The clinical lecture deals with topical emergency problem in obstetrical practice, i.e. hematomas of soft tissues of the birth canal. The first part of the lecture presents modern data on the epidemiology and etiopathogenesis, classification approaches, clinical manifestations, modern facilities for diagnosis and treatment of obstetrical hematomas of different localization. The second part of the lecture will describe and analyze clinical cases of hematomas of the birth canal that occurred at maternity hospitals of Gomel region, as well as rare cases of obstetric hematomas according to foreign publications. The third part of the lecture will present data on health status of children whose mothers developed obstetrical hematomas during their delivery.

Objective: to develop and create new absorbers of microwave radiation on polymer basis; to assess the perspectives of application of polymer composite radioabsorbing materials (RAM) and electromagnetic screens (EMS) for solving of the problem of electromagnetic ecology and electromagnetic protection of biological objects. Material and methods. Monolithic, fibrous and combined RAM based on filled thermoplastics were chosen as subjects of the study. Dielectric, magnetic and electroconducting substances different in nature, shape, size and a phase state were used as a filler. The RAM structure was study with means of a scanning electronic microscope. Results and discussion. The application of polymer composite materials for protection of biological objects from the effect of microwaves has been shown as efficient. The prospects for creation of polymer RAM, containing biodegradable components, nanoparticles, chiral structures, encapsulated liquids and also as non-woven RAM and polymers with own electroconductive have been analysed. Conclusion. RAM based on polymer composite thermoplastics and EMS are highly effective means for solving the problems of electromagnetic ecology.

The article presents information from national and foreign sources on the significance of long QT syndrome on the electrocardiogram as a predictor of severe heart rhythm disturbances and sudden death. It considers the pathologic physiology of the present syndrome, the deficiency of intracellular magnesium plays an important part in its mechanism, which determines the therapeutic aspects leading to normalization of the QT interval

Early diagnostics and removal of precancer lesions of the mucous membrane in the colon are recognized as a modern preventive measure against colorectal cancer. Thanks to the development of endoscopic equipment and emergence of systems of high resolution, the idea about the morphology of predecessors of malignant tumors has changed. It has become possible to predict the histologic structure of the epithelial mass in real time. Notions about situations when one should resort to standard polypectomia, mucosal resection or submucosal dissection have been so far formed.

Objective: to assess the value of indirect markers of liver fibrosis in patients with chronic hepatitis B (CHB) and C (CHC). Material and methods. We have examined 137 patients with CHB (n = 34) and CHC (n = 103) having known the stage of liver fibrosis based on liver biopsy or indirect methods (fibroelastography, FibroTest). 9 parameters of hemogram and biochemical blood test along with 8 indices calculated on their base were taken into account. Their prognostic values were evaluated by means of ROC analysis. Results. The higher fibrosis stage is in patients with CHB and CHC, the lower platelet, cholesterol, albumin rates are in peripheral blood and the higher RDW, MPV, ALT, AST, ALP, GGT levels are (p < 0.05). The indices of Forns, S-index, FIB-4, Virahep-C model, APRI, RDW/PLT, MPV/PLT are significantly different (p < 0.0001) in patients with minimal (F0-F1) and evident (F2-F4) fibrosis. Forns index, Virahep-C model, FIB-4, and RDW/PLT are the most significant predictors of evident liver fibrosis (F2-F4) for patients with CHB. S-index index, Forns, FIB-4, and Virahep-C model have the greatest predictive value in patients with CHC. Conclusion. The assessment of indirect markers of liver fibrosis in patients with CHB and CHC can be easily performed at any stage of the treatment, it is quite informative and can be used for selection of patients for further examination and timely antiviral therapy.

Objective : to determine special features of the immunological status as a result of immunophenotyping of peripheral blood leukocytes in patients with different transient disturbances of cerebral blood circulation in comparison with patients with stroke. Material and methods . We examined 14 patients with transient ischemic attack (TIA), 7 patients with cerebral hypertensive crisis (CHC), 9 patients with lacunar stroke, and 9 volunteers. All the patients underwent immunophenotyping of peripheral blood leukocytes and their immunoglobulin level was determined by immunoturbodimetrical method on the first day after admission. Results . We have defined the specific features of the inflammatory process presented by activation of the classical way of inflammation in CHC patients on the first day of the illness in the form of increased level of proteins of the complement system, activity of T- and B-cellular links of immunity in a combination with low expression of adhesion molecules. We have revealed depression of T-cellular immunity without activation of B-cellular immunity in TIA group, which distinguishes transient disturbances of cerebral blood circulation from stroke. Conclusion. Absence of the activation of B-cellular immunity in patients with CHC and TIA and low level of the expression of adhesion molecules make the sanogenic potential of transient disturbances of cerebral blood circulation in comparison with stroke.

