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Arterial hypertension is the most common comorbid condition in the patients with chronic obstructive pulmonary disease. These diseases spread among one age group of patients with frequent development of coronary heart disease, the main cause of which is atherosclerosis. The increased association of these pathologies is explained by the presence of common pathogenetic mechanisms, i.e. chronic systemic inflammation, endothelial dysfunction, activation of sympathoadrenal and renin−angiotensin−aldosterone systems with the progression of pathological vasoconstrictor reaction. Cardiovascular effects caused by endothelial dysfunction, atherosclerosis, and hypertension are currently considered as potentially systemic manifestations of chronic obstructive pulmonary disease. To establish the effect of the combined use of fosinopril, nebivolol and atorvastatin on markers of chronic systemic inflammation and endothelial dysfunction (TNF−α, hsSRP, endothelin−1), lipid spectrum parameters, respiratory function in patients with stage II hypertension in combination with chronic obstructive pulmonary disease of stage I−II. There were examined 127 patients. They were two groups randomized, one of which received standard antihypertensive therapy (ACE inhibitor + dihydropyridine antagonist Ca2 + + thiazide diuretic), the other composed a combination of drugs (fosinopril + nebivolol + atorvastatin + thiazide diuretic). Clinical examination of patients included the study of anamnesis, objective condition, results of instrumental and biochemical studies. It was found that the combination therapy with fosinopril, nebivolol and atorvastatin for 32 weeks led to a significant reduction in endothelin−1, TNF−α, hsSRP, normalized the lipid spectrum, allowed the achievement of target blood pressure levels and did not impair external function.

Identifying the risk groups with potentially higher susceptibility and worse prognosis is an important to combat the COVID−19. Bronchial asthma is a common non−infectious disease of the respiratory system, and this group of patients is usually prone to more severe consequences of viral infections. Already at the early stages of the COVID−19 pandemic, this pathology was classified as a comorbid which can potentially increase the risk of coronavirus infection and worsen its course. However, recent scientific evidence suggests that the prevalence of allergic diseases and asthma among those infected is lower than expected compared to other comorbidities. Analysis of the results of most studies shows that patients with COVID−19 have concomitant bronchial asthma with no increased risk of hospitalization, admission to the intensive care unit, intubation / ventilation, higher clinical severity or mortality than the patients without bronchial asthma. This may be due to the pathogenetic mechanisms of allergic reaction and the use of inhaled corticosteroids. Considering the effect of asthma therapy on the course of COVID−19, the researchers found that the systematic use of inhaled corticosteroids reduces the incidence of exacerbations of bronchial asthma, allergen immunotherapy may play a protective role in very ill patients with COVID−19. Studies indicate a potential effect of monoclonal antibodies against IgE on the viral response. Taking into account the potential protective effects of bronchial asthma treatment and the high risk of its exacerbations when basic therapy is discontinued, as well as following the GINA 2020 guidelines for the management of such patients in COVID−19, the authors consider appropriate its prescribing during a pandemic.

Pathogenetic therapy is an important stage in comprehensive treatment of tuberculosis, which accelerates the reversal of inflammation, restores an adequate immune response, enhances reparative processes in the body, prevents the formation of severe residual changes, and prevents adverse reactions to anti−TB drugs. Drug methods of pathogenetic effects include detoxification, anti−inflammatory, desensitizing, antioxidant and immune therapy, use of antihypoxants, angioprotectors, hormonal drugs, metabolic regulators, vitamins, as well as maintenance therapy aimed at prevention and elimination of the reactions. One of the ways of effective and safe treatment of secondary immunological insufficiency is a personalized approach to treatment. The nature of inflammation in the affected organ is a factor that allows to individualize the approach to the pathogenetic treatment of tuberculosis. The appointment of pathogenetic therapy should be based on the results of a comprehensive analysis of the patient's condition, which takes into account the form, clinical course, features of pathomorphosis, depending on the immune system, free radical oxidation and antioxidant protection, metabolism and energy metabolism. Now the studying the directions of pathogenetic therapy of patients with pulmonary tuberculosis is still actual. Assuming the differences in immune status, indices of free radical oxidation and antioxidant protection, the use of combinations of drugs that have immune modulatory and antioxidant effects in patients with tuberculosis is justified and can improve treatment in terms of resorption resorption and infiltration resorption, as well as reducing the frequency of adverse toxic reactions.

