Authors
Polidanov M.A.1, 2, Maslyakov V.V.3, 4, Dubrovskaya M.A.4, Eliseev Y.Y.4, Eliseeva Y.V.4
1 University «Reaviz», Saint Petersburg
2 Medical University «Reaviz», Samara
3 Saratov Medical University «Reviz», Saratov
4 Saratov State Medical University named after V.I. Razumovsky, Saratov
Abstract
Rationale. Abdominal injuries, particularly in the pelvic region, remain a serious problem, especially in wartime. Studies show that such injuries account for a significant proportion of combat injuries, and their severity is particularly high in the pelvic region. In women, pelvic gunshot wounds are often associated with serious complications and even death. The more time that passes between injury and surgery, the higher the risk of complications. The traumatic morbidity that develops after a gunshot wound is also related to macronutrient levels in the body, especially calcium. Although the problem has been widely studied, there are still questions that need to be answered.
Objective. To track and analyze the changes in blood calcium levels in women who received a gunshot wound to the pelvis in the first days after surgery.
Methods: The study analyzed the consequences of penetrating pelvic gunshot wounds in 35 women who were injured in localized combat operations. The average age of the patients was 35±5 years. In the process of the study the level of total calcium in blood was studied: free, ionized, bound to proteins, as well as undissociated complexes with citrate and phosphate. For the study of blood calcium level data, venous blood was collected, which was further analyzed on an automatic analyzer «Indiko Plus, Thermo Fisher Scientific». To assess the relationship between the indicators, the χ2 test of agreement was used. Statistical significance was determined by r value: 0,01–0,29: weak positive relationship; 0,30–0,69: moderate positive relationship; 0,70–1,00: strong positive relationship.
Results. The study showed that postoperative blood calcium levels increase in the first 24 hours as a result of traumatic shock. Patients who received care sooner (group A) had lower calcium levels than those who received care later (group B). Calcium levels returned to normal more quickly in group A. Three days after surgery, Group B patients’ calcium levels began to rise due to an increase in hormones that regulate metabolism. Complete recovery of calcium levels in group B occurred 17-19 days after surgery.
Conclusions. It was found that intracellular calcium levels increased after surgery compared to the initial value. The peak of this increase was observed on the third day after surgery, when calcium levels were 23% higher than preoperatively. By the fifth day after surgery, calcium levels began to decrease in group A, and in contrast, calcium levels peaked in group B. Importantly, intracellular calcium levels were significantly higher than normal, indicating enhanced cellular damage due to elevated calcium levels.
Keywords: immediate postoperative period, gunshot wounds, calcium balance changes, small pelvis, local armed conflict, pelvic organs, complications.
References
1. Chin CM, Gutierrez M, Still JG, Kosutic G. Pharmacokinetics of modified oral calcitonin product in healthy volunteers. Pharmacotherapy. 2004; 24(8): 994-1001.
2. Deluca HF. Overreview of general physiological features and function of vit. D. Am J Clin Nutr. 2004; 80(6): 1689-1696.
3. Dibba B, Prentice A, Ceesay M et al. Effect of calcium supplementation on bone mineral accretion in Gambian children accustomed to a low calcium diet. Am J Clin Nutr. 2000; 71: 544-549.
4. Caroli A, Poli A, Ricotta D, Banfi G, Cocchi D. Invited review: dairy intake and bone health: a viewpoint from the state of the art. J. Dairy Sci. 2011; 94(11): 5249-5262.
5. Ermak G., Davies KJ. Calcium and oxidative stress: from cell signaling to cell death. Mol. Immunol. 2002; 38(10): 713-721.
6. Sandow SL, Senadheera S, Grayson TH, Welsh DG, Murphy TV. Calcium and endothelium-mediated vasodilator signaling. Adv. Exp. Med. Biol. 2012; 740: 811-831.
7. Marangoni F, Pellegrino L, Verduci E, et al. Cow’s Milk Consumption and Health: a health professional’s guide. J. Am. Coll. Nutr. 2019; 38(3): 197-208.
