Modern diagnostics is aimed at detecting heart failure with preserved ejection fraction (HF-SPI) at early stages. The most informative technique to diagnose CH-SPI is echocardiography (echocardiography) using tissue Doppler imaging.

This paper is a systematic review of literature covering the use of decision support systems in the diagnosis and treatment of acute pancreatitis. The authors provide modern literature data on the efficacy of different support systems for decision-making based on artificial neural networks to determine the severity of acute pancreatitis outcomes, prognosis and diagnosis of infected pancreatic necrosis.

This analytic review of literature deals with the studies on preventive measures against the risk factors for cardiovascular diseases (CVD)

Objective: to evaluate the prospects and role of the methods of imaging (ultrasound and CT) in the diagnosis of the pathogenic aspects of the development and correction of portal hypertension in liver cirrhosis. Material and methods. Patients with liver cirrhosis and portal hypertension, Doppler ultrasound, multislice computed tomography. Conclusion. The combined use of ultrasound and computed tomography facilitates tracing of the dynamics of the disclosure of portocaval anastomoses and predict the course of liver cirrhosis and portal hypertension. The application of the integrated ultrasound to determine the rate of blood flow volume in vessels of portal system and portocaval anastomosis will enable development of differential diagnostic criteria for the early diagnosis of portal hypertension. The detection of recanalized umbilical vein by means of 3D-visualization of its anatomy makes it possible to use it for delivering of therapeutic agents to the liver in its pathology.

Objective: to define the state of venous outflow after femoral vein harvesting for aortoiliac reconstruction. Material and methods. The distant results of 22 aortoiliac reconstructions with deep femoral veins performed at Gomel Regional Vascular Surgery Department over 2010-2015 have been studied. 5 patients were operated for late complications (false aneurisms) of previous aorto-femoral bypass, 8 patients were treated for acute prosthetic infection and 9 patients underwent initial surgery for terminal stage of critical limb ischemia. Results and discussion. The group of the patients after initial reconstructions revealed significant edema and lymphorea immediately after the surgery. It was not necessary to perform fasciotomy in all the cases. There were no signs of chronic venous insufficiency in all the patients in the remote postoperational period. Conclusion. The application of femoral vein for aortoiliac bypass is safe from the point of view of venous morbidity. Outflow disturbances were transient in all the cases and no additional treatment was needed.

To study the characteristic features of the course of the disease in patients with different types of chronic decompensated tonsillitis (RT, PTA, AD) hospitalized for tonsillectomy.

Aim: analyzing the causes of the uncontrolled course of bronchial asthma (BA) to reveal the states and phenotypes influencing the efficiency of therapy. Material and methods. 762 patients seeking medical advice or referred for specialized pulmonogical aid have been comprehensively examined. Results. We have defined the prevalence of different phenotypes and states of asthma and the risk for the uncontrolled course of BA. Conclusion. Patients with chronically severe distal and unstable BA detect the highest risk for the uncontrolled course in the absence of compliance, in irrational therapy, asthma-COPD overlap syndrome, decompensated chronic severe pathology and critical mistakes in the application of dosage aerosol inhalators.

Aim: to detect cognitive impairments (CI) in patients with transient ischemic attack (TIA) and cerebral hypertensive crisis (CHC) and their influence on the prognosis of ischemic stroke. Material and methods. 21 TIA patients, 13 CHC patients, 11 patients with lacunar stroke (LS), and 5 volunteers were examined. The TIA and CHC patients were performed neuropsychological tests on the 2^nd and 10^th days of admission. The LI patients and volunteers were tested once. Results. On the 2^nd day the TIA and CHC patients revealed cognitive impairments represented by impaired visual gnosis, short-term visual memory loss, and semantic aphasia. Conclusion. Cognitive impairments in TIA and CHC have the same direction with those in LS. The estimation of short-term memory for visual images has the greatest prognostic value in relation to ischemic stroke.

The aim of this study was to analyze variants of sequestration of multi-level herniated lumbar intervertebral discs and their neurological disorders. Material and methods. The study included a survey of patients and evaluation of clinical data taking into account the results of neuroimaging of the lumbar spine by CT and MRI. Results . Cases of high-level radicular compression with sequestration of the lumbar intervertebral disc prevailed in men (67.4 %). Men had the most common size of the sequestered herniation in both the upper and the lower level within the range of 7-9 mm (11 cases- 30.6 % and 5 cases- 13.8 %, respectively). The same ratio was typical for women: the size of 7-9 mm prevailed in pairs of top and bottom hernias (5 cases - 31.3 % and 4 cases - 25.0 %, respectively). Conclusion . We have defined the clinical symptoms which can be used as markers of sequestration of herniated intervertebral disc (biradikulopathy L₄ and S₁ - 31.0 % and L₄ and L₅ - 13.0 %). Data on the most frequent level of sequestrum (L_IV-L_V - 48.1 %) and the prevailing caudal direction of sequestration (84.6 %) will facilitate the verification of the pathology in the evaluation of CT scans.

