The human body, along with extensive microbial communities called the microbiome, contains various viruses, collectively referred to as the «virome», and the number of such microorganisms is characterized by great complexity and heterogeneity and exceeds the number of bacteria in the microbiome by a factor of 10. Human virome is constantly renewed due to rapid evolution and entry of viruses from the environment, and the viral community of the human body is an indicator of human health. One of the components of virome is bacteriophages, the diversity of which is determined primarily by the species comprising the bacterial component of the microbiome. Along with other anatomical structures of the body, the respiratory tract of healthy humans is represented by a huge community of viruses just as much as by bacterial communities, and analysis of the full viral diversity of the airways is vital for understanding the features of the human virome. To date, next-generation sequencing approaches, the cost of which has decreased significantly recently, are the most convenient methods for virome analysis and the use of the results in clinical practice.

Objective. To develop a method for isolating a group of patients with arterial hypertension of the II degree with an increased risk of the total number of myocardial infarctions, strokes, lethal outcomes from cardiovascular diseases (CVD) in the next 1-3 years, taking into account the assessment of heart rate variability and heart rate turbulence parameters.

Materials and methods. In the course of a prospective clinical study 214 patients with arterial hypertension (AH) of the II degree aged 35 to 70 (57,7±7,6) years and 26 practically healthy individuals aged 30-60 (51,7±7,7) years were examined. All were given a comprehensive examination, including Holter monitoring (HM), electrocardiography (ECG), echocardiography (EchoCG). Statistical processing of the results was carried out using the “Statistica 10.0” software.

Results. The total number of myocardial infarctions, strokes, and lethal outcomes registered in patients with arterial hypertension of the II degree over a period of 2.6±1.3 years was estimated, the factors associated with their development were determined. A method has been developed to identify a group of patients with arterial hypertension of the II degree who have an increased risk of developing adverse cardiovascular events over the next 1-3 years, it has been shown that its sensitivity is 90.9%; specificity is 95.8%.

 Conclusion. It is shown that the use of heart rate variability (HRV) and heart rate turbulence (HRT) parameters provides a significant increase in the sensitivity and specificity of the identification of a group with an increased risk of developing the total number of strokes, myocardial infarctions and lethal outcomes in the next 1-3 years.

Objective. To analyze the pharmacoeconomical affordability of antipsychotic drugs (APD) in patients with mental disorders in the structure of dementia at the level of the Gomel region of the Republic of Belarus

Materials and methods. The study used data from the State Register of Medicines of the Republic of Belarus (2022); Clinical Protocol for providing medical care to patients with mental and Behavioral Disorders (2010); website data https://myfin.by about the average pension amount and the minimum subsistence budget of the Gomel region for 2022; data from «State Register of Medicines of the Republic of Belarus» website. For the analysis, the price list for medicines (drugs) of the largest pharmacy chains in Belarus was used, which included the state pharmacies of the Gomel UP «Pharmacy» and commercial pharmacies of the well-known brands in Belarus «ADEL» and «Dobrya Leki». Parameters such as the price affordability of the APD and 4 availability coefficients (Cd) were determined, allowing to correlate the average cost of antipsychotic drugs packaging and the cost of the average daily dose of antipsychotic drugs with the consumer income, as well as the total affordability coefficient (Cd total.).

Results. According to all criteria, the most economically affordable drug from the group of typical APD was the generic Haloperidol–Ozone (Ozon, Russia), and the least affordable from the group of atypical ones was the generic Olanzapine (Belmedpreparaty, Republic of Belarus).

Conclusion. There is a large selection of APD on the pharmaceutical market of the Gomel region. Generic APD predominate on sale, which are more affordable compared to the original APD. But one should not forget about the advantages of the original drugs – efficiency, safety, innovativeness, reproducibility of the effect and strict quality control, confirmed in clinical trials. However, the genetic drug Olanzapine (Belmedpreparations, RB) is not in any way more superior in terms of affordability, but even inferior to some drugs. This study allowed us to establish that in the Gomel region of the Republic of Belarus, a patient with dementia is provided with a wide choice of APD and the ability to determine the criteria for preference when buying a specific drug.

