Optimization of prevention measures of septic complications in women with high infectious risk

2018 ◽  
pp. 108-113
Author(s):  
Yu.R. Feyta ◽  
◽  
V.I. Pyrohova ◽  
Keyword(s):  
High Risk ◽  
Postpartum Period ◽  
Comparison Group ◽  
Infectious Complications ◽  
Main Group ◽  
Septic Complications ◽  
Effective Prevention ◽  
Vaginal Gel ◽  
Infectious Risk ◽  
Treatment Techniques

Despite the introduction of modern diagnostic technologies, prophylaxis and treatment techniques in obstetrical practice, the incidence of postpartum purulent-septic complications (PPSC) remains rather high and is an important medical and social problem, as they take one of the leading places in the structure of maternal morbidity and mortality. The objective: to improve the management of parturient womenwith a perineal birth injury in anamnesis, as part of an effective prevention of purulent-septic complications of puerperium. Materials and methods. The study included 77parturient women. Main and comparative groups were formed by women with a violation of the integrity of the perineum in the previous labor and with a high risk of developing infectious complications in puerperium. Women of the main group (n = 24) during each vaginal examination in labor (and an additional injection in 15-30 minutes after the rupture of the membranes) and twice a dayat a dose of 5 ml for 5 days postpartum, an antiseptic agent in the form of a vaginal gel, which consists of: 0.02% decamethoxin (antiseptic component), 0.5% hyaluronic acid (regenerating component) and lactate buffer (regulatory component). The comparison group included 27 women, without using vaginal gel in laborand using traditional wound treatment techniques in the postpartum period. The control group consisted of 26 women with uncomplicated somatic status, physiological course of pregnancy and labor. The evaluation of the effectiveness of the prescribed treatment was based on subjective symptoms (pain, discomfort, burning in the region of the perineal sutures), clinical data (swelling, hyperemia, nature of suturing healing), generally accepted indicators in dynamics (bacterioscopy of vaginal contents, pH-metry of the vaginal environment). Results. At the background of the use of three-component vaginal gel in the main group, the level of injury of soft tissues of the birth canal in these deliveries was lower by 19.9% than in the comparison group, prevalence of the 1st degreeperineumruptures, decreased the need for repeated episio- and perineotomy, which reduced the duration stay at hospital and improved postpartum rehabilitation in relation to the comparison group. On the third day of puerperium, hyperemia and edema of the wound area in women of the main group were observed almost three times less compared with the comparison group. On the fifth day of the puerperium in the main group the complaints were insignificant and appeared on the average 5 times less often, the healing was by the primary tension without infectious complications. The use of vaginal gel reduced the number of leukocytes in wound secretions by shortening the time of wound epithelization (1.5 times faster than in the parous from the comparison group). On the fifth day of using vaginal gel, 2/3 of the patients observed normalization of the vaginal microflora, the restoration of pH was observed. The results indicate the benefits of early onset of prophylactic measures and high effectiveness of topical antiseptic therapy in women with high infectious risk. Conclusions.In order to prevent antibiotic resistance tactics of prevention of PPSC in the group of high-risk septic complications provides one of the elements of anintegrated approach to use local antiseptics. Inclusion of the latter into a complex of prophylactic and treatment measures in the management of a high-riskwomen in puerperium contributes to the reduction of traumatic and infectious complications and provides more favorable course of labor and the postpartum period. Key words: labor traumatism, postpartum purulent-septic complications, local antiseptic.

Clinical value of c-reactive protein level in predicting the development of postpartum endometritis

2020 ◽  
Vol 69 (2) ◽  
pp. 5-14
Author(s):  
Tatyana V. Batrakova ◽  
Irina E. Zazerskaya ◽  
Tatyana V. Vavilova ◽  
Vitaly N. Kustarov
Keyword(s):  
Postpartum Period ◽  
Comparison Group ◽  
Threshold Value ◽  
Main Group ◽  
C Reactive Protein ◽  
Clinical Value ◽  
Septic Complications ◽  
Reactive Protein ◽  
Diagnostic Threshold ◽  
Wide Range

