For the successful functioning of the health care quality management system in military healthcare organizations, a high degree of personnel involvement is required as the main resource for ensuring it.
157 doctors took part in a sociological survey conducted in three military hospitals of Belarus. Along with a high subjective assessment of the quality of medical care provided by the military healthcare organization, where the respondents work, there is a low level of awareness and involvement in the health care quality management system.

Object. To create an integral index of health impairment of servicemen as a part of the implementation of scientific research work.

Materials and methods. Following medical and statistical indicators of morbidity among military personnel were used: general and primary morbidity, necessity in dispensary observation, hospitalization, days of disability, dismission for health reasons and mortality. An expert survey was conducted to determine the significance coefficients of medical and statistical indicators of morbidity.

Results. In the structure of health impairment integral assessment among conscripts ranks were following: 1st – respiratory diseases (chapter X), 2nd – trauma, poisoning and some other consequences from external causes (chapter XIX), 3rd – diseases of the gastro-intestinal system (chapter XI), 4th – diseases of the musculoskeletal system and connective tissue (chapter XIII), 5th – diseases of the skin and subcutaneous tissue (chapter XII). In the structure of the integral assessment ranks dispensed as following: 1st – acute respiratory infections of the upper respiratory tract (J00 – J06), the 2nd – diseases of the esophagus, stomach and duodenum (K20 – K31), the 3rd – injuries involving several areas of the body (T00 – T09), 4th – the consequences of trauma, poisoning and other consequences from external causes (T90 – T98), 5th – diseases of the oral cavity, salivary glands and jaws (K00 – K14).

Conclusions. The developed integral index of health impairment optimizes the effect of some indicators of morbidity and reliably correlates the contribution of chapters and nosologies to the final assessment, which allows timely, completely and promptly assess the quality of medical support to conscripts.

The use of interactive teaching methods such as situational tasks, business games in practical classes in epidemiology and military epidemiology with cadets increases the quality and efficiency of the educational process. They are considered as a kind of methodological resource that allows for practice-oriented training of cadets. In the course of the classes, the peculiarities of the implementation of teaching methods are taken into account, which have an important role and significance in the formation of professional and general competencies among cadets.

This publication is a continuation of the article «Syncope: to help the practitioner» (Communication 1). It outlines actual approaches to the diagnosis and interpretation of data from clinical and instrumental research methods in patients with various types of syncope in accordance with the recommendations of the American College of Cardiology (2017) and the European Society of Cardiology (2018).

The article presents the main provisions of recent recommendations for the use of diagnostic methods in patients with various types of syncope.

The emphasis is placed on the possibilities of diagnostics after the initial examination to determine the subsequent treatment tactics, prevent possible complications, and resolve expert questions.

In this article, the authors reflect the results of experimental studies devoted to the study of traumatic lesions of limb muscles in laboratory animals. The effect of different routes of administration (intraperitoneal and intramuscular paravulnary) of methylethylpyridinol hydrochloride (emoxypine) on the state of the microvasculature was evaluated. In the course of the experiment, it was found that intramuscular paravulnar administration of emoxipin makes it possible to more effectively eliminate the pathology of the microvasculature in comparison with the intraperitoneal route of administration. Also, as a result of the studies, it was noted that the MSB staining method is the most appropriate in terms of fibrin differentiation and assessment of the state of the microvasculature. The data obtained will make it possible to develop new approaches in the treatment of traumatic lesions of the limb muscles.

Introduction. Hirschsprung‘s disease is a congenital malformation characterized by the absence of intramural ganglia in the intestinal wall. The goals of the surgical treatment of HD are to remove the aganglionic segment of the intestine and restore the patency of the gastrointestinal tract, bringing down the normally innervated intestine to the anus while maintaining the function of the sphincters. An incorrect determination of the length of the affected segment of the colon can lead to non-radical surgical treatment with a persistent aganglionic zone. The use of an intraoperative express biopsy to determine the resection area during radical surgery will help to solve this problem.

Purpose: determination of the level of agangliosis of the colon in the surgical treatment of Hirschsprung‘s disease.

