The analysis of the world and domestic literature devoted to modern approaches to the complex treatment of closed segmental and multi-fragmented diaphyseal fractures of the lower leg bones in people of working age is carried out, as well as the pathogenetic mechanisms of remodeling in the fracture zone are consecrated. To date, there is no comprehensive information on the required number of sessions and their duration when using hyperbaric oxygenation and antioxidants in the pre- and postoperative periods in patients with fractures of the lower leg bones. This justifies the relevance of further research in order to develop a new concept of complex treatment, which consists in a differentiated approach to the use of hyperbaric therapeutic oxygen in combination with antioxidants in patients with fractures of the lower leg bones.

Experimental work was carried out using a hybrid material based on fibrin and hydroxyapatite gel for use in septoplasty. On the model of the pig’s head, the technology was worked out with the reimplantation of a part of the nasal septum with a hybrid material containing small fragments of cartilage. After separating the soft tissues of the nose, detaching the mucoperichondrium, a part of the porcine nasal septum 2ђ3 cm in size was resected and fragmented, which was used to form a hybrid material. The basis of the hybrid material was citrate plasma. To initiate the fibrin polymerization cascade, a mixture of solutions based on 10 % calcium gluconate and adrenaline (1.85 mg/ml) was used at a calcium gluconate/ adrenaline volume ratio of 17:1. Synthetic hydroxyapatite gel was used to stimulate osteoconduction and osteoinduction. From the above components, a hybrid material was formed, which, upon repeated compression, was compacted due to fibrin retraction. The hybrid material was successfully installed in the area of the porcine nasal septal defect, which confirms the possibility of performing septoplasty using this technique.

The article describes all three sections of the classification of gluten-related disorders. From the very beginning of our presentation, the emphasis is placed on the section less covered in the medical literature, we are talking about non-celiac gluten sensitivity (NCCHG). According to international experts, the prevalence of this condition in the world is greater than celiac disease and wheat allergies. Triggers for the development of NCCHG in addition to gluten may be non–gluten proteins ATI – trypsin and amylase inhibitors. ATI is a group of several low molecular weight proteins that are highly resistant to proteolysis in the intestine. In wheat grains, ATI are in the gluten protein network. Gluten-free products do not contain ATI. The details of the clinical picture are given, both on the part of the intestine and extraintestinal symptoms. NCCHG is called «gluten-sensitive irritable bowel syndrome. The criteria of the Salt – diagnostic algorithm of the NCCHG are given. The following two parts provide information about celiac disease, an immunomediated systemic disease, and modern possibilities for its diagnosis, as well as describe wheat allergy options. Wheat contains more than three hundred proteins, three dozen of them are recognized as allergenic. Each section presents a clinical picture, diagnostic methods and treatment.

To diagnose NCCHG, it is necessary to establish the relationship of symptoms with gluten intake, prove the absence of serological markers of celiac disease and exclude wheat allergy. All these stages are described in the article.

Infertility is one of the most increasing health problems of the population. Endometrial structure and receptivity are among the most significant factors for successful embryo implantation and pregnancy development. Nevertheless, the available data on the regulation of endometrial function and its structure in conditions of hormonal and metabolic dysbalance are insufficient. This makes it necessary for deeper research of the human endometrium in these fields. In the review we analyzed the genetic and epigenetic changes of the endometrial tissue, presented modern ideas about the cellular and tissue levels of regulation of normal endometrium and their changes in patients with polycystic ovarian syndrome (PCOS). Modern diagnostic markers of endometrial dysregulation are also considered. However, it is noted that further research is required to develop clear diagnostic algorithms and therapeutic effects aimed at improving reproductive outcomes in PCOS.

Gram-negative bacteria (GAB) continue to lead in terms of antibiotic resistance among the causative agents of opportunistic infections. K. pneumoniae occupies a special placeamong GOBs, causing secondary bacterial infections with a high frequency in patients with COVID-19.

Objective. To study the dynamics of sensitivity/resistance to antibiotics of K. pneumoniae clinical isolates isolated from biological material in patients with secondary bacterial infection with COVID-19.

