Vol 27, No 4 (2025)

BACKGROUND: An analysis of the nature of casualties in the context of modern armed conflicts revealed the need to improve the diagnosis of combat injury complications. Acute kidney injury is a multifactorial condition resulting both from injury and systemic dysfunction. Current methods of diagnosing acute kidney injury are inadequate and time-consuming, which results in worse clinical outcomes. Developing innovative systems that can predict acute kidney injury at an early stage will optimize the timing of emergency and intensive care, thereby improving the quality of care provided.

AIM: This study aimed to evaluate the diagnostic value of the proposed immunochromatographic test system in semi-quantitative determination of urine cystatin C levels for the prediction of acute kidney injury in patients with combat injuries.

METHODS: This was a prospective analysis of the assessment results of 168 patients with combat injury who were admitted to a specialized medical care facility. Urine samples were collected at admission. The obtained material was used determine the threshold urine concentrations of cystatin C with a semi-quantitative method using innovative immunochromatographic test strips. The results were compared to those of the standard diagnosis technique for acute kidney injury, which involved monitoring serum creatinine levels and diuresis rates over time.

RESULTS: The innovative test system revealed a high (91.6%) diagnostic value of urine concentrations of cystatin C in predicting acute kidney injury in patients with combat injuries. The sensitivity and specificity of the test was 83.3% and 92.8%, respectively.

CONCLUSION: The proposed test for early acute kidney injury prediction should be implemented at the initial stage of medical care to establish evacuation procedures, initiate emergency preventive measures, and select treatment options for acute kidney injury in patients with combat injuries.

BACKGROUND: Providing the least costly, safe, and highly effective pharmacotherapy to patients with rheumatoid arthritis remains an urgent issue.

AIM: This work aimed to develop approaches for optimizing drug provision for patients with rheumatoid arthritis (using the city of Almaty as an example).

METHODS: This work used the information resources of the Ministry of Health of the Republic of Kazakhstan; reports from the Almaty City Rheumatology Center, the State Register of Medicinal Products of the Republic of Kazakhstan, the Clinical Protocol for the Diagnosis and Treatment of Rheumatoid Arthritis No. 12 dated September 29, 2016; wholesale prices for medicinal products, antineoplastic agents, and immunomodulators (anatomical therapeutic chemical groups L01, L04) provided by the City Rheumatology Center; and statistical indicators accumulated based on data from the World Health Organization and the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan.

RESULTS: The highest disease prevalence (60%) was observed among working-age patients aged 35–55 years, whereas only 0.36% of the medicinal products used belonged to biologic agents. The cost ranking (ascending order) of adverse drug reaction therapy was as follows: adalimumab, etanercept, rituximab, tocilizumab, golimumab, and infliximab. With regard to additional cost expenditures, the leading agents (based on the lowest cost of the treatment course) were golimumab, rituximab, and infliximab. The lowest total treatment cost across all treatment stages (in ascending order) was identified for etanercept, adalimumab, and infliximab.

CONCLUSION: Strengthening physician-led patient education regarding treatment strategies is necessary to improve adherence among patients with rheumatoid arthritis. To expand therapy options, the inclusion of etanercept in the guaranteed free medical care list must be considered. To reduce expenditures for medicinal provision, producing biologic agents in the Republic of Kazakhstan is required.

BACKGROUND: Subclinical conditions are a primary focus of military medicine because military personnel are routinely exposed to adverse conditions.

AIM: This study aimed to evaluate the actual significance of risk factors for esophageal, gastric, and duodenal disorders in National Guard of Russia personnel in order to develop a screening model for upper gastrointestinal diseases.

METHODS: A survey included 504 personnel of National Guard of Russia aged 21 to 65 years, who had participated in combat operations. Of these, 197 were officers and 307 were contract servicemen. Their combat tours ranged from 3 to 6 months. Esophagogastroduodenoscopy was performed in 55 respondents (22 officers and 33 contract servicemen). The rank dependence of the risk factors on endoscopic changes was calculated using paired linear correlations. The data were then extrapolated to the entire population (n = 504).

RESULTS: The effects of risk factors on disease onset differed among officers and contract servicemen for seven parameters: combat tour duration (p < 0.0001), history of periodic alcohol consumption (p = 0.0153), rushed food intake (p = 0.0020), smoking (p = 0.0116), physical exertion (p = 0.0011), consumption of chemically contaminated products (p = 0.0098), and asthenic body habitus (p = 0.0031). Using Kendall’s tau rank correlation, the relative risk, and the odds ratio, five key risk factors were identified from seven risk factors involved in the development of upper gastrointestinal disorders in the group of officers. These factors included consumption of chemically contaminated products, periodic alcohol consumption, smoking, physical exertion, and asthenic body habitus.