Methods: From 2010 to 2019, 49 patients aged 3 weeks to 16 years underwent an intraoperative express biopsy to determine the area of bowel resection.

The use of intraoperative express biopsy made it possible to objectively and reliably determine the area of bowel resection, to reduce the number of complications associated with errors in resection of the aganglionic segment.

Conclusion. When performing radical surgery for Hirschsprung‘s disease, an intraoperative express biopsy is required to determine the level of coloanal anastomosis in order to avoid errors in determining the aganglionic region and the transitional zone of the intestine.

Purpose of the study: to determine the rate of progression of primary chronic glomerulopathies (GP) in patients and to establish the main risk factors for the development of this process. Materials and methods. 188 children who were under observation and treatment at the Republican Center for Pediatric Nephrology and Renal Replacement Therapy of the «2nd Children‘s City Clinical Hospital» in Minsk, with morphologically verified kidney damage, were included in the study: group № 1 – patients with minimal change disease (MCD), n = 53; group № 2 with IgM nephropathy (IgMN), n = 26; group №3 with focal segmental glomerulosclerosis (FSGS), n = 55; group № 4 with IgA nephropathy (IgAN), n = 54. The duration of the period from the onset of the disease to reaching the 3rd stage of CKD and predictors that determine the rate of progression of GP using Kaplan-Meier method was studied. Results. Anamnestic, clinical, laboratory, immunological (blood concentration of markers of T and B lymphocyte activation RANTES and BAFF), proinflammatory (caspase 1, IL1β and TNFα), vascular (VEGF) and tissue (TGF1β) growth factors), metabolic status (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes were analyzed. Each of the variables was considered as a likely risk factor for the progression of GP. Conclusion. A mathematical model has been developed for predicting the risk of progression of secondary GP in children, including risk factors as predictors: impaired renal function at the onset of the disease, non-compliance with therapy, and a decrease in the estimated glomerular filtration rate (eGFR) at the onset of the disease less than 87 ml/min. The predictive accuracy of the model was 90,9% (95%ДИ 79,3-100%).

There is still no single point of view regarding the choice of the most effective method for treating leftsided portal hypertension, due to the difficulties in organizing the recruitment of patient groups for controlled studies on this topic.

Aim. Preliminary analysis of the results of performing endovascular embolization of the splenic artery in our own modification in patients with left-sided portal hypertension.

Materials and methods. Endovascular embolization of the splenic artery in our own modification was performed in three patients with chronic recurrent pancreatitis and left-sided portal hypertension (all males) aged 46 to 59 years after a repeated episode of bleeding from varices of the gastric fundus (2 to 3 relapses). A distinctive feature of our modification of X-ray endovascular partial embolization of the proximal segment of the splenic artery was that the criterion for stopping the process of reducing blood flow through the splenic artery was endoscopic confirmation of the fact of achieving reliable hemostasis.

Results and discussion. All patients underwent successful surgery. Two patients were transferred after surgery to the Department of Surgical Pancreatology, Hepatology and Transplantation. In one case, it was required to stay in the intensive care unit for four days after surgery due to the severity of preoperative blood loss. The time spent in hospital in the postoperative period was (Me [min; max]) – 7 [6; 7] days. During the postoperative observation of these patients for the period from 22 to 60 months, no recurrence of bleeding from gastric varices was noted. In all patients, endoscopic examination after a year showed regression of the degree of expansion of gastric varices.

Сonclusions. The method of endovascular embolization of the splenic artery presented in the article makes it possible to effectively achieve reliable hemostasis in bleeding from varices of the fundus of the stomach in patients with left-sided portal hypertension while maintaining blood flow through the splenic artery sufficient to minimize the risk of developing total necrosis and abscess of the spleen, necrotic changes in the fundus of the stomach and pancreas.

The reproducibility of the surgical intervention, its effectiveness and safety should be noted. It is advisable carry out further studies of the effectiveness of the technique in randomized controlled trials.

