The article reviews problematic issues of headaches and management the patients with chronic migraine, as one of the types of primary headaches. Risk factors and triggers, mechanisms of chronicization of migraine headaches are presented. Possible approaches and methods for increasing the effectiveness of chronic migraine treatment are reviewed. The article presents a clinical case of successful use of a multidisciplinary approach in the treatment of a patient with chronic migraine combined with drug-induced headache at the RRCRM&HE with the participation of medical specialists of various profiles, with the administration of drug preventive therapy, cognitive-behavioral therapy, acupuncture and psychotherapy sessions, and treatment of drug-induced headache.

It is known that immune reconstitution is a multicomponent process that determines the survival and quality of life of patients after allogeneic hematopoietic stem cell transplantation. For an optimal immune response, it is necessary to restore all subpopulations of immune cells in a timely manner; normally, restoration occurs unevenly. The main factors influencing T-cell restoration are GVHD and immunosuppressive treatment.

The review presents data on immune restoration as a complex process, factors influencing the restoration process. Features and timing of restoration of natural killers, cytotoxic T-lymphocytes, T-helpers, B-lymphocytes.

This review presents current information on cardiovascular risk factors and the course of cardiovascular diseases (CVD) in patients with chronic lymphocytic leukemia (CLL). It also examines comorbidity in patients with CLL and the pathogenetic mechanisms common to both CLL and CVD, including chronic inflammation, endothelial dysfunction, and oxidative stress, including those mediated by viral agents. The need for antitumor treatment is associated with the risk of developing cardiovascular complications (cardiotoxicity). Current approaches to the early detection and prevention of cardiotoxicity in CLL are presented. These approaches will potentially change approaches to cardiovascular risk stratification in patients with CLL, develop an algorithm for dynamic monitoring and timely cardioprotection, including for subclinical changes in myocardial function, preventing disease progression. A multidisciplinary teamwork between a cardiologist and an oncohematologist will reduce the risk of cardiovascular complications in patients with CLL and improve their prognosis.

Glaucoma is a progressive disease and is one of the leading causes of irreversible vision loss worldwide. The global prevalence of glaucoma in the world is growing and will increase to 111,8 million people by 2040. Any surgical treatment for glaucoma is aimed at reducing intraocular pressure in order to prevent further vision loss. Traditionally, facoemulsification is considered to remove cataracts and improve vision, and surgical treatment of glaucoma to reduce intraocular pressure.

This review article examines the role and effectiveness of phacoemulsification in various forms of glaucoma, which allows us to evaluate this operation not only from a traditional point of view, but also as a modern microinvasive surgical procedure in the treatment of glaucoma.

The global COVID-19 pandemic has necessitated mass population testing, highlighting the critical importance of the preanalytical stage of diagnostics. This study aimed to comparatively evaluate the effectiveness of using saliva as an alternative biomaterial and nasopharyngeal swabs collected using flocked and traditional cotton swabs for PCR diagnosis of SARS-CoV-2. A prospective study was conducted on 31 patients with parallel collection of saliva and nasopharyngeal swabs. It was shown that the mean threshold cycle (Ct) value for detecting the human genome in saliva was 3 points higher, and the viral load was significantly lower, indicating lower sensitivity of PCR analysis of saliva (mean Ct deviation for SARS-CoV-2 — -3,175). The second part of the study involved a paired comparison (n=217) of the collection efficiency of flocked and cotton swabs. Statistical analysis (paired t-test, t(24)=5.856; p<0.00001) revealed a highly significant advantage of flocked swabs: the mean difference in efficiency was ΔM = 3,74 ± 3,19 units, 0.00001) revealed a highly significant advantage of flocked swabs: the mean difference in efficiency was ΔM = 3,74 ± 3,19 units, Cohen's d effect size=1,171. The results demonstrate the critical importance of the choice of biomaterial and collection tools at the preanalytical stage. Nasopharyngeal swabs collected with flocked swabs are the preferred method for achieving maximum sensitivity in PCR diagnosis of SARS-CoV-2, while saliva can be considered an acceptable alternative only in exceptional cases.

The article presents a comparative analysis of the prevalence of genetic variants of two genes of the CYP3A subfamily and gene ABCB1 in a group of kidney transplant recipients and a comparison group in order to determine regional features of the frequencies of clinically significant variants of the genes studied.

Molecular genetic analysis revealed that in a group of 81 kidney transplant recipients and a general population of 92 individuals, the frequency of the clinically significant allele for the 3435C>T polymorphism of the ABCB1 gene was 0,438 and 0,533, respectively; for CYP3A4*1G, it was 0,068 and 0,076; and for CYP3A5*3, it was 0,056 and 0,033, respectively. No significant differences in allele and genotype frequencies were found between the study groups.