Palliative care, which is devoted to the current problem of modern pediatrics, is presented as an important area not only in science but also in practical medicine. It is known that the quality of life of any person consists of various aspects and depends on many factors. Clinical nutrition is a set of therapeutic activities aimed at optimizing homeostasis and adaptive reserves of the patient. The modern concept of metabolic treatment, or nutritional support, is primarily organoprotective, which allows to improve the clinical outcome. That is why the nutritional support (in its various options: parenteral, enteral, including sip feeding, nutrition) as a leading factor in preventing the multiple organ failure can be considered one of the main aspects of palliative medicine. To determine the relevance of this issue, the main objectives of clinical nutrition were identified, namely: neutralization of symptoms of hypermetabolism − hypercatabolism, restoration of somatic or visceral protein pool, prevention or treatment of immune suppression, reducing the risk of infectious diseases or their complications, activation of reparative processes life of palliative patients. But recently, the attitude to nutritional support has been radically revised and a new concept has been developed taking into account the main processes in a certain pathological condition (rate of lipolysis, dysproteinemia, metabolic acidosis, circulating blood volume, increased degenerative changes in the pancreas). The need for nutritional correction in the patients with chronic non−progressive conditions, which is a leading component of improving quality of life, has been proven by a clinical example. Thus, a modern comprehensive approach to the correction of the nutritional status of the patient will contribute to the faster disappearance of symptoms and complications.

At the present stage of discussion of the treatment tactics for the patients with acute intestinal obstruction, the issue of enteral insufficiency syndrome is relevant, the occurrence of which is caused by changes in the intestine secretory, absorption and barrier functions. To analyze the results of treatment of patients with acute intestinal obstruction aggravated by enteral insufficiency syndrome and to identify ways to improve it, 62 patients were examined. It is noted that the most common etiological factors of obstruction were determined by the colon tumors. In the peripheral venous blood flow of patients, coagulation activation with depression of fibrinolysis was recorded, and in the blood flowing from the intestine, the changes in coagulation were observed according to the type of disseminated intravascular coagulation syndrome. The development of systemic endotoxemia of intestinal origin was clearly correlated with the clinically manifested syndrome of disseminated intravascular coagulation, which allowed to consider endotoxin as an etiological factor of this syndrome. The results of this study showed that in the examined patients the development of enteral dysfunction led to septicotoxemia. In this case, its toxic and mediator components are detected on the background of stress immunodeficiency and act independently of each other. The increase in the severity of the enteral insufficiency syndrome is accompanied by the changes in the coagulogram of patients: in the degree 2 the signs of hypercoagulation are more often observed, and in the degree 3 this was hypocoagulation. However, as a result of statistical analysis of hemostasis, depending on the severity of the correlation syndrome, their changes were not detected. This indicates an indirect relationship between coagulogram parameters and the processes occurring in ntestines of these patients, which indirectly demonstrates the role of the liver in buffering changes in intestinal circulation and systemic hemostasis.

Neoplasms of the mediastinum are located in a dangerous anatomical area that contains important vascular structures, heart, nerves and plexuses. The number of the mediastinum tumors and cysts is 0.5−3.0 % of the total neoplasia. Among the age structure of the population, the mediastinal neoplasms are most common among people of working age. Due to the frequent long−term asymptomatic course, the diagnosis of tumors is often caused by compression of the mediastinal organs, which occurs in large tumors. In world practice, over the past decade, thoracoscopic surgery has become the method of choice among the surgical treatment of mediastinal tumors. In 2018−2020 at the O.O. Shalimov National Institute of Surgery and Transplantology (Kyiv) 38 patients with mediastinal neoplasia were treated. All patients underwent removal of tumors by thoracoscopic access. Three clinical examples are provided. Patients were divided into groups depending on the location of tumors and analyzed for surgical treatment of mediastinal tumors, the prevalence of the latter by age and sex of the patient, tumor size and presence of concomitant pathology. In most cases, it was a neoplasia of the anterior mediastinum. Patients underwent the computed tomography and magnetic resonance imaging with intravenous contrast, video esophagogastroduodenoscopy, spirography, ultrasound of the heart, bronchoscopy. Due to the reduction of trauma and rapid post−surgery rehabilitation, the thoracoscopic surgery in the treatment of mediastinal tumors occupies a key place among other minimally invasive and open methods of surgery. This tactics helps to reduce the duration of surgery, diminish the number of post−surgery complications, and also it plays an important role in improving the treatment outcomes in the patients with mediastinal tumors.

