Objective. To determine the attitude of world religions to surrogacy, to analyze relevant regulatory legal acts of a number of European countries, to identify the main problems associated with the practice of surrogacy.
Materials and methods. To achieve the above objective, we analyzed up-to-date literary sources and studied regulatory legal acts of several European countries.

Results. The attitude of world religions to surrogacy has been analyzed. The legal acts regulating the concerns in relation to surrogacy in different countries of the world have been presented. The main problems associated with the practice of surrogacy have been outlined.
Conclusion. The social value of surrogacy as a way of procreation is obvious. In conditions of low life expectancy, increasing number of infertile marriages, population aging in a number of countries in the world, this method of reproduction allows preventing adverse demographics. When it comes to commercial contract, the institution of surrogacy solves economic problems of a certain category of population.
High costs of medical manipulations, legal aspects, and religious problems of procreation using the method of surrogacy are not obstacles to the further development of this type of reproductive techniques.

Spontaneous echocardiographic contrast is a manifestation of SLUDGE syndrome in the cavities of the heart. The factors that contribute to the emergence of this phenomenon are atrial fibrillation, mitral stenosis, mitral valve prosthesis, left atrial dilatation, decreased left ventricular ejection fraction, hypercoagulable blood conditions, inflammatory diseases, dyslipidemia. Spontaneous echo contrast is a prothrombogenic condition and increases the risk of thromboembolic events, including cerebrovascular complications. This article presents an analytical review of literary sources on this phenomenon for the purpose of its study and determination of treatment tactics in each clinical case.

Elderly patients represent a group of population in need of a rather wide range of medical and social services [1]. It has been found that the quality of life of the elderly population is inseparable from the level of medical and social services, which requires mutually coordinated efforts from healthcare and social authorities [2].

Objective. To perform an analytical assessment of the dynamics of COVID-19 patients` state in the conditions of a hospital healthcare organization taking into account their comorbid diseases in May 2020 and May 2021, and to determine the prognostic indicators for a severe course of COVID-19.
Materials and methods. 96 medical records of COVID-19 patients who had undergone treatment at Gomel City Clinical Hospital No. 3 in May 2020 and 130 medical records of COVID-19 patients who had undergone treatment in May 2021 were retrospectively analyzed.
Results. The average age of women treated for pneumonia associated with COVID-19 at the hospital healthcare organization in 2020 was 58 years, in 2021 – 64.5 years, of men in 2020 – 58 years, in 2021 – 60.5 years. All patients underwent clinical examination according to temporary protocols. The most common COVID-19 comorbid background diseases in both 2020 and 2021 were coronary artery disease (CAD), arterial hypertension (AH), non-alcoholic fatty liver disease, diabetes mellitus (DM), kidney disease, and obesity. Polymorbidity in 2021 was observed 1.5 times more often than in 2020 (pFisher<0.001). C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels are statistically associated with the severity of pneumonia (rS=0.33; p<0.001 and rS=0.2; p=0.03, respectively). The neutrophillymphocyte ratio (NLR) level in patients with a mild course of pneumonia associated with COVID-19 in 2020 was 1.58, in 2021 – 1.05, while in patients with a severe course in 2020 – 7.7, in 2021 – 10.63.
Conclusion. CRP, LDH and NLR serve as available methods for predicting the course of COVID-19 in comorbid patients in clinical practice.

Objective. To assess the possibility of using blood neutrophil reactivity parameters to monitor the inflammatory process in patients with rheumatoid arthritis (RA).
Materials and methods. The parameters of the functional activity of neutrophils (netosis activity, absorbing capacity, production of active oxygen species and nitric oxide) were assessed in 61 patients with a verified RA diagnosis in the dynamics of inflammatory process.
Results. In the patients, the values of netosis parameters (NET_SP30, NET_CT30, NET_SP150, NET_ST150) and oxygen-producing activity (NST_SP) are increased during the exacerbation period compared to the clinical improvement phase. The threshold values of the parameters were determined using the categorical regression analysis, on the basis of which an assessment scoring system of the activity of inflammation in patients with RA has been proposed.
Conclusion. The parameters for evaluating the functional activity of neutrophils (NET_SP30, NET_ST30, NET_SP150, NET_ST150 and NST_SP) are additional laboratory criteria for assessing the activity of inflammation in RA.

