Military Medical Academy

In patients with decompensated liver cirrhosis, the presence of acute hemorrhage is a common clinical finding. The different types of bleeding that may be observed include variceal and non-variceal gastrointestinal bleeding and systemic bleeding due to abnormalities in overall coagulation status. This retrospective study included 438 patients with liver cirrhosis who were selected from the endoscopy records. Of all admitted patients, 323 had a variceal source of bleeding. The remaining 115 patients had non-variceal bleeding. The findings show that the most frequent etiology was variceal bleeding. Peptic ulcer (gastric and duodenal ulcer) was dominant (60%) in the etiology of non-variceal upper gastrointestinal bleeding. The significant rate of all acute GI hemorrhage in cirrhosis was variceal, but a considerable proportion had non-variceal causes. Our study showed that in about 26.3% of the cirrhotic patients with upper gastrointestinal hemorrhage, the bleeding occurred from non-variceal sources, of which the most frequent one was ulcer. These results show that therapy should be approached after clinical evaluation and upper gastrointestinal endoscopy.

The deformation method for the structural analysis is recognized as more accurate and reliable, as it is based on experimental deformation diagrams of materials (concrete and reinforcement). However, in practice, there are still no detailed examples of calculating the crack resistance and rigidity of bending reinforced concrete elements using a deformation model, despite its convenience and the ability to quickly obtain results through iterative procedures. Purpose : The aim is to calculate deformation of crack resistance and rigidity of bending reinforced concrete elements (service limit state), using design parameters obtained from calculating the deformation strength of the structure (ultimate limit state). Methodology : The study is based on initial data and design parameters obtained in the strength calculation. The methodology includes the following steps: determination of the crack formation moment by summing internal forces, arising from normal stresses in each small section; calculation of the distance between adjacent cracks, taking into account the tensile zone in the limit state; calculation of the crack opening width depending on stresses in tensile reinforcement. Determination of the element deflection taking into account the maximum curvature calculated using the deformation modulus. The paper also presents the adopted assumptions and prerequisites, theoretical formulas with respect to calculated ultimate strains and stresses (including the strain modulus). Research findings : A practical calculation example was performed, and a comparative analysis was conducted, calculating the percentage difference in between the deformation and standard (limit state) methods. Value : The novelty of the paper lies in the algorithm development for practical calculation of the crack resistance and rigidity of bending element based on the deformation model for the structural analysis.

Abstract The current concepts for the risk factors for myopia state nowadays factors can be analyzed from the perspective of their modification and the prevention of the eye disorder. The main question is not only what the risk factors are, but also how to reduce them in order to delay the myopia onset and progression. In that regard, some more important risk factors are identified than others. The risk factors closely linked to the concept of prevention of myopia are: timing, brightness and UV light exposure in outdoor activities; duration and distance of near work (more than 2 hours per day, less than 20 cm), the type of electronic devices used, and breaks from near work; indoor illumination (over 250 lux, which is protective for myopia); age – pre-myops aged 6-8 years are at extreme risk of myopic complications. The complications of excessive myopia can be sight-threatening. With the aim of preventing them, a screening program was implemented in Bulgarian schools for a 7-year-period (2018-2025). The results, as well as the new methods of myopia prevention, are discussed and outlined.

This Community Service Program (PKM) aimed to strengthen the implementation of good governance principles through the optimization of administrative governance in Sidoagung Village, Tempuran District, Magelang Regency. Village administrative governance serves as a fundamental instrument in establishing transparent, accountable, effective, efficient, and participatory village government, as mandated by Law Number 6 of 2014 on Villages and Minister of Home Affairs Regulation Number 47 of 2016 concerning Village Government Administration. The preliminary assessment identified several issues, including unsystematic archival management, manual and poorly documented correspondence recording, limited understanding of administrative standards among village officials, and the absence of standardized administrative service procedures (SOP). The program applied a participatory and collaborative approach consisting of preliminary observation, needs assessment, socialization of good governance principles, technical training on village administration, drafting of service SOPs, implementation mentoring, and comparative evaluation before and after the intervention. The activity involved 13 lecturers and 11 supporting personnel, with 348 participants comprising village officials, village institutional representatives, and community members involved in administrative services. The results demonstrated significant improvement in village officials’ conceptual understanding of transparency, accountability, effectiveness, efficiency, and public participation principles. Technically, improvements were observed in archival classification and organization, systematic recording of incoming and outgoing correspondence, better documentation of population administration, and the formulation of draft administrative service SOPs as a foundation for service standardization. Post-activity evaluation indicated enhanced public service quality characterized by more structured procedures, increased responsiveness, and greater transparency. Beyond technical improvements, the program also fostered positive changes in the work culture of village officials toward a more professional and service-oriented governance model. Therefore, this community service initiative provides a tangible and sustainable contribution to strengthening village administrative governance as a foundation for implementing good governance at the local government level. Keywords: good governance, village administrative governance, public service, capacity building, community service program.

