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

Clinical, laboratory and radiological associations with extending of the intensive phase of treatment in patients with first diagnosed infiltrative pulmonary tuberculosis

Despite the availability of medical services, timely detection of pulmonary tuberculosis, before the appearance of destructive changes, is often difficult. The management of patients with an infiltrative form in a hospital setting does not always guarantee the same positive effect and sometimes requires prolongation of therapy. The effectiveness of therapy can be associated with various factors and is of interest to study. The aim of this work was to study the effectiveness of standard therapy in patients with first diagnosed infiltrative pulmonary tuberculosis, clinical laboratory and radiological associations with prolongation of the intensive phase of treatment. Materials and methods. The study involved 109 men from 18 to 53 years old with first diagnosed infiltrative pulmonary tuberculosis with preserved MBT sensitivity to 1-st line anti-tuberculosis drugs. Patients were examined before and after 60 doses of the intensive phase of treatment, after which two groups were formed. Group 1 included patients with pronounced positive clinical and radiological dynamics, who entered the continuation phase of therapy. Group 2 included patients with insufficient clinical and radiological dynamics, for whom the intensive phase of treatment was extended to 90 doses. Results. Weak dynamics in patients who needed prolongation of treatment was associated with the characteristics of the initial data of patients in this group compared with similar indicators in Group 1. These were a reliably higher frequency of symptoms of intoxication and coughing, a reliably greater number of patients excreting mycobacterium tuberculosis in large quantities in sputum, with reliably high blood concentrations of haptoglobin and ceruloplasmin levels. Conclusions. Patients requiring prolongation of the intensive phase of treatment are characterized by an initially higher prevalence of infiltrative changes in the lungs, a small number of lung lesions limited to 2 segments, the presence of destructive changes in 100 % of cases, and a significant increase in the factors of the systemic inflammatory response

The relation of atherosclerotic lesions of BCA against the background of COPD in patients aged 40-60 years. Review of the literature and retrospective analysis

The aim: to determine the possible relationship between chronic obstructive pulmonary disease and the presence of atherosclerosis of the brachiocephalic vessels in persons aged 40–60 years for the possibility of early prevention of cardiovascular events. Materials and methods: to do this, we reviewed articles using open sources such as PubMED, Medscape and Cochrane library, highlighting the relationship between the development of atherosclerosis and the presence and severity of COPD. Also, based on the University Clinic of ONMedU and Military Clinical Center of the Southern Region, a retrospective analysis of patients with an inconclusively confirmed diagnosis of COPD and conducted biochemical blood tests was carried out in order to study changes in the lipid profile and the presence of BCS in these patients. Result: In the course of a retrospective analysis of patients, a relationship was found between the presence of BCA atherosclerosis and the presence of COPD, and based on the literature data, a parallel was drawn between changes in the lipid profile in patients with COPD. But, in view of the insufficient number of patients, this topic requires additional research. Conclusions: thus, based on the obtained data, it can be concluded that there is a connection between the presence of COPD, changes in the lipid profile, and the presence of BCА atherosclerosis. This connection can become one of the key mechanisms of early diagnosis of BCА atherosclerosis

Influence of complex treatment on the functional state of the hepatobiliary system in patients with diabetes mellitus

Liver damage in diabetes mellitus is of particular interest, since this factor significantly affects the course of the disease, the level of compensation and prognosis of the underlying disease. The aim. To study the effect of complex treatment using ursosan on the functional state of the hepatobiliary system in patients with diabetes mellitus. Materials and methods. The study included 30 patients with type 1 diabetes mellitus and 48 patients with type 2 diabetes. According to the duration of diabetes, patients were divided into three subgroups: a) up to five years; b) 5–10 years; c) more than 10 years. The number of patients was: 1a group – 13, 1b group – 10, 1c group – 7 people; Group 2a – 23, 2b group – 13, 2c group – 10 people. The control group consisted of 23 apparently healthy people. Ursosan was prescribed at a dose of 10-12 mg per 1 kg of body per day for 6 months. Clinical laboratory and instrumental research methods were used to study the functional state of the liver and gallbladder. Research results. After the course of treatment with Ursosan, patients with diabetes mellitus showed normalization of protein, pigment, enzymatic metabolism and, to a lesser extent, lipid metabolism in the liver, which led to an improvement in cellular metabolism and redox processes, providing a stable course of diabetes. Conclusions. A 6-month course of treatment with Ursosan in diabetic patients promotes long-term diabetes compensation. Patients during treatment have a decrease in cytolysis syndrome indicators (alanine aminotransferase (AlAT), aspartate aminotransferase (AsAT), lactate dehydrogenesis (LDH)) by about 1.5 times in all 3 indicators compared to the indicators before treatment. The same trend was observed in terms of gamma-glutamine transferase (GGT) and alkaline phosphatase (ALP)

Kidney`s functional state assessment when using different regimens of intraoperative fluid therapy

