Introduction The full-scale war with Russia on the territory of Ukraine has revealed several problems related to care of the wounded. In this article, we summarize the mechanisms of injury and injuries sustained for the period February to April 2022, focusing on extremity injuries. Materials and methodsWe compared these to a period of lower-intensity warfare in 2014-2021. In both cases, we report patients treated by the National Military Medical Clinical Center (NMMCC) in Kyiv. We also sought to evaluate the care of the wounded from an organizational viewpoint, taking into account the four-level system of care also used by the North Atlantic Treaty Organization (NATO). Third, we sought to understand lessons learned that could improve the care of the wounded. Conclusion During the 2022 conflict, the percentage of patients with extremity wounds who had long bone fractures increased and the percentage of people with long bone fractures who had bone defects increased, compared with 2014-2021. This may be due to the higher blast energy from the weapons used in the current conflict. Second, we adapted the four-level NATO system of care. Level 2 (first level hospital) care was provided by civilian hospitals close to the fighting, rather than mobile military hospitals. Level 3 (specialized) and 4 (highly specialized) care were combined into one hospital (NMMCC). This is the first description of flexible use of NATO's four levels. Finally, a major lesson learned was the need to improve use of damage control surgery. Dedicated to the heroic deeds of Ukrainian doctors in the name of life!.
One of the main tasks in the fight against anemia is to carry out preventive measures, to develop and to introduce new preparations containing iron, to provide the pharmaceutical market with anti-anemic agents. That's why to investigate the chronic toxic effect of Iron(IV) hexahydrazide clathrochelate (new iron-containing drug) in mice was the article's aim. The study of chronic toxic effect of Iron(IV) clathrochelate was performed on 45 white mice (19–25 g) separated into 3 groups: control (I) and two experimental (II and III). Animals of II and III groups were daily fed the water solution of Iron(IV) clathrochelate at a rate of 125.8 and 251.6 mg/kg of body weight, respectively. It was monitored the dynamics of body weight of white mice, relative coefficients of the mass of internal organs, hemoglobin content and morphological parameters of blood, biochemical indices of blood serum on the 10th, 20th and 30th day of the experiment. It was established a decrease of body weight by 16–21% and relative weight indices of internal organs (liver, kidney, heart, and spleen) – by 5– 43% in white mice of II and III experimental groups, respectively. Changes in the morphological composition of the blood showed stimulation of leukocytopoiesis. A significant decrease in creatinine (hypocreatinemia) and uric acid (hypouricemia) was observed, which indicates an increase in the filtration capacity of the renal glomeruli. Complex studies of the effect of Iron(IV) clathrochelate solution (at a dose of 125.8 and 251.6 mg/kg of body weight) did not cause any visible signs of intoxication and death of animals at the first time. Iron(IV) clathrochelate solution (at a dose of 125.8 mg/kg of body weight) is demonstrated more safe effect.
A new class of highly valent iron compounds is formed by atmospheric oxidation in aqueous media and it is extremely stable both in solid and soluble conditions and may exist indefinitely in a medium without signs of degradation. The first clathrochelate complexes of iron (IV) are infinitely stable in water and readily available from simple, commercially available, inexpensive source materials with surprisingly mild reaction conditions. To create new drugs on their bases, research on their toxicity is required. In this study, the results of preclinical studies of a new iron clathrochelates drug are presented. Experiments were carried out on white rats and quails, which in the previous experiment were divided into five experimental and two control groups. The solution of iron clathrochelate complexes was administered intragastrically in doses 50, 500, 1000, 2000 and 5000 mg/kg, respectively. Our results have shown that there were no grounds for using rats in the advanced experiment because the conducted research has established that iron clathrochelate is non toxic to rats. Thus, the minimum dose of iron clathrochelate complexes did not cause death of quails, and the largest dose caused 100% mortality. The basic experiment was conducted on 6 groups of birds, each consisting of 7 quails. The drug was administered in the following doses: 500, 600, 700, 800, 900, 1000 mg/kg. The monitoring observation of the laboratory birds lasted for 14 days. It has been established that the average lethal dose of clathrochelate of the investigated drug for internal administration in quails is 764 ± 33 mg/kg. According to the classification of chemicals by the degree of danger (State ST 12.1.007-76), iron (IV) clathrochelate complexes correspond to the third class of hazard, and according to the classification of substances for toxicity they are classified as category 4 (low toxicity substances). The prospect of further research is to investigate the pharmacological and toxicological properties of iron (IV) clathrochelate for chronic toxicity.
Anemia is one of the most common non-contagious diseases of pigs. Modern antianemic drugs have several drawbacks, so finding new drugs is a pressing issue. We previously reported the results of preclinical studies of iron in rare high valence IV. This allowed us to determine, supplement, and generalize the data on clinical studies of the new drugs with the active substance iron (IV) clathrochelate. Therefore, we studied its antianemic effect on piglets. Experiments were carried out on piglets-analogues neonates, which were divided into three groups: control and two experimental groups. Piglets were kept with sows on suckling. For the purpose of prevention of iron deficiency anemia, the traditional solution of iron dextran was administered once intramuscularly to piglets of I control group. The aqueous solution of iron (IV) clathrochelate complexes was administered once intramuscularly to piglets of II experimental group. Iron (IV) clathrochelate complexes were dissolved in a solvent of rheopolyglucin and administered once intramuscularly to piglets of III experimental group. 1 mL of test solutions contained 100 mg of active substance. The investigative material were the samples of blood and serum of piglets, their liver and spleen. The experiment lasted during a 30-day period since the birth of the piglets. According to the results of the experiments, iron (IV) clatrochelate complexes which were dissolved in water for injection and rheopolyglucin had higher antianemic activity compared to the control. This is evidenced by the dynamics of probable changes in the number of erythrocytes, hemoglobin content and hematocrit, iron content in serum and its mass fraction in the blood, liver and spleen of piglets. The effectiveness of the action of iron (IV) clatrochelate complexes is demonstrated by the full supply of piglets with iron and its higher bioavailability.
We studied the chronic toxicity of the compounds of Iron(iv). We monitored the dynamics of the body weight, relative weight coefficients of the internal organs, the content of the hemoglobin, the morphological parameters of blood, and biochemical parameters of serum of blood of quails after use of Iron(IV) clathrochelate complexes at the doses 1/10 and 1/5 DL50 them for 30 days. Daily drinking of quails of experimental groups of solution of Iron(IV) clathrochelate complexes3 at the doses 76.43 and 152.86 mg/kg of body weight caused the reduction of body weight by 3 and 5% respectively on the thirtieth day. A tendency to increase the relative weight of the kidneys and to decrease the relative weight of the liver, heart and spleen showed an excessive load of Iron(IV) clathrochelate complexes on the internal organs of quails. Hemoglobin in the blood of the quails of the experimental groups was less by 2-34% (P 0.05) than the control indicator but the indicator of the number of erythrocytes in the quails of the control and experimental groups for 30 days was within the physiological values. The use of Iron(IV) clathrochelate complexes caused the development of hypoproteinemia, hypoalbuminemia, and short-term hypoglycemia in the serum of the blood of the quails of the experimental groups. Changes in an activity of alanine aminotransferase and aspartate aminotransferase for 30 days were not expressed, but the activity of alkaline phosphatase was significantly higher compared to the control indicators during the experimental period. Drinking the solution of Iron(IV) clathrochelate complexes caused hypercreatinemia and hyperuricemia, which indicates a decrease in the filtration capacity of the kidney glomeruli. We have seen an increase in the levels total Calcium and inorganic Phosphorus.
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