Bulletin of the Russian Military Medical Academy

Journal "Bulletin of the Russian Military Medical Academy" is an official publication of the Academy, which accepts submissions for publication (original researches, reviews, anniversaries, etc.) on the main areas of clinical, fundamental, preventive, military and extreme medicine and pharmacy. Publication priority is given to original research findings that readers can use for practice and research purposes.

The journal is oriented to the higher-education teaching personnel of educational and scientific organizations of medical and pharmaceutical profile, candidates for a degree and students, the information is also useful for the practical activities of doctors in clinical medicine, medical and preventive care, psychophysiology and pharmacy.

A specific section is devoted to current issues of military medicine and emergency medicine.

"Bulletin of the Russian Military Medical Academy" was established by the Academy's scientific council on the initiative of academician Yuri Leonidovich Shevchenko within the framework of Academy's 200th anniversary preparations as a scientific platform for publishing the most significant scientific findings obtained both in the Academy and by our colleagues in Russia and abroad.

Bulletin of the Russian Military Medical Academy is a research and practice medical publication, which is in demand not only in the Academy, but also in Russia and abroad.

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Vol 24, No 2 (2022)

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Research paper

Assessment of post-vaccination collective immunity against new coronavirus infection (COVID-19) among servicemen of the Armed Forces of the Russian Federation
Azarov I.I., Ovchinnikov D.V., Kuzin A.A., Lantsov E.V., Bulankov Y.I., Artebyakin S.V., Zharkov D.A., Kulikov P.V.
Abstract

The recent vaccination campaign targeting the new coronavirus infection (COVID-19) carried out in the Armed Forces of the Russian Federation, on the background of the current unstable global pandemic situation, makes it necessary to study post-vaccination population immunity to the SARS-CoV-2 virus and thus identify key features of immunity in organized military collectives. In the future, this will make it possible to objectively assess the risks of a worsening pandemic situation, effectively adjust the ongoing sanitary and anti-epidemic measures aimed at preserving and strengthening the health of military personnel, as one of the main conditions for maintaining the combat readiness of the Armed Forces of the Russian Federation. During a study conducted on epidemic indications, it was found that vaccination with Gam-Covid-Vac contributes to the formation of collective immunity with 95% effectiveness. A gender-based analysis of the immune response showed that the proportion of persons who lack class G immunoglobulins to SARS-CoV-2 among females is twice than that among men (9.3% and 4.7%, respectively). Seroprevalence indicators, classified by blood group, range from 94.4% (AB (IV) Rh–) to 97.4% (A (II) Rh–). There were no significant differences in seroprevalence between groups of people with different blood groups; however, the highest value of seroprevalence was seen among military personnel with blood group A (II) Rh–. In this context, it is advisable to continue monitoring the formation of immunity in individuals with various blood groups. The results obtained made it possible to form a primary medical and social “portrait” of a serviceman with the most adequate immune response to the introduction of the Gam-Covid-Vac vaccine (a man under the age of 20 with blood type A (II) Rh–) and to draw a conclusion about the high effectiveness of vaccination in military units (formations) staffed by conscripts and military educational organizations.

Bulletin of the Russian Military Medical Academy. 2022;24(2):267-276
pages 267-276 views
Prognostic assessment of risk factors for type 2 diabetes mellitus in young military personnel
Petrankov K.V., Salukhov V.V., Pugachev M.I., Dobrovolskaya L.M., Alexandrova A.V., Shipilova D.A., Livarsky P.A.
Abstract

Risk factors for the development of type 2 diabetes mellitus were assessed in 212 military personnel aged 20–45 years serving under a contract, of which 95 people (an experienced group with risk factors) and 117 people without risk factors (an experienced group), as well as 60 practically healthy males who are not military personnel Ministry of Defense of the Russian Federation aged between 18 and 45 years (control group). It was revealed that the indicators with the greatest influence on the development of type 2 diabetes include older age, body mass index, waist circumference, insulin resistance index, and the results of the psychological questionnaire “Tendency to deviant behavior” on the scale of “Aggressiveness” as well as the questionnaire “Strong-willed self-control.” It was found, on 3-year follow-up, that prediabetes developed in 8 (8.4%) patients of the experimental group with risk factors for type 2 diabetes mellitus who did not have carbohydrate metabolism disorders, and in 8 (6.8%) patients of the experimental group. At the same time, type 2 diabetes mellitus occurred in 2 (2.5%) patients of the experimental group and in 2 (1.7%) military personnel of the experimental group with risk factors for type 2 diabetes but initially normal glycemic indices, as well as in 8 (8.4%) patients of the same group who had prediabetes at the beginning of the study. In addition, prediabetes was detected in 2 people of the control group after 3 years and type 2 diabetes mellitus in 1 person. According to the results of the study, a mathematical model is proposed to assess the likelihood of developing type 2 diabetes in military personnel with a waist circumference ≥94 cm. The proposed model has a sensitivity of 95% and a specificity of 91%. The prognostic value of a negative result is 89.2%, and that of a positive result is 87%. Thus, military personnel with a waist circumference of ≥94 cm are characterized by a more frequent development of new cases of prediabetes and type 2 diabetes mellitus than civilians, which is due to the stressful nature of military service. The use of the proposed mathematical model will make it possible to predict the development of carbohydrate metabolism disorders in military personnel with a waist circumference of ≥94 cm over a 3-year period with the identification of a risk group requiring the use of a set of preventive measures aimed at reducing body weight.

