This review is devoted to the analysis of the literature containing experimental and clinical data on radiation-induced changes in connective tissue and its cellular component to create an overall picture of the leading mechanisms of radiation fibrosis development.
The review analyzed publications for the period 1995-2022, presented in three academic databases: Scopus, PubMed and Web of Science. In the search process, various combinations of logical operators (or, and, not) were used to combine search keywords (ionizing radiation, connective tissue, fibroblasts) to find relevant studies in academic databases. The development of radiation fibrosis is determined by radiation-induced changes in the properties and functions of fibroblasts. The article discusses the main biological effects of irradiation of fibroblastic cells with X-ray, gamma and alpha radiation, presents the mechanisms of radiation-induced differentiation in the fibroblast/myofibroblast system, and also notes the role of connective tissue microenvironment and oxidative stress associated with mitochondria in this process. The main experimentally established effects presented in the review and the general scheme of the mechanisms of non-lethal action of ionizing radiation on fibroblasts contribute to a better understanding of the mechanisms of radiation-induced fibrosis development

Objective. To evaluate the levels of interleukins (IL) -1β, -2, -6, -8 in the blood serum of patients with wounds, depending on the clinical and microbiological characteristics of the wound process.
Materials and methods. The evaluation of IL-1ß, IL-2, IL-6, IL-8 indices in the blood serum of 206 patients with wounds was carried out. When analyzing changes in IL, the clinical and microbiological characteristics of the wound process were taken into account.
Results. Changes in the levels of IL-1ß, IL-2, IL-6 and IL-8 in the blood of patients with wounds are determined by the duration of the wound process, the presence of clinical signs of inflammation and the presence of microorganisms in the wound. The absence of a systemic response to the presence of potential pathogens (S. aureus) in an acute wound, when IL levels do not exceed 10 pg/ml, can serve as an additional criterion for contamination with minimal wound life (up to 4 days). Preservation of high values of IL-8 from 38.16 pg/ml (33.31; 42.11), no changes in IL-2 (no more than 2.23 pg/ml (1.41; 4.01)) in the blood of patients with wounds which duration exceeds 22 days is a sign of a violation of the healing process and the formation of a chronic wound. The level of IL-6 is recommended as an additional criterion determining the progression of the infectious process in patients with wounds, when an increase in IL-6 values is recorded from 18.79 pg/ml (15.71; 23.01) at critical colonization to 51.65 pg/ml (35.19; 51.95) at the stage of wound infection. IL-6 values of no more than 10 pg/ml indicate the absence of an active inflammatory process.
Conclusion. The levels of proinfl ammatory interleukins in the blood of patients can serve as additional laboratory criteria determining the disruption of wound healing and progression of the wound infection process.

Objective. To evaluate the parameters of sarcopenia (SP) and the factors affecting them in patients with diabetes mellitus (DM).
Materials and methods. A study of 87 hospitalized patients with DM (29 men — 33% and 58 women — 67%) aged 21 to 61 years was conducted. The study included the determination of clinical and laboratory parameters, including anthropometric data, laboratory parameters, determination of sarcopenia parameters (muscle mass, muscle strength, muscle function), ultrasound examination of skeletal muscles.
Results. A decrease in muscle mass was observed in 11% of patients with DM and depends on the composition of the body. A decrease in muscle function was observed in 30% of patients with DM and depends on the patient’s age (over 41 years; AUS — 0.826; p < 0.001) and the degree of excess body weight (in 87% of patients, BMI is more than 30 kg/m2). A decrease in muscle strength was noted in 44% of patients and depends on the severity of diabetic neuropathy (more than 1 point according to the results of the NDSm scale; AUS — 0.876; p < 0.001). The circumference of the lower leg is positively correlated with the thickness of the intermediate broad thigh muscle (rs = 0.44; p < 0.05) and the thickness of the musculoskeletal fold (rs = 0.70; p < 0.05), determined by ultrasound technique.
Conclusion. The probability of SP was noted in 44% of patients with DM and depends on the length of DM and the severity of diabetic neuropathy. Muscle function is reduced in 30% of patients with DM and is associated with the patient’s age and overweight. A decrease in muscle mass was observed in 11% of patients with DM and depends on the composition of the body. The thickness of the intermediate broad thigh muscle and the thickness of the musculoskeletal fold at the hip level (according to ultrasound results) are significantly interrelated with muscle mass.

