Pub Date : 2021-03-25DOI: 10.32902/2663-0338-2021-1-15-21
O. Bororova
BACKGROUND. There are many unsolved medical problems and, of course, pneumonia is one of them. Communityacquired pneumonia (CAP) is a multifactorial disease, but the role of viruses as causative agents is constantly growing. Specific antiviral therapy for CAP is limited. Therefore, the search for drugs with virucidal activity remains relevant. An antimicrobial agent with a broad spectrum of action – decamethoxin – is successfully used today for treatment of patients with infectious exacerbations of bronchial asthma and chronic bronchitis. At the same time efficacy of decamethoxin in CAP patients was not studied. OBJECTIVE. To evaluate the effectiveness and safety of the inhaled antimicrobial drug decamethoxin in the complex treatment of patients with group III viral-bacterial CAP. MATERIALS AND METHODS. There was enrolled 62 patients with group III viral-bacterial CAP. All patients received the same sequential antibiotic therapy: protected aminopenicillin with macrolide or III generation cephalosporin with macrolide. Patients of the main group were prescribed inhalations through a nebulizer of the antiseptic drug decamethoxin in addition to antibacterial therapy from the first day of treatment for 5-7 days. RESULTS AND DISCUSSION. No adverse events were detected in any of the patients during treatment. In all cases, recovery was diagnosed. At the same time, the term of achieving positive results in the main group was 12.2±0.7 days, and in the control – 17.2±0.7 (р <0,05). The average duration of antibiotic use was different in main and control groups: respectively 9.4±0.4 and 10.7±0.4 days (р <0,05). There were no infectious complications in the patients of the main group, while 24 (72 %) patients of the control group were diagnosed with acute rhinopharyngitis (47.0 % of cases), lateral pharyngitis (13 %) and sinusitis (9 %), other complications (otitis, infectious exudative pericarditis). In 22 (66 %) cases there was one complication and in 2 (6 %) cases there were two complications. CONCLUSIONS. For patients with group III viral-bacterial CAP additional inclusion in the empirical sequential antibiotic therapy of inhaled decamethoxin can significantly reduce the frequency of infectious complications, duration of antibiotic therapy, as well as the duration of positive treatment results.
{"title":"Efficacy and safety of decamethoxin in complex treatment of patients with group III viral-bacterial community-acquired pneumonia","authors":"O. Bororova","doi":"10.32902/2663-0338-2021-1-15-21","DOIUrl":"https://doi.org/10.32902/2663-0338-2021-1-15-21","url":null,"abstract":"BACKGROUND. There are many unsolved medical problems and, of course, pneumonia is one of them. Communityacquired pneumonia (CAP) is a multifactorial disease, but the role of viruses as causative agents is constantly growing. Specific antiviral therapy for CAP is limited. Therefore, the search for drugs with virucidal activity remains relevant. An antimicrobial agent with a broad spectrum of action – decamethoxin – is successfully used today for treatment of patients with infectious exacerbations of bronchial asthma and chronic bronchitis. At the same time efficacy of decamethoxin in CAP patients was not studied. \u0000OBJECTIVE. To evaluate the effectiveness and safety of the inhaled antimicrobial drug decamethoxin in the complex treatment of patients with group III viral-bacterial CAP. \u0000MATERIALS AND METHODS. There was enrolled 62 patients with group III viral-bacterial CAP. All patients received the same sequential antibiotic therapy: protected aminopenicillin with macrolide or III generation cephalosporin with macrolide. Patients of the main group were prescribed inhalations through a nebulizer of the antiseptic drug decamethoxin in addition to antibacterial therapy from the first day of treatment for 5-7 days. \u0000RESULTS AND DISCUSSION. No adverse events were detected in any of the patients during treatment. In all cases, recovery was diagnosed. At the same time, the term of achieving positive results in the main group was 12.2±0.7 days, and in the control – 17.2±0.7 (р <0,05). The average duration of antibiotic use was different in main and control groups: respectively 9.4±0.4 and 10.7±0.4 days (р <0,05). There were no infectious complications in the patients of the main group, while 24 (72 %) patients of the control group were diagnosed with acute rhinopharyngitis (47.0 % of cases), lateral pharyngitis (13 %) and sinusitis (9 %), other complications (otitis, infectious exudative pericarditis). In 22 (66 %) cases there was one complication and in 2 (6 %) cases there were two complications. \u0000CONCLUSIONS. For patients with group III viral-bacterial CAP additional inclusion in the empirical sequential antibiotic therapy of inhaled decamethoxin can significantly reduce the frequency of infectious complications, duration of antibiotic therapy, as well as the duration of positive treatment results.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83203248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-25DOI: 10.32902/2663-0338-2021-1-28-36
O. Halushko
BACKGROUND. The free radical scavenger edaravone helps to reduce the area of ischemic injury and improve the longterm effects of stroke, and is therefore widely used in the treatment of ischemic stroke. However, the role of edaravone in the treatment of hemorrhagic stroke patients has not yet been clarified. OBJECTIVE. To investigate the feasibility and effectiveness of the use of the free radical scavenger edaravone in the treatment of patients with acute hemorrhagic stroke. MATERIALS AND METHODS. A search was conducted for studies and systematic reviews for the keywords “acute stroke”, “intracerebral hemorrhage”, “subarachnoid hemorrhage”, “hemorrhagic transformation”, “edaravone” in the Google Scholar database published between 2003 and 2020. RESULTS. The use of edaravone in patients with intracerebral hemorrhage was accompanied by activation of anti-inflammatory and reduction of pro-inflammatory peptides, activation of anti-apoptotic mechanisms, reduction of lipid peroxidation and oxidative trauma, reduction of permeability of the hematocenosis. CONCLUSIONS. The main effects of edaravone have been to reduce neurological deficits, accelerate the rate of recovery of neurological disorders, and improve functional outcomes. Thus, the introduction of edaravone in patients with hemorrhagic stroke has proven to be reliably effective and safe.
