Left ventricular thrombosis is a potentially life-threatening condition due to a significant risk of stroke and systemic thromboembolism. Despite the more frequent use of primary percutaneous coronary interventions and dual antiplatelet therapy in clinical practice the majority of left ventricular thrombus are diagnosed after myocardial infarction, although such a complication can occur both in ischaemic and non-ischaemic cardiomyopathies. The article provides information on left ventricular thrombosis in internal diseases according to current concepts. The authors characterize risk factors and pathophysiological mechanisms in thrombosis, the predictors of embolic events. Modern imaging methods for diagnosis of left ventricular thrombosis are described. The article outlines that cardiac magnetic resonance has the highest diagnostic accuracy, followed by echocardiography with the use of echocardiographic contrast agents. Particular attention is paid to the treatment with vitamin K antagonists and direct oral anticoagulants. There is growing evidence of the benefits of direct acting oral anticoagulants in treatment of left ventricular thrombosis. It is expected that ongoing clinical trials will help elucidate the best management strategies for these patients.

The article presents the results of comparative urine studies of patients with pyelonephritis and patients without signs of UTI. The results of bacterioscopic and bacteriological examination of urine of 69 patients with pyelonephritis and 27 without UTI were analyzed. A high prevalence of negative urine culture in pyelonephritis (59.4 %) was revealed, as well as the prevalence of negative culture in the presence of bacteriuria detected microscopically in urine sediment (37.5 %). In patients without pyelonephritis, a bacteriological study showed bacterial growth in 66.7 % of cases, which indicates the prevalence of asymptomatic bacteriuria in urological patients. Literature data on diagnostic problems and possible causes of false negative results of bacteriological examination in UTI are analyzed. One of the reasons for these results are the disadvantages and limitations of standard bacteriological culture. The need to introduce new advanced methods of bacteriological research into clinical practice is urgent.

The article highlights the problem of differential diagnosis of peripheral vestibular syndrome, which hides such pathological processes as benign positional paroxysmal vertigo, vestibular neuronitis, Meniere’s disease. The lack of specification in the diagnosis in this category of patients leads to erroneous diagnosis, inadequate treatment, an increase in the duration of disability and the occurrence of anxiety and depressive disorders. The article presents the differential diagnosis of peripheral vestibular syndrome, examples of therapeutic maneuvers and cases from practice. For effective diagnosis and treatment, it is necessary to take into account the clinical signs of the onset and manifestations of peripheral vestibular disorders, pay special attention to the questioning and detailed description of the patient’s complaints, conduct special positional tests and consult with specialized specialists.

To achieve high efficiency of endodontic treatment, it is necessary to ensure highquality cleaning of the root canal. Using only mechanical processing, it is impossible to completely clean the entire root system. For drug treatment of root canals, a wide range of antiseptic agents is used, the most popular of which is a remedy based on sodium hypochlorite solution. For maximum therapeutic effect, the irrigation solution must be in direct contact with the entire surface of the root canal dentin, penetrating into all its branches. Therefore, the creation of an adequate taper, the choice of the optimal method of supplying the agent based on sodium hypochlorite solution affects the quality of drug treatment of the root canal and subsequent obturation.

Target. To evaluate the penetration efficiency of the agent based on 3 % sodium hypochlorite solution into the macrocanal of the tooth and its branches, depending on the choice of the method of mechanical and medical treatment of root canals in vitro.

Materials and research methods. The data obtained as a result of a survey of practicing dentists were statistically processed in Microsoft Excel 6. In the course of the work, root canals were treated with manual and machine tools, followed by washing with a drug based on sodium hypochlorite solution using various methods

Results. The highest degree of diffusion of the agent based on sodium hypochlorite solution was established in root canals treated with machine tools using the aspiration method of sanitation. Manual preparation of root canals showed the lowest degree of penetration of the irrigant into the root canal compared to machine processing. Regardless of the method of root canal preparation, it was found that the best degree of penetration of the agent based on sodium hypochlorite solution was observed with the aspiration method of debridement than with the traditional method of antiseptic treatment using an endodontic needle.

