Vol 9, No 1 (2023)

OBJECTIVE: Based on the analysis of literature data, highlight the mechanisms of anti-inflammatory action of hyperbaric oxygenation (HBO) in peptic ulcer of the stomach and duodenum (PUS and D).
MATERIALS AND METHODS: The subject of study was scientific publications on the use of hyperbaric oxygenation (GBT) in treatment (PUS and D). The search was carried out on the international databases Elibrary, Pub Med, Scopus, Google Scholar from 1980–2022. A total of 38 literature sources were selected, of which at least 60% were published within the last five years.
RESULTS: The effectiveness of the therapeutic effect of HBO (ulcer healing rate) in PUS and D depends on the location and size of the ulcer defect on the wall of the stomach or duodenum. At the moment, there is no conclusive data on the optimal number of HBO sessions required to achieve the maximum therapeutic effect in the treatment of PUS and D.
DISCUSSION: The leading link in hyperoxic sanogenesis in this pathology is the anti-inflammatory effect of hyperbaric oxygen (HBO2), which is realized by: a) through stimulation of mucocyte formation; b) through regulation of HBO2 qualitative composition of mucocyte secretion; c) by stimulating the formation of bicarbonates by additional cells and increasing the sensitivity of these cells to their endogenous stimulant -solar acid (HCl); d) through the effect of HBO2 on gastrin formation (HCl stimulant), as well as on the diffusion of HCl from the gastric lumen into its capillary network. Together, this leads to a rapid cessation of pain syndrome, which creates conditions for the elimination of dyspeptic syndrome. This is realized through the restoration of the myoelectric activity of the stomach wall and duodenum, the regulation of the myogenic tone of their walls, as well as the elimination of the violation of gastric accommodation in the conditions of HBO.
CONCLUSION: The anti-inflammatory effect of HBO2 in the treatment of PUS and D allows us to consider hyperbaric oxygenation as an integral part of the treatment of ulcerative lesion of the upper gastrointestinal tract.

INTRODUCTION: The pandemic of a new coronavirus infection has become a serious test of our country’s health care system.
OBJECTIVE OF THE STUDY: Analysis of the dynamics of the performance of emergency hospitals during the pandemic of a new coronavirus infection.
MATERIALS AND METHODS: The material was the data of federal state statistics (sources - FSN No. 14 and 30, 2019- 2021) of 2 multidisciplinary hospitals operating in ambulance hospitals (24/7/365), which have fundamental structural and functional features related to the availability of beds for patients with COVID-19. Regulatory, statistical (analysis of averages using parametric T-test and one-way-ANOVA analysis of variance, Spearman correlation analysis) and analytical methods (analysis, synthesis, comparison) were used.
RESULTS: For a hospital with deployed beds for patients with COVID-19, there was a characteristic decrease in volumetric performance indicators: the number of patients in the admission department (by 61.7 %), non-hospitalized patients (by 82.2 %) and patient refusals from hospitalization (by 83.6 %), the number of outpatients (by 77.7 %), the number of discharged patients (by 17.7 %), carried out by patients bed-days (2.9 %), patient re-hospitalizations (96.1 %). For a hospital that was not re-profiled for COVID-19, there was a slight increase in visits (+ 1.4 %) with a decrease in the number of discharged patients (-22.8 %) and spent bed days (-12.4 %), an increase in the number of non-hospitalized patients (by 34.2 %) and the volume of care on an outpatient basis (+ 22.7 %), the number of re-hospitalized patients increased (+ 55.5 %).
In hospitals, there was an increase in the number of patients who died (by 154.8 % and 29.2 %, respectively), including those with respiratory diseases (by 433.3 % and 145.5 %, respectively).
DISCUSSION: Two multidisciplinary emergency hospitals had significant differences in the organization of their work in the period 2019-2021, due to the re-profiling of beds for receiving infectious patients (for patients with COVID-19) and the assignment of additional volumes of specialized non-infectious medical care to the non-redesigned multidisciplinary hospital.
CONCLUSION: Currently, multidisciplinary emergency hospitals require the development of new models and principles for organizing the medical and diagnostic process, providing for the deployment of inpatient emergency departments, mobile bed capacity, infectious beds, development of algorithms for admission and triage of patients, reduction of unreasonable and non-core hospitalization, increasing the availability, efficiency and quality of medical care, which will increase the readiness to work in emergency situations of such a pandemic with a new coronavirus infection (COVID-19).

