Belarusian Medical Academy of Post-Graduate Education

Abstract The Belarusian diaspora has undergone a profound transformation since the political crisis of 2020, which featured contested elections, mass protests and severe repressions. This study examines the evolving dynamics between the ‘old’ (pre-2020) and ‘new’ (post-2020) Belarusian diaspora communities in Poland, Lithuania and Germany, focusing on their values, identities and sense of solidarity. Using a mixed-methods approach involving two online surveys and 30 in-depth interviews, this article reveals that the differences between these groups are not just chronological but are also influenced by symbolic, political and emotional factors. The ‘new’ diaspora, driven by political exile, exhibits heightened digital connectivity and emotional mobilisation, whereas the ‘old’ diaspora emphasises cultural practices. Despite symbolic boundaries, solidarity emerges through shared trauma and digital platforms, fostering a hybrid, translocal identity. In the context of Central and Eastern European diaspora studies, this case study highlights the impact of political crises and digital infrastructures on the redefinition of transnational communities.

Острые респираторные инфекции у детей встречаются повсеместно, их клинические формы многообразны. Но самой тяжелой из них является пневмония, при которой отмечается высокая смертность в возрасте до 5 лет. При подготовке данной работы был осуществлен электронный поиск в PubMed, UpToDate, Scopus, Web of Science, eLIBRARY, CDC, ECDC, WHO/ВОЗ без языковых ограничений. Подавляющее большинство ОРИ имеют вирусную этиологию, но инфекции бактериальной этиологии особенно ответственны за тяжелые инвазивные формы. Многими авторами было обращено внимание на значимость коинфекций, особенно часто наблюдались бактериально-бактериальные, вирус-бактериальные и вирус-вирусные коинфекции. Хотя роль бактериально-вирусных коинфекций не определена, но, по-видимому, они могут иметь отношение к тяжести заболевания. Распространенность коинфекции была неодинакова среди пациентов с COVID-19 в различных исследованиях и могла достигать 50%. На начальном этапе пандемии SARS-CoV-2 проведение противоэпидемических мероприятий сопровождалось снижением частоты инвазивных бактериальных и других вирусных инфекций, передающихся воздушно-капельным путем. Однако уже на втором году пандемии было отмечено, что «рутинный» микробный пейзаж восстанавливается. Среди бактериальных патогенов было обращено внимание на стремительное увеличение числа случаев инвазивных заболеваний, вызванных Streptococcus pyogenes. По нашим наблюдениям, только за 6 месяцев 2023 г. показатель частоты встречаемости случаев заболевания скарлатиной составил 8,1 (95% ДИ 6,3–9,9) на 1000 госпитализированных детей, в 2,8 раза превысив аналогичный показатель за весь предшествующий 2022 календарный год (p<0,05). Среди госпитализированных детей мы наблюдали крайне тяжелые формы инфекции. Одно из таких наблюдений с основным диагнозом «скарлатина» у мальчика 7 лет, ранее не болевшего, приводится в статье. Заключение. На данном этапе необходимо продолжить статистический анализ эпидемиологических характеристик респираторных возбудителей у госпитализированных детей с инфекциями дыхательных путей, чтобы более четко определить спектр ведущих патогенов, наладить своевременную диагностику и организацию адекватного лечения. Acute respiratory infections in children are ubiquitous, their clinical form is diverse. But the most severe of them is pneumonia, in which there is a high mortality rate before the age of 5 years. In preparing this work, an electronic search was carried out in PubMed, UpToDate, Scopus, Web of Science, eLIBRARY, CDC, ECDC, WHO/WHO without language restrictions. The vast majority of ARIs are of viral etiology, but infections of bacterial etiology are particularly responsible for severe invasive forms. Many authors have drawn attention to the significance of co-infections, especially bacterial-bacterial, virus-bacterial and virus- viral co-infections were observed. Although the role of bacterial-viral co-infections has not been determined, it seems that they may be related to the severity of the disease. The prevalence of co-infection was not the same among patients with COVID-19 in different studies and could reach up to 50%. At the initial stage of the SARS-CoV-2 pandemic, anti-epidemic measures were accompanied by a decrease in the frequency of invasive bacterial and other viral infections transmitted by airborne droplets. However, already in the second year of the pandemic, it was noted that the "routine" microbial landscape was being restored. Among bacterial pathogens, attention has been drawn to the rapid increase in the number of cases of invasive diseases caused by Streptococcus pyogenes. Based on our observations in only 6 months of 2023, the incidence rate of the cases of scarlet fever 8.1 (95% CI 6.3–9.9) per 1000 hospitalized children, and 2.8 times higher than the same indicator for the entire previous calendar year 2022 (p<0.05). Among hospitalized children, we observed extremely severe forms of infection. One of these observations, with the main diagnosis of scarlet fever in a 7-year-old boy who had not previously been ill, is given in the article. Conclusion. At this stage, it is necessary to continue the statistical analysis of the epidemiological characteristics of respiratory pathogens in hospitalized children with respiratory tract infections in order to more clearly determine the range of leading pathogens, establish timely diagnosis and organize adequate treatment.

