UDC: 617.77-002:616-056.3]-06-07 

Abstract. Blepharitis is a very common disease in ophthalmology, dermatology, and allergist practice. It can be acute or chronic. Acute blepharitis is most often caused by viruses (Herpes simplex and Varicella zoster) and bacteria (Staphylococcus). Chronic blepharitis is a symptom of allergies, metabolic syndromes most often associated with liver disease, autoimmune diseases, fungal infections, and Demodex. The liver is a vital organ that supports immunity, metabolism, digestion, stores vitamins, and is responsible for detoxification. Therefore, liver dysfunction can also cause skin lesions around the eyes. Stress, through the activation of the pituitary-hypothalamic-adrenal system, promotes cell activation and the release of biologically active cytokines, which in turn
is a factor in skin damage. Clinically, blepharitis is manifested by redness, itching, and swelling of the eyelids, sometimes the formation of scales on the eyelids. As a rule, both eyes are affected and the disease has a recurrent course. In most cases, blepharitis does not pose a threat to the patient's life, but it reduces the quality of life and is dangerous for the development of such complications as conjunctival lesions and the formation of corneal marginal ulcers.
The article presents clinical cases of patients with chronic blepharitis who had similar symptoms but differed in etiology and treatment regimens.
Key words: blepharitis, contact dermatitis, toxic blepharitis.

Резюме. Хронічні обструктивні захворювання бронхолегеневої системи є одними з найбільш поширених у світі. Бронхіальна астма (БА) та хронічне обструктивне захворювання легень (ХОЗЛ) значно обмежують пацієнтів, знижують їхню працездатність і потребують чималих фінансових витрат. Сьогодні ми маємо можливість допомогти таким пацієнтам, призначивши доступні та дієві ліки. Однак частина пацієнтів не може досягти контролю над хворобою. Частою причиною цього є погана прихильність до лікування.
Мета дослідження: визначення прихильності до лікування та її вплив на перебіг хвороби
Матеріали та методи. У дослідження було включено 52 пацієнти з бронхіальною астмою та хронічним обструктивним захворюванням легень. Важкість захворювання визначали за допомогою шкали оцінки важкості задишки (MRC), спірометричними показниками. Прихильність до лікування оцінювали за допомогою опитувальника, що включає 7 запитань.
Результати. Оцінку результатів тестувань проводили на першому візиті, через 3 та 6 місяців після початку лікування. Через 6 місяців середні показники опитувальника MRC покращилися в обох групах, однак у групі пацієнтів БА кількість пацієнтів, які оцінювали свою задишку як важку, була значно меншою (7 пацієнтів у групі ХОЗЛ та 2 пацієнти в групі БА). Прихильність до лікування незначно відрізнялася в обох групах (4,5±0,1 бала проти 4,2±0,3 бала, р<0,05). Основними факторами, що впливають на прихильність, є вартість препарату, тривалість використання та
можливі побічні дії.
Ключові слова: бронхіальна астма, хронічне обструктивне захворювання легень, прихильність до лікування.  

УДК 616.514-036.12-02:616.8-008.615.1]-036.864

Introduction. Skin is the largest human organ. Its main functions are protective, excretory, receptory, thermoregulatory, respiratory, etc. Any metabolic disorders in our body, infectious and autoimmune diseases, toxic lesions, chronic renal diseases and those of gastrointestinal tract, diseases of the blood, liver, gall bladder can manifest as skin lesions, for example, in the form of chronic urticaria (CU). Nervous system also plays a significant role in the development of urticaria.
Objectives. Studying the prevalence of urticaria in adult patients, main causes of increased skin itching and rash, effect of stress on the frequency and severity of urticaria exacerbations and treatment effectiveness.
Materials and methods. The article presents the results of instrumental and laboratory methods of examination of urticaria patients, as well as comparison of the treatment effectiveness depending on the obtained research findings and stress test results. The study included 75 patients aged 18 and over. Patients in both groups underwent laboratory and instrumental examinations, stress testing (The Kessler Psychological Distress Scale (K10)), and the UAS7-test for urticaria control. The main study included 63 patients with urticaria, who were divided into three groups (depending on the results of the stress test).
Conclusions. Nowadays CU is an important global problem. Due to constant itching, sleep disturbances, decrease in performance, cosmetic discomfort, the patients’ quality of life is getting worse. Timely diagnosis and prescription of treatment improves patients’ well-being and social adaptation. The research shows that stress exacerbates the course of CU. Patients with high and medium level of stress noticed expressed reduction in rash and itching when treatment included sedative medications. 

