The review presents data from various researchers, including the authors of this article, regarding the role of lipid metabolism disorders, as well as the causes that caused them in the formation of multiple organ dysfunction syndrome (MODS). Information is provided on the contribution of intense lipolysis in fat depots to the development of the immune response, as well as the formation of acute respiratory distress syndrome and acute kidney injury. The contribution of intense lipolysis to the process of changing the composition of fatty acids in blood plasma is characterized. The importance of intensifying the oxidative metabolism of arachidonic acid in the blood in the development of circulatory disorders and the occurrence of systemic inflammation is shown. Changes in lipid metabolism of erythrocyte membranes and its effect on hemodynamics are described. The relevance between disorders of lipid metabolism, dysfunction of cell membranes and their consequences, including the development of necrotic processes in tissues, has been characterized. Particular attention is paid to the importance of reducing the content of total cholesterol, as well as high-, low- and very low-density lipoprotein cholesterol in the formation of MODS, in particular, the proposed ways of influencing cholesterol deficiency on the progression of organ dysfunction are described. Data are provided on changes in the content of modified lipoproteins, as well as phospholipids and triglycerides in the blood plasma during MODS. The presence and probable role of plasma plasmalogen deficiency in organ disorders in MODS is noted. The problem of functional and metabolic role of peroxisome and mitochondria dysfunction in the pathogenesis of MODS is considered. The rationale for the importance of monitoring lipid metabolism parameters when assessing the severity of the condition of patients with MODS is provided.

Objective. To evaluate the prevalence of PNPLA3 gene variants in patients with liver cirrhosis (CKD) in the outcome of alcoholic liver disease (ALD), and the influence of the mutation on the course of the disease in the case of the Belarusian population.

Materials and methods. A total of 260 subjects of Caucasian origin were included in the study and divided into three groups: group I - subjects with ALD with CKD features (n=91), group II - subjects with ALD without CKD (n=51), group III - healthy volunteers (n=118).

Results. The GG genotype was prevalent in persons of group I compared to group II and III (χ2=10.64; p=0.001 and χ2=4.87; p=0.03, respectively). The risk of developing alcoholic liver cirrhosis in persons with the GG genotype is 2.2–2.4 times higher than in those with the CC and CG genotypes.

Conclusion. The study was the first to investigate the prevalence of different genotypes of PNPLA3 gene in patients with CKD in the outcome of ALD and to show a higher risk of disease progression in homozygotes for G allele in the case of the Belarusian population.

Objective. To present the possibilities of angiopulmonography with a nitroglycerin test in the differential diagnosis of acute pneumonia with acute abscess and gangrene of the lung.

Material and methods. А pulmonary angiogram with a nitroglycerin test was performed in 51 patients with suppurative inflammations of the lungs and pleura in cases where it was difficult to interpret computed tomography data.

Results. Acute gangrenous lung abscess was diagnosed in 27 (53%) patients (absence of the parenchymal phase of contrast, including after administration of nitrospray, of which in 4 cases it was due to thrombosis of the segmental branches of the pulmonary artery). In 14 (27%) cases there was lung gangrene (absence of the parenchymal phase of contrast, including after administration of nitrospray, of which 5 were associated with thrombosis of the segmental branches of the pulmonary artery). With preserved main blood flow along all branches of the pulmonary artery and a pronounced parenchymal phase or its restoration after a nitroglycerin test, a conclusion was made about the functional nature and reversibility of the identified microcirculation disorders, the absence of necrotic changes in the pulmonary parenchyma and the presence of acute pneumonia in the patient - 4 (8%) cases. In case of deformation of the pulmonary artery branches with preservation of blood flow through them and the parenchymal phase, a conclusion was made about compression of the pulmonary parenchyma by pleural effusion, on the basis of which pleural empyema was suspected in 6 (12%) patients.