Bulletin of the Russian Military Medical Academy. 2022;24(2):277-287
pages 277-287 views
Analysis of the incidence of COVID-19 in organized military collectives of various types
Gorenchuk A.N., Zhogolev S.D., Kuzin A.A., Kulikov P.V., Zhogolev K.D., Ustinov A.E., Kuznetsova R.Y.
Abstract

Against the background of the global spread of the new SARS-CoV-2 coronavirus, the prevention of infections with airborne mechanisms of transmission has become a priority in the Armed Forces. The development of effective COVID-19 prevention measures requires consideration of the peculiarities of military service and everyday life due to the inability of organized military collectives to comply with the requirements of the lockdown regime introduced at the peak of morbidity by the civilian health system. The patterns of incidence of COVID-19 in military personnel of the Western Military District in organized military collectives were studied in relation to the conditions of training and combat activities and the characteristics of military service. It was found that the dynamics of the incidence of COVID-19 among military personnel of the Western Military District in 2020–2021 exhibited a wave-like character and included four epidemic rises that coincided with epidemic waves among the civilian population. At the same time, from April to December 2020, the morbidity rate in military personnel was significantly higher than that in the general population, and from January to December 2021 against the background of mass vaccination of military personnel against COVID-19, the incidence rate in military personnel decreased by 50% relative to that in the general population. The effectiveness of anti-epidemic measures has increased significantly in recent months. The average number of patients in the epidemic outbreak decreased by 46.3%, the average duration of the outbreak decreased by 12.4%, and the proportion of group morbidity in the structure of the overall incidence of COVID-19 decreased by 19.8%. It is shown that the incidence of COVID-19 in various types of military collectives depends on the conditions of military service and the specifics of daily activities. The highest epidemiological significance of COVID-19 was detected in military units of constant readiness, as well as in medical and military educational organizations.

Bulletin of the Russian Military Medical Academy. 2022;24(2):289-297
pages 289-297 views
Polymorphisms of genes associated with psycho-emotional deviations in a sample of healthy male conscripts
Malyshkin S.S., Krivoruchko A.B., Kutelev G.G., Koreshova E.I., Kalyuzhnaya O.V., Shapoval R.M., Derevyankin D.S., Zhurbin E.A., Potapov P.K.
Abstract

The prevalence of candidate gene polymorphic alleles associated with personality disorders was studied in a sample of healthy male Military Innovation Technopolis «ERA» recruits, science mouth operators of Caucasian race aged 23–27 (median age 24). Genotyping of 10 studied polymorphic variants of genes was carried out using polymerase chain reaction in real time. According to the results, the distribution of genotypes in the studied group of single nucleotide polymorphisms corresponded to Hardy–Weinberg equilibrium, except for the C677T MTHFR variant (rs1801133). The occurrence of minor alleles was as follows: 0.500 for A1438G and 0.310 for C102T (HTRA2); 0.175 for G-6A (CNTF); 0.508 for C > T (UCP2); 0.270 for A1298C and 0.325–C677T (MTHFR); 0.278–A2756G (MTR); 0.571–A66G (MTRR); 0.381–Alu Ins/Del (ACE); 0.294–G1444A (PPARGC1A). In the studied sample, the frequency of occurrence of minor alleles of 10 genetic markers correlated with data collected on people of European descent. The greatest statistical deviation was observed by comparison with data on people of African descent. Statistically significant concordances with different populations and studies conducted in them are the basis for including the selected polymorphisms in a candidate list of psycho-emotional and neurological pathologies influencing the occupational fitness of servicepersons. However, reliable data on the association between mental disorders and the development of degenerative disorders are not available simultaneously in all populations; therefore, additional research is required on this subject.

Bulletin of the Russian Military Medical Academy. 2022;24(2):299-306
pages 299-306 views
Immune dysfunction in millitary personnel participating in special tasks and the possibility of medical and psychological rehabilitation
Zaitseva N.S., Bagmet A.D., Tsygan V.N.
Abstract

The article considers immune dysfunction in military personnel participating in special operations and the possibilities of their medical and psychological rehabilitation. The state of the immune status of 73 servicemen (average age 37.6 ± 4.1 years) who participated in special operations in areas with a difficult operational situation and underwent a 20-day standard course of medical and psychological rehabilitation in the sanatoriums of the sanatorium complexes “North Caucasian”, “Sochi”, and “Crimean” was monitored. Immune status was assessed before and after participation in special operations and after a course of medical and psychological rehabilitation. Immune dysfunction due to quantitative and functional changes in the immune status was established. Soldiers participating in special operations registered a decrease in the synthesis and differentiation of T-lymphocytes, inhibition of the functionality of cytotoxic lymphocytes, reduced cytolytic potential of natural killer cells, impaired antigen-presenting function of monocytes, and a significant decrease in the number of B lymphocytes with preserved antibody-producing function. The rehabilitation course for military personnel participating in special operations led to the normalization of the analyzed parameters, except for the functional activity of natural killer cells and monocytes. Given the lack of full recovery of homeostatic reserves in the immune system, a more in-depth study of the problem and development of a personalized approach to rehabilitation of the military participants with the assessment of immunological markers are necessary.