Recent studies allow us to consider sleep disorders not only as a sign of somatic pathology, but also as an independent risk factor for cardiovascular diseases.

However, general clinical practice does not pay sufficient attention to the evaluation of sleep disorders. This misses the opportunity to improve cardiovascular prognosis in patients who have avoidable sleep disturbance factors. The aim of the study was to assess the duration and quality of sleep in 73 patients of the cardiology departments of 432 Main military clinical medical center in various age groups by interviewing and filling out a questionnaire to assess the quality of sleep. It is established that this method can be used for the primary assessment of sleep quality. The disadvantage of this method is its subjective nature, which can be corrected by evaluating sleep based on programs embedded in fitness trackers. An algorithm for diagnosis and management of patients with sleep disorders in different age groups is proposed.

The article focuses on the study of the neuropsychological features of the patients with schizophrenia, who have the signs of the disordered eating at the preclinical stage. The paper contains the data of the study of 60 female patients (aged 28 (25-33) years, median Me (25%-75%)) who have suffered from paranoid schizophrenia for up to 5 years. 23 of the female patients have had the disordered eating in the past medical history, i.e. during the examination the female patients reported that they had tried to loose weight, had taken laxatives and had trained intensively 5 years before they were diagnosed with schizophrenia. At the moment of examination the female patients have also had the signs of the disordered eating, moreover, the signs included only overeating and purging behavior. Besides, we have used the Kaplan-Meier method to determine the difference in the time of making clinical diagnoses (schizophrenia) depending on the absence and presence of the relevant signs of the disordered eating.

Staple line and anastomotic leakage is frequent and threatening complication of bariatric surgery. Its early diagnostics is difficult, and search for new diagnostic criteria is necessary.

Objective. To improve post-bariatric staple line and anastomotic leakage diagnostics by revealing new early diagnostic criteria.

Materials and methods. Following hypothesis considered: postoperative stab neutrophils level is early sign of staple line and anastomotic leakage after bariatric surgery. Retrospective comparative study performed to test the hypothesis. Study group consisted of patients with staple line and anastomotic leakage in postoperative period (n = 9). Control group consisted of patients with uncomplicated postoperative period (n = 253). ROC-curves for stab neutrophils levels in 12 and 36 hours after surgery analyzed in both groups. The reference method was a comprehensive dynamic examination.

Results. Area under the ROC-curve for stab neutrophils in 36 hours (AUC = 0,613) was higher, than area under ROC-curve for stab neutrophils in 12 hours (AUC = 0,543). So stab neutrophils in 36 hours is more sensitive and specific early diagnostic criterion for staple line and anastomotic leakage. Sensitivity Se = 55,56% and specificity Sp = 72,13% achieved at the stab neutrophils in 36 hours after surgery level above 9%.

Conclusion. As staple line and anastomotic leakage early diagnostic criterion stab neutrophils level in 36 hours after bariatric surgery has high specificity. Proposed criterion available in early postoperative period, when signs of leakage are obscured. In combination with other methods it promotes staple line and anastomotic leakage earlier diagnostics, what improve patients’ treatment results.

Goal. To improve the results of surgical treatment of chronic pancreatitis complicated by vascular pathology of the parapancreatic zone.

Materials and methods. On the basis of the «Grodno University Clinic» in the department of X-ray Endovascular Surgery of the period 2010 to April 2020, were performed 16 embolizations of the arteries of the parapancreatic zone due to complications of chronic pancreatitis. Among the patients there were 13 (81.25%) men and 3 (18.75%) women. They had a history of chronic pancreatitis, which was confirmed using instrumental and laboratory research methods. One of the patients (6.25%) had a stationary aneurysm. 15 (93.75%) patients had a bleeding clinic, which required urgent surgical interventions.

Results. Angioembolization of the parapancreatic arteries was effective in 15 (93.75%) patients, which was confirmed by the results of control angiograms.

Conclusions. The use of intraluminal embolization for vascular pathology of the parapancreatic zone in treatment of chronic pancreatitis complications is a minimally invasive and effective method.

