Vol 23, No 2 (2021)

The results of a study of the concentration of rivaroxaban in the peripheral blood in patients with atrial fibrillation, receiving different doses of rivaroxaban, as well as in the case of developing hemorrhagic complications, are presented. 65 patients admitted for treatment for atrial fibrillation were examined. As an anticoagulant drug, rivaroxaban was prescribed at a dose of 15 or 20 mg once a day, depending on the state of renal function. The patients were divided into 3 groups depending on the prescribed dose of rivaroxaban and the presence or absence of hemorrhagic complications. At the same time, each patient underwent therapeutic drug monitoring of the drug. It was found that in patients, who received rivaroxaban at a dose of 15 mg, in 35% of cases its concentration in the blood was below the average minimum values. In patients, who received the drug at a dose of 20 mg, in 16% of cases its concentration in the blood serum exceeded the average maximum values. Patients treated with 15 mg of rivaroxaban lacked any hemorrhagic complications. In the group of patients with advanced hemorrhagic complications who received rivaroxaban at a dose of 20 mg, its serum concentration at all stages of therapeutic drug monitoring was significantly higher than the average maximum values and more than 4 times higher than in the control group (without hemorrhagic complications). The results of the study indicate the advisability of conducting therapeutic drug monitoring with the determination of rivaroxaban concentrations in the blood serum of patients receiving the drug, especially when they develop hemorrhagic complications.

A 2-stage comprehensive psychological and physiological examination of freshmen of a higher naval educational institution was carried out. At the first stage, characteristic profiles of cadets were determined. At the second stage, the identified characteristic profiles were correlated with the traditional criteria for military-professional adaptation. It was found that the most often examined young men (according to the Leonhard – Schmiszek technique) have such character accentuations as hypertimicity (81.8%) and demonstrability (53.1%), less often — stuck (39.3%), pedanticity (19.6%), emotion (18.2%), exaltation (15.4%), and even less often — cyclothymic (8.4%), excitability (7.7%), anxiety (2.8%) and dysthymic (2,1%). Cadets assigned to the “passive-aggressive” stereotype group manage worse in the main disciplines than cadets from other groups. Cadets with “passive-aggressive” stereotype have lower academic performance as compared to other groups. They have lower expert scores in discipline, neuropsychic stability, communication skills, credibility in a team and level of general culture. In addition, in cadets of this group, the mobility of the main nervous processes at the level of the motor analyzer is somewhat lower to the comparison group. The study showed that the characterological features in the form of mixing or opposing accentuations of characters revealed in cadets play in favor of their personal development, health and successful study only in about 20–40% of cases. In other cases, these character features do not contribute to this and can develop into personal disorders incompatible with military service during the training process. Based on the results of the study, psychological and pedagogical tasks were formulated to improve the system of selecting of cadets for naval educational institutions and to improve their professional education.

It was found that the frequency of stress-induced somatic diseases in cadets during 4–5 training years increased from 0 in the I cours to 10% in the V–VI courses. The first place in frequency is occupied by diseases of the digestive system (K00–K93 according to the International Statistical Classification of Diseases and Related Health Problem 10^th revision), during the training their level increased from 0 to 7.3%. Diseases of the circulatory system (I00–I99) increased to 2.7%. Based on the psychophysiological, psychological and psychosocial indicators of the surveyed cadets, a discriminant analysis was performed and a linear classification function model for predicting the propensity to stress-induced somatic diseases was obtained. The model is statistically significant, the percentage of correct classifications is 95.8%, that indicates a good separation ability of this model. The stability of the model indicators during the entire training period is shown, so that makes it possible to use it as a prognostic model and apply to identify propensity of the junior cadet to developing stress-induced somatic diseases. Timely identification of cadets who are prone to developing stress-induced somatic diseases and personalized approach to psychological correction will contribute to the prevention of somatic health disorders, the increasing of efficiency and reliability of activity and the professional longevity of future military specialists. The indicators included in the model shows that the propensity to stress-induced somatic diseases is determined by both innate features (the speed of nervous processes and the ratio of inhibition and stimulation in the central nervous system, typological properties of the personality), and acquired skills of social behavior (coping models and psychosocial characteristics of the personality), as well as stress-induced neurotic manifestations which accumulated in the process of personal development. Psychological correction should be aimed at awareness and self-disclosure of their personal characteristics while developing the desired behavioral and social interaction skills, as well as training in mental self-regulation skills.