Recently, the prevalence of overweight and obesity among the world's population has become a pandemic. According to many authors, this is facilitated by rapid electrification and gadgetization, the transition to a free labor market, increasing the impact of stressful situations, rising the number of vehicles and fast food restaurants, changing food culture and general physical activity, quarantine restrictions through COVID−19. Individuals with a higher body mass index have been found to have a significant risk of fractures in segments such as the humerus, tibia, and calcaneus. This may be due to the increased risk of falling and their different structure compared to non−obese individuals. It is known that overweight and obese patients need an individualized approach to their treatment, due to the difficulties that arise in the process of providing medical care. Excess body weight causes difficulties in transporting the patient to the hospital, its preoperative preparation, stabilization of the general condition and local condition of parafractory soft tissues, limits the choice of anesthesia for the patient. The results of treatment of 773 people were analyzed and evaluated, among which 442 had isolated fractures of the tibia. It is concluded that the classical approach to treatment of such patients is not perfect, because sustainable approaches to treatment tactics can not fully ensure quality of life, restoration of body functions in general and the lower extremity in particular, the return of a person to active life. Neglecting the lifestyle, peculiarities of food and motor diets, overweight, psycho−emotional features on the background of a tibial fracture lead to the choice of suboptimal rehabilitation program for such patients.

The abdominal cavity urgent diseases are the largest group in general surgical hospitals and require an emergency surgery. According to systematic reviews of the published reports, a significant influence of age and baseline severity of patients on the level of short− and long−term mortality was found. To analyze the initial state of the body water sectors and hemodynamics in the patients with average surgical risk in acute abdominal pathology, 157 patients underwent urgent surgery in the amount of emergency laparotomy were examined. In the structure of the main disease among the individuals the perforation of gastric and duodenal ulcers, pinched hernia, and acute intestinal obstruction were dominated. Clinical, hardware, laboratory, and computational fluid deficiency methods were used for all the patients. The state of central and peripheral hemodynamics was established instrumentally. There was a decrease in the plasma of patients with K + levels by 14.9 % of normal and an increase in Ca2 + levels by 91.1 % above normal. This coincided with a decrease from the norm of extracellular space by 20.0 % due to a reduction in both the volume of the interstitium and intravascular fluid by 21.0 % and 17.0 %, respectively, an increase in the level of vasopressin by 54.8 % above normal. This caused a decrease in stroke volume and formed a moderately hyperdynamic type of circulation due to an increase in heart rate and total peripheral vascular resistance by 21.2 % and 8.1 %, respectively. Thus, in the patients with an average surgical risk, urgent pathology of the abdominal organs contributes to the development of hypokalemia and hypercalcemia, the formation of a moderately hyperdynamic type of blood circulation on the background of tachycardia, vascular spasm to increase oxygen consumption and utilization.

Polycystic ovary syndrome is not considered as an independent disease, but as a phenomenon that combines a number of symptoms and has common clinical and biochemical manifestations. It is accompanied by ovarian dysfunction, increased secretion of androgens, estrogens, insulin, pathology of the pituitary gland and hypothalamus. This is a clinical syndrome in which there are found many 2−6−millimeter or larger follicular cysts containing atretic follicles in the ovary. The ovaries are usually enlarged and have a thickened and smoothed protein shell. To comparatively analyze the hormonal and biochemical parameters for the patients suffered from polycystic ovary syndrome with and without metabolic syndrome, 140 women were examined. The study of insulin resistance in such patients deserved a special attention, as its development is closely related to hyperandrogenemia, i.e. the syndrome direct cause. Hormonal studies of the blood of women with polycystic ovary syndrome showed that the changes in hormonal background were unidirectional, regardless of the presence of metabolic disorders. No significant differences, with the exception of prolactin levels, in the groups of patients with and without metabolic syndrome were detected. The data obtained indicate the presence of ovarian hyperandrogenism, which leads to a disorder of the central and peripheral mechanisms of regulation of steroidogenesis. Hormonal secretion and biochemical parameters of patients depend on the clinical form of the disease. Moderate hyperprolactinemia, decreased somatomedin−C levels on the background of insulin resistance were observed in the patients with metabolic disorders, and moderate hyperandrogenism was found in the patients without metabolic changes. Both groups were characterized by an increased ratio of luteinizing and follicle−stimulating hormones, which were more pronounced in women with metabolic syndrome.