{"title":"Application of a free radical scavenger edaravone in patients with hemorrhagic stroke","authors":"O. Halushko","doi":"10.32902/2663-0338-2021-1-28-36","DOIUrl":"https://doi.org/10.32902/2663-0338-2021-1-28-36","url":null,"abstract":"BACKGROUND. The free radical scavenger edaravone helps to reduce the area of ischemic injury and improve the longterm effects of stroke, and is therefore widely used in the treatment of ischemic stroke. However, the role of edaravone in the treatment of hemorrhagic stroke patients has not yet been clarified. \u0000OBJECTIVE. To investigate the feasibility and effectiveness of the use of the free radical scavenger edaravone in the treatment of patients with acute hemorrhagic stroke. \u0000MATERIALS AND METHODS. A search was conducted for studies and systematic reviews for the keywords “acute stroke”, “intracerebral hemorrhage”, “subarachnoid hemorrhage”, “hemorrhagic transformation”, “edaravone” in the Google Scholar database published between 2003 and 2020. \u0000RESULTS. The use of edaravone in patients with intracerebral hemorrhage was accompanied by activation of anti-inflammatory and reduction of pro-inflammatory peptides, activation of anti-apoptotic mechanisms, reduction of lipid peroxidation and oxidative trauma, reduction of permeability of the hematocenosis. \u0000CONCLUSIONS. The main effects of edaravone have been to reduce neurological deficits, accelerate the rate of recovery of neurological disorders, and improve functional outcomes. Thus, the introduction of edaravone in patients with hemorrhagic stroke has proven to be reliably effective and safe.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76528318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-25DOI: 10.32902/2663-0338-2021-1-63-64
Ю.І. Фещенко, В.Г. Матусевич
Інформаційний бюлетень до Всесвітнього та Всеукраїнського дня боротьби з туберкульозом «Боротьба з туберкульозом – невід’ємна складова Глобального плану "Зупинити ТБ"»
{"title":"Інформаційний бюлетень до Всесвітнього та Всеукраїнського дня боротьби з туберкульозом «Боротьба з туберкульозом – невід’ємна складова Глобального плану \"Зупинити ТБ\"»","authors":"Ю.І. Фещенко, В.Г. Матусевич","doi":"10.32902/2663-0338-2021-1-63-64","DOIUrl":"https://doi.org/10.32902/2663-0338-2021-1-63-64","url":null,"abstract":"Інформаційний бюлетень до Всесвітнього та Всеукраїнського дня боротьби з туберкульозом «Боротьба з туберкульозом – невід’ємна складова Глобального плану \"Зупинити ТБ\"»","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83140373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.32902/2663-0338-2020-4-5-12
S. Zaikov
BACKGROUND. During 2020 coronavirus disease (COVID-19) is at the focus of many scientific studies. National approaches to the management of conditions associated with the SARS-CoV-2 can differ significantly due to socio-economic characteristics, capabilities of the health care system in different regions of the world, inertion in making regulatory decisions, as well as the variability and limitations of evidence base regarding effectiveness of various therapeutic approaches. OBJECTIVE. To review guidelines and clinical experience in the management of patients with COVID-19 around the world. RESULTS. National guidelines for COVID-19 management can vary significantly in different regions of the world. The governments of each country, in cooperation with leading experts and taking into account global experience, choose and constantly adjust the best ways to overcome COVID-19 epidemic in local population. CONCLUSIONS. The choice of methods for prevention and treatment of COVID-19 is associated with the capabilities of the healthcare system, regional level of antibiotic resistance, current epidemiological conditions, socio-economic factors, etc. Over the past 5-6 months the epidemiological conditions in different regions of the world have varied significantly, which could create unequal conditions for conducting high-quality clinical trials with a large number of participants. Even within one country the conclusions and recommendations for the treatment of COVID-19 developed by different medical associations and expert groups may differ significantly. Expert organizations conduct an independent evaluation of emerging clinical experience in the treatment of COVID-19 and come to different conclusions. This phenomenon is quite normal and desirable to minimize systematic error in the context of rapidly updating clinical evidence.
{"title":"Therapy of patients with COVID-19: clinical studies and recommendations in different countries","authors":"S. Zaikov","doi":"10.32902/2663-0338-2020-4-5-12","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-4-5-12","url":null,"abstract":"BACKGROUND. During 2020 coronavirus disease (COVID-19) is at the focus of many scientific studies. National approaches to the management of conditions associated with the SARS-CoV-2 can differ significantly due to socio-economic characteristics, capabilities of the health care system in different regions of the world, inertion in making regulatory decisions, as well as the variability and limitations of evidence base regarding effectiveness of various therapeutic approaches. \u0000OBJECTIVE. To review guidelines and clinical experience in the management of patients with COVID-19 around the world. \u0000RESULTS. National guidelines for COVID-19 management can vary significantly in different regions of the world. The governments of each country, in cooperation with leading experts and taking into account global experience, choose and constantly adjust the best ways to overcome COVID-19 epidemic in local population. \u0000CONCLUSIONS. The choice of methods for prevention and treatment of COVID-19 is associated with the capabilities of the healthcare system, regional level of antibiotic resistance, current epidemiological conditions, socio-economic factors, etc. Over the past 5-6 months the epidemiological conditions in different regions of the world have varied significantly, which could create unequal conditions for conducting high-quality clinical trials with a large number of participants. Even within one country the conclusions and recommendations for the treatment of COVID-19 developed by different medical associations and expert groups may differ significantly. Expert organizations conduct an independent evaluation of emerging clinical experience in the treatment of COVID-19 and come to different conclusions. This phenomenon is quite normal and desirable to minimize systematic error in the context of rapidly updating clinical evidence.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83373010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-21DOI: 10.32902/2663-0338-2020-4-13-16
M. Kuzhko, V. Melnyk, М. Gumeniuk, T. Tlustova, T. Sprynsian
ABSTRACT. Here we present the results of retrospective analysis of medical records of 2292 patients with all forms of pulmonary tuberculosis aged 20 to 65 years, who were treated at the National Institute of Tuberculosis and Pulmonology named after F.G. Yanovsky of National Academy of Medical Sciences of Ukraine in 2000-2018. We analyzed the most common side effects of anti-tuberculous drugs and their impact on treatment effectiveness. Practical recommendations for the elimination of adverse reactions to anti-tuberculous drugs in order to increase the effectiveness of treatment of patients with pulmonary tuberculosis are given here.
