卷 22, 编号 1 (2020)
- 年: 2020
- 文章: 51
- URL: https://journal-vniispk.ru/1682-7392/issue/view/1425
- DOI: https://doi.org/10.17816/brmma.391
完整期次
Articles
Characteristics of the etiological structure of infection associated with the provision of medical care in a multi-specialty hospital
摘要
Epidemiological data on infections associated with medical care in surgical hospitals are presented. The features of the epidemic process of infections associated with Klebsiella spp. were studied among the patients of surgical profile. The study of the etiological structure in hemocultures in 33% of cases revealed the predominance of Klebsiella spp. In patients with a surgical profile, the incidence of Klebsiella spp. has increased over the past 10 years in wound content from 0,4 to 8,3% and in 7,7% of cases - in hemocultures. Significant resistance of Klebsiella spp. strains was detected currently used in the clinical practice of surgical hospitals antibacterial drugs. The highest sensitivity among Klebsiella spp. strains antimicrobial resistance was detected in the group of carbapenems. The structure of the epidemic process of infections caused by Klebsiella spp. is considered among patients of surgical clinics in 2018. In 32% of cases, the infectious process was localized in the lower respiratory tract, in 25% of cases - in the urinary tract, in 22% of cases - in the blood and in 21% of cases - in the area of surgical intervention. The results obtained do not differ significantly from the data obtained in other medical organizations in the country. The need for a comprehensive approach to microbiological monitoring and the appointment of antibacterial therapy for infections associated with the provision of medical care in surgical hospitals has been established. For example, the «Strategy for controlling antibacterial therapy» developed by the Russian Association of specialists in surgical infections, which is well-established in several dozen large hospitals in the country, is being more widely introduced into medical practice.
Bulletin of the Russian Military Medical Academy. 2020;22(1):7-11
7-11
Clinical and economic rationale for the choice of treatment method for patients with kidney stones 10-20 mm
摘要
The clinical and economic rationale for choosing a method of treating patients with kidney stones 10-20 mm in size is presented. Remote lithotripsy was found to be effective in 94,2% of patients whose urolitic density is less than 1000HU and in 81.6% of patients who have a stone density of more than 1000 HU. A «stone free state» with standard and mini- percutaneous nephrolitholapaxia was achieved in 93,5 and 94,1% in patients with a stone density of more than 1000 HU. Uroliths with a density of less than 1000 HU were removed in all patients using standard percutaneous nephrolitholapaxia and in 95% of patients using mini percutaneous nephrolitholapaxia. The smallest direct medical costs were observed when performing remote lithotripsy (patients with a density of uroliths less than 1000 HU - 24292,4 rubles, patients with a density of stones more than 1000 HU - 36930 rubles). When performing operations of standard and mini-nephrolitholapaxia, the cost of treatment was 38715,7 and 35900 rubles. for patients with uroliths with a density of less than 1000 HU, 40024 and37312,8 rubles. in patients with uroliths with a density of more than 1000 HU. The cost increment coefficient showed that additional costs of 1% of the treatment efficiency when using the minipercutaneous technique will require 30,6 rubles, with standard nephrolitholapaxy - 260 rubles per person compared with distance lithotripsy. From the standpoint of clinical and economic analysis, the mini-and standard percutaneous nephrolitholapaxia should be considered as reasonable methods for the surgical treatment of patients with high-density stones of 1-2 cm, remote lithotripsy is the first-line method for the treatment of calculi of lower density.
Bulletin of the Russian Military Medical Academy. 2020;22(1):12-17
12-17
Evaluation of the antiischemic effect of a prolonged form of trimetazidine in patients with stable angina pectoris using speckle-tracking technique
摘要
Studies of global and segmental myocardial contractility using the speckle-tracking technique in patients suffering from stable angina pectoris compared to healthy individuals are presented. It was revealed that, in patients suffering from stable angina pectoris, the values of longitudinal deformation in the anterolateral and apical segments of the left ventricle, as well as global longitudinal deformation, decrease. Differences in longitudinal myocardial deformation in other segments were not observed in the subjects. Possible causes of a decrease in the longitudinal deformation of the myocardium, both in general and in individual segments of the left ventricle, are examined. The data on longitudinal segmental deformity of the left ventricle on the background of anti-ischemic therapy are presented. A direct correlation between the values of the global longitudinal deformation and the distance traveled by patients before the development of an angina attack was revealed.In addition, a direct correlation was found between the longitudinal deformation of the myocardium in the anterior septal region of the left ventricle and exercise tolerance. Adding a prolonged form of trimetazidine to complex anti-ischemic therapy leads to a significant increase in segmental and global deformity of the left ventricle, which is accompanied by a decrease in the daily need for nitroglycerin and an increase in exercise tolerance. The lack of dynamics of the longitudinal strain in the basal parts of the left ventricle during treatment may be due to the development of cardiosclerosis.
Bulletin of the Russian Military Medical Academy. 2020;22(1):18-22
18-22
Endovideosurgical removal of ectopic thymoma
摘要
A clinical case of endovascular surgical removal of ectopic thymoma in the hospital surgery clinic of S. M. Kirov Military Medical Academy performed a planned surgical intervention - thymomtectomy from left-side thoracoscopic access. 4 thoracoports used. The time of surgical intervention was 125 minutes, the volume of intraoperative blood loss was less than 50 ml. The postoperative period was uneventful. Drainage removed the next day. There were no postoperative complications. Discharged on the 5th day of the postoperative period in satisfactory condition. It is believed that ectopic thymomas arise from scattered ectopic thymus tissue, which could not migrate to the anteroposterior mediastinum. Currently, the surgical method is the «gold standard» in the treatment of patients with thymus neoplasms. Complete surgical removal of the thymus gland is a prerequisite for the effective treatment of thymic tumors. The basic principle of radicalism is the complete excision of the tumor surrounding the tissue with the lymph nodes. Particular care should be exercised when removing the spurs of the gland, which often go high on the neck, as the left tissue can cause a relapse of the disease. To remove the thymus, various «open» (transcervical, full, partial and oblique partial transsternal, right-, left- and bilateral transpleural), video-assisted (thoracoscopic, transcervical and subciphoidal, transoral) and robot-assisted surgical approaches are proposed. In this case, the choice of surgical access should be approached individually in each case.
Bulletin of the Russian Military Medical Academy. 2020;22(1):23-27
23-27
Screening of sarcopenia of haemodialysis patients
摘要
The informativity of the screening method of sarcopenia «Strength, Assistance, Rise, Climb, Fall» in haemodialysis patients was evaluated. When diagnosing sarcopenia according to the recommendations of the European Working Group on Sarcopenia in Older People, the screening method studied showed a sarcopenia diagnosis accuracy index of 53%, that is, using this method eliminated rather than confirming the diagnosis of sarcopenia. Due to the low level of the sarcopenia diagnosis accuracy index for the screening method under investigation, at the second stage of the study, an attempt was made to develop a highly sensitive and specific screening method for sarcopenia in haemodialysis patients. In the course of the study, a screening method for «Screening of sarcopenia haemodialysis patients» sarcopenia was formed. This method includes two questions asked to the patient, anamnestic data (hemodialysis therapy experience), as well as two laboratory indicators (level of prealbumin and serum C-reactive protein), where each indicator has a score from 0 to 2. As a result of screening, the patient can score a maximum of 10 points. A total score of more than 5 indicates a high risk of sarcopenia in this patient. When diagnosing sarcopenia according to the recommendations of the European Working Group on Sarcopenia in Older People, the developed method demonstrated a sensitivity of 89% with a specificity of 73,5%, the overall accuracy index was 77%.
Bulletin of the Russian Military Medical Academy. 2020;22(1):28-30
28-30
Metabolic status, ultrasound changes of liver and vascular artery wall in men with abdominal obesity
摘要
The prevalence of metabolic, vascular and hepatic disorders in young and middle-aged men suffering from abdominal obesity was estimated. It was found that in men suffering from initial obesity, compared with patients with normal diet, a high frequency of arterial hypertension (67 and 37%, χ2=41,5; p <0,001), atherogenic dyslipidemia (59 and34%, χ2=26; p<0,001), prediabetes (47 and 17%; p<0,001), atherosclerosis of the common carotid arteries (26 and 15%, χ2=8,2; p=0,004) and non-alcoholic fatty liver disease (27 and 6%, χ2=124; p <0,001). In obesity, a moderately elevated concentration of leptin (p<0,001), tumor necrosis factor α (p=0,005) and ghrelin (p=0,009) were detected. Patients with a body mass index >30 kg/m2 showed signs of remodeling of the left heart chambers in the form of an increase in the volume of the left atrium and left ventricular hypertrophy (p<0,001). The arterial stiffness indices as a whole in the sample and in the groups were within normal values without intragroup differences (p>0,05). A significant correlation between obesity and prediabetes, dyslipidemia and dysglycemia, hypertrophy of the left heart chambers, and stage of hepatic fibrosis was revealed. Against the background of initial obesity, an adipokine and carbohydrate-lipid imbalance is determined, which contributes to the development of insulin resistance, chronic aseptic inflammation and endothelial dysfunction. The presence of non- alcoholic fatty liver disease in combination with its fibrosis in this category of patients should be considered an early marker of metabolic syndrome and atherosclerosis.
