Medicine of Extreme Situations
Scientific and Practical reviewed Journal
of FMBA of Russia

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№3, 2012 (September)

Medical exposure and health of workers that work in x-ray rooms.

Year: 2012 (September) Number: №3 Pages: 5-14

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: M.M. Vlasova, V.M. Shubik. 

Organization: Federal State Healthcare Institution Medical and Sanitary unit №144 of FMBA of Russia, St. Petersburg. The Scientific and Therapeutic Center for Veterans of Special Risk Subdivisions Federal State Healthcare Institution Medical and Sanitary Unit №144 of FMBA of Russia, St. Petersburg.

Annotation: 

Objective: The objective is to describe anxiety regarding radiation and to characterize the indicators of health among workers of X-ray rooms.

Materials and method: Survey method and scale of self-assessment by Ch.D. Spilberger and U.L. Hanina (1984) were used in order to indicate anxiety regarding radiation. Health analysis of primary and total morbidity was held during 20 years of dispensary observation of workers of X-ray rooms in St. Petersburg.
The control group was among not radiation-related medical workers of the hospital named after Peter the Great.

Results: It was shown that the work of radiologists is considerably associated with anxiety for their health due to radiation damage. Anxiety regarding radiation does not reduce with the increase of work experience, but, on the contrary, increases. Increase in primary and total morbidity was revealed among workers of X-ray rooms.

Conclusion: The work of radiologists is associated with combined effect of small doses of radiation and other unfavorable factors of non-radiation nature, environmental and social, that is resulting in increased morbidity with temporary disability, primary and total morbidity. 

Keywords: 

Radiologists, primary and general incidence, anxiety.

Diagnostics and treatment features of combined injury of the heart.

Year: 2012 (September) Number: №3 Pages: 15-30

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: V.B. Rozanov, A.I. Bolotnikov, V.N. Lebedev, A.V. Bondarenko, A.V. Kildyashev.

Organization: Federal State Healthcare Institution Clinical Hospital №123 of FMBA of Russia, Odintsovo.

Annotation: 

Objective: The objective is to improve the diagnostic and treatment program in combined injuries of the heart.

Materials and methods: The analysis of the results of treatment of 43 patients with concomitant heart injuries was done. The average age was 30, 7 ± of 2, 2 years. Modern understanding of the structure and classification of the wounds of the heart was demonstrated. Diagnostics issues of wounds of the heart were considered. Features of the clinical picture of the heart wounds were mentioned. The diagnostic value of the pericardial, X-ray, ECG, echocardiography (Echo-CG) and videothoracoscopy procedures was discussed. The possibility of conservative treatment of heart injuries by needle removal of blood from the pericardium cavity was considered. The following conclusion was made: the wound of the heart is an absolute indication for emergency surgery and heart puncture is only temporary measure, which allows to prepare patient for surgery.

Results: Among injured 33 survivors the following complications in postoperative period were observed: pericarditis - 8, pneumonia - 2, pleural effusion- 6, pleural empyema - 2. All 33 victims were discharged in satisfactory condition. Follow up period was after 1-3 years: they fell good, they had no any complaints, freely performed their normal physical activity. Most of them (27 - 81, 8%) did not have any ECG violations of myocardial function; in 6 patients (18,2%) signs of myocardial scarring were revealed.

Keywords: 

Heart, combined injuries, diagnostic and surgical policy.

Normative parameters of ECG in children based on expert evaluation.

Year: 2012 (September) Number: №3 Pages: 31-38

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: L.M. Makarov, V.N. Komolyatova, I.I. Kiseleva.

Organization: Syncope and Arrhythmia Centre for Children and Adolescents of FMBA of Russia based on Federal State Healthcare Budgetary Institution Children’s Clinical Hospital of FMBA of Russia.
Department of Clinical Physiology and Functional Diagnostics of Professional Development Institute of FMBA of Russia, Moscow.

