The issues of the methodology of historical and medical research are considered. A weak methodological basis for research on the history of medicine is shown, which consists in the use of phenomenological and ideographic methods, which is not a study of history itself, but is a chronicle. Attention is focused on the patterns of the turn of historical and medical research to the study of social problems in medicine. The importance of using civilizational and modernization concepts of historical knowledge was emphasized. The description of the features of teaching the discipline «History of Medicine», manifested in the reference and biographical presentation of the material, is given. The main conclusion is that the study of the history of medicine can only be successful on the basis of an interdisciplinary approach by the joint efforts of doctors and professional historians.

The issues of treatment of critical lower limb ischemia (KINK), an acute syndrome complex representing a severe outcome of chronic arterial insufficiency due to obliterating vascular diseases (OSD), are considered. It is the appearance of KING, which occurs in every 10–12 patients with OS, that causes them to have a high risk of amputations and adverse outcomes.
A pathogenetically based approach in the treatment of CINK is restorative and reconstructive interventions that promote direct vascularization of the arterial bed. In cases of infra-lingual arterial lesion, synthetic prostheses used in other proximal types of reconstructions have very limited use. The use of autovenous conduits for femoral-tibial reconstructions, which is considered the «gold standard», cannot be performed due to a number of technical conditions in almost every third patient with KINK.
In such cases, vascular freshly prepared or cryopreserved allografts or freeze-dried xenografts are of particular importance. However, after their use, there is a high risk of aneurysmal degeneration of shunts, hyperacute or chronic rejection, diffuse fibrosis of the wall with lumen stenosis. Indirect vascularization methods used in KINK, as well as various X-ray vascular interventions, including percutaneous transluminal balloon angioplasty followed by endostentation or endovascular rotational and laser atherectomy, can be used only in a limited number of patients with distal arterial blood flow damage. Alternative treatment options in these cases are drugs aimed at improving microcirculation; genetically engineered compositions containing individual neovasculogenesis activation factors or stem cells providing cellular tissue revascularization and paracrine effects.

One of the most promising directions in the surgical treatment of osteoarthritis of the wrist joint is the resection of the proximal row of carpal bones. Unlike total arthrodesis, this procedure preserves a certain range of motion, eliminates pain, and restores hand function. This surgical intervention also reduces the risk of possible nonunions observed in other types of operations and shortens the duration of postoperative immobilization. The authors studied the long-term results of surgical treatment in 43 patients who underwent this procedure over an eight-year period. Among the patients, there were 31 men and 12 women. The patients’ ages ranged from 25 to 69 years (average age: 50 years). Pathology of the right wrist joint was noted in 25 cases, and of the left wrist joint in 18 cases. Among the patients, 37 were engaged in light physical labor, 2 in heavy physical labor, and 4 were retirees. The causes of the pathology were as follows: scaphoid nonunion in 12 patients, scapholunate dissociation in 14, chronic perilunate dislocations in 4, Kienböck’s disease in 4, and gouty arthritis in 4 patients. In 5 cases, osteoarthritis developed against the background of previous chronic synovitis of unknown etiology. Satisfaction with the treatment outcome was excellent in 14 patients, good in 21, and satisfactory in 8. All working patients returned to their jobs without changing their working conditions, including two who used their hands for heavy physical activity.

Traumatic damage to the tubular bones of the limb leads to dysfunction of its musculoskeletal system. Compensatory reactions of the body systems that occur in response to damage to bone tissue are aimed at creating optimal conditions necessary for restoring the anatomical structure of the bone and altered functions of the limb. The development and introduction of new technologies into modern medicine has made it possible to develop methods of minimally invasive surgical treatment of tubular bone fractures aimed at stabilizing the fracture and ensuring rapid bone tissue regeneration processes in children. The return of the support ability and physical shape of the lower limb largely depends on the state of the neuromuscular and vascular apparatus, the mechanisms of restoration of which in children at the stages of reparative osteogenesis remain poorly understood. The purpose of the study is to determine changes in neuromuscular activity and regional blood flow in the lower limbs in children with tibial diaphysis fractures under conservative and surgical treatment.
Materials and methods. Electrophysiological and Doppler studies were performed in 20 patients (mean age 11 ± 1.1 years) with tibial shaft fractures, divided into two clinical groups depending on the treatment method. Study periods: 1.5–2, 3, 6, 9 and 12 months after the treatment.
Results. The obtained data of electromyographic and Doppler studies indicated the advantages of treating tibial shaft fractures using the method of minimally invasive osteosynthesis with titanium elastic rods. A faster restoration of the support capacity of the injured limb with this treatment method was due to the possibility of early dosed loading on the injured limb, a higher level of blood filling of the foot of the injured limb and, accordingly, a rapid increase in the motor activity of the corresponding muscle groups.