Bulletin of the Russian Military Medical Academy. 2022;24(2):307-314
pages 307-314 views
Influence of a positive self-concept on the successful in-flight training of cadets
Blaginin A.A., Sinelnikov S.N., Gridin M.Y., Sazonov Y.V., Zhiltsova I.I.
Abstract

The paper presents professionally important qualities of the cadets of the Krasnodar Higher Military Aviation School of Pilots named after the Hero of the Soviet Union A.K. Serov, necessary for mastering the flying profession, and highlights the influence of the professional self on the degree of their success in flight training. The dynamics of changes in the professional self as a component of the professional self-concept among cadets with different levels of success in flight training have been experimentally investigated. The paper also presents the results of the psychological examination of cadets regarding the stable dominant mental state, characteristics of the psychological and sociopsychological levels of the dominant mental state according to the method of L.V. Kulikov (short version) and their relationship with the level of formation of flight skills. Cadets with a high level of success in flight training were characterized by more pronounced increases in average values on the scales “active–passive attitude to the life situation,” “tone: high–low,” “stability–instability of the emotional background” and “satisfaction–dissatisfaction with life in general,” which indicated the formation of more professional self. However, too much increase in the level of the self-concept can lead to negative results. Inadequate self-concept negatively affects the functional state of cadets. In this regard, a personalized approach to the medical support of cadets’ flights and their dynamic observation, taking into account individual psychophysiological characteristics, is relevant. The participation of an aviation doctor in the training of cadets of aviation schools with a pronounced professional self helps the instructor pilot in organizing a personalized approach; the formation and development of professionally important qualities, fostering a well-founded sense of confidence in their abilities, strengths, and capabilities from the very beginning of flight practice; motivation of cadets to strive to improve their flight skills; and assistance in their awareness that the successful completion of the task and flight safety depend on a real assessment of their professional skills and level of flight training.

Bulletin of the Russian Military Medical Academy. 2022;24(2):315-321
pages 315-321 views
Determination of psychophysiological and neuropsychological correlates of deviant behaviors in military personnel
Lobachev A.V., Marchenko A.A., Lobachev S.A., Vinogradova O.S.
Abstract

Deviant behaviors among military personnel are being considered. Healthy servicemen and servicemen with various forms of deviant behaviors (addictive, suicidal, and antisocial) were examined using clinical psychopathological, experimental psychological, psychophysiological, and neuropsychological methods. The survey results by various methods were analyzed statistically, and their significance in diagnosing the propensity for deviant behaviors of servicemen is studied. The isolated use of individual methods does not increase the efficiency of the diagnostic process. Moreover, the combined use of neuropsychological (affective priming and Wisconsin card sorting test) and psychophysiological (oculography) methods with a high level of reliability makes it possible to differentiate healthy military personnel from military personnel prone to deviant behaviors. The most informative psychophysiological signs when performing neuropsychological techniques were the frequency and duration of blinking and duration of gaze fixations. An algorithm for diagnosing deviant behaviors of military personnel has been developed based on the analysis of neuropsychological and psychophysiological indicators using an ethological approach (oculography and pupillometry).

Bulletin of the Russian Military Medical Academy. 2022;24(2):323-332
pages 323-332 views
Analysis of the association between professional development and the official growth of military pharmacists in modern conditions
Miroshnichenko Y.V., Kononov V.N., Lobachev I.V., Perfiliev A.B.
Abstract

We adopted a retrospective study design to explore the regulatory acts affecting the training military pharmaceutical specialists for the medical service of the Armed Forces of the Russian Federation after accreditation of medical (pharmaceutical) workers, professional standards and transition to continuous medical education (continuous professional development). On this basis, we assessed the main areas of training of medical supply specialists, their career development, advanced training and retraining within the existing military healthcare system before and after mandatory accreditation of medical (pharmaceutical) workers. The main issues related to the introduction of professional standards and the compliance of the labor specified in them with the real functional duties of pharmacist officers in the military and hospital level, as well as the discrepancy between the nomenclature of pharmaceutical officer positions and that in civil healthcare. This creates certain difficulties with the passage of reaccreditation and the possibility of assigning (renewal) a qualification category (class rating). The necessity of an integrated approach to harmonize the training of military and civilian healthcare specialists, their accreditation for compliance with professional standards, career growth, positions held in accordance with competence and skills acquired, and continuous professional development cannot be overemphasized.

