Belarusian State Medical University

Sepsis is a serious global problem, resulting in significant healthcare costs. The World Health Organization recognizes sepsis as a priority. The aim of this study was to identify predictors of sepsis caused by gram-positive and gram-negative bacteria based on a comparative analysis of clinical manifestations and laboratory parameters. Materials . A retrospective analysis of clinical data and laboratory parameters was conducted for 96 patients with sepsis treated at the Minsk City Children's Infectious Diseases Clinical Hospital from 2009 to 2023. To conduct a comparative analysis, patients were divided into groups based on the pathogen: Group 1 – 53 patients with sepsis caused by gram-positive bacteria, and Group 2–43 patients with sepsis caused by gram-negative bacteria. Results . Septic shock developed in approximately half of the patients in both groups (47.2 % and 58.1 %, respectively), the median time from the onset of the first symptoms to the development of sepsis was 4 days (2–5) in Group 1 and 8 days (3–28) in Group 2 (p < 0.01), organ failure assessment using the Pelod, pSofa, Phoenix, and Prism scales revealed a trend toward higher scores in Group 2 (sepsis caused by Gram-negative bacteria). Conclusion . According to the analysis, it was established that patients in Group 2 had a more severe course (according to clinical and laboratory data) and more often an unfavorable outcome.

Objective — to analyze current data on anesthetic management techniques for abdominal delivery in pregnant women with morbid obesity. The review was conducted by searching PubMed, Google Scholar, and eLibrary databases from January 1, 2000, to August 31, 2024, using the keywords: pregnancy, obesity, body mass index, cesarean section, anesthesia, and complications. The search yielded 724 references. 655 references were excluded from the review due to their description of pregnancy management and spontaneous labor in obese patients. The literature review included 69 references. Inclusion criteria: design (clinical studies in all peer-reviewed journals without language or national restrictions); subjects (pregnant women with obesity grade II or higher). This review examines anesthesia techniques for cesarean section in pregnant women depending on the severity of obesity. The analysis revealed a wide range of neuraxial and general anesthesia techniques, each with its own advantages and disadvantages, and none is “perfect.” Anesthetic management of abdominal delivery in pregnant and postpartum women with morbid obesity requires a personalized, multidisciplinary approach. The review data suggest that further research is needed to personalize anesthesia for cesarean section in obese patients.

Objective. To study the natural course of squamous intraepithelial lesions (high-grade squamous intraepithelial lesions — HSIL) of the cervix of a high degree during pregnancy and the effect of the method of delivery on the outcomes of this disease. Data about the effects of pregnancy on HSIL changes remain limited and contradictory. Material and methods. The data of 65 pregnant women with HSIL were retrospectively analyzed (median age — 30.7 years, median gestation period — 15 weeks). The diagnosis was confirmed by biopsy, excision procedures were not performed during pregnancy. The monitoring included regular cytological monitoring. Among 65 patients, 44 gave birth naturally, 21 by caesarean section. After delivery, conization (23), cervical amputation (20), hysterectomy (2), cervical ablation (6), or follow-up (14) were performed. Results. Postpartum regression of HSIL was noted in 21.5% of cases (in 14 out of 65), persistence — in 78.5% (in 51 out of 65). Further progression to invasive cancer was recorded in 4.6% (in 3 out of 65). The regression rate after natural childbirth was 27.3% versus 9.5% after cesarean section (p=0.122). Conclusion. The method of delivery has no statistically significant effect on the outcome of HSIL (p=0.122). However, the high frequency of persistence (78.5%) and the risk of progression (4.6%) emphasize the need for mandatory postpartum follow-up and excision procedures if indicated.

Non-ST-segment elevation myocardial infarction (NSTEMI) is one of the most common forms of acute coronary syndrome (ACS), characterized by a high risk of cardiovascular events and increased mortality. Despite the achievements of modern medicine in the field of diagnostics and treatment of ACS, predicting adverse outcomes in this category of patients remains an urgent task. The purpose of this article is an overview of modern predictors of adverse cardiovascular events in patients with NSTEMI.

Aim: To compare the safety and efficacy of excimer laser coronary angioplasty (ELCA) versus conventional CTO-PCI under routine OCT guidance and speckle-tracking echocardiography. Materials and methods: a single-center cohort study included 36 ELCA patients and 22 controls without laser. The endpoints included technical success, OCT parameters (MSA, apposition), changes in GLS and LVEF, and a 12-month MACE. Results: ELCA yielded a larger stent area, a lower malapposition, and greater improvements in GLS and LVEF with comparable safety. Conclusion: OCT-guided ELCA improves stent geometry and LV functional recovery compared with non-laser CTO-PCI.

