Vol 339, No 9 (2018)

In accordance with the decision of the Minister of Defense of the Russian Federation, General of the Army S.K.Shoigu, the project «Development of military medicine. Strengthening the health of servicemen» of the «Effective Army» program aimed at increasing the effectiveness of spending budget funds for the medical provision of the Armed Forces, the accessibility and quality of medical care provided to servicemen and citizens discharged from military service. For the period of project implementation in 2015-2017 the number of servicemen and dismissed from military service increased by 9% annually, and free medical care was provided annually, and medical and psychological rehabilitation was provided 241.3%, medical facilities provided with modern medical equipment grew by 4%, and annual budgetary savings were increased By 2017, it exceeded 1 billion 375 million rubles. The implementation of the project activities will be continued in 2018-2020. According to preliminary estimates, after its implementation, the annual economic effect can reach up to 4.6 billion rubles.

The establishment of the spleen damage mechanism is one of the main issues in the manufacture of forensic medical examinations of people with trauma of this organ. Despite a large number of scientific works devoted to the establishment of the mechanism of spleen injury, there is no data on the effect of its internal structure (cytoarchitectonics) on the formation and distribution of stresses in the organ. The results of experimental macroscopic studies of the internal structure of the spleen, as well as changes in the size characteristics of the organ in both sexes, mainly of senile age, are presented. The age-related changes in deformity and strength characteristics of the spleen have been determined significantly, the most dangerous areas on the body of people of senile age have been identified for the formation of organ damage, which must be taken into account when establishing the organ trauma mechanism both in the clinical diagnosis of spleen injuries and forensic medical examinations.

Contusion of the heart in severe combined wounds and injuries - an urgent problem of surgery of injuries, anesthesiology and reanimation. Based on the database of the clinic of military field surgery of the Military Medical Academy named by S.M.Kirov on gunshot wounds received in local armed conflicts, shows the incidence of a heart injury in the overall structure of gunshot wounds, the frequency of complications and lethality. The analysis of the clinical course of the disease in wounded patients with a heart attack against a background of mine-explosive wounds of the chest, shrapnel wounds of the chest, with bullet wounds of the chest.

During the three 11-year cycles of the Schwab-Wolf (1985-1996-2007-2017), 2528 patients with myocardial infarction - men aged 28-60 years, at different times after the infarction (16 days - 5 years) were examined. The external and internal causes of desynchronosis, which affect the incidence of myocardial infarction and its course, have been studied. The effectiveness of their correction in the process of rehabilitation in a sanatorium with the use of natural, preformed, pharmacological agents and their combinations has been estimated. The developed diagnostic and therapeutic algorithms allowed to increase the detection of early forms of desynchronosis in patients with myocardial infarction not only by clinical indicators, but also by functional, metabolic and psychological. A differentiated qualitative and quantitative assessment of the degree of severity of adaptation was carried out, which allowed for long-term monitoring of the course of the disease in the early and distant post-infarction periods, and monitoring of the implementation of therapeutic and preventive measures. On the basis of statistical data and multi-criteria analysis, a model of the algorithm for predicting the effectiveness of rehabilitation of patients with myocardial infarction from the position of chronomedicine was developed.

The leading role of streptococci in the etiology of upper respiratory tract and pneumonia in servicemen, skin diseases and subcutaneous tissue determines the importance of timely diagnosis of streptococcosis and the need to carry out effective and common for their various nosological forms of anti-epidemic and therapeutic-prophylactic measures. The article presents the results of clinical testing of the rapid diagnostic test system «Streptatest». The carrier of the b-hemolytic streptococcus of the A group of 200 military personnel under the contract, who had consulted about acute tonsillitis, was examined. Of these, the number of patients with a positive test was 31 (15.5%), with a negative - 169 (84.5%). Prior to the application of the test system, antibiotic therapy was prescribed in 80-90% of cases, after the beginning of its use of antibiotics was reduced to 16%. Determination of the prevalence of b-hemolytic group A streptococcus in military collectives and differential rapid diagnosis of streptococcal infections allow one to temporarily make the necessary medical appointments, reduce the risk of complications and the severity of the course of the disease, and reduce economic costs for treatment.

The article deals with the incidence and prevalence of angina in organized military collectives. The results of the observational (not intervention) study of the effectiveness of the drug aminodihydrophthalazinedione sodium in the complex treatment of uncomplicated sore throat in conscripts. It was shown that the inclusion of sodium aminodihydrophthalazinedione in the complex treatment of angina contributes to earlier relief of intoxication and catarrhal syndromes, normalization of hematological parameters, and a decrease in the duration of the disease.

The paper sets out the key principles of safety management of medical care, that provide for the construction of a proactive culture of risk management of the injury; the creation of an effective accountability mechanism and algorithm of investigation of incidents, implementation of a multilevel model of prevention of the transformation of the latent threat into an adverse event. These principles are based on the understanding of the main mechanism of development of complications of medical interventions - the transformation of latent threat into an adverse event through a dangerous situation, a dangerous process and a dangerous event.

The history of the 454th military hospital, which dates back to October 10, 1956, is presented. Over the years, the organizational and staff structure and name of the hospital have changed many times, but the essence of the work has not changed: the provision of qualified and specialized medical assistance to servicemen, reserve officers, members of their families, war participants, civilian personnel of the Ministry of Defense.

The article is devoted to the work of the three Soviet epidemiological and parasitological expeditions that carried out in Iran from December 1941 to July 1943 the task of providing anti-epidemic protection to the Red Army troops stationed on the territory of that country after the Soviet-British Operation Consent. The emergence during the operation of a large number of infectious diseases of personnel required urgent anti-epidemic measures. Expeditions under the guidance of Academician E.N.Pavlovsky thoroughly and comprehensively studied each area of the deployment of troops, compiling a detailed report on the diseases characteristic of individual localities. In the studies, a comprehensive approach was used to assess the impact of climatic and geographical factors, water supply characteristics, health status, dominant religious dogmas and customs of the Iranian population on the epidemic processes. Numerous microbiological studies have been performed to identify pathogens of infectious diseases among the population, in the environment. The ways of distribution of cholera and the danger of its introduction into Soviet territories were analyzed in detail. Foci of major transmissive diseases were studied. The work of the expeditions in terms of the volume, the vastness of the problems studied, the depth and practical significance were a great contribution to ensuring the sanitary and epidemiological well-being of the Red Army military contingents deployed in Iran.