Russian Military Medical Academy Reports

BACKGROUND: Due to the active development of molecular genetic diagnostic techniques, much attention is now being paid to the study of intestinal microflora. A number of studies have demonstrated the major influence of the intestinal microbiota on the course of pregnancy. However, the number of publications devoted to this problem is limited.

AIM: The aim of the investigation is to assess the qualitative and quantitative composition of the intestinal microflora in pregnant women.

MATERIALS AND METHODS: To achieve this goal, 200 pregnant women in the age group 18 to 43 years and with a gestational age of 6 to 22 weeks were examined. A quantitative and qualitative analysis of the microbiocenosis of the vagina and rectum was performed using the real-time polymerase chain reaction method.

RESULTS: The results of the study demonstrated the presence of intestinal dysbacteriosis in 100% of pregnant women. Grade I dysbacteriosis was diagnosed in 64.5% of cases, grade II in 26.5% and grade III in 9%. In patients with moderate to severe dysbacteriosis, opportunistic pathogens Enterobacter spp., Clostridium difficile, Campylobacter spp. and Streptococcus spp. in concentrations exceeding formally permissible values. High quantitative indicators of clinically significant opportunistic pathogens in the vaginal biotope were detected amid the decrease in normal flora and a high concentration of opportunistic pathogens in the intestinal biocenosis. Grade II and III intestinal dysbiosis should be considered as a risk factor for the formation of a complicated course of the gestational period in the early stages.

CONCLUSIONS: Thus, pregnancy is a predisposing factor to the formation of dysbiotic changes in the intestine. In turn, rational management of intestinal dysbacteriosis can contribute to the correct course of the gestational period in the early stages.

Rhabdomyolysis is a life-threatening skeletal muscle disease, the time of diagnosis and initiation of treatment of which directly affects the likelihood of developing acute kidney injury and the quality of recovery of muscle function. The ultrasound method of diagnostics is accessible and can be used at the stage of primary diagnosis, but it has low sensitivity of 68% and specificity of 57% when using such ultrasound symptoms as a diffuse expressed increase of echogenicity (homogeneous or heterogeneous), disorder of transverse striation of the muscle structure and high volume of the muscular tissue damage (over 30%).

The possibility of ultrasonic elastography in the diagnosis of rhabdomyolysis in 95 patients admitted with suspected damage to muscle tissue are discussed. Comparison of the parameters of shear wave elastography in patients with rhabdomyolysis and patients with other diseases manifested by muscle edema (muscle contusion, inflammatory myopathies, post-exercise muscle edema), as well as with the control group, significant differences were noted (p < 0.01) allows to determine the quantitative ultrasound characteristics of muscle tissue, pathognomonic for rhabdomyolysis. The use of shear wave elastography with obtaining lateral wave velocity of less than 1.64 m/s increased the sensitivity and specificity of the method in the diagnosis of rhabdomyolysis to 75 and 62%, respectively.

A logit model with integrated use of elastography indices was developed, with a diagnostic accuracy of 77%. During muscle recovery, there was an increase in lateral wave velocity to the level of control group values, which can be used as one of the markers of patient recovery.

The specifics of military labor, the effect of harmful, and sometimes dangerous factors in the form of impulse noise, shock waves, constant high-level noise, leads to the risk of developing acutraumatic damage to the hearing organ in military personnel. The urgency of the problem is caused by the lack of a unified theory of the pathogenesis of the disease, the low efficiency of currently existing treatment approaches and the insufficient implementation of a system of preventive measures aimed at hearing preservation and health improvement of people working in conditions of increased noise load. The effect of high-intensity noise causes a disorder of microcirculation in the inner ear resulting in the development of hypoxia. As a result of the above-mentioned processes, there are changes in bioenergetics of cells, accumulation of reactive oxygen and nitrogen forms, leading to oxidative stress, and then to their programmed and/or necrotic death. In addition to hair cell damage, irreversible damage to spiral ganglion neurons also occurs. According to current studies, it has been established that the key role in the regulation of oxygen homeostasis under hypoxia is played by a molecule of the factor induced by it. This undoubtedly stimulates the search for drugs acting on it as a target molecule for the treatment of hearing loss of noise etiology. The paper presents data on the incidence of acutraumatic damage to the hearing organ due to noise of high intensity in military personnel, as well as the current views on the pathogenesis of the disease. Particular attention is paid to the analysis of approaches to the treatment of acute sensorineural hearing loss and the prospects for preventive and therapeutic use of antihypoxants.

