Kirov Military Medical Academy

INTRODUCTION: Patients with disorders of consciousness (DoC) represent a complex patient cohort requiring a multidisciplinary approach. Despite the availability of modern national clinical guidelines (2023), real-world clinical practice in Russia continues to be challenged by the use of outdated terminology, insufficient implementation of validated diagnostic scales, and a lack of standardized management approaches, including pain assessment and management. This study was prompted by the need to assess the current situation and identify key issues to improve the quality of care for patients with DoC in Russia. OBJECTIVE: To assess the current practices, awareness, and key challenges faced by Russian healthcare professionals in the diagnosis, treatment, and management of patients with chronic DoC. MATERIALS AND METHODS: In 2024, an anonymous online survey of 204 medical and paramedical professionals (anesthesiologists, neurologists, rehabilitation specialists, psychologists, nursing staff) from various regions of Russia was conducted. The 47-item questionnaire covered demographic data, terminology used, diagnostic scales, treatment and rehabilitation methods, as well as approaches to pain assessment and management. RESULTS: Despite modern clinical guidelines, outdated terminology persists in practice: apallic syndrome (13.3 %), vegetative state. Only 62.9 % of respondents use the validated Coma Recovery Scale-Revised (CRS-R) for DoC diagnosis, while 77.1 % still use non-relevant scales (Glasgow Coma Scale, Full Outline of UnResponsiveness — FOUR). 30 % of respondents, including physicians responsible for diagnosis, use exclusively these non-relevant tools. Significant differences in approaches were identified among specialists of different profiles (intensivists, neurologists, rehabilitation specialists). The majority of respondents (83 %) acknowledge that DoC patients experience pain; however, the assessment methods (autonomic signs, grimacing) are not standardized and can be non-specific. CONCLUSIONS: The study results indicate insufficient awareness and fragmented implementation of modern standards for the diagnosis and management of patients with DoC in Russia. The findings highlight the necessity of developing and implementing educational programs for healthcare professionals aimed at standardizing terminology, promoting the use of validated diagnostic scales (CRS-R), and harmonizing approaches to pain management.

Sleep-disordered breathing is one of the most common sleep-related disorders. According to basic and clinical research, severe obstructive sleep apnea (OSA) is associated with increased all-cause mortality. Other adverse conditions associated with untreated OSA include cardiovascular disease and its complications, the development of type 2 diabetes, obesity and continued weight gain, cognitive impairment, decreased quality of life, excessive daytime sleepiness, and an increased risk of motor vehicle accidents. Their prevalence tends to increase with age. Tools for accurately diagnosing OSA and treatment options have been developed. Obesity is one of the most significant and independent risk factors for the development of OSA. Weight loss is a key aspect of treating patients with OSA, as it has been shown to improve daytime respiratory failure, pulmonary hypertension, sleep-related breathing parameters, and cardiovascular and metabolic outcomes. This review focuses on the results of the SURMOUNT-OSA trial, which assessed the safety and efficacy of tirzepatide, a drug with incretin activity and the first dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, for the treatment of adults with OSA and obesity. The pathogenic mechanisms of OSA in obesity are discussed based on the latest fundamental research and the mechanisms mediated by tirzepatide. In patients with moderate to severe OSA and obesity, tirzepatide reduced the apneahypopnea index, body weight, hypoxic load, high-sensitivity CRP concentration, and systolic blood pressure, and improved patient-reported sleep-related outcomes.

Background: To assess the efficacy of drugs used in the treatment of diseases, it is important to understand the physicochemical properties of a compound, particularly its ability to cross cellular membranes. There are many methods for determining the capacity of substances to penetrate the blood–brain barrier (BBB). The distribution of a compound between the membrane and the extracellular fluid can be expressed by a quantitative characteristic of partitioning (lipophilicity), referred to as logP, which is calculated as the ratio of the compound’s distribution between an organic phase and water. Aim: The work aimed to determine and compare parameters that may serve as predictors of BBB penetration in silico and in vitro and to verify the obtained data in in vivo experiments. Methods: Predictors of BBB penetration were assessed using in silico approaches (the Way2Drug portal and the VEGA ZZ software), in vitro methods based on ultraviolet spectrophotometry to determine experimental logP, and pharmacological analysis of drug effects following intraperitoneal injection using behavioral tests: open field, pole test, elevated plus maze, sexual motivation, and rotarod. Results: Predictor values for BBB penetration were determined for 6-hydroxydopamine (6-OHDA), oxytocin, kisspeptin-10, and haloperidol (including DEEP, MEP, MLP, PSA, HBASS, HBDON, logS, logBB, logP, and others). Partition coefficients were calculated based on optical density measurements (6-OHDA, –1.01; kisspeptin-10, –0.79; oxytocin, –0.816; haloperidol, –0.2). A pharmacological evaluation of BBB penetration based on behavioral effects was performed, and theoretical (in silico) and experimental (ultraviolet spectrophotometry) partition coefficients (logPexp) were compared with in vivo pharmacological findings. The combined analyses demonstrated that only haloperidol possesses physicochemical properties favorable for BBB penetration. Conclusions: The study has found that physicochemical properties obtained in silico and in vitro for predicting BBB penetration of drugs are confirmed by pharmacological analysis based on behavioral effects.