{"title":"Adverse reactions to anti-tuberculous drugs in patients with pulmonary tuberculosis and ways to eliminate them","authors":"M. Kuzhko, V. Melnyk, М. Gumeniuk, T. Tlustova, T. Sprynsian","doi":"10.32902/2663-0338-2020-4-13-16","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-4-13-16","url":null,"abstract":"ABSTRACT. Here we present the results of retrospective analysis of medical records of 2292 patients with all forms of pulmonary tuberculosis aged 20 to 65 years, who were treated at the National Institute of Tuberculosis and Pulmonology named after F.G. Yanovsky of National Academy of Medical Sciences of Ukraine in 2000-2018. We analyzed the most common side effects of anti-tuberculous drugs and their impact on treatment effectiveness. Practical recommendations for the elimination of adverse reactions to anti-tuberculous drugs in order to increase the effectiveness of treatment of patients with pulmonary tuberculosis are given here.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78646047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-15DOI: 10.32902/2663-0338-2020-3.2-80-81
O. Dynnyk
Background. The microcirculatory system (MCS) is a network of blood vessels that includes arterioles, capillaries, venules, and terminal lymphatic vessels. Microcirculation is characterized by the constant variability. Factors of atherogenesis development due to MCS dysfunction include shear stress, hyperglycemia, dyslipidemia, systemic and local inflammation, hypoxia and endothelial dysfunction mediated by oxidative stress. Laser Doppler flowmetry (LDF) is used to study microcirculation in the clinical settings. The advantages of LDF include simplicity, accessibility and non-invasiveness. Objective. To describe the features of microcirculation disorders and their elimination. Materials and methods. Analysis of literature data on this topic; own study. The study involved 98 patients (59 females; 39 males) with a mean age of 52.0 years. The first group consisted of patients with coronary heart disease (CHD) and chronic heart failure of I-IIA grades, the second – of relatively healthy individuals. All patients underwent LDF, ultrasound examination of the carotid arteries, and determination of anthropometric parameters. Results and discussion. MCS dysfunction is not only a risk factor for atherogenesis, but also a trigger for its acute complications (myocardial infarction, stroke, sudden death). Nitric oxide (NO) deficiency plays an important role in this. A potential target of therapeutic influence in the treatment of coronary heart disease is not only macrovascular system, but also vasa vasorum. The condition of the latter determines the course of atherosclerosis. According to the results of our own study, patients with CHD demonstrated a muscle mass decrease, an increase in waist and hip circumference, and in body mass index. In addition, the groups differed in thickness of the intima-media complex of both common carotid arteries (right common carotid artery: CHD group – 0.79±0.18 mm; group of relatively healthy individuals – 0.69±0.13 mm, p<0,05; left common carotid artery: CHD group – 0.81±0.19 mm, group of relatively healthy individuals – 0.70±0.14 mm, p<0,05). When assessing the indicators of wavelet analysis of LDF, a significant decrease in the rate of microcirculation and capillary blood flow reserve is revealed in the CHD group, as well as an increase in peripheral vascular resistance. According to previous own studies, sorbitol (Reosorbilact, “Yuria-Pharm”) and pentoxifylline (Latren, “Yuria-Pharm”) can be used to correct microcirculation disorders. The use of these drugs leads to vasodilation of precapillary sphincters and improvement of regional microperfusion. Conclusions. 1. Disorders of MCS are the pathogenetic factors of the atherogenesis. 2. Laser Doppler flowmetry is used to study microcirculation in the clinical settings. 3. In patients with CHD there is an increase in neuro- and myotonus of the MCS, which is associated with the impaired release of nitric oxide. 4. Changes in microcirculation contribute to the development of
背景。微循环系统(MCS)是一个血管网络，包括小动脉、毛细血管、小静脉和末梢淋巴管。微循环的特点是不断变化。MCS功能障碍导致动脉粥样硬化发展的因素包括剪切应激、高血糖、血脂异常、全身和局部炎症、缺氧和氧化应激介导的内皮功能障碍。激光多普勒血流仪(LDF)用于临床研究微循环。LDF的优点包括简单性、可访问性和非侵入性。目标。描述微循环障碍的特点及其消除。材料和方法。本课题的文献资料分析;自己的研究。该研究涉及98例患者(59例女性;39名男性)，平均年龄52.0岁。第一组包括冠心病(CHD)和I-IIA级慢性心力衰竭患者，第二组是相对健康的个体。所有患者均行LDF、颈动脉超声检查和人体测量参数测定。结果和讨论。MCS功能障碍不仅是动脉粥样硬化的危险因素，也是其急性并发症(心肌梗死、中风、猝死)的触发因素。一氧化氮(NO)缺乏在其中起着重要作用。冠心病治疗的潜在靶点不仅是大血管系统，还有血管。后者的情况决定了动脉粥样硬化的进程。根据我们自己的研究结果，冠心病患者表现出肌肉量减少，腰围和臀围增加，体重指数增加。此外，两组患者颈总动脉内膜-中膜复合体厚度也存在差异(右颈总动脉:冠心病组- 0.79±0.18 mm;相对健康组- 0.69±0.13 mm, p< 0.05;左颈总动脉:冠心病组- 0.81±0.19 mm，相对健康组- 0.70±0.14 mm, p< 0.05)。在评估LDF小波分析指标时，冠心病组微循环率和毛细血管血流储备明显下降，外周血管阻力增加。根据以往自己的研究，山梨糖醇(Reosorbilact，“Yuria-Pharm”)和己酮茶碱(Latren，“Yuria-Pharm”)可用于纠正微循环障碍。使用这些药物可使毛细血管前括约肌血管舒张，改善局部微灌注。结论:1。MCS紊乱是动脉粥样硬化的发病因素。2. 激光多普勒血流仪用于临床研究微循环。3.冠心病患者MCS神经张力和肌张力增加，这与一氧化氮释放受损有关。4. 微循环的改变有助于动脉粥样硬化的发展，在为这类患者选择治疗时应考虑到这一点。5. 山梨醇(Reosorbilact)和己酮茶碱(Latren)可用于纠正微循环障碍。
