The literature review presents data on the problem of respiratory tuberculosis in women of reproductive age. The review focuses on the epidemiology of tuberculosis in young women, their medical and social characteristics, factors predisposing to the disease, clinical peculiarities and drug resistance of the pathogen.

The article discusses modern views on colorectal carcinogenesis and precancerous changes in the mucous membrane and presents the key summaries of the latest domestic, American, British, and European guidelines on healthcare enhancement for patients with premalignant colorectal lesions and their dynamic follow-up from the standpoint of cancer prevention.

This article provides a review of foreign literature data including a number of aspects that cover guidelines on cancer patient management during the COVID-19 pandemic. The author focuses on the fact that the pandemic has become a serious challenge for the health system not only in the Republic of Belarus, but also has demonstrated a number of problems in the organization of healthcare in most countries of the world. In particular, the pandemic has led to a deteriorated situation with the availability and quality of medical care provided to cancer patients, and periodicals often report a high risk of severe complications in this population group during the spread of COVID-19.

Objective. To analyze a HM ECG recording in the placement of the electrodes in accordance with the procedure established by the manufacturer for the domestic recorder “Cardian-SDM” and in changed placement of the electrodes.

Materials and methods. The study included 30 patients, the average age of the subjects was 34.7 ± 16.9 years, the median was 23 years, of which males accounted for 40 % (n = 12), females – 60 % (n = 18). When analyzing the HM ECG, the amplitude of the main ECG teeth, the displacement of the ST segment, and the change in the morphology of extrasystolic complexes were evaluated using the “standard” and “optimized” recording techniques. Such parameters as sensitivity and specificity of the proposed method were determined. The statistical analysis was carried out using the SPSS Statistics program.23 and Microsoft Excel.

Results. During the automatic analysis of significant deviations in the amplitude of the ECG waves, rhythm disturbances, no ST segment changes were not registered when using the “optimized” technique compared to the “standard” one. The analysis of 30 HM ECG episodes taking into account the amplitude of the main teeth according to the “optimized” technique has a specificity of 93.4 % and sensitivity of 96.7 %, the deviation of the amplitude parameters has no significant differences, p > 0.05.

Conclusion. The changes in the amplitude of the teeth did not exceed 10 %, the duration of the complexes, segments, and intervals did not change, p > 0.05. The specificity of the proposed “optimized” technique was 93.4 %, sensitivity – 96.7 %. The “optimized” technique can be used instead of the existing one to improve the quality of the ECG recorded in patients during physical exercise.

Objective. To determine the structural features of the root canals of mandibular premolars and molars, to assess the quality of endodontic treatment on the basis of cone-beam computed tomography (CBCT).

Materials and methods. The structure of 50 teeth (premolars and molars of the mandible) after performed endodontic treatment was studied retrospectively on the basis of CBCT in 50 patients. The number of roots, as well as root canals and their angle of inclination, the presence of additional canals were taken into account. The obtained data were processed statistically.

Results. No significant differences in the angle of inclination of the root canals and the number of roots were found. The ratio of unsatisfactory episodes of endodontic treatment was 82 %. Destructive processes in the periapical region were revealed in all the examined teeth.

Conclusion. The results of the study prove the neсessity to develop the differentiated use of surgical methods for the treatment of foci of chronic odontogenic infections in the periapical region of mandibular molars and premolars.

Objective. To assess an incidence rate of reduced bone mineral density (BMD) in children diagnosed with dystrophic bone cysts.

Materials and methods. We examined 2 groups of patients: 25 children diagnosed with dystrophic bone cysts (experimental group) and 42 children diagnosed with idiopathic scoliosis (control group). The methods were: dual X-ray absorptiometry (roentgen densitometry), computer tomography; the comparative assessment of the results was performed.

Results. It has been found that only in 36 % of the patients with bone cysts (n = 9), the BDM value was within the age norm, 36 % revealed osteopenia, 28 % – osteoporosis. Among the patients diagnosed with idiopathic scoliosis, changes in BMD were found only in 21.5 % (n = 9) of the patients (in 14.3 % of the cases — osteopenia, in 7.2 % – osteoporosis).

Conclusion. In addition to appropriate surgical treatment, it is necessary to measure BMD in children with dystrophic bone cysts.

Objective. To study the effect of the degree of pectus excavatum in children on the severity of clinical manifestations, as well as the function of the chest organs before and after surgical treatment.

Materials and methods. The study included 36 patients with II-III degree pectus excavatum undergoing surgical treatment and examination at the Orthopedics and Traumatology Department of the Gomel Regional Children’s Clinical Hospital from January 2019 to September 2021. All the patients were examined in clinical setting with laboratory and instrumental methods, were performed electrocardiography, echocardiography, Holter monitoring, the study of the function of external respiration, computed tomography of the chest.

