Applying Pharmacogenomic Guidelines to Combat Medical Care

ABSTRACT Pharmacogenomics is a pillar of personalized medicine that has the potential to deliver optimized treatment in many medical settings. Military medicine in the deployed setting is unique and therefore warrants separate assessment pertaining to its potential capabilities and impact. Pharmacogenomics for United States Active Duty Service Members medical care in the deployed setting has not, to our knowledge, been previously reviewed. We present potential applications of pharmacogenomics to forward medical care through two comprehensive references for deployed medical care, the Tactical Combat Casualty Care Guidelines (TCCC) and Emergency War Surgery (EWS) fifth edition. All drugs within the deployment manuals, TCCC guidelines and EWS book, were identified and the list was cross-referenced to the Clinical Pharmacogenetics Implementation Consortium guidelines and genes–drugs interactions list as well as the Food and Drug Administration Table of Pharmacogenomics Biomarkers in Drug Labeling. Ten pharmacologic categories were identified, consisting of 15 drugs, along with the classes, aminogylcosides, beta-blockers, and volatile anesthetics. Drugs and pharmacogenomics liabilities were tabulated. Eight specific drugs or classes are expounded upon given the belief of the authors of their potential for impacting future treatment on the battlefield in the setting of prolonged field care. This review outlines several genes with liabilities in the prolonged field care setting and areas that may produce improved care with further study.

Military surgery research laboratory — yesterday, today, tomorrow…

Presents the history of organization and development of a unique research unit of the Military Medical Academy named after S.M. Kirov, which is engaged in conducting field experiments and field tests using laboratory animals. The history of the laboratory starts in 1982 with the organization of the combat trauma research laboratory, led by an experienced abdominal surgeon, holder of post-doctoral degree in medicine, professor, colonel of Medical Corps V.A. Popov. Within a short time, the research laboratory succeeded in staffing with highly qualified interdisciplinary team, including surgeons, pathophysiologists, critical care physicians, biochemists, morphologists, microbiologists. This gave the opportunity to carry out research on modern combat trauma not only in the experiments with laboratory animals and on the treatment of casualties admitted to the Academys clinics, but also in the combat environment of Afghanistan war as a mobile interdisciplinary team based at medical institutions of the 40th Army. In June 1993 the Combat Trauma research laboratory was combined with the Shock and Terminal State research laboratory, as a result the War Surgery research laboratory was organized, which joined War Surgery department. The laboratory activity focused on in-depth study of problems of experimental surgery and wound ballistics, pathobiochemistry and pathomorphology of ballistic wound. In July 5, 2011, because of staffing measures the laboratory became part of a newly formed research department (experimental medicine) of the Research Center of the Academy. Then laboratory scientists proceeded with the development of traditional research directions: the study of modern wound ballistics, assessment of weapons damage and protective characteristics of individual body protective facilities (body armor, helmets), carried out in terms of War Surgery, as well as the study of a new type of weapon "nonlethal" weapon, the development of unbiased diagnostic tests and complication prognosis for casualties with multiple trauma, optimization and improvement of treatment policy under variety of conditions. At present, the research laboratory (War Surgery) specialists in cooperation with colleagues of War Surgery department are actively involved in the studies devoted to investigation of combat surgical trauma, effectiveness of modern individual armor, development of medical items and technologies treatment of casualties, taking an active part in the educational process.

In memory of Georgiy Nicolaevich Tsibulyak

The biography of colonel of Medical Corps, professor Georgiy Nicolaevich Tsibuliak (19322020) is presented. In 1956 G.N. Tsibuliak graduated from the Kirov Military Academy being awarded with gold medal. When being a cadet, he got actively engaged in research. In 1961 G.N. Tsibuliak defended candidates dissertation on the injury treatment in casualties damaged by ionizing radiation, took part in the study of multiple injuries occurring in atomic tests. After graduating from the medical residency he stayed in War Surgery department of the Academy, was eventually assigned as a senior lecturer, the head of the research laboratory carrying out the study of shock and terminal state. In1966 he defended a doctorate in pathogenesis, clinical findings and treatment of tetanus. G.N. Tsibuliak became one of the leading advocates for the concept of traumatic shock in individuals. This fact that at present emergency physicians and surgeons dealing with traumatic shock consider to be an axiom, is scientifically based, and was gained through hard routine work in treating severely injured casualties. From 1976 to 1982 Georgiy Nicolaevich was Surgeon-in-Chief in Group of Soviet Forces in Germany. In 19901993 he was in charge of research laboratory dealing with combat surgical trauma in the Academy. Since 1993 G.N. Tsibuliak had retired from active duty, holding the position of a professor at the War Surgery department. He is the author of more than 200 scientific papers, including 7 monographs. G.N. Tsibuliak was closest associate of A.N. Berkutov in studying traumatic shock in casualties, took an active part in formation of a new clinical specialty resuscitation.

