Alcohol is a toxic substance that is associated with a spectrum of liver damage, including simple steatosis or fatty- degeneration of liver, alcoholic hepatitis, fibrosis, and cirrhosis. Alcoholic liver disease (ALD) is the general term used for this spectrum of alcohol-related liver damage. Excessive or harmful alcohol use is among the top five risk factors for death and disability worldwide, causing 2.5 million deaths and 69.4 million annual disability-adjusted life years. The diagnosis of ABP can usually be made on the basis of anamnesis, clinical and laboratory findings. However, the diagnosis of ABP can be clinically challenging because there is no a single diagnostic test to confirm the diagnosis, and patients may not report the extent of their alcohol use.

Objective. To analyze and systematize data on the use of neoadjuvant chemotherapy in the complex treatment of stomach cancer.
Materials and methods. The original publications containing information on the use of neoadjuvant chemotherapy in the complex treatment of gastric cancer deposited in the resources of PubMed and the information portal eLIBRARY.
RU have been studied.
Results. The most important aspects concerning the use of neoadjuvant polychemotherapy in the complex treatment of gastric cancer have been outlined.
Conclusion. According to the available literature data, the use of neoadjuvant chemotherapy can serve as an important factor in preventing the progression of the tumor process due to the impact on undetected micrometastases, but many aspects are not covered sufficiently in scientific publications. Therefore, the study of neoadjuvant chemotherapy in the complex treatment of gastric cancer, including D2 lymphodissection, is currently very relevant.

Objective. To measure leptin and soluble leptin receptor levels in patients with endometrial hyperplastic processes.
Materials and methods. 90 patients were included in the study, 70 with hyperplastic endometrial processes made up the main group, 20 with morphologically normal endometrium were included in the comparison group. The concentration of leptin and the soluble leptin receptor in the blood serum was measured by the method of enzyme immunoassay, the clinical and anamnestic characteristics of the disease were studied Results. There were no significant differences between the groups when comparing serum leptin levels: in the study group, the hormone level was 6,01 (3,64;7,50) ng/ml, in the comparison group — 6,44 (3,55;10,11) ng/ml (z = 0,61, p = 0,54). The level of soluble leptin receptor was significantly lower in patients in the main group and was 8531 (5697; 15895) ng/ml, and 16181 (10696; 20251) ng/ml in the comparison group (z = 2.614, p = 0.008).
Conclusion. Patients with endometrial hyperplastic processes are characterized by a decreased level of the soluble leptin receptor, whereas a leptin level has no significant differences compared to those in patients without endometrial pathology. The identified condition causes a defect in the signal transmission from the leptin receptor and a decrease in the hormone transport, leading to a disruption of the biological action of leptin. The established level of soluble leptin receptor < 14769 pg/ml, in combination with ultrasound examination, will increase the efficiency of diagnostic measures to detect endometrial hyperplastic processes.

Objective. To study the clinical and laboratory data of patients with viral-bacterial pneumonia caused by SARS-CoV-2, to evaluate the spectrum of bacterial causative agents and their sensitivity to antibacterial drugs.
Materials and methods. 50 cases of viral-bacterial pneumonia associated with the COVID-19 infection were analyzed. The gender-age structure of patients, clinical and laboratory data, degree of disease severity and concomitant diseases were studied. Microbiological examination of sputum and bronchoalveolar lavage (BAL) was performed by bacteriological method using an automatic microbiological analyzer. Identification of the selected cultures and the determination of their sensitivity to antibacterial drugs were provided.
Results. The average age of the patients in the studied group was 71,1 ± 14,8 years. 90% of patients had concomitant diseases, mainly of cardiovascular system. The secondary bacterial infection was diagnosed on 13,0 ± 5,0 day from the disease onset and was characterized by bilateral lung lesions. The most common etiological factors of bacterial pneumonia were the microorganisms of the Enterobacteriaceae family — 37%, Staphylococcus aureus — 23% and Acinetobacter baumannii — 13%. The isolated strains were characterized by drug resistance to aminopenicillins, cephalosporins, fluoroquinolones, aminoglycosides and carbapenems.
Conclusion. The high level of resistance of bacterial pneumonia causative agents isolated from patients with SARS-CoV-2 infection to antimicrobial drugs requires wider use of reserve drugs and implementation of other treatment strategies.

