligations and agreements that existed at the time of the full-scale invasion on February 24, 2022. This allowed the insurance companies to meet the terms of the corporate insurance programs,” said Adonis.
Adonis notes, however, that there have been delays in payments for medical services performed since the war began, but the IGC “allowed insurance companies to accept insureds at our medical centers and this allowed the situation to even out.”
“Since February 2022, both Adonis Medical Group Company (MGC) and the insurance companies have restructured their operations and adapted to the circumstances. All insurance companies have found a way to settle with us for prior periods. Many companies have established a process of settlement and payment in a very clear and timely manner. This gives hope that together we will be able to increase the number of insured patients and help even more Ukrainians”, – stressed in “Adonis”.
The MGC noted that “some insurance companies have left the market, but “Providna”, UNIKA, “Ukrainian Group”, ARCS, “Kraina”, “Universalna”, “SOS Service”, the European Insurance Union, UCO, INGO work stably and coherently”.
In turn, the director of corporate sales of the medical network “Dobrobut” Dmitry Grossoo also noted that the share of insurance patients in total sales of “Dobrobut” before the war in 2022 was 25%, while in 2021 – 20%.
“The share of corporate customers in 2022 is up 25% over 2021. This is because the ‘subscription’ format for services has proven to be more sustainable than one-time referrals,” he said.
Gross said that in 2022 corporate insurance programs, about 20% of customers did not renew insurance for a variety of reasons, but “there were customers who were first-time insured who thought it was very important today.”
Commenting on delays in payments under corporate clients’ health insurance programs, the expert noted that “nurse partners have shown themselves to be at their best when it comes to financial discipline during a difficult period for everyone.”
“Our corporate clients have no problem debts to Dobrobut Medical Network,” he said.
Commenting on the prospects for the post-war recovery of the corporate health insurance sector, Grossoo stressed that the development of this sector in Ukraine because of the war continues.
“This is confirmed by the constant, albeit small, dynamics. Difficult times give rise to strong decisions, which become the foundation for growth,” he stressed.
An increase in the number of oncological diagnoses is expected in Ukraine in the post-war period, which will be caused by insufficient diagnosis during the war.
This opinion was expressed by the participants of the round table held at the Interfax-Ukraine agency on Wednesday and dedicated to the problem of wartime oncology.
“Today, the influence of stress on the onset of cancer has not been proven, but during the war, all chronic diseases, including cancer, are definitely exacerbated. Therefore, we expect an acceleration in the development of cancer. Interruption in treatment and diagnosis leads to the worsening of the situation. The statistics of oncological diseases after our victory, I think, for many will be a big “surprise” in a negative way,” said Kostiantyn Kopchak, the deputy medical director of the Dobrobut network, said.
According to the forecasts of the deputy director for inpatient work of the Kyiv City Clinical Oncology Center, Tamara Hrushynska, the sad statistics on the incidence of oncology will be visible in 1.5 years.
“Some patients did not have the opportunity to receive the necessary medical care during active hostilities, for example, when there was only one family doctor in the whole city or people did not have the opportunity to get to the clinic. I think the sad statistics will appear in a year and a half. We will see that the number of oncological diseases will increase much, unfortunately,” she said.
She noted the number of patients in the Kyiv Oncology Center has not decreased, people traveled from different regions and received help.
For his part, Ivan Klymniuk, the head of the oncology department of the ADONIS clinic, said that almost the entire country had dropped out of the early diagnosis system for at least six months.
“People focused on survival and safety, they did not think about screening and diagnosis. We will see the echoes of the war in the field of oncology a little later, there will be many neglected forms. If earlier the patient could be diagnosed at the first-second stage, which makes it possible to stop the process, then now we will face the fact that cancer will be detected at the third-fourth stage,” he said.
At the same time, he stressed that now all representatives of the oncological service of Ukraine have consolidated and are providing assistance to patients.
The growth of neglected forms of oncological pathologies is also expected by the head of the parliamentary subcommittee on the prevention and control of oncological diseases of the committee of the nation’s health, medical care and medical insurance, Valeriy Zub.
“This is logical, because there were interruptions in treatment, untimely diagnosis and the inability to go to a medical facility. We predict and, unfortunately, we already see: the number of neglected forms of cancer has been growing in most cancer centers even in recent months,” he states.
Zub considers it necessary to reconfigure the work of the oncology service, since it will be necessary to carry out more complicated surgical interventions and apply more complex chemotherapy regimens.
According to him, the working group created in the Ministry of Health will develop proposals for adjusting the development of the oncological service, taking into account the current situation.
“The task is not to return the oncological service to the form in which it was before, but to make it better, in particular making regional oncology centers better,” he said.