Objective. To analyze the data of ultrasound examination of the kidney transplant in patients with a favorable outcome of transplantation.

Materials and methods. The analysis of 32 images and protocols of ultrasound diagnostics of a kidney transplant (16 men and 16 women), implemented on the 1st day after kidney transplantation, as well as 3 months after the intervention in 2017-2020, was carried out.

Results. It was found that for a satisfactory course of the post-transplant period with renal allotransplant, an increase in the volume of kidney transplant was characteristic in men of the first and second periods of maturity – by 1.12 times, in elderly men – by 1.24 times, in women of the first period of maturity – by 1, 07 times, the second period – 1.17 times, in elderly women - 1.25 times. Analysis of parenchyma perfusion by energy Doppler mapping in all studied groups was interpreted as good or satisfactory, which characterized the favorable course of the post-transplant period.

Conclusion. Monitoring of morphometric and hemorheological parameters of a kidney transplant for 3 months and their comparative analysis on the 1st and 90th day reflects a positive dynamic of the kidney transplant function. The study of the morphometric and hemodynamic parameters of the kidney transplant makes it possible to objectively assess the functional state of the kidney transplant in dynamic in order to timely identify various complications in the post-transplant period.

Objective. To reveal the effective and safe timing of tracheostomy in patients with CNS diseases by comparative assessment of the duration of respiratory support and ICU, the frequency of development ventilator-associated pneumonia, the assessment of the level of consciousness according to the Glasgow Coma Scale (GCS), survival rate, as well as the incidence of complications rate.

Materials and methods. A retrospective study was conducted among neurological and neurosurgical patients treated from 2010 to 2017 who underwent tracheostomy. Patients (n=131) were divided into 3 groups depending on the tracheostomy time.

Results. The relation between early tracheostomy and the duration of respiratory support, the ICU bed-day, the probability of developing ventilator-associated pneumonia in patients with the central nervous system pathology was revealed; no relationship was found between the tracheostomy time and the neurological outcome and survival rate in this category patients.

Conclusion. The use of early tracheostomy in intensive care of patients with the central nervous system pathology is effective, which is proved by a 2,2 times reduction of the duration of mechanical ventilation, by a 1.9 times reduction of the duration of the ICU day, by a 1.6 times lower risk of developing ventilator-associated pneumonia, without affecting outcomes and being safe due to the absence a lot of complications both during and after the surgical intervention.

Objective. Evaluate the possibility of using ultrasound compression elastography for detecting early dystrophic changes in the long dorsal sacroiliac ligaments in case of pain in the lower back

Materials. To achieve this goal, we compared the data of compression elastography of the long dorsal sacroiliac ligament in 36 patients aged 46.0 years [23; 54] with lower back pain (experimental group) and 30 patients aged 36.5 years [29; 48] without lower back pain (control group).

Results. The results of the evaluation of diagnostic significance of ultrasound compression elastography were as follows: AUC ‒ 0.81 (95% CI (0.63; 0.93)), p=0.0001; Juden index ‒ 0.64, sensitivity ‒ 90% (95% CI (0.69; 0.99)), p=0.0001; specificity ‒ 74% (95% CI (0.56; 0.99)), p=0.0001.

Conclusion. Compression elastography enables to detect areas of long dorsal sacroiliac ligament structure disorganization in cases where standard B-mode can’t reveal changes in the structure of this ligament. For the long dorsal sacroiliac ligament, ultrasound compression elastography has comparable sensitivity (90%) to shear wave elastography, but lower specificity (74%) and prognostic value (81%), allowing a fairly confident diagnosis of early degenerative changes in the long dorsal sacroiliac ligament.

Objective. To evaluate the role of the T(-344)C polymorphism of CYP11B2 gene in the development of cardiorenal syndrome (CRS) in diabetes mellitus (DM).