Results. As a result of the conducted studies, it has been found that the degree of thoracic deformity in children affects the severity of clinical and functional changes in the chest organs.

Conclusion. The performed study has showed that the surgical treatment of pectus excavatum contributes to the elimination of functional disorders in the work of the heart and respiratory organs.

Objective. To assess the features and current status of diabetes self-management and to identify the driving factors responsible for behavior shaping related to diabetes.

Materials and methods. To study the behavioral features of 206 patients with 2 type diabetes mellitus (DM), we used the experimental and psychological methods (Diabetes Self-Management Questionnaire – DSMQ – and a random questionnaire). A qualitative and correlational analysis of the obtained data was also conducted.

Results. The median score of diabetes self-management according to the DSMQ scale was 5.48 (4.64; 6.04) (10 was the maximum point). The analysis of other subscales was as follows: “Glucose self-monitoring” – 7.33 (6.00; 8.00) (p-value: < 0.001); “Dietary self-monitoring” – 5.00 (3.33; 5.83) (p-value: < 0.001); “Self-monitoring of physical activity” – 4.44 (2.22; 5.56) (p-value: < 0.001); “Skill in using qualified medical care” – 5.56 (3.33; 6.67) (p-value: < 0.001). The answers to the 16th question “My diabetes self-management is low” were as follows: “Applies to me extensively” – 27.20 %; “Applies to me to a considerable degree” – 4.76 %; “Applies to me to some degree” – 33.80 %; “Does not apply to me” – 34.27 %. Furthermore, a correlational analysis was carried out between the DSMQ subscales and the duration of the disease, age of the patients, degree of cognitive impairment, and the average hemoglobin A1c value.

Conclusion. According to the data of the validated DSMQ diabetes self-management scale, the questionnaire and the average HbA1c value, the external locus of control prevails among the patients with 2 type DM. Low self-management levels were revealed for the three indicators: “Dietary self-monitoring” – 5.00, “Self-monitoring of physical activity” – 4.44, “Skill of using qualified medical care” – 5.56.

Objective. To assess the characteristics of early neonatal adaptation in underweight and small for gestational age newborns and to determine the key predictors of its complicated course.

Materials and methods. The study was conducted at the Republican Scientific and Practical Center “Mother and Child” and included a group of 115 full-term newborns. The main group consisted of 77 newborns with low body mass index (BMI) at birth, among whom 2 subgroups were distinguished: study group 1 (Gr1) ‒ 52 underweight and small for gestational age newborns with adaptation disorders, study group 2 (Gr2) ‒ 25 newborns without signs of maladaptation. Lipid status indicators, levels of adipokines and vitamin D were studied in mother-child dyads. To control the correct operation of the identified predictors and the regression model, an examination sample including 38 underweight newborns was studied.

Results. Maternal history of placental insufficiency, fetal growth retardation, and hypertensive disorders was associated with a significant increase in the risk of maladaptation in the early neonatal per (p = 0.036, p < 0.001, and p = 0.029, respectively). Pregravid body weight and BMI of the Gr1 women were significantly higher (p = 0.026 and p = 0.035). It has been found that the most significant quantitative neonatal factors associated with the risk of maladaptation in underweight for gestational age newborns, were gestational age (p = 0.002), z-score BW at birth (p=0.003), mean corpuscular volume erythrocyte (p = 0.001), cord blood leptin level (p = 0.033). A multifactor model has been developed to determine the probability of a complicated course of the early neonatal period in underweight for gestational age newborns. AUC = 0.95 ± 0.025 (0.902–0.998), p < 0.001. A high degree of reproducibility of the developed model was established on the examination sample of underweight newborns.

Conclusion. The search for objective criteria for the development of neonatal maladaptation is an important and complex task of modern neonatology. A comprehensive assessment of the totality of ante-, intraand postnatal predictors has a high accuracy in predicting the likelihood of a complicated course of the neonatal period.

Objective. To determine the features of the course and outcomes of macrofocal myocardial infarction (MI) complicated by ischemic acute renal failure.

Materials and methods. The study included 173 patients with acute macrofocal MI. The patients were stratified into two study groups based on the functional state of the kidneys at the time of their admission to hospital: 111 patients with MI and ischemic acute renal failure (ARF) (main group) and 62 patients with MI without ARF (comparison group).

Results. The patients with MI and ischemic ARF required longer inotropic and/or vasopressor support, more frequent use of intra-aortic balloon counterpulsation, the course of the disease in them was more often complicated by the development of prognostically unfavorable arrhythmias. The patients with MI and ARF compared to the patients without ARF revealed longer mean group time intervals from the onset of pain syndrome to the primary medical contact, a higher number of cases of adverse outcomes within 12 months from the onset of the disease.

