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No 1 (2014)
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REVIEWS AND LECTURES 

7-14 243
Abstract
Herpes infection is one of the most common infections, having chronic course with frequent long exacerbations and high resistance to the therapy. Recurrent herpetic infection is a type of infection with constant persistence of the pathogen. However, the clinical manifestation of the infection, recurrence and progression of the disease is determined not only by the efficient functioning of specific antiviral immunity, but also by general reactivity of a macroorganism. The article considers the important sides of the innate and adaptive immunity, mechanisms to avoid viruses from immune factors, discusses the important role of laboratory examination in monitoring the state of patients with recurrent herpes infection.
14-20 271
Abstract
Aim of research: to review publications on the topical issue. Materials. The publications containing topical information about the method of Holter monitoring, its diagnostic and predictive prospects, fields of application. Discussion. The article provides assessment of modern diagnostic and predictive potential of Holter monitoring, such as the analysis of heart rate variability and heart rate turbulence, T wave alternans, late ventricular potentials. Conclusion. New methods of recording, registration, analysis and new algorithms of diagnosing of an electrocardiogram curve, as well as huge technical progress made it possible to expand the diagnostic methods of dynamic monitoring. Taking arrhythmia diagnosis as a base, we diagnosed myocardium ischemia analyzing the changes of ST segment, and later vegetative imbalance by means of RR interval variability or heart rhythm turbulence. New technological potential bring considerable expansion of the clinical application of Holter monitoring. The electrocardiographic parameters assessed by this method play the role of an independent predictor for mortality and severity extent of chronic heart insufficiency and sudden death. Along with cardiology, indications for out-patient monitoring of an electrocardiogram are also used for metabolic, neurological diseases and even sports medicine
20-25 266
Abstract
Amyotrophic lateral sclerosis is one of the most prevalent lethal neurodegenerative multifactorial diseases with selective lesion of the central and peripheral motor neurons and often with genetic predisposition and participation of the environmental factors (sex, age, exogenuos toxins, traumas, etc.). Clinical data and electroneuromyography (ENMG) changes are the main diagnostic markers of the illness. However, the prevalent symptomatic syndrome of the motor neuron involvement makes it difficult to diagnose the true illness, and the absence of pathogenetic therapy demands further scientific study