Materials and methods. 270 patients with type 1 and type 2 diabetes aged over 25 years were examined. All patients underwent molecular genetic analysis using deoxyribonucleic acid isolated from whole venous blood.

Results. The TT genotype was associated with the risk of developing CRS manifestations such as left ventricular hypertrophy (odds ratio (OR) 2.64; 95% CI (0.93–4.19), chronic heart failure (OR 4.26; 95% CI (2.26 - 8.06), subclinical atherosclerosis (OR 4.04; 95% CI (1.89 - 8.58), chronic kidney disease (CKD) (OR 10.77; 95% CI (3.56 - 32.61), and the CT genotype (OR 3.28; 95% CI (1.02 – 10.59) with CKD risk..

Conclusion. There are pathogenetic associations between renin-angiotensin-aldosterone system, cardiovascular complications and a decrease of renal function. Further research is needed for a deep understanding of the complex pathogenetic mechanisms of the development and progression of cardiovascular and renal pathology.

Objective. The article considers and confirms a statically significant relationship between styles of self-regulation and aggression in alcohol-addicted individuals. The revealed relationship made it possible to determine the violation of the process of self-regulation and the spontaneous manifestation of various types of aggression common to persons with alcohol addiction.

Materials and methods. The study sample included 295 men with alcohol addiction syndrome (F10.2) aged 21 to 60 years, mean age 40.7±8.9 years, and alcohol consumption averaged 13.5 years. The following materials were used for the study: the methodology “Types of aggressiveness” developed by L. G. Pochebut (2012); questionnaire “Style of self-regulation of behavior” (SSRM). Statistical package SPSS 19.0 was used for statistical analysis. The Spearman correlation coefficient for independent samples was used, and the difference between two independent samples was estimated using the Mann-Whitney U-test.

Results. Identified difference between persons in LTP (group I) and persons in hospital (group III) in parameters of “Planning” and “Independence” (p <0.01) The noted average level in all groups I, II and III in the parameters of the scale “General indicator of self-regulation” and revealed weak and moderate negative relationships of the scale “General indicator of self-regulation” with the scale “General level of aggression”. There was a significant decrease in indicators below the average level in persons of group III on all scales: “Planning”, “Programming”, “Flexibility”, “Modeling”, “Evaluation of results”, “Independence” and “General indicator of self-regulation”. The revealed difference between groups I and III in terms of “Planning” and “Independence” (p <0.01) showed that as they stop consuming alcohol in isolation, people in group I gradually regain access to awareness, adaptive restraint, perspective thinking and selfregulation.

Conclusion. The main rehabilitation work in the conditions of the penitentiary system should be aimed at increasing volitional self-regulation, the formation of positive attitudes, the restoration of social and normative qualities and skills of prosocial interaction.

Objective. To establish the relationship between the ASSIST score (Humeniuk R. et al. 2008) «risk of harm from alcohol use» (RHAU), impaired social functioning and manifestation of aggression in patients with schizophrenia and related disorders.

Materials and methods. From 2014 to 2020 a comparative, one-stage, observational study was conducted on the basis of the Gomel Regional Clinical Psychiatric Hospital with a sampling formation using directional selection method. Patients who met diagnostic criteria of schizophrenia (F20) or acute psychotic disorder (F23) according to ICD-10 were included in the study. 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 OASCL (Yudofsky S. C. 1986).

Results. The entire sample of 123 people examined by us was divided into 3 groups depending on the level of RHAU. The first group «ASSIST 0» (n=37) was accepted as a control group, since RHAU was equal to 0. The second group is «ASSIST up to 10» (n=42), with minimal RVUA (1-10 points on the ASSIST scale). The third group «ASSIST over 11» (n=44) combines moderate and high RHAU. The group study did not show any differences between men and women in alcohol consumption and aggression within the groups. Comparison of 3 groups, and their subsequent pairwise comparison, made it possible to establish statistically significant differences in social dysfunction groups (decrease in the working status of «ASSIST 0» – 81%, «ASSIST over 11» – 73%, «ASSIST up to 10» – 45%) and of aggression (OASCL total score H 62.4=p≤0.001: physical aggression vs. others H=45.2 p≤0.001).

