Aim: To assess outcomes of retrograde intra-renal surgery (RIRS) for kidney stone disease performed in sitting as compared to standing positions in terms of procedural and patient-related outcomes.Materials and Methods: Experienced endourologists from 20 centres in 15 countries participated in this study. A total of 6669 cases were recorded including 5218 procedures performed standing and 1451 performed sitting. Data including demographics (age, sex, race, stone site and size, anaesthetic and laser used) and outcomes (complications, stone free status (SFR), length of stay and re-intervention required) was collected. Data were retrospectively analysed using SPSS version 25.0 for statistical significance.Results: Flexible ureteroscopy (F-URS) in a sitting position showed overall 18.7% complications versus 11.0% in the standing group which included mild haematuria not needing intervention (9.8% vs 4.3% standing group), temperature spike within 24 hours only (7.8% vs 5.6% sitting group), sepsis not needing intensive care unit (ICU) (1.9% vs 1.1% standing group) and ureteric injuries managed with stent insertion only (1.8% in each). Significantly fewer patients in sitting group had preoperative stents (44.9%) versus standing group (47.2%). The sitting group also had a significantly shorter laser time (22.93 +/- 16.73 minutes vs 28.65 +/- 17.75 minutes in standing group). The mean length of stay was significantly higher in the sitting group (5.11 +/- 3.68 days) versus standing group (3.19 +/- 3.28 days). A significantly higher residual fragments (defined as any single fragment >= 4 mm or multiple fragments of any size) were found in the sitting group (34.2%) versus standing group (18.2%).Conclusion: Our real-world study is the first attempt to objectively compare outcomes of RIRS performed by surgeons in sitting and standing position. While statistically significant findings favour standing in univariate analysis, Multi-variable analysis (MVA) showed that surgeon position is not directly responsible for SFR and complication outcomes. This study does show that sitting position is safe, efficacious and replicates the same principles when done in standing. A dedicated randomized controlled trial (RCT) in a controlled set up with comparable lasing techniques will be needed to make stronger inferences. As sitting position is ergonomically proven better our study encourages surgeons to perform F-URS in this position.
Introduction . Occupational injuries are defined as the aggregate of injuries sustained by workers in the workplace over a certain period of time, e.g. one year. Occupational injuries are a manageable process and an operational safety indicator. The aim is to study the level of occupational injuries among the personnel of the Russian Emergencies Ministry and identify the leading circumstances of injury, the prevention of which will minimize injury rates. Methods. We studied reports on occupational injuries among the EMERCOM of Russia personnel, compiled by the Occupational Safety Department of the Directorate for Political and Educational Work of the EMERCOM of Russia from 2015 to 2024. Occupational injuries were classified by personnel categories, type of activity, causes of injury, and 18 categories of injury circumstances. The average annual occupational injury rate was calculated per 10,000 personnel, or as injuries/ (person per year) × 10 –4 . Data similarities and differences were assessed using the nonparametric Kruskal–Wallis criterion. Five qualitative injury severity levels were identified. Results and discussion. Between 2015 and 2024, a total of 2,123 occupational injuries among the EMERCOM of Russia personnel were recorded. The average annual occupational injury rate among the EMERCOM personnel was 10.10 × 10 –4 injuries/ (person per year), including 13.66 × 10 –4 for technical, 10.96 × 10 –4 for managerial, 9.82 × 10 –4 for operational, and 5.62 × 10 –4 for preventive personnel. A decreasing trend in injury rates was observed over the study period. Qualitative levels of occupational injury rates among the EMERCOM personnel were calculated for each federal district of Russia. Firefighting and clean-up of consequences of other emergencies was associated with the average annual injury rate of 4.38 × 10 –4 , compared with 3.87 × 10 –4 injuries/(person per year) for routine activities and 1.85 × 10 –4 injuries/(person per year) for training and sports. The average annual injury rate associated with psychophysiological causes was 5.87 × 10 –4 , with hazardous fire and other emergency factors contributing 2.58 × 10 –4 , organizational and technical causes standing at 1.45 × 10 –4 and 0.19 × 10 –4 injuries/(person per year) respectively. The leading causes of occupational injuries were individual negligence, e.g. falls (41.5 %), traffic violations (11.1 %), exposure to defective items, parts, machines, etc. associated with organizational causes (9.9 %), collapse or falling of building structures, objects, or materials during firefighting and emergency clean-up (7.3 %), poisoning by combustion products (5.0 %). The cumulative contribution of these circumstances accounted for 74.8 % of all injuries. Unfortunately, a trend to underreport and conceal occupational injuries persists across the EMERCOM units, with one fatality and no more than 12 occupational injuries reported between 2015 and 2024. Conclusion . In order to minimize occupational injury rates, all injury types should be comprehensively taken in account, including cause and effect analysis; involvement of department heads, engineers, occupational health and safety specialists, doctors, and other professionals is a prerequisite.
