Chronic obstructive pulmonary disease is a multifactorial disease characterized by gene-gene interaction as well as environmental effects. The incidence of type 2 diabetes mellitus is proved to be higher in the presence of chronic obstructive pulmonary disease than in the case of its absence. We aimed to study the genotypes of MDR1 (C3435T) gene polymorphism and its relationship with clinical, instrumental, and laboratory parameters in chronic obstructive pulmonary disease associated with type 2 diabetes mellitus. All the patients were divided into two groups. The first group included 53 patients with chronic obstructive pulmonary disease, and the second group included 49 patients with chronic obstructive pulmonary disease with comorbid type 2 diabetes mellitus. The COPD assessment test (CAT), 6-minute walk test, BODE integral index, spirometry, and bioimpedansometry were used for examination. Lipid spectrum, carbohydrate metabolism, endothelial functional status, leptin, adiponectin, and serum levels were also determined by means of enzyme immunoassay. Our study results showed no significant difference between the genotypes of the control group of healthy individuals and patients with chronic obstructive pulmonary disease and comorbid type 2 diabetes mellitus. Though, a certain association of this gene polymorphism with clinical findings by CAT-test, specific parameters of carbohydrate (fasting glucose) and lipid metabolism (total cholesterol and low-density cholesterol lipoproteins), endothelial functional state (nitrate/nitrite level) with the minor allele T available was found.

The study of the pathogenetic treatment and prevention of Helicobacter pylori (Hp)-associated gastroduodenopathies (GDP) induced by nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with osteoarthritis (OA) is one of the most serious problems in modern clinical medicine. Sixty patients with OA and concomitant Hp-associated GDP induced by NSAIDs were examined. The levels of epidermal growth factor (EDF), sAPO-1/Fas and tumor necrosis factor-α (TNF-α) were determined. Group I included 30 patients who received triple anti-Helicobacter (AHT) therapy, and group II included 30 patients who received rebamipide. Long-term effects were assessed 6 months and 1 year after treatment. All subjects showed a significant increase in TNF-α (4.7 times), EDF (2.2 times) and a decrease in sAPO-1/Fas (3.6 times) levels compared to healthy individuals. After 1 month of treatment, a significantly more significant decrease in TNF-α and an increase in sAPO-1/Fas and EDF was found in group II. In the long-term treatment, a further decrease in TNF-α and an increase in the content of sAPO-1/Fas levels were observed in all groups. However, these changes were significantly more significant in group I compared to group I. The long-term follow-up showed a declining trend of EDF in all groups. The data obtained indicate the effectiveness of rebamipide in the complex pathogenetic treatment and prevention of Hp-associated GDP induced by NSAIDs in patients with OA.

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The effectiveness of pulmonary rehabilitation (PR) has not yet been established in patients with asthma – chronic obstructive pulmonary disease overlap (ACO) depending on their nutritional status. We aimed to evaluate the effectiveness of a short-term PR program in patients with comorbid asthma, chronic obstructive pulmonary disease (COPD), and obesity. We included 40 ACO patients and divided them into 3 groups according to body mass index (BMI) and then subdivided them into PR (n=21) and control (n=19) groups. The COPD Assessment Test (CAT), the Asthma Control Test (ACT), and the modified Medical Research Council dyspnea scale (mMRS) were used to evaluate symptoms levels. BODE index (body mass index, forced expiratory volume in one second, dyspnoea, and 6-min walk distance) was used to evaluate the effectiveness of pulmonary rehabilitation. In addition, spirometry and bioimpedansometry were performed. All measurements were done before and after a 6-month PR program. A significantly lower decline in the BODE index was observed in overweight patients (decreased by 43.6% compared to baseline and lower by 40.7% compared to the control group). The six-minute walking test (6MWT) significantly increased in all groups (p<0.001). There was a decrease in total CAT score by 25.4% and by 31.2% in the overweight group (p<0.001). The BMI decreased more in the obese group (by 9.4% compared to baseline). Our study result showed that early use of PR program significantly improves functional capacity and BODE index, leads to dyspnea and CAT scores reduction and improvement in pulmonary function, cause a decrease in BMI, body fat percentage, and visceral fat level, and an increase in muscle mass in overweight and obese patients with ACO.

