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

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№4, 2017 (December)

Special aspects of medical care provided the to sailors working in the Arctic regions

Year: 2017 (December) Number: №4 Pages: 8-14

Article type: Scientific article.

Authors: E.V. Kazakevich, V.L. Arkhipovskiy, A.P. Sereda, A.A. Abakumov

Organization: Federal State Budget Institution of Healthcare “Northern Medical Clinical Center named after N.A. Semashko of Federal Medical-Biological Agency”, Arkhangelsk; Federal Medical-Biological Agency, Moscow.

Annotation:

The article singles out a unique part of the country - the Arctic Region, which in recent years has become one of the priorities in Russian socio-economic development. The Federal Medical Center that provides medical care to sailors working in the Arctic Regions, shares its experience. The specifics of Arctic Sea voyages, the morbidity patterns among sailors; the analysis of problems in marine medicine related to the professional training provided to the doctors on board, the medical offices provision with the pharmaceuticals, medical devices and medical equipment, the policy for medical consultations at sea and the medical trainings provided to the commanding officers; the establishment the Regional Maritime Medical Center were considered and justified in the article.

Keywords:

Arctic Regions, sailors, doctors on board, medical consultations at sea, medical training for the commanding officers, Marine Medical Center.

Special features of medical care given to seafarers working in the Arctic region

Year: 2017 (December) Number: №4 Pages: 15-20

Article type: Scientific article.

Authors: E.V. Kazakevich, V.L. Arkhipovsky, A.P. Sereda, A.A. Abakumov

Organization: Federal State Budget Institution of Healthcare “Northern Medical Clinical Centre named after N.A. Semashko of Federal Medical-Biological Agency”, Arkhangelsk; Federal Medical-Biological Agency, Moscow.

Annotation:

The Arctic region has recently become the top priority in the socio – economic development of Russia. Federal State Budget Institution of Healthcare “Northern Medical Clnical Center named after N.A. Semashko of Federal Medical-Biological Agency”, Arkhangelsk (FSBI NMCC) has gained valuable experience in providing medical care to the crews working in the Arctic region. We have evaluated the peculiarities of sea voyages in this particular region as well as the structure of the diseases which affected seamen working in the Arctic conditions. We have analyzed the spectrum problems which marine medical society may encounter including training of medical professionals engaged in maritime health; provision and selection of medical technologies, pharmaceuticals and treatment options as well as medical equipment of medical health centres on board. We have also estimated the appropriateness of setting up Regional marine medical centre.

Keywords:

Arctic region, seafarers, ship doctors, medical consultations at sea, medical training of officers in command, Marine medical centre.

Neurophysiology in early diagnosis and prediction of clinical course of neuroinfections

Year: 2017 (December) Number: №4 Pages: 21-29

Article type: Scientific article.

Authors: Voitenkov V.B., Vilnits A.A., Skripchenko N.V., Grigoryev S.G., Klimkin A.V., Aksenova A.I.

Organization: Pediatric Research and Clinical Center for Infectious Diseases, St-Petersburg.

Annotation:

The aim of our work was to evaluate the prognostic value of neurophysiology based methods (TMS, EMG, BAEPs) in detection and recovery prediction of various forms of neuroinfections in children. Methods: 146 children (3–17 years old) were evaluated with BAEPs, TMS and EMG: 65 patients had acute bacterial meningitis, 37 had acute inflammatory demyelinating polyneuropathy (AIDP), 24 had acute transverse viral myelitis and 20 healthy controls of comparable age. I–V and III–V intervals, amplitudes of the III and V peaks were registered and analyzed with BAEPs, in AIDP patients were used EMG and TMS with an assessment of cortical and lumbar MEP`s latencies, shapes and amplitudes and CMCT, CMAP amplitudes, CV and H-reflex thresholds, latencies and amplitudes were averaged and analyzed.
There was statistically significant difference between the groups on the I–V interpeak interval and amplitudes of III and V peaks. ROC-analysis revealed that I–III, I–V interpeak intervals and amplitudes of III and V peaks were sensitive and specific in psycho neurologic deficit prediction within the recovery period. Significant differences between children with AIDP and controls on latencies of both cortical and lumbar MEPs were registered. Cortical MEPs shapes were disperse in 100% of the cases, and lumbar MEPs in 57% of the cases. Also H-reflex was absent in 94,5% of children on 3–7 day from the onset of the first symptoms. Thus, diagnostic TMS and H-reflex investigation on the early stage of the AIDP in children may be implemented as the additional tool of early detection. In myelitis most significant for the recovery was absence or presence of MEPs lower than the lesion’s level. Neurophysiology methods may be used for the detection and prediction of recovery from various forms of neuroinfections in children.

