The article provides a literature review on the anatomy, physiology, diagnosis and treatment of diaphragm eventration in children. There are congenital and acquired variants of pathology. The reason of congenital eventration development is a malformation of its muscle layer. The main reasons of obtained diaphragmatic eventration in children are damage of the phrenic nerve during surgical correction of congenital heart defects (CHD), birth trauma or catheterization of central veins. Injuries of the phrenic nerve, accompanied by diaphragm eventration, are registered after cardiac surgery with a 0.3 % to 12.8 % rate. The frequency of this complication in the Republican Scientific and Practical Center of Pediatric Surgery (Belarus) was 2.54 % in 2021; 2.94 % in 2022; 3.16 % in 2023. The increase in the diaphragm eventration number after cardiac surgery is associated with an increase in the complex surgeries number in the structure of surgical activity, as well as the number of repeated heart operations (resternotomies).

Advances in science are leading to a better understanding of the mechanisms underlying the functioning of the human body. Until May 2023, betacoronavirus B, SARS-CoV-2, was a global public health emergency. Evidence suggests that many patients with COVID-19 suffer from multiple symptoms that persist beyond the acute event for several years. This phenomenon is called post-COVID syndrome (PCS) or long COVID. This article provides some clinically important scientific data on the prevention, diagnosis, and treatment of neurological disorders caused by SARS-CoV-2 in the post-COVID period. It demonstrates the importance of a thorough history of the disease development with a search for a possible connection between current symptoms and the  “common”  ARI  that  preceded  them. The importance of an integrated approach to the diagnosis and treatment of symptoms of long COVID is shown.

The article presents a review of the current approaches to testing and treatment of HCV infection in prison populations. It provides data from literature sources; including research and review articles; as well as clinical guidelines from the European (2020) and American (2023) Liver Disease Societies. Particular attention is paid to the treatment of HCV infection in patients in prison; as this contributes to the elimination of HCV infection in the community.

Pulse waves and the response of arterial vessels to changes in hemodynamics have been studied in 121 subjects, of which 58 women and 59 men were of age 21.5 ± 1.6 years old, and 4 subjects 63–79 years old. Pulse waves were recorded by two methods: using photoelectric and mechanoelectric sensors, synchronously with ECG in 2nd standard lead. The reaction of small arteries and arterioles was recorded by method of microspectrometry. Based on the analysis of the results of this study and literature data, the following conclusions and assumptions can be made:

- the use of sensors that respond to mechanical pulsating displacements of the arterial wall caused by changes in blood pressure in the systole and diastole of the heart allows recording pulse pressure The use of sensors sensitive to changes in the volume and velocity of blood flow makes it possible to record pulse flow waves. Synchronous recording of pulse oscillations with these two types of sensors makes it possible to record both types of pulse waves;

- pulse pressure waves propagate along the arterial wall at a higher velocity than the velocity of pulse flow wave in blood, and pulse pressure wave is recorded earlier than flow wave;

- pulse waves parameters (amplitude, steepness of anacrotis, duration of delay of onset of anacrotis relative to R wave on ECG, delay pulse flow waves relative pulse pressure waves, pulse waves propagation velocity) depend on the rate of myocardium excitation, stroke volume, arterial pressure and volume of blood flowing into arterial

Additional research is required to verify the assumptions made about the role of pulse waves in implementation and regulation of hemodynamics in a healthy body, and the possible significance of its disturbance in the  mechanisms  of  development  of  cardio  vascular and other diseases.

Objective. To study the frequency of blood transfusions during open adenomectomy and TURP, as well as to evaluate the degree of blood loss and the frequency of red blood cell transfusions in a prospective randomized clinical trial.

Materials and methods. The frequency of open operations and TURP in the 4th Minsk City Clinical Hospital for 2016–2018. The frequency of blood transfusions was studied in a retrospective study, and the degree of blood loss and the frequency of red blood cell transfusions were determined in a prospective randomized clinical trial.

