THE STATE OF THE CARDIOVASCULAR SYSTEM IN CHILDREN OF KIDNEY TRANSPLANT RECIPIENTS

Damage of the cardiovascular system (cardiovascular disease, CVD) is the main cause of reduced life expectancy in children with chronic kidney disease (CKD). In the development of damage of the heart and blood vessels, both traditional factors and caused by impaired renal function, which appear already in the early stages of kidney disease, play a role. Purpose of the study: assessment of markers of the structure, function and metabolism of the heart and study of their changes in children, kidney transplant recipients. Materials and methods. 54 children, a kidney transplant recipients (Tx), who were under observation and treatment at the National Center for Pediatric Nephrology and Renal Replacement Therapy, Minsk 2nd Children's City Clinical Hospital, aged 3 to 17 years, were included in the study. The analysis of the data of the Tx group and conditionally divided subgroups: 1) with glomerular disease leading to the end stage of CKD (ESRD), n = 26; 2) with non-glomerular pathology, n = 27, in one patient the cause of ESRD was not specified. The control group consisted of healthy children from cardiology department without kidney pathology (n = 86). Results. Anamnestic, clinical, laboratory, immunological (serum concentration of T- and B-lymphocyte activation markers (RANTES and BAFF), proinflammatory (caspase 1, IL1fi and TNFa), vascular (VEGF) and tissue (TGF1p) growth factors), metabolic status (adyponectin, leptin, obestatin, vitamin D 25(OH)D), cardiospecific molecules (highly sensitive C-reactive protein (hsCRP), proBNP, transferrin, TSAT index), instrumental changes. Conclusion. Changes in the cardiovascular system in Tx are ambiguous. On the one hand, there is a significant improvement in the geometry of the myocardium and arterial hypertension, on the other hand, the atherogenic direction of metabolic changes and biochemical markers of CVD remains.

ANALYSIS OF THE SAFETY LEVEL OF PHARMACOTHERAPY CHRONIC DISEASES OF THE MENTAL GROUP: REGIONAL ASPECT

The article presents the issues of assessing the level of safety of pharmacotherapy of chronic diseases of the mental group in a single subject of the Russian Federation. It was found that in the Pskov region, when subsidized drug provision for mental illness is financed from the Federal and regional budgets, epilepsies and schizophrenia are the most expensive. The frequency analysis of the occurrence of side effects when taking psychotropic drugs and their systematization by type A — predictable and type B — unpredictable reactions were performed. It is established that adverse reactions are most often encountered when using anticonvulsants.

A CLINICAL CASE OF COVID-19 IN A NEWBORN

The problem of coronavirus infection has captured the whole world. In one year, the views on the disease itself and its treatment have radically changed. Doctors all over the world cannot give definite answers to a number of questions regarding this virus and its impact on newborn babies. Low susceptibility to coronavirus in young children may be due to some peculiarities of the immune system. Today it is considered to be the main ways of transmission of the virus are airborne and contact. However, the airborne route of infection in newborns is unlikely, because from birth the child is isolated from the sick mother. The issue of the vertical transmission of the virus from an infected mother to a child is discussed. There is no evidence of transmission of coronavirus through breast milk. The diagnosis of coronavirus infection in children is established with a positive epidemiological history and with 2 clinical symptoms with laboratory confirmation. The article presents a single clinical case of coronavirus infection in a newborn. The possible ways of infection of the newborn, the clinical picture, the possibility of joint stay of the mother and the child, breastfeeding, and treatment of the newborn are discussed.

AGEISM AS A PROBLEM OF MODERN SOCIETY

In the modern world, there is discrimination against older people because of their age, called ageism. It can manifest itself either in the form of discriminatory policies of States or companies, or in the form of psychological or physical violence against third-age persons. This type of discrimination was described in the 60s of the XX century, but concern about this phenomenon at the level of who and the UN arose only in the early 2000s. Research has established many causes of ageism: negative stereotypes about older people, upbringing, negative experience of interaction between older people and other age groups, etc. There are explicit and latent, deliberate and unintentional ageism. Proposed various methods for the identification of ageism. The article examines the causes of this type of discrimination, forms of its manifestation and existing research methods, and based on the literature data, offers suggestions for possible ways to combat ageism.

