Vol 40, No 3 (2021)

Cover Page

Full Issue

Military and extreme medicine

Scientific research of military medicine and training of scientific staff in its interests (to the 90th anniversary of the Department of Organization of Scientific Work and Training of Scientific-Pedagogical Staff of the Military Medical Academy)

Ovchinnikov D.V.

Abstract

The content of this article was presented in the form of a report at the International Military-Technical Forum “Army-2021” and are devoted to the formation and the present day of the system of organizing scientific work in medicine. It is shown how medicine formed the attributes of science with a system of state scientific attestation, certain forms of scientific work and the system of establishing its organizational foundations with the formulation of tasks by control units for the development of specific directions in the interests of military medicine. The role in this paper of the scientific department of the Military Medical Academy and a brief outline of its history are described. Significant attention is paid to the current state of scientific work, its forms and types, the peculiarities of their functioning in modern conditions, as well as development prospects. Modern scientific ties, relationships with the Russian Academy of Sciences, the Military Innovative Technopolis “Era” and other ties with the crucial partners have been demonstrated. The specifications of the system of training scientific and scientific-pedagogical personnel are given, starting with the system of the military scientific society of cadets and listeners to the election of members of the RAS. The role of military medical science in the fight against the COVID-19 pandemic is shown, as well as the prospects for the development of scientific practices of the Military Medical Academy (4 figs, bibliography: 6 refs).

Russian Military Medical Academy Reports. 2021;40(3):5-12
pages 5-12 views

Three-year results of solving medical and biological problems in the Military Innovative Technopolis “ERA”

Fisun A.Y., Zhurbin E.A., Markin I.V., Shchelkanova E.S.

Abstract

The article summarizes the experience of solving medical and biological problems in the Military Innovative Technopolis “ERA”. The main scientific directions of research, the results of activities, as well as scientific achievements for three years of work in the interests of military medicine are described. The directions in improving the training of operators of scientific companies for the purpose of implementing innovative activities are presented (7 figs).

Russian Military Medical Academy Reports. 2021;40(3):13-17
pages 13-17 views

Clinical medicine

From theory to practice: immunotherapy of purulent-inflammatory diseases and purulent-septic complications

Alekseeva N.Y., Dyumnikov D.A., Solovyev I.A., Kalyuzhin O.V.

Abstract

Lack of anti-infective protection is one of the reasons for the occurrence of purulent-inflammatory diseases of the skin, soft tissues and purulent-septic complications in the postoperative period. Immunocorrective therapy is extremely relevant in surgical practice, and it can be used both for the prevention and treatment of postoperative complications. In this regard, special attention should be paid to low molecular weight fragments of peptidoglycan of cellular bacteria – muramyl peptides.

The study included 65 patients with purulent inflammatory diseases, of which 35 men aged 23–55 years with chronic recurrent pyoderma (ostiofolliculitis, folliculitis, sycosis, furunculosis), and 30 patients aged 18 to 65 years with purulent inflammatory diseases of soft tissues, mainly abscesses and phlegmons of various localization without pronounced concomitant pathology. The examination included 26 patients with purulent-septic complications in the postoperative period. The patients included in the study were divided into 2 equal groups: 1 is the main group, in which patients received intramuscularly Polimuramil 200 mg daily for 5 days in addition to treatment; Comparison group 2, in which patients received only standard treatment. The clinical symptoms of pyoderma were assessed from day 0 to day 7, then on day 14, after 1 and 6 months of the study. Blood samples were taken from all patients for hematological and immunological studies. The timing of the appearance of granulations was monitored daily.

The inclusion of Polimuramil in the complex treatment of pyoderma accelerated the regression of the main clinical manifestations of the disease and promoted the induction of stable remission. In patients with soft tissue infections, Polimuramil increased the degree of regression of the depth and area of the wound and accelerated the appearance of granulations. The clinical efficacy of Polimuramil in patients with purulent-septic complications in the postoperative period correlated with a decrease in CRP and procalcitonin levels. The study confirms the effectiveness of Polimuramil in the treatment of purulent-inflammatory diseases and purulent-septic complications in the postoperative period and its high immunomodulatory potential (8 figs, 2 tables, bibliography: 5 refs).

Russian Military Medical Academy Reports. 2021;40(3):19-26
pages 19-26 views

The state of the circulatory, respiratory and hemostasis organs of the servisemen, suffered from coronavirus pneumonia, in a remote recovery period

Serdyukov D.Y., Rodichev N.S., Tretyakovа A.A.

Abstract

The problem of the long-term effects of COVID-19, especially its severe forms, is already acutely relevant for world healthcare. Severe course of the novel coronavirus infection (“cytokine storm”) may be accompanied with the damage of respiratory system, circulatory system, and hemostasis.

In the Department of Hospital Therapy Military Medical Academy have been examined 64 servicemen: 1st group of 44 people aged 46.1 ± 7 years with developed “cytokine storm”; 2nd group — 20 men 47 ± 4.4 years without this complication. Patients were screened and treated under the standard scheme; 3 months after discharge from the hospital, respiratory, heart failure and D-dimer levels were assessed.

