To the Question about the Methods Used in Combustiology Practice to Assess the Condition of Patients and Predict General and Local Complications

The aim. The article is devoted to the methods used in combustiology practice to assess the condition of patients and predict general and local complications. Results. With severe thermal trauma, there is a risk of developing life-threatening conditions in the victims, in particular, sepsis and multiple organ failure. Informative for assessing the course of burn disease is a modified scale of physiological disorders, which takes into account the syndrome of systemic inflammatory response, endogenous intoxication during periods of toxemia and septicotoxemia, and concomitant pathology. The development of intoxication in severe burn injuries requires determining the degree of severity of the process and its assessment in dynamics. The toxicity of blood plasma is studied by the resistance of red blood cell membranes in the acid hemolysis reaction, indicators of the red blood cell intoxication index, and the content of universal markers of intoxication, in particular, medium-weight molecules. Methods for biosensor indication of cytotoxic factors have also been developed. Assessment of the severity of the condition of victims with burns and monitoring the effectiveness of therapy is carried out taking into account the level of procalcitonin and presepsin. To determine the effect of the wound process on the formation of early sepsis in patients with burns in the capillary zone of thermal damage, the content of homocysteine, endothelin and nitric oxide is studied. To assess the severity of the condition of burn patients and predict the development of complications, the values of integral hematological indices are informative. Reliable data on the depth of a burn wound are obtained using thermotopometry and pH measurement of burn wounds, the method of magnetic resonance imaging. In order to assess violations and dynamics of blood supply restoration in the area of thermal damage, the method of laser Doppler flowmetry and optical tissue oximetry is used. Determination of interstitial pressure in burns of the extremities and intra-abdominal pressure in common burns is a way to predict the development of compartment syndrome. To monitor the patient's glycemic status, it is proposed to determine the level of glycosylated hemoglobin. Microbiological research data is used to predict the risk of developing general complications of burn disease, as well as – together with cytological data and methods for determining the maturity of granulation tissue – to assess the readiness of granulating wounds for autodermoplasty. Conclusion. The development of new effective ways to predict and prevent the development of complications in burns is promising

The effect of hyperoxia on the hemostasiological status of severely burned patients

The state of the hemostasis system was studied in 9 patients of the middle age group (44 ± 9.94 years) who received thermal trauma on an area of more than 32% (49.4 ± 18.3) of the body surface, accompanied by the development of burn shock. The standard therapy for burn injury was supplemented with HBO sessions. Treatment with hyperbaric oxygen was carried out in pressure chambers BLKS-307, BLKS-307/1. The state of the coagulation, anticoagulant and fibrinolytic links of the hemostasis system, as well as the viscoelastic properties of the blood, were assessed immediately before the HBO session and immediately after it. The total number of comparison pairs was 45. Under the influence of HBO therapy, there was an increase in the activity of antithrombin III (ATIII), protein C (PrS) and a decrease in the viscoelastic properties of blood (p <0.05). Positive deviations in the values of ATIII, Pr C, von Willebrand factor, APTT, prothrombin and thrombin time, fibrinogen, factor XIII, XIIa-dependent fibrinolysis, D-dimers and thromboelastography parameters were revealed. The maximum frequency of their occurrence was recorded for ATIII (95%), the minimum - for the D-dimer (62%). After HBO procedures, undesirable deviations of the hemostatic system parameters were also noted. They were chaotic, were compensated by an increase in the activity of physiological anticoagulants and were not accompanied by complications of a thrombogenic nature. Thus, conducting HBO therapy sessions in the acute period of burn disease increases the activity of physiological anticoagulants and stabilizes the viscoelastic properties of blood. There is a high frequency of occurrence of positive effects of hyperoxia on the components of the hemostasis system. The identification of its undesirable effects indicates the need to monitor the state of the hemostasis system during HBO procedures.

