The article analyzes the use of polymer materials for solving problems of theoretical and practical medicine. The effectiveness of the use of polymers in reconstructive cardiac surgery, radiation therapy, etc. has been shown. The basic requirements set for polymers and composites for medical devices have been identified. The most important criterion for the selection of polymers is the safety of their use in clinical practice and their ability to biodegrade when they enter a living organism along the usual metabolic pathways in the absence of inflammatory and allergic reactions of surrounding tissues during longterm followup care.

The literature review highlights modern notions of dizziness. There are three types of the onset of chronic dizziness: originating from vertigo, chronic imbalance, and the one with unknown onset. Foreign researchers mention the most common type of chronic dizziness - persistent postural-perceptual dizziness, which has clear diagnostic criteria. The article considers the causes of occurrence, features of the clinical course, methods of diagnosis, and treatment of dizziness. Some guidelines for the management of patients with this disorder have been given

These article presents the results of an analysis of literary sources dealing with the problems of traumatic brain injury. All the analyzed articles were published in 2019 and placed in the PubMed database. The aim of the article is to analyze the results of recent studies dedicated to the investigation of this problem, acquaintance with the latest trends in this area.

Objective: to determine a complex of the most significant prognostic factors in chronic lymphocytic leukemia (CLL) for the purpose of evaluation of the probability of the disease progression. Material and methods. The study included 127 CLL patients whose clinical and laboratory parameters (sizes of the lymph nodes, liver and spleen, general and biochemical blood tests, β2-microglobulin, thymidine kinase, tissue polypeptide antigen (TPA), immunophenotypic markers) had been evaluated at the setting of the diagnosis. As a result of a dynamic followup, the patients were divided into 2 groups: 71 patients who had been observed in the outpatient setting and had had no signs of CLL progression within 3 years of the followup (group 1), and 56 patients with clinical signs of the disease progression that had manifested themselves after 3 years of the followup (group 2). Results. The study has revealed statistically considerable differences (Mann-Whitney test) between the groups in the size of the lymph nodes, liver and spleen, in the Binet stages, leukocyte count, absolute values of lymphocytes, the counts of red blood cells, hemoglobin and platelets, as well as the levels of β2-microglobulin, thymidine kinase, TPA, and immunophenotypic markers of CD24, ZAP-70, and CD38 in the blood, which indicates the interconnection of the levels of these parameters at the setting of the diagnosis with subsequent rapid CLL progression. According to the results of the use of logistic regression and Cox regression analysis, 10 parameters showing the strongest interconnection between the progression and 3-year progression free survival (PFS) have been selected. The use of the step-by-step selection of variables has made it possible to formulate a qualitative Cox regression equation including 5 main parameters: β2-microglobulin, thymidine kinase, TPA, ZAP-70, and CD38, which is indicative of the possibility to use this combination of the markers to predict CLL progression. Conclusion: The prognostic value of the complex of the laboratory parameters (β2-microglobulin, thymidine kinase, TPA, ZAP-70, and CD38) has been determined to assess the probability of CLL progression at the setting of the diagnosis, which can be used for the determination of the management tactics and selection of the treatment scheme for these patients.

Objective: to evaluate the results of minimally invasive surgical treatment of congenital idiopathic clubfoot and its relapses in children. Material and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot (main group) over the period of 2010-2018 were analyzed in comparison with the results of the treatment of 41 children with relapsed congenital clubfoot, the primary treatment of which had been performed before 2010 (comparison group). Results. It has been found that in the treatment of congenital clubfoot using the Ponseti method relapses occur in no more than 21.79 % cases, and in traditional treatment - in 57.74% cases. The surgical treatment of the relapses using the Ponseti method is to perform release operations on the tendon-ligament apparatus from minimally invasive accesses, whereas cases of rigid chronic deformities require extensive releases on soft tissues, as well as resection-arthrodesis interventions on the joints of the foot. Conclusion. In the treatment of children with congenital clubfoot using the Ponseti method, the rate of relapses is twice as low as that in the application of traditional methods. Relapses in the treatment of congenital clubfoot in children occur mainly at the age of 5. Repeated relapses of foot deformation after the performance of minimally invasive operations did not occur during the study.

