Medicine of Extreme Situations
Scientific and Practical reviewed Journal
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№1, 2019 (March)

NUTRITIONAL SUPPORT IN THE INTENSIVE CARE OF PATIENTS WITH A CLOSED HEAD INJURY

Year: 2019 (March) Number: №1 Pages: 8-16

Article type: Scientific article.

Authors: Sabirov D.M., Khaidarova S.E.

Organization:

Tashkent Institute of Postgraduate Medical Education, 100007, Republic of Uzbekistan

Annotation:

The article presents the modern concept of closed craniocerebral trauma (CCT) as a trigger for hypermetabolism-hypercatabolism syndrome and justifies the need for adequate nutritional support for complex intensive care for victims. The aim of the study was to improve the results of intensive care of patients with closed craniocerebral injury with the help of a shedulae for correcting metabolic disorders using parenteral and enteral nutrition with the inclusion of pharmacological ingredients developed on the basis of studying the characteristics of the development of hypermetabolism-hypercatabolism. The materials of the analysis and discussion were the results of the examination and complex treatment of 110 victims with intracranial injury of various etiology treated in neurosurgical resuscitation unit of the Republican Center for Emergency Medical Care in Tashkent from 2016 to 2018. Various options for parenteral and enteral nutrition were investigated, and the effectiveness of the use was assessed in addition to the standard nutritional support of pharmacological nutrients such as glutamine, omega-3 fatty acids, and metabiotics. Statistical processing of the materials obtained was performed using methods of variation statistics. To assess the significance and reliability of the results obtained, the criteria of Kolmogorov-Smirnov, Kruskal – Wallis, Mann – Whitney, Student, Fisher were used. The work carried out has made it possible to establish the metabolic response to trauma on the very first day to be manifested by an increase in energy needs, an increase in negative nitrogenous balance, hypoproteinemia, hypotransferrinemia, and dyslipidemia; additional enteral administration of glutamine to patients with closed craniocerebral injury leads to the restoration of the functions of the gastrointestinal tract by 2–3 days earlier compared with the control group of patients; The proposed comprehensive shedulae for the treatment of CCT patients with the additional enteral use of pharmaconutrients and hypercaloric enteral mixture containing dietary fibers contributed to themore rapid relief of hypermetabolism-hypercatabolism syndrome, elimination of energy deficiency, restoration of protein metabolism, restoration of gastrointestinal tract functions with general improvement of treatment results and reduction mortality rate by 5.3 ± 0.7%.

Keywords:

closed head injury; basic intensive care; nutritional support.

NEED FOR DENTAL TREATMENT AND PROSTHETIC IN MEMBERS OF THE COSMONAUT TEAM

Year: 2019 (March) Number: №1 Pages: 17-30

Article type: Scientific article.

Authors: Olesov E.E.1,2, Novozemtseva T.N.3, Shmatov K.V.2, Lerner A.Ya.1, Olesova V.N.1,2, Mikryukov V.V.1,2

Organization:

1Clinical Dental Center of the Federal Medical and Biological Agency of Russia, 2Academy of Postgraduate Education, Moscow, 125371, Russian Federation; 3Dental Clinic № 62, Moscow, 115516, Russian Federation

Annotation:

The good health, including dental one, is the most important requirement for the cosmonaut's profession. The aim of the study was to obtain an objective understanding of the need for various types of dental treatment and prosthetics to completely ensure the dental health in members of cosmonauts team. The analysis of the indices of the need for dental treatment and prosthetics in members of the cosmonaut team was carried out on the basis of a survey on the WHO Dental Status Assessment Card in the age groups of from under 35, 35–44, and over 45 years. The need for treatment of caries, replacement of inadequate fillings, repeated endodontic treatment, as well as professional oral hygiene and treatment of periodontal diseases is presented. The need for prosthetics with ceramic crown inserts, artificial crowns, including implants (or bridgeworks), is calculated. The dynamics of changes in the need for different types of dental treatment and prosthetics, depending on the age of the cosmonaut team, has been revealed. Due to the medical reject to enroll people with periodontal diseases in the cosmonaut detachment, there is almost no need for treatment of gingivitis and periodontitis, but there is still a need for professional oral hygiene, which increases with advancing age. The need for caries treatment with fillings is greatest in persons under 35 years, for ceramic inlays and repeated endodontic treatment in the group of 35 - 44 years old, for replacing limited defects of dentition is approximately the same in all age groups.

Keywords:

dental treatment, prosthetic, cosmonauts.

INDICES OF THE MORBIDITY RATE OF CARDIOVASCULAR DISEASES IN THE COHORT OF WORKERS PARTICIPATING IN THE UTILIZATION OF NUCLEAR WARHEADS

Year: 2019 (March) Number: №1 Pages: 30-39

Article type: Scientific article.

