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

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№3, 2018 (September)

LEAN MANUFACTURING TECHNOLOGIES IN HEALTHCARE (EXPERIENCE OF FMBA OF RUSSIA)

Year: 2018 (September) Number: №3 Pages: 8

Article type: Scientific article.

Authors: Uyba V.V., Zabelin M.V., Mironova V.V., Kasymova O.A., Kretov A.S.

Organization:

Federal Medical-Biological Agency, Moscow, 123182, Russian Federation;
A.I. Burnazyan Federal Medical Biophysical Centre, Moscow, 123182, Russian Federation

Annotation:

Optimization of the work of medical organizations and institutions of the Federal Medical-Biological Agency (FMBA) of Russia, providing primary health care (PHC) to adults and children, allowed reducing the loss of working hours associated with the production processes of medical services, increase the availability of primary health care and population satisfaction with the conditions for receiving medical care.

Keywords:

outpatient care; optimization; thrifty polyclinic; Federal Medical-Biological Agency (FMBA of Russia); satisfaction with medical care.

THE STATE OF INFECTIOUS DISEASE PREVALENCE RATE IN CHILDREN IN THE RUSSIAN FEDERATION FOR THE PERIOD OF 2016–2017

Year: 2018 (September) Number: №3 Pages: 13

Article type: Scientific article.

Authors: Lobzin Yu.V., Rychkova S.V., Skripchenko N.V., Uskov A.N., Fedorov V.V.

Organization:

Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical-Biological Agency of Russia, St. Petersburg, 197022, Russian Federation

Annotation:

The importance of infectious pathology as one of the basic criteria of public health being recognized by the world medical community, the prevalence of infectious and parasitic diseases is considered to be one of the most important components of the health index. Infectious diseases, despite a wide range of drugs: antibiotics, immunomodulators, antiviral drugs, adaptogens, etc., remain at one of the leading positions in the ranking structure of the morbidity rate in children of all age groups. In the structure of the infant mortality rate, the lethality rate from infectious diseases in children aged from 0 to 14 years in the Russian Federation takes the 4th place in the class of main causes and accounts for 2.8 per 100 000 children of the corresponding age, and the 6th place in the structure of the infant mortality rate. The article presents an analysis of official statistics on the state of childhood infectious diseases in the Russian Federation for 2016-2017. The structure of the rendering medical assistance in the field of infectious diseases in children is specified.

Keywords:

children; infection; morbidity; Russia.

ORGANIZATION OF ACTIVITIES TO ENSURE LABOR CONDITIONS AND ALGORITHMS OF ACTIONS OF PERSONNEL OF THE BLOOD CENTER

Year: 2018 (September) Number: №3 Pages: 23

Article type: Scientific article.

Authors: Filippova A.A., Goldobin V.N., Shirokov A.Yu., Golosova S.A., Zarinova L.A., Klyueva E.A., Blinova E.A.

Organization:

Institute for Advanced Studies of the Federal Medical-Biological Agency, Moscow, 125371, Russian Federation;
Central Blood Center of the Federal Medical-Biological Agency, Moscow, 123182, Russian Federation;

Annotation:

The blood service is the most important branch of Russia’s health care. This service provides the hightech specialized medical care in peacetime and in emergency situations, being aimed to replenish quality transfusion therapy. Blood Center of the Federal Medical-Biological Agency of Russia is a part of the unified system of the Russian Blood Service. The history of the Federal State Budget Health Care Institution “The Blood Center of the Federal Medical-Biological Agency of Russia” as an independent treatment and prophylactic institution began in 1972. The blood center aims to provide 200 medical organizations with components of donor blood. System maintenance of safe working conditions (constant social and hygienic assessment of working conditions and elimination of emergency or emergency situations) is a reliable measure to prevent infection of medical personnel. The problem of the stuff safety remains relevant in view of the fact that blood and its components are related to a potential risk factor for infection with infectious diseases. Infection of personnel is possible at all stages of the production process. In fact, there is a risk of the stuff involvement when working with toxic chemicals and components. Thus, the staff of the Blood Center carries a double burden on the degree of health risk, consisting of the potential danger of exposure to toxic chemical reagents and components, as well as the likelihood of the involvement by pathogenic biological agents. The number of jobs and employees of the Blood Center of the Federal Medical-Biological Agency of Russia, certified in the category of hazardous working conditions (class 3), is 80% (89 jobs), of which 90% are occupied by women (97 people). According to the results of a periodic medical examination (PME) in 2018, 49 employees of the Blood Center (50% of the number of people who have undergone PME are in need of outpatient examination and treatment, 41 of them (41.8%). At PME 2 people were also revealed to be in need of the inpatient treatment, 19 employees demanded the sanatorium treatment (recovery). Even from the absolute statistical data of the PME results in 2018, it is obvious that the collective health of employees requires medical rehabilitation, adjustment and a positive orientation of preventive measures. However, the current system for ensuring the safety of workers in contact with harmful factors makes it possible to consider selected preventive measures as effective. For 20 years, in the Blood Center of the Federal Medical-Biological Agency of Russia, no case of occupational diseases and poisonings was recorded.

