An analytical review of literature data on modern approaches to the management of pregnant patients with fetal growth restriction (FGR) was carried out, which revealed the main problems relating to terminology, diagnosis, treatment, prevention and delivery of patients with this pathology. Data from literary sources are illustrated by personal observations, which showed that FGR remains a complex problem of obstetrics and requires a high degree of professional competence and ethical responsibility when choosing tactics for pregnancy management. According to the conducted study, it was concluded that it is necessary to introduce international approaches to the problem of FGR into the clinical practice of obstetricians and gynecologists of the Republic of Belarus.

Objective. To analyze data on synthetic prostheses used in herniology, features of the body’s reaction to their implantation, possible infectious complications, and to search for ways to solve identified problems.

Materials and methods. An analysis of publications in the PubMed, Web of Science, Elibrary and CyberLeninka systems was carried out, describing the use of synthetic prostheses for hernioplasty and the nature of complications in the postoperative period. The following search terms were used: “synthetic prostheses”, “tension-free hernioplasty”, “bacterial biofilm”, “infectious complications of hernioplasty”. A total of 38 original publications were selected.

Results. The materials used for tension-free hernioplasty and their physical and mechanical properties were studied. The concept of bacterial biofilm was studied as one of the reasons for maintaining infectious complications on mesh endoprosthesis.

Conclusion. Currently, the use of synthetic prostheses in operations on hernias of the anterior abdominal wall is the “gold standard”. The material of choice for the manufacture of endoprostheses is polypropylene. The elasticity of the polypropylene mesh is close to the physiological elasticity of the anterior abdominal wall. The polypropylene mesh consists of monofilament threads that do not have capillarity and wicking. In response to implantation, the polypropylene mesh causes a weak inflammatory reaction of soft tissues. At the same time, the use of polypropylene meshes in hernioplasty in comorbid patients, patients with strangulated hernias can lead to postoperative infectious complications, which is associated with the formation of a biofilm on the surface of the endoprosthesis. The development of a polymer coating for a mesh polypropylene prosthesis with prolonged release of antibiotics to delay bacterial colonization and the formation of a bacterial biofilm in conditions of bacterial contamination of the surgical field is relevant.

Objective. To determine the composition of the microbiota of ascitic fluid in patients with liver cirrhosis and compare it with the intestinal microbiota and urobiota.

Materials and methods. A cross-sectional single-center study was conducted for 5 hospitalized patients with decompensated liver cirrhosis with ascites who, along with standard research methods, underwent metagenomic sequencing of ascitic fluid, urine and feces. High-throughput sequencing was performed using a MiSeq genetic analyzer (Illumina, USA) using a protocol based on the analysis of variable regions of the 16s rRNA gene. The assignment of taxonomic levels and quantitative assessment of the microbiome composition were performed using the Kraken 2 program (PlusPF database dated 06/05/2024). The study is registered in Clinicaltrials.gov (NCT05335213).

Results. A unique composition of the ascitic fluid microbiota represented by 29 types, 35 classes, 67 orders, 129 families, 231 genera, and 266 bacterial species has been determined in patients with liver cirrhosis with ascites in the absence of spontaneous bacterial peritonitis. The Pseudomonadota is the dominant type (95,4% [94,8; 95,9]), the Gammaproteobacteria is the dominant class (47,7% [45,9; 48,4]), the Stenotrophomonas is the dominant genera (47,6% [46,2; 48,0]) in the microbiota of ascitic fluid.

For the first time it has been shown that the similarity of the microbiota of ascitic fluid and urobiota is 68,3%, microbiota of ascitic fluid and gut – 69,0% at the type level.

Conclusion. The study examined the microbiota of ascitic fluid in patients with liver cirrhosis using metagenomic sequencing. Despite the negative results of cultural research methods, it has been shown that ascitic fluid is not a sterile medium and contains a large number of microorganisms, which in most cases have commonalities with the microbiota of the gut and urinary tract.

Objective. To evaluate the effectiveness of superoxide dismutase (SOD) as a marker for predicting cognitive impairment at the end of the acute period of cerebral infarction (CI) in patients with sleep apnea (SA).

Materials and methods. Seventy four patients in the acute period of CI and concomitant SA and 36 patients with СI without AS were examined. All patients underwent respiratory polygraphy, determination of cognitive impairment using the Montreal Cognitive Assessment, and blood SOD analysis.

