Vol 22, No 2 (2020)

Articles
Optimization of diagnosis of SARS-CoV-2 infection using polymerase chain reaction in a large multi-specialty hospital
Zhdanov K.V., Kozlov K.V., Bulankov Y.I., Zakharenko S.M., Uliukin I.M., Zagorodnikov G.G., Grigoriev S.G., Orlova E.S., Shuklina A.A., Ivanov A.M., Maltsev O.V., Sukachev V.S., Kasyanenko K.V., Grinchenko N.E.
Abstract
Аbstract. We consider the possibility of optimizing the diagnosis of infection caused by SARS-CoV-2 using polymerase chain reaction in a multi-specialty hospital, repurposed for the treatment of COVID-19 patients, using the example Of the military medical Academy named after S.M. Kirov. The analysis of scientific publications selected in accordance with the purpose of the study, analyzed data from 218 samples of polymerase chain reaction in patients with COVID-19, who were in the clinics Of the military medical Academy named after Sm. Time intervals were established depending on the clinical forms and severity of the infectious process, in which the probability of a positive and negative result of a polymerase chain reaction to SARS-CoV-2 RNA was maximum and minimum. It was shown that during the examination and treatment, molecular biological diagnostics were performed excessively (4 times in more than 50% of patients) and in 97,3% of patients unreasonably early (8,5±0,4 days). At the same time, the highest frequency of negative results of polymerase chain reaction to SARS-CoV-2 RNA was observed in the period from 9 to 10 and from 12 to 14 days, while it depended on the clinical form and severity of the infectious process. In this regard, the volume diagnosis using polymerase chain reaction should be reduced and to conduct research when entering the hospital, on the 9th-10th day (in patients inapparently forms and acute respiratory diseases, lung flow) and 12-14 days before discharge in patients with moderate and severe course of the infectious process.
Bulletin of the Russian Military Medical Academy. 2020;22(2):7-10
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Possibilities of transient and two-dimensional shear wave elastography in the diagnosis of fibrosis in nonviral chronic diffuse liver diseases in military personnel
Zhirkov I.I., Gordienko A.V., Yakovlev V.V., Serdyukov D.Y., Dorohov G.Y., Vashchenkov V.V., Brynyuk A.S., Shichkin M.F.
Abstract
The study examines the possibilities of transient and two-dimensional shear wave elastography in the diagnosis of fibrosis in the most common chronic diffuse liver diseases of non-viral etiology: alcoholic and non-alcoholic fatty liver disease, as well as their combination. It was found that in patients suffering from these diseases, the values of aspartate and alanine aminotransferase, gamma-glutamyl transpeptidase, cholesterol, triglycerides, as well as the oblique vertical size of the right lobe of the liver were significantly (p<0,05) higher than in patients of the control group. Moreover, most of these indicators reliably (p<0,01) reached the highest values in patients suffering from fatty liver disease of alcohol-metabolic etiology, which confirms a more pronounced damaging effect on the liver with a combination of alcohol and metabolic factors. It has been established that the use of transient and two-dimensional elastography is characterized by high diagnostic significance in determining the stage of fibrosis in chronic diffuse liver diseases of non-viral etiology. The greatest diagnostic significance of elastographic research methods is noted in the third and fourth stages of fibrosis. In the second stage of fibrosis, the quality of diagnostic significance when using transient elastography was higher than when using two-dimensional shear wave. The use of transient and two-dimensional shear wave elastography in most cases avoids liver biopsy in patients suffering from chronic diffuse liver diseases of non-viral etiology. Therefore, in the diagnosis of chronic diffuse liver diseases, the presence and degree of fibrosis is a factor that will largely determine the prognosis, treatment tactics and the likelihood of complications in a particular patient.
Bulletin of the Russian Military Medical Academy. 2020;22(2):11-15
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Criteria for assessing renal allograft dysfunction
Lavrishcheva Y.V., Yakovenko A.A., Belskykh A.N.
Abstract
The significance of the glomerular filtration rate calculated by the Cockcroft - Gault formula as one of the highly sensitive criteria for assessing renal allograft dysfunction is substantiated. The study demonstrated that in the group of patients with an increased level of daily proteinuria there is a significantly lower level of serum creatine in comparison with the group of patients with a normal level of daily proteinuria. Moreover, in patients with a normal level of daily proteinuria, there are significantly higher values of glomerular filtration rate calculated by the Cockcroft - Gault formula, compared with patients with an increased level of daily proteinuria. Thus, it is shown that the level of serum creatinine currently used in clinical practice, as a laboratory marker of renal allograft dysfunction, does not allow to detect impaired renal allograft function at the earliest possible date. It has been demonstrated that the glomerular filtration rate calculated by the Cockcroft - Gault formula is a highly sensitive and specific laboratory marker of renal transplant dysfunction. Determining the glomerular filtration rate calculated by the Cockcroft - Gault formula makes it possible to diagnose renal allograft dysfunction at the earliest stages, which will significantly improve the survival of the transplanted kidney due to timely changes in patient management tactics and correction of immunosuppressive therapy.
Bulletin of the Russian Military Medical Academy. 2020;22(2):16-18
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Assesment of premarure death in patients with pulmonary tuberculosis and chronic obstructive pulmonary disease
Katicheva A.V., Brazhenko N.A., Brazhenko O.N., Chuikova A.G., Zheleznyak S.G., Tsygan N.V., Nikolau A.V.
Abstract
The risk of developing cardiovascular pathology and premature death from it in patients with pulmonary tuberculosis in combination with chronic obstructive pulmonary disease is assessed. It has been established that more than 80% of patients with pulmonary tuberculosis are regular tobacco users. Chronic tobacco intoxication leads to the formation of chronic obstructive pulmonary disease, affecting the course of the tuberculosis process. In patients with tuberculosis on the background of smoking and chronic obstructive pulmonary disease, pronounced clinical manifestations of the disease are determined, which are accompanied by a common tuberculosis process, decomposition in the lung tissue and bacterial excretion. Patients suffering from comorbid pathology revealed deep disturbances in the homeostatic balance of the body and changes in the reactivity of the body. Changes in the proteinogram were determined, with the predominance of g γ- и α-2 fractions, an increase in C-reactive protein and fibrinogen, which confirms a pronounced systemic inflammatory response. The pathological state of homeostatic equilibrium of the body is accompanied by the development of hypoxemia, oxidative stress, systemic inflammation, endothelial dysfunction and dyslipidemia. In a third of patients, changes in the lipid profile are determined against the background of a lack of body weight, which is an unfavorable prognostic sign during chronic obstructive pulmonary disease. Such phenomena contribute to the development of multifocal atherogenesis, systemic arterial hypertension, cardiac remodeling and the rapid development of cardiovascular pathology. In patients with comorbidity, changes in the electrocardiogram are characterized by remodeling of the myocardium, a change in the position of the electrical axis of the heart, overload of the right heart, hypertrophy of the left heart. These patients are characterized by a decrease in exercise tolerance, a moderate and high risk of developing cardiovascular complications and premature death from them. Identified changes are predictors of early disability and premature death of patients with tuberculosis, contribute to a decrease in the quality and life expectancy of patients.
Bulletin of the Russian Military Medical Academy. 2020;22(2):19-22
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Diagnostic significance of otorhinolaryngological and ophthalmic pathology in patients suffering from neurosyphilis infected with human immunodeficiency virus
Orlova I.A., Telichko S.I., Smirnova I.A., Dudko V.Y., Piryatinskaya A.B., Telichko I.N.
Abstract
It was found that eye damage can be considered as a marker of neurosyphilis. Similar data regarding the diagnostic value of damage to the ears, nose and throat in patients with syphilis infected with human immunodeficiency virus are single. It was revealed that neurological symptoms in patients suffering from neurosyphilis are equally common in patients infected with human immunodeficiency virus and those not infected with this virus (42,2 and 44,7%, respectively). In other cases, the disease is asymptomatic. At the same time, specific damage to the eyes, ears, nose and throat is diagnosed in 57,8% of patients with neurosyphilis infected with the human immunodeficiency virus. The structure of the specific damage to the ears, nose and throat in patients suffering from neurosyphilis infected with the human immunodeficiency virus is presented in 30,7% of cases with specific angina, in 15,3% - decrease in bone conduction, in 7,6% - hearing loss and in 46, 10% - other unspecified symptoms. The structure of the damage to the organ of vision was papillitis - 38,4%, anterior uveitis and panuveitis - 23,1 and 15,3%, respectively. Neuroveitis, retinal angiopathy, and peripheral chorioretinal dystrophy were equally common in 7,6%. For patients suffering from neurosyphilis infected with the human immunodeficiency virus, a combination of damage to the eyes, ears, nose and throat is characteristic. In particular, in one patient a combination of specific tonsillitis with papillitis was noted, in the other with uveitis. Thus, specific damage to the eyes, ears, nose and throat is characteristic of patients suffering from neurosyphilis infected with the human immunodeficiency virus.
Bulletin of the Russian Military Medical Academy. 2020;22(2):23-26
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Impact of infusion therapy programs on homeostasis indicators in patients suffering from shockogenic trauma from the point of view of statistical reliability
Stepanov S.S., Girsh A.O., Stukanov M.M., Leonov G.V., Malyuk A.I., Eselevich R.V., Kozlov K.K.
Abstract
From the point of view of statistical reliability, the influence of various infusion therapy programs on homeostasis indicators of patients suffering from shockogenic trauma is considered. It has been revealed that when entering the intensive care and intensive care department in patients suffering from severe traumatic shock, against the background of algorithms of anti-shock measures at the pre-emergency and hospital stages there are significant individual intervals of examined homeostasis parameters, which indicates expressed personalized disorders of indicators of reflecting function of organs and systems of patients. The variation in the canonical space of the investigated parameters in patients increased after 12 hours, after admission to the intensive care and resuscitation department. Anti-shock therapy contributed to the fact that the distribution of patients of all three groups in the canonical space after the first 24 hours was dynamically compacted, indicating a decrease in differences between patients of each group during the treatment process. Cluster analysis and multi-dimensional scaling revealed the multilateral dynamics of the relationship between independent variables in various infusion therapy programmes. When patients were admitted to the intensive care and intensive care unit, almost the same orientation of the features of connections between independent variables was noted, however, their polarity was recorded during the treatment process. This shows that the infusion therapy program in patients suffering from severe traumatic shock should be carried out taking into account the dynamics of individual disorders of the investigated homeostasis parameters. It has been statistically proven that different infusion therapy programs have very different effects on homeostasis rates. The use of sterofundin isotonic and 4% modified gelatin in this category of patients has been proven to be the most effective and safe volemic recovery scheme.
