Gout is one of the most common inflammatory diseases of the joints, which is often accompanied by comorbid pathology, most often diseases of the cardiovascular system and metabolic disorders. This fact reflects the influence of hyperuricemia and the lack of compensation for purine metabolism disorders. Most researchers explain the lack of effective control of purine metabolism in gout with patients’ low adherence to treatment. This idea led to the formation of the concept of insufficient use of hypouricemic therapy and, as a result, to the lack of control over the course of the disease and the possibility of preventing the deterioration of the general state of the patient’s health, which is largely due to the progression of concomitant pathology. Many retrospective studies demonstrate a low frequency of timely appointment of hypouricemic therapy, inefficient dosage, which does not allow to reach target levels of SC in blood serum and effectively control the disease. Febuxostat is an effective means of reducing the level of SC in the blood serum in this disease. The literature provides data on the serious advantages of febuxostat over other hypouricemic agents. The purpose of this work was to study the possibility of obtaining a clinical and laboratory effect in a short time after the start of febuxostat therapy (up to 3 months) in patients with gouty nephropathy who have concomitant pathology. A study of the efficacy and safety of febuxostat (tablets of 80 or 120 mg) was conducted in gout patients with concomitant diseases. The observation period was 3 months, during which time the possibility of patients achieving the target level of SC (≤360 μmol/l) was evaluated. 6 patients reached the target SC level within 1.5 months of treatment. In 19 (30%) patients, the SC level decreased to ≤360 μmol/L after 3 months of therapy. Exacerbations of gout were noted in the first 2 months of therapy in individual patients and were characterized by less activity of joint syndrome. It is known that hyperuricemia is one of the main risk factors for endothelial dysfunction, which, in turn, contributes to the development of arterial hypertension and damage to target organs. Regardless of hypertension, an increase in the level of SC in the blood serum affects the cells of the endothelium and vascular smooth muscle, leading to the formation of microvascular damage to the kidneys. According to our data, the presence of CKD, DM and/or hypertension significantly reduces the speed of reaching the target levels of SC and increases the frequency of new cases of gout attacks, each of which increases the severity of inflammation, as well as the risk of cardiovascular disasters and death. Achieving the target level of SC in 6 patients 1.5 months after starting febuxostat and in a quarter of patients after 3 months. therapy demonstrates its powerful hypouricemic effect, which provides an early response to treatment.

As a result of the analysis, it was established that demographic trends and a shift towards the aging of the population contribute to the increase in the prevalence of degenerative diseases of the joints (osteoarthrosis) and spine (spondyloarthrosis, osteochondrosis) in society. The problem of po stmenopausal and senile osteoporosis remains relevant as a cause of fracture of the femoral neck, vertebrae, and the lower third of the forearm. A significant part of these people need professional palliative care in specialized departments of oncology and multidisciplinary hospitals, separate hospices and boarding homes for the elderly or at home, in the family, with the participation of professional visiting teams of doctors, nurses and psychologists, as is done in many Western countries. Palliative patients and their family members need adequate pain relief and symptomatic treatment, professional care, moral, psychological and spiritual support, and sometimes just human compassion and attention. According to the actual state of the organization of palliative medicine in Ukraine, it is appropriate to consider that hospice medicine deals with a complex of issues related to the assistance of palliative patients in the terminal period of life in special medical and social institutions – hospices or palliative and hospice care departments of medical institutions. The introduction of palliative care should be at an early stage. Support should be administered after diagnosis. Elderly people with comorbid pathology suffer from pain more than representatives of other age groups. Pain can be aggravated by a sedentary lifestyle, which causes muscle stiffness, deterioration of joint mobility, and increased osteoporosis. Elderly people experience a combination of musculoskeletal pain, constipation, infections, neuropathy of peripheral nerves, emotional disturbances, major and minor injuries, etc. Analgesic therapy should be started at the first signs of pain. Analgesics are prescribed at equal intervals of time, without waiting for the recovery of pain, in order to ensure constant analgesia. Adjuvant and symptomatic drugs must be prescribed strictly according to indications. Constant monitoring of patients is established, especially at the beginning of treatment. Careful monitoring is also required in the future to correct treatment and prevent possible complications. In palliative medicine, there are medicinal (pharmacological) and non-pharmacological conservative (used mainly for mild or moderate pain) and aggressive (neurosurgical, used for severe and unbearable pain) methods of controlling chronic pain syndrome. According to WHO recommendations, there are three main levels of analgesia for chronic pain syndrome in palliative patients. In rheumatological patients, pain is caused by pathological changes in peripheral structures (skin, muscles, tendons, ligaments, synovial membrane, joint capsule, cartilage, bones). When assessing the features of the pain syndrome, one should take into account anamnestic data, comorbid conditions, results of clinical and laboratory examination methods and individual characteristics of the patient. Only such a comprehensive approach makes it possible to develop an effective plan of treatment and rehabilitation measures. NSAIDs are the most popular tool of analgesic therapy in medical practice due to the combination of efficiency, safety, availability and ease of use. Opioids are used for moderate or severe chronic pain in a patient with an incurable form of the disease. That is, medicine is able to save the patient from painful suffering and give him the opportunity to walk his last path with dignity. It is important for a palliative patient to formulate a clear plan of action with their doctor. A timely visit to your family doctor will help you cope with this.

