Vitebsk Medical Journal

Evaluation of neurovascular fascio-cutaneous flaps microcirculation in various kinds of plastic surgeries

K.A. Fedorov , V.G. Bogdan , A.I. Kubarko — Fri, 18 Jul 2025 00:00:00 +0300

Abstract.

Objectives. To evaluate the dynamics of changes in spectrometry parameters in the assessment of soft tissue microcirculation in various kinds of plastic surgery of extensive post-traumatic soft tissue defects of the distal lower extremities using non-free neurovascular fascio-cutaneous flaps.

Material and methods. Within the framework of the research work of the Department of Military Field Surgery of the Military Medical Institute of the Belarusian State Medical University on the topic of «Improving the directions of diagnostics and complex treatment of patients with post-traumatic defects of soft tissues of the extremities» (state registration No. 20170424 dated March 29, 2017), a comparative analysis of the dynamics of changes in spectrometry parameters was carried out in 30 patients with the extensive defects of soft tissues of the distal parts of the lower extremities who underwent surgical treatment at the 432 Order of the Red Star Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus during the period 2016-2021.

Results. The article analyzes the two-phase dynamics of changes in the microcirculation parameters of the neurovascular fascio-cutaneous flaps in various plastic surgery options for the extensive post-traumatic soft tissue defects of the lower limbs distal segments based on the results of percutaneous spectrometry.

Conclusions. It has been proven that the restoration of microcirculation parameters in the displaced neurovascular flap during plastic surgeries using the developed method occurs two days earlier than during a standard reconstructive surgery due to full functional adaptation of tissues by the fifth day after surgery with normalization of the blood oxygen saturation and complete compensation of the vascular network density. A decrease in the absolute values of oxyhemoglobin content in the early postoperative period and individual critical values of blood vessel density in the range of 0.05-0.01% may be prognostically unfavorable signs indicating the possibility of irreversible changes in the displaced flap.

The experience of providing medical assistance to victims of the explosion in Vitebsk on September 22, 2005

A.G. Solovyova, A.P. Sivitskaya, E.P. Kogalyonok — Fri, 16 May 2025 00:00:00 +0300

The article analyzes the provision of medical care to the wounded as a result of the explosion on September 22, 2005 in the city of Vitebsk, examines the nature of injuries and their severity among the victims, studies the medical care provided in Vitebsk City Clinical Hospital of Emergency Medical Care (surgical interventions, hemotransfusions, vaccinations, psychological assistance), assesses the level of hospital readiness for the simultaneous admission of a large number of victims with injuries of varying severity.

Providing assistance to patients with mine-explosive trauma is a fairly relevant topic in our time due to the increasing number of armed conflicts in the world, and as a result, an increase in the number of the wounded. Therefore, this problem will always require special attention and discussion in order to improve the provision of medical and psychological assistance to victims.

Analysis of serum iron levels in patients with traumatic brain injury

Tue, 25 Mar 2025 00:00:00 +0300

Abstract.

Decreased serum iron levels can be frequently observed in patients after traumatic brain injury.

Objectives. To investigate the dynamics of serum iron levels in patients with irreversible traumatic brain injury.

Material and methods. 107 patients with severe traumatic brain injury were included in the prospective non-randomized study. The patients were 52 (39; 60) years old; weight – 78 (70; 85) kg; 83 (77.6%) male and 24 (22.4%) female patients. Depending on the treatment outcome, 2 groups were formed: patients with a positive treatment outcome (group 1, n=56) and withan unfavorable results of intensive care (group 2, n=51), in whom the brain death was declared during treatment. In patients the serum iron levels were analyzed on the 1, 2, 3, 5, 7 and 10 days.

Results. Statistically significant differences were found between the two groups in: level of consciousness according to the Glasgow Coma Scale upon admission (12 (8; 14) points in group 1 and 5 (4; 6) points in group 2 (p<0.0001)); volume of the intracranial hematoma (76 (56; 107) ml and 150 (75; 185) ml, respectively (p=0.0057)); the volume of blood loss during surgery (293.5 (211; 505) ml and 500 (254; 750) ml, respectively (p=0.038)); severity of the condition according to the SOFA scale upon admission (3 (1; 6) points and 7.5 (6; 11) points, respectively, (p<0.0001)). No statistically significant differences in the serum iron level on the 1st and 2nd days were found: on the 1st day – 7.9 (4.1; 12.7) μmol/l in group 1 and 5.4 (2; 11.9) μmol/l in group 2 (p=0.48). On the 3rd and subsequent days of the study, statistically significant differences in the iron level between the groups of patients were observed: on the 3rd day - 5.1 (3.3; 9.8) μmol/l in group 1 and 3 (2; 4.1) μmol/l in group 2 (p=0.002).

