УДК: 616.33/.34-005.1-02-073.48-08

Hemosuccus pancreaticus (НР) є небезпечним для життя станом, і його слід враховувати у пацієнтів з болем у животі, шлунково-кишковою кровотечею та високим рівнем амілази в сироватці крові. Різноманітність проявів HP та обмеженість літературних даних через його рідкість ускладнюють діагностику. Діагностичні методи включають КТ з контрастуванням, ендоскопічні процедури, такі як езофагодуоденоскопія та ендоскопічна ретроградна холангіопанкреатографія, і ангіографію. Терапевтичне втручання за допомогою інтервенційного радіологічного підходу з використанням спіральної емболізації є безпечним та ефективним у гемодинамічно стабільних пацієнтів із НР. Ендосонографія може бути інноваційним підходом до діагностики та лікування пацієнтів, яким неможливо ввести контрастну речовину; однак його безпека та ефективність мають бути підтверджені майбутніми дослідженнями. У цьому огляді наведені сучасні погляди на діагностику і лікування хворих із hemosuccus pancreaticus.

Abstract. Background. Liver steatosis is a common condition that can progress to steatohepatitis, fibrosis,  and cirrhosis and increases the risk of death from cardiovascular and liver complications. Understanding the  link between steatosis and non-alcoholic fatty liver disease, obesity, and gut microbiota is essential. Recent  studies have revealed that gut microbiota plays a crucial role in developing this condition, highlighting the  importance of microbiota control. The purpose of the study was to detect changes in gut microbiota and new  markers associated with hepatic steatosis in obese patients. Materials and methods. The study involved  60 men aged 38 to 65, divided into two groups: 32 patients with hepatic steatosis (experimental group) and 28  with no steatosis (controls). As part of the study, the levels of the lipogram were determined, anthropometric  measurements were made, a bioimpedance analysis of the body was performed, as well as liver ultrasound and  shear wave elastography. The gut microbiota of all participants was also examined using sequencing techno- logies (material collected from stool samples). Results. In the experimental group, there are significantly more  patients with overweight, dyslipidemia (hypercholesterolemia, triglyceridemia, high low-density lipoproteins,  high atherogenicity coefficient, and low high-density lipoproteins). Also, patients with hepatic steatosis are more  likely to have an excessive percentage of fat and an excessive amount of visceral fat, hepatomegaly due to  the craniocaudal size of the liver, and increased liver stiffness. Regarding the intestinal microbiota, there is an  increase in bacterial groups belonging to the Bacteroidetes. Our analysis showed that specific markers such  as body mass index, blood lipid profile, body fat percentage, and liver ultrasound parameters are essential for  diagnosing steatosis. Body mass index above 24.9 kg/m2 and increased waist circumference were associated  with steatosis. Bioimpedance analysis parameters, including body fat percentage and relative visceral fat level,  were also crucial indicators. Dyslipidemia, with increased levels of total cholesterol, triglycerides, low-density  lipoproteins, high atherogenicity coefficient, and lower high-density lipoproteins, was related to steatosis. The  liver stiffness was significantly higher among patients with steatosis, indicating additional risk of liver fibrosis.  Shear wave elastography can be a valuable tool for detecting liver steatosis. Conclusions. Patients with steato- sis were characterized by signs of obesity (increased waist circumference, body mass index) and dyslipidemia,  higher percentage of adipose tissue, relative amount of visceral fat, craniocaudal liver size, liver stiffness, and  low levels of high-density lipoproteins. An increase in the gut microbiota of bacterial groups belonging to the  Bacteroidetes has been observed. Keywords: obesity; liver steatosis; intestinal microbiota

УДК: 616–057:61:378

Introduction. Occupational diseases are those that result from exposure to unfavorable, harmful, or dangerous factors in the production environment and work process. These factors can directly or indirectly cause health disorders in employees. Professional pathology has long been and continues to be a crucial component of a physician's comprehensive training, culminating in the attainment of a master's degree. The primary objective of the occupational diseases learning curriculum is to instruct students in the techniques of patient examination, diagnosis, and treatment of prevalent occupational ailments, as well as in organizational strategies to prevent their occurrence, and the principles of professional selection and labor examination. It is essential to maintain vigilance in identifying and addressing occupational diseases in patients. Doing so will not only help in addressing medical concerns related to prevention and the escalation of severity among working individuals, but also in mitigating social and economic issues. These include preserving the productivity of the nation's workforce and reducing the need for social benefits due to work incapacity. Given the unpredictable nature and life-threatening potential of certain pathologies, it is imperative that doctors across all specialties possess knowledge about the clinical aspects, specific diagnostic features, and treatment of occupational diseases. Mastering the discipline "Occupational diseases" involves obtaining certain competencies by students.

The aim of the study. To investigate the problem of teaching the discipline "Occupational diseases" at Danylo Halytskyi Lviv National Medical University.

Materials and methods. The analysis of the number of hours allocated to the average statistical group of students during the period since 2005 till 2023 at Danylo Halytsky Lviv National Medical University has been conducted.

Results. During period under investigation, there was a threefold decrease in the total number of hours, as shown in graph 1. The maximum number of academic hours - 48 - was documented in academic year 2009-2010, and the minimum - 16 - was in 2022-2023. The number of academic hours allocated for practical classes has also undergone significant changes, as depicted in graph 2. The number of practical hours is calculated for one academic group. The decline in the number of hours for practical classes corresponds to the decrease in the total number of academic hours in the discipline "Occupational diseases" for the specified period. During this period, the hours for writing and processing the medical history of a patient with symptoms of an occupational disease were reduced. Academic hours for the lecture presentation of the material were also significantly reduced: the maximum hours per student group was 18 – in academic year 2005-2006, and till academic year 2013-2014 it was reduced threefold. The indeces for academic year 2023-2024 are similar to those of the period 2022-2023.

