The relevance of the problem of recurrent urogenital infection is determined by its highest prevalence in the structure of gynecological morbidity. At present, the proportion of diseases of the lower genital tract associated with a quantitative imbalance of opportunistic pathogens of the vagina of a bacterial nature continues to increase.

The author systematized conceptually new knowledge on pathogenetic features of bacterial vaginosis in women of reproductive age, current methods of clinical and laboratory diagnosis of recurrent bacterial vaginosis, modern effective methods for the treatment, proposed by both domestic and foreign experts and used to prevent complications and prevent recurrence.

The article provides a historical background of the etiopathogenesis, approaches to diagnosis and surgical treatment of pectus excavatum (PE). Foreign and domestic literary sources on morphological changes in the chest and the functional state of internal organs in patients with intracranial hypertension and correlations with diseases of other organs and systems were studied. Data on diagnostics and treatment tactics for PE are summarized and systematized.

Objective. Systematization of data and analysis of the diagnostic effectiveness of ultrasound elastography for mononeuropathies of the lower limb girdle and free part of the lower limb.

Materials and methods. Publications in the PubMed, EMBASE and Web of Science systems were analysed thoroughly, describing cases of the use of imaging methods in patients with mononeuropathy of the lower limb girdle and free part of the lower limb.

Results. The most promising for implementation in wide clinical practice ultrasound elastography techniques have been identified. The use of them can, if refined, provide early diagnosis of mononeuropathies of the lower limb girdle and the free part of the lower limb.

Conclusion. The use of ultrasound elastography for the diagnosis of mononeuropathy of the lower limb girdle and free part of the lower limb is hampered by the lack of clear ideas regarding the reference values of stiffness indices (kPa, m/s) for specific peripheral nerves and the possible influence of artifacts from bones and other adjacent tissues on these stiffness indices. In addition, there is no clear algorithm for choosing an ultrasound elastography technique, depending on the location and cross-section of the nerve. Solving these issues will allow optimizing the use of ultrasound elastography for the diagnosis of mononeuropathies of the lower limb girdle and the free part of the lower limb.

Objective. Determination of the dynamics of hemoglobin and hematocrit concentrations in blood, assessment of interrelation between these indicators and blood loss in patients undergoing open-heart surgery using artificial circulation.

Materials and methods. A group of 67 patients requiring open-heart surgery using artificial circulation was formed. Each patient was assessed for the dynamics of hemoglobin and hematocrit concentrations in the analysis of the acid-base state of arterial blood at 7 stages of hospital treatment.

Results. The dynamics of changes in the content of hemoglobin and erythrocytes were assessed, the volume of blood loss and the presence of correlation of the studied parameters were determined.

Conclusion. During open-heart surgery with cardiopulmonary bypass, a decrease in hemoglobin and hematocrit occurs. A correlation was found between hemoglobin concentration during the operation of infrared cardiopulmonary bypass apparatus and the volume of perioperative blood loss.

Objective. To analyze cosmetic results in reconstruction of defects in the distal anatomical parts of the nose.

Materials and methods. The results of 103 reconstructions in patients with acquired defects of the external nose with loss of distal anatomical parts were studied. The evaluation of cosmetic results was performed using a 5-point scale of the NAFEQ (Nasal Appearance and Function Evaluation Questionnaire). Complication rate and assessments in groups with median and lateral localization of the defect (33 and 70 patients, respectively) depending on the method of reconstruction were compared.

Results. Complication rate in the reconstruction of median defects (4 cases, 12.1%) and lateral defects (2 cases, 2.9%) did not have a statistically significant difference (Fisher’s exact two-tailed test, p=0.066). With median defects, a decrease in assessment of cosmetic results was more often noted in indications of “nasal tip”, “nasal alar”, and “nasal back”; with lateral defects – “nostril size”, “nasal alar”, “nasal back”. The estimates of the tip and back of the nose were statistically significantly higher after the reconstruction of lateral defects than median ones, p=0.004 and p<0.001, respectively. There was no statistically significant difference between the groups in the estimates of the nasal alar and the nostril size. The indicator “total appearance of the nose” did not have a statistically significant difference in the groups, p=0.129. The results for the indicators “nostrilя size”, “color of the outer nose”, “total appearance of the nose” were statistically significantly higher when using a puzzle flap compared with alternative methods. The estimates of the “nasal tip” index were statistically significantly higher following reconstruction with a frontal flap compared with nasal flaps.

