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Vol 25, No 4 (2023)

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Research paper

Blood coagulation system in experimental acute lung injury and its treatment with dexamethasone

Voloshin N.I., Chuchalin E.O., Pugach V.A., Salukhov V.V., Tyunin M.A., Kharitonov M.A., Rudakov Y.V., Minakov A.A., Goverdovskiy Y.B., Belyakova T.A., Kochukova V.V.

Abstract

The effects of short- and long-term administrations of dexamethasone on survival, severity of pulmonary edema, and hemostasis on experimental lipopolysaccharide-induced acute lung injury in rats were analyzed. Acute lung injury in rats was modeled by the intratracheal injection of lipopolysaccharide from the Salmonella enterica cell wall. White male rats were randomly divided into nine groups: the intact group consisted of 10 animals; two control groups of 20 animals each, in which acute lung injury was simulated without further treatment and removed from the experiment on day 3 or 7; six comparison groups of 20 animals each, in which, 3 h after modeling of acute lung injury and then once a day for 3 days (short mode of administration) or 7 days (long mode of administration), dexamethasone solution was administered intraperitoneally in the following doses: 0. 52 (equivalent to 6 mg/day for humans), 1. 71 (20 mg/day for humans), and 8 mg/kg/day (94 mg/day, pulse therapy for humans). On days 3 and 7, the survival rate, coagulogram values (active partial thromboplastin time, prothrombin time, activity of antithrombin, and soluble fibrin monomer complexes), and low-frequency piezotromboelastography data were assessed in the surviving animals. The results revealed that dexamethasone reduces mortality in acute lung injury and has a dose-dependent effect on the hemostasis system: with an increase in the dose administered, blood clotting processes increase and fibrinolysis is inhibited. Low-frequency piezothromboelastography with a conventional coagulogram allows for a comprehensive assessment of the hemostasis system, identifying violations, and timely drug correction.

Bulletin of the Russian Military Medical Academy. 2023;25(4):545-556
pages 545-556 views

Clinical significance of behavioral type “a” in patients suffering from rheumatoid arthritis

Yudin V.A., Odin V.I., Kuvshinnikov A.V., Inamova O.V., Zhigulina A.I., Tyrenko V.V.

Abstract

According to modern concepts, rheumatoid arthritis is a classic psychosomatic disease that leads to a decrease in the quality of life of patients and their early disability. To date, few foreign and domestic studies have examined the relationship between behavioral type “A” and rheumatoid arthritis. The clinical significance of behavioral type A in patients with rheumatoid arthritis has been studied to determine new therapeutic and diagnostic approaches. As part of a one-stage (cross-sectional) study, 74 people suffering from rheumatoid arthritis were examined during the year, which were represented by two groups, in accordance with the diagnosed behavioral type. The first group consisted of 22 patients suffering from rheumatoid arthritis with behavioral type A, and the second group consisted of 52 patients suffering from rheumatoid arthritis with behavioral type B. All patients received standard basic and anti-inflammatory therapy in the form of methotrexate at a dose selected individually. The duration of adequate basic therapy corresponded to the incidence of rheumatoid arthritis in both groups. Patients with behavioral type A were characterized by lower immunological activity, manifested, among other things, by a lower level of antibodies to cyclic citrullinated peptide and C-reactive protein, whereas the frequency of erosive lesions was higher. The presence of behavioral type A in patients with rheumatoid arthritis is a risk factor for the development of atherosclerotic damage. A personal negative quality, i. e. , hostility, which is included as one of the characteristics of behavioral type “A,” has a reliable direct relationship with the number of erosions, and significantly, its value directly correlates with the incidence of rheumatoid arthritis. Thus, the stratification of patients suffering from rheumatoid arthritis, according to the presence of behavioral type “A,” demonstrates the clinical and laboratory features of the disease and may be important for the development of new therapeutic and diagnostic approaches and the provision of therapeutic and preventive interventions in these patients

Bulletin of the Russian Military Medical Academy. 2023;25(4):557-566
pages 557-566 views

Effect of vaccination on the course of novel coronavirus infection in young patients

Kalamova R.R., Cherkashin D.V., Ulyatovsky V.A., Zarubenko A.I., Salakhbekov I.S., Filippov V.Y., Bogdanov D.S., Voevodin E.E.

