The combined disorders in a human’s body related to functioning of such vital organs as heart and kidney with development and progress of concomitant hemodynamic disorders is called as cardiorenal syndrome. In early studies, insufficient cardiac pump function with subsequent renal dysfunction was considered as the main pathophysiologic component of cardiorenal syndrome. At the current stage of studying this syndrome, there is a greater understanding of the mechanisms of its development, however, there are also insufficiently studied aspects, since multiple systems of the human body can influence its occurrence and course.

This review aims to analyze scientific publications covering the studied etiological factors, pathophysiological mechanisms, and pathogenesis of type 2 cardiorenal syndrome, as well as current issues in diagnosis and treatment of chronic kidney disease associated with chronic heart failure.

The objective of the review is to analyze current data on pathogenetic mechanisms, diagnostic approaches and treatment strategies for type 2 cardiorenal syndrome, focusing on novel biomarkers and therapeutic methods.

The literature review was conducted according to:

1. Systematic analysis of publications in international databases (PubMed, Scopus, Web of Science).
2. Priority to clinical guidelines and meta-analyses.
3. Critical evaluation of evidence base.
4. Emphasis on studies with clear diagnostic criteria of type 2 cardiorenal syndrome.
5. Inclusion of both fundamental and clinical research

The analysis covers publications from 2018-2023, including some seminal earlier works that have fundamental importance for understanding of pathogenesis. Special attention was given to studies conducted for the period of 2020-2023 and reflecting modern diagnostic and therapeutic advances.

Objective. To determine the concentration of osteoprotegerin in venous blood plasma in chronic lower limb ischemia due to obliterating atherosclerosis combined with type 2 diabetes mellitus, and the effect of its dynamics on the disease progression after open and roentgen-endovascular surgeries.

Materials and methods. Concentration of osteoprotegerin in venous blood plasma was studied in 221 patients with chronic lower limb ischemia of atherosclerotic genesis. Two groups were formed: Group 1 (n=92) – patients with obliterating atherosclerosis without carbohydrate metabolism disorders, Group 2 (n=129) – patients with obliterating atherosclerosis and concomitant type 2 diabetes mellitus. The comparison groups included patients with type 2 diabetes mellitus without signs of obliterating atherosclerosis (Group 3, n=16), and conditionally healthy patients (Group 4, n=51). 78 patients were followed for 24 months after revascularization surgery in Group 2. The patients were divided into Group 2A (with preserved lower limb, n=60; 76.92%) and Group 2B (with amputated lower limb, n=18; 23.08%) depending on the outcome of the operation.

Results. The combination of obliterating atherosclerosis of the lower limbs and type 2 diabetes mellitus is characterized by an increase in the concentration of osteoprotegerin in plasma compared to healthy individuals, patients with isolated atherosclerosis of the arteries of the lower limbs, as well as isolated type 2 diabetes mellitus (p<0.001). The threshold value of the osteoprotegerin level, the excess of which indicates a high probability of the presence of obliterating atherosclerosis in patients with type 2 diabetes mellitus is 189.37 pg/ml. The initial osteoprotegerin values in patients of Group 2A (with preserved lower limb after arterial revascularization) and Group 2B (with amputated lower limb) limb after arterial revascularization) were comparable. However, in patients of Group 2A, the concentration of osteoprotegerin gradually decreased significantly after 14 days and 3 months, while in patients of group 2B this indicator increased, preceding the amputation of the lower limb in the above-mentioned periods.

Conclusion. Osteoprotegerin of venous blood plasma can be considered as one of the diagnostic factors for the presence of obliterating atherosclerosis in patients with type 2 diabetes mellitus. It is advisable to study its dynamics in the postoperative period for carrying out a set of therapeutic measures to prevent an unfavorable outcome of arterial revascularization.

Objective. To study the structure of clinical set of symptoms in post-COVID syndrome among young adults (18–44 years old).

Materials and methods. The study included 263 patients at the ages from 18 to 44 years old recovered from COVID-19 in 2020-2024 with duration of symptoms more than three months. All participants were proposed to fill a validated “Post-COVID-19 Health Self-Assessment Questionnaire”. A statistical analysis included assessment of symptom burden, pairwise and multiple combinations of the set of symptoms, as well as calculation of conditional probabilities and correlation coefficients. Data processing were done using StatTech v.4.8.5 and Python 3.12.

