Vol 9, No 4 (2023)

Cover Page

Full Issue

LECTURE

Clinical blood test interpretation. Part 1. Neutrophil granulocytes

Bazarnyi V.V., Sosnin D.Y.

Abstract

INRODUCTION. Recent decades are characterized by a rapid introduction of modern automated analytical systems in clinical laboratory diagnostics such as hematology analyzers, which provide a high accuracy of results as well as additional (compared to routine tests) and often more valuable information. Automated blood test has made urgent the problem of interpreting both new tests and “routine” parameters that is relevant to any section of clinical medicine. Therefore, this lecture is aimed at doctors of different specialties.

OBJECTIVE. Interpret a clinical blood test.

DISCUSSION. It is hard to review all aspects of hematological analysis within the scope of one lecture, thus part 1 will investigate one of leukocyte populations – neutrophil granulocytes, which include stab and segmented neutrophils. The lecture presents well-known data about neutrophilic leukocytosis and neutropenia. The emphasis is placed on new parameters of automated blood test – IG (immature granulocytes), Neut-RI (reactivity index), Neut-GI (granularity index), MNV (the average volume of neutrophil), structurally dispersed characteristics (NE-WX, NE-SFL, NE-WZ) and some others. Along with modern parameters it was noted the importance of the traditional cytological examination of blood smear, enabling to detect anomalies of neutrophil (degenerative-dystrophic changes of cytoplasm, apoptosis, nucleus pathology).

Overall, recent years have shown a significant improvement in laboratory diagnostic capabilities of reactive changes (with inflammation, injury, etc.) and blood diseases (anemia, myelodysplastic syndromes, hemoblastosis, etc.), based on accumulated knowledge in the field of laboratory hematology, including clinical significance in evaluating neutrophils.

Marine Medicine. 2023;9(4):7-15
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REVIEW

Wound dressings on the basis of seaweed polysaccharides, promising for the treatment of burn wounds

Kuznetsova T.A., Polovov S.F.

Abstract

INTRODUCTION. Severe burn injury or burn disease is one of the most dangerous injuries to life. Treatment of burns, as well as subsequent rehabilitation of the burn patients are a serious problem for both civil health care and military medicine. The key component of local treatment of burn wounds is the use of wound dressings. Among the wide variety of used wound dressings the most promising are hydrogel based on seaweed polysaccharides (PS).

OBJECTIVE. Based on the analysis of data from domestic and foreign literature, to justify the use of seaweed polysaccharides (PS) as a basis or as therapeutic components of promising wound dressings for the treatment of wounds and burns.

MATERIALS AND METHODS. The articles included in the databases and information systems are analyzed: the scientific electronic library Elibary.ru, RISC, Web of Science, Pubmed, Scopus, Elsevier and Google Scholar (as of February 2023) by keywords: marine medicine, burn wounds, seaweed polysaccharides, wound dressings, hydrogels

RESULTS. The review presents information about modern biodegradable and biocompatible wounded dressings that have been used in clinical practice or are at the stage of experimental research and developed using seaweed PS (alginates and fucoidans of brown algae, carraginans of red algae, ulvanas of green algae) as a basis or as therapeutic components. A brief characteristic of the physicochemical properties and high biological activity of the PS, important both for macroorganism as a whole and for wounds healing is presented.

DISCUSSION. The use of PS when constructing wound dressings is justified, and the results of their experimental and clinical trials for the treatment of wounds and burns are analyzed. Particular attention is paid to the ability of the PS to form hydrogel, since hydrogel dressings meet the main requirements for the ideal wound dressings for the treatment of wounds of various genesis, including burn wounds.

CONCLUSION. Seaweed PS are widely used in modern technologies for creating wound dressings for the treatment of burn wounds.

Marine Medicine. 2023;9(4):16-25
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Chemical composition of seaweed and its medical-biological properties

Gorbachev A.L., Kubasov R.V.

Abstract

RELEVANCE. Seaweed, along with all the other aquatic biological resources, is of great economic importance for all countries of the world community. Due to positive effects of biologically active substances, contained therein, it is widely used as dietary supplements, drugs, hydrocolloids (agar, alginates, carrageenan).

OBJECTIVE. Based on literature data to study current knowledge about the chemical composition of seaweed and its medical-biological properties, which can be used in life activity.

MATERIALS AND METHODS. The study used literature sources from international databases Web of Science, Scopus as well as the national library system eLibrary. The keywords in the search engine: seaweed, biochemical composition, biologically active properties, medical importance.

