Infusion & Chemotherapy最新文献

{"title":"Promising ways to treat unpromising uterine fibroids","authors":"O. Manzhura","doi":"10.32902/2663-0338-2020-3.2-202-203","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-202-203","url":null,"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.). \u0000Objective. To describe current trends in the treatment of uterine fibroids. \u0000Materials and methods. Analysis of own experience in the treatment of fibroids and literature sources on this topic. \u0000Results 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. \u0000Conclusions. 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","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74566380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of short-term and long-term infusion therapy: review of the vascular access technologies from the point of view of the nurse. Catheterization of peripheral veins","authors":"Ye.V. Hryzhymalskyi","doi":"10.32902/2663-0338-2020-3.2-60-62","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-60-62","url":null,"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). \u0000Objective. To describe the features of short-term and long-term IT. \u0000Materials and methods. Analysis of literature sources on this topic. \u0000Results 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. \u0000Conclusions. 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 Venopo","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74707721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience in the open multicenter randomized controlled trial of Rheo-STAT on the efficacy and safety of Reosorbilact in patients with sepsis","authors":"V. Cojocaru","doi":"10.32902/2663-0338-2020-3.2-154-155","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-154-155","url":null,"abstract":"Background. Elimination of intoxication syndrome is one of the main components of sepsis treatment. The Rheo-STAT study is an interventional open multicenter randomized controlled trial of the efficacy of Reosorbilact (“Yuria-Pharm”) in the treatment of intoxication syndrome. The study was conducted in 7 countries, patients of the sepsis subgroup were recruited in 5 of them (Ukraine, Moldova, Georgia, Kazakhstan, Uzbekistan). \u0000Objective. To determine the efficacy and safety of Reosorbilact in patients with sepsis. \u0000Materials and methods. The study involved 628 adult patients with sepsis, peritonitis, pneumonia and burns. The subgroup of sepsis consisted of 180 people (72 % males, mean age – 41.3 years), the most common comorbidities were cardiovascular diseases (24 %), diabetes mellitus (15 %), and infectious diseases (8 %). The inclusion criteria were the following: age 18-60 years, diagnosis of sepsis, established by the ACCP/SCCM criteria ≤24 hours before the initial visit, obtaining of the informed consent, baseline SOFA scale value ≥2. The primary endpoint was the total score on the SOFA scale on the 3rd day of treatment compared to the baseline value. The secondary endpoints included the change in the overall score according to the APACHE II, SAPS II, MODS, PSI/PORT, CURB-65 scales; changes in biochemical, immunological and integral markers of endogenous intoxication. \u0000Results 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, which is especially important for critically ill patients. Exogenous lactate in Reosorbilact did not increase the content of endogenous lactate (1st day – 2.27 mmol/L, 3rd day – 1.63 mmol/L), which indicates the high safety of the solution. In the complex of intensive care administration of Reosorbilact helped to reduce hyperthermia (1st day – 38.2 °C, 3rd day – 36.8 °C, p<0.001), heart rate (1st day – 95.43 beats/min, 3rd day – 81.13 beats/min, p<0.001) and the number of leukocytes (1st day – 14.5×109/L, 3rd day – 8.8×109/L) as a marker of endogenous intoxication. During 3 days of therapy Reosorbilact also normalized the acid-base composition of the blood. \u0000Conclusions. 1. Elimination of intoxication syndrome is one of the main components of sepsis treatment. 2. Reosorbilact infusion therapy increases the volume of circulating blood without the risk of volume overload. 3. The inclusion of Reosorbilact in the complex treatment of sepsis after 3 days provides a decrease in body temperature, heart rate, white blood cell count and normalization of the acid-base composition of the blood.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79537762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric blood loss: priorities in the choice of infusion solutions","authors":"Kim Jong-Din","doi":"10.32902/2663-0338-2020-3.2-117-119","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-117-119","url":null,"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. \u0000Objective. To describe infusion therapy (IT) for obstetric bleeding. \u0000Materials and methods. Analysis of literature data on this issue. \u0000Results 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 osmot","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75804767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative anesthesia","authors":"І.