The most common type of uterine tumors are smooth muscle tumors: benign leiomyomas, smooth muscle tumors of uncertain malignant potential (STUMP), sarcomas. The incidence of STUMP is difficult to estimate. They account for 1,3% of all uterine malignancies. A thorough histopathological examination is necessary to confirm the correct diagnosis of STUMP due to the unreliability of preoperative imaging techniques for differentiating between leiomyoma, STUMP and leiomyosarcoma. Compared with sarcomas, STUMP have a better prognosis, but their biological potential is uncertain because recurrence, malignancy, and metastasis are possible many years later. Considering the rarity of tumors with uncertain malignant potential, the small number of publications on their treatment, there are no clinical recommendations for the management and treatment of patients with this pathology. The article reviews current data on the diagnosis and differential diagnosis of smooth muscle tumors, management tactics, treatment, and prognosis of patients with STUMP.

Pelvic floor dysfunction (PFD) in women includes conditions such as vaginal relaxation syndrome (VRS), pelvic organ prolapse (POP), urinary and fecal incontinence, obstructed defecation, and sexual dysfunction. Etiopathogenesis is associated with disorders of the pelvic floor fixing apparatus that arise due to traumatic childbirth, genetic changes in the structure of connective tissue (polymorphism of the gene for connective tissue enzymes NAT2). Techniques used to diagnose pelvic floor injuries include x-rays, computed tomography, magnetic resonance imaging (MRI), and ultrasound. In this publication, we presented an overview of the most relevant and recent data on the etiopathogenesis, diagnosis of DTD.

The development of atopic dermatitis at an early age and subsequent allergic rhinitis and asthma at a later age is known as the atopic march phenomenon. Despite the complexity and diversity of mechanisms of atopy development, it has been shown that atopic dermatitis and allergic respiratory diseases share a common pathogenesis. It was determined that the atopic dermatitis progression to bronchial asthma and rhinitis is associated with a complex interaction of genetic, immunologic, environmental, and psychosocial factors. In particular, the progression of atopy is influenced by the presence of filaggrin gene mutations, the onset and severity of atopic dermatitis, epicutaneous sensitization to aeroallergens, and colonization by bacterial superantigens. Despite significant progress in the studying of the role of skin barrier defects, impaired Th2 activation, hereditary component and environmental factors in the formation of atopy, to date no generally accepted algorithm for determining the risk of progression of atopic diseases has been developed. Information about the most significant factors associated with an increased risk of atopic march development may be useful for specialists providing medical care to children with allergic diseases.

The article provides an overview of the problem of postoperative adrenal insufficiency (AI) in patients after unilateral adrenalectomy. The clinical picture of AI and the consequences of untimely provision of medical care are described. The prevalence of the disease in various types of adrenal neoplasms after their surgical treatment is systematized and highlighted. Predictors of the AI development and modern laboratory methods for its diagnosis are presented. The issue of the current possibility of pharmacotherapy for this pathology has also been studied and highlighted. And more importantly, directions for the prevention of adrenal insufficiency in patients with adrenal neoplasms who are indicated for surgical treatment are described.

For the first time, the transition from an emergency exposure situation to an existing exposure situation has been scientifically substantiated and a draft resolution of the Council of Ministers of the Republic of Belarus on the implementation of this transition has been developed. The analysis of the radiation doses of the population from natural sources of ionizing radiation and Chernobyl origin allowed us to propose a reference level of exposure of citizens of Belarus in the current situation of the existing exposure of 10 mSv per year. The value of the reference level is mainly determined by the existing exposure of the population from natural sources, mainly radon. It has been proved that the radiation from the Chernobyl fallout is currently significantly lower than from natural sources. The proposed value of the reference level for the post-Chernobyl period coincides with the reference level adopted in Japan after the accident at the Fukushima nuclear power plant.

