Vol 344, No 8 (2023)

A prospective analysis of the treatment of patients with abdominal wounds evacuated to the clinic of military field surgery of the Military medical Academy from the area of the Special military operation was carried out. The majority of patients (89.7%) were delivered 2–4 days after the injury. Shrapnel wounds (84.2%) prevailed over bullet wounds (15.8%). The proportion of combined injuries was 98.4%. The vast majority of the wounded (71.6%) at the previous stages of medical evacuation (levels 2–3), surgical intervention in a reduced volume was performed within the framework of the use of Damage Control (DCS) tactics for medical and tactical (61.2%) and vital (10.4%) indications, the tactics of simultaneous surgical treatment (ETC) with complete elimination of damage was implemented much less frequently – in 8.3% of cases, the tactics of Non-Operation Treatment (NOT) tactics – in 13.5% of cases. Operations for undiagnosed abdominal injuries were performed in 14.2% of cases. The mortality rate among the wounded with penetrating abdominal wounds was 8.4%.

The article is devoted to the psychological aspects of the activities of the military personnel of the NBC protection troops in carrying out measures to counter the spread of a new coronavirus infection. The influence of the level of theoretical and practical training of the personnel of operational groups of special processing on its moral and psychological state in performing assigned tasks is considered. Using the method of an expert survey of military personnel, several indicators were assessed that characterize working conditions, the organization of the workplace, technical means of special processing, and well-being during actions in the working environment using personal protective equipment. Authors showed the necessity of preliminary theoretical studies and practical trainings. This makes it possible to improve the results and quality of the work carried out, increase the stress resistance of military personnel, and reduce the level of exposure to psycho-traumatic factors when working in the contaminated area using personal protective equipment and technical means of special treatment.

The effectiveness of endovascular correction of hemodynamically significant atherosclerotic stenosis of the renal arteries in patients with resistant vasorenal hypertension was analyzed. It was shown that after endovascular interventions, blood pressure levels significantly decrease in all patients, the number of antihypertensive drugs significantly decreases, while the dynamics of kidney functional parameters depend on their initial state. The possibility of developing radiopaque nephropathy in the early postoperative period should be considered. Correction of renal artery stenosis due to atherosclerosis is recommended for resistant hypertension.

Pulmonary embolism ranks third in the structure of cardiovascular mortality. Clinical manifestations of pulmonary embolism are non-specific, there are no express confirmation systems similar to the troponin test in acute coronary syndrome. Due to these reasons, some patients die both before hospitalization and directly in the hospital due to late and/or improper treatment. The leading factors of venous thromboembolism at a young age are injuries and surgical treatment; pregnancy, in vitro fertilization, the postpartum period and contraceptive use; oncological diseases, thrombophilia, long air travel, infectious diseases, and intravenous drug use. Most cases of pulmonary embolism under 50 years of age are unprovoked, and it is difficult to establish its cause and eliminate the risk factor. Therefore, there are difficulties in secondary prevention, associated with the establishment of the required period of ongoing anticoagulant therapy and possible hemorrhagic complications during its indefinitely long duration.

Kidney damage is common in patients with COVID-19, which is associated with a poor prognosis. The causes and mechanisms of nephropathies, structural disorders, the course of acute kidney injury and chronic kidney disease in the acute phase of the disease, and renal disorders in the post-COVID period are considered. The features of the treatment of a new coronavirus infection in kidney diseases and the treatment of nephropathies in COVID-19 are presented. Attention is drawn to the constant monitoring of the nephrological safety of all prescribed drugs. Early rehabilitation can prevent kidney damage in the post-COVID period. This review highlights only part of the questions that the new coronavirus infection poses to the medical community. More research is needed to answer the many unresolved problems of kidney damage in COVID-19.

The results of the analysis of the main statistical and spectral indicators of heart rate variability in servicemen with signs of fatigue of varying severity are presented. It has been shown that the state of fatigue is significantly associated with a low value of the standard deviation of R–R intervals (SDNN), the total power of the spectrum (TP), a decrease in the variation range (MxDMn), and the mode of RR intervals (Mo). At the same time, a characteristic increase in the vagosympathetic index (LF/HF), stress index (SI), and the indicator of the adequacy of regulatory processes (PAPR) according to Baevsky R.M. was revealed. It has been determined that a high correlation of various indicators of heart rate variability with each other allows using only a part of the most resistant to registration defects and easily interpretable heart rate variability metrics as a screening of the functional state of military personnel: SDNN, LF/HF and PAPR. The limited informativeness of the method of analysis of heart rate variability for direct prediction of the quality of operator activity is noted.

Improving the means and methods of preventive and therapeutic measures in the system of medical and biological protection of the troops and the population of Russia can be implemented through the use of various immunomodulators, including probiotics based on non-pathogenic saprophytic microbes. One of them is the drug Biosporin, designed based on aerobic spore-forming microorganisms of the genus Bacillus. The domestic industrial production of biosporin provides for the production of a limited number of finished dosage forms – a lyophilization for the preparation of a suspension in vials and the form of tablets. The article presents the results of a study of the general problems of the use of probiotics in the system of medical and biological protection of the troops and the population of Russia, the shortcomings of the manufactured ready-made forms of biosporin, and the areas of effective use of biosporin capsules. It has been shown that biosporin is competitive in the domestic and world pharmaceutical markets, is promising for use in military medical practice, and therefore it is extremely important to develop the composition of its encapsulated form, the main operations, processes, and technology for its production.

Data are presented on the features of the course of a new coronavirus infection COVID-19 in patients with cardiovascular diseases and, in particular, with arterial hypertension, as well as on a higher incidence of adverse outcomes in this group of patients. The article touches upon information about additional risks in patients with arterial hypertension against the background of coronavirus infection, including those associated with antihypertensive therapy, and approaches to the management of such patients.

An indispensable component of the treatment and rehabilitation of patients with degenerative-dystrophic diseases of the spine is therapeutic physical culture. However, this method is not always used in the treatment of such patients for various reasons related to organizational issues, the mentality of the patient, the material base of the medical institution. The severity of the influence of therapeutic physical culture on the results of treatment of patients with degenerative-dystrophic diseases of the spine and on their quality of life, the degree of loss of treatment efficiency due to the lack of therapeutic physical culture in the complex treatment of this pathology were studied according to the experience of the department of therapeutic physical culture of a military hospital.

The article describes the history of the creation of the District Military Medical Commission of the Far Eastern Military District and the formation on its basis of Branch No. 4 of the FGKU «Main Center for Military Medical Expertise» of the Ministry of Defense of the Russian Federation, the formation and development of its activities. The main tasks of the bodies of military medical expertise and the directions of this work are reflected. At present, Branch No. 4 of the Main Center for Military Medical Expertise of the Ministry of Defense of the Russian Federation occupies a worthy place in the system of military medical organizations of the Eastern Military District. At a new stage of development, many years of experience in the work carried out to recruit the Armed Forces, and improve the quality of medical examination and examination of conscripts, military personnel, and former military personnel is preserved and multiplied.