One of the slogans of modern clinical vaccinology is — “You have taken enough care of your children’s health, and now it is time to take care of yourselves and your parents — it is high time to think seriously about vaccinating adults!” It is indeed true that for a long time vaccinology has been confined to the paediatric service only, while general practitioners and specialists of the therapeutic branches of medicine have dealt with vaccination very rarely, and only in relation to seasonal influenza. This is often due to the fact that clinicians often have insufficient or inaccurate information regarding the need for and the effectiveness of vaccination in adult patients, including those with immunosuppression or comorbidity. In some cases, the infrastructure needed to develop a tailored vaccination schedule for adult patient groups at increased risk of developing infectious complications is lacking. This article presents current data with regard to vaccination of immunosuppressed adult patients.

Objective: to systematize and analyze data on the anatomical and morphological characteristics of the superior cluneal nerves and to consider the potential of the application of medical imaging techniques for the diagnosis of their damage.

Materials and methods. We studied original publications deposited in PubMed resources and the information portal eLIBRARY.RU which contained information on the application of imaging techniques for the diagnosis of superior cluneal nerve neuropathy.

Results. The work highlights the most important aspects relating to the potential of the application of imaging techniques in the diagnosis of superior cluneal nerve neuropathy.

Conclusion. Modern methods of radiodiagnostics make it possible to provide visualization of superior cluneal nerve neuropathy. However, the lack of reliable diagnostic criteria does not allow of trustworthy diagnosis of this pathology and, accordingly, of verification of associated low back pain cases.

The collapse of the USSR and the subsequent economic crisis had a negative impact on the stability of the national economic complex, including health care. In the post-Soviet space, the principle of preferential medical and preventive care for workers of industrial enterprises, which was put forward during the formation of the Soviet power and justified itself by the outcomes in the following decades, has gradually begun to lose its significance. The curtailment of industrial health care has manifested in the reduction of the volume of medical care provided according to the occupational principle. This review highlights the features of the organization of medical care for chemical manufacturing employees at the current stage of the socioeconomic development of the society. The search for ways to provide full-fledged and comprehensive medical services to the working population remains an urgent problem for almost all states.

Objective: to analyze literature data on the effectiveness of preoperative mechanical bowel preparation (MBP), and on the basis of our own data to perform a comparative analysis of immediate MBP results in patients operated on right-sided colon cancer.

Materials and methods. We reviewed literature data relevant to the use of MBP and performed a retrospective analysis of the immediate results of surgical interventions on right-sided colon cancer in 349 patients having undergone MBP with polyethylene glycol (PEG) compounds (n = 186) and without the use of PEG (n = 163).

Results. The incidence rates of complications in the patients of groups I and II were 6.7 % and 9.8 % (P>0.05), anastomotic leak rates were 0.6 % and 1.6 % (P>0.05), postoperative death rates — 1.2 % and 1.6 % (P>0.05), the average durations of the postoperative period were 14.9 and 12.1 days, respectively (P>0.05).

Conclusion. The use of preoperative MBP with PEG compounds does not result in enhancing the immediate results of the surgical treatment of patients with right-sided cancer.

Objective: to determine the variants of topography and quantity of the anastomoses of the iliolumbar artery.

Materials and methods. The material of the research was 206 dead bodies of men (aged 22–82 at the time of death) and 113 dead bodies of women (aged 32–93 at the time of death) who had died of accidental causes not related to pelvic pathology. The vascular injection method, preparation method were used to achieve the objective of the study. The statistical processing of the obtained data was performed.

Results. It has been found that the formation of the anastomoses of the iliolumbar artery is most often found in its proximal and middle thirds, significantly rarely — in its distal third. We have revealed no statistically significant differences between the average diameters of the iliolumbar artery and the average diameters of its anastomoses in men.

Conclusion. The performed research has demonstrated that the anastomoses of the iliolumbar artery in men and women have a definite pattern of origination.

Objective: to evaluate the effectiveness of the STOP-BANG questionnaire, Berlin questionnaire, and the Epworth sleepiness scale in the screening diagnosis of sleep apnea syndrome in patients with ischemic stroke.

Materials and methods. We examined 107 patients (45 women and 62 men; the median age was 64 (56; 74) (aged 36–88). The study involved questioning using the STOP-BANG questionnaire, Berlin questionnaire, Epworth sleepiness scale, and nocturnal respiratory polygraphy.

