Little is known about the Russian military medicine in the first years of Soviet power. Intention. To present littleknown events in the process of formation, improvement and activity of military medical structures in the Red Guard created by the Bolsheviks, and then its successor – the Red Army – for the period from October 1917 to April 1918. Methods andResults. The authors give generalized information on the military and political situation, the process which the Bolsheviks folloed to set up bodies of power, armed formations, the Collegium of the Main Military Sanitary Directorate, the Council of Medical Colleges, the medical support system for their combat activities with the participation of the sanitary detachments of the Proletarian Red Cross and regular military medical units. A special section describes problems with medical personnel and the positive role of the Military Medical Academy in their solution. Conclusion. At the beginning of the Civil War, the medical service largely relied on the experience of the First World War, which military experts from the former army who volunteered to serve in the Red Army brought with them. Unfortunately, in the military medical management there was a lack of unity of command and the parallelism of collegial principles.

Relevance. It is known that diffuse liver diseases can be associated with increased ammonia levels in blood serum, that have toxic effects on the central nervous system. Intention. To establish the clinical importance of hyperammonemia in chronic non-alcoholic steatohepatitis in the liquidators of Chernobyl nuclear power (CNPP) plant accident aftermath. Methods. In 65 Chernobyl accident liquidators, liver fibrosis, plasma ammonia levels were also assessed via enzyme method in addition to general clinical examination, including microbiota disorders. Results and Discussion. Hyperammonemia was detected in 46 % of liquidators with chronic nonalcoholic steatohepatitis, with greater severity of clinical manifestations of asthenic-vegetative and dyspeptic syndromes, liver fibrosis and disorders of intestinal microbiota and intrahepatic hemodynamics, including noncyrrotic portal hypertension. In previous studies, the role of hyperammonemia was mainly studied at the stage of the formed cirrhosis of the liver accompanied by the hepatic encephalopathy. Conclusion. It is necessary to determine the level of ammonia in the blood plasma in all liquidators of CNPP accident aftermath suffering from chronic non-alcoholic steatohepatitis.

Relevance. In recent years, volumes of emergency care markedly decreased (from 47,5 million in 2010 to 45,4 million responses of emergency teams in 2016). One of the related problems – staff shortage in a system of emergency medical services.Intention. To assess personnel capacity of a system of emergency medical services, identify problems and search their solutions.Methodology. Federal statistical data (Form No 30 “Data on the medical organization”) for 2010–2016 were analyzed. Results and Discussion. The staff shortage was revealed (30 % in 2016), the number of doctors decreased by 20.2 %, structure and profiles of emergency teams changed, particularly 72.1 % of physicianled teams were replaced by doctor’s assistants. Concurrently, inpatient emergency systems developed. Conclusion. Overcoming the staff shortage is the priority task to maintain efficient emergency medical services. Special measures to improve the personnel policy have been developed.

 

 

Relevance. In the Arkhangelsk region, there is M-8 “Kholmogory” federal highway with typical for northern roads features, which contribute to numerous road traffic accidents (RTA) with medical consequences and, on the other hand, interfere with timely medical care to victims. Intention. To investigate RTA medical consequences in the Arctic zone of Russia under study and assess their medical social and medical-tactical aspects. Methods. 327 case histories of RTA victims urgently admitted to multispecialty hospitals in Severodvinsk in 2012–2014. Results and Discussion. RTA with medical consequences prevailed during the summer period, specifically at weekends and in the evening (6.00–11.00 pm). People of working age under 40 years accounted for more than 50 % of all victims. Drivers and passengers of motor vehicles prevailed among RTA at M-8 federal highway and pedestrians – on the city roads of Severodvinsk. Among injured, 57.8 % had single traumas, 8.5 %, multiple, and 33.7 %, combined traumas. Trauma severity by the ISS scale (М [q1; q4]) was 4.0 [4.0; 4.0]; 9.2 [4.0; 13.8] and 13.4 [6.0; 17.3], respectively. Emergency teams virtually used no infusions at the prehospital stage. Among injured, 235 (71.9 %) received medical treatment, and more than 92 (28.1 %) required urgent surgical interventions, predominantly osteosynthesis with angular stability plates and blocked intramedullary osteosynthesis. Conclusion. According to our data, management of emergency care and treatment of RDA victims should be improved.

