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O.A. Zhurylo, A.I. Barbova
Infusion & Chemotherapy pp 13-20; https://doi.org/10.32902/2663-0338-2022-3-13-20

Abstract:
BACKGROUND. To ensure timely and accurate detection of tuberculosis (TB), including TB with multiple drug resistance in Ukraine, the document “Health Standards for TB” (Order of the Ministry of Health of Ukraine № 2161 of 06.10.2021), which the basis of laboratory diagnosis of TB is the use of modern molecular genetic methods and tested in the Central Reference Laboratory of Ukraine for microbiological diagnosis of TB. RESULTS AND DISCUSSION. The article presents complex algorithms for the diagnosis and monitoring treatment of pulmonary TB using rapid molecular genetic methods. The basic principles and approaches to the diagnostic process, on which the domestic normative document is based, corresponds to those recommended by World Health Organization experts for the countries of the European region. When testing for TB, a molecular genetic test must be performed to detect the presence of Mycobacterium tuberculosis DNA in the diagnostic sample. Then (depending on the capabilities of the laboratory) one or another technology is used to detect mutations associated with the resistance of M. tuberculosis to the maximum possible range of AMBP I and II lines. After receiving the results of seeding in the automated system BACTEC MGIT, which is currently the gold standard for the study of drug sensitivity of M. tuberculosis to AMBP I and II lines, the treatment regimen is adjusted if necessary according to the phenotypic test of drug sensitivity. CONCLUSIONS. According to the latest international guidelines for the diagnosis of TB, preference should be given to molecular genetic diagnostic tests and culture studies in liquid nutrient media. Microscopic and cultural studies are important and remain necessary to monitor treatment.
K.Yu. Gashynova, K.S. Suska, V.V. Dmytrychenko
Infusion & Chemotherapy pp 21-28; https://doi.org/10.32902/2663-0338-2022-2-21-28

Abstract:
BACKGROUND. While the incidence of bronchiectasis is increasing every year, the treatment of this category of patients today is a real challenge for practical medicine, as the only existing guideline contain only low and medium quality data. OBJECTIVE. To determine the effectiveness of short-term differentiated inhalation therapy with salbutamol (Nebutamol®, “Yuria-Pharm”), hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) and decametoxinum (Decasan®, “Yuria-Pharm”) in patients with bronchiectasis, which was separated the for four different subgroups depending on the presence of sputum colonization by pathogens and airways obstruction. MATERIALS AND METHODS. 99 adult patients with confirmed clinically significant bronchiectasis in a stable condition were included in a single-center prospective study lasting 12 months. The number of exacerbations in the previous year and the year after treatment, subjective assessment of the severity of cough and sputum, amount of daily sputum, serum C-reactive protein level, microbiological examination of sputum, and spirometry were performed. RESULTS AND DISCUSSION. Short-term personalized inhalation therapy with bronchodilators, mucolytics and antiseptics in the subgroup of patients with airway obstruction and colonization reduced the severity of the main symptoms and reduced the total bacterial load by 45.9 %, and in the subgroup of patients with airway colonization without airway obstruction reduced the severity of cough and the total bacterial load in 76.2 % of cases. Prescribed therapy was effective in statistically significant reduction in the number of exacerbations by 43 %.
Yu.I. Feshchenko, , , S.M. Bilokon, O.V. Tereshkovych, B.м. Konik, L.I. Levanda, L.M. Zagaba, , M.I. Kalenychenko, V.I. Lysenko, S.м. Shalagay
Infusion & Chemotherapy pp 7-15; https://doi.org/10.32902/2663-0338-2022-1-7-15

Abstract:
MATERIALS AND METHODS. Preliminary clinical and morphological analysis of a group of patients with various post-COVID complications and with surgical treatment was performed. For the period 2020-2021 in the clinic of thoracic surgery of the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” 12 patients were treated who had coronavirus disease (COVID-19) in anamnesis and underwent surgery for COVID-19 complications. RESULTS AND DISCUSSION. Data on the type of surgery, X-ray conclusion and preliminary clinical diagnoses of patients with post-COVID pulmonary complications are presented. At the time of surgical treatment, according to clinical data, 4 (22.2 %) patients were diagnosed with lung abscess, 4 (22.2 %) patients had a disseminated process in the lungs of unclear origin, 2 (11.0 %) – a solitary formation of the lung, one (5.5 %, respectively) observation – spontaneous pneumothorax and suspected tumor of the lung. The results of the histopathological conclusion on the operative material and the final clinical diagnosis in the group of patients with atypical lung lesions after COVID-19 are presented. The results of histopathological examination showed that after 3 months and more after recovery from COVID-19 in some patients there are persistent pathological changes in lung tissue of various characters, and quantitatively among them prevail cases of various pathologies associated with damage to the vascular bed of the lungs. CONCLUSIONS. In most cases of pulmonary complications after suffering COVID-19, preliminary clinical diagnoses did not fully correspond to the identified pathological process. Morphological examination of the operative material of patients with a history of COVID-19 and postcocious complications associated with the lungs, found that vascular pulmonary pathology predominates: persistent microvasculitis of small blood vessels, pulmonary infarction, metacarpal metaplasia, secondary vascular malformation.
M.V. Bondar, M.M. Pylypenko, O.A. Loskutov
Infusion & Chemotherapy pp 32-39; https://doi.org/10.32902/2663-0338-2022-1-32-39

Abstract:
BACKGROUND. The world currently has a huge clinical experience in the treatment of SARS-CoV-2 infection. However, emerging scientific data opens up new information on the manifestations of coronavirus disease (COVID-19) and its consequences, which can affect both the changes of its clinical picture and the quality of patients’ life. OBJECTIVE. To summarize the results of literature search and own experience of intensive care of endothelial dysfunction in COVID-19. MATERIALS AND METHODS. The work is based on the results of an internet search with a help of Google and PubMed using the following key words: “intensive care of SARS-CoV-2”, “pathophysiological changes in coronavirus infection”, and “endothelial dysfunction”. RESULTS. This review describes the links of COVID-19 pathogenesis, mechanisms of viral endothelial damage and hypercoagulopathy, and the main directions of prevention and treatment of endothelial dysfunction. CONCLUSIONS. SARS-CoV-2 infection promotes endotheliitis in various organs as a result of viral infection. The presence of COVID-19-induced endotheliitis can explain the systemic microcirculation disorders in various vascular beds and their clinical consequences.
, K.O. Bielosludtseva, M.A. Krykhtina
Infusion & Chemotherapy pp 12-17; https://doi.org/10.32902/2663-0338-2021-3-12-17

Abstract:
BACKGROUND. Despite the significant progress in the diagnostic and treatment of community-acquired pneumonia (CAP), the issues of timely defining thrombotic complications of CAP and their timely treatment have not yet been fully resolved. OBJECTIVE. To determine the prognostic signs of the risk of thrombotic complications in patients with CAP. MATERIALS AND METHODS. Thus, 45 patients with CAP of the 3rd and 4th clinical groups were examined. The result of the cluster analysis was the distribution of patients into certain clusters (classes). There were 3 clusters of patients depending on the predisposition to thrombosis. RESULTS AND DISCUSSION. Patients belonging to cluster 2 and cluster 3 had a high risk of thrombosis. A feature of these patients was a severe course of CAP (by SMRT-CO scale), accompanied by significant leukocytosis or leukopenia in combination with severe systemic inflammation (C-reactive protein) and low protein C. CONCLUSIONS. This category of patients should consider the possibility of prescribing anticoagulant therapy. While in patients with mild CAP, less pronounced systemic inflammation and high levels of protein C, the risk of thrombosis will be low. Therefore, this category of patients will not require the appointment of anticoagulants.
V.M. Melnyk, V.G. Matusevych, O.P. Nedospasova, L.V. Veselovsky, O.R. Tarasenko, I.V. Bushura, A.M. Prychodko, I.O. Novozhylova
Infusion & Chemotherapy pp 18-24; https://doi.org/10.32902/2663-0338-2021-3-18-24

Abstract:
BACKGROUND. Among countries of Europe in Ukraine the incidence and mortality rate from tuberculosis (TB), including the incidence of the relapses in patients with pulmonary tuberculosis (RPT), remain high. Absence of the national program of fight from TB, lack of financing of anti-TB measures, unsatisfactory statistical information confirm the necessity of study of situation from relapses in patients with RPT and development of measures on their warning. OBJECTIVE. To estimate the features of dynamics of the incidence of RPT in the last few years and consisting of epidemic situation of TB in a country. MATERIALS AND METHODS. An analysis of official statistical reports of anti-TB establishments of administrative territories of Ukraine, information of SI “Center of Public Health of the Ministry of Health of Ukraine” and SI “Center of Medical Statistics of the Ministry of Health of Ukraine” in the last few years. RESULTS AND DISCUSSION. By the features of dynamics of the incidence of RPT in the last few years in a country are high the incidence in patients with RPT with sputum positive smears with comparison in the incidence in patients with RPT with sputum negative smears; decline of index on 46,0 %; high part of RPT with sputum positive smears among patients with TB sputum positive smears (the TB new cases + relapses); diminishing of amount of cases of TB which the diagnosis of multidrug-resistant TB is confirmed, from them growth of percent of patients with extended resistant of Mycobacterium tuberculosis. The signs of epidemic situation are: decline of the TB incidence of lights (the new cases + relapses); high percent of patients sputum positive smears; high TB incidence among children by age 15-17; diminishing of the TB mortality rate and his prevalence; absence of changes of index prevalence of TB among children by age 0-17 and 0-14. CONCLUSIONS. The analysis of statistical data testifies to the presence of failings in an exposure and treatment of patients with the relapses of TB, on the necessity of introduction of complex anti-TB measures for warning of relapses within the framework of the national program of fight from TB.
Л.а. Грищук
Infusion & Chemotherapy pp 8-8; https://doi.org/10.32902/2663-0338-2021-2.1-05

Abstract:
Обґрунтування. За даними Всесвітньої організації охорони здоров’я, у 2019 р. було виявлено близько 465 тис. осіб із резистентним до хіміопрепаратів туберкульозом (ТБ), із них менш як 40 % змогли отримати доступ до лікування. Перебої в роботі служб, спричинені пандемією COVID-19, призвели до подальших невдач. У багатьох країнах людські, фінансові й інші ресурси були перерозподілені з ТБ на COVID-19. Системи збору даних і звітності також зазнали негативного впливу. Проблема хіміорезистентного ТБ в Україні надзвичайно актуальна, кількість хворих із первинною та набутою резистентністю постійно зростає. Хіміорезистентність до протитуберкульозних препаратів значно знижує ефективність лікування хворих на ТБ, подовжує терміни терапії, а також підвищує економічні витрати на лікування. Мета. Порівняти результати виявлення мультирезистентного ТБ (МРТБ) у 2019 та 2020 рр. згідно з даними Тернопільського обласного протитуберкульозного диспансеру. Матеріали та методи. Проведено аналіз стаціонарних історій хвороби 128 пацієнтів із МРТБ, які були виявлені та лікувалися у 2019-2020 рр. Результати. Чоловіків було 85,6 %. Особи працездатного віку, які не працювали, – 69,0 %, інваліди – 16,0 %, працювали – 8,0 %, пенсіонери – 7,0 %. За типами туберкульозного процесу хворі розподілися так: уперше діагностований ТБ легень – 54,6 % випадків, рецидив туберкульозного процесу чи неефективне лікування – 45,4 %. З-поміж клінічних форм ТБ легень переважно спостерігалися інфільтративна – 83,5 %, фіброзно-кавернозна – 8,3% і дисемінована – 6,2 %. У динаміці спостерігалося зменшення виявлених випадків у 2020 р. Зокрема, у 2019 р. виявлено 82 випадки МРТБ, а у 2020 р. – тільки 46 (на 50 % менше). В усіх випадках процес локалізувався в легенях. Бацилярні форми ТБ легень було виявлено у 2019 р. у 77 хворих (93,9 %), у 2020 р. – у 44 (95,7 %). Щодо деструкцій у легенях, то у 2019 р. Вони були виявлені в 56 хворих (68,3 %), у 2020 р. – у 30 (65,2 %). Висновки. У Тернопільській області останніми роками спостерігається складна ситуація з МРТБ. У зв’язку з пандемією COVID-19 через недовиявлення значно зменшилася кількість хворих на МРТБ. Це призводить до зниження ефективності лікування таких хворих.
Я.м. Волошин, І.а. Калабуха, В.є. Іващенко, О.в. Хмель, О.м. Пилип’Як
Infusion & Chemotherapy pp 7-7; https://doi.org/10.32902/2663-0338-2021-2.1-04

Abstract:
Обґрунтування. Хіміотерапія неефективна в 35-49 % хворих зі вперше виявленим деструктивним туберкульозом легень. Покращити результати лікування можливо при своєчасному спрямуванні хворих на операцію. Мета. Дослідити результати резекції легень у хворих зі вперше виявленим деструктивним туберкульозом легень. Матеріали та методи. Проведено ретроспективний аналіз історій хвороб 238 пацієнтів зі вперше виявленим деструктивним туберкульозом легень, прооперованих у торакальному відділенні Національного інституту фтизіатрії і пульмонології. Осіб чоловічої статі було 143, жіночої – 95, вік – від 10 до 65 років. Із приводу туберкульом протягом 2-10 місяців лікувалися 59 пацієнтів, протягом 11-16 місяців – 42. Із приводу інфільтративного та фіброзно-кавернозного туберкульозу легень упродовж 4-17 місяців лікувалися 109 хворих. Через помилки діагностики 29 хворих не приймали хіміопрепаратів. У 78 пацієнтів із 3-9-го місяця хіміотерапії туберкульозний процес прогресував. Показаннями до операції були: туберкульома легень – 130 випадків, кавернозний туберкульоз – 5, фіброзно-кавернозний – 91, казеозна пневмонія – 12. Дослідження виконувалося коштом держбюджету. Результати. Усім хворим виконано операції: сегментектомія – 83, екстракапсулярне видалення туберкульоми – 27, лобектомія – 77, комбінована резекція – 23, пневмонектомія – 28. Резекції за допомогою новітньої технології – біологічного зварювання живих тканин – виконано 22 хворим. Післяопераційні ускладнення виникли у 25 осіб (10,5 %) і були повністю усунені. Післяопераційна летальність становила 0,4 %. Клінічне вилікування досягнуто у 237 хворих (99,6 %). При патоморфологічному дослідженні препаратів відзначена виражена активність специфічного процесу в 183 осіб (77,0 %). Найсприятливіший перебіг післяопераційного періоду відзначено у хворих із туберкульомами, які лікувалися до операції протягом 2-5 місяців, і фіброзно-кавернозним туберкульозом – 4-6 місяців. У віддаленому періоді спостереження (1-17 років) повна клінічна ефективність зберігалася в 97,3 % пацієнтів. Висновки. Своєчасне виконання резекцій легені з використанням нових хірургічних технологій дало змогу досягнути значного клінічного ефекту.
В.і. Ігнатьєва, М.і. Линник, Г.л. Гуменюк, В.а. Святненко
Infusion & Chemotherapy pp 12-12; https://doi.org/10.32902/2663-0338-2021-2.1-09

Abstract:
Обґрунтування. Запровадження карантину з приводу COVID-19 може призвести до зниження виявлення хворих на туберкульоз, зростання захворюваності та смертності від цього захворювання. На тлі виснаження імунної системи населення дедалі частіше трапляється поєднана туберкульозна патологія, зокрема поєднання туберкульозу легень і туберкульозного отиту. Туберкульоз середнього вуха виникає як вторинний процес у хворих на дисеміновані й інші форми легеневого туберкульозу. Діагностика поєднаної патології значно утруднена, коли специфічний процес перебігає на тлі хронічної неспецифічної патології легень. У таких випадках актуальності набуває застосування додаткових методів дослідження, а саме комп’ютерної томографії (КТ) скроневих кісток та органів грудної порожнини (ОГП). Клінічний випадок. Хвора Т., 1982 р. н., в анамнезі має всі календарні щеплення БЦЖ. Із 2008 р. cпостерігається в пульмонолога з приводу бронхоектатичної хвороби нижньої частки лівої легені. Неодноразово лікувалася стаціонарно й амбулаторно. З березня 2018 р. cпостерігається в оториноларинголога з приводу хронічного лівобічного гнійного середнього отиту. Останнє загострення було в лютому 2020 р. Виконано пункцію та шунтування барабанної порожнини. Тоді ж з’явилися загальна кволість, нежить, біль і пирхота в горлі, підвищення температури тіла до 37,5 ° С, потім – кашель із гнійним мокротинням, осиплість голосу. Отримувала декілька курсів неспецифічної антибактеріальної терапії, але без позитивного ефекту. З метою уточнення діагнозу та лікування направлена до Національного інституту фтизіатрії і пульмонології. Проведено КТ скроневих кісток, у ході якої виявлено ознаки лівобічного середнього отиту та мастоїдиту (рис. 1). На аудіограмі – погіршення слуху за типом слухопроведення (кістково-повітряний розрив на частоті 4000 Гц дорівнював 50 дБ). Виділення з лівого зовнішнього слухового проходу відсутні. На КТ ОГП – ознаки дисемінованого туберкульозу легень, сегментарний ателектаз нижньої частки зліва (рис. 2). Мікроскопія мокротиння: КСП не виявлено, GenXpert МТВ + RIF-. Розпочато основний курс антимікобактеріальної терапії за I категорією. Місцево – офлоксацин (вушні краплі). У результаті призначеного лікування отримано позитивну динаміку поєднаної патології (рис. 3). Висновки. Незважаючи на своєчасне звернення по медичну допомогу, у хворої на хронічний середній отит і бронхоектатичну хворобу, що не піддавалися неспецифічній антибактеріальній терапії, не було своєчасно діагностовано туберкульоз. Проведення КТ скроневих кісток та ОГП у пацієнтів із хронічними захворюваннями легень у поєднанні з хронічним середнім отитом має високу інформативність у виявленні туберкульозного процесу й оцінки ефективності лікування.
Є.м. Маєтний
Infusion & Chemotherapy pp 16-16; https://doi.org/10.32902/2663-0338-2021-2.1-13