І. Lisnyi","doi":"10.32902/2663-0338-2020-3.2-178-179","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-178-179","url":null,"abstract":"Background. Ensuring adequate analgesia is a prerequisite for rapid recovery after surgery. Improving the management of acute pain is important to ensure the safe and effective analgesia needed for early mobilization and for avoidance of organ dysfunction due to inadequate analgesia. For this purpose, multimodal analgesia (MMA) is used. It includes opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAID), paracetamol or metamizole, local anesthetics and ancillary drugs. \u0000Objective. To describe modern views on perioperative analgesia. \u0000Materials and methods. Analysis of literature data on this issue. \u0000Results and discussion. MMA involves an opioid-preserving approach (reducing the dose of opioids without reducing the quality of analgesia), procedure and patient specificity. The postoperative recovery improvement program includes several items, three of which have been associated with a reduction in treatment duration, namely, multimodal prevention of postoperative nausea and vomiting, perioperative NSAID use, and post-operative opioid protocol. The combined use of NSAID and paracetamol provides a better result than the use of each of these drugs alone. At the correct dose, paracetamol (Infulgan, “Yuria-Pharm”) is an effective non-opioid analgesic for the treatment of acute pain with minimal side effects for a long time. Pre- and intraoperative administration of paracetamol is recommended in a number of guidelines. Intravenous administration of local anesthetics is an another important component of MMA. The 2016 Cochrane review showed that long-term intravenous perioperative infusion of lidocaine significantly reduced the postoperative need for opioids. However, the meta-analysis of 10 randomized controlled trials found that perioperative intravenous lidocaine did not differ from placebo in post-operative pain assessed with the help of a visual analog scale and in opioid requirements (Rollins K.E., 2020). Similar results have been obtained in other studies in recent years. Inclusion of nefopam in MMA can reduce the dose of opioids. The use of nefopam, paracetamol and deksketoprofen makes it possible to dramatically reduce the use of morphine. Neither pain nor postoperative recovery can be adequately controlled with a single treatment due to the multifactorial nature of the problem. It is recommended to use MMA, but there are no recommendations for optimal combinations of analgesics for specific procedures. Administration of paracetamol and NSAID in combination with the use of regional techniques is a golden standard of MMA. \u0000Conclusions. 1. After the surgery, the patient should be adequately anesthetized. 2. To achieve optimal, preferably non-opioid, analgesia, it is recommended to use MMA. 3. NSAID, paracetamol, nefopam and regional techniques are the important components of MMA.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78558957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial dysfunction and its role in the prevention, treatment and complications of critical conditions in obstetrics","authors":"Kim Jong-Din","doi":"10.32902/2663-0338-2020-3.2-120-122","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-120-122","url":null,"abstract":"Background. Preeclampsia (PE) remains the leading cause of maternal and perinatal morbidity and mortality. As of today, there is no treatment for PE, and the childbirth is the only way to completely eliminate this condition. However, early childbirth is associated with a high risk of fetal morbidity and mortality. \u0000Objective. To describe the role of endothelial dysfunction (ED) in the development of PE and the possibility of its correction; to evaluate the effectiveness of Tivortin (“Yuria-Pharm”) in the correction of uterine-fetal-placental dysfunction. \u0000Materials and methods. Analysis of literature sources on this topic; own PLACENTA study. The study involved 535 women with mild PE at 26-29 weeks of gestation. Group I received standard therapy, group II – standard therapy in combination with Tivortin (4.2 g per day for 7-10 days). \u0000Results and discussion. Until the fetus reaches viability, PE treatment is aimed at correcting hypertension, however, antihypertensive therapy does not have a beneficial effect on the condition of the kidneys and placental blood flow. Decreased blood flow in placenta leads to the syndrome of limited fetal development (SLFD) and multisystem ED. The development of PE is inextricably linked with the systemic damage to maternal endothelial cells and a further decrease in endothelium-dependent vasodilators, which promotes vasospasm and activates the coagulation cascade. PE is accompanied by the imbalance in the systems of prostacyclin and nitric oxide (NO), as well as thromboxane and endothelin. Superficial placentation with insufficient remodeling of the