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

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№4, 2011 (December)

Experience of rendering specialized medical care to the victims of emergency situations.

Year: 2011 (December) Number: №4 Pages: 5-13

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: O.P. Kuzovlev, O.R. Shablovsky, V.A. Laptev, Yu.V. Ivanov.

Organization: Federal State Healthcare Institution Clinical Hospital №83 of FMBA of Russia, Moscow.

Annotation:

This article tells about experience of Clinical hospital №83 of FMBA of Russia in rendering specialized medical care to the victims of emergency situations. Special attention is paid to the organization of medical and evacuation measures, algorithm of diagnostics of damages and injuries, stages of treatment.

Keywords:

Specialized medical care, emergency situation, organization of medical and evacuation measures.

Health state assessment of the persons which are subjected to periodic medical examinations and participating in development, assembling and disassembling of nuclear ammunition.

Year: 2011 (December) Number: №4 Pages: 14-22

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.R. Tukov, G.I. Gneusheva, Yu.V. Suvorova, O.N. Prokhorova.

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

Annotation:

Materials and methods
Health of employees of 6 enterprises who worked with radioactive materials was estimated (more than 175000 people).

Results
The analysis of incidence showed its growth for the observed period. This tendency is typical for the population of all country. The increase in incidence is caused by social and economic transformations in the country, aging of the personnel, and also improvement of quality of diagnostics at early stages of diseases by ultrasonography use. High incidence of blood circulatory system diseases, stomach ulcer and chronic bronchitis is possible to charge to psychophysiological tension and, perhaps, selective impact of harmful factors on a stomach that needs to be researched.

In average, over the period, the incidence of malignant neoplasms did not exceed those of the institutions of FMBA of Russia and the Russian Federation.

Mortality is lower in comparison with the data of the institutions of the FMBA of Russia and the Russian Federation that is due to the syndrome of "healthy worker".

Keywords:

Research of incidence and mortality of persons working at development, assembling, disassembling of nuclear ammunition.

Radiodiagnosis of the temporal and mandibular joint injuries.

Year: 2011 (December) Number: №4 Pages: 23-29

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.P. Dergilev, Ya.L. Manakova, A.V. Sudarkina.

Organization: Federal State Institution Siberian district Medical Center of FMBA of Russia, Novosibirsk; Novosibirsk State Medical University, Novosibirsk.

Annotation:

Objective
High prevalence of maxillofacial injuries and their severe consequences cause the relevance of timely and high-quality radiodiagnosis.

Material and methods
In this article research results of 72 patients with mechanical injuries of a temporal and mandibular joint (TMJ) are given.

Results
Application of the computer tomography (CT) allowed to investigate in detail morphology and topography of injuries of joint bone elements, an articulate disk, intra articulate ligaments, bilaminary zone.

Conclusions
It is proved that for precise diagnostics of the morphological changes arising in bone and soft tissue joint elements requires complex application of CT and MRI.

Keywords:

Temporal and mandibular joint, injury, computer tomography, magnetic resonance imaging.

Treatment of the gastroesofageal reflux disease complicated by Barrett’s gullet.

Year: 2011 (December) Number: №4 Pages: 30-35

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.N. Novikov, A.S. Ivanyuk, G.G. Freynd, A.S. Nagayev, Yu.B. Busyrev, N.V. Lozhkina, S.N. Ivanov.

Organization: Federal State Healthcare Institution №140 of FMBA of Russia, Perm.

Annotation:

Gastric metaplasia with an ulceration and an intestinal metaplasia are the undoubted indication to surgical correction. Complex treatment of patients with Barrett's gullet has to include the following options of interventions: a fulguration of a mucous membrane, conservative treatment within 1 month and after regeneration of a flat epithelium, krurorrafiya and a fundoplication, and in the presence of polyp and dysplasia of adenose structures on first stage it is necessary to carry out an endoscopic resection of a mucous membrane with a polyp. Fulguration and resection of a gullet’s mucous membrane at careful execution differ by minimum invasiveness that allows to reduce days of hospitalization. Optimum anti-reflux correction is the laparoscopic krurorrafiya and Nissen fundoplication.