CLINICAL MEDICINE 

37-42 220
Abstract
The purpose: to make the comparative analysis of effectiveness of low-invasive intervention technologies at various stages of acute destructive pancreatitis. Material and methods. 132 patients with acute destructive pancreatitis were examined. Depending on the prevalence of destructive changes in the pancreas and parapancreatic cellulose, low-invasive interventions were performed. Results. The article presents analysis of the results of treatment of the patients with destructive forms of acute pancreatitis. Among the infected forms of acute pancreatitis when there was distribution of the pathological process on the retroparapancreatic cellulose, open operations from drainage access appeared to be the most effective. The conclusion. The efficiency of low-invasive interventions is defined by the morphological form of acute pancreatitis and scale destruction, both in the pancreas and in the retroperitoneal cellulose. These interventions are most effective in intraabdominal exudation and generated parapancreatic congestions of liquid and when there is no septic secvestration retroparapancreatic cellulose.
42-46 206
Abstract
To assess the clinical severity of health state, we included 33 patients with cystic fibrosis (aged 18-37) in our study. All the patients were divided into three groups according to the severity of the clinical presentations of respiratory lesions (latent, moderate and expressed). In order to develop an algorithm of the grouping of the patients with cystic fibrosis, a classification tree was built for the examined patients (training sorting). Using methods of cluster analysis it was proved that cystic fibrosis patients are divided into three clusters depending on the severity of bronchopulmonary lesions. The cluster distribution of the patients corresponded to that in clinical groups selected out in the empirical way. The research results can be used to differentiate the patients in the development of medical rehabilitation programs.
46-51 256
Abstract
Objective: to analyze the immediate and long-term results of surgery of pancreatic cancer (PC). Material and methods. The study included 97 patients with PC. 64 (66,0 %) patients underwent pancreaticoduodenectomy (PDE), 31 (31,9 %) - distal pancreatikosplenectomy (DPSE), 2 (2,1 %) patients underwent total pankreatikoduodenektomy (TPDE). Results. After DPSE, the postoperative morbidity and mortality were 9,6 and 3,2 %, respectively. After TPDE, there were no complications. The five-year actuarial survival rate among the patients after PDE made up 19,6 ± 5,5 %, after DPSE - 59,5 ± 9,6 % (P < 0,001). The lowest rates were observed in adenocarcinoma of the intestinal type (10,0 ± 8,8 %), ductal (21,9 ± 7,7 %) and mucin producing adenocarcinomas (30,0 ± 14,5 %), invasive mucinous cystadenocarcinoma (0 %), often localized in the head of the pancreas. 26,7 % of the patients after PDE revealed complications, 4.7 % died, the cause of death was failure of pancreatic anastomosis due to focal necrotizing pancreatitis. In 2 cases of neuroendocrine carcinoma there was multifocal lesion of the pancreatic gland, which demanded TDPE. One of the two patients having undergone TDPE was alive for 6 more years. Conclusion. The inadequate long-term results of the treatment of pancreatic head cancer are related to the predominance of aggressive forms of tumors and are indicative of the need to develop the methods of combined treatment.
51-56 228
Abstract
The analysis of recent achievements in immunophenotyping of hematopoietic progenitor and maturing cells in dysplastic bone marrow points to a significant role of flow cytometry in the diagnosis of myelodysplastic syndromes. The research revealed the MDS-associated phenotype of blast cells in de novo myelodysplastic syndromes. The standardization of flow cytometry analysis in myelodysplastic syndromes may thus improve the diagnosis of these diseases.
56-62 222
Abstract
Goal: to describe and analyze modern approaches to the surgery of portal hypertension, to suggest a perspective way in solving this problem. Material and Methods. Analytical review of periodic medical scientific publications, Internet resources PubMed and Medline; the authors`developments. Results. At present, there are recommendations summing modern notions about pathophysiology and treatment for portal hypertension and its complications, based on the data from controlled randomized trials and meta-analyzes. However, despite the significant progress in approaches to diagnosis and treatment of portal hypertension, the liver cirrhosis mortality remains to be high. The potential of organ transplantation does not cover its needs. Therefore, the development of new methods of treatment based on cell biotechnology using mesenchymal stem cells is a promising area of modern medicine.
62-66 227
Abstract