Conclusion. Patients with macrofocal MI and ischemic ARF are characterized by a more severe course of the MI acute phase, as well as a more frequent development of adverse outcomes within 12 months from the onset of the disease.

Objective. To optimize the composition of polymer coatings based on the assessment of the duration of the antibacterial resistance in infected wounds of laboratory animals.

Materials and methods. Woven vascular prostheses consisting of fibrous-porous polypropylene and one of the three types of coatings based on a polyvinyl-chitosan complex with the addition of biologically active substances were used in the study. All the samples were impregnated with 1% vancomycin for 30 minutes. The research methods were: bacteriological, molecular and genetic methods. Qualitative results of the antibacterial resistance of the coatings during the study period in the groups were confirmed with three or more repetitions of the results.

Results. In the qualitative assessment of the duration of the antibacterial resistance of the prostheses according to the PCR and bacteriological studies, woven vascular prostheses with coatings containing polyvinyl alcohol, polyvinylpyrrolidone, chitosan, antibiotic vancomycin, and hyaluronic acid do not get infected with S. aureus for up to four days, and woven vascular prostheses with coatings consisting of polyvinyl alcohol, polyvinylpyrrolidone, chitosan, antibiotic vancomycin, and L-aspartic acid and woven prostheses with coatings of polyvinyl alcohol, chitosan, antibiotic vancomycin, and L–aspartic acid up to five days.

Conclusion. The presence of L-aspartic acid in the composition of polymer coatings increases the duration of the antibacterial resistance of woven vascular prostheses in comparison with hyaluronic acid. The presence of polyvinylpyrrolidone in polymer coatings significantly (p = 0.012) reduces the contamination of S. aureus, increasing the antibacterial resistance of woven vascular prostheses, whereas polyvinyl alcohol does not have such an effect.

Objective. To perform histological evaluation of cell and tissue reactions in response to experimental implantation of various variants of antibacterial modifications of artificial vascular prostheses.

Materials and methods. The study of the cell and tissue reactions was carried out on 45 laboratory white rats. Industrially produced samples of textile woven vascular prostheses modified by two types of developed coatings based on a polyvinyl-chitosan complex with the addition of biologically active substances and the antibiotic Vancomycin 1 % were studied. In accordance with the design of the study, the animals were removed from the experiment on the 5th, 14th day and 20th week of the postoperative period by means of decapitation. Samples were taken for histological examination.

Results. The study of the cellular composition of tissues along the periphery of the vascular prostheses has showed that the animals of the experimental groups had less pronounced inflammatory reactions compared with the control one on the 5th day of observation. The largest number of cells forming connective tissue fibers was in the samples of the second experimental group (p < 0.05). During the intermediate followup periods (day 14), the inflammatory reaction continued to decrease in the experimental samples and a high rate of formation and maturation of granulation tissue was observed (p < 0.05). The inflammatory productive reaction decreased significantly (p < 0.05) in the samples of the second experimental group compared to the first experimental group. During the late follow-up period (20 weeks), the experimental groups were significantly characterized (p < 0.05) by less severe chronic inflammation reactions and a higher degree of maturation and transformation of granulation tissue into coarse-fibrous one, and a higher content of mature connective tissue cells was determined in the second experimental group compared to the first experimental group (p < 0.05).

Conclusion. We have found that the most preferred modifications of textile woven vascular prostheses are antibacterial coatings without polyvinylpyrrolidone, which significantly reduce inflammatory reactions and enhance the fibroplastic properties of the prostheses during all follow-up periods.

Objective. To compare different variants of TTV, TTMDV, and TTMV DNA detection in the blood plasma of patients with various liver diseases and in individuals without signs of liver disease.

Materials and methods. To detect TTV TTMDV, and TTMV DNA, the PCR method was used.

Results. A fairly high frequency of TTV virus DNA detection was found using different laboratory approaches. The frequency of TTV DNA detection was significantly highest when using the primers for the non-coding region UTR – 77.3 % compared with the coding region ORF1 – 38.4 % (p < 0.001) and the commercial kit 53 % (p < 0.005).

Conclusion. TTV DNA is detected significantly more often in patients with liver diseases compared with healthy individuals (90.3 % and 65.6 % in the UTR region and using the commercial kit, respectively), TTMV DNA (83.9 % – UTR region) and mixed DNA of the TTV + TTMDV + TTMV viruses (62.4 % – UTR region). To standardize the DNA detection of the TTV family viruses by the PCR method, it is advisable to create a panel of sera containing reliably positive and negative samples.

Objective. To analyze the awareness of medical students about COVID-19 and the preventive strategies.