A literature review on abnormal uterine bleeding in gynecological patients with thyroid pathology has been presented. Massive bleeding is an urgent problem of modern gynecology, because it occurs in almost a third of women of childbearing age and compose significant part of surgery. The variety of types and severity of clinical manifestations of abnormal uterine bleeding is a common reason for appointing the erroneous or ineffective treatment. Recent studies have shown an increase of up to 25.0 % of thyroid lesions, including hypothyroidism, in women of reproductive age. Therefore, it is necessary to assess the state of hormonal function of the thyroid gland in the complex of medical and diagnostic management of abnormal uterine bleeding. The biochemical affinity of thyroid hormones and reproductive system leads to an increased dysregulation in the case of damage to at least one of the systems that forms a vicious circle. Common mechanisms of central regulation of hormonal balance determine the importance of studying the pathogenetic mechanisms that arise at the level of the hypothalamic−pituitary−ovarian and hypothalamic−pituitary−thyroid systems. The direct effect of excess or deficiency of thyroid hormones through specific receptors in the ovaries and endometrium forms a direct pathogenetic effect on the development of menstrual disorders and, as a consequence, abnormal uterine bleeding. Implementation of the effects of thyroid−stimulating hormone and triiodothyronine not only affects the formation of structures of the reproductive system at the biochemical and cellular levels, but also causes an impairment of the cascade of hormonal interactions with prolactin, estrogen, progesterone, etc., which are also the triggers of menstrual disorders. Assessment of the state of hormonal function of the thyroid gland is necessary in the complex of medical and diagnostic management of abnormal uterine bleeding.

Endometrial hyperplasia is a polyetiological process, the development and progression of which can be facilitated by various factors. One of the most significant is hormonal changes in a woman's reproductive system. In endometrial hyperplasia, the changes in the receptor apparatus in its tissue are unidirectional. To study the morphological features of endometrial hyperplastic processes and the state of receptors in glandular−cystic and adenomatous endometrial hyperplasia, taking into account the tissue homeostasis, we investigated 85 women aged from 42 to 50 years. All patients underwent a comprehensive clinical examination: ultrasound, hormonal profile, morphological, histological, immunohistochemical and endosurgery. It was found that the levels of the proliferation marker Ki−67, as well as the expression of estrogen and progesterone receptors can predict the activity of the hyperplastic process. Based on the results of this study, the principles of individual therapeutic tactics in women with this pathology have been formulated. It is noted that the differential approach to treatment should be performed with respect to the levels of expression of estrogen and progesterone receptors, the clinical course of the disease and morphological state of the endometrium. Treatment should be aimed at normalizing endocrine and metabolic processes in women. The effectiveness of the proposed treatment approaches was determined by clinical observation, assessment of menstrual function, dynamic ultrasonographic monitoring, Doppler blood circulation in the basal layer of endometrium and spiral arteries, control cytological and histological studies. A rational and competent approach to the treatment of endometrial hyperplastic processes is a reserve for reducing the frequency of its oncological pathology.

Human being lives in a changeable environment, characterized by a certain periodicity. Daily and seasonal rhythms of physiological functions were formed and fixed in biosystems in accordance with the changes in natural processes during the day and year. Numerous interdisciplinary studies have shown the influence of heliogeophysical factors on human biorhythms, which are associated with solar activity, fluctuations in geomagnetic fields, indices of geomagnetic activity, features of the structure and state of the atmosphere. The results of researches of biorhythmological status of a person at mental and behavior disorders of different genesis and influence of heliogeophysical factors on them have systematized and analyzed. It was found that helio− and meteorological factors created the conditions for the occurrence of pathological manifestations due to desynchrony, affected the exacerbation of most mental illnesses in certain seasons of the year and caused clear peaks of hospitalization of patients depending on the pathology. Circadian dysfunction can also lead to the development of mental disorders, exacerbate clinical symptoms and affect them. The adaptability to environmental influences was reduced in the individuals of evening type of working capacity to a greater extent than in the morning and in those of undifferentiated types. Therefore, belonging to the evening biorhythmological type is a risk factor for neurotic disorders, dependence on psychoactive substances, as well as an increased level of suicidal risk. Representatives of the evening type of working capacity had a more pronounced desynchronization of physiological functions than those of the morning type. This was manifested by more frequent displacements of the acrophase, bathyphase, rhythm inversion and a combination of different disorders in the studied pathologies. The use of psychotropic drugs, taking into account the state of circadian rhythms, has a more pronounced therapeutic effect compared to traditional methods of treatment beyond the connection with circadian rhythms.