Objective. The aim of this study was to understand the significance of pathogen identification for Urinary tract infection and Helicobacter pylori infection in Diabetes Mellitus Type 1 and Diabetes Mellitus Type 2 patients.
Materials and methods. The study was conducted among 1749 patients with Type 1 and Type 2 Diabetes Mellitus. Using microbiological techniques, the frequency of urinary tract infection was identified and the aetiology and sensitivity of microorganisms to antibacterial drugs were assessed. Data collected on Helicobacter pylori infection were verified through PCR tests on biopsies collected from the gastric mucosa.
Results. The study showed that urinary tract infection has a high incidence rate with 58.3% of cases from Type 1 diabetes mellitus, and in 47.2% of cases from Type 2 diabetes. Pathogens such as Escherichia coli, Staphylococcus saprophyticus, Enterococcus faecalis and Klebsiella pneumoniae were the main causative agents of urinary tract infections. Helicobacter pylori infection was common in DM and more in cases of Type 2 Diabetes Mellitus at 27.1%, compared to cases in Type 1 Diabetes Mellitus at 22.8%. Also 5.9 % cases of Type 2 Diabetes Mellitus had combined Helicobacter pylori and urinary tract infections.
Conclusion. The study showed the significance in identification of urinary tract infections and Helicobacter pylori infections in patients with Type 1 and Type 2 Diabetes Mellitus, and especially significant for Type 2 Diabetes Mellitus patients.

Objective. To study blood cortisol level in patients with diabetic foot syndrome (DFS), to analyze the possibility of using cortisol level as a biochemical criterion of diagnosis and severity of DFS.
Materials and methods. A non-randomized study was performed on 59 patients, who were divided into two groups: patients with the 3rd degree deforming arthritis of the knee joint without a history of diabetes mellitus (DM) and patients with DFS. Venous blood was collected on an empty stomach to determine the levels of cortisol, C-reactive protein, glycated hemoglobin, total protein, and hemoglobin.
Results. Our data demonstrated that the blood cortisol level was statistically significantly higher (p < 0.05) and higher than normal in the experimental group of patients with DFS (701.69 (626.44; 904.63) nmol/L) when compared with the control group of patients with 3rd degree deforming knee joint arthrosis without a history of DM (423.7 (326.5; 516.20) nmol/L). Blood cortisol levels in patients with DFS decreased statistically significantly in 5 days after the treatment and was 382.26 nmol/L. Body mass index (BMI) (r = 0.946; p < 0.01) correlated with blood cortisol levels in patients with type 2 diabetes and with a complication of DFS. In patients with DFS, determination of blood cortisol content has the greatest diagnostic value as a biochemical criterion of DFS compared with other studied parameters (AUC, 0.915; p = 0.037). Cortisol content in patients with DFS gradually increases with the increase in the classification category of the University of Texas.
Conclusion. Determining the level of cortisol in blood can be useful in the diagnosis of DFS, as well as to determine the degree of soft tissue damage of the lower extremities.

Objective. To identify the features of transient hyperglycemia in dynamics in acute coronary heart disease in patients without impaired glycemic metabolism.
Materials and methods. We performed a retrospective analysis of 178 medical records of inpatients with acute forms of coronary heart disease: transmural myocardial infarction (MI), subendocardial MI, unstable angina - initially urgently hospitalized and further treated in the institution “Gomel Regional Clinical Cardiology Center” in 2021-2022. All the patients were examined and treated in accordance with the clinical protocol for the diagnosis and treatment of diseases of the circulatory system [1]. Venous blood glucose level in dynamics was measured at hospitalization during the first hours of the disease not on an empty stomach and then on an empty stomach on the 1st, 2nd, 3rd, 4th and 5th day; according to EchoCG data on the 1st-3rd day included the ejection fraction (EF) and local contractility index (LCI). The patients were divided into groups depending on the disease, blood glucose level at hospital admission (not requiring pharmacological correction 4.1–10.9 mmol/l, requiring pharmacological correction 11 mmol/l and more [1]) and the presence/absence of a rise in blood glucose levels on the first day of hospitalization (the 1st day of the diseases).
Results. Transient hyperglycemia in acute forms of coronary heart disease in patients without impaired glycemic metabolism is most evident with transmural MI, hyperglycemia of more than 11.0 mmol / l occurs in 7% of cases of all transmural MI, of which 28.5% persists on the 1st day, which requires continued pharmacological correction. Relative normalization of glucose at initial glucose values up to 11 mmol/l occurs on the 2nd day, with a tendency in transmural myocardial infarction and glucose levels over 11 mmol/l - on the 3rd day, of MI and an episode of glucose level rise in dynamics — on the 4th day of MI. Transient hyperglycemia with subendocardial MI and unstable angina is not characterized by an increase in glucose more than 11.0 mmol/l, with relative normalization on the 2nd day, while higher glucose levels are observed at admission compared to those with unstable angina.
Conclusion. Transient hyperglycemia over 11 mmol/l in transmural MI in patients without glycemic metabolism disorders in 28.5% of cases remains on the 1st day of MI, which requires continued medication correction of hyperglycemia. Subendocardial MI and unstable angina are not characterized by the occurrence of transient hyperglycemia, requiring pharmacological correction, with relative normalization of the index by 2nd day.

