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Dear participants,
Ministry of Defense of the Republic of Serbia is honored to host the 3rd Pan
European Congress of Military Medicine taking place in Belgrade, June 2-6, 2014.
By this we present you the abstract book which contains all presentations divided
over several plenary, parallel and poster sessions. Abstracts were closely examined
by the ICMM Scientific Council and National Scientific Committee in order to enter
into the congress program. The carried out activity was considered with special
seriousness and pleasantness, searching at the same time the right balance
between different types of presentations. We sincerely express our gratitude to all
contributors for their efforts and hard work and wish all the attendees a successful
and beneficial congress.
Chairman National Scientific Committee
Brigadier General Prof. Marijan Novaković, M.D., Ph.D
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Authors
Aboulfazl Jafarzadeh, MD.
Hamed Aghdam, MD, Emergency Medicine Specialist.
Babak Mahshidfar, Emergency Medicine Specialist.
Hossein Yari, Emergency Medicine Specialist.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
Comparing Long Back Board and Vacuum Mattress Splint
ABSTRACT
immobilization of the injured transported by prehospital emergency
trauma
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Background Patients with SCI (Spinal Cord Injury) must be transported to a hospital
motionless. This study compares the LBB and VMS immobilization in trauma victims taken to
hospital by EMS.
Method In this clinical trial, 60 injured in road accidents caused by trauma or spinal injury
crash risk were divided into 2 groups of 30. Each group was immobilized using either VMS
or LBB. Immobilization rate, The comfort level of the person performing the immobilization,
immobilization of the injured spine and ease of the injured scoring 5-1 (Likert) was recorded
on the form.
Results In this study, immobilization of the injured with LBB was much faster than VMS
(211.66±28.53 versus 654/00±16.61 seconds). With an LBB, higher spine immobilization
was shown. Also, according to the personnel performing, easy immobilization and comfort
level of the injured was better via LBB than VMS.
Conclusion The findings suggest that the LBB compared with VMS immobilization performs
better and more comfortable for the patient.
Key words:
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Immobilization, Long Back Board ale (LBB), Vacuum Mattress Splint
(VMS).
Reza Hiradasa 3, Kassani Aziz1, MenatiRostam1, Asterki Paiman2,
Delpisheh Ali 1.
1
Prevention of Psychosocial Injuries Research Centre, Ilam
University of Medical Sciences. Ilam-Iran.
2
Faculty of Medicine School, Ilam University of Medical Sciences.
Ilam-Iran.
3
Headquarter Of Police Force Medicine, I. R. Iran
Affiliation
Police Force Medicine/ Tehran/ Iran
E-mail
[email protected]
TITLE OF THE
EPIDEMIOLOGY OF MINE EXPLOSION AND OTHER MUNITIONS PHYSICAL
ABSTRACT
INJURIES IN I LAM PROVINCE FROM 2001-2007
Topic/session
Basic Research In Trauma
Presentation suggestion
ORAL
POSTER
Authors
Background and objective: The widespread use of explosive weapons such as mine is
cause of various injuries in victims. That is very important about the health and life of the
people and military personnel as Special Forces in providing the security of country.
Epidemiological studies in these events are one of the most effective ways to manage and
reduce the damage caused by the explosion of groups in the border areas contaminated by
mines and other explosive materials. This study deals to evaluate the physical injuries
related to mine and munitions explosion and their related factors in Ilam province.
Method: This survey is cross-sectional (descriptive - analytical study) study. Data for this
study were collected from census of all case records of injuries caused by the explosion of
mines and other munitions between 2001-2007 that were registered in Ilam Legal Medicine
office. In this study we used descriptive statistics and Chi-square, Fisher exact, one-way
ANOVA and Tukey tests.
Results: from the total of the 106 injuries over the years 95.3% were male and the rest were
female, the age group of 20-40 years had the highest number of injuries (47.2 %). Also
among the injuries, 43.4 %( CI95%:0.29-0.57) had organ failure, 16% (CI95%:0.01-0.33) had
skin lesions, 15.1 %( CI95%:0.01-0.32) had nephropathy, 3.8 %( CI95%:-0.14-0.22) had
upper extremity bone defects, 18.9% (CI95%:0.02-0.36) had lower limb bone defects and
2.8% (CI95%:-0.15-0.21) had skull bone injuries. Also, it was found significant relationship
between the type of injury and age, gender, occupational status and type of explosives in
injuries.
Conclusion: The degree of impairment caused by the explosion of mines and other
ammunition in this study is higher than some other similar studies. These events can leave
irreparable harm to the physical or mental health of the affected people. Also ignoring the
affected areas can make much more mental damage to residents, such as farmers, ranchers
and army soldiers live and work at the borders.
Key words:
mine, physical injuries, munitions
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Authors
Colonel Saeed Reza Lotfi (MD)
Zahra Arab(MSN)
Colonel AliReza Hamid(MD)
Police Medical center of Mashhad, Iran.
[email protected]
EPIDEMIOLOGY OF TRAUMA CAUSED BY FIREARMS IN THE MILITARY
Affiliation
E-mail
TITLE OF THE
ABSTRACT
MEDICAL CENTER CLIENTS
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
(underline)
POSTER
Introduction/Objective: Trauma as a result of the use of fire arms in society has led to
many casualties and as a major health problem in developing countries is considered. The
purpose of this study was to evaluate the outcome of trauma patients in the use of fire arms
in a military medical center.
Materials and Methods: In this cross-sectional study, all patients with injuries caused by
fire arms during March 2011 to January 2014, referred to in one of the military hospitals were
examined. Data collected included demographic characteristics, organ injury, and type of
injury, surgery, hospital stay, complications, final status at discharge, and the average cost
of the treatment.
Results: 98 patients had been admitted at the interval. All were male and the average age
of 32± 3.12 years (minimum 15, maximum 45). 80% offender, 15% soldier and 5% were
military personnel. 0.5% of patients were dead on arrival at hospital. The Location of bullet,
76% upper extremity, 16% lower extremity, 1% chest, 0.8% head and neck, 6.2% the
abdomen and pelvis. The radiologic findings in 35% had at least one broken bone. In 74.3%
cases surgery was performed. The highest incidences of complications were bleeding
(20%), infection (14.3%), major organ involvement (11%), and vascular complications
(10.8%). Average stay in ICU for 2 days and surgical ward was 5 days. 82% of patients were
discharged without disability and 1% with disability and 0.3% had died.
Conclusions: According to rising in the incidence of gunshot to the abdomen and pelvis and
also the government is incurring huge costs. Recommended military personnel in dealing
with offenders, during clashes in operation, pay attention to this matter. It also requires
doctors are better informed than the damage caused by firearms and their proper treatment
that can reduce hospital mortality rates.
Key words:
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Fire arms, trauma, conflict action, war damage
Authors
Colonel AliReza Hamid(MD)
Colonel SaeedReza Lotfi (MD)
Zahra Arab(MSN)
Payam Pishnamaz(MD)
Affiliation
Police Medical center of Mashhad, Iran.
E-mail
[email protected]
TITLE OF THE
SURGICAL MANAGMENT OF EXTENSIVE INJURY TO PELVIC
ABSTRACT
AND PENIS CUTTING, REPORT OF A C ASE IN POLICE HOSPITAL
Topic/session
War Surgery
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Introduction: Perineal trauma is a common problem during operational conflicts. The
present report, surgery in extensive damage to pelvic and genital cutting is during
operational conflicts.
Case report: The patient is a 25-year Iranian Police man penetrating trauma caused by
gunshot was referred to one of Police Force Hospitals in Mashhad-Iran. At reviews had
severe pain, decline of haemoglobin and blood pressure. Emergency surgery was performed
immediately. During surgery, was observed a completed destruction of the right testicle, cut
off the root of the penis and urethra, bladder large rupture, rupture of the ileum and
approximately two liters of blood was in the peritoneal space. Resection and anastomosis of
the bowel was done. Abdominal vascular and bladder rupture was repaired. The penis was
drawn intot hrough Retropubic space and spongius and corpuses cavernosum was repaired
to form water tight and end to end. Artificial erection and penis artery was normal. Right
testis was removed and the drain cystostomy fixed in and wall was repaired. During surgery,
the patient received 2units of blood and 4 units FFP. After 9 days hospitalized patient was
discharged with urethral catheters and catheter cystostomy. Follow-up showed that the
patient does not have urinary problems and had normal erection.
Conclusions: Due to the bony anatomy, rich pelvic vascular supply and the difficulty in
achieving haemostasis by direct pressure, following of military events, emergency surgery
team in the least possible time, can be a life-saving individual and social life.
Key words:
genital trauma, fire arms, military events
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Authors
Lt col R Gopi, Brig PS Bhandari,VSM, Col V Langer
Affiliation
Army Hospital ( Referral and Research) , New Delhi, India
E-mail
[email protected]
TITLE OF THE
COMPREHENSIVE STRATEGY TO THUMB INJURIES
ABSTRACT
MANAGEMENT IN HAND INJURIES OF WAR
Topic/session
War Surgery – Theme 1
Presentation suggestion
ORAL
POSTER
(underline)
Introduction Hand trauma in war injuries can lead to life style altering disabilities of
combatant. Thumb is the pivotal digit in the functioning of any hand. Aesthetic and
functional reconstruction of injured thumb is the goal in management of these injuries.
Materials and Methods A retrospective study of the patients with soft tissue thumb injuries,
managed in a tertiary care military hospital over previous three years was undertaken. The
inclusion criteria were injuries while on duty, involving soft tissue of the thumb and managed
by surgery. The performa of study included aetiology, size of the defect, zone of injury, mode
of reconstruction, extent of functional recovery and patient satisfaction.
The data was correlated to strategize an algorithm to manage the soft tissue injuries of the
thumb.
Results A total of 92 cases of thumb defects and amputations were included in the study.
Distal defects (involving only terminal phalange) were the predominant site of injuries (47),
followed by amputations of thumb at varying levels (29). Soft tissue defects requiring cover
were better rehabilitated by local flaps and amputations by a single stage double flap
technique. Thumb tip sensation and mobility were the main concern of patient in follow up.
Almost 65% of the combatants returned effectively to their duties while 25% required change
of trade.
Conclusion A well planned strategy to identify & manage the hand injuries of war,
particularly thumb injuries, preferably by a trained hand surgeon is the key for effective
rehabilitation of many combatants.
Key words:
Thumb, double flap
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Authors
Lieutenant colonel assistant professor dr. Goran Pavlicevic, colonel
professor dr. Zoran Roganovic, dr. Drazen Ivetic, dr Olivera
Jovanikic
Medical military academy/neurosurgical clinic /Belgrade, Serbia
[email protected]
Chronic pain treatment with intrathecal morphine
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Topic/session
surgery
Presentation suggestion
(underline)
ORAL
POSTER
Introduction/Objective: Chronic pain management by chemical neuromodulation is gaining
an increasing use, in the last twenty years more then 95000 intrathecal morphine pump has
been implanted.
Materials and Methods: Prospective study included 21 patients with clinically significant
pain syndromes including malignant pain, neurophatic and nociceptive pain. Pain intensity
was assessed before and after treatment using visual analog scale and treatment outcome
was defined as successful (pain relief 70%), fair (pain relief between 50 and 69%) and poor
(pain relief 50%)
Safety was assessed by documenting pharmacological, mechanical and surgical
complications throughout the study.
Results: 6 patients had neurophatic, 12 nociceptive and 3 malignant pain origin. The
median duration of severe, intractable pain prior to ITNP was 60 months (2-108 months).
The mean follow-up since implantation was 30,7 m (range: 6-45 m) Average age was 61,9
years. Pain intensity according VAS was 6-9 (average 7,8) before and 1-4 (average 2,2)
after treatment.
Successful outcome had 40%, fair 50% and poor 10% of patients. Initial average daily dose
was 1,2mg, raised to 1,6mg six months later and remained stable throughout treatment.
4 patients had mechanical (catheter disconnection, pump dysfunction), 2 surgical (infection),
and 1 pharmacological complication (altered mental status).
Conclusion(s): Implantation of intrathecal morphine pump can successfully alleviated pain
of different origin without significant time-dose increase. Although the complication rate is
high (35%) most of them are mechanical and easily treatable.
Key words:
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Pain, intrathecal, opioids
Authors
Lieutenant colonel assistant professor dr. Goran Pavlicevic, colonel
professor dr. Zoran Roganovic, dr. Drazen Ivetic, dr Olivera
Jovanikic
Medical military academy/neurosurgical clinic /Belgrade, Serbia
[email protected]
WARFARE RELATED CRANIAL DEFECT RECONSTRUCTION
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Topic/session
surgery
Presentation suggestion
(underline)
ORAL
POSTER
Introduction/Objective: Warfare related cranial defect reconstruction is specific entity,
different then cranioplasty caused by other etiology. Cranioplasty can be done with autograft
or alograft, dilemma about factors that indicate use one or another material and operation
result still exist in modern literature.
Materials and Methods: Clinical retrospective-prospective study on 207 patients with
warfare related cranial defect reconstructed with auto or allograft. Final outcome result was
based on esthetic effect and existent of complications. In homogeny experimental groups 10
factors influence on outcome was tested.
Results: Predictors for failed cranioplasty are: defect area, previous local infection, cranial
defect communication with frontal sinus and bad skin quality. There are not differences in
outcome for auto or allograft. Risk for infection is lower with autograft and esthetic effect is
better with allograft. Risk for postoperative infection increases with defect area and with
previous local infection. Esthetic effect depends only on defect area.
Conclusion(s): Cranial defect reconstruction can be successfully done with auto or allograft
one month after injury. Cranioplasty should be done with autograft in cases with previous
local infection. For defect with more than 55 cm2 area allograft is better solution. Open
paranasal cavity should be reconstructed before cranioplasty.
Key words:
Cranioplasty, cranial, defect
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civilian, мaster of science Olivera JOVANIKIC, colonel Professor
Zoran ROGANOVIC, PhD, colonel Assistant professor Goran
PAVLICEVIC,PhD
Affiliation
Military Medical Academy/Clinic of Neurosurgery /Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
THE DIFFERENT VARIOUS LESIONS IN THE SOME
ABSTRACT
GENERALIZED PURE PRIMARY BLAST INJURIES IN 1999.
Topic/session
War Surgery
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction: The blast injuries are special group of war trauma. It mostly investigates on
experimental animals, and the last often at the battlefield. The results of the experimental
investigations are not completely the same, what we meet in the practice.
Objective: to analyse the traits of the generalized pure primary blast injuries: external and
internal lesions, fractures, burns and haemorrhage.
Material, methods and results: we selected 30 male patients 30,1±8,5 years old, with
generalized pure primary blast injury: 24 with aer blast,6 with solid and 18 injured often.
Blast injuries was assessment by the PSS of JTYelverton modified for people 10,6±5,62, ISS
=30,67 and by RTS=5,70 score. The most common external lesions were traumatic
amputation of extremity 26,7%, open fractures 16,7% and simple laceration and flash burns
20%. The 10% patients have not any external lesions. Between internal lesions, the some
kind of bleeding was at the firs place: haemothorax 63,3%, SAH 60%, haematosinus 60%,
and haemotympanon 40% or epistaxis 33%. The rarest injuries were abdominal lesions: the
injury of pancreas, perforation of the colon, rupture of the spleen, subcapsular renal
hematoma - 3,3%. In cases of aer blast, the head and neck was injured in 36,7%, lower
extremity 30%, upper extremity 23,3% and body 16,7%, and it is different then in solid blast
(100%, 50%,25%,75% respectively).
Conclusions: the new generation of blast weapons modify characteristics of blast injuries,
condition of injury as well. The blast-injured patients need very careful, detail and not
stereotype examination.
Key words:
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blast injury, scoring, recognizing
Authors
Affiliation
Jefta Kozarski, Zoran Mirković¹, Nikola Ostojić, G.Šijan
Medical faculty o fMMA, Belgrade, Serbia
Clinic for plastic surgery and burns Belgrade, Serbia
¹Clinic for maxillofacial surgery Belgrade, Serbia
E-mail
TITLE OF THE
FREE FLAPS IN HEAD AND NECK RECONSTRUCTION
ABSTRACT
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
The head and neck region’s defects presents a great challenge for reconstructive surgeons.
We report our experience in the treatment of 54 patients with head and neck free flap
reconstruction (15 tumor resection, 2 with burns, one with postburned neck’s contracture,
and 36 wounded patients).
We applied six fibular, four scapular, three radial forearm, one dorsalis pedis and one
latissimus dorsi free flaps. Fibular and radial forearm flaps were used for reconstruction of
the mandibular bone, while scapular, dorsalis pedis and latissimus dorsi flaps were used for
filling the defects of the mouth floor, orbital or maxilar region. We used scapular free flaps for
covering the burn of the face, scapular and parascapular flaps for the covering of the neck
and exposed mandibular bone and preexpanded scapular and parascapular flap for
correction of the neck’s postburn contracture.
We treated extensive wartime tissue defects of the lower third of the face with composite
free flaps: seven scapular, nine radial forearm and twenty fibular flaps. Length of the
mandibular defects varied from 5-16 cm. The bones were fixed by wire, miniplates or
external fixation. The skin parts of the flaps were used in reconstruction of lower lip, chin
and/or cheek, respectively. Vascular pedicles of the flaps were microsutured to either the
superior thyroid, facial or external maxillary and carotid vessels. Our experience and results
in microvascular reconstruction in the head and neck region support the use of this
reconstructive method.
Key words:
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Authors
Affiliation
Colonel Prof dr Nebojsa Jovic
Miltary medical Academy Clinic for maxillofacial surgery Belgrade
Serbia
[email protected]
TWENTY YEARS WITH OSTEOGENETIC DISTRACTION
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
Something new what we did during last 20 years in maxillofacial surgery is method of
ostegenetic distraction to treathing the patients with defects and deformities of the facial
bones and jaws.
It all started when Dr Ilizarov, in the far 1956 when he used the weels of the childs bike and
the pins that he placed on the osteotomy fragments of the lower leg and distracted them to
the desired length.
When many years later in the North America, Mc Carthny performend the first distraction on
the lower jaw in four children using phalanx distractor, this method started to be used in
clinical practice for dentofacial deformity treatment. His successful results were published in
1992
Over the next 10 years, this method was applied for the correction of the upper jaw
deformities, the alveolar extention of the jaws, widening of the narrow jaws, compensation of
the deformities involving the zigomatic area, ect.
However, some doubts arose with respect to its indication, designes of distracters for diverse
deformities, treatment protocols, the right time (the age of patients) for the beginning the
distraction, the way osteotomy affects the growth centers, the commodity of patients at the
time of distraction, whether to use the distraction of a bone supstitutents, or wether to use
this method in patients after the surgical removal of malignant tumors.
Distraction osteogenesis does not only generates a new bone formation, the soft tissue
mass is also gradually increased through distraction histogenesis.
The first distraction in the Clinic for maxillofacial surgery MMA was performed in 1999.
Some doubts are still present. This surgical method we started to use 20 years ago but we
still have a wide fild for different researshes.
Key words:
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Col. K. Korzeniewski MD PhD1, Lt. Col. S. Pieniuta MD2,
Col. R. Gregulski3,
1
Affiliation
Department of Epidemiology and Tropical Medicine, Military Institute
of Medicine, Warsaw, Poland
2 th
4 Military Clinical Hospital with Polyclinics, Wrocław, Poland
3
Operations Command of the Polish Armed Forces, Warsaw, Poland
E-mail
[email protected]
TITLE OF THE
BATTLE INJURIES IN POLISH SOLDIERS DEPLOYED
ABSTRACT
TO ISAF OPERATION IN AFGHANISTAN
Topic/session
Trauma Combat Casualty Care
Presentation suggestion
PUBLICATION
ORAL
(underline)
Authors
Objective. The article presents the results of studies into the occurrence of battle injuries
among Polish military personnel deployed to Afghanistan in the period from 2010 to 2013.
Material and Methods. The authors have analyzed medical records of 340 Polish soldiers,
members of the Polish Military Contingent (PMC), who required in-patient treatment at the
Medical Support Group (MSG, Role 2) in Forward Operating Base Ghazni (ISAF, East
Region) due to battle injuries in the period April 2010-October 2013. We have conducted
a census study, i.e. each member of the study population was subjected to statistical
analysis. The study population comprised 902 soldiers hospitalized and treated at MSG and
15 504 soldiers assigned to PMC Afghanistan within the given period.
Results. The most common cause of hospitalizations among Polish soldiers were battle
injuries (37.1/100 patients). A total of 420 injuries were sustained in 335 soldiers treated on
an inpatient basis at MSG. The injuries were all caused by the use of weapons such as
improvised explosive devices (IED), mortar or RPG shells or small arms. The most common
battle injuries were musculoskeletal contusions (the effect of shock wave), shrapnel wounds,
gunshot wounds, and fractures. 42% of the patients who sustained battle injuries, mainly
those with shrapnel and gunshot wounds or fractures, were medically evacuated from
Afghanistan to Poland. 58% of the wounded soldiers treated at MSG were returned to duty.
Conclusions. The unconventional armed conflict led in Afghanistan is an example of
asymmetric warfare, where battle injuries are the major health problem among the ISAF
personnel.
Key words:
battle injuries, Polish soldiers, Afghanistan
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Col. R. Gregulski1, Col. K. Korzeniewski MD PhD2,
Lt. Col. S. Pieniuta MD3
1
Affiliation
Operations Command of the Polish Armed Forces, Warsaw, Poland
2
Department of Epidemiology and Tropical Medicine, Military Institute
of Medicine, Warsaw, Poland
3 th
4 Military Clinical Hospital with Polyclinics, Wrocław, Poland
E-mail
[email protected]
TITLE OF THE
MEDICAL EVACUATIONS OF POLISH SOLDIERS DEPLOYED TO
ABSTRACT
ISAF OPERATION IN AFGHANISTAN
Topic/session
Trauma Combat Casualty Care
Presentation suggestion
PUBLICATION
ORAL
(underline)
Authors
Objective. The article presents the results of research into medical evacuations of Polish
military personnel deployed to Afghanistan from 2010 to 2013 (ISAF operation) who were
treated at Medical Support Group (MSG, Role 2) in Forwards Operating Base Ghazni (ISAF,
East Region) and then transferred to Poland for further specialist treatment.
Material and Methods. The authors have analyzed medical records of 340 soldiers who
required medical evacuation from Afghanistan to Poland due to battle injuries, non-battle
injuries and diseases in the period April 2010-October 2013. We have conducted a census
study, i.e. each member of the study population was subjected to statistical analysis. The
study population comprised 902 soldiers hospitalized and treated at MSG and 15 504
soldiers assigned to PMC Afghanistan within the given period.
Results. In the period from April 2010 to October 2013, 2.2% of the Polish military personnel
(n=340) relocated to the ISAF area of operation in Afghanistan were evacuated for medical
reasons. 42.0% of all medical evacuations were due to battle injuries, 32.3% were due to
non-battle injuries, 25.7% - due to diseases.
Conclusions. The fact that the majority of medical evacuations were the result of battle
injuries clearly demonstrates that the ISAF operation is a combat mission. Additionally, the
predominance of a traumatic profile among the military personnel requiring medical
evacuation determines the direction of medical support in a contemporary theater of
operations.
Key words:
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medical evacuations, Polish soldiers, Afghanistan
Authors
Major dr Dragan RADOICIC, lieutenant colonel dr Radoslav
BARJAKTAROVIC, colonel dr Milimir KOSUTIC
Affiliation
Clinic for orthopaedic surgery and traumatology , Military Medical
Academy Belgrade, Sebia
E-mail
[email protected]
TITLE OF THE
TIMING OF SURGERY AND OUTCOME OF OPEN ARTICULAR
ABSTRACT
DISTAL HUMERUS FRACTURES
Topic/session
Hirurgija
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective: Open intraarticular distal humerus fractures classified as OTA 13 C
may have devastating consequences for patient’s quality of life, especially if leading arm in
younger active patient is involved. We conducted a study to determine if timing of open
reduction and internal fixation of open intraarticular distal humerus fractures affects the
outcomes.
Materials and Methods: multicentric prospective study. In the first group were 15 patients,
10 men 5 women, mean age 38.7 years, operated in less than 6 hours of injury. In the
second group 17 patients, 11 men and 6 women mean age 42.3 years operatively treated in
delayed settings, mean delay to operation 4.6 days of injury. In both groups patients had
open distal humerus articular metaphyseal multifragmentary fractures classified as OTA
13.C2 or 13.C3.
Functional outcome was assessed with Mayo elbow performance score and DASH.
Results: Mean MEP score in the first group was 71 (range 30 to 100), in the second mean
MEP was 64.3 (range 25 to 100). The mean DASH in the first group was 27.89 (range from
1.7 to 75.8) and in the second mean DASH score was 32.6 (range 5.8 to 77.5). There were
no statistically significant differences between two groups, MEP t(28)=0.935, p<0.358;
DASH t(28)= -0.636, p<0.530.
Conclusion(s): Our study shows that early open reduction and internal fixation, of open
distal articular humerus fractures reduces the hospital stay, but does not significantly affect
the overall outcomes and complications.
Key words:
open intraarticular, distal humerus fractures, OTA 13 C, open
reduction, bicolumnar fixation
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Authors
Major General, Senior Consultant Surgery, Ravi, Kale
Affiliation
Army Hospital, Delhi India
E-mail
[email protected]
TITLE OF THE
PRIMARY REPAIR OF COLON INJURIES: OUTCOME OF 50
ABSTRACT
CASES
Topic/session
War Surgery
Presentation suggestion
ORAL
POSTER
(underline)
Background: Colonic injuries are common in low intensity conflict operation (LICO) where
most of the injuries occur due Improvised Explosive Devices (IED) explosion followed by
gunshot wounds. Primary repair of penetrating colon injuries is an appealing management
option. However, uncertainty about its safety persists. The objective of this study was to
review the morbidity and mortality rates after primary repair of penetrating colon injuries in
50 such consecutive casualties.
Material and methods: The data of 50 consecutive causalities deployed in LICO of colonic
injuries brought to a zonal hospital over a period of 3 yrs and repaired primarily were
included in the study. The exclusion criteria were those with multiple devitalised areas of gut
and those subjected to damage control measures.
Results: The mean age of patients was 38 yrs with 88% of them having associated injuries.
32 patients had only right colonic injury. There were 2 deaths one each in right colonic
involvement and one with left colonic injury. Complications ranging from mild wound infection
to leak requiring re-exploration were seen in 36% of patients. Morbidity both in numbers and
severity was more in those with left colonic injury.
Conclusion: According to our experience, we believe that the policy of primary repair of
colon injuries can be applied more liberally in patients with right colonic injury with high
success rate. Those with left colonic injuries are better managed with a two stage procedure.
Key words:
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Colon, Injuries, LICO, Primary Repair
Authors
Affiliation
Colonel (Ret), MD, PhD, Professor, Igor SAMOKHVALOV
Head of Department and Clinic of War Surgery, Deputy Chief
Surgeon of the Russian Armed Forces /Kirov Military Medical
Academy, St. Petersburg, Russia
E-mail
[email protected]
TITLE OF THE
THE USE OF DAMAGE CONTROL SURGERY TACTICS IN THE
ABSTRACT
ARMED CONFLICTS
Topic/session
Session 1 - SURGERY
Presentation suggestion
ORAL
POSTER
(underline)
Damage control surgery (DCS) tactics in patients is aimed at the prevention of unfavorable
outcome development by reducing the extent of primary surgical operation and shifting in
definitive recovery of injured organs and structures toward stabilization of vital functions of
the body or evacuation to the specialist.
Specifics of DCS tactics use in the armed conflicts in Afghanistan (1979-1989) for major
artery injury (63 casualties), in the North Caucasus (1994-2003) – for vascular injuries (47),
long bone fractures and unstable pelvic fractures (26), neck, chest and abdomen injuries
(25) have been studied.
The indications for the use of DCS tactics in patients has been formulated, i.e. the
development of life-endangering consequences (hemorrhage, asphyxia) or the presence of
the injuries which could develop life-endangering consequences and severe complications in
the process of evacuation, in the situations, when a complete surgery could not be carried
out because of the severity of patient’s condition or organizational factors. Proceeding from
this, it has been determined that DCS tactics at Medical Treatment Facilities could be used
in 44% of patients, including 35% cases – on medico-tactical indications (in the medical
units, Role 2) and in 9% cases – emergency surgery (in the forward hospital, Role 3). The
use of DCS tactics demands differential approach. It seems advisable to perform an
objective assessment of patients’ condition severity in mobile resource-limited medical units,
and in the case of critical situation - to reduce the administered care down to pre-evacuation
preparation (emergency medical care) with the following aeromedical evacuation.
Key words:
combat damage control surgery, forward war surgery
23
Authors
Affiliation
Colonel (Ret), MD, PhD, Professor, Igor SAMOKHVALOV
Head of Department and Clinic of War Surgery, Deputy Chief
Surgeon of the Russian Armed Forces /Kirov Military Medical
Academy, St. Petersburg, Russia
E-mail
[email protected]
TITLE OF THE
THE USE OF DAMAGE CONTROL SURGERY TACTICS IN THE
ABSTRACT
ARMED CONFLICTS
Topic/session
Session 1 - SURGERY
Presentation suggestion
ORAL
POSTER
(underline)
Damage control surgery (DCS) tactics in patients is aimed at the prevention of unfavorable
outcome development by reducing the extent of primary surgical operation and shifting in
definitive recovery of injured organs and structures toward stabilization of vital functions of
the body or evacuation to the specialist.
Specifics of DCS tactics use in the armed conflicts in Afghanistan (1979-1989) for major
artery injury (63 casualties), in the North Caucasus (1994-2003) – for vascular injuries (47),
long bone fractures and unstable pelvic fractures (26), neck, chest and abdomen injuries
(25) have been studied.
The indications for the use of DCS tactics in patients has been formulated, i.e. the
development of life-endangering consequences (hemorrhage, asphyxia) or the presence of
the injuries which could develop life-endangering consequences and severe complications in
the process of evacuation, in the situations, when a complete surgery could not be carried
out because of the severity of patient’s condition or organizational factors. Proceeding from
this, it has been determined that DCS tactics at Medical Treatment Facilities could be used
in 44% of patients, including 35% cases – on medico-tactical indications (in the medical
units, Role 2) and in 9% cases – emergency surgery (in the forward hospital, Role 3). The
use of DCS tactics demands differential approach. It seems advisable to perform an
objective assessment of patients’ condition severity in mobile resource-limited medical units,
and in the case of critical situation - to reduce the administered care down to pre-evacuation
preparation (emergency medical care) with the following aeromedical evacuation.
Key words:
24
combat damage control surgery, forward war surgery
Authors
Samokhvalov, V. Badalov, A. Goncharov, V. Denisenko
Affiliation
E-mail
TITLE OF THE
THE USE OF DAMAGE CONTROL SURGERY TACTICS
ABSTRACT
IN THE ARMED CONFLICTS
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
Damage control surgery (DCS) tactics in patients is aimed at the prevention of
unfavourable outcome development by reducing the extent of primary operation and shifting
in definitive recovery of injured organs and structures toward stabilization of vital functions
of the body or evacuation to the specialist.
Specifics of DCS tactics use in the armed conflicts in Afghanistan (1979-1989) for major
artery injury (63 casualties), in the North Caucasus (1994-2003) – for vascular injuries (47),
long bone fractures and unstable pelvic fractures (26), neck, chest and abdomen injuries
(25) have been studied.
The indications for the use of DCS tactics in patients has been formulated, i.e. the
development of life-endangering consequences (persistent external and internal
hemorrhage, asphyxia) or the presence of the injuries which could develop life-endangering
consequences and severe complications in the process of evacuation, in the situations,
when a complete surgery could not be carried out because of the severity of patient’s
condition or organizational factors. Proceeding from this, it has been determined that DCS
tactics at Medical Treatment Facilities could be used in 44% of patients, including 35%
cases – on medico-tactical indications (in the medical units, Role 2) and in 9% cases –
emergency surgery (the forward hospital, Role 3). The use of DCS tactics demands
differential approach. It seems advisable to perform an objective assessment of patients’
condition severity in mobile resource-limited medical units, and in the case of critical
situation - to reduce the administered care down to pre-evacuation preparation (emergency
medical care) with the following aeromedical evacuation.
Key words:
25
Authors
I.Samokhvalov M., V. Badalov I., A. Gaidash A., K. Golovko P.,
A. Denisov V.
Affiliation
E-mail
TITLE OF THE
BONE TISSUE ULTRA STRUCTURAL CHANGES
ABSTRACT
IN GUNSHOT INJURIES
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
Using research nanotechnologies (scanning electron microscopy, atomic force
microscopy, micro-hardness testing), it has been determined that the common mechanism of
bone destruction in gunshot fractures is a wide-pore osteoporosis-like transformation of bone
matrix with its nanopores enlargement and hydroxyapatite amorphization. The character of
bone tissue changes is determined by bone structural pattern. Flat bones are destroyed
causing perforating fractures predominantly of tough type (the main mechanism of bone
matrix destruction is its layers shifting and its ruptures). The destruction of long bones of
tough-brittle type occurs with the formation of splintered fractures (main mechanisms of bone
matrix destruction are fissures, ruptures, lacunar-cavernous deformity, as well as bone
matrix homogenization and condensing in the area of tubular membranes). To correct
changes diagnosed in gunshot fractures antiosteoporotic medicine – strontium ranelate, was
used. In the experiment dealing with inflicting gunshot fractutes in sheep, it has been found
that strontium ranelate causes enlargement of trabecula of bone and spine line crests,
surface folds hypertrophy, hydroxyapatite crystalline lattice reinforcement. Thus, strontium
ranelate, exerting stabilizing action on hydroxyapatite crystals in regenerate, prevents their
amorphization and promotes callus bone matrix reinforcement. Because of this, the quality of
gunshot fracture union of extremity long bones is improved (bone density rate increased by
6% according to densitometry findings).
Key words:
26
Authors
Maximov LB., MD, professor; Brizhan' L.K., MD; Babich M.I.;
Buryachenko B.P., PhD.; Axenov Yu.V., PhD.; Artemyev V.A.
Affiliation
E-mail
TITLE OF THE
ABSTRACT
MODERN MEANS IN THE TREATMENT OF EXTREMITY
GUNSHOT INJURY SEQUELAE UNDER CONDITIONS OF
MULTIPURPOSE HOSPITAL
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
The treatment results obtained from 635 casualties with different sequelae
of extremity gunshot injuries were analyzed. The use of complex and individual approach in
the patients including modern technologies depending on the leading pathological symptom
complex in different stages of treatment process allowed achieving favorable results in most
cases.
During the last 20 years 992 casualties with extremity isolated, combined
and multiple injuries underwent different types of surgical and conservative treatment in Burden Main Military Clinical Hospital. Subsequently in 635 (64%) cases different sequelae of
extremity injuries developed that were classified according to the leading symptom complex
and required the performance of reconstructive operations. Articular contractures were in 52
(82%) cases, false joints -in 246 (38,7%), bone defects - in 100 (15,7%), bone deformations
in 44 (6,9%), neurogenic deformations - in 32 (5,0%), deforming arthrosis of large joints in51 (8,1%), inveterate injuries of peripheral nerves, tendons and ligaments - in 105 (13,5%),
soft tissue defects - in 25 (3,9%).
482 (75,9%) patients had various combinations of injury sequelae that required complex and individual approach to the choice of surgical tactics taking into account the leading
pathological symptom complex during different treatment stages.
Complex approach with the use of modern technologies (simultaneously or staged) for
extremity injury sequelae included the following types of surgical treatment: large joint endoprosthetics (37 cases), Ilizarov external osteosynthesis for false joints (322), consecutive internal
osteosynthesis for false joints (32), substitution of bone defects using Ilizarov not free osteoplasty method (132), consecutive osteosynthesis by external fixation apparatus (58), different
types of free (auto-, alio-, xeno- and combined) osteoplasty (241), Ilizarov external osteosynthesis for bone and neurogenous deformations (76), transposition of muscle-"motor" tendons to paralyzed muscle tendons (42), neurolysis, suture and plasty of peripheral nerves (480), different
types of not free plasty for soft tissue defects (24) and osteoplasty (184), arthroplasty (57), large
joint arthroscopy (64), different types of tendon and ligament plasty (252).
To substitute small bone defects (1-5 cm) one osteotomy of longer fragment was performed, middle defects (6-9 cm) usually required 2 osteotomies, large defects (10-20 cm) -23 osteotomies and super large defects - 3 osteotomies and more. In 10 cases of large and
super large defects of tibial diaphysis fibula transpositions to the bone defect zone with fixation of bone fragments in Ilizarov's apparatus were performed. The post-gunshot defects of
articular ends of proximal and distal femur were treated by endoprosthetics of hip or knee joints. Articular end defects of distal tibia were replaced by Ilizarov's method with subsequent
ankle arthrodesis in functionally favorable foot position. For articular defects of proximal tibia
the total endoprosthetics of knee joint by individually selected tibial components with revisional limb was performed. For endoprosthetics of defective bones forming elbow joint the home-produced and foreign implants were used.
