Vol 342, No 5 (2021)

Interest in tactical medicine is due to the change like modern military conflicts, the emergence of new means of saving the lives of seriously wounded service members on the battlefield. The authors analyzed domestic and foreign literary sources in the subject area. The term «tactical medicine» has a right to exist. Simultaneously, the system and content of medical and evacuation measures require further improvement, in connection with which it is necessary to revise the approaches to the volume and timing of medical care in the zones of conflict, evacuation, transportation, supply, and security of personnel. The organization of medical support should improve the provision of medical care, primarily in the combat zone. An increase in the level of military medical training of personnel, saturation with modern means of providing medical care is required. The perspective volumes of the provision of prehospital care by different categories of service members within the framework of the concept of tactical medicine and its modernization in the Armed Forces are presented.

The study aimed to optimize surgical treatment tactics of patients with thermal trauma when a new coronavirus infection is detected to develop recommendations to reduce the likelihood of disease for patients and staff of burn departments. Of the total number of patients (n=593, March - December 2020) of the department of thermal injuries of the SARS - CoV-2 Institute, 18.1% of victims with extensive burns and 11.6% with limited area burns (all transferred to repurposed for the treatment of COVID-19, multidisciplinary hospitals 1-3 days after a positive PCR). Infection of those burned with the virus was accompanied by an increase in mortality by more than 2.5 times, which is due not only to the severity of the course of COVID-19 but also to the difficulties in providing high - tech medical care such patients outside the burn centers. Prevention of COVID-19 in burned patients consists of expanding the indications for outpatient treatment, abandoning planned and reducing urgent interventions, minimizing the use of aerosol - generating equipment and instruments. In re - profiled hospitals, surgical care scope should include bandaging burn wounds and staged necrectomies of a burn scab. To improve medical care effectiveness for such victims, it is necessary to concentrate them in one infectious hospital with simultaneous training of personnel and daily consultations of specialists from burn centers.

The study aimed to identify and evaluate patients’ clinical and angiographic features with recurrent angina pectoris after coronary artery bypass grafting. We examined 113 patients. The total number of shunts was 275, of which 101 were autoarterial (internal thoracic artery in situ), 174 were autovenous. The median of the postoperative period was 58 [48, 75] months. In 51 patients (45.1%; 95% CI 37.8-55.9%), dysfunction of one or more conduits was revealed. The total number of failed shunts was 66 (24%; 95% CI 19.3-29.4%), dysfunction of autovenous conduits was observed 2.6 times more often than autoarterial ones (p<0.001). In most cases, the lesion was occlusive, and its prevalence was significantly higher in patients with accute forms of coronary heart disease (p=0.007). Despite the high incidence of coronary bypass dysfunction, early treatment and timely percutaneous intervention allow angioplasty and graft or coronary artery stenting to be performed in more than 77% of cases with good angiographic and clinical results. The impossibility of endovascular revascularization, as a rule, is determined by a chronic occlusive lesion of the anterior interventricular branch and/or shunt to it, which may require repeated coronary bypass grafting.

The features of adaptive reactions in children with infantile cerebral palsy in the process of rehabilitation and the effectiveness of using botulinum toxin in their complex health - resort treatment were studied. The results of treatment according to the new scheme of 115 children with cerebral palsy are presented. All patients were injected with the botulinum toxin medication «Dysport» according to the health - resort method. One month after the injection and the course of health - resort rehabilitation, the patients showed a significant decrease in spasticity. The effect prevents the transition of limitation of movements in the joint to contracture. The entire treatment process took place against a physiologically favorable background. It is concluded that when a patient with infantile cerebral palsy is undergoing a health - resort treatment, to achieve pronounced positive dynamics in the child’s motor development, the traditional use of preformed health - resort factors must be combined with the administration of botulinum toxin.

Modern ideas about the structure and relationships of microorganisms in communities are analyzed. The leading role of biofilms as the cause and mechanism of the development of infectious pathology, the formation of resistance to antibacterial drugs. Is shown the analysis of current clinical guidelines and individual experimental and clinical studies in the subject area. The need to revise the concept of the pathogenesis of chronic infections by introducing existing data on biofilms into it is emphasized. In practical terms, this requires the use of new methods of diagnosis and treatment. The point of application of the etiotropic approach to biofilms’ effect may be the mechanisms of the initial adhesion of bacteria to the surface, blocking the synthesis or destruction of the polymer matrix, disruption of intercellular information exchange, and exposure to bactericidal agents.

When adapting to training conditions, cadets had serum IgA, IgM within the reference limits; IgG exceeded them in the pre - epidemic period and at the peak of morbidity in the class «Diseases of the respiratory system.» So, at the beginning of the training period, a fourth of the cadets had IgA increased or within the norm’s upper limit. An increase in IgA production to the peak of morbidity indicated the activation of humoral immunity. The amount of IgM after two months of adaptation increased by 1.8 times. An increase was found in 76.7% of the examined. At the beginning of the observation, the 75 quartiles of the IgG border were within the upper limit of the norm. In the pre - epidemic period, the median was slightly lower, at the peak of the incidence - outside the normal range. The boundaries of the 75 quartiles during these periods reached 19.92-22.51, while the average limit was 16.5. The immune response in the form of an immediate increase in IgM, then IgG confirmed the presence of target cells (introduction of the pathogen) in the body in the first months of adaptation. This necessitates an early increase in the resistance of the cadets’ organism.

The results of the examination of 162 wounded with pulmonary pathology and various localizations of wounds (head, chest, abdomen, limbs) are presented. The authors revealed hyperventilation syndrome in 36 (22.2%) examined patients. Its clinical characteristics are presented. It was noted that mental disorders occupied a special place in the structure of hyperventilation syndrome. A clear connection was revealed between hyperventilation and the levels of personal and reactive anxiety. As a result of the ongoing comprehensive rehabilitation program for wounded with hyperventilation syndrome using breathing exercises and bioacoustic correction, this syndrome’s clinical manifestations were relieved.

Based on the literature analysis data, the article presents the achievements of Soviet maxillofacial surgeons in traumatology, restorative, and reconstructive surgery of the maxillofacial area during the Great Patriotic War of 1941-1945. Facial injuries were found in 4% of the total number of wounded service members. In contrast, injuries to the facial skeleton bones were 1.5 times more common than isolated soft tissue injuries. The successive transparent system of staged treatment of maxillofacial wounds created during the war years made it possible to return to service 85.1% of soldiers and officers wounded in the face and in the shortest possible time.