Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации8165UnclassifiedTHE IMPACT OF MILITARY OPERATIONS ON THE OCCURRENCE OF DISEASES OF THE CARDIOVASCULAR SYSTEM IN HUMANSVugernichekAnastasia Yurievna<p>3rd year student</p>vugernicheknastya@bk.ruhttps://orcid.org/0009-0004-6082-1895State educational organization of higher professional education «Donetsk National Medical University named after M. GORKY»2004202312S277803001202307032023Copyright © 2023, Vugernichek A.Y.2023<div class="Translate-Scroll"> <div class="Translate-ScrollBar Translate-ScrollBar_visible"></div> </div> <div class="Translate-TargetText Translate-TargetText_userSelect_enabled" aria-hidden="true">The relevance of the work is to study the influence of extreme factors of combat operations on a person, difficulties in adapting to traumatic situations and exhaustion of the body under constant stress. However, the peculiarities of the violation of the health of the civilian population in military events have not been sufficiently studied so far. The aim is to calculate the dynamics of morbidity among citizens living in military combat conditions. This article evaluates the shift in the incidence of cardiovascular diseases in civilians of the Donetsk People's Republic living during hostilities. The frequency of occurrence of coronary heart disease with hypertensive heart disease was calculated according to statistical data from the collection "Indicators of public health and the activities of healthcare institutions of the Donetsk People's Republic for 2014 and 2021" for the republic. The article reveals some of the military episodes that occurred with citizens, and which could directly or indirectly affect the state of health.Since psychological pressure, biological, chemical, nuclear weapons, explosive events were applied to the civilian population, which undermine the resistance of the organism and disrupt its vital activity. It was found that pathologies of the cardiovascular system occupy a leading position among other diseases, and their growth could be facilitated by the presence of military events on the territory of the republic.</div>coronary heart diseasehypertensive heart diseasemilitary eventsmorbidityишемическая болезнь сердцагипертоническая болезнь сердцавоенные событиязаболеваемость<p><strong>Relevance</strong>. As a result of the aggravation of the situation in the region, interest in studying the relationship between military actions and human health has grown.</p> <p><strong>Objective:</strong> To assess the dynamics of the growth of coronary heart disease (hereinafter - CHD) with hypertension in civilians during hostilities.</p> <p><strong>Materials and methods.</strong> A retrospective analysis of the data of coronary heart disease with hypertension in the collections "Indicators of public health and the activities of health institutions of the Donetsk People's Republic for 2014, 2021" was carried out. The morbidity of the population (per 10000 people) was studied according to the annual statistical reports of the health authorities of the Donetsk People's Republic.</p> <p><strong>Results.</strong> As you know, the war in the Donetsk People's Republic (hereinafter - the DPR) has been going on since 2014. During this time, a large number of weapons, including foreign ones, were used in our area. To create fear and to achieve their goals, indiscriminate violence was used against the peaceful citizens of the republics: psychological pressure, biological, chemical, nuclear weapons and explosive events. According to the Geneva Protocol of 1925, all types of terrorism are prohibited for use [1].</p> <p>Bioterrorism is the deliberate release of biological agents, modified or natural, to provoke deaths and diseases in humans, animals, plants [2]. Examples of the use of biological weapons in the territories of the DPR:</p> <ol> <li>A NATO bio-laboratory was discovered on the territory of the Azovstal plant in Mariupol, where experiments and the development of bioweapons were carried out.</li> </ol> <p>There is documentation that says about the destruction of pathogens of pathogens of plague, cholera, tularemia, anthrax and other deadly diseases [3].</p> <ol start="2"> <li>In February 2022, Ukraine received from the West 50 drones capable of spraying various biological substances.</li> </ol> <p>Chemical weapons are weapons of mass destruction consisting of toxic chemicals: toxic substances, toxins and phytotoxins. The results of the use of this type of weapon are severe environmental and genetic consequences and the moral and psychological effect of the impact on people [4].</p> <p>1) As a result of the shelling of the Sarmat brewery by Ukrainian soldiers, ammonia (a highly toxic substance) ignited on 10.08.2022. The volume of ammonia loss is about a ton. The radius of destruction was 2 km. These events caused an increase in ammonia above the permissible norm in the air, in the reservoir of the Donetsk Botanical Garden, provoking the destruction of the flora and fauna of the area. All fish and crustaceans, plankton, invertebrates died, birds and mammals died, having consumed water or inhabitants of the reservoir. The lives of herons, croaks, and minks were under threat [5].</p> <p>2) In 2017. during the next shelling of the filtration station, shells flew into the room where 7 tons of chlorine were stored, but the containers were not damaged. If their integrity was violated, then a huge number of victims would be within a radius of 200 meters from this place.</p> <p>3) In 2021, botulinum toxin and benzoxazepine arrived in Ukraine from the USA, as well as containers for their storage, transportation and combat use.</p> <p>Nuclear terrorism is a threat to global security. The phenomenon of nuclear weapons is that it has the qualities of an ideal instrument of terror - threat, blackmail, psychological impact on the leaders and citizens of the opposing country. One of the types of nuclear terrorism is an attack on a nuclear facility (for example, a nuclear power plant). The Ukrainian army has been shelling the Zaporozhye NPP since 05.28.2022. If there is an ingress into a nuclear reactor or into sarcophagi with spent nuclear materials, an oxygen station, an oil and fuel economy, an automated radiation monitoring post, then an environmental and economic catastrophe will occur, which threatens most of the world [6].</p> <p>Explosive events, shelling in the DPR, have been happening daily since 2014, and have become more violent since 2022. Since 2014, the DPR authorities have registered over 8,6 thousand deaths from shelling (statistics as of August 4, 2022), among them 3,5 thousand deaths only for the period of escalation of the conflict after February 24, 2022.