Bulletin of the Russian Military Medical Academy. 2020;22(1):31-35
31-35
Comparative characteristics of patients with arterial hypertension and stenosing atherosclerosis, depending on the localization of the pathologicalprocess in the vascular bed
摘要
A comparative analysis of the clinical and functional state of patients suffering from arterial hypertension is given, depending on the localization of vascular stenosis of atherosclerotic origin. It is shown that stenosing atherosclerosis often affects men with hypertension. Lesions of the brachiocephalic arteries and renal arteries in patients suffering from arterial hypertension are detected at a younger age than with other localizations. Patients suffering from lesions of the coronary and brachiocephalic arteries are characterized by the presence of concentric left ventricular myocardial hypertrophy and hyperlipidemia. In patients suffering from damage to the renal arteries, leg arteries, and multivascular pathology, myocardial hypertrophy is eccentric, in addition, they have atherogenic dyslipidemia and significant signs of renal dysfunction. An excessive decrease in blood pressure at night is most often recorded in people suffering from coronary atherosclerosis, and its excessive increase in patients suffering from damage to the arteries of the legs. Arterial hypertension in patients with stenosing atherosclerosis in most cases is well-mediated, however, with stenosis of the renal arteries and with multivascular lesions, it is less likely to achieve a level of «normal» or «high normal» systolic blood pressure than with damage to other vascular pools. Significant differences in the levels of both systolic and diastolic blood pressure in all comparison groups indicate a different effect of local hemodynamic disturbances on systemic blood pressure.
Bulletin of the Russian Military Medical Academy. 2020;22(1):36-38
36-38
Prevalence and features of polymorbidity of servicemen of different age groups according to the results of their medical examination to determine the category of fitness for military service
摘要
The prevalence of polymorbidity and its features in military personnel of various age groups was studied. It has been established that polymorbidity during medical examinations of military personnel occurs in all age groups, increasing with age. For each age group of military personnel, its characteristic polymorbidity models are formed. So, in the age group up to 35 years, polymorbidity occurs in one third of the examined and is characterized by both functional disorders of the circulatory system and digestive organs, and the presence of organic pathology of the circulatory system (congenital malformations (developmental defects), mitral and other valve prolapse), digestive organs (chronic gastritis, gastroesophageal reflux disease) and the musculoskeletal system (flat feet, dorsopathies). At the age of 35 to 45 years, polymorbidity occurs in93,5% of those examined and is characterized by the presence of a cardiac and gastroenteric component in all polymorbidity models, in 80% of the models - the musculoskeletal component, in 60% - the metabolic component, in 40% - the endocrine component. Polymorbidity occurs in 97,5% of those examined over the age of 46 years and is characterized by the presence in all models of polymorbidity of the cardiac, cerebrovascular and musculoskeletal component, in 75% of the models - the metabolic component, in 50% - the endocrine component.
Bulletin of the Russian Military Medical Academy. 2020;22(1):39-44
39-44
Modern Aspects of Etiological Diagnostics, Clinical Picture and Treatment of Severe Community-Acquired Pneumonia in Soldiers
摘要
The problem of community-acquired pneumonia is one of the most relevant for military medicine. The relevance of community-acquired pneumonia is determined by the high incidence of conscription by military personnel, the severity of the clinical course, the presence of severe complications, the duration of labor losses, the tendency to epidemic spread, and the risk of deaths. It is necessary to improve laboratory research methods with the introduction of express methods for verifying bacterial and viral agents, determining the clinical features of the viral-bacterial pneumonia, and justifying the inclusion of antiviral agents in the etiotropic treatment regimen. An expanded complex of microbiological diagnosis of pneumonia has been developed, combining classical bacteriological methods with express methods (polymerase chain reaction, enzyme- linked immunosorbent assay, immunochromatography), which made it possible to determine atypical pathogens and viruses in addition to agents of a bacterial nature. Using these techniques, the modern etiological structure of community-acquired pneumonia in the military has been established, the prevalence of viral-bacterial pneumonia has been revealed. Among viruses, the leadership of adenovirus infection has been established, clinical and laboratory features of the disease are shown depending on the pathogens identified, the feasibility of additional prescribing of antiviral agents in addition to antibiotics in the treatment of viral-bacterial pneumonia is justified.
Bulletin of the Russian Military Medical Academy. 2020;22(1):45-52
45-52
Features of assessing the quality of medical care for patients with prostate cancer in the late stages of the oncological process
摘要
Despite the successes in the examination and treatment of patients with prostate cancer, the problems associated with the organization of medical care for patients suffering from this disease remain. Defects in the verification of oncological diseases of the prostate often cause a decrease in parameters reflecting the quality and life expectancy of men. The data on the clinical case presented in the work demonstrate the difficulties of verifying a disease of a patient with prostate cancer, despite the involvement of many specialists of several medical institutions in the diagnostic process. With significant amounts of medical measures, the quality of the medical care provided at all stages can be considered inappropriate, primarily due to a violation of continuity in the management of the patient. Health care resources were used irrationally despite the fact that attempts were made to save the patient’s life at all levels and stages of medical care. Probably, defects in the provision of medical care could have been prevented by applying unified approaches in the diagnostic and treatment process using the advantages of information technology in modern computer databases of medical institutions, which make it possible to monitor the stages and volume of medical care provided to patients individually. In addition, the proper organization of medical care, as well as the targeted routing of patient flows should be provided not so much by clinicians as health managers. In the absence of opportunities in the treatment and prevention facilities, where patients are sometimes unplanned in urgent cases, the possibilities for carrying out diagnostic and treatment procedures, the healthcare organizers, together with the clinicians, must find reserves for referring patients to specialized medical organizations, in which examination and treatment of patients can be guaranteed. At the same time, the role, importance and effectiveness of the activities of health managers in the examination of the quality of medical care in each case should be evaluated separately.
Bulletin of the Russian Military Medical Academy. 2020;22(1):53-59
53-59
Possibilities of computed tomography enterography in the diagnosis of complicated forms of Crohn’s disease
摘要
The possibilities of computed tomographic enterography in the diagnosis of complicated forms of Crohn’s disease are substantiated. Presented are 2 clinical observations of patients being treated at the clinic of naval surgery of S.M. Kirov Military Medical Academy regarding the complicated form of Crohn’s disease. It was established that early diagnosis of the disease and the most accurate determination of the form of Crohn’s disease allows you to increase the period of remission of this disease. The standard for diagnosing Crohn’s disease is an endoscopic examination with multiple biopsies. Identification of extraintestinal complications determines the prognosis of the course of Crohn’s disease and directly affects the choice of treatment tactics. In this aspect, computed tomographic enterography comes first, which, in addition to determining the nature, localization and extent of structural changes in the intestinal wall, makes it possible to assess the state of the mesentery and parenchymal organs of the abdominal cavity. The high availability, speed and non-invasiveness of the study makes computed tomography enterography the method of choice among other imaging techniques. Currently, computed tomography enterography is a reliable and timely research technique for complicated forms of Crohn’s disease. Its results allow you to choose the most suitable tactics of conservative or surgical treatment, which allows you to improve the prognosis of the disease in each case, as well as track the dynamics of the pathological process and the effectiveness of the therapy
Bulletin of the Russian Military Medical Academy. 2020;22(1):60-65
60-65
Study of prooxidant activity and some indicators of the pituitary-gonadal system in patients suffering from chronic endometritis
摘要
The state of lipid peroxidation and the oxidative modification of proteins in the blood of 29 women with chronic endometritis aged 27 to 40 years were studied. The control group consisted of 19 healthy women aged 27 to 44 years. The intensity of lipid peroxidation was estimated by the level of diene conjugates and malondialdehyde, the oxidative modification of proteins - by the level of carbonyl derivatives. It was shown that in the blood of women with chronic endometritis, the concentration of aliphatic aldehyde groups and 1,9 times the carbonyl groups in protein molecules increases by 3,3 times compared with the control group. A significant increase in diene conjugates by 34% and malondialdehyde in blood plasma and red blood cells by 47 and 43%, respectively, was established. The increase in lipid peroxidation products and oxidative protein modification in the blood indicates the development of oxidative stress in women suffering from chronic endometritis. Compared with healthy patients with chronic endometritis, a convincing tendency toward an increase in prolactin and anti- Muller hormone against a decrease in progesterone was revealed in the group compared to healthy ones. To predict possible complications in patients with chronic endometritis, it is advisable to study the indicators of protein and lipid peroxidation as markers of oxidative stress and the severity of the inflammatory process. In addition, such patients should be advised to take antioxidant drugs in combination with the basic therapy.
Bulletin of the Russian Military Medical Academy. 2020;22(1):66-69
66-69
Experience in the use of dynamic interspinous fixation in the treatment of lumbar spine stenosis
摘要
The results of surgical treatment of lumbar stenosis using the dynamic intercostal fixator Coflex in the period from September 2016 to February 2019 were analyzed in 36 patients, 25 of them with monosegmental stenosis, 11 with two levels. Caudogenic intermittent claudication was observed in 27 patients. Dynamic interspinous fixation was performed on38 vertebral-motor segments of the lumbar. Assessment of the quality of life and the intensity of pain in the back and leg before and after the operation, as well as the outcome of the operation in the distant period after the operation, was carried out by validated scales and questionnaires. There were no intraoperative complications. In the distant period after surgery, the results of control functional spondylography of the lumbar revealed a direct dependence of the mobility of the operated vertebral-motor segment on the value of the disk height index. In all observations, a decrease in the mobility of the operated level was noted, which indicated the high-quality functioning of the interspinous implant. An increase in the height of the intervertebral foramen additionally provided indirect decompression of the spinal nerve in all cases. Syndrome of caudogenic intermittent claudication by the time of discharge regressed in all cases. For the period of observation of cases of development of postoperative instability and restenosis at the operated level was not noted. Satisfactory outcomes were obtained in 33 (91,7%), and unsatisfactory outcomes in 3 (8,3%) cases. Unsatisfactory outcomes in two cases were due to chronic pain in the lower back due to symptomatic stenosis of the spinal canal at an adjacent level, and in one observation, severe pain in the right leg due to the formation of sequestered herniated discs at an adjacent level. In general, interspinous dynamic stabilization has proven itself in the treatment of spinal stenosis of the lumbar spine, as the completion of the operation after the decompression phase.
