Objective. To compare the effectiveness of different nutritional support programs in patients with severe traumatic brain injury (TBI) during comprehensive intensive care.
Materials and methods. The study, conducted from 2017 to 2024, included 116 patients with severe TBI admitted to the ICU. Patients were randomized into two groups with different nutritional support strategies. The methods included evaluating clinical and laboratory parameters, catabolism levels, and outcomes using the Glasgow Outcome Scale, alongside durations of mechanical ventilation, intensive care, and hospital stay, as well as complication frequency.
Results. Patients in the intervention group received target levels of energy (28.84—33.59 kcal/kg/day) and protein (1.08—1.73 g/kg/day) from the first day of hospitalization, whereas in the control group the values were significantly lower (0—30.62 kcal/kg/day; 0—1.27 g/kg/day) (p < 0.05). C-reactive protein levels did not differ significantly between the groups throughout the observation period, while procalcitonin concentrations were significantly lower in the intervention group on days 3, 5, and 7 (p < 0.05); at other time points, the differences were not statistically significant. The median duration of hospitalization was longer in the intervention group (47 vs. 26 days, p < 0.05), while the incidence of complications was lower (pneumonia: 57.6 % vs. 84.0 %, p < 0.05; multiple organ dysfunction syndrome: 16.7 % vs. 34.0 %, p < 0.05). Mortality in the intervention group was 51.5 % compared to 80.0 % in the control group (p = 0.0261), and favorable outcomes occurred more frequently (40.9 % vs. 14.0 %, p < 0.05).
Conclusion. A nutritional support program aimed at achieving ≥ 30 kcal/kg/day of energy and ≥ 1.5 g/kg/day of protein intake contributed to a reduction in mortality and complication rates and improved clinical outcomes. The longer hospital stay observed in the intervention group may reflect increased survival and the need for extended rehabilitation time.

Objective. To improve the assessment of the severity of functional disorders in a patient with respiratory tuberculosis by using the developed clinical and diagnostic methodology for creating an individual functional profile based on the International Classification of Functioning, Disability and Health.
Materials and methods. To achieve this goal, the study included 224 patients with respiratory tuberculosis of working age, who were referred for the first time to a medical rehabilitation expert commission to determine disability. The average age of the surveyed population was 47.38 ± 10.63 years. Among the examined patients there were 168 (75.0 %, 95 % CI (68.9—80.2)) men, whose average age was 49.24 ± 10.24 years, and 56 (25.0 %, 95 % CI (19.7—31.1)) women, whose average age was 41.82 ± 9.89 years.
Results. Based on the results of the study, a clinical and diagnostic methodology was developed for forming an individual functioning profile of a patient with tuberculosis of the respiratory system from the perspective of the International Classification of Functioning, Disability and Health.
Сonclusion. The developed clinical and diagnostic methodology for forming an individual profile of the functioning of a patient with tuberculosis of the respiratory system from the perspective of the International Classification of functioning, Disability and Health allows an objective assessment of the severity of functional disorders and disability in patients with tuberculosis of the respiratory system, which in turn will be aimed at making an objective expert decision, timely referral of patients with this pathology for medical and social examination and prevention of primary disability aggravation.

Autism spectrum disorders (ASD) are a group of neurodevelopmental disorders characterized by deficits in social interaction, communication, as well as limited and repetitive patterns of behavior, interests, or activities. The prevalence of this pathology in the world, including in the Republic of Belarus, is steadily increasing, which requires the development of unified methods for its early diagnosis by healthcare specialists of various profiles.
Objective. To evaluate the diagnostic value of a new test for healthcare workers to identify ASD in young children in outpatient healthcare organizations of the Republic of Belarus.
Materials and methods. In 2023—2024 1984 children were examined using a screening test for healthcare workers to determine the presence and severity of signs of autism spectrum disorders in young children. The survey results were analyzed using descriptive statistics, ROC analysis, and calculation of the main diagnostic characteristics of the test.
Results. It was found that the new test has a high diagnostic value (AUC = 0.9952; 95 % CI (0.9911—0.9985)) with an optimal cutoff of 33 points. The sensitivity of the test was 98.44 %, specificity — 95.47 %. Positive predictive value — 42.00 %, negative predictive value — 99.95 %.
Conclusion. The developed test is a highly effective tool for screening ASD in young children and can be recommended for widespread implementation in the practice of outpatient healthcare organizations.

