Voenno-medicinskij žurnal

A modern concept of providing medical care to the wounded with injuries to the musculoskeletal system has been developed and implemented, tested during special tasks in Syria and implemented during a special military operation. The concept is based on the following principles: early and effective treatment of shock and traumatic illness, including correction of regional circulatory and microcirculation disorders; early saving (organ-preserving) primary surgical treatment of gunshot musculoskeletal wounds during the first 4–12 hours, followed by repeated surgical treatment for 24–72 hours; early stabilization of damaged segments with external fixation devices (within 24 hours); early air ambulance evacuation to the stage of providing specialized medical care; early closure of integumentary tissue defects (up to 3 weeks) using portable and stationary systems for vacuum drainage of wounds, physical methods and acute shortening techniques; early performance of reconstructive operations in specialized centers using plastic surgery techniques, external and minimally invasive internal, as well as sequential osteosynthesis within a period of 3 to 5 weeks; application of additive technologies; early comprehensive and individual rehabilitation with the return of military personnel to duty.

The historical stages in the development of ideas about chemical injury are characterized. For the first time, a detailed etiopathogenetic classification of chemical poisonings is presented according to the causes and conditions of their occurrence, modern statistical data on the frequency of cases of acute chemical poisonings, as well as related information that allows for a critical assessment of the influence of chemical factors on the population of Russia. Modern challenges for medical toxicology and military field therapy are assessed with an emphasis on current practical problems that require solutions in the near future. An important direction should be considered the implementation of round-the-clock information and advisory support, including the format of telemedicine, in the interests of medical units and primary care organizations in the provision of medical care on the territory of each constituent entity of Russia. It is advisable to resume teaching the issues of providing medical care for chemical trauma in specialty programs within the educational disciplines “Military Field Therapy” and “Military Toxicology, Radiology and Medical Protection”. Promising areas of research have been identified to improve the means and methods of preserving the lives of military personnel when exposed to chemical damaging factors.

The goal is to evaluate the effectiveness and safety of the use of nefopam in the provision of medical care. The study of the effectiveness of nefopam was carried out in 2 groups: the 1st group (n=53) included patients who, because of dissatisfaction with analgesia, were additionally prescribed a non-steroidal anti-inflammatory drug and trimeperidine at a dose of 20 mg within 30 minutes after the administration of nefopam; Group 2 (n=201) received only nefopam. The administration of nefopam was accompanied by a decrease in pain intensity, normalization of heart rate, and respiratory movements in all 254 patients. The reason for the ineffective relief of pain in group 1 was the development of an initially severe pain syndrome. The likelihood of developing side effects (nausea, vomiting, tremors, sweating, subcutaneous erythema) was 2–9 times lower in group 2. Nefopam is recommended for the relief of pain of moderate intensity; its effectiveness for the relief of severe pain is insufficient.

Chest injury is the most common type of combat injury. With the introduction of new approaches and methods of medical care in combat conditions, mortality rates from this injury have noticeably decreased, which is confirmed by the results of the operations of the US armed forces and their allies «Iraqi Freedom» and «Enduring Freedom». However, at the stages of medical evacuation, the number of deaths from wounds and chest trauma, in comparison with the Vietnam war, increased from 3 to 10%. The advanced stages of evacuation are characterized by early complications – inadequate choice of the drainage site, subcutaneous placement of drainage, intraoperative damage to the vessels, organs of the thoracic and abdominal cavity, in high-tech centers – late – coagulated hemothorax, pneumonia, pleural empyema, and several others. The study of clinical and diagnostic approaches to the provision of medical care to wounded with chest trauma is an urgent problem requiring, among other things, structuring the complications of pleural cavity drainage, optimization of diagnostic algorithms, and improvement of training methods for medical specialists.

The article reflects the historical evolution of approaches to solving the problem of vaccinal prevention of viral infections. The effectiveness of modern vaccine prophylaxis is associated with advances in biotechnology, immunization with attenuated viruses, purified viral proteins, specific antibodies, and activated T-lymphocytes. The success of vaccination depends on the formation of collective immunity. Immunization should cause the same type of immune response as the infection. The effectiveness of vaccination is affected by options for the introduction of vaccines, violations of the «cold chain», the age and health of the vaccinated. Prospects for vaccination are associated with new options for obtaining subunit vaccines, vaccines based on nucleic acids. They are characterized by rapid development, low-cost and safe production, and effective activation of cellular and humoral immunity. Increasing the effectiveness of vaccine prevention of viral infections will also be associated with further study of the biology of viruses and the immunopathogenesis of viral infections, taking into account the individual immune response.

The article presents characteristics of the activities of pharmaceutical workers in evacuation hospitals of besieged Leningrad, including those deployed based on the Military Medical Academy. Ways to overcome difficulties in the manufacture of medicines in conditions of lack of electricity and centralized water supply, shortage of pharmaceutical substances and excipients, glassware and closures are shown. Information is provided about the professionalism and heroism of pharmacists and pharmacists who worked in the pharmacies of evacuation hospitals, who, like all the defenders and residents of the besieged city, steadfastly and courageously overcame hardships, showed dedication and patriotism.

The author told about the collection on the basis of the N.I. Pirogov Saki military clinical health-resort. The priority area today is medical rehabilitation and medical-psychological rehabilitation of active military personnel of the Armed Forces of the Russian Federation – participants in a special military operation. Some work has been carried out to restructure the activities of medical institutions of the sanatorium-resort complex, and active training of qualified rehabilitation specialists is underway. A number of problematic issues were also discussed.