Naval Hospital Research Articles

Happiness With New Smile After Composite Filling in The Fractured Teeth

Background: A Fractured front teeth have an impact on children's psychology. Treating the front teeth with good aesthetics restores happiness. Dentists will try to restore fractured front teeth at a low cost will help the patient and family. Objective: #11 pulp necrosis accompanied by Ellis class III fracture, positive percussion test, positive bite test, and grade I mobility. Case: A 12th years old boy, visited pediatric dentistry clinic dr. Ramelan Naval Hospital Surabaya with his mother complaining that her child fell and broke his front teeth. And her child didn't want to go to school because not confident. Case management: Root Canal Treatment was restored with a composite using a palatal index with a layering technique supported by his insurance. Conclusion: The aesthetics of the teeth, especially the anterior teeth, is very important for the patient's confidence because they are visible when smiling, optimal support for children in the process of growth and development both physically and psychologically and selection of the type of treatment needs to consider the patient's finances while maintaining good quality

Outstanding Surgeon and Scientist Dmitry Alekseevich Arapov

In 2022, we are approaching 125 years since the birth of Dmitry Alekseevich Arapov, a prominent domestic surgeon, scientist, experimenter, organizer of the military medical services. Dmitry A. Arapov, one of the most prominent representatives of the S.S. Yudin scientific school, worked at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 1929 till 1984. He quickly proved himself not only as an excellent doctor and a skilled surgeon, but also as a researcher, and soon became one of the closest students and associates of S.S. Yudin. Dmitry A. Arapov drafted as a field surgeon during the Soviet-Finnish war of 1939-1940, from the first to the last day he went through the Great Patriotic War, being the Head of the surgical service of the Northern Fleet in Polyarny. In this position, he significantly improved the system for providing emergency surgical care on ships and in naval hospitals, based on the experience gained over the years of work at the N.V. Sklifosovsky Research Institute for Emergency Medicine. From July 1950 Dmitry A. Arapov was Chief Surgeon of the USSR Navy, from May 1953 he was Deputy Chief surgeon of the Main Military Sanitary Directorate of the USSR Ministry of Defense, and from May 1955 again Chief Surgeon of the USSR Navy, until his retirement in October, 1968. At the same time, Dmitry A. Arapov did not leave his work at the N.V. Sklifosovsky Research Institute for Emergency Medicine until the last days of his life. Dmitry A. Arapov is the author of more than 200 research papers, including 14 monographs. Scientific interests of Dmitry A. Arapov went far beyond emergency surgery, to which he naturally paid most attention. His works are devoted to various issues of military and emergency surgery of the abdominal and thoracic organs, topical issues of burn injuries, surgical site infections, reconstructive surgery, neurosurgery, treatment of endocrine disorders, and anesthesiology and resuscitation. Also Dmitry A. Arapov successfully dealt with the problems of autotransfusion, blood reinfusion from the chest and abdomen, transfusion of fibrinolytic blood. The main directions of scientific research, laid down by Dmitry A. Arapov, are currently being continued at the Scientific Department of Emergency Surgery, Endoscopy and Intensive Care of the N.V. Sklifosovsky Research Institute for Emergency Medicine. Memory of Dmitry A. Arapov has been preserved to this day. To the 100th anniversary of the birth of D.A. Arapov, a scientific conference was held at our Institute. The naval hospital in the town of Polyarny, Murmansk region, was named after Dmitry A. Arapov, and in honor of D.A. Arapov, a memorial plaque was installed on its building. In the 70s of the twentieth century, People’s Artist of the USSR L.E. Kerbel created a sculpture of Dmitry A. Arapov, which was stored in the local history museum of the town of Polyarny. His bust portrait (by artist T.S. Smagina) is exhibited at the Scientific Department of Emergency Surgery, Endoscopy and Intensive Care of the N.V. Sklifosovsky Research Institute for Emergency Medicine. In addition, the N.V. Sklifosovsky Research Institute for Emergency Medicine owns an earlier portrait of Dmitry A. Arapov by artist F.S. Bulgak. We introduce these portraits into scientific circulation for the first time. We are confident that they will be able to tell contemporaries a lot about this scientist, surgeon and man who made a great contribution to surgery and military medicine, and rightfully entered the history of Russian medicine.