Results. Among 75 patients with sleep apnea syndrome, the STOP-BANG questionnaire, Berlin questionnaire, and the Epworth sleepiness scale showed sensitivity — 91 %, 72 %, 51 %, respectively, specificity — 53 %, 78 %, 84 %, respectively, diagnostic accuracy — 72 %, 75 %, 68 % respectively, positive predictive value — 82 %, 89 %, 88 %, respectively, and negative predictive value — 71 %, 54 %, 42 %, respectively.

Conclusion. The STOP-BANG questionnaire and the Berlin questionnaire are convenient and informative for the screening assessment of the risk of sleep apnea syndrome in patients with ischemic stroke, but their use should be complemented by instrumental diagnostic methods for reliable exclusion of sleep-disordered breathing.

Objective: to evaluate the efficiency of monotherapy and fixed combination therapy of secondary glaucoma (SG) in patients with endocrine ophthalmopathy (EOP).

Materials and methods. We examined 145 patients (290 eyes and orbits) with different forms and activity of EOP. Among them, 30 patients (58 eyes and orbits) were diagnosed with ″SG detected for the first time and associated with EOP″ (20 % of the cases).

The patients with SG received beta-adrenoblockers (BA) or prostaglandin analogues (PGA) as initial monotherapy. Two weeks later, in the absence of intraocular pressure (IOP) compensation, fixed combinations of beta-blocker/carbonic or anhydrase inhibitor (BB/CAI) or beta-blocker/prostaglandin analogue (BB/ PGA) were prescribed.

Results. The PGA monotherapy reduced the IOP level by 29 % compared to the baseline level in 33 % of the cases in increased ophthalmic tonus within Me 27 [26;28] mm Hg. (Wilcoxon test, p = 0.005). In IOP levels over 29 [28;31] mmHg, BB/PGA fixed combination therapy reduced IOP by 33 % from the baseline level.

Conclusion. SG monotherapy in patients with EOP is effective in increased IOP within Me 27 [26;28] mmHg. In initial IOP levels higher than 29 [28;31] mmHg, it is expedient to prescribe BB/PGA fixed combination therapy as initial therapy.

Objective: to assess the morphofunctional properties of platelets in patients with rheumatoid arthritis (RA) in combination with other clinical and laboratory characteristics of the disease.

Materials and methods. The parameters of platelet hemostasis were studied in 51 RA patients with varying degrees of disease activity according to the DAS28 index.

Results. It has been found that the count of platelets in the peripheral blood and their aggregation properties depend on the indicators of the activity of the inflammatory process (degree of activity, ESR, level of C-reactive protein). Platelet indices (MPV, P-LCR, PDW) are interrelated with the relative counts of lymphocytes and segmented neutrophils in the peripheral blood. In RA patients who are seropositive for rheumatoid factor, its titer is associated with the morphofunctional properties of platelets (platelet count, MPV, maximum degree of aggregation in the ADP test).

Conclusion. The role of platelets in the RA pathogenesis is not limited exclusively to the hemostatic function. The associations we identified between the platelet activity and the clinical and laboratory characteristics of the disease are indicative of their active participation in immunological processes.

Objective: comparative assessment of the detection of diseases of the hepatobiliary system in patients of different age groups undergoing treatment in therapy wards.

Materials and methods. The epicrises of patients undergoing treatment in therapy wards were analyzed. The parameters of biochemical blood test, coverage of ultrasound examination, diagnoses based on the results of examinations were assessed. Statistical data processing was performed.

Results and discussion. Cholelithiasis was more common (13.4 % and 2.6 %, p = 0.0001) in patients over 60 than in those who were under the age. The prevalence rate of non-alcoholic fatty liver disease was higher among patients under 60 years old (9.6 % and 0.3 %, p = 0.002). An increase in ALT was detected in 12.1 % of the cases, ultrasound examination was performed in about half of patients with high ALT. The high prevalence rate of heart failure may have influenced the detection of liver disease.

Conclusion. Insufficient detection of liver pathology in patients over 60 is due to a rare increase in ALT activity, incomplete coverage of patients by ultrasound examination, and the presence of concomitant pathology.

Objective: to compare and identify differences in the psychopathological symptoms and domains of social cognition in groups of individuals suffering from schizophrenia with a high level of aggression with or without alcohol consumption.