Results. Women accounted for 69,2% (n=182) in the studied group of patients with post-COVID syndrome (n=263).

A high level of multisystem manifestation was observed, with an average of 4,7 ± 2,1 set of symptoms per one patient. The most frequent sets of symptoms were neurological (86.3%), cardiovascular (61.2%), and otolaryngological (60.8%) ones. Polysystem forms (≥4 sets of symptoms) were identified in 72.6% of patients, and extensive multisystemity (≥6) in 38.4%. Women demonstrated a significantly higher symptoms burden than men (p<0.001). Stable symptom combinations were commonly observed, particularly those involving neurological and psycho-emotional components (r=0.321; p<0.05).

Conclusion. Post-COVID syndrome in young adults is characterised by a high degree of multisystem involvement, with neurological and cardiovascular symptoms predominating. These findings highlight the need for a comprehensive approach to diagnosis and rehabilitation, even in a relatively safe age group.

Objective. To assess the efficacy and safety of the main treatment methods of chronic recurrent postcoital cystitis due to vaginal ectopia of the external urethral opening and/or urethral hypermobility in women.

Materials and methods. The study group included 42 female patients with chronic recurrent postcoital cystitis. The study included 3 stages. Patients used behavioral treatment and non-antibacterial drugs administration at stage 1. In case of ineffectiveness of the stage 1 they moved on to stage 2: patients received antibacterial drugs according to the prescribed regimen — drugs from the nitrofuran group at a single dosage of 100 mg after each sexual contact, or according to bacteriological urine culture. Stage 3 included surgical treatment — transposition of the external opening of the urethra with excision of urethrohymenal adhesions, if any. This stage was used if stages 1 and 2 were ineffective. No relapses of postcoital cystitis were detected after surgical treatment in 94.7% of patients. All patients underwent cystoscopy with a biopsy of the bladder mucosa before surgery and 3–6 months after it. The observation period was at least 12 months after surgery.

Results. Behavioral treatment and non-antibacterial drugs administration were effective in 4/42 (9.6%) patients.

Effectiveness of antibacterial therapy according to the prescribed regimen after each sexual contact was 14/42 (33.3%). Surgical treatment was performed in 38/42 (90.5%) patients. Effectiveness of surgical treatment of eliminating recurrent postcoital cystitis was 36/38 (94.7%).

Conclusion. If surgical intervention is clinically indicated, and with a technically correct surgical technique, the risk of complications is minimal, and cystoscopy with bladder biopsy is an objective method for diagnosing morphological changes in the mucosa. Persistence of relapses of chronic recurrent cystitis against the background of morphological changes in the bladder mucosa after surgical correction of pathogenetic factors (vaginal ectopia of the external urethral opening and/or urethral hypermobility) indicates other pathogenetic mechanisms for the development of the disease.

Objective. To assess the risk of developing cervical dysplasia depending on the type of human papillomavirus (HPV) and the age of women (on the case of women from Gomel region).

Materials and methods. Cytological examination and testing for HPV of Viral Cancer Risk (VCR) were carried out from 2018 to 2023 using the Abbott RealTime hrHPV (USA) kit on the Abbott m2000sp device. This test separately detects HPV 16, HPV 18 and a pool of 12 additional HPV hrHPV types (HPV 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). Material — scrapes from the cervical canal. 11382 women from Gomel region were examined.

Results. According to the results of the molecular genetic study, the infection rate of HPV VCR in women of Gomel region was 8.97% (n=1022). A tendency for the highest infection rate was noted in younger women. Thus, the highest number of HPV-positive samples was detected in the groups of 18-24 years old (n=276), 25-29 years old (n=156), 30-34 years old (n = 154). It was found that the relative risk (RR) of developing high-grade dysplasia in case of infection with HPV VCR was significantly higher in women of the age groups of 25-29 years old (RR — 66.3 (95% confidence interval (CI) 15.58; 281.7)), 35-39 years old (RR 35.4 (95% CI 13.05; 95.79)) and 18-24 years old (RR 18.5 (95% CI 5.31; 64.46)). 711 (6.2%) women with a high probability of developing cervical dysplasia were identified. A high risk of developing dysplasia was noted in cases of infection with type 16 and/or type 18 of the virus, as well as for women aged 18-34 infected with other genotypes of HPV VCR.

