Marine Medicine

Distribution and illegal trafficking of new psychoactive substances, related to designer drugs, create preconditions for growth in the number of potentially drug-addicted patients, including among students of maritime educational institutions and persons, belonging to crew personnel. Signs of drug addiction as well as the presence of drugs in the human body, psychotropic substances and their metabolites during medical check-ups, including chemical-toxicological studies, are the reasons for contradictions to work on the vessel. The article presents the review of a large group of synthetic narcotic drugs, related to designer drugs and differed in structure, mechanisms of toxicity, narcotic potential and behavioral disturbance. Classifications of designer drugs, different aspects of the problem of their use and prevalence in the population are considered. Mechanisms of a toxic effect of most prevalent designer drugs from groups of synthetic cannabinoids, synthetic cathinones and synthetic opioids are discussed.

INTRODUCTION. В₁₂-deficient anemia is a type of megaloblastic anemia due to the violation in the formation of red blood cells and hemoglobin, caused by impaired DNA synthesis, the hemolysis of erythrocytes, low regeneration of hemopoiesis, and is characterized by macrocytosis and hypertrophy.

OBJECTIVE. Updating and systematization of data on kinetics, metabolism of vitamin В₁₂ in the body and the causes of their violation as well as diagnosis and treatment of В₁₂-deficient anemia.

MATERIALS AND METHODS. The search was conducted through the international RSCI database, PubMed for 1991–2024. The query words: vitamin В₁₂, cyanocobalamin. 29 works were selected, at least 80 % of which have been published for the last 10 years.

RESULTS. The work shows the role of active coenzymes of vitamin В₁₂ (methylcobalamin, deoxyadenosylcobalamin) and their deficiencies in emerging hematological, gastroenterological and neuropsychological syndromes with В₁₂-deficient anemia. The incidence of detecting autoimmune antibodies to internal factors and vitamin В₁₂ deficiency increases with the age of patients. It is important to assess the initial level of vitamin В₁₂ in the diagnosis of anemia before starting therapy, which decreases less than 140 pg/ml with anemia.

DISCUSSION. The leading cause of vitamin В₁₂ deficiency is the violation in the formation of the intrinsic factor of an autoimmune nature or after gastrectomy. Effective treatment might include pathogenetic therapy with cyanocobalamin and its preferred prescription of 100–200 µg in a day for 1–1,5 month.

CONCLUSION. В₁₂-deficient anemia is often caused by an autoimmune nature or stomach gastrectomy, which frequency increases with age, but it is effectively corrected by vitamin В₁₂.

OBJECTIVE. To assess the development of the subject, regarding the impact of factors of the military professional activity on reproductive health of the Navy personnel.

MATERIALS AND METHODS. There was the analysis of 65 Russian and foreign scientific publications in databases PubMed, Cochrane, elibrary.ru over the past 25 years, 14 of which were included in the review, meeting the inclusion and exclusion criteria.

RESULTS. Reproductive health of the Navy personnel is regularly exposed to a number of adverse factors of the military professional activity. The article presents analysis of studies, showing the effect of such factors as service on nuclear-powered submarines, work under high temperature conditions, exposure to radiofrequency electromagnetic field as well as sexual deprivation, related to forced sexual abstinence. It provides data, reflecting high prevalence of infections of sexually transmitted diseases in the Navy personnel. At the same time, it should be noted that the analyzed sources do not contain information concerning integrated assessment of military professional factors, allowing to predict changes of reproductive health.

DISCUSSION. The results of the conducted systematic analysis of studies correspond to the works which study the issue above from a broader perspective. Thus, the literature presents data on the negative impact on overload fertility, experienced by servicemen of military aviation, shows a high prevalence of infertility in men, involved in hostilities, finds a link between exposure to electromagnetic radiation and much lower number of spermatozoa in the ejaculate. A high prevalence of prostatitis and varicocele in military personnel are noted in a series of papers.

COCNLUSION. The analysis of scientific publications showed insufficient development of the issue both in Russian and foreign literature that dictates the need to carry out further research, regarding the issue of reproductive health in individuals of the above categories.

INTRODUCTION. Preserving the life and health of highly qualified military specialists of the Navy of the Russian Federation is an actual problem at any historical stage of the state development and is impossible without a full-fledged medical supply, relevant to the current development stage. Modern geopolitical conditions allow to evaluate the progress of the previous stages of upgrading health services in practice and to work out relevant proposals for ways to improve the existing medical kits on ships and vessels of the Navy.

OBJECTIVE. Based on operational experience, to justify the need for improvement and offer options for new samples and medical kits to provide medical care to the military seamen in ship conditions.

MATERIALS AND METHODS. Based on the analysis of the guidance documents, regulating provision rates of medical kits for ships and vessels of the Navy as well as the analysis of their samples, supplied on vessels of Operational-Strategic Command “Northern Fleet”, including on the basis of practical experience in counselling industrial enterprises when purchasing medical equipment, supplies and medications on vessels under construction and repair, theoretical and empirical research methods were applied.

RESULTS. Currently existing features of basic medical kits are defined, limiting their practical application in the conditions of the Navy ships and vessels. Medical supply determinants of vessels under construction and repair are identified.

DISCUSSION. The modern approach to medical supply of the Navy vessels has high inertia and does not allow to quickly implement new samples of medical and drug kits in accordance with applicable clinical guidelines and regulations, and therefore this requires the change in the concept of the Navy medical supply. Recommendations for optimizing the current samples of the medical kit are offered.