Objective: to define the main types of bone resection and geometric shapes of the bone window made by means of computer calculation, to estimate the effectiveness of the proposed method in the early postoperative period using the visual analog scale (VAS). Material and methods . 31 patients with compressive pathology of the lumbosacral spine were operated using the invented method of calculation in the years 2015-2016. The patients were surveyed, the case histories, protocols of X-ray computed tomography (X-ray CT) and magnetic resonance imaging (MRI) were analyzed. Results. Due to the application of the method, the intensity of radicular pains in the early postoperative period decreased in all the studied subgroups. According to the VAS scale, the pains in the subgroup of patients with herniated discs without sequestration decreased from 7.50 (6.00; 9.00) to 2.00 (1.00; 3.50) - p = 0.001, in the subgroup of herniated discs with sequestration - from 9.50 (7.25; 10.00) to 2.5 (1.25; 3.75) - p = 0.011, in the subgroup of herniated discs in combination with stenosis - from 8.00 (5.00; 9.50) to 2.00 (1.00; 3.50) - p = 0.008. Conclusion. The developed method of calculation of minimally sufficient areas of bone resection made it possible to perform economical, reasonable resection of the posterior supportive complex bone structures, besides it was used in different types of the compressive spine pathology.

Objective: to study the clinical and morphological characteristics of triple negative breast cancer (TNBC) revealed in Gomel region in 2014. Material and methods . The material of the study became 85 cases of TNBC revealed in Gomel region in 2014. The clinical and morphological analysis was made on the database of the Pathoanatomical Branch of the Gomel Regional Clinical Oncological Clinic. Results . In the year of 2014 TNBC was detected in 85 out of 412 cases of BC, which made up 20.6 %. The similar results in the same year were received in Vitebsk region - 82 out of 425 (19.3 %) and Grodno region - 77 out of 380 (20 %). The average age of the patients with TNBC was 56.0 years, which corresponded to literary data and practically did not differ from the data received in Vitebsk region - 55.8 years and Grodno region - 56.5 years. Conclusion. The results of the study of the histological degree of malignancy, prediction indicators (TNM) and parities of clinical stages have confirmed the data of the given literary sources on more adverse prognostic value of TNBC detection. The clinical and morphological characteristics of TNBC revealed in Gomel region in the year of 2014 correspond to the data of literary sources and the results received during the study in other regions of Belarus.

Objective: to analyze the correlations of the parameters of heart rate variability (HRV) and heart rate turbulence (HRT) in patients with arterial hypertension of the II-nd degree. Material and methods. We have studied the parameters of heart rate variability and turbulence in 214 persons with arterial hypertension of the II-nd degree, of them 80.8 % having ventricular arrhythmias according to the Holter monitoring. We have analyzed the correlations of the parameters with the patient’s age, average heart rate (HR), circadian index (CI), left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). The statistical analysis of the results has been made using the analytical package «Statistica» 10.0. Results. We have revealed statistically significant correlations of the HRV parameters with the age of patients, average HR, circadian index, ejection fraction. Thus, high level of the statistical significance of the interrelation of HRV parameters has been confirmed. We have received statistically significant correlations of the HRT parameters with the left ventricular mass index (LVMI), ejection fraction, HR average, quantity ventricular extrasystoles. High level of the statistical significance of the interrelation of HRT parameters (TO and TS) has been revealed. Conclusion. The received results can be used during the selection of the group of patients with arterial hypertension having high risk for unfavorable outcomes. Taking into account the features of the heart rate variability and turbulence parameters and factors associated with them this will enable the individualization of the assessment of the risk in arterial hypertension as much as possible and prescription of adequate treatment for each patient.

Objective: to analyze the possibility of the use of iron metabolism indicators (serum ferritin and serum iron) as predictors of diabetes mellitus type 2 in patients with chronic hepatitis. Material and methods. We have examined 120 patients with chronic hepatitis of various etiology and have assessed the possibility of the use of serum iron and serum ferritin in the diagnosis of diabetes . Results. We have received the data about the diagnostic value of iron metabolism indicators in detection of diabetes mellitus type 2. The sensitivity of serum ferritin in patients with chronic hepatitis at a point of separation of 234mkg/l was 66.7 %, the specificity was 73.9 %, AUC - 0.735 (95 % CI 0.643-0.815, р = 0.001). The odds ratio of the detection of diabetes mellitus type 2 for patients with high-level serum ferritin was 4.6 (95 % CI 1.6-13.6, р = 0.005). Conclusion. Serum ferritin has shown the highest prognostic value as a predictor of diabetes mellitus type 2 among the indicators of iron metabolism in the patients with chronic hepatitis.