Bulletin of the Russian Military Medical Academy. 2020;22(2):27-33
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Analysis of incidence of tibia stress fractures among the militaries
Omarov G.J., Paltushev A.A., Panov S.A., Iontsev V.I., Apchel V.Y.
Abstract
Аbstract. In the process of special training of military servicemen, various elements of the musculoskeletal system of a person are constantly exposed to mechanical loads of various frequencies, intensities and strengths. With such prolonged and shock loads characteristic of military personnel and athletes, permanent minor damage to the bones occurs, which over time can lead to impaired formation of bones and joints, up to the development of the disease. Violation of the motor reactions of the limb ultimately leads to the suppression of the mechanisms of social adaptation, physiological functions and aggravates the course of most diseases, decompensating processes that affect not only the quality of life, but also its duration. A very important point is that labor losses in military personnel during stress fractures can reach 6 months, which negatively affects the service, with a total duration of 12 months of military service. In this regard, questions arise about the advisability of such military servicemen in the army and further spending of budget funds for their maintenance. The stress fractures of long bones are analyzed on the example of fractures of the tibia. It has been established that the greatest number of injuries associated with stress fractures occur during combat training conducted in a special military uniform. A feature of the course of stress fractures is increasing pain in the limb. Among injured with tension fractures, 83,5% of the military did not do the sports before drafting, and physical activity that arose during the service was difficult or not tolerated.
Bulletin of the Russian Military Medical Academy. 2020;22(2):34-38
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Impaired heart conduction in pilots of civil aviation of the older age group
Kuzmina A.Y., Blaginin A.A., Fisun A.Y.
Abstract
Prevalence, structure and clinical significance of conduction disturbances was studied according to the electrocardiography findings in 1189 older pilots in aged 55 years and older, who were to the Central Civil Aviation Hospital (Moscow) and examined on the regular bases. Resting electrocardiogram was recorded in all subjects according to generally accepted methods. Heart conduction disorders were detected in 16,9% of pilots of the older age group. More common were intraventricular conduction disturbances - 13,7% of cases, atrioventricular conduction disturbances were recorded less often- 1,8% of cases, and their combination was even less common - 0,6% of cases. Cardiac conduction abnormalities as part of another electrocardiogram syndromes were noted in 10 (0,8%) peoples. Older civil aviation pilots are characterized a lower frequency of electrocardiogram changes compared to a general population of the same age in the Russian Federation. The signs of cardiac conduction disturbances on the electrocardiogram in civil aviation pilots did not always lead to unfitness to fly. The evaluation of fitness to flight in some electrocardiogram deviations is depend of the presence or absence of cardiovascular disease, functional condition of the cardiovascular system and the data of additional examination methods. Diagnosis of heart rhythm and conduction disorders is important in assessing the state of the circulatory system, especially in flight personnel. Timely detection of cardiac conduction disorders in civil aviation pilots is essential for maintaining medical safety, especially in older people. Electrocardiography is performed as an initial method for assessing the state of the conducting heart system in civil aviation pilots.
Bulletin of the Russian Military Medical Academy. 2020;22(2):39-44
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Results of surgical treatment of patients with stage IV colon cancer of older age groups and ways to improve them
Sazonov A.A.
Abstract
The effectiveness of cytoreductive operations in geriatric patients with stage IV colon cancer was assessed. A comparative analysis of the results of surgical treatment of metastatic colon cancer in patients of various age groups was carried out. The molecular biological properties of colon adenocarcinoma in patients with metastatic colorectal cancer were studied. The clinical significance of immunohistochemical markers as the proliferative index of stem cancer cells (ALDH+Ki-67+) and the chemokine receptor CXCR4 was determined for predicting the long-term results of surgical treatment of patients with stage IV colon cancer has been determined. It was found that the survival rates of elderly and senile patients are not inferior to those in patients under 60 years of age. A comparative analysis of the immediate and long-term results of treatment indicates the effectiveness of cytoreductive interventions in elderly and senile patients suffering from stage IV colon cancer. It was found that the expression level of the receptor for CXCR4 chemokines and the proliferative activity of stem cancer cells correlate with the life expectancy of patients after cytoreductive interventions and can be used to clarify the indications for their implementation.
Bulletin of the Russian Military Medical Academy. 2020;22(2):45-50
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Dynamic medical observation of the flight crew in the Far North is the basis of the primary prevention of adaptation disorders
Apchel V.Y., Zagorodnikov G.G., Zagorodnikov G.N.
Abstract
Dynamic medical monitoring of flight crew during the first year of service in the Far North allows you to organize and carry out activities for the primary prevention of adaptation violations in flight crew. It was established that in pilots with diagnosed diseases of the circulatory system, gastrointestinal tract and various parts of the spine, compared with pilots diagnosed «Healthy», there was a statistically significant (p<0,01) increase in the average primary morbidity rate by 11,1; 10,8 and 10,7%, respectively, which indicates the tension of adaptive mechanisms in the former in the initial period of adaptation to the conditions of the Far North. Most pilots after assessing such areas of quality of life as physical satisfaction (activity, mobility, the possibility of self-care, full military duties, lack of pain and independence from medications) and psychological satisfaction (emotional background, learning ability, memory, concentration of attention), received integral ratings of 4-5 points. The dynamics of the level of development of cognitive mental processes indicates that in pilots with diagnosed diseases, compared with healthy pilots, there is an increase in the average efficiency indicator of the methods «Analogies», «Numeric series», «Visual memory», «Creative thinking»; «Arithmetic score», «Verbal memory» and «Establishment of patterns», respectively, by 10,5; 10,4; 10,4; 10.5; 10,5; 10,2 and 10,2% (p<0,01). Thus, in pilots with diagnosed diseases of the circulatory system, gastrointestinal tract and various parts of the spine, as compared to healthy pilots, adaptive mechanisms are observed in the initial period of adaptation to the conditions of the Far North.
Bulletin of the Russian Military Medical Academy. 2020;22(2):51-54
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Clinical features and diagnosis of tuberculous meningoencephalitis in patients infected with human immunodeficiency virus
Milyaev A.A., Dantsev V.V., Belova A.I., Platonova R.A., Zaretsky B.V., Muchaidze R.D., Karpushchenko V.G.
Abstract
The results of a prospective study of 66 patients aged 32,6±3,8 years infected with the human immunodeficiency virus who were treated in an anti-tuberculosis medical organization for tuberculosis meningoencephalitis are presented. Of these, 49 (74,2%) were newly diagnosed with tuberculosis, and 17 (25,8%) had relapses and chronic forms of tuberculosis. According to social characteristics, patients were distributed as follows: working - 9 (13,6%), non-working - 57 (86,4%), disabled people with tuberculosis - 4 (6,1%), persons who previously served their sentences in prison - 48 (72,7%). All the surveyed patients had bad habits: they continued to actively use psychoactive substances - 52 (78,8%) people, abused alcohol - 43 (65,2%), smoked - 60 (90,1%). In 97% of cases, tuberculosis of the meninges and Central nervous system was a complication of respiratory tuberculosis: tuberculosis of the intra-thoracic lymph nodes - 42,4%, disseminated pulmonary tuberculosis - 27,3%, infiltrative pulmonary tuberculosis - 22,7%, and caseous pneumonia- 7,6%. The most effective method for diagnosing the tuberculosis etiology of meningoencephalitis in patients infected with the human immunodeficiency virus is the study of cerebrospinal fluid using a polymerase chain reaction. Deoxyribonucleic acid of Mycobacterium tuberculosis was detected in 31 (47%) patients. The characteristics of the cerebrospinal fluid in the examined patients are presented as follows: a decrease in glucose in 45 (68,2%) patients, an increase in protein in 59 (89,4%), and cytosis at the upper limit of normal values in 10 (15,6%). High mortality rates (47,7%) in patients infected with the human immunodeficiency virus in combination with tuberculosis meningoencephalitis are associated with a high degree of immunosuppression.
Bulletin of the Russian Military Medical Academy. 2020;22(2):55-58
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Neuronavigation Assistance. Decreased radiation exposure during spinal surgery in patients with severe combined trauma
Badalov V.I., Spitsyn M.I., Korostelev K.E., Yarmoshuk R.V., Rodionova A.A.
Abstract
Absnract. The results of the study of intraoperative x-ray irradiation of the affected two arrays are presented: the main array using neuronavigation and the control group, where standard 2D fluoroscopy was used. The radiation load on the operating surgeon and auxiliary operating personnel was also evaluated. Intraoperative visualization was carried out using the second-generation «iNtellect ENT Navigation» rack of the «Stryker» company (United States of America) for the victims of the main array and the «Ziehm Vision RFD» optical-optical converter (Germany) of the company for the victims of the control group. The imaging option using an electron-optical transducer is especially important for minimally invasive procedures, where instrumentation is performed percutaneously without direct anatomical control, as opposed to open procedures or working with distorted anatomical structures during injuries. Biplanar fluoroscopy was one of the first intraoperative methods of imaging in real time, and remains one of the leading technologies in orthopedic and spinal surgery. However, radiation exposure from intraoperative fluoroscopy remains a serious problem for patients, surgeons, and operating support staff. The negative effect of ionizing radiation leads to cell damage through the induction of deoxyribonucleic acid and the release of reactive oxygen species. In this regard, cell death or genome instability occurs, which leads to various radiation-related pathologies. It was found that the use of neuronavigation reduces the number of errors, reduces intraoperative trauma, and significantly reduces intraoperative radiation exposure to the injured, operating surgeon and auxiliary operating personnel. The large-scale introduction of navigation technologies will reduce or completely eliminate the harmful effects of ionizing radiation on the injured and medical personnel.
Bulletin of the Russian Military Medical Academy. 2020;22(2):59-65
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The role of blood loss in the structure of thanatogenesis factors in explosive injury during peacetime
Trukhan A.P., Samokhvalov I.M., Tolmachev I.A., Isakov B.D., Golovko K.P., Skakunova T.Y., Ryadnov A.A.