Bulletin of the Russian Military Medical Academy. 2022;24(2):333-340
pages 333-340 views

Review

Extrahepatic manifestations of chronic viral hepatitis C
Kryukov E.V., Cherkashin D.V., Saluhov V.V., Matjushenko K.V., Sobolev A.D., Shcherbina N.N.
Abstract

Chronic viral diseases of the liver are frequently characterized by clinical signs of intrahepatic complications. Infection caused by the hepatitis C virus should be considered as a systemic disorder associated with the frequent development of various extrahepatic complications, such as cryoglobulinemia, glomerulopathy, lymphoproliferative diseases, seronegative arthritis, type 2 diabetes mellitus, lichen planus, and late cutaneous porphyria. Often, extrahepatic complications become the main features of the clinical disease picture, forcing patients to seek medical help from various specialists and delaying diagnosis. In some cases, the treatment of extrahepatic manifestations becomes an independent, complex task, surpassing the actual treatment of chronic hepatitis C. The relationship between hepatic and extrahepatic complications of viral hepatitis C is not linear; rather, extrahepatic manifestations often outstrip the development of liver damage. The effects of hepatitis C virus on the organs and systems of the body are caused by the direct action of the virus, pathogenetically induced by the development of steatosis/steatohepatitis, and by the disruption of system regulation of hepatokines and cytokines. Treatment of chronic hepatitis C virus infection should be comprehensive and should include antiviral therapy, treatment of metabolic-associated fatty liver disease and treatment of hepatic-related disorders. Antiviral therapy with preparations of direct antiviral action allows the prevention of not only liver complications but also of many extrahepatic complications of hepatitis C virus. Comorbid states significantly increase the natural progression of chronic hepatitis C infection and vice versa: the hepatitis C virus increases the clinical manifestations of co-pathology. In the age of direct antiviral drugs, it is possible to eliminate the hepatitis C virus, but in some cases, elimination alone does not arrest the progression of liver disease.

Bulletin of the Russian Military Medical Academy. 2022;24(2):341-352
pages 341-352 views
Protein signaling molecules affecting the development of innate immunity mechanisms
Moskalev A.V., Gumilevsky B.Y., Apchel V.Y., Tcygan V.N.
Abstract

The principle protein molecules (interferon gene stimulator, adapter proteins, B-cell lymphoma 2 proteins, zinc-finger antiviral protein, and others), mechanisms of apoptosis, necroptosis, perforation of plasma membranes with kinase-like proteins of a mixed line, and ribonucleic acid neutralization, which ensure the development of innate immunity, are described. The main defense mechanisms that viruses have developed at the various stages of evolution are considered. The features of the development of the mechanisms of apoptosis and autophagy in a new coronavirus infection, which are associated with increased secretion of pro-inflammatory cytokines and chemokines, leading to severe damage to host cells, are given. It has been found that serum levels of several proteins formed during autophagy caused by SARS-CoV-2 can be used to predict disease severity. These include a protein associated with microtubules 1A/1B, a protein of sequestoma 1, and a protein of the cellular system of autophagy ― beclin-1. The multifaceted role of interferons in the inhibition of viral infection and the features of the violation of the activating functions of interferons in coronavirus infection are described.

Bulletin of the Russian Military Medical Academy. 2022;24(2):353-362
pages 353-362 views
Justification of the need to create a cryobank of the reproductive material of military personnel in the interests of the armed forces
Markin I.V., Shchelkanova E.S., Zhurbin E.A., Frolov D.A., Kaluzhnaya O.V., Varlamova N.V.
Abstract

Arguments are given in favor of creating a cryobank to preserve the reproductive material of military personnel. Fertility, or the ability to bear children, can be impaired by many detrimental factors associated with the conditions or place of service. In the Russian Federation, over the past few years, the rate of natural population decline has exceeded that of population growth, which has created a demographic void. According to the national concept of the demographic policy of the Russian Federation, by 2025 the population should reach 142–143 million people, due to an increase in the overall birth rate, as well as the birth of a second child and subsequent children in families. However, sociological and statistical studies show that the adopted packages of measures are not yet affecting the birth rate, and with a simultaneous increase in mortality, the population continues to decrease. An important medical and social problem is infertility in marriage; in Russia its frequency is 15%–17% of the total number of families. The contribution of male infertility to the overall structure of familial infertility is 40%. Stress and negative external factors, which are especially pronounced in high-risk groups, can affect male fertility. Military service associated with negative factors, stress, and life- and health-threatening situations can affect the reproductive system and lead to a decrease in reproductive potential or the development of infertility in a soldier. Cryopreservation of ejaculate allows childbearing to be delayed with the help of assisted reproductive technologies and can give the family a chance to have a child, even if the man has completely lost fertility. The creation of a cryobank of reproductive material will make it possible to protect military personnel whose service is associated with risks to life and health. One of the key responsibilities of the state health care system is the protection of the health of its citizens, especially those at risk, and the possibility of childbearing significantly affects the growth and population of the country.

