Vol 41, No 1 (2022)

Original articles

Influence of intestinal dysbacteriosis on the course of pregnancy

Bezmenko A.A., Shmidt A.A., Sadovaya N.D., Zakharov I.S.


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.

Russian Military Medical Academy Reports. 2022;41(1):5-13
pages 5-13 views

Features of hemodynamics of pelvic organs in women with tubal-peritoneal infertility

Kharkevich O.N., Mirov A.I., Golofast I.G., Kaplun I.B.


BACKGROUND: Insufficient effectiveness of modern methods of treatment of tubal-peritoneal infertility, including the use of in vitro fertilization, may be due to a persistent violation of the hemodynamics of the pelvic organs in patients.

AIM: To identify the features of the hemodynamics of the pelvic organs in women with tubal-peritoneal infertility using the method of computer tetrapolar reopletismography.

MATERIALS AND METHODS: The study included 53 women aged 25 to 35 years, according to the criteria for inclusion, non-inclusion in the study and exclusion from the study. The main group included 33 patients with secondary tubal-peritoneal infertility, confirmed by laparoscopy and chromohydrotubation. The control group consisted of 20 apparently healthy women with a history of spontaneous pregnancy, vaginal delivery and no abortions. The tetrapolar reopletismography study was performed on days 19–21 of the ovulatory menstrual cycle. Statistical processing of the obtained results was carried out using the computer software package Statistica v. 11 (StatSoft, Inc., USA) using methods of parametric and nonparametric statistics.

RESULTS: The study revealed a significant decrease in volumetric indicators of pelvic blood flow, systolic blood flow to the pelvic organs and blood circulation intensity, as well as significant changes in vascular tone and regional vascular resistance in the pelvic basin, in the main group patients compared with the control.

CONCLUSIONS: Identified significant violations of the hemodynamics of the pelvic organs in tubal-peritoneal infertility can be regarded as an unfavorable factor that must be taken into account when choosing a treatment strategy. Therefore, the normalization of the hemodynamics of the organs of the female reproductive system using medical and efferent methods should be an important component in the complex treatment of tubal-peritoneal infertility, including before in vitro fertilization.

Russian Military Medical Academy Reports. 2022;41(1):15-22
pages 15-22 views

Shear wave elastography in the diagnosis of rhabdomyolysis

Emelyantsev A.A., Bardakov S.N., Boikov I.V., Malakhovskiy V.N., Rameshvili T.E., Tsargush V.A., Romanov G.G., Bagrova A.A.


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.

Russian Military Medical Academy Reports. 2022;41(1):23-30
pages 23-30 views

Possibilities of methods for assessing the severity of occupational stress and determining its role in the formation of individual cardiovascular risk in military personnel of the Navy

Sobolev A.D., Cherkashin D.V., Vypritsky P.A., Kutelev G.G., Sukhoroslova I.E., Nikashin A.N., Tkachenko K.N., Pastukhov A.V., Matуushenko K.V., Khomina V.V.


The relevance of cardiovascular diseases among the military personnel of the Russian Navy is reflected, as well as the role of occupational stressful load in the formation of cardiovascular risk.

The results of a single-stage study were demonstrated, which included 86 men aged 23–40 years, in the course of the study they were divided into two groups corresponding to different professional loads. The profile of behavioral factors associated with cardiovascular risk (anthropometric indicators, adherence to smoking, amount of alcohol consumed, food preference), as well as morphological and functional indicators of the system, was studied in servicemen exposed to and not exposed to factors caused by staying in deep-sea technical means, blood circulation. The effectiveness of stress testing was assessed, which included the Reeder self-assessment scale for psychosocial stress, the hospital scale for anxiety and depression, a work stress questionnaire, and a differential assessment of the state of reduced performance.

It was revealed that the profile of cardiovascular risk in servicemen of both groups is low, however, there is a significant difference in a number of indicators (the amount of adipose tissue detected by bioimpedansometry, total cholesterol level, an increase in heart rate during psycho-mental test, values of vascular age and the scale of relative cardiovascular risk The most informative technique, which made it possible to identify significant differences between the study groups, is the questionnaire of work stress Ch. Spielberg 1989, adapted by A.B. Leonova and S.B. Velichkovskaya, 2000. It has been determined that the severity of occupational stress factors on the formation of cardiovascular risk in servicemen exposed to factors caused by their stay in deep-sea technical equipment is lower than among servicemen in the control group, which is expressed in lower values of additional methods for assessing stressful impact, as well as in the absence of significant associations between the indicators characterizing the occupational stress-generating load and the indicators of the circulatory system.