Abstract:
Бажання зазирнути у Всесвіт і в глибини Людини протягом віків надихає вчених. Практичні хірурги здавна вивчають структуру та співвідношення внутрішніх органів й утворень. Важливість отриманих даних важко переоцінити. Яскравим прикладом є праці видатного вченого, хірурга зі світовим ім’ям, засновника топографічної анатомії Миколи Івановича Пирогова. Вільгельм Конрад Рентген у 1895 р. відкрив короткохвильове електромагнітне випромінювання, відоме як рентгенівські промені. Також існують праці Івана Павловича Пулюя, австро-угорського фізика з Галичини, який вивчав електричні розряди у вакуумних трубках за 10 років до відкриття Рентгена, але подальшим розвитком і патентуванням не займався. Вивчення «рентгенівських тіней» і розвиток обчислювальних технологій зумовили виникнення методу пошарового вивчення внутрішньої будови, запропонованого в 1972 р. Годфрі Хаунсфільдом. Системою реєструються ослаблення опромінення на детекторі та формуються зображення. Візуальна та кількісна оцінка проводиться за шкалою ослаблення рентгенівського опромінення (шкалою Хаунсфільда). Умовно вона розподілена на середину – щільність води, або 0 одиниць Хаунсфільда (HU), та крайні точки: повітря -1000 HU та кісткова тканина +1000 HU. Із розвитком томографічного обладнання до «покрокових» апаратів додали детектори, «кроки» перейшли в «спіраль», значно збільшилися кількість детекторів і час обчислення результатів. На сьогодні КТ-реконструкції дають змогу доопераційно виконати віртуальну фібробронхоскопію, вивчити розгалуження артеріальних стовбурів та особливості венозних судин у зоні оперативного втручання. Доопераційне визначення анатомічних особливостей та індивідуальної структури паренхіми допомагає значно оптимізувати оперативне лікування, що особливо важливо при мініінвазивних торакоскопічних втручаннях. Вивчення особливостей денситометричних змін на тлі лікування дало можливість обґрунтовано встановлювати оптимальні терміни оперативного втручання та прогнозувати наслідки. Передопераційне визначення структури легеневої паренхіми дало змогу підібрати оптимальні заходи запобігання легенево-плевральним ускладненням як інтраопераційно, так і в післяопераційному періоді. Роботи з визначення структури легеневої паренхіми на основі денситометричних змін допомагають автоматизувати скринінг і первинну діагностику легеневих хвороб. Розроблені за договором співпраці з Національним авіаційним університетом автоматизовані системи дають змогу визначати активність специфічного процесу та відсоток ураження легені. Створено програму виявлення COVID-ураження легеневої паренхіми. Завдяки структурно-параметричному синтезу загорткової нейронної мережі можна проаналізувати гістограми легень, отримуючи значно більше інформації від проведеного КТ-дослідження. У практичній діяльності широко розповсюдженим є аналіз КТ-зображень за допомогою DICOM-VIEWER, як безкоштовних програм, так і професійних. Принциповим за сенситометричного аналізу легеневої паренхіми є прецизійне виділення на КТ-зрізах ділянок ураження, без залучення просвіту бронха чи каверни. Потрапляння в зону вимірювання повітроносної структури радикально викривляє результати вимірів, роблячи їх нерепрезентативними. Збільшення кількості замірів денситометричних...
К.д. Мажак, О.а. Ткач
Infusion & Chemotherapy pp 17-17; https://doi.org/10.32902/2663-0338-2021-2.1-14

Abstract:
Обґрунтування. Складність трактування змін біохімічних показників зумовлена їхніми різними захисними функціями, мобілізація котрих залежить від вираженості відповіді на інтенсивність агресії, що визначається біологічними властивостями мікобактерій туберкульозу (МБТ) й адекватністю реакції організму. Вивчення особливостей зрушень із боку ключових ланок біохімічних процесів у хворих на туберкульоз (ТБ) з різним клінічним перебігом, профілем хіміорезистентності МБТ дасть можливість науково обґрунтувати оптимальні моделі застосування індивідуальної пацієнт-орієнтованої корекції ведення випадку, що сприятиме інтенсивнішому відновленню реактивності організму, підвищенню результативності стаціонарного лікування та запобігатиме розвитку рецидиву. Матеріали та методи. З цією метою вивчено особливості змін низки ключових біохімічних показників у крові 126 хворих на хіміорезистентний ТБ (ХРТБ) з різною ефективністю лікування до, під час (3,5-4 місяці), після курсу інтенсивної хіміотерапії (ХТ), що дало змогу визначити величину впливу ХТ і виявити прогностичні маркери сприятливого чи несприятливого перебігу специфічного процесу. Залежно від результативності лікування хворих розподілили на три групи: І група – 44 особи з позитивною клініко- рентгенологічною динамікою та БК- (ХТ ефективна); ІІ група – 42 особи з незначною позитивною рентгенологічною динамікою або її відсутністю та БК- (ХТ малоефективна); ІІІ група – 40 хворих із негативною рентгенологічною динамікою, збереженим бактеріовиділенням або його реверсією (ХТ неефективна). Результати та їх обговорення. У хворих на вперше діагностований ХРТБ легень незалежно від тяжкості процесу зростають рівні глікопротеїнів, фібрину, α1-антитрипсину, γ-глобулінів, молекул середньої маси (МСМ), знижується вміст альбуміну. При тяжчому перебігу захворювання (поширений легеневий процес із деструкціями, масивне бактеріовиділення, виражена імуносупресія) суттєво зростають рівні С-реактивного білка, аденозиндезамінази (АДА), загальної оксидантної активності (ЗОА), перекисного гемолізу еритроцитів (ПГЕ), гаптоглобіну (Нр) і, відповідно, МСМ. За наявності вираженого синдрому системної запальної відповіді поглиблюється диспротеїнемія та вдвічі відносно норми зростають рівні МСМ. Прогностично значущими чинниками недостатньої ефективності ХТ є: надмірно виражена гострофазова мобілізація захисних сил організму, що супроводжується виснаженням резервів детоксикації; підвищення АДА, Нр, коефіцієнту De-Ritisa, високий рівень інтоксикації (МСМ >0,38 ум. од.), дефіцит антиоксидантного, антипротеолітичного потенціалів. Встановлено максимально допустиму прогностичну межу параметрів окремих біохімічних показників для прогнозу ефективності ХТ («успішна» чи «неуспішна») у хворих на ХРТБ легень: у разі успішної ХТ АДА <18,0 од. акт., МСМ <0,30 ум. од., ЗОА <15,0 %, ПГЕ <14,5 %, Нр <2,0 г/л. У хворих із несприятливим прогнозом лікування зазначені показники вищі (р <0,01). Проведений кореляційний аналіз між досліджуваними біохімічними показниками свідчить про предикторну інформативність більшості з них (системи перекисного окислення ліпідів – антиоксидантного захисту, протеїнази – інгібітори протеїназ, МСМ – АДА, Нр, α1-антитрипсин – АДА) стосовно вираженості деструктивних змін у легеневій тканині, рівня...
O.S. Zotov
Infusion & Chemotherapy pp 108-110; https://doi.org/10.32902/2663-0338-2020-3.2-108-110

Abstract:
Background. 39 years old Betsy Lehman, which in 1994 took part in a clinical study, died because of the excessive infusion of cyclophosphamide (4 times higher dose). The mistake was revealed only in 10 weeks after the patient’s death. Now there is a Betsy Lehman Center of Patient Safety and Decrease of Medical Errors. According to the definition, medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to the harm of the patient. In turn, wrong usage of the drug is an intentional misuse not in accordance with the instruction for medical usage (including, with some illegal aims). According to the statistics, only in USA medical errors harm 44,000-98,000 patients annually and cause the death of 7,000 patients. Objective. To define the main concepts of medical errors and methods of their avoidance. Materials and methods. Analysis of literature data on this topic. Results and discussion. Categories of medical mistakes include the mistakes of prescribing, of dispensing, of preparation, of administration and of monitoring. Retrospective analysis of the correctness of drug administration had revealed that the risk factors of mistakes included patient’s age 64 y. o., and a big quantity of administered drugs. Nurses with different professional experience equally often made mistakes; mistakes were more often during night shifts. Medical mistakes in oncology have some peculiarities. Namely, in oncology the drug dose often depends on the body surface and other factors; exceeded dose is accompanied by the high toxicity, and the insufficient dose – by the severe decrease of treatment effectiveness; anticancer treatment is accompanied by the administration of the big amount of additional drugs (antiemetics, hemopoesis stimulators, glucocorticoids, etc.). Analysis of chemotherapy of 1311 adult patients, which underwent the treatment in the university clinics of Valencia (Spain), revealed the mistakes in 17.2 % of cases. Mistakes in drug prescription were the most often (75.7 %). Similar French study revealed the mistakes in 5.2 % of cases, the majority of them (91 %) were also the mistakes in prescription (wrong choice of treatment regimen, incomplete prescriptions, inadequate doses). Such mistakes have not only medical, but also the social and economic consequences, including the increase of treatment cost. Meta-analysis of R. Ashokkumar et al. (2018) revealed that the frequency of medical errors in oncology, according to the different studies, was about 0.004-41.6 %. There is one more problem: because of the fear of punishment healthcare workers hide their errors, that’s why the small amount of errors may not be the real favorable parameter, but just a result of incomplete notification. Factors of medical mistakes appearance are divided into 3 groups: due to healthcare workers (training level, knowledge, physical and emotional condition), due to clinics administration (presence of treatment standards, communication quality, registration and analysis of error cases) and social (staff workload, time limitations, workplace organization, payment). With the aim of prevention of medical errors in oncology we must implement the treatment standards and local protocols, control technics of preparation and administration of anticancer drugs, widen the network of clinical pharmacists, use external drug compounding, thoroughly manage the medical documents, introduce electronic control systems and improve the communication between medical workers. Talking about legal aspects, concept of medical error does not have any legal consolidation. Literature includes about 70 its definitions. In case of a complaint of patient or his/her relatives healthcare workers will be asked such questions: whether the diagnostics of the patient was complete, whether the diagnosis was correct and timely made, what are the causes of the unfavorable outcomes, is there any direct causative link between healthcare workers’ actions and these outcomes, whether there was any standards’ violations. In general, vague criteria of standardization of medical care decrease the level of legal protection of both patients and healthcare workers. Conclusions. 1. Medical errors are quite often, but their exact incidence can’t be established. 2. Medical errors in oncology have some peculiarities because of the peculiarities of tumor treatment. 3. With the aim of prevention of medical errors in oncology we must implement the treatment standards and local protocols, control technics of preparation and administration of anticancer drugs, widen the network of clinical pharmacists, use external drug compounding, thoroughly manage the medical documents, introduce electronic control systems and improve the communication.
S.V. Kovalenko
Infusion & Chemotherapy pp 149-150; https://doi.org/10.32902/2663-0338-2020-3.2-149-150

Abstract:
Background. Coronavirus disease (COVID-19) is a new disease, and there is no vaccine, specific drugs and treatment protocols. In 15-20 % of patients the course is severe course, and 4 % of cases are fatal. 15 % of adults infected with the SARS-CoV-2 coronavirus develop pneumonia. In 5 % pneumonia progresses to a critically severe condition with the development of respiratory failure and acute respiratory distress syndrome. Objective. To describe the potential options of COVID-19 therapy. Materials and methods. Analysis of literature sources on this topic and the own clinical study, which involved 60 patients with COVID-19 (main and control groups, standardized by age and sex). In the control group, standard treatment was prescribed, and in the main group – basic therapy and Ksavron tid, Tivorel once a day and Reosorbilact once a day (all medications – by “Yuria-Pharm”). Results and discussion. Antiviral drugs (nelfinavir, remdesivir, favipiravir), recombinant human monoclonal antibodies to interleukin-6 receptors tocilizumab, and chloroquine-related drugs (sometimes in combination with azithromycin) are used for COVID-19 pharmacotherapy. Usage of edaravone (Ksavron) to inhibit the cytokine storm and of Reosorbilact to reduce the incidence of pulmonary complications, the duration of mechanical ventilation, and the volume of infusions has a great potential. The use of the latter is especially appropriate under the conditions of restrictive infusion regimen. In addition, L-arginine and L-carnitine (Tivorel) can be used. L-arginine reduces spasm of smooth bronchial muscles and improves the vasomotor function of the pulmonary endothelium. L-carnitine has anti-inflammatory and immunomodulatory effects. The own study found out that the level of C-reactive protein in the main group (standard therapy + Ksavron, Tivorel and Reosorbilact) has decreased from 39.45 to 7.5 mg/L, and in the control group – from 46.26 to 12.50 mg/L, indicating a more pronounced reduction of inflammation in the main group. In addition, the content of D-dimer and ferritin decreased more markedly in the main group (by 24.1 % and 27.1 % respectively). The additional pathogenetic treatment listed above helped to improve blood oxygen saturation, reduce the number of leukocytes and decrease the length of hospital stay. Conclusions. 1. Antiviral drugs, tocilizumab, chloroquine-related drugs, and azithromycin are used to treat COVID-19. 2. Potential treatment options include the usage of Ksavron, Reosorbilact and Tivorel. 3. According to own research, the inclusion of these drugs into the combined therapy reduces the activity of the inflammatory process in the lungs and counteracts the tendency to thrombosis.
Ye.V. Hryzhymalskyi
Infusion & Chemotherapy pp 60-62; https://doi.org/10.32902/2663-0338-2020-3.2-60-62

Abstract:
Background. Infusion therapy (IT) has a number of features that both doctors and nurses need to know. IT can be performed via a needle, a peripheral intravenous catheter (PIC), and an implanted system for long-term infusions (ISLI). Objective. To describe the features of short-term and long-term IT. Materials and methods. Analysis of literature sources on this topic. Results and discussion. First of all, every healthcare worker should remember that the patient should be identified before any manipulation and then the procedure may start. IT via the needle has a number of disadvantages: complications due to the frequent punctures and prolonged stay of needle in the vein; limited possibility of long-term IT; increased risk of needle injuries among medical staff. The advantages of PIC above needle include the lower risk of infection, better safety, the possibility of rapid administration of drugs in various combinations, easy use of IT and parenteral nutrition, and the ability to monitor central venous pressure. PIC are classified by the presence of an additional injection port, by the material from which they are made, by the shape of the needle tip sharpening, by the visibility on X-ray and size. Venoport Plus (“Yuria-Pharm”) is an elastic teflon catheter with a low coefficient of surface friction, X-ray contrast strips and the possibility of a long stay in a vein (up to 72 hours). The advantages of the Venoport Plus PIC are the adaptive shape of the cap, the optimal inclination angle and SMART SLOT – a hole near the tip of the needle, which allows you to visualize the blood between the catheter and the needle without waiting for it to appear in the indicator chamber. The most suitable for the PIC placement veins are located on the outside of the hand and on the inner surface of the forearm. It is recommended to use the ulnar vein only for laboratory blood sampling and emergency medical care. When choosing PIC one should take into account the vein diameter, necessary speed of infusion, potential time of stay of a catheter in a vein, and features of the infused solution. After installing PIC, it is advisable to use special transparent aseptic bandages. Bandage replacement is performed as needed; daily replacement is not required. After PIC installation and after infusion, PIC should be washed with 0.9 % NaCl, heparin (1:100 dilution), or Soda-Bufer solution (“Yuria-Pharm”). If the catheter is not used, washing should be performed once a day. ISLI Yu-Port (“Yuria-Pharm”) provides long-term venous access and can be used if the patient needs multiple administrations of drugs during a long course of therapy. Conclusions. 1. IT can be conducted via a needle, PIC, or ISLI. 2. The advantages of PIC over the needle injection are lower risk of infection, better safety, the possibility of rapid administration of drugs in various combinations, facilitated use of IT and parenteral nutrition, and the ability to monitor central venous pressure. 3. PIC Venoport Plus (“Yuria-Pharm”) is an elastic teflon catheter with an adaptive shape of the cap and the optimal angle. 4. When choosing PIC one should take into account the vein diameter, the required speed of infusion, the potential time of stay of a catheter in a vein, and the features of the infused solution. 5. ISLI Yu-Port provides long-term venous access and can be used if necessary for the multiple administrations of drugs during a long course of therapy.
Ye.V. Hryzhymalskyi
Infusion & Chemotherapy pp 63-65; https://doi.org/10.32902/2663-0338-2020-3.2-63-65

Abstract:
Background. Sedation is a controlled medical depression of consciousness with the preservation of protective reflexes, independent effective breathing and response to physical stimulation and verbal commands. Requirements for sedation include rapid onset of effect, short action, minimal impact on the cardiorespiratory system, lack of delirium and emetic effect. The goals of sedation include patient comfort, minimization of pain and discomfort, anxiolysis, amnesia, control of patient behavior, rapid recovery. Objective. To describe the features of sedation in obstetrics and gynecology. Materials and methods. Analysis of literature data on this topic; own research. The study included 64 women with gynecological diseases who underwent elective surgery under regional anesthesia. Longocaine and Longocaine Heavy (“Yuria-Pharm”) were used as local anesthetics. Sedation by dexmedetomidine ("Yuria-Pharm") was used in group 1, and by propofol in group 2. Results and discussion. Cesarean section is characterized by high levels of stress. The main requirements for sedation during caesarean section include the preservation of consciousness, self-breathing and protective reflexes of the respiratory tract, minimal impact on hemodynamics, short duration of action of drugs. Subjective methods (different scales, verbal contact with the patient, assessment of pupil dilation, pulse, respiratory rate, blood pressure) and objective methods (electroencephalography, BIS spectral index) are used to determine the degree of sedation. Mandatory monitoring during sedation includes non-invasive blood pressure measurement, pulse oximetry, electrocardiography, capnography, BIS monitoring. Capnography is the most effective type of monitoring. For the safety of procedure carefully trained personnel, the device for mechanical lung ventilation, a set for ensuring passability of respiratory tracts, a defibrillator, and drugs for emergency medical care are necessary. For procedural sedation, drugs such as propofol, barbiturates, benzodiazepines, dexmedetomidine, ketamine, and inhalation anesthetics are used. The advantages of benzodiazepines are rapid effect and amnestic action, the disadvantages include the promotion of delirium and respiratory depression, no analgesic effect. The last two effects are also typical for propofol, which also causes pain in the vein during administration and the propofol infusion syndrome. The advantages of propofol include rapid onset of effect and rapid awakening, ease of titration, amnestic and antiemetic action. Ketamine also provides a rapid onset of effect and rapid awakening, and has an analgesic effect, however, causes hallucinations and hypersalivation, increased motor activity. Dexmedetomidine is an analgesic, has a sedative effect and a minimal effect on respiratory status. Disadvantages of dexmedetomidine include slow onset of effect and dose-dependent decrease in blood pressure. A number of scientific studies indicate the absence of adverse effects of dexmedetomidine during cesarean section under regional anesthesia. According to our own study, sedation with dexmedetomidine caused hypotension 26.5 % less often than sedation with propofol. Targeted sedation with dexmedetomidine caused almost no respiratory depression, whereas sedation with propofol led to moderate hypoxemia in 21 % of patients and severe hypoxemia in 35.9 % of patients. Dexmedetomidine contributed to a more pronounced reduction in pain, which can be explained by its own analgesic effect. Conclusions. 1. The goals of sedation include patient comfort, minimization of pain and discomfort, anxiolysis, amnesia, control of patient behavior, rapid recovery. 2. The main requirements for sedation during caesarean section include the preservation of consciousness, independent breathing and protective reflexes of the respiratory tract, minimal impact on hemodynamics, short duration of action of drugs. 3. Capnography is the most effective type of monitoring during sedation. 4. Sedation with dexmedetomidine caused hypotension 26.5 % less often than sedation with propofol. 5. Targeted sedation with dexmedetomidine caused almost no respiratory depression. 6. Dexmedetomidine contributed to a more pronounced reduction in pain than propofol.
S.O. Dubrov
Infusion & Chemotherapy pp 94-96; https://doi.org/10.32902/2663-0338-2020-3.2-94-96