Bulletin of the Russian Military Medical Academy. 2022;24(2):363-370
pages 363-370 views
Inhalation of antibiotics in the treatment of bronchopulmonal infection
Gembitskaya T.E., Kharitonov M.A., Chermensky A.G., Chugunov A.A., Kitsyshin V.P., Zdybko A.S.
Abstract

An analysis of the current treatment protocol for lower respiratory tract infection using inhaled antibiotics is presented. Information about the pathophysiology and features of pathogens of bronchopulmonary infection in patients suffering from cystic fibrosis, nosocomial pneumonia, chronic obstructive pulmonary disease, and bronchiectasis of various etiologies is considered. The advantages and applications of inhaled antibiotics in the treatment of this category of patients are discussed. It has been established that acute and chronic infectious diseases of the lower respiratory tract are often the cause of severe human diseases and one of the leading causes of infectious mortality worldwide. Early initiation of adequate antibiotic therapy, especially in patients with a tendency to develop chronic inflammation, improves disease prognosis. However, mortality and the resistance of pathogens in this category of patients remain high. Traditional oral or parenteral antibiotic therapy does not achieve bactericidal concentrations in the lungs. Increasing dosages and combining antibiotics increases the likelihood of toxicity, superinfection, and resistance and causes undesirable side effects. Inhalation of antibiotics allows the delivery of higher concentrations directly to the lesion, thereby affecting the causative agents of the infectious process effectively while minimizing potential systemic toxicity. The large surface area of the alveoli and the thin epithelial layer provide a favorable environment for the deposition of inhaled drugs. Acute and chronic gram-negative bronchial infection caused by certain types of opportunistic microorganisms causes chronic inflammation, which leads to airway remodeling, damage to local defense mechanisms, further persistence of respiratory pathogens, and the formation of antibiotic resistance. In these cases, the use of inhaled forms of antibiotics has significant advantages in terms of effectiveness, stabilizing lung function and reducing the frequency of hospitalization, which improves quality of life and the need for systemic antibiotic therapy, reduces the risk of side effects, and reduces the cost of treatment. The results of the work can be useful for both therapists and pulmonologists.

Bulletin of the Russian Military Medical Academy. 2022;24(2):371-380
pages 371-380 views
Modern view on the role of pattern-recognition receptors and signaling pathways in the development of innate immunity in viral infections
Moskalev A.V., Gumilevsky B.Y., Apchel A.V., Tsygan V.N.
Abstract

Features of organization and functioning of pattern-recognizing receptors and signaling pathways in induction of antiviral immune response are considered. The recognition of antigenic structures of the virus is carried out by pathogen-associated molecular patterns of innate immunity cells. These are Toll-like receptors, nucleotide-binding oligomerization domain-like receptors, lectin C-type receptors, and RIG-I-like receptors. The functioning of these receptor structures depends on protein molecules that provide activation signals. These are the adapter proteins of the primary response of myeloid differentiation 88, interleukin-1 receptor-associated kinase, nuclear factor-KB. Interactions of cellular proteins in the activation of signaling pathways are complex and receptor-ligand reactions can lead to different outcomes in a single cell, in most cases leading to a limitation of viral reproduction. An important obstacle to the effective recognition of viruses and the development of an adequate immune response is the close organization of viral antigens and receptor structures of the cell. The role of LGP2 protein molecules is associated with the peculiarities of the development of the immune response, which can be not only positive, but also negative regulators of the transmission of excitation signals from intracellular cytoplasmic helicase receptors. A number of viral proteins inhibit activation signals, which ultimately leads to various options for the development of the immune response. A special role belongs to the transmembrane protein of the endoplasmic reticulum, which increases the expression of interferon β — a stimulator of interferon genes that provide detection of deoxyribonucleic acid viruses. Maximum activation of this protein, ensures the effective development of a cellular antiviral immune response.

Bulletin of the Russian Military Medical Academy. 2022;24(2):381-389
pages 381-389 views

History of medicine

Apothecary order, Robert Erskine and the Letter of Peter I
Milasheva N.V., Ovchinnikov D.V., Samoilov V.O.
Abstract

