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).

УДК: 615.5–002.525.2:616.1]–06–07

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with numerous clinical manifestations that affects any organs or systems and requires a comprehensive study.

The aim of the study. To find out the clinical markers of the heart and blood vessels syntropic lesions in patients with SLE and evaluate their diagnostic value.

Materials and methods. The study included 118 patients with SLE with the presence of syntropic (having common etiological and/or pathogenetic mechanisms with the main disease) lesions of the heart and blood vessels (107 women (90.68%) and 11 men (9.32%) aged 18 to 74 years (average age 42.48 ±1.12 years)).

The study included the identification of clinical markers of syntropic lesions of the heart and blood vessels, determination of the diagnostic value of individual clinical markers and their constellations in terms of sensitivity, specificity and accuracy in patients with SLE, and the identification of one of them with the most reliable diagnostic value.

Results. Clinical markers for detecting mitral valve insufficiency in patients with SLE are morning stiffness, new rash, dyspnea, memory problems, presence of weakened cardiac sounds, systolic murmur on the apex of the heart, accent of the second sound on the pulmonary artery; mitral valve consolidation - new rash, the presence of legs edema, dyspnea, a feeling of interruptions in the work of the heart, pain in the heart area, the presence of weakened cardiac tones, systolic murmur on the top of the heart; myocarditis - muscle ache, alopecia, legs edema, shortness of breath , palpitation, systolic murmur on the top of the heart; pericardial effusion – legs edema, dyspnea, palpitations, the presence of weakened cardiac tones; endocarditis - the presence of the accent of the second tone on the pulmonary artery.

The optimal value for the diagnosis of mitral valve insufficiency in patients with SLE is the constellation of clinical markers "pain in the joints + new rash + accent of the second tone on the aorta"; of mitral valve consolidation - "dyspnea + a feeling of interruptions in the work of the heart"; of myocarditis - "heart palpitations + systolic murmur on the apex of the heart"; of pericardial effusion - "pain in the joints + weakening of heart tones"; of endocarditis - "fever + systolic murmur over the top of the heart + emphasis of the second tone on the pulmonary artery".

Conclusions. In patients with SLE the optimal value among clinical monomarkers and their constellations for the diagnosis of mitral valve insufficiency is dyspnea and the constellation "pain in the joints + new rash + accent of the second tone on aorta"; for MV consolidation - a complaint of a feeling of interruptions in the work of the heart and the constellation "shortness of breath + feeling of interruptions in the work of the heart"; for myocarditis - palpitations and the constellation "heartbeat + systolic murmur on the apex of the heart", pericardial effusion - the presence of weakened cardiac tones and the constellation "pain in the joints + weakened cardiac tones"; for endocarditis - accent of the second tone on the pulmonary artery and the constellation "fever + systolic murmur on the apex of the heart + accent of the second tone on the pulmonary artery". Constellations of clinical markers, but not individual clinical markers, have optimal value for the diagnosis of the syntropic heart lesions in patients with SLE.

УДК: 618.173:615.322

Резюме. Менопаузальна гормональна терапія (МГТ) залишається найбільш ефективним методом лікування вазомоторних симптомів (ВМС) та генітоуринарного менопаузального синдрому (ГУМС) і, як було показано, запобігає втраті й руйнуванню кісткової тканини. Ризики МГТ різняться залежно від типу, дози, тривалості використання, шляхів введення, термінів початку та застосування як естрогенів, так і прогестогену. Лікування має бути індивідуалізоване з вибором найбільш відповідного препарату для МГТ, дози, складу, шляху введення та тривалості використання, із застосуванням найкращих наявних даних для максимілізації переваг і мінімізації ризиків із періодичною переоцінкою переваг та ризиків продовження або припинення використання МГТ. Однак за наявності абсолютних протипоказань для її використання необхідний пошук альтернативних методів корекції менопаузальних розладів.

