Vol 21, No 3 (2019)

Articles
Medical and psychological rehabilitation of servicemen serving in the Arctic zone of Russia
Dolgikh S.V., Ponomarenko G.N., Bobrov L.L., Ishchuk V.N., Merzlikin A.V.
Abstract
The analysis and results of the generalization of domestic scientific research on the issues of service activities of military personnel and civilians in the Arctic are given. The problems of the organization of the protection of the health of servicemen serving in the Arctic region are shown. It has been established that military personnel performing combat training tasks in the Arctic zone of Russia mainly (more than 95% of cases) have the following types of psychophysical and neurotic disadaptosis - somatoform dysfunction of the autonomic nervous system, overwork, restrictions on activity caused by a decrease or disability. The role of medical and psychological rehabilitation as one of the effective methods for the prevention and treatment of maladaptive disorders in the military has been shown. Methodical approaches to the organization of medical and psychological rehabilitation of servicemen performing training and combat tasks in the Arctic zone of Russia, in particular, recommendations on the use of corrective methods in accordance with the clinical characteristics of syndromes are proposed.
Bulletin of the Russian Military Medical Academy. 2019;21(3):4-15
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Legal regulation of telemedicine in the health care system of the Russian Federation: state and prospects for improvement.
Allamyarova N.V., Sanakoeva E.G.
Abstract
The legislation in the field of e-health, adopted in 2017, opens fundamentally new opportunities in the development of medical care using telemedicine technologies. The article provides an analysis of regulatory legal documents that establish the legal framework for the provision of medical care using telemedicine technologies. An assessment is made of the current state of telemedicine legal regulation in Russia. The law on telemedicine requires adjustment and refinement of existing regulations, procedures, standards of medical care with a detailed regulation of tools and situations of their application.
Bulletin of the Russian Military Medical Academy. 2019;21(3):15-22
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Lenta novostey
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Bulletin of the Russian Military Medical Academy. 2019;21(3):22
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Probabilistic predictive mathematical model of chronic respiratory conditions to reduce the risk of disability in case of poisoning with substances with a pulmonotoxic effect.
Vengerovich N.G., Yudin M.A., Konshakov Y.O., Chepur S.V., Ivanov I.M.
Abstract
In the experimental model of poisoning of rats with phosgene of severe degree (single administration in Tox dose 1 of Lt50 - 3.92 mgґmin/l), the parameters of the respiratory system and histopathological changes of the lung parenchyma were investigated. It was established that 45 days after exposure to phosgene, half of the surviving animals formed a complex of persistent physiological, functional, and structural changes in the syndrome of the syndrome and the chronic respiratory state (J68.4 ICD-10). The main independent predictors from the number of laboratory and functional parameters in the acute period of pulmonary toxicant poisoning (6 hours) were established by the method of mathematical analysis, on the basis of which a model was developed to predict the likelihood of chronic respiratory states in poisoned animals as consequences of severe phosgene poisoning. It is shown that an increase in the concentration of lipid peroxidation products in the blood plasma by 25% determines the likelihood of late effects of more than 0.95. The obtained mathematical model will allow predicting the characteristics of the flow of affected, in need of emergency medical prevention of chronic respiratory conditions in the provision of medical care in the acute period of pulmonary toxicity poisoning.
Bulletin of the Russian Military Medical Academy. 2019;21(3):23-29
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Bulletin of the Russian Military Medical Academy. 2019;21(3):29
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Use of ultraviolet radiation in modern medicine (Literature review).
Markevich P.S., Alekhnovich A.V., Kislenko A.M., Esipov A.A.
Abstract
The article describes the main directions and areas of application of ultraviolet radiation in clinical practice. A special place is given to the mechanisms of biological effects of ultraviolet radiation, therapeutic effects, as well as the main indications, contraindications, equipment for the use of this method of treatment at the present time. Ultraviolet radiation in all possible methods and methods of delivery to biological tissues is of high importance in modern practice, effectively used in most sections of medicine - surgery, urology, gynecology, dermatology, pulmonology, cardiology, otorhinolaryngology, hematology, immunology and many others. This forms the basis for a wider introduction of UV radiation, further improvement of equipment and methods of its application in practical medicine.
Bulletin of the Russian Military Medical Academy. 2019;21(3):30-36
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Algorithm for diagnosing bronchial asthma in citizens of military age.
Zakrevskii Y.N., Arkhangelskii D.A., Balakhnov D.O., Lemeshko P.N.