Conclusion. The developed method for the differential diagnosis of acute pneumonia with acute abscess and gangrene of the lung by means of angiopulmonography with a nitroglycerin test makes it possible to supplement and improve the early and differential diagnosis of purulent-inflammatory diseases of the lungs in difficult clinical situations. Nitroglycerin preparations improve microcirculation in the inflammation of the pulmonary parenchyma.

Objective. To evaluate planned and obtained results of implantation of pedicle screws using individual navigation templates in patients with degenerative diseases of the lumbar spine.

Materials and methods. Based on the results of computed tomography, the safety and accuracy of installing pedicle screws (30 patients, 126 screws) were analyzed using individual navigation templates.

Results. The degree of safety 0 is registered in 96% (121 screws), the degree 1 is in 4% (5 screws). There were no cases of bone perforation by more than half of the screw diameter. There were no significant differences in the standard deviation of the sagittal angle between the planned installation and the actual trajectory of the screw. In the axial plane, no significant differences in standard deviation were observed at the entry and expected exit points of the screw. Statistical analysis showed insignificant differences between the planned and actual results (p>0.05)

Conclusion. The use of individual navigation templates makes it possible to implant pedicular screw structures in the lumbar spine with a high level of safety and accuracy.

Objective. To determine the peculiarities of species composition and quantitative ratios of microorganisms in the intestine of patients with atopic dermatitis.

Materials and methods. Fecal microbiologic examination was carried out in 50 children with atopic dermatitis aged from 1 to 17 years to determine the species composition and quantitative ratios of microorganisms in the intestine.

Results. The change in the species composition and quantitative ratios of microorganisms in the intestine was detected in 84% of children with atopic dermatitis. Decreases in the number of lactobacilli and/or bifidobacteria were observed in half of the patients, changes in the qualitative and quantitative composition of Escherichia coli were detected in 50% of children with atopic dermatitis. The I severity level of intestinal dysbiosis was detected in 5 (10%) patients with atopic dermatitis, II level - in 16 (32%) patients, III level - in 21 (42%) children.

Conclusion. In children suffering from atopic dermatitis the frequent occurrence of intestinal dysbiosis was revealed mainly due to the decrease of the main representatives of the obligate intestinal microflora, bifido- and lactobacilli, as well as due to changes in the qualitative and quantitative composition of Escherichia coli. 

Objective. To conduct a comparative analysis of the genotype distribution of polymorphic variants of the PNPLA3 gene (rs738409) and the TM6SF2 gene (rs58542926) in patients with nonalcoholic fatty liver disease (NAFLD) and healthy volunteers residen at Gomel region.

Materials and methods. 127 patients with nonalcoholic fatty liver disease without liver cirrhosis aged 55 (46; 62) and 98 healthy volunteers aged 41 (31;44) were examined. DNA was isolated using a set of reagents manufactured by «ArtBioTech» LLC, according to the manufacturer’s instructions (the kit is designed to isolate RNA and DNA from a wide range of clinical material).

Results. The rs738409 polymorphism in the PNPLA3 gene and rs58542926 of the TM6SF2 gene is associated with the progressive course of nonalcoholic fatty liver disease (the development of steatosis, fibrosis and hepatocellular carcinoma). Through the study of the polymorphism of the PNPLA3 gene the GG genotype occurred in 43 (34%) patients with nonalcoholic fatty liver disease, and it showed a significant difference with the comparison group — 21 people (21,4%), p=0.0356, the GC genotype was determined in 17 patients (13,3%) and 15 healthy individuals (15,3%), p=0.7040. When analyzing the polymorphism of the TM6SF2 gene, TT genotype was found in 2 (1.5%) patients with nonalcoholic fatty liver disease, 3 (3%) healthy individuals; the TC genotype was determined in 24 (19%) patients and 16 (16.4%) healthy individuals.

Conclusion. As a result of the study, it was revealed that the prevalence of the GG genotype of the PNPLA3 gene is significantly higher in patients with nonalcoholic fatty liver disease than in healthy individuals. In healthy individuals the CC genotype was the most common (63,3%) among the genotypes of the polymorphic locus rs738409 PNPLA3. The polymorphic locus rs58542926 TM6SF2 was characterized by a more frequent presence of the CC genotype (80,6%).