Objective: to assess the efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children by means of the performance of the comparative analysis of perioperative adverse events and complications, consumption of the inhalation anesthetic sevoflurane and the cost of anesthesia, and also the course of the early postoperative period. Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with 0.25% bupivacaine solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of 0.25% bupivacaine solution and adjuvant (group 3, n = 45). Results. The performed analysis has not revealed any statistically significant distinctions in the assessment of anesthesia complications but it has found some significant distinctions in the consumption of sevoflurane, depth of anesthesia and its cost, as well as the necessity for postoperative anesthesia and introduction of analgesics, which testifies to the efficiency and safety of combined anesthesia and its economic benefit. Conclusion. The most effective, safe, and economically reasonable is the technique of combined anesthesia with the application of caudal blockade with local anesthetic solution and 0.1% adjuvant of morphine solution during surgical correction of congenital malformations of the lower parts of the urogenital system in children.

Objective: to identify clinical and laboratory features of common variable immune deficiency (CVID) in different age groups of patients. Material and methods. The clinical and anamnestic characteristics of 36 patients (16 men and 20 women) aged 15 to 65 (the average age was 37.0±12.7) diagnosed with CVID were studied. Results. Among the examined patients the disease was manifested at the mature age in 25 people (69.4 %) - the 1st group, while in 11 people (30.5 %) the debut of the disease occurred during childhood (from 4 to 17) - the 2nd group. Among the patients of the first group, the greatest number of cases (10 cases, 40.0 %) was found at the age of 20-30; in the children's age group, the greatest number of cases (8 cases, 72.7%) occurred at the age of 13-17. Non-infectious manifestations were significantly more common in adult patients at the onset of the disease (64 %; χ² = 15.68; p < 0.001). Infectious and inflammatory diseases of the ENT organs and respiratory tract were observed with the same frequency in both the groups. Children significantly more often than adults (72.7 %; χ² = 26.6; p < 0.001) observed a deficit in the three classes of immunoglobulins (Ig) (IgA, IgM, and IgG), whereas in patients with CVID manifestation in adulthood, the concentrations of IgA and IgG were mainly reduced, and meanwhile the degree of the decrease in the immunoglobulin level was more pronounced (72.0 %; χ² = 14.47; p < 0.001). Conclusion. Significant differences in the clinical and laboratory parameters of CVID manifestation in the patients depending on age have been revealed.

Objective: to assess the parameters of echocardiography, structure of cardiovascular pathology in patients suffering from morphea. Material and methods. The echocardiographic data and cardiovascular pathology were studied in 74 patients with morphea. Results. Diastolic dysfunction of the left ventricle was revealed in 37.5 % of the morphea patients, dilatation of the left atrium was found in 10.8% of the patients, pathological regurgitation on the aortic valve - in 21.62 %. 86.5 % of the patients had morphea combined with arterial hypertension. Conclusion: Such comorbid pathologies as arterial hypertension, dilatation of the left atrium, pathological regurgitation on the aortic valve and left ventricular diastolic dysfunction are common for patients with morphea.

Objective: to develop standardized methods for performing diagnostic blockades increasing their effectiveness in lumbosacral ligamentoses. Material and methods. The study included the results of sonographically controlled blockades of the iliolumbar (66 patients), posterior long sacroiliac (126 patients), and sacrotuberal ligaments (25 patients). All of the patients had manifestations of low back pain syndrome. Results. The use of the standardized method of therapeutic and diagnostic blockades in all the patients with ligament-induced low back pain syndrome led to a marked decrease in the intensity of the pain syndrome and allowed verification of its cause. Conclusion. Sonographically controlled blockade of the iliolumbar, posterior long sacroiliac, and sacrotuberal ligaments is an effective way to verify and treat low back pain syndrome in lumbosacral ligamentoses.

