Victor M. Mitsura

Community-acquired pneumonia in children remains one of the leading infectious causes of mortality, its etiological structure is constantly changing. A high proportion of pneumonias with an unspecified pathogen is characteristic of the Republic of Belarus that complicates the rational selection of initial therapy and contributes to the growth of antibiotic resistance.A retrospective cohort study of 485 clinical records of children aged 0 to 17 years with confirmed community-acquired pneumonia was conducted. Bacteriological culture, polymerase chain reaction (PCR) of respiratory tract samples, and enzyme-linked immunosorbent assay (ELISA) for IgM/IgG antibodies to M. pneumoniae and C. pneumoniae were used for etiologic diagnosis.In 64,9% of cases, the etiology was not identified. Among cases with an established etiology, respiratory viruses predominated in children under 5 years of age (60,9%), Mycoplasma pneumoniae predominated in children aged 10 years and older (78,3%), while in the 5–9 years ago group, no single pathogen showed a clear predominance (M. pneumoniae — 48,1%, respiratory viruses — 29,6%, typical bacteria and mixed infections — 11,1% respectively).The identified age-related pattern, combined with the high proportion of cases with unidentified etiology, allows the proposal of three clinical-therapeutic strategies. In children under 5 years of age, antibiotic use should be limited in the absence of firm indications. In children aged 10–17 years, macrolides are the preferred choice for initial therapy. In the 5–9 years age group, diagnostic investigation is necessary, including mandatory assessment of inflammatory biomarkers and pathogen verification.

Objective. To systematize current trends in the application of AI in diagnostic radiology, to analyze the evidence base, clinical efficacy, and limitations of real implementation, as well as to assess regulatory, ethical, and organizational and economic factors. Materials and methods. A descriptive analytical review of publications indexed in the PubMed/MEDLINE and RSCI databases for the period of 2020–2026 was conducted, analyzing the primary directions of AI application in radiology. Results. This review presents an analysis of the current state of AI technology application in diagnostic radiology. The main directions of the clinical use of AI systems are examined: detection and classification of paroplasms, quantitative assessment of focal lesions, medical image reconstruction, and generation of structured reports. The evidence base of AI solutions efficacy was analyzed taking into account external validation results. Regulatory requirements, ethical issues, and organizational aspects of integrating AI into radiological practice were discussed. Special attention was paid to the limitations of existing studies and the future prospects for the development of this field. Conclusion. AI systems demonstrate significant potential for enhancing the quality and efficiency of diagnostic radiology; however, their clinical value is determined not only by accuracy metrics, but also by their ability to perform reliably in real-world clinical settings, and their compliance with regulatory requirements.

Forty years have passed since one of the world’s largest man-made disasters — the accident at the Chernobyl Nuclear Power Plant. To provide high-quality and accessible medical care to the population affected by the Chernobyl accident, the State Institution «Republican Research Center for Radiation Medicine and Human Ecology» (RRCRM&HE) was established in 2002. It remains a leader in the development of new medical technologies and scientific advances in radiation medicine. This article presents the main achievements of the RRCRM&HE in providing medical care to the population affected by the Chernobyl accident, including its interactions with the Gomel regional healthcare system and Gomel State Medical University, the activities of the State Registry of Persons Affected by the Consequences of the Chernobyl Disaster, participation in the implementation of Union State events, and the diagnostic and therapeutic activities of its outpatient clinic and inpatient department. Information on the implementation of new methods, educational, scientific and practical activities and the international cooperation of the RRCRM&HE is provided.

This review presents current information on cardiovascular risk factors and the course of cardiovascular diseases (CVD) in patients with chronic lymphocytic leukemia (CLL). It also examines comorbidity in patients with CLL and the pathogenetic mechanisms common to both CLL and CVD, including chronic inflammation, endothelial dysfunction, and oxidative stress, including those mediated by viral agents. The need for antitumor treatment is associated with the risk of developing cardiovascular complications (cardiotoxicity). Current approaches to the early detection and prevention of cardiotoxicity in CLL are presented. These approaches will potentially change approaches to cardiovascular risk stratification in patients with CLL, develop an algorithm for dynamic monitoring and timely cardioprotection, including for subclinical changes in myocardial function, preventing disease progression. A multidisciplinary teamwork between a cardiologist and an oncohematologist will reduce the risk of cardiovascular complications in patients with CLL and improve their prognosis.

