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1 2 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 3 4 5 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: 6 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 7 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: 8 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 9 10 11 12 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 13 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: 14 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 15 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: 16 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: 17 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: 18 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 19 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: 20 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 21 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: 22 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 E-mail TITLE OF THE ABSTRACT Topic/session Presentation suggestion (underline) ORAL POSTER 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 107 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 E-mail TITLE OF THE ABSTRACT Topic/session Presentation suggestion (underline) ORAL POSTER 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: 108 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 Topic/session Presentation suggestion (underline) ORAL POSTER 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 109 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 Presentation suggestion (underline) 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 Topic/session Presentation suggestion ORAL POSTER (underline) 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 (underline) 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 Presentation suggestion (underline) 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 115 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 (underline) 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 Presentation suggestion (underline) ORAL POSTER 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 Presentation suggestion 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 (underline) 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