The review presents information about the most common causes of sudden cardiac death in children and adolescents, predictors of sudden cardiac death in these diseases, modern methods of examination of patients threatened by the development of sudden cardiac death.

The article presents a review of literature works and personal studies on the biological significance and homeostatic regulation of zink in animals and humans.

Quality of life is one of the important criteria for general welfare and health of population at the present-day stage of development of medicine [1, 2]. The article presents the issues of ocular prosthetics as one of the main stages of rehabilitation of patients with anophthalmos [3]. Ocular prosthetics makes it possible to adapt the patient to the absence of the eyeball most completely, to restore the habitual facial assimetry and rehabilitate the person in terms of public and social life.

The specific features of psoriatic arthritis include the combined lesion of the joints of limbs and the spine, diversity of the clinical symptoms, variability of the initial manifestations, serological and X-ray negativity at the early stages. This causes difficulties in the diagnosis of the disease. The article presents the diagnostic criteria of psoriatic arthritis and principles of the differential diagnosis of the disease.

We conducted the immunohistochemical examination of 2008 patients with breast cancer determining Her2/neu, receptor estrogene, and progesterone in Grodno region over 2010-2015. We revealed triple negative breast cancer to be negative to these markers in 19.8 %, with annual fluctuations of its share within 16.4-21.6 %. 39 women from the BRCA-1 database (449 women with breast cancer) detected triple negative breast cancer. Mutation of BRCA-1 was identified in 5 out of 39 (12.8 %) cases. Histologically, these tumors were presented by invasive ductal carcinoma, by G2-G3 and also medullary cancer in 3 cases, by G3 - in 2 cases. During the immunohistochemical study of 23 cases, CD-117 expression of varying intensity was detected in 11 (47.8 %) and focal nuclear expression of androgen receptors (< 1 %) in 1 case (4.35 %). The presence of C-kit (CD-117) hyperexpression presupposses the study of the possibility of the targeted therapy with imatinib by analogy with gastrointestinal stromal tumors, which, in turn, requires the inclusion of C-kit (CD 117) into the list of mandatory immunohistochemical markers in triple negative breast cancer, and the postoperative diagnosis of triple negative breast cancer presupposses the necessity for BRCA-1 mutation identification.

Objective: to determine the type of changes of shear stress in vessels of the vertebrobasilar system in patients of young age with spondylogenic vertebrobasilar insufficiency (SVI). Material and methods. We examined 131 patients (70 women and 61 men) aged 18-40 (average age was 29.8 ± 3.8) with manifestations of spondylogenic vertebrobasilar insufficiency associated with muscular reflex, neurovascular and radicular syndromes of osteochondrosis of the cervical part of the vertebral column. 25 healthy donors made the control group. All the patients underwent radiological examination of the cervical part of the vertebral column with functional probes, doppler and duplex ultrasound of vessels of the neck and arteries of the head with functional probes; we performed the detection of endothelin-1, nitric oxide (NO) of blood serum. The changes of the shear stress in vessels of the vertebrobasilar system were assessed analyzing the Stuart index (ISD), systolic and diastolic parameter. Results. It has been found that development of spondylogenic vertebrobasilar insufficiency is accompanied by signs of endothelial dysfunction (ED), which is characterized by increased concentration of endothelin-1 related to the reduction of active metabolite of nitrogen oxide - S-NO. One of the mechanisms of ED in this cohort of patients is changes of the shear stress. Conclusion. In order to predict the development of ED in patients with spondylogenic vertebrobasilar insufficiency, it is recommended to pay particular attention to the state of the vascular wall.

To study the role of IL28B gene polymorphisms in the development of chronic hepatitis C, we have determined polymorphic types of the gene at sites rs12979860 and rs8099917 using allele-specific polymerase chain reaction with real-time product detection in 21 patients with this disease. We have found the association of chronic hepatitis C with the presence of unfavorable TT genotype of gene IL28B polymorphism rs12979860, which can be regarded as a predictor of the development of this pathology. Favorable genotypes of CC rs12979860 and TT polymorphism of rs8099917 of gene IL28B are more common in healthy individuals and they are associated with higher activity of the inflammatory process in patients with chronic hepatitis C. Therefore, gene IL28B polymorphisms can affect not only the outcome of an acute viral infection but also the further course of chronic hepatitis C.

