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Vol 342, No 4 (2021)


Experience in deploying multifunctional medical centers of the Ministry of Defense in the extreme conditions of the COVID-19 pandemic

Trishkin D.V., Sergoventsev A.A., Bryzgalov M.V., Komkov D.S., Golubkov A.V., Smolskii E.A.


Information on the stages of a pandemic of a new coronavirus infection caused by SARS-CoV-2 is provided. The necessity and feasibility of building medical centers on the basis of prefabricated structures on the territory of military hospitals are shown. The article covers the regulatory, organizational, and economic aspects of the design and construction of multifunctional medical centers in 15 regions of Russia. The developed conceptual and technological solutions are adopted as standard and essential. They are used to create multidisciplinary medical centers in several Russian Federation regions with an unstable epidemic situation. The measures taken on time by the leadership of the medical service of the Armed Forces did not allow the explosive growth of the spread of the new coronavirus infection in the army and the navy, to ensure the provision of medical care to patients not only from among the military personnel and members of their families but also to the civilian population. All centers are capital construction projects and can be used for over 30 years. Since the opening, specialists of multifunctional medical centers have provided medical care to more than 13 thousand patients, including 7.4 thousand patients with COVID-19.
Voenno-medicinskij žurnal. 2021;342(4):4-11
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Modern technologies of medical rehabilitation of traumatological patients in the health resort organization of the Ministry of Defense

Dolgikh S.V., Kirsanova A.A., Kovlen D.V., Abuseva G.R., Ivashchev V.V., Ostapenko S.N., Guseva A.V.


The development of innovative non - drug technologies and high - tech medical services in trauma patients’ medical rehabilitation is one of medicine’s priority tasks. The introduction of modern technologies of physical and rehabilitation therapy into the rehabilitation programs for patients with diseases and injuries of the musculoskeletal system can significantly increase rehabilitation measures’ effectiveness. The development and scientific substantiation of modern technologies for the complex rehabilitation of such patients should be based both on a comprehensive practical experience of their use and the analysis of evidence - based studies to assess the effectiveness of using physical methods in patients with diseases and injuries of the musculoskeletal system.
Voenno-medicinskij žurnal. 2021;342(4):11-17
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Experience in the organization of prosthetics and medical rehabilitation of service members with limb amputation

Yudin V.E., Yaroshenko V.P., Popravka S.N.


The study aimed to assess the effectiveness of medical rehabilitation and prosthetics of wounded service members with amputation defects of the limbs in a treatment and rehabilitation center’s conditions. Amputation defects of the lower extremities were found in 71.2% of the victims, the upper ones - in 18.7%, multiple amputations (from 2 to 4 limbs) - in 9.9% of the victims. There are three stages in the process of prosthetics and medical rehabilitation. The first includes medical rehabilitation in preparation for prosthetics, the second - directly prosthetics, the third - final rehabilitation with training in using the prosthesis. The timely use of reconstructive surgical interventions aimed at eliminating defects and diseases of the stumps of the extremities, the introduction of medical and training prosthetics, and the implementation of comprehensive medical rehabilitation at all stages of prosthetics made it possible to shorten the start of prosthetics by 2-3 weeks, improve the quality of life of patients - energy, sleep, emotional reactions, physical activity.
Voenno-medicinskij žurnal. 2021;342(4):18-25
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Voenno-medicinskij žurnal. 2021;342(4):25
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Syndromic pathological processes in toxic and radiation injuries: assess their mechanisms and search for pharmacological correction approaches

Chepur S.V., Yudin M.A., Drachev I.S., Tyunin M.A., Basharin V.A., Pronina E.V., Morozov E.V., Stepanov V.A., Mosin A.V.


