Vol 41, No 3 (2022)

BACKGROUND: Patients who have undergone a COVID-19 infection are in need of comprehensive rehabilitation, taking the polysyndromic manifestations of the post- COVID syndrome and comorbidities into account.

AIM: The purpose of this article is the need to evaluate the effectiveness of medical rehabilitation programs for patients who underwent a COVID-19 infection at the second and third stages of medical rehabilitation from the standpoint of evidence-based medicine.

MATERIALS AND METHODS: 330 medical rehabilitation programs for patients who had a COVID-19 infection were examined. All patients underwent functional tests: control of blood oxygen saturation (SpO₂), spirometry, Stange and Gench tests, testing on the Borg exercise tolerance scale and the MRC dyspnea scale; the EQ-5D quality of life questionnaire was completed. Patients were divided into 2 representative groups (160 and 170 people). The average duration of treatment was 14 days. The methods of physical and rehabilitation medicine: therapeutic exercises, breathing exercises, inhalation therapy were applied to the patients in the observation group. Patients in the observation group underwent rehabilitation treatment programs depending on comorbidities and severity of symptoms in organs and systems. The survey was conducted on at 2 control points: 1 day (first), 14 day (second).

RESULTS: The observation group showed significantly better recovery results (p < 0.05). The average values of the Stange and Gench samples showed a positive trend. There was an improvement in the subjective assessment of the tolerability of the 6-minute walk test on the Borg scale, a decrease in the severity of dyspnea on the MRC dyspnea scale, and an improvement in the quality of life on the EQ-5D scale.

CONCLUSION: The structure of the rehabilitation programs used in the clinic of medical rehabilitation and recovery treatment was analysed, showing positive results that have indicated the effectiveness of the methods of physical and rehabilitation medicine in patients with various manifestations of post-COVID syndrome.

BACKGROUND: Patients Arctic conditions complicate the pathogenesis of various skin and soft tissue injuries. For the treatment of these diseases, the possibility of using multipotent mesenchymal stromal cells, which promote the proliferation of granular tissue cells, angiogenesis, and reduce the duration of the inflammatory phase during wound healing due to the secretion of cytokines and growth factors, is being considered.

AIM: In order to evaluate the effectiveness of cell therapy, experimental studies were carried out on the model of a lacerated wound in rats under conditions of hypoxia and hypothermia.

MATERIALS AND METHODS: The animals were kept in a climate chamber (15% oxygen, 4°C) for 48 hours. Injury was applied 24 hours after placement in controlled conditions. The introduction of stem cells was carried out a day after the wound was applied. Mesenchymal stromal cells obtained from the red bone marrow of Wistar rats were used for injection. The cell culture used had an immunophenotype corresponding to stem cells and had the ability to differentiate in the osteogenic, chondrogenic and adipogenic directions. During the study, the degree of inflammatory reaction in injured tissues and the presence of possible pathological discharges from the wound canal were assessed in rats, and the thickness of the injured paw was measured.

RESULTS: The stimulating effect of the suspension of mesenchymal stem cells on the dynamics of reducing the edema of the injured hip by 10% was established compared to the control group. To describe the process of inflammation, a histological analysis was performed on the 6^th and 21^st days after the wound was applied. On the 6^th day of the study, a weak infiltration of lymphocytes in the muscle tissue was noted in rats that were injected with MMSC, which may indicate an earlier transition of the wound process to the proliferative phase.

CONCLUSION: The stimulating effect of the suspension of mesenchymal stem cells on the dynamics of reducing the edema of the injured hip by 10% was established compared to the control group.

Modern concepts about the dynamics of states of servicemen following combat mental trauma are presented. Psychological mechanisms of the development of post-traumatic stress disorder are described. The results of psychological examination of servicemen-combatants are briefly summarized. It is shown that 40% of them have negative psychological consequences of combat stress in the form of signs of partial post-traumatic stress disorder, which correlate with manifestations of neurotic disorders. Signs of partial post-traumatic stress disorder in healthy military combatants reduce the self-assessment of the quality of life, but do not significantly affect the professional aspect of social functioning in favorable conditions, that does not allow to identify the presence of negative psychological consequences of combat stress by commander expert assessment.