Introduction. Ph-negative myeloproliferative neoplasms (MPN) are chronic clonal disorders characterized by the proliferation of mature cells from one or more myeloid cell lines. These disorders include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The incidence of classical Ph-negative MPN varies significantly throughout the world. These differences may be due to geographical or population features, as well as due to differences in methods of diagnosis and recording. Aim: to determine incidence of Ph-negative MPN in Belarus. Materials and methods. Data on all cases of newly diagnosed Ph-negative MPNs (PV, ET and PMF) for 2014-2018 were collected from central regional medical institutions with a hematology specialization. Population epidemiological analysis of incidence was carried out by determining crude incidence rates per 100 000 population per year with distribution by genderand age groups at diagnosis, age-standardized rates, as well as average annual percent change. Results. The overall annual standardized incidence rate of classical Ph-negative MPN in Belarus was 1.96 (1.86–2.07), PV — 0.93 (0.86–1.01), ET — 0.63 (0.57–0.70) and PMF — 0.40 (0.36–0.45) per 100 000 population per year, respectively. The overall crude incidence rate was 3.26 (3.10–3.43) per 100 000 population. The crude incidence rates increased steadily with the increase in age of patients with a peak value of 12.78 (10.97–14.81) in the age group of 70–74 years. No significant changes were revealed in the overall incidence of the MPN and for each of the studied diseases separately during the study period. Conclusion. For the first time the nationwide features of incidence of the Ph-negative MPN in Belarus were estimated, which made it possible to provide substantial information for public health management. The incidence of MPN in Belarus is generally comparable to the levels determined in the analysis of the populations of other countries.

Background: Multiple myeloma (MM) remains an incurable disease with the development of relapses, sometimes with an uncontrolled course leading to death regardless of the age of the patient. The use of new schemes and methods of treatment has not only significantly improved outcomes in younger MM patients but also improved the quality of life and survival in people over 65 years of age. Objective: to determine the clinical features of the course of the disease and response to therapy in patients of different age groups with newly diagnosed multiple myeloma. Material and Methods: An analysis of the data of 139 patients with newly diagnosed MM was carried out. The median follow-up was 25 months, with a maximum of 58 months. Patients were divided into study groups depending on age at the time of diagnosis: the first group - age up to 65 years (n=65); the second group - age from 65 years and older (n=74). The material of the study was clinical and anamnestic data, the results of laboratory blood tests: biochemical analysis and immunochemical analysis. All the patients underwent the whole body CT scan, diffusely weighted whole body MRI and bone marrow aspiration biopsy with immunophenotypic study. As an induction therapy, according to international recommendations, courses of chemotherapy were used using various regimens containing bortezomib, depending on age and comorbidity. Results. The MM variant with IgA secretion occurred 1.76 times more often in the first group (p=0.128). In the first group hypercalcemia was somewhat more common (2.4 times, p=0.099) and an excess of LDH levels (2.9 times, p=0.072). In contrast, the presence of infectious complications (by 1.2 times, p=0.392), excess of the level of β2-microglobulin > 3 mg/l (by 1.6 times, p=0.086) and kidney damage (by 1.45 times, p=0.037) were more common in the second group, and in the latter case the differences were statistically significant. Disease stage (p=0.0001), excess of β2 microglobulin level (p=0.004), excess of LDH level (p=0.03), presence of anemic syndrome (p=0.003), hypercalcemia (p=0.02), presence of infectious complications (p=0.01) at the time of diagnosis were predictors of worse survival in the general group of MM patients. Conclusion. The active use of new therapeutic strategies and regimens improves treatment outcomes not only in patients under 65 years of age, but also in older patients. New studies are needed to identify prognostic factors in individuals of different age groups in order to start personalized therapy and improve treatment outcomes.