Objective. To conduct an analytical assessment of the pattern of congenital malformations in newborns born in 2017 and 2021 in a hospital-based healthcare organization, taking into account the anamnesis of mothers as a possible cause of the formation of a malformation in the fetus.
Materials and methods. A retrospective analysis of 90 developmental histories of newborns delivered between January and December 2017 (first group) and 100 histories of newborns born between January and December 2021 (second group) in the maternity hospital of the Gomel Regional Clinical Hospital was conducted.
Results. The leading place among congenital malformations (CM) in the studied two groups is occupied by congenital heart defects (CHD) and defects of the urinary system. In the group of newborns with CM delivered in 2017, boys (60%) prevailed, in 2021 — girls (58%). Mothers of the children from the first comparison group were more likely to live in cities (77.7%). When analyzing the extragenital pathology of mothers, data were obtained that the mothers of the children of the first study group most often suffered from cardiovascular, endocrine diseases, diseases of the urinary system. In mothers of the children of the second comparison group, concomitant chronic diseases came out on top. The structure of maternal diseases during pregnancy is diverse, but the only statistically significant indicator was COVID-19 infection, which affected the mothers during pregnancy in 2021. The data on the diagnosis of CM in the fetus by ultrasound examination of a pregnant woman are statistically insignificant, it is impossible to draw a conclusion about the improvement or deterioration of the quality of early diagnosis of CM. The percentage of diagnosis of CM prenatally in 2017 and 2021 was 33.3 and 40%, respectively.
Among CHD in percentage, the leading place in both groups is occupied by a defect of the interventricular septum ― 67.7 and 51%. In the structure of defects of the urinary system, a statistically significant defect is kidney dystopia in 2021 (28%). When analyzing malformations of the musculoskeletal system, all indicators were statistically insignificant. Conclusion. As a result of the analysis, it was found that the stable leadership among the CM belongs to the CHD and the CM of the urinary system. The frequency of diagnosis of CM in the fetus by ultrasound examination of pregnant women remains at a fairly low level. Chronic diseases of mother, diseases of the cardiovascular system, endocrine and urinary system, COVID-19 suffered by mother during pregnancy may be a possible cause of the formation of CM in the fetus.

Objective. To obtain data on the comparative characteristics of traditional and improved methods of hemostasis for the middle rectal artery (MRA).
Materials and methods. The material for the sectional study was 206 corpses of men (the age of the deceased was from 22 to 82 years, the average age was 57 years) and 113 corpses of women (the age of the deceased was from 32 to 93 years, the average age was 63 years). To achieve the purpose of the study, the following methods were used: vascular injection, dissection, statistical processing. 85 patients of both sexes aged from 57 to 75 years were selected to conduct the clinical part of the study at Gomel Regional Specialized Clinical Hospital. Among them, 50 people were in the comparison group and 35 people were in the main group. All patients were diagnosed with stage I or II rectal cancer. The operative technique for performing hemostasis on the MRA during anterior rectal resection in the comparison group included sequential ligation and stitching between the clamps first of the distal third of the length of this artery, and then its proximal third. In the main group, the method of hemostasis for MRA was supplemented by ligation and stitching of this vessel in the middle third of its length. Statistical data processing included parametric and nonparametric methods of comparative analysis.
Results. On cadaveric material, it was found that most of the extraorgan anastomoses of the MRA both in men and women have been localized in the middle third of this artery. The results obtained during the clinical study demonstrate the superiority of the improved hemostasis method for MRA over the traditional method. The proposed method includes additional ligation and stitching of the middle third of the MRA.
Conclusion. The improved hemostasis method for MRA in anterior rectal resection is highly effective, which makes it possible to recommend it as the method of choice in the surgical treatment of upper ampullary rectal cancer of stage I or II. 

