Vol 341, No 11 (2020)

The article presents the characteristics of the modern organization of medical care for service members of the Armed Forces with acute and chronic viral hepatitis, tied to the territorial system of medical support. The state of implementation of the requirements of the guidelines regulating the activities of infectious disease specialists on this problem is highlighted. The experience of treating patients over ten years is generalized, and the results obtained are compared with the civil health care system. In the structure of viral hepatitis in military personnel in peacetime, chronic forms prevail, among the latter - hepatitis C (more than 70%). In case of a deterioration of the sanitary and epidemiological situation (natural and human - made disasters, the conduct of hostilities), a significant increase in the proportion of acute viral hepatitis with the fecal - oral transmission mechanism can be expected. Modern etiotropic treatment’s effectiveness ensures the elimination of viral hepatitis C and long - term suppression of viral hepatitis B replication in more than 95% of patients.

The results of the analysis of literature data on the problem of diagnosis and prediction of the course of acute respiratory distress syndrome of various etiologies are presented. The relevance of research in this area is determined by the high prevalence of severe respiratory distress syndrome development as a non - specific complication of many diseases and injuries in peacetime and wartime. Considering etiological factors, the most informative biomarkers of lung tissue damage were significant for early diagnosis and prediction of the syndrome’s course. As a promising direction, the development of a diagnostic multi - marker panel is substantiated, which allows assisting at the stages of medical evacuation to study critical levels of interleukin-6, interleukin-8, angiopoietin-2, vascular endothelial growth factor, the soluble form of the receptor for the final glycosylation products, and surfactant protein D, as well as markers of endothelial glycocalyx destruction and hemostatic system dysfunction. The variety of etiological factors causing acute respiratory distress syndrome indicates the need to continue the search for biomarkers with the highest diagnostic and prognostic significance.

The current literature data on an extremely rare and severe pathology - a spontaneous violation of the inferior vena cava wall’s integrity with the formation of a retroperitoneal hematoma - are summarized. The data of our own experience of treating three patients with this pathology are presented. One of them was operated on with subsequent death. The rest were treated conservatively; the outcome was favorable. The individual probable causes of the development of spontaneous large retroperitoneal venous hematoma and the features of the right choice of treatment tactics were analyzed. The value of correctly selected anticoagulant therapy in the treatment of such patients is shown. It is concluded that surgical interventions for spontaneous violation of the inferior vena cava’s integrity can be undertaken only for health reasons if the refusal of the operation will inevitably lead to an unfavorable outcome.

The article shows the historical path of purulent surgery, the evolution of treatment and diagnosis. Domestic and foreign authors’ contribution to the formation and development of purulent hand surgery is briefly characterized and evaluated. The relationship between the development of medical technology and the results of treatment of patients, as well as the long - term effects of various treatment methods, are demonstrated. The problem of treating purulent wounds of the hand has not lost its relevance. At the same time, surgical treatment remains the most crucial stage of medical care for patients. Presented are modern approaches to the treatment of purulent - inflammatory processes in hand. Even though the method of treating purulent - inflammatory diseases of hand has not undergone significant changes and consists in opening the purulent focus and its adequate drainage and rehabilitation, thanks to the extensive possibilities of instrumental diagnostics, the risk of complications are minimized, and treatment of the patient becomes as useful as possible.

The modern medical community is actively discussing predicting and preventing multifactorial diseases, such as atherosclerosis, metabolic syndrome, and oncopathology. Almost every significant risk factor in humans has a specific genetic determination. Statistics show that 12% of the population has a burdened family history of cardiovascular disease. In research on the human genome study, special attention is paid to single - nucleotide polymorphisms and associated mutations, leading to the development of diseases of the circulatory system. The article presents population frequencies, phenotypes, and the results of our studies of genetic polymorphisms of several relevant genes associated with the development of atherosclerosis, obesity, leptin resistance, arterial hypertension, and type 2 diabetes mellitus. The modern views on epigenetic heredity are presented on the example of methylation of deoxyribonucleic acid, its influence on the genome, and phenotypic manifestations of atherosclerosis.

The functional state of the organism of 30 former military men - participants of local military conflicts, at the age of 55-60 years, with post - traumatic stress disorders, was assessed. The effectiveness of complex standard and osteopathic treatment methods of patients with post - traumatic stress disorders has been revealed.

The system of medical support in the Strategic Missile Forces (Strategic Missile Forces) was formed, considering the specifics of the troops’ organizational and staff structure and their deployment areas, the specifics of service by personnel. In August 1960, a military command body was created - the Strategic Missile Forces’ medical service. In 1963-1964 the Central Military Clinical Hospital of the Strategic Missile Forces was formed, hospitals were reorganized into military hospitals. New military hospitals, polyclinics, medical centers, health resorts, pioneer camps, etc. were built. Experienced tactical and special exercises were regularly conducted in the troops to work out organizing medical and evacuation measures. In 1997, when the military units of the Strategic Missile Forces, the Military Space Forces, and the Rocket and Space Defense Troops were united, the grouping of forces and means of the medical service increased. In reforming the Armed Forces and reducing the Strategic Missile Forces, the system of medical support was rebuilt and improved. In 2010, the governing body of the medical service of the Strategic Missile Forces was liquidated, military hospitals of missile formations were reassigned to district military hospitals as their branches and structural units. In 2013, the medical service as a governing body for the organization of medical support for the military department was restored.