Pub Date : 2024-05-07DOI: 10.33667/2078-5631-2024-5-23-26
V. Akhmedov
Cholelithiasis is a fairly common disease of the digestive system, affecting from 10 % to 15 % of the adult population. Despite many studies devoted to this problem, the mechanisms of formation of gallstone disease have not been fully elucidated. Recently, aspects of the influence of the intestinal microbiota on the mechanisms of formation of various pathologies of the gastrointestinal tract such as non-alcoholic fatty liver disease, inflammatory bowel diseases, irritable bowel syndrome, pancreatic diseases, gastroesophageal reflux disease have been considered. The presented review article examines the possible involvement of the gastrointestinal microbiome in the pathogenesis of gallstone disease. The article discusses the role of microorganisms and their metabolites in the formation of gallstones.
{"title":"Intestinal microbiota and gallstone disease – is there a connection?","authors":"V. Akhmedov","doi":"10.33667/2078-5631-2024-5-23-26","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-23-26","url":null,"abstract":"Cholelithiasis is a fairly common disease of the digestive system, affecting from 10 % to 15 % of the adult population. Despite many studies devoted to this problem, the mechanisms of formation of gallstone disease have not been fully elucidated. Recently, aspects of the influence of the intestinal microbiota on the mechanisms of formation of various pathologies of the gastrointestinal tract such as non-alcoholic fatty liver disease, inflammatory bowel diseases, irritable bowel syndrome, pancreatic diseases, gastroesophageal reflux disease have been considered. The presented review article examines the possible involvement of the gastrointestinal microbiome in the pathogenesis of gallstone disease. The article discusses the role of microorganisms and their metabolites in the formation of gallstones.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"126 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141002957","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-27-31
G. Bikbavova, M. A. Livzan, N. S. Lisyutenko, A. E. Romanyuk, A. V. Indutny, O. V. Martynenko
Numerous studies show that in the pathogenesis of ulcerative colitis (UC), a significant role is played by a change in the diversity of the intestinal microflora, which is associated with fewer bacteria producing short-chain fatty acids (SCFAs). SCFCS affect the differentiation and activation of cells of the immune system, play a protective role in maintaining the integrity of the epithelial barrier, participate in the regulation of intestinal peristalsis and blood supply to its wall, muscle anabolism, bioavailability of amino acids.The aim of the study. To evaluate the content of SCLC in the feces of UC patients with varying degrees of severity of the current attack, as well as to investigate the relationship between the content of SCLC with dietary characteristics, body mass index (BMI), and dyspenia.Materials and methods. The study involved 80 UC patients, conducted a survey, objective examination, filling out medical history and outpatient records, blood and stool sampling. The content of SCLC was determined in feces. The study of nutritional characteristics in patients with UC was conducted using a standardized questionnaire of the WHO CINDI program. Statistical methods: median (Me), upper and lower quartiles (P25, P75) were calculated; Mann-Whitney criterion; Kolmogorov-Smirnov criterion; nonparametric correlation analysis was performed.Results. The absolute content of SCFCS in the feces of patients with UC is lower than the reference values. The relative content of propionic acid in the subgroup with severe attack was significantly lower than in the remission subgroup, in the subgroup with mild and moderate attack of the disease. In patients with body weight deficiency, the relative content of propionic acid is lower than in UC patients with normal or overweight. A positive relationship was found between the total content of SCFCS in feces and the amount of dietary fiber consumed in the form of fruits and vegetables. In patients with dinapenia, the relative content of butyric acid in feces is significantly lower than in patients without dinapenia.
