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: 616–057:61:378

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 616.5-002.525.2-031.81-06:616.12-008-039.5]-037-074

Резюме. Системний червоний вовчак (СЧВ) – хронічна автоімунна недуга, за якої уражаються майже всі внутрішні органи і серед них – органи системи кровообігу (ОСК).

Мета. З’ясувати прогностичне значення діагностично цінних лабораторних маркерів системного черво-ного вовчака для визначення ймовірности виникнення коморбідних синтропічних уражень органів системи кровообігу.

Матеріали і методи.  У дослідження включено 125 хворих на СЧВ із наявністю уражень ОСК, серед яких переважали жінки молодого віку. Хворих стратифікували за наявністю коморбідних синтропічних уражень ОСК. Результати опрацьовано у програмі «Exсel», статистично достовірною вважали різницю, якщо р < 0,050. Зв’язок вважали підтвердженим, якщо коефіцієнт асоціації ≥ 0,50 або коефіцієнт контингенції ≥ 0,30.

Результати. З’ясували, що для визначення ймовірности виникнення ангіопатії сітківки у хворих на СЧВ найкраще прогностичне значення має констеляція із ↑ ЛПНЩ + ↑ ІА + ↑ anti-ds DNA + ↑ ANA; для капіляриту – окремий маркер ↑ АлТ; для синдрому А. Г. М. Рейно – окремий маркер ↓ С3; для ретикулярного ліведо – ↑ ШОЕ + ↑ малих ЦІК + ↑  anti-ds  DNA  + ↑ anti-Sm; для атеросклерозу  –  ↓ гемоглобіну + ↑ ЛПНЩ + ↑  ANA  + ↓ С4; для недостатности мітрального клапана – ↑ ШОЕ + ↑ anti-ds DNA + ↑ ANA + ↑ антифосфоліпідних антитіл Ig М; для ущільнення мітрального клапана  –  ↑ ШОЕ + ↑ ЛПНЩ + ↑ малих ЦІК + ↑  ANA; для перикардіального випоту  – еритропенія + ↑ С-РП + ↑ вовчакового антикоагулянту; для легеневої гіпертензії  –  гіперхолестеролемія + ↑ ЛПНЩ + ↑ anti-ds  DNA  + ↑  ANA; для міокардиту  –  окремий маркер ↓ С4; для ендокардиту  –  не виявлено; для симптоматичної артеріальної гіпертензії – ↑ ЛПНЩ + ↑ anti-ds DNA + ↑ ANA  + ↑ anti-SSA (Ro); для тромбозу вен – еритропенія + ↓ гемоглобіну + ↑ ЛПНЩ + ↑ ANA.

Висновки. Для кожного коморбідного синтропічного ураження органів системи кровообігу у хворих на системний червоний вовчак визначено діагностично цінні окремі лабораторні маркери або їхні констеляції, які мають найкраще прогностичне значення для визначення ймовірности виникнення цих уражень.

УДК 616.72-002:611-018.4]-07

Introduction. Patients with rheumatoid arthritis(RA)are twice as likely to have osteoporosis (OP) compared to the general population. The strength of bones depends on mineral substances, mainly represented by calciumphos phatemicrocrystals. The chiefrole in the regulation of calcium-phosphorus metabolism is played by vitamin D and parathormone(PTH). 
The aim of the study. To investigate markers of calcium-phosphorus metabolism in patients with rheumatoid arthritis accompanied by bone mineral density (BMD) disorders and to find out their diagnostic value.
Materials and methods. 76 patients with RA (64 premenopausal women and 12 mature men) were included in the study. All patients with RA were subjected toultrasound bone densitometry and according to its results, patients were divided into three groups: patients with RA and osteopenia, patients with RA and OP; RA patients without BMDdisorders. The control group included 22 healthy individuals of both genderswithout BMD abnormalities. To evaluate calcium-phosphorus metabolism, ionized calcium, total calcium, phosphorus, PTH, and vitamin Din blood serum, and levels of calcium and phosphorusin urine were detected.
Results. It was revealedthat concentration of total calcium in blood serum of patients with RA is lower compared tohealthy individuals, while the same index in urine ofpatients with RA accompanied byosteopenia,OP or without BMD disorders is higher compared to healthy people. The concentration of vitamin D is significantly lower in patients with RA and OP compared to patients with RA with osteopenia, without BMD disorders,or healthy individuals. The concentration of PTH is higher inhealthy individuals compared to patients with RA without BMD abnormalities or with osteopenia.
Conclusions. In patients with rheumatoid arthritis with osteopenia orosteoporosis, significantly more often than in patients with rheumatoid arthritis without a violation of bone mineral density, ionized and total calcium, phosphorus in serum and urine, as well asvitamin D indices have deviations from the reference valuesand are of diagnostic significance.