Goal of research : to assess the effect of ART on the efficacy of treatment for tuberculous meningoencephalitis in HIV-positive patients. Material and methods. We examined 70 HIV-positive patients with tuberculous meningoencefalitis, of them 16 developed tuberculosis, including meningoencephalitis, within the first three months of ART (tuberculous-associated IRIS) and 28 patients were diagnosed with TM before ART. Antiviral treatment was prescribed after taking antituberculosis drugs (main group) and 26 patients took antituberculous medications only (comparison group). Results. The characteristic features of IRIS-associated TM forms were acute onset and high incidence of generalized tuberculosis. The patients of this group observed high indices of death rate - 81,3 %, 282,6 cases/100 patient-years, which could be affected by neither antituberculosis therapy nor ART. ART included into specific chemotherapy led to decreased in-patient death rate (17,9 %, 30,1/100 patient-years) in the main group. At the same time, the development of tuberculosis-associated IRIS in the form of worsened TM course, increased intoxication, development of new pulmonary or extrapulmonary tuberculosis were detected in 14 cases (50,0 ± 9,4 %). However, only in 2 (14,3 ± 9,4 %) cases they led to death. In the comparison group, 61,5 % patients died of TM, the death rate made up 192,8/100 patients-years. The differences of the death rates between the main group and the group of comparison had statistical significance with a high level of reliability, p < 0,001. Conclusion . The inclusion of ART into the antimicobacterial therapy of non-IRIS-associated TM was accompanied by decreased indices of the in-patient death rate (43,6 % and 6,4 times decrease/100 patients-years). 50,0 ± 9,4 patients revealed symptoms of tuberculosis-associated IRIS, but only (14,3 ± 9,4 %) cases resulted in death.
66-72 207
Abstract
An open study was carried out to assess the efficiency of physical rehabilitation in 342 patients in the subacute stage of myocardial infarction (MI). Depending on myocardial revascularization, the patients were divided into two groups: those with and without revascularization. The non-vascularized patients had an increase in the strong group comparable with the rehabilitation values in the group which had underwent stenting and bypass surgery in acute myocardial infarction before (23,6 % vs. 24,1 % (p > 0,05), which is indicative of the expressed potential of physical rehabilitation during the subacute stage.
72-80 174
Abstract
Worldwide, the number of people killed in road traffic accidents is estimated to be 1.3 million, with other 50 million injured each year. More than 85 % of these casualties and 96 % of the total child death rate occur in underdeveloped countries. According to the WHO, road traffic deaths are predicted to increase by 83 % in underdeveloped countries, and to decrease by 27 % in developed countries over the next 20 years.
80-84 199
Abstract
Goal: to analyze iron metabolism in patients with chronic cryptogenic hepatitis with HFE gene mutations and assess the most significant indicators of iron metabolism in diagnosis of mutations. Material and methods. We examined 81 patients diagnosed with chronic cryptogenic hepatitis. The indicators of iron metabolism in patients with various HFE gene mutations were assessed. Results. 47 (58 %) patients detected normal genotype (N/N). Simple heterozygous mutations were revealed in 23 patients, of them 19 (23,5 %) - H63D/N, 4 (4,9 %) - C282Y/N. The complex heterozygotes C282Y/H63D were found in 4 (4,9 %) patients. 7 homozygous mutations were detected, 3 (3,7 %) - C282Y C282Y/C282Y, 4 (4,9 %) - H63D/H63D. The transferrin saturation index showed the highest prognostic value in the diagnosis of significant HFE gene mutations. AUC for this indicator was 0,916 ± 0,073, at the separation point at a level of 45,8 % the sensitivity was 85,7 %, specificity - 90,5 %. Conclusion. The patients with chronic cryptogenic hepatitis revealed high prevalence of significant HFE gene mutations (8,6 %). It was revealed that the transferrin saturation index had the greatest diagnostic value the most important mutations of hemochromatosis gene (C282Y/C282Y and H63D/C282Y)
84-89 227
Abstract
Goal: to study the psychosomatic relations in patients with recurrent herpes simplex taking into account their psychogenic reactions and personality traits. Material and Methods. 107 patients with severe form of recurrent herpetic infection (RHI) were examined. The complex examination consisted of questionnaires and psychometric study. The psychometric study included identifying personality traits (SMOL), evidence of psychopathologic symptoms by Simptom Check List-90-Revised (SCL-90-R) and level of life quality by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Dermatology Life Quality Index (DLQI). The program «Statistica» was used for statistical analysis of the data. Results. The analysis revealed the characteristics of psychosomatic relations in the patients with recurrent herpes simplex: neurotic trait profile, whose development is promoted by the intensity of pain syndrome and high level of anxiety and depression, predominance of somatic anxiety in the evidence of the psychopathological symptomatology. Conclusion. The obtained data are basis for the development of psychotherapeutic effect to improve quality of life in patients with recurrent herpes simplex.