Keywords:

Brainstem auditory evoked potentials, transcranial magnetic stimulation, H-reflex, bacterial meningitis, acute inflammatory demyelinating polyneuropathy, acute transverse myelitis, children, prognostic tools.

The first experience in mobilization of hematopoietc stem cells into the pripheral blood steream in patients with lymphoproliferative dosoders

Year: 2017 (December) Number: №4 Pages: 30-35

Article type: Scientific article.

Authors: S.V. Gritsaev, A.A. Kuzjaeva, I.I. Kostroma, I.M. Zapreeva, Zh.B. Chubukina, A.V. Celjtser, V.A. Balashova, V.I. Rugal’, S.S. Bessmeltsev, A.V. Chechetkin

Organization: Federal State Budget Institution “Russian research institution of hematology and transfusiology of Federal Biomedical Agency”. 191024, Russia, St.Petersburg.

Annotation:

The data on mobilization regimen with vinorelbine used to collect an autologous stem cell transplantation graft in patients with multiple mueloma and lymphoma were analyzed. The toxiсity evaluation for vinorelbine along with quantitative and qualitative characteristic of autograft have been done. The conclusion is that application of vinorelbine is safe, effective and is a simple method of stem cell mobilization.

Keywords:

Vinirelbine, mobilization regimen, autologous stem cell transplantation, multiple myeloma, lymphoma.

Catastrophic antiphospholipid syndrome in critical care

Year: 2017 (December) Number: №4 Pages: 36-49

Article type: Scientific article.

Authors: K.A. Popugaev, I.N. Lobanova, S.A. Abudeev, N.M. Krugliakov, K.A. Belousova, G.I. Bagzhanov, S.A. Bakharev, D.G. Shmarova, Yu.D. Udalov, M.V. Zabelin, A.S. Samoilov

Organization: Research Medical Center Burnasian State, Federal Medical & Biological Agency of Russia Moscow; Federal Medical-Biological Agency, Moscow.

Annotation:

Ischemic damage of organs is one of the leading mechanisms of the pathogenesis in critical illnesses and the standard mechanisms of thanatogenesis. Prevention methods for thromboembolic events are included in contemporary protocols of management. However, rates of these complications remain high, and diffuse thrombotic microangiopathy can occur in critically ill patients. The syndrome of disseminated intra vascular coagulation, hepa rininduced thrombo cytopenia, thrombotic thrombocytopenic purpu ra, hemolytic-uremic syndrome, and catastrophic antiphospholipid syndrome can be developed in critically ill patients, and manifested with hypercoagulation and thromboembolic complications, which can not be prevented with standard anticoagulation prophylactics.

Keywords:

Disseminated intravascular coagulation, heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, catastrophic antiphospholipid syndrome, thromboembolic complications.

Update on dental care continuity provided to personel subjected to hazardous and dangerous workplace environment

Year: 2017 (December) Number: №4 Pages: 50-55

Article type: Scientific article.

Authors: V.N. Olesova, V.V. Uiba, A.N. Shmakov, E.E. Olesov, E.V. Glazkova

Organization: FGBOU DPO «Institute for Advanced Studies of FMBA of Russia», Moscow.

Annotation:

The article analysis the performance of dentists at the ministerial sanatoriums at the FMBA of Russia; the indicators of dental issues related to the with workplace conditions; described the results of the survey in the sanatorium, we calculate the need for dental treatment in sanatorium facility and the labor intensity. Were worked out the actual regulations that define professional relations between the dentists working at the sanatorium.

Keywords:

Sanatorium, dental morbidity, the need for treatment, labour intencity, the complexity of the organization.

Application for the Con-Trex Diagnostic and Training Unit with Biological Feedback in Injured Shoulder Joint Post-Operative Rehabilitation

Year: 2017 (December) Number: №4 Pages: 56-62

Article type: Scientific article.

