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Документ Атопія і метаболічний синдром: обгрунтування патогенетичних підходів до діагностики, лікування та профілактики.(Вищий державний навчальний заклад України «Українська медична стоматологічна академія», 2014) Сакевич, Вікторія Дмитрівна; Трибрат, Тетяна Анатоліївна; Шуть, Світлана Володимирівна; Сакевич, Виктория Дмитриевна; Трибрат, Татьяна Анатольевна; Шуть, Светлана Владимировна; Sakevich, V.; Tribrat, T.; Shut, S.В оглядовій статті приведені дані літератури, присвячені обгрунтуванню патогенетичних підходів до діагностики, лікування та профілактики атопії та метаболічного синдрому.Однак, сучасні літературні дані є недостатні , а часом і суперечливі щодо клініко - функціональних особливостей перебігу БА та АР, атопічної триади на тлі МС , про зв'язок між вираженістю компонентів МС та ступенем тяжкості зазначених патологій, ступенем алергічного запалення, не розроблені рекомендації щодо раннього виявлення компонентів МС у пацієнтів з поєднаною патологією та їх лікування та профілактики; В обзорной статье приведены данные литературы, посвященные обоснованию патогенетических подходов к диагностике, лечению и профилактике атопии и метаболического синдрома; Однако, современные литературные данные недостаточные, а порой и противоречивы по клинико – функциональным особенностям течения БА и АР, атопической триаде на фоне МС, о связи между выраженностью компонентов МС и степенью тяжести указанных патологий, уровнем сенсибилизации больных к аллергенам, степенью аллергического воспаление, не разработаны рекомендации по раннему выявлению компонентов МС у пациентов с сочетанной патологией и их лечения и профілактики; Over the last decade, the frequency of allergic diseases has significantly increased, especially in economically developed countries and countries with not good ecological situation according to the forecast of some scientists of twenty-first century will be the century of allergic diseases. Such wide-spread allergic diseases, in particular, such as bronchial asthma, allergic rhinitis, atopic dermatitis are becoming more and more urgent and serious problem year by year. The prevalence of allergic rhinitis (AR) over the past century has increased by dozens of times. In the world the population of from 10 up to 40% of all age groups suffers from AR. In 2007 compared with 2006 the incidence of allergic rhinitis in Ukraine increased by 6.5 % and is 113.0 per 100 thousand of the adult population (in 2006 – 106.1). Information about the incidence of AR in Ukraine are mainly recorded if there is appeal of patient, therefore, they do not show the true prevalence of this disease. Traditionally, the symptoms AR are paid little attention both by patients and, unfortunately, doctors. The importance of this issue is caused by the fact that AR is closely connected with such spread diseases as acute and chronic rhinosinusitis, allergic conjunctivitis, and it is also one of the risk factors of bronchial asthma (BA).Metabolic syndrome (MS), syndrome X is the pathogenetically interrelated metabolic abnormalities in the condition of a patient. There is a large complex of factors involved in the occurrence of metabolic syndrome, and this does not allow carrying out an accurate scientific understanding of its pathophysiological mechanisms. The MS prevalence among the adult population in different countries is also quite large; it reaches up to 25-35 % and starts becoming of epidemic character. This is primarily caused with a high prevalence of worldwide obesity. Obesity contributes to the development of arterial hypertension, coronary heart disease; diabetes mellitus (DM) of 2nd type, heart failures, cardiac arrhythmias, stroke, gallstones, osteoarthritis deformans, cancer of large intestine, prostate, uterus, ovaries, breast, there is a directly proportional connection between body weight and total mortality.In recent years, the attention of scientists all over the world is increasingly drawn to the problem of co-morbidities, which is one of the most difficult that doctors face. This is especially important concerning the widespread and socially significant diseases, including allergic pathology and MS.It is found out a link between changes in the living conditions of people and the incidence of allergic pathology and that improvement in living conditions contributes to the growth of not only obesity, but also of morbidity with asthma, allergic rhinitis and atopic dermatitis. This allows to consider the allergic diseases such as allergic rhinitis, as “diseases of modernization", the risk of which increases with improving nutrition and increasing the weight of the person and it is not limited only with the increasing body weight. Obesity contributes to bronchial hyperresponsiveness caused by physical loads both at BA and without it. Up to date there are a lot of controversial issues concerning to the frequent development of hypertension at patients with allergic pathology. The deterioration of bronchial obstruction at patients, who suffer from BA and AH, is often accompanied by a rise of AD, although some patients have the reducing hypertensive crises. Also there is no exact answer to the question whether the pathological process at atopy promotes the developing hyperglycemia or other factors cause possible links between BA and DM (e.g. change of compliance, level of physical activity, the impact by such children`s parents and ect. ) However, modern literary data are insufficient and sometimes they are contradictory clinical concerning to the functional characteristics of the course BA, BA and AR, atopic triadi on the background of MS , the connection between the severity of MS components and the severity of these abnormalities, the level of sensitization of patients to home and inhalant allergens, the degree of allergic inflammation, content of serum biomarkers in the blood (immunoglobulin E interleukin -4, 10), there is no developed recommendations on early detection of MS components at patients with combined pathology.