Annotation: 

The review of main works made within years and devoted to the definition of the normative parameters of ECG in children from 0 to 18 years in various population (European, Canadian, Eastern European, Chinese, and so on) was performed. Common ground and differences of individual parameters were shown; age, sex and ethnic differences of the results were discussed. Taking into account existing differences in the number of parameters, which are explained by their different selection criteria, methods of processing of ECG, relatively limited number of subjects, different way of thinking among the group of authors, that have wide experience in screening of ECG in large populations of healthy children, and developed the original expert evaluation of ECG criteria in children using aggregated data held earlier in studies (including their own)that are used in practical analysis of ECG in children in Syncope and Arrhythmia Centre of FMBA of Russia and have already in Russian national recommendations as regulatory parameters.

Keywords: 

ECG in children, practical analysis, expert evaluation criteria, normative parameters.

Multiple stomach bezoars.

Year: 2012 (September) Number: №3 Pages: 39-41

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: L.I. Vorobyova, A.B. Leontiev.

Organization: Federal State Healthcare Institution Medical and Sanitary Unit №107 of FMBA of Russia, Krasnokamensk, Transbaikal Territory.

Annotation: 

The article describes the clinical observation of the patient with multiple stomach bezoars. Historical information, classification, etiology, pathogenesis, clinical manifestation of disease (syndromes), the results of the methods of diagnostics and treatment are described.

Keywords: 

Bezoars, X-ray diagnostics, endoscopic diagnostics, treatment, outpatient monitoring.

The results of epizootic monitoring of natural centers of zoonotic infections on objects of chemical weapons destruction in Kambarka city and Kizner settlement (Udmurt republic).

Year: 2012 (September) Number: №3 Pages: 42-49

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: A.V. Karmanov, D.A. Bondarenko, T.N. Mamaeva.

Organization: Federal State Healthcare Budgetary Institution Center of Hygiene and Epidemiology №41 of FMBA of Russia, Glazov. Udmurt Republic Federal State Healthcare Budgetary Institution Main Center of Hygiene and Epidemiology of FMBA of Russia, Moscow.

Annotation: 

Objective: The objective is to reveal the detailed current epizootic situation on the natural focal zoonotic infections at the objects of chemical weapons destruction in the Udmurt Republic.

Material and methods: The study was conducted in the period of 2007-2011 on the objects of chemical weapons destruction in the surrounding area of Kambarka city and of Kizner settlement. 4736 traps were placed; 1122 animals of six species were caught. 661 of individual rodents were investigated in laboratory regarding zoonotic infections.

Results and conclusions: Natural biotopes were examined on the territories near the objects of chemical weapons destruction. The specific structure and the number of small mammals transmitting zoonotic infections were revealed. Distribution of the natural centers of HFRS was established; frequency and intensity of manifestation of an epizooty in populations of the red vole was revealed. The assessment of intensity of an epizooty of HFRS in various points of monitoring is given. Most intensively an epizooty of HFRS proceeded in vicinity of Kizner settlement. The results of monitoring were used for timely prevention of an infection.

Keywords: 

Zoonotic infections, epizootic monitoring, hemorrhagic fever with renal syndrome (HFRS), the population of rodents, Udmurt Republic.

The analysis of primary examinations of persons of working age with professional disease fluorosis in the Volgograd region for the period of 2007-2011.

Year: 2012 (September) Number: №3 Pages: 50-58

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: S.N. Pavlenko, T.N. Salomatina, E.L. Troshina.

Organization: Federal State Institution the Main Bureau of Medical and Social Examination of Volgograd region of FMBA of Russia, Volgograd.

Annotation: 

Objective: The objective is to analyze the professional ability to work of persons with fluorosis that involved in aluminium production.

Materials: The materials are medical and expert data of 52 patients of working age according to the results of primary examinations with fluorosis in the Volgograd region for 2007-2011.

Results and conclusions: Such occupational disease as fluorosis occurs due to prolonged contact (7 - 10 years) with fluorine in terms of aluminum production. The average age of the victims is 53 years old, male-dominated. During the initial examination when I and l-II stage of fluorosis determined the incapacity is from 10% to 30%, on stage II it is from 40% to 60%. Modernization of aluminium manufacture and regular prophylactic medical examinations with the purpose to determine fluorosis in the early stages helps to prevent it and reduces economic losses due to insurance payments.

Keywords: 

Chronic fluoride intoxication (fluorosis), the degree of incapacity.

Distant education of children with disabilities in the Orenburg region.