The main directions and problem aspects of improving medical-psychological support to military personnel are considered. This term denotes an integral part and logical continuation of military professional psychological selection, which, due to a number of reasons, is less developed than professional psychodiagnostics in the interests of selection and rational distribution of military personnel. The main idea of the article is to prove the necessity of a unified theoretical basis of the whole complex of medical-psychological support to military personnel. The appropriateness of modern psychological theories of personality, closely associated with neurophysiology (in particular, G. Gray’s theory) is emphasized. The possibility of practical use of some achievements of the foreign project Research Domain Criteria (RDoC) in interests of diagnostics, examination and monitoring of professional mental health of military personnel is noted. With the purpose of dynamic estimation of functional states of the military personnel it is suggested to create a psychodiagnostic tool on the basis of the concept of interaction of stress-activating and stress-limiting systems. The questions of artificial intelligence application for psychophysiological diagnostics, necessity of further development of “psychological riskology” and preventology for the purpose of medical-psychological support of the military personnel improvement are discussed. The elaboration of a modern scientific basis for the development of the system of medical-psychological support will make it possible to use a multilevel approach to the evaluation of mental health of military personnel, taking into account the socio-cultural, psychosocial and biological levels of mental disorders and behavioral deviations. The transition to continuous and comprehensive prevention as a preventive branch of military, clinical psychology and psychiatry will be greatly accelerated.

The modern information systems market offers a large number of software products for the management of medical assets. Therefore, the substantiation for the criteria for selecting information systems is relevant area of decision-making policy for the management of the medical-military organisation. The purpose of the study was to substantiate the criteria. The materials of the study include the works of Russian scientists in the sphere of organizing civil and military healthcare, managing medical property resources, the methodology of sociological research, and other scientific, methodological, and reference literature on the topic of the study, as well as questionnaires completed by experts. Structural-functional, system and problem analysis, statistical methods of analysis, methods of sociological research, methods of comparison and description, and logical analysis were used during the research. The sociological study was carried out on the basis of the S.M. Kirov Military Medical Academy of the pharmaceutical profile departments and consisted of two stages: the formation of an initial list of criteria based on the results of content analysis and problem analysis; expert assessment according to the Delphi method in several stages (rounds). As a result of the study, the criteria for selecting an information system for managing medical assets in military medical organizations are substantiated. At the same time, a simple in implementation and subsequent statistical processing method with reliable results that can be used for making a decision on the selection of an information system, taking into account the specifics of each military medical organization, has been substantiated and applied.

BACKGROUND: The use of personal protective equipment in contact with patients with new coronavirus infection is the basic measure to ensure the safety of medical personnel. It is known that the use of protective equipment made of materials with low hygroscopicity, air and vapor permeability, under high ambient temperatures and physical activity, can cause overheating of the body. Objectively, during the pandemic, medical personnel reported a deterioration in the functional state up to and even fainting, caused by prolonged use of protective suits. Protective equipment made it difficult to perform routine tasks and led to a reduction in the quality of work performed.

PURPOSE OF THE STUDY: Assessment of the effect of personal protective equipment on the functional status of medical personnel.

MATERIALS AND METHODS: A survey of 156 medical workers of military medical organizations was carried out using the original questionnaire. The ease of use of protective equipment was assessed, and at the same time the negative aspects of its use were identified. A study of the thermal condition of 6 volunteers during the use of reusable and disposable personal protective equipment sets was carried out under laboratory conditions.