{"title":"Assessment of the content of short-chain fatty acids in ulcerative colitis as an indicator of the patient's metabolic health","authors":"G. Bikbavova, M. A. Livzan, N. S. Lisyutenko, A. E. Romanyuk, A. V. Indutny, O. V. Martynenko","doi":"10.33667/2078-5631-2024-5-27-31","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-27-31","url":null,"abstract":"Numerous studies show that in the pathogenesis of ulcerative colitis (UC), a significant role is played by a change in the diversity of the intestinal microflora, which is associated with fewer bacteria producing short-chain fatty acids (SCFAs). SCFCS affect the differentiation and activation of cells of the immune system, play a protective role in maintaining the integrity of the epithelial barrier, participate in the regulation of intestinal peristalsis and blood supply to its wall, muscle anabolism, bioavailability of amino acids.The aim of the study. To evaluate the content of SCLC in the feces of UC patients with varying degrees of severity of the current attack, as well as to investigate the relationship between the content of SCLC with dietary characteristics, body mass index (BMI), and dyspenia.Materials and methods. The study involved 80 UC patients, conducted a survey, objective examination, filling out medical history and outpatient records, blood and stool sampling. The content of SCLC was determined in feces. The study of nutritional characteristics in patients with UC was conducted using a standardized questionnaire of the WHO CINDI program. Statistical methods: median (Me), upper and lower quartiles (P25, P75) were calculated; Mann-Whitney criterion; Kolmogorov-Smirnov criterion; nonparametric correlation analysis was performed.Results. The absolute content of SCFCS in the feces of patients with UC is lower than the reference values. The relative content of propionic acid in the subgroup with severe attack was significantly lower than in the remission subgroup, in the subgroup with mild and moderate attack of the disease. In patients with body weight deficiency, the relative content of propionic acid is lower than in UC patients with normal or overweight. A positive relationship was found between the total content of SCFCS in feces and the amount of dietary fiber consumed in the form of fruits and vegetables. In patients with dinapenia, the relative content of butyric acid in feces is significantly lower than in patients without dinapenia.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"38 s172","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003472","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-13-17
G. Bikbavova, V. A. Livzan, V. Akhmedov, T. V. Tretyakova, V. A. Voyat, L. I. Telyatnikova
Ulcerative colitis (UC) is one of the most serious and poor-studied problems of modern gastroenterology. This nosology is a diffuse inflammation of the intestinal mucosa, limited to the colon with a predominant lesion of the rectum and sigmoid colon. Due to the progressive nature of the disease, patients require lifelong drug therapy and monitoring. Extra-intestinal manifestations are often found in patients with UC and represent a complex problem that requires the close attention of specialists and the appointment of modern pathogenetically-based treatment, including genetically engineered biological drugs. This clinical observation reflects the importance of early diagnosis of UC with extra-intestinal manifestations – primary sclerosing cholangitis and arthropathy, as well as the effectiveness of treatment with ustekinumab.
{"title":"A clinical case of a continuous course of ulcerative with extra-intestinal manifestations","authors":"G. Bikbavova, V. A. Livzan, V. Akhmedov, T. V. Tretyakova, V. A. Voyat, L. I. Telyatnikova","doi":"10.33667/2078-5631-2024-5-13-17","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-13-17","url":null,"abstract":"Ulcerative colitis (UC) is one of the most serious and poor-studied problems of modern gastroenterology. This nosology is a diffuse inflammation of the intestinal mucosa, limited to the colon with a predominant lesion of the rectum and sigmoid colon. Due to the progressive nature of the disease, patients require lifelong drug therapy and monitoring. Extra-intestinal manifestations are often found in patients with UC and represent a complex problem that requires the close attention of specialists and the appointment of modern pathogenetically-based treatment, including genetically engineered biological drugs. This clinical observation reflects the importance of early diagnosis of UC with extra-intestinal manifestations – primary sclerosing cholangitis and arthropathy, as well as the effectiveness of treatment with ustekinumab.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"35 S140","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003624","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-36-42
D. Trukhan, I. Viktorova
Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the associations between PPIs and a number of diseases/conditions. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to January 30, 2024. In this review, we examined the effect of long-term use of PPIs on the urinary system. This review demonstrates possible changes in the urinary system and an increased risk of developing nephrolithiasis, acute interstitial nephritis, acute kidney injury, chronic kidney disease, end-stage renal failure with long-term use of PPIs, which should certainly be taken into account when prescribing them for a long period, especially in patients with comorbid pathology.