Objective. To determine the anamnestic and biochemical predictors of obstetric and perinatal complications in women with intrahepatic cholestasis of pregnancy (ICP).
Materials and methods. 59 women with ICP and 30 pregnant women included into the comparison group were examined. The characteristics of the reproductive history, anamnesis of the disease, complaints, biochemical parameters of liver function (syndromes of cholestasis and hepatocyte cytolysis, function of protein synthesis), features of the course and treatment of ICP were studied.
Results. The main predictors of preterm birth in the women with ICP were: age (P(U)=0.027), multiple pregnancy (OR=17.5, p=0.033); alkaline phosphatase (ALP) blood level > 499 U/l (AUC=0.801; p=0.008); De Ritis Ratio value ≤ 0.49 (AUC=0.757; p=0.005). The main prognostic markers for meconium staining of amniotic fluid (MSAF) in the patients with ICP were: ICP in previous pregnancies (OR=7.1; p=0.029); serum bile acid concentration > 14 μmol/l (AUC=0.718; p=0.043); total bilirubin blood level > 13 μmol/l (AUC=0.773; p=0.007); ALP activity > 484 U/l (AUC=0.728; p=0.033); blood creatinine concentration ≤ 60 μmol/l (AUC=0.930; p=0.0001) in asymptomatic course. The development of respiratory disorders in children born to women with asymptomatic ICP was associated with a total protein concentration in the blood of 78 g/l or less (AUC=0.852; p=0.0001).
Conclusion. The anamnesis of the disease and the determination of the levels of the biochemical parameters of liver function allows predicting obstetric and perinatal complications in ICP.

Objective. To analyze the morphometric parameters of the optic disc (OD) in patients with symptomatic ophthalmohypertension and secondary glaucoma associated with endocrine ophthalmopathy (EOP) according to the data of optical coherence tomography (OCT).
Materials and methods. The morphometric parameters of OD and retinal nerve fiber layer (RNFL) thickness were assessed according to OCT data of 175 patients (350 eyes and orbits) with different forms and activity of EOP. 30 patients (60 eyes and orbits) were diagnosed with symptomatic ophthalmohypertension in active EOP stage. 30 patients (58 eyes and orbits) were diagnosed for the first time with secondary open-angle glaucoma associated with inactive EOP course. The control group comprised 30 somatically healthy individuals comparable in terms of age and sex without clinical EOP symptoms with normal ophthalmic tonus.
Results. The patients with symptomatic ophthalmohypertension have revealed increased peripapillary RNFL thickness up to Me 95.5 [90; 101] μm (Mann-Whitney U=1107, p=0.0002), and increased neuro-retinal rim (NRR) area up to Me 1.65 [1.5; 1.9] mm² (Mann-Whitney test U=1425; p=0.04). The patients with secondary glaucoma associated with EOP have found a statistically significant decrease of the average RNFL thickness to Me 85[80;89] μm (by 8%) compared to the control group (Mann-Whitney U=553, p=0.00). The NRR area was statistically significantly reduced to Me 1.15 [1.0; 1.2] mm² (Mann-Whitney U=255.5; p=0.00).
Conclusion. Patients with symptomatic ophthalmohypertension and active course of the processs detect signs of increased RNFL and NRR area thickness, which is related to retrobulbar fiber swelling and development of compressive ischemic optic neuropathy. Patients with secondary glaucoma are characterized by remodeling of OD parameters at the expense of decreased average peripapillary RNFL thickness, reduced NRR area and extended excavation, which is typical for glaucomatous optic neuropathy.

Objective. To analyze the clinical and microbiological and morphological features of wounds of different duration, allowing to differentiate the stages of the infectious process and to determine recommendations for further tactics of preoperative preparation.
Materials and methods. Clinical and microbiological and morphological assessment of the state of acute and chronic wounds in 313 patients was performed.
Results. Colonized wounds were characterized by the presence of pathological signs (atrophy, cicatricial changes) in fine-grained granulations, the frequency of which increased from 38.5% for wounds lasting 22–28 days up to 85.1% for wounds lasting more than 2 months (χ2 = 14.0 ; p=0.003). Infected wounds were more often detected at terms of 22–28 days (24.6%, vs 3.9% for wounds more than 2 months old, χ2=40.51; p<0.001). Critically colonized wounds made up with coarse-grained granulations were detected at all stages of wound existence (from 21.6 to 32.8%). The analysis of biopsy specimens revealed the initial signs of proliferation disorders in 22-28 day wounds, which justifies the need to classify them as chronic. Second phase reparation failure was detected in all cases of chronic wounds; the severity of the signs of purulent inflammation increased depending on the stage of the infectious process.
Conclusion. Differentiation of the stages of the infectious process in wounds using the clinical and microbiological and morphological research methods is necessary for the determination of the indications for the use of local wound debridement and systemic antibiotic therapy at the stage of wound preparation for plastic closure.

