Objective — to study the features of clinical symptomatology, course and some functional parameters in patients with chronic obstructive pulmonary disease (COPD) and concomitant ischemic heart disease (ІHD) in the development of pulmonary hypertension syndrome (РH).
Materials and methods. In the study, 121 patients with a diagnosis of COPD and IHD were randomized to undergo all clinical trials, spirography, EchoCS to determine pulmonary arterial pressure (РA), Borg and mMRC questionnaires, and a 6­minute walk test. All patients were divided into two groups: the first group (63 patients) with an increase in the pressure in the РA, the second group of comparison — without РH (58 patients). The study included only patients who at the time of screening received stable therapy according to international and national standards. The study was conducted against the background of previously selected ІHD therapy, and dose correction or replacement of the drug was not allowed without significant need. Spirometry was performed to all patients according to the standard procedure of determining the volume of forced exhalation for the first second (FEV1) out of the best three spent tests, the forced vital capacity (FVC) and the ratio of FEV1/FVC in % of the proper values.
Results and discussion. The subjects did not differ in sex, body mass index. The median age of the patients in the first group was higher than that of the control group, although the upper quartile of the age was higher in the comparison group, which might indicate that the development of РH with COPD required time. The duration of IHD was comparable in both groups. The duration of COPD at the time of inclusion in the study was not large and amounted to 5.5 (3.5—10.0) years in the first group and 4.0 (1.0—6.0) in the control group (p < 0.05). But in the first group, the presence of LH was statistically significant and  depended on the duration of COPD (U = 1150.0; Z = 3.4; p = 0.0006). This may indicate that even patients  with a short COPD history may suffer from РH.
Conclusions. In the development of pulmonary hypertension syndrome in patients with COPD with concomitant coronary artery disease, tolerance to physical activity is decresed, dyspnea, and atherosclerosis develop more aggressively. Functionally, the indicators of external respiration are lower in the group where the РH has developed. But РH develops with a longer history of COPD. Violation of lipid metabolism is more pronounced in the group with the presence of elevated pressure in the pulmonary artery, which, in turn, is associated with a decrease in the indicators of external respiration and the development of hypoxia. The clinical course of COPD is characterized by a large number of exacerbations in the development of РH compared with the control group.

Keywords: chronic obstructive pulmonary disease, ischemic heart disease, comorbidity, pulmonary hypertension syndrome, clinical features.

Objective — ​to study the nitric oxide (NO) state in patients with ischemic heart disease (IHD) and concomitant nonalcoholic steatohepatitis (NASH) in the dynamics of pathogenic therapy.
Materials and methods. 59 patients with IHD and concomitant NASH were examined. The liver function, lipid metabolism and nitric oxide system state were evaluated. Patients against the background of IHD basic therapy received ursodeoxycholic acid (UDCA) in combination with levocarnitine.
Results and discussion. We observed the most pronounced elimination of cytolysis syndrome, reduction of atherogenic dyslipidemia and endothelial dysfunction in patients with IHD in combination with NASH in the context of UDCA and levocarnitine administration  accompanied the  basic therapy.
Conclusions. Patients with IHD and concomitant NASH receiving basic therapy of IHD and combination of UDCA with levocarnitine had significant improvement of the functional liver state, lipid metabolism and endothelial function.

Keywords: nonalcoholic steatohepatitis, ischemic heart disease, endothelial dysfunction, nitric oxide, nitric oxide synthase, ursodeoxycholic acid, levocarnitine.