质子泵抑制剂（PPI）是治疗胃酸相关疾病的最有效药物。近几十年来，PPIs 的使用量成倍增加。长期以来，PPIs 被认为是短期和长期使用都完全安全的药物。然而，现代临床指南指出，在长期大剂量处方 PPIs 时，应考虑到副作用的可能性。近年来，国外发表了多篇综述，探讨了 PPI 与多种疾病/病症之间的关联。我们在 PubMed 和 Scopus 信息数据库中搜索了有关 PPI 使用安全性的出版物，包括截至 2024 年 1 月 30 日的资料来源。在这篇综述中，我们研究了长期服用 PPI 对泌尿系统的影响。本综述表明，长期使用 PPIs 可能会导致泌尿系统发生变化，并增加患肾炎、急性间质性肾炎、急性肾损伤、慢性肾病、终末期肾衰竭的风险。
{"title":"Side effects of proton pump inhibitors with long-term use: focus on the urinary system","authors":"D. Trukhan, I. Viktorova","doi":"10.33667/2078-5631-2024-5-36-42","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-36-42","url":null,"abstract":"Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the associations between PPIs and a number of diseases/conditions. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to January 30, 2024. In this review, we examined the effect of long-term use of PPIs on the urinary system. This review demonstrates possible changes in the urinary system and an increased risk of developing nephrolithiasis, acute interstitial nephritis, acute kidney injury, chronic kidney disease, end-stage renal failure with long-term use of PPIs, which should certainly be taken into account when prescribing them for a long period, especially in patients with comorbid pathology.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"76 s323","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141002343","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 : 2024-05-07DOI: 10.33667/2078-5631-2024-5-7-12
M. A. Butov, M. Msakni, V. M. Butova, N. A. Sudakova, I. Y. Vornacheva, L. I. Karpova
Purpose of the study. Evaluation of the clinical effectiveness of combination therapy for FGID with overlap syndrome – gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the PPI omeprazole and the myotropic antispasmodic mebeverine hydrochloride in extended-release capsules (Meberin ML, Micro Labs Limited, India) on clinical manifestations and motor-evacuation function of the gastrointestinal tract in patients with FGID with overlap syndrome – GERD, FD with gastric hypersecretion and IBS.Materials and methods. We examined 27 patients with FGID with overlap syndrome of GERD, FD with gastric hypersecretion of hydrochloric acid and IBS.Results and conclusion. It has been established that combination therapy with these drugs for two weeks in 97 % of cases eliminates the clinical symptoms of the syndromes, improves the quality of life of patients, normalizes intestinal motility and myoelectric activity of the gastrointestinal tract.
{"title":"The effect of mebeverine in extended-release capsules on intestinal motor function in patients with functional gastrointestinal pathology","authors":"M. A. Butov, M. Msakni, V. M. Butova, N. A. Sudakova, I. Y. Vornacheva, L. I. Karpova","doi":"10.33667/2078-5631-2024-5-7-12","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-5-7-12","url":null,"abstract":"Purpose of the study. Evaluation of the clinical effectiveness of combination therapy for FGID with overlap syndrome – gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the PPI omeprazole and the myotropic antispasmodic mebeverine hydrochloride in extended-release capsules (Meberin ML, Micro Labs Limited, India) on clinical manifestations and motor-evacuation function of the gastrointestinal tract in patients with FGID with overlap syndrome – GERD, FD with gastric hypersecretion and IBS.Materials and methods. We examined 27 patients with FGID with overlap syndrome of GERD, FD with gastric hypersecretion of hydrochloric acid and IBS.Results and conclusion. It has been established that combination therapy with these drugs for two weeks in 97 % of cases eliminates the clinical symptoms of the syndromes, improves the quality of life of patients, normalizes intestinal motility and myoelectric activity of the gastrointestinal tract.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"23 22‐23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005710","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 : 2024-05-06DOI: 10.33667/2078-5631-2024-3-17-22
A. Komarova, S. Bliznyuk, D. S. Lyasina, E. A. Naryshkina, A. V. Bumbu, S. Covantsev
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults worldwide. The use of oral anticoagulants (DOACs) is an effective way to prevent ischemic stroke in patients with AF, reducing the risk of stroke by approximately 64 %. In patients with liver cirrhosis (LC), the presence of AF is associated with higher rates of in-hospital mortality, stroke and acute kidney injury compared with patients without arrhythmia. Liver disease and especially cirrhosis are associated with an increased risk of not only thrombosis but also bleeding, making the decision about anticoagulant therapy in these patients very difficult. The article reviews the current literature regarding the use of modern DOACs and traditional antithrombotic agents, such as vitamin K antagonists and heparins, in patients with cirrhosis and AF.
