Andrii Kuzminets

Disorders of gut-brain interaction (DGBI), including irritable bowel syndrome and functional constipation, are common conditions with an estimated global prevalence of 4.1 and 11.7 %, respectively. Most patients identify food as the primary trigger of their symptoms, making dietary interventions the cornerstone of DGBI management. This article reviews current dietary approaches in DGBI. General healthy diet advice, such as guidelines issued by the National Institute for Health and Care Excellence and the British Dietetic Association, serves as a first-line therapy. The low-FODMAP diet (LFD), in turn, is used as a second-line strategy for patients with persistent symptoms. The role of dietary fiber is also examined, with psyllium being the only supplement to demonstrate consistent clinical efficacy in irritable bowel syndrome. LFD follows a structured three-phase protocol encompassing a restriction phase, reintroduction, and dietary personalization. Meta-analyses confirm its superiority over other dietary interventions in reducing general symptoms, abdominal pain, and bloating. Long-term studies indicate that 57–67 % of patients achieve sustained symptom relief when adhering to a personalized LFD over a period of 6–12 months. It should be emphasized that such dietary interventions require gui­dance from a qualified dietitian, and that an individualized approach is key to achieving lasting therapeutic outcomes. The purpose was to review and summarize current evidence on the effectiveness of medi­cal nutrition therapy in common disorders of gut-brain interaction, particularly irritable bowel syndrome and functional constipation.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in the world, which determines the relevance of studying the characteristics of cardiovascular risk and the course of cardiac conditions at the present stage. For a long time, bias regarding the development and clinical manifestations of CVD in women hindered timely diagnosis, prevention and treatment. At the same time, the modern concept of personalized medicine contributed to the revision of the role of sex as a set of biological factors and gender as a complex of social and psychological determinants in the formation of cardiovascular risk throughout the human life cycle. The purpose of this review is to summarize current scientific data on the sex and gender characteristics of cardiovascular risk. An analysis of review and original scientific publications in the PubMed and Google Scholar databases of recent years was conducted using systematic literature analysis methods. It has been found that traditional risk factors, in particular hypertension, dyslipidemia, diabetes mellitus, smoking and obesity, affect men and women differently. Hormonal mechanisms, endothelial dysfunction and cardiometabolic disorders, which are considered leading factors, play an important role in the formation of differences. The problems of insufficient awareness of modern cardiometabolic risk factors remain relevant. The role of hypertension as a modifiable factor in the formation of cardiovascular risk and its consequences is emphasized. In addition to biological factors, the role of gender-based socio-economic and cultural aspects is crucial for the development of CVD. Special attention is paid to the impact of full-scale military aggression in Ukraine, which is accompanied by chronic psychosocial stress, lifestyle changes and limited access to medical care, enhancing the negative impact of cardiovascular risk factors. The implementation of screening programs, increasing the availability of modern treatment methods and a personalized approach to patient management are remarkable in preventing cardiovascular disasters. Thus, sex and gender differences have a significant impact on cardiovascular risk, clinical manifestations, and CVD outcomes. The implementation of a personalized approach, the development of gender-oriented prevention strategies, and further prospective studies remain a promising direction, particularly in the context of modern social challenges.

Background. The increasing pace of modern life, the pandemic, the war in Ukraine, the presence of somatic pathology and mental states are interconnected and have a direct cause and effect relationship. Psychological distress is often experienced as physical symptoms. Psychotherapeutic and psychocorrective methods recommended by the Rome Committee have become the standard of therapy for patients with functional gastrointestinal disorders or, according to modern terminology, disorders of the gut-brain interaction (DGBI). In adjustment disorders and many neurotic disorders against the background of chronic distress, psychocorrection, cognitive behavioral and other types of psychotherapy play an important role in addition to pharmacological correction. The method of biosuggestive therapy (BST) is the successor of hypnotherapy in Ukraine and, as an effective non-pharmacological psychocorrective approach, has recently gained considerable popularity in the correction of psychological disorders. The goal of our research was to analyze all publications available in 2023 on the experience of using and the results of the effectiveness of the BST as a method of intestinal-directed therapy, and in other clinical situations researched and published in the scientific literature. Discussion. As a result of our analysis, 21 works were selected that were presented in Ukrainian and foreign publications regarding the effectiveness of the biosuggestive therapy. When BST is used in patients with functional gastrointestinal disorders or DGBI, a decrease in the manifestations of the disease was noted in addition to a decrease in the severity of mental disorders. In forcibly displaced persons from the ATO zone and during military operations in Ukraine, the use of BST in chronic pain led to a decrease in symptoms of anxiety and depression, the level of stress and an increase in general well-being in stress-related conditions. The BST showed a reduction in behavioral disorders in children and adults. Conclusions. The BST method can be used to correct various psychosomatic and stress-related disorders, combined with functional and chronic diseases, endocrine pathology, behavioral problems of childhood and adolescence. The use of BST as a branch of gut-directed hypnotherapy needs further research with regard to different manifestations of DGBI, which will be presented in the near future.