spiral arteries and impaired response to changes in blood flow is one of the main causes of PE. ED is the most studied pathogenetic mechanism of PE. NO has a potent vasodilating effect and is involved in inhibiting thromboxane formation, platelet aggregation and stimulating prostacyclin formation. NO-synthase of endothelial cells, the substrate of which is L-arginine, is the main enzyme of NO production. Disorders of vasodilation in pregnant women with PE can be eliminated by prescribing L-arginine. Literature data show that L-arginine is successfully used in the need to continue pregnancy, as well as to eliminate hypertension and correct SLFD. Canadian guidelines for the treatment of hypertensive complications of pregnancy state that L-arginine is able to improve uteroplacental blood flow. According to a study by J. Chen (2016), the inclusion of L-arginine contributes to both maternal and perinatal outcomes of pregnancy. The effect of L-arginine on fetal growth is mediated by promoting the production of creatine, skeletal muscle protein and growth hormone. L-arginine also promotes the synthesis of polyamines, which can stimulate the growth and development of placenta. Own studies have shown that the use of L-arginine (Tivortin, “Yuria-Pharm”) in the combined PE therapy had improved the growth rate of the fetus and its functional condition, which allowed to prolong pregn","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78660672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal liability and risks during infusion therapy","authors":"N. Lisnevska","doi":"10.32902/2663-0338-2020-3.2-175-177","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-175-177","url":null,"abstract":"Background. The issue of legal liability is extremely important for all healthcare workers (HCW). HCW are solely responsible for medical violations during the performance of their professional duties. There is a misconception that in case of non-provision or error in the provision of medical care outside the medical institution, the HCW will be liable. However, this is not always so, as in this case the HCW is considered an ordinary citizen and bears ordinary civil liability. \u0000Objective. To describe the legal aspects of MP liability, in particular, during infusion therapy (IT). \u0000Materials and methods. Analysis of the legal framework. \u0000Results and discussion. The public consciousness has formed the idea of the great responsibility of HCW for human life and health. Unfortunately, in Ukraine, people often do not care about their own health and do not take preventive measures, shifting all responsibility to HCW. Citizens have the right to receive health care and the right for the compensation of improper medical care and damage caused by the actions of the HCW. According to surveys, a lawsuit from a patient is the leading fear of HCW. This fear needs to be reduced, as the doctor and nurse should not be afraid of their patients. According to the objective model of liability, the HCW is guilty of the damage caused to the victim (patient), if the average citizen believes that the actions of HCW were the cause of the unfavorable course of events. This model is often used by domestic media, although in Ukraine it is not enshrined in law. For a long time, criminal liability for medical crimes has dominated Ukraine. Currently, there are criminal, administrative, disciplinary and civil kinds of liability. According to the criminal legislation of Ukraine, criminal liability arises for a crime that contains a crime according to the Criminal Code. Criminal activity contradicts the very essence of medical activity, so special attention is paid to such crimes. It should be noted that the intentional crimes committed by HCW are much less common than crimes of negligence. An important problem is that lawyers do not always understand the specifics of the nature of a medical crime. There are circumstances in which HCW are released from liability for a crime. These circumstances include actions of extreme necessity and actions in risk settings. Extreme necessity often takes place in urgent medical interventions. These circumstances often accompany emergency care in case of accidents, military problems and disasters. \u0000IT is often a kind of experiment, because the drugs administered may be perceived differently by the patient, even with a normal previous history. Because treatment is often associated with risk, for example, in case of IT side effects, a nurse who continues to administer the drug on a protocol or off-protocol (subject to consultation with the patient and/or the board of physicians) will not be criminally liable. Similarly, a nurse will not be criminally ","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79834165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experience of management of COVID-19: focus on the pneumonia","authors":"L. Moroz","doi":"10.32902/2663-0338-2020-3.2-218-220","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-218-220","url":null,"abstract":"Background. Coronaviruses