In addition to the psychological examination, the servicemen underwent stress testing on the “Rehacor” hardware psychophysiological software complex, which consisted in the fact that the subject was alternately presented with stress stimuli consisting of video and audio sequences on the monitor screen and in headphones in accordance with a pre-compiled scenario. In the course of stress testing the physiological parameters of the subject were recorded. In military personnel with signs of partial post-traumatic stress disorder, a decrease in the threshold of sensitivity to stress was found, which in combat conditions can lead to the development of acute stress-induced mental disorders and to be the reason for the growth of violations, mistakes, the adoption of incorrect operational and tactical decisions, the demoralization of personnel, the growth of sanitary and irretrievable losses and losses of military equipment and weapons.

Based on the physiological parameters obtained during stress testing, a method for diagnosing signs of partial post-traumatic disorder has been developed. This method makes it possible to objectify the identification of the negative psychological consequences of combat stress and can be used in the interests of psychological and psychiatric intelligence.

In this study we have shown the relevance of the nucleic acid testing for the diagnosis of the human immunodeficiency virus infection and hemocontact viral hepatitis in the military medical organizations as well as the experience of majority of the foreign countries that actively apply modern molecular methodologies for the diagnosis of infectious diseases. The possibility of using the rapid tests, molecular biology techniques and an alternative carrier of the biological material — the “dry drop” method, the potential of this method of biological material preparation in infectious diseases diagnostics in case of laboratory remoteness and for follow-up observation of patients with socially significant hemocontact viral infections is shown.

New algorithm of human immunodeficiency virus infection laboratory testing using polymerase chain reaction as an expert test followed by methods of determination of recency of acquisition of human immunodeficiency virus antibodies especially in questionable laboratory result cases are proposed.

Promising molecular genetic methods for implementation in laboratories in military medical organizations such as nester-polymerase chain reaction, loop-mediated isothermal amplification, digital polymerase chain reaction, mass spectrometry of polymerase chain reaction — amplicons, Deoxyribonucleic acid sequence are observed. We have defined the main approaches to improve laboratory diagnostics of social significant hemocontact viral infections in military medical organizations: optimization of logistics of pre-analytical step with expansion of validated biomaterial samples storage and delivery methods (including “dry drop”); reduction in the duration of analytical phase through increase in the clinical use of polymerase chain reaction testing (including isothermic variant); improving the sensitivity and accuracy of serological and molecular diagnostics; development of validation methodology and laboratory tests results interpretation While ensuring military medical expertise. The necessity of specialists training in new diagnostics techniques and result interpretation, improving regulatory framework on examination and registration of human immunodeficiency virus positive military officers, determination of the legal status of cases with unfinished human immunodeficiency virus diagnostic process in order to ensure timely preventive and treatment care events and to objectify statistical recording of this category.

The number of operations with the use of osteoplastic materials is increasing annually, which is explained by the increasing number of high-tech operations, reconstructive interventions for bone pathology, oncoorthopedics, bone deformities, as well as tissue defects resulting from combat trauma. Bone as an object of transplantation and is preferable because the use of bone tissue and materials made on its basis creates the necessary conditions for biological restoration of bone as an organ.

The modern trend is the development of regenerative medicine technologies and the development of modified materials with improved and predetermined properties — osteoplastic materials ceased to be static structures and their inertness gave way to functional activity.

