Vol 343, No 12 (2022)

The important climatic-geographical, sanitary, epidemiological and military-professional factors of the Arctic zone of the Russian Federation, which have a significant negative impact on the metabolic health of military personnel, have been studied. The study showed that in young and middle-aged people serving in the Arctic zone, the frequency of registration of metabolic syndrome was significantly higher than in temperate climates. In order to effectively solve the problems of the medical service to prevent metabolic disorders in these conditions, it is recommended to amend the existing legal acts that determine the procedure for medical examination and dispensary observation of military personnel in the Arctic zone of the Russian Federation, considering more thorough control of risk factors and the effectiveness of drug therapy.

The aim of the study was to evaluate the effectiveness of primary health care for patients with COVID-19 at the Medical Center for Premorbid and Emergency Conditions of the Central Military Hospital. The main accounting data for 1150 patients was retrospectively studied (April 2020 – Q1 2022). Assistance was provided by medical and nursing teams that carried out diagnostics, sampling of biomaterial, treatment and transportation of patients to the infection center, doctors of filtration rooms. An increase in the share of completed outpatient cases from 64.3% in 2020 to 89.8% in Q1 2022 and a decrease in the share of hospitalized patients, respectively, from 35.7% to 10.2% are associated with early diagnosis and early treatment, its timely correction and, possibly, a decrease in the pathogenicity of a constantly mutating strain of the pathogen. There were no lethal outcomes. The quantitative indicators of the provision of planned medical care to patients of the medical center remained at the pre-pandemic level.

Community-acquired pneumonia is an urgent problem for the medical service of the Armed Forces. During the pandemic of a new coronavirus infection, several serious problems in the management of patients with lung lesions came to the fore, including the incorrect interpretation of clinical situations, the substitution of terms and, as a result, the wrong treatment tactics. The results of the analysis of the greatest difficulties in the management of patients requiring the return of the attention of the therapeutic service to the issues of determining the severity and prognosis of the disease, the criteria for referring patients to intensive care units and intensive care units, and rational tactics for prescribing antibiotics are presented. On clinical examples, typical mistakes of doctors in the medical center of the unit, the reception and therapeutic departments, the resuscitation and intensive care department of a military hospital were revealed. A special place is given to the diagnosis of community-acquired pneumonia, terminology, antimicrobial chemotherapy and indicators of the quality of medical care for patients with pneumonia in military medical organizations.

An observational descriptive study was conducted in 220 patients aged 18–44 years without comorbidities treated for severe community-acquired pneumonia in the intensive care unit from 2011 to 2017. Acute kidney injury developed in 25.4% of patients and in 85.7% were on artificial lung ventilation. Acute kidney injury significantly increased the duration of hospital stay (28 days vs. 23 days in patients without acute kidney injury), in the intensive care unit (4 days vs. 3, respectively) and mortality (10.7% vs. 0.6%, respectively). By the time of discharge from the hospital, in 99.52% of the surviving patients, the signs of acute kidney injury resolved, diuresis and serum creatinine normalized. At a 3-month follow-up, there were no signs of impaired renal function in all patients. In the treatment of patients with severe community-acquired pneumonia, it is necessary to be vigilant by doctors, monitor kidney function, prevent the development of acute kidney damage, and, in case of its occurrence, promptly start nephroprotection and renal replacement therapy.

The clinical and epidemiological features of the «dry eye» syndrome in patients with diabetes mellitus were studied. According to the data of visits to the outpatient department, the prevalence of this syndrome among patients with diabetes mellitus was 58.2±5.3%, among patients with an ophthalmological profile – 43.7±3.8% (p≤0.05). All patients were diagnosed with corneal-conjunctival xerosis of varying severity as: muco-filamentous discharge in the lower conjunctival fornix (in 61.1% of patients), reduction/absence of the meniscus at the edges of the eyelids (53.7%), local edema of the bulbar conjunctiva (35.8%), roughness and dullness of the cornea (30.5%). Significant discrepancies were found in the rates of tear production disorders depending on the severity of the clinical course of diabetes mellitus (p≤0.05), because of which diabetes mellitus can be considered as a aggravating factor for corneal-conjunctival xerosis.

A study was made of the carriage and serotype landscape of Streptococcus pneumoniae in military personnel upon arrival at the military unit and after 1.5 months of their military service. The work was performed as part of a cohort prospective study involving 190 people. Pneumococcal serotype was determined using the multiplex polymerase chain reaction method. After 1.5 months of their stay in the army, a significant increase in both the number of carriers of pneumococcus and the coefficient of biological diversity of the latter was established. Thus, the conditions of military personnel staying in military units contribute to a significant activation of the mechanism for the development of the epidemic process of pneumococcal infection. The preventive effect of vaccination on this process has been proven. The risk of S. pneumoniae infection in the unvaccinated group was over 5 times higher than in the vaccinated individuals.

The data on modern approaches to the complex treatment of severe combined traumatic brain injury in military personnel are presented. The presented observations demonstrate the justification and success of simultaneous reconstructive surgical treatment with simultaneous neurosurgical and maxillofacial (traumatological) stages with the restoration of damaged anatomical structures.

The material on the history of creation, formation, development and the current state of Branch No. 1 of the N.N.Burdenko Main Military Clinical Hospital is presented. Currently, the hospital is the only specialized institution of the Russian Ministry of Defense, which is entrusted with the tasks of inpatient examination with subsequent medical examination of aviation personnel of state aviation.

On August 19, 2022, within the framework of the International Military-Technical Forum «Army-2022» a round table was held on the topic: «COVID-19 and its consequences: features of the clinical course, achievements in diagnosis, treatment and medical rehabilitation». The round table was attended by employees of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation, the S.M.Kirov Military Medical Academy, specialized research institutes of the Ministry of Defense of the Russian Federation, the N.N.Burdenko Main Military Clinical Hospital named after, the Department of Science and Innovation health development of the Ministry of Health of the Russian Federation. Leading medical specialists of the Russian Ministry of Defense in infectious diseases, laboratory diagnostics, anesthesiology and resuscitation, cardiology, pulmonology and medical rehabilitation made presentations at the event. During the round table, problematic issues were raised and strategic and tactical approaches to their solution were developed, key areas were identified for the revision of guides, as well as further scientific research on the COVID-19 problem in the interests of the Armed Forces of the Russian Federation.