Arterial hypertension in the metabolic syndrome in the elderly contributes to the formation of cognitive disorders and anxiety-depressive disorders. It is shown that the severity of these deviations of the psychological continuum significantly decreases after 1 year, under the influence of an antihypertensive fixed combination of amlodipine, mesinopril and rosuvastatin in the chronotherapy mode (evening reception), than in the traditional application (morning reception in the equivalent dosage of 5/10/10 mg per day in both cases. The dynamics of cognitive impairment in chronotherapeutical approach in patients 60–74 flights from arterial hypertension with metabolic syndrome is characterized by a significant increase in the average score on a scale MMSE, f source 17.8 ± 0.3 to 23.5 ± 0.4 points (р < 0.001), against 16.9 ± 0.3 to 20.4 ± 0.4 points (р < 0.001) in the morning taking the drug. Situational anxiety decreased from 40.8 ± 2.2 to 30.6 ± 1.8 points (р > 0.05) and from 40.0 ± 2.5 to 32.1 ± 2.0 points (р > 0.05), personal anxiety from 48.8 ± 2.0 to 25.4 ± 1.9 (р < 0.001) and from 44.9 ± 1.9 to 30.7 ± 1.7 (р < 0.01) points in the evening and morning the reception, respectively. Depressive disorders decreased slightly more significantly in chronotherapy (14.1% vs. 7.7%) than in the traditional scheme, but despite this, both cases with (groups) corresponded to depressive spectrum disorders. The results obtained indicate that chronotherapy is more effective than the traditional use of a fixed combination of amlodipine, lisinopril and rosuvastatin in arterial hypertension with metabolic syndrome.

The increase in the number of patients with thyroid nodules requires the development of the most effective methods of preoperative diagnosis, allowing timely detection and differentiation of follicular neoplasia and highly differentiated cancer. A comprehensive study was carried out, which made it possible to optimize the diagnosis and choice of therapeutic tactics in patients of this category through the use of a new molecular genetic panel. Results of examination and surgical treatment of 60 patients suffering from benign and malignant thyroid gland formations are analyzed, pre-operative diagnosis of which was supplemented by immunocytochemical and molecular genetic methods of studying cellular material obtained during fine-needle aspiration biopsy. The threshold value of the Galektin-3 expression level for the differential diagnosis of follicular neoplasia in the direction of adenomas or well-differentiated thyroid cancer was determined. The significance of the BRAF V600E gene mutation in the detection of papillary thyroid cancer, the features of its clinical course and the determination of rational surgical tactics was proved. The limit value of the sodium-iodide symporter for predicting the resistance of thyroid cancer to radioactive iodine therapy, which determines the need to expand the scope of surgical intervention, has been established. The place of these molecular genetic markers in the algorithm of diagnosis and treatment in patients with thyroid nodules was determined.

A clinical case of treatment of a patient with long-term consequences of a gunshot wound to the lumbar spine with a follow-up period of fifteen years is presented. In the last year and a half, the repeatedly recurrent retroperitoneal phlegmon associated with a foreign body of the lumbar spine has prompted a decision on the issue of surgical treatment (removal of a foreign body - a bullet). The location of the foreign body and previous experience with endoscopic foreign body removal played a decisive role in the choice of surgical tactics. Removal of the wounding projectile was performed using a percutaneous transforaminal endoscopic approach. The choice of such an approach was dictated by the peculiarity of the location of the foreign body (coaxial with the endoscopic tube in the foraminal approach), as well as sufficient experience in using the technique of percutaneous endoscopic surgery. At the same time, the conversion plan was worked out in sufficient detail with both posterolateral and anterior open approaches with the involvement of appropriate specialists. So, in case of failure, it was planned to transfer endoscopic access to “open,” using the already installed working tube of the endoscope as a conductor to a foreign body. In case of inefficiency, for some reason, this version of the operation was planned for the next, third stage: wound suturing, patient turning on the back with a right-hand retroperitoneal approach to the anterior-lateral surface of LI and LII bodies. Fortunately, the purpose of the operation was achieved using the most gentle version of the allowance. The given clinical case testifies that the technique of percutaneous transforaminal endoscopic surgery is not limited in indications to the treatment of degenerative-dystrophic diseases of the spine.