RESULTS. The chemical composition of seaweed is due to its habitat. It contains practically all chemical elements, present in seawater. Because of beneficial biological effects, seaweed is widely used by humans, especially in medicine. Among organic compounds seaweed is rich in polysaccharides, lipids, protein compounds as well as vitamins. The main part of polysaccharides belongs to alginic acid and fucoidan. Alginates have anti-inflammatory, sorption and reparative properties, normalize metabolism. Fucoidans have anticoagulant and antioxidant effect, inhibit penetration of viruses into tissue cells.

DISCUSSION. Seaweed is rich in protein compounds. It contains all essential amino acids. Moreover, all classes of fatty acid (especially polyunsaturated) are found in seaweed. Lastly, many water-soluble and fat-soluble vitamins are synthesized in seaweed, like plants on land: ascorbic acid, tocopherols, carotenes, thiamine, cobalamins, etc.

It is concluded that seaweed can be considered a unique supplier of biologically active components: minerals, proteins, polysaccharides, polyunsaturated fats and vitamins. Its use is justified with therapeutic and preventive purposes.

Marine Medicine. 2023;9(4):26-33
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ORIGINAL ARTICLE

The risk of professional incompetence in employees of Azerbaijan Caspian shipping company: retrospective study

Gurbanova M.H.

Abstract

OBJECTIVE. Estimate risk factors of professional competence on health grounds in employees of the Azerbaijan Caspian Shipping Company.

MATERIALS AND METHODS. The study used materials of preventive medical examinations of 9904 ACSC employees and the conclusions of the medical and advisory commission for professional competence examination of persons for 2021. The commission recognized professional incompetence in 53 employees.

Statistical processing was carried out using a set of methods of qualitative feature analysis. The frequency of professional incompetence was set per 1000 examined, 95% confidence interval (CI) was calculated at t=1,96. Statistical significance (critical value 0,05) of differences in the proportion of professional incompetence was estimated by χ² criteria.

RESULTS. The frequency of professional incompetence among ACSC employees was 5,4‰ (95% CI 4,9 - 5,8‰). The maximum value of the indicator was observed in workers of “Zigh” Shipyard (8,2‰; 95% CI 6,5 - 10,0‰), basic services of ACSC did not differ significantly from each other in the frequency of professional incompetence cases. Professional incompetence was established among seamen (14,7‰), motormen (11,6‰), mechanics (6,0‰), boatswains (4,1‰), captains (4,3‰), mates (3,7‰), locksmiths (13,9‰) and painters (16,5‰). The comparison against these groups in frequency of professional incompetence refutes the valid null hypothesis (р=0,045).

DISCUSSION. The criteria for the professional suitability of seafarers in Azerbaijan are identical to those in the Russian Federation; the frequency of professional unfitness identified during periodic medical examinations of seafarers in the Sakhalin region was 9.0 ± 2.1 ‰ (2011–2016). The indicator in ACSC (5.4 ± 0.7 ‰) is noticeably lower, but the difference between these indicators is statistically insignificant. The nosological structure of the causes of professional unsuitability of seamen in the Sakhalin region and ACSC is similar: the share of diseases of the circulatory system is 55.5% and 60.4%, respectively, blood 5.5% and 5.7%, injuries 5.5% and 5.7% almost the same. The share of musculoskeletal diseases is 2 times less among the causes of professional incompetence in ACSC.

CONCLUSIONS. Significant risk factors of professional incompetence on health grounds are age (>45 years) and work experience (>20 years). The work of locksmiths, painters, seamen, motormen and mechanics compared to the work of captains, boatswain and mates creates significantly higher risks for pathology, provoking professional incompetence, the main causes of which are circulatory system diseases.

Marine Medicine. 2023;9(4):34-39
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Ground-level ozone concentration and emergency conditions in patients with bronchial asthma on southern coast of Crimea: retrospective study

Evstafeva E.V., Lapchenko V.A., Dudchenko L.S., Belyaeva S.N.

Abstract

OBJECTIVE. To evaluate the link of emergency conditions in patients with bronchial asthma to the ground-level ozone concentration in different seasons of the year on the southern coast of Crimea.

MATERIALS AND METHODS. Epidemiological study of frequency of visits concerning emergency conditions in patients with bronchial asthma in Yalta according to the ambulance station from April 2010 to March 2011; permanent recording of the ground-level ozone concentration at the background environmental monitoring station (BEMS) by the optical method using automatic gas analyzer APOA 370 (HORIBA). Analysis of the collated data dependence via the Spearman non-parametric correlation analysis.

RESULTS: Correlation analysis of daily, average monthly and seasonal data on ambulance call with regard to severe bronchial asthma and average daily, maximum, minimum ground-level concentration (GLC) during the astronomical year (April 2010- March 2011) has revealed single-type dependence in nature on the amplitude of ozone changes: statistically significant in November and at the level of trends – in September 2010 that does not provide a sufficient basis to talk about a negative ozone impact on the condition of patients with bronchial asthma on the territory of the southern coast of Crimea. The possible causes of the identified weak dependence are analyzed, though the daily average of ozone was typically higher than MPV (maximum permissible value) throughout the follow-up period, and in the summer – higher than MPV with 8-hour exposure.

