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Introduction: One of the features of modern clinical medicine is that the diseases lose their mononosological character and more often have a comorbid course.  Chronic pathology of the gastrointestinal tract (GIT) combined with syndrome of undifferentiated connective tissue dysplasia (UCTD) occupies a special place.  And although scientists have increasingly investigated the relationship between gastroesophageal reflux disease (GERD) and UCTD syndrome in recent years, but the available scientific literature provides an extremely limited amount of material directly on the subject.  Aim: To analyze literature data on the features of the course and treatment of gastroesophageal reflux disease in patients with syndrome of undifferentiated connective tissue dysplasia. Methods: A systematic literature search of Web of Science Core Collection, MEDLINE, PubMed, EMBASE, and the Cochrane Library until December 2019 with keywords "gastroesophageal reflux disease", "syndrome of undifferentiated connective tissue dysplasia", "ghrelin", "matrix metalloproteinase-9", "prostaglandin E2", "prostoglandin F2α", "oxyproline", "micro- and macronutrients", was performed Results: According to scientific data, the digestive system is the second system of the body according to the frequency of involvement in the dysplastic process after the cardiovascular system (Bodolay E. et.al., 2003).  The high degree of collagenation of the digestive system allows us to expect a variety of manifestations of UCTD.  Dysplastic changes in the gastrointestinal tract include insufficiency of cardia, diaphragmatic hernia, ptosis of abdominal organs, anomalies of shape and structure of esophagus, stomach, duodenum, esophageal diverticula and various departments of intestines.  In this case, the presence of UCTD syndrome causes certain features of metabolism, adaptation and existence of the organism in conditions of defective collagen (Nica A. E et.al., 2016).      From a clinical point of view, UCTD is a heterogeneous and polymorphic condition, which underlie various defects in the formation of collagen and elastin fibers as a result of genetic predisposition, which lead to disorders at the tissue and organism levels (Chemodanov V. and others.  , 2018).  Acording to the science data, assignment of patients to the UCTD group is possible if its manifestations are not specific for such connective tissue diseases as rheumatoid arthritis (RA), scleroderma, systemic vasculitis, myositis, systemic lupus erythematosus, Sjogren's syndrome (Antunes M. et al., 2019.) The complexity of the morphology and the variety of connective tissue functions also determine the prevalence of visceral manifestations of UCTD.  Moreover, as the phenotypic signs UCTD increases, the likelihood of detecting pathological changes in the internal organs increases.  The degree of damage to the internal organs and usually determines the severity of the clinical picture and individual prognosis.  (Usenko O. Yu et al., 2017; Denaxas K. et.al., 2018).     GERD is a multifactorial disease in the occurrence of which play a role as a support (stress, obesity, smoking, intake of some medications, nutritional features) and determining factors that include cardiac insufficiency, gastric reflux and resistance of the mucous membrane of the esophagus due to a decrease in its clearance.  The risk of developing GERD also increases with generalized or regional disruption of connective tissue structure that is widespread in the population (Kadurina T. I. et.al., 2010).  Cardia insufficiency is one of the manifestations of UCTD, and there is a direct relationship between the degree of UCTD and the incidence of gastroesophageal reflux (Denaxas K. et.al., 2018).      On the background of UCTD, in combination with gastroesophageal refluxes (GER), a pronounced inflammation of the mucous membrane of the lower third of the esophagus was more often found.  Frequent GER may affect the state of the autonomic nervous system through the nerve and anatomical ligaments of the esophagus and deepen connective tissue dysfunction.  In some works, it was found, that on the background of UCTD syndrome, the symptoms inherent in GERD were detected more often than in patients without signs of the first.  In  particular, these patients complained more frequently of heartburn, severe chest pain, more frequent gastroesophageal and duodenogastric refluxes and erosion of the mucous membrane of the lower third of the esophagus. Thus, as can be seen from the above data, conditions for such important pathogenetic links of the development of GERD, such as impaired function of the lower esophageal sphincter (LES), reduction of the barrier capacity of the mucous membrane of the esophagus, an increase in the number of acid and mixed refluxes. (Kamataki A. et.al., 2015; Baia X. et. Al., 2019). The exclusive role of PGE2 in maintaining mucosal integrity, preventing acid reflux, and esophagitis by modulating various gastrointestinal functions has been scientifically validated (Baia X. et al., 2019). At the same time, in the available literature, we have not identified any studies examining the role of different classes of prostaglandins in protecting mucous membrane of the esophagus in UCTD.      