БАНКИ З ДЕРЖАВНОЮ УЧАСТЮ В УКРАЇНІ: ПРИЧИНИ ВИНИКНЕННЯ ТА ФУНКЦІЇ

The research defines the importance of state-owned banks for socio-economic growth ofUkraine; it also outlines the international experience of state share in the national banking systems and possible reasons for its appearance and existence. The lack of the unified approach to the classification of the state-owned banks functions has been revealed.It is suggested to consider the reasons for the dominance of the state share in the Ukrainian banking system both from the point of view of external (historical prerequisites, market demand and necessity to perform non-specific functions) and internal (preventing the bankruptcy of system significant banks, the impact of the national and / or international financial and banking crisis) reasons. The changes in the total number of banks and state-owned banks as well as the shares of state-owned banks assets in the total volume of assets of the banking system for 2005-2017 were analyzed. It was revealed that during the 2015-2017 years, the share of state property in Ukrainian banks was expanded.The author’s interpretation of the state-owned banks functions is suggested (promotion of innovation economy, compensation of market mechanism deficiencies, ensuring economic security of the state, activating the development of small and medium businesses). The positive consequences  (the impact on the socio-economic situation in the country, the impact on the development  of the real sector of the economy, the implementation of the state economic and innovation policy, much higher stability and high profitability of banks with state share, a barrier for a risky increase in the presence of foreign capital) and the negative ones (possible misuse of public funds, significant influence of the country's political elite on the management of the bank with the state participation, creation of certain advantages for some participants in the banking market in relation to the others ) of the state property significant share in the banking system are dwelt upon. The necessity of the state-owned banks management national reform is emphasized.В исследовании определена значимость банков с государственным участием в социально-экономическом росте Украины. Рассмотрены существующие в мировой практике причины появления государственного капитала в банковской системе. Выявлено отсутствие унифицированного подхода к классификации функций банков с государственным участием. Обоснованно причины доминирования государственной доли собственности в банковской системе Украины. Приведено авторское толкование функций банков с государственным участием; выделены положительные и отрицательные последствия доминирующей доли государственной собственности в банковской системе. Отмечена необходимость реформирования системы управления банков с государственным участием в Украине.Визначено значущість банків з державною участю в соціально-економічному зростанні України. Розглянуто причини появи державного капіталу вбанківській системі, які існують у світовій практиці. Виявлено відсутність уніфікованогопідходу до класифікації функцій банків iз державною участю.Обґрунтовано причини домінування державної частки власності в банківській системіУкраїни, які поділяють на зовнішні (екзогенні) щодо банків (історичні передумови танеобхідність виконання специфічних функцій, не властивих приватним банкам) і внутрішні(ендогенні) причини (недопущення банкрутства системно важливих банків, вплив кризовихявища на банки). Проаналізовано зміни в загальній чисельності банків і банків із державноюучастю, а також частки активів банків із державною участю в загальному обсязі активівбанківської системи за 2005-2017 рр. Виявлено, що упродовж 2015-2017 рр. відбулосярозширення частки державної власності в банках України.Наведено авторське тлумачення функцій банків із державною участю (сприяннярозвитку інноваційної економіки, компенсація недоліків ринкового механізму, забезпеченняекономічної безпеки держави, активізація розвитку малого і середнього бізнесу);виокремлено позитивні (вплив на соціально-економічну ситуацію у країні, вплив на розвитокреального сектору економіки, реалізація державної економічної та інноваційної політики,значно вища стабільність і висока рентабельність банків із державною участю, бар’єр дляризикованого збільшення присутності іноземного капіталу) і негативні (можливе нецільовевикористання державних коштів, значний вплив на управління банком з державною участюполітичної еліти країни, створення певних переваг для одних учасників банківського ринкущодо інших) наслідки домінуючої частки державної власності в банківській системі.Наголошено на доцільності реформування системи управління банків із державною участю вУкраїні

Experience of long-term use of anti-IgE therapy in a patient with chronic spontaneous urticarial

Chronic spontaneous urticaria is an urgent health problem. Recurrent urticarial rashes, angioedema and severe itching reduce the quality of life of patients. The ineffectiveness of standard therapy requires the search for new modern methods of treating this disease. Taking into account the current data on the pathogenesis, the third line of therapy for chronic spontaneous urticaria is the addition of anti-IgE therapy (omalizumab) to antihistamines of the 2nd generation. The presented clinical case is devoted to the experience of long-term use of omalizumab in a patient with chronic spontaneous urticaria. Having a disease duration of about a year, the patient was thoroughly examined, all concomitant diseases were identified and compensated, parasitic invasion was treated, but this did not lead to a regression of symptoms. Antihistamines of the 2nd generation in standard and increased doses (up to 4 times) did not control the disease, systemic glucocorticosteroids stopped the symptoms for a short time, and therefore, in  the future, the  patient began to use them independently and uncontrollably. Almost daily use of  corticosteroids for 6 months caused the development of complications in the form of weight gain and Cushing’s syndrome. Omalizumab completely stopped all the symptoms during the first day, no side effects were detected. The clinical effect lasted from 3 to 4 weeks. Thus, omalizumab therapy allowed the patient to almost completely get rid of the symptoms of CSC, which significantly improved the quality of life and made it possible to cancel systemic glucocorticosteroids. The peculiarity of the presented case is the duration of the use of omalizumab (more than 2 years) with the inability to cancel due to the return of urticarial rashes and itching

