Suchergebnisse

Public health is the most important power factor of a nation, from which all other factors derive. Infectious diseases are the most important cause of morbidity and mortality in humans. Vaccination is the most important method of prophylaxis of infectious-contagious diseases. Mass implementation of vaccination prevents the occurrence of epidemics, epizootic diseases or homonymous pandemics, and at the individual level ensures the specific active immunity (total or partial). So the vaccination of the population and/or the risk groups is of strategic importance to the nation, both in peacetime and in time of war. The national antidote production along with anti-infectives (vaccines, therapeutic serums, immunomodulators, antimicrobial chemotherapies and pesticides) has a strategic importance for the health of the population and of the troops. Biological crisis situations are cases of force majeure, where the Medicines Law provides the exception for manufacturing and use, even without a ""marketing authorization"". The military scientific research could make micro-production of specific drugs (antidotes, antiinfectives) for the needs of the army and the risk groups of the population. An example would be the preparation of vaccines for the prophylaxis of diseases caused by BWA and bioterrorism as niche products. Nothing hinders the preparation of any medication, such as magistral and galenical preparations, or pilot batch, provided there is adequate space, equipment, staff and procedures according to the law or the exception.

The Military Medical Research Center (CCSMM) is a health research unit, subordinated to the Medical Directorate of the Ministry of National Defence. The overall objective is represented by conducting researches on the medical protection against weapons of mass destruction (ADM) that use chemical, biological, radiological and nuclear (CBRN) agents, on the accidents involving CBRN agents and on the military-medical expertise in the field. The CCSMM specialists develop methods and techniques for diagnosis, prophylaxis, treatment and recovery to optimize medical countermeasures during peace, war, or crisis situations. The activity is complementary to the one carried by the "Cantacuzino" National Military-Medical Institute for Research and Development which deals with the diagnosis of infectious diseases (microbiology and epidemiology) and the production of reagents and biological medicinal products for infectious diseases. In conclusion, CCSMM is a unique healthcare unit nationwide, by its field of activity, having a tradition of over half a century, during which it has formed specialists and has had outstanding achievements in the medical protection against CBRN weapons and agents. There are prerequisites for the further development and visibility of the institution.

The novel coronavirus, identified in December 2019, has caused a pandemic that will remain in the medical literature as SARS-CoV-2, the etiological agent of the Covid-19 disease. It was initially stated that this disease would not be more serious than the flu, in terms of prevalence, frequency of complications and mortality. Although in the country of origin the epidemic was only local, the virus spread successively to other countries, until it quickly spread to all inhabited continents and was declared a pandemic. Being a new disease and a new virus, the world panicked. The World Health Organization released guidelines to member countries, which they have implemented. Because the disease sped out of control, it became not only a health crisis but also a socio-economic one. A year later, we are still facing this disease, about which we have learned a lot but not yet all that is necessary and so the time has come for a certain summing up. The Covid-19 pandemic is a reality of current times, the year 2020 being portrayed as the "COVID year". The international scientific community has shown that, when needed, it can collaborate beyond classical barriers. Statistics show that the virus is not very aggressive, the disease is not very serious but there are also serious, sometimes fatal complications to which appropriate measures must be applied. The risk of serious illness and life-threatening complications is statistically reduced over time, the disease being less severe now than at the beginning, so it is on a downward slope.

"The evolution of the planet's climate is multifactorial influenced and has a dynamic over time. Many scientists have approached this controversial field, and each relies on objective but divergent statistics. Geographers have established that planet Earth is in a period of slight slow cooling, not at the level of the four prehistoric ice ages, but only at the level of the Little Ice Age from the Middle Ages which probably caused the great migration of peoples from Asia to Europe. This slow cooling is only slowed down and may even be partially reversed by anthropogenic activities. The industry produces large amounts of carbon dioxide from burning fossil fuels and other greenhouse gases. Animals produce carbon dioxide through respiration and digestion, some also methane. The waste degradation, fires, volcanic eruptions, swamps, and thawing of permafrost release carbon dioxide, methane, and other greenhouse gases into the atmosphere. Climate change exit and has always existed, but there is no scientific evidence for global warming or for climate risks other than those we already know. Public health is already facing danger, directly and indirectly, for multiple reasons, to which "climate change" is added. "

Making medical countermeasures requires documentation to assess vulnerabilities, threats and operational risks and bioterrorism through the collection and processing of specific multidisciplinary data in human medicine, veterinary, phytosanitary, the environment, defense and national security, etc. Based on retrospective data and late information (medical intelligence), we can estimate the prospective risk to public health, respectively for troops and civilian population in a given area, the area of operations. The biological military or bioterrorist attack, whether overtly or masqueraded as human or animal epidemics can cause a major biological crisis for troops and the civilian population, for domestic and wild animals, for crops or wild plants or for the environment, which remains contaminated. Therefore, it is important to constantly monitor the situation of infectious diseases in the area of responsibility (national territory, operations theaters) to assess vulnerability, threat and bioterrorist risk but also for making medical anti-bioterrorist countermeasures, which can only be effective by genuine cooperation between all specialized structures of the Ministry of Defense, other departments and the civil society.