Conclusion. In patients with schizophrenia and disorders close to it, the «risk of harm from alcohol use» indicator (ASSIST scale) indirectly indicates the formation of psychosocial dysfunction and indicates a differentiated effect of alcohol in the display of aggression in this group of patients.

Objective. To analyze the functional state of the visual analyzer and characterological features of children at a primary school age with orthophoria and heterotropia.

Materials and methods. Eighty-four children (168 eyes) aged 6-11 years were examined. Two groups comparable in age and gender were formed. Group 1 included 35 children (70 eyes) with orthophoria with moderate degree hyperopia Hm 4.1 [1.0; 8.75] Dptr; Group 2 consisted of children with concomitant convergent strabismus with a moderate degree hyperopia Hm 4.3 [0.75; 9.75] Dptr - 49 patients (98 eyes). To study the properties of the nervous system (NS) hardwaresoftware complex “NS-Psychotest” (Neurosoft LLC, Ivanovo, Russia, http://neurosoft. com/ru) was used. Neurodynamic indices of sensorimotor reaction were determined according to the methods “Simple visual-motor reaction” (PMR), “Distinguishing reaction” (DR), “Choice reaction” (PC), “Reaction to a moving object” (RMA), “Critical flicker fusion frequency” (CFF), Lusher’s color test.

Results. Concomitant strabismus in group 2 children significantly increased “Simple visual-motor reaction” (SVMR), “Discrimination reaction” (RR) and “Choice reaction” (RС) by 43 ms, 80.8 and 57.8 ms, respectively (p<0.05), compared to the group of children with orthophoria, indicating reduced mobility of nervous processes and predominance of inhibitory processes in the central nervous system (CNS).

Conclusion. It follows from the results obtained that the presence of heterotrophy in group 2 children reliably leads to a decrease in the mobility of nervous processes and the predominance of inhibitory processes in the CNS. The combination of low reaction rate and expressed inertness of nervous processes in children of the 2nd group indicates a mismatch in the relationship between the centers of the visual and motor analyzers.

Objective. Тo evaluate the possibility of using instrumental methods (spirometry and ultrasound diagnostics) for dynamic monitoring of patients with COVID-19-associated lung disease.

Materials and methods. To achieve this goal, we performed a comprehensive instrumental diagnosis of respiratory system lesions in 58 patients (age - 56.0 years [31; 65]) with confirmed COVID-19, followed by examination of indexes of external respiratory function and ultrasound pattern in the dynamics.

Results. In the process of dynamic observation, there was a parallelism of changes in the indexes of external respiratory function and changes revealed by lung ultrasound in patients with COVID-19.

Conclusion.Combination of such methods of lung condition examination as spirometry and ultrasound diagnostics allows effective dynamic monitoring of COVID-19 patients without use of imaging methods associated with radiation exposure.

Objective. To analyze the energetic role of glutamate in thymocytes and tissues of the thymus at different stages of its age-related involution.

Materials and methods. The studies were performed on white male rats. The state of energy metabolism was determined by the rate of oxygen consumption by thymus tissues and thymocytes using a polarographic method.

Results. It was found that in the thymus tissues of 4, 5 and 6-month-old rats the rate of oxygen consumption is constant and does not significantly change in response to glutamate administration. Thymocytes - the immunocompetent thymus cells of 3- and 8-month-old animals, despite similar levels of oxygen consumption on endogenous substrates, respond differently to glutamate action. In thymocytes of 3-month-old animals, the action of glutamate has a more pronounced stimulating effect on bioenergetic processes compared to 8-month-old animals. There is a reason to believe that the decrease in the efficiency of glutamate action as the animals grow older is caused by the processes of age-related involution of the thymus

Conclusion. Glutamate stimulates aerobic respiration in the thymocytes of 3- and 8-month-old animals, with a greater stimulating effect in the thymocytes of younger animals. At the same time, glutamate does not cause significant changes in the rate of oxygen consumption in the thymus tissues of 4-, 5-, and 6-month-old animals.