Objective. The objective of the analysis is to conduct a comparative analysis of the results of ultrasound examinations of the intestines for COVID-19, ulcerative colitis and Crohn’s disease, and to identify ultrasound criteria that are most specific for COVID-associated lesions.

Materials and methods. To achieve this objective, ultrasound data from 50 patients with COVID-associated ienteropathy (age range 18-73 years), 4 patients with Crohn’s disease and 4 patients with ulcerative colitis (age range 20-38 years) were compared.

Results. A highly specific ultrasound criterion for COVID-19-associated ienteropathy has been identified (Youden index ‒ 1.0, AUC ‒ 95% CI (0.87 ‒1.0); specificity ‒ 95% CI (85.2 ‒ 100.0)), namely: the presence of small areas of reduced echogenicity (with wavy contours) in the thickness of the mucous membrane and submucosal plate, which are the ultrasound equivalent of zones of lymphoid infiltration.

Conclusion. It is arguable that the presence of small areas of reduced echogenicity (with wavy contours) in the thickness of the mucous membrane and submucosal plate as an ultrasound sign of COVID-19-associated ienteropathy, which is not found in other inflammatory diseases of the gastrointestinal tract.

Objective. To analyse the immediate and remote results of surgical treatment of patients with periampullary tumors, depending on the presurgery biliary drainage (PBD).

Materials and methods. In an observational retrospective study, the results of surgical treatment of 249 patients with malignant periampullary tumors were analyzed, depending on the PBD (performed in 119 cases). The main indication for PBD was the level of total bilirubin above 200 μmol/l (since 2015 – above 250 μmol /l).

Results. The overall incidence of postsurgery complications in patients underwent one–step surgery and underwent PBD was 43.1 and 41.2%, the incidence of severe complications (≥IIIa according to Clavien – Dindo) was 20.8 and 17.6% (p>0.05), pancreatic fistula – 26.2 and 25.2% (p>0.05), hospital mortality – 7.7 and 3.4% (p=0.14), 90-day mortality – 8.7 and 4.3% (p=0.17). The overall five–year survival rate in the groups without PBD and with PBD was 45.0±8.5 and 20.2±8.4 (p=0.36) for cancer of the Fater papilla, 66.7±19.2 and 55.6±16.6 (p=0.77) for cancer of the common bile duct, 34.7±5.9, and 4.2±2.7 for pancreatic cancer (PC) of all histological variants – 34.7±5.9 and 4.2±2.7 (p=0.00001), ductal adenocarcinoma PC – 27.0±6.2 and 2.3±2.2% (p=0.002).

Conclusion. One-step surgeries for periampullary tumors were not accompanied by an increase in the overall frequency of postsurgery complications, the frequency of severe (grade IIIa according to Clavien - Dindo) complications, hospital and 90-day mortality, compared with two-stage surgeries. In patients with cancer of the Fater papilla and cancer of the common bile duct, there were no differences in survival rate depending on the PBD. In pancreatic head cancer, there was a decrease in the overall survival rate of patients underwent PBD in comparison with those surgically operated without PBD, especially among patients with ductal adenocarcinoma of the pancreas, which requires improved approaches to the treatment of this category of patients.

Objective. To develop a new model of acute destructive pancreatitis (ADP) in rats, similar in terms of changes in the human pancreas, characterized by technical simplicity and viceless of known models of experimental ADP, lasting for a long time and allowing the evaluation of the data obtained in early and long-term periods, and suitable for testing new drugs.

Materials and methods. The experiment was performed on 54 cyclic Wistar rats to simulate ADP by introducing a solution of the ionic detergent sodium dodecyl sulfate into the pancreatic tissue, after which hematological, biochemical and serological studies were performed. The obtained data were subjected to comparative statistical analysis. The rats were divided into 3 groups of 18 individuals, where group №1 was the control group, groups №2 and №3 were modeling ADP by introducing 10% and 20% sodium dodecyl sulfate solution, respectively. Mortality rates, inflammatory markers, and end-organ laboratory changes were compared at 24, 96, and 192 hours. Statistical data processing was carried out using the program «Statistica 10».

