bluuebunny/crossref_metadata_2025 huggingface dataset:
Peculiarities of outpatient care for COVID-19 patients using telemedicine technologies
Authors: Tyazhelnikov Andrey A. , Polunina Natalya V. , Kostenko Elena V. , Polunin Valery S.
Published: July 2021

BACKGROUND: The use of telemedicine in providing outpatient care for COVID-19 patients is an integral part of the most intensively developing and promising areas of national health care.
AIM: This study aims to demonstrate the efficiency of using telemedicine technologies in outpatient care for COVID-19 patients.
MATERIALS AND METHODS: This study is the retrospective analysis of remote consultations for 57,256 patients with COVID-19 from April 1, 2020, to May 24, 2020.
RESULTS AND DISCUSSION: The results of human resource analyses, the physician workloads, and the categories of observed patient categories are presented. The majority of patients were asymptomatic (45%), a mild form of the disease was observed in 4534 (34%) patients, and moderate cases were observed in 2800 (21%) patients. Concomitant pathology was observed in 60.0% of patients. The capacity of the telemedicine center was 52.8 patients for one physician per shift.
CONCLUSIONS: The telemedicine structure of the center, which regulates the interactions of physicians with patients and other healthcare facilities, has enabled the appropriate use of human resources to ensure that therapeutic, diagnostic, and epidemiological activities are adequate and timely in outpatient settings.
Preparation for decannulation of children with the consequences of cervical vertebrospinal cord injuries in surgical hospitals
Authors: Novoselova Irina N. , Ponina Irina V. , Machalov Vladislav A. , Valiullina Svetlana A.
Published: July 2021

BACKGROUND: Approximately 40 million people worldwide suffer from vertebrospinal cord injuries every year. According to different authors, children account for 1% to 5% of those injured. The relevance of developing a protocol for preparing children with vertebrospinal cord injuries for decannulation is due to the frequency of respiratory disorders and the peculiarities of the mechanism of their occurrence in patients with cervical spinal cord injuries, the lack of clear recommendations on preparing the patient for decannulation, and early comprehensive rehabilitation measures that contribute to restoring or compensating respiratory, muscular function, and the need for a unique approach to performing rehabilitation measures that consider the age of the child.
AIM: This study aims to develop a preparation protocol and an algorithm for decannulation of children with cervical vertebrospinal cord injuries and assess the efficiency of early rehabilitative measures in the preparation process.
MATERIALS AND METHODS: This study included 74 children with vertebrospinal cord injuries admitted to the Emergency Childrens Surgery and Traumatology Research Institute from 2014 to 2019. The patients were divided into two groups depending on the time of admission. Group 1 consisted of children admitted to the institute in the acute and early periods of vertebrospinal cord injuries. Group 2 included children in the intermediate and recovery periods. All patients were prepared for spontaneous breathing according to the protocol.
RESULTS AND DISCUSSION: Group 1 patients with C2C4 vertebrospinal cord injury levels were decannulated on days 110140 after the injury. One child was diagnosed with an overgrowth of granulations over the tracheostomy tube, which required medical correction followed by successful decannulation. Group 1 patients with C5C8 vertebrospinal cord injury levels were decannulated on days 1541 after the injury. All Group 1 patients underwent early rehabilitation measures, which began immediately after stabilizing vital functions.
On days 97110 after the injury, 12 patients of Group 2 with С5С8 vertebrospinal cord injury levels were decannulated. In contrast to Group 1 patients with the same injuries, Group 2 patients did not undergo early rehabilitation measures in primary inpatient settings. Therefore, they required much more time to adapt to spontaneous breathing.
CONCLUSIONS: Compliance with the proposed protocol allows determining the patients readiness for decannulation, reduces the risk of potential complications that may arise due to the untimely removal of the tracheostomy tube, increases the effectiveness of rehabilitation measures in this patient category, and reduces the length of the hospital stay. The preparation algorithm for decannulation may serve as a practical guide for specialists involved in treating and rehabilitating children with vertebrospinal cord injuries.
Laparoscopic plasty of giant diaphragmatic hernia using a biocarbonic implant
Authors: Rozenfel’d Igor’ I.
Published: July 2021

