Medicine of Extreme Situations
Scientific and Practical reviewed Journal
of FMBA of Russia
included in the list of HAC
№1, 2018 (March)
BIOTERRORISM IN SERIES OF BIOLOGICAL THREATS: PAST AND PRESENT.
Year: 2018 (March) Number: №1 Pages: 22-34
Article type: Scientific article.
Authors: Lobzin Yu.V., Lukin E.P., Lukin P.E., Uskov A.N.
Organization:
Children’s Scientic and Clinical Center of Infectious Diseases of the Federal Medical-Biological Agency», Saint Petersburg, 197022, Russian Federation; Central Research Institute of the Ministry of Defense of the Russian Federation, Sergiev Posad-6, 141306, Russian Federation; M.V. Lomonosov Moscow State University, Moscow, 119992, Russian Federation; I.I. Mechnikova North-West State Medical University, St. Petersburg, 195067, Russian Federation.
Annotation:
The threat of bioterrorism is one of the forms of terroristic threat in general, despite the fact that there is an undoubted proximity between the issues of bioterrorism and biological warfare, as in both cases pathogens are the means of the destruction. Since international Convention on the prohibition of the development, production and stockpiling of bacteriological (biological) and toxin weapons and on their destruction has been signed (1972) and came into force (1975), the threat of full-scale biological war can be considered to be eliminated. The acts of bioterrorism in the future are not excluded, although they are unlikely. The threat due to accidents and emergencies while working with pathogens in the research process and during the production of biologic products, as well as the threat of nosocomial infections, remain to be more urgent. However, not anthropogenic, but natural biological threats, in the form of outbreaks of infectious diseases, previously unknown or non-endemic for some particular region, are the greatest danger to the modern mankind.
Keywords:
Terrorism; biological terrorism; biological warfare; biological agent; biological attack; biological threat
TO THE QUESTION OF MEZO-LEVEL MEDICAL-SOCIAL REHABILITATION IN THE RUSSIAN FEDERATION (ON THE EXAMPLE OF THE SOUTHERN FEDERAL DISTRICT).
Year: 2018 (March) Number: №1 Pages: 35-41
Heading: Medical sciences.
Article type: Scientific article.
Authors: Zabelin M.V., Liderman E.M.
Organization:
Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Moscow,123182, Russian Federation; A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medico-Biological Agency of the Russian Federation, Moscow, 123182, Russian Federation.
Annotation:
In the article on the basis of the system approach, there is explained the need for the organization of medical and social rehabilitation at the meso-social level, located in the territorial structure of the Russian Federation and represented by federal districts. The study of the organization of medical and social rehabilitation at the meso-level was emphasized to be able to serve as an instrument (or model) for the creation of an integrated national-state system of medical and social rehabilitation, which is itself a rather complex social construct. The study of its organization, management, functioning requires the analysis of various objective factors and conditions characteristic of a particular level of the social organization. Meso-level is a sub-regional organization of the society, characterized by both general and specific (local) characteristics - territorial, natural and climatic, socio-economic, mental, sociocultural, demographic, urbanization, etc. At this level of social organization, medical and social rehabilitation is presented by a subregional intermediate system between the micro-level (city, district) and macro-level (state-national) systems. The study of the specifics of the organization of medical and social rehabilitation at the meso-level will allow identifying and resolving the most important contradictions hampering the process of its integrated organization, as well as adaptation to national policy in this area to the local level. These contradictions are between general and special matter; the integration and differentiation in the construction of the state-national system of the medical and social rehabilitation (MSR); the needs of the region in it and the possibility of satisfaction at the expense of state programs; innovative forms of management and the inertia of local authorities to take them, etc. On the example of the Southern Federal District (SFD) in the article, there are outlined the most important meso-level features of the organization of an integrated system of medical and social rehabilitation. The complexity is emphasized not to be only the unity of medical, socio-psychological and vocational rehabilitation, but also the unity of the social levels of the organization: from the nano-level, represented by district and city health facilities and rehabilitation centers, to the mega-level represented by the national-state system, and the meso-level is the integrating link relating them. The distribution of institutions providing medical assistance on the profile of the “medical rehabilitation” in the SFD is quite uneven in both quantitative and qualitative terms. In all subjects of the district, the first and second stages of medical rehabilitation are carried out by medical institutions in which rehabilitation departments or beds are in operation, and the routing of patients during medical rehabilitation is provided. Private clinics and rehabilitation centers, whose activities, although subject to licensing, are not effective enough, compensating the need for the medical and social rehabilitation but fail to cover the need for rehabilitation assistance, as well as there is lack of professional staff - a rehabilitation physician, instructor-methodologist in physiotherapeutic y exercises, a nurse for rehabilitation; doctor-rehabilitologist on the profile of the disease. At all levels of the MSR there is a traditional tariff-qualification grid of ranks, which is not justified in the new conditions of economic development. However, despite all the negative aspects of the problem, socio-economic development and infrastructure of the SFD allow actively implementing the automation of diagnostic and treatment methods, develop telemedicine in this area, and provide organizational and information support for rehabilitated persons.
