The technology of video-assisted minimally invasive interventions on the thoracic spine is a promising direction in surgical endoscopy. Thoracic endoscopic spine surgery is effective for the diagnosis and treatment of various pathologies (tumors, inflammation, deformities, degenerative-dystrophic lesions, injuries). The advantages of thoracic endoscopic interventions are – trauma/injury reduction, reduced blood loss, full visualization of the operation area, the ability to control the allocation of surgical instruments, early activation and rehabilitation of patients as a result of minimally invasive technology, reduced hospital stay and treatment costs.

Video-assisted minimally invasive interventions on the thoracic spine are a promising area of surgical endoscopy. The use of thoracoscopic technology allows us to move to a qualitatively new level of surgical interventions from anterior surgical approaches for various pathologies of the thoracic spine (tumors, deformities, degenerative-dystrophic lesions, injuries, inflammatory processes).

The incidence of Parkinson's disease currently outpaces the rate of aging and is growing disproportionately in newly industrialized areas of the globe. Scientific evidence suggests that exposure to environmental toxicants during neurodevelopment, whether in utero, perinatal or childhood, may have a significant impact on the risk of developing Parkinson's disease in the future. More often we have a combination of factors/triggers that last for decades, such as pesticides, organic solvents, metals and air pollution. The relationship between exposure and disease is variable, meaning that gene-environment and environment-environment interactions and other exposure dynamics contribute to the disease phenotype. Since all disease phenotypes are the result of our genes (intrinsic factors) and environment (extrinsic factors), there is no doubt that gene-environment interactions account for most cases of idiopathic Parkinson's disease. Unraveling key aspects of our understanding of the environmental risk associated with Parkinson's disease in the human population requires experimental work. Collaboration between interdisciplinary teams and new technologies combined with basic toxicological principles is required. With both laboratory and analytical support, incorporating biomarkers, transcriptomics or metabolomics, and geneenvironment interactions into research projects would be an ideal mechanism for PD research, both in the preclinical and clinical areas. Understanding the contribution of the environment to PD is critical as it could potentially help prevent the development and/or progression of this as yet incurable disease in some percentage of cases.

Objective of the study. To identify and analyse clinical and laboratory features in immunocompetent patients with thrombotic complications in acute cytomegalovirus infection. Development of the algorithm of prognosis and early diagnosis of thrombotic complications in order to reduce the risk of severe course of the disease and lethal outcome.

Materials and Methods. The study included 100 immunocompetent adult patients undergoing inpatient observation and treatment with laboratory-proven acute cytomegalovirus infection. All patients had a detailed clinical and epidemiological history for the possible presence of modifiable and/or non-modifiable prothrombotic risk factors; a multifaceted laboratory and instrumental examination was performed.

Results. Out of one hundred patients with acute cytomegalovirus infection selected in the study, thrombotic diseases were observed in 7 % of cases (in 7 patients). The mean age of the patients was 41 (38; 42) years. Patients were hospitalised on average on 12 (10; 14) days from the onset of the disease. The main complaints on admission were: prolonged fever up to 38 °С and marked general weakness. The patients had elevated ALT and AST in 88 % and 80 % of cases, respectively. The presence of reactive lymphocytes was registered in 57 % of cases. Enlargement of liver and spleen was observed in 67 % and 70 % of cases, respectively. Compared to patients with uncomplicated course of acute cytomegalovirus infection, statistically significant laboratory differences were observed in SRB (p < 0.001) and D-dimers (p < 0.05) in patients who had thrombotic complications. All patients who had genetic material (DNA) to CMV in the blood had positive tests for rr65 antigenemia. The polymorphism of factor V gene G1691A (FVLeiden) was detected in only one patient, who was a carrier of heterozygous GA allele.