Results. A threshold value of serum SOD activity ≤47.9 activity units was established, which is a prognostic marker of impairments in visual-constructive/executive skills (AUC ‒ 0.725 (95% CI 0.609–0.823; p=0.003); sensitivity ‒ 70.9% (95% CI 58.1–81.8); specificity ‒ 66.7% (95% CI 34.9–90.1)) and delayed recall (AUC ‒ 0.701 (95% CI 0.584–0.802; p=0.005); sensitivity ‒ 70.5% (95% CI 57.4–81.5); specificity ‒ 61.5% (95% CI 31.6–86.1)) at the end of the acute period of CI in patients with SA.

Conclusion. In patients with SA the threshold value of the blood SOD activity indicator ≤47.9 activity units can be used as a good-quality classifier for identifying risk groups for the development of visual-constructive/executive skills disorders and delayed recall starting from the first days of the CI, and planning their treatment and rehabilitation measures including the appointment of continuous positive airway pressure therapy.

Objective. To make associations between the composition of the gut microbiota and the dosage of immunosuppressive drugs in patients after allogeneic hematopoietic stem cell transplantation.

Materials and methods. In this study, we studied the composition of the gut microbiota using the V3-V4 sequencing method of the 16S rRNA gene in 36 patients after allogeneic hematopoietic stem cell transplantation with various types of immunosuppression.

Results. Use of Tacrolimus significantly reduced the abundance of bacteria like Bacteroidetes and particularly Bacteroidaceae family in stool samples compared to cyclosporine A; patients with higher Akkermansia abundance more often required immunosuppression dose reduction to maintain target serum levels, as confirmed by two multivariate methods, while patients with higher Faecalibacterium, Oscillibacter, and Hungatella density had a higher median cyclosporine A dose to maintain therapeutic concentrations.

Conclusion. Additional studies are necessary to identify the relationship between gut microbiome and immunosuppressant drugs taking into account variable concentrations of calcineurin inhibitors, potential adverse events associated with insufficient or excessive serum drug levels, and the associations found between patients’ gut microbiome abundance and immunosuppressant dose

Objective. To conduct a comparative study of topographic, anatomical and morphometric features of fallopian tubes in the late fetal period and in the first year of postnatal ontogenesis.

Materials and methods. The uterine tubes (autopsy material) of 6 fetuses of 37-40 weeks of intrauterine development and 6 girls aged 0 to 1 year died from causes not related to pathology of genital organs and malformations served as the material for the study. The length of the right and left fallopian tubes was measured using the organometric method, and the linear dimensions of the main structural components of the fallopian tube walls were determined using the morphometric method.

Results. The most significant changes in the thickness of the fallopian tube layers were observed on the serosa/adventitia side in all parts of the organ. When comparing fetuses and children of the first year of life, the greatest increase in the thickness of the serous/adventitial membrane was observed in the isthmus and ampulla of the organ, and the least – in the intramural part. The thickness of the muscularis of the fallopian tube, starting from the late fetal period and up to the first year of life, increases 4 times in the isthmus of the organ and 3.5 times in the ampulla. The appearance of lymphocytes in the epithelium of the fallopian tubes in infants has been established.

Conclusion. Intensive growth of all uterine tube layers has been established, which is associated with the cessation of haematotrophic nutrition and transition to enteral type of nutrition, as well as with the change in the type of respiration.

Intraepithelial lymphocytes appeared when comparing the features of histogenesis of the epithelial layer of the fallopian tube mucosa in infants and 37-40 weeks fetuses. The appearance of lymphocytes in the epithelial lining is associated with birth (change of habitat) and formation of own local immunity.

Objective. Сompare gender differences in the component composition of the body of primary school children aged 7-10 years.

Materials and methods. 96 schoolchildren aged 7-10 years (46 boys and 50 girls) were examined at the gymnasium No. 56 in Gomel. Body composition indicators were determined in pipils using bioimpedance research: body mass index (BMI), fat mass (kg), proportion of fat mass (%), lean mass (kg), cell mass (kg), proportion of cell mass (%), musculoskeletal mass (kg), proportion of skeletalmuscle mass (%), total fluid (kg), extracellular fluid (kg), intracellular fluid (kg), basal metabolism (kcal/day).

Results. As a result of the study, it was found that 7-year-old boys showed a decrease in BMI compared to the norm (p<0.05), while girls had no significant differences. The body mass index in 8-year-old girls was below normal values and significantly lower compared to boys (p<0.01). In boys of all studied groups, compared with girls, the studied indicators were significantly higher (p<0.01). In 10-year-old pupils, in contrast to children of other study groups, gender differences were observed in the value of basal metabolic rate: which was significantly higher in boys by 16% (p=0.02).

Objective. To assess the detection frequency of rare (minor) enteric viruses in patients with acute gastroenteritis in the capital region of the Republic of Belarus, and to study the prevalence of them in general population based on wastewater analysis, with the subsequent establishment of their genotypes.