Conclusions. Patients with the brain death have lower serum iron levels on the 3rd and subsequent days; it is associated with both greater brain damage and systemic inflammatory response syndrome, which increases significantly with brain death.

Risk factors associated with unfavorable outcome in patients with severe traumatic brain injury

V.V. Hancharou — Mon, 30 Jun 2025 00:00:00 +0300

Traumatic brain injury (TBI) remains one of the leading causes of mortality and disability.

Objectives. To identify key risk factors for unfavorable outcome in patients with severe TBI.

Material and methods. The prospective study was conducted in the ICU (for neurosurgical patients) of the Minsk City Clinical Emergency Hospital from 2017 to 2024 years on the impact of potential risk factors on trauma outcomes. 116 patients with severe TBI were included in it.

Results. The age of patients with the unfavorable outcome was 50,00 [37,75; 60,00] and 38,00 [34,00; 56,00] years in case of the favorable outcome (p=0,0478). The volume of transfusion for 14 days in the ICU in patients with the unfavorable outcome was 2360,00 [1082,50; 4857,50] ml versus 1120,00 [50,00; 2280,00] ml in case of the favorable outcome (p=0,0006). While proving nutritional support the protein value of ≥1.5 g protein/kg/day was in 63,6% of patients with an unfavorable outcome compared to 38,4% with a favorable outcome (p=0, 0158). 80,2% of patients (n=93) had complications and only 63,8% of patients (n=74) had multiple complications (≥2). Pneumonia was present in 69,0% cases (n=74), pulmonary embolism – in 41,4% (n=48), MOF (multiple organ failure) – in 24,1% (n=28), meningitis and sepsis – in 12,1% of cases each (n=14).

Conclusions. The risk factors were identified: the age over 40 years (RR=1,53; p=0,0099), transfusion volume >2300 ml (RR=1.43; p=0,0099), protein part of nutrition support <1.5 g protein/kg/day (RR=1,42; p=0,0158) and presence of complications (RR=39,57; p=0,0086): pneumonia (RR=11,10; p<0,0001), pulmonary embolism (RR=2,22; p<0,0001), MOF (RR=1,70; p<0,0001), meningitis and sepsis (RR=1,48; p=0,0002).

Evaluation of some structural and functional changes in the erythrocyte membrane in patients with age-related macular degeneration. A clinician’s view

L.M. Miadzvedzeva, N.K. Karalkova, N.N. Yarotskaya — Fri, 18 Jul 2025 00:00:00 +0300

Objectives. To determine the content of total protein and lipids in erythrocyte membranes in patients with age-related macular degeneration (AMD).

Material and methods. The study group consisted of patients with the “wet” form of AMD, and the comparison group without AMD. The first group included 76 patients (mean age was 73 years), 72% women and 28% men, and the second group included 50 people (mean age was 70 years), 60% women and 40% men. The ophthalmological examination was performed, venous blood was taken and erythrocyte membranes were isolated using the Dodge method. Total cholesterol was determined using the Zlatkis-Zak method. The content of total phospholipids was measured by the optical density of the standard. Protein concentration was determined using the Lowry method.

Results. It was revealed that the groups differed significantly in the content of total protein (TP) in erythrocyte membranes (p=0.000005). The ratio of cholesterol to total protein (Chol/TP) in the study group was significantly lower, p=0.00039, phospholipids to total protein (PL/TP), p=0.021, was also lower, and cholesterol to phospholipids (Chol/PL) was greater than 0.9 in both groups (p=0.78), which corresponds to the age-related changes.

Discussions. Having studied the protein-lipid profile of the erythrocyte membrane of patients with AMD, it was found that the content of total protein in the membrane was 1.5 times higher, the ratio of Chol/TP and PL/TP was significantly lower. The expected difference in the content of Chol, PL and the PL/Chol index was not revealed. Changes in the membrane structure naturally lead to functional disorders in the erythrocyte itself, which entails a number of possible systemic changes. AMD should not be considered as a local process associated with changes only in the retinal pigment epithelium, Bruch’s membrane and choriocapillaris. The onset of the disease, its course, can serve as a risk factor for systemic disorders and requires further study.