Hearing helps a person by warning him of danger, serves to receive information and to acquire knowledge, and can cause very strong emotions. Drug damage to the inner ear occurs during the treatment of other diseases. The main reason is incorrectly selected drugs or non-compliance by patients with the recommended dosage and frequency of administration.

This review defines the concept of “iatrogenic ototoxicity”, describes the mechanisms of its occurrence in some groups of drugs. Also, measures have been proposed to prevent the ototoxic effect of drugs that cause irreversible hearing changes up to deafness or lead to temporary hearing loss and hearing loss when applied topically, especially in the presence of perforation of the tympanic membrane.

There is no specific treatment for drug-induced iatrogenic ototoxicity. The report lists drugs that have ototoxicity, as well as clinical and pharmacological characteristics of drugs used to improve hearing in sensorineural hearing loss.

The review proves that the significant ototoxicity of certain groups of drugs in many cases limits or completely excludes their prescription to patients, and also requires strict medical control, timely detection and accounting.

Cytokine release syndrome with increased levels of interleukin-6 (IL-6) is associated with multiple organ damage and death in severe coronavirus disease. Trials to investigate the efficacy of IL-6 inhibitors, namely Tocilizumab, are ongoing with promising but conflicting results.

Objective. To identify the effectiveness of complex therapy for COVID-19 with the appointment of the drug Tocilizumab.

Material and methods. In order to identify the effectiveness and criteria for prescribing targeted therapy using Tocilizumab, a statistical analysis of clinical and laboratory parameters was performed in patients with severe and moderate COVID-19, in the group of patients treated with the drug (n = 174) and the group of patients receiving standard therapy (without Tocilizumab therapy) (n = 70). The comparison groups were similar in terms of gender and age characteristics.

The effectiveness of targeted therapy with the use of tocilizumab was assessed in terms of general and biochemical blood tests, levels of procalcitonin, IL-6 and presepsin, and outcomes among patients.

Results. The average values of the analyzed values (concentration of leukocytes, neutrophils p/n, AST, CPK-MB, LDH, creatinine, urea, IL-6, P-SEP before therapy were variably higher or lower than normal in patients of both analyzed groups and had statistically significant differences when compared between groups (p < 0.05). The concentrations of erythrocytes, hemoglobin, hematocrit, platelets, lymphocytes, ALT, albumin, CPK, total protein, CRP, ferritin and PCT did not have statistically significant differences between the groups before the appointment of therapy.

All analyzed parameters showed a variable change in the end point of control, depending on the improvement of the patient’s condition or death. At the same time, the stabilization of leukocytes, neutrophils p/I, ALT, AST, CPK-MB, creatinine, CPK, ferritin, PCT, IL-6 and P-SEP in the tocilizumab therapy group was noted compared with the baseline and indicators of the comparison group.

The expected survival rate for therapy with tocilizumab was 2.5 times higher than for therapy without Tocilizumab.

Conclusion. After the use of Tocilizumab in patients of group 1, the level of CRP concentration significantly decreased (by 46.7 mg/l – 63 %), ferritin (by 366.9 µg/l – 84 %), PCT (by 0.122 ng/ml – 76 %), IL-6 (by 51.2 pg/ml – 93 %), P-SEP (by 225 pg/ml – 67 %), (by 4.1 U/l – 9 %), AST (by 34.5 U/l – 56 %), CPK (by 121 U/l – 57 %).

The article discusses the classification of highly energetic injuries of the lower extremities, their role and determining importance in choosing the scope of examination, preoperative treatment and the choice of a treatment method, proposed a new classification of these injuries.

Based on the study of the clinical experience of surgical treatment of 239 patients with complex segmental and complex irregular diaphysial fractures of tibia, the high effectiveness of this classification in determining the algorithm of pre- and postoperative management, surgical treatment of patients depending on the degree of bone tissue damage, the size and nature of wounds in open fractures, the degree of soft tissue damage in closed fractures is shown.