The aim of the research. To study the kidneys functional state when using different regimens of intraoperative fluid therapy in high cardiac risk patients during abdominal surgery. Materials and methods. 142 patients who underwent abdominal surgical interventions mainly for oncoproctological diseases of the gastrointestinal tract, aged over 50 years old and with a history of stable coronary heart disease were divided into four groups depending on the way of intraoperative fluid therapy, which was performed according to two regimens: restrictive (R) and liberal (L). R1 (n=36) with rate of intraoperative fluid therapy 3–5 ml/ kg/ h, R2 (n=35) patients received 5–8 ml/kg/h during surgery, L1 (n=35) with intraoperative fluid rate of 8–11 ml/kg/h and L2 (n=36) – more than 11 ml/kg/h intraoperatively. The study of the functional state of the kidneys included the determination of such indicators as urea, creatinine, diuresis, the degree of AKI according to KDIGO in two stages of the study – before surgery and 18–24 hours after. Results. The greatest tendency to develop acute kidney injury was observed in R1 subgroup with a restrictive intraoperative fluid therapy regimen, and the smallest in L1 subgroup with a relatively liberal regimen. The R2 and L2 subgroups took an intermediate place in the number of renal complications. A high tendency to develop renal dysfunction in patients of R1 subgroup was associated with circulatory hypokinesia and a moderate decrease of renal perfusion. Conclusions. The study found that restriction of infusion in R1 subgroup contributed to the development of renal dysfunction in almost half of the patients. First of all it was associated with a decrease of GFR in conditions of circulatory hypokinesia, which is larger in R1 subgroup and amounted to about 35 %. The safest regimens of intraoperative fluid therapy in relation to renal function in the perioperative period were relatively liberal (subgroup L1) and relatively restrictive (subgroup R2), which provided the least number of complications in patients

Epidemiology and trend of rabies post exposure prophylaxis at anti rabies clinic of a tertiary care hospital in India

Background and Objectives Effective prevention of rabies is possible by vaccination following a rabid animal bite. Objectives of this study was to describe demographics, circumstances of bite and the trend of vaccination over last three years (January 2019-November 2021) in an anti-rabies clinic of a tertiary care hospital. Materials and Methods This was an observational study of prospective design. All animal bite victims who attended the anti rabies clinic (ARC) of the study institution during the study period were invited to participate in the study. Data was collected using a structured schedule on first visit and at 28th day to check for on time compliance to vaccination schedule. On time completion was defined as taking all vaccine doses on due dates. Distribution of variables was shown by frequencies and percentages. Indicators were recorded for three consecutive years. Year wise indicators were compared by chi-square test. Results Data was collected for 293 victims. Median age of bite victims was 41.8 years (range 3-78 years) while 58.7 % respondents were below 45 years of age; 71.3 % victims were male. 82.3 % bites were by dogs; 38 % victims had multiple bites. Post-exposure prophylaxis (PEP) with anti-rabies vaccine (ARV) was initiated within 72 hours for 80 % victims and it was completed on time for 66.2 % victims. Three years trend for PEP indicators did not show a statistically significant difference. Conclusion On time PEP schedule completion was fairly high at the studied ARC. Health seeking for PEP following animal bite was not affected by the corona virus pandemic

Profile of abortion seekers in the tertiary center of northern hills with review of medical termination of pregnancy act in India

The aim of the present study was to investigate the socio-demographic and obstetric profile of pregnant women, seeking medical termination of pregnancy in accordance with the Medical Termination of Pregnancy (MTP) Act and the reasons for undergoing termination of pregnancy in the tertiary care center of the hilly region of Northern India and to further review the amendments in the Medical Termination of Pregnancy Act 1971 along with its future implications in legalizing abortions in India. Materials and Methods: A registry-based retrospective study was carried out among pregnant women, attending the gynecologic outpatient department for termination of pregnancy at the tertiary care teaching hospital and the referral center for Himalayan foothills in Northern India. The records of women, seeking termination of pregnancy during a 1-year period between October 2020 and September 2021, were reviewed and information on their demographic and obstetric profile, reason for undergoing termination of pregnancy, and acceptance of contraception, following termination of pregnancy was recorded in the data sheet. The information obtained was analyzed using SPSS version 20 (IBM, Chicago, USA) for descriptive statistics. Results: A total of 400 pregnant women underwent Medical Termination of Pregnancy between October 2020 and September 2021. 30.5 % (122/400) women between 26–30 years of age underwent termination of pregnancy, followed by 27.3 % women aged between 31–35 years. Social reasons for termination of pregnancy were more evident in women aged 26 years and above. 84.09 % pregnancies were terminated in the second trimester (>12 weeks) on eugenic ground, while 65.01 % pregnancies were terminated in the first trimester (6–12 weeks) on social grounds. Only 7.75 % (31/400) women opted for sterilization or family planning after MTP, out of which the majority opted for temporary methods of contraception. Conclusion: We conclude from the results of the present study that women in the peak reproductive age (26–30 years) are more likely to seek pregnancy termination and this group of women needs to be the focus of contraceptive counseling and family planning services. Timely ultrasound scans by an expert sonologist may be a step forward towards lowering the rates of late pregnancy termination. There is a need to educate women to avail and use contraceptive methods in an effective manner and to make them aware of utilizing sterilization services, once they complete their families to avoid unwanted pregnancies.

