COMPARATIVE ANALYSIS OF EFFECTIVENESS OF OBESITY TREATMENT IN PRIMARY CARE USING PATIENT-ORIENTED APPROACH WITH MOTIVATIONAL COUNSELING FOR LIFESTYLE CORRECTION AND ITS COMBINATION WITH ARMODAFINIL THERAPY IN PATIENTS WITH CONCOMITANT SHIFT WORK SLEEP DISORDER.

OBJECTIVE: Aim: Conduct a comparative analysis of effectiveness of obesity treatment in primary care using patient-oriented approach with motivational counseling for lifestyle correction and its combination with armodafinil therapy in patients with concomitant shift work sleep disorder. PATIENTS AND METHODS: Materials and Methods: 75 patients with obesity were studied, 38 patients had shift work disorder. Patients were divided into 2 groups: I (37 patients with obesity treated with motivational counseling) and II (38 patients with obesity and shift work disorder treated additionally with armodafinil 150 mg daily). The examination was at baseline, after 1st, 3th and 6th months. Statistical analysis was provided. RESULTS: Results: After 1 month of treatment, there were improvement of eating behavior, level of anxiety and depression, prognosis of diabetes development. At 3rd month, more pronounced changes were observed in 2nd group: 10% body weight loss, changes in eating behavior, sleep quality, anxiety level (p<0.05). After 6 months, examined indicators in both groups normalized, but dynamics in 2nd group was more significant; armodafinil-treated group had significantly better results in body weight loss, BMI, WC, HC, ConI, AVI, BPs, HOMA index, serotonin, leptin, levels of anxiety and depression, eating behavior, daytime dysfunction, level of sleepiness, quality of life and risk of developing diabetes. CONCLUSION: Conclusions: The use of armofafinil in addition to patientoriented motivational counseling in lifestyle correction ("5 As" and "5R") in patients with obesity connected with shift work disorder and excessive daytime sleepiness allows to reduce body weight by more than 16,52%, in contrast to isolated use of the same technique of motivational counseling in obese patients without sleep disorder (only 5,51%).

THE INCREASE OF EFFICIENCY OF TREATMENT IN PATIENTS WITH NON-STABLE ANGINA PECTORIS WITH USE OF NITROGEN OXIDE DONATOR

OBJECTIVE: Introction: One of the leading pathogenetic factors of CVD is a violation of the function of the endothelium of the vessels, which leads to endothelial dysfunction. The aіm: Increasing the efficiency of treatment of patients with NSAP based on the study of the dynamics of clinical picture, blood parametres, CRP, indices of endothelium dependent vasodilatation of the brachial artery with the use of arginine hydrochloride. PATIENTS AND METHODS: Materials and methods: The 45 patients with non-stable angina pectoris (NSAP), who were in inpatient treatment in the cardiological department of the Clinical city hospital of emergency care in Lviv, were examined. The average age of patients was 56.8 ± 4.9 years. The patients were divided into 2 groups depending on the treatment. The first group (22 patients) took the common basic therapy, based on the standards of treatment of patients with NSAP. Another group (23 patients) received common standard (basic) treatment plus arginine hydrochloride, as a endothelial protector. The control group included 15 practically healthy individuals. The statistical analysis of the materials was carried out using the Statistica 8.0 program with the definition of the Student's t-criterion. RESULTS: Results: When complex treatment of patients with NSAP using arginine hydrochloride improves the clinical picture faster than with basic therapy. After treatment, statistically significant changes in the lipid profile of the blood were observed only in the group of patients who underwent complex therapy with arginine hydrochloride, the level of total cholesterol, LDL cholesterol and atherogenic index decreased, HDL cholesterol increased compared with those before treatment. After the complex treatment, the rate CRP decreased on 40,8% (p <0,05) and on 29,7% (p> 0,05) in the basic therapy. After 30 days of treatment in the group of patients with intermittent use of arginine aspartate, a positive trend was observed in 74% of patients, considering that endothelial dysfunction was detected in 95.1% of patients before treatment. CONCLUSION: Conclusions: Comprehensive treatment of patients with NSAP using arginine hydrochloride is more effective than basic therapy, as evidenced by faster normalization of the clinical picture of the disease, laboratory blood parameters, and improvement of the function of the endothelium.