The inflammatory process of any localization is accompanied by an increase in enzymatic activity in the inflammation site and blood, which is an important pathogenetic link in the development and outcome of inflammation in the uterus. Experimental modeling of endometritis in rats (n = 15) was performed using intrauterine administration of Escherichia coli lipopolysaccharide (LPS) at a dose of 250 μg/0.05 ml LPS. Comprehensive verification of the created model was performed using clinical (on the 1st and 3rd days of observation), histological (on the 1st and 3rd days) and electrohysterographic (on the 1st and 3rd days) studies.
Electrohysterographic signs of endometritis were revealed: a decrease in the contractile function of the uterus in the form of a 2.2-fold decrease in the amplitude of contractile potentials, the frequency of their occurrence and an extension of the pause between them compared to healthy postpartum animals.Morphologically, the spread of the inflammatory reaction to the endometrium primarily occurs in the areas of its contact with the mucous membrane, in which the inflammation focus is initially formed. Then the inflammation spreads from the adjacent areas of the affected endometrium to the myometrium, which correlates with the development of uterine hypotension in animals. Comprehensive verification of the experimental model of postpartum endometritis confirmed its validity, which further allows using the model to develop a new complex method of treating patients.

Objectives. To study the possibilities of anatomical table “Pirogov II” for its use in practical classes of morphology departments of a medical university and to calculate the teaching time that will be allocated for the work of students of different faculties using traditional (cadaveric) material and with the use of a digital platform of a virtual person.
Materials and methods. To achieve this aim, all teachers of the department of human anatomy with a course of operative surgery and topographic anatomy completed an introductory course on working with interactive complex “Pirogov”. The timing of educational time on the use of an interactive anatomical table and biological materials was carried out during practical classes on human anatomy when studying the unit “Splanchnology”.
Results. The primary analysis of the data obtained showed that the average amount of study time allocated to explain a new topic in the unit “Splanchnology” in practical classes for working on a «Pirogov table» is 25 ± 3 minutes and when using biological material – 20 ± 2 minutes for students of the Faculty of Medicine (practical classes duration is 4 academic hours). In groups of students of the Medical diagnostic Faculty and the Medical preventive Faculty, the time intervals for similar parts of the practical class were 30 ± 3 minutes and 20 ± 2 minutes, respectively (practical classes duration is 4 academic hours). For students of the Faculty of Foreign students these time intervals were equal to 35 ± 5 minutes and 30 ± 5 minutes (practical classes duration is 4.5 academic hours).
Conclusions. The duration of practical classes on human anatomy within the framework of class time allows you to synchronize the classical method (on corpses and natural organs) of studying the subject with the interactive method (on a virtual body).

Experimental modelling of temporomandibular joint (TMJ) osteoarthrosis in rabbits (n = 10) was performed using intra-articular administration of 0.5 ml/3.5 mg rebospan. Complex verification of the created model was performed using ultrasound (on the 21^st and 30th days of observation), histological (on the 30th day) and biochemical (on the 1st, 14th, 21st and 30th days) investigation. Ultrasound picture of osteoarthrosis was observed: osteophytes of the mandible head on the right, its contour was uneven, discontinuous, the thickness of the subchondral-cartilaginous complex on the right was 0.9 mm versus 0.5 mm on the left (p = 0.021), an increase in the capsular-condylar distance of TMJ on the right – lateral size 3.6/4.7 mm versus intact on the left 2.0/3.8 mm (p = 0.011). It was revealed morphological changes of joint tissues characterized of osteoarthrosis: hypoplasia of chondrocytes with loss of polarity of location, depletion zones with acellular areas in the intermediate and basal layers, karyorrhexis and karyopyknosis of synoviocytes, collagen fibers are thickened and fragmented. The dynamics of the inflammation marker CRP content in the blood of animals during modelling indicated an increase in signs of systemic inflammation by the 30th day. Complex verification of TMJ osteoarthrosis experimental model confirmed its validity, which further allows using this model to develop a new surgical method for treating patients.