Authors: Briks K.V., Bannikova M.V., Azizova T.V., Zhuntova G.V., Grigorieva E.S.

Organization:

Federal State Unitary Enterprise South Ural Institute of Biophysics, FMBA of Russia, Ozersk, 456780, Russian Federation

Annotation:

Purpose. To assess the incidence rates of acute and chronic cardiovascular diseases (CVD), codes: I20-I25 according to ICD-10 in a cohort of workers involved in the disposal of nuclear warheads (NW). Materials and methods. The cohort under study included chemical and metallurgical production workers of the Federal State Unitary Enterprise Production Association "Mayak" firstly employed in the enterprise in 1949-2014. and observed until December 31, 2017 (10908 people). The analysis of the incidence of non-standardized (“raw” or “intensive”) and standardized (by age) indices was carried out. Standardization was performed indirectly using an internal standard. Incidence rates were calculated using medical statistics per 1000 workers. Results. In the studied cohort of workers, at the end of the observation period, 2691 cases of chronic forms and 1048 cases of acute forms of CVD were registered. The standardized incidence rates of acute and chronic forms of CVD in the male cohort under study was shown to be statistically significantly higher if compared with women. In men of the studied cohort, no statistically significant trends in the dynamics of standardized incidence rates of acute and chronic forms of CVD were found. In women, a trend towards an increase in the standardized incidence rates of acute forms of CVD by the end of the observation period was found to be close to a statistically significant (R² = 0.78).

Keywords:

morbidity, cardiovascular diseases, disposal of nuclear warheads.

SCIENTIFIC AND METHODOLOGICAL JUSTIFICATION OF THE MAIN DIRECTIONS OF IMPROVING THE MEDICAL AND BIOLOGICAL SUPPORT OF SPORTOF HIGHER ACHIEVEMENTS. ARTICLE TWO: PUBLICATION TWO:MAIN VECTORS OF SCIENTIFIC AND PUBLICATION ACTIVITY ON THE PROBLEMS OF MEDICAL AND BIOLOGICAL SUPPORT SPORTS OF HIGHER ACHIEVEMENTS IN RUSSIA AND FOREIGN COUNTRIES IN 2011–2017

Year: 2019 (March) Number: №1 Pages: 49-58

Article type: Scientific article.

Authors: Zholinsky A.V.1, Komarevtsev V.N.1, Berzin I.A.2, Feshchenko V.S.1, Ogannisyan M.G.1, Razumets E.I.1, Zhivaev S.N.1, Kravchuk D.A.1, Staschuk K.A.1, Arutyunov Yu.A.1, Pushkina T.A.2, Vyhodets I.T.2

Organization:

1Federal Scientific and Clinical Center for Sports Medicine Rehabilitation FMBA of Russia, 121059, Moscow; 2Federal Medical and Biological Agency, 123182, Moscow

Annotation:

The second publication of a series of articles prepared by the employees of the Federal Research and Clinical Center for Sports Medicine and Rehabilitation of the Federal Medical and Biological Agency (FMBA) of Russia and the Federal Medical and Biological Agency for the Scientific and Methodological Substantiation of Improving Medical and Biological Support for Higher-Grade Sports there are presented data of the analysis of indexed scientific publications and reports in Russia and foreign countries in 2011 - 2017 on sports topics. There were treated a domestic scientific literature database – the scientific electronic library eLIBRARY, as well as the Web of Science (Сore Collection) scientific literature database. The results of the work carried out allowed us to completely identify the scientific and applied significance of research that was carried out in the FMBA of Russia and their compliance with domestic and foreign trends in scientific research as objectively as possible in quantitative terms. It has been confirmed that research directions in Russia and abroad are generally comparable. However, a number of differences have been identified. So, in Russia, the largest number of studies were devoted to the study of diets of athletes. Less research has been done on the rehabilitation and prevention of injuries in athletes. Abroad, a large proportion of research was carried out in the field of sports injuries and significantly less in the field of prevention and correction of sportsmen’s diseases. But at the same time, the data obtained unequivocally indicate that the subjects and results of the work performed by the FMBA of Russia as a whole met the challenges of the time and needs of athletes of national teams of the Russian Federation and practicing sports doctors, as evidenced by the sporting achievements and victories of our athletes in major competitions. Among the deficiencies in the planning, organization and conduct of FMBA scientific and applied research on the problems of higher achievements of sport, there was an insufficient number of works on sports immunology, sports pharmacology, metabolic correction and neurotransmitter regulation of the organism, cellular technologies, genetic research, information, digital technologies and telemedicine, evaluating the effectiveness of the existing system and developing new programs for biomedical support of an athlete s of the national teams of the Russian Federation, including the use of the latest medical devices, sanatorium and resort factors in recreation and rehabilitation of athletes after the competition and past illnesses and injuries.