List of references:  
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2.    Huberhryts NB, Klochkov AE, Lukashevych HM, Beliaeva NV, Ahybalov ANю «Steatel»: ot nauchnуkh faktov k klynycheskoi praktyke. Suchasna hastroenterolohiia. 2014;2(76):116-119.
3.    Dolzhenko MM, Bazylevych AYa, Volosheniuk IO, Konoplianyk LA. Konstyliatsiia ishemichnoi khvoroby sertsia i nealkoholnoi zhyrovoi khvoroby pechinky: pytannia patohenezu. Novosty medytsynу y farmatsyy: Kardyolohyia. 2011;6:1-3.
4.    Dolzhenko MN, Bazylevych AYa. Novуe aspektу prymenenyia ursodezoksykholevoi kyslotу: vzghliad kardyoloha. Zdorove Ukraynу. 2015;2:56-58.
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Objective — to examine risk factors, prognosis and the specific aspects of osteopenic syndrome course in patients with type 2 diabetes mellitus (DM2) with concomitant stable coronary heart disease (CHD).
Materials and methods. 42 women with DM2 in the post­menopausal period were examined. 15 women with DM2 and concomitant CHD formed the main group; 27 women with DM2 without CHD formed the comparison group. The mean age of the patients in the main group was (56.4 ± 2.16) years, in the comparison group — (56.8 ± 2.22) years.
The duration of the history of DM2 was (7.1 ± 1.91) and (6.9 ± 1.79) years, respectively; the duration of menopause was (4.7 ± 0.91) and (4.4 ± 0.83) years, respectively. The parameters of mineral and lipid metabolism were studied by biochemical methods, bone mineral density (BMD) was studied by ultrasonic densitometry. The 10-­year probability of fractures was determined using FRAX questionnaire.
Results and discussion. Risk factors for osteoporosis (OP) as early menopause and smoking were more common for patients of the main group than in patients from the comparison group. These factors increase the risk of disease of both OP and CHD. High expressivity of these factors in the main group caused the earlier occurrence and progression of atherosclerosis in patients with diabetes, and created the prerequisites for metabolic disorders of bone tissue.
Under biochemical studies, a slight decrease of ionized calcium in the serum of the patients in the main group was detected. However, these changes were not significant but demonstrated a tendency.  Levels of total cholesterol and low­density lipoprotein cholesterol in patients from the main group were increased in comparison with those of the comparison group. BMD by T­test in patients with comorbid course of DM2 and CHD was significantly lower than in patients with uncomplicated DM2. The 10­year probability of development of OP-­dependent fractures of any location was also significantly higher in the main group of patients compared with patients with DM2 without concomitant CHD.
Conclusions. The problem of OP is vital for patients with comorbid course of DM2 and CHD. Risk factors for OP are more often recorded in patients with DM2 and CHD than in patients with isolated DM2. A number of risk factors have similarities and pluripotency for CHD and OP. Smokers with DM2 and CHD with early menopause and elevated levels of cholesterol and low­density lipoproteins form a risk group for OP. Concomitant CHD increases the probability of fractures in patients with DM2. Screening, prevention and treatment of OP in these patients is an important component of medical practice.

Keywords: type 2 diabetes, ischemic heart disease, osteoporosis, risk factors, pathogenesis, diagnostics.

