Objective. Analysis of the experience of transport immobilization (TI) in fractures of long tubular bones of the lower extremities

The study of the need and frequency of application of means of transport immobilization for various injuries and types of medical care is carried out. Advantages and disadvantages of existing tires are considered: Diterichs tire, folding distraction tire – KTD (Kendrick traction device, USA), folding distraction tire – STS (Slishman Traction Splint), folding traction tire «ShTS-01-Medplant» (Russia), improved version of the latter, «U-ShTS», in conditions of their use at the pre-hospital stage. Approbation of our patent «Transport immobilization tire» was carried out at the stage of emergency medical care in 10 victims with isolated hip fractures, fractures of the femur and lower leg bones at the same time. 7 victims had a fracture of the femur, in 3 cases there was a fracture of the bones of the lower leg in the middle third and thigh. Fractures of the long tubular bones of the limbs were accompanied by traumatic brain injury in 2 victims, thoracoabdominal injuries were also observed in 2 victims and unstable fracture of the pelvic bones in one victim.

Conclusion. The available samples of modern transport tires have a number of design flaws that impede their effective use.

The «Transport immobilization tire» used by us has confirmed its effectiveness, operational safety, reliability and ease of use.

The article presents a set of organizational and special measures to eliminate the anthrax outbreak using the joint formation of radiation, chemical, biological protection and medical support of the Collective Security Treaty Organization during the military training exercise Barrier 2023 exercise. The full range of training and application of the joint formation was worked out for the first time, including with the participation of the medical service of the Armed Forces of the Republic of Belarus. During the military training exercise, the issues of the use of a joint formation were practically worked out, proposals were developed to increase its mobility, self-sufficiency and the possibility of carrying out anti-epidemic protection measures for troops in the event of the occurrence and spread of dangerous infectious diseases. Testing of modern mobile and wearable technical means of disinfection provided by radiation, chemical, and biological protection units in the exercise ensured the safety and protection of military personnel, medical personnel during the organization and conduct of special treatment, sanitary and anti-epidemic measures for the localization and elimination of the focus of biological infection.

The results of a quantitative and qualitative analysis of the inflammatory cell infiltrate in autoimmune dermatoses of the oral mucosa are presented. It has been established that these pathology groups are characterized by high expression of Tand B-lymphocytes of both stroma and epithelium against the background of decreased macrophage protection. The data from the original study can be further used to develop methods for express diagnostics and pathogenetic therapy.

In the current work we examined the role of lung biopsy in the diagnosis and evaluation of the progressive fibrotic phenotype in 80 patients with interstitial lung diseases. Morphological patterns with different inflammatory and fibrotic characteristics have been identified. The identified differences were correlated with the clinical data of 2 groups of patients with progressive fibrosis (n = 42) and a favorable course (n = 38). The morphological characteristics of a pattern with a probable progressive phenotype of pulmonary fibrosis in patients with interstitial lung diseases were determined. This has practical implications for patient management.

The article discusses one of the most important and urgent problems of medicine at the present stage, not only in our country, but throughout the world, the solution of which is given great attention – antibiotic resistance. The authors provided general information on antibiotic resistance, antibiotic therapy in the provision of medical care to military personnel in conditions of 1134 VKMC, a retrospective analysis of the results of bacteriological research and determination of the sensitivity of microflora to antimicrobial drugs used in antibacterial therapy was carried out. Statistical data indicating the development of significant resistance to various antimicrobial drugs are presented, the choice of antibiotic therapy tactics for patients is proposed depending on the results of the antibiotic.

The article describes the «classic» manifestations of catatonia, as well as those that are quite rare in the everyday practice of a doctor. Attention is paid to the origin of catatania, which can be both idiopathic and due to organic causes. The latter give the clinical picture of the disorder the persistence of pathological symptoms, which complicates the treatment of patients. Manifestations of catatonia are examined from the perspective of violations of its spatio-temporal organization, which leads to the disappearance or distortion of human consciousness. It is shown that the disorder of the latter is the main cause of the pathogenesis of catatonia.