EXPERIMENTAL MEDICINE AND BIOLOGY 

89-93 196
Abstract
Objective: to study the effect of soy milk diet on the structural and functional status of rats colon during the monosodium glutamate (MSG) treatment. Materials and methods . The experiments were performed on male white outbred rats with the initial body mass of 144,3 ± 1,72 g (n = 49). The dose of monosodium glutamate was calculated by the following scheme - 0,5 % per kg of the product the guests according to Sanitary Regulations and Norms of November 28 2002 No.94, the dose of soy milk - at a volume of 2 ml. Histological and biochemical studies were performed by standard methods. Results. One-month MSG therapy was determined to cause structural reorganization of the mucous membrane of the rats colon, violation of mucus production with goblet cells related to hyperplasia and hypertrophy, and lead to an increase in the content of sialic- and fukoglycoproteins, reduced lysozyme activity. The introduction of soy milk into the diet during treatment with sodium glutamate is accompanied by restoration of the wall structure of the colon, normalization of goblet cells «work», decreased levels of sialic acid and fucose in their secretion, increased activity of lysozyme. Conclusion. The introduction of soy milk into the diet eliminates the negative effect of the MSG therapy: restores the structure of the mucous membrane of the rats colon, promotes its protective function and contributes to the natural resistance of the organism.
93-97 233
Abstract
Goal: to evaluate capillarity and wicking of traditional suture material and its analogues covered with bioinert poly-para-xylylene. Material and methods. A thread was fastened in a tripod; the free end of the thread was attached with a load. Then the load was dipped into a dye solution. An hour later the height of the liquid rise was measured from the surface of the solution along the thread. While studying the wick effect, some museum strains of microorganisms were used as an indicator culture. The dyed part of the thread was divided into segments, each of 2 cm. The segments were put onto elective medium and after 24 hours of incubation the number of new colonies was counted. Results. These results indicate high capillarity and wicking of threads made of traditional suture material. In all the cases a strong reverse relation was identified between the value of the capillarity and the PPX concentration, used for modification of traditional surgical threads. The PPX modification of traditional suture material makes it possible to reduce the wick effect. Conclusion. The modification of surgical threads by applying bioinert covering is an effective way to prevent purulent and septic complications in the early postoperative period.
97-102 217
Abstract
Objective: to identify the features of morphometric parameters of the main thigh and crus arteries in newborns and develop reliable noninvasive methods for determination of morphometric parameters of the main thigh and leg arteries. Material and methods: macromicropreparation, morphometry, statistical method. Results. The high origin of the deep femoral artery was frequently observed in male newborns (68 %). The origins of the deep femoral artery in 75 % cases were caused by posteral lateral circumference of the femoral artery. In 57,2 % of the cases A.circumflexa femoris medialis was originated from the deep femoral artery and in 42,8 % cases from the femoral artery. During dissection of the popliteal artery, two cases revealed its trifurcation. Conclusions. The regression models received over the research help to calculate the length of the femoral artery and level of the deep femoral artery origin, which makes it possible to simplify the procedure of finding the optimum surgery assess to main arteries in the limited application of angiography.
102-107 242
Abstract
Purpose: to define the diagnostic value of morphometric parameters of fibroblast programmed differentiation cells in dystrophic changes of the iliolumbar ligament. Material and methods. Iliolumbar ligaments (n = 86) from 43 corpses (aged from 25 till 90): 28 men (average age 62,9 ± 13,1) and 15 women (average age 63,9 ± 17,1). Results. The correlation (R = 0,74; р = 0,0001) was revealed between the Bonar scale, characterizing the intensity of the dystrophic changes and the morphometric parameters of the nuclei of fibroblast programmed differentiation cells. Conclusion. It was concluded that it was possible to use the parameter representing the relation of the highest value of the cross dimension to the longitudinal one of the cell nucleus of the fibroblastic programmed differentiation for approximate evaluation of the intensity of the dystrophic changes in the iliolumbar ligaments.
107-110 199
Abstract
Goal: to find out antimicrobial efficacy of ophthalmologic drugs containing fluoroquinolons of II-III generations. Material and methods. Minimal inhibitory concentrations for isolates of Staphylococcus aureus and Pseudomonas aeruginosa were determined for four drugs containing fluoroquinolons of II-III generations. The kinetics of growth and dying off of the test-culture of Pseudomonas aeruginosa ATCC 27853 under different fluoroquinolon concentration were performed in nutrient broth medium. Results. The minimal inhibitory concentrations for various drugs ranged from 0,125 to 1,0 mcg/ml. In relation to the test-cultures of Staphylococcus aureus , III generation fluoroquinolones (levofloxacin MIC 0,25-0,5 mcg/ml) were the most active. Ciprofloxacin was the most active against Pseudomonas aeruginosa (MIC 0,125 mcg/ml). It was shown that the bacterial effect of all the fluoroquinolones depends directly on the concentration of antibiotic in the medium. Conclusion. The antimicrobial activity of II-III generation fluoroquinolones from different producers was similar. The concentration of fluoroquinolones in the studied drugs makes it possible to achieve the bactericidal effect for sensitive gram-negative strains, even after short-term exposure. It is preferable to use III generation fluoroquinolones to treat for infections caused by gram-positive microorganisms
110-115 183
Abstract
The goal of research: to identify the thermodynamic and kinetic parameters of adsorption of mercury, lead and nickel cations on various enterosorbents which make it possible to compare their effectiveness in binding and excretion of heavy metals from dilute aqueous solutions, which can be regarded as a simplified model of human biological fluids. Materials and methods. The subject of the study was enterosorbents that are widely applied in clinical practice. Results. The article proposes a mathematical model representing the kinetic and thermodynamic parameters of the adsorption of mercury, lead and nickel cations on the enterosorbents. The calculated parameters can give a quantitative assessment to the effectiveness of the enterosorbents, widely used in clinical practice to remove heavy metals from model solutions.
115-118 205
Abstract
The goal of research: to assess the toxicity of suture material based on polyamide with poly-p-xylylene coating. Material and method: Common polyamide suture material and that with poly-p-xylylene coating were studied. The acute toxicity of suture material was identified «in vitro». We used the methods of extracts effect on human erythrocytes and bull spermatozoids. The toxic effect of the polymeric material of surgery threads was studied on the extracts obtained on the third and tenth days. The results: The hemolytic test showed that the percentage of hemolysis in all the tests was less than 1 %. It indicates that the suture material has no hemotoxic effect of hydrolysis products. The cytotoxicity test on the livestock sperm cells revealed the toxicity index being 1, which indicates the absence of cytotoxicity of the suture material. Conclusion. The extracts from the polyamide suture and that with poly-p-xylylene coating have no hemolytic effect and do not have a toxic impact on the bulls sperm cells.
118-123 193
Abstract
Goal: to find out the presence and characteristics of the interconnection between the composition, physical and chemical properties of lipoprotein blood complexes and the fatty acid spectrum of erythrocyte membranes phospholipids in sportsmen and people who go in for sports. Materials and methods. We used fluorescent probing, ultracentrifugation and chromatographic methods to study lipoprotein blood complexes and erythrocyte membranes in sportsmen and people who go in for sports. Results. The microviscosity of blood lipoprotein complexes is higher and the direct correlation with the cholesterol concentration is stronger in sportsmen than in people who do not go in for sports. The differences of the correlations between the physical and chemical properties of blood lipoprotein complexes and phospholipid fatty acid spectrum of erythrocyte membranes were detected. Conclusion. Sports activities considerably influence the physical and chemical properties of blood lipoprotein complexes and erythrocyte membranes and their interconnection.