Abstract

The features of the course of the new coronavirus infection in vaccinated and unvaccinated young patients (aged 18–35 years) were assessed. In total, 111 patients with new coronavirus infection were examined, and they were divided into two groups. The first group included 32 people vaccinated against the new coronavirus infection (21 men and 11 women; average age, 22. 31 ± 5. 04 years), and the second group included 79 unvaccinated people (70 men and 9 women; average age, 20. 76 ± 3. 674 years). A direct dependence of hospitalization time on the presence of vaccination was observed. The average volume of erythrocytes was significantly greater in the vaccinated group than in the unvaccinated group, and the average concentration of hemoglobin in erythrocytes was higher in the unvaccinated group, both at disease onset and over time. In addition, in the vaccinated group, the values of inflammatory markers in the blood such as erythrocyte sedimentation rate, C-reactive protein, ferritin, procalcitonin, and D-dimer, increase much faster. According to the results of repeated computed tomography, the unvaccinated group had longer persistence of signs of viral pneumonia. The primary pathology recorded on the electrocardiogram, particularly bradycardia, was more frequently recorded in the unvaccinated group. Overall, most patients, regardless of vaccination, had a mild course of new coronavirus infection. This may indicate a negative dependence of the severity of the new coronavirus infection on the age of the patient. Despite the low risk of developing complications of coronavirus infection at a young age, to prevent and quickly recover from a new coronavirus infection, all age groups are encouraged to receive vaccination, which will reduce the number of hospitalizations, burden on healthcare, and economic costs of medical care.

Bulletin of the Russian Military Medical Academy. 2023;25(4):567-574
pages 567-574 views

Features of emergency medical care outside a medical organization in saint petersburg

Karailanov M.G., Panfilov M.S., Cherkasov S.N., Prokin I.G.

Abstract

The organization of emergency medical care outside a medical organization in Saint Petersburg is analyzed. It has been established that a number of organizational issues related to the interaction between medical organizations and improving the efficiency of the ambulance service have not been fully resolved. Based on the analysis, the main directions of optimization of emergency medical services in this subject are proposed, taking into account a rational and effective approach to calculating the required number of emergency medical teams and their composition. It is shown that the strengthening of operational interaction between medical organizations and the creation of unified control centers for emergency medical teams will meet the needs of the population, create more comfortable conditions for emergency medical personnel. In general, the importance and necessity of this type of medical care is certainly high, and the ambulance service can be regarded as a factor of national security. The issued Order of the Ministry of Health of the Russian Federation No. 388n dated June 20, 2013 “On approval of the Procedure for the provision of emergency, including emergency specialized, medical care” regulated the activities of emergency, including emergency specialized, medical care throughout the territory of the Russian Federation as a separate particularly significant type of medical care and contributed to its further development and improvement. At the same time, there was an approach to calculating the required number of emergency medical teams, taking into account the rational use of available resources. All this testifies to the unified nature of the ambulance, including emergency specialized medical care. Only with the use of this model can maximum accessibility and, therefore, the effectiveness of emergency medical care be provided to patients in the largest districts of the cities of our country. Timely provision of residents of a large city with effective emergency medical care will reduce the statistics of mortality and disability. Providing medical care to the victim in the first minutes after the injury or the development of a life-threatening disease plays the most important role not only in increasing the chance of saving life, but also in a favorable outcome of the disease. To return an able — bodied citizen to the social environment is a task of the state level, since a working person is a guarantee of the security of the state in all senses of this expression.

Bulletin of the Russian Military Medical Academy. 2023;25(4):575-582
pages 575-582 views

Diagnostic criteria of endothelial dysfunction, subclinical atherosclerosis and their relationship with NOS3 and HIF1A gene polymorphism in military personnel in extreme conditions of the arctic zone

Lemeshchenko A.V., Gurina O. ., Tsygan V.N., Makarov A.B., Krivolutskaya T.A., Berg D.V., Kirillov A.S.