Year: 2012 (September) Number: №3 Pages: 59-63

Heading: Organization and improvement of medical care and the state sanitary and epidemiological supervision. Prevention and liquidation of consequences of emergency situations.

Article type: Scientific article.

Authors: T.V. Voloboyeva, T.N. Smagina, A.M. Platonihina.

Organization: Federal State Institution the Main Bureau of Medical and Social Examination Orenburg region of FMBA of Russia, Orenburg.

Annotation: 

Objective: The objective is to analyze the state of distant education of children with disabilities in the Orenburg region.

Material and methods: The analysis is carried out using documentary and statistical information of Federal state institution of the Main Bureau of Medical and Social Examination in Orenburg region, the information provided by the Ministry of education and Ministry of social development of the Orenburg region, and according to data published in periodicals.

Results: In order to ensure the quality of education for children with disabilities there are two projects proceeded in this field: «Creation the ways of distant learning for children with disabilities who do not attend schools due to problems with health» and «Development of distant education for children with disabilities». Two centers of distant learning were created for children with disabilities.
By 2011, January 1st in the centers of distant learning in the framework of the implementation of the above projects, remote training covers 239 children with disabilities from 12 cities and 26 district centers. Of these, 36% of children live in settlements. For the 2011-2012 academic year it is planned to learn 250 children with disabilities. Over the years, the inclusive education helped to graduate for 42 disabled that were in the category «disabled child».
From 2002 for the disabled there is higher education in the Orenburg region; the faculty of distant educational technologies is in State Educational Institution of higher education «Orenburg State University». The process of learning is conducted in 12 professions. In 2011 years 79 disabled students were studied, including 26,6 % that lived in settlements. Basically the majority of these students are of group III - 51,9%; 18,9% are group I.
For 2009-2011 years 3 disabled persons graduated from faculty of distant educational technologies in State Educational Institution of Higher Education «Orenburg state University».

Conclusions: In order to create a learning environment that ensures access of qualified education and integration of disabled people into the active social life, the wide introduction of distant education is required.

Keywords: 

Distant education, inclusion, accessibility, centers, integration in the society.

General requirements to the order of metrologic studies for certification of techniques of measurements.

Year: 2012 (September) Number: №3 Pages: 64-71

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: N.A. Bogdanenko, YU.S. Stepanov.

Organization: Federal medical biophysical center Named after A.I. Burnazyan of FMBA of Russia, Moscow.

Annotation: 

Objective: The objective is to execute the requirements of article 17 of the Federal Law "About technical regulation", as well as ensuring the application in the Federal Medical Biophysical center named after A.I. Burnazyan FMBA of Russia the Russian national standards, international standards on test methods, principles of organization and management of scientific studies.

Material and methods: The analysis of Russian national standards, international standards was performed on test methods and their certification, principles of organization and management of scientific studies.

Results: The document was developed. It regulates the main algorithms for computation of the errors and uncertainties in radiometric and chemical analyses and examples of calculation; it sets general requirements to the procedure of metrological studies, examination of the document on the measurement procedure and registration of the certification.

Conclusions: The standard is applied in the subdivisions of Federal Medical Biophysical center named after A.I. Burnazyan FMBA of Russia that realize the development of documents on measurement techniques and their certification. Its provisions allow employees of Federal Medical Biophysical center named after A.I. Burnazyan FMBA of Russia clearly understand the technology research at certification of the techniques.

Keywords: 

Standard, measurement technique, metrological expertise, certification, metrological characteristics.

Principles for evaluating health status of persons involved in emergency radiation situations: for practicing doctor and workers of healthcare.

Year: 2012 (September) Number: №3 Pages: 72-78

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: A.K. Guskova.

Organization: Federal Medical Biophysical center named after A.I. Burnazyan of FMBA of Russia, Moscow.