Objective. To study the efficacy of statins in the treatment of morphea in patients with metabolic syndrome and to study the dynamics of inflammatory markers on the background of atorvastatin use.
Materials and methods. Atorvastatin at a dose of 20 mg per day was included in the treatment of patients with morphea asociated with metabolic syndrome. Clinical efficacy was evaluated after 3, 6, and 9–12 months on the basis of the dynamics of the modified localized scleroderma skin severity index mLoSSI, changes of laboratory markers of inflammation (C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha)), which was evaluated in 27 patients.
Results. In patients whose treatment complex included atorvastatin, there was a persistent clinical improvement, which was manifested in a more pronounced decrease in the modified severity index of morphea mLoSSI relative to the control group after 6, 9-12 months of taking the drug, a marked decrease in the number of recurrences of the disease. When taking atorvastatin in patients with morphea with concomitant metabolic syndrome, there was a statistically significant decrease in the levels of inflammatory markers: CRP and TNF-alpha (p < 0.05).
Conclusion. The use of Atorvastatin at a dose of 20 mg per day in patients with limited scleroderma in combination with metabolic syndrome showed pronounced clinical efficacy, reduced the number of recurrences of the disease. There was a decrease in the levels of proinflammatory markers (CRP, TNF-alpha) when taking atorvastatin in patients with morphea associated with metabolic syndrome. The use of atorvastatin in patients with morphea and concomitant metabolic syndrome is effective in preventing relapses of morphea, reducing its severity.

Objective. Compare the effectiveness of systemic and local administration of adipose-derived mesenchymal stem cells (ADMSC) at a dose of 1х106 cells/kg on nociceptive sensitivity to mechanical and thermal stimuli in rats and changes in histostructure of sciatic nerve and surrounded tissues of affected hind paw in experimental model of peripheral neuropathy of sciatic nerve.
Materials and methods. 26 male Wistar rats were used to perform a model of peripheral neuropathy by axotomy of the sciatic nerve. On the 7th day, the experimental animals underwent systemic or local transplantation of ADMSC at a dose of 1x10⁶ cells/kg. Nociceptive responses to mechanical and thermal stimuli were assessed for 90 days, and the histostructure of the sciatic nerve and surrounding tissues was analyzed after systemic and local transplantation of ADMSC.
Results. Systemic administration of ADMSC at a dose of 1x10⁶ cells/kg to rats with sciatic nerve axotomy increased the mechanical withdrawal threshold (MWT) by 17.1% and had no effect on the thermal withdrawal latency (TWL). Local administration of ADMSCs in an equivalent dose contributed to the full recovery of the MWT and TWL by the 21^st day of the experiment, as well as suppressed the inflammatory reaction in the soft tissues of the operated hind paw of experimental animals.
Conclusion. Intramuscular administration of ADMSC into the area of sciatic nerve axotomy of rats was significantly more effective than systemic administration of an equivalent dose of a cell transplant. This method of administration is more appropriate for further studies of the mechanisms of antinociceptive and reparative effects of ADMSCs.