Materials and methods. The methods of theoretical analysis of philosophical, psychological and pedagogical literature on the problem of research, questionnaires, observations, method of statistical analysis of empirical data (j*-Fisher’s criteria) were used. The study sample included 156 medical students.

Results. The performed study has made it possible to determine the theoretical foundations for social awareness about COVID-19 and the preventive strategies in medical students. The analysis of the socio-psychological aspects of the medical students’ attitude to COVID-19 has showed that above all the study participants see the absence of protocol treatment and specific medications as the greatest danger. The students rate their awareness of questions related to the COVID-19 pandemic quite highly, but at the same time future medical professionals do not show much interest in getting new information about the coronavirus disease.

Conclusion. The most important task of medical education is the formation of medical students’ awareness of using various methods and means for COVID-19 prevention. The professional formation of health workers and the effectiveness of their subsequent professional activity depend on the formation of their own social norms, understanding of the relationship between a health status and the use of means and methods to contain the spread of infection in the situation of a pandemic.

Objective. To assess the opportunities and economic effectiveness of the use of e-Health resources for disease prevention and health promotion.

Materials and methods. During the investigation of e-Health opportunities we used the data of the two previous pivotal studies conducted by us which concern the features of the implementation of modern methods of prevention and health promotion used in the Republic of Belarus. To evaluate the economic effectiveness, the method proposed by J. Pearson-Stuttard et al. was used taking into account the requirements from the guidelines for evaluating the effectiveness of scientific, technical and innovative developments and their implementation.

Results. The result of the study was the creation and justification of an organizational model of disease prevention and health promotion developed on the basis of the use of e-Health resources which can be applied in practice by professionals in the field of prevention and health promotion.

Conclusion. The developed model will help to increase the effectiveness of disease prevention, to promote health and a healthy lifestyle among the population, as well as to introduce modern methods to public health and healthcare.

Intracranial hypotension (IH) is a clinical and radiological syndrome manifested by a decrease in the volume or pressure of the cerebrospinal fluid caused by various reasons. Orthostatic headaches are one of the main clinical manifestations of the syndrome, and magnetic resonance imaging (MRI) is considered to be the “gold standard” of radiation diagnostics. Increased awareness of radiologists, neurologists, and neurosurgeons about this pathology will allow to diagnose IH in the early stages and to react to it in a timely manner defining further tactics.
This publication presents the author`s own clinical observation of a patient with chronic intracranial hypotension, his MRI picture and the results of the treatment using the “blood patch” method.

The work describes a clinical case of urgent percutaneous dilational tracheostomy in complicated conditions. The surgery was performed on a 47-year-old patient with decompensated stenosis of the larynx associated with a massive recurrent malignant tumor of the thyroid gland. It was not possible to perform a standard tracheostomy procedure due to widespread tumor infiltration of the trachea and soft tissues of the neck, extensive scars after previous operations, the inability to extend the neck due to Bekhterev’s disease. In addition, the patient developed severe dyspnoea in the supine position. Given the above, low percutaneous dilational tracheostomy was performed under local anesthesia directly above the jugular notch of the sternum in the patient’s sitting position. Due to the absence of specialized tools at the General Surgery Department of the Central District Hospital, a set for percutaneous nephrostomy was used. This technique can be used in urgent situations when it is impossible to perform standard conicotomy or tracheostomy.

Abstract
Primary hemochromatosis refers to a congenital autosomal recessive disease associated with a mutation of the homeostatic iron regulator (HFE gene), whose pathogenetic mechanism is increased iron absorption in the intestines, which leads to excessive accumulation of iron in organs and tissues, mainly in the liver, pancreas, heart, pituitary gland, testicles. The consequence of the disease is the development of fibrosis and insufficiency of these organs. Genotyping of HFE gene mutations is the main method of hemochromatosis verification. The presence of the C282Y/C282Y genotype in combination with iron overload manifestations is a diagnostic criterion of the disease. The basic treatment of patients with hemochromatosis is phlebotomy, which can be combined with the prescription of iron chelators, symptomatic therapy.
A clinical case of primary hemochromatosis in a 48-year-old man is of interest due to long-term persistence of certain symptomatic manifestations of hemochromatosis and verification of the disease only after decompensation of a cardiovascular pathology and magnetic resonance imaging (MRI) of the thoracic cavity. After obtaining the final diagnosis and treatment, the patient showed positive dynamics of clinical symptoms, laboratory and instrumental data.

This article presents a clinical case of the removal of a foreign body, an intrauterine device, from the lumen of the sigmoid colon. This case is of undoubted interest because despite the non-specific complaints of the patient and numerous instrumental examinations, the migration of the foreign body was only visualized at the time of another videocolonoscopy. The migrating spiral was removed endoscopically through the intestinal lumen without any complications.