The Effect of Betulin Diphosphate in Wound Dressings of Bacterial Cellulose-ZnO NPs on Platelet Aggregation and the Activity of Oxidoreductases Regulated by NAD(P)+/NAD(P)H-Balance in Burns on Rats

The inhibition of platelet aggregation, and the activity of oxidoreductases and microhemocirculation in a burn wound on the treatment of burns with wound dressings based on bacterial nanocellulose (BC)-zinc oxide nanoparticles (ZnO NPs)-betulin diphosphate (BDP) were studied. The control of the treatment by BC-ZnO NPs-BDP on burned rats by the noninvasive DLF method showed an increase in perfusion and the respiratory component in wavelet spectra, characterizing an improvement in oxygen saturation in the wound. The study on the volunteers’ blood found the inhibition of ADP-induced platelet aggregation by 30–90%. Disaggregation depends on the dose under the action of the ionized form of BDP and ZnO NPs-BDP in a phosphate buffer; it was reversible and had two waves. It was shown on rats that the specific activity of LDHreverse and LDHdirect (control-intact animals) on day 21 of treatment increased by 11–38% and 23%, respectively. The LDHreverse/LDHdirect ratio increased at BC-ZnO NPs-BDP treatment, which characterizes efficient NAD+ regeneration. AlDH activity increased significantly in the first 10 days by 70–170%, reflecting the effectiveness of the enzyme and NAD+ in utilizing toxic aldehydes at this stage of burn disease. The activities of GR and G6PDH using NADP(H) were increased with BC-ZnO NPs-BDP treatment.

Measures of Risk for Sepsis and Mortality in Severe Burned Patients with Stress Induced Hyperglycemia.

Background; Hyperglycemia as a medical condition due to diabetes or other underlying conditions like Stress-Induced Hyperglycemia and sepsis as a life-threatening medical condition are two of the challenges faced during burn treatment. The purpose of this study was to evaluate the risk for sepsis and mortality for the patients with critical hyperglycemic values during the disease. Material and Methods; This is an observational retrospective cohort study conducted in the Service of Burns of the University Hospital Centre “Mother Teresa” in Tirana (UHCT), Albania from 1st January 2010 to 31st December 2014. Patients were categorized as having euglycemia (mean BG values ranging from 80-120 mg/dl), moderate hyper Sepsis was defined according to the ABA Consensus Panel Publication for Infection and Sepsis glycemia (mean BG values <180 mg/dl) or critical hyperglycemia (mean BG values ≥180 mg/dl). to evaluate the impact of the presence of critical hyperglycemia during the disease in sepsis and mortality, we performed Relative risk, Odds ratio Results; Those who had overall hyperglycemia (Moderate and Critical) had 2.6 times the risk for sepsis compared to those who were in the euglycemia group. Analyzing the risk of mortality in patients with overall hyperglycemia during the disease, we observed that the chance of a bad outcome was 2.7 times more likely to occur if the patient had hyperglycemia (RR=2.7). Conclusions: Glucose values on admission, as one of the derangement features of burn shock, are prognostic factors in critical hyperglycemia during burn disease and have a close relationship with other outcomes (sepsis and mortality).

COMPARATIVE CHARACTERISTICS OF CHANGES IN HEMO - AND LYMPHOMICROCIRCULATORY VESSELS OF ILEUM ACCUMULATED LYMPHOID NODES OF RATS IN THE CASE OF APPLICATION OF INFUSION SOLUTIONS IN EXPERIMENTAL BURN DISEASE