Objective: to carry out the analytical assessment of outpatient management of patients with rheumatoid arthritis in real clinical practice and study the structure of comorbid pathology. Material and methods. The medical records of 88 patients have been analyzed at 6 outpatient clinics of Gomel. The Charlson comorbidity index was applied for the quantitative assessment of the comorbid status. Results. The most common provoking factors of the development of rheumatoid arthritis were acute respiratory viral infections and exacerbation of chronic diseases; and the background disease was thyroid pathology. The most frequent complications of rheumatoid arthritis were osteoarthritis, anemia of chronic inflammation, osteoporosis, coronary heart disease. Comorbid pathology occured in 97.7 % of the patients with rheumatoid arthritis. Conclusion. At present, the problems of management of patients with rheumatoid arthritis are late diagnostics; discrepancy of real treatment to the modern recommendations of EULAR; insufficient use of disease-modifying antirheumatic drugs; absence of individual approach aimed at early detection of comorbid pathology and its adequate treatment.

Objective: to determine the level of stress in students of different years of studies of medical and agrarian universities, to estimate the level of stress expressiveness and prevailing symptoms. Material and methods. The level and structure of stress were estimated using the scale of PSM-25 adapted by N. E. Vodopyanova. The level of stress in groups of first and fourth year students was determined, the prevailing symptoms in different age groups were assessed. Results. The obtained data confirm the low level of stress in different year students of different universities. It has been found that first year medical students had higher level of stress than those of agrarian universities. It has been revealed that first year medical students had prevailing symptoms related to higher level of anxiety and fourth year medical students had prevailing symptoms related to physical ailment. Conclusion. The obtained results make it possible to formulate practical recommendations promoting successful adaptation of students at institutions of higher education.

Objective : to carry out the comparative analysis of clinical and morphological pathologic factors and long-term results of surgical treatment of cancer of the pancreas head (CPH) depending on prior biliary drainage (PBD). Material and methods . 39 patients (group I) were performed single-step surgery, PBD was performed in 41 cases (group II) at a total bilirubin level of more than 200 umol/l. Results . The prevalence of cancer of the pancreas head in the surveyed groups did not differ, patients of groups I and II revealed low-grade ductal adenocarcinoma in 43 and 79 %, respectively (p = 0.003), the survival median was 14 and 13 months, 3-year survival rate was found in 28.9 ± 8.4 and 3.5 ± 3.4 %, 5-year - 19.3 ± 7.9 and 0 % (p = 0.04). Conclusion . It is advisable to expand the indications for single-step surgical treatment for CPH complicated by obstructive jaundice.

Objective: complex assessment of the functional status of neutrophils in patients with chronic recurrent furunculosis (CRF) and recurrent herpetic infection (RHI). Material and methods. We have studied the functional status of neutrophils: ROS-, NO-production and NET-generation, apoptosis, phagocytosis, and bactericidal ability of 103 patients with CRF and 238 patients with RHI examined during remission and exacerbation stages. Conclusion. The patients examined during remission showed the same type of the functional status changes of neutrophils in comparison with healthy individuals. The exception was the parameters of the bactericidal activity of neutrophils decreased in the patients with CRF. During the acute stage we marked the maximum changes of netosis and apoptosis. We have defined the possibility of using these data for more precise differentiation of exacerbation and remission in patients with CRF and RHI.

Objective: to determine regularities of the dynamics of carbohydrate metabolism indices in the application of various techniques of the treatment for local wounds in patients with diabetes mellitus. Material and methods. We studied the glycemia dynamics in 83 patients with different types and duration of diabetes mellitus who had local wounds of various genesis and limitation period. We applied various ways of conservative therapy and surgical treatment of wound defects and also their combinations in the out-patient conditions of hospital. Hypocarbohydrate diet, various schemes of insulin therapy with short and long acting preparations, oral application of antihyperglycemic preparations of biguanide and sulfonylurea groups, and also their combination were applied as antihyperglycemic therapy. Results. Elimination of local wound defects with a small amount of necrotic mass or its absence in patients with different types of diabetes mellitus by means of various conservative techniques and operative treatment leads to the decrease of prandial glucose concentration in capillary blood. Patients with significant volume of wound detritus did not reveal such a relation. Conclusion. Necrotizing tissues in the area of a local wound defect in patients with impaired glucose metabolism are the cause of persistent hyperglycemia in these patients. This is an unfavorable factor for medicinal compensation of carbohydrate metabolism.

