N on-communicable diseases have become a global challenge in recent years, and their prevalence is significantly affecting countries worldwide, including the Republic of Belarus. These diseases are influenced by various factors such as behavior, genetics, environment, and social conditions, all of which contribute to the increased likelihood of disease development, progression, and unfavorable outcomes. Risk factors associated with non-communicable diseases include smoking, alcohol abuse, and excessive consumption of salt and sugar. In Belarus, there is a high prevalence of these risk factors, leading to increased morbidity, disability, and mortality rates. Therefore, it is crucial to address the prevention and mitigation of the impact of these risk factors on the human body. A modern approach to tackling non-communicable diseases involves the prevention and control
of these risk factors.
The purpose of this study is to establish and develop the key principles of a concept for reducing harm caused by specific risk factors of non-communicable diseases, such as tobacco smoking, alcohol abuse, and excessive salt and sugar consumption. This concept will serve as the foundation for the national public health policy of the Republic of Belarus. The justification for developing a harm reduction concept stems from assessing the consequences of the high prevalence of noncommunicable diseases and their associated risk factors in Belarus. Furthermore, the study considers global theoretical frameworks, scientific debates on harm reduction, and analysis of successful practices implemented in other countries.
We have developed the key provisions of the Harm Reduction Concept and outlined its prospects for subsequent inclusion in the state program “People’s Health and Demographic Security.” Additionally, we have formulated recommendations for regulators based on regulatory differentiation.
2023 Том 7, №1

A therosclerosis is a chronic inflammatory disease of the arteries that occurs during a complex interaction between risk factors (low-density lipoprotein cholesterol, obesity, diabetes mellitus, hypertension, smoking, etc.), components of the vascular wall, as well as immune and inflammatory cells. Various cells from intima, media, adventitia and perivascular adipose tissue not only make up an intact and normal arterial vessel wall, but also participate in the inflammatory reaction in atherosclerosis.
The process of atherosclerosis is initiated by activation of the endothelium, followed by a cascade of events (accumulation of lipids, migration and proliferation of smooth muscle cells, transformation of fibroblasts into myofibroblasts). The atherosclerotic plaque causes narrowing of the vessel and leads to cardiovascular complications. The article reviews the results of recent studies that reveal the role of various cells of the arterial vessel wall, as well as cells of innate and adaptive immunity in the development of atherosclerosis.
2023 Том 7, №1

The article discusses the relationship between depressive disorders and ischemia, as well as changes in the blood coagulation system in patients with depressive disorders. Significant defects in the physiological characteristics of platelets are revealed, including increased reactivity and increased production of platelet factor 4 and p-thromboglobulin. The features of increased vasoconstriction, platelet activation, and thrombus formation are also considered, which may be the basis for the progression of coronary artery disease and mortality after acute myocardial infarction in patients with depression.
Aim. To reveal the impact of anxiety-depressive disorders on the development of cardiac muscle necrosis.
Materials and methods. Experimental and clinical studies have been carried out on patients with necrosis of the heart muscle.
Results. Patients with necrosis of the heart muscle and depression do not immediately seek medical help, unlike patients without depression. This may affect treatment options (e.g., thrombolysis) and the prognosis in such patients.
Conclusion. Further research is needed to determine whether depression causes inflammation, inflammation causes depression, or if a third, as-yet-unknown pathological process causes both inflammation and depression.
2023 Том 7, №1

O steosarcopenia is characterized by a combination of low muscle mass (sarcopenia) and reduced bone mineral density (osteopenia/osteoporosis). The results of scientific studies conducted in recent years indicate the existence of a relationship between arterial hypertension, disorders of bone metabolism and / or sarcopenia. In particular, it is known that systemic inflammation, oxidative stress, and insulin resistance are involved in the development and progression of both arterial hypertension and sarcopenia. The same factors may play a role in the pathogenesis of osteopenia and osteoporosis, and the pathological mechanisms underlying the increase in blood pressure, as shown in experimental and clinical studies, can additionally influence the decrease in bone mineral density. This review outlines the current understanding of the diagnosis, epidemiology, etiology, and possible mechanisms of the pathogenesis of osteosarcopenia in patients with arterial hypertension.
2023 Том 7, №1