A comparative analysis of the methods used for assessing and forecasting individual accumulated external exposure doses since the Chernobyl accident showed that conservative approaches to assessing doses and underestimation of indirect dose-forming factors have a negative influence on dose forecasting in general. The proposed new methodological approach of assessing of individualized external exposure doses is consistent with its analogues (Kendall’s concordance factor W=0,96; p<0,03), but at the same time allows taking into account not only the direct dose-forming factor (contaminated density) but also indirect factors in the aggregate (occupational employment, gender and age), which, in turn, makes it possible to reconstruct individualized external exposure doses for each year under study with minimal error. Regression analysis showed that there is a high correlation between new method’s estimates and individual dosimetric control data (R=0,875; p<0,05), the estimation error of the proposed method is ~4 times lower than previous methods.

A computer-oriented method for rapid assessment of the activity of remote gamma radiation sources in situ (in the field without sampling) is proposed. For calibration of portable and on-board detection units, reference gamma radiation sources are sequentially located at two points: one close to the crystal body, and the second, with an activity of at least 50 kBq, at a distance of 2 m or more along the axis of the detector. The net areas of the total absorption photopics, the live time of the spectrum set, the distances to the sources and their activity are used to determine special calibration coefficients. The calibration coefficients, together with the zero-distance efficiency curve, are used to assess the activity of remote gamma radiation sources (if the distance to the source exceeds its size by an order of magnitude or more). When calculating, the approximate distance to the detector is indicated, the material and wall thickness of the container can be taken into account. An independent expert examination found that the uncertainty of the proposed measurement method does not exceed 30% (p=0,95), which is quite acceptable for in-situ studies.

In the article the dynamics of the population (in total, children and people of working and retirement age), mortality and incidence rates were analyzed in 21 districts of the Republic of Belarus contaminated due to the Chernobyl disaster. A decrease in the population in the affected areas was shown. The decline in the urban population is less pronounced, the maximum rate of decline was observed among the rural population of the areas most remote from large cities with developed infrastructure. At the same time, there was no increase in mortality rates in the affected areas and its decrease in the Republic of Belarus by 1,4% per year. Mortality from malignant neoplasms and cardiovascular diseases was 1,5 times higher in the affected areas than in the Republic of Belarus. The incidence rates of all diseases was 1,5 times higher (p<0,05) in the Republic of Belarus. However, the incidence of thyroid and circulatory diseases was significantly higher in the affected areas. The incidence of thyroid cancer was higher in the affected areas, but statistically insignificant, which indicates an equalization of indicators in all areas of the republic.

The article presents the results of fundamental research into the effect of dark deprivation on female rats during pregnancy. Dark deprivation leads to a decrease in the number of living embryos by 3,4 times, 3,1 times and 3,3 times on the 7th, 14th and 21st days. A decrease in the average weight of embryos was revealed by 1.9 times on the 7th day, by 1.5 times on the 14th day and by 1.8 times on the 21st day.

A significant decrease in the average craniocaudal size of embryos in the experimental group was recorded. This indicator decreased by 2,7 times on the 7th day, by 1,8 times on the 14th day and by 1,8 times on the 21st day. Preimplantation death due to chronodestruction showed an increase of 4,3 times relative to the control at the final stage of the study (day 21). There was an increase in post-implantation death under the influence of constant light on the 7th day to 70,51%, on the 14th day – to 68,26%, on the 21st day – to 69,71%.

The findings may have important translational implications and will be used to find effective methods to prevent complications in pregnant women with disrupted circadian rhythms.

The analysis of the structure of X-ray diagnostic examinations and the levels of effective exposure doses to the population of the Gomel region for the period of 2014-2021 has been conducted based on data of the State Dosimetry Registry.

The dynamics of indicators from 2014 to 2021 are shown.

During the studied period there was a dominance of radiographic (51-54)% and fluorographic (40-35)% methods for examinations in the structure of X-ray diagnostic studies carried out in medical institutions of the Gomel region.

There is a trend towards an increase in the collective effective dose of medical exposure to the population of the Gomel region by 38%. The significant changes in the structure of the collective dose were observed: in 2014 radiographic examinations accounted for 50%, and by 2021 their contribution decreased up to 25%, while the contribution of computed tomography over the corresponding period increased from 15% up to 53%.