OBJECTIVE: Assess the connection between clinical, laboratory and radiological manifestations of the new coronavirus infection.
MATERIALS AND METHODS: The study conducted a retrospective analysis of 100 patient medical histories, treated in Saint Petersburg State Budgetary Healthcare Institution «the Holy Martyr George Hospital» with confirmed diagnosis «Coronavirus infection COVID-19, the virus is identified». A statistical analysis of clinical laboratory values was carried out based on severity of COVID-19 course and infiltrative changes of lung tissue by computed tomography data. Statistics. Statistical analysis of the data was held using PC and set of software StatPlus 8.0.
RESULTS: Depending on the nature of COVID-19 course, the comparison of clinical laboratory data among patients (average age 63,5 [19–98]) found that with increase in severity of the disease (mild – moderate − severe) there were changes in the following clinical laboratory values: erythrocyte sedimentation rate 15,4 ± 6,3 mm/h − 18,5 ± 13,5 mm/h – 31 ± 17 mm/h (positive correlation); lymphocyte level 1,49 ± 0,67 x 10⁹ /l − 0,86 ± 1,45 x 10⁹ /l − 0,68 ± 0,31 x 10⁹ /l (negative correlation); C-reactive protein 8,4 ± 4,7 mg/l − 47,3 ± 18,7 mg/l − 148,7 ± 53,1 mg/l (positive correlation); ferritin 43,4 ± 24,8 µg/l − 743,9 ± 50,3 µg/l – 1425 ± 485,4 µg/l (positive correlation) and the degree of pulmonary tissue lesion according by computed tomography 0 % − 32 ± 13 % − 56 ± 11 % (positive correlation).
DISCUSSION: In the course of this study it was found that mild course of COVID-19 is characterized by minor changes of laboratory values, compared to the group of severe and moderate course. There was a strong correlation between the level of COVID-19 severity and lymphocyte level (negative) as well as ferritin (positive) and the degree of infiltrative changes in lungs according on the computed tomography (positive).
CONCLUSION: The revealed correlations do not allow a full planning of patient management tactics and to predict the course of COVID-19. Developed diagnostic and treatment algorithm should be based on clinical laboratory and instrumental assessment of the patient’s condition.

OBJECTIVE: To detect oral mucous membrane disease of the mouth, lips and tongue in seafarers on long voyage, to evaluate preventive measures and treatment effectiveness.
MATERIALS AND METHODS: There was a dental examination of 169 men, aged 22-52 on long voyage, who got full treatment and preventive measures of oral rehabilitation in the pre-deployment period in a time manner. The seafarers were divided into 2 groups. The 1^st group included 57 seamen, who were part of the crew. The 2^nd group consisted of 112 men, who were training and had the first long voyage. The oral mucosa diagnosis was based on a clinic examination. When identifying pathology, treatment was provided and there were anti-relapse measures after its completion, which were possible given the people on board on long voyage.
RESULTS: It was found that the structure of oral mucosa is quite different among people of the 1^st and 2^nd groups. The pathology among the crew occurred more often due to the autoimmune component of pathogenesis in 5,26% and 0,9% cases respectively, while the people in the 2^nd group, being on long voyage as part of their training, experienced infectious oral mucosa pathology (12,28% and 15,32% respectively) significantly more often, and also lesions of the lips due to meteorological factors in 8,77% and 10,81% cases accordingly.
DISCUSSION: The article discusses the treatment of meteorological cheilitis, the fracture of the vermilion border of the lip, Vincent disease, herpetic fever and chronic recurrent aphthous stomatitis with the use of domestic medicine for topical application.
CONCLUSION: On long voyage 26,04% seafarers had cases of oral mucosa, among which most frequently diagnosed ones were infectious diseases, pathology due to meteorological factors, and also diseases with the autoimmune component of pathogenesis. In all cases domestic medicine for topical application was used to reveal pathology of oral mucosa, and further, to prevent its recurrence that allowed to achieve a good therapeutic result and to avoid recurrence of oral mucosa disease, typical for seafarers during a 9-month voyage. 