Objective. To determine the role of placental growth factor, fibronectin, certain hemostatic parameters and glycodelin in the genesis of early miscarriage.
Materials and methods. Venous blood, inpatient medical records (form No.003/u-07), prenatal records (form No.113/u-07) of 94 pregnant women. The software package "Statistica" 10.0 and the programming language "R" version 4.1 were used for statistical analysis.
Results. Placental growth factor, fibronectin and glycodelin can be considered as laboratory markers of miscarriage during the first trimester of gestation.
Conclusion. The markers of early reproductive losses we have identified underlie the development of endothelial and hemostasiological disorders and morphofunctional inferiority of the endometrium.

Objective. Based on the study of clinical and laboratory parameters, to identify groups of patients with chronic hepatitis B virus (HBV) infection who need antiviral therapy, and to evaluate the effectiveness of tenofovir treatment.
Materials and methods. The study group included 234 patients with various forms of chronic HBV infection. Сlinical data, blood laboratory parameters (biochemical blood test, complete blood count, coagulogram, serum HBV DNA level), liver fibrosis stage were studied.
Results. Currently, chronic HBV infection is more common in the age group of 30-39 years (35.5%), and is more prevalent in males (73.1%). Advanced liver fibrosis (stage F2 and higher) was found in 38.4% of patients, and liver cirrhosis – in 19.8%. Patients were predominantly HBeAg-negative (86.8%), they had lower serum aminotransferase levels (p=0.03) and DNA HBV viral load (p<0.001) as compared with HBeAg-positive ones. HBsAg-negative (occult) chronic HBV infection is detected in 1.3% patients and may occur with progressing liver disease.
Conclusion. The clinical and laboratory characteristics of the patients with chronic HBV infection have been presented, indications for antiviral therapy in 48.7% of the patients have been determined. Antiviral tenofovir therapy allows to achieve a biochemical and virological response in most patients, but due to its indefinite duration and high cost, the question of adherence to the therapy is crucial.

Objective. To evaluate the possibility of using X-ray radiation to model dystrophic lesions of the myotendinous junction in biological models (rats).
Materials and methods. The objects of the study were model animals (6 rats). The animals were irradiated in the 10 Gy and 20 Gy modes using the biological irradiation unit X-RAD 320 Precision X-ray Inc in doses of 10 and 20 Gy. The morphological examination of the hind limbs of the rats after exposure to ionizing radiation was carried out according to the standard scheme. Sonography was performed on an expert class Mindrey DС-80 ultrasound scanner (a linear transducer with an operating frequency of 18-20 MHz was used).
Results. А parallelism has been found between histological, immunohistochemical and sonographic changes in radiation-induced damage to the myotendinous junction (these changes are short-term in nature in the tendon part and long-term in the muscle part, while the severity of the changes is predetermined by the absorbed dose, which makes it possible to reproduce any stages of the pathological continuum).
Conclusion. Тhe proposed model of radiation-induced damage to the myotendinous junction allows reproducing a histological and sonographic pattern corresponding to the subacute and chronic phase of the specified pathological process without traumatic effects on the muscle and tendon.

Objective. To study the resistance to medication washout from textile woven vascular prostheses with various types of polymer coatings experimentally.
Materials and methods. Samples of a textile woven vascular prosthesis completely covered with one of three types of hydrogel coatings were examined. The resistance to washout of 1 % vancomycin and 0.2 % linezolid from the coatings was assessed by the magnitude of the antibacterial activity of the samples. The research methods were: disc diffusion and according to the ability to suppress the visible growth of Staphylococcus aureus ATCC 25923 (S. аureus) in Muller- Hinton broth.
Results. All the samples of the textile woven vascular prosthesis with the coatings soaked for 30 minutes in 1 % vancomycin or 0.2 % linezolid solutions inhibit the growth of S. аureus culture on the surface of the agar, which leads to the formation of optically transparent sterility zones at the polymer-medium interface. The size of the sterility zone without washout is larger for all linezolid coatings. However, in 7 day washout, the size of the sterility zones is larger for all vancomycin coatings.
Conclusion. Textile woven vascular prostheses with various types of polymer coatings and antibiotic vancomycin (1 %) are statistically significantly more resistant to washout during 7 days than with linezolid (0.2 %). The presence of L-aspartic acid in polymer coatings statistically significantly increases the resistance to antibiotic washout compared to hyaluronic acid, and the presence of polyvinylpyrrolidone statistically significantly reduces the resistance to antibiotic washout from polymer coatings.

