Infusion & Chemotherapy最新文献

{"title":"Medical secrecy: the rights and responsibilities of participants of the medical process","authors":"N. Lisnevska","doi":"10.32902/2663-0338-2020-3.2-172-174","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-172-174","url":null,"abstract":"Background. Medical secrecy (MS) is a set of information about the disease, its treatment, the results of examinations, which became known to certain healthcare workers (HCW) during their professional activities. The attending physician and the nurse who performs the drug administration are most aware of the patient’s condition. The information included in the MS is divided into two types: medical and personal information of the patient, which became known during the performance of medical professional duties. \u0000Objective. To describe selected aspects of the MS problem. \u0000Materials and methods. Analysis of the legal framework. \u0000Results and discussion. Medical information belongs to professional confidential information and should not be disclosed. Even the information about the very fact of seeking medical care belongs to professional confidential information. Unlawful intentional disclosure of MS by a person to whom it became known in the course of its professional duties entails criminal liability. This applies not only to HCW, but also to other staff of medical institutions. It is possible to provide information about the treatment and even the patient’s stay in the hospital to third parties, including relatives of any degree of kinship, only with the patient’s own consent. Exceptions include cases of extreme urgency, such as when a patient is taken to hospital unconscious and relatives can provide information on existing allergies and comorbidities. Of course, in such cases, the necessary disclosure limits should be followed. If a relative or other person wishes to visit a patient in the hospital, he or she should be contacted in person and visited only with personal consent. With regard to law enforcement officers, the answer to the question of whether a particular patient is treated in this institution should be given only in the presence of criminal proceedings and after resolving this issue with the chief physician. It should be noted that medical information concerning the deceased is also confidential and cannot be disclosed. It should not be assumed that the deceased can no longer be harmed, so any liability will be absent. Disclosure of such information is also a crime, on the basis of which criminal proceedings may be started. Recently, the medical legislation in Ukraine was changed, and as of today, the fine for disclosing MT is over UAH 50,000. When treating patients with disabilities, all necessary information should be provided to their parents or carers. When treating children aged 14-18, it is impossible not to provide information about treatment to parents, although this may be contrary to the wishes of the child. An important issue is the provision of information to children who are incapacitated by age, but legally capable. If a 5-year-old child asks questions about his or her health, a doctor or other HCW must answer them in a form that is accessible. A similar situation occurs with mentally ill patients: they are deprived of","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83424691","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":"Pain syndromes in endometriosis: an integrated approach to the problem management","authors":"T. Tatarchuk","doi":"10.32902/2663-0338-2020-3.2-271-273","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-271-273","url":null,"abstract":"Background. Endometriosis affects 10 % of women of reproductive age. Endometriosis is often accompanied by the following symptoms: dyspareunia, pelvic pain, and dysmenorrhea. Pain is a leading symptom of endometriosis and often persists despite treatment. \u0000Objective. To elucidate the basics of pathogenesis and treatment of pain in endometriosis. \u0000Materials and methods. Analysis of literature data on this topic; own study involving 64 women with endometriosis. Group 1 was given dienogest (2 mg per day) for 3 months, and group 2 was given dienogest in combination with Tivortin (5 intravenous infusions of 100 ml each other day with the switch to Tivortin aspartate (“Yuria-Pharm”) orally). \u0000Results and discussion. Pain in endometriosis includes several pathophysiological mechanisms: increased nociception, inflammation, and changes in the recognition of pain in the nervous system. Significant pelvic vascularization promotes the rapid transmission of pain signals from this area to the brain. The severity of pain noted by women poorly correlates with the degree of disease detected during surgery. According