Objective: to develop, test, and introduce new methods of helping people suffering from alcohol dependence. Material and methods. We have performed a comparative study of a representative sample of patients with alcohol dependence (F 10.202) in compensated (I group, n = 88) and subcompensated (II group, n = 44) remission. Results. It has been found that the highly significant comprehensive examination using clinical, psychological, and laboratory methods (sensitivity - 81.4 %, specificity - 80.0 %) makes it possible to diagnose the threat of relapse in patients with alcohol dependence. Conclusion. The proposed integrated approach to the determination of the quality of remission is a new, effective, simple, and easily accessible way of providing targeted assistance to persons with alcohol dependence.

The article gives the description of the epidemic situation for tuberculosis in Gomel. Organization of controlled chemotherapy during all the stages of the treatment is the key to the successful solution of tuberculosis problems. The article analyzes the effectiveness of the model of outpatient treatment for tuberculosis in city conditions and presents the order of the organization of outpatient treatment for tuberculosis in town, lists activities aimed at the improvement of adherence to the treatment.

Objective: to study the possibility of diagnosis of spinal static deformities using the method of topographic photometry over time before and after rehabilitation follow-up in school-aged children. Material and methods. The study involved 411 children (207 boys and 204 girls) aged 6-16. 77 children with spinal deformities (scoliosis, postural disorder) underwent complex rehabilitation treatment. 46 patients were done X-ray investigation. Results. The groups of the boys and girls were analyzed in accordance with the data of their examination by the method of topographic photometry. The data of topographic photometry obtained after the examination of the children before the treatment and 6 months after it were analyzed. The X-ray and topographic data were compared. The results of X-ray and optical topography were identical in 35 (76 %) cases. Thus, the method of topographic photometry makes it possible to estimate the results of rehabilitation activities in children without extra X-ray exposure. Conclusion. The high information value of topographic photometry without radiation exposure defines the reasonability of the use of this method for the control of efficiency of rehabilitation activities in static spinal deformities in children.

Objective: to study concentrations of anthropogenic air pollutants on streets with different traffic load and prevalence of laryngotracheitis (LT) among children residing on those streets. Material and methods. We have analyzed the quality of free air on streets with different traffic density in Vinnytsya during 2000-2003. We have studied the concentrations of suspended matters with the content of silicon dioxide less than 20 %, sulfur dioxide, carbon dioxide, and nitrogen dioxide. We have analyzed the frequency of LT cases (1-3 episodes of the disease) and recurrent LT (4 or more episodes of the disease) among children under 14 residing on the streets with different traffic load. Results. The indices of the average and maximum concentrations of free air pollutants on the streets with high traffic density significantly exceeded those on the streets with low traffic density. The prevalence of LT and recurrent LT was significantly higher on the streets with high traffic load. We have found a connection between the prevalence of LT among children, traffic density and concentrations of free air pollutants. The connection between the prevalence of LT and the concentration of nitrogen dioxide has turned out to be the strongest. Conclusion. The prevalence of LT in children is related to traffic load and concentrations of anthropogenic free air pollutants.

Objective: to study the vegetative regulation of cardiac function by means of Holter monitoring in patients diagnosed with diffuse toxic goiter associated with therapy with tireostatics and beta adrenoblockers (рropranololum, bisoprolol). Material and methods . 82 patients diagnosed with a diffuse toxic goiter aged 18-60, out of them 24 men and 58 women participated in the study. The patients were divided into two groups: the first group (46 patients) took non-selective beta adrenoblocker Propranololum (Anaprilin), the second group (36 patients) took beta1-adrenoblocker Bisoprolol. The control group included 30 almost healthy volunteers. All the patients were performed Holter monitoring with the assessment of heart rate variability, their thyroid status was studied. Results. We have done the comparative analysis of the thyroid status in the groups of the patients with diffuse toxic goiter following different schemes of pathogenetic therapy. We have analyzed the data of Holter monitoring with the assessment of heart rate variability related to the intake of cardioselective and non-selective beta adrenoblockers. Conclusion . Patients with compensated thyrotoxicosis taking Bisoprolol at a dose of 5 mg/day and Thiamazolum of 15 mg/day have signs of vegetative imbalance in the form of dominance of sympathetic section of the vegetative nervous system. When the compensation of thyrotoxicosis is achieved in patients using the scheme of 40 mg/day of Anaprilin and 20mg/day of Thiamazolum, the vegetative regulation of cardiac function is characterized by vegetative balance. The correction of medicamentous therapy of vegetative imbalance is possible taking into account results of Holter monitoring.

