Demographic characteristics and radiological features of pneumonia cases in military personnel

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Community-acquired pneumonia (CBP), along with influenza, acute respiratory viral infections, and acute bronchitis, occupies a leading place in the structure of diseases of internal organs of conscripted and contracted military personnel [1-3]. Respiratory diseases have been the main cause of morbidity among military personnel for 60 years [4-6]. Despite the improvement of service conditions, the incidence of military conscription of VVP remains quite high [5-7]. Along with the negative impact on the health of military personnel and undermining the combat readiness of military units, the IBP causes significant economic damage [7, 8].

The share of the influence of weather conditions on the incidence of respiratory infections in the structure of risk factors is about 30% [7, 9, 10]. Military personnel who are called up in the fall are more difficult to adapt to the autumn-winter outbreak of IBD, their disease is more severe, with severe bright symptoms. During transitions between military personnel with reduced resistance, typical for the period of adaptation to military service, the virulence of pathogens of acute respiratory infections in the nasopharynx increases [9, 10, 11].

The purpose of the study is to study the influence of demographic factors in military personnel with pneumonia, depending on climatic and geographical conditions.

Material and methods of research

To study the prevalence of community-acquired pneumonia among military personnel, a retrospective analysis of the level of this disease for the period 2006-2019 was conducted at the Main clinical hospital of the Armed forces of Azerbaijan.

The study material was 266 military personnel aged ≥ 18 years. The diagnosis of IBD was based on clinical and radiological data. In addition, the medical records of patients with pneumonia who were diagnosed with clinical and radiological indicators, but who were not hospitalized, that is, those who were sent to outpatient departments, were checked.

Despite its retrospective nature, this study has the advantage of evaluating a relatively homogeneous cohort of young, healthy patients who were tested for disqualification for medical conditions. In addition, all patients were in the same inpatient facility with standardized laboratory and radiographic diagnostic practices, which ensured almost 100% capture of hospitalized pneumonia cases and consistency in diagnostic procedures and interpretations.

Statistical analysis

We studied the frequency of occurrence of demographic factors and radiological features, as well as their absolute values and percentages using Association analysis. The reliability of the results was determined using the student's t-test.

The results of the study and their discussion.

"Mixing" and "adaptation" factors play an important role during the period of receiving a new replenishment. As well as in the formation of military collectives as a result of factors of "mixing" and "crowding" of placing a large number of people in dormitories, the mechanism of transmission of acute respiratory infections released from carriers with acts of exhalation: physiological (breathing, talking) and pathology (cough, runny nose, sneezing). The graph shown in figure 1 shows the incidence of pneumonia in recruits aged 18-26 years.

Fig. 1. distribution of patients by age

Young recruits are much more likely to suffer from community-acquired pneumonia (18 years-70 people (26.3%), 19 years - 66 people (24.8%), 20 years - 49 people (18.4%). At 25 years of age, the incidence of pneumonia among military personnel decreases by 1.9%, and at 26 years of age - by 0.4%.

The movement of military personnel to another climatogeographic region should be identified with an important risk factor for community-acquired pneumonia. This circumstance should be taken into account when carrying out preventive measures.

It was found that before conscription, urban residents predominated among young people of military age with respiratory tract infections compared to the rural population. Figure 2 shows the distribution of military personnel by place of residence before conscription into the armed forces. It was also found that it is more difficult for new recruits to adapt to new climatogeographic conditions in the autumn-winter period, which contributes to longer periods of treatment.

Fig. 2. Distribution of military personnel by place of residence before conscription into the armed forces

It was found that more often pneumonia is registered in recruits for the period of 1-6 months of their stay in service and according to the results of the study, this figure was 53%. Figure 3 shows the incidence of pneumonia depending on the start of service.

Fig. 3. the incidence Of pneumonia depending on the start of service.

The predominance of recruits among all military personnel with pneumonia is associated with both the "mixing" factor and a decrease in resistance when adapting to military service conditions, which indicates the need to immunize military personnel with pneumococcal vaccine.

One of the Central risk factors for developing serious human health problems is tobacco addiction, and it is becoming a global epidemic that significantly expands the scope of pathologies of the cardiovascular, respiratory systems, as well as cancer [12, 13].