Objective: to analyze cosmetic results following reconstruction of nasal alar defects using cheek skin flaps. Material and methods. The results of 29 operations were analyzed. The reconstruction was performed with nasolabial flaps and jigsaw puzzle flaps. The cosmetic outcomes were evaluated by the five-point scale by means of patient-report and specialist-report questionnaire. Results. Acceptable overall outcomes were achieved in 22 cases according to the experts’ assessment and in 24 cases according to the patients’ assessment. The highest scores were noted for alar color and position, and the lowest scores - for alar size, shape, and nostril size. The complication rate was 11.1 %. Delayed surgical corrections were undertaken in 10 patients. Conclusion. The reconstruction of full thickness nasal alar defects using cheek skin flaps made it possible to achieve acceptable outcomes with minimal donor site damage in the majority of the patients.

Objective: to assess the species diversity and frequency of detection of nontuberculous mycobacteria (NTM) in patients of antituberculous organizations in Gomel region. Material and methods. 1057 isolates of mycobacteria were analyzed. To identify the species of the mycobacteria, phenotypic and molecular genetic studies of the isolates were performed. Results. A total of 13 NTM types have been identified. The most common were M. avium and M. intracellulare (MAC complex) - 63.7 % (60.79-66.67), followed by M. gordonae and M. fortuitum (7.66 %; 6.13-9.43 and 7.57 %; 6.05-9.33, respectively). Multiple isolation of NTMs of one species (from 2 or more samples) was observed in 190 patients, which amounted to 37.4 % of all the patients. In 75.3 % of the cases, MAC was obtained (χ² = 97.01; p <0.001). The second place in terms of etiological significance was occupied by M. xenopi (6.43 %), the third one - by M. gordonae (5.3 %). Conclusion. Out of 13 identified NTMs, the most common causes of the development of mycobacteriosis were MAС complex, M. xenopi , M. gordonae .

Objective: to analyze the neurodynamic indicators of the sensorimotor response of primary school age children with orthophoria and heterotropia. Material and methods. 51 children (102 eyes) aged 6-11 were examined. 2 groups that could be compared in terms of age and sex were formed. The first group consisted of 20 patients (40 eyes) with orthophoria associated with moderate hypertropia of Hm 3.5 (2.3; 5.3) diopters, the second group included children with concomitant convergent strabismus associated with moderate hypertropia of Hm 4.25 (2.0; 6.5) diopters - 31 patients (62 eyes). To study the properties of the nervous system (NS), the computer appliance «NS-Psychotest» (LLC «Neurosoft», Ivanovo, http://neurosoft. com/ru) was used. The neurodynamic indicators of the sensorimotor response were identified with the techniques «Simple Visual Motor Response» (SVMR), «Discrimination reaction» (DR), «Moving Object Response» (MOR), «Critical Flicker-Fusion Frequency» (CFF). Results. Concomitant strabismus in the children of the second group reliably leads to an increase in the time of SVMR, DR by 65.5 ms and 42.4 ms, respectively (p < 0.05), in comparison with the group of the children with orthophoria. The difference between the indices of DR and SVMR in the children of group 1 - 51.5 ms, of group 2 - 28.4 ms, verifies a decrease of the rate of the neurodynamic processes of the NS in the children with heretotropia. In the study with the MOR technique, the time of response in the first group was - -31 (-127; 50) ms, in the second group - 22 (-29; 94) ms (р = 0.000008), a positive value of the indicator of the response time in the children of the second group is a consequence of the prevalence of inhibition processes in the central nervous system in most the examined patients. Conclusion . The obtained results show that the presence of heterotropia in the children of the second group reliably leads to decreased mobility of nervous processes and predominance of inhibition processes in the central nervous system. The combination of the low velocity of the response and expressed inertness of nervous processes in the children of the second group are indicative of a lack of coordination of the interrelations between the centers of the visual and motor analyzers.