Despite several publications on the history of Russian medicine of the 17th and 18th centuries, this period remains insufficiently studied. The works of the first Russian historians of medicine ― V. Richter, Ya.A. Chistovich, and L.F. Zmeev ― are well known. Unfortunately, their works do not always contain an accurate description of historical facts and correct dates of events. This refers to the era of Emperor Peter the Great ― the reformer of Russia, founder of the regular Russian army and navy, and reformer of Russian medicine and military medical education in the country ― as well as to the history of the Apothecary order. The focus is on the date of the appointment of the closest associate of Peter the Great, a professional doctor Robert Erskine, to the position of head of the Apothecary order and to the position of Archiater, the chief of all military and civil medical institutions in Russia. We have already written briefly about this in our earlier publications. This important issue continues to cause controversy and disagreement among historians. Professor Ya.A. Chistovich argued that Robert Erskine was appointed to the position of Archiater only in 1716, according to the date of issuance of the Letter of Peter I to Robert Erskine: April 30, 1716. Earlier, in the historian’s opinion, the boyar, Prince Ya.N. Odoevsky, was the head of the Apothecary order and the chief of all medical institutions in Russia. He had no medical education but had successfully carried out the reforms during the Great Northern War (1700−1721). In 1907, an outstanding Russian and Soviet scientist, jurist (lawyer), historian of Law and Medicine, Master of Police Law (1907), Doctor of Police Law (1919), Doctor of Historical Sciences (1943), Professor Nikolai Yakovlevich Novombergsky (1871−1949), after many years of studying and analyzing archival documents of the 17th and 18th centuries, convincingly proved the incorrectness of statements by L.F. Zmeev (related to 1714) and Ya.A. Chistovich (related to 1716) on the date of appointment of doctor Robert Erskine to the position of Archiater. The great work by N.Ya. Novombergsky “Development of Russian medicine in the pre-Petrine era” (1907) was presented by him as the dissertation for a master’s degree in Police Law, and he was awarded the Grand Prize named after Count A.S. Uvarov of the Imperial Academy of Sciences of Russia (1908). The author paid special attention to the history of the Apothecary order and documented that in 1706 Doctor Robert Erskine was already an Archiater. The appointment of Robert Erskine as Archiater in 1706 significantly influenced the further development and establishment of Russian medicine, and this year was the most important for the Russian medical service. Our study of archival documents of the beginning of the 18th century, published documentary sources, and scientific works on the history of medicine, has confirmed the evidence and conclusions of N.Ya. Novombergsky. On April 30, 1716, Robert Erskine was granted the rank of the actual state councillor. An analysis of the text of the Letter of Peter I to Robert Erskine has also confirmed that event.

Bulletin of the Russian Military Medical Academy. 2022;24(2):391-400
pages 391-400 views
Hygienic assessment of the hospital environment and methods of providing medical care to patients at the stages of health care development in Russia in the XVIIIth–XIXth centuries
Yakovlev A.G., Maydan V.A., Kuznetsov S.M., Baranov I.V.
Abstract

The article analyzes the problem of hygienic assessment of the conditions of the hospital environment and health-improving methods of treatment of patients of medical institutions at the stages of formation and development of healthcare in Russia in the XVIIIth and XIXth centuries. It has been established that in various historical periods, the problem of patient safety in medical organizations has always been the leading one in the management of “people's health” and the organization of healthcare as an agency that has been forming for several centuries. Organizational, legal, administrative, economic, and hygienic measures have been developed purposefully in the system of public health protection in Russia. This made it possible to improve the system of medical care on the basis of compliance with the provisions of hospital hygiene, such as the placement of patients in hospitals and compliance with the anti-epidemic regime. The systematization and analysis of the data from the Russian literature on the studied scientific problem were performed. Three leading directions of hospital hygiene development were established: organization of medical care, architectural and planning solutions, and therapeutic nutrition. The importance of developing the legislative framework of the listed areas at the state and departmental levels is shown. The results of the analysis of the application of sanitary and hygienic measures and scientific solutions of the XVIIIth to XIXth centuries confirm the need to use scientific, practical, and organizational experience in the introduction of new solutions to the modern system of medical care, including elements of hospital hygiene and patient safety. Proposals have been developed on the legality and prospects of using the historical experience of the development of preventive medicine and hygienic education of the XVIIIth and XIXth centuries, as well as the achievements of predecessors in the field of monitoring and accounting for the peculiarities of patient care and ensuring an anti-epidemic regime.

Bulletin of the Russian Military Medical Academy. 2022;24(2):401-410
pages 401-410 views
The system of training of pedagogical and scientific personnel during the leadership of the department of general and military epidemiology by academician V.D. Belyakov (to the 100th anniversary of the birth of academician V.D. Belyakov)
Belov A.B., Ishkildin M.I., Lantsov E.V.
Abstract

On the basis of generalization and analysis of published scientific works and memoirs of academician V.D. Belyakov’s contemporaries, the main stages of his scientific and pedagogical activity as head of the Department of General and Military Epidemiology of the Military Medical Academy named after S.M. Kirov are considered. It is shown how, under the leadership of the activities of the department staff by Vitaly Dmitrievich Belyakov, the training of the teaching staff was set, ensuring continuous professional development and the ascent of employees along the hierarchical service and scientific “ladder.” The system of training its own personnel worked correctly and effectively within the department, and some such systems continue to work even now, preserving the best traditions laid down in the era of V.D. Belyakov to maintain the reputation of the department created for decades. Academician Vitaly Dmitrievich Belyakov, an outstanding military epidemiologist, scientist, and teacher, Major General of the medical service, who consistently headed the epidemiology departments of two leading educational medical institutions of the country in St. Petersburg and Moscow, had a great influence on the development of not only military epidemiology but also domestic medicine in general. Having developed, with his students at the S.M. Kirov Military Medical Academy, the theory of internal regulation of parasitic systems, recognized as the biological foundation of the epidemiology of infectious diseases, he reformatted the previous theory of the epidemic process into the paradigm of population pathology of biomedical sciences. He was one of the first to consider epidemiology as a general medical diagnostic and preventive discipline, actively introducing epidemiological research methods into clinical medicine and public health, as well as into medical education at all levels at the I.M. Sechenov Moscow Medical Academy. He can be considered the founder of the methodology of epidemiological diagnostics, who extended it to population non-infectious pathology, and the founder of the original and effective concept of epidemiological surveillance. In addition, the system of training and management of pedagogical and scientific personnel created by V.D. Belyakov deserves attention.