{"title":"Microcirculation as a goal of correction in macroangiopathy (atherogenesis)","authors":"O. Dynnyk","doi":"10.32902/2663-0338-2020-3.2-80-81","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-80-81","url":null,"abstract":"Background. The microcirculatory system (MCS) is a network of blood vessels that includes arterioles, capillaries, venules, and terminal lymphatic vessels. Microcirculation is characterized by the constant variability. Factors of atherogenesis development due to MCS dysfunction include shear stress, hyperglycemia, dyslipidemia, systemic and local inflammation, hypoxia and endothelial dysfunction mediated by oxidative stress. Laser Doppler flowmetry (LDF) is used to study microcirculation in the clinical settings. The advantages of LDF include simplicity, accessibility and non-invasiveness. \u0000Objective. To describe the features of microcirculation disorders and their elimination. \u0000Materials and methods. Analysis of literature data on this topic; own study. The study involved 98 patients (59 females; 39 males) with a mean age of 52.0 years. The first group consisted of patients with coronary heart disease (CHD) and chronic heart failure of I-IIA grades, the second – of relatively healthy individuals. All patients underwent LDF, ultrasound examination of the carotid arteries, and determination of anthropometric parameters. \u0000Results and discussion. MCS dysfunction is not only a risk factor for atherogenesis, but also a trigger for its acute complications (myocardial infarction, stroke, sudden death). Nitric oxide (NO) deficiency plays an important role in this. A potential target of therapeutic influence in the treatment of coronary heart disease is not only macrovascular system, but also vasa vasorum. The condition of the latter determines the course of atherosclerosis. According to the results of our own study, patients with CHD demonstrated a muscle mass decrease, an increase in waist and hip circumference, and in body mass index. In addition, the groups differed in thickness of the intima-media complex of both common carotid arteries (right common carotid artery: CHD group – 0.79±0.18 mm; group of relatively healthy individuals – 0.69±0.13 mm, p<0,05; left common carotid artery: CHD group – 0.81±0.19 mm, group of relatively healthy individuals – 0.70±0.14 mm, p<0,05). When assessing the indicators of wavelet analysis of LDF, a significant decrease in the rate of microcirculation and capillary blood flow reserve is revealed in the CHD group, as well as an increase in peripheral vascular resistance. According to previous own studies, sorbitol (Reosorbilact, “Yuria-Pharm”) and pentoxifylline (Latren, “Yuria-Pharm”) can be used to correct microcirculation disorders. The use of these drugs leads to vasodilation of precapillary sphincters and improvement of regional microperfusion. \u0000Conclusions. 1. Disorders of MCS are the pathogenetic factors of the atherogenesis. 2. Laser Doppler flowmetry is used to study microcirculation in the clinical settings. 3. In patients with CHD there is an increase in neuro- and myotonus of the MCS, which is associated with the impaired release of nitric oxide. 4. Changes in microcirculation contribute to the development of","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73541260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-15DOI: 10.32902/2663-0338-2020-3.2-252-253
R. Ruslami
Background. Tuberculosis (TB) of the central nervous system (CNS) is the most severe and life-threatening form of TB. Diagnosis of TB of CNS is difficult, and treatment is suboptimal. At present, the treatment of tuberculous meningitis (TBM) involves the same drugs and doses as for pulmonary TB, however, the problem is that not all the drugs cross the blood-brain barrier. Objective. To describe the penetration of anti-TB drugs (ATBD) into the foci of infection in patients with TB of CNS and the choice of pharmacotherapy. Materials and methods. Analysis of literature sources on this issue. Results and discussion. Options for optimizing the TBM treatment include a non-pharmacological approach, treatment prolongation, and increasing the residence time of ATBD at the infection site. A meta-analysis of 17 observational studies found no significant benefits of 9-month treatment over 6-month regimens. To increase the residence time of the drug in CNS, you can increase the dose of drugs that poorly penetrate the CNS, add drugs with better brain penetration characteristics, modify drug delivery systems and physical and chemical properties of drugs. The optimal dose provides the maximum effectiveness of the active substance on the background of the minimum number of side effects, so increase of the dose without taking into account the risks of side effects is not advisable. One of the main ATBD rifampicin is characterized by poor penetration into the cerebrospinal fluid. The killer activity of rifampicin depends on its concentration. In our own study, it was found that the administration of a high dose of rifampicin (600 mg) intravenously for 14 days was characterized by lower mortality in patients with TBM than treatment with oral rifampicin (standardized risk ratio was 0.42). Intravenous high-dose treatment was safe and well tolerated by patients. The disadvantages of this treatment include its high cost, invasiveness and poor availability. A meta-analysis of Indonesian patient data confirmed that high doses of rifampicin were associated with lower mortality (Svensson E. et al., 2019). Other drugs that need research in TBM include a new drug bedaquiline, fluoroquinolones (levofloxacin), linezolid. Isoniazid, pyrazinamide, cycloserine, ethionamide, prothionamide are also characterized by the good permeability to cerebrospinal fluid. Therefore, in a strategy to optimize the TBM treatment high-dose rifampicin, high-dose isoniazid and pyrazinamide (?) are the first line, and cycloserine, ethionamide, linezolid, delamanide, pretomanide – the second line. Conclusions. 1. Diagnosis of TB of CNS is difficult, and treatment is suboptimal. 2. Not all the drugs cross the blood-brain barrier. 3. Options for optimization of the TBM treatment include a non-pharmacological approach, prolongation of therapy and increasing the residence time of ATBD in the infection focus. 4. Administration of high-dose rifampicin (600 mg) intravenously for 14 days was characterized