Abstract

The state of the arterial vascular endothelium against the background of subclinical atherosclerosis and its relationship with gene polymorphism in military personnel serving in the Arctic climatic zone, depending on the duration of service, was evaluated. In total, 251 male servicemen aged 28–40 years were examined. The group of servicemen of the Arctic climate zone included 99 people, who were divided into three groups according to the duration of military service in the Arctic: group 1 included 8 (8%) servicemen with up to 5 years of military service; group 2, 21 (21%) people with 5–10 years; group 3, 70 (71%) servicemen with > 10 years. The control group included 152 military personnel aged 28–40 years from the temperate climate zone. All participants underwent a test with reactive hyperemia, elastography, measurement of the thickness of the intima–media complex on the brachial artery, ultrasound examination of the common carotid arteries, photoplethysmography, pulse oximetry, spirometry, anthropometry, biochemical blood analysis, and determination of gene polymorphism using polymerase chain reaction. The results revealed that endothelium-dependent vasodilation rats in groups 2 and 3 were 1. 7 and 2. 7 times less than that in group 1 (p < 0. 05). In 11 (16%) military personnel of group 3, thickening of the intima–media complex was found in >50% of the adjacent areas of the common carotid arteries. In groups 2 and 3, the total blood cholesterol level exceeded the value by 10% and 14%, respectively, compared with group 1 (p < 0. 05). The artery wall was rigid in carriers of the T/T genotypes of the HIF1A and NOS3 genes and was most elastic in the G/T genotypes of the NOS3 gene and C/C of the HIF1A gene. In general, military personnel serving in the Arctic climatic zone with a service duration of >10 years have endothelial dysfunction and peripheral vascular stiffness with subclinical atherosclerosis phenomena, particularly in military personnel with the T/T genotypes of HIF1A (rs11549465) and NOS3 (rs1799983). We believe that the leading pathogenetic link of endothelial dysfunction of arterial vessels is the resistance of myocytes to the effects of vasodilation factors expressed by the vascular endothelium, particularly nitric oxide. The longer the service experience of military personnel under conditions of polar hypoxia, the higher the probability of developing endothelial dysfunction.

Bulletin of the Russian Military Medical Academy. 2023;25(4):583-594
pages 583-594 views

The register of patients suffering from heart failure in St. Petersburg ”persona-chf”: interim results

Koltsov A.V., Tyrenko V.V.

Abstract

The prevalence of heart failure is becoming global, and the number of patients is steadily increasing annually. The assessment of the number of patients suffering from heart failure in St. Petersburg, as well as their characteristics, is one of the most important tasks for which the Saint Petersburg Register of Patients Suffering from Chronic Heart Failure, PERSONA-CHF, was developed and initiated. Data analysis was performed for the period from February to May 2023. A total of 158 people comprised the sample. The Hospital for War Veterans (Saint Petersburg) participated in the pilot project. The average age of the patients was 81. 14 ± 11. 39 years. The number of points based on the assessment scale of the patient’s clinical condition was 6. 4 ± 2. 6. The average left ventricular ejection fraction was 59. 1% ± 11. 1%. Moreover, >70% of patients had a left ventricular ejection fraction of >50%, and in 23. 4% of patients, it was even higher than 65%. Comorbid pathologies prevailed: hypertension, 93%; coronary heart disease, 79. 1%; chronic kidney disease, 46. 8%; atrial fibrillation, 32. 9%; anemia, 31. 6%; and diabetes mellitus, 24. 7%. A high percentage of the presence of comorbid pathology leads to the need to modify therapy and use modern groups of drugs. Beta-blockers were most often prescribed (86. 7%), diuretics (75. 3%), mineralocorticoid receptor antagonists (62%), angiotensin-converting enzyme inhibitors (61. 4%), and angiotensin II receptor blockers (39. 2%). The appointment of modern groups of drugs, such as angiotensin receptor-non-lysine inhibitor and sodium-glucose cotransporter inhibitor 2-type, was 5. 1%. Attention was drawn to the lack of continuity in the provision of medical care and low compliance of patients with modern quadrotherapy, given its high cost for the patient. In general, the efficiency of the PERSONA-CHF registry platform is quite good and allows us to more accurately understand the epidemiological aspects of heart failure, the solution of which will make it possible to improve the quality of medical care, identify the need for necessary medicines, and reduce mortality and mortality rates. However, a much larger set of patients and a different profile of medical institutions are required for the most complete understanding of the problem of heart failure in Saint Petersburg, since the Hospital for War Veterans reflects only a small sample of patients, mainly of senile age, and several comorbid pathologies. In addition, this register requires further improvement to increase the number of connected medical organizations, expand the number of analyzed parameters, automate the process, and possibly connect artificial intelligence for data analysis.

Bulletin of the Russian Military Medical Academy. 2023;25(4):595-602
pages 595-602 views

The effectiveness of the protocol of focused ultrasound examination of the wounded and injured in combat surgical trauma

Lakhin R.E., Kusai A.S., Usoltsev E.A., Kasimov R.R., Tsygankov K.A., Tsvetkov V.G., Shustrov V.V., Fadeev S.V.