Method of treatment of nosocomial sinusitis in patients of intensive care units

D.S. Schelkunov , K.M. Kubrakov , V.P. Semenov , E.A. Matusevich — Mon, 07 Jul 2025 00:00:00 +0300

Abstract.
The clinical significance of nosocomial sinusitis (NS) is in its association with an increase in infectious complications such as ventilator-associated pneumonia (VAP), sinus thrombosis, sepsis, etc. Due to the difficult outflow of the contents of the paranasal sinuses and high antibiotic resistance of NS pathogens, the use of local treatment methods such as drainage is rather relevant.
Objectives. To develop an effective method for drainage of the maxillary sinuses (MS) in NS for patients of the intensive care unit (ICU).
Material and methods. An open, prospective, non-randomized study was performed. Patients were in the ICU and divided into 2 groups: Group 1 – 28 patients with NS on the mechanical ventilation (MV) and treated according to the method we have developed; Group 2 – 26 patients, in whom the treatment of NS was carried out by the standard method – the maxillary sinus puncture.
Results. While comparing two groups, significantly lower total time was established for the sanitation of the maxillary sinus (number of procedures n=2) in patients of group 1 (pMann–Whitney U test<0.05). Also, during repeated manipulations for the sanitation of the maxillary sinus in patients of group 1, there was no pain reaction from the procedure and there was no need to use local anesthetics. Nasal bleeding from during manipulations in patients of group 1 was observed in 2 cases, while in group 2 – in 8 cases respectively.
Conclusions. The developed method of maxillary sinus drainage, which includes the installation of a double-lumen catheter into the maxillary sinus cavity with subsequent daily rinsing of the sinus with 0.05% chlorhexidine bigluconate solution, is more effective and safer both in terms of time spent on the procedure (pMann–Whitney U test<0.05) and the number of bleedings (p=0.0255), compared to the standard method of the maxillary sinus puncture.

Acupuncture as an additional way for achieving control over bronchial asthma

E.B. Paramonova , N.S. Aliakhnovich , G.V. Tretiakova — Mon, 17 Feb 2025 00:00:00 +0300

Abstract.

The effect of acupuncture on achieving control over bronchial asthma (BA) during the period of exacerbation was analyzed. The efficiency of acupuncture (using both asthma treatment and general tonic methods) was determined by improvement in clinical findings, an increase of asthma control degrees according to the results of questionnaires, and a rise in indices of the external respiration function in patients with BA exacerbation. Including acupuncture in the asthma treatment regimen significantly improved the vital capacity of patients’ lungs.

Long-term control over the disease (1 month after hospital discharge) remained only in patients treated by BA treatment method of acupuncture, while general tonic method contributed to increasing absolute number of leukocytes.

High levels of immunoglobulin E and interleukin 13 were registered in the blood of all patients after treatment. The interferon- decrease in the blood of patients was found after achieving asthma control and undergoing more acupuncture sessions in accordance with asthma treatment method in addition to the main therapy.

Thus, acupuncture can be considered an effective additional method for achieving control over asthma, including long-term control in patients during an exacerbation.

Issues of the quality assessment of medical rehabilitation and medical and social expertise in the Republic of Belarus

I.A. Kireeva , V.B. Smychek , А.И. Разуванов — Wed, 07 May 2025 00:00:00 +0300

Abstract.

Objectives. To identify the list of relevant and priority issues that hinder the high-quality provision of the specified types of medical services with subsequent formalization of the grounds for developing modern quality criteria.

Material and methods. The study was conducted in 2022 and consisted of three stages. In the first stage on the basis of the official documents analysis (the results of republican meetings of the Ministry of Health for 2017, 2019, 2020), the list of systemic problems in the field of MR and MSE was formed. The second stage included content analysis of 8 regulatory documents governing the conduct of quality assessment, with the participation of 3 experts. The third stage included an expert survey of 18 specialists using the Delphi method to determine the significance and priority of previously revealed problems. Descriptive and non-parametric statistical methods were used, as well as the calculation of the intraclass correlation coefficient (ICC).

Results. At the first stage of the study, the analysis of official materials from the Ministry of Health of the Republic of Belarus was conducted, including reports on the results of republican meetings of the medical examination and rehabilitation service for 2017, 2019 and 2020. The list of 23 key problems (10 in the field of medical and social examination and 13 in the field of medical rehabilitation) was identified that hinder the effective implementation of procedures and affect the final quality of care.

