The article presents current views on the evolution of infectious processes and the role of infectious diseases in global healthcare. The reversion of the main components of epidemic processes leads to an atypical course of many infectious diseases and to the emergence of new transmission pathways. Urbanisation, global climate change, agroindustrial boost, migration waves and other factors provoked a cross-border expansion of many wild focal infections across countries and continents. The high morbidity and mortality of infectious diseases are determined by novel and “resurrecting” infections. The possibility of appearing both epidemic and pandemic outbreaks of emergent infections is as relevant as ever.

In this context, the impact of modern scientific achievements on environmental microbiotic associations and human microbiome, as well as safety of medical technologies, is of paramount importance.

Despite current progress in the drug therapy of infectious diseases, a serious emerging challenge is amplified antimicrobial resistance and drug interference.

Preterm labour (PL) is a relevant problem in maternal and child healthcare displaying a persistent trend. The risk of death is 25–35 times higher in premature infants than in normal children, whilst PL-associated stillbirth is 8–13 times more frequent over term labours. Severity of complications with prematurity is inversely proportional to the term of gestation. In general, PLs account for up to 70% of perinatal mortality. At the last FIGO Congress in 2018, PL was identified as an unsolved problem with no current treatment. Lack of scientific grounds for the PL aetiology and pathogenesis precludes practical success alike in prevention and treatment of this complication of pregnancy. In the bottom line, the past 60 years have not witnessed a global decline in the PL rate, it reaches to 9.5% of total births (with a slight variation depending on national commonwealth), and 15m premature infants are born annually. Two challenges currently face improvement of the PL perinatal outcomes: understanding the mechanism of PL and developing a strategy to render support at each stage of medical care to postpone, prevent the distress syndrome and sustain the foetus. The article tackles major issues in the diagnosis, treatment and prevention of preterm labour, aside with its impact on neonatal morbidity and mortality.

The article describes action of the Infectious Diseases Service of the Armed Forces in national biosecurity control through leveraging experience of military involvement, emergencies, infectious epidemic outbreaks, including rescue measures rendered during the SARS-CoV-2 pandemic.

We utilise experience of military infectiologists to exemplify medical care management under admission influx of contagious patients. Principles are clarified of early clinical diagnostics of potentially pandemic infectious diseases and early active detection, isolation, sorting and evacuation of contagious patients in martial and close field conditions. Besides, specifics of providing specialised medical care to contagious patients, including preventive intensive care, is detailed.

In 2020, healthcare and legal authorities worldwide recognised the critical capability to act under conditions close to real combat and so satisfy a minimum qualification standard of a military doctor, including infectiologist’s skills, at both systemic and individual levels of infection control, regardless of primary medical specialty. From this perspective, expertise of the Chair of Infectious Diseases (with training in medical parasitology and tropical diseases) of the Military Medical Academy can be an asset both in practice and teaching in medical universities country-wide.

In its traditional form, medical education begins with learning basic science disciplines, with subsequent transition to clinical training. The basic sciences are taught as a series of separate academic courses, with no coordination applied at the inter-disciplinary level. During past decades, the integrated curriculum has become increasingly popular as a novel instructional strategy that promotes contextual learning in medical practice. The curriculum breaks down the barriers between basic and clinical sciences (vertical integration), interconnects teaching of various basic science disciplines (horizontal integration) and facilitates the acquisition of critical thinking, problem-solving and team-working skills through collaborative learning. The vertical integration is encouraged with training in clinical and communication skills starting in the first semester, teaching basic sciences at the interface with medical problems and involving clinicians in giving lectures on applied anatomy and clinical physiology. In order to facilitate the horizontal integration, basic science disciplines are taught concurrently within interdisciplinary units aligned around the body organ systems. This contributes to a better understanding of complex interrelations between structure and function and stimulates wider insights into mechanisms of the disease. The integrated curriculum supports conceptual learning rather than simple memorisation of fragmented factual knowledge. As such, it relieves the information overload imposed on students due to a rapid growth of medical knowledge in the contemporary world. With the integrated curriculum, the main emphasis is placed on problem-oriented learning guided by an experienced tutor in a small group of students. In this setting, a realistic medical case is used as a trigger for discussion aimed at linking basic science concepts with the clinical problem. Through collaborative problem-solving, students develop a clinical reasoning and team-working skills. Overall, problem-based learning puts forward a student-centred approach in a sense that students themselves are primarily responsible for identifying relevant learning objectives and self-guided acquisition of medical knowledge. This raises their motivation in learning basic sciences and markedly improves the perception of learning environment. In summary, the integrated curriculum offers a number of benefits to medical students and appears to provide an effective instrument in developing professional competencies required in clinical work.