Conclusion. The complication rate in the reconstruction of the distal subunits of the nose was 5.8% and had no difference in the median and lateral localizations of the defect. Cosmetic results differed when assessed by individual measures. The assessment of the total appearance of the nose had no significant difference in the median and lateral localizations of the defect. The use of a puzzle flap and a forehead flap presented better results for the particular subunits.

Objective. To evaluate morphological changes in the bladder mucosa against the background of vaginal ectopia of the external urethral orifice and/or urethral hypermobility in women, efficacy and safety of transposition of the external urethral orifice as a method of surgical treatment of postcoital cystitis.

Materials and methods. The study group included 29 patients undergoing surgical treatment for chronic recurrent postcoital cystitis in the form of transposition of the external orifice of the urethra according to B.K. Komiakov. Before surgical treatment, all studied patients underwent cystoscopy with bladder biopsy. The obtained biopsy specimens were fixed in buffered formalin, further processed in increasing concentrations of alcohols, and embedded in paraffin blocks according to the standard technique. Sections were obtained from the blocks and mounted on histologic slides and stained with hematoxylin and eosin. The follow-up time was 12 months after surgical treatment.

Results. Histologic confirmation of squamous cell metaplasia was revealed in 2/29 (6.8%) patients in the bladder fundus projection and in 23/29 (79.3%) in the Lieto triangle projection, lymphoid infiltration was determined in 14/29 (48.2%) patients in the fundus projection and in 21/29 (72.4%) in the Lieto triangle projection. The combined squamous cell metaplasia and lymphoid infiltration was detected in 16/29 (55,2%) patients in the Lieto triangle projection and in 1 (3,4%) patient in the bladder fundus projection. At follow-up examination, 28 patients had no recurrence of postcoital cystitis. Inflammatory changes of the bladder mucosa underwent regression in 20 patients in control cystoscopy. Morphologically, lymphoid infiltration was detected in 1/29 (3.4%) patients, and squamous cell metaplasia was determined in 5/29 (17.2%) patients.

Conclusion. As a result of long-term inflammatory process in the bladder in the course of frequent recurrences of postcoital cystitis, the bladder wall undergoes morphologic changes that require mandatory morphologic verification. By surgical release of pathogenetic factor - vaginal ectopia of the external urethral orifice and/or urethral hypermobility, it is possible to achieve regression of morphologic changes in the bladder mucosa.

Objective. To assess the main statistical indicators of malignant neoplasms of the nasal cavity and paranasal sinuses in the Republic of Belarus, and analyze the long-term results of treating patients with squamous cell cancer of the nasal cavity and paranasal sinuses.

Materials and methods. The material for the epidemiological study was the data from the Belarusian Cancer Registry on 2016 patients with malignant neoplasms of the nasal cavity and paranasal sinuses (C30.0 and C31), identified during the period of 1998-2022 in the Republic of Belarus.

Results. The ratio of mortality to incidence of malignant neoplasms (MN) of the nasal cavity (CN) and paranasal sinuses (PS) in the Republic of Belarus was 60% in 2018-2022 (in 1998-2002 - 80%). The diagnosis rate in stages III-IV was 73.8% in 2018-2022. 5-year adjusted survival rate decreased from 38.2±0.2% in 2003 to 35.9±3.3% in 2022. The proportion of stages III and IV in the group of squamous cell carcinoma (SCC) associated with sinonasal inverted papilloma (SIP) was 69%, in the group of de novo SCC – 89% (p = 0.026). The 5-year adjusted survival (АS) of patients with SIP-associated SCC was 73.4% (SE 11.5%), de novo SCC was 38.7% (SE 5.1%) (p=0.012).