The second stage involved the content analysis of regulatory documents governing the assessment of the quality of medical care (including regulations on the quality management system, departmental instructions, and orders). The sample included eight documents selected using the

Keywords:

‘quality of medical care,’ ‘quality of MSEC,’ and ‘quality of rehabilitation.’ During the expert assessment using a pre-developed form, it was found that most documents poorly disclose the procedural components of the assessment (according to the Donabedian model) and do not reflect the criteria for recording effectiveness and patient’s satisfaction.

In the third stage, the Delphi survey was conducted with the participation of 18 experts, including medical rehabilitation specialists, representatives of the MREC, and heads of healthcare institutions. Each expert assessed 23 previously identified problems on two scales: relevance and priority of solution. The analysis results showed a high degree of agreement among the experts (intraclass correlation coefficient ICC = 0.94). The most significant problems included: low level of coordination between MSE commissions and IPRI (individual programs of rehabilitation of invalids) implementers, poor assessment of comorbidities when determining disability, violation of the stages of rehabilitation, and lack of systematic recording of patients’ feedback. This confirmed the need for systematic refinement of the existing quality assessment criteria.

Conclusions. The study made it possible to identify objectively deficiencies in the regulatory framework for assessing the quality of MR and MSE, as well as to systematize problem areas. The data obtained formed the basis for the subsequent development of criteria for assessing the quality of medical rehabilitation and medical and social expertise.

Criteria for evaluating the quality of medical rehabilitation and medical and social assessment in healthcare organizations

Kireeva I.A. , V.B. Smychek , A.I. Razuvanau — Fri, 30 May 2025 00:00:00 +0300

Abstract.

Objectives. To justify and develop criteria for assessing the quality of medical and social expertise and medical rehabilitation using the expert assessment method.

Material and methods. The study was conducted using the Delphi method. The expert group consisted of 16 specialists with higher medical education, at least 10 years of work experience in the field of medical and social expertise or medical rehabilitation, and experience in the organization, implementation and quality assessment of relevant areas of medical activity. The expert assessment covered 23 areas (10 in MSEs and 13 in MRs), each of which was analyzed along two axes: significance and applicability. The survey was conducted remotely with the 100% response rate. Statistical processing of the results included the calculation of median values, rank positions, and criteria for consistency of opinions (χ², Wilcoxon’s z-test, ICC).

Results. Based on the assessment results, the list of priority areas was formed and detailed criteria for assessing the quality of MSEs and MRs were developed. The most significant problems in the field of MSEs were identified as: compliance with the examination procedure, legal justification of decisions, staffing, quality of documentation, and objectivity in assessing persistent functional disorders. In the field of MR, the leading positions were taken by the compliance with the procedure for conducting rehabilitation, routing, assessment of violations on scales, compliance with the clinical and functional diagnosis, and the effectiveness of programs. The developed criteria (structural, procedural, and performance) were tested in healthcare institutions and showed high applicability of assessments. The final list is included in Resolution No. 13 of the Ministry of Health of the Republic of Belarus dated 23 January 2023 «On the assessment of the quality of medical care and medical examinations, and the examination of the quality of medical care».

Conclusions. The developed criteria for assessing the quality of medical rehabilitation and medical and social expertise ensure the objectification of key areas of MR and MSE quality, the identification of systemic problems and the formation of an evidence base for management decisions. The use of the proposed quality assessment criteria will improve the effectiveness of MR and MSEs, minimize errors and strengthen the healthcare system’s focus on clinical effectiveness and a patient-centered approach.

Justification of the criteria for rationing and the maximum permissible concentration in the working area air of antibacterial drugs on the example of the pharmaceutical substance clindamycin hydrochloride

V.O. Zemtsova , R.V. Bogdanov, V.V. Shevlyakov, V.A. Filonyuk, I.S. Poznyak — Mon, 05 May 2025 00:00:00 +0300

Abstract.

Objectives. To substantiate analytically the criteria and principles of hygienic regulation of the content of antibacterial drugs in the air of the working area with their testing on the example of the pharmaceutical substance of the antibiotic clindamycin hydrochloride.