CONCLUSION: The evidence has been collected to support the role of certain risk factors in the early diagnosis of upper gastrointestinal diseases. It may be used to generate a screening model for National Guard of Russia servicemen.

BACKGROUND: Modern armed conflicts evolve rapidly, resulting in changes in combat scenarios, tactical settings, and military medicine. This, in turn, influences the prevalence of combat-related surgical injuries, with a significant effect on the scope and type of surgical care provided during the early stages of casualty evacuation. The medical evacuation support system established at the beginning of the military operation is currently facing new challenges. These include providing medical care throughout a lengthy prehospital phase as well as the need for specialty care and military medical examination for the increasing number of light casualties in the active army.

AIM: This work aimed to assess the prevalence of combat-related surgical injuries as well as the type and scope of surgical care in various combat scenarios of a modern regional conflict.

METHODS: Data on casualties that required surgical treatment were pooled and analyzed for several forward medical facilities of individual medical battalions, including those of reinforced combat teams, during a modern armed conflict.

RESULTS: Modern warfare is evolving rapidly, as evidenced by the fact that three-fourths of patients admitted to tertiary care were injured as a result of unmanned aerial vehicle attacks. Changes in combat conditions have significantly altered the prevalence of combat-related surgical injuries and the type of surgical care provided. The longer time to casualty evacuation for specialty surgical care is the most significant change influencing the current medical evacuation support system. Other changes, including the decreased proportion of severe and extremely severe wounds (by 15.4%), the increased proportion of minor wounds (by 49.9%), the decreased incidence of penetrating wounds (by 45.2%), and the increased incidence of isolated wounds (by 53.2%), facilitate secondary and tertiary casualty evacuation.

CONCLUSION: The changes discussed above are primarily associated with a longer time to casualty evacuation for specialty surgical care. These changes signify a new, significant challenge for tactical medicine during a lengthy prehospital phase. Specialized military hospitals for light casualties deployed in a combat area and its immediate vicinity have reduced the need for casualty evacuation to rear military medical facilities.

BACKGROUND: Skin wound healing is a global public health concern that has a significant effect on quality of life. Ongoing exploratory studies demonstrate the consistently expanding potential of nanoparticles in wound healing. However, although there has been extensive biomedical research of nanoparticles, nanocerium has yet to find use in real-world practice.

AIM: This work aimed to examine the biological properties of nanosized cerium phosphate compounds and assess the effect of various concentrations of colloidal solution on the proliferative activity of cells involved in regeneration and skin wound healing.

METHODS: Multivalent cerium compounds were manufactured in the form of nanosized cerium phosphate powder, containing both Се³⁺ and Се⁴⁺, as well as methyl cellulose–based nanocomposites. Human fibroblasts were co-cultured with various colloidal solutions of cerium phosphate nanoparticles. The proliferative activity was evaluated using a thiazolyl blue tetrazolium bromide (MTT) assay and direct cell counting with live/dead quantification 72 hours after co-incubation with samples.

RESULTS: Cerium phosphate nanoparticles significantly increase the metabolic activity of cells while having no noticeable effect on cell numbers. The most significant effect was reported for cerium phosphate (Ce^3+/4+) + methyl cellulose 0.5 g/L as well as cerium(III) phosphate (CePO₄-I, CePO₄-II) at a maximum concentration of 10⁻³ M. No samples showed a cytotoxic effect.

CONCLUSION: Nanosized cerium phosphate compounds, including methyl cellulose–based nanocomposites, exhibited a significant stimulating biological effect in cell cultures involved in regeneration. This highlights their potential in the development of effective medical devices that contain cerium phosphate particles for healing wounds of various origins. However, the findings do not explain the mechanisms behind this stimulatory effect.

Post-traumatic stress disorder (PTSD) is becoming increasingly common among military personnel who have participated in combat operations, posing a significant challenge to their normal social functioning. Without effective rehabilitation programs, maladaptive behaviors can become habitual, hindering social integration. Therefore, it is crucial to start the mental recovery process as early as possible. This work evaluated the validity of the diagnostic approaches recommended by the Research Domain Criteria (RDoC) project in evaluating the PTSD severity. We used the RDoC and International Classification of Functioning, Disability, and Health (ICF) domains to evaluate PTSD-associated functional impairment. The work reviewed the syndromic heterogeneity of PTSD, the challenges of differential diagnosis, and the impact of etiological factors on the clinical presentation. We identified three main categories of functional impairment: stress-related behaviors, interpersonal interactions, and cognitive abilities. Diagnostic approaches and research paradigms were proposed to assess and standardize these categories. The RDoC and ICF concepts provide a new perspective on the pathogenesis of PTSD and development of personalized management strategies. It appears promising to enhance specialized diagnostic approaches for this patient population, considering their cultural and mental background.