Immunostimulating (immunomodulatory) drugs belong to the group of immunotropic drugs, the therapeutic effect of which is associated with a predominant effect on the human immune system. Medicines based on human normal immunoglobulin are immunostimulatory drugs of natural origin. In the practice of a doctor, immunoglobulins are made from human plasma and are more often used in the form for intravenous and subcutaneous administration. Immunoglobulins differ in the ratio of various subclasses of immunoglobulins G (IgG), as well as immunoglobulin class A (IgA), individual immunoglobulins are enriched with antibodies of the IgM classes, and specific immunoglobulins contain a significantly larger amount of IgG class antibodies against certain pathogens than standard immunoglobulins. Approaches to the classification of immunoglobulins, the mechanism of action, indications, contraindications, as well as clinical and pharmacological features of the use of human normal immunoglobulin, drugs available on the market in the Republic of Belarus are described, recommendations are given for their use in clinical practice. The possibilities of using immunoglobulins as a replacement (for immunodeficiency states, agammaglobulinemia) and immunomodulatory (for autoimmune diseases) therapy are presented. The possibility of using intravenous immunoglobulin for the treatment of Kawasaki syndrome, idiopathic thrombocytopenic purpura, Guillain-Barré syndrome, autoimmune polyneuropathy, diseases arising in oncological, surgical and obstetric practice, as well as for complex therapy of sepsis, including in newborns, is considered. Timely appointment of immunoglobulins in optimal doses will reduce the duration of therapy in patients with immunosuppression of various origins, reduce bleeding in immune thrombocytopenia.

Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty. However there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.

We formed the database which included the main identification indicators about people living in the ¹³⁷Cs-contaminated territory (Luninets district, Brest region). The calculation and assessment of annual effective doses from internal exposure was carried out based on the results of 58 809 measurements. We were using the human radiation spectrometer (HRS) to make measurements in the formed cohort during 5 years (from 2015 till 2019).

We found that internal exposure doses are the sum of two distributions. 83.3 % of HRS measurements form the main mode of the bimodal distribution. It is close to the normal distribution and different in gender and age features of internal exposure dose formation. The second mode of data distribution is different in significantly higher values of the internal doses and some other parameters like a sex and age.

The article presents an analysis of the surgical treatment of 224 male patients who underwent inguinal hernioplasty: 90 patients with the Liechtenstein operation, 124 with TEP (total extraperitoneal hernioplasty). The presence of concomitant pathology in patients, the duration of surgery, the need for analgesics, early and late postoperative complications were analyzed. Patients with TEP needed less analgesia in the early postoperative period, they had fewer postoperative wound complications, and their ability to work was restored faster. The Liechtenstein operation was performed in older patients with comorbidities. In the late postoperative period, no recurrence of the disease was observed, regardless of the hernioplasty technique.

One effective mechanism for managing health and reducing the growth of non-communicable morbidity in the population is to find meaningful managed risk factors and to eliminate or reduce the force of their potential impact in a timely manner. In order to identify removable risk factors for non-communicable diseases, a simultaneous cross-sectional study of the health status of children and adolescents 12–17 years old in relation to their lifestyle was carried out. The increase in hypodynamics leads to a noticeable decrease in the number of absolutely healthy persons and an increase with chronic diseases in the stage of sub and decompensation. The probability of developing health abnormalities in the group of persons exposed to hypodynamics is significantly higher than among adolescents leading an active lifestyle. It was calculated that when implementing the WHO recommendations to ensure a rational motor regime, one can expect a reduction in the risk of developing major non-communicable diseases by 13 % among children and adolescents with movement deficit and by 17 % when optimizing physical activity among students on a daily basis who did not have independent forms of its organization.