Keywords:
Nano-social level; macro-social level; meso-social level of the organization of medical and social rehabilitation; model of the medical and social rehabilitation; publicprivate partnership in health care; the informatization of medicine and health.
STAGNATION OF MODERN SPACE MEDICINE: SYMPTOMS, DIAGNOSIS AND APPROACHES TO THE MANAGEMENT.
Year: 2018 (March) Number: №1 Pages: 42-47
Heading: Medical sciences.
Article type: Scientific article.
Authors: Ushakov I.B.
Organization:
A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medico-Biological Agency of the Russian Federation, Moscow, 123182, Russian Federation.
Annotation:
In recent years there are begun to appear some objective and subjective circumstances, which are the reasons for the stagnation in space medicine (SM): regularly forced time-shifting of major projects and programs in the space sector; leftover financing principle and subjective features (the lack of elaborate personnel policy, the tendency of some scientists to create monopoly and, respectively, ignore the very opportunity of the fundamental changes within the system of flight medical support). Signs (symptoms) of the stagnation, which simultaneously are the causes in large part, are following: the absence of new scientific facts, concepts and theories; the sharp decline in the number of significant representative experiments; apparent lack of major summarizing monographs; weakening with each year conferences; decreasing number of its participants; a growing number of complaints from the astronauts on the various components of medical support system. For overcoming this stagnation it is necessary to solve the problems with practical implementation. Anticipating developments are urgently required in order to improve radiation protection in space missions.
Keywords:
Space medicine; stagnation; medical support system; space flights’ risks; radiation safety.
PECULIARITIES OF RENDERING HEALTH CARE IN GUNSHOT WOUNDS OF THE CHEST IN CONDITIONS OF LOCAL ARMED CONFLICT.
Year: 2018 (March) Number: №1 Pages: 48-59
Heading: Medical sciences.
Article type: Scientific article.
Authors: Maslyakov V.V., Barsukov V.G., Kurkin K.G.
Organization:
Branch of a Private Institution of the Educational Organization of Higher Education «Medical University» Reaviz «, Saratov, 410004, Russian Federation.
Annotation:
The performed analysis showed primary specialized care for gunshot wounds to the chest to have to include: sorting, anesthesia, hemostatic treatment, infusion-transfusion therapy, symptomatic treatment and timely surgical intervention. The injured patients needed of emergency surgical treatment are sent to the operating room: first of all, those injured with intense hemopneumothorax, suspicion of cardiac tamponade, ongoing external or internal bleeding; secondly - the wounded without deterioration of the vital functions for the primary surgical treatment of chest wounds. In the intensive care unit, the wounded patients were hospitalized in a state of shock, with breathing and hemodynamic disorders that did not need an emergency surgical intervention, as well as the wounded cases shown to be in need of the preoperative preparation. In the surgical department, there were hospitalized wounded persons in need of conservative treatment, in which the amount of surgical intervention could be performed in a dressing room. At the same time, the main shortcomings in rendering assistance to civilians with severe gunshot trauma in the conditions of a local military conflict are the absence both of a system of prehospital care, a proper infrastructure of the hospital stage, continuity in treatment, rehabilitation, and the possibility of analyzing the results of care. An important factor is insufficient training of personnel to provide assistance to the wounded with severe combined trauma.
