This is a reflective piece about a family who I cared for during my first year of residency.
This article will focus on the well-known symptom of heartburn and a disease closely related to it – GERD. In a concise and accessible presentation, the causes and mechanism of the development of the disease and symptom in particular, as well as their complications, will be described. Detailed recommendations for adjusting lifestyle are given. It will be useful both for specialists with medical education and for a wide range of readers.
INTRODUCTION Simulation is a key aspect of the military unique curriculum at the Uniformed Services University (USU). The Department of Military and Emergency Medicine conducts rigorous high-fidelity simulations for military medical students during each year of their medical school training: Patient Experience (first year), Advanced Combat Medical Experience (second year), Operation Gunpowder (third year), and Operation Bushmaster (fourth year). There is currently a gap in the professional literature regarding students' progression through each of these simulations. This study, therefore, explores the experiences of military medical students at USU in order to understand how they learn and develop as they progress through these high-fidelity simulations. MATERIALS AND METHODS Using a grounded theory approach to qualitative research design, we analyzed qualitative data from 400 military medical students across all four years of military school who participated in the four high-fidelity simulations during 2021-2022. Our research team used open and axial coding to categorize the data and to make connections between each of these categories, which we articulated in a theoretical framework and illustrated in a consequential matrix. This research was approved by the Institutional Review Board at USU. RESULTS During Patient Experience, the first-year medical students described the stress, chaos, and lack of resources that military physicians face as they experienced the realism of the operational environment. Later at Advanced Combat Medical Experience, the second-year medical students practiced their medical skills hands-on for the first time in the simulated stressful operational environment. As a result, they gained confidence and began to formulate their professional identity. Next, at Operation Gunpowder, the third-year medical students advanced to more complex tactical field care as they performed prolonged casualty care, forward resuscitative care, forward resuscitative surgical care, and en route care as a team, often revealing gaps in their knowledge that needed to be filled. During the capstone simulation, Operation Bushmaster, the fourth-year medical students closed these gaps and solidified their professional identity as leaders and physicians, culminating in a strong confidence regarding their readiness for their first deployment. CONCLUSIONS Each of the four high-fidelity simulations impacted the students in unique ways as they were incrementally challenged to practice and build upon their knowledge, skills, and abilities related to combat casualty care, teamwork, and leadership in the operational environment. As they completed each of the simulations, their skills improved, confidence grew, and professional identity solidified. Therefore, completing these rigorous simulations progressively over the course of 4 years of medical school appears to be a vital process and foundation for the deployment readiness of early-career military physicians.
The aim of the study was to analyze the activity of erythrocyte acetylcholinesterase in puerperia with a complicated and physiological course of puerperia. A survey of 41 puerperas (mean age 26.5±2.1) who were hospitalized in the physiological department of the 3rd City Clinical Hospital named after E.V. Klumova, Minsk. All patients were divided into the following groups: 1st - 19 puerperas with a physiological course of labor and the postpartum period (mean age 25.2±2.3); 2nd - 22 puerperas with impaired contractile function of the uterus during childbirth and the postpartum period (mean age 27.0±2.2). The study of AChE activity in erythrocytes was carried out by the kinetic method using Cormay test kits (Poland) on an FP-900 biochemical analyzer (Finland). The results of the study allow us to consider the activity of acetylcholinesterase in erythrocytes, the echographic size of the uterine cavity according to sonography, and the level of uterine tone according to the hysterogram as significant markers of impaired labor contractile activity of the myometrium after childbirth. The threshold value of the size of the uterine cavity, the upward deviation from which indicates the formation of postpartum subinvolution of the uterus, was 15.3 mm at AUC 0.99±0.02 (p < 0.001; HR 90.2%, DS 88.4%). The threshold value of the uterine tone, the downward deviation from which indicates a violation of the contractile function of the uterus in the puerperal, was 4.7 mm Hg. Art. at AUC 0.9±0.015 (p < 0.001; HR 96.3%, DS 88.5%). The threshold point of AChE activity was 11745.4 U/l with an AUC ROC curve of 0.82±0.07 (p < 0.001; PN 94.2%, DS 61.1%), which allows us to regard the studied parameter as a classifier physiological course of the postpartum period and postpartum subinvolution of the uterus. When choosing means of influencing postpartum subinvolution of the uterus, preference should be given to drugs and physiotherapeutic methods that have a stimulating effect on the contractile function of the uterus in order to eliminate the pathologically enlarged cavity and prevent the development of hemorrhagic and inflammatory complications.
The article presents the main historical milestones associated with the creation, formation and functioning of the 73rd Internship of the medical staff of the Red Banner Turkestan Military District of the Armed Forces of the USSR in the period from 1938 to 1992 and its successor - the internship of the medical staff of the medical service of the Armed Forces of the Republic of Uzbekistan in the period from 1992 to 2012.