PUBLIC HEALTH AND HEALTH CARE, HYGIENE 

123-126 265
Abstract
This article considers the role of medical examination and rehabilitation of patients with glaucoma in the prevention of disability. The necessity for rehabilitation of patients and the disabled is one of the most important health and social issues which involves the efforts of the progressive-minded public in many countries of the world. The modern concept of social protection and aid is a complex of state, social and economic, medical, professional, educational, psychological and other activities aimed at the preservation of health, prevention of disability, as well as the possible comeback of disabled people to socially useful work.
126-131 213
Abstract
Goal: to assess the efficiency of medical aid in dermatology. Material and methods. The bank of basic information about 90 psoriasis in-patients from their admission to discharge was formed; the medical technology was given an expert assessment, the questionnaire survey of the patients was carried out; the state and use of human and material resources were studied. Results. The list of criteria statistically reliable and interfacing (р < 0.05) for the efficiency of the medical technology was identified. We found reserves in using more adequate technology (P = 0.72) through the improvement of material (O = 0.79) and human (B = 0.80) resources, which will ensure high quality level of rendering medical aid and satisfaction of medical service consumers (Y = 0.68). Conclusion. The results of this study can be used for to assess and improve the efficiency of work at public health departments and of individual doctors.
131-136 192
Abstract
The present review covers present-day data on development of nanotechnologies in the world and prospects of their application in preventive medicine in the Republic of Belarus. The application of nanotechnologies and creation of the system of nanosafety in our country are of consequence for health preservation of the present and further generations.

CLINICAL CASES 

136-141 553
Abstract
Goal: the article describes a clinical case of tetany in a pregnant woman. Material and methods. The article deals with a clinical case of tetany in a pregnant woman, who underwent total thyroidectomy and radioiodine therapy. It also presents results of diagnostic procedures and differential diagnosis, monitoring of the dynamics of laboratory parameters. The article describes treatment of the patient during pregnancy, delivery and postpartum. Results. The causative factors for tetany were postoperative uncompensated hypoparathyroidism, increased physiological requirements for calcium in its low alimentary admission, endogenous calcium intake for myometrium contractions and ionic antagonism with magnesium, used for tocolysis. Conclusion. Rational clinical examination and individualized management of patients after surgical thyroidectomy makes it possible to prevent hypoparathyroid hypocalcemic complications in mothers, fetuses and newborns.

NEW TECHNOLOGIES 

145-151 192
Abstract
The object of the study was samples of sod-podzol sandy-loam soil and podded plants (clover pink, clover red, yellow lucerne) selected in September 2013 around the enterprise area of the plant «Tsentrolit», Gomel. We studied the correlation interactions between the values of the accumulation coefficients (Ka) of heavy metals and some mass ratios of the fractions of humic acids extracted by the simplified Turin scheme, modified by Ponomareva and Plotnikova. We determined a reliable correlation between the Ka values and the ratio of fractions of F1 + G1 + F1а/F3 + G3 humus. The data dependencies are described by the polynomial of the second order: y = ax2 - bx + c with the values of the R2 determination coefficients for zinc, lead, cobalt and nickel 0.93; 0.95; 0.81, 0.93, respectively. No reliable correlation was found between the Ka values and the total content of humus according by the studied heavy metals as well as the content of each of the fractions according to Сtotal.
151-155 208
Abstract
Purpose: to create technical conditions for spiral X-ray computer tomography of the lumbosacral spine in conjunction with the iliopsoas ligament. Materials and methods. The new protocol of computer tomography was tested on phantoms, followed by approbation in 47 patients (average age - 56,1 ± 8,7) with the pain syndrome in the lower back. Results. We developed a new research protocol that makes it possible to visualize not only the structural elements of the spine, but also to obtain information about the spatial characteristics and morphometric parameters of iliopsoas ligaments. Conclusion. The application of multiplanar reformatting and three-dimensional reconstructions of the data obtained from CT scans by the new research protocol provides the most complete information about the state of iliopsoas ligaments.


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ISSN 2220-0967 (Print)
ISSN 2708-6011 (Online)