Introduction. Cervical squamous intraepithelial lesions associated with high-risk human papillomavirus represent a significant concern in gynecological practice. Investigating the risk factors for this pathology is essential for improving methods of prevention and early diagnosis. Objective: to assess the clinical and anamnestic characteristics of patients with cervical squamous intraepithelial lesions and to identify the risk factors for this pathology in women of early reproductive age. Materials and Methods. A prospective cohort study was conducted from 2020 to 2025 at the clinical base of the Department of Obstetrics and Gynecology with Advanced Training and Retraining at the Belarusian State Medical University, in cooperation with the 1st City Clinical Hospital in Minsk. The study included 186 women aged 18–35 years with histologically confirmed cervical intraepithelial lesions. The participants were divided into two groups: group 1 – 102 women with low-grade squamous intraepithelial lesions (LSIL), group 2 – 84 women with high-grade squamous intraepithelial lesions (HSIL). A comprehensive analysis of anamnestic, clinical, and laboratory data was carried out. Results. It was established that early onset of sexual activity, smoking, frequent change of sexual partners, a history of induced abortions, and the use of coitus interruptus as a contraceptive method are significant risk factors (p < 0,001) for the development of highgrade cervical intraepithelial lesions. Statistically significant associations were also found with a family history of cervical cancer (p = 0,015), as well as comorbidities of the digestive and respiratory systems (p < 0,001). Particular attention is warranted by the identified association of HSIL with HPV type 16 (p < 0,001), chlamydial infection (p = 0,042), and recurrent vaginitis (p < 0,001).

Coronary artery atherosclerosis is one of the causes of coronary heart disease (CHD) and its chronic form – stable angina. Atherosclerosis can be considered as a chronic immune-inflammatory process in which antigenic stimuli originate from peroxide-modified lipoproteins. Literature data indicate the production of circulating immune complexes (CIC) containing lipoproteins as an antigen in patients with stable angina. The aim of the study was to determine the content of CIC in patients with stable angina with functional classes (FC) I, II, III, IV. Material and methods. The study was conducted in the Cardiology Department № 1 of the 6th Clinical Hospital of Minsk. The study included 141 patients with stable angina with functional classes (FC) I, II, III, IV, which made up 4 main study groups (A, B, C, D). The control group consisted of 30 practically healthy individuals of comparable age. The CIC was determined by the enzyme immunoassay method in the venous blood of patients. Statistical data processing was performed using the Statistica 10.0 program. At p < 0.05, the differences were considered statistically significant. Results and discussion. In patients with angina pectoris FC I, the CIC level was 243.0 ± 31.4 conventional units. As the FC of stable angina pectoris increased, the CIC level also increased, which in patients with FC IV was 404.0 ± 52.4 conventional units. Conclusion. With an increase in the severity of stable angina pectoris, the content of CIC statistically significantly increases, which indicates the development of an immunopathological process as coronary circulatory failure progresses.

The aim of the study was to evaluate the relationship between the concentration of interleukin-15 (IL-15) in the blood and coagulation and biochemical parameters in women with COVID-19 at different times of pregnancy and depending on the clinical course of COVID-19. Materials and methods. The study included 60 pregnant women with COVID-19: 14 women in the first trimester, 17 in the second trimester and 29 in the third trimester. The comparison group consisted of 20 pregnant women without clinical and laboratory signs of acute respiratory viral infections. The concentration of IL-15 in the blood serum was determined by enzyme immunoassay. Statistica 10.0 (StatSoft, USA) was used for statistical data processing. The statistically significant error level was considered to be p < 0.05. Results. The main clinical manifestations of COVID-19 in pregnant women are catarrhal respiratory syndrome (93.3 ± 3.23 % of cases), intoxication syndrome (86.7 ± 4.38 % of cases) and neurological manifestations (66.7 ± 6.08 % of cases). Pregnant women with COVID-19 had higher blood levels of IL-15 (p = 0.003). COVID-19 is characterized by a decrease in the level of IL-15 in the blood in the third trimester of gestation compared to the first and second trimesters (p = 0.001; p = 0.013). IL-15 in the blood of SARS-CoV-2-infected pregnant women had a direct correlation with prothrombin time (p = 0.017), thrombin time (p = 0.027) and international normalized ratio (p = 0.039), and an inverse correlation with the level of lymphocytes in the blood (p = 0.009), fibrinogen (p = 0.005), serum iron (p = 0.012) and direct bilirubin (p = 0.008 in mild COVID-19). Factors associated with IL-15 in the blood of pregnant women with COVID-19 are impaired sense of smell and taste (p = 0.043), cough (p = 0.014) and vomiting (p = 0.005). Conclusion. The relationship of IL-15 concentration in the blood with coagulation and biochemical parameters in women with COVID-19 at different stages of pregnancy and depending on the clinical course of COVID-19 was evaluated.