Materials and methods. In terms of sensitivity/resistance, 535 clinical isolates of K. pneumoniae isolated from patients with COVID-19 in various regions of the Republic of Belarus in the period 2019–2021 were studied.

Results. The proportion of clinical isolates of K. pneumoniae resistant to antibiotics against the background increased in 2021 compared to 2019 and was for carbapenems in 2019 ertapenem – 46,4 ± 3,35 %, imipenem – 35,8 ± 3,19 % and meropenem – 39,6 ± 3,28 % and in 2021 ertapenem 66,7 ± 4,74 % (p = 0,000603), imipenem 54,4 ± 4,66 % (p = 0,001253) and meropenem 54,5 ± 4,49 % (p = 0,008182). K. pneumoniae showed a high frequency of resistance to colistin: against the background of COVID-19 in 2019 – 95,0 ± 4,87 %, in 2020 – 100,0 ± 0,0 % (p = 0,311608), in 2021 – 55,3 ± 7,25 % (p = 0,000046).

Conclusion. Among clinical isolates of K. pneumoniae, widespread resistance to most antibiotics was observed, as well as an increase in resistance to carbapenems.

Hepatitis E virus (HEV) is a poorly understood pathogen that is widespread in humans and animals. In the genomes of all organisms, there is a bias in the use of synonymous codons. Mutations, genetic drift and natural selection are the main factors that determine codon usage bias in the genomes of viruses. The aim of this study was to study the systematic error in the use of synonymous codons in whole genome sequences of HEV RNA genotypes 1 and 3 isolated from different hosts. We studied 309 complete HEV genomes deposited in the GenBank NCBI database (in silico). In the sequences of open reading frames ORF1, ORF2, and ORF3, the nucleotide composition, the composition of dinucleotides, the relative use of synonymous codons were studied, ENC-Plot analysis and parity rule analysis was performed, the dN/dS ratio was calculated. Found: GC composition of HEV sequences is 59.3 ± 0.52 %; in ORF1 and ORF2 in the third codon position, 3T(U) or 3C is more preferred, and in ORF3 – 3C or 3G; in ORF1 and ORF2, CpG and TpC dinucleotides are underrepresented, while TpG are overrepresented; in the synonymous codons of ORF2, a U/A terminal shift was detected, in ORF1 and ORF2 – 3G or 3C; the effect of translational selection on HEV-1 is more pronounced than HEV-3; preference for the use of synonymous codons in ORF3 does not depend on the action of translational selection; the leading factor in the evolution of ORF1 and ORF2 HEV is negative (purifying) selection; neutrally selected sites predominate in ORF3 of HEV-1, which is a consequence of the established relationship between the virus and the host.

In this research the question regarding the clinical characteristics of children with a patent foramen ovale (PFO) was raised. Today, this small anomaly of the heart, while common, has the potential to cause serious complications for children in rare cases. In this study we evaluated the patient family histories of cardiovascular diseases and connective tissue dysplasia, the course of pregnancy, the level of physical development of the children, laboratory findings, echocardiography and ECG data, the dynamics of PFO closure in 37 children of the main group and 37 children of the control group aged from birth to 6 years of age. Among the children of the main group, the following subgroups were identified: with the closure of the PFO at 1, 3 and 6 years, as well as the absence of PFO closure by the age of six years. It was found that boys predominated among the children of the main group. The closure of the PFO was noted to happen later in boys. In the group with the absence of PFO closure boys also predominated. Pregnancy with children of the main group was often accompanied by hypothyroidism and chronic nicotine intoxication in the mothers. In the family histories of the children of the main group connective tissue dysplasia was more frequent. A below-average level of physical development prevailed in children with a PFO low physical development was noted in children with a nonclosed PFO. Among children with a non-closed PFO by age six, a negative trend emerged with the PFO showing a tendency to increase in diameter.

Purpose. Determination of the effectiveness of the treatment of postnasal syndrome caused by vasomotor rhinitis using the method of laser photocoagulation of the distal branches of the vidian nerve based on subjective criteria.