Results. The rate of open adenomectomies was 33.6 %, and TURP – 66.4 %. The rate of red blood cell transfusion after TURP was 2.8 % (21 patients), after open adenomectomy – % (33 patients) (χ² = 2, p = 0.001)). In a randomized study, the frequency of blood transfusions in the main group was 2.2 % (2 patients), in the comparison group – 12.6 % (11 patients) (F = 0.199, p = 0.007). Total blood loss after adenomectomy from the open approach was 500 (373–600) ml in patients from the comparison group, 240 (124–340) ml in patients from the main group (U = 881.0, p = 0.001).

Conclusion. The frequency of open operations for large volumes of BPH has remained high in recent years – 30.4–42.2 %. The total blood loss after open adenomectomy is 2.1 times lower, and the frequency of blood transfusions is 5.5 times lower with intraoperative use of the Gamastat, which undoubtedly indicates its good hemostatic effect.

Introduction. Arterial switch operation is performed in children with transposition of the great arteries (TGA) in modern pediatric cardiac surgery. Pulmonary valve begins to function as a systemic one after arterial switch operation, that is neoaortic valve (neo-AV). Objective was to evaluate the possibilities of neo-AV repair and replacement after arterial switch operation in children with TGA.

Materials and methods. Arterial switch operation was performed in 305 children with TGA at the RSPC “Cardiology” and RSPC of Pediatric Surgery from 2004 to 2024 years. Mean age of the children was 11.2 ± 3.8 days. Simple TGA was in 213 children (69.8 %).  TGA with ventricular septal defect was in 67 patients (22.0 %). Double outlet right ventricle with TGA (Taussig-Bing anomaly) was in 24 children (7.9 %). Congenitally corrected TGA with ventricular septal defect was in 1 patient (0.3 %).

Results. There were 18 deaths (5.9 %) during hospital stage after arterial switch operation, postoperative complications were diagnosed in 13 patients (4.3 %). Long-term period was studied in 253 children (83.0 %) after arterial switch operation. Mean follow-up duration was 8.1 ± 4.7 years. Neo-AV repair was performed in 1 patient (0.4 %), neo-AV replacement with mechanical prostheses was performed in 3 children (1.2 %) in long-term period after arterial switch operation.

Conclusion. It’s possible to replace neo-AV with mechanical prostheses of the required diameter in children with TGA after arterial switch operation.

According to the World Health Organization in 2019, for a citizen of Belarus, the probability of death (aged 30 to 70 years) from any of the four major non-communicable diseases (NCDs) is 23.8 %. Developing interventions to prevent chronic NCDs requires evidence to characterize the prevalence of behavioral risk factors. The contribution of insufficient daily consumption of vegetables and fruits to premature mortality from chronic NCDs is 12.9 %, and to the loss of healthy years of life – 6.9 %. It is of scientific interest to study the characteristics of the consumption of vegetables and fruits as alimentary risk factors in an urbanized environment. In the Republic of Belarus, the state preventive project “Healthy cities and towns” has been implemented in 2012 and in 2024 the project unites 379 settlements.

Aim. to assess the prevalence of consumption of vegetables and fruits as risk factors for the development of chronic NCDs in residents of settlements participating in the implementation of the state preventive project “Healthy cities and towns”.

Material and methods. The work was carried out within the framework of the initiative research “To develop an algorithm for assessing the effectiveness of the state preventive project” Healthy cities and towns. “ The material for the study was the data of a sociological study on the prevalence of behavioral risk factors for the development of NCDs in the population aged 18–69 years, conducted in 6 regional centers from 6 regions of the Republic of Belarus, implementing the state preventive project “Healthy cities and towns” for at least 4 years (n = 1608).

Results. A sufficient level of daily consumption of vegetables and fruits is noted in 30.35 %. Daily in the diet there are vegetables in 43.12 %, fruits in 35.95 % of the population. Every seventh adult practically does not eat vegetables (14.37 %) or consumes them 1–2 times a week, and every sixth (15.86 %) fruits. The frequency of daily consumption of vegetables and fruits is higher among women. With age, there is an increase in the frequency of daily consumption of vegetables and fruits from 28.69 % and 19.92 % among people 18–30 years old to 47.24 % and 40.71 % at 51–69 years old. Statistically significant differences in the consumption of fruits and vegetables were established depending on the duration of the implementation of the state preventive project “Healthy cities and towns.”

