Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

There are still many complex issues in the management of autoimmune pathologies in gynecology and reproductology, endometriosis in particular. Naltrexone, a competitive antagonist of opiate receptors in the central and peripheral nervous systems, reveals new qualities such as effects on autoimmune processes. Naltrexone in low doses of 1.7–5 mg (Low Dose Naltrexone, LDN) revealed the opposite effect on opiate receptors in the form of a rebound effect and, as a consequence, a strong increase in endogenous endorphins and enkephalins. Studies of elevated levels of these neurotransmitters have provided evidence of a multidisciplinary beneficial effect on the immune system of people with endorphin and enkephalin deficiency, an association between the endogenous opiate system and cells and tissue growth in general and healthy immune function was confirmed. The most explored effects of them are such as blocking the synthesis ofpro inflammatory cytokines IL-6, IL-12, tumor necrosis factor, the effect on neuroglia through toll-like receptors, the effect on the cycle cells growth, especially malignant tumor cells, through interaction with opiate growth factor, modulation synthesis of T- and B-lymphocytes. Growing evidence of LDN efficacy is becoming a potentially effective clinical practice in autoimmune pathologies, but still off-label used.Some data of clinical trials is presented. Four studies with Crohn's disease with results of relief of symptoms and remission, including experience in pediatrics. Three clinical trials with LDN results in multiple sclerosis with improved quality of life and improved symptoms. The scientific hypothesis suggests the success of LDN due to the reduction of induced nitric oxide synthase activity. The success of management of patients with malignant tumors is also presented. The article contains the latest data from clinical trials on reported serious and non-serious side effects of naltrexone at various doses, including data confirming the safety of taking mid-therapeutic naltrexone doses throughout pregnancy. These effects of LDN may prove to be effective in management patients with endometriosis.

АКТУАЛЬНІСТЬ ПРОБЛЕМИ Недостатність вітаміну D вважають однією з проблем охорони здоров'я в усьому світі, яка, за даними Всесвітньої організації охорони здоров'я, має характер пандемії. Особливо схильні до дефіциту вітаміну D люди, які проживають північніше 35-ї паралелі (в Північній півкулі), що обумовлено недостатнім рівнем інсоляції протягом року. Наприклад, в Європі 57-64% населення мають дефіцит вітаміну D-його рівень у крові нижчий за 20 нг/мл (рис. 1) [22]. Проблема гіповітамінозу D актуальна і для України. Нормальний рівень вітаміну D в плазмі крові зареєстровано лише в 4,6%, недостатність (21-30 нг/мл)-у 13,6%, дефіцит (< 20 нг/мл)-у 81,8% українців. Лише в 6,1% жінок різного віку відзначають нормальний рівень вітаміну D [47]. Таким чином, приблизно 95% населення України має низький рівень вітаміну D, що зокрема призводить до збільшення числа зареєстрованих випадків рахіту в дітей та остеомаляції в дорослих. Окрім того, дефіцит вітаміну D мають 88,9% пацієнтів з алергічними захворюваннями, від нього страждають 53,3% дітей, хворих на бронхіальну астму, а також на 46% збільшується ймовірність виникнення агресивних форм раку простати. Д.Г. КОНЬКОВ д.мед.н., доцент кафедри акушерства і гінекології №1 Вінницького НМУ ім. М.І.Пирогова ORCID: 0000-0002-9375-7509 О.В. ФУРМАН к. мед. н., доцент кафедри акушерства та гінекології № 2 Вінницького НМУ ім. М.І. Пирогова

Chronic pelvic pain (HTB) remains a relevant multidisciplinary problem. Its symptoms are the result of interaction between psychological factors and dysfunction of the immune, neurological and endocrine systems. HTB is a serious problem for women. Approximately 14% of women experienced HTB at least once in their lives. HTB is grueling and related to significant costs and incidence, and its etiology is multifactorial, which often complicates medical treatment and treatment of associated symptoms. Best practice guidelines recommend an interdisciplinary and biopsychosocial approach to treatment. However, the problem of HTB requires further comprehensive study and expanding possible methods of effective pain control and improving the quality of life of the female population. The article systematizes literary sources on the genesis of pain, the principles of classification, diagnostics and management.

No abstract