Objective. To compare the wound healing after implantation of the freshly frozen allogeneic cartilage and the autogenic cartilage in a cutaneous flap.

Materials and methods. Two groups of eighteen non-breed white lab rats weighing 180-200 g of both genders were studied. Each specimen had a plastic material with the inclusion of a skin flap and cartilage graft formed. Group 1 used the animal’s own cartilage, group 2 used freshly frozen allogenic cartilage. Histological examination of the flap and graft preparations was carried out on the 7th, 14th and 21st days after the intervention.

Results. Semi-quantitative evaluation of inflammation and tissue reaction after cartilage autograft and allograft implantation was carried out. A gradual decrease in the evidence of the inflammatory reaction and the formation of a fibrous capsule around the implant during the study period was registered. The comparative analysis revealed no statistically significant differences in each of the indicators.

Conclusion. Implantation of an allograft from freshly frozen cartilage has no negative effect on skin flap wound healing in the experiment. Freshly frozen allogenic cartilage can be used for reconstructive interventions on a par with autologous material.

Objective. To evaluate the ability of a combination of budesonide and azithromycin to influence the migration of blood monocytes and lymphocytes in patients with chronic obstructive pulmonary disease (COPD).

Materials and methods. Peripheral blood mononuclear cells from patients with COPD (n=8) were incubated with glucocorticoid budesonide (10 nM), macrolide antibiotic azithromycin (10 µg/mL), or their combination, and then transferred to chemotaxis chambers containing chemokines RANTES (CCL5, 10 nM) or IP-10 (CXCL10, 10 nM). Cells migrated to the lower compartment of the chamber were collected, stained with monoclonal antibodies to CD3, CD14, CD19, CD45 and counted on a flow cytometer.

Results. Azithromycin alone and in combination with budesonide inhibited the migration of blood T-lymphocytes and B-cells and enhanced the migration of blood monocytes to RANTES and IP-10. The combination of azithromycin and budesonide had a more suppressive effect on the chemotaxis of blood T- and B-lymphocytes to RANTES and IP-10 than budesonide alone. The combination of azithromycin and budesonide had an effect similar to azithromycin alone on the migration of blood T- and B-lymphocytes, as well as monocytes in patients with COPD.

Conclusion. The results of the study demonstrate the ability of azithromycin alone to modulate the chemotaxis of peripheral blood monocytes and lymphocytes in patients with COPD and the lack of advantages of its combination with budesonide.

Objective. To carry out a comparative assessment of physical development indexes of pupils of general education schools with hot meals and a buffet type of catering.

Materials and methods. There were examined 432 schoolchildren from 7 to 15 years old, divided into two groups: group 1 – pupils of general education schools in which there were canteens based on food raw materials and semifinished products; group 2 – pupils of general education schools with a buffet with implementation of ready meals, confectionery, drinks, etc. To study the main indexes of physical development somatometric research methods were used. Differences at p≤0,05 were considered statistically significant.

Results. The absence of hot meal service contributes to an increase in the number of children with body length below average in 2.3-15.7 times (among girls aged 11-15 –  p<0.001); with excess body weight – 1.2-5 times (among boys aged 7-10 – p<0.01), with reduced body weight – 1.4-1.7 times; with increased and excessive nutrition – 1.3-11.6 times (among boys - p<0.05-0.001, and among girls – p<0.05). Consequently, the absence of hot meal service in general education schools affects the indicators of the physical development of children: deviations from the mean values in body length being more frequently observed in girls, and in body weight in boys.

Conclusion. The absence of hot meal service in education institutions negatively affects the physical development of students. For the harmonious development of children, the formation of hygienic skills of healthy eating and a conscious attitude to the choice of a proper diet, it is necessary to organize hot school meals and strengthen sanitary and educational work.