 

 

Relevance. Interventional pain management and minimally invasive surgery are common methods in the treatment of spinal pathology. The use of navigation in these interventions is obligatory and fluoroscopy is the basic method; however, intraoperative radiation exposure is not sufficiently studied. During pain interventions, a number of pharmacological substances are administered closet to neurovascular structures but possible complications are poorly described. Intention. To assess and analyze complications of the pharmacological treatment and radiation exposure during interventional and minimally invasive procedures in patients with various spine pathology. Methodology. 1353 interventions in 849 patients were analyzed, 1033 of them were interventions for pain syndromes (blockades, radiofrequency ablation, disk interventions), 320 – minimally invasive surgeries (endoscopic discectomy, vertebroplasty, percutaneous transpedicular fixation). Results and Discussion. Reactions to the local anesthetics were detected in 4.4 % of patients, 1 patient required intensive therapy. Contrast agents were not associated with complications. Adverse effects of glucocorticosteroids were most frequent (26.3% of patients); unsubstantiated repeated steroid infusions and blockades at the polyclinic stage were associated with an increased risk. The average effective dose ranged from (1.03 ± 0.4) mSv to (3.03 ± 1.9) mSv for interventions, from (1.92 ± 1.2) mSv and to (11.31 ± 4.9) mSv for minimally invasive operations and could exceed the recommended limits of effective doses of ionizing radiation from technogenic sources, especially with repeated interventions and previous diagnostic studies. Conclusion. The obtained data substantiate the necessity of controlling the use of glucocorticosteroids during interventions taking into account their administration at previous stages of treatment, and test blockades to confirm the causes of pain syndrome in unclear clinical situations. Radiation exposure of patients and staff can be reduced by improving intervention procedures, decreasing the number of projections used, as well as introduction of ultrasound-based navigation.

 

Relevance. Professional health of the servicemen of the Armed Forces of the Russian Federation (Russia AF) is very important for optimizing their functional state for combat readiness and professional longevity. Intention. To study generalized incidence rates by disease classes in the Russia AF personnel by categories: officers, contract servicemen (soldiers and sailors, sergeants and foremen), women servicemen and military conscripts. Methods. 60 % of medical reports on the health of personnel and the medical service of military units (Form 3/MED) for the period from 2003 to 2016 were analyzed. The standard indicators were calculated for the classes of diseases by International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Results and Discussion. In the personnel of Russia AF, the following health indicators were reported: overall incidence rate (1460.9 ± 49.0) ‰, primary incidence rate (728.6 ± 43.3) ‰, the need for follow-up (119.7 ± 5.7) ‰, hospitalization (537.0 ± 36.9) ‰, absenteeism (7037 286) ‰, dismissal for health reasons (12.32 ± 0.87) ‰. The death rate per 100,000 military personnel per year was (82.4 ± 6.0), which is 8 times less than that of the working-age population of Russia. Polynomial trends in overall and primary incidence rates, hospitalization and absenteeism, with different rates of determination, showed increasing trends. Meanwhile, the need for medical follow-up, dismissal for health reasons and mortality declined. The structure of generalized assessment of health abnormalities included 83.8 % of 7 disease classes (V, IX, X, XI, XII, XIII and XIX), 22.7 % of respiratory diseases (class X), 22.3 % – trauma and other external causes (class XIX), and 8 % of mental / behavioral disorders (class V) and nutrition diseases (class XI) each. In the overall incidence structure, data of servicemen accounted for 60 %, officers, 20–25 %, contract servicemen, 11–13 %, and female servicemen, 5–6 %; the latter to a greater extent was determined by their number in the Russia AF. In the structure of mortality, the officers’ indices were 47 %, military men under the contract and draft – 24 % each, and female servicemen – 4 %. Conclusion. Emphasis on the prevention of diseases of the leading classes by ICD-10 can significantly reduce incidence rates in personnel of Russia AF.