心房颤动（房颤）是全球成人中最常见的心律失常。使用口服抗凝剂（DOACs）是预防房颤患者缺血性中风的有效方法，可将中风风险降低约 64%。在肝硬化（LC）患者中，与无心律失常的患者相比，房颤的存在与较高的院内死亡率、中风和急性肾损伤相关。肝脏疾病，尤其是肝硬化不仅会增加血栓形成的风险，还会增加出血的风险，这使得这些患者很难做出抗凝治疗的决定。文章回顾了有关肝硬化和房颤患者使用现代 DOAC 和传统抗血栓药物（如维生素 K 拮抗剂和肝素）的现有文献。
{"title":"Anticoagulant prophylaxis in patients with liver disease and atrial fibrillation","authors":"A. Komarova, S. Bliznyuk, D. S. Lyasina, E. A. Naryshkina, A. V. Bumbu, S. Covantsev","doi":"10.33667/2078-5631-2024-3-17-22","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-3-17-22","url":null,"abstract":"Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults worldwide. The use of oral anticoagulants (DOACs) is an effective way to prevent ischemic stroke in patients with AF, reducing the risk of stroke by approximately 64 %. In patients with liver cirrhosis (LC), the presence of AF is associated with higher rates of in-hospital mortality, stroke and acute kidney injury compared with patients without arrhythmia. Liver disease and especially cirrhosis are associated with an increased risk of not only thrombosis but also bleeding, making the decision about anticoagulant therapy in these patients very difficult. The article reviews the current literature regarding the use of modern DOACs and traditional antithrombotic agents, such as vitamin K antagonists and heparins, in patients with cirrhosis and AF.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"354 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006814","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 : 2024-05-06DOI: 10.33667/2078-5631-2024-3-23-28
I. A. Kozlov, A. Ovezov, S. A. Rautbart
The objective was to study the effect of early planned use of transpulmonary thermodilution (TPTD) and therapeutic measures to stabilize blood circulation on the clinical outcome of sepsis.Materials and methods. The cohort study involved 132 patients with abdominal sepsis with SOFA >7 and blood lactate >1.6 mmol/L. Septic shock was diagnosed in 56 % of patients. TPTD in the early periods of intensive care was began in 53.8 % of patients. Logistic regression and ROC-analysis were used to process the data.Results. Early use of invasive monitoring (OR 2,3715, 95 % CI 1,1107–5,0635, p=0,026, AUC 0.655) and infusion volume >43 ml/kg per day (OR 1.0313, 95 % CI 1.0073–1.0558, p=0.01, AUC 0.677) were predictors of survival in patients with abdominal sepsis. The use of TPTD compared to patients of group II was accompanied by an increase in the daily infusion volume (53.7 [38.1–63.5] vs 38.2 [29.9–47.2], ml/kg per day, p = 0.0001), more frequent use of inotropic drugs (39.4 vs 16.4 %, p = 0.004), and higher level of the inotropic scale (0 [0–4.7] vs 0 [0–0], p = 0.01). There were no differences in the frequency of prescription (57.7 vs 65.5 %, p = 0.376) and dosages (0.2 [0.1–0.4] vs 0.3 [0.2–0.4] μg/kg/min, p = 0.554) of norepinephrine. Twenty-eight-day mortality in groups I and II was 31 and 50.8 % (p = 0.022), hospital mortality was 32.9 and 54.0 % (p = 0.014).Conclusion. When assessed by SOFA > 7 points and lactatemia > 1.6 mmol/L, the onset of TPTD and infusion volume > 43 mL/kg/day increase the likelihood of survival of patients with abdominal sepsis, as a result, 28-day and hospital mortality decrease by 1.6 times. The use of invasive monitoring of central hemodynamics in this clinical situation is accompanied by an increase in the prescription of inotropes by 2.4 times with an unchanged intensity of norepinephrine use.