Materials and methods. The work is based on the results of examination and treatment of 89 patients with postnasal syndrome caused by vasomotor rhinitis. The study group consisted of 45 patients (22 men and 23 women), these patients, along with laser photocoagulation of the inferior turbinates, underwent photocoagulation of the distal branches of the vidian nerve. The comparison group consisted of 44 patients (20 men and 24 women) who underwent only laser photocoagulation of the inferior turbinates. The evaluation of the results of surgical treatment of patients with postnasal syndrome caused by vasomotor rhinitis was performed on the basis of objective criteria for the following indicators: • Assessment of the quality of life of patients using the SNOT-22 questionnaire (RUS); • Evaluation of the quality of life of patients using a visual analogue scale (VAS – 10-point subjective scale).

Results. In the preoperative period, the quality of life of patients was assessed using a specialized questionnaire SNOT-22 (RUS) and VAS. Based on the data obtained, the effect of vasomotor rhinitis with a postnasal component on the quality of life of patients in the study group and the comparison group corresponds to a moderately disturbing scale (the study group – 40.6 ± 3.35 points, the comparison group – 42.8 ± 6.5 points, statistically significant there was no difference between the groups p > 0.05, breathing through the nose and smell before surgery in the study group according to VAS – 10.0 [9.0; 10.0] points, in the comparison group – 10.0 [9.0; 10.0] points. Complaints about the flow of mucus along the back of the throat in the study group – 9.0 [9.0; 9.0] points, in the comparison group – 9.0 [8.75; 9.0] points), a statistically significant difference between the groups not detected p > 0.05. The use of surgical methods of treatment made it possible to improve the quality of life of patients, a progressive decrease in indicators was noted (1 month after the operation, the respiratory and olfactory function in patients of the study group was 2.0 [1.0; 2.0] points, in the comparison group – 2.0 [2.0;3.0] points Complaints about mucus flow down the posterior pharyngeal wall patients of the study group – 1.0 [0.0;1.0] points, comparison group – 4.0 [4.0;4.0] points, a statistically significant difference between the groups p < 0.05 was revealed. The quality of life of patients using a specialized questionnaire SNOT-22 (RUS) 1 month after surgery in the study group – 7.95 ± 1.46 points, in the comparison group – 14.3 ± 2.55 points, a statistically significant difference between the groups was revealed p < 0.05.

Conclusions. In the treatment of postnasal syndrome caused by vasomotor rhinitis, the developed method of surgical treatment using laser photocoagulation of the distal branches of the vidian nerve allowed a statistically significant improvement in the quality of life of patients, thereby proving its effectiveness, which is confirmed by the assessment of subjective criteria.

Based on the calculation of the excess lifetime risk of cancer of various organs and systems as a result of total exposure in employees of X-ray diagnostic hospitals in Minsk, it was shown that in men the likelihood of oncopathology is more pronounced in relation to the intestines, lungs and bladder. In women, the critical organs are the mammary gland and lungs. In the process of carcinogenesis, both in one and the other case, other organs may be involved. At the same time, the likelihood of developing malignant tumors in the esophagus, rectum, pancreas and thyroid gland is low. These data are consistent with the results of other researchers, although data on the risk of oncopathology in health workers are very contradictory. The risk of developing tumors at a young age in both men and women is much higher.

The data obtained imply the need for a properly organized medical examination in relation to the personel of the X-ray diagnostic departments of medical institutions of the republic.

The aim of the study was to establish the prevalence, size and location of maxillary sinus septa in patients with a dentate posterior maxilla.

Materials and methods. The data of cone-beam computed tomography of 150 dental patients (295 maxillary sinuses) were analyzed.

Results. Maxillary sinus septa were identified in 43.3 % of patients inside 98 of 295 sinuses (33.2 %). The most common orientation of septa was medio-lateral for a number of 112 from 122 (91.8 %). Septa were most common (49.2 %) in the region of the first and second maxillary molars. The mean size of septa was 6.58 ± 3.18 mm (range 2.5–17.31 mm). Complete septa (dividing the sinus into two relatively separated cavities) were identified in 19.4 % of cases.

Conclusion. Detection of the topography of maxillary sinus septa by using cone-beam computed tomography is essential when planning sinus augmentation procedures in order to avoid unnecessary intra- and postoperative complications.

