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The problems of ensuring continuity of medical care are considered. Information and cybernetic issues of continuity, in particular information standards, resource management systems of a medical institution, are analyzed. It emphasizes the need to develop standards for the continuity of care. It is concluded that long-term continuity of medical measures in rehabilitation is one of the main components of the effectiveness of medical care. Further qualitative research is needed, including some types of rehabilitation services (e. g. specialized medical care). At the same time the most important factors for ensuring continuity at the current stage of medicine development are the use of ontologies, representing the most general conceptual concepts of the modeled field of medicine, completely abstracted from specific models of knowledge representation and practical implementation. It is also shown that the specification of the patient management model in the rehabilitation period of treatment is provided by a wide application of telemedicine consultations. The index of continuity of medical aid is also proposed. It represents a simple additive function that reflects the change in the probability of an unfavorable outcome.

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Background. The purpose of the study is to analyze the content of free fatty acids (FFA) in the blood serum of overweight and underweight patients with gastrointestinal diseases. Mate­rials and methods. Thirty-one patients with gastrointestinal diseases were examined, 19 (61.3 %) men and 12 (38.7 %) women with a median age of 39 (27; 48) years. Depending on the results of the body composition study with the multifunctional monitor TANITA MC-780MA (Japan), they were divided into the following groups: overweight patients (body mass index (BMI) more than 25.0 kg/m2) and underweight persons (BMI below 18.5 kg/m2). Determination of the FFA spectrum in the blood serum was carried out using a gas chromatograph with a flame ionization detector Chromatek-Crystal 5000. The control group consisted of 16 practically healthy people. Statistical processing of the results was carried out using the Statistica 6.1 application program package. Results. Patients with a change in body weight reported a statistically significant decrease in the median total content of short-chain saturated FFA (C4:0) mainly due to a decrease in the butyric acid content by 67 times (p = 0.001) with increased BMI and by 114 times (p = 0.002) with decreased BMI compared to controls. At the same time, the analysis of the serum spectrum of saturated FFA with an average carbon chain length showed a probable increase in the content of capric acid by 14 times (p < 0.01), undecyl acid by 19 times (p < 0.01), and lauric acid by 25 times (p < 0.001) in patients with changes in body weight. The content of caproic acid increased in the group with excessive body weight by 3.9 times (p = 0.046) compared to controls and by 2.6 times (p > 0.05) compared to underweight patients. The total content of monounsaturated FFA in the blood serum of patients with increased and decreased BMI increased significantly by 32 times (p < 0.001) and 19 times (p = 0.001), respectively, compared to controls. The total content of polyunsaturated FFA in the blood serum of patients of both groups was found in a trace amount. Overweight patients had a 38-fold (p < 0.01) increase in the trans-FFA elaidic acid (C18:1(trans-9)) compared to controls, while underweight patients had a decrease in linoelaidic acid (C18:2(trans-9,12)) by 11.7 times (p < 0.05). Correlation analysis revealed a positive relationship between BMI and increased serum content of saturated caproic acid (r = 0.39; p = 0.019); monounsaturated acids — palmitoleic (r = 0.33; р = 0.045) and heptadecenoic (r = 0.35; р = 0.034); trans-configuration fatty acids — elaidic (r = 0.43; p = 0.009) and linoelaidic (r = 0.43; p = 0.007). Conclusions. Patients with gastrointestinal diseases had an imbalance in the fatty acid spectrum of the blood serum. Against the background of the tendency to decrease the total content of short-chain saturated FFA, a significant increase in the content of monounsaturated FFA and trans-FFA was noted, especially with increased BMI. In all patients, the trace amount of polyunsaturated FFA fractions was found. The obtained results can be used to improve the differential treatment of metabolic disorders in patients with gastrointestinal tract pathology.

Background. The purpose of the study is to investigate the peculiarities of lipid and carbohydrate metabolism in patients with gastrointestinal diseases depending on the body mass index (BMI). Materials and methods. Forty patients with digestive disorders were examined, 13 women (32.5 %) and 27 men (67.5 %) whose median age was 37 (24; 51) years. The patients were divided into 3 groups: I — 20 people with BMI exceeding the norm; II — 11 patients with a BMI below the norm; III — 9 patients with normal BMI. The control group for evaluating the results of laboratory tests consisted of 15 practically healthy people. Total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), glucose and insulin serum levels were evaluated. The atherogenic index (AI) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were calculated. Statistical processing of the results was carried out using the Statistica 6.1 software package. Results. In patients with digestive diseases who had an increased BMI, the development of atherogenic dyslipidemia was detected, as indicated by a probable decrease in serum content of HDL-C by 1.7 times (p = 0.003) and an increase in TG by 1.9 times (p = 0.002), VLDL-C by 1.4 times (p = 0.05), AI by 2 times (p = 0.03) compared to the controls. No significant signs of the development of atherosclerotic processes were found in patients with reduced and normal BMI. Carbohydrate metabolism disorders were observed in 47.5 % of patients with gastrointestinal diseases, and HOMA-IR in patients with increased BMI was 2.9 times higher (p < 0.05) compared to those with reduced BMI and 2.5 times (p < 0.05) higher — with normal BMI. It was found that an increase in BMI is associated with an increase in serum TG (r = 0.381; p = 0.017), LDL-С (r = 0.383; p = 0.016), AI (r = 0.566; p < 0.001), insulin (r = 0.651; p = 0.0001) and HOMA-IR (r = 0.681; p = 0.0001), as well as that BMI is negatively correlated with the content of HDL-С (r = –0.448; p = 0.004). At the same time, an inverse correlation was found between HOMA-IR and the level of HDL-С (r = –0.389; p = 0.016), and a direct relationship between the index of insulin resistance and AI (r = 0.437; p = 0.006). Conclusions. The revealed correlations confirm the hypothesis of the BMI influence on the development of dyslipidemia and insulin resistance in patients with gastrointestinal diseases. This substantiates the expediency of including bioimpe­dance measurements into the algorithm for predicting metabolic disorders in this category of patients.