The article covers problematic aspects of the management of local wound defects in patients with diabetes mellitus, analyzes and summarizes modern data of national and foreign researchers in this area.

Objective: to access (according to data of literature references) mechanisms of development of neuropathic pain in osteoarthritis and methods of its management. Material and methods. Analysis of publications containing information on neuropathic pain in osteoarthritis which are stored on the PubMed resource and the Russian information portal eLIBRARU.RU. Results. The pathogenesis of neuropathic pain of various localization in osteoarthritis has been determined, methods of its treatment have been studied. Conclusion. The work draws an inference that it is requisite to develop a more thorough approach to the treatment of pain in osteoarthritis and assessment of its effectiveness and safety.

Treatment of breast cancer (BC) remains to be a topical worldwide issue as the annual BC incidence rate continues to increase by 20 %, and the mortality rate - by 14 %. To develop the most optimal treatment method for each patient, it is necessary to rely not only on the extent to which the tumorous process has spread, but at times more importantly, on the biological subtype of the tumor. This allows to improve the long-term results of the treatment (higher general and relapse-free survival rates), to expand the potential for organ-preserving treatment, to reduce frequency of postoperative complications, to achieve better aesthetic results, and, accordingly, a better quality of the patient’s life. Since 2017 the indications for radiation and drug therapy for some BC types have been curtailed, and on the contrary the indications for drug therapy (targeted therapy and chemotherapy) for aggressive forms (triple negative, HER2-positive and some types of luminal B-like cancer) have been broadened, which is endorsed in international guidelines on BC treatment.

Objective: to evaluate the potential of the use of a diagnostic puncture for the analysis of intensity of dystrophic changes in ilio-lumbar, sacro-iliac, and sacro-tuberal ligaments. Material and methods. The work presents the comparison of the results of the semi-quantitative morphological evaluation (Bonar scale) of the sectional material and the material obtained during biopsy of the iliac-lumbar, sacroiliac and sacro-ligamentous ligaments from 15 corpses (the average age at death was 64.5 ± 6.5). Results. The comparison of the sectional data and biopsy data detected differences in the evaluations of intensity of dystrophic changes in the part concerning the evaluation of fibroblasts that lead to a decreased final Bonar score by 1 point. Conclusion. Biopsy material can be used for approximate evaluation of intensity of dystrophic changes according to the criteria «interstitial substance», «collagenous fibers» and «vascularization». The evaluation according to the criterion «fibroblastic programed differentiation cells» can be decreased by 1 point, which should be taken in account in the data interpretation.

Objective: to study clinical characteristics of children with neurocirculatory dystonia (NCD) on hypertonic type. Material and methods . The study included 30 children aged 7-16 with NCD on hypertensive type who were undergoing a check-up or treatment at the Cardiologic Ward of Gomel Regional Children's Clinical Hospital. Results. According to the data of the clinical examination of the children with NCD on hypertensive type, it was found that the majority of the patients had neurological and cardiac complaints; intensive physical development, clinically non-significant arrhythmias, hypersympathicotonic vegetative reactivity, moderate exercise tolerance and labile arterial hypertension according to the data of 24-hour blood pressure monitoring were predominant. Conclusion . The described clinical characteristics of the children with NCD on hypertonic type testify to the presence of functional shifts in the vegetative regulation in the patients of this group, which makes it possible to select a pathogenetically grounded therapy and to control its effectiveness.

Objective: to determine the level of alpha-2 microglobulin of fertility in the serum and endometrium of female patients of reproductive age. Material and methods . 30 female patients of reproductive age were included in the study. According to the results of clinical and case history data, 20 (66.67 %) patients with reproductive dysfunction were included in the study group, 10 (33.33 %) healthy patients were included in the control group. The concentration levels of hormones (FSH, LH, testosterone, prolactin, estradiol, progesterone, fertility alpha-2 microglobulin) in the blood serum and the level of alpha-2 microglobulin of fertility in the endometrial tissue were determined by the method of enzyme immunoassay. Results . The female patients with reproductive dysfunction revealed changes in the concentration of sex hormones. The estradiol concentration was 0.22 (0.21-0.24) nmol/l in the study group of the patients, and 0.25 (0.24-0.28) nmol/l in the healthy patients (z = -3.37, p = 0.0007). The progesterone concentration was 9.57 (7.60-53.54) nmol/l in the study group of the patients and 5.37 (3.59-26.44) nmol/l in the healthy women (z = 1.78, p = 0.07). The level of alpha-2 microglobulin of fertility did not differ significantly in the patients of both the groups. The level of alpha-2 microglobulin of fertility in the endometrium was 0.87 (0.69-1.38) ng/ml in the female patients of the study group and 1.82 (1.38-5.81) ng/ml in the patients of the control group (z = -2.31, p = 0.02). Conclusion . The obtained results are indicative of the involvement of the endometrium in the development of reproductive dysfunction. The data on the levels of alpha-2 microglobulin of fertility in the endometrial tissue are promising for further study and determination of the boundaries of its normal values. Further research in this area will facilitate the development of a test to predict successful implantation.