Keywords:
Gunshot wounds to the chest; civilian population; health care; local military conflict.
PREVENTION OF VENOUS THROMBOEMBOLIC COMPLICATIONS IN COMBAT GUNSHOT TRAUMA.
Year: 2018 (March) Number: №1 Pages: 60-71
Heading: Medical sciences.
Article type: Scientific article.
Authors: Zubritskiy V.F., Koltovich A.P., Nikolaev K.N., Kapustin S.I., Dolidze D.D., Belyakov K.V., Bezuglyy A.V., Kandyba S.I., Mayorov A.V., Martirosyan K.V.
Organization:
Main Clinical Hospital of MIA of Russia, Moscow, 123069, Russian Federation; Institute of Medical and Social Technologies of the Moscow State University of Food Production, Moscow, 125080, Russian Federation; Main Military Clinical Hospital of the Troops of the National Guard of the Russian Federation, Balashikha, 143912, Russian Federation; Russian Research Institute of Hematology and Transfusiology FMBA of Russia, St. Petersburg, 191024, Russian Federation; Russian Medical Academy of Continuous Professional Education; Moscow, 123995, Russian Federation; S.M. Kirov Military Medical Academy, St Petersburg, 194044, Russian Federation; Academician N.N. Burdenko Main Military Clinical Hospital, Moscow, 105229, Russian Federation.
Annotation:
The aim of the study was the improvement of the methods of preventing venous thromboembolic complications in the victims with combat gunshot trauma.
Material and methods. The analysis of the results of treatment and methods of the prevention of venous thromboembolic complications in 254 victims with combat gunshot injury received during the conduct of combat operation, which were provided with qualified medical assistance in a separate medicalsanitary battalion and special-purpose medical unit in the North Caucasus, followed by the evacuation in the Main Military Clinical Hospital of the troops of the National Guard of the Russian Federation and the Main Clinical Hospital of the Ministry of Internal Affairs of the Russian Federation over the period from 1994 to 1997 and from 1999 - 2016.
There were used pharmacological (unfractionated heparin, low molecular weight heparins) and mechanical (bandaging of the lower limbs with elastic bandages, compression knitwear, pneumocompression, electromyostimulation) were used. The evaluation of the effectiveness of preventive measures included ultrasound angioscanning of the veins of the lower limbs, examination of the platelet and coagulation compartments of the coagulating blood system, the estimation of the genetic predisposition of the wounded patients to thrombosis.
Results. The comprehensive prevention of thromboembolic complications in patients with head injuries at all stages of treatment was shown to allow reducing the incidence of venous thrombosis by 2.3 times. Genetic defects of the hemostatic system were detected in 62.5% of the wounded cases with venous thrombosis. Pathological changes in the hemostasis system were established to persist for 30 days after injury and maintain a high risk of thrombus formation. Long-term preservation of thrombinemia indicates to the need for preventive measures until both the normalization of the coagulation system and the elimination of existing risk factors for venous thromboembolic complications.
Complex prevention of venous thromboembolic complications is a safe, effective component of the treatment of the wounded.
Keywords:
Wound of head, thrombosis, embolism, thrombophilia, prevention.
IMPROVEMENT OF LABORATORY METHODS OF EARLY DETECTION AND SPECIES IDENTIFICATION OF BACTERIA AND MICROMYCETES IN BLOOD WITH THE USE OF PCR IN THE «REAL TIME» MODE.