Results. By the analysis of methodological documents on the development of maximum permissible concentration in the air of the working zone (MРCw.z.) of different types of industrial substances we have substantiated the criteria for standardization of antibacterial drugs (ABD) by the nature of their leading harmful effect on the body depending on the quantitative prevalence of the values of threshold concentrations of general toxic or specific allergic and/or dysbiotic action established in chronic inhalation experiments; the procedure for calculating the safety factor to the established value of the threshold concentration of chronic toxicity of ABD when substantiating MРCw.z. has been clarified as well.

Conclusions. The standardization of the pharmaceutical substance clindamycin hydrochloride (CH) according to the limiting criterion of the leading harmful general toxic effect on the body is shown; the MРCw.z. of CH aerosol according to the established value of the threshold concentration of chronic general toxic effect (Lim_с_h at the level of 4.4 mg/m³) is substantiated taking into account the calculated safety factor (11) at the level of 0.4 mg/m³, hazard class II

Sanitary and chemical safety indicators of disposable medical products made of polyamide, polyorganosiloxane, metals and alloys

Wed, 16 Apr 2025 00:00:00 +0300

Abstract.

Objectives. To study sanitary and chemical safety indicators of medical products made from polyamide, polyorganosiloxane, metals and alloys after their accelerated aging.

The work studied the sanitary and chemical indicators of 16 disposable medical products made of polyamide and polyorganosiloxane and 19 made of metals and alloys. They were subjected to accelerated aging by incubation at the temperature of 80 to 95°C, which was increased by 50°C from the maximum storage temperature indicated on the label of each medical product. The incubation duration was 3.7, 11.2 and 18.7 days. The control groups were not subjected to accelerated aging. After incubation, for each medical device, its intended use conditions were simulated, and extracts from the products were prepared for this purpose. Subsequently, extracts from the control and experimental groups were studied according to sanitary and chemical indicators. The increase in the aging time of products to 18.7 days was established to contribute to a more pronounced statistically significant increase in migration of formaldehyde, acetaldehyde, lead, zinc, iron, nickel, pH, Δ pH, permanganate oxidizability and reducing impurities, and migration levels of formaldehyde, acetaldehyde, dibutyl phthalate, dioctyl phthalate, lead, iron, cadmium and nickel into the model medium from individual products exceeded hygienic standards.

Thus, it has been experimentally established that when determining the shelf life of disposable medical devices made of polyamide, polyorganosiloxane, metals and alloys, it is necessary to study sanitary and chemical safety indicators for human health.

The degree of the masticatory-speech apparatus involvement in patients with bruxism

S.P. Rubnikovich, A.S. Grishchenkov, Yu.L. Denisova, E.V. Kuzmenko — Fri, 30 May 2025 00:00:00 +0300

Abstract.

Objectives. To assess the degree of the masticatory-speech apparatus involvement in patients with bruxism in the context of the neuronal network disturbances of the trigeminal nerve in the brainstem.

Material and methods. The object of the study was the patients in the key age group of 35–44 years with clinical signs of bruxism seeking dental care. Two study groups were formed: the main group (10 patients with clinical signs of bruxism) and the control group (10 patients without clinical signs of bruxism). The clinical examination was carried out according to clinical protocols approved by the Ministry of Health of the Republic of Belarus by Resolution No. 84 of 10.08.2022. Statistical analysis of the research results was performed using the «Statistica» analytical package (Version 10).

Results. Electromyographic examination revealed persistent dysfunction of the maxillofacial region muscles, characterized by deviations in the amplitude of bioelectrical activity and asymmetry of the frequency spectrum. This affects negatively the masticatory-speech apparatus, contributing to parafunctional activity of the masticatory muscles, TMJ incoordination, periodontal diseases and dental arch deformations. Deformations of the dental arches, in turn, can affect the muscular complex, forming a vicious circle of pathological changes.

For patients with characteristic excessive jaw clenching, an increase in the volume of the periodontal space was determined, more in the area of the chewing teeth group, with the appearance of apical foci of the bone tissue destruction, or with a horizontal type of the bone tissue resorption. For patients with bruxism, a decrease in the volume of the periodontal space was determined, along with an increase in the cortical closing plate.

Conclusions. A correlation is observed between the type of parafunctional activity of the masticatory muscles and changes in all structures of the masticatory-speech apparatus – dental, muscular, periodontal, and articular. Involvement of these signs is a mandatory clinical criterion in patients with bruxism, which is confirmed by the data from clinical and radiological diagnostic methods carried out within the framework of this study.