Hypothesis/aims of study. In the Russian Federation, postpartum septic complications are third among the causes of maternal mortality, along with obstetric bleeding and preeclampsia. A wide range of methods for predicting postpartum endometritis has been proposed. However, none of these methods has sufficient clinical efficacy. The lack of information and the lack of clear criteria highlight the difficulties in the early diagnosis and prognosis of postpartum endometritis. The aim of this study was to evaluate the role of C-reactive protein (CRP) in the prediction of postpartum endometritis in puerperas with a high risk of developing septic complications. Study design, materials and methods. The study included 135 puerperas, who were retrospectively divided into two groups. The main group consisted of women with developed postpartum endometritis (n = 72), and the comparison group comprised individuals with physiological course of the postpartum period (n = 63). Serum CRP levels were determined for all puerperas on days 1 and 3 of the postpartum period using the immunoturbodimetric method. Results. On day 1 of the postpartum period, the diagnostic threshold value for CRP levels was 69 mg / ml. The sensitivity and specificity of the method were low: 62% (95% CI 5074) and 65% (95% CI 5176), respectively. The predictability at a CRP level above 69 mg / ml was 67% (95% CI 5477). Thus, in puerperas on day 1 of the postpartum period at a CRP level above 69 mg / ml, the probability of developing postpartum endometritis was 67%, the chances of developing postpartum endometritis being extremely low, increasing by 1.76 times. There were no statistically significant differences when comparing CRP levels in the study groups of puerperas on day 1 of the postpartum period. On day 3 of the postpartum period, CRP level was significantly higher in the main group of puerperas 148 mg / ml (95% CI 126171), and in the comparison group 43 mg / ml (95% CI 3849) (p = 6 1014). On the 3rd day of the postpartum period, the diagnostic threshold value for CRP levels was 60 mg / ml. The sensitivity of the method was moderate 79% (95% CI 6886), the specificity of the method being high 93% (95% CI 8598). The predictability at a CRP level above 60 mg / ml was 93% (95% CI 8496). Thus, in postpartum women on day 3 of the postpartum period at a CRP level above 60 mg / ml, the probability of developing postpartum endometritis was 93%, with the chances of developing postpartum endometritis increased by 10 times (95% CI 530). In addition, determining CRP level on day 3 of the postpartum period is clinically informative, as evidenced by the standardized effect size (SES) equal to 1.4 (p = 6 1014). This is confirmed by the ROC analysis data: the clinical significance value (AUC indicator) was 0.89 (CI 0.810.93), according to which CRP determination is evaluated as a method with high clinical informativity. Conclusion. The determination of CRP on day 3 of the postpartum period is a clinically informative method. An increase in CRP level above 60 mg / ml is a predictor of postpartum endometritis with a sensitivity of 79% and a high probability (93%).

Clinical features and etiology of postpartum endometritis in women with a high risk of purulent-septic complications

2021 ◽  
Vol 69 (6) ◽  
pp. 23-30
Author(s):  
Tatyana V. Batrakova ◽  
Irina E. Zazerskaya ◽  
Yulia V. Dolgo-Saburova ◽  
Elena Yu. Vasilyeva ◽  
Darya O. Saprykina
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Species Composition ◽  
Enterococcus Faecalis ◽  
Postpartum Period ◽  
Comparison Group ◽  
Main Group ◽  
Postpartum Women ◽  
Septic Complications

