Transpiloric feeding in gastroesophageal reflux in neonatology

Optimizing nutritional support is essential for critically ill children, and premature infants are particularly vulnerable to the effects of prolonged fasting. There is a lot of evidence in the scientific literature for the benefits of enteral nutrition. It is known that premature babies need an individual approach to nutrition due to the prevalence of catabolic processes, while treatment in the intensive care unit requires a surplus of calories. Timely introduction of enteral nutrition helps to reduce morbidity and mortality in this population. Gastroesophageal reflux is common in preterm infants. When there is a decrease in tolerance to enteral feeding, doctors usually prefer parenteral nutrition. However, its use can be associated with metabolic, infectious and iatrogenic complications. A step-by-step therapeutic approach is recommended in the treatment of GER in preterm infants. Conservative treatment should be considered as first-line therapy in children without clinical complications. Feeding through a gastric tube is not always well tolerated by seriously ill people patients. As for the treatment of complicated GER, extensive studies show that the use of transpiloric feeding is comparable in effectiveness to fundoplication. Transpiloric feeding tube can be justified as a strategy for treating GER that is refractory to conservative therapy.

Peculiarities of surgical treatment of cervico-mediastinal goiter

Objective. To analyze a surgical tactics and a component of operative interventions, performed for goiter of cervico-mediastinal localization; to formulate the operative technique peculiarities, which give positive effect. Materials and methods. Into the investigation the materials of clinical work in 2005 - 2019 yrs were incorporated of Department of Surgery No 2 of the Second Municipal Clinical Hospital of Poltava City, which constitutes a base of the Department of Surgery No 1 of Ukrainian Medical Stomatological Academy. There were analyzed the results of surgical treatment of 530 patients, suffering various forms of goiter. Results. Basing on data of complex clinic-instrumental and cytological investigations several tactically different operative interventions were performed, the content of which was directly dependent on anatomic peculiarities present. In 155 patients a cervico-mediastinal goiter was present. Conclusion. In big mediastinal goiter a severe operative situation occurs, necessitating nonstandard surgical decisions making. That is why the neck surgical access of the authors own in accordance to Kocher method was proposed. Extrafascial procedures may prevent some iatrogenic complications.

Features of inflammatory rheumatic diseases treatment in older people

Currently the number of older people with chronic rheumatic diseases is increasing. Distinctive features of this population are the increased risk of cardiovascular and infectious diseases, tumours, as well as iatrogenic complications, while this group of patients is rather heterogeneous. On the one hand, modern biological and targeted synthetic drugs, provide new, previously inaccessible, treatment options; on the other hand, their use is associated with risk of side effects. In this review specifics of prescribing immunosuppressive drugs in older patients with rheumatoid arthritis and spondyloarthritis has been analyzed. An effective and safe approach to the use of these drugs in older people can be based on a comprehensive interdisciplinary approach, taking into account geriatric characteristics of the patients.

Prediction of nerve damage by comparing periapical radiographic signs of impacted mandibular third molars in close proximity to inferior alveolar nerve with their true tomographic relationship – An observational study

The purpose of the study was to correlate the accuracy of Roods and Shehab signs in an intraoral periapical radiograph (IOPAR) with Cone-beam computed tomography (CBCT) findings to indicate Cone-beam computed tomography only in high-risk conditions.70 impacted mandibular third molar teeth in 58 patients above 18 years with intraoral periapical radiographs presenting with one or more root and canal signs of Rood and Shehab criteria were included in the study. Winter's classification was recorded, and the patients were exposed to a Cone-beam computed tomographic scan. True canal – tooth relationship was assessed in the sectional images. Pearson Chi-square test was used to correlate periapical radiograph and tomographic findings, and an unpaired t-test was applied for descriptive analysis.Rood and Shehab canal criteria in the periapical radiographs were significantly correlated to direct contact of an impacted lower third molar with the canal (p< 0.05) and loss of cortication of Mandibular canal (p< 0.05) on the cone-beam computed tomography. Cone-beam computed tomography is recommended to assess the periapical radiographs with canal risk markers pre-operatively to help avoid iatrogenic complications.