Bulletin of the Russian Military Medical Academy. 2022;24(2):411-418
pages 411-418 views
Academician V.N. Tonkov: outstanding domestic anatomist, teacher, scientist and organizer of medical service
Gaivoronskiy I.V., Nichiporuk G.I., Gaivoronskaya M.G., Kirillova M.P., Goryacheva I.A.
Abstract

Prominent Russian and Soviet anatomist Vladimir Nikolaevich Tonkov (1872–1954) made a significant contribution to anatomical science and education. He is the founder of the theory of collateral circulation. For the first time, he established the patterns of blood supply to the intervertebral nodes, nerves, and lymph nodes, identified the source of the development of the spleen, and are a pioneer in the use of X-rays to study the structure of the human body. He prepared an original textbook on normal human anatomy, which went through six editions, and organized anatomical museums at Kazan University and the Military Medical Academy. The name V.N. Tonkov is associated with major social events. He was the first president of the Military Medical Academy in Soviet times. After the revolution, he headed the work of the commission to improve the life of scientists, was elected deputy of various government bodies, and was awarded many orders and medals. During the Great Patriotic War, together with the Military Medical Academy, he evacuated to Samarkand, where, in addition to teaching, he headed the faculty of training doctors during his stay in evacuation. He was one of the organizers of the All-Union Scientific Society of Anatomists, Histologists, and Embryologists, was repeatedly elected its chairman, and created the first in the Soviet Union and numerous anatomical schools. For his significant contribution to science in 1944, V.N. Tonkov was awarded the high title of a full member of the USSR Academy of Medical Sciences. The life and work of V.N. Tonkov became the property of the history of science, and his works, which have passed the strictest test of time, continue in the school he created through the efforts of many generations of his students and their followers. V.N. Tonkov lived for 82 years ― this is a beautiful, worthy life of a great scientist, an example of high service to the people and science, and an example of a bright purposeful personality. He died in 1954 and is buried at the academic site of the theological cemetery. In memory of this outstanding scientist, the Department of Normal Anatomy of the Military Medical Academy has been named after him since 1997.

Bulletin of the Russian Military Medical Academy. 2022;24(2):419-430
pages 419-430 views
Foundation and development of the oldest orthopedic department and clinic of Russia
Khominets V.V., Kudyashev A.L.
Abstract

Issues of the foundation and development of scientific schools, medical specialties, departments, and clinics of the Military Medical Academy of S.M. Kirov, as well as their succession, remain largely debatable to this day. Moreover, their study appears to be extremely interesting when understanding the processes underlying the differentiation of the fundamental sections of medicine, formation of new areas of surgery, and their evolution to the state of independent surgical specialties. Several archival documents, reports, historical essays on the departments of desmurgy and mechanurgy, orthopedics, military field surgery, desmurgy and orthopedics, orthopedics and traumatology, and traumatology and orthopedics are analyzed. The origins of the formation and stages of transformation of the modern department of military traumatology and orthopedics are traced. Scientific orthopedics in Russia was started at the end of the 18th century in the bowels of the fundamental surgical departments of the Imperial Medical and Surgical Academy. On March 7, 1836, by the resolution of the conference of the Academy, the Department of Surgery was divided into the Department of General and Private Surgery with theoretical oculistics and the Department of Operative Surgery and Oculistics, Desmurgy and Mechanurgy, and Surgery on troupes. On February 20, 1888, an independent department of desmurgy and mechanurgy was established at the Academy. On March 24, 1900 (April 6, O.S.), based on Order No. 301 of the Minister of War of October 29, 1899, the Academy Conference decided to create the Orthopedic Clinic headed by Professor G.I. Turner, and the date mentioned went down in history as the birthday of the first orthopedic chair and clinic in Russia. From August 21, 1924, to August 8, 1931, it was renamed the Department of Military Field Surgery, Desmurgy and Orthopedics (Order no. 205 of August 9, 1924, by the Military Sanitary Department), and the reading of this subject was assigned to the senior assistant of the department E.Yu. Osten-Sacken who prepared the corresponding programs. From August 8, 1931, the department and the clinic reverted to their former name – the Department and Clinic of Orthopedics, and Professor V.A. Oppel headed already an independent, established based on the Decree of the Union of Soviet Socialist Republics Revolutionary Military Council of April 2, 1931, the Department of Military Field Surgery. In 1955, the Department of Orthopedics was renamed the Department of Orthopedics and Traumatology (Directive of the Chief of Staff of the Army No. OSN 5/1367869 of November 28, 1955), and in 1960, due to the pronounced traumatological orientation in educational and clinical work, to the Department of Traumatology and Orthopedics (Directive of the Chief of the Union of Soviet Socialist Republics Defense Ministry No. ST/2/711247 of June 4, 1960). In 1974 the department was renamed Military Traumatology and Orthopedics Department (Directive No. 158/0267 of the Headquarters of the Union of Soviet Socialist Republics Armed Forces Rear No. 158/0267 of February 15, 1974). Based on the analysis, it appears reasonable to offer readers a view of the prehistory of the origin, continuity, and development of the specialty “traumatology and orthopedics” at the Military Medical Academy of S.M. Kirov.