to the recommendations of NICE (2017), one or more of the following symptoms are sufficient for suspected endometriosis: chronic pelvic pain (>6 months), dysmenorrhea, which adversely affects quality of life and daily activity, dyspareunia, gastrointestinal disorders and urinary system symptoms associated with menstruation, and infertility in combination with one or more of the above symptoms. Endometriosis requires flexible adaptation of management and the constant choice of treatment tactics depending on the symptoms and life situation of the patient. The basic goals of treatment inlude elimination of symptoms, restoration of quality of life and fertility, prevention of recurrences and repeated surgical intervention. Analgesics, neuromodulators and hormonal agents are used for pharmacological pain management. Additional and alternative methods include reflexology, manual therapy, osteopathy, exercise, dietary changes, and sleep hygiene. Elimination of the oxidation imbalance is one of the methods to treat pain in endometriosis. The uterus is a highly vascularized organ and its cells are constantly affected by high concentrations of oxygen. In settings of hypoxia, steroidogenesis, angiogenesis, inflammation and metabolic transition occur in endometrial cells. In women with endometriosis, there is an increase in markers of oxidative stress in the blood. Intrauterine oxidative stress can be eliminated with the powerful antioxidant L-arginine (Tivortin, “Yuria-Pharm”). In our own study, it was shown that the inclusion of Tivortin into the treatment allowed to decrease the intensity of intermenstrual endometriosis-associated pelvic pain more markedly than the standard treatment. The initial pain level was 61.32±3.2 according to the visual-analog scale in group 1 and 64.2±2.8 in group 2 (Tivortin). A month later, the indicators were 36.5±2.6 and 27.2±2.2,","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80922440","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 the infusion therapy and their prevention","authors":"O. Halushko","doi":"10.32902/2663-0338-2020-3.2-45-47","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-45-47","url":null,"abstract":"Background. Infusion solutions are divided into several groups: crystalloids, colloids (natural and artificial), polyatomic alcohols, special drugs (infusion antibiotics, analgesics, hemostatics). Each solution type has its own complications. \u0000Objective. To identify the main complications of infusions and prevention measures. \u0000Materials and methods. Analysis of the available literature on this topic. \u0000Results and discussion. After the transfusion of 1 liter of 0.9 % NaCl only 275 ml of this solution remains in plasma, and 725 ml passes into the interstitial space, causing edema. In addition, there is a risk of hyperchloraemic acidosis in case of massive transfusions. 0.9 % NaCl is inadequate in its ionic composition, has no reserve alkalinity, deepens hyperosmolar changes, so it is not used as monotherapy in daily practice. It is used as a solvent only. Ringer’s solution is also easily excreted into the interstitial space with the edema formation. It is hyperosmolar, contains a large number of chlorine ions and is excreted by the kidneys, so it should be used with caution in patients with kidney disease. A number of drugs (aminocaproic acid, amphotericin B, blood products, sodium thiopental) are incompatible with Ringer’s solution and Ringer’s lactate. In turn, 5 % glucose solution is ineffective for detoxification, liver cirrhosis and restoring the circulating blood volume in case of blood loss. Glucose infusions can increase the production of carbon dioxide and lactate, increase ischemic damage to the brain and other organs, and promote tissue edema. At present, the routine use of glucose during surgery and in critically ill patients has been completely abandoned. Preparations of polyatomic alcohols can be divided into the preparations of six-atomic alcohols – mannitol (Mannit) and sorbitol (Sorbilact, Reosorbilact) and five-atomic alcohols (xylitol – Xylate, Gluxyl, Lactoxyl) (all of the listed solutions are made by “Yuria-Pharm”). Side effects of mannitol include tachycardia, thrombophlebitis, chest pain, skin rash, dehydration, dyspepsia, fluid and electrolyte balance, and hallucinations. Hypotension is the most common complication of mannitol usage. Reosorbilact is a modern balanced infusion solution. Its effects include the hypovolemia correction, restoration of electrolyte disturbances, normalization of cardiac activity and nerve conduction, increase of alkaline blood reserve and restoration of energy balance. In case of the significant overdose Reosorbilact can cause alkalosis. Contraindications to its administration include