When hypotrophic and atrophic distractive regenerations occur as well as in the cases of delayed bone adhesion in the area of bone fragment contact the methods of free bo27
ne auto- and alloplasty, implantation of different biocomposite materials based on
hydroxyapatite are widely used in the clinical practice. In the patients with false joints and
bone defects having concomitant lesions of nerve trunk, in the cases of sciatic, fibular, median and radial nerve damage, the surgical intervention included operations on nerve trunks
together with transposition of muscle-"motor" ten-dons to paralyzed muscle tendons. The
stable large joint contractures were treated in two stages. In the first stage the operation was
performed that included myolysis, arthrolysis, tendolysis, and after wound healing the osteosynthesis of joint-forming bones was performed with the use of external fixation apparatus.
Subsequently, after apparatus dismantlement the staged plaster splints were applied in order to achieve stable favorable functional results.
The analysis of data obtained shows that the use of modern methods of surgical treatment with staged and subsequent restorative therapy in the rehabilitation centers of Russian Defense Ministry allows achieving good results in 527 (83,0%) casualties and satisfactory - in 95 (14,9%). The unsatisfactory outcomes (chronicle osteomyelitis, deformations,
stable contractures and ankylosis) were diagnosed in 13 (2,1%) patients. It was conditioned
by the severity of wounds, tactical mistakes and psychosomatic disorders during the long
staged therapy.
Key words:
28
Authors
Affiliation
Slobodanka VUKELIC-MARKOVIC, Ružica KOZOMARA, Miroslav
BROCIC, Nebojsa JOVIC, Srboljub STOŠIĆ
Clinic of Maxillofacial Surgery, Military Medical Academy,
Belgrade, Serbia
E-mail
TITLE OF THE
FOUR CASES OF LOCALIZED CASTLEMAN'S DISEASE AT THE
ABSTRACT
NECK
Topic/session
Presentation suggestion
(underline)
Background: Castleman's disease (angiofollicular lymph node hyperplasia or giant lymph
node hyperplasia) appears as localized or – rarely - multicentric benign lymph node mass of
the mediastinum, but it has been reported in abdominal and retroperitoneal cavities, lungs,
axillary and cervical region.
Case report: during last 15 years there were four cases of Castleman's disease localized at
the neck: 54 years old lady and three males: 32, 48 and 20 years old. All of them had
asymptomatic, slowly growing tumor mass; diameter 9, 7, 6 and 8 cm respectively; without
data about previous inflammatory episodes; under the upper third of the sternocleidomastoid
muscle, with clinical presentation resembling lateral branchial cyst and clear
ultrasonographic description of a solitary, clearly limited lymph node with abundant
vascularization. Intraoperatively they were soft, fatty, bloody and easy removable. After
pathohistologic verification of hyaline-vascular type of Castleman's disease in all four cases,
patients are followed up during a period of 15, 5, 4 and 2 years with repeated
ultrasonographic examination of the neck, axillas and abdomen and CT examination of the
chest, but none of them developed any sign of local or multicentric relapse.
Conclusion: Castleman's disease is the rarest benign lymph node hyperplasia in our
surgical praxis. These four cases were successfully operated and carefully followed up for
years.
Key words:
29
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Kozomara R.,Vukelić-Marković S., Jovic N., Stošić S., Broćić M.,
Lončarevic S.
Clinic of Maxillofacial Surgery, MMA, Belgrade, Serbia
THE RELAPSE RATE OF ORAL SQUAMOCELLULAR
CARCINOMA AFTER SURGERY AND POSTOPERATIVE
IRRADIATION THERAPY
Topic/session
Presentation suggestion
(underline)
Background: Frequency and importance of etiologic factors in onset of oral squamocellular
carcinoma (OPCC) at tongue and the floor of the mouth, together with their pathohistologic
and clinical features, point to high incidence of its relapse. Aim: According to available
prognostic parameters, including tumor parameters (pathohistologic and TNM classification),
it is not possible for certain to explain the high incidence disease relapse in patients with the
same histologic type, stage and size of tumors which were treated in the same way (surgery
and postoperative irradiation) and which were all pathohistologicly proved to be completely
excised.
Patients and methods: During three years long clinical follow up of 84% male and 16%
female patients, 43-80 years old, with OPCC of tongue and the floor of the mouth, we
analyzed 12% patients in the second and 88% patients in the third stage of the disease, with
10% of T-1, 76% of T-2 and 14% of T-3 tumor size. The lesion was mostly localized at the
middle third of tongue margin. 54% of patients showed the infiltrative tumor growth. All of the
patients underwent tumor excision as well as regional lymphadenectomy. In 88% patients
the dissection of the neck was performed: in 80% of patients it was suprahyoid – 63%
unilateral and 17% bilateral – dissection, while 14% of the patients underwent radical and
7% supraomohyoid dissection of the neck. Pathohistologic examination confirmed positive
lymph nodes in 71% cases of suprahyoid and all cases of radical and supraomohyoid
dissection.
Results: Clinical follow up demonstrated relapse of the disease in 46% of the patients: in
65% of them it appeared early (during the first twelve months after treatment), while in 35%
of them in the period 12-36 months after treatment. Simultaneous appearance of both local
and locoregional relapse appeared early in 21% and lately in 8% of the patients.
Conclusion: The high incidence relapse of the disease in patients with OPCC at tongue and
the floor of the mouth who have been treated by surgery and radiotherapy show that the
course of malignant disease may be in correlation with aggressiveness of tumors.
Key words:
30
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Kozomara R.,Vukelić-Marković S., Jovic N., Stošić S., Broćić M.,
Lončarevic S.
Clinic of Maxillofacial Surgery, MMA, Belgrade, Serbia
THE RELAPSE RATE OF ORAL SQUAMOCELLULAR
CARCINOMA AFTER SURGERY AND POSTOPERATIVE
IRRADIATION THERAPY
Topic/session
Presentation suggestion
(underline)
Background: Frequency and importance of etiologic factors in onset of oral squamocellular
carcinoma (OPCC) at tongue and the floor of the mouth, together with their pathohistologic
and clinical features, point to high incidence of its relapse.
Aim: According to available prognostic parameters, including tumor parameters
(pathohistologic and TNM classification), it is not possible for certain to explain the high
incidence disease relapse in patients with the same histologic type, stage and size of tumors
which were treated in the same way (surgery and postoperative irradiation) and which were
all pathohistologicly proved to be completely excised.
Patients and methods: During three years long clinical follow up of 84% male and 16%
female patients, 43-80 years old, with OPCC of tongue and the floor of the mouth, we
analyzed 12% patients in the second and 88% patients in the third stage of the disease, with
10% of T-1, 76% of T-2 and 14% of T-3 tumor size. The lesion was mostly localized at the
middle third of tongue margin. 54% of patients showed the infiltrative tumor growth. All of the
patients underwent tumor excision as well as regional lymphadenectomy. In 88% patients
the dissection of the neck was performed: in 80% of patients it was suprahyoid – 63%
unilateral and 17% bilateral – dissection, while 14% of the patients underwent radical and
7% supraomohyoid dissection of the neck. Pathohistologic examination confirmed positive
lymph nodes in 71% cases of suprahyoid and all cases of radical and supraomohyoid
dissection.
Results: Clinical follow up demonstrated relapse of the disease in 46% of the patients: in
65% of them it appeared early (during the first twelve months after treatment), while in 35%
of them in the period 12-36 months after treatment. Simultaneous appearance of both local
and locoregional relapse appeared early in 21% and lately in 8% of the patients.
Conclusion: The high incidence relapse of the disease in patients with OPCC at tongue and
the floor of the mouth who have been treated by surgery and radiotherapy show that the
course of malignant disease may be in correlation with aggressiveness of tumors.
Key words:
31
POSTERI
Authors
Prof. Abdul Nasser Kaadan, MD, Ph D
Prof & Consultant in Orthopedic Surgery
PhD, History of Islamic Medicine
Aleppo University, Aleppo-Syria
[email protected]
The War in Syria Obliged Some Hospitals to Apply Primitive
Ways of Sterilization
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
Old Chinese and Egyptian physicians used some chemical methods for the treatment of
wounds and injuries. Although the beneficial effect of passing surgical instruments through
flame was well known to ancients civilizations, the heat as a preservative method in medical
industry, was first introduced in 1809 in France. Joseph Lister’s (1827–1912) believed that it
was microbes carried in the air that caused diseases to be spread in wards. Sterile gowns
and caps used by Gustav Neuber. Surgical masks were applied in 1897 by Mikulicz, while
rubber gloves advised by William Halstead in 1890.
For the last three years, Syria suffers from the worst kind of war. So far more than 125
thousands civilians were dead and more than four hundred thousands were injured. A lot of
sever different casualties resulted, which was extremely above the capacity of the local
hospitals, especially that some hospitals were occupied by some fighting sides and used for
military purposes. Some houses changed into field hospitals, where there is no even some
degree of sterilization. As I am an orthopedic surgeon, I found myself going back to practice
a primitive form of sterilization. We applied smoking and boiling the metal surgical
instruments. Other non-metal instruments were used without sterilization. Some surgical
procedures, such as amputations, were performed with bare hands, as there is no surgical
gloves. Bone saws were sterilized by flaming. The percentage of infection is very high due
to lacking in antibiotics as well.
The aim of this paper is to shed lights on the primitive methods of sterilization inside
some hospitals in Syria, where the war in still flaming.
Key words:
32
Authors
Farzad Shirazian, MD, Anesthesiology Specialist.
Sahel Bakhtiari, MSc.
Affiliation
Valiasr Hospital/ Tehran / Iran
E-mail
[email protected]
TITLE OF THE
ANALYZING THE COMPARISON BETWEEN GCS AND FOUR
ABSTRACT
SCORE IN PATIENTS WITH LOW LEVEL OF CONSCIOUSNESS
FOR THEIR NEUROLOGIC PROGNOSTICATION
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
EVIDENCE
The GCS is widely accepted tool in the evaluation of (loc) and predictor of prognosis. The
full out line of unresponsiveness (four) is a tool to measure patient by omitting some
components and add other component to GCS. Therefore providing a more accurate
prognosis prediction.
EVALUATION
This study was performed in one of police hospitals in Tehran-Iran. The GCS and the four
score were obtained on admission, after two weeks, and follow up the patients after one
month. Addition of it APACHE4 was performed on admission day .finally out come was
evaluated for all patients after one month and compare the GCS and the four in predict
prognosis and compare them with APACHE4 in evaluation and prediction.
RESULT
Among of the 42 patients analyzed %9.5 discharged with goodness state, %42.9 with
neurological deficit and %47.6 died during or up to one month. Pearson showed a
statistically correlation between four and apache4 r=-0.360 and p=0.019 and between GCS
and apache4 r=-0.316 and p=0.41 and between GCS and four r=0 .21 and p<0.001. There
was not a significant difference between scales in serial evaluations but the four is better
than the GCS for primary evaluation.
RECOMMENDATION
We anticipated that the four would demonstrate significant advantages over of the GCS
because of its components .however; result did not indicate any real difference between
scales. the four is better than the GCS in the first evaluation but neither tool is complete and
should better test and evaluate the four more and complete it if be necessary.
Key words:
GCS, four, APACHE4
33
Authors
Hamed Aghdam, MD, Emergency Medicine Specialist.
Seyyed Mohammad reza Seyyedahmadian, MD.
Saeed Abbasi, Emergency Medicine Specialist.
Nayyereh Garjani, Emergency Medicine Specialist.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
COMPARISON BETWEEN ULTRASOUND GUIDED HEMATOMA
ABSTRACT
BLOCK AND MEDIAN NERVE BLOCK GUIDED
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Aim:
Distal radius fractures are frequently treated in the emergency department (ED) with closed
reduction and splinting. Ultrasound (US) has been recently a useful tool for diagnostic and
trapeutic procedures.
The aim of this study was to compare the effect of reducing pain in median and radial nerve
block with hematoma block both guided by sonography in patients attending hospital by
distal radius fracture.
Method:
This study has been accomplished as a uni-blinded randomized clinical trial, in which 120
patients participated and were randomized to two 60-member groups to receive hematoma
block or median and radial nerve block technique both guided by ultrasound.
All patients were recorded by a visual pain assessment scale before, during and after the
procedure.
Results:
The mean pain score during 5 min. intervals of US guided nerve blockade was significantly
lower than the US guided hematoma blocked group (P<0.005).There was also significant
difference between mean averages of pain score in two groups before and in 5 min. intervals
after reduction (P<0.005). Mean average of pain score during reduction in US guided nerve
blockade group was lower than the US guided hematoma block group, but this difference
was not statistically significant (P=0.103).
Discussion:
The findings of this study showed that the ultrasound-guided technique for median and radial
nerve block as a simple and safe procedure that could be accomplished by Emergency
Physicians even more simply than the ultrasound-guided hematoma block technique.
Key words:
34
ultrasound-guided median and radial nerve block, ultrasound-guided
hematoma block, Distal radius fracture
Ali Amirahmadi MD1, Somayeh Zavareian DDS2
1.
Rajaie Cardiovascular Medical & Research Center, Iran
University of Medical Sciences, Tehran, Iran.
2.
MSc in operative and estethetic dentistry, Tehran, Iran
Affiliation
Valiasr Police Hospital/ Tehran / Iran
E-mail
[email protected]
TITLE OF THE
MID-TERM PATENCY RATES IN RADIAL ARTERY AND
ABSTRACT
SAPHENOUS VEIN AFTER CORONARY ARTERY
BYPASS GRAFT SURGERY
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Objective: To compare the mid-term patency of radial artery (RA) left internal thoracic artery
(LITA) and saphenous vein (SV) grafts in asymptomatic patients after coronary artery
bypass graft surgery (CABG).
Method: In this study, 30 three-vessel disease patients with 104 RA, LITA, and SV grafts
used concomitantly for primary isolated non-emergent CABG surgery admitted in one of
Police Force Hospitals in Tehran-Iran were assessed. The primary end point was CT
angiographic graft patency rate. After 53.5 (24-97) months’ follow-up, graft patency was
assessed using 128-slice, dual-source CT coronary angiography. Logistic regression
analysis was used to detect the independent predictors of graft failure.
Result: A total of 104 grafts, including 30 LITA, 44 SV and 30 RA grafts, were studied.
Cumulative graft patency rates were 93.3% in the LITA, 83.3% in the RA, and 70.5% in the
SV grafts, respectively. There was a statistically significant difference between the LITA and
the SV graft patency rates (p = 0.019), whereas the difference between the RA conduit
patency and the LITA or SV graft patency rates did not constitute statistical significance (p =
0.424 and p = 0.273, respectively). Independent predictors of RA graft failure were native
coronary stenosis <70% and female gender.
Conclusion: In our patients, the RA grafts had an acceptable patency rate at 2-5 years’
follow-up. Although the SV grafts had a relatively higher patency rate than did the RA grafts
in our asymptomatic patients, the patency rates in the RA and SV grafts were close. The RA
graft function was poor in the patients with a higher number of risk factors and in the
females.
Key words:
Coronary arteries bypass graft; Radial artery; Saphenous vein;
Graft patency; CT- angiography
35
Authors
Ali Majidi, MD, Neurosurgery Specialist
Hamed Aghdam, MD, Emergency Medicine Specialist.
Mojtaba Chahardoli, Emergency Medicine Specialist.
Mohammadreza Maghsoudi, Emergency Medicine Specialist.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
RELATION BETWEEN POST- HEAD TRAUMA CLINICAL
ABSTRACT
SYMPTOMS AND ABNORMAL CT SCAN FINDINGS IN MINOR
HEAD INJURY PATIENTS
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Introduction: Minor head trauma accounts for 70 to 90% of all head traumas. Previous
studies stated that minor head traumas were associated with 7-20% significant abnormal
findings in brain CT-scans. We aimed to re-evaluate clinical criteria of taking brain CT scan
in patients who suffered from minor head trauma.
Methods: We enrolled 680 patients who presented to an academic trauma hospital with
minor head trauma in a prospective manner. All participants underwent brain CT scan if they
consistent with inclusion criteria and the results of scans were compared with clinical
examination finding.
Results: loss of consciousness (GCS drop or amnesia) was markedly associated with
abnormal brain CT scan (P<0.05). Interestingly, we found 7 patients with normal clinical
examination but significant abnormal brain CT scan.
Conclusion: According to the results of our study, we recommend that all patients with
minor head trauma underwent brain CT scan in order not to miss any life-threatening head
injuries.
Key words:
36
Minor head trauma, Glasgow Coma Scale (GCS), Amnesia,
Brain CT scan.
Authors
Ali Majidi, MD, Neurosurgery Specialist.
Hamed Aghdam, MD, Emergency Medicine Specialist.
Mani Mofidi, Emergency Medicine Specialist.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
ROLE OF SERUM AMMONIA LEVEL IN DETECTING
ABSTRACT
INTRA-ABDOMINAL HEMORRHAGE FOLLOWING
ABDOMINAL BLUNT TRAUMA
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Introduction: Blunt abdominal injury is a leading cause of death in trauma patients. Finding
a reliable test predicting intra abdominal hemorrhage would be a novel method. This study
aimed to assess the diagnostic accuracy of using serum ammonia level in detection of intraabdominal bleeding in patients with blunt abdominal trauma.
Methods: In this observational study, all patients suffering from blunt abdominal trauma,
referred to our university teaching hospital included. The levels of ammonia were measured
at the time of admission to emergency department and one hour after initial treatment.
Demographic data, vital signs and venous blood gas reports were recorded. Findings of
abdominopelvic CT scan and laparotomy were assumed as a gold standard for abdominal
injuries.
Results: 104 patients enrolled in the study. 15 patients (14.4%) had intra-abdominal
hemorrhage and the mean serum ammonia level in this group was significantly higher than
the other patients (101.73± 5.41 µg/dl vs. 47.36± 26.31 µg/dl, P<0.001). On ROC curve
analysis, in cut-off point of 95.5 µg/dl, the sensitivity, specificity, positive and negative
likelihood ratios were 86.67% (95%CI, 62.1-96.2), 94.38% (95%CI, 87.5-97.5), 15.42
(95%CI, 6.43-36.98), and 0.14 (95%CI, 0.03-0.51) respectively.
Conclusion: These data suggest that measurement of serum ammonia at the time of
admission in patients with blunt abdominal trauma could be a predictive test for intra
abdominal hemorrhage. Also, ammonia level decrement could be a useful marker for
monitoring response to treatment in these patients.
Key words:
Serum Ammonia level, intra-abdominal hemorrhage,
abdominal blunt trauma
37
Ali Amirahmadi 1, Somayeh Zavareian 2
1. Rajaie Cardiovascular Medical & Research Center, Iran University
of Medical Sciences, Tehran, Iran.
2. MSc in operative and esthetic dentistry, Tehran, Iran
Affiliation
Valiasr Police Hospital/ Tehran / Iran
E-mail
[email protected]
TITLE OF THE
SEX DIFFERENCE IN MID-TERM PATENCY OF ARTERIAL AND
ABSTRACT
VENOUS GRAFTS AFTER CORONARY ARTERY BYPASS
GRAFT SURGERY
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Background: The aim of this study was to compare the sex difference in patency rates of
left internal thoracic artery (LITA), radial artery (RA) and saphenous vein (SV) grafts in
asymptomatic patients after coronary artery bypass graft surgery (CABG) after 2-5 years
follow up period.
Method: We assessed 30 patients with three-vessel coronary artery disease including 104
LITA, RA, and SV grafts concomitantly used for isolated elective CABG surgery admitted in
one of Police Force Hospitals in Tehran-Iran. The primary end point was rates of graft
patency in both men and women. After 2-5 years follow-up, graft patency was assessed by
128-slice, dual-source CT coronary angiography.
Result: There were 21 men and 9 women in this study. A total of 104 grafts, including 30
LITA, 44 SV and 30 RA grafts, were studied. Total graft patency rate was 84/104 (80.8%).
Graft patency rate in men was 64/78 (82.1%) and in women was 20/26 (76.9%; p=0.774).
LITA graft patency rates were 20/21(95.2%) in men and 8/9 (88.9%) in women (p=1.000).
Patency rates in RA were 21/22 (95.5%) and 4/8 (50%; p=0.016), and in SV were 22/34
(64.7%) and 9/10 (90%) in men and women respectively (p=0.251).
Conclusion: This study revealed that in asymptomatic patients who underwent CABG
surgery 2-5 years ago there is a statistically significant lower RA patency rate in women
compared with men. We didn’t find any difference in LITA or SV grafts patency rates
between men and women in mid-term follow up.
Key words:
38
Coronary artery bypass graft, Radial artery, Saphenous vein,
graft patency, CT- angiography
Authors
Ali Majidi, MD, Neurosurgery Specialist
Reza Hiradasa, Pediatric Medicine Specialist
Sareh Samadi, MSc.
Ali akbar Golmohammadi, PhD
Nima Soleymanzadeh Ardebili
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
THE EFFECT OF STEP LENGTH ON VERTICAL AND POSTERIOR
ABSTRACT
COMPONENTS OF GROUND REACTION FORCE DURING FIXED-CADENCE
MARCHING
Topic/session
War Surgery
Presentation suggestion
ORAL
POSTER
(underline)
Introduction and objective: Officers and soldiers in the military training program undergo a
structured regimen of training and exercise that yields a high incidence of lower-extremity
injury. Stress fractures of the lower extremity are one of the major overuse injuries of military
training programs. This type of bone fracture occurs following exposure to cyclic subthreshold loadings.
Methods: Officers and soldiers in military training program, march together in a fixedcadence manner, in which the running speed and the step rate are fixed over time. The aim
of this study was 1 ) to assess and compare the ground reaction force and loading rate
responses of the fixed-cadence marching at the fourth step and single leg landing, and 2 )
the effect of over striding in the fourth step of fixed-cadence marching on the ground reaction
forces and loading rates.
Results: The results showed a high correlation between the vertical and posterior
components of ground reaction force and loading rate(VGRF, PGRF, VROL and PROL)
between the fixed-cadence marching at the fourth step and single leg landing (respectively r
=0.863, r=0.781, r=0.847, r=0.798 and p<0.05). Increasing the step length, all variables
(VGRF, PGRF, VROL and PROL) increases significantly (p <0.05).
Conclusion: The increase in the amount and rate of ground reaction forces can increase the
risk of stress fracture on the lower extremities of soldiers and officers. As a mechanism to
prevent over striding in the fixed-cadence marching, a proposal is that soldiers and officers
with the same height can be arranged to a group during marching, so that their step length
maintain around their preferred one.
Key words:
Stress fracture, Ground reaction force, loading rate, Step length
39
Authors
Ana MALIVUKOVIĆ1, Nenad NOVAKOVIĆ2, Milan LEPIĆ2, Ljubodrag
MINIĆ2
Affiliation
1
E-mail
[email protected]
TITLE OF THE
ABSTRACT
HISTORY, CURRENT STATE AND FUTURE POSSIBILITIES IN
CRANIOPLASTY
Topic/session
War Surgery
Clinic for Plastic Surgery and Burns, Military Medical Academy,
Belgrade, Serbia
2
Neurosurgical Clinic, Military Medical Academy, Belgrade, Serbia
Presentation suggestion (underline)
ORAL
POSTER
Introduction: Trepanation of the cranium is one of the oldest known surgical procedures
which evidences are dating from at least 1500 BC. It was not rare that the trepanation was
followed by an immediate or even a delayed Cranioplasty of the defect, and the historical
evidences from ancient Peruvian times are revealing intended gold plate cranioplasty of the
bone defect, even the ones where the bone has healed around the foreign body that proves
that the cranioplasty was performed antemortem. Cranioplasty development sped up with
development of neurosurgery, where more patients survived despite the cranial defect, as a
result of the disease or traumatic injury, especially those of war gunshot trauma in WWII,
which directly influenced the Poly(methyl methacrylate) introduction in cranial reconstruction.
Materials and Methods: This article will review materials used in cranioplasty from it´s very
beginning until modern times, and future materials which time is yet to come.
Results: There are features that the ideal material should have, but still none of the materials
to time fuses all the features in it. The materials used are autograft cranium and other bones,
allograft metal and non-metal grafts out of which titanium and PMMA are the most common
ones.
Conclusion(s): While there is still no perfect material, newly developed pre-made implants
are near future subject of interest (both grinded and 3D printed which are still not present in
everyday praxis for their high cost), before stem cell and morphogenic proteins take the main
role and get evolved for ideal material features.
Key words:
40
craniolplasty, features, history, pre made implants
Authors
Professor, Colonel, Mahir Güleç
Affiliation
Prof. GATA Public Health Department, TURKEY
E-mail
[email protected]
TITLE OF THE
ABSTRACT
IDENTIFYING THE FREQUENCY OF HAVING FRACTURES
AND DISLOCATIONS IN YOUNG MALE ADULTS
Topic/session
Presentation suggestion (underline)
SUMMARY
Injuries due to accidents in children and adolescents who are more sensitive to different risk
factors in the social and physical environment have an important part in the reason of
mortality and morbidity. Fractures are the most commonly seen problems among these
injuries.
This is a cross-sectional study was carried out in a military school in Ankara. All 2720
students in the school were included and giving a questionnaire to the students collected the
data.
It is found out that 418 (17%) out of 2461 students we could interview had had a fracture. No
statistically meaningful relationship was found between the frequency of having fractures and
the educational status of the parents or whether the mother is working or not. However, it
was seen that the frequency of fractures increased as the economical status of the parents
increased.
The high frequency of having fractures in childhood and adolescence in young male adults
and bonesetters being the first place that people with a fracture go (27%) are 2 important
results that should be taken into consideration.
Key words:
41
Authors
Reza Hiradasa, Pediatric Medicine Specialist, Police Force Medicine
of I.R. Iran
Mohsen Hajzeinolabedini, Education administration of Police Force
Medicine of I.R. Iran
Hamed Aghdam, MD , Emergency Medicine Specialist
Nader Tavakkoli, Emergency Medicine Specialist
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
ANTERIOR SHOULDER DISLOCATION COMPLICATED BY
ABSTRACT
ARTERIAL AND VENOUS THROMBOSIS, A CASE REPORT IN
TRAUMA MANAGEMENT
Topic/session
Basic Research In Trauma
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Anterior shoulder dislocation is an exceedingly common form of shoulder dislocation and
compromises more than 90% of all shoulder dislocations. Axillary artery involvement after
dislocation of the shoulder joint is very unusual. In our knowledge, vascular damage after
shoulder fracture-dislocation has an incidence of 0.6%, and much more rare without any
fracture. Unawareness for closed axillary artery trauma by many physicians managing
shoulder dislocations, often leads to missed or delayed diagnosis. This report presents the
possibility of axillary artery injury with anterior shoulder dislocation.
This report documents a case of anterior shoulder dislocation admitted with arterial and
venous thrombosis. This patient suffered a falling down injury to his outstretched arm and
displaced left humeral heads anteriorly. After closed reduction, he developed an axillary
artery and vein thrombosis less than a day later and required surgical therapy.
Key words:
42
Axillary artery injury, Shoulder dislocation,
Arterial and Venous Thrombosis.
Authors
Hamed Aghdam, MD , Emergency Medicine Specialist.
Houshang Shavvakh, MD.
Mohammad Reza Yasin zadeh, Emergency Medicine Specialist.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
EVALUATION OF NEUROPROTECTIVE EFFECTS OF
ABSTRACT
ERYTHROPOIETIN IN HUMAN TRAUMATIC BRAIN INJURIES
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Aim To test the possible neuroprotective effect of high-dose erythropoietin-alpha (Epoalpha) after human traumatic brain injuries.
Methods In a prospective, double blind controlled trial, the cases of moderate traumatic
brain injury were randomly allocated into two groups: Epo-groups and control groups (n
=30). Participants in Epo group received a first dose of erythropoietin as soon as possible,
followed by an additional injection every 24 h during the first 72 h after admission (40,000 IU
intravenously each injection).Neurologic outcome was assessed up to day 28 and were
compared with those of matched-paired controls.
Results There was not any significant difference of age (P=0.678), sex (P=0.360), Outcome
of head trauma (P=0.983), ICU admission (P=1.000), GCS (P=0.660), Barthel Index
(P=0.347), and Minimal Mental State (P=0.660) on admission between two studied groups.
The mean Glasgow Coma Scale (GCS) and Barthel Index (BI) on days three, seven and 28
or discharge date of Epo group was significantly higher than the control group. Mean
average of Minimal Mental State Examination (MMSE) on days three, seven and 28 or
discharge in Epo group were higher but not significant than the control group, but the
difference was statistically significant on day 28.
Conclusions EPO has protective effects after moderate TBI, and among victims of human
traumatic brain injuries treated with erythropoietin, we observed a high survival rate, with no
minor cerebral or haematological side effects. Future studies of Epo should pay particular
attention to these findings.
Key words:
Human traumatic brain injuries; Neuroprotection; Erythropoietin.
43
Authors
Affiliation
J. Kozarski , B.Piščević, G Šijan, N.Ostojić
Medical faculty of MMA, Belgrade, Serbia
Clinic for Plastic Surgery and Burns, Military Medical Academy,
Belgrade, Serbia
[email protected]
MICROSURGERY IN WAR SURGERY
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
War wounds caused by modern infantry weapons or explosive devices are very often
followed by defects of various tissues. In accordance with war surgical doctrine at the Clinic
for Plastic Surgery and Burns, we used free flaps in treating wounded with vast tissue
defects. With an aim of closing war wounds, covering deep structures or making the
preconditions for later reconstruction of deep structures, we applied the free flaps. The main
criteria for using free flaps were: general condition of wounded, extent, location, and
structure of tissue defects. We analyzed free flaps that we applied. After free flap transfer
we performed (16,6 %) revisions, and after (9,2%) unsuccessful revisions we applied
another free flaps in (2,5 %) patients, local skin flap in (0,8%) patient, cross leg flaps in
(4,2%) patients, or performed below knee amputation in (1,6%) patients.
These war-wounds were accompanied by various tissue defects in over 50% of the wounded. In
more than two-thirds of the wounded patients treated at our clinic, the structure of the war-wounds
tissue defects was complex, therefore the surgical treatment of these wounds often required a multidisciplinary procedure and a joint work of various surgeons-specialists usually with orthopaedists.
The surgical treatment of war-wounds accompanied by tissue defects consists of primary or
secondary excision of devitalized tissue, delayed closure of the wounds as well as of secondary
reconstructure of deep structures. An adequate primary excision of devitalized tissue makes the
delayed closure of the wound possible. A proper closure provides the conditions necessary for
secondary reconstructions of deep structures. Reconstructive microsurgery had fined application in
the treatment of wounded from civil war in The Former Yugoslavia. Microvascular transplantation of
free flaps was first time performed in the history of Yugoslav medicine for the treatment of war
wounds with various tissue defects. In the epidemic situation of war trauma, followed by skin and soft
tissue defects, it was possible to perform transplantation of large, free flaps of various structures by
microvascular technique in one act operation. The aim of free flap application in wounded with
various tissue defects was different according to the phase of surgical treatment. In the first phase of
the surgical treatment the aims are: defect closing, deep structure covering and forming prerequisites
for secondary reconstruction of the deep structures. That is why free flaps with skin component-skin
island, were used in this early phase of the treatment. In the second phase of the surgical treatment the phase of the reconstruction of the deep structures , the aim of the microvascular tissue
transplantation was compensation of deep tissue structures ,usually bone tissue . In this late phase
of surgical treatment, phase of reconstruction of the deep structures free flaps with bone component
or vascularised bone grafts were used The advantages of the free flap transfer are single act surgical
procedure, shorter closing period of war wounds with vast tissue defects and earlier beginning of
physical therapy of wounded and the disadvantages are long duration of surgical procedures and
the facta that microsurgical equipment and trained microsurgical team are required.
Key words:
44
Authors
Affiliation
Kozarski J., Gačević M., Šijan G. Stanković G.
Medical Faculti of MMA Belgrade, Serbia
Clinic for Plastic Surgery and Burns
[email protected]
E-mail
TITLE OF THE
RECONSTRUCTIVE METHODS IN THE TREATMENT OF
ABSTRACT
THE LOWER LEG WAR WOUNDS WITH TISSUE DEFECTS
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
The specificity of the lower leg is in sparse collateral blood flow of the skin cover in the
middle and distal part, reduced subcutaneous tissue and prominence of the front side of tibia
immediately under skin. These characteristics of the lower leg make the application of
standard plastic reconstructive principles to a certain degree impossible. The progress in
anatomical knowledge of vascularization of the tissue territories, application of surgical
microscope, new suture materials provides reconstructive surgeon modern methods of
reconstruction – micro vascular transplantation of tissue and reverse fasciocutaneous flaps.
The aim of this study is to show available methods in the treatment of lower leg injuries. On
the basis of our experiences in the management of the war wounds we would like to point on
the existence of the clear indications for the applications of certain reconstructive methods
depending on size, localization and tissue defect structure, as well as the advantages and
disadvantages of the available reconstructive procedures.
Key words:
45
Authors
Milan LEPIĆ1, Nenad NOVAKOVIĆ 1, Ana MALIVUKOVIĆ 2,
Ljubodrag MINIĆ 1
Affiliation
1 Neurosurgical Clinic, Military Medical Academy, Belgrade, Serbia
2 Clinic for Plastic Surgery and Burns, Military Medical Academy,
Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
ABSTRACT
SUMMARY ON CRANIOPLASTY IN MILITARY MEDICAL
ACADEMY, BELGRADE
Topic/session
War Surgery
Presentation suggestion
ORAL
POSTER
Introduction: Cranioplasty is one of the most common surgical procedures in neurosurgery.
Neurosurgical Clinic, Military Medical Academy is currently performing autograft, titanium
mesh and Poly(methyl methacrylate) (Palacos®) procedures, that are following the majority
of cranial surgeries, and are subject of it’s own for complications regardless of primary
disease. Foreign materials were used when there is no possibility of returning the autologous
bone (gunshot wound to the head, fractures, invasive tumours, graft infection…), and
therefore used less frequently.
Materials and Methods: Our results are a product of a combined retrospective-progressive
study that includes 117 randomised cases (66 autograft, 35 titanium mesh and 16 Palacos®,
where the cranioplasty was performed and followed for at least 6 months for direct
cranioplasty complications.
Results: As a result, three types of complications were evidented: cerebrospinal fluid leak
(fistula), dehiscention and wound infection. The three are present in 10 cases (which stands
for approximate of 8.55% of all patients). The distribution of complications by material
showed that Titanium mesh is suffering to difficult placement and moulding related
complications, while Palacos is easy to mold and place, but its frequent complication rate
makes it the least suitable material.
Conclusion(s): Neither of materials, that are widely used, is good enough to replace patients
own bone because of unsatisfactory functional or cosmetic results. We have successfully
sorted out possible complications that are resulting to cranioplasty which we will be using to
guide the cranioplasty approach.
Key words:
46
cranioplasty, allograft, complications, approach
Authors
BG (ret) Rob van der Meer, MD
Affiliation
MOTEK medical, Amsterdam, The Netherlands
E-mail
[email protected]
TITLE OF THE
RECENT DEVELOPMENTS IN COMPUTER ASSISTED
ABSTRACT
REHABILITATION ENVIRONMENTS
Topic/session
War surgery and traumatology
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Computer Assisted Rehabilitation Environment (CAREN) is a system that integrates a
training platform (motion base), a virtual environment, a sensor system (motion capture) and
D-flow software. It is useful for both diagnostic and therapeutic use. The human gait pattern
can be impaired due to disease, trauma or natural decline. Gait analysis is a useful tool to
identify impaired gait patterns. Traditional gait analysis is a very time consuming process
and therefore only used in exceptional cases. With new systems a quick and extensive
analysis is possible and provides useful tools for therapeutic purposes. The range of
systems will be described in this presentation, highlighting both their diagnostic use and the
therapeutic possibilities. Because wounded warriors often have an impaired gait due to
amputations of other extremity trauma, these systems are very useful for military
rehabilitative efforts. Additionally, the virtual reality environment creates a very challenging
situation for the patient, enhancing their rehabilitation experience. For that reason several
Armed Forces have these systems already in use. The most recent experiences will be
discussed; including new developments both in the extension of the range of systems and
the improvement and adaptation of the software. A new and promising development, the use
of CAREN in a special application for patients with PTSD, will also be reviewed.
Key words:
Rehabilitation, Wounded Warriors, Virtual Environment
47
Authors
Affiliation
Ružica KOZOMARA, Slobodanka VUKELIC-MARKOVIC, Nebojša
JOVIC, Zoran MIRKOVIC, Miroslav BROCIC, Saša JOVIC
Clinic of Maxillofacial Surgery, Military Medical Academy, Belgrade,
Serbia
E-mail
TITLE OF THE
EXTREMELY AGRESSIVE CASE OF DERMATOFIBROSARCOMA
ABSTRACT
OF THE FACE
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Dermatofibrosarcoma is rare tumor in head and neck region, it is asymptomatic and it rarely
metastasizes. Here we present a case of on extremely aggressive, rapidly growing and
mutilating DFS seemingly non-responsive to wide surgical excision.