According to foreign scientists, Smoking does not worsen the physical component of the quality of life, but only leads to a decrease in its psychological component [14]. The revealed dependence is explained by the researchers by the presence in the public consciousness of a negative attitude to Smoking and strict restrictions for smokers existing in Western society. At the same time, the impact of Smoking on people's quality of life is still a poorly understood problem. Among military personnel with pneumonia, the fact of tobacco Smoking was detected in 98 (36.84%), while the number of non-Smoking employees was 168 (63.15%) cases (figure 4).

Fig. 4. Prevalence of tobacco Smoking among military personnel

As a result of the analysis of variance, it was found that the share of the influence of weather conditions on the incidence of respiratory diseases in the structure of risk factors in military personnel is about 30% [7, 8, 15].

The most significant impact of the cold factor as a risk factor. The development of acute respiratory infection occurs in sleeping rooms during sleep when the temperature is disturbed. The air temperature in the barracks in winter often falls to 8-14°C (with regulatory requirements-not less than 18°C). While the warm season (may-October) accounts for only 25-35% of acute respiratory infections, in the cold season (November-April) this figure is 65-75% [11].

In our study of 266 recruits, the frequency of hypothermia was found in only 207 people (90.8%). Repeated cases of pneumonia accounted for only 9.2% (Fig. 5).

Fig. 5. Cases of repeated pneumonia with previous hypothermia

The indirect effect of the cold factor is due to the fact that in cold weather, military personnel are mostly in closed, poorly ventilated rooms, so the mechanism of transmission of the pathogen, including pneumonia, is activated. Studies have shown that cooling the body contributes not only to low air temperature, but also increased humidity, as well as a sharp wind.

The rearrangement of temporary biorhythms, along with frequent sleepless nights associated with military service duties (internal bandages, guards, exercises, night watches, etc.), lead to asynchrony, which reduces the body's resistance and contributes to the occurrence of pneumonia. One of the factors that stimulate such transmission is the factor of "mixing" of personnel, in which infectious agents are activated and epidemic strains are formed. The most intensive "mixing" of personnel occurs when stocks are replenished [10, 14, 16].

Having established the features of the risk factors for the development of IBD in military personnel, we will consider the topical characteristics of the inflammatory focus identified by the method of radiation diagnostics. The table shows the radiological characteristics of the pneumonic focus.

Table

Topical characteristics of the pneumonic focus (n=266)

X-ray changes abs. number % P1 P2

Left upper lobe 38 ± 0.08 14.3 <0.001

Left lower lobe 106 ± 1.61 39.8 - <0.001

Right upper lobe 9 ± 0.01 3.4

Right middle lobe 18 ± 0.06 6.8 <0.05

Right lower lobe 49 ± 0.12 18.4 <0.01

Two-way

pneumonia 46 ± 0.09 17.3

Note: P1 – reliability of indicators between the lobes in each lung; P2 - between indicators of lower-lobe localization of the lungs

As can be seen from the table, the left lung was the most susceptible to pneumonic damage, while left-sided lower lobe pneumonia was the most frequent localization of the pathological process – 106 cases (39.8%) compared to 49 (18.4%) of the right lung. The top right lobe was the least favored localization of IBP -

9 cases (3.4%) compared to 38 cases (14.3%) of left lung. There were 46 cases of bilateral lung damage (17.3%).

Thus, the intensity of the epidemic process of pneumonia in military personnel depends on the intensity of the pathogen's circulation, and the clinical forms of infection depend on the degree of reduced resistance of the body under the influence of adverse factors of service and life. At the same time, according to the research results and literature data, in order to reduce the incidence of IBD in military units, it is necessary to consider the issue of pre-immunization of military personnel with pneumococcal vaccine during the period from 1 to 6 months of service [17].

Conclusions.

1. IBD is most common among military recruits aged 18 years (70 cases-26.3%) during 1-x 6 months of service (141 cases – 53%), which is associated with a change in the climatic and geographical region and the fact of acclimatization as an important risk factor for the development of the disease.
2. the Predominance of recruits among all military personnel with pneumonia is associated with both the "mixing" factor and a decrease in the reactivity of the body when adapting to the conditions of military service, which must be taken into account when carrying out preventive measures.
3. the left lung was the most susceptible to pneumonic damage, while left-sided lower lobe pneumonia was the most frequent localization of the pathological process – 106 cases (39.8%) compared to 49 (18.4%) in the right lung.

作者简介

Fidan Shirinova

编辑信件的主要联系方式.
Email: lyuba.nauchnaya@yandex.ru
ORCID iD: 0000-0002-1716-3266

Adjunct, doctor of the polyclinic Department of the Central military hospital

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