Abstract:
Background. Blood transfusions (BT) remain one of the most common medical procedures: about 110,000 doses of whole blood are collected annually and almost as many are transfused. Approximately every 10th patient who undergoes invasive procedures in the hospital needs BT. However, 40-60 % of BT in patients without bleeding are inappropriate. Objective. To describe modern views on the BT. Materials and methods. Analysis of the literature on this issue. Results and discussion. The triad of major risk factors for perioperative complications includes three interrelated factors: blood loss, anemia, and BT. The use of blood products is accompanied by an increase in the number of complications (not directly related to BT) and 30-day mortality. Fatal consequences of blood transfusion are also possible. They include acute lung damage associated with BT, hemolytic and bacterial complications, circulatory overload, anaphylaxis. Patient blood management (PBM) includes early detection and treatment of preoperative anemia, especially in patients at high risk of bleeding; minimization of blood loss and maximally blood-saving tactics; rational and guideline-adequate administration of allogenic blood products. About 39 % of patients scheduled for surgery have preoperative anemia. Absolute iron deficiency (ID) is present in 62 % of patients with preoperative anemia. Ferritin level <30 μg/L is an indicator of such anemia. Preoperative anemia is an independent risk factor for mortality and complications, so in presence of anemia, major emergency surgery should be postponed until hemoglobin returns to normal. The target level of the latter in the treatment of preoperative anemia should be 130 g/L for both sexes. If surgery is scheduled 6-8 weeks after the revealing of ID with or without anemia, oral replacement therapy should be performed. Parenteral forms of iron are used if there are <6 weeks left before the planned operation or the hemoglobin level is <100 g/L. If necessary, BT can be performed according to a liberal (BT is prescribed at a hemoglobin level <90-100 g/L) or restrictive (500 ml). In patients with trauma with massive blood loss or with a high risk of intracranial hemorrhage, it is also advisable to use tranexamic acid. Its activity is 26 times higher than the activity of aminocaproic acid. Tranexamic acid is highly effective; it reduces the need for BT without increasing the risk of thrombosis. Conclusions. 1. The triad of major risk factors for perioperative complications includes three interrelated factors: blood loss, anemia, and BT. 2. PBM includes early detection and treatment of preoperative anemia, minimization of blood loss and adequate administration of allogenic blood products. 3. In conditions of preoperative anemia, it is advisable to correct diabetes with oral or parenteral forms of iron. 4. Tranexamic acid drugs are prescribed to minimize blood loss.
S.I. Zhuk
Infusion & Chemotherapy pp 106-107; https://doi.org/10.32902/2663-0338-2020-3.2-106-107

Abstract:
Background. Perinatal obstetrics involves the interests of both the mother and the fetus. The main sections of perinatal obstetrics are prenatal diagnosis, intensive care during pregnancy and childbirth, choice of optimal delivery way, resuscitation and care of the newborn. WHO experts believe that the comfort of the mother, psychological support of relatives, adequate analgesia, lack of aggressive delivery (unreasonable opening of the amniotic sac or unreasonable labor stimulation), monitoring of the childbirth dynamics and even the pose of the woman during labor are extremely important. Objective. To describe the modern views on childbirth. Materials and methods. Analysis of literature data on this issue. Results and discussion. Current trends in childbirth include the increase of the average weight of the fetus, of the number of high-risk mothers, of childbirth duration, of the incidence of traumatic injuries of the birth canal, of the frequency of surgical interventions. Obstructive labor is often accompanied by the aggressive management: hyperactive actions of obstetricians and gynecologists, uncontrolled use of oxytocin, any action in immature cervix. In obstructive labor, the obstetric situation should be assessed by vaginal examination and/or transabdominal ultrasound (US). If the latter does not show the middle structures of the head, one can combine transabdominal and transperitoneal US. With regard to birth injuries, their prevention should begin several weeks before the expected date of birth to reduce the risk of episiotomy and spontaneous perineal rupture. To do this, there are special vaginal hydrogels that reduce friction during childbirth. The composition of the hydrogel Ginodek (“Yuria-Pharm”) includes an antiseptic component (decamethoxine 0.02 %), a regenerating component (hyaluronic acid 0.5 %) and a component that regulates the vaginal pH (lactate buffer). Decamethoxine has bactericidal, viricidal, fungicidal, anti-inflammatory, desensitizing and antispasmodic action. Lactate buffer eliminates the symptoms of acid-base imbalance, helps to moisturize the vaginal mucosa and to maintain normal microflora. Hyaluronic acid restores the water balance of cells, promotes the entry of nutrients into the cells and the excretion of metabolic products, stimulates regeneration. Indications for the use of Ginodek include the prevention of infectious complications in obstetrics and gynecology before surgery, minor diagnostic operations, abortion, childbirth, intrauterine device insertion, as well as treatment of genital infections and conditions accompanied by dryness and atrophy of the vaginal mucous membrane. Conclusions. 1. When conducting childbirth in a natural way, the comfortable condition of the woman in labor, psychological support of relatives, adequate anesthesia, and the absence of aggressive assistment are of great importance. 2. There are vaginal hydrogels that prevent birth injuries via reducing the friction during childbirth. 3. Ginodek hydrogel, which contains decamethoxine, hyaluronic acid and lactate buffer, helps to reduce the number of birth injuries.
N.O. Lisnevska
Infusion & Chemotherapy pp 172-174; https://doi.org/10.32902/2663-0338-2020-3.2-172-174

Abstract:
Background. Medical secrecy (MS) is a set of information about the disease, its treatment, the results of examinations, which became known to certain healthcare workers (HCW) during their professional activities. The attending physician and the nurse who performs the drug administration are most aware of the patient’s condition. The information included in the MS is divided into two types: medical and personal information of the patient, which became known during the performance of medical professional duties. Objective. To describe selected aspects of the MS problem. Materials and methods. Analysis of the legal framework. Results and discussion. Medical information belongs to professional confidential information and should not be disclosed. Even the information about the very fact of seeking medical care belongs to professional confidential information. Unlawful intentional disclosure of MS by a person to whom it became known in the course of its professional duties entails criminal liability. This applies not only to HCW, but also to other staff of medical institutions. It is possible to provide information about the treatment and even the patient’s stay in the hospital to third parties, including relatives of any degree of kinship, only with the patient’s own consent. Exceptions include cases of extreme urgency, such as when a patient is taken to hospital unconscious and relatives can provide information on existing allergies and comorbidities. Of course, in such cases, the necessary disclosure limits should be followed. If a relative or other person wishes to visit a patient in the hospital, he or she should be contacted in person and visited only with personal consent. With regard to law enforcement officers, the answer to the question of whether a particular patient is treated in this institution should be given only in the presence of criminal proceedings and after resolving this issue with the chief physician. It should be noted that medical information concerning the deceased is also confidential and cannot be disclosed. It should not be assumed that the deceased can no longer be harmed, so any liability will be absent. Disclosure of such information is also a crime, on the basis of which criminal proceedings may be started. Recently, the medical legislation in Ukraine was changed, and as of today, the fine for disclosing MT is over UAH 50,000. When treating patients with disabilities, all necessary information should be provided to their parents or carers. When treating children aged 14-18, it is impossible not to provide information about treatment to parents, although this may be contrary to the wishes of the child. An important issue is the provision of information to children who are incapacitated by age, but legally capable. If a 5-year-old child asks questions about his or her health, a doctor or other HCW must answer them in a form that is accessible. A similar situation occurs with mentally ill patients: they are deprived of legal capacity, but they have the right to know about their health. You should also be very careful in keeping medical records. For example, information on viral infections (hepatitis, HIV/AIDS) should not be placed on the cover of the medical history, but inside. Conclusions. 1. MS information is divided into two types: medical and personal information of the patient. 2. Medical information belongs to professional confidential information and should not be disclosed. 3. It is possible to provide information about the treatment and even the patient’s stay in the hospital to third parties, including relatives, only with the patient’s own consent. 4. In the treatment of patients with disabilities, all necessary information should be provided to the parents or carers.
V.P. Andriushchenko
Infusion & Chemotherapy pp 7-9; https://doi.org/10.32902/2663-0338-2020-3.2-7-9

Abstract:
Background. The priority areas of the problem of acute widespread peritonitis (AWP) include the standardization of terminology and classification, assessment of the severity of the process, control of the infection source and correction of pathological intra-abdominal syndromes. Objective. To outline the conceptual aspects of AWP surgical treatment based on consensus guidelines and own research. Materials and methods. The study involved 371 patients with AWP. Patients underwent the necessary clinical, laboratory, biochemical, bacteriological, radiological, instrumental and pathomorphological studies. Results and discussion. To assess the severity of the disease one should assess the general clinical condition of the patient, the source and the site of infection, the presence or absence of organ or multiorgan dysfunction, the characteristics of the pathogen. The assessment of the clinical condition takes into account the patient’s age, physiological status and comorbid diseases, the general scales ASA, SOFA, APACHE, Marshall and peritonitis-specific scales (Mannheim Peritonitis Index, Peritonitis Index Altona). When determining the infection source, it is advisable to determine whether the process is provoked by damage to the upper or lower segment of the gastrointestinal tract. The most common causes of AWP in the own study were acute appendicitis (23 %), perforated gastric ulcer (21 %), acute pancreatitis and pancreatic necrosis (18 %). Acute cholecystitis, intestinal perforation, and anastomosis failure were somewhat less common. Suboperative measures during AWP surgery include detection and assessment of the source of the pathological process, elimination of the detected changes, lavage and adequate drainage of the abdominal cavity, correction of intra-abdominal pathological syndromes, clarification of the feasibility of programmed relaparotomy. Dekasan (“Yuria-Pharm”) is used for lavage. It is a local antiseptic, effective against gram-positive and gram-negative bacteria, viruses, and fungi. Dekasan is a surfactant that removes fibrin, pus, colonies of microorganisms and blood clots. According to V.V. Boiko et al. (2012), abdominal lavage with the help of Dekasan reduces postoperative mortality by almost 9 %, and the frequency of secondary purulent complications – by 16.5 %. Pathological intra-abdominal syndromes that need correction include abdominal compartment syndrome (ACS), intestinal insufficiency, and the excessive colonization of the proximal small intestine by pathological microflora. Prolonged tubal decompression of the small intestine, hyperbaric oxygenation, VAC-therapy, and application of negative pressure are used to decrease intra-abdominal hypertension in ACS. Tube techniques used in AWP include enteral lavage, enterosorption, selective pharmacological decontamination, and intraluminal transtubal electrophoresis. It is advisable to introduce enteral nutrition early. For additional detoxification and correction of water-electrolyte balance, low-volume infusion therapy with hyperosmolar solutions (Reosorbilact, “Yuria-Pharm”) is used. Reosorbilact contains sorbitol, sodium lactate and the necessary ions. Conclusions. 1. Modern approaches to solving the problem of AWP should be based on modern terminological and classification principles and provide an understanding of the content of surgery and the validity of antibiotic therapy. 2. Control of the source of peritonitis includes its complete elimination, lavage and drainage of the abdominal cavity, ensuring the decompression of the digestive tract with the implementation of a tubal program of measures. 3. Antibiotic therapy and infusion therapy are the important components of treatment. 4. The implementation of these statements will increase the effectiveness of AWP treatment.
V.Z. Netiazhenko
Infusion & Chemotherapy pp 227-230; https://doi.org/10.32902/2663-0338-2020-3.2-227-230

Abstract:
Background. Analysis of the mortality structure of patients with coronavirus disease (COVID-19) had found that 69.2 % of non-survivors had hypertension. Comorbid diabetes mellitus (31.8 %) and coronary heart disease (28.2 %) were also common. During pandemic, it is necessary to maintain optimal cardiovascular therapy by continuing to administer its main drugs (acetylsalicylic acid, statins, β-blockers, angiotensin-converting enzyme inhibitors – ACEI). Objective. To describe infusion therapy (IT) for cerebrovascular and cardiovascular diseases in settings of the COVID-19 pandemic. Materials and methods. Analysis of the literature on this topic. Results and discussion. Although the spike proteins of the new coronavirus have the tropism to ACE-2, discontinuation of ACEI is unwarranted and may worsen the course of cardiovascular disease (CVD). Particular attention should be paid to the diagnosis of acute coronary syndrome (ACS) in COVID-19. In myocardial infarction, myocarditis or cardiomyopathy on the background of COVID-19, there is a moderate increase in troponin, brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide. An increase in D-dimers is a prognostic marker of the unfavorable prognosis. The algorithm for the ACS diagnosis includes the detection of typical clinical symptoms, ECG analysis, detection of disorders of local contractility of the left ventricle. Determination of troponin in patients without clinical manifestations of ACS with nonspecific manifestations of COVID-19 is not recommended. As for reperfusion therapy strategies, it is indicated in patients with symptoms of ischemia lasting >12 hours and a persistent increase in ST in two adjacent leads. In the absence of prior testing for coronavirus infection, all patients should be managed according to the tactics for COVID-positive patients. In non-STEMI, patients should be stratified according to their risk level (very high, high, moderate, low). In case of high risk, the early (55 years, women >65 years and people with the CVD history). Lopinavir and ritonavir may also decrease the levels of active metabolites of clopidogrel and increase – of ticagrelor, so prasugrel is the antiplatelet drug of choice for COVID-19. Amiodarone also interacts with a large number of antiviral drugs. In turn, statins have multiple immunomodulatory effects including increase of the innate antiviral immune response. It is recommended to continue taking those statins that were prescribed earlier. If co-administration with lopinavir and ritonavir is required, the minimum dose of rosuvastatin or atorvastatin should be started. These antivirals are able to interact with calcium channel blockers and increase their concentration, so the dose of amlodipine and diltiazem can be reduced by 50 %. Endothelial dysfunction (ED) caused by a viral infection leads to the excessive thrombin formation and inhibition of fibrinolysis, increasing the risk of thrombotic complications. Nitric oxide (NO) plays an important role in counteracting ED. NO also inhibits the replication of the acute severe respiratory syndrome coronavirus and improves the survival of infected cells. L-arginine (Tivortin, “Yuria-Pharm”) is the only substrate for NO synthase that catalyzes the formation of NO in endothelial cells. According to the results of the own study, Tivortin helped to reduce the content of fibrinogen and soluble fibrin-monomer complexes, as well as to increase the thromboplastin time. Endothelium-dependent vasodilation also improved after administration of Tivortin. Tivorel (“Yuria-Pharm”) contains L-arginine and L-carnitine, which allows this drug to increase the survival of cardiomyocytes and endothelial cells, to restore homeostasis in the affected areas of the myocardium, and to counteract the progression of atherogenesis and thrombosis. In case of COVID-19, it is also advisable to prescribe edaravone (Ksavron, “Yuria-Pharm”), which neutralizes the cytokine storm, inhibits lipid peroxidation, protects against endothelial damage and, penetrating the blood-brain barrier, counteracts cerebral edema. In case of the need in IT, it is advisable to choose Reosorbilact (“Yuria-Pharm”), which has anti-shock, rheological, detoxifying, alkalizing and osmodiuretic effects. In hypovolemic shock and intracranial hemorrhage, the use of isotonic low-molecular-weight gelatin preparations (Volutenz, “Yuria-Pharm”) has been shown. Conclusions. 1. In the absence of prior testing for coronavirus infection, all patients should be managed following the tactics for COVID-positive patients. 2. The use of azithromycin, chloroquine, hydroxychloroquine, lopinavir, ritonavir is associated with a risk of cardiotoxicity and life-threatening arrhythmias. 3. ED, caused by a viral infection, increases the risk of thrombotic complications. 4. It is reasonable to include the required solutions (Tivortin, Tivorel, Ksavron, Reosorbilact, Volutenz) into the combined IT of COVID-19 patients.
V.S. Vasyliev
Infusion & Chemotherapy pp 26-27; https://doi.org/10.32902/2663-0338-2020-3.2-26-27

Abstract:
Background. The national primary healthcare system (PHS) includes 1939 institutions, 27.7 million patients, 24,607 doctors, 1122 pharmacies and 9395 pharmacists. The eHealth informational space was created to coordinate the work of the PHS. Objective. To describe the features and functioning of the eHealth informational space. Materials and methods. Analysis of the current situation regarding the work of eHealth. Results and discussion. An important function of eHealth is the transition to electronic prescriptions and electronic referrals to specialists under the medical guarantee program. Adopted in 2020 budget of this program amounted to 72 billion UAH, which was allocated to primary care, secondary, tertiary, emergency and palliative care, medical care for children, medical care for pregnancy and childbirth, medical rehabilitation. In total, UAH 1758 billion was spent on the diagnosis and treatment of oncological diseases, of which 80.7 % – on diagnosis and chemotherapy, and 29.3 % – on the diagnosis and radiation treatment. The eHealth system provides the cooperation between the Ministry of Health of Ukraine, the National Health Service of Ukraine and medical institutions with medical information systems. Benefits of the united informational system include the elimination of paperwork, creating a united medical card of each patient, online registration for a doctor’s consultation, eliminating the possibility of drug receipt falsification, increasing the availability of telemedicine consultations, improving communication between healthcare professionals, planning and monitoring of strategic procurement. If the patient uses a smartphone, this informational space allows him to transmit his data (for example, the results of blood pressure measurements) through a mobile application to the telemedicine platform with their subsequent analysis and correction of prescriptions. Additional opportunities of the informational space include monitoring of drugs’ side effects, educational programs for doctors, and the possibility of creating professional communities. Conclusions. 1. The eHealth system enables Ukrainian doctors and patients to use electronic prescriptions and electronic referrals to the specialists. 2. Benefits of this informational system include the elimination of paperwork, the creation of a united medical card of each patient, online registration for a doctor’s consultation, improved communication between health professionals, improved planning of strategic procurement, etc. 3. The eHealth system includes a number of useful services for both doctor and patient.
Infusion & Chemotherapy pp 15-21; https://doi.org/10.32902/2663-0338-2021-1-15-21