Objective. To analyze locoregional relapses (LRR) after reconstructive plastic and organ-preserving operations in breast cancer (BC)
Materials and methods. A retrospective analysis of the results of the treatment of 303 patients with BC who underwent reconstructive plastic and organ-preserving operations in the period from 2014 to 2019 in the Oncological Department of General Oncology and Rehabilitation of Gomel Regional Clinical Oncological Dispensary was carried out. The median age was 44 years (25-70 years). Statistical data processing was carried out using the application software package “Statistica”, 10.0. To characterize the surveyed groups, a standard methodological approach based on the calculation of descriptive statistics data was used. In order to statistically assess the relationship between the frequency of relapses depending on the stage and the molecular biological type of neoplasm, the Spearman correlation coeffi cient was used. The accepted level of statistical signifi cance (p) was 0.05.
Results. Locoregional relapses were recorded in 11 (3.6%) patients, of which local — in 8 (2.6%), regional — in 3 (1.0%). The minimum period of development of LRR was 15 months, the maximum was 74 months; the median period of occurrence of LRR was 47 months. Depending on the stage of breast cancer, relapses developed: at stage I — in 4 (3.7%) cases, II — 5 (3.5%), III — 2 (4.2%). Depending on the molecular biological subtype of the neoplasm, LRR were distributed as follows: with luminal A — 1 (1.3%) case, luminal In HER2-negative — 1 (0.9%), luminal In HER2-positive — 6 (9.7%), non-luminal HER2-positive 1 (6.3%), three times negative — 2 (5.6%). Discordance of the receptor status was detected in 8 (72.7%) patients with recurrent tumor, most often due to the loss or decrease in the number of progesterone receptors (PR). The level of tumor-infi ltrating lymphocytes (TILs) in primary neoplasm ranged from 4 to 12%, in recurrent tumors it remained low: 5-10%.
Conclusion. Given the heterogeneity of BC, the risk of developing LRR depends on many factors. LRR developed in luminal HER2-positive cancer in 9.7% of cases (p 0.05), stage III breast cancer — 4.2% (p 0.05). One of the important predictive factors is the evaluation of TILs. We noted a low level of TILs in both primary and recurrent tumors. There is a high discordance in the receptor status — 72.7%, which is important to take into account when prescribing systemic therapy.

Objective. To identify and evaluate immunological features in immunocompetent patients with acute cytomegalovirus infection (CMVI).
Materials and methods. Thirty-three immunocompetent adult patients with acute cytomegalovirus infection were included in the study; 4 of them had thrombotic complications. The control group consisted of 10 healthy donors. All 33 blood samples were tested by flow cytometry. The content of antigen-specific cells was checked in all patients. Results. All patients had positive cytomegalovirus DNA PCR tests. The content of activated T cells in patients with acute CMV infection and thrombotic complications is 7.7 times higher (p < 0.001) than in conditionally healthy patients (median values: 36.02% (31.01; 47.92) and 4.68% (3.39; 5.25), respectively). The content of granulocytic myeloid suppressor cells (G-MLSC) in patients with acute CMV infection and thrombosis exceeds the same indicator in the group of healthy volunteers by 8.3 times (p < 0.001) (median values were 0.38% (0.24; 0.54) and 0.05% (0.03; 0.07) respectively). The number of regulatory T cells in patients with acute CMV infection and thrombosis was reduced by 3.1 times (p < 0.001) compared to the same indicator in the group of healthy volunteers (median indicators: 0.79% (0.57; 1.09) and 2.45% (2.01; 3.86), respectively). Immunophenotyping of CD3+ cells showed a tendency to increase the proportion of more mature cells, namely effector memory cells (TEM) and terminally differentiated memory cells (TEM RA) with a decrease in the percentage of “naive” cells.
Conclusion. A high level of antigen-specific T-cell response and a low content of T-regulatory cells may indicate insufficient control of the proliferation of T-cytotoxic lymphocytes, which may contribute to the long-term persistence of the virus and the development of chronic inflammation of the vessel wall, which requires further study. Thus, in patients with acute CMV infection, an additional risk factor for thrombosis appears, which must be taken into account when carrying out therapeutic and diagnostic measures.

