Introduction. The study was to assess the effectiveness of a comprehensive physical rehabilitation program based on the dynamics of the functional parameters of the respiratory and cardiovascular systems, and the tolerance of daily stress in middle--aged patients with chronic obstructive pulmonary disease (CoPd). The incidence of CoPd continues to grow, and life expectancy of the patients is shortened by an average of 8 years. Globally, losses from CoPd are projected to increase over the coming decades owing to the long-term exposure to risk factors and population aging. A significant role in improving CoPd patients condition and preventing the disease is played by physical rehabilitation. Methods. Analysis of modern scientific literature, content analysis of outpatient documentation, conclusions of X-ray examinations, anthropometric measurements, pulse oximetry, arterial tonometry, spirographic studies, 6-minute walk distance, methods of mathematical statistics. Results. A comprehensive physical rehabilitation program was developed for use in a polyclinic, which included a common set of physical exercises combined with breathing gymnastics with elements of superficial breathing, sound gymnastics, therapeutic massage, nebulizer therapy, Nordic walking. After the program application, chest excursion increased and airway patency statistically significantly improved. The exercise tolerance of the cardiovascular system increased. Conclusions. The physical rehabilitation program for middle-aged CoPd patients contributed to the economization of the respiratory system, slowing down the recovery of cardiovascular parameters, and improving the tolerance of daily exercise, which was confirmed by mathematical processing.Citation: Ruban L, Kochuieva M, Rohozhyn A, Kochuiev G, Tymchenko H, Samburg Y. Complex physical rehabilitation of patients with chronic obstructive pulmonary disease at a polyclinic stage of treatment.

Objective. Determination of the effect of antioxidants on clinical and laboratory parameters in alcohol drinkers with infiltrative newly-diagnosed pulmonary tuberculosis (PTB). Materials and Methods. 109 patients with newly-diagnosed PTB were examined. All patients underwent a comprehensive medical examination, immunological blood tests, determination of the parameters of the oxidative stress-antioxidant defense system. Patients were divided into three main groups, depending on the level of alcohol consumption. Patients in each of the three groups were further divided into two subgroups depending on the treatment regimen. Statistical analysis was performed using the STATISTICA program. Results. In patients who received standard therapy, increased alcohol consumption was associated with a decrease in the positive changes of the majority of inflammation and immune status indicators. This trend, in particular, was observed with regard to the progress of the decay cavities closure, persistence of cough complaints, changes in indicators of the immune-inflammatory (CRP, CD8+, CD4/CD8, PAMW, IPC) and oxidative status (SOD, GPX) (p ≤ 0.05). After the antioxidants had been added, the best improvement of immune-inflammatory and oxidative status was observed in group 2 (p ≤ 0.05). Additional antioxidant therapy in patients with newly-diagnosed PTB, regardless of alcohol consumption, contributed to better positive dynamics of cellular immunity, oxidative stress, and endogenous intoxication. Conclusions. The addition of antioxidant drugs to the standard therapy of patients with newly-diagnosed PTB was accompanied by improved clinical and radiological, oxidative and immune-inflammatory parameters. Antioxidant therapy in such patients, regardless of the initial level of alcohol consumption, promoted better positive dynamics of phagocytic and enzymatic activity of neutrophils, oxidative stress, and endogenous intoxication. The best changes in immune-inflammatory and oxidative status among patients taking antioxidants were observed in those who took alcohol at a health-threatening level.

