Romanian Journal of Military Medicine Issue No.1 / 2021, Vol. CXXIV, February

Edition number: 1 | Volume: CXXIV | Month: February | Year: 2021

Concepts for the implementation of a technological platform for the production of specific antidotes for CBRN medical protection

All large armies (EU and/or NATO) have pharmaceutical production facilities to provide the necessary antidotes for the troops and the population: The French Army Medical Directorate produces many military-specific pharmaceutical products in its own laboratory, the Turkish Army owns its own medicines factory, including CBRN antidotes, the US Army, in addition to a sustained drug purchase program in the pharmaceutical industry has launched a new concept: Pharmacy on demand. Providing the armed forces with antidotes is a necessity, the concept for their endowement in this sense can be based on imports (sometimes impossible to achieve) or on the national development of a specialized production structure. The design or construction of a specific production capacity for antidotes can be accomplished on multiple variants, with a complexity proportional to the identified need. The total costs are high, but the objective and implementation of effective antidote supply mechanisms is a security guarantee for the armed forces and the civilian population (through commercialization to allied forces), given the risks of terrorist threats and hybrid warfare.

Peptide nucleic acid (PNA) as a novel tool in the detection and treatment of biological threatening diseases

Peptide Nucleic Acids (PNAs) are nanostructures similar to nucleic acid molecules (synthetic DNA/RNA analogs) wherein the negatively charged backbone (sugar-phosphate) present in DNA/RNA molecules is replaced by a backbone without polyamide or peptide charge. Later, it was found that PNAs containing both purine and pyrimidine bases form highly stable duplexes with DNA and RNA. Although it is not as stable as 2PNA/DNA triplexes containing a homopyrimidine strand, it is still more stable than DNA/DNA and/or DNA/RNA duplexes. The unique characteristics of PNAs add new aspects to these nanostructures relative to conventional analogs to make them appropriate for molecular biology studies. The most important applications include the use of these nanostructures in the detection and treatment of diseases caused by threatening biological agents using the antisense/antigen technology and as genetic regulator drugs.

Mass shooting incidents: evolution of preventive procedures, preparation, treatment, and medical care supply

Mass shootings incidents occur with increasing frequency over time. Studying these cases proved that, despite their diversity, several common features could be taken into account in the early detection and possible prevention of certain future cases. Accepting that such incidents may occur anywhere and anytime, societies need to be prepared for their more effective response. Informing citizens about the best way to react to a mass shooting event is considered crucial and essential. The "Run-Hide-Fight" guideline/directive seems to be the most appropriate guideline given to the public. Proper training, of both the Suppression Forces and the emergency medical care providers, is considered of utmost importance. The role of the Incident Commander, regarding the incident management, as well as the external bleeding control of the injured people, are factors of paramount importance in trying to mitigate the casualties from such an incident. The alertness of both citizens and organizations/structures may lead to early detection of potential perpetrators and thereby averting a mass shooting incident. To achieve increased survival and a reduced number of casualties from a mass shooting event it is vital proper education be present at all levels. The response to a mass shooting event should be imprinted in an Emergency plan. Such a plan should have been decided and made, by the Security and Suppression Forces, the Healthcare Institutions, and the Public Safety Answering Point.

Indian experience of tetanus – A study from south India

Introduction: Tetanus is an old world disease where 2 centuries ago people had realized the link between wound leading to muscle spasm and fatality, Even today there are many cases of fatalities of tetanus being reported from different parts of the country even after viability of a tetanus toxoid and Immunoglobulin injections. This one of very few recent studies done in India on tetanus, as there is very little data available on tetanus so we are trying to share our experience on tetanus, so it will help the physicians to get a better understanding. Materials and Methods: This retrospective study has done collecting the patients' detail from 2017- 2019, detailed case sheet review was done and the patients' clinical presentation and the prognosis were noted in predesigned format. Inclusion criteria – all diagnosed cases of tetanus, exclusion criteria – patient already received treatment from the local hospital. The patient details were kept confidential during all times. Results: The total of 58 cases – 35 males and 23 females, The average duration of hospital stay was 15 days. The most common occupation were farmers (barefoot workers). The site of injury was the foot in 65% cases followed by injuries to the fingers or the hand in 30% and 5% cases due to injury while tooth picking with a pin, splinter removal using pins. Clinical symptoms – trismus “lockjaw” (41), difficulty in walking (2), limb pain/stiffness (17), back muscle pain/stiffness (12), dysphagia (7), 72% autonomic dysfunction. Opisthotonus position and risus sardonicus developed after 7-8 days of infection. 20% of cases were vaccinated still developed diseases. 18% mortality was noted most cases were unvaccinated cases. Conclusion: Tetanus is preventable diseases if TT vaccination and IMMUNOGLOBIN are administered on time. In all primary health care levels, the cold chain should be maintained for vaccines. The patients should be made sensitized about the consequence of the disease process.