List of references:
1.    Fracture risk assessment tool - ​FRAX [Electronic resource]. Access mode: https://www.sheffield.ac.uk/FRAX/tool.jsp?lang=rs. Title from the screen. Date viewed: 29.07.2017. (Rus).
2.    Klymentyeva GI, Kurnikova IA, Kuznetsova IA, Afonova TM. Type 2 diabetes and the problem of comorbid pathology. Kuban scientific medical bulletin. 2012;1(130):81-84. (Rus).
3.    Larin O, Kyrylіuk M, Tretiak O, et al. Osteoporosis: effect of age, sex, obesity and diabetes mellitus. Clinical endocrinology and endocrine surgery. 2014;1:3-14. (Ukr).
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6.    Sergeeva VV, Dymnova SE. Effect of concomitant comorbid pathology on the development of osteoporosis in elderly patients. Bulletin of the International Scientific Surgical Association. 2017;6(2):5-11. (Rus).
7.    Bijelic R, Balaban J, Milicevic S. Correlation of the Lipid Profile, BMI and Bone Mineral Density in Postmenopausal Women. Mater Sociomed. 2016;28 (6):412-415. doi: 10.5455/msm.2016.28.412-415.
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9.    Hough FS, Pierroz DD, Cooper C, Ferrari SL. Mechanisms in endocrinology: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus. Eur J Endocrinol. 2016;174(4):127-138. doi: 10.1530/EJE‑15-0820.
10.    International Osteoporosis Foundation. Fixed risk factors [Електронний ресурс]. Access mode: https://www.iofbonehealth.org/fixed-risk-factors. Title from the screen. Date viewed: 29.07.2017.
11.    Lee SN, Cho JY, Eun YM, et al. Associations between osteoporosis and coronary artery disease in postmenopausal women. Climacteric. 2016;19(5):458-462. doi: 10.1080/13697137.2016.1200550.
12.    Lewiecki EM. Fracture Risk Assessment in Clinical Practice: T-scores, FRAX, and Beyond. Clinic Rev Miner Metab. 2010;8:101-112. doi:10.1007/s12018-009-9054-6.
13.    Napoli N, Chandran M, Pierroz DD, et al. Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol. 2016;13;4:208-219. doi: 10.1038/nrendo.2016.153.
14.    Salari P, Abdollahi MA. Comprehensive review of the shared roles of inflammatory cytokines in osteoporosis and cardiovascular diseases as two common old people problem: actions toward development of new drugs. Int J Pharmacology. 2011;7(5):552-567. doi: 10.3923/ijp.2011.552.567.
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17.    Uyama O, Yoshimoto Y, Yamamoto Y, Kawai A. Bone changes and carotid atherosclerosis in postmenopausal women. Stroke. 1997;28 (9):1730-1732. doi: 10.1161/01.STR.28.9.1730.

Objective — ​to assess the efficacy of ultrasound imaging of the esophagus for diagnosing gastroesophageal reflux disease (GERD) in the patients with bronchial asthma (BA).
Materials and methods. 81 patients with bronchial asthma have been examined. Special diagnostic methods, including ultrasound imaging of the esophagus, have been used for the diagnosis of GERD.
Results and discussion. Contrast-enhanced ultrasound imaging of the esophagus allows to diagnose pathological gastroesophageal reflux in 88,8 % of the patients with clinical pattern of GERD. Moreover, ultrasound imaging of the esophagus demonstrates its efficacy for diagnosing a hiatal hernia that has been detected in 43.8 % of the study patients. The comparative analysis of ultrasound findings with the results of other instrumental studies has shown that pathological changes have been revealed in 3 cases during fibroesophagogastroduodenoscopy (FEGDS) and roentgenography of the esophagus and stomach while sonographic findings have been normal. Conversely, the signs of GERD have been defined in 3 out of 4 patients during the additional ultrasound imaging while FEGDS findings have been normal.
Conclusions. US of the esophagus has proved its high efficacy as the additional method for a primary GERD diagnosis. It is necessary to comprehensively examine the upper digestive tract of the patients with BA by means of ultrasound imaging of the esophagus.

Keywords: ultrasound imaging of the esophagus, gastroesophageal reflux disease, bronchial asthma.

