The article presents modern approaches to the management of patients with syncopal conditions. In accordance with the recommendations of the American College of Cardiology (2017) and the European Society of Cardiology (2018), approaches to risk stratification during fainting are identified and diagnostic issues are considered.

This article provides information on the most important functions of albumin and shows its place in the infusion therapy of critical conditions.

Modern drugs of first choice for the treatment of gonorrhea should be widely available, low toxicity, cause eradication of gonococcus with a single use and quickly lead to the cure of infected patients. When choosing a method of treatment for gonococcal infection, WHO recommends a test for antimicrobial sensitivity, and in the absence of such an opportunity to use combination therapy. Monotherapy is allowed, but the choice of treatment depends on reliable local data on antimicrobial sensitivity. The article presents the outcomes of studies and results of treatments of patients with gonococcal infections, as well as the compliance of ongoing outpatient treatments according to clinical protocols approved in the Republic of Belarus by order N 1020 of 10.29.2009. It has been established that, due to the high resistance of gonococcus to penicillin, tetracycline and macrolide drugs, their use as monotherapy is impractical. The appointment of combination therapy (ceftriaxone + azithromycin) will not only reduce the risk of developing resistance to ceftriaxone, but also increase the effectiveness of treatment of under-examined patients with co-infection with C. Trachomatis.

Spondylodiscitis is a syndrome complex that includes the defeat of various structures of the spinal column, which occurs, as a rule, on the background of long-term osteochondrosis.
An analysis of management of 33 patients suffering from spondylodiscitis syndrome hospitalized in the 2nd surgical unit of 5th city clinical hospital was performed. For accurate topical diagnostics, modern methods were used (CT, MRI).
The main treatment method was long-term antibiotic therapy, however, in case of occurrence of signs of spinal cord compression or septic foci, surgical treatment was indicated.

Timely and effective relief of somatic and neurological symptoms of alcohol withdrawal syndrome is one of the important task to prevent the more serious consequences of alcohol dependence. The article presents the results of our own research, the purpose of which was to apply the use of oxygen therapy methods in combination with standardized treatment with drugs to increase the efficiency and optimization of treatment of somatic and neurological symptoms of alcohol withdrawal. A comparative assessment of the effectiveness of the use of methods of normoxic therapeutic compression, hyperbaric oxygenation in combination with the treatment of drugs and standardized therapy of drugs. The effectiveness of using oxygen therapy methods for certain somatic and neurological symptoms of alcohol withdrawal syndrome. The prognostic effectiveness is shown for this pathology.

The aim of the study was to evaluate the effectiveness of treatment of patients with spinal epidural abscesses.

Methods. From 2008 to 2019, 24 patients with retrodural isolated spinal epidural abscess (SEA) were treated at the Vitebsk Regional Clinical Hospital (VRCH). Surgical treatment was performed in 21 (87.50%, 95% CI 73.23–100) patients. In 8 (38.10%, 95% CI 15.44–60.75) cases, SEA was removed wiht a vacuum-draining system (VAC-system) – group I, in 13 (61.90%, 95% CI) 39.25–84.56) cases we used the classic lamin – (hemilamine) ectomy followed by flow-washing wound drainage – group II. The modified Frankel scale was used to assess the evolution of neurological disorders, and the visual analogue pain scale (VAS) was used to assess the pain syndrome

Results. There was a statistically significant (pWilcoxon = 0,02) decrease in the severity of pain according to the VAS scale from 8 [7–9] points at admission to 1 [0–2] point at discharge in the I-st group. Regression of neurological deficit was characterized by an increase in the strength and volume of active movements in the lower extremities, normalization of the functions of the pelvic organs with a progressive transition of patients to higher functional classes (71.43%) according to the adapted Frankelm scale (рWilcoxon = 0,04). There were no repeated hospitalizations and operations in the I-st group of patients. In the II-nd group, 4 (30.77%) patients required repeated hospitalizations with 1 operation (7.69%). In 33.3% (95% CI: 13–53.67) cases, the course of SEA was accompanied by a septic state with high intoxication syndrome and impaired immunoreactivity.