Objective: to identify the features of modeling and give a morphofunctional assessment of the course of experimental myocardial infarction (EMI) in rats within the first 48 hours after ligation of the left coronary artery (LCA). Material and methods. EMI was reproduced according to the method of H. Selye [1] in Jian Ye`s modification [2] by means of LCA ligation in 24 Wistar rats. Electrocardiographical, histological, biochemical studies were performed. The control group consisted of 7 falsely operated animals in which the chest had been opened without manipulation on the LCA. Results. 5-15 minutes after LCA ligation, an ischemic change in the (Q)RST complex was observed as a monophasic curve. The Q wave appeared on the EGG after 1 hour of EMI in 20% cases, after 7 hours in 88% cases, in 100% cases after 27 hours and remained by 48 hours of EMI. Histologically, within the first 7 hours there was acute alterative myocardial damage followed by a quantitative increase in diffusely located necrotic cardiomyocytes (CMC) by 27 hours and the appearance of a clear zone of coagulation necrosis by 48 hours; which was accompanied by corresponding changes in the level of troponin I. Conclusion. The course of EIM after LCA ligation is characterized by the staging of myocardial changes similar to that in humans, which provides a prerequisite for possible extrapolation of the results of the studies to humans.

Objective: to study the prevalence of non-conventional risk factors among patients with chronic obliterating diseases of lower limb arteries.

Material and methods. To identify the non-conventional risk factors among patients, the Hospital Anxiety and Depression Scale (HADS), DS-14 questionnaire were used. The survey included 250 patients with chronic obliterating diseases of lower limb arteries (men - 192 patients (76.8 %), women - 58 (23.2 %). The statistical analysis of the data was carried out by means of the program «Statistica» 8.0. Differences between the groups were considered as statistically significant at p < 0.05.

Results. Anxiety symptoms were observed in 53.2 % of the patients. The average HADS-A subscale score was 8.0 (5.0; 9.0) points. Symptoms of hospital depression were observed in 38.4 % of the patients. The average HADS-D subscale score in all the patients was 6.0 (4.0; 9.0) points. Personality type D was detected in 51.2 % of the patients.

Objective: to evaluate the experience and possibilities of the use of eHealth technologies during the pandemic.

Material and methods. A systematic review of literature containing information about the use of telemedicine, crowdsourcing monitoring and other eHealth resources during the COVID-19 pandemic was performed.

Results. The main advantages and disadvantages of the use of eHealth technologies have been highlighted, the main problems arising on the way of their implementation have been identified and options for their solution have been proposed.

Conclusion. In developed countries the COVID-19 pandemic has already accelerated the implementation of eHealth as a tool to combat the pandemic. But despite this, new laws and regulations governing liability in the field of remote treatment are needed, as well as guidelines regarding the use of crowdsourcing disease monitoring systems in addition to traditional epidemiological surveillance systems.

Objective: to develop a healthcare organizational model of secondary prevention of cervical cancer.

Material and methods. The work analyzes the quality of medical care given to women of reproductive age living in Grodno region in whom cases of cervical intraepithelial neoplasia and cervical cancer were detected from 2010 to 2019. On the basis of the results of questioning of 200 women who had been treated in Oncology Ward No.3 of Grodno University Clinic, the most significant risk factors of the development of the pathology were identified. Statistical processing was performed by means of the program «Statistica» 10.0.

Results. An effective model of secondary prevention of cervical cancer has been developed: from 2015 to 2019 compared to the previous quinquennium the detectability of cervical intraepithelial neoplasia and non-invasive cervical cancer increased by more than 17 % and 25 %, and the average parameters of the newly diagnosed morbidity were 69.97 ± 2.42 and 19.91 ± 2.28 per 100,000 women of reproductive age (p < 0.05). This made it possible to take timely measures for carcinogenesis interruption.

Conclusion. The implementation of the healthcare organizational model of secondary prevention of cervical cancer contributes to improvement of the quality of medical care, and, therefore, maintainance of perspective realization of the child-bearing function for women of reproductive age.

Objective: to study the effect of non-conventional risk factors on the progression of peripheral artery diseases.