Peptide hormone such as ghrelin has a pronounced effect on gastric motility.  This hormone is mainly released from the stomach and has many physiological actions, such as stimulating food intake, regulating the motility of the gastrointestinal tract, stimulating the release of growth hormone, lowering blood pressure and regulating the complex process of energy metabolism, through the correction of hunger signals.  As ghrelin stimulates gastric motility and accelerates gastric emptying, the effect of this intestinal hormone on GIT motility is being actively studied, in particular in pathological GER (Kitazawa T. et.al., 2018).  At the same time, the role of ghrelin in GERD as an independent disease and its combination with UCTD has not been studied.      Involvement of the esophagus in the pathological process of UCTD is also explained by the accumulation of the extracellular matrix in its walls, remodeling and degradation of collagen and other compounds, and the key regulators of these processes, both under physiological and pathological conditions are matrix metalloproteinases (ММР’s) (Chen et al., 2009).  The cofactors of matrix metalloproteinases are micro- and macroelements that are involved in the formation of collagen, giving elasticity to the connective tissue matrix (Ismail AA, 2016). At the same time, the level of micro- macroelements in blood and MMP-9 activity was not studied in patients with GERD on the background of UCTD.      With regard to drug therapy of this combined pathology in adults, in cases of development of GERD on the background of UCTD pathogenetically justified complex therapy has not been developed, which also determines the relevance of this study.       Conclusion: A study of the literature on the comorbidity of GERD and UCTD has shown that variability in clinical pathology markers is not fully reflected in publications on this topic.  This complicates early diagnosis, making the right diagnosis at the initial examination of the patient.  The clinic for such combined pathology remains poorly understood.  In this regard, the treatment of this pathology is not prophylactic, aimed at preventing possible complications, but remains symptomatic. Therefore, the next step in this study will be: to study the frequency of combination of GERD with phenotypic and biochemical markers of UCTD syndrome;  establishment of features of clinical manifestations, changes in gastric motility, indicators of daily pH-metry, condition of the mucous membrane of the lower third of the esophagus in patients with GERD in combination with syndrome UCTD

Introduction.According to scientific data, unemployed, lonely and students are most prone to procrastination. And what about teachers, in particular, higher education institutions? There is not enough data in the available literature. As practice shows, in the case of teachers, procrastination or postponement can manifest itself in the form of stress caused by failure to fully realize goals and plans vital to the individual. Negative consequences are expressed both in reduced work capacity and in acute emotional experiences of one's own failure, dissatisfaction with the results of one's work. The aim of the study .was to investigate and evaluate the level of anxiety, depression and the nature of manifestations of procrastination among teachers of the Ivano-Frankivsk National Medical University during the period of altered psycho-emotional state during forced social distancing in connection with the COVID-19 pandemic and its impact on social functioning and quality of life. Materials and methods: The survey was voluntary and anonymous. The research was approved by the Bioethics Committee of Ivano-Frankivsk National Medical University and conducted according to the principles of the Helsinki Declaration. We used two clinical test methods to identify emotional disturbances: the Hospital Anxiety and Depression Scale (HADS) and the Montgomery-Asberg Depression Rating Scale (MADRS) (Zigmond A.S. et.al.,1983; Svanborg P., 2001). In order to assess the degree of expressiveness of the propensity to postpone matters "for later" among the surveyed teachers, we created a special Google questionnaire created on the basis of data."Questionnaire to study the propensity of the individual to procrastination" (Shivari ,O.A., 2015), which is a modification of the "General Procrastination Scale" (Lay, C., 1986) and consists of two scales: "Personally conditioned procrastination scale" (Scale I) and "Situationally conditioned procrastination scale" (Scale II). Scale I indicates the general level of procrastination, and Scale II - motivational procrastination, its high indicators suggest that the questionnaire will perform some work only in the presence of motivation. In addition, in order to assess the quality of life, the data of "The Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q-SF)" were evaluated. (Endicott J; Rapaport MH; Clary C; Fayyad R). The statistical analysis of the results was performed using STATISTICA 7.0 software packages