42 years old men underwent surgical excision of discreet, painless left cheek soft tissue
lesion. There were no palpable lymph nodes on the neck and chest radiography was normal.
On histopathological examination, the lesion was thought to be dermatofibroma. Three years
later, he presented with a recurrence at the site of excision. After excision the recurrent
lesion was suggestive of dermatofibrosarcoma. During almost next three years the patient
has been operated six times: each time the tumor rapidly and aggressively had grown
outwards, destroying the whole middle third of the face, so at the moment of death only
forehead, left eye, tongue and part of mandible had left.
Comparing to dermatofibrosarcoma protuberans which appeared in our three patients,
slowly relapsed and never tended to be aggressive, dermatofibrosarcoma itself, on the other
hand, acted completely reverse, especially in this case where we have observed visible
rapid growth of huge tumor masses destroying face, never giving regional or distant
metastases.
Key words:
48
Authors
Affiliation
Ružica KOZOMARA, Slobodanka VUKELIC-MARKOVIC, Nebojša
JOVIC, Zoran MIRKOVIC, Miroslav BROCIC, Saša JOVIC
Clinic of Maxillofacial Surgery, Military Medical Academy, Belgrade,
Serbia
E-mail
TITLE OF THE
EXTREMELY AGRESSIVE CASE OF DERMATOFIBROSARCOMA
ABSTRACT
OF THE FACE
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
Dermatofibrosarcoma is rare tumor in head and neck region, it is asymptomatic and it rarely
metastasizes. Here we present a case of on extremely aggressive, rapidly growing and
mutilating DFS seemingly non-responsive to wide surgical excision.
42 years old men underwent surgical excision of discreet, painless left cheek soft tissue
lesion. There were no palpable lymph nodes on the neck and chest radiography was normal.
On histopathological examination, the lesion was thought to be dermatofibroma. Three years
later, he presented with a recurrence at the site of excision. After excision the recurrent
lesion was suggestive of dermatofibrosarcoma. During almost next three years the patient
has been operated six times: each time the tumor rapidly and aggressively had grown
outwards, destroying the whole middle third of the face, so at the moment of death only
forehead, left eye, tongue and part of mandible had left.
Comparing to dermatofibrosarcoma protuberans which appeared in our three patients,
slowly relapsed and never tended to be aggressive, dermatofibrosarcoma itself, on the other
hand, acted completely reverse, especially in this case where we have observed visible
rapid growth of huge tumor masses destroying face, never giving regional or distant
metastases.
Key words:
49
Authors
Affiliation
Slobodanka VUKELIĆ-MARKOVIĆ1, Miroslav Broćić1, Ružica
Kozomara1, Srboljub Stošić1, Biserka Vukomanović-Ðurđević2
1
Clinic for Maxillofacial Surgery, Military Medical Academy, Belgrade,
Serbia
2
Institute of Pathology and Forensic Medicine, Military Medical
Academy, Belgrade, Serbia
E-mail
TITLE OF THE
A CASE OF FIBROMYXOMA OF THE MAXILLA
ABSTRACT
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Objectives: Myxofibroma or fibromyxoma (FM) is a rare odontogenic mesenchimal tumour
arising from connective tissue of dental papilla, slightly more common between females,
during the fourth decade, equally appeared in both jaws, being even exceptional in other
bones. FM is locally aggressive, slow growing, non-metastazing tumour which microscopic
examination reveals loose stellate cells, odontogenic epithelial rests and collagenous fibrous
tissue. Its intracellular substance is shown to be rich in hyaluronic acid, accounting for its
neoplastic behaviour.
Material and Method: Here we present a case of 19 year old male with two years long
slowly and painlessly enlarging right cheek, who did not even noticed compromised
breathing through the right nostril and discrete protrusion of the right eye. All his teeth were
in satisfactory condition and clinical signs pointed to cyst, but plain X-ray demonstrated
radiolucency without clear contouring of maxillary walls. CT showed solid intraantral tumor
partially destroying expanded walls of the right maxilla. Through simple intraoral
mucoperiostal incision and slight widening of defect of the front wall we approached firm,
white tumor and removed it completely from antral and right nasal cavity. There were no
postoperative complications. Histopathologic analysis revealed fibromyxoma.
Results: After three months the external asymmetry has been almost completely reduced.
Three years later routine MSCT revealed smaller relapse, which was easily removed. All
teeth remained vital. One year later, there is no signs of another relapse.
Conclusion: This is a case of a rare aggressive odontogenic tumor that can be easily
understood as a cyst in absence of detailed preoperative examination. There is not much
available data in present literature, but complete surgical removal is a therapy of choice.
Key words:
50
Authors
Affiliation
Slobodanka VUKELIC-MARKOVIC, Ruzica KOZOMARA, Nebojša
JOVIC, Srboljub STOSIC, Miroslav BROCIC
Clinic of Maxillofacial Surgery, Military medical Academy, Belgrade,
Serbia
E-mail
TITLE OF THE
ISOLATED NECROSIS OF PALATAL MUCOSIS – CASE REPORT
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
Background: this is an illustrative case of isolated necrosis of palatal soft tissue, followed by
temperature and cough, which „lasted“ three weeks, when 22 years old young man died
without diagnosis, that has been revealed post mortem: disseminated T-cell non-Hodkgin
lymphoma.
Case report: after eight days of treatment of »common-cold« symptoms, 22 years soldier
was admitted at the Clinic because of isolated necrosis of soft palate tissue size 4x2 cm,
followed by fever. After antibiotic therapy, he recovered for a moment, but three days latter,
he became highly febrile with moments of consciousness disturbed. MSCT confirmed that
palatal bones remained intact. EEG excluded inflammatino of the CNS. RTG revealed
bilateral bronchopneumonia. Inspite of microbiologic and mycotic findings and suspicion to
granulomatose infection, he received intense antibiotic and antimycotic therapy, but his
condition progressively worsened: eighth day he was highly febrile, dyspnoic, hypotensive,
with renal and respiratory insufficiency, so he was moved into Intensive Care Unit, where he
was intubated and fed through nasogastic tube. In a meantime he was continously observed
by pulmologist, infectologist, neurosurgeon, neurologist, psychiatrist, general surgeon; CSL
was taken and ultrasound of abdomen was repeated. On the twelweth day because of acute
meningoencephalitis and sepsis he fell into comma, the next day, because of the presence
of the free liqiud into abdomen explorative lapatorotomy was done, but he died of
bronchopneumonia in the afternoon. Autopsy revealed T-cell non-Hodkgin lymphoma
disseminated all over his heart, kidneys, meninges, suprarenal glands, thymus, bones,
stomach and cholecyst, salivary glands, testicles and palatinal mucosa.
Conclusion: in previously healthy soldier isolated necrosis of palatal mucosa actually was the
only visible sign during peracute deterioration of his general condition caused by
disseminated T-cell non-Hodkgin lymphoma that led to death within three weeks.
Key words:
51
Authors
Affiliation
Kozomara R., Vukelić-Marković S., Jović N., Stošić S., Broćić M.
Clinic of Maxillofacial Surgery, Military Medical Academy, Belgrade,
Serbia
E-mail
TITLE OF THE
HYBERNOMA, rare tumor head and neck
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
Hybernomas are rare, asymptomatic, benign tumors that arise mostly in adults from the
remnants of fetal brown adipose tissue, and usually affect muscle and subcutaneous tissue.
This tumor was first described by Merkl in 1906 The brown fat, described by Velch in 1670, is
a specialized form of fat found in the hibernating and non hibernating animals such as rats,
cats, monkeys, rabbits, and humans. Usually occurs between ages 20 and 50 years. In the
adult, brown fat is usually found in scattered foci as persisting vestigial remnants along the
oesophagus, trachea, posterior neck, and interscapular area and around the great vessels of
the mediastinum. Four morphologic variants of hybernoma were identified: typical; myxoid;
spindle cell, and lipoma-like.
General features: the tumor is divided into lobules by thin septa. There are three cell types:
large coarsely vacuolated cells, large finely vacuolated cells with eosinophilic granular
cytoplasm and mature univacuolated adipocytes.
Differential diagnosis: lipoma, adult rhabdomyoma, chondroid lipoma, liposarcoma,
granular cell tumour, metastatic renal cell carcinoma. However, infiltrImmunohistochemistry
and cytogenetic analysis are necessary for definitive diagnosis.
Treatment: although hybernomas are considered benign, they tend to enlarge in size
sometimes causing compression of the neighboring structures. Complete excision is the
treatment of choice. In this case report, we describe the presentation and treatment of a
patient with hybernoma on the supraclavicular region.
Key words:
52
Authors
Szilárd Rendeki MD, Csaba Loibl MD, Livia Szélig MD, Zalán Szántó
MD, Tamás F Molnár MD
Affiliation
University Of Pécs , Medical School, Department of Operational
Medicine , Pécs , Hungary
E-mail
[email protected]
TITLE OF THE
IT HAPPENED A CENTURY AGO :
ABSTRACT
THE BIRTH OF THORACIC SURGICAL ANAESTHESIA
Topic/session
Parallel Session 1 (Surgery)
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective
There have been several turning points in the history of anaesthesia and analgesia,
however, the period exactly preceding the Great War (1914-1918) and the painful and
’bloody’ experiences of the first years of war have been rarely discussed separately. The
development of surgery deriving from war experiences or more specifically, the birth of lung
surgery was an accepted fact at the time. Contrastingly, approaches to the possibilities of
anaesthesia and sedation enabling the performance of surgeries, together with solutions and
answers to thoracic surgical challenge have remained largely unexplored.
Materials and Methods
We felt compelled by becoming familiar with the magnificence of solutions given to
seemingly ’mind-breaking’ challenges of the times to record our nearly a decade long
research and collection of data.
Doctors and medical students working for the military service have shown interest in reading
comprehensible, well-structured, clear and accurate articles and to share and learn from
experiences of military surgery.
Results
The era was that of a real ’brainstorming’ and it is especially the improvised anaesthetic
machines which clearly demonstrate the strengths of the creative mind within the general
state of lethargy of the war period. These machines were simple and reliable constructs put
together from available health care instruments and household appliances. War-time
surgeries proved that the new anaesthetic machines were functioning justifiably well.
Choices of local, general or regional anaesthesia justified the existence of a well-considered
plan. The great number of blunt and penetrating injuries provided the background for finding
solutions for special problems of military surgery.
Conclusion(s)
In contemporary textbooks of surgery, anaesthesia was devoted a separate chapter and
thus was no longer an insignificant appendix to a meditation on surgical technique.
Related literature of nearly a hundred years were browsed through and dusted. Our analysis
had been fuelled by the interesting fact that a once discovered and successfully applied
knowledge
Key words:
Great War, The Birth of Anesthesia,
53
54
55
* M.Sc. Boris Glavač
† Prof. Dr Milivoj Dopsaj
† Prof. Dr Marina Đorđević Nikić
* Prof. Dr Marjan Marinković
§ Prof. Dr Jasmina Nedeljković
Affiliation
* Military Academy, University of Defence, Belgrade, Serbia
† Faculty of Sports and Physical Education, Belgrade, Serbia
§ Faculty of Legal and Business Studies, Novi Sad, Serbia
E-mail
[email protected]
TITLE OF THE
INFLUENCE OF THE EDUCATIONAL PROCESS ON THE
ABSTRACT
ASPECTS OF PHYSICAL EDUCATION WITHIN THE SERBIAN
ARMED FORCES
Topic/session
Mental health
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction/Objective: The aim of this paper is to establish the condition and changes in
the indicators of morphological characteristics, motor skills and life habits within the Serbian
Army members.
Materials and Methods: The subjects of research were students of the Military High School
(N 217), cadets of the Military Academy (N 490), and officers (N 200). Morphological
analysis has been performed using the bioelectrical impedance. Motor skills were tested
using the prescribed tests and lifestyle by survey.
Results: Progressive increase of the morphological characteristics and motor skills are
present until the third year of schooling with the students of the Military High School, except
for the body fat, which decreases with each generation. Eating habits are in accordance with
the nutritional requirements. The muscle mass stabilizes with cadets and body fat
progressively increases. Lifestyle show dominance over the educational system. Motor skills
are stagnating and declining. Endurance tends to decline with age. Stagnation in muscle
mass and significant increase in body fat was observed with officers. The influence of
lifestyle and habits is predominant in the field of inadequate nutrition and insufficient physical
activity.
Conclusions: Indicators of morphological and motor developments and status in the
Serbian Army are predominantly influenced by education during the period of secondary
school, where there is no record of overweight or obesity. Based on the test indicators, a
significant decrease in the influence of education has been noted with the cadets, while
lifestyle prevails in adulthood in terms of inadequate nutrition and insufficient physical
activity.
Key words:
56
morphology, motor skills, education, students, cadets
Authors
Consultant in Anaesthesia,Dr.,Csaba,LOIBL;
Consultant in Anaesthesia, Dr.,Szilard,RENDEKI
Affiliation
University of Pecs, Medical School, Department of Operational
Medicine – Military Medicine, Disaster Medicine and Law
Enforcement Medicine/Pecs/Hungary
E-mail
[email protected]
TITLE OF THE
EDUCATIONAL ASPECTS OF THE OPERATIONAL MEDICINE
ABSTRACT
CONCEPT AMONG THE MEDICAL SCHOOLS IN HUNGARY
Topic/session
Round Table 1 - Education
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective:The Department of Operational Medicine was founded in March
2013 at the Medical School of the University of Pecs, Hungary. After reviewing the system
and goals of our Department, we shall shed light on the crucial problems of Military and
Disaster Medicine in Hungary and present a solution to these difficulties.
Materials and Methods: In our lecture we shall give a brief introduction into the education of
Military, Disaster and Law Enforcement Medicine in Hungary and its role in the different
educational levels, from the armed forces to tertiary education. The educational concepts of
the Department are based on the practice and the knowledge of basic sciences. These
concepts are focusing on research and development and the education of specific subjects.
Results: This is the first ever initiative for cooperation among the Hungarian Medical
Schools to involve experienced and well-trained practitioners of the associated professions.
With this lecture our intention is to build connections.
Conclusion(s): By demonstrating the results of our Department’s first year we are open to
any debate and opinion coming from the audience. We are also search the international
cooperation and opportunity of the topic’s education.
Key words:
Operational Medicine; Education of Military, Disaster and
Law Enforcement Medicine; Medical Schools
57
Authors
Hadi Shirzad, MD.
Hamed Aghdam, MD, Emergency Medicine Specialist.
Mani Mofidi, Emergency Medicine Specialist.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
BASIC LIFE SUPPORT; VIDEO SELF-INSTRUCTION OR CONVENTIONAL
ABSTRACT
LECTURING, WHICH ONE IS MORE EFFICIENT IN MEDICAL TRAINEES
Topic/session
Basic Research in Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Background: Medical schools apply new methods to improve the level of educational
preparedness of their students. The aim of this study is to evaluate the application and
performance of the video self-instruction (VSI) methods in training Basic Life Support (BLS)
and to compare it with conventional lecturing.
Methods: 81 undergraduate medical students were randomly assigned to receive either 12
minutes of VSI with reply facilities (case group) or the traditional BLS course (control group).
Recruited students participated in pre-test and post-test based on American Heart
Association (AHA) guideline in 2010.
Results: The average score of VSI group and the conventional group before training were
8.85±2.42 and 8.57±2.22 respectively (p = 0.592). After training, VSI group achieved
remarkably better results compared with the control group, 20.24±0.83 versus 18.05±1.86
(p<0.001).
Conclusion: This study demonstrated that training through VSI is more flexible and has
better effects than conventional lecturing. Besides BLS training, distance-learning could be
suitable for more widespread use in medical students’ courses.
Key words:
58
Basic Life Support, Video Self -Instruction, Distance-learning,
Medical student
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Louisa Morris, defence lecturer in general practice, 1 Richard
Withnall, defence professor of general practice,1 Dudley Graham,
senior lecturer in military general practice, 1 Marcy Wallace, research
manager.
1
Royal Centre for Defence Medicine (Research and Academia),
Medical Directorate, ICT Centre, Birmingham Research Park,
Vincent Drive, Edgbaston, B15 2SQ, UK.
[email protected]
AUDIT OF ANNUAL MEDICAL APPRAISAL AND REVALIDATION
ACTIVITY ACROSS THE UK DEFENCE MEDICAL SERVICES
(DMS)
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Aim: The first overarching audit of annual medical appraisal activity across the DMS for
appraisal year 2013.
Background: Medical appraisal as defined within the Medical Appraisal Guide produced by
the National Health Service (NHS) Revalidation Support Team (RST). Annual medical
appraisal for all doctors working within the DMS was introduced in 2002. The General
Medical Council (GMC) began issuing licences to practise to eligible DMS doctors in Nov 11.
Revalidation of all GMC-registered doctors went live across the UK in Dec 13. Primacy for
annual appraisal processes and revalidation recommendations rests with the Responsible
Officers (ROs) of GMC-approved Designated Bodies (DBs). In total there are five DBs within the
DMS: Royal Navy (RN), Royal Air Force (RAF), Army (Army), Defence Primary Health Care
(DPHC), Defence Deanery (DHET) plus British Forces Germany (BFG) which has its own RO
and is therefore considered in its own right for the proposes of the audit. Civilian medical
practitioners transferred across from single service DBs to DPHC DB in October 2013.
Method: In February 2014 a detailed questionnaire was sent to the ROs of all DMS DBs and
BFG. Results were analysed and collated in order to get an accurate picture of the situation
across the DMS in Appraisal year 2013. Questionnaires consisted of 17 multi-stem
questions relating to; General Information, Appraisals, Revalidation, Appraisers and Quality
Assurance.
Results: Questionnaires were returned and analysed from all six participants. One
participant repeated the questionnaire as the initial results returned were for appraisal year
Arp 12 / Mar 13 with all other DBs reporting on appraisal year Apr13 / Mar14.
- The majority of DMS doctors (55.7%) provided evidence of undergoing successful annual
appraisal, with most (74.5%) being appraised within the DMS excludes Army data.
Across DBs the proportion of doctors providing the RO with evidence of a completed
appraisal ranged from 27% (Army) to 100% (RN).
- Of those doctors not completing an annual appraisal the majority did not attempt an
appraisal.
- Between 12.7% and 34.5% of doctors had a revalidation date set with only a small
number (12) across the DMS having their revalidation deferred due to lack of evidence
and 100% eventually achieving a positive revalidation recommendation.
- The total number of military appraisers ranged widely across relevant DBs (4-70) as did
the number of appraisals conducted per appraiser (range 0-18). It is likely that more
appraisers are required across all three services.
- There is no coherent DMS appraisal and revalidation quality assurance process at
59
present however all DBs and BFG are independently.
Conclusions:
- Despite challenges of data collection the majority of doctors across the DMS are known
to have undergone appraisal (55.7%).
- All eligible doctors have thus far been successfully revalidated.
- By-speciality data is not readily available across all DBs however there is no apparent
by-speciality discrepancy in compliance with appraisal and revalidation.
- GDMO appraisal data is not clearly reported and therefore needs to be further explored.
- Data for Reservists is not held by the DMS DBs and is therefore an unknown entity.
- No single live database is in use across defence for recording and monitoring of
appraisal activity.
- No coherent Quality Assurance process is in place across defence.
Recommendations:
- All DBs should now maintain a live database with up-to date appraisal and revalidation
data in order to satisfy the GMCs requirement for quality assurance.
- It is suggested that the National Health Service (NHS) Revalidation Support Team
(RST)1 RO dashboard is used as the majority of DBs are already using this system.
- All three services should invest in appraiser training in order to ensure that the demand
for military appraisers is met.
- This audit should be repeated for the next appraisal year to monitor any emerging trends
and encompassing data on GDMOs.
- The data obtained will support DMS appraisal and revalidation policy and quality
assurance work; and also inform the future DMS appraiser training requirement.
Key words:
60
Authors
Alexander Grebenyuk
Affiliation
E-mail
TITLE OF THE
MILITARY MEDICAL EDUCATION IN RUSSIAN FEDERATION
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
The Russian Military Medical Academy is a unique institution in the medical education
system of Russia. It is one of the largest, and actually the only highest education
establishment of military medicine in Russia, the main research institution in management
and coordination of military medicine studies, the leading in Ministry of Defense military
medical service hospital of Russian Federation.
The Academy exercises three interrelated functions: educational, scientific and medicaldiagnostic. For the implementation of these functions the Academy has:
- 7 faculties for medical officer training: the Superior Commanding Medical Staff Faculty,
the Army and Missile Corps Medical Faculty, the Air Force Medical Faculty, the Naval
Medical Faculty, the Foreign Medical Officer Faculty, the Continuing Education Faculty,
the Undergraduate and Graduate Medical Training Faculty for Civil Physicians;
- Medical College for training and refresher course of nurses and paramedical personnel;
- 60 departments, including 17 surgical, 14 therapeutic, 3 prophylactic, 7 special military
medical and 19 theoretical;
- Scientific research center, Pharmaceutical center, Technical-engineering center, clinical
base, base of providing educational activities and other services.
Every year more than 3 thousand medical officers, cadets and students study at the
Academy and additionally about 2 thousand medical officers take professional refresher
courses at the Continuing Education Faculty.
Foreign Medical Officer Faculty provides higher professional education, postgraduate
education and professional development. It trained more than 3,000 military medical
professionals for a number of countries in Europe, Asia, Africa and Latin America. Now it
realize training program of higher professional education for physicians, dentists and
pharmaceutics.
Key words:
61
Authors
Col (Prof) Rob Russell
Affiliation
Royal Centre for Defence Medicine, Birmingham UK
E-mail
[email protected]
TITLE OF THE
„THE TRAUMA CALL”
ABSTRACT
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
This presentation will address the essential elements required for an effective and efficient
“Trauma Call”. This will include:
- indications for calling the trauma team
- organization of the trauma team
- preparation
- reception of the severely injured battlefield casualty
It will also show how the UK DMS prepare trauma teams for deployment and how human
factors play a vital role in determining the smooth running of the resuscitation.
Key words:
62
Trauma, Trauma Team, Resuscitation, Human Factors
Authors
Affiliation
Biljana BOZIC1,2, Atia ELKILANY1, Katarina ZELJIC1,2, Dragan
DJORDJEVIC3,4, Maja SURBATOVIC3,4, Zvonko MAGIC3,4
1
University of Belgrade, Faculty of Biology, Belgrade, Serbia; 2
Institute for Medical Research, Military Medical Academy, Belgrade,
Serbia; 3 Clinic of Anesthesiology and Intensive Therapy, Military
Medical Academy, Belgrade, Serbia; 4 Faculty of Medicine, Military
Medical Academy, University of Defense, Belgrade, Serbia;
[email protected], [email protected]
TOLL-LIKE RECEPTORS GENES POLYMORPHISMS IN SEPSIS
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Research in trauma and sepsis
Presentation suggestion
ORAL
(underline)
POSTER
Introduction
Sepsis is the leading cause of mortality and morbidity in intensive care units. The most
serious complication of major injury is MODS, which is usually associated with severe
sepsis. Therefore, the prevention of sepsis is fundamental in the treatment of trauma
patients. Gene polymorphisms could be critical determinants of inter-individual differences of
inflammatory response in these patients. Considering that TLR2, TLR3, and TLR4 play very
important role in inflammatory processes, the question arises whether presence of
polymorphisms in these genes is associated with susceptibility to sepsis. The aim of this
study was to examine the association of these TLR genes polymorphisms with clinical
characteristics and outcome of Serbian critically ill patients.
Materials and Methods
A follow-up study was conducted on 121 Caucasian Serbian critically ill patients. Five
polymorphisms in TLRs genes: TLR2 (rs5743708), TLR3 (rs3775291, rs5743312) and TLR4
gene (rs4986790, rs4986791) were genotyped by Real Time PCR method.
Results
Investigated polymorphisms in TLR2 and TLR4 genes were not associated with clinical
characteristics and outcome of critically ill patients. The TLR3 rs3775291 polymorphism was
associated with patient’s outcome (p=0.018). Patients with sepsis and TLR3 rs3775291
mutated genotype had four times higher mortality rate compared to the wild type and
heterozygous carriers. Multivariate regression analysis showed that age, sex and TLR3
rs3775291 polymorphism are independent variables of outcome of these patients.
Conclusion
For the first time, our preliminary findings indicate role of TLR3 with MyD88 independent
signaling and its polymorphism (TLR3 rs3775291) in sepsis and survival in Serbian critically
ill patients.
Key words:
TLR polymorphisms, critically ill patients, sepsis, trauma
63
Authors
Prof. Maja Šurbatović
Affiliation
Military Medical Academy, Serbia
E-mail
[email protected]
TITLE OF THE
“Mediators of Immune response to combat Trauma”
ABSTRACT
Topic/session
Research
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Aim of this study was to assess the prognostic value of tumor necrosis factor (TNF)-α,
interleukin (IL)-8, IL-4 and IL-10 in combat casualties. Fifty six casualties with severe
trauma (blast and explosive) who developed sepsis and 20 casualties with same severity of
trauma without sepsis were enrolled in this study. Fifty five casualties developed multiple
organ dysfunction syndrome (MODS), 36 died. Blood was drown on the first day of trauma.
Concentrations of IL-8, TNF-α, IL-4 and IL-10 were determined in plasma using ELISA
assays. Mean values of IL-8 were 230-fold, IL-10 42-fold and TNF-α 17-fold higher in
trauma + sepsis group (p<0.01). Mean values of IL-8 were 60-fold, TNF-α 43.5-fold and IL10 70-fold higher in MODS group (p<0.01). Mean values of IL-8 were 2.3-fold and IL-10 1.4fold higher in non-survivors and TNF-α 2.2-fold higher in survivors (p<0.01). IL-4 had no
significance as predictor of severity and outcome.
Key words:
64
blast trauma, cytokines, MODS, outcome
65
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Dr. Shodeko Gbenga Odukoya. Adams Tunde Ademola
Federal medical Center, Surulere, Lagos, Nigeria
[email protected]
The challenges and ethical dilemmas of a military medical
officer serving with a peacekeeping operation in regard to the
medical care of the local population
Topic/session
Morning
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT:
Medical Officers serving with their national contingents in peacekeeping operations are
faced with difficult ethical decisions in regard to their obligations to the local civilian
population. Such populations may be under-resourced in regard to medical care, and
vulnerable to abuse and exploitation. Though the medical officer may support the local
medical services, he/she should never undermine these resources. Adopting a human rights
approach and observing the requirements of ethical medicine, aids the doctor in prioritising
his/her duties. At times there may be conflict with one’s own military superiors. It is wise to
discuss potential difficulties prior to setting out on the mission. Human rights abuses cannot
be ignored. The medical officer has a duty to do his/her best to report their observations so
as to prevent abuse or to bring it to an end.
Introduction/Objective
Military medical officers are assigned to support the military personnel involved in
peacekeeping operations. Their primary duty of care is to the peacekeepers. In this regard
they are supported by the medical support section of the Department of Peace Keeping
Operations (DPKO). The mission statement of the medical support section of the DPKO is:
“[the] United Nations Support Mission is to secure the health and wellbeing of members of
United Nations Peace Keeping Operations, through planning, coordination, execution,
monitoring, and professional supervision of excellent medical care”. Nothing is mentioned
about providing medical support for the surrounding civilian population. Though many
peacekeeping military medical officers do this in practice. There is a requirement that they
are sensitive to the social and cultural needs of the local population and are able to liaise
seamlessly with the aid agencies.
The obligations and challenges of military medical officers attached to peacekeeping
operations toward the civilian population, has only been partly explored. The author
previously examined some of these issues, in relation to UN military psychiatry in 2000.
Military medical officers have an ethical obligation to provide what medical aid they can to
the surrounding indigenous population. Their ethical obligations in this regard have been
largely ignored in the literature.
In their Regulations in Time of Armed Conflict (Declaration of Havana), published in 1956,
the World Medical Association stated: “medical ethics in time of armed conflict are identical
to medical ethics in time of peace”. They make no distinction between doctors serving purely
in the military from other doctors working in a civilian practice. The Declaration of Havana
was to function as the World Medical Association’s translation of the Geneva conventions
into practical guidelines for doctors. The first regulation of the Declaration of Havana states
that: “The primary obligation of a physician is his professional duty; in performing his
professional duty the physician’s supreme guide is his conscience”. The declaration also
emphasizes that the key duties of physicians are focused on the relationship between the
physician and the individual patient, which includes maintaining patient confidentiality, acting
in the best interest of the patients, and respecting the rights of patients. The WMA
document, Regulations in Time of Armed Conflict 3rd revision, is currently under review by a
66
working group composed of members of the British and German Medical Associations.
The Boston based organization, Physicians for Human Rights, recognized that there were
unique factors that they considered were specific for peacekeeping operations. In their
report, Dual Loyalty and Human Rights, published in 2003, they state: “In such operations,
military health professionals confront the medical needs of the civilian populations in the
area of their assignment; yet they may be subject to rules and regulations preventing them
from providing professional assistance to civilians”. They recommend that medical personnel
should resist the culture of their military colleagues and remain loyal to the ethical standards
of their civilian medical colleagues.
There are natural tensions between the military medical officers and their military colleagues.
In his commentary on the role of the Dutch Battalion in the fall of Srebrenica in 1995, Lt Col
Vermeulen reported there were major differences of views between the leadership of the
military unit and its medical staff. He failed to recognize that the unit’s medical officers also
had an ethical obligation to the surrounding civilian population as well as being subject to
military law. The Dutch military medical officers were bound by the international code of
ethics promulgated by the WMA in 1983, which states: “a physician shall give emergency
care as a humanitarian duty unless he is assured that others are willing and able to give
such care”.
During peacekeeping operations care for the local population is normally provided by the
civil local authorities, or by international aid agencies. Peacekeeping military medical officers
usually become involved when these resources are either absent or inadequate. When
peacekeeping military medical officers are involved in providing medical aid, they should
consider the following areas: (a) medical obligations and humanitarian law; (b) the cultural
and social sensitivities of civilians at a time of war, and (c) the allocation of medical
resources.
Results
THE ALLOCATION OF MEDICAL RESOURCES
In his address to the International Peace Academy, the secretary general of the UN, Koffi
Annan, stated: “our impartial benevolence is not neutral in its effects” (UN press release:
Secretary general’s address to the International Peace Academy on 20 Nov 2000,
SG/SM/7632, 20 November 2000.)
Humanitarian assistance can be manipulated by warring factions and unscrupulous regimes,
for their own political purposes. Particularly in complex emergencies, humanitarian aid can
fall into the hands of the warring parties.An example of this is the situation that arose in
Goma, Zaire, in 1994. The refugee camps were under the strict control of the Interhamwe
and the ex FAR (Forces Armees Rwandaises). This led to some of the humanitarian
supplies being obtained by the genocidaires who ran the camps and launched military raids
into Rwanda.
In 2000 Reade discussed the effects of having a UN military hospital that treated civilian
patients as well as military patients, in Bosnia and Herzegovina.The hospital was primarily to
serve 8000 Stabilisation Force for the Former Yugoslavia (SFOR) troops. It was well
provisioned and had excess capacity. The hospital authorities tried to impose guidelines that
would not undermine the local practitioners, and would encourage the civil authorities to
build up a civil medical infrastructure. The plan was to deal only with civilian major surgical
cases and civilian medical emergencies. Communication difficulties led to patients being fully
medically examined to establish the extent of their illness. By the time this was done, it was
difficult to turn the patients away without giving medical treatment.
The primary responsibility for the care of a population falls upon the local authorities. It is
only if they fail, or are unable to meet their humanitarian duty, those humanitarian
organisations should step in to remind them of their responsibilities toward the victims, and if
necessary, to take the practical measures required.
Many troop contributing countries provide humanitarian relief through their respective
contingents, outside an international framework policy, or an integrated command and
control centre. This has the undesirable effect of making aid distribution uneven. If the
67
mandated area of peacekeeping operations has a mixed hostile population, it can be
perceived that the humanitarian and medical aid favours one population over another, as the
different contingents in the operational area will have different levels of humanitarian and
medical resources.
One commentator said the lesson of Srebrenica was that the home government of the
peacekeeping contingent had a duty to ensure that sufficient facilities were available to
provide for the troops and the civilian population, “in a qualitative responsible manner under
varying circumstances”. This ignores the fact that the peacekeeping forces, once deployed,
are the responsibility of the UN, and not of their national governments. Clasper, in a
discussion about military medicine in general, states: “Military and civilian planners must also
prepare for a full range of eventualities, with adequate resources for the care of the civilian
population at risk, including pregnant women and young children”. Currently, United Nations
contingents are expected to bring in 90 days supply of medical consumables when entering
into the mission area. These supplies are supposed to be for their own use. To bring in
medical supplies for the civilian population as well may make the operation too unwieldy and
prohibitively expensive for some troop contributing countries.
CONCLUSION
United Nations peacekeeping military medical officers can often be faced with ethical
dilemmas in regard to their duties of care toward the surrounding civilian population. They
are frequently unprepared for the challenges facing them in this regard, and there is little
guidance available to them. This area of medical ethics is only now being explored.
These areas of ethical dilemmas also are present for soldiers serving in national armies in
times of war. The doctor may not have control of his medical supplies, but he/she does have
control over his/her medical expertise. This expertise should be for the benefit of the most
needy, independent of status, in a conflict zone.
Key words:
68
Authors
Affiliation
Captain MD Nenad MILOJKOVIC,
Prof MD PhD Gordana DEDIC G,
Zoran MD CUKIC*, Col Prof MD PhD Dragan Jovanovic*
Clinic for Psychiatry Military Medical Academy Belgrade,
Clinic for Nephrology, Department for hemodialyisis Military Medical
Academy Belgrade*
[email protected]
QUALITY OF LIFE OF HEMODIALYSIS PATIENTS
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Mental Health
Presentation suggestion
(underline)
ORAL
POSTER
Introduction/Objective: The quality of life (QOL) has emerged as an important parameter
for evaluating the quality of health-care for patients with renal failure. The aim of this study is
to assess the quality of life (QOL) of patients with endstage renal disease undergoing
hemodialysis (HD).
Material and methods: 76 endstage renal disease patients (48 males and 28 females)
undergoing HD included. All patients were older than 18 years, have been on HD at least
three months. To measure QOL, the short form-36 (SF-36) questionnaire was used. We
calculated the components of physical component scale (PCS) and mental component scale
(MCS) for each patient. Clinical and biochemical parameters are presented.
Results: The mean age of the study patients was 57,24±16,37, with 13,50±3,31 years of
education, most of them are married (65.8%). The mean duration of dialysis was
84.92±83.22 months. The most often suffered from glomerulonephritis (26.3%), hypertension
(14.5%), obstructive uropathy (10.2%), diabetes (9.2%) and potential transplantants recieved
15.2% patients. High and medium comorbidity is evidenced in 42.1% patients. On waiting list
for kidney transplantant were 22 patients (28.95%). The QOL scores were: PF (Physical
Function) 71.84±24.98; RP (Role Physical) 50.34±23.34; BP (Bodily Pain) 64.14±33.93; GH
(General Health) 40.19±13.81; VT (Vitality) 52.22±21.57; SF (Social Functioning)
83.22±27.04; RE (Role Emotional) 60.50±26.65 and MH (Mental Health) 66.11±11.12
Conclusions: These findings indicate a general need for psychosocial support for patients
on HD and early diagnosis and management of comorbid conditions. Psychological approaches and physical rehabilitation for those groups of patients are recommended.
Key words:
quality of life; hemodialysis; kidney transplantation
69
Authors
professor Gordana MANDIC-GAJIC
Affiliation
MMA/Clinic of psychiatry/Belgrade, Serbia
E-mail
TITLE OF THE
THE ART GROUP THERAPY IN TREATMENT OF
ABSTRACT
POSTTRAUMATIC STRESS DISORDER WAR VETERANS
Topic/session
Mental health/ Psychological consequence of war trauma
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective: After war deployment, many veterans have difficulties in family and
civilian environmental reintegration process expressing numbing and avoidance. The
integrative pharmacotherapy and psychotherapy are the most effective in posttraumatic
stress disorder – PTSD treatment, however there is less information supporting group than
individual PTSD therapy. In this paper the clinical observations of art group therapy as a part
of integrative Day hospital treatment of PTSD veterans with prominent avoidance and
numbing symptoms are explored.
Materials and Methods: The patients met the ICD-10 PTSD criteria and have been
integrative treated in Day hospital for two months. After drawing by free associations the art
group meets once a week. The group is open, heterogeneous and discus drawings. The
drawings and group protocols are qualitatively analyzed and illustrated by clinical vignettes.
Results: The PTSD veterans often avoid structured groups, but they generally response to
the art therapy, as an initial activity. Drawings make possible visual expression
of dysfunctional cognitions, beliefs and interpersonal relations with various themes from war
trauma to humor. Discussing about drawings reduces anxiety in the group, opens large
variety in communication and intensifies emotional expression and self-confidence.