Materials and methods. In the period from 2014 to 2020, we performed a comparative, cross-section, one-stage, observational study with the formation of a sample by the method of directed selection at Gomel Regional Clinical Psychiatric Hospital. The following assessment methods were used: 1. Screening for alcohol use — ASSIST scale (Humeniuk R. et al. 2008), 2. Determination of the level of aggression — OAS scale (Yudofsky SC 1986), 3. Degree of severity of psychopathological symptoms — PANSS scale (S. Kay, L.Opler 1986), 4. Hostile attributive style of the AIHQ scale (Combs D. R. et al., 2007). 5. The research of emotional processing was performed using a computerized neuropsychological battery (PennCNP) to study the neuropsychological functioning of the Laboratory of Brain Problems of the University of Pennsylvania.

Results and discussion: The group with a preclinical level of alcohol consumption revealed changes in emotional processing (″reduced facial memory″), a bias in the attributive style towards hostility, and changes in the psychopathological symptoms, such as an increase in ″emotional lability″ and ″decreased judgment and awareness of the disease″. In the group without alcohol consumption, an increase in ″false positive recognition of neutral emotions″ and an increase in the degree of manifestation of the symptom of ″delusion″ were revealed.

Conclusion: Alcohol and aggression are in conjunction with the psychopathological symptom ″emotional lability″ (PANSS scale) and the domain of social cognition ″attributive style″ (″anger index″). In the group without alcohol consumption, aggression is related to the ″delusion″ symptom.

Objective: to evaluate the existing approaches to the treatment of inguinal hernias in the elderly and to propose a strategy for choosing the method of surgical treatment taking into account the metric assessment of the state of the topographical and anatomical parameters of the inguinal canal.

Materials and methods. The analysis of surgical interventions for inguinal hernias in elderly patients in surgical in-patient clinics of the Grodno region over 2018–2019 was carried out. The morphometric parameters of the inguinal canal being determinants for choosing the method of hernioplasty were studied in 39 elderly patients.

Results. The coefficient for choosing the method of inguinal herniation (K) has been proposed. It is calculated by the formula: К = h : m, where h is the height of the inguinal space (mm), m is the total thickness of the upper wall of the inguinal canal (mm). At K>4.83 they choose atension methods of hernioplasty.

Conclusion. The use of the coefficient for choosing the method of inguinal hernioplasty has made it possible to reduce the number of recurrent hernias in the long-term postoperative period from 5.7 % to 2.0 % of cases.

Objective: to assess the clinical significance of cystatin C in the early diagnosis of diabetic nephropathy.

Materials and methods. We examined 449 patients with type 1 and type 2 diabetes mellitusolder than 25 years. The laboratory examination of the patients included the measurement of cystatin, creatinine in the blood serum, GFR calculation according to the CKD-EPI equation, and the determination of albuminuria levels.

Results. The role of cystatin C as a reliable marker of diabetic nephropathy has been demonstrated: the level of cystatin C ≥ 0.72 mg/L with sensitivity of 90.8 %, specificity of 88.9 %, was associated with a decline of renal function in the diabetic patients (ROC AUC = 0.951).

Conclusion. The determination of the level of cystatin C, alone or in conjunction with creatinine, will help to more accurately diagnose GFR and assess the risk of mortality and renal complications in patients with diabetes mellitus.

Objective: to determine the variants of the syntopy of the internal iliac vein (IIV) and superior gluteal artery (SGA) in individuals of the brachimorphic somatotype.

Materials and methods. The material for research was 29 dead bodies of males (from 25 to 82 years) and 11 dead bodies of females (from 28 to 78 years) who had died of causes not related to pelvic pathology. The vascular injection, preparation methods, and statistical processing of the obtained data were used to achieve the objective.

Results. It has been found that, regardless of gender, the frequency of variants of the spatial localization of IIV and SGA, in which it is relatively safe to perform a. glutea superior ligation, is approximately equal, which is ≈ 24 % for men and ≈ 23 % for women.

Conclusion. The performed study has showed that the variants of IIV and SGA syntopy, in which it is advisable to perform IIA ligation, are much more common than types of the spatial localization of v. iliacainterna and a. glutea superior in which selective ligation of SGA is possible.