Hypothesis/Aims of study. Postpartum purulent-septic complications continue to rank third in the structure of maternal mortality. In the etiology of postpartum endometritis, the key role is played by opportunistic microflora, including associations of microorganisms, as well as a history of chronic urogenital infection, bacterial vaginosis, and sexually transmitted infections. Despite numerous studies, the question of which microorganisms colonizing the birth canal are potentially dangerous in relation to the development of infectious and inflammatory pathology of the postpartum period is still a subject of discussion. The aim of this research was to study the etiology and identify the clinical features of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications. Study design, materials and methods. This retrospective comparative study included 199 puerperas, who were divided into two groups: the main group consisted of women who developed postpartum endometritis (n = 72), and the comparison group comprised women with the physiological course of the postpartum period (n = 127). Bacteriological examination of lochia was performed on the third day of the postpartum period, as well as with the development of postpartum endometritis before empirical antibiotic therapy was started. Results. During the bacteriological study of lochia in the main group of patients, potentially pathogenic microorganisms were observed in 68 % of puerperas, with the pathogen of endometritis not detected with repeated crops of lochia in 32 % of postpartum women. In the comparison group, this proportion was only 15 % (p 0.005). During pregnancy, the release of microorganisms from the cervical canal was observed in 26.4 % of cases in the main group and in 7 % of cases in the comparison group of puerperas (p 0.005). Despite the absence of clinical symptoms, all patients received systemic antibacterial therapy. Subsequently, 90 % of maternity patients in the main group revealed the ineffectiveness of empirical therapy due to antibiotic resistance of the identified microflora. When analyzing the species composition of microorganisms, intestinal microflora in monoculture was more often isolated in the patients of the main group: Escherichia coli (40 % vs. 2.4 % in the comparison group) and Enterococcus faecalis (25 % vs. 4.7 % in the comparison group). In 10 % of postpartum women with severe purulent-septic complications (sepsis, parametritis, pelvioperitonitis), the composition of the released microflora in lochiae did not differ from that of maternity women with endometritis without severe purulent-septic complications, and microbial associations were only detected in two cases. Conclusion. The etiological cause of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications is intestinal bacteria (Escherichia coli, Enterococcus faecalis) more often detected as a monoculture. The species composition of microorganisms that cause severe forms of postpartum purulent-septic complications does not differ in principle from the pathogens of uncomplicated forms of postpartum infection. Unreasonable antibacterial therapy during pregnancy is associated with antibiotic resistance of microorganisms that cause postpartum endometritis, which poses significant difficulties in the selection of antibacterial drugs for its treatment.

New possibilities of the use of surgical lasers in obstetrics

1997 ◽  
Vol 78 (6) ◽  
pp. 434-438
Author(s):  
I. F. Fatkullin
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Postoperative Complications ◽  
Cesarean Section ◽  
Laser Welding ◽  
Comparison Group ◽  
Obstetrics And Gynecology ◽  
Septic Complications ◽  
Basic Group ◽  
Section Operation

The laser welding suture of peritoneum in pregnants and in women in labor with high risk of pyo-septic complications is used in cesarean section operation. In the basic group the postoperative complications are three times as little than in the comparison group. The promise of the use of the biological laser @welding@ in obstetrics and gynecology to improve technology and results of surgical treatment especially in delivery of women with high risk of pyo-septic complications is noted.

Reproductive anamnesis of women with postpartum purulent-septic complications

2017 ◽  
pp. 65-68
Author(s):  
V.I. Pyrohova ◽  
◽  
Y.R. Feyta ◽  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cesarean Section ◽  
Postpartum Period ◽  
Preventive Measures ◽  
Control Group ◽  
Study Group ◽  
Negative Consequences ◽  
Septic Complications ◽  
Significant Percentage

Postpartum purulent-septic complications are considered to be one of the main causes of maternal loss, hence, this is why they continue to maintain their relevance and priority in modern obstetrics. The incidence of this disease remains high and aggravates the extension of the postpartum period in 5–26% of cases. Mostly postpartum purulent-septic complications are caused by not one, but a combination of several reasons that can act simultaneously or sequentially and are often caused by a combination of medical and social factors. These factors require the necessity of diligent analysis of the reproductive anamnesis of women who suffered from complications of septic nature during the postpartum period, in order to highlight the risk factors for these complications. The objective: to explore the possibility of formation of high-risk groups based on the analysis of reproductive anamnesis in women with postpartum purulent-septic complications as part of preventive measures. Patients and methods. According to the purpose of this research a detailed retrospective analysis was made of anamnesis histories of 89 women (study group) with postpartum septic complications, namely, 58 women with postpartum purulent-septic complications who bore through natural birth canal; 31 women with postpartum purulent-septic complications after cesarean section. The control group consisted of 40 women recently confined within uncomplicated maternal postpartum process. Results. It was investigated that in the group of women with postpartum complications prevailed women who were pregnant for the second time (especially after cesarean section).It is important to highlight the fact that significant percentage of menstrual disorders and the commencement of early sexual live of women in the study group. Analysis of an illness revealed a significant incidence of inflammatory diseases of the female reproductive organs, cervical pathology, chronic tonsillitis, chronic pyelonephritis, cystitis, anemia clinical history in the main group. Significant percentage is noticed of the women with thyroid disorders. Significantly higher frequency was noticed with regards to pregnancies that had negative consequences in anamnesis, the presence of gynecological pathology, surgery and vaginal microbiota disturbances before and during pregnancy in women with postpartum purulent-septic complications. A combination of two or more selected factors, especially in women with extragenital pathology and transferred infectious diseases in anamnesis, greatly increases the risk of septic complications in the postpartum period. Conclusions. Current analysis has provided implicit evidences to ensure that it is important to select a separate group at high risk of postpartum septic complications on the stage which precedes pregnancy for the development of an individual plan for diagnostic and preventive measures to prevent this disease. Key words: postpartum purulent-septic complications, risk factors, reproductive anamnesis.

