The literature data of the last three decades on the problem of comorbidity of multiple sclerosis (MS) and epilepsy have been analyzed, such as issues of pathogenesis, clinical course, prognosis, and treatment of this dual pathology. Epileptic seizures occur in 2–3% to 5.9% of patients with MS, which is 3–6 times more common than in the general population. The incidence of epilepsy raises with increasing duration and severity of MS, with its
progressive course, and also depends on the effect of drugs for the treatment of MS. There is no unanimity in the literature on the age and gender characteristics of the occurrence of  epileptic seizures in MS. Probable mechanisms of MS comorbidity and epilepsy are analyzed. Data on certain common pathophysiology of MS and epilepsy and the concept according to which the model of epilepsy in MS is considered as a network disease are presented. Data on clinical manifestations and diagnosis of comorbid MS with epilepsy are presented. Epileptic seizures can occur at any stage of MS: before the clinical manifestations, at the onset of the disease, in the late stages, or can indicate exacerbation of MS. Types of epileptic seizures with a dual diagnosis (MS + epilepsy) are diverse. The majority of patients (up to 87.5%) have focal seizures (aware or unaware) or focal seizures to bilateral tonic-clonic, and a small share of patients have seizures of unknown origin. Most researchers believe that patients with MS and epilepsy have a more severe MS course and a worse long-term prognosis. The main directions of MS treatment and the impact of such treatment on the development of epileptic seizures are highlighted. Data on the effect of some disease-modifying drugs for the treatment of MS on the course of epilepsy and, on the other hand, on the impact of some antiseizure medications on the course of MS are presented. It is concluded that patients with MS have individual profiles and interindividual variability of epileptogenicity. The principles of treatment of epileptic
seizures/epilepsy in patients with MS are proposed.

Taras I. Pupin, Zoriana M. Honta, Ihor V. Shylivskyy, Oksana M. Nemesh, Khrystyna B. Burda

ABSTRACT

This work presents an analysis of the literature data of modern scientific research regarding the assessment of pathogenetic mechanisms of the impact of adaptive stress response on the condition of periodontal tissue. Chronic stress and depression suppress the immune system, predetermine hormonal imbalances, lead to metabolic disorders in tissues and increase the risk of dystrophic and inflammatory processes in periodontal tissues. All this leads to impaired masticatory function, tooth loss, pronounced psycho-emotional instability and significant decline in quality of life. That is why the problem of studying the adaptive stress response of the body requires further research to gain a deep understanding of its role in the etiology and pathogenesis of dental diseases and justify effective treatment and prevention measures.

KEY WORDS: periodontal tissues, generalized periodontitis, psychoemotional stress, adaptation, maladaptation, psycho-emotional disorders.

Метою даного дослідження є аналіз епідеміологічної ситуації з ентеробіозу серед дівчат з патологією сечової системи і при ураженнях нижніх відділів статевої системи за даними баз літератури (PubMed, Google Scholar, ResearchGate, PLoS, Hindawi) та висвітлення результатів власних клінічних спостережень. Ми опрацювали понад 200 робіт, присвячених впливу ентеробіозу на розвиток апендициту, близько 70 робіт про виявлення відповідного паразита в жіночій репродуктивній системі і близько 50 публікацій щодо його виявлення в сечовидільній системі. Ми подали 4 клінічні спостереження щодо наявності ентеробіозу в дівчаток і підлітків. Навели фотографії гостриків у центрифугаті сечі й у нижніх відділах жіночої статевої системи з описами негативних впливів паразита на здоров’я дівчаток і підлітків. Ентеробіоз може бути першочерговим чинником хронічних запальних процесів сечової системи та нижніх відділів статевих шляхів у дівчаток і підлітків.

The objective is to study the epidemiological situation on enterobiasis among girls with urinary system pathology and lesions of the lower parts of the reproductive system by analyzing literature databases (PubMed, Google Scholar, ResearchGate, PLoS, Hindawi) and to consider the results of our own clinical observations. We have processed more than 200 works on the effect of enterobiasis on the development of appendicitis, about 70 works on the detection of this parasite in the female reproductive system, and about 50 publications on enterobiasis in the urinary system. We presented 4 clinical cases on the presence of enterobiasis in girls and adolescents. We provided photos of pinworms in the urine centrifuge and in the lower parts of the female reproductive system with descriptions of the negative effects of the parasite on the health of girls and adolescents. Enterobiasis can be a primary factor in chronic inflammatory processes of the urinary system and the lower genital tract in girls and adolescents.