Investigation of the mechanisms promoting the development of irritable bowel syndrome (IBS) in obese patients is one of the most important issues of modern medicine. We examined 97 patients suffering from IBS. The group of comparison included 10 individuals with obesity. The control group included 21 practically healthy individuals. The levels of C-reactive protein (CRP) in the blood serum, tumor necrosis factor-α (TFNα), transforming growth factor-β1 (TGFβ1), interleukin-10 (IL-10), 8-isoprostane (IP), ceruloplasmin (CP) were examined. Endotoxicosis intensity was identified by the content of average molecular peptides in the blood and the Limulus Amebocyte Lysate (LAL) test. In the case of IBS with prevailing diarrhea, especially its comorbid course with obesity, cytokine imbalance was observed, which was manifested by a decreased amount of IL-10 in the blood serum and increased levels of TNFα and TGFβ1. Patients suffering from irritable bowel syndrome with prevailing diarrhea associated with obesity were characterized by high levels of C-reactive protein, fibrinogen and average molecules, increased content of pro-inflammatory cytokines (TFNα and TGFβ1) with a decreased content of IL-10, as well as imbalance of the pro-oxidant and anti-oxidant blood systems (increased content of 8-isoprostane and ceruloplasmin).

The study of the role of Moodle software among medical students is relevant, as distance learning is now new in terms of learning, processing, and teaching educational material online. The representation of new (latest) informative data using Moodle during distance learning contributes to and increases the level of students' knowledge. Moodle software is a valuable resource that presents an archive of educational (scientific) materials to students and teachers with unlimited access. The study is aimed at determining the role of Moodle for medical students during distance learning based on a theoretical review of the literature. Three stages of methodological justification were proposed as the basis for this study. At the first stage of the study, Moodle software was characterised; during the second – the role of distance learning was defined; third – the quality of medical students' training during distance learning through the use of innovative technologies, namely Moodle, was assessed. The study substantiates the significant role of Moodle and distance learning: understanding the goals of learning, gaining a significant “baggage” of knowledge, the latest information and access to resources, self-learning, self-improvement, and development of a “doctor” personality. The expediency of using the software among medical students is proved, taking into account the structure, logic, constant updating of materials, direct assessment of the student using test tasks and practical classes. Using Moodle software during distance learning, a medical student independently and consciously focuses on pathology based on the acquired knowledge, clearly and reasonably makes a preliminary conclusion (diagnosis) with subsequent appropriate treatment. The combined use of Moodle software and highly qualified teachers improve the quality of education and guide the medical student to focus on the study material and improve one’s practical skills with the presented materials and visual aids

Досліджено порушення ліпідних параметрів крові у хворих на ревматоїдний артрит (РА) у поєднанні з артеріальною гіпертензією (АГ), абдомінальним ожирінням (АО) та цукровим діабетом типу 2 (ЦД 2) залежно від поліморфізму гена T-786C ендотеліальної оксиду азоту синтази (eNOS). Матеріал і методи. Етап скринінгу пройшли 60 хворих на ревматоїдний артрит із АГ, АО та ЦД 2 та 20 практично здорових осіб. Поліморфізм гена eNOS (rs2070744) визначали методом полімеразної ланцюгової реакції, а при оцінюванні ліпідного профілю брали до уваги наявність коморбідних станів. Результати. Проведене дослідження показало, що перебіг РА супроводжувався дисліпідемією: рівень загального холестерину (ЗХС), вищий від популяційної норми, наявний у 61,67 % пацієнтів, холестерину ліпопротеїнів низької щільності — майже в кожного другого (45,0 %), тригліцеридів (ТГ) — у 80,0 % осіб, а рівень холестерину ліпопротеїнів високої щільності (ХС ЛПВЩ), навпаки, був нижчим від норми у 2/3 пацієнтів (65,0 %). Типування дисліпідемій засвідчує наявність майже в половини хворих (45,0 %) змішаного ІІb типу за D. Fredrickson, у кожного третього (35,0 %) — ендогенної гіперліпідемії ІV типу (гіпертригліцеридемії). Висновки. Зміни ліпідного обміну з урахуванням поліморфних варіантів гена eNOS (rs2070744) асоціюються з вищим рівнем ТГ у носіїв мутантної С-алелі — на 81,71 % (рТТ = 0,04) і 36,58 % (рТТ = 0,015), а також більшою частотою осіб із рівнем ЗХС, вищим від популяційної норми, серед носіїв СС-генотипу — на 75,0 % (р = 0,005). Натомість серед носіїв дикої Т-алелі частіше наявні особи з нижчим вмістом антиатерогенного ХС ЛПВЩ — на 31,04 % (р = 0,018) і 30,44 % (р = 0,039) та хворі із вищим рівнем ТГ — на 51,72 % (р < 0,001) і 56,52 % (р < 0 ,001) відповідно.

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