Authors: E.M. Kabaev, V.I. Troubnikov, A.B. Malkov

Organization: Center for Restorative Medicine of the Federal Siberian Research and Clinical Center of the Russian Federal Medical and Biological Agency, Krasnoyarsk; Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky, Krasnoyarsk.

Annotation:

To study the possibilities and effectiveness of robotic mechanotherapy using Con-Trex module in the rehabilitative treatment of patients who underwent an arthroscopic shoulder reconstructive surgery. 26 patients on rehabilitative treatment after arthroscopic shoulder reconstructive surgery (Bankart and Hill-Sachs lesions) were divided into two groups. The control group of 10 people received standard treatment (special training sessions with an instructor, physiotherapy and massage) and the experimental group of 16 people received complex restorative treatment using robotized mechanotherapy. The treatment results were assessed using goniometry and visual-analogue scale (VAS). Within the three months period, on a weekly basis, individual charts were filled out and performed the statistical evaluation of the recovery dynamics. In the experimental group in addition have been studied the data from Con-Trex feedback protocols.
The complex rehabilitation with the use of robotic mechanotherapy showed reliable clinical improvement in pain syndrome in 4 weeks, and in the joint ROM – in 2 weeks. In three months full recovery of functional activity was seen in 15 participants in the experimental group and in 5 participants from the control group. More efficient restorative treatment of postoperative functional insufficiency of the shoulder joint with using robotized mechanotherapy of Con-Trex module in isokinetic and CPM modes was identified. It allowed to accelerate the process of active rehabilitation.

Keywords:

Post-operative rehabilitation, shoulder joint, robotic mechanotherapy, Con-trex.

Genetic researches for medicine of extreme situations (review)

Year: 2017 (December) Number: №4 Pages: 63-74

Article type: Occupational safety and security.

Authors: N.Yu. Ponomareva, V.G. Mitkovsky, E.N. Yampol'skaya, A.V. Kochetkov

Organization: Federal State Budgetary Healthcare Institution Central Clinical Hospital of Rehabilitation Federal Medical Biological Agency of Russia, Moscow, Russia.

Annotation:

The analysis of innovative technologies has been carried out: molecular and genetic researches of the genome; microbiome; identification of biomarkers of a pathogenesis and thanatogenesis; the personalised approaches in diagnostics, treatment and prevention of widespread multifactorial pathologies; the role of the genotype, hereditarily and environment factors in adaptive response of an organism; development of pathological and borderline conditions. Was considered a possibility of the practical application at the FMBA medical institutions in health careprovision, including the extreme situations. Such knowledge of genetically determined features - as physical (endurance, speed, force, a regulation of a tone of vessels, a hemostasis, the immune response, an inflammation, a metabolism, mechanisms of detoxicating of an endogenic and exogenenic origin), and characterologic - is undoubted not only concerning the patient to whom the medical care, but also concerning professional selection of the experts working in extreme conditions, emergency situations, sports of the highest achievements is provided. It is important to give definition to the pharmacokinetics features, risk of development of undesirable reactions to medicines in advance (prior to the emergency situation). A recent trend in an intensive care is the genetics of critical states. The research of of microbiota, molecular mechanisms of integrating human and microbiota metabolisms, formation of resistance to drug therapy represents the possibilities of practical application of this information in the medicine of critical states. Using the approaches of systematic review and meta-analysis allows the GP to critically evaluate, correctly generalize and apply the results of clinical studies, huge arrays of biomedical information and technologies in health care.

Keywords:

Extreme situations, extreme conditions, border line conditions, personalized medicine, genes, polymorphism, predisposition, biomarkers, pharmacogenetics, sports.

What biological impact electromagnetic radiation has on waterways transport crew and ways to reduce the exposure

Year: 2017 (December) Number: №4 Pages: 75-79

Article type: Occupational safety and security.

Authors: A.A. Abakumov, S.V. Novikov, V.K. Novikov, N.V. Aleksandrova

Organization: FMBA of Russia; FSUE SSRIBE; MSAWT – branch of FSEI HE Admiral Makarov State University of Maritime and Inland Shipping.

Annotation:

The article proposed a number of organizational and scientific methodological activities to increase the level of crews’ safety from the electromagnetic field. The suggestion is based on data analysis of the biological impact electromagnetic field have on humans; information about the sources of electromagnetic field on waterways transport; organization, control and protection of waterways transport crews from the impact of the field.

