Urinary tract infections (UTIs) are of considerable practical interest due to their high prevalence, presence of complications in the form of generalized infection with the development of sepsis, relapsing course, negative effects on the mother and fetus in pregnant women associated with the intensive use of antibacterial drugs leading to the development of Clostridioides diffcile-associated colitis and antibiotic resistance. The approaches to the treatment of urinary tract infections are undergoing changes. If earlier it was believed that urine is sterile and the detection of bacteriuria led to an unjustifed prescription of antibiotics, then now the introduction of new methods of urine testing has proved the opposite — asymptomatic bacteriuria is a fraction of the microbiota which normally inhabits the urinary tract and performs a protective role. New knowledge has led to an understanding of the negative impact of antibacterial drugs on the composition and the species diversity of the microorganisms of the urinary tract, genital tract, intestines, rethinking of approaches and indications for their prescription and search for alternative methods of patient treatment by modifying the diet, prescribing pre-, pro-, synbiotics, synthetic microbiota, vaccines, bacteriophages, microbiome transplantation.

The literature review presents international statistical data on the rates of both completed and failed suicide attempts in various countries. The works lists the reasons contributing to suicide risk, factors triggering suicidal behavior among which are: gender, age, marital status, severe diseases, psycho-emotional state, economic, social reasons and others. Also, in consideration of the coronavirus disease pandemic spreading around the world, the work adduces the results of the studies on the COVID-19 impact on people including not only patients but also medical personnel severely strained in the situation of the pandemic which have been performed across countries. We have made a conclusion about the necessity and possibilities to prevent suicide attempts, have analyzed the experience of other countries in the organization of assistance to this segment of the population, have advanced forth an opinion on the appropriateness of the development of the national integrated suicide risk prevention policy in the Republic of Belarus.

It has been established recently that both genes and the environment contribute to the risk of suicide. In this case, a combination of genes predisposing to certain qualities is of paramount importance. In the article, the authors provide an analytical review of literature devoted to the study of the genetic aspects of suicidality.

Objective. To increase the effciency of spinal anesthesia (SA) in operative delivery of pregnant women with type 1 diabetes mellitus (DM).

Materials and methods. A dynamic assessment of the clinical effciency of spinal anesthesia in cesarean sections was performed in 123 pregnant women with DM. The level of the sensor and motor block was determined depending on the dose of a 0.5% hyperbaric solution of bupivacaine calculated according to the original method.

Results. The SA method in cesarean sections in pregnant women with diabetes mellitus has been proposed taking into account the dosage of a hyperbaric solution of bupivacaine depending on the patient`s height and gestational age. The application of this method provided the development of the necessary degree of the sensory and motor block by the eight minute and created the requisite conditions for a cesarean section.

Conclusion. The proposed method of the calculation of the hyperbaric solution dosage for subarachnoid anesthesia taking into account the patients` height and gestational age makes it possible to ensure the necessary degree of the sensor block at the level of 4-5 thoracic segments and suffcient relaxation in the surgical area during a cesarean section.

Objective. To study the quality of life (QoL) and psycho-emotional state in patients with different degrees of ulcerative colitis (UC) activity.

Materials and methods. The study involved 52 patients with UC and 52 healthy volunteers (HVs). The survey was performed using the questionnaire IBDQ, assessing the quality of life in patients with inflammatory bowel diseases, the Hospital Anxiety and Depression Scale (HADS), and the questionnaire by A.M. Vein.

Results. The patients with UC in comparison with the HVs have a lower QoL in the overall score (p < 0.05), a greater severity of psychological problems both according to the anxiety scale (p < 0.05) and to the depression scale (p < 0.05).), and they tend to develop the autonomic dysfunction syndrome more often (p < 0.05).

Conclusion. The method of the QoL assessment and psycho-emotional state in patients with UC provides accurate scientifc information about the physical, psychological, emotional and social status of the patients.

Objective. To conduct an analytical assessment of the dynamics of the state of patients with COVID-19 in the conditions of a clinical healthcare organization taking into account comorbid diseases.