Clinical and morphologic changes in 155 autopsies with alcoholic disease during 1980–1998 studied in Baranovichi interdistrict pathologoanatomic department were studied. According to the data of morphologic study, several groups were distinguished in the structure of pathologoanatomic diagnosis and complications. The first group consisted of observations with predominant liver damage, the second – with alcoholic heart damage, the third – with alcoholic damage of the pancreas, the fourth – with croup pneumonia.

In alcoholic disease and in cases of chronic alcoholism, pathological changes occur in all internal organs with predominance of damage in one of them, which allows us to talk about the thanatogenetic significance of such lesions and to distinguish different forms of alcoholic disease. Alcoholic lesions of internal organs are characterized by fatty dystrophy, primarily of the liver and heart. Ethanol as a factor directly damaging cell membranes, tissue hypoxia caused by it, contribute to the development of sclerotic processes in the walls of vessels and stroma of organs, especially in the liver, heart, pancreas. However, it should be noted that the atherosclerotic process in those who died from complications of alcoholic disease and chronic alcoholism is expressed to a lesser extent than in non-drinkers and occurs mainly in elderly patients. The most significant changes occur in the liver. The cirrhosis of the liver developed in this case leads to portal hypertension, one of the manifestations of which is varicose veins of the esophagus, often complicated by bleeding from them, as well as liver failure. Heart damage in the form of alcoholic cardiomyopathy, predominantly of the dilated type, is very often observed. Of some importance is pancreatitis, which can run chronically, or acquire an acute form. In a number of cases, the cause of death in alcoholic disease is pneumonia.

The article presents the results of a study involving 91 patients with COVID-19-induced pneumonia, confirmed by polymerase chain reaction and computed tomography of the chest organs. Coagulogram parameters were assessed upon hospital admission. Patients were divided into three groups based on the extent of lung involvement: CT1 group – less than 25 % lung involvement, CT2 grouюp – 25-50 % lung involvement, and CT3 group – more than 50 % lung involvement. An increase in D-dimer levels in blood plasma was found in 56.0 % of the overall group of patients, specifically in the CT2 group (92.1 % of patients) and CT3 group (100 % of cases). An increase in fibrinogen levels was also observed only in the CT2 and CT3 groups: 86.8 % of patients and 100 % respectively, while in the overall group, it was noted in 53.8 % of patients. An increase in the prothrombin index was less frequently observed in the CT2 and CT3 groups: 26.3 % in the CT2 group and 100 % of cases in the CT3 group, and in the overall group – 28.6 % of patients. It was concluded that the identified changes in the coagulogram – COVID-19-induced coagulopathy – are an important element in the pathogenesis of the disease and one of the most significant adverse prognostic indicators. These changes are associated with the severity of COVID-19-induced pneumonia and are important for assessing the clinical situation, choosing therapy, and preventing complications.

Objective: To evaluate the feasibility of predicting the local extent of the primary tumor in gastric cancer (GC) based on the analysis of preoperative clinical data.

Materials and methods: A retrospective analysis of the results of treatment of 1054 patients who underwent radical surgery for non-metastatic GC was carried out. The relationship between preoperative clinical, morphological and laboratory parameters and the depth of invasion of the gastric wall by the primary tumor (pT) was studied. Comparison of quantitative indicators was carried out using the Kruskal-Wallis test; when examining contingency tables, the chi-square test was used; in case of violation of the assumptions underlying the chi-square test, Fisher’s exact test was used.

Results: The coincidence of cT and pT values occurs only in 58.8 % of cases, while in 23 % of cases defined as cT2-3, the true depth of invasion corresponded to pT1, and 31 % of cases defined as cT2-3 were in subsequently classified as pT4. It has been established that the growth of the primary tumor beyond the mucous-submucosal layer of the stomach wall is more common: with infiltrative tumors in comparison with expansive growth pattern; with non-cohesive adenocarcinoma (high grade) in comparison with cohesive (low grade); with total-subtotal damage to the stomach in comparison with less widespread damage. Evaluation of changes in a number of laboratory parameters (absolute values of platelets, leukocytes, neutrophils, their ratios, as well as fibrinogen levels) confirmed the relationship with the depth of invasion of the gastric wall by the primary tumor previously described in a number of studies.