Abstract
Despite the presence of various international and Russian documents regulating the diagnosis of bronchial asthma, in everyday practice, doctors are constantey face a significant problem when confirming or excluding this disease in people of military age during their medical examination. This is due to the peculiarity of the natural course of the disease in military age: frequent long-term remissions, the predominance of mild or asymptomatic, normal indicators of respiratory function in the remission phase. It was necessary to revise the algorithm for diagnosing asthma in this category of persons in order to avoid making the wrong expert decisions. It has been taken into account that service in the army, with increased physical and emotional loads, exposure to various adverse environmental conditions can be a factor in both debut and exacerbation of the disease. Attention is drawn to the need for an integrated approach in conducting a survey before making a decision on the final rendering of a medical opinion. At the same time, a specific allergological examination, evaluation of spirographic studies, testing aimed at confirming the preserved bronchial hyperreactivity, and in controversial cases, inhalation tests with a clinically significant allergen are mandatory.
Bulletin of the Russian Military Medical Academy. 2019;21(3):36-43
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Peculiarities of the mental health of servicemen serving in submerged command posts.
Abritalin E.Y., Zhovnerchuk I.Y., Zhovnerchuk E.V.
Abstract
The features of the mental health of 150 servicemen (an experimental group), who perform military service in submerged command posts, are analyzed in comparison with 60 servicemen whose professional activities are outside the influence of the conditions of these points (control group). It has been established that the mental health indicators of the military personnel of the experimental group differ for the worse in comparison with the same indicators in the control group. With an increase in the duration of service in the buried points, the severity of mental disorders increases, and the level of social adaptation decreases, which necessitates an expansion of the scope of psycho-preventive measures. Within the framework of psycho-prevention, it is advisable to conduct psychocorrectional measures with the use of methods of mental self-regulation, allowing to improve the neuro-psychological adaptation of military personnel.
Bulletin of the Russian Military Medical Academy. 2019;21(3):44-49
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Bulletin of the Russian Military Medical Academy. 2019;21(3):49
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Instructive story of one high-altitude flight: decompression sickness in an aircraft crew and its consequences
Dvornikov M.V., Volovik Y.A., Matyushev T.V.
Abstract
The article is devoted to a retrospective analysis of the medical aspects of the cause and consequences of high-altitude decompression sickness in the crew of a Su-24M aircraft, which arose in conditions of a forced long flight in a depressurized cabin at high altitude. We studied the documentary evidence of the direct participants and witnesses of the aviation event, the data of the technical analysis of the cause of the failure of the life support system of aircraft and the clinical examination materials of the pilot. The deficiencies in the instructions to the crew and aviation medicine specialists in diagnosing and assisting with the threat of this pathology, which caused the pilot to develop a severe form of altitude decompression sickness, were identified. Formulated recommendations for the prevention of this disease and its consequences, applicable in conditions of combat aviation units in modern conditions.
Bulletin of the Russian Military Medical Academy. 2019;21(3):50-54
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Bulletin of the Russian Military Medical Academy. 2019;21(3):54
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Application of laboratory express diagnostics in a multidisciplinary medical hospital and at the stages of the evacuation of patients
Stets V.V., Lyubimov M.D.
Abstract
The article shows the reasonability of implementation of the «laboratory analysis at the place of delivery of medical care» into medical practice. The main advantages of using the «point-of-care testing» technology for a comprehensive assessment of the condition of patients with various pathologies both in the hospital and during transportation of patients in serious condition are highlighted. Examples of using the i-STAT 300 G (Abbott) device to determine treatment tactics in various clinical situations are given. The results of analyzes obtained with the help of this apparatus correspond to those using the «classical» laboratory equipment, and its advantages can help to improve the outcomes of treating patients. The characteristics of the device make it possible to recommend its use in various conditions for the laboratory diagnosis of life-threatening disorders of homeostasis and correction of the treatment of patients with various pathologies.
Bulletin of the Russian Military Medical Academy. 2019;21(3):55-58
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Revascularization of the lower limb in multisegmental atherosclerotic lesions.
Pinchuk O.V., Obraztsov A.V., Yamenskov V.V., Rakov A.A., Abrosimov A.A.
Abstract
The issues of surgical treatment of multisegmental atherosclerotic lesions of lower limb arteries are considered. Data and analysis of own observations are given. The experience of 9 rare shunt operations of «long» shunts is summarized. Such operations, as an alternative to amputation, can be performed with an adequate assessment of the state of the arterial vascular bed and a strictly individual approach. In some cases, such methods of revascularization provide direct compensation for the blood circulation of the limb with a long-term positive result.
Bulletin of the Russian Military Medical Academy. 2019;21(3):59-60
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Community-acquired pneumonia in elderly patients: the effectiveness of antimicrobial therapy regimens.
Kulagina I.T., Likhodii V.I., Zaitsev A.A.