Introduction. Echinococc is a biohelminthiasis that mainly affects the liver. Annually in the Republic of Belarus is registered 10–18 cases of echinococcal lesions, most of which are asymptomatic. The purpose of the study. Analysis of the results of the first experience of performing laparoscopic left-sided lateral sectionectomy in hepatic echinococcosis. Material and methods. The article presents the successful experience of treating a patient with echinococcosis of the liver, who underwent laparoscopic left-sided lateral liver sectionectomy for the first time in the Grodno University Clinic. Results. We applied laparoscopic intrahepatic isolation, hardware stitching and clipping of the glissone legs of the II and III segments of the liver, which contributed to the anatomical resection of the left lateral sector, achieving reliable hemostasis and cholestasis. No complications were observed in postoperative period. Conclusions. Laparoscopic left–sided lateral sectionectomy using intrahepatic glissone access is a safe and affordable operation in patients with echinococcal lesions of the II and III segments of the liver.
The article summarizes the experience of domestic and foreign specialists in the field of treatment of combat urological injury at the stages of medical evacuation. First of all, we described the surgical tactics of treating the wounded at the stage of qualified care, where, as a rule, there is no urologist. Modern methods of treating urological trauma in a multidisciplinary medical center are considered. The article is supplemented with general information about the tactics of "damage control" and its private activities regarding urological trauma.
The study of heart rate variability and the function of the pituitary-adrenal axis was carried out in 91 patients with various forms of psoriasis. The tension of the regulatory systems of the heart rhythm and disorders of the autonomic nervous system observed in conditions of an active orthostatic test were established. Impairment of the autonomic nervous system was associated with high glucocorticoid and mineralocorticoid activity of the adrenal glands. The difference in the heart rate, pituitary and adrenal hormones was revealed in patients with streptococcus-associated psoriasis and psoriasis without streptococcal association.
148 patients with benign prostatic hyperplasia were examined, 76 of them (group 1) - with open prostatectomy (OP) and 72 (group 2) - after transurethral resection of the prostate (TURP), additionally the groups were divided depending on the presence of cystostomy before surgery. The quality of life associated with urination during 12 months and 4 years after surgery, as well as the overall quality of life were assessed by filling out the SF-36 questionnaire in two groups. When assessing the quality of life associated with urination, only the presence of pains during urination in the period of 12 months after TURP depends reliably on the method of surgery. Frequent urination, nocturia and urine leakage were more common during cystostomy before surgery, regardless of the method of surgery. The physical component of health is significantly higher in patients 4 years after TURP, regardless of the setting of cystostomy. The psychological component of health is higher in patients after OP, and at the expense of subgroups who did not undergo cystostomy before surgery.
Relevance. Homocysteine (Hcy) is an amino acid involved in the formation of atherosclerotic changes in the arterial wall and contributes to the progressive course of lower extremity arterial disease. Polymorphisms C677T, A1298C of the methylenetetrahydrofolate reductase (MTHFR) gene, A2756G of the methionine synthase (MTR) gene, and A66G of the methionine synthase reductase (MTRR) gene involved in Hcy metabolism are the most functionally significant.
Introduction. The currently used standard of radically treating locally advanced gastric cancer (IGC) employs a combination of radical surgery and adjuvant polychemotherapy (APCT) that cannot prevent metachronous peritoneal dissemination (MPD), especially when treating infiltrative lGC. Therefore, it needs to be supplemented by intraperitoneal chemotherapy (ICT). Objectives. Evaluating survival rates and cumulative incidence of рТ1-4N1-3M0 lGC after administering normothermic ICT and systemic capecitabine/oxaliplatin APCT. Materials and methods. Long-term results of radical surgery performed on 341 lGC patients (pT1-4N1-3M0, type III-IV on the R. Borrmann scale) were analyzed. The adjuvant treatment comprised cisplatin-based normothermic ICT and capecitabine/oxaliplatin APCT. Long-term treatment results were analyzed by means of the Kaplan-Meyer multiplier estimation method, competing risks analysis to evaluate cumulative incidence (CI) of progression including that of MPD. The Fine-Gray model was used to assess the effect of ICT and APCT on the risks of tumor progression (MPD, distant lymphohematogenous metastases (RLHM) and their combinations). Results. The application of normothermic ICT and APCT resulted in the decrease (1) in the 3-year CI of tumor progression in comparison to surgical treatment alone (59.7±3.1%), scoring after each of these procedures 48.3±9.6% and 37±6.9%, respectively, (р = 0.001); (2) in the 3-year MPD CI (in an isolated variant) in comparison to surgical treatment alone - 732 Both normothermic ICT and APCT reduce the risk of developing MPD (in an isolated variant) in comparison to surgical treatment - HR 0.31 (95% confidence interval 0.12-0.80), р = 0.016and HR 0.17 (95% confidence interval 0.06-0.47), р < 0.001, without effecting RLHM and combined MPD+RLGM development risks (р > 0.05). Conclusion. The possibility of preventing MPD after administering systemic APCT and normothermic ICT highlights the importance of accounting the extent of drug therapy in evaluating the probability of MPD development after lGC radical surgery.