scholarly journals Unconventional Technique of Terminolateral Pancreatojejunostomy Formation

2021 ◽  
Vol 14 (1) ◽  
pp. 25-32
Author(s):  
Badri Valerievich SiguA ◽  
Vyacheslav Petrovich Zemlyanoy ◽  
Evgeny Alekseevich Zakharov ◽  
Malkhaz Yurievich Tsikoridze ◽  
Anatoliy Nikolaevich Napalkov
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Main Group ◽  
Soft Pancreas ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Novel Method

Backgraund. Pancreatoduodenal resection (PDR) is the only radical treatment for malignant tumors of the periampullary zone. The development of postoperative pancreatic fistula (POPF) is the most common complication of PDR. The main risk factors for the development of POPF are the narrow main pancreatic duct and the soft, "juicy" pancreatic parenchyma. Thus, it is the stage of formation of a pancretodigestive anastomosis that is of decisive importance for the course of the postoperative period.The aim of the study was to improve immediate surgical treatment outcomes of patients suffering from oncological diseases of the periampullary zone with a soft pancreas and a narrow pancreatic duct.Methods. A novel method to form terminolateral reservoir invagination pancreatojejunostomy has been developed and introduced into clinical practice. The results of treatment of 94 patients with tumors of the periampullary zone were analyzed. Based on preoperative radiological diagnosis and intraoperative findings, such factors of a high risk of POPF development as a soft pancreas and a narrow major pancreatic duct ( 3 mm) were detected in 23 patients (24.4%). In 11 patients who were treated in 2018-2019, a novel method of pancreato-jejunoanastomosis formation was applied. The comparison group consisted of 12 patients who received treatment in 2014-2017; a differentiated approach to the formation of a pancreatodigestive anastomosis was not applied.Results. In patients of the main group, there was a tendency to an increase in the proportion of pylorus-saving PDRs. The only statistically significant difference was the use of reservoir terminolateral pancreatojejunostomy at the reconstructive stage of surgery. Complicated postoperative course was observed in 7 (63.6%) patients of the main group and in all patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% (p 0.05) in the study group. Repeated surgery was required in 3 (27.2%) patients of the main group and 7 (58.3%) patients in the comparison group (p 0.05). The lethal outcome was recorded in 2 (18.2%) patients of the main group and in 3 (25%) in the comparison group (p 0.05).Conclusion. A soft, loose pancreas and a narrow main pancreatic duct are the most significant risk factors for complications in the postoperative period. Management of this condition requires a differentiated approach to the treatment option of pancreatodigestive anastomosis formation, depending on the characteristics of the pancreas of an individual patient. The proposed technique for the reservoir terminolateral pancreatojejunoanastomosis formation allowed statistically significantly reducing the incidence of complications from 100 to 63.6% and the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% in high-risk patients..

scholarly journals Fluid resuscitation patients with burn sepsis

2020 ◽  
pp. 42-43
Author(s):  
O.M. Kovalenko ◽  
O.I. Osadcha ◽  
A.A. Kovalenko ◽  
A.S. Grisha ◽  
O.M. Lynnyk ◽  
...  
Keyword(s):  
Comparison Group ◽  
Total Body Surface Area ◽  
Clinical Manifestations ◽  
Main Group ◽  
Oxidation Products ◽  
Control Group ◽  
Carbonyl Groups ◽  
Septic Complications ◽  
Endogenous Intoxication ◽  
Lipid Oxidation Products