This article discusses the results of a prospective randomized study of laparoscopic plasty of giant hiatal hernias with a hernial defect area of 1020 cm2. A total of 92 patients underwent surgery from 2014 to 2020. The patients were divided into two study groups. Group 1 included 46 patients who underwent laparoscopic plasty of the esophageal hiatus by posterior cruroraphy. Group 2 consisted of 46 patients who underwent laparoscopic plasty of the esophageal hiatus using a two-layer Ultrapro (Ethicon) mesh biocarbonic implant according to the developed technique.
Open-chest or transcatheter aortic valve implantation?
Authors: Chernyavsky Mikhail A. , Strelkov Dmitry А. , Zubarev Dmitry D. , Prokhorikhin Alexey A. , Susanin Nikolay V. , Kazantsev Anton N.
Published: July 2021

This literature review focuses on the choice of treatment strategies in patients with aortic stenosis. The main surgical techniques for this condition are presented. The rationale for the efficiency of transcatheter aortic valve implantation is provided. The results of studies comparing the outcomes of surgical and endovascular correction of aortic stenosis are analyzed. Particular attention is paid to the treatment choices in patients with aortic stenosis and a history of coronary artery bypass grafting. Conclusions on the perspectives of transcatheter aortic valve implantation in this cohort of patients are reached.
Use of modern spinal braces in the treatment of idiopathic scoliosis
Authors: Shavyrin Il’ya A. , Kolesov Sergey V. , Levkov Vitaly Yu. , Lobov Andrey N. , Polyaev Boris A.
Published: July 2021

This review presents an analysis of scientific papers on the conservative treatment of idiopathic scoliosis with spinal braces.
Insufficient awareness of brace treatment for spinal deformities is often the reason for the negative attitude of orthopedists toward brace therapy and the conservative treatment of scoliosis in general.
In world practice, braces have been the primary and scientifically proven technique for conservative treatment of intermediate forms (grades IIIII) of scoliosis in children and adolescents for over 50 years. Modern spinal braces are active orthopedic products that provide three-dimensional correction of the existing deformity and prevent the progression of scoliosis. The main goal of using braces is to eliminate the pathological displacement of the vertebrae, ribs, and pelvis to a physiological state by applying pressure to specific body areas and actively correcting the deformity. Using a brace is the only non-surgical method to treat scoliosis with scientifically proven efficiency. The poor results of using braces to treat scoliosis are primarily due to insufficient correction in the brace, non-compliance with the wearing time, and the lack of adjunctive therapy. The efficiency of brace therapy depends on three main factors that require the personal involvement of the patient: the time of wearing the corset per day, the degree of correction in the corset, and constant (daily) training of the back muscles. The results of recent multicenter studies confirm the efficiency of using braces to treat idiopathic adolescent scoliosis.
Screening of sarcopenia of haemodialysis patients
Authors: Lavrishcheva Yu V , Belskykh A N , Yakovenko A A , Rumyantsev A Sh
Published: July 2021

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%.
Prospects of studying the stability to decompression sickness of professional divers
Authors: Alpatov V N , Sovetov V I , Yatmanov A N
Published: July 2021

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
Diagnosis of hepatic steatosis in non-alcoholic fatty liver disease in the military
Authors: Zhirkov I I
Published: July 2021

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
The role of thematic expertise of medical care quality in improvement of results of its performance in cases of acute pancreatitis
Authors: Scryabin O N , Movchan K N , Tatarkin V V , Klitsenko O A , Morozov Yu M , Yakovenko T V , Artushin B S
Published: July 2021