Age-related aspects of women’s health have been in the focus of attention of cardiologists, gynecologists, and endocrinologists for many years. The physiological features of the course of the peri- and postmenopausal periods and the possible consequences of estrogen deficiency are already well-studied. For nearly 20 years, there has been a debate about the benefit-risk ratio of menopausal hormone therapy. The evidence for its protective effect on age-related cases is overwhelming: prevention of osteoporosis development, cardiovascular diseases, cognitive decline, and improvement of the overall quality of life.
The article presents current data on the association of menopausal hormone therapy with venous thromboembolic complications, depending on the type of estrogen and progestogen components, dose, regimen and methods of application. The feasibility and safety of menopausal hormone therapy in the context of the COVID-19 coronavirus pandemic is considered. The probability of increased risk of thromboembolic complications in case of COVID-19 infection during menopausal hormone therapy has not been proven in clinical practice. The data from the latest publications are presented, indicating the likely positive effect of female sex hormones on the course of SARS-CoV-2 and the recommendations of the leading international communities on menopause measurement regarding the admissibility of menopausal hormone therapy during the pandemic and limited ability to counsel patients.
2022 Том 6, №2

Despite advances in the field of diagnosis and treatment of patients with coronary heart disease, the incidence of cardiovascular complications remains quite high. The main factor in the development of ischemic diseases of the cardiovascular system is atherosclerosis.
Over the past three years, research findings have been obtained indicating that atherosclerosis is an inflammatory disease. It is widely accepted that both innate and adaptive immune responses are important for initiation and progression of atherosclerosis, which mainly consist of monocytes, macrophages, neutrophils, T lymphocytes, and B lymphocytes. Moreover, inflammatory biomarkers such as high-sensitivity C-reactive protein and interleukin-6 are known to predict future cardiovascular events, as well as conventional low-density or high-density lipoprotein cholesterol.
Thus, current understanding of the inflammatory mechanisms of atherosclerosis have led us to explore novel therapeutic approaches that reducing vascular inflammation itself could lower the rates of critical cardiovascular events. In this review, we will first outline the mechanisms of atherosclerosis, especially focusing on their inflammatory aspects. Then we will introduce several critical inflammatory biomarkers that contribute to risk stratification of clinical cardiovascular events.
2022 Том 6, №2

The creation of lipid-lowering drugs has become one of the greatest achievements of medicine over the past 100 years. Nowadays, cardiovascular diseases caused by atherosclerosis are the leading cause of death in most countries.
Atherosclerosis is a complex process involving the deposition of lipids and the activation of immune and inflammatory responses that ultimately lead to cardiovascular disease as a result of arterial occlusion. Currently, the main strategy for the treatment of cardiovascular diseases caused by atherosclerosis is lipid-modifying therapy. Although clinical trials of agents that lower low-density lipoprotein cholesterol (LDL-C) (statins, ezetimibe, PCSK9 [subtilisin/kexin 9] proprotein convertase inhibitors) reliably indicate a decrease in cardiovascular events, a relatively high risk of cardiovascular events persists in a significant proportion of patients despite such treatment.
2022 Том 6, №2

Objective. To study frequency and identify predictors of myocardial ischemia-reperfusion injury in patients with unstable angina and stenting of the coronary arteries.
Materials and Methods. The study included 61 patients with unstable angina and coronary artery stenting. Stenting was performed 3.2±1.4 days after admission to the hospital. The average number of affected vessels was 1.76±0.3 per person, the average number of implanted stents was 1.9±1.32 per person. The risk according to the GRACE scale at the time of stenting was 100.3±8.46 points. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; platelet, plasma and vascular hemostasis were evaluated. Patients also underwent echocardiography and coronary angiography.
2022 Том 6, №2

According to the World Health Organization, every third adult on the planet suffers from varicose vein disease of the lower extremities (VVD). In the Republic of Belarus there are more than 2 million people with VVD of the superficial veins of the lower extremities, of which about 400,000 reside in Minsk. Trophic disorders are observed in 2% of the total population. According to the RELIEF study (Reflux assurance and quality of life improvement with micronized Flavonoids in chronic venous insufficiency (CVI) – a study conducted from March 1997 to December 1998 in 23 countries with more than 10,000 patients suffering from CVI), 78% patients with symptoms of CVI did not receive treatment. Nowadays, surgical treatment methods for the VVD are very diverse. Currently, in developed countries, there is a trend towards an increase in minimally invasive interventions in the treatment of VVD performed on an outpatient basis. Among the proposed types of invasive methods of treatment, endovenous laser ablation, sclerotherapy, endovenous mechanochemical and radiofrequency obliteration are most widely used.
2022 Том 6, №2

