Актуальность. Уровень сывороточного холестерина частично регулируется благодаря метаболизму желчных кислот в кишечнике, зависящему от активности бактериальной гидролазы солей желчных кислот (ГСЖК). Существующие данные относительно четкого влияния ГСЖК на липидный обмен и сердечно-сосудистый риск недостаточны и противоречивы. Целью исследования было оценить взаимо­связь между относительной активностью (ОА) кишечной бактериальной ГСЖК и уровнями сывороточного холестерина и сердечно-сосудистым риском (ССР). Материалы и методы. Исследование проводилось по дизайну «случай — контроль» и включало 26 относительно здоровых участников (контрольная группа) и 77 пациентов с дислипидемией, без анамнеза тяжелых сердечно-сосудистых событий (основная группа). У участников были определены общая ОА кишечной бактериальной ГСЖК, показатели липидного профиля и уровни ССР по 5 шкалам риска. Результаты. ОА кишечной бактериальной ГСЖК была выше у здоровых участников по сравнению с участниками с дислипидемией (р < 0,001). Была выявлена отрицательная корреляционная связь умеренной силы между ОА ГСЖК и общим холестерином (ОХ) (–0,38) и липопротеинами низкой плотности (ЛПНП) (–0,36) с линейным соотношением, которое определялось уравнением: ЛПНП = –5,33 • ОА ГСЖК + 4,479. Было обнаружено, что с увеличением ОА ГСЖК риск дислипидемии снижается (р < 0,001), ОШ = 1,06 • 10–10 (95% ДИ; 2,5 • 10–15 – 4,5 • 10–6). Выявлена умеренная отрицательная корреляционная взаимосвязь между ОА ГСЖК и ССР, оцененным по шкалам Globorisk (–0,34), Framingham (–0,34), алгоритму ACC/AHA 2013 (–0,32), PROCAM (–0,35) и шкале ВОЗ (–0,34). Выводы. Общая ОА кишечной бактериальной ГСЖК негативно коррелировала с ОХ, ЛПНП, ССР, оцененным по 5 шкалам, и негативно ассоциировалась с риском дислипидемии.

Introduction: Motility disorders can be an important factor in the occurrence of symptoms of dyspepsia that consequently require evaluation of clinical significance of noninvasive diagnostic approaches when observing patients with functional dyspepsia (FD), gastroesophageal reflux disease (GERD), and Helicobacter pylori-associated diseases of the stomach and duodenum. Aim: To determine the relationship between various motility disorders and to improve the diagnostics and treatment with the use of 13 C-urea (UBT) and 13 C-octanoic breath tests (OBT). Material and methods: A total of 591 patients, aged 18-83 years, who underwent upper gastrointestinal endoscopy at our department were evaluated. Age, sex, and duration of symptoms of dyspepsia were recorded. UBT and OBT were examined in patients with dyspepsia, GERD, and H. pylori-associated diseases. Results: Patients with dyspepsia syndrome had H. pylori infection in 70 ±1.3% of cases. The strategy of "test-and-treat" using UBT can be applied in 76.5% of cases of unexplained dyspepsia in the Ukrainian population. In patients with GERD, slowing down of the gastric emptying (GE) prevails (overall 79.7 ±4.4%), which is a reliable predictor of early relapse of GERD symptoms (OR = 4.9, 2.4-7.0). In the case of H. pylori-associated diseases, the slowing down of GE according to OBT data is a prognostic sign of the return of the symptoms of dyspepsia after successful eradication of H. pylori (OR = 2.1, 1.9-2.3). In H. pylori-associated diseases with a slow GE, recurrence of dyspeptic syndrome after H. pylori-eradication therapy is observed in 33.1% of cases; the appointment of prokinetics reduces this probability to 9.2% (p = 0.0074). Conclusions: Investigations into the clinical use of new facilities of 13 C-breath tests in gastroenterology are shown. The clinical efficacy of urea and octanoic breath tests in FD, GERD, and H. pylori-associated diseases was proven experimentally among patients of the Ukrainian population. New simplified diagnostic and treatment approaches were proposed for certain groups of patients with gastric dyspepsia syndrome, based on the results of the UBT and the OBT.