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.
3D printing technologies in the treatment of patients with injuries and diseases of the forearm and hand
Authors: Khominets V V , Peleshok S A , Volov D A , Titova M V , Eliseeva M I , Kushnarev S V , Shirshin A V , Adamenko V N , Nebylitsa Ya I
Published: July 2021

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.
Problems of Organization of Radiation Diagnostics to Dispensary Cancer Patients
Authors: Lomakov S Yu
Published: July 2021

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).
Discovery of intravenous anesthesia ON THE 110TH ANNIVERSARY OF THE FIRST INTRAVENOUS HEDONAL ANESTHESIA)
Authors: Rostomashvili E T , Schegolev A V
Published: July 2021

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.
At the origins of the organization of trauma care to the population of the Soviet Union
Authors: Morgoshiia T Sh , Apchel V Ya , Ryzhova A M
Published: July 2021

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.
The role of blood loss in the structure of thanatogenesis factors in explosive injury during peacetime
Authors: Trukhan A. P. , Samokhvalov I. M. , Tolmachev I. A , Isakov B. D. , Golovko K. P. , Skakunova T. Y. , Ryadnov A. A.
Published: July 2021

Currently, explosive trauma is rare in peacetime injury surgery, but is of great importance in the work of surgeons. This is due to damage of a large number of anatomical areas, various damaging factors of the explosion and the simultaneous entering of several victims. The results of forensic medical examinations of 24 corpses of people who died as a result of terrorist acts in the subway of Minsk on 11/04/2011 and St. Petersburg on 03/04/2017 were analyzed. Incompatible with life injuries as the immediate cause of death were found only in 33,3% of cases. Profuse blood loss was the immediate cause of death in 66,7% of those killed. The most common (in 87,5% cases) cause of profuse blood loss was internal bleeding: in 7 (50%) cases - due to damage to organs and large vessels of the chest, in 6 (42,9%) cases - due to combined damage to the anatomical structures of the chest and abdomen, in 1 (7,1%) case - due to damage to the parenchymal organs of the abdominal cavity and retroperitoneal space. The leading role in thanatogenesis during the considered explosive peacetime injuries was occupied by blood loss, its specific gravity was 66,7%. Profuse blood loss in 87,5% of cases was due to damage to the organs of the chest and abdomen. Potentially salvable were 7 (29,2%) dead who received damage to the main vessels of the limbs, damage to internal organs without injuring the heart and large blood vessels. Thus, the development of new ways to stop intracavitary bleeding at the advanced stages of medical care for victims with explosive injuries and injuries is a priority aim.
Features of the course of chronic obstructive pulmonary disease in patients with respiratory tuberculosis in modern conditions
Authors: Katicheva A. V. , Brazhenko N. A. , Brazhenko O. N. , Chuikova A. G. , Zheleznyak S. G. , Tsygan N. V.
Published: July 2021

Abstrаct. The features of the course of chronic obstructive pulmonary disease are considered. It was established that this pathology is widespread in patients with tuberculosis and is determined in one third of patients. Moreover, the combination of respiratory tuberculosis and chronic obstructive pulmonary disease have a mutual aggravating effect, and the patients serious condition can be caused by both exacerbation of chronic obstructive pulmonary disease and progression of the tuberculosis process. The severity of the comorbid state is associated with a decrease in adaptive-adaptive mechanisms and a violation of the state of the homeostasis of the body. Patients with a combination of pulmonary tuberculosis and chronic obstructive pulmonary disease are characterized by intense types of adaptive reactions, with their extreme manifestations, a deep and pronounced disturbance in homeostatic balance and a decrease in the reactivity of the body. Such changes are combined with functional disorders of the respiratory system (changes in spirometric indicators, impaired airway, impaired ventilation function and diffusion capacity of lung tissue). The combined course of pulmonary tuberculosis and chronic obstructive pulmonary disease affects the effectiveness of the treatment and its outcome. In patients with comorbid pathology, there is a decrease in the frequency of abacillation and closure of decay cavities, the formation of pronounced residual tuberculous changes in the lungs. At the same time, in patients with pulmonary tuberculosis, chronic obstructive disease has a more severe course, with a pronounced symptom complex and a high probability of frequent exacerbations. In more than half of cases, chronic obstructive pulmonary disease is characterized by an unfavorable course with a high risk of exacerbations, more than twice a year, which is an extremely unfavorable factor for predicting the course of chronic obstructive pulmonary disease and the development of complications. Identified violations impair the quality of life of patients suffering from comorbidity. Therefore, it is diagnostically important to assess the initial state of chronic obstructive pulmonary disease in patients with tuberculosis, to predict its course and the risks of exacerbations.
Gunshot wounds to the chest and abdomen when using modern body armor
Authors: Denisov A. V. , Krainyukov P. E. , Logatkin S. M. , Yudin A. B. , Kokorin V. V. , Altov D. A. , Demchenko K. N.
Published: July 2021