Objective: to assess the features of the expression of the epithelial marker E-cadherin in the epithelial layer and stroma of the small intestinal mucous membrane after the administration of the food additive E407a.

Materials and methods. E-cadherin expression was studied by the immunohistochemical method in 8 WAG rats receiving daily the food additive E407a orally for a period of 2 weeks in the amount of 140 mg per kg of body weight, and 8 control animals.

Results. It has been found that the administration of E407a leads to reduced E-cadherin expression in intestinal epithelial cells (0.037 ± 0.004 U versus 0.129 ± 0.021 U in the control group, p<0.0001) per unit of area (250 × 250 micron).> < 0.0001) per unit of area (250 × 250 micron).

Conclusion. Ingestion of the food additive E407a leads to a change in the expression patterns of the epithelial marker E-cadherin, which may contribute to the disruption of the intestinal epithelial barrier.

Objective: to evaluate the correlation between the values of the magnetic resonance imaging (MRI) apparent diffusion coefficient (ADC) and the count of cellularity in histological material and to establish a relationship between the cellular structure and the prognostic properties of MRI with diffusion-weighted imaging (MRIDWI) in various morphological types of lymphomas.

Materials and methods. 101 patients with morphologically verified lymphoma (Hodgkin lymphoma (HL) — 52 patients, non-Hodgkin lymphomas (NHL) — 49) underwent whole body MRI-DWI before treatment and ADC measurement in the target lesion. An excisional biopsy of the lesion was performed from the same anatomical area and the count of cellularity in the histological material was determined.

Results. In HL, aggressive NHL and diffuse large B-cell lymphoma (DLBCL), ADC is statistically significantly higher, and cellularity is lower than in indolent NHL and cells of the mantle zone of NHL. We have found an inverse correlation between the values of ADC and cellularity in aggressive NHL (ρ = -0.47, p = 0.005) and DLBCL (ρ = -0.48, p = 0.006).

Conclusion. ADC values depend on the cellular structure of the lymphomas. The correlation of ADC and cellularity values of various morphological types of lymphomas allows explaining the prognostic properties of ADC.

Objective: to assess the constitutional features of the age dynamics of secondary sexual characteristics and functional parameters of city schoolchildren in the age range of 7–17 years.

Materials and methods. The objects of the study were schoolchildren aged 7–17. The stages of the expression of secondary sexual characteristics were determined visually according to the scheme by J.M. Tanner. The functional parameters of the examined schoolchildren were assessed using the methods of dynamometry, spirometry; blood pressure and heart rates, as well as the time of simple sensorimotor reactions were measured.

Results. As a result of the performed studies, it has been found that representatives of the hypersomnic types are ahead of other types to reveal the first stages of secondary sexual characteristics. Schoolchildren with the leptosomic morphotypes due to higher rates of their development have reached the definitive stages by the same age as those with the hypersomnic variants. The intensity of age-related changes in functional parameters (strength qualities, circulatory and respiratory systems, nervous system) in the studied objects depends on their body type.

Conclusion. The stage and rate of puberty, as well as the development of functional parameters in city schoolchildren depends on their somatotype.

Objective: to conduct comprehensive hygienic studies of the dust factor in the asbestos cement manufacturing industry and to determine the presence of a relationship between the content level of respirable fibres and the mass concentration of suspended particles in order to actualize the methodology of the assessment of the air of a working area containing mineral fibrous aerosols.

Materials and methods. The mass concentrations of dust and the content level of respirable fibres in the air of the working area and the morphological characteristics of dust aerosol were analyzed.

Results. The content of dust in the air of the working area in terms of the mass measurements of suspended particles does not exceed the hygienic standards and ranges from 0.20 ± 0.004 mg/m³ to 1.47 ± 0.085 mg/m³, and the content level of respirable fibres is from 0.20 ± 0.044 f/cm³ to 1.13 ± 0.204 f/cm³. The presence of a positive correlation of moderate strength between the content level of respirable fibres and the mass concentration of suspended particles has been found.

Conclusion. The microscopy of the preparations of dust samples makes it possible to determine a morphological picture which is characteristic for various stages of the technological process. There is a positive correlation of moderate strength between the content level of respirable fibres in the air of the working area and the concentration of suspended particles. However, the obtained patterns of dependence are capable of accounting up to 49.3 % of the variations of respirable fibres on the basis of the mass concentration of suspended particles, which does not make it possible to use them for the conversion of the values.