Objective. To give a clinical assessment and conduct a comparative analysis of the frequency of postoperative complications in patients with free and strangulated hernias of various localizations after tension-free hernioplasty using synthetic implants.
Materials and methods. A retrospective analysis of 965 medical records of inpatient patients who underwent tension-free hernioplasty for hernias of various localizations in the period from 2018 to 2022 was carried out. The results of the study were processed using applied statistics using MS Excel and a software package for statistical analysis “Statistica v. 10.0”. Statistically significant differences were considered at p < 0.05.
Results. The study revealed that in the postoperative period after tension-free hernioplasty in patients with strangulated hernias, the complication rate was 15.8%. At the same time, the frequency of complications was higher after “onlay” hernioplasty in patients with strangulated hernias than in patients with free hernias. The frequency of postoperative complications in patients with impaired postoperative ventral hernias is 8.3 times higher than in patients with free postoperative ventral hernias. In the postoperative period, complications such as seroma and infiltration of the postoperative wound were detected in 10.5 and 5.2% of cases in patients with strangulated hernias. The duration of inpatient treatment for patients with complications after hernioplasty is 2.6 times longer compared to patients without complications (p < 0,05).
Conclusion. In the postoperative period, in patients with strangulated hernias, the incidence of complications was observed in 15.8% of cases, and in patients with free and irreducible hernias in 1.5% of cases. Clinically, such postoperative complications as seromas, infiltrates of the postoperative wound, ligature fistulas, scrotal hematoma, orchitis, abscess of the postoperative wound were identified.

Objective. To analyze the structure and frequency of kidney pathology in liver cirrhosis according to sectional analysis and to study the relationship between acute renal injury and urinary tract infection.
Materials and methods. The design of the study is mixed: descriptive and analytical, which included conducting a retrospective case–control study of kidney pathology based on the results of the protocols of pathoanatomical autopsies on the basis of the state healthcare institution “Gomel Regional Clinical Pathoanatomical Bureau” for the period of January 2022 – July 2023 and clinical, laboratory, instrumental, cytological, microbiological data of patients with liver cirrhosis. The study included 98 deceased patients, including 70 (71.4%) men, 28 (28.6%) women. The average age was 53.9 years, the majority of patients were persons of working age — 72.9% of men and 60.7% of women, 21.4% were young people.
Results. The most common kidney pathology in liver cirrhosis according to sectional analysis is acute renal injury (57.1%). Kidney abscesses (3%), tubulointerstitial nephritis (2%) and pyelonephritis (4%) were less frequently diagnosed. Despite the absence of a history of kidney diseases in most patients with cirrhosis, classical clinical, laboratory and instrumental signs of renal tissue damage, macroscopic and microscopic changes of the kidneys were revealed in 100% of cases at autopsy. In 84.7% of cases, acute tubular necrosis was morphologically diagnosed from focal (51%) to total (19.4%), which was not always accompanied by an increase in serum creatinine levels. A moderate relationship was established between acute kidney injury and urinary tract infection (OR = 14; 95 % CI 11.13–16.61).
Conclusion. The most common complication of liver cirrhosis associated with an unfavorable prognosis is acute renal injury, which is associated with the presence of urinary tract infection.

Objective. To determine the predictors of an unfavorable outcome in patients with severe pneumonia against the background of COVID-19 infection.
Materials and methods. A retrospective analysis of the case histories of deceased patients (control group, n = 40) for January 2021 (a continuous sample — 15.01.21–31.01.21) and surviving patients for the same period (n = 40) with a confirmed PCR diagnosis of coronavirus infection, who were on inpatient treatment at the state healthcare institution “Gomel City Clinical Hospital No. 3” (SHI “GCCH №3”) in Gomel. The Ethical Committee of SHI “GCCH №3” found no violations contradicting ethics and morality in conducting the study. Treatment of patients, assessment of the severity of the condition were carried out according to modern protocols for the diagnosis and treatment of COVID-19 infection, approved by the Ministry of Health of the Republic of Belarus (No. 1195 of 11.11.2020). The group of surviving patients was represented by 11 men and 29 women versus 24 men and 16 women in the control group (p < 0.05).
According to computed tomography of chest organs (CT CO), all 80 patients had signs of bilateral viral pneumonia characteristic of COVID-19. When processing and describing CT data, a semi-quantitative scale was used to estimate the volume of infiltration and consolidation zones of the lungs, recommended by temporary protocols. The total volume of lung damage in COVID-19 infection (“frosted glasses”, “cobblestone pavement”, “consolidation sites”) was > 55% in both groups, p > 0.05. CT CO was performed on Somatom Emotion 6 (Siemens) with a spiral type of scanning.
Patients of both groups were comparable in age, concomitant comorbid pathology: coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus (DM), etc., however, they had differences in gender (the proportion of males prevailed in the group of deceased). A feature of the study was a solid sample among deceased patients. Taking into account the group differences by gender, in this study, an additional comparison of the results by gender was carried out. Results. The course of COVID-19 infection at the stationary stage is characterized by large-scale negative clinical dynamics, fever, “explosion” of acute phase indicators, thrombosis, distress syndrome with a drop in saturation and unfavorable outcomes. The indicators obtained using the NEWS-2, SHOCK-COVID scales (scales for predicting the severity of the clinical course of coronavirus infection) in severe patients, although they indicate a worsening of the patient’s clinical condition, but rather late, when the “cytokine storm”, powerful inflammation, thrombosis, significant damage to lung tissue already dominate among clinical syndromes, the decrease in saturation and the effectiveness of drug therapy is significantly limited.
Conclusion. According to the results of the study, it is recommended to divide patients into groups of moderate and high risk of adverse outcome based on clinical, instrumental, laboratory data in dynamics. In patients with moderate risk, protocol therapy in most cases is sufficient to stabilize the general condition. In patients with an unfavorable outcome, this therapy does not restrain the growth of lung tissue damage with negative clinical, laboratory dynamics, which requires additional decisions, changes in the doses of drug therapy to prevent fatal outcomes.