Conclusion(s): The art group therapy may reduce avoidance and numbing of war veterans
and can be useful as adjunctive PTSD therapy. This technique facilitates group intervention
thus promoting active attitude, increases compliance with the treatment and enhances family
and civilian society reintegration of PTSD veterans.
Key words:
70
PTSD, veterans, psychotherapy, group, art.
Authors
Affiliation
E-mail
Mandic-Gajic G, Sundric Z, Dedic G, Zivic B , Antonijevic J,
Milosevic N, Eror A, Stojanovic Z, Spiric Z.
MMA/Clinic of psychiatry/Belgrade, Serbia
[email protected]
TITLE OF THE
ABSTRACT
STRESS EVENTS AND CHARACTERISTICS OF ALCOHOLISM
AMONG CIVILIANS AND MILITARY PERSONNEL DURING WAR
Topic/session
Mental health/ Psychological consequence of war trauma
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective: Alcohol abuse could increase during war, especially in combat
environment as expedient pathway to stress management. The drinking pattern can be
changed through the influence of the life stresses and general level of drinking among
associates. Stress events and clinical characteristics of alcoholism among inpatient civilians
and military personnel who were treated during war were explored.
Materials and Methods: The 389 male primary alcoholics aged 20-60 years were
consecutive recruited on clinical admission during war. Alcoholics were divided in the military
personnel (MP) group (n = 90) and the civilian (C) group (n = 299). The frequency and type
of stress events and clinical characteristics of alcoholism according ICD-10 criteria were
analysed. The data from medical records were obtained.
Results: There were not significant differences between MP and C group in demographics.
The MP group had more frequent stress events, which were more intensive and war specific
(death of companion, wounded, captivity). There were more frequent blackouts (55% vs.
26%) and relapse (55% vs. 26%), but less frequent loss of alcohol tolerance in the MP than
in the C group.
Conclusion(s): The MP alcoholics had more frequent stress events, blackouts and relapse
than civilian alcoholics during war. It might be related to intensive intoxications during
exposition to war stressors with alcohol as most available anti-anxiety drug. The prevention
of excessive alcohol use in military units is necessary because serious health consequences
for personnel and combat readiness.
Key words:
alcoholism, stress, events, military, war.
71
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Col. MD Phd Radosław TWORUS, MSc Ludmiła KOSIŃSKA,
Maj. MD Piotr ILNICKI, Ret. Col. Prof. Stanisław ILNICKI,
Col. Prof. Tomasz TARGOWSKI
Military Institute of Medicine, Department of Psychiatry and Combat
Stress, Warsaw, Poland
[email protected]
HYPERBARIC OXYGEN THERAPY - THE NEW APPROACH IN
TREATMENT OF TRAUMATIC STRESS AND BRAIN INJURY.
A CASE STUDY
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Introduction/Objective
Hyperbaric oxygen therapy (HBOT) has been used in the treatment of central nervous
system (CNS) disorders with different results. In the last years the new research on
effectiveness of hyperbaric oxygen therapy in the treatment of mild brain injuries appeared.
We can also find reports of its use in post-traumatic stress disorder (PTSD) diagnosed
patients. We present a case study of hyperbaric oxygen therapy used in treatment of
comorbid PTSD and mild traumatic brain injury (mTBI) symptoms.
Materials and Methods
The patient was a 34-year old soldier with traumatic stress symptoms and somatic
syndromes. He was evacuated from Iraq after explosion of a rocket in a close distance from
him. Psychological examination showed developing post-traumatic stress disorder
symptoms. The psychotherapy and pharmacotherapy were both applied however without
satisfying results. After additional medical examination the hearing disorder was found,
which had previously been dissimulated by the patient. Organic CNS microinjuries have also
been diagnosed. This lead to conclusion of comorbidity of PTSD symptoms and mild
traumatic brain injury as a result of explosion experienced. The further treatment of acoustic
injury was applied in the form of hyperbaric oxygen therapy. This resulted in hearing loss
symptoms elimination as well as improvement of mental functioning.
Results
In presented case hyperbaric oxygen therapy was effective in PTSD and mTBI symptoms
reduction.
Conclusion(s)
Hyperbaric oxygen therapy can be promising in mTBI and stress related disorders treatment,
but still requires further research on a large group.
Key words:
72
hyperbaric oxygen therapy, traumatic brain injury, post-concussive
syndrome, posttraumatic stress disorder
Authors
Maysoon Althawadi
Affiliation
E-mail
[email protected]
TITLE OF THE
Military Work Stress/ Qualitative Research
ABSTRACT
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
Objective: This study provided a qualitative exploration of the impact of military rank and
culture on the perception of worksite stress and available initiatives for work stress reduction
and management.
Background: The military hierarchical chain of obligations, roles and rights that is nourished
by military culture divides military personnel into officers and non-officers with different stress
vulnerability. Military ranking plays a pivotal role in shaping work environments for personnel,
but little is known about how it affects their perception of work stress and their coping
resources.
Methods: This qualitative exploratory study determined what sources of work stress officers
and non-officers differently experience, what coping strategies they utilise under the
influence of stress moderators, what health and performance outcomes they report and what
health initiatives for work stress reduction they acknowledge and recommend. A purposive
sample of 10 military personnel from officer and non-officer ranks participated in the study.
Semi-structured interviews which focused on stressor-stress-performance relationship were
conducted. The transcribed interviews then thematically analysed.
Results: Different stressors were reported by the two groups. They all were conceptualised
under Effort-Reward-Imbalance and Demand-Control-(Support) models. Officers reported
better coping. Non-officers reported more health and performance adverse consequences.
Different perception of moderators was also generated. Officers continuously pointed to
existing positive leadership while non-officers recommended more constructive supervisory
support. The study generated four themes amenable to intervention.
Conclusion: The interplay between military rank, individual factors, and leadership
perception is the determinant of the work stress perception and coping strategies. Military
rank represents a social class paradigm where the higher the rank the better is the job
control, opportunities and effort-reward-balance.
Findings from this study suggest that to address the military rank in establishing stress
managing strategies that should be based on a combination between individual factors and
organisational culture and supportive structure that facilitate coping measures.
Key words:
73
Authors
Dr Natasa MILOSEVIC, psychiatrist
Affiliation
Military Medical Academy/Psychiatric Clinic /Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
CASE REPORT OF WAR VETERAN’S AND HIS WIFE’S
ABSTRACT
ALCOHOLISM
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
The objective of this case report is to illustrate multidimensionality of secondary war trauma
in longer period of time.
War veteran, actually 59 years old, was shot by seven bullets and hospitalized for more than
six months at different surgery departments at age of 36. Before that he was somatically
healthy, his only problem before the war was alcohol abuse that was treated when he was
27 years old. After succesful 10 years in apstinence he relapsed in alcoholism, when he was
released from hospital after wounding. He was not psychiatrically treated at that and he
clearly denies psychiatric symptoms. In next years he continued to drink until he became
alcohol dependent, together with his wife who started to drink with him. The most serious
consequence was neglection of their youngest dother, born after the war. The girl became
grossly obese and had serious development problems. The war veteran and his wife were
both treated of alcoholism when he was 50 years old. The alcoholism treatment was
successful for both, they are still abstinents, rehabilitated also in their lifestyle. Three older
children are professionally succesful, have families of their own, but the youngest dother is in
continuous psychiatric treatment with problems in education and in personal relations.
Key words:
74
war, secondary trauma, alcoholism, family
Authors
Robert DOLNIČAR, M.D., psychiatrist
Affiliation
Medical Center MoD, Ljubljana, Slovenia
E-mail
[email protected]
TITLE OF THE
SUICIDE IN MILITARY
ABSTRACT
Topic/session
suicide
Presentation suggestion
ORAL
(underline)
POSTER
ABSTRACT TEXT:
The purpose of the research project is to establish an up to date overview of the
epidemiological situation in different NATO member countries.
Military is an elevated load and higher risk environment, especially for participants
involved in high level intensity operations. An important role represents also socalled pre-loaded personality.
To date, there has been no systematic effort across countries to collaboratively
examine the public health problem of military suicide and to identify best practices for
suicide prevention among Armed Forces and Veterans or there are different ways of
monitoring and follow-up. Standardization of follow up procedures are important for
better future comparability of datas.
Key words:
military, suicide, follow-up, best practices
75
Authors
V. Shamrey, S. Kolov
Affiliation
E-mail
TITLE OF THE
BIOPSYCHOSOCIAL PATTERN REMOTE CONSEQUENCES
ABSTRACT
OF COMBAT STRESS
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Importance researching remote consequences of combat stress dictated as their high
degree of distribution and social importance, as well their low research potential all over the
world. Extensive accumulation of empiric material about hard influence of combat stress on
different kinds of human existence shows importance of system view post-combat mental
disorders in complex of biological, behavior and social manifestations.
Biopsychosocial pattern remote consequences of combat stress in our opinion considered
as unique complex of biological, psychological and social disorders, which unite and
constantly interact with clinical criteria. The most important difference these pattern for the
«traditional» is that influence of intensity and exposition of combat stress to mental disorders
in remote period is less important in combatants versus other ethiopathogenetical factors.
For example, some non-steroid hormones (dihydroepiandrosteron, cortisol) are one of
objective signs to biological grade remote consequences of combat stress and objective
criteria positive dynamics of combatant’s treatment. The character of non-steroid disfunction
changes depending of post-combat intensity defining those biological peculiarities, they
differently associate with clinical and psychosocial aspects post-combat stress disorders. In
turn, it is important to consider personal influences (transpersonal interaction, personal
characteristics) and other psychological and social factors which can influence not only on
clinical picture, but efficiency of treatment generally.
Key words:
76
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
V. Shamrey, S. Kozlov, A. Lobachev
PERSONAL AND SOCIO-PSYCHOLOGICAL FACTORS
IN THE GENESIS OF THE REMOTE CONSEQUENCES OF THE
FIGHTING STRESS
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
Need of systems (biopsychosocial) approach to diagnostics and treatment of the remote
consequences of a fighting stress causes now the increasing interest from scientists and
clinical physician. Special significance, thus, is attached to studying of influence of
constitutional and personal features of combatants and socio-psychological factors on
expressiveness and a clinical originality of alienations, concrete pathogenetic (sanogenetic)
of the mechanisms, promoting (interfering) development of this or that mental pathology in
the remote post-fighting period.
As a result of inspection of 557 combatants (man, middle age of 39,9±0,4 years; mean time
after return from war until inspection - 17±0,3 years) is shown that their clinical picture
included a wide range of the mental violations consisting from obligate (PTSR signs) and
facultative violations (neurotic, bound to a stress, affective frustration, personal deviations,
etc.). Thus, personal features of combatants represented a continuum from the
compensated changes at the premorbid (psychological) level, being characterized an
imbalance central "I" - functions, to total personal disharmony. Psychological features played
a "soil" role in formation of post-fighting stressful frustration, defining vulnerability of
mentality to fighting and post-fighting stress factors, promoting, often, to emergence of
asocial behavior.
Social etiopatogenetic factors in the remote period of post-fighting stressful frustration were
characterized by the relative negative orientation, including change of social perception: the
strong level of stigmatization of combatants from various social groups and high rates of a
social frustrivity of combatants. Asocial manifestations were, as a rule, a constituent of postfighting clinical violations and, quite often, had affective and hostile character, amplifying at
increase of weight of post-fighting frustration.
Key words:
77
Authors
V.I. Dyagterenko
Affiliation
E-mail
TITLE OF THE
PSYCHOGENESES OF THE MODERN WARS
ABSTRACT
Topic/session
Presentation suggestion
ORAL
(underline)
POSTER
ABSTRACT TEXT:
Psychogeneses were the main pathology in the structure of incoming stream of casualties and patients in the territory of Chechen Republic. Psychogenic factors and their incidence
were the following: conflicts with commanders (70-80%); long period of service without leave
(60%); distant from family and home (50%); staying in potentially dangerous zone at high
risk of life (40%o); informational deprivation (36%); climatic conditions (30%); dissatisfaction
with living conditions (25%). All these led to adaptive mechanism failure and neurotization of
the personnel.
In the local armed conflicts sanitary losses of psychoneurological profile remain rather
stable and high enough: 17,2% (1999-2005) and 17,1% (1994-1996) of the total number of
casualties and patients.
At the same time in the structure of such losses the share of victims with border level of
psychic disorders has increased last years with simultaneous decrease in the number of persons with endogenic procedural and exogenous and organic diseases.
Early classification of patients with psychoneurological disorders and right decision concerning their evacuation allow decreasing the time and material expenditures and contribute
to the prophylaxis of psychogenia protracted course.
Rendering of specialized psychiatric service close to the theatre of war operations allows
increasing the number of soldiers who return to their service, shortening the terms of staying
in psychiatric in-patient department and avoiding the repeated hospitalizations.
Key words:
78
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Samardzic Radomir, Spiric Z, Mandic-Gajic G, Krstic D, Jokovic D,
Dolic M, Stojanovic Z.
Clinic of Psychiatry, Military Medical Academy, Belgrade, Serbia;
Faculty of Medicine of Military Medical Academy, University of
Defence, Belgrade, Serbia
[email protected]
REEVALUATION OF DISABILITY ASSESSMENT
IN WAR VETERANS WITH POSTTRAUMATIC STRESS
DISORDER
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Aim: The study describes the reevaluation process of the PTSD diagnosis in war veterans
so as to assess their disability and the consequent financial compensation.
Method: The diagnosis reevaluation has been done in 259 war veterans. They had
previously been diagnosed with PTSD and treated by psychiatrists in their places of
residence. The diagnoses were being confirmed by a regional comission who evaluated the
level of disability and directed the assessment to a head comission on the state level, after
which the veterans were given the right to financial compensation. The participants in the
reevaluation process were a team of experts made up of psychiatrists, psychologists and
social workers. There have been analyses of all previous diagnoses and medical
documentation, as well as repeated examinatons of the war veterans through a structured
diagnositc interview (CAPS). After this the initial diagnosis was either confirmed or revised,
together with the disability status and financial compensation.
Results: In the majority of the veterans (n=156) the above-mentioned expert examination
has been done in clinical conditions. Hospital examination (n=103) was effectuated when
there was a need for a more detailed clinical assessment and an observation of the
behavioural manifestations of the examinees. Among these there were also 140 veterans
wounded in combat. The diagnosis of PTSD was confirmed in 82 subjects, while 19 of them
were diagnosed with a lifetime disorder.
Conclusion: The difference in the diagnostic assessment can come as a consequence of
an inadequate approach to the diagnostic process. In the process of assessing traumatic
experiences it is very important to take into account the anamnesis, but also the colateral
information, especially from military files. In assessing the presence of symptoms and their
intensity it is necessary to apply structured and standardised scales. It is also important to
keep in mind the countertransference and socio-political aspects that may arise when
assessing the disability of war veterans.
Key words:
79
80
Prof.dr Željko ŠPIRIĆ, Col.dr Radomir SAMARDŽIĆ, LtCol. dr
Dragan KRSTIĆ, Maj.Danilo JOKOVIĆ, Capt. Mirko DOLIĆ, prof.dr
Gordana MANDIĆ GAJIĆ
Affiliation
Military Medical Academy/Clinic for Psychiatry/Belgrade/Serbia
E-mail
[email protected]
TITLE OF THE
DIFFERENCIES IN TRAUMA RELATED SYMPTOMS BETWEEN
ABSTRACT
VICTIMS OF WAR TORTURE AND OTHER WAR EXPOSED
SUBGROUPS
Topic/session
Mental Health& Consequences of War Psychological Trauma
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction
Consequences of traumatic stressors during the wars in ex-Yugoslavia during nineties of
20th century were different in respect to various populations. The objective of this analysis
was to compare psychological consequences of war stressors in 7 different groups of warexposed subjects in Serbia, with an emphasis on general psychopathology and
posttraumatic stress disorder (PTSD).
Methods
Results from six studies conducted in the period of ten years, 1998-2008, were used to
analyze data from psychological questionnaires implemented in investigation of seven
specific groups (war veterans with current and lifetime PTSD, war veterans without PTSD,
soldiers in the war zone out of combat activities, victims of torture from concentration camps,
refugees, healthy volunteers). The joint sample from six studies counted 1265 subjects. Data
concerning general psychological symptoms were obtained from Symptom Check list –
Revised (SCL-90-R) and data concerning traumatic stress were obtained from Impact of
Events Scale – Revised (IES-R) and Clinician Administered PTSD Scale (CAPS).
Results
General psychopathology estimated with SCL-90-R was far most prominent in the group of
tortured persons, with the highest scores on all nine scales, followed by the group of
veterans with current PTSD than by the group of veterans with lifetime PTSD. Posttraumatic
stress disorder estimated by IES-R and CAPS followed the same pattern.
Conclusion
Tortured prisoners of war were by far the most traumatized and with most prominent
psychological consequences of all investigated war exposed subjects. As most vulnerable
subgroup of war traumatized people, victims of war torture are in the continuous need for
adequate psychosocial help.
Key words:
Posttraumatic stress disorder; war trauma; torture
81
Authors
Prof MD PhD Gordana DEDIC, Col MD Milivoj PANIC,
Lt. Col MD Bratislav ZIVIC
Affiliation
Military Medical Academy, Clinic for Psychiatry, Belgrade,
Serbia
E-mail
[email protected]
TITLE OF THE
SUICIDE RISK FACTORS IN THE SERBIAN ARMED
ABSTRACT
FORCES WITHIN THE PERIOD 2001 TO 2010
Topic/session
Mental Health
Presentation suggestion
ORAL
POSTER
(underline)
Introduction: Analyses of the suicide risk factors enable to undertake appropriate
preventive measures within the Suicide Prevention Program in the military
environment, which was fully applied in the Serbian Armed Forces in 2003.
Objective of this study is to establish the suicide risk factors of the professional
military personnel and soldiers of the Serbian Armed Forces from 2001 to 2010.
Methods: Analysis of the suicide risk factors was carried out on the basis of data
obtained by psychological suicide autopsy. Descriptive statistics method was used
for the risk factors analysis.
Results: 35 soldiers aged 22-49 years (21.76±1.76) and 30 professional military
personnel aged 22-49 years (30.53±6.24) committed suicide within the period 20012010. Distal suicide risk factors for soldiers are primarily in immature personality
organization and its relation with family and military environment factors. The
following distal suicide risk factors for professional military personnel have been
ascertained: family factors (unmarried, no children, parental loss in early childhood,
psychiatric heredity and debts), military environment factors (low motivation for
military service, without completed military school) and habits (gambling, alcohol
abuse). The most common proximal suicide risk factors in officers is negative life
achievement, in contract soldiers and non-commissioned officers problematic
relationship with the emotional partner, and in soldiers exhausted adaptation
capacity for the military service.
Conclusion: In accordance with the presence of multiple suicide risk factors, the
Suicide Prevention Program of the Serbian Armed Forces is oriented to prevention of
both proximal and distal suicide risk factors.
Key words:
suicide, risk factors, officers, soldiers, military environment,
prevention
82
Authors
Affiliation
M.D. Dorota WOJTŁOWSKA-WIECHETEK¹, LTC. M.D. Ph.D Radosław
TWORUS¹,
M.D. Ph.D Mirosław DZIUK² , MA Ana PETROVIĆ¹, MA Sylwia
SZYMAŃSKA¹,
MA Maciej ZBYSZEWSKI¹, MAJ. M.D. Ph.D Paweł KRZESIŃSKI³, COL. Prof.
Tomasz TARGOWSKI4
¹Military Institute of Medicine/Department of Psychiatry and Combat
Stress/Warsaw/Poland
²Military Institute of Medicine/Department of Nuclear Medicine/Warsaw/Poland
³Military Institute of Medicine/Department of Non-Invasive Cardiology and
Telemedicine/Warsaw/Poland
4
Military Institute of Medicine/Department of Internal Disease, Pulmonology and
Allergology/Warsaw/Poland
[email protected]
IMPACT OF THE PRESENCE OF BROWN ADIPOSE TISSUE
(BAT) ON THE REACTIVITY OF AUTONOMIC NERVOUS
SYSTEM AS A PREDICTOR OF STRESS DISEORDERS IN
POLISH SOLDIERS –PRELIMINARY REPORT
Mental Health
Topic/session
Presentation suggestion (underline)
ORAL
POSTER
E-mail
TITLE OF THE
ABSTRACT
The aim of the study was to find whether there are connections between autonomic nervous system agitation and
functional changes in central nervous system (CNS) and adrenals.
A group of 14 mentally and somatically healthy soldiers was examined. They were qualified on 10th rotation in
Afghanistan. A basal PET (positron emission tomography) examination was made to see the basic metabolic
activity of their brains and adrenals. This examination shown in 6 of them the presence of active brown adipose
tissue (BAT) which does not normally occur in adults. We’ve conducted a study using Virtual Reality (VR)
equipment: for 10 minutes we measured soldier’s basic vegetative system related parameters such as heart rate
(HR), blood pressure (BP), skin conduction (SC) and peripheral temperature on the index finger. Then for 10
minutes we introduced them into VR environment using combat scenarios to observe arousal. Also during the
exposure the vegetative nervous system parameters were measured. All soldiers experienced autonomic arousal
manifested by an increase in HR, BP and SC, but there were significant differences. In soldiers with active BAT
HR, BP and SC increased less and their peripheral temperature increased instead of decreased which is normally
observed in agitation. In the 8 remaining cases with no active BAT the exposure to VR stressors gave the
typical reaction of peripheral temperature drop. Directly after VR stimulation we made another PET scan
examination, which shows no functional changes in CNS and adrenals. Our examination indicates that the
presence of brown adipose tissue modify the response to stressors.
Key words:
Brown adipose tissue, Virtual Reality stimulation, PTSD
83
POSTER
Authors
Affiliation
Captain MD Nenad MILOJKOVIC,
Prof MD PhD Gordana DEDIC G,
Zoran MD CUKIC*, Col Prof MD PhD Dragan Jovanovic*
Clinic for Psychiatry Military Medical Academy Belgrade,
Clinic for Nephrology, Department for hemodialyisis Military Medical
Academy Belgrade*
[email protected]
QUALITY OF LIFE OF HEMODIALYSIS PATIENTS
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Mental Health
Presentation suggestion
(underline)
ORAL
POSTER
Introduction/Objective: The quality of life (QOL) has emerged as an important parameter
for evaluating the quality of health-care for patients with renal failure. The aim of this study is
to assess the quality of life (QOL) of patients with endstage renal disease undergoing
hemodialysis (HD).
Material and methods: 76 endstage renal disease patients (48 males and 28 females)
undergoing HD included. All patients were older than 18 years, have been on HD at least
three months. To measure QOL, the short form-36 (SF-36) questionnaire was used. We
calculated the components of physical component scale (PCS) and mental component scale
(MCS) for each patient. Clinical and biochemical parameters are presented.
Results: The mean age of the study patients was 57,24±16,37, with 13,50±3,31 years of
education, most of them are married (65.8%). The mean duration of dialysis was
84.92±83.22 months. The most often suffered from glomerulonephritis (26.3%), hypertension
(14.5%), obstructive uropathy (10.2%), diabetes (9.2%) and potential transplantants recieved
15.2% patients. High and medium comorbidity is evidenced in 42.1% patients. On waiting list
for kidney transplantant were 22 patients (28.95%). The QOL scores were: PF (Physical
Function) 71.84±24.98; RP (Role Physical) 50.34±23.34; BP (Bodily Pain) 64.14±33.93; GH
(General Health) 40.19±13.81; VT (Vitality) 52.22±21.57; SF (Social Functioning)
83.22±27.04; RE (Role Emotional) 60.50±26.65 and MH (Mental Health) 66.11±11.12
Conclusions: These findings indicate a general need for psychosocial support for
patients on HD and early diagnosis and management of comorbid conditions.
Psychological approaches and physical rehabilitation for those groups of patients are
recommended.
Key words:
84
quality of life; hemodialysis; kidney transplantation
85
Authors
Sareh Samadi, MSc.
Aliakbar Golmohammadi, Phd.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
THE RELATION OF OCCUPATIONAL STRESS, WORK ABILITY INDEX AND
TITLE OF THE
SHIFT WORK AMONG I RANIAN MILITARY HOSPITAL NURSES
ABSTRACT
Topic/session
Mental Health
Presentation suggestion (underline)
ORAL
POSTER
Objective: The aim of this article was to analyse the association between work stress and
work ability in a population drawn from a random sample of Iranian Military hospital nurses
and investigate whether these variables are varied between nurses with shift and fixed work
schedule.
Materials and Methods: A total of 103 nurses aged 20-40 years from military hospitals were
included in the analyses. Work stress was tested by Occupational Stress Assessment
Questionnaire which has been created for healthcare workers and comprised seven groups
of stressors (i.e. interpersonal conflicts at workplace). Work ability was assessed by the
Work Ability Index (WAI) and the score was calculated from answers to its seven items (i.e.
current work ability compared with the life time best). The relation of stressors, WAI, and
shift works was analysed by correlation coefficients and t-test analysis.
Results: Approximately 45.6% and 17.5% of the respondents reported good and excellent
work ability respectively, indicating satisfying work ability among studied nurses. The most
perceived stressors were: Work overload, Professional life, Excessive paperwork and Time
limits. Negative correlation observed between WAI and Poor work organization, Poor
communication with superior, patients' inadequate expectations, 24-h responsibility,
Professional and private life, Time limits, Excessive paperwork, Threats of lawsuit, Conflicts
with colleagues and patients and their family(p< 0.05). Shift workers reported significantly
higher level of stress than nurses with fixed work time (p=0.039).
Conclusion: Work stress is strongly correlated to WAI. We found nurses with lower WAI
perceived occupational factors more stressful than nurses with higher WAI. But more future
analyses are required to confirm a causal relation.
Key words:
86
Work ability – Occupational stress –Shift work- Military hospital
nurses
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Senior Nurse, Nada Stojadinović
Miltary Medical Academy, Department for Neurosurgery, Belgrade,
Serbia
[email protected]
USEFULNESS OF ARTIFICIAL NUTRITION DURING
TREATMENT OF PATIENT WITH SEVERE CRANIOCEREBRAL
TRAUMA
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Objective: Artificial nutrition (AN) is the only way to prevent and treat malnutrition. Recently,
AN is controversial to some extent, mostly regarding indications. The aim of this study was
to investigate clinical benefit of AN in patients with severe craniocerebral trauma.
Materials and Methods: A retrospective study included 38 adults with severe craniocerebral
trauma. Indications for AN were established multidisciplinary and nasogastric tube was used
more frequently (n=35), than gastrostomy (n=3). Outcome was assessed at discharge,
according to the Glasgoe Outcome Score (GOS).
Results: The series included 26 males and 12 females, ranging in age from 24 to 76 years.
At the beginning of AN, 12 patients were comatous, 5 patients were in vigile coma, 10 in
sopor, and 11 were somnolent. At discharge, lethal outcome existed in 17 patients, vigil
coma in 2, severe disability in 11 and moderate disability in 8 (GOS=3 and GOS=4,
respectively). Lethal outcome was noted in 11/12 comatose patients, 1/5 patients with vigile
coma, in 3/10 soporous patients, and in 2/11 somnolent patients. Complications neither
threaten the life, nor caused a long-term deterioration. Nausea and vomiting were found in
20%, diarrhea in 38.3%, constipation in 13.3%, malabsorption in 10%, and transient
metabolic complications in 33% of patients.
Conclusion: Artificial nutrition should not be used comatose patientsts. Tube feeding is a
safe procedure if performed by trained personnel and using montoring.
Key words:
Malnutrition, Nutritional status, Critical care, Coma, Presistent
vegetative state
87
Authors
Sharififar simintaj
Affiliation
AJA University of medical science, nursing faculty, Tehran, Iran,
E-mail
[email protected]
TITLE OF THE
THE PRIORITY OF CONTINUING MILITARY NURSING
ABSTRACT
EDUCATION NEEDS IN IRANIAN MILITARY HEALTH CENTERS
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
Introduction:
Nurses are the most important participants in disaster management. Their very essential
roles in mitigation, preparedness, impact, and recovery period at disaster cycle are totally
clear. Continuing nursing education (CNE) in manmade disasters is necessary for
preparedness in disaster management implementation. Nursing educational needs
assessment in military nursing fields has reduced unnecessary repeated education and has
elevated nurses’ motivation.
OBJECTIVES:
The aim of this study was to determine the priority of continuing nursing education in
manmade disasters through self-reporting
DESIGN:
A cross-sectional design was undertaken.
Material and methods:
Sampling was randomized clustering in selected military hospitals in Iran.
A researcher made questionnaires, each made up of 34 questions filled by 150 registered
nurses from Iranian military hospitals. This questionnaire was self-reported.
The questionnaire included 7 demographic questions, 6 questions about barriers of
continuing education, 4 questions about motivating factors and 17 questions about priority of
manmade disaster educational needs. Except for the demographic questions, all questions
had 5 items of Likert scale. In the end, one open-ended question about interests and needs
regarding military nursing education were asked. The questionnaire was valid with
comments from 10 faculty members from the Army Medical Science University. The internal
reliability of this questionnaire was approved via Cronbach's alpha test(0/7).
Results:
According to the military nurses, learning priority needs included the subjects of: Viral
encephalitis, nerves agents, disaster management and care for traumatic patients. The most
significant barrier in the effectiveness of military nursing continuing education was the issue
of interferece with the nursing shifts. The most motivating factor for participating in
continuing education programs was elevated knowledge levels.
Conclusion:
Ongoing education on all aspects of the military nursing is recommended for civil and army
nurses. Determining learning priority needs according to nurses and education planning is
very effective in boosting motivation levels, unnecessary repetition and unwanted education.
Continuing education in military nursing based on learning priority needs of military nurses is
very important because repeated and unwanted education dissatisfied military nurses.
Exposure to continuing education in military nursing in the workplace is the most consistent
determinant of professional performance and preparedness for disaster cycle.
Key words:
88
89
90
Prof dr Gordana ŽUNIĆ
Institute for Medical Research, Military Medical Academy,
Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
L-ARGININE – A KEY AMINO ACID IN TRAUMA
ABSTRACT
AND INFLAMMATION
Topic/session
Basic Research in Trauma and Sepsis
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Affiliation
ABSTRACT TEXT:
L-arginine (Arg) is a proteinogenic, nutritionally semi-essential amino acid with important
roles in metabolism after various injuries. Our experimental and clinical studies indicate that
it is involved in both local and systemic response to the injury. We reported that experimental
hind-limb ischemia in rats decreased the Arg level in uninjured musculature as a general
response to the injury, while increased nitric (NO) formations followed by increased arginase
activity induce relative lack of Arg at the wound site. Blast injury appears to be unique
among the other traumatic events, being sufficient to induce complete cleavage of Arg from
the systemic circulation, mainly as consequence of prompt NO overproduction early after
injury. Similar disturbances of Arg metabolism we observed in bombing casualties, too. Lack
of circulating Arg observed in patients with renal transplant, occur probably as a
consequence of inappropriate coupling of the "citrulline-NO cycle" with endothelial NO
production that can explain why the kidney switches from Arg release to Arg uptake after
renal ischemia/reperfusion injury. Interestingly, recently we observed that unilateral
nephrectomy causes an early abrupt decrease in plasma Arg and simultaneous reduction in
glomerular filtration rate in living kidney donors early after surgery. The results obtained in
our investigations also indicate that impaired balance between Arg utilization and release/
resynthesis from endogenous sources after various injuries causes increased net protein
catabolism in peripheral tissues, disturbed nutritional status and urea cycle activity,
suggesting Arg as a key amino acid in posttraumatic metabolism, particularly during the
early period after severe injuries.
Key words:
Arginine, nitric oxide, injury
91
Authors
Maj (MC) Dr. Hagen FRICKANN, Cpt (MC) Rebecca HINZ, LtCol
(MC) PD Dr. Ralf Matthias HAGEN
Affiliation
Department of Tropical Medicine at the Bernhard Nocht Institute,
German Armed Forces Hospital of Hamburg, Hamburg, Germany
E-mail
[email protected]
TITLE OF THE
PROS AND CONS OF MOLECULAR SEPSIS DIAGNOSTICS
ABSTRACT
DURING TROPICAL DEPLOYMENTS
Topic/session
Sepsis / Parallel session 2 (research)
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective. Blood culture-based diagnostic approaches of septic patients are
limited by methodical problems in tropical settings. Logistic problems resulting in increased
storage and transport time of samples as well as climatic influences hamper reliable
identifications. Further, a complete microbiological lab allowing for culture-based biochemical
identification of pathogens is usually available in role3 field hospitals only. Molecular
diagnostic approaches might help to overcome these problems, thus reducing the time to
appropriate pathogen-adapted antimicrobial therapy.
Materials and Methods. We evaluated the use of a target-specific multiplex realtime PCR
assay as well as a pan-eubacterial amplification approach with consecutive sequencing for
the use with blood culture materials. The tests were evaluated with samples from tropical
Ghana to assess their reliability in case of poor pre-analytic conditions.
Results. Target-specific multiplex realtime PCR increased the detection rate in comparison
to culture. Sequence-based diagnosis, however, was hampered by contamination events in
the course of acquisition and preparation of samples in the tropics.
Conclusions. The combination of pre-incubation with PCR- and sequence-based diagnostic
procedures can increase the detection rates of pathogenic bacteria in septic patients even
under poor pre-analytic conditions during tropical deployments. Thus, PCR and sequencing
might facilitate the onset of appropriate pathogen-adapted antimicrobial therapy in severely
ill sepsis patients. Owing to the currently unresolved contamination problem, however,
sequencing results have to be interpreted with care and considering the clinical situation of
the patient.
Key words:
92
blood culture diagnostics; PCR; sequencing; tropics; sepsis
LTC Assist. Saša MILIĆEVIĆ, MD, MSc,
BG Prof. Marijan NOVAKOVIĆ, MD, PhD,
LTC Assist Prof. Nenad STEPIĆ, MD, PhD,
COL Prof. Jefta KOZARSKI, MD, PhD,
LTC Assoc. Prof. Boban DJORDJEVIĆ, MD, PhD
Affiliation
Military Medical Academy
Medical Faculty of the University of Defense
Clinic for plastic surgery and burns
Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
OUTPATIENT TREATMENT OF PATIENTS WITH LOWER LEG
ABSTRACT
SKIN DEFECTS AFTER VACUUM-ASSISTED COMPRESSION
THERAPY
Topic/session
Research in Trauma and Sepsis
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction
Vacuum -assisted compression therapy (VAC) provides rapid granulation tissue formation
and preparation for the definitive skin cover with defects of varying etiology, especially in the
region of the lower leg due to poor circulation of distal third of lower leg.
Materials and Methods
This paper describes the treatment of 30 patients with lower leg skin defects, of which 20
patients were hospitalized, with the use of VAC therapy and skin graft, while the remaining
10 patients underwent outpatient basis, with modern dressing for wound healing.
Hospitalized patients continued outpatient treatment, with or without the use of modern
dressings for wound healing.
Results
The minimum time of treatment, up to a complete epithelization, it is present in patients who
are hospitalized, with the use of VAC therapy and skin graft and the longest in patients
treated only with the application of modern dressings for the treatment of wounds. One third
of patients require subsequent application of a dressings for the treatment of chronic
wounds, in order to shorten the time of epithelization .
Conclusion
Treatment of lower leg skin defects is very complex, due to poor circulation and the
presence of associated diseases. The use of VAC therapy shortens healing time, but it
needs a good knowledge of indications in certain phases of treatment.
Key words:
lower leg, skin defects, vacuum-assisted compression therapy
93
Authors
Szilárd Rendeki MD*, Csaba Loibl MD*, Lívia Szélig MD*, Bálint
Nagy MD * Krisztina Kovács MD**,
Gábor Smuk MD*** , János Lantos MD**** , Gábor Jancsó
MD****, Tamás F Molnár MD DSci* Zalán Szántó MD *****
Affiliation
University of Pécs, Medical School, Department of Operational
Medicine, Military Medicine, Disaster Medicine and Law
Enforcement Medicine , Department of Anesthesia and Intensive
Therapy, Hungary
** University of Pécs Medical School Department of Biochemistry
and Medical Chemistry, Hungary
*** University of Pécs Medical School Department of Pathology,
Hungary
**** University of Pécs Medical school Department of Surgical
Research and Techniques, Hungary
*****University of Pécs Medical School Department of Surgery,
Hungary
E-mail
[email protected]
TITLE OF THE
INITIAL RESULTS OF INVESTIGATIONS OF
ABSTRACT
LUNG CONTUSION WITH ANIMAL MODELS
Topic/session
Parallel Session 2 (Research)
Presentation suggestion
ORAL
POSTER
Introduction/Objective Lung contusion caused by chest trauma can result from blunt or
penetrating injury. Our aim was to gain deeper insight into and thus understanding of the
physiology of chest and lung injuries of various etiology and pathomechanism and thereby
improve morbidity and mortality rates of these patients.
