Vol 343, No 9 (2022)

The purpose of the study is to determine the main directions for the development of a system of remote telemedicine consultations to improve the quality of ongoing medical support measures for the Armed Forces. From 2016 to 2021, the number of military medical organizations equipped with telemedicine complexes increased 6.4 times (from 8 to 51), and the number of events held increased 16 times (from 100 to 1598), including telemedicine consultations (in emergency, urgent and planned forms), educational and research activities. The authors define the main directions for the development of the system such as: increasing the role of the leading medical specialists of the Ministry of Defense and military medical organizations; development of a list of activities required to be carried out in the system of remote telemedicine consultations; expanding the list of medical support measures recommended for implementation using telemedicine technologies; attracting more resources from military medical organizations of military districts (fleet) to provide telemedicine measures in the territorial system of medical support for troops (forces); a gradual increase in the information’s capacity system, data processing and storage center in proportion to the number of military medical organizations equipped with telemedicine systems.

27 Scientific Center of the Ministry of Defense of the Russian Federation, Moscow, Russia

The article considers the possibility of using toxins for terrorist purposes, based on their known properties based on the generalization and analysis of open publications of Russian and foreign experts. The definition of toxins is proposed, their classification is considered, and a comparative assessment with pathogenic biological agents and toxic substances is given. It has been shown that toxins are several orders of magnitude more toxic than nerve agents. A list of toxins that pose the greatest danger in the event of an act of bioterrorism, including with the use of postal items, is given.

The P.V.Mandryka Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation, Moscow, Russia

In order to prevent the formation of long-term seromas after alloplasty of inguinal hernias, we have proposed a method for forming an additional layer capable of absorbing serous fluid. A non-free peritoneal flap is cut out from the wall of the hernial sac, fixed over the implanted mesh, maintaining viability and ensuring rapid absorption of fluid from the periprosthetic space. A positive effect is the absence of direct contact between the mesh and the spermatic cord, which reduces the manifestations of implant-associated inflammation in the tissues of the spermatic cord. This method has received an author’s patent for the invention No. 2636872 dated September 20, 2016. We studied the possibility of preventing seroma by this method in 25 patients in the period from 2017 to 2021 on the day after the operation, serous fluid in the periprosthetic space was noted in 15 (60%) cases, one developed a complication, and the average postoperative bed-day was longer by 1 day.

One of the most severe complications in the long-term period after reconstructive operations on the abdominal aorta is aortoenteric fistula, the lethality in the formation of which is over 90%. To date, there are no methods for preventing this condition in the literature, there are only instructions for combating an already developed complication, the mortality rate in radical surgical treatment of which also remains extremely high (9–17%). Based on their own experience (174 patients), the authors planned the stages of the pathogenesis of a duodenal defect with the subsequent formation of an aortoenteric fistula, and developed a scheme for the primary prevention of complications. Observations of operated patients (since 2012) have shown that the proposed method of prevention is an effective way to prevent fatal bleeding from the area of the central anastomosis between the abdominal aorta and an artificial blood vessel.

The purpose of the study is to evaluate the effectiveness of the third stage of medical rehabilitation of patients with pathology of the nervous system in a multidisciplinary sanatorium in terms of the dynamics of clinical and functional indicators and quality of life indicators. The study (2020–2022) included 240 patients (217 men, 33 women, mean age 40.12±1.03 years) with temporary functional disorders of the central or peripheral nervous system. For the main group (n=140), individual medical rehabilitation programs were developed considering the syndromic-pathogenetic approach and under evidence-based clinical guidelines. Patients of the comparison group (n=100) were treated with physical factors without considering clinical recommendations. Patients noted an improvement in the quality of life, more pronounced in the main group. The effectiveness of individual programs in the main group was 88%, in the comparison group – 67%.

Adaptation to civilian activities during the dismissal of military personnel in the reserve causes them certain difficulties. This determines the relevance of studying personal characteristics, on which the effectiveness of socio-psychological adaptation to civilian life depends. The data got during the study show that the adaptability of retired military personnel is satisfactory or reduced, while the adaptive potential of men is higher than that of women. For the studied professional sample, externality is determined in relation to health, failures, and industrial relations. The internal level of subjective control is revealed in the sphere of achievements, in family relations, in interpersonal relations. The servicemen of the reserve are satisfied with their work at the end of their service in the army. The relationship of moral modality with the external locus of personality control in health, place of residence, communication skills and job satisfaction was revealed. The results got can form a system of psychological support measures for discharged servicemen in order to increase the efficiency of their adaptation to the conditions of civilian life.