DISCUSSION. However, considering data of numerous foreign studies on the quantification of ozone negative impact on the human body, it is necessary to analyze more long-term series of observations in view of related weather factors of the Southern coast of Crimea that can significantly modify response of the body to GLC. This will determine ozone levels along with other weather conditions, safe for patients with bronchial asthma, including those who undergo rehabilitation in sanatorium-resort institutions of Crimea.

Marine Medicine. 2023;9(4):40-50
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Modern diagnostic approaches to osteoarticular manifestations in Navy diving personnel: retrospective study

Krukov E.V., Kireeva E.B., Chumakov A.V., Cherkashin D.V., Yazenok A.V., Makiev R.G., Agafonov P.V.

Abstract

OBJECTIVE. Study the features of the pathogenesis and clinical picture of musculoskeletal disorders in different categories of the Navy military personnel and pensioners of the Defense Ministry (DM) based on a set of clinical, instrumental, laboratory and genetic examination methods.

MATERIALS AND METHODS. There was screening and study of medical records of 98 Navy military personnel and pensioners of DM in the following groups: I — the Navy military personnel with no hyperbaric exposure in the anamnesis, II — military personnel, belonging to deep water divers with moderate experience (total work experience in hyperbaric conditions: 20–500 hours), III — military personnel, belonging to deep water divers with considerable experience (total work experience in hyperbaric conditions: 700–2500 hours), IV — pensioners of DM, whose professional activities were related to operations on extreme depth (aquanauts), V — pensioners of DM with no hyperbaric exposure in the anamnesis. There was a detailed laboratory and instrumental examination of bone metabolism, including digital radiography, osteodensitometry, MRI, CT and genetic testing.

RESULTS. The Navy diving personnel experience significant osteoarticular manifestations by type of dysbaric osteonecrosis, most pronounced in pensioners of DM – aquanauts.

DISCUSSION. Digital radiography and MRI are found to be an optimal diagnostic method of dysbaric osteonecrosis and “dysbarogenic osteoarthropathy”. As a method of express diagnostics, it is advisable to use innovative urine test strips to determine threshold concentrations of β-crosslaps and α-crosslaps markers of bone resorption.

Marine Medicine. 2023;9(4):51-62
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Inhalation of heated oxigen-helium mixture in treating obstetrtic and gynecological pathology: prospective experimental study

Petrukhin V.A., Shuginin I.O., Lazarev V.N., Shidlovskaya N.V., Babunashvili E.L., Shchukina N.A., Buyanova S.N., Chechneva M.A., Budykina T.S., Kovalenko T.S., Magilevskaya E.V., Osipov R.S.

Abstract

INTRODUCTION. The heated oxygen-helium mixture has found application in treating acute respiratory failure in patients with the exacerbation of chronic obstructive pulmonary disease, postextubation stridor, croup and viral bronchiolitis in children, acute respiratory distress syndrome in newborns. The article presents the results of own study according to the results of applying inhalations of the heated oxygen-helium mixture (oxygen 30%, helium 70%) in order to improve reparative processes in postoperative gynecological cases (after myomectomy) and to treat placental insufficiency in pregnant women with diseases of the bronchopulmonary system.

OBJECTIVE. То estimate efficacy of the heated oxygen-helium mixture on the reproductive health of pregnant women with bronchopulmonary pathology and gynecological cases with patients of reproductive age after myomectomy.

RESULTS. Against the background of the treatment, there was an increase in blood oxygen saturation, normalization of indicators of fetoplacental hemodynamics and hormonal function of fetoplacental complex in pregnant women. Inhalations of the heated oxygen-helium mixture in gynecological cases after myomectomy led to an increase in blood flow velocity in the area of ligatures.

CONCLUSION. The study has shown that the method of inhalation through the heated oxygen-helium mixture (70% helium, 30% oxygen) is effective, safe and prospective for applying in obstetric and gynecological practice.

Marine Medicine. 2023;9(4):63-71
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Differentiated approach to preoperative preparation of patients with various cardiovascular risk in locally advanced cancer of abdominal organs: experimental study

Kuchev R.D., Shulenin K.S., Soloviev I.A., Surov D.A., Korzhuk M.S., Filippov V.Y., Tyuryupov M.S., Shulenin D.K.

Abstract

INTRODUCTION. Malignant neoplasms of the abdominal organs often lead to exacerbation of cardiovascular diseases or trigger their development. Only proper evaluation of cardiovascular risk allows to effectively prepare for the operation, to choose best option of surgery and to decrease the likelihood of complications in the postoperative period.

