The aim of the work is to evaluate the impact of physical therapy and preformed physical factors in pregnant women with chronic pyelonephritis on central hemodynamic indicators. Materials and methods. The dynamics of 134 pregnant women with chronic pyelonephritis (CP) in the remission stage, who underwent a complex sanatorium rehabilitation program, were examined. The main study group consisted of 79 pregnant women with chronic pyelonephritis. In this contingent of women, the sanatorium rehabilitation complex additionally included a course of intermittent normobaric hypoxytherapy (INH). The comparison group consisted of 55 pregnant women with CP, for whom the sanatorium rehabilitation complex did not include an INH course. The control group is represented by 37 somatically healthy women with a physiological course of pregnancy. All pregnant women were examined for central hemodynamic (CH) indicators using the computer diagnostic complex REOKOM (Kharkiv). Results. Pregnancy periods of 20–30 and 31–30 weeks in women with CP are characterized by a pathological load on central hemodynamics. At the same time, the application for the INH course in the sanatorium rehabilitation complex (the main group) allows for an increase in the compensatory capabilities of the pregnant woman with CH. Thus, in the period of pregnancy of 22–30 weeks in the main group, indicators of diastolic blood pressure and heart rate were probably lower than the control values (P < 0.001), which in this group is determined by values of peripheral resistance of blood vessels close to those of the control group (P > 0.05), regardless of the timing of the study. The study of CH and the comparison of different periods of gestation and between research groups indicate an inverse relationship between indicators that reflect the intensity of cardiohemodynamics and indicators of vascular resistance, as one of the final mechanisms of maintaining blood pressure at a physiological level, or its pathological increase in chronic pyelonephritis and preeclampsia Taking into account that the ratio of cardiac index indicators and total peripheral vascular resistance in all study groups was stable and directly dependent on the level of blood pressure, it is advisable to recommend for practical application in order to assess the state of CH of pregnant women with CP indicators of stroke or cardiac indices, which characterize the intensity cardiohemodynamics and do not depend on the anthropometric data of the pregnant woman. Conclusions. The application of physical therapy and preformed physical factors, namely, intermittent normobaric hypoxytherapy in pregnant women with chronic pyelonephritis in a complex program of sanatorium rehabilitation increases the compensatory capabilities of the cardiovascular system, which is confirmed by a significant decrease in the values of the total peripheral resistance against the background of an increase in the cardiac index.

The article summarizes the data of the scientific publications about the management of patients with androgen-dependent dermatopathies, namely acne, taking into account the current view on the pathogenesis, clinical manifestations and results of the examinations of this group of women. Androgen-dependent dermatopathies are not only a medical problem but also a socio-economic one, as they lead to impaired socialization and reduced quality of life. Acne is one of the most common dermatoses. Acne is a chronic multifactorial disease of the pilosebation complex, which is clinically manifested by polymorphic rash in the form of open and closed comedones, papules, pustules, nodules. The pathogenesis of the disease is based on four main links: changes in the quantitative and qualitative composition of sebum due to hypersecretion of androgens and/or increased sensitivity of receptors to their action, impaired follicular keratinization, inflammation and changes in skin microbiome. Besides the main pathogenetic aspects, trigger factors are taken into account, such as nutrition, stress, smoking, mechanical agents. The current treatment of acne according to dermatological protocols is presented in the article, which is based on a combination of topical therapy with local retinoids and antibiotics, benzoyl peroxide, azelaic acid, in case of severe or ineffective local therapy systemic antibiotics and systemic retinoids are used. However, despite the presence of many treatment regimens for dermatosis, it is often not possible to achieve a lasting effect of treatment, and the adherence of patients to follow the doctor’s recommendations decreases. Given that the leading role in the pathogenesis of acne is due to hyperandrogenic effects on the skin, as well as the fact that the disease reduces the quality of life and self-esteem in patients, it is necessary to involve a wider range of specialists, such as dermatologists, gynecologists, endocrinologists and psychotherapists for successful treatment and prevention of persistent aesthetic skin defects.

Тhe diagnosis of polycystic ovary syndrome (PCOS) in adolescence still raises many questions. The problem is that the characteristics of normal puberty often coincide with the symptoms of PCOS. The article presents the criteria of a normal menstrual cycle, clinical and laboratory hyperandrogenism. In the diagnosis of the latter, the most informative indicators are the determination of the index of free testosterone and androstenedione, and the assessment of free and total testosterone are relatively low sensitivity. Clinical hyperandrogenism in adolescents includes only severe acne and hirsutism. The level of antimullerian hormone has no independent significance. Irregular menstrual cycles during the first year after menarche represent a normal period of puberty. At the second and third year after menarche , menstrual cycles of less than 21 days and more than 45 days are considered irregular, and from the fourth year – less than 21 days and more than 35 days. From the second year after menarche, menstrual irregularities are considered to be more than 90 days for any cycle. Primary amenorrhea is indicated by the absence of menarche at 15 years, or 3 years after telarche. Ultrasound is not used as a criterion for PCOS in the first 8 years after menarche due to the high frequency of ovarian multifollicularity in adolescence. Therefore, adolescent girls in the presence of menstrual disorders and hyperandrogenism may be diagnosed with «PCOS. Phenotype B» (ultrasound signs are not taken into account). Adolescents who have signs of PCOS but do not meet the diagnostic criteria are at risk for PCOS. The most important stage of PCOS therapy is lifestyle modification, normalization of body weight and metabolic processes. Combined oral contraceptives in adolescents are more often prescribed not for direct purposes (contraception), but as off-label therapy not only at diagnosis, but also in the «risk group», which involves the treatment of irregular menstrual cycles and / or clinical hyperandrogenism. In the absence of the effect of lifestyle changes, proper nutrition to correct metabolic disorders in addition to combined oral contraceptives may be prescribed metformin, inositol and etc.