The importance of the formation of stress resistance is reflected, achieved by high requirements of professional selection, regular training of professional skills, as well as the creation of a favorable professional environment.

Russian Military Medical Academy Reports. 2022;41(1):31-42
pages 31-42 views


Modern approaches and perspectives on the prevention and treatment of high-intensity noise damage in military personnel

Dvoryanchikov V.V., Kuznetsov M.S., Golovanov А.E., Glasnikov L.A., Pastushenkov A.L.


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.

Russian Military Medical Academy Reports. 2022;41(1):43-48
pages 43-48 views

Application of digital processing methods for automated cardiac segmentation from computed tomography data

Shirshin A.V., Boikov I.V., Malakhovskiy V.N., Rameshvili T.E., Kushnarev S.V.


Computed tomography is now widely used in cardiac surgery as a method of non-destructive study of internal structure of objects, including specific tasks, such as mathematical modeling of physiological processes, surgical interventions in augmented reality, 3D printing, and radiomics. One of the key steps in creating a 3D model from computed tomography data is segmentation – the process of selecting objects in the image. Currently, there are several approaches to automating the segmentation process, including image processing methods, texture analysis and machine learning algorithms (in particular, clustering). Image processing methods are the simplest of the presented approaches and are found in various applications for segmentation of tomographic data. This paper reviews the advantages and disadvantages of various image processing methods (threshold, region growing, contour detection, and morphological watersheds) as tools for automated cardiac segmentation from computed tomography data. It was revealed that computed tomography images have characteristic features affecting the segmentation process (presence of noise, partial volume effect, etc.). The choice of the segmentation method is based on the brightness characteristics of the area of interest and also requires knowledge of the subject area, so it should be performed by a specialist with competence in anatomy and digital image processing. As independent methods of automated segmentation, the listed methods are applicable only in relatively simple cases (selection of homogeneous or high-contrast areas), otherwise, a combination of these methods, the use of machine learning algorithms or manual correction of the results is required.

Russian Military Medical Academy Reports. 2022;41(1):49-54
pages 49-54 views

Short-term prospects for solving the problems of medical-psychological support to military personnel

Yusupov V.V., Korzunin V.А., Demkin A.D., Ovchinnikov B.V.


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.

Russian Military Medical Academy Reports. 2022;41(1):55-61
pages 55-61 views

Organization of provision of medical equipment to the military level by wholesale pharmaceutical organizations and opportunities for its improvement

Dobrovol’skiy A.V., Koidan V.V., Likhogra I.A., Samarin S.V.


One of the main tasks of the main military medical directorate and the medical service of the district (fleet) is the complete and timely provision of medical equipment to military units (ships) in accordance with the territorial medical support system of the district (fleet). Military units and organizations calculate the need for medical equipment on the basis of supply standards, and taking into account the upcoming tasks by preparing and submitting to a higher authority the report and application documentation. The planned provision of medical equipment for military units and organizations of the district (fleet) is carried out once a year. The provision of medical equipment to military units (ships) is carried out through wholesale pharmaceutical organizations of the Ministry of Defense, such as the Center for Pharmacy and Medical Equipment and the Centers for the Provision of Medical Equipment and Property of the district (fleet) hereinafter Center for Pharmacy and Medical Technology. Since not all the centers for providing medical property of the district (fleet) have their own financial service and departments for conducting procurement procedures (contract groups), the provision of medical property of the military level is carried out by the forces from the property that comes centrally, and the property that comes centrally and property that will be purchased according to the procurement plan for the year in most cases by garrison hospitals. The range of medical equipment procured by a hospital is usually established and broader and more specific, the procurement of military-level medical equipment to provide military units of the district requires additional development of technical specifications for nomenclature unusual for hospitals and increases the burden on contract groups of hospitals. This article deals with the issue of providing a military unit with a decentralized order by the forces of the centers for providing medical equipment and property.

Russian Military Medical Academy Reports. 2022;41(1):63-68
pages 63-68 views

Substantiation for the selection criteria for a medical asset management information system in military medical organizations

Davydova M.V., Shcherba M.P., Kononov V.N., Merkulov A.V., Kostenko N.L., Golubenko R.A.


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.