Conclusion. High mortality-to-morbidity ratios indicate problems in the diagnosis and treatment of malignant tumors of the PN and acute urinary tract in the Republic of Belarus. The risk group for developing cancer of the PN and PN, requiring additional medical supervision, is the population over the age of 40 years.

Objective. Improving the quality of transfusion care by developing a model of organizational and methodological support for online applications based on the analysis of applications for blood components for various nosological groups.

Materials and methods. The object of the study was the content of the following medical documentation: an application for transfusion media, approved by the Order of the Ministry of Health of the Republic of Belarus as of July 14, 1998 No. 202, including information on the needs of healthcare organizations for transfusion media for the period of 2016-2017; regulatory legal acts on transfusiology in the Republic of Belarus.

Results. The need for transfusion media (erythrocyte-, platelet-, plasma-containing blood components, including cryoprecipitate) and the drug Albumin was analyzed.

It has been established that the maximum volume of consumption (37-81%) of all transfusion media occurs in therapeutic departments, namely hematology departments. A significant consumption of platelet blood components and cryoprecipitate (29% and 37%, respectively) occurs in obstetrics and gynecology departments.

A calculation of the need for a blood component is proposed, which is based on a patient model, including the patient’s age and nosological profile of the disease (ICD-10 code), technological level of medical care, and number of applications for hospitalization.

An online application has been developed, the parameters of which include the date, institution, patient’s full name, ordered blood component or drug Albumin, blood group and Rh factor (other antigenic systems, if necessary), as well as the patient’s diagnosis according to ICD-10.

Conclusion. The developed online application software allows keeping records and analyze the average need for blood components and the drug Albumin per patient assigned to one of the models. Using an online application will allow auditing the appointment and generate an estimated need for the next time period, based on a calculation including a patient model, allows optimizing the management of blood service resources.

Objective. To study state dynamics of the cardiovascular system of athletes in acyclic sports against the background of submaximal physical activity to identify individuals at high risk of cardiovascular complications, including sudden cardiac death

Materials and methods. The survey was conducted among athletes of acyclic sports. Number of people examined: 50, average age 20.0±3.5 years old. Of these, 30 (60%) were men, average age 19.9±3.4 years old; women – 20 (40%), average age 21.0±3.8 years old. Qualification of athletes: CMS, MS, MSIC.

Results. At rest, instability of the depolarization phase is indicated by two ECG markers: a fragmented frQRS complex and a spatial QRS-T angle of more than 105º. Fragmented frQRS was detected in 73% of young males and 33% of young females. The average values of the QRS-T angle were within the physiological norm: 63±23º in young males and 40±14º in young females. Electrical ventricular systole, expressed by the Q-T interval, was 373±26 ms in young males and 385±35 ms in young females. The average value of the second indicator of repolarization instability Q-T interval dispersion was 50.7±12.8 ms in young males and 39.3±14.6 ms in young females. The average TWA amplitude in young males was 21.0 (18; 24) μV, and 20.5 (14; 25) μV in young females. Analysis of ECG markers of dysfunction of autonomic nervous regulation showed that the slowdown in heart rate DC was 19.0 (14.8; 31.5) ms in young males, 19.5 (11.8; 21.5) ms in young females. The acceleration of heart rate AC in young males was 19.8 (13.8; 26.0) ms, and 19.5 (11.5; 21.5) ms in young females.

After the load, no statistically significant changes in the frequency of detection of fragmented frQRS were observed in young males (p = 0.7472), while in young females a statistically significant increase in the frequency of detection of frQRS was detected (p = 0.0226). The average value of the QRS-T angle increased significantly – from 63±23º
to 85±25º in young males (p = 0.0117), while it did not change significantly in young females – from 40±24º to 55±26º  (p = 0.2606). Q-T dispersion in afterload compared to rest increased from 50.7±12.8 ms and reached 72.8±25.0 ms (p = 0.000) in young males and from 39.3±14.6 ms to 68.2 ±10.7 ms in young females (p = 0.0029). Deceleration (DC) and acceleration (AC) of heart rate decreased significantly in young males. For young males – by 77.7 and 82.3%, respectively (p < 0.0001), and for young females – by 84.9 and 80.0%, respectively (p < 0.0001).