The number of X-ray procedures in medical institutions of the Gomel region in average 1,8 per capita annually during the entire observation period. The average effective dose from medical exposure per capita of the Gomel region increased by 44%.

The influence of the environment on the immune system function can lead to the development of an environmentally conditioned secondary immunodeficiency. The importance of searching for immunological markers to assess the impact of environmental factors on the health of the child population can be expressed in the results of immunological studies and can show the degree of influence of environmental pollution on the child’s health and condition. This article analyzes the humoral immune factors in children living in the ecologically disadvantaged Ararat region of the Republic of Armenia. A decrease of the IgM and IgG concentrations in saliva was found in combination with an increase of the total IgE and C3a component of the complement system levels in the blood serum of the examined children, which indicates the manifestation of environmental immunosuppression and can serve as a marker of the state of the immune system under the influence of various adverse environmental factors.

126 outpatients were examined. In January-June 2023 – 29 people with post-Covid syndrome. In January-June 2022 – 47 people were anxious patients with signs of Covid phobia and 50 people with neuropsychiatric disorders who fell ill even before the COVID-19 pandemic. The study was conducted according to the methodology in environmental psychiatry using the author’s quantified map, including: socio-demographic, anamnestic sections, determination of the perception of socio-environmental factors, a clinical section with assessment of mental status according to ICD-10 and psychophysiological indicators – anxiety and vegetative support. What is common to all groups is that 2/3 of women have had a coronavirus infection, mostly in a mild form. As a result of the study, the predominantly psychogenic etiology of post-Covid syndrome was established, with leading anxiety spectrum disorders. Long-term exposure to anxiety causes organic transformation with an increase in cognitive dysfunction, cerebrasthenia and the formation of psychosomatic pathology. At the basis of cognitive dissonance, there is a tendency to reduce the perception of the danger of coronavirus infection, in the presence of signs of Covid phobia, which is the essence of the phenomenon. The phenomenon of decreased perception of the coronavirus infection factor affects the weakening of vaccine motivation. Taking into account clinical, personality-typological characteristics and peculiarities of perception of the environment provides grounds for targeted prevention, psychocorrection and rehabilitation.

The information content of the confocal laser microscopy (CLM) method for diagnosing of parathyroid gland pathology (adenoma/hyperplasia) in 30 patients who had the clinical and laboratory signs of hyperparathyroidism was analyzed. The pathology of the parathyroid gland was finally verified by histological method, based on the presence of follicle-like structures in the biopsy samples, the absence of stromal fat cells, and the absence of pronounced connective tissue septa. The sensitivity of CLM was assessed in comparison with the methods of ultrasound, CT scan, MRI, and scintigraphy with 99mTc-sestamibi. CLM showed the highest diagnostic accuracy for identifying parathyroid gland pathology with the establishment of a full set of pathognomonic criteria in 76,7% of cases (χ2=74,051, p<0,001). The advantage of CLM was proven by the absence of false negative results, while with ultrasound, scintigraphy, CT and MRI their frequency was 6,7%, 3,4%, 25,0% and 15,8%, respectively. An integrated approach to the instrumental diagnosis of parathyroid gland pathology for the purpose of subsequent surgical treatment is reflected in the developed algorithm. To ensure accurate topical diagnosis with determination of the morphological structure of pathological formations of the parathyroid gland using the CLM method during surgical intervention, a computer program «Hyperparathyroidism» has been developed (registration certificate № 1377, 31.12.2020).

Cytokines regulate the functioning of the mucosal immune system at various levels of innate and acquired immune response. The disturbances in cytokines balance result in the loss of the mucous membranes barrier function as well as the development of a protumorigenic or chronic autoimmune microenvironment. Changes in the local microenvironment of the mucous membranes as a result of a complex network of interactions between cytokines and target cells may be a key step towards understanding the pathogenesis of immune-mediated mucosal system diseases and the development of new effective methods of diagnosis and therapy. In this article the cytokine in situ production of IL-15, αIFN and Reg3γ, IL-8, IL-17 and TGFβ was assessed in 55 patients with immunopathology of the mucous membranes (malignant and benign neoplasms of the nasal cavity and paranasal sinuses, polypous rhinosinusitis and Crohn’s disease). The relationship of cytokines and mechanisms of innate and acquired immunity has been established under conditions of pathological tolerance and chronic autoimmune inflammation development.