Bulletin of the Russian Military Medical Academy. 2020;22(1):70-75
70-75
Experience in the use of angiotensin receptor neprilysin inhibition in patients with chronic heart failure and chronic obstructive pulmonary disease
摘要
The results of evaluating the effectiveness of the use of an angiotensin receptor-neprilysin inhibitor (valsartan / sacubitrile) in addition to standard therapy in comorbid patients suffering from chronic heart failure and chronic obstructive pulmonary disease are presented. It was revealed that the combination of valsartan / sacubitrile has a more pronounced therapeutic effect than the separate use of valsartan. At the same time, the level of the N-terminal cerebral natriuretic peptide decreases, especially in patients with a left ventricular ejection fraction of less than 40%, which indicates the effect on the pathogenetic mechanisms associated with the formation and progression of chronic heart failure. The effectiveness of the recommended combination of valsartan / sakubitrile is confirmed by a significant increase in the ejection fraction of the left ventricle of patients suffering from chronic heart failure, which significantly affects the increase in exercise tolerance and improving the quality of life. Improving the quality of life is confirmed by the positive dynamics of the «symptoms», «activity» blocks of the questionnaire for patients suffering from respiratory diseases, St. George’s hospital and «mobility», «usual daily activities» of the quality of life questionnaire, which also shows the advantage of using valsartan / sakubitril and increases patient commitment to prescribed therapy. A decrease in the cavity of the left atrium and a decrease in pressure in the pulmonary artery indicates not only an improvement in the function of the left chambers of the heart, but also of the right ventricle.
Bulletin of the Russian Military Medical Academy. 2020;22(1):76-80
76-80
Etiological characteristics of acute respiratory diseases in servicemen of the Western military district in 2014-2019
摘要
The species affiliation of respiratory pathogens isolated from patients and carriers in the military units of the Western Military District in 2014-2019 was studied. The analysis of long-term and seasonal dynamics of their circulation is carried out. It was found that S. pneumoniae and adenoviruses are more often detected in acute respiratory diseases in conscripts. The genetic material of adenoviruses was found in 31,9% of samples, influenza viruses in 13,3%, rhinoviruses in 11,2%, respiratory syncytial viruses in 1,7%, metapneumoviruses in 0,9%, parainfluenza viruses 0,7%, bocaviruses0,5%, coronaviruses 0,1%, S. pneumoniae 33,9%, H. influenzae 13%, M. pneumoniae 9%, C. pneumoniae - in 3,3%, N. meningitidis - in 16%. Comparison of the results of work with studies carried out by domestic research groups among the civilian population in the same period showed that the circulation of various respiratory viruses depends on the year, season, and is also influenced by socio-demographic factors. A direct high functional correlation was found between the dynamics of circulation of adenovirus and S. pneumoniae in different years and epidemic seasons. Evidence has been obtained of the active implementation of the process of self-maintenance of the reservoir of infections and the multifactorial nature of the overall environmental sustainability of the system in organized military teams. In the etiological structure of respiratory infections, the proportion of pathogens varies depending on the season in different years, the characteristics of the formation and composition of organized groups, as well as epidemic periods.
Bulletin of the Russian Military Medical Academy. 2020;22(1):81-86
81-86
Prospects of studying the stability to decompression sickness of professional divers
摘要
The prospects of studying the resistance to decompression sickness of professional divers are considered. 36 men and professional divers aged 21-37 years were examined. Based on echolocation data after a standard supersaturation of the body with air nitrogen in a pressure chamber (air compression up to 0,4 MPa (30 m water) over 7 minutes, isopression60 minutes, decompression 63 minutes), 8 people were unstable and 28 resistant to decompression gas formation. It has been established that the resistance of professional divers to decompression sickness is determined by their anthropometric (age), physiological (minimum distance between R-R teeth according to the results of variational pulsometry) and psychological indicators (level of development of spatial thinking, level of reactive anxiety). For stable divers, the age and minimum distance between the R-R tines are statistically significantly less than for unstable ones. Unstable have a statistically significantly higher level of development of spatial thinking and the level of reactive anxiety. When conducting a discriminant analysis using the «forward step by step» method, a model for predicting resistance to decompression sickness is obtained: Lambda Wilks:0,27584 approximate F (4,31)=20,346; p<0,0001, recognition accuracy 94,44%. An algorithm is proposed for determining the prognosis of resistance of professional divers to decompression sickness. When conducting professional psychological selection of divers in the absence of the ability to assess resistance to decompression sickness by echolocation after a standard supersaturation of the body with air nitrogen, the developed discriminant model can be used as an additional calculation method for predicting resistance to decompression sickness in divers.
Bulletin of the Russian Military Medical Academy. 2020;22(1):87-90
87-90
Screening studies in the diagnosis of chronic carrier of the causative agent of the typhoid fever among residents of different countries
摘要
The results of screening studies of chronic carriage of the causative agent of typhoid fever (S. Typhi) among residents of various countries are presented. We studied 810 blood serums, including: 462 from citizens of the Republic of Guinea, 244 from labor migrants who arrived in the Russian Federation from Central Asia, and 104 from residents of St. Petersburg. Antibodies to S. Typhi Vi antigen were determined in the passive hemagglutination reaction as a marker of possible chronic carriage of bacteria. When screening studies of sera of citizens of the Republic of Guinea in 21 (4,5%) cases, a positive result was obtained. The level of antibodies to Vi- antigen above diagnostic was found in 6 (1,3%) sera. In 5 samples, the level of antibodies was 1:80, in one - 1: 160. Positive results in a screening study of the sera of labor migrants were obtained in 24 people. A confirmatory test revealed antibodies to the Vi antigen in the diagnostic titer in 9 sera. Positive results were obtained from 2 (3,64%) citizens of Tajikistan and 7 (4,09%) citizens of Uzbekistan. Antibodies to the S. Typhi Vi antigen were not found in residents of St. Petersburg (citizens of the Russian Federation). A comparable level of possible chronic carriage of typhoid fever was revealed for residents of epidemiologically unfavorable territories (Africa) and labor migrants coming to our country from Central Asia. The chances of the emergence of sources of infection in our country are increasing due to the increase in international contacts, which requires additional preventive measures.
Bulletin of the Russian Military Medical Academy. 2020;22(1):91-94
91-94
Program extracorporeal photophoresis in complex treatment of psoriatic arthritis
摘要
The results of complex treatment with the programmed procedures of extracorporeal photopheresis and methotrexate in patients with psoriatic arthritis for 12 months are presented. It has been established that program extracorporeal photopheresis in combination with basic therapy with methotrexate in patients with psoriatic arthritis have a significant effect on the relief of articular syndrome (reduction of morning stiffness, pain intensity, joint swelling). It was revealed that the inclusion of programmed extracorporeal photopheresis and methotrexate in the complex treatment of psoriatic arthritis reduces the level of circulating low molecular weight, medium molecular weight and high molecular weight immune complexes and in most cases leads to clinical and immunological remission. This is confirmed by a decrease in complaints of the severity of articular syndrome and a decrease in the clinical and laboratory activity of the disease (a significant decrease in the level of C-reactive protein, erythrocyte sedimentation rate). A scheme has been developed for the programmed use of extracorporeal photopheresis procedures in the complex treatment of psoriatic arthritis, which consists of 2 procedures every other day with an interval of 2,5-3 months for 12 months. Combined therapy with the programmed application of extracorporeal photopheresis procedures and methotrexate prolongs the period of disease remission and can be recommended for patients with psoriatic arthritis with high activity, insufficient effect of basic therapy and intolerance to higher doses of immunosuppressive drugs.
Bulletin of the Russian Military Medical Academy. 2020;22(1):95-99
95-99
Diagnosis of hepatic steatosis in non-alcoholic fatty liver disease in the military
摘要
The diagnostic possibilities of non-invasive methods for assessing liver steatosis in patients suffering from non- alcoholic fatty liver disease have been studied. It was found that in patients suffering from non-alcoholic fatty liver disease, the values of the controlled parameter of ultrasound attenuation were significantly higher than normal values and were significantly higher (p<0,001) than in the group of subjects without liver pathology (277 [270; 283] and 215 [205; 225] dB/m). Patients suffering from non-alcoholic fatty liver disease were most often diagnosed with steatosis of the second and third degree (33,5 and30,9%), less often with steatosis of the first degree and absence of steatosis (26,4 and 9,2%). In the group of subjects without liver pathology, steatosis was not detected in 63,7% of people, in 29,8% the first degree was detected, in 6,5% of patients-the second degree of steatosis. Fatty liver index in the group of persons suffering from non-alcoholic fatty liver disease was higher than normal values and significantly (p<0,01) exceeded the value of the group of subjects without liver disease (75,4 [72,2;78,5] and 27,4 [23,1; 31,7] units). Results above the threshold were observed in 76,2% of patients, while values of less than30 units, indicating the absence of the disease, were determined only in 3,5% of people. Hepatic steatosis index in the groupof patients with non-alcoholic fatty liver disease was higher than the threshold values and significantly (p<0,001) differedfrom the control group (39,3 [37,9; 40,6 and 25,8 [24,9; 26,8] units). At the same time, in the group of patients sufferingfrom non-alcoholic fatty liver disease, it was detected in 71,3% of people, while in the healthy group only 7,3% of people.The quality of the diagnostic model, a value of the controlled attenuation parameter of the ultrasound was regarded as verygood (area under curve receiver is 0,854±0,026 units, Youden index 0,603 units), the indices of fatty liver disease and hepaticsteatosis as excellent (area under curve receiver 0,941±0,016 and 0,919±0,0168 units, Youden index 0,783 and 0,708 units).