Rheumatoid arthritis is a chronic autoimmune disease that affects the synovial membrane of the joints and leads to progressive articular damage, disability and reduced quality of life. Despite the emergence of more innovative therapeutic strategies that have improved the duration of remission, rheumatoid arthritis is associated with high levels of comorbidities, infections, malignancies and cardiovascular disease. It is known that some pathogenic proinflammatory mediators in rheumatoid arthritis, such as interleukin-1β (IL-1β) and tumour necrosis factor, may play a central role in the development of cardiovascular disease. Interestingly, various preclinical and clinical studies have shown that biologic agents, who are widely used in the therapy of patients with rheumatoid arthritis, may be effective in the therapy of cardiovascular diseases as well. For this purpose we have studied adipocytokines. Adipocytokines are pleiotropic molecules that are mainly released by white adipose tissue and immune cells. Adipocytokines modulate the function of different tissues and cells, and, in addition to energy homeostasis and metabolism, enhance inflammation, immune response and tissue damage. Adipocytokines may contribute to the proinflammatory conditions in patients with rheumatoid arthritis and the development of bone damage. In addition, they may be associated with the development of cardiovascular disease. In this study, we considered the already known evidence about adipocytokines in the pathogenesis of rheumatoid arthritis, because they are also actively involved in the pathogenesis of cardiovascular disease and are possible biomarkers of prognosis and treatment outcomes, because of their potential, as a possible new therapeutic target.

Аrterіаl hypertensіon – іs one of the most аcute medіcаl аnd socіаl problems іn the world. Despіte the obvіous successes іn the treаtment of hypertensіon, the totаl number of hypertensіve pаtіents іn the world hаs exceeded 1 bіllіon people аnd іs steаdіly іncreаsіng; by 2022, аccordіng to аpproxіmаte estіmаtes, іt mаy аmount to 1.5 bіllіon cаses. Аt the sаme tіme, hypertensіon іs the leаdіng cаuse of deаth of the populаtіon (12.8%), whіch іs 7.5 mіllіon people per yeаr. Іn turn, а hypertensіve crіsіs іs аn аcute, pronounced іncreаse іn blood pressure, аccompаnіed by clіnіcаl symptoms аnd requіrіng аn іmmedіаte controlled decreаse from the purpose of preventіng or lіmіtіng dаmаge to tаrget orgаns. Bаsed on thіs defіnіtіon, іt іs іmportаnt to emphаsіze once аgаіn thаt іt іs unаcceptаble to clаssіfy epіsodes of аn аcute pronounced іncreаse іn blood pressure thаt аre not аccompаnіed by clіnіcаl symptoms to hypertensіve crіsіs. Іn аddіtіon, іt іs іmportаnt not to refer to hypertensіve crіsіs аs cаses of аcute myocаrdіаl іnfаrctіon, аcute cerebrovаsculаr аccіdent, аccompаnіed by а secondаry pronounced іncreаse іn blood pressure (due to pаіn syndrome, аcute cerebrаl іschemіа, etc.). Thus, the hypertensіve crіsіs should іnclude those cаses when аn аcute pronounced іncreаse іn blood pressure precedes аnd іs the cаuse of аcute dаmаge to tаrget orgаns. The іssue of treаtment of аrterіаl hypertensіon аnd hypertensіve crіses does not lose іts relevаnce now. The possіbіlіtіes of rаpіd аnd effectіve relіef of crіses аt the prehospіtаl stаge hаve іncreаsed severаl tіmes wіth the аdvent of the drug ebrаntіl. The mаіn goаls of the treаtment of hypertensіve crіsіs аre relіef of the crіsіs, post-crіsіs stаbіlіzаtіon, аnd preventіon of repeаted hypertensіve crіses.