Objective: to assess the 24 hours fluctuations of blood pressure in school age children by ambulatory blood pressure monitoring Material and methods. 45 children of school age were examined. Daily blood pressure monitoring was performed in the hospital using the device Ambulatory Blood Pressure Monitor Holter ABPM50. Results. Among the surveyed children normal circadian index had only two patients (1.28 and 1.32 i.u.). The remaining patients had rigid circadian rate (less than 1.2 i.u.), which may indicate the presence of vegetopathology and violation of both afferent and efferent chains of vagosympatic regulation of heart rate, the phenomenon of «denervated» heart

Objective : to define the features of the course of pregnancy, delivery, postpartum period and state of newborns in female patients with genital HPV infection, depending on its form and viral load; to assess the factors of the course of gestation and delivery in the vertical transmission of neonatal persistence of HPV infection. Material and methods. The study involved 132 pregnant women with genital HPV infection, their babies immediately after birth (n = 107) and at the age of 6 months (n = 106). The comparison group included pregnant patients, women in delivery and postpartum period who were under supervision and who gave childbirth in Gomel region over 2011-2012 (30087 pregnancies, 33477 births). Results. Pregnancy in women with HPV infection is frequently complicated by the threat of miscarriage (p = 0.0016). The clinical manifestations of HPV infection showed no effect on the gestation. Patients with high HPV load (5 lg GE per 100,000 cells) had birth canal injuries (p = 0.029) 3 times more often. Pregnancy complicated by gestosis and anemia, as well as vaginal childbirth were risk factors for perinatal transmission of HPV. The course of pregnancy and delivery were not determining factors in the persistence of HPV in the baby`s upper airways. Conclusion. We have defined the features of the course of pregnancy and delivery in women with genital HPV infection (the threat of miscarriage, birth canal injury with high viral load of HPV), the factors of perinatal transmission (gestosis and anemia during pregnancy, vaginal delivery).

The article presents the results of the assessment of the role of platelets in formation of extracellular traps by neutrophils. We have detected the ability of platelets to oppress the formation of extracellular traps by neutrophils in vitro cultures in patients with rheumatoid arthritis (RA) (n = 42) and systemic lupus erythematosus (SLE) (n = 24), but not in patients with hemorrhagic vasculitis (GW) (n = 15). The study has revealed the interrelation of NETosis and rheumatoid factor in patients with RA and SLE, as well as NET formation and number of platelets in patients with GW.

Primary hyperparathyroidism (PHPT) is a disease developing as a result of primary lesion of the parathyroid gland (PTG) (adenoma, hyperplasia, cancer) and conditioned by the hyperproduction of parathyroid hormone and is declared in imbalance of calcium, phosphorus, affection of bone system and/or internal organs. Surgery is the only acceptable and pathogenetically grounded method of PHPT-correction. In modern endocrine surgery there is no unanimous opinion about common approaches to the surgical treatment of PTG pathology. At the present moment, different kinds of surgical inventions are applied. The most widely used method is classical Kocher`s incision of the parathyroid gland. However, the minimal access combined with different kinds of anesthetic support is gaining importance. This article provides the results of the examination of 200 after parathyroidectomy after the use of different methods of surgical support.

We have studied the connection between the number of nucleoli in skin melanoma and the disease outcomes, proliferative activity and morphology of the tumor. We have found that the number of nucleoli in melanoma is an independent prognostic parameter and its increase is associated with poor outcome of the disease.

The article deals with the problem of the organization of nutrition of one-year-old infants. It considers the advantages of breastfeeding of infants and enumerates the differencies between breast milk and cow`s milk, which is used for production of most of milk formulae. The results of medical and social questionnaire surveys have revealed considerable violation of terms of introduction of supplemental feeding and its succession, which can increase the incidence of illnesses of digestive, endocrine, cardiovascular and other systems. A complex of measures promoting the competence of medical personnel and parents in questions of rational feeding of infants during their first year of life is needed.