Bulletin of the Russian Military Medical Academy. 2020;22(1):100-104
100-104
The role of thematic expertise of medical care quality in improvement of results of its performance in cases of acute pancreatitis
摘要
The parameters of assessing the quality of medical care provided in 2014 to 416 patients with acute pancreatitis in 9 hospitals in St. Petersburg were expertly studied. All medical institutions were licensed in the format of providing services for the examination and treatment of patients suffering from acute surgical diseases of the abdominal organs. According to the results of the data analysis, a correlation was observed between the consequences of defects in the medical diagnostic process in medical organizations with insufficient regulation and activity in clinical expert work on the profile of “abdominal surgery”. The facts of overdiagnosis of cases of acute pancreatitis in mild variants of the severity of the disease have been established. Preservation of low operational activity indicators in the treatment of patients with acute pancreatitis without a tendency to use (when indicated) modern (primarily, endovideo surgical) technologies has been observed. It was noted that with a positive (in general) trend in the development of emergency pancreatology, in cases of assessing the particular results of the activities of specialists of specific surgical teams involved in providing medical care to patients with acute pancreatitis, compliance with systemic clinical and expert approaches with timely management decisions should be a priority in quality management of diagnostic and treatment measures. It is substantiated that the calculation of the volume of medical care for residents of a metropolis with acute pancreatitis should be based on the quality of the examination and treatment of patients with this disease on the basis of a thematic examination of assessing the conformity of the diagnostic process to the level of modern ideas about the theory of development and course of this disease.
Bulletin of the Russian Military Medical Academy. 2020;22(1):105-112
105-112
3D printing technologies in the treatment of patients with injuries and diseases of the forearm and hand
摘要
In the last decade, the range of applications of three-dimensional printing (3D printing) in surgery has been expanding. In traumatology, orthopedics and rehabilitation of injuries of the upper limbs, there is growing interest in creating splints and orthoses that can take into account the individual anatomical features of the human body. Traditional orthoses and splints are not always convenient and can lead to undesirable consequences such as pain, swelling, pressure, or even lack of therapeutic effect. The prospects of 3D printing technology in medicine from the beginning of its mass introduction, the features of modeling, manufacturing and application of means for immobilization of injuries and diseases of the upper extremities according to domestic and foreign publications over the past 5 years are considered. The data on the functionality of 3D-printed tire structures and orthoses used to immobilize the upper limb are analyzed in comparison with traditional methods of fixation. Three-dimensional images of patients with injuries obtained using computed tomography, magnetic resonance imaging or using a 3D scanner can be used to create virtual 3D models of the forearm, wrist, fingers of the patient, and 3D printing with these anatomical models allows you to create personalized tires and orthoses. Thanks to an individual approach and the use of various solutions, three-dimensional printing can be widely used in traumatology and orthopedics. As a result of this approach, it becomes possible to implement and effectively use a variety of solutions that will find support in healthcare.
Bulletin of the Russian Military Medical Academy. 2020;22(1):113-118
113-118
Theory of hibernament ensembles and the possibility of its use to ensure life activity for extremal impacts
摘要
The possibility of efficient use of the theory of hibernation ensembles to ensure vital activity in extreme conditions is considered. Hibernation ensembles are strictly selected sets of tools, among which are special combinations of pharmacological preparations and hypostabilizers, respiratory mixtures different in gas composition, controlled hypothermia, etc., which, when coordinated, cause the formation of a special state of the body, referred to as «hypobiosis and cryobiosis» or artificial hibernation. The data of experimental studies on changes in the body’s resistance to the extreme effects of gamma radiation, to acute hypobaric hypoxia and to flight overloads under conditions of artificially induced hibernation are generalized to determine the possibility of using the theory of hibernation ensembles while ensuring vital activity under extreme influences. It is shown that under the influence of vegetotropic agents against the background of hypothermia, the metabolic processes slow down significantly and the organism of warm-blooded animals begins to acquire ambient temperature. The condition that occurs in this case is accompanied by an increase in the body’s resistance to extreme factors, such as acute hypobaric hypoxia, deep hypothermia, exposure to ionizing radiation, toxic lesions, massive blood loss, pain shock, etc. This area of research is of particular relevance for the development of methods for long-term life support person in extreme conditions, with severe injuries and in the provision of medical care in conditions of mass admission victims, since it provides a reserve of time necessary for organizing the safe transportation of victims to the places of specialized and high-tech medical care, that is, actually providing medical care at a later date.
Bulletin of the Russian Military Medical Academy. 2020;22(1):119-123
119-123
Fabrication of human Wharton’s jelly extra cellular matrix for tissue engineering
摘要
The development of tissue engineering is based on the use of the extracellular matrix as a construct to which cells migrate and attach for proliferation, differentiation, and long-term functioning. The preparation of the matrix is one of the most important tasks, since it must be non-immunogenic, have optimal mechanical properties, contain cell adhesion molecules and growth factors and degrade at the predicted time. The search for biomaterial for the manufacture of the matrix is limited by a number of circumstances. Tissue-specific for the matrix intravital biomaterial is limited, cadaveric is not acceptable due to age-related changes or diseases that reduce the regenerative capacity of tissues; synthetic materials lack cell adhesion molecules or are not degraded. The umbilical cord is an accessible homologous biomaterial of non- embryonic origin, preserving the features of the embryonic phenotype. The optimal method of decellularization of the Warton jelly of the human umbilical cord in the manufacture of a full-component cell-free matrix is substantiated. Umbilical cord decellularization was carried out using a detergent method with a 0.05% sodium dodecyl sulfate solution for 24 hours. The quality of the decellularization was evaluated microscopically by staining with fluorescent dye and quantification of nucleic acids. The gentle method used to remove cells from the Warton jelly tissue meets the existing criteria for the effectiveness of decellularization, since only single cells and a small amount of deoxyribonucleic acid remain in the processed biomaterial. The technique does not provide centrifugation at high speeds, in which glycosaminoglycans and proteoglycans are lost from the matrix, the enzymatic action that destroys fibrillar collagen structures, and non-physiological conditions of decellularization. The therapeutic success of tissue-engineering structures based on the extracellular matrix will depend not only on the bioactivity of the umbilical cord, but also on the safety of the composition, structure and mechanical characteristics of the matrix. Due to the availability and non-invasiveness of receiving from healthy young donors, provisional organs are an excellent source of homologous biomaterial for matrix production.
Bulletin of the Russian Military Medical Academy. 2020;22(1):124-130
124-130
Experimental modeling of deforming osteoarthrosis of the knee in small rodents
摘要
The results of experimental work on modeling deforming osteoarthrosis of the knee joint in small rodents are presented. The pathogenetic basis of this process is a violation of the blood supply and the distribution of physiological load in the joint. Variants of rigid and non-rigid limb immobilization systems are proposed. The results of morphofunctional assessment are given, indicating a violation of the anatomical and histological structure of the metaphysis, pineal gland and metaepiphysis of the femur and tibia. The leading role in the development of deforming osteoarthritis of the knee belongs to the violation of the physiological distribution of the dynamic load on the joint, and the most vulnerable to the progression of this process are subchondral structures. Violation of regional blood circulation of the lower limb of the animal was achieved by crossing the femoral artery. Limb immobilization was carried out for 4 weeks. The results were evaluated by the severity of changes in the morphological structure of the operated joints and radiographic examination. The high mitotic activity of cellular elements, revealed as a result of histological examination in all groups of animals, indicates the rapid formation of vascular collaterals in rats. It was noted that with non-rigid immobilization of the joint with a plaster cast, the cartilaginous tissue of the articular surface becomes thinner, while the subchondral structures change slightly. With severe immobilization of the joint in the external fixation apparatus, significant changes are revealed precisely in the structure of subchondral structures. In animals subjected to a two-week rehabilitation period after dismantling the external fixation apparatus, a further progression of the pathological process was noted. Thus, with severe immobilization of the limb in the experiment, it was possible to obtain a stable joint deformation corresponding to the 3rd clinical and radiological stage of osteoarthritis.
Bulletin of the Russian Military Medical Academy. 2020;22(1):131-137
131-137
The study of biodegradation of thermo-polimerized collagen gels
摘要
The possibility of biodegradation of thermopolymerizable collagen gel (without cultured stem cells) in various concentrations is considered. In an experiment, an unpolymerized collagen gel was injected into the conjunctival cavity during preliminary blepharography. A polymerized collagen gel was obtained by incubating a thermopolymerizing collagen gel at37°C for 30 min until complete polymerization, then the gel was placed on the ocular surface and fixed by blepharography. Collagen gel biodegradation was evaluated at the 1st and 4th hours after surgery. Evaluation criteria: visually by the change in the volume of the plugged conjunctival cavity, leakage of fluid through the intershoot spaces, and also 12 hours after the operation according to the volume of collagen gel remaining in the conjunctival cavity (after removal of blepharoraphic sutures). It was revealed that biodegradation of thermally polarizable collagen gel is carried out by the mechanism of its dehydration regardless of the state of the implanted gel (unpolymerized/polymerized). The volume of the dehydrated collagen framework is directly proportional to its concentration. To increase the biodegradation time of a thermopolarizable collagen gel, it is advisable to develop a method for retaining fluid inside the collagen frame.