The aim of the study was to determine whether the presence of psoriatic arthritis is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis. 56 patients with psoriatic arthritis were recruited from the rheumatology department of «Poltava Regional Clinical Hospital n.a. M.V. Skliphosovskyi of Poltava Regional Council» and 38 psoriasis without arthritis patients from the outpatient department of «Poltava Regional Clinical Hospital n.a. M.V. Skliphosovskyi of Poltava Regional Council». The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both psoriatic arthritis and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios, comparing the odds of ever having a given comorbid disease in psoriatic arthritis patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities. According to the research the prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus and at least one cardiovascular event in patients with psoriatic arthritis was 36,9%, 31,1%, 20,3%, 11,09% and 8,7% respectively. This was significantly higher than in psoriasis without arthritis patients with unadjusted odds ratios ranging from 1,55 to 2,58. In the multivariate analyses, hypertension remained significantly elevated (corrected probability factor 2,18). Psoriatic arthritis was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted odds ratios 2,79; 4,75; 21,47; and 7,68, respectively). Infections treated with antibiotics and depression / anxiety were relatively common in psoriatic arthritis with a prevalence of 31,8% and 19,3%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments. According to the study was founded that inflammatory joint disease (psoriatic arthritis) may play a main role in the development of both cardiovascular and other comorbidities in patients with psoriatic arthritis.

Osteoarthritis (OA) is a common, poly-etiological disease of the joints, the occurrence and development of which is associated with a number of genetic, endogenous (hormonal balance, immune disorders, oxidative stress) and exogenous factors (trauma, overload). The combination of metabolic syndrome (MS) and OA is one of the most pressing medical and social issues for healthcare today. This is due to both their extremely high prevalence and high comorbidity with other conditions and diseases that have a significant impact on the quality of life of patients. The aim of our work was to study the pleurotropic effect of rosuvastatin on the pain intense and disease intensity in the course of OA in patients with comorbid MS, as well as its effect on blood pressure (BP), heart rate (HR), level of anthropometric indicators and lipidogram indicators. 30 patients were examined for OA and MS. Patients were divided into two age-matched groups. Rosuvastatin was prescribed to group I (n = 15) in a dose of 20 mg once a day for 12 days. The criteria for assessing the therapy efficacy included pain severity, articular and anthropometric parameters, laboratory and instrumental parameters, the level of quality of life. Patients were examined twice: before the therapy and on the day 12 of the therapy. It has been established that the rozuvastatin prescribed for this category of patients can reduce pain, improve joint function, lower the intensity of the disease and improve the quality of life of patients. In addition, rozustastatin does not affect the level of systolic and diastolic blood pressure, and can be prescribed for patients with concomitant arterial hypertension.

The frequency of the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) is highlighted in the work, and it is concluded that there is a fairly significant stratum of patients, namely 25,9%, with combined pathology of the respiratory system and cardiovascular. On the basis of the therapeutic department of the Poltava central regional clinical hospital, 97 patients (84 men and 13 women) with a combination of COPD and CHD were examined: stable angina pectoris, grade II, which were hospitalized due to exacerbation of respiratory pathology. They were divided into 2 groups. Group 1 patients (51 people) received only basic therapy (β2-agonists, anticholinergics, methylxanthines, inhaled glucocorticosteroids, phosphodiesterase-4 inhibitors). In addition to basic therapy, patients of the 2nd group (46 people) were additionally prescribed L-arginine («Tivomax») in the form of a 4,2% solution of 100 ml intravenously once a day for 10 days. As a result of the treatment, a positive dynamics of the regression of clinical manifestations of acute exacerbation of COPD was revealed in both study groups. However, in the second group of subjects who receive L-arginine on the basis of basic therapy, clinical indicators, indicators of the function of external respiration and exercise tolerance, indicators of cardiohemodynamics significantly (p<0,05) improved compared with the control group. It was concluded that the inclusion of L-arginine in the complex treatment of patients with exacerbation of COPD and concomitant CHD increases the effectiveness of the treatment of respiratory pathology and improves cardiodynamics. The addition of L-arginine to complex therapy for patients with COPD in combination with CHD leads to a statistically significant improvement in clinical and instrumental parameters, which is due to the antihypoxic, antiplatelet, cytoprotective and vasodilatory effects, detoxification activity of L-arginine (“Tivomax”), which is safe improves the effectiveness of treatment.

