Репозитарій

УДК: 616.1/.8–018.2–002.28:616.71–018.4–008.9]–07

Introduction. Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations associated with multiple autoantibodies formation and deposition of immune complexes, and other immune processes. Despite significant advances in treatment, the disease remains disabling, in particular, due to increased bone fragility and low-energy fractures. The study of bone remodeling in patients with SLE should help to improve the therapy and quality of their treatment.

The aim of the study. To investigate the features of bone mineral density, calcium-phosphorus metabolism and bone remodeling in patients with systemic lupus erythematosus.

Materials and methods. The study involved 123 women with SLE aged 21-51 years. The comparison group (CG) consisted of 25 women without SLE in premenopausal status of the appropriate age. The control group included 25 practically healthy women.

In order to study bone mineral density (BMD), dual-energy X-ray densitometry (DXA) of the lumbar spine was performed using a dual-energy X-ray absorptiometer. For the study of calcium-phosphorus metabolism (CPM), total calcium (Ca), ionized Ca, phosphorus (P) in blood and Ca, P, creatinine in daily urine, as well as parathyroid hormone (PTH) and 25-hydroxyvitamin D in serum were determined. Markers of bone remodeling (osteocalcin, procollagen type 1 amino-terminal propeptide (P1NP) and isomerized C-terminal telopeptide (β-crosslaps) in serum were measured.

To achieve the stated goal, the first step included the determination of bone damage prevalence in patients with the diagnosed SLE; the second step was directed towards the characterization the particular bone condition in patients with SLE based on the results of BMD, CPM indices and markers of bone remodeling assessment.

Results. According to the results of DXA of the lumbar spine, 88 (71.54 %) women of the SG and only 8 (32.00 %) women of the CG had a decrease in BMD (p < 0.001). According to the mean values, the studied CPM indices of the SG patients, CG and control group wemen exposed no significant differences. Similarly, no significant differences were detected in the mean values of urinary phosphorus and in between blood PTH values in SG, CG, and control. The level of 25-hydroxyvitamin D was significantly lower in SG (15.14 ± 0.80 ng/ml) than in CG (19.62 ± 0.46 ng/ ml) and control (22.38 ± 1.34 ng/ml) p < 0.05. The mean value of osteocalcin in woman with SLE was significantly lower than in CG and control (11.81 ± 0.49 ng/ml versus 18.61 ± 0.75 ng/ml and 19.28 ± 1.88, p < 0.001). No significant difference were detected in between the mean values of P1NP in SG, CG and control. The mean values of β-cross laps were significantly higher in patients with SLE (0.51 ± 0.02 ng/ml) compared to GC (0.26 ± 0.02 ng/ ml) and control (0.28 ± 0.02 ng/ml), p < 0.001.

Conclusions. Bone mineral density, calcium-phosphorus metabolism and bone remodeling in patients with systemic lupus erythematosus have peculiarities as follows: a significant decrease in bone mass in 71.54 % of patients, namely 18, 70 % - grade I osteopenia, 21.14 % - grade II osteopenia, 14.63 % - grade III osteopenia; 17.07 % - osteoporosis, increased calcium excretion, vitamin D deficiency, decreased osteoblastic and enhansed osteoclastic functions.

УДК: 616.36–004:616.24–008.811.6–036

The aim of the study. To determine the frequency and character of syntropic extrahepatic lesions in cirrhotic patients depending on the hepatopulmonary syndrome severity degree.

Materials and methods. In a randomized manner with preliminary stratification by the presence of hepatopulmonary syndrome were studied 93 patients with liver cirrhosis, who underwent the comprehensive clinical-laboratory and instrumental examination.

Results. According to the obtained results, most often in patients with liver cirrhosis associated with hepatopulmonary syndrome syntropic extrahepatic lesions affected other organ systems as follows: digestive system - 100.0 % patients under investigation; hematopoietic system - 84.9 %; nervous system - 81.7 %; integumentary system and mucous membranes - 78.5 %; blood circulatory system - 76. 3 %; osteoarticular system - 67.7 %; urinary system - 22.6 %. Increased severity of hepatopulmonary syndrome significantly (p < 0.05) correlated with thein creased frequency of lesions.

Among syntropic polymorbid lesions of the integumentary system and mucous membranes, 68.8 % patients with hepatopulmonary syndrome had jaundice, 66.7 % - telangiectasia. Among lesions of the osteoarticular system osteopenia was diagnosed in 44.7 % of patients, osteoporosis - in 27.7 %. Among lesions of the circulatory system 52.7% of patients suffered from heart rhythm disorders, 49.5 % - from arterial hypotension, 20.4 % - from cirrhotic cardiomyopathy. Among lesions of the hematopoietic system anemia (76.3 %), coagulopathy (73.1 %) and thrombocytopenia (61.3 %) were diagnosed most often. Digestive system lesionsinclude esophageal veins varicosities (94.6 % of patients), hemorrhoidal veins varicosites (68.8 %), and cirrhotic gastropathy (62.4 %). Among lesions of the urinary systemin 21.5 % of patientswas diagnosed type II hepatorenal syndrome. Among the lesions of central nervous system in 81.7 % of patientswas diagnosed hepatic encephalopathy. The frequency of syndromes and nosological units increased significantly (p < 0.05) with the increase of hepatopulmonary syndrome severity.

Conclusions. 100.0 % patients with liver cirrhosis accompanied byhepatopulmonary syndromewere affected by syntropic polymorbid lesionsof the digestive system, 94.6 % of which were represented by esophageal vein varicosites. Out of 84.9 % of patients with hematopoietic lesions anemia was diagnosed in 76.3 %, coagulopathy - in 73.1 % of cases. Of total 81.7 % patients withnervous system injurieshepatic encephalopathy was diagnosed in 81.7 % patients. In 78.5 % cases of damaged skin, its appendages and mucous membranesjaundice covered 68.8 %, and telangiectasia 66.7 % of cases. In 76.3 % of cardiovascular system lesions arrhythmias were diagnosed in 52.7 %. With the increasing severity of hepatopulmonary syndrome, the frequency of the above lesions increased significantly (p < 0.05).

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".