Lung contusion as monotrauma may alone become a life-threatening condition , however,
lung contusion of a multitrauma patient worsens survival manifold. Whereas it may seem
logical, it is not only primary damage of tissue oxygenisation that is responsible for
consequences of morbidity and mortality. Several factors of SIRS caused by lung contusion
are still to be discovered.
Materials and Methods With the participation of specialists of clinical practice and
theoretical sciences a series of animal experiments were performed which had been
designed from a multidisciplinary approach and which is now being continued involving
human subjects in the light of the present results.
In animal experiment models we investigated lung contusion caused by kinetic energy and
complement activation triggered thereby. We intended to search for an extent of contusion
which triggers an immune response that converges with the immune response of lethal
injury. Searching for measurable parameters we managed to find the dividing line between
insignificant and inevitably lethal injury.
Results We explored the connection between contusion causing hypoxia and tissue immune
response. The purpose of our investigations is to define a marker which is a reliable and
early indicator of subsequent SIRS in patients with lung contusion
Conclusion(s) The first phase of our experiments had unexpected results. Defining
objective parameters which clearly indicate tissue and functional lesions may result in
changes in patient care in areas of intensive care, thoracic surgery and traumatology by
defining an optimal time for surgery and by limiting the extent of the intervention. As a result,
an improving survival rate of patients having undergone lung injury may be expected.
Key words:
94
95
96
Authors
Affiliation
Ass. prof Branka Durovic, MD. PhD, Maj. Dorde Vukmirovic, MD
Military Medical Academy , Occupational Health Institute, Radiation
Protection and Dosimetry Unit;
Medical Faculty of MMA-University of Defense;
Belgrade, Serbia
[email protected]
IMPROVEMENT OF NATIONAL RADIATION EMERGENCY PLAN
E-mail
TITLE OF THE
ABSTRACT
Topic/session
CBRN
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
During the negotiations on the accession of Serbia to the EU one of conditions was
the harmonization of existing legislation with EU legislation in many areas, such as radiation
protection, including National radiation emergency plan (NREP).
The aim of this paper is to present draft of new NREP and point- out actual problems
and possible solutions.
Serbian government established Commission, whose task was to create a new
NREP, synchronized with EU and neighboring countries plans in accordance with the criteria
of the IAEA. Harmonization is necessary due to RS signatory to international conventions
and agreements on early notification and mutual assistance in case of NR accident broader
scale. Main goal was to establish clearly the roles and responsibilities of the different State
and other organizations, which can provide response, as well as their means for
coordination, command and control. Commission recognized main subjects, but still had a
numerous problems in coordination of their activities. Therefore, Serbian authorities,
requested Emergency Preparedness Review Services – EPREV mission from IAEA.
In this paper draft of national plan and suggestions of EPREV- mission are presented
and discussed.
The proposed concepts of operations and the organizational schemes developed in
the NREP should be tested for their functionality. Although the improvement of the RS
response to NR accidents needs a lot of funds, according to the joint conclusion of the
Commission and EPREV-mission, most important are organized education, trainings and
exercises for teams and established chain of command and responsibility.
Key words:
National radiation emergency plan
97
Authors
Ass.Prof. Dr Elizabeta RISTANOVIC, PhD, Col.Ass.Prof. Srdjan
Lazic, PhD, MS Vesna PROTIC-DJOKIC, DVM, MS Sonja
ATANASIEVSKI, mol.biologist, Prof.Dr Sonja RADAKOVIC, PhD
Military Medical Academy
[email protected]
CRISIS COMMUNICATION IN THE CBRN EVENTS
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Management of CBRN exposure
Presentation suggestion
ORAL
(underline)
POSTER
Introduction/Objective
The
terorist
actions
with
CBRN agents
and accidents associated with them are unpredictable events that cause confusion and fear,
requiring rapid
action of
responsible
institutions.
They are
also
great
communication challenge. Public relations are very important for successfull CBR events
management. The aim of this paper is to emphasise specific tools of crisis PR extremely
important for medical professionals that can be applied.
Results and conclusions CBRN threat is our reality, so it is necessary
to raise awareness of the general public and indicate the possible consequences of their
use. Coordinated approach between institutions, media and the population is necessary for
that. If the accident or terrorist action occurs, public relations must be directed to public
sector employees, injured, sick and vulnerable population, domestic and international public.
It is most important to inform the media as soon as possible. The focus of communication
should be experts and professions essential in the crisis management. The first
information must include answers to the questions-who, what, where, when, how
and possibly why. The message should emphasize caution,
protection, and public
behavior as well as the state of grief and empathy if there are tragic consequences. It is
important to inform the public of any new details. In the end it is necessary to evaluate the
crisis communication plan.
Key words:
98
crisis communication, CBRN, terrorism
Authors
Alexander Grebenyuk, Dmitry Sidorov
Affiliation
E-mail
TITLE OF THE
MEDICAL SERVICE IN MANAGEMENT OF CBRN EXPOSURE
ABSTRACT
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Military doctors of all countries are carrying out a very important mission: provision of
medical care to the wounded, sick and injured regardless of ethnic, political or religious affiliation of the affected people. This is especially important for CBRN exposure, in which medical care will require a very large number of people both military and civilian.
Nowadays we consider not only the weapons of mass destruction, but significant
chemical, biological and radiological extreme factors or CBRN threats. There are: chemical,
biological and nuclear weapons (NBC); chemical, biological and radiation accidents, including impact of the destroyed chemical, biological and radiation hazardous facilities (objects);
defoliants and riot-agents; diversionary agents and another terrorist threats. Danger of any of
these factors demands carrying out measures of health protection and medical support. These measures primarily include activities at medical readiness and management designated
as medical defense.
Change of shape of modern armies and the big number of the tasks facing to medical
service, has changed also volume of measures in the field of medical defense. If in XX century the primary goal of medical defense was rescue the lives of soldiers and officers from
NBC action in war, in XXI century it is required not only to rescue lives, but also to keep health and professional serviceability of military staff and the civil personnel at action of numerous factors of the chemical, biological and radiating nature in war and a peace time. For this
purpose special hygienic, special preventive and special treatment actions are carried out.
Main directions of medical defense are the organization and conduct of measures for
chemical, biological and radiation safety of troops and civil personnel in peacetime and wartime. Second direction include providing health care for the chemical, biological and radiation
injuries, detection and treatment of diseases caused by the action of occupational exposures. Third direction of medical defense is monitoring compliance with regulatory and legal
acts ensuring to rescue the life, to keep health and professional serviceability of personnel in
terms of chemical, biological and radiating exposure.
Key words:
99
Authors
Branislava Rusic, Vladimir Pikula, Kristina Denic, Marko Antunovic,
Snezana Djordjevic, Vladimir Nesic, Vesna Kilibarda
Affiliation
Poisoning Control Centre, Military Medical Academy,
Crnotravska 17, Belgrade
E-mail
[email protected]
TITLE OF THE
DETERMINATION OF AMPHETAMINES COMPOUND IN URINE
ABSTRACT
BY LIQUID CHROMATOGRAPHY WITH MASS SPECTROMETRY
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Testing of soldiers for drugs abusing is routine test in Serbian Army. The first step in
analyzing of urine is applying immunochromatographic test strips, which provide preliminary
results in short time. According to Serbian Poison Control Center, abuse of amphetamine
compounds is increased. Because of possibility of false positive results after therapeutic use
of drugs which have similar or different structure in comparison to amphetamine (ephedrine,
pseudoephedrine, phenylephrine, ranitidine, trazodon etc). It is necessary to confirm every
positive results by mass spectrometric technique.
We developed liquid chromatography mass spectrometric method for determination of
amphetamine,
metamphetamine,
MDMA
(3,4-methylendioxy-N-methylamphetamine
„Ecstasy“) and MDA (3,4-methylendioxyamphetamine).
Urine samples were prepared by alkaline chloroform extraction. The chromatographic
®
separation was performed on ODS RP18 column, using a mixture of 0.1% formic acid in
acetonitrile-formic buffer pH 3.5 (70:30) as mobile phase, with flow of 0.5 mL/min. For
determination of amphetamine, metamphetamine, MDMA and MDA were used ions: m/z
136, 150 194 and 180 respectively. Linearity was achieved in the range from 50-1500
ng/mL. Retention times of amphetamine, metamphetamine, MDMA and MDA were 8.9, 10.2,
9.4 and 8.3 minutes respectively.
Knowing the causes leading to false positive results has great importance for the correct
interpretation each result. Because of the large number of agents that can interfere with
amphetamine assays, every positive result must be analyzed by mass spectrometry.
Described method is accurate, sensitive and it can unambiguously confirm or reject positive
strip test.
Key words:
100
Authors
Affiliation
Vladan Radosavljevic, Lieutenant colonel, Associate Professor,
Military Medical Headquarter, Ministry of Defense, Bircaninova 5,
11000 Belgrade, Serbia
E-mail
TITLE OF THE
A NEW METHOD OF DIFFERENTIATION BETWEEN A
ABSTRACT
BIOLOGICAL ATTACK AND OTHER EPIDEMICS
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
Background. The main obstacle in identifying a biological attack (BA), while preventing
false alarms, epidemics of panic and unnecessary expenditures is the insufficient data on
which to rely. Тhis new method of outbreak analysis is based on our original model of
bioterrorism risk assessment.
Aim. The intention was to develop a model of quick and accurate evaluation of an unusual
epidemiologic event (UEE) that would save time, money, human and material resources and
reduce confusion and panic.
Methods. This UEE analysis is a subtle and detailed differentiation through assessment of
BA feasibility in comparison with three other types of outbreak scenarios. There are two
types of differences between these four scenarios: qualitative and quantitative. Qualitative
and quantitative differences are defined with 23 and 10 indicators, respectively. Both types
of indicators can have three different values: N/A, 0 or 1.
Results/Discussion. We have carried out a feasibility analysis for subtle and detailed
differentiation among four outbreak scenarios. As a tool for feasibility analysis we have
introduced a “system of elimination”. System elimination is applied if one component
contains all indicators scored with 0 or as N/A – the related scenario is then eliminated from
further consideration. The system was applied to four UEEs: (1) an intentional attack by a
deliberate use of a biological agent (Amerithrax), (2) a spontaneous outbreak of a new or reemerging disease (“swine flu”), (3) a spontaneous outbreak by an accidental release of a
pathogen (Sverdlovsk anthrax), and (4) a spontaneous natural outbreak of a known endemic
disease that may mimic bioterrorism or biowarfare (Serbian tularemia).
Conclusion.It was found that “agent” was the most important and the most informative UEE
component of the new scoring system.
Perspectives.This system might be helpful in the analysis of unusual epidemic events and a
quick differentiation between biological attacks and other epidemics.
Key words:
101
POSTERI
Colonel, Professor, Ahmet KORKMAZ
Department of Physiology, Gulhane Military Medical Academy,
Ankara, Turkey
E-mail
[email protected]
TITLE OF THE
EFFECTS OF VALPROIC-ACID AND 5-AZACYTIDINE ON LUNG
ABSTRACT
DAMAGE INDUCED BY THE CHEMICAL WARFARE AGENT
NITROGEN-MUSTARD
Topic/session
Parallel Session 2 – Research (CBRN)
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Affiliation
Introduction/Objective The cytotoxic mechanism of mustards hasn’t been fully elucidated;
recently, we reported that reactive oxygen-nitrogen species and epigenetic factors are
involved in the pathogenesis and responsible for mustard induced toxicity. Valproic-acid (VA)
and 5-Azacytidine (AZ) are agents that act through antioxidant and/or epigenetic
mechanisms. Using the prototypic nitrogen mustard (mechlorethamine/HN2) as a model and
based on its known cytotoxic mechanisms, the present study was performed to test VA and
AZ for its capabilities in protecting the lungs of injured rats.
Materials and Methods Twenty-eight male Sprague-Dawley rats were divided into 4
groups: sham, HN2, HN2+VA and HN2+AZ. Lung mustard toxicity was induced via an
intratracheally injection of HN2 (0.5 mg/kg) dissolved in saline (100 µl). Control animals were
injected the same amount of saline only. VA and AZ were administered intraperitoneally with
two different doses (respectively 150 mg/kg or 2.5 mg/kg) beginning 1 h before HN2
application and continued every 12 h for six replications. Forty-eight hours after the last VA
and AZ injections, the animals were sacrificed and their lungs were taken for further assay,
i.e., routine histopathological analysis (H&E), oxidant-antioxidant (malondialdehyde (MDA)
and superoxide dismutase (SOD)) levels and cytokine levels (TNFα, IL-6, IL-10).
Results HN2 caused increased MDA, TNFα, IL-6 activity and histopathologic score in lung;
lung SOD activity was significantly depressed (p<0.05). VA restored histopathologic score,
MDA, SOD, TNFα, IL-6 levels but AZ didn’t.
Conclusion(s) In conclusion, the results of study provide evidence that VA may have the
ability to reduce mustard-induced toxicity in the lungs.
Key words:
102
Chemical Warfare, Nitrogen Mustard, Valproic-acid, 5-Azacytidine,
Lung
Authors
Affiliation
E-mail
Major Doctor Carla Maria CLAUSI and Major Doctor Claudio
Guimarães de AZEVEDO
Commandment and Major-State School of Brazilian Army / Rio de
Janeiro, RJ, Brazil
[email protected]
TITLE OF THE
THE SANTA MARIA’S CHEMICAL INCIDENT
ABSTRACT
Topic/session
Management of CBRN Exposure
Presentation suggestion
ORAL
(underline)
POSTER
ABSTRACT TEXT:
On January 27th, 2013, a fire in a nightclub in Santa Maria, in the brazilian south state Rio
Grande do Sul, killed 242 and hurt 116 young people. The incident was performed by a
firework artefact shot by one of the band singers, and caused the release of a chemical
product from the roof lining, that later was identified as a hematogenic one. The aim of this
presentation is to show the way that Brazilian Armed Forces, civilian defense and public
health institutions worked together, with the obstacles and difficulties found in the middle of
this hard work; how people gave the first aid inside the club; how many people died because
of this action; how the transportation of the victims was made, including of those who were
being ventilated; how the beds from Intensive Care Units were “created”; and how the real
diagnosis was concluded, by the help of expertise people from all over the world, by
videoconferences. For Brazil it was the second worse fire incident in all its story, and the fifth
biggest tragedy. The Armed Forces considered it as a “chemical war”, because of the
victim’s numbers. The intention of the authors is to show the world the experience achieved
with this disaster, to try to prevent other incidents as this one.
Key words:
Santa Maria’s tragedy, chemical incident, Brazilian Armed Forces
103
Authors
Affiliation
Tanja Stevović, Danica Srnić M.Stevović
National Poison Control Centre, Military Medicine Academy
Faculty of Medicine MMA, University of defence Belgrade,
Crnotravska 17
E-mail
TITLE OF THE
THE EFFECTS OF CROCODILE-CASE REPORT
ABSTRACT
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
Objective: „Krokodil” (crocodile) is a street name for a synthetic opiod analog a desomorphine. As a new substance of abuse that was first produced in Siberia in 2002 year. It can be
easily to make at home. It is administered intravenously
Case Report: A 35-year-old female , an opiate addict for a longer period of time, was admited to the clinic two days after she took intravenously heroin and the ’’cristal’’. She complaining leg swelling, large areas of skin necrosis on her tights and the lower-extremity ulceration. Traces of the numerous needle marks were visible on the tight skin.
In the further course of her treatment, the necrotic areas spread and extended into deeper
tissue layers, so that the necroctomy of the inner side of the left lower leg and the knee pit
was performed. The additional attempts to repair the defect were unsuccessful. Two months
later, both her legs were amputated.
Conclusion: This is the first patient at the clinic treated for the symptoms and signs characteristic for the use of crocodile. They are described in a small number of professional journals, but they are accessible on the YouTube clips and the photography resources on the internet.
Key words:
104
crocodile, desomorphine, new substance of abuse, necrosis
Authors
Affiliation
Maj. Dorde Vukmirovic, MD, Ass. prof Branka Durovic, MD. PhD,
Military Medical Academy , Occupational Health Institute, Radiation
Protection and Dosimetry Unit;
Medical Faculty of MMA-University of Defense;
Belgrade, Serbia
[email protected]
RISK ASSESEMENT AT THE AEROMECHANICS WORKPLACE
E-mail
TITLE OF THE
ABSTRACT
Topic/session
CBRN
Presentation suggestion
(underline)
ORAL
POSTER
Background: In order to achieve high speeds and altitudes military aircrafts are built of very
specific materials. They are made of alloys whose elements are sometimes even
radioactive. One of the most important is thorium-232, which alloyed with other elements,
greatly improves the properties of aero-engines. In order to enable the proper functioning
and safety regular and frequent controls of aero-engines are necessary. Therefore, aeroengines could be treated as ionizing radiation sources for professionals engaged in controls.
The aim of this paper is to review and assess radiation occupational risks during the
maintenance of aero-engines.
Methods: Measurements of ionizing radiation is performed on the workplaces of 32 persons
specialized in different specialties (aircraft and engine, electrical equipment and instruments,
electronic equipment and weapons) engaged in aero-engine maintenance. Measurements
were performed by ionization chamber model 450P-DE-SI "Victoreen" according to
Methodology, given in national regulation on the application of ionizing radiation. The results
were compared with the similar of German Army radiation protection service.
Results: The calculated values of effective doses in different working positions ranged from
0.42μSv/h - 5.79μSv/h. Based on doses and exposure time, estimation of the annual doses
and of risk for each working position were performed. According to results, all investigated
positions should be considered as risky workplaces considering exposure to ionizing
radiation and personnel should be considered as occupational exposed to ionizing radiation.
Conclusion: Application of statutory safeguards, professional competence and health status
of professionals engaged in maintenance of certain aero-engines are necessary
preconditions for safe operation.
Key words:
aero-engine maintenance, ionizing radiation, risk
105
Biochemist Gordana BRAJKOVIĆ, Prof. MD PhD Vesna KILIBARDA,
Chemist Dragana RANČIĆ, Master of Pharmaceutical Sciences
Milica ZLATKOVIĆ, Physical Chemist Nadežda KRSTIĆ, Master of
Pharmaceutical Sciences Biljana ĆIRIĆ, Prof. MD PhD Slavica
VUČINIĆ
Affiliation
National Poison Control Centre, Military Medical Academy, Belgrade,
Serbia
E-mail
[email protected]
TITLE OF THE
AB-FUBINACA-SYNTHETIC CANNABINOID IN HERBAL
ABSTRACT
MIXTURES ON THE SERBIAN MARKET
Topic/session
CBRN Defence
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction: Synthetic cannabinoid receptor agonists, are highly popular, because the
current screening methods do not detect them. New synthetic cannabinoid, AB-FUBINACA
is structurally an indazole derivative, agonist of the CB1 receptor that mimics the effect of Δ9THC, but it is considerably more potent than natural Δ9-THC. We have identified it in herbal
smoking mixture, “Rainbow special”, which is available as “legal high”.
Methodology: AB-FUBINACA isolated from the methanol extract by gas chromatography
with mass spectrometry (GC–MS), using GC-Ion-Trap-MS systems equipped Thermo TG5MS capillary column. The injector was operated in split mode (50:1) at 260 °C. Helium gas
was used as the carrier gas at flow rate of 1,0 ml/min. The oven temperature was hold 100
°C for 1 min and ramped to 300 °C at a rate of 12° C/min and held for 9 min. The MS
conditions were as follows: transfer line heater: 200 °C; ion source temperature: 220 °C. The
injection volume 1 µl.
Results: Analysis was performed in the full scan mode, from 50 to 550 amu. After GC–MS
analysis of the “herbal mixture” peak was identified with its major ion signals at m/z 324,
253, 109, as AB-FUBINACA.
Conclusions: Synthetic cannabinoids are available to the wider population, but we did not
detect them in biological samples yet. Existing analytical methods have to be adapted in
order to provide reliable results. By developing and validating analytical methods for
detection and constantly informing about the toxic characteristic of these compounds will
reduce their consumption.
Key words:
106
AB-FUBINACA; Synthetic cannabinoid; gas chromatography
Authors
Affiliation
Gordana Vuković Ercegović, Jasmina Jović Stošić, Slavica Vučinić,
Olivera Potrebić, Nataša Perković Vukčević, Dragana Đorđević,
Tomislav Režić
Department of Emergency and Clinical Toxicology, Military Medical
Academy, Belgrade, Serbia
[email protected]
ACCIDENTAL CHLORINE GAS EXPOSURE: CLINICAL
PRESENTATION, TREATEMENT AND OUTCOME
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TITLE OF THE
ABSTRACT
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INTRODUCTION: Chlorine gas is a pulmonary irritant that causes acute damage in the
upper and lower respiratory tract. It was used as a chemical weapon in World War I.
Chlorine liquid is presently used in cleaning agents (eg, bleach, disinfectants), in water
purification, and in many industries. Exposures to chlorine are due to accidental release from
an industrial site, transport vehicle, or when produced through inappropriate mixing of
cleaning agents (household exposure) or swimming pool chemicals. Toxicity is determinated
by dose and occupational exposures constitute the highest risk for serious toxicity from highconcentration chlorine. Chlorine is moderately soluble in water and reacts in combination to
form hypochlorous (HOCl) and hydrochloric (HCl) acids that may cause biological injury.
Symptoms may vary depending on the degree of exposure. Acute exposure to low
concentration is characterized by eye tearing and irritation of upper respiratory tract, but high
level exposure may result in more seriously condition (dyspnea, upper airway swelling and
obstruction may occur, violent cough, nausea and vomiting, headache, chest pain or
retrosternal burning) that can progress to a severe respiratory distress. The most important
aspect of treating patients exposed to chlorine gas is the provision of good supportive care
(supplemental oxygen, bronchodilators, corticosteroids, mechanical ventilation as
necessary). Most individuals exposed to chlorine gas recover without significant sequelae.
METODOLOGY: Retrospectively were analysed data of patients exposed to chlorine who
were treated in the Department of Emergency and Clinical Toxicology, both hospitalised and
ambulatory treated, during two year period.
CONCLUSION: It is very importante to educate the public on the risks associated with the
improper handling of chlorine chemicals and the improper mixing of household cleaning
chemicals.
Key words:
chlorine, inhalation, respiratory tract
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Authors
Affiliation
Nataša Perković Vukčević, Jasmina Jović Stošić, Slavica Vučinić,
Gordana Babić, Olivera Potrebić, Gordana Vuković Ercegović,
Dragana Đorđević, Tomislav Režić
Department of Emergency and Clinical Toxicology, Military Medical
Academy, Belgrade, Serbia
[email protected]
SMOKE AND CARBON MONOXIDE POISONING IN FIRE VICTIMS
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TITLE OF THE
ABSTRACT
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INTRODUCTION: Smoke is a mixture of heated particles and gases. It is impossible to
predict the exact composition of smoke produced by a fire. Toxic combustion products are
classified into three categories: simple asphyxiants, irritant toxins, and chemical asphyxiants.
Respiratory symptoms such as dyspnea, cugh, hoarseness, chest pain, expectoration of
carbonaceous sputum, stridor are often findings in most of patients. Acute mental status
changes include agitation, confusinon or coma. The most common sings of cardiotoxicity are
hypotension, tachycardia and myocardial ischaemia. The arterial blood gas analysis,
carboxyhemoglobin concentration, methemoglobin concentration, electrocardiogram and
chest radiography are the most important laboratory test to obtain. The presence of
metabolic acidosis may be an early sign of tissue hypoxia and arterial blood gas analysis
detected hypoxemia or repiratory failure.The treatment for smoke inhalation is high flow
supplemental oxygen administered by tight-fitting mask or endotracheal tube. Studies
suggest that hyperbaric oxygen therapy is superior to normobaric 100% oxygen in correcting
toxicity and preventing delayed sequelae.
METOD: Retrospectivly were analised medical records of patients exposed to fire and
smoke who were admited in the Department of Emergency and Clinical Toxicology during 5
years.
RESULTS: During 5 years, there were 93 patients who were hospitalised in The Department
of Emergency and Clinical Toxicology due to acute smoke inhalation in residental fire.
Respiratory filure was developed in 15 patients, partial in 13 and global in 2 patients.
According to Poisoning Severity Score, 36 individuals had PSS 1, 12 was scoring as PSS2
and 38 individuals developed severe intoxication , PSS 3. Four patients died.
CONCLUSION: Smoke inhalation continues to contribute significantly to the morbidity and
mortality of fire victims.
Key words:
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smoke inhalation, carbon monoxid, fire
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Olivera Potrebić, Jasmina Jović Stošić, Gordana Vuković Ercegović,
Nataša Perković Vukčević, Tanja Radonjić, Nina Radonjić
Department of Emergency and Clinical Toxicology, Military Medical
Academy, Belgrade, Serbia
[email protected]
NEEDS OF ANALYSIS FOR INTUBATION AND MECHANICAL
VENTILATION IN ACUTE POISONED PATIENTS
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INTRODUCTION: In order to analyze the indications of intubation and application of MV in
acute poisoned patients were considered indications for respiratory support, the most
appropriate modalities, the need for sedation during intubation and further during the
implementation of MV. A small number of studies are focused on ventilator support in acute
poisoning.
METHODS: We retrospectively analyzed medical records of patients admitted to the
Department of Emergency and Clinical Toxicology, Military Medical Academy in 2012.
RESULTS: Although intubation and MV are indicated when the level of consciousness is
reduced (GCS <8), in patients poisoned with psychotropic drugs, particularly
benzodiazepines, in most of cases there was no need for intubation. The weakness of the
respiratory muscles is usually a reason for intubation and several daily MV of
organophosphate poisoning. Adult respiratory distress syndrome and acute lung injury due
to which it was necessary MV are most frequent during opiate overdose (heroin,
methadone), and duration of MV was short. Hemodynamic weakness is, independent from
the type of the agent, also a frequent indication for usage of MV. Parameters for monitoring
of MV in patients with acute poisoning are the same as in other conditions. Depending on
the type of agent, there may be an increased risk of hemodynamic instability, barotrauma or
acid-base imbalance. The most commonly initiated usage mode is controlled MV FiO2 0.5
and Tidal volume of 7.5 mg / kg, followed by a controlled-assisted ventilation. The need for
sedation during intubation of patients with acute poisoning in a coma is relative, depending
on the risk of aspiration. The need for maintenance of sedation is not clearly defined,
especially in the case of coma caused by psychoactive medication. It may be necessary to
facilitate the adaptation of the ventilator, particularly in incomplete awake or agitated
patients.
CONCLUSION: Securing of airways is one of the main measures of urgent resuscitation in
the treatment of acute poisoning. Although it is necessary to follow the general principles of
the intubation and MV, we should bear in mind the specifics of intoxication, especially when
it is about consciousness disorder as an indication, as well as the need for additional
sedation in these patients.
Key words:
Keywords: acute poisoning, intubation, mechanical ventilation
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Assist Prof.Snezana Djordjevic,
National Poison Control Centre, Military Medical Academy, Mecial
faculty, University of Defence, Belgrade, Serbia
[email protected]
E-mail
ANALYTICAL MTHODS IN DETERMATION OF CHEMICAL
TITLE OF THE
WAREFARE
ABSTRACT
CBRN
Topic/session
Presentation suggestion (underline)
ORAL
POSTER
ABSTRACT TEXT:
Surviving in case of applying of chemical warfare agents (CWA), depends on their fast
detection. Different types of chemical detectors can be used for detection of CWA in the air
in the field condition. Chemical Agent Monitor (CAM) detector has two working modes for
detection of chemical from the group of mustard and nerve agents (H and G agents).
Identification of chemical compound on site could be done in mobile laboratory using
modern mobile analytical instruments, such as mobile gas chromatography with mass
spectrometry (HAPSITE) and infra-red spectrometer (Gasmet)/ Analysis of soil, water, liquid
waste or solid samples (rubber, clothes, part of missile) in order to identify CWA and their
degradation products is carried out in stationary laboratory. Gas chromatography with
nitrogen-phosphorus (NP) and flame-photometric (FP) detector is used as a screening method
for detection of CWA which contains nitrogen, phosphorus and sulfur. Due to sensitivity and
reliability, gas chromatography with mass spectrometry (GC-MS) is method of choice for
confirmation, identification and determination of CWA and their degradation products. This
is the only method which can provide information about chemical structure of CWA.
Applying of electron or chemical ionization and different databases, as well as different
software, enables identification of traces of CWA and their degradation products in sapmples.
Authors
Affiliation
Key words:
110
Chemical warfare agents, detector, gas chromatography
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Zahra Aghaei1, Ramin Abrishami2
1. Pharm.D. Candidate, Tehran University of Medical Sciences,
Tehran, Iran
2. Pharm.D., Clinical Pharmacy Specialist, Medical Department,
Islamic Republic of Iran Police.
[email protected]
THE ROLE OF OXIMES IN ORGANOPHOSPHATE
NERVE AGENT TOXICITY
Topic/session
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ORAL
POSTER
Abstract
Organophosphorus (OP) compounds are widely used, extremely toxic materials that used as
both chemical warfare and pesticides. Despite efforts to prohibit the use of these agents, the
threat is still ongoing, as evidenced by the World War I, the Iran–Iraq war, the Tokyo subway
incident in Japan, and recently in Syrian civil war. Two main groups of antidotes are used to
treat their toxic effects: Anticholinergics (mainly atropine) and re-activators (oximes).
Regardless of the fact that oximes are regarded a major component in the pharmacotherapy
of OP poisoning, there is an ongoing debate on the therapeutic value of oximes. We
reviewed some of the clinical trials that utilized oximes in the treatment of OP poisoning.
Key words:
111
Authors
Vadim Basharin, Alexander Grebenyuk
Affiliation
E-mail
TITLE OF THE
ISSUES OF MEDICAL DEFENSE AGAINST CHEMICAL THREATS
ABSTRACT
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ORAL
POSTER
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ABSTRACT TEXT:
Chemical safety of Army’s personnel is an actual problem. Quantity of chemical threats of peacetime and wartime increases constantly.
Earlier the main chemical threat was chemical weapon use in military conflicts. Today
leaders of many countries understand serious danger for humanity from the type of weapon
of mass destruction and aspire to destroy chemical weapons stockpile on our planet. Russia
executes the obligations of the international convention on the prohibition of the development, production, stockpiling and use of chemical weapons and on their destruction. Unfortunately, we cannot exclude an opportunity of chemical weapon use until the present.
Terrorists can apply chemical agents similar to those used by military services. However, several factors limit the use of the weapon by many terrorists. They use common
chemicals, because standard military chemical agents can be difficult or dangerous to manufacture, access, or disperse.
Several chemicals (chlorine, phosgene etc.) were used as chemical weapon. Today
they are used at chemical plants widely and can lead to massive sanitary losses in cases of
chemical accidents (for example, on fire).
Therefore medical service must be constantly readiness to carry out its measures
when chemical threats exist. Specialists of medical service must have knowledge about chemical threats and measures of medical defense which could decrease adverse toxic effects.
Medical measures of life saving are important purpose of medical service, but also saving of
health and professional capacity of the military personnel is main missions in chemical accidents in XXI century.
The solution of issues on ensuring medical protection is possible if a complex of special events will be carried out. They consist of hygienic, preventive and medical measures.
The first direction of medical defense includes observance of the legal documents for preservation of life, health and professional working capacity of the personnel in the conditions of
chemical exposures. Special preventive events are based on prevention of unfavorable effects of chemicals. Special medical measures include system of medical care standards at
chemical threats.
The medical support at chemical threats consist of two phases. The first phase is a
“planning”. Medical service plans measures in case of chemical accidents or other situations.
This phase includes following measures:
- analysis of information about chemical threats,
- training of medical experts;
- defense of medical facilities of chemicals hazards.
So for example, the scale, character of consequences of accident can be in advance
defined, at least for stationary industrial facilities. Measures of medical service directed on
preventive of casualties and organization of medical care can be defined in cases chemical
accidents beforehand.
The medical service takes part in previous training of the military personnel for action
at chemical threats. In this time medical doctors teach rules of behavior on the territory contaminated chemical substances, control correctness of use of personal protective equipments. Personnel must know issues of decontamination, medical care and medical means
against chemicals.
112
The following phase includes medical measures after chemical accident. Missions of
medical service are:
- preventive contact of wounded, sick and medical personnel with chemicals (an use of
personal protective equipments, a removal of casualties from the contaminated area, partial
and full decontaminations;
- medical treatment on the different echelons of medical care, including antidotes, means of the pathogenetic and symptomatic therapy;
- examination of water and food on chemicals contamination;
- identification of chemicals for solve of medical service missions.
Thus, the current list of missions facing the medical service in cases of chemicals treats is extremely large. We believe that carrying out the missions together with other measures allow to decrease sanitary losses among military men in chemical accidents significantly.
Training of medical service specialists for solution of medical defense issues is principal missions when chemical threats exist.
Key words:
113
Authors
Affiliation
V. Gurkalo1, I. Konyshev2, V. Sibilyov1, A. Yumanov2
1
Main Military Clinical Hospital named after N.N.Burdenko of the
Ministry of Defense of the Russian Federation, Moscow
2
Medical Educational and Scientific Clinical Center named after
P.V.Mandryka of the Ministry of Defense of the Russian Federation,
Moscow
E-mail
TITLE OF THE
CHEMICAL TERRORISM AS A NEW POSSIBLE TYPE OF
ABSTRACT
TERRORISM
Topic/session
Presentation suggestion
ORAL
POSTER
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ABSTRACT TEXT:
In case of a chemical attack an important point in the organization of medical help to
the victims are both readiness of the medical staff and the level of protection of the medical
staff against the negative effects during the providing of help at the accident site, during the
evacuation of the victims and in the medical institutions.
Destabilization of work of medical institutions as a target of a terrorist attack may be
caused among other means by use of chemical and biological agents.
It is worth mentioning that demonstrative fear mongering may be one of the purposes
of chemical terrorist attack.
Technogenic accidents and catastrophes may be prevented through precaution
measures, but prevention of a terrorist attack is impossible in most cases.
The possibility to produce highly toxic chemicals in laboratories provides the criminals
with the broad range of toxic agents to terrify people.
There are several specific features in the problem of chemical terrorist attacks:
- variety of the chemical agent which can be used by terrorists;
- great diversity of the forms of acute period of the toxic effects on the organism;
- some repercussions are understudied or not studied at all.
Another problem related to the use of chemical agents by terrorists is non-availability
of antivenoms for some agents or insufficient amount of antivenoms in the medical
institutions which have no specific toxicology departments.
Despite the fact that the medical staff gets the information about the clinical aspects
of effects of warfare agents and basic hazardous chemicals during training, advanced
training and Civil Defense and Emergency Situations classes medical staff in the medical
institutions have little practical knowledge of clinical aspects of acute and chronic effects of
chemical agents which can be used in terrorist attacks.
Due to growth of risk of chemical terrorism and increasing number of accidents at
chemically hazardous objects the relevance of providing help to the victims grows which
requires relevant training of the healthcare specialists.
Key words:
114
Authors
Affiliation
I.Konyshev1, A.Yumanov1, A.Murzin2, V.Zakharov2, Y.Akimov2
1
Medical Educational and Scientific Clinical Center named after
P.V.Mandryk of the Ministry of Defense of the Russian Federation,
Moscow
2
Scientific Research Institute of Communication and Management,
Moscow
E-mail
TITLE OF THE
ABSTRACT
GEOINFORMATION TECHNOLOGIES IN THE ASSISTANT
SYSTEM OF MAKING DECISIONS BY COUNTERACTION OF
CHEMICAL AND BIOLOGICAL THREATS
Topic/session
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ORAL
POSTER
ABSTRACT TEXT:
Scientific and technical level of works in the field of genetic engineering,
biotechnology, toxicology, molecular biology and other related sciences allows creating
Hazardous Chemical Substances (HCS) and pathogenic biological agents (PBA) of new
generation, to improve techniques and methods of application. Huge selection of agents for
covert or open usage by terrorists at any scale and purpose (frightening, deprivation of food
sources, provocation of disorders and discontent of state administration bodies, discredit of
health care, etc.) makes it difficult to take countermeasures because of need for operational
processing a large array of incoming information, an adequate analysis of the situation on
the ground, differentiation of the circumstances, when the leading pathogenic factors occur,
evaluation of the available forces and means, gradation of activities in order of their
importance,
etc.
In connection with intensification of migratory flows, ingress of especially dangerous
infections not typical for the area is possible, so the doctors have insufficiently knowledge of
clinical aspects, and skills to limit the harmful pathogen action.
For prompt decisions about medical tactics in place, the possible complications of the
situation, charring out of circumstances verification of the affects being received (natural
course of events or special use of pathogens), increases need rapid informing the regulatory
bodies about emerging threats.
Lagging in reaction to emerging threats of chemical and biological nature is largely
related to the lack of modern software and hardware transmission, the analysis of the
information and the intelligent assistant system (IAS) of making decisions, which require
creation of systems engineering, software and information components with due regard to
climatic and geographical, ethnographic, migratory, religious, structural and functional
characteristics of the troop disposition region.
