1,, 1 2 ABSTRACT Introduction: According to present knowledge, hyperhomocysteinemia is one of the risk factors of cardio-vascular pathology. Patients with chronic kidney disease are known to develop hyperhomocysteinemia more often than those in general population. Іmportant cause of hyperhomocysteinemia is the deficiency of vitamins В6, В9 and В12 that are involved in homocysteine metabolism. Vitamins deficiency, we believe, can be one of the causes of hyperhomocysteinemia in the patients with chronic renal failure. The aim: To analyze the plasma homocysteine level in patients with chronic kidney disease and its assosiation with the levels of vitamins B6, B9, B12 in Ukraine. Materials and methods: The study involved 148 persons with different stagesis of chronic kidney disease who underwent immunoenzyme determination of total plasma homocysteine, B9, cobalamin and vitamin В6 status. Results: It was found that in ukrainian patient population with chronic kidney disease 58.7% of patients have hyperhomocysteinemia. Homocysteine level was shown to increase with the increase of chronic kidney disease stage. Supply of vitamins В6, В9 та В12 in the patients with chronic kidney disease was lower than in apparently healthy persons, but there was significant decrease of folic acid level proportionally to the increase of chronic kidney disease stage. There was close relationship between homocysteine level and folic acid status in the patients with chronic kidney disease, but it appeared to be independent on cobalamin and pyridoxin status. Conclusions: The obtained data are promising for finding effective means of correction of hyperhomocysteinemia in patients with chronic kidney disease by normalizing the vitamin status of such patients.

Introduction: Administration of an oxygen-ozone mixture is one of the innovative techniques used in single-drug or complex therapeutic schemes for treatment of many degenerative-dystrophic pathologies of the musculoskeletal system and related neurological complications. Aim: The aim was to determine the mechanisms of physiological action of the oxygen-ozone mixture in order to substantiate its efficacy for treatment of chronic pain syndrome with underlying degenerative-dystrophic pathologies of the musculoskeletal system. Material and methods: The article covers biochemical and pathomorphological studies that explain the mechanism of the pain syndrome and the potential effect of the ozone therapy. Results and discussion: The treatment schemes and benefits of different routes of ozone administration (intramuscularly, intravenously, intradiscally and intraarticularly) were analyzed. Diverse research data demonstrated influence on the causes of chronic pain, pathophysiological phases, and possible complications. The prospects of further studies for development of the most effective techniques for treatment of various pain syndromes were assessed. Conclusions: Ozone therapy is one of the alternative rehabilitation methods with a substantial pain relieving effect. As of today, the possibility of using the oxygen-ozone mixture for treatment of chronic back pain related to intervertebral disk hernia and fibromyalgia has been substantially confirmed.

Annotation. Clinical observations indicate that one of the rather important mechanisms in the pathogenesis of complications in CKD stage VD are disorders in the hemostatic system leading to the development of thrombophilia. Comorbidity in this category of patients significantly worsens the prognosis due to the potentiation of hypercoagulation, which, as a comorbid syndrome, accelerates morphological changes in the kidneys, contributes to the deposition of fibrin in the glomeruli and the development of thrombosis. The aim of the study was to study the indices of the main links of hemostasis depending on some comorbid conditions (acute inflammation, secondary hyperparathyroidism, hepatitis B and C). The study involved 52 men and 36 women with CKD stage VD, who were on programmed hemodialysis, in whom the levels of soluble fibrin, D-dimer, fibrinogen, protein C, indicators of hemostatic potential in these comorbid conditions were determined. Statistical processing of materials was performed using the methods of variation statistics.It was determined that the presence of a fast phase of inflammation enhances the processes of hypercoagulability, and a high level of parathyroid hormone (˃800 pg/ml) in combination with hyperphosphoremia slightly increases the level of fibrinogen. Infection with hepatitis C significantly increases the level of soluble fibrin, and infection with hepatitis B decreases the level of protein C. The study and implementation of a comprehensive assessment of the state of hemostasis in patients with CKD stage VD complicated by comorbid diseases makes it possible to identify imbalances in the pro- and anticoagulation system.

The article presents the problem of treatment rates improvement of the patients with community-acquired pneumonia as a result of inclusion of Thiotriazolin® metabolic correction and analysis of the clinical treatment rates in the complex of therapeutic measures. Inclusion of Thiotriazolin® in the treatment complex provided faster normalization of sputum cytogram, significantly reduced the level of the endogenous intoxication, which led to the increase in the number of favorable adaptive responses of the organism, more significantly than the traditional therapy, reduced the intensity of the inflammatory response in the lungs and reduced the time of elimination of the clinical disease.