Based on the results of the analysis of 1616 medical records of adult (over 18 years old) patients with burns who were discharged after inpatient treatment in a satisfactory condition, and 83 with an unfavorable outcome of the injury, it was found that in the general structure of medical procedures performed, the largest number accounted for x-ray examinations (39.6 %), less for necrectomy (18.6 %) and dermoplasty (15.0 %), and the proportion of these procedures is statistically significantly higher in discharged persons. In patients with an unfavorable outcome of injury, the proportion of central vein and bladder catheterizations, intubations, bronchoscopy, fibrogastroduodenoscopy prevails in the structure of interventions for therapeutic purposes. In patients of the same group, the frequency and frequency of performing both diagnostic and therapeutic procedures is much higher due to more extensive and deep damage to the outer integument by the flame in the vast majority (92.8 %) of the victims.

Inguinal hernia is one of the most common surgical pathologies. With all the variety of hernioplasty methods available in the surgeon’s arsenal, the ideal method of operation has not yet been invented. Modern trends force us to evaluate surgical methods of treatment from a new perspective – the postoperative quality of life of the patient. The purpose of the study: to evaluate the effectiveness of the Lichtenstein operation and total extraperitoneal plasty for inguinal hernias through the prism of the long-term postoperative quality of life of the patients. 429 completed questionnaires for assessing the quality of life of men SF-36 (The Short Form-36) were received and studied. Of these, n1 = 80 had an inguinal hernia and needed elective surgery, n2 = 288 did not have a hernia defect (conditionally healthy); within 3–6 months after hernioplasty (using the Lichtenstein method or total extraperitoneal plasty), 61 patients were re-questioned. The results of the analysis showed that men with inguinal hernias had a significant decrease in the psychological component of health compared to apparently healthy individuals; 3–6 months after the operation, the physical component of health became significantly higher (p < 0.001) and did not depend on the type of hernioplasty.

The article presents data from a study of the effect of the drug modafinil on neurodynamic performance indicators, determined by the method of T. D. Loskutova, in persons under conditions of sleep deprivation.

The negative impact of being in conditions of sleep deprivation on indicators of the level of reaction and functionality was shown.

Data were obtained on the preservation of the indicators of the reaction rate, the functional level of the system and the level of reaction at the same level after taking the drug modafinil at a dose of 200 mg in the evening on the eve of a sleepless night.

Taking the drug modafinil did not cause any adverse reactions.

Currently, the only method that can replace all the liver functions is organ transplantation. Due to the donor organs shortage, various bioartificial liver models are being developed. Decellularization of a liver unsuitable for transplantation from a deceased donor is a challenging topic of research. Data on the technical features of the preparation of the liver for the process of decellularization are given. An algorithm for obtaining a cell-free matrix of the human liver and the process of decellularization using a device for dynamic conservation of donor organs with subsequent evaluation by electron microscopy are described.

According to the WHO data, induced labor accounts for up to 25 % of all labors in the world, which makes this problem relevant in modern obstetrics. There is currently increasing interest in expanding indications and methods for pre- and/or induction. In the course of the study, an analysis of induced labor in the 5th City Clinical Hospital for 2021–2022 was carried out. The most commonly used methods of induction, their advantages and disadvantages, as well as the timing and outcomes for the mother and fetus after induction of labor were determined. As a result of the analysis, it became clear that the induction of labor in the Republic of Belarus, as well as throughout the world, is being used more and more often. The main indications for labor induction were more than 287 days of pregnancy, extragenital pathology and pregnancy complications. The ineffectiveness of induction is apparently due to a combination of structural features of the cervix, uterine sensitization to uterotonics, and the state of calcium-magnesium metabolism, which requires further research.