IAS allows automating and technically providing work of the officers, specialists of the
expert group and surgeon generals with means of individual and collective information
display, the ability to use information from a single database in the available area, to enrich
the intellectual potential in their subject area using a knowledge system base.
Using IAS allows to monitor the sanitary-epidemiological situation in the operational
area, timely to detect its complication, emergence of mass infectious diseases, poisonings,
to predict consequences, and most importantly, to make efficient decisions about
organization and carrying out of a range of targeted measures to eliminate any occurred
source areas attracting necessary forces and means.
IAS of making decisions on threats counteraction of biological and chemical nature in
regard to health care service has been planned as the geographically distributed, fixedmobile hierarchical structure covering by means of system the agencies and offices of health
care service, which ensure population’s sanitary and epidemiological welfare.
System operation is supported by the within the telecommunications environment
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interconnected software and hardware complex of various modification being installed in the
organizational structures. All components of the system interact together via the Internet
using the client -server technology. This technology allows the client and the server (data
processing center) to exchange the minimum required amount of information.
To ensure continuous monitoring of the sanitary and epidemiological situation (SES),
prompt response on its complication the mobile (portable) automated workplaces (AWP) for
the health care regulatory body and the epidemiology, toxicology, hygiene experts,
responding to the receptor, are used as part of the IAS beside of the stationary workplaces.
For the central office and regional structures IAS creates Situational centers with
complex of software and hardware, operating in real time and providing implementation of
system analysis and development trends of existing SES on the device with the display for
collective use (screen) on the background of geographical maps.
IAS operates under the interaction principles of open systems using conventional
tools, and providing both phased increase of software and hardware, and removal from the
system obsolete resources. To reduce the costs of IAS creating, usage of commercially
available means of general purpose is provided, as well as logging in the design of the
existing infrastructure and staff qualification.
IAS provides the following tasks solution:
- information support by the formulation of the preliminary clinical and epidemiological
diagnosis of an infectious disease or an injury of hazardous chemicals in order to
verify outbreaks, to establish their connection with the emergencies of biological or
chemical nature;
- extraordinary, daily, weekly and monthly monitoring of sanitary-epidemiological
situation;
- forecasting of sanitary and epidemiological situation with the expectation of possible
sanitary losses (number of sickness cases);
- formation of recommendations to implement the preliminary preventive measures
under the conditions, when the threat of complications of the sanitary-epidemiological
situation exists
- intelligent assistance by making decision in planning and carrying out actions for
localization and liquidation of epidemic outbreaks of infectious diseases.
When designing a system, modern and in practice adapted methods and tools for
decision support are used for different organizational structures on the basis of their tasks.
Reduced sanitary losses cut on the average in 5 times the cost of infectious diseases
prevention. Application of proven methods and means of software and technical, information
and linguistic support in IAS designing minimizes financial risks by creation and development
of the system.
By IAS development confidentiality and official nature of medical information is
considered. Therefore, the knowledge base has an open character, and except the function
of informational support, has also an instructional value. Database is differentially closed for
the public; the owners of the access key are defined by the district surgeon general for
medical specialists, and by the chief medical officer in the military district (navy).
Created experimental IAS has no analogues in the Russian Federation, its design is
completely new and provides under its functional characteristics superiority over such
foreign systems as GermAlert, GermWatcher, Gideon, RODS, EssENCE Electronic and
LEADER.
Key words:
116
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Z. Segrt, D. Djordjevic, N. Rancic,
Military Medical Academy, Belgrade, Serbia
COMPARISON OF PARAMETERS OF SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE AND HEART RATE AFTER
SINGLE AND COMBINED APPLICATION OF FLUMAZENIL AND
THEOPHYLLINE IN ACUTE INTOXICATIONS WITH
BENZODIAZEPINES
Topic/session
Presentation suggestion
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ORAL
POSTER
Abstract
Comparison of parameters of systolic and diastolic blood pressure and heart rate after single
and combined application of flumazenil and theophylline in acute intoxications with
benzodiazepines
Background / Aim
Acute benzodiapines intoxications are the most common drug poisonings in many countries.
Clinical manifestations include different levels of consciousness disturbances (from
somnolence to coma), dysarthria, ataxia, hypotonia, hypo and/or areflexia, miosis and
horizontal nystagmus. Cardiocirculatory effects usually lead to the occurrence of a
tachycardia, but bradycardia and hypotension are possible too. In ECG may be registered
conduction disorders, such as – 1st degree AV block, the left bundle branch block and/or
intraventricular conduction disorders, as well as negative or biphasic P in aVL.
The therapeutic approach to the acute intoxicated patients with disorders of consciousness
involves the application of flumazenil as a specific antagonist of benzodiazepine receptors.
In most cases, result of flumazenil therapy is a rapid reversal of consciousness disorders.
Half-life of flumazenil was about 50 minutes and the duration of its effect is much shorter
than the duration of some benyodiazepine action (such as diazepam). Therefore, it is often
need re-application of flumazenil and/or its use in continuous infusion, which considering its
price, and the time spent in the hospital that significantly increase the cost of treatment of
this category of patients.
The main objective of the study is that in order to investigate the combined use of flumazenil
and theophylline in patients poisoned with benzodiazepines determine whether the
combined use of two drugs leads to changes in systolic and/or diastolic blood pressure
and/or heart rate.
Methods
The study was conducted as a prospective clinical study in patients who were divided into
three groups, and who received singly or combined theophylline and flumazenil terapy. In
order to monitor of possible side effects of combined use of theophylline and flumazenil in all
groups were analyzed arterial blood pressure and heart rate, before giving, as well as in
certain intervals (at 1, 30, 120 and 240 minutes) after single and combined application of
flumazenil and theophylline.
Results
Systolic blood preasure:
1. Statistical significant difference was only determinate between groups who received
only teophylline and combined flumazenile and teophylline therapy after the 1st minute
of application (p< 0.05) (Table 1).
Diastolic blood preasure:
2. Statistical significant difference was not determinate between groups who received
117
single flumazenile or teophylline therapy and combined flumazenile and teophylline
therapy (Table 2).
Heart rate:
3. Statistical significant difference was only determinate between groups who received
only flumazenil and combined flumazenil and teophylline therapy after 120 minutes (p<
0.05) and 240 minutes (p< 0.05) of application (Table 3).
Conclusion
Differences in values of monitored parameters of arterial blood pressure and heart rate
between the groups of patients who received theophylline and flumazeni alone compared to
the group that received the combined theophylline-flumazenil therapy were minimal and
therefore in this segment we do not have limits for the application of combined therapy.
Key words:
118
Authors
Pharmacist, Branislava RUSIC, Pharmacist, Vladimir PIKULA,
Pharmacist, Kristina DENIC, Pharmacist, Marko ANTUNOVIC,
Assist. Prof, Snezana DJORDJEVIC, Pharmacist, Vladimir NESIC,
Prof. Vesna KILIBARDA
Affiliation
E-mail
Military Medical Academy/Poison Control Centre /Belgrade, Serbia
[email protected]
TITLE OF THE
DETERMINATION OF AMPHETAMINES COMPOUND IN URINE
ABSTRACT
BY LIQUID CHROMATOGRAPHY WITH MASS SPECTROMETRY
Topic/session
CBRN Defence
Presentation suggestion
ORAL
POSTER
(underline)
Testing of soldiers for drugs abusing is routine test in Serbian Army. The first step in
analyzing of urine is applying immunochromatographic test strips, which provide preliminary
results in short time. According to Serbian Poison Control Center, abuse of amphetamine
compounds is increased. Because of possibility of false positive results after therapeutic use
of drugs which have similar or different structure in comparison to amphetamine (ephedrine,
pseudoephedrine, phenylephrine, ranitidine, trazodon etc). It is necessary to confirm every
positive results by mass spectrometric technique.
We developed liquid chromatography mass spectrometric method for determination of
amphetamine,
metamphetamine,
MDMA
(3,4-methylendioxy-N-methylamphetamine
„Ecstasy“) and MDA (3,4-methylendioxyamphetamine).
Urine samples were prepared by alkaline chloroform extraction. The chromatographic
separation was performed on ODS® RP18 column, using a mixture of 0.1% formic acid in
acetonitrile-formic buffer pH 3.5 (70:30) as mobile phase, with flow of 0.5 mL/min. For
determination of amphetamine, metamphetamine, MDMA and MDA were used ions: m/z
136, 150 194 and 180 respectively. Linearity was achieved in the range from 50-1500
ng/mL. Retention times of amphetamine, metamphetamine, MDMA and MDA were 8.9, 10.2,
9.4 and 8.3 minutes respectively.
Knowing the causes leading to false positive results has great importance for the correct
interpretation each result. Because of the large number of agents that can interfere with
amphetamine assays, every positive result must be analyzed by mass spectrometry.
Described method is accurate, sensitive and it can unambiguously confirm or reject positive
strip test.
Key words:
Amphetamines, false positive results, urine test strips
119
120
Authors
Affiliation
Colonel Pharmacist, Dr., Boris, MEY
Supervisory Agency for Public Law Tasks of the Bundeswehr
Medical Service South, Munich, Germany
E-mail
[email protected] [email protected]
TITLE OF THE
FOOD CONTROL AND EXAMINATION IN MISSION:
ABSTRACT
RECENT FINDINGS AND FUTURE PERSPECTIVES
Topic/session
Update in Preventive and Veterinary Medicine
(Update in Infectious Diseases, Food and Water Control)
Presentation suggestion
ORAL (45 min)
POSTER
(underline)
Introduction
In out of area missions of the German Armed Forces, veterinarians and food-chemists
guarantee food and water safety by inspecting mess facilities, canteens and dining-facilities
as well as by auditing food manufacturers and suppliers. Besides they also examine on-the
spot, foodstuffs, articles of daily use and water in deployable laboratories. This is done at a
high scientific level and in close collaboration with home base laboratories, based on a riskorientated and interdisciplinary approach.
Case Study
Mycotoxins implicate a particular challenge in food control due to their high toxicity and their
frequency of occurrence. In 2012, for instance, samples of pre-packaged ultra heat treated
milk of Pakistani origin were drawn in various NATO-Camps in Afghanistan. These samples
were at first screened for Aflatoxins on site in Mazar-i-Sharif using Enzyme-Linked
Immunosorbent Assays. The quantification and confirmation, which was done in a homebase laboratory, included sample clean-up and pre-concentration by Immunoaffinity
Chromatography, separation by High Performance Liquid Chromatographie and detection by
means of a Fluorescence detector and a Mass Spectrometer (validation). The resulting
quantities of aflatoxins exceeded by far the safety limits established by regulatory agencies
(2.5 / 25-fold). Consequently, in all regional commands of ISAF, the stocks of the milk brand
were eliminated and immediately replaced.
Conclusions
It is hoped that the described capabilities will be of interest to other allies in particular within
the Connected Forces and Smart Defense Initiatives.
Way ahead
Presentation of research and development projects aimed at the analysis of biotoxins,
contaminants and bacteria in foodstuffs.
Key words:
food safety in mission, on-site controls, biotoxins, analytics,
deployable laboratories
121
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Miroslav Kojić, Petar Ćurčić, Radmila Rajić-Dimitrijević, Milomir
Milanović, Vesna Begović, Darko Nožić, Dragan Mikić
Military Medical Academy, Clinic for infectious and tropical diseases
[email protected]
TUBERCULOUS MENINGITIS IN MILITARY MEDICAL ACADEMY
(1978-2005): CLINICAL, LABORATORY AND THERAPEUTIC
REVIEW
Topic/session
infectious diseases
Presentation suggestion
(underline)
ORAL
POSTER
Introduction/Endpoint. The most frequent and the most serious form of tuberculosis of CNS is
tuberculous (TB) meningitis, the illness in which if the therapy is started to late, permanent
sequels or lethal outcome can occur. The endpoint was to analyze clinical and laboratory
characteristics, therapy and the outcome of patients with TB meningitis treated in the Clinic for
infectious and tropical diseases of Military medical academy in the period from 1978 to 2005.
Methods. Total of 31 patients were included in investigation, 20 (64.5%) male and 11
(35.5%) female, average age of 36.3±17.2 (10-85). Diagnosis was made according to the
clinical picture, cito-biochemical characteristics of cerebrospinal fluid (CSF), CSF culture and
by response to therapy. Antituberculous therapy and it’s side effects were analyzed too.
Results. Fever and headache were registered in all patients, and 20% of them had ptosis,
anizocoria, dyplopio and urine retention. Positive meningeal signs had 83.9%,
unconsciousness 77.4%, pathological reflexes 67.7% and 51.6% of patients had lesions of
cranial nerves. The average cell number per mm3 of CSF was 226 (13-2480), proteinorachia
was 1.71 (0.66- 6.7) g/l, while ratio between glucoses level in CSF and serum was 0.3 ± 0.18
(0.02 - 0.85). Mycobacterium tuberculosis was isolated in CSF of 16 (52.9%) patients.
Antituberculous drugs (streptomycin 1000 mg, rifampicin 600-1200 mg, izoniazid 300-1200
mg, etambutol 800-1600 mg, pyrazinamid 1500-2000 mg and izobutol 200-400 mg per day)
were used in 29 (93.5%) patients while 2 patients had died before the diagnosis was made.
Side effects of antituberculous drugs were registered in 22 (75.9%) patients. Corticosteroids
were used in 23 (74.2%) patients. Complete recovery was registered in 18 (58.1%) patients,
sequels in 9 (29%), while 4 (12.9%) patients has died.
Conclusion. TB meningitis could be a big diagnostic problem, what can lead to delay with
specific therapy and worse outcome.
Key words:
122
tuberculous meningitis, clinical picture, therapy, outcome
Authors
Affiliation
LTC Alfonso GIORDANO, veterinary officer
Italian Joint Operations Hq – JMED Division – Chief of Preventive
Medicine and Veterinary Section
E-mail
[email protected] – [email protected]
TITLE OF THE
ITALIAN VETERINARY SERVICE ON JOINT & MULTINATIONAL
ABSTRACT
OPERATIONS ABROAD – A PERSONAL CONTRIBUTION
ABOUT THE MAIN PERSPECTIVES FOR THE FUTURE
Topic/session
Update in Preventive and Veterinary Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Since 1982 in Lebanon, the Italian military veterinary service has always provided its support
to the contingent deployed in various theaters during peace-keeping operations abroad,
contributing towards the force health protection and guaranteeing the veterinary support to
MWDs units.
Over the years, veterinary activities have undergone a constant evolution, in order to ensure
a service in close connection with a whole range of needs, in terms of tasks, organization
and materials.
The author's purpose, after having briefly outlined the main tasks of the service and its
organization in support of Italian operations abroad, is to illustrate a specified analysis and
evaluation conducted on a wide range of feedback received from veterinary officers
deployed, and, through the experience as Chief of Preventive medicine and veterinary
Section in the Italian Joint Operations Hqs, to give a personal contribution about what could
be the key perspectives of development of the veterinary service on operations.
In his conclusions, considering a priority to ensure a service in keeping with a large wide of
needs of the Italian armed forces in operations, the author thinks that the main challenges
for the vet service of the future should be largely focused on:
- a greater integration in joint, multidisciplinary and multinational sense;
- the development of a technical doctrine that, in accordance with the national law and
regulations and, at the same time, with the NATO/EU doctrine, aiming to a greater
standardization of procedures and to an ease of interoperability in multinational sense;
- the development of new skills and technical and professional capabilities, especially in
the force of health protection and preventive medicine and in the veterinary support to the
MWDs units;
- the study and development of new materials and equipments adapted to different
operating situations;
- the education and training of personnel, directed to the development of new technical
skills integrated with the capability of working in a joint and multinational staff.
Key words:
MILITARY VETERINARY SERVICE - OPERATIONS ABROAD –
MULTIDISCIPLINARY MULTINATIONAL AND JOINT
INTEGRATION.
123
Authors
Maj Jovan MLADENOVIC, Col Prof. Radovan CEKANAC, Col Ass.
Prof. Srdjan LAZIC, Capt Zoran MLADENOVIC, Maj Dragan
DJORDJEVIC, Maj Željko JADRANIN, Milena KRSTIC
Affiliation
Hospital/Clinic /Other, City and Country
Institute of Epidemiology, Military Medical Academy, Belgrade
E-mail
[email protected]
TITLE OF THE
INFECTIOUS DIARRHEAL OUTBREAKS IN SERBIAN ARMED
ABSTRACT
FORCES, 1991-2010
Topic/session
Update in Preventive and Veterinary Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective Infectious diarrhea remains a significant health problem. Diarrheal
outbreaks can lead to considerable morbidity, lost workdays, and significant economic costs.
In the military, such outbreaks have been known to incapacitate large numbers of soldiers in
active duty units such as flight staffs, naval crews and soldiers on training bases. Risk
factors for diarrheal outbreaks in military units are crowded living conditions, substandard
personal and unit hygiene practices, mass food processing facilities, lack of adequate
refrigeration under field conditions, and frequent movement of personnel among units and
throughout various geographic locations.
The purpose of the current report was to summarize and characterize diarrheal outbreaks in
the Serbian Armed Forces (SAF) from 1991 to 2010.
Materials and Methods This study was a retrospective analysis of epidemiological reports,
gathered by the Institute of epidemiology Military Medical Academy, representing all reported
outbreaks of diarrhea in the SAF between 1991 and 2010 that had either an identified
bacterial cause or no known cause.
Results Total of 66 outbreaks was reported during study period. The greatest number (7
outbreaks) occurred in 1993 whereas the fewest (1 outbreak per year) were recorded in last
3 years of study period. Total number of cases was 3087. Number of cases per outbreak
ranged from 5 to 170 and average number was 47. Most outbreaks (51.5%) had less than 35
cases and 15.2% of outbreaks had more than 100 cases. Attack rates in outbreaks ranged
from 0.44% to 100% with mean attack rate of 25.95%. Outbreaks last from 1 to 21 days
(average duration of outbreak was 4.65). Majority of outbreaks occurred during warmer
months of year, especially in June and July. Most frequent mode of transmission in
outbreaks was food (63.6%), then water (28.8%), unidentified (6.1%) and contact (1.5%). In
majority of outbreaks etiological agent was not identified (59.1%). Salmonella species was
isolated in 10 outbreaks and Shigella species in 8 outbreaks and they were most commonly
isolated microorganisms in outbreaks.
Conclusion Outbreaks of infectious diarrhea can be limited by attention to basic principles
of infection control. A combination of education on military bases regarding hygiene
practices, improvements in infrastructure pertaining to food maintenance, and overall
upgrading of the physical condition of bases can contribute to decline in the incidence of
diarrheal outbreaks.
Key words:
124
military, outbreaks, diarrhea, epidemiology
Author
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Colonel Matthias MEYER
Bundeswehr Joint Medical Service, Munich, Germany
[email protected], [email protected]
OPERATION OF A STAND-ALONE WATER QUALITY
LABORATORY DURING THE EXERCISE CAPABLE
LOGISTICIAN 2013
Topic/session
Update in Preventive and Veterinary Medicine
(Update in Infectious Diseases, Food and Water Control)
Presentation suggestion
ORAL
POSTER
(underline)
Introduction
In 2013 the Multinational Logistics Coordination Centre Prague conducted the multinational
logistics field training exercise “Capable Logistician 2013” (CL13) with 35 participating
nations, hosted by the Slovak Republic.
The Bundeswehr Joint Medical Service contributed a container based laboratory module to
the exercise and provided highly sophisticated laboratory capabilities and medical special
matter experts (SME) for the fresh water production and supply chain.
Aim and Challenge
The aim of CL13 was to assess interoperability of logistics systems, services and equipment
and commonality of procedures, in order to enhance interoperability and standardization of
procedures for current and future operations.
For the first time during CL13, a Bundeswehr water quality laboratory module was supposed
to be operated stand-alone, temporarily self-sustaining in a multinational logistics
environment, independent and detached from a role2+ medical facility.
Results and Conclusions
The participation of the Bundeswehr Medical Service in CL13 was a great success both for
the laboratory unit and the supported and supporting multinational logistics units with a great
mutual benefit for conducting future operations.
The possibility and the capacity of operating a stand-alone laboratory module have been
proved and a lot of valuable experiences were gained during the exercise.
The laboratory unit’s SME and their technical capabilities were not only highly appreciated
but also contributed greatly to the safety and quality of the fresh water production and
supply.
The stand-alone laboratory module fits into NATO’s “connected forces” concept and can be
a valuable contribution of the Bundeswehr Joint Medical Service to future multinational
operations.
Key words:
water supply, water quality, water control, laboratory module,
125
Authors
Major Nenad JOVANOVIC, DVM MSc1.
Novica STAJKOVIĆ, MD PhD, Colonel Radovan Cekanjac, MD PhD,
Milena KRSTIC, MD MS, Captain Oliver STOSIC, DVM Sc
Affiliation
Military Health Department MoD R.Serbia1, Military Medical Academy
Belgrade 2, Centre of Veterinary services3
E-mail
[email protected]
TITLE OF THE
INVESTIGATIONS OF VECTORS AND RESERVOIRS
ABSTRACT
OF B.BURGDORFERI IN AREA OF MILITARY RANG
„PASULJANSKE LIVADE” IN 2011.
Topic/session
Preventive/ Veterinary medicine
Presentation suggestion
ORAL
POSTER
(underline)
Introduction
The first case of Lyme disease in Serbia was discovered in 1987. In our country were
registered about 10.000 cases of Lyme disease, 75 in Military personnel. Natural foci
Disease in Serbian armed forces has been investigated periodically and we made several
investigations during seasonal tick’s activity at different locations.
Objective In this study, we were investigated prevalence of Borrelia burgdorferi in Ixodes
ricinus ticks, and small rodents during 2011. in area belong to Military rang Pasuljanske
livade.
Materials and Methods We trapped small rodents and removed Ticks from them. Ticks
were examinated in dark field microscopy (400 x) on present of B. burgdorferi. Cultivation of
samples and isolation of B. burgdorferi was examinated in the laboratory of MMA.
Results During the study period were trapped 17 small rodents belong to 4 different
species: Apodemus flavicollis, A. agrarius, Clethrionomis glareolus and Glis glis. Presence of
Ectoparasites found in all 17 small rodents, presence of ticks in 12 small rodents, fleas in 1,
and both ticks and fleas in 4. We collected 69 ticks: 48 I. ricinus (40 nymphs and 8 larvae) i
21 Gamasoides ticks. Prevalence of B. burgdorferi in ticks removed from small rodents, was
31.2% - 15 samples (13 nymphs and 2l molts). Infected ticks had been removed from 7
small rodents: 1 A. agrarius, 3 A. flavicollis, 2 Cl. glareolus and 1 G. glis. After maceration of
spleen of all trapped small rodents and cultivation in Kelly medium we found B. burgdorferi in
6 (35,3%): 1 A. agrarius, 4 A. flavicollis and 1 Cl. glareolius.
Conclusion We concluded, the presence of B. burgdorferi in ticks and small rodents
indicate that risk of Lyme disease exists in area belong to Military rang Pasuljanske livade
Key words:
126
Lyme disease, ticks, small rodents, Borrelia burgdorferi, risk
Major Rafał SOKOŁOWSKI MD1, Aneta GUZEK2 MA, Elżbieta
SAKS2 MA, Colonel Prof. Tomasz TARGOWSKI MD, PhD1, Colonel
Prof. Tadeusz PŁUSA MD,PhD1
1
Affiliation
Department of Pneumonology; 2Department of Laboratory
Diagnostics; Military Institute Of Medicine
Warsaw, Poland
E-mail
[email protected]
TITLE OF THE
NOSOCOMIAL INFECTION – PATHOGENS AND DRUG
ABSTRACT
RESISTANCE in the Department of Pneumonology
Military Institute of Medicine
Topic/session
Research in Trauma and Sepsis
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction
Nosocomial infections are one of the most common complications of hospital treatment.
They are responsible for cases of sepsis even with lethal form.
The aim of the study was to estimate the pathogens isolated from biological materials
collected from patients hospitalized in the Department of Pneumonology Military Institute of
Medicine Warsaw Poland and its antimicrobial resistance.
Materials and Methods
911 symptomatic patients suspected for nosocomial infections hospitalized during 2012-2013
were enrolled to the study. In all, biological material (sputum and/or blood and/or urine) were
collected and then the pathogens were cultured and identified according to a standard
microbiological procedures. Identification and drug susceptibility were performed with using
VITEK2 (bioMerieux) system.
Results
A pathogens were found in 381 samples. Amount them the most frequent were
Enterobacteriaceae n=217 (57%) including n=37(9%) ESBL form, and Staphylococcus
aureus n=89(23%) including n=13(3%) of strains with resistance to methicillin (MRSA),
Pseudomonas aeruginosa n=37(9%); Acinetobacter baumannii n=31(8%), Enterococcus spp
n=7(2%)
Among the strains of the family Enterobacteriaceae ESBL mechanism there was a high
resistance to antibiotics.
Among S. aureus strains with resistance to methicillin (MRSA) was total resistance to
ciprofloxacin and clindamycin
Conclusions
Enterobacteriaceae and Staphylococcus aureus are the most common cause of nosocomial
infections in Department of Pneumonology Military Institute of Medicine.
The alarm pathogens (MRSA, ESBL+) comprise low percentage of all pathogens
Key words:
nosocomial infection, alarm pathogens, antibiotic resistance
127
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Panin A.L., Belov A.B.
ARCTIC ECOLOGY AND FEATURES DISEASE CONTROL
TROOPS (NAVY) RUSSIAN FEDERATION (RF) IN THE HIGH
LATITUDES
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
Climatic and environmental conditions in the Arctic negatively affect the health of
military personnel, as well as complicate the organization of sanitary-epidemiological
(preventive) measures in the areas of deployment of military contingents. Unstable weather
to sudden changes in atmospheric pressure, the prevalence of high winds, the long period of
low temperature, the negative balance of the annual solar radiation, significant fluctuations of
atmospheric oxygen, the monotony of the landscape, long periods of polar night (midnight
sun), magnetic storms negative effect on the health of people and contribute to health
problems. Their influence is weakening immunity and nonspecific resistance hinders the
military and the challenges they face.
Prospects deteriorating health situation on the planet associated with signs of global
warming, which develops at the poles three times faster than in other regions. As a result of
reduced permafrost territory, which leads to the expansion of the habitat of various kinds of
infections and rodent sources prokormiteley arthropods constituting reservoirs of pathogens
and zoonotic diseases sapronotic. Infecting the people living in the northern territories or
mastering these regions, creating more than 200 points burial animals that died in the past
from the most dangerous infections (even without the traditional and local anthroponoses
parasitosis).
Hydrological and geological features of soils contribute to a natural constant and
independent of people circulating in the biosphere (including among plants and prokaryotes)
psychrophilic microorganisms. Therefore, in organized groups in situations of Arctic, possible
outbreaks of infectious diseases caused by pathogenic as obligate and opportunistic
pathogens, including facultative parasites of humans and animals that have been circulating
in the Arctic zone of the Russian Federation. Have an impact on increasing the risk of
infection in humans and especially social conditions polar regions relatively low level of
health culture of the population (especially Aboriginal); unsatisfactory cleaning areas from
human excreta; clutter settlements and water, the availability of food items for rodents,
water, food and clothing stores, housing, inadequate provision of safe drinking water and the
use of open waters, ice and snow for drinking water.
Council recently approved security document "Principles of State Policy of the
Russian Federation in Artik for the period until 2020 and beyond" to initiate a new task of
logistic and medical support of troops deployed in the polar areas. They are associated with
compulsory contingents deployed in the package of preventive and anti-epidemic measures
to reduce the negative impact of climate and environmental factors on the health of the high
latitudes of the military. Of particular importance is the sanitary- epidemiological intelligence
and business areas settles sanitary- epidemiological surveillance of military morbidity
relevant to infections in these regions, and within these measures microbiological and
environmental monitoring locations of military garrisons, building towns and special facilities.
Emerging problems of the organization of medical care and military groups are
compounded by isolation of people from the "great land", the complexity of supply and
transport links and limited possibilities of health care institutions and bacteriological
laboratories of local health and medical service garrisons. Under these conditions, real life
128
organized groups outbreaks of infectious diseases caused by pathogens not only
conventional anthroponoses (dysentery and other OCI, viral hepatitis, etc.), but also
zoonoses (anthrax, tularemia, hemorrhagic fever, encephalitis, salmonella, avian influenza,
psittacosis, etc.), as well as sapronoses (yersiniosis, leptospirosis, listeriosis, klebsiellezy
etc.). Therefore, when placing troops in the polar zone is necessary in any medical institution
to provide an insulator at least two infections (intestinal and airborne) and ensure readiness
to undertake the necessary anti-epidemic measures. Medical Service is obliged to
strengthen the control of the officials mentioned measures for the prevention of infectious
diseases of personnel and compliance with the rules of personal and public hygiene, as well
as restrictive measures.
By the harsh climate of high latitudes and complicated life in severe environmental
conditions necessary to prepare personnel in advance. Education and health education
personnel is part of the medical support units and units deployed in the polar zone, and
should be aimed at familiarizing troops with specific social and climatic characteristics of the
area of their placement. On special activities and briefings should be given an idea of
meteozavisimosti people, the possible appearance of depressive states, eye excessive solar
radiation, the quality of sleep disorders during the polar night, teach techniques preventing
the consequences of these phenomena. Special danger of hypothermia and frostbite,
especially associated with the effects of the use of alcohol-containing liquids. Things have to
be adapted to the possible deployment of military sites and tailored to the way of life of small
peoples of the North living in the region. At the stage of training of personnel necessary to
strengthen measures for hardening soldiers introduction in the diet of dairy products,
including local authorized for use CSES. Personnel must take vitamins and adaptogens on
the established schemes and rules. Increased calorie meal should be done four times a day,
providing separately located units providing emergency rations and independent cooking hot
meals in inclement weather. In the barracks and dormitories should operate smoothly dryer
maintained a comfortable temperature.
Compounding the preventive work of the local health service in the North poorly
developed communications system and the lack of bacteriological laboratories in local
hospitals. So there may be difficulties with delivery of material for diagnostic and follow-up
research in the bacteriological laboratory FGUZ branches in regional centers. Because of
this comprehensive control measures are carried out with a delay, reduced their
effectiveness. Under these conditions the value of sanitary-epidemiological investigation,
microbiological monitoring of pathogens relevant to organized groups infections, medical
service interaction forces (Navy) with local branches and laboratories CSSES FGUZ in
district centers and medical institutions. In the most difficult cases, to conduct research using
the forces and means of medics, involving aircraft for transporting the samples to antiepidemic agencies.
Analysis of the literature and our own experience gained in the North together with
the specialists of Medicine and Research Institute of Hydromet expeditions to the Arctic and
Antarctic regions, suggests the relevance of the organizational effectiveness of sanitaryepidemiological (preventive) measures in medical support of troops in the Arctic zone of the
Russian Federation particularly full of sanitary-epidemiological intelligence and surveillance.
Thus, our work in conditions of the Arctic (1966-67, 1980) and participation in the activities of
Soviet (Russian) Antarctic expeditions (1982-83, 2004-05, 2010-11) Revealed some
difficulties in organizing and conducting microbiological monitoring pathogens mentioned
zoonotic infections sapronotic in organized groups. To improve the efficiency of
microbiological monitoring requires strengthening health service involved parts (connections)
bacteriologist and laboratory diagnosis by means of specific infections mentioned, other
laboratory assets that enhance the ability of bacteriological laboratories . This will accelerate
the etiological diagnosis of infectious diseases in high latitudes and implementation of antiepidemic measures in military collectives.
Key words:
129
Col. MD PhD Srđan LAZIĆ, Col. MD PhD Radovan ČEKANAC, MD
Milena KRSTIĆ, PhD Novica STAJKOVIĆ biologist., Maj. MD Jovan
MLADENOVIĆ, Maj. MD Željko JADRANIN, MD PhD Sonja
RADAKOVIĆ *, MD PhD Slavica RAĐEN PhD *, PhD Elizabeta
RISTANOVIĆ biologist. ''
Affiliation
MILITARY
MEDICAL
ACADEMY,
DEPARTMENT
OF
PREVENTIVE MEDICINE, INSTITUTE OF EPIDEMIOLOGY,
*INSTITUTE OF HYGIENE, '' INSTITUTE OF MICROBIOLOGY
E-mail
[email protected]
TITLE OF THE
AN EMERGING PATHOGEN – VEROTOXIN-PRODUCING
ABSTRACT
ESCHERICHIA COLI
Topic/session
Update in Preventive and Veterinary Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Introduction/Objective: A "new" pathogenic agent, verotoxin-producing Escherichia coli
(VTEC) emerged in the last few decades, causing an increased number of sporadic cases,
as well as outbreaks of diarrhoeal diseases, notably in industrialized countries. It is well
established that in our geographic region domestic animals, especially ruminants, are a
significant VTEC reservoir, but in spite of this, sporadic diseases in humans caused by
these agents are rare, and no outbreaks have been registered so far. Therefore it is
important to estimate how often domestic VTEC isolates belongs to subgroup known as
enterohaemorrhagic E. coli (EHEC), which are a common cause of disease in human
beings. To test the isolated VTEC strains for some phenotypic and genotypic traits, and to
determine the prevalence of EHEC.
Materials and Methods: The VTEC strains were tested for the presence of verotoxin
genes and haemolytic activity, as well as their ability of adherence to Hep-2 tissue culture
cells. We also determined serogroups of isolated strains. We classified as EHEC all VTEC
strains which belonged to characteristic serogroups (O26, O55, O111, O128 ili O157),
which displayed localized pattern of adherence and/or produced enterohaemolysin.
Results: Only 4 (0.9%) of 450 strains exhibited such features. All EHEC strains were
isolated from healthy cattle, belonged to O 157 serogroup, produced enterohaemolysin and
all of them presented verotoxin genes detected with PCR.
Conclusion: The rarity of phenotypic traits typical for EHEC among animal isolates of
VTEC may explain the apparently low incidence of human VTEC-associated disease in
Serbia.
Key words:
130
verotoxin, Escherichia coli,VTEC, EHEC,
Authors
Maj. Zdenko Cvijetic DVM spec., Capt. Bratislav Dubicanin DVM
1st Lt Aleksandar Ilic DVM, 1st Lt Danijela Ristic DVM
Army civilian employee Verica Cvijetic DVM,
Army civilian employee Sanja Jaksic vet tech
Affiliation
SAF TRAINING COMMAND LOGISTIC TRAINING CENTER DOG
GUIDES TRAINING, BREEDING AND DOGS TRAINING COMPANY
E-mail
[email protected]
TITLE OF THE
THE PREVALENCE OF CANINE FILARIASIS IN DOG GUIDES
ABSTRACT
TRAINING, BREEDING AND DOGS TRAINING COMPANY
Topic/session
Update in Preventive and Veterinary Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective
According to the reports of SAF military working dogs (MWDs) stationed on the territory
of AP Vojvodina dying with confirmed diagnosis of canine filariasis, the urgent need for
preventive health check of all MWDs in the Company appeared. The aim was to determine
the prevalence of canine dirofilariasis, as well as the percentage of certain filaria species.
Materials and Methods
In this research samples of the peripheral blood were used obtained from the MWDs
situated in the Company. It was planed to conduct diagnosis of Dirofilaria spp. antigen in
three stages for all MWDs in the Company, hence, in the first stage we took a total of 35%
MWDs, with which we conducted general clinical examination and checkup for
ectoparasites contamination. The samples of anti-coagulated whole blood and lab
treatment was conducted in the Company’s laboratory. All the samples were orderly and
unequivocally recorded and marked. For in vitro diagnostic for the detection of the heart
worm we used SNAP* 4Dx* Plus Test Kit IDEXX Laboratories, USA.
Results and Conclusion
By applying the above mentioned immunodiagnostic technique at MWDs that participated
in the study, we hadn’t detect not one case of the contamination with D. immitis. Тhe test
kit used in this study was able to give us indications for the presence of Anaplasma
phagocytophilum and A.platys antibody, Borrelia burgdoferi antibody, Ehrlichia canis
antibody and E.ewingii antibody, so we find out that all of the MWDs that were tested, were
also free from this diseases.
Key words:
dirofilariasis, D. immitis, prevalence, immunodiagnostic
131
Mohammad Ali Bayatzadeh1, 2, Reza Zilabi1, Alireza Barani1,
Abbass Barani1
1-Police University, Ahwaz Branch, Ahwaz, I.R. Iran
2-Razi Vaccine and Serum Research Institute, Ahwaz, I.R. Iran
Correspondence: [email protected]
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
A SURVEY ON HEPATITIS B AND HEPATITIS C,
ABSTRACT
AND THEIR RISK FACTORS AMONG PATIENTS
IN A POLICE MEDICAL LABORATORY
Topic/session
Preventive Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Authors
Background and objective: Hepatitis B and C virus are the major causative agents of acute
and chronic liver disease worldwide and responsible for a million deaths annually. This study has
investigated the prevalence and risk factors associated with HBV and HCV infections based on
serologic and molecular tests in Ahwaz, police medical laboratory from 2010 till 2013.