Annotation: 

Currently, doctors have a huge number of publications and documents on assessment of the conditions of exposure and effects on the health of the persons involved in radiation accident. General principles of dose estimation and forecast of population health consequences is relatively straightforward. However, specific recommendations do not take into account the type of accident, the time from the moment of its occurrence, event scale, the specific situation in the country and region. The analysis of the gained experience, including with the participation of the author, allows to give practitioners the main reference points in the assessment of the radiation situation and prognosis of medical consequences for different groups of persons involved in the accident.
Practical physician and healthcare worker on the basis of this publication may take the closest to a real case scenario of accident, to consider availability and the possibilities of information support and to take decisions on the measures of most appropriate parameters mentioned above.
Specific examples are analyzed to achieve the most appropriate practical solutions and the main sources of errors in the assessment of information, depending on the absent of necessary information available for certain period after the accident. The most appropriate areas of clinical research are mentioned, allowing to estimate the reliability of the forecast or to make appropriate adjustments.

Keywords: 

Radiation accident, the classification of the accident, radiation and not radiation risk factors, the number of involved in an accident: a separate group, the time after the accident, time constraints, recommendations, the main sources of errors in the forecast of medical consequences.

Cellular technologies.

Year: 2012 (September) Number: №3 Pages: 79-94

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: S.V. Mamaev, A.V. Potemkin, O.S Tseka.

Organization: Clinical hospital №85 of FMBA of Russia, Moscow.

Annotation: 

According to many researchers cell technologies are one of the most perspective directions of medicine. However, so far there is no clear definition of this term. Interpretation of cellular technology only as stem cells study is too narrow, leaving aside technologies such as the creation of cellular products which, when introduced into the patient is able to actively functioning, resulting in the improvement or modification of an existing function of an organ or tissue, or the repair or replacement of the lost function.

Therefore, technologies of modification of blood cells of the patient are very interesting; they allow to carry various drugs and to perform targeted immunotherapy.
Technology of erythrocyte mass incubation with antibacterial drugs is the method of targeted drug delivery using blood cells of patients allowing to reduce the risk of side effects and significantly change pharmacokinetic and pharmacodynamic properties of drugs.

Technology of incubation of leukocyte mass with the immunomodulators is the method that is different from the usual immunocorrection; leukocytes during processing them with immunomodulators are beyond the control of the factors that formed in the body of the patient and prevents cell activation in vivo; the drug is not introduced directly into the patient that excludes adverse reactions and complications and can be used in concentrations exceeding therapeutic.

Unlike basic therapy with non-specific immunosuppressive activity, the method of T-cell vaccination is more physiological and selective on elimination from the body of those lymphocytes, which are responsible for the development of autoimmune process. This technology of immune memory offers the possibility to obtain long-term clinical effect.

The results of using cellular technologies in treatment of patients with rheumatoid arthritis: the authors have developed the program of treatment the patients with rheumatoid arthritis, including the above mentioned cell technologies. Results of the application of the programs are shown, allowing to achieve significant improvement in patients with rheumatoid arthritis.

Keywords: 

Cellular technologies, the definition of cellular technology, cellular therapy, biomedical cell technologies, technologies of modification of blood cells, the directed transport of medicines, extracorporal anti - bacterial therapy, extracorporal immunopharmacotherapy, incubation of blood cells with antibiotics, incubation of leucocytes with immunomodulators, t-cell vaccination, the method of t-cell vaccination, rheumatoid arthritis, treatment rheumatoid arthritis, cell technologies in the treatment of rheumatoid arthritis, the program of treatment of rheumatoid arthritis.

Early manifestations of acute resorptive action of highly toxic alkylating substances.

Year: 2012 (September) Number: №3 Pages: 95-101

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: Yu.Yu. Ivnitskiy, V.N. Malahovskiy, V.L. Raynyuk, T.V. Sheffer.

Organization: Federal State Institution of Science Institute of Toxicology of FMBA of Russia, St. Petersburg. Military Medical Academy named after S.M. Kirov, St. Petersburg.

Annotation: 

Objective: The objectives are to identify the conditions under which the neurological manifestations of acute resorptive action of yperites limit the terms of capacity of affected and to identify areas of preventive medicine.

Results: In the next few hours after exposure of yperite in damaging doses neurological disorders occur, the most typical of which are emetic syndrome, headache, weakness, in lethal doses adynamia, tremor and convulsions. At isolated percutaneous exposure of sulfur yperite these disorders limit the terms of viability of the victims and determine the nature of the medical care they need at pre- hospital stage. In case of use of gas masks in combination with protection of skin, acute neurological disorders can be the only cause of exposure.