Relevance. The militarization of a number of countries and the number of armed conflicts in the world are not decreasing, which necessitates the development of programs to curb armed violence and improve the safety of the population in a number of countries. The aim is to study the risks of deaths in armed conflicts in the regions of the world, which can be extrapolated to sanitary losses and optimize the elimination of consequences. Methods . We have studied 6 scientific projects that index the consequences of armed conflicts in the world. Deaths by category (combatants, civilians, unidentified persons) were obtained from the UCDP/PRIO database on armed conflicts [https://ucdp.uu.se/]. The number and types of armed conflicts (state, non-state and «unilateral violence») were specified on the electronic resource War and Peace [https://ourworldindata.org/war-and-peace]. Knowing the number of the world’s population and regions that you have received on the site [https://countrymeters.info /] calculated the individual risks of death in armed conflicts per 1 million people of the population (10 -6 ). Acceptable (conditionally acceptable risk) is data that differs by 1 / 3 from the global average, optimal – less than 1 / 3 of the average value, high (unacceptable) – more than 1 / 3 . The dynamics of the indicators were presented in the form of polynomial trends of the 2nd order with the calculation of the coefficient of determination, the threshold of significance of which was 0.5. The results and discussion . In 10 years (2015-2024), 1.754 armed conflicts were registered in the world, in which 1 million 489.3 thousand people died, of which 53 conflicts occurred in Europe, 284 in Asia, 305 in the Middle East, 998 in Africa, 320 conflicts in America with the deaths of 258 thousand, 211, 364, 529 and 127 thousand people, respectively. The average annual individual risk of death in all armed conflicts in the world was 19.27 ∙ 10 -6 deaths/(person ∙ year), in state conflicts – 15.32 ∙ 10 -6 , in non–state conflicts – 2.76 ∙ 10 -6 deaths/(person ∙ year). There is a tendency of increasing risks in the dynamics. The high risk of death in all conflicts was 78.94 ∙ 10 -6 deaths/(person ∙ year) in the Middle East, 40.33 ∙ 10 -6 in Africa and 34.41 ∙ 10 -6 in Europe, 4.53 ∙ 10 -6 in Asia and 12.54 ∙ 10 -6 deaths/(person ∙ year) in America. A similar qualitative gradation was observed with the risks of death of combatants, for example, the risk in the Middle East was 46.92 ∙ 10 -6 , in Africa – 30.64 ∙ 10 -6 , in Europe – 28.53 ∙ 10 -6 , in Asia – 3.91 ∙ 10 -6 and in America – 0.36 ∙ 10 -6 deaths/(person ∙ year). The risks of civilian deaths in the regions of the world correlated with the acceptable gradation, with the exception of the Middle East, where risk indicators approached the upper limit of the conditionally acceptable – 23.36 ∙ 10 -6 deaths/(person ∙ year). There is a multidirectional trend of risks in the regions. The reasons for the expressed risks in the regions have been clarified. Conclusion. The death of the population can be extrapolated to sanitary losses and, thus, to refine the forces and means of disaster medicine in regions (countries) to eliminate the consequences of armed conflicts.