List of references:
1.    Arutiunov AG, Burkov SG. Gastroesophageal reflux disease in the advanced age and elderly patients (Rus). Klinicheskie perspektivy gastroenterologii, gepatologii [Clinical perspectives of gastroenterology, hepatology] (Rus). 2005;1:31.
2.    Atabekoba LA. Transabdominal ultrasound diagnostics of the diseases of the distal one-third of the esophagus (Rus). Dissertation abstract for Candidate of Medical Sciences Degree, Moscow; 2002:13.
3.    Heidelbaugh JJ, Gill AS, Harrison van R, et al. Atypical presentations of gastroesophageal reflux disease. Am Fam Physician. 2008;15(4):483-488.
4.    Brinke A, Sterk PJ, Masclee AA. Risk factors of frequent exacerbation in difficult-to-treat asthma. Eur Respir J. 2005;26(5):812-818.
5.    Cinquetti M, Micelli S, Voltolina С. The pattern of gastroesopha­geal reflux in asthma children. J Asthma. 2002;39(2):135-142.
6.    Dickman R, Fass R. Noncardiac chest pain. Clin Gastroenterol Hepatol. 2006;4:558-563.
7.    Ivannikov IO. Analysis of the symptoms in the patients with GERD. Eksperimental’ naya i klinicheskaya gastroenterologiya [Experimental and clinical gastroenterology] (Rus). 2004:11-14.
8.    Isakov VA, Morozov SV., Tsodikova OM. Extraesophageal signs of gastroesophageal reflux desease. Kachestvo zshizni. Meditsina [Life Quality. Medicine] (Rus). 2004;2:12-17.
9.    Kalinin AV. Gastroesophageal reflux disease: diagnostics, therapy and prophylaxis. Pharmateka [Pharmateka] (Rus). 2003;7:45-55.
10. Vasilyev YuV. Gastroesophageal reflux disease at the stage of reflux-esophagitis: diagnostics and therapy. Pharmateka [Pharmateka] (Rus). 2004;13: 34-38.

Objective — ​to study the relationship of dysnatriemia with aldosterone, potassium ions, brain natriuretic peptide and parameters of cardiohemodynamics in patients with chronic heart failure (CHF) with preserved ejection fraction (PEF).
Materials and methods. The study included 97 patients with CHF II—III FC and LVEF at the age of 39 to 89 years. The results were processed using the statistical software package SPSS 17.0. Statistically significant differences in the data and correlation between them were considered for p ≤ 0,05.
Results and discussion. An increase of sodium concentration in serum of patients  with CHF and PEF was associated with an increase of  aldosterone content and a decreased level of potassium ions. Evaluation of the parameters of heart rate, systolic and diastolic blood pressure in the compared groups did not reveal any differences. Echocardiographic parameters in patients with CHF and PEF were not associated with the level of sodium in  serum.
Conclusions. The sodium increase in serum in patients was accompanied by an increase in the content of heart failure marker NT-­proBNP, which may indicate the likely role of electrolyte disorders in the pathogenesis of heart failure in this category of patients. Parameters of life quality and exercise tolerance are higher in patients with CHF and PEF in the range of serum sodium from 139.4 to 149.7 mmol/l, compared with Na values that go beyond these limits. Assessment of the clinical significance of minor differences in echocardiographic parameters in patients with different levels of serum sodium requires further studies.

Keywords: dysnatriemia, chronic heart failure, preserved ejection fraction, aldosterone, brain natriuretic peptide.