Conclusion. Acute cytomegalovirus infection in immunocompetent patients includes a symptom complex consisting of a typical clinical picture (prolonged febrile intoxication, hepatosplenomegaly, elevated hepatic transaminases, CRP and D-dimer levels) and obligatory laboratory detection of the virus (positive PCR and/or Ag pp65 tests for CMV). Cytomegalovirus is an independent and reliable prothrombotic risk factor, with thrombotic complications occurring in 7 % of cases. Patients with risk factors for thrombotic complications with verified acute cytomegalovirus infection are recommended to be prescribed anticoagulant therapy at prophylactic doses. Also, patients with a proven case of thrombotic process on the background of acute cytomegalovirus infection are recommended a course of etiotropic antiviral therapy.

Cardiovascular diseases are still the leading causes of death in the world. Atherosclerosis of the arteries of the lower extremities is one of them. A risk factor for the development of atherosclerosis is diabetes mellitus, particularly type 2. The fact that these diseases are systemic and multifactorial is generally recognized. Considering the progress of genetics and gene therapy in recent decades, the search for genes responsible for the development of both lower limb atherosclerosis and type 2 diabetes mellitus is relevant. Their identification can probably help to improve the prognosis of the course of these diseases, personalize the system of prevention and treatment. Homocysteine is an amino acid involved in the pathogenesis of both obliterative atherosclerosis and diabetes mellitus. In this context, folate cycle genes, which play a major role in the development of hyperhomocysteinemia, are of particular interest.

Trophic ulcers as a result of chronic vascular diseases of the lower extremities are an urgent and complex task of surgical treatment. Local treatment of the ulcer is an important role after revascularization. Hyaluronic acid (HA) preparations are among the most promising in this regard. HA provides increased tissue resistance to ischemia, suppression of the inflammatory response, stimulation and acceleration of tissue regeneration. HA ensures the formation of a temporary matrix in a fresh wound, facilitates the diffusion of nutrients and cleans the wound from products of cellular metabolism. Secondly, it takes an active part in the proliferation and migration of keratinocytes, which make up the bulk of the epidermis. Due to the insignificant use of HA in local therapy of trophic disorders of chronic vascular diseases of the lower extremities, it is interesting to further study the effect as part of complex and pathogenetically oriented treatment in patients of this group.

The non-tumor blood disease paroxysmal nocturnal hemoglobinuria, which develops as a result of acquired mutations in the PIG-A gene, is presented. As a result of mutation, there is a loss of complement-regulating proteins (GPI-AP) on the surface of blood cells (on erythrocytes – CD55, CD59, on granulocytes – CD16, CD24, on monocytes – CD14, CD48). A clone of cells subject to complement-mediated hemolysis is formed. With intravascular hemolysis of erythrocytes, a lot of hemoglobin appears in the bloodstream, then it enters the urine, it darkens. Neutrophils are also destroyed, platelet aggregation increases. Venous and arterial thrombosis can occur throughout the body. The criteria and forms of PNG are described. The clinical manifestations are highlighted, the knowledge of which is necessary for doctors of different specialties to suspect PNG at the beginning of its development. When the diagnosis is delayed, the patient with thrombosis is treated under different diagnoses, time is running out… Identification of patients at risk can affect the outcome of PNG. Highly sensitive flow cytometry makes it possible to detect an APG clone with a size of 0.01 % or more. Monoclonal antibody therapy changed the natural course of APG. The article presents the medical history of a patient with PNG. The diagnosis was made in our clinic at the stage of serious thrombotic complications, after a stay in two Moscow clinics where this disease was not suspected.

Lipoma is a benign neoplasm, often encountered in the practice of maxillofacial surgeon. The clinical manifestations of lipomas are varied. The formation is encapsulated, does not cause pain, leads to bulging of the affected area, and easily moves with pressure. It can grow to enormous sizes, causing stretching and sagging of the skin. The treatment of this pathology is surgical. The complexity of surgical intervention depends on the location of the formation and its size. To diagnose lipomas, in addition to clinical methods (examination, palpation), instrumental research methods are used. This article analyzes the frequency of lipomas in the maxillofacial area, clinical manifestations, and differential diagnosis of this disease. A clinical case of lipoma of the temporal region is described.