Materials and methods. Acute gastroenteritis (AGE) of viral etiology is caused by a wide range of different viruses, the prevalence of individual types of which varies significantly in different countries. 235 fecal samples of acute gastroenteritis (AGE) patients and 233 wastewater samples were analyzed during 2022. Detection of rotaviruses (RV), noroviruses of genogroups 1 and 2 (NoV 1 and 2), adenoviruses F (AdV), enteroviruses (EV), astroviruses (AsV), sapoviruses (SpV), parechoviruses (PEV), bocaviruses (BoV) and aichi viruses (AiV) was performed with “real time” multiplex PCR. Genotypes of BoV, AsV, SpV were determined by use of type-specific PCR and sequencing.

Results. It was found that RV (61.3%), NoV2 (14.5%) and AdV (12.8%) were predominant in patients with AGE, and minor viruses were detected in a total of 6.4% of patients. AdV (33.6%), BoV (31.4%), RV (11.7%) and AsV (6.7%) were most frequently detected in wastewater. Molecular genetic typing of BoV, AsV, SpV made it possible to determine the circulation of the following genotypes: BoV genotypes HBoV-1, HBoV-2, HBoV-3, AsV genotype HAsV-1 and SpV genotype HuSpV GI.2.

Conclusion. The obtained results indicate that, despite the low frequency of detection of BoV and AsV in patients with a clinical diagnosis of AGE, they widely circulate in the population and may be the cause of AGE mild cases that have not seen by infectologists and for which laboratory diagnostics have not been carried out.

Objective. To evaluate the respiratory activity of tissue fragments of the small intestine of rats on endogenous and exogenous substrates under conditions of internal irradiation.

Materials and methods. The study involved 16 white male rats weighing 180-250 grams. The experimental group of animals received radioactive feed for 30 days, the control group was kept on a standard vivarium diet. The parameters of energy metabolism were studied by polarography on a Record 4.

Results. A decrease in tissue respiration indices of the small intestine of rats under conditions of internal irradiation with the incorporation of 137Cs by 32% of the control group was established. Succinic and glutamic acids had a stimulating effect on mitochondrial oxidation of the tissue of intact and experimental animals. Dinitrophenol did not show an uncoupling effect on oxidative phosphorylation in the experimental group. Incoupling was observed under the action of dinitrophenol and the intensity of respiration increased In the control group.

Conclusion. The study of the internal irradiation effect on the respiratory activity of tissue fragments of the small intestine of rats in doses actually possible in the population showed high sensitivity of the mitochondrial oxidation system and significant changes in the ratio of oxidized substrates under the influence of incorporated 137Cs. The study showed that the chosen method allows determining the negative impact of internal irradiation on the energy function of the small intestine. Timely detection of disturbances in the energy metabolism of intestinal tissue will optimize the treatment of intestinal pathologies, work out measures to prevent development of destructive processes when using radiotherapy of abdominal organs.

Objective. To conduct a system-structural analysis of the causes and indicators characterizing the dynamics of mortality among the elderly population of Gomel city and Gomel region.

Materials and methods. The source of the research was the data of the National Statistical Committee of the Republic of Belarus on the population in Gomel region, based on which the indicators of the dynamics and mortality of the elderly population (men over 60 years old, women over 55 years old) were calculated, its causes were identified using the International Classification of Diseases of the 10th revision (ICD-10). Statistical data processing was carried out by using SPSS v.20.0 (IBM, USA) and Excel, 2013 (Microsoft, USA).

Results. For the period from 2012 to 2017 it was a steady growth of the population over the working age in Gomel city and Gomel district. However, it stopped after 2017, and this indicator remained almost at the same level up to and including 2019. The number of deaths among the elderly population had a weak increasing tendency (p=0.056), primarily due to such reasons as diseases of the cardiovascular system (26.88% in 2019), neoplasms and symptoms, signs and deviations from the norm identified in clinical and laboratory studies. Similar results were obtained when analyzing data in general for Gomel region.

Conclusion. The systematic and structural analysis revealed an urgent need for development and implementation of comprehensive coordinated approaches to provision of primary medical and social care to the elderly people. This will be facilitated by a systematic and structural analysis of the causes and dynamics of mortality on a regular basis, the results of which can be used for developing measures aimed at improving quality of life and preventing premature mortality of the elderly people.

Objective. To carry out predictive assessment of the content of radionuclides in environmental components and the effective radiation dose of the rural population living in the zone of distribution of regular emissions of nuclear power plants with VVER-1200 reactors.