Conclusion. Information on age and infection ith various genotypes of HPV VCR may be very useful for formation of risk groups of development of cervical dysplasia and effective strategies design for prevention of precancerous processes and cervical cancer associated with HPV.

Objective. To determine features of IL-8 and IL-10 production in pregnant women with urogenital infections (UGI) in the first trimester, and their role for prognosis of obstetric and perinatal complications.

Materials and methods. The prospective cohort study included 98 pregnant women in the first trimester, of which 66 patients were diagnosed with genital infections (GI) — main group, 8 had genital infections combined with urinary tract infection — comparison group, and 24 pregnant women without urogenital infection formed the control group. Concentration of IL-8 and IL-10 in the blood serum was determined by the enzyme immunoassay method. The characteristics of the course of pregnancy, childbirth, and the condition of the newborns were assessed.

Results. Systemic production of IL-8 and IL-10 in the first trimester of pregnancy does not depend on the presence of genital infection. Recurrence in patients of the main group is preceded by higher serum levels of IL-8, determined in pregnant women in the first trimester with diagnosed GI (p=0.0001; Z=3.794). It is possible to predict the development of a relapse of GI in the second-third trimester (AUC=0.809; 95 % CI 0.694-0.895; p=0.0001) at IL-8 concentration of more than 7.6 pg/ml in pregnant women with GI in the first trimester with a sensitivity of 82.4% and a specificity of 83.7%.

The formation of placental insufficiency in patients of the main and control groups was preceded by higher concentrations of IL-8 in the first trimester of pregnancy (pо = 0.0001; Z=3.871; pк =0.025; Z=2.235). In pregnant women without UGI with a serum IL-8 level of more than 14.15 pg/ml, it is possible to predict the development of placental insufficiency with a sensitivity of 100% and a specificity of 95.5% (AUC=0.977; 95% CI 0.817-0.988; p=0.0001).

Development of threatened miscarriage was associated with higher serum levels of IL-10 in the first trimester of pregnancy (pо=0.007; Z=2.682; pк =0.031; Z= 2.153) in the main and control groups.

Conclusion. Determination of IL-8 and IL-10 levels in the blood serum of women in the first trimester of pregnancy allows predicting the development of gestational complications such as threatened miscarriage, development of genital infection and placental insufficiency, development of genital infection and placental insufficiency, timely formation of risk groups for medical prevention of these complications and, thereby, improvement of maternal and perinatal outcomes.

Objective. To evaluate clinical effectiveness of the main methods of surgical treatment of patients with extensive post-traumatic soft tissue defects of the distal areas of lower extremities.

Materials and methods. A comparative analysis of the results of surgical treatment of 72 patients with extensive post-traumatic soft tissue defects of the distal areas of lower extremities was carried out. They were treated at 432 Order of the Red Star Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus in the period of 2016-2021.

Results. Autodermoplasty with a split skin flap, transplantation of free flaps with the creation of vascular anastomoses and non-free skin-fascial flaps with axial blood supply is accompanied by a high incidence of local postoperative complications in 40-52.4% of cases, the need for repeated surgeries in 33.6-45.2% of patients, a long period of complete wound healing of 24-35 days.

Conclusion. Plastic surgery with neurovascular (sural or safenus) flaps can be considered as a basic method of surgical treatment of patients with extensive post-traumatic defects of soft tissues of the distal areas of lower extremities, taking into account justified need for technical improvement of this operation, including additional use of regenerative technologies.

Objective. To study prevalence and relationship of polymorphic variants of the PNPLA3 and TM6SF2 genes on liver function tests, as well as on lipid and carbohydrate metabolism parameters in patients with non-alcoholic fatty liver disease (NAFLD) living in the Gomel region.