Conclusion. At rest, we identified only 10 markers of electrical instability of the myocardium, and 38 markers after exercise, that is, almost 4 times more. This suggests that even in highly qualified athletes, load causes a trend towards electrical instability of the myocardium, mainly in the repolarization phase and in relation to autonomic nervous regulation.

Objective: To study the effect of a phytocomposition with nootropic properties on the cognitive functions of the human brain.

Materials and methods. Conditionally healthy volunteers of both sexes over the age of 45 took part in the study. The function of attention was studied using the Bourdon correction test. The short-term memory function was assessed using the tasks “Memorizing 10 numbers”, “Memorizing 10 words”. Logical thinking was assessed using the Complex Analogies test.

Results. The parameters of the attention function such as productivity, accuracy of attention, integrative indicator of stability of attention, coefficient of mental productivity, mental performance, and level of concentration increased significantly in the group of people took phytocomposition. The ability to find logical connections between words pairs increased according to the results of the test. The effect of the phytocomposition was more pronounced, the lower the initial indicators were.

Conclusion. The phytocomposition “Memoris” has a positive effect on cognitive functions (attention, thinking).

Objective. To identify the relationships between the levels of microRNA and mRNA during pathological angiogenesis under the conditions of experimental toxic liver cirrhosis.

Materials and methods. Fibrosis and liver cirrhosis were induced in male Wistar rats using a freshly prepared solution of thioacetamide over 17 weeks. The dynamics of the process were studied at 9 time points. The areas of interlobular veins and interlobular arteries were measured in micrometers. The numbers of interlobular arteries, interlobular veins, and sinusoidal capillaries were counted. The expression levels of mRNA genes Ang, Vegfa, Tweak, Fn14, Notch1, Notch2, and microRNAs-195-5p, microRNAs-664-3p, microRNAs-489-3p, microRNAs-3085, microRNAs-3558-3p in the liver were determined by real-time polymerase chain reaction.

Results. It was found that during progressive venous angiogenesis, as well as against the background of changes in the number of interlobular veins, sinusoidal capillaries, and the area of interlobular veins, the nature and strength of correlational interactions between the genes Ang, Vegfa, Tweak, Fn14, Notch1, Notch2, and microRNAs-195-5p, microRNAs-664-3p, microRNAs-489-3p, microRNAs-3085, microRNAs-3558-3p are associated with the stage of fibrosis and liver cirrhosis. Strong, moderate, and mild correlational links (p<0.01) were identified between the genes Ang, Vegfa, Tweak, Fn14, Notch1, Notch2 throughout the experiment.

Conclusion. The obtained results indicate that the studied microRNAs - microRNAs-195-5p, microRNAs-664-3p, microRNAs-489-3p, microRNAs-3085, microRNAs-3558-3p - are involved in the processes of restructuring the intrahepatic vascular bed at different stages of experimental toxic fibrosis and liver cirrhosis. The results of the study not only reveal additional mechanisms of formation of the indicated conditions but also identify the biological role of the studied microRNAs in the progression of fibrosis and liver cirrhosis as potential targets for studying pathogenesis and developing treatment methods.

Objective. To determine the effect of pooling (merging) of single cultures of olfactory mucosa-derived mesenchymal stem cells (MSCs) of the nasal cavity on the suppression of the proliferative activity of T-lymphocytes.

Materials and methods. Using flow cytometry, the effect of pooling single cultures of MSCs obtained from healthy donors (n=7) on the mitogen-induced proliferation of T-lymphocytes in the peripheral blood of volunteers (n=5) was studied. The proliferation index and the number of dividing CD3⁺ T-cells were assessed by changes in the fluorescence intensity of Tag-it Vio. Statistical processing of the obtained data was carried out using non-parametric statistics.

