Vol 341, No 6 (2020)

According to data from medical reports in form 3/MED of military units in which about 60% of the total number of officers of the Armed Forces served, the dynamics and structure of their dismissal due to health conditions in 2003-2018 were studied. The average annual dismissal rate was 7.98‰‰ and over the observation period decreased by 4.4 times - from 10.5 to 2.4‰‰. In the structure of dismissal by 25 nosologies (class groups), which accounted for 78.6% of all releases, the leading nosologies were diseases characterized by high blood pressure (I10-I15 according to ICD-10), coronary heart disease (I20-I25), and diseases of the esophagus, stomach and duodenum (K20-K31), obesity and other types of excessive nutrition (E65-E68), deforming dorsopathies (M40-M43). In total, the share of these nosologies (class groups) in the structure of all dismissals of officers amounted to 44.7%. A significant increase in the dismissal rate in 2009-2011 was identified, which coincided with the period of unpopular organizational and staff reform of the Armed Forces. Prevention, timely treatment, and rehabilitation of leading nosologies will contribute to improving health and increasing the professional longevity of officers.

The results of the analysis of the organization and work experience of a large departmental multidisciplinary medical institution as a level 1 trauma center for the provision of medical care to 191 victims of road traffic accidents are presented. It was shown that the introduction of new organizational solutions and medical technologies led to a decrease in in - hospital mortality in patients with polytrauma by 3.7%. The main directions of further improvement of the practical activities of the medical organization to improve critical indicators of the effectiveness of the treatment of victims of traffic accidents are determined. Improving the efficiency and quality of specialized medical care for victims of polytrauma depends on the legislative solution to the issue of financing a trauma center for actual expenses from both compulsory health insurance funds and state budget funds.

A study was conducted to analyze the characteristics of combat acoustic trauma in modern armed conflicts and the experience of providing medical care for this pathology. The urgency of the problem of specialized otorhinolaryngological care in case of combat acoustic trauma is associated with an increase in the proportion of such victims in the overall structure of sanitary losses and the importance of the auditory analyzer for the professional activities of military personnel. During the hostilities in the North Caucasus (1999-2002), combat acoustic trauma accounted for 42.9% of all sanitary losses of the ENT profile. There was a predominance of mine - explosive wounds and an increase in the number of combined injuries of the ENT organs, an increase in the number of concussion lesions, and above all, contusion of the ear with rupture of the tympanic membrane. The information obtained is the fundamental source data for the application of computational and analytical methods for determining the need for appropriate forces and means of medical service, including personnel of otolaryngology surgery specialists.

The results of the surgical treatment of 446 patients with carbuncles with primary localization on the back - 21%, neck - 20%, hip - 18%, buttock - 16%. The prevalence of inflammatory events is 20-180 cm2. In the initial microbiological study, Staphylococcus aureus predominated - 87.9%. Subsequently, in the process of treating postnecrectomy wounds, their contamination with gram - negative microflora was observed (7.2%), and more often (25.4%) in patients with diabetes mellitus (18.4%). Significant violations of microcirculation of the skin in the lesion were revealed, which correlated with the severity and prevalence of purulent - necrotic injuries. Differentiated surgical tactics were used depending on the location, nature, and incidence of inflammation, in which access to necrotic tissue was achieved either using a linear incision or two bordering incisions with excision of the necrotic skin. The third option (with small carbuncles and mobile surrounding skin) was excision of the carbuncle within healthy tissues with the application of the primary suture and adequate drainage. After the inflammation subsided, skin - plastic reconstructive operations were used according to indications: wound repair with local tissues by the method of simultaneous or metered stretching (28.1%), autodermoplasty with a free split graft (34.2%), combined plastic surgery using both previous techniques (37.7% ). Purulent postoperative complications were noted in 7.9% of the operated patients (most often among patients with diabetes mellitus - 15.4%), but they did not differ in severity. They did not significantly affect the positive results of treatment.