The prevalence of allelic variants of the studied genes was comparable to European population values.

This study examines the conditions and mechanisms of microbial contamination of donor organs and tissues, which is a critical issue in the field of transplantology. The data collected were obtained as a result of microbiological control of central venous catheters and solutions used for preserving pulmonary artery allografts. When culturing sections of the central venous catheter, positive results were obtained in 5 out of 51 cases (9,8%), all of which were K. pneumoniae and A. baumannii. When was examining the preservation solution, positive results were obtained in 11 of 51 samples (21,5%), with the spectrum of microflora including K. pneumoniae, A. baumannii, E. faecalis, S. haemolyticus, and combinations thereof. It was found that microbial contamination of donor materials can occur at various stages of conditioning, including the donor preparation stage. The results show two main mechanisms of infection: internal, associated with the transfer of bacteria from the internal environment of the donor's body, and external, resulting from contamination during organ removal. The study highlights the need for further work to gain a deeper understanding of the pathways of infection and to develop effective methods for preventing microbial contamination in transplants.

Despite advances in the treatment of acute lymphoblastic leukemia in children, the toxicity of chemotherapy remains an open question and requires further analysis and practical solutions to reduce the incidence and severity of complications. An analysis of the structure and frequency of toxic complications of polychemotherapy under the ALL-MB-2008 program was conducted in 41 children. Hematological toxicity, infectious toxicity, and hepatotoxicity were observed in 100% of patients throughout the entire treatment period. Toxic complications developed statistically significantly more frequently during the induction and consolidation therapy stages compared to maintenance therapy. Adequate supportive therapy can mitigate toxic complications and reduce mortality in pediatric patients with acute lymphoblastic leukemia.

Multiple myeloma (MM) is a heterogeneous disease that undergoes a multi-stage process of cell transformation in its development, including changes in the genetic profile due to additional events such as somatic mutations, epigenetic and chromosomal changes, which leads to the emergence of a pathological clone.

To identify mutations in the NRAS, KRAS, and BRAF genes, DNA isolated from bone marrow samples of 55 patients with newly diagnosed MM was used. The studies were carried out using real-time PCR, melting curve analysis and electrophoresis analysis.

Among the examined patients with newly diagnosed MM, the mutation frequency for the NRAS gene ranged from 20,00% to 23,64%. For the KRAS gene, the frequency ranged from 16,36% to 30,91%. For the BRAF gene, the frequency was 21,82%. A combination of two mutations was detected in 16.36% of cases, and three mutations were found in 7,27% of the examined patients. In patients with MM, mutations in the KRAS gene were more common among patients with IgA secretion, bone lesions without extramedullary foci, as well as with multiple bone lesion and the presence of extramedullary lesions in the presence of the mutant T allele. No reliable associations with clinical and laboratory parameters were established between the detection of mutations in the BRAF and NRAS genes. However, the combined carriage of polymorphisms c.1799T>A in the BRAF gene and 181C>A in the NRAS gene was recorded in patients with a worse prognosis. Patients with a combination of KRAS/NRAS mutations at the time of primary diagnosis had a more aggressive course of the disease and lower progressionfree survival.

A high prevalence of mutations in the NRAS, KRAS, and BRAF genes has been established in patients with newly diagnosed myeloma. Studies have revealed an association between the studied mutations in the NRAS, KRAS, and BRAF genes and certain clinical and laboratory parameters and the course of MM.

Aim: to study the features of the renin-angiotensin-aldosterone system (RAAS) response to emotional arousal in patients with arterial hypertension (AH) and associated clinical conditions (ACS). Objectives: 1) to determine the clinical significance of the Kerdo autonomic index (KAI) in patients with hypertension and ACS; 2) to find signs of increased RAAS activity during emotional arousal; 3) to assess the clinical significance of increased RAAS activity; 4. To determine the practical significance of identifying signs of increased RAAS activity A total of 105 patients with hypertension and comorbid pathology were studied. Design: observational clinical study in specially formed groups.