У рамках цієї статті докладніше зупинимося на альтернативних методах лікування не локальних, а переважно системних проявів клімактеричного синдрому (КС) (вазомоторних симптомів, безсоння, емоційної лабільності, а також тривожно-депресивних станів). Адже якщо з пацієнтками, які не мають чітких протипоказань до МГТ, все чітко та ясно, то питання щодо контингенту жінок з їх наявністю або з так званою гормонофобією досі залишається відкритим і контраверсійним. Довгий час світова фармакологічна спільнота займається розробкою альтернативного, естроген-імітуючого методу лікування клімактеричних розладів. Ключовими складовими даних препаратів є рослинні компоненти, що імітують фізіологічну дію естрогенів, за винятком його проліферативного впливу, що визначає діапазон можливостей для усунення симптомів КС і підвищення якості життя в пацієнток із серцево-судинними захворюваннями (ССЗ) в анамнезі, проліферативними захворюваннями репродуктивних органів та гормонофобією.

  Abstract. Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms (VMS) and genitourinary menopausal syndrome (GMS) and has been shown to prevent bone loss and destruction. The risks of MHT vary depending on the type, dose, duration of use, routes of administration, timing of initiation, and use of both estrogen and progestogen.

  Treatment should be individualized with the selection of the most appropriate MHT drug, dose, composition, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reassessment of the benefits and risks of continuing or discontinuing MHT use.    However, in the presence of absolute contraindications for its use, it is necessary to search for alternative methods of correction of menopausal disorders.

  In the framework of this article, we will dwell in more detail on alternative methods of treatment of not local, but mainly systemic manifestations of the climacteric syndrome of CS (vasomotor symptoms, insomnia, emotional lability, as well as anxiety-depressive states). After all, if everything is clear and clear with patients who do not have clear contraindications to MHT, then the question of the contingent of women with their presence or with the so-called hormonophobia still remains open and controversial. For a long time, the world pharmacological community has been engaged in the development of an alternative, estrogen-imitating method of treatment of climacteric disorders. The key components of these drugs are plant components that mimic the physiological action of estrogens, with the exception of its proliferative component, which provides a wider range of possibilities for eliminating CS symptoms and improving the quality of life in patients with a history of cardiovascular disease (CVD), with hyperproliferative reproductive diseases organs and hormone phobia.

УДК: 618.1 (075.8)

Резюме. Первинна недостатність яєчників (ПНЯ) є спектром захворювань, що впливають на жіночу фертильність, сприяють захворюваності й смертності та пов’язані з наростаючим дефіцитом естрогенів. Первинна недостатність яєчників, поширеність якої зараз наближається до 4%, стає все більшою проблемою громадського здоров’я. ПНЯ впливає на психічне здоров’я, фертильність, здоров’я серцево-судинної системи та здоров’я кісток. Незважаючи на відсутність єдиної думки щодо критеріїв оцінки ПНЯ, важливо обстежувати будь-яку жінку з первинною чи вторинною аменореєю. Первинна аменорея визначається як відсутність менструацій протягом усього життя, якщо менархе не настало до 15 років або через три роки після телархе. Вторинна аменорея визначається відсутністю менструації протягом трьох послідовних місяців за раніше регулярних менструацій або відсутністю менструацій протягом 6 місяців поспіль за раніше нерегулярних менструацій. ПНЯ діагностується на тлі аменореї при двох підвищених значеннях ФСГ у менопаузальному діапазоні (>25 МО/л), отриманих з інтервалом у 30 днів. У цій статті описано визначення, принципи діагностики та менеджменту первинної недостатності яєчників.

Abstract. Primary ovarian insufficiency (POІ) is a spectrum of diseases that affect female fertility, contribute to morbidity and mortality, and are associated with increasing estrogen deficiency. Primary ovarian failure, with a prevalence now approaching 4%, is a growing public health problem. POI affects mental health, fertility, cardiovascular health and bone health. Although there is no consensus on the criteria for evaluating POI, it is important to screen any woman with primary or secondary amenorrhea. Primary amenorrhea is defined as the absence of menstruation throughout life unless menarche occurs before age 15 or three years after thelarche. Secondary amenorrhea is defined as the absence of menses for three consecutive months after previously regular menses or the absence of menses for 6 consecutive months with previously irregular menses. POI is diagnosed on the background of amenorrhea with two elevated FSH values in the menopausal range (>25 IU/L), obtained at an interval of 30 days. This article describes the definition, principles of diagnosis and management of primary ovarian insufficiency.