Symptomatology of oncological diseases consists not only of local symptoms caused by the primary malignancy or its metastases, but also by general systemic signs that are not directly connected with the tumor. These symptoms are mostly associated with autoimmunity or endocrine influences. In many cases, the source of paraneoplastic syndromes (PNS) is unknown. Nearly 15% of oncological patients demonstrate these syndromes but it is diagnosed much more rarely. The survey of the numerous PNS is offered. The significance of the PNS differs for oncologists and other physicians who encounter it in their practice. The reason of those differences, as well as the connection between PNS and cancer toxicity is discussed. The experience of antitoxic therapy (hemosorption, lymphosorption, enterosorption) used in our clinic in the previous years is overviewed.

Sarcopenia is a progressive and generalized loss of muscle mass and function with advancing age. 1,2) This geriatric syndrome is now considered an increasing public health issue worldwide. 3) Sarcopenia is associated with adverse health outcomes such as physical impairment, mobility limitations, increased fall risk, hospitalization, and mortality. 4) In the last decade, several sarcopenia definitions and proposals for diagnostic criteria have been published. Among these, the revised consensus criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2) appear to be the most promising. The EWGSOP2 considers sarcopenia to be present when a person presents with both low muscle strength and low muscle mass. Additionally, people with low physical performance are categorized as severely sarcopenic. 3) This condition can also impact patient quality of life. Since this aspect is not straightforward for clinical evaluation, the issue is less studied so far. The existing quality of life questionnaires, such as the Short Form 36 (SF-36) and EuroQoL 5-dimension (EQ-5D), are designed for use in a broad swath of health conditions and pa

The assessment of long-term outcome of functional disability and disease activeness in adult patients with juvenile idiopathic arthritis appears to be complicated due to the absence of a unified approach to the classification and estimation of disease activeness, as well as the loss of supervision over a patient because of remission or his/her transition from pediatric to adult rheumatic service. The objective of the research was to determine how adults with the history of juvenile idiopathic arthritis fulfill the classification criteria for adult rheumatic diseases, as well as to assess activeness of these diseases, the degree of functional disorders, and social activeness of patients in Ukraine. Materials and methods. Patients with juvenile idiopathic arthritis older than 18 years and with more than 3 years of disease duration living in different parts of Ukraine were included into the study. Data regarding sociodemographic features, fulfillment of adult classification criteria, Health Assessment Questionnaire, articular and extra-articular Juvenile Arthritis Damage Index and disease activity were analyzed.Results. We observed 122 adult patients with the history of juvenile idiopathic arthritis irrespective of the presence of active inflammation at the moment of the examination. This group included patients from different regions of Ukraine diagnosed with juvenile idiopathic arthritis during 1984-2013. An adult rheumatologist examined all patients and the diagnosis was revised according to the adult classification of rheumatic diseases. Typical diagnostic criteria for rheumatoid arthritis were estimated in 32.8% of patients, ankylosing spondylitis – in 31.1% of patients, undifferentiated arthritis – in 13.9% of patients, Still’s disease – in 4.9% of patients, psoriatic arthritis – in 0.8% of patients, steady clinical laboratory remission – in 16.5% of patients. Most patients (81.8%) with rheumatoid factor positive polyarticular juvenile idiopathic arthritis fell under rheumatoid arthritis criteria in adulthood, and in 85% of patients with enthesitis-related arthritis as well as 53.8% of patients with extended oligoarthritis ankylosing spondylitis developed in adulthood. 68.8% of patients with systemic juvenile idiopathic arthritis, 68% of patients with rheumatoid factor negative polyarthritic subtype and 55% of patients with enthesitis-related arthritis had disability and incapacitation. Minimal disorders of the patients’ general condition according to the Health Assessment Questionnaire in adult age were found in most subtypes of juvenile idiopathic arthritis classified according to the International League of Associations for Rheumatology (extended and persistent oligoarthritis, rheumatoid factor positive polyarthritis, systemic subtype); moderate disorders of the general condition were found in enthesitis-related arthritis and rheumatoid factor negative polyarthritis. Side effects of juvenile idiopathic arthritis according to the articular Juvenile Arthritis Damage Index included severe articular damage being most frequently found in systemic and rheumatoid factor positive polyarthritis subtypes of juvenile idiopathic arthritis, while side effects of juvenile idiopathic arthritis according to the extra-articular Juvenile Arthritis Damage Index included extra-articular damage being found in systemic and rheumatoid factor negative polyarthritis subtypes of juvenile idiopathic arthritis, that was confirmed by the assessment of physical health according to the Short Form Health Survey-36, which was the worst in patients with systemic (40.3±12.6) and rheumatoid factor negative polyarthritis (38.9±9.4) subtypes of juvenile idiopathic arthritis.Conclusions. Further research of remote consequences of juvenile idiopathic arthritis in adult age and long-term observation of such patients require a detailed study to improve diagnostics and provide adequate treatment of rheumatic diseases with juvenile onset in adult age.

