Extreme Medicine

ISSN Print 2713-2757 ISSN Online 2713-2765

Extreme Medicine

SCIENTIFIC AND PRACTICAL REVIEWED JOURNAL OF FMBA OF RUSSIA

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Cherkashin MA, Berezin NS, Berezina NA, Nikolaev AA, Kuplevatskaya DI, Kuplevatsky VI, Rakova TM, Shcheparev IS

The COVID-19 pandemic affected every sector of society, radically altering the work of health systems throughout the world. In the situation of the mass influx of patients seeking medical care that was hard to control, the issue of the widespread adoption of the medical sorting (triage) principles became urgent within weeks. The review provides analysis of 49 publications dealing with various aspects of arranging pre-hospital triage. The dynamic changes in approaches to triage, its objectives and technologies, as well as in the contribution of various X-ray imaging methods depending on the evolving experience of working with the novel infection, are of great interest. The search for literature in Russian and English published before March 10, 2022 was performed in a number of databases (Embase, Medline/PubMed, Researchgate, medrxiv.org, RISC). The search was performed using the following keywords: COVID-19, coronavirus, коронавирус, SARS-COV-2, 2019nCOV, lung ultrasound, computed tomography, computerized tomography, компьютерная томография, СT, triage, сортировка. The strategy of establishing pre-hospital triage centers or stations in case of pandemic makes it possible to reduce both the burden on the emergency departments and the occupancy rate for inpatient services. Quick access to various imaging methods (X-ray imaging, lung ultrasound or computed tomography) greatly facilitates taking clinical decisions, and could be considered beneficial in the current extraordinary situation.

Received: 2022-04-14

Published online: 2022-05-25

DOI: 10.47183/mes.2022.015

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VIEWS 1929

Turlakov YuS, Grabsky YuV, Arefeva DV, Shayakhmetova AA, Firsanov VB, Petushok AV

Studying the features of radiological situation in the workplace and assessing the individual effective doses in employees of research organizations working with open radiation sources (RS) are an urgent scientific task due to additional risks resulting from variability in the conditions and regimes of the technological operations. The study was aimed to assess the working conditions and intake of radionuclides by the employees of the V. G. Khlopin Radium Institute working with open RS. The data on exposure to work-related radiation factors were obtained by dosimetry, radiometry, and spectrometry. It was found that radiological situation in the employees' workplaces was characterized by the broad range of the gamma ambient dose equivalent rate values (0.10–122 µSv/h), alpha and beta working surface contamination, radioactive pollution of air in the working areas. In some individuals, spectrometry revealed the following: 125I in the thyroid gland (up to 9,850 Bq), 90Sr in the skeleton (up to 16,500 Bq), 137Сs in the whole body (up to 1,100 Bq), etc. The findings can provide the basis for developing the measures to improve the quality of individual internal dose control and the efficiency of medical care provision to the research organization employees dealing with open RS.

Received: 2022-03-24

Published online: 2022-05-18

DOI: 10.47183/mes.2022.014

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VIEWS 1731

Bespyatykh JA, Basmanov DV

Tuberculosis, caused by Mycobacterium tuberculosis, remains a global burden on our country and entire world. According to the World Health Organization, 10 million incident cases of tuberculosis were registered in 2019. A steady increase in the drug-resistant tuberculosis aggravates the situation and appears to be the major obstacle to the fight against the disease. A thorough understanding of the pathogen physiology and virulence properties is extremely important for the development of new diagnosis methods and treatment strategies. Multiomics approaches to studying the infectious agents are indispensable in understanding the nature of the disease. Despite the availability of sufficient genomic and transcriptomic data, pathogenic potential, survival rate, persistence, immunomodulation, mechanisms underlying drug resistance and host–pathogen interaction remain poorly understood. The use of proteomic approaches has been more informative, and provides more information about the true state of the cell in various conditions. Proteomic and bioinformatic approaches helped considerably in identification and characterization of target proteins that could be used for the development of new therapeutic options. Nevertheless, OMICs data integration with simultaneous use of the system approach to studying various clinically significant mycobacterial strains makes it possible to increase knowledge about the disease mechanisms and infection control methods. The review outlines various OMICs technologies and their role in the development of the M. tuberculosis diagnostic panels.

Received: 2022-04-12

Published online: 2022-05-16

DOI: 10.47183/mes.2022.013

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VIEWS 1732

Zvereva ZF, Torubarov FS, Vanchakova NP, Denisova EA

Psychophysiological assessment of employees of 10 Russian nuclear power plants revealed a low degree of psychophysiological adaptation (PPA) in 30% of subjects. Studying the fuctional activity (FA) of the brain by EEG revealed the decline in FA in individuals with the low degree of PPA. The impaired cerebral energy exchange could be one of the factors contributing to the decline in the brain functional state. The study was aimed to assess the features of the cerebral energy exchange in the employees of the hazardous nuclear facilities and productions with the low degree of PPA. A total of 159 EEG recordings acquired from individuals with the low degree of PPA (50.8 ± 4.6), and 152 EEG recordings acquired from individuals with the high degree of PPA (48.8 ± 1.5) were studied. Energy exchange was assessed in individuals with the low FA of both brain as a whole and the following conditionally distinguished structural and functional units (SFUs) of the CNS: mainly cerebral cortex (SFU-1), cortical-subcortical interactions (SFU-2), central control of the cardiovascular system (SFU-3). EEG was recorded by standard method using the electroencephalography unit. The magnitude of the hemispheric differences (HD) in the power of biopotentials (BP) between the homologous EEG leads was used to assess the cerebral energy exchange. There is evidence of the cerebral energy exchange increase in the anterior cortical areas of individuals with the low degree of PPA. The increased cerebral energy exchange has been also revealed in SFU-1 and SFU-2 responsible for the mental and psychophysiological functions of the CNS. However, cerebral energy exchange remains unchanged in the SFU-3 reflecting the central control of the CVS.