Документ Метаболічний синдром в практиці сімейного лікаря(Вищий державний навчальний заклад України «Українська медична стоматологічна академія», 2015) Трибрат, Тетяна Анатоліївна; Шуть, Світлана Володимирівна; Сакевич, Вікторія Дмитрівна; Трибрат, Татьяна Анатольевна; Шуть, Светлана Владимировна; Сакевич, Виктория Дмитриевна; Trybrat, T.; Shut, S.; Sakevich, V.Актуальною проблемою в усьому світі, зокрема в Україні, залишається рання діагностика метаболічного синдрому. Саме на підвищення настороженості сімейних лікарів, на усвідомлення ними всієї серйозності наслідків і ускладнень МС спрямована освітня робота. Для відображення реальної епідеміологічної ситуації в Україні з поширеності метаболічних захворювань з метою їх профілактики та своєчасної корекції, необхідно запровадити моніторинг метаболічного синдрому; Актуальной проблемой во всем мире, в частности в Украине, остается ранняя диагностика метаболического синдрома. Именно на повышение настороженности семейных врачей, на осознание ими всей серьезности последствий и осложнений МС направлена образовательная работа. Для отображения реальной эпидемиологической ситуации в Украине с распространенности метаболических заболеваний с целью их профилактики и своевременной коррекции, необходимо внедрить мониторинг метаболического синдрома; At the present metabolic syndrome (MS) is one of the most urgent problems of medicine. The prevalence of this disease, which is characterized by a combination of many risk factors for diabetes mellitus (DM) and cardiovascular disease, causes serious concern of the medical community. Today, researchers are studying the features of metabolic syndrome among different groups of population. Modern medicine provides a great opportunity concerning the correction of metabolic disorders if timely detection and efficient MS treatment algorithm are provided. The mentioned problem is worldwide and actual, particularly in Ukraine and the early diagnosis of it is real problem. So the educational work should provide first of all the increasing attention of practitioners, the awareness of the seriousness of the consequences and complications of MS. Metabolic syndrome is a condition of high risk of cardiovascular disease. In addition, the prevalence of metabolic syndrome is increasing year by year, taking the nature of the epidemic, and it occurs on average at every fifth adult in high developed countries . Frequency and terms of MS occurrence is different depending on ethnic, age data and criteria selected for identification, the accumulation of risk factors, stages of ontogeny, the degree of genetic predisposition, state compensation systems, the severity of environmental factors. This is due to neglect the healthy lifestyle, eating rich food contained the digestible carbohydrates, overeating, constant stress and sedentary lifestyle. An effective fight against MS is possible only on condition of deep understanding of the pathogenesis of this condition and development of pathogenetic approaches to drug therapy and prevention. MS develops gradually and long runs without obvious clinical symptoms. The presence of MS can be assumed even when external examination and patient history collection. Abdominal obesity (AO) is recognized by its characteristic redistribution of adipose tissue. Patients with a similar type of obesity often (70%) have the syndrome of obstructive sleep apnea (OSA), about which patients may be unaware. The patient may mark only the presence of snoring. When the patients` history are collected the detailed survey should be done to identify the patients` complaints on daytime sleepiness, the impaired concentration and anxious, choking episodes and / or stop breathing during sleep, loud cracked snoring, nocturia, irritability and personality changes, decreased libido, indentifying the events and / or risk of accidents (fact of dozens of short sleeps during driving). Particular attention should be paid to the fact of occurring complaints or stops of breathing during sleep. If the patient cannot answer this question, you must carefully ask relatives or friends of the patient . Clinic doctor may suspect the respiratory failure during sleep using a simple survey of the patient. The most common scale for evaluation of OSA symptoms is the Epworth Sleepiness Scale . If the patient suffers for AO you should clarify in detail the history of the disease, life, heredity and take the additional measurements. This can be important not only for the diagnosis of MS, prognosis, but also for determining the treatment. Most such patients are the majority of patients with hypertension and coronary heart disease, who refer to family doctors. So it is a family doctor who should refer the patients with cardiovascular disease and obesity research in lipid profile, determination of blood glucose and, if it is necessary to refer the patient to further consultation and treatment of a cardiologist and endocrinologist. It is not difficult to identify the patients with MS, the main thing is to be attentive and indifferent to patients, continuous analysis of their condition and possible complications of existing diseases. Underestimating MS leads to negative consequences. Treatment of MS effects is much more expensive in every respect than the early detection and treatment of metabolic disorders. To reflect the current epidemiological situation in Ukraine with the prevalence of metabolic diseases with the aim of prevention and early treatment should introduce monitoring of metabolic syndrome.Документ Метаболічний синдром і здоровий образ життя(Вищий державний навчальний заклад України «Українська медична стоматологічна академія», 2017) Трибрат, Тетяна Анатоліївна; Шуть, Світлана Володимирівна; Сакевич, Вікторія Дмитрівна; Трибрат, Татьяна Анатольевна; Шуть, Светлана Владимировна; Сакевич, Виктория Дмитриевна; Trybrat, T.; Shut′, S.; Sakevich, V.