Conclusion: The presence of a relationship between a number of clinical, morphological and laboratory parameters and the depth of invasion of the gastric wall creates prerequisites for the development and application of prognostic models in order to increase the accuracy of preoperative T-staging.

Objective: To evaluate the effectiveness of treatment of patients with perforated gastroduodenal ulcers based on materials from the surgical departments of the «GK BSMP» healthcare institution in 2022-2023.

Material and methods. An analysis of the tactics and results of surgical treatment of 121 patients with this pathology was carried out. Of these: 82 men (67.8 %), 39 women (32.2 %) aged from 20 to 96 years. Upon admission to the clinic, patients underwent a plain radiography of the abdominal cavity. According to indications – esophagogastroduodenoscopy, repeated survey radiography of the abdominal cavity, computed tomography, laparoscopy. In the duodenum, the pathological process was localized in 104 patients (85.9 %), in the stomach – in 14 (11.6 %), in three (2.5 %) – in the area of gastroenteroanastomosis.

Results and its discussion. In the absence of a history of ulcers, the small size of the ulcer, its soft edges, symptoms of local peritonitis, and the absence of severe concomitant pathology, suturing of the perforation hole using the laparoscopic method was performed in 53 patients (43.8 %). Laparotomy and suturing of a perforated ulcer were performed in 21 patients (17.4 %); laparotomy, excision of ulcer according to Judd – 21 (17.4 %); laparotomy, excision of ulcer, transverse duodenoplasty – 17 patients (14.0 %). Excision of the perforated ulcer, extraduodenization, and transverse duodenoplasty were performed in 4 (3.3 %). When the process is located in the stomach, laparotomy, excision of the ulcer, and gastroplasty were performed in 4 cases (3.3 %), in 1 (0.8 %) – gastric resection according to Billroth-1, in 1 (0.8 %) – according to Billroth-1. 2 in the Hofmeister-Finsterer modification. 18 patients died (14.9 %). After laparotomy and suturing of the perforation – 12 (9.9 %). The most common direct cause of death was multiple organ failure syndrome – 13 (10.8 %).

Conclusion. The most frequently performed operation for perforated gastroduodenal ulcer in our clinic is currently laparoscopic suturing of the perforated hole – 53 (43.8 %). Patients experience a smooth course of the early postoperative period and no mortality.

Enterovirus infections (EVI) are a group of acute infectious diseases of viral etiology caused by various members of the Enterovirus genus, currently including more than 100 types of non-polio enteroviruses (NPEV). EVI cause a serious health problem in many countries around the world, including the Republic of Belarus.

This work is dedicated to the analysis of the monitoring studies results of the type diversity of NPEV that circulated in different territories of the Republic of Belarus in 2022–2023, and their molecular genetics as well as the epidemiological characteristics, the recorded incidence rates of EVI being taken into account.

Population of NPEV in 2022–2023 on the territory of the Republic of Belarus, was represented by both regularly registered serotypes Coxsackie B 4, Coxsackie B 5, Coxsackie A 1, Coxsackie A 5, Coxsackie A 9, ECHO 6, ECHO 7, ECHO 9, ECHO 11, and the newly identified enterovirus HEV B80. In the structure of NPEV, the group of ECHO viruses prevailed (51.9 %) with the dominance of serotype ECHO 6 (40,7 %).

The main etiological agents of enteroviral meningitis registered in the republic in 2023 were the ECHO 6 viruses of the ECHO 6 C1_BY1 genovariant. 2023 was another year of increased incidence of EVI. Based on the patterns of dynamics of the epidemic process of EVI and the situation in the world, the 2024 may become a period of another epidemic rise. In these conditions, molecular epidemiological monitoring of NPEVs circulating in the country on a regular basis is a matter of particular importance for the purpose of early detection of their new seroand genotypes with high epidemic potential.

The level of COVID-19 morbidity and labor losses due to COVID-19 in the Armed Forces of the Republic of Belarus is of interest to the medical service of the Armed Forces to this day. The organizations interested in studying these issues were the Military Medical Department of the Ministry of Defense of the Republic of Belarus and the 23 Sanitary and Epidemiological Center of the Armed Forces of the Republic of Belarus.

