УДК 616.13/.14-008-06:[616.13-004.6:616.12-008.331.1

Актуальність. На сьогоднішній день в Україні налічується декілька мільйонів громадян з цереброваскулярною хворобою
(ЦВХ), що пов’язано з прогресуванням старіння населення, несприятливими економічними та екологічними умовами, нераці-
ональним харчуванням, гіподинамією. Проте, основною причиною розвитку ЦВХ є розлад кровотоку у речовині мозку, який
порушує механізм саморегуляції мозкового кровообігу, викликаючи кисневе голодування та негативно впливаючи на систем-
ний кровообіг. Тому проблема підвищення ефективості медичної і фізичної реабілітації пацієнтів з ЦВХ потребує вирішення
шляхом підбору комплексу дієвих відновних засобів з урахуванням її стадії і періоду захворювання, станом мозкового кровоо-
бігу, етапів реабілітації, що обумовлює актуальність напрямку дослідження.
Мета дослідження. Визначення морфофункціональних показників, стан центральної та церебральної гемодинаміки
обстежених пацієнтів з І–ІІ стадіями ЦВХ.
Методи дослідження. Теоретичний аналіз та узагальнення наукової літератури, аналіз даних історії хвороби та амбу-
латорних карток, лабораторні методи, інструментальні методи дослідження – ЕКГ, УЗДГ магістральних артерій голови
та шиї, методи математичної статистики. Предмет дослідження – структура та зміст комплексної програми медичної
та фізичної реабілітації пацієнтів з ЦВХ І та ІІ стадій, визначення її впливу на функціональний стан організму.
Результати дослідження. Наведено результати обстеження функціонального стану гемодинамічних показників по
магістральних артеріях у 100 хворих з ЦВХ, що дасть можливість раціонально скорегувати комплекс реабілітаційних захо-
дів, враховуючи індивідуальні особливості та стадії перебігу хвороби. Визначено морфофункціональні показники, стан цен-
тральної та церебральної гемодинаміки обстежених пацієнтів з ЦВХ на грунті атеросклерозу та гіпертонічної хвороби.
Висновок. Комплексна оцінка рівня структурних змін функціонального стану гемодинамічних показників по магістраль-
них артеріях голови пацієнтів з ЦВХ дасть можливість раціонально скоригувати комплекс реабілітаційних заходів, врахову-
ючи індивідуальні особливості, стадію перебігу хвороби та супутні захворювання.
Ключові слова: судинна система, цереброваскулярна хвороба, гемодинамічні порушення.

ABSTRACT
Background: Currently, a topical area of research is the multidimensional approach to both reliable tools and professional interventions aimed at improving the attitudes of Ukrainian society toward people with disabilities in the context of the armed conflict in Ukraine.
Aim of the study: The purpose of this study was to study the factor structure of the Multidimensional Attitudes Scale Toward Persons with Disabilities (MAS) questionnaire on a sample of Ukrainian students to create an adaptation of the original version (MAS-UA).
Material and methods: The main authors of the questionnaire gave their consent for the adaptation. The Ukrainian version of the MAS was developed using the method of back translation from the original language. The proposed multi-factor structure of the MAS-UA was tested in an anonymous online study of 1619 Ukrainian students.

Results: The factor analysis and a parallel exploratory factor analysis resulted in a 5-factor structure for the MAS-UA (the classic domains – cognitive, affective, and behavioral – and two additional domains, negative effects and items concentrated in the factors “Calm” and “Desire to communicate”). These five factors yielded 62.6% of the total variance score.
Conclusions: The MAS-UA was developed and presented as a reliable instrument for examining attitudes toward people with physical disabilities. The instrument can be used for the initial assessment when developing prevention and educational programs in the field of social policy, as well as to evaluate their effectiveness. Studies using the adapted version of the scale (MAS-UA) will allow the comparison of results from other countries where other language versions are used.
Keywords: Ukrainian students, MAS questionnaire, multidimensional attitudes, disability, measurement
scale, factor analysis

Abstract.
Non-thyroidal illness syndrome (NTIS) also known as euthyroid sick syndrome or low T3 syndrome is hypothyroidism caused by peripheral changes in the metabolism and thyroid hormone transport caused by severe debilitating diseases, in particular, heart failure. Recent data indicate that chronic heart failure can result in thyroid hormone metabolism disruption, which contributes to a progressive decrease in the concentration of triiodothyronine. The objective was to evaluate the effectiveness and safety of hormone replacement therapy with low doses of thyroxine in congestive heart failure in patients with low triiodothyronine syndrome. The levels of thyroid-stimulating hormone, thyroxine-binding globulin, free thyroxine, total triiodothyronine, free triiodothyronine, and reversible triiodothyronine were measured by radioimmunological assay from samples obtained from 56 patients with chronic heart failure and 19 practically healthy individuals of the control group matched by age, gender, and body mass index. Patients with low triiodothyronine syndrome were prescribed hormone replacement therapy with low doses of thyroid hormones (thyroxine 12.5-25 mcg/day) until the euthyroid state was achieved. The values of total and free triiodothyronine were significantly lower in patients with heart failure, the level of thyroxine- binding globulin was also reduced, more than twofold increase in reversible triiodothyronine level was demonstrated compared to controls. Low triiodothyronine syndrome was diagnosed in 33.9% of patients with heart failure. Hormone replacement therapy resulted in a slight improvement in contractile function in individuals with low triiodothyronine levels, 2 (10.5%) patients manifested with signs of hyperthyroidism. Advanced stages of heart failure might be linked with NTIS. Hormone replacement therapy with low doses of thyroxine can contribute to a moderate improvement in contractile function, as evidenced by the improvement in left ventricular ejection fraction.  

