УДК 616.5-002.525.2-031.81:616.1]-06

Introduction. Systemic lupus erythematosus (SLE) is a disease with numerous clinical manifestations and an unpredictable course. It often lasts for several months or years, with alternating remissions and exacerbations. 

Multiple organs can be affected simultaneously with varying degrees of severity, resulting in treatment- and disease-related comorbidities, including circulatory system diseases, which are one of the leading causes of death of SLE patients.
The aim of the study.To find out the nature and frequency of the circulatory system organs comorbid lesions in patients with systemic lupus erythematosus, to characterizethemdepending on the gender, age and the disease duration.
Materials and methods. Prior to performing the study all patients signedthe voluntary consent to participate in accordance with the requirements of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine. The cohort under investigation included 112 patients with diagnosed SLE of dif-ferent severity with preliminary stratification as follows: females 89.29 %, patients of working age (57.14 % – young and 39.29 % – middle aged), unemployed(58.04 %), III disability grouppatients(45.54 %), city residents (62.50 %).According to the results of the diseaseduration assessment, a significant numberof patients with SLE and circulatory system organs comorbid lesions have been ill for 1–5 years (36.61 %) and more than 10 years (38.39 %). All of them were patients of the rheumatology department of the Communal Non-Profit Enterprise of the Lviv Regional Council "Lviv Regional Clinical Hospital" from 2016 to 2021.The research was carried out in several stages, duringwhich the nature and frequency of the circulatory system comorbid lesions with respect to gender, age and disease duration were estimated.
Results. While completingthe study, almost half of patients with SLE were diagnosed with Raynaud’s syndrome, mitral valve insufficiency and atherosclerosis, about 1/3– with myocarditis, retinal angiopathy, symptomatic arterial hypertension and livedo reticularis. Thevaricose veins of the lower extremities, hypertensive disease, diffuse cardiosclerosis, tricuspid valve insufficiency, veinthrombosis, post-thrombophlebitis syndrome, aortic valve insufficiency, capillaritis, pulmonary hypertension, coronary artery disease (CAD) includingstable angina pectoris, cardiomyopathy and post-infarction cardiosclerosiswere found with the decreasing frequency. Raynaud’s syndrome was significantly more often diagnosedin femalesand young people;retinal angiopathy, livedo reticularisand symptomatic arterial hypertension – in femalesand those patients whose SLE lastedfor more than 10 years;myocarditis, varicose veins of the lower extremities – in males;capillaritis – in patients with the shortest duration of SLE;atherosclerosis and mitral valve insufficiency – in elderly patients and patients with SLE lastingfor6–10 years;veinthrombosis and stable angina – in elderly patients and those with SLElasting for more than 10 years; hypertensive disease, diffuse cardiosclerosis, aortic valve insufficiency, post-infarction cardiosclerosis werethe most characteristic for theelderly patients with SLE.
Conclusions. In patients with systemic lupus erythematosus, a number of circulatory system organs comorbid lesions were found. Having studied their nature and frequency, characterizing them depending on gender, age and the disease duration, we found out the certain features that should be taken into considerationduring the screening examination of circulatory systemdisorders inpatients with systemic lupus erythematosus and providing them the
integrated care to improve their lifequality. With this in mind, systemic lupus erythematosus requires further detailed study.

УДК 616.311.2-002+616.314.17-008.6)]-06:616.1/.4

The role of periodontal pathology and oral cavity condition in the occurrence of general somatic diseases

Z. M. Honta, I. V. Shylivskyy, O. M. Nemesh, Kh. B. Burda

 Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

 The aim of the study is a review of modern home and foreign literature on the influence of the state of the oral cavity and the pathology of periodontal tissues, and in particular generalized periodontitis, on the occurrence and severity of the course of diseases of internal organs and body systems.

Inflammatory-dystrophic periodontal diseases lead to an increase in the level of chronic inflammatory agents due to the systemic spread of inflammatory mediators released during local tissue destruction, as well as the systemic spread of pathogenic microorganisms, which contributes to the development of cardiovascular diseases, atherosclerosis, pathological processes in the gastrointestinal tract, complicates the course of diabetes mellitus and respiratory diseases in patients with periodontal diseases. That is why the study of pathogenetic interrelations of periodontal diseases and comorbid conditions is an urgent problem of modern dentistry.

Conclusions. Considering that certain extraoral pathologies arise as a result of damage by disseminated periodontopathogens may provide new therapeutic opportunities to reduce the risk of developing comorbid conditions etiopathogenetically associated with generalized periodontitis. The data of clinical and experimental studies that are presented in this literature review definitely show the need for timely treatment of periodontal diseases, which provides not only the health of the oral cavity, but also prevents the occurrence of general somatic diseases.

Key words: periodontal disease, generalized periodontitis, cardiovascular diseases, atherosclerosis, diabetes, diseases of the gastrointestinal tract.

УДК 616.36-004:616-007.251:616.71-007.234]-07

Introduction. The problem of osteoporotic fractures and the evaluation thresholds forintervention in patients with liver cirrhosis (LC) remains obscure so far.Ukrainian model offracture risk assessment (FRAX®) has never been implemented among patients with LC in Ukraine.

The aim of the study. To find out the peculiarities of the Ukrainian model of Fracture Risk Assessment, its diagnostic and prognostic value for implementation among patients with liver cirrhosis accompanied by impaired bone mineral density.

