Object: to determine the development of researches in the world literature on the problem of conscripts health status assesment and to form a direction for further improvement in the interests of the medical service of the Armed Forces of the Republic of Belarus.

Materials. Original publications and literature reviews containing information on the health status and morbidity of conscripts were studied and analyzed.

Results. The most important aspects concerning the possibilities of using the assessment of the health status of conscripts are highlighted.

Conclusion. The presented analysis of scientific publications on the morbidity of conscripts in the world and in the Republic of Belarus reflects the need for the development of theoretical and applied developments dedicated to the generalized (integral) assessment of the health status of this contingent in order to improve the system of medical support of the Armed Forces of the Republic of Belarus.

Despite significant progress in the understanding of the pathogenesis of paraproteinemic hemoblastoses, these diseases remain incurable. In their development, they go through the stage of paraproteinemias, benign diseases, characterized by the detection of monoclonal paraprotein in the blood serum and / or urine, presence of clonal plasma cells in the bone marrow or in extramedullary tissues. It remains unclear why some paraproteinemias progress to multiple myeloma or other lymphoid tumors and how malignant progression occurs. An important role in the progression is played by molecular and genetic mechanisms, cytokines. Nevertheless, little is known about how the bone marrow microenvironment influences disease progression. In this review, we made an attempt to summarize the most significant biological, clinical characteristics on the course of paraproteinemias and the role of changes in the bone marrow microenvironment that contribute to malignant transformation.

The performed analytical review of literature on constitutional features of the formation of morphological status in the peripubertal period of ontogenesis has found that somatometric indicators of schoolchildren living in different urban-ecological conditions statistically significantly differ but the identified trends in the physical development of children and adolescents are often contradictory. There is lack of synthesizing data that characterize the somatic status of different body type representatives among urban schoolchildren in Belarus, although these data are important for the assessment of the health status of children cohorts.

Material and methods. We performed a prospective cohort study including 66 patients with oncohematological pathology and confirmed COVID-19 infection who underwent treatment at the SI “Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology” from March to September 2020.

Results. The overwhelming majority of patients with hematological pathology and COVID-19 infection were diagnosed with multiple myeloma (MM) — 25 (37.8 %). The highest mortality rate was recorded in patients with multiple myeloma and acute leukemia (21 % and 12 %, respectively). Stage 4–5 chronic kidney disease (p<0.05, Fisher’s exact test; 0.01) is a statistically significant factor of adverse outcomes in patients with oncohematological diseases. The presence of coronary artery disease, diabetes mellitus or other pathology did not affect the outcome. We found no effect of previous polychemotherapy performed within the time of less than a month (HR 1.15; 95 % CI 0.66–2.0) and less than 3 months (HR 0.94 %; 95% CI 0.53–1.65) on the risk of the fatal outcome of the infection in patients with neoplastic diseases of hematopoietic tissue. Age over 60 (HR 1.8; 95 % CI 1.01-3.28) and the stage of progression according to the underlying disease (HR 2.8; 95 % CI 1.9–4.0) were statistically significant factors of the fatal outcome in patients with oncohematological diseases.

Conclusion. The presented study has determined the predictors of the fatal outcome in COVID-19 patients with oncohematological diseases: age over 60 and the stage of progression of the underlying disease. At the same time, the highest mortality rate in COVID-19 was recorded in patients with multiple myeloma and acute leukemia (21 % and 12 %, respectively). Among all the analyzed comorbidity factors, stage 4–5 chronic kidney disease had a statistical significance for adverse outcomes.

Objective: to study the MIC90 of the most commonly used antiseptics for the main representatives of the microflora of purulent wounds and to study the influence of the most effective in vitro antiseptics on the bacterialload of the wound surface in patients with purulent wounds.

Material and methods. Bacteriological studies determining the MIC90values of antiseptic drugs were performed on 70 clinical isolates. Clinical studies determining the level of the bacterial load of the wound surface were performed in 30 patients with purulent wounds.