The protracted war in Ukraine, sparked in 2014 and persistently escalating, has significantly impacted the country’s healthcare system. It has amplified existing challenges, such as shortages of medical supplies and personnel, outdated infrastructure, and restricted access to healthcare services. Destruction of medical facilities, non-adherence to prevention and treatment standards, lack of medical personnel and supplies, and logistical disruptions are hampering the provision of timely healthcare to the Ukrainian population. This study employed a rapid review methodology to synthesize available research concerning the healthcare crisis in Ukraine, with an explicit focus on the war’s sustained impact on the healthcare system. Through this review, a series of critical challenges facing Ukraine’s healthcare system were identified. These included the shortage of medical supplies and personnel, insufficient infrastructure, and funding deficits. Additionally, the review brought to light various interventions and strategies aimed at counteracting these challenges. These comprised international aid and support, initiatives enhancing the resilience of the Ukrainian health system, and others. Given the ongoing war, this review highlighted the pressing need for continuous support and investment in the Ukrainian healthcare system. This commitment is essential to guarantee access to quality healthcare for the Ukrainian population during the war and in its aftermath. The findings presented here can serve as a guide for policymakers and healthcare professionals working not only in Ukraine but also in other regions impacted by war. These insights can inform the development and implementation of effective strategies and interventions tailored to such challenging contexts.

Background. Young adults with juvenile idiopathic arthritis (JIA) often have an active disease with signi icant functional impairment in adulthood that can affect their physical and mental functions. Aim.To determine the impact of JIA on quality of life (QoL) in young adults with JIA during the transition healthcare. Materials and methods.The cross-sectional study of 89 young adults aged 16 to 22 years with a history of JIA regardless of the presence or absence of active in lammation at the time of the survey was performed in the Oleksandrivsky Central Clinical Hospital in Kyiv, Ukraine in the period between April 2015 and February 2017. 25 age-and sex-matched controls (without rheumatic disease) were included. There was performed an evaluation of the age at disease onset, duration, JIA activity, received therapy and quality of life.Results. Out of 89, 37 (41,6%) patients were considered to be in remission. Juvenile idiopathic arthritis had a large impact on the physical scales of quality of life. Patients with JIA had worse (p <0.001) physical health in comparison with the control group. The pain was the most important factor affecting the quality of life in cases of juvenile idiopathic arthritis. The indices responsible for the physical (p<0.001), role (borderline signi icance, p=0.04) functioning, and intensity of pain (p<0.001) were decreased, compared with the control group. However, the indicators responsible for psychological function in patients with JIA did not differ from the control group. The correlation analysis revealed signi icant negative association between disability severity (HAQ) and physical function (r=-0,56, p<0.001), role function (r=-0,33, p<0.001), pain intensity (r=-0,60, p<0.001), general health (r=-0,40, p=0.01), vital activity (r=-0,46, p<0.001), social function (r=-0,48, p<0.001), mental health (r=-0,42, p<0.001).Conclusion. In our transitional cohort of patients at the era of biological therapies, juvenile idiopathic arthritis had a larger effect on the physical than mental SF-36 subscale. The pain was the main factor in luencing the quality of life.