Keywords:

blood service; components; reagents; health care; donor; recipient; assessment of working conditions; a warning; infection; staff; risk factors; infection; problems; security; manufacturing process.

VACCINOPROPHYLACTICS AS A FACTOR OF THE BIOLOGICAL SAFETY

Year: 2018 (September) Number: №3 Pages: 32

Article type: Scientific article.

Authors: Kharit S.M., Fridman I.V.

Organization:

Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency, St. Petersburg, 197022, 123098, Russian Federation

Annotation:

The article presents definitions of biological risks and biological protection, allowing the application of these concepts to vaccine-preventable infections and vaccination. There is analyzed the role of infections in the mortality rate of the population, there was shown the situation on the incidence of controlled infections, the need to expand the calendar of vaccinations in Russia as a tool for the biological protection of the population is presented. The need to increase the safety in the implementation of vaccine prevention is underlined.

Keywords:

vaccine prophylaxis; morbidity; biological safety

TRAVEL MEDICINE: MODERN STATE OF PROBLEMS AND ACTUALITY FOR THE DOMESTIC HEALTH SYSTEM

Year: 2018 (September) Number: №3 Pages: 37

Article type: Scientific article.

Authors: Nechaev V.V., Garderobova L.V., Bakhtina I.S.

Organization:

North-West State Medical University. I.I. Mechnikova, St. Petersburg, 191015, Russian Federation;
The St. Petersburg center of postgraduate medical education under Federal Medical-Biological Agency of Russia, St. Petersburg, 194291, Russian Federation

Annotation:

This review is devoted to the modern aspects of travel medicine. There are considered questions that determine the relevance of this direction for the domestic health care system during the period of the activation of migration processes in Russia and in the world. The current state of the problem of preventing infectious diseases among travelers has been analyzed. In the context of the subject of the article, the foreign experience is described. System approaches to providing effective and safe medical care to patients with imported (including quarantine and recurring) infections are presented by means of the resource readiness of medical organizations and additional professional education of medical specialists. The principles of optimization of epidemiological surveillance of cases of infections, which are subject to the International Health Regulations, are formulated with a view to preventing their spread to the territory of the country.

Keywords:

travel medicine; population migration; international tourism; globalization of the epidemic process; illness of travelers

MYCOSES ARE THE IMPLICIT THREAT

Year: 2018 (September) Number: №3 Pages: 49

Article type: Scientific article.

Authors: Klimko N.N.

Organization:

I.I. Mechnikov North-West State Medical University, St. Petersburg Petersburg, 194291, Russian Federation

Annotation:

More than 1.5 million people die of fungal diseases every year. The upsurge in the prevalence rate of severe mycoses is associated with the HIV/AIDS pandemic, an increase in the number of tuberculosis and oncological diseases, widespread use of antibiotics, cytotoxic agents, corticosteroids and immunosuppressive agents, and organ and tissue transplantation. According to recent studies, invasive candidiasis occurs annually in ~ 700,000 patients, pneumocystis pneumonia ~ 500,000, invasive aspergillosis ~ 250,000, chronic aspergillosis of the lungs ~ 3,000,000 cases. Early diagnosis allows an effective (> 80%) managing, the absence of which inevitably leads to death, severe chronic illness or disability.