Materials and methods. The initial data were the activity of the permissible annual emission of a typical nuclear power plant with 4 VVER-1200 reactors. An assessment of the content of radionuclides in the surface layer of air, the root layer of soil, basic foodstuffs and the radiation dose of the rural population at various distances from the NPP was carried out based on the IAEA’s methodological recommendations.

Results. The average long–term volumetric activity of radionuclides in the surface air layer is predicted at a distance of 1-2 km from the NPP and can reach 0.7 Bq/m3 for ¹³³Xe, 0.2 for ³H and ⁸⁸Kr, units-tenths of μBq/m³ for radioisotopes of caesium and iodine. Over 30 years of NPP operation, the density of contamination of the root-inhabited soil layer at a distance of 1-2 km from the NPP is predicted to be ~5 Bq/m² according to ¹³⁷Cs. In food, the content of ³H and ¹⁴C can reach units of Bq/kg, and radioisotopes of caesium – tens of mBq/kg. The average long–term effective radiation dose of the rural population at a distance of ~1 km from the NPP is estimated at ~1.4 μSv/year, 3 km – 0.7, 10 km – 0.15 and at the border of the 30-kilometer zone – 0.5. At the same time, the contribution of internal radiation to the effective dose reaches 70% of the oral intake of radionuclides, the main dose-forming radionuclides are ³H and ¹⁴C.

Conclusion. With regular emissions of nuclear power plants, the effective radiation dose of the rural population will be ~1.4 μSv/year at a distance of ~1 km from the NPP, which is significantly lower than the permissible for the population according to NRB-99/2009 (1 mSv/year), the quota for irradiation of the population from aerosol emissions of an operating NPP (200 μSv/year) and the minimum a significant dose (10 μSv / year).

Objective. To analyze annual effective radiation doses of the Polesie State Radiation and Ecological Reserve (PSRER) staff over a period of 2021-2022, and identify the factors causing differences in these indicators among various categories of enquired personnel.

Materials and methods. The results of 840 measurements of external and internal radiation doses (obtained respectively by the method of thermoluminescent dosimetry and based on WBC measurements) for the period from 2021 to 2022 were studied. Professional, gender and age differences in personnel radiation dose were specified using nonparametric statistics methods by comparing two independent samples, as well as using one-way analysis of variance.

Results. The median annual effective dose of radiation for PSRER employees was 1.14 mSv/year in 2021-2022. The highest value of external radiation dose is typical for forestry workers, it is statistically significantly higher compared to executives (p<0.05), specialists (p<0.05), workers (p<0.05), service personnel (p<0.05), drivers (p<0.05), engineers (p<0.05) and researchers (p<0.05).

The age factor has a significant impact on dose indicators: for workers aged 59–72 years, the parameters of the annual effective dose are the highest and significantly exceed the doses of workers aged 18-26 years (by 29%) (p<0.05). Higher annual effective dose rates were found in men compared to women (1.2 times, p<0.05).

Conclusion. Analysis of radiation doses on employees of the PSRER made it possible to reveal the greatest influence of professional and gender factors on the annual effective dose and effective external exposure dose

Objective. To analyze suicidal activity among the population of Gomel region over a period of 2018-2024.

Materials and methods. An analysis of suicidal activity in the population of Gomel region over a period of 2018-2024 was carried out according to protocols of absentee interdepartmental analysis of suicide death cases, as well as cases of death from external causes with signs of suicide. All personal data of patients is encoded, and actions are carried out within the legislation of the Republic of Belarus.

Results. Male gender was noted in the protocols among the presumed risk factors that caused suicide. Thus, 1204 cases (83,09%) of suicides during the study period were committed by men, 245 (16,91%) suicides occurred among women. The average age of this persons’ category was 51,24 (+/-17,50, 52,00 [38,00; 63,00] [11,00; 100,00], n=1208) years old, of which 740 (51,1%) were people of working age. Taking into account the information received, in 555 (56,0%) cases the suicide person was a city resident. 138 people (42,72%) were married, 87 people (26,93%) were unmarried, 67 people (20,74%) were divorced, 31 (9,6%) were widowers. However, the distribution of suicide victims by maintaining a joint household showed that 102 citizens (31,19%) lived alone. A study of the employment indicator showed that 302 (47,26%) people did not have a permanent place of work.

Conclusion. To improve the situation with suicide at the governmentwide level, it is necessary to put into practice the following measures: create a permanent interdepartmental group responsible for monitoring and improving the quality of data on suicide, regularly assess the availability and completeness of data on suicide and suicide attempts, organize work on monitoring suicide not independently, but at the governmentwide level with the involvement of prevention subjects.

