Vol 43, No 3 (2024)

BACKGROUND: The use of modern technology and weapons forces us to reconsider classical approaches to the prevalence and understanding of the specifics of the existing pathology of participants in hostilities and providing them with medical care.

AIM: To study the prevalence of pathology of the upper gastrointestinal tract in servicemen of the North Caucasian District of the Russian Guard, participating in hostilities, and their clinical features.

DESIGN OF THE STUDY: 118 participants in combat operations were examined, all men aged 21 to 65 years, 48 officers and 70 military personnel of the contract service with a background mild surgical and therapeutic pathology and a burdened gastroenterological history. Statistical processing of the results was carried out using the variable frequency method in the MedCalc Statistical Software version 22.009 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2023).

RESULTS: In patients participating in combat operations (at р < 0.0001), acute and chronic erosive and ulcerative destructive damage to the mucous membrane in the gastrointestinal tract prevails (61%), chronic superficial gastritis occurs in 19%, GERD in 15% and functional dyspepsia in 5%. Among officers, acute gastric erosions, combined erosive-ulcerative pathology and chronic gastritis were more common; among contract military personnel, chronic duodenal ulcers, the erosive form of GERD, chronic gastritis and combined pathologies predominated.

CONCLUSION: Participants in combat operations are susceptible to erosive and ulcerative lesions in the gastrointestinal tract and require close attention with an emphasis on a group of officers, as well as the creation of modern clinical and diagnostic programs for the early detection of diseases of the upper parts of the digestive organs to prevent delayed complications.

BACKGROUND: Insomnia has a significant impact on the quality of life of patients. Despite the progress in understanding the pathophysiological mechanisms of insomnia, the possibilities of its objective diagnosis remain insufficiently studied. This study can contribute to understanding the neural mechanisms of insomnia, contribute to the development of new diagnostic and treatment methods, and personalize therapeutic approaches to improve the quality of life of patients with insomnia disorders.

AIM: to evaluate changes in the brain connectome in patients with psychophysiological and paradoxical insomnia by performing functional magnetic resonance imaging.

MATERIALS AND METHODS: A total of 31 patients were examined who applied for a somnologist appointment at the Federal State Budgetary Institution Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation with diagnosed chronic insomnia. All patients underwent polysomnographic examination using Embla N 7000 (Natus, USA) and SOMNO HD (SOMNOmedics, Germany) for one night with an assessment of the main characteristics of sleep according to the rules of AASM 2.5. Also, all study participants underwent magnetic resonance imaging of the brain on tomographs with a magnetic field induction force of 3.0 Tl at two time points. Statistical analysis of MRI data was performed using MathLab 2023a, CONN v22.a packages. Descriptive statistics, the Kolmogorov–Smirnov criterion were used for processing materials, depending on the characteristics of the data, the Mann–Whitney U-criterion and Pearson Chi-squared were used to analyze demographic data.

DISCUSSION: The study demonstrates the possibilities of functional magnetic resonance imaging in obtaining data on the functional connections of the brain in insomnia. The detected changes in the activity of various brain regions indirectly or directly involved in the regulation of sleep and wakefulness are consistent with the most common pathogenetic models of insomnia, in particular with the theory of hyperactivation and the model of sleep reactivity to stress.

CONCLUSION: The results of the study emphasize the relevance of studying functional changes in the brain in insomnia, opening up new opportunities for more accurate diagnosis and the development of personalized treatment methods.

BACKGROUND: The Disorders of cerebral circulation and sleep are inextricably related, since sleep disorders, including hypersomnia, are closely intertwined with cardiovascular diseases and increase the risk of stroke. Research works on visualization of functional brain changes in patients with sleep disorders and acute ischemic stroke are very few and need more study.

AIM: to determine the functional connections of the brain in hypersomnia in patients with acute ischemic stroke by performing functional magnetic resonance imaging at rest.