Prematurity and related diseases are the main cause of neonatal mortality. The overall morbidity in children born prematurely is inversely proportional to gestational age. Early anemia of prematurity is one of the pathologies that aggravate the course of many diseases in children born prematurely. But it is not fully understood how comorbid conditions affect the development of anemia of prematurity and whether they make any contribution to the aggravation of this condition in premature children, according to the data of the literature published to date. The article presents the results of the analysis of the association of the rate of decrease in hemoglobin in babies with early anemia of prematurity and anthropometric parameters (weight and height at birth); asphyxia at birth, points on the Apgar scale at 1 minute; the presence and duration of artificial ventilation, laboratory parameters of the erythroid germ of peripheral blood at birth; comorbid conditions that were most often noted in this cohort of patients. The data analysis did not reveal any association between the rate of hemoglobin decrease and anthropometric parameters, birth asphyxia, presence and duration of artificial ventilation. No positive effect of erythropoietin administration on the rate of manifestation of early anemia of prematurity was found. An association was found between the rate of hemoglobin concentration decrease and neonatal jaundice for the entire cohort of children. It was also established that the hemoglobin concentration has an advantage over that the absolute number of erythrocytes when assessing erythron parameters over time.

A retrospective observational “case-control” study was conducted on 80 cases of pneumonia associated with K. pneumoniae, including 40 cases (main group) in patients with tuberculosis (TB) of the respiratory organs and 40 cases in those without TB (comparison group). Each patient of the main group was matched with a patient of the comparison group of the same gender and age group. The article presents the results of the study of clinical and laboratory data of patients, sensitivity of isolated K. pneumoniae strains to antibiotics (AB). Among comorbidities, TB patients with Klebsiella pneumoniae co-infection more often had a history of HIV infection and chronic alcoholism, 27.5 % of patients had no complaints. 72.5 % of patients of the main group and all patients (100 %) of the comparison group noted deterioration of health associated with pneumonia onset (χ² = 12.75, p < 0.001). Most patients in the comparison group noted cough (χ² = 12.58, p < 0.001) and fever (χ²= 4.94, p = 0.026). Other complaints found in patients of both study groups had no statistically significant differences. The isolated strains of K. pneumoniae are characterized by a high level of resistance to aminopenicillins, respiratory fluoroquinolones, carbapenems; meanwhile have 100 % sensitivity to colistin and fosfomycin, tigecycline, amikacin was noted.

Conditioning of functional systems and proper medical support of a potential donor must necessarily include timely assessment, rapid recognition and elimination of organ dysfunction and functional system failure.
The aim of the study was to investigate the dynamics of organ dysfunction indicators and C-reactive protein (CRP) in brain-dead donors.
Materials and methods. The prospective study included 106 brain-dead organ and/or tissue donors who underwent intensive care in the anesthesiology and resuscitation departments of the Mogilev region from 01.01.2020 to 1.11.2023.
Results. In deceased donors statistically significant increase in CRP was observed from day 1 to day 4 of intensive care: in day 1d – 13.3 (3.86; 29.1) mg/l, 2d – 85 (45.4; 140.6) mg/l (p < 0.0001 vs 1d), 3d – 135.3 (73.6; 238.2) mg/l (p < 0.0001 vs 2d), 4d – 219.7 (112.7; 326.4) mg/l (p < 0.0001 vs 3d). On days 5–7, CRP level did not change statistically significantly. A moderate correlation was found between the CRP level and the level of creatinine (R = 0.37), urea (R = 0.34), total protein (R = –0.32), cholesterol (R = –0.27). From day 1 to day 4, potential donors showed a statistically significant decrease in the concentration of total protein and cholesterol. Also, on days 2 to 6, there was an increase in the level of creatinine and urea compared to the initial level.
Conclusion. CRP in organ and tissue donors can be used as a quantitative cumulative indicator of the presence of a systemic inflammatory response and multiple organ dysfunction.