Chest CT-scan findings in COVID-19 patients: the relationship between the duration of symptoms and correlation with the oxygen saturation level

Purpose: This study is carried out to evaluate the diagnostic value of using common features of computed tomography (CT) imaging in COVID-19 disease, and to assess the relationship between blood oxygen saturation level and severity of CT findings. Materials and Methods: In this retrospective study, the chest CT of 173 test-confirmed COVID-19 patients have been evaluated to determine the patterns of involvement in multiple phases of illness. Then, the correlation between the severity of lung involvement and oxygen saturation levels has been assessed. Results: The chest CT results show that 87.6% of patients had GGO, which was the most common pattern in our findings. 83.8% of patients had bilateral lung involvement with the dominant multifocal and peripheral distribution. peribronchovascular involvement was also a common finding in our study (47.2 %). we found predominantly peribronchovascular view in 3 patients (1.7%), pleural effusion in 4 patients (2.3%), lymphadenopathy in 10 patients (5.8%), the tree in the bud in one patient (0.6%), and nodules in 4 patients (2.3%). We also found that GGO is the most common pattern during the early phase of the disease (97.4% of early phase cases). However, in the intermediate and late phases, consolidation and crazy paving patterns are more common. Moreover, our findings indicate that there is a significant relationship between oxygen saturation level and Total Severity Score, with the exclusion of the young adult patients (20-40 years). Conclusion: Relying on chest CT-scan findings apart from the oxygen saturation level is sufficient for the diagnosis and management of patients with COVID-19 pneumonia.

Burnout syndrome in the Emergency Department of the Central Military Emergency Hospital before and during the COVID-19 pandemic

Introduction: Public interest in burnout has grown recently in developed countries, as has media coverage. Burnout has been a topic of scientific research in recent years for psychologists and sociologists alike. They have published numerous articles on the identification and classification of burnout syndrome. The medical staff is quite exposed to burnout because they often experience strong emotions such as the desire to treat or save their patients, fear of failure, occasional failures in the treatment of diseases. Materials and methods: This study aims to highlight the impact of the burnout syndrome in the Emergency Department of the Central Military Emergency Hospital during the COVID-19 pandemic, by conducting a comparative study based on the results of a questionnaire applied to the medical staff before and during the COVID-19 pandemic. Results: The study interviewed 65 participants aged between 20 and 60 years. They had to anonymously answer 16 questions marked with scores from 1 to 4. Comparing the results highlighted by the questionnaire, applied before the COVID-19 period, with those obtained in the questionnaire applied between May and June 2020, we noticed an increase in the level of burnout in all categories interviewed during the pandemic. Conclusions: In conclusion, the high level of contagiousness and the lack of a vaccine or treatment against SARS-CoV2 infection are additional concerns for burnout syndrome among healthcare professionals.

Quality of life impairments and stress coping strategies during the Covid-19 pandemic isolation and quarantine – A Web-based survey

Isolation and quarantine during the Covid-19 pandemic affected the lifestyle and daily functioning of the population around the world, leading to social, psychological, and economic changes which further multiplied the stress related to the threat of coronavirus contagion by adding financial, relational, academic, professional and mental health vulnerabilities. To assess the impact of isolation and quarantine over the quality of life in the Romanian population, we conducted a Web-based survey focused on the evaluation of stress level, perception of lifestyle changes, communication patterns, mental health, major concerns, perception of one’s future, but also on the preferred coping strategies that people have used to deal with the isolation stress. The answers were collected during one month and the results for the first 2 weeks of quarantine/isolation were compared with the results after one month of such regimen. Several recommendations based on the survey results analysis were formulated regarding possible strategies for decreasing the impact of stress factors over the general population and specific, vulnerable groups.

A systematic review of the various treatment options regarding the effectiveness of IVIG for nephropathy due to BK virus

Introduction: BK virus is an opportunistic infectious disease that causes disease and serious problems when the immune system is suppressed. One of the treatments used against this virus is intravenous immunoglobulin (IVIG). We aimed to review the major relevant articles in case of the efficacy of IVIG and determine its usefulness. Methods: We searched online databases such as PubMed, MEDLINE, Wiley, EMBASE, ProQuest Dissertations and Thesis, ISI Web of Knowledge, Scopus, and Google scholar. Two reviewers have independently assessed and extracted the titles and abstracts. Disagreements were being fixed by discussion. Where resolve was not feasible, a third review author was discussed. Results: We screened a total of 6 full texts. Three studies evaluated the effectiveness of IVIG in the Treatment of BK Infection in Renal Transplant Patients. Also, three studies assessed the various treatment options for Nephropathy due to the BK virus. Results showed that mean peak BK reduced with IVIG therapy after a one-year follow-up. Also, a high percentage of patients have functioning grafts after IVIG therapy. Conclusion: A review of studies shown powerful follow-up and early decrease of immunosuppression leading detection of BK viremia, with qualitative monitoring, can avoid the progress of clinically notable BK nephropathy. Combination treatment IVIG is more successful in removing viral load in patients with BKVAN, compared with traditional standard-of- care therapy.