Aim. Substantiation of cisatracurium dosing in routine gynaecological laparoscopic surgery in obese patients based on comparative development time and duration of the neuromuscular block.

Materials and methods. The assay included 24 women with class II-III obesity and routine laparoscopic gynaecological surgery divided into two cohorts. In cohort 1, cisatracurium was dosed at 0.15 mg/kg ideal body weight estimated with the Lorentz formula. In cohort 2, cisatracurium dosing was 0.15 mg/kg real body weight.

Results. Tracheal intubation and total operation doses of the relaxant were higher when rated for real body weight. Time between cysatracurium administration and maximal neuromuscular transmission inhibition was less in cohort 2, and recovery time of the first response to stimulation — in cohort 1. Neuromuscular block recovery time to 25% TOF count and the recovery index did not differ significantly between the cohorts.

Conclusion. Cysatracurium dosage rated for ideal body weight resulted in a better controlled course of the neuromuscular block, whilst rating for real body weight resulted in a dose-dependent increase of the duration of action and total consumption rate of the relaxant.

Aim. This experimental work presents a comparative assessment of the effect of hyaluronic acid and crystalline calcium hydroxyapatite on derma in separate and combined application setting.

Materials and methods. The study used rats (30 animals) for subdermal injection of 0.05 ml medium. Group 1 was administered calcium hydroxyapatite (Radiesse (Merz, Germany)), group 2 received hyaluronic acid (Restylane (SabQ, Sweden)) and Group 3 — both preparations combined in ratio 1:1 (Mix). Results were evaluated 4 months after the filler injection. Sections were stained with haematoxylin–eosin, van Gieson’s and Masson’s trichrome techniques. Collagen types I and III were detected with polyclonal antibodies (Abcam, England). Fibroblasts were positively identified with vimentin (LabVision), macrophages — with CD68 (LabVision) tagging. Effect of extracellular matrix remodelling was studied with α-SMA actin (Abcam, England).

Results. We demonstrate that separate filling of hyaluronic acid and calcium hydroxyapatite produces different response mechanisms, while their combined administration does not lead to a marked voluming of the dermal extracellular matrix.

Conclusion. Combined administration of the two fillers under study may facilitate a prolonged effect of their combined action exceeding 4 months, due to the absence of fibrosis, complications and side effects.

Aim: To assess the relationship between the presence of hypertension and the quality of life of contracted military personnel in the Far North, as well as to establish a correlation between the military rank and body mass index.

Materials and methods. A medical and sociological study was conducted using a questionnaire survey of 613 military personnel serving on a contract basis in the Far North. The main research tool was a short version of the World Health Organization questionnaire developed for estimating the subjective quality of life. Additionally, questions were asked regarding the health status, as well as the conditions of service and life of military personnel.

Results. A positive answer to the question about the presence of a hypertension diagnosis was given by 52 (8.5%) of the respondents. 135 (22%) of the respondents confirmed episodes of increased blood pressure. According to the scale, the quality of life of the military personnel with hypertension comprised 94 points (95% CI: 90.25–97.75), whereas this value equaled 95.33 points (95% CI: 93.10–97.57) and 99.99 points (95% CI: 98.91–101.06) for people experiencing episodes of increased blood pressure and for healthy individuals, respectively. A statistically significant difference in the general assessment of the quality of life was noted between the group of healthy individuals and the group of the personnel suffering from hypertension (U = 10861, p ˂ 0.01), as well as from the group of healthy individuals and people experiencing episodes of increased blood pressure (U = 17185, p ˂ 0.05). In terms of the military rank, statistically significant differences were noted in the hypertension group — between unranked military personnel and warrant officers (U = 78.5, p ˂ 0.05), and in the group experiencing episodes of increased blood pressure — unranked military personnel and warrant officers (U = 587.5, p ˂ 0.05) and warrant officers and junior officers (U = 620, p ˂ 0.05). Spearman correlation criterion values were obtained for the relationship between the body mass index and both hypertension (r_s = –0.212, p ˂ 0.001) and high blood pressure (r_s = –0.231, p ˂ 0.001).