A wide range of speech disorders causes the complex structure of the defect, which results in a disharmonious clinical and psychological characteristic of autism. The expediency of using the method of speech disorders in children with infantile autism is justified by the results of diagnostic efficiency analysis from the standpoint of evidence-based medicine. A wide range of speech disorders causes the complex structure of the defect, which results in a disharmonious clinical and psychological characteristic of autism. Objectivization of speech pathologies with the help of scientifically grounded diagnostic method of speech disorders in children with infantile autism gives an opportunity to create a speech profile of the child, which helps to determine the principles of their correction. The expediency of using the method is justified by the results of diagnostic efficiency analysis from the standpoint of evidence-based medicine.

The work was carried out using a verbal communication method of psychological research, the participants of which were minors 12–17 years old both with signs of attention deficit hyperactivity disorder (ADHD) and without this pathology, in order to identify the characteristics of their aggressive behavior, taking into account lifestyle risk factors for the subsequent justification of medical prevention measures. Statistically significant differences were established in the prevalence of aggressive and hostile reactions in the study groups with lower values in the group of healthy respondents and higher – among children and adolescents undergoing inpatient treatment according to the profile of behavioral disorders. In the study participants with signs of ADHD, the pathology of the circulatory and digestive systems was more often noted than among respondents without signs of hyperactivity and tendency to deviant behavior, and the presence of aggressive behavior models significantly increases the risk of developing the above diseases. A high proportion of children and adolescents who consume alcoholic beverages has been established. At the same time, the risk of physically aggressive behavior is 1.16 times higher against the background of alcohol-containing products consumption and the elimination of this risk factor makes it possible to reduce the likelihood of physical aggression by 13.8 %.

One of the effective mechanisms for reducing the development of pathologies at menopause is the search for significant alternative means of reducing the severity of menopausal manifestations. In order to identify the correction of the severity of climacteric symptoms a study of 154 patients was conducted, the patients were divided into three groups: 53 women at natural menopause, 50 women at surgical menopause, the same patients (n = 53 and n = 50) 6 months after taking flaxseed oil and 51 control patients.

Thus, it was found out that operated women develop more often extragenital pathology and more frequently consult medical specialists than those at natural menopause and healthy participants. Comorbidity in the main groups is more than two nosologies with a predominance of arterial hypertension. According to the Green scale menopausal severesymptoms in female patients with oophorectomy and moderate biological menopause symptoms of vasomotor and emotional-mental statusare leading. After daily use of flaxseed oil in operated women and those at natural menopause the severity of menopausal symptoms decreased equaling moderate and mild severity, respectively, along with the frequency of patients’visits to specialists to a greater extent in patients at natural menopause. The effectiveness of taking flaxseed oil by women at surgical or natural menopause for menopausal disorders of varying severity makes it possible to use it as an alternative for correction during the period of estrogen deficiency.

The article presents the results of a study of changes in the lipid spectrum of the blood plasma and certain indicators of Holter monitoring and echocardiographic data in patients with coronary heart disease (CHD) and hypothyroidism who were in a cardiology hospital. The incidence of hypothyroidism in cardiac patients was 2.8 %. In patients with ischemic heart disease and hypothyroidism, no reliable correlation has been established between the presence of hypothyroidism and dyslipidemia, but a high incidence of hypercholesterolemia and increased levels of low-density lipoprotein cholesterol was found in patients with ischemic heart disease in combination with hypothyroidism, as in the control group. Extrasystole was determined in all patients with coronary artery disease, regardless of the presence of hypothyroidism. Only 2.7 % of patients with coronary artery disease and hypothyroidism had a decrease in myocardial contractile function according to the assessment of left ventricular ejection fraction (EF). The detection rate of left ventricular hypertrophy (LVH) in patients with coronary artery disease and hypothyroidism was 83.7 %. There was a significantly significant moderate correlation in the group of patients with coronary artery disease, regardless of the presence of hypothyroidism, between the number of premature atrial complexes (PAC) and the number of premature ventricular complexes (PVC). There was no effect of TSH level on EF values and the presence of LVH in patients with coronary artery disease in combination with hypothyroidism and in the absence of the latter.