Oxidative stress and adverse cardiovascular effects among professional divers in Egypt

Professional divers are exposed to unique multifactorial hazards in their working environment and adverse cardiovascular effects such as ischemia, arrhythmia, stroke, and death are associated with professional diving. Cardiovascular events are aggravated by diving-induced oxidative stress and account for one-fourth of diving fatalities. This study aimed to measure oxidative and cardiovascular stress in a group of professional divers in Alexandria, Egypt using a panel of biomarkers. A comparative cross-sectional study was conducted between June 2017 and May 2018 at the General Naval Hospital in Alexandria. A total of 50 professional divers and a comparison group of 50 marine seafarers sharing similar maritime environments were enrolled in the study. Participants were clinically evaluated by electrocardiography (ECG) and plasma measurement of trace metals (Fe+, Cu+, and Zn+), electrolytes (Na+, K+, Ca+), and oxidative stress biomarkers (OSBMs; MDA, TAS, GST, GSH, GR, GPx, SOD, and CAT). Significant ECG abnormalities including short corrected QT interval, sinus bradycardia, left ventricular hypertrophy, early repolarization, first-degree heart block, and intraventricular conduction defect were identified among divers. Biochemical analyses revealed high mean levels of FBG [89.0 ± 12.46 vs. 100.5 ± 29.03 mg/dl], LDH-C [41.46 ± 4.01 vs. 39.34 ± 4.34 mg/dl], electrolyte imbalance [higher Na+ (9.44 ± 0.52 vs. 9.19 ± 0.60 mmol/L), and lower Ca+ (141.72 ± 3.53 and 143.26 ± 3.99 mmol/L)], disturbed trace metals [Fe+ and Zn+ (101.1 ± 38.17 vs. 147.6 ± 38.08 and 85.52 ± 27.37 vs. 116.6 ± 21.95 µm/dl, respectively), higher Cu+ (271.3 ± 75.01 vs. 100.8 ± 30.20 µm/dl)], and higher OSBMs (high MDA and reduced CAT, GPx, GSH, GR, and GST enzyme levels) among professional divers compared to the marine seafarers (t-test p < 0.05). Oxidative stress and trace metal imbalance are associated with the pathophysiology of cardiovascular disease; this association, together with electrophysiological changes of ECG may serve as biomarkers for cardiovascular risk assessment in diver periodic medical examinations.

Intraocular pressure changes under an atmospheric pressure spectrum in a multiplace hyperbaric chamber.

To evaluate the influence of atmospheric pressure changes on the behavior of intraocular pressure of healthy military individuals-students and instructors of the National Navy's Diving & Rescue School at the "ARC BOLÍVAR" naval base-during a simulated immersion in the hyperbaric chamber of the Naval Hospital of Cartagena. A descriptive exploratory study was performed. The intraocular pressure was measured at different atmospheric pressures during 60-min sessions in the hyperbaric chamber while breathing compressed air. The maximum simulated depth was 60 feet. Participants were students and instructors of the Naval Base's Diving and Rescue Department. A total of 48 eyes from 24 divers were studied, of which 22 (91.7%) were male. The mean age of the participants was 30.6 (SD=5.5) years, ranging from 23 to 40. No participant had a history of glaucoma or ocular hypertension. The mean base intraocular pressure at sea level was 14 mmHg, which decreased to 13.1 mmHg (decreased by 1.2 mmHg) at 60 feet deep (p=0.0012). However, during the safety stop at 30 feet, the mean IOP kept decreasing until reaching 11.9 mmHg (p<0.001). By the end of the session, the mean intraocular pressure reached 13.1 mmHg, which is inferior and statistically significant when compared with the intraocular pressure base mean (p=0.012). In healthy individuals, the intraocular pressure decreases when reaching a depth of 60 feet (2.8 absolute atmosphere pressure) and it decreases even more during ascension at 30 feet. Measurements at both points were significantly different when compared with base intraocular pressure. The final intraocular pressure was lower than the baseline intraocular pressure, suggesting a residual and prolonged effect of the atmospheric pressure on intraocular pressure.

СТАНОВЛЕННЯ І РОЗВИТОК ВІЙСЬКОВО-МОРСЬКОЇ МЕДИЦИНИ НА ПІВДНІ УКРАЇНИ (кінець ХVІІІ – початок ХХ ст.)

