Infusion & Chemotherapy最新文献

{"title":"Own experience in an open multicenter randomized controlled trial Rheo-STAT on the efficacy and safety of Reosorbilact in patients with peritonitis in Moldova","authors":"S. Agop","doi":"10.32902/2663-0338-2020-3.2-4-6","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-4-6","url":null,"abstract":"Background. Peritonitis is a consequence of complications of the abdominal cavity organs’ diseases (inflammation, injury) and systemic inflammatory reaction of the organism, which is manifested by symptoms of intoxication and dysfunction of all the organs. In case of diffuse peritonitis mortality is about 80 %. Prerequisites of the lethal outcomes include a late visit to the doctor, elderly age, the presence of cancer and diabetes, antibiotic resistance of the pathogen, diagnostic errors. In the department of purulent gynecology peritonitis most often accompanies endometritis, purulent salpingitis, pyosalpinx, abscesses, uterine perforation during curettage. In Moldova, the principles of treatment of peritonitis include the urgent surgery to remove the infection source, aspiration of exudate, massive lavage, abdominal drainage, antibiotic therapy, and correction of metabolic disorders. \u0000Objective. To determine the effectiveness of Reosorbilact in eliminating the intoxication syndrome in peritonitis. \u0000Materials and methods. The Rheo-STAT study was an international multicenter, randomized, open-label clinical trial of the efficacy and safety of Reosorbilact (“Yuria-Pharm”) in the treatment of sepsis, peritonitis, community-acquired pneumonia, and burn disease. The study was conducted in 7 countries (Ukraine, Moldova, Georgia, Vietnam, Kazakhstan, Kyrgyzstan, Uzbekistan). 5 of them (Ukraine, Moldova, Georgia, Kazakhstan, Uzbekistan) took part in the sub-study Rheo-STAT Peritonitis. The study involved 628 adult patients with sepsis, peritonitis, pneumonia and burns. The subgroup of peritonitis consisted of 180 people (27 % males, 73 % females; mean age – 37 years; concomitant infectious diseases were observed in 25 %, complicated appendicitis – in 17 %), 117 of them were treated in Moldova (87 % females, 13 % males, mean age – 45.2 years). The inclusion criteria were age 18-60 years, diagnosis of peritonitis, the first hours of the postoperative period, no later than 24 hours from diagnosis to the first visit of the study, obtaining informed consent, baseline level on the SOFA scale ≥2. The total score on the SOFA scale on day 3 of treatment compared to baseline was considered a primary endpoint. Secondary endpoints were the change in the overall score on the APACHE II, SAPS II, MODS, PSI/PORT, CURB-65 scales; changes in biochemical, immunological and integral markers of endogenous intoxication. \u0000Results and discussion. Low-volume infusion therapy with Reosorbilact (200-400 ml per day) resulted in an increase in circulating blood volume and a decrease in the total volume of infusions required without the risk of volume overload. Exogenous lactate in Reosorbilact did not increase the content of endogenous lactate, which indicates the high safety of the drug. The inclusion of Reosorbilact in the comprehensive treatment after 3 days provided a decrease in body temperature from 37.1 to 36.75 °C, heart rate – from 88.5 to 82.0 bpm, the leukocyte count – f","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79437215","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}

{"title":"“Reach the cells”: microcirculatory support","authors":"A. Lymanska","doi":"10.32902/2663-0338-2020-3.2-168-169","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-168-169","url":null,"abstract":"Background. Vessels of the microcirculatory tract provide regulatory, drainage, thermocontrol and signal functions. Disorders of these vessels are the part of the pathogenesis of coronary heart disease, endarteritis obliterans, Raynaud’s disease, etc. Common causes of microcirculation disorders include disorders of central and regional blood circulation, impaired blood volume and viscosity, impaired permeability of microvessel walls. \u0000Objective. To describe the features of microcirculatory support. \u0000Materials and methods. Analysis of literature sources on this topic. \u0000Results and discussion. In order to improve microcirculation, various drugs are used: antiplatelets, anticoagulants, antioxidants, and nitric oxide donors. The purpose of these drugs are to improve the rheological properties of blood, to improve the delivery of nutrients to the vascular wall, to regulate the vascular tone, and to improve endothelial function. Reosorbilact (“Yuria-Pharm”) opens precapillary sphincters, increases the area of blood contact with the target cell, improves tissue oxygenation and rheological properties of blood. Reosorbilact includes such components as sorbitol, basic cations (Na, Ca, K, Mg) and sodium lactate. Sorbitol is used for urgent energy needs, metabolized and stored as glycogen, has a disaggregating effect, improves microcirculation and tissue perfusion. The hyperosmolar action of Reosorbilact is to stimulate the flow of fluid from the intercellular space into the vascular bed. Correction of metabolic acidosis with Reosorbilact is slower than due to sodium bicarbonate buffer, so this solution does not cause severe fluctuations in pH. The detoxifying effect of Reosorbilact involves washing of metabolites and toxins out from damaged cells, tissues and organs, followed by their rapid excretion due to increased diuresis. The improvement of liver microcirculation and replenishment of glycogen depot, which normalizes the functional state of hepatocytes and enhances physiological detoxification, is an additional beneficial effect. Hemodilution is also important, because it allows to reduce the content of toxic metabolites in blood plasma. In addition, Reosorbilact gently stimulates peristalsis, has choleretic and cholekinetic effects, reduces bilirubin and creatinine, improves energy metabolism, stabilizes systemic hemodynamics, reduces the symptoms of pain due to anti-edematous effect, and accelerates wound healing. Reosorbilact can be considered a drug № 1 for low-volume infusion therapy. The positive hemodynamic effect of the drug is manifested within 2-3 hours. Reosorbilact promotes the transition of the hypokinetic type of blood circulation into eukinetic due to the redistribution of extracellular fluid into the vascular bed. The drug should be prescribed at a dose of 7 ml/kg of body weight for 5-7 days or until the symptoms of intoxication are reduced. \u0000Conclusions. 1. Vessels of the microcirculatory tract provide regulatory, drainage, thermoregula","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79498853","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}

{"title":"Tuberculosis in the context of the COVID-19 pandemic: what to expect and how to act?","authors":"L.D. Todorico","doi":"10.32902/2663-0338-2020-3.2-283-285","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-283-285","url":null,"abstract":"Background. As of the end of December 2019, the list of priority areas of research and development of WHO included coronavirus of severe acute respiratory distress syndrome, coronavirus of the Middle East respiratory syndrome and mycobacterium tuberculosis (TB). In January, a new coronavirus SARS-CoV-2 was added to this list. The COVID-19 pandemic puts enormous pressure on the health systems of all countries, including those with a high TB burden, including Ukraine. \u0000Objective. To describe the condition of TB care in the context of the COVID-19 pandemic and to analyze the prospects for the consequences of the interaction between COVID-19 and TB. \u0000Materials and methods. Analysis of literature and statistics on this issue. \u0000Results and discussion. As a result of social distancing and staying at home, it is difficult to provide quality TB care: the level of timely diagnosis decreases, treatment control deteriorates, the number of undetected side effects in outpatients increases, the proportion of patients with uncontrolled or interrupted TB treatment increases. These processes can have serious adverse consequences. A comparison of TB incidence, including relapses, found out that in Ukraine in the first half of 2020 the TB incidence decreased by 27.4 % compared to the same period in 2019. Unfortunately, this most likely does not indicate a true decrease in incidence, but the reduction of the TB detection due to quarantine measures. The largest difference between 2019 and 2020 is observed in Zhytomyr, Ivano-Frankivsk, Rivne, Ternopil and Chernivtsi regions, which roughly corresponds to the distribution map of COVID-19. The incidence of TB in combination with HIV/AIDS in 2020 is also lower than in 2019 (by 28.4 %). Advanced cases have started to be registered more and more often, and in the conditions of strict quarantine patients with active bacterial excretion pose a serious threat to contact persons, first of all, to risk groups for COVID-19. Coronavirus infection can accelerate the activation of latent TB. According to the WHO, latent TB affects a quarter of the world’s population, so if the activation is accelerated, the process can easily get out of control. All viral infections, including