Keywords:  Non-thyroidal illness syndrome (NTIS),  euthyroid sick syndrome,  heart failure,  hormone replacement therapy.

Secondary post-traumatic and post-operative pain is a problem that is increasingly encountered by medical professionals in Ukraine today in the conditions of war. Chronic pain is an independent nosological unit, which is a severe complication of many performed surgical procedures. Сhronic pain as a result of surgical interventions occurs up to 10% of patients. It develops significantly often after amputations (50–85%), thoracotomies (5–65%), cardiosurgical interventions (30–55%), and chest surgeries (20–50%). Long-term post-operative pain is one of the primary, mostly unrecognized clinical problems.

It can be assumed that patients whose wounds do not heal in time have a predisposition to the development of secondary chronic pain. The long healing process of the wound surface is directly related to the following features: the wound microbiota, the resistance of microorganisms to antibiotics, the group of antibacterial agents chosen for treatment and the duration of exposure to the drug.

Understanding the interaction between microorganisms and the sensory systems of neurons can reveal more information for the putative pain mechanisms study.

In recent years, much attention has been paid to studying the concept of pain sensitization. Inflammation and nerve damage contribute to increased pain signaling, stimulating wound hyperalgesia. These processes can directly affect the formation of long-term post-operative pain.

Among the key problematic factors that contribute to the appearance of remote peripheral neuropathy, the duration of administration, increased dosage, and possible combinations of antimicrobial drugs should be highlighted, as well as the persistence and exacerbating of manifestations of local inflammation with the participation of resistant opportunistic bacteria that colonize the lesion and can directly produce metabolites vital activities, pathogenicity factors with pro-inflammatory properties. This allows us to assume a significant role of persistence in the primary lesion of antibiotic-resistant opportunistic bacteria, as well as antibiotic therapy as a delayed iatrogenic factor, as predictors of the formation of chronic pain syndrome in the wounded.

УДК: 616.1/.8–018.2–002.28:616.71–018.4–008.9]–07

Introduction. Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations associated with multiple autoantibodies formation and deposition of immune complexes, and other immune processes. Despite significant advances in treatment, the disease remains disabling, in particular, due to increased bone fragility and low-energy fractures. The study of bone remodeling in patients with SLE should help to improve the therapy and quality of their treatment.

The aim of the study. To investigate the features of bone mineral density, calcium-phosphorus metabolism and bone remodeling in patients with systemic lupus erythematosus.

Materials and methods. The study involved 123 women with SLE aged 21-51 years. The comparison group (CG) consisted of 25 women without SLE in premenopausal status of the appropriate age. The control group included 25 practically healthy women.

In order to study bone mineral density (BMD), dual-energy X-ray densitometry (DXA) of the lumbar spine was performed using a dual-energy X-ray absorptiometer. For the study of calcium-phosphorus metabolism (CPM), total calcium (Ca), ionized Ca, phosphorus (P) in blood and Ca, P, creatinine in daily urine, as well as parathyroid hormone (PTH) and 25-hydroxyvitamin D in serum were determined. Markers of bone remodeling (osteocalcin, procollagen type 1 amino-terminal propeptide (P1NP) and isomerized C-terminal telopeptide (β-crosslaps) in serum were measured.

To achieve the stated goal, the first step included the determination of bone damage prevalence in patients with the diagnosed SLE; the second step was directed towards the characterization the particular bone condition in patients with SLE based on the results of BMD, CPM indices and markers of bone remodeling assessment.

Results. According to the results of DXA of the lumbar spine, 88 (71.54 %) women of the SG and only 8 (32.00 %) women of the CG had a decrease in BMD (p < 0.001). According to the mean values, the studied CPM indices of the SG patients, CG and control group wemen exposed no significant differences. Similarly, no significant differences were detected in the mean values of urinary phosphorus and in between blood PTH values in SG, CG, and control. The level of 25-hydroxyvitamin D was significantly lower in SG (15.14 ± 0.80 ng/ml) than in CG (19.62 ± 0.46 ng/ ml) and control (22.38 ± 1.34 ng/ml) p < 0.05. The mean value of osteocalcin in woman with SLE was significantly lower than in CG and control (11.81 ± 0.49 ng/ml versus 18.61 ± 0.75 ng/ml and 19.28 ± 1.88, p < 0.001). No significant difference were detected in between the mean values of P1NP in SG, CG and control. The mean values of β-cross laps were significantly higher in patients with SLE (0.51 ± 0.02 ng/ml) compared to GC (0.26 ± 0.02 ng/ ml) and control (0.28 ± 0.02 ng/ml), p < 0.001.

Conclusions. Bone mineral density, calcium-phosphorus metabolism and bone remodeling in patients with systemic lupus erythematosus have peculiarities as follows: a significant decrease in bone mass in 71.54 % of patients, namely 18, 70 % - grade I osteopenia, 21.14 % - grade II osteopenia, 14.63 % - grade III osteopenia; 17.07 % - osteoporosis, increased calcium excretion, vitamin D deficiency, decreased osteoblastic and enhansed osteoclastic functions.