Received: 2022-04-15

Published online: 2022-05-03

DOI: 10.47183/mes.2022.012

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VIEWS 1694

Osipov MV, Sokolova VA, Kushnir AS

COVID-19 pandemic announced by World Health Organization in March 2020 raised concern on potential demographic losses. This retrospective study was aimed to analyze the pandemic-related changes in the demographic status of the Ozyorsk urban district located close to the nuclear industry facility — the “Mayak” Production Association. Population changes in the Ozyorsk urban district over the last decade were analyzed based on the open-access demographic data. The impact of the COVID-19 pandemic on the demographic status of the Ozyorsk urban district was assessed using the crude overall mortality rates. Comparison of the overall mortality rates has been performed between 2020 and each previous year to assess the deviation of mortality from the forecasted value. The overall mortality rate in 2020 has been found increased significantly by 19%. Excess mortality attributed to the impact of the pandemic was 13.4%. The expected absolute number of excess deaths from COVID-19 being the main cause of death was 60 (4.2%). The COVID-19 pandemic had a significant negative impact on the demographic status of the Ozyorsk urban district; however, the role of COVID-19-associated deaths in overall mortality was not predominant.

Received: 2022-03-10

Published online: 2022-04-21

DOI: 10.47183/mes.2022.011

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VIEWS 1815

Vologzhanin DA, Golota AS, Kamilova TA, Makarenko SV, Scherbak SG

The clinical spectrum of SARS-CoV-2 infection continues to expand, raising important fundamental issues regarding the SARS-CoV-2 cellular tropism and pathogenic mechanisms. Liver damage is observed in patients with all forms of COVID-19, especially severe and critical forms, which could be due to the direct viral damage, immune dysregulation (systemic inflammatory response and cytokine storm), hypoxia-ischemia, drug-induced hepatotoxicity, and concomitant chronic disorders. Liver damage, defined primarily by elevated transaminase levels, is often observed in patients with COVID-19 and correlates with clinical outcomes, including mortality. Diagnostic criteria, pathogenesis, clinical characteristics, treatment, and prognosis of liver injury in COVID-19 should be clarified in further clinical trials. Currently, there is a critical shortage of proven treatment options for patients with COVID-19, resulting in an urgent need to study the multiple organ failure and liver damage pathogenesis in patients with this disease. The review provides information about the pathophysiological mechanisms of the SARS-CoV-2-induced liver damage and the development of liver failure in COVID-19. Information sources were searched in the PubMed database using the keywords “liver damage in COVID-19” and “immune liver damage in COVID-19”.

Received: 2022-03-14

Published online: 2022-03-31

DOI: 10.47183/mes.2022.009

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VIEWS 1791

Popova EV, Krivorotov DV, Gamazkov RV, Radilov AS

Development of drug delivery systems based on branched biocompatible polymers is one of the most promising areas of modern nanopharmaceutics. Researchers have been exploring this area several decades now, and the results of their efforts quickly find their way into production. Dendrimers, a new class of universal synthetic polymers with a highly functional surface, have a number of unique properties: constant size, high degree of branching, multivalence, solubility in water, definite molecular weight, internal cavities. With the release of VivaSol gel, the first dendrimer-based commercialized product, the "model range" of dendrimer carriers has grown significantly. Poly(amide-amine) (PAMAM) dendrimers, which consist of an alkyldiamine core and tertiary amine branches, are believed to be among the most promising compounds that can be used in the development of the new generation drugs. However, they were kept out of the list of clinically acceptable compounds for a long time because of their toxicity, unclear behavior in living systems and pharmacokinetic profile, as well the difficulties associated with establishing a therapeutic dose. This review presents basic information about PAMAM dendrimers and attempts to assess the prospects of their application in treatment of various diseases, including COVID-19.

Received: 2022-03-10

Published online: 2022-03-30

DOI: 10.47183/mes.2022.008

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VIEWS 1842

Nazaryan SE, Samoylov AS, Sedin VI

In the beginning of 2020 there appeared an urgent need for substantial advancement of the medical and psychological support for medical personnel involved in medical care provided to patients with the new coronavirus infection (COVID-19) in hospital settings. This need originated from the necessity to diagnose the risks of doctors developing mental states that adversely affect their professional performance and, subsequently, lead to disorders. In addition, there are under-researched matters of dependence of the prevalence of destructive mental states on the intensity of workload experienced by doctors in the "red zones", where the risk of patient fatalities is high. This study aimed to investigate the workload-dependent dynamics of psycho-emotional exhaustion among the medical staff of a COVID hospital. We analyzed the psychological tests (MBI, Maslach Burnout Inventory) that 121 people completed during a four-week assignment in the "infectious" zone and two weeks in the observation department. Seventy-nine doctors comprised the heavy workload group and 42 were in the moderate workload group. The study showed that healthcare workers experiencing heavier workloads exhibit high values of the psycho-emotional exhaustion indicators more often. We registered significant differences (р ≤ 0.05) by the Emotional Exhaustion scale at the third and fifth weeks of the study. By the fifth week, i.e., when the assignment in the "infectious zone" was over, heavy workload group had the median of 25 (23.5; 27), while in the moderate workload group it was 14 (14; 15), which is 56% lower.

Received: 2022-03-01

Published online: 2022-03-28

DOI: 10.47183/mes.2022.010

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VIEWS 1701