Keywords:

mycoses; invasive candidiasis; aspergillosis; pneumocystis pneumonia; chronic aspergillosis of the lungs.

VIRAL HEPATITIS E. A MODERN VIEW OF THE PROBLEM

Year: 2018 (September) Number: №3 Pages: 53

Article type: Scientific article.

Authors: Malinnikova E.Yu., Kuregyan K.K., Polyakov A.D., Amon E.P., Mikhailov M.I.

Organization:

Russian Medical Academy of Continuing Professional Education, Moscow, 125993, Russian Federation

Annotation:

The problem of viral hepatitis remains one of the central to the world and the domestic health care system. Over the past 10 years, the incidence of hepatitis E has increased among people living in areas previously considered non-endemic for this infection. Outbreaks caused by the hepatitis E 3 genotype virus, severe fulminant and chronic forms of the disease, extrahepatic manifestations in the form of neurologic symptoms have been registered in the countries of the European Union.

Keywords:

hepatitis E; endemic territories; outbreaks of hepatitis E; chronic hepatitis E; neurological symptoms of hepatitis E.

SUBSTANTIATION OF FIXED PROSTHODONTICS ON IMPLANTS IN FULLY EDENTULOUS CASES IN TERMS OF LABOR INTENSITY AND COST PRICE

Year: 2018 (September) Number: №3 Pages: 60

Article type: Scientific article.

Authors: Olesov E.E., Uyba V.V., Novozemtseva T.N., Shmatov K.V., Ivanov A.S., Olesov A.E.

Organization:

Clinical Center for Dentistry of the Federal Medical and Biological Agency, Moscow, 123098, Russian Federation

Annotation:

The article presents the results of the phased timing of implantation and the production of a permanent prosthesis on implants in fully edentulous cases. The results of the economic calculation of the cost price of prosthetics on implants are given in view of labor costs, material costs, wages and other expenses. The labor intensity and cost of the implantation and prosthesis manufacturing operation were determined - in the amount of 18.8 hours and 98.5 thousand rubles, respectively.

Keywords:

implants; prosthesis; full adentia; labor intensity; cost price.

CLINICAL CASE OF BINODAL DYSFUNCTION AGAINST OF THE BACKGROUND OF CHRONIC HERPETIC INFECTION

Year: 2018 (September) Number: №3 Pages: 65

Article type: Scientific article.

Authors: Malkina E.V., Kvetnaya A.S., Egorov D.F.

Organization:

Academician V.A. Almazov National Medical Research Center, St. Petersburg, 197341, Russian Federation;
Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency, St. Petersburg,197022, Russian Federation;
Academician I.P. Pavlov State Medical University, St. Petersburg, 197022, Russian Federation;
Municipal Clinical Hospital No. 31, St. Petersburg, 197119, Russian Federation

Annotation:

The article presents a case of the clinical observation of a child with pronounced binodal dysfunction (dysfunction of the sinus node, AV joint dysfunction, transient first degree AV blockade, second-degree transient AV blockade, type I) of the acquired genesis against a background of chronic herpetic infection. According to the results of clinical and laboratory and instrumental studies in dynamics including ECG, ECHO-CG, stress tests, daily Holter ECG monitoring, transesophageal electrophysiological examination of the heart, progression of binodal dysfunction was observed. The child had an HV infection that could potentially contribute both to manifestation and progression of the binodal dysfunction. After managing HV infection, improvement in the heart conduction was demonstrated.

Keywords:

myocarditis; arrhythmias; AV blockade; inflammation; children; infection

CHARACTERISTICS OF THE BIOLOGICAL ACTIVITY AND SELF-CLEANING CAPACITY OF SOIL CONTAINING METOXAZINE

Year: 2018 (September) Number: №3 Pages: 72

Article type: Scientific article.

Authors: Maslennikov A.A., Demidova S.A.

Organization:

Research Institute of Hygiene, Toxicology and Occupational Pathology of the Federal Medical-Biological Agency of Russia, Volgograd, 400048, Russian Federation

Annotation:

The purpose of the study is an experimental assessment of the overall sanitary index of soil contamination contaminated with metoxazine.