One year after the beginning of the Covid-19 pandemic, on the world graph of daily morbidity can be seen that we are in the downturn of the third epidemic wave, consistent with the downturn of the third wave of daily deaths from/with Covid-19. However, the written press and the audiovisual media continue to present alarming balance sheets several times a day that lead the public to the idea of public danger. Doubts about the adequacy of declaring the pandemic were interpreted by some "naysayers" as doubts about the existence of the disease and the virus, and some loudly expressed their opposition against the prophylactic measures. Increasingly, public opinion, the press, and the judiciary system are shedding light on the causes of these approaches, which claim to be based on scientific criteria but sometimes prove to be pseudo-scientific, causing an "infodemic". The best objective orientation in this informational chaos is based on the mathematical-statistical processing of official data that is centralized daily from all countries of the world and published on the Internet. The statistical calculation suggests that in addition to the inequalities inherent in different populations, there are also cases of over-reporting, overdiagnosis, over-treatment, and/or over-media coverage of the Covid-19 case practice. As a general conclusion, the virus is real, the disease is real, but the risk to public health is not particularly serious except in certain geographical areas. If scientifically established prophylaxis and treatment measures are followed, the pandemic may end this year.

Abstract: All large armies (EU and/or NATO) have pharmaceutical production facilities to provide the necessary antidotes for the troops and the population: The French Army Medical Directorate produces many military-specific pharmaceutical products in its own laboratory, the Turkish Army owns its own medicines factory, including CBRN antidotes, the US Army, in addition to a sustained drug purchase program in the pharmaceutical industry has launched a new concept: Pharmacy on demand. Providing the armed forces with antidotes is a necessity, the concept for their endowement in this sense can be based on imports (sometimes impossible to achieve) or on the national development of a specialized production structure. The design or construction of a specific production capacity for antidotes can be accomplished on multiple variants, with a complexity proportional to the identified need. The total costs are high, but the objective and implementation of effective antidote supply mechanisms is a security guarantee for the armed forces and the civilian population (through commercialization to allied forces), given the risks of terrorist threats and hybrid warfare. Keywords: medical protection, antidote, production, technological platform, medical countermeasures, pharmaceutical technique, orphan drug production

Military Medical Service is able for detection, identification and confirmation of biological agents; it is part of medical protection against CBRN weapons. We are specialized capabilities for in vitro tests, under construction, the maximum containment laboratory designed for work with Risk Group Microorganisms. An efficient primary containment system must be in place, consisting of oneor a combination of the following: Class III safety cabinet laboratory, passage of two doors, suit, laboratory, controlled access, controlled air system. Negative pressure in the facility, supply and exhaust air must be HEPA-filtered, decontamination of effluents, sterilization of waste and materials, airlock entry ports for specimens, materials and animals must be provided etc. Complementary is an Animal facility for in vivo tests. This is suitable for work with animals that are deliberately inoculated with microorganisms in Risk Group.

Electroporation is considered a new start-up in the treatment of various tumors; currently, researches are being conducted in order to develop this technology with medical applications. The technique consists in the significant increase in the electrical conductivity and permeability of the plasma membrane of cells resulting from the application of an external electric field. It is routinely used in molecular biology to transform bacteria, yeast, protoplasts and is performed using the electroporators. Currently, the process seems to be a real solution that enables a targeted drug to act with maximum efficiency on cells and tissues requiring treatment, resulting in obtaining a good therapeutic effect without major side effects. Therefore, pharmaceutical companies are trying to demonstrate through preclinical studies the potential efficacy of this technology, succeeding in recent years to achieve important steps in this direction.