COVID-19, also have an immunosuppressive effect that promotes TB progression. In case of co-existence, COVID-19 and TB have a mutually reinforcing effect, which reduces the likelihood of favourable outcomes for the patient. The interruption of TB treatment on the background of COVID-19 is an additional danger. Patients with TB, COVID-19 and diabetes are the most difficult to treat. In a pandemic, the feasibility of using intravenous forms of anti-TB drugs, which can intensify treatment, dramatically increases. On the positive side, the response of the medical community to COVID-19 can help the long-term efforts to combat TB through infection prevention and control, the development of a contact control system, surveillance and monitoring. The WHO recommends cont","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81582402","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}

{"title":"Risks of work with cytotoxic drugs","authors":"A. Boşnak","doi":"10.32902/2663-0338-2020-3.2-19-20","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-19-20","url":null,"abstract":"Background. Cytotoxic drugs (CTD) are widely used in medicine for the treatment of tumors and other diseases. According to the definition, CTD are the drugs, which are toxic for cells, that is, interrupt their replication or growth. Effects of CTD are not targeted, that’s why when they get into the organism, they can harm not only target cells, but any other cells, and not only the patient, but also the other people who contact with them, especially, the healthcare workers (HCW). \u0000Objective. To define the risks of work with CTD. \u0000Materials and methods. Analysis of the literature data on this topic. \u0000Results and discussion. In case of breaking the safety rules, HCW may contact CTD. They can be exposed via skin contact, inhalation of aerosols or swallowing of the particles of CTD, via needle injuries. Actions and procedures, which can be accompanied by the contact of HCW with CTD, include drug preparation and administration, handling of drug containers and waste materials, handling the biological liquids of CTD-treated patient, cleaning of the spills or items, polluted by biological liquids. Exposure to CTD can result in the abdominal pain, hair loss, vomiting, liver injury, nasal sores, contact dermatitis and allergic reactions, miscarriages and fetal malformations (in pregnant women), changes in total blood analysis, mutations appearance. It is not proven that long occupational exposure to CTD leads to cancer, despite it is known that the majority of CTD have genotoxic, cancerogenic and mutagenic effects. Tactics of risk minimization in work with CTD includes definition of risk groups (pregnant women, newbies), assessment of the potential harms of used drugs, written fixation and often reassessment of risk estimation, HCW education. The latter must include methods of CTD preparation, peculiarities of CTD usage and waste handling, correct usage of individual protective equipment (IPE) etc. CTD must be prepared exclusively by the HCW, who underwent the adequate training, and in the specialized settings (HEPA-filtered exhaust systems, negative pressure rooms, absorbing surface covers). IPE must include vinyl or nitrile gloves, waterproof long-sleeved robe or overall with elastic cuffs, goggles or face shield, respirator, shoe covers. Potentially polluted by CTD waste must be collected into the polypropylene or polyethylene bags with the appropriate labeling. \u0000Conclusions. 1. CTD may harm not only target cells, but also the other cells, and not only patients, but all the other exposed people. 2. CTD exposure may lead to the abdominal pain, hair loss, vomiting, contact dermatitis, miscarriages and fetal malformations, etc. 3. There is a spectrum of protective measures to protect HCW from CTD exposure (IPE, equipment of specialized working places for CTD solutions’ preparation, correct waste handling).","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85929002","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}

