UDC 616.36-004-06:612.015.11:616.24-008.4]-092

Background. Hepatopulmonary syndrome is one of the most dangerous syntropies in case of liver cirrhosis. Consequently, it is important to determine the role of oxidative stress, acid-base balance and ventila-tion-perfusion disorders as factors of hepatopulmonary syndrome development in cirrhotic patients.

Materials and methods. We included 44 cirrhotic patients with hepatopulmonary syndrome verified according to the patented. Method for diagnosing degrees of hepatopulmonary syndrome severity in patients with liver cirrhosis. In addition tothe traditional examinations, we determined the gas composition parameters in venous blood, acid-base balance parameters, catalase activity and malondialdehyde level in all the patients. The received material was processed on a personal computer using Excel 2010, Statistica 6.0, RStudio v. 1.1.442 and R Commander v. 2.4-4.

Results. Analysis of blood gas parameters revealed the reliability of the difference for PCO2(р = 0.03) depending on the class of liver cirrhosis severity. Also, with the liver cirrhosis severity increase, the malondialdehyde level increased,and catalase decreased. Moreover, significant inverse relationships between malondialdehyde content and PCO2(p = 0.039), HCO3(p = 0.039), TCO2(p = 0.036), Beb (p = 0.049), BEecf (p = 0.043) were found resulting in hypo-capnia and partiallycompensated metabolicacidosis.The found direct correlation between malondialdehyde level and AaDO2(p = 0.044) indicates the arteriovenous pulmonary shunts, ventilation-perfusion disorders. The absenceof catalase content changes can obviously be explained by the fact that its activity can be partially compensatory maintained.

Conclusions. In patients with hepatopulmonary syndrome, the peroxidation activity enhances with anincrease in the liver cirrhosis severity, resulting in the redox homeostasis imbalance, leading to the ventilation-per-fusion disorders and partially compensated metabolic acidosis.

Keywords: liver cirrhosis; hepatopulmonary syndrome; intrapulmonary vasodilatation; oxidative stress; metabolic acidosis

Introduction. Celiac disease (CD) is a global public health problem. Recent studies have revealed the global prevalence of approximately 1.4% in adults. It is known to manifest usually in childhood and have different symptoms similar to other diseases. In the presented case reports the case of CD in adult, manifested by various atypical symptoms, that became the obstacle to diagnosis the CD in time was described.

Methods. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a comprehensive literature search using such databases as Web of Science, Embase, PubMed. The search strategy included the following terms: "celiac disease", "gluten sensitivity", "pathophysiology", "diagnosis and treatment", "case report". Case description was described according to Case Report (CARE) guidelines.

Results. Recent advances in CD research have significantly enhanced our understanding of its epidemiology, pathophysiology, diagnosis, and management in adults. Advances in genetic and immunological research have deepened our understanding of disease mechanisms, paving the way for novel diagnostic and therapeutic approaches.

А female patient had the complaints of constant pain in the periumbilical and left hypochondriac areas, irregular defecation, diarrhea; legs swelling up to the level of knees. During the ultrasonography of the internal organs, free fluid in the abdominal cavity (approximately 2.0l) was detected. During the gastroscopy it was found pyloritis, gastroptosis, gastroduodenal reflux, CD was suspected, biopsy was taken. The results of the duodenal descending part biopsy: chronic enteritis with significant atrophic-inflammatory changes. To confirm the CD the serological testing also was conducted: IgA to deamidated gliadin > 9.0 (N-<1.0), IgG to deamidated gliadin 0.22 (N-<1.0), IgA to tissue transglutaminase 2 – 2.88 (N-<1.0), IgG to tissue transglutaminase 2 – 0.06 (N<1.0). After the mentioned examination the diagnosis of CD was set. The patient received symptomatic treatment followed by the gluten-free diet (GFD). After 10 days in the hospital the patient was discharged with improved condition and the main recommendation to maintain the GFD.

Discussion. CD is “getting older” and can be very similar to or accompanied by chronic pancreatitis, gastritis, irritable bowel syndrome etc. As could be seen from the clinical case description, the combination of the characteristic symptoms such as abdominal pain, bloating, continuous or frequently repeated diarrhea should lead to the thorough examination of a patient including endoscopy with biopsy and if any suspicion exists, subsequent serological testing. GFD remains the cornerstone of treatment, ongoing research into enzyme supplements, immunomodulators, and even genetic modification of wheat offers hope for additional management options.

Conclusions. Only the multifaceted approach, combining serological tests, instrumental examinations and qualified histopathological assessment, offers a comprehensive means of identifying CD and enabling the timely treatment.

The fight against biological threats has been a key factor in humanity's survival throughout history. Taking into account the latest epidemiological, biotechnological, and geopolitical trends, this paper provides a comprehensive analysis of both natural and anthropogenic sources of biological hazards. Special attention is given to zoonotic infections, synthetic biology, biological weapons, bioterrorism, and global environmental factors that influence the epidemiological situation. International risk management strategies are summarized, the legal framework of biosafety is analyzed, and recommendations are proposed for improving systems for the prevention and response to biological threats.

УДК 615.5–002.525.2:616.1]–06–07

Introduction. Systemic lupus erythematosus (SLE) due to damage to numerous organs or systems still requires comprehensive study.

The aim of the study. To find out the clinical markers of the blood vessels syntropic lesions in patients with systemic lupus erythematosus, their diagnostic value.