We researched the dependence of cognitive abilities, mostly connected to functions of right and left hemispheres, and physical endurance on phases of sexual cycle. We discovered that on the first day of the cycle the number of correct tasks, connected with functions of the right hemisphere, was bigger than in the middle of the cycle, while no difference was detected in tasks, connected with functions of the left hemisphere. In the beginning of the cycle all test subjects correctly answered more "right hemisphere" questions, than during the ovulation phase, in the middle of the cycle the majority of test subjects correctly answered more "left hemisphere" tasks. We assume that sexual steroids moderate functional differences, connected with functions of right and left hemisphere. Precisely, low level of sexual steroids in the beginning of the cycle helps to activate functions of the right hemisphere, while steroids’ concentration in the middle of the cycle stops those functions. The level of heartbeat under the physical load was bigger in the luteal phase than before the ovulation; with the increase of load the heartbeat decreased before the ovulation and increase in the luteal phase. We assume that increased content of estrogens before the ovulations lead to decrease in physical endurance, while the decrease of concentration of estrogens in the luteal phase increased this endurance. Therefore, influence of sexual steroids helps to activate functions, which characterize specific psychological and physical status of women sex, particularly verbal abilities, lower abilities for visual analysis, and lower physical endurance of women.

The technology for obtaining biologically active substances of a lipoid nature, enriched with omega-3 acids, from waste from the processing of hydrobionts by means of electrochemical hydrolysis and cryoconcentration has been developed. A comparative analysis of the composition of wastes from cutting herring and trout is carried out, and the expediency of their use for obtaining biologically active substances of a lipoid nature is shown. A technological scheme has been developed and fat yields have been determined when it is obtained from fish waste by an electrochemical method. The fatty acid composition of the fat obtained by the electrochemical method has been determined. It was found that cryoconcentrated fat obtained from wastes from trout and herring cutting by the electrochemical method has a significantly increased content of omega-3 acids and, accordingly, biological value compared to edible and medical fish oil from the liver of the cod family. It was found that during cryoconcentration, the concentration of polyunsaturated fatty acids increases, reaching values close to 90%, which allows the resulting product to be classified as biologically active additives. It was shown by calculation that to create functional fish-based food products from fish of the salmon family, it is sufficient to introduce 4 g of the obtained biologically active additive per 100 g of the product. There is also an improvement in the organoleptic properties of foods from lean fish species. It has been shown that in order to meet 30% of the recommended daily intake of omega-3 acids in the development of functional food products based on rainbow trout and Atlantic herring, it is necessary to introduce 1.98 g and 1.8 g of cryoconcentrated fish oil. After encapsulation in nanocapsules, the drug will be suitable for enrichment with omega-3 acids in any food products, which is the subject of further research.

To analyze the rates of injuries in servicewomen in the Russian Armed Forces with injuries in the leading groups for 17 years (2003–2019). We conducted a selective statistical analysis of reports on the health status of personnel in the form 3/MED of military units, in which about 80% of the total number of servicewomen served. Injury rates by medical statistic reporting were correlated with the 19th-grade groups «Injury, poisoning and certain other consequences of external causes» (S00–T98) by the International Statistical Classification of Health-Related Diseases and Problems, 10th Review. The average annual rate of injuries (primary incidence) of servicewomen in 2003–2019 was 11.70 ± 0.82‰, its share in the structure of primary morbidity for all classes of International Statistical Classification of Health-Related Diseases and Problems, 10th Review was 1.7 ± 0.2%, hospitalizations — 6.89 ± 0.54‰ and 2.5 ± 0.2%, days of labor-loss — 239.5 ± 17.8‰ and 3.7 ± .3%, dismissal 0.11 ± 0.02‰ and 1.2 ± 0.2%, mortality rate 22.87 ± 4.41 per 100,000 servicewomen and 18.0 ± 1.6%. The dynamics show a decrease in the level and proportion of injuries in the statistical reporting analyses. The most pronounced injuries in servicewomen were with knee and lower leg injuries (International Statistical Classification of Health-Related Diseases and Problems, 10th Review Chapter XIX, block 9, S80–S89), ankle and foot injuries (block 10, S90–S99), wrist and hand injuries (block 7, S60–S69), head injuries (block 1, S00–S09), elbow and forearm injuries (block 6, S50–S59). The structure of the types of injuries to the areas of the body is presented. Conducted military-epidemiological evaluation of the negative impact of injuries on the health of servicewomen. The found medical and statistical indicators of traumatism can determine the safe conditions of activity, prevention of injuries, health-improving and rehabilitation measures among servicewomen.