Objective. To study the level of endogenous respiration of the small intestine mucosa of experimental animals after exposure to external irradiation at a dose of 0.5 and 1.0 Gy.
Materials and methods. The study was conducted on white male outbred rats weighing 180-200 g. The animals were irradiated once in the “IGUR-1” unit, 137Cs source, dose rate 0.92 Gy/min. The parameters of tissue respiration were studied by polarographic method using Record-4 device (RF) in a 2 ml cell with a closed platinum Clark electrode at 25°C.
Results. It was shown that changes in respiratory activity over time are non-monotonous. This confirms the high sensitivity of the small intestine to radiation exposure.
Conclusion. The level of endogenous respiration of the small intestine mucosa can be one of the criteria for assessing the energy status of the tissue after irradiation.

Objective. To assess the condition of the microbial-tissue complex of the large intestine when hepatotoxic concentrations of acetaminophen are administrated to the body of animals.
Materials and methods. The experiments were performed on 24 white outbred rats weighing 180–220 g, which were divided into three groups. The control group received 2% starch solution enterally, the first experimental group was enterally administered with acetaminophen in starch solution at a dose of 1500 mg per kilogram of body weight, five times a day with one day interval; and the second experimental group was administered with acetaminophen at a dose of 2500 mg per kilogram of body weight the same way. Free amino acids and their nitrogen-containing metabolites were determined by high-performance liquid chromatography in samples of the microbial-tissue complex (MTC) of the large intestine previously frozen at -70 °C. For microbiological study, the aseptically isolated MTC was immediately sent to a microbiological laboratory for identification of the content of the main representatives of the intestinal microflora. Samples of the wall of the ascending colon were subjected to histological and electron microscopic examination. The hepatotoxic effect of acetaminophen was evaluated by registering the activity of enzymes and the content of total bilirubin in blood plasma.
Results. Enteral administration of hepatotoxic amounts of acetaminophen to rats increases the concentrations of free amino acids and their nitrogen-containing derivatives in the microbial-tissue complex of the large intestine. At the same time, the concentrations of essential amino acids are significantly increased. Morphological changes in the cells of the epithelium of the large intestine and the structure of mitochondria have been shown.
Conclusions. Toxic doses of acetaminophen have a significant impact on the indicators of the microbial-tissue complex of the large intestine. There are changes in biochemical parameters of amino acid metabolism: increased levels of substitutable amino acids and changes in the colonocytes (size and shape of mitochondria, the height of the brush border, the volume of the goblet cells), indicating decreased ability of the cells to use amino acids to support the functioning of the Krebs cycle. This is also confirmed by significantly increased concentrations of essential amino acids, which are mainly used for protein synthesis. The dysbiosis caused by acetaminophen further contributes to the damage to the large intestine. The negative effect of acetaminophen is confirmed by the dose-dependent changes we found in the microbial-tissue complex.

Objective. Conduct a comprehensive assessment of the indicators of screening programs for early detection of breast and cervical cancer in the Gomel region.
Materials and methods. A total of 7,611 first-time detected cases of breast cancer and 1,370 cases of cervical cancer in the Gomel region were analyzed for the period 2012-2022 (according to Belarusian Cancer Registry). The results of examination of 105130 participants of the screening program for early detection of breast cancer and 70258 participants of the screening program for early detection of cervical cancer were analyzed.
Results. During the period 2017-2022, due to screening, 12% of cases of breast cancer were detected from the total number of newly diagnosed malignant breast pathologies. From 2018 to 2022, the proportion of newly detected cases of cervical cancer within the screening program increased from 0.83% to 2.61%, which indicates that the introduction of the screening program contributes to an increase in the detection of precancerous conditions of the cervix.
Conclusions. The screening program for breast cancer and cervical cancer has shown its effectiveness in detecting new cases of malignant neoplasms of these localizations. An important result of the screening conducted in the Gomel region is the fact that the observed trend towards a decrease in the detection of breast cancer and cervical cancer in the early stages does not give any cause for optimism, as this is evidence of a deterioration in the structure of the detected pathology.