OBJECTIVE. To study the possibility of a differentiated approach to additional preoperative preparation in the surgical treatment of locally advanced cancer of the abdominal organs in patients with different degrees of cardiovascular risk.

MATERIALS AND METHODS. The first stage included retrospective result analysis of planned surgical treatment of 250 patients under the standard approach to pre-operative examination and preparation. At the second stage, 101 patients were tested a modified algorithm of additional preoperative examination where there was emphasis on persons with an average cardiovascular risk. The observation period did not exceed 30 days. The stratification of perioperative cardiovascular risk was conducted by RCRI and NSQIP-MICA index calculation. Statistical processing of the results was carried out using “Statistica 12.5” application packages (StatSoft, USA).

RESULTS. The standard approach to preoperative preparation was characterized by relatively high mortality in the early postoperative period (18,4%). Most deaths (54,3% on RCRI scale and 69,5% on NSQIP-MICA scale) were among patients of an average cardiovascular risk. Differentiated algorithm implementation of additional preoperative examination has reduced the incidence of postoperative complications by 2,1-5,9 times, the duration of the patient’s stay in intensive care by 1,4 times and hospital mortality by 2,3 times (up to 7,9%).

DISCUSSION. The proposed algorithm is focused on the most problematic subgroup of patients with an average cardiovascular risk (1 risk factor on RCRI scale and/or decreased (indefinite) functional status) which, in standard preparation for surgery, have the same chance of an adverse outcome as persons with high comorbidity.

CONCLUSION. The use of validated methods in evaluating perioperative risk, differentiated approach to additional examination and rational pharmacotherapy reduce hospital mortality in patients with locally advanced cancer of the abdominal organs.

Marine Medicine. 2023;9(4):72-84
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Features of doctors training for navy in modern conditions: retrospective study

Luchnikov E.A., Chernikov O.G., Kupriyanov S.A., Minaev N.V., Zakrevsky Y.N.

Abstract

OBJECTIVE. To study features and issues of preparing future doctors for the Navy.

MATERIALS AND METHODS. There was analysis of reports on the results of the naval internship of cadets-trainees, undergoing practical training on surface ships and submarines, during the period of completing education in 2021-2022 and 2022-2023 school year in the Northern, Black-Sea and Baltic fleets. Report processing was carried out by the method of historical comparison, systemic and comparative analysis. There was a comparison of the preparation system for Navy doctors of the Russian Federation at different historical stages, economic component and level of medical specialists’ training.

RESULTS. It was found that surgical patients constitute more than 60 % of all cases of initial visits and 70 % of all evacuations on surface ships during the long voyage. Thus, surgical pathology is decisive in causes of morbidity and evacuation, being a limiting factor in medical support of the long voyage and requiring the organization of adequate qualified surgical aid directly on ships. Analysis of enhanced medical support on a ship long voyage in modern realities showed that with medical specialists it reaches almost 100 % as a consequence of staffing naval positions with specialists of the qualification “medical doctor”.

DISCUSSION. Due to the shortage of naval doctors with a surgical specialty, 5 options of the position substitution with “surgery” specialization were offered, based on the analysis of the system of training doctors for the Navy and in view of the changed regulatory framework in the preparation of medical specialists.

Marine Medicine. 2023;9(4):85-96
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CLINICAL CASE

Clinical cases of “MR-negative” myelopathy amid SARS-CoV-2 infection

Kushnir Y.B., Bezvodinskikh A.I., Vladykina A.V., Gotovchikov A.A., Totolyan N.A.

Abstract

INTRODUCTION. Neurological complications are often observed in patients with a new coronavirus infection. Cerebrovascular diseases prevail among them. There is damage to the peripheral nervous system and spinal cord of various kind, including inflammatory and vascular myelopathy. The incidence of myelopathy syndrome among all neurological complications of the new coronavirus infection reaches 3%.

OBJECTIVE. To characterize clinical and instrumental features of the rare case – “МR-negative” myelopathy amid SARS-CoV-2 infection.

MATERIALS AND METHODS. The article describes a clinical case of myelopathy, associated with COVID-19 without structural changes in the spinal cord on MR-imaging using standard pulse sequences, however, visualized via spinal tractography.

CONCLUSION. COVID-19 associated myelopathy is one of the characteristic complications amid the new coronavirus infection. To verify “MR-negative” damage to the central nervous system in COVID-19, advanced protocols of MRI studies might be used, including the promising method – МR-tractography.

Marine Medicine. 2023;9(4):97-106
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CORRESPONDENCE

How ICL mobile posts help RCH doctors

Shagivaleev A.A.
Marine Medicine. 2023;9(4):107-112
pages 107-112 views


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