The aim of the work – the analysis of the pedagogical effectiveness of the introduction of interactive learning technologies in the training of an internship doctor in the specialty “General Practice Family Medicine”. The main body. The article presents the main technologies of interactive learning, which are used at the Department of Family Medicine and Therapy in the training of a medical specialist: brainstorming, discussion, presentation, role play. The features of each of these methods and their advantages were given. The evaluation of the effectiveness of the used pedagogical technologies was carried out at the end of the discipline by testing and the licensed computer program “Elex” (150 questions of 2-3 levels of complexity on the corresponding specialty were offered) and by checking the acquisition of practical skills in accordance with standardized cards of practical skills and summing up the results, anonymous questionnaire. The effectiveness of using individual interactive teaching methods in the training of a medical specialist is shown. Conclusions. To achieve maximum mastering of the material, to make the classroom interesting and dynamic, it is necessary to use various interactive teaching methods, in particular: brainstorming, discussion, role play, presentation. For the effective use of one or another interactive method in the training of a specialist, it is important to be familiar with a variety of methods, to understand their features, to take into account the bene ts and limitations, and to take into account the recommendations for their use, to apply interactive methods in accordance with the topic, goals and objectives of the occupation.

The article considers features of organization of training of interns at the department of family medicine and therapy: outpatient care, follow-up of patients in the hospital, participation in the preparation of clinical and clinical-anatomical conferences, abstract reviews, multimedia presentations; describes forms of distance learning, organization of scientific work of interns, study in the educational and practical center.

В статье освещаются особенности течения сердечной недостаточности у пациентов пожилого возраста, вопросы фармакотерапии хронической сердечной неокончательности, рассматриваются особенности патогенетической терапии ß-адреноблокаторами и ингибиторами АПФ, а также диуретиками и сердечными гликозидами.

Мета дослідження – аналіз педагогічної ефективності курсів передатестаційного циклу для лікарів з фаху “Загальна практика – сімейна медицина”, що проводилися на базі кафедри сімейної медицини і терапії навчально-наукового інституту післядипломної освіти та на філії кафедри у м. Кременчук.Матеріали та методи дослідження. Оцінка ефективності використаних педагогічних технологій проводилася наприкінці циклу шляхом проведення тестування за допомогою ліцензованої комп’ютерної програми “Elex” (пропонувалося 150 питань 2-3 рівня складності з відповідного фаху) і шляхом перевірки опанування практичних навичок згідно зі стандартизованими картами практичних навичок та підведення підсумків з анонімним анкетуванням. Важливою особливістю навчального процесу в галузі післядипломної медичної освіти також є тісне поєднання теоретичної та практичної підготовки фахівців, тому велике значення має саме комплексність навчання: використання дистанційних форм на етапі теоретичної підготовки та відпрацювання практичних навичок на клінічних базах стажування. Це є переконливим поясненням наявності заочної частини навчання та пояснює перевагу дистанційної освіти, коли слухачі віддалені від бази навчального закладу. Дистанційні форми освіти не можуть існувати самостійно та використовуються у поєднанні з класичними формами навчання.Результати й обговорення. Показана ефективність використання дистанційних форм навчання за даними результатів тестування та опанування практичних навичок.Висновки. Дистанційна освіта на післядипломному етапі навчання лікарів-інтернів та лікарів-курсантів є самостійна цілеспрямована робота з використанням сучасних інформаційних технологій, ефективність якої залежить від методологічно структурованого викладачем процесу та інформаційно-комунікаційних можливостей вищого навчального закладу. Надані рекомендації щодо впровадження елементів дистанційного навчання в практику роботи Навчально-наукового інституту післядипломної освіти.

The paper elucidates the peculiarities of heart failure course in elderly patients, as well as issues of pharmacotherapy, chronic heart failure. Features of the pathogenetic therapy of ß-blockers and ACE inhibitors, as well as diuretics and cardiac glycosides have been considered.