В статті розглянуто особливості застосування немедикаментозних засобів лікування та профілактики щодо корекції станів, що об’єднуються терміном метаболічний синдром, відповідно до міжнародних рекомендацій та національних уніфікованих клінічних протоколів, де основними заходами є підтримання здорового способу життя ,основаного на раціональному харчуванні, спрямованого на схуднення або підтримання нормальної маси тіла ,відмова від куріння і надмірного вживання алкоголю, а також дозовані фізичні навантаження; В статье рассмотрены особенности применения немедикаментозных средств лечения и профилактики по коррекции состояний, объединяемых термином метаболический синдром, согласно международных рекомендаций и национальных унифицированных клинических протоколов, где основными направлениями являются поддержание здорового образа жизни ,основанного на рациональном питании, направленном на похудение или поддержание нормальной массы тела ,отказ от курения и чрезмерного употребления алкоголя, а также дозированные физические нагрузки; Goal – the analysis of large-scale studies has shown that among the adult population the MS is diagnosed 30% of population depending on characteristics and criteria used for the MS diagnosis (metabolic syndrome) Social importance of the MS problem is associated with the increased educational activity in patients` surroundings, necessity of implementation of the main principles of primary prevention of obesity and diabetes especially among children and young people, promotion of healthy diet principles, the increased role of physical culture and sports. Therapeutic interventions in the treatment of MS patients should be directed to the main elements of the pathogenesis of this syndrome, namely the reduction of body weight, the optimal level of blood pressure (BP), metabolic control, prevention of acute and remote cardiovascular complications. Despite the large number of studies devoted to the problem of obesity treatment, lots of the ways of reducing excess weight, this task remains extremely complicated and requires great effort both the doctor and the patient. Nowadays it is stated that the only thing that really leads to a reduction fat mass is an energy deficit or another words - predominance of energy consumption over its receipt. Therefore, non-pharmacological interventions aimed at the creation of this deficit are of priority importance in the treatment of obesity. Patients should be aware that currently there is no drug that is able completely eliminate the health risks associated with obesity, but at the same time, the change in lifestyle can prevent the progression of metabolic disorders and seriously reduce the risk of complications. The treatment of obesity, as well as treatment of any chronic disease must be continuous – without any break. After reaching the weight loss the efforts of the doctor and patient should be directed to maintain the effect and prevent relapses of disease. Activities aimed at reducing the weight and maintaining the achieved result should include: a balanced diet, explaining to patients about proper way of living with changing eating habits, keeping a food diary and doing exercises. Reduction of body weight by 5-10% over 6-12 months (optimal reduction is considered to be 2-4 kg, but not more than 5 kg per month) is accompanied by a reliable reduction of the risk to health and feasible for most patients. For the compilation of a balanced diet it is necessary to calculate the number of calories allowed to consume per day based on individual energy consumption. And based on the daily calorie norm it is possible make the menu for the day (reducing caloric intake should be achieved the mainly due to reducing fat and partially at the expense of carbohydrates). Staff in primary health care system must take into account the emotional and personal characteristics of the patient at prescribing and making the individual diet programs to prevent the instability of interest of treatment, give practical advice taking into account cultural, religious, ethnic and economic standards. Physical exercising (workout) is an important component of recommendations to change lifestyle. At the stage of body weight reduction doctors add another food to the reduced calorimety diet and allow having a negative energy balance. Under the influence of loads of moderate intensity insulin sensitivity is improving, triglycerides is reducing, HDL cholesterol is increasing, the functional reserves of the cardiovascular and respiratory systems are improving. At the maintenance stage the physical activity becomes even more important being one of the main prognostic factors in maintaining the desired weight. Before the start of physical exercising it is necessary to assess the patient's tolerance to physical loads using veloergometry or treadmill test. It is especially important to carry out a load test if there is coronary heart disease (CHD), when a patient is after the age of 40 and after the age of 30 with risk factors such as IHD, hypertension, DM, smoking and dyslipidemia. To reduce body weight (maximum energy reduction) aerobic exercises are shown, which are continuous rhythmic exercises and involve large muscle groups for quite a long time, increasing the heart rate. The most common varieties of aerobic exercise is the so-called cyclic kinds of sport: walking, swimming, running, skating, skiing, cycling, tennis, basketball, dancing and fitness. Therefore, the main measures of non-pharmacological MS treatment is to maintain a healthy lifestyle based on a diet aimed at weight loss or maintenance of normal body weight, giving up smoking and excessive alcohol consumption, and also dosed exercising with the support of a doctor or nutritionist.