 

Relevance. Mortality in pelvic injuries reaches 15 % and increases to 45–60 % in case of hemodynamic instability due to continuous massive bleeding. Intention. To determine the effectiveness of extraperitoneal pelvic packing (EPP) for surgical hemostasis in patients with unstable pelvic injuries and unstable hemodynamics. Methods. We analyzed treatment of 22 patients with unstable pelvic injuries and signs of hemodynamic instability in 2 firstlevel trauma clinics (St. Petersburg, 2013–2017). In all cases EPP was performed after mechanical stabilization of the pelvic ring to stop bleeding. Before and after EPP, the following hemostatis parameters were assessed: systolic blood pressure, volume of blood transfused, pH and base deficit, arterial blood lactate. Pelvic angiography was used to control and verify arterial bleeding sources. Results and Discussion. EPP made it possible to stop the ongoing pelvic bleeding in 14 (73.7 %) patients. EPP effectiveness was confirmed by statistically significant changes in mean systolic BP before and after packing, and a 3:1 ratio of the average volume of blood transfusion therapy. The total mortality rate was 14 (63.6 %) cases, 5 (22.7 %) patients died during the first day (mainly from irreversible blood loss), 9 patients (40.9 %) died within the first two weeks due to infectious complications. Our results are consistent with literature data. Conclusion. Extraperitoneal pelvic packing can be widely used in combination with mechanical stabilization of the damaged pelvic ring in patients with severe pelvic injuries. EPP does not exclude subsequent angiography and angioembolization.

Relevance. Diseases associated with atherosclerosis such as cerebrovascular diseases, ischemic heart disease, lesions of blood vessels of the kidneys and extremities significantly decrease professional longevity of servicemen. Their lifestyles are often more active than in civilians, however younger servicemen have suffered from these nosological forms over past decades. Intention. To assess clinical, ultrasound and biochemical parameters of the liver and pancreas in young and middle-aged servicemen with initial manifestations of atherosclerosis. Methods. 158 servicemen of (37.8 ± 5.5) years underwent in-depth examination. Along with conventional risk factors of cardiovascular diseases, apolipoproteins A and B, hepatic transaminases, and ultrasound indices of the liver, pancreas and vascular wall were studied. Results and Discussion. Based on clinical and laboratory-instrumental data, 3 groups were identified: Group 1 – 61 men with subclinical atherosclerosis and pancreas and hepatobiliary lesions; Group 2 – 32 men with isolated initial atherosclerosis of carotid arteries; Group 3 (controls) – 65 otherwise healthy men without overt cardiovascular, pancreas and hepatobiliary pathology. Group 1 had the worst cardiovascular anamnesis, alimentary status, glycemic profile and early remodeling of left atrium. Conclusion. A prognostic model of the nonalcoholic fatty liver and pancreas disease was developed using such markers as obesity duration, waist circumference and endothelium thickness. Morphological changes in the liver and pancreas of the young men with initial manifestations of atherosclerosis are accompanied with concealed dysfunction of these organs manifested as early post-load hyperglycemia and dyslipidemia with considerably increased long-term risk of type 2 diabetes mellitus and cardiovascular complications.

Relevance. Hypothermia prophylaxis in casualties is an essential part of medical-evacuation measures. It is most important in the low-temperature environment, particularly in the Arctic. Intention. To substantiate small-volume infusions for emergency care under extremely low temperatures. Methods. An experimental model of an acute hemorrhage (approximately 50 % of circulating blood volume) in male Romanov sheep with average weight 29.3 ± 0.5 kg was used. Rectal temperature and vital signs (heart rate, respiratory rate, arterial pressure) were monitored following infusion of cooled (down to –3 °C) test colloidal solution based on hydroxiethylamylum (blood volume replacement 1:1) or hypertonic (7.5 %) NaCl solution (blood volume replacement 1:9). Results and Discussion. One day following infusions, all the experimental animals survived. Arterial pressure and respiration rate returned to initial levels. Hydroxiethylamylum-based blood substitutes in a volume equivalent to hemorrhage led to 7 °С decrease in the rectal temperature of experimental animals. Following small-volume infusions (hypertonic NaCl), the rectal temperature decreased by 2 °С, while the duration of infusion decreased approximately 8.6 times. Conclusion. The following conclusion was drawn: small-volume infusions, even with cold solutions, are highly effective and expedient for blood replacement under extreme environmental conditions. Thus, iatrogenic hypothermia is less pronounced and interventions are shorter.