The purpose of the article is to study the peculiarities of the formation and development of naval medicine in the South of Ukraine using the example of the city of Mykolayiv, as a centre of shipbuilding and command of the Black Sea Fleet at the end of the ХVІІІth – the beginning of the XXth century. To find out its compliance with the state of development of medicine and the health care requirements of the military personnel of the naval department and the residents of the city at that time. The research methodology is based on the principles of historical knowledge (scientific, historicism, objectivity, systematic and comparative analysis), as well as on the application of general scientific, special and historical, special source studies methods. The scientific novelty of the research consists in the fact that for the first time the formation conditions and features of the initial functioning of naval medicine in Southern Ukraine, which laid the foundations for the development of this important branch of domestic medicine, have been highlighted and analyzed. The Conclusion. The birth of naval medicine in the South of Ukraine had its beginnings precisely in Mykolayiv, where a centre of practical and scientific medical professional elite of naval doctors was formed. The establishment of naval hospital in Mykolayiv played a significant role in the recovery of patients with infectious diseases and wounded servicemen during the Crimean War and the Russo-Turkish Wars, as well as weakening the spread of epidemics among the urban civilian population. Mykolayiv naval doctors made a significant contribution to the development of the city's public medicine, the science of domestic naval medicine and the development of sanitary and anti-epidemic measures during epidemics both in the troops (including on warships) and among the civilian urban population.

Diagnosis and Treatment of Tuberculous Meningoencephalitis and Toxoplasma Encephalitis in Positive HIV Patient: Case Report

Background Tuberculous meningoencephalitis (TBME) and toxoplasma encephalitis (TE) are the most frequent cerebral opportunistic infections in positive HIV patients in developed countries. This study aims to determine a presumptive diagnosis of TBME and TE based only on clinical, CD4-count, and radiology features and to attend suitable early treatment for better patient outcomes. Case Description A 40-year-old presented to the emergency unit of dr. Mintohardjo Naval Hospital with decreased consciousness. History of positive HIV status, pulmonary tuberculosis for six months and anti-tubercular-treatment (ATT) drop-out. The GCS was E2M5V2, lung crackles, nuchal rigidity, positive Babinski reflex, and duplex hemiparesis. CD4-count: 4 cells/mm3. Multiple hypodense lesions, “finger-like-oedema”, featured on non-contrast head CT-scan. A lumbar puncture was not performed. Treatment of TBME included an ATT regimen, pyridoxine, cotrimoxazole, anti-oedema, and TE treatment included clindamycin and pyrimethamine. Based on the clinical and radiological diagnosis of TBME (nuchal rigidity, history of ATT drop-out, multiple hypodense lesions on CT-scan) and TE (altered mental status, duplex hemiparesis, CD4-count, “finger-like-oedema” projections on CT-scan), ATT and TE treatment were given for ten days. There were significant clinical improvements by GCS E4M6V3, negative nuchal rigidity after being treated early by ATT and TE treatment. Conclusions Presumptive Diagnosis of TBME and TE in HIV patients can be determined only based on clinical, CD4-count, and radiology examination. However, there are significant clinical improvements in giving ATT along with TE treatment immediately in positive HIV patients.

Presenting Issues of Concern among Active-Duty Service Members with Depression and/or Suicidality

The military continues to have higher rates of suicide than the civilian population. Literature indicates that rates of depression and suicidality are influenced by branch of service, marital status, rank, and deployment. However, the specific issues of concern for service members who seek mental health treatment with depression and/or suicidal ideation when they first present is absent from the literature. This study inspects archived records and counselor notes from 422 outpatient and inpatient mental health records at a US naval hospital to examine presenting issues among service members with documented depression or suicidality. Fourteen presenting issues were identified. The most pervasive presenting issues were work stress (32%) and partner relational stress (28.9%). Statistically significant differences are presented based on gender, inpatient/outpatient status, living status, marital status, suicide attempt, rank, and age.

Public hospitals in Madras and people associated with them.

In this follow-up article, we refer to the other public hospital facilities of Madras, viz. the Lock and Naval Hospitals, the Native Infirmary, Lunatic Asylum, Eye Infirmary, Maternity Hospital (Egmore), and the Queen Victoria Hospital for Caste and Gosha Women, some of which are operational today. We also include brief notes on a few of the pioneering men and women, who contributed to the development of these facilities.