Conclusion. The results of the study indicate that higher population activity in the consumption of vegetables and fruits is associated with female gender and older age and significantly differs depending on the region.

Etiological factors in the development of congenital deformities of the spine, as well as any congenital pathology, may be the effects of adverse factors and teratogens during embryonic development (valproic acid, alcohol, hyperthermia, insulin-dependent diabetes in the mother, etc.). There are also hereditary forms due to the presence of mutations in the genes involved in the laying and development of connective tissue.

Materials and methods. The studies were carried out in 52 patients with congenital spinal deformities. Polymorphisms of detoxification genes GSTT1, GSTM, GSTP1 (lle105Val), GSTP1 (Ala114Val) were studied. To study mutations in the genes responsible for the growth rate and structure of the vertebrae and intervertebral discs – the HOXA11, HOXD13, RUNX2, CHST3, DLL3, MESP2, LFNG, HES7 genes, primers were developed for amplification and sequencing of the coding exons of these genes.

At the same time, the microelement composition of the blood (Zn, P, Ca, Cu), as well as the content of Se, Ag, Pb, Cd were studied in 52 patients. To measure the content of heavy metals cadmium and lead, as well as trace elements of silver in biosubstrates, an Agilent 240Z AA atomic absorption spectrometer with electrothermal atomization was used; to measure the selenium content, an atomic emission spectrometer with an Ultima-2 inductively coupled plasma was used. We also studied Zn, P, Ca, Cu «macroelements», the concentration of which in the body exceeds 0.01 %.

Results and its discussion. When conducting a genetic study, two mutations were identified in the HOXA11 and LFNG genes in two different patients, which are responsible for the development of connective tissue in general. In patients, there were gene polymorphisms, as well as deletions / insertions that are not pathogenic and either do

Results and its discussion. When conducting a genetic study, two mutations were identified in the HOXA11 and LFNG genes in two different patients, which are responsible for the development of connective tissue in general. In patients, there were gene polymorphisms, as well as deletions / insertions that are not pathogenic and either do not lead to an amino acid substitution in the protein or are a normal variant found in the normal population. As a result of the analysis of the data obtained in the study of trace elements and heavy metals, it was found that the ranges of values for the content of trace elements in  the  blood  serum  of  children  with  progressive  congenital  spinal  deformities  are,  μg/l: for lead – 0.001–246.460; cadmium – 0.001–3.387; silver – 0.001–165.786; selenium - 0,01–52.26 with medians, respectively, 001; 0.001; 3.819 and 14.650. An analysis of the lead content in the blood serum of children with bone pathology showed that in 32.7 % of the samples the content of this element exceeded the “conditional” norm by 2 times. The content of selenium in the blood serum of children is significantly below the “conditional” norm, while even the maximum value (52.26 μg/l) does not reach the lower limit of the reference range, the concentration of cadmium corresponds to the norm, in 86.4 % there was an increased content of phosphorus in the blood. Serious mutations have been observed in children with combined congenital malformations. They were combined with the absence of detoxification genes against the background of an increase in the content of lead and phosphorus in the blood of the subjects.

Conclusions

1. The presence of mutations in the genes responsible for the development of connective tissue as such can lead to the presence of multiple congenital
2. The most dangerous are the variants that correlate with an increase in the reference values of heavy metals such as lead and phosphorus in the absence of detoxification genes.
3. Conducting research using the determination of molecular genetic and biochemical markers in the diagnosis of congenital pathology is a promising direction, since it can be used to search for congenital pathology, along with radiation research

Pathology associated with impaired obliteration of the processus vaginalis in children is one of the most common conditions in childhood that requires surgical treatment, both planned and emergency. Currently, for indirect inguinal hernia, the use of ligature transcutaneous herniorrhaphy under laparoscopic visual control is becoming increasingly popular among pediatric surgeons. At the same time, a generally accepted surgical tactic when a direct inguinal hernia is detected in a child at the diagnostic stage of laparoscopic surgery has not yet been formed. Aim of this work was to develop a method of laparoscopic-assisted transcutaneous laparoscopic repair of the posterior wall of the inguinal canal in children with a direct inguinal hernia. In this case, the minimum set of surgical instruments used for laparoscopic herniorrhaphy for indirect inguinal hernia in children was used.