Year: 2018 (March) Number: №1 Pages: 72-78
Heading: Medical sciences.
Article type: Scientific article.
Authors: Kiseleva E.E., Kaytandzhan E.I., Stizhak N.P., Burylev V.V., Chebotkevich V.N., Bessmeltsev S.S.
Organization:
Russian Research Institute of Hematology and Transfusiology FMBA of Russia, St. Petersburg, 191024, Russian Federation.
Annotation:
The article describes a method for the early detection and species identification of bacteria and micromycetes in the blood of bloodstream infections patients on the base of the molecular biological method. The developed method is based on obtaining hemoculture in an automatic analyzer of bacteria with the subsequent identification of microorganisms with the use of real-time PCR. The efficacy of the method for adult patients was 95.5%. The process of species and generic identification of pathogens using PCR-RV was shown to be reduced up to 5-7 hours, which is important for the timely implementation of the etiotropic therapy.
Keywords:
Blood flow infections, PCR-RV, hemoculture, infectious complications.
THE IMPACT OF EXTREME SITUATIONS ON THE STATE OF HUMAN HEALTH.
Year: 2018 (March) Number: №1 Pages: 79-85
Heading: Medical sciences.
Article type: Scientific article.
Authors: Nevzorov V.P., Chuchko V.I.
Organization:
A.I. Burnazyan Federal Medical Biophysical Centre of the Federal Medico-Biological Agency of the Russian Federation, Moscow, 123182, Russian Federation; Main Military Clinical Hospital of the Troops of the National Guard of the Russian Federation, Balashikha, 143912, Russian Federation.
Annotation:
The purpose of this work is to show the influence of the external environment, acting on the body by means of potentially dangerous agents of different nature (physical, chemical, biological, etc.), on the health status of workers of extreme medicine. There are considered principles of the determination of the biological age (BA) of a person and its deviation from the calendar age for people exposed to extreme factors (radioactive effects, working with radioactive sources, performing the work in emergency situations and extreme conditions), among which the participation of organized collectives play a decisive role. To assess these effects, we used biomarkers, which are a system of indices of aging of the body, its organs, and functions. BA was shown to fully meet the requirements of the indicator value for the improvement of the expert evaluation of the influence of any extreme factor acting for a long time.
Keywords:
Biological age; prolonged influence of extreme factors; radioactive radiation; examination of the state of health.
ORGANIZATION OF THE CONTROL SYSTEM AND ISSUES OF HEALTH PERSONNEL SUPPORT IN THE CONDITIONS OF ENTERING OF RADIONUCLIDES PLUTONIUM AND AMERICIUM THROUGH DAMAGED SKIN COVERING.
Year: 2018 (March) Number: №1 Pages: 86-93
Heading: Occupational safety and security.
Article type: Scientific article.
Authors: Bogdanov I.M., Zaytsev E.P., Ovchinnikov A.V., Krivoshein D.D., Izmestev K.M.
Organization:
Hygiene and Epidemiology Center No. 81 of the Federal Medical and Biological Agency, Seversk, 636000, Russian Federation; Joint Stock Company “Siberian Chemical Combine”, Seversk, 636039, Russian Federation.