There was a significant increase pulmonary damage with decrease in saturation to 92.3 % (p = 0.003) in the 1st group; laboratory signs of myocardial lesions: increase of troponin T to 15.4 ng/l (p = 0.001), a significant increase in the total creatine phosphokinase, aspartate amine transferase and alanine aminotransferase compared to patients of the 2nd group. The average rates of standard hemogram, with the exception of platelet levels (173 × 103/l, p = 0.03) in the 1st group were no different from similar parameters of patients from the 2nd group. It was drawn to attention the reliable increase in C-reactive protein, D-dimer and ferritin in men of the 1st group. During the reexamination after 3 months more often diagnosed the phenomenon of respiratory and heart failure and hypercoagulation in patients from the 1st group, which dictates the need for further dynamic monitoring of this category (1 figure, 2 tables, bibliography: 14 refs).

Russian Military Medical Academy Reports. 2021;40(3):27-32
pages 27-32 views

The role of infectious and seasonal factors in the development of myocardial infarction in men under 60 years old

Gordienko A.V., Sotnikov A.V., Nosovich D.V.

Abstract

The influence of seasonal and infectious factors on the risk of an unfavorable outcome in the first 56 days of myocardial infarction, a complicated course of the disease, the development of chronic heart failure of the second functional class and higher during this period was studied. The results of examination and treatment of 556 men 19–60 years old with verified type I myocardial infarction were evaluated. The analysis of the risks of an unfavorable outcome, a complicated course of the disease, and the development of chronic heart failure was carried out by the method of multivariate analysis of variance. Chronic foci of infections of the abdominal cavity and kidneys, myocardial infarction in winter, spring and autumn have a moderate negative effect on the prognosis of the disease in the examined. Predictors of unfavorable prognosis are heterogeneous across the seasons. Frequent respiratory infections and chronic inflammatory lung diseases reduce the risk of death in those examined in the first months of myocardial infarction, however, they significantly increase the risk of developing chronic heart failure (bibl.: 19 refs).

Russian Military Medical Academy Reports. 2021;40(3):33-38
pages 33-38 views

Diseases of the digestive organs and COVID-19

Grinevich V.B., Kravchuk Y.A.

Abstract

With a new coronavirus infection (COVID-19), gastroenterological symptoms are often detected, which is due to both the damage to the digestive organs by the SARS-CoV-2 coronavirus and the exacerbation of chronic diseases, as well as aggressive multicomponent therapy. The severity of gastroenterological manifestations, primarily impaired liver function, is associated with a more severe and complicated course of COVID-19 infection. Numerous mechanisms of damage to the digestive organs in COVID-19 have been identified: direct damage by the virus due to resuscitation and multicomponent therapy, impaired central and peripheral nervous regulation, immunothrombotic syndrome, virus persistence in the gastrointestinal tract, induction of autoimmune reactions by the virus, humoral disorders (changes in serotonin levels, bradykinin, activation of mast cells). Violation of the microbial-tissue complex of the intestine and the permeability of the intestinal barrier, induced by the SARS-CoV-2 virus, ensures the formation and progression of chronic systemic inflammation, cytokine aggression, insulin resistance, endothelial dysfunction, which affect the severity of the infection. Therapy for patients with COVID-19 should include therapeutic approaches aimed at correcting disorders of the intestinal microbiota, intestinal barrier permeability, and relief of gastroenterological manifestations (bibliography: 20 refs).

Russian Military Medical Academy Reports. 2021;40(3):39-44
pages 39-44 views

"Bonded by one chain, related to one purpose": what is primary in the development of thrombotic complications in COVID-19 — mechanisms of inflammation or endothelium damage?

Cherkashin D.V.

Abstract

The ongoing COVID-19 pandemic has caused significant morbidity and mortality worldwide, as well as a profound impact on society. Among the nosologies that increase the risk of a severe course of COVID-19, coronary heart disease, chronic heart failure, cardiomyopathy. The main complications caused by coronavirus infection include thrombotic ones. Spike protein SARS-CoV-2 can interact directly with platelets and fibrin, causing blood hypercoagulation and obstructing blood flow. The presence of the spike protein in circulation leads to structural changes in fibrin, complement 3 and prothrombin, which can contribute to hypercoagulability in COVID-19 positive patients and cause a significant violation of fibrinolysis. Endothelial damage and systemic inflammation, being interrelated triggers of coagulopathy characteristic of COVID-19, trigger a cascade of reactions resulting in thrombotic complications against the background of endothelial dysfunction and hyperinflammation, which may be of clinical importance in the treatment of hypercoagulability in patients with COVID-19 (bibliography: 14 refs).

Russian Military Medical Academy Reports. 2021;40(3):45-49
pages 45-49 views

Health Care organization

Legal aspects of conducting clinical trials and military trials with the participation of military personnel

Fateev I.V., Seleznev A.B., Ivchenko E.V., Ivanov V.S.