Based on a retrospective analysis of medical reports in form 3/MED for 2020–2023 and data from the reports on the epidemiological situation for the years under study, the results indicating an increase in the incidence rate due to COVID-19 and labor losses associated with this infection were obtained. During the study period, the peak of reported COVID-19 cases in military personnel was observed in 2021 (6441) and resulted in 127693 days of labor losses. Organized vaccination has resulted in a reduction of COVID-19 cases and labor losses due to COVID-19 in the Armed Forces of the Republic of Belarus in 2022–2023.

Objectives. Evaluation of the accuracy of bone age assessment and efficiency of clinical use of the web– based software applications developed by the author to assess the bone age of children in the Republic of Belarus.

Materials and methods. X–ray images of the hand and wrist joint in direct projection of 600 male and female patients at the age of 2–15.9 years. Bone age determination was performed using the Greulich–Pyle method and various modifications of the Tanner-Whitehouse method (TWII (CARPAL), TWII 20 (20 BONE), TWII (RUS), TWIII (RUS)) using paper versions of manuals and web-based software applications.

Results. The accuracy values of bone age assessment calculated using web–based software applications are comparable to the accuracy values obtained using paper versions of the Greulich–Pyle and Tanner–Whitehouse manuals. Web–based software applications can significantly reduce the time required to analyze radiographs and simplify bone age calculations. The use of digital technologies enables specialists to use more objective, accurate and complex methods of bone age assessment in routine clinical practice, such as the Tanner– Whitehouse TWIII (RUS) method, consuming the same amount of time to analyze X–ray images as when using the simple and less accurate Greulich–Pyle method.

Conclusion. Web–based software applications can be used for bone age assessment in clinical practice. The use of applications allows clinicians to utilize more accurate and objective methods of bone age assessment, reduce examination time and simplify the process of analyzing the X–ray anatomical features of the bones of the hand and distal forearm.

Foot ulcers in patients with diabetes are significant social problem. Correct foot of floading is the basis for the treatment of such ulcers. The article provides an overview of the treatment of neuropathic foot ulcers using the «gold standard» – an individual discharge bandage Total contact cast, as well as the staging technique used in the office «Diabetic foot» of the Minsk City Clinical Endocrinology Center. The using of this method in clinical practice can significantly improve the results of treatment of foot ulcers.

The purpose of the study is to analyze the literature data on the use of negative pressure wound therapy in clinical practice, in particular in traumatology and orthopedics, to explore current trends in the development of this method, as well as to analyze the effectiveness of techniques already introduced into clinical practice. The first mentions of the use of local negative pressure in medicine appeared more than four hundred years ago. Subsequently, many scientists experimented with the use of negative pressure therapy systems to treat soft tissue infections and wounds. Negative pressure wound therapy is used in various branches of medicine. This method plays an important role in traumatology and orthopedics, helping to achieve the solution of assigned problems. Negative pressure wound therapy has a number of undeniable positive effects, but there are also a number of possible complications in connection with the use of this method of treatment. The fundamental concept of the system for negative pressure therapy was developed more than twenty years ago, however, to this day there is an improvement and search for new and improved components of the system, as well as ways to improve the classical scheme in order to increase the effectiveness of treatment with this method. In clinical practice, both ready-to-use kits and non-commercial devices modeled for a specific clinical case are used. Over many years of using negative pressure therapy, the authors have developed a generalized methodology for managing patients treated by negative pressure wound therapy kit.

