Objective. To identify the leading factors involved in the formation of adverse outcomes in the early phase of acute necrotizing pancreatitis (ANP) and to determine possible promising ways to influence them at the hospital stage.
Materials and methods. To identify the dynamics in the structure of causes of death and factors associated with fatal outcomes, the results of pathological studies of those who died due to ANP in the periods from 2010 to 2012 (n = 151) and from 2018 to 2021 (n = 164) were comparatively analysed.
Results. In ANP, adverse outcomes within 2 weeks of onset were 1.4 times more common in both comparison groups than at later stages (p = 0.003). Widespread pancreatic necrosis (PN) was observed in the vast majority of cases (96 % and 89 %, respectively) among patients who died in the comparison periods. However, isolated lesions of only one part of the pancreas were three times more common between 2018 and 2021 (p = 0.019), indicating a closer association between adverse outcomes and not only the extent of PN, but also other extrapancreatic lesions. Damage to the parapancreatic and retroperitoneal tissue was observed in the majority of deceased (98.4 %), the pathological process was predominantly widespread (63.2 %), while the overall incidence of parapancreatitis in 2018– 2021 became significantly higher compared to 2010–2012 (p = 0.018). In patients who died due to ANP, infected formations of various localizations were detected 1.7 times more often in 2018–2021 compared to 2010–2012 (124 and 72 cases, respectively; p = 0.028), with infected fluid collections most consistently (34.2 %) localized in the omental bursa; in recent years, their number has increased 4.6 times (55 and 12 cases, respectively; p = 0.001), and infection of fluid collections of this localization within 2 weeks from the onset of ANP occurred significantly more often than in 2010–2012 (16 and 4 cases, respectively; p = 0.001). In most cultures of sectional material, hospital flora was found, and intestinal flora was sown an order of magnitude less often (75 and 12 cases, respectively; p = 0.001). Of the 75 cases of contamination before death, 63 deaths (84 %) were operated on, a direct correlation was revealed between these signs (p = 0.049). The immediate cause of death in ANP in the majority of cases (219 (69.5 %) deaths) was multiple organ failure syndrome. In those who died in the early phase of ANP in 2018–2021, pathological lesions of the kidneys (91.7 %, p = 0.001), brain (89.6 %, p = 0.001), and liver (81.3 %, p = 0.001) became significantly more common.
Conclusion. A comparative analysis of the results of pathological examinations of patients who died due to ANP between 2010– 2012 and 2018–2021 revealed the dynamics of the main factors associated with adverse outcomes that should be addressed through medical interventions and the development and implementation of new, meaningful, and effective approaches at the early stage of the disease.

Objective. To determine clinical parameters for assessing immune and respiratory dysfunction in patients with tuberculosis of the respiratory organs and, based on these parameters, develop rules for quantitative assessment of functional disorders using data mining methods.
Materials and methods. The study included 149 patients with respiratory tuberculosis, who were referred for the first time for medical and social examination to determine disability, and 75 patients in the control group who successfully completed the course of treatment. The study was conducted at the Minsk City Medical and Rehabilitation Expert Commission, the Minsk Regional Tuberculosis Dispensary, and the outpatient department of the Republican Scientific and Practical Center for Medical Technologies, Informatization, Management and Economics of Healthcare from 2017 to 2024. The mean age (SE) of patients in the study cohort was 47.4 (0.71) years.
Results. In the course of the conducted study, key clinical indicators determining the severity of immune and respiratory dysfunction in patients with tuberculosis of the respiratory organs were identified. The main predictor of the expert assessment of severe immune dysfunction was the clinical indicator of the presence of bacteria excretion (diagnostic accuracy of 90 %). The presence of bacteria excretion indicates the activity of the tuberculosis process and significant suppression of the immune system, which must be taken into account when determining the disability group. In the absence of bacteria excretion, the phase of the disease course is of decisive importance in assessing the severity of immune dysfunction: the resorption/consolidation phase correlates with moderate disorders, and the clinical cure phase – with mild disorders. The leading indicator for assessing the severity of respiratory dysfunction was the clinical indicator of blood oxygen saturation (SpO₂): a blood SpO2 level of more than 95 % correlates with minor respiratory dysfunction (accuracy of 88.6 %); a blood SpO₂ level of 92–94 % indicates mild respiratory impairment (accuracy 73.9 %). A clarifying criterion for assessing the severity of respiratory impairment is the forced expiratory volume in one second (FEV₁): a blood SpO₂ level of less than 92 % and an FEV1 value of less than 74 % of the predicted values indicate severe respiratory impairment (in 80 % of patients).
Сonclusion. The results obtained during the study have high practical significance for medical and social assessment and rehabilitation of patients with respiratory tuberculosis. The developed algorithms and criteria for assessing the severity of functional impairments, based on objective clinical and functional indicators, contribute to the standardization of expert decisions and increase their objectivity.

