УДК 340.134+342.951:364.69+347.56:614.25 (Ук)

Відповідно до термінологічного  визначення, наведеного у статті 3 Основ, охорона здоров’я - система заходів, спрямованих на збереження та відновлення фізіологічних і психологічних функцій, оптимальної працездатності та соціальної активності людини при максимальній біологічно можливій індивідуальній тривалості її життя. Такі заходи здійснюють: органи державної влади та органи місцевого самоврядування, їх посадові особи; заклади охорони здоров’я; фізичні особи - підприємці, які зареєстровані у встановленому законом порядку та одержали ліцензію на право провадження господарської діяльності з медичної практики; медичні та фармацевтичні працівники, фахівці з реабілітації; громадські об’єднання і громадяни.

Безперечно, основне місце та роль в системі охорони здоров’я належить медичним працівникам, як суб’єктам, які безпосередньо надають медичну пацієнтам. Власне поняття медичної допомоги Основи розкривають через професійну діяльність медичних працівників. Так, медичною допомогою є діяльність професійно підготовлених медичних працівників, спрямована на профілактику, діагностику та лікування у зв'язку з хворобами, травмами, отруєннями і патологічними станами, а також у зв'язку з вагітністю та пологами (ст. 3 Основ).

У цій статті проаналізовано та з'ясовано ключові проблемні аспекти нормативного визначення категорії "медичні працівники" як ключових суб'єктів, які здійснюють діяльність у сфері охорони здоров'я.

UDC 616.47-006.488:618.3-06

Abstract.  Pheochromocytoma (PHEO) manifestation can be triggered by many different factors, including infectious diseases. In 2019, measles continued to spread in global outbreaks around the world. According to WHO data, more than 60 % of all measles cases in European Region were reported in Ukraine, a leader in measles occurrence. Measles is a dangerous viral disease, which remains an overwhelmingly important problem for healthcare system. Measles cause various life-threatening complications, which not only affect patients’ health and decrease quality of their lives, but can also lead to onset of many other medical conditions. Authors provide an example from their own clinical experience, which they have observed during the measles outbreak. Patient D., 22 y.o., female, was admitted to Lviv Infectious Diseases Communal Clinical Hospital because of measles. Condition was followed by severe intoxication, fever, hacking cough, skin rash all over the body. On 4th day after the appearance of rash patient developed atypical hypertensive crisis: in supine position started severe tachycardia, thumping headache, tremor of proximities and whole body, arterial blood pressure increased to 180/110 mm Hg; after changing the sitting position, symptoms started slowly decrease, in this regard patient had to spend a few days crouched in bed, she also complained about exaltation, insomnia, psychic tension, asthenia. Patient has undergone surgical treatment — laparoscopic left adrenalectomy. Perform differential diagnostics of hypertension accurately, paying special attention to determining its’ reason. Take into consideration, that PHEO manifestation
and hypertonic PHEO crises can be provoked by multiple reasons. If PHEO is suspected, hormonal, visualization and morphological examination methods should be performed. Keep in mind, that PHEO can be a constituent part of number of hereditary diseases: MEN 2A, MEN 2B, Von Recklinghausen’s Disease (Neurofibromatosis 1)

Binge eating disorder (BED) and night eating syndrome (NES) are common eating disorders (EDs) in individuals with diabetes type 2 (DT2). They worsen metabolic control, have a negative impact on physical and mental health and reduce quality of life. The roles of appetite-controlling hormones – leptin and ghrelin – is not clear enough in EDs and need to be investigated in order to establish new approaches and markers of EDs. Aim: To assess the difference in leptin and ghrelin levels in DT2 patients with and without EDs. 57 patients with DT2 were involved in the study. After physical examination and screening
for EDs, blood samples for leptin and ghrelin measuring were obtained.
Results: 19 participants (33.3%) were screened positively for ED (BE or NES). Leptin levels were higher in participants with ED (p<0.05). Conversely, ghrelin levels were lower in those with BE or NES (p<0.05). Leptin level is increased in DT2 individuals with BED and NES, whereas ghrelin is decreased. Leptin and ghrelin alterations maintain emotional eating, increase the frequency of binge and night eating episodes. In screening for EDs, assessing leptin and
ghrelin levels will facilitate obesity reduction and improve metabolic control in diabetic patients.

Summary
Aim:
Improving the quality of diagnosis and treatment orthodontic pathology in patient with temporomandibular joint disorders.

Materials and methods: Analysis – to determine objectives and study plan; clinical-diagnostic methods that include dental and radiological examination (to establish the clinical diagnosis of patients with temporomandibular disorders), electronic axiography (to determine the features of the movements of the articular heads of the mandible), instrumental study the models of jaws in the articulator (to diagnose the state of functional occlusion), statistical (to calculate averages and assess the probability of the results).
Results: After developed and implemented algorithm total dental rehabilitation we have eliminated functional disorders in the masticatory muscles and temporomandibular joints, completely restored the lost function of the masticatory apparatus.
Conclusions: Creation of occlusal relations, which are harmoniously combined with the function of masticatory muscles and temporomandibular joints, allowed to achieve the long period of remission, absence of the complications and recurrences of the disease in the near and long term. These points became the criterions that improved effectiveness of scientifically based individual treatment of mandibular disorders.

Key words: temporomandibular joint disorders (TMDs), malocclusion, individual treatment management

słowa kluczowe: zaburzenia skroniowo-żuchwowe (TMD), wada zgryzu, indywidualizacja terapii