Based on the analysis of literary sources and the data of our own experimental studies, we examined the features of gunshot wounds of military personnel protected by body armor. The classification of body armor by design is given. In addition, the gradation of body armor according to the protection class according to GOST 34286-2017 is given. It is shown that the widespread use of body armor in modern armed conflicts has led to a noticeable decrease in the frequency of gunshot wounds to the chest. According to the mechanism of the formation of a gunshot injury through a bulletproof vest, three main types of injuries were identified: closed local contusion injury when the bulletproof vest was not broken; a gunshot wound when piercing a bulletproof vest; gunshot wounds due to ricocheting of striking elements from the surface of the body armor (external or internal ricochet). It has been established that closed trauma in case of bulletproof vest penetration can occur both in the form of damage to the skin and subcutaneous tissue with the formation of hemorrhages, and in the form of bruises of internal organs, accompanied in severe cases by ruptures of internal organs (liver, spleen, lungs, etc.), with development life- threatening complications - intense pneumothorax, intra-abdominal bleeding, etc. It is shown that when piercing a bulletproof vest through the wound, in addition to a deformed bullet and clothing elements, fragments of armor can be introduced lei with additional damage. When bullets approach a bulletproof vest at angles of 20 degrees or more, rebound elements of dismantled bullets can occur, which can cause severe damage to both the owner of the bulletproof vest and others.
The effectiveness of the narcological service in the Russian Federation in terms of target indicators
Authors: Esina K. M. , Skripov V. S. , Kochorova L. V. , Klyukovkin K. S. , Pronina A. V. , Semenova N. V.
Published: July 2021

The analysis of the effectiveness of the narcological services based on the primary and general incidence rates, as well as target indicators considered in the Health Care Development program, is presented. A decrease in both the general and primary incidence of mental and behavioral disorders associated with the use of psychoactive substances in 2013-2018 was revealed. This decrease can be explained by the increasing role of primary prevention and regulation of the consumption of psychoactive substances at the state level, as well as a change in the order of dispensary monitoring of persons with mental disorders and (or) behavior disorders associated with the use of psychoactive substances. An analysis of the target indicators characterizing the activities of the drug treatment service showed that remission rates among patients with alcoholism and drug addiction increase and remain above target values. At the same time, the proportion of patients with alcoholism and drug addiction hospitalized repeatedly during the year exceeds the target values and amounts to 26,3 and 28,2%, respectively. This fact may be associated with insufficiently effective continuity in the work of the outpatient and inpatient stages of treatment of patients with drug addiction and alcoholism. The shares of people included in outpatient and inpatient medical rehabilitation programs also increased - the growth was 5 and 5,7%, respectively. The effective work of the service, in terms of rehabilitation, is also indicated by the fact that the proportion of patients who successfully completed medical rehabilitation programs both in outpatient and inpatient settings tend to increase. In general, the incidence of drug abuse disorders and indicators characterizing the work of the drug treatment service are determined by the strong negative impact of drug addiction and alcoholism on the demographic and economic situation in society.
Attitude of Ophthalmologists to the Problems of Organizing Corneal Transplantation in Russia
Authors: Konstantinova P. I.
Published: July 2021