Bulletin of the Russian Military Medical Academy. 2020;22(1):138-141
138-141
Willingness to understanding and cooperation of people of other faiths and views with young men in various ethnic language groups
摘要
Аbstract. In our days, representatives of various cultural traditions and principles of living arrangements are forced to share one geographical space. This rapprochement, as shown by real behavioral experience, does not always proceed peacefully and calmly. Interethnic (intercultural) tension, up to and including open confrontation, ethnocentrism, xenophobia - all this testifies to serious problems in modern social relations. Tolerance indicators were studied in 129 practically healthy young men (average age 22,98±1,92 years) of various ethnic-speaking groups using the «Tolerance Index» questionnaire, which determines both the general attitude to the outside world and other people, and social attitudes in different areas of interaction where tolerance and intolerance of a person are manifested (ethnic tolerance, social tolerance, tolerance as a personality trait). The average level of general tolerance in all groups is shown, which reflects an adequate approach to the selection of candidates for training. The revealed significant differences in the indicator of general tolerance between some groups are due to psychological differences dictated by ethnocultural dissimilarity and an individual, depending on upbringing and education, sociological approach to emerging problems). Indicators of ethnic tolerance, social tolerance and tolerance as personality traits are also of an average nature, since all the individuals examined had approximately the same social status. The combination of a person with both tolerant and intolerant traits, manifesting themselves depending on social situations, must be taken into account during the educational process.
Bulletin of the Russian Military Medical Academy. 2020;22(1):142-145
142-145
About the prognosis of breast reconstruction quantity after mastectomy in cancer cases
摘要
The 5-year survival rates for women with breast cancer are steadily increasing. The number of cases of mastectomy for breast cancer is not reduced annually. In this regard, the analysis of epidemiological data on the observations of breast cancer in women in Russia seems to be an urgent activity in terms of predicting measures to optimize the volume of the recovery component of providing medical care to patients who have undergone mastectomy. It was established that in2017 in St. Petersburg the incidence rate of breast cancer reached 60,1100/. The parameter of the prevalence of malignant0000neoplasms of the mammary glands for the analyzed period exceeds the similar all-Russian by 19,3%. The frequency of casesof active detection of breast cancer in 2011-2018. increased 7,2 times. In the same period, the number of working-age urbanwomen diagnosed with breast cancer increased by 16,6%. The proportion of cases of verification of breast cancer of the I - IIstage of the tumor process in 2011-2018 increased by 1,2 times, reaching 72,2% in 2018. From 2011 to 2018, the growth of5-year survival of patients with breast cancer in St. Petersburg reached 4,9%, amounting to 63,4 in 2018% The parameterof annual mortality in breast cancer in 2011-2018 decreased by 30,6%. The performance indicators of the St. PetersburgOncology Service for the treatment of patients with breast cancer are comparable with similar parameters in Moscow clinicsand medical organizations in Russia as a whole. The increase in potential needs for prosthetics of the mammary glands dueto the increase in the number of patients with cancer who underwent mastectomy, in the future will necessitate the expansionof the high-tech types of medical care provided to patients suffering from malignant neoplasms of the mammary glands.
Bulletin of the Russian Military Medical Academy. 2020;22(1):146-151
146-151
Trends in implementation of good practices in pharmaceutical organizations
摘要
The level of knowledge and competencies of a graduate of a pharmaceutical university and specialist regarding the requirements of good pharmacy practice in pharmaceutical organizations of the Republic of North Ossetia-Alania is analyzed. A gap in the knowledge of graduates and specialists was identified and an author’s program for developing competencies for creating modern quality systems for pharmaceutical services and products was developed. The sample of the study was formed from the heads and pharmacists of retail pharmacy organizations of the Republic of North Ossetia-Alania of all forms of ownership, of which 38% were heads of a pharmaceutical organization, and the rest were pharmacists. Significant gaps and shortcomings of basic knowledge were identified among the management team, the main staff of pharmacists authorized for quality and implementation issues, as well as the creation of quality management systems in pharmaceutical organizations. Disadvantages associated with the lack of mechanisms for implementing the requirements of good pharmacy practice and the creation of a quality system in a pharmaceutical organization require action. So, it is necessary to develop modern educational modules that reflect the trends of modern transformations in the pharmaceutical industry. The low motivation of the staff of pharmaceutical organizations to improve their qualifications on the creation of quality systems was noted, due to the lack of basic knowledge among pharmacists and a sufficient amount of educational programs and modules. The author’s model of training specialists capable of creating modern quality systems in the pharmaceutical organization and the characteristics of the educational complex of the new discipline of choice are presented
Bulletin of the Russian Military Medical Academy. 2020;22(1):152-157
152-157
Problems of Organization of Radiation Diagnostics to Dispensary Cancer Patients
摘要
Currently, the Russian Federation pays unprecedented attention to the prevention, early diagnosis and treatment of cancer. In this regard, the identification of problems at the stage of dispensary observation of patients with cancer is extremely important, and their solution will ensure the proper level of quality and availability of medical care provided to them. A sociological survey of 1230 patients under dispensary supervision of oncologists of regional oncology offices in St. Petersburg was conducted. Identified limitations to the availability of radiation diagnostic techniques for cancer patients observed in the primary cancer office under dispensary observation: the waiting time needed for patients diagnostic tests often exceed the standard (8,9% during ultrasound examination, 25,8% - computed tomography, 28,8% - ultrasound, 34,6% - magnetic resonance imaging, in some cases, patients have to pay for designated health services, all of which is guaranteed free of charge (advice of a specialist - 36,7 per 100 respondents, laboratory diagnostic tests - 35,4 per 100 respondents). When conducting diagnostics using radiation methods, patients were most often forced to pay for ultrasound (43,3 per 100 respondents). The identified problems affected patient’s perception of medical care: only 79,5% were satisfied with the organization of dispensary observation in the primary oncology office. Direct dependence of the low level of patients satisfaction with the organization of follow-up in primary cancer study on long waiting diagnostic studies, inability to get directions for the study directly from the oncologist, restrictions in its timely implementation is free, the lack of explanation from the treating oncologist on an order and conditions of granting of medical aid (p=0,05; r=0,7-1).
Bulletin of the Russian Military Medical Academy. 2020;22(1):158-162
158-162
Activators hemorrhagic fevers and them epidemiology
摘要
The current epidemiological characteristics of pathogens of especially dangerous infections abroad and in the Russian Federation are given. The biology of the causative agents of hemorrhagic fevers, as well as their species and subspecies, is especially reflected. The biology and epidemiology of the most common causative agents of hemorrhagic fevers are described in more detail: Dengue, Ebola, Marburg, Lassa, Machupo (Bolivian), Hanin (Argentinean) fever, Rift Valley fever, Omsk, Congo-Crimean, and renal fever their intermediate hosts - mosquitoes and ticks, the options for getting these pathogens into the human body. The most severe and widespread human infections, caused by alpha viruses and flaviviruses, the most severe epidemics in various countries are characterized. The modern systematics and immunopathogenesis of the causative agents of these infections, the features of virological and immunological diagnostics using both classical and modern techniques are presented. The new pathogens of hemorrhagic fevers, which have been fatal in recent years, are described. Given the current tense situation associated with the causative agents of hemorrhagic fevers, measures are proposed that are aimed at preventing the entry of pathogens into the Russian Federation, as well as the algorithm of actions of employees of medical institutions when patients with suspected infection associated with causative agents of especially dangerous infections are admitted.
Bulletin of the Russian Military Medical Academy. 2020;22(1):163-172
163-172
Vesiculation red blood cells. Its role in donor erythrocytes components
摘要
The formation of microvesicles by blood cells: monocytes, platelets, granulocytes, erythrocytes and endothelial cells is the most important feature of intercellular interactions. Red blood cells form microvesicles to remove damaged cell components, such as oxidized hemoglobin and damaged membrane components, and thus extend their functioning. Two hypotheses have been put forward for the formation of microvesicles: programmed cell death (eryptosis) and clustering of the band 3 protein as a result of disruption of intercellular interactions. In the process of eryptosis, damage to hemoglobin and a change in the pathways of phosphorylation of membrane proteins, primarily protein of strip 3, weaken the strong bonds between the lipid bilayer and the cytoskeleton, which is accompanied by the transformation of the membrane, the formation of protrusions and their transformation into microvesicles. It was found that the formation of microvesicles by red blood cells is impaired in patients suffering from various pathologies of red blood cells: sickle cell anemia, glucose-6-dehydrogenase deficiency, spherocytosis, and malaria. Studies of the last decade show that a violation of the interaction between the membrane and the cytoskeleton is probably the main mechanism, since it is confirmed by data obtained in the study of structural changes in red blood cells of donor hemocomponents stored in a blood bank. Currently, studies on the effect of microvesicles on the safety of erythrocyte-containing blood components have become widespread. A discussion was resumed on the relationship between the number of accumulated microvesicles in blood components and the effectiveness of donor components for patients during transfusion, depending on the shelf life of the components. Detailed data on proteomic, lipidomic and immunogenic comparisons of microvesicles obtained from various sources are convincing in the identification of trigger stimuli causing the generation of microvesicles. Elucidation of the contribution of microvesicles obtained from red blood cells to inflammation, thrombosis, and autoimmune reactions confirms the need to further study the mechanisms and consequences of the generation of microvesicles by red blood cells of donor components used for transfusion medicine.