{"title":"Carbohydrate balance in the perioperative period","authors":"O. Halushko","doi":"10.32902/2663-0338-2020-3.2-28-30","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-28-30","url":null,"abstract":"Background. Deep and multifaceted disorders during the perioperative period can lead to severe metabolic disorders that are life-threatening and require immediate care. Such conditions include the disorders of carbohydrate metabolism (CHM). \u0000Objective. To describe CHM disorders in the perioperative period and the possibility of their correction. \u0000Materials and methods. Analysis of literature sources on this topic. \u0000Results and discussion. The pathogenesis of CHM disorders in the perioperative period includes such links as the impact of surgical stress and/or infections, relative insulin deficiency, increased production of ketone bodies etc. Grades of CHM disorders include compensation (normoglycemia, aglucosuria), subcompensation (moderate glycemia (up to 13.9 mmol/L), slight glucosuria), and decompensation (high glycemia, significant glucosuria, ketone bodies). The main tasks of preoperative preparation in patients with CHM disorders include CHM normalization, correction of volemic disorders, maximum compensation of renal function, prevention and treatment of infectious complications. Glycemic levels in perioperative CHM disorders are highly variable and are not always associated with the severity of the condition, although glycemia >30 mmol/L is usually associated with severe diabetic ketoacidosis. Surgery is one of the triggers of stress hyperglycemia (for patients without diabetes, the glucose level in these cases is 7.7-11.0 mmol/L). In the treatment of persistent hyperglycemia in hospitalized patients, insulin therapy should be initiated, starting from a blood glucose threshold of 10.0 mmol/L. The target is 7.8-10.0 mmol/L. Ketoacidotic coma is an absolute contraindication to surgery due to concomitant severe water-electrolyte disorders. Surgery for vital indications can be performed only after restorative measures in 3-4 hours after recovery of consciousness and reduction of glycemia to <15 mmol/L. Only profuse, life-threatening bleeding can be the basis for reducing the time and volume of preoperative preparation of a patient with diabetes decompensation. Criteria of readiness for surgery include normal or close to normal blood glucose levels, adequate hydration and elimination of ketoacidosis. In patients with severe diabetes, relative compensation (8.8-10.0 mmol/L) can be used as a criterion. Most researchers recommend transitioning patients with impaired CHM to simple insulin injections before surgery. Insulin concentration is important for wound healing and prevention of purulent complications. Sodium bicarbonate or Soda-Bufer (“Yuria-Pharm”) can be used to correct metabolic acidosis. Ketogenesis should be eliminated with xylitol (Xylate, “Yuria-Pharm”). Routine glucose use in critically ill patients has been abandoned. \u0000Conclusions. 1. Many patients in the perioperative period develop CHM disorders, which worsen the course of the underlying disease. 2. The main tasks of preoperative preparation in patients with CHM disorders are CHM ","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87955018","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}

{"title":"The main complications of infusion therapy and methods to overcome them","authors":"Ye.V. Hryzhymalskyi","doi":"10.32902/2663-0338-2020-3.2-57-59","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-57-59","url":null,"abstract":"Background. Infusion therapy (IT) is an integral part of the modern treatment process and the most common method of inpatient treatment. Indications for the IT use include dehydration, changes in blood properties, intoxication, the impossibility or inexpediency of the drug administration in other ways, the impossibility of oral nutrition, and impaired immunity. \u0000Objective. To describe the main complications of IT and their treatment. \u0000Materials and methods. Analysis of literature data on this issue. \u0000Results and discussion. Before conducting IT, you should take into account all the indications and contraindications and carefully read the instructions for use of drugs. It is advisable to use several drugs to reduce the number and severity of side effects. The rate of administration is important: in most cases, the safe rate is 20-30 drops per minute. Accidental needle injuries (ANI) and blood contact are potential IT risks for healthcare professionals. The National Union of Nurses of Private Practice has launched a survey of health workers to reduce the prevalence of these injuries. There are three components to injection safety: safe solution preparation, safe injection, and safe disposal. IT via the needle has a number of disadvantages: complications due to frequent punctures, limited ability to conduct long-term IT, increased risk of ANI. The installation of a permanent venous catheter reduces the likelihood of these defects. After catheter placement, before and after infusion, it should be flushed with 0.9 % NaCl, heparin or Soda-Bufer solution (“Yuria-Pharm”). However, as the number of catheterizations