Vol 344, No 3 (2023)

The purpose of the study is to determine ways to improve medical care for the wounded with injuries of the musculoskeletal system in modern armed conflict. The essence and content of various types of medical care provided in the combat zone and at the stages of medical evacuation to the wounded with injuries of the musculoskeletal system are outlined. High-intensity combat operations with the use of heavy weapons and remote fire weapons, the use of personal protective equipment determine the prevalence of injuries to the limbs, which require changes in organizational and therapeutic measures aimed at saving the lives of the wounded and achieving acceptable functional results of their treatment. The basic approaches to the treatment of the wounded with injuries of the musculoskeletal system are outlined, which makes it possible to significantly improve the results of treatment. Rapid evacuation of the wounded to specialized traumatological departments of central military medical organizations, the use of modern high-tech surgical interventions and a well-organized system of medical rehabilitation are the basis for achieving high anatomical and functional results of treatment, reducing its duration, reducing the level of disability and dismissal, as well as the basis for the speedy return of the wounded to performance of military duties.

The purpose of the study is to clarify and evaluate methodological approaches to medical sorting of those affected by combined radiation injuries. Medical sorting is carried out considering the threat to life from exposure to both radiation and non-radiation components. Its primary tasks are to eliminate the life-threatening consequences of injuries and traumas, to predict the severity of the radiation component, and to prepare the injured for evacuation. A feature of providing help in the case of combined radiation injuries is sanitization, which in Russia is carried out at all stages of medical evacuation, in contrast to NATO, where it is limited to complete sanitization at the stage of first aid. Most of the triage systems in Russia and NATO are based on the assessment of physiological parameters specific to the etiology of the non-radiation component, the severity of the primary reaction to radiation. The difference between NATO approaches is to combine all categories of weapons of mass destruction into one common group (CBRN) with common organizational principles in response, which simplifies medical triage and the provision of medical care in the case of mass sanitary losses.

The role and place of surgical tactics of damage control in modern combat conditions are shown. Surgical tactics of “injury control” are effectively applied at all stages of medical evacuation. The key sign for the use of “injury control” surgical tactics is the serious and extremely serious condition of the wounded in the case of combined and multiple injuries. The main stage of medical evacuation, where the surgical tactics of damage control are used, is the stage of providing qualified surgical care. At the stages of providing first medical and specialized surgical care, such tactics are used less frequently, but no less effectively. The necessity of using damage control tactics in the work of a military field surgeon and its further improvement is shown.

The aim of the study was to evaluate the efficacy and safety of using immune plasma from donors vaccinated against a new coronavirus infection in patients with severe COVID-19. Patients were divided into 2 groups: experimental (n=105), who received, besides basic therapy (regimen, diet, antiviral, antibacterial, anticoagulant, anti-inflammatory and symptomatic therapy), transfusions of immune plasma from vaccinated donors, and control (n=86), receiving only basic therapy. In the experimental group, there was a significantly shorter period of viral replication of SARS-CoV-2, transfusion of immune plasma did not cause serious adverse events. However, general clinical efficacy in severe COVID-19 did not differ significantly between the groups.

Scientific literature data and clinical practice show a significant role of Yersinia in the genesis of chronic intestinal inflammation in several patients. The aim of this study was to determine the features of the course, diagnosis and treatment of inflammatory bowel diseases in patients with identified markers of yersiniosis. We examined 22 patients with chronic relapsing course of inflammatory bowel diseases in the acute phase, who, despite the ongoing therapy, retained signs of the disease. To establish a yersinia etiology of the disease, additional laboratory tests of blood and feces were performed: detection of pathogenic yersinia by bacteriological and polymerase chain reaction methods, as well as determination of specific anti-yersinia antibodies by enzyme immunoassay and immunoblot. All examined patients received conventional anti-inflammatory and/or immunosuppressive therapy. Because of empirical antibiotic therapy, improvement in clinical parameters was achieved in 24% of patients. Clinical remission was observed in the early stages in 57% of patients receiving etiotropic antibiotic therapy. Experience shows that the achievement of remission of inflammatory bowel diseases with the use of various antibacterial agents in most cases is associated with their use as a starting antibiotic therapy.

A study was conducted to develop the main directions for maintaining the health of medical workers of sanitary and epidemiological organizations during the COVID-19 pandemic. The article presents the results of a hygienic assessment of the working conditions of specialists in the laboratories of departments of especially dangerous infections of the centers of state sanitary and epidemiological surveillance of the RF Ministry of Defense of the Eastern, Central, Western and Southern military districts. The study showed that the working conditions of specialists in terms of the thermal load of the environment correspond to the «Harmful» class (subclass 3.3–3.4), which must be considered when developing preventive measures to reduce the negative impact of working environment factors on the body. A set of preventive measures should be aimed at optimizing the regime of work and the rest of workers. Using personal protective equipment in a heating microclimate and increased physical activity has a negative impact on performing medical personnel. Preventive measures should include the regulation of the time of continuous use of personal protective equipment, considering the need to provide laboratory research.

With the onset of the novel coronavirus infection pandemic, air traffic between China and Russia was suspended from February 1, 2020, while some Russian citizens could not return to Russia. Under the decision of the President of the Russian Federation, their evacuation by air transport of the Ministry of Defense was organized, for which a merged detachment of medical specialists was formed comprising 5 medical and nursing teams (each with an epidemiologist, a general practitioner (infectionist) and 2 nurses), representatives of the radiation troops, chemical and biological protection. The evacuation was carried out simultaneously by two Il-76MD aircraft. During the flight, every 2 hours, passengers were subjected to thermometry with electronic thermometers and thermal imagers, regular questioning of complaints, and replacement of disposable protective masks. In total, 144 people were evacuated, including 128 Russian citizens.

Using the example of the Moscow Military Hospital (now the N.N.Burdenko Main Military Clinical Hospital), the article tells about the history of women’s care for wounded soldiers. For the first time, several archival documents are published on the activities of full-time nurses in military hospitals and, in particular, in the Moscow military hospital, on helping wounded soldiers of sisters of various communities of mercy, etc.

In November 2022, in St. Petersburg, under the leadership of the chief urologist of the Ministry of Defense, a scientific and practical conference (gathering of urologists of the Ministry of Defense of the Russian Federation) «Trauma of the genitourinary system. Innovations in Urology», dedicated to the 80th anniversary of the Urology Department of the Military Medical Academy. The conference was attended by chief specialists of urological centers and departments of hospitals of central subordination, district (naval) hospitals and their branches, chief urologists of the Russian law enforcement agencies (Ministry of Internal Affairs, the Russian Guard and the Ministry of Emergency Situations), heads of specialized departments of medical universities and leading urologists of St. Petersburg, as well as the faculty of the Urology Department of the Military Medical Academy, and the clinic staff and students of the academy. The main directions of providing urological care for injuries of the urogenital organs in modern hybrid wars and wars of a new type, the problems of high-tech medical care in military urology, including the prospects for the use of robot-assisted and minimally invasive operations were discussed.