Bulletin of the Russian Military Medical Academy. 2022;24(2):431-438
pages 431-438 views

Discussion

The origin of the Military Medical Academy (dedicated to the 350th anniversary of Peter the Great)
Ovchinnikov D.V., Kryukov E.V., Fisun A.Y., Samoilov V.O., Ivchenko E.V., Milasheva N.V.
Abstract

In 2019, under the initiative of corresponding members of the Russian Academy of Sciences A.Ya. Fisun and V.O. Samoilov, in preparation for the celebration of the 350th anniversary of Peter the Great, a commission was established at the Military Medical Academy to determine the date of its founding and to establish the role of the emperor in this event. The reason for this decision was a debate about the age of the academy, which has endured for more than a century. The absence of a legislative act on the establishment of the academy prevents an uncontroversial decision from being made on this issue. The conditionality of the selection of Paul I’s decree of December 18, 1798 on the construction of hospital buildings became acute when the Russian State Navy Archive discovered information about a similar decree of Catherine II of April 29, 1796 on the construction of the same buildings. The collection of identified and published documents accumulated over the past 20 years allows us to state with complete certainty that the hospital schools in Saint Petersburg have been in operation practically since the very founding of the city, having been created approximately simultaneously with the famous Moscow hospital school of Nicolaas Bidloo. In 1715 the Emperor Peter the Great completed the construction of Saint Petersburg hospital schools, teachers were allocated to available pupils, and the educational and material foundation was laid in the form of two base hospitals. The assistants and advocates for these ideas of Peter the Great were the archiaters R.K. Erskine and I.L. Blumentrost. The emperor did not live to witness the final work, and the construction of buildings was completed after his death; only during the reign of Anna Ioannovna was the staff (1733) approved by the archiatrist J.H. Rieger and the uniform procedure of preparation (1735) by archiatrist J.B. von Fischer. The activities of P.Z. Kondoidi in the reign of Elizabeth Petrovna brought teaching to a new level, provided an influx of teaching staff, and expanded the list of disciplines. Under Catherine II, the schools were merged into the Main Medical College. The completion of the transformation of schools into an academy in the reign of Paul I is associated with the name of Count A.I. Vasiliev, thanks to whom, on February 12, 1799, the oldest medical school in Russia became an academy.

Bulletin of the Russian Military Medical Academy. 2022;24(2):439-450
pages 439-450 views
Arterial hypertension or hypertension type of neurocirculatory asthenia in persons of military age
Korneeva N.V., Khabibrahman E.P., Dyakonova E.V., Patsuk S.V.
Abstract

The authors raise the urgent problem of the discrepancy between the conceptual apparatus and strategies for the management of military age persons with high blood pressure, examined by military medical examination, and the current recommendations on arterial hypertension of the Russian Society of Cardiology. The reader's attention is focused on the preventive concept of the Russian Society of Cardiology: the desire for early diagnosis of hypertension and the initiation of treatment even with grade 1 hypertension in the absence of target organ damage. The authors propose consideration of a medical examination of males aged 18–27 years, registered or not registered in the military, as one of the effective tools for the early diagnosis of arterial hypertension. The urgency of the problem is due to the unfavorable phenotype of arterial hypertension at a young age, in which target organ damage is involved early in the pathological process. The above excerpts from the “Regulations on the military medical examination No. 565” draw the attention of readers to two articles of paragraph 9 of the disease schedule: 43–hypertension and 47–neurocirculatory asthenia, characterized by increased blood pressure, creating confusion in the diagnosis. Literature data are presented confirming the ambiguity of the interpretation of elevated blood pressure in the group of people aged 18–27 years, the complexity of the diagnosis, and differential diagnosis of hypertension and neurocirculatory asthenia. At the same time, the diagnosis of neurocirculatory asthenia, according to the literature, is established quite often in this age group and reaches 75% in the structure of cardiovascular disease. The results of studies by Russian scientists, indicating a subclinical lesion of target organ damage in young people with neurocirculatory asthenia with hypertensive reactions, call into question the appropriateness of this diagnosis and management strategy. With modern diagnostic capabilities, an unreasonable lengthening of the examination time for people of military age, examined by a military medical examination to confirm the diagnosis of hypertension and timely initiation of antihypertensive therapy, is emphasized. The question is raised about the correctness and expediency of using the term "neurocirculatory asthenia" in people of military age with high blood pressure.

Bulletin of the Russian Military Medical Academy. 2022;24(2):451-457
pages 451-457 views

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