Abstract

The provision of medical care in armed conflicts has several features. Ultrasound examination is one of the available and informative diagnostic methods for the wounded and injured under conditions of limited material and technical resources. The sensitivity and specificity of the diagnosis of free fluid in the abdominal cavity and pneumothorax using an extended protocol of focused ultrasound evaluation in wounded patients with combat trauma requiring surgical care were determined. A retrospective cohort study of the medical data of 85 patients with injury and chest and abdominal wounds was performed to identify the extent of damage. For this purpose, a focused ultrasound examination was performed using an extended protocol of focused ultrasound evaluation in patients with wounds and combat trauma. This protocol was applied to all victims with chest and abdominal wounds to identify the extent of damage. The results revealed that the sensitivity and specificity of the extended protocol of focused ultrasound evaluation in the wounded during combat trauma for the diagnosis of free fluid in the abdominal cavity were 100% and 66%, respectively. The sensitivity and specificity of the extended focused ultrasound evaluation protocol for the diagnosis of pneumothorax in the wounded during combat trauma were 87% and 78%, respectively. The results further confirmed the need to use an expanded protocol of focused ultrasound assessment in wounded patients with combat trauma to make decisions on the surgical techniques in settings where other diagnostic methods were not unavailable, particularly during armed conflicts with mass admission of wounded and injured patients. In addition, the use by anesthesiologists or surgeons of an extended focused ultrasound evaluation protocol for wounded patients in combat trauma is important, although teamwork is required when deciding about performing surgery.

Bulletin of the Russian Military Medical Academy. 2023;25(4):603-610
pages 603-610 views

Morphometric characteristics of the abdominal surface of the diaphragm for various benefits

Prosvetov V.A., Gaivoronsy I.V., Surov D.A., Goryacheva I.A., Panenko P.S., Fandeeva O.M.

Abstract

The dependence of the regional morphometric characteristics of the abdominal surface of the diaphragm on body shape was evaluated because the information available in the specialized literature on this issue differs significantly. The study was conducted on 30 corpses aged 50–70 years, who were embalmed using a special technology (preserving tissue elasticity, giving the diaphragm a physiological shape with deep exhalation by pumping air into the abdominal cavity). The objects were then frozen, abdominal organs were sequentially removed, and linear dimensions and areas of subdiaphragmatic, subhepatic, and splenic depressions, physiological openings (inferior vena cava, aorta, esophagus, and ligamentous apparatus of the upper floor of the peritoneal cavity), area nuda, diaphragm legs, and lumbar–rib triangles were examined. The results of the analysis of the morphometric parameters revealed significant statistically significant differences in the linear dimensions and areas of the right and left subdiaphragmatic, subhepatic, splenic depressions, and individual parts of the diaphragm in individuals with different body shapes. For these anatomical formations of the peritoneum, the highest values of morphometric parameters are characteristic of the brachymorphic form of the physique, except for the sizes of the lumbar–costal triangles, medial legs, and height of the diaphragm domes, which have the maximum dimensions with a dolichomorphic form. Attention was drawn to the significant differences in the area nuda between extreme forms of physique, which reached 59%. Statistically significant differences were found in the morphometric parameters of the abdominal surface of the diaphragm in mesomorphic and extreme forms of physique; however, they are characterized by smaller values, ranging from 8% to 42% for various parameters. Of particular importance is knowledge of the size of the studied parts of the diaphragm covered by the peritoneum during cytoreductive interventions. Anatomical studies performed on specially embalmed objects with preservation of tissue elasticity and the physiological shape of the diaphragm allow us to obtain its reliable morphometric characteristics.

Bulletin of the Russian Military Medical Academy. 2023;25(4):611-618
pages 611-618 views

Relationship of the myostatin level and secondary sarcopenia in patients undergoing programmed hemodialysis

Tsygan V.N., Boriskina O.L., Yakovenko A.A., Tutin A.P.

Abstract

The role of myostatin in the development of sarcopenia in patients receiving programed hemodialysis and the severity of the relationship with other risk factors, particularly between the myostatin level in the blood and skeletal muscle indicators, were analyzed. A single-stage prospective non-interventional study was conducted among 196 patients (97 women and 99 men, aged 54–66 years) receiving programed hemodialysis. After signing the informed consent form, all patients underwent a series of examinations consisting of the assessment of anthropometric data, measurement of vital signs, determination of the state of the muscular system for the diagnosis of sarcopenia, including bioimpedance, and laboratory tests (clinical and biochemical blood tests). The level of myostatin in the blood serum of patients was determined once 10 min before the next hemodialysis session. A statistically significant negative correlation of myostatin level with age (ρ = –0. 361; p < 0. 001), skeletal muscle strength (ρ = –0. 140; p = 0. 05), and walking speed (ρ = –0. 245; p < 0. 001) was observed. High myostatin levels were more often detected in men (U = 2633, z = –5. 462; p < 0. 001). A positive correlation between the levels of myostatin and interleukin-6 was found (ρ = 0. 410; p < 0. 001). The use of myostatin for the diagnosis of sarcopenia had a sensitivity of 71. 4%, specificity of 71. 4%, cut-off point of 5. 01 ng/mL, and area under the curve of 0. 714 (95% confidence interval: 0. 632–0. 795; p < 0. 001). An increase in myostatin levels above 5. 01 ng/mL increases the likelihood of sarcopenia by 6. 25 times (95% confidence interval: 3. 314–11. 788; χ2 = 34. 639; p < 0. 001). The chances of an increase in myostatin above the threshold value by 2,196 times according to the results of a short international questionnaire for determining physical activity (95% confidence interval: 1. 209–3. 988; χ2 = 6. 78; p = 0. 009) were higher in patients with reduced physical activity than in patients with normal physical activity. In general, in patients with chronic kidney disease receiving programed hemodialysis, along with the determination of myostatin level, a positive statistically significant association of myostatin level with interleukin-6, male sex, age, and decreased physical activity was noted, and myostatin could be used as a predictor of sarcopenia.