Objective: to determine the intensity of age-related dystrophic changes in different areas of iliolumbar, long dorsal sacroiliac ligament, and sacrotuberous ligaments. Materials. We have studied iliolumbar and long dorsal sacroiliac ligaments of 81 corpses: 39 men (the average age was 62.6 ± 8.8) and 20 women (the average age was 58.0 ± 11.8) and sacrotuberous ligaments of 15 male corpses (the average age was 69.2 ± 5.8) and 10 women (the average age was 57.8 ± 11.9). Results. We have revealed statistically significant differences between the parameters characterizing the intensity of dystrophic changes in the central and peripheral areas (i.e. in the areas adjacent to enthesitis) of iliolumbar, long dorsal sacroiliac and sacrotuberous ligaments. There was a strong relation between the age and intensity of dystrophic changes in various areas of iliolumbar, long dorsal sacroiliac, and sacrotuberous ligaments. Conclusion. Dystrophic changes in the iliolumbar, long dorsal sacroiliac and sacrotuberous ligaments develop unevenly in different parts (earlier and more pronounced changes appear in the areas adjacent to enthesis); age-related dystrophic changes of iliolumbar, long dorsal sacroiliac and sacrotuberous ligaments are closely linked, and therefore any changes that break this rule (for example, the emergence of asymmetrical expression or localization changes) are appropriate to consider as a potential pathological substrate of the lower back pain.

Objective: to assess the results of clinical monitoring of drug-resistant tuberculosis in palliative care patients. Material and methods. We have analyzed the clinical data and results of the monitoring of drug resistant tuberculosis in 165 patients who were changed to palliative treatment. Results. Clinical forms with subacute course and secondary drug resistance of tuberculosis mycobacterium were found to predominate, within the first 12-18 months of the observation of palliative care patients as a rule no bacterioexcretion was detected. Conclusion. The analysis of the monitoring results will make it possible to optimize standards of management of patients with drug resistant tuberculosis who are changed to palliative care.

Objective: to study the morphological changes occurring after closure of the liver wound with omentum and fragment of the synthetic material fluoroplastis-4 in experiment. Material and methods. Modeling of the marginal resection of the liver was performed on white rats in experiment. Depending on the material used for the plastic closure of the wound surface, the experimental animals were divided into two groups (comparative and experimental): in the 1st group, a strand of omentum on the vascular pedicle was used, in the 2nd - a fragment of fluoroplastic-4. After the rats had been excluded from the experiment, the macroscopic changes in the abdominal cavity were evaluated and sampling from the surgery zone for the manufacture of histological preparations and study by means of light microscopy was done. Morphometric studies were carried out with the statistical processing of the received data. Results. Using greater omentum in late terms after the operation we detect adhesions within the area of the resection, presence of newly formed capsules of the liver under the omentum and no signs of inflammation. At the microscopic level, the key feature of the use of fluoroplastic-4 is the formation of a connective tissue capsule around the material. Another characteristic feature of its use is presence of giant multinucleated cells of foreign bodies on the boundary «polymer-liver». Conclusion. The experimental study demonstrates the viability and morphological substantiation of application of synthetic polymer fluoroplastic-4 as an alternative method of closure of the liver wound surface after resection.

Objective: to establish key factors influencing the level of implementation of modern information and communication technologies in the sphere of medical and social welfare and disease prevention among the elderly. Material and methods. We have studied publications containing information about the key factors that determine the level of implementation of modern information and communication technologies in the sphere of public health aimed at maintaining high quality of life and health promotion among the elderly. The analysis, processing, and classification of the received data have been carried out. Results and discussion. The article identifies and systematizes factors that may affect the level of implementation of information and communication technologies into daily life of elderly patients, determines the degree of modifiability of these factors and the possibility of further practical application of the received data in the Republic of Belarus. Conclusion. Most of the factors identified in the article are modifiable. Correction of these factors by teaching the elderly, changes in the legislation or other evidence-based methods can improve the health and quality of life of the elderly population.

We have developed a method for obtaining specific test allergens from bacteria of industrial strains Bacillus subtilis 494 and Pseudomonas fluorescens S 32, whose use in laboratory allergological diagnostics has made it possible to establish significant and widespread (85.7% of the surveyed persons) induction of hypersensitivity of delayed-immediate type of professional polymicrobial etiology in the organism of workers of biotechnological enterprises.

The examination of city school children aged 7-17 has revealed that the periods of the maximum growth of the width and circumference body sizes in boys are between the age 10-11, cross diameter of chest is between 15-16, and sagittal diameter - between 13-14. The most intensive period of growth of circumference body sizes, shoulder width, pelvis width, cross and sagittal diameters of chest in girls are between the age interval 9-10, width of extremity epiphysis (shoulder, forearm, and shin) - from 9 to 10. It has been found that boys and girls aged 7-17 reveal the growth of chest flattening.