Relevance:Metachronous peritoneal dissemination (MPD) is among the top factors in the structure of gastric cancer (GC) progression, considerably worsening radical surgery outcomes. Since cancer cell dissemination in the peritoneal cavity is often triggered during surgery, assessing its role in MPD development is important.
 The study aimed to assess the effect of the extent of radical surgery and lymph node dissection on the MPD development in radically operated gastric cancer patients.
 Methods: The results of radical surgery performed on 1080 patients with gastric cancer (рТ1-4N0-3M0) without spreading to the esophagus were assessed (647 males and 433 females) depending on the extent of surgical treatment (proximal/distal subtotal gastric resection (SGR), n=639/gastrectomy (GE), n=334; standard/combined surgery, n=973/107) and the extent of lymph node dissection (LD) – D1 (n=151) or D2 (n=929). Also assessed were survival rates (Kaplan-Meyer multiplier estimation method), cumulative incidence (CI) of competing events –MPD, metastases of other localizations, and mortality cases unrelated to gastric cancer (competing risks analysis).
 Results: The analysis showed a statistically significant increase in the cumulative incidence of GC progression after combined operations (55.6±4.9%) as compared with the standard radical treatment (GE – 42.3±2.7%, SRG – 25.6±1.7%, respectively), including an increase in MPD CI in each of applied surgical procedures (after combined operations – 36.8±4.7%, after standard GE – 21.6±2.3% and SRG – 11.1±1.2%, respectively; рGray<0.001). In the presence of lymphohematogenous metastases of other localizations, the relevant figures were 9.4±2.9% after combined operations, 9.3±1.6% after standard GE, and 5.0±0.9% after SRG (рGray=0.022). Lymph node metastases increased MPD CI after LD D1 from 8.3±2.8% (pN0) to 29.1±6.2% (рN1-3) (рGray<0.05), those after LD D2 increased from 9.4±1.3% (pN0) to 27.3±2.1% (рN1-3) (рGray<0.05).
 Conclusion: It is advisable to assess the extent of the planned surgical treatment and the condition of local lymph nodes when evaluating the probability of MPD development. The applied lymph dissection procedure did not affect the cumulative incidence of GC progression, including MPD development.

Background: Metabolic flexibility describes the body's adaptive ability to changing metabolic or energy requirements. Objective: To determine the possibility of detecting dysmetabolism based on bioimpedancemetry (systemic dysmetabolism) and metabolic flexibility (local dysmetabolism) by the intensity of switching from the glucogenic to the ketogenic variant of energy supply. The biological age was determined with tetrapolar bioimpedansometry. The amino acid L-lysine was taken orally to induce ketosis, the content of ketones in the exhaled air was dynamically recorded for 3 hours. Results: All practically healthy volunteers (mean age 42.5 years (95% CI 36.0-49.1)) had an increase in exhaled ketones after taking lysine. For the first time, lysine has been shown to have a significant ketogenic effect in humans. A randomized comparison of groups divided according to the correspondence of biological age to chronological age was carried out. A significant relationship was found between the degree of hepatic ketosis and the difference between biological and chronological age, i.e. younger age was characterized by higher metabolic flexibility. The results deepen the scientific understanding of the metabolic flexibility assessment according to the original indicator -the induction of physiological ketosis by an amino acid metabolized in the liver and make it possible to implement a personalized approach in the diagnosis and differentiation of metabolic unhealthy phenotype.