Common variable immunedeficiency (CVID) is a group of diseases that are inborn errors of the immune system and are characterized by impaired production of protective antibodies. The reason is a defect in the T- and B-cells, leading to impaired ability to produce specific antibodies after vaccination and infections with a significant decrease in immunoglobulins. Laboratory methods for diagnosing CVID usually include: flow cytometry and enzyme-linked immunosorbent assay to determine the levels of immunoglobulins (IgG, IgA, IgM) and antibody titer, however, these methods do not provide sufficient information about the neogenesis of lymphocytes. Our study is aimed at obtaining information about the possibility of using a simple and effective method for determining T- and B-lymphocyte receptor recombination products (TREC/KREC) in CVID. This method allows you to evaluate the neogenesis of T and B lymphocytes. The study included 12 patients diagnosed with CVID at the age of 11,2 (7,8; 15,0) years. In 2 patients CVID was determined by defects in the NFkB1 and NFkB2 genes. In 10 patients with CVID, the genetic defect was not identified; the diagnosis was established on the basis of clinical and laboratory data. To assess the diagnostic significance of the analyzed method, ROC analysis was used, followed by calculation of diagnostic sensitivity and specificity for each indicator. Our data allows us to assert that the quantitative determination of TREC/ KREC allows using this method with high diagnostic sensitivity and specificity at the stages of diagnosing CVID.

Over an 11-year observation period, type 2 diabetes mellitus (E11) was recorded in isolated cases at the age of 25-29 years against the preceding background of primary incidence of obesity associated with excess intake of energy resources (E66). A low incidence of various forms of impaired glucose tolerance was reported (R73). The incidence rate of dyslipidemia (E78) was comparable to the incidence rate of type 2 diabetes mellitus.

Predictors and risk of developing type 2 diabetes mellitus were determined in more than 1,5 thousand healthy respondents. More than 80,0% of respondents had a low 10-year risk of developing type 2 diabetes mellitus. However, the analysis indicated a negative effect of atherogenic lipids on the levels of hemoglobin glycation, a probable effect on the development of insulin resistance, an increased risk of prediabetes and clinical and laboratory manifestations of type 2 diabetes mellitus in patients with a high 10-year risk. In the group of healthy workingage respondents, the RR high risk/low risk (according to Findrisk) of prediabetes was 2,58 (1,58; 4,22) and was statistically significant.

Analysis of factors influencing the risk of developing type 2 diabetes mellitus showed a high prevalence of both modifiable and non-modifiable risk factors in all groups of the workingage population of the Republic of Belarus.

When planning activities for the primary prevention of non-communicable diseases in the population, it is necessary to be based on the results of the assessment and the feasibility of reducing population risks. Risk assessment makes it possible to identify and form followup groups of population for which it is possible to administer preventive treatment to correct metabolic disorders.

Every year the study of the qualitative component of the albumin molecule becomes more and more relevant. Therefore, the aim of our work was to study the structural and functional state of serum albumin in patients with uterine body cancer under the action of radiation therapy.

In order to study radiation-induced changes in serum albumin when irradiated with therapeutic doses of ionizing radiation, biological material (blood) of 33 people from the Gomel region was used: 1st gr. (control) – 13 healthy people; 2nd gr. – 20 patients diagnosed with uterine body cancer who underwent remote gamma therapy (30 Gy). The collection of biological material in the 2nd group was carried out as follows: upon admission to inpatient treatment; after the 1st session of radiotherapy (2 Gy); after the 3rd session of radiotherapy (6 Gy); after the 5th session of radiotherapy (10 Gy); after the 7th session of radiotherapy (14 Gy); after the 10th session of radiotherapy (20 Gy) and after the 15th session of radiotherapy (30 Gy).