Results. An evaluation of 35 variants of co-culture of single MSCs with T-cells and 33 variants of co-culture of pooled MSCs with T-cells was performed. The inhibitory effect of both single (p = 0.0001) and pooled MSCs (p = 0.0001) on

PHA-induced proliferation of CD3⁺ T-cells in the total fraction of peripheral blood lymphocytes was identified. It was shown that pooled MSCs have a significantly more pronounced suppressive effect on T-cell proliferation compared to single MSCs (p=0.000004).

Conclusion. PoolMSCs have a significantly more pronounced effect in suppressing PHA-induced proliferation of peripheral blood T-cells compared to MSC monocultures, which justifies the use of poolMSCs in medicine to achieve better results in the treatment of immune-mediated diseases.

Objective. To assess the exposure on the population caused by the content of priority cyanotoxins in drinking and recreational waters, health risks associated with their complex chronic intake, and scientifically substantiate methodological approaches to modeling the conditions of aggregated exposure of chemical substances of biological origin for various types of water use.

Materials and methods. The study analyzed 313 samples of drinking and recreational water for the content of priority cyanotoxins (cylindrospermopsin and microcystin-LR). Aggregated doses were calculated for their intake into the organism of different population groups by drinking, domestic and recreational water use, taking into account multiple ways of intake.

Results. Aggregated average daily doses under chronic exposure for drinking, domestic and recreational water use, taking into account oral and dermal ways of exposure under the worst-case scenario, for cylindrospermopsin ranged from 1, 58 x 10^-6 mg/(kg x day) (adults) to 3.62 x 10^-6 mg/(kg x day) (children under 6 years of age) for cylindrospermopsin and from 4.24 x 10^-6 mg/(kg x day) (adults) to 9.00 x 10^-6 mg/(kg x day) (children 6-18 years of age) for microcystin-LR.

Conclusion. Aggregated average daily doses with chronic exposure to microcystin-LR and cylindrospermopsin under the worst-case scenario of drinking, domestic and recreational water use do not exceed reference doses for all population groups, including vulnerable one (children). The main contribution to the aggregated average daily intake of cyanotoxins for realistic scenarios is made by drinking and domestic water use, oral route of intake.

The proposed methodological approaches of modeling of aggregated exposure by multiple ways of exposure to chemicals of biological origin, taking into account different types of water use and seasonality of exposure can be used for building an evidence base for substantiate the hygienic standards and criteria for assessing health risks associated with chemical factor of biological origin.

Objective. To analyze the implementation of cancer screening program in Gomel region in order to identify key aspects affecting its efficiency and quality, and to develop a differentiated model of interdepartmental organization of cancer screening.

Materials and methods. The study methodology included analysis of scientific articles and official documents on cancer screening. The study was based on conceptual models describing the sequence of screening stages and interaction between health care organizations, which allowed identifying general trends and features of screening, as well as factors affecting its effectiveness.

Results. The article analyzed the resource and personnel support of cancer screening in Gomel region, identified barriers that prevent its effective implementation. The ways to improve the system of cancer screening in Gomel region, including the development of a differentiated model of interdepartmental organization of screening, were proposed. The results of the study can be used to develop more effective cancer screening programs and optimize the organization of medical services, contributing to the early detection and treatment of cancer.

Conclusion. There is a low coverage of cancer screening in the Gomel region. Differentiated screening programs, standardization of methods and terminology, and consideration of contextual factors will play a key role in improving the effectiveness of cancer screening program implementation. The development of unified reporting systems is also critical to ensure consistency in screening results. And the development of unified reporting systems will promote consistency in interpretation of screening results.