Abstract
The clinical efficacy of using «protected» aminopenicillins (amoxicillin/clavulanate, amoxicillin/sulbactam) and the 3rd generation cephalosporins in the treatment of mild community-acquired pneumonia in patients older than 60 years in hospital has been evaluated. Analyzed 71 case histories. The assessment was carried out on the basis of a comprehensive analysis of clinical, laboratory and radiological data. A comparative analysis of the clinical efficacy and safety of the antibiotic regimens under study demonstrated the obvious advantage of using «protected» aminopenicillins over the existing practice of treating non-severe community-acquired pneumonia in patients of older age groups.
Bulletin of the Russian Military Medical Academy. 2019;21(3):60-62
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Hemorrhagic fever with renal syndrome among military personnel in Primorsky Krai
Iunikhina O.V., Kompanets G.G., Solovei A.L., Rybakova N.A., Naduda E.A.
Abstract
A study was made of the specific features of the incidence of hemorrhagic fever with renal syndrome among military personnel in the territory of Primorsky Krai and the relationship between the manifestations of infection and the epizootic process among natural carriers of hantavirus. It was established that the incidence of this infection from 2001 to 2015 was characterized by a predominance of middle-aged persons, a connection between the severity of the clinical course and infection conditions, a seasonal and long-term distribution of cases and features of the epizootic process among murine rodents - natural carriers of hantavirus. Infection with ortho-hantavirus among military personnel took place both in domestic conditions and in the process of military professional activity. The circumstances of the most frequent occurrence of sporadic and group cases of diseases are revealed.
Bulletin of the Russian Military Medical Academy. 2019;21(3):62-65
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Pecularities of medical rehabilitation in a multidisciplinary hospital.
Khmil A.Y., Shchegolkov A.M., Belov D.F., Molchanov B.A.
Abstract
The experience of the Medical and Rehabilitation Clinical Center of the Ministry of Defense of the Russian Federation is highlighted. This multi-disciplinary rehabilitation hospital, due to its staffing and organizational structure, equipment and staffing with highly qualified specialists, has the opportunity to conduct comprehensive medical rehabilitation for patients of all rehabilitation profiles. It effectively works multidisciplinary teams, using all modern methods of medical rehabilitation. Evidence is presented of the high performance of medical rehabilitation measures, thus ensuring a substantial replenishment of the rehabilitation potential of the military medical service. The necessity of further improving the organization of medical rehabilitation of military personnel using the capabilities of a modern multidisciplinary rehabilitation center in the system of medical care for the wounded and sick has been shown.
Bulletin of the Russian Military Medical Academy. 2019;21(3):65-67
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Modern approaches to evaluating the effectiveness of treatment of chronic heart failure
Potekhin N.P., Fursov A.N., Kazakov S.P., Putkov S.B., Pestovskaya O.R., Lyapkova N.B., Zakharova E.G., Makeeva T.G., Vereshchagina A.V.
Abstract
The efficacy of therapy for patients with chronic heart failure, a new combination drug valsartan/sacubitrile according to the levels of biomarkers ST2 and NT-proBNP was evaluated. In all patients of the study group, valsartan/sacubitrile therapy improved the NYHA functional class, in the control group - only in 75%. The dynamics of indicators of biomarkers ST2 and NT-proBNP coincided with the improvement of the clinical status of patients against the background of therapy, and to a greater extent this trend reflects the indicator NT-proBNP.
Bulletin of the Russian Military Medical Academy. 2019;21(3):67-68
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Impact of previous work in the conditions of industrial noise on the development of sensorineural hearing loss in the outcome of a military injury.
Churkin D.V., Lastkov D.O., Dolgoshapko O.N., Antropova O.S.
Abstract
The results of a survey of militia members - industrial workers aged 35-39 years who had previously worked in the conditions of industrial noise are presented. As a result of a military trauma (combined head injury, acutrauma, barotrauma) they developed sensorineural hearing loss. The level of hearing loss and the degree of involvement in the pathological process of the sound-perceiving apparatus is related to the length of work experience in the conditions of industrial noise. For persons who worked in conditions of constant low-amplitude broadband noise (n=30), hearing loss is more pronounced compared to persons (n=30) who worked in conditions of pulsed high-frequency high-amplitude noise. In the control group (35-39 years, n=30), who previously worked outside of industrial noise, the level of hearing loss is determined by the frequency of traumatic brain injury and is associated with the formation of post-traumatic osteochondrosis and vertebrobasilar insufficiency.
Bulletin of the Russian Military Medical Academy. 2019;21(3):68-71
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Acute bronchitis: answers to key questions.
Zaitsev A.A., Budoragin I.E., Likhodii V.I., Savushkina O.I.