Features of cellular structure of the induced sputum and profile of cytokines at sintropiya of bronchial asthma and obesity at young patients

Aim. To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. Materials and methods. 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. Results. There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. Conclusion. Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient

Free-radical oxidation as a pathogenetic factor of metabolic syndrome

The medical and social significance of cardiovascular diseases remains high. One of the factors that determine cardiovascular risks is metabolic syndrome. As a result of excessive accumulation of lipid and carbohydrate metabolism products in metabolic syndrome, oxidative (oxidative) stress develops. The article considers both domestic and foreign scientific studies, which highlight various aspects of the influence of reactive oxygen and nitrogen species, as well as other free radicals on the formation of oxidative stress in pathological conditions that are part of the metabolic syndrome complex. This describes the mechanisms of the formation of chronic inflammation through excessive secretion of pro-inflammatory cytokines and adipokines, activation of the transcription factor NF-kB, as well as damage to the antioxidant system in obesity. Separately, a number of mechanisms of the stimulating effect of adipokines: leptin, adiponectin, chimerine, omentin 1, resistin, on the formation of oxidative stress have been noted. The ways of activating the polyol pathway, as well as diacyl-glycerol — protein kinase C — the signaling pathway of oxidative stress, the formation of mitochondrial dysfunction is described. As a result of which there is an excessive production of free radicals in insulin resistance, diabetes mellitus and macroand microvascular complications of diabetes. In addition, the influence of oxidative stress directly on the formation of cardiovascular diseases of atherosclerotic genesis, as well as arterial hypertension, has been shown

Experience with the triple fixed combination in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the most important problems of modern medicine associated with a high mortality rate, high costs of treatment and relief of exacerbations of COPD. The main objectives of COPD treatment are symptom control, reduce the frequency of exacerbations and hospitalizations, and reduced risk of exacerbation in the future. The recommendations of the GOLD initiative propose a treatment approach based on the assessment of exacerbation rates external respiratory function indicators (spirometric classification of GOLD), the severity of symptoms assessed on the CAT test and mMRC. When choosing therapy, the physician must first of all take into account the effectiveness, safety of the drug, adherence to treatment in order to achieve the therapeutic goals of treating patients with COPD. The change in therapeutic approaches in COPD treatment is associated with the accumulation of knowledge in physiology, clinical pharmacology, and the isolation of new clinical phenotypes of COPD. Currently, the main classes of drugs for the treatment of COPD are long-acting beta-agonists (LABA), longacting anticholinergics (LAMA), and inhaled glucocorticosteroids (ICS). The evolution of therapeutic approaches in COPD treatment has led to the creation of new fixed inhalation combinations of the main groups of drugs for COPD treatment. The therapeutic strategies recommended by GOLD and the Russian Federal Guidelines determine the long-term goals of COPD treatment – the impact on the risk of exacerbations in the future. The presented clinical observation of a patient with severe COPD demonstrates the effectiveness of a triple fixed combination vilanterol/umeclidinium/fluticasone furoate 55/22/92 μg as a basic therapy. The  chosen treatment strategy not only reduces the  severity of  the  symptoms of  the  disease, but also reduces the  risk of exacerbations in the future

Роль катепсина S в патофизиологии бронхиальной астмы

To date, the study of the role of proteases in the pathogenesis of various diseases remains relevant. The variety of cathepsin functions is associated with the peculiarities of their localization, expression, and regulation, due to which cathepsins are involved in development of many pathologies. Dysregulation of proteases, their inhibitors, and substrates can lead to the development of multiple organ dysfunction.The review presents data on the characteristics of the entire family of cathepsins and cathepsin S, in particular. The pathophysiological role of cathepsin S in the formation of bronchopulmonary pathologies, as well as in bronchial asthma is described, and intraand extracellular implementation mechanisms are considered. The authors believe it is this enzyme that could be targeted in targeted asthma therapy to prevent airway wall remodeling at the earliest stages of the disease. The literature search was carried out in the search engines Medline, eLibrary, Scopus, the Cochrane Library, and RSCI.До настоящего времени сохраняет свою актуальность изучение роли ферментов – протеаз в патогенезе различных заболеваний. Многообразие функций катепсинов обусловлено особенностями их локализации, экспрессии и регуляции, благодаря чему они принимают участие в развитии многих патологических процессов. Дисрегуляция активности протеаз, их ингибиторов и субстратов может привести к развитию полиорганных заболеваний.В обзорной статье представлены данные о характеристике всего семейства катепсинов и катепсина S в частности; описаны его патофизиологические роли при формировании бронхолегочных патологий, а также при бронхиальной астме; освещены внутрии внеклеточные механизмы реализации. Авторы считают, именно этот фермент может стать мишенью для таргетной терапии астмы с целью предотвращения ремоделирования бронхиальной стенки на самых ранних этапах заболевания. Поиск литературы осуществлялся в поисковых системах Medline, еLibrary, Scopus, The Cochrane Library, РИНЦ