Conclusion: Promising areas of drug prevention and treatment of the early manifestations of acute resorptive action of mustards are the use of antiemetics, painkillers, and the elimination of endogenous toxemia caused by inflammation mediators and biologically active substances of gastrointestinal origin.

Keywords: 

Yperite, early signs of acute resorptive action, neurological disorders, disability, prevention by medicines.

The evaluation of the functional reserves of the organism in persons in a state of chronic psychoemotional stress.

Year: 2012 (September) Number: №3 Pages: 102-108

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: S.V. Alaiceva, N.G. Abdulkina, A.A. Zaitseva.

Organization: Federal State Institution Tomsk Scientific Research Institute of Physiotherapy and Balneology of FMBA of Russia, Tomsk.

Annotation: 

Objective: The objective is to assess the functional reserves of individual systems and general functional reserve (GFR) of the organism in population and persons in a state of chronic psychoemotional stress.

Materials and methods: The study was performed on 293 patients (65 people (group III) - persons, whose activity is connected with chronic psycho-emotional pressure; 187 people (II group) who work at enterprises with exposure of harmful factors; 41 patients are in control (I) group). The groups were comparable by sex and age.

Results: The comparison of the parameters of the functional condition of the organism in patients from groups III and II revealed that persons living on its territory, in contrast to persons employed directly in the production area, have lower functional reserve (FR) of the respiratory system and gastrointestinal tract (p<0,05 and p<0,001 respectively). However, in patients of group III there is a marked reduction of FR; in persons of the (II) group it is at the premorbid state (p<0,01). As you can see, these multidirectional changes in the level of functioning of physiological systems lead to the fact that GFR in patients of III and II groups is virtually the same.

Conclusion:
1. In persons living on the same territory, there is a decrease in the level of the FR as separate systems (FR_SSS, FR_MPS, FR_End, FR_MPS) and general functional reserves of the organism.
2. In persons, permanently residing in a state of chronic psycho-emotional stress and harmful factors, there is pathological and physiological shifts in the work of MPS, while persons only staying on the same territory, have lower FR of other systems (FR_DS and FR_GKT).
3. For a more detailed study of the health status of the relevant groups of persons it is necessary to carry out a correlation analysis with data from other methods of functional diagnostics (ultrasound, veloergometry, monitoring of blood pressure, etc).

Keywords: 

Chronic stress, functional reserve, adaptation of organism.

Hematologic status of mice received prebiotics, probiotics, simbiotics and antibiotics.

Year: 2012 (September) Number: №3 Pages: 109-116

Heading: The results of research works in the field of studying the influence on the humans especially dangerous and harmful production factors.

Article type: Scientific article.

Authors: N.E. Andrianova, V.N. Maltsev, A.M. Ulanova, N.M. Stavrakova, A.A. Ivanov.

Organization: Federal Medical Biophysical center named after A.I. Burnazyan of FMBA of Russia, Moscow.

Annotation: 

Objective: The objective is to evaluate the influence of bacterial drugs and their combinations with antibiotics on haemopoiesis that is critical in radiation sickness.

Materials and methods: The analysis of the drugs action was carried out on the basis of the results of research of peripheral blood in mice, the total number of nucleated cells in the bone marrow of the femur and splenic weights. The following drugs were used: vitaflor, vitaflor forte, actoflor that was introduced directly in stomach, gentamicin and nystatin that were given with drinking water.

Results: During research after the 2nd introduction of bacterial drugs the increase in the level of leukocytes in peripheral blood was shown; myelokaryocytes in the bone marrow (lactoflor), erythrocytes and hemoglobin (vitaflor) were also increased; significant reduction of splenic weights was registered in all groups. The use of vitaflor or vitaflor forte after 7 days of treatment with antibiotics neutralized side effects in terms of number of myelokaryocytes in the bone marrow.

Conclusion: For the first time it was shown that bacterial drugs intended for normalization of intestinal microflora, have a modifying effect on hematological status after their short-term course.

Keywords: 

Bacterial drugs, antibiotics, peripheral blood, bone marrow, the weight of spleen.

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