Introduction: secretion of bacterial bile salt hydrolase (BSH) is one of the main mechanisms by which gut microbiota play role in cholesterol metabolism. There are limiting and controversial data regarding the clear effect of gut BSH activity correction on modification of serum cholesterol and cardiovascular risk (CVR). Aim of investigation was to evaluate the relationship between modification of the gut bacterial BSH relative activity (RA) by probiotic L. plantarum and serum cholesterol with CVR levels. Methods: the study was conducted as open, comparative, randomized, parallel and included 26 almost healthy participants (healthy control group) and 77 patients with dyslipidemia and without anamnesis of major cardiovascular events, that were divided in two groups: main treatment group (n=41) received combination therapy (capsules with Lactobacillus plantarum in the amount of 2*109 CFU one time a day and tablets simvastatin 20 mg one time a day) and control treatment group (n=36) received monotherapy (simvastatin 20 mg one time a day) during 12 weeks. Before and after 12 weeks of treatment the assessment of total RA of gut BSH, lipid profile and CVR level according to 5 risk scores were performed. Results: at baseline the RA of BSH was higher in healthy adults comparing to participants with dyslipidemia (p<0,001); after 12 weeks of treatment there wasn`t difference between healthy control and only main treatment groups (р=0,45). It was found that with increasing of RA of gut bacterial BSH, the risk of failure of treatment efficacy endpoints achievement (³20% reduction of values) decreased regarding: total cholesterol (TC) (p=0,0306), OR=0,00133 (95% CI; 3,28*10-6-0,538); low-density lipoproteins (LDL) (p<0,001), OR=5,65*10-14(95% CI; 6,38*10-20-5*10-8); CVR level according to Framingham score (р=0,0035), OR=4,09*10-5(95% CI; 4,66*10-8-0,0359); CVR level according to 2013 ACC/AHA algorithm (р=0,0135), OR=3,8*10-4(95% CI; 7,34*10-7-0,197); CVR level according to PROCAM score (p=0,00125), OR=8,38*10-6 (95%; CI; 6,93*10-9-0,0101). Conclusions: additional supplementation with BSH-producing bacteria L. plantarum was more effective in increasing of BSH activity compared to simvastatin monotherapy. Increasing of BSH RA by L. plantarum was associated with higher chances to achieve treatment efficacy goals regarding reduction of TC, LDL and CVR levels according to Framingham, 2013 ACC/AHA algorithm and PROCAM scores.

Background. Every year, the number of people with rare forms of the disease is increasing worldwide. One of these is the catastrophic antiphospholipid syndrome — Asherson’s syndrome. To date, it is being actively studied, but the pathophysiological mechanisms of its development have not yet been fully investigated. Our work is the first attempt to describe Asherson’s syndrome on the example of a clinical case in Ukraine. Objective: to determine the factors and mechanisms that led to the death of a patient with Asherson’s syndrome in Ukraine. Materials and methods. The structural-logical analysis and the clinical-statistical method were used. Results. Based on clinical and laboratory criteria, our medical team established a clinical diagnosis of systemic lupus erythematosus complicated by a catastrophic antiphospholipid syndrome (CAPS). Despite treatment with glucocorticoids and anticoagulants according to international guidelines, the patient died. The autopsy results showed that the immediate cause of death was a large blood clot that blocked the pulmonary artery and its main branches. Histological examination revealed thrombosis of small vessels of the kidneys and brain; a neuroendocrine tumor (G2; pT3pNxpM1b) of the small intestine with metastases to the liver, brain, myocardium and kidneys was suspected. An additional immunohistochemical study was performed to clarify the histological diagnosis. The morphological picture and results of immunohistochemical study mostly correspond to the moderately differentiated (G2) non-keratinizing squamous cell carcinoma (ICD-O code: 8070/3) with damage to the walls of the small intestine, liver, lungs, kidneys, myocardium and brain. Conclusions. These data emphasize that despite the rarity of Asherson’s syndrome, it is always necessary to consider its probability in the presence of signs of multiple thrombosis and multiple organ failure. Because its development is the result of serious diseases, including connective tissue diseases, malignancies, infections, the etiotropic and pathogenetic treatment can prevent the development of CAPS and death.

Background: Food allergy affects 1-3% of adults worldwide. More than 160 foods can cause allergic reactions. Food allergy may preceed and stimulate allergic rhinitis. Aim of the study was to assess the spectrum and frequency of sensitization to food allergens in patients with established allergic rhinitis from Kyiv, Ukraine.Methods. The investigation was conducted as a cross-sectional study. 175 Kyiv adult patients with allergic rhinitis were enrolled to the trial. Sensitization to allergens and their components was determined by skin prick tests and in vitro detection of allergen specific IgE by ELISA in serum of the blood – multicomponent Allergy Explorer2- ALEX2 test.Results. It was shown, that sensitization to following inhalant allergens was predominant: to timothy grass – in 50,3%, to ragweed - in 48,6%, to birch – in 44%, to wormwood – in 24%, to Alternaria alternatus mold – in 15,4% of patients. 131 (74,9%) participants have co-sensitization to at least one food allergen. Sensitization to following food allergens was predominant: to hazelnut – in 27,5%, to apple – in 26,3%, to peanut – in 21,7%, to celery – in 14,3%, to soy – in 13,1%, to fish carp – in 11,4%, to kiwi – in 9,1%, to crab – in 9,1%, to codfish – in 8,6%, to oyster – in 8,6%, to peach – in 8%, to lobster – in 8%, to carrot – in 7,4%, to anisakis – in 6,3%, to prawn – in 6,3%, to tiger prawn – in 5,7%, to beef – in 5,1%. It was found that the frequency of sensitization to cross-reactive proteins PR-10 was 20,5% (95% CI; 9,7%-33,9%) in patients with allergic rhinitis without food co-sensitization comparing to 51,1% (95% CI; 42,5%-59,7%) in participants with both allergic rhinitis and food co-sensitization, p<0,001; to nsLTP was 2,3% (95% CI; 0-8,9%) and 19,8% (95% CI; 13,4-27,2%), respectively, p=0,011.Conclussion. In Kyiv adult population with allergic rhinitis approximately three quarters of patients have food co-sensitization, that may be the reason of exacerbations of allergic rhinitis after consuming vegetables, fruits and nuts due to cross-reactivity with inhalant allergens, that should be considered when manage such patients.