The article presents a case of diagnosis of eosinophilic granulomatosis with polyangiitis, Churg-Strauss syndrome. The staged course of the disease is being described, attention is being focused on hemoptysis, systemic symptoms, as well as on the expediency of antibodies detection to the cytoplasm of neutrophils (ADCN) in recurrent pneumonia and verifying significance of the biopsy.

The objective of the article is to sort out the impact of comorbidity of extragenital diseases (EGD) on the women’s health during pregnancy, as well as on the course of pregnancy in order to prevent and early complication diagnosis.

Extragenital diseases (EGD) is a large group of multiple and diverse diseases, syndromes, conditions in pregnant women, combined only by the fact that they are not gynecological diseases and obstetric complications of pregnancy [1]. EGD includes a number of diseases, and it is important for clinical purposes to divide it into a significant and minor. Minor types of EGD include those diseases or conditions in which maternal and perinatal mortality rates, the incidence of complications of pregnancy, childbirth and the post-partum period, and perinatal morbidity do not differ from general population. In other words, these are diseases incidence of which has a little impact on course and outcome of pregnancy, the state of the foetus and the newborn. A significant EGD is a large group of diseases or conditions that affect the above-mentioned indicators to varying degrees. The main risk of EGD is that it may cause maternal death [1].

The article presents the clinical case of comorbidity of extragenital diseases in pregnancy, analyzes the literary sources, clinical data, and the results of laboratory and instrumental research.

Objective. To demonstrate a clinical case of atypical ankylosing spondylitis.

Materials and methods. Retrospective analysis of the medical history of a patient hospitalized in the Rheumatology Department of Gomel City Clinical Hospital No. 1.

Results. Ankylosing spondylitis is one of the most difficult to diagnose causes of specific pain in the lower back. The medical and social significance of the disease lies in a high level of disability of young people, and in a decrease in the quality of patients’ life. There are no specific diagnostic markers of spondylitis at an early stage of the disease. The reasons for the late diagnosis of the disease are the untimely arrival of patients for medical help, the asymptomatic course of ankylosing spondylitis, and insufficient knowledge of the diagnostic criteria of the disease by doctors.

The article presents a clinical case of atypical ankylosing spondylitis in a young patient with no signs of systemic inflammation and classic manifestations of the disease.

Conclusion. Targeted examination of the lumbosacral spine and sacroiliac joints should be recommended for patients with pain in the lower back in order to verify ankylosing spondylitis.

This article presents a clinical case of a rare soft tissue tumor, chondroid lipoma of the right leg, characterized by a complex morphological structure with myxoid areas, lipoblast-like cells, and zones of ossification. Despite histological similarities with chondroblastoma, parosteal osteochondromatous proliferation, myxoid liposarcoma, and chondrosarcoma, immunohistochemical (IHC) analysis and correlation with clinical and instrumental data allowed these pathological processes to be excluded.

Chondroid lipoma is a rare benign tumor, and its complex structure and potential for ossification can pose significant challenges in differential diagnosis. This case emphasizes the importance of a comprehensive approach, combining morphological, clinical, and imaging data, for the accurate diagnosis of rare bone and soft tissue tumors.

Objective. To establish the composition of microbiome and select target taxa of upper respiratory tract biomaterial in order to apply the results in the model of diagnosis of Congenital pneumonia (ICD – 10 P23), based on a microbiome-associated approach to providing medical care to premature newborns.

Materials and methods. The study group consisted of 154 premature newborns. The sampling was carried out in the first 5-15 minutes of life with a sterile probe swab. The composition of the upper respiratory tract microbiota in newborns was determined by the new generation sequencing method. Statistical data processing was carried out in the R programming environment (version4.3.1), the RStudio program (2023.09.1+494). The significance level is assumed to be 0.05.

Results. According to the sequencing results, the genera Brucella (≥5.8%), Achromobacter (≥3.1%), Ralstonia (≥0.3%), Stenotrophomonas (≥9.0%), Klebsiella (≥0.02%), Pseudomonas (≥1.5%) in children with chronic intrauterine hypoxia were proposed to be used in the model of diagnosis of “Congenital pneumonia” (ICD – 10 P23) as a part of microbiome-associated approach to providing medical care to premature newborns. A combination (Pseudomonas + Klebsiella) has been isolated molecularly and genetically, which is significantly predominant in the group of premature newborns with a verified diagnosis of Congenital pneumonia.

Conclusion. Development of a microbiome-associated approach to providing medical care to premature newborns with congenital pneumonia will reduce the time spent on diagnostic search, and allow conduct therapy that meets the principles of personalized medicine.