ANXIETY AND DEPRESSIVE DISORDERS IN GENERAL MEDICAL PRACTICE: TOPICAL ISSUES AND UNSOLVED PROBLEMS

Diagnosis of anxiety and depressive disorders in general medical practice is a very important problem of modern medicine. This review article provides basic information about the epidemiology and economic burden of anxiety-depressive disorders, their comorbidity with other mental and somatic diseases, and the connection with suicidal behavior. According to the Decree of the Ministry of Health of the Republic of Belarus dated 02.03.2020 № 13 «On approval of the clinical protocol» «Diagnosis and treatment of patients with mental and behavioral disorders by general practitioners», this article focuses on depression, generalized anxiety, panic, mixed anxiety and depressive disorder in general medical practice. Relevant issues of low quality diagnosis of anxiety and depressive disorders are identified, which are associated both with the complexity of the clinical picture of the diseases in question and with organizational problems. Particular attention is also paid to the need for further integration of psychiatric care into general medical practice while increasing its accessibility and quality. For this, it is necessary to continue studying the best practices of foreign countries in which family and general practitioners have been providing psychiatric care to patients for many years.

EFFICACY OF PERFUSION THERMOCHEMOTHERAPY IN GASTRIC CANCE MANAGEMENT BASED ON RESULTS OF PROSPECTIVE RANDOMIZED STUDY

The article analyses the results of a prospective randomized study of a cohort of 154 radically operated patients with stage IIB-IIIC gastric cancer (Borrmann type 111 IV). 76 patients were administered intraoperative perfusion thermochemotherapy (HIPEC). It was noted that enhancing radical surgery procedure by complementing it with HIPEC in managing this prognostically unfavorable group of patients resulted in a decrease in the frequency of progression cases (p = 0.009), metachronous peritoneal dissemination — (p < 0.001), and 5-year cumulative carcinomatosis incidence — 70.7 ± 6.8 % to 23.6 ± 5.2 % (p < 0.001) thereby building a groundwork for improving 5-year adjusted survival rate from 27.0 ± 6.7 % to 45.1 ±6.4 % (p = 0.05), progression-free survival — from 16.3 ± 5.5 % to 42.1 ± 6.3 % (p < 0.001), and dissemination-free survival — from 19.4 ± 5.9 % to 45.2 ± 6.3 % (p = 0.001).

ECONOMIC EFFICIENCY OF NEW TECHNOLOGIES IN TREATMENT OF PARTIAL DEGENERATIVE DAMAGES OF THE ROTARYBICEPITAL COMPLEX

The authors studied the economic efficiency of conservative treatment of 196 patients with injuries of the rotator-bicepital complex on the basis of the City Clinical Hospital № 6 in Minsk for the period from 2013 to 2020 using the developed approaches and the introduction of new technologies. As a result of shortening the length of stay of patients in a hospital with the use of new treatment technologies, it can reduce the cost of money. The total economic effect was 30726 BYN. The study of the parameters of economic efficiency indicates the feasibility of using the introduced medical technologies. As a result, the total amount of savins from reducing economic losses amounted to 24 006 BYN.