Congenital malformations of the hearing organ occur with a frequency of 1–2 per 500 (mild anomalies) to 1–2 per 10 000 (severe anomalies) newborns. Up to 15 % of them are heritable and up to 10 % are bilateral. Anomalies of the first branchial cleft from which the structures of the external ear predominantly develop, are quite rare malformations (less than 10 % of all gill anomalies), but can present a significant problem of differential diagnosis. Most commonly, these anomalies manifest clinically as periauricular cysts, fistulous or reduplication of the external auditory canal. There are both isolated congenital anomalies of any of the parts of the hearing organ and syndromal ones. This article describes our own observation of a congenital anomaly of the external auditory canal in a child (a type of reduplication of the external auditory canal) and secondary cholesteatoma on this background. This case is interesting because the patient had multiple congenital anomalies: branchial cysts on both sides for which she had been operated on earlier and reduplication of the external auditory canal, a much rarer pathology of the first branchial cleft. At the same time, the difference in time when these anomalies manifested and were detected was almost 10 years.

This publication analyzes the long-term pathology associated with thyroid function in women who were pregnant in April 1986 and, as a result of the Chernobyl accident, received radiation due to the incorporation of radioactive iodine. The comparison group consisted of women living in the same region of Belarus, but whose pregnancy occurred after the decay of the iodine radioisotope. The age of women in both groups at the time of pregnancy was 22–24 years, the gestation period was 21–23 weeks. Due to the incorporation of radioactive iodine, an average absorbed dose of 60–80 mGy was generated. The incidence of endocrine system diseases in women was expressed mainly due to diseases of the thyroid gland, nutritional and metabolic disorders (obesity). The cumulative incidence in the main group was not much different from the incidence in the comparison group. Based on the data presented, a conclusion is made about the non-radiation nature of the identified pathology, which can be associated with an excess of stable iodine due to its intake from food and the use of iodine-containing medications during pregnancy.

Methotrexate is the mainstay drug in the treatment of juvenile idiopathic arthritis (JIA). The effect of methotrexate on the hematopoietic system manifests itself in the form of its inhibition, contributing to the development of aplastic anemia, leukopenia, neutropenia and thrombocytopenia.

The purpose of the study was to study the effect of methotrexate on the state of the leukocyte and megakaryocyte pool of cells in patients with JIA.

Material and methods. The study was carried out on the basis of the 2nd City Children's Clinical Hospital in Minsk. A study of the state of hematopoiesis was carried out in 82 children with JIA who received only methotrexate. The comparison group consisted of 40 patients who were diagnosed with JIA and had a complete blood count performed before starting methotrexate therapy.

Results. Statistically significant differences were identified in both the megakaryocyte and leukocyte series. Against the background of an increase in the number of platelets before the start of basic therapy, there was a decrease in the average volume of platelets (p < 0.01) and, accordingly, the distribution of platelets by volume (p < 0.001). Changes in the white blood cell count (WBC) were manifested in a gradual decrease in the number of leukocytes during long-term use of methotrexate (p < 0.001).

Conclusion. The use of methotrexate in patients with JIA contributes to a significant decrease in the content of platelets, leukocytes, neutrophils, lymphocytes, and monocytes, which is due to the relief of the inflammatory process. The duration of methotrexate administration did not affect the content of lymphocytes and basophils.

Objective. To evaluate pregnancy and labor outcomes in women with varicose veins in a COVID-19 pandemic.

Material and methods. Sixty-eight pregnant women were included in the study, 38 of whom used compression stockings (main group), and 30 patients were included in the comparison group. During follow-up, 8/38 (21 %) patients from the main group and 9/30 (30 %) patients from the comparison group had COVID-19 infection. All patients underwent clinical, laboratory, gynecologic, and ultrasound examinations. The primary endpoints of the study were maternal complications of pregnancy and labor. Secondary endpoints were pathologic conditions and perinatal parameters related to the fetus.