Keywords:

medical and biological support for athletes; topics of indexed scientific articles and reports; characteristics of the publication activity of domestic and foreign authors.

CHARACTERISTICS OF NEGATIVE MANIFESTATIONS OF 3,3-BIS (CHLOROMETHYL) OXETANE IN THE POLLUTION OF WATERS RESERVOIRS

Year: 2019 (March) Number: №1 Pages: 59-70

Article type: Scientific article.

Authors: Maslennikov A.A., Demidova S.A., Коbа А.А., Velikorodnaya Yu.I.

Organization:

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

Annotation:

Aim of the study. Ecological and toxicological risk assessment of the content of 3,3-bis (chloromethyl) oxetane in the water of reservoirs. Material and methods. A standard sample of 3,3-bis (chloromethyl) oxetane (pentaplast, pentone, BHMO) was used as an object of research. The density of the substance is 1.2951 g / cm3. The molecular weight is of 70000–200000. The number according to CAS is 78-71-7. Experimental studies of the danger of water pollution with BHMO were conducted according to organoleptic, all-sanitary and sanitary-toxicological signs of harm in accordance with the requirements of the current guidelines. Results and discussion. The ecotoxicant, when it was contained in water at a concentration of 130.0 mg/l, was established to lead to water foaming (height 1,0 mm). In addition, when the compound was added to water at the same concentration, this medium acquired an aromatic odor. Based on the above, the specified level of BHMO is defined as a threshold for organoleptic evidence of harm. In the course of studying the effect of the toxicant on the general sanitary regime of water bodies (biochemical oxygen consumption, saprophytic microflora, nitrification processes), its negative impact on all considered processes of self-healing and self-purification of water has been proved. For all three indices adopted a single threshold concentration of the substance - 1.0 mg/l. In experiments on laboratory animals under conditions of oral administration, it was established that a single exposure to the tested xenobiotics caused a significant change in a number of physiological, behavioral and hematological indices. The threshold for a single general toxic effect of BHMO accounted for 128.9 mg/kg. Under the subchronic administration, there was established its negative impact on animals of all three experimental groups. Judging by the insignificant prevalence of the number of indices in the first half of the experience, the chemical agent did not exhibit cumulative properties. The threshold dose of BHMO in the subacute experiment was of 1.0 mg/kg. The data obtained during the chronic six-month experiment indicates that the component of the powders in all doses had a general toxic effect on animals. At the same time, the negative effect increased with an increase in the dose of the substance both in the breadth and depth of the effect, which indicates the presence of a straightforward dose-effective relationship. The threshold level of the chronic general toxic effect of the compound corresponds to a value of 0.03 mg/kg. The revealed behavioral patterns of 3,3-bis (chloromethyl) oxetane in the water of reservoirs should be taken into account when justifying its MAC in this ecosystem.

Keywords:

water; 3,3-bis (chloromethyl) oxetane; sanitary regime of water bodies; general toxic effect; threshold doses and cоncentrations.

COMPLEX VASOACTIVE ELECTROSTIMULATION IN СORRECTION OF IMMUNE DISORDERS AND CYTOKINE IMBALANCE AS RISK FACTORS FOR THE DEVELOPMENT OF CARDIOVASCULAR PATHOLOGY IN WORKERS OF RADIATION-DANGEROUS PRODUCTION

Year: 2019 (March) Number: №1 Pages:71-81

Article type: Scientific article.

Authors: Smirnova I.N., Antipova I.I., Barabash L.V., Titskaya E.V., Tonkoshkurova A.V.

Organization:

Siberian Federal Scientific and Clinical Center of the Federal medical and biological Agency, Tomsk, 634050, Russian Federation

Annotation:

The purpose of the study is to investigate the state of systemic immunity and the features of cytokine production, determine the nature of their relationship with well-known risk factors for cardiovascular pathology (obesity, smoking, physical inactivity, dyslipidemia, hyperglycemia) and laboratory markers of inflammation in workers at radiation-hazardous production, scientific justification for the reason¬ability and efficacy of the correction of dysfunctions of systemic immunity and cytokine imbalance by complex vasoactive electrostimulation from the perspective of early prevention of the development and progression of diseases of cardiovascular diseases. As a result of an open, prospective, randomized study, conducted in parallel groups with the formation of observation groups and a comparison of a clinical study, there were examined 149 workers of the Siberian Chemical Combine, contacting with ionizing radiation. There was established a statistically significant correlation between the percentage of immune competent cells in the serum and the concentration of anti-inflammatory cytokines, serum immunoglobulins, laboratory markers of inflammation and total known risk factors for the development of the heart disease. The presence of a direct relationship between indices of systemic immunity and cy¬tokines with serum C-reactive protein and generally recognized risk factors for cardiovascular pathol¬ogy leaves no doubt about the active participation of the immune system in the formation of diseases of the cardiovascular system in workers at radiation-hazardous industries. The positive effect of complex vasoactive electrostimulation on the functioning of the immune system and restoring the balance of anti-and pro-inflammatory cytokines in the blood serum of workers at radiation-hazardous industries has been proven, which makes it possible to consider it as an effective measure of the early prevention of the formation and progression of atherosclerotic vascular wall damage in this category of people.