Цель. Оценить минеральную плотность костной ткани (МПК) по данным двухэнергетической рентгеновской абсорбциометрии и представить частоту нарушений костной плотности у детей с детским церебральным параличом (ДЦП). Материалы и методы. В исследование включено 106 детей в возрасте 5–18 лет (медиана – 10,4 (8,1; 13,2) года) с ДЦП, находившихся на обследовании в республиканском центре детского остеопороза. Оценка МПК проводилась методом двухэнергетической рентгеновской абсорбциометрии по программам исследования всего тела (без учета костной ткани черепа, TBLH) и поясничного отдела позвоночника (L1–L4). Согласно рекомендациям Международного общества клинической денситометрии (ISCD), низкая МПК определялась при значениях Z-критерия ≤–2,0 SD. Результаты. В когорте обследованных пациентов с ДЦП медиана МПК L1–L4 составила 0,476 (0,406; 0,587) г/см2, МПК TBLH – 0,581 (0,521; 0,663) г/см2; Z-критерий МПК L1–L4 – –0,7 (–3,0; –0,4) SD, Z-критерий МПК TBLH – 0,6 (–0,7; 1,8) SD. Установлено, что частота выявления низкой МПК не была ассоциирована с полом и возрастом ребенка и составила в общей когорте обследованных детей с ДЦП 46,2%, достигая среди пациентов, принимавших антиконвульсанты, 61,4%, у детей с IV–V уровнями по GMFCS – 71,4%, с переломами в анамнезе – 78,6%, с недостаточностью питания – 82,9%, с низкорослостью – 86,8%. У каждого пятого ребенка с низкой МПК верифицирован остеопороз (20,4%). Заключение. Выявлена высокая частота низкой МПК среди детей с ДЦП. Снижение МПК у детей с ДЦП было ассоциировано с приемом антиконвульсантов, снижением мобильности (IV–V уровни по GMFCS), наличием переломов в анамнезе, недостаточностью питания и низкорослостью. Purpose. To assess the bone mineral density (BMD) according to Dual-energy X-ray absorptiometry and to present the frequency of bone density disorders in children with cerebral palsy (CP). Materials and methods. The study included 106 children aged 5–18 years (median age – 10.4 (8.1; 13.2) years) with CP who were examined at the Republican Center for Pediatric Osteoporosis. Total body less head (TBLH) BMD and lumbar spine (L1–L4) BMD were measured by means of Dual-energy X-ray absorptiometry. According to the International Society for Clinical Densitometry (ISCD) guidelines, low BMD was defined as Z-score ≤–2.0 SD. Results. The median L1–L4 BMD in the cohort of examined patients with CP was 0.476 (0.406; 0.587) g/cm2, TBLH BMD was 0.581 (0.521; 0.663) g/cm2. The median BMD Z-score (L1–L4) was –0.7 (–3.0; –0.4) SD, BMD Z-score (TBLH) was 0.6 (–0.7; 1.8) SD. It was found that the frequency of low BMD was not associated with the sex and age of the child and amounted to 46.2% in the total cohort of the examined children with CP, reaching 61.4% among patients taking antiepileptic drugs, in children with IV–V levels of GMFCS – 71.4%, with a history of fractures – 78.6%, with undernutrition – 82.9%, and with short stature – 86.8%. Osteoporosis was diagnosed in every fifth child with low BMD (20.4%). Conclusion. A high frequency of low BMD was revealed among children with CP. Decreased BMD in children with CP was associated with taking antiepileptic drugs, decreased gross motor function (IV-V levels according to GMFCS), and a history of fractures, malnutrition, and short stature.

First of all, the protection of gastro mucosa against injury, which can be caused by a variety of noxious agents, and the restitution of mucosal integrity after mucosal damage depends on the interplay of numerous different effectors and mediators. Second. The mucus is the first line of defense against luminal attacks on mucosal integrity. The intact microcirculation which is necessary for tissue protection and repair. Thirdly, the process of mucosal restitution and regeneration is controlled by various endogenous components, including growth factors, particularly EGF and TGFα. Fourthly, some agents which can cause mucosal damage like non-steroidal anti-inflammatory drugs, including acetylosalicylic acid, and probably can be protected by natural substances via the mechanism of adaptive gastroprotection. Essential is the presence of a series of exogenous natural substances that have a gastroprotective effect, increasing the gastric mucosa endogenous adaptive cytoprotection potential. Among such exogenous natural substances, we paid attention to the Coniferous Pine Needles Extract (Baltic pine or Pinus sylvestris). The phytochemical substances present in Coniferous Pine Needles Extract are nontoxic at therapeutic levels, with clearly gastroprotective effect.

First of all, the protection of gastro mucosa against injury, which can be caused by a variety of noxious agents, and the restitution of mucosal integrity after mucosal damage depends on the interplay of numerous different effectors and mediators. Second. the mucus is the first line of defense against luminal attacks on mucosal integrity.

В статье приводится обзор отечественной и зарубежной литературы, описывающий современные подходы к хирургическому лечению переломов основания черепа (ПОЧ) и их осложнений. Уделяется внимание показаниям к оперативному лечению и срокам его выполнения. Подняты вопросы эндоскопического и транскраниального способов лечения ликвореи при ПОЧ, приводятся основные преимущества и недостатки данных методик в зависимости от локализации и размеров ликворной фистулы. Изложены основные принципы оперативного лечения, виды хирургических подходов (открытый, эндоскопический) и материалов для пластики основания черепа с акцентом на пациентов детского возраста. The article provides a review of domestic and foreign literature describing current approaches to surgical treatment of skull base fractures and their complications. Attention is paid to indications for surgical treatment and its terms. Issues of endoscopic and transcranial methods of cerebrospinal fluid leak treatment are raise, and the main advantages and disadvantages of these techniques depending on liquor fistula localization and size are presented. The main principles of surgical treatment, types of surgical approaches (open, endoscopic) and materials for skull base plasty with an emphasis on pediatric patients are outlined.