The pandemic of recent years caused by the new COVID-19 virus has been associated with a number of cardiovascular complications, including myocarditis. Therefore, the issue of timely detection and treatment of heart muscle damage in patients with the SARS-CoV-2 virus has become relevant. There are several hypotheses for the pathogenesis of coronavirus myocarditis: direct damage to cardiomyocytes by the virus; severe inflammation and cytokine storm with overproduction of inflammatory cytokines; production of autoantibodies due to molecular mimicry between viral antigens and autoantigens, as well as the release of autoantigens from virus-infected cardiomyocytes. The article presents the results of examination of 19 patients, including 10 (64.6 %) women and 9 (47.37 %) men aged 44 to 81 years. They were diagnosed with myocarditis 7–12 days after diagnosis of COVID-19 infection, on average, 8.63 ± 1.54 days. The patients’ complaints were as follows: weakness (in 100 %), cough (in 100 %), feeling of interruptions in the heart’s work (in 78.95 %), shortness of breath (in 63.16 %), pain in the left half of the chest (in 63.16 %), discomfort in the chest (42.1 %), headache (in 57.89 %), muscle pain (in 52.63 %). The following laboratory changes were revealed: C-reactive protein was, on average, 184.21 ± 113.2 mg/l, troponin I – 0.69 ± 0.37 ng/ml, D-dimer level – 1209.53 ± 855.95 ng/ml, NT-proBNP level – 791 ± 418.63 pg/ml, procalcitonin – 0.56 ± 0.34 ng/ml, ferritin – 1221.55 ± 802.58 μg/l, the number of lymphocytes in the blood plasma – 1.07 ± 0.63 * 109/l. All patients had heart rhythm and conduction disturbances. According to echocardiography, the left ventricular ejection fraction was reduced in 26.3 % of patients.

It was developed a questionnaire to assess the impact of wearing medical masks on the functional and psychophysiological body condition of medical workers. We assessed the influence of physical and emotional state on the implementation of social activity, as well as the influence of emotional state on the quality of everyday functions. The questionnaire included two blocks of identical questions regarding the health of a medical worker in the process of using medical masks in different periods – during a favorable epidemic situation and during the COVID-19 pandemic (an unfavorable epidemic situation 270 medical workers of outpatient and inpatient health organizations were interviewed. The operation time of medical devices for respiratory protection by medical workers when working in an unfavorable epidemic situation exceeds that when working in a favorable epidemic situation. It was determined that the number of symptoms of fatigue and the degree of their severity increased. with increasing of the time of wearing medical masks in an unfavorable epidemic situation. This information will make it possible to differentially approach the development of measures aimed at preventing violations of the health of medical workers in the process of professional activity.

Introduction. The development of laparoscopic methods for treating gallstone disease (GSD), especially such a form as choledocholithiasis, is a topical issue in modern surgery.
Objective. Analyze the treatment provided with a brief review of the literature.
Materials and methods. The data of instrumental and laboratory examinations are presented, as well as the results of surgical treatment of the patient for mechanical jaundice due to choledocholithiasis. In this case, a laparoscopic method of treatment was used, which consisted of cholecystectomy, choledochotomy with choledocholithoextraction and the formation of a side-to-side choledochoduodenoanastomosis.
Results. As a result of successful surgical treatment, the patient was quickly discharged for outpatient treatment without complications in the immediate observation period.
Discussion. Choledocholithiasis has a number of types of surgical treatment, while at the moment the «gold standard» is endoscopic papillosphincterotomy (EPST). Despite this, EPST has a number of limitations in application.
Conclusions. In case of impossibility of performing endoscopic papillosphincterotomy, the option choice may be laparoscopic formation of choledochoduodenoanastomosis with all the advantages of this minimally invasive method. This type of surgical intervention can be performed, including the level of the interdistrict surgical center.