Tuberculous empyema of the pleura is a particular form of pleuropulmonary pathology, characterized by a purulent - destructive process in the residual pleural cavity with gross morphofunctional specific changes in the pleura caused by tuberculosis mycobacteria, with characteristic signs of purulent intoxication and respiratory failure. In cases of suspected pleural tuberculous empyema, invasive methods of morphological verification of pleural changes should come to the fore. Among them, the most informative are puncture, video thoracoscopic, and open pleura biopsy. A belated diagnosis of tuberculous empyema of the pleura, as well as a delay in conservative treatment, can lead to severe pathological changes in the patient’s body and any hope of salvation, and surgical procedure will be impossible.

In cardiovascular diseases, all patients are shown lifelong antithrombotic therapy to prevent cardiovascular complications. The use of antiplatelet agents, along with a reduced risk of thrombotic complications, entails negative consequences in the form of an increased likelihood of bleeding. The article presents a review of literature data on modern approaches to the use of antiplatelet drugs for cardiovascular diseases and proton pump inhibitors as gastroprotection of gastroduodenal erosive and ulcerative complications. Given the inter - drug interaction of these drugs, an algorithm is proposed for the differential use of proton pump inhibitors in patients receiving antiplatelet therapy. It is concluded that such use of these agents in comorbid cardiovascular and gastroduodenal pathology can reduce risks from both the cardiovascular system and the gastrointestinal tract.

Modern military conflicts are accompanied by sanitary losses, among which the share of mine - explosive injuries from the direct impact on the human body of the damaging factors of landmines, anti - vehicle, and anti - personnel mines, mainly as a result of the indirect effect of shock overload and blast wave, is growing. In terms of preserving the life and professional health of military personnel, the leading role belongs to technical means, the development of which requires knowledge of biomedical problems. Ergonomic ways to ensure and optimize the activities of military specialists at various stages of the construction of mine protection, selection, and training and their psychophysiological training in extreme conditions are considered. The need for conducting training of personnel in the use of means of protection against undermining factors aimed at developing and maintaining strong skills for action under challenging conditions is updated.

The global prevalence of diabetes mellitus, which has risen sharply in recent times, is forcing more intensive use of effective glycemic control. To ensure the quality of life, patients need constant monitoring of blood glucose levels. However, the cost of testing your blood glucose is a significant part of your health care costs. New methods are being developed to create the next generation of painless and accurate glucose monitoring in diabetes. The need to develop new methods is explained by the presence of significant limitations inherent in the existing practice of self - monitoring of glucose in the blood.

In 2020, the 200th anniversary of the birth of Ya.A.Chistovich (1820-1885), the founder of a great Russian medical dynasty, is celebrated. Chistovich was a famous domestic forensic physician, hygienist, medical historian. Almost all his professional activities were related to the Military Medical Academy. He owned the initiative to create the first independent hygiene department in Russia. He founded the first forensic department in Russia in a hospital. A significant contribution to the history of domestic medicine is the historical and medical works of Ya.A.Chistovich. Contemporaries remembered him as an extremely hardworking, modest, and versatile scientist. His three sons, grandchildren, and subsequent generations of descendants also connected their lives with medicine; some of them made a significant contribution to the development of domestic medical science.

Formation and development of a system for delivering the wounded and sick by air to medical facilities in the 1920-1930s. Initially, it was determined both by the technical capabilities of the aircraft, and the need to provide medical care to persons who were at a remote distance from hospitals with qualified personnel. The practical experience gained by military doctors in local armed conflicts testified to the significant advantages that the aircraft provided as a vehicle. Based on the analysis of the primary sources, the authors summarized information on the main aspects of the formation and development of aviation evacuation, as a fundamentally new element of medical support for troops in the period between the First and Second World Wars. The primary technical data of aircraft, which during the described historical period were used to solve medical problems, was collected and presented. Statistical data on the transport of the wounded and sick in North Africa and the Middle East by French aviation units are provided. The practical experience accumulated by military experts served as an incentive for the creation of air ambulance services in various countries of the Red Cross-national societies. Information is provided on ways to resolve legal issues governing the flight of ambulance aircraft in peacetime and wartime.