Russian Military Medical Academy Reports. 2022;41(1):69-75
pages 69-75 views

Clinical Practice Guidelines

Assessment of personal protective equipment for medical personnel during a new coronavirus pandemic

Batov V.E., Kuznetsov S.M.


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.

Russian Military Medical Academy Reports. 2022;41(1):77-82
pages 77-82 views

Hyperprolactinemia syndrome in women: diagnosis and correction

Zakharov I.S., Shmidt A.A., Timoshkova Y.L., Silaeva E.A.


The article is devoted to modern views on the diagnosis and treatment of hyperprolactinemia syndrome in women. Prolactinomas are the leading cause of hyperprolactinemia syndrome. The main clinical manifestations of a pathological increase in the level of prolactin are hypogonadism and galactorrhea, in some cases there are neurological symptoms, as well as psycho-emotional and asthenovegetative disorders. The publication reviews management tactics of patients with prolactinomas and pathological conditions secondary to elevated prolactin levels. Both conservative approaches to the correction of hyperprolactinemia and surgical treatment methods are described. It is noted that at present, drug therapy has priority over surgery. In the medical treatment of hyperprolactinemia, dopamine receptor agonists are used. The duration of therapy with this group of drugs is at least 2 years. The targets should be long-term normalisation of prolactin levels and a significant reduction in the size of the tumour or its absence according to the results of magnetic resonance imaging of the brain. Women with drug-resistant prolactinomas are advised to increase the dose of dopamine receptor agonists to the maximum tolerated dose before considering surgical intervention. Special attention is paid to the management of patients whose pregnancy occurred amid a pathological increase in the level of prolactin. In addition, methods for correcting drug-induced hyperprolactinemia are considered. The long list of drugs that can cause increased prolactin levels shows that the problem of hyperprolactinemia may be encountered by doctors of various specialties. The data presented in the publication are based on clinical guidelines approved by the Russian Ministry of Health and comply with the principles of evidence-based medicine.

Russian Military Medical Academy Reports. 2022;41(1):83-91
pages 83-91 views

International experience in organizing medical care for the population of Italy and Serbia by military medical specialists during the COVID-19 pandemic

Svistunov S.A., Shipitsyn K.S., Kolesnikov V.V.


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.

Russian Military Medical Academy Reports. 2022;41(1):93-98
pages 93-98 views


Teacher, tutor, general (70th anniversary of Oleg L’vovich Evlanov)

Kryukov E.V., Ivchenko E.V., Kotiv B.N.


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).

Russian Military Medical Academy Reports. 2022;41(1):99-102
pages 99-102 views

Therapy as a vocation. To the 55th anniversary of professor V.V. Tyrenko

Kryukov E.V., Ivchenko E.V., Ovchinnikov D.V.


March 11, 2022 was the 55th birthday of the Head of the S.P. Botkin Faculty Therapy Department, chief cardiologist of the Ministry of Defense of Russian Federation, chief therapist-pulmonologist of the Health Committee of the Government of St. Petersburg, Honored Doctor of Russian Federation, Colonel of the Medical Service Professor V.V. Tyrenko. After graduation from the II faculty of the Military Medical Academy in 1989 he was sent to serve in the military unit of the Turkestan Military District. Since 1995, after graduating from residency, he worked successively as a senior resident, a lecturer, and a senior lecturer. After defending his doctoral dissertation in 2004, which was dedicated to Cardiac Syndrome X, in 2005 he was appointed Deputy Head of the Faculty Therapy Department for clinical work, and in 2009 he became a Head of this department. Professor Tyrenko is a well-known scientist in the field of medical problems of therapy and, in particular, rheumatology and hematology, he created his own scientific school. Scientific developments of Professor Tyrenko found practical reflection in military-medical organizations. Under his supervision, departmental standards for the use of various diagnostic and treatment techniques and methods in providing specialized medical care to rheumatologic, hematologic, and therapeutic patients were developed, which are also successfully used in medical institutions in Saint Petersburg and the North-West region. For his great merits in protecting the health of military personnel and civilians, organizing the therapeutic and diagnostic process and providing medical care, implementing modern methods of complex treatment of therapeutic patients, based, among other things, on his own scientific achievements, he was awarded with the Order of Honor 2008. He also received the honorary title “Honored Physician of Russian Federation” in 2013 and a commendation of the President of the Russian Federation in 2019 (1 figure).

Russian Military Medical Academy Reports. 2022;41(1):103-106
pages 103-106 views

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