Psychological study of the "bodily dysphoria" phenomenon as a distress caused by abnormal−negative perception of one's own bodies, requires the examining of psychobiographical, genodispositional, psychotraumatic, psychosocial, introspective and behavioral characteristics of the persons suffering from gender identity disorder, anorexia, behavioral identity disorder obesophobia and dysmorphophobia, as well as the patients having an experience of living in this range of conditions. In order to develop the principles of clinical and psychological examination of the persons with gender identity disorders, digestive behavior and dysmorphophobia in the perspective of the concept of "bodily dysphoria", a prospective pilot study was conducted with the participation of 37 individuals. Among the contingent of patients were those with gender dysphoria, anorexia nervosa and bulimia, manifestations of dysmorphophobia (in the structure of anxiety and depression). The study used anamnestic and clinical−psychological methods. Certain groups of distress factors in "bodily dysphoria" were given general characteristics by means of the method of structured psychodiagnostic interview of patients (according to the structure of the author's questionnaire). Psychological problematization of the concept of "bodily dysphoria" is not possible without homogenization of the elements of distress, which is in the persons being in a state of disturbed gender identity, eating behavior and aesthetic component of self−perception. Each of the elements of distress can be implemented via three basic affective reactions: frustration, anxiety, adversion. Based on the analysis of self−perception in the surveyed contingent, 13 main categories of distress were identified: morphological, functional, genodispositional, somatoaffective, prospective, sexual, invective, hedonistic, competent, attributive, social, appellate, aesthetic.

The problem of radiation diagnostics at the stages of medical evacuation of the wounded / injured individuals as a result of current combat trauma in a hybrid war is relevant due to the multivariate damage and significant costs of medical and radiological care. To increase the efficiency of radiological diagnosis of modern combat trauma, depending on the diagnostic radiological support at the II, III and IV levels of medical care during the war in Eastern Ukraine, a retrospective analysis of research results in 1,013 wounded / injured has been performed. During the period of 2014−2020, 3,852 radiological examinations were performed in the patients at the II, III, and IV levels of medical care. The coefficients of need for radiological researches have been offered: integral (Kn) and they were specialized for each method of RD (KnRD) at the II, III, IV levels of medical care, which depends on the technical equipment of medical institution and the intensity of hostilities. It is established that at the stages of medical evacuation most often current combat trauma is diagnosed by ultrasound. Digital radiography was mainly used at the IV level of highly specialized surgical care. Multidetector computed tomography as a leading strategic method of radiological diagnostics was used in the wounded / injured individuals for diagnostic and sorting purposes, and magnetic resonance imaging − for diagnostic and palliative purposes in the provision of highly specialized surgical care. X−ray contrast angiography was performed exclusively at the IV level of medical care with subsequent appropriate endovascular surgery. The proposed coefficients of need make it possible to predict the required number of radiological studies in the event of a massive arrival of wounded / injured and thus contribute to the provision of medical care with identified needs during the evacuation stages.

Acute venous thrombosis is a common and dangerous disease, its frequency in the general population is about 160 per 100 thousand population. Thrombosis in the inferior vena cava is the most common and dangerous type of this pathology and the main source of pulmonary embolism. One of the risk factors for thrombosis is damage to the musculoskeletal system, including surgery in bones and joints, because forced limb immobilization or bed rest create the most favorable conditions for deep vein thrombosis and thromboembolic complications. Thus, in surgeries in the shoulder joints, the risk of thrombosis is 30−50 %. To determine the frequency, location and structure of thrombosis of the veins of the upper extremities in trauma patients in the pre−and postoperative periods, as well as to estimate the frequency of thrombosis of the veins of the lower extremities depending on the location of injuries using two−dimensional mode, color and energy Doppler mapping, pulse functional tests with compression. The results of ultrasound examinations of the veins of the upper extremities in the patients aged from 30 to 75 years, operated on for rupture of the shoulder rotator cuff, fractures of the humeral head large hump, fracture of the shoulder surgical neck. In a smaller number of cases, the shoulder joint injuries are accompanied by thrombosis of the inguinal veins in the preoperative period. In patients operated on for injuries, the incidence of inguinal vein thrombosis reaches 22 %. Mostly unilateral thrombosis of the subclavian−axillary segment of the deep veins of the upper extremities and its occlusive nature were revealed. Ultrasonography at the present stage is a non−invasive, affordable and highly effective method of research in the diagnosis of thrombosis of the veins of the upper extremities.