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The article summarizes historical materials on the establishment of the Department of Emergency Medical Care and Injury Surgery in St. Petersburg on the basis of the First St. Petersburg State Medical University named after Academician I.P. Pavlov. The main stages of its development are presented, the scientific potential and contribution to the development of emergency and emergency medical care to the population of the city are shown. Since 2012, the staff of the Department, in cooperation with the St. Petersburg Research Institute of Emergency Medicine, has contributed to the study and solution of scientific, practical, organizational and methodological issues in the field of emergency medical care in the Russian Federation.

It was found that for the period from X.2017 to III.2020 among patients admitted to a multidisciplinary hospital with acute poisoning with narcotic drugs (NV) and psychoactive substances (PAS), persons in whose biological environment GHB was detected ranged from 20,1 to 40,1%. The prevalence of acute poisoning of the studied class in male patients (86%) of working age (the average age was 34,2 ± 2,9 year) was proved. The patients used 1,4-butanediol (1,4-BD) as a toxicant (GHB) in 95% of cases. The dynamics of the incidence of acute GHB poisoning over a three-year period was uneven, with peaks of maximum values in August (Me = 168), March (Me = 90), and September (Me = 103) and low rates - in June (Me = 71) and total upward trend - y = 6,6573x = 343,23, R2 = 0,053. The severity of acute GHB poisoning at the time of admission on the PSS scale was 2,2 ± 0,57 points, PSSSP – 22,7 ± 2,17 points. Acute GHB poisoning was characterized by signs of toxic-hypoxic encephalopathy, clinically manifested in the form of depression of consciousness to the level of deep stunning - coma. The duration of inpatient treatment of patients was (1,76 ± 3,7, min = 1, max = 35) days, the period of stay in the intensive care unit (ICU) was 4,2 ± 0,4 hours. The increase in hospitalization (more than a day) was due to somatic complications of acute poisoning (nasocomial pneumonia, systemic rhabdomyolysis, acute renal failure) - in 14% of cases, severe withdrawal syndrome with delirious confusion - in 3,5% of cases. The post-intoxication period was characterized by moderate withdrawal symptoms – 13,7 ± 2,1 points, according to the CIWA-Ar scale. The delirious syndrome was characterized by a protracted course (9,5 ± 1,2 days), an atypical clinical picture, and metabolic disorders. The mortality rate due to acute GHB poisoning increased from 0,09 to 0,22%, in 2019 the cause of death was pronounced degenerative changes in internal organs and varying degrees of severity of microcirculation disorders.

In 21 male patients aged 20 to 40 years, metabolic disorders in post-toxic delirious syndrome caused by gamma-hydroxybutyric acid poisoning and its precursors were studied. In the examined group of patients, hyperammonemia was detected in 71.4% of cases, metabolic lactic acidosis was revealed in 76.2%. The direct correlation between the severity of metabolic disorders and delirious syndrome according to DRS-R-98 scale was established. The statistically significant increase in capillary blood levels of lactate on day 3 of psychotic period was 4.9 mlmol/L and ammonia on day 5 was 187.0 mmol/L. The greatest severity of metabolic disorders was found in patients over the age of 27 years who systematically use the studied substances with narcotic effects for 7 months or more and combine their intake with other psychoactive substances.

Introduction. The article presents the epidemiological analysis of the structure of acute poisonings with modern psychoactive substances.The aim of the study was to analyze the structure of acute poisonings with modern psychoactive substances among patients hospitalized in General hospitals for 2019 to improve preventive measures.Material and methods. There were used data obtained from the consolidated accounting documents of branches of the Centre for the treatment of acute poisoning. The aggregation of the material used numerical characteristics of the variables with the assessment of their accuracy and reliability, the significance of differences increased non-parametric Pearson criterion.Results. The prevalence in biological fluids in hospitalized patients of γ-hydroxybutyrate was 46.6% (1452), synthetic α-PVP - 20,2% (631), synthetic opioids (methadone) and 13.2% (413). In the overall structure of acute poisonings registered in 2019, the proportion of poisoning with modern drugs amounted to 22.2% (4442), the case-fatality rate is 0.3%, which proves its high epidemiological significance. In the course of studying the dynamic characteristics of the epidemiological process the main peaks of the detection of psychoactive substances among the total number of performed laboratory research were established to be noted in July (52%), August (60,8%) and November (54,3%) 2019 based on the analysis conclusions are made about the feasibility of improving the system of prevention of acute poisonings with modern psychoactive substances at the pre-hospital and hospital stages.

The analysis of the peculiarities of rendering psychiatric care to patients with alcoholism and harmful alcohol use in a multidisciplinary hospital for the period from 2009 to 2016 is presented. with the establishment of multi-year trends, dynamics and structure of morbidity. The average annual and average daily intake of patients with an alcoholic factor was analyzed. It is established that 20.1% of those entering the multidisciplinary hospital suffer from alcoholism and the harmful use of alcohol. The prevalence of residual psychotic disorders and alcohol withdrawal with delirium in the structure of alcohol pathology in patients with somatopsychiatric department is proved. The predominance of combined somatic pathology in patients suffering from alcoholism, weighting the course of the mental illness, is established.

Dynamics of substance abuse morbidity in the Armed Forces of the Russian Federation during the last 10 years (2002-2012) was analyzed. Results of performed analysis showed decreasing tendency since 2007 in conscripts (0.07% in 2012) and in contract soldiers (0.3% in 2012). Alcoholism prevailed in the structure of substance abuse in conscripts (0.05%), drug abuses were diagnosed 2,5 times less often (0.02%). In contract soldiers non-alcohol abuses were diagnosed in 0.004% of cases. It is stated that the major aims of substance abuse prevention are qualitative recruiting of military units (especially in troops maintaining the combat readiness) and departments (subunits) of military education, creating conditions for propaganda for healthy lifestyle, prohibition of drugs and psychopharmaceuticals in military units. For early detection of persons liable to substance abuse and facts of drug consumption it is necessary to perform a medical examination with the help of special program apparatus complex (such as "Addicts") and take into account clinical signs of addiction. Besides, it is necessary to introduce planned and unexpected medical examinations of servicemen. Algorithm of measures in case of detection of serviceman with alcohol or drug intoxication is given. In conclusion the main organizational principals of substance abuse prevention in the Armed Forces are given.