Abstract
Currently, explosive trauma is rare in peacetime injury surgery, but is of great importance in the work of surgeons. This is due to damage of a large number of anatomical areas, various damaging factors of the explosion and the simultaneous entering of several victims. The results of forensic medical examinations of 24 corpses of people who died as a result of terrorist acts in the subway of Minsk on 11/04/2011 and St. Petersburg on 03/04/2017 were analyzed. Incompatible with life injuries as the immediate cause of death were found only in 33,3% of cases. Profuse blood loss was the immediate cause of death in 66,7% of those killed. The most common (in 87,5% cases) cause of profuse blood loss was internal bleeding: in 7 (50%) cases - due to damage to organs and large vessels of the chest, in 6 (42,9%) cases - due to combined damage to the anatomical structures of the chest and abdomen, in 1 (7,1%) case - due to damage to the parenchymal organs of the abdominal cavity and retroperitoneal space. The leading role in thanatogenesis during the considered explosive peacetime injuries was occupied by blood loss, its specific gravity was 66,7%. Profuse blood loss in 87,5% of cases was due to damage to the organs of the chest and abdomen. Potentially salvable were 7 (29,2%) dead who received damage to the main vessels of the limbs, damage to internal organs without injuring the heart and large blood vessels. Thus, the development of new ways to stop intracavitary bleeding at the advanced stages of medical care for victims with explosive injuries and injuries is a priority aim.
Bulletin of the Russian Military Medical Academy. 2020;22(2):66-69
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The use of methods of spatial displacement of the myocardial structure (speckle tracking) to determine the indications for coronary angiography in patients suffering from coronary heart disease
Kuchmin A.N., Yaroslavtcev M.Y., Afendikov N.V., Galova E.P., Evsukov K.B., Morozov S.L., Shevelev A.A.
Abstract
The indicators of global and segmental longitudinal deformation of the left ventricular myocardium are presented and analyzed in patients suffering from coronary heart disease. The latter, as before, remains one of the urgent diseases of the circulatory system. To verify and determine management tactics for patients suffering from coronary heart disease, coronary angiography is performed. Indications for its implementation are based on the results of exercise tests, in particular, stress echocardiography. However, its implementation can be difficult due to poor visualization of the walls of the left ventricle, and the conclusion is not without subjectivity. One of the modern methods for assessing the contractility of the left ventricular myocardium, both global and segmental, is the spatial displacement of the myocardial structure (speckle-tracking- echocardiography). The technique automatically calculates the longitudinal deformation of the myocardium, expressed as a percentage of the initial values. It was found that the global and segmental longitudinal deformation of the left ventricular myocardium in the majority of the evaluated segments in the examined patients did not differ before loading. When conducting a stress test, the exact opposite dynamics of changes in the parameters of the global and segmental longitudinal deformation of the left ventricular myocardium is observed. So, in patients with a high risk of complications of coronary heart disease, a decrease in these indicators was observed, in patients without a risk of complications, on the contrary, their increase was observed, which indicates an increase in myocardial contractility during physical exertion. It was revealed that the indicator of global longitudinal deformation of the left ventricular myocardium is highly informative. The lower value of the decrease in the global longitudinal deformation of the left ventricular myocardium was calculated, which can serve as an additional indication for coronary angiography.
Bulletin of the Russian Military Medical Academy. 2020;22(2):70-73
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Late silicosis - the rare form of pneumoconiosis
Halimov Y.S., Tsepkova G.A., Vlasenko A.N., Shilov V.V., Andreenko O.N.
Abstract
A clinical case of a relatively rare variant of pneumoconiosis, late silicosis, which developed 25 years after the termination of contact with fibrogenic dust, is described. The patient was examined at the consultative and outpatient department of the North-West Scientific Center for Hygiene and Public Health (the clinical base of the Department of Military Field Therapy of S.M. Kirov Military Medical Academy). It was established that the patient worked for 15 years as a crusher at a mining and processing plant, where the work was accompanied by exposure to dust of fibrogenic action (granite gneiss) containing free crystals of silicon dioxide, noise, vibration and an unfavorable microclimate, and also worked as a repairman for 12 years where it was exposed to abrasive dust, noise and adverse climate. In the general assessment of working conditions, taking into account the combined and combined effects of harmful factors, they are considered harmful to the crusher (class3.3) and acceptable to the crusher / repairman (class 2.0). For the entire period of work of this employee, occupational diseases were not established and he was not referred to a professional pathologist. Based on the study of a professional history, data on the sanitary and hygienic characteristics of working conditions, the results of a clinical examination, including physical and laboratory methods, spirography, fibrobronchoscopy, radiography and computed tomography of the lungs, a diagnosis of late silicosis was established.
Bulletin of the Russian Military Medical Academy. 2020;22(2):74-78
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Analysis of the provision of paradontology in the Armed forces of the Russian Federation
Nikitenko V.V., Grebnev G.A., Chernysh V.F., Kovalevsky A.M., Sheenko L.I.
Abstract
A statistical study of the appeal to the dental clinic of S. M. Kirov Military Medical Academy patients who were diagnosed with chronic generalized periodontitis, as well as the analysis of treatment methods for inflammatory periodontal diseases in the Armed Forces based on data from the Main Military Medical Directorate for 2012-2018. Analysis of treatment methods for chronic generalized periodontitis in the military unit indicates the choice of a radical method - tooth extraction. Most patients who applied to the clinic of maxillofacial surgery and surgical dentistry were diagnosed with a severe degree of chronic generalized periodontitis. Basically, patchwork operations were performed on the upper jaw and lower jaw. The proportion of patients with moderate severity of chronic generalized periodontitis prevailed in the dental clinic. In the conditions of the dental clinic, no flap periodontal operations were performed, most often the method of curettage of periodontal pockets was used, which was carried out to improve the quality of the intervention according to classical recommendations in the field of several teeth, including using high-tech equipment. Timely and high-quality comprehensive treatment of inflammatory periodontal diseases is the basis for successful activities to reduce periodontal morbidity and improve oral health in military personnel. Due to the relevance of inflammatory periodontal diseases in the Armed Forces of the Russian Federation, the choice of treatment method should be based on etiological and pathogenetic therapy, dentists should abandon the radical method of tooth extraction.
Bulletin of the Russian Military Medical Academy. 2020;22(2):79-83
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Tactics of surgical treatment of patients with lumbar spondylolysis
Nadulich K.A., Khominets V.V., Nagornyi E.B.
Abstract
The bilateral defect of the pars interarticularis (spondylolysis) is often the cause of low back pain syndrome and can lead to development of spondylolistesis. In some cases inefficiency of conservative treatment of this condition forces orthopedists to use surgical technologies. At the same time, in young patients with intact intervertebral discs, the rigid segmental fixation of the spine should be avoided. Where no neural decompression is needed, selective osteosynthesis of the pars defect is an optimal technique. The authors present the results of surgical treatment of 15 patients with single and two-level lumbar spondylolysis, 4 of which revealed minimal I degree lytic spondylolystesis of the L5 vertebrae. Localization of the pathological process in all patients was noted on both sides. In two patients spondylolysis defects of two vertebrae were detected (in one- adjacent L4 and L5, in the other - L2 and L4 vertebrae with sacralization of L5). The average period from the onset of symptoms ranged from 6 months to 2 years (an average of 14 months). All patients undergone bone autoplasty with iliac crest bone graft, and osteosynthesis of vertebral arches by a combined laminar-transpedicular system of the «screw - rod - hook» type. All patients had excellent and good anatomic and functional results. The used method of surgical treatment of patients of this category should be considered pathogenetically justified, as it is aimed at repair of spondylolytic defects as the main cause of segmental instability and forward displacement of vertebrae. The possibility to avoid fixation of intact segments of spine allows to categorize this operation as organ-preserving.
Bulletin of the Russian Military Medical Academy. 2020;22(2):84-93
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Dental rehabilitation of total adentia at pensioners of the Ministry of defense and contingent attached to military medical organizations
Muzikin M.I., Grebnev G.A., Iordanishvili A.K., Tereshchuk S.V., Melnikov M.V.
Abstract
Legal, economic and clinical aspects of treatment of military personnel, retired military personnel, as well as the attached contingent in the conditions of hospitals of the Ministry of defense are presented. The study is based on the results of studying the number of dental implants installed in patients from 2014 to 2019 based on the medical records and outpatient records of a dental patient in two specialized departments of multidisciplinary hospitals of the Ministry of defense of the Russian Federation. Primary medical records were studied, data on the sex and age of patients, the presence (absence) of opportunistic diseases used implant system, the installation of dental implants and their amount and frequency of soft tissue and osteoplastic operations (to increase the volume of the bone and soft tissues of the alveolar bone (part) jaws) and the Protocol of the temporary and permanent prosthesis. Based on the analysis, we describe the current possibilities of medical and diagnostic work and present various types of orthopedic structures on dental implants for the dental rehabilitation of the above-mentioned contingents with complete adentia of the jaws (including in cases where absolute indications require the removal of all teeth due to foci of chronic odontogenic infection or periodontitis). The methods of treatment of patients in cases of combination of adentia with varying degrees of atrophy of the alveolar processes (parts) of the jaws are analyzed in detail. Clinical examples of dental rehabilitation are shown both with and without the use of methods for increasing the volume of jaw bone tissue, using various modern protocols for fixing orthopedic structures on zygomatic and root dental implants, and the frequency of their use in military medical organizations of the Ministry of defense of the Russian Federation during the reporting period. Based on the presented results, it is shown that the military medical organizations of the Ministry of defense of the Russian Federation have a full range of opportunities to provide comprehensive dental care to patients with complete secondary adentia, even in the presence of extreme bone atrophy of the jaws.
Bulletin of the Russian Military Medical Academy. 2020;22(2):94-105
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Features of the course of chronic obstructive pulmonary disease in patients with respiratory tuberculosis in modern conditions
Katicheva A.V., Brazhenko N.A., Brazhenko O.N., Chuikova A.G., Zheleznyak S.G., Tsygan N.V.