Currently, much attention is paid to the preservation of vision in the Russian Federation. Of particular importance are corneal diseases requiring surgical treatment (keratoplasty). In this regard, the identification of problems in the organization of specialized ophthalmic care for patients in need of keratoplasty is extremely relevant, and their solution will ensure the proper level of quality and accessibility of medical care provided to them. A survey of 840 ophthalmologists from different regions of the Russian Federation was conducted. Problems with obtaining donor material (53,6 per 100 respondents), inaccessibility of keratoplasty in the region (28,6 per 100 respondents), imperfection of the legal framework for corneal transplantation (26,2 per 100 respondents), long waiting times for the operation were identified patients (22,6 per 100 respondents), the lack of equipping a medical organization with modern medical equipment (20,2 per 100 respondents) and an insufficient number of quotas for operations (20,2 per 100 respondents). The absence of a donor tissue bank significantly affects the availability and quality of specialized ophthalmic medical care and requires the adoption of appropriate organizational measures. Experts note the need to provide medical organizations with an adequate amount of donor material. In this case, the improvement of the regulatory framework governing the issues of donation and corneal transplantation is of great importance. The creation of tissue banks in various constituent entities of the Russian Federation will shorten the waiting time for keratoplasty by patients and increase the degree of satisfaction rendered to them by medical care.
Indicators of dismissal of military personnel of the Armed Forces of the Russian Federation for health reasons in 2003-2018
Authors: Evdokimov V. I. , Sivashchenko P. P. , Grigoriev S. G. , Ivanov V. V.
Published: July 2021

The dynamics and structure of the dismissal of officers and military personnel of the Russian Armed Forces for health reasons in 2003-2018 are analyzed. It was established that the average annual dismissal rate for officers was7,981,10, contract servicemen 3,920,32, conscripted military personnel 17,571,19, female military personnel9,141,37. The polynomial trend of dismissal of all categories of military personnel showed decreasing trends. The level ofdismissal of military personnel by the leading classes of diseases and nosologies (groups in chapters) is presented. The indicatorsof the causes of dismissal were correlated with the chapters and nosologies of the International Statistical Classification ofDiseases and Health Problems, 10th revision. The 1st rank of dismissals for health reasons for officers was taken by indicatorsof diseases characterized by high blood pressure (I10-I15), the 2nd - coronary heart disease (I20-I25), the 3rd - diseases ofthe esophagus, stomach, and duodenum (K20-K31); contracted military personnel have diseases of the esophagus, stomachand duodenum (K20-K31), diseases characterized by high blood pressure (I10-I15), neurotic, stress-related, and somatoformdisorders (F40-F48); in conscripted servicemen - neurotic, connected stress, and somatoform disorders (F40-F48), diseasesof the esophagus, stomach, and duodenum (K20-K31), behavioral disorders in adulthood (F60-F69); among female militarypersonnel obesity and other types of excess nutrition (E65-E68), diseases characterized by high blood pressure (I10-I15),inflammatory diseases of the female pelvic organs (N70-N77). Prevention, timely treatment and rehabilitation of leadingnosologies will contribute to improving the health and professional longevity of the Russian Armed Forces.
Monitoring primary disability of former military personnel by applying to the bureau of medical and social expertise as a basis for choosing measures for the professional rehabilitation of disabled people: a regional aspect
Authors: Nurova A. A.
Published: July 2021