目的是研究早期有计划地使用经肺热稀释（TPTD）和稳定血液循环的治疗措施对脓毒症临床结局的影响。这项队列研究涉及 132 名 SOFA >7 和血乳酸 >1.6 mmol/L 的腹腔败血症患者。56%的患者被诊断为脓毒性休克。53.8%的患者在重症监护早期开始出现TPTD。数据处理采用了逻辑回归和ROC分析法。早期使用有创监测（OR 2,3715，95 % CI 1,1107-5,0635，p=0,026，AUC 0.655）和输液量大于每天 43 毫升/千克（OR 1.0313，95 % CI 1.0073-1.0558，p=0.01，AUC 0.677）是腹腔败血症患者生存的预测因素。与第二组患者相比，使用 TPTD 的患者每日输液量增加（53.7 [38.1-63.5] vs 38.2 [29.9-47.2], ml/kg per day, p = 0.0001），使用肌力药物的频率更高（39.4 vs 16.4 %, p = 0.004），肌力评分水平更高（0 [0-4.7] vs 0 [0-0], p = 0.01）。去甲肾上腺素的处方频率（57.7 % vs 65.5 %，p = 0.376）和剂量（0.2 [0.1-0.4] vs 0.3 [0.2-0.4] μg/kg/min，p = 0.554）没有差异。第一组和第二组的二十八天死亡率分别为31%和50.8%（p = 0.022），住院死亡率分别为32.9%和54.0%（p = 0.014）。通过 SOFA > 7 分和乳酸血症 > 1.6 mmol/L 评估，TPTD 开始和输液量 > 43 mL/kg/天会增加腹腔败血症患者的生存几率，因此，28 天死亡率和住院死亡率降低了 1.6 倍。在这种临床情况下使用有创中枢血流动力学监测的同时，肌注药物的处方量增加了 2.4 倍，而去甲肾上腺素的使用强度保持不变。
{"title":"Role of invasive hemodynamics monitoring in sepsis intensive care","authors":"I. A. Kozlov, A. Ovezov, S. A. Rautbart","doi":"10.33667/2078-5631-2024-3-23-28","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-3-23-28","url":null,"abstract":"The objective was to study the effect of early planned use of transpulmonary thermodilution (TPTD) and therapeutic measures to stabilize blood circulation on the clinical outcome of sepsis.Materials and methods. The cohort study involved 132 patients with abdominal sepsis with SOFA >7 and blood lactate >1.6 mmol/L. Septic shock was diagnosed in 56 % of patients. TPTD in the early periods of intensive care was began in 53.8 % of patients. Logistic regression and ROC-analysis were used to process the data.Results. Early use of invasive monitoring (OR 2,3715, 95 % CI 1,1107–5,0635, p=0,026, AUC 0.655) and infusion volume >43 ml/kg per day (OR 1.0313, 95 % CI 1.0073–1.0558, p=0.01, AUC 0.677) were predictors of survival in patients with abdominal sepsis. The use of TPTD compared to patients of group II was accompanied by an increase in the daily infusion volume (53.7 [38.1–63.5] vs 38.2 [29.9–47.2], ml/kg per day, p = 0.0001), more frequent use of inotropic drugs (39.4 vs 16.4 %, p = 0.004), and higher level of the inotropic scale (0 [0–4.7] vs 0 [0–0], p = 0.01). There were no differences in the frequency of prescription (57.7 vs 65.5 %, p = 0.376) and dosages (0.2 [0.1–0.4] vs 0.3 [0.2–0.4] μg/kg/min, p = 0.554) of norepinephrine. Twenty-eight-day mortality in groups I and II was 31 and 50.8 % (p = 0.022), hospital mortality was 32.9 and 54.0 % (p = 0.014).Conclusion. When assessed by SOFA > 7 points and lactatemia > 1.6 mmol/L, the onset of TPTD and infusion volume > 43 mL/kg/day increase the likelihood of survival of patients with abdominal sepsis, as a result, 28-day and hospital mortality decrease by 1.6 times. The use of invasive monitoring of central hemodynamics in this clinical situation is accompanied by an increase in the prescription of inotropes by 2.4 times with an unchanged intensity of norepinephrine use. ","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"37 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141010746","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 : 2024-05-06DOI: 10.33667/2078-5631-2024-3-50-54
V. A. Baulin, A. A. Gulyaev, A. Baulin, O. A. Baulinа, L. A. Averyanova, V. A. Starodubtsev
The article is devoted to the use of a new method in open and laparoscopic surgery of gastroesophageal reflux disease and hiatal hernia. The essence of the technique is to fix the esophageal-gastric junction under the diaphragm with a combined tape of xenopericardium and propylene or propylene only. Comparative data on the results of Nissen operations in 126 patients and the new method in 258 patients are presented. The authors used an original comparative outcome assessment scale, which combines the main negative outcomes encountered after operations for gastroesophageal reflux disease and hiatal hernia, as well as Visick scale. The advantage of the new technique has been statistically reliably proven, where the absence of such severe complications as dysphagia, diarrhea, and stasis in its use is especially emphasized.