Results. Septomyrin and 0.02 % chlorhexidine bigluconate have been found to be the most active drugs against the main representatives of the microflora of purulent wounds in our region. In the combined use of septomyrin and chlorhexidine, the bacterial load of the wounds decreased below the critical level already 2 days after surgical debridement (p < 0.01), while in the single application of septomyrin, this had occurred only by the fifth day (p < 0.01), and chlorhexidine — by the sixth day (p<0.01).

Conclusion. The combined use of septomyrin and 0.02 % chlorhexidine bigluconate is characterized by high clinical effectiveness in the local treatment of purulent wounds during the first phase of the wound healing process.

Objective: to analyze the clinical characteristics of the course of the disease in patients with neuroischaemic diabetic foot depending on the presence of bacterial monocultures and associations in wounds.

Material and methods. We have performed a comparative analysis of the parameters of the clinical course of the disease and the condition of patients’ wounds (n = 76) depending on the presence of monocultures (group 1, n = 32) and microbial associations (n = 42). The list of the compared parameters in the groups included the duration of diabetes, number of hospitalizations per year, achievement of target HbA1c levels (<7.5 %), condition of granulation tissue of wounds.

Results. With increased duration of the course of diabetes (from 5 to 15 years), higher number of hospitalizations per year, deteriorated carbohydrate metabolism (HbA1c> 7.5%) in combination with clinical signs of the initial stages of wound infection, the frequency rate of the detection of mixed bacterial cultures increased.

Conclusion. The work has found differences in the duration of the course of diabetes, the number of hospitalizations per year, local status of wounds in the patients, as well as the frequency of achieving the target levels of HbA1с <7.5 %, depending on the severity of microbial load.

Objective: to specify indications for endometrial biopsy in postmenopausal women with endometrial pathology revealed by ultrasound, to study the structure of comorbidity, the parity of pregnancies and childbirth in patients with endometrial hyperplasia.

Material and methods. We performed an observational retrospective case-control study. The study included 60 postmenopausal patients with endometrial pathology revealed by ultrasound referred for further endometrial biopsy. After the results of the histological examination of the endometrium had been obtained, 30 patients who had detected endometrial pathology were included in the study group, 30 patients with histologically normal endometrium were included in the comparison group.

Results. In comparing clinical and anamnestic data, no statistically significant differences have been found between the groups. The comparison of the indices of the ultrasound study of the uterus has revealed a statistically significant M-echo value in patients with confirmed endometrial pathology — 10.00 (8.00; 13.00) mm, in the comparison group — 7.80 (6.00; 9.75) mm. If an M-echo value is > 7 mm with a sensitivity of 76.67 % and a specificity of 46.65%, endometrial pathology is likely to develop. The area under the curve (AUC) was 0.706 (95 % CI 0.574 — 0.816; p < 0.001).

Conclusion. The obtained data determine an M-echo value more than 7 mm detected by ultrasound as an indication for endometrial biopsy in postmenopausal patients. If an M-echo value is from 5 to 7 mm and clinical manifestations are absent, dynamic observation with ultrasound control can be performed. No specific risk factors for the disease have been found in the postmenopausal patients with endometrial hyperplasia, which necessitates the search for the genetic markers of estrogen metabolic disorders.

Objective: to assess the state of the pro-oxidant/antioxidant system in children with hereditary spherocytosis (HS) depending on its severity.

Material and methods. The study involved 44 HS patients at the age from 1 to 17 who were divided into 2 groups depending on the disease severity: mild course (n = 24) and moderate or severe course (n = 20). The control group included 23 practically healthy children who were comparable with the main group by gender and age. The state of the pro-oxidant/antioxidant balance of blood plasma was assessed by the method of luminol-dependent chemiluminescence (LDCL) with the determination of the maximum luminescence intensity (Imax, %) and the light sum of chemiluminescence (S, %). The activity of superoxide dismutase (SOD) and catalase was determined in the erythrocytes of the examined children.