The problem of the pathogenesis of diabetic foot being a complication of diabetes mellitus has been very topical up to now. The supply of oxygen to tissues is one of the key issues of the pathogenesis of diabetic foot. The aim of the work was to study the physical and chemical properties of erythrocyte membranes and activity of oxygen transfer in patients with diabetic foot. It has been found that the activity of oxygen release from erythrocytes is the most significant among the studied parameters in detection of patients with diabetic foot and healthy people. Patients with diabetic foot are divided into two groups in terms of physical and chemical properties of erythrocyte membranes and the activity of oxygen release. The first group of patients with diabetic foot is different from healthy people by the activity of oxygen release and micropolarity, microviscosity of annular lipid pool. The second group of patients with diabetic foot differs from healthy people by micropolarity of annular lipid pool (with 2 concentrations of pyrene), microviscosity of total lipid pool and the activity of oxygen release.

The article considers the questions of economic efficiency of rendering medical aid to patients with pathology of the organ of vision. Using the example of Gomel region we have given the assessment of the parameters of economic efficiency of medical aid to patients with ophthalmopathology. The work points out the importance of applying techniques that make it possible to justify the necessity and the profitability of the expenses for the preservation and restoration of vision properly, to determine the efficiency of medical aid to the patients by assessing the resource provision, adequacy of treatment and diagnostic process, financial support, and patient satisfaction.

Objective: to substantiate the directions for optimization of the management of the doctor career in medical organizations. Material and methods. We have conducted an anonymous survey of 407 doctors, processed the data on documentation in career management in 65 medical organizations and have surveyed 32 experts in healthcare management. Results . We have studied the particular aspects of the doctor career in medical organizations and the state of managing this process. We have developed the profiles of formation of competences and professionally important qualities for different positions of healthcare managers in medical organizations and have provided rationales for reorganization of the professional development training program. We have formed the ways to assess the success of a certain doctor`s career and methods to manage this process, on the grounds of which the corresponding optimization technique has been designed. Conclusion . The obtained materials can be used in practice in everyday activities of medical organizations.

The article considers the topical questions of a well-balanced diet of teenagers living in Gomel region. The dietary patterns of 220 city and rural school children at the age of 12-16 have been studied using the medical and social method (questioning). We have revealed significant shortcomings in the dietary patterns and quality of diet of the school children. We have found that the majority of the children do not follow the dietary pattern. The inadequate consumption of meat products, fish, diary products, and fruit by the school children affects their health and creates prerequisites for alimentation-dependent illnesses: every third child has dyspeptic complaints, every fifth child has already undergone out-patient treatment for the gastrointestinal diseases. Due to this, it is necessary to redouble the sanitary and educational and psychological and preventive work aimed at the leveling of the effect of the detected negative factors among teenagers.

The article analyzes the content of phosphorus in fruit bodies of wild macromycetes and assesses the dynamics of the changes of its content in Carpophorus during heat treatment in water and 1N solution of NaCl. It has been shown that extracting of fungi in water by boiling reduces the content of phosphorus by 35-54 % and in table salt solution - by 68 %.

Acute ethylene glycol poisoning is a topical medical and social problem. According to the statistics, ethylene glycol poisoning ranks second among intoxications with technical liquids. The availability of ethylene glycol and lack of public awareness about its poisonous properties is a condition for the occurrence of poisoning. The clinical picture of ethylene glycol intoxication is characterized by the development of three successive stages: the first stage - CNS depression (narcotic phase), the second stage - toxic lesions of the heart and the lungs, the third stage - toxic lesions of the liver, kidneys with the development of acute kidney failure, as well as metabolic acidosis. The article presents a case report of acute poisoning with ethylene glycol, gives the results of the diagnostic activities, the dynamics of the clinical manifestations and laboratory parameters, describes the treatment of the patient.

Human dirofilariasis is zoonotic, tissue, imaginal helminthiasis with vector-borne transmission. Over the last decades the prevalence of dirofilariasis has been rising, the invasion area has been increasing and moving further into Republic of Belarus. Its clinical manifestations are different, but dirofilariasis occurs rarely in the urological practice. The article presents a literature review of the etiology, pathogenesis, clinical symptoms, diagnostics, and treatment of dirofilariasis and describes a clinical case of dirofilariasis in the urological practice. The diagnosis has been confirmed histologically.

The worked out technique of the reconstruction of full-thickness nasal defects consists in formation of three-layer plastic material based on skin-fascial flap, allogene cartilage and dermal transplantation. We have performed 13 operations, and all the patients have achieved acceptable clinical outcomes. The article presents the data on surgical wound healing, detection of the transplanted allocartilage, estimation of the cosmetic results by the visual analog scale.

The article gives the detailed description of some means of optimization of well-known morphological methods of the study of the duodenum with the use of computer technologies as well as detailed instructions on their realization. It notes the advantages of the developed means before the existing traditional morphological procedures and points out the prospects of their application during the study of not only the duodenum, but also other anatomical formations.