The objective of our study was to interpret and discuss atypical multiple myeloma case. The article describes the case of clinical observation of a patient K, in which manifestations of chronic kidney disease and circulatory failure prevailed in clinical picture of the disease. The authors recommended an X-ray examination of skull and pelvic bones as a screening method suitable for elderly people with symptoms of chronic renal insufficiency and chronic bone and muscle pain resistant to treatment.

Annotation. Diabetes is one of the most common metabolic diseases in the world with a large number of complications. Threatening conditions that significantly reduce the quality of life and even lead to the death include a diabetic foot syndrome. The aim of the study was to investigate the effectiveness of combined ozone therapy in the treatment of patients with type 2 diabetes with chronic lower extremity trophic ulcers. A prospective study of the effectiveness of using the combined method of ozone therapy in the treatment of trophic ulcers of the lower extremities was conducted in the surgical and rehabilitation departments of the University Clinic of the National Pirogov Memorial Medical University. The study involved 52 patients with diadetes mellitus 2 type, who were randomly assigned to the main (n=26) and control (n=26) groups. Subjective and objective changes in the condition of patients were evaluated: an area of trophic ulcers (by A.V. Kuleshov's method), a rate of ulcer’s defect epithelization (by L. Popova's formula) and the quality of life parameters of patients (by the questionnaire SF-36) before and after the treatment. The endpoint of the study was a complete epithelization of the diabetic trophic ulcer. The treatment was carried out according to the generally accepted methodology in both observation groups, and the combination ozone therapy was additionally used for patients of the main group. The latter provided for the intravenous administration of an oxygen-ozonized 0.9% NaCl solution and local exposure of the trophic ulcer defect to the ozonized mixture by chamber aeration. The course of complex treatment was carried out after removal of necrotic tissue and wound cleansing, consisted of 10 local and general ozone therapy procedures, which were carried out every other day. The data obtained were processed using the SPSS for Windows 10.0 and STATISTICA 6.1 application software package (license number BXXR901E245722FA). One month after, the observation changes of the trophic skin defects and Quality of life indicators showed the significantly (p<0.01) better results of treatment in the main group than in the control group. The endpoint of the study was achieved in 85% of patients after complex treatment versus 29% of patients in the control group after a conventional treatment (p<0.01). Using as modern rehabilitation method as ozone therapy is an appropriate complement to the existing treatment regimens, which can significantly accelerate the clinical recovery of patients and, as a result, improve the quality of life. The particular value of the method confirmed by an absence of contraindications and drug overloads of the patient. The study of the effects of ozone therapy on the metabolism of patients with diabetes mellitus type 2 can be a promising area for further research.

For patients who survived a new coronavirus infection, rehabilitation measures are necessary to relieve the sequela of the disease. The article summarized literature data with a rationale and expected outcomes of ozone therapy in patients with post-COVID-19 syndrome. The presented clinical case demonstrates the effectiveness of intravenous ozone therapy as a part of rehabilitation program in patient with community-acquired polysegmental pneumonia associated with the SARS-CoV-2 virus. The use of this technique (combination of the infusion of ozonated saline and ozonated saline saturated with the patient’s blood) allows to reduce the activity of the inflammatory process, which contributes to the complete restoration of physical exercise tolerance and the improvement of the patient’s quality of life. Key words: COVID-19, pneumonia, rehabilitation, ozone therapy

IntroductionLow back pain is one of the most common causes of short-term, and sometimes long-term, disability in the population younger than 45 years old. Approximately 60% to 80% of the population in developed countries experience back pain in various locations (neck, mid and lower back) at least once in their lifetime. Guidelines regarding back pain treatment are undergoing constant modifications and improvements. The relevance of dorsalgia as a significant medical problem and its management is shown by the increased number of recently published papers, which has tripled in the past several years (from 22% to 65%).AimTo analyze the most critical risk factors of the degenerative intervertebral disk disease, and to review the effectiveness of invasive and noninvasive methods of treatment of the lower back pain syndrome.Material and methodsRecently published papers focusing on invasive and noninvasive treatments of low back pain syndrome.Results and discussionSurgical intervention as a single method of back pain treatment is indicated in a small number of cases. The risk of repeated surgeries for intravertebral disk herniation should be considered before any surgical intervention. A wide variety of treatment options allows to choose the most effective approach based on individual needs.ConclusionsConservative, noninvasive approach has shown to be an effective alternative for lower back pain and radiculopathy treatment. It has been determined that ozone therapy is an appropriate, relevant, and affordable treatment method for patients with vertebral degenerative changes and intravertebral disk diseases.