Vol 25, No 2 (2023)

This study examines the etiological structure and antibiotic resistance features of pathogens causing infectious complications in wounded patients receiving specialized medical care are considered. A total of 3845 clinical isolates were analyzed from wounded individuals admitted t o a multidisciplinary hospital for treatment. The analysis revealed that polyresistant pathogens, namely, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were predominant among the isolated microorganisms. The prevalence of Acinetobacter baumannii varied based on the type of clinical material, with higher rates observed in wounds and respiratory, and urinary tract discharges. The polyresistant clinical isolates of Acinetobacter baumannii were sensitive to tigecycline and polymyxin, while Klebsiella pneumoniae and Pseudomonas aeruginosa were sensitive to polymyxin only. A comparison of the 2022 data with a previous study conducted in 2020 on wound discharges revealed a significant shift in the spectrum of pathogens causing wound infections. This shift involved an increase in the proportion of Acinetobacter spp., Bacillus spp., Enterococcus spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae, as well as a decrease in the proportion of certain gram-negative bacteria, including Proteus spp. and Escherichia coli. Additionally, a notable five-fold reduction in the proportion of Streptococcus spp. and Staphylococcus aureus was observed. It is likely that early empirical therapy for combat wounds effectively prevents the development of wound infections associated with these pathogens. Bloodstream infections were primarily caused by coagulase-negative staphylococci (34.5%) and Klebsiella pneumoniae (27.8%). Notably, 80% of Staphylococcus spp. isolates were methicillin-resistant. The prolonged course of infectious complications associated with polyresistant strains and the challenges in selecting appropriate antibacterial therapy may contribute to the circulation of antibiotic-resistant nosocomial strains within the hospital environment. Therefore, it is crucial to increase the vigilance of the epidemiological service in addressing the high frequency of polyresistant pathogens to implement timely antiepidemic measures. Overall, these findings indicate the involvement of polyresistant gram-negative bacteria in the development of infectious complications during the inpatient treatment of wounded individuals.

The significance of a patient’s level of education as a social characteristic in shaping their attitude toward the provision of medical care in outpatient settings has been scientifically supported. This analysis is based on primary data obtained from interviews conducted with 502 patients seeking outpatient medical care in Moscow. The main group consisted of 185 patients with secondary or specialized secondary education, while the control group comprised 273 patients with incomplete higher, higher or multiple higher education. Various approaches have been employed to assess the management system of medical care in patients with different educational backgrounds. The data reveals a correlation between the frequency of patient visits and their evaluation of the medical care system, with distinct trends observed. Patients with lower levels of education, who make more frequent visits to medical facilities, tend to provide more critical assessments of the administrative structures. The data reveals a correlation between the frequency of patient visits and their evaluation of the medical care system, with distinct trends observed. Patients with lower levels of education, who make more frequent visits to medical facilities, tend to provide more critical assessments of the administrative structures. On the contrary, patients with higher levels of education, who also visit medical organizations frequently, tend to hold a more positive view of the administrative structures. Despite both groups assigning similar overall ratings to the medical organizations providing outpatient care, patients with higher education levels tend to file more complaints specifically concerning the organization of certain departments within the polyclinic. These complaints are predominantly related to the functioning of the laboratory service, specialized specialists, and senior management within the polyclinic’s staff. Consequently, a patient’s social characteristics significantly influence their behavior and attitude toward the health care system. It should be noted that the list of social characteristics that can impact an individual’s behavior and their perception of the healthcare system is extensive.