alkalosis, cerebral hemorrhage, pulmonary embolism, and 3 grade hypertension. Xylitol is a five-atom alcohol that is rapidly incorporated into the pentose phosphate metaboliс pathway. Its side effects include the allergic reactions, hypertension, nausea, and lactic acidosis. The main disadvantage of hydroxyethyl starch (HES) drugs is the adverse effect on hemostasis (especially in drugs of the first generation). In a","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87847930","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":"Four D concept of fluid therapy","authors":"M. Mulbrain","doi":"10.32902/2663-0338-2020-3.2-193-195","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-193-195","url":null,"abstract":"Background. D (definition): the daily fluid balance is the sum of all the amounts of consumed and excreted fluid. Assessment of fluid accumulation per day allows to detect fluid overload. At early stages (the first 1-3 hours) of infusion therapy (IT) targeted administration of necessary drugs should be carried out. The volume of infusion is 10-30 ml/kg of body weight. Subsequently, during the first week of treatment in the intensive care unit (ICU) it is necessary to achieve two consecutive days with a negative fluid balance. In the later stages of treatment, active fluid removal is performed with diuretics or renal replacement therapy. The concept of four D IT actually includes seven D: definitions, diagnosis, drug, dose, duration, de-escalation, discharge. \u0000Objective. To describe the basic principles of modern IT. \u0000Materials and methods. Analysis of literature sources on this topic. \u0000Results and discussion. The improvement and proper application of the existing IT techniques and drugs is an important step in improving treatment outcomes. Frequent mistakes include too long IT, wrong choice of drug or dose. Hypervolemia as a result of excessive infusions is even more dangerous than hypovolemia because it can lead to the interstitial edema. To address the issue of IT, it is advisable to focus on preload – the degree of stretching of a cardiomyocyte before contraction. Echocardiographic indicators of preload include end-diastolic volume and end-diastolic pressure of left ventricle. When choosing a solution for IT, it is necessary to take into account its tonicity and osmolality, as it depends on whether the solution will remain in the vessels or enter the intercellular space. Choosing an optimal IT, one should take into account the choice of solution or combination of solutions, the optimal time and duration of its introduction, the pathological condition of the patient. Thus, in case of trauma, blood and crystalloids are prescribed, in case of sepsis – crystalloids, and later albumin, in the perioperative period – hydroxyethyl starch (HES) and crystalloids. When choosing an antibiotic for IT, you should pay attention to the recent history of hospitalizations, length of stay in a medical institution (term >5 days increases the likelihood that the patient’s infection is nosocomial), comorbid conditions, history of steroid use, previous antibiotic therapy (ABT), duration of mechanical lung ventilation. Dose is another important aspect of IT. In ABT, too high dose can be toxic to the macroorganism, and too low dose can be ineffective and cause bacterial resistance. When selecting the dose of the antibiotic, attention should be paid to the distribution volume of the drug, the liver and kidney function and the peculiarities of the drug clearance, albumin level, ability to penetrate into tissues, minimal inhibitory concentration. In turn, when selecting the dose of solutions for IT, it is necessary to take into account the volume of distribution, type of","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":"87515734","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":"Procedural sedation – a patient’s whim or a necessity?","authors":"O. E. Domoratskyi","doi":"10.32902/2663-0338-2020-3.2-89-90","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-89-90","url":null,"abstract":"Background. Procedural sedation (PS) is a condition that allows patients to avoid discomfort when undergoing certain painful manipulations on the background of stable hemodynamics and respiration and maintaining the ability to respond adequately to verbal commands or tactile stimulation. PS is most often used in dentistry, maxillofacial surgery, endoscopy, ophthalmology, otorhinolaryngology. \u0000Objective. Describe the main features of the PS. \u0000Materials and methods. Analysis of literature data on this topic. \u0000Results and discussion. Risk groups during PS include patients with cardiovascular decompensation, morbid obesity, obstructive sleep apnea, grade III-IV chronic renal failure, liver