Aim. To determine the most significant indicators for predicting a fatal outcome in patients with pneumonia caused by carbapenem-resistant K. pneumoniae.Materials and мethods. A total of 114 cases of pneumonia caused by K. pneumoniae, including those associated with COVID-19, were retrospectively analyzed. Depending on the outcome of the disease, two groups were formed: group 1 included 54 patients discharged from the hospital upon completion of treatment; group 2 encompassed 60 patients with an unfavorable (fatal) outcome. Patients who did not have a concomitant COVID-19 infection were analyzed separately. The profile of concomitant diseases, hemogram parameters, C-reactive protein (CRP) level, and hematological indices (neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR)) were studied, and the risk of death according to the CURB-65 score was assessed.Results. Patients with an unfavorable outcome were characterized by higher leukocyte and neutrophil counts, higher NLR, MLR, PLR, and CRP levels, higher risk according to the CURB-65 score, and lower lymphocyte and platelet concentrations. According to the results of the ROC analysis, the most significant prognostic indicators of an unfavorable outcome were lymphocytes, neutrophils, NLR, CURB-65, CRP, and TLR. The diagnostic value of the CURB-65 score (3–5 points) in predicting the risk of an unfavorable outcome was the following: test sensitive ity was 47.5%, specificity was 98.2%, positive predictive value was 96.6%, negative predictive value was 63.1%, accuracy was 71.7%. For NLR (at a threshold value > 6), sensitivity was 85.0%, specificity was 87.0%, positive predictive value was 87.9%, negative predictive value was 83.9%, accuracy was 86.0%. For MLR, the diagnostic accuracy was 79.0%, and for PLR – 73.7%.Conclusion. The parameter of choice that can be used at the early stage to predict the fatal outcome of pneumonia caused by carbapenem-resistant K. pneumoniae should be NLR (> 6) due to its high sensitivity (85%) and specificity (87%) and ease of use. In addition, the CURB-65 score can be used at NLR > 3.

Pneumonia caused by carbapenem-resistant K. pneumoniae often has a severe course and a significant risk of unfavorable outcome. Various scales and indices have been proposed for timely assessment of the patient's condition and detection of a high risk of unfavorable outcome. For the attending physician, the ease of use and prognostic accuracy of the index used in the assessment are important.   The aim of the study was to evaluate the diagnostic significance of clinical and laboratory parameters for predicting a fatal outcome in patients with pneumonia caused by carbapenem-resistant K. pneumoniae. A total of 71 cases of pneumonia caused by K. pneumoniae with multiple and extreme drug resistance were retrospectively analyzed. Two groups of patients were formed depending on the outcome: group 1 – 41 patients discharged from the hospital upon completion of treatment; group 2 – 30 patients with a fatal outcome. The structure of concomitant diseases, body mass index (BMI), blood saturation (SpO₂), hemogram parameters, C-reactive protein (CRP) were analyzed. It was found that patients with a fatal outcome were characterized by higher leukocyte counts, neutrophils in the hemogram, neutrophil/lymphocyte ratio (NLR), CRP, BMI; lower lymphocyte counts, SpO2. The most significant prognostic indicators of an unfavorable outcome are lymphocytes, neutrophils, NLR, BMI. To predict the risk of death, we proposed the index (BMI*NLR)/SpO₂. ROC analysis was performed: the AUC was 0,99 (0,93–1,00), test sensitivity 100,0 %, specificity 97,6 % at a cutoff point of > 1,53, Youden index 0,98. Diagnostic value of the index (BMI*NLR)/SpO₂ (at a threshold value > 1,53): test sensitivity is 100,0 %, specificity is 95,1 %, positive predictive value is 93,8 %, negative predictive value is 100,0 %, accuracy is 97,2 %. The proposed index (BMI*NLR)/SpO₂ (at a level > 1,53) may be preferable for predicting a fatal outcome of pneumonia caused by carbapenem-resistant K. pneumoniae, due to its high sensitivity (100 %) and specificity (97,6 %), as well as ease of use.

The object of study was to investigate the clinical and laboratory characteristics, the outcomes of the disease, the susceptibility to antibiotics and to different combinations in the patients with pneumonia caused by K. pneumoniae associated and not associated with COVID-19.We analysed 93 cases of pneumonia with K. pneumoniae detected in biological materials including 65 ones with COVID-19 and 28 ones without COVID-19.In the both groups, the diseases of the circulatory system and metabolic disorders were the most common concomitant conditions. The laboratory data were not statistically different. The lethal outcomes were found reliably more often in the patients with COVID-19 (66 % vs 32 %). K. pneumoniae was detected predominantly after the tenth day of admission to the hospital (nosocomial strains). In the both groups, the majority of detected K. pneumoniae strains had a multiple resistance to antibiotics. The combinations of antibiotics with no colistin demonstrated a low efficacy, including those with carbapenems. A proportion of 40 (61.5 (48.6–73.3) %) K. pneumoniae samples isolated from patients with COVID-19 had carbopenemases detected.The results of the study refer to the preferability of the colistin comprising the schemes of antibiotics for treatment of pneumonia caused by K. pneumoniae associated and not associated with COVID-19.

Анализ клинического течения пневмонии, вызванной карбапенеморезистентными штаммами Klebsiella pneumoniae, устойчивыми и чувствительными к комбинациям

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 a clinical case of yersiniosis with fever of unclear genesis. For early diagnosis of yersiniosis, its adequate therapy and prevention of complications, it is necessary to take into account the dynamics of clinical manifes- tations and timely conduct specific diagnosis of the disease. Late diagnosis may be associated with the lack of vigilance of doctors with regard to this infection.