CONCLUSION. The practical use of forces and means of medical service of the Russian Federation Armed Forces in modern geopolitical conditions allows to identify new opportunities to improve medical supply of units and subunits. Revision of medical kit allowance of the Navy ships and vessels will allow to optimize financial expenditures with improving the quality of providing primary health care for military seamen, and also to increase the level and timeliness of first aid for military marine specialists to the extent of self-help and mutual aid at sea.

OBJECTIVE. Improve scientists’ information capabilities by analyzing directions of scientific research in foreign articles on underwater medicine, using VOSviewer program, in 20 years from 2003 to 2022.

MATERIALS AND METHODS. The search query (Submarine Medicine) OR (Diving medicine) in PubMed bibliographic reference database provided 2476 responses to scientific articles, published in 2003–2022. The created array of publications in «.txt» format was uploaded to analysis program VOSviewer 1.6.20, capable of quick recognizing patterns in a huge array of bibliographic data. There were 6786 keywords in the array of articles. In recording 10 repetitions of keywords in articles, they became 358, being grouped into 7 clusters.

RESULTS. Cluster 1, named diving medicine, included 24,8 % of articles with the mutual association of 23,9 % of the total array. A large number of keyword associations with the terms in the other clusters was revealed. Cluster 2, dubbed the “experimental animal studies”, had 17,3 % of articles with the mutual association of 19,8 %, in cluster 3 – decompression sickness – 12 % and 13 %, in cluster 4 – problems of hypoxia effect on the body’s functional reserves from the standpoint of evidence-based medicine – 11,5 % and 12,8 %, in cluster 5 – hyperbaric oxygenation – 13,5 and 12,6 %, in cluster 6 – the use of evidence-based methods in research on underwater medicine – 12,8 % and 11,4 %, in cluster 7 – military medicine – 8 % and 6,5 %. There is visualization of keywords, presented in the clusters. Leading scientific schools of co-authorship and affiliated organizations have been identified.

DISCUSSION. There is dynamics of increase in the number of articles on underwater medicine. There are 11 authors, who have published 30 and more articles personally or co-authored in 20 years from 2003 to 2022. 3 lead authors of papers are from China, 2 –Croatia, 2 – Australia. There are surprisingly few lead co-authors from the USA – 1.

CONCLUSION. The conducted studies can increase information support of research on underwater medicine and help scientists determine directions of own scientific work.

INTRODUCTION. The demographic situation in Russia remains a key medical and social issue, the important aspect of which is the trend of increasing frequency of infertility. The growth in the number of female militaries dictates the need to study the structure of female infertility among them in the ranks of the Armed Forces of the Russian Federation.

OBJECTIVE. To reveal the structure of infertility in female militaries.

MATERIALS AND METHODS. The study was carried out in the period from 2020 to 2021 г. in the Obstetrics and Gynecology Clinic in the Kirov Military Medical Academy, involving 192 female militaries, aged 18–40. All patients were divided into 2 groups: the main group – patients with different forms of infertility (n = 54), control group – patients with no information on infertility (n = 138). The patients of the main group were divided into 3 subgroups, depending on forms of infertility: IA – tuboperitoneal infertility (n = 26), IБ – endocrine infertility (n = 17), IВ – unexplained infertility (n = 11). Gynecological history was collected from the patients of both study groups, clarifying the nature of menstrual, sexual and reproductive functions; there was analysis of microscopic examination data of genital organs, ultrasound examination of the pelvic organs with folliculometry as well as the study of hormonal profile, including determination of the levels of follicle-stimulating, luteinizing, anti-Mullerian hormone in the blood serum. Hormonal and ultrasound examinations were conducted on the 3^rd-5^th day of menstrual cycle.

RESULTS. The study found that infertility in marriage is diagnosed in 54 (28 %) out of 192 femalemilitaries, and tuboperitoneal form of infertility was in 49 % (26/54) of women, in 31 % (17/54) – endocrine form of infertility, the cause of infertility has not been established in 20 % (11/54) of women.

DISCUSSION. According to various authors, the tuboperitoneal factor is the main cause of female infertility in the world and particularly in Russia. The study result has found that this factor is the most common cause of infertility among female militaries (49 %), in 100 % of cases patients with tuboperitoneal infertility had pelvic inflammatory disease in the history, in 61,5 % – surgery of internal genital organs. Endocrine infertility is the second most common cause of female infertility. According to our data, the incidence of endocrine infertility among female militaries is 31 %. A high incidence of autoimmune thyroiditis (23,5 %) as well as the reduction of follicular ovarian reserve (64,7 %) are discovered in the group of patients with endocrine infertility.

CONCLUSION. Thus, as a result of the study, it has been determined that it is now possible to identify various direct and indirect causes of female infertility, and also predisposing factors of its development in women. This makes it relevant to further explore methods of treatment and prevention of infertility in military personnel.

Retrospective cohort longitudinal study, conducted as part of the analysis of medical assistance to victims by emergencies with traumatic shock at the prehospital stage in the Arctic region of the Russian Federation, has determined features of epidemiology, structure, methanogenesis of injuries and the volume of medical care for the affected. It identified diagnostic and treatment defects in providing emergency medical assistance to victims. The publication proposes recommendations, aimed at improving health care for the injured with traumatic shock at the prehospital stage in the extreme natural and climatic conditions of the Arctic.