Keywords:

Barrett's gullet, gastric and intestinal metaplasia, mucous membrane resection, fulguration of a mucous membrane, krurorrafiya, fundoplication.

Integrated approaches to the assessment of influence of air pollution on health of the population from closed administrative territorial formation in Zheleznogorsk Krasnoyarsk region.

Year: 2011 (December) Number: №4 Pages: 36-43

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.P. Blochin, E.P. Kozina, Yu.L. Krupichev, N.V. Senina.

Organization: Regional Department №51 of FMBA of Russia, Zheleznogorsk, The Closed Administrative Territorial Formation, Zheleznogorsk.

Annotation:

The material presented in article generalizes practical experience of Regional Department №51 of FMBA of Russia according to influence of environmental factors on health of the population. Results of research of influence of air pollution including caused by industrial emissions of the industrial enterprises with especially dangerous working conditions on health of the population of the Closed Administrative Territorial Region in Zheleznogorsk are stated; the results were received with the use of various methodological approaches.

Keywords:

Environmental factors, pollution of atmospheric air, industrial atmospheric emissions, health of the population, incidence, management of risk for health, forecasting.

Actual problems of drinking water supply taking into account natural features of the surface water (on the example in Polyarnye Zori, Murmansk region).

Year: 2011 (December) Number: №4 Pages: 44-52

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.V. Korolev, E.N. Zheleznova.

Organization: Regional department №118 of FMBA of Russia, Polyarnye Zori.

Annotation:

Objective
Experience of Regional Department №118 of FMBA of Russia in the field of quality control of drinking water supply for population in the subordinated territory is presented. In this article features of use of natural waters of the southern part of the Lake Imandra for the purpose of drinking water supply for population in Polyarnye Zori and the Afrikanda-2 community are considered. Actual problems of drinking water supply of the population from a source with the raised content of organic substances are revealed and the ways of their solutions are proposed.

Materials and methods
Metrological certified techniques for quality control of natural and drinking waters according to the content of formaldehyde are used: PND F 14.1:2:4.187-02, PND F 14.1:2:4.84-96 (edition of 2003) and total indicators of water pollution (oxidability, Chemical Oxygen Consumption, Biochemical Oxygen Consumption 5): PND F 14.1:2:3:4.123-97, PND F 14.1:2:.100-97.

The assessment of research results is executed according to the SanPiN 2.1.4.1074-01 “Drinking water. Sanitary requirements to quality of systems of the centralized water supply. Quality control”, GN 2.1.5.1315-03 “Maximum permissible concentration (MPC) of chemicals in water of water objects of economic drinkable, cultural and domestic utilization”.

Results
The analysis of obtained data showed the following:

  1. Quality of water of the southern part of the lake Imandra is unstable on the indicators characterizing impurity by easy and complex oxidability organic substances. Thus the tendency to stable increase in the content of pollution on these indicators of rather average annual concentration within maximum concentration limit is observed.
  2. In water supply source water in places of water intakes in Polyarnye Zori and in Afrikanda-2 doesn't correspond to sanitary maximum concentration limits on formaldehyde from 10 to 25% of the studied tests respectively; the tendency to increase in the content of formaldehyde in distributive networks of drinking water supply at increase in concentration of formaldehyde in natural waters is revealed.

Recommendations about improvement of the centralized drinking water supply of the population in the subordinated territory are given.

Conclusions
Further studying of quality of natural waters is necessary in the lake Imandra for the purpose of receiving statistically reliable data and possibility of carrying out calculation of risk for health of the population from the use of water with the raised content of formaldehyde and organic substances.

It requires development of complex actions for protection of drinking water supply systems against pollution by toxic substances, modernization of the existing systems of water supply and process of technical solutions on the mode of their operation.

Keywords:

Drinking water supply, water supply source, organic substances, formaldehyde, oxidability.