A comparison of the syndromes of somatic and neurological diseases with pathological conditions arising from toxic and radiation injuries and the reproduction of which is excluded when studying the effectiveness of medical protective equipment has been carried out. Considering the pathogenetic commonality of syndromic processes, the possibility of using the results of clinical trials of drugs to create medical remedies and adjusting experimental data regarding the prognosis of effective and safe doses of drugs is shown. Formation of the concept of syndromic conditions will expand the possibilities for assessing the effectiveness of medications concerning the means of pathogenetic and symptomatic therapy of toxic and radiation injuries.
Voenno-medicinskij žurnal. 2021;342(4):26-30
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Skin reconstructive plastic surgery in patients with unformed intestinal fistulas

Demko A.E., Zinovev E.V., Pogosov N.V., Batyrshin I.M., Soloshenko V.V., Fomin D.V., Krainyukov E.P.


The study aimed to determine the indications and the possibility of performing skin grafting to eliminate laparostomy wounds in the treatment of unformed intestinal fistulas. The experience of surgical treatment of 62 patients with unformed intestinal fistulas is generalized. Single fistulas were observed in 37 (60%) patients, multiple fistulas - in 25 (40%) patients. The results of the use of the developed staged approach in the treatment of such a category of patients, which provides for the temporary closure of the laparostomy at the first (preparatory) stage due to free autodermoplasty, counter displacement of skin - fatty or skin - fascial flaps, or a combination of these techniques, performed after preparation of the wound defect of the laparostomy under conditions negative pressure. At the second (reconstructive) stage, the method of choice for the final closure of the abdominal cavity is the component - wise division of the abdominal wall and combined skin grafting techniques. The early use of free autodermoplasty is also recommended to close the eventration with the development of purulent complications after the component - wise division of the anterior abdominal wall.
Voenno-medicinskij žurnal. 2021;342(4):31-38
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Problems of diagnosis and treatment of central serous chorioretinopathy in medical organizations of the Ministry of Defense

Kulikov A.N., Vasilev A.S., Burnasheva M.A., Maltsev D.S.


The clinical characteristics of patients with central serous chorioretinopathy who were treated in the structures of the medical service of the Ministry of Defense of the Russian Federation were studied by analyzing the database of the S.M.Kirov Military Medical Academy. We performed a retrospective analysis of patients’ medical records for the period 2017-2019, who were examined using multimodal imaging, including fluorescence angiography and optical coherence tomography. In total, 79 patients with an average age of 44.8±10 years were selected for the study, of which 26 military personnel and 26 non - departmental patients were chosen for comparative analysis. It was determined that the disease’s initial severity, assessed by the subfoveal thickness of the choroid, was higher in the group of military personnel, which also had worse functional outcomes compared with unknown patients. Military personnel admitted for treatment from district hospitals have an increased incidence of glucocorticosteroid use as first - line treatment for central serous chorioretinopathy, resulting in part account for the greater severity and worse outcomes of the disease in this group.
Voenno-medicinskij žurnal. 2021;342(4):39-47
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Risk factors for gastrointestinal bleeding in patients with acute coronary syndrome

Balabanov A.S., Gordienko A.V., Serdyukov D.Y.


The article gives an idea of the main risk factors that are predictors of gastrointestinal bleeding in the treatment of patients using double and triple antiplatelet therapy regimens for the acute coronary syndrome. 65 men with the acute coronary syndrome were examined. Most patients have a high prevalence of risk factors for bleeding (over 65 years of age - 80%, arterial hypertension - 49%, renal dysfunction - 57%, anamnesis of the complicated course of peptic ulcer disease - 21.5%) and the need for prophylactic administration of secretolytics. Many patients who underwent percutaneous coronary intervention due to acute coronary syndrome, due to the high risk of gastrointestinal bleeding, should take a long - term therapy with proton pump blockers (omeprazole, rabeprazole). The intake of rabeprazole is preferable for this category of patients due to the smaller number of dyspeptic complaints, a long antisecretory effect, and the optimal cost of the drug.
Voenno-medicinskij žurnal. 2021;342(4):47-52
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Multiple thromboses of the pulmonary artery branches as the onset of primary antiphospholipid syndrome (clinical observation)

Starikov V.N., Tsokolov A.V., Kalenitskaya A.O., Trofimets A.I., Zhukov D.E.