背景。中枢神经系统结核(TB)是最严重和危及生命的结核形式。中枢神经系统结核的诊断是困难的，治疗是次优的。目前，结核性脑膜炎(TBM)的治疗涉及与肺结核相同的药物和剂量，然而，问题是并非所有药物都能穿过血脑屏障。目标。目的探讨抗结核药物(ATBD)对中枢神经系统结核患者感染病灶的渗透及药物治疗的选择。材料和方法。对这一问题的文献来源进行分析。结果和讨论。优化TBM治疗的选择包括非药物方法、延长治疗时间和增加ATBD在感染部位的停留时间。一项对17项观察性研究的荟萃分析发现，9个月的治疗方案与6个月的治疗方案相比没有显著的益处。为了延长药物在中枢神经系统的停留时间，可以通过增加穿透中枢神经系统较差的药物的剂量，加入具有较好脑穿透特性的药物，改变给药系统和药物的理化性质。最佳剂量在副作用最少的情况下提供活性物质的最大功效，因此不考虑副作用风险而增加剂量是不可取的。一种主要的ATBD利福平的特点是难以渗透到脑脊液中。利福平的杀伤活性取决于它的浓度。在我们自己的研究中，发现TBM患者静脉注射高剂量利福平(600mg) 14天的死亡率低于口服利福平(标准化风险比为0.42)。静脉大剂量治疗是安全的，患者耐受良好。这种治疗方法的缺点包括成本高、侵入性和可及性差。对印度尼西亚患者数据的荟萃分析证实，高剂量利福平与较低的死亡率相关(Svensson E. et al.， 2019)。其他需要研究的TBM药物包括新药贝达喹啉、氟喹诺酮类药物(左氧氟沙星)、利奈唑胺。异烟肼、吡嗪酰胺、环丝氨酸、乙硫酰胺、丙硫酰胺对脑脊液的渗透性也很好。因此，在优化TBM治疗策略中，大剂量利福平、大剂量异烟肼和吡嗪酰胺(?)为一线，环丝氨酸、乙硫酰胺、利奈唑胺、德拉马尼、普雷托马尼为二线。结论:1。中枢神经系统结核的诊断是困难的，治疗是次优的。2. 并不是所有的药物都能通过血脑屏障。3.优化TBM治疗的选择包括非药物方法、延长治疗时间和增加ATBD在感染病灶的停留时间。4. 大剂量利福平(600mg)静脉注射14天的TBM患者死亡率低于口服利福平治疗。5. 大剂量利福平、大剂量异烟肼和吡嗪酰胺是TBM治疗的一线药物。
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Pub Date : 2020-12-15DOI: 10.32902/2663-0338-2020-3.2-300-302
O. M. Tsyganchuk
Background. Hands are a favorable environment for bacterial colonization. The microflora of skin is divided into resident and transient. The latter gets to the hands of healthcare workers (HCW) by the contact during professional activities during various diagnostic and treatment procedures, as well as by the contact with contaminated objects. General requirements for hand hygiene include short nails, absence of false nails, absence of infected skin injuries (or covered injuries) on the hands and forearms, absence of jewelry or watch. If there is visible dirt, the hands should be washed with usual soap. As for disinfection, it is divided into focal (current and final) and preventive (planned and according to the epidemic indications). Not only the hands of the HCW, medical devices, surfaces and furniture, but also medical waste (MW) should be disinfected. Objective. To describe the features of disinfection and MW management. Materials and methods. Analysis of the literature on this issue. Results and discussion. After use, the syringes are disinfected together with the needles without caps and collected in waterproof and puncture-proof containers. When using containers for sharp objects, it is allowed to fill them for 3 days. Medical devices should be immersed in a disinfectant solution immediately after use; the solution should cover the tools at least 1 cm above their surface. Containers with disinfectant solutions must be marked with the name of the solution, its concentration, purpose, exposure time, date of preparation and expiration date. Disinfectants are divided into halide-containing, alcohol-containing, aldehyde-containing, oxidizing, detergent and composite. Decamethoxine – an antiseptic and antifungal drug for topical use – is widely used for disinfection. The mechanism of action of this solution is to disrupt the permeability of the cytoplasmic membrane of bacteria and fungi by binding to phosphatide groups of membrane lipids. The problem of MW is a major problem in the domestic health care system. Ukraine annually produces about 400 thousand tons of MW, 100-120 thousand of which are dangerous. The risks caused by MW are divided into infectious, chemical and radiation-associated. Categories of MW include category A – epidemically safe MW, B – epidemically dangerous MW, C – toxicologically dangerous MW, D – radiologically dangerous MW. The waste management system includes its collection and sorting; marking; disinfection; transportation within the institution; utilization or disposal (category A only). For each type of waste there are special types of containers and markings regulated by normative documents. Category A waste include household waste of all departments of the hospital, except infectious; waste that have not had contact with biological fluids of the body; food waste of all departments of the hospital, except infectious. Food waste is collected separately from other waste. When collecting MW of B category (used medical
背景。手是细菌定植的有利环境。皮肤微生物群分为常驻菌群和瞬时菌群。后者通过在各种诊断和治疗程序的专业活动期间的接触以及接触受污染的物体而到达卫生保健工作者手中。手卫生的一般要求包括短指甲，无假指甲，手和前臂无感染皮肤损伤(或覆盖损伤)，无珠宝或手表。如果有可见的污垢，应该用普通的肥皂洗手。至于消毒，分为重点消毒(当前和最终消毒)和预防性消毒(有计划并根据流行指征)。不仅要对医护人员的手、医疗器械、表面和家具进行消毒，还要对医疗废物进行消毒。目标。介绍消毒和微细颗粒物管理的特点。材料和方法。对这一问题的文献进行分析。结果和讨论。使用后，注射器与不带帽的针头一起消毒，收集在防水防刺的容器中。当使用尖锐物品的容器时，允许填充3天。医疗器械使用后应立即用消毒液浸泡;溶液应覆盖工具表面以上至少1cm。装消毒液的容器必须标明消毒液的名称、浓度、用途、暴露时间、配制日期和使用期限。消毒剂分为含卤、含醇、含醛、氧化性、去污剂和复合型。十甲氧辛是一种局部使用的防腐剂和抗真菌药物，广泛用于消毒。该溶液的作用机制是通过与膜脂的磷脂基团结合，破坏细菌和真菌细胞质膜的通透性。MW问题是国内卫生保健系统中的一个主要问题。乌克兰每年生产约40万吨兆瓦，其中10 -12万吨是危险的。MW造成的风险分为感染性、化学性和辐射相关风险。MW的分类包括A -流行安全MW, B -流行危险MW, C -毒理学危险MW, D -放射学危险MW。废物管理系统包括废物收集和分类;标记;消毒;机构内交通运输;利用或处置(仅限A类)。每种废物都有特殊类型的容器和由规范性文件规定的标记。A类垃圾包括医院各科室的生活垃圾，但感染性垃圾除外;未与人体生物体液接触的废物;医院所有科室的食物浪费，除传染性外。食物垃圾与其他垃圾是分开收集的。收集B类(二手医疗器械)MW时;被血液或者其他生物液体污染的物品;患者有机MW;传染病部门的食物垃圾)，禁止切割或破坏该废物，禁止从注射器中取出针头，禁止泄漏或压紧MW，禁止在距离加热器具1米以内的距离安装废物收集容器。C类废物包括药品、诊断用物质和消毒剂;电池;含有汞和重金属的物品;由于运输、照明系统等的运作而产生废物。收集和临时储存与细胞抑制剂和基因毒性药物有关的废物，以及由于其制备(C类)而产生的所有MW，不允许未经净化。它还需要净化工作场所。任何处理此类废物的工作都应在专门通风的房间内使用个人防护设备。D类废物管理是按照乌克兰关于放射性废物管理和辐射安全标准的立法要求执行的。结论:1。MW问题是国内卫生保健系统的一个重大问题。2. MW的分类包括A -流行安全MW, B -流行危险MW, C -毒理学危险MW, D -放射学危险MW。3.废物管理系统包括废物收集和分类;标记;消毒;机构内交通运输;利用或处置(仅限A类)。