Bulletin of the Russian Military Medical Academy. 2023;25(4):619-627
pages 619-627 views

Frequency and causes of blood chimera in combat trauma victims

Tsygankov К.A., Gorban D.Y., Lakhin R.E., Shchegolev A.V., Savelyeva L.P., Konoshenko P.P.

Abstract

The frequency and causes of blood chimeras in victims of combat trauma who arrived from special military operations were analyzed. Data from immunohematological studies of patients admitted to the clinics of the Military Medical Academy named after S. M. Kirov in the period from February to December 2022 were analyzed. All patients were assessed for blood group membership by AV0 systems and Rh factor with phenotyping of erythrocytes and the presence of antierythrocyte antibodies. Chimerism was found in 21% of the patients. According to the AB0 system, general chimerism was detected in 3. 1% of cases, whereas blood chimerisms for antigens A and B were found in 81. 8% and 36. 4% of the cases, respectively. Moreover, blood chimerism for antigens C, c, E, and e was detected in 100% of the cases, and for antigen D, the rate of chimerism was 7. 6%. The identified chimerism in the patients was caused by the use of “universal” doses of erythrocyte blood components by advanced medical service units. In general, the frequency of blood chimerism in victims of combat trauma in the clinics of the Military Medical Academy named after S. M. Kirov was 21%. Blood chimerism in combat trauma victims did not lead to significant immunization. Despite the absence of detected immunization, blood chimerism was a favorable background for possible hemolytic posttransfusion complications during treatment. Possible options for the prevention of blood chimerism include the introduction into practice of advanced use of artificial oxygen carriers, active use of hardware support for reinfusion of blood spilled into the cavity, and preparation of autokrovi for certain patients. These measures are aimed at reducing the number of transfusions of donor blood components, thereby preventing the formation of antierythrocyte antibodies and blood chimeras.

Bulletin of the Russian Military Medical Academy. 2023;25(4):629-635
pages 629-635 views

Effect of topical application of a modified dosage form of granulocyte-colony stimulating factor in complex therapy of Ascherman syndrome

Ob’edkova K.V., Tovpeko D.V., Komarova E.M., Krikheli I.O., Ryzhov J.R., Gzgzyan A.M., Tapilskaya N.I.

Abstract

The effectiveness of the use of a modified intrauterine gel form of granulocyte colony stimulating factor in the complex treatment of Ascherman syndrome is evaluated. The study involved 31 patients with a history of Ascherman syndrome. For 6 months, the patients underwent weekly intrauterine administration of 1 ml of gel with a concentration of granulocyte colony stimulating factor of 9 million IU/ml using an intrauterine catheter. Monthly M-echo was evaluated on the 19th–22nd day of the menstrual cycle, as well as the volume of menstrual blood loss according to the Pictorial Blood Loss Assessment Chart. After the treatment was completed, a control hysteroscopy was performed. There is a statistically significant increase in M-echo from 2. 61 ± 1. 71 to 6. 52 ± 1. 23 mm (p < 0. 001). At the same time, the proportion of patients with M-echo 6 and 7 mm increased from 6. 45 and 0% to 80. 65 and 51. 61, respectively, over the 6 months of the study. There is also a statistically significant increase in menstrual blood loss from 24. 9 ± 2. 6 to 53. 5 ± 3. 4 points on the Pictorial Blood Loss Assessment Chart (p < 0. 001). A response to therapy was achieved in 17 patients, among them 12 patients were diagnosed with pregnancy that occurred spontaneously (17. 65%) or as a result of in vitro fertilization protocol (52. 9%). The data obtained indicate that intrauterine administration of a gel with granulocyte colony stimulating factor promotes endometrial regeneration in patients suffering from Ascherman syndrome, which is expressed in an increase in M-echo and the volume of menstrual blood loss. Thus, adjuvant use of a hydrogel with granulocyte colony stimulating factor and hyaluronic acid is an effective treatment option in restoring reproductive function and preventing recurrence of adhesiogenesis after surgical treatment of Ascherman syndrome. In general, the proposed gel form with granulocyte colony stimulating factor allows us to reduce the frequency of administration of the drug, which theoretically can increase both the compliance of patients primarily by reducing the number of invasive procedures, and reduce treatment costs.