Abstract:
BACKGROUND. There are many unsolved medical problems and, of course, pneumonia is one of them. Communityacquired pneumonia (CAP) is a multifactorial disease, but the role of viruses as causative agents is constantly growing. Specific antiviral therapy for CAP is limited. Therefore, the search for drugs with virucidal activity remains relevant. An antimicrobial agent with a broad spectrum of action – decamethoxin – is successfully used today for treatment of patients with infectious exacerbations of bronchial asthma and chronic bronchitis. At the same time efficacy of decamethoxin in CAP patients was not studied. OBJECTIVE. To evaluate the effectiveness and safety of the inhaled antimicrobial drug decamethoxin in the complex treatment of patients with group III viral-bacterial CAP. MATERIALS AND METHODS. There was enrolled 62 patients with group III viral-bacterial CAP. All patients received the same sequential antibiotic therapy: protected aminopenicillin with macrolide or III generation cephalosporin with macrolide. Patients of the main group were prescribed inhalations through a nebulizer of the antiseptic drug decamethoxin in addition to antibacterial therapy from the first day of treatment for 5-7 days. RESULTS AND DISCUSSION. No adverse events were detected in any of the patients during treatment. In all cases, recovery was diagnosed. At the same time, the term of achieving positive results in the main group was 12.2±0.7 days, and in the control – 17.2±0.7 (р <0,05). The average duration of antibiotic use was different in main and control groups: respectively 9.4±0.4 and 10.7±0.4 days (р <0,05). There were no infectious complications in the patients of the main group, while 24 (72 %) patients of the control group were diagnosed with acute rhinopharyngitis (47.0 % of cases), lateral pharyngitis (13 %) and sinusitis (9 %), other complications (otitis, infectious exudative pericarditis). In 22 (66 %) cases there was one complication and in 2 (6 %) cases there were two complications. CONCLUSIONS. For patients with group III viral-bacterial CAP additional inclusion in the empirical sequential antibiotic therapy of inhaled decamethoxin can significantly reduce the frequency of infectious complications, duration of antibiotic therapy, as well as the duration of positive treatment results.
H. Kehlet
Infusion & Chemotherapy pp 113-116; https://doi.org/10.32902/2663-0338-2020-3.2-113-116

Abstract:
Background. The main problems of the postoperative period include organ dysfunction (“surgical stress”), morbidity due to hypothermia, pain, hyper- or hypovolemia, cognitive dysfunction, sleep disturbances, immobilization, semi-starvation, constipation, thromboembolism, anemia, postoperative delirium and more. A multimodal approach to optimizing enhanced recovery after surgery (ERAS) includes improving the preoperative period, reducing stress and pain, exercise, and switching to oral nutrition. These measures accelerate recovery and reduce morbidity. Objective. To describe the measures required for ERAS. Materials and methods. Analysis of literature sources on this issue. Results and discussion. The majority of postoperative complications are associated with the so-called surgical stress involving the release of stress hormones and the start of inflammatory cascades. The stress response is triggered not only directly as a result of surgery, but also as a result of the use of regional anesthesia and other medications. Mandatory prerequisites for ERAS include procedure-specific dynamic balanced analgesia, as well as patient blood management (PBM). The latter consists of hematopoiesis optimization, minimization of bleeding and blood loss, improvement of anemia tolerability. The presence of preoperative anemia before joint replacement significantly increases the number of complications in the 30-day period (Gu A. et al., 2020). Preoperative anemia also leads to the unfavorable consequences of other interventions, which underlines the need to detect and treat it early. An optimal infusion therapy with a positive water balance (1-1.5 L) is an integral component required for ERAS. Balanced solutions should be used; opinions on the use of colloids are contradictory. Venous thrombosis remains a significant problem, as immobilization is an important pathogenetic mechanism. The question of optimal prevention of this condition has not been clarified yet. In 40-50 % of cases after major surgery and in <5 % of cases after minor interventions, the patient develops postoperative orthostatic intolerance. The mechanisms of the latter are a decrease in sympathetic stimulation against the background of increased parasympathetic stimulation; the effects of opioids and inflammation are likely to play an additional role. Preventive methods have not been definitively established, α1-agonists (midodrine) and steroid hormones are likely to be effective. Unfortunately, for most of these problems, there is a gap between the available scientific evidence and the actual implementation of the recommended procedures. The ERAS Society has created recommendations for the management of patients, undergoing a number of surgical interventions (gastrectomy, esophagectomy, cesarean section, oncogynecological surgeries, etc.). For example, recommendations for colon interventions include no premedication and bowel preparation for surgery, use of middle thoracic anesthesia/analgesia, administration of short-acting anesthetics, avoidance of sodium and fluid overload, use of short incisions, absence of drainages, use of non-opioid oral analgesics and non-steroid anti-inflammatory drugs, stimulation of intestinal motility, early removal of catheters, oral nutrition in the perioperative period, control of surgery results and adherence to treatment. Knowledge of procedure-specific literature data and recommendations, multidisciplinary cooperation, monitoring, identification and sharing of methods that have economic advantages are necessary for the ERAS improvement. Outpatient surgery and one-day surgery are becoming more and more common. In a study by N.H. Azawi et al. (2016) 92 % of patients after laparoscopic nephrectomy were discharged home within <6 hours after surgery. Repeated hospitalizations of these patients were not recorded. In a study by G. Ploussard et al. (2020) 96 % of patients after robotic radical prostatectomy were discharged home on the day of surgery; 17 % required re-hospitalization. Early physical activity is an important component of rapid recovery after surgery. There is an inverse relationship between the number of steps per day and the severity of pain after a cesarean section. Despite a large body of literature on the subject, large-scale randomized trials and definitive procedure-specific recommendations are still lacking. This justifies the need for thorough pathophysiological studies and, once completed, randomized controlled or cohort studies. The objectives of these studies should include clear clarification of the pathophysiology of postoperative organ dysfunction, the introduction of a procedure-specific and evidence-based set of perioperative measures, monitoring of purely surgical and general medical consequences of surgeries, identifying areas for improvement and finding new treatment and prevention strategies. Conclusions. 1. Multimodal approach to ERAS optimization includes improvement of the preoperative period, reduction of stress and pain, physical activity, transition to oral nutrition, etc. 2. Procedure-specific dynamic balanced analgesia, PBM, optimal infusion therapy with a positive water balance are the mandatory prerequisites for ERAS. 3. For the majority of problems of the perioperative period, there is a gap between the available scientific evidence and the actual implementation of the recommended procedures. 4. New preclinical and clinical studies are needed to form definitive guidelines for the management of patients in the perioperative period.
O.A. Loskutov
Infusion & Chemotherapy pp 183-185; https://doi.org/10.32902/2663-0338-2020-3.2-183-185

Abstract:
Background. Sepsis is often accompanied by arrhythmias and conduction disorders. It can be assumed that pacemaker cells of the sinoatrial node, strongly sensitized by massive stimulation with β1-adrenergic catecholamines, tend to trigger arrhythmias. The importance of the inflammatory component in the development of new atrial fibrillation (AF) events is also confirmed by the existence of a strong correlation between increased levels of C-reactive protein, interleukin-6 and tumor necrosis factor and the onset of fibrillation. Under the conditions of the new-onset AF, the hospital mortality of patients of general profile in the intensive care unit (ICU) significantly exceeds that for people without AF. Objective. To describe the features of treatment of life-threatening arrhythmias. Materials and methods. Analysis of literature data on this issue. Results and discussion. Amiodarone, diltiazem and lidocaine are the most commonly used treatments for life-threatening arrhythmias. According to a UK-wide study, amiodarone is used to treat new-onset AF in ICU in 80.94 % of cases, β-blockers (BB) – in 11.60 %, other antiarrhythmic drugs (AAD) – in 3.87 %, and digoxin – in 3.31 %. However, this tactic is not in line with the existing guidelines. According to the recommendations for the heart rate (HR) control in emergency care for AF (Bokeria L.A. et al., 2017), in an acute situation in the absence of ventricular pre-excitation syndrome intravenous administration of BB or non-dihydropyridine calcium channel blockers (CCB) is recommended to slow ventricular rhythm in patients with AF. Caution should be taken in patients with hypotension or heart failure. For the last group of patients intravenous administration of cardiac glycosides or amiodarone is recommended. In patients with ventricular pre-excitation syndrome, class I AAD or amiodarone are the drugs of choice. In presence of the pre-excitation syndrome and AF BB, non-dihydropyridine CCB, digoxin and adenosine are contraindicated. The guidelines for the management of AF patients, developed in 2017 by the European Society of Cardiology in collaboration with the European Association of Cardiothoracic Surgery, recommend to use different management tactics depending on the left ventricular ejection fraction (LV EF). In case of LV EF <40 % or signs of heart failure, the lowest effective dose of BB should be prescribed to achieve rhythm control. Amiodarone is prescribed to hemodynamically unstable patients or to individuals with severely reduced LV EF. The primary goal of treatment is to achieve a HR <110 beats/min. In the absence of this result, digoxin should be added. In case of LV EF ≥40 %, BB, or diltiazem, or verapamil should be administered. In the absence of clinical result, digoxin should be added. Practical models of AF treatment in sepsis have demonstrated the superiority of BB over CCB, digoxin and amiodarone (Walkey A.J. et al., 2016). BB weaken the stimulating effect of the sympathetic part of the autonomic nervous system on the myocardium, have a negative chronotropic effect, improve the contractility of ischemized cardiomyocytes, slow atrioventricular conduction, reduce myocardial oxygen demand, and apoptosis. Esmolol (Biblok, “Yuria-Pharm”) is indicated for supraventricular tachycardia (except for ventricular pre-excitation syndrome) and for the rapid control of ventricular rhythm in patients with AF or atrial flutter in the pre- and postoperative periods or in other circumstances when it is necessary to normalize ventricular rhythm with a short-acting drug. Studies show that esmolol inhibits inflammation in sepsis by increasing the expression of the antimicrobial peptide cathelicidin. Kaplan – Mayer analysis shows better survival for experimental animals with sepsis receiving esmolol compared to animals in the 0.9 % NaCl group (Ibrahim-Zada I. et al., 2014). Conclusions. 1. Sepsis is often accompanied by arrhythmias and conduction disorders. 2. Under the conditions of new-onset AF, the hospital mortality of patients of general somatic profile in ICU significantly exceeds the number for people without AF. 3. In case of AF and LV EF <40 % or signs of heart failure, the lowest effective dose of BB should be prescribed to achieve rhythm control. 4. In case of LV EF ≥40 %, BB, or diltiazem, or verapamil should be administered. 5. Esmolol is indicated for supraventricular tachycardia and for the rapid control of ventricular rhythm in patients with AF or atrial flutter. 6. Esmolol inhibits inflammation in sepsis by increasing the expression of the antimicrobial peptide cathelicidin.
K. Meier
Infusion & Chemotherapy pp 191-192; https://doi.org/10.32902/2663-0338-2020-3.2-191-192

Abstract:
Background. Ljubljana declaration (2006) states that the close cooperation between oncologists and oncopharmacologists is vitally important to provide an optimal medical care. Multiprofessional approach allows to increase the cost-effectiveness of treatment and to make it safer. Objective. To prove the importance of the multiprofessional approach and cooperation of various specialists in the oncology field. Materials and methods. Analysis of the literature data on this topic. Results and discussion. According to the questionnaires’ results, 59 % of the respondents want to receive information about drugs and their side effects from the pharmacist. It explains the importance of creation of European Society of Oncology Pharmacology (ESOP), which at the moment includes 63 countries. Key principles of ESOP are the compliance to the standards of treatment quality, continuous professional growth and multiprofessional collaboration. Tasks of ESOP include the increase of the compliance to the oral drugs for cancer treatment, the struggle with the lack of drugs in all the world and the providing safety for patients and healthcare workers, which works with cytotoxic drugs (CTD). According to the data of different authors, low adherence can be predicted by the depression and cognitive disorders, side effects of drugs, asymptomatic disease course, difficult and expensive treatment, unsatisfactory control of treatment, etc. Talking about lack of drugs, since 2000s their frequency has increased. Even the drugs, which are included in the List of the Essential Medicines, are not available in every country, that’s why doctors have to change treatment regimens, interchange drugs, decrease the doses and postpone treatment. Struggle to fight the environmental pollution by CTD is one more task of ESOP. Studies have revealed that the most polluted surfaces in hospitals include working surfaces, floors, counters, drug fridge doors. In general, such characteristics as patient-centricity, multidisciplinary and multiprofessional approach, general coordination of treatment process, defined responsibilities, strict treatment protocols, continuous education of medical stuff, and advanced information systems are the most important for high-quality medical care. ESOP also focuses on the increase of pharmacist’s influence, that’s why this organization provides specialized webinars, trainings and workshops in oncology pharmacy field. Conclusions. 1. High-quality of medical care in cancer needs a pharmacist involvement. 2. Key principles of the ESOP include the compliance to the standards of treatment quality, continuous professional growth and multiprofessional collaboration. 3. Tasks of ESOP include the increase of the compliance to the oral drugs for cancer treatment, the struggle with the lack of drugs in all the world and the providing safety for patients and healthcare workers.
V.I. Mamchur
Infusion & Chemotherapy pp 199-201; https://doi.org/10.32902/2663-0338-2020-3.2-199-201

Abstract:
Background. Endothelioprotectors (EP) are a group of drugs with different pathogenetic mechanisms of action that prevent disruption and/or restore the structural and functional properties of vascular endothelium. EP are mainly used in the treatment and prevention of cardiovascular and cerebrovascular diseases and their complications. Objective. To describe the role of EP in modern therapy of vascular diseases on the example of L-arginine (Tivortin, “Yuria-Pharm”). Materials and methods. Analysis of literature data on this topic. Results and discussion. The endothelium can be considered as a separate organ that regulates the work of blood vessels. Nitric oxide (NO) is the main signaling molecule of the endothelium. In humans, NO is produced from L-arginine. The latter is a conditionally essential amino acid, which means that it is synthesized in sufficient quantities only in perfectly healthy adults. Arginine is practically not synthesized in children under 5 years of age and in persons over 50 years of age. The main food sources of arginine are meat (pork, poultry), chocolate, soybeans, however, nutrition may not always provide the necessary need for L-arginine. The effects of NO include decreased intracellular calcium, smooth muscle cell relaxation, and vasodilation. As a result, the total peripheral vascular resistance and blood pressure decrease. One of the leading negative factors affecting the heart and blood vessels is hypercholesterolemia, which disrupts the production and release of NO. An improvement in endothelium-dependent vasodilation and a reduction in the size of atherosclerotic plaques with L-arginine have been demonstrated in a rabbit model with hypercholesterolemia. Endothelial dysfunction is an important concept in modern cardiology and medical science. Its main manifestation is a decrease in the NO bioavailability, so in order to eliminate endothelial dysfunction, EP are prescribed. The ideal EP should have such properties as a pronounced cardio- and cerebroprotective effect, rapid onset of action, no side effects, and low cost. L-arginine (Tivortin) is one of the best known EP. It can be used in the treatment of chronic heart failure to increase exercise tolerance. Tivortin supplies the depleted endothelium with a substrate for NO synthesis, facilitating cell function. Tivortin can be used not only in cardiological patients. The research of V.V. Bezugla et al. (2017) showed that Tivortin aspartate for oral administration improves the general and special performance of athletes in cyclic and strength sports, as well as reduces the severity of psychophysiological stress. In addition, the neuro-rehabilitation properties of Tivortin are demonstrated, which justifies its feasibility in the treatment and prevention of stroke. In the study of M.M. Sunychuk et al. (2014) the inclusion of Tivortin (100 ml infusion once a day from the 4th day after stroke for 10-14 days) in the complex therapy contributed to a more positive dynamics of assessments on the NIHSS, Bartel and Rankin scales than the use of standard therapy only. Improvement of the cerebral blood flow with the use of Tivortin is shown in other scientific papers (Mankovsky B.N. et al., 2014). The beneficial effect of L-arginine on the course of hypertension has also been proven (West S.G. et al., 2005). Studies conducted at the Department of Pharmacology and Clinical Pharmacology of the Dnipropetrovsk Medical Academy confirmed the cardiotropic and vasotropic properties of L-arginine. Conclusions. 1. NO – the main signaling molecule of the endothelium – is produced from L-arginine, the production of which almost stops after 50 y. o. 2. EP supply the endothelium with a substrate for NO synthesis, facilitating its function. 3. L-arginine (Tivortin, “Yuria-Pharm”) improves clinical, laboratory and functional parameters in patients with cardiovascular and cerebrovascular diseases.
O.P. Manzhura
Infusion & Chemotherapy pp 202-203; https://doi.org/10.32902/2663-0338-2020-3.2-202-203

Abstract:
Background. Preventive check-ups reveal uterine fibroids for the first time in 1-5 % of women. In the presence of gynecological diseases this number is about 30-35 %. Pathomorphological examination of deceased women of different ages reveals fibroids in 77-85 % of them. The age of this diagnosis has become significantly younger, and it is important, because uterine fibroids are associated with problems with fertilization and pregnancy. Myomas are divided into types by localization (interstitial, intraligamentary, subserous, interstitial-subserous, submucosal, etc.). Objective. To describe current trends in the treatment of uterine fibroids. Materials and methods. Analysis of own experience in the treatment of fibroids and literature sources on this topic. Results and discussion. Conservative myomectomy can be performed laparotomically, laparoscopically and hysteroscopically. It is often impossible to perform a traditional conservative myomectomy of large nodes of II-V grades without significant damage to the uterine wall, so as a result, conservative myomectomy turns into a hysterectomy. HiFu ablation is an another method of treating fibroids. This method is based on the influence of a high-power ultrasonic wave, which is generated by a radiating lens and passes through the patient’s body to the pathological focus. Degasated water acts as a conductor between the patient’s body and the lens. The goals of treatment are to preserve the uterus and to create the possibility of pregnancy. Before treatment, magnetic resonance imaging of the pelvic organs and assessment of the potential for malignancy must be performed. Criteria for the selection for ablation include the desire to preserve the uterus; established diagnosis of uterine fibroids, local adenomyosis; obvious symptoms of fibroids (abnormal uterine bleeding, dysmenorrhea, pain, secondary anemia); node size 1-15 cm (submucosal or intramural type of growth). The preservation of a woman’s fertility is a main indication for ablation. There are no alternative methods to HiFu ablation in terms of efficacy and safety, but if the nodes were too large or too numerous, conservative myomectomy is performed after significant tumor regression after two sessions of HiFu. The nodal bed and pelvic floor should be washed with decamethoxine solution during the operation. The required volume of solution is about 2 liters. The advantages of decamethoxine include the lack of absorption by the wound surface and a powerful bactericidal effect. If the walls of the uterus are thin and it is not possible to preserve their integrity during myomectomy, plastic surgery is performed with the introduction of high molecular weight hyaluronic acid to prevent the formation of adhesions and accelerate regenerative processes. Conclusions. 1. Uterine fibroids are common tumors that in young women are accompanied by problems of fertilization and pregnancy. 2. It is often impossible to perform traditional conservative myomectomy of large nodes without significant damage to the uterine wall. 3. HiFu ablation is the modern method of treatment of fibroids. 4. Maintaining a woman’s fertility is a main indication for ablation.
L.F. Matiukha
Infusion & Chemotherapy pp 204-206; https://doi.org/10.32902/2663-0338-2020-3.2-204-206

