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Purpose: Among other reasons, the deteriorating global security situation and dangers associated with nuclear weapons have increased the need for deeper knowledge of the basic mechanisms involving the human immune system and ionizing radiation (IR). We conducted a review as to the effects of IR on thymic tissue, and particularly on the development of thymocytes and the T lymphocytes population in peripheral blood.Existing knowledge on this topic is based in part on national registers that store records concerning irradiated people. The majority of studies in this area, however, are based on experimental animal models. The main open question in this subject area regards the delayed effects of IR on thymus tissue, development of thymocytes, and subsequent impact on the immune system. Findings acquired to date on effects of IR are contributing to emerging fields such as immunotherapy, the objective of which is to support or activate natural immunity response.Methods: Recent research articles were reviewed regarding the influence of IR on thymus tissue and thymocytes development.Results: Differentiation and proliferation of thymocytes constitute a complex and sensitive process that is partially altered after irradiation, as are, too, the mechanisms for movement of early (derived from bone marrow) and derived (thymus derivatives) precursors. Disruption of these processes may lead to alteration of immune system function.Conclusions: Low doses (<200 mGy) may lead to changes in or disruption of functions of the thymus, thymocytes, and mechanisms of the immune system. The extent of IR’s influence is dependent not only on the individual’s radiosensitivity but also on his or her sex and age. With increasing absorbed IR dose, the risk of damage to thymus tissue and thymocytes in the organism rises and the extent of damage increases.

In this paper we have compiled and summarized the steps which manufacturers and clinical investigators need to undertake to perform a target population definition during the Health technology assessment process of medical device, namely external cardio stimulator (pacemaker). Based on available data using top-down approach we have defined target population for external cardiostimulator and estimated, that the size of the target population for external pacing will not exceed 16000 patients per year in the Czech Republic and is of comparable size with other states in the region.

Taking into account the events of recent years, a risk of exposure to high toxic substances including chemical weapons is not negligible. Therefore the Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence introduced analytical and biological samples (plasma, urine) preparation methods for determination of biomarkers of exposure to nerve agent (sarin, cyclosarin, soman, tabun, VX and VR agent) and sulphur mustard. Evidence of chemical weapon use is based on detection of their metabolites (Alkyl methylphosphonic acids as metabolites of the organophosphorus nerve agents, thiodiglycol as a metabolite of sulphur mustard) and products of their reactions with biomolecules (tyrosine adducts of organophosphorus nerve agents, sulphur mustard-albumin adducts). Gas chromatography tandem mass spectrometry and liquid chromatography tandem mass spectrometry are used for determination of biomarkers. Functionality of described methods is validated and discussed participating in Biomedical proficiency test, which is organized by The Organisation for the Prohibition of Chemical Weapons every year.

As of 14^th July 2020, 12,964,809 confirmed cases of coronavirus (COVID-19) and 570,288 deaths had been reported globally. In Kuwait, the numbers stood at 55,508 confirmed cases and 393 deaths. The disease seems to be hitting hard on the country despite the measures that have been put in place. The current study sought to examine healthcare workers HCWs awareness and perceptions of coronavirus disease in Kuwait hospitals. A prospective study design was used to examine the development of the disease among 28 HCWs between mid-May and the start of June 2020. The primary findings were as follows; most of the study participants had attended lectures/ discussions on COVID-19, only few HCWs could identify the incubation period of the novel coronavirus. However, the majority could identify the most common symptoms of the disease as fever, cough, headache, sore throat, runny nose, and skin rashes. Most of the HCWs were aware that the virus transmitted through contact. A good number of the study participants also identified pneumonia, respiratory failure and death as complications associated with coronavirus disease. The study recommends running health education programs in Kuwait to promote knowledge on the coronavirus and help the HCWs develop positive attitudes and uphold important practices.