</p> <p>Explosive events also have an impact on the occurrence of cardiovascular diseases. In one experiment it was proved that ecchymoses in the pericardium, epicardium and endocardium, myocardial hemorrhage, endocardial hematoma were found in sheep exposed to an aerosol bomb in an open field. With constant exposure to an explosive wave of overpressure in sheep, the consequences of a heart attack were revealed in the form of multiple scars on the myocardial wall with a decrease in the contractility of the heart. Thus, the connection between pathologies of the cardiovascular system and explosive events was substantiated [7].</p> <p>In another experiment, pathological changes were detected in mice more often in the right half of the heart than in the left, when they were lying on their backs parallel to the direction of the blast wave.</p> <p>Post-traumatic stress disorder (PTSD) occurs in people who have suffered events of a threatening or catastrophic nature, for example, military operations. It should be understood that for one person to hear an explosion in the distance is a huge mental strain, and another patient will more easily tolerate the explosion of an exploding shell on his street [8]. It should be noted that the manifestation of symptoms depends on the level of exposure, proximity, and the significance of military culture. PTSD specifically affects the hypothalamic-pituitary-adrenalin system, when a patient experiences stress, there is a marked decrease in the level of corticosterone in the blood serum, behavioral signs of anxiety appear. As is known, the stress reaction determines the morphological, functional and biochemical changes of the heart, which plays a strategically important role for the vital activity of the body. In the study of sections of the myocardium stained with hematoxylin and eosin, heterochromasia of eosin color, tortuosity of muscle fibers, violation of transverse striated, chromatin homogenization in the nuclei was violated. These morphological changes indicate a violation of the functional activity of myocardial muscle fibers. Glycogen, which is a bioenergetic resource for maintaining normal contractile activity, is also reduced. Consequently, PTSD induces a drop in glycogen in the myocardium, and a change in metabolism in the heart indicates a prenosological state of the body [9].</p> <p>To prove all of the above, a retrospective analysis of the data of coronary heart disease with hypertension in the collections "Indicators of public health and the activities of healthcare institutions of the Donetsk People's Republic for 2014 and 2021" was carried out. According to the data of the Main Department of Statistics of the DPR in 2014, the population was 2,345. 4 thousand people, and in 2021 2,227.9 thousand people, which indicates a decrease in the population of the republic. The mortality rate of the population for the main reasons (per 100,000 people) in 2014 amounted to 1250.0, and in 2021 2022.8, which indicates an increase in mortality. The causes of death of the population are also diseases of the circulatory system, which in 2014 were equal to 812.7, and in 2021 1176.4. In 2014, their share occupied 65.1%, and in 2022 - 58.2%, a decline is noticeable, but diseases of the cardiovascular system dominate among other causes of death. The incidence of coronary heart disease with hypertension of the entire population (per 10,000 population) in 2014 was 99.5, and in 2021 121.4. The growth rate is 22.01%, this is a fairly large percentage, which indicates a significant increase in the incidence rate, which means that there is a relationship between military operations and the occurrence of pathologies of the cardiovascular system.</p> <p>Summarizing the above, the population from 2014 to 2021 decreased by 117.5 thousand people, which may be due to emigration of the population and natural decline. However, the incidence of coronary heart disease with hypertension among the population increased by 22.01%. Such a big rise was greatly influenced by military events, air pollution by exhaust gases of military equipment, soil chemicals after ammunition explosions.</p> <p>From the above, it can be concluded that the residents of the republic have experienced all kinds of violence and terrorism. The health of the population of the DPR is also negatively affected by economic factors. For example, a decrease in living conditions and quality of life due to a shortage of water, heating, constant interruptions of gas pipes, TV towers, it is also very difficult for a citizen to work, as he may simply not get to work or home due to shelling, lack of rest and silence. Psychological factors constant stress loads from incessant shelling, loss of housing or familiar people, concern for the lives of relatives and one's own. The duration of sleep decreases due to night shelling on residential areas. All these factors, rapidly depleting the body's resources, provoke an increase in morbidity.</p> <p>Everyone tolerates military actions differently, but in order to reduce the negative impact of war, a person should always keep his thoughts under control. He needs to be distracted from the negative reality surrounding him, by communicating with relatives and people pleasant to him, playing sports or other favorite thing. He can master the fields of activity of interest, as well as, if necessary, take sedatives, perform breathing practice, but in no case should you concentrate all day on the data of the operational summary of the shelling and lock yourself in the captivity of negative feelings. However, if a person finds himself under fire, these recommendations may not be enough, in which case he should work out the psychological trauma with a psychotherapist.</p> <p><strong>Conclusion:</strong> The study showed that from 2014 to 2021 in the DPR, the number of people suffering from coronary heart disease with hypertension increased by 22.01%, while the population decreased by 117.5 thousand people. Consequently, constant emotional and psychological stress from fighting, lack of sleep, environmental pollution, sedentary lifestyle as a result of military events in the republic can be considered as provoking factors for the development of coronary heart disease with hypertension. Thus, citizens of the republic, due to the growth of this pathology, need to undergo an annual preventive examination, even in the absence of complaints and symptoms, in order to start treatment on time.</p>1.Корженяк А.М. 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