UTERINE GRANULOCYTIC SARCOMA AS AN EXTRAMEDULLARY RELAPSE OF ACUTE MYELOID LEUKAEMIA IN AN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION RECIPIENT

Myeloid Sarcoma (MS) is a common condition characterized by proliferation of immature myeloid cells in extramedullary sites. It most often develops in patients with Acute Myelogenous Leukaemia (AML), myeloproliferative neoplasms or myelodysplastic syndromes. MS in AML may precede the disease, appear during the onset or as a relapse, especially in patients after bone marrow transplantation (BMT). Although MS can present in various parts of the body, the most common sites are lymph nodes, central nervous system, bones and soft tissues. MS of the gynaecologic tract is rare, especially in the cervix and uterus. We report an unusual case of EM relapse in the uterus without evidence of a bone marrow (BM) recurrence, two years after an allogeneic BMT. A nulliparous female 32 years old patient was currently attending the hematologic service at a quaternary Brazilian Naval Hospital since 2018, due to AML. She had no specific molecular mutation in the diagnosis. The patient was submitted to an unrelated BMT after her second complete remission in 2020 and had a relapse nine months after, with loss of variable number of tandem repeats (VNTR) from the donor and minimum residual disease (MRD) positive. Donor's Lymphocytes were infused twice and chemotherapy with a hypomethylating agent and BCL-2 inhibitor Venetoclax was established. The patient achieved her third complete remission and was in follow-up until she presented herself with complains of neuropathic and acute abdominal pain. Clinical examination revealed several soft tissue tumorations resembling MS. During the investigation, an abdominal pelvic magnetic resonance imaging (MRI) peculiarly demonstrated a large uterine mass with compression of the right ureter and pyelocalyceal dilation. Gynaecological clinical exam showed a large violaceus mass about four cm with anterior and right vaginal wall infiltration. The first diagnostic hypothesis was primary cervical cancer stage IV. The biopsy revealed a massive infiltration of immature myeloid cells with the expression of anti-ERG and myeloperoxidase antibodies, confirming MS. The immunophenotypical analysis of the bone marrow aspirates showed the patient still had a complete remission with MRD negative and a VNTR with full donor chimerism. The patient started systemic chemoterapy with a hypomethylating agent and BCL-2 inhibitor Venetoclax. Decision making on the treatment of cervical MS is challenging due to the absence of gynaecological classification guidelines. In patients in this age group with no offspring, the choice of therapy should consider the fertility issue, covering from hysterectomy to radiation, with or without a second BMT. Finally, MS should be a differential diagnosis in a patient with a uterine mass and a previous medical history of AML and BMT.

Development of Contract Management SOP with it Service Providers Supplier Based on the Framework Cobit 5 and ITIL V3 Hospital Case Study Dr Ramelan Navy

RSAL Dr. Ramelan is a naval hospital in Surabaya. It is currently developing its Management Information Systems (MIS) with the supplier of IT (Information Technology) service providers. Problems arose when the management change interfere with MIS development. The current management wanted to change MIS supplier before the development process is completed. This can cause financial and time losses. The process of supplier selection, negotiation, contracting and fulfillment control of supplier contracts to always fit the needs of the business is conducted at the Supplier Management. This study aims to make a reference to the management of IT service provider suppliers contracts in the form of SOP (Standard Operating Procedure) which is based on the COBIT 5 framework domain APO10 Manage Supplier and ITIL V3 Supplier Management. Formulation of IT service providers supplier contract management in RSAL Dr. Ramelan SOP document is carried out in four stages. The first stage is the observation of IT services in RSAL Dr. Ramelan. The second stage is the stage of the analysis. This stage is to identify COBIT 5 Manage Supplier and ITIL V3 Supplier Management activities and mapping the activities. Having formed a new activity, adjustments are made to the Regulation of the President of the Republic of Indonesia No. 54 of 2010 concerning the Procurement of Goods and Services. In the third stage, SOP document preparation is done by decomposition of these activities to become sequential action steps. The last stage is the stage of evaluation and improvement, which begins with the verification done in RSAL Dr. Ramelan, then the improvement is done based on the results of verification. The result of this study is an IT service providers supplier contract management SOP document that has been tailored to the condition in RSAL Dr. Ramelan. From the result of the evaluation, it is known that the SOP produced was still in need for improvement in terms of grammar, role and order activity. The SOP document that has been evaluated before has been corrected and improved based on the feedback given by RSAL Dr. Ramelan. Key Words : Supplier Management , COBIT 5 , ITIL , Standard Operating Procedure , Underpinning Contract . The SOP document that has been evaluated before has been corrected and improved based on the feedback given by RSAL Dr. Ramelan. Key Words : Supplier Management , COBIT 5 , ITIL , Standard Operating Procedure , Underpinning Contract . The SOP document that has been evaluated before has been corrected and improved based on the feedback given by RSAL Dr. Ramelan.