A study was made of the mechanisms of changes that occur in water-electrolyte metabolism and kidney function during diving descents under conditions of high pressure of the gaseous medium, hypoxia, hyperoxia, toxic concentrations of nitrogen and decompression gas formation. 44 male divers aged 19–23 were examined. Emerging changes in the subjects were determined using oral renal exercise tests and registration of hormonal manifestations. It was revealed that the mechanisms of regulation of water-electrolyte metabolism and kidney functions under conditions of decompression gas formation, hypoxic hypoxia, toxic effects of nitrogen and oxygen are determined by changes in the functioning of the renin-angiotensin-aldosterone system. Changes in water and electrolyte metabolism that occur under the influence of hyperbaric factors on unstable subjects are because of stimulation of the sympathetic nervous system, an increase in the activity of neurons in the posterior hypothalamus, an effect on the functioning of vascular α-adrenergic receptors, and an effect on the respiratory system because of an increase in the density of the respiratory gas mixture. In subjects with high resistance to hyperbaric factors, the activity of the excretory system is aimed at increasing the excretion of sodium and chlorine in the urine, as well as at the development of polyuria – «pressure diuresis».

The purpose of the study is to evaluate the requirements for the quality of medical oxygen 93%, obtained by the technology of short-cycle heatless adsorption, imposed in FS.2.2.0037.22 «Oxygen 93%», and to substantiate ways to improve the organization of its quality control in medical divisions of formations and military medical organizations. Scientific and methodological approaches to the substantiation of controlled quality indicators of this type of medical oxygen are presented. When operating adsorption plants, medical organizations must provide and control the volume fraction of oxygen and regulated impurities, which can be determined by alternative methods. Improving the organization of quality control of medical oxygen 93% in medical organizations consists in several measures, including the completion of adsorption installations with devices for monitoring the most important indicators of the quality of medical oxygen in the «on-line» mode, similar to the implemented technical solution in MUPC-KBA-93.

The literature data on the frequency of congenital malformations of the inferior vena cava system and their significance in the formation of venous insufficiency are analyzed. An own clinical observation of a case of successful endovascular intervention with hypoplasia of the external iliac and common femoral veins is presented. The necessity of the presence of caution in the doctors of draft military commissions, military units, regarding the possibility of the existence of congenital defects of the venous system in young military personnel is emphasized.

Until now, there have been no attempts to evaluate the contribution of the Military Medical Academy to the development and exploration of Antarctica – the article opens a series of publications devoted to this issue. In 1820, graduates of the Medico-Surgical Academy, who were part of the expedition of Bellingshausen and Lazarev as ship doctors, were among the discoverers of the new continent. Since 1956, the period of constant operation of the domestic Antarctic expedition begins – until 1991, the Soviet, and then the Russian. Since 1959, military doctors – graduates and employees of the Military Medical Academy – have been participating in Antarctic expeditions. The main purpose of the polar doctor of the Antarctic expedition is to provide qualified medical help to winterers, but this does terminate there. The medical personnel of the Antarctic stations actively participate in implementing various programs of scientific study of the southern continent, a significant part of which is devoted to the problems of biology, medicine and related disciplines. Scientific research carried out by representatives of the academy has become part of the common scientific heritage of the Antarctic expeditions. To study the Academy’s contribution to the history of Antarctic expeditions comprehensively, the authors analyzed and summarized numerous publications of polar doctors, unpublished documents, and some archival materials. In this article, the authors dwelled on the periodization of the stages of exploration and study of Antarctica and characterized the composition of the participants from the academy, their total number, distribution by the number of wintering carried out, by dislocation points (Antarctic stations), professional specialization, structural divisions of the academy. Based on the analysis, conclusions were drawn about the high activity and noticeable representation of the Military Medical Academy in the development and study of Antarctica.

The article is devoted to the branch health-resort «Avrora» of the health-resort complex «Sochi» of the Ministry of Defense. The history of formation and the main periods of development of this health-resort institution are outlined. In the current state, the possibilities for health-resort treatment and rehabilitation of military personnel (including reserve and retired) and their families are shown.