Abstract:
Background. The main goal of reforming the primary health care system (PHC) is to improve its quality and accessibility. At present, 30.45 million declarations have been signed in Ukraine with 23,453 primary care physicians. More than 70 % of those who signed the declaration are satisfied with their family doctor (FD). All PHC utilities have signed the agreements with the National Health Service of Ukraine. However, only 9 % of respondents considered health care reform successful. Objective. To describe the current condition of PHC reform. Materials and methods. Review of the available statistics and publications on this issue. Results and discussion. High-quality transformation of PHC requires consideration of historical experience, regulatory framework, financial efficiency, organization of quality medical care, effective human resources policy, and social efficiency. The groundwork for the current reform began in 2006, when the concept of the State Program for PHC development was adopted. Since 2010, there is a separate medical specialty “General practice – family medicine”. By 2020, there should be a complete retraining of physicians and pediatricians for FD, who had to take care of 80 % of the patient’s needs. New principles of financing for real patients and the functioning of the system allowing to choose a doctor were implemented only in 2017-2020, and all the imperfections of PHC could not be eliminated. FD should be aware that their competence and the depth of services provided are now particularly important. Another task of the reform is to improve the financial efficiency of PHC: streamlining the budget, providing the feasibility and justification of costs, establishing the free package of guaranteed medical services. The disadvantages of the current financial system are that the re-indexation of doctors’ salaries has not taken place, inflation and rising drug prices have not been taken into account. Apart from that, there are no adjustment factors for rural doctors and payment for home visits. The reasons for inefficient funding are the lack of budgetary resources, the inertia of management in the context of frequent changes in the leadership of the Ministry of Health, non-transparent management of some institutions, negative lobbying by representatives of other sectors of health care. The organization of medical care also does not address a number of issues: there are no national screening programs, no criteria for the quality of work of doctors and nurses, and no mechanism of life and health insurance of medical staff. The eHealth system and the personnel aspects of PHC also need improvement. Thus, in 5 out of 6 outpatient clinics there is a shortage of medical staff. The forced retraining of long-serving physicians has provoked considerable resistance, and some of these physicians have never become FD. Among other issues that need to be addressed are the establishment of interactions between the departments of medical universities and clinical bases, legalization of scientific and pedagogical workers in the system of the National Health Service of Ukraine, payment for the work of interns. In terms of social efficiency, the benefits for the patient are the ability to choose a doctor and a PHC facility, the availability of an electronic queue, free basic services, the ability to communicate with a doctor and order medication online. Disadvantages include problems with medical care in case of temporary absence of a doctor, especially unpredicted, lack of possibility of emergency admission in some institutions, long travel distance to the PHC institution. Conclusions. 1. The main goal of reforming the PHC system is to improve its quality and accessibility. 2. Qualitative transformation of PHC requires taking into account historical experience, regulatory framework, financial efficiency, organization of quality medical care, effective personnel policy, social efficiency. 3. The current PHC system has a number of gaps that should be gradually addressed. 4. Among other issues that need to be addressed – the establishment of interactions between the departments of medical universities with clinical bases, legalization in the system of the National Health Service of Ukraine of scientific and pedagogical workers, payment for the work of interns. 5. The advantages of the modern PHC system for the patient are the ability to choose a doctor and a PHC facility, the availability of an electronic queue, free basic services, the ability to communicate with a doctor and order medication online.
S.P. Moskovko, O.V. Kyrychenko
Infusion & Chemotherapy pp 221-223; https://doi.org/10.32902/2663-0338-2020-3.2-221-223

Abstract:
Background. Each 6 seconds 1 person in the world dies of a stroke. The stages of stroke care are the following: case detection, emergency medical care, diagnosis, treatment in the hyperacute and acute period, early and subsequent rehabilitation. The main symptoms of stroke can be identified with the help of FAST system (face – facial asymmetry, arm – limb weakness, speech – blurred speech, time – time after the event). Objective. To identify the main features of the management of stroke patients. Materials and methods. Analysis of the guidelines and literature data. Results and discussion. According to the recommendations of the American Heart Association for the emergency service, the time of processing of the call should be up to 90 seconds, the response time of the emergency service – 8 minutes, and the time spent at the place of care – up to 15 minutes. Upon admission to the hospital, the doctor of the stroke unit collects the anamnesis and takes a brief neurological examination, as well as determines the main physiological parameters. The nurse performs tests, the results of which come during thrombolysis. Then the patient undergoes a computed tomography, first aid is given and thrombolysis begins (still in the tomography apparatus). Time must be constantly documented. The median time should be 25 minutes. To organize the work of the stroke unit in the hyperacute and acute period of stroke it is necessary to create a local protocol – a document that lists the care procedures in a particular institution and describes the responsibility and coordination of individual units, time frames of each stage and basic medical services. It is also necessary to create a clinical roadmap for the patient, which includes a map of his moving, the content of procedures and their timer. Optimization of the stroke management is extremely important, as each 15 minutes of time saved leads to the 4 % reduction in mortality and to the 4 % increase in the likelihood of no adverse effects. In the first 3 hours it is especially important to monitor such parameters as body temperature, blood glucose, swallowing function (fever, sugar, swallowing – FESS) thoroughly. It is a significant problem, but for the most options of medical support the evidence base is insufficient, and therefore the doctor faces the choice to follow imperfect recommendations or to prescribe drugs according to the pathogenesis of cerebral ischemia. This choice has to be made in settings of severe time shortage, because the stroke kills 9,000 neurons every second. Stages of the ischemic cascade include ischemia, glutamate excitotoxicity, mitochondrial damage and dysfunction, oxidative and nitrosative stress, inflammation, and microcirculation disorders. Edaravone affects these stages, reducing the activity of oxygen radicals, the permeability of the blood-brain barrier, and the activity of secondary inflammation. This reduces the ischemic penumbra and the brain tissue necrosis area, which increases the likelihood of functional recovery. The study by M. Enomoto et al. (2019) showed that the use of edaravone and the endovascular reperfusion is a promising strategy for the treatment of ischemic stroke. Conclusions. 1. To coordinate the work of the stroke unit in the hyperacute and acute period of stroke, it is necessary to create local protocols and the clinical roadmap. 2. During the first 3 hours it is especially important to monitor such parameters as body temperature, blood glucose, and swallowing function. 3. Edaravone affects the ischemic stroke, reducing the activity of oxygen radicals, the permeability of the blood-brain barrier, and the activity of secondary inflammation.
О.V. Kuriata, M.M. Grechanyk
Infusion & Chemotherapy pp 159-161; https://doi.org/10.32902/2663-0338-2020-3.2-159-161

Abstract:
Background. Arterial hypertension (AH) and heart diseases are the leading causes of morbidity, mortality and the number of visits to the doctor. Cardiac patients are characterized by the frequent polymorbidity. The cardiovascular continuum, which predicts the course of events from atherosclerosis to the final stages of cardiovascular diseases (CVD), includes the following pathogenetic links: oxidative stress, inflammation and endothelial dysfunction (ED). Objective. To describe the management of a cardiac patient with comorbidity and promising options for the ED correction. Materials and methods. Analysis of the literature on this issue. Results and discussion. The previous paradigm of CVD development involved damage to target organs due to hypertension. Instead, according to the current paradigm, CVD are the result of the vascular dysfunction. The recently proposed paradigm indicates that all CVD are based on ED. Nitric oxide (NO) is the main molecule necessary for the proper functioning of the endothelium. NO takes part in the relaxation of blood vessels and smooth muscles, regulates the synthesis and secretion of a number of hormones, controls platelet activity and the interaction of leukocytes with vascular walls, participates in antipathogenic reactions of the immune system. ED is known to be a predictor of complications and poorer survival in patients with coronary heart disease. Dysfunctional endothelium promotes vasoconstriction, oxidation, inflammation and thrombosis. To improve the condition of the endothelium, it is advisable to increase the NO content. The increase in NO content can be the result of angiotensin-converting enzyme inhibitors, calcium channel blockers, sartans, statins, estrogens, antioxidants, and aspirin intake, as well as exercise. L-arginine is the substrate for the NO formation in human body. Potential mechanisms of L-arginine effect in AH include improvement of endothelial function, increase of vascular NO synthesis, decrease of endothelin-1 and angiotensin II activity, modulation of renal hemodynamics and reduction of oxidative stress. L-arginine therapy (9 g per day for 4 weeks) reduced systolic blood pressure by 4 mm Hg and diastolic – by 2.6 mm Hg. L-arginine also has a beneficial effect on the metabolic profile via increasing insulin sensitivity. The use of L-arginine is well studied in patients with chronic heart failure (HF) with preserved ejection fraction. In this category of patients, such treatment leads to an increase in glomerular filtration rate, improvement of endothelium-dependent vasodilation, reduction of the functional class of HF. The ESPEN guidelines on parenteral nutrition state that the use of L-arginine has both NO-dependent and NO-independent effects. The latter include the synthesis of creatine, proline and polyamines; stimulation of insulin and growth hormone secretion. Administration of L-arginine in combination with L-carnitine helps to eliminate the advanced glycation end products and to increase the rate of glomerular filtration. Conclusions. 1. The cardiovascular continuum includes such elements as oxidative stress, inflammation and endothelial dysfunction. 2. NO is the main molecule necessary for the proper functioning of the endothelium. 3. L-arginine is the substrate for the NO formation in human body. L-arginine also helps to improve endothelial function, to reduce the activity of endothelin-1 and angiotensin II, to modulate renal hemodynamics and to reduce oxidative stress. 4. L-arginine also has a beneficial effect on the metabolic profile via increasing insulin sensitivity. 5. In patients with chronic HF with preserved ejection fraction, treatment with L-arginine leads to an increase in glomerular filtration rate, improvement of endothelium-dependent vasodilation, reduction of the functional class of HF.
O.A. Halushko
Infusion & Chemotherapy pp 31-32; https://doi.org/10.32902/2663-0338-2020-3.2-31-32

Abstract:
Background. Intoxication syndrome (IS) is one of the most common syndromes in the medical practice, but its exact scientific outline has not yet been established. This is due to a variety of toxic factors, a large polymorphism of symptoms, and complex interactions between the processes of toxin production and detoxification. Objective. To describe the main features of IS and its treatment. Materials and methods. Analysis of literature sources on this issue. Results and discussion. The morphological basis of IS is the subcellular interaction between the toxin and the receptor. IS develops if the toxins’ entry or formation outweigh their elimination. Intoxications are divided into exogenous and endogenous. The diagnostic criteria for exogenous intoxications are the contact of the patient with the substance that caused the intoxication and the corresponding damage to the organs. Exogenous intoxications have a clear clinical picture, and the introduction of specific antidotes or antitoxins is the best treatment. In turn, endogenous IS is mediated by the accumulation of bacterial endotoxins, excess amounts of physiological metabolic products, biologically active substances and mediators. Natural ways of detoxification include metabolism, excretion and immune mechanisms. Infusion detoxification (IDT) with a significant load by crystalloids and multicomponent drugs is a mandatory treatment for both exogenous and endogenous IP. In most cases, the volume of infusion should be 25-35 ml/kg body weight. Requirements for the ideal drug for detoxification include hypervolemia, improving microcirculation and rheological properties of blood, correction of electrolyte disorders and disorders of acid-base balance, increase of diuresis and peristalsis. All these effects are typical for Reosorbilact (“Yuria-Pharm”). In general, the IDT program may include classical and balanced crystalloids (800-1500 ml), Reosorbilact (600-800 ml), specialized solutions (100-200 ml), and symptomatic drugs. The optimal duration of treatment with Reosorbilact is 7 days. Conclusions. 1. Exact scientific characteristics of IS are still missing. 2. IDT is the mandatory method of treatment of exogenous and endogenous IS. 3. Reosorbilact is the main component of IDT in any IP, as it affects the main links of the pathogenesis of the latter.
O.B. Dynnyk
Infusion & Chemotherapy pp 80-81; https://doi.org/10.32902/2663-0338-2020-3.2-80-81

Abstract:
Background. The microcirculatory system (MCS) is a network of blood vessels that includes arterioles, capillaries, venules, and terminal lymphatic vessels. Microcirculation is characterized by the constant variability. Factors of atherogenesis development due to MCS dysfunction include shear stress, hyperglycemia, dyslipidemia, systemic and local inflammation, hypoxia and endothelial dysfunction mediated by oxidative stress. Laser Doppler flowmetry (LDF) is used to study microcirculation in the clinical settings. The advantages of LDF include simplicity, accessibility and non-invasiveness. Objective. To describe the features of microcirculation disorders and their elimination. Materials and methods. Analysis of literature data on this topic; own study. The study involved 98 patients (59 females; 39 males) with a mean age of 52.0 years. The first group consisted of patients with coronary heart disease (CHD) and chronic heart failure of I-IIA grades, the second – of relatively healthy individuals. All patients underwent LDF, ultrasound examination of the carotid arteries, and determination of anthropometric parameters. Results and discussion. MCS dysfunction is not only a risk factor for atherogenesis, but also a trigger for its acute complications (myocardial infarction, stroke, sudden death). Nitric oxide (NO) deficiency plays an important role in this. A potential target of therapeutic influence in the treatment of coronary heart disease is not only macrovascular system, but also vasa vasorum. The condition of the latter determines the course of atherosclerosis. According to the results of our own study, patients with CHD demonstrated a muscle mass decrease, an increase in waist and hip circumference, and in body mass index. In addition, the groups differed in thickness of the intima-media complex of both common carotid arteries (right common carotid artery: CHD group – 0.79±0.18 mm; group of relatively healthy individuals – 0.69±0.13 mm, p<0,05; left common carotid artery: CHD group – 0.81±0.19 mm, group of relatively healthy individuals – 0.70±0.14 mm, p<0,05). When assessing the indicators of wavelet analysis of LDF, a significant decrease in the rate of microcirculation and capillary blood flow reserve is revealed in the CHD group, as well as an increase in peripheral vascular resistance. According to previous own studies, sorbitol (Reosorbilact, “Yuria-Pharm”) and pentoxifylline (Latren, “Yuria-Pharm”) can be used to correct microcirculation disorders. The use of these drugs leads to vasodilation of precapillary sphincters and improvement of regional microperfusion. Conclusions. 1. Disorders of MCS are the pathogenetic factors of the atherogenesis. 2. Laser Doppler flowmetry is used to study microcirculation in the clinical settings. 3. In patients with CHD there is an increase in neuro- and myotonus of the MCS, which is associated with the impaired release of nitric oxide. 4. Changes in microcirculation contribute to the development of atherosclerosis, which should be taken into account when choosing treatment for such patients. 5. Sorbitol (Reosorbilact) and pentoxifylline (Latren) can be used to correct microcirculation disorders.
A. Astier
Infusion & Chemotherapy pp 10-11; https://doi.org/10.32902/2663-0338-2020-3.2-10-11

Abstract:
Background. For hospital pharmacists and nurses it is critical to have real data about the stability of injectable drugs in practical situations: opened drug formulation, after the reconstitution of lyophilized production or after the dilution in various vehicles. Unfortunately, these data are seldom available. The manufacturer’s stability data are usually quoted as “stable for 24 hours at 4 °C” not for the true reasons, but considering the possible bacterial contamination or due to the fact that stability tests were only conducted during a very short period. This problem is of paramount importance for therapeutic proteins, mainly monoclonal antibodies, because the latter are very expensive. Objective. To define the in use stability of anticancer drugs. Materials and methods. Analysis of literature data on this topic; own study on diluted rituximab stability. Results and discussion. Biologic drugs have revolutionized the treatment and prevention of many debilitating and life-threatening diseases. Biologics are much bigger and have a much more complicated structure than classical drugs. Principal causes of biologics’ instability include temperature changes, dilution, absorption, oxidation, shaking and shearing etc. Protein instability can be divided into physical and chemical instability. The former includes aggregation, denaturation and absorption on surfaces, and the latter – desamidation, disulfide bonds breakage and formation, oxidation, hydrolysis, isomerization, non-disulfide cross-linking, and deglycosylation. Instability of anticancer drugs and biologicals can lead to their toxicity, immunogenicity and efficacy loss. Instability can be overcome by the centralization of pharmacy handling, but firstly it needs to be thoroughly studied with the help of modern methods. The own study has revealed that the diluted rituximab is stable up to 6 months in polyolefin bags stored at 4 or 22 °C. The preparations can be realized without any problems. There also no fear of instability in case of thermal excursions. Such findings if introduced in practice can save about 150,000 euros a year. Conclusions. 1. In-use analysis of proteins requires several methods. 2. Instabilities are divided into physical and chemical. 3. Aggregation is an initial response to any stress and must be completely eliminated.
S.V. Bolgarska
Infusion & Chemotherapy pp 17-18; https://doi.org/10.32902/2663-0338-2020-3.2-17-18