decompensation, as well as age over 70. The conditions for safe PS are as follows: all medical staff are trained to provide cardiorespiratory resuscitation; there is a constant quick access to resuscitation equipment; a routine pre-procedure assessment of the patient’s condition (especially the upper respiratory tract) was carried out; pre-procedure fasting was prescribed; careful monitoring of the patient’s condition is provided. The main scales for sedation assessment include Ramsay Sedation Scale, Sedation Agitation Scale, Motor Activity Assessment Scale, Vancouver Interactive and Calmness Scale, Richmond Agitation-Sedation Scale, Adaptation to Intensive Care Environment, Minnesota Sedation Assessment Tool. Midazolam, propofol, dexmedetomidine can be used for PS. Minimal sedation (anxiolysis) is a medical condition in which the patient responds normally to voice commands. Cognitive function and coordination in this condition may be impaired, however, cardiorespiratory function remains unchanged. Such sedation is prescribed in traumatology, maxillofacial surgery, urology, gynecology, plastic surgery. Moderate sedation is a medical suppression of consciousness in which the patient responds to voice commands accompanied by light tactile stimulation. Adequate respiration and functioning of the cardiovascular system is maintained. Diazepam/sibazone, midazolam, dexmedetomidine are prescribed for this purpose. The latter is recommended for fiber-optic intubation in a state of complete consciousness. The dangers of PS include passive aspiration and ventilation disorders, which leads to hypoxia and hypercapnia. Caution should be taken with propofol due to the possible development of respiratory depression and hemodynamics, pain in the vein during administration. Dexmedetomidine does not cause respiratory depression, however, this does not eliminate the need for monitoring. \u0000Conclusions. 1. Adequate sedation during surgery is a logical component of the intervention if the regional methods of anesthesia are applicated. 2. Sedation outside the operating room will account for more and more of the use of anesthetics. 3. There is a need for clear regulation of PS. 4. When choosing a drug one should take into account the purpose of its administration, curability of complication","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77081098","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":"Patient care after surgery: suture care and wound care process","authors":"О. Kovalenko","doi":"10.32902/2663-0338-2020-3.2-138-140","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-138-140","url":null,"abstract":"Background. A wound is a defect of skin and underlying tissues that can be caused by many factors. Wound care is more than just changing dressings. Different wounds require different approaches and care. Optimal wound care supports the natural healing process in an effective but gentle way. Wounds are classified into acute and chronic, as well as cut, scalped, chopped, stabbed, bruised, torn, bitten, gunshot, and surgical. Surgical wounds are distinguished by the fact that they are applied specifically, for medical or diagnostic purposes, in special aseptic conditions, with minimal tissue trauma, in conditions of anesthesia, with thorough hemostasis and joining of separated anatomical structures with sutures. \u0000Objective. To describe the modern approach to wound care. \u0000Materials and methods. Analysis of literature data on this topic. \u0000Results and discussion. Types of wound healing include primary tension healing, delayed primary tension healing, secondary tension healing, and scab healing. When caring for surgical wounds, primary protection against microorganisms is important. In this case, sterile dressings play an important role, for example, a medical surgical patch with an absorbent pad (Yu-Fix, “Yuria-Pharm”). The pad is characterized by high hygroscopicity, does not stick to the wound and does not leave fibers in the wound. The frequency of dressings changing depends on the healing process and the amount of exudate released from the wound. For festering wounds, the dressing should be changed daily and sometimes more often. Hands and gloves should be worn before bandaging. After removing the gloves, the hands are also treated with an antiseptic (Gorosten, “Yuria-Pharm”, a decamethoxine-based antiseptic). The use of Gorosten in medical institutions for prophylactic purposes is indicated for disinfection of staff hands in order to prevent the spread of transient microflora. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. However, in this period there are still wound channels from the threads, so after that it is necessary to treat the wound several times with antiseptic (Dekasan, “Yuria-Pharm”). Signs of local infection of the wound are redness, excess exudate, sometimes – with the addition of pus, odor, pain in the area of injury, fever, edema. Sometimes postsurgical wound suppuration occurs even with proper care due to weak immunity or rejection of surgical suture material. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. Unlike 2 % povidone-iodine, which causes severe inhibition of granulation in an open wound, Dekasan does not damage granulation tissue. Surgical treatment, lavage, drainage, antibiotics, laser or ultrasound may also be required. After removing the signs of local inflammation, secondary sutures are applied to the wound or the edges of the wound are connected with the he","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":"87363481","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":"Analysis of the intermediate results of the INVENT-1 clinical trial: open-label, randomized, multicenter study","authors":"O. Denysov","doi":"10.32902/2663-0338-2020-3.2-78-79","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-78-79","url":null,"abstract":"Background. Attempts to treat tuberculosis (TB) with the help of intravenous drugs have been made since the early XX century. However, XXI century medicine recommends treating TB with pills, and invasive anti-TB drugs (ATBD) are rarely used. International expert groups recommend intravenous administration only for critically ill patients or for patients with absorption disorders. Meanwhile, the advantages of intravenous ATBD include direct monitoring of treatment, accurate dosing for each patient, fewer side effects, and avoidance of taking a large number of tablets. \u0000Objective. To evaluate the efficacy, safety, and tolerability of intravenous and oral administration of ATBD in the intensive phase of treatment in patients with advanced destructive pulmonary TB with bacterial excretion. \u0000Materials and methods. The study involved 318 patients from 9 clinical centres. The total duration of the study was 18 months. Intravenous and oral administration of isoniazid, rifampicin and ethambutol were compared. The intensive phase of the study lasted 2 months, the maintenance phase lasted 4 months. Inclusion criteria were the following: age 18-65 years, diagnosis of pulmonary TB, at least one positive test result for TB mycobacteria, radiological confirmation of lung destruction and advance TB process, in women – negative urine test for pregnancy, informed consent, negative GenXpert MTB/RIF analysis, and verbal consent to abstain from alcohol during the study. \u0000Results and discussion. Due to the resistance to 1st line drugs 14 people were excluded from the study, due to the lack of data on culture – 16 people, for other reasons – 7 people. In the infusion treatment group, 52.63 % had disseminated TB, and 47.37 % had infiltrative TB. In the group of tablet treatment disseminated TB occurred in 35.2 % of patients, infiltrative – in 61.8 %, miliary – in 3 %. At 4th visit, the efficacy of abacillation in both treatment groups was comparable: 34.2 % in the infusion group and 35.26 % in the oral treatment group. But as of the 6th visit, the share of abacillation in the infusion group was 57.42 %, and in the oral treatment group – 46.96 %. Analysis of the time needed to achieve a negative result on mycobacterium TB also revealed the benefits of infusions. Thus, up to the 3rd visit this parameter was reached by 15.78 % of the infusion group patients, and by 13.76 % of oral therapy group patients. The total proportion of patients with a negative test for mycobacterium TB and clinical improvement in the infusion group was 60 %, and in the oral therapy group – 52.90 %. In infiltrative TB, 27.8 % of the infusion group and only 9.5 % of the tablet therapy group reached abacillation by the 3rd visit. In disseminated TB, abacillation was achieved up to 3rd visit in 5 % of the infusion group and 8.3 % of the tablet treatment group, however, the total numbers at the end of the study were 45 and 25 %, respectively. \u0000Conclusions. 