Vol 345, No 7 (2024)

The article presents the structure of sanitary losses at the stage of providing qualified surgical care (Role 2) in the active phase of hostilities, when the enemy uses the entire arsenal of fire weapons. As in the general structure of sanitary losses, shrapnel wounds prevailed – 79.3%. The absolute majority are limb injuries – 81.4%. Combined and multiple injuries account for 70.5 and 20.3%, respectively. The proportion of severe and extremely severe injuries in the active phase of hostilities is higher and reaches 34.6%, which must be taken into account when planning the work of the stages of medical evacuation. Also, in this phase of warfare, there is a high frequency of penetrating abdominal wounds. When working with advanced medical groups in these conditions, it is advisable to reduce the amount of surgical care to urgent measures, and actively use surgical tactics of «damage control». The high frequency of combined and penetrating wounds, as well as a significant proportion of severe limb injuries, naturally determine the need for a multidisciplinary approach – strengthening the advanced stages of evacuation by traumatologists and vascular surgeons in order to carry out emergency specialized surgical care.

The system of quality control of medical care in the activities of a medical organization of any level and departmental affiliation remains an important link. The quality control system and its elements regulated by regulatory legal acts in public health protection extend to a greater extent to the medical units of a medical organization, where the immediate results of public health protection are visible as certain accepted statistical indicators. The divisions of the diagnostic service of a medical organization, functioning in the general system of medical care, remaining an important link in the diagnostic process, do not have criteria for quality control of diagnostic activities. The authors, based on the continuity and connection of all elements of the quality control system, have developed and put into practice quality control criteria for assessing the daily activities of diagnostic units, which increases its objectivity and significantly affects the quality of medical care provided to assigned contingents.

The article reflects the morphological features of external and internal damage to the human body caused by spherical submunitions of the GMLRS type ammunition for the M270 MLRS, M142 HIMARS multiple launch rocket systems and their modifications, as well as damage to clothing. The results of x-ray examination of damage and scanning electron microscopy with energy dispersive x-ray analysis (SEM/EDX) of the damaging elements of the specified type of ammunition are presented. The possibility of diagnosing damage caused by spherical damaging elements of GMLRS type ammunition based on the morphological features of the damage in conjunction with x-ray examination of victims and electron microscopy with an elemental analysis of damaging elements has been shown.

One of the major tasks in the treatment of a gunshot wound is to prevent the progression of secondary necrosis by optimizing local adaptation processes, including by improving regional perfusion. The effect of prolonged conduction blockade of the brachial plexus on the state of microcirculation of the affected limb in patients with mine blast injury was studied. Continuous injection of a local anesthetic solution carried reversible pharmacological sympathetic blockade out to the brachial plexus structures for 10–15 days. A statistically significant increase in transcutaneous oxygen tension in tissues (TcPO2) and a decrease in the level of partial carbon dioxide tension in tissues (TcPO2) were noted, which led to stimulation of repair processes in the affected limbs.

Pulmonary hemorrhage is a serious complication that can occur after direct forceps biopsy and transbronchial lung biopsy. The experience of stopping bleeding after biopsy in 132 patients with various lung pathologies is presented. Aminocaproic acid and the drug «Hemoblock», an incomplete silver salt of polyacrylic acid, were used as hemostatic agents. Researchers carried out a retrospective study on the quality of hemostasis using these agents. The use of the drug «Hemoblock» made it possible to reduce the time required to stop bleeding to 3 minutes, whereas when using aminocaproic acid, this time averaged 24 minutes. Thus, the drug «Hemoblock» allows you to obtain a lasting clinical effect in the shortest possible time. Based on the results obtained, we recommended using the developed method for widespread use in clinical practice.

Currently, Clostridium difficile associated infection (CDI) is the leading cause of nosocomial diarrhea, the incidence of which has a steady upward trend. Higher incidence and severity of CDI have been reported in patients with inflammatory bowel disease. The defeat of the immune system, the similarity of a number of clinical symptoms, the difficulty of choosing adequate therapy make it difficult to manage such patients. The clinical case of the debut of ulcerative colitis in combination with CDI presented in the article shows the difficulty of differential diagnosis of these diseases. The prevalence and severity of the inflammatory process in the patient were due to a combination of two etiological factors — CDI and autoimmune damage to the colon mucosa. Timely diagnosis of CDI enabled optimal treatment, resulting in remission of ulcerative colitis and the elimination of Clostridium difficile associated infection.

The characteristics of emerging and new viral infections are presented. The epidemiological features of infections, such as measles and smallpox, and their causative agents, are examined from a modern perspective. The emergence of new types of viruses is associated with variants of their interspecies transmission and features of interaction with intermediate and definitive hosts. The peculiarities of life of modern humans facilitate the spread of viruses and the emergence of new infections with the emergence of a new dominant intermediate host. Changes in the human genome and immune homeostasis have contributed to increased susceptibility to viral agents. The processes of recombination of viruses contribute to the emergence of new species. It is assumed that animal vaccination options may be promising to control the spread of viral infections, since they are the primary hosts of many viruses.

The variety of damaging factors of special types of weapons determined a change in approaches to the formation of block No. 2 of the individual first aid kit, or «block of special attachments», which are based on the syndromic principle of acquisition and «separation» of sets (modules) of medicines from other medical equipment. The appearance of anti-chemical and anti-radiation protection modules has been determined. The conditions for the provision of first and pre-medical aid are identified, which determine the feasibility of including in wearable kits medications classified as medical protective equipment – the risk of pathological conditions for which assistance can be delayed or provided only as mutual assistance. The introduction of etiotropic therapy drugs (antidotes, serums) is justified as the nature of the damaging factor is verified. The use of antidotes at the end of the toxicogenic phase determines the need to evaluate their effectiveness under conditions of delayed administration. The use of antibacterial agents to avoid the development of antibiotic-resistant strains should be determined as part of a unified strategy, taking into account the continuity of medical care during the stages of medical evacuation.

Damage to peripheral nerves is one of the important links in the pathogenesis of the new coronavirus infection COVID-19. To determine the types and depth of nerve damage, the use of clinical electroneuromyography is required. Data from an analysis of the diagnostic results of 78 patients who had COVID-19 and were observed for damage to the peripheral neuromotor system are presented. The results of the study showed that in patients who have had COVID-19, clinical signs of damage to the peripheral nervous system, manifested in the form of dysfunction of motor and sensory nerve fibers, may persist in the long-term period.

The article analyzes the possibilities of using the ultrasound method for diagnosing prostate cancer and evaluates the sensitivity of ultrasound diagnosis of this pathology in an institution in comparison with all-Russian indicators. It was concluded that to improve the quality of diagnosis of malignant neoplasms of the prostate gland, the ultrasound department needs to work closely with urologists.

The publication describes the professional career and personal participation of the authorized People’s Commissariat of Health of the RSFSR M.I.Baranov in the development of the healthcare system and medical education in Siberia. The features and specific difficulties of restoring medical institutions in the region after the Civil War are noted, statistical data on the surviving medical personnel is provided, and the content of measures to strengthen the social prestige of healthcare workers and their legal status is analyzed. The primary attention is paid to the development of special programs for the organization of systematic medical and preventive measures in the Siberian region. The specific steps of the Commissioner of the People’s Commissariat of Health Baranov to overcome material and financial problems in the healthcare sector are considered. The practical results of Baranov’s activities in expanding the system of training medical specialists, opening an institute for advanced training of doctors in Siberia, increasing the influence and role of the Red Cross Society, disseminating scientific and educational knowledge in medicine were revealed. Assessments of Baranov’s activities by his contemporaries are also given.