increases, the number of catheter-associated infections increases too, ranking third among nosocomial infections and first among the causes of bacteremia. In general, the frequency of complications of venous catheterization is 15 %. Mechanical complications occur in 5-19 % of patients, infectious – in 5-26 %, thrombotic – in 2-26 %. Complications of IT are classified into the complications due to violation of the rules of administration (hematoma, tissue damage, thrombophlebitis (septic, mechanical and chemical), embolism) or blood composition disorders (acidosis, blood thinning), as well as overdose, and specific complications (anaphylactic shock, pulmonary edema, hyperthermia). Anaphylaxis most often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc. The first line of treatment of anaphylactic shock involves drug discontinuation, intravenous adrenaline, 100 % oxygen, rapid intravenous infusion of crystalloids, in case of bronchospasm – 2-3 inhalations of salbutamol. Additionally, antihistamines and glucocorticoids may be prescribed. \u0000Conclusions. 1. IT is an integral part of the modern treatment process and the most common method of treatment in the hospital. 2. In IT, it is advisable to use several drugs, which reduces the number and severity of side effects. 3.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86163432","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}

{"title":"Neuroinvasion and neurological complications in COVID-19","authors":"O. Loskutov","doi":"10.32902/2663-0338-2020-3.2-186-187","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-186-187","url":null,"abstract":"Background. Coronavirus disease (COVID-19) affects not only the alveoli but also the central nervous system. The pathogenesis of neurological complications of COVID-19 is based on the receptor damage, cytokine-mediated injury, damage of the nervous system due to hypoxia, and neuronal damage due to the retrograde transport of the virus through nerve fibers. \u0000Objective. To determine the mechanisms of coronavirus neuroinvasion and treatment of neurological complications COVID-19. \u0000Materials and methods. Analysis of literature sources and own research on this topic. \u0000Results and discussion. In 3 days after infection viral antigens are detected in the olfactory sensory neurons of the nasal cavity epithelium, which confirms the transnasal invasion of coronaviruses. According to various authors, 36.4-84 % of patients with COVID-19 have neurological manifestations. In general, neurological symptoms of COVID-19 can be divided into three categories: symptoms of the central nervous system disorders (headache, dizziness, consciousness disorders, nausea and vomiting, ataxia, acute cerebrovascular disease, and epilepsy), symptoms of the peripheral nervous system disorders (hypogeusia, hyposmia, hypopsia, and neuralgia) and musculoskeletal symptoms. As viral infections cause cytokine storm, inflammation and hyperactive oxidation, it is advisable to use antioxidants in their treatment. According to the Japanese clinical guidelines for the treatment of acute respiratory distress syndrome, edaravone may be used as a free radical scavenger in such patients. In the experiment, edaravone reduced the area of infarction and promoted functional recovery in cerebral thrombosis. Other properties of edaravone include the prevention of excessive permeability of the pulmonary vessels’ endothelium. Own research has shown that edaravone (Ksavron, “Yuria-Pharm”) reduces the severity of inflammation and mortality in patients with COVID-19. In the control group, the level of the proinflammatory mediator interleukin-6 exceeded the upper limit of normal values by 1652.40 %, and in the Ksavron group – only by 269.97 %. Mortality in the control group was 14.3 %, and in the Ksavron group – 0 %. \u0000Conclusions. 1. Coronaviruses affect not only the lungs but also the nervous system. 2. Neurological symptoms of COVID-19 include headache, dizziness, consciousness disorders, nausea and vomiting, ataxia, acute cerebrovascular disease, hypogeusia, hyposmia, hypopsia, neuralgia, and musculoskeletal symptoms. 3. Edaravone (Ksavron) reduces the severity of inflammation and has an antioxidant effect, which justifies its use in COVID-19.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88826300","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}