Materials and methods. 96 in-patients` medical records kept in the state healthcare institution “Gomel City Clinical Hospital No.3” have been retrospectively analyzed.

Results. The median age for women having undergone hospital treatment for pneumonia associated with COVID-19 was 58 years [45; 66], for men — 58 years [39; 64]. All the patients underwent a clinical examination according to temporary protocols. The most frequent comorbid diseases in the patients with COVID-19 were: arterial hypertension, ischemic heart disease, non-alcoholic liver disease, diabetes mellitus, chronic pyelonephritis, obesity. Polymorbidity was revealed in 49 % of the patients. Most patients had moderately severe pneumonia associated with COVID-19 (75 % of all the surveyed patients). In the patients with a mild course of pneumonia associated with COVID-19, the neutrophil-to-lymphocyte ratioin the peripheral blood was 2.1, whereas in the patients with a severe course — 8.82, which correlated with traditional prognostic indicators — the levels of C-reactive protein, d-dimers, lactate dehydrogenase.

Conclusion. The neutrophil-to-lymphocyte ratio in the peripheral blood is a simple and affordable method of COVID-19 course prediction in comorbid patients.

Objective. To evaluate the effectiveness of preoperative coagulation of the vein adjacent to a tumor nodule in sonographically-guided percutaneous radiofrequency thermal ablation of perivascular liver metastases of colorectal cancer.

Materials and methods. To address the issue, we compared the results of sonographically-guided percutaneous radiofrequency thermal ablation of perivascular liver metastases of colorectal cancer in 27 patients (aged 60.5 (58; 68) years) without prior coagulation of the adjacent vein (control group) and 26 patients (62.0 (60; 74)) with prior coagulation of the adjacent vein (experimental group).

Results. Lower incidence of residual tumor in the ablation area in the patients with prior coagulation of the adjacent vein (14.3 % vs. 29 % of the patients in the control group) and a higher relapse-free survival of such patients (65.2 % vs. 53.6 % and 55.6 % vs. 33.3 %) were reported as compared to the group without prior coagulation of the adjacent vein (after 6 and 12 months, respectively).

Conclusion. Preoperative coagulation of the vein adjacent to colorectal cancer liver metastasis allows reducing the effect of heat removal from the RFA zone, thereby contributing to higher radicality of the treatment and resulting both in a lower incidence of residual tumor in the ablation zone and a higher relapse-free survivalof patients, notably without signifcant concomitant changes in the affected part of the liver (segment atrophy).

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.

Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).

Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.

Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

Objective. To determine the clinical and anamnestic risk factors for neonatal intrauterine infection (IUI) in pregnant women with urogenital infections (UGI).

Materials and methods. 431 patients were examined: the main group (group 1) — 353 women with UGI during pregnancy (subgroup 1A — 215 women whose children were diagnosed with IUI, subgroup 1B — 138 women whose children were born without signs of IUI; the comparison group (group 2) — 78 women without UGI during pregnancy (subgroup 2A — 44 patients whose children were born with signs of IUI, subgroup 2B — 34 women whose children did not have IUI. We studied the obstetric and gynecological, somatic anamnesis of the patients, the course of their pregnancy.

Results. The presence of gynecological and somatic diseases in the anamnesis of the pregnant women with UGI was associated with a signifcant increase of the risk for neonatal IUI (p = 0.003 and p = 0.005, respectively). Vaginitis (p = 0.041), background and precancerous diseases of the cervix (p = 0.027) were signifcantly most prevalent in the pregnant women with UGIs in their history. Pregnancy complicated by UGI proceeded with a recurrent miscarriage risk (p = 0.046) was most often accompanied by acute respiratory infection (p ˂ 0.001) and signifcantly most often ended in premature birth — 24.7% (p = 0.009).

Conclusion. The search for objective criteria for the development of neonatal IUI is an important and complex task of modern obstetrics. The analysis of the anamnesis of pregnant women with urogenital infections, as well as timely diagnosis and adequate treatment of urogenital infection and acute respiratory infection will reduce the miscarriage rate and the incidence rate of neonatal IUI.