Material and methods. The study involved 250 patients (76.8 % men (192 patients) and 23.2 % women (58 patients)). The non-conventional risk factors among the patients were identified using the «Hospital Anxiety and Depression Scale» (HADS), «Scales for assessing the level of reactive and personal anxiety» (Ch. D. Spilberger, Yu. L. Khanin). The degree of chronic arterial insufficiency was determined in accordance with the classification of Pokrovsky-Fontaine (1985). The statistical analysis of the obtained data was performed by means of the «Statistica» 8.0 program, using the Pearson χ2 criterion. Differences between the groups were considered statistically significant at p < 0.05.

Results. A high prevalence rate of personal (95.2% of the patients) and reactive (91.6 % of the patients) anxiety has been revealed among patients with peripheral artery disease. Higher levels of personal and reactive anxiety have been found among patients with critical ischemia threatened by limb loss (group 3) (46.0 (41.0; 50.0); 47.0 (43.0; 51.0), respectively) compared with the values in groups 1 and 2 of the patients.

Objective : to study the severity and analyze the causes of burnout syndrome in doctors of various specialties.

Material and methods . A survey of doctors in which 331 respondents took part was conducted in health care institutions of the Republic of Belarus. The validated method for burnout diagnosis - «Maslach Burnout Inventory» - was applied. The questionnaire includes a general part (questions regarding sex, length of service, place of work, and chosen specialization); 22 questions evaluate burnout syndrome according to 3 domains: «Emotional exhaustion», «Depersonalization», «Reduction of professional achievements»; 14 questions identify possible causes that contribute to the development of burnout syndrome. The study involved doctors of various specialties (obstetrician-gynecologist; anesthetist-resuscitator; general practitioner; pediatrician; ambulance doctor; surgeon). The sociological and statistical methods were used.

Results . The integral index of burnout syndrome for obstetrician-gynecologists (n = 50) was 65.3 points; for anesthetist-resuscitators (n = 46) - 83.1 points; for general practitioners (n = 74) - 71.8 points; for pediatricians (n = 66) - 62.5 points; for ambulance doctors (n = 42) - 86 points; for surgeons (n = 53) - 69.8 points.

Conclusion . Currently, there is a tendency towards an increase in the burnout syndrome rate among all the groups of specialists. The highest indices are observed in the groups of ambulance doctors and anesthetist-resuscitators. At the level of health care insitutions, in order to mitigate the burnout risk factors, the optimization of the organizational environment should include the following criteria: availability of prospects for financial and professional growth of doctors, corporate development and effective leadership; effective trade union management; professional, legal and administrative support of doctors.

Objective: to conduct a sociological study aimed at identifying the «primary» bioethical notions of the first-year and six-year students of the Faculty of General Medicine of the educational institution «Gomel State Medical University».

Material and methods. The results of a survey of 115 first-year students and 114 six-year students of the Faculty of General Medicine were analyzed.

Results. The survey has revealed statistically significant differences in the responses of the first- and six-year students to questions regarding the use of the human body or its separate organs and tissues for purposes of practical medicine or biomedical research ( χ² = 5.27; p = 0.022), personal social status as the basis for making decisions about any medico-biological manipulation ( χ² = 9.33; p = 0.002), necessity of the present-day form of human biological existence in future ( χ² = 6.51; p = 0.011), acceptability of separating personal consciousness from the physical body for the human society in future ( χ² = 4.23; p = 0.04), necessity to take a special «oath» to perform professional activities in everyday medical practice ( χ² = 8.92; p = 0.003).

Conclusion. The results of the study have shown that the first-year students have no clearly formed system of bioethical notions of living beings and possibilities for medical manipulations with them due to the lack of essential relevant knowledge. The sixth year students demonstrate more conscious answers to the questionnaire questions, which indicates the presence of theoretical knowledge and formation of their bioethical outlook for the subsequent development of practical skills for making moral decisions on this basis.

Objective: to identify possible genetic variants of Mycoplasma pneumoniae in a glycerol-3-phosphate oxidase gene fragment corresponding to the FAD binding domain of the enzyme, and to study their pathogenic properties.