Introduction: Fluoroquinolones are a frequently prescribed class of antibiotics, which has been blacklisted in recent years because of a growing evidence of the connection with serious undesirable effects, infections Clostridioides difficile, and a connection with the occurrence of multiresistant strains.Methods: In the University Hospital Hradec Kralove in the course of the years 2009-2019, several antibiotic stewardship restrictive and educational interventions were performed by the Antibiotic Centre aiming to decrease quinolone antibiotics administration. The data of the consumption of quinolone antibiotics were retrospectively evaluated and correlated with the development of sensitivity and occurrence of multiresistance of selected bacteria in the hospital.Results: In the period under investigation, consumption of fluoroquinolone antibiotics significantly decreased (p<0.001) in 10 years by 71.8% to 26.7 DDD/1000 patient day. Sensitivity of Escherichia coli and Pseudomonas aeruginosa to fluoroquinolones in the period under investigation increased by 4.8% (respectively by 15%); on the other hand, sensitivity of Staphylococcus aureus decreased by 4.2% to 85.5% share of sensitive strains. The incidence of the multiresistant isolates Pseudomonas aeruginosa decreased by 8.1%, but the occurrence of ESBL-producing Klebsiella pneumoniae was increased in the period under investigation. The occurrence of methicillin-resistant Staphylococcus aureus did not show a stable trend and finally it was moderately increased by 2.9%.Conclusion: Implementation of programmes of antimicrobial stewardship for hospitalized patients resulted in a decrease and a rationalization of fluoroquinolone administration. The reduction of their consumption in our hospital resulted in a statistically insignificant increase in the sensitivity of Escherichia coli and Pseudomonas aeruginosa, but not Staphylococcus aureus.

Pharmacists are responsible for dispensing drugs and protecting the patient by making sure that they use drugs appropriately. They play an important role not only in the overall cost implications of healthcare but also in the concerns about patient safety when using medication. The scope of this paper was to evaluate the practice of navigation of medical resources among pharmacy students through a simulated event of acute kidney injury using a prospective research methodology. A sample of 65 students was used, among which 2 failed to identify the error in dosing (3.1%) while 56 (86.2%) responded with the presence of error in renal dosing and recommended correctly. Only 7 (10.8%) of the study population had an incomplete recommendation. Even though a greater percentage of the student populations were able to identify dosing errors, there were a few that were unable to identify the errors. Even though this percentage is small, it is much significant when placed in various healthcare institutions and is likely to have a significant impact on patient safety.

Pregnancy related maternal mortality defines the state of maternal health. The increasing incidence of maternal death in the U.S indicates that this complex issue is not unique only to developing countries.  It is obvious that improvements are needed to reinsure appropriate healthcare for all pregnant women.  Without precise methodical data collection and data evaluation advancement of this important determinant of maternal health can’t be achieved.The aim of this paper is to provide contemporary perspective on pregnancy related maternal mortality.  In addition, this paper will discuss common ethnical disparities that underline maternal deaths.  Furthermore, this paper will address the confusing inconsistencies of maternal death terminology and variations in disease classification.  Finally, this paper will propose improvements in defining terminology and data collection that influence the understanding of pregnancy related morbidity.Quick Points - 1. Maternal mortality is a determining characteristic of existing maternal health in a given geographical region. 2. While it is impossible to completely eliminate all maternal deaths, preventable pregnancy complications    resulting in injury or death need to be reduced across the world. 3. Healthcare leaders need to work on identification of maternal mortality trends and development

Kenya is a coastal equatorial state in the eastern part of the African continent with a typically tropical climate. Before visiting of this country (according to the length, character and place of stay), yellow fever, hepatitis A, hepatitis B and typhoid, or rabies, should be inoculated. Another problem is brucellosis or endemic malaria, with a typical occurrence in areas over 2 500 m above sea level, around the capital city of Mombasa and along the coast. Endemic occurrence is also reported for cholera. In standing freshwaters, parasitic infestation with schistosomosis is a threat. Tropical species of invasive mosquitoes are not only vectors for yellow fever, but also dengue and chikungunya could be serious problem.

The interest and the increasing need for communication, exchange of experience and materials, training in diagnostics and research methods has led to the idea of creating an international scientific society focusing on tularemia. Tularemia meetings focus on fundamental, clinical, and applied research regarding any aspect of Francisella tularensis.  Research uncovers not only the biology of this fascinating bacterium, but also provides the basis for future development of treatments, preventive interventions, and disease diagnosis. Under the umbrella and with active participation of WHO, a group of scientists has met to develop this idea.