We are presenting the review of scientific publications and the clinical case of Rendu — Osler — Weber disease which is a rare disorder tending to complicate with lung hemorrhage. The disease was primarily found in a pregnant woman. The disease develops pulmonary (as well as cerebral and visceral) arteriovenous malformations which leads to right-to-left blood shunt. Pregnancy may promote the progressive growth of arteriovenous malformations with potential life-threatening complications.
The clue to the proper diagnosis in the case presented was the dissociation of clinical and X-ray manifestations of the disease — the persistent refractory decrease of blood oxygenation with no X-ray findings of the lung parenchyma affected. The typical telangiectasia was found on the oral mucosa by purposeful searching. Moreover, the patient had passed through thrombotic cerebral accident at a young age which might be an early manifestation of Rendu — Osler — Weber disease while remained unrecognized.
We showed the critical role of the computed tomography angiography for the differential diagnosis of the diseases manifesting with hemoptysis.
The diagnosis in the case presented was yet more challenging as Rendu — Osler — Weber disease manifested with pulmonary bleeding on the background of the using of anticoagulants due to concomitant thrombophilia. Whereas the disease combination severely increased the risk of both hemorrhagic and thrombotic complications the preterm abdominal delivery followed by embolization of the pulmonary malformations was successfully applied to the patient.

Objective. To study the nature and sequence of development of pathomorphological processes in rat coronary arteries at different stages of modeling chronic cardiac ischemia.
Materials and methods. Chronic heart failure of ischemic genesis in Wistar rats was modeled by subcutaneous administration of β-adrenomimetic isoproterenol hydrochloride at a dose of 10 mg/kg/day for 14 days. In 4, 6 and 8 weeks after the last injection in experimental animals the features of morphofunctional changes in coronary vessels and the dynamics of changes in the activity of enzymes of cellular energy metabolism were analyzed.
Results. During the development of chronic isoproterenol-induced ischemic myocardial damage (from the 4th to the 8th week of the experiment), progression of structural changes in the vascular walls of rat coronary arteries was observed: both intima (deendothelialization and desquamation of endotheliocytes, focal subendothelial edema, disruption of the integrity of the outer and inner elastic membranes) and media and adventitia (dystrophy and necrobiosis of smooth muscle cells, loosening, edema, disorganization of layers, fibrosis) in combination with increasing sclerotic changes of perivascular spaces. Histochemical changes in endothelial cells of rat coronary vessels are manifested by a compensatory increase in lactate dehydrogenase activity by the 4th week of the experiment with a subsequent decrease in succinate and lactate dehydrogenase activity from the 6th to the 8th week of the experiment.
Conclusion. The morphological changes in rat coronary arteries have been revealed, which illustrate the dynamics of development of structural and functional changes in vessels in chronic isoproterenol-induced cardiac ischemia at late stages of its development. Structural changes in vascular walls are combined with a decrease in the efficiency of both aerobic and anaerobic pathways of energy formation.