The obese asthma is characterized by a more severe course. The feature of this comorbid condition is the reduced effectiveness of basic therapy with inhaled corticosteroids, which prevents optimal control of symptoms, requires increasing doses and increases the number of exacerbations and hospitalizations. The problem of life quality (LQ) research in patients with asthma and obesity is highly relevant today, which made it the reason for this study. The aim of the study was to determine the effect of obesity on LQ in patients with asthma. Materials and methods. We selected for participating in the study 46 patients with moderate severity asthma. Examination of the patients included: objective examination with an anthropometric evaluation, the test of the LQ with two questionnaires: general one – Medical Outcome Study SF-36 (MOS SF-36) and specialized Asthma Quality of Life Questionnaire (AQLQ). Results. The increase in body mass index (BMI) in patients with asthma according to the questionnaires MOS SF-36 and AQLQ is associated with significant reductions in viability (r=–0.33, p<0.05), physical activity (r=–0.37, p<0.01), social activity (r=–0.36, p <0.01) and the degree of reduction of the patient's tolerance to adverse environmental factors (r=–0.29, p<0.05) Conclusions. The presence of concomitant obesity in patients with asthma is associated with significant reductions in the parameters of physical and social activity, viability and with an increase in the subjective pain assessment (according to the questionnaire MOS SF-36) and characterized by significantly lower rates of activity, tolerance to adverse environmental factors and general life quality (according to the AQLQ questionnaire).

The aim of the study was to investigate the effectiveness of different schemes of basic asthma therapy depending on the polymorphism of the LTC4 gene. Materials and methods. 181 patients with asthma were recruited to participate in the study. All patients included in the study underwent a general clinical study, spirometry, the level of asthma control was determined by Asthma control questionnaire 5 (ACQ-5), by studying the polymorphism of the LTC4 gene, it was determined that patients belong to the A/A, A/C and C/C genotypes. Results. Allelic -444C polymorphism of the LTC4-S gene (rs 730012) had the following genotype frequency among asthma patients: A/A – 77 people (42.6 %), A/C – 73 people (40.3 %) and C/C – 31 people (17.1 %). In groups of patients with genotypes A/A and A/C, during treatment with a low dose of ICS and montelukast, there was a significant improvement in FEV1 and the score according to the ACQ-5 questionnaire (asthma control level). However, in the group of patients with the C/C genotype, there were no significant changes in FEV1 and the score according to the ACQ-5 questionnaire. In the groups of patients with genotypes A/A and C/C on the background of increasing the dose of ICS to medium in a fixed combination with LABA compared with the results of treatment with low-dose ICS and montelukast, there was a significant improvement in FEV1 and asthma control – ACQ- 5. At the same time, in the group of patients with genotype A/C, there were no reliable indicators of FEV1 and ACQ-5 score changes. Conclusions. The frequency of genotypes A/A, A/C and C/C for LTC4S polymorphism in the studied population are 42.6 %, 40.3 % and 17.1 %, respectively. Patients with genotypes A/A and C/C have a significant response to treatment with a low dose of ICS and montelukast in the form of an improvement in FEV1 and ACQ-5 score. Increasing the dose of ICS up to moderate in a fixed combination with β2-LABA in groups of patients with genotypes A/A and C/C leads to a significant improvement in the FEV1, as well as in the asthma control level - ACQ-5

The aim of the research: identify combinations of genetic and neurohumoral factors that influence the development of true resistance to antihypertensive therapy (AHT) in patients with concomitant obesity (OB). The study included 200 patients aged 45–55 with uncontrolled hypertension and obesity. Treatment was prescribed in accordance with the European Guidelines 2018. Thiazide-like diuretics were additionally prescribed to those patients who did not reach the target blood pressure (BP) level after 3 months of dual therapy. Resistant hypertension was diagnosed in 48 patients who had an uncontrolled course of hypertension at the optimal doses of three antihypertensive drugs during the next month of their reception, while true resistance was found in 21 patients. The effectiveness of comprehensive treatment was evaluated after 6 months. The application of the logistic regression method at the stage of initial examination of patients showed that the early predictors of the formation of truly resistant hypertension in obese patients are CIMT, HOMA index and genetic polymorphism IRS-1. After treatment, the model of truly resistant hypertension in patients with obesity included indicators that influenced its formation at the pre-treatment stage, as well as the new ones: adiponectin, waist circumference and genetic polymorphism ADIPOQ. Genetic markers, insulin resistance, and vascular wall status play a leading role in the development of true resistance to AHT in obese patients. It is established that the main determinants of the formation of true resistance to AHT in patients with this comorbidity are IRS-1 polymorphism, HOMA index and CIMT.