The factors of the formation of primary disability in the former military personnel in the Republic of Dagestan were studied according to the appeal to the bureau of medical and social expertise over 5 years (from 2014 to 2018). The article analyzes gender and age indicators, social affiliation, causes of disability, nosological diseases of military personnel that led to disability, severity by disability group and others. An analysis of the disability indicators of former military personnel in the Republic of Dagestan as a large subject of the North Caucasus Federal District of the Russian Federation is important for organizing measures to continue previous professional activities for persons with limited ability to work. The revealed complex of socio-hygienic and medical-social indicators made it possible to determine the directions of labor and social integration of persons with disabilities from among former military personnel in society. The social indicator established in more than half of disabled people, the place of residence in rural areas, made it possible to recommend self-employment in the agricultural areas of activity (animal husbandry, vegetable growing, fruit and berry processing), in the service sector, and small business, including those related to revival and development of national Dagestan crafts. The state program Accessible Environment (2011-2020-2025) emphasizes the need to take into account the regional characteristics of primary and general disability, the national specifics of the development of territories. In this regard, the results of medical and social analysis allow us to more accurately determine the direction of the organization of labor and social integration of persons with disabilities from among former military personnel in the Republic of Dagestan.
The modern significant of the bronchial asthma
Authors: Salukhov V. V. , Kharitonov M. A. , Zaycev A. A. , Ramazanova K. A. , Asyamov K. V.
Published: July 2021

A review of modern literature on the diagnostic algorithm of bronchial asthma and a detailed examination of all its stages is presented. It is known that bronchial asthma is the most common form of the disease, prone to progression to more severe forms, but fraught with the development of exacerbations, even fatal. Often, general practitioners perceive bronchial asthma as a manageable, understandable disease, for the successful treatment of which it is enough to identify and isolate the allergen, as well as prescribe therapy. Understanding the mechanisms of development of bronchial asthma helps to increase the effectiveness of the diagnosis and treatment of asthma, preferably taking into account the phenotype. Determining the phenotypic characteristics of bronchial asthma is a requirement of the time, because personalized medicine does not yet require the creation of a separate drug, diagnostic or prophylactic method for each individual patient, but it requires the selection of patients (allocation of subpopulations / clusters / phenotypes of bronchial asthma) that are most responsive to a particular drug, a method for diagnosing or preventing a disease. The essence of phenotyping in medicine is the optimization of diagnosis, treatment and prevention. The central and most studied links of the pathogenetic mechanism and its variants of development are described, phenotypes of bronchial asthma are discussed, as well as options for basic and targeted therapy of bronchial asthma. The necessity of studying personalized therapy and flexible dosing of drugs used in the treatment of bronchial asthma is emphasized.
Hero of the Soviet Union Dyskin Efim Anatolyevich - legendary person (to the 75th anniversary of victory in the Great Patriotic War)
Authors: Fisun A. Y. , Gaivoronsky I. V. , Odinak M. M. , Litvinenko I. V. , Nichiporuk G. I. , Dyskin D. E. , Koshkaryov M. A.
Published: July 2021

Hero of the Soviet Union Efim Anatolyevich Dyskin - a prominent domestic scientist and teacher of higher education, head of the department of normal anatomy (1968-1988), Honorary Doctor of the Military Medical Academynamed after S.M. Kirov, major general of the medical service. Professor E.A. Dyskin is the founder of the new scientific direction Anatomy and Military Medicine. At the age of eighteen E.A. Dyskin volunteered for the front, participated in battles to defend Moscow. On November 16, 1941, he accomplished a heroic feat, for which he was posthumously awarded the title of Hero of the Soviet Union. However, after a serious wound, the Red Army soldier Dyskin survived, was treated in hospitals for about a year, at the same time he graduated from the feldsher school, from 1942 to 1947 studied at the Military Medical Academy. After graduating from the Academy from 1948 to 1968 E.A. Dyskin worked under the direction of Professor A.N. Maksimenkov a at the Department of Operative Surgery and Topographic Anatomy, where he went from an adjunct to a professor. In 1968 he was appointed as a head of the Department of Normal Anatomy, which he directed for 20 years.He created a scientific anatomical school that developed pecularities on the morphology of various types of gunshot wounds and the effects of extreme factors of military labor on the human body. Under his leadership, research was also conducted to study the state of collateral circulation, the functional anatomy of the digestive system, craniology, and the history of military medicine. Scientific ideas of Professor E.A. Dyskin continues to develop in the writings of students and followers at the Department of Normal Anatomy, and neuromorphology - at the Department of Nervous Diseases of Military Medical Academy.
Professor Sergey V. Grebenkov - naval doctor, scientist, teacher (on the 65th anniversary)
Authors: Lobzin Yu. V. , Petreev I. V.
Published: July 2021