Materials and methods. A total of 152 patients with NAFLD without liver cirrhosis aged 56 [48;63] years were examined to determine the PNPLA 3 gene polymorphism. A total of 144 patients with NAFLD aged 56 [48;63] years were examined to determine the TM6SF2 gene polymorphism. DNA was isolated using a reagent kit manufactured by ArtBioTech LLC, Republic of Belarus, according to the manufacturer’s instructions (the kit is designed to isolate RNA and DNA from a wide range of clinical material).

Results. In the study of prevalence genotype GG was identified in patients with NAFLD due to polymorphism of the PNPLA3 gene in 60 (39.5%) people, the GC genotype was determined in 22 patients (14.5%), the CC genotype - in 70 (46%) patients. When determining the prevalence of the TM6SF2 gene polymorphism It was established that the TT genotype was detected in 2 (1.3%) patients with NAFLD, TC genotype – in 30 (20.7%), CC genotype – in 112 (78%) patients.

Conclusion. As a result of the study, a difference in the levels of alanine aminotransferase (ALT) and alkaline phosphatase (ALP) was found in patients with the rs738409 polymorphism in the PNPLA 3 gene (GG genotype) compared to the CC genotype (p=0.0243 and p=0.0029, respectively). Patients with the rs58542926 polymorphism of the TM6SF2 gene (TT +TC genotype) also had a higher level of ALP (p=0.0034) compared to the CC genotype.

Objective. To assess satisfaction of medical staff with the organization of their activities before and after the implementation of a multi-level system of medical support of sports training.

Materials and methods. Sociological (survey) and statistical methods were used in the study. A total of 277 medical professionals from institutions of various levels of medical support of sports training participated in the study.

Results. The level of general assessment of the organization of activity before and after the introduction of a multilevel system of medical support of sports training was characterized by a statistically significant (Chi-square test: x2=84,43, p=0,00001) increase in the proportion of respondents who assessed this process above average from 12,3% to 68,9%.

Conclusion. The implementation of the new multi-level system of medical support of sports training ensured an improvement in the quality and efficiency of medical assistance throughout the entire training process.

Objective. To conduct a hygienic assessment of technological cards and a study of the quality of dishes intended for children with celiac disease using laboratory methods.

Materials and methods. An analysis of technological cards for dishes designed for children with celiac disease was performed in order to assess their compliance with hygienic standards. Laboratory tests were conducted to detect gluten traces and phenylalanine content in the prepared dishes, including the examination of ingredients and adherence to technological processes, as well as calculation of macronutrient content (proteins, fats, and carbohydrates).

Results. According to the obtained results in samples of dishes 1-5 and 7-13, the gluten content was less than 10 mg/kg. Gluten content in the sample 6 was more than 80 mg/kg, and it should therefore be categorized as a product with reduced gluten content. The analyzed dishes contain sufficient amounts of protein, although some of them can be classified as low-protein dishes, and could be used not only for children with celiac disease but also with other diseases requiring to keep a low-protein diet. The analysis showed that most dishes contain an adequate amount of fat, and carbohydrates are also presented in sufficient quantities.

Conclusion. The conducted study demonstrated that the technological cards developed for children with celiac disease meet basic hygienic requirements. The hygienic assessment of the developed technological cards confirms the importance of a comprehensive approach to organizing meals for children with celiac disease, and implementation of these technological cards will significantly enhance the effectiveness of the diet and improve the quality of life for children with celiac disease. However, when using the developed technological cards in educational institutions, where children eat collectively, there may be situations that could lead to unintended contact between gluten-free dishes and gluten-containing products. Preventative measures to avoid potential cross-contamination with gluten should be considered.

Objective. Evaluation of the level of population immunity to SARS-CoV-2 among the population of the Republic of Belarus.

Materials and methods. Evaluation of population immunity to SARS-CoV-2 among the population of the Republic of Belarus was carried out in accordance with the protocol developed by World Health Organization (WHO) and adapted for the Republic of Belarus («An age-stratified seroepidemiological investigation protocol for COVID-19 infection in the Republic of Belarus») within the 3-stage longitudinal stratified by age seroepidemiological study, which included questionnaires and a study of the seroprevalence to the RBD fragment of the SARS-CoV-2 S protein. Determination of total (IgM and IgG) antibodies to SARS-CoV-2 was carried out using the qualitative enzyme immunoassay kit Wantai SARS-CoV-2 Total Ab (Beijing Wantai Biological Pharmacy Enterprise, Beijing, China).