Objective. The purpose of the study was to conduct a cross-cultural analysis of the quality of life of medical workers in Belarus and Japan, to assess the similarities and differences, to identify cultural characteristics and factors affecting the quality of life of medical workers of both countries.
Materials and methods. The study was conducted in medical organizations in Gomel, Belarus, where 400 respondents (doctors and nurses) were interviewed and in university clinics in Nagasaki (Japan), where 238 medical workers took part in the survey. The survey was conducted using a validated Russian and English versions of the WHO Brief Questionnaire for Quality of Life (WHOQOL-BREF).
Results. The results of the study showed that Japanese medical workers are less satisfied with their ability to work and the ability to perform their duties compared to Belarusian medical workers (31.0 and 34.0% of respondents in Japan and 68.9 and 62.2% of respondents in Belarus, respectively, p < 0.001). About a third of respondents (31.6% in Belarus, 38.0% in Japan) often experience negative emotions (bad mood, anxiety, despair, depression). 79.0% of respondents in Belarus are satisfied with their personal relationships, while in Japan this indicator was 49.3% (p < 0.001). The percentage of dissatisfaction with their sex life is high among Japanese medical workers (71.9% compared to 21.8% of respondents in Belarus, p < 0.001). 56.6% of Japanese medical workers and 77.2% of Belarusian medical workers are satisfied with the support from friends (p < 0.001). Indicators of psychological health and social relations are higher among respondents who are married. The incidence of medical workers in both countries is very high: from 20 to 30% of respondents report the presence of a disease or health problem.
Conclusion. Medical workers’ assessment of their quality of life depends largely on the different ways of life in the two countries, the peculiarities of the health care system, the general standard of living of the population, and other factors. However, as the survey showed, statistically these differences in the assessment of the quality of life are insignificant.

Objective. To evaluate the economic efficiency of the photocatalytic method of oxidation of organic substances in the framework of laboratory analysis.
Materials and methods. Standard statistical methods
Results. The high economic feasibility of using photocatalysis to determine chemical oxygen demand (COD) has been demonstrated.
Conclusion. The use of the photocatalytic method for determining COD seems economically justified and promising.

Erratum

Objective. Define the concept of “informed voluntary consent”. To develop ethical recommendations and legal standards for the registration of consent and refusal of the patient in relation to medical intervention.
Materials and methods. To achieve this goal, we conducted a content analysis of domestic and foreign literature, as well as regulatory legal acts of the Republic of Belarus devoted to this issue.
Results. The definition of the concept of “informed voluntary consent” is given. Ethical recommendations and legal standards for the registration of the patient’s consent and refusal regarding medical intervention have been developed.
Conclusion. Compliance by medical professionals with ethical recommendations and legal standards will significantly mitigate the risks of conflict situations and avoid their consequences.

This article describes a clinical case of the course and management of pregnancy complicated by cervical insufficiency with prolapse of the fetal bladder and formation of “sludge” in the amniotic fluid at 20–21 weeks of pregnancy. Gradual use of antibacterial therapy and hormonal support with micronized progesterone, subsequent surgical serclage and the installation of an unloading obstetric pessary allowed to prolong pregnancy to 284 days and to deliver through the natural birth canal with a newborn without signs of intrauterine infection.

Autoimmune liver disease is a heterogeneous group of diseases in which the body’s immune cells and antibodies are directed against its own components of the liver tissue. The main diseases from this group are: autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis. Most often there are classical monovariants of the disease, but in some cases, manifestations of two forms from the autoimmune liver disease are observed at once. The term “overlap syndrome” is used to describe such conditions. The article presents a clinical case of a combination of PBC and AIH, one of the most common overlapping syndromes in practice. Most often there are classical monovariants of the disease, but in some cases there are manifestations of two forms of autoimmune liver diseases. Overlap syndrome is a term used to describe these conditions. This article presents a clinical case of a combination of PBC and AIH, one of the most common cross-linked syndromes in practice.

Objective. To present a clinical case of diagnosis and surgical treatment of one of the forms of extragenital endometriosis – umbilical ring endometriosis.
Materials and methods. A clinical case of patient M., 33 years old, female, with diagnosed and operated endometrial heterotopia in the projection of the soft tissues of the umbilical region.
Results. The probable role of the migration theory of the pathogenesis of endometriosis is demonstrated due to the lack of a history of surgical treatment in this area.
Conclusion. The migration theory of the pathogenesis of endometriosis can be explained by the mechanism of retrograde penetration of endometrial cells through blood and/or lymphatic vessels from the pelvic cavity.

Acromegaly is a neuroendocrine disease with diverse clinical manifestations that develop over a long period. In the process of examining a patient, it may be necessary to conduct a differential diagnosis of acromegaly with various syndromes and conditions, including such a rare disease as pachydermoperiostosis. Features of the clinical presentation and diagnosis are given in the description of a clinical case from our practice.