This study examines the immunophenotype characteristics of the stem cell population in colon adenocarcinoma at various stages of the disease and evaluates their impact on the prevalence of the oncological process. The research involved analyzing surgical specimens from 67 patients with histologically confirmed colon adenocarcinoma using microscopic and immunohistochemical techniques. The patients were divided into two groups based on the extent of the neoplastic process. The first group consisted of 32 patients with localized colorectal cancer (T_3–4aN₀M₀), while the second group included 35 patients with colorectal cancer with synchronous monoorgan liver metastases (T_3–4aN_0–2M_{1a (hep)}).The study assessed the immunophenotype of the tumor and investigated its correlation with the disease stage. The analysis revealed no significant correlation between the proliferative activity index of the immunohistochemical marker Ki67 and the stage of the disease (p = 0.108). However, when comparing the immunophenotype of stem tumor cells in the group of patients with metastatic colorectal cancer, statistically significantly higher levels of expression were observed for the following immunohistochemical markers: ALDH1⁺ (p = 0.028), ALDH1⁺Ki67⁺ (p = 0.0002), and CXCR4⁺ (p = 0.005). These results indicate a strong association between immunohistochemical markers characterizing the stem cell population and the prevalence of the tumor. Therefore, markers such as ALDH1⁺, ALDH1⁺Ki67⁺, and CXCR4⁺ can provide valuable insights into the molecular and biological properties of stem tumor cells, aiding in the clinical assessment of the potential aggressiveness of colon adenocarcinoma. The study also found that the median stem cell proliferation index, which considers the proportion of proliferating cells only within the stem cell population and not the entire cell pool, in the group of patients with localized colorectal cancer was 16%. Notably, none of the patients in stage II of the disease had a stem cell proliferation level below 50%, and the stem cell proliferation index ranged from 0% to 50%. Notably, none of the patients in stage II of the disease had a stem cell proliferation level below 50%, and the stem cell proliferation index varied from 0% to 50%. In contrast, the median index of stem cell proliferation in the group of patients with metastatic colorectal cancer was 45.5%, with values ranging from 7% to 100%. The stem cell proliferation index in this group was significantly higher (p = 0.00001) than that in the group with localized tumor processes. Considering the small population of stem tumor cells, determining the index of stem cell proliferation is advisable for a more accurate assessment of their proliferative activity.

A method for identifying single nucleotide polymorphisms of the PfMDR1 gene (A958146T, A961013G, G961625T) based on the analysis of the lengths of restriction fragments using polymerase chain reaction technology with specific primers is presented. To identify the polymorphism A958146T (amino acid substitution N86Y), it was proposed to amplify a fragment of parasitic deoxyribonucleic acid with a length of 417 bp, including the 86th codon of the PfMDR1 gene, followed by treatment of the amplicon with ApoI endonuclease, the restriction site of which includes the sequence of the analyzed mutation. With the Plasmodium falciparum genotype unchanged, the isolated deoxyribonucleic acid site is divided into two fragments of size 239 and 179 bp. In the case of an altered genotype containing a single nucleotide missense mutation A > T, the original fragment 417 bp will be preserved. When designing the system to detect the amino acid substitution N1042D caused by the A961013G mutation, a pair of specific primers were selected that limit the 404 bp-long section of parasitic deoxyribonucleic acid. For restriction analysis, the most optimal was the use of AseI endonuclease, which in the case of an unchanged Plasmodium falciparum genotype divides the initial amplicon into 4 fragments (132, 116, 99 and 25 bp), and in the presence of A > G mutation — into 3 (248, 99, 25 bp). It was found that a fragment of the PfMDR1 gene, including the G961625T mutation leading to the amino acid substitution D1246Y, contains 1 site corresponding to the restriction site of endonuclease BglII. Therefore, in the case of the wild genotype of Plasmodium falciparum, the initial fragment of deoxyribonucleic acid is cut into 2 short sections (300 and 269 bp). With the D1246 mutation, the replacement of the nucleotide G > T leads to the disappearance of the restriction site, so only one source fragment (509 bp) will be recorded on the electrophoregram. Based on the analysis of the data obtained, criteria for evaluating the drug resistance of Plasmodium falciparum have been developed. The decrease in sensitivity to mefloquine and its derivatives of pathogens of tropical malaria can be evidenced by positive results obtained using the developed methods for detecting haplotypes A > T (N86Y (band 417 bp)), A > G (N1042D (bands 248, 99 and 25 bp)), G > T (D1246Y (509 bp)). The developed methods can be used to analyze the spread of drug-resistant tropical malaria.