Impact of ranolazine on exercise tolerance and arrhythmias in patients with INOCA

The aim of the study to evaluate the effect of supplementation of basic therapy by ranolazine in patients with INOCA on exercise test parameters and Holter ECG monitoring. Materials and methods. 53 patients with stable coronary heart disease were examined, including 18 men (33.9 %) and 35 (66 %) women, the average age of patients was 57 (±9.68) years. According to the results of coronary angiography all patients had non-obstructive coronary arteries. In addition to physical and laboratory examination, bicycle ergometry, Holter ECG monitoring and echocardiography were included in the examination of patients. Patients were divided into 2 groups: group I - patients who in addition to standard therapy received ranolazine at a dose of 1000 mg twice a day for 6 months, and group II patients with standard coronary heart disease therapy. After 6 months from the beginning of the observation an objective examination, echocardiography, exercise test, Holter ECG monitoring were repeated. Results. The study found that patients receiving ranolazine in addition to standard therapy had a statistically significant increase in exercise duration after 6 months compared with baseline and group II. Before treatment in group I, the duration of the exercise test was 356.51±180.24s, and after treatment 414.32±142.10s (p=0.03). In group II, the duration of the test before treatment was 361.4±160.24 c, and after 380.5±152.2 s (p=0.15). It was also found that the duration of the test differed significantly in group I after treatment of patients from group II after treatment of patients with a standard treatment regimen (p=0.04). According to the results of Holter ECG monitoring in group I found a positive effect of ranolazine on the frequency of ventricular arrhythmias: before treatment n=1142 [30; 2012], after treatment n=729 [23; 1420], while in group II a significant difference between the number of extrasystoles before treatment and after not detected (n=1026 [17; 1920], n=985 [15; 1680], respectively) p=0.18. Conclusions. The addition of ranolazine to the basic therapy of patients with non-obstructive coronary arteries disease helps to increase exercise tolerance (according to the loading stress test) and contributes to a significant reduction in the number of ventricular arrhythmias (according to Holter-ECG) compared with both baseline and group II

Use of different options of anti-inflammatory therapy in patients with severe COVID-19

The aim of the study. To compare the effectiveness of methylprednisolone, dexamethasone and tocilizumab in patients with severe coronavirus disease. Identify the most appropriate treatment option. Materials and methods. Patients of group 1 (n=20) received for anti-inflammatory purposes tocilizumab at a dose of 600–800 mg. Patients in group 2 (n=82) received pulse therapy with methylprednisolone. Patients in group 3 (n=20) received dexamethasone 6 mg / day. Data are presented as M [25–75]. Statistical analysis of the results was performed using the program "Statistica 10". Significance of differences in indicators was assessed using the nonparametric Wilcoxon test. The results were considered reliable at values of p <0.05. Results. The severe course of coronavirus disease with the development of cytokine storm and respiratory distress syndrome is characterized by an increase in markers of inflammation: in group 1 the median CRP was 89.2 g / l, in group 2 – 64.2 g / l, and in 3 – 76.2 g / l, and did not differ significantly between groups (p> 0.05). The level of IL-6 in group 1 was 61.8 pg / ml, in group 2 – 64.6 pg / ml, and in group 3 – 46.5 pg / ml without significant differences between groups (p> 0.05). The level of ferritin in all groups exceeded normal values. Conclusions The most favourable result was obtained when using methylprednisolone: it was possible to reduce the mortality rate to 59.8 %. The relative risk of developing VTE was significantly higher in groups 1 and 3 (RR12 6.8 [2.7–16.8] p12 <0.0001, RR23 0.15 [0.06–0.35] p23 <0.0001), which gives grounds to confirm the presence of anticoagulant activity in methylprednisolone

A descriptive study of COVID-19 at a tertiary care hospital

Coronavirus disease 2019 (abbreviated “COVID-19”) is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The cases of COVID-19 infection since then were showing increasing trend in all over the world. The aim: to study the epidemiological distribution and determinants of COVID-19 pandemic. Methods: it is a descriptive study carried out at a tertiary care hospital of India. The population comprised of patients admitted in the hospital. Sample size comprised of all the subjects admitted in the hospital with established COVID 19 +ve cases. The duration of study was April 2020 to June 2020. The study was approved by the Institutional Ethical committee and Informed consent was obtained from each subject before the conduct of the study. Data collection was done by a pre-structured questionnaire. Data entry and analysis was done using SPSS version 20 software. Results: out of total 38 COVID-19 +ve cases, 95 % were male and 5 % female ant the maximum numbers of cases ranges between 36–40 years of age group with the median age of 32 years.53 % of cases were Muslim and 47 % Hindu by religion. The median duration of stay in hospital of all COVID-19 +ve cases was11 day that on further differentiation with co-morbidity was 15 days and 11.5 without any co-morbidity. The median duration taken between 1st sample taken and report provided was 2 days, between 2nd sample taken and report provided 1 day and between 1st and 2nd sample taken was 11 days. Conclusions: present study concluded that middle age persons were affected in majority which may be due to more exposure to public places. Co-morbidities are strong predictors of requirement for admission and duration of stay at hospital