Results. Control group №1 is characterized by the absence of mortality and minimal laboratory changes, which corresponds to the pancreas response to surgery. In group №2, mortality was 16.67% with statistically significant laboratory changes relative to group №1, which corresponds to moderate ADP. Group №3 has a high mortality rate (66.66%) and statistically significantly higher laboratory markers compared to groups №1 and №2. This group is characterized by severe ADP.

Conclusion. In rats of group №2 moderate ADP developed. This model can be recommended as a universal one for testing new drugs for the treatment of ADP. Hematological, biochemical, and serological tests allow assessing the severity of acute destructive pancreatitis in experiment on rats.

Objective. To identify the expression patterns of ALDH1A1, CD133, CD271 and ISLR in endometrioid adenocarcinoma of the uterine corpus at different outcomes.

Materials and methods. Histological archival material of 188 cases of endometrioid adenocarcinoma of the uterine corpus were used in the study. All cases were divided into 2 groups according to the outcome of the disease. The group with favourable outcome included 148 cases without tumour progression. The group with unfavourable outcome included 40 patients who had disease progression during follow-up. ALDH1A1, CD271, CD133 and ISLR expression was evaluated as the percentage of positive cells to the total number of cells in the field of view. Comparison of groups was performed using the Mann-Whitney test.

Results. There were statistically significant differences between groups (p<0.05) in ALDH1A1, CD271, CD133 and ISLR expression. Conclusion. Expression of ALDH1A1, CD133 ISLR markers in groups with different disease outcome may indicate their predictive role in the prognosis of endometrioid adenocarcinoma of the uterine corpus. Keywords: endometrioid adenocarcinoma, ALDH1A1, CD271, CD133, ISLR> ˂ 0.05) in ALDH1A1, CD271, CD133 and ISLR expression.

Conclusion. Expression of ALDH1A1, CD133 ISLR markers in groups with different disease outcome may indicate their predictive role in the prognosis of endometrioid adenocarcinoma of the uterine corpus.

Objective. To conduct the analysis of works devoted to the professional activities of Nikolay Alexandrovich Semashko, to evaluate his contribution to the creation and development of the healthcare system of Belarus.

Materials and methods. Historical, analytical, logical, and bibliographic methods were used for conducting this study. The primary material was the scientific works published by Nikolay Alexandrovich Semashko and his associates, the search of which was carried out in the electronic scientific libraries eLibrary, CyberLeninka, PubMed, Google Scholar, the Central Scientific Medical Library of the Ministry of Health of the Russian Federation and the Russian State Library, using the keywords: Nikolay Alexandrovich Semashko, Belarus, history of medicine from 1918 to the present.

Results. The analysis of the works devoted to the professional activities of Nikolay Alexandrovich Semashko, revealed the effectiveness of the organizational measures he had taken, including those influenced the creation of the modern healthcare system in Belarus.

Conclusion. The activity of Nikolay Alexandrovich Semashko contributed to the creation of the unified healthcare system in the BSSR for the provision of medical assistance to the residents of the Republic. His achievements in the introduction of anti-epidemic measures, which improved the well-being of the population, contributed to the training of specialists, and increased sanitary literacy of the population, were particularly noteworthy. The principles of local division and dispensary observation were introduced, the provision of emergency and planned medical assistance was organized, insurance medicine was introduced, the role of preventive activities was emphasized. All these measures were aimed at the functioning in the long term.

Objective. To make a comprehensive evaluation of the epidemiological situation on the incidence rate of breast cancer (BC) in Gomel region, to analyze the dynamics of morbidity and mortality, as well as to study the degree of disability as a result of this disease.

Materials and methods. The data on morbidity, mortality and primary disability from BC in Gomel region for 2013-2023 were analyzed.