Objective. To develop an experimental device, an algorithm for visual and analytical evaluation of the parameters of pulse signals used in electrical stimulation for further application in the course of Medical and Biological Physics.

Materials and methods. The data obtained with the help of the experimental device were used as research materials. The analysis of the obtained results (characteristics of the pulse signal) was carried out with the analytical and numerical methods.

Results. The proposed experimental device for receiving and analyzing pulse signals applied in electrical stimulation in education allows mastering the methods of the determination of the parameters of pulse signals, studying the methods to alter the characteristics of pulse signals used in electrical stimulation.

Conclusion. The application of the experimental device makes it possible to acquire skills to evaluate the parameters and characteristics of difference pulse signals through their visualization and analytical evaluation.

Objective. To study the interconnection between the indices of matrix metalloproteinases (MMPs) of type I collagen terminal telopeptides in patients with end-stage chronic kidney disease (CKD) and in patients with anterior abdominal wall hearnias.

Materials and methods. 39 patients with CKD stage 5D, 24 patients with primary anterior abdominal wall hernias and 25 patients of the comparison group without visual signs of connective tissue dysplasia were included into the prospective study. The concentrations of the levels of MMP-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase 1 (TIMP-1), TIMP-3, N-terminal telopeptide NTX-N, C-terminal telopeptide CTX-C were determined in plasma using the enzyme immunoassay (ELISA).

Results. The end-stage patients with CKD and the patients with anterior abdominal wall hernias showed no statistically signifcant biochemical indices of ongoing bone tissue destruction based on the levels of terminal telopeptides NTX-N and CTX-C. There are statistically signifcant increases in the levels of MMP-1, MMP-2, MMP-9 (p ˂ 0.001) in the CKD stage 5D patients and major TIMP-1 and TIMP-3 (p ˂ 0.001) in relation to the comparison group. These indices were comparable with the changes in the connective tissue of the patients with primary anterior abdominal wall hernias.

Conclusion. The obtained results indicate disturbances in the regulation of the synthesis and structural relationships of connective tissue in CKD stage 5D patients and in patients with primary anterior abdominal wall hernias. CKD stage 5D patients and primary anterior abdominal wall hernias reveal identical direct correlations in the indices of connective tissue metabolism according to NTX-N, MMP-1 and MMP-9, TIMP-1, which indicates similar disturbances in the regulation of the synthesis and structural disorders in connective tissue.

Objective. To study the dynamics of reparative bone tissue regeneration in experimental animals using a native transplantation autosmix (NTA).

Materials and methods. Male Wistar rats weighing 180–200 g and aged 6–7 months were used. Bone tissue defects were modelled using a cutter with a diameter of 2 mm (experimental group). A similar defect of the middle third of the right tibia was formed in the control group animals without flling the defects with bone tissue. The animals were removed from the experiment on days 3, 7, 14, 30 and 60 of the experiment (per 6 animals for each observation period). The indicators of defect occupancy, necrosis, the area of bone trabeculae, the area of granulation tissue were determined in the histological sections. All the indicators were presented as percentage of the tested area. Osteoblasts, osteocytes, and osteoclasts were calculated in absolute values on the tested area.

Results. The study has showed a higher rate of bone tissue formation in the bone defects in the experimental animals after autotransplantation of the bone mixture. Bone recovery in the experimental group had a higher rate, which was manifested by faster flling of the bone tissue defect, a low percentage of the necrosis area, a higher area of bone trabeculae, its rapid transformation into lamellar bone tissue.

Conclusion. Osteogenesis had practically completed by day 30 of the experiment. At the same time, in the control group it had completed by day 60. The results obtained are a theoretical precondition for further research in the feld of bone autoplasty. Advanced development of surgical and minimally invasive technologies of bone mixture application will increase the effciency of modern reconstructive surgery of bones and joints.

Objective. To reveal changes in the structural and nanomechanical properties of the erythrocyte surface caused by the action of X-ray radiation in vitro on the whole blood of rats on a high-cholesterol diet using the method of atomic-force microscopy.