The Future Forces Forum in Prague occurs biennially and offers a premier venue to exchange best practices, ideas, academic and technical debate with key military decision makers on the future of military medicine. In the over 13 events in modern times, all sectors of military and defense forces have shared experiences, strategies of deterrence, common defense structures and modalities to mitigate human suffering and reduce the morbidity and mortality associated with conflict, war and disaster. Czech Republic Ministry of Defense Brigadier General Bubenik has taken the lead with this event to drive future innovation and all things battlefield medicine, to include chemical, biological, radiological and nuclear threats, with overall emphasis on emerging global health security threats. Under his tutelage, Brig. Gen. Bubenik has ushered in a marque venue for such debate at the Future Forces Forum, Prague 2018 (FFF 2018). The expert event took place from October 17^th to the 19^th, 2018 in Prague. This short conference report should serve as a synopsis of the key takeaways, in addition to highlighting some core conclusions to support all medical operations across NATO and at the civilian-military interface.

Perfluoroisobutene (PFIB) is a colorless toxic gas which can be absorbed into the body by inhalation. The substance irritates the respiratory tract and may be used as a potential chemical warfare agent.  Inhalation exposure may cause severe symptoms of pulmonary edema associated with wheezing, difficulty in breathing and sputum expectoration. A bluish skin color is also observed. Initially, cough and chest pain may occur. However, severe symptoms of pulmonary edema may be delayed for several hours before a rapid deterioration of health occurs. Excessive exposure may cause death.

Background. Extracts from plant and/or animal tissues are frequently used in alternative medicine as drugs or food supplements. Such extracts may contain a complex of pharmacologically or physiologically active factors but frequently there exists no experimental confirmation as to precise mechanisms of action. This work aimed to verify if a long used bovine blood extract Imuregen registered as a food supplement has desirable effect on tumor cells.Methods. Two independent methodological approaches were used. Viability of cell cultures was evaluated using WST-1-based cell cytotoxicity assay. Cell growth was monitored in real time using xCELLigence cell analysis. Normal human adherent lung fibroblasts (NHLF) were used to represent non-tumor lung cells. A human non-small cell lung carcinoma cell line H1299 was used as a model of tumor cells.Results. Our study demonstrated a direct influence on viability of the H1299 tumor cell line (p < 0.005) and a cytostatic/cytotoxic effect of the bovine blood extract after 72h. of cultivation while leavingnon-tumor NHLF cell line unaffected. The extract (0.1 µg/ml and 1 µg/ml, resp.) also significantly affected the viability of irradiated H1299 tumor cell line (p < 0.005, Co, 4Gy) compared to non-tumor irradiated counterparts. In addition to the cytotoxic effect, the extract slightly modified the generation time of the cells and substantial differences between the effects on tumor and non-tumor cell lines were observed.Conclusion. The data presented here might suggest the extract intervenes into the proliferative cell cycle and subsequently influences the generation time of cells. Further analyses should be oriented toward the effects of animal tissue extracts on cellular systems defending against tumors and/or infections and intercellular communications that lead to influencing the fate of individual cell types.

Imuregen is a unique dietary supplement that was developed by leading Czech immunologists, made and distributed from the Czech Republic, and first came out in the 1950s. Imuregen boasts of decades of research and clinical exposure. It was created for the immune system sourced only from all natural ingredients that support cellular immunity and energy, tissue regeneration, wound healing, endocrine gland repair, intestinal integrity, memory enhancement, and has antitumor effects.

Nerve agents (NAs) belong to family of organophosphorus inhibitors (OPIs) of acetylcholinesterase (AChE) enzyme. Although the use of highly toxic OPIs as chemical warfare agents is prohibited, they have been misused several times and thus still represents an emerging threat. For these reasons, the development of novel prophylactic agents and therapeutic intervention against NAs is still up-to-date and of high importance. Prophylactic administration of antidotes not only increases body's resistance to the effects of NAa, e.g. when operating at a contaminated environment after a terrorist attack, but also potentiates the subsequent antidotal therapy after exposure. Currently, pharmacological prophylaxis can be delivered either by protection of AChE against irreversible Inhibition, administration of commonly used antidotes in advance (i.e. oxime reactivators) or by the use of bioscavengers. The aim of the recent review is to highlight the current trends in prophylaxis and outline breakthroughs in prophylaxis based on reversible cholinesterase inhibitors like huperzine A or acridine derivatives.