Results. At the first stage of the study, conducted one year after the registration of the first COVID-19 case, the population immunity in the Republic of Belarus was 63.2%. The proportion of seropositive participants both among children and adults increased during the subsequent two stages, reaching a combined total of 81.0% by October 2021. Seroprevalence among participants with an active lifestyle was higher compared to individuals who limited physical contacts during this period. At all three stages of the study, the highest proportion of seropositive individuals was found among healthcare workers.

Conclusion. Formation of the population immunity to the SARS-CoV-2 virus occurred through a hybrid pathway, combining natural protection following infection and post-vaccination immunity. The country’s COVID-19 response strategy, including the absence of lockdowns and a large-scale vaccination campaign, had a significant impact on the level of seroprevalence.

Objective. To study the main characteristics of a single population first recognized as disabled due to hand and wrist injuries.

Materials and methods. An unselected sampling of the patient population was formed, which included 747 people aged over 18 years old who underwent initial examination in the medical and rehabilitation expert commission of the Republic of Belarus for the period of 2014-2023, and were recognized as disabled due to physical dysfunction caused by the consequences of hand and wrist injuries. Materials of the database of the Republican Information and Analytical System on Medical Assessment and Rehabilitation of Disabled Persons of the Republic of Belarus were used.

Results. The average annual rate of primary disability due to hand and wrist injuries average for the period of 2014- 2023 in the Republic of Belarus was 0.10 (95% DI: 0.09-0.11) per 10,000 population, the proportion of men in the structure of primary disability was 83.5 %, the average age of persons first recognized as disabled was 46.4±12.1 years old. Among the persons first recognized as disabled, 82.7% were employed in working professions, urban residents prevailed over rural residents by 1.9 times. Crushing and traumatic amputation at the level of the wrist and hand, leading to disability, prevailed in 18-49 year olds and urban residents, accounting for 38.9%. Among rural residents, nerve injuries at the level of the wrist and hand were the predominant disabling injuries in 37.0% of cases. In 29.2% of cases of primary disability due to injuries of the hand and wrist, the cause of disability was determined as “labour injury”, of which in 34.5% of cases, the degree of loss of professional working capacity was determined as 60% due to loss of fitness for a skilled occupation.

Conclusion. The main characteristics of the contingent, first recognized as disabled due to hand and wrist injuries, are of working age, male gender, employment in working specialties, a significant proportion of persons who received industrial trauma, the prevalence of severe injuries in the form of traumatic amputations of the hand and wrist, a high percentage of loss of professional ability to work, which, taking into account the crucial role of the hand in human production activity, indicates the central direction of rehabilitation of this population — elimination of restrictions to work through professional rehabilitation measures, creation of an inclusive environment for obtaining the opportunity to carry out work activities, as well as improving preventive measures of this type of injury.

Objective. Analysis of organizational measures for early detection of pharyngeal mycosis in patients with respiratory diseases by validating original questionnaires.

Materials and methods. In a prospective study for early detection of pharyngeal mycosis in patients with respiratory diseases, 127 children (2-17 years old) participated in the pulmonology department of the “Gomel Regional Clinical Hospital” from October to December 2018. Questionnaires using original tools were completed by the children’s legal representatives. The diagnosis of pharyngeal mycosis was verified comprehensively: clinical examination (pharyngoscopy), microscopy (KOH, Gram), mycological culture (titer ≥10⁴ CFU/ml). An analysis of organizational measures for early detection of pharyngeal mycosis in patients with respiratory diseases was performed by validating the authors’ questionnaires. Statistical analysis was performed in R environment (version 4.5.0) using packages: rstatix (statistical testing), ggstatsplot and ggplot2 (visualization), pROC (ROC analysis), and dplyr (data manipulation).