It is relevant to determine the characteristic parameters of physiological anemia in young children, which does not require correction. Differential diagnosis based on these parameters will identify pathological cases of anemia that require adequate correction. Pathological variants of anemia during this period are associated both with the pathology of pregnancy and childbirth, and with diseases in the postpartum period. Then the iron deficiency state is revealed, as well as the effect on erythropoiesis of various diseases – anemia of chronic diseases – ACD, etc., requiring multidirectional correction.

Purpose of the study: to establish the features (patterns) of physiological anemia in young children in order to identify cases of pathology that “fall out” from this group.

The results of a survey of 526 patients, aged from 4 days to 8 months, who were treated and examined in departments of various profiles of the 3rd State Children’s Clinical Hospital in Minsk in 2021–2023 (in the early childhood departments and the rehabilitation department) were analyzed. The following indicators were studied: erythrocyte content, hemoglobin, color index, MCV, MCH, reticulocytes, reticulocyte hemoglobin, serum iron, serum ferritin. C-reactive protein.

A quantitative PCR study was conducted using TaqMan Array Card on stool samples from 97 children in the acute phase of hemolytic uremic syndrome (HUS). Diarrheagenic E. coli was detected in 45 children, in 88.9 % (40/45) of cases it was shigatoxin-producing (STEC). Shiga toxin type 2 was detected in 67.5 % (27/40) of STEC strains, and both Shiga toxins:  types  1  and  2  were  detected  in  32.5  %  (13/40).  Serotyping  of  40  STEC  strains using  PCR  allowed  to  establish  the  O  serogroup  for  77.5  %  (31/40)  of  them.  The  most frequently encountered serogroups were: O157 – in 32.5 % (13/40) of the samples, O111 – in 17.5 % (7/40) and O145 – in 12.5 % (5/40). Three more O-serogroups (O55, O104 and O26) accounted for 15.0 % of the samples. Typing of the H antigen performed for 7 STEC strains using fliC gene sequencing showed that the H4 antigen was the most common. Analysis of the relationships between STEC O-serogroups and the severity of the course and outcome of HUS in a small group of patients showed that the groups of patients with O157 (13 people) and non-O157 (27 people) STEC-HUS practically did not differ in clinical and laboratory parameters, severity of the course and complications.

In accordance with the regulatory documents governing the testing of anti-tuberculosis effect, tuberculocidal regimens for disinfectants should be developed only based on the reference strain M. terrae ATC C 15755 as a target, since non-pathogenic M. terrae has a higher resistance to disinfectants than pathogenic mycobacteria. However, the time frame for disinfectants effectiveness assessment on the M. terrae test culture is at least 3 weeks. The aim of the work: to select a test culture from among the reference strains of fastgrowing non-tuberculous mycobacteria comparable in resistance to M. terrae ATCC 15755 for the purpose of disinfectants effectiveness testing acceleration. The comparative study of M. terrae ATCC 157, M. fortuitum ATCC 6841, M. smegmatis ATCC 19420 and M. phlei ATCC 1175 by a quantitative suspension method revealed similar minimal effective concentrations for all six studied disinfectants from different chemical groups in relation to M. terrae and M. fortuitum. This indicates the possibility of the M. fortuitum reference strain usage for accelerated (within 4–5 days) determination of the disinfectants effectiveness in relation to mycobacteria.

Tuberculosis remains one of the most pressing medical, social and economic problems of modern society due to its prevalence, duration and severity of the course, as well as the severity of primary disability in young and middle-aged people. 

Objective of the study. To analyze the indicators of primary disability in persons aged 18 years and older due to respiratory tuberculosis in the Republic of Belarus for the period 2013–2022.

Materials and Methods. The study included 2050 patients with respiratory tuberculosis aged 18 years and older initially examined by a medical rehabilitation expert commission for the period 2013–2022.