RESULTS AND DISCUSSION: The majority of respondents reported a negative impact on the functional state of the body when using personal protective equipment. According to questionnaire data, skin damage occurred in 88% of cases; fogging of safety glasses in 81%; visual impairment in 70%; inadequate suit size in 61%; subjective feeling of heat at work in 61%; headaches in 45% of cases. An assessment of the thermal condition of the reusable and disposable suits at a temperature of 25°C and light physical work indicated that the body heat levels of the volunteers were within acceptable normative values.

CONCLUSIONS: The use of personal protective equipment has a negative effect on the functional state of the medical workers body, which requires a rational approach to the selection of protective the provision of an optimal regime of work and rest Considering the possibility of using personal protective equipment under different conditions, including increased ambient temperatures (over +30°С) and/or intense physical exertion, there is a need for further study of their effects in order to develop preventive measures.

Based on the decision of the President of the Russian Federation, interservice teams of the Armed Forces of the Russian Federation were formed to combat a new coronavirus infection (COVID-19) in Italy and Serbia. Eight medical and nursing teams were formed from the medical personnel in each detachment, led by epidemiologists, each consisting of an anaesthesiologist (resuscitator), an infectious disease specialist (therapist), and an anesthesiologist nurse. Their main task was to provide medical care for patients with new coronavirus infection in the medical and preventive organizations of these countries. In order to accomplish their tasks and to provide high-quality medical care (protection of personnel from contamination by biological agents), each group was equipped with personal protective equipment. The work of the medical teams on the territory of Italy and Serbia consisted in sanitary and epidemiological reconnaissance, epidemiological examination of the outbreaks of the new coronavirus infection, organization of anti-epidemic measures and treatment of patients with COVID-19 in the medical and preventive organizations of these countries. Calculations of mobile aerosol disinfection complexes and auto-filling stations of the radiation, chemical and biological protection troops were involved in carrying out anti-epidemic measures on a daily basis. As a result of the measures taken, experience was gained in using the forces and resources of the Ministry of Defense of the Russian Federation to localize the outbreaks of the new coronavirus infection in the territory of foreign countries. The joint work of the group of the Armed Forces of the Russian Federation and local authorities has reduced the incidence of a new coronavirus infection among the local population of Italy and Serbia.

March 14, 2022, retired Major General of Medical Service O.L. Evlanov turned 70 years old. After graduating from the IV Faculty of the Military Medical Academy in 1975, he served as a chief of medical service on a submarine of the double time Red Banner Baltic Fleet. Since 1979, when he became an adjunct in the Organization and Tactics Department of Medical Service of the fleet, Oleg L’vovich has connected all his further life with the Military Medical Academy. After finishing his postgraduate studies and defending his dissertation (1983), he became a teacher, and 10 years later, in 1993, he became the Head of the Department. Thereafter, he successively held the positions of the Head of Educational Department (1999), Deputy Head of the Academy for Academic Work (2002) and Deputy Head of the Academy for Academic and Scientific Work (2010). Since 2013, he worked in the Academic Department, and since 2021 — in the Educational and methodological Department. Under his leadership introduction of educational standards, the first accreditation activities, establishment of certification system for medical and pharmaceutical specialists, creation of supplementary education system were carried out for the first time. On the initiative of O.L. Evlanov the Pedagogy Department was created in the Academy, where the training of adjuncts, novice teachers and advanced training of experienced lecturers are carried out. O.L. Evlanov successfully established the engagement between the departments and all the Academy subdivisions involved in the provision of educational activities such as clinics, faculties, training department, medical school and library. He built constructive relations with the heads of medical institutions of St. Petersburg, which allows carrying out the practical part of education at more than 150 city educational bases in a qualitative way. For his service to the homeland O.L. Evlanov achieved the Order “For Military Merit” and the Order of Honor, received the honorary title “Honored Worker of Higher Education of Russian Federation”, he received a commendation from the President of Russia, and in 2018 the Academic Council of the Academy elected him as an Honorary Doctor (1 figure).