Abstract
Abstrаct. The features of the course of chronic obstructive pulmonary disease are considered. It was established that this pathology is widespread in patients with tuberculosis and is determined in one third of patients. Moreover, the combination of respiratory tuberculosis and chronic obstructive pulmonary disease have a mutual aggravating effect, and the patient’s serious condition can be caused by both exacerbation of chronic obstructive pulmonary disease and progression of the tuberculosis process. The severity of the comorbid state is associated with a decrease in adaptive-adaptive mechanisms and a violation of the state of the homeostasis of the body. Patients with a combination of pulmonary tuberculosis and chronic obstructive pulmonary disease are characterized by intense types of adaptive reactions, with their extreme manifestations, a deep and pronounced disturbance in homeostatic balance and a decrease in the reactivity of the body. Such changes are combined with functional disorders of the respiratory system (changes in spirometric indicators, impaired airway, impaired ventilation function and diffusion capacity of lung tissue). The combined course of pulmonary tuberculosis and chronic obstructive pulmonary disease affects the effectiveness of the treatment and its outcome. In patients with comorbid pathology, there is a decrease in the frequency of abacillation and closure of decay cavities, the formation of pronounced residual tuberculous changes in the lungs. At the same time, in patients with pulmonary tuberculosis, chronic obstructive disease has a more severe course, with a pronounced symptom complex and a high probability of frequent exacerbations. In more than half of cases, chronic obstructive pulmonary disease is characterized by an unfavorable course with a high risk of exacerbations, more than twice a year, which is an extremely unfavorable factor for predicting the course of chronic obstructive pulmonary disease and the development of complications. Identified violations impair the quality of life of patients suffering from comorbidity. Therefore, it is diagnostically important to assess the initial state of chronic obstructive pulmonary disease in patients with tuberculosis, to predict its course and the risks of exacerbations.
Bulletin of the Russian Military Medical Academy. 2020;22(2):106-109
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Pathogenetic factors of trauma and post-traumatic immunodeficiency
Alexandrov V.N., Kondratenko A.A., Mikhailova E.V., Kromsky S.V., Sigareva L.P., Eliseeva M.I., Pak N.V., Gorichnyi V.A.
Abstract
It is well known that the severe condition of patients can be caused not only by shock, but either by epiphenomenon of post-traumatick shock, mestly pulmonary, quite often ending by death, as a manifestation of a successful treatment- resistant secondary post-traumatic immunodeficiency. On our deep persuasion, based on the analysis of literature, and afterwards own experimental data, pathogeny of post-traumaticimmunodeficit at the level of organism and according to its pathogenetic prophylaxis can not be unsealed without the analysis of reaction of the immune system on the pathogenetic factors of trauma: 1) inadequate (foremost pain) impulsation from the damaged fabrics; 2) blood-plasma loss 3) entering blood of bioactive substances; 4) hypoxia. What are the immunomodulatory effects of these factors, not at all, but in case of specific mechanical injury? What is the specific contribution of each factors to the development of immunosuppression in case of specific injury, which one is the main pathogenetic factor in the pathogenesis of post-traumatic immunodeficiency? There are no publications about the specific role of known pathogenetic factors of trauma in the formation of post-traumatic immunodeficiency. The available data gives an idea about the role of pain afferentation, stress, blood loss, toxemia, hypoxia in modulating the immune response in general, regardless of any type of trauma, and the primary changes in the immune system of patients after assistance, including surgical intervention bearing the risk of developing immunosuppression along with drug therapy. The study of these problematic issues of the pathogenesis of post-traumatic immunodeficiency at the system level in the context of severe mechanical trauma experimental model is provided with sufficient understanding of significance of urgent and adequate assistance in the context of ideas about the role of pathogenetic factors of trauma in the pathogenesis of post-traumatic immunodeficiency.
Bulletin of the Russian Military Medical Academy. 2020;22(2):110-114
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Gunshot wounds to the chest and abdomen when using modern body armor
Denisov A.V., Krainyukov P.E., Logatkin S.M., Yudin A.B., Kokorin V.V., Altov D.A., Demchenko K.N.
Abstract
Based on the analysis of literary sources and the data of our own experimental studies, we examined the features of gunshot wounds of military personnel protected by body armor. The classification of body armor by design is given. In addition, the gradation of body armor according to the protection class according to GOST 34286-2017 is given. It is shown that the widespread use of body armor in modern armed conflicts has led to a noticeable decrease in the frequency of gunshot wounds to the chest. According to the mechanism of the formation of a gunshot injury through a bulletproof vest, three main types of injuries were identified: closed local contusion injury when the bulletproof vest was not broken; a gunshot wound when piercing a bulletproof vest; gunshot wounds due to ricocheting of striking elements from the surface of the body armor (external or internal ricochet). It has been established that closed trauma in case of bulletproof vest penetration can occur both in the form of damage to the skin and subcutaneous tissue with the formation of hemorrhages, and in the form of bruises of internal organs, accompanied in severe cases by ruptures of internal organs (liver, spleen, lungs, etc.), with development life- threatening complications - intense pneumothorax, intra-abdominal bleeding, etc. It is shown that when piercing a bulletproof vest through the wound, in addition to a deformed bullet and clothing elements, fragments of armor can be introduced lei with additional damage. When bullets approach a bulletproof vest at angles of 20 degrees or more, rebound elements of dismantled bullets can occur, which can cause severe damage to both the owner of the bulletproof vest and others.
Bulletin of the Russian Military Medical Academy. 2020;22(2):115-121
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Immunoprotective therapy of suppression of humoral immune response, pain induced (search for narcotic analgesics with immunoprotective activity)
Aleksandrov V.N., Kondratenko A.A., Mikhailova E.V., Kromsky S.V., Sidorin V.S., Sigareva L.P., Eliseeva M.I., Gorichny V.A., Pak N.V., Slizhov P.A.
Abstract
Problematic issues of prevention of humoral immune response suppression induced by pain in conditions of the experimental model of severe mechanical trauma are highlighted. It has been established that one of the pathogenetic factors of trauma depressing the humoral immune response is pain. Thus, drugs inhibiting intra-central transmission of afferent impulse, and, in particular, narcotic analgesics, may be considered as drugs with immunoprotective activity. Evaluation of the immunoprotective activity of five narcotic analgesics administered immediately after trauma to immunized mice in the first 24 hours of post-traumatic period showed the presence of the estimated effect in morphine hydrochloride, fentanyl and pifurben. By 106 splenocytes of mice received these preparations and immunized on the first day after the trauma, reliably more antibodies forming cells are formed in mice in comparison with their number in animals received after the trauma as narcotic analgesics intermediol and dipidolor. Thus, morphine hydrochloride, fentanyl and pifurben, i.e. drug analgesics with immunoprotective activity, should be considered as the preferred drugs in the group of narcotic analgesics in emergency care for patients with severe trauma. The use of narcotic analgesics with immunoprotective properties should be considered as one of the measures in the complex of measures aimed at the prevention of post-traumatic immunodeficiency and infection in an immunocompromised host. Infections are difficult to diagnose and often with an unfavorable outcome.
Bulletin of the Russian Military Medical Academy. 2020;22(2):122-124
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Assessment of the prospects for introducing drug insurance into military healthcare as part of project activities
Fisun A.Y., Miroshnichenko Y.V., Shcherba M.P., Golubenko R.A.
Abstract
It is shown that one of the priority areas of the social policy of the Russian Federation is the consideration of improving the drug supply, the rationale for the national drug policy, as well as the introduction of the drug reimbursement (insurance) system, as one of the key mechanisms to increase the affordability of drugs by partially or fully reimbursing their cost citizens when providing medical care on an outpatient basis. It was revealed that in the context of reforming the healthcare system, the specifics of the work of power ministries and departments are not sufficiently taken into account. In this regard, the features have been studied and an assessment has been given of the prospects for introducing drug insurance into military health care as part of project activities, as one of the mechanisms for implementing interagency cooperation in modern socio- economic conditions when reforming drug supply. It is reflected that the introduction of drug insurance mechanisms can increase the availability of drugs, have a positive effect on the health of the assigned contingents, and reduce the frequency and duration of hospitalizations. At the same time, the following were identified as the main prospects and systemic prerequisites for implementation: the need to create a reliable legal basis for the formation and subsequent development of a unified state system of drug supply, taking into account the specifics of military health; transition to a rational system of financing drug supply for the provision of medical care on an outpatient and inpatient basis as part of a project to develop a new model for the provision of primary health care and specialized medical care based on a unified medical and technological hospital base; prospective reduction of expenses for the supply of medical care in stationary conditions; optimal distribution of rights and responsibilities, ensuring coherence between health authorities; prevention of duplication, ensuring equal and guaranteed drug supply for citizens as part of the project to ensure the quality and accessibility of medical care to privileged contingents of the Ministry of Defense of the Russian Federation. A possible model of drug supply for contingents attached to military medical organizations is substantiated when providing medical care on an outpatient basis when introducing a drug insurance system at the state level. The following key elements of a grounded model are described: adjustment of drug supply management; clarification of the categories of assigned contingents; optimization of the order of dispensing of drugs; the formation of restrictive lists of drugs; optimization of financing.
Bulletin of the Russian Military Medical Academy. 2020;22(2):125-133
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The effectiveness of the narcological service in the Russian Federation in terms of target indicators
Esina K.M., Skripov V.S., Kochorova L.V., Klyukovkin K.S., Pronina A.V., Semenova N.V.
Abstract
The analysis of the effectiveness of the narcological services based on the primary and general incidence rates, as well as target indicators considered in the Health Care Development program, is presented. A decrease in both the general and primary incidence of mental and behavioral disorders associated with the use of psychoactive substances in 2013-2018 was revealed. This decrease can be explained by the increasing role of primary prevention and regulation of the consumption of psychoactive substances at the state level, as well as a change in the order of dispensary monitoring of persons with mental disorders and (or) behavior disorders associated with the use of psychoactive substances. An analysis of the target indicators characterizing the activities of the drug treatment service showed that remission rates among patients with alcoholism and drug addiction increase and remain above target values. At the same time, the proportion of patients with alcoholism and drug addiction hospitalized repeatedly during the year exceeds the target values and amounts to 26,3 and 28,2%, respectively. This fact may be associated with insufficiently effective continuity in the work of the outpatient and inpatient stages of treatment of patients with drug addiction and alcoholism. The shares of people included in outpatient and inpatient medical rehabilitation programs also increased - the growth was 5 and 5,7%, respectively. The effective work of the service, in terms of rehabilitation, is also indicated by the fact that the proportion of patients who successfully completed medical rehabilitation programs both in outpatient and inpatient settings tend to increase. In general, the incidence of drug abuse disorders and indicators characterizing the work of the drug treatment service are determined by the strong negative impact of drug addiction and alcoholism on the demographic and economic situation in society.
Bulletin of the Russian Military Medical Academy. 2020;22(2):134-137
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Measuring instruments metrological monitoring in a medical organization based on a process approach
Mendel S.A.