The article describes the basic advantages of bone tissue and allogenic osteoplastic materials for their prospective use in reconstructive and reconstructive surgery of the musculoskeletal system. Data on the experience in the use of donor bone tissues for homoplasy at the clinic of military traumatology and orthopedics of the Kirov Military Medical Academy are presented. The advantages of allogeneic decellularized tissues for use in clinical and scientific practice are considered. The importance of preserving the architecture of native tissue for successful bone transplantation is shown. Decellularization is a method that allows the removal of immunogenic agents from tissues and organs, including cells and residual DNA, preserving the natural composition and architecture of the extracellular matrix for the most effective use of allogeneic bone tissue. The use of decellularized allogenic bone tissue purified to a mineral-collagen matrix or demineralized is the most practical option among other osteoplastic materials when large bone fragments need to be replaced.

In modern conditions, the possibilities of using 3D printing in medicine are expanding, and it occupies about 11% of the global additive manufacturing market. At the Kirov Military Medical Academy and the ERA Military Innovation Technopolis, 3D printing is used for training, preoperative planning, the creation of splints, the manufacture of non-invasive functional products, and the creation of COVID-19 prevention aids.

In order to determine the prospects for development, foreign experience in the use of 3D printing in medicine has been studied over the past 5 years.

It is established that a register of clinical data on 3D printing is being created for training, 3D models are being printed to simulate tissue resistance during surgery. With the help of preoperative planning, Siamese twins are separated, doctors are trained in surgical operations on 3D models of elastic resin feet, cardiological models are used to predict the risk of complications during transcatheter implantation of an artificial aortic valve, as well as rehearsals of operations with congenital heart anomalies. Individual implants are manufactured for the lumbar and cervical spine, replacement of the damaged area of the chest and rib, finger phalanges, hip and knee replacements. As auxiliary products, individual surgical instruments for operations with low trauma, orthopedic insoles, elastic stents for the urethra and mesh stents of the trachea are created. New materials made of polyamide (PA11), polyesteresterketone, titanium alloys, absorbable polymer and biocompatible resin are offered for 3D printing. There are new 3D printing software and updates of existing ones. Personalized braces and aligners are printed in dentistry. With the help of 3D printing, individual multi-layered polytablets, smart tablets that release medicinal substances on command from a smartphone, children’s chewing tablets are created. For research purposes, the following devices have been printed: simulating cardiac tissue with sensors to track the effects of drugs and toxins; predicting the individual response of the biopsy tumor material to treatment; diagnosing some infectious diseases using a smartphone and a silicon microfluidic chip.

The use of 3D printing in medicine individualizes and improves the quality of medical care.

BACKGROUND: One of the problems with managing patients with a new coronavirus infection is the irrational use of antibiotics. Antibacterial drugs are not active against viral infection, including COVID-19. Unfortunately, in actual clinical practice, the level of antibiotic use remains extremely high, reaching 70–80%. Unwanted antibacterial therapy leads to a number of undesirable phenomena that can significantly worsen the patient’s condition, and sometimes lead to life-threatening consequences. In this context, the most important question is the formulation of the diagnosis. In particular, the reference to the term “pneumonia”, in the case of COVID-19, is neither scientifically or clinically feasible. The most correct would be to call this process — viral or virus-associated lung damage. This term will allow you to set priorities in the choice of tactics leading the patient. That is, viral lesion (not pneumonia!) will induce the practical doctor to analyze the situation requiring prescription in the presence of indications of anti-inflammatory (monoclonal antibodies, glucocorticosteroids) and anticoagulation therapy, and will avoid unnecessary in the overwhelming number of antimicrobial prescription situations.

AIM: Formulate criteria for prescribing antibacterial therapy in patients with COVID-19.

MATERIALS AND METHODS: The study is based on a review and analysis of the literature on new coronavirus infection, drawing conclusions and recommendations.

RESULTS: In actual Russian practice, the level of use of antibiotics remains extremely high, reaching 70–80%.

CONCLUSION: The prescription of antibacterial therapy in patients with COVID-19 is justified only if there are convincing signs of bacterial infection — the appearance of purulent sputum, increased procalcitonin of blood more than 0,25–0.5 ng/ml, an increase in blood white count of more than 10 thousand/mcl with an increase in the number band neutrophils more than 10%.