Exsanguination is one of the leading causes of death in a battlefield. Patients who require cardiopulmonary resuscitation after moribund trauma have an unfavorable prognosis. The determinant of survival in critically injured is a time to surgical intervention. Resuscitative emergency thoracotomy may be the lifesaving treatment in selected patients with trunk trauma and cardiac arrest after hemorrhagic shock.This is a case report of successfully applied resuscitative surgical techniques in severely injured allied soldier with hemorrhagic shock and cardiac arrest after suicide bomber explosion. A prompt diagnosis and a rapid emergency thoracotomy are lifesaving in moribund penetrating or blunt trunk trauma.

Internal medical disciplines (internal medicine and other internal specialties) are among the key clinical branches for the Ministry of Defence and the military medical service. The work provides an overview of the current state of internal medical disciplines within the Ministry of Defence. The main problem is the lack of qualified medical personnel and a complicated system of specialized training due to complexity of these fields. The results section provides options for the further development of internal medical disciplines to secure fulfilment of tasks of military medical service in favour of the Ministry of Defence, in the field of therapeutic-preventive, pedagogical-educational and scientific-research. Internal medicine is a fundamental branch of military health care and the model of a possible development way of one discipline is applicable also to other medical disciplines.

N-Methyl-D-aspartate (NMDA) receptor belongs to the group of glutamate receptors, which are further divided into ionotropic and metabotropic. It affects synaptic plasticity and the development of neuronal synapsis in CNS. Ionotropic NMDA receptors are activated by glutamate, thereby flowing positively charged ions through the membrane along its concentration gradient. However, glutamate overload leads to excitotoxicity, due to high levels of Ca²⁺, which leads to cell death assocciated with neurodegenerative diseases. NMDA antagonists like dizocilpine reduce intracellular concentration of Ca²⁺ by modulating permeability of NMDA receptor channel. Dizocilpine act as a non-competitive NMDA receptor antagonist with anticonvulsant and anesthetic properties. Its therapeutic use in humans is limited due its numerous side effects, but it is experimentally used as an animal model of schizophrenia.

The following thesis focuses on the issues regarding catering and food and its impact on health and life satisfaction of coalition soldiers during their deployment on a military operation in the Middle East area. Obviously, food is a part of our lifestyle and it is certainly an area affecting our life satisfaction, all the more affecting the life satisfaction of soldiers specifically in an armed conflict environment where they are exposed to higher stress conditions. Furthermore, life satisfaction is one of the variables influencing the work itself. And work influences our lifestyle and vice versa. It can be also said that life satisfaction influenced by the working environment also affects the health of soldiers. It turns out that work satisfaction has a very strong and lasting relationship with life satisfaction, as work is a central factor for most people, influencing their identity Firstly, it was necessary to find out and describe information from the area of catering of troops in field conditions and fighting food rations which can be provided to deployed soldiers. The authors’ fundamen-tal research question is how the catering and food in the military operational environment affects the life satisfaction and health of deployed soldiers. To obtain the data, a standardized method, Life satisfaction question-naire (authors: J. Fahrenberg, M. Myrtek, J. Schumacher and E. Brähler, 2001), was used. Food and catering play a very high role in our lifestyle, affects our health and furthermore, the quality of life in any situation. In life satisfaction, Danish soldiers have higher values, followed by American soldiers, and British men are the least satisfied during the foreign operation. The reasons for differences and their clarification corespondes with the last published “Happines Index” which is investigated annually by the United Nations agency.

Many unfavourable factors can affect decontamination efficacy when personnel wearing personal protective equipment are decontaminated prior to their final exit from the hot zone. One of the most important factors is the quality of aerosol, which is determined mainly by the size and amount of droplets. Aerosol quality is closely related to the target area coverage efficacy or to deflection of droplets from the direction of flight, so called drift. Studies comparing, e.g., droplet size, velocity, trajectory, spray height, viscosity, surface tension, and wind speed are scarce. The quality of spraying and its application have been intensively studied by agricultural research since the 1950s. Although this research has specific characteristics, it can provide important guidance for the decontamination of high-risk biological pathogens.