Abstract
A model of the process of metrological control of measuring instruments is presented. The model includes 6 or9 stages, depending on the results of metrological control. Based on the list of measuring instruments, a contract is concludedfor metrological control. After the conclusion of the contract, the collection of documents necessary for verification iscollected. Further, the measuring instruments are transferred to an accredited organization. An accredited organization carriesout verification. If, according to the results of verification, the tool is deemed suitable for use, then the stage of obtainingconfirmation of the verification is carried out. The output at this stage will be a verification certificate. If, according to theresults of verification, the measuring instrument is not suitable for operation, then the stage of canceling the verificationcertificate is carried out. The next steps in this case are to receive notice of unsuitability for use and write-off of the measuringinstrument. At this process is considered complete. The target indicators (indicators) of the process are: the measurementerror of specific measuring instruments within the established limits. Monitoring (control) of the process is carried out bya metrology engineer of a medical organization. Control methods are: control of the calibration intervals of measuringinstruments. The model is recommended as a model for use in medical organizations. The use of this model in the presenceof a target indicator (indicator) of the process of metrological control will ensure the necessary quality of metrological workin a medical organization within the framework of the internal quality control system.
Bulletin of the Russian Military Medical Academy. 2020;22(2):138-141
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Features of the Institute of professional liability insurance for medical workers
Averyanova O.V., Andreev S.I., Prokudin Y.A., Semenov S.L.
Abstract
The features of the institute of professional liability insurance of medical workers are analyzed where, medical activity is a special object of legal regulation. Medical law has become a real phenomenon in the science of law, which is associated with the activities of the Government of the Russian Federation to carry out a large number of reforms in the health sector. However, the closed medical community introduces a number of difficulties in the development and implementation of ongoing reforms. The growth of the legal culture of the population as a whole requires the development and preparation of professional protection and support of the medical community. Based on the ongoing reforms of the health insurance system, the question of studying measures to ensure the professional responsibility of medical activities is raised particularly urgently. Given the specifics of the legal relationship, the doctor is the patient, in which the medical institution, in the conditions of which the medical services were provided, is obligatory involved in the medical institution, the right to have regressive claims in this institution if the patient’s claims are satisfied is quite obvious. It becomes obvious the need for professional liability insurance of medical workers, which is able to ensure financial stability not only of a medical institution, but also of every employee in the healthcare sector, and in the first place - to be a guarantee of the future for young professionals.
Bulletin of the Russian Military Medical Academy. 2020;22(2):142-145
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Attitude of Ophthalmologists to the Problems of Organizing Corneal Transplantation in Russia
Konstantinova P.I.
Abstract
Currently, much attention is paid to the preservation of vision in the Russian Federation. Of particular importance are corneal diseases requiring surgical treatment (keratoplasty). In this regard, the identification of problems in the organization of specialized ophthalmic care for patients in need of keratoplasty is extremely relevant, and their solution will ensure the proper level of quality and accessibility of medical care provided to them. A survey of 840 ophthalmologists from different regions of the Russian Federation was conducted. Problems with obtaining donor material (53,6 per 100 respondents), inaccessibility of keratoplasty in the region (28,6 per 100 respondents), imperfection of the legal framework for corneal transplantation (26,2 per 100 respondents), long waiting times for the operation were identified patients (22,6 per 100 respondents), the lack of equipping a medical organization with modern medical equipment (20,2 per 100 respondents) and an insufficient number of quotas for operations (20,2 per 100 respondents). The absence of a donor tissue bank significantly affects the availability and quality of specialized ophthalmic medical care and requires the adoption of appropriate organizational measures. Experts note the need to provide medical organizations with an adequate amount of donor material. In this case, the improvement of the regulatory framework governing the issues of donation and corneal transplantation is of great importance. The creation of tissue banks in various constituent entities of the Russian Federation will shorten the waiting time for keratoplasty by patients and increase the degree of satisfaction rendered to them by medical care.
Bulletin of the Russian Military Medical Academy. 2020;22(2):146-148
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Contemporary problems of professional activity of anesthesiologists-resuscitators
Klyukovkin K.S., Kochorova L.V., Okulov M.V., Kozhin S.A.
Abstract
The results of studying the opinions of anesthetists-resuscitators on topical issues of the implementation of their professional activities are presented. A total of 450 doctors were interviewed in St. Petersburg and 450 doctors in other regions of the North-West Federal District. It was found that 68,8% of anesthetists-resuscitators received specialized training in anesthesiology-resuscitation immediately after graduating from a medical university and work by vocation. At the same time, their professional activity is associated with increased workload (about a third of specialists work with workloads of up to80-90 hours a week), including psycho-emotional work (57,4% of respondents experience constant stress, 45,6% have chronic diseases, resulting from professional activities). The main directions of optimizing the conditions of their activity, doctors call both financial (raising wages, equipping with modern medical equipment), and organizational measures (optimizing the balance of work and rest, reducing the load). 61% of doctors working in St. Petersburg would not want to change jobs, in other regions only 27,6% of respondents would not want to change anything, and 15,5% plan to change their medical specialty. Among the positive aspects of their work, doctors unanimously noted the factors of emotional comfort: the ability to help people, a good work team, and a convenient work schedule. Doctors consider tension and fatigue, wage mismatch with the workload, and lack of legal protection as negative sides. Given the high degree of commitment of resuscitation anesthetists to their profession, adaptation to difficult conditions, the main efforts should be directed to measures to attract and retain medical personnel, optimize the required volumes and forms of advanced training, introduce a system of psychological adaptation of specialists to working conditions, development of legal support measures for doctors.
Bulletin of the Russian Military Medical Academy. 2020;22(2):149-152
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Professional important abilities of aviation doctor that necessary for medical support of flight safety
Trofimenko S.V., Annenkov O.A., Blaginin A.A.
Abstract
Professionally important qualities of aviation doctors that have a direct impact on flight safety have been investigated. It was established that in the practice of an aviation doctor out of 200 professionally used bathrooms, only 99 turned out to be professionally important and noted as desirable. Of these, 26 competencies are necessary. It was found that out of 99 desirable professionally important qualities, organizational qualities are one of the main (30,3%) and become the main and determining (53,8%) of the 26 necessary professionally important qualities. The latter included: a high level of responsibility for the work performed, a small impossibility, the ability not to succumb to someone else’s influence, especially on the part of reputable persons, discipline, demanding, the ability to defend his point of view before the command, integrity, readiness and ability to accurately perform the prescribed actions and instructions, the ability not to prevent himself from working even to immediate superiors. Also, among the 26 necessary professionally important qualities, the second most important for flight safety are the qualities characterizing cognitive processes (15,4%), and the qualities characterizing knowledge (11,5%) become the third. The absence of negative moral attitudes such as the admissibility of material remuneration for professional services in addition to wages and a tendency to dependent behavior (gambling, psychostimulants, alcohol intake, tobacco smoking, Internet addiction, sexual or food dependence) plays an important role in the practical work of the aviation doctor. At the same time, the presence of such personality features as risk propensity and acceptance in relation to people are undesirable in medical safety assurance of flights.
Bulletin of the Russian Military Medical Academy. 2020;22(2):153-156
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Anti-epidemic protection of military from malaria in South-East Asia (for the 15th anniversary of the humanitarian operation to eliminate the consequences of the tsunami in Indonesia)
Solovev A.I., Kovalenko A.N., Tokmakov V.S., Vasilev V.V.
Abstract
The experience of organizing a system of anti-epidemic measures in the Russian military medical group operating on the territory of the island of Sumatra during the humanitarian operation to eliminate the effects of the tsunami in 2005 is presented. A characteristic of the consequences of a natural disaster, a climatogeographic description of the region is presented. The natural-climatic and socio-economic conditions for the spread of malaria infection in the coverage area of the Russian military medical group are analyzed. Russian military physicians acted in an equatorial climate in a zone of tropical rainforest in a highly endemic area for tropical (P. falciparum) and three-day (P. vivax) malaria, as well as for vector-borne tropical infections such as dengue fever, vuhereriosis, and brugiosis. Among the carriers of malaria parasites and other tropical infections on the territory of about. Sumatra mosquitoes Anopheles sundaicus are of the greatest epidemic importance. In 2005, their mass breeding occurred in late January - early February (1,5-2 months earlier than usual). A system of anti-malarial protection of personnel is described, aimed at reducing the risk of infection of military personnel, preventing the development of the disease and its malignant course, early detection of patients and their effective treatment. There were no cases of malaria among the Russian military personnel during their entire stay in the endemic territory. At the same time, the incidence rate among Indonesian soldiers and local residents was constantly increasing. In hospitals, the number of patients with severe forms of tropical malaria increased. Thus, the effectiveness of the developed system of anti- malarial measures among the military personnel involved in peacekeeping and humanitarian operations in the territory with a continuous season of transmission of malaria infection has been confirmed.
Bulletin of the Russian Military Medical Academy. 2020;22(2):157-163
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Indicators of dismissal of military personnel of the Armed Forces of the Russian Federation for health reasons in 2003-2018
Evdokimov V.I., Sivashchenko P.P., Grigoriev S.G., Ivanov V.V.
Abstract
The dynamics and structure of the dismissal of officers and military personnel of the Russian Armed Forces for health reasons in 2003-2018 are analyzed. It was established that the average annual dismissal rate for officers was7,98±1,10‰, contract servicemen 3,92±0,32‰, conscripted military personnel 17,57±1,19‰, female military personnel9,14±1,37‰. The polynomial trend of dismissal of all categories of military personnel showed decreasing trends. The level ofdismissal of military personnel by the leading classes of diseases and nosologies (groups in chapters) is presented. The indicatorsof the causes of dismissal were correlated with the chapters and nosologies of the International Statistical Classification ofDiseases and Health Problems, 10th revision. The 1st rank of dismissals for health reasons for officers was taken by indicatorsof diseases characterized by high blood pressure (I10-I15), the 2nd - coronary heart disease (I20-I25), the 3rd - diseases ofthe esophagus, stomach, and duodenum (K20-K31); contracted military personnel have diseases of the esophagus, stomachand duodenum (K20-K31), diseases characterized by high blood pressure (I10-I15), neurotic, stress-related, and somatoformdisorders (F40-F48); in conscripted servicemen - neurotic, connected stress, and somatoform disorders (F40-F48), diseasesof the esophagus, stomach, and duodenum (K20-K31), behavioral disorders in adulthood (F60-F69); among female militarypersonnel obesity and other types of excess nutrition (E65-E68), diseases characterized by high blood pressure (I10-I15),inflammatory diseases of the female pelvic organs (N70-N77). Prevention, timely treatment and rehabilitation of leadingnosologies will contribute to improving the health and professional longevity of the Russian Armed Forces.