{"title":"Complications of ventral hernia alloplasty: treatment and prevention","authors":"Y. Feleshtynskyi","doi":"10.32902/2663-0338-2020-3.2-292-293","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-292-293","url":null,"abstract":"Background. Postoperative ventral hernias (PVH) account for 22.4-25.0 % of the total number of abdominal hernias. Complications of PVH alloplasty are divided into general (abdominal compartment syndrome (ACS), acute intestinal obstruction, pneumonia, pulmonary embolism) and local (seroma, hematoma, suppuration, marginal skin defect, calcification, fistula). \u0000Objective. To describe the treatment and prevention of complications of PVH alloplasty. \u0000Materials and methods. Analysis of literature data on this topic. \u0000Results and discussion. ACS occurs after alloplasty of giant PVG as a result of a steady increase in intra-abdominal pressure (IAP) >12 mm Hg within 6-12 hours after surgery. ACS is caused by the excessive tension of the supporting structures of the abdominal wall and a decrease in the volume of the abdominal cavity. The growth of IAP leads to compression of large vessels, kidneys, increased intrathoracic pressure with the development of heart and lung failure, so during and after surgery it is necessary to monitor this parameter with the help of Foley catheter. Prevention of ACS is carried out by the optimal choice of the method of compartment separation. In the postoperative period, anesthesia (paracetamol – Infulgan, “Yuria-Pharm”), oxygen therapy, abdominal bandaging, nonsteroidal anti-inflammatory drugs (NSAID), medications for the correction of water-electrolyte metabolism (Reosorbilact, “Yuria-Pharm”) are prescribed. Among wound complications seroma is the most common (30.8-60.4 %). Methods of its treatment include vacuum drainage, puncture, antibiotics and NSAID. In presence of localized limited infection in the tissues of the abdominal wall around the mesh, excision of the mesh area with granulomas within healthy tissues, washing of the wound with Dekasan solution (“Yuria-Pharm”) and defect plastics are indicated. Antibiotic therapy is performed according to sensitivity. In the presence of a widespread infection in the tissues of the abdominal wall along the perimeter of the mesh, its explantation is indicated. Repeated direct alloplasty in such cases is contraindicated. Prevention of wound complications includes antibiotic prophylaxis (ceftriaxone 2 g), adequate choice of alloplasty, washing of the surgical wound with Dekasan solution at the different stages of surgery, vacuum drainage and ultrasound monitoring. \u0000Conclusions. 1. Optimization of prevention of wound complications during non-purulent surgical interventions is reached by washing of the surgical wound with Dekasan solution. 2. Optimization of prevention of wound complications during conditionally clean (non-purulent) surgical interventions is reached by antibiotic prophylaxis and washing of the surgical wound with Dekasan solution at various stages of surgical dissection.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"202 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83554176","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}

{"title":"Diabetic foot: diabetic ulcer care","authors":"S. Bolgarska","doi":"10.32902/2663-0338-2020-3.2-17-18","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-17-18","url":null,"abstract":"Background. Diabetic foot syndrome (DFS) is the presence of an infection and/or ulcer defect of the foot associated with neuropathy and circulatory disorders of the lower extremities of varying severity. Insensitivity of the foot, its deformation and constant load lead to the formation of necrosis under hyperkeratosis with the potential infectious process development. \u0000Objective. To describe the features of the course and treatment of DFS. \u0000Materials and methods. Analysis of literature data on this issue. \u0000Results and discussion. Classification of diabetic ulcers is carried out according to the PEDIS system, where P means perfusion, E – extent, D – depth, I – infection, S – sensation. To assess the circulatory status of the lower extremities, the ankle-brachial index (ABI) and transcutaneous oxygen tension are determined. Critical ischemia is determined by the following criteria: tibial systolic blood pressure <50 mm Hg, big toe blood pressure <30 mm Hg, or transcutaneous oxygen tension <30 mm Hg, or ABI <0.5. DFS treatment involves unloading the foot with the help of special shoes or orthoses, ultrasonic or vacuum cavitation of wounds, surgery, antibiotic therapy. If necessary, anti-pseudomonad antibiotics should be used (ceftazidime, cefoperazone, cefepime, imipenem, meropenem, ciprofloxacin, amikacin). 