Abstract:
Background. Diabetic foot syndrome (DFS) is the presence of an infection and/or ulcer defect of the foot associated with neuropathy and circulatory disorders of the lower extremities of varying severity. Insensitivity of the foot, its deformation and constant load lead to the formation of necrosis under hyperkeratosis with the potential infectious process development. Objective. To describe the features of the course and treatment of DFS. Materials and methods. Analysis of literature data on this issue. Results and discussion. Classification of diabetic ulcers is carried out according to the PEDIS system, where P means perfusion, E – extent, D – depth, I – infection, S – sensation. To assess the circulatory status of the lower extremities, the ankle-brachial index (ABI) and transcutaneous oxygen tension are determined. Critical ischemia is determined by the following criteria: tibial systolic blood pressure <50 mm Hg, big toe blood pressure <30 mm Hg, or transcutaneous oxygen tension <30 mm Hg, or ABI <0.5. DFS treatment involves unloading the foot with the help of special shoes or orthoses, ultrasonic or vacuum cavitation of wounds, surgery, antibiotic therapy. If necessary, anti-pseudomonad antibiotics should be used (ceftazidime, cefoperazone, cefepime, imipenem, meropenem, ciprofloxacin, amikacin). 95 % of the microorganisms present in the world are able to coexist in the form of biofilms – communities of microorganisms in a matrix of polymers (mucopolysaccharides), which are released by the same bacteria. Taking this into account, one should choose antibiotics that can penetrate biofilms. Diabetic ulcers should be covered with dressings such as Hydroclean plus, which contain an antiseptic that protects the wound from secondary infection, prevents excessive evaporation of moisture and has an atraumatic contact layer that prevents traumatization of the young granulation tissue. This dressing continuously releases Ringer’s solution into the wound and absorbs the wound exudate, creating a continuous washing effect. Lacerta (“Yuria-Pharm”) can be used to stimulate the regeneration of long-term defects of connective tissues. Lacerta activates the migration and proliferation of fibroblasts, accelerates their metabolic activity, and enhances angiogenesis. Other methods of accelerating of the wound healing include the use of cryopreserved amniotic membranes and the injection of stem cells. Conclusions. 1. DFS is the presence of an infection and/or ulcerative defect of the foot associated with neuropathy and circulatory disorders of the lower extremities. 2. Classification of diabetic ulcers is carried out according to the PEDIS system. 3. Treatment of DFS involves unloading the foot with special shoes or orthoses, ultrasonic or vacuum cavitation of wounds, antibiotic therapy, surgery. 4. It is advisable to cover diabetic ulcers with hydrogel bandages. 5. Lacerta can be used to stimulate the regeneration of persistent skin defects.
A.J. Garga
Infusion & Chemotherapy pp 48-50; https://doi.org/10.32902/2663-0338-2020-3.2-48-50

Abstract:
Background. Personal protective equipment (PPE) is an item of clothing designed to protect healthcare workers (HCW) or others from infection. PPE includes gloves, masks, gowns, respirators, goggles, face shields, headgear, boot covers, rubber shoes, and more. Objective. To describe the evolution of medical devices for HCW protection. Materials and methods. Review of literature data on this issue. Results and discussion. Medical gloves are divided into sterile and non-sterile. The purpose of wearing non-sterile gloves is to prevent contamination of the hands of HCW with microorganisms. They should be worn when there is a risk of contact with blood or other body fluids, patient secretions, or contaminated equipment. Gloves do not protect against contamination and after their use it is still necessary to treat hands with antiseptic. Latex gloves have good elasticity and flexibility, are convenient and anatomically suitable for hands, have a good sensitivity to touch. However, they can cause allergies or skin irritation. Latex allergy is the most common cause of perioperative anaphylaxis in children. It is recommended to use powder-free gloves. Nitrile gloves for examination manufactured by “Yuria-Pharm” are characterized by high toughness, elongated cuff, and special texture facilitating holding the instruments. Surgical masks consist of three layers of thermoplastic polymer located between the layers of nonwoven fabric. They are designed to protect against pathogens (mainly bacteria) transmitted in large droplets (>5 μm). The Cochrane review did not show any convincing effect of wearing of surgical masks on reducing the risk of infectious complications during sterile surgical procedures. WHO recommends wearing surgical masks to prevent the transmission of coronavirus disease (COVID-19). N95 or FFP3 class respirators are recommended for aerosol-generating procedures (tracheal intubation, bronchoscopy) and for dangerous infections. N95 respirators are the standard for working with patients with COVID-19 in USA. They can be with a valve or without it. These respirators consist of thermoplastic polymer and nonwoven fabric and filter 95 % of particles sized ≥0.3 μm. They should tightly fit to the face and be tested for leaks before the contact with patient. A similar tactic should be used when wearing FFP3 respirator. Valve respirators are easier to use because the presence of a valve facilitates exhalation. The valve also increases comfort and prevents excessive accumulation of moisture under the respirator. Such respirators do not filter the exhaled air, so they do not protect others from infection. Another field of PPE application is its usage in hematocontact infections caused by hepatitis B/C virus and human immunodeficiency virus. The risk of HCW infection is associated with pricks, cuts, contact with the patient’s body fluids, and any invasive diagnostic or treatment procedures. The risk of patient’s infection is present in case of the improper instruments sterilization, use of non-sterile infusion solutions, transfusion of blood and its components, transplantation, and contact with biological fluids of the infected HCW. To reduce the risk of HCW infection, always wear gloves if there is a risk of contact with blood or other body fluids; never put the cap on the needle after using it; always keep a container for sharp objects on hand; carry out the necessary vaccinations; use PPE and safety needles, scalpels and syringes. Conclusions. 1. Wearing masks reduces the risk of COVID-19 transmission. 2. During aerosol-generating procedures it is necessary to use all available PPE. 3. When wearing a respirator, it is advisable to check its tightness. 4. The number of extra injections should be minimized.
V.I. Chernii
Infusion & Chemotherapy pp 303-305; https://doi.org/10.32902/2663-0338-2020-3.2-303-305

Abstract:
Background. Inadequate volume of perioperative infusion therapy (IT) is one of the predictors of postoperative complications. There are different types of infusion solutions on the pharmaceutical market: albumin, dextrans (Reopoliglukin), polyatomic alcohols (Reosorbilact, Sorbilact), hydroxyethyl starch preparations (Gekodez), modified gelatin (Volutenz), balanced colloid-hyperosmolar solution (Gekoton), etc (all listed solutions are produced by “Yuria-Pharm”). Objective. To describe the main features of perioperative IT. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Inadequate IT can cause hypo- and hypervolemia, as well as slow the recovery after surgery, so the choice of infusion solution should be made very carefully. To eliminate endothelial dysfunction, which often accompanies the perioperative period, it is advisable to prescribe L-arginine (Tivortin, “Yuria-Pharm”), which acts as a substrate for the synthesis of nitric oxide. Tivortin has the following properties: membrane stabilizing, antioxidant, cytoprotective, detoxifying, endothelioprotective, anabolic, hepatoprotective, antihypoxic. L-arginine (Tivortin) also helps to correct acid-base balance, neutralizes and removes ammonia, promotes insulin synthesis and regulates blood glucose, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium. The position paper of the International Fluid Optimization Group (2015) states that in planned operations without blood loss, crystalloids can be prescribed (2 ml/kg/h for surgeries lasting >4 hours, up to 10 ml/kg/h for surgeries lasting up to 1 hour). However, the disadvantages of the most famous crystalloid (0.9 % saline) are the risk of hyperchloremic acidosis and the development of edema in case of overdose, so it is advisable to use ion-balanced solutions instead of 0.9 % NaCl. The ideal electrolyte solution should be isovolemic, isohydric, isooncotic, isoionic, and isotonic to the blood plasma. Elimination of the metabolic acidosis is an important task of perioperative IT. Soda-Bufer (“Yuria-Pharm”) can be used for this purpose, as the administration of sodium bicarbonate reduces mortality in patients with severe metabolic acidosis and acute kidney damage. To eliminate the intoxication syndrome, drugs of polyatomic alcohols (Reosorbilact) have been successfully used. Efficiency of Reosorbilact in the treatment of sepsis, peritonitis, pneumonia, burns, etc. was confirmed in the numerous studies. In addition to detoxification, Reosorbilact supports hemodynamics and microcirculation, corrects metabolic acidosis and water-electrolyte disorders, stimulates diuresis, normalizes the rheological properties of blood, which makes it the main drug for low-volume IT in the perioperative period. In turn, Xylate is the main solution in diabetes because it has antiketogenic and lipotropic properties, improves hemodynamics and microcirculation, corrects metabolic acidosis and has an osmodiuretic effect. In shock settings IT should be administered according to the ROSE concept (R (rescue) – aggressive IT; O (optimization) – support of tissue perfusion; S (stabilization) – supportive IT; E (evacuation) – deresuscitation, restoration of body functions). Conclusions. 1. Optimal IT improves the consequences of the surgery. 2. To eliminate endothelial dysfunction, it is advisable to prescribe L-arginine (Tivortin). 3. Reosorbilact is successfully used to eliminate the intoxication syndrome, which also supports hemodynamics and microcirculation, corrects metabolic acidosis and water-electrolyte disorders, which makes it the main drug for low-volume IT in the perioperative period. 4. Xylate is the main solution in diabetes because it has antiketogenic and lipotropic properties, improves hemodynamics and microcirculation. 5. In shock settings IT should be administered according to the ROSE concept (rescue, optimization, stabilization, evacuation).
V.I. Chernii
Infusion & Chemotherapy pp 306-308; https://doi.org/10.32902/2663-0338-2020-3.2-306-308

Abstract:
Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance. Objective. To describe modern IT. Materials and methods. Analysis of the literature sources on this topic. Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes, reduces the aggregation of erythrocytes and platelets, normalizes the electrolyte composition of blood plasma, and Tivortin acts as a substrate for the formation of nitric oxide – the main signaling molecule of the endothelium. In addition to EI, IT usage is often prescribed for diabetic ketoacidosis. In such cases, it is advisable to use Xylate (“Yuria-Pharm”), which has antiketogenic properties, improves hemodynamics, corrects acidosis, and does not increase blood glucose levels. Xylate is recommended to be used only after preliminary rehydration with the help of isotonic saline solutions. Conclusions. 1. IT is an important method of treating a number of diseases. 2. EI accompanies not only diseases that involve intoxication syndrome, but also almost all internal diseases. 3. Reosorbilact and Xylate are the optimal solutions for detoxification. 4. It is reasonable to use combined IT, for example, the combination of Reosorbilact with Latren and Tivortin.
S.I. Zhuk, Ye.S. Antoniuk
Infusion & Chemotherapy pp 103-105; https://doi.org/10.32902/2663-0338-2020-3.2-103-105

Abstract:
Background. Anemia is a decrease in the number of erythrocytes and hemoglobin levels as a result of blood loss, disruption of erythropoietic cell production, and increased erythrocyte breakdown or a combination thereof. Anemia of pregnant women is divided into physiological anemia and pathological conditions. In case of latent iron deficiency clinical manifestations are absent. This condition is characterized by a decrease in iron and erythropoietin to a level sufficient to maintain hematological parameters at the lower limit of normal values. In the absence of iron supplements administrations 65 % of cases of latent deficiency end up in a manifest deficiency. Objective. To describe the features of the anemia treatment in inpatient settings. Materials and methods. Analysis of literature sources on this issue. Results and discussion. The normal value of hemoglobin for the 1st and 3rd trimesters is ≥110 g/l, for the 2nd – ≥105 g/l. After childbirth, anemia is determined as a decrease in hemoglobin <100 g/l. Risk factors for anemia in pregnant women include poor nutrition, chronic diseases, chronic intoxication, history of anemia, bleeding during pregnancy, multiple pregnancy, frequent childbirth with a long lactation period, and short intervals between births. Anemia in pregnant women increases the probability of premature birth by 63 %, of low birth weight – by 31 %, of perinatal mortality – by 51 %, of neonatal death – in 2.5 times. In case of maternal anemia, the newborn has a worse development of external respiratory function, a lag in the weight gain and a greater susceptibility to infectious diseases. To diagnose anemia, a general blood test and determination of additional indicators (serum iron, ferritin, ferritin saturation, transferrin, soluble ferritin receptor) are used. Patients with mild anemia do not require hospitalization; patients with moderate anemia need hospitalization in the absence of a response to oral iron supplements; patients with severe anemia need hospitalization after the mandatory consultation of hematologist. The purposes of anemia treatment include the normalization of blood tests, correction of iron deficiency, and the creation of iron stores to ensure full fetal development and lactation. Evaluation of treatment is performed on the 21st day after treatment; normally the increase in hemoglobin is about 1 g per 1 day of therapy. If hemoglobin has increased by <10 g/l, it is advisable to prescribe intravenous iron. Indications for parenteral administration also include the intolerance to oral iron supplements, peptic ulcer disease in the exacerbation phase, lack of confidence in the good adherence of the patient, hemodialysis, swallowing disorders, and the need for a more pronounced increase in hemoglobin. If it is necessary to quickly restore the level of blood hemoglobin in the late stages of pregnancy, Sufer (“Yuria-Pharm”) can be administered (10.0 ml in 200.0 ml of saline intravenously 1-3 times a week). Parenteral administration of iron supplements should be administered with caution in case of polyvalent allergies, active infections, chronic liver disease, and signs of iron overload. Parenteral administration of iron supplements is not indicated in the 1st trimester of pregnancy. Conclusions. 1. Anemia in pregnant women increases the likelihood of premature birth, low birth weight, perinatal mortality, and neonatal death. 2. The purposes of anemia treatment are the normalization of blood tests, correction of iron deficiency and the creation of iron stores. 3. Indications for parenteral administration of iron are lack of response and intolerance to oral iron supplements, exacerbation of the peptic ulcer disease, and the need for a more pronounced increase in hemoglobin. 4. If it is necessary to quickly restore the level of hemoglobin in the late stages of pregnancy, Sufer may be prescribed.
I.A. Kriachok
Infusion & Chemotherapy pp 156-158; https://doi.org/10.32902/2663-0338-2020-3.2-156-158

Abstract:
Background. Treatment of blood malignancies is often accompanied by the hematological toxicity. Thrombocytopenia is one of the most common phenomena, which can be caused by pseudothrombocytopenia, production deficiency or increased destruction of platelets, their pathological distribution or aggregation. Objective. To determine the features of hematological toxicity in the treatment of malignant blood diseases. Materials and methods. Analysis of literature data and recommendations on this topic. Results and discussion. Diagnosis of thrombocytopenia involves a detailed study of a peripheral blood smear to assess the morphology of all cells, as well as additional studies (determination of lactate dehydrogenase, D-dimer, fibrinogen, etc.; aspiration and bone marrow biopsy; virological and bacteriological studies; clinical examination). The main causes of thrombocytopenia in cancer patients are chemotherapy (ChT) and radiation therapy (RT), however, the diagnosis should take into account all possible nosological options. The assessment should be performed if the platelet count is <100,000/μl. The normal lifespan of platelets is 8-10 days, so after many types of ChT thrombocytopenia develops about 7th days after treatment, reaches a maximum of 14th days and ends in 28-35th days. After RT thrombocytopenia usually starts in 7-10th days after its termination and is present during 30-60 days. Before treating thrombocytopenia, the need for ChT should be re-evaluated and the risk of bleeding assessed, and the ChT regimen should be changed if possible. If the risk of bleeding is high or the platelet count is critically low, platelet transfusion is prescribed, however, it has recently been found that absolute platelet count is not a predictor of bleeding risk in this patient population (PLADO study). In addition, platelet transfusion is limited in resources and costly, and is accompanied by the risk of side effects (acute lung damage due to transfusion, fever, bacterial sepsis, development of transfusion intolerance). This became the basis for the search for alternative treatment options. Recombinant interleukin-11 (oprelvekin) reduces the need for platelet transfusion from 96 to 70 % of patients on ChT. However, although this drug is FDA-approved, it is characterized by a large number of side effects. In turn, thrombopoietin receptor agonists (subcutaneous romiplostin, oral eltrombopag) bind to the corresponding receptors and increase the number of platelets in the blood. The effectiveness of treatment is within 70 %. Emaplag (“Yuria-Pharm”) is the first and only eltrombopag in Ukraine. Emaplag is indicated for the treatment of thrombocytopenia caused by ChT in patients with solid tumors, patients with platelet counts <50×109/L, and in cases where the physician decides to increase platelet count. With regard to anemias, their main causes in cancer patients are the factors of the underlying disease (bone marrow infiltration, infectious processes), the impact of ChT or RT, other causes (malnutrition, bleeding, renal dysfunction). Examination of patients with anemia should include history taking, evaluation of blood smear and iron metabolism, exclusion of occult gastrointestinal bleeding and renal failure, Coombs’ test, determination of endogenous erythropoietin. Treatment options for ChT-induced anemia include blood transfusions and the use of erythropoietins (epoetins α and β, darbepoetin) with or without iron supplements (oral or intravenous). The advantages of using erythropoietin include reducing the need for transfusion of erythrocyte mass, a gradual increase in hemoglobin, increasing quality of life. However, erythropoietins are not recommended for use in cancer patients who do not receive ChT or receive RT, because in these cases, their use is associated with an increased mortality risk. Because in some patient groups erythropoietins accelerate tumor growth or reduce survival, the patient must give a written informed consent for their use. Given these data, it is advisable to prescribe intravenous iron, as it allows not only to quickly increase hemoglobin and improve quality of life, but also to reduce the dosage of erythropoietins. Iron carboxymaltose if the most modern parenteral iron preparation. It is characterized by low toxicity and high stability. Conclusions. 1. Thromboconcentrate transfusion is a fast and effective way to correct thrombocytopenia, which has a number of disadvantages. 2. Thrombopoietin receptor agonists (eltrombopag) make it possible to increase the effectiveness of treatment without interrupting the planned therapy. 3. In the presence of anemia, all possible causes should be corrected before prescribing erythropoietins. 4. If the anemia is caused by ChT, the patient needs to take erythropoietins. 5. Addition of intravenous iron preparations to erythropoietin therapy significantly increases the effectiveness of treatment.
S.G. Agop
Infusion & Chemotherapy pp 4-6; https://doi.org/10.32902/2663-0338-2020-3.2-4-6