The study aimed to analyse the adverse drug reactions report form data received by the State Expert Center of the Ministry of Health of Ukraine from healthcare professionals in the Lviv region in 2022. Regarding specific types of medicines, the ones with proven cause-and-effect relationships that caused the highest frequency of adverse drug reactions incidents were chemotherapeutic agents (35.5%), medicines affecting the cardiovascular system (20.3%), and non-steroidal antiinflammatory drugs (8%). Within the penicillin class, amoxicillin potentiated by clavulanate (67%) and amoxicillin (29%) were the dominant drugs showing the highest incidence rate of adverse reactions. Among cephalosporins, ceftriaxone (46%) and cefixime (15%) were found to take the lead in terms of adverse reaction frequency. The highest proportion among all adverse drug reactions caused by penicillins and cephalosporins was attributed to allergic reactions. To confirm or rule out immediate or delayed type allergies in patients, as well as in patients with a history of immediate-type allergic reactions to β-lactams and planned administration of another β-lactam, it is necessary to conduct skin testing (skin prick test, or, in the case of parenteral administration, intradermal test) with the planned β-lactam antibiotic. The second highest proportion of induced adverse drug reactions was attributed to drugs affecting the cardiovascular system (20.3%). The leading medications in the angiotensin-converting enzyme inhibitors category were enalapril (47%) and the combination of lisinopril with hydrochlorothiazide (24%). In the angiotensin II receptor blockers category of medications, valsartan (30%) and telmisartan-hydrochlorothiazide combination (20%) ranked highest. In the category of CCB drugs, amlodipine (66%) and nifedipine (20%) held the leading positions. among angiotensinconverting enzyme inhibitors, enalapril caused the most prevalent and predicted adverse reaction, that of cough, affecting 10.5% of patients, whereas, with the combination therapy of lisinopril and hydrochlorothiazide, the cough was observed in only 5.2% of patients. Angiotensin II receptor blockers have a better safety profile, particularly concerning cough. Analysis of adverse drug reactions reports for angiotensin II receptor blockers showed no cases of cough with valsartan and telmisartan-hydrochlorothiazide combination. Among calcium channel blocker medications, amlodipine emerged to rank highest, causing one of the predicted adverse drug reactions, that of lower extremity oedema in 64% of patients. The second position was taken by the combination of amlodipine with valsartan, which showed a statistically significant reduction of 14.3% (p≤0.05) in the incidence of oedema. Using amlodipine at a dose of 5 mg in combination with sartan medicines as angiotensin receptor blockers is an effective therapeutic alternative not only for enhancing blood pressure control in hypertensive patients but also for improving the safety profile of amlodipine. Among all the non-steroidal anti-inflammatory drugs prescribed to patients in the Lviv region in 2022, the highest number of adverse reactions was associated with the administration of diclofenac, ibuprofen, paracetamol, and nimesulide, causing adverse drug reactions in 22%, 19%, 17%, and 10% of cases, respectively. The most common systemic manifestations of adverse reactions with these non-steroidal anti-inflammatory drugs were allergic reactions (63.4%) and gastrointestinal disorders (26.8%). From an evidence-based medicine perspective, the most justified approach for primary and secondary prevention of gastrointestinal complications is the use of proton pump inhibitors.

Cultural impact on the Polish and Ukrainian results of the TSIDAV vignette (Thrombocytopenia Symptoms Impact on patients Daily Activities Assessment Vignette) was analyzed. The impact of the disease symptoms was assessed using TSIDAV vignette and the main research was followed by the analysis related to the cultural impact on the results. The cultural impact analysis was based on Hofstede’s national culture model.
49 Ukrainian and 61 Polish patients participated. Mean Ukrainian TSIDAV value was 0.31 (SD 0.83). Gender values ranged <0 to -1.0, and according to the key for results interpretation it confirmed high disease impact on daily activities. Higher disease impact among men than among women (mean TSIDAV value 0.18, SD 0.95; and 0.44, SD 0.69 respectively). Mean Polish TDSIDAV value was 0.68 (SD 0.69). Among Polish women mean value was -0.85 (SD 0.54), within men mean -0.35 (SD 0.83). Applying G. Hofstede’s cultural model Ukrainian Power Distance score 92 reflects power holders societal distance. Low scores of Individualism and Masculinity dimensions. Uncertainty avoidance score 95, meaning feeling threatened by ambiguous situations. Long term
orientation dimension score 86 reflects Ukrainian society pragmatism. Polish results shown hierarchical (scoring 68), individualist (score 60), masculine society (score 64). Avoidance dimension scores 93 in Poland, meaning avoid uncertainty preference. Long Term Orientation dimension scored 38, defining more normative than pragmatic society.