Methods: Serum samples were collected from 920 patients who were applicant for hepatitis
B and C viruses. At first, a questionnaire filled for all patients, including: age, sex, blood
transfusion history, history of surgery and vaccination and then blood samples of patients
were tested for the detection of HBsAg and anti-HCV by ELISA. The positive samples were
tested for HBV DNA (PCR) and HCV RNA (RT-PCR).
Results: 9 (0.97%) patients were HBsAg and 8 (0.86%) patients were HBV DNA positive (5
males and 3 females). 13 (1.4%) were HCVAb and 9 (0.97%) were HCV RNA positive (6
males and 3 females). The rates of both were higher in males. The mean age was 32±10
years, and most common risk factors were in order to history of blood transfusion, surgery
and dental procedure in the past decade.
Conclusion: The sero prevalence of co-infection with hepatitis B and C virus in our study
was lower than worldwide prevalence (>10%). This finding has been affected by the
screening system of police force. These findings highlight the necessity of public policies to
control hepatitis infections and emphasize the importance of hepatitis vaccination especially
in military environments.
Key words:
132
hepatitis B, hepatitis C, risk factors, ELISA, PCR, RT-PCR
Authors
Hadi Shirzad, MD, Phd Of Biotechnology.
Ali Majidi, MD, Neurosurgery Specialist.
Majid Sadeghizadeh, PhD of Molecular Genetics
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
DESIGN AND CONSTRUCTION OF BIO-LUMINESCENCE
ABSTRACT
SENSOR FOR MEASURING LEAD LEVELS IN BLOOD
AND ENVIRONMENTAL SAMPLES
Topic/session
Preventive Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Introduction and aim: Since 2007 arsenic, mercury and lead have been determined as the
most harmful heavy metals by ATSDR. From that time, monitoring and controlling of these
elements in the environment and measuring their biological toxicity has become very
important On the other hand, continuous entrance of lead as a human carcinogen to
environment through car exhausts and defence industries can threatens human health
particular those who have daily exposure due to their job. Therefore, the present study was
conducted to design and construct a bio bacterial sensor with rapid measurement ability of
lead level in in blood and environmental samples.
Methods: To achieve the aim, current investigation used the pbr operon promoter
plasmidpMOL30 and luciferase reporter gene. Pbr promoter encodes a set of genes that can
lead to bacterial resistance against lead. Luciferase gene in pGL3 vector was placed under
the control of pbr promoter and new recombinant vector resulted from pGl3/pbr-Biosensor
was entered into E.coli bacteria by transformation. Activity of biological sensor in the
presence of different concentrations of Pb (400-1 ppm) was measured and a standard
diagram was drawn. With this diagram, unknown concentrations of lead (range 1 to 100
ppm) in the blood environmental and sample can be determined.
Results: In the present study, bio-luminescence sensor for measuring lead levels of blood
and environmental samples was designed that it's most prominent features are included:
Using the classical methods such as spectrometry (ICP / MS) or (ICP / AES) in the
manufacturing process, its ability to measure the specificity and sensitivity of 1 ppm of lead
in blood and environmental samples in 12 hours, low cost for maintenance, cultivation and
bio-activity measurement and need of Luminometer with a weight about 700 grams to
measure bio-activity.
Conclusion: With the result achieved from this study, the designed sensor can be applied to
measure blood lead level of traffic and defence industry personnel to recognize vulnerable
people to diseases caused by increased blood lead and take appropriate action.
Key words:
bio-luminescence sensor, bacteria, lead, blood and environmental
samples
133
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Tadić-Pilčević J., Obrencevic K, Jovanović D., Petrović M., Ignjatović
Lj., Pilčević D.,Mijušković M
/ Military Medical Academy / Clinic of Nephrology/Belgrade, Serbia
HAEMORRHAGIC FEVER WITH PULMO-RENAL
SYNDROME - CHRONIC RENAL SEQUELAE AND
DIABETES MELLITUS DE NOVO – CASE REPORT
Topic/session
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ABSTRACT TEXT:
The Hantaviruses are known to cause hemorrhagic fever with renal syndrome (HFRS) which
is characterized by fever, hemorrhage and acute renal failure. The long-term prognosis of
HFRS has been considered favorable. There are, however, some reports about subsequent
chronic renal failure after previous Hantavirus infection.
A 31-year-old air-conditioning solder presented with abdominal pain and influenza like illness
eventually developed thrombocytopenia and haemoconcentration with renal impairment 14
days after admission. The patient required a section of haemodialysis for acute oliguric renal
failure with fluid overload. We observed favorable effect of "an early dialysis" to the course of
the disease and outcome. Hantaan virus infection with haemorrhagic fever with renal
syndrome was confirmed by serologic test- Beograd virus infection (BGD). In our patient
after ten days need for mechanical ventilation because of pulmonary Sy (Acute respiratory
distress syndrome (ARDS)) . We were treated with high dose of steroids and haemodialysis.
Chronic sequeale were chronic renal failure, diabetes mellitus, after tretman with high dose
steroids. In our patient we done renal biopsy, in first hospitalisation and three month later.
According to clinical characteristic and syndromes that follow HFRS, the most of our patients
had severe form of illnes. BGD virus infection is associated with more severe disease type
and development of chronic renal failure as a sequela of the disease. The long term follow
up of renal function in these patients is recomended.
Key words:
134
Haemorrhagic fever with renal syndrome, chronic sequeale
2nd Lt. Monika Konior1, Maj. Grażyna Goryszewska PhD2,
Col. Krzysztof Korzeniewski MD PhD1
1
Affiliation
Military Institute of Medicine, Department of Epidemiology
and Tropical Medicine, Warsaw, POLAND
2 nd
2 Military Field Hospital, Wrocław, POLAND
E-mail
[email protected]
TITLE OF THE
LABORATORY DIAGNOSTICS IN THE POLISH MILITARY
ABSTRACT
CONTINGENT IN AFGHANISTAN
Topic/session
Update in Preventive Medicine (Diagnostics)
Presentation suggestion
PUBLICATION
ORAL
(underline)
Authors
ABSTRACT TEXT:
The article presents tasks and structure of a diagnostic laboratory functioning in the Polish
Military Contingent in Afghanistan at the Medical Support Group (Field Hospital, Role 2) in
Forward Operating Base Ghazni (ISAF, East Region). The authors briefly describe the types
of analytical, serological, parasitological and microbiological (including clinical and
environmental) tests performed by a team of diagnosticians consisting of three people. The
laboratory personnel of the Polish Military Contingent need to handle a wide range of
different tasks. The requirement to undertake such a variety of tasks is unusual for other
NATO countries. The solutions adopted by the United States and European Armed Forces
has demonstrated that laboratory diagnostics performed in operational conditions ought to
be divided into two different areas, the clinical one aimed at supporting the diagnostic and
therapeutic process, and the environmental one performed by preventive medicine
personnel as a part of sanitary-hygienic support.
Key words:
laboratory diagnostics, Polish Military Contingent, Afghanistan
135
Authors
Affiliation
Col. Krzysztof Korzeniewski MD PhD
Military Institute of Medicine, Department of Epidemiology and
Tropical Medicine, POLAND
E-mail
[email protected]
TITLE OF THE
SEXUALLY TRANSMITTED DISEASES
ABSTRACT
IN THE MILITARY ENVIRONMENT – PAST AND PRESENT
Topic/session
Update in Infectious Diseases
Presentation suggestion
PUBLICATION
ORAL
(underline)
ABSTRACT TEXT:
The article presents the prevalence of sexually transmitted diseases (STD’s) in the military
environment, which have been a threat to soldiers throughout history. STD’s are responsible
for considerable morbidity, if left untreated, lead to pelvic inflammatory disease, ectopic
pregnancy, chronic pain and infertility among women, and epididymitis, prostatitis, infertility
in men. STD’s do not pose a serious epidemiological risk among army personnel, under the
condition of regular clinical and laboratory supervision of the soldiers’ health status. The risk
of acquiring an infection increases drastically in cases of unprotected casual, sexual
intercourse. In recent years the hazard of developing of venereal diseases in the military
environment has increased due to the fact that military service has ceased to be an all-male
profession, and women account for a substantial part of the armed forces. This led to
a conclusion that preventive medicine tasked with controlling STD’s in the military
environment can no longer focus only on transmission of STD’s among female sex workers
and men soldiers, but it should also concentrate on transmission among soldiers of both
sexes assigned to military duty in the same time and place. The incidence of venereal
diseases diagnosed among soldiers serving in their home countries are comparable to those
observed in the local civilian population. However, the situation may change drastically if
troops are deployed to an area of operations overseas. The prevalence of venereal diseases
in combat troops is then strictly connected with ongoing military activities in the theater
operations.
Key words:
136
sexually transmitted diseases, soldiers, epidemiology
Authors
S. Zhogolev, P. Ogarkov, K. Zhogolev
Affiliation
E-mail
TITLE OF THE
EPIDEMIOLOGY AND PROPHYLAXIS OF PNEUMONIA
ABSTRACT
AND ACUTE RESPIRATORY DISEASES IN THE TROOPS
Topic/session
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ORAL
POSTER
(underline)
ABSTRACT TEXT:
Acute respiratory diseases (ARD) including ARIs, acute bronchitis, communityacquired pneumonia and acute tonsillitis are now one of the most pressing issues for military
medicine in connection with a high incidence among conscripts. The percentage of ARD
among all diseases was 46.6% in 2012 and 41.5% in 2013. The percentage of pneumonia in
the structure of ARD increased from 8.5% to 10%.
ARD occur primarily in young recruits during the first 3 months of service. The annual
evolution of the incidence of all the ARD nosological forms demonstrates a synchronism and
2 peaks: a little one in the summertime and a great one - in winter, in relation with periods of
reinforcement admission.
Our investigations have shown that the major risk factors for pneumonia in the armed
forces are factors that activate the mechanism of transmission of pathogens. This is the
"mixing" of personnel while reinforcement admission and crowded conditions of
accommodation, as well as factors that contribute to decreasing body resistance: a low
temperature in the barracks in autumn and winter periods, excessive cooling in the open air,
increase in ARI incidence, stress, fatigue, particularly frequent in the period of adaptation to
military service, lack of food.
An important factor in the development of pneumonia is lowered body resistance.
Frequent ARIs are indirect signs of immune deficiency. It was found that 57.8 % of recruits
suffered from frequent ARIs before conscription: 3 or more times a year. In the 70ties the
proportion of recruits with frequently occurred diseases did not exceed 30 %. This fact
indicates a decreased immunity of our conscripts.
As in previous years, under current conditions pneumococci are a leading role in the
occurrence of pneumonia. They were found in 40% patients. However, in the 90s, when
pneumococcal vaccine were not used, pneumococci were found more frequently - in 50-70%
of patients with pneumonia. But at present streptococci group A and staphylococci became
more frequent finding in patients with pneumonia. In addition, Mycoplasma, Chlamydophila
and respiratory viruses, particularly adenoviruses were frequently found. In ARIs and acute
bronchitis a range of identified pathogens was the same, but the frequency of their detection
was different. If pathogens of bacterial nature were predominant in pneumonia, then agents
of viral, especially adenoviral nature were predominant in ARIs. It should be noted that in 40
to 50 % of the cases there were identified mixed infections, mostly viral-bacterial ones.
On the basis of the identified epidemiological features of pneumonia, the complex of
measures to be carried out by joint efforts of command, logistics services, commanders of
the units and personnel, along with the medical service are proposed to take for its
prevention.
Early detection of diseased persons in the units, their timely isolation and
hospitalization are the measures in regard to the source of infection. All military personnel
undergoes x-ray examination twice a year. When unfavorable sanitary and epidemiological
state of the unit is detected observation is conducted which include increased medical
surveillance of contract personnel and conscripts with daily thermometry, the prohibition of
public meetings and entertainment events, organization of individual meals for the most
respiratory infections affected units. To identify the subclinical forms of pneumonia the
unscheduled x-ray examination is carried out.
137
The following measures should be undertaken to break the mechanism of
transmission of pathogens: the military personnel, particularly young recruits, should be
accommodated in the least crowded conditions, the volume of air per person in a sleeping
room should be more than 12 m³. Dormitories and classrooms should be periodically aired
as well as wet cleaning and disinfection. In the over-heaped accommodation it is appropriate
to apply UV air sterilizers of closed type. The studies have shown that after the installation of
air sterilizers in sleeping rooms of one of the unit the microbial contamination of air in it has
become 6-16 times lower, while the overall incidence of acute respiratory diseases for 5
months - 2.7 times lower than in the same sleeping room without air sterilizers.
Measures aimed at the susceptibility of the organism, should be considered as
having a particular importance. It is possible to divide these measures to measures of
medical and non-medical character.
Non medical measures are taken by command and rear service corps and include
prevention of excessive cooling, maintaining the required temperature in the dormitories,
prevention of crowded conditions of accommodation, improvement of working and living
conditions of servicemen, normalization of nutritional status.
Medical measures meant to the susceptibility of the organism consist in increasing
resistance of the organism by means of specific and non specific prevention: vaccines and
immunotropic products.
Given the leading role of pneumococci in the etiology of pneumonia, pneumococcal
vaccine should be considered as the main specific mean of prevention. At present time
Pneumo 23 is used and in future 13-valent vaccine Prevenar is going to be used.
During the period of continuous vaccination by polysaccharide pneumococcal
vaccine Pneumo 23 of the November reinforcement of training units (2004-2008), the
average rate of decrease in pneumonia incidence in the Land Forces was 11.2% and in
whole Armed Forces - 10.3% a year. For six years after the vaccination beginning (from
2002 to 2008), the incidence of pneumonia decreased significantly in all military districts. In
general, the incidence in the Land Forces decreased by 39.2%, and in the Armed Forces by 37.8%.
Thus, the polysaccharide 23-valent pneumococcal vaccine is an effective mean of
pneumonia prevention in armed forces. It needs to be widely used in new conscripts. Its
effectiveness is 66.7 %. Among vaccinated subjects, the average incidence was three times
lower than in the unvaccinated. Joint use of pneumococcal and influenza vaccines was
especially effective.
However, to achieve a more significant effect of the vaccine, a full coverage of young
conscripts (and not only autumn, but spring reinforcement also) in the first 1-2 days after
arrival is indispensable. It would be even better to give the vaccination at recruit reception
centers.
Nevertheless, the problem of pneumonia in the armed forces can not be solved by
only use of a Pneumo 23 vaccine because of polyetiological character of pneumonia and the
important role of organizational and sanitary measures in their appearance.
Violations of the Regulations requirements for the accomodation could exacerbate
the epidemic situation with ARDs, that happened in 2009 when an incidence of all the ARDs
increased in all the army branches and military districts.
The fact that during the transition to a shorter service duration from two years to one
year, the number of recruits increased by 2 to 3 times. Each new recruitment resulted in
renewal of the units not by 25% (as it was at two-year service), but by 50%, that resulted in a
significant increase in the effect of the "mixing" factor because of the greater density of the
accomodation.
Given the polyetiological character of pneumonia and other ARD, the lack of specific
means of prevention against the majority of them (with the exception of pneumococcal and
influenza vaccines), and the important role of the decreased resistance in ARD
development, it is worthwhile to use non-specific preventive means: antiviral drugs,
immunotropic products and probiotics, in addition to the vaccination or without it (in the
absence of vaccines).
138
For several years the Department of General and Military Epidemiology of the Military
Medical Academy studied the effectiveness of such products. The incidence of ARD in
groups where non-specific means of prevention were used together with Pneumo 23
vaccination was significantly lower than in groups in which the only vaccine Pneumo 23 have
used.
All the tested products were effective in varying degrees, especially in the first month
following the 4 to 10 days administration. Imudon showed the greatest efficiency. A
promising drug is a probiotic Vitaflor. The use of antiviral agents: Cytovir, Cycloferon,
Kagocel and Arbidol showed to be expedient.
Thus, the prevention of pneumonia and other ARD in military units is based on
organizational and hygienic measures: improving accommodation conditions, prevention of
excessive cooling, as well as active detection and treatment in hospital of patients with ARI,
vaccination with pneumococcal and influenza vaccines for conscripts of not only November,
but also of the May reinforcement in the first days after arrival, combined to other nonspecific means of prevention, such as Imudon, Kagocel, Arbidol and others.
Key words:
139
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
N. Lvov, E. Peredelsky, I. Grishin, O. Maltsev, K. Zhdanov
FREQUENCY OF ISOLATION OF ADENOVIRUS IN YOUNG
PEOPLE FROM ORGANIZED GROUPS AND THE CLINICAL
SIGNIFICANCE
OF RELEVANT SEROTYPES
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
During the epidemic season of 2012-2013 part of adenoviral diseases in the overall structure
of acute respiratory infections in young people from organized groups made up 51.0%.
According to our long-term (1997-2013) observations of adenoviral disease, in 17.5% cases
it was complicated by development of viral or viral-bacterial pneumonia.
The etiological structure of adenovirus disease in young people from organized groups was
investigated and the clinical features of acute respiratory infections caused by different
serotypes of adenovirus was identified.
We examined 382 patients with adenovirus disease. Shedding from nasopharyngeal swabs
were carried out on cell cultures of Vero, HeLa, Hep-2. Serotyping was performed in virus
neutralization with monoclonal rabbit sera. Calculated the average (M), standard deviation
(SD) and frequency of occurrence (%) of clinical signs (respiratory and non-respiratory
syndromes, of pneumonia, protracted and recurrent course). Significance of the difference
(p<0.05) average frequency of cases compared to independent groups was evaluated by
Student t-test and criterion φ2 (phi - square) Fischer, respectively.
199 adenovirus strains (52.1 %) was allocated. 183 strains was serotyped: 64 (32.2 %) - 3
serotype, 42 (21.1%) – 4 serotype, 38 (19.1 %) – 7 serotype, 15 (7.5 %) – 5 serotype, 11
(5.5%) – 21 serotype, 8 (4.0%) – 1 serotype, 3 (1.5%) – 2 serotype, 2 (1.0%) – 6 serotype. In
assessing the features of the clinical course of adenoviral diseases caused actual serotypes
(3, 4, 7) adenoviruses revealed that in diseases caused by serotype 7 was significantly
longer remained febrile fever (4.3+2.74 days, p<0.05), rhinitis (9.4+6.01 days, p<0.05),
pharyngitis (7.9+2.87 days, p<0.05), laryngitis (7.3+2.87 days, p<0.05) and bronchitis
(11.8+8.03 days, p<0.05), significantly more frequently observed tonsillitis (63.0%, φ2=12,6,
p<0.05), lymphadenopathy (63.0%, φ2 =5.3, p<0.05) and pneumonia (34.2%, φ2=3.84,
p<0.05).
The study showed that the adenoviruses of 3, 4 and 7 serotype have the greatest
epidemiological significance. Clinical features of adenoviral diseases caused by 7 serotype
are: more frequent registration of non-respiratory syndromes and the development of
pneumonia.
Key words:
140
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
S. Svistunov, I. Medvedev, A. Kuzin, D. Zharkov
MICROBIOLOGICAL MONITORING IN
SANITARY-EPIDEMIOLOGICAL DISEASE SURVEILLANCE,
ASSOCIATED WITH THE PROVISION OF HEALTH CARE
Topic/session
Presentation suggestion
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ORAL
POSTER
ABSTRACT TEXT:
In the modern terms one of actual problems of medicine is a traumatism, the major
socially-meaningful indexes of that are mortality and disability of population, lethality and
days away from work. According to the WHO, up to 2 million person perishes from a trauma
in a year. In Russia under age 35 for women and 45 to for men traumatic damages are main
reason of death. A main place in this statistics occupies not isolated, but, constituent of 6070 percent of all traumas. The greatest relative density in this statistics is borrowed not
isolated, and concomitant injury making 60-70 % of all traumas. High frequency of failures of
treatment of victims, especially with heavy traumas, is connected with progress at them
infectious complications. High frequency of failures of treatment of victims, especially with
heavy traumas, is connected with progress at them infectious complications. Progress of
infectious complications at patients with a heavy trauma raises risk of a lethal outcome
almost in 6 times. Infectious complications of heavy traumas prevail in a clinical picture after
3 day after the moment of delivery of the victim and are a principal cause of lethal outcomes
in the recent period of a polytrauma. From the general death-roll from complex and plural
traumas of 20 % die of the heavy damages, become complicated an infection.
One of the important directions of diagnostics, preventive maintenance and treatment
of infectious complications at victims with heavy traumas is carrying out of the
microbiological researches allowing not only to correct antibacterial therapy, but also in
scales of a hospital to reveal prevalence of activators. Research has shown, that from 142
surveyed victims with a heavy trauma at 90 % have been revealed bacteriologic the
confirmed infectious complications, basic which clinical displays were infections of area of
surgical intervention, an infection of respiratory ways, infections urinoexcretory ways and an
infection of a blood-groove. In the general structure of infectious complications prevailed
visceral forms among which there were infections urinoexcretory ways-50,7 % and infections
of respiratory ways – 44,4 %. Local forms of infectious complications were defined in the
form of an infection in the field of surgical intervention in 26,8 % of cases, bacteriaemia – in
12,7 %. Thus at 43,4 % of victims with heavy traumas the isolated complications of one
localization have been revealed, at 56,6 % of patients developed associated complications
of several areas. It has been established, that infectious complications at victims with heavy
traumas start to develop in early timeframes. So, local forms of infectious complications
started to develop from fourth day. Infections of respiratory ways developed for the third day
of hospitalization in the form of purulent tracheobronchitis, and from the fifth – in a
combination to a pneumonia. Infections urinoexcretory ways were diagnosed from fifth day,
backteremia it was marked, since 6 day and reaching the maximal frequency of revealing for
9-12 day. Thus duration of infectious complications depend on their type. Duration of
infectious complications depend on their type. Longer timeframes of current of infectious
complications were characteristic for generalizable (backteremia – 15,4±1,0) and
viscerogenic forms (a pneumonia – 12,7±0,7; tracheobronchitis – 11,9±0,6). At occurrence
of infectious complications at victims with heavy traumas (n=129), duration of their
hospitalization (45,2±3,8 days) increased in 2 times in comparison with timeframes (24,8±4,3
days) treatments of patients without infectious complications (n=13) (р <0,05).
Thus, results prospective the supervision lead in a special-purpose surgical hospital
141
on treatment of heavy wounds and traumas, have allowed to establish, that in structure of
complications at victims with heavy traumas infections respiratory and urinoexcretory ways
prevail local and в viscerogenic forms ofinfectious complications to which infections of area
of surgical intervention concern. Thus, results prospective the supervision lead in a specialpurpose surgical hospital on treatment of heavy wounds and traumas, have allowed to
establish, that in structure of complications at victims with heavy traumas infections
respiratory and urinoexcretory ways prevail local and viscerogenic forms of infectious
complications to which infections of area of surgical intervention concern. Frequency of
revealing of infectious complications is characterized by its increase at combine character of
progress that predetermines an indispensability of duly revealing of the possible additional
centers of generalization of an infection with carrying out of a complex treatment-andprophylactic and antiepidemic actions. In this connection victims with heavy traumas should
join in the microbiological monitoring allowing actively to reveal first signs of progress of
infectious complications, to estimate etiological structure of activators and to appoint
necessary antibacterial preparations that will make in a timely manner possible updating of
treatment-and-prophylactic actions and to predict dynamics of frequency of progress of
infectious complications different etiology in interests of improvement of quality and
efficiency of epidemiological supervision of the hospital infections connected with rendering
of medical aid.
Key words:
142
Authors
Volynkov I.
Affiliation
E-mail
TITLE OF THE
MODERN PROBLEMS OF SANITARY-AND-EPIDEMIOLOGICAL
ABSTRACT
SURVEILLANCE AND PATIENT PROPHYLAXIS AND THERAPY
Topic/session
Presentation suggestion
(underline)
At the present stage the epidemiological surveillance in Russian Federation Armed Forces
represents the information system for providing medical service with data necessary to
implement measures on prophylaxis and decrease of disease incidence among the
servicemen and civil personnel. Abroad it is called public health surveillance. As information
system the epidemiological surveillance serves to be the basis for development of strategy,
tactics, rational planning, realization, correction and improvement of sanitary-andantiepidemic service activity in the struggle with infectious diseases and their prophylaxis.
The main principles of epidemiological surveillance (collection, analysis, interpretation and
spread of information about serviceman health state) can be referred to noninfectious
diseases.
To solve the wide spectrum of questions devoted to the problems of sanitary-andepidemiological surveillance and prophylaxis of infection the following measures are
necessary:
- To activate the work on creation of highly technological base for prevention, early
detection, emergency response and liquidation of extreme situations in the area of
population sanitary-and-epidemiological safety (execution of summits' decisions (Russia,
2006, Germany, 2007, Japan, 2008));
- To ensure the sanitary-and-epidemiological safety of population by improvement of
epidemiological-and-epizootological surveillance, microbiological and molecular-andgenetic monitoring of extremely dangerous and natural focal infectious diseases basing
on cooperation of sanitary-and-epidemiological surveillance institutions (Russian
Federation Defense Ministry, Russian Federation Ministry of Internal Affairs, Russian
Federation Federal Security Service, Federal Service on Customers' Rights Protection
and Human Well-being Surveillance (Rospotrebnadzor), Public Health and
Rosselkhoznadzor (Federal Service for Veterinary and Phytosanitary Surveillance));
- To co-ordinate and plan scientific investigations and introduction of research work results
into medical service practice in terms of federal and departmental special-purpose
programs;
- To develop and realize the paramount directions of scientific investigations on the
problems of territory sanitary protection, epidemiology, epizootology, microbiology,
diagnosis, pathogenesis, genetics, immunology, specific and unspecific prophylaxis of
dangerous, natural-and-focal bacterial infections having bacterial and viral etiology, as
well as biological safety and biological terrorism;
- To improve the information support of scientific investigations with implication of modern
informative technologies and to provide the information exchange with Rospotrebnadzor
practical institutions including those of disinfection profile;
- To contribute to realization of personnel policy involving the graduators from higher
schools, to improve their qualification and training of high qualification specialists;
- To improve international scientific co-operation of CIS countries (Commonwealth of
Independent States) and fare-off foreign countries.
Key words:
143
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
N. Lvov, E. Peredelsky, I. Grishin, O. Maltsev, K. Zhdanov
FREQUENCY OF ISOLATION OF ADENOVIRUS IN YOUNG
PEOPLE FROM ORGANIZED GROUPS AND THE CLINICAL
SIGNIFICANCE OF RELEVANT SEROTYPES
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
During the epidemic season of 2012-2013 part of adenoviral diseases in the overall
structure of acute respiratory infections in young people from organized groups made up
51.0%. According to our long-term (1997-2013) observations of adenoviral disease, in 17.5%
cases it was complicated by development of viral or viral-bacterial pneumonia.
The etiological structure of adenovirus disease in young people from organized
groups was investigated and the clinical features of acute respiratory infections caused by
different serotypes of adenovirus was identified.
We examined 382 patients with adenovirus disease. Shedding from nasopharyngeal
swabs were carried out on cell cultures of Vero, HeLa, Hep-2. Serotyping was performed in
virus neutralization with monoclonal rabbit sera. Calculated the average (M), standard
deviation (SD) and frequency of occurrence (%) of clinical signs (respiratory and nonrespiratory syndromes, of pneumonia, protracted and recurrent course). Significance of the
difference (p<0.05) average frequency of cases compared to independent groups was
evaluated by Student t-test and criterion φ2 (phi - square) Fischer, respectively.
199 adenovirus strains (52.1 %) was allocated. 183 strains was serotyped: 64 (32.2
%) - 3 serotype, 42 (21.1%) – 4 serotype, 38 (19.1 %) – 7 serotype, 15 (7.5 %) – 5 serotype,
11 (5.5%) – 21 serotype, 8 (4.0%) – 1 serotype, 3 (1.5%) – 2 serotype, 2 (1.0%) – 6
serotype. In assessing the features of the clinical course of adenoviral diseases caused
actual serotypes (3, 4, 7) adenoviruses revealed that in diseases caused by serotype 7 was
significantly longer remained febrile fever (4.3+2.74 days, p<0.05), rhinitis (9.4+6.01 days,
p<0.05), pharyngitis (7.9+2.87 days, p<0.05), laryngitis (7.3+2.87 days, p<0.05) and
bronchitis (11.8+8.03 days, p<0.05), significantly more frequently observed tonsillitis (63.0%,
φ2=12,6, p<0.05), lymphadenopathy (63.0%, φ2 =5.3, p<0.05) and pneumonia (34.2%,
φ2=3.84, p<0.05).
The study showed that the adenoviruses of 3, 4 and 7 serotype have the greatest
epidemiological significance. Clinical features of adenoviral diseases caused by 7 serotype
are: more frequent registration of non-respiratory syndromes and the development of
pneumonia.
Key words:
144
Authors
MS Sonja ATANASIEVSKA, mol.biologist, Prof.Dr Elizabeta
RISTANOVIC, PhD, MS Vesna PROTIC-DJOKIC, DVM, MS Milica
TRESNJIC, mol.biologist, Dr Dusan VUCETIC, PhD, Prof.Dr Bela
BALINT, PhD
Affiliation
Military Medical Academy, Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
SEROPREVALENCE OF SYPHILIS IN THE POPULATION
ABSTRACT
OF HEALTHY BLOOD DONORS (BD) IN SERBIA
Topic/session
Update in Preventive and Veterinary Medicine
(update in Infectious Disease, Food and Water Control)
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/Objective. Syphilis is an infectious, chronic disease caused by spirochete
Treponema pallidum. Lately, there is an increase in the syphilis incidences in the world. This
disease often appears in association whit other sexual transmitted disease. Checking of
syphilis among healthy population and risk groups is a necessary step in the strategy of
disease prevention. The purpose of this paper was to examine the frequence and trend of
syphilis infection in the blood donor population and seroprevalence of the disease in Serbia.
Methods. The sample of 49.027 donors, collected from 2009-2011, have been examined at
the Institute of Transfusiology, Military Medical Academy, Belgrade, Serbia. All samples
were initially tested using ELISA test, and every potentially positive sample (81) was
examined at the Department of Microbs Genetics and Immunology according to the following
protocol: VDRL, TPHA and Western blot test.
Results. In VDRL test we obtained 21 positive samples (25,93%), while there were 27
positive samples (33,33%) gained by TPHA method. Using Western blot test the following
resluts were attained: 30 samples were IgM positive (37,03%) and 54 (66,67%) were IgG
positive. It is determined that seroprevalence of syphilis in healthy BD population is 0,13%.
The highest percentage of infection is shown among age range 21-30.
Conclusion. Use of high sensitive screening tests can provide the reduction of T.pallidum
infection through blood transfusion. Obtained results of syphilis seroprevalence (0,13%) in
our BD population indicate requirement for continuous monitoring and improvement of
measures for detection, curing, and above all, prevention of this disease.
Key words:
syphilis, blood donors, seroprevalence
145
Authors
captain, veterinarian, Srdjan Milentijević
Affiliation
Garda VS, Belgrade, Serbia
E-mail
[email protected]
TITLE OF THE
The intestinal bacteria - chance to improve its diversity
ABSTRACT
Topic/session
Update in Preventive and Veterinary Medicine
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT: An international collaboration of researches, has for the first time
analyzed the gut microbiotia of a modern hunter gatherer community, the Hadza of
Tanzania.
The results show that Hadza have a more diverse microbe ecosystem compared
with representative of „westernized“ population. This is extremely relevant for human
health, because several diseases in industrial countries like IBS, colorectal cancer,
obesity, tipe II diabetes, Crohn's disease and others are significantlu associated with
a reduction in gut microbial diversity. Genetic diversity of bacteria is likely the most
important criterion for the health and stability of the gut microbiome.
Conclusion: Changing the way of nutrition, using similar foods as our ancestors did,
may be the path which people in industrial countries can increase diversity of
intestinal bacteria.
Introduction The intestinal bacteria of present-day hunter-gatherers has for the first
time been deciphered by an international team of researches. Studies of the Hadza
offer an especially rare opportunity for scientists to learn how humans survive by
hunting and gathering, in the same environment and using similar foods as our
ancestors did.
Objective This study may be the way of prevention of some diseases in industrial
countries, by increasing diversity of intestinal bacteria.
Materials Маx-Plank-Gessellschaft „Lifestyle determines gut miscobes: Study with
modern hunter-gatherers tells tale of bacteria co-evolution.“
Methods Hypothesis
Results The study shows how gut microbiota may have helped our ancestors adapt
and survive during the Paleolithic.
Conclusion Changing the way of nutrition, using similar foods as our ancestors did,
may be the path which people in industrial countries can increase diversity of
intestinal bacteria.
Key words:
146
The intestinal bacteria
147
Authors
Maj (Pharmacist) Dr. Florian Plößl, Col (Pharmacist) Dr. Thomas
Zimmermann, Col (Pharmacist) Dr. Bernd Klaubert
Affiliation
Central Institute of the Bundeswehr Medical Service Munich,
Department of Pharmacy, Ingolstädter - Landstraße 102, 85748
Garching-Hochbrück, Germany
E-mail
[email protected]
TITLE OF THE
QUALITY CONTROL OF STOCKPILED MEDICINES
ABSTRACT
IN THE GERMAN ARMED FORCES
Topic/session
Round Table:
Update in Military Medical Management and Supply
Presentation suggestion
ORAL
POSTER
(underline)
The general surgeon of the German Armed Forces (GAF) and with him addressed the
Pharmacy Corps is assigned with full supply of soldiers with an adequate amount of
medicines like antidotes, narcotics, analgesics or special chemotherapeutics. Even after the
cold war, long term stockpiling enables an independent storage, planning and management
with these medicines, which are not available in sufficient amount, quality and only with a
stiff price on open market, respectively. The Pharmacy Corps of the GAF obtains these
important medicines in high lot sizes and manages the shelf life on different ways: Several
products, like morphine auto injectors usually consumed within their regular shelf life time.
On the other hand several medicines without an imprinted date of expiry, like antidotes are
stocked for mass casualties and CBRN threats. Due to legislative regulations in Germany,
notably these medicines could be handled without an imprinted date of expiry until the
pharmaceutical quality, effectiveness and safety of the products prohibits an application.
Therefore the individual shelf life time has to be determined lot by lot in context with scientific
and pharmaceutical standards for all of the military important pharmaceutical and medicinal
products. Under care of pharmacists, these scientific studies take place at the Central
Institute of the Bundeswehr Medical Service Munich, an associated member of the Official
Medicines Control Laboratories in Europe (OMCL). Parameters as sterility of solutions for
parental application, content and purity of active pharmaceutical ingredients, mechanical
performance of auto injectors like ejection time and volume, needle draw and length are
basis for detailed analytical reviews, which are the scientific basis for legislative release as
well as toxicological assessment of the stockpiled medicines within the GAF. The
widespread analytical techniques and comprehensive experience is a unique feature of the
Department of Pharmacy, which is important for quality control of stockpiled medicines in the
GAF and in addition a connecting factor for other nations within the “pooling and sharing”
concept.
Key words:
148
stockpiled medicines, quality control
Authors
Col. Assist Prof. Miljojko JANOSEVIC, Col. Prof. Branko Tesanovic
Affiliation
University of Defence, Military Academy, Belgrade, Serbia
E-mail
TITLE OF THE
SUPPLY CHAIN MANAGEMENT IN FOOD DISTRIBUTION
ABSTRACT
Topic/session
Military Medical Management and Supply
Presentation suggestion
ORAL
POSTER
(underline)
ABSTRACT TEXT:
This case study includes material tracing and information processes within the flows of raw
materials, semifinished and ready-made food products in human nutrition. This study put a
special accent on information processes and serves as the basis for decision making which
can have positive effects and contribute to the successful control of food processing and
distribution costs. In order to establish an integral (logistic) system for supervising supply
transportation, storage, processing and distribution chains, we have defined logistic
modalities to provide the most optimal solution to the nutrition issue within the Armed Forces
facilities. The model was tested on the example of Military Medical Academy in Belgrade. By
applying this mathematical model as an instrument for logistics management, we have
identified optimal solution for organizing food processing and distribution and defining
nutritional structure for optimal cost-effective annual, quarter and monthly nutrition plans.
Application of the model ensures a continuous economic and effective management of food
processing, storage, and distribution chains as well as professional development and
management the whole food supply chain system and logistic.