Pathology of smell is an interdisciplinary problem. Olfactory disorders are polyetiological and occur in a wide variety of diseases. However, with these complaints, patients first turn to otolaryngologists. The article describes the etiopathogenetic mechanisms of olfactory disorders, identifying the following main causes and risk factors for the development of olfactory dysfunction in adult patients: diseases of the nose and paranasal sinuses; acute respiratory viral diseases; head and nose injuries; consequences of surgical treatment in the nasal cavity and paranasal sinuses, intracranial operations; diseases of the nervous system; diseases of the endocrine system and internal organs; intoxication; taking medications; smoking; alcohol and drug addiction, age over 65 years, metabolic disorders. The mechanism of disturbance of the olfactory function is determined by the level of damage to the olfactory analyzer and is conductive, sensorineural, central and mixed. Chronic diseases of the nose and paranasal sinuses are the most common cause of olfactory dysfunction. Timely detection of olfactory disorders is fundamentally important for early diagnosis of the diseases that cause them. Determining the causes and risk factors of olfactory disorders is an important task, as it helps determine treatment tactics for patients.

The publication provides an analytical review of the literature regarding modern technologies for the treatment of toe deformities (valgus deformity), and evaluates their advantages and disadvantages. Extensive primary experience with minimally invasive technologies for correction of foot deformities through subcapital osteotomy of the first metatarsal bone and paraosseous fixation, results and outcomes is presented. The need to develop new technologies for correction of hallux valgus deformity is substantiated.

The article is devoted to the application of ultrasound in the differential diagnosis of early arthritis. The authors present a brief history of sonography use in rheumatology. The article characterizes imaging standards of The European League Against Rheumatism (The European Alliance of Associations for Rheumatology) working group on musculoskeletal ultrasound. The authors outline the advantages of ultrasound over other methods of visualization used by rheumatologists in the diagnosis of arthritis, including cost-effectiveness, accessibility, safety, and the ability to perform real-time multidimensional and dynamic assessment of joints. The article presents the consensual definitions of common sonographic pathological changes in rheumatic diseases described by the Ultrasound Working Group, including synovitis, enthesitis, tenosynovitis, tendon damage, bone erosions, osteophytes, cartilage damage, and crystal deposition. The authors discuss the difficulty in diagnosing of early arthritis with ambiguous findings of clinical examination, laboratory tests, and X-ray. The article describes the ultrasound signs of joint lesions in rheumatoid arthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, and systemic connective tissue diseases. Special attention is paid to differential diagnosis between various types of early arthritis. The authors substantiate the importance of using ultrasound in identifying early arthritis as an additional method of imaging.

The article presents the results of observation of military personnel who were hospitalized in the infectious diseases department of the State Institution «432 Order of the Red Star, Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus» for respiratory diseases. The relationship between respiratory diseases, ferritin levels, C-reactive protein, hemoglobin, and general blood test parameters with hair trichogram results was studied. Analysis of the data obtained from a group of military personnel showed that the accelerated transition of hair to the telogen phase is significantly influenced by the presence of dysplasia of the hair follicle in the anagen phase (p = 0.04).

The article presents the results of a survey of groups of male military personnel aged 18 to 49 years (n = 115) serving in the Air Force and Air Defense Forces. A voluntary anonymous survey of military personnel was conducted in accordance with the questionnaire. The survey questions reflected the respondents’ attitude towards smoking, timing, duration, and number of cigarettes smoked. The military personnel were divided into groups: by age (18-29 years (n = 66), 30-39 years (n = 29), 40-49 years (n = 20), by category: conscripts and cadets (n = 29) , military personnel – contract service (n = 10), officers, warrant officers (n = 76), by the nature of military service – flight personnel (n = 54), technical personnel (n = 23). The results of the study of male respondents aged 18 to 49 years show that the prevalence of nicotine addiction among military personnel remains high at 48.7 % (n = 56). At the same time, the greatest prevalence of nicotine addiction occurs among permanent personnel (officers, warrant officers) – 56.6 % (n = 43). The relevance of the problem of smoking in the practice of a military doctor, in the framework of preserving and strengthening the health of military personnel remains a serious medical and social problem and requires the development of more effective methods of combating smoking.

Over the past 20 years, the treatment of NP has changed significantly away from open surgery to minimally invasive methods, but mortality remains high and ranges from 39 to 90 % depending on the complications that develoр.

Purpose of the study: to justify the choice of the extent of surgery in patients depending on the category of necrotizing pancreatitis.