Relevance. The need to improve prevention of mental disorders in professionals with dangerous jobs, the growth of profes sional requirements for a specialist’s personality, the guarantee of professional reliability and the high need to ensure sustain able adaptation to traumatic influences at the initial stage of work in extreme conditions determine the relevance of this study. Intention. Analysis of prerequisites for increasing the effectiveness and reliability of professionals under extreme conditions. Methods. The analysis of foreign theoretical and empirical studies over the past ten years and systematization of occupational factors affecting mental health, adaptation and professional reliability of those engaged in dangerous occupations. Results and Discussion. It is noted that the main factors of professional reliability of professionals with dangerous jobs are: characteristics of combat stress reactions; emotional stability; effective coping strategies; lack of hierarchical social barriers; emotional regulation strategies, decision-making skills. The main professional stress factors include: lack of control over the performance of official tasks, role conflicts, increased workload, professional pressure, social stress, beliefs about the low quality of the command staff performing their duties. It was noted that expressed mental distress due to a high professional stress is associated with the number of suicides, aggressive behavior, depression symptoms, post-traumatic stress disorder, neuropsychological and physiological disorders. Conclusion. The analysis of foreign research data allows us to conclude about the principles and strategies for preventing adverse effects of work under extreme conditions on the mental health.

Relevance. Currently, prevention and rehabilitation measures for injured in emergency situations, including terrorist acts, are especially important. The high level of terrorist threat refers to the stressors associated with vital threat and is characterized by a wide range of neuro-emotional, physiological, and clinical changes that persist over many years and decades. Intention. To define correlations between personality characteristics and the development of fertility disorders in women inhabitants of the Republic of Dagestan exposed to the terrorist threat during the occupation by militants in September 1999. Methods. 125 women of childbearing age from different regions of the Republic of Dagestan were surveyed in the antenatal clinics, 66 of them experienced traumas due to the terrorist threat during the occupation by militants in September 1999. Results and discussion. Psychological characteristics typical for women survived psychological trauma due to the high risk of a terrorist threat were identified. Low emotional stability, frustration and high anxiety were the most important personality characteristics of these women. Women survivors of vital stress due to terrorist threat are significantly more aggressive and hostile to people nearby; this manifests in all the behavioral responses and is associated with higher anxiety, low mood, increased neuro-emotional stress, impulsiveness, expansiveness, reduced self-esteem and lack of self-confidence as well as difficulties in interpersonal communication, resentment and suspiciousness. Neurotic disorders such as affective lability, asthenic, depressive, somatic and vegetative manifestations are also typical. Conclusion. The obtained results demonstrate effects of the vital stress on the formation of long-term mental disorders contributing to reproductive dysfunction.

Relevance. Specific clinical course and symptoms of post-traumatic stress disorders (PTSD) related to combat operations make it possible to classify it as a separate form – combat PTSD. Intention. Identify the age-specific effects of combat stress, PTSD and its clinical variants in war veterans. Methods. 161 combatants (mean age 42.9 ± 9.6 years) exposed to various types of fighting stressors during military operations in the territory of Afghanistan and the North Caucasus were examined. The intensity of combat stress was determined by the author’s scale from 0 to 5 points, PTSD – using a questionnaire of traumatic stress by I. O. Kotenev. Results and Discussion. The average PTSD score by Kotenev’s questionnaire was (65.5 ± 1.0). Manifestations or symptoms were mild in 42 (26.1 %), moderate – in 47 (29.2 %), expressed – in 58 (36 %) combatants. For combatants over the age of 60 and in case of considerable duration of the post-war period, former combat stress factors rated higher than in younger people. This could be due to age-related cognitive changes and vivid emotional experience of long-standing events. The intensity of PTSD manifestations in combatants depended on increased age, the duration of the post-war period and the prevailing clinical manifestations. Conclusion. In the treatment of post-stress disorders, it is necessary to establish their main symptoms and age-specific stress-induced pathologies.