A study of 40 patients with acute ischemic stroke and sleep disorders was performed on the basis of the Federal State Budgetary Institution Almazov Research Center of the Ministry of Health of the Russian Federation. All patients underwent neurological examination, assessment of sleepiness, worry and depression, magnetic resonance imaging was performed on tomographs with a magnetic field induction force of 1.5T, using a standard protocol and special pulse sequences of T-gradient echo 3D MPRAGE and BOLD. Functional magnetic resonance imaging of the brain at rest was used to assess functional connections. Postprocessing was performed using specialized CONN-TOOLBOX software with an appropriate graphical representation of quantitative results based on the selection of areas of interest.

RESULTS: Among the examined patients, 23 had hypersomnolence; of these, 8 patients were diagnosed with secondary hypersomnia associated with sleep apnea syndrome. Thus, in the examined sample, post-stroke hypersomnolence was detected in 15 patients (34%). Patients with an unspecified subtype of stroke and right-sided lesions showed a high degree of drowsiness (p < 0.05). With the help of functional magnetic resonance imaging of the brain at rest, changes in functional connections between the main nodes of the default mode network with the left temporal pole, cerebellum, central cerebral cortex on the left, angular gyrus on the left, with the dorsal attention network on the right are determined (p < 0.05).

CONCLUSION: The use of complex magnetic resonance imaging, which includes structural and functional magnetic resonance imaging in patients with acute ischemic stroke and sleep disorders, allows us to identify structural changes and changes in functional connectivity and identify neuroimaging markers of this pathology. Hypersomnolence is typical for patients with an unspecified subtype of ischemic stroke and damage to the right hemisphere of the brain.

The results of a retrospective epidemiological analysis of the incidence of COVID-19 in the regions of the Republic of Cameroon in dynamics from 2020 to 2023 are presented. It was noted that COVID-19 cases were first reported in the Central Region of Cameroon, and then spread to the remaining 9 administrative regions of the country with an average weekly growth rate of 38.1 ± 18.6% in 2020, 15.3 ± 13.1% in 2021, and 13.4 ± 12.2% in 2022, respectively, however, the incidence rate varied significantly in time and space. Epidemiological analysis made it possible to rank the territory of Cameroon by the magnitude of the incidence rate. The highest rate was recorded in the North region (233.1‰), in the Coastal region (204.9‰) and in the Center region (173.7‰). The regions of Adamawa and the Far North had the lowest incidence rates (25.6‰ and 22.5‰, respectively). The results of a comparative analysis of the incidence of COVID-19 infection by time and territory and factors contributing to the rapid spread of infection are presented. Comparative mapping of reported COVID-19 cases in space and time was performed for the 10 administrative regions of the country using the full version of the QGIS (quantum GIS) LTR program; with the help of which the distribution of cases across the territory and dynamics over time was clearly shown. During the study period, the link between COVID-19 cases reported in Cameroon and neighboring African countries was demonstrated. It has been shown that the distribution of cases in the national territory does not always depend on the population density in administrative areas, but is also associated with other risk factors that may affect the occurrence and spread of COVID-19 cases.

BACKGROUND: Currently, respiratory support is successfully used to treat pulmonary edema of non-toxic origin. The manifestations of pulmonary edema of non-toxic origin and toxic pulmonary edema have similar features, so respiratory support can be effective in treating the latter.

AIM: To describe the manifestations of toxic pulmonary edema in rabbits and demonstrate the effectiveness of artificial pulmonary ventilation with support of positive end-expiratory pressure (PEEP) in case of severe intoxication with thermal destruction products of fluoroplastic-4.

MATERIALS AND METHODS: Three rabbits were used in the study: rabbit N 1 (control), rabbit N 2 (intoxication) and rabbit N 3 (treatment). Rabbits N 2 and 3 were subjected to severe intoxication with thermal destruction products of fluoroplastic-4 (1,5 HLC50, 15 min). For treatment, rabbit N 3 (treatment), an hour after exposure, underwent mechanical ventilation with PEEP (pressure-controlled mode; oxygen fraction — 0,3; starting PEEP — 5 cm H₂O, tidal volume — 20–25 ml). At various times, chest radiography was performed, oxygenation index, hemoglobin saturation (SaO₂), and partial pressure of carbon dioxide in exhaled air (PetCO₂) were determined. Posthumously, pathological changes in lung tissue, pulmonary coefficient were determined, and histological examination was performed.