Thecalutein cysts are benign and quite rare pathology in pregnancy. The article presents clinical cases of large thecalutein cysts that occurred during pregnancy, first identified in the second trimester of gestation with different outcomes – complicated by spontaneous rupture of the ovary in the postoperative period and with a favorable outcome and spontaneous reduction of cysts after delivery. During dynamic follow-up, there was a progressive increase in the size of the neoplasm, with the maximum volume reached by the time of delivery at 37–38 weeks gestation in the first case, and an increase in ovarian formations in the second trimester, followed by volume stabilization by 32 weeks of gestation, at the time delivery was performed, in the second case. The postoperative period in the first clinical case was complicated by spontaneous cyst rupture with the development of intraabdominal bleeding on the first day of the postpartum period, which necessitated relaparotomy and adnexectomy. While in the second clinical case, the postoperative period was uneventful, a month later, a regression of ovarian formations was identified by control ultrasound examination.

Undoubtedly, the most common cause of pain in the throat (pharyngoalgia) is acute or chronic diseases of the pharynx and most often with such a complaint patient turn to a general practitioner, pediatrician or otorhinolaryngologist. However, it should be remembered that, in addition to inflammation there are many other possible etiologic factors of pain in the throat, from diseases of nearby organs to systemic diseases and psychoneurological disorders. The problem of polyetiology of pain in the throat becomes more relevant when a doctor deals with an elderly patient and it is necessary to keep in mind the concomitant pathology usually occurring in this group of patients as well as the effects of therapy which the patient takes including on a regular basis.
The article describes a case of a patient's initial visit to an otorhinolaryngologist for acute (within 3 days) throat pain the cause of which was thrombosis of the internal jugular vein probably as a complication after treatment of oncologic disease. Timely examination made it possible to detect this complication in the patient, to prescribe the necessary treatment and thus to avoid its severe consequences.

Simulation technologies in the practical training of medical professionals are the most important tool of modern medical education. A review of the literature on the use of simulation training in the field of medical education is presented, articles on simulation training at the specialist level and continuing postgraduate medical education are analyzed. Research has shown that training using simulation technologies leads to an improvement in the quality of training for future doctors. With the opening of simulation centers and the introduction of certification using simulation technologies at medical universities across the country, simulation training is becoming basic in the structure of medical education. Due to the expansion of opportunities, the prospects for the use of simulation technologies are significantly expanding, and there is a need to develop new methods to improve the effectiveness of specialist training.

Virtual reality (VR) training is used in various areas of medical education.
Auscultation training involves mastering theoretical material and working at the patient’s bedside. It is optimal when a student comes to a patient with minimal sound recognition skills.
The aim of the project is to compare the effectiveness of lung and heart auscultation training using traditional teaching methods and virtual reality technologies.
Materials and Methods. Cardiac and pulmonary auscultation training was conducted using the Oculus Quest 2 headset with virtual stethoscope software. The study involved 77 third-year students. The students were divided into 2 groups: those trained in virtual reality (VR, n = 28) and those trained without the use of virtual technologies (CS, n = 49).
Results and discussion. Students trained in virtual reality recognized sounds better immediately after completing the training than students trained using conventional technologies (54.5 versus 38.3 %). Wet rales were recognized significantly worse in the VR group. Recognition of sounds during cardiac auscultation in the VR protocol group was slightly better compared to the SP protocol group (44.5 % versus 36.8 %). Knowledge retention was monitored after 3 months: long-term results were better in the VR group.
Conclusion. We consider this project as a pilot one, which will allow us to conduct a large, well-organized clinical and pedagogical study in the future.

In connection with the development of the endoscopic service of the Republic of Belarus, the development of new methods and the introduction of new technologies, the issue of primary training and improvement of skills of endoscopists without risk to patients is relevant. The simulation center of Republican Clinical Medical Center has developed and implemented programs for simulation training of endoscopists which allow training doctors in the skills of diagnostic and therapeutic endoscopy, preparing them for independent work with patients and improving their professional qualifications. Currently, training is conducted according to the following programs: 1. “Flexible endoscopy” (16 hours of training). 2. “Diagnostic and therapeutic endoscopy” (80 hours of training). 3. “Operative endoscopy of neoplasms of the gastrointestinal tract” (80 hours of training).  