The results of a dynamic microbiological study of the samples of 195 patients with extensive burns are presented. Depending on the order of hospitalization of patients, differences were found in the structure of the microbiota, the level of resistance to antibiotics and the manifestation of pathogenic properties (biofilm formation, secretion of protective proteases and aggression factors, adhesive activity, the presence of virulence genes). There was an increase in the frequency of matches of the species composition, especially for isolates of P. aeruginosa, K. pneumoniae, A. baumannii, in 2 or more types of samples, depending on the length of stay in the intensive care unit. The results obtained determine a differentiated approach to microbiological examination and empirical initial antibiotic therapy in patients with extensive burns with the need to take into account the order of hospitalization. An algorithm for interpreting the results of sowing discharge from extensive burns is presented, taking into account the timing of the study, the number of bacteria, the level of resistance, markers of pathogenic potential, the coincidence of the species composition in biomaterials.
An analytical review of modern literature on the problem of penetrating ocular injuries with a retained intraocular foreign body is presented. The statistically significant relationship between the final low visual acuity and such key factors as retinal detachment, endophthalmitis, hemophthalmus and relative afferent pupillary defect in most studies was established. The association between the functional outcome of a penetrating injury of the eyeball and such factors as the length and localization of the wound of the intraocular foreign body, its final localization, volume, mass and speed of entry into the eyeball was contradictory. This indicates the need for additional comprehensive studies, taking into account heterogeneity, pathogenetic mechanisms of traumatic damage to the eyeball. Timely determination of the probability of an unfavorable outcome will make it possible to identify a risk group and improve the tactics of personalized treatment of patients with penetrating wounds of the eyeball.
The article presents the relevance of infectious diseases of military epidemiological significance in the conditions of military conflicts, as well as approaches to the specific protection of military personnel. In the conditions of military operations, a significant proportion of non-combat sanitary losses are associated with endemic diseases of an infectious nature. A review of strategies and tactics for specific protection of military personnel based on the experience of different states showed the presence of a wider list of infectious diseases in the calendars of preventive vaccinations for epidemic indications, in comparison with the calendars for immunization of the civilian population. An important task of military epidemiology is to predict epidemiological situations with a high risk of outbreaks of infectious diseases in combat conditions or during the deployment of military personnel in areas with various endemic and geographic features.
We substantiated the expediency of using synthetic analogs of the hormone melatonin in the regimen for the prevention of exacerbations and recurrences of gastric and duodenal ulcers after surgical treatment. Melatonin is used as a drug for management of desynchronosis – the mismatch of daily endogenous biorhythms during periods of increased risk of complications taking into account the patient's individual annual cycle. Computer program developed by the authors was used to calculate such periods for the first time.
The article presents the history of the creation and development of the military department of the Vitebsk State Medical Institute (University), the training of medical personnel from the moment of its formation to the present, as well as brief information about the activities of the department staff.
This overview outlines aspects of the pathogenesis and ECG diagnostics of diseases of the cardiovascular system in COVID-19 and in post-covid syndrome, which occur in the patient, serving in the army. Included case reports, retrospective and prospective studies, systematic reviews and metanalyses, national guidelines and other descriptive reviews, results of own researches.
More than 100 serotypes of non-polio enteroviruses (NPEV) that are pathogenic for humans can cause deseases of different manifestations and severity, being a serious health problem in many countries of the world, including the Republic of Belarus. In this regard, monitoring the causative agents of enterovirus infections (EVI) circulating in the country aiming of early new sero- and genotypes detection has much of significance. This work is dedicated to the analysis of NPEV monitoring results concerning their circulation in the territory of the Republic of Belarus in 2021–2022, data on their spectrum, molecular genetics and molecular epidemiological characteristics of the serotypes, as well as on the registered signs of the incidence of EVI. It was found that NPEV that circulated in the country in 2021–2022 were Coxsackie B3, Coxsackie B5, Coxsackie A9, ECHO 7, ECHO 30 and HEV B80 viruses. The group of Coxsackie B viruses prevailed (57,1%) with the dominance of the Coxsackie B3 serotype (35,7%). Coxsackie B5 and ECHO 30 viruses, which have a high epidemic potential, were manifested by genotypes that were actively circulating in the country in the previous years. It is shown that 2022 was the year of the rise in the incidence of EVI. At the time, the prerequisites for sharp NPEV sirculation increase are unlikely though not impossible in case of new sero- or genotypes of NPEV being found.