1. Monitoring the patient’s treatment is a cor","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85733624","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":"Infusion therapy of traumatic shock","authors":"V. Chernii","doi":"10.32902/2663-0338-2020-3.2-309-311","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-309-311","url":null,"abstract":"Background. Analysis of all deaths due to military trauma (MT) over the last decade revealed that 1/4 of them could have been prevented. Up to 90 % of these deaths are related to blood loss. Trauma induces acute endogenous coagulopathy within a few minutes in 25 % of patients, which quadruples mortality. The main feature of MT is its combined nature, because in explosive injuries the local action of the explosion is combined with shrapnel wounds and distant damage to organs, and the wound canal goes through several anatomical parts of the body. In case of concomitant injuries, there are several sources of pain impulses, there is a deep endotoxicosis and impaired function of damaged organs. Under MT conditions, it is difficult to determine the nature of the shock due to a combination of hemorrhagic and traumatic shock. Uncontrolled post-traumatic bleeding is the leading cause of preventable death. \u0000Objective. To describe infusion therapy (IT) of shock. \u0000Materials and methods. Analysis of literature data on this issue. \u0000Results and discussion. In approximately 1/3 of hospitalized patients with trauma, the bleeding is coagulopathic. The severity of coagulopathy is determined by the influence of environmental factors, metabolic disorders, therapeutic strategy, the presence of brain and liver injuries, individual characteristics of the patient, the trauma and shock, hemodilution coagulopathy. The primary task of managing a patient with trauma is to eliminate the so-called lethal triad (hypothermia, acidosis, coagulopathy) and ensure perfusion of vital organs. Damage Control Resuscitation (DRC) is a systemic approach to the treatment of severe injuries that combines a resuscitation strategy with a range of surgical techniques from the moment of injury till the end of the treatment. DRC is aimed at blood loss minimization, maximization of tissue oxygenation, and optimization of outcomes. Surgeries performed as part of the DRC approach include an incision from the xiphoid process to the pubis with evacuation of blood and clots from the abdominal cavity, thorough examination and termination of all bleedings. Damaged parenchymal organs are completely resected. Damaged intestine is resected and connected with clips without anastomosis formation. Damaged vessels are ligated. The abdominal cavity is closed with a sterile bandage, but not sutured. After 1-2 days, tampons are removed, anastomoses are formed, and all non-viable tissues are removed. As for examinations, magnetic resonance imaging is the gold standard for assessing the severity of the injury and detecting extraperitoneal bleeding. In patients with closed abdominal trauma, hypotension, or an unknown mechanism of trauma, a rapid ultrasound examination is indicated to look for blood at potential sites of its accumulation. In the treatment of injuries with bleeding and shock, IT is of great importance. Its principles include the restriction of crystalloids use, the use of blood products in the optimal","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78038526","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":"Artificial blood: where are we now?","authors":"Amany A.E. Ahmed","doi":"10.32902/2663-0338-2020-3.2-14-16","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-14-16","url":null,"abstract":"Background. The creation of artificial blood (AB) and/or its components can change medicine, but currently available artificial oxygen carriers (AOC) do not perform other blood functions: vascular volume maintenance, coagulation, immunity, transport of neurotransmitters, nutrients and waste. \u0000Objective. To describe the current situation regarding AB. \u0000Materials and methods. Analysis of literature data on this issue. \u0000Results and discussion. The need to create an AB is justified by the high cost of collecting, processing and storing donor blood, low infectious safety of drugs received against HIV, viral hepatitis B and C, cytomegalovirus, etc., reduction of the number of donors, problems with blood incompatibility. Immunological effects of blood transfusions are associated with a higher frequency of infectious processes during surgery, slowing of wound healing and progression of malignant diseases. Requirements for an ideal AB preparation include adequate oxygen uptake and delivery under physiological conditions, no toxic or physiological effects, ability to be eliminated and excreted by the human body, sufficient intravascular half-life, ease of use and storage, stability at room temperature, universal compatibility, availability and low cost, ability to maintain blood pressure and pH, viscosity similar to real blood. Available AOC include oxygen-transport solutions based on hemoglobin and perfluorocarbon compounds (PFC) in the form of emulsions. Natural (human, bovine) or genetically modified hemoglobin is used for the production of the former, and hemoglobin of yeast or bacterial origin can also be used. The advantages of hemoglobin solutions include the increased erythropoietin production, adequate oxygen delivery at a hemoglobin level of 20 g/L without side