Bulletin of the Russian Military Medical Academy. 2023;25(4):637-646
pages 637-646 views

Experimental evaluation of the purity of medical oxygen obtained by adsorption technology with pressure fluctuations taking into account the variability of the parameters of the incoming air

Miroshnichenko Y.V., Enikeeva R.A., Klimkina E.A.

Abstract

This study presents the results of the evaluation of the purity of medical oxygen obtained by adsorption technology with pressure fluctuations, taking into account the variability of the parameters of the incoming air, and the results of the correlation analysis of data obtained from the monographs of the European and American Pharmacopoeias. The quality of oxygen obtained from air that meets sanitary standards and under conditions of the “worst case,” while fixing the time of the output of the slip signal of monoxide and carbon dioxide as marker gases, was assessed. The slip time under the experimental conditions was 13 h 22 min. The composition of the gas produced by installation was analyzed. Impurities of nitrogen, argon, and water were recognized as predominant quantitatively. Nitrous gases and sulfur dioxide were not detected. A comparative assessment of the data on medical oxygen (93%) presented in the European EP 8. 0 (No. 2455) and the American USP 38-NF (No. 4180) pharmacopeias showed that no single approach is available to assess the quality of 93% medical oxygen in pharmaceutical practice worldwide. The authors of the above-mentioned pharmacopeias note that installations for obtaining 93% medical oxygen, implementing adsorption technology with pressure fluctuations, must be equipped with gas-analytical devices to quantify the level of at least two impurities: carbon monoxide and dioxide. In general, the data obtained indicate that when obtaining 93% medical oxygen by adsorption technology with pressure fluctuations from air corresponding to sanitary and hygienic indicators (clean), the resulting gas did not contain impurities requiring quantitative assessment and/or identification. If oxygen in its pure form is rarely supplied to the patient, its further dilution to 40%–60% is more often required, and the content of hypothetically possible impurities becomes negligible. However, the technology of air separation on molecular sieves is a complex physicochemical (thermodynamic) process, and its effectiveness depends on the component composition of the incoming air, which may change when working under unfavorable environmental conditions in various locations. In this regard, medical oxygen production plants that implement this technology must employ gas-analytical devices to quantify the level of carbon dioxide and carbon monoxide impurities without fail.

Bulletin of the Russian Military Medical Academy. 2023;25(4):647-652
pages 647-652 views

Review

Resistant arterial hypertension: modern view of the problem

Kuchmin A.N., Diskalenko O.V., Izotova A.B., Morozov S.L., Ekimov V.V.

Abstract

In clinical practice, uncontrolled arterial hypertension remains a difficult but solvable task, given the available arsenal of antihypertensive drugs. However, resistant arterial hypertension is diagnosed in 10%–15% of these cases. A significantly higher risk of cardiovascular complications indicates the extreme importance of the successful treatment of this pathology. Resistant hypertension is defined as above-goal high blood pressure in a patient despite concurrent use of three antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a renin–angiotensin blocker (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. All antihypertensive drugs should be administered at maximum or maximally tolerated doses. Resistant hypertension also includes cases in which blood pressure targets are achieved with ≥4 antihypertensive medications. The diagnosis of resistant hypertension requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office blood pressure above goal but out-of-office blood pressure at or below the target). Once antihypertensive medication adherence is confirmed and out-of-office blood pressure recordings exclude a white-coat effect, the evaluation includes the identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. The management of resistant hypertension includes the maximization of lifestyle interventions, correction of sleep disorders, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower blood pressure if blood pressure remains high.

Bulletin of the Russian Military Medical Academy. 2023;25(4):653-664
pages 653-664 views

A new look at the immunopathogenesis of infection caused by the human immunodeficiency virus

Moskalev A.V., Gumilevsky B.Y., Apchel V.Y., Cygan V.N.

