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: 616–057:61:378

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: 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: 616.1/.4–07

Один  із визначальних маркерів якості професійної діяльности лікаря – уміння сформулювати клінічний діагноз відповідно до сучасних вимог, які передбачають етіологічний і патогенетичний принцип його побудови, використання сучасних класифікацій хвороб на основі Міжнародної класифікації хвороб десятого перегляду (МКХ-10), а також актуальних клінічних класифікацій.

Очевидно, що коректно сформульований діагноз свідчить про належну кваліфікацію клініциста, який завершує діагностичний етап надання допомоги хворому, і є підставою для призначення адекватного комплексного лікування.

Проте, починаючи від первинної ланки медичної служби і завершуючи високоспеціалізованими підрозділами університетських клінік, часто практикуються некоректні моделі його написання, зокрема, через відсутність уніфікованих прикладів формулювання, а також відповідних видань, які б сприяли розв’язанню цієї проблеми.

Це й є обґрунтуванням актуальности доповненого та переробленого другого видання (перше видання вийшло друком у 2005 р.) навчального посібника «Сучасні класифікації з прикладами формулювання  діагнозів найпоширеніших хвороб системи кровообігу», підготовленого до друку колективом кафедр внутрішньої медицини № 1, № 2 та сімейної медицини Львівського національного медичного університету імені Данила Галицького й виданого за сприяння Львівського обласного благодійного фонду «Надії Нації» та керівництва  Львівського національного медичного університету імені Данила Галицького.

У навчальному посібнику подаються приклади написання варіантів діагнозів на всіх етапах надання допомоги хворим із особливим акцентом на вмінні формулювати власне клінічний і остаточний діагнози.