Retrospective medico-social analisys of the results of treatment patients with the concequences of long bone fractures

The problem of long bones fractures treatment remains actual, despite a significant number of studies carried out on this topic. Such fractures of the musculoskeletal system occur more often and are accompanied by various complications, significantly compromise the quality of patients life and often lead to the disability. Objective. To analyze different types of traumatic injuries in patients with the consequences of long bone fractures, to evaluate the effectiveness of diagnostics, treatment and to analyze the state of disability. Methods. A retrospective medical and social analysis of the results of treatment of 333 patients (232 (69.6 %) men, 101 (30.4 %) women) with the consequences of long bone fractures, based on the obtained study group in the Kharkiv Regional Center for Medical and Social Expertise № 2, for the period 2018–2019. Results. Three main methods of surgical treatment were analyzed: internal fixation (ORIF), blocking intramedullary nailing (IMN) and treatment with external fixation devices (EF). They were applied in the following rate: ORIF — 204 (61.3 %) cases, IMN — 98 (29.4 %), EF — 31 (9.3 %). The most typical complications of the treatment of patients with fractures of the long bones were delayed union or nonunion, neuropathies of the treated extrimities, joint contractures, osteoarthritis of adjacent joints, deformities of affected extrimities, osteomyelitis. Causes of disability were: 63 % — severity of injuries, 46 % — different posttraumatic complications, 6.5 % — iatrogenic complications. Among the latter, the most common were: diagnostic — 7.1 %, incorrect method of treatment — 29.7 %, iatrogenic incorrect surgery methods — 45 %. Conclusions. The data obtained showed that the improvement of organization measures for the prevention of complications and disability in patients with consequences of long bones fractures could help to increase the efficiency and quality of specialized medical help. Key words. Fractures, long bones, limbs, consequences, complications, disability.

Prerequisites to Use Preservative-Free Drugs in Medication Therapy of Glaucoma

Purpose — to analyze the literature data on the benefits of preservative-free medication therapy for glaucoma.Materials and methods. 482 articles in the Pubmed database published from 1975 to 2020 were analyzed using the terms: “glaucoma”, “preservatives”, “preservative-free therapy”, “benzalkonium chloride”. The review includes 78 articles. Inclusion criteria: studies that examined the effect of local antihypertensive therapy on the condition of the ocular surface in comparison with preservative-free drugs.Discussion. BAC is the most common preservative used in ophthalmology, accounting for 70 % of eye drop formulations. But it has a pronounced toxic effect on the ocular surface, so other classes of preservatives have been developed. These include polyquaternium-1 detergent; oxidizing preservatives — stabilized oxychlorocomplex and sodium perborate; ionic buffer preservative. However, most of the publications are devoted to BAC, as it is considered the most toxic and, at the same time, the most commonly used preservative. There is a large number of switching studies from preservative therapy to preservative-free, in which almost all groups of drugs used for the treatment of glaucoma were studied, but the use of antihypertensive drugs is associated not only with the action of preservatives, but also with the active substance, excipients and buffers. However, most switching studies demonstrate the benefits of preservative-free drugs. Other studies compared preservative and preservative-free drugs with the same active ingredients, in which a comparable hypotensive effect and safety profile was revealed, which indicates that BAC is not required for adequate penetration of the active substance to the point of application. At the same time, statistically significant advantages in the tolerability of preservativefree therapy were also revealed.Conclusion. Glaucoma preservative therapy has a toxic effect on the ocular surface, which leads to a decrease in the quality of life and compliance. Switching to preservative-free drugs can help reduce iatrogenic complications during long-term treatment of patients with glaucoma

Features of the retinal structual and functional state under cardiopylmonary bypass during cardiac surgery

Introduction. Cardiac surgeries using cardiopylmonary bypass (CB) have been successfully performed for more than 60 years, but at present it is necessary to further study the changes in tissue hemodynamics during interventions to minimize possible iatrogenic complications. One of these tissues available for direct observation of the vessels of the microvasculature is the retina. Aim – to study the structural and functional state of the retina in patients who underwent cardiac surgery with the use of CB, and to identify potential factors that negatively affect the retinal blood flow. Materials and methods. The clinical study involved 10 patients (20 eyes). All patients before cardiac surgery using CB and 10–14 days after it underwent visometry, perimetry, non-contact tonometry, biomicroscopy, reverse binocular ophthalmoscopy, fundus photography, optical coherence tomography of the retina of the macular region and optic nerve head with determination of the thickness of the layer of ganglion cell and the layer of nerve fibers. To carry out CB, pharmaco-cold cardioplegia was performed with the Custodiol solution using unified surgical and anesthetic tactics. CB was performed on a device with disposable membrane oxygenators (Strockert, Germany) under normothermic conditions, blood circulation was provided with non-pulsating blood flow with a volumetric flow rate of 2.4–2.8 L/min/m2 at an initial dose of heparin of 300 U/kg. Results. The studies revealed a correlation between changes in the histoarchitectonics of the retina and the level of mean arterial pressure (MAP). So, in 30 % of patients, the appearance of ischemic foci along the vascular arcades was found. In 10 % of patients, a decrease in the thickness of the ganglion layer and the layer of retinal nerve fibers was reported as a result of impaired blood circulation in the vessels supplying the optic nerve. Conclusion. Increase in MAP up to 90 mm Hg and above and fluctuations in its level of more than 20 mm Hg (p<0.05) during cardiac surgery under cardiopulmonary bypass in 67 % of cases is accompanied by transient disturbance of regional blood circulation at the level of vessels of the microvasculature of the retina with the appearance of ischemic foci in the retinal tissue. In this regard, it is necessary to carefully monitor the MAP parameters during the cardiopulmonary bypass to prevent circulatory disorders in various organs and tissues of the body.