Conclusion. The obtained data confirm the negative impact of conditions associated with increased blood pressure on such aspects as the physical and mental well-being, self-perception, self-assessment of the quality of life and the state of health, general assessment of the quality of life. A correlation between the overall quality of life, the body mass index and the military rank of military personnel was established.

Aim. Description of current dynamics of registered alcohol-attributable mortality in Krasnodar Krai.

Materials and methods. The study was conducted using official statistics reports and published materials of the Federal State Statistics Service. The survey covers 1,398,636 cases in Krasnodar Krai from 2000 to 2018, including 42,612 deaths from alcohol-related causes. Intensive (IM), extensive (EM) and standardised mortality (SM) rates were estimated according to the European Population Standard. Statistical analyses were performed with Microsoft Office software.

Results. Krasnodar Krai displays a positive trend of alcohol-attributable mortality (AAM), with a reduction rate 3.5 times above the similar total mortality (TMR) values (74.4 vs. 21.5%). The decline is more pronounced in both men and women compared to the country average. Thus, AAM in men and in women was 2.9 and 3.7 times lower, respectively, in Krasnodar Krai in 2018. At the same time, TMR values were similar, 1,245.2 against 1,200.6 per 100,000 population in the Russian Federation and Krasnodar Krai, respectively (p <0.05). Alcoholic cardiomyopathy, alcoholic liver disease and poisoning prevailed as causes of AAM for almost the entire period analysed, with their total cumulative contribution varying from 55.6 to 91.7%.

We demonstrate a steady growth of AAM incidents subject to state registration in Form C-51 (from 4 in 2000 to 17 in 2018), which hampers a retrospective analysis of AAM dynamics in terms of individual nosologies’ contribution.

Conclusion. The trends revealed objectively illustrate a positive AAM dynamics in Krasnodar Krai. However, overall contribution of alcohol-attributed causes to the current total mortality profile of the population is underestimated. Recommendations in national healthcare are needed for step-wise improvement and strict supervision of statistical indicator reporting, particularly, of death causes associated with alcohol intake.

Aim. To assess the current state of the cardiology bed fund in round-the-clock and day-patient facilities in the Russian Federation and the efficiency of its use in 2010–2018.

Materials and methods. Using the method of descriptive statistics, the data from the Federal Statistical Observation Forms (No. 30, 47 and 14DS) were analyzed in order to assess the current state and dynamics of the use of cardiology beds during the 2010–2018 period.

Results. The absolute number of cardiology hospital beds in Russia in 2018 amounted to 49,578 beds, which number was lower than in 2010 by 5,899 beds. The absolute number of cardiology beds in day-patient facilities of all hospital types increased by 169 beds and equaled 4,019 beds. The provision of the Russian population with round-the-clock hospital cardiology beds decreased from 3.88 per 10,000 population in 2010 to 3.38 in 2018 (–12.9%). The provision of the population with cardiology beds in day-patient facilities in hospitals providing inpatient care increased by 19.6% (from 0.12 to 0.14 per 10,000 population) in 2010–2018. This indicator decreased by 11.5% (from 0.15 to 0.14 per 10,000 population) in day-patient facilities in medical organizations providing outpatient care in 2014–2018. In Russia, the hospitalization rate in round-the-clock cardiology departments increased from 9.3 per 1000 population in 2010 to 10.8 in 2018 (+16.1%). The average length of patient stay in round-the-clock cardiology departments decreased from 13.1 days to 9.7 days (–26.0%), with the indicator of bed turnover growing by 29.2%. The mortality rate decreased by 3.6% (from 1.96% in 2010 to 1.89% in 2018).

Conclusion. The total number of patients treated in cardiology beds of both round-the-clock and day-patient facilities was 266,311 people higher in 2018 compared to 2010, out of which 89.6% (236,004 people) were treated in round-the-clock hospital facilities and 10.4% (27,307 people) — in hospitals providing outpatient care. At the same time, the absolute number of round-the-clock hospital beds decreased. As a result, the rate of substituting treatment at round-the-clock hospital facilities with that at outpatient medical organizations remains insignificant.