Material and methods: The material for the obtainment of Mycoplasma pneumoniae isolates was sputum, epithelial cell scrapings from the nasopharynx, tracheobronchial secretion from 85 children and adolescents diagnosed with bronchitis and pneumonia and detecting Mycoplasma pneumoniae DNA. The isolation of Mycoplasma pneumoniae from the clinical material was proceeded in a mycoplasma medium without an energy source. The DNA isolation from the biological material and from the culture fluid was performed by the method of sorption extraction. The sediment of the cellular elements of the sputum was used for the DNA extraction with the use of the CTAB reagent.

Results. Synonymous and non-synonymous nucleotide substitutions have been identified in 54 clinical isolates of Mycoplasma pneumoniae . It has been found that the amino acid substitutions His51Leu and Asp55His are essential for the realization of the pathogenic potential of the Mycoplasma pneumoniae isolates associated with the production of hydrogen peroxide.

Conclusion. The A152T (His51Leu) and G163C (Asp55His) substitutions were identified in the G3P oxidase gene of the Mycoplasma pneumonia clinical isolates, and their presence was associated with the variability in the activity of the enzyme. The Mycoplasma pneumoniae isolates carrying the A152T substitution (His51Leu) produced hydrogen peroxide in significantly lower amounts (5 mg/l) in comparison with the reference strain (10 mg/l) and had reduced cytotoxicity in relation to respiratory epithelial cells. The Mycoplasma pneumoniae isolates carrying the substitution G163C (Asp55His) were characterized by enhanced pathogenic properties, such as increased production of hydrogen peroxide (25 mg/l) and more pronounced cytotoxicity towards respiratory epithelial cells.

Objective: to identify associations between clinico-morphological and molecular-genetic markers in skin biopsy on the basis of a complex analysis.

Material and methods. Skin punch-biopsies with a diameter from 1 till 4 mm were used as a material for research. To assess the morphological charcateristis of the skin, the histological analysis was carried out; to assess the level of gene expression, real time PCR with reverse transcription was performed.

Results. It has been found that the presence of morphological alterations in the skin of patients with chronic dermatosis is associated with the levels of normalized expression of СOL1A1 gene less than 100 % and/or gene COL1A2 gene less than 200 % and/or gene LOX less than 50 %.

Conclusion. Real time PCR with reverse transcription can be used for objective assessment of the degree of skin alteration in patients with chronic dermatosis.

Objective: to identify the difference of the numerical values of parameters characterizing the geometric and mechanical (adhesive) properties of inorganic nanosized particles and nanosized particles of biological origin by atomic force microscopy using the mode of the mapping of surface features at nanosized resolution.

Material and methods. Exosomes isolated from the blood of Af mice by the method of sequential ultracentrifugation were used as bionanoparticles. Silver nanoparticles were used as inorganic nanoparticles. The nanoparticles were scanned in air with the help of the BioScope Resolve (Bruker) atomic force microscope in the PeakForce QNM in Air mode with the recording of the maps of adhesion forces and imaging of the topography of the studied surfaces.

Results. The silver nanoparticles and exosomes had similar but statistically different diameters (45.59 ± 1.04 nm and 41.25 ± 0.91 nm, р < 0.001 t-test). Nevertheless, the silver nanoparticles were characterized by higher values of both height and free surface area in comparison with the corresponding values of the exosome parameters. This leads to a higher value of the spreading ration for exosomes (the average ratio of diameter to height (d/h) was 11.78 for exosomes and 6.67 for nanoparticles (p < 0.001, Mann-Whitney U test) due to greater adhesion properties of the exosome membranes compared to the silver nanoparticles and a lower value of the ratio of the particle volume to its surface area. Averaged over the nanoscale areas of the nanoparticle surface, the adhesion forces of exosomes were higher (3.2 ± 0.57 nN) compared to those of silver nanoparticles (2.2 ± 0.03 nN, p < 0.05, Mann-Whitney U test).

Conclusion. The differences in the parameters of the geometric (diameter, height, free surface area) and mechanical properties (adhesion forces) of the silver nanoparticles and exosomes have been revealed, which allows identifying and differentiating of these nanoparticles by the methods of atomic force microscopy during the study of complex biological fluids with possible content of both the types of nanoparticles.