Objective. The purpose the of the study is to improve the fluid therapy regimens for burn sepsis patient. Materials and methods. The study is based on the observation 52 patients with burn sepsis aged 23 to 65 years, with a total body surface area more than 35 % at the Kyiv City Clinical Hospital № 2 during 2016-2019. Patients were divided into two groups: the main group – 30 patients were treated with crystalloids, plasma, albumin and Rheosorbilact (RSL); control group – 16 patients received treatment without using of RSL. Clinical and biochemical parameters of endogenous intoxication (tissue destruction products, medium weight molecules (MWM), concentrations of lipid oxidation products (LOP) – by diene conjugate content and oxidatively modified proteins (OMP) – by carbonyl groups) were studied. Results and discussion. Syndrome of endogenous intoxication was an increase in burn sepsis patients, which correlated with an increase in the number of LOP, OMP, MWM, namely an increase in the hydrophobic (most toxic) fraction of MWM, which is 2-3 times higher than in healthy, sick and both groups. MWM and hydrophobic fraction remained high during the observation period in patients of the comparison group. MWM decreased by 1.35 times in patients of the main group relative to the group of crystalloids. The level of carbonyl groups of serum OMP in patients of the comparison group was 50 % higher than in the main group. The indicators of LOP exceeded 1.45 times in the comparison group, which testified to the continuation of oxidative stress and the continuation of systemic inflammation. Acute respiratory distress syndrome (ARDS) was characterized by the appearance of bilateral infiltrates in the lungs, according to radiography. This common organ dysfunction was detected in 75 % of patients in the comparison group and in 63 % of patients in the RSL-group. The duration of mechanical ventilation in the main group decreased by 1,6 days. Conclusions. The use of Rheosorbylact for patients with burn sepsis at a dose of 15 ml/kg has led to a decrease in the manifestations of intoxication syndrome, reduction of MWM, LOP, OMP, clinical manifestations of systemic inflammatory response, septic complications by 1.3 times, septic shock from 16 to 12 %, and the incidence of ARDS from 75 to 63 %.

scholarly journals PURULENT SEPTIC COMPLICATIONS OF ACUTE PANCREATITIS AND THEIR PATHOGENETIC RELATIONSHIP WITH HELICOBACTER PYLORI

2021 ◽  
Vol 29 (5) ◽  
pp. 542-548
Author(s):  
I.V. Kolosovych ◽  
◽  
I.V. Hanol ◽  
Keyword(s):  
Acute Pancreatitis ◽  
Helicobacter Pylori ◽  
Antibiotic Therapy ◽  
Positive Result ◽  
Comparison Group ◽  
Main Group ◽  
Immunoglobulin M ◽  
Septic Complications ◽  
Bacteriological Study

Objective. To study of the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications. Мethods. The study was conducted in the period of 2015-2020; patients with acute pancreatitis (n=124) were divided into 2 groups: the main group (66 patients with moderate severity and severe course) and the comparison group (58 patients with a mild form). All patients underwent a screening study of Helicobacter pylori in feces and serological blood test to detect antibodies, namely immunoglobulin M to Helicobacter pylori (determination of the phase of the disease - acute or chronic). In 39 (31.5%) patients of the main group, a bacteriological study of biological and biopsyspecimensof antral mucous membrane were taken and examined histologically for organisms. The selection of antibiotics for treatment was carried out taking into account the infection of patients with Helicobacter pylori and was performed using the author’s method, the effectiveness of treatment was controlled microbiologically. Results. The positive result of the express test was in 66 (100%) patients of the main group and in 39 (67.2%) patients in the comparison group. During serological examination, a positive result was obtained: 24 hours after hospitalization - in 8 (13.8%) patients in the comparison group, in 23 (34.8%) patients in the main group; after 7 days - in 9 (15.5%) patients and 42 (63.3%) patients, respectively. Helicobacter pylori is sensitive to the majority of antibiotics used to treat purulent-septic complications of acute pancreatitis; after finishing the course of antibiotic therapy, eradication was achieved in 37 (94.9%) patients of the main group. Conclusion. Positive results of a serological study of Нelicobacter pylori after 7 days from the moment of hospitalization were more common in patients of the main group (63.3%) in relation to the comparison group (15.5%) (χ<sup>2</sup>=28.9, p<0.001), which gives grounds to consider bacteria, as one of the markers of the development of purulent-septic complications of acute pancreatitis. What this paper adds The role of Helicobacter pylori (HP) in the pathogenesis of acute pancreatitis has been studied for the first time and its value as a marker for septic complications development of acute pancreatitis is shown. It allowed optimizing the etiotropic antibiotic therapy for this disease.