effects, complete absence of virus transmission and 25 % better reperfusion recovery than with real blood. Potential fields of AOC use include shock, organ ischemia, erythrocyte incompatibility, acute lung injury, organ storage for transplantation, cardioplegia, sickle cell anemia, tumor treatment, and air embolism. The main problem is the release of pro-inflammatory cytokines in response to hemoglobin solution administration. Side effects of these solutions include neuro- and nephrotoxicity, immunosuppression, vasoconstriction, coagulopathy, release of free radicals, and errors in blood tests. In turn, PFC does not bind oxygen, but dissolves it in proportion to the partial pressure. PFC are eliminated by phagocytes and eventually excreted by the lungs during respiration. PFC particles are much smaller than natural erythrocytes (0.2 vs. 7 μm) and are easier to deform, which facilitates their delivery to ischemic areas. Side effects of PFC include transient face flushing, headache and back pain, nausea, fever, anaphylactoid reactions, bleeding tendency, pulmonary edema, and acute right ventricular failure. Because high partial pressures are required to achieve the desired PFC effects, artif","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"199 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76389155","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":"Peculiarities of care for patients with coronavirus infection. Important safety issues for health care workers","authors":"A. Savych","doi":"10.32902/2663-0338-2020-3.2-254-256","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-254-256","url":null,"abstract":"Background. In case of coronavirus disease (COVID-19), contact persons include, but are not limited to, health care workers (HCW) and caregivers of COVID-19 patients. Personal protective equipment is required for HCW working with patients or individuals with suspected COVID-19. Correct sequence and the correct technique of putting them on is very important. \u0000Objective. To describe the safety measures for HCW in care of patients with COVID-19. \u0000Materials and methods. Analysis of literature sources on this topic. \u0000Results and discussion. Contaminated environmental surfaces take part in the contact route of transmission. To reduce the role of fomites in the transmission of the new SARS-CoV-2 coronavirus, special recommendations of the Ministry of Health on surface cleaning and disinfection have been developed. After cleaning, disinfectants must be used to reduce the viral load on the surface. These disinfectants are also effective against other pathogens that are important in health care settings. Such agents include ethanol 70-90 %, chlorine-based agents, and hydrogen peroxide >0.5 %. The register of disinfectants of Ukraine contains more than 200 brands. The vast majority of them are represented by alcohol- and chlorine-containing solutions of various concentrations, colors and odors. The use of these solutions is limited to the torso and extremities. These solutions have a number of limitations and caveats in their use. For instance, in case of contact with mucous membranes, they have an irritating effect and require rinsing with plenty of water. Vapors of some of them should not be inhaled, so they should be used in well-ventilated areas or with protective equipment. Alcohol-based products should not be applied to damaged areas of the skin due to protein denaturation. The Food and Drug Administration (FDA) recommends to use the chlorine- and alcohol-based solutions with caution due to the lack of evidence of their safety. The decamethoxine-based solution Yusept (“Yuria-Pharm”) is intended for disinfection of hands and other parts of the body, including the face; for disinfection of HCW gloves and gloves in other places; for disinfection and pre-sterilization cleaning of all medical devices from various materials; for disinfection of hairdresser’s, manicure, pedicure and cosmetic accessories; for disinfection of rooms, furniture, patient care items, hygiene products, utensils, containers, sanitary equipment, rubber carpets; for current, final and preventive disinfection; for use in aerosol disinfection systems such as Yu-box and other disinfection systems. Proper hand washing technique is also an important preventive measure. The effectiveness of prevention of HCW infection during their professional duties depends on how serious the problem is taken by the management of the health care institution and the HCW, who work with infectious patients, themselves. \u0000Conclusions. 1. For HCW working with patients or persons with suspected COVID-19, the use ","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78752976","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}