The paper presents a universal methodology for creating an assessment tool for an objective structured clinical examination. The assessment tool is based on a checklist with penalty points. The algorithm assumes a step-by-step solution to the problem of creating an assessment tool, the condition for the use of which is the mandatory calculation of the agreed opinion of the developers and independent experts from among the specialized specialists, for which the calculation of the Kendall concordance coefficient is used. The final decision on the suitability of the assessment tool is made after analyzing the reliability of the assessments using the Cronbach's alpha criterion after preliminary testing.
To facilitate the registration of examinees' actions, checklists are recorded in spreadsheets using “cloud” technologies. Automation of calculations of final grades is carried out by writing special formulas using the function wizard.
The methodology considered in the article is the result of many years of searching for an optimal solution to create an adequate and convenient OSCE assessment system. The developed assessment tool has been implemented in the practice of educational activities of the simulation and certification center of the educational institution “Vitebsk State Order of Friendship of Peoples Medical University” and has been successfully tested during objective structured clinical examinations during current and final certifications.

The OSCE is an approach to assessing clinical or professional competence, in which the components of competence are assessed systematically and in a structured manner, with a special attention to the objectivity of the assessment, based on a comprehensive assessment with a certain number of assessment stations modeling various aspects of clinical competence [1]. The Argus MS is designed to automate the basic processes of training and certification of specialists in medical simulation and attestation centers in order to increase the objectivity of skill assessment and reduce the workload for the teacher [2]. The article presents the first experience of using the Argus MS to assess the competencies of first-year students of the Faculty of General Medicine and the Medical Faculty for International Students of the educational institution “Belarusian State Medical University” during the assessment on “First Aid” academic discipline.

The goals of the Medical Simulation Center are to organize and provide maintenance of specific conditions for improving the efficiency and quality of postgraduate education of medical doctors by using modern training technologies. In order to study the efficiency of the training model of simulation technologies, an anonymous survey of students of advanced training programs and educational courses was conducted. The article presents an analysis of the results of the survey of specialists with different work experience and qualification categories. All participants were satisfied with the organization of the educational process, the work of teachers, the applied forms and methods of training, the variety of activities, material and technical equipment and provision of the educational process with appropriate highly realistic equipment.

After the adoption of the Resolution of the Council of People's Commissars of the USSR “On the Establishment of the USSR Academy of Medical Sciences” dated June 30, 1944, No. 797, organizational work continued on the creation of the USSR Academy of Medical Sciences, including the selection of candidates for the first composition of full members of the USSR Academy of Medical Sciences. The main role in forming the list of the first composition of academicians of the USSR Academy of Medical Sciences was played by the People's Commissar of Health of the USSR G. A. Miterev, Deputy People's Commissar of Health of the USSR V. V. Parin, Chairman of the UMS of the People's Commissariat of Health of the USSR N. N. Burdenko, as well as employees of the apparatus of the Central Committee of the All-Union Communist Party (Bolsheviks) in charge of personnel and science issues. The final list was agreed upon by Deputy Chairman of the Council of People's Commissars of the USSR K. E. Voroshilov and approved by the Resolution of the Council of People's Commissars of the USSR “On the Approval of Full Members of the USSR Academy of Medical Sciences” dated November 14, 1944, No. 1580, i. e. more than a month before the 1st Constituent Session of the USSR Academy of Medical Sciences. Moreover, the resolution was signed not by Stalin I. V., as Chairman of the Council of People's Commissars of the USSR, but by his First Deputy Molotov V. M. The first composition of academicians of the USSR Academy of Medical Sciences included 60 people, of which 17 were generals of the medical service.
The 1st Constituent Session of the USSR Academy of Medical Sciences began on December 20, 1944, on the eve of the 65th anniversary of Stalin I. V. – December 21, 1944. During the 3-day session, the President (N. N. Burdenko), vice-presidents, other members of the Presidium of the USSR Academy of Medical Sciences, secretaries (academiciansecretaries) and members of the bureau of the departments of sciences, directors of a number of institutes (12 out of 25) were elected, speeches were heard on current, problematic and promising areas of development of medical science by the People's Commissar of Health of the USSR, the President, vice-presidents and members of the Presidium of the USSR Academy of Medical Sciences, secretaries of the departments of sciences, some directors of the USSR Academy of Medical Sciences, and other academicians of the USSR Academy of Medical Sciences. The 1st Constituent Session of the USSR Academy of Medical Sciences ended with a vivid summary speech by the President of the USSR Academy of Medical Sciences N. N. Burdenko.