Results. In the Republic of Belarus for the period 2013–2022. the level of primary disability due to respiratory tuberculosis was 0.27 ± 0,07 per 10 thousand population. The severity of primary disability (disability groups 1 and 2) due to respiratory tuberculosis during the analyzed period as a whole amounted to 82,9 %. Among disabled people of group 2, the following clinical forms of pulmonary tuberculosis predominated: infiltrative pulmonary tuberculosis – 65,7 %, fibrous-cavernous pulmonary tuberculosis – 15,0 %, disseminated pulmonary tuberculosis – 13,5 %, caseous pneumonia – 3,2 %, pulmonary tuberculoma – 1,2 %. Among disabled people of group 1: infiltrative pulmonary TB – 16,7 %, disseminated pulmonary TB – 50,0 %, caseous pneumonia – 33,3 %. Middle age groups (50–54 years old – 0,35 ± 0,03 per 10 thousand population, 40–44 years old – 0,33 ± 0,02 per 10 thousand population) are predominant in the contingent of those initially recognized as disabled due to respiratory tuberculosis.

Conclusion. Studying the dynamics, medical and social aspects of disability due to respiratory tuberculosis is necessary to determine the types and volumes of medical care, as well as medical, social and professional rehabilitation when developing an individual rehabilitation program for a disabled person and their social integration.

In recent years, there has been a significant increase in the frequency of delivery by cesarean section. The article reflects the results of vaginal delivery of 80 women with a scar after surgery on the uterus. The anamnesis, clinical data, features of the course and management of labor, the condition of newborns, the severity of blood loss during childbirth, and the course of the postpartum period were studied. The favorable outcome of childbirth in women with surgical trauma of the uterus, meeting the criteria allowing for vaginal delivery, was 72.4 %. Management of childbirth through the natural birth canal in women with surgical trauma of the uterus has a beneficial effect on reducing the frequency of complications both on the part of the mother and on the part of the newborn and contributes to the early restoration of maternal activity. Total blood loss and length of hospital stay after vaginal delivery were significantly less than after cesarean section. All mothers were discharged home in satisfactory condition. In the context of rapid development of medicine, it is important not only to carefully select patients who do not have absolute contraindications to vaginal delivery, but also to increase the number of such women using modern technologies.

Total of 126 patients with heartburn but without esophageal mucosal injury were studied. They received a standard dose of PPI for 8 and more weeks. All of them underwent 24-hour multichannel intraluminal impedance–pH monitoring without acid suppressive therapy. According to all instrumental studies, three groups were identified: patients with non-erosive reflux disease, functional heartburn and reflux hypersensitivity. Based on the studies the differences between patients with heartburn in these groups were in esophageal acid exposure time, number of total acid/ weakly acidic reflux episodes, correlation between symptoms and reflux events, esophageal clearance function, mucosal integrity values.

Diffuse polyposis of the colon is a genetically determined disease that affects young people, inherited according to the principle of autosomal dominance with an 80 % degree of penetration of the APC gene and an almost 100 % malignancy index. 

Total coloproctectomy is the only radical method of treating diffuse colon polyposis, which leads to disability of the patient and is accompanied by impaired sexual and reproductive function. Total colectomy provides better functional results, but the remaining portion of the rectum can become a source of recurrence of polyps and lead to the development of rectal cancer.

Laparoscopic coloproctectomy is a modern method of treating diffuse colon polyposis that meets the requirements of early rehabilitation of patients, has optimal functional results while maintaining oncological principles of radicalism by removing malignant tumors.

This article reflects our unique experience of performing laparoscopic coloproctectomy with D3 lymphodissection in a patient with multiple primary colorectal cancer in the background of diffuse colon polyposis. The use of laparoscopic techniques provided the opportunity for early rapid rehabilitation (the patient was discharged on the 13th day in satisfactory condition) with subsequent good functional, psycho-emotional and social results when assessing the quality of life using the SF-36 questionnaire. At the same time, all the principles of oncological radicalism are observed, including the non-routine performance of D3 lymphodissection. Based on the results of histological and moleculargenetic studies, a decision was made to carry out chemotherapy in CapeOx regimen. During the control CT study and determination of the level of tumor markers six months after the operation, no evidence of progression was obtained.