Results. On average, the parameters of the pro-oxidant/antioxidant status in the HS patients significantly differed from those of the control group (p <0.05), which corresponded to moderately pronounced oxidative stress. The activity of SOD and catalase in the erythrocytes of the patients was higher as compared with that of the control group (p = 0.0001 and p <0.0001, respectively). The comparison of the severity of oxidative stress depending on HS severity has determined that the degree of stress was more pronounced in patients with moderate or severe course of the disease (p <0.05).

Conclusion. HS patients develop oxidative stress (decreased activity of the antioxidant system associated with increased accumulation of prooxidant substances), the degree of which is higher in patients with a severe course of the disease. This allows of considering plasma LDCL indicators as an additional marker for the assessment of the severity of the disease and of justifying the necessity to include antioxidants in the HS treatment regimen.

The article presents modern approaches to the diagnosis of pancreatic cancer, discusses the feasibility of resectable tumor biopsy, and provides clinical cases illustrating the negative aspects associated with biopsy.

Objective: to determine the clinical efficiency of antioxidant therapy in patients with liver cirrhosis and acute blood loss.

Material and methods. The study included 286 patients with liver cirrhosis and acute blood loss of varying degrees of severity. The patients were divided into two series of studies. In the first series, the patients received the therapy according to the clinical diagnostic and treatment protocols, in the second series 1 according to the same protocols in combination with an intravenous administration of the antioxidant complexes “Reamberin” and “Fluimucil”. After 48 hours from admission, the antioxidant status of blood serum, the blebbing index of lymphocytes, the concentration of uric acid, and the level of hemoglobin were analyzed. The indicators of the clinical efficiency of the treatment were determined: risk of absolute mortality, risk of relative mortality, the number needed to treat.

Results. The blood serum of the patients from the first series of studies was characterized by pronounced prooxidant activity, high values of the lymphocyte blebbing index, and a small amount of uric acid, which was indicative of the development of oxidative stress. The mortality rate in this series of studies was 26.0 %. The patients of the second series of studies were characterized by pronounced antioxidant activity of blood serum, low values of the lymphocyte blebbing index, and high concentrations of uric acid, which indicated a decrease in the activity of systemic oxidation processes. The mortality rate in this series of studies was 18.2 %. The duration of the treatment decreased from 16.5 days (first series) to 13.0 days (second series).

Conclusion. The combined use of the “Reamberin” and “Fluimucil” complexes as part of the therapy according to the clinical diagnostic and treatment protocols leads to a relief of oxidative stress in patients with liver cirrhosis complicated by acute blood loss. The blood serum of these patients is characterized by pronounced antioxidant activity, low values of the lymphocyte blebbing index, and a high concentration of uric acid, which reduces the risk for the development of multiple organ failure syndrome. This therapy decreases the mortality rate to 18.2 % and the duration of the treatment to 13.0 days.

Objective: to study the features of the topography of the unpaired visceral branches of the abdominal aorta in men and women at different periods of adulthood.

Material and methods. We analyzed 190 (93 male and 97 female) computer scans of the abdominal aorta with no cases of vascular and other pathology detected in the patients.

Results. It has been found that the topographic parameters of the unpaired visceral branches of the abdominal aorta change with age in both the men and women. In the women in all age groups, the orifice of the celiac trunk is located higher than in the men. In 31.3 % of the women, the origin of the celiac trunk corresponds to the Th12–L1 level of the intervertebral disc, and in 37.0 % of the men — to the intervertebral disc L1–L2. The orifice of the superior mesenteric artery is skeletotopically located at the level of the middle of the body L1 in 25.9 % of the men and in 25.2 % of the women. The orifice of the inferior mesenteric artery in 40.4 % of the men corresponds to the lower edge of the body L3, and in 36.4 % of the women — to the level of the middle edge of the body L3.

Conclusion. The obtained data on the sex and age characteristics of the position of the orifice of the celiac trunk, superior and inferior mesenteric arteries are not only of anatomical interest, but also of clinical significance in angiography, abdominal surgical interventions and in X-ray endovascular surgery.