Abstract

Thanks to the achievements of biotechnology and genetics, numerous features of reproduction of the human immunodeficiency virus and its immunopathogenesis have been established. Genetic studies have called into question the African origin of the virus. Thus, the number of individuals with mutational changes in the CCR5∆32 allele among the population providing genetic protection against human immunodeficiency virus is decreasing from north to south. The probability of adaptation of the great ape virus in the human population is characterized. New biological effects and their influence on the immunopathogenesis of infection of the well-known human immunodeficiency virus genes Gag (structural proteins), Pol (enzymes) and Env (envelope glycoproteins), the proteins encoded by them, as well as a number of additional proteins have been discovered. Thus, the main task of the Tat gene is to stimulate the transcription of proviral deoxyribonucleic acid and the transport of ribonucleic acid from the nucleus to the cytoplasm of the cell. Rev promotes the synthesis of viral structural proteins and enzymes, ensures the availability of full-sized genomic ribonucleic acid for inclusion in the reproduced viral progeny. Viruses with the absence of the vif gene are about 1000 times less virulent compared to wild strains. The APOBEC3G factor inhibits the reproduction of lentiviruses in primates, but in humans it is characterized by polymorphism of biological effects. Viral protein R affects the rate of reproduction of the virus in T-lymphocytes, contributes to their destruction. It also promotes proteasomal degradation and protein modification. Vpr targets may be a structurally specific endonuclease subunit SLX4, uracil-deoxynucleoacid glycosylase 2, and a helicase-like transcription factor. Vpu is a powerful inhibitor of teterin by type 1 immunodeficiency viruses of group M, and in group N viruses it shows low activity. Vpu, Nef, and Env proteins of most lentiviruses are characterized by higher tropicity to the CD4 receptor compared to teterin, serine incorporation proteins. These proteins are incorporated into viral particles and reduce their infectivity by inhibiting fusion with target cells. The protein containing the tripartite motif 5a, the protein of mixovirus activity 2/B constitute an ancient system of protection against retroviruses and are extremely variable in their effectiveness to disrupt the reproduction of viruses.

Bulletin of the Russian Military Medical Academy. 2023;25(4):665-680
pages 665-680 views

Features of the epidemiological surveillance system of rabies and monkeypox in the Republic of Cameroon

Yumba Е.Е., Kuzin A.A., Zobov A.E.

Abstract

The prevention and control of zoonotic infections remain a problem in most countries. However, this problem has become particularly relevant in recent decades, when the occurrence and pandemic spread of zoonotic diseases have become more frequent. All spheres of the national economy that ensure the fight against infections of this group (healthcare systems, veterinary medicine, and ecology) are trying to jointly find appropriate solutions to ensure antiepidemic protection of the population by taking adequate measures to prevent and combat infectious zoonoses. According to the World Health Organization, the spread of zoonotic infections is observed on all continents, particularly in Asia and Africa. The epidemiological significance of zoonoses depends on their effects on the population (morbidity and mortality), their ability to overcome interspecific barriers, and the individual characteristics of pathogens. It is also influenced by factors such as geographical location, climate, population density, economic growth rates, and development level of private and industrial livestock and poultry farming. The epidemiological surveillance systems in Cameroon are compared with the surveillance system in Russia and with the standards set by international organizations such as the World Health Organization and the Food and Agriculture Organization of the United Nations. The emergence and spread of current zoonotic infections in the Republic of Cameroon are presented. The study showed the geographical, social, administrative, economic, and health characteristics of Cameroon, which may influence the emergence and spread of infectious zoonosis in the country. Zoonotic diseases have only begun to receive special attention in Cameroon’s health system in 2014–2016, following an outbreak of monkeypox (mpox) in Cameroon. Moreover, the study described the epidemiological surveillance system and a classification of epidemic events monitored by the Cameroon Disease, Epidemic and Pandemic Control Authority. In general, the surveillance system for human and animal zoonoses in Cameroon was designed to ensure a rapid response during an epidemic. However, some shortcomings exist, such as low data for some zoonotic diseases and insufficient or virtually nonexistent surveillance in some regions of the country. To intensify the fight against the epidemic spread of these zoonotic infections, the capacity of health workers and technical means for detection and monitoring must be improved. The update of the national vaccination schedule should consider diseases such as rabies, given its endemic nature in the country; this may be possible through the establishment of a service or office responsible for surveillance, detection, and response to infectious zoonotic diseases.

Bulletin of the Russian Military Medical Academy. 2023;25(4):681-690
pages 681-690 views

History of medicine

The celebration of the 100th anniversary of the imperial military medical academy as a recognition of its special role in the development of russian medicine

Salukhov V.V., Ovchinnikov D.V., Kurenkova I.G.