The description of the antiphospholipid syndrome and its clinical observation of multiple pulmonary artery branches’ multiple thromboses at the onset of the primary antiphospholipid syndrome in a 46 - year - old patient is given. The final diagnosis of the underlying disease: Primary antiphospholipid syndrome with plasma circulation of lupus - type anticoagulants, antibodies to beta - 2 - glycoprotein, cardiolipin. Condition after thrombosis of medium and small branches of the pulmonary artery. He was certified by the military medical commission - not fit for military service. It is concluded that timely comprehensive laboratory and instrumental diagnostics in severe multivessel pulmonary artery disease (thrombosis, embolism) within the primary antiphospholipid syndrome framework ensures adequate treatment and prevention of early and delayed life - threatening complications.
Voenno-medicinskij žurnal. 2021;342(4):53-58
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Voenno-medicinskij žurnal. 2021;342(4):58
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Plasma processing of medical waste

Artemov A.V., Pereslavtsev A.V., Voshchinin S.A., Tresvyatskii S.S., Korobtsev S.V.


The data on the processing of medical waste using a high - temperature plasma converter complex with a total capacity of 12.5 thousand tons per year and a technological scheme for obtaining basalt - like slag, electrical and thermal energy are presented. According to a particular program, the calculation of the leading technical and economic indicators of the converter operation was carried out; the authors analyzed the influence of the main technological parameters on them. The optimal modes of the process were selected. The calculation results showed the possibility and prospects of using plasma technology for the neutralization of medical waste. Its advantages are complete and safe disposal of waste without affecting the environment, the production of useful products, the absence of toxic emissions, cost recovery, the ability to process a mixture of medical and municipal waste.
Voenno-medicinskij žurnal. 2021;342(4):59-65
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The use of reflexology in the treatment of asthenic - vegetative syndrome in military personnel who have undergone COVID-19

Kuvshinov K.E., Khritinin D.F., Tyan V.N., Karakozov A.G., Gryaznova O.I., Katenko S.V., Ragozhin Y.E., Karakozova M.G., Levchenko O.B., Molodova A.I.


From March to October 2020, 125 officers (all male) who had undergone COVID-19 were treated at the 9th Diagnostic and Treatment Center of the Ministry of Defense. Patients of the main group (n=67) received complex treatment following the clinical guidelines to treat new coronavirus infection (medication, physiotherapy, exercise therapy, diet). The complex treatment scheme also included reflexology. Training sessions were conducted on cognitive training and mastering self - relaxation techniques. Patients in the control group (n=58) received standard therapy. Significant regression of the asthenic - vegetative syndrome’s main symptoms was observed in 81% of patients in the main group and 31% of the control group. An improvement was noted in 19 and 25%, respectively. Little or no effect was observed in 44% of the servicemen in the control group.
Voenno-medicinskij žurnal. 2021;342(4):66-67
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Impact of the COVID-19 pandemic on government procurement of medicines and consumable medical supplies

Dadazhanova E.E., Tatarintsev S.G., Uskov A.V., Cherepkova T.N.


The COVID-19 pandemic has been included in the list of reasons for force majeure in public procurement as a necessary mechanism for conducting public procurement in particular conditions. At the same time, customers received the right to conduct public procurement, guided by clause 9 of part 1 of article 93 of Federal Law 44-FZ. The study’s purpose was to assess the impact of the COVID-19 pandemic as a force majeure circumstance on public procurement of goods, works, and services to meet the country’s defense and state security needs analyze their economic efficiency. The analysis of auctions from March to June 2019 and 2020 showed a decrease in the number of competitive procedures by 20.7% - from 1721 to 1365. The consequence of this was a decrease in procurement activities’ economic efficiency and an increase in budgetary funds’ expenditure due to the absence of lower price alternatives.
Voenno-medicinskij žurnal. 2021;342(4):68-69
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Arterial hypertension and atherosclerosis: a comparative analysis of indicators of daily monitoring of blood pressure

Fursov A.N., Kryukov E.V., Potekhin N.P., Chernov S.A., Zakharova E.G., Makeeva T.G., Lyapkova N.B.