The onset of 2020 clearly demonstrated that infection agents pose a major threat to mankind. Current infectiology is shaped by resurrection of “old” seemingly forgotten infections, emergence of “new” infection agents, unusual combinations of known agents, evolving resistance of microorganisms to antibacterial drugs, transformation of human microbiome leading to distortions in herd immunity and, ultimately, emergence of healthcare-related infectious diseases, not letting alone threats of bioterror. Infection agents evolve together with mankind. Novel facets emerge in infectiology, alongside with trends in diagnosis, treatment and prevention of infectious diseases that become more diverse as the list of pathogens grows. Human and infection agent links extend beyond antagonistic relations towards symbiosis. Microorganisms adapt quickly in the new technogenic environment giving rise to novel pathogens and making it unlikely for the mankind to get free from infections any time soon.

The total economic damage from infectious diseases increases by year, despite continuous improvement in therapy. Infectious mortality in children aged 0 to 14 years is the top fourth among other causes of death. The work assesses comparative dynamics of “common” childhood infections in the Russian Federation during 2018–2020. We analyse official statistics on paediatric infectious morbidity, comparative dynamics of main infectious diseases (acute respiratory diseases, intestinal infections of bacterial and viral nature, neuroinfections, anthropozoonotic infections, viral hepatitises), assess trends in morbidity of vaccine-preventable infections in children and adults in the Russian Federation, with greater detail towards selected regions, from January 2018 to April 2020.

Aim. To assess the importance, role, methods and conditions for creating and sustaining positive motivation of medical personnel in deploying a modern management system based on lean production to optimise the production flow in medical institutions, improve quality, availability and efficiency of public medical care.

Materials and methods. The authors employed historical, bibliometric and statistical methods to analyse domestic and foreign scientific archives on lean production, motivation and motivational risks as key factors in implementing lean technologies in medical institutions.

Results. Implementation of lean production (LP) as a manufacturing management system is among key conditions for creating a new model of the medical institution. Principles of LP are applied at three interfaces: with patients, personnel and resources. Positive motivation of employees is prerequisite for accomplishing a project, which requires supervisors to know and leverage the basics of motivational management. Creation of a motivating environment for various categories of employees in developing a LP system requires taking into account the type and management culture level of a medical institution.

Conclusion. In order to create and sustain motivation for realising creative potential of the team, it is necessary to account for the motivation risks, develop and implement a motivation system differentially by employee categories and project stages. Effective motivational measures are necessarily based on a system of material and non-material incentives with clear and achievable criteria, amounts and forms valued by employees and rooted in medical and economic feedback of implementing the LP principles.

The review considers modern evidence on a rare genetic disease, leukoencephalopathy of brainstem and spinal cord associated with elevated lactate content. The research history of the disease is described. The epidemiology of the disease prevalence in a population is described. Emphasis is placed on aetiology of leukoencephalopathy and peculiar genetic and pathomorphological changes associated with a DARS2 gene mutation leading to mitochondrial aspartyl-tRNA synthetase deficiency. The review details the clinical picture, manifestations specific in various age groups and identifies diseases with similar clinical symptoms and morbid changes that require differential diagnosis. Modern relevant diagnostic approaches are outlined based primarily on neuroimaging techniques. The major neuroimaging approach to leukoencephalopathy is magnetic resonance imaging that allows detection of disease-specific lesion patterns in the brainstem and spinal cord. Magnetic resonance spectrometry is used in turn to detect a usually higher lactate content in the affected white matter of the brain. Definitive diagnosis is based on detection of the marker DARS2 mutation in patients with characteristic clinical picture and MRI signatures in the brain and spinal cord. The review describes contemporary treatment strategies utilising pathogenetic effects to potentially contain the disease. However, its genetic determination renders symptomatic therapy yet a common treatment.

Aim. A clinical analysis of Burkitt’s lymphoma (BL) in a 4 years-old female child.

Materials and methods. A retrospective analysis was conducted for the history, disease’s course, laboratory and instrumental diagnosis and treatment in patient B. with BL, 4 years old.

Results. A 4-yo patient was diagnosed with BL spread to bone marrow, CNS, lymph nodes, both kidneys and spleen. Leukocytosis in common blood profile. Elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) in biochemical blood profile. Neck lymphadenopathy, mediastinum in computed tomography (CT). Splenomegaly. Multifocal lesion of both kidneys. Retroperitoneal lymphadenopathy. Positive clinical dynamics (normalisation of body weight) is observed with background therapy, LDH 335 U/L in biochemical blood profile, reduced multifocal kidney lesion and spleen size in CT.