Short bowel syndrome (SBS) develops when the remaining intestine is unable to sustain adequate nutrient and electrolyte absorption following extensive bowel resection. The condition is characterized by malabsorption and significant fluid losses which lead to dehydration and progressive weight loss, thus promoting patient dependence on parenteral fluids or nutrition. After an initial acute phase marked by accelerated intestinal transit and gastric hypersecretion, long-term clinical outcomes are largely determined by the capacity of the remaining bowel for intestinal adaptation-a sustained process of structural, functional, and molecular remodeling that enhances absorptive efficiency and restores fluid and nutrient homeostasis. This review summarizes the key histological and cellular features of the adaptive response, including crypt and villus remodeling, mucosal hyperplasia, and smooth muscle hypertrophy, and integrates emerging concepts in crypt biology that define the dynamic cross-talk between intestinal stem cells and the mesenchymal niche, together with their upstream regulatory pathways.

Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques-both invasive and non-invasive-have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain. We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman-Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I2 statistic and Cochrane's Q test. Twelve RCTs involving 413 patients (mean age 53years; 55% female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD-0.82; 95% CI [-1.13, -0.50]; p<0.00001; I2=53%) and analgesic consumption (SMD-0.91; 95% CI [-1.63, -0.20]; p=0.01; I2=81%) compared to sham. No significant difference was found in functional disability (SMD-0.31; 95% CI [-0.85, 0.24]; p=0.28; I2=44%). The pooled female proportion was 55% (95% CI [42.99, 66.95]; I2=73%), and the prevalence of adverse effects was 12.48% (95% CI [6.13, 20.39]; I2=0%). This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.

This research aims to characterize extended reality flight trainers and to provide a detailed account of the sensors employed to collect data essential for qualitative task performance analysis, with a particular focus on gaze behavior within the extended reality environment. A comparative study was conducted to evaluate the effectiveness of an extended reality environment relative to traditional flight simulators. Eight flight instructor candidates, advanced pilots with comparable flight-hour experience, were divided into four groups based on airplane or helicopter type and cockpit configuration (analog or digital). In the traditional simulator, fixation numbers, dwell time percentages, revisit numbers, and revisit time percentages were recorded, while in the extended reality environment, the following metrics were analyzed: fixation numbers and durations, saccade numbers and durations, smooth pursuits and durations, and number of blinks. These eye-tracking parameters were evaluated alongside flight performance metrics across all trials. Each scenario involved a takeoff and initial climb task within the traffic pattern of a fixed-wing aircraft. Despite the diversity of pilot groups, no statistically significant differences were observed in either flight performance or gaze behavior metrics between the two environments. Moreover, differences identified between certain pilot groups within one scenario were consistently observed in another, indicating the sensitivity of the proposed evaluation procedure. The enhanced realism and validated effectiveness are therefore crucial for establishing standards that support the formal adoption of extended reality technologies in pilot training programs. Integrating this digital space significantly enhances the overall training experience and provides a higher level of simulation fidelity for next-generation cadet training.

Pulmonary nodules are mostly solitary focal opacities typically round or oval in shape, with a diameter of less than 3 cm. They are surrounded by aerated lung parenchyma or located subpleurally, and are not associated with abnormalities, such as lymphadenopathy or atelectasis. Pulmonary nodules are found in up to one-third of computed tomography scans taken in adults, whereas they are significantly less common in children. In adult patients, incidentally detected pulmonary nodules are more frequently associated with neoplastic processes, while they are primarily related to congenital disorders or inflammatory conditions in paediatric populations. The identification of single or multiple pulmonary nodules should always prompt an attempt to determine the likely aetiology. The so-called idiopathic nodules, for which no definitive cause can be established, are a particular subgroup. Although the majority of these lesions are benign in children, some may represent an early stage of malignancy. Due to the lack of standardised management guidelines for the paediatric population, clinical decisions regarding follow-up and further diagnostic workup are often challenging. This literature review outlines the potential causes of incidentally detected paediatric pulmonary nodules, from malignant tumours to other diseases that can present in this form, and discusses methods for assessing the malignant risk of pulmonary nodules in paediatric patients. Finally, a management strategy is proposed for asymptomatic pulmonary nodules detected on imaging, computed tomography in particular.

Objectives: To investigate the efficacy of femtosecond laser-assisted cataract surgery (FLACS) with the FEMTO LDV Z8 laser system in comparison to manual conventional cataract surgery (CCS). Background: Preservation of corneal endothelial integrity remains one of the most critical determinants of long-term visual quality after cataract surgery. The introduction of low-energy femtosecond laser systems has raised expectations for safer and more efficient procedures, particularity in cases with denser cataracts. Methods: This is a prospective, randomized study. Here, 38 eyes in the FLACS group and 40 in the CCS group were included. The changes in central corneal thickness (CCT), endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were analyzed. In addition, the effective phacoemulsification time (EPT), the total phacoemulsification time (PT), and the intraoperative time (IT) were evaluated as a function of cataract grade. The total follow-up period was six weeks. Results: On postoperative day 1, BCVA improved significantly faster in the FLACS group (0.91 ± 0.14) compared with the CCS group (0.70 ± 0.17; p < 0.05). FLACS also demonstrated a significantly shorter EPT (1.01 ± 0.91 s) than CCS (1.61 ± 1.70 s; p < 0.05). No significant differences were observed between groups regarding postoperative ECD or CCT at any time point. No intraoperative or postoperative complications occurred. Conclusions: Low-energy FLACS achieved comparable endothelial safety to CCS, while providing significantly faster early visual recovery and reduced ultrasound energy use. These finding support the clinical value of FLACS in patients with moderate to dense cataracts.