Asthma in patients with the syndrome of undifferentiated dysplasia of connective tissue: peculiarities of the course or mutually aggravating mechanisms?

OBJECTIVE: Aim: To analyse laboratory and biochemical features of the severe persistent course of asthma in patients with undifferentiated connective tissue dysplasia (UCTD) syndrome, and their phenotypic and visceral stigmas of dysembryogenesis. PATIENTS AND METHODS: Materials and Methods: We enrolled 60 male patients with asthma, aged from 23 to 62 years (mean age (46.83 ±0.85) years): 30 patients with the background of UCTD, and 30 - without UCTD. We analysed clinical, somatometric, surveying (original questionnaire based on the phenotypic map of Glesby), instrumental (spirography, echocardiography, endoscopy, esophagofibrogastroduodenoscopy) and laboratory (including eosinophilic granulocytes and aldosterone levels) data. RESULTS: Results: Correlations were found in men with UCTD between the number of UCTD markers and rate of earlobe diagonal fold (r=+0.75; р<0.05), asthenic constitution (r=+0.72; р<0.05), easy bruising (r=+0.7; p<0.05) and straight abdominal line hernia (r=+0.52; p<0.05). Average aldosterone serum level in patients with UCTD (176,10 ±11,22) was significantly higher than in those without UCTD (142,77 ±9,43), (p<0.05), as well as average eosinophils levels (1.3 ±0.25 vs. 0.57 ±0.12, p<0.05). In the absolute majority of patients with UCTD (93.3%) asthma onset was confirmed after pneumonia, and their age of asthma manifestation was significantly higher (37.2 ±1.21) than in patients without UCTD (21.4 ±1.13). Also, in patients with UCTD there was a high number of severe exacerbations during the last year (2.7 ±0.12 per year) on the background of high doses of combined inhaled glucocorticosteroids use. CONCLUSION: Conclusions: Identified "phenotypic profile", clinical and biochemical features of patients with asthma on the background of UCTD syndrome, which determine the severe course and early formation of asthma complications, will further accelerate the diagnosis of this asthma phenotype and improve approaches to the selection of treatment regimens for these patients.

TRAUMATIC EVENTS AND MENTAL DISEASES: THE ROLE OF CERTAIN NEUROTRANSMITTERS, METALLOENZYMES AND HORMONES

OBJECTIVE: Aim: To study the role of certain neurotransmitters (brain-derived neurotrophic factor (BDNF), 5-hydroxytryptamine (5-HT)), metalloenzymes (matrix met-alloproteinase-9) (MMP-9) and hormones (ghrelin) in the pathogenesis of mental disorders associated with stress under the impact of traumatic events. PATIENTS AND METHODS: Materials and methods: We conducted a systematic search of major electronic medical databases published before October 1, 2022. Such keywords as (post-traumatic stress disorder OR PTSD), (Brain-derived neurotrophic factor OR BDNF), (matrix metalloproteinase-9 OR MMP-9), (serotonin OR 5-HT), ghrelin, melatonin identified relevant studies. All articles were reviewed, including original studies, systematic reviews and meta-analyses. CONCLUSION: Conclusions: Unfortunately, the imbalance of neurotransmitter systems of the brain remains not fully understood under such a condition at this stage of world science development. Their role remains unclear both during the immediate exposure to the stress factor and in the remote period. Therefore, under¬standing the mechanisms underlying the systemic consequences of PTSD is crucial for the development of prediction models and timely rational therapy.

PECULIARITIES OF DYNAMICS OF INDICATORS OF PROTEINS OXIDATIVE MODIFICATION AND MATRIX METALLOPROTEINASE-9 ACTIVITY IN PATIENTS WITH PARANOID SCHIZOPHRENIA DEPENDING ON THE DISEASE DURATION.