Relevance. Hazardous occupational environment exposes the military contractors to an increased risk of overstrained functional health reserves, conducive of ENT disorders and injuries. The objective is to analyze the ENT morbidity statistics among military contractors of the Russian Ministry of Defense over 5 years of peacetime (2017 to 2021) to be further compared with that for the Russia’s civilian labor force. Methods. The servicemen morbidity database (medical reports under reference code 3/MED) were analyzed with a specific focus on the diseases of the ear and mastoid process in accordance with the International Statistical Classification of Diseases and Related Health Problems 10 th Revision (ICD-10; Chapter 8). Morbidity statistics for the military and the civilian labor force of Russia was compared. Morbidity was calculated per 1,000 (%), while the discharge from service was estimated per 100,000 (10 –5 ). Similarities and differences across the datasets were assessed using the Mann–Whitney U test for non-parametric hypothesis testing. Dynamics and trends were analyzed using time series analysis and second-order polynomials; trend congruence was assessed by Pearson correlation coefficient. Results and analysis. In 2017–2021, the multi-year average for total ENT morbidity among military contractors was 24.9 %, accounting for 2.7 % of the total morbidity across all ICD-10 classes. Newly detected cases stood at 13.2 % (2.7 %); labor loss accounted for 12.6 % (2.5 %), with 102.2 % (2.4 %) of working days lost and 2.8 • 10 –5 (0.5 %) of discharge rate. ENT diseases with highest morbidity rates included otitis externa (H60), nonsuppurative otitis media (H65), suppurative and unspecified otitis media (H66.0), sensorineural hearing loss, bilateral (H90.3) and conductive hearing loss, bilateral (H90.0), contributing 77.2 % to the overall morbidity, 79.9 % to the incidence rate, 78.5 % and 78.1 % to labor loss and working days lost respectively. The discharge causes were dominated by sensorineural hearing loss, bilateral (H90.3), mixed conductive and sensorineural hearing loss, bilateral (H90.6), suppurative and unspecified otitis media (H66.0), conductive hearing loss, unspecified (H90.2), and otitis externa (H60), accounting for the total 64.8 %. A downward trend in ENT morbidity dynamics among the military contractors was observed. Once compared to the working-age population of Russia, the ENT morbidity among the military was significantly low. Conclusion. The analysis of the multi-year average for ENT morbidity among contract servicemen of the Russian Ministry of Defense allows to anticipate future demands for healthcare capacities and resources.
Introduction. Activity in extreme conditions can potentially lead to disruptions in psychological adaptation, reduce the body’s functional reserves, and decrease the combat effectiveness of military personnel. The study aim is to assess the quality of life indicators among combatants of the special military operation and identify targets for psychocorrective interventions. Methods. A total of 279 combatants of the special military operation presented with mild to moderate injuries were examined in a field triage hospital. The average age was 34 years, with the length of special military operation service of approximately 9 months. The quality of life was assessed using a specific questionnaire of 30 statements regarding satisfaction with their life, military professional and family relationships, health status, and health saving behavior. Combatants were asked to assess their attitude to each statement by indicating the score on a 7 cm horizontal line with the earlier indicated starting and end points. The intervals were measured in millimeters and assigned scores, with an average score of 35 points. Psychological adaptation parameters were identified using the Combat-Related Mississippi Posttraumatic Stress Scale, while response bias was measured using 10 honesty assessment questions from the Standardized Multifactor Personality Inventory. Results and analysis. The average quality of life satisfaction score among combatants included 38 points: 2.2 % reported low satisfaction, 90.3 % reported moderate satisfaction, and 7.5 % reported high satisfaction. Among the quality of life parameters, health status indicators ranked top in significance followed by psychological family well-being and family relations; military professional relationship stood top three, followed by health saving behavior, and life satisfaction ranked top five. The average Mississippi Scale score was 80 points, indicating normal psychological adaptation among the combatants. Potential psychological adaptation disturbances were found in 21 % of cases, including the 4.9 % risk of post-traumatic stress disorder development. Quality of life assessments showed low negative, though statistically significant correlation with the length of special military operation service and the Combat-Related Mississippi Scale score. Conclusion. The designed questionnaire for quality of life satisfaction assessment allows to evaluate the psychological adaptation in combatants, as well as the extense of gained experience. These measures might be useful to identify the targets for psychocorrective interventions.