Annotation:
The article considers the joint experience of Joint Stock Company «Siberian Chemical Combine» and Hygiene and Epidemiology Center No. 81 of the Federal Medical and Biological Agency of Russia for the detection of radionuclide receipts through the damaged skin in the staff of plutonium production facilities. Under the conditions of the work of various enterprises (both domestic and foreign), such cases were shown to occur quite often and can lead to the occurrence of significant dose loads on the body of workers. Analysis of cases allowed identifying critical occupations associated with the greatest risk of radionuclide intake through the damaged skin. In the staff of critical occupations, wounds contaminated with radionuclides were shown to be most often localized in the area of the hands. The observation of the character of radionuclide propagation in internal organs and tissues from the wound site allowed suggesting an effective detection system for previously unreported cases of the entering americium and plutonium radionuclides through damaged skin. Such a system assumes the periodic performance of direct measurements of personnel on the counters of human radiation unit. The article notes that not only direct measurements in the hand area (as the most probable place of radionuclide intake) are practically significant, but also in the area of regional lymph nodes (the organ depositing radionuclides). Direct dosimetric measurements must be supplemented with indirect methods for the determination of the presence of radionuclides in the body by their content in the excretion of the worker. Evaluated indices on the content of radionuclides in excretion may indicate to their possible entering through damaged skin and must signal the need for an additional examination of the employee. The approbation of the proposed system for the detection cases of radionuclide intake through damaged skin was carried out both during the routine inspection of the operating staff of Joint Stock Company «Siberian Chemical Combine, and with the involvement of workers who had already completed their work in connection with their retirement. The study showed that, despite the possible high dose loads, the RF legislation does not provide further medical and sanitary support in the part of following up in specialized laboratories for the direct and/or indirect dosimetry. Thus, at present, a number of problems remain unresolved, which requires the introduction of additions and revision of the current normative and methodological documentation.
Keywords:
Plutonium, americium, damaged skin, the dose of internal irradiation, Siberian Chemical Combine.
PSYCHOPHYSIOLOGICAL MECHANISMS OF ADAPTATION TO EXTREME CONDITIONS OF THE ENVIRONMENT.
Year: 2018 (March) Number: №1 Pages: 94-101
Heading: Occupational safety and security.
Article type: Scientific article.
Authors: Reps V.F., Ishchenko D.V., Efimenko N.V., Tovbushenko T.M., Abramtsova A.V.
Organization:
Pyatigorsk State Scientific Research Institute of Balneology of the Federal Medical and Biological Agency, Pyatigorsk, 357500, Russian Federation; Northern Caucasian Regional Center of EMERCOM of Russia, Pyatigorsk, 357528, Russian Federation.
Annotation:
Some psychophysiological determinants of human adaptation to extreme environmental conditions are considered. The article presents the results of the assessment of the level of psychological adaptation among servicemen and employees of the federal firefighting service of various subjects of the North Caucasus Federal District of the Russian Federation after the impact of extreme situations for the development of strategies for medical and psychological correction. The first block of research included such 3 age groups of servicemen (EMERCOM employees) after short-term expeditions with the exposure to extreme conditions as Group I - 25 cases aged 20-30 years, II group - 38 cases of 30-40 years and III group 16 persons over 40 years. The second block of research involved 2 groups of volunteers after short-term exposures to extremely high altitude conditions. In a group of volunteers there was evaluated the heart rate variability (HRV) as an index of the functional state of the organism when adapting to hypobaric hypoxia at an altitude of 2070 (1st group, n = 11) and 2500 m (2nd group, n = 9) above the sea level. The HRV indices were evaluated in 3 states (the 1st state - before the trip, the 2nd state - after 2-3 hours in the mountains, and 3rd measurements were carried out in the 1st- and 2nd groups at different times (in the 1st group - immediately after the end of the trip, and in the 2nd group - on the second day of the stay in the mountains in the morning). Adaptation strategies are determined depending on the high altitude level and the duration of the subjects’ stay in conditions of hypobaric hypoxia. First, a one-day stay at an altitude of 2070 m above sea level (1st group) is characterized by the response of the «delay» in the compensatory-adaptive response from the cardiovascular system by measuring the calculated index of exertion IE1: 340 ± 66 relative units, 2nd - IE2: 305 ± 78 relative units, 3rd - IE3: 588 ± 120 units (χ2 = 6.0; p = 0.04); secondly, a longer stay in conditions of hypobaric hypoxia at an altitude of 2500 m makes it possible from the activation state (2nd measurement) of compensatory responses (1st measurement IEI: 184 ± 52 relative units, 2nd - IE2: 556 ± 188 relative units, 3rd - IE3: 243 ± 57 relative standard units (χ2 = 6.5; p = 0.03) to adapt to high altitude conditions, which is confirmed by a decrease in the exertion index in the 3rd measurement. Thus, even a short-term exposure to conditions of hyperbaric hypoxia activates stressrealizing systems and so the associated adaptation load on the cardiovascular system may not be taken into account. In this regard, extrapolation the results of the study of the adaptation of volunteers to the conditions of the activity of employees of emergency services requires the compliance with the rehabilitation regime after extreme short-term loads.
