Nowadays low paraoxonase activity is generally recognized as an independent risk factor of cardiovascular diseases involved in pathologic remodeling of the heart and vessels as well as thrombosis in the general population. But the role of paraoxonase activity in RA patients is unknown. Based on the above, the aim of the work was to study serum paraoxonase activity in patients with rheumatoid arthritis, to evaluate its association with clinical course and structural and functional status of the cardiovascular system. 67 patients with RA, 18 males and 49 females were studied. The control group consisted of 25 apparently healthy individuals. Rheumatoid arthritis was diagnosed according to international classification criteria ACR 2012. The indices of total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and triglycerides (TG) in blood serum were determined by standard conventional methods. Low density lipoprotein cholesterol (LDLC) values were calculated by Friedwald formula. Serum paraoxonase activity was measured by spectrophotometric method. High resolution ultrasound and Doppler ultrasonography of the brachial artery were performed to study endothelium function. Sonographic B-mode scanning and pulsed Doppler ultrasound of heart and blood flow spectra were done on ultrasound scanner. Serum paraoxonase activity was found to be about 18.8% lower in the patients with RA than in the control group. Serum paraoxonase activity was shown to decrease proportionally to the increase of the age in RA patients. In the group of patients over 45, the level of the enzyme was 13.0% lower than in the patients over 30. The study established that the increase of systolic and diastolic arterial pressure is associated with decrease of serum paraoxonase activity in RA patients. The patients with RA combined with arterial hypertension had significantly (by 10.9%) lower activity of the studied enzyme than those with no arterial hypertension. However, no significant relationship between paraoxonase activity and duration of the disease, obesity and smoking was revealed. Paraoxonase activity in RA patients was demonstrated to be dependent on lipid levels. The lowest paraoxonase activity was recorded in individuals with the highest levels of TC, LDLC and the lowest HDLC indices. Paraoxonase activity in RA patients is associated not only with atherosclerotic vascular damage (IMT, decreased FMDBA) but also with structural and functional heart status (systolic and diastolic functions, left ventricular myocardial hypertrophy). Decreased serum paraoxonase level is suggested to be the predictor of early development of cardiovascular complications in RA patients.

Annotation. In recent years, new data have been obtained regarding the course of liver cirrhosis (LC) and ways of its decompensation. Acute-on-chronic liver failure (ACLF) is a newly identified separate clinical syndrome that develops in 30% of patients with acute LC decompensation, characterized by hepatic and extrahepatic organ failure and high short-term mortality. The aim of this review was to describe the clinical and prognostic value of acute LC decompensation and ACLF, the pathophysiological mechanisms of their development, and existing diagnostic and treatment approaches. A search in the PubMed database using the keywords "liver cirrhosis, acute decompensation of cirrhosis, acute-on-chronic liver failure" allowed us to select 46 sources published in 2005-2022. This review discusses new concepts about the stages of the course of compensated and decompensated LC, which differ in the severity of portal hypertension, the number and type of decompensation events, and patient survival. The clinical and prognostic value of acute LC decompensation, which manifests as recent ascites, bleeding, hepatic encephalopathy, bacterial infection, and requires hospitalization of the patient, was considered. The trajectories of the further development of acute decompensation, which are represented by stable or unstable decompensated LC, pre-ACLF, and ACLF, were discussed. Current European diagnostic criteria for ACLF, severity criteria for ACLF, and tools for predicting patient survival were reviewed. The latest data on the pathophysiological role of portal hypertension, systemic inflammation, metabolic disorders, and immunopathological cell damage in the development of organ failure in ACLF was given. The existing therapeutic measures and promising methods of treatment of patients with acute LC decompensation and ACLF were considered.

Актуальність. В умовах бронхіальної обструкції при бронхіальній астмі (БА) розвиваються зміни газового складу крові, оксидативний стрес, електролітний і метаболічний дисбаланси, що сприяють формуванню емфіземи легень і хронічної дихальної недостатності. При цьому виникають зміни дихальних м’язів, зокрема й у діафрагмі, що характеризуються прогресуючою їх атрофією з наступною втратою м’язової сили й маси. Мета: визначення функціональних можливостей скелетних м’язів і частоти розвитку саркопенії у хворих на БА. Матеріали та методи. Обстежено 70 осіб віком 47,82 ± 13,54 року. Першу групу становили 35 пацієнтів, які хворіють на БА, другу — 35 здорових осіб. Для оцінки функціональних можливостей скелетних м’язів застосовували 8-кроковий тест визначення швидкості ходьби. Силу скелетної мускулатури оцінювали за допомогою ручного пружинного динамометра. За величиною окружності гомілки оцінювали стан м’язової маси, якість життя вивчали за допомогою опитувальника О.С. Чабана. Результати. При оцінці сили скелетної мускулатури встановлено зменшення показників кистьової динамометрії на 22 % при тяжкому перебігу БА порівняно з показниками хворих на БА середньої тяжкості і на 29 % — порівняно із показниками здорових осіб. Встановлено кореляційні зворотні зв’язки між тяжкістю БА та силою кисті в жінок (r = –0,65) і чоловіків (r = –0,3); швидкістю ходьби у жінок (r = –0,72) та чоловіків (r = –0,6); окружністю гомілки у жінок (r = –0,17) і чоловіків (r = –0,28). Зниження сили м’язів і толерантності до фізичного навантаження асоціювалось із втратою м’язового компонента в 80 % пацієнтів з БА. Висновки. Саркопенія діагностована у 5,71 % осіб контрольної групи і у 25,71 % хворих на БА. Залежно від тяжкості БА і віку хворих саркопенію виявлено у 9,5 % пацієнтів із середньотяжкою БА і у 35,71 % — із тяжкою БА; у 10,53 % осіб віком молодших 45 років і у 31,25 % — старших 45 років.