Cortical focal hemosiderosis (CFS) is the deposition of iron metabolites, especially hemosiderin,  in  the  superficial  layers  of  the  brain  and/or  spinal  cord.  Clinical  manifestations in this disease depend on the location of the lesion, however, the deposition of hemosiderin may occur unnoticed. Common symptoms include hearing loss, cerebellar ataxia, pyramidal signs, dementia, urinary incontinence, disorders of the cranial nerves, sensory deficits.

Defects in the dura mater of the spinal cord, intracranial neoplasms, vascular abnormalities, related neurosurgical interventions, cerebral amyloid angiopathy (CAA) can lead to the development of CFS. There is also idiopathic superficial siderosis.

While CFS is diagnosed, it is important to search for the causes of hemosiderosis to increase the quality of life and decrease mortality rates in the structure of patients. For example, CFS is one of the key criteria for the diagnosis of CAA. This type of angiopathy is closely associated with an increased risk of spontaneous intracerebral hemorrhages.

The article presents data on the clinical picture, diagnostic features, as well as the results of our own observation of two clinical cases of CFS.

In 1932, at a meeting with leading medical scientists of the USSR on the issue of creating the All-Union Institute of Experimental Medicine (VIEM), which should be engaged in a comprehensive study of man and the implementation of the obtained results in practical health care for effective prevention, diagnosis, treatment and rehabilitation of patients, the General Secretary of the Central Committee of the All-Union Communist Party (bolsheviks) Stalin I. V. raised the question of the possibility of creating the USSR Academy of Medical Sciences instead of VIEM. However, medical scientists considered that it was too early to create the USSR Academy of Medical Sciences at that time and that it was first necessary to learn how to work comprehensively within the framework of the multidisciplinary VIEM. Stalin's proposal was supported and, created in 1932 in Leningrad with a branch in Moscow, VIEM began to conduct extensive scientific research. In 1934, the main core of VIEM was relocated to Moscow, and the Leningrad part received the status of a branch. However, VIEM failed to establish close ties with practical healthcare, which led to the development of work on the creation of the USSR Academy of Medical Sciences using, in particular, the VIEM database. This work was intensified during the Great Patriotic War. The issues of organizing the  USSR  Academy  of  Medical  Sciences  were  considered  at  meetings of the Scientific Medical Council of the USSR People's Commissariat of Health (UMS). A special Commission was created for these purposes. The following took an active part in the work on organizing the USSR Academy of Medical Sciences: USSR People's Commissar of Health Miterev G. A., Deputy People's Commissar of Health of the USSR, who supervised science, professor-physiologist Parin V. V., Chairman of the UMS, Chief Surgeon of the Red Army, Academician of the USSR Academy of Sciences, neurosurgeon Burdenko N. N., Director of VIEM, Corresponding Member of the USSR Academy of Sciences, physiologist, neurologist and neurosurgeon Grashchenkov N. I. and others.

Nikolay Semenovich Misyuk is a doctor of medical sciences, professor, corresponding member of the USSR Academy of Medical Sciences, chief neuropathologist of the Ministry of Health of the Byelorussian SSR. This article attempts to tell his life story in honor of the 105th anniversary of his birth. Nikolay Semenovich made a significant contribution to healthcare of both the USSR as a whole and the Byelorussian SSR, in particular: he was the first to perform stereotactic operations on the thalamus, one of the first in the USSR to formulate the principles of endovascular surgery and performed a series of operations for hypertension, the founder of medical forecasting in clinical neuropathology based on mathematics and computer work, the creator and first head of the Belarusian Republican Center for Forecasting Cerebral Strokes. He went through the Great Patriotic War as a doctor and commander of medical units, and was awarded medals and orders. N. S. Misyuk trained more than one generation of doctors, working at the Department of Nervous Diseases of the Leningrad State Institute for Advanced Medical Studies, and later heading a similar department at the Arkhangelsk State Medical Institute and the Minsk State Medical Institute. N. S. Misyuk is an outstanding person who left his mark on history, a doctor, an organizer, who is remembered by descendants, colleagues, friends and all those who ever knew him!