Background. Intestinal dysbiosis is associated with violating both quantitative and qualitative intestinal microbiome (IM) composition. It accompanies different gastrointestinal disorders, including non-celiac gluten sensitivity (NCGS) and celiac disease (CD). A gluten-free diet is the only existing treatment for CD and NCGS. One of the questions of interest is the characteristics of the IM of patients with gluten-related diseases and its relationship with diet therapy. Materials and methods. The study included 25 adults, 14 (56 %) with CD and 11 (44 %) with NCGS; all were on agliadin diet. We determined the faecal content of the Bacteroidetes, Firmicutes, and Actinobacteria and the rest bacterial DNA (“other” indicator) using the real-time polymerase chain reaction. Results. The Bacteroidetes content was 28.4 (Q1-Q3 9.195–37.83) % in CD and 24.98 (Q1-Q3 9.615–30.597) % in NCGS patients, p = 0.565. Firmicutes content was 53.47 (Q1-Q3 49.98–56.798) % in CD patients and 53.0 (Q1-Q3 48.12–68.53) % in NCGS, p = 0.763. The Actinobacteria content was 4.8 (Q1-Q3 3.82–6.84) % in CD patients and 5.37 (Q1-Q3 4.09–7.77) % in NCGS, p = 0.572. There was a moderate positive correlation with the diet duration (p = 0.397, p = 0.03). The Firmicutes/Bacteroidetes ratio was 1.996 (Q1-Q3 1.35–6.85) in CD patients and 2.0 (Q1-Q3 1.65–7.58) in NCGS patients, p = 0.681. The content of “other” types of IM was 15.39 (Q1-Q3 7.44–22.33) % in CD patients and 13.78 (Q1-Q3 10.65–15.58) % in NCGS patients, p = 0.936. Conclusions. We found similar intestinal microbiome features in patients with celiac disease and non-celiac gluten sensitivity. The detected intestinal microbiome changes are most likely to be a consequence of dietary features in such patients, namely the side effect of maintaining an agliadin diet.

Актуальность. Железодефицитная анемия (ЖДА) — это наиболее частый внекишечный симптом при целиакии у взрослых. Исследований наличия или отсутствия железодефицита, в том числе скрытого, у пациентов, имеющих как целиакию, так и непереносимость глютена без цели­акии (НГБЦ), ранее в нашей стране не проводилось. Цель исследования: изучить и проанализировать общеклинические и биохимические показатели крови, отражающие наличие анемии и/или железодефицита у больных целиакией и непереносимостью глютена без целиакии, находящихся на АГД. Материалы и методы. В исследование были включены 38 взрослых с диагностированными ранее основными видами непереносимости злаков — целиакией и НГБЦ. Все они находились на диете с полным исключением глютена. Всем исследуемым определялись гематологические показатели: общая железосвязывающая способность сыворотки, содержание эритроцитов, гемоглобина, ферритина, железа и трансферрина крови. Результаты. В результате обследования 38 пациентов, находящихся на аглиадиновой диете продолжительностью 6,5 (IQR 4–12) года, выявлено наличие ЖДА легкой степени у 13,16 % обследованных, при этом латентный железодефицит выявлялся у 18,42 % обследованных. Снижение концентрации сывороточного железа крови отмечено у 23,08 % больных общей группы, но частота железодефицита (в том числе латентного) в обследованной группе по анализу показателей концентрации сывороточного ферритина достигла 31,58 %, превалируя над частотой выявления ЖДА почти вдвое. При этом содержание эритроцитов было нормальным у 100 % обследованных. Среди пациентов с железодефицитом лица с целиакией встречаются чаще, чем среди пациентов с НГБЦ (83,3 и 16,7 % соответственно). Выводы. Больные целиакией и НГБЦ остаются в группе риска по развитию ЖДА, несмотря на то, что они находятся на аглиадиновой диете. Изолированный показатель эритроцитов не является информативным для диагностики не только скрытого железодефицита, но и ЖДА. Изолированный сывороточный уровень железа также не является показательным для диагностики данных состояний. В этом отношении именно ферритин становится наиболее показательным маркером железодефицита. Необходимо целенаправленное наблюдение за этой группой больных с целью выявления скрытых форм микронутриентного дефицита, в частности железа, и осуществления обоснованной, индивидуализированной коррекции их последствий.