According to the method of Yu.A. Gryzunov, G.E. Dobretsov the following indicators were determined: total albumin concentration (TAC)− the number of albumin molecules capable of binding toxic ligands is equal to the albumin concentration determined by in any other way; effective albumin concentration (EAC) − the number of albumin binding centers unoccupied by toxic ligands; reserve of albumin binding (RAB) − reflects the degree of structural modification of the protein; index of toxicity (IT) − characterizes the filling of albumin centers with toxic ligands.

Conclusions.

1. The total albumin concentration is within normal values, both for healthy and cancer patients throughout the course of radiation therapy. Analysis of indicators characterizing the structural and functional state of serum albumin (EAC, RAB and IT) in patients with uterine body cancer showed that the amount of fully functioning protein statistically significantly decreases when compared with a group of healthy people.
2. When studying the effect of radiation therapy on the structural and functional state of serum albumin in cancer patients, it was shown that:

• in 45% the values of the IT indicator increase after a course of radiotherapy, and in 55% − decrease;
• after the 1st session of radiotherapy, the further dynamics of IT after treatment is determined: if after 2 Gy the values of IT indicator increased, then by the end of therapy this indicator will be higher than when entering treatment, and, conversely, if after 2 Gy the values of IT indicator decreased, then after the course of radiotherapy this indicator will be less than entering treatment.

1. Determination of albumin indicators characterizing the structural and functional state of serum albumin, in particular, the index of toxicity in patients with uterine body cancer should be used as an individual diagnostic and prognostic criterion in the dynamics of observation of patients undergoing remote gamma therapy.

Plasma cell neoplasms are characterized by tumor proliferation of a clone of plasma cells secreting pathological immunoglobulin. The most common types of plasma cell tumor include multiple myeloma, its predecessor smoldering myeloma, monoclonal gammopathy of undetermined significance, as well as rare forms – solitary plasmacytoma and extramedullary lesions with minimal or no bone marrow involvement. Among extramedullary lesions, several forms are distinguished, some of which are associated with bone tissue, and others are extraosseous, located in soft tissues or affecting various organs.

The article presents a rare clinical case of extramedullary lesions with minimal bone marrow changes in a 49-year-old female patient with monoclonal gammopathy of undetermined significance and rheumatoid arthritis. Literature data, clinical manifestations, features of diagnosis and therapy are presented.

Review of herbal remedies in alternative antihypertensive and neuroprotective treatment of glaucoma Due to the fact that glaucoma is a chronic, slowly progressive disease, patients are often disappointed in traditional treatment methods, and this leads to an independent search for other treatment strategies. The purpose of this review is to summarize data on the effect of herbal agents on the course of the glaucomatous process and discuss the validity of their use. An analysis of works devoted to the study of the neuroprotective and hypotensive effects of alternative medicine was carried out. The results presented in the review allow us to conclude that traditional treatment tactics remain relevant, and the prescription of any alternative agents requires special caution and does not eliminate the need for adequate control of intraocular pressure levels.

Glaucoma is only partially associated with increased intraocular pressure. Normal-tension glaucoma (NTG) is a form of open-angle glaucoma in which optic nerve damage and visual field defects are present despite a baseline intraocular pressure of less than 21 mmHg. The exact mechanism by which anatomical and functional damage occurs remains unknown in patients with NTG. The proposed theories, mechanical and vascular, do not fully explain the pathogenesis of the disease. This dictates the need to perform both structural and functional ophthalmological and radiological diagnostic methods in differentiating the diagnosis. The authors analyzed a clinical case of NTG in 66-year-old patient over 3-year period of the disease. The results presented in the article allow us to conclude that traditional ophthalmological examinations remain relevant. Energy metabolism and dysfunctional neurodegeneration metabolic pathways play a role in the pathophysiology of NTG. The role of cerebral glucose metabolism is not fully understood and requires study in NTG. It may provide clinicians with additional opportunities for diagnosing and treating the disease.