RESULTS: Exposure of rabbit N 2 (intoxication) to the thermal destruction products of fluoroplastic-4 led to the sequential formation of the interstitial and alveolar phases of toxic pulmonary edema, which contributed to its death 13 hours after exposure. As SaO₂ decreased and PetCO₂ increased (3 and 5 hours after exposure), in rabbit N 3 (treatment), during respiratory support, PEEP was increased twice by 2 cm H₂O (maintaining a given respiratory volume), which led to the normalization of the studied parameters. On the 7^th day after exposure, the condition of rabbit N 3 (treatment) did not differ from the condition of rabbit N 1 (control); no pathological changes in the respiratory system were detected.

CONCLUSION: Carrying out mechanical ventilation with PEEP, started an hour after exposure (with a stepwise increase in PEEP as the condition worsens), is effective for correcting toxic pulmonary edema in rabbits caused by severe intoxication with the thermal destruction products of fluoroplastic-4.

During the hybrid armed conflict in which Russia became involved — the Special Military Operation — the medical service of the Armed Forces faced a number of challenges. This review analyzes foreign publications indexed in PubMed® concerning the conditions and factors affecting the activities of the medical services of armed forces, primarily those of NATO countries. It was revealed that a limiting factor for operational effectiveness is the staffing levels and qualitative composition of medical personnel, their preparedness to provide care for the specific pathologies of wartime, and maintaining these competencies in an up-to-date state. Important conditions for successful provision of medical care are preserving the integrity of medical facilities during targeted attacks on them, and the ability to use infrastructure in hostile or newly occupied territories. Prehospital care serves as a limiting factor in reducing lethality, with the main causes being fatal hemorrhages and head injuries from mine-blast trauma. Proper tourniquet application, rapid evacuation, and blood transfusions make the greatest contribution to reducing prehospital mortality. Among casualties, those with limb wounds are most significant, as they subsequently create the greatest social burden on the state, exceeding the “years lived with disability” parameter for all other disease classes, including oncological and cardiovascular diseases. In modern conflicts, the most dangerous in terms of lethality are mine-blast injuries (61.4–83.5%) and head injuries (20.9–59.0%), and in terms of subsequent disease burden, limb injuries (45.7%) constitute an absolute majority and are the point of focus for the main efforts of the medical services of the warring states’ armed forces. At the same time, there are no unified approaches regarding the place of application of qualified and specialized care among countries.

The review article is devoted to modern methods of diagnosing syncope, which is becoming more and more common among young people every year. This article discusses the causes and mechanisms of syncope, as well as methods of diagnosing and differentiating it. Particular attention is paid to syncope that occurs as a result of orthostatic hypotension. Unfortunately, syncope has long been ignored by both doctors and patients. It is not uncommon for patients to ignore isolated episodes of loss of consciousness, explaining them by lifestyle features. A long absence of any diagnosis, and, as a consequence, treatment leads to the progression of the underlying disease that provokes this syncope. But the problem of diagnosing syncope depends not only on patients, but also on doctors. Due to the lack of a clear algorithm that allows for accurate diagnosis of syncope and differentiation, doctors’ diagnostic capabilities are limited. However, this is not the only problem, since the lack of special equipment in most medical institutions also affects the quality of syncope diagnostics. Tilt test is currently the gold standard in syncope diagnostics according to the 2018 European Society of Cardiology recommendations. The equipment is expensive, and the diagnostic ability of this method does not provide the desired results for diagnosis verification. Today, the attitude to this problem is changing and in 2023, the development of a plan of clinical recommendations of the Russian Society of Cardiology began, where syncope is highlighted in a separate chapter. Accurate diagnostics of syncope is needed not only to determine the underlying disease. In the clinical practice of a doctor, there are often cases of simulation of syncope by young people of draft age for personal purposes. It is practically impossible to clinically confirm the presence of syncope in the past at the moment (especially if it was a single episode of loss of consciousness). The lack of a clear algorithm significantly complicates the verification of the diagnosis. The purpose of writing this article was to study the most effective diagnostic methods that allow you to most accurately determine the cause of syncope.