Materials and methods.90 patients with LC(27 women and 63 men aged 18 to 66 years) were randomly assignedinto the study. Stratification into groups was based on information about bone condition. 72 patients were included intoan experimental group (EG, patients with impaired bone mineral density (IBMD), which was divided into two subgroups – EG A (patients with osteopenia, 46) and EG B (patients with osteoporosis, 26). Controlgroup (CG) included18 patients without IBMD.

The peculiaritiesof the fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model (2019) amoung patients with LC with bone disorderswereestablished (significant differences betweenfrequency of features in groups and substantial stochastic associations of featureswithIBMD or its manifestations were investigated). The diagnostic characteristcs (diagnostic value,predictive value, likelihood ratio) of the detected features for IBMDin general,osteopenia and osteoporosis in particular, were revealed, and after that the post-test probability of certain bone disorders was determined among all patients with LCin the case ofapplying the identified features.

The results.It was found that although most of the risk factors occurred more often in patients with bone disorders, significant differences were detected only between the frequency of previous fractures in EGand CG, including EGB and CG,and EGA and EGB; between the frequency of cases of normal body weight, as well as overweight in EGand CG, including EGB and CG. The evaluation thresholdsaccording to the Ukrainian FRAX® model also differed significantly: the values above the upper evaluation threshold – in EGB and CGand in EGA and EGB; theintermediatevalues of fracture risk – in EGA and CG; the values below the lower evaluation threshold – in EGand CG, as well as in EGA and CGand in EGB and CG, including. Bone disorders had a substantialdirect stochastic associationin the following cases: IBMD in general – with the previous fractures, normal body weight and values above the upper evaluation threshold; osteopenia – with the previous fractures, normal body weight and intermediate values of fracture risk; osteoporosis – with the previous fractures, normal body weight andvalues abovethe upper evaluation threshold.All manifestations of bone disorders had substantial negativestochastic association with overweight and values below the lower evaluation threshold, as well as osteoporosis withshort height (indicates that features are inherent for normal bone mineral density).

It was foundoutthat fracture risk factors and evaluation thresholdsaccording to the Ukrainian FRAX® model are mainly single-vector markers, since they can confirm the disease beingdetected, or deny it in thecasethey are absent. The previous fractures are highly specific for IBMD, especially for osteoporosis, and can be useful for confirming these disorders beingpresent in patient with LC.The normal body weight is medium-specific for IBMD and for osteoporosis, but can be more useful for indicating IBMD if it is present, andexcluding osteoporosis being absent. The values above the upper evaluation threshold according to the Ukrainian FRAX® modelare highly specific forosteoporosis and can confirm osteoporisis being present. The intermediate values of fracture risk according to the Ukrainian FRAX® modelare medium-specificfor osteopenia, but can be more useful forexcluding osteopenia if they are absent. The overweight,especially the values below the lowerevaluation threshold, will most likely indicatenormal bone mineral density.

Conclusions.The use of the Ukrainian modelofFracture Risk Assessment (FRAX®) has certain peculiarities and can be valuable tool for detecting or excluding impaired bone mineral density in patients with liver cirrhosis.

Background We examined the human toll and the subsequent humanitarian crisis resulting from the Russian invasion of Ukraine, which began on 24 February 2022.
Method We extracted and analyzed data resulting from Russian military attacks on Ukrainians between 24 February and 4 August 2022. The data tracked direct deaths and injuries, damage to healthcare infrastructure and the impact on health, the destruction of residences, infrastructure, communication systems, and utility services – all of which disrupted the lives of Ukrainians.
Results As of 4 August 2022, 5552 civilians were killed outright and 8513 injured in Ukraine as a result of Russian attacks. Local officials estimate as many as 24 328 people were also killed in mass atrocities, with Mariupol being the largest (n=22 000) such example. Aside from wide swaths of homes, schools, roads, and bridges destroyed, hospitals and health facilities from 21 cities across Ukraine came under attack. The disruption to water, gas, electricity, and internet services also extended to affect supplies of medications and other supplies owing to destroyed facilities or production that ceased due to the war. The data also show that Ukraine saw an increase in cases of HIV/ AIDS, tuberculosis, and Coronavirus (COVID-19).
Conclusions The 2022 Russia-Ukraine War not only resulted in deaths and injuries but also impacted the lives and safety of Ukrainians through destruction of healthcare facilities and disrupted delivery of healthcare and supplies. The war is an ongoing humanitarian crisis given the continuing destruction of infrastructure and services that directly impact the well-being of human lives. The devastation, trauma and human cos

УДК 616.36-004-036-06:616.12-008.1]-079.4

Liver cirrhosis is a common disease occurring mainly among people of working age and frequently resulting in lethal outcomes. The causes of such epidemiology of liver cirrhosis are syntropic comorbid lesions, in particular lesions of the circulatory system organs. The study was carried out in three consecutive steps, namely: in the first phase the proportion of patients with liver cirrhosis with extrahepatic cardiovascular lesions  was revealed, in the second, the frequency of each  individual cardiovascular disease in patients was evaluated, and in the thirdphase the frequency of cardiovascular system lesions in every severity class of liver cirrhosis in accordance with C.G. Child-R.N. Pugh criteria and correlation between their incidence and class of cirrhosis were revealed. 81.3 % of patients with liver cirrhosis have lesions of the circulatory system, among which cirrhotic cardiomyopathy and disorders in the system of blood pressure regulation with the emergence of persistent arterial hypotension have common pathogenetic mechanisms with liver cirrhosis, namely, they are syntropic, whilst postinfarction cardiosclerosis, angina pectoris,

 acquired heart defects, and painless form of coronary heart disease are concomitant