Objective: to develop a criterion for normality/abnormality of the inferior vena cava diameter in children that is convenient to use in wide clinical practice.

Material. In order to achieve the above objective, we performed measurements of the antero-posterior cross-section of the inferior vena cava in children (n = 100) in different age periods.

Results. We have determined a criterion allowing of assessing the normality/abnormality of the inferior vena cava diameter in different age periods with sufficiently high accuracy.

Conclusion. The work has concluded on the potential of the use of the coefficient reflecting the ratio of height and diameter (range — 0.04–0.1) as a reliable reference point for the assessment of the normality / abnormality of the inferior vena cava diameter in different age periods.

Objective: to evaluate the cost-benefit ratio of the use of invasive intraoperative hemodynamic control of peripheral blood flow during correction of multilevel lesions in chronic arterial occlusive disease of the lower extremities.

Material and methods. We compared the cost of the in-hospital period of treatment among patients of 3 comparable groups: the patients of the first group underwent interventions under angiographic control, of the second — under invasive intraoperative hemodynamic control of the state of peripheral blood flow in addition to angiography, and in the patients of the third group invasive hemodynamic control of the state of peripheral blood flow was followed by pharmacological tests.

Results. The use of the given method made it possible to correct the extent of the performed procedures of revascularization and to estimate the efficiency of the phases of the operation in real time. The result of interventions in the groups with hemodynamic control was a reliable increase of the ankle-brachial index (ABI index) values (p — 00001) in shorter length of segments after revascularization (p — 0.05). At the same time, the reduced extent of the correction resulted in saving 807 BYN per case.

Conclusion. The use of invasive intraoperative hemodynamic control allows of reducing the extent of the reconstruction in multisegment lesions with the achievement of satisfactory clinical outcomes with lesser economic costs.

Objective: to study the quality of life in patients who underwent surgical intervention on cancerous tumors of the mucous membrane of the oral cavity and oropharynx.

Material and methods. An analysis of the quality of life was performed in 31 patients with tumors of the mucous membrane of the oral cavity and oropharynx using the EORTC QLQ-30 and EORTC QLQ-H & N35 questionnaires.

Results. The study of the quality of life using the EORTC QLQ-30 questionnaire in dynamics revealed improved general health status, emotional functioning, cognitive function, lower pain level, decreased frequency of insomnia (p> 0.05). The assessment of clinical meaning and magnitude according to K. Cocks et al. showed that these factors were characterized by a low level of clinical meaning and magnitude of changes in the studied parameters for all scales, except for the insomnia scale corresponding to an average level of clinical meaning and magnitude. At the same time, a statistically significant change score in the fatigue scales (p <0.01) corresponded to a low level of clinical meaning and magnitude, and low appetite (p < 0.05) should be r egarded as irrelevant. The survey of the patients using the EORTC QLQ — H & N35 questionnaire showed deterioration in some functions associated with the consequences of anticancer treatment, including impaired taste and odor perception (p < 0.01), speech disorders (p < 0.05), difficulties related to eating in public places (p < 0.01), difficulties in social contacts (p < 0.05), viscous saliva (p <0.05).

Conclusion. The study has revealed positive changes in the quality of life of patients with oral and oropharyngeal cancers in the period from 4 to 6 months after the end of treatment, which indicates a gradual return to the initial level of vital activity and the need for regular monitoring of the quality of life of the patients in the long follow-up.

Objective: to study ascariasis as a factor leading to changes in the expression levels of BIRC-5, GLI, VEGF and the TP53 suppressor gene in tissue biopsies in rats during the reproduction of experimental C6 glioma.

Material and methods. C6 glioma tumor was modelled in situ in female rats of the first (“control group with tumor”) and second groups (“glioma in combination with ascariasis”). The material was taken on the 14^th, 21^st, 28^th, 35^th days of tumor development in the animals of the first group, on the 7^th (14^th day of tumor development), 14^th (21^st day of tumor development), 21^st (28^th day of tumor development), 28^th day after infection (35^th day of tumor development) in the females of the second group. The animals of the third group were healthy (10 animals). Tissue biopsies were taken from them once.