Objective: to develop a method for differential diagnosis of age-related and dystrophic changes developing in the iliolumbar, long dorsal sacroiliac, and sacrotuberous ligaments due to functional overuse. Material : iliolumbar, long dorsal sacroiliac ligaments, and sacrotuberous ligaments taken from 101 corpses (65 men and 36 women, aged 25-83). Results. We have obtained data describing the intensity of dystrophic changes in the iliolumbar, long dorsal sacroiliac, and sacrotuberous ligaments at different age periods of patients. Conclusion . Comparison of a patient`s Bonar score with the permissible age-related changes makes it possible to differentiate age-related changes from those caused by functional overuse.

Objective: to assess the clinical, hemodynamic, laboratory efficiency and survival potential of patients having undergone plastic repair of atrioventricular valves. Material and methods . Patients with functional class (FC) III and IV chronic heart failure (CHF) according to NYHA (New York Heart Association - Functional Classification), who had undergone plastic repair of atrioventricular valves, were included in the study. Results. The study has found that the return of mitral regurgitation after mitral valve repair in patients is associated with their age, 4 degree and volume of mitral regurgitation of more than 42 ml before the surgery. Conclusion . The results obtained during the study allow to draw a conclusion that surgical reconstruction of atrioventricular valves contributes to a longer life expectancy and enhances quality of life of patients. Furthermore, it makes it possible to postpone heart transplantation and thus may be regarded as «a surgical bridge» to othotopic heart transplantation.

Objective: to investigate the features of preterm birth and state of health of Belarusian and Japanese premature newborns. Material and methods. We have performed a comparative evaluation of the characteristics of preterm birth and condition of premature newborns born at the gestational age of 189-252 days in the maternity wards of Gomel Regional Clinical Hospital (n = 50) and Nagano Prefectural Children's Hospital (n = 50). Results. Preterm birth is observed in Belarusian women at a younger age (p = 0.02) at a higher parity of pregnancy (p = 0.004) and significantly more often begins with premature rupture of the membranes (60 % vs 32 %, p = 0.009). Japanese premature newborns have low gestational weight (50 % vs 10 %, p < 0.0001) more often than Belarusian ones, but despite the greater number of newborns born at the state of severe asphyxia, they have a higher Apgar score (Zt = -3.9, p < 0.001) and better indices of blood gas (Zt = -2.9, р = 0.004) by the fifth minute of life. The perinatal period in preterm newborns in Belarus is more often complicated by intrauterine infection (74 % vs. 8 %, p < 0.0001) and respiratory distress syndrome (88 % vs. 38 %, p < 0.0001). Conclusion. Premature births have geographical features, which is due to sociomedical and constitutional factors

Objective : to identify correlative interrelations among the parameters of the tumor microenvironment of endometrioid adenocarcinoma and relative risk of its prognosis. Material and methods. Immunohistochemic and morphometric studies were performed on the histological material of 60 patients. Results. Correlative interrelations were revealed among the studied parameters in groups with favorable and unfavorable outcomes. Relative risks for progression of endometrioid adenocarcinoma of the corpus uteri were determined. Conclusion. The revealed differences in the interrelations among morphological and immunohistochemical parameters in female patients with endometrioid adenocarcinoma of the corpus uteri of different survival potential reflect biological features of the tumorous growth and the disease progression.

Objective: to evaluate the effectiveness of intake of vitamin D-containing drugs at different dose modes with an assessment of 25-hydroxy-cholecalciferol (25(ОН)D) level and echocardiography parameters in patients with chronic heart failure with preserved ejection fraction (CHF-PEF). Material and methods. 82 patients with CHF-PEF and D-hypovitaminosis were divided into 4 groups: group I (n = 26) - received Cholecalciferol 2000 IU/day, group II (n = 16) - 1000 IU/day, group III (n = 23) - a vitamin D-containing food additive, the comparison group (n = 17) - underwent only complex pathogenetic CHF therapy. Results. The 25(OH)D level in group I reached the optimal level in 84.6 % persons, in group II - in 56.2 % (p = 0.04), in group III - in 69.6 %, in the comparison group in 29.4 % (p = 0.0006). The level of 25(OH)D was negatively associated with the thoracic aorta diameter and end-diastolic volume of the left ventricle (EDV-LV). Conclusion. Optimization of 25(OH)D has a positive effect on the thoracic aorta diameter, anterior-posterior size of the left atrium and EDV-LV.

