Vol 24, No 2 (2022)

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

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

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

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

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

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

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

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

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

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

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