Rhabdomyolysis is a condition characterized by the primary (mechanical) or the secondary (metabolic) damage to skeletal muscles, resulting in cell death and massive release of potentially toxic substances into the general circulation. Alertness to this complex pathological condition is very low among primary care physicians. Most often, traumatologists-orthopedists and resuscitators deal with the clinical picture of rhabdomyolysis. However, an in-depth analysis of literature data on the etiopathogenesis of this process implies a wide range of specialties, who need knowledge of the clinical picture of the development of rhabdomyolysis as well as of therapeutic specifics and prevention to manage this specific contingent patient. At the end of 2021, the clinical consensus of the intensive care committee of the American Association for the Surgery of Trauma (AAST) took place, which resulted in the formulation of recommendations for the management of patients with rhabdomyolysis. The document reviews and compiles knowledge of the causes of muscle fiber breakdown, diagnosis, treatment, and outcomes of acute rhabdomyolysis in critically ill patients.
2022 Том 6, №1

The article discusses the prevalence of polymorphic variants of the MTNR1B gene and the C6310T locus of the CYP1A1 gene in patients with obstructive sleep apnea syndrome (OSAS) and analyzes their association with melatonin levels and the risk of developing OSAS.
2021 Том 5, №2

The article is devoted to a comparative analysis of morphological changes in the tissues of the reproductive system of women under the influence of a neodymium laser and bipolar coagulation during laparoscopic operations. The results of assessing the reliability of dif ferences in morphometric indicators of tissue damage (sections of the fallopian tubes, fragments of ovarian tissue, membranes of benign cystic formations of the ovaries, leiomyomatous nodes of the body of the uterus) under the influence of electromagnetic radiation of various wavelengths are presented. The recorded changes directly depend both on the applied heat or light energy, and on the histological structure of the tissue under study. Fundamental differences in artifactual changes in tissues of the reproductive system were revealed when using bipolar coagulation and laser radiation in surgical practice, and the dependence of morphological changes on the wavelength of a neodymium laser was established for the first time.
2021 Том 5, №2

Investigation of the microcirculatory bed (MVB) has induced heightened interest both theoretical and practical in the medical world of the XX–XXI century. Evaluation of the MVB state has been widely used for revealing pathogenesis and developing an efficient treatment plan in cardiology, diabetology, oncology, dermatovenereology, dentistry, surgery, nephrology, urology, resuscitation and other branches of medicine. It’s worth noticing that evaluation of the microcirculatory parameters should be included into COVID-19 management for optimal medication of the patients especially in severe cases. The ar ticle provides a description of the microcirculator y bed, its structure, functions, mechanisms of regulation, causes of damage, and methods for diagnosing disorders. Proper consideration is given to the current techniques used to improve microcirculatory readings. Non-invasive techniques applied in the Republic of Belarus for improving the microcirculatory readings include the method of enhanced external counterpulsation and gravity therapy.
2021 Том 5, №2

Varicocele is found in 8–40% of young men between the ages of 15 and 40. In 25.4% of cases, it is combined with a violation of reproductive function and in 40% of cases it causes pain syndrome in the scrotum. The etiology and pathogenesis of the disease are associated with various disorders in venous hemodynamics of the upstream vascular network. The peculiarity of venous blood outflow from the organs of the scrotum is the presence of a developed network of anastomoses and collaterals at the level of the scrotum, the inguinal region and the retroperitoneal space.
2021 Том 5, №2

The frequency of recurrence after surgical treatment of varicocele reaches 29%. This circumstance encourages the medical community to search for the optimal surgical aid to prevent pathological reflux of blood into the venous plexuses of the testicle from the overlying parts of the vascular network. The operation is indicated in case of presence of the clinical symptoms, the development of orchopathy and disorders of spermatogenesis, regardless of the degree of development of varicocele (WHO classification 2010). Operations aimed at eliminating varicocele are divided into 2 large groups: the first group – preserving the renocaval shunt or shunting operations and the second group – not preserving the renocaval shunt or occlusive operations. Shunting operations include the creation of intervenous anastomoses: proximal, distal and bidirectional. Proximal anastomoses are aimed at eliminating renal venous hypertension as the direct cause of the disease. The imposition of bidirectional and distal anastomoses is considered inappropriate, since in the first case, the time of surgical intervention increases, and in the second case, renal hypertension is not eliminated. Occlusive operations are indicated for primary varicocele and the absence of pronounced venous hypertension. According to the level of vein ligation, they are divided into supra-inguinal and sub-inguinal, by selectivity into selective and non-selective, and by operative access into open, laparoscopic and endovascular. The lowest number of relapses and postoperative complications is observed in sub-inguinal selective and endovascular techniques. They are the most universal ones and eliminate all hemodynamic types of varicocele. Supra-inguinal selective techniques show their high effectiveness in the renospermatic type of varicocele and, unlike sub-inguinal operations, there is no risk of damage to the testicular artery during the operation. Thus, a differentiated approach to choosing the type of surgery reduces the risk of postoperative complications and prevents recurrence of the disease.
2021 Том 5, №2