Population aging remains one of the most important demographic processes in recent decades. Representatives of the older age groups make up a significant proportion of various patient profiles. Among the specific features of these patients there is not only comorbidity, but also age-related changes in the peripheral tissues. Although formally they remain physiological, such changes may significantly burden the patient's condition. One of the processes accompanying aging is the loss of muscle tissue-sarcopenia. At the same time, hypertension is the most common cardiovascular disease, which develops in people over 40 years of age, and among the elderly its prevalence is 30-40%. The development of hypertension-associated complications, comorbidity in the elderly is directly related to disability, loss of self-care capacities and loss of physical independence. Redu cing physical activity may contribute to the progression of muscle tissue involution, which negatively affects the quality of life, as well as life span prognosis. Taking into account the above mentioned facts, the review deals with the pathogenetic mechanisms of communication of arterial hypertension and sarcopenia, their mutual influence on the clinical course in people of the older age groups. The emphasis lies on the negative effects of potentiating synergism of sarcopenia, sarcopenic obesity, disorders of the hemostasis system and autonomic regulation on the development of hemodynamic disorders associated with hypertension, especially in the elderly. This article is of interest to a wide range of internists, which care for the older patient groups.

Objective — to determine affects of the intermittent normobaric hypoxytherapy on the dynamics of general non‑specific adaptive reactions in the complex rehabilitation of patients with chronic obstructive pulmonary disease (COPD). Materials and methods. The treatment and examinations involved 450 patients with COPD, including GOLD 2 in 55.56 % (250 people) and GOLD 3 in 44.44 % (200 patients). The mean age was (52.65 ± 14.80) years, proportion of female and male subjects was equal. All patients received basic drug therapy according to the Order of MoH of Ukraine. The disease duration was 10 to 30 years, the remission stage was established in all patients. Patients were randomized into two groups: main (400 people) and control (50 people) with the same COPD severity distribution. Patients of the main group received additional 30 minutes sessions of interval normobaric hypoxytherapy for 20 days. The examination were performed for the dynamics of clinical symptoms, respiratory function, nonspecific resistance of an organism. Results. Most patients had symptoms of the disease against the background of basic COPD medication even on the remission stage. Unfavorable and intense adaptive reactions were determined in 71.33 % of COPD patients, and eustress reactions only in 16.89 %. Sanogenetic types of adaptive reactions were found in 28.45 % of subjects, maladaptive types — in 21.78 % of persons, pathogenetic — in 63.33 % of patients. At GOLD 2, tense reactions were diagnosed in 69.6 % of subjects, and in GOLD 3 in 73.0 %. As the severity of the disease increased, there was an increase in the development of intense training and activation responses. Upon completion of the course of hypoxytherapy, the exercise tolerance increased, and shortness of breath appeared only after severe physical activity in 90.25 % of patients in the main group, whereas in the control group similar changes were observed only in 20.0 % of patients. The respiratory function indicators in patients of the main group increased on average by 17.52 %, while in the control group — by 3.3 %. In the main group, favorable adaptation reactions prevailed in 88.25 % of patients, while in the control group this indicator was 32.0 %. The percentage of adverse reactions in the main group decreased significantly and was 11.75 % after treatment, the proportion of stress reactions — 46.25 %. In GOLD 2, the proportion of pathogenetic reactions decreased to 17.33 % and 56.00 % of the main and control groups, and in GOLD 3 — in 20.44 % and 44.0 %, respectively (p < 0.05). Conclusions. The use of a course of normobaric hypoxytherapy promoted the reduction of the main clinical COPD symptoms, increase of the frequency of favorable adaptive reactions up to 88.25 %, it raised clinical effectiveness of the treatment, which allowed to avoid disease exacerbations during the year in 80.95 % of patients.