Results. The validated express questionnaire for patients with pharyngeal mycosis (EQPM) associated with respiratory diseases (≥6 points: PPV=81%, NPV=77,4%, AUC=0.684, point-biserial correlation r=0.816, p<0.001), and the questionnaire for anxiety in pharyngeal mycosis (QAPM) (98% vs 8% of disorders with/without pharyngeal mycosis, AUC=0.982, point-biserial correlation r=0.963, p<0.001) revealed a strong association of pharyngeal mycosis with somatic symptoms and psychosomatic disorders, justifying their use for early detection of pharyngeal mycosis and the need for an interdisciplinary approach.

Conclusion. Implementation of the EQPM and QAPM into clinical practice allows optimizing the early diagnosis of pharyngeal mycosis in patients with respiratory diseases, timely initiate etiotropic therapy, assess concomitant psychosomatic symptoms, and personalize treatment improving control of the basic disease and patients’ quality of life.

Objective. To conduct medical and sociological study of the awareness of the population and healthcare professionals (HCPs) on medical prevention, diagnosis, and treatment of patients with pharyngeal mycosis (PM) against the background of respiratory diseases (RDs); to improve effectiveness of early detection and diagnosis of pharyngomycosis (PhM) associated with RDs through the implementation of a standardized clinical and organizational algorithm

Materials and Methods. A comprehensive clinical and organizational algorithm including original questionnaires, a sequence of diagnostic stages, regulated techniques for obtaining biological material, and pharyngeal tissue biopsy for resistant and/or invasive forms of PhM, was developed. The medical and sociological study on the awareness of the population (108 respondents of different age categories and education levels) and healthcare professionals (100 specialist doctors in otorhinolaryngology (ENT) and other specialties) regarding medical prevention, diagnosis, and treatment of patients with PM against the background of RDs was conducted. All questionnaires were developed based on international analogues and underwent a process of sociological review. A statistical analysis was performed in the R environment (version 4.5.0) using packages: rstatix (performing statistical tests), ggstatsplot and ggplot2 (visualization of results), pROC (ROC-analysis), dplyr (data manipulation).

Results. Developed clinical and organizational algorithm for early detection and diagnosis of PM associated with respiratory diseases (RDs) increased the detection rate of superficial forms to 32.3%, and pharyngeal fungal lesion to 40.2% (clinically, microscopically, microbiologically), and invasive forms to 2% (morphologically), owing to standardized questionnaires, stepwise diagnostics with clear criteria of pharyngeal tissue biopsy and standards for obtaining biological material. The implementation of the algorithm justified by critical knowledge deficits in the population (only 35.2% associate hormone therapy with the risk of mycoses, χ² = 9.48, p = 0.002; 70.4% mistakenly consider PM as contagious, χ² = 18.93, p < 0.001) and healthcare professionals (low awareness of algorithms, p = 0.099; U-shaped relationship of knowledge with work experience), ensured medical and economic efficiency: preventing one case of invasive PM saves ~ 98 thousand BYN (system potential is ~ 45.5 million BYN/year), optimized patient flow (67.6% of the population is ready to seek care for symptoms), and unified approaches for early detection and diagnostics of PM associated with RDs in the healthcare system of the Republic of Belarus.

Conclusion. Implementation of the clinical and organizational algorithm for early diagnosis of RD-associated PM eliminates critical knowledge deficiency among doctors (only 24% of HCPs are aware of algorithms), increases the detection of superficial forms to 32.3%–40.2% and invasive forms to 2%, ensuring annual savings of ~45.5 million BYN and standardization of medical care in the Republic of Belarus.

The article presents a clinical case of observation and successful treatment of a patient with rapidly developing avascular necrosis of the both femoral heads and septic arthritis of both hip joints. Methods and tactic of staged conservative and surgical treatment of the patient were described. A good result of two-staged arthroplasty of one of the hip joints concluded in restoration of the support ability of the leg and the ability of the patient to move independently is noted.

The article presents a clinical case of a rare disease - angiolymphoid hyperplasia with eosinophilia. Once considered to be different stages of the same disease, angiolymphoid hyperplasia with eosinophilia and Kimura’s disease are considered as different diseases now. Timely diagnosis and adequate treatment are essential for prognosis.