Condition of professional incidence and primary disability owing to professional diseases in the Orenburg region in 2004-2009.

Year: 2011 (December) Number: №4 Pages: 53-59

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.

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

Annotation:

Objective
The objective is to define a condition of prevention and detectability of professional incidence and primary disability owing to professional diseases in the Orenburg region in 2004-2009.

Materials and methods
The analysis is carried out with the use of published materials of deputy hearings of Legislative Assembly of the Orenburg region “About health protection of the working citizens of the Orenburg region” from 28.01.2010, an annual form of federal state statistical supervision №7 social security for 2004-2009.

Results
199380 people in the Orenburg region work at 2121 industrial and agricultural facilities in the conditions of influence of harmful and dangerous factors, 73102 – 36.7% of them work in the conditions which aren't satisfy to sanitary standards.

For 2004-2009 in 3.5 thousand organizations and the enterprises of the Orenburg region 201.8 thousand workplaces were certified that makes nearly 25% from total workplaces (in the Russian Federation about 15%). In 2004 54% of workplaces didn't fit to admissible working conditions, in 2008 – 74.7%, in 2009 – 73%. Total amount in Russian Federation in 2009 was 69.2%.

Quality control of certification of 5492 workplaces on 42 objects revealed its poor quality. 40% of employers don't carry out the instruction of a certifying commission.

For 01.01.2010 there are about 1.5 thousand patients with occupational diseases in the Orenburg region. The level of professional incidence on 10 thousand of working population in the Orenburg region decreased from 1.2 in 2004 to 0.78 in 2009 – by 35%. The level of occupational disease in the Orenburg region is lower, than in the Russian Federation. In 2008 the level in the region was 0.53 and in Russia – 1.5. The level of revealed occupational diseases is inadequate to a state of working conditions.

For 2004-2009 in the Orenburg region for the first time 232 workers left work due to disability owing to occupational diseases; 202 (87.1%) of them were at working-age.

The level of primary disability owing to professional diseases has decreased: in adult population from 0.4 in 2004 to 0.15 in 2009 – for 62.5%, in working population from 0.5 to 0.18 – for 64%. The level of primary disability owing to professional diseases of adult population in region is lower, than in the Russian Federation. In 2009 is on 25% lower. At working age in 2006-2007 corresponded to the Russian Federation level, in other years was lower; in 2008 it was on 50% lower.

Conclusions
Professional incidence and primary disability owing to professional diseases tend to decrease and are in direct dependence on the activity of public authorities and local government directed on preservation and improvement of workers’ health.

Keywords:

Risk of development of occupational disease, certification of workplaces, quality of medical examinations, professional incidence, primary disability.

Evolution of research and practical activities of scientific research institute of children's infections (to 85-year anniversary).

Year: 2011 (December) Number: №4 Pages: 60-70

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.V. Lobzin, N.V. Skripchenko, I.G. Samoylova, V.M. Volzhanin.

Organization: Federal State Institution Scientific Research Institute of Children's Infections of FMBA of Russia, St. Petersburg.

Annotation:

The history and evolution of development of research institute of children's diseases is reflected in article from the moment of its foundation in 1927. The main directions of scientific and practical activities are presented. The priority of institution and its role in improvement of delivery of health care to children with infectious pathology are defined. The special stage of activity of the FMBA medical institution is noted. Scientific achievements are described; its implementation in practical health care has social value.

Keywords:

Institute, history, science, medical care, quality.

Consequences of nuclear tests on the new Earth. Message 2. Health of the inhabitants of far north living near northern nuclear test site.

Year: 2011 (December) Number: №4 Pages: 71-79

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: V.M. Shubik.

Organization: Scientific Health Center of Veterans of Divisions of an Extra Risk Federal State Healthcare Institution Medical and Sanitary Unit №144 of FMBA of Russia, St. Petersburg.

Annotation:

Objective
The objective is to evaluate a condition of immunity and health of the natives of Far North of Russia living near Northern nuclear test site (Novaya Zemlya).