A clinical study of dermatotses in neonates in Silchar medical college

According to WHO a neonate, is a child under 28 days of age. The neonatal skin changes show a wide geographic and ethnic variation. It is important to know the pattern of dermatoses prevalent among Indian children during the neonatal period. The current study was conducted to study the prevalence of neonatal dermatoses in southern Assam and to study relationship of neonatal dermatoses with maturity and birth weight of neonates.150 neonates who developed cutaneous lesions over a period of one year were examined. Proportion of each dermatoses and prevalence ratio were calculated using relevant formulae. Out of the 150 neonates, 66 % neonates had transient physiological changes, 11.33% had congenital disorders and genodermatoses, 4.67% had iatrogenic complications, 30% had acquired skin diseases, 8% had neonatal infections and 2% had other miscellaneous diseases. The five most common dermatoses overall were diaper dermatitis (17.33%), miliaria (14%), erythema toxicum neonatorum (13.33%), infantile seborrheic dermatitis (12.67%), sebaceous gland hyperplasia (6%) and Mongolian spot (6%). Low birth weight babies had predilection for vernix caseosa, sucking blisters, candidiasis, miniature puberty, caput succedaneum, cephalohematoma, physiological jaundice, infantile acropustulosis, salmon patch, Epstein’s pearls/ Bohn's nodules, miliaria, sebaceous gland hyperplasia, neonatal acne, Mongolian spot, bullous impetigo, erythroderma Preterm neonates had predilection for vernix caseosa, sucking blisters, miniature puberty, candidiasis, Mongolian spot, caput succedaneum, cephalohematoma, erythroderma, miliaria, Epstein’s pearls/ Bohn's nodules and a positive association was seen between post-term neonates and physiological desquamation, diaper dermatitis. Neonatal psoriasis and neonatal dermatophyte infection were the unusual findings which we found in our study.

Risk assessment of contrast-induced acute kidney injury in patients with acute myocardial infarction after coronary angiography and percutaneous coronary intervention

Aim. To assess the risk of contrast-induced acute renal injury (CI-AKI) in patients with acute myocardial infarction in a highly specialized hospital after coronary angiography.Material and methods. The study sample included 502 patients who were treated in the cardiology department of a specialized hospital. CI-AKI was established by an increase in creatinine >26 μmol/L within 48 hours after percutaneous coronary intervention (PCI) with radiopaque contrast agents or an increase in creatinine >50% within a week after PCI. A multistage statistical analysis was used to search for possible predictors of CI-AKI.Results. In total, CI-AKI was diagnosed in 57 (11,3%) patients. Based on the analysis performed, 3 significant predictors of CI-AKI were identified: patient’s age, contrast medium volume (ml/kg) and anemia (presence/absence). An equation for assessing the risk of CI-AKI in patients after PCI has been created.Conclusion. A simple scale for assessing the CI-AKI risk makes it possible to identify a category of patients who requires preventive measures to reduce iatrogenic complications and mortality.

Acute and Chronic Hyponatremia

Hyponatremia is the most common electrolyte disorder in clinical practice. Catastrophic complications can occur from severe acute hyponatremia and from inappropriate management of acute and chronic hyponatremia. It is essential to define the hypotonic state associated with hyponatremia in order to plan therapy. Understanding cerebral defense mechanisms to hyponatremia are key factors to its manifestations and classification and subsequently to its management. Hypotonic hyponatremia is differentiated on the basis of urine osmolality, urine electrolytes and volume status and its treatment is decided based on chronicity and the presence or absence of central nervous (CNS) symptoms. Proper knowledge of sodium and water homeostasis is essential in individualizing therapeutic plans and avoid iatrogenic complications while managing this disorder.