RAGE and HMGB1 expressions in fetal membranes of premature rupture of membranes patients

BACKGROUND Premature rupture of membranes (PROM) often occurs in pregnancy. The fetal membrane weakening is caused by inflammation involving receptor activation for advanced glycation end-products (RAGE) and high mobility group box protein 1 (HMGB1). The associations between RAGE and HMGB1 with PROM are rarely studied. Hence, this study aimed to determine those associations in fetal membranes with PROM occurrence.&#x0D; METHODS This case-control study was conducted at Dr. Ramelan Central Naval Hospital, Surabaya, Indonesia, from August to November 2019. The subjects, determined using a non-probability sampling method (a saturated sample), were divided into PROM and normal pregnancy with intact fetal membranes (control) groups. Fetal membrane specimens were collected during vaginal and cesarean section deliveries. The expressions of RAGE and HMGB1 were determined using the immunohistochemical method and further analyzed using the Mann–Whitney U test.&#x0D; RESULTS The expression of RAGE in fetal membranes with PROM was significantly higher than the control (52.74% versus 14.9% expression/mm2, p&lt;0.001), as well as the expression of HMGB1 (45.9% versus 8.5% expression/mm2, p&lt;0.001).&#x0D; CONCLUSIONS The higher expressions of RAGE and HMGB1 in fetal membranes were associated with PROM.

Lessons Learnt from a Pneumonia Outbreak in a Naval Training Establishment

Introduction: In August 2014, an unusually large number of cases of pneumonia was reported from amongst Naval Recruits in a Naval Training Establishment by the co-located Indian Naval Hospital Ship. Material and Methods: The study was descriptive observational (retrospective) in nature, which was carried out at Indian Naval Training Establishment and Indian Naval Hospital Ship. The following information was collected: (a) Batch-wise comparison of data of recruits at Indian Naval Training establishment (where two major batches undergo training every year) was done for the occurrence year (2014) and the preceding 03 years i.e 2011, 2012 and 2013. Further, data on cases of pneumonia was collected from Indian Naval Hospital Ship as recorded by the hospital for last 03 years (2011, 2012 &amp; 2013) and the year 2014, using an epidemiological format. Results: (a) Overcrowding. (b) Confirmation of existence of Outbreak. (c) Distribution of cases as per symptomatology and X-ray findings. (d) Manmade overcrowding, physical and psychological stress of military training exposes non-immune persons to several pathogens. The study confirms overcrowding with per capita standard for floor space and air space being 5 sqm and 18 m 3. The recommended distance between two adjacent beds is 1.8m 1 Infact, they were even below the standard of 4 sqm recommended by WHO 4. A positive Correlation is known to exist between overcrowding and incidence of pneumonia 5. Conclusion: Batch-wise comparison of cases and incidence of LRTI/ Pneumonia confirmed the outbreak. Further, there were no cases of Pneumonia amongst training staff (officers &amp; sailors) and other civilian in adjoining areas. Consequent to increase in induction pattern at Naval Training Establishment, coupled with absence of accompanying increase. Consequently, analysis of living conditions established that overcrowding existed in dormitories, dining areas and all facilities related to training.