List of references:  
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2.    Aronson D, Verbalis JG, Mueller M, et al. Short- and long-term treatment of dilutional hyponatriemia wuthsatavaptan, a selective arginine vasopressin V2-receptor antagonist: the DILIPO study. Eur J Heart Fail. 2010;13:326-336.
3.    Barsony J, Sugimura Y, Verbalis JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem. 2011;286:10864-10875.
4.    Binanay C, Califf RM, Hasselblad V, et al. ESCAPE Investigators and ESCAPE Study Coordinators. Evaluation Study of Congestive Heart Failure and Pulmonary ArteryCatheterization Effectiveness: the ESCAPE trial. JAMA. 2005;294:1625-1633.
5.    Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J. 2007;28:980-988.
6.    Gheorghiade M, Gattis WA, O’Connor CM, et al. Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Congestive Heart Failure (ACTIV in CHF) Investigators. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291:1963-1971.
7.    Gheorghiade M, Gattis WA, O’Connor CM, et al. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291:1963-1971.
8.    Gheorghiade M, Konstam MA, Burnett JCJr, et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials. JAMA. 2007;297:1332-1343.
9.    Gheorghiade M, Niazi I, Ouyang J, et al. Tolvaptan Investigators. Vasopressin V2-receptor blockade with Tolvaptan in patients with chronic heart failure: results from a double-blind randomized trial. Circulation. 2003;107:2690-2696.
10.    Gheorghiade M, Rossi JS, Cotts W, et al. Characterization and Prognostic Value of Persistent Hyponatremia in Patients With Severe Heart Failure in the ESCAPE Trial. Arch Intern Med. 2007;167:1998-2005.
11.    Gottlieb SS, Abraham W, Butler J, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Cardiol Fail. 2002;8:136-141.
12.    Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169-172.
13.    Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999;106(4):399-403
14.    Klein L, O’Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation. 2005;111:2454-2460.
15.    Konstam M, Gheorghiade M, Burnett J, et al. Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure: The EVEREST Outcome Trial. JAMA. 2007;297:1319-1331.
16.    Kovesdy CP, Lott EH, Lu JL, et al. Hyponatriemia, hypernatriemia and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125:677-684.
17.    Lee DS, Austin PC, Rouleau JL, et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290:2581-2587.
18.    Mahammed AA, van Kimmenade RR, Richards M, et al. Hyponatriemia, natriuretic peptides, and outcomes in acutely decompensated heart failure: results from the International Collaborative of NT-proBNP Study. Circ Heart Fail. 2010;3:354-361.
19.    Mastorakos G, Weber JS, Magiakou MA, et al. Hypothalamic–pituitary–adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin‑6 in humans: potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endocrin Metabol. 1994;79:934-939.
20.    Park SJ, Shin JI. Inflammation and hyponatremia: an underrecognized condition?. Korean J Pediatr. 2013;56:519-522.
21.    Rusinaru D, Tribouilloy C, Berry C, et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure with preserved and with rediced ejection fraction: an individual patient data meta-analysis. Meta-analysis Global Group in Chronic heart failure (MAGGIC). Eur J Heart Fail. 2012;14:1139-1146.
22.    Schrier RW. Body water homeostasis: clinical disorders of urinary dilution and concentration. J Am Soc Nephrol. 2006;17:1820-1832.
23.    Shah MR, O’Connor CM, Sopko G, et al. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE): design and rationale. Am Heart J. 2001;141:528-535.
24.    Shchekochikhin DY, Schrier RW, Lindenfeld J, et al. Outcome Differences in Community-versus Hospital-Acquired Hyponatremia in Patients with a Diagnosis of Heart Failure. Circulat Heart Fail. 2013;6 (3):379-386.
25.    Wald R, Jaber BL, Price LL, et al. Impact of hospital-associated hyponatriemia on selected outcomes. Arch Intern Med. 2010;170:294-302.

Objective — to develop a risk assessment of  coronary heart disease progression(CHD) in patients with concomitant pathology after myocardium surgical revascularization of the (MSR) at the stage of renewal treatment (RT).
Materials and methods. 170 patients with coronary artery disease and concomitant pathology, after the myocardium surgical revascularization, received the standard medicamental therapy complex at the treating­recovery complex «Bila acacia» (Odesa city, Ukraine). Patients of the main group (n = 135) were divided into 3 subgroups, depending on the concomitant pathology: subgroup of 1 to 45 patients with concomitant arterial hypertension (AG); subgroup of 2—50 patients with diabetes mellitus (DM); Subgroup of 3—40 patients with concomitant gonarthrosis. The control group consisted of 35 patients with coronary artery disease who did not have concomitant pathology. The research algorithm (before and after treatment) included the collection of anamnesis, dynamic clinical observation of objective and subjective state of patients, laboratory diagnostics, psychological state (scale HADS), life quality was evaluated by SF 36 scale and integral evaluation before and after the RT. The course of RT included: medical treatment, a mode of motor activity burning­coaching, climatic, diet, physiotherapy (magnetolazerotherapy), balneotherapy («dry» carbonic baths) and exercise therapy. The course of treatment was 21 days.
Results and discussion. In 55.2 % of patients with CHD and concomitant pathology after MSR, who came for RT, were overweight, 65.3 % had dyslipidemia, increased leptin levels was observed in  all patients with coronary heart disease and concomitant pathology after surgical PM, especially in patients with concomitant diabetes mellitus — almost 2.5 times. The integral index in the beginning of RT increased in the group of patients with concomitant diabetes in 2.4 times compared to patients without concomitant pathology, and by 15.7 and 41.1 % compared with patients with concomitant hypertension and OA. After RT there was significan decrease of this indicator in all groups.
Conclusions. Integral assessment of the risk of IHD progression in patients with concomitant pathology after MSR is necessary. RT in these patients reduces the risk of progression of coronary artery disease.

