[Assessing of iodine consumption with iodized salt in organized nutrition of children of preschool and school age in the Tyumen region].

The territory of the Tyumen region is an endemic region with insufficient iodine content in the environment, in which, since the early 1990s, active preventive measures have been taken to increase the use of iodized salt (IS) in households, catering and the food industry. The purpose of the research was to assess the consumption of iodine with IS used in the organized nutrition of children in the Tyumen region. Material and methods. The assessment of iodine intake was carried out in preschool institutions and schools randomly selected the city of Tyumen and rural areas (village of Isetskoye). Modeling of iodine consumption in organized groups was carried out for children aged 1-3, 3-7, 7-11 and 12 years and older in urban and rural areas, respectively, using a standard menu and a technological map of dishes. Iodine intake was estimated based on the content of 40 µg of iodine in 1 g of salt and its 30% loss during cooking. Model 1 assumed the mandatory use of IS in the preparation of all salt-containing meals for preschoolers and schoolchildren. Model 2, in addition to the mandatory use of IS in school and preschool meals accounted the consumption of iodine with bakery products (BP) produced with IS. Results. The modeling showed that the average intake of iodine with meals (model 1) in preschool institutions in Tyumen was 89±16 µg/day for children aged 1-3 years. When BP with IS were included in the menu (model 2), iodine intake increased to 101±14 µg/day. In children aged 4-7 years iodine intake was 115±18 and 126±18 µg/day, respectively. In rural areas, iodine intake was lower: in children aged 1-3 years, under model 1, iodine intake was 66±3 µg/day, under model 2 - 76±4 µg/day. In children aged 4-7 years, these figures were 83±3 and 92±4 µg/day, respectively. Iodine consumption in a school in Tyumen under model 1 in children 7-11 years old was 24±5 µg/day, and in children 12 years and older - 27±6 µg/day. When BP with IS were included in the menu (model 2), iodine intake increased to 32±5 µg/day in children 7-11 years old and to 39±6 µg/day in children 12 years of age and older. In rural areas, when using model 1, iodine intake in children aged 7-11 years was 37±15 µg/day, in children aged 12 and over 40±21 µg/day. When BP with IS were included in the menu (model 2), iodine intake increased to 44±15 µg/day in children aged 7-11 years and to 50±21 µg/day in children 12 years of age and older. Conclusion. The use of IS in the preparation of salt-containing meals in preschool educational institutions of the Tyumen region fully covered the iodine requirements of preschool children, which confirms the effectiveness of the chosen strategy for the prevention of iodine deficiency and can be considered as an important part of the concept of universal salt iodization. The use of IS in preparation of school breakfast meals provides 23.5-36.9% of the recommended nutrient intake for iodine in rural schools and 15.4-26.4% of the recommended nutrient intake in urban schools, which can be a significant contribution to the total intake of this micronutrient.

[Comments to clinical guidelines "Iodine deficiency disorders and diseases"].

The Letter to Editor presents an analysis of some sections of the clinical guidelines «Diseases and conditions associated with iodine deficiency¼ published in No. 3 of the journal «Problems of Endocrinology¼ for 2021. In particular, the discussion deals with the coding of thyroid diseases according to ICD-10, depending on the iodine status of the population of constituent entities of the Russian Federation, as well as issues of diagnosis and treatment, such as «verification¼ of goiter detected by palpation, or treatment of the vast majority of children, adolescents and adults with potassium iodide. The obstacles to the epidemiological assessment of the iodine status of the population when examining schoolchildren are discussed separately, in connection with the introduction in 2020 of the new regulation, which requires the mandatory use of iodized salt for cooking in school canteens throughout the country.

[Modeling of iodine consumption with industrial processed foods made with iodized salt in the adults and pregnant in Armenia and Moldova].

In recent years, significant progress has been made at the global level in eliminating of iodine deficiency. However, until recently, there has been a gap in methods for estimating iodine intake with industrially processed foods (IPF) produced with iodized salt (IS). The aim of this work was to study the iodine consumption with IPF and kitchen salt by the adult population and pregnant women in Armenia and Moldova. Material and methods. For modeling iodine consumption, a special matrix based on MS Excel spreadsheets was used, into which data on the average per capita daily consumption of the main IPF, salt content in IPF, the share of IPF produced with IS in the total volume of their consumption, percentage of households using IS, and the iodine content in salt according to the national standard were entered. Results and discussion. The estimated average daily salt consumption per capita of the adult population of Armenia was 10.6 g. Due to the use of IS in 93% of households and in the production of 82% of bakery products, 7% of cheese, 83% of meat products, 44% of canned vegetables and 5% of pasta, iodine intake in adults was 149% of the recommended daily allowance (RDA). Bakery products and iodized kitchen salt were the main sources of iodine (66 and 70% of the RDA respectively), and the share of other IPF did not exceed 13%. In Moldova, salt consumption was 11.9 g per day. Due to the use of IS for the production of 50% bakery products, 12% of canned vegetables and 20% of pasta, iodine consumption in adults in Moldova amounted to 74% of RDA almost entirely due to bakery products and kitchen salt (37 and 35% of the RDA respectively). The median urinary iodine concentration indicated adequate iodine intake in both countries and was significantly higher in Armenia (242 µg/L) than in Moldova (136 µg/L). A planned 30% reduction in salt intake may lead to an inadequate reduction in iodine intake in pregnant women. Conclusion. Adequate iodine intake among the adult population of Armenia and Moldova is ensured mainly through the use of IS in households and in the production of bakery products.