OBJECTIVE: The aim: The objective of the research was to study the indicators of oxidative modification of proteins (OMP) and the activity of matrix metalloproteinase-9 (MMP-9) in patients with paranoid schizophrenia depending on the disease duration. PATIENTS AND METHODS: Materials and methods: 320 patients were included in the examination. 20 patients were with "Primary psychotic episode" (Comparison Group) and 300 patients were diagnosed with "Paranoid schizophrenia" (Experimental Group): 60 of them have suffered from this disease for a duration from 3 to 5 years (Subgroup I ); 60 patients have suffered for a period from 6 to 10 years (Subgroup II); 60 individuals - from 11 to 15 years (Subgroup III); 60 patients have suffered for a duration from 16 to 20 years (Subgroup IV); 60 patients - from 21 years and longer (Subgroup V). RESULTS: Results: The presented data showed that the levels of OMP indicators in Subgroup I constituted 0.826±0.046 conventional units at a wavelength of 356 nm; 0.864±0.051 conventional units at a wavelength of 370 nm; 0.444±0.019 conventional units at a wavelength of 430 nm; 0.176±0.007 conventional units at a wavelength of 530 nm, which is 1.99; 1.6; 1.13 and 1.43 times higher than in the Comparison Group. The content of OMP products was higher by 2.24; 1.74; 1.17, and 1.43 times in Subgroup II, respectively, by 2.4; 1.80; 1.36 and 1.46 times in Subgroup III, respectively; by 2.5; 1.9; 1.4; 1.6 times in Subgroup IV, respectively; by 2.5; 2.02; 1.54; 1.7 times in Subgroup V, respectively. The conducted correlation analysis indicated a direct correlation between OMP indicators and the disease duration. The concentration of MMP-9 in the patients of the Comparison Group was equal to 892.84±87.80 pg/ml, which was 11.2% less compared to the Experimental Subgroup I, where this indicator was 992.84±67.50 pg/ml. MMP-9 constituted 1092.53±47.20 pg/ml on average in the patients of Subgroup II, which was 22.36% higher than in the Comparison Group. This indicator was 1702.84±37.60 pg/ml in Subgroup III, which was 90.7% higher than in the Comparison Group. It constituted 1492.84±47.29 pg/ml in Subgroup IV, which was 67.2% higher than in the Comparison Group; and 2037.21±57.80 pg/ ml in Subgroup V, which was more than two times higher than in the Comparison Group (p<0.05). The conducted correlation analysis showed a direct relation between MMP-9 expression and the increase in OMP indicators. This relation was more significant between MMP-9 and OMP products of a neutral nature. The correlation strength between MMP-9 and OMP products of a basic nature was somewhat less significant. CONCLUSION: Conclusions: According to the results of the conducted analysis, the examined patients had the signs of decompensation of reactive-adaptive biomolecular mechanisms which activated radical reactions with the subsequent accumulation of oxidation products.

FEATURES OF SOCIAL DYSFUNCTION, ASSESSMENT OF LEVELS OF SOCIAL FRUSTRATION AND SATISFACTION WITH THE QUALITY OF MEDICAL CARE IN PATIENTS WITH SCHIZOPHRENIA ON THE BACKGROUND OF SOMATIC COMORBIDITY.

OBJECTIVE: The aim: To study the features of social dysfunction, assess the levels of social frustration and satisfaction with the quality of medical care in patients with schizophrenia on the background of somatic comorbidity. PATIENTS AND METHODS: Materials and methods: The study included 105 patients (55 women - 52.38% and 50 men - 47.61%) with a verified diagnosis of schizophrenia (F20.0-F20.3). The psychopathological condition of patients was assessed according to the "Positive and Negative Syndrome Scale" (PANSS). A special psychodiagnostic technique by L. I. Wasserman in the modification of V.V. Boiko was used to assess the level of social frustration. Peculiarities of social dysfunction were assessed based on the "Personal and Social Performance scale" (PSP). "The Health Resource Use Questionnaire" was used to obtain the information about the coverage of this patient with primary or specialized somatic care during the last three months. General and systematic examination of the patient was also performed, physical methods of diagnosis (palpation, percussion, auscultation) were applied, body mass index was calculated. Consultations of specialists, instrumental (ECG, ultrasound, Echo-CS, etc.) and laboratory diagnostic methods were prescribed depending on the detection or suspicion of concomitant somatic pathology. RESULTS: Results: The results showed significant social isolation of the respondents, their contacts were limited to communication with relatives and friends. This was confirmed by the data of social functioning on the PSP scale, according to which the most pronounced violations in the examined patients were found in the areas of "personal and social relationships", "socially useful activities, including work and study". It should be noted that the higher the rates of social dysfunction, the stronger the level of frustration (p<0.05). In particular, the low level of satisfaction with the field of medical services due to its inaccessibility, according to respondents, attracts attention. According to the relatives, the main reason for this restriction was the patients' lack of awareness of their condition, neglect and indifference. CONCLUSION: Conclusions: Further attention is required to develop strategies to improve comorbid treatment in the patients with schizophrenia regardless of whether this situation is the result of negative attitude of health professionals towards patients with mental illness, or the result of the patients' ignorance of their physical condition, or other factors.