Disorders in the blood coagulation system play an important role in the development of cardiovascular pathology in diabetes. Factors that cause them are hyperglycemia, insulin deficiency, insulin resistance, dyslipidemia, oxidative stress. The most significant changes are observed in the vascular-platelet link of hemostasis. Diabetes is characterized by morphological and functional changes in the endothelium of blood vessels. The activity of platelets increases, which is manifested by their high level of spontaneous aggregation and increased sensitivity to the action of activating factors. The role in the disturbance of hemostasis is played by increasing the activity of the von Willebrand factor, reflecting damage to endothelial cells. Diabetes is characterized by an increase in the activity of plasma clotting factors (I, II, III, VII, VIII, IX, XI, XII and XIII), activation of the callicrein-kinin system. In some cases, this correlates with the development of complications of diabetes. Characteristic disorders in the coagulation inhibition system are a decrease in the activity of antithrombin III, reduced formation of thrombin-antithrombin complexes, reduction of thrombomodulin and protein C. In diabetes, there is a decrease in fibrinolysis, due to a decrease in the expression of tissue activator plasminogen and an increase in the level of the inhibitor of the activator plasminogen. The possibilities of drug correction of hypercoagulation factors in diabetes are to achieve glycemic control with sugar-reducing drugs and elimination of dyslipidemia through hypolipidemic therapy. The most well-studied sugar-lowering drug that improves the state of the blood clotting system is metformin. The system of hemostasis in diabetic patients is positively affected by statins both due to the direct hypolipidemic effect, and by improving endothelial function and increasing fibrinolysis.

In 2020 the whole world was faced with an epidemiological outbreak caused by a new coronavirus SARS-CoV-2. The information available to date suggests that the newly isolated SARS-CoV-2 coronavirus should be assigned to superantigens, the main manifestations of which, as it is known, are suppression of nonspecific resistance factors and suppression of innate immunity mechanisms associated with the formation of a systemic inflammatory response in the form of cytokine storm and pathological activation of phagocytes in the lung tissue with its alteration and subsequent fibrosis. In this case, it is quite difficult and sometimes even impossible to observe the formation of fully-fledged specific immune answer on the effect of such antigens. This, along with the high infectious nature of the disease and the associated mortality, requires special attention to the underlying immunopatomechanism(s). Perhaps that is why little information has been obtained regarding the immunogenic properties of the newly isolated SARS-CoV-2 coronavirus so far, as well as, most importantly, about the structures of the virus itself responsible for the formation of specific immunity to it. The latter will serve as the basis for patient management and vaccine development. Nevertheless, a certain point of view on this issue is already beginning to form, as tools for detecting specific antibodies are being actively developed, as well as modern diagnostic tests for coronavirus, which include real-time polymerase chain reaction, real-time reverse transcription polymerase chain reaction and isothermal amplification mediated by reverse transcription. The presented analysis makes it possible to expand the understanding of the issue concerning the immunopathogenesis of COVID-19, the mechanisms of the onset and development of the disease in a living organism, the formation of an immune response to the new coronavirus, and also to determine the therapeutic tactics of managing patients with severe coronavirus infection. Elucidating the mechanisms of the emergence and development of a new coronavirus infection can help scientists, general practitioners, clinicians, and laboratory physicians respond correctly to the COVID-19 pandemic.