scholarly journals Combined prevention of fetal growth restriction based on determination of diagnostic markers

2021 ◽  
pp. 9-15
Author(s):  
Vladimir Golyanovskyi
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Preventive Measures ◽  
Comparison Group ◽  
Fetal Distress ◽  
Main Group ◽  
Growth Restriction ◽  
Control Group ◽  
High Risk Women ◽  
Micro Elements

Due to the morbidity of mothers and newborns caused by fetal growth restriction (FGR) and preeclampsia, preventive measures should be taken, especially in women at high risk of developing these conditions. Many studies have been conducted on the prevention of FGR and preeclampsia in high-risk women, especially anticoagulants, aspirin, paravastatin, nitric oxide, microelements (L-arginine, folic acid, vitamins E and C, phytonutrients, vitamin D) and calcium. The aim is to improve perinatal consequences by preventing FGR in high-risk women. Materials and methods: A prospective study of 137 pregnant women in the period of 110–136 weeks was conducted at the Perinatal Center in Kyiv. Pregnant women were divided into 3 groups. The main group included 47 women at high risk of FGR who received therapy (low doses of aspirin, low molecular weight heparin (LMWH) and vitamin and micro elements drugs). The comparison group included 45 women who had a high risk of FGR but did not receive treatment. The control group consisted of 45 women who were not at risk of FGR. The frequency of FGR and placental dysfunction were analyzed as well as a fetal distress was analyzed ante- and intranatally. Results: Therapy with low doses of aspirin, LMWH and a complex preparation of vitamins and micro elements improves the course of pregnancy and gestational complications. In the main group FGR was detected in 8.5 %, in the comparison group – in 17.8 %, in the control group – 4.4 %. Placental dysfunction was detected in 13.3 % in the control group, and only 6.4 % in the main group that was close to the control group – 2.2 %. Similar tendencies were found for fetal distress ante- and intranatally. Conclusions: The proposed prophylactic measures can improve maternal outcomes by reducing the level of gestational complications in pregnant women with biochemical signs of risk of FGR development. In addition, these preventive measures can reduce the frequency of children births with growth restriction, which significantly reduces early neonatal and perinatal morbidity and mortality.

scholarly journals Prophylaxis of рurulent-septic diseases of postpartum period for high-risk puerperas

2020 ◽  
pp. 164-169
Author(s):  
A. E. Mitichkin ◽  
Yu. E. Dobrokhotova ◽  
N. Yu. Ivannikov ◽  
V. I. Dimitrova ◽  
O. A. Slyusareva ◽  
...  
Keyword(s):  
High Risk ◽  
Postpartum Period ◽  
Genital Tract ◽  
Inflammatory Diseases ◽  
Disease Incidence ◽  
Control Group ◽  
Septic Complications ◽  
Study Results ◽  
Group 2 ◽  
Standard Hygiene