[Iodine deficiency disorders as a non-infectious epidemic: a look at the problem at the tome of COVID-19 pandemic].

Radioactive iodine, flying out of the destroyed reactor of the Chernobyl nuclear power plant, like a corona virus quickly spread throughout Europe. Iodine deficiency in the regions of Ukraine, Belarus and Russia adjacent to nuclear power plants became a factor in increased uptake of radioactive iodine by the thyroid gland in children and after 5 years led to an epidemic of thyroid cancer. Optimal iodine intake could become a kind of vaccination, which sharply reduces the risk of developing thyroid cancer, as has happened after the accident at the Fukushima nuclear power plant in Japan. Endemic goiter was eliminated 50 years ago, but returned to the country in the early 1990s after the collapse of iodized salt production and has not been eliminated to this day due to the lack of a legislative framework for mandatory salt iodization. The actual average consumption of iodine by residents of Russia is from 40 to 80 mcg per day, which is 23 times less than the recommended norm. Mild and moderate iodine deficiency was detected throughout the Russian Federation, and it is more typical for the the rural population. The iodine deficiency has the greatest negative effect on the psychomotor development of the child during the critical period the first 1000 days of life from the moment of conception to the end of the second year of life. According to WHO, over the past 20 years, iodine deficiency has been eliminated in 115 countries of the world, and the number of iodine-deficient countries has dropped to 25, but Russia is still among them. We believe that after the COVID-19 pandemic, it will no longer be necessary to prove the need for effective support for the prevention of both infectious and non-infectious diseases, and the declared preventive direction of Russian medicine will indeed become such.

[Diagnostics of pneumothorax with ultrasound].

The article deals with a method of pneumothorax diagnostics based on verification of four ultrasound sings--lung sliding absence, B-lines absence, lung pulse absence and lung point presence. Use of ultrasound allows to quickly diagnose a pneumothorax and to monitor the condition of pleural space. Introduction of the ultrasound methods into routine work ICU specialists can increase safety of patients.

[Prophylaxis iodine deficit: information support].

An insufficient intake of micronutrients has massive and permanent nature and influence negatively to health, growth and vitality of the entire nation. One-third part of Russian schoolchildren suffer from deficiency of iron and iodine. Every year in Russia 215,000 children are born with brain damages associated with iodine deficiency. Raising the public awareness regarding the risks and prevention of micronutrient deficiency is the key issue of public health and nutrition. The study which included 4500 respondents in the Urals Federal District showed 2-4-fold increase awareness of the respondents in different positions after the communication campaign for prevention of micronutrient deficiency.

[Clinical characteristics, diagnosis, and treatment of acute intoxication by baclofen].

For last few years in Russia and in the Armed Forces of RF is marked a growth of number of acute intoxications by GABA-agonists and by muscle relaxants, particularly by baclofen. Manifestations of intoxication by this specimen include cerebral and somatic-vegetal disorders, in grave cases of illness could evolve psychic excitement, delusions and coma. Treatment of baclofen intoxication compares of gastric lavage using a thick pathfinder, accompanied by insertion of adsorbent and apocathartic means, maintaining of impaired vital functions of body. Hereafter these injured patients should be hospitalized in a treatment institute, where exists a possibility of effectuating of reanimation and intensive care as well as extracorporal detoxication (hemosorption, hemodialysis).

[Some disputable issues of transfusion therapy in wounded patients].

On the basis of an analysis of the tactics of transfusion therapy in 272 wounded persons and victims with acute massive blood loss, the authors conclude that it is necessary to strictly follow the principle of individual directionality during blood transfusions. By taking into account the high risk of development of iatrogenic complications in the postshock periods of traumatic disease, it is expedient to do away with hemotransfusions in the advancing mode.

[Organization of anesthesiological and resuscitative care delivered to the wounded and patients in the large specialized hospital].

On the basis of an analysis of the specific features of organization of anesthesiological and resuscitative care, the authors formulate a number of points that are of great importance for the quality of work. They give the optimal recommendations for organizing the professional activities of physicians of intensive care units and consultants. The paper presents conceptual sketches of the training of anesthesiologists working in a specialized center are presented. The authors show it necessary to follow the principle in the gradation of anesthesiological and resuscitative care.

[Prevention of iodine-deficient diseases].