Cardiac manifestations in COVID-19, including myocardial injury with elevated troponin levels, are common. Myocarditis has been reported as a possible complication in coronavirus patients, but direct evidence for SARS-CoV-2 myocarditis remains limited. The described series of histopathological confirmations of myocarditis in COVID-19 differ in severity and interpretation. Clinical manifestations of non-ischemic myocardial injury are nonspecific, differential diagnosis is even more difficult due to the complications after viral pneumonia. Cardiac Magnetic Resonance Imaging (CMRI) is a powerful tool for studying structural and functional changes in myocardial injury. New pulse sequences of parametric mapping with determination of the T1 and T2 relaxation times of the myocardium are a unique method for quantitative assessment of the myocardium tissue. Within 6 months in 2021, we retrospectively analyzed the CMRI results of 45 patients with COVID-19 at the Republican Scientific and Practical Center “Cardiology”. The percentage of patients with positive criteria for Lake Louise myocarditis was 18% (n = 8). The elevated reference values of T2 ≥ 2σ up to 33% was the most frequent pathological change in myocardial tissue characteristics. There is significant variability in the published data collection as to the prevalence of myocarditis associated with different research methodologies in studies and discrepancies in the interpretation of MRI-mapping data. This brief review is aimed at revising and summarizing current knowledge on myocarditis in COVID-19 patients and highlight the problems of CMRI diagnostics.
2021 Том 5, №2

An increased number of elderly people in the medical terms means the predominance of pathology in the morbidity structure, which is determined by comorbidity, systemic lesions and an unfavorable prognosis. Comorbid patients are the most vulnerable group with a particularly high risk of adverse outcomes. In the presented review, the problem of management of acute coronary syndrome (ACS) in elderly patients in the context of the COVID-19 pandemic is addressed. The review demonstrates results of randomized clinical trials and registries of recent years, which purposefully included patients with ACS aged ≥ 75 years. Particular attention is paid to the need for a geriatric assessment of patients, the presence and severity of senile asthenia and its influence on the choice of treatment tactics and prognosis. The problem of choosing a method of myocardial revascularization and drug therapy schemes in elderly patients is considered under pandemic conditions. Issues related to drug interactions between drugs for the treatment of acute forms of coronary heart disease and drugs for the treatment of COVID-19 are reflected. In this situation, taking into account the risks of possible drug-drug interactions is of particular importance, which is especially challenging in elderly comorbid patients. Based on the available data, we have analyzed the main trends in the choice of treatment tactics for elderly patients with ACS during the COVID-19 pandemic.
2021 Том 5, №2

The article presents data on clinically significant heart impairment in patients with rheumatoid arthritis (RA), as well as features of the development of ischemic and non-ischemic heart disease with a significant increase in the risk of adverse cardiovascular events. Patients with RA are characterized by an increased risk of developing myocardial infarction, heart failure, rhythm disturbances, sudden cardiac death, and general cardiovascular death. The paper emphasizes the possibility of a fairly rapid development of myocardial dysfunction in patients with RA from the moment of manifestation of the disease, the development and progression of atherosclerosis of the coronary arteries. Besides, in case of the development of a coronary artery disease in RA patients, the worst survival rate after a heart attack was established. The available findings suggest that rheumatoid arthritis is a disease that makes a significant contribution to cardiovascular morbidity and mortality.
2021 Том 5, №2

Introduction. Pathomorphological changes in destructive pancreatitis develop both in the pancreas and in various organs and tissues, it determining the clinical course and outcome of the disease. Most often in destructive pancreatitis, the cardiopulmonary system is affected, as well as the liver, kidneys, and brain. Damage to these target organs is one of the main elements of pathogenesis and thanatogenesis in destructive pancreatitis and is of interest not only for surgeons, but also for other clinical specialists, including cardiologists. Aim. To conduct a retrospective analysis of the most common morphostructural changes in the cardiopulmonary system and other target organs based on the results of autopsy reports of the deceased from destructive forms of acute and chronic pancreatitis and to identify the most characteristic morphostructural changes in the target organs.
2021 Том 5, №1