Keywords: ischemic heart disease, myocardium surgical revascularization, renewal treatment, concomitant pathology, integral assessment, risk of progression.

Objective — to study the dynamics of the the vascular wall endothelium functional state indices and the factors determining it, for smokers of long­term (6 months) use of electronic nicotine delivery systems (ENDS).
Materials and methods. An open local 6­month study included 60 smokers men and women (49 and 11 people respectively) over the age of 18 who were examined within the epidemiological screening of unorganized urban population. All participants had more than 15 years smoking experience and smoked 15 cigarettes and more each day. According to the protocol, three groups of 20 people were formed: Group I, as an alternative to traditional smoking, used the iQOS tobacco heating system, Group II switched to electronic cigarettes Joyetech eGo AIO and Group III continued to smoke traditional cigarettes in their usual mode. The certified ENDS in Ukraine was used. The participants’ survey included: measurement of anthropometric indicators followed by calculation of the Quetelet index (IC), assessment of motivation degree to quit smoking, nicotinic dependence (Fagerstrem test) and the type of smoking behavior (D. Horn questionnaire), recording of an electrocardiogram at rest in 12 standard leads, blood pressure (BP) with a sphygmomanometer. All participants underwent a complete examination in the beginning, and also after 3 and
6 months of the program.
Results and discussion. In a comparative analysis of the groups, a 6­month follow­up showed an increase in flux­dependent vasodilatation (HDV) among all tested subjects, with the exception of those who continued to smoke without reducing intensity. For example, in the iQOS and cigarette sharing group, the increase in HVAC was 15.7 %, while among iQOS only, Δ of this indicator was 20.3 %. Among those surveyed using ES and partially continue smoking, the increase in the level of HVMD was 23.3 %, in a smokers group this index increased only by 8.0 %, but, as a more detailed subanalysis showed, this positivization of the results is due to reduced number of cigarettes smoked. The most impressive indicator of HDV has improved in the group of only electronic systems users: by 20.6 % and 25 % among users of iQOS and ES, respectively. The greatest increase in HDAP in association with a decrease in the level of PSA as an indicator of systemic inflammation (by 25 %) and a decrease in the concentration of KPI (an average of about 20 %) and ET-1 (especially expressively this figure decreased among users only ES — by 14.0 %) are indisputable markers of endothelial function improving, both in the group sharing ES and traditional cigarettes, and among users ES only. At the same time, among the subjects who did not decrease the TC intensity, there was a tendency to increase the S-RP concentration by 5.0 %, KPE by 3.5 %, an increase in the ET­-1 concentration, accompanied by a low level of HDVD (10.1 and 10.3 % at 6 months of follow­up, respectively), indicating a possible progression of endothelial dysfunction under the influence of tobacco smoke components.
Conclusions. The transition to electronic nicotine delivery systems and the introduction of nicotine into the body with the elimination of the damaging effect of cigarette smoke makes it possible to avoid disturbances in the oxygen transport function of the blood, damage of the vascular endothelium, and the development of pro­atherogenic changes in the metabolism of lipids and blood lipoproteins. When combined with traditional smoking, the protective effect is manifested in a weakened form.