Relevance. Thermal burns of the skin cause the development of burns, the main factor of which is endogenous intoxication. The infusion of detoxification solutions is a mandatory component of the treatment of burns, as it corrects its course and prevents the development of certain stages and complications. According to the stage of the burn disease and the different direction of its links in its pathogenesis, infusion therapy should not only restore water-electrolyte balance and detoxify the body, but also contribute to the normalization and stabilization of vital (including immune) body functions. Objective: study of changes in the vessels of the hemo- and lymphomicrocirculatory system of Peyer's patches in burnt rats at the stages of burn disease, under conditions of intravenous infusion of isotonic sodium chloride solution and combined colloidal-hyperosmolar solutions (lactoprotein and sorbitolum). Materials and methods. The experiment was performed on 72 white rats. Experimental animals were divided into 4 groups (18 animals in each group). I, II, III - rats with skin burn trauma, which received a separate infusion of isotonic sodium chloride (I), lactoprotein with sorbitol (II) and hecoton (III), at a dose of 10 ml / kg. IV - intact animals (control group). Simulation of burn disease was performed by inflicting burn injury by applying to the lateral surfaces of the body of animals four copper plates, which were previously kept for 6 minutes in water with a constant temperature of 100 ° C. Histological and electron microscopic examination were performed. Light microscopy was used. Results. Intravenous administration of the applied infusion solutions caused various phase changes of the hemo- and lymphomicrocirculatory tract of Peyer's patches of the ileum of burnt rats, depending on the applied solution. In the case of infusion of burnt rats with 0.9% sodium chloride solution, the negative effects of burn disease were exacerbated, which were manifested by damage to the vascular wall of the hemo- and lymphocapillary channels, resulting in plasma and lymph seepage through the affected areas into the perivascular space. This process was accompanied by a violation of the rheological properties of blood, the formation of edema. The established "membrane-plastic effect" of lactoprotein with sorbitol revealed clear organ-specific features, which had manifestations of penetration through the damaged wall of microvascular electron-dense impregnations, which contributed to a significant thickening of the basement membrane in the wall of the blood capillary formation and its gradual formation of rounded membranous structure. This structure of variable electron density not only strengthened the vascular wall, but also served as a closure, helping to close the vascular lumen at the site of largest damage. The difference between the perinodal lymphatic capillaries in burnt rats infused with lactoprotein and sorbitol is characterized by the phenomenon of "overflow" of the lymphocapillary channel with cells in different functional states. In the case of infusion of hecoton solution, the effect of "overflow" of the lymphocapillary channel was not observed, which indicates adequate implementation of the immune function of immunocompetent cells. Conclusions. Intravenous infusion of colloid-hyperosmolar solutions causes various changes in the hemo- and lymphomicrocirculatory tract of Peyer's patches. Infusion of a 0.9% sodium chloride solution leads to a deepening of the negative consequences of burn disease, which manifests itself in the form of damage to the vascular wall of the hemo- and lymphocapillary channels. Infusion of solutions of lactoprotein with sorbitol and hecoton helps to preserve the vascular wall of the nodular lymphatic capillaries. When a solution of lactoprotein with sorbitol is applied around the damaged vessels of blood capillaries and venules, annular membrane formations are formed, which promote selective recirculation of structurally intact lymphocytes.

УЛЬТРАСТРУКТУРНІ ОСОБЛИВОСТІ НЕЙРО-ГЛІАЛЬНО-КАПІЛЯРНИХ ВІДНОСИН СА3 ПОЛЯ ГІПОКАМПА ЧЕРЕЗ 21 ДОБУ ЗА УМОВ ЕКСПЕРИМЕНТАЛЬНОЇ ТЕРМІЧНОЇ ТРАВМИ

Severe thermal injury leads to a number of morphofunctional changes that occur in violation of integrity or loss of skin in deep burns and endogenous intoxication on the background of which significant structural and metabolic disorders in all organs and systems of the affected organism are developed. This is manifested in a complicated symptom complex of burn disease. Changes in the central nervous system play an important role in the pathogenesis of burn injury, the nature and depth of morphofunctional changes in individual cerebral structures, in particular in the hippocampus (central organ of the limbic system, which is especially sensitive to various pathogens), after thermal lesions remain poorly studied. The aim of our study was to establish the features of submicroscopic changes in the structural components of the hippocampus after 21 days under conditions of experimental thermal injury. The experimental study was performed on white laboratory male rats. Third-degree burns were applied under thiopental-sodium anesthesia with copper plates heated in boiled water to a temperature of 97–100°C. The size of the affected area was 18–20% of the rats’ body epilated surface. Histological changes were studied on the 21st day from the beginning of the experiment. For electron microscopy, the obtained ultrathin sections were contrasted with uranyl acetate and lead citrate according to the Reynolds method. It was found that on the 21st day after the experimental thermal injury significant alternative changes in neurons, glial cells and the microcirculatory tract of the hippocampus were defined which developed on the background of excessive endogenous intoxication. Neurons are hypochromic and sharply hyperchromic, disorganized and have an altered shape; there are cell-free areas. Endoplasmic reticulum, Golgi complex, mitochondria are destructively changed. Degeneration of macroglial cells has been noticed. Their nuclei are high in electron density in which heterochromatin predominates. Destruction and lysis of organelles, lysosomes have also been found in the cytoplasm. These changes of astrocytic glia lead to impaired trophic function and the relation between astrocytes and blood capillaries. Hemocapillaries wall remodeling is manifested by the total edema, compaction of the basement membrane. The lumenal surface of the plasmolemma of endothelial cells is homogeneous, indistinctly contoured. The cytoplasm of endothelial cells is swollen, enlightened, and poor in organelles; there is a small number of micropinocytic bubbles and vesicles.