The aim of the study was to study the clinical effectiveness of the complex treatment of postpartum subinvolution of the uterus with intrauterine dialysis of levofloxacin solution by assessing the correlation between the size of the uterine cavity, the level of norepinephrine and cholinesterase in the blood serum of puerperas. We examined 35 puerperas with SCI (mean age 26.1 ± 2.2) who were in the physiological postpartum department of the ME “3rd City Clinical Hospital named after E. V. Klumova, Minsk. The control group consisted of 19 puerperas with a physiological postpartum period (mean age 24.5 ± 2.1). The main group included 17 patients who received drug therapy in accordance with the treat- ment protocol in combination with intrauterine dialysis of a solution of levofloxacin in a volume of 20 ml, diluted in 20 ml of chlorhexidine solvent, using a syringe into the uterine cavity bolus 1 time per day for 3–5 days. In addition, AMF procedures were prescribed for the lower abdomen in the area of the projection of the uterus from the 1st day after childbirth every day 1 time per day. The comparison group consisted of 18 patients who received only drug treatment (intramuscular injection of a solution of oxytocin at 5 IU after 12 hours, intravenous administration of a solution of cefotaxime intravenously at a dose of 1 g after 8 hours) for 5 days.The results obtained convincingly demonstrate a decrease in the level of norepinephrine and an increase in the activity of cholinesterase in the blood serum of puerperas with the development of postpartum subinvolution of the uterus, which is associated with an increase in the size of the uterine cavity.

Based on the results of the analysis of 322 medical records of adult patients (over 18 years of age) with burns admitted for inpatient treatment in a state of intoxication (alcohol and/or drugs), and 1377 in a sober state, it was found that in the aggregate of diagnostic and therapeutic procedures in patients analyzed groups, X-ray examinations prevail (21.5–23.8 %) and primary surgical treatment of wounds (20.2–37.5 %). Injured in a state of intoxication, catheterization of the central veins (3.9 times) and bladder (3.6 times), tracheal intubation (3.9 times), bronchoscopy (4.7 times), fibrogastroduodenoscopy (7.2 times), tracheotomy (in 9.3), necrectomy and dermoplasty (in 1.7 times), and the multiplicity of these interventions was greater due to more extensive and deep lesions than among those injured in a sober state. Primary surgical treatment of a smaller number of those hospitalized in a state of intoxication is objective due to the more frequent occurrence of an unfavorable outcome in this contingent of victims on the first day of hospitalization. Between the frequency of necrectomy and dermoplasty, there was a direct correlation of a high degree (rxy = 0.99), indicating a high contingency of these medical interventions.

Tuberous sclerosis complex (TSC, tuberous sclerosis, Burneville-Pringle disease) is a multiorgan syndrome manifested by the development of benign and malignant tumours with different localizations. The main cause of death in patients with TSC is the progression of subependymal giant cell astrocytomas in the brain, angymyolipomas in the kidneys and the development of lymphangiomyomatosis.

Although renal cell carcinoma is relatively rare (only 2–4 % of patients with TSC), it nevertheless contributes significantly to mortality. Extrarenal manifestations of TSC in the chest, abdomen and central nervous system help in the diagnosis of TSC.

The paper presents the data on the pathogenesis, clinical picture, diagnostic criteria, current approaches to therapy and results of our own observation of patient with TSC.

Symptoms of nasopharyngeal tumors may be scanty for a long time and flow under the “mask” of another pathology. Clinical manifestations of neoplasm of the nasopharynx in a pediatric patient require a diagnostic search between hypertrophy of the pharyngeal tonsil (adenoids) as well as benign and malignant nasopharyngeal tumors. Among nasopharyngeal tumors in children and adolescence first of all it is necessary to exclude the juvenile nasopharyngeal angiofibroma. It is a benign but rapidly progressive neoplasm with a high risk of bleeding and a tendency to destructive growth. Among malignant neoplasms of the nasopharynx in children there are both epithelial (undifferentiated carcinoma) and connective tissue tumors (sarcoma, among which rhabdomyosarcoma predominates) as well as extranodal forms of lymphoma (in particular, with lymphoepithelial organs defeat). The article presents our own clinical observation of a case of non-Hodgkin lymphoma (Burkitt lymphoma) of the nasopharynx in a 6-year-old child, which initially looked like hypertrophy of the pharyngeal tonsil. However, the rapid growth and а tendency to bleeding, which led to the anemization of the patient, posed to specialists a number of differential-diagnostic questions. A comprehensive examination made it possible to make a diagnosis in a short time.