Results. BC in the Gomel region stands out among other cancers in terms of incidence – 111.8 per 100,000 population, which is significantly higher than the incidence rate of other cancers in 2023. Thus, the incidence rate of BC is more than twice as high as the incidence rate of cancer of the uterine body (43.6) and even more – colon cancer (31.6), stomach (24.5) and rectum (21.8). Also, BC has one of the highest mortality rates – 22.8 per 100,000 population in 2023. In addition, against the background of a decrease in mortality from malignant neoplasms in the region, BC remains one of the main causes of primary disability among women.

Conclusion. In Gomel region, BC has the highest incidence rates among all types of malignant neoplasms, with a steady increase in the number of newly diagnosed cases from 2013 to 2023. BC mortality has also increased, but in recent years there has been a downward trend. The number of cases of primary disability (PD) due to BC is increasing, although the severity index of PD is decreasing, which may indicate an improvement in the quality of treatment. Comprehensive measures are needed to effectively combat BC, including prevention, early diagnosis, improved treatment and rehabilitation, as well as social support for patients.

Object. To evaluate risk criteria of respiratory tuberculosis (TB) in women of reproductive age.

Materials and methods. We studied 260 cases of respiratory TB in women of reproductive age (aged 18–45). We investigated epidemic, medical, social, and additional risk factors. Using multinominal logistic regression, we found coefficients for risk factors and logistic regression formula. The threshold for coefficient total was determined by ROC-analysis. The model was tested on a random group (47 vs 35 women with and without TB respectively).

Results. Additional to epidemic, medical, social risk factors the most significant criteria for women of reproductive age are body mass index lower than 20, inter-birth interval shorter than 2 years, TB in the family history, and progesterone insufficiency. Using the model of logistic regression women with vs without TB were recognized with sensitivity 82,9% and specificity 77,1%.

Conclusion. The comprehensive evaluation of epidemic, medical, social, and additional risk factors will help to detect high vulnerability of women of reproductive age to TB. Creating of target groups will contribute to early diagnosis of TB during pregnancy and after the childbirth.

The article describes a clinical case of hereditary anomaly of the renal vessels with the development of pyeloectasis. This pathology is a risk factor for the development of secondary arterial hypertension and requires both dynamic monitoring and decision-making on the choice of treatment method. Taking into account the psychosomatic background, it was decided to give this patient a course of holistic massage (a method of body-oriented therapy) in order to reduce the influence of sympathicotonia on the general condition of the patient. In terms of control – Holter ECG monitoring, assessment of function and ultrasound of the kidneys (size of the renal pelvis). Knowledge of the individual characteristics of the patient with the involvement of specialists of relevant competencies and correction of treatment taking into account the level of anxiety can affect the quality of life of the patient with concomitant pathology and the duration of the state of compensation.

A clinical case of L₅ radiculopathy with the onset of pain in the lower leg with subsequent addition of pain in the lower back after one month is presented. In the neurological status, hypoaesthesia and decreased muscle strength in the extensor hallucis longus of the left foot were noted. A serial three-fold electroneuromyographic study was performed. When testing the tibial nerve from the abductor hallucis, an A-wave was detected, which was recorded after the F-wave, whereas two months after the onset of the disease, the A-wave disappeared, but the combined duration of the F-wave was increased. Thus, the analysis of electroneuromyographic data in the form of the presence of the A-wave with its localization after the F-wave and an increase in the combined duration of the entire F-wave complex during the study of the tibial nerve in combination with clinical and neuroimaging data is important for the diagnosis of L₅ radiculopathy.