Pregnant or postpartum patients with history of substance use disorder who desire to breastfeed present healthcare providers with numerous issues as drug use increases risk for adverse health outcomes for both the mother and her child. Drug use in the U.S. is common. In 2013, an estimated 24.6 million Americans aged 12 or older were current illicit substance users representing 9.4 % of the population. This statistic unfortunately closely corresponds with substance use in pregnant women. Totally 9% of pregnant women used drugs during their first trimester. Substance use during pregnancy and during breastfeeding presents serious problem for the health of our society. When a mother with a history of illegal/illicit drug use or illegal substance abuse desires to breastfeed, her healthcare providers are faced with several ethical dilemmas. The most obvious is whether she should be allowed to breastfeed her child. Does the benefit of breastfeeding outweigh the risk of possible substance transmission to the infant or is formula feeding safer and more appropriate option for the infant? What is the consequence of formula feeding on the fragile relationship between the newborn and the troubled mother? Lastly, the infant’s right to be breastfed needs to be taken into consideration as a part of this complex issue. Healthcare leaders need to be able to understand ethical challenges of this specific population, acknowledge variances between individual substances, and most importantly differentiate between occasional drug use, diagnosable substance use disorder and treated substance use disorder. Healthcare leaders should be able to clearly identify how to best provide the most effective and supportive care. Changes to policies and healthcare practices can advance the overall health of this specific and challenging population as well as can improve the relationship between these patients and their healthcare providers.

Vaccination protects the community as a whole from serious communicable diseases, such as polio, pertussis, diphteria, measles and others. The incidence of these diseases has been successfully reduced in the last decades. Switzerland with its National vaccination strategy takes part in an international effort on public health described in WHO’s 2011-2020 Global Vaccine Action Plan (1), and in the European 2015 - 2020 Vaccine Action Plan (2). However, in contrast to the Czech Republic, Switzerland doesn´t have a compulsory global vaccination schedule. It only presents the vaccination recommendations. Vaccination rates are not always high enough in Switzerland and vary from one region to another.

Chitosan is low toxic, non-immunogenic and biodegradable natural biopolymer. As the deacetylated form of chitin, it is extensively used in medicine, agriculture and industry for easy production, biocompatibility and antimicrobial activity. Chitosan is also widely studied as the main structural unit of nanomaterials. Numerous studies have shown the strong antimicrobial activity of chitosan including its efficacy as an adjuvant for construction of new vaccines. In this overview, we present the basic information on chitosan nanopar-ticles, their preparation, purification, and  characterization as well as the new data on their utilization for the construction of targetted drugs based on nanotechnologies.

On March 4, Sergei Skripal, a former Russian spy who was convicted and imprisoned in Russia for working as a double agent, and his daughter were found unresponsive and slumped on a shopping-center bench in Salisbury, England. On 12 March 2018, British Prime Minister Theresa May said in Parliament that the two had been poisoned with Novichok, a “military grade” nerve agent developed by Russia, and she moved swiftly to retaliate against the government of President Vladimir Putin (BBC News, 12 March 2018). It was the first use of a nerve agent on European soil since World War II. Russian authorities have rejected May’s claims as nonsense. On 14 March 2018, the UK expelled 23 Russian diplomats after the Russian government refused to meet the UK's deadline of midnight on 13 March 2018 to give an explanation for the use of the substance...

Survival and recovery from nerve agent poisoning requires a continuum of medical care, starting with a rapid initial response followed by continued support though the medical chain. In a military context, research into countermeasures to nerve agent poisoning has traditionally focussed on first-aid, pretreatment and prophylaxis; however, there are many opportunities to optimise the management of nerve agent-poisoned casualties. We have previously demonstrated the efficacy of bioscavenger as a post-exposure, pre-symptomatic therapy in guinea-pigs poisoned by VX via the dermal route. Data will be presented on the efficacy of bioscavenger before, on and after the appearance of signs of poisoning and the influence of introducing a delay between initial treatment and the administration of bioscavenger. Treatment regimens including bioscavenger offered near-complete protection against the VX challenge, in the absence of continuing supportive therapy. The potential for bioscavenger use within the treatment chain could range from pre-exposure to hospital use. Inclusion of bioscavenger has potential to reduce the level of medical care, monitoring and therapeutic intervention for casualties that have been poisoned percutaneously. The results will be discussed in the context of the UK military medical management chain and the considerations and constraints of the operational environment.