The main autobiographical, pedagogical and scientific segments of the life of the head of the Department of naval and radiation hygiene (1996-2006) S.M. Kirov military medical Academy, doctor of medical Sciences, Professor Sergey V. Grebenkov, who turned 65 on April 30, 2020. His work fell on one of the most difficult periods in the history of modern Russia and its Armed forces, associated with the collapse of the Union of Soviet Socialist Republics, the change of socio-economic formation. In these difficult conditions, the most important task was to preserve the scientific potential of the Department and ensure the further development of naval and radiation hygiene. S.V. Grebenkovs contribution to the development of hygiene consists, first of all, in the fact that in his PhD thesis (1988) he justified the list and types of promising individual means of water treatment in the field; in his doctorate (1996) - formulated the concept of human stay in a radiation- destabilized environment, developed principles and recommendations for optimizing the life of military personnel and the population in conditions of long-term stay in radioactively contaminated territories. Under his leadership, the Department developed the conceptual foundations of military ecology. He is the author (co-author) of 367 works, including three textbooks, a two-volume guide to naval and radiation hygiene (1998, 1999), 21 monographs, and a multimedia program Ecological and hygienic bases of military health protection (2001). After graduating from the military medical Academy named after S.M. Kirov, S.V. Grebenkov served in the Northern fleet as head of the medical service of a multi-purpose nuclear submarine (Western Litsa, 1978-1985), then - at the military medical Academy named after S.M. Kirov (adjunct, 1985; teacher, senior teacher, associate Professor, 1988-1996; head of the Department). After demobilization (2006) - head of the Department of occupational medicine of the North-Western state medical University named after I.I. Mechnikov, where he continues to work successfully to this day.
Prevalence and clinical significance of electrocardiogram abnormalities in older civil aviation pilots
Authors: Kuzmina A. Yu. , Blaginin A. A. , Fisun A. Ya.
Published: July 2021

Abstract. Prevalence and clinical significance of electrocardiography findings was studied in 1189 older pilots in aged 55 years and older, who were consistently admitted to the Central Civil Aviation Hospital (Moscow) and examined on the regular bases. Resting 12-lead electrocardiogram was recorded in all subjects according to generally accepted methods. Normal electrocardiogram was found in 78,5% of older pilots. None of the examined showed signs of myocardial infarction. Minor electrocardiogram abnormalities was registered in 21,5% of pilots. Cardiac conduction disorders were predominated 16,1% of cases, most of them were intraventricular conduction disorders 13,7% of cases. Another electrocardiogram abnormalities were less common 4% of cases. Mixed electrocardiogram abnormalities were noted in a small number of observations in 1,4% of individuals. Thus, older civil aviation pilots are characterized a lower frequency of majority electrocardiogram deviations compared to a population of the same age. The evaluation of fitness to flight in some electrocardiogram deviations is depend of the presence or absence of cardiovascular disease, functional condition of the cardiovascular system and the data of additional examination methods. On the whole, the electrocardiogram use as a screening in asymptomatic individuals has some significant limitations - a number of detected abnormalities may be normal variants, as well as a normal electrocardiogram may be in significant narrowing of the coronary artery. Nevertheless, the need for electrocardiogram recording is recognized by aeromedical specialists of different countries, since this method is exclude a number of pathological changes, which are significant for flight safety.
Risk factors for the formation of polymorbidity in military personnel based on the results of their medical examination
Authors: Voronin S. V.
Published: July 2021