Keywords: smoking, electronic nicotine delivery systems, endothelial function, cardiovascular disease.

Objective — determine the effectiveness of various therapeutic approaches in the treatment of psychosomatic disorders in adolescents.
Materials and methods.  60 (3 groups) adolescents (18 boys and 42 girls) with psychosomatic disorders  were examined with comprehensive clinical psychopathological examination. The mean age of adolescents was (14.9 ± 2.0) years old. The 1-st group consisted of adolescents treated at the regional children’s clinical hospital, who received treatment with Sertraline 25 mg/day at the age from 12 to 16 years  and 50 mg/day — children over 16 years old. The duration of treatment was 1.5—2 months. Adolescents of the 2­nd group received treatment with Lamotrigine in the dosage of 1—3 mg/kg/day. Adolescents of the 3­rd group (14 person) were prescribed Lamotrigine therapy in combination with psychotherapy. Control of therapeutic effectiveness was evaluated by Spielberger anxiety questionnaire (STPI — State Trait Personal Inventory), Phillips’ school anxiety test and CDI scale (Children Depression’s Inventory) by M. Kovacs. Statistical processing of the obtained research results was carried out on the basis of the computer program Statistica 6.1 (Stat Soft Inc., USA).
Results and discussions. The vast majority of children (75.0 %) had low or optimal levels of school anxiety. The anxiety level on all scales of Spielberger anxiety questionnaire moved to an average level of anxiety after medication, except situational negative experiences, which remained at a high level. The anxiety test scores decreased to an average level after complex treatment. At the same time the level of personal cognitive activity remained high, that confirmed the positive effect of combined treatment of psychosomatic disorders due to increased interest, curiosity, interest, which activate cognitive activity of adolescents. The analysis of school anxiety by Philips test identified that in adolescents of the 1­st and 2­nd groups the fear of self­expression decreased significantly comparing it before treatment. Complex treatment of psychosomatic disorders significantly increases the adaptive capacity of an organism to stress factors. The level of depression in the 1­st and 2­nd groups of adolescents after the treatment was (2.16 ± 0.16), which corresponded to the level of subdepression or masked depression with high scores on scale B. Against the background of combined treatment in adolescents the level of depression decreased to (1.71 ± 0.12), which corresponded to slight decrease of mood with high scores on scale B. Adolescents with psychosomatic disorders who responded positively to psychotherapy were characterized by low level of somatization (p < 0.05), but higher specific weight of psychological problems and difficulties in interpersonal relationships (p < 0.01) in the internal picture of the illness with peaks at subclasses of interpersonal sensitivity and hostility.
Conclusions. Pharmacology therapy of psychosomatic disorders with the help of both drugs Sertraline and Lamotrigine, has a positive effect on the severity of mental disorders in adolescents: reduction anxiety and fear of self­expression to average level, depression — to subdepression or masked depression. The combined therapy with the help of medication and psychotherapy of psychosomatic disorders in adolescents provided a surely with better result: it increased the adaptive capacity of the body to stress, the personal cognitive activity, which manifested with low level of somatization, reduced the level of depression to a mild level of mood decreasing and anxiety level decreasing to the average level.

Keywords: psychosomatic disorders, adolescents, psychotherapy, client­centered therapy.

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Objective of the study — an evaluation of the most probable factors of unfavourable prognosis considering the rate of sarcoidosis regression.
According to literature data such factors include: presence of clinical signs of sarcoidosis (respiratory symptoms, fatigue); high density small nodule dissemination in lung parenchyma; lung function disturbances; hypercalcemia.
We performed a retrospective analysis of clinical, spirometry, computed tomography (CT) data, including lung parenchyma densitometry, and serum calcium concentrations in 80 patients  recovered  stage II sarcoidosis, after the completion of standard glucocorticosteroid therapy course. All cases were relatively similar in terms of lung parenchyma lesions morphology: the predominant one was a pattern of small nodule dissemination without atypical findings.
A period of time between the therapy onset and clinical cure was considered as an indicator, reflecting the rate of sarcoidosis regression. It was calculated based on retrospective comparison of CT scans, taken every 3 months of therapy.
It was revealed that one of the factors of unfavourable prognosis, regarding the rate of sarcoidosis regression, was the presence of high density (> –800 HU) dissemination CT scans and/or lung ventilatory function failure. The presence of these factors in the the disease onset slowed down the regression of sarcoidosis by 1.4—1.75 months. The presence of clinical symptoms and hypercalcemia at initial examination had no significant influence on the rate of regression of disease during the course of glucocrticosteroid therapy.

