УДК:616.34: 616.008.87:579.61: 615.33.015.8:612.017

Анотація. На підставі узагальнення літературних даних вітчизняних і зарубіжних авторів висвітлено проблему необхідності профілактики шлунково-кишкових хвороб викликаних збільшенням застосування антибіотиків, імуносупресивної терапії, онкологічної патології, споживанням людством неякісної продукції, а також перспективи застосування пробіотиків у медичній практиці. Проаналізовано 27 джерел вітчизняної та зарубіжної літератури. Представленo сучасний погляд на доцільність застосування пробіотиків при захворюваннях шлунково-кишкового тракту асоційованих з інфекціями, патологічних процесах, у патогенезі яких важлива роль належить розладам імунітету.

Abstract. According to general conclusion of literature facts of Ukrainian and foreign authors we have the sight of the necessity of prophylaxis of gastrointestinal diseases caused by more usage of  antibiotics,  immunosuppressive  therapy,  oncological  pathology,  consumption  of  the  low-quality products,  as  well  as  perspectives  of  the  usage  of probiotics  in  medical  practice.  They  analyzed  27 sources of Ukrainian and foreign literature. They presented the modern sight on the expedience of the  usage  of  probiotics  in  case of  diseases  of  the  gastrointestinal  tract  associated  with  infections, pathological processes, in the pathogenesis of which immune disorders play an important role.

УДК 616.24-002.5-036.22-036.8

Анотація. За результати моніторингу епідемічної ситуації з туберкульозу в окремо взятих регіонах та Україні в цілому під час пандемії коронавірусної інфекції SARS-CoV-2 встановлено особливості розвитку епідемічного процесу за співвідношенням показників захворюваності на туберкульоз, поширеності та смертності від нього.

Abstract. Based on the results of monitoring the epidemic situation with tuberculosis in selected regions and Ukraine as a whole during the pandemic of the SARS-CoV-2 coronavirus infection, the peculiarities of the development of the epidemic process were established based on the ratio of indicators of tuberculosis incidence, prevalence and mortality from it.

УДК 616.24-007.272: 578.834.1

Анотація. Перебіг коронавірусної хвороби 2019 (COVID-19) ускладнюється різними супутніми захворюваннями; хронічне обструктивне захворювання легень (ХОЗЛ) є одним із них. Це дослідження мало на меті дослідити вплив ХОЗЛ, як потенційного супутнього захворювання на прогноз формування важкого перебігу COVID-19. Попередні дані щодо Covid-19 продемонстрували нижчу поширеність ХОЗЛ, ніж можна було очікувати при гострому респіраторному захворюванні, такому як COVID-19. Цей факт призвів до припущення, що застосування інгаляційних глюкокортикостероїдів (ІГКС) може захистити від інфікування або розвитку тяжчого перебігу COVID-19. Аналіз досліджень, проведених у різних групах хворих з важким перебігом Сovid-19 з коморбідністю ХОЗЛ дозволив виявити статистично значимі дані для вдосконалення прогностичних шкал несприятливого прогнозу хвороби. Подальше вивчення і застосування таких показників у загальній клінічній практиці дозволить вчасно виявляти пацієнтів групи ризику з метою прицільного моніторингу та ранньої зміни чи інтенсифікації лікувальної тактики, в тому числі супутніх захворювань.

Abstract. The course of the 2019 coronavirus disease (COVID-19) is complicated by various concomitant diseases; chronic obstructive pulmonary disease (COPD) is one of them. The purpose of this study was to investigate the impact of COPD as a potential comorbidity on the prognosis of the severe course of COVID-19. Preliminary data on Covid-19 have shown a lower prevalence of COPD than would be expected in an acute respiratory illness such as COVID-19. This fact has led to the assumption that the use of inhaled glucocorticosteroids (IGCS) can protect against infection or the development of a severe course of COVID-19. The analysis of studies conducted in different groups of patients with a severe course of Сovid-19 with comorbidity of COPD made it possible to reveal statistically significant data for improving prognostic scales of an unfavorable prognosis of the disease. Further study and application of such indicators in general clinical practice will allow timely detection of patients of risk groups for the purpose of targeted monitoring and early change or intensification of treatment tactics, including concomitant diseases.