Bulletin of the Russian Military Medical Academy. 2020;22(1):173-179
173-179
Clinical aspects of providing specialized care to people burned after the disaster in Bashkiria in 1989
摘要
The contents of the organization of specialized medical care for those burned after a railway accident in Bashkiria in 1989 are investigated. Features of the evacuation and sorting of victims into various burn centers of the Union of Soviet Socialist Republics are described. The data on sorting and evacuation to various regions of the country are given. The materials on the statistics and structure of those who were burned from Bashkiria to medical institutions of federal significance are summarized. Information was collected from various primary sources on the number and structure of patients delivered to the burn clinics of the country. Information was obtained on the treatment methods applied to injured by medical teams of hospitals. The role of the decision of the leadership of the Ministry of Health in organizing the dispersal of a large number of burned, concentrated in Bashkiria, to the regional and federal medical centers of the country is emphasized. Information is given on the participation of both individual specialists, teams, and foreign states in assisting victims of the railway accident in Bashkiria. The significance of the accumulated scientific and practical experience is summarized in several scientific and practical conferences. So, they highlighted the issues of providing victims with medical care at the stages of evacuation, the provision of specialized medical care and rehabilitation at the hospital stage. They indicated that it is necessary to follow the provisions of the military medical doctrine and organize medical care on the principles of staged treatment.
Bulletin of the Russian Military Medical Academy. 2020;22(1):180-184
180-184
Respiratory tuberculosis associated with chronic obstructive lung disease - actual problem of modern phthisiology
摘要
In modern conditions, the problems of tuberculosis of the respiratory system and chronic obstructive pulmonary disease are highly relevant. Tuberculosis remains high among the population. During its course, the frequency of common destructive forms, the number of patients with multiple and extensive drug resistance of mycobacteria, and comorbid conditions in which pulmonary tuberculosis is combined with immunodeficiency and respiratory pathology increased. Chronic tobacco intoxication and chronic obstruction in the lungs increase the activity of tuberculosis inflammation, contribute to the development of common forms of pulmonary tuberculosis, accompanied by abundant bacterial excretion and destruction of lung tissue. In patients with comorbid pathology, pronounced clinical manifestations of the disease, deep functional disorders in the respiratory system and homeostatic balance of the organism are determined. Chronic tobacco intoxication and chronic obstruction in the bronchi have a significant impact on the processes of atherogenesis, systemic inflammation, endothelial dysfunction and the formation of cardiovascular pathology. These phenomena contribute to insufficient treatment efficiency, the formation of pronounced residual changes in the respiratory organs, a decrease in the quality and life expectancy of patients, a high frequency of exacerbation (relapse) and pose a threat to the spread of tuberculosis. In patients with comorbid pathology, cardiovascular complications, dyslipidemia and atherogenesis appear much more often, which are predictors of early disability and premature death.
Bulletin of the Russian Military Medical Academy. 2020;22(1):185-190
185-190
Senile eye cataract: medical and social aspects and the risk to public health
摘要
A review of literature data on issues related to the prevalence of cataract among the population and the possibilities of its treatment is provided. In 2010, there were more than 10,8 million people worldwide who completely lost their vision due to cataracts, and partially lost more than 35,1 million people. Currently, the growth rate of senile cataract is two times faster than the growth rate of the total population, and in industrialized countries - five times. The problem of the wide spread and severity of injury in cataracts, along with the medical one, also has a medical and social character, which is why worldwide attention is paid to the study of etiopathogenesis and treatment options for cataracts among people of working age. To date, cataract treatment involves only surgical removal of a clouded lens with implantation of an intraocular lens. More than 20 million such operations are carried out annually in the world. With the development of medical science and technological progress, new, more advanced surgical techniques are being developed, such as ultrasound and femtolaser phacoemulsification, which allow performing operations in the early stages of the disease and achieving better results in terms of visual acuity, avoiding the development of induced astigmatism, and reducing the likelihood of complications, including macular edema. However, despite the improvement of surgical techniques for cataract phacoemulsification, cases of postoperative complications are not uncommon. Thus, despite the study of the etiopathogenesis of cataracts and the development of advanced modern methods for its surgical treatment, the risk of complications remains. At the same time, the problem of preventing the development of macular postoperative edema is one of the main reasons for the decrease in visual acuity in operated patients. To reduce intraoperative complications, it is necessary to take into account risk factors, their combination, as well as improve the methods of their drug prophylaxis and treatment.
Bulletin of the Russian Military Medical Academy. 2020;22(1):191-195
191-195
Myocardial reperfusion syndrome. Pathogenesis, clinic, diagnosis
摘要
The basics of pathogenesis, clinic and diagnosis of myocardial reperfusion syndrome are considered. Myocardial reperfusion syndrome is defined. Its relevance as one of the most poorly studied and formidable complications of cardiac reperfusion in myocardial infarction with elevation of the S-T segment has been explained. A brief review of the historical review of this problem and such types of manifestations of myocardial reperfusion syndrome as: diastolic myocardial dysfunction, post-reperfusion disturbances of the heart rhythm, the phenomenon of no-reflow and irreversible damage to the myocardium are briefly reviewed. The modern views on the pathological physiology of diastolic myocardial dysfunction, post-reperfusion damage to the myocardium, and the no-reflow phenomenon are analyzed. A review of current views on the pathological physiology of the development of post-reperfusion disturbances in heart rhythm is carried out. The clinical picture and the effect on the hemodynamics of such a manifestation of myocardial reperfusion syndrome as diastolic myocardial dysfunction are described. A brief description of the clinical picture of irreversible post-reperfusion damage to the myocardium is given. The clinical picture and types of post-reperfusion rhythm disturbances are described. The diagnostics of the no-reflow phenomenon has been analyzed in detail, the coronary angiographic scales for assessing thrombolysis in myocardial infarction and for assessing myocardial perfusion are graphically shown. A description of the basics of diagnosing post-reperfusion disturbances in heart rhythm, diastolic myocardial dysfunction, and post-reperfusion irreversible damage to the myocardium is given. A brief description of the known in the world literature predictors of the development of myocardial reperfusion syndrome is presented.
Bulletin of the Russian Military Medical Academy. 2020;22(1):196-200
196-200
Atypical rolandic epilepsy spectrum and related conditions
摘要
In the last decade, a sufficient amount of data has accumulated that testifies to the ambiguity of the assertion about the «benignity» of benign childhood epilepsy with centro-temporal commissures («Rolandic»). More and more researchers are providing evidence of cognitive impairment associated with age-dependent epilepsy. A literature review is given on this problem, the main trends and main criteria the diagnosis of typical and atypical age-dependent epilepsy with centro-temporal commissures on the electroencephalogram are considered. It has been established that the main criteria for the atypical nature of age-dependent epilepsy include such signs as the intermittent focus of slow waves, multiple asynchronous peak waves, long peak wave clusters, generalized 3 Hz «absance-like» runs, the relationship of interictal paroxysms with negative or positive myoclonus, and abundance interictal finds during wakefulness and sleep. A continuum of conditions associated with the condition under consideration is highlighted, which includes a number of conditions from relatively favorable to severe and disabling. We have singled out the term «atypical rolandic epilepsy», which has already taken shape in the world literature and includes such signs of atypicality as: early debut of seizures (up to 4 years), the presence of daytime seizures, duration of seizures (more than 30 minutes), with a tendency to form status, changes in neuroimaging studies (both morphological - computed and magnetic resonance imaging - and functional - positron emission tomography), impaired cognitive and / or behavioral sphere (including Indra attention deficit hyperactivity disorder), disorders of motor development as well as the mental and speech development, atypical manifestations in the electroencephalogram (unusual localization rolandic spikes, their generalization, the presence of «3Hz absansopodobnyh runs»).
Bulletin of the Russian Military Medical Academy. 2020;22(1):201-209
201-209
Experience with information and communication technology in mastering medical knowledge based on intelligence cards
摘要
We consider the information and communication technology of conducting classes using intelligence cards that meets the requirements of the modern subject-subject paradigm of education, which obliges one to be guided by the principle of communication. This principle implies significant changes in the organization of the process of interaction between the teacher and students in the classroom. The following parameters characterize such a technology for conducting a lesson: speech-cognitive activity, functionality, heuristic, motivated actions, the search for personal meaning in the work of students in the lesson. To implement these parameters in the educational process at A.F. Mozhaysky Military Space Academy. and S. M. Kirov Military Medical Academy used the capabilities of intelligence cards as a tool for information and communication technology. The innovation of the latter lies in the fact that the educational process is based on the active work of students both during the lesson and during the organization of their independent work, allowing them to effectively absorb educational information and subsequently apply it in practical activities. The study reflects the experience and describes an effective educational methodology using intelligence cards for lectures, practical classes, independent work of students and their research work. As an illustrative example, one of the developed intelligence cards is given and the methodological support of the lesson on the study of measures aimed at maintaining and strengthening the health of military personnel is described.
Bulletin of the Russian Military Medical Academy. 2020;22(1):210-214
210-214
The Department of organization and tactics of medical service. Past, present, future
摘要
The Department of organization and tactics of medical service, celebrating its 90th anniversary, is a leading department of our alma mater, as well as a leading academic and scientific centre of the Chief Military Medical Directorate of the Russian Federation Ministry of Defence. The department develops applied research tasks in the sphere of organization of medical service and provision of medical services to the Armed Forces of the Russian Federation in peacetime and wartime, engages in preparation of directive documents within its profile, analyses efficiency of medical services provided to the armed troops (forces) in daily activities of the medical service and in combat conditions. The department has always taken an active part in the development, preparation and conduct of research command-post and special tactical exercises in conjunction with the medical service of the Russian Federation Armed Forces, as well as in different stages, including the international stage, of the Military Medical Relay Competition jointly with the medical staff of military districts (fleets), branches and services of the Russian Federation Armed Forces. The department is engaged in serious work aimed at training qualified specialists for the overhead structures of the medical service of the Russian Federation Armed Forces, as well as military medics for the army. Over the 90 years of its existence, the department has developed into five new departments: department of military disciplines (operational- tactical training), department of organization and tactics of naval medical service (with a course of naval fighting equipment), department of medical service control automation with a course in military medical statistics, department of military medical supply and pharmacy, department of organization and economics of military healthcare. Among the significant achievements of the Department of organization and tactics of medical service is the development of a number of department-level training courses and academic disciplines some of which have turned (are turning) into independent departments, educational research schools.