{"title":"State sanitary and anti-epidemic rules and norms of medical waste management","authors":"O. M. Tsyganchuk","doi":"10.32902/2663-0338-2020-3.2-300-302","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-300-302","url":null,"abstract":"Background. Hands are a favorable environment for bacterial colonization. The microflora of skin is divided into resident and transient. The latter gets to the hands of healthcare workers (HCW) by the contact during professional activities during various diagnostic and treatment procedures, as well as by the contact with contaminated objects. General requirements for hand hygiene include short nails, absence of false nails, absence of infected skin injuries (or covered injuries) on the hands and forearms, absence of jewelry or watch. If there is visible dirt, the hands should be washed with usual soap. As for disinfection, it is divided into focal (current and final) and preventive (planned and according to the epidemic indications). Not only the hands of the HCW, medical devices, surfaces and furniture, but also medical waste (MW) should be disinfected. \u0000Objective. To describe the features of disinfection and MW management. \u0000Materials and methods. Analysis of the literature on this issue. \u0000Results and discussion. After use, the syringes are disinfected together with the needles without caps and collected in waterproof and puncture-proof containers. When using containers for sharp objects, it is allowed to fill them for 3 days. Medical devices should be immersed in a disinfectant solution immediately after use; the solution should cover the tools at least 1 cm above their surface. Containers with disinfectant solutions must be marked with the name of the solution, its concentration, purpose, exposure time, date of preparation and expiration date. Disinfectants are divided into halide-containing, alcohol-containing, aldehyde-containing, oxidizing, detergent and composite. Decamethoxine – an antiseptic and antifungal drug for topical use – is widely used for disinfection. The mechanism of action of this solution is to disrupt the permeability of the cytoplasmic membrane of bacteria and fungi by binding to phosphatide groups of membrane lipids. The problem of MW is a major problem in the domestic health care system. Ukraine annually produces about 400 thousand tons of MW, 100-120 thousand of which are dangerous. The risks caused by MW are divided into infectious, chemical and radiation-associated. Categories of MW include category A – epidemically safe MW, B – epidemically dangerous MW, C – toxicologically dangerous MW, D – radiologically dangerous MW. The waste management system includes its collection and sorting; marking; disinfection; transportation within the institution; utilization or disposal (category A only). For each type of waste there are special types of containers and markings regulated by normative documents. Category A waste include household waste of all departments of the hospital, except infectious; waste that have not had contact with biological fluids of the body; food waste of all departments of the hospital, except infectious. Food waste is collected separately from other waste. When collecting MW of B category (used medical ","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75526097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-15DOI: 10.32902/2663-0338-2020-3.2-239-240
T. Petrenko
Background. In 2018 7 million new cases of tuberculosis (TB) were registered, which is more than in previous years. Undoubtedly, TB is one of the most important threats to the public health globally. In developing countries, where there are no new TB drugs (TBD) and modern medical services, this threat is even more serious. Intravenous administration is an option to optimize the existing drug regimens, as it is accompanied by increased bioavailability. Objective. To substantiate the rationality of infusion therapy in TB. Materials and methods. Analysis of literature data on this topic; own study involving 106 patients with newly diagnosed infiltrative and disseminated pulmonary TB with bacterial excretion. Results and discussion. The medical community is concerned not only about the increase in the TB incidence, but also about the increase in the number of drug resistance (DR) cases. Improper treatment is one of the causes of DR. In case of oral administration absorption disorders of the drug are possible in people with digestive system diseases, in addition, part of the drug is metabolized by passing through the liver. In contrast, intravenous drugs enter the superior vena cava system, right ventricle, and pulmonary arteries. In a number of patients’ subgroups, it is not possible to achieve a sufficient concentration of drugs in serum when taken orally for various reasons. In particular, these reasons include host organism factors (features of drug metabolism (fast acetylators are more likely to have DR than slow ones), malabsorption, drug clearance, inability of the drug to reach lung tissue) and mycobacteria factors (biofilm formation, drug resistance due to efflux pumps, metabolic status of the bacterium – division phase or sleep phase). These factors are considered to be the consequences of continuous oral administration of TBD. Achieving a high concentration of TBD in the source of infection due to intravenous administration allows to overcome the DR of mycobacteria. In the own study, oral (n=33) and intravenous (n=73) modes of TBD administration were compared. The groups were identical in age, sex, and TB stage. In the intravenous treatment group there was a significantly higher proportion of complete closure of the decay cavities (90.5 % vs. 60.4 % in the oral treatment group; p=0.04), as well as the significantly lower number of toxic reactions (14.3 % vs. 57.9 %; p=0.001) and poor tolerability of treatment (31 % vs. 57.9 %; p=0.04). On the background of intravenous therapy less fluoroquinolone DR was observed. Conclusions. 1. Intravenous therapy in patients with pulmonary TB is more effective than standard in terms of closure of the decay cavities. 2. Intravenous therapy is accompanied by significantly less toxicity and better tolerability. 3. Intravenous TB therapy is less likely to provoke the development of DR.