Abstract

Currently, the procedure for conducting clinical trials and military trials is regulated by a number of regulatory documents ranging from Federal laws to local orders of medical organizations. The article analyzes the regulatory documents of the Russian Federation in relation to conducting clinical trials and military trials with the participation of military personnel. It is noted that the legal status of a volunteer (military personnel) when conducting research in full-scale conditions is not fixed. In addition, in the case of conducting research with the involvement of military personnel as volunteers, it should be borne in mind that a serviceman has the right to engage in scientific, pedagogical and other creative activities. There is no regulatory document defining payments to volunteers participating in clinical trials. These organizational aspects require legislative permission to exclude legal conflicts in the planning, organization and conduct of research involving military personnel as volunteers (patients) (bibliography: 9 refs).

Russian Military Medical Academy Reports. 2021;40(3):51-56
pages 51-56 views

Features of management of patients with liver diseases in the conditions of the COVID-19 pandemic

Kravchuk Y.A.

Abstract

Liver dysfunction is common with COVID-19 infection, and the prevalence is higher in men as well as in the elderly. Manifestations of liver damage such as high aspartate aminotransferase and alanine aminotransferase activity, increased bilirubin levels, low albumin levels, and prolonged prothrombin time are associated with severe COVID-19 infection. Mortality in patients with diffuse liver diseases without cirrhosis with COVID-19 infection was 12 %, in the presence of liver cirrhosis — up to 40%, decompensated liver cirrhosis — up to 43–63%. The mechanisms of liver damage in COVID-19 include direct hepatotoxicity and indirect liver damage (due to systemic inflammation with impaired immunity, sepsis, hypoxia, ischemia, coagulopathy, endotheliitis, right ventricular failure, worsening of the course of existing liver diseases, drug liver damage). Treatment of patients with diffuse liver diseases includes lifestyle and nutritional modification, the use of hepatoprotective drugs, and means of correcting the intestinal barrier (bibliography: 30 refs).

Russian Military Medical Academy Reports. 2021;40(3):57-62
pages 57-62 views

The role of influenza vaccination in the prevention of pulmonary and cardiovascular diseases

Vasin A.V.

Abstract

Influenza is an acute respiratory disease that causes annual epidemics and periodic pandemics with high mortality. It is characterized by the development of severe complications, the main of which are pulmonary and cardiovascular ones. The only effective method of preventing influenza, and therefore the influenza-associated complications, is vaccination, which is carried out annually on the basis of World Health Organization influenza vaccines composition recommendations. This article provides the review of the research data confirming the effective role of influenza vaccination in the prevention of pulmonary and cardiovascular pathologies (bibliography: 12 refs).

Russian Military Medical Academy Reports. 2021;40(3):63-67
pages 63-67 views

Biomedical research

Domestic devices for molecular genetic analysis: developments of the IAP RAS and SINTOL LLC

Kurochkin V.E., Alekseev Y.I., Petrov D.G., Evstrapov A.A.

Abstract

The set of domestic devices and reagent kits for molecular genetic analysis has been developed, which provides for all stages of the study, from the automated isolation of nucleic acids, their amplification with real-time detection to classical and genome-wide DNA sequencing. With the help of the created equipment and reagent kits, approaches for the specific indication of pathogens of a wide range of diseases have been successfully implemented. The high efficiency of the proposed approaches is shown by the example of detecting and analyzing the RNA of the pathogen SARS-CoV-2 in the fight against the COVID-19 coronavirus pandemic (7 figs, bibliography: 4 refs).

Russian Military Medical Academy Reports. 2021;40(3):69-74
pages 69-74 views

History of medicine

Scientific potential of military medicine in the Great Patriotic War (1941–1945)

Kotiv B.N., Ganapolsky V.P., Tsygan V.N., Fomin N.F., Korovin A.E., Ovchinnikov D.V.

Abstract

Reconstruction of the historical and scientific-practical heritage of the military-medical and scientific potential of the country during the Great Patriotic War is of enduring relevance. Already by 1940, more than 250 specialized scientific institutions were created in relation to theoretical, preventive and clinical medicine in which more than 21,000 scientific workers worked (of them 2394 doctors and 5025 candidates of sciences). During the war, the scientific potential of military medicine continued to be strengthened (4 academicians, 22 honored scientists, 275 professors, 556 associate professors, 306 doctors and 1199 candidates of sciences).

The Military Medical Academy played an important role in solving scientific problems. Active scientific work continued not only in the departments and laboratories of the Academy, but also at the fronts. Scientists of the academy prepared many instructions and instructions on various issues of military medicine, which contributed to the improvement of the system of medical support for troops on the basis of military field medical doctrine. For the first time, methods have been developed for planning medical support for combat and issues of organizing medical support for army and front-line operations.

The practical significance of the principles of the military field doctrine developed during the Great Patriotic War was repeatedly confirmed by the experience of medical support of Soviet troops during the war in Afghanistan, as well as in the provision of medical assistance during counter-terrorist operations in the North Caucasus (9 figs, bibliography: 5 refs).

Russian Military Medical Academy Reports. 2021;40(3):75-82
pages 75-82 views


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