Objective. Improving the postoperative ventral hernias surgical treatment efficiency.

Authors of the article define the clinically developed method of plastic surgery of the anterior abdominal wall in postoperative ventral hernia. Operations with this technique were performed in 37 patients. The endoprosthesis used was a polypropylene net made by “Eticon”. In the postoperative period complications took place in 2 (5,4%) patients.

Conclusion. The developed method of the anterior abdominal wall plastics effectiveness was established in the article.

The article reflects the experience of the response of the Republic of Belarus and other countries to emergencies of biological origin and the importance of interagency cooperation for their prevention, localization and elimination.

Diabetes mellitus is one of the most common comorbidities in patients with COVID-19. The complex bidirectional cross impact of both diseases leads to the severity and an increased risk of mortality in patients with coronavirus infection. The clinical experience of specialists in many countries has led to the development of optimal algorithms for the management of diabetic patients in pandemic conditions.

Obesity is associated with an increased risk of venous thromboembolism (VTE), including during the perioperative period of bariatric surgery. The effectiveness of various methods of perioperative prevention of VTE is discussed in this review.

The article reviews current problems related to mono – and combined use of medications (Tropicamide, Pregabalin («Lyrica»)). The article presents statistics on the detected use of medicines in 2016–2019 in Moscow for non-medical purposes. A review of domestic and foreign studies of the clinical aspect of consumption of these substances is conducted. A number of acute regulatory and legal problems related to the turnover of drugs in the pharmacy chain are highlighted. The authors conclude that, given the recent increase in the number of people abusing Tropicamide and Pregabalin, strict prescription control over their release in the pharmacy chain should be recommended. Caution should be exercised when prescribing these drugs for therapeutic purposes.

Today, adhesive disease of the abdominal cavity is a disease characterized by a high risk of postoperative complications, a significant level of disability and the likelihood of death. The purpose of the article was to analyze the literature on the etiology, pathogenesis of abdominal adhesive disease, the results of prevention and treatment of this disease and its complications. It was found that at the moment there are no methods for the prevention of adhesive disease with proven effectiveness, and the proposed methods are often multidirectional, based on the subjective vision of the problem by the researcher. Analysis of foreign and domestic literature has shown the absence of barrier agents that meet safety requirements and have a significant preventive effect. Thus, there are currently no standard approaches to the treatment and prevention of abdominal adhesive disease. This issue requires further study.

The article is dedicated to the study of the conversion of cases of anorexia syndrome to bulimia nervosa and to schizophrenic spectrum disorders, as well as to the contribution of neuropsychological parameters on the clinical findings of mental and behavioral disorders. The analysis of literature sources reveals that it is anorexia nervosa that most clearly demonstrates the thinness of the line between the variants of a normal and pathological mental state. The authors consider this problem taking into account the current knowledge regarding anorexia syndrome. This paper provides the results of a study that involved 65 female patients (the age, the median Me (25-75%) was 20 (17-24) years old) suffering from anorexia nervosa, whose 5-year follow-up diagnosis was changed to bulimia nervosa (20 people) or schizophrenic spectrum disorders (5 people).

We also spotted the difference in the time required to diagnose a case (of anorexia nervosa) depending on the presence or absence of a change in the diagnosis to bulimia nervosa in a 5-year follow-up, using the Kaplan-Meier method.

New psychoactive substances are an extremely important issue in modern narcology. Dependence on this group of substances develops faster than on drugs of plant origin, the mechanism of action of synthetic derivatives is unpredictable in clinical manifestations. The purpose of this article is to discuss the features of the formation of the syndrome of dependence on synthetic cathinones and the features of the course of the disease.

The article shows modern methods of hydration control in sports and strategies for ensuring water and electrolyte balance, taking into account the nature and specifics of sports activity.

The article provides data on the issuance of the order of the People‘s Commissar of Defense No. 281 on August 23, 1941, which stipulated the possibility of rewarding junior and middle medical personnel for good combat work during the Great Patriotic War of 1941–1945. in connection with the provision of medical assistance to the wounded and sick on the battlefield.