Material and methods. An analysis of the treatment of 88 patients with severe acute pancreatitis was carried out. There were 49 men (55.7 %), 39 women (44.3 %). The average age was 57.5 years. Of the total number of patients, 45 (51.1 %) had biliary pancreatitis, 31 (35.2 %) had nutritional pancreatitis, 9 (10.2 %) had posttraumatic pancreatitis, 3 (3.4 %) had postpartum pancreatitis. When treating patients, we followed a tactic based on the category of necrotizing pancreatitis, which can be parenchymal, peripancreatic, combined, sterile and infected.

Results and discussion. At the stage of pancreatogenic toxemia, 36 (40.9 %) patients were operated on according to absolute indications, including 3 women with postpartum pancreatitis, 13 (36.1 %) patients died. At the stage of pancreatogenic infiltrate, 3 (3.4 %) patients were forced to undergo surgery for the same indications and to the same extent, 1 (33.3 %) died. At the stage of purulent complications, 49 (55.7 %) patients were operated on, 20 (40.8 %) died. 30(61.2 %) patients had infected parenchymal pancreatitis, 6(20 %) died. In 19 (38.8 %) patients with peripancreatic and combined NP with the spread of phlegmon to the retroperitoneal space along the right and left lateral canals and to the mesentery of the colon, 14 (73.3 %) died. In 9 NP patients with widespread phlegmon, 8 (88.9 %) died during partial resection of the colon and proximal colostomy; out of 10, 6 (60 %) died during subtotal colectomy with ileostomy.In case of infected peripancreatic and combined necrotizing pancreatitis with the spread of phlegmon to the mesocolon, subtotal colectomy with end colostomy allows for better results than with resection of a section of the colon with end colostomy, thus reducing mortality in patients with end-stage disease.

This article provides an overview and suggestions of the team of authors on the implementation of the protocol of massive transfusion in patients with gunshot and explosive wounds complicated by acute massive blood loss. Acute massive blood loss is the irretrievable loss of a certain volume of circulating blood by the body as a result of intense ongoing bleeding, leading to hypovolemia and disorders in the body‘s homeostasis systems. Massive transfusion is the transfusion of large volumes of blood products over a short period of time to a patient with massive or uncontrolled bleeding.

Conclusion

Acute massive blood loss requires emergency massive transfusion of blood products in order to adequately perfuse organs and tissues. Effective training and scientific and logistical interaction between specialist doctors (anesthesiologists, surgeons, transfusiologists and clinical and laboratory staff) are necessary for rational intensive care for the wounded with acute massive blood loss, regardless of etiological factors.

A case of spontaneous dissection of the anterior interventricular branch of the left coronary artery in a young man 26 years old.

Gender dysphoria is a clinical condition in which a state of internal suffering, distress and anxiety occurs when a person’s biological sex and gender identity do not match. People who identify as transgender are more vulnerable and may have high rates of body dissatisfaction, which is often associated with eating disorders (ED).

The aim of the work is to study the relationship between dissatisfaction with one’s own body, nutrition, body mass index (BMI) of people with gender identity disorders (being examined at the state institution «Republican Scientific and Practical Center of Mental Health» (hereinafter referred to as the State Republican Scientific and Practical Center of Mental Health)), determining their relationship with mental status, as well as assessing psychometric diagnostics. The authors describe one clinical case of a patient of this profile with deviant eating behavior.

State institution «23 Sanitary and Epidemiological Center of the Armed Forces of the Republic of Belarus»1, Educational institution «Belarusian State Medical University»2

It is well known that the preservation, strengthening and restoration of human health is achieved in two ways – the prevention of diseases, primarily temporary wear and aging of the body and the treatment of sick people. Accordingly, since ancient times, two main directions in medicine have been formed – preventive (preventive medicine) and curative (clinical medicine). The implementation of the first direction of preventive medicine in the Armed Forces of the Republic of Belarus has been carried out for 80 years by the staff of the state institution

«23 Sanitary and Epidemiological Center of the Armed Forces of the Republic of Belarus» (hereinafter – 23 SEC of the Armed Forces of the Republic of Belarus), the main purpose of which has always been the preservation and strengthening of health military personnel of the troops and military formations of the Belarusian army.