OBJECTIVE of the study is to determine the influence of changing oxygen status in the animal’s body on nitrogen toxic effect under pressure.
MATERIALS AND METHODS: A hyperbaric chamber was used to create normothermic effect of hyperbaric nitrogen up to 4,1 MPa amid changing oxygen concentration from 0,03 to 0,004 MPa, recording rats’ motor activity and posture reflexes.
RESULTS: Oxygen decrease in the respiratory gas medium from 0,021 to 0,004 MPa due to nitrogen compression raised biphasic sensitivity of Wistar rates to nitrogen toxic effect. Yet in the sites of non-compensable hypoxia sensitivity to hyperbaric nitrogen effect increased 4,5 times. Preliminary exposure of pregnant rats in hypoxia led to decrease in the offspring’s sensitivity to toxic effect of hyperbaric nitrogen by 35% on average after reaching puberty.
DISCUSSION: The obtained data allows to regard toxic effect of hyperbaric nitrogen as oxygen-dependent process. While hypoxia along with hyperbaric nitrogen effect enhances nitrogen narcosis, hypoxia, prior to nitrogen compression, reduces intoxication of this gas.

OBJECTIVE: Based on the analysis of national normative documents and a series of animal experiments to evaluate the effectiveness of a not common method of a diver’s recompression after emergency ascent, skipping all the mandatory decompression stops in order to prevent the development of decompression sickness.
MATERIALS AND METHODS: In the study Wister rats (n = 30) were used. The animals were placed in the chamber and there was air compression up to 9 АТА with exposure under pressure within 15 min. Decompression was carried out by pressure release with imitation of emergency ascent. After 5 minutes there was recompression by air up to АТА, isopressure within 10 minutes and elongated decompression. During recompression, further decompression and 2 hours after its completion the animals experienced behavioral response and signs of compression disorder development.
RESULTS: The study showed that the test group where the animals’ exposure under 9 ATA completed with the planned decompression on the regime did not experience any behavioral disorder and reflexes of posture during and after decompression. There were also no registered gas bubbles in the brain. Similar results were obtained in the test group with emergency ascent, recompression and further elongated decompression, but not in the group with emergency ascent without recompression.
DISCUSSION: The application of the proposed recompression method after imitation of emergency ascent leads to neither visual nor morphologically registered signs of decompression disorders. Along with a shorter period of recompression and decompression as compared with the ones, described in regulatory documents, it allows to adopt the proposed method for reducing the loss of time and resources while maintaining diver’s health and performance after emergency ascent. 

The clinical case of acute myocardial infarction and pulmonary embolism in a young soldier with the first occurred protracted attack of angina. The survey found the link between these conditions and gene mutation of type 1 plasminogen activator inhibitor that plays a key role in fibrinolysis by inhibiting the formation of plasmin and leading to slowdown in fibrinolysis processes and a longer-term persistence of blood clot. It is proven that homozygous 4G/4G mutation found in the patient results in the development of arterial and venous thrombosis at a young age and is associated with a tendency to relapse. It clearly shows that hereditary thrombophilia is characterized by the absence of obvious provocative factor and single universal diagnostic algorithm; the diagnosis is based on the comprehensive evaluation of laboratory data.

Divers use tables with decompression modes when conducting diving descents. Currently, tables are being replaced by underwater computers, into which modern mathematical models of decompression algorithms are programmed. None of the existing models takes into account the individual characteristics of the organism, the processes occurring in the body under conditions of high pressure of the gas and water environment, and does not describe the real processes well enough.
Modern diving computers are able to supply a diver with a large amount of information. Based on data on depth, time, number of dives and time of surface intervals, they help to plan dives, inform when it is necessary to make an ascent, assign, if necessary, safety stops and calculate the time before the flight by plane.
Currently, it is safe to say that a computer is simply necessary for a diver. His health, and sometimes his life, depends on it.

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