Materials and methods. 118 patients with SLE with syntropic lesions of the circulatory system were examined (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 blood vessels syntropic lesions, 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 A. G. M. Raynaud’s syndrome in patients with SLE are morning stiffness, new rashes, paleness of the fingers and toes in the cold, chilliness of the extremities, memory problems, symptomatic hypertension - skin dryness, legs swelling, shortness of breath, palpitations, headache, increased blood pressure, displacement of the left border of the heart to the left, accent of the second tone on the aorta, livedo reticularis - skin dryness, chilliness of the extremities, shortness of breath,  retinal angiopathy - morning stiffness, paleness of the fingers and toes in the cold, legs swelling, shortness of breath, palpitations, headache, increased blood pressure, displacement of the left border of the heart to the left, accent of the second tone on the aorta, pulmonary hypertension - morning stiffness, legs swelling, shortness of breath, palpitations, memory problems, accent of the second tone on the pulmonary artery, atherosclerosis - muscle ache, shortness of breath, memory problems,  venous thrombosis - legs swelling, shortness of breath, palpitations, capillaritis - headache.

The optimal value for the diagnosis of A. G. M. Raynaud’s syndrome in patients with systemic lupus erythematosus is the constellation of clinical markers "joint pain + chilliness of the extremities", symptomatic hypertension - a separate clinical marker accent of the second tone on the aorta, livedo reticularis - "joint pain + new rash + shortness of breath", retinal angiopathy - "joint pain + increased blood pressure", pulmonary hypertension - a separate clinical marker accent of the second tone on the pulmonary artery or the constellation "joint pain + accent of the second tone on the pulmonary artery", atherosclerosis - a separate clinical marker shortness of breath or the constellation "joint pain + shortness of breath", venous thrombosis - "joint pain + photosensitivity + shortness of breath", capillaritis - "palpitations + headache + increased blood pressure".

Conclusions. In patients with systemic lupus erythematosus the optimal diagnostic value among clinical monomarkers and their constellations for the detecting of A. G. M. Raynaud’s syndrome have chilliness of the extremities, "joint pain + chilliness of the extremities" with an advantage in the constellation, symptomatic hypertension - accent of the second tone on the aorta, "joint pain + accent of the second tone on the aorta" with an advantage in the monomarker,  livedo reticularis - shortness of breath, "joint pain + new rash + shortness of breath" with an advantage in the constellation, retinal angiopathy - increased blood pressure, "joint pain + increased blood pressure" with an advantage in the constellation, pulmonary hypertension - accent of the second tone on the pulmonary artery or the constellation "joint pain + accent of the second tone on the pulmonary artery", atherosclerosis - shortness of breath or the constellation "joint pain + shortness of breath", venous thrombosis - legs swelling, "joint pain + photosensitivity + shortness of breath" with an advantage in the constellation, capillaritis - headache, "palpitations + headache + increased blood pressure" with an advantage in the constellation.

УДК 616.72–002.77–06:[616.71–018.4:612.015.7]–073.48–73.75

Вступ. Ревматоїдний артрит (РА) – хронічна системна хвороба сполучної тканини нез’ясованої етіології складного автоімунного патогенезу, яка часто ускладнюється вторинним остеопорозом (ОП), що погіршує перебіг і прогноз основної хвороби.

Мета. Дослідити частоту й характер уражень кісток у хворих на ревматоїдний артрит, виявлених за допомогою ультразвукової та  рентгеностеоденситометрії, зясувати їх діагностичну цінність для оцінки мінеральної щільности кісткової тканини.

Матеріали й методи. У дослідження в рандомізований спосіб із попередньою стратифікацією за наявністю РА, діагностованого згідно з критеріями Американської колегії ревматологів та Європейської ліги проти ревматизму (2010), у жінок пременопаузального періоду та чоловіків зрілого віку, включено 74 хворих (62 жінки (84,93 %) і 12 чоловіків (15,07 %) віком від 38 до 60 років (середній вік на час обстеження жінок  – 48,67 ± 2,34 року, чоловіків – 45,42 ± 2,78 року)), що лікувалися (вживаючи метилпреднізолон 4,0–24,0 мг/добу та не отримуючи лікарські засоби для лікування ОП) в ревматологічному відділі Комунального некомерційного підприємства Львівської обласної ради «Львівська обласна клінічна лікарня» з 2013 по 2019 рік (дослідна група – ДГ). Контрольну групу (КГ) створено з 29 здорових осіб (22 жінок (75,86 %) і 7 чоловіків (24,14 %), середній вік жінок на час обстеження 44,95 ± 2,12 року, чоловіків – 40,71 ± 2,75 року) аналогічних статі й віку. Усім хворим проведено оцінку МЩКТ за допомогою ультразвукової кісткової денситометрії п’яткової кістки, методу рентгеностеоденситометрії кисті.

Результати. Виявлено міцний кореляційний зв’язок між результатами ультразвукової денситометрії п’яткової кістки і рентгеностеоденситометрії кисти, що дає підстави рекомендувати діагностувати зміни МЩКТ обома методами, причому чутливішим виявився метод рентгеностеоденситометрії.

Висновки. Застосування обох методів діагностики ОП, а саме – ультразвукової денситометрії п’яткової кістки та рентгеностеоденситометрії кисти – у хворих на ревматоідний артрит є науково обґрунтованим.