A comparative analysis of indicators of daily monitoring of blood pressure in patients with arterial hypertension against the background of atherosclerosis and in its absence was carried out. Differences in the increase in diastolic and systolic blood pressure levels, its variability during the day, and indicators of arterial stiffness are shown. Patients with atherosclerosis are characterized by an insufficient or excessive decrease in blood pressure at night. Achievement of target blood pressure levels against the background of combined antihypertensive therapy is more typical for patients without atherosclerotic lesions of the arterial bed.
Voenno-medicinskij žurnal. 2021;342(4):70-73
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Prevalence of foci of odontogenic infection in periapical tissues in military personnel in the Republic of South Ossetia’s military garrison

Pavlovets S.A., Grebnev G.A., Kul’nev S.V., Zheleznyak I.S.


A study was carried out to study the prevalence of pathological changes in the dentoalveolar system in service members of the military garrison of the Republic of South Ossetia using a panoramic X-ray diagnostic dental apparatus. Were examined 1,017 military service members under contract and conscription, aged 18 to 59 years. The authors obtained information on the presence of odontogenic foci of infection in the periapical tissues and other pathological changes in the dentoalveolar system that a dentist did not diagnose during a clinical examination of the oral cavity. The survey results confirm the need to include orthopantomography in the standard of critical studies for the in - depth medical survey of service members.
Voenno-medicinskij žurnal. 2021;342(4):73-75
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On the treatment of precancerous lesions of the skin with the help of external local preparations

Lamotkin I.A., Selezneva E.V., Khlebnikova A.N., Smirnova L.M., Anpilogova E.M., Lamotkin A.I.


The efficacy of various topical therapy drugs for actinic keratosis and Bowenoid papulosis in 70 patients was studied, which amounted to 100%. However, the minimum duration of treatment in combination with the completed epithelization after discontinuation of the use of drugs was different: for Mardil Selen® and Mardil Zinc® Max - 7 days, for Podophyllotoxin - 15 days, 5% of 5-fluorouracil cream - 35 days, for Imiquimod - 112 days.
Voenno-medicinskij žurnal. 2021;342(4):76-77
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The efficiency of carotid endarterectomy in patients with ischemic stroke

Litvinenko M.A.


To assess carotid endarterectomy’s effectiveness, 72 patients with ischemic stroke and hemodynamically significant stenosis of the head’s main arteries were examined. In 57 patients, revascularizing operations were performed on the head’s main arteries at various periods of ischemic stroke; 15 patients received only conservative therapy. It has been shown that carotid endarterectomy has a positive effect on cognitive functions and reduces the neurological deficit in patients operated earlier after a stroke than patients who underwent surgical treatment in the late recovery period of stroke.
Voenno-medicinskij žurnal. 2021;342(4):78-80
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Voenno-medicinskij žurnal. 2021;342(4):80
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Ivan Ivanovich Makaveev - the last head of the Imperial Military Medical Academy

Poddubny M.V., Petrov R.E.


The biography of I.I.Мakaveev (16(28).09.1846-04.03.1921), who headed the Imperial Military Medical Academy in 1913-1917, is presented. The causes and consequences of the 1913 crisis, connected with introducing the new «Regulations» on the Academy, are considered in detail. Some new facts related to the Military Medical Academy’s history at the beginning of the 20th century are presented. Most of the archival documents are published for the first time.
Voenno-medicinskij žurnal. 2021;342(4):81-90
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Voenno-medicinskij žurnal. 2021;342(4):90
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Voenno-medicinskij žurnal. 2021;342(4):91-93
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Voenno-medicinskij žurnal. 2021;342(4):94-96
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