Results. The number of cases of preterm labor, utero-placental blood flow disorders, preeclampsia, and gestational diabetes mellitus was higher in the control group compared to the comparison group (p > 0.99). Fetal distress developed in 2/30 (6.7 %) observations from the comparison group of laboring women (p = 0.605). The highest number of infants (70–75 %) who scored 9 Apgar score at the 5th minute of life was recorded in the main group. Comparative analysis of pregnant women with mild COVID-19 and without COVID-19 found no significant effect of coronavirus infection on obstetric and perinatal outcomes.

Conclusion. The results of this study confirm the information about the adverse effect of concomitant varicose veins on the outcomes of pregnancy and childbirth. These findings support the rationale for the combined use of compression and phlebotropic pharmacological therapy in pregnant women with varicose veins.

Osteoarthritis (OA) of the knee joint is the commonest form of OA. It occurs commonly in the medial compartment because of a preponderance of varus knees. High tibial osteotomy, total knee replacement and unicompartmental knee replacement are technically demanding procedures, while proximal segmental fibular resection (PSFR) significantly relieves pain and improves joint function in knee osteoarthritis (OA). This study was conducted at the department of traumatology and orthopedics at the Belarusian state medical university. The objective of this study was to assess functional outcomes after PSFR and its correlation with bone mineral density.

23 patients with unicompartmental OA with varus deformity were included in the study. Inclusion criteria included patients with moderate-to-severe symptomatic medial unicompartmental OA of the knee, who had an indication for a surgical procedure, and who were able to give informed consent for the surgery. Exclusion criteria included patients with posttraumatic knee OA or inflammatory joint disease and patients with a history of previous operations or fractures the primary outcome was measured by calculating the ratio of knee joint space. The secondary outcome measure was pain measured by the visual analog scale (VAS).

Autism spectrum disorders (ASD) affect 1–2 % of the population worldwide [1].The majority of people diagnosed with ASD, including those without intellectual disabilities,experience severe behavioral and functional impairments that require corrective measures(in particular, executive functions) [2]. Treatment options for these entities that improvelong-term outcomes are limited. The heterogeneity inherent in autism spectrum disordersand the lack of consistent biological markers are key challenges for innovative treatments.

The aim of the work is to discuss the results of the use of physiotherapy and reflexologyin the treatment of ASD. The authors describe 1 clinical case of a patient with autismspectrum disorders, demonstrating the exceptional importance of comprehensive treatmentof these disorders.

Every year there is an increase of almost 10 million cases of dementia worldwide. This disease is the seventh leading cause of death in the world and is one of the leading causes of disability in older people. Minimizing the pathological (social and economic) impact of dementia on society is based on improving the primary prevention model. Currently, there is an increase in evidence-based data on the harmful effects of potentially modifiable factors that can induce neurodegenerative diseases. The article contains information about hyperepithelial permeability syndrome, which leads to increased circulation of lipopolysaccharides; it is concluded that “dysbiosis” contributes to the development of neurodegenerative and neuroinflammatory changes in the central nervous system; the importance of the nutritional factor contributing to the development of the syndrome of increased epithelial permeability and “dysbiosis” is shown. The importance of moderate physical activity and neurocognitive training in the prevention is demonstrated. It is concluded that the primary focus of prevention methods is to eliminate the influence of exogenous factors (reducing/eliminating the impact of pathogenic herbicides and pesticides, stressinduced conditions), modifying nutritional factors (rational and balanced nutrition), but also stimulating the physical and intellectual activity of patients.

Autism spectrum disorders (ASD) are neurological and developmental disorders characterized by difficulties with social communication and repetitive interests and/or behaviors that begin before age of 3 years. The exact etiology of ASD remains unknown today. According to literature reviews, several factors may predispose to the development of these entities, which, according to scientific publications, can be both genetic and environmental factors. A problematic area remains the timely provision of highly qualified assistance in the management and treatment of such patients [1]. It is important that the child with ASD and his family have the support of a multidisciplinary team to help overcome current situations and problems. The aim of the work: to emphasize the advantages of a multidisciplinary approach in accompanying children with autism spectrum disorders. The authors describe some epidemiological data on autism spectrum disorders using the example of Minsk.