MANIFESTATIONS OF EXCESSIVE DAYTIME SLEEPINESS AND GHRELIN LEVEL IN CASE OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE.

OBJECTIVE: The aim of the study was to discover the interrelation between the severity of gastroesophageal reflux disease (GERD) symptoms, acid exposure time (AET), excessive daytime sleepiness (EDS) and the level of active blood plasma ghrelin in the patients with undifferentiated connective tissue disease (UCTD). PATIENTS AND METHODS: Materials and methods: The study included 120 patients with GERD. All the patients were divided in two groups: Group I - GERD was not accompanied by the signs of connective tissue disease (n=45) and Group II - GERD developed on the background of UCTD syndrome (n=75). Daily transnasal pH monitoring was performed to determine the nature of pathological refluxes. EDS was detected by The Epworth Sleepiness Scale. Active ghrelin in blood plasma samples was determined by ELISA. RESULTS: Results: 80% of the patients of Group II and 35.48% of Group I suffered from EDS (p<0.05). The mean daily AET index was 5.48±0.4% in Group II and 6±0.2% in Group I, in the night hours mostly when patients were in the upright position. This phenomenon contributed to a deterioration of sleep quality and the appearance of EDS and was supported by a connection between AET and EDS (r=+0.827 for Group I and r=+0.768 for Group II). The mean De Meester index was higher in the patients of Group II (23.01±2.24 in Group I vs 31.08±2.4 in Group II; p<0.05). CONCLUSION: Conclusions: GERD manifestations are strongly related to the level to AET and intensity of EDS. The EDS symptoms depend on circulating ghrelin level.

THE QUALITY OF LIFE FOR STUDENTS IN EDUCATIONAL INSTITUTIONS: CURRENT SITUATIONS AND BASIC PRINCIPLES OF PSYCHOHYGIENIC IMPROVEMENT.

OBJECTIVE: The aim: To develop the key principles of psychohygienic improvement of the processes of personality formation and enhancement of the quality of life of pupils and students of modern educational institutions of various types. PATIENTS AND METHODS: Materials and methods: While working out the basic principles of psychohygienic correction of the processes of personality development and improvement of the quality of life of pupils and students of modern educational institutions of various types, we have conducted surveys of the adolescent boys and girls studying at five modern educational institutions in Ivano-Frankivsk city, namely Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk Finance Commercial Cooperative College named after Stepan Hranat, Ivano-Frankivsk State Music School named after Denys Sichynskyi, Ivano-Frankivsk Vocational Lyceum of Road Transport and Construction No. 15, and Ivano-Frankivsk Boarding Lyceum for Gifted Young People from Rural Areas. A total of 420 pupils and students studying at different types of educational institutions took part in the survey. They were in both natural and preformed conditions due to application of the program of psychophysiological effects on the body, psychohygienic correction of personality development processes and improvement of the quality of life of pupils and students. RESULTS: Results: While conducting the research, we have noted that the practical application of the program of psychophysiological effects on the body, psychohygienic correction of personality development processes and improvement of the quality of life of pupils and students occurs at mental, personal and psychophysiological levels of the adolescent boys and girls, anticipating correction of emotional, motivational and behaviour-based key characteristics of personality, psychophysiological adaptation and quality of life, thus being a platform for development of creative potential, self-analysis, self-expression and self-control skills, as well as discovery of positive landmarks and meaning of life of the boys and girls. CONCLUSION: Conclusions: The obtained data demonstrate that implementation of the program of psychophysiological effects on the body, psychohygienic correction of personality development processes and improvement of the quality of life of pupils and students, which includes: study of the level of development of psychophysiological functions, personality characteristics and indicators of the quality of life in each of the participants as well as taking into account the leading areas of their development within certain frameworks of educational process (the milestone of psychodiagnostics and assessment of the level of development of psychophysiological functions and personality traits); performing a set of exercises to relieve muscle spasms, isometric and respiratory gymnastics, as well as exercises of asymmetric gymnastics (the milestone of physical impact); application of psychophysiological component (the milestone of psychophysiological influence); introduction of a psychohygienic component (the milestone of psychohygienic correction) serves the basis for creating the foundation for activating positive changes in the peculiarities of psychophysiological and mental adaptation and characteristics of the quality of life of modern youth at educational institutions of various types.