Objective: to analyze the distribution of the cohort of patients with malignant tumors of ENT organs in Gomel region over 1998-2012. Material and methods. We analyzed the absolute case numbers of cancer of the larynx, oropharynx, hypopharynx, nasal cavity and paranasal sinuses. The patients were grouped in accordance with sex, age, and tumor stage. Results. The most common sites of ENT tumor were: the larynx - 40 %, the hypopharynx - 27 %, the oropharynx - 24 % (2010-2012). The dynamics of the sites: stable number of patients with laryngeal and hypopharyngeal cancer and cancer of the nasal cavity and paranasal sinuses, increase in the number of patients with oropharyngeal and laryngopharyngeal cancer. The ratio of 50-64 year-old patients increased. More than half of the cases of cancer of the oropharynx, laryngopharynx, nasopharynx, nasal cavity and paranasal sinuses are detected at III-IV tumor stage. Conclusion. The annual number of patients with tumors of ENT organs in Gomel region is more than 200 and is increasing due to the cases of oropharyngeal and laryngopharyngeal cancer. More than 90 % of the patients are men of the employable age. Early diagnosis of tumors of ENT organs stays a topical issue in the region.

Congenital hypothyroidism (CH) is the most common congenital endocrine disorder whose incidence in newborns is 1:2,000 to 1:4,000. It is the leading cause of mental retardation. Neonatal Screening Programs make it possible to identify the disease at an early stage and to start the adequate therapy of the children, thanks to which it is possible to avoid complications related to the hormone deficiency.

Lymphangioleiomyomatosis is a rare interstitial lung disease of unknown etiology which is characterized by progressive diffuse infiltrating growth of neoplastic smooth muscle-like cells, cystic lung destruction, and obliteration of lymphatic and blood vessels

Cornelia de Lange syndrome is a multisystem malformation syndrome recognized primarily on the basis of characteristic facial dysmorphism, including low anterior hairline, arched eyebrows, synophrys, anteverted nares, maxillary prognathism, thin lips, «carp» mouth, in association with prenatal and postnatal growth retardation, mental retardation and, in many cases, upper limb anomalies. However, there are clinical options with milder phenotypes in this syndrome. The prevalence of the syndrome is 1:10,000-30,000 live births, occurs equally, regardless of gender. Although this syndrome is considered rare, experts agree that it is likely underdiagnosed.

The work presents a clinical case of the aggressive form of multiple myeloma including predominant lesions of the kidneys, stomach, liver, and lymph nodes.

The present work analyzes a medical case and gives review of literature on the comorbid combination of alcohol abuse and schizophrenia, discusses the difficulties of the diagnosis and treatment.

Objective: to analyze the features of body composition and parameters of aerobic and anaerobic working capacity at speed-power physical exercises. Material and methods. We examined 15 male athletes at the age of 18-20 and 15 young men of the control group. The body composition was evaluated using the parameters of bioimpedance analyzer АВС-01 «Medass», and functional state parameters by the data of the computer program complex «D-test». Results . Higher parameters of muscular and active cellular mass and lower amount of fatty mass in athletes were associated with lower parameters of aerobic working capacity comparing with the control group. Conclusion . The features of body composition and functional state parameters at speed-power physical exercises have been defined.

Objective: to give complex assessment of compensation in diabetes mellitus type 1 (DM 1) using the continuous glucose monitoring system. Material and methods. The study included 162 patients with DM 1 who were examined using the complex of methods: questionnaire survey, clinical and anamnestic analysis, laboratory investigation of glycohemoglobin level, and continuous glucose monitoring using a CGMS system. Results. The data analysis has showed that only 23% examined patients have adequate control of DM 1. The quality of DM 1 control did not depend on age, DM 1 duration and body mass index (BMI). The highest glycemia variability depended on the total daily dose of injected short action insulin. We have found a high risk for development of hypoglycemia episodes independently of DM 1 quality control. Conclusion. In order to prescribe correct treatment for patients with DM 1, besides the main target criteria of compensation, it is very important to determine the hypoglycemia and hyperglycemia risk indices as well as clinical hypoglycemic reactions for the assessment of DM 1 compensation.