Happy Smile of a New-Born Infant with Cleft Lip and Cleft Palate

Background: Cleft palate of the new-born infants with or without cleft lip, are recognized to be at risk of feeding difficulties, making it difficult to maintain adequate nutrition, and also interfere the speech function and the parents also their psychological growth. Purpose: Surgical closure of the cleft lip may be accomplished shortly after birth to relieve the parents’ anxiety as long as the general rules “ triple tens ” ( more than : 10 week of age, 10 pounds of body weight, 10 grams of haemoglobine ) that is frequently used in determining optimum timing for lip closure must be fulfilled. Case Report: Female baby at age 5 days, who was referred to pediatric dentistry clinic dr. Ramelan Naval Hospital Surabaya with parents complaining that their baby was born with cleft lip and palate and could not drink breast milk, easily choked, so they had to depend on the sonde. Case management: A maxillary feeding plate (=MFP) was made to close the cleft palate and regenerate the function of chewing and swallowing so that the infant obtains good nourishment and gain body weight until the palatal cleft closure operation. Conclusion: After the closure, her mother and family are psychologically able to prepare comprehensive protection for the child so that they too feel comfortable and confident. Smile can represent 80% of communication. When children feel comfortable because they can freely smile, this smile can attract other people to make it easier to adapt and socialize.

Molecular characterization of multidrug-resistant ESKAPEE pathogens from clinical samples in Chonburi, Thailand (2017–2018)

BackgroundESKAPEE pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli are multi-drug resistant (MDR) bacteria that present increasing treatment challenges for healthcare institutions and public health worldwide.Methods431 MDR ESKAPEE pathogens were collected from Queen Sirikit Naval Hospital, Chonburi, Thailand between 2017 and 2018. Species identification and antimicrobial resistance (AMR) phenotype were determined following CLSI and EUCAST guidelines on the BD Phoenix System. Molecular identification of antibiotic resistant genes was performed by polymerase chain reaction (PCR), real-time PCR assays, and whole genome sequencing (WGS).ResultsOf the 431 MDR isolates collected, 1.2% were E. faecium, 5.8% were S. aureus, 23.7% were K. pneumoniae, 22.5% were A. baumannii, 4.6% were P. aeruginosa, 0.9% were Enterobacter spp., and 41.3% were E. coli. Of the 401 Gram-negative MDR isolates, 51% were carbapenem resistant, 45% were ESBL producers only, 2% were colistin resistance and ESBLs producers (2%), and 2% were non-ESBLs producers. The most prevalent carbapenemase genes were blaOXA-23 (23%), which was only identified in A. baumannii, followed by blaNDM (17%), and blaOXA-48-like (13%). Beta-lactamase genes detected included blaTEM,blaSHV, blaOXA, blaCTX-M, blaDHA, blaCMY, blaPER and blaVEB. Seven E. coli and K. pneumoniae isolates showed resistance to colistin and carried mcr-1 or mcr-3, with 2 E. coli strains carrying both genes. Among 30 Gram-positive MDR ESKAPEE, all VRE isolates carried the vanA gene (100%) and 84% S. aureus isolates carried the mecA gene.ConclusionsThis report highlights the prevalence of AMR among clinical ESKAPEE pathogens in eastern Thailand. E. coli was the most common MDR pathogen collected, followed by K. pneumoniae, and A. baumannii. Carbapenem-resistant Enterobacteriaceae (CRE) and extended spectrum beta-lactamases (ESBLs) producers were the most common resistance profiles. The co-occurrence of mcr-1 and mcr-3 in 2 E. coli strains, which did not affect the level of colistin resistance, is also reported. The participation of global stakeholders and surveillance of MDR remain essential for the control and management of MDR ESKAPEE pathogens.