The management of a hypertensive patient with a history of syncope is aimed at maintaining a balance between cardiovascular and hypotensive (syncope) risks. The article presents an analysis of the literature data regarding the relationship between these clinical problems, and also draws practical conclusions that allow to ensure the optimal reduction in blood pressure in the interests of preventing cardiovascular diseases without the threat of drug-related hypotension (fainting). Variants of syncope in patients with arterial hypertension are summarized, depending on the association with antihypertensive therapy. There presented an expert opinion on the recommended target level of systolic blood pressure (120 mm Hg) in hypertensive patients under 70 years of age with a low syncope but high cardiovascular risk, as well as the target level of systolic blood pressure (140 mm Hg) in patients with high syncope and low cardiovascular risk or in elderly and / or frail individuals with hypertension. There noted the admissibility of bringing the systolic blood pressure to the target value up to 160 mm Hg in persons with severe frailty or disability. Examples of normal and pathological (hypotensive) patterns of hemodynamic response in persons with hypertension to long-term passive orthostasis obtained during the tilt test and influencing the decision-making on the activity of antihypertensive therapy are given. The importance of an interdisciplinary team approach with the participation of experts in regulatory circulatory disorders and geriatrics, which can significantly improve the quality of management of patients with a combination of hypertension and syncope, is stated.

The concept of «norms» is common to biology and medicine. It represents the essence of any phenomenon. In medicine, human health is expressed through the category of norm. The basis of the construction of the norm (normology) should be based on the principle of correspondence of morphofunctional properties of the organism to the environment, and not their nature. And then indicators that reflect the stability of a living non-equilibrium system or the state of an adapted organism will characterize (normal) human health. The norm is always stable, otherwise it will not be the norm. The science of human health developed through analysis — the decomposition of a complex whole into simple parts. In this case, the object disappeared as a whole, as a system with all its inherent features. The norm was derived from the fitness, balance of the body with the environment. Recently, it has become possible to consider a person as a system that is determined by the relationship of the whole and its parts (the golden ratio). In biology, the golden ratio manifests itself in many ways, from the structure of polypeptides to the human body. The study of a living organism as a system allowed us to establish the harmonic essence of its structure. The idea of the harmony of the world of systems is connected with the relations of "opposites" within the object. The "golden opposites" of healthy people are a kind of norm reference. What brings "opposites" to unity is harmony. Harmony is closely related to the golden ratio. Golden harmony is the basis of human health. Mathematical expression of harmony, symmetry — a method of assessing (norm) human health. Deviations from the "golden" relations can be used in medicine as indicators (criteria) for the diagnosis of pathological disorders.

The introduction of distance learning into the practice of educational process at the Military Medical Academy named after S.M. Kirov is justified in the context of the pandemic of the new coronavirus infection COVID-19. The modern principles of distance learning are presented. The experience of distance learning at the Department of Hospital Therapy of the Military Medical Academy named after S.M. Kirov during the COVID-19 pandemic is described. Aspects of the organization and teaching of the discipline “Hospital Therapy” in cadets and students of the 6th year in distance learning are considered. Practical training using an electronic information environment included studying theoretical material using an electronic textbook, watching a lecture presentation, and testing. Solving situational problems with pre-diagnosis, appointment of a plan of examination and treatment of patients allowed to preserve the practical component of the classes. The positive and negative aspects of distance learning are discussed. The data of the anonymous questionnaire of 70 cadets and students of the 6th year of the Faculty of Medicine on satisfaction with the educational process in the distance learning mode are given. The questions concerned the organization, merits and disadvantages of distance learning at the department in conditions of self-isolation of teachers and students. The experience of teaching has shown that cadets and students have high motivation, organization, good enough skills to work in the mode of distance learning. This has contributed to rapid adaptation to a new form of training in the face of the COVID-19 pandemic. In general, teachers and students are satisfied with the remote learning process. However, distance learning, according to most teachers and students, cannot fully provide a practical part of the future doctor’s training program. Positive experience of the department has shown that distance learning can be considered as an alternative to traditional learning in the conditions of self-isolation of teachers and students in the pandemic of the new coronavirus infection COVID-19.