Results. TThe A. suum invasion of the animals at a dose of 40 eggs per gram of animal body weight increases the expression of BIRC-5, GLI, VEGF genes and the TP53 suppressor gene in the rats with experimental glioma.

Conclusion. Therefore, the authors` experimental model of C6 glioma in situ in rats has showed that the A. suum invasion at a dose of 40 eggs per gram of body weight increases the expression of BIRC-5, GLI, VEGF genes and TP53 suppressor gene in rats with experimental glioma.

Objective: to study the role of neurohumoral and biochemical changes in the pathogenesis of prolonged second stage of labor.

Material and methods. To achieve the above objective, we examined 35 parturient women with prolonged second stage of labor and 45 parturient women with physiological labor. We studied the levels of progesterone, estradiol, relaxin, serotonin, cholesterol, thiobarbituric acid reactive substances (TBARS), total antioxidant capacity of plasma, products of final protein oxidation, as well as the total concentrations of nitrite and nitrate ions (NOx) in blood plasma.

Results. In the women with prolonged second stage of labor, the levels of estradiol and progesterone were significantly higher than in those with physiological childbirth (p1 = 0.037, p2 = 0.029). The women giving birth by operation had higher estradiol (p = 0.017) and progesterone (p = 0.07) levels than those giving birth physiologically. The level of relaxin was lower in the women with prolonged second period of labor than in those with physiological labor (p = 0.084), especially in the case of operative delivery (p = 0.041), the risk of which increases 4.1 times when the relaxin concentration is less than 36.4 ng/l. Compared to the patients giving physiological childbirth, the patients with prolonged second stage of labor who delivered by cesarean section had significantly higher TBARS levels (p = 0.043). Its concentration > 180.3 μmol/l increases the risk of cesarean section almost by 12 times (p = 0.003).

Conclusion. The hormonal aspect of the pathogenesis of prolonged second stage of labor is characterized by higher concentrations of steroid hormones — estradiol and progesterone, as well as by a lower level of relaxin in plasma. The biochemical aspect of the pathogenesis is represented by an increased concentration of lipid peroxidation products, which can be identified with severe physical fatigue in childbirth. The detected changes can be applied in the complex diagnostics of prolonged second stage of labor.

Objective: to develop an integral assessment framework of the health status of conscripts.

Material and methods. The study included the morbidity parameters among servicemen: general and primary morbidity, necessity in dispensary observation, hospitalization, period of being disabled, dismission for health reasons and mortality. To determine the priority coefficients for the morbidity parameters, we performed an expert survey.

Results. Within the structure of the integral assessment of the health status among conscripts, the priority ranking was as follows: 1st — respiratory diseases (chapter X), 2nd — traumas, poisoning and some other consequences of external causes (chapter XIX), 3rd — diseases of the gastro-intestinal system (chapter XI), 4th — diseases of the musculoskeletal system and connective tissue (chapter XIII), 5th — diseases of the skin and subcutaneous tissue (chapter XII). Within the structure of the integral assessment, the priority nosology ranking was as follows: 1st — acute respiratory infections of the upper respiratory tract (J00–J06), 2nd — diseases of the esophagus, stomach and duodenum (K20 – K31), 3rd — multitraumas affecting several body areas (T00–T07), 4th — effects of traumas, poisoning and other consequences of external causes (T90–T98), 5th — diseases of the oral cavity, salivary glands and jaws (K00–K14).

Conclusion. The developed integral assessment framework of the health status optimizes the effect of some morbidity parameters and reliably correlates the contribution of the chapters and nosologies with the final assessment result, which makes it possible to timely, completely and promptly assess the quality of medical care to conscripts.

Objective: to assess cardiovascular parameters in medical students depending on the type of blood flow autoregulation during physical exercise.