Material and methods. Metoxazine (methylene bis (N’-methoxydiazene-N-oxide, C3H8N4O4) was used as an object of research. Molecular mass is 164.12 u. It is a solid crystalline substance with a dispersion of fewer than 5 microns (95.0%). It is used as one of the initial components in the production of gunpowder. During the evaluation of the influence of metoxazine on the functional activity of the soil, the state of the microbionocenosis, the processes of nitrification, enzymatic activity and respiration rate was investigated.

Results and discussion. The studies performed for the first time made it possible to establish the environmental toxicant to have a negative impact on soil microbiocenosis, realized in reducing the number of colonies of saprophytic bacteria against the background of an increase in the amount of E. coli. During the determination of the state of the nitrogen triad, the introduction of a substance into the soil was noted to contribute to a decrease in the content of nitrite nitrogen and a virtually similar change in the nitrification processes at their final stage (nitrogen nitrates) without causing deviations in the ammonification index. When assessing the intensity of biochemical processes occurring in soil containing the test compound, multidirectional changes in urease concentration and an increase in protease activity were recorded without causing significant deviations in the invertase and catalase indices. Analysis of the influence of the chemical on the production of carbon dioxide from the soil revealed the stimulation of this process to 118%. For metoxazine, a single threshold value of 10 mg/kg and subthreshold (maximum inactive) of 5.0 mg/kg of concentration was established for all indices of a general health indication of harmfulness. The observed features of the behavior of metoxazine were taken into account in justifying its MAC in the soil.

Keywords:

soil; metoxazine; general health index of harmfulness; subthreshold level.

ANTIBIOTIC RESISTANCE: THE ROLE OF CARBAPENEMASES

Year: 2018 (September) Number: №3 Pages: 80

Article type: Scientific article.

Authors: Lazareva I.V., Ageevets V.A., Sidorenko S.V.

Organization:

Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical-Biological Agency of Russia, St. Petersburg. Petersburg, 197022, Russian Federation

Annotation:

Gram-negative bacteria producing carbapenemases (enzymes destroying carbapenem antibiotics) are one of the global threats to the healthcare system. The number of known carbapenemases is constantly increasing, but only four following types NDM-type, KPC-type, OXA-48-type, and VIM-type have become most widespread. Carbapenemases producers were found in hospitals of St. Petersburg, Moscow, Yekaterinburg, Vologda, Murmansk, Kurgan, Krasnoyarsk, Izhevsk, and Perm. In the vast majority of cases, the production of carbapenemases was detected in Klebsiella pneumoniae. K. pneumoniae, producing carbapenemases, differed in significant genetic diversity, so the producers of the NDM-type belonged to eight different sequence types (Sequence Types - ST), cattle-type - to three and OXA-48-type - to four types. Representatives of the globally dominant genetic line include the Clonal Group (CG) CG258, as well as a number of less common lines: ST147, ST273, ST307, and ST377. K. pneumoniae was characterized by a high incidence of the cross-over and associated resistance with antibiotics of different groups. The frequency of resistance to cephalosporins and fluoroquinolones was close to 100%. Among the producers of NDM, the frequency of resistance to aminoglycosides exceeded 90%, among the producers of cattle, the frequency of resistance to amikacin was 66%, and to gentamycin - 93%, among OXA-48 producers the frequency of resistance was even lower: 50% and 73%, respectively. A high level of resistance to imipenem and meropenem manifested about 80% of NDM producers, about 90% of cattle producers and only 60% of OXA-48 producers. The frequency of resistance to tigecycline ranged from 6.7 to 14.8%; to polymyxin - from 4.2 to 20%. Acinetobacter spp., Producing carbapenemases OXA-40 and OXA-23-type, retained sensitivity only to polymyxin. Obviously, the possibilities of etiotropic therapy for infections caused by carbapenemase producers are limited.

Keywords:

antibiotics; resistance; carbapenemase.

RESULTS OF THE FIRST EXPERIMENT ON OBTAINING THE ACID PROBIOTIC PRODUCT ON THE BOARD OF A PILOTED SPACESHIP

Year: 2018 (September) Number: №3 Pages: 89

Article type: Scientific article.

Authors: Kobatov A.I., Evstigneev V.I., Gureeva E.A., Verbitskaya N.B., Dobrolezh O.V.