Bulletin of the Russian Military Medical Academy. 2020;22(2):164-170
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Predictability study of the pharmacodynamic properties of drugs in silico by the example of comparing data on the naphazoline clinical use and the results of computer modeling
Ivanov V.S., Seleznev A.B., Ivchenko E.V., Cherkashin D.V., Kutelev G.G., Boyko Y.G.
Abstract
The forecast of naphazoline pharmacological properties has been made using the PASS computer program and the ADVER-Pred web resource of the Way2Drug information and computing platform. Biological activity, mechanisms of action, toxic and side effects, as well as other types of activity of the studied drug associated with interaction with antitargets, metabolism and gene expression regulation have been determined. The results of the naphazoline pharmacological properties forecast obtained in silico have been compared with the information available in the literature about its systemic effects in clinical use and poisoning.It has been established that the studied chemical compound has a very wide spectrum of action, which is primarily associated with the stimulation of adrenoreceptors and imidazoline receptors located in many organs and tissues of the body. At the same time, other mechanisms of naphazoline action forecasted in silico allow us to determine possible directions for further research of its clinical use. Among the toxic and side effects, along with such known adverse events as effect on the central nervous system and arterial hypertension, in the clinical use of naphazoline special attention should be paid to the cardio-, hepato- and nephrotoxic effects forecasted with a high degree of probability. The prominent toxic effect of naphazoline can cause the occurrence of life- threatening conditions - acute cerebrovascular disorder, myocardial infarction, cardiac rhythm disorders, acute left ventricular failure. The obtained data confirm that the use of modern computer methods that provide an assessment of biological activity based on the drug-like compound graphic formula allows us to obtain a forecast with a high degree of confidence for both new pharmacological substances and for drugs approved for clinical use in order to clarify their pharmacological properties.
Bulletin of the Russian Military Medical Academy. 2020;22(2):171-176
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Monitoring primary disability of former military personnel by applying to the bureau of medical and social expertise as a basis for choosing measures for the professional rehabilitation of disabled people: a regional aspect
Nurova A.A.
Abstract
The factors of the formation of primary disability in the former military personnel in the Republic of Dagestan were studied according to the appeal to the bureau of medical and social expertise over 5 years (from 2014 to 2018). The article analyzes gender and age indicators, social affiliation, causes of disability, nosological diseases of military personnel that led to disability, severity by disability group and others. An analysis of the disability indicators of former military personnel in the Republic of Dagestan as a large subject of the North Caucasus Federal District of the Russian Federation is important for organizing measures to continue previous professional activities for persons with limited ability to work. The revealed complex of socio-hygienic and medical-social indicators made it possible to determine the directions of labor and social integration of persons with disabilities from among former military personnel in society. The social indicator established in more than half of disabled people, the place of residence in rural areas, made it possible to recommend self-employment in the agricultural areas of activity (animal husbandry, vegetable growing, fruit and berry processing), in the service sector, and small business, including those related to revival and development of national Dagestan crafts. The state program «Accessible Environment» (2011-2020-2025) emphasizes the need to take into account the regional characteristics of primary and general disability, the national specifics of the development of territories. In this regard, the results of medical and social analysis allow us to more accurately determine the direction of the organization of labor and social integration of persons with disabilities from among former military personnel in the Republic of Dagestan.
Bulletin of the Russian Military Medical Academy. 2020;22(2):177-181
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Old new coronavirus
Moskalev A.V., Gumilevskiy B.Y., Apchel V.Y., Cygan V.N.
Abstract
The main biological characteristics of Coronaviridae viruses, including viruses, severe acute respiratory syndrome and Middle East respiratory syndrome, are presented. The features of immunopathogenesis associated with these infections and their differences from the infection 2019-2020 are analyzed. It is believed that the modern incidence of upper respiratory tract in adults, associated with coronaviruses, is between 10 and 30%. Coronaviruses are ecologically diverse, with the greatest diversity in bats, suggesting that they are the main reservoirs of coronaviruses. Research into the genome of the new coronavirus - 2019-nCoV has shown that it has about 80% nucleotide identity with original viruses of severe acute respiratory syndrome and the ability to bind to angiosine-transforming receptors еnzyme 2. This, along with the high genetic proximity of coronaviruses, indicates their overall origin and overall probable source. However, the receptors of the angiosin-transforming enzyme 2 are the key that gives access to the cell even with low infecting activity. It has been shown that the main diagnostic methods to increase the specificity of detection of a new coronavirus should be variants of polymerase chain reaction and immunoblotting. However, there is still a lot of unknown related to the life of the 2019-nCoV virus. There is a clear identification and comparison of the genomes of the virus in different countries. Identify those genetic inserts that allow the virus to escape from the control of the immune system and turn into a hypervirulent strain. Proving or disprove the possibility of the 2019-nCoV virus is altering its genetic and antigenic potential in different animal species and becoming a new type of virus.
Bulletin of the Russian Military Medical Academy. 2020;22(2):182-188
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Golden symmetry - an indicator of the norm and pathology of the human heart
Malov Y.S., Kuchmin A.N., Borisov I.M., Malova A.M.
Abstract
The concept of «norm» is the key to biology and medicine. Recently, the norm has been associated with harmony. That which leads «opposites» to unity is harmony. It is closely related to the proportion of the golden ratio. The golden ratio is the basis of human health. Deviations from it can be used in medicine to diagnose pathological conditions. This fully applies to the work of the heart. The mathematical expression of harmony, symmetry is a method of assessing the norm of the heart. The golden proportion is manifested in the relationship of the temporal parameters of the cardiocycle, volumes of the left ventricle, types of blood pressure: pulse, diastolic, systolic. It was found that the golden proportions of systole, diastole and cardiocycle close to 0,382,0,618 are observed in men with a heart rate of 65 beats/min, in women - 55 beats/min. This mode of work of the heart corresponds to the rest of the body and is the norm. During physical activity, changes in the parameters of the cardiocycle occur (symmetry transformation). Violations of the golden relationship of the phases and the cardiocycle indicate damage to the heart. The magnitude of these deviations from the golden ratio depends on the severity of heart failure. Golden harmony in healthy people can be traced in the relations between the volumes of the left ventricle. These relationships are the ideal norm. Deviations in the relationship of volumes from golden ratio are a manifestation of pathology. Based on the principle of golden symmetry in healthy people, the normal EF is 62±3%, and not 50-80% as is accepted in practice. It is not an indicator of the norm. The mechanical activity of the heart is also determined by the laws of harmony. Pulse, diastolic and systolic blood pressure in healthy individuals are among themselves in the golden ratio (0,618). Violations of golden ratio are found in unstable forms of hypertension and damage to the heart muscle. Golden symmetry is the basis of the reference of the norm and the identification of pathologies of the human heart.
Bulletin of the Russian Military Medical Academy. 2020;22(2):189-194
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Рerfectionism of young people
Berezovskii A.V., Uliukin I.M., Orlova E.S.
Abstract
Аbstract. The current situation of the crisis state of various spheres of life of our compatriots makes such characteristics of a competitive individual as success, mobility, flexibility in decision making more and more popular. Perfectionism, previously studied as a personality trait responsible for the pursuit of excellence, is a state that can determine the course of thoughts and actions of a person, as well as change under the influence of circumstances or over time (since there is always the possibility of transition from one state to another, while that at any moment of being this or that state determines the further destiny of a person). Highlight perfectionist aspirations that are associated with the positive aspects of perfectionism, and perfectionist anxiety associated with maladaptive behavior. It is shown that only perfectionist anxiety has a direct correlation with perception of stress at work, while perfectionist aspirations do not have such a correlation. In adolescence, the pursuit of excellence is especially important, since at this time a hierarchy of values and authenticity (identity) are built, the search for one’s place in life starts the activity of creating conditions for the realization of personal potential. Therefore, the main direction of medical and psychological support for young people is the formation of adequate self-esteem and self-reliance, which allows them to know the characteristics of their personality, receive feedback (both from peers and from socially significant individuals),«work out» their «I» in simulated conditions, and thereby increase the effectiveness of the psychological correction of non- adaptive forms of perfectionism, because the positive aspects of perfectionist attitudes are a potential development potential for young people one hundred.
Bulletin of the Russian Military Medical Academy. 2020;22(2):195-198
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Factors influencing the choice of antibiotic therapy regimen for pleural empyema
Kotiv B.N., Dzidzava I.I., Valiev G.V., Barinov O.V., Suborova T.N., Deinega I.V., Zubarev P.N.
Abstract
There are considered the factors affecting the choice of an antibacterial drug for antibacterial therapy, based on the analysis of the material. The analysis of these factors was provided. The most problematic pathogens of pleural empyema are non-fermenting gram-negative bacteria: P. aeruginosa, Acinetobacter spp.; Еnterobacteriales: K. pneumoniae, Escherichia coli, Enterobacter spp., Proteus spp.; gram-positive cocci: Staphylococcus spp., Streptococcus spp., Enterococcus spp.; anaerobic bacteria: Bacteroides spp., Clostridium spp., Fusobacterium spp., Peptococcus spp., Peptostreptococcus spp. Most authors note an increase of antibiotic resistance in pathogens of pleural empyema, which significantly complicate the choice of antibacterial therapy. It was revealed that the choice of drug for antimicrobial therapy should be justified on the basis of a systemic, integrated approach taking into account the etiology of the pleural empyema, the severity of the patient and concomitant pathology. The main factors influencing the choice of antibacterial drug are the origin of pleural empyema (in-hospital or out-of-hospital), the presence of previous admissions, the previously provided antibacterial therapy and the results of stratification of patients by the risk of polyresistant microflora. With the appearance of clinical signs of the in-hospital pleural empyema the choice of antibacterial drug for antimicrobial therapy should be made taking into account clinical and epidemiological data and the results of microbiological monitoring in the hospital.
Bulletin of the Russian Military Medical Academy. 2020;22(2):199-203
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New approaches to the selection of genetic markers associated with multifactorial phenotypic traits
Kutelev G.G., Krivoruchko A.B., Trandina A.E., Ivanov A.M., Cherkashin D.V., Marchenko A.A., Grishaev S.L.