Aortic valve (AV) bioprostheses can be divided into framed and frameless, as well as those implanted using surgical and endovascular methods. The study of hemodynamic criteria for the functioning of sutured, seamless and transcatheter biological prostheses, including the dynamics of reverse structural and functional remodeling of the heart in the long term, is necessary to select the most correct and effective treatment tactics. The aim of the study: to evaluate, using objective radiation methods of research, hemodynamic parameters and the dynamics of reverse structural and functional remodeling of the heart in the late period after correction of degenerative aortic valve defect using cardiac surgery and endovascular methods. Materials and methods. A comparative, non-randomized, longitudinal study was conducted, including 89 people with severe aortic stenosis, who underwent isolated surgical or endovascular valve replacement. The patients were divided into three groups: a group with AV prosthetics using the method of implantation of a seamless biological prosthesis (n = 23); a group using a sewn-in biological prosthesis (n = 45); a group with a transcatheter aortic valve implantation technique (TAVI) (n = 21). The median age of patients using a sutured biological prosthesis was 71.0 [66.7; 74.0] years, the age of patients with implantation of a seamless biological prosthesis was 73.0 [69.0; 76.8] years (p = 0.055); in the group with a transcatheter technique for implantation of a biological prosthesis, the median age was 75.0 [69.0; 79.0] years (p = 0.013). The female gender was 20 (44.4%), 16 (69.6%), 11 (52.4%) (p = 0.050), respectively. In the dynamics of objective monitoring of the condition and implementation of the study goal, all patients underwent echocardiography (ECHO) according to the generally accepted method. Results. In three groups, a comparison of structural and functional parameters “before” and “after” the intervention was carried out, and an intergroup comparison was performed between two groups (surgical correction using suture and sutureless bioprostheses), since the initial characteristics of the group with endovascular treatment, in particular, age, differed from the other groups. After correction of aortic stenosis using both cardiac surgery and transcatheter methods, reverse structural and functional remodeling of the heart is observed in the long term. In patients using sutured biological prostheses, LVMM decreased by -22.0 [-28.0; -17.0]% (p = 0.0002), seamless biological prostheses – by -20.0 [-27.0; -13.0]% (p = 0.01), with transcatheter aortic valve implantation – by -16.0 [-22.0; -10.0]% (p = 0.0001); left ventricular (LV) hypertrophy concentricity decreased by -21.0 [-29.0; -14.0]% (p < 0.0001), -24.0 [-31.0; -15.0]% (p = 0.0002), -24.2 [-35.6; -1.1]% (p = 0.002), respectively. In groups using cardiac surgical methods, an improvement in longitudinal systolic function was demonstrated: absolute values of global systolic longitudinal deformation of the LV, assessed by the speckle-tracking method, increased in patients with implanted biological prostheses by 19.3 [7.5; 54.0]% (p = 0.032), with seamless biological prostheses – by 18.4 [3.3; 42.8]% (p = 0.027), the S’ lat mv tissue dopplerography indicator increased – by 36.7 [22.1; 51.3]% (p < 0.0001) and 42.8 [17.5; 57.1]% (p = 0.0005), respectively. In individuals with TAVI, the S’ lat mv values increased by 25.0 [14.3; 55.3]% (p = 0.005). Recovery of left ventricular systolic function in the remote period, established on the basis of the results of 2D speckle tracking echocardiography, was diagnosed in 12 (60.0%) patients with sutured and sutureless biological prostheses. Conclusion. Correction of severe AS using cardiac surgical and endovascular methods is associated in the long term with favorable indicators of intracardiac hemodynamics and reverse structural and functional remodeling of the LV.