Based on the results of previous work, we have proposed two mathematical models to predict the low effectiveness of glucocorticoids in patients hospitalized for treatment of exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to compare their characteristics. In total, 28 COPD patients who were admitted to hospital due to exacerbations were included in this study. Determination of the regression equation, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and eosinophil count in the blood of examination group of patients showed high diagnostic efficiency (78.6 %), sensitivity (81.8 %) and specificity (76.5 %) of the mathematical model. Another model, which includes blood eosinophil count, PLR and MIF (macrophage migration inhibitory factor) level, had diagnostic efficiency of 85.7 %, sensitivity of 81.8 %, and specificity of 88.2 %. The first model, which includes only parameters of complete blood count, can be calculated after the initial examination by the attending physician. The second model, which requires the determination of blood plasma MIF level by enzyme linked immunosorbent assay and, accordingly, more time, but has higher efficiency and specificity, should be used after a second examination by the attending physician.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the second most common group of drugs leading to the development of drug-induced liver injury (DILI).

Objective: to determine the clinical features of DILI in patients with gout when using NSAIDs.

Material and methods. The study is monocentric, observational, retrospective. Performed in the period from 2012–01–01 to 2020–12–31 in the Rheumatology Department of the 11th City Clinical Hospital. The study included 527 patients with gouty arthritis (GA). The type of DILI was determined in accordance with the recommendations of EASL, 2019. An updated scale RUCAM (Roussel Uclaf Causality Assessment Method) was used to assess causal relationships.

Results. DILI was detected in 91 patients (14.3 %), in 80 – hepatocellular, in 11 – mixed type of DILI. The 1st category of DILI severity was stated in 88, the 2nd category – in 3 patients. We observed DILI more often in younger patients without severe comorbidity, but with an alcoholic surplus preceding a GA attack and, after, during attack an excess of the average therapeutic doses of NSAIDs was registered.

Conclusions. Thus, we did not observe a severe course of DILI in patients taking NSAIDs for the relief of GA. However, NSAID hepatotoxicity in this category of patients is a social and medical problem.

Objective. Establish frequency of change of internal organs and the atherosclerotic process in patients suffering from chronic alcoholism and determine the causes of death.

Material and methods. The results of autopsies of the 94 dead with chronic alcoholism in the Centre of Mental Health for 2005–2014 years. Analysis of the material was carried out on the basis of macroscopic and microscopic examination (histological specimens stained with hematoxylin-eosin, pikrofuksin on Van Gieson, on myelin by Kluver-Barrera). During the autopsy, it drew attention to the presence of atherosclerotic lesions in the aorta, coronary and cerebral arteries.

Results. According to the morphological study and pathologic diagnosis all observations are as follows: delirium tremens – 24, encephalopathy Gayet-Wernicke – 13, alcoholic encephalopathy – 10, alcoholic dementia – 3, myelinolysis pontis – 8, disease Marchiafawa-Bignami – 1, alcoholic cirrhosis of the liver – 1. All observations were accompanied by severe morphological changes at least 3–4 of the internal organs. Severe atrophic gastritis occurred in 39 cases (75 %), alcoholic dilated cardiomyopathy – 31 (59.6 %), sclerosing pancreatitis – 32 (61.5 %), morphological changes in the liver (steatosis and alcoholic hepatitis) – 43 (82.7 %), two observations – alcoholic cirrhosis of the liver, bronchopneumonia – 23 (44.2 %). Signs of atherosclerosis were found in 19 cases (36.5 %). The average age of the deceased in these cases was 53.4 years.

Conclusion. Complications of chronic alcoholism accompanied by morphological changes of internal organs, which greatly aggravate the disease. The most significant are the changes in the heart in the form of alcoholic dilated cardiomyopathy with the development of acute or chronic cardiovascular failure. A certain importance is pancreatitis, which can result in the development of pancreatic necrosis and changes in the liver with the development of liver failure. In some cases (especially in patients with alcoholic dementia) a major role in tanatogenesis can play bronchopneumonia. Atherosclerotic process is not significant in tanatogenesis of patients with chronic alcoholism and occurs predominantly in elderly patients.