Keywords:
Psychological adaptation, hypobaric hypoxia, heart rate variability, physiological levels of adaptation.
HYGIENIC ASSESSMENT OF THE WORKING CONDITIONS OF THE STAFF OF THE INSTITUTE OF HIGH ENERGY PHYSICS AND MONITORING OF SOME HEALTH INDICES.
Year: 2018 (March) Number: №1 Pages: 102-114
Heading: Occupational safety and security.
Article type: Scientific article.
Authors: Goldobin V.N., Shirokov A.Yu., Mynkina N.V., Peleshko V.N.
Organization:
Institute for Improvement Qualification of the Federal Medical Biological Agency of the Russian Federation, Moscow, 125310, Russian Federation; Interregional Office No 174, Protvino, 142280, Russian Federation; A.A. Logunov Institute for High Energy Physics of the National Research Center «Kurchatov Institute», Protvino, 142280, Russian Federation.
Annotation:
The article presents the hygienic assessment and characterization of working conditions of the staff of the State Research Center “Institute of High Energy Physics" (IHEP), which is a city-forming facility for the city of Protvino, the Moscow Region. At the same time, an analysis was made of the state of the somatic morbidity of workers at the enterprise based on the results of periodic medical examinations and in accordance with the International Classification of Diseases (ICD-X) for 2011-2015. The complexities of the estimation of the radiation load under conditions of the experimental character of the operation at accelerators are considered. The sources of radiation and the impact factors on IHEP personnel are beams of accelerated protons and secondary high-energy particles; gamma and beta radiation of radionuclides formed in nuclear interactions; X-rays generated by the operation of highvoltage electrovacuum devices, as well as ionizing radiation from various closed sources used for the calibration and adjustment of electronic and physical equipment. In the course of the production control, in addition to the radiation factor, other physical factors (noise, vibration, illumination, microclimate, electromagnetic fields from a PC), as well as studies of the content of harmful chemicals in the air of the working area, were evaluated. The variety of jobs characteristic of the research center does not allow relating the results of production control and the results of periodic medical examinations. It is important to note that during the reporting period of 2011–2017, in the course of periodic medical examinations, neither occupational diseases or their symptomatic signs nor mental disorders and behavioral disorders (F00-F99) were detected; No injuries, poisoning and some consequences of external causes (S00-T98) were observed. The comparison of the results of production control and a special assessment of working conditions shows that a decrease in the total number of jobs with unfavorable working conditions and a reduction in jobs belonging to category 3.4 may be the result of the refusal to take into account the intensity of the labor process under a special assessment of working conditions.
Keywords:
Staff, harmful factor of the working environment, harmful working conditions, hygienic assessment, assessment of working conditions, periodic medical examinations, morbidity, socio-hygienic monitoring, federal laws, sanitary rules and regulations.
EXTRAORDINARY FOREIGN BODIES OF THE RESPIRATORY TRACT IN CHILDREN.
Year: 2018 (March) Number: №1 Pages: 115-120
Heading: Observation from practice.
Article type: Scientific article.
Authors: Mustafaev D.M., Egorov V.I.
Organization:
M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, 129110, Russian Federation.
Annotation:
The authors present 4 clinical cases from their own practice with unusual foreign bodies in the lower respiratory tract in children. Clinical cases are analyzed from the positions of the diagnosis and aspects of the surgical treatment. To remove foreign bodies, the modern endoscopic technique is used.
Keywords:
Foreign body, airways, bronchoscopy.
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