To Evaluate the Effectiveness of Plasmapheresis as a Method for the Graft Disease Prevention in Patients with Keratoplasty

Purpose: to evaluate the effectiveness of plasmapheresis as a method for preventing and treating the graft rejection reaction in corneal transplantation.Patients and methods. The study involved patients with surgical pathology of the cornea, who underwent a prophylactic course of plasmapheresis procedures and underwent penetrating keratoplasty (Main group); and patients with surgical pathology of the cornea who underwent penetrating keratoplasty, but did not undergo plasmapheresis (Comparison group), whose data were analyzed retrospectively. The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group.Results. Patients with keratoplasty who received a course of therapeutic plasmapheresis in the perioperative period demonstrated a statistically significant increase in the number of cases of a decrease in the level of C-reactive protein and a statistically significant decrease in the median values of the mean stimulated cytochemical index and the mobilization coefficient. Depending on the risk group for keratoplasty, the patients showed different dynamics of the levels of the studied interleukins after the course of plasmapheresis and keratoplasty. In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24 %) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn’t demonstrate any cases of graft disease. In patients of the Comparison group (in total for two subgroups), the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. At the same time, the patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease (in both subgroups).Conclusion: the obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.

PROVIDING EMERGENCY SURGICAL CARE TO PATIENTS IN A COVID-19 PANDEMIC

Among the features of surgical care for patients with COVID-19 are the need for strict compliance with the epidemiological regime, minimizing the number of staff in the operating room, the possible minimization of surgical interventions and reducing their duration. The most important task in these conditions is the safety of personnel. Materials and methods. The results of surgical treatment of 85 pa-tients with acute surgical pathology are presented, and the presence of the virus was confirmed by the results of laboratory tests in 75.3 %. 24.7 % of patients had a clear picture of pneumonia of viral etiology with a high probability. All operations were performed in compliance with the epidemiological regime by pre-trained and instructed per-sonnel in compliance with the rules of asepsis and antiseptics. Discussion of results. There are no fundamental changes in the tac-tics of management of patients with acute surgical pathology. Howev-er, in the presence of the patient, in addition to acute surgical disease, COVID-19 and viral pneumonia of varying severity, it is necessary to take into account the increased risk of both bacterial and thrombo-embolic complications. Conclusions. Given the limitations caused by the spread of COVID-19, emergency surgical care should be provided to all pa-tients in a timely, highquality and complete manner. Any action of the emergency surgical service must be justified by the specific situa-tion, with the absolute priority of public and patient safety.

Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade?

Objectives: The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma in situ (NCDCIS). The study tested the hypothesis that lesions with sonographic findings have higher upgrade rate compared to lesions seen on mammography or MRI only. Methods: This retrospective study included patients with ductal carcinoma in situ diagnosed by image-guided core breast biopsy from December 2009 to April 2018. Patients with microcalcifications on mammography or concurrent ipsilateral cancer on core biopsy were excluded. An upgrade was defined as surgical pathology showing microinvasive or invasive cancer. Results: A total of 71 lesions constituted the study cohort. Sixty two percent of cases (44/71) had a mammographic finding, and 38% (27/71) of mammographically occult lesions had findings on either ultrasound, MRI, or both. Of the 67 cases that underwent sonography, a mass was noted in 56/67 (83.6%) cases and no sonographic correlate was identified in 11/67 (16.4%) cases. Twenty-one percent (15/71) of lesions were upgraded on final surgical pathology. The upgrade rate of patients with sonographic correlate was 27% (15/56) versus with mammographic findings only was 0% (0/11). Conclusion: Ductal carcinoma in situ (DCIS) should be considered in the differential diagnosis of architectural distortion, asymmetries, focal asymmetries, and masses, even in the absence of microcalcifications. NCDCIS diagnosed by ultrasound may be an independent risk factor for upgrade. Advances in knowledge: Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.

Unique technologies for organizing medical care for COVID-19 patients with concomitant diseases of the cardiovascular system and surgical pathology

The article describes some of the key elements of unique technologies for organizing medical care for patients with COVID-19 with concomitant diseases of the cardiovascular system and surgical pathology, which, along with ensuring infectious safety, allow to optimize the stream of value creation for these patients. Innovative approaches to managing the production activities of a medical organization are proposed. The goal of the work done by the hospital administration was to create a management model for a state medical organization based on modern methods, including a process-oriented approach and lean healthcare technologies. The relevance of the chosen topic is due to the fact that the activities of healthcare institutions in the context of the global coronavirus pandemic require more flexibility and mobility; therefore, the primary task is to master new management tools for a medical organization, taking into account industry characteristics and consumer needs. Analytical and descriptive methods, sociological survey were used. The article describes our own experience in carrying out structural changes in a medical organization. The use of modern management approaches allows the formation of positive interaction within the workforce and provides active feedback with patients.

Pediatric surgical sepsis: diagnostics and intensive therapy

The aim: Optimization of diagnostics and schemes of pathogenetic intensive therapy of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring. Materials and methods: The research period is 2018-2020. The object of the study (n=73) – children with surgical pathology (widespread peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, abdominal trauma, etc.). Research methods: microbiological monitoring to determine the sensitivity of the microorganism to antibiotics was carried out before and at the stages of treatment (sputum, urine, wound, bronchoalveolar lavage, tracheal aspirate, blood, contents from drainages, wound surface). Determination of the sensitivity of the isolated strains to antibiotics was carried out by the disk-diffusion method. To determine predictors of sepsis in surgical patients, clinical (mean arterial pressure (mAP), heart rate (HR), respiratory rate (RR), SpO2, etc. and laboratory parameters on days 1–2 (up to 48 hours) of sepsis identification, days 4 and 8 of intensive therapy. Procalcitonin was determined by immunofluorescence on a Triage® MeterPro analyzer (Biosite Diagnostics, USA). Blood gases and electrolytes were analyzed using a Stat Profile CCX analyzer (Nova Biomedical, USA). Results: studies have shown the effectiveness of complex intensive care in 86.3 % of cases. Mortality was found in 13.7 % of cases. Patients with severe surgical pathology died: widespread peritonitis, severe TBI + coma with irreversible neurological disorders, urosepsis against the background of chronic renal failure, after repeated surgical interventions, due to the development of refractory septic shock (SS). Conclusions. Early diagnosis of sepsis, rational early ABT under the control of microbiological monitoring, non-aggressive infusion therapy with early prescription of vasopressors (SS) with constant monitoring of the child's main life support organs contribute to an improvement in sepsis outcomes and a decrease in mortality