This review provides information about blistering chemical warfare agents. The main focus lies on the sulfur mustard. The article summarizes the history of this agent from its discovery to the present, physicochemical properties, toxicokinetics, and the clinical picture of acute intoxication. Late effects of poisoning are discussed as well. The laboratory diagnosis of sulfur mustard exposure is an issue that is currently being discussed by many research groups worldwide. Current therapeutic approaches recommended by NATO are aimed at rapid decontamination and symptomatic treatment. In spite of all efforts, no potent and usable antidote has been found to prevent the devastating outcomes of the exposure. Therefore, efficient protection against sulfur mustard still consists of preventing the contact with organism.

Anthrax is still a high threat biological agent, with historical precedence of potential terrorist use. While lack of human-to-human transmission may contain attacks in pockets, attacks can be multiple, coordinated and/or covert, therefore successful containment is heavily dependent on rapid identification after the smallest (possible) number of early cases, immediate and accurate statistical assessment of its geographic extent based on case histories, and a rapidly targeted prophylaxis strategy that considers both antibiotics and vaccine. Persistence of spores could lead to continued post-event threat, lack of guarantee that total decontamination has been achieved, fear of repeat attacks, concerns and disruptions to normal life, and tremendous loss to the economy. These considerations were among those that underpinned the recent 'Anthrax Counter Measures 2013' international conference held at the think-tank Royal United Services Institute, London, on 4 February 2013. Peer-reviewed abstracts of fifteen oral papers and nineteen posters presented in this conference are published as proceedings in this issue of the Military Medical Science Letters journal (ISSN 0372-7025). This meeting brought together academic, government and third sector organisations to debate key issues in anthrax counter measures under four themes: 'What might happen? How will we know? How to respond? What does the future look like?'. Topics explored include injectional anthrax (the latest and fourth mode of infection), inhalational anthrax (which drives biodefence considerations like animal models, emergency preparedness, etc.), the role of US government agencies post-Amerithrax attacks (especially the Animal Rule and Project BioShield, and the first licensed product raxibacumab), current and emerging trends in detection and diagnostics, etc. Discussions took place on how to accelerate products from laboratory to field, how to make the most out of the currently licensed antibiotics and vaccines, and how to bridge the gap between science and frontline response to anthrax. More efforts are needed to quantify the overall burden of the Amerithrax attacks, including the impact on tourism and business showdowns or diversions. This will enable governments to demonstrate value for taxpayer money and identify gaps through initiatives such as the annual preparedness index, shelf-life extension programmes, etc. Continued fiscal pressures could also encourage like-minded friendly governments to share resources and stockpiles, leading to other benefits such as increased resilience and cooperation.

The circumstances of the WW II, paradoxically, contributed to the development of modern surgery of the hand, when General Norman T. Kirk, the US Army Surgeon General at that time, initiated establishment of centers for treatment of war hand injuries. Concurrently, he asked Sterling Bunnell, the author of the book Surgery of the hand, to train specialists in order to diminish number of disabled persons due to hand injuries. In 1946, nine leaders of those centers were among others who established the American Society of Hand Surgery, while Sterling Bunnell became its first President. Bunnell's influence exceeded the American continent noticeably. Some important representatives of hand surgery in Europe belonged among his pupils too. Remarkable progress of this special surgical discipline was achieved during the second half of the 20^th century (dynamic splinting after tendons suture, new methods of osteosynthesis, reconstruction using the microsurgical technique). By application of new technologies, tissue engineering and particularly when immunotoleration will be achieved, some another progressive development within surgery of the hand is to be expected in the future.

Together with the protection of the sick and wounded in armed conflicts, rules of international humanitarian law (IHL) provide protection to medical facilities and personnel. Despite universal acknowledgement of these rules, their violations occur regularly. Causes of these violations are numerous and complex, however, in order to be respected, IHL rules need to be in the first place implemented within domestic legislations of individual states. Specific measures to be taken are to a certain extent left up to discretion of every state concerned. This article examines existing legislation and measures adopted in this context by the national authorities of the Czech Republic with respect to the Czech Armed Forces. A particular attention is directed at internal regulations of the Armed Forces against the wider background of Czech legal order. The article also touches upon areas of military training and criminal liability.