Objective: using a clinical case of zoonotic cutaneous leishmaniasis to characterize the possibilities of its diagnosis and treatment options. Material and methods. Data on the medical history, clinical and laboratory parameters of the examination of the patient with a disseminated form of zoonotic cutaneous leishmaniasis were studied in comparison with data from literary sources. Results. The patient with cutaneous leishmaniasis was infected in Turkmenistan. Skin lesions (multiple ulcers, lymphangitis, edema) progressed and led to disability. After Itraconazole course failure, the treatment with Glucantime was prescribed, including its systemic and local (with Dimexidum) application, after which the local manifestations decreased significantly. Conclusion. Imported cases of zoonotic cutaneous leishmaniasis into the Republic of Belarus have become more frequent. Doctors specializing in dermatology, infectious diseases, and general practitioners must know the principles of diagnosis and treatment of this disease. Combined systemic and local application of Glucantime can promote rapid relief of local symptoms.

Cystic fibrosis (CF) is not only medical but also a social problem as it considerably worsens the quality of life and requires immense expenses on medical aid, care, and rehabilitation of children and adults. The early manifestation of CF takes more severe course in children who have had meconium ileus. There are the following types of cystic fibrosis: mixed (pulmonary and intestinal); preferentially pulmonary; preferentially intestinal; liver cirrhosis, portal hypertension and ascites; electrolyte depletion; meconium ileus; neonatal high concentration of IRT (Immunoreactive trypsinogen); atypical, and suppressed. During the 1950s about 80 % of patients died before the age of 10, however, at the present time, the average life expectancy of CF patients is 29 years and more.

The article presents clinical cases and also fragments of the electrocardiogram in children with early repolarization syndrome in different clinical situations and gives literary data on the importance of this phenomenon. It has been indicated that early repolarization syndrome may be related to many reasons, which requires an individual diagnostic approach. If the child`s electrocardiogram exposes early repolarization syndrome, it is necessary to consider the medical history and clinical characteristics of the child and to use the diagnostic algorithm presented in the article before allowing the child to do physical exercise and sports.

Vipera berus is the only venomous snake living in Belarus. Poison of a viper has a hemorrhagic and necrotizing effect. As a result of the poisoning with these poisons, hemorrhagic hypostases, blood clotting disorders, and destruction of tissues develop, which can lead to multiple organ dysfunction syndrome or even a fatal outcome. It is extremely dangerous when a viper bites a person into the area of the heart or neck. If medical aid is not provided in time, the person may die of suffocation as the edema on the neck will weigh upon the trachea [1, 2]. The article presents the observation of clinical cases of MODS development in children after a viper`s bite and the favorable outcome after performing a course of intensive care at ICU Gomel Regional Clinical Hospital.

Lymphangioma is a benign tumor of the lymphatic system which often develops during the embrionic period. The manifestation usually takes place before the age of 1 with non-specific clinical presentation. An obstetrician-gynecologist may face this pathology in the fetus and newborn as well as rendering emergency aid. The article presents two clinical cases of lymphangioma in a fetus and the newborn, and a 16 year-old child.

Objective: to study the level of interleukin-6 in the blood of patients with liver cirrhosis and to identify the diagnostic significance of this parameter. Material and methods. We have done the research among patients with chronic liver diseases (cirrhosis, chronic hepatitis, non-alcoholic fatty liver disease) and have determined the IL-6 level in the blood plasma in the patients and in healthy people of the control group. Conclusion. We have revealed a statistically significant increase of the interleukin-6 level in the blood plasma of the patients with liver cirrhosis compared to the similar parameter in the healthy people of the comparison group. The degree of the increased IL-6 level was directly proportional to the severity of the pathological process. The value of the concentration of interleukin-6 in the blood can be used as an additional criterion for evaluation of severity of liver cirrhosis and portal hypertension.

Objective: to create a mathematical model of prognosis of endometrial adenocarcinoma of the uterine body I-III stages. Material and methods. The training group included 60 patients, the screening one - 40. The clinical course of the disease in each female patient was monitored using data of the Belarusian Cancer Registry. Predictors that had a significant (p < 0.05) effect on the survival rate were selected by multivariable regression analysis of Cox`s proportional hazards. Results. Among all the studied morphological and immunohistochemical parameters of endometrioid adenocarcinoma only 4 were predictors of adverse clinical outcomes of the disease: vascular area, expression of CD3-lymphocytes, dendritic cells (S100), and the expression of vascular growth factor (VEGF). Conclusion. The results of this study give an opportunity to put the female patients into groups with high or low survival rate with the diagnostic accuracy of 92.5 %.