Objective. To assess the possibility of using platelet-associated NETosis parameters to monitor inflammatory activity in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Materials and methods. 50 patients with RA and 29 patients with SLE were examined. The parameters of early and late platelet-associated NETosis were assessed in autologous mixed cultures containing a leukocyte suspension and intact and ADP-stimulated platelets.
Results. In patients with RA and SLE in the acute stage, rates of platelet-associated NETosis were increased compared to healthy individuals (p = 0,00001-0,001). During the period of clinical remission, NETosis parameters decreased in comparison with the exacerbation stage (NET-Рst: p=0,017-0,04), in some cases reaching control values. Based on regression analysis, threshold values for platelet-associated NETosis parameters were determined to assess the activity of the inflammatory process in patients with RA and SLE.
Conclusion. Parameters of platelet-associated NETosis are informative laboratory markers of the inflammatory process in patients with RA and SLE.

Objective. By the means of atomic force microscopy to determine the changes in the parameters of the structural and mechanical properties of peripheral blood lymphocytes induced by the irradiation of whole blood by X-rays and identifying the possibility of assessing a state and radiation-induced lymphocyte death programs by analyzing a set of such parameters.
Materials and methods. Whole blood of rats and humans was irradiated with X-rays (1–100 Gy) in vitro. Lymphocytes were isolated from the blood after a day of storage, placed on glass slides, fixed with glutaraldehyde and dried. The study of structural and mechanical properties was carried out with the help of atomic force microscope Bruker Bioscope Resolve in Peak Force QNM mode in air. For the sets of AFM parameters, which included elastic modulus, adhesion force, cell surface roughness and cell sizes, a k-mean clustering of data was carried out for the studied experimental groups.
Results. The X-ray irradiation of the blood caused changes in the structural and mechanical properties of lymphocytes measured by AFM at the nanoscale. Clustering analysis of the sets of AFM parameters revealed clusters with similar structure in each experimental group (humans, 6and 16-month rats). The studied four clusters were associated with cell states and cell death programs: non-activated cells, activated cells with increased stiffness, apoptotic cells with reduced stiffness, and cells dying via programs other than apoptotic ones with increased stiffness. Each cluster (cell type) with a specific set of AFM parameters was represented differently in the blood lymphocyte population, depending on the dose of X-rays.
Conclusion. The set of ACM parameters of lymphocytes including elastic modulus, adhesion force, roughness, and cell sizes, can be helpful for automatically determining the state and death program of lymphocytes after the local irradiation of humans with the involvement of peripheral blood (for example, after radio-therapeutic causes).