Conclusion. The development and implementation of new types of surgical treatment of SEA with the use of VAC-systems made it possible to reduce re-hospitalization of patients from 30.77% to 0% (pWald-Wolfowitz = 0.002), reduce the length of hospital stay of patients from 51 (33–81) to 28, 5 (22.50–35) days (pMann-Whitney = 0.03) and reduce the cost of their treatment by 13 427.11 BYN / year.

Adequate amount of food energy, macro-and micronutrients on the background of adequate treatment are the main principles and approaches for correcting the nutritional status of patients with acute pancreatitis during inpatient treatment.

The article presents the clinical and instrumental characteristics of 64 hip joints in patients with osteonecrosis of the femoral head in various stages. The original diagnostic search algorithm was presented, a number of criteria were identified for establishing a diagnosis of the femoral head necrosis in adults. A systematic classification of femoral head osteonecrosis has been developed, including numerical and alphanumeric encryption of various categories of signs to indicate changes in the bone and soft tissue structures of the hip joint, as well as the etiopathogenetic part. A radius method for calculating the magnitude of collapse was described for dynamic monitoring of the weightbearing zone of the femoral head.

The treatment of colorectal cancer is one of the most challenging problems of modern oncology due to the high incidence both in the Republic of Belarus and in the whole world. Since chemotherapy remains the main method of treatment of metastatic disease, there remains a need to develop and introduce into clinical practice new effective methods of chemotherapy for colorectal cancer. This article presents the interim results of treatment of colorectal cancer patients in Minsk City Clinical Oncologic Dispensary with the use of maintenance metronomic chemotherapy, who were enrolled from 2016 till 2019 (n = 60). Metronomic regimen consisted of oral capecitabine 500 mg 3 times a day and oral cyclophosphane 50 mg daily. The control arm consisted of mCRC patients who received the same induction chemotherapy without maintenance from 2011 till 2015 (n = 70). Median follow-up time was 18,5 months. Median progression-free survival (PFS) was 9.0 and 7.4 months in the maintenance and control arms respectively. Median overall survival (OS), counted from the beginning of induction chemotherapy, is currently 22.9 months in the maintenance arm, and 14.7 months in control. Low expression levels of genes, encoding enzymes TS (thymidylate synthetase), DPD (dihydropyrimidine dehydrogenase) and receptor VEGFR1, high expression level of gene TP (thymidylate phosphorylase), as well as low levels of tumor markers CEA and СА 19-9 are the prognostic factors of sensitivity to metronomic chemotherapy given to colorectal cancer patients. Based on these data, we identified a group of patients who are recommended to use this method of treatment.

Progressively increasing discrepancy between the number of effective donors and the number of patients requiring transplantation leads to use of allografts from extended criteria donors. This fact leads to an increase of early allograft dysfunction, the level of biliary complications, and a decrease of graft survival.

Objective. To assess the effect of various preservation methods on the degree of ischemic damage to liver grafts.

Materials and methods. During the case-control study, the effect of hypothermic oxygenated machine perfusion and static cold storage on the degree of liver cells damage was assessed. Liver transplants that were recognized as extended criteria during the multi-organ retrieval procedure were explanted according to the classical method and were preserved with static cold storage (SCS) for the period of transportation. During the “back-table” procedure, a complete separation of the liver parenchyma along the Cantle line was performed. After randomization by random number method, one part was preserved with static cold storage at a temperature of 40C (control group, n = 10), and the second was preserved by hypothermic oxygenated machine perfusion through the portal vein with 2 liters of Belzer UW MPS solution at a temperature from +4 to + 10 ° C, perfusion pressure 3 mmHg, 100% O2 flow – 1 l / min, pO2 = 34.7 ± 1.1 kPa for 4 hours (study group, n = 10). The sampling of effluent and parenchyma biopsies for biochemical and morphological evaluation were performed at the beginning of the study, after 2 and 4 hours after the start of the experiment in both groups.

