Vol 345, No 10 (2024)

The subject area of hygiene as a leading preventive science, academic discipline and practical area of activity, its key elements have been clarified: study of patterns of interaction between environmental objects and human health; planning and implementation of sanitary-hygienic (preventive) and anti-epidemic measures on their basis; subsequent evaluation of their effectiveness, if necessary – correction of preventive programs and hygienic standards; their legal registration at the legislative, executive state, departmental, regional levels. Methodological approaches to conducting hygienic analysis based on empirical and theoretical methods of cognition have been developed. The expediency of a systems approach in relation to hygienic analysis of health and morbidity as an independent subsystem in hygienic diagnostics has been shown. The options, types, forms, methods of hygienic analysis in the system of hygienic diagnostics, adequate to the tasks to be solved, target settings, capabilities of forces and means when conducting diagnostic procedures in preventive medicine have been substantiated.

The article presents the structure of fatal injuries typical for a modern major armed conflict. The features of gunshot, explosive, thermal and other types of combat trauma are shown depending on the damaging factors, localization of injuries, their number and combination. Blast (74.5%) and gunshot (14.7%) injuries were predominant. Isolated injuries often occur when wounded by fragments of explosive devices and bullets fired from firearms, while combined injuries occur because of gas-detonation and thermal effects during an explosion. Taking into account the area of the body surface that falls on the damaged part, the head and neck are the most vulnerable. In isolated cases, injuries to the head, chest and lower extremities are most often fatal, while death because of limb injury is not a natural occurrence (the «potentially survivable» group).

The article summarizes modern Russian and foreign data on the endovascular endoprosthetics of the aortic arch and its branches. The authors gave a description of the unique, first-time operation of total endoprosthetics of the aortic arch and its branches in a wounded person with post-traumatic aneurysm of the aorta and its branches. The advantages of this method and complications are shown. This clinical case demonstrated the significance and high potential of endovascular methods in the treatment of complex combat injuries of the thoracic aorta. Endoprosthetics of the aortic arch using supra-aortic endodebranching is an effective and alternative method of treating patients with pathology of the thoracic aorta in whom, for various reasons, traditional prosthetics under artificial circulation cannot be performed.

An analysis of the literature indicates that there is no consensus on the choice of the most effective and safe endoscopic method and timing of drainage of pancreatic fluid formations. The results of the clinical study demonstrate the advantages of endoscopic active transmural drainage of high-density fluid formations in clinical success and lower incidence of complications compared to endoscopic passive transmural drainage. A relationship was revealed between the density of delimited fluid accumulations, the method of endoscopic drainage, clinical effectiveness and the rate of complications. When assessing long-term results, the minimum terms for stent installation were determined. Endoscopic drainage methods can eliminate pancreatic hypertension, create conditions for restoring the integrity of the pancreatic duct, or the formation of a persistent internal pancreatic fistula.

Compliance in medicine, and in dentistry in particular, is an indicator of a patient’s adherence to the doctor’s recommendations, which allows one to predict the outcome of treatment. Following the specialist’s recommendations is inextricably linked with the warranty period and service life of both dental therapeutic restorations and orthopedic structures, including those supported by dental implants.

The use of diuretics in combination with antihypertensive drugs can cause hypokalemia, the manifestations of which are largely nonspecific and, in some cases, occur under the guise of acute conditions. The publication presents a clinical case of severe symptomatic hypokalemia that developed during long-term use of a combination of antihypertensive drug containing amlodipine, perindopril and indapamide. The advisability of monitoring serum electrolytes when prescribing thiazide-like diuretics to patients with arterial hypertension is shown.

The Department of Outpatient and Polyclinic Care of the S.M.Kirov Military Medical Academy has come a long way from a non-staff, experimental training unit of the academy to a regular formation with its own clinical base, its own traditions and views. October 15 – the date of the first lesson – is traditionally celebrated as the birthday of the department. The department solves the problems of the pre-hospital stage of medical care and reflects modern trends in the development of military and civilian healthcare: increasing the role of outpatient and polyclinic institutions, expanding and introducing inpatient-substituting medical care, strengthening the practical focus in preparing graduates of the academy to perform their official duties as intended. The department contributes greatly to the development of the professional community and holding all-Russian congresses of specialists in the out-of-hospital stage of medical care.

The major topics of two scientific and practical conferences on combat trauma, surgical infection and sepsis held at the A.A.Vishnevsky Central Military Clinical Hospital were the evacuation of patients with combat trauma, wounds and mutilations, as well as their treatment, recovery and rehabilitation. Military doctors shared their clinical experience and achievements in the treatment of combat trauma, abdominal wounds, non-infectious complications of gunshot fractures, infectious complications and sepsis in combat surgical trauma, craniocerebral wounds, the use of vitreoretinal surgery methods, and reconstructive plastic surgeries. Military doctors discussed surgical tactics for gunshot and mine-explosive wounds to the heart, other organs and limbs, issues of removing foreign bodies from cavities and organs of the chest in case of gunshot and shrapnel wounds, and modern methods of surgical rehabilitation of patients. The presented reports were based on the analysis and generalization of combat experience gained by military doctors during a special military operation.