背景。2018年，新登记的结核病病例为700万例，高于往年。毫无疑问，结核病是全球公共卫生面临的最重要威胁之一。在没有新的结核病药物和现代医疗服务的发展中国家，这一威胁更为严重。静脉给药是优化现有药物方案的一种选择，因为它伴随着生物利用度的提高。目标。目的:验证输液治疗结核的合理性。材料和方法。本课题的文献资料分析;自己的研究纳入106例新诊断的伴有细菌排泄的浸润性和播散性肺结核患者。结果和讨论。医学界不仅关注结核病发病率的增加，而且关注耐药病例数量的增加。不适当的治疗是dr的原因之一。在口服给药的情况下，消化系统疾病的人可能会对药物的吸收产生障碍，此外，部分药物通过肝脏代谢。相反，静脉注射药物进入上腔静脉系统、右心室和肺动脉。在一些患者亚组中，由于各种原因，口服药物在血清中不可能达到足够的浓度。特别是，这些原因包括宿主生物因素(药物代谢特征(快速乙酰化者比缓慢乙酰化者更容易发生DR)、吸收不良、药物清除、药物无法到达肺组织)和分枝杆菌因素(生物膜形成、外排泵引起的耐药性、细菌分裂期或睡眠期的代谢状态)。这些因素被认为是持续口服TBD的后果。由于静脉给药，在感染源中获得高浓度的TBD可以克服分枝杆菌的耐药性。在本研究中，比较口服(n=33)和静脉注射(n=73) TBD给药方式。这两组在年龄、性别和结核病分期上都是相同的。静脉治疗组龋齿完全闭合的比例明显高于口服治疗组(90.5%比60.4%);P =0.04)，毒性反应发生率显著降低(14.3% vs. 57.9%;P =0.001)和治疗耐受性差(31% vs. 57.9%;p = 0.04)。在静脉注射治疗的背景下，观察到氟喹诺酮类药物的不良反应较少。结论:1。在关闭龋齿方面，静脉注射治疗肺结核患者比标准治疗更有效。2. 静脉注射治疗的毒性明显降低，耐受性更好。3.静脉结核治疗不太可能引起DR的发展。
{"title":"Principles and rationale of infusion therapy in tuberculosis","authors":"T. Petrenko","doi":"10.32902/2663-0338-2020-3.2-239-240","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-239-240","url":null,"abstract":"Background. In 2018 7 million new cases of tuberculosis (TB) were registered, which is more than in previous years. Undoubtedly, TB is one of the most important threats to the public health globally. In developing countries, where there are no new TB drugs (TBD) and modern medical services, this threat is even more serious. Intravenous administration is an option to optimize the existing drug regimens, as it is accompanied by increased bioavailability. \u0000Objective. To substantiate the rationality of infusion therapy in TB. \u0000Materials and methods. Analysis of literature data on this topic; own study involving 106 patients with newly diagnosed infiltrative and disseminated pulmonary TB with bacterial excretion. \u0000Results and discussion. The medical community is concerned not only about the increase in the TB incidence, but also about the increase in the number of drug resistance (DR) cases. Improper treatment is one of the causes of DR. In case of oral administration absorption disorders of the drug are possible in people with digestive system diseases, in addition, part of the drug is metabolized by passing through the liver. In contrast, intravenous drugs enter the superior vena cava system, right ventricle, and pulmonary arteries. In a number of patients’ subgroups, it is not possible to achieve a sufficient concentration of drugs in serum when taken orally for various reasons. In particular, these reasons include host organism factors (features of drug metabolism (fast acetylators are more likely to have DR than slow ones), malabsorption, drug clearance, inability of the drug to reach lung tissue) and mycobacteria factors (biofilm formation, drug resistance due to efflux pumps, metabolic status of the bacterium – division phase or sleep phase). These factors are considered to be the consequences of continuous oral administration of TBD. Achieving a high concentration of TBD in the source of infection due to intravenous administration allows to overcome the DR of mycobacteria. In the own study, oral (n=33) and intravenous (n=73) modes of TBD administration were compared. The groups were identical in age, sex, and TB stage. In the intravenous treatment group there was a significantly higher proportion of complete closure of the decay cavities (90.5 % vs. 60.4 % in the oral treatment group; p=0.04), as well as the significantly lower number of toxic reactions (14.3 % vs. 57.9 %; p=0.001) and poor tolerability of treatment (31 % vs. 57.9 %; p=0.04). On the background of intravenous therapy less fluoroquinolone DR was observed. \u0000Conclusions. 1. Intravenous therapy in patients with pulmonary TB is more effective than standard in terms of closure of the decay cavities. 2. Intravenous therapy is accompanied by significantly less toxicity and better tolerability. 3. Intravenous TB therapy is less likely to provoke the development of DR.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78419262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-15DOI: 10.32902/2663-0338-2020-3.2-294-295
C. Fenger-Eriksen
Background. Analysis of 99 studies found that the predictor properties of various tests to determine the blood coagulation condition, including the newest ones (thromboelastography, rotational thromboelastometry), regarding the risk of intra- and postoperative bleeding are low. The results of prothrombin time or activated partial thromboplastin time measurements can be very variable depending on the concentration of reagents and the characteristics of the analysis. That is why standard methods of screening to assess the condition of the coagulation system in all patients in the preoperative period are not recommended. Objective. To describe the features of perioperative blood clotting and management of patients. Materials and methods. Analysis of literature data on this topic. Results and discussion. Before performing invasive procedures, a careful history should be taken to determine the presence and severity of previous bleeding and to ask about antithrombotic medications. If the general hemorrhagic history is favorable, further determination of coagulographic parameters is not required. If the history is unfavorable or there is evidence