and the package of statistical functions of Microsoft Excel. Results and discussion: Were interviewed 214 teachers of various departments of the Ivano-Frankivsk National Medical University: 174 (81.6%) women, 40 (18.6%) - men. 58 interviewees (27.1%) worked at theoretical departments, 156 (72.9%) – at clinical departments. The analysis of the results of the survey according to the «Personally conditioned procrastination scale» showed that 32 (14.9%) of the teachers interviewed by us have had a low, 96 (44.8%) - medium, and 86 (40.3%) - a high level of personal tendency to procrastination. Data of "Situationally conditioned procrastination scale"showed that 54 (25.2%) have had a low level of situational procrastination,76 (35.5%) - medium and 84 (39.3%) - high, respectively.Based on the results of the survey on the HADS scale, a normal level of anxiety-depressive symptoms (0-7 points on a scale) was found in 9 (15.5%) workers from the theoretical departments and in 52 (33.3%) - clinical departments. According to the data of the conducted questionnaire according "The Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q-SF), the least satisfied respondents were by daily functioning, present depressed mood, inability to perform housework efficiently and to spend leisure time interestingly, engage in hobbies or even perform professional duties. Conclusions. The complex of research methods made it possible to comprehensively consider procrastination as a model of the behavior of the subjects and to determine the factors influencing its occurrence during the period of changes in the psycho-emotional state caused by forced distancing in connection with the Covid-19 pandemic and to study the relationship of procrastination with the level of quality of life (from the point of view of satisfaction and enjoyment of life). The main reasons for procrastination were dominated by: lack of motivation to work; stress, as a result of uncertainty and fear of the future; laziness; limited "live" communication and an excess of virtual, external distractions. It is noteworthy that among teachers this phenomenon is not limited to academic procrastination, in most cases everything is fine in this cluster, but more often it extends to homework, interpersonal communication, social and personal life. Attention is drawn to the fact that among teachers this phenomenon is not strictly limited to academic procrastination, but extends to household tasks, interpersonal communication, social and private life.

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. 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: 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. 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.

Introduction. It has been scientifically confirmed that the risk of developing gastroesophageal reflux disease (GERD) increases especially with generalized or regional disruption of connective tissue structure, which is widespread among the population. Patients with such comorbid pathology may have a wide range of symptoms that may go beyond the general symptoms of heartburn and regurgitation. The symptoms and complications of GERD affect general health, daily and social functioning, physical and emotional activity. It also affects the quality of life (QoL) associated with health through frequent breaks during sleep, work and social activities. Purpose. study the dynamics of the level of quality of life and social functioning in patients with gastroesophageal reflux disease in combination with the syndrome of undifferentiated connective tissue dysplasia. Methodology. A total of 120 patients were included in the study: 65 men and 55 women: in 75 of them (Group II) GERD occurred on the background of UCTD, in 45 (Group I) as an independent disease. The control group consisted of 12 healthy individuals. The study was comprehensive. The Medical Outcomes Study 36-Item Short-Form Health Status (SF-36),the Gastrointestinal Symptom Rating Scale (GSRS) and the scale of "Personal and social performance" (PSP) -  were used to study patients in detail. Results and Discussion. Analyzing the results obtained on the basis of the GSRS questionnaire (Table 1), in patients with GERD on the background of UCTD, compared with patients of group I and the control group, there is a significant increase in three and four from the five scales. QoL in patients of Group II on the scale "Abdominal pain" were 14.3 ± 0.4 points, in Group I - 5.6 ± 1.3 points, in the Control Group - 2.4 ± 0.8 points, on the scale "Reflux syndrome": 13.7 ± 0.9, 10.5 ± 1.3 and 3.1 ± 0.9, respectively. "Dyspeptic syndrome" - 15.3 ± 0.4 points in Group II, 12.2 ± 0.6- in Group I and 6.1 ± 0.3- in the control group. "Constipation syndrome" 9.5 ± 0.8, 5.6 ± 1.03 and 5.7 ± 0.4, respectively (p <0,05). Conclusions: In this research we investigated the effect of comorbid pathology on QoL in patients with GERD, which developed against the background of UCTD. The results confirm that patients with such combined pathology have a lower level of quality of life and social functioning, and the tactics of treatment of such patients should take into account these changes