Objective. To study the opinion of the managers of healthcare organizations (HOs) of the Gomel region on the specifics of the functioning of outpatient and inpatient HOs in the region in the context of the third wave of COVID-19 spread, the impact of the current situation on the delivery of health care to the population.
Materials and methods. A survey of 96 managers of outpatient and inpatient HOs was conducted, the features of the work in the context of an increased COVID-19 incidence rate and associated difficulties were identified.
Results. The vast majority of the surveyed managers of outpatient HOs (77.3%) are convinced that the professional qualifications of medical personnel in their institutions fully meet the requirements for the work with COVID-19 patients, while this belief is shared by less than half (46.7%) of the managers of inpatient ones. However, with such a high assessment of the staffing, the managers of outpatient HOs are experiencing a real shortage of personnel: only 10.6% of them responded that they had not experienced difficulties with staffing during their work in the conditions of the COVID-19 pandemic, and 56.7% of the managers of inpatient HOs responded the same. This is probably why outpatient health care tier managers one and a half times more often noted a significant increase in the duration and intensity of the work of medical personnel during the pandemic than their colleagues from inpatient institutions (62.1 and 40%, respectively). But the opinion about the moral and psychological climate in teams practically coincides in both groups of the managers: deterioration in outpatient HOs was noted in 47% of cases, stability in inpatient ones - in 53.3% of cases. Also, in both the groups, the managers of HOs were satisfied with the normative documentation regulating the delivery of health care in the conditions of the COVID-19 pandemic (managers of outpatient HOs - 7.63 ± 1.35 points, managers of outpatient ones - 7.18 ± 1.92 out of maximum 10 points).
Conclusion. The fight against the coronavirus has become a serious test for the healthcare system of the Republic of Belarus. The performed survey has revealed problematic issues that arose in the course of the professional activities of the managers of inpatient and outpatient HOs. According to the respondents, during the COVID-19 pandemic, there was a significant increase in the duration and intensity of work. There were also difficulties related to carrying out the diagnostics, shortcomings in the interaction of medical personnel, etc.

The article presents a clinical case of operative treatment and early controlled mobilization in isolated chronic flexor digitorum profundus tendon injury. The work describes the techniques of blocking commissure destruction and control of finger flexor tendons separate sliding and notes the safety of daily controlled mobilization of the operated finger.

The article presents a clinical observation of total injury to the esophagus and cardiac orifice of the stomach with overall damage to the membranous part of the trachea. Of interest is the mechanism of a trauma which occurred during the extraction of a nasogastric tube. A good treatment result has been achieved.

The article describes a case of uterine rupture in the second trimester of pregnancy during medical termination of pregnancy using misoprostol. This case is of undoubted interest, since the rupture of the uterus in the second trimester of pregnancy is an extremely rare phenomenon described in domestic literature. The presented material may remind practicing doctors that this complication is likely to occur.

Anemia is a clinical and hematological syndrome which is one of the most common diseases in the world. The clinical manifestations of anemia syndrome can be caused by both anemia itself and various manifestations of hypoxia and hypercapnia. Due to the similarity of the clinical manifestations, doctors of various specialties face a difficult task of the differential diagnosis of anemias and the selection of therapeutic tactics.
The article presents a clinical case of anemia syndrome in a patient with comorbid pathology and latent vascular malformation. The presence of comorbid diseases in the patient especially those requiring anticoagulant and antithrombotic therapy often leads to the development of anemia, difficulties in diagnosis and prescription for etiotropic treatment. As a rule, in such patients, anemia syndrome has a mixed cause. It often consists of the combination of anemia of chronic disease with iron deficiency or of vitamin B12-deficient anemia and acute or chronic posthemorrhagic anemia.

Objective. To optimize the parameters for testing the antimicrobial activity of modified non-woven materials used for the production of medical masks against sanitary-indicative microorganisms and to quantify their antimicrobial potential using a method with optical detection.
Materials and methods. The antimicrobial potential was assessed by simulating a direct contact of the material with antimicrobial impregnation under in vitro conditions by the method with optical detection based on the proposed marker Ts – the time it takes for a population of microorganisms to reach the stationary phase of development under conditions of periodic cultivation. The antimicrobial potential was calculated according to the proposed formula and evaluated in accordance with a reasonable quantitative scale.
Results. In laboratory conditions, the parameters for testing the antimicrobial activity of nonwoven materials with antimicrobial treatment with zinc oxide - ZnO - using an instrumental method with optical detection have been optimized. It was found that the sample obtained using electron beam spraying from the active gas phase demonstrated more pronounced antimicrobial potential of AMP against the tested strains of Staphylococcus aureus compared with the sample obtained by wet chemistry impregnation from a solution in vacuum.
Conclusion. An instrumental method with optical detection for quantitive assessment of the antimicrobial potential of nonwoven materials has been developed. The criterion-significant marker Ts (the time it takes a population of microorganisms to reach the stationary phase of development in a periodic culture system) has been substantiated, and a discrete scale for assessing the antimicrobial potential has been proposed.