Materials and methods. The blood of male Wistar rats being on a high-cholesterol diet for two months was exposed to X-ray radiation (320 kV) at doses of 1 and 100 Gy. The structural, elastic and adhesive properties of the surface of isolated and glutaraldehyde-fxed erythrocytes at the nanoscale were studied using the atomic- force microscope BioScope Resolve in PeakForce QNM mode in air.

Results. The study has identifed an increase in the stiffness of the erythrocyte surface at a dose of 1 Gy and its decrease to almost control values at a dose of 100 Gy, which was accompanied by an increase in the size of the average cell of the erythrocyte membrane skeleton. At the same time, no signifcant changes in the morphology, adhesive properties and roughness of the relief of erythrocytes have been found.

Conclusion. The obtained data indicate that X-ray radiation (1–100 Gy) induces the dose-depending reorganization of the structure and changes in the stiffness of the erythrocyte surface layer at the nanoscale without changing the cell morphology for rats on a high-cholesterol diet.

Objective. To evaluate the activity of pyruvate kinase (PK) isoforms in normal conditions, in toxic damage of the liver and during its regeneration.

Materials and methods. An experimental study was carried out on 45 Wistar rats. Toxic liver damage was induced by the intraperitoneal administration of carbon tetrachloride. Mechanical damage was simulated by the surgical resection of the liver. The levels of PK isoforms R/L and M in the blood serum and liver tissue of the laboratory animals were measured with an ELISA test.

Results. It has been found that the level of PK isoform M signifcantly increases in chronic toxic liver damage, which may indicate the activation of the processes of liver cell proliferation in response to the damaging effect of hepatotoxin (Mann-Whitney U Test: Z = 2.143; p = 0.032). After liver resection, the level of PK R/L, which characterizes the activation of glycolysis, increased and the level of pyruvate kinase M increased signifcantly, which reflected the processes of reparative regeneration in the liver.

Conclusion. The serum level of PK isoforms may be used as a laboratory criterion for the activity of reparative regeneration processes, which can be used to evaluate the reparative potential of the liver in case of toxic or mechanical damage, as well as in chronic diffuse diseases.

Objective. To determine the order of the application of simulation-based learning (SBL) elements during the period of professional training in a medical college.

Materials and methods. We analyzed literature sources on the research problem, regulatory documents and academic programs of medical colleges, used the methods of questioning and survey.

Results. Each of the identifed stages (preclinical, clinical, professional) of the SBL model of training has its own characteristics and potentialities for the implementation of certain SBL elements. The application of SBL elements occurs in steps depending on the term of training and is aimed at overcoming diffculties arising in the process of professional adaptation.

Conclusion. The step-by-step introduction of SBL elements depending on the stages of professional adaptation in a medical college makes it possible to regulate the preparatory process for students depending on their understanding of educational material, which allows them to acquire clinical experience of professional activity during the training period and to improve psychological readiness for unsupervised professional activity.

The article is devoted to an urgent problem of gastroenterology — eosinophilic esophagitis (EoE) in children. This problem has not been suffciently studied and requires further research and observation of clinicians. This article will be of interest to gastroenterologists, allergists, pediatricians, general practitioners, rehabilitation therapists, endoscopists, and pathomorphologists. The paper presents a description of a clinical case of EoE, the diagnosis of which was carried out only at the stage of complications, such as food penetration into the esophagus.

Objective. To describe the sonopattern of limited scleroderma (LS) in the early stages after the onset of erythema.

Materials and methods. The work describes a clinical case of limited plaque scleroderma. The sonographic examination was carried out on an ultrasound scanner using a transducer with operating frequencies of 10–16–18 MHz. Material sampling for the histologic examination of the skin was performed from the area with the most pronounced inflammatory changes under sonographic control.

Results. It has been found that increased echogenicity of the dermis, “blurring” of the dermis/hypodermis boundary, increased echogenicity and the “stalactite-like” pattern of subcutaneous fat occur in the frst week of the disease; normalization or a signifcant improvement of the sonopattern is noted by the end of the second week or by the beginning of the third week after the onset of erythema.