Abstract:
Background. Peritonitis is a consequence of complications of the abdominal cavity organs’ diseases (inflammation, injury) and systemic inflammatory reaction of the organism, which is manifested by symptoms of intoxication and dysfunction of all the organs. In case of diffuse peritonitis mortality is about 80 %. Prerequisites of the lethal outcomes include a late visit to the doctor, elderly age, the presence of cancer and diabetes, antibiotic resistance of the pathogen, diagnostic errors. In the department of purulent gynecology peritonitis most often accompanies endometritis, purulent salpingitis, pyosalpinx, abscesses, uterine perforation during curettage. In Moldova, the principles of treatment of peritonitis include the urgent surgery to remove the infection source, aspiration of exudate, massive lavage, abdominal drainage, antibiotic therapy, and correction of metabolic disorders. Objective. To determine the effectiveness of Reosorbilact in eliminating the intoxication syndrome in peritonitis. Materials and methods. The Rheo-STAT study was an international multicenter, randomized, open-label clinical trial of the efficacy and safety of Reosorbilact (“Yuria-Pharm”) in the treatment of sepsis, peritonitis, community-acquired pneumonia, and burn disease. The study was conducted in 7 countries (Ukraine, Moldova, Georgia, Vietnam, Kazakhstan, Kyrgyzstan, Uzbekistan). 5 of them (Ukraine, Moldova, Georgia, Kazakhstan, Uzbekistan) took part in the sub-study Rheo-STAT Peritonitis. The study involved 628 adult patients with sepsis, peritonitis, pneumonia and burns. The subgroup of peritonitis consisted of 180 people (27 % males, 73 % females; mean age – 37 years; concomitant infectious diseases were observed in 25 %, complicated appendicitis – in 17 %), 117 of them were treated in Moldova (87 % females, 13 % males, mean age – 45.2 years). The inclusion criteria were age 18-60 years, diagnosis of peritonitis, the first hours of the postoperative period, no later than 24 hours from diagnosis to the first visit of the study, obtaining informed consent, baseline level on the SOFA scale ≥2. The total score on the SOFA scale on day 3 of treatment compared to baseline was considered a primary endpoint. Secondary endpoints were the change in the overall score on the APACHE II, SAPS II, MODS, PSI/PORT, CURB-65 scales; changes in biochemical, immunological and integral markers of endogenous intoxication. Results and discussion. Low-volume infusion therapy with Reosorbilact (200-400 ml per day) resulted in an increase in circulating blood volume and a decrease in the total volume of infusions required without the risk of volume overload. Exogenous lactate in Reosorbilact did not increase the content of endogenous lactate, which indicates the high safety of the drug. The inclusion of Reosorbilact in the comprehensive treatment after 3 days provided a decrease in body temperature from 37.1 to 36.75 °C, heart rate – from 88.5 to 82.0 bpm, the leukocyte count – from 11.0 to 7.2×109/L. Reosorbilact therapy in 3 days improved the acid-base balance, as evidenced by the increase in the base excess from -2.73 to -0.57 mmol/L and an increase in standard bicarbonate from 21.8 to 23.5 mmol/L. Conclusions. 1. Prerequisites for the lethal consequences of peritonitis include a late visit to the doctor, elderly age, the presence of cancer and diabetes, antibiotic resistance of the pathogen, and diagnostic errors. 2. Elimination of intoxication syndrome is one of the main components of peritonitis treatment. 3. Reosorbilact infusion therapy increases the volume of circulating blood without the risk of volume overload. 4. The inclusion of Reosorbilact into the comprehensive treatment of sepsis after 3 days provided a decrease in body temperature, heart rate, white blood cell count and normalization of the acid-base composition of the blood.
M.A. Treshchynska
Infusion & Chemotherapy pp 286-288; https://doi.org/10.32902/2663-0338-2020-3.2-286-288

Abstract:
Background. Dorsopathy is a group of diseases of the musculoskeletal system and connective tissue associated with degenerative diseases of the spine. Risk groups for the development of dorsopathies include people with a sedentary lifestyle, people working in difficult conditions, athletes, military personnel, people with obesity. Clinical classification of dorsopathies involves their division according to the affected level (cervical, thoracic, lumbosacral). Objective. To describe the management of patients with back pain. Materials and methods. Analysis of literature data on this topic. Results and discussion. Cervicocranialgias, related to dorsopathies, include vertebral artery syndrome (VAS) and extravasal artery compression (EAC). VAS is a complex of cerebral, vascular and autonomic disorders that occur due to the damage of the sympathetic plexus of vertebral artery, deformation of the wall or changes in its lumen. In turn, EAC involves the compression of blood vessels by bone abnormalities, muscles, osteophytes of the cervical vertebrae, scars, tumors, and so on. Lower back pain (LBP) is one of the most common dorsopathies. Its prevalence has doubled in the last decade. The mechanism of aseptic inflammation in dorsopathies includes such links as the release of proinflammatory mediators, activation of peripheral nociceptors, production of cyclooxygenase-2 and the formation of prostaglandins. Pain in dorsopathies is classified into nociceptive (caused by the excitation of nociceptors in damaged tissues), neuropathic (caused by damage to the central or peripheral nervous system) and psychogenic (caused by primary mental disorders). By duration, LBP is classified into acute (3 months). According to the etiology, the following subspecies are distinguished: radicular (disc herniation, spondylosis, vertebral canal stenosis), specific (cancer, infection, fracture, equine tail syndrome) and nonspecific (myogenic disorders, facet syndrome). In the presence of so-called symptoms of red flags, it is recommended to conduct imaging examinations according to the indications. Such symptoms include pain development at the age of 55 years, recent back injury, progressive character, deterioration or lack of dynamics after keeping horizontal position, prolonged use of glucocorticoids, history of malignant tumors, osteoporosis, intravenous drugs injection, immunodeficiency, weight loss, fever, focal neurological symptoms, pain on palpation of the spine, spinal deformity. The symptoms of yellow flags predict pain chronization. The latter include certain work-related circumstances, beliefs, behaviors, and affective symptoms. The main causes of non-specific back pain include muscular-tonic pain syndrome (MTPS), myofascial pain syndrome (MFPS), arthropathies. Microcirculatory disorders, caused primarily by the reflex muscle spasm, play a significant role in the development of pain in these conditions. MTPS develops on the background of degenerative-dystrophic changes in the spine, ligaments and muscles as a result of exposure to provoking factors (significant physical exertion, injuries, sudden movements, prolonged stay in a static position, general or local hypothermia). Chronization of MTPS leads to the development of MTFS. Ischemic muscle spasm leads to the spasm of arteries and dilation of venules with impaired microcirculation and accumulation of inflammatory mediators. In turn, radicular ischemia develops with radicular pain. Venous plexus, which is compressed at the stage of stenosis without signs of direct compression of the root, is the most vulnerable structure of the intervertebral space. Treatment of LBP includes bed rest, sleep on a hard surface, the use of non-specific anti-inflammatory drugs, local administration of local anesthetics, muscle relaxants, B vitamins, therapeutic exercises and surgical treatment. Restoration of microcirculation makes it possible to influence the pathogenesis of radiculoischemia. Drugs that improve microcirculation and hemodynamics are included in the domestic clinical protocol for the treatment of dorsalgia. Reosorbilact (“Yuria-Pharm”) improves substance exchange between blood and tissues and helps to remove metabolic products. These effects are based on the opening of precapillary sphincters on the background of this solution use. For dorsalgia, it is also advisable to prescribe Latren (“Yuria-Pharm”) – a combination of pentoxifidine and Ringer’s lactate. Latren inhibits the aggregation of blood cells, increases the elasticity of erythrocytes, promotes vasodilation, normalizes the electrolyte composition of blood plasma. To eliminate endothelial dysfunction, Tivortin (“Yuria-Pharm”) is prescribed, which promotes vasodilation. The use of the listed above infusion drugs influences the pathogenesis of the process, eliminating dorsalgia. Conclusions. 1. LBP is one of the most common dorsopathies. 2. Pain in dorsopathies is classified into nociceptive, neuropathic and psychogenic. 3. Microcirculatory disorders play a significant role in the development of nonspecific LBP. 4. Combined use of Reosorbilact, Latren and Tivortin influences the pathogenesis of the process, eliminating dorsalgia.
Yu.V. Davydova
Infusion & Chemotherapy pp 72-74; https://doi.org/10.32902/2663-0338-2020-3.2-72-74

Abstract:
Background. Experience in high-risk obstetrics shows that a significant part of the determining factors affects the woman and the fetus before the first visit to the doctor. Improving a woman’s health before conception can improve her reproductive performance and reduce financial costs spent on obstetric medical aid. Objective. Describe the key concepts of preconception training. Materials and methods. Analysis of literature sources on this topic; own study involving 42 pregnant women (22 women with systemic lupus erythematosus (SLE), 20 women with congenital heart disease (CHD) and hypertensive complications of previous pregnancies), who were divided into two groups. Group 1 received routine drugs and L-arginine (Tivortin, “Yuria-Pharm”) in doses recommended for cardiac patients, and group 2 – only routine drugs. Results and discussion. The components of preconception programs include the individual responsibility of women throughout life, awareness of women, preventive visits, interventions on identified risks, pre-pregnancy examinations and pregnancy supervision, health insurance for low-income women, health programs and strategies, medical research, and the improvement of monitoring. Target groups of preconception include women with unfavorable obstetric history (premature birth, cessation of fetal development, cesarean section, stillbirth, multiple miscarriages, birth of children with birth defects, hypertensive complications of pregnancy) and chronic diseases (type 1 diabetes mellitus, SLE, antiphospholipid syndrome, severe cardiovascular pathology, arterial hypertension, pulmonary hypertension). An important role in the management of pregnant women belongs to the prevention of preeclampsia (PE). Administration of acetylsalicylic acid reduces the likelihood of PE by 10 % in low-risk pregnant women and by 25 % in high-risk pregnant women, but the drug should be started during gestation. The use of calcium (1000 mg) reduces the risk of PE in high-risk pregnant women by 37 %. Preconception preparation is especially important, because some processes, such as the implantation of placental structures, begin and end before a woman learns she is pregnant. Remodeling of the spiral arteries also begins in the early stages of pregnancy, so its correction after the confirmation of pregnancy is less effective than prevention before it occurs. E.E. Camarena Pulido et al. (2016) studied the role of L-arginine (5 tablets of 600 mg per day from the 20th week of gestation before delivery) in the prevention of PE in high-risk women. In the L-arginine group significantly fewer cases of PE (3/49 vs. 11/47 in the placebo group; p=0.01) and a lower incidence of preterm birth were detected. In the another study, pregnant women with chronic hypertension received oral L-arginine or placebo. In the arginine group, there was a lower need for antihypertensive drugs, as well as lower frequency of births before 34 weeks, PE and neonatal complications (Neri I. et al., 2010). In the own study, favorable obstetric results of Tivortin were found. The percentage of births at >37 weeks in the Tivortin group among women with SLE was 90.9 %, and in the group of standard therapy – 50 % (p<0.01), among women with CHD – 90 % and 75 % respectively; p<0.05). No newborns with an Apgar score of <7 were found in the Tivortin group. In the comparison group their number was 27.7 %. Laboratory studies have shown that there is a significant increase in endothelial progenitor cells in the Tivortin group. Conclusions. 1. Preconception preparation of pregnant women is a multifaceted set of measures. 2. A significant number of physiological and pathological processes occur in the early stages of pregnancy, so they can be influenced only in the preconception period. 3. The use of L-arginine during gestation reduces the risk of PE, premature birth and other complications in all women and especially in women with hypertension.
D.O. Butov
Infusion & Chemotherapy pp 24-25; https://doi.org/10.32902/2663-0338-2020-3.2-24-25

Abstract:
Background. Impaired drug absorption is one of the reasons of the ineffectiveness of tuberculosis (TB) treatment. Malabsorption syndrome (MS) is a clinical syndrome that occurs due to the impaired digestive and transport function of the small intestine and is characterized by impaired absorption of nutrients, vitamins, microelements and drugs from the digestive tract. MS accompanies the following pathological conditions: pancreatic diseases, cholestasis, inflammatory bowel diseases, autoimmune enteropathies, diabetes mellitus, amyloidosis, hyperthyroidism, atrophic gastritis, HIV/AIDS, infections and parasitosis of the digestive system, alcoholism, and TB. Objective. To describe the ways to overcome the influence of MS on TB treatment. Materials and methods. Analysis of literature data on this topic. Results and discussion. MS can worsen the treatment of all forms of TB, especially severe. The latter include tuberculous meningitis, disseminated TB, miliary TB, caseous pneumonia, and infiltrative TB. Causes of death from severe forms of TB include untimely diagnosis, lack of thorough differential diagnosis, insufficient intensity of therapy, decreased maximum concentration of oral forms of anti-TB drugs (ATBD) in blood. The latter often occurs in severe forms of TB and in case of co-infection with TB and HIV/AIDS. Injectable forms of the drugs are recommended by the World Health Organization to increase the effectiveness of TB meningitis treatment. The American Thoracic Society and the American Society of Infectious Diseases also recommend the use of intravenous ATBD in patients with impaired absorption. Most patients receiving oral ATBD have extremely low plasma concentrations of these drugs. This is probably due to a decrease in the functional area of intestinal absorption in patients with TB. Indications for intravenous ATBD include severe forms of TB, the presence of severe disorders of the digestive system and severe comorbidities, TB with multiple and widespread resistance to ATBD, pre- and postoperative periods, low adherence to therapy. The intensive phase of therapy and the patient’s preference may be the additional indications. Studies show that intravenous ATBD is associated with significantly better survival than oral, in the absence of an increase in the number of side effects. The advantages of intravenous administration also include 100 % bioavailability, 100 % controllability of treatment, intensification of therapy, overcoming and preventing the development of resistance of mycobacteria, reducing the risk of adverse reactions, improving the tolerability of chemotherapy. Conclusions. 1. Impaired drug absorption is one of the reasons for the ineffectiveness of TB treatment. 2. MS can worsen the treatment of all forms of TB, especially severe. 3. In patients with malabsorption it is recommended to use intravenous ATBD. 4. Intravenous ATBD is associated with significantly better survival than oral, in the absence of an increase in the number of side effects.
O.A. Halushko
Infusion & Chemotherapy pp 33-35; https://doi.org/10.32902/2663-0338-2020-3.2-33-35

Abstract:
Background. An analysis of 44,415 Chinese patients with COVID-19 found a critical condition defined as severe hypoxemia and/or other organ damage or shock in 2087 (5 %) (Wu Z. et al., 2020). In inpatients, the frequency of shock is likely to be higher and can reach 20-35 % (Yang X. et al., 2020). Risk factors for shock and unstable hemodynamics in COVID-19 are older age, the presence of comorbidities, lymphopenia, higher levels of D-dimer. Objective. To describe the features of infusion therapy (IT) in patients of the therapeutic profile during the COVID-19 pandemic. Materials and methods. Analysis of literature sources on this topic. Results and discussion. The Surviving Sepsis guidelines state that crystalloids, not colloids, should be used for acute resuscitation of patients with COVID-19. The recommendation is based on indirect data on critically ill patients (Cochrane review by S.R. Lewis et al.). It is advisable to use buffered/balanced crystalloids. Such solutions include Reosorbilact (“Yuria-Pharm”), which has such effects as hemodynamic, detoxifying, microcirculatory, and diuretic. Reosorbilact corrects fluid-electrolyte and acid-base balance, improves the rheological properties of blood, reduces the need for sympathomimetics. The use of hydroxyethyl starch, gelatin and albumin in COVID-19 is not recommended. In the treatment of coronavirus pneumonia, IT is significantly limited due to the risk of fluid overload and the development of pulmonary edema. The use of conservative rather than liberal IT strategy is recommended, including for patients with acute respiratory distress syndrome (ARDS) who are on mechanical lung ventilation (MLV). In severe pneumonia, the use of vasopressors is recommended. Noradrenaline is used as a first-line vasoactive agent. The use of hyperosmolar solutions reduces the volume of infusion required to maintain stable hemodynamics in patients with severe sepsis. Hypertonic solutions also reduce the length of MLV in patients with shock. For adults with COVID-19 and refractory shock, low-dose corticosteroid therapy (bolus doses or infusion of prednisolone at a dose of 200 mg per day) has been suggested. Systemic corticosteroids should also be used in ARDS. In the absence of the latter, routine use of systemic corticosteroids is not recommended. Empirical use of antibacterial drugs is advisable in patients on ARDS, as superinfections in this group of patients are extremely common. The advantages of levofloxacin (Leflocin 750, “Yuria-Pharm”) include high efficiency against all respiratory pathogens, good penetration into the inflammatory focus, and active influence on microorganisms in biofilms. Leflocin 750 mg is administered once a day intravenously for 5-14 days. It is recommended to use paracetamol (Infulgan, “Yuria-Pharm”) to control fever. The advantages of the latter are lowering the temperature within 30 minutes after administration, antipyretic effect lasting up to 6 hours, safety for patients with gastrointestinal and hematological diseases. Infulgan is administered intravenously (1 g up to 4 times a day). Conclusions. 1. Balanced IT holds a leading position in the treatment of severe coronavirus infection. 2. Preference should be given to balanced solutions of crystalloids. 3. The IT program should be designed taking into account the quality of life and creating maximum patient comfort.
V.V. Hrubnyk
Infusion & Chemotherapy pp 69-71; https://doi.org/10.32902/2663-0338-2020-3.2-69-71

Abstract:
Background. About 46.5 million of surgical procedures and 5 million of gastrointestinal endoscopies are performed annually in the United States alone. Each procedure involves contact of the medical equipment with sterile tissues of the patient, so transmission of infection is the main risk of such procedures. Objective. To describe the main errors and dangers in laparoscopic surgery. Materials and methods. Analysis of literature data and own research on this topic. Results and discussion. Endoscopic examinations in gastroenterology can transmit more than 300 types of infections, 70 % of which are salmonella and Pseudomonas aeruginosa. During bronchoscopy 90 types of infections are transferred. Different hospital facilities undergo different decontamination procedures. Objects that penetrate the skin or mucous membranes, or into sterile tissues or the circulatory system, require sterilization. Endoscopes are subject to pre-cleaning, leak testing, manual cleaning, rinsing and disinfection. Ideally, laparoscopes and arthroscopes should be sterilized between procedures in different patients. Such devices are difficult to clean and disinfect due to their complex structure. In the absence of adequate disinfection, infection of the patients occurs in cases where the number and virulence of the introduced bacteria or fungi is sufficient to overcome their own immune defenses. Prevention of infectious complications includes preoperative antiseptic treatment of the operating field and appropriate antibiotic prophylaxis (ABP). Abdominal drainage should be performed only when blood or bile accumulates in the operating field. Regular use of drainage in uncomplicated laparoscopic cholecystectomy (CE) increases the likelihood of infection. Examination of 65 laparoscopic operations for postoperative ventral hernias revealed that the reinforcement of preoperative ABP by the means of 7-day course of fluoroquinolones or cephalosporins significantly reduced the volume and rate of seroma formation. The strategy for the prevention of postoperative complications includes delicate tissue handling, thorough sterilization of instruments, abdominal lavage with Dekasan (“Yuria-Pharm”), the use of broad-spectrum antibiotics, the use of plastic containers for removed organs and pathological formations, etc. In laparoscopic surgery, more than half of intestinal and vascular injuries are the access complication (pneumoperitoneum, the introduction of the first trocar). A significant proportion of such injuries is not diagnosed during injury. Thermal injuries are also possible during laparoscopic interventions. To prevent them, it is advisable to check the instruments for damage, use plastic trocars, use bipolar coagulation methods, use safe methods of dissection and coagulation (ultrasound scissors, vessel sealing technology). The frequency of damage to the bile ducts during laparoscopic CE is 0.26-0.30 %. The author’s study evaluated the effectiveness of laparoscopic subtotal CE in performing technically complex CE. Dekasan was used as an antiseptic for external and intraabdominal lavage during the interventions. Properties of Dekasan are the following: bactericidal, fungicidal, virocidal, sporocidal effects; lack of resorptive action; enhancing of the antibiotics’ effect; reducing the adhesion of microorganisms. In the first period (2005-2008) complex CE (1.5 %) was switched to the open operations. The frequency of postoperative complications was 28 %. In the second period, subtotal CE were used. The average operation time was 95 minutes; the average blood loss was 80 ml. Postoperative complications occurred in 14.6 % of patients. Mortality in the first period was 0.1 %, in the second – 0 %. Conclusions. 1. Endoscopes should be thoroughly disinfected to minimize the risk of infections transmission. 2. Prevention of infectious complications also includes preoperative antiseptic treatment of the operating field and appropriate ABP. 3. In laparoscopic surgery, more than half of intestinal and vascular injuries are the complications of access. 4. Performing laparoscopic subtotal CE is an alternative to conversion in cases where it is impossible to laparoscopically identify anatomical structures.
Kim Jong-Din
Infusion & Chemotherapy pp 117-119; https://doi.org/10.32902/2663-0338-2020-3.2-117-119