Objective. To provide an assessment of ¹³⁷Cs and ²⁴¹Am levels in Narovlya district of the Gomel region adjacent to the Polesie State Radiation-Ecological Reserve

Materials and methods. The data on soil and food contamination is obtained for 113 private backyards located
in 32 villages of the Narovlya district. A gamma-spectrometry technique was used to measure ²⁴¹Am in soil and ¹³⁷Сs in soil and food samples. ²⁴¹Am in food samples was measured via a radiochemical method with the use of alpha-spectrometry measurement.

Results. The values of specific activity of radionuclides in the soil of all sites range from 230 to 2770 Bq/kg for ¹³⁷Сs and do not exceed 10 Bq/kg for ²⁴¹Am. The specific activities of ¹³⁷Cs in food samples range from 3 to 160 Bq/kg, and the values of ²⁴¹Am concentration stay within units or tens of millibecquerels per 1 kilo of a product. The estimates show that, considering the present-time ²⁴¹Am contamination of locally produced foods, its share in the total internal radiation dose is not likely to be higher than 0.1% from both radionuclides, ¹³⁷Сs and ²⁴¹Am. However, inhalation of ²⁴¹Am can increase its share in the total internal dose up to 3%. Consumption of ¹³⁷Сs-contaminated foodstuffs may potentially cause 97 to 100% of the total internal radiation dose in the district.

Conclusion. At the present stage of the radioecological context in the existing exposure situation the major contribution to the public internal exposure is ¹³⁷Сs intake through consumption of contaminated food that produced locally; its contribution is more than 97% of the total internal dose received by the Narovlya district residents. It is recommended to minimize any type of fieldworks on the dry and dusty soils that can cause excessive inhalation of the alpha-emitting ²⁴¹Am.

Objective. To review and systematize the legislative acts of the Republic of Belarus on the organization and provision of medical care and services to maintain and strengthen reproductive health for women living with HIV, and to determine the need for their updating.

Materials and methods. The article discusses the legal documents of the health care system regulating the organization and provision of medical care to women living with HIV, and the practice of their use in screening women for HIV, pregnancy and childbirth care, including drug provision and antiretroviral therapy, termination of pregnancy, family planning, providing gynecological care to women and providing services for the prevention of HIV infection in teenage girls, monitoring cases of HIV infection on the territory of the Republic of Belarus.

Results. In the context of the reproductive needs of women living with HIV, the current regulatory documents establish many norms and recommendations that have lost their relevance and validity. There are no modern recommendations for the organization and provision of gynecological care that take into account the particularities of genital tract diseases in HIV-infected women of different ages. The multiplicity of recommendations from various clinical protocols creates uncertainty when making decisions by medical workers, or becomes a precedent for examining the quality of medical care.

Conclusion. The development of a comprehensive clinical protocol based on scientifically based data on the modern characteristics and reproductive needs of women living with HIV, as well as timely revision of legislative acts on the provision of medical care to people living with HIV, with additions and changes, will make it possible to provide targeted medical care and maintain their reproductive health.

Toxoplasmosis is an infectious disease, the causative agent of which is Toxoplasma gondii - the simplest, intracellular parasite, which infects up to a third of the world’s population.

Clinical manifestations of toxoplasmosis in immunocompetent patients are characterized by lymphadenopathy syndrome, high level of specific antibodies and a favorable outcome. At the same time, the enlargement of the lymph nodes requires a multidimensional differential diagnosis to exclude other diseases.

The article presents a clinical case of toxoplasmosis in a woman with lymphadenopathy. The role of the histological evaluation in the study of biopsy of the lymph nodes in toxoplasmosis was demonstrated. The analysis of literature sources, clinical data, results of laboratory and instrumental studies was carried out.

This article provides a review of the literature on impaired perception of one’s own body. Modern views on the features of impaired perception of one’s own body are considered. The stages of development of the diagnosis of dysmorphic disorder and changes in scientific views on nosological affiliation are described. Describing a clinical case of a patient with dysmorphic symptoms in the structure of a personality disorder, we emphasize the clinical and social significance of the problem and difficulties in differential diagnosis and diagnosis verification.