The article presents a rare clinical case of non-specific arteritis involving the vessels of the brachiocephalic arteries system, the clinical course of which was characterized by manifestations of chronic cerebral insufficiency without signs of focal neurological deficit in the history and upon hospitalization, but accompanied by pronounced, widespread vascular involvement supplying the brain, with tandem common carotid artery lesions (critical stenosis of the common carotid artery and occlusion of the common carotid artery on the contralateral side), occlusion of both subclavian arteries and the right vertebral artery. This type of lesion is associated with a high risk of developing ischemic stroke and death, which was an indication for subsequent surgical treatment. In addition, the pronounced inflammatory process in the vessel wall and perivascular structures, the rate of disease progression, as well as the absence of subcutaneous veins of the necessary diameter, immunosuppression in the background of taking hormonal drugs, led to the decision to use arterial donor allograft as a biological material for subsequent reconstructive surgical intervention.

Objective. To study the microbial diversity of the respiratory microbiota in patients with undifferentiated pathological changes in the lungs.

Materials and methods. The study of biopsy material obtained during video-assisted thoracoscopic lung resection was conducted in 36 patients with undifferentiated pathological changes in the lungs. The study of the microbial diversity of the lungs was carried out by high-performance sequencing using the MiSeq sequencer (Illumina, USA) using a protocol based on the analysis of variable regions of the 16s rRNA gene.

Results. The density and microbial diversity of the pulmonary microbiota of the obtained samples were studied. In all patient samples, the dominant taxa at the Phylum level are Proteobacteria (the median relative representation of the taxon is more than 90%); the Phylums Firmicutes, Bacteroidetes, Actinobacteria are represented in smaller numbers, and the Phylums Fusobacteria and Cyanobacteria – only in some groups. Fusobacteria were found only in patients with lung sarcoidosis, and only in this group the median relative representation of the Phylum Actinobacteria was much higher than in the rest (p<0.05). The Genuses Stenotrophomonas and Delftia are the most widely represented in all samples. A bacterium of the Genus Pseudomonas has been found in patients with lung cancer. Conclusion. Proteobacteria were a significantly predominant Phylum of microbiota in patients with undifferentiated pathological changes in the lungs; Fusobacteria were found only in patients with lung sarcoidosis, and only in this group the median relative representation of the Actinobacteria were much higher than in the other groups. The greatest taxonomic diversity at the Genus level was observed in patients with lung sarcoidosis. Keywords: microbiota, lungs, tuberculosis, sarcoidosis, lung cancer> ˂ 0.05). The Genuses Stenotrophomonas and Delftia are the most widely represented in all samples. A bacterium of the Genus Pseudomonas has been found in patients with lung cancer.

Conclusion. Proteobacteria were a significantly predominant Phylum of microbiota in patients with undifferentiated pathological changes in the lungs; Fusobacteria were found only in patients with lung sarcoidosis, and only in this group the median relative representation of the Actinobacteria were much higher than in the other groups. The greatest taxonomic diversity at the Genus level was observed in patients with lung sarcoidosis.

Objective. To establish correlations between laboratory parameters and the degree of liver fibrosis in patients with chronic HBV infection.

Materials and methods. A retrospective analysis of clinical and laboratory data of 107 hospitalized patients with chronic hepatitis B (CHB) was carried out. During the study, indicators of a general blood count, biochemical blood test and coagulogram were studied, and predictive indices FIB-4 and APRI were calculated. The presence of correlations between laboratory parameters, predictive indices and the degree of liver fibrosis in patients with CHB was assessed.

Results. In patients with F3 and F4, there was an increase in the level of ESR, total bilirubin, AST, ALP, GGTP and INR, and a decrease in the level of red blood cells, platelets and creatinine. The FIB-4 and APRI index values increased with the progression of fibrosis and had a direct correlation with each other. A direct correlation has been established between F (METAVIR) and the FIB-4, APRI indices, ALT, AST, GGTP, ALP, APTT, PT and INR levels. An inverse relationship was observed between the levels of red blood cells, hemoglobin, leukocytes, platelets and the stage of fibrosis. There was no correlation between the stage of fibrosis and the level of total bilirubin, creatinine, total protein and fibrinogen.

Conclusion. Correlations have been established between individual laboratory parameters and the stage of liver fibrosis, which can serve as additional markers in the non-invasive diagnosis of liver fibrosis in patients with CHB.