On the occasion of centenary of the birth of I.I.Deriabin (1920–1987)

On the 2nd of August, 2020 marked the 100th anniversary of the birth of the famous Russian surgeon, the Head of War Surgery department of the Academy, professor, Major-General of the Medical Corps Ilia Ivanovich Deriabin. I.I. Deriabin was the participant of the Great Patriotic War and the war against militarist Japan, the warfare in Afghanistan, the first postwar postgraduate fellow under professor S.I.Banaitis, a student and associate professor of A.N. Bercutov, an officer working many years at War Surgery department, Kirov Military Medical Academy. I.I. Deriabin was also the Head Surgeon to the Group of Soviet Forces in Germany, the founding principal of War Surgery department at the Military Medical faculty, Moscow Central Institute for Advanced Medical Education, Deputy Chief Surgeon of the Soviet Army. In the history of military medicine professor I.I. Deriabin will stay as a great scientist and organizer in the field of War Surgery, a founder of traumatic disease tactical treatment concept, the author of the idea of medical-transport immobilization (anticipating popular modern tactics Damage Control). He also came up with an idea of an improvised frame for unstable pelvic fracture immobilization, developed the technique of peritoneal dialysis (in cooperation with M.N. Lizanets and E.V. Chernov), devised (coauthored with A.C. Rozhkov) multicomponent anti-inflammatory local wound blockade for injury control and septic complications prevention.

The Italian mobile surgical units in the Great War: the modernity of the past

Medical services in WWI had to face enormous new problems: masses of wounded, most with devastating wounds from artillery splinters, often involving body cavities, and always contaminated. Tetanus, gas gangrene, wound infections were common and often fatal. Abdominal wounds were especially a problem: upon entering the war the commanders of all medical services ordered to avoid surgery, based on dismal experiences of previous wars. Surgical community divided into non-operative and operative treatment supporters. The problem seemed mainly organizational, as the wounded were rescued after many hours and treated by non-specialist doctors, in inadequate frontline settings or evacuated back with further delay of treatment. During initial neutrality, Italian Academics closely followed the debate, with different positions. Many courses and publications on war surgery flourished. Among the interventionists, Baldo Rossi, to provide a setting adequate to major operations close to the frontline, with trained surgeons and adequate instruments, realized for the Milano Red Cross three fully equipped, mobile surgical hospitals mounted on trucks, with an operating cabin-tent, with warming, illumination and sterilizing devices, post-operative tents and a radiological unit. Chiefs of the army approved the project and implemented seven similar units, called army surgical ambulances, each run by a distinguished surgeon. Epic history and challenges of the mobile units at the frontline, brilliant results achieved on war wounds and epidemics are described. After the war they were considered among the most significant novelties of military medical services. Parallels with present scenarios in war and peace are outlined.

Single center experience of war-related thoracic injury in Syria

Background: The Syrian civil war caused serious deaths and injuries. Thoracic surgery has shown its effectiveness in this war as it is a war surgery. In this study, we analyzed war related chest trauma patients to describe the profile of chest trauma, determine the predictors’ morbidity and mortality. Methods: From 2012 to 2017, 47 consecutive patients underwent surgical treatment for chest trauma at the Gaziantep University Sahinbey Research and Practice Hospital, in Turkey. The demographic and relevant clinical information were retrospectively collected from the hospital records. Data included mechanism of injury, gender, and age, findings, treatment modality complications, and length of hospital stay, morbidity and mortality. Injuries were classified as penetrating (gunshot or shrapnel wounds) and blunt injuries. Results: The average age of patients was 25.4 years (range, 4 to 43 years) and 40 patients were males (85%). Sadly, 6 patients were under 18 years old. There were 41 patients (%87,2) penetrating and 6 patients (%12,8) blunt injuries. The most penetrating injuries of the chest were caused by shrapnel (61,7%). Eleven patients had already had emergency thoracotomy in another hospital before admission. As multiple diagnoses, there were 50 (45,45%) pneumothorax, hemothorax, or both in patients. However, there were 26 (23,64%) lung contusions in patients. No surgery-related deaths or major morbidity occurred. One patient died 35 days after admission; the causes of death in this patient included bronchobiliary fistula, hypovolemic shock, and sepsis. So, all cases mortality rate was 2,13%. Conclusion : Intervention in thoracic trauma patients is life-saving and satisfying compared to other system injuries. War surgery is a multidisciplinary approach, which is vital.

Evaluation of a fellowship abroad as part of the initial training of the French military surgeon

IntroductionMilitary surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment.MethodsThis study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents’ first foreign deployment.ResultsSixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10.ConclusionA fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees’ feedback confirms its relevance.

Military assistance to the civil authority: medical liaison with the Manchester clinicians after the Arena bombing

UK Defence Medical Services’ personnel have experienced an intense exposure to patients injured during war over the last decade and a half. As some bitter lessons of war surgery were relearned and innovative practices introduced, outcomes for patients impr oved consistently as experience accumulated. The repository of many of the enduring lessons learnt at the Role 4 echelon of care remain at the Queen Elizabeth Hospital Birmingham (QEHB), with the National Health Service and Defence Medical Services personnel who treated the returning casualties. On 22 May 2017, a terrorist detonated an improvised explosive device at the Manchester Arena, killing 22 and wounding 159 people. In the aftermath of the event, QEHB was requested to provide support to the Manchester clinicians and teleconferencing and then two clinical visits were arranged. This short report describes the nature of the visits, outlines the principles of Military Aid to the Civil Authority and looks to the future role of the Defence Medical Services in planning and response to UK terrorism events.