Materials and methods
Indicators of cellular and humoral immunity were studied in natives and visitors of the region of the Far North located near the Northern test site – the Nenets Autonomous Area and the Kola Peninsula, and also for comparison in the remote area – Chukotka Autonomous Area.

Data of medical statistics and primary medical documentation (outpatient cards and clinical records) were analyzed for the characteristic of mortality, incidence, the course of pregnancy and childbirth.

Results
The expressed abnormalities of cellular immunity, less considerable – humoral immunity, increase of infectious incidence, abnormalities of processes of pregnancy and childbirth are shown at natives of the European North of the Russian Federation – the Komi, Sami, Nenets. A cause of abnormality of immunity and health at natives of Far North is the stressful situation connected with change of traditional way of life and extreme ecological consequences. Pathological changes develop according to the scheme: stress - change in immunity - abnormality of health.

Conclusions
The stressful situation is a consequence of withdrawal pains of change of traditional way of life as a result of fast rates of industrial development of the North, tests of the nuclear weapon on New Earth, effect of toxic chemicals in combination with extreme living conditions; these cause abnormality of immunity and health of natives.

The combined action of small doses of radiation and toxic emissions of the chemical companies are needed to be studied.

Keywords:

Northern test site, natives, stress, immunity, health.

System approach to the assessment of biological effects of ionizing radiation.

Year: 2011 (December) Number: №4 Pages: 80-84

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: E.V. Goloborodko, Yu.A. Solovyov.

Organization: Department of organization of scientific researches of FMBA of Russia, Moscow.

Annotation:

In this article possibility of application of the principles of system biology at the description of action of ionizing radiation is discussed. In particular, the combination of methods of genomics, proteomics and metabolomics allows to gain the most complex impression about effects of this extreme influence. It is shown that such methodological approach is possible, perspective and widely applied in world science.

Keywords:

Ionizing radiation, genomics, proteomics, metabolomics, systemic radiobiology.

Disinfection of rooms by aerosols of the electroactivated solutions.

Year: 2011 (December) Number: №4 Pages: 85-90

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: E.N. Sventitsky, E.V. Chernyaeva, T.S. Egorova, N.V. Kontorina, Yu.N. Tolparov, V.L. Iskritsky.

Organization: Federal State Unitary Enterprise State Research Institute of especially pure preparations of FMBA of Russia, St. Petersburg.

Annotation:

Objective
The objective is to investigate efficiency of disinfection by high-disperse aerosols of the electroactivated chloride sodium water solution.

Materials and methods
The electroactivated disinfecting solution was obtained on the “STEL” installation (NPO “Ekran”, Moscow). Dispergation of a disinfectant was made by the original high-performance vortex acoustic generator.

Experimental samples were prepared by putting bacterial or virus suspension on a surface with various physical properties. Disinfection of samples was carried out in the 2.9 m3 aerosol camera or in the room of 80 m3.

Efficiency of decontamination was estimated by comparing quantity of viable cells on the prototypes processed by an electroactivated aerosol and control samples which processed an aerosol of physiological solution in the similar mode.

Toxicity of an aerosol of electroactivated solution was studied on white not purebred mice. In addition the assessment of influence of an aerosol of electroactivated solution in the course of disinfection on appearance of interior materials, operability of the electronic equipment and laboratory devices was carried out.

Results
It is shown that the aerosol of electroactivated solution had high biocidal activity. Efficiency of disinfection depended on a species of microorganisms, properties of contaminated surfaces and dispersion of an aerosol. The use of a high-disperse aerosol of electroactivated solution provided inactivation of grams - positive and gram - negative bacteria, micobacteria of tuberculosis, bacterial spores, viruses H5N1 and A H1N1 on various surfaces with high level of a contamination (1х106 CFC's/cm2 for bacterial and 1х106 EID50/cm2 of virus containing surfaces).

It is shown that for aerosol disinfection of the isolated room it was required from 25 to 100 ml of electroactivated solution for 1 m3. Disinfection didn't make toxic impact on experimental animals, and also didn't damage interior materials and laboratory equipment.