Keywords:

immune system; cytokines; inflammation; convection risk factors; cardiovascular pathology; workers of radiation-dangerous production; vasoactive electrostimulation.

EFFECT OF RIBOSE AND GLUTAMINE ON THE EXPRESSION OF ENDOGENOUS INTOXICATION IN THE BRAIN OF REANIMATED RATS

Year: 2019 (March) Number: №1 Pages:82-91

Article type: Scientific article.

Authors: Zolin P.P.1, Konvay V.D.1,2, Mantrova A.I.1

Organization:

1Omsk State Medical University, Omsk, 644099, Russian Federation; 2P.A. Stolypin Omsk State Agrarian University, Omsk, 644008, Russian Federation

Annotation:

The aim of this work is to find out how the levels of molecules of average mass in the brain change in the early post-resuscitation period, as well as to check whether ribose and glutamine can affect them in resuscitated and healthy animals. Material and methods. The experiments were performed on 81 white male rats, subjected to 6.5-min¬ute mechanical asphyxia, followed by resuscitation. Rats were euthanized 30 minutes after the onset reanimated animals and separate groups of control rats, or L-glutamine solution (200 mg/kg) was in¬travenously administered 5 minutes after the start of reanimation. In the brain, the levels of molecules of average weight were determined 30 minutes after the start of resuscitation. Results and discussion. The average value in the group of reanimated rats could alter due to the fact that the content of molecules of average weight in each individual animal changed, as well as due to the fact that rats with the highest concentration of molecules of average weight perished before their brain was taken. 30 minutes after the beginning of resuscitation, the levels of average-weight molecules in the brain were established to increase statistically significant if compared with the control group. Intravenous administration of D-ribose (50 mg/kg) or intravenous administration of L-glutamine (200 mg/kg) immediately after resuscitation did not affect the level of molecules of average weight in the brain of reanimated rats. Due to the death of a part of animals from the pathology under study, there are occurred non-random elisions of digital values in groups of reanimated animals. The authors suggest non-random elisions to mutilate the effect of D-ribose and L-glutamine on the levels of average-weight molecules in the brain Conclusion. In the early post-resuscitation period, the severity of endogenous intoxication in the rat brain increases. No effect of D-ribose and L-glutamine on this increase was found. Accounting for the possible impact of non-random passes allows interpreting results more correctly.

Keywords:

resuscitation; brain; medium weight molecules; ribose; glutamine; endotoxicosis; non-random elisions; postresuscitation period; rats.

BACTERIAL INTESTINAL INFECTIONS WITH HEMOCOLITIS SYNDROME IN CHILDREN: ETIOLOGY, LABORATORY DIAGNOSIS (REVIEW)

Year: 2019 (March) Number: №1 Pages:92-104

Article type: Scientific article.

Authors: Gonchar N.V.1,2, Ermolenko K.D.1, Klimova O.I.1, Ermolenko E.I.3,4, Gostev V.V.1, Lobzin Yu.V.1,2

Organization:

1Children's Scientific-Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia, St. Petersburg, 197022, Russian Federation; 2North-West State Medical University. I.I. Mechnikov, Ministry of Health of the Russian Federation,191015, St. Petersburg; 3Institute of Experimental Medicine, St. Petersburg, 197376, Russian Federation; 4Saint Petersburg State University, St. Petersburg, 199034, Russian Federation

Annotation:

The article provides information on the incidence of children with various nosological forms of infectious diarrhea occurring with hemocolitis syndrome. Possible complications and adverse outcomes of this pathology are described. The problems of the etiological diagnosis of bacterial intestinal infections in children with hemocolitis syndrome at the present stage are highlighted. Based on the analysis of the results of a large number of scientific studies, a high frequency of detection of several pathogens simultaneously and the need for differential diagnosis with non-infectious inflammatory bowel diseases have been shown. Approaches to the verification of bacterial intestinal infections with hemocolitis syndrome are described.

Keywords:

intestinal infections; hemocolitis syndrome; children; morbidity; etiological diagnosis.

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