Conclusion. A clinical case of Burkitt’s lymphoma is reported affecting the bone marrow, CNS, lymph nodes, both kidneys and spleen. Intensive polychemotherapy allowed stabilisation of the patient and containment of oncological processes.

Aim. To describe a rare occurrence of fibromuscular vasa vasorum dysplasia of the aortic aneurysm wall.

Materials and methods. Surgical material from the ascending aortic aneurysm wall was examined. Longitudinal strips of the aortic wall were excised for histological examination with subsequent 24-h fixation in 10% buffered formalin. A histological isopropanol assay was performed with an automated Logos microwave tissue processor (Milestone, Italy) with subsequent sample embedding into paraffin. Sections were obtained with a rotary microtome (Leica, Germany). Staining was performed with haematoxylin-eosin, van Gieson’s picrofuchsin, orcein for elastic fibres, Hotchkiss’ PAS reaction with alcian blue for glycosaminoglycans. Histological and histochemical properties of the aortic wall were studied and imaged with a Leica DM 1000 microscope (Germany) equipped with a camera ICC50 E at magnifications 40x, 100x, 200x, 400x.

Results. The conducted histological examination of the aortic aneurysm wall revealed most pronounced changes in media and adventitia layers. Elastic fibres in media were swollen, homogeneous, crimped, with pronounced dystrophic and necrobiotic changes in smooth myocytes. Regions of compromised cells and elastic fibres in media contained pockets of alcian-positive glycosaminoglycans. Specific changes were revealed in adventitia vasa vasorum in the form of a pronounced wall thickening and lumen narrowing due to dysplastic fibromuscular tissues.

Conclusion. A rare form of fibromuscular dysplasia of the vasa vasorum of the ascending aortic aneurysm wall observed in a 43 years-old woman demonstrated the morbid morphology of smooth myocytes, as well as fibrous collagenous and elastic structures. The described features were likely associated with the aortic wall trophic structure and aneurysm morphogenesis.

Endothermal heat-induced thrombosis (EHIT) is a complication of endovenous thermal ablation in treatment of varicose veins. Existing classifications do not account for the length of thrombus extension floating in the deep venous system. While the risk of extension is minor, the consequences can be baleful.

Aim. To report a rare clinical case of endothermal heat-induced thrombosis extension formed in spite of ongoing anticoagulant treatment in a patient with endovenous laser ablation.

Results. A 39 years-old man with endovenous laser ablation of the right great saphenous vein had class 2 EHIT with 1.92 cm length on the next day after surgery. Rivaroxaban was prescribed at a dose of 15 mg 2 times a day. EHIT extension above the inguinal ligament occurred on the 15th day after surgery, despite oral anticoagulant treatment. Open thrombectomy with high ligation was ordered. Postoperative period without complications. Preoperative Caprini score was 6 (varicose veins, BMI> 25 kg/m² , minor surgery, personal history of venous thromboembolism (VTE)).

Conclusion. The reported clinical case illustrates that both the choice of treatment strategy and follow-up of patients with EHIT need to account for the combined risk of embolism with existing EHIT and potential thrombus extension with subsequent massive embolism.

Aim. Identification of factors affecting coronary bypass graft patency in patients with type 2 diabetes (T2D) during one year after coronary bypass grafting.

Materials and methods. Coronary artery bypass grafting for stable effort angina was ordered in 23 men with T2D. The patients had transthoracic echocardiogram before surgery. All patients were verified for lupus anticoagulant (LA) in blood on the 14th day after surgery. A year later, the patients underwent coronary shuntography to assess bypass patency.

Results. LA was detected in 15 of 23 patients (65%). One year after surgery, occlusions of coronary shunts were revealed in 10 of 23 patients. In patients with coronary shunt occlusions, end-diastolic and end-systolic dimensions, end-diastolic and end-systolic volumes, end-systolic and end-diastolic indices (EDD, ESD, EDV, ESV, ESI, EDI, respectively), as well as the LA ratio significantly exceeded those in patients without occlusions (Mann—Whitney p values 0.004, 0.012, 0.012, 0.006, 0.006, 0.004, 0.017, respectively). A method is proposed for predicting coronary shunt occlusions based on assessment of end-diastolic volume of left ventricle and the LA ratio.

Conclusion. Echocardiographic values for left ventricle (EDD, ESD, EDV, ESV, ESI, EDI) and the LA ratio are predictors of coronary graft occlusions in patients with type 2 diabetes.