Conclusions
On the example of the use of aerosol with electroactivated solution it is shown high disinfecting efficiency of the fine aerosols used by the VAG vortex acoustic generator. The small expense of a disinfectant and absence of negative impact on environment allow to recommend the offered disinfection method for practical use.

Keywords:

Disinfection, high-disperse aerosols, electroactivated solutions, ecological safety.

HBO as a method of choice in successful treatment of patient with acute oral trotyl poisoning. Clinical case.

Year: 2011 (December) Number: №4 Pages: 91-95

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.N. Ostapenko, V.V. Fedorenko, A.N. Evtyukov, O.V.Obukhov, A.Yu. Kovrigin, E.Yu. Ivanova, Yu.Yu. Bukharin, P.G. Rozhkov.

Organization: Municipal Budgetary Institution City Hospital №1, Kostroma; Federal State Institution Scientific and Practical Toxicological center of FMBA of Russia, Moscow.

Annotation:

Objective
The objectives are to describe a clinical case of rare acute oral poisoning with trotyl (trinitrotoluene), choice of rational therapy in the absence of a specific antidote – solution methylene blue, the use of information and advisory support.

Materials and methods
The materials and methods are analysis of data of a medical record of the inpatient (form №003/y) including the description of symptoms in dynamics, results of the clinical and biochemical blood test, urine which is carried out by standard techniques, methemoglobin level by a photocolorimetry method, and also record cards of patient’s consultation with acute chemical poisoning (form №163/y-04).

Results
The clinical case of treatment is described in City Hospital №1 in Kostroma city of acute poisoning owing to a swallowing a piece of a trotyl checker which was followed with characteristic for influence nitro - and amino derivatives of aromatic hydrocarbons by symptoms: cyanosis, formation of a methemoglobin in quantity from 44,1% at hospitalization to 56,0% for the next days. In view of absence of antidote – methylene blue therapy included conservative detoxication actions (digestive tract sanation, the forced diuresis), injection of ascorbic acid solutions, glucose. HBO was the main method of treatment directed on reduction of consequences of blood hypoxia. 6 sessions were carried out in total with the expressed positive dynamics of improvement of health, reduction of cyanosis, normalization of oxygen saturation. The further disease course was without complications.

Conclusions
Poisoning with trinitrotoluene proceeded with a typical for this toxic agent low metgemoglobin level which was in the limits allowing to classify poisoning as average weight.

In the conditions of antidote absence – methylene blue, major importance conferred to HBO that decrease level of hypoxia, and to positive results of a clinical course, reduction of cyanosis allowed to be limited by methods of a conservative detoxication.

Feature of a case is timely use of information and advisory support of toxicologists of the Federal Scientific and Practical Toxicological center of FMBA of Russia.

Keywords:

Trinitrotoluene, methemoglobin, hyperbaric oxygenation (HBO), toxicological information.

Medical and psychological assistance to the victims during Georgian-South Ossetia conflict.

Year: 2011 (December) Number: №4 Pages: 96-101

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: E.A. Ogurtsova, T.I. Mitrokhina, S.A. Malmberg.

Organization: Children's Clinical Hospital №38, Center of Ecological Pediatrics of FMBA of Russia, Moscow.

Annotation:

In this article medical and psychological aspects of assistance to victims during military operations are considered. The team of neuropsychiatrists and psychologists examined 42 patients evacuated from a zone of Georgian-South Ossetia conflict. According to clinical and psychological examination anxious phobia, asthenia, depressive and dysphoric manifestations of post-traumatic stressful frustration are revealed.

The specialized help was carried out taking into account a clinical picture, structure and severity of revealed mental disorders, age, existence of the accompanying somatic and neurologic abnormalities, prescribed anxiolytics, antidepressants, tranquilizers, nootropic range of action, short-term psychotherapy. Ways of further medical and psychological rehabilitation of victims are offered.

Keywords:

Psychotherapeutic help, Georgian-South Ossetia conflict.

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