Objective: to determine the genetic and phenotypic drug resistance of M . tuberculosis to first-line and second-line anti-TB drugs. Material and methods. Gene mutations in 247 strains of M. tuberculosis (MBT) associated with drug resistance to isoniazid, rifampicin, fluoroquinolones, and aminoglycosides were studied. Genetic resistance of a tuberculosis causative agent was determined by means of LPA (GenoType® MTBDRsl MTBDRplus and MTBDRsl, ver.2.0). The results of the study are confirmed by the determination of phenotypic drug resistance in the automated system BACTEC ™ MGIT ™ 960. Results. The drug resistant MBT strains circulating around Gomel region have been determined, and the high reliability of molecular and genetic determination of MBT drug resistance has been confirmed by microbiological methods (isoniazid and rifampicin - 97.2 %, fluoroquinolones - 85.1 %, aminoglycosides - 92.3 %). A considerable number of drug resistant MTB strains with gene mutations (45.1 %) which are not included in the GenoType® MTBDRsl system were detected. Conclusion. Тhe considerable genetic variability of drug-resistant MBT strains requires complex application of all the methods of drug resistance testing.

Primarily infected aneurysm of the abdominal aorta is a rare but life-threatening disease that is difficult to diagnose. The progression of the disease and absence of timely surgical treatment lead to development of such complications as a rupture, which is accompanied by an extremely high mortality rate. The article presents a clinical case of a verified infected aneurysm of the infrarenal aorta caused by Citrobacter freundii . The clinical case describes successful treatment of a primary infected aortic aneurysm with open surgical resection and revascularization by aortic-bifemoral bypass. The intraoperative findings allowed to suspect that the aneurysm was infected, and a sample from its lumen was taken for bacteriological examination. The specific features of the course of the postoperative period were a long-term remitting fever, a long period of lymphorrhea from areas of postoperative wounds. This condition required adjustment of the antibacterial therapy according to the sensitivity of the detected Citrobacter freundii .

Diabetic enteropathy is a rarely diagnosed complication of diabetes mellitus. According to literature sources, most researchers note an association of this complication with the manifestation of diabetic autonomic neuropathy. The main clinical manifestations of diabetic enteropathy are: disrupted peristaltic activity of the small intestine, excessive bacterial growth, diarrhea, and steatorrhea. The article describes a clinical case of diabetic enteropathy in a young patient, which developed 8 years after diabetes mellitus type 1 had been diagnosed.

Chatterjee phenomenon reflects changes in repolarization of the myocardium after long-term abnormal depolarization of the ventricles and is revealed in changes of the final part of the spontaneous ventricular complex on the electrocardiogram. The article presents a clinical example of Chatterjee phenomenon in a female patient after implantation of a pacemaker, which was detected by the electrocardiogram data during the early postoperative period.

The article presents a complex case of differential diagnosis of primary immunodeficiency and lymphoma in a 29-year-old patient, shows the diagnostic tactics of forming the diagnosis of primary immunodeficiency (general variable immune deficiency) and describes the clinical manifestations, as well as laboratory and instrumental studies and the performed therapy.

Objective: to study features of PCR analysis of TTV ( Torque teno virus ) viruses and their prevalence in patients with chronic liver diseases and in relatively healthy individuals. Material and methods. To conduct the research, polymerase chain reaction (PCR), electrophoretic detection, and statistical method were applied. 212 patients with chronic liver diseases and 125 relatively healthy individuals were examined. Results. TTV, TTMV and TTMDV DNAs in the main and control groups were detected. The data of absolute values, relative frequencies (confidence interval - 95% CI) of DNA detection of TTV, TTMDV, TTMV viruses and their various combinations in the control and main groups of patients are given. Conclusion. The work shows the predominance of mixed infections: TTV, TTMDV and TTMV DNAs were detected in 67 % and 72 % patients of the main and control groups, respectively. The combination of TTV + TTMV viruses was detected in 15.6 % patients of the main and in 12 % patients of the control group. Other combinations, as well as mono-infection of TTMDV and TTMV, were considerably less common and were only single instances. The absence of TTV, TTMV, TTMDV or their combinations in human organism is rare, the frequency of DNA detection of at least one of these viruses in the main and control groups is 95.3% and 89.6%, respectively, with no statistically significant difference.

The development of the information-consultative system «SVBI-pro» has been substantiated by the results of examination of 240 patients with verified diagnosis of spondylogenic vertebrobasilar insufficiency (sVBI). Its application ensures decreased terms and volume of examination and at the same time increases availability of sVBI diagnosis. The efficacy of the information-consultative system «SVBI-pro» was studied by the inverse method on 136 young persons without neurological pathology and 240 patients with verified sVBI (І stage - 104, ІІ stage - 76, ІІІ stage - 60 patients). It has been found out that sVBI was diagnosed in 7 out of 136 healthy persons according to the results of the algorithmic evaluation of the «SVBI-pro» system (the error of hyperdiagnostics is 5.1 %), and 32 patients out of 240 with verified sVBI were identified by the «SVBI-pro» system as healthy persons (the error of hyperdiagnostics is 13.3 %).