Objective. To determine the structural features of COVID-19 epidemic waves in the Republic of Belarus in 2020–2022.
Materials and methods. A retrospective descriptive-analytical study of COVID-19 incidence dynamics was conducted using aggregated official statistical data from February 28, 2020 to May 8, 2022. Epidemic waves were identified based on weekly incidence trends. The following indicators were calculated: duration of epidemic waves, peak and mean incidence rates (per 100,000 population), peak-to-mean ratio, intensity coefficient, cumulative epidemic burden, as well as the calculated reproduction number (R).
Results. Four consecutive epidemic waves were identified. Peak incidence increased from 71.4 to 583.7 per 100,000 population, while mean incidence rose from 37.1 to 134.3 per 100,000 population. At the same time, the duration of epidemic waves decreased from 45 to 17 weeks. The highest cumulative epidemic burden was observed during the second (3699.0) and third (3133.2) waves. A progressive shift in the relationship between COVID-19 and acute respiratory infections was identified, from discordant dynamics in the first wave to near-complete temporal alignment in the fourth wave. The mean values of the estimated reproduction number decreased from 2.4 to 1.0 and did not correlate with the intensity of epidemic peaks.
Conclusion. The transformation of the COVID-19 epidemic process manifested as changes in the configuration of epidemic waves, a reduction in their duration alongside increasing intensity, and convergence with the seasonal circulation patterns of respiratory infections, thereby substantiating the feasibility of its epidemiological surveillance within the existing monitoring system for acute respiratory infections.

Objective. To assess the prevalence and antibiotic resistance of S. maltophilia in Belarus over a five – year period (2020–2024).
Materials and methods. A retrospective analysis of microbiological surveillance data (WHONET) was performed on clinical S. maltophilia isolates obtained from patients in six regions of Belarus and Minsk city. A total of 3267 isolates were included. Antimicrobial susceptibility was determined by disk diffusion or automated systems and interpreted according to CLSI criteria. Statistical analysis included calculation of 95 % confidence intervals (Clopper – Pearson method), comparison of proportions and trend assessment.
Results. The largest numbers of isolates were recovered from Minsk city (56.1 %), Minsk region (13.3 %), Mogilev region (13.0 %) and Gomel region (8.2 %). Resistance to trimethoprim/sulfamethoxazole was 32.5 % (95 % CI (30.6–34.3 %)), susceptibility – 48.9 %. Sharp interregional differences were observed: resistance ranged from 7.4 % in Mogilev region to 95.7 % in Grodno region. Susceptibility to levofloxacin was high (81.7 %), with a trend of decreasing resistance from 24.7 % in 2021 to 5.7 % in 2024 (p < 0.001). High resistance rates to ceftazidime (80.1 %) and ticarcillin/clavulanate (24.6 %) confirmed intrinsic β-lactamase-mediated resistance. According to preliminary data (n = 43), minocycline showed high activity (88.4 % of susceptible isolates).
Conclusion. Significant interregional differences in S. maltophilia resistance to trimethoprim/sulfamethoxazole and fluoroquinolones were found in Belarus. A marked positive trend of restoration of susceptibility to levofloxacin was observed. These findings support the need for continuous epidemiological surveillance and a region tailored approach to empirical therapy of S. maltophilia infections.

Objective. To adapt the drug resistance index calculation methodology to electronic databases and drug consumption analysis tools available in the Republic of Belarus and to develop instructions detailing the sequence of steps required for the correct application of the methodology.
Materials and methods. This study is methodological. It is based on a methodology for calculating the integrated drug resistance index. WHONET software, used to generate samples of microorganisms and their susceptibility to antimicrobials, is considered as the source of initial data. A demonstration example using simulated data is used to illustrate the method.
Results. A step-by-step process for calculating the drug resistance index is presented, including formalization of all stages of data processing and indicator aggregation. The demonstration example illustrates the calculation sequence and the specifics of interpreting the final index value.
Conclusion. Proposed approach ensures transparency and reproducibility in calculating the integrated drug resistance index and can be used to standardize data analysis. Detailed methodology facilitates its implementation in scientific and practical activities, objectifying it as a tool for making management decisions in the field of antibacterial therapy management.