Objective. To assess the hemostatic potential, preclinical safety and in vitro efficacy of lyophilized plasma in patients and blood donors.
Materials and methods. The study of acute toxicity was carried out on outbred mice of both sexes (n=120), pyrogenicity – on rabbits of both sexes (n=30), abnormal toxicity – on mice (n=25) and guinea pigs (n=6). Histopathological studies were carried out on preparations of five fragments of the middle part of the mouse tail after intravenous administration of the maximum dose (4500 mg/kg) lyophilized plasma (LP), physiological solution, fresh frozen plasma (FFP) and pathogen-reduced FFP (PRFFP) using the Intercept system. The proand anticoagulant activity was investigated by clotting and chromogenic method to evaluate the hemostatic potential of PL. The effect on hemostasis was studied in vitro by thromboelastometry when FFP and LP were added to blood samples of patients (n = 23) and donors (n = 20). Results. Acute toxicity study showed the absence of death and clinical signs of intoxication in all series. On the 14th day, body weight gain was observed in animals of all series. Regardless of the used LP dosage, no development of effusion and adhesions in the thoracic and abdominal cavities, as well as macroscopically detectable pathologic changes of the main organs were observed in animals. The analysis of the relative weight of internal organs of animals did not reveal statistically significant differences in experimental and control series relative to the values of similar indicators in intact animals. The studied hemostatic potential showed that LP was not inferior to PRFFP in the content of coagulation factors of the blood system. Evaluation of the effect of LP application in vitro in female patients showed statistically significant correction of CT (clotting time) index, which indicates the effectiveness of its application for replenishment of blood coagulation factors (BCF).
Conclusion. Preclinical animal studies of LP have proven its safety and efficacy compared to FFP.

Objective. To conduct a clinical and molecular genetic study of two cases of acute hepatitis E in pregnant women from Belarus.
Materials and methods. A total of 227 pregnant women with clinical symptoms of liver damage were included in the study. Blood serum samples were used for detection of antibodies to hepatitis E virus by enzyme-linked immunosorbent assay, virus nucleic acid was detected from fecal samples by reverse transcription nested polymerase chain reaction. The nucleotide sequence was determined on an automated sequencer using the Sanger method. Nucleotide sequences were analyzed, genotyped and evolutionary distances calculated using MEGA X software.
Results. Out of 227 sera tested, immunoglobulins of class G to hepatitis E virus were detected in 15, which is 6.61%. M immunoglobulins were also detected in the blood of six pregnant women, which is 2.6%. Two clinically evident cases of acute hepatitis E were identified. One of the two patients ended her pregnancy with antenatal fetal death. Virus nucleic acid was isolated from another woman diagnosed with hepatitis E, who had an episode of nutritional contact with raw minced pork. The virus RNA sequence isolated from this patient’s body is clustered into a common phylogenetic branch with the sequence obtained from the body of a patient from Belarus with a history of kidney transplantation and sequences isolated from the body of a domestic pig in the Republic of Belarus.
Conclusion. Hepatitis E virus poses a significant threat to pregnant women. A set of preventive measures against hepatitis E in pregnant women has been proposed.

Objective. To analyze the dynamics of COVID-19 coronavirus infection incidence in patients with chronic heart failure (CHF) on the background of vaccination against SARS-CoV-2 virus, to evaluate the role of vaccination in preventing decompensation of chronic heart failure, reducing mortality, primary disability in patients with cardiovascular diseases complicated by CHF.
Materials and methods. The study included 200 people who were included in the Register of patients with CHF of the State Healthcare Institution “Gomel City Clinical Polyclinic No. 5 named after S. V. Golukhova”. Patients were divided into two equal in number groups: Group 1 unvaccinated against COVID-19 coronavirus infection (n = 100) and Group 2 vaccinated patients (n = 100). The follow-up was conducted for one year (2021) in an outpatient setting.
Results. The incidence rate in the group of unvaccinated patients was 3.2 times higher. The incidences of COVID-19 coronavirus infection in the two groups were 16 (16 %) and 5 (5 %), respectively (χ2 = 5.32, p = 0.0210). The incidence of hospitalization for decompensation of CHF was 3.2 times higher in the unvaccinated group than in the vaccinated group (χ2 = 14.93, p = 0.0001). Lethality among the unvaccinated was recorded 1.8 times higher than in the vaccinated group (χ2 = 2.166, p = 0.1410). When comparing the rates of primary disability due to CVD, there was a tendency for increased disability in the unvaccinated cohort (χ2 = 0.592, p = 0.4420).
Conclusion. It has been established that vvaccination contributes to the reduction of hospitalization for decompensation of CHF, reducing the risk of mortality.