Material and methods. We examined 58 students whose average age was 19 ± 1.13 years. During the examination, we recorded electrocardiograms (ECG), registered the parameters of central hemodynamics and determined systolic and diastolic blood pressure and heart rate. We performed the comparison of the parameters of the cardiovascular system (CVS) in students with different types of blood flow autoregulation (BFA) (cardiac, cardiovascular and vascular) during physical exercise.

Results. The study has identified the dynamics of electrocardiographic and rheographic parameters during physical exercise expressed in excessive activation of energy resources and strain of the CVS functioning in young men with the cardiac type of BFA, which provides adaptation to short-term effects of disturbing environmental factors. On the contrary, the vascular type of BFA is the most economical, and this type of CVS has a wide range of the function mobilization to long-term physical activity.

Conclusion. The study has found statistically significant differences in the cardiovascular parameters in the students with different types of blood flow autoregulation during physical activity.

Objective: to analyze the effectiveness and characteristics of teaching the discipline “Phthisiopulmonology” with the use of various methods in the training of physicians during the pandemic.

Material and methods. We analyzed modern publications on the problem, performed comparative interpretation of the first results of the use of the distance format of academic process for the teaching of the clinical discipline “Phthisiopulmonology” at specialized departments of universities in selected CIS countries.

Results. In the spring of 2020, the system of higher medical education was forced to transition to teaching students with the use of online techniques. This teaching method is almost always evaluated positively for a number of reasons. Teaching at the clinical departments of medical universities, where practical skills are priority in contact with patients, may incorporate only elements of remote techniques. The phthisiopulmonology departments of medical universities (Kursk, Gomel, Tashkent) applied various techniques of remote teaching during the pandemic.

Conclusion. The first results of the use of the distance format has demonstrated that the use of the hybrid method (full-time training with elements of distance learning) is the most reasonable for teaching clinical rotations.

Objective: to study the efficiency of the application of atomic force microscopy for the identification of differences in the structural and mechanical properties of gastric epithelial cells in normal conditions and in gastric cancer.

Material and methods. The structural and mechanical properties of the membrane of the epithelial cells of the gastric mucosa in 7 patients with gastric cancer were assessed using atomic force microscopy in contact mode.

Results. The comparison of the size and shape of gastric mucous cells (GLC), their healthy and tumor areas has showed that in both the cases they have a slightly elongated rounded shape and similar dimensions: length × width × height of the cell is norm (in μm): 7.5 × 6.8 × 0.6, and in case of oncologic pathology (in μm): 7.2 × 6.9 × 1.0. Tumor cells are characterized by a 13% increase in their surface roughness compared to normal epithelial cells. The lateral force microscopy method allows of obtaining data on the structure of the submembrane cortical layer of the cell cytoskeleton. According to experimental data, a 2.48-fold decrease in the value of the friction force (Fl) in epithelial cells from healthy areas of the coolant indicates increased density and integrity of the cortical layer of the cytoskeleton in normal conditions compared to those of tumor cells.

Conclusion. The analysis of the experimental data has found that tumor cells from the gastric mucosa differ from healthy cells in terms of their nanomechanical properties: they are characterized by a rougher surface, which consists of fewer structural elements of a larger size. The work has showed the interrelation of the indicators of the frictional properties of the cell surface: the values of the friction forces and the roughness of the friction map.

Objective: to analyze the characteristics of hepatitis C virus chronic infection with concurrent cryogobulinemia, to assess the prevalence of extrahepatic diseases in the population of Belarusian patients under study.

Material and methods. An open, non-randomized observational study with the inclusion of patients with hepatitis C virus (HCV) chronic infection and cryoglobulinemia (CG) was conducted.

Results. The study has determined the core characteristics of HCV infection in CG patients, incidence rates and a wide array of extrahepatic diseases (EHDs), as well as HCV infection distinctive features compared to those without extrahepatic diseases.

Conclusion. The revealed variety of common EHDs in HCV infection indicates that many organs and systems are involved in the pathological process and this variety should be taken into account when considering prognosis and treatment tactics.