are the RNA viruses, which have a crown-shaped outer layer. These viruses have a tropism to the respiratory epithelium. SARS-CoV (coronavirus of the severe acute respiratory syndrome), MERS-CoV (coronavirus of the Middle East respiratory syndrome) and the new coronavirus SARS-CoV-2 are the most significant coronaviruses, able to affect a human organism. Coronavirus disease (COVID-19) pathogenesis includes the coronavirus replication in the respiratory epithelium and the diffuse alveolocyte injury with the development of viral pneumonia or acute respiratory distress syndrome. The main symptoms of COVID-19 include fever (83-99 %), appetite loss (40-84 %), cough (59-82 %), fatigue (44-70 %), anosmia (15-30 %), myalgia (11-35 %). Apart from that, COVID-19 is often accompanied by coagulopathies together with venous thrombosis, myocardial infarction and disseminated intravascular coagulation syndrome. Risk factors of coagulopathies include sepsis, history of chronic obstructive pulmonary diseases and liver disorders, malignant tumors, fever and acute course of COVID-19. \u0000Objective. To describe the peculiarities of coronavirus pneumonias treatment. \u0000Materials and methods. Analysis of literature data and clinical cases from own practice. \u0000Results and discussion. 40 % of COVID-19 patients have a mild course, 40 % – moderate, 15 % – severe, and 5 % – critical. The majority of patients with lethal outcomes have at least one from the listed parameters: malignant tumor, morbid obesity, diabetes mellitus, cardiovascular diseases, diseases of kidneys and lungs, hypoalbuminemia, age >60 years old. Diagnosis of coronavirus pneumonia needs to be proved with the help of computer tomography (CT) during the initial visit or hospitalization, then in 2-3 days in case of the absence of improvement, in case of clinical condition worsening, in 5-7 days in case of no dynamics or of positive dynamics. Lung affection according to CT is divided into 4 grades according to the presence of frosted glass symptom, consolidation presence and the percentage of lung parenchyma involvement. Pathogenetic treatment, including off-label drug usage, can decrease the risk of fatal complications. Edaravone (Ksavron, “Yuria-Pharm”) is an antioxidant drug with an anti-inflammatory effect due to cytokine storm inhibition and the possibility to decrease the lung vessels’ endothelium permeability. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection (enzymes superoxiddysmutase, catalase, glutathione peroxidase). It underlines the reasonability of edaravone usage in acute respiratory distress-syndrome. Edaravone prevents the increase of permeability of lung vessels’ endotheliocytes similarly to dexamethasone, but has a lower amount of side effects. L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) are also actively studied. L-arginine improves microcirculation, promotes vasodilatation, activates Т-cell immunity, stabili","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76263139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2020 challenge: the potential options of COVID-19 therapy","authors":"S. Kovalenko","doi":"10.32902/2663-0338-2020-3.2-149-150","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-149-150","url":null,"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. \u0000Objective. To describe the potential options of COVID-19 therapy. \u0000Materials 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”). \u0000Results 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. \u0000Conclusions. 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.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86362387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care for critically ill patients on the example of patients with severe burns","authors":"O. Kovalenko","doi":"10.32902/2663-0338-2020-3.2-141-143","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-141-143","url":null,"abstract":"Background. More than 200,000 patients with burns in Europe and the United States need inpatient treatment every year. In Ukraine, 35,000 people suffer thermal injuries each year. Medical care for burns in Ukraine is provided on 1,060 specialized beds (875 – for adults, 175 – for children). Indications for transporting people to the burn center include burn area >10 % of the body surface in adults; burns of the face, hands, feet, perineum, genitals, large joints; deep burns >3 %; electrical or chemical burns; inhalation burns; circular burns of the extremities or chest; burns in pregnant women, children, the elderly, patients with severe comorbid conditions; burns in combination with polytraumas. \u0000Objective. To describe the management of critically ill patients with burns. \u0000Materials and methods. Analysis of literature sources on this issue. \u0000Results and discussion. Care for patients with burns is divided into general and special. The use of specialized beds “Clinitron” and air-insolating complexes is of paramount importance. Since the heat loss from the burn wound is 580 kcal