Objective. To evaluate the role of medical and organizational measures in improving the quality of early detection and medical examination of autoimmune thyroiditis in the population of the Republic of Belarus.
Materials and methods. The data of population statistics and the State register of persons affected by the Chernobyl catastrophe and other accidents on cases of thyroid pathology, as well as outpatient records of patients were analyzed. Epidemiological, statistical and sociological methods were used.
Results. It was noted that different clinical and laboratory variants of autoimmune thyroiditis (AIT) are encountered in clinical practice. Subclinical AIT with sonographic signs of the disease but without diagnostic concentrations of antibodies to thyroid peroxidase (AB/TPO) and disturbances of its function is registered in 14.1 (6.0-24.4) %. AIT with diagnostic concentrations of autoantibodies to AB/TPO, with preserved thyroid function or hypothyroidism occurs in 22.5 (13.534.0) % of the cohort subjects. The frequency of combining AIT with nodular neoplasms of the thyroid increased by the 4th stage of screening and reached 20.7 (11.2-33.4) %.
The reasons for different approaches to diagnosis were analyzed and measures to improve organizational and medical measures for early detection and dispensary treatment of patients with AIT were proposed: groups of persons at high risk of AIT and primary hypothyroidism (PHT) were identified, an algorithm for early detection and dispensary treatment was developed, etc.
Conclusion. When making a decision to improve the quality of medical care to the population of the Republic of Belarus on early detection and medical examination of patients with AIT, it is necessary to take into account the timeliness of thyroid status studies in the population, compliance with the terms of dynamic observation for persons at high risk of AIT and PHT development, peculiarities of clinical and laboratory variants of AIT course.

Objective. To identify the features of medical university students’ professional value orientations.
Material and methods. Methods of theoretical analysis of philosophical, psychological and pedagogical literature on the research problem were used; G. E. Leevik’s questionnaire “Value orientations of personality 8” (VOP-8); methods of statistical analysis of empirical data (generalization and grouping of data, Spearman’s rank correlation method).
Results. The analysis of professional value orientations of junior medical university students showed that the participants of the study are characterized, first of all, by such value orientations as labor and material values, the desire to be financially secure, a good specialist, to have a vast professional experience, to improve themselves in the profession. At the same time, there is an underestimation of the importance of moral and moral qualities of effective professional communication of a doctor.
Conclusion. To ensure high quality of professional medical education it is important to form in students value orientations and professionally important qualities, which are necessary for successful professional activity and effective communication with patients, their relatives, colleagues and administration of medical institution.

The article presents a clinical case of yersiniosis with fever of unclear genesis. For early diagnosis of yersiniosis, its adequate therapy and prevention of complications, it is necessary to take into account the dynamics of clinical manifes- tations and timely conduct specific diagnosis of the disease. Late diagnosis may be associated with the lack of vigilance of doctors with regard to this infection.

Objective. To study the primary resistance of Helicobacter pylori (H. pylori) to levofloxacin in residents of Gomel region by real-time polymerase chain reaction (RT PCR).
Materials and methods. The study included 170 patients diagnosed with gastritis and duodenitis, K29, median age - years (25% and 75% 37 and 61 years). According to the questionnaire data of the patients, eradication therapy with levofloxacin was not performed for them. To determine the resistance of H. pylori to levofloxacin we used RT PCR. Results. Out of 170 DNA samples analyzed, 8 samples had doubtful results and according to the methodology for recording the results are subject to rearrangement from the DNA isolation stage. The remaining 162 samples were positive for the β-actin gene (internal control sample ICS) and were taken into account in further analysis (Ct, CY5 19.6-27.4). 16sRNA gene DNA (Ct, ROX 19.5-30.04), indicative of bacterial infection, was confirmed in 152 samples (93.8%). DNA of the gyrA gene (point mutations A259T, T261C, G261A, G271A, G271T and A272G) was detected in 19 of 152 DNA samples, and H. pylori resistance to levofloxacin was 12.5 %, (Ct, Hex 23.2-30.7). The positive control samples had characteristic curve growth on the corresponding detection channels, while the negative samples showed no curve growth.
Conclusion. Primary resistance of H. pylori to levofloxacin in residents of Gomel region amounted to 12.5%. Mutations of gyrA gene are the most sensitive marker for predicting successful eradication when using fluoroquinolones, in particular levofloxacin. RT PCR is a reliable method of mutation detection and allows simultaneous detection of H. pylori DNA and resistance to levofloxacin, which significantly reduces the study time.