The "volatile" international context requires the strengthening of the national security measures, including in the field of CBRN and public health. The medical countermeasures for the defense are based ultimately on the prophylactic treatment (pre-exposure, intra-exposure and post-exposure) and on the curative treatment (of emergency, maintenance and recovery) of the contaminated and the sick. Depending on the rapid and correct etiological diagnosis, the appropriate treatment is immediately applied. Although in times of peace this scenario is almost non-existent, during war or terrorist attack it can be a mass pathology, like an explosive epidemic, that requires specific therapeutic means. Military medicine had and has the conceptual capacity to make antidotes for CBRN medical protection; some have been patented and/or produced as experimental models, but it has no manufacturing capacity anymore.

The biological attack is the artificial spread by various means of pathogens that can cause serious infectious and contagious diseases as well as the spread of germ toxins that can be used by an aggressor as a means of fighting in order to reduce the troops' fighting force, by causing serious disease outbreaks or by killing people, animals and/or plants. Biological agents are microorganisms and/or microbial, animal or plant toxins, used as specific ammunition for biological weapons or used by terrorists in "bio-chem" attacks. The risks of bioterrorism and biocrime attack in the contemporary world are real, and the history of the 20th century and the beginning of the 21st century confirms this. It is necessary for preventive measures to be implemented on the unlawful use of biological agents. Early medical and nonmedical countermeasures must be prepared for the prophylaxis, treatment and cessation of the consequences of any biological attack.

Escherichia coli is the species of the genus Escherichia with the greatest epidemiological impact. Escherichia coli infections are found mainly in places with poor hygiene; the infants with ages between 1 and 3 years old are included in the category with the highest risk. It is a "fecal-oral" transmission mechanism as a result of consumption of contaminated food or water, or by "dirty hands". The foods most commonly implicated in the transmission of the infection are unpasteurized milk and milk products, beef, especially the one insufficiently cooked, unpasteurized fruit juice, lettuce and insufficiently washed vegetables. The disease has been reported worldwide, being described numerous episodes of infection with Escherichia coli that caused multiple illnesses and deaths. Escherichia coli has three types of antigens: antigen "O" (somatic), antigen "H" (flagella) and antigen "K" (capsular). Clinical manifestations are present in the form of non-specific diarrhea, a dysentery form of enteritis, choleriform enteritis, hemorrhagic colitis and hemolytic uremic syndrome (HUS). The Escherichia coli infection diagnosis is made by identifying the etiologic agent and/or by highlighting the VTI toxin in the feces. The treatment consists in precautionary antibiotherapy, hydrodynamics and electrolyte rebalancing, blood transfusions and dialysis, if in the case of renal failure. The prevention of infections with Escherichia coli is achieved by personal hygiene, food hygiene and work hygiene.

In the current military-political context, with the Cold War having ended, we find ourselves in full anti-terror war, in which Romania is a direct participant, as a member of N.A.T.O. and the E.U., and the issue of biological warfare and bioterrorism is again highly topical but bearing other valences. There is information that there are still laboratories and plants specializing in the research and manufacture of biological weapons. Most of the results of such research are not intended to be published; however, a number of research guidelines that testify to the trends in the improvement of biological weapons and their means of use can be deduced from the data published by researchers from several research institutes. We believe that the threats posed by bioterrorism are real and that it is mandatory to be prepared at any time to prevent, combat and liquidate the consequences of ""bio-chem"" attacks, respectively the management of the consequences.

The treatment of diseases is based on pharmacological and non-pharmacological means, but adequate devices are needed for their application. Medicine uses a wide range of medical devices. Currently, many medical devices are used, many of them being disposable. As recognition of the importance of medical devices, the national authority of the drug is the ANMDM (National Agency for Medicines and Medical Devices). Medical devices are indispensable for therapy, and their evolution has led to an extraordinary diversification of the field and the emergence of industry related to the pharmaceutical industry, with specific laws and regulations.

Given the continuous growth of the bacterial resistance phenomenon, the appropriate choice of antibiotherapy represents an important step in the treatment and prophylaxis of infectious diseases. Depending on the symptomatology, the dose required for the effective treatment of an infection may vary. Inadequate dosing not only reduces the effectiveness of the antibiotic, but also promotes the emergence of resistant bacterial strains. Also, too high of a dose increases the toxic side effects of antibiotics. Therefore, a personalised antibiotherapy according to: the patient's clinical status, body mass, associated chronic diseases, etc. represents a promising approach in the treatment of infectious diseases. The purpose of this study is to present the most important current affairs regarding the emergence of new antibiotics, the maximum doses recommended by the latest version of the ""European Committee on Antimicrobial Susceptibility Testing"" (EUCAST - version 9/2019) and providing an indication on whether these antibiotics are used in Romania.