Conclusions: 1) subjects with «parasympathicotonia» (KAI <-10,0) were older, among them there were more often II and III degrees of hypertension, high and very high cardiovascular risk (CVR) and chronic heart failure (CHF) of 1 and 2a degrees, while subjects with «normotonia» (-10,0 ≤ KAI ≤10,0) and «sympathicotonia» (KAI >10.0) did not differ from each other; 2) criteria for increased RAAS activity in patients with hypertension are an increase in indicators in a state of emotional arousal to the previous state of rest above the found threshold value: diastolic blood pressure (DBP) ≥4 mm Hg and KAI ≥19,0 units, as well as an increase in heart rate (HR) < 11 beats / min. 3) Clinically increased RAAS activity during emotional arousal is characterized by a higher incidence of moderate-high CVR, cardiosclerosis, and coronary heart disease (CHD); 4) No differences were found between groups with different RAAS activity by age, gender, and other social characteristics. With moderate-very high CVR, an increase in DBP above the threshold was observed in 79,6%, and a change in KAI was observed in 50,5%.

Cervical cancer remains a serious public health problem. It is the fourth most common cancer in women worldwide, with an estimated 604,000 new cases and 342,000 deaths in 2020. Human papillomavirus (HPV) vaccination, combined with screening and treatment of precancerous lesions, is an effective and cost-effective method for preventing cervical cancer. Vaccination selection depends on the circulating HPV genotypes in different regions.

This article presents the prevalence of HPV and its genetic variants in women in Gomel city and the Gomel district. HPV genotypes 16, 51, and 58 were found to be most frequently detected, with their highest prevalence in the 18-24 age group and the 25-29 age group for cervical dysplasia. According to the obtained results, the tactics of conducting vaccination against high-risk HPV for the purpose of preventing cervical cancer are justified.

Analysis of the relationship between clinical and laboratory parameters and the development of thrombotic complications during the period after diagnosis in a group of 194 patients with Polycythemia Vera (PV) confirmed the effectiveness of using a risk stratification system based on the presence of thrombotic events in the anamnesis and age over 60 years for predicting the risk of thrombosis (OR=3,6 [95% CI (1,6 and 8,0)], p=0,0008). Methods for additionally assessing the risk of arterial and venous thrombosis were proposed. Clarification of the risk of arterial thrombosis is based on determining such factor as the presence of coronary heart disease in the anamnesis (OR=5,2 [95% CI (1,8–14,8)]). An additional assessment of the risk of venous thrombosis is based on determining the presence of varicose veins of the lower extremities in the anamnesis (OR = 3,3 [95% CI (1,3–8,3)]) and a platelet count of more than 600×109 /l when diagnosing PV (OR = 3,2 [95% CI (1,1–9,7)]).

Activities aimed at reducing mortality rate from cardiovascular diseases are a priority and determine the directions of development of specialized medical care; improvement of the healthcare system; development and implementation of long-term strategies for the formation of a healthy lifestyle, algorithms for managing cardiovascular and metabolic risks.

The objective of the study was to analyze the prevalence of risks of developing diabetes mellitus type 2 and their impact on the absolute risk of death, and to find ways to correct them in women of working age.

Selective immunoglobulin A (IgA) deficiency is considered the most common primary immunodeficiency. A specific genetic defect leading to this disease has not yet been identified. The true frequency of selective IgA deficiency in the population is unknown, as it is often asymptomatic and is a random laboratory finding. This immunodeficiency can manifest as respiratory tract infections, gastrointestinal tract infections, allergic disorders, and autoimmune diseases. According to the literature, patients with autoimmune disorders who have selective IgA deficiency have more severe and aggressive disease courses with a poorer prognosis. The clinical example of a combination of selective IgA deficiency and Crohn's disease demonstrates that patients with primary immunodeficiencies may not be aware of their condition for a long time. The article presents a case of Crohn's disease in a patient with selective immunoglobulin A deficiency, which was detected in early childhood.

The article considers issues of diagnostics of ischemic heart disease, the importance of myocardial perfusion visualization methods. In accordance with the latest recommendations, myocardial perfusion testing using myocardial scintigraphy or positron emission tomographycomputed tomography should be considered for patients with suspected chronic coronary syndrome. Myocardial perfusion scintigraphy with physical activity also allows one to assess the hemodynamic significance of intermediate coronary stenoses, which is especially important when choosing a method for patient management. The aim of the work was to analyze the results of myocardial scintigraphy in patients based on the State Institution «Republican Research Centre for Radiation Medicine and Human Ecology». The presented clinical examples confirm the high efficiency of the method, including in the selection of patients for invasive coronary angiography. In 2024, 224 patients referred by cardiologists for myocardial scintigraphy using single-photon emission computed tomography were examined at our clinic. Based on the results of myocardial perfusion assessment, 35 patients (15,6%) were referred with a recommendation to perform coronary angiography as soon as possible.