Background. Postpartum purulent-septic diseases are one of the topical issues of modern obstetrics due to high prevalence and absence of downward trend toward reduction in the disease incidence.Objective: improve the management of high risk puerperas to prevent the development of purulent-septic complications in the postpartum period.Materials and methods. The cohort prospective comparative study included 78 puerperas, who experienced spontaneous labour complicated by injuries to birth canals. The patients were divided into two groups according to the risk of developing purulentseptic complications and the management of patients. Group 1, control group, (n = 20) included the puerperas, who did not show any signs of inflammatory diseases of the genital tract during pregnancy. Group 2 included patients, who were diagnosed with various forms of vaginal dysbiosis based on the results of bacterioscopic and bacteriological examination of the genital tract. The group was further divided into two subgroups depending on the type of treatment. Subgroup 1 of Group 2 (n = 28) only received standard hygiene care, and subgroup 2 (n = 30) received standard hygiene procedures combined with vaginal irrigation using benzidamine hydrochloride solution (Tantum Rosa) for 3 days in the obstetric hospital.Results. The study resulted in improving postpartum care of high-risk puerperas to prevent purulent-septic complications. Discussion The test results showed that the use of benzidamine hydrochloride (Tantum Rosa) in the postpartum period prevents the purulent-septic complications of puerperium, such as inflammation and disruption of perineal muscle sutures and endometritis, as well as relieves pain and discomfort, and improves the puerperas’ quality of life.Conclusion: Based on the study results, we recommend the use of this drug in the early postpartum period to prevent purulentseptic complications in the high-risk groups.

scholarly journals OF PHOTOPHERESIS IN KIDNEY TRANSPLANTATION

2018 ◽  
Vol 20 (1) ◽  
pp. 55-65 ◽  
Author(s):  
A. P. Faenko ◽  
A. B. Zulkarnayev ◽  
Ju. Ju. Chuksina ◽  
V. A. Fedulkina ◽  
R. O. Kantaria ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Immunosuppressive Therapy ◽  
Postoperative Period ◽  
T Regulatory Cells ◽  
Comparison Group ◽  
Graft Loss ◽  
Infectious Complications ◽  
Main Group ◽  
Late Postoperative Period

Aim– to perform a comparative study of the long-term results of the combined use of extracorporeal photochemotherapy (photopheresis) and drug immunosuppression and standard immunosuppressive therapy in patients after kidney transplantation.Materials and methods. An open cohort randomized study was conducted, including 60 patients with chronic kidney disease stage 5D. All patients underwent single-group cadaveric kidney transplantation. Patients were randomly divided into two groups. All transplants were paired, the fi rst kidney transplant was received by the patient of the main group, the second – by comparison group. 30 patients of the main group received standard protocol of immunosuppression and 10–15 sessions of photopheresis during the fi rst six months after transplantation. All patients of the comparison group received standard immunosuppressive therapy only. End points: primary – graft loss, surrogate – the number of acute rejection episodes and infectious complications, the dynamics of creatinine blood concentration, the glomerular fi ltration rate and daily proteinuria, the dynamics of tacrolimus C0 blood concentration. To study the mechanism of photopheresis action in the late postoperative period, we evaluated the immunological parameters: subpopulation of naive T-cells (CD3+CD4+CD45RO–CD28+), the level of CD28 molecule expression (MFI) on these cells and also – subpopulation of T-regulatory cells (CD3+CD4+CD25 (Hi)CD127–).Results.The use of photopheresis leads to the graft function improvement in the late postoperative period: the creatinine concentration (p = 0.017) in the blood and daily proteinuria (p = 0.011) were lower in patients of the main group, the glomerular fi ltration rate was higher (p = 0.027). The incidence rate ratio (IRR) of rejection in the main group was signifi cantly lower than in the comparison group: 0.2509 (95% CI 0.05386, 0.9167), p = 0.0358. The risk of graft loss was also lower in the main group: IRR 0.2782 (95% CI 0.07562, 0.8657), p = 0.026, as well as the risk of infectious complications: IRR 0.3888 (95% CI 0.2754; 0, 5445), p < 0.0001. Survival rate of transplants was higher in the main group (Log Rank p = 0.009; Breslow p = 0.005). The use of photopheresis made it possible to reduce the concentration of tacrolimus in the late postoperative period (p = 0.0017) without increasing the risk of graft rejection. The photopheresis tolerogenic effect in the late postoperative period may be due to an increase in the population of T-regulatory cells with the CD3+CD4+CD25(Hi)+CD127– phenotype compared to the patients which received only standard immunosuppressive therapy (p = 0.024).Conclusion.The preventive use of photopheresis contributes to improvement of the kidney transplantation long-term outcomes. Further studies are needed to study the mechanisms of photopheresis action and markers of partial immunological tolerance to the allograft.

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