This review examined Russian and international publications on the diagnosis, classification, surgical treatment, and drug therapy of acute traumatic pancreatitis, a condition caused by pancreatic injury. Pancreatic injuries, although uncommon, typically have an unfavorable prognosis. Timely diagnosis and optimal surgical treatment are essential for the prognosis. Diagnosing pancreatic injury is made challenging by the anatomical position of the pancreas, resulting in delayed treatment. Because of its subclinical course, acute traumatic pancreatitis is frequently difficult to diagnose, especially early after injury. The lack of typical clinical signs is the main cause of diagnostic errors in acute traumatic pancreatitis. This review discusses the contemporary diagnostic techniques for pancreatic injury. Furthermore, it addresses the clinical course of acute traumatic pancreatitis and measures to prevent complications. The American Association for the Surgery of Trauma pancreatic organ injury scale is the primary generally accepted classification for traumatic pancreatic injuries. The main aspects of medical care in modern armed conflicts are highlighted in this review. The surgical treatment of acute traumatic pancreatitis combines conservative management, minimally invasive and conventional open surgeries, and the early prevention of complications. Further research is warranted to develop unified diagnosis and surgical treatment protocols and to assess the long-term treatment outcomes in acute traumatic pancreatitis. The review of published research suggests that this subject is insufficiently studied, highlighting the relevance of this work.

Examining the lives of prominent military physicians is one way to honor our nation’s heroes. Instilling national spiritual and moral values in future generations is vital. This article honors the life and research of Professor Pavel P. Goncharov, a well-known Soviet pathophysiologist who made significant contributions to military medicine. Throughout his lengthy academic career, Professor Goncharov contributed substantially to the establishment and evolution of interoception, a unique branch of science. He demonstrated the efficacy of sulfonamides in the treatment of combat injuries and promoted significant changes in military medicine research, emphasizing the practical applicability of discoveries. Professor Goncharov’s leadership had a significant impact on the S.M. Kirov Military Medical Academy, one of Russia’s oldest and most unique educational institutions. He made an invaluable contribution to the Academy’s history as a researcher, educator, and manager, helping to reform its academic programs and elevate the status of military medical education. Professor Goncharov published more than 80 research works, with the most notable being the monographs “On Cardiac Tamponade” and “On Intestinal Visceral Reflexes.” His work and research are inseparable from the traditions of the Military Medical Academy and its renowned scientific schools. Professor Goncharov is a true example of a military physician who valued service to his country and its people the most. Learning about the lives and work of outstanding scientists shapes the attitudes and motivations of young people who choose to pursue a career in military medicine.

This article highlights the life, teaching activities, and research work of Professor Anatoly M. Shelepov, Doctor of Sciences in Medicine, retired Major General of Medical Service. It examines the milestones in his career as a researcher and the head of one of the leading theoretical departments of the S.M. Kirov Military Medical Academy. Anatoly M. Shelepov, a Suvorov Military School alumnus, has always followed Suvorov’s credo, “Never give up!” In his 18 years as department head, he has reached his full potential as a researcher, educator, and academic team leader. Professor Shelepov has consistently expanded the department’s scientific capacity. Approximately 80 doctoral and candidate theses were defended under his supervision. Many of Shelepov’s former students now hold managerial positions in various military and civilian organizations, lead medical services of military districts and branches of the Russian Armed Forces, or work at the Military Medical Academy. In 1998, Professor Shelepov founded the scientific school for military medicine management. In 2003, the federal government recognized the school’s leading scientific status. Shelepov’s fellow researchers proposed theories and concepts for the development of the Russian Armed Forces Medical Service, addressed practical issues of military medicine during armed conflicts and peacetime emergencies, worked on standardization in medical care, and explored the history of military medicine. Since 1993, Professor Shelepov has been a member of the medical geography department of the Russian Geographical Society. Under his supervision, a territorial medical support system was developed; the scope of military medical care during local wars, armed conflicts, and peacekeeping efforts was proposed; and a plan for the Russian Armed Forces Medical Service development until 2030 was established.