Актуальность. Важным является изучение состояния костной ткани у молодых взрослых с диагностированным в детстве ювенильным идиопатическим артритом (ЮИА), поскольку длительный прием глюкокортикоидов и наличие хронического системного воспаления могут приводить к потере костной ткани у молодых людей. Цель исследования: изучение минеральной плотности костной ткани (МПКТ) у молодых женщин с ЮИА. Материалы и методы. Девяносто девять женщин в возрасте от 19 до 39 лет распределены на две группы: I — 59 практически здоровых молодых женщин; II — 40 молодых женщин с ювенильным идиопатическим артритом. Оценивали возраст дебюта заболевания, время от начала первых клинических проявлений до момента установления диагноза, длительность заболевания, ILAR-вариант в дебюте заболевания, МПКТ в различных участках и их Т- и Z-показатели. Результаты. Установлено, что у женщин с ЮИА заболевание начиналось в возрасте 11,16 ± 4,34 года; время от начала первых клинических проявлений до установления диагноза составило 23,52 ± 21,37 месяца; продолжительность заболевания на момент осмотра — 11,9  ±  9,4 года; персистирующий олигоартрит выявлен у 25  % больных; РФ-отрицательный полиартрит — у 22,5  %; распространенный олигоартрит — у 10  %; РФ-положительный полиартрит — у 10  %; системный ЮИА — у 12,5  %; энтезитассоциированный ЮИА — у 15  %; недифференцированный артрит — 10  %; псориатический артрит — 5  % больных. МПКТ (p < 0,000001), Т- (p = 0,00001) и Z-показатели на уровне поясничного отдела позвоночника у больных ниже, чем у здоровых. МПКТ (p < 0,000001) и Т-показатель (р = 0,00002) в области бедренной кости, МПКТ всего скелета (p < 0,000001), Т- (р = 0,00009) и Z-показатели (р < 0,000001) ниже у больных с ЮИА, чем у здоровых. Однако показатель МПКТ в области ультрадистального отдела костей предплечья больных отличался от такового у здоровых лишь по Т- и Z-показателям (р = 0,004). Показатель Z < –2 SD среди молодых взрослых выявлен у 40  % больных на уровне поясничного отдела позвоночника, у 24  % больных на уровне шейки бедренной кости, у 35,5  % больных во всем скелете и у 52,9  % пациентов в ультрадистальном отделе костей предплечья, а Т-показатель < –2,5 SD — у 3,3  % больных на уровне поясничного отдела позвоночника, у 3,4  % — на уровне шейки бедренной кости, у 36,7  % — во всем скелете, у 23,5  % — в ультрадистальном отделе костей предплечья. Остеопения по Т-показателю на уровне поясничного отдела позвоночника обнаружена у 43,3  %, шейки бедренной кости — у 41,4  %, всего скелета — у 36,7  %, в ультрадистальном отделе костей предплечья — у 23,5  % больных. Выводы. У женщин молодого возраста с ЮИА выявлено значительное снижение МПКТ, Т- и Z-показателей на уровне поясничного отдела позвоночника, шейки бедренной кости и всего скелета по сравнению со здоровыми женщинами соответствующего возраста. Наличие ЮИА в детском возрасте отрицательно влияет на формирование пика костной массы у женщин и приводит к снижению МПКТ во взрослом возрасте, что требует активного наблюдения и назначения профилактической терапии в детстве и при необходимости лечения во взрослом возрасте для профилактики остеопоротических осложнений.

Институт геронтологии им. Д. Ф. Чеботарева НАМН Украины, Украинский научно-медицинский центр проблем остеопороза; 2 Национальный медицинский университет им. Богомольца, Киев, Украина Введение. На состояние костной ткани у пациентов с ювенильным идиопатическим артритом (ЮИА) влияет наличие хронического системного воспаления и прием глюкокортикоидов. Цель исследования: изучение минеральной плотности костной ткани (МПКТ) у молодых женщин с ЮИА.

Juvenile idiopathic arthritis is known to persist into adulthood which is associated with the development of a large number of long-term consequences, including low quality of life.         The objective of the research was to evaluate quality of life in young adults with juvenile idiopathic arthritis and to analyze the risk factors for the development of its low level using the 36-Item Short Form Health Survey.     Materials and methods. There were examined 135 adult patients with juvenile idiopathic arthritis without severe comorbidity at the age of 18 to 40 years and 25 apparently healthy young adults of the same age and gender. Quality of life was evaluated using the 36-Item Short Form Health Survey.     Results. In patients with juvenile idiopathic arthritis, the physical health score (44.8±9.9) was lower (p=0.001) as compared to healthy individuals (55.7±6.9). Patients with juvenile idiopathic arthritis had lower indicators of physical functioning (p=0.001), role functioning (p=0.001) and bodily pain (p=0.001) than healthy individuals. However, in patients with juvenile idiopathic arthritis, the indicators of the mental health score and associated vitality, social functioning, role limitations due to emotional problems and mental health did not differ from those in the control group. Prolonged morning stiffness (p<0.05) and polyarticular variant of joint damage (p<0.05) were the risk factors for the development of low physical health score in young adults with juvenile idiopathic arthritis. According to the articular juvenile arthritis damage index (p<0.001), the presence of long-term articular damage was associated with high physical health score. There were found no risk factors for the development of low mental health score.      Conclusions. Young adults with juvenile idiopathic arthritis at the age of 18 to 40 years had worse quality of life than healthy individuals of the same age and gender. They had worse physical well-being scores including physical functioning, role functioning and bodily pain. The risk factors for the development of low physical health score in young adults with juvenile idiopathic arthritis were the presence of prolonged morning stiffness as a manifestation of disease activity and polyarticular variant of joint damage, while the presence of prosthetic joints improved their physical health score.