{"title":"Long-term results of alternative antireflux surgery for gastroesophageal reflux disease and hiatal hernia","authors":"V. A. Baulin, A. A. Gulyaev, A. Baulin, O. A. Baulinа, L. A. Averyanova, V. A. Starodubtsev","doi":"10.33667/2078-5631-2024-3-50-54","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-3-50-54","url":null,"abstract":"The article is devoted to the use of a new method in open and laparoscopic surgery of gastroesophageal reflux disease and hiatal hernia. The essence of the technique is to fix the esophageal-gastric junction under the diaphragm with a combined tape of xenopericardium and propylene or propylene only. Comparative data on the results of Nissen operations in 126 patients and the new method in 258 patients are presented. The authors used an original comparative outcome assessment scale, which combines the main negative outcomes encountered after operations for gastroesophageal reflux disease and hiatal hernia, as well as Visick scale. The advantage of the new technique has been statistically reliably proven, where the absence of such severe complications as dysphagia, diarrhea, and stasis in its use is especially emphasized.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"12 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141009584","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 : 2024-05-06DOI: 10.33667/2078-5631-2024-3-36-47
A. A. Aleksandrovskiy, V. S. Suryakhin, A. V. Salikov, S. A. Rautbart, D. M. Makhmudov, A. V. Geise
Acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression of chronic kidney disease (CKD), financial burden on the health care system, and increases mortality in various entities. Extended renal replacement therapy (CRRT) is the predominant form of renal replacement therapy (RRT) in intensive care units (ICU) by providing hemodynamic stability in critically ill patients, more precise control of fluid balance, correction of acid-base imbalances, electrolyte disorders and achieving a stable level of osmolarity correction, including in multimorbid patients. This article examines the various aspects of CRRT in critically ill patients with severe AKI with high comorbidity, as well as in patients with sepsis and multiple organ failure. An analytical evaluation of the choice of CRRT over intermittent/intermittent hemodialysis (IHD) in selected clinical settings is being conducted. Filter/dialyzer life is assessed, including assessment of filtration fraction, use of anticoagulation options including regional citrate anticoagulation (RCA), dose of CRRT prescribed and delivered, vascular access management, general criteria, timing of initiation and cessation of CRRT, and initiation of renal replacement therapy for nonrenal indications. with AKI and/or sepsis.
{"title":"Renal replacement therapy in critical ill patients","authors":"A. A. Aleksandrovskiy, V. S. Suryakhin, A. V. Salikov, S. A. Rautbart, D. M. Makhmudov, A. V. Geise","doi":"10.33667/2078-5631-2024-3-36-47","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-3-36-47","url":null,"abstract":"Acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression of chronic kidney disease (CKD), financial burden on the health care system, and increases mortality in various entities. Extended renal replacement therapy (CRRT) is the predominant form of renal replacement therapy (RRT) in intensive care units (ICU) by providing hemodynamic stability in critically ill patients, more precise control of fluid balance, correction of acid-base imbalances, electrolyte disorders and achieving a stable level of osmolarity correction, including in multimorbid patients. This article examines the various aspects of CRRT in critically ill patients with severe AKI with high comorbidity, as well as in patients with sepsis and multiple organ failure. An analytical evaluation of the choice of CRRT over intermittent/intermittent hemodialysis (IHD) in selected clinical settings is being conducted. Filter/dialyzer life is assessed, including assessment of filtration fraction, use of anticoagulation options including regional citrate anticoagulation (RCA), dose of CRRT prescribed and delivered, vascular access management, general criteria, timing of initiation and cessation of CRRT, and initiation of renal replacement therapy for nonrenal indications. with AKI and/or sepsis.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"327 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006995","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 : 2024-05-06DOI: 10.33667/2078-5631-2024-3-54-58