Abstract

The study describes the solemn celebration of the 100th anniversary of the Imperial Military Medical Academy. This celebration not only fixed the special status of the academy among the educational and medical institutions of prerevolutionary Russia but also allowed us to summarize the main results of its development and formation. For 100 years of its existence, it has turned into the largest military educational medical institution, known worldwide, and has experienced periods of ups and downs, heydays and declines, and hopes and disappointment. In 1809, shortly after its foundation, the academy was named the Imperial Military Medical Academy and was introduced into the rank of the first scientific institution of the Russian Empire. The academy reached its greatest heyday when it was part of the military Department, which generously paid for the expenses of its “offspring. ” Thanks to the care of the curators and trustees of the academy, the initiative and creative activity of its leaders in the second half of the XIX century created a wonderful complex of buildings with amphitheaters, auditoriums, classrooms, and medical Departments. More than 10 thousand military doctors had already been educated at the academy by that time. Continuous improvement of teaching and encouragement of the scientific activity of teachers and students put the academy on par with the leading scientific and educational institutions of the West, and some of its institutions nearly surpassed even the best European models. Anniversary events include laying a wreath at the grave of Emperor Paul I, assembly speeches, festive dinners, routs, and visiting the theater and remained in the memory of the participants of the celebration for a long time. During its anniversary, Russian scientists have received numerous warm and heartfelt congratulations from outstanding figures of world science. The involvement of the country’s top officials and the medical community in this celebration testifies to the great respect and love for this oldest military educational institution, the profession of a military doctor, and the recognition of the academy’s merits in the development of Russian and world medical science in helping a suffering person.

Bulletin of the Russian Military Medical Academy. 2023;25(4):691-698
pages 691-698 views

Personalia

Professor Alexey Nikolaevich Kuchmin (on the 60th anniversary of his birth)

Nagorny M.B., Shulenin S.N., Morozov S.L.

Abstract

On July 27, 2023, Alexey Nikolaevich Kuchmin, the Head of the Department of Propaedeutics of Internal Diseases of the Military Medical Academy, named after S. M. Kirov

doctor of Medical Sciences, Professor, and former chief therapist of the Ministry of Defense of the Russian Federation, turned 60 years old. A. N. Kuchmin was born on July 27, 1963, in Mineralnye Vody, Stavropol Territory. After graduation, he entered the Faculty of training doctors for the Navy of the Military Medical Academy named after S. M. Kirov, where he graduated with honors in 1986. For 4 years, he served as the Head of the medical center and the infirmary of the Baltic Fleet Naval Aviation. Since 1990, his life and fate have been inextricably linked with the Department of Propaedeutics of Internal Diseases of the Kirov Military Medical Academy, within the walls of which he has passed through a difficult but bright career path from a 3rd-year cadet to an associate Professor, from a teacher to a Professor and Head of the Department. Here, A. N. Kuchmin joined the scientific, pedagogical, and clinical ideas of Professor N. N. Savitsky. Having started his scientific activity under the guidance of Professor Yu. S. Malov, Alexey Nikolaevich devoted himself to the research of the most pressing issues of cardiology, pulmonology, and physiology. After graduating from the adjunct program in 1993 at the Department of Propaedeutics of Internal Diseases of the Academy, A. N. Kuchmin defended his PhD thesis on “The role of salivary glands in maintaining homeostasis in patients with hypertension”. Since that time, he has been a senior resident, then a teacher, associate Professor, and deputy Head of the Department of Propaedeutics of Internal Diseases (for clinical work) since 2005. In 2003, Alexey Nikolaevich defended his doctoral dissertation on cardiac arrhythmias in patients with bronchial asthma. His research interests now include issues in rapidly developing areas, such as endocrinology, ultrasound diagnostics, and functional diagnostics. During his work as the Chief therapist of the Ministry of Defense of the Russian Federation, A. N. Kuchmin proved himself to be a competent Head of the therapeutic service of the Ministry of Defense of the Russian Federation, particularly during the armed conflict in Abkhazia and Georgia. A. N. Kuchmin’s talent as a clinician and organizer of clinical and expert work was also manifested in his leadership from November 2008 to 2010 in the Department of Therapy of the State Institute of Advanced Training of Doctors of the Ministry of Defense of the Russian Federation and since 2015 in his native Department of Propaedeutics of Internal Diseases of the Military Medical Academy named after S. M. Kirov. In all his positions, Alexey Nikolaevich was and remains a highly professional specialist in his field with several clinical interests and knowledge.

Bulletin of the Russian Military Medical Academy. 2023;25(4):700-706
pages 700-706 views


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