Results. The use of hypothermic oxygenated machine perfusion for 4 hours at the end of static cold storage reduces the level reactive oxygen species and as well as the level of AST, ALT, LDH in comparison with static cold storage alone.

Conclusion. It was found that the use of hypothermic machine perfusion can reduce the degree of ischemic liver grafts damage.

Torsion and necrosis of fat grafts of the colon is a fairly rare pathology in the structure of all emergency surgical diseases of the abdominal cavity and it is about 0.3 %. The absence of pathognomonic clinical manifestations makes it difficult to diagnose both at the pre-hospital and hospital stages. In a retrospective study of a clinical series of cases based on the 1st surgical department of the state institution “432 orders of the red Star main military clinical medical center of the Armed Forces of the Republic of Belarus” in the period from 2012 to 2018. The analysis of 34 medical records of inpatient patients with the disease of epiploic appendagitis, which made up the main group, was carried out. Comparison groups: 34 patients with acute appendicitis and 30 patients with functional bowel disorders. A common complaint among patients of the main group with epiploic appendagitis pathology was a pain syndrome in the abdominal area without a clear topographical localization in combination with various complaints of a General somatic nature, which confirms the non-specific manifestation of this disease. The results of clinical, laboratory and instrumental studies are non-specific, so the final method for diagnosing of epiploic appendagitis pathology it is laparoscopy.

According to the results of the study of contamination by pyogenic microorganisms of wound exudate, blood, sputum, urine among adults and children with burn injury, significant differences were found in the frequency of detection of certain types of infectious agents: Acinetobacter spp. prevails in the wound content of adult patients., P. aeruginosa, Klebsiella spp., Proteus spp., and in children-S. aureus and S. epidermidis; in the blood, respectively, Acinetobacter spp. and S. epidermidis. In the urine of adults, Acinetobacter spp is more often detected. and P. aeruginosa, and in children Enterococcus spp., Candida spp. and E. coli. The species composition of microorganisms isolated from sputum in patients of both age groups did not differ significantly and was characterized by the same proportion of predominant bacteria Acinetobacter spp. and P. aeruginosa.

The article presents the results of the study of the effectiveness of the hemostatic agent alufer in the experiment and clinic. Methods of applying an alufer to a bleeding surface and a procedure for eliminating an excess portion thereof outside the bleeding surface are shown.

The results of total hip arthroplasty in the treatment of femoral head necrosis in 40 patients are presented. The average follow-up was 3 years and 7 months. The comparison group consisted of cases with idiopathic coxarthrosis. The main types of implants that were used, surgical approaches were analyzed. Radiological signs of instability of the femoral and acetabular components, wear of the polyethylene liner were described. The clinical results of endoprosthetics in the study groups were similar, positive results prevailed in patients in the age group from 24 to 40 years, as well as in women. Among the complications in the osteonecrosis group, dislocations of the endoprosthesis head, periprosthetic fractures, periprosthetic infection were noted. Endoprosthesis survival rate in the osteonecrosis group was 91.5%, and in the osteoarthritis group 97.2%.

The article presents modern concepts of estimation of adverse cardiovascular events in patients with prediabetes and type 2 diabetes mellitus. The changes in recent years in risk stratification are outlined.

The review presents the key points of the XIV Congress of the Russian Medical Society of Therapists, reflecting current trends in the development of medicine, affecting cardiovascular morbidity.

This article covers epidemiology, classification, features of diagnostics and basic principles and schemes of rational antibiotic therapy of urinary tract infections.

A review of the scientific literature on the study of the phenomenon of alexithymia in people with a narcological profile (with alcohol and drug addiction) is presented. The main and current trends in alexithymia studies in patients who use psychoactive substances are described. Existing psychotherapeutic approaches to the problem of alexithymia and an assessment of their effectiveness are analyzed. An analysis of the scientific literature indicates a lack of methods for the psychological correction of alexithymia among patients with alcohol and drug addiction, and the absence of comprehensive prevention programs that take this phenomenon into account.
The authors of the article highlighted promising areas for further studies of alexithymia in patients with alcohol and drug addiction. The development of methods for the psychological correction of secondary alexithymia, prevention programs with an orientation on socio-psychological factors is proposed.