A. V. Bormyshev, T. G. Morozova
Objective. To conduct a clinical and diagnostic substantiation of computed tomography (CT) of internal organs in acute lung injury (ALI) in intensive care.Methods. 96 patients of the intensive care unit of the Clinical hospital No 1(Smolensk) were examined. CT scans of the lungs, liver, and brain were performed using a tomograph GE Revolution EVO64. Clinical structure of the patients: 49 – with pneumonia, 15 – septic condition, 12 – Inhalation of toxic substances, 8 – aspiration of toxic liquids, 3 – aspiration of disosmolar liquids, 3 – disseminated intravascular coagulation, 3 – pulmonary contusion, 3 – shock condition. Statistical processing of the results was carried out in the Statistica 6.0 program.Results. Of the 15 patients without changes of the lungs on CT scan, in 12 patients’ attenuation value of liver parenchyma was 14–28HU, brain attenuation value was 24–30HU. In patients with established changes in lung tissue (n=81), the density of liver tissue less than 54HU, brain density less than 32HU in 80.2 % of cases allowed us to predict an unfavorable course of ALI. 10 deaths were recorded, 6 patients were in critical condition for a long period of time. Treatment of hemostasis disorders, normalization of water-electrolyte homeostasis, elimination of hypoxemia, prescription of hepatoprotective, antibacterial, detoxification therapy helped to avoid an unfavorable outcome.Conclusions. 1. It is recommended to consider of criteria for an unfavorable course in patients with acute lung injury the attenuation value of liver parenchyma less than 54HU and brain tissue attenuation value less than 32HU on CT (r=0.969 and r=0.988). 2. CT scan of the liver and brain allows the resuscitator to correct therapy and decide whether it is necessary to involve other specialists. 3. Diagnostic and prognostic significance of a complex CT scan in patients with acute lung injury, at the patient’s admitting AUROC 0.998; CI 0.901–0.999; at follow-up AUROC 0.835; CI 0.822–0.847.
{"title":"Clinical and diagnostic substantiation for computed tomography of internal organs in acute lung injury in intensive care unit","authors":"A. V. Bormyshev, T. G. Morozova","doi":"10.33667/2078-5631-2024-3-54-58","DOIUrl":"https://doi.org/10.33667/2078-5631-2024-3-54-58","url":null,"abstract":"Objective. To conduct a clinical and diagnostic substantiation of computed tomography (CT) of internal organs in acute lung injury (ALI) in intensive care.Methods. 96 patients of the intensive care unit of the Clinical hospital No 1(Smolensk) were examined. CT scans of the lungs, liver, and brain were performed using a tomograph GE Revolution EVO64. Clinical structure of the patients: 49 – with pneumonia, 15 – septic condition, 12 – Inhalation of toxic substances, 8 – aspiration of toxic liquids, 3 – aspiration of disosmolar liquids, 3 – disseminated intravascular coagulation, 3 – pulmonary contusion, 3 – shock condition. Statistical processing of the results was carried out in the Statistica 6.0 program.Results. Of the 15 patients without changes of the lungs on CT scan, in 12 patients’ attenuation value of liver parenchyma was 14–28HU, brain attenuation value was 24–30HU. In patients with established changes in lung tissue (n=81), the density of liver tissue less than 54HU, brain density less than 32HU in 80.2 % of cases allowed us to predict an unfavorable course of ALI. 10 deaths were recorded, 6 patients were in critical condition for a long period of time. Treatment of hemostasis disorders, normalization of water-electrolyte homeostasis, elimination of hypoxemia, prescription of hepatoprotective, antibacterial, detoxification therapy helped to avoid an unfavorable outcome.Conclusions. 1. It is recommended to consider of criteria for an unfavorable course in patients with acute lung injury the attenuation value of liver parenchyma less than 54HU and brain tissue attenuation value less than 32HU on CT (r=0.969 and r=0.988). 2. CT scan of the liver and brain allows the resuscitator to correct therapy and decide whether it is necessary to involve other specialists. 3. Diagnostic and prognostic significance of a complex CT scan in patients with acute lung injury, at the patient’s admitting AUROC 0.998; CI 0.901–0.999; at follow-up AUROC 0.835; CI 0.822–0.847.","PeriodicalId":18337,"journal":{"name":"Medical alphabet","volume":"62 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141008843","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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