Objective. To evaluate the dynamics of the cardio-ankle vascular index (CAVI) and augmentation index (AI) in men with arterial hypertension (AH) of the I and II degrees in the age groups 30—39 and 40—49 years; to identify modifiable and nonmodifiable factors associated with an increase and decrease in CAVI and AI in healthy individuals and in patients with AH 30—49 years old.
Materials and methods. The study involved practically healthy men and men with AH of the I and II degrees aged 30—49 years, who were divided into 6 subgroups: IA — 38 practically healthy men aged 30—39 years; IB — 38 patients with AH of the I degree aged 30—39 years; IC — 21 patients with AH of the II degree aged 30—39 years; IIA — 23 practically healthy men aged 40—49 years; IIB — 35 patients with AH of the I degree aged 40—49 years; IIC — 28 patients with AH of the II degree aged 40—49 years. The CAVI and AI were determined twice on a volumetric sphygmograph VaSera VS-1500 (Japan) with an interval of 13 [12—16] months.
Results. In men from subgroups IA, IB, IIB AI increased with repeated measurement (p = 0.001, p = 0.00001, p = 0.04, respectively). In healthy men the probability of an increase in AI is associated with pulse arterial pressure (β = 0.173, OR — 1.19 (95 % CI (1.08—1.33)), p = 0.0009, AUC = 0.711), non-HDL cholesterol (β = 0.772, OR — 2.16 (95 % CI (1.24—4,05)), p = 0.01, AUC = 0.675) and the presence of excess body weight (β = 1.371, OR — 3.94 (95% CI (1.53—10.84)), p = 0.006, AUC = 0.675). In individuals with AH the increase in AI was associated with obesity (β = 1.462, OR — 4.31 (95 % CI (1.50—13.37)), p = 0.008, AUC = 0.638), but the use of angiotensin II receptor blockers reduced the probability of AI increase (β = -1.117, OR — 0.3273 (95 % CI (0.13—0.76)), p = 0.012, AUC = 0.602).
Conclusion. During the observation period AI increased in healthy individuals aged 30—39 years and in all patients with AH of the I degree, while CAVI did not change in any of the study groups.
The increase in AI in healthy men is associated with the content of non-HDL cholesterol, the level of pulse arterial pressure and excess body weight. The increase in AI over time in patients with hypertension is associated with the presence of obesity. The increase in CAVI was not associated with the studied factors.

Objective. Identify the forms of aggressive and autoaggressive behaviour in persons with alcohol dependence, to determine the effectiveness of pharmacotherapy of alcohol dependence with normotimic drugs in comparison with acetaldehyde dehydrogenase inhibitors.
Materials and methods. The results of psychometric diagnostics of the depression scales developed by A. Beck, the Bass — Darky Test, the Hand Test and the Minnesota Multiphasic Personality Inventory (MMPI) have been investigated. The study involved two groups of patients: group 1 consisted of 25 individuals diagnosed with ”alcohol dependence syndrome” who were undergoing drug therapy with acetaldehyde dehydrogenase inhibitors, while group 2 comprised 30 patients with “alcohol dependence syndrome” who were receiving drug therapy with carbamazepine. The statistical analysis was conducted using the R 4.2.2 environment.
Results. The study revealed that two groups of examined patients exhibited a high level of aggressiveness, hostility, and propensity for open aggressive behavior, as indicated by elevated scores on the aggressiveness index and hostility index. Upon repeated examination, it was revealed that patients in group 1 exhibited a reduction in the number of points scored on the Beck test after a six-month period of treatment. Additionally, patients in group 1 demonstrated a decline in the initial scale of the MMPI test. Similarly, the sixth scale of the MMPI test demonstrated a decrease in the same patients. Conversely, an increase in the aggressiveness index was observed in group 1 patients after six months of treatment. Re-examination of group 2 patients revealed a decrease in the sixth, seventh, and eighth scales of the MMPI test.
Conclusion. The conducted work revealed the prevalence of latent aggression in the behaviour of patients and the manifestation of open aggression against people close to the patient. Furthermore, it demonstrated the greater effectiveness of carbamazepine in comparison with acetaldehyde dehydrogenase inhibitors.

In the article information about G. I. Sidorenko, a cardiologist, academician of the National Academy of Sciences, one of the founders of cardiology in Belarus is presented.