In the article, the authors review modern approaches to explaining the genetic determination of schizophrenia, which has a complex multi-level nonlinear character. The evolution of views on the relationship of genes and disease in the context of the influence of hypothetical environmental factors is reflected. Various methodological approaches to studying the role of genetic factors of schizophrenia in a comparative vein are discussed, and problematic issues of such studies are raised from a conceptual perspective.
An analytical review is based on the mention of literature data, which are the primary source of various ideological approaches to the interpretation of the role of genes in the occurrence of schizophrenia.

The development of any state as a social and legal structure has always been aimed at preserving the health and life of its population, including from criminal attacks. Socially dangerous acts can be committed either intentconally or for painfull reasons. Features of the course of schizophrenia in some cases create conditions for the occurrence of criminal events, first of all, if patients have imperative auditory hallucinations, delusional ideas of attitude, jealousy, etc. At the same time, the opinions of scientist and practitioners regarding the social danger emanating from patients with schizophrenia differ and they still can not come to a common opinion on this issue. The prevention of social danger acts on the part of patients with schizophrenia is one of the most urgent tasks of our time.

Results of the treatment of intraarticular fractures of the distal tibia have improved significantly during last two decades. Better understanding of the role of soft tissues has led to the development of a staged treatment strategy of these injuries. Initial application of external fixation provides the restoration of the length of the limb, partial fracture reduction through ligamentotaxis and relatively stable position of the fracture fragments, that is important for the healing of soft tissues. Definitive surgical treatment is delayed until the condition of soft tissues becomes safe. During this time thorough preoperative planning is performed on the base of detailed study of the fracture morphology with CT-scanning. Sophisticated choice of the surgical approach(-es), atraumatic soft tissue handling and the use of modern fixation techniques for the metaphyseal component provide optimal conditions the fracture union and restoration of the limb function.

Today, there are many diseases that are “masked” as acute respiratory distress syndrome. Their insufficient intravital diagnosis leads to a high percentage of mortality from these diseases. A group of autoimmune diseases that occur with simultaneous damage to the lungs and kidneys (pulmonary-renal syndrome) is available in the article. Clinical and radiological these diseases are similar to acute respiratory distress syndrome. Given the observed clinical picture of this pathology and the rate of symptom progression, patients with pulmonary-renal syndrome are hospitalized immediately in the intensive care and resuscitation department. The doctor should be wary of the patient with simultaneous damage to the lungs and kidneys and conduct differential diagnosis between autoimmune and non-immune natural pathology. Specific treatment of such patients consists of immunosuppressive therapy (glucocorticosteroids, cytostatics, monoclonal antibodies) and the appointment of plasmapheresis as indicated.

Introduction. Hemorrhage from esophageal varices is an emergency requiring emergency therapy, the goals of which are to achieve hemostasis, prevent bleeding recurrence and the associated 6-week mortality.

Aim. Analysis of the results of escalation tactics for the use of hemostasis methods for persistently recurring bleeding from esophageal varices in a patient with cirrhosis.

Materials and methods. Sequential escalation of endoscopic hemostasis, insertion of an obturator probe, transjugular portosystemic shunting, laparoscopic esophagogastric devascularization with esophageal transection were performed in a 32-year-old patient with liver cirrhosis of mixed etiology (viral hepatitis C plus alcohol), Child-Pugh class B for persistent recurrent bleeding from esophageal varices in Grodno Regional Clinical Hospital in December 2016.

Results and conclusions. The use of the escalation algorithm in the treatment of repeatedly recurrent bleeding from esophageal varices contributed to the achievement of persistent hemostasis and the absence of recurrence of bleeding from esophageal varices in the postoperative period. The step-by-step application of endoscopic hemostasis, an obturator probe, transjugular portosystemic shunting, laparoscopic esophagogastric devascularization with esophageal transection for persistently recurrent bleeding from esophageal varices is an effective backup algorithm in the treatment and prevention of bleeding of this etiology.