Abstract
Modern approaches to searching for associations between the studied phenotype and structural variations of the human genome are analyzed. Most complex phenotypic traits, including diseases, do not follow the laws of Mendelian inheritance, but have a multi-factor nature, that is, a significant contribution to their development is made by the genetic component in combination with the influence of environmental factors. In General, there are several approaches to the design of a limited set of polymorphic markers for point genotyping. Selection of individual molecular genetic markers is carried out based on either their statistically significant Association with the studied multivariate feature, or their functional significance for the implementation of this feature. The «candidate gene» approach allows you to focus on one or more polymorphic variants in the region of a gene (allelic variant), the product of which is likely involved in the development of a disease or trait. The cheaper procedure for full-genome screening using ultra-high-density microchips has made available another approach for searching for genetic predispositions - full - genome Association search. We believe that the unification of both approaches into a single algorithm for the choice of molecular genetic markers to conduct point genotyping will allow for both markers selected based on a priori assumptions about the functional significance of candidate genes, and Association with the studied trait on the basis of genome-wide associations search. This approach will optimize the diagnostic efficiency of the created test suite.
Bulletin of the Russian Military Medical Academy. 2020;22(2):204-210
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Stem cells: an origin and marks
Moskalev A.V., Gumilevskiy B.Y., Apchel A.V., Cygan V.N.
Abstract
The basic physiological functions of stem cells are given: the ability to reproduce and generate offspring, which are manifested at the level of the population, and not of a single cell. The manifestation of these functions depends on the quantitative and qualitative composition of the microenvironment. Stem cells consist of two fundamentally different types: pluripotent, which exist only in vitro (in vitro) and tissue, existing in the postpartum body (in vivo). Stem cells can be replaced without limitation in vitro and lead to the appearance of a wide range of cell types. Tissue stem cells under normal conditions do not generate cells characteristic of other types of tissue. Stem cells include cells capable of expressing the gene products characteristic of them. However, there is no universal marker to differentiate stem cells from non-stem cells. A key marker of pluripotency is the transcription factor - a pituitary-specific transcription factor is positive. A component that can be found in almost all types of stem cells is the telomerase complex. Another stem cell marker is called CD34 glycoprotein. The functional activity of stem cells is associated with a molecular marker referred to as leucine-rich repeat containing G-protein bound to receptor 5. However, other types of cells do not express this marker. The physiological capabilities of stem cells depend both on the cells themselves and on their environment. The most reliable way to identify stem cells is to determine their phenotype in vivo. This suggests that stem cells do not carry a universal molecular marker. Most likely, they have significant differences from transplanted cells, and these differences cannot always be detected in individual cells, but only at the population level.
Bulletin of the Russian Military Medical Academy. 2020;22(2):211-216
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Justification of the form and necessity of creating and maintaining a sepsis register
Gumilevsky B.Y., Ivanov F.V.
Abstract
The results of large multicenter epidemiological studies of sepsis indicate a tense epidemiological situation and important microbiological features inherent in each medical institution. Together with the abundance of clinical information necessary for making a diagnosis and assessing the severity of a patient with sepsis, these facts dictate the need to create and maintain a septic register - a system for collecting, recording and storing unified information about patients with a specific disease receiving a specific treatment. The multifaceted nature of the sepsis problem leaves an imprint on the features that need to be given to the sepsis register. It is important that the prospective registry takes into account the microbiological, immunological and clinical aspects of sepsis. The uniqueness and variability of the microbiological landscape of a particular intensive care unit and intensive care unit suggests that each medical institution needs to maintain its own sepsis register, taking into account the data of microbiological monitoring. Also, the prospective registry should contain a detailed clinical description of each case entered into it, including all the necessary laboratory data to assess the severity of the patient’s condition in dynamics. The creation and implementation of the registry in medical institutions will allow you to own the epidemiological situation in sepsis, monitor patients throughout their lives, analyze the adequacy of the therapy and timely correct it, as well as carry out timely diagnosis and correction of the long-term consequences of the disease. Due to individual characteristics, each medical institution needs to create and systematically maintain its own sepsis register.
Bulletin of the Russian Military Medical Academy. 2020;22(2):217-221
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Modern approach to the management and treatment of patients with precancerous conditions and changes in the gastric mucosa
Pavlovich I.M., Pugacheva I.L., Alper G.A., Yudin V.A.
Abstract
The modern views and approaches to the management of patients with precancerous conditions and changes in the gastric mucosa are analyzed. There are no national or international recommendations for the management of this category of patients. Several draft recommendations have been published over the past 10 years, but the most noteworthy are the so-called recommendations for the management of precancerous conditions and stomach lesions (2012 and 2019). Representatives of the European society of gastrointestinal endoscopy, the European group for the study of Helicobacter pylori and the microbiota of the European society of pathologists participated in the development of these recommendations. The recommendations are supported by a number of major studies in accordance with the principles of evidence-based medicine. The problem of oncological diseases of the gastrointestinal tract always remains one of the most significant unsolved problems of world health. Today, the issue of timely diagnosis of precancerous conditions is acute. They include harmless, at first glance, conditions that do not have pronounced symptoms, but bring significant inconvenience to the patient’s life. This is what allows precancerous conditions to progress, to transform from benign to malignant neoplasms. There is only one way to prevent the process of cancer formation: timely detection and treatment of precancerous diseases. This is one of the most important tasks of a General practitioner. The constant search for ways to solve the problem of cancer determines the choice of successful, timely tactics of patient management and its favorable outcome. The presented data can be used in practice by internists and gastroenterologists.
Bulletin of the Russian Military Medical Academy. 2020;22(2):222-226
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The modern significant of the bronchial asthma
Salukhov V.V., Kharitonov M.A., Zaycev A.A., Ramazanova K.A., Asyamov K.V.
Abstract
A review of modern literature on the diagnostic algorithm of bronchial asthma and a detailed examination of all its stages is presented. It is known that bronchial asthma is the most common form of the disease, prone to progression to more severe forms, but fraught with the development of exacerbations, even fatal. Often, general practitioners perceive bronchial asthma as a manageable, understandable disease, for the successful treatment of which it is enough to identify and isolate the allergen, as well as prescribe therapy. Understanding the mechanisms of development of bronchial asthma helps to increase the effectiveness of the diagnosis and treatment of asthma, preferably taking into account the phenotype. Determining the phenotypic characteristics of bronchial asthma is a requirement of the time, because personalized medicine does not yet require the creation of a separate drug, diagnostic or prophylactic method for each individual patient, but it requires the selection of patients (allocation of subpopulations / clusters / phenotypes of bronchial asthma) that are most responsive to a particular drug, a method for diagnosing or preventing a disease. The essence of phenotyping in medicine is the optimization of diagnosis, treatment and prevention. The central and most studied links of the pathogenetic mechanism and its variants of development are described, phenotypes of bronchial asthma are discussed, as well as options for basic and targeted therapy of bronchial asthma. The necessity of studying personalized therapy and flexible dosing of drugs used in the treatment of bronchial asthma is emphasized.
Bulletin of the Russian Military Medical Academy. 2020;22(2):227-234
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Optimal models for predicting the outcome of burns
Matveenko A.V.
Abstract
Burn injury is a serious problem with high morbidity and mortality. Burn injury outcomes are the most important indicators of research results and an important criterion for decision making in clinical practice. The presence of dozens of prognostic techniques indicates the absence of an «ideal» model for predicting the outcome of burns, as evidenced by the need to validate them in each burn center. The use of prognosis models for clinical purposes allows you to determine the risk of mortality of an individual patient, that is, the severity of his condition. However, point scales do not allow to determine the severity of the condition of groups of patients. Moreover, the achievement of most of the stated goals of the forecast becomes impossible. A methodological error lies in the violation of the sequence of actions during the experiment. First of all, it is necessary to stratify research groups according to the severity of the condition, and only then study their characteristics. However, none of the known forecast models makes it possible to determine the severity of the condition of a group of patients, and, therefore, to stratify them for research purposes. Given the structure and methods of creating models of hope for multicenter randomized prospective studies, which are expected to improve their quality, are not justified. The criterion for creating the best model is its optimality, which allows forecasting to determine the severity of the condition in order to achieve maximum practical benefit. With its help, it becomes possible to plan experiments and solve real problems of combustiology. This model will allow you to create practical recommendations and standards for the treatment of burns.
Bulletin of the Russian Military Medical Academy. 2020;22(2):235-240
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Paraspinal structures of thermoregulation
Gaivoronskiy I.V., Rodionov A.A., Gaivoronskiy A.I., Gaivoronskaya M.G., Nichiporuk G.I., Goryacheva I.A., Khabibullina N.K.
Abstract
A detailed analysis of the literature on the structure and functions of the paraspinal structures of human thermoregulation involved in maintaining temperature homeostasis is presented. It is shown that in the process of evolution, a peculiar paraspinal morphofunctional complex is formed around the spinal center of thermoregulation, including thermal- generating structures (adipose and muscle tissue); venous thermal distribution rings formed by paraspinal venous plexuses and thermoregulatory nervous apparatus (meningeal and posterior branches of the spinal nerves and their nerve endings). It was found that the heat-generating structures are represented by adipose tissue of the epidural space, adipose tissue of the bone marrow, paravertebral and interscapular adipose tissue, back muscles and intercostal muscles). Bone marrow fatty tissue plays an important role not only in thermoregulation, but also in bone remodeling. Fatty tissue mainly includes components of white and a small amount of brown adipose tissue. Heat from muscles through the venous system of the spinal column affects the functioning of the spinal center of thermoregulation by contractile thermogenesis. It has been shown that around the center of thermoregulation of the spinal cord, venous vessels form four thermal distribution rings. The first of them is the venous bed of the soft membrane of the spinal cord and cerebrospinal fluid of the subarachnoid space; the second is the internal vertebral venous plexus; the third - intraosseous (intraorgan) venous plexuses of the vertebrae; the fourth is the anterior and posterior external vertebral venous plexuses. All four thermal distribution venous rings anastomose among themselves, forming a single thermal distribution system around the spinal center of thermoregulation. The innervation of thermal generating structures and thermal distribution of venous rings is carried out by somatic and autonomic nerve fibers.
Bulletin of the Russian Military Medical Academy. 2020;22(2):241-245
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Hero of the Soviet Union Dyskin Efim Anatolyevich - legendary person (to the 75th anniversary of victory in the Great Patriotic War)
Fisun A.Y., Gaivoronsky I.V., Odinak M.M., Litvinenko I.V., Nichiporuk G.I., Dyskin D.E., Koshkaryov M.A.