PREVALENCE OF CLINICAL FORMS OF CHRONIC SINUSITIS IN HIV INFECTED PATIENTS

Purpose: to identify patterns in the prevalence of various clinical forms of chronic sinusitis (exudative, proliferative, alterative) depending on the clinical and immunological stages of HIV infection. The study involved 108 HIV-infected patients who were diagnosed with chronic sinusitis. The prevalence of each of the clinical forms of chronic inflammation of the paranasal sinuses (exudative, proliferative, alterative) at different immunological and clinical stages of HIV infection was determined. The majority of HIV-infected persons with chronic sinusitis were diagnosed with a proliferative form of inflammation of the paranasal sinuses (61.1 ± 4.7). As the clinical stage of HIV infection progressed (WHO classification), a decrease in the prevalence of exudative forms of chronic sinusitis (from 84.8 ± 6.2 at the first stage to 4.0 ± 3.9 at the fourth) and, accordingly, an increase in proliferative forms (with 15.2 ± 6.2 at the first stage to 92.0 ± 5.4 at the fourth). As the number of CD4-lymphocytes in the blood of HIV-infected patients decreased, a significant decrease in the frequency of detection of exudative forms of chronic sinusitis was observed (from 85.0 ± 8.0 with a CD4-lymphocyte level of more than 500 uL-1 to 12.9 ± 4.3 with the level of CD4 lymphocytes is less than 200 uL-1) and, accordingly, an increase in the prevalence of proliferative forms of chronic inflammation of the paranasal sinuses (from 15.0 ± 8.0 to 83.9 ± 4.7, respectively). As immunological deficiency progresses in HIV-infected patients, the prevalence of proliferative forms of chronic inflammation of the paranasal sinuses increases, which is a factor determining the tactics of treating chronic sinusitis in this group of patients.

ALLERGENIC ACTIVITY AND DANGER OF INDUSTRIAL DUSTS OF DRY PRODUCTS OF COW'S MILK PROCESSING

The purpose of the work was to establish in a model experiment the allergenic activity and danger of the extracts obtained from the dust of dry products of cow's milk processing (DPMP), containing complexes of soluble whey (WMP) or casein milk proteins (CMP), as a stage of hygienic regulation of the content of dust DPMP in the air of the working area. Experiments on albino guinea pigs sensitized by the intradermal injection of standard doses of WMP and СМР solutions into the ear revealed the development of severe allergic reactions in the animals of the experimental groups with the prevalence of mixed mechanisms of immediate anaphylactic and delayed cell-mediated types. According to the criteria for the classification of industrial allergens, the WMP and СМР complexes have a strong allergenic activity and are differentiated to the 1-st class of allergenic hazard, which determines the classification of the DPMP dust containing them as extremely dangerous industrial allergens. This is confirmed by the established high levels of indicators of allergic-diagnostic reactions in vivo and in vitro when testing sensitized WMP and СМР animals with a solution of skim milk powder dust, indicating the presence of antigenic determinants of whey and casein milk proteins in it and a real ability to form cross-allergic reactions in the body of workers to dust from all dry milk processing products containing these proteins.

HYGIENIC ANALYSIS OF WORKING CONDITIONS IN THE PRODUCTION OF TABLETS AND CAPSULE

In the present research, the working conditions of workers employed in the production of medicines in the form of tablets and capsules of a modern enterprise of the pharmaceutical industry have been studied. Based on the results of attestation of workplaces and data of industrial laboratory control of the factors of the production environment for the period from 2016 to 2019, a complex of harmful production factors at workplaces was determined and a comprehensive hygienic assessment of the working conditions of a general purpose machine operator of chemical and pharmaceutical preparations, packaging machine operator, stacker-packer and processor of technological containers and tares. It has been established that the labor activity of the leading professional groups of workers in production is associated with the influence of a predominantly chemical factor due to the presence of harmful chemicals in the air of the working area. According to the data obtained, the air of the working area at the workplace of the operator of a wide profile of chemical and pharmaceutical preparations of the tableting and filling of capsules section is contaminated with harmful chemicals (doxycycline, nystatin, lincomycin, rifampicin, tetracycline, etc.), the concentrations of which exceed the maximum permissible. A hygienic assessment of the parameters of the microclimate, noise and tension of the labor process at the studied workplaces established that there are no deviations from hygienic standards and the working conditions according to these factors are permissible. Thus, the data obtained allow us to conclude that the working conditions of the operator of a wide profile of chemical and pharmaceutical preparations belong to class 3.3, the stacker-packer — 3.1, and the working conditions of the operator of filling and packaging machines and the processor of technological containers and tares are assessed as acceptable.