Bulletin of the Russian Military Medical Academy. 2020;22(1):215-219
215-219
Mikhail Kuzmich Geykin and his contribution to development of scientific and applied questions of maxillofacial surgery and stomatology (to the 120 anniversary since birth)
摘要
Materials on the history of military medicine are presented, maxillofacial surgery and dentistry in connection with the 120th birthday of a prominent maxillofacial surgeon and dentist, one of the patriarchs of Russian dentistry, a World War II veteran, doctor of medical sciences, assistant professor, colonel of the medical service Mikhail Kuzmich Geikin, who was at the forefront of Russian dentistry and was among the first to create Russian military dentistry and maxillofacial surgery. The data on the formation of M.K. Geikin as a military doctor, dentist and maxillofacial surgeon, his military career during the Soviet-Finnish and World War II. Turning to life, professional and social activities M.K. Geikin, you can find not only interesting scientific facts from the history of military medicine, dentistry and maxillofacial surgery, but also analogies with the present, answers to many clinical problems of the specialty and medicine of today. The main directions of his scientific activity, which touched on the issues of almost all sections of dentistry and maxillofacial surgery, are noted. Being the first adjunct of the Department of Odontology of the S.M. Kirov Military Medical Academy, a major research scientist, he contributed to the development of the first Russian theory of dental caries and the pathogenesis of periodontal diseases, one of the first to study the aviation aspects of military dentistry, and to develop new methods for temporary and therapeutic immobilization of jaw fragments in injuries and injuries of the maxillofacial region. He created a technique for intravital capillaroscopy and capillarography, did a lot for use in dentistry auriculodiagnostics and acupuncture, proposed a device for searching for biologically active points on the human body - tobiskop Geikina. M.K. Geykin did not create his own scientific school, but being one of the founders of Russian dentistry in Russia, including military dentistry and maxillofacial surgery, he should rightfully be recognized as one of the patriarchs of military medicine, dentistry and maxillofacial surgery.
Bulletin of the Russian Military Medical Academy. 2020;22(1):220-223
220-223
Anton Wolfler - forgotten genius of surgery
摘要
Nowadays, when surgery as a science was so rapidly developed, the names of many scientists who stood at its origins are forgotten or rarely mentioned, and their contribution remains underestimated. One of them is the innovator of surgery of the XIX century. Czech scientist Anton Welfler, whose bold ideas have spread far beyond the boundaries of abdominal surgery. Unfortunately, for many he is known only as the author of the methodology for the formation of gastroenteroanastomosis and as a student of Theodore Billroth. However, in reality, A. Welfler made an incomparably greater contribution not only to gastric surgery, but also to herniology, thyroid surgery. The result of his study of embryogenesis, the histological structure of the thyroid gland, his own clinical experience gained two monographs, subsequently recognized as fundamental in this section of surgery. He developed a histological classification of thyroid cancer, for the first time described both solid and cystic forms of papillary cancer. He also suggested the possible mechanisms of carcinogenesis. Together with Theodore Billroth A. Welfler introduced the technique of total thyroidectomy into clinical practice. Widely used in modern surgical practice, gastroenteroanastomosis with the loop of the small intestine turned off and the U-shaped inter-intestinal anastomosis, named after Caesar Roux, was in fact, developed by A. Welfler in the experiment. Caesar Roux himself noted A. Welfler’s priority in the invention of this design. In 1897, Caesar Roux modified the method of A. Welfler, forming a posterior-free version of this operation.
Bulletin of the Russian Military Medical Academy. 2020;22(1):224-227
224-227
The scientific legacy and reflections on the surgery of the prominent French Clinician Professor Rene Lerishe (to the 140th anniversary of his birth)
摘要
The scientific work of the outstanding French surgeon Rene Leriche is analyzed. Little-known facts from his life are noted. Lerish has published more than 1,200 scientific papers, including 21 monographs. Most of his works are devoted to problems of general and private clinical physiology and served as the basis for the establishment and development of the physiological direction in surgery. He investigated the problem of pain, in particular pain syndrome resulting from injuries; studied the possibilities of using surgical techniques for pathogenetic treatment. He was one of the first to propose the use of surgical interventions on the autonomic nervous system for the treatment of mainly peripheral vascular diseases. R. Lerish believed that the disease is not a distortion of normal, but the emergence of new physiological relationships. R. Lerish developed a technique for blockades and surgical interventions in the sympathetic department of the autonomic nervous system, including periarterial sympathectomy. He described the clinic in detail and proposed a method for surgical treatment of chronic occlusion of the terminal abdominal aorta (Lerish syndrome). R. Lerish attached great importance to the individual characteristics of a healthy person and indicated that doctors know little about a person during his illness. He was also worried by the fact that doctors know little why the disease takes one form or another, why the infection is virulent in one and benign in the other, while the contagiousness is the same. Lerish put forward in medicine the concept of individual pathology. He pointed out that the form of the disease depends on the organic personality of the person and does not depend on the type of infection. Referring to his impressions, Lerish said that he tried to search on this path, but found nothing but banality. For his work on the treatment of infected wounds, R. Lerish was awarded the Lister Medal (1939). He was the founder and first president of the European Society of Cardiovascular Surgeons; He was an honorary doctor of 30 foreign universities, an honorary member of several foreign academies and societies, including the All-Union Society of Surgeons of the Union of Soviet Socialist Republics.
Bulletin of the Russian Military Medical Academy. 2020;22(1):228-233
228-233
Theodor Bil’roth - gastric surgery founder
摘要
More than a century has passed since the death of the great German surgeon Christian Albert Theodor Billroth. Despite such an impressive time, he is still widely known in the surgical community as the founder of gastric surgery, whose results of many years of work have largely influenced the development of abdominal surgery in the XIX-XX centuries. This person combined the features of a talented surgeon, teacher and organizer in equal measure. Thanks to strict adherence to aseptic rules, Theodor Billroth was the first to begin surgical interventions in anatomical areas, previously considered«forbidden» due to the high frequency of purulent-septic complications. Over the seven years he spent as head of the Zurich surgical clinic, the Billroth contributed to its significant expansion and modernization. He first introduced into the clinical practice statistics of surgical interventions and their results, thereby taking another step from the surgical craft to art and science. Being a versatile person, one of the brightest personality traits of Theodore Billroth was artistry, which was equally manifested both at the operating table and at the piano keyboard, because he, among other things, was a gifted pianist and violinist. In his life and work, he did not oppose science and art. As a scientist-innovator, professor Billroth was the first to perform successful interventions on organs previously considered to be inaccessible to operative effects, thus opening a fundamentally new page in the history of abdominal surgery.
Bulletin of the Russian Military Medical Academy. 2020;22(1):234-237
234-237
Contribution of the staff of the Military medical academy to the development of peripheral nerve surgery
摘要
The formation of the neurosurgical service in our country, as well as the development of peripheral nerve surgery, is inextricably linked with prominent figures - employees of the S. M. Kirov Military Medical Academy: L.M. Puseppa, V.N. Shamova, V.I. Grebenyuk, B.A. Samotokina, A.N. Solomina, E.I. Usanova, E.D. Alekseeva, F.S. Govenko, B.V. Martynova, A.E Belousova, etc. Already from the beginning of the 20th century, Ludwig Martynovich Pusepp has been actively engaged in the diagnosis and surgical treatment of peripheral nerve damage at the Imperial Military Medical Academy. In the second half of the XX century. peripheral nerve surgery undergoes an important stage: the transition to microsurgery. This stage is marked by the rapid development and implementation of microsurgical techniques in the treatment of patients suffering from traumatic lesions of limbs and nerves. The Academy is actively developing revascularization and reinnervation techniques for injuries to the limbs. Based on the analysis of the data of the Great Patriotic War and the war in Afghanistan, the Academy staff published works on the organization of medical care and surgical treatment of combat injuries of peripheral nerves. Thanks to the active scientific and practical work of A.E. Belousova, N.G. Gubochkina, E.D. Alekseeva, F.S. Govenko, B.V. Martynova at the beginning of the XXI century. Clinic of Neurosurgery of the S. M. Kirov Military Medical Academy becomes a leading institution in Russia, where they provide assistance to patients suffering from injuries and diseases of the peripheral nervous system.
Bulletin of the Russian Military Medical Academy. 2020;22(1):238-241
238-241
Thoughts of N.I. Pirogov «About desirable transformations of the Medico-Surgical Academy»
摘要
The great doctor, anatomist, surgeon, teacher, professor Nikolai Ivanovich Pirogov (1810-1881) glorified not only Russian medicine, but also Russia as a whole. The vast majority of scientific results were achieved by him during his work at the Imperial Medical and Surgical Academy from December 1840 to July 1856. His discoveries and achievements relate primarily to anatomy and its topographic direction, surgery and its military field, the military medical «administration» - the organization of medical support for the army. Contemporaries N.I. Pirogov was noted for his high pedagogical abilities. 21 years after the death of N.I. Pirogov, his wife transferred part of the archive to Novorossiysk (now Odessa) University. Among the works was an article written in pencil, «On the desirable transformations of the Medical and Surgical Academy». Professor of Anatomy of the University N.A. Batuev published an article in the Russky Doktor newspaper in 1902, in which the idea that military doctors are educated in universities in European countries on the basis of medical faculties, which should be administratively independent of university leadership, was a common thread. Nikolai Ivanovich proposed at the initial stage of training to guide students through the general faculty of natural sciences. Further, his proposal was that the medical faculty should be divided into two departments: the first - for the training of civilian doctors, and the second - for those wishing to enlist in the military. Commonwealth with the University of N.I. Pirogov was seen as an opportunity to deepen and expand the knowledge acquired by students, especially natural sciences, in the initial period of study.