THE BONE-BRAIN AXIS? BIOPSYCHOSOCIAL ASPECTS OF ORTHOPEDICS AND A MENTAL WELLBEING ACTION PLAN IN MUSCULOSKELETAL CARE.

OBJECTIVE: The aim: To review the biopsychosocial aspects of psychiatric comorbidity in patients with musculoskeletal conditions and recommend a relevant mental health action plan. PATIENTS AND METHODS: Materials and methods: Keywords (orthopedics, psychiatry, mental health) were used to list down and analyze the literature in PubMed and Google Scholar. All types of articles, including original research, systematic reviews, and meta-analyses, along with gray literature dating back to 2000. We excluded studies reporting a significant conflict of interest and findings dispersed through popular media instead of peer-reviewed journals. CONCLUSION: Conclusions: The biopsychosocial aspects of the "bone - brain axis" need to be better addressed by means of a pragmatic approach involving all concerned parties and acknowledging the challenges and limitations along the way.

The frequency of visceral and phenotypic markers in patients with the combination of undifferentiated connective tissue disease and gastroesophageal reflux disease.

OBJECTIVE: The aim: The aim of the research was to study the prevalence of visceral and phenotypic markers of UCTD syndrome in patients with GERD for the purpose of early diagnosis of this comorbidity. PATIENTS AND METHODS: Materials and methods: The study included 120 patients: 75 patients (Group II) - GERD was on the background of UCTD, 45 (Group I ) - the patients with GERD. The average age of the patients was 42.05 ± 6.5 years. Evaluations of UCTD's were performed accordingly to the criteria recommended by M. Moska et al., A. Doria et al., T. I. Kadurina, L. M. Abbakumova in the modification of T. Milkovskaya-Dimitrova, and the degree of their expression on the scale of T. Y. Smolnova. RESULTS: Results: Among the examined patients, the specific criteria for the certain connective tissue diseases were detected in the patients with UCTD from 2.7 and 20.0% more often. Bone, joint and skin phenotypic signs of dysplasia were observed in patients with GERD associated with UCTD by 4-4.5 times more often. Various abnormalities of internal organs development were detected in the majority of patients of Group II, namely in 88.0%, and only in 6.6% of the patients of Group I. According to the data on daily pH monitoring, esophagus AET constituted 4.6% of the total monitoring period in Group I and 5.48% in the patients of Group II. The number of refluxes with pH<4 recorded in the patients of Group I constituted 57±8 episodes, and 79±6 episodes in the patients of Group II. CONCLUSION: Conclusions: The obtained data indicated that the number of pathological GER was significantly higher in the setting of comorbidity. Our research also showed that the chances of diagnosing Reynaud's Syndrome, arthralgia, unmotivated body weight loss, dysphagia, skin rash, oral ulcers, proximal muscle weakness in the patients with GERD associated with UCTD are higher in comparison with the patients with GERD without comorbidity (р<0.05). This should necessarily be taken into account in the early diagnosis and when assigning a complex therapy in case of this pathology.