This paper presents the experience of using augmented reality (AR) technology in the surgical treatment of a patient with encapsulated foreign bodies in the lower extremities. The study aims to test a previously developed algorithm for implementing AR technology in surgery and assess its effectiveness in treating patients with encapsulated foreign bodies. The study was conducted by a multidisciplinary team, comprising the Department of Naval Surgery of the S.M. Kirov Military Medical Academy and the Technical University named after Peter the Great. The medical and technical aspects involved an AR hardware and software package, including a personal computer and Microsoft Hololens II AR glasses. An invasive fixation system was also developed, incorporating a threaded pin used as an X-ray contrast mark with a seat for attaching special markers. The clinical part of the study involved observing and subsequently removing encapsulated foreign bodies in a patient who received inpatient treatment at the clinic of the Department of Naval Surgery in October 2022. Overall, AR technology demonstrated the potential for performing minimally invasive removal of encapsulated foreign bodies in limbs. The detailed visualization provided by AR allowed for determining optimal operative access, the volume of the upcoming operation, and the exact position, skeletotopy, and syntopia of the foreign body during the preoperative stage. Consequently, various intervention options could be digitally simulated. The use of AR technology facilitated intraoperative navigation, enhancing the safety and efficiency of the operation. Thus, AR technology has proven to be a minimally invasive, safe, and effective tool in surgical treatment. However, several unresolved issues require further research.

In recent years, the primary healthcare sector in our country has undergone significant development, driven by the implementation of tasks and the achievement of key indicators outlined in the National Healthcare Project. This growth has been supported by the country’s economic progress, leading to increased funding for the healthcare industry. Recently, a notable shift in focus has been toward preventive measures and outpatient care in medical facilities that provide primary health services. These measures include promoting a healthy lifestyle, assessing disease risks, and ensuring timely treatment and monitoring. The primary objective of all therapeutic and preventive measures is to enhance the lifespan and quality of life of our population. Since its establishment in 2020, the modernization of primary care, identified as a priority for healthcare development in the upcoming years, has made significant strides in improving accessibility and the quality of medical services. A key driver of this progress of healthcare in the Russian Federation is the extensive use of modern medical technologies, particularly in the provision of primary health care. This shift has also necessitated significant changes in professional terminology within the field. Consequently, an in-depth analysis of the potential integration and widespread use of modern medical technologies in medical facilities providing primary health care has led to the proposal of a new term: “ambulatory complementary technologies”. This term aims to enhance the conceptual framework of primary healthcare systems and eliminate discrepancies in medical professional terminology. This paper not only describes the reasons behind the emergence of the term “ambulatory complementary technologies” but also provides a clear definition and outlines prospects for its further development. By introducing this term, we aim to achieve a more accurate interpretation of the key indicators used to comprehensively assess primary healthcare across various regions of the Russian Federation. Ultimately, these efforts are geared toward enhancing the effectiveness of primary healthcare organizations.

This study investigates the classification features of “return” losses of the personnel of the troops, specifically focusing on psychiatric profile losses and stress-associated mental disorders in the context of modern military conflicts and emergencies of various natures. The term “return losses” refers to individuals who have regained their combat and work capacity after a temporary loss during military conflicts and are deemed physically fit to resume their functional duties. Additionally, temporarily lost combat and working capacity refers to individuals unable to perform their functional duties for a short period, typically ranging from several minutes to 24 hours. This category includes individuals with stress-associated mental disorders. The research finds that at least 20% of victims in modern military conflicts and emergencies exhibit signs of mental maladaptation within the first day of battle or during the elimination of the medical and sanitary consequences. To address the classification of personnel losses in psychiatric and stress-related cases, as well as the inconsistency in existing terminology, a proposed classification system based on the ability to return to service is presented. Furthermore, new principles have been established to determine the return losses of military personnel, facilitating the provision of adequate and timely assistance for individuals affected by stress-associated mental disorders. The article also outlines medical and psychological correction measures at various levels and elements of first aid for combat stress-induced maladaptive phenomena. Additionally, the study recommends future research on developing a methodology to assess the size and structure of contingents consisting of individuals who temporarily lose their combat and working capacity due to modern enemy weapons during combat operations, as well as in diverse emergency situations.