Bulletin of the Russian Military Medical Academy. 2020;22(1):242-245
242-245
Pofessor B.S. Uvarov - a patriot and defender of the Fatherland, founder of domestic military anesthesiology and resuscitation (to the 100th anniversary of the birth and to the 75th anniversary of Victory in the Great Patriotic War)
摘要
The main stages of the life and work of a military surgeon and anesthesiologist, Professor Boris Stepanovich Uvarov are presented. Professor B.S. Uvarov made an invaluable contribution to the formation and development of domestic military anesthesiology and resuscitation. After working for 12 years with his teacher, academician of the Academy of Medical Sciences of the Union of Soviet Socialist Republics P.A. Kupriyanov, on whose initiative the first department of anesthesiology in our country was created, becoming his successor, B.S. Uvarov made every effort to establish domestic military anesthesiology and resuscitation. For 23 years he was the head of the department of anesthesiology and intensive care at the S.M. Kirov Military Medical Academy, non-staff assistant to the chief surgeon (1964-1968) and deputy chief surgeon for anesthesiology and intensive care (1976-1986) of the Ministry of Defense of the Union of Soviet Socialist Republics. As a dissertation, scientific adviser or consultant, B.S. Uvarov completed 24 candidate and 7 doctoral dissertations in three main areas: 1) express diagnostics and monitoring of the condition of a patient in critical condition; 2) improving anesthetic and resuscitation care; and 3) organizing anesthetic and resuscitation care in the Armed Forces. He realized the problem of organizing anesthetic care in the light of the demands of military medicine. The implementation proposed by B.S. Uvarov, systems of anesthesiological and resuscitation care in the Armed Forces in peacetime, is reflected in the textbook «Anesthesiology and Resuscitation» (1979) and other published materials. Boris Stepanovich took an active part in the public life of the country, showing remarkable human qualities. Confirmation of the merits of B.S. Uvarov to his 100th birthday is the assignment to the B.S. Uvarov Department of Military Anesthesiology and Intensive Care of the S.M. Kirov Military Medical Academy.
Bulletin of the Russian Military Medical Academy. 2020;22(1):246-254
246-254
Discovery of intravenous anesthesia ON THE 110TH ANNIVERSARY OF THE FIRST INTRAVENOUS HEDONAL ANESTHESIA)
摘要
After the discovery of ether anesthesia, its shortcomings quickly revealed: it was impossible to maintain anesthesia when a surgeon worked on the head or neck, these operations were impossible or very difficult to carry out under ether anesthesia. The suffocating feeling after inhaling the first portions of the ether pushed patients away from repeated operations under ether anesthesia. The use of chloroform instead of ether revealed its small therapeutic breadth, several deaths occurred in different countries from chloroform in people with heart disease. Attempts to use chloroform and ether intravenously revealed the thrombogenic effect of these drugs, experimental animals and even patients died from pulmonary embolism. The first safe drug for intravenous anesthesia, hedonal, was invented in Strasbourg in 1889 under the direction of Oswald Schmiedeberg. The drug entered the physiological laboratories of many countries, including Russia, and the laboratory of Professor N.P. Kravkova, Head of the Department of Pharmacology, Military Medical Academy. The drug had a strong hypnotic effect and was an ideal tool for vivisection. Given this, an assumption was made about the possibility of using hedonal in humans. This idea was supported by Professor S.P. Fedorov, Head of the Department of Hospital Surgery, Military Medical Academy. A comprehensive study of the hedonal was carried out during the years 1908-1909 by the intern of the hospital surgery clinic Alexander Porfirevich Jeremic. On December 7, 1909, the first ever operation was performed under intravenous hedonal anesthesia, which was called «Russian anesthesia» abroad.
Bulletin of the Russian Military Medical Academy. 2020;22(1):255-258
255-258
Peter the Great is the founder of the military medical education in Saint Petersburg
摘要
The study is dedicated to the founding date of medical (medical and surgical) schools at the General hospitals of St. Petersburg, which are the historical foundation of the Medical and Surgical (Military Medical) Academy. Archival documents from the funds of the Russian State Archive of the Navy, as well as published sources prove and confirm that Peter the Great is the founder of medical (medical and surgical) schools at the General hospitals of St. Petersburg. According to the ingenious converter of Russia, the establishment of medical schools in the military and naval capital of the Russian Empire was part of state reform plans, it was extremely necessary and mandatory for the development of domestic medicine. A historical review of Russian military legislation of the era of Peter the Great is presented, where issues of medicine are touched. Particular attention is paid to archival documents. The reports (programs) of the first archivist and president of the Medical Chancellery and the entire medical service of Russia, Robert Erskine, and his successor, archivist Ivan Lavrentievich Blumentrost, to the president of the Admiralty Board, General Admiral Count F.M., were examined and analyzed in detail. Apraksin on bringing the medical unit in the fleet in proper condition. In the report I.L. Blumentrosta dated December 3, 1719 explicitly said about the already established medical school at the Admiralty Hospital of St. Petersburg and about the conduct of training sessions in it. The submitted documents developed a plan for the organization of marine hospitals, calculated the staff of medical personnel in the hospital and navy, reflected the plan for training medical students and preparing doctors, proposed solutions to other issues of organizing a medical service. The «Regulations on hospitals and on the positions of commissioners, doctors, clerks and others identified by them» of 1722, compiled on the basis of the programs of R. Erskine and I. L. Blumentrosta. This Regulation was the Russian hospital charter until the approval of the new law - the «General Regulation on Hospitals» (1735), which included 40 paragraphs of the Regulation 1722.
Bulletin of the Russian Military Medical Academy. 2020;22(1):259-267
259-267
At the origins of the organization of trauma care to the population of the Soviet Union
摘要
Traumatological assistance to the population of the Soviet Union is analyzed. It is shown that Soviet doctors, using the experience of field surgery of the First World War, in the post-war period sought to improve the entire system of organizing trauma care for the population. Traumatological assistance in industry and agriculture became generally accessible and gradually assumed an organized, harmonious character. Non-governmental organizations were involved in the fight against injuries - labor protection, social insurance, trade unions and police. First aid points were opened at factories, and trauma centers were set up at polyclinics and outpatient hospitals. A lot of health education was ongoing to prevent injuries and provide first aid. At the end of 1939, at the plenum of the Scientific Medical Council of the People’s Commissariat of Health of the Russian Soviet Federative Socialist Republic, significant successes were noted in organizing trauma care and treating victims. At the first All-Russian meeting on combating injuries and its consequences in 1947, it was established that occupational injuries tend to decrease, despite the difficult post-war situation. The organization and treatment of trauma patients was developed not only in special institutions, but also in individual surgical clinics, in large hospitals, where special trauma departments were also created. Particular attention was paid to childhood injuries. In this case, the methodological guidance of the fight against injuries in children was entrusted to the Leningrad Children’s Orthopedic Institute. G.I. Turner with the involvement of representatives from other cities - Moscow, Sverdlovsk, Lviv, Kazan, Gorky, etc. It is shown that the teaching of traumatology as an integral part of surgery must be included in the programs of higher medical schools. The absolute need for institutes for the improvement of doctors is noted, the allocation of this discipline as an independent.
Bulletin of the Russian Military Medical Academy. 2020;22(1):268-272
268-272
Centenary on the protection of the health of military communication workers
摘要
The main historical dates of formation and formation of the system of preservation and improvement of health of military personnel from among students (cadets and listeners) and permanent staff (faculty and supporting) of the Military Telecommunications Academy named after the Soviet Union Marshal Budienny S. M. for 100 years are presented. The place and role of the medical service of the Military Telecommunications Academy in the training of military liaison officers are covered. A historical report on the formation of a system of training of military specialists and their health protection is presented. The medical service of the Military Telecommunications Academy, as a structural unit, began operations in 1932. During the ninety-year period of work, the medical service of the Military Telecommunications Academy has gone through a difficult and long path of its formation and development. It was served and employed by various specialists who left significant contributions to the maintenance and preservation of the health of all categories of students and faculty. Today’s days of medical service of the Military Telecommunications Academy are the prevention of the most significant diseases for military personnel, in particular respiratory organs and cardiovascular system. The management of the Academy constantly interacts with the S.M. Kirov Military Medical Academy, 442 Military clinical hospital of the Ministry of Defense of the Russian Federation, as well as in its branches and structural subdivisions. The level of morbidity, hospitalization and labour loss of military personnel of the Military Telecommunications Academy remains quite low. This is facilitated by the good equipment of the functional offices of the medical clinic and the polyclinic of the Academy, where surgical (outpatient), therapeutic, gynaecological and dental care is provided to various contingents of persons entitled by law to receive free medical care.
Bulletin of the Russian Military Medical Academy. 2020;22(1):273-276
273-276
Professor Nikolay Andreevich Brazhenko (to the 80th anniversaru)
Bulletin of the Russian Military Medical Academy. 2020;22(1):277-278
277-278
Pravila dlya avtorov
Bulletin of the Russian Military Medical Academy. 2020;22(1):279-280
279-280