Клиника и лечение бронхиальной астмы, сочетающейся с патологией сердечно-сосудистой системы

The purpose of research - to study cardiovascular diseases frequency in patients with bronchial asthma (BA), the influence of cardiovascular disease on clinical course and severity of BA, the role of base and symptomatic therapy, to evaluate quality of diagnostics and treatment of cardiovascular disease in patients with BA. The date of patients register BA in Krasnoyarsk (2005) was analyzed - 5 104 patients. The frequency of occurrence of BA with cardiovascular pathology is high and amounts to 88,3%. Small number of patients with severity course of BA - 55%, middle severity stage - 44%, invalidity - 64%. It was revealed, that cardiovascular pathology appears against a background BA. The part of patients with cardial pathology before BA diagnostics had therapy, influenced on hyperactivity and this therapy assisted in forming and worsening of asthma. Base therapy of BA in most cases did not correspond to severity stage of asthma and recommendations of GINA. The absences of symptom control is bound up with unregular research functional lung ability and with insufficient attention to diagnostics and treatment accompanied pathology of cardiovascular organs. Not only adequate therapy but study of patients with the purpose of complex realization of recommendation, decrees of risk factors and treatment of accompanied pathology is necessary for improvement of asthma control, decrease of exacerbation number, unplanned visits of doctor and calls to emergency.Цель исследования - изучить частоту встречаемости заболеваний сердечно-сосудистой системы (ССС) у больных бронхиальной астмой (БА), влияние заболеваний ССС на течение и степень тяжести БА, роль базисной и симптоматической терапии; оценить качество диагностики и лечения ССС у больных БА. Проанализированы данные регистра больных БА г. Красноярска за 2005 г. (5 104 пациента). Частота встречаемости БА в сочетании с патологией ССС высока и составляет 88,3%. Наибольшее количество больных с тяжелым течением БА - 55%, средней степени тяжести - 44%, имеющих группу инвалидности - 64%. Выявлено, что патология ССС чаще регистрируется уже на фоне имеющейся БА. У части больных терапия кардиальной патологии до диагностики БА включала препараты, влияющие на гиперреактивность, и могла способствовать формированию или обострению астмы. Базисная терапия БА в большинстве случаев не соответствовала степени тяжести астмы и рекомендациям GINA. Отсутствие контроля симптомов также связано с нерегулярным исследованием функциональной способности легких и с недостаточным вниманием к диагностике и лечению сопутствующих заболеваний органов ССС. Для улучшения контроля астмы, уменьшения количества обострений, неплановых визитов к врачу, вызовов скорой медицинской помощи необходимо не только назначение адекватного лечения, но и обучение пациентов с целью достижения комплаенса в выполнении рекомендаций, устранение факторов риска, провоцирующих обострение БА, и лечение сопутствующей патологии

Common variable immunodeficiency disorder: a clinical case

Primary immunodeficiency is a rare congenital pathology associated with failure of immune system, manifested by disturbances of its functions. These defects lead to increased susceptibility of patients to various infectious agents, as well as the development of autoimmune, malignant and other diseases. Primary immunodeficiency is classified as a rare disease, which was previously associated with a poor prognosis with a high risk of mortality in childhood. To date, the emergence of highly effective treatment methods has changed the course and prognosis of these diseases. Clinicians of various specialties increasingly meet with this pathology in everyday practice, including adult age cohorts. In this regard, early diagnosis of primary immunodeficiency in adults becomes relevant, being associated with choosing optimal therapy, prevention of severe internal organ damage, determination of management strategy for the patient, as well as the need to identify inherited disorders and provide information to the patient’s family. Delayed verification of the diagnosis may cause disability of the patient and development of irreversible, often fatal complications. This article presents our own clinical case with a newly diagnosed clinical condition: Common variable immunodeficiency disorder (CVID), the most common form of primary immunodeficiency in adults. The symptoms of common variable immunodeficiency disorder appear in these patients in adulthood, but a high-quality collected history of the disease will allow you to trace symptoms in the patients even since early childhood. There is a common gap for several years between the onset of the disease and clinical diagnosis, since erroneous diagnosis is often made due to non-specific clinical symptoms that resemble other, more frequent diseases. The prognosis of patients with CVID depends on several factors: frequency of infections, structural disorders in the lungs, the occurrence of autoimmune diseases and the success of infection prevention. Thus, a variety of clinical forms of primary immunodeficiency, lack of awareness of doctors about this pathology, complexity of immunological examination in the general medical network lead to the fact that CVID is not diagnosed for long terms, and patients do not receive the necessary pathogenetic therapy. There is a need for drawing attention of doctors of various disciplines to the fact that the recurrent inflammatory processes of various localization, which are difficult to respond to adequate traditional therapy, may be caused by changes in the immune system, including congenital, genetically determined immunodeficiency