Introduction. Recently, metabolically associated fatty liver disease (MAFLD) had been proposed as a new term. Due to increasing prevalence, significant morbidity and hepatic and cardiovascular mortality, the association of MAFLD with cardiovascular diseases is gaining considerable relevance and needs further study. The aim of our study was to determine the proportion of MAFLD among patients with a very high cardiovascular risk, and to elucidate clinical features and gender differences in this cohort.
Materials and methods. All patients underwent a comprehensive examination to assess both cardiovascular risk and MAFLD. Hepatic steatosis was diagnosed after liver ultrasonography. Participants who met MAFLD criteria were included into the group 1 (n=77; 32 women, 45 men), other patients were assigned to the group 2 (n=39; 19 women, 20 men).
Results. Among patients with very high cardiovascular risk, proportion of MAFLD was 66.7 %. Although mild alanine aminotransferase elevation was much more common among patients with MAFLD (16 women (50.0 %) vs. 2 women (10.5 %) in group 2, P = 0.006; 21 men (46.7 %) vs. 2 men in group 2 (10.0 %), P = 0.005), none of the participants met the criteria for steatohepatitis. Despite, the presence of metabolic disorders in the vast majority of participants, proportion of obesity, metabolic dyslipidaemia, prediabetes and type 2 diabetes were significantly higher in patients with MAFLD. Besides,
patients with MAFLD usually met 4 or 5 metabolic syndrome criteria, had higher median values of lipid accumulation product (LAP) and HOMA-IR
index, but lower median values of Matsuda index. Significant direct correlations were found between MAFLD and LAP, logarithmic index(TG/HDL-C), and HOMA-IR; negative correlations were observed between MAFLD and insulin sensitivity indices. Women with MAFLD had significantly higher median values of glycated haemoglobin, postload glucose, fasting insulin levels; there was direct correlation between MAFLD and non-HDL-C. Among women with MAFLD, a history of menopause before 45 years of age had 15 persons (46.9 %) vs. one person (5.3 %) in group 2 (P < 0.002); the median age when ASCVD was diagnosed was 58.5 [53.0; 64.0] years vs. 68.0 [63.0; 69.0] years in group 2 (P = 0.002); cardiac valve calcinosis was detected in 31 women (96.6 %) vs. 9 women (47.4 %) in group 2 (P = 0.0001); the left ventricular myocardial mass (LVM) index was 77.5 [62.1; 86.9] g/m2.7 vs. 64.0 [50.6; 74.0] g/m2.7 in women without MAFLD, 67.0 [55.1; 74.0] g/m2.7 in men with MAFLD, and 63.9 [50.0; 73.5] g/m2.7 in men without MAFLD (Kruskal–Wallis ANOVA P <0.0001; median test P=0.002). The prevalence of smoking and alcohol intake was significantly more common among men (gender differences P <0.0001 and P=0.0001 in group 1; P = 0.0004 and P=0.0023 in group 2 for smoking and alcohol intake, respectively). Men with MAFLD had significantly higher median values of fasting plasma glucose, fasting and post-load insulin levels than men without MAFLD; there was a significant direct correlation between
MAFLD and serum TG level. In addition, 11 men with MAFLD (24.4 %) had hypertriglyceridemia >2.3 mmol/l that was not observed among men
without MAFLD (P=0.013). The proportion of men with fasting and postload hyperinsulinemia was much higher in group 1 than in group 2 (28 persons (62.2%) vs. 3 persons (15.0 %), P=0.0005 and 26 persons (57.8%) vs. 2 persons (10.0 %), P = 0.0003, respectively).
Conclusions: among patients with a very high cardiovascular risk, the prevalence of MAFLD was significantly higher than in the general population. Concomitant MAFLD was associated with more severe metabolic disorders (i.e., obesity, metabolic dyslipidaemia, hyperglycaemia, insulin resistance), which usually combined. The LAP index is a simple available tool that may be used in routine clinical practice to determine the need for MAFLD screening. Women with MAFLD frequently had early menopause, cardiac valve calcification, and much higher median value of LVM index; direct correlation was observed between MAFLD and non-HDL-C. Men with MAFLD more often had fasting and/or post-load hyperinsulinemia and moderate hypertriglyceridemia.