Abstract
Hero of the Soviet Union Efim Anatolyevich Dyskin - a prominent domestic scientist and teacher of higher education, head of the department of normal anatomy (1968-1988), Honorary Doctor of the Military Medical Academynamed after S.M. Kirov, major general of the medical service. Professor E.A. Dyskin is the founder of the new scientific direction «Anatomy and Military Medicine». At the age of eighteen E.A. Dyskin volunteered for the front, participated in battles to defend Moscow. On November 16, 1941, he accomplished a heroic feat, for which he was posthumously awarded the title of Hero of the Soviet Union. However, after a serious wound, the Red Army soldier Dyskin survived, was treated in hospitals for about a year, at the same time he graduated from the feldsher school, from 1942 to 1947 studied at the Military Medical Academy. After graduating from the Academy from 1948 to 1968 E.A. Dyskin worked under the direction of Professor A.N. Maksimenkov a at the Department of Operative Surgery and Topographic Anatomy, where he went from an adjunct to a professor. In 1968 he was appointed as a head of the Department of Normal Anatomy, which he directed for 20 years.He created a scientific anatomical school that developed pecularities on the morphology of various types of gunshot wounds and the effects of extreme factors of military labor on the human body. Under his leadership, research was also conducted to study the state of collateral circulation, the functional anatomy of the digestive system, craniology, and the history of military medicine. Scientific ideas of Professor E.A. Dyskin continues to develop in the writings of students and followers at the Department of Normal Anatomy, and neuromorphology - at the Department of Nervous Diseases of Military Medical Academy.
Bulletin of the Russian Military Medical Academy. 2020;22(2):246-251
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To the 90th birthday of professor Stanislav Alekseevich Bugrov
Ushakov I.B., Blaginin A.A., Lustin S.I.
Abstract
June 10, 2020 it is the 90th anniversary of the birth of major General of the medical service, doctor of medical Sciences, Professor, honored doctor of Russia, head of the State research and testing Institute of aviation and space medicine of the Ministry of defense of the Union of Soviet Socialist Republics (1984-1988), head of the air force aviation and space medicine service - Deputy head of the Central military medical Department of the Ministry of defense of the Union of Soviet Socialist Republics (1988-1991), Head of the faculty of training doctors for the Air force of the S.M. Kirov Military Medical Academy (from 1975 to 1982), Chairman of the State medical Commission for selection of cosmonauts, Chairman of the State Commission for the preparation and launch of a series of biosatellites «Cosmos», co-chair of the subgroup «Space medicine» joint Soviet-American working group on space exploration (1988-1991), member of the International Academy of Astronautics, a member of the fighting in Afghanistan, Chevalier of the order of the red Star, «For service to Motherland in the Union of Soviet Socialist Republics Armed forces» III degree, and numerous medals, veteran of the Armed forces of the Russian Federation, honorary doctor of the State research and testing Institute of the Ministry of defense of the Russian Federation (aviation and space medicine) and honorary Professor of the Voronezh N.N. Burdenko state medical University.
Bulletin of the Russian Military Medical Academy. 2020;22(2):252-255
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To the history of the creation of anatomical theaters in the Medical and Surgical (Military Medical Academy)
Gaivoronskiy I.V., Tvardovskaya M.V.
Abstract
Was established that the prototype of anatomical theaters in Russia was the anatomical theater of Leiden University (Holland), built in 1575. This theater is shown in color engraving of Cornelius Woodan, created in 1610. In St. Petersburg, at the Department of Anatomy and Physiology of the Imperial Medical and Surgical Academy, this engraving was received in 1805 as part of the collection of the anatomist V. Kruikshenk, acquired for the academy with the direct assistance of Emperor Alexander I. In Russia, the first anatomical theater appeared only in 1708. It was created at the Moscow Medical and Surgical Academy. Historians connect his appearance with a visit in 1697 by Emperor Peter the I of Leiden University. In St. Petersburg, the history of anatomical theaters dates back to the PetrovskayaKunstkamera, built in 1722. It demonstrated rarities - «freaks», and also heard scientific reports. Russian anatomical theaters as an arena for the production of public spectacular autopsy did not receive their development but became an integral part of the anatomy department at higher educational institutions. Such an anatomical training theater was built at the foundation of the Imperial Medical and Surgical Academy on the right bank of the Neva in a stone two- story building. The first head of the Department of Anatomy and hysiology, P.A. Zagorsky took part in its design and equipment. Zagorsky. There was a table in the center of the amphitheater, the dimensions of which made it possible to demonstrate a whole corpse at a lecture, to conduct physiological experiments. In this amphitheater, lectures were given by Professor P.A. Zagorsky, I.V. Buyalsky, P.A. Naranovich. It lasted until 1871. The creation of a new anatomical theater in Imperial Medical and Surgical Academy is associated with the name of Professor V.L. Gruber, who after N.I. Pirogov headed the Anatomical Institute. In 1857, V.L. Gruber visited 13 anatomical institutes in Germany and in his trip report substantiated the idea of building a new anatomical building - a specialized Anatomical Institute. V.L. Gruber report was approved by the Academy Conference, headed by its head - P.A. Dubovitsky. In 1864, the building was laid, the construction of which was completed only in 1871. The construction was carried out under the guidance of an engineer - captain of the academician of architecture K.Ya. Sokolova. In this three-story building, the current Anatomical building, two classrooms were built in each wing - № 1 and № 2. They look like an amphitheater and are a prototype of the best European anatomical theaters. Currently, overhaul has been carried out in this building; the design of the anatomical theater has been preserved in classrooms 1 and 2. These auditoriums, which are a historical monument of the Imperial Medical and Surgical Academy, are equipped with modern technical training aids. It is in these classrooms that cadets and students of the S.M. Kirov Military Medical Academy are currently starting their journey into medicine.
Bulletin of the Russian Military Medical Academy. 2020;22(2):256-261
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N.I. Pirogov and his proverbial: «I believe in hygiene»
Zholus B.I., Petreev I.V.
Abstract
The great doctor, anatomist, surgeon, teacher, professor Nikolai Ivanovich Pirogov (1810-1881) glorified not only Russian medicine, but also Russia as a whole. His discoveries and achievements relate primarily to the anatomy and its topographic direction, surgery and its military field, the military medical «administration” is the organization of medical support for the army. The vast majority of scientific results were achieved by Professor N.I. Pirogov during his work at the Imperial Medical and Surgical Academy from December 1840 to July 1856. Among all his wonderful quotes and expressions, the words «I believe in hygiene» and «The future belong to preservative medicine» gained the most popularity. They were published in Russian in his fundamental work «The Beginnings of General Military Field Surgery, Taken from Observations of Military Hospital Practice and Memoirs of the Crimean War and the Caucasian Expedition» in 1865. For more than 150 years, these phrases continue to be quoted by doctors of many specialties. . The question of what meaning Nikolay Ivanovich invested in these winged words and served as the reason for this article. To understand the great scientist’s judgments, his words «individuality» and «fatalism», which preceded these historical phrases, are analyzed. The sources of knowledge and experience of hygiene of the first half of the XIX century, which N.I. could use Pirogov since, until 1865, neither in Europe nor in Russia did hygiene acquire the status of an independent science, its provisions were based on empirical information received by doctors in both peacetime and wartime. With full confidence, it can be argued that the highest authority of N.I. Pirogov and his catch phrase «I believe in hygiene» served as a powerful incentive for the development of all hygiene science.
Bulletin of the Russian Military Medical Academy. 2020;22(2):262-267
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Contribution of Professor B.M. Savin to the development ofaviation and space medicine
Blaginin A.A., Bukhtiarov I.V., Pashenko P.S., Savin A.V.
Abstract
The main milestones of scientific and pedagogical activity, as well as the life path of one of the leading representatives of aviation medicine, Doctor of Medical Sciences, professor, outstanding researcher and wonderful teacher, author of works on the problem of influence of overload and hypervesomity on the body and central nervous system of man- Boris MikhailvichSavin are considered. Separate moments of his participation in the Great Patriotic War before daily work as the head of research department of the Military Medical Academy named after S.M. Kirov are presented. The contribution of Boris Savin to the study of issues related to aviation and space medicine, in particular: the study of the action on the body of overload and the clarification of physiological mechanisms underlying changes in higher nervous activity at accelerations, was analyzed; Studying the state of the central nervous system when exposed to various factors; Development of neuroreflective theory of adverse effect of accelerations on human body. Boris Mikhailvich has made a huge contribution to the development of aviation and space medicine and has entered the history of aviation and space medicine through his research and scientific publications, which include monographs «The influence of overload on the functional state of the central nervous system and the mechanism of disruption of its activities» and «Hypervesomeness and functions of the central nervous system».
Bulletin of the Russian Military Medical Academy. 2020;22(2):268-270
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Professor Sergey V. Grebenkov - naval doctor, scientist, teacher (on the 65th anniversary)
Lobzin Y.V., Petreev I.V.
Abstract
The main autobiographical, pedagogical and scientific segments of the life of the head of the Department of naval and radiation hygiene (1996-2006) S.M. Kirov military medical Academy, doctor of medical Sciences, Professor Sergey V. Grebenkov, who turned 65 on April 30, 2020. His work fell on one of the most difficult periods in the history of modern Russia and its Armed forces, associated with the collapse of the Union of Soviet Socialist Republics, the change of socio-economic formation. In these difficult conditions, the most important task was to preserve the scientific potential of the Department and ensure the further development of naval and radiation hygiene. S.V. Grebenkov’s contribution to the development of hygiene consists, first of all, in the fact that in his PhD thesis (1988) he justified the list and types of promising individual means of water treatment in the field; in his doctorate (1996) - formulated the concept of human stay in a radiation- destabilized environment, developed principles and recommendations for optimizing the life of military personnel and the population in conditions of long-term stay in radioactively contaminated territories. Under his leadership, the Department developed the conceptual foundations of military ecology. He is the author (co-author) of 367 works, including three textbooks, a two-volume guide to naval and radiation hygiene (1998, 1999), 21 monographs, and a multimedia program «Ecological and hygienic bases of military health protection» (2001). After graduating from the military medical Academy named after S.M. Kirov, S.V. Grebenkov served in the Northern fleet as head of the medical service of a multi-purpose nuclear submarine (Western Litsa, 1978-1985), then - at the military medical Academy named after S.M. Kirov (adjunct, 1985; teacher, senior teacher, associate Professor, 1988-1996; head of the Department). After demobilization (2006) - head of the Department of occupational medicine of the North-Western state medical University named after I.I. Mechnikov, where he continues to work successfully to this day.
Bulletin of the Russian Military Medical Academy. 2020;22(2):271-278
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Pravila dlya avtorov
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Bulletin of the Russian Military Medical Academy. 2020;22(2):279-280
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