Key words:
Logistics, process, model
149
Authors
K. Zhdanov, D. Gusev, K. Kozlov, D. Shakhmanov,
S. Zhabrov, V. Sukachev, I. Gabdrakhmanov
Affiliation
E-mail
TITLE OF THE
ORGANIZATION OF SPECIALIZED CARE RUSSIAN MILITARY
ABSTRACT
PERSONNEL PATIENTS WITH CHRONIC VIRAL HEPATITIS
Topic/session
Presentation suggestion
(underline)
ABSTRACT TEXT:
Creation in March 2010 at the clinic of infectious diseases of the Military Medical
Academy freelance treatment center for chronic viral hepatitis Russian Ministry of Defense
(MoD RF) was a prerequisite for new solutions in the organization of medical care to
servicemen MoD RF, patients with chronic viral hepatitis (CVH). Based on the registration
cards CVH patients sent to the address of the main specialist on infectious disease MoD RF
from military districts (fleets ) was compiled register of patients, allowing to keep records of
patients requiring initial examination, antiviral therapy (AVT) as well as under medical followup. Practical activities showed that the number of beds and personnel resource clinic of
infectious diseases allows patients planned hospitalization for primary survey and decide on
the need for appointing AVT based 20-25 people per month. In this planned hospitalization
distributed by week calendar month. Hospitalization of patients for primary survey carried out
by direct calls to sick soldiers established procedures. Had the greatest relevance for
planning hospitalization landmark control AVT efficacy and safety, which was due to the time
frames determined by the number of antivirals issued by the patient at each stage of
treatment monitoring . In this regard, it was decided to supply each patient at discharge from
the hospital for routine follow-coupon hospitalization, indicating the exact date. This measure
allowed to rationalize the use of bed capacity clinic of infectious diseases and to avoid a
large number of one-time income patients with CVH .
As of January 2014 in the Armed Forces servicemen registered 1149 with CVH.
Completed AVT - 268 people. Get AVT - 212. Total secured AVT from 2010 to December
2013 - 480 ( 41.7 %). In the structure of morbidity CVH prevails chronic hepatitis C (66.4 %).
Key words:
150
U. Miroshnichenko, A. Merkulov, V. Kononov, A. Goryachev,
A. Tikhonov, I. Klochkova
TITLE OF THE
THE DEVELOPMENT OF NAVY SHIPS AND FLEETS MEDICAL
ABSTRACT
EQUIPMENT ALLOWANCE LIST SYSTEM
Presentation suggestion
(underline)
ABSTRACT TEXT:
One of the Russian national security guarantors in the shore areas traditionally is the
Navy. of Ships and fleets under construction are equipped with modern samples of weapons
and medical equipment. At this time there is a question about the absence of system that is
adequate to the Navy medicine needs. To address this issue is the development of a
modern system of Navy ships and fleets allowance list.
The proposed ships and fleets medical equipment allowance list system has
significant differences in qualitative characteristics of the system, which is currently:
- the number of allowance list is optimized and corresponds to the new combat
composition of the forces of the Navy;
- the medical equipment nomenclature is optimized that facilitates planning of
medical support ships and fleets of the Navy in the conditions of daily activities and
the execution of combat and combat training tasks;
- the nomenclature of medicines and medical equipment is harmonized with new
Russian Federation Ministry of Defense legal documents.
One of the features of the new allowance list system is the equipment of main and
emergency health care posts of Navy ships with modern sets of medical equipment, allowing
to place the equipment with regard to save space, ensure the survivability and rapid medical
units deployment for medical assistance the wounded and sick.
The initial procurement of medical equipment of ships under construction, as well as
the ships that passed a deep modernization, is planned to be implemented by the
enterprises of the shipbuilding industry. Replacement of existing medical apparatus and
devices for modern standards, in accordance with the proposed Allowance list, will be
implemented as of failure and write-off of medical equipment. Subsequent replenishment of
medical equipment is planned to carry out through pharmaceutical organizations and
business units of the Ministry of Defense.
In the new system the rescue ships allowance list is provided for medical support of
diving slopes. Proceeding from the specifics of the work of the rescuers, the norms take into
account the salaried special physician, basic equipment which is naval special assistance
set.
Revised the approach to the formation of the hospital ship equipment allowance list.
Drill norms supply allows to optimize the supply of functional divisions of the acting hospital
ships, proceeding from the existing fleet project and assigned tasks. Also it will help to
design a new hospital ships with a set of modern functional divisions. When designing a new
allowance system taken account of the medical-technical characteristics of existing hospital
ships for their optimal reequipment in the shortest possible time without reducing the quality
of medical care in the units.
Thanks to the use of new approaches to equipment of ships and fleets of the Navy
with modern compact samples package-lists, property and medical equipment reduced
weight and volume indices of the allowance list, which will reduce the term of readiness of
the ships, the period of loading-unloading operations and other activities.
Development of a new Navy ships and fleets medical equipment allowance list
system is carried out in order to organization of better equipping of ships and fleets of the
Navy Forces in existing conditions at the present stage of development of science and
technology.
Authors
Key words:
151
Authors
U. Miroshnichenko, V. Gainov, R. Golubenko, A. Goryachev, I.
Klochkova, L. Bunina
Affiliation
E-mail
TITLE OF THE
ABSTRACT
THE IMPROVEMENT OF PHARMACEUTICAL ALLOWANCE
LIST SYSTEM IN RUSSIAN FEDERATION MILITARY FORCES
HEALTH CARE
Topic/session
Presentation suggestion
(underline)
Improving the efficiency of Russian Federation citizens pharmaceutical care was allocated by the highest political leadership in a number of priority directions of social development. Ministry of Defense of the Russian Federation carries out purposeful work to improve
the pharmaceutical provision of attached contingents in outpatient and inpatient conditions:
military men, Ministry of Defense pensioners, their family members, children and teenagers
attending in military schools, the civil personnel of the Ministry of Defense.
The key principle of Russian Federation Military Forces logistics support, including the
provision of medicines, is the principle of planned normalized subsistence allowance, that
provides for the procurement with planned frequency by authorized allowance lists. Positive
aspects of this principle are: guaranteed supply of drugs and the possibility of inventory management in various conditions, especially during the fighting. However, there are negative
aspects that require scientific support and actualization of the norms of supply: compulsiveness and limitation of the nomenclature, obsolescence of the allowance list.
Allowance lists are authorized by the Minister of Defense and are binding on all levels of
the system of military health care. They are scientifically proven nomenclature and quantity of
medicines intended for carrying out, within a certain period of time, complex medical services.
The composition and structure of allowance list are affected by various factors, including: volume of medical services; the number of staff of the military unit; structure of the attached contingents (contract military men, conscripts and others); the number and qualifications of medical personnel; the number of regular beds in the medical units; the availability of
special capabilities and cabinets, etc.
Pharmaceutical allowance lists are designed according to the following algorithm. At the
first stage, determine the average value and the disease rate structure of the calculation
specified number of personnel (other attached contingents) or medical units and organizations specialized beds (sickbay, medical platoon, military hospital and others). Then, by content-analysis of clinical protocols, care standards and orders, examine the organizational
structure of the units and the medical and pharmaceutical organizations of the Ministry of
Defense, develop the structure of normalizing document and the list of relevant norms of
supply. Further, using the care orders and standards , define the «working nomenclature» of
medicines and calculate quantity indexes of allowance list. At the final stage conduct comparative pharmacoeconomic study taking into account medical, social, economic and other factors, the result of which are scientifically proven norms of supply of medicines.
At the second stage of the modeling for each nosological form of the disease produce
systematization of statistical indexes to measure the effectiveness of drug therapy schemes
in the ratio of recovery of the patient / the cost of drugs. Economic assessment of the effectiveness of drug therapy in the provision of medical care in outpatient conditions hold in comparison with the direct costs for inpatient care.
At the third stage of the modeling, for each nosological form of the disease, using a method of «the tree of solutions», produce the selection of pharmacoeffective therapy schemes.
The methodology of drug regulation in the military health care is the basis for the development of scientifically proven pharmaceutical allowance list of connections, military units and
military medical organizations, ensuring continuity of activities in the field of pharmaceutical
152
care to the military men, military pensioners and other categories of citizens.
Pharmaceutical allowance lists, even in the conditions of insufficient financing, are ensuring
the quality of pharmaceutical procurement management in the system of military medical logistics support, increasing the efficiency of use of budgetary funds, contributing to the preservation and strengthening of health of military men.
Key words:
153
POSTERI
Authors
Abhishekkumar Ramasamy
Affiliation
Eurasian federation of oncoloy
E-mail
[email protected] , [email protected]
TITLE OF THE
HEMOSTATSIS FILM CONVERTABLE GAUZE
ABSTRACT
Topic/session
Presentation suggestion (underliORAL
ne)
POSTER
ABSTRACT TEXT
Chitosan is the deacyelitated derivative of chitin, the second most abundant biopolymer
just after cellulose. Without doubt, its biomedical usages have gained more importance
among the vast variety of chitosan applications owing to its good biocompatibility and biodegradability. In recent years, particular interest has been devoted to chitosan hydrogels as a
promising alternative in competition with conventional sutures or bioadhesives. Different parameters such as acid type and concentration, and degree of deacetylation (DD%) of chitosan, were altered to modify hydrogel properties including viscosity, pH, cohesive strength,
and tissue bioadhesiveness . In the current work, we have investigated the effectiveness of
chitosan hydrogel encapsulated with tanexamic acid to stop bleeding. Chitosan film was obtained with solubilization of chitosan powder in aqueous acidic media.
In vivo experiments have been conducted on rat and rabbit models that provide a convenient way to evaluate the efficacy of prepared samples. The arteries vein was punctured on the
hind limb of the rat and the gauze was been applied on the punchered area. Bioadhesive
strength as well as irritant effects were discussed. Samples with higher degree of deacetylation,
including Chs-16 and Chs-19 that were dissolved in lactic media showed best sealing effect.
Introduction/Objective
NORMALLY, the wound healing process can be divided into four different but overlapping
phases: inflammation, granulation tissue formation, matrix remodeling, and reepithelialisation .
Dressing has been applied to open wounds for centuries . It can prevent wound from further injury and bacteria invasion. Nowadays, high quality wound dressings are designed to create a
moist occlusive environment to promote healing . In general, wound dressing can be classified
into a number of types based on their format and composition . Gauze is the simplest and most
widely used dressing, which has many advantages such as easy handling, great absorbent capability, and low cost. However, gauze may easily create secondary injury when peeling off. Wound dressings of film formed from polyurethane or silicon etc., are commonly used to treat the
wound without large volume exudation. Many kinds of dressings such as collagen–glycosaminoglycan sponge, alginate gel, occlusive or semi-occlusive dressing have been reported Chitosan [poly(1,4-b-D-glucopyranosamine)], the Ndeacetylated polysaccharide, has shown great
promise in accelerating the wound healing . It was reported that chitosan (CS) can accelerate
the hemostasis of the wound by coalescing erythrocytes, forming a blood clot . Meanwhile, CS
can also stimulate the migration of polymorphonuclear (PMN) as well as mononuclear cells and
accelerate the reepithelialization of skin [9]. It was also documented that CS possesses considerable antibacterial capability against a broad spectrum of bacteria . Because of its positive charge, CS can interact with the negatively charged microbial cell walls, leading to the leakage of intracellular constituents . On the other hand, CS also shows the property of DNA binding and inhibition of mRNA synthesis via the penetration of CS molecules into the nuclei of the bacteria
when the CS’s molecular weight is lower than 60,000 . Hyaluronic acid (HA), a linear polysaccharide composed of repeating disaccharide units of N-acetyl-glucosmine and D-glucuronic acid,
was firstly discovered by Meyer and Palmer in 1934 in the vitreous of cattle eyes . Being a component of extracellular matrix (ECM), HA has the high capacity of lubrication, water-sorption, and
water retention, especially influences on several cellular events such as attachment, migration,
and proliferation . As a wound dressing, the anti-adhesive property plays a key role in determi154
ning the process of wound repair. Herein, based on the advantages of CS and HA, a novel wound dressing is fabricated. Its physical and biological performance shall be studied as well.
Materials and Methods Chitosan (practical grade) , Lactic acid and absolute alcohol were
obtained from sigma chemicals where obtained from SIGMA , Glucosamine salt and DGlcosamine solvent and N-Acetyl Glocisamine were purchased from Fluka . Sodium chloride
solution (0.9% w/v ) was purchased from ITC .
Chitosan (1.4% w/v) in 1% w/v lactic acid or 2% w/v acetic acid was prepaired by stirring
overnight using a magnetic stirrer . Finally, Chitosan with know drug is loaded. Resulting the
solution was filtered and dried . The solution in a casting plate was kept at 60 degree C for
24 hr in an drier . The film was stored in an air tight container maintained at room temperature at 25± degree with a relative humidity of 60-65 degree.
Results The PVA-chitosan film encapsulated with tranexamic acid was checked for enzyme
stability and hydrophobicity compared to the bare chitosan molecule. The changes in the sessile
drop water and octane contact angle as a function of exposure time (enzyme treatment)
In vitro study of blood compatibility of the hydrogel was evaluated by the amount of plasma
protein adsorbed onto the hydrogel surface. When foreign material was placed in contact with
blood, the adsorption of protein onto the surface occurred, leading to platelet adhesion and activation Because the albumin adsorption on the synthetic surfaces could inhibit platelet activation,
it did not promote clot formation. Generally, as the albumin/fibrinogen adsorption ratio was higher, the number of adhering platelets was lower. The adsorption of both HSA and HPF increased as chitosan increased. However, the HSA/HPF adsorption ratio hardly changed as chitosan
increased. Therefore, chitosan did not significantly affect the adhesion of platelets to artificial surfaces.
Conclusion(s) In this study, a new kind of film containing tranexamic acid and PVA was
prepared based on chitosan using emulsification and cross-linking. These films had a porous
structure, confined size distribution, satisfactory water absorption, and acceptable
biodegradability and safety. Through loading of a local hemostatic agent, tranexamic acid the
hemostatic performance of the gauze was clearly improved. Importantly, the hemostatic film
agent not only demonstrated good hemostatic performance and could be used in any wound.
Furthermore, due to its biodegradability and safety, this agent could be used to treat intraabdominal solid organ injuries as well as external wounds. In addition, the film is ready and easy
to use with minimal training, cost effectiveness and it is lightweight and durable. Given these
characteristics, the chitosan appear simple and effective for use as a hemostatic agent.
However, further studies will be needed to understand the hemostatic efficiency of the chitosan
in aortic bleeding and in coagulopathic subjects compared with many other currently available
dressings.
Key words:
Chitosan, biocomaptibility, biodegradability, bioadhersive,
deacetylation.
155
Authors
Affiliation
Col. A. Olszewski MD1, Col. K. Korzeniewski MD, PhD2
1
Department of Prophylaxis and Treatment, Inspectorate of Military
Health Service, Warsaw, Poland
2
Department of Epidemiology and Tropical Medicine, Military Institute
of Medicine, Warsaw, Poland
[email protected]
WALKING BLOOD BANK IN ISAF OPERATION IN AFGHANISTAN
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Trauma Combat Casualty Care
Presentation suggestion
ORAL
(underline)
PUBLICATION
ABSTRACT TEXT:
Fresh whole blood (FWB) therapy is an effective life-saving medical procedure. In
combat conditions it is performed on individuals suffering from multiple organ injuries or
patients with massive hemorrhage. Collection and safe use of FWB requires selecting an
appropriate number of potential donors known as a Walking Blood Bank. The authors
present selected aspects of the blood donor qualification procedures adopted at the Polish
Field Hospital (Role 2) in Afghanistan, with particular emphasis on the effects of
environmental factors on the implementation of the project.
Key words:
156
walking blood bank, ISAF, Afghanistan
Authors
Affiliation
Abdolali Sadeghi (NAJA),
Nasrallah Fathian (General Staff),
Rostami, Mahmoud Tajik (General Staff)
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
[email protected]
DESERT HOSPITALS (FIELD SANITATION REQUIREMENTS)
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Preventive Medicine
Presentation suggestion
(underline)
ORAL
POSTER
ABSTRACT TEXT:
Without sanitation, health, and injured workers will be seriously threatened. Providing
safe, potable water and food for injured employees, waste removal and disposal of waste is
considered the basic components of the field hospital. Water supply, a major problem in
critical situations such as battlefield and environmental conditions become unfavorable. To
provide safe and potable water in these situations need to respect the minimum
requirements in this document will refer to them. Due to differences in activity level and type
of hospital service that provides a field hospital, waste production, and operating conditions
are different and function of the number of victims. Activity in the field hospital, field hospital
to the accumulation of waste and waste can become a problem in the field hospital
functioning optimally. The most important presentation of this paper is as follows:
1-Purpose: The purpose of this formulation, the field hospital hygiene requirements,
including environmental health services, food and clothing is.
2-Scope: Scope of this paper, the field hospitals of the armed forces is used.
3- Terminology and definitions.
4- Maximum allowable drinking water.
5 - Chemical waste, pharmaceutical waste, waste of internal displacement, displacement
of foreign waste.
6 - Symbols.
7 - Requirements: {General requirements - the requirements of drinking water (the
physical properties of water - drinking water limits of chemical pesticides and chemical
properties of pesticides in drinking water - radioactive water - properties of water - water
filtration - chlorination - means tested)
Key words:
Public health requirements relating to clothing - food hygiene
requirements - general requirements
157
Authors
Rahman Arefi, MSc.
Alireza Jabbedar, MD.
Hadi Shirzad, MD.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
COMMAND AND DISCIPLINARY MANAGEMENT
ABSTRACT
SEARCH IN REASONS OF INCREASING THE EMPLOYEE'S
SATISFACTION WITH MEDICAL SERVICES
Topic/session
Preventive Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Background and Objective: Present research is performed in order to command &
disciplinary management search in reasons of employee’s satisfaction in increasing with
medical services of military hospitals.
Methods: The current descriptive research is conducted about faculty aim & in order to keep
labour-force in military. Tangibility, reliability, responsibility, assurance& empathy extracted
from methods of SERVQUAL model that is known as proper quality assessment tool in
health care centers, was used. Study population was contained of 430 patients who were
workers, retired and military family in one of Police Force Hospitals in Mashhad -Iran for 3
days of 2009. With use of Cochran Formula, 140 people who stayed at least 3 nights at
hospital, were selected for sample and completed the questionnaire. The questionnaire used
had 24 close and 1 open questions that were completed even with patients discharge from
the hospital or by visiting their home.
Results: the results of investigation have indicated that all the five components of quality
were effective in increasing staff satisfaction. We also found that the priority of component in
staff satisfaction is: tangibility with rang of 4.59, assurance with rang of 2.77, reliability with
rang of 2.74, responsibility with rang of 2.57 and empathy with rang of 2.32.
Conclusion: With attention to researcher’s finding five component of SERVQUAL model is
recommended as an appropriate tool for evaluation of employee's satisfaction. Moreover, it
is suggested to managers to pay more attention to tangibility dimensions of hospitals that are
contain; buildings, medical places, facilities and physical methods used for employee's
needs as well as their appearance.
Key words:
158
Satisfaction, employees, medical services, increasing, military
hospitals
159
160
Authors
LTC Dr. Ahmed Humaid , Army Mobile Field Hospital Commander
Affiliation
E-mail
[email protected]
TITLE OF THE
TACTICAL COMBAT CASUALTY CARE INNOVATIONS
ABSTRACT
AND FUTURE. IS IT A MYTH OR TRUTH?
Topic/session
Tactical Combat Casualty Care
Presentation suggestion
ORAL
(underline)
Introduction/Objective
Most battlefield casualties died of their injuries before ever reaching a surgeon. As most preMilitary Task Forces deaths are non-survivable, mitigation strategies to impact outcomes in
this population need to be directed toward injury prevention.
Methods
To significantly impact the outcome of combat casualties with Potential Survival Injury,
strategies must be developed to mitigate haemorrhage and optimize airway management or
reduce the time interval between the battlefield point of injury and surgical intervention.
Therefore, understanding battlefield mortality is a vital component of the military trauma
system optimization.
Result/Conclusion
How do we know the Tactical Combat Casualty Care system and guideline is working? How
could we facilitate performance improvements among all personnel in Tactical Combat
Casualty Care to eliminate preventable battlefield death? What would be the best modality
for improving pre hospital trauma care and casualty outcome on the battlefield? And would
this have considerable implication on the civilian trauma system? Is it a Myth or Truth?
Key words:
Tactical Combat Casualty Care, Battlefield innovations, Battlefield
mortality mitigation
161
Authors
LTC Dr. Ahmed Humaid , Army Mobile Field Hospital
Commander
Affiliation
E-mail
TITLE OF THE
ABSTRACT
[email protected]
THE IMPACT OF HIGH FIDELITY MEDICAL SIMULATION
ON THE APPLICATION OF TACTICAL COMBAT
CASUALTY CARE
Topic/session
Tactical Combat Casualty Care
Presentation suggestion (underline)
ORAL
POSTER
Introduction/Objective
Simulations have been used widely in High Risk Environments like Military Air Force
to prepare their staff for real critical scenarios and to minimize human related errors.
These Innovations have been advancing for the last 20 years. Therefore, the high
fidelity simulation technologies in medicine and in Military Field Medicine have been
claimed to be effective and of high impact on knowledge, skills and attitudes among
health care providers.
Results
Many Countries their Armed Forces started implementing these technologies as part
of their strategic vision of improving "training gaps" and performance among
personnel of the Tactical Combat Casualty Care.
Conclusion.
Would these technologies contribute the continuous improvement in military health
care services in the field? And, is it cost effective solution to boost the training quality
among troops? Is there enough evidence based guidance to answer whether these
technologies are Myth or Truth?
Key words:
162
High Fidelity Simulation, Tactical Combat Casualty Care,
Training Gaps, and Battlefield Simulation.
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
ShabbooJafarzadeh (MA),
RezaJafarzadeh(MD)
Police Medical center of Mashhad, Iran.
[email protected]
HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH
CHEMICAL WARFARE-INDUCED CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Topic/session
Mental Health
Presentation suggestion
(underline)
ORAL
POSTER
Introduction and Objectives: Chronic obstructive pulmonary disease has a great effect on
the quality of life of suffering patients. Presence of many chemical warfare patients in our
country and their presence in the middle age group of the society and the consequences of
this disease on their daily activity all show the importance of evaluating the Health Related
Quality of Life (HRQL) in these patients.
Materials and Methods: Respiratory impairment and HRQL of 43 male COPD patients due
to chemical warfare, were assessed according to lung function tests and St George
Respiratory Questionnaire (SGRQ). Data were analyzed by SPSS version 11.5 by KruskalWallis, ANOVA and qui square tests.
Results: According to lung function tests data analysis, the mean of FEV1, FVC, FEV1%
and FEV1 (% predicted) was 1.9, 2.6, 59.2 and 53.1 respectively. Most of the patients
(72.1%) were assessed as stage II (Moderate) according to lung function tests and GOLD
parameters. There was also a reverse collaboration between FEV1% and FEV1 (% predict)
with period of symptoms (p=0.035, p=0.004 respectively). A significant relation between lung
function tests status and SGRQ scores was also determined.
Conclusion: According to results mentioned, most of these patients experience a bad
quality of life and disturbing symptoms. Longer period of morbidity and lower lung function
tests results in a more severe disease. On the other hand lower lung function test results
conclude to a greater SGRQ score and therefore worsening of quality of life in all three
components of symptoms, activity and impact.
Key words:
COPD, Quality of life, SGRQ, chemical warfare patients
163
Authors
Aliakbar Golmohammadi, PhD.
Ali Majidi, MD, Neurosurgery Specialist.
Reza Hiradasa, Pediatric Specialist
Aboulfazl Jafarzadeh, MD.
Sareh Samadi, MSc.
Affiliation
Office of Applied Research, Department of Police (NAJA) Medicine,
Tehran, Iran
E-mail
[email protected]
TITLE OF THE
USE OF COMPLEMENTARY MEDICINE AMONG MILITARY
ABSTRACT
STAFF
Topic/session
Preventive Medicine
Presentation suggestion
ORAL
POSTER
(underline)
Background and Objective: Complementary medicine (CM) combines the therapies and
philosophies of conventional medicine with those of alternative medicine, such as
acupuncture, herbal medicine, and biofeedback. In the present study, we sought to examine
the frequency of use of CM and evaluate the association between this therapy and
demographic factors among military staff and their family members.
Methods: 55 staff in various positions who met the inclusion criteria took part in this
descriptive study. The data was gathered using a questionnaire developed by authors
included demographic factors and also the information related to the use of CM. The data
were analyzed using SPSS software with Student's t-test, mean and frequency distribution.
Results: Age ranged from 22 to 51yr, 90% were male, 84% were married and 66% born in
city. The frequency of CM use was %54 that was most due to personal health promotion.
The most common CMs were herbal medicine (20%), and sports therapy (%18).The most
important reasons respondents gave for not using prescribed medicines were its cost and
side effects. In addition, we found that the use of CMs was significantly higher among
women and also staff in traffic and information organizations (p≤ 0.05).
Conclusions: In our survey the rate of CM use was high is one of the most common
treatments that can be justified by Muslim beliefs. Since Complementary medicine
treatments are now increasingly popular and the public demand for information is growing
rapidly further research is needed to demonstrate the real value of this kind of medicine for
both physical and mental diseases.
Key words:
164
complementary medicine, military staff
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Svetlana Antic¹, V.Rabrenovic¹, Z.Kovačevic¹, D.Jovanovic¹,
M.Petrovic¹, A.Antic², Lj Ignjatovic¹ , D.Pilčevic¹, J.Tadić-Pilčevic¹,
D.Savic¹, Z.Čukic¹
Clinic of nephrology ¹Military Medical Academy, Belgrade,Serbia,
The First Surgical Clinic², Clinical Centre of Serbia, Belgrade
[email protected]
THE LUMBAR PAIN AS AN INITIAL SYMPTOM OF THE
GAUCHER DISEASE - THE PRESENTATION
OF
RARE
METABOLIC DISEASE
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Aim: To present a case of a patient with the lumbar pain which was not caused by
microlythiasis as initially suspected, but was an initial symptom of this very rare disease.
Case report : A 50-year old female patient was hospitalized for dull lumbar pain more to the
right side, and for the suspected renal microlythiasis . At the examination, lumbar tenderness
more to the right side could be observed, and hepatosplenomagaly was palpated. The
findings of the abdominal echosonography showed the normal values for the kidney, but
revealed the enlarged liver 165 mm without focal lesions, and the enlarged spleen 211 mm
with no focal lesions. The lab. values for nonspecific inflammations were elevated (ERS
116,CRP 33,3), indicating pancitopenia (Er. 3,0, Hb76,5, Le 3,42, thrombocytes were 62,5).
The microscopic analysis of the peripheral blood smear demonstrated the decrease in the
RBC values. Changes of Er such as hypochromia, anizocytosis,
poikilocytosis, and
dacriocytes were found, the Le and thrombocyte values were lower). After hematologist’s
consultation, mielogram was indicated. It displayed clearly multiplied macrophage-histiocyte
cells which, by their morphology, are Gaucher cells. The determination of the high specific
lisosomic enzyme - chitotriosidase - 13234 nmol/mL/h, and the acid phosphatases – 13,0
U/L by biochemical analyses indicated the presence of this disease. Additional analysis
showed low levels of the acid-beta-glucosidase enzyme (<2), after which a specific therapy
was introduced into her treatment.
Conclusion: Through the presentation of this case, we would like to highlight the
importance of a good differential diagnosis for the timely establishment of a diagnosis and
the initiation of the treatment, particularily when lumbar pain is initial symptom of a rare
desease such as the Gaucher disease
Key words:
lumbar pain,
disease
the acid-beta-glucosidase enzyme, the Gaucher
165
Authors
Bojana Jovanović
Affiliation
Serbian Armed Forces, Pančevo, Serbia
E-mail
[email protected]
TITLE OF THE
ABSTRACT
A RISK FACTOR FOR TYPE-2-DIABETES:
ACUTE EMOTIONAL STRESS IN WAR CONFLICT
Topic/session
Preventive Medicine
Presentation suggestion
ORAL
POSTER
Introduction: Diabetes mellitus is a chronic disease caused by inherited and/or acquired
deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin
produced. Such a deficiency results in increased concentrations of glucose in the blood,
which in turn damage many of the body's systems, in particular the blood vessels and
nerves. There are two basic types of diabetes: Type 1 and Type 2.
Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's
inability to respond properly to the action of insulin produced by the pancreas. Type 2
diabetes is much more common and accounts for around 90% of all diabetes cases
worldwide. It occurs most frequently in adults, but is being noted increasingly in
adolescents as well.
Materials and Methods: Recently compiled data of the World Health Organization show
that approximately 150 million people have diabetes mellitus worldwide, and that this
number may well double by the year 2025. Much of this increase is due to population
growth, ageing, unhealthy diets, obesity and sedentary lifestyles.
Results: Adding to the above mentioned risk factors that can lead to type-2 diabetes,
one-time severe stress can also trigger the disease. Recent research data showed that
the sugar levels rose significantly during the war conflict Indicated that acute mental
stress could trigger the development of type-2 diabetes or cause diabetes becoming
more serious.
Conclusion(s): Therefore it is advisable to include prevention activities (i.e. developing
healthy life style, regular controls) for the people exposed to severe acute stress.
Key words:
166
diabetes, risk factors, stress, war
Authors
Affiliation
2LT MD Ivana DIMKOVSKI*, MD PhD Sladjana ZIVKOVIC˟, Lt Col
MD PhD Nebojsa STOJANOVIC˟, Lt Col MD PhD Asst.Prof. Milos
KOSTOV°, Lt Col MD Predrag CVETANOVIC
*The Serbian Armed Forces, VP 4522 Batajnica, SERBIA
˟Military Hospital, Department of Urology, Nis, SERBIA
°Military Hospital, Department of Pathology, Nis, SERBIA
Military Hospital, Department of Dermatology, Nis, SERBIA
E-mail
KERATOSIS LICHENOIDES
TITLE OF THE
ABSTRACT
PHIMOSIS: A CASE REPORT
Topic/session
Presentation suggestion
(underline)
CHRONICA-RARE
CAUSE
OF
Introduction. Keratosis lichenoides chronica is a rare acquired mucocutaneous dermatosis
of unknown origin. It is characterized by violaceous, keratotic lichenoid papules that are
arranged in a characteristic linear and reticulated pattern. The location of these papules is
often limbs and trunk, while mucous membranes, genitals, nails, dorsal feet and hands may
also be affected. Very rare localisation of the disease is foreskin which can lead to
complications such as phimosis.
Case report. We presented a 38-year old man with generalized form of KLC and phimosis
as a genital localisation of the disease. The patient was treated conservatively for more than
10 years without any respond to various topical treatment modalities over the years. The
preputial localisation of KLC has led to phimosis which was successfully treated by
circumcision. Histopathologic examination of the papular lesions of the foreskin showed
irregular acanthosis, hyperkeratosis, parakeratosis and abundant lymphocytic infiltration in
upper dermis, a classical feature for KLC.
Conclusion. Because of the diversity of etiology and clinical findings of balanitis, it is
complicated to establish the diagnosis and treatment, especially with a rare genital
localisation of KLC. Conservative treatment is not suitable for a balanitis with phimosis.
Surgical procedure is the only possible therapeutic solution which also contributes to
histopathological verification of the disease.
Key words:
keratosis; phimosis; balanitis; circumcision
167
Authors
Colonel (Dr) Nikhil Moorchung, Lt Gen P P Varma, Col Vijay Bhatti,
Maj B L Lahareesh, Maj Gen Bipin Puri
Affiliation
Command Hospital (Northern Command), Udhampur, INDIA
E-mail
[email protected]
TITLE OF THE
A CRITICAL RE EVALUATION OF THE BATTLE PHYSICAL
ABSTRACT
EFFICIENCY TEST
Topic/session
Presentation suggestion
ORAL
POSTER
(underline)
Introduction/ Objective – The BPET is a standard test employed by the Indian Army to test
for physical fitness. This study was taken up to evaluate the relevance of the BPET in the
Army today.
Materials and Methods – 485 soldiers were evaluated in this study. We evaluated the
BPET timing with the grade of training, the Body Mass Index (BMI) and a history of tobacco
and alcohol consumption.
Results – There was a strong correlation of the BPET timing with the age of the subjects
(p – 0.001). There was also a strong correlation of the BPET timing with the grade of training
(p – 0.001). The BMI also showed a strong inverse correlation with the BPET timing and the
soldiers who had a higher BMI performed significantly worse as compared to those who had
a lower BMI (p – 0.042). Finally, we al o found that soldiers who smoke and consume
alcohol performed worse in the BPET as compared to non smokers and non drinkers (p –
0.04).
Conclusions – The BPET is still a relevant test for the Armed Forces to evaluate physical
fitness. It appears that no revision in timing or in any of the other parameters of the BPET
requires any revision.
Key words:
168
BPET, physical fitness
Authors
Affiliation
LT. KOCAK Necmettin MD1, MAJ. ISTANBULLUOGLU Hakan MD2,
MAJ. YILDIRAN Nuri MD2, CAP. AYDIN Ibrahim MD3, MAJ.TURKER
Turker MD4, COL. GULEC Mahir MD4 COL. KILIC Selim MD4
1
Turkish Coast Guard Command, Ankara, Turkey.
2
Turkish General Staff , Ankara, Turkey.
3
Ministry of Defence, Ankara, Turkey
4
Gülhane Military Medical Academy, Department of Public Health,
Ankara, Turkey
[email protected]
REASONS FOR UNFITNESS FOR MILITARY SERVICE AT
TURKISH ARMED FORCES BETWEEN 2008 AND 2010
E-mail
TITLE OF THE
ABSTRACT
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Objective: Disability is a particularly important issue for military services, affecting the
numbers of active and reserve personnel. The aim of this study was determine the reasons
for unfitness for military service among recruits at Turkish Armed Forces between 2008 and
2010.
Materials and Methods: This cross-sectional study was conducted between December
2010 and May 2012 after reviewing the health reports belonging to 40717 recruits who are
concluded with decree B and D after being taken into Health Board in order to finalize their
proceedings upon various diagnoses in 41 Military Hospital between 2008 and 2010 in
Turkish Armed Forces. The study has been initiated after getting necessary ethical
permissions from Ethics Committee of Gulhane Military Medical School.
Results: The first three most involved clinics were psychiatry with 21.7%, ophthalmology
with 13.7%, and internal medicine with 10.9%. The most common three diagnoses were
antisocial personality disorder with 11.2%, sensorineural hearing loss with 6.3%, and obesity
with 5.2%, respectively. The recruits from eastern Anatolia have the biggest proportion
among all study group with respect to the decision B and D.
Conclusion: It was also realized in this study that the accuracy and completeness of data
was very important. In our opinion, the administrators who are in the position of policy
making may use these findings to improve for both the quality and accessibility to healthcare
services.
Key words:
Turkish Armed Forces, Unfitness for Military Services
169
Authors
Affiliation
E-mail
TITLE OF THE
ABSTRACT
Violeta Rabrenović¹, Zoran Kovačević¹, Ljiljana Ignjatović¹, Dragan
Jovanović¹, Neven Vavić¹, Milorad Radojević¹, Milica Petrović¹,
Mirjana Mijušković¹, Dejan Pilčević¹,Jelena Tadic Pilčević¹.
Clinic of nephrology ¹Military Medical Academy, Belgrade,Serbia,
[email protected]
COMPLICATIONS IN PATIENTS WITH TRANSPLANTED KIDNEY
WHO WERE PREVIOUSLY TREATED
BY PERITONEAL
DIALYSIS (1996-2011)
Topic/session
Presentation suggestion
(underline)
ORAL
POSTER
Aim: The aim of this study is to provide a review of complications and renal function in
patients with transp. kidney who were previously treated by peritoneal dialysis.
Method: Retrospective analysis conducted in the period 1996–2011y, with the monitoring
period of 2-144 months. 324 kidney transplantations performed, 40 (12,3 %) were done in
PD pts (18 female, 22 mail, average age 33,35 ±5,2 y). 5 transp. from deceased donors, 35
living donor kidney transplantation were performed. We observed the graft survival,
occurence of early and chronic complications and the renal function as well through the
values of creatinine and clearence creatinine.
Results: Thrombosis of renal artery and early loss of graft occured in 6 pts. mainly with
diabetes mellitus. As far as the early complications are concerned, we registered bleeding in
5 pts, hematoma on the surgical injury site in 4 and lymphocele in 5pts. Delayed graft
function occured in 5 and acute rejection in 10pts. There wasn’t any case of peritonitis
identified. As for the chronic complications, there were 7 cases of ch. rejection with 4 loss of
graft, 4 was with uretyera stenosis. With regard to the infections, 7 bacterial inf.,9 cases of
reactivation of CMV inf, and 1 pts with Herpes Zoster. The reccurence of disease occured in
3, and 2 pts loss of graft. The stable medium volume of s/creatinine was 129,62 ±10,3umol/l
in the early stage and 146,86 ±12,1umol/l in the end of the monitoring. The medium volume
of CCCr was 63,26±6,5ml/min at the early phase of monitoring period and 64,78±6,2ml/min
in the end).
Conclusion: This study has shown that more frequent surgical (vascular) complications
occure in patients with diabetes mellitus. There wasn’t any case of peritonitis identified
probably because the peritoneal catheter was removed during the transplantation
Key words:
170
transplantation, peritoneal dialysis, graft survival, complications