Conclusion. Occupational diseases have been and continue to be a significant issue within the healthcare system, not only in Ukraine, but worldwide, in terms of both morbidity and mortality rates. Given the efficient functioning of industries with unfavorable or harmful working conditions, there is little chance for a rapid decrease in these indeces. Between the academic years 2005-2006 and 2023-2024, there has been a notable reduction in the total number of academic hours and hours allocated for lectures and practical classes in the discipline "Occupational diseases." Furthermore, there has been a complete absence of hours allocated for writing the history of the disease for almost a decade. This concerning trend, despite the acquisition of relevant knowledge and skills, significantly limits the amount of processed information at the master's level of education. We believe that improving the "Occupational diseases" syllabus can be achieved by engaging various didactic mechanisms into the learning curriculum for this discipline. This improvement requires an increase and a fixed number of academic hours to support the professional growth of students in higher education, particularly those in the field of 22 "Healthcare" and the specialty of 222 "Medicine".

УДК: 616.33–089:616.71–007.234]–06–055.1–008.9

Introduction. The problem of osteoporosis (OP) has become an epidemic unprecedented in its scale. Numerous studies of various aspects of OP leave out men with a history of gastric resection (GR) as a result of complicated peptic ulcer disease (PUD). Therefore, a detailed characteristics of clinical parameters and hormonal and metabolic homeostasis in men with postgastric resection disease (PGRD) and comorbid OP will allow the improvement of the treatment and prevention of osteodeficiency conditions in this category of patients.

The aim of the study. To characterize clinical parameters and hormonal and metabolic homeostasis in men with postgastric resection disease and comorbid osteoporosis.

Materials and methods. 164 men with PGRD and comorbid OP were examined with preliminary random stratification by the presence of a history of five or more years of GR surgery as a result of complicated PUD. In addition to routine examinations, hormonal homeostasis was studied by the effect of hormones on protein metabolism: anabolic (growth hormone, parathyroid hormone, gastrin, and testosterone) and catabolic (triiodothyronine, thyroxine, glucagon, and cortisol) hormones and cyclic nucleotides. Plasma electrolytes and protein profile were also analyzed.

Results. It was established that the vast majority of patients who underwent the surgery with PGRD and comorbid OP have clinical signs of calcium metabolism disorders. They had significant abnormalities in hormonal and metabolic homeostasis manifested by dyshormonemia, dyselectrolytemia and dysproteinemia. We believe that these scientific facts will help to improve the treatment and prevention of secondary osteoporosis complications in this category of patients.

Conclusions. Among the clinical parameters in men with PGRD and comorbid OP, bone pain and muscle cramps prevailed. Hormonal homeostasis was characterized by dyshormonemia with a significant decrease in almost all studied anabolic hormones and an increase in almost all studied catabolic hormones. Deviations in metabolic homeostasis were manifested by dyselectrolytemia (hypophosphatemia, hypomagnesemia, decreased ionized calcium) and dysproteinemia (hypoalbuminemia, hyper-a₁-globulinemia, hyper-β-globulinemia, sharply reduced glycoproteins).

Background: The diagnosis of adnexal torsion is challenging due to the absence of specific symptoms that can determine the postponing of surgery, and as the consequence, the development of necrotic changes of adnexa. Nowadays, the surgical treatment of patients with this pathology shifting to the ovary-sparing surgery (detorsion) despite to the presence of necrotic changes during surgery. By that, the question of the choice of the method of treatment in case of adnexal torsion still under debate between pediatric surgeons and gynecologists

Aim of the study was to summarize the own experience in treatment of patients with adnexal torsion

Methods: This study was based on the results of retrospective and prospective analysis of treatment of 73 patients with adnexal torsion, who were operated at Lviv Regional Children’s Clinical Hospital «OHMATDYT» during 2010-2022 years. Diagnosis was established on results of clinical investigation and ultrasonography (US). It was performed 74 surgical procedures (one patient was operated twice), among them 57 (77%) by laparoscopic and 17 (23%) by open approach (laparotomy). It was 49 (66,2%) ovary-sparing surgeries (detorsion with or without cystectomy) and 25 (33,8%) – adnexectomy.

Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8). Results: The average age of patients was 11,5±0,5 years. Abdominal pain (in 100%) and vomiting (in 49,3%) were the main clinical appearances. Unilateral ovarian enlargement and peripherally displaced follicles were the most frequent US findings. The absence of the blood supply was revealed in 39,5% and the whirlpool sign in 11,6% of patients. Among all patients, simple torsion confirmed in 24,3%, while the torsion caused by cyst or dermoid tumor, revealed in 75,7% of patients. Detorsion was performed only in 24,3% of patients and in 42,5% of patients it was supplemented by cystectomy. Adnexectomy was performed in 32,2% of patients.

Conclusions. The diagnosis of adnexal torsion should be considered in all females with acute abdominal pain syndrome. Ultrasonography with or without Doppler is the first-line imaging modality. Detorsion was performed regardless of the degree of torsion, and indications for adnexectomy were the presence of a dermoid cyst and clear signs of ovarian necrosis. Laparoscopic detorsion, simple or with cystectomy, is the method of choice for treatment of patients with adnexal torsion. (TCM-GMJ June 2024; 9 (1):P23-P27)