of potential risk factors for bleeding (e. g., liver disease), a comprehensive coagulation study should be performed. Bleeding coagulopathy is a component of the so-called lethal triad, which also includes hypothermia and acidosis. Active administration of infusion solutions can deepen or provoke coagulopathy due to hemodilution. The use of balanced infusion solutions reduces the risk of this complication. According to some authors, the fibrinogen level <2 g/L is the predictor of bleeding probability. The causes of this condition include hyperfibrinolysis, dysfunctional fibrinogen in case of the administration of colloid solutions, increased decomposition of fibrinogen due to acidosis. Colloidal solutions (hydroxyethyl starch) increase the risk of reoperation and the need for transfusions, so their routine use is not currently recommended. Hyperfibrinolysis is a condition in which the rate of blood clot breakdown exceeds the rate of blood clot formation. As a result, hemorrhagic shock worsens and coagulopathy develops. Hyperfibrinolysis develops due to fibrinolytic agents and hypoperfusion. Tranexamic acid is used for heavy bleeding, in particular, postpartum. The WOMAN study involved 20,600 women with postpartum haemorrhage who received 1 g of tranexamic acid or placebo. Mortality due to bleeding in the tranexamic acid group was 1.2 %, and in the placebo group – 1.7 % (p=0.008). Conclusions. 1. Routine use of colloid solutions should be avoided during bleeding. 2. It is necessary to detect and eliminate anemia, hypothermia and acidosis. 3. Detection and elimination of deficiency or dysfunction of coagulation factors, hyperfibrinolysis, thrombocytopenia is an important component of bleeding prevention. 4. Reducing bleeding and improving blood clotting leads to the less need for transfusions and better outco
{"title":"Pathophysiology of coagulation during bleeding","authors":"C. Fenger-Eriksen","doi":"10.32902/2663-0338-2020-3.2-294-295","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-294-295","url":null,"abstract":"Background. Analysis of 99 studies found that the predictor properties of various tests to determine the blood coagulation condition, including the newest ones (thromboelastography, rotational thromboelastometry), regarding the risk of intra- and postoperative bleeding are low. The results of prothrombin time or activated partial thromboplastin time measurements can be very variable depending on the concentration of reagents and the characteristics of the analysis. That is why standard methods of screening to assess the condition of the coagulation system in all patients in the preoperative period are not recommended. \u0000Objective. To describe the features of perioperative blood clotting and management of patients. \u0000Materials and methods. Analysis of literature data on this topic. \u0000Results and discussion. Before performing invasive procedures, a careful history should be taken to determine the presence and severity of previous bleeding and to ask about antithrombotic medications. If the general hemorrhagic history is favorable, further determination of coagulographic parameters is not required. If the history is unfavorable or there is evidence of potential risk factors for bleeding (e. g., liver disease), a comprehensive coagulation study should be performed. Bleeding coagulopathy is a component of the so-called lethal triad, which also includes hypothermia and acidosis. Active administration of infusion solutions can deepen or provoke coagulopathy due to hemodilution. The use of balanced infusion solutions reduces the risk of this complication. According to some authors, the fibrinogen level <2 g/L is the predictor of bleeding probability. The causes of this condition include hyperfibrinolysis, dysfunctional fibrinogen in case of the administration of colloid solutions, increased decomposition of fibrinogen due to acidosis. Colloidal solutions (hydroxyethyl starch) increase the risk of reoperation and the need for transfusions, so their routine use is not currently recommended. Hyperfibrinolysis is a condition in which the rate of blood clot breakdown exceeds the rate of blood clot formation. As a result, hemorrhagic shock worsens and coagulopathy develops. Hyperfibrinolysis develops due to fibrinolytic agents and hypoperfusion. Tranexamic acid is used for heavy bleeding, in particular, postpartum. The WOMAN study involved 20,600 women with postpartum haemorrhage who received 1 g of tranexamic acid or placebo. Mortality due to bleeding in the tranexamic acid group was 1.2 %, and in the placebo group – 1.7 % (p=0.008). \u0000Conclusions. 1. Routine use of colloid solutions should be avoided during bleeding. 2. It is necessary to detect and eliminate anemia, hypothermia and acidosis. 3. Detection and elimination of deficiency or dysfunction of coagulation factors, hyperfibrinolysis, thrombocytopenia is an important component of bleeding prevention. 4. Reducing bleeding and improving blood clotting leads to the less need for transfusions and better outco","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79170608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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