Introduction. Anti-B-cell therapy that prevents clonal expansion of B cells expressing CD20 is a significant achievement in the pharmacotherapy of multiple sclerosis (MS). Randomized studies have shown high efficacy of monoclonal antibodies (mAb), confirmed by a reduction in the annualized relapse rate (ARR), MRI activity, and the risk of disability progression. Divozilimab (DIV) is a humanized afucosylated anti-CD20 mAb with a modified Fc fragment that provides high effector activity. The aim is to evaluate the efficacy and safety of DIV in patients with various MS phenotypes in real-world clinical practice. Materials and methods. The prospective study included 43 patients: 24 with rapidly progressive MS, 9 with highly active MS, and 10 with secondary progressive MS with relapses. All received DIV therapy for 6–12 months. We assessed ARR, MRI activity (lesions with contrast enhancement (T1-Gd+), new/enlarged T2 lesions), changes in the Expanded Disability Status Scale (EDSS), CD19+ B-cell levels, and the safety profile. Data were analyzed before therapy, at 6 months, and at 12 months of treatment. Results. Over 12 months of therapy, ARR decreased from 1.3 to 0.03; the proportion of patients without T1-Gd+ lesions increased from 27.9% to 100%, and new T2 lesions were detected in 6.1%. The median EDSS decreased from 3.0 [2.0; 3.5] to 2.5 [2.0; 3.0]. Profound depletion of CD19+ B cells was noted (0% [0.0; 0.2]); NEDA-3 (No Evidence of Disease Activity-3) status was achieved in 84.9%. Adverse events were limited to mild/moderate infusion reactions (30.2% at the first infusion), and no serious adverse events were recorded. Conclusion. DIV provides rapid and sustained suppression of clinical and MRI activity in MS with pronounced B-cell depletion and a favorable safety profile, justifying its early use in patients with high disease activity.

The ability to diagnose gunshot pericardial contusion using chest CT is established. Pericardial contusion is diagnosed in 45.1% of mine blast chest wounds. Primary CT signs of contusion are pericardial edema and hemopericardium. Edema corresponds to pericardial leaflet thickening up to 2-3 mm. Pericardial thickness exceeding 3 mm indicates blood accumulation.

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.

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.

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR-encephalitis) was first described as an immune-mediated disorder of behavior and cognitive functions in patients with ovarian teratoma. Subsequently, it was recognized as a separate type of autoimmune encephalitis with a characteristic clinical picture and the possibility of development in the absence of data on tumor formations. The course can have both monophase and recurrent variants with periods of improvement or stabilization of the condition and subsequent progression of the disease. The article presents a clinical observation of a patient with a relapse of the disease 2 years later. The diagnosis of anti-NMDAR-encephalitis was established based on the presence of antibodies to NMDA receptor epitopes in the patient's cerebrospinal fluid, both at the onset of the disease and during the relapse. According to foreign literature, the incidence of recurrent anti-NMDAR-encephalitis varies from 12% to 24%, depending on the study, which requires additional monitoring of patients with this diagnosis.

This review examines thematic articles published from 2011 to 2025, which examined technical aspects, immediate and long-term results of using microwave ablation for the destruction of primary and secondary malignant liver tumors, and a comparative assessment of various thermal degradation techniques. In the course of reviewing the research results, it was found that the use of microwave ablation (MVA) for the destruction of secondary liver tumors allows achieving similar treatment results with surgical interventions and expands the possibilities of radical surgical treatment in somatically burdened patients.

In this article, we report two cases of obesity in sibs associated with a leptin receptor ( LEPR ) gene polymorphism ( LEPR : с .233A>G, p.Arg223Gln ( rs1137101 )). To date, more than 9 thousand polymorphic variants of this gene have been identified. The p.Arg223Gln polymorphism leading to an amino acid substitution in the extracellular domain of a receptor that is common to all its isoforms is one of the best-investigated polymorphisms. An association was found between this polymorphism and increased weight and obesity. Several dozen cases of LEPR mutations in patients with early onset of rapidly progressive severe morbid obesity and hyperphagic eating behaviour have been described in foreign literature. We discuss the features of the course of this obesity “phenotype”, the choice of further follow-up strategy, and treatment options based on the clinical cases that we studied. Currently, both patients continue to be followed up in outpatient settings. The doctor gave their mother a talk about the need for strict adherence to a healthy dietary pattern, and restricting children`s access to food products. A low-calorie diet with a low carb and fat content for 6 months has been recommended. The total caloric content of food recommended for a boy is 1700 kcal/day, and for a girl – 1200 kcal/day. The family was referred for psychotherapy to change their eating behaviour. An individual 12-month program including pediatric endocrinology follow-up appointments and clinical examinations of children was created.