8. Sheikh MS, Santa Ana CA, Nicar MJ, Schiller LR, Fordtran JS. Gastrointestinal absorption of calcium from milk and calcium salts. N. Engl. J. Med. 1987; 317(9): 532-536.
9. Ilesanmi-Oyelere B.L., Kruger M.C. The role of milk components, pro-, pre-, and synbiotic foods in calcium absorption and bone health maintenance. Front. Nutr. 2020; 23(7): 578702.
10. Shin C.S., Kim K.M. The risks and benefits of calcium supplementation. Endocrinol. Metab. (Seoul). 2015; 30(1): 27-34.
11. Eliseev YY, Spirin VF, Eliseeva YV. Complex assessment of the influence of territorial environmental factors and conditions of vocational training on the adaptation of the organism of students when mastering working specialties. Labor Medicine and Industrial Ecology. 2021; 546-551. (In Russ.)
12. Eliseeva YV, Ratushnaya NSh, Dubrovina EA. Influence of psychological environment on the risk of emotional burnout development in a team of medical workers. Russian journal of hygiene. 2022; 28-32. (In Russ.)
13. Abakumov MM, Tsamalaidze LN, Voskresensky OV, et al. Wounds of the neck, chest and abdomen by firearm traumatic weapons. Surgery. Journal of N.I. Pirogov. 2010; 11: 16-22. (In Russ.)
14. Borovoy IS, Gerusov MA, Agarkov AV, Lobanov GV. Surgical treatment of gunshot injuries of the pelvis and hip joint. Polytrauma, 2023; 1: 39-44. (In Russ.)
15. Linyov KA, Torba AV. Tactics of surgical treatment of gunshot wounds of the abdomen. Surgical News. 2016; 24(1): 93-98. (In Russ.)
16. Maslyakov VV, Dadaev AY, Kerimov AZ, et al. Immediate and distant results of treatment of patients with gunshot wounds of the abdomen. Fundamental Research. 2013; 7: 339-343. (In Russ.)
17. Maslyakov VV, Dadaev AY, Kulikov SA, et al. Improvement of treatment results of civilian abdominal gunshot wounds received in local paramilitary conflicts. Bulletin of the medical institute «Reaviz»: rehabilitation, doctor and health. 2020; 2: 51-56. (In Russ.)
18. Maslyakov VV, Salov IA, Sidelnikov SA, Barachevsky YE, Parshin AV, Polidanov MA. Characterization of the types of first aid for pelvic wounds in women received in a local military conflict. Journal named after N.V. Sklifosov. Neotrudnaya meditskaya aplika. 2023; 12(4): 601-606. (In Russ.)
19. Maslyakov VV, Salov IA, Sidelnikov SA, Barachevsky YE, Parshin AV, Polidanov MA. Characterization of the types of first aid for pelvic wounds in women received in a local military conflict. Journal named after N.V. Sklifosov. Emergency Medical Aid. 2023; 12(4): 601-606. (In Russ.)
20. Maslyakov VV, Salov IA, Sidelnikov SA, et al. Optimization of surgical treatment of gunshot wounds of the small pelvis with damage to internal genitalia in women. Polytrauma. 2023; 4: 13-19. (In Russ.)
21. Maslyakov VV, Sidelnikov SA, Barachevsky YE, et al. Mass simultaneous admission of victims in emergency situations to medical treatment organizations: organizational problems and possible ways of their solution. Disaster Medicine. 2023; 2: 51-55. (In Russ.)
22. Semyonov AV, Sorokovikov VA. Scales of severity assessment and prediction of trauma outcome. Polytrauma. 2016; 2: 80-90. (In Russ.)
23. Aliev SA, Aliev TG. Surgical treatment of gunshot wounds of the chest and abdomen. Bulletin of the N.I. Pirogov National Medical and Surgical Center. 2023; 51-57. (In Russ.)