95 % of the microorganisms present in the world are able to coexist in the form of biofilms – communities of microorganisms in a matrix of polymers (mucopolysaccharides), which are released by the same bacteria. Taking this into account, one should choose antibiotics that can penetrate biofilms. Diabetic ulcers should be covered with dressings such as Hydroclean plus, which contain an antiseptic that protects the wound from secondary infection, prevents excessive evaporation of moisture and has an atraumatic contact layer that prevents traumatization of the young granulation tissue. This dressing continuously releases Ringer’s solution into the wound and absorbs the wound exudate, creating a continuous washing effect. Lacerta (“Yuria-Pharm”) can be used to stimulate the regeneration of long-term defects of connective tissues. Lacerta activates the migration and proliferation of fibroblasts, accelerates their metabolic activity, and enhances angiogenesis. Other methods of accelerating of the wound healing include the use of cryopreserved amniotic membranes and the injection of stem cells. \u0000Conclusions. 1. DFS is the presence of an infection and/or ulcerative defect of the foot associated with neuropathy and circulatory disorders of the lower extremities. 2. Classification of diabetic ulcers is carried out according to the PEDIS system. 3. Treatment of DFS involves unloading the foot with special shoes or orthoses, ultrasonic or vacuum cavitation of wounds, antibiotic therapy, surgery. 4. It is advisable to cover diabetic ulcers with hydrogel bandages. 5. Lacerta can be used to stimulate the regeneration of persistent skin defects.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78286201","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}

{"title":"Gold standards of CT-diagnostics of cancer","authors":"R.S. Tytorenko","doi":"10.32902/2663-0338-2020-3.2-276-277","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-276-277","url":null,"abstract":"Background. Methods of diagnostics and staging of the disease in oncology can be divided into physical, laboratory, endoscopic, cytohistological, molecular, and radiation methods. Radiation diagnostics allows to establish the localization of the pathological process and to stage it. Medical imaging methods include ultrasound diagnostics, X-ray diagnostics, computed tomography (CT), magnetic resonance imaging, scintigraphy, single-photon positron emission CT, positron emission tomography. The choice of the imaging method depends on the specific clinical situation. \u0000Objective. To describe the standards of CT diagnostics of cancer. \u0000Materials and methods. Analysis of recommendations and literature sources on this topic. \u0000Results and discussion. The advantage of multislice CT (MCT) is the possibility of one-step study of several anatomical areas. Thus, the study of the thoracic cavity includes the assessment of pathological conditions of the lungs, mediastinum, chest, visible neck, bones, as well as the assessment of the vascular bed (if contrast is used). Examination of the abdominal cavity allows to detect pathology of the digestive system, pelvis, retroperitoneal space, visible parts of the chest, bones and vascular bed (if contrast is used). Another advantage is the absence of “dumb” zones, as it is possible to estimate changes in different planes (coronary, sagittal, oblique) and in the three-dimensional image. When imaging tumors, contrast agents should always be used. Contrast testing is the gold standard of diagnosis worldwide because it improves organ and tissue differentiation. The main risk factors for post-contrast acute kidney damage are chronic kidney disease, kidney surgery, proteinuria, hypertension, diabetes, myeloma. In patients with risk factors, non-contrast MСT should be considered and, if this is not possible, the patient should be pre-hydrated (sodium bicarbonate solution or saline). The hydration protocol is selected individually based on a benefit/risk assessment. In order to prevent complications, it is advisable to use low- or isoosmolar contrast agents. After the contrast study, hydration should be continued according to the protocol and the glomerular filtration rate determined in 48 hours. \u0000Conclusions. 1. Imaging studies in oncology are extremely informative. 2. The advantages of MСT include the option of one-time study of several anatomical areas and the absence of “dumb” areas. 3. When imaging tumors contrast agents should always be used. 4. Patients at risk of post-contrast acute renal injury may undergo the visualization in settings of pre- and post-contrast preparation/management.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82167154","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}