The features оf immunopathogenesis of sepsis and immunodiagnostics in severely burned patients

Intention. To study the possibility of predicting early burn sepsis based on the content of proinflammatory cytokines in the peripheral blood of patients with extensive burns.Methodology. The study included 60 patients (of them 37 men) aged 21 to 58 years (mean age 46.8 ± 9.3 years) with extensive skin burns (Degree III burns by ICD 10 from 20 to 60 %, average 34.1 %, of the body surface). Depending on the skin area affected and the course of burn disease, the patients were divided into three groups, each of 20 patients: group 1 - the course of burn disease without early sepsis, burn area from 21 to 40 % of the body surface; group 2 - the course of burn disease without early sepsis, burn area from 41 to 60 % of the body surface; group 3 - the early burn sepsis, burn area of 20 to 60 % of the body surface. To achieve the goal of the study, all the patients underwent sequential peripheral blood sampling 24 and 72 hours after a burn injury. The levels of IL-1β, IL-6, IL-10, and TNFa were analyzed in the obtained samples. Data were processed using Microsoft Office Excel 2007 and IBM SPSS 20.0 by methods of descriptive and non-parameter statisticsResults and Discussion. The analyzed indicators statistically significantly correlated with the severity of burn injury and the likelihood of burn sepsis. Decreased concentrations of IL-1β, IL-6 and TNFα within Days 1-3 after getting a burn suggest a relatively favorable course of burn disease. No significant positive dynamics of these laboratory parameters may indicate a high probability of developing early burn sepsis.Conclusion. Concentrations of IL-1β, IL-6 and, especially, TNFα in the peripheral blood make it possible to predict early burn sepsis.

OPTIMIZATION OF INTENSIVE THERAPY FOR BURN SHOCK

The literature provides about 100 different definitions of the concept of shock(G. Bernard, 2001). A large number of definitions of the concept are directly dependent on the reasons that caused it. Burn shock is the first stage of burn disease and develops when the surface of the body is affected by an area of 10-15% for superficial and 5-10% for deep burns.This article discusses the optimization of intensive therapy for burn shock.Keywords:pathogenesis, stages of burns, treatment principles, Evans formula, criteria for recovery from shock

THE EFFECT OF ENTEROSORPTION AND INTRATISSULAR ELECTROFORESIS OF ANTIBACTERIAL DRUGS ON PROGRESS OF BURN DISEASE

Summary. The purpose of the research was to explore the appropriateness of combined usage of enterosorption amplification and intratissular electrophoresis (ITE) of antibiotics in injured with the substantial thermal burns. Clinical effect of the enterosorbtion and ITE antibacterial drugs in burn disease cases was studied in 26 patients with superficial and deep dermal burns (IIb-III deg.) from 27 to 60 % of their body surface. Enterosgel was prescribed from 3rd day after injury for 15–20 g 3–4 times a day for 7–14 days. ITE of antibiotics conducted from the 3–4 day by the «Поток-1» device, applying the direct current with density 0,03-0,05 mAh/cm2 for 60 min. Materials and methods. The authors studied the leukocyte reaction by a general blood test. The degree of intoxication was determined by the level of molecules of average mass and blood plasma electrical conductivity. They evaluated the dynamics of the wound process, conducted bacteriological and cytological researches of the burn wounds in dynamics on 1–3, 6–7, 13–14, and 19-21 days after traumatization. Results and discussion. This treatment tactic allows to reduce the level of endogenous intoxication, to optimize the course of the wound process in the area of thermal damage, to intensify demarcation-cleansing processes and reparative regeneration, which increases the clinical effectiveness of treatment. Conclusions. As a result of the research, it was found that the combined usage of enterosorption detoxification by enterosgel and ITE of antibacterial drugs in the complex treatment of victims with widespread burns is appropriate and justified.