The Interregional center of public health and development assisted by Sechenov Moscow Medical Academy undertook, 1999-2000, a study of the standard of knowledge, attitude and conduct of consumers in respect to the use of iodinated salt (IS) in the prevention of iodine-deficient diseases (IDD). It was demonstrated that, on the average per one district, 19% of city respondents and 13% of rural respondents used IS only. About 31% of city respondents used IS when it was available at the next-door shop, i.e. from time to time. This figure reached 48% in Irkutsk and Orenburg Regions. The share of those who used IS sometimes in rural regions made an average of 20.7%. 67.2% of those who believe that IDD can be prevented think that ID can also be prevented. Less than 5% of them say ID cannot be regarded as a reliable tool in the prevention of IDD.

[Clinical guidelines developed by the Russian Association of Endocrinologists for the diagnosis and treatment of nodular goiter].

The guidelines presented do not pretend to be a systematic presentation of all aspects of the diagnosis and treatment of nodular goiter and are not intended to replace guidelines for various medical disciplines. In real clinical practice, situations may arise that are beyond the scope of the recommendations presented, in connection with which the final decision regarding a specific patient and responsibility for him lies with the attending physician.The recommendations presented are mainly devoted to the diagnosis and treatment of nodular (multinodular) euthyroid colloid, differently proliferating goiter in adults (over 18 years of age) and are the agreed opinion of the RAE experts who developed them. Nodular (multinodular) toxic goiter, tumors (malignant and benign), as well as other diseases that can manifest themselves by nodular formations of the thyroid gland (thyroid gland), are discussed mainly in the context of differential diagnosis. The recommendations also do not affect the features of diagnosis and treatment of nodular goiter in children and adolescents.

[Specifics of intensive therapy in abdominal gunshot wounds]. / Osobennosti intensivnoi terapii pri ognestrel'nykh raneniiakh zhivota.

Among the wounded admitted to the departments of anesthesiology, resuscitation and intensive therapy there were from 57.8 to 77.6% of gunshot injuries of the abdomen. Successful treatment of such patients is dependent not only on the timeliness and quality of surgical interventions but also on the correct choice of intensive therapy before and during operation and in the postoperative period. The temporizing strategy providing for expanding the list of the methods used as late as the symptoms of the unfavorable course of the postoperative period can not be considered sufficiently effective. Complex intensive therapy with a forestalling action on different links of the wound disease pathogenesis in most cases allows not only the elimination of organic and systemic impairments resulting from the wound but also is more effective for defensive compensatory mechanisms. Differentiation of the programs of treatment depending not only on the severity of the patient's state but also on the character of injuries of organs of the abdominal and retroperitoneal areas is of the leading significance.

[Anesthesiological aspects in determining indications and contraindications for surgical interventions in patients with severe wounds and injuries in the post shock period]. / Anesteziologicheskie aspekty v opredelenii pokazanii i protivopokazanii k vypolneniiu operativnykh vmeshatel'stv pri tiazhelykh raneniiakh i travmakh v postshokovom periode.

Approaches to validation of indications and contraindications for interventions in wounded patients and victims were developed on the basis of many-year experience. The desirability of intervention is determined primarily by strategic tasks which it solves. The operation is to be performed despite severe clinical condition if it removes the cause of critical state or creates conditions for preventing life-threatening complications of the traumatic disease. All the rest interventions can be postponed till complete or partial compensation of vital systems.

[Acute insufficiency of the gastrointestinal tract in patients with severe gunshot injury]. / Ostraia nedostatochnost' organov zheludochno-kishechnogo trakta pri tiazheloi ognestrel'noi travme.

Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.

[Approaches to decreasing polypragmasy in intensive care of patients with severe injuries]. / Puti umen'sheniia polipragmazii pri intensivnoi terapii u postradavshikh s tiazheloi travmoi.

A total of 277 patients with grave combined injuries were treated. Polypragmasy involved all the trends of intensive care and was most often observed in infusion-transfusion and drug therapy. Three main approaches to decreasing polypragmasy in intensive care of victims with grave combined injuries consist in decreasing the volume of infusion-transfusion therapy, use of a limited number of antihypoxants, and early short courses of antibiotics.

[Anticipated intensive care in gunshot injuries of the abdomen]. / Operezhaiushchaia intensivnaia terapiia pri ognestrel'nykh raneniiakh zhivota.

Analysis of intensive care of 345 patients with gunshot wounds permitted the development of standard protocols of such care with consideration for the visceral injuries. In wounds to the large intestine, multiple-modality treatment including hyperbaric oxygenation, extracorporeal detoxication, and intraaortic infusion of drugs is recommended irrespective of the phase of peritonitis. In injuries to the small intestine, traditional intensive care (infusion therapy, partial parenteral nutrition, prolonged epidural blocking, and antibiotics) can be sufficient. However, in both cases these methods are to be used not after manifestation of signs of disorders in the abdominal cavity, but anticipate them, and the treatment is to be based on the general regularities in the course of traumatic disease in wounded patients. Such an approach can prevent the progress of peritonitis and improve the outcome of wound.