Abstract:
Background. Bleeding accounts for 34 % of maternal mortality. Every 7 minutes 1 woman dies from bleeding during the labour. Retrospective analysis of medical records shows that in 60-80 % of cases, fatal consequences can be avoided. Criteria for defining the concept of “massive blood loss” are the loss of 100 % of circulating blood volume (CBV) within 24 hours or 50 % of CBV within 3 hours, loss of 150 ml/min, of 2 % of body weight within 3 hours, reduction of hematocrit by 10 % in combination with hemodynamic disturbances, one-time blood loss more than 1500-2000 ml or 25-35 % CBV, the need for transfusion of >10 doses of erythromass for 24 hours. The main causes of bleeding in obstetrics include uterine atony, premature placental abruption, uterine rupture, placental abruption, hereditary blood diseases, coagulopathy, sepsis, amniotic fluid embolism. Objective. To describe infusion therapy (IT) for obstetric bleeding. Materials and methods. Analysis of literature data on this issue. Results and discussion. Strategies for the treatment of obstetric hemorrhage include restriction of the traditional massive crystalloid-based IT, applying the principle of antihypertensive resuscitation, using of adequate doses of tranexamic acid, fibrinogen concentrate and prothrombin complex concentrate, early informed use of blood components, and low-volume IT. Routine use of unbalanced crystalloid solutions in critically severe patients is dangerous. Infusion of large amounts of 0.9 % NaCl may cause metabolic hyperchloremic acidosis. Therefore, except in cases of hypochloremia, it is advisable to replace saline with balanced solutions. Reosorbilact (“Yuria-Pharm”) is the most suitable solution for this purpose. It mobilizes the own fluid of the organism, helping it to move from the intercellular space into the vessels. Hypotensive resuscitation involves the introduction of limited amounts of fluid in the early stages of treatment of hemorrhagic shock (until the bleeding stops). Low-volume IT program is a part of hypotensive resuscitation. In this case, the following solutions can be used: Reosorbilact, Sorbilact, Gekoton (“Yuria-Pharm”), 130/0.4 hydroxyethyl starch (HES), hypertonic NaCl solutions (including combined solutions with colloids), polyhydric alcohols. It should be noted that the new generation of HEC has less effect on coagulation than older drugs. Due to the risk of kidney damage, HEC solutions should be used in the lowest effective dose for as shortest period of time as possible. HEC infusion should be stopped as soon as hemodynamic targets are reached. Solutions containing polyhydric alcohols (Reosorbilact, Sorbilact, Xylate) occupy an important position in IT of critically ill patients. Due to their high osmolarity, Reosorbilact and Sorbilact cause fluid to move from the intercellular space into the vascular bed, improving microcirculation and tissue perfusion. The polyhydric alcohol sorbitol contained in these solutions creates increased osmotic pressure in the renal tubules, which provides a diuretic effect. In case of the blood loss volume of I-II functional class up to 1500 ml and stopped bleeding, IT is performed in a limited mode. The volume of intravenous infusion together with blood components should not exceed 200 % of the blood loss volume. Reosorbilact (10-15 ml/kg) is an initial solution in combination with 0.9 % NaCl (20-30 ml/kg). In case of unstable hemodynamics HEC may be added (up to 1,5 L). Blood components are used only in case of confirmed coagulopathy and continued bleeding. In case of massive critical blood loss >1500-2000 ml, it is advisable to use the protocol of massive blood transfusion 1:1:1:1. In order to reduce the pathological response of the endothelium to IT, it is advisable to use a substrate for the nitric oxide synthesis, namely, Tivortin (“Yuria-Pharm”). To stop life-threatening obstetric bleeding, CBV must be refilled using the protocol of massive blood transfusion and automatic blood reinfusion, oxytocin and prostaglandin analogues for the correction of uterine tone, uterine massage, correction of coagulopathy, balloon tamponade of the uterus. Conclusions. 1. Emergency care for massive bleeding in obstetrics is one of the priorities in reducing maternal morbidity and mortality. 2. Intensive therapy of blood loss should be based on modern recommendations and the use of modern drugs. 3. The indications for transfusion of blood components should be clearly applied.
Yu.Yu. Kobeliatskyi
Infusion & Chemotherapy pp 129-131; https://doi.org/10.32902/2663-0338-2020-3.2-129-131

Abstract:
Background. According to the Decree of the Ministry of Health of Ukraine № 275 issued on 11.09.2018, there is a list of measures to ensure surgical safety and patient’s safety. These measures can be divided into those that should be performed 1) before anesthesia; 2) before skin dissection; 3) before the patient leaves the operating room. Perioperative medicine (POM) is a patient-centered and interdisciplinary perioperative care for surgical patients. Objective. To describe the current recommendations for POM. Materials and methods. Review of available guidance documents. Results and discussion. The pathophysiology of postoperative complications (infectious processes, intestinal paralysis, respiratory failure, kidney damage, etc.) includes the following factors: triggers (anxiety, pain, surgical trauma), patient factors (age, comorbid conditions), the consequences of general operative stress (autonomous system imbalance, inflammation, coagulopathy, metabolic imbalance). Clinical evaluation or biomarkers should be used to identify high-risk patients in the perioperative period. Measures to improve postoperative rehabilitation should be carried out in the pre-, intra- and postoperative period. Thus, in the preoperative period it is necessary to examine the patient, to provide the carbohydrate load 2 hours before the intervention, to conduct antibiotic prophylaxis, to correct or stabilize the comorbid diseases (especially cardiovascular and renal diseases, diabetes, anemia). In the intraoperative period it is necessary to maintain normovolemia and normothermia, to use protective mechanical lung ventilation, to limit the use of opioids, to perform extubation immediately after the intervention. In the postoperative period early activation, early enteral nutrition and early removal of drainages and catheters should be used. The key components of POM include the identification of low-risk patients in order to save resources, the identification of high-risk patients with the possible use of alternative management strategies, and the frequent risk reassessment. The main components of the success of anesthesia include preoperative assessment of the patient’s somatic status and risk, use of controlled hypnotics and effective and predictable muscle relaxant, use of analgesics that break down quickly and have no ability to accumulate, control of the hemodynamics stability, blood gases and acid-base balance. To prevent the perioperative myocardial ischemia, it is advisable to use esmolol – a cardioselective β-blocker of ultrashort action. Preoperative anxiety, intubation and extubation, surgical manipulations lead to the excessive adrenergic response, which justifies the use of β-blockers. The pharmacological effects of esmolol (Biblok, “Yuria-Pharm”) include the reduction of myocardial oxygen consumption, increase of the diastole duration, limitation of the free radicals’ production, control of the activity of metalloproteinases, and the reduction of inflammation around atherosclerotic plaques. In addition, esmolol (Biblok) is able to reduce intra- and postoperative use of opioids, and therefore its use as a component of multimodal total intravenous anesthesia has been proposed. Preoperative administration of esmolol may also be an effective and safe method of myocardial protection in patients undergoing cardiac surgery. β-blockers are well tolerated in patients with acute hypovolaemia during anesthesia, however, episodes of hypercapnia should be avoided during their use. Conclusions. 1. For the optimal POM, the individual risk of perioperative complications should be determined. 2. POM includes a number of pre-, intra- and postoperative measures. 3. The use of ultrashort-acting β-blocker esmolol prevents intraoperative myocardial ischemia, has antioxidant and anti-inflammatory effects, reduces the need for opioids.
O.M. Nosenko
Infusion & Chemotherapy pp 237-238; https://doi.org/10.32902/2663-0338-2020-3.2-237-238

Abstract:
Обоснование. Эндотелиальные клетки различных сосудистых зон имеют разные форму и набор рецепторов, что позволяет им быть функционально гетерогенными. Функциями эндотелия являются транспортная, гемостатическая, вазомоторная, рецепторная, секреторная, сосудообразующая и барьерная. Для обеспечения каждой из этих функций эндотелий вырабатывает вещества, отвечающие за диаметрально противоположные функции. Состояние дисбаланса между медиаторами, в норме обеспечивающими оптимальное течение всех эндотелийзависимых процессов, получило название эндотелиальной дисфункции (ЭД). Цель. Охарактеризовать защиту эндотелия и возможности коррекции ЭД в акушерстве. Материалы и методы. Анализ данных литературы по этому вопросу. Результаты и их обсуждение. Оксид азота (NO) играет важнейшую роль в физиологическом функционировании эндотелия во время беременности. Субстратом для синтеза NO выступает L-аргинин. При недостатке NO возникает ЭД, которая в сочетании с дефективной глубокой плацентацией является главной причиной развития основных акушерских осложнений (преэклампсии (ПЭ), синдрома задержки внутриутробного роста плода, преждевременных родов, преждевременной отслойки плаценты, привычного невынашивания). При ПЭ можно отметить изменение эндотелия различных сосудов, в том числе печеночных и мозговых. Выявление ЭД до беременности требует прегравидарной подготовки с помощью донаторов NO (L-аргинина). Накопление в крови беременных метилированных аналогов последнего ведет к снижению биодоступности NO и развитию ЭД. В результате запускается своеобразный порочный круг: ЭД усиливает ишемию и способствует образованию свободных радикалов, которые, в свою очередь, вызывают ЭД. Включение L-аргинина в комплексную фармакологическую профилактику и лечение перечисленных акушерских синдромов с целью преодоления патогенетических эффектов метилированных аналогов L-аргинина, прежде всего асимметричного диметиларгинина (ADMA), является патогенетически оправданным. Успешность данного подхода подтверждена в ряде исследований. Введение большого количества экзогенного L-аргинина вытесняет ADMA и восстанавливает эндогенный синтез NO до физиологического уровня. Тремя основными средствами для устранения ЭД в акушерстве выступают ацетилсалициловая кислота, препараты кальция и L-аргинин (Тивортин, «Юрия-Фарм»). Применение последнего позволяет предотвратить развитие ПЭ у женщин высокого риска, улучшить маточно-плацентарный кровоток, нормализовать объем околоплодных вод. Выводы. 1. ЭД – основное звено патогенеза акушерских осложнений. 2. Основной молекулой, необходимой для нормального функционирования эндотелия, является NO. 3. Тивортин как субстрат для образования NO способствует устранению ЭД и улучшению маточно-плацентарного кровотока.
V.O. Potapov
Infusion & Chemotherapy pp 250-251; https://doi.org/10.32902/2663-0338-2020-3.2-250-251

Abstract:
Background. Pelvic inflammatory diseases (PID) include the wide range of inflammatory processes in the upper reproductive tract of women. 70 % of PID occur in women under 25 years. Adverse consequences of PID include chronization and recurrence of the disease, purulent tuboovarian formations, obstruction of the fallopian tubes, and ectopic pregnancy. Objective. To describe the main aspects of PID treatment and rehabilitation of reproductive health. Materials and methods. Analysis of literature data on this topic. Results and discussion. Risk factors for PID include intrauterine interventions and contraceptives, surgery on uterine appendages, and risky sexual behavior. There are three main targets for PID therapy: infection, release of inflammatory mediators, and repair of damaged tissues. Etiotropic therapy is used to overcome infections, nonsteroidal anti-inflammatory drugs and detoxification drugs are used to prevent active inflammation, and microcirculation correction is used to promote tissue repair. Broad-spectrum antibiotics (ceftriaxone, doxycycline, metronidazole) are used for etiotropic therapy. Fluoroquinolones (levofloxacin) are especially relevant in modern PID treatment regimens because they are effective against 94 % of urogenital tract pathogens, penetrate cell membranes, and slowly cause resistance. The combination of levofloxacin + ornidazole is highly effective against mixed aerobic-anaerobic and protozoal-bacterial infections. A solution for intravenous administration containing a combination of levofloxacin and ornidazole is widely used to treat severe PID. Tobramycin is the drug of choice for PID, mainly caused by antibiotic-resistant intestinal pathogens. After an acute episode of PID, abnormal blood flow in the vessels of the uterus and ovaries is significantly more common. Circulatory disorders contribute to blood stagnation, fibrotization, and sclerosis with the subsequent development of infertility, anovulation, premenstrual syndrome, abnormal uterine bleeding, adhesions, and obstruction of the fallopian tubes. In order to accelerate the excretion of toxic substances and inflammatory metabolites and eliminate oxidative stress, infusion solutions based on sorbitol and L-arginine are prescribed. Sorbitol-based hyperosmolar solution promotes the opening of precapillary sphincters, improves the rheological properties of blood, corrects metabolic acidosis and normalizes water-electrolyte balance. L-arginine solution, in turn, causes dilatation of peripheral vessels, promoting better microcirculation. L-arginine also acts as a substrate for the NO formation. The latter has an antibacterial activity, promotes the migration of T-cells, and takes part in the regulation of the sex hormones synthesis in the ovaries. According to our own data, infusions of L-arginine in PID reduce the proportion of adhesions from 34 to 5.4 %. Conclusions. 1. PID is a spectrum of diseases with a number of adverse consequences, a significant part of which develops in young women. 2. The main components of PID treatment and restoration of reproductive health include elimination of the pathogen, blockade of inflammation and detoxification, correction of microcirculation and tissue repair. 3. Infusion solutions based on sorbitol and L-arginine are successfully used in the comprehensive therapy of PID.
O.A. Halushko
Infusion & Chemotherapy pp 42-44; https://doi.org/10.32902/2663-0338-2020-3.2-42-44

Abstract:
Background. Deep and versatile disorders in case of acute diseases can lead to severe metabolic disorders that are life-threatening and require immediate care. Such conditions include carbohydrate metabolism disorders (CMD): ketoacidosis, non-diabetic ketoacidosis, ketoacidotic and hyperosmolar coma, hypoglycemic syndrome, hypoglycemic and lactic acid coma. Objective. To describe the possibilities of CMD correction. Materials and methods. Analysis of literature sources on this topic; own study involving 126 patients with CMD. Patients were prescribed classic and balanced crystalloids (1200-1400 ml per day), in case of ketoacidosis – Xylate (6-8 ml/kg/day), in case of hyperosmolar conditions – Volutenz (400-600 ml per day). Results and discussion. Necessary laboratory tests in CMD include the assessment of glycemia, potassium, sodium, urea, creatinine, acid-base status, ketonemia, ketonuria; clinical blood test; blood culture and antibiotic sensitivity determination (according to the indications). It should be noted that the level of glycemia in diabetic ketoacidosis (DKA) can vary from a slight increase to a severe hyperglycemia. In case of the clinical picture of advanced ketoacidosis the semiquantitative analysis can reveal 3-4 pluses of ketonuria. However, the nitroprusside method allows to determine acetoacetic acid only, whereas the severe DKA is characterized by the more pronounced increase in the content of β-oxybutyric acid. It may create the preconditions for the underdiagnosis of ketoacidosis. Due to certain features of the analysis, ketosis is usually diagnosed in a decompensated state. Therefore, first of all, it is necessary to be rely by a clinical condition of the patient. Infusion therapy (IT) for DKA involves the use of 0.9 % NaCl solution or Ringer’s solution. If the patient has hypernatremia, 0.45 % NaCl solution is administered. During the first 30-60 minutes of treatment one should administered 1 liter of these solutions. Subsequently, the infusion is continued at a rate of 4-14 ml/kg/h until the glucose level reaches <12 mmol/L, then the infusion should be continued with 5 % glucose solution. IT must be performed with caution in elderly patients and people with heart failure. In addition to IT, insulin therapy (0.1 U/kg/h) is prescribed for DKA, followed by dose adjustment to ensure a decrease in blood glucose concentration at a rate of 2-3 mmol/L. Acidosis is corrected by IT and insulin therapy. Treatment of severe acidosis (pH <7.0) with bicarbonate requires dose adjustment under acid-base control. Xylitol (Xylate, “Yuria-Pharm”) is the main antiketogenic solution. It enters the pentose phosphate metabolism, increases the intensity of glycolysis, enhances glycogen production in the liver and stimulates insulin secretion. On the background of Xylate use, the content of β-oxybutyrate in the urine is halved in 5 hours, and the level of acetone – decreases in 2.5 times in 2 hours. Xylate reduces lactate levels and normalizes tissue perfusion. The unique effects of Xylate include pronounced antiketogenic effect, correction of metabolic acidosis, role as a non-insulin-independent energy source, correction of water-electrolyte balance, and hydration. Evaluation of the effectiveness of therapy in patients with DKA should include regular monitoring of neurological status. If deterioration is observed, cerebral edema, stroke, infectious diseases of the central nervous system, traumatic brain injury, hyperosmolar condition should be excluded. In the latter case, it is advisable to enter a hypotonic solution of 0.45 % NaCl. Because the use of such solutions is associated with a risk of cerebral edema, most recommendations prefer isotonic solutions. In the own study, the described above IT scheme helped to reduce the total volume of infusions, increase diuresis, improve consciousness on the 3rd day of treatment, and reduce the length of stay in the intensive care unit. Conclusions. 1. Many patients develop CMD, which worsen the course and prognosis of the underlying disease. 2. The use of IT should be started at the first signs of DKA. 3. Modern antiketogenic agent Xylate affects the pathogenesis of CMD and has an additional energy effect.
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