This study analyzes the impact of the new coronavirus infection pandemic on the course of coronary heart disease. It highlights the role of factors such as endothelial dysfunction, microvascular hypoperfusion, thrombosis, and systemic inflammation in worsening cardiovascular pathology, including coronary heart disease. The paper also explores additional causes for the deterioration of coronary heart disease during the peak of the pandemic. Despite recommendations advocating for percutaneous intervention in all patients with acute coronary syndrome and S–T-segment elevation, there has been a notable decrease in the number of percutaneous intervention procedures performed during the peak of the pandemic. This decline is observed in patients with both S–T-segment elevation and those without (reductions of 21% and 37%, respectively). Despite the recommendations advocating for percutaneous intervention in all patients with acute coronary syndrome and S–T-segment elevation, there has been a notable decrease in the number of percutaneous intervention procedures performed during the peak of pandemic. This decline is observed in patients with both S–T-segment elevation and those without (reductions of 21% and 37%, respectively). Furthermore, there has been an increase in the time interval between ambulance contact and the execution of percutaneous procedures, resulting in prolonged myocardial ischemia and subsequently poorer patient prognosis. Moreover, due to limitations in the ability to provide inpatient examination and treatment for individuals with chronic heart failure, there has been a pronounced exacerbation of the condition and an increase in mortality rates. Similarly, the provision of cardiac rehabilitation after myocardial infarction has been significantly restricted. Given the extensive number of patients who have been affected or continue to suffer from new coronavirus infection, it is of utmost importance to develop predictive models that account for the development of post-new coronavirus infection syndrome and the emergence of early and late complications of a new coronavirus infection, including coronary artery disease, and comorbidities. The current risk assessment models, aimed at predicting mortality and guiding the treatment of patients with new coronavirus infection or post-infection, do not comprehensively consider all the necessary parameters nor do they predict the emergence of long-term complications. Therefore, further prospective studies are required to address these limitations.

This article presents the activities of the medical service in organizing the provision of medical equipment to the troops (forces) of the Russian Federation in the first decade of the 21^st century. It reflects the main stages of development of the pharmaceutical industry in the post-default state of the economy and the emergence of new mechanisms and forms of interaction with transnational pharmaceutical companies. The article showcases the positive features and shortcomings of implementing programs for additional drug provision and ensuring the population has access to necessary drugs. Additionally, it discusses the reorganization of the medical service of the Armed Forces of the Russian Federation as part of a large-scale reform of the military organization. The organizational and staffing changes in the military administration of the medical service, pharmaceutical organizations of the Ministry of Defense of the Russian Federation, and medical supply units are represented, highlighting their reorganization and restructuring by the end of the 2000^s during the ongoing modernization of the Russian Federation Armed Forces. The article also describes the three-level system of medical supply of troops (forces) that developed after modernization. The leading role of the Department of Military Medical Supply and Pharmacy of the Kirov Military Medical Aca demy and the Center for Pharmacy and Medical Equipment in updating the regulatory legal framework for the medical supply system for troops (forces) is discussed. Their activities of these entities during the modernization of the medical supply system for troops (forces) to create key regulatory legal acts such as orders and directives of the Minister of Defense of the Russian Federation and official documents as part of research work are disclosed. Finally, the article provides a list of normative legal acts and service documents developed during this period, which regulate various aspects of activities related to providing military equipment to the troops (forces) and have been updated and harmonized with the legislation of the Russian Federation, is given.

This article focuses on the life and professional achievements of Alexander Ivanovich Panyushkin (1933–2022), who served as the first neurosurgeon at the Oktyabrskaya Railway Road Hospital and later became its chief physician from 1974 to 1999. Panyushkin obtained his neurosurgical specialization at the Department of Neurosurgery of the Military Medical Academy named after S.M. Kirov, studying under renowned academic neurosurgeons such as V.A. Shustin, V.A. Grebenyuk, and B.A. Samotokin. In the 1960^s, Panyushkin studied under renowned academic neurosurgeons such as Associate Professor V.A. Shustin (a specialist in treating discogenic radiculitis), Professor V.A. Grebenyuk, and Professor B.A. Samotokin (head of the department) and other figures and doctors of the academy. The article highlights the establishment of the neurosurgical department of the Road Hospital, which served as the base of the Department of Neuro surgery of the Military Medical Academy named after S.M. Kirov, as well as the close relationship between the hospital and the academy for many years. It also explores Panyushkin’s significant contributions to the diagnosis and surgical treatment of discogenic lumbosacral radiculomyeloishemia, as reflected in his well-known monographs. The article provides insights into Panyushkin’s remarkable career journey from a young surgeon to the head physician of a renowned spinal neurosurgical department in Leningrad. Under Panyushkin’s leadership, the hospital witnessed substantial development, including the construction and equipping of new buildings between 1976 and 1985, where the main capacities of the hospital are concentrated today. The authors draw on Panyushkin’s memoir to shed light on the history of the Road Hospital, its doctors from different generations, and the experiences of Soviet medicine during the 1960^s to 1990^s. The authors of this article constantly refer to the materials of this book, which may be useful to clinicians as well as those who are interested in the history of domestic medicine.