Objective. To calculate the number of lost (including healthy) years of life in patients aged 50 years and older with proximal femur fractures (PF) in the Republic of Belarus based on primary incidence data and evaluate the cost-effectiveness of the therapeutic model for the secondary prevention of osteoporotic fractures.

Materials and methods. A comprehensive assessment of health losses was carried out using DALY analysis based on our own epidemiological data on the primary incidence of PF and is presented in years of life lost to due to premature mortality and the years lived with a disability. The alendronic acid (AA) prescription after a primary PF fracture was proposed for secondary prevention of PF fractures. The cost-effectiveness was calculated based on the cost of one saved (including healthy) year in relation to the national GDP per capita.

Results. In the Republic of Belarus taking into account sex and age structure of the population it is expected to have a total of 2867 PF fractures in men (558 atal cases during the first year) and 7921 (2382 fatal cases) in women per year. The total number of lost (including healthy) years of life due to osteoporotic PF fractures was 8719.0 in men and 8169.9 in women. The administration of AA after PF fracture will save 1806.11 years of healthy life. The cost of one saved (incl. healthy) year was 1044.2 BYN/year for men (6.5% of GDP per capita) and 1720.1 BYN/year for women (10.8% of GDP per capita).

Conclusion. Prescription of antiresorptive therapy in the form of alendronic acid to men and women aged 50 years and older after a osteoporotic PF fracture for prevention of recurrent osteoporotic fractures is highly cost-effective and can be considered when assessing the threshold of intervention in treating patients with osteoporosis in the Republic of Belarus.

Objective. To evaluate the effectiveness of using the “Painmetrica” software for the diagnosis and selection of treatment for pain in degenerative diseases of the spine.

 Materials and methods. Software “Painmetrica” was developed for the diagnosis and selection of treatment for pain in degenerative diseases of the spine. Through a bidirectional nonrandomized controlled trial, its effectiveness was evaluated using telephone interviews with 42 patients. For comparison, a telephone interview was conducted with 47 patients for whom the Panimetrica program had not been used in the treatment.

Results. The effectiveness of using “Painmetrica” software for the diagnosis and selection of treatment for patients with back pain was demonstrated. In the main group, the decrease in pain syndrome tended to differ due to an increase in the number of patients in whom pain was relieved by more than 50% and completely disappeared (p = 0,09 according to the two-tailed Fisher’s exact test). Patients treated with Painmetrica algorithms experienced sleep recovery due to a decrease in pain: changes persisted in 12 cases (28,6%), while in the comparison group, sleep changes remained in 24 patients (51,1%) (p=0,05 according to two-tailed Fisher’s exact test). Against the background of effective pain relief in patients who used Painmetrica, there was a decrease in the use of non-steroidal anti-inflammatory drugs (NSAIDs) (17 patients (40,5%) of the main group versus 36 patients (76,6%) of the control group, p = 0,001 according to the twotailed Fisher’s exact test ). At the same time, only 8 patients (19.1%) in the main group and 30 patients (63.8%) in the comparison group (p < 0.001 according to Fisher’s two-sided exact test) indicated the need to consult a neurologist.

Conclusion. The effectiveness of the use of “Painmetrica” software for the diagnosis and selection of treatment of patients with degenerative diseases of the spine on an outpatient basis in relation to the need for patients to use nonsteroidal anti-inflammatory drugs, the need for additional consultation of a neurologist, as well as effective relief of sleep disorders caused by pain were demonstrated.

Objective. To evaluate the efficiency and safety of using two thoracic internal arteries during myocardial revascularization.

Materials and methods. The study included 32 patients over 18 years of age who were operated on for coronary artery diseases using two internal arteries as an auto-graft. The incidence of postoperative complications was assessed taking into account the proposed criteria for selecting patients.

Results. No increase in the number of postoperative complications in the early postoperative period was detected during bilateral internal thoracic artery coronary artery bypass graft.

Conclusion. Coronary bypass grafting using two internal thoracic arteries under general multicomponent balanced anesthesia is an effective and safe method of myocardial revascularization. It does not increase the risk of complications in the postoperative period with proper selection of patients.