Faecal calprotectin (FC) level can be increased in several conditions, which are characterised by neutrophilic inflammation. Some medications, particularly NSAIDs, can elevate its level as well. NSAIDs are taken by patients in many chronic conditions, including osteoarthritis (OA).On the other hand, there is growing evidence that osteoarthritis is not only a degenerative disease, but it has a significant inflammatory component. The role of systemic inflammation is well-known in inflammatory joint diseases, but there is some evidence that it can play an essential role in the OA as well. It can suggest that in the OA, the inflammatory changes could be found in the different organs and systems.The aim of this study was to investigate the FC level in patients with osteoarthritis depending on the NSAIDs intake and to compare it to the FC levels in healthy adults.Materials and methods. In this small observational study, we evaluated the FC levels in patients suffering from OA (36 persons), divided them into two groups depending on their NSAIDs intake, and compared it to FC levels in healthy participants (12 persons). We compared the FC levels depending on the selectivity of the NSAIDs taken by our participants, as well.Results. The median calprotectin level in our patients was 72.57 (IQR 20.55-221.57) mg/kg, 95 %CI 26,18-109.01. OA patients had higher levels than the healthy group (p0.05).Conclusions. Patients who suffer from OA have higher FC levels than healthy individuals, and patients with OA who take NSAIDs regularly have higher FC levels than those who do not. The intake of non-selective NSAIDs is associated with higher FC levels, than the intake of high-selective NSAIDs. FC levels of those who take high-selective NSAIDs do not differ statistically from those who do not intake NSAIDs. Further research is needed in this area.

The purpose of this study is to scrutiny the Dynamics of heart rate variability (HRV) in patients with PICS with 2nd type DM against the background of Taurine (TN) and meldonium (ME). The results of the investigations prove the decrease of the oxidative stress, which is basis of DACN, under the influence of sulfur-containing amino acid taurine (TN), and meldonium (ME) - a competitive inhibitor of gamma-butyrobetaine hydroxylase. Biochemical mechanisms of synergistic action of ME and TN are also described. The results of the studies of 98 patients with PICS and concomitant 2nd type diabetes mellitus were analyzed. They were distributed by simple randomization method into two groups, comparable according to age and sex: the main group (MG) (n = 68): and group of comparison (GoC) (n = 30). HRV was evaluated twice daily at the Cardiosense HMEGG system: at baseline and after 12 weeks of treatment. For the assessment of HRV the frequency and spectral parameters were used. While evaluating the different methods of treatment, their influence on the range of spectral and time indices of HRV was determined (p = 0.001 by the criterion of Kruskall-Wallis). It was learned that the combined application of ME and TN gives a statistically significant (p <0.01) increase of SDNN, HF at night, pNN - on 50% by day (p <0.01, p <0.001 and p <0.01 respectively), and statistically significant decrease in LF at night, compared to GHG.

Изучение кишечного микробиома является очень актуальной темой, популярной среди исследователей. По ней проводится большое количество исследований. В настоящее время высокими темпами растет количество данных относительно кишечного микробиома человека как в здоровом состоянии, так и при различных патологических состояниях. С ростом накопленных данных расширяется понимание того, что микробиом является весьма сложной системой, части которой находятся в тесных взаимоотношениях с организмом хозяина, а также реагируют на факторы окружающей среды, в том числе на рацион питания и лекарства. Исследователи находят все больше данных относительно взаимного влияния приема медикаментов, кишечной микрофлоры и внекишечных заболеваний. Cтатья посвящена обзору данных, имеющихся в современной литературе, об особенностях состояния кишечной микрофлоры у больных остеоартритом, ее возможному влиянию на патогенез данного заболевания, а также изменениям, которые возникают в микробиоме на фоне лечения остеоартрита, в частности с помощью нестероидных противовоспалительных препаратов.