The article presents a clinical case of a 16-year-old girl with clinical manifestations of congenital long QT interval syndrome in the form of syncope which were primarily diagnosed as epileptic syndrome for which the patient was taking anticonvulsant drugs having qualities of secondary prolongation of QT interval. At the same time, the data of family anamnesis (sudden death of the mother at a young age) in combination with typical manifestations of disease and electrocardiographic signs (prolonged QT interval measured from the standard electrocardiogram, paroxysms of spindle-shaped ventricular tachycardia accompanied with syncope conditions) made it possible to diagnose congenital long QT interval syndrome and implant an electric cardiac pacemaker.

The article presents a case of a successful application of mesenchymal stem cells in clinical practice and provides an analysis of literature sources on this topic, clinical data, and results of laboratory studies.

The article describes a clinical case of an increased level of hepatic transaminases during a delayed period of the treatment in a patient with coronavirus disease COVID-19 using remdesivir and a possible effect of hepatic steatosis on the severity of cytolytic syndrome associated with the course of COVID-19.

Objective: to identify the molecular genetic criteria of the risk of tension-type headache and migraine chronization development.

Materials and methods. The detection of the results for the determination of allelic variants was carried out by means of horizontal electrophoresis using a molecular weight marker. The determination of the genotypes of the polymorphic variants of genes was carried out using high resolution melting PCR analysis.

Results. Based on the performed molecular genetic studies, it has been established that the statistically significant (p < 0.05) risk factors of tension-type headache chronization are: the identification of the A-allele and AA-genotype of the DBH3 polymorphism of the dopamine-beta-hydroxylase gene DBH, as well as the identification of the G-allele and the GG-genotype of the Intron3SNP polymorphism of the preprotachykinin gene TAC1. It has been found that the statistically significant (p < 0.05) risk factors of migraine chronization are: the identification of the A-allele, GA- and AA-genotypes of the G29A polymorphism of the serotonin transporter gene SLC6A4, as well as the identification of the G-allele and the GG-genotype of the rs7793277 polymorphism of the preprotachykinin gene TAC1.

Conclusion. The detection of these polymorphisms of the dopamine and preprotachykinin genes in the blood serum increases the risk of tension headache chronization by 1.395–1.991 times; the risk of migraine chronization by 1.235–1.395 times.

Objective: to evaluate the effectiveness and safety of anticoagulant and glucocorticosteroid therapy in patients with COVID-19, to determine step-by-step solutions in the prescription of drug therapy at the inpatient stage.

Materials and methods. We performed two randomized continuous prospective comparative studies including 1,801 patients diagnosed with COVID-19 pneumonia who were undergoing inpatient treatment in November-December 2020 (1,004 patients) in Gomel Regional Clinical Hospital for the Disabled of World War II and in February 2021 (797 patients) in Gomel City Clinical Hospital No. 3.

Results. The step-by-step strategy for treating patients with pneumonia associated with COVID-19 is to divide the patients into groups of high and moderate risks of adverse outcomes (based on the developed predictors) on the first day of hospitalization. In moderate-risk patients, the “protocol” therapy stabilizes the condition; in high-risk patients, it is not effective. Early preemptive anticoagulant therapy (ACT) and individual hormone therapy (prior to pulse therapy) may stabilize the condition of the patients, increase the survival rate from 82.1 % to 96.8 %, p = 0.0001. The additional steps are: targeted use of tocilizumab in the Somatic Department before the Intensive Care Department (70 % survival, p = 0.031), oxygen therapy, pronposition, catheterization of patients, use of the domestic hepatoprotector, membrane-stabilizing antiischemic drug “Thiotriazoline” in patients with high blood lactate levels (lactate dehydrogenase (LDH)), which stabilizes metabolic processes in the affected organs (in dynamics by 342.7 ± 92.8 units/l for 5 days compared to the control group, p=0.0001). When the patient’s condition gets stabilized, the use of respiratory and physical rehabilitation are the final steps of the recovery strategy at the inpatient stage.

Conclusion. Therapeutic anticoagulant and individual glucocorticosteroid therapy in combination with oxygen therapy, the use of thiotriazoline in some COVID-19 patients being at a high risk of adverse outcomes have led to an increased survival rate — from 82.1 % to 96.8 % at the hospital stage, p = 0.0001.