Conclusion. There is a certain parallelism between the histologic and sonographic patterns, which makes it possible to adequately assess both the activity and the stage of the LS process.

Extragonadal germ cell tumors (GCTs) are neoplasms that develop from germ cells and have a similar histopathological structure with the gonadal forms of GCTs, but are located outside the gonads. GCTs are the most common malignant neoplasms in men aged 15–35. From 1 to 5 % of malignant GCTs are of the extragonadal origin.

The work describes a clinical case of extragonadal mediastinal germ cell tumor, which was diagnosed at the stage of the histological examination of the surgical material.

Objective. To analyze a rare clinical case of the aneurysmal bone cyst (ABC) of the paranasal sinuses in a 9-year-old patient.

Materials and methods. We studied the data of the anamnesis, diagnostic and treatment methods contained in the medical history of the inpatient. We examined the patient and kept her under clinical observation during the process of the examination and treatment.

Results. The fnal diagnosis of the ABC of the paranasal sinuses in the 9-year-old patient was verifed after the obtainment of the results of the performed clinical and morphological studies. The neoplasm was surgically removed. One year after the surgery, the MRI investigation showed no relapse. The child is in a fair condition.

Conclusion. To diagnose an ABC, it is required to perform a histological examination of the tumor including the use of immunohistochemical methods.

Objective. The aim of this work was to review the main results of genomic studies of microorganisms and their communities performed on the base of the Research Laboratory of Gomel State Medical University.

Materials and methods. Genomic, transcriptomic and metagenomic analysis of the microorganisms of the stomach and respiratory tract.

Results. The capabilities of modern next-generation sequencing platforms have been analyzed, and the authors` own results of the use of genomic, transcriptomic and metagenomic analysis of the microbiota in patients with various gastric and respiratory pathologies have been described.

Conclusion. The analysis of the obtained data has revealed peculiarities of the structure of the microbial communities of the stomach of the patients infected with H. pylori with different gastric pathology: the proportion participation of H. pylori in the metagenome of the samples with different forms of gastric cancer did not exceed 25 %, of gastritis — 6 %, of peptic ulcer — 1 %. At the same time, the minimal amount of H. pylori in all the cases could reach 0.1 %. A signifcant degree of CagA and CagY loci variability of H. pylori was detected. Streptoccocus genus bacteria dominated (36 %) in the bacterial microbiome of a patient diagnosed with the coronavirus disease, and in the viral microbiome, SARS-CoV-2 constituted 59 % of the total number of viruses in the material. The analysis of 13 strains of Klebsiella pneumoniae with multiple and extreme resistance to antibiotics has found that the studied strains belong to fve MLST-types, three of which are classifed as high epidemic risk groups.

Objective. To evaluate the expression of G protein-coupled estrogen receptor (GPER1), heme oxygenase-1 (HO-1), and heme oxygenase-2 (HO-2) in patients with chronic endometritis and to determine the importance of these markers in the diagnosis of the disease.

Materials and methods. The results of GPER1, HO-1, and HO-2 expression were analyzed in patients with a confrmed diagnosis of chronic endometritis and in patients of the comparison group.

Results. The expression of GPER1 ≤ 79 % (sensitivity — 100.00 %; specifcity — 95.83 %; +PV — 94.00 %; -PV — 100 %), the expression of HO-1 positive cells > 5 % (sensitivity — 100.00 %; specifcity -100%; +PV — 100 %; -PV — 100 %) are signifcant for the development of chronic endometritis. The endometrial glands in the patients with chronic endometritis express the markers of inflammation HO-1 and HO-2 signifcantly more often than in the comparison group (p < 0.001).

Conclusion. The presented data indicate defects of the enzymes of iron metabolism and non-canonical pathways of estrogen reception in chronic endometritis. The determination of GPER1, HO-1, HO-2 expression in the endometrium in patients with chronic endometritis is a reliable criterion and may be used in the diagnosis of the disease.