A non-randomized study of 121 patients was conducted, which were divided into group 1 – patients with chronic venous insufficiency, group 2 – with deforming arthrosis of the knee joint of the 3rd degree, group 3 – with chronic arterial insufficiency. Patients with deforming arthrosis of the knee joint of the 3rd degree underwent total knee arthroplasty, with varicose veins of the lower extremities – radical phlebectomy with removal of the great saphenous vein with varicose-dilated branches and subfascial ligation of the perforating veins, patients with chronic arterial insufficiency with the development of irreversible changes in the area of the foot, bone-myoplastic amputation of the lower limb was performed at the level of the middle third of the thigh. In patients of the formed groups, blood was taken to determine the content of C-reactive protein (CRP) before surgery, 24–48 and 72 hours after surgery. At the 1st stage of the study (before surgery), the content of CRP in the blood serum of all patients of the three groups was 4,6 (0,66; 101?74) mg/l, at the 2nd stage (24–48 hours after the operation) there was a significant an increase in CRP, which amounted to 43,35 (16,23; 165,24) mg/l (p < 0,05), at stage 3 (72 hours after surgery) – 51,49 (19,28; 197,01) mg/l (p > 0,05). The level of CRP was equal in group 1: at stage 1 – 0,49 (0,2; 2,19) mg/l, at stage 2 – 13,74 (7,06; 18,62) mg/l (p < 0,05), at stage 3– 15,89 (8,02; 21,06), (p > 0,05). The content of CRP in group 2 was equal to: 3,44 (0,77; 6,5) mg/l at stage 1, 41,68 (23,72; 75,83) mg/l at stage 2 (p < 0,05), at stage 3 – 47,32 (26,97; 86,32), (p > 0,05). In group 3, the CRP level was equal to: 183,73 (118,74; 183,73) mg/l at stage 1, 270,96 (182,24; 250,24) mg/l at stage 2 (p < 0,05), 298,44 (197,33; 263,35) at stage 3 (p > 0,05). The dynamics of the content of CRP in patients during surgical interventions on the lower limbs can be considered as a biochemical criterion for the traumaticity of surgical interventions.

Mesenchymal stromal stem cells (MSSCs) are a unique object for the development of new methods for the treatment of multiple sclerosis (MS) due to their immunomodulatory properties, stimulation of repair and transdifferentiation processes under certain conditions in the direction of glial cells and even neurons. The article presents the results of a study aimed at assessing the effect of allogeneic MSSC transplantation on some immunological parameters of patients with MS. The most significant changes in the immunological status were observed by 6 months of the post-transplantation period. After therapy with allogeneic MSSCs, there was no pronounced inhibition of the functional state of T-lymphocytes in response to nonspecific stimulation, which indicates the functional viability of immune system cells in maintaining antigenic homeostasis.

According to epidemiological evidence, the prevalence of oncological diseases of the maxillofacial region continues to increase all over the world despite the active development of medical technologies and preventive measures. Postoperative defects of the maxillofacial region in patients with malignant neoplasms of the upper jaw are a serious pathology, since they lead to functional and cosmetic disorders, which significantly worsens the quality of life of patients and creates big problems in their social adaptation and rehabilitation. Increasing the effectiveness of prosthodontic treatment of this category of patients, which is associated with the elimination of extensive postoperative defects by dentures, remains one of the most urgent problems of modern dentistry. The aim of the study was to analyze current trends in the treatment of maxillary defects after surgery of malignant neoplasms. The results of study show that still there aren’t general methods of prosthetics, there isn’t consensus on the timing of prosthetics and the structure of the prostheses that replaces the maxillary defect.

The article is devoted to the activities of the Belarusian Medical Institute in evacuation in 1943–1944. During the Great Patriotic War, the medical institutes of Belarus temporarily suspended their work. Their activities resumed in Yaroslavl, where in 1943 the Belarusian Medical Institute was opened, uniting the Minsk and Vitebsk institutes. In 1944, the only graduation of doctors was carried out. After the liberation of Belarus from the fascist invaders, the Belarusian Medical Institute was reevacuated to its republic. In Yaroslavl, on its basis, the Yaroslavl Medical Institute was opened, where many teachers and students continued to work and study. The article, based on archival documents, analyzes this period of activity of Belarusian scientists in the training of medical personnel of higher education.