Abstract. The risk factors for the formation of polymorbidity in military personnel of different age groups were studied during a medical examination to determine the category of fitness for military service. It was established that the most effective indicators in the form of linear dependences were: the level of trans-systemic polymorbidity and body mass index, waist-to-hip ratio, the cardio-anklevascular index, the thickness of the intima-media complex of the common carotid artery, the level of total cholesterol, and alcohol consumption.In the group of military personnel under the age of 35, positive correlation was found between trans-systemic polymorbidity and body fat, body fat percentage, body mass index, total cholesterol and low density lipoproteins.In the group of military personnel aged 36 to 45 years, positive correlation was found between trans-systemic polymorbidity and body mass index, percentage of body fat, and fat tissue in the body. Given the positive correlation between trans-systemic polymorbidity and indicators characterizing overweight, obesity is one of the leading factors in the formation of polymorbidity under the age of 45 years. It is shown that measures aimed at the prevention of polymorbidityshould basicallyinclude generally accepted measures for cardiovascular prophylaxis and obesity.
Analysis of airmen disadaption factors after combat stress exposure
Authors: Schegol’kov A. M. , Blaginin A. A. , Fisun A. Ya. , Cherkashin D. V. , Makiev R. G. , Gornov S. V. , Kutelev G. G.
Published: July 2021

Abstract. Factors of disadaptation of pilots after combat stress are analyzed as one of the main factors in the development of post-traumatic stress disorder. It was found that the effects of combat stress have a great impact on young, thin pilots, with a predominance of the parasympathetic division of the autonomic nervous system and a reduced basic metabolism of the body. The data obtained allow for early diagnosis and identification of functional disorders in pilots for their medical and psychological rehabilitation. The use of the proposed discriminant function can be divided into adapted and unadapted (differently processing traumatic experience), for the development of appropriate rehabilitation programs within their medical and psychological rehabilitation. The revealed decrease in the reserve capabilities of the Central nervous system and the adaptive capabilities of the body of pilots subsequently leads to a decrease in the reliability of the professional activity of the pilot with an increase in its physiological price. In terms of methodology, understanding the postponement of the negative impact of combat stress factors on the pilots body requires constant measures for early detection and correction of emerging functional disorders. The consequences of combat stress are considered as an integral reaction of the body to the complex impact of various factors of combat stress, which is manifested at the psychophysiological and somatic levels and leads to early disqualification of pilots for medical reasons.
Doppler ultrasoundgraphy capability in the evaluation of renal circulation in patients with type 2 diabetes mellitus and chronic kidney disease
Authors: Shipilova D. A. , Nagibovich O. A. , Shchukina N. A.
Published: July 2021

Abstract. The 72 patients with type 2 diabetes mellitus and chronic kidney were examined to clarify Doppler ultrasound capability in assessing the renal circulation. Hemodynamics changes in kidney tissue appeared on early stage of diabetic kidney disease. Intrarenal hemodynamics disturbances in patients with type 2 diabetes mellitus is revealed through a decrease in the minimum blood flow velocity and an increase in the intrarenal vascular resistance parameters. We found the correlation between dopplerographic indicators, kidney functions and other parameters (age, disease duration, glycated hemoglobin level), which play a pathogenetic role in diabetic kidney disease. Serum creatinine level and glomerular filtration rate were indicators of renal hemodynamic changes. Resistant index above 0,7 conventional units, pulsatility index above 1,54 conventional units, systolic diastolic ratio above 3,8 conventional units were ultrasound signs of kidney damage. Patients without standard signs of chronic kidney disease have diagnostically significant index of resistance in 72% of cases, a pulsation index in 50%, a systolic-diastolic ratio in 28%. Renal blood flow examination in right segmental artery area will be use for non-invasive diagnosis and estimation of kidney dysfunction in patients with type 2 diabetes mellitus.