Abstract
The publication is devoted to the etiology and pharmacotherapy of acute bronchitis in adults. The authors obtained data on the etiology of the disease, indicating that in the clear majority of cases acute bronchitis is caused by various respiratory viruses (adenoviruses, influenza viruses and parainfluenza, and combinations of different viruses). The results of the study show that the starting prescription of antibacterial drugs for acute bronchitis is impractical, and the decision on their use should be based on objective data indicating the development of the bacterial process. A good tool for «distinguishing» a viral and bacterial infection is the quantitative determination of C-reactive protein in serum, the level of which is less than 20 mg/l, which is in favor of viral infection.
Bulletin of the Russian Military Medical Academy. 2019;21(3):71-73
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To the 100th anniversary of the opening of the State Higher Medical School in the Moscow Military Hospital.
Kryukov E.V., Kostyuchenko O.M., Bobylev V.A., Ovchinnikova M.B.
Abstract
The article is devoted to the State Higher Medical School, opened in March 1919 in the Moscow Military Hospital, which was due to the need of the new Soviet state for highly educated medical personnel. The Higher Medical School was a kind of continuation of the traditions of training medical personnel at the Moscow Hospital after the medical-surgical school and the Moscow Medical-Surgical Academy.
Bulletin of the Russian Military Medical Academy. 2019;21(3):74-86
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A.D.Shaikov - a military doctor, a scientist, a chancellor.
Korneev A.G., Aminev R.M., Shevlyuk N.N., Lantsov E.V.
Abstract
The article is dedicated to the 100th anniversary of the birth of a prominent Russian epidemiologist and former rector of the Orenburg State Medical Institute, lieutenant colonel of the medical service of retired Anatoly Dmitrievich Shaikov. He left a bright trace in the history of naval medicine, having traveled from the ship doctor to the flagship epidemiologist of the 7th Pacific Navy. In the 1960s, under the direction of A.D.Shaikov, a pediatric faculty, a preparatory department, more than 10 new departments and 6 laboratories were created at the Orenburg Medical Institute; A.D.Shaikov made a significant contribution to the scientific development of the problems of military epidemiology, epidemiology of intestinal infections, parasitology, etc.
Bulletin of the Russian Military Medical Academy. 2019;21(3):87-89
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Bulletin of the Russian Military Medical Academy. 2019;21(3):89
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Opening of main medical building in the Branch N 1 of the A.A.Vishnevsky 3rd Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation.
Meshkov A.V., Nezhivov R.N., Galik V.P., Musailov V.A.
Abstract
In the Branch N 1 of the A.A.Vishnevsky 3rd Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation in December 2018, the ceremonial opening of the newly created operating unit, the intensive care unit and the main medical building after the repair took place. Presentations were made by the Head of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation Dmitry Trishkin and the head of the branch, Colonel of Medical Service Andrei Meshkov. The commissioning of new units after repair will allow for a short period to realize a new stage in the development of the hospital.
Bulletin of the Russian Military Medical Academy. 2019;21(3):90-91
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First training and practical course on field surgery and trauma surgery «SMART» in Russia.
Samokhvalov I.M., Fomin N.F., Goncharov A.V., Reva V.A., Petrov A.N., Kasimov R.R., Nosov A.M., Koskin V.S.
Abstract
In recent years, significant progress has been made in the treatment of severe injuries and traumas. In critical situations, for the heaviest category of wounded, the outcome is largely determined in the next few minutes after admission to the hospital. The only possible tactic that gives a chance to save the lives of such victims is the tactics of multi-stage surgical treatment (damage control). The low effectiveness of traditional methods of training surgeons in the basics and techniques of this tactic makes it necessary to develop new forms of training. One of the most progressive and sought-after is training on biological material (large animals or cadaver material), but the methodology for conducting such studies has not been worked out before. For the first time in Russia in November 2018, a unique training and practical course «SMART» (Modern Methods and Algorithms for the Treatment of Wounds and Traumas) was conducted, combining training in both living tissues and cadavers. Participants were given the opportunity to see and independently work out the basic combinations of typical surgical techniques and maneuvers aimed at eliminating the life-threatening consequences of injuries and traumas.
Bulletin of the Russian Military Medical Academy. 2019;21(3):92-95
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Experience of organization of the first meeting of chief and senior medical nurses of the Airborne Forces.
Kalinin P.A., Kovaleva T.V.
Abstract
A brief report on the first training and methodological meeting of chief (senior) nurses of medical organizations and units of the Airborne Forces for the first time conducted in the Armed Forces of the Russian Federation. The event was held in September 2018 in the city of Ivanovo based on the 36th separate medical unit (airmobile). Competent planning and organization of fees allowed to achieve their goals.
Bulletin of the Russian Military Medical Academy. 2019;21(3):95-96
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