Keywords: pulmonary sarcoidosis, glucocrticosteroid therapy, rate of regression, prognostic factors.

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The Ist chapter of the article introduces the relevance of the formulated problem; describes   the role of vascular endothelium in the organism’s regulation and some causes of its disturbances. Inparticular, the significance of tobacco smoking as a major factor damaging the endothelium at chronic obstructive pulmonary disease (COPD) is discussed. The role of lipids peroxidation intensifying with the consequent development of oxidative and nitrosative stresses in conditions of hypoxia is analyzed, that process leads to the vascular wall remodeling and secondary chronic vasoconstriction. The high prevalence of insulin resistance and metabolic disorders, wich are accompanied by comorbid cardiovascular diseases and affect the clinical picture of the dominating disease, is found.
The II chapter of the article presents summarized data about correlation of low long­term systemic inflammatory process and endothelial dysfunction (ED) in patients with COPD; the importance of assessing C-­reactive protein, as the most significant marker of systemic inflammationis,is  emphasized. Its elevated level is observed even in the period of remission even at mild and moderate severity of COPD, determining the necessity of long­term treatment administration, in particular for the prevention of cardio­vascular risk (acute cardiovascular events); the role of cytokines’ imbalance and adhesion molecules in the development and maintenance of ED is discussed.

Keywords: chronic obstructive pulmonary disease, endothelial dіsfunction, systemic inflammatory process, C-­reactive protein, cytokines, adhesion molecules.

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The review is dedicated to the most important health problem — prevention and treatment of cardiovascular diseases and major complications associated with them — myocardial infarction and stroke, by applying a new concept, so­called рolypill. According to the results of a meta­analysis of the numerous large international randomized multicenter studies, a long­term use of a рolypill, containing a fixed combination of antiplatelet drug (aspirin 75 mg), statin (simvastatin 40 mg or atorvastatin 10 mg) and a half­dose combo antihypertensive drug (β-­blockers, ACE inhibitors and diuretics), provides the reduction of  CHD risk by 88 % and stroke — by 80 %.

Keywords: рolypill, cardiovascular disease, prevention.

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The article presents an overview of some literature data on the comorbidity of such nosological forms as coronary heart disease and chronic periodontitis. Possible effects of traditional therapy of coronary heart disease on the course of periodontitis, taking into account their pathogenetic relation, are analyzed. The beneficial effect of drugs used in the therapy of coronary heart disease on the condition of the periodontal complex is determined. It creates a good background for successful dental treatment in this category of patients.

Keywords: chronic periodontitis, ischemic heart disease, combined pathology, periodontitis microcirculation disturbance, acetylsalicylic acid.

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Presently the attention of medical professionals to probiotics use in the different areas of medical treatment is increasing.Correspondingly, the number of different probiotic drugs and food supplements (BAS) is growing as well. Many of them are now available in Ukraine. In order to identify the most efficient product considering its cost and pharmacological parameters, it is necessary to assess two most important efficiency criteria: the combination (and a ratio) of different bacterial strains in the formulation of the product and their total count  in one therapeutic dose. Altogether they represent the probiotic potential of the product. International experts recognize, that the minimal significant number of live (lyophilized) bacteria in one therapeutic dose is one billion cells.

Keywords: probiotics, probiotic potential.