Keywords:

Electromagnetic field, biological impact, crews, vessel, waterways transport.

Development of standard samples of structure of blood, containing toxic metals: lead, mercury, cadmium, beryllium and thallium

Year: 2017 (December) Number: №4 Pages: 80-94

Article type: Occupational safety and security.

Authors: V.K. Sibiryakov, A.V. Malov, R.K. Glushkov, M.V. Marchenko, G.V. Rutkovsky, L.I. Goryaeva

Organization: «Institute of toxicology» of Federal Medico-Biological Agency», Saint – Petersburg; Federal State Unitary Enterprise «The Ural Research Institute for Metrology», Yekaterinburg.

Annotation:

Purpose – reconciliation of the research results related to the creation of standard reference materials (SRM), containing toxic metals in blood (lead, mercury, cadmium, beryllium and thallium). Donated human blood and bovine blood enriched by in vitro methods with water solutions of the above metals forms the basis of the SRM’s. In addition the blood of rats treated via peroral administration of metal salts is used. Blood samples, containing the above metals, were treated by lyophilic drying in order to produce reference materials. SRMs were checked for homogeneity and stability. In addition attestation analysis and inter laboratory metrological evaluation was done. Types of developed SRMs approved by Rosstandard and included in the State Registry with the appropriate registration numbers.

Keywords:

Lead, mercury, cadmium, beryllium, thallium, blood, standard samples, stability, the attestative analysis, the statement such as a standard sample.

Motion pattern of human gait in varying gravitation load on the musculoskeletal system

Year: 2017 (December) Number: №4 Pages: 95-104

Article type: Occupational safety and security.

Authors: A.V. Shpakov, A.V. Voronov

Organization: Research Institute for Space Medicine Federal Research Clinical Center of Federal Biomedical Agency of Russia, Moscow; Federal Research Center of Physical Education and Sports, Moscow.

Annotation:

Fifteen men and nine women participated as volunteers in the investigation. They performed a walking on treadmill at the pace of 90 steps/minute with different gravitational loading on the musculoskeletal system. We investigated the biomechanical characteristics of the normal walking on a treadmill under conditions of different gravitational load on the musculoskeletal system. The change and regulation of the gravitational load on the musculoskeletal system produced by the vertical suspension with «H/P/Cosmos-Airwalk» system. Electromyographic activity of the leg and thigh muscles was recorded and analyzed. The article presents the results of a comparative analysis of the electromyographic profile of muscles in a double-step cycle during walking under conditions of different gravitational load on the musculoskeletal system (100, 38 and 16% of the body weight). The results of the study revealed significant changes in the motor pattern of walking in the conditions of reducing the weight load on the musculoskeletal system. The most pronounced changes in EMGactivity and EMG amplitude were observed in the shin muscles, in particular, the ankle extensors m. soleus and m. gastrocnemius medialis in different phases of the double step.

Keywords:

Locomotion, normal walking, electromyography, EMG-activity of muscles, simulated gravity, double step, double-step phases.

Organizational and Methodical and Legal Basis for Medical and Medical-Biological Support of Persons Who Do Physical Training and Sports on Their Own

Year: 2017 (December) Number: №4 Pages: 105-112

Article type: Occupational safety and security.

Authors: A.B. Fedin, A.S. Samoylov, I.T. Vykhodets, I.V. Kruglova

Organization: State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency (SRC-FMBC), Moscow, Zhivopisnaya str., 46.; Ministry of Healthcare of the Russian Federation, Moscow, Rakhmanovskiy lane, 3; Federal Research and Clinical Center of Sports Medicine and Rehabilitation of Federal Medical Biological Agency (FSMC), Moscow, Bolshaya Dorogomilovskaya str., 5..

Annotation:

The article contains an analysis of the existing regulatory documentation, as well as the organiza tional and methodological basis for medical and medical-biological support for persons who do physical training and sports on their own. Based on the analysis of the legal and regulatory basis, it is determined that at present in the Russian Federation the issues related to health care of persons who do physical training and sportson their own are not fully addressed in these documents, including such kinds of sports that are serious and stressful enough to the body, for instance - amateur triathlon.

Keywords:

Sports and physical training, regulatory acts, legal regulation, medical support, medicalbiological support, triathlon.

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