Catamenial pneumothorax is a pathological condition which appears to be difficult to recognize. The specific type of spontaneous pneumothorax tends to recur during menstruation, within 72 hours before or after the onset of a cycle. As a rule, pathogenetic relation to gynecological disease leads to the delayed diagnosis despite catamenial pneumothorax is one of the most common manifestations of thoracic endometriosis. Extensive awareness and alertness of all medicine specialists will lead to understanding that catamenial nature should be considered in all cases of spontaneous pneumothorax in women (primarily of reproductive age). It will help to make accurate diagnosis and to choose adequate treatment tactics and relapses prevention.

The article presents a review of research studies on catamenial pneumothorax and relevant clinical observation.

Objective. To examine possible factors indicating the development of delusional jealousy as a case study and available literary studies.

Materials and methods. The degree of expression of psychopathological symptoms was assessed using the PANSS scale (Kay et al., 1987). The degree of expression of anxiety was assessed using the Spielberger-Khanin Anxiety Scale (STAI). The degree of distortion of thinking was assessed using pathopsychological diagnostics by using the methods of «elimination of the superfluous», «classification of objects», «pictogram method», «explanation of proverbs and metaphors», «comparison of concepts», and «Leontiev’s method».

Results. Changes in the understanding of the formation, prevalence, and emotional component of delusional jealousy are discussed in a brief literature review. The literature review also includes examination and discussion of a clinical case of a 42-year-old patient with underlying alcohol use disorder, substance use disorder (barbiturate), anxiety disorder, and delusional jealousy.

Conclusion. The presented case demonstrates the difficulty of delusional jealousy diagnosing at the initial stage of the disease. Pronounced symptoms of anxiety might be predictors of the transformation of the psychological construct of jealousy into delusional jealousy. Taking into account a high risk of aggressive behavior in delusional jealousy, patients with high anxiety and jealousy require additional thinking diagnostics and close observation.

Objective.To scientifically substantiate a microbiome-associated approach to medical prevention of congenital pneumonia in premature newborns based on determination of the oropharyngeal microbiome, and identification of signs of chronic intrauterine hypoxia.

Materials and methods. 75 premature newborns with congenital pneumonia against the background of chronic intrauterine hypoxia (the main group) and 79 infants without congenital pneumonia with infectious diseases specific for the perinatal period (the comparison group) were examined. A new generation sequencing was performed with the MiSeq (Illumina) apparatus. Statistical data processing was carried out in the R programming environment (version4.3.1), RStudio program (2023.09.1+494). The significance level was accepted equal to 0.05.

Results. The median gestational age in the main group was 28.00 [26.00; 30.00] weeks, and in the comparison group it was 33.00 [31.00; 35.00] weeks, with p-val <0.001. During the sequencing process of the oropharyngeal biomaterial, microbiome-associated biomarkers of congenital pneumonia were identified in premature newborns at the genus level: Brucella (≥5.8%, Se=0.88 and Sp=0.57); Achromobacter (≥ 3.1%, Se=0.667 and Sp=0.658); Ralstonia (≥0.3%, Se=0.653 and Sp=0.709); Stenotrophomonas (≥ 9.0%, Se=0.64 and Sp=0.671); Klebsiella (≥ 0.02%, Se = 0.693 and Sp=0.595); Pseudomonas (≥1.5%, Se=0.6 and Sp=0.684). Obtaining one or more microbiome-associated biomarkers in the form of the above-mentioned bacteria in a nasopharyngeal sample is a basis for definition of pneumonia probability in premature newborns within the method for medical prevention of pneumonia in premature newborns.

Conclusion. With regard to identified microbiome-associated biomarkers (Brucella ≥5.8%, Achromobacter ≥3.1%, Ralstonia ≥ 0.3%, Stenotrophomonas ≥9.0%, Klebsiella ≥0.02%, Pseudomonas ≥1.5%) and the level of hypoxia-inducible factor (HIF-1-alpha ≥0.017 ng/ml), a medical software has been developed on the ground of artificial neural networks allowing to determine likelihood of having congenital pneumonia in premature newborns. Based on the identified biomarkers, the “Method of Medical Prevention of Pneumonia in Premature Newborns” has been developed and implemented in practical healthcare, approved by the Ministry of Health of the Republic of Belarus as of 26.05.2025, with the registration number 005-0225, and in the form of an instruction for use.