УДК 616.24:612.1]-06

Leptin, a hormone produced by white adipose tissue and recognised as an inflammatory biomarker, has an undefined role in the progression of chronic obstructive pulmonary disease (COPD). Objective — to evaluate the leptin level and its correlations with the levels of clinical, functional and anamnestic indicators in COPD patients.
Materials and methods. This study employed a case-control design involving 42 patients experiencing acute exacerbation of COPD and 20 control subjects. The patients were examined according to the standard protocol. Additionally, the examination included ultrasonic scanning of the abdominal cavity, evaluation of the serum leptin level, scoring of the anxiety and depression and quality of life.
Results and discussion. It was revealed that hyperleptinemia in the patients with acute exacerbation of COPD occurred significantly more frequently than in the healthy persons ((73.8 ± 6.8) vs (40.0 ± 11.0) %; р < 0.05). Besides, the COPD patients manifested increased leptin levels much more frequently than normal levels ((73.8 ± 6.8) vs (26.2 ± 6.8) %; р < 0.01). Hyperleptinemia was found to co-occur with severe COPD 
cases belonging to E clinical group ((51.6 ± 9.0) vs (18.2 ± 11.6) % in group with normal leptin level; р < 0.05). Kendall correlation analysis established that elevated circulating leptin levels were associated with an increased body mass index ( = 0.3; р = 0.02), female gender ( = 0.3; р = 0.01), non-smoking history ( = – 0.2; р = 0.03), stronger manifestation of such symptoms as shortness of breath ( = 0.3; р=0.01), disturbed home ( = 0.3; р = 0.002) and out-of-home activities ( = 0.3; р = 0.02) and lack of energy ( = 0.3; р = 0.01). It also correlated with increased severity of pulmonary insufficiency ( = 0.3; р = 0.003) and decreased forced vital capacity (= – 0.2; р = 0.04), elevated systolic blood pressure ( = 0.2; р = 0.02), elevated cholesterol ( = 0.3; р = 0.01) and -lipoproteins levels ( = 0.2; р = 0.04), pronounced depression ( = 0.3; р = 0.002) and lowered quality of life ( = 0.3; р = 0.01).
Сonclusions. COPD patients with elevated leptin levels manifest not only with an increased body weight, but also with arterial hypertension, disturbed lipid metabolism, more pronounced pulmonary insufficiency, depressive disorders and lowered life quality with more severe subjective respiratory symptoms.
Keywords. Chronic obstructive pulmonary disease, leptin, hyperleptinemia

УДК 616.002.5-021.3-053.8-035.7

Objective — to study the frequency and causes of diagnostic errors in primary pulmonary tuberculosis (PrPTB) in adults.
Materials and methods. The frequency and causes of diagnostic errors in verifying PrPTB in adults were studied by analyzing thpathomorphosis aspect of a specific process. Sectional material from 200 adult deaths due to primary forms of tuberculosis (PrFTB) over a period of 45 years (1974—2020) was analyzed. The study period was divided into three periods: the first period spanned from 1974 to 1988, during which three 
antimycobacterial drugs (isoniazid, streptomycin, and PASC) were used; the second period ranged from 1989 to 2005, during which rifampicin, ethambutol, and pyrazinamide were added to the treatment regimen; and the third period covered from 2005 to 2020, during which aminoglycosides, fluoroquinolones, linezolid, and other antimycobacterial drugs were widely utilized.
Results and discussion. Studies conducted on clinical and pathological material from 200 deaths related to primary forms of tuberculosis (PrFTB) over the last 45 years (1974—2020) based on data from prosectures in Lviv indicate a significant decrease in the number of deaths from primary pulmonary tuberculosis (PrPTB) among the adult population. This decline is attributed to the widespread adoption of modern antimycobacterial therapy for patients with pulmonary tuberculosis (PTB). The predominant clinico-pathological form of PrPTB is tuberculosis of the intrathoracic lymph nodes (TBILN), which manifests with various progression variants. Complications of a specific nature (such as miliary TB, TB meningitis, and TB sepsis) prevail among the direct causes of death. However, diagnosing PrPTB in adults poses significant challenges in modern conditions, with an increasing frequency of underdiagnosis over the years. Diagnostic errors most commonly occur in general diagnostic hospitals during the verification of TBILN and its complications in patients over 30 years old.
Conclusions. The frequency of underdiagnosing PrPTB has increased due to its atypical course, likely resulting from the pathomorphosis of a specific process. The discrepancy between clinical and pathoanatomical diagnoses, attributable to the unique clinical course of PrPTB, was observed in 7.3 % of cases in the first period, 27.2 % in the second, and 40.0 % in the third. Several factors contribute to the underdiagnosis of PrPTB, including short-term hospital stays, the atypical course of PrPTB due to the pathomorphosis of a specific process, inadequate patient examination, the lack of urgency for phthisiological evaluation in general medical institutions and incorrect interpretation of clinical, radiological and laboratory data.
Keywords Primary tuberculosis in adults, diagnosis, errors