The data on the experience of creating the first specialized departments for the treatment of victims of thermal injury in the Soviet Union are presented. Outstanding representatives of military medicine took an active position in this process: I.I. Dzhanelidze, S.S. Girgolav, I.S. Kolesnikov, B.N. Postnikov, T.Ya. Ariev, etc. The topic of their scientific research and publications, as well as of colleagues from various research and medical institutions in our country, indicates that burns and frostbite were a very urgent scientific problem for scientists of that time. However, due to objective reasons, the studies were carried out separately, were often aimed at solving particular problems, and had no confirmation in a clinical setting. The situation changed radically after the creation in 1960 at the Military Medical Academy named after S.M. Kirov Department of Thermal Injuries with a clinic for 100 beds. Its first boss was T.Ya. Ariev. A highly qualified scientist, a comprehensively trained surgeon, a teacher with extensive work experience, an experienced methodologist was able to form a team of like-minded people in a short time. Under his leadership and with his direct participation, the department began to solve a wide range of urgent scientific problems associated with thermal injury. This is evidenced by the list of topics and titles of publications that were found in the fundamental library of the Military Medical Academy named after S.M. Kirov. A careful attitude to the publications of that time is of great educational value for the student cadets, trainees, students and all employees of the academy. Thus, we preserve the memory of those representatives of military medicine who created the history and glory of our academy.

In 2021, it was 100 years since the death of a prominent domestic hygienist, Professor Irinarch Polikhronievich Skvortsov (1847–1921), son of a clergyman, after getting medical education at the Kazan Imperial University and the title of a physician in 1871 he worked for a short time in the position of zemstvo doctor in the Samara Governorate. In 1872 he was admitted to the Kazan Imperial University Department of Hygiene and till the end of his life devoted his scientific and pedagogical activity to hygiene. Irinarkh Polikhrontovich improved his knowledges in hygiene in the years 1873–1874 under the guidance of Professor A.P. Dobroslavin at the Imperial Medical and Surgical Academy Department of General, Land and Naval Forces Hygiene where defended his Doctor of Medicine degree thesis in 1874. In 1877, I.P. Skvortsov, associate professor of hygiene at the Imperial Kazan University, published the first in Russia "A short course of military field hygiene for officers and military doctors". Of particular interest is one of the annexes of this course, entitled "Instructions for protecting the health of military ranks of the army" ("Highly approved" on December 2, 1876), which is certainly an important element in the history of hygiene of military personnel. Later Professor I.P. Skvortsov headed the Department of Hygiene of the Warsaw and Kharkov Universities, and finished his career at the Kiev University. The creative heritage of this prominent Russian hygienist professor I.P. Skvortsov is comprehensive and multifaceted but is not fully known by modern specialists.

The article briefly covers the scientific, pedagogical and creative activities of Vladimir Olegovich Samoilov, whose life and fate have been associated with his alma mater for more than six decades. May 7, 2021 Vladimir Olegovich Samoilov turned 80 years old. Vladimir Olegovich — Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Retired Major General of the Medical Service, Honorary Doctor of the Military Medical Academy named after S.M. Kirov. Vladimir Olegovich made a significant contribution to the emergence of an independent scientific discipline in medical universities of the country — medical biophysics, which began to study the fundamental problems of metabolism and bioenergetics at the molecular, cellular and systemic levels. Samoilov developed original training courses in biophysics and medical electronics and headed the Department of Medical Physics for 14 years. Together with the staff of the department, he revived and rebuilt the teaching of higher mathematics and general physics at the Academy on the basis of the deductive method. Since 1974 Biophysics is taught at the Military Medical Academy named after S.M. Kirov as a system of physical and physico-chemical processes underlying life activity. In 1988, V.O. Samoilov was appointed Deputy Head of the Academy for Academic and Scientific Work. In the next six years, under his leadership, the system of basic military medical education was restructured. In 2001 Vladimir Olegovich headed the Department of Normal Physiology. During the difficult time of the change of generations, the department reorganized the educational process and resumed scientific research on the main sections of normal physiology. He formed one of the brightest scientific academic schools, which consists of seven doctors and 22 candidates of science.