Organization:

State Scientific Research Institute of Extremely Clean Biopreparations of the Federal Medical-Biological Agency of Russia, St. Petersburg, 197110, Russian Federation;
JSC “Biopreparat”, 119830, Moscow;
Rocket and Space Corporation “Energia”, Korolev, Moscow Region, 141070, Russian Federation

Annotation:

The paper presents the results obtained during the direct experiment on obtaining a fermented probiotic product from the dry intermediate product delivered to the International Space Station (ISS), under microgravity conditions. The semi-product consisted of seed material presented by porous tablets containing 2 symbiotic strains of Lactobacillus acidophilus and a nutrient medium - a powder of freezedried dried drinking milk. A regular bilayer polyethylene special package was used as a bioreactor for the thermostatic cultivation of acidophilic lactobacilli and obtaining the final probiotic product on the ISS board. The technology for obtaining a probiotic product directly on ISS board is a onestage process: the drinking water from the onboard sources is introduced into the package with a dry intermediate, after which the bag is sealed and placed in the onboard thermostat for 24 hours. The fermented milk product prepared in the thermostat is transferred to the onboard refrigerator and stored there until the moment of intake. This technology for obtaining a fermented probiotic product on the ISS board was successfully carried out by the ISS-expedition 50 crew. The fermented milk product obtained as a result of the pilot experiment contained 2 strains of lactobacilli and had a high probiotic potential: biological activity, acidity, antagonism in the relation of opportunistic bacteria

Keywords:

fermented probiotic product; Space experiment “Probiovit”; Lactobacillus acidophilus; microgravity; ISS-Expedition 50.

AVIATION INTRA-CABIN NOISE AS THE FACTOR OF THE RISK OF PROFESSIONAL CARRIAGE DEVELOPMENT

Year: 2018 (September) Number: №3 Pages: 100

Article type: Scientific article.

Authors: Vilk M. F., Pankova V.B., Glukhovsky V.D., Kaptsov V.A.

Organization:

All-Russian Research Institute of railway hygiene, Moscow, 125438, Russian Federation;
State Research Institute of Civil Aviation, Moscow, 125438, Russian Federation

Annotation:

There is shown the urgency of the problem of occupational deafness among the members of the flight crews of the Aircraft of Civil Aviation of Russia, which amounts to one-third of all indices of occupational diseases of the hearing organ in the country. The risk factor for the development of the disease is the occupational noise exceeding the Admissible Limit Level. The analysis of indoor cab noise indices of domestic and foreign airliners as a risk factor of occupational deafness is presented, the late diagnosis of which determines the loss of the occupational working capacity of the flight crew. It is noted that the data of the sanitary and hygienic characteristics are inconsistent with the information of the Protocols of the equivalent noise level for the entire period of flying activity, presented in the requirements of the Methodical guidelines of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare 4.3.2231-07, which leads to a free interpretation of the acoustic load and unreasonable positive expert decisions on the connection of the hearing organ disease with the occupation, which creates controversial and conflict situations. For the analysis of the risk of occupational deafness in the pilots of the Air Force Civil Aviation, hygienic studies were conducted with an assessment of the level of intra-cabin noise of the aircraft, taking into account the additional acoustic load from the headset. There were pointed out shortcomings of the methodology for estimating the trainee coefficients of equivalent noise doses for the entire period of flight activity, the lack of full data of the noise-protective properties of the headset, as well as the errors in diagnosis and examination of the connection between hearing and hearing aids in the pilots of the Armed Forces. There was executed the actualization of Sanitary regulations and Norms 2.5.1.2423-08 with the inclusion of methodology of an estimation of an acoustic load of internal noise with taking into account the additional noise load from the use of the headset on members of aviation personnel of the Armed Forces of domestic and foreign aircraft. The new version of the Federal Aviation Regulations contains proposals for improving diagnostic criteria and regulations for expert decisions on the relationship of hearing loss in flight crew members to the occupation. The Instruction on the order of interaction between medical centers, medical flight-expert сommission of Civil Aviation, Central medical flight-expert сommission of Civil Aviation, the Center for Occupational Pathology and Occupational Hygiene of the Central Clinical Hospital with territorial organizations of the pathological profile was developed.

Keywords:

intra-cabin aircraft noise; air radio; professional risk; occupational deafness; aviation personnel

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