The Wales Endoscope: The First American Cystoscope

IntroductionPhilipp Bozzini, a German army surgeon, in 1807 invented the Lichtleiter, the predecessor of the modern cystoscope. By the mid-1800s, several new instruments were created including one, a variation on Bozzini's instrument by Antoine Desormeaux in Paris. The William P. Didusch Museum of Urologic History acquired the Wales endoscope, a rare and unique cystoscope that was invented around the same time in the United States. MethodsWe researched the life of Philip Wales and the description of his cystoscope as well as Horatio Kern, the instrument maker that produced Wales' instrument. We examined the Wales cystoscope acquired by the William P. Didusch Museum. ResultsPhilip Skinner Wales (1837-1906) was a surgeon who entered the United States Navy in 1856 and served throughout the Civil War. He organized and held charge of the Naval Hospital at New Orleans during the operations of Admiral Farragut's fleet in the Mississippi River. He was one of the first surgeons to attend President Garfield when he was shot. He was Surgeon General of the Navy (1879-1884) and founded the Museum of Naval Hygiene in Washington D.C. which later, combined with the naval laboratory and Department of Instruction, became the prototype of the Naval Medical School.In 1868 he published a series of papers in the Philadelphia Medical and Surgical Reporter on “Instrumental Diagnosis,” with a paper entitled “Description of a New Endoscope.” The instrument contained a metal shaft with an acute beak and used an ophthalmologic mirror to reflect light down the channel. The surgeon peered through the center hole to look into the bladder. Wales used his instrument multiple times in his private practice. Wales writes that the advantages of his cystoscope were that it was simple to produce and cheap compared to Desormeaux's endoscope. Furthermore it was light, weighing approximately 2 pounds. The main drawbacks of Wales' cystoscope were the inadequate illumination, as the light source was external and projected from the outside through a narrow channel into the bladder, and that without an optical system the image appeared relatively small. Horatio Kern, a well-known instrument maker in Philadelphia, that also supplied surgical sets and instruments for the U.S. Army during the Civil War, produced Wales' cystoscope.While he was Chief of the Bureau of Medicine, a subordinate embezzled Navy funds and Dr, Wales was court-martialed. Though he was eventually exonerated, he lived the rest of his life in disgrace in France. ConclusionThe Wales endoscope is unique in that it had an American inventor, was simple in design and cheap to produce. It is an important historical artifact and is one of the earliest and rarest cystoscopes developed.

Relationship between Apolipoproteins, Lipoprotein (a) and conventional cholesterol and lipids with insulin resistance.

Objective: To evaluate Apo-A1, Apo-B and Lipoprotein (a) and conventional lipid profile parameters among subjects with high and low insulin resistance groups. Study Design: Cross Sectional study. Setting: Naval Hospital, Islamabad. Period: 2018 to 2020. Material &amp; Methods: To include 164 subjects after several exclusions. We carried out conventional lipid indices along with serum insulin, Apo-A1, Apo-B and Lp (a) on these subjects after formal permission. We calculated insulin resistance by using the the HOMAIR index. Results: Male population demonstrated higher Apo-B [(Male: 66.44+21.75) vs (Female: 60.84+19.96), p=0.095], triglycerides [(Male: 2.29+1.35) vs (Female: 1.84+0.93), p=0.014] while male showed lower Lp (a) [(Male: 126.13+9.15) vs (Female:16.60+9.39), p=0.095] and Apo-A1. 126.13+21.97) vs (Female: 135.34 +25.24), p=0.017]. Apo-A1 showed highest but still weak positive correlation with HDLc, while Apo-B demonstrated higher positive correlation with total correlation, triglycerides, LDLc, non-HDLc and Lp (a). Among comparison between high and low insulin resistance groups, we could only demonstrate significant differences between triglycerides [Low insulin resistance group: 1.94+1.15 vs High insulin resistance group: 2.41+1.29, p=0.019] and Apo-A1 [Low insulin resistance group: 132.54+23.16 vs High insulin resistance group: 124.91+24.17, p=0.050]. Conclusion: Apo-B demonstrated higher positive correlation with total correlation, triglycerides, LDLc, non-HDLc and Lp (a). There were significant differences for triglycerides and Apo-A1 between insulin resistance groups. Female gender and higher insulin resistance groups demonstrated higher Apo-A1 levels.

The Effect of Hypertension as a Comorbid Factor on the Length of Stay in Patients Undergoing Cholecystectomy

Background: One of the gold standard procedures for cholelithiasis is cholecystectomy. Cholecystectomyhas numerous variated Length of stay results relies upon every nation and medical clinic. Hypertensionis perhaps the most widely recognized comorbid factors and are thought to impact prolonged length ofstay.Aim of Research: To study the effect of hypertension as a comorbid factor on the length of stay in patientsundergoing cholecystectomy in Dr. Ramelan Naval Hospital Surabaya from June 2019-September 2020.Method of Research: This is an analytic descriptive research with retrospective study. The samplingtechnique used in this research is total sampling. The data were collected from medical record data ofpatients at the Internal Medicine and Digestive Surgery Polyclinic.Result of Research: The number of patients who underwent cholecystectomy with hypertensionwho underwent a length of stay &gt; 5 days were 36 people (83.7%). The result from the CoefficientContingency test shows that there is a correlation between hypertension as a comorbid factor and thelength of stay (p&lt;0,0001).Conclusion: This research shows that there is comorbidity such as hypertension affects the length ofstay in cholecystectomy.