Objective. To determine the role and effectiveness of endoscopic diagnostic and treatment methods in patients with ureteral injury (UI) diagnosed after obstetric and gynecological surgery.
Materials and methods. A retrospective analysis of 95 medical records of patients with PM was performed. Nine (9.5 %) women had previously undergone surgery in obstetric departments, 61 (64.2 %) – in gynecological departments for benign diseases, 25 (26.2 %) – in gynecological or oncogynecological departments for malignant diseases (stage Tis-T2N0M0). The age of patients ranged from 19 to 72 years (mean age 47.2 ± 7.3). The time of admission to the urology hospital after the primary obstetric or gynecological surgery varied from 2 to 38 days. Among benign formations in gynecology, the most common disease was uterine fibroids – 46 (75.4 %) patients; among malignant ones – uterine cancer – in 13 (52.0 %) and cervical cancer in 9 (36.0 %) patients. Diagnosis of PM was based on an analysis of clinical manifestations, laboratory, and instrumental examination methods. Surgical treatment of patients was performed in three stages. In the first stage, all women admitted to the urology department were operated on: 62 (65.3 %) underwent surgical interventions using endourological methods, percutaneous puncture nephrostomy was performed in 28 (29.4 %), and ureteroneocystostomy was performed through an open surgical approach in 5 (5.3 %). In the second and third stages, after a control examination, surgical treatment was performed only in patients whose urodynamics had not been restored during the previous stage of treatment. Long-term treatment outcomes in patients treated using endourological methods were assessed 1–1.5 years after completion of specialized treatment based on the results of a comprehensive examination, including an assessment of urodynamics and the functional state of the kidney on the side of the operation.
Results. Throughout the treatment period, endoscopic surgical methods for the treatment of PM demonstrated high efficacy. In 55 (88.7 %) of 62 patients, endourological methods were used exclusively as first-line treatment at the date of admission to the urology hospital and subsequently. Of these (n = 55), good long-term results were noted in 48 (87.3 %), satisfactory – in 7 (12.7 %). The use of endourological methods was most effective in patients with short ureteral strictures. With a stricture length of up to 5 mm (n = 43), a good final result was obtained in 40 (93.0 %), satisfactory – in 3 (7.0 %); with a length from 5 to 10 mm (n = 9) – good – in 8 (88.9 %), satisfactory – in 1 (11.1 %); with a length from 10 to 20 mm (n = 3), only satisfactory results were achieved in all patients (100.0 %).
Conclusion. The obtained data demonstrate the high efficacy and practical feasibility of using minimally invasive endoscopic procedures in patients with ureteral strictures diagnosed after obstetric and gynecological surgery. The best results are achieved in patients with strictures up to 10 mm in length.

Objective. Based on an analysis of the literature, to identify the main risk factors for postoperative delirium (POD) in elderly patients with femoral neck fractures undergoing hip arthroplasty and to substantiate contemporary approaches to its prevention.
Materials and methods. A systematic review of domestic and international literature published between 2015 and 2025 was conducted using PubMed, Scopus, eLibrary, and the Cochrane Library databases. The following keywords were used: hip fracture, delirium, risk factors, elderly, perioperative care, regional anesthesia, and PENG-block. Metaanalyses, systematic reviews, randomized controlled trials, and prospective cohort studies were included.
Results. The incidence of POD after hip arthroplasty for femoral neck fractures reaches 40–60 %. The following modifiable risk factors were identified: anemia, electrolyte imbalance, hypoalbuminemia, polypharmacy, prolonged preoperative fasting, intraoperative hypotension, deep anesthesia, hypothermia, severe pain syndrome, high opioid doses, and delayed mobilization. A key role in prevention is attributed to multimodal opioid-sparing analgesia with a regional component (PENG-block), which reduces opioid consumption by 50–70 % and lowers the risk of POD by 25–35 %. The use of dexmedetomidine in high-risk patients decreases the incidence of POD by 40–50 %. Implementation of comprehensive multidisciplinary protocols can reduce POD incidence by 30–40 %.
Conclusions. POD in elderly patients with femoral neck fractures undergoing hip arthroplasty is a multifactorial complication, the prevention of which should be based on correction of modifiable risk factors using regional anesthesia, dexmedetomidine, early mobilization, and a complex of non-pharmacological interventions.