Society of Naval Doctors of Kronstadt meeting on February 25, 2021

The next meeting of the Society of Naval Doctors of Kronstadt was held on February 25, 2021. in the reading room of the library of the Kronstadt Naval Hospital. The meeting was attended by 36 members and guests of the Society, including 15 4th-year cadets of the Faculty of Training Doctors for the Navy of the Military Medical Academy named after S. M. Kirov. We heard and discussed the report of the chairman of the Society of Naval Doctors of Kronstadt, Professor Nikitin E.A. «Kronstadt Naval Hospital in the revolutionary events of 1917–1921. The Kronstadt Mutiny.» The revolutionary events of 1917–1921 played a huge social significance in the life of the Russian state. To date, there is no unambiguous political assessment of the Kronstadt mutiny of 1921 and its suppression. Thanks to the selfless work of doctors, medical assistants, nurses, and orderlies of the Kronstadt Naval Hospital, despite the huge overload of the hospital with wounded and infectious patients, all patients (rebels and suppressing the mutiny) were provided with the necessary medical care and they received proper care.

Protocols of the Company Arkhangelsk Doctors in the library of the Kronstadt marine hospital

The Society of Arkhangelsk Doctors (OAB) was founded in 1863 and was one of the first public medical organizations in Russia. The Society has been active for 55 years. Despite the small number (8–15 people), the OAB immediately began to publish the minutes and proceedings of the Society. Copies of publications were distributed to libraries and similar societies in other regions of the Russian Empire. In the unique library of the Kronstadt Naval Hospital, 30 copies of the protocols and works of the Society of Arkhangelsk Doctors from 1864 to 1896 are preserved. Immediately after the revolution (1917) in the Arkhangelsk province, as well as throughout Russia, the work of the OAB was suspended. The activities of the Society played an important role in uniting the doctors of the province, contributed to the growth of their qualifications and the development of health care in the Russian North.

Evaluation of Biochemical Test Results in Patients with COVID-19 Infection

Background: The current pandemic outbreak of COVID-19 due to SARS-CoV-2 virus, affected the health care systems, health services and economy globally. Moreover, it significantly affected the health of the population worldwide. Mortality and morbidity rates are still increasing. According to WHO, as of September 2021 there have been 224180869 confirmed cases of COVID-19, including 4621173 deaths. USA, India, and Brazil are the three world's worst-hit countries. In Greece the mortality rate is at 3%.&#x0D; Methods: Study population included 565 patients, who were admitted at the Emergency Department and the Pathology Department of Naval and Veterans Hospital, Athens, Greece, during a period of 3,5 months. Patients’ demographic characteristics, underlying diseases, travel history, symptoms, aetiology of admission and history of contact with confirmed cases were recorded. All patients included to the study were positive for SARS-CoV-2 and characterized as COVID-19 patients. All statistical analyses were conducted using MINITAB 17.&#x0D; Results: Statistically significant differences in the results of albumin (marginal p-value), urea, creatinine, AST, ALT, and LDH between hospitalized and non-hospitalized patients were detected. Also, we observed statistically significant differences in the results of albumin, urea, creatinine, and ALT, between male and female patients. Moreover, patient age was statistically significant between male and female patients. The Logistic regression model of hospitalization show that statistically significant variables are ALT, LDH, age and gender.&#x0D; Conclusions: The rapid spreading of the new COVID-19 pandemic due to SARS-CoV-2 increased the need for the measurement of biochemical tests and the evaluation of their correlation with patient hospitalization. Biochemical monitoring of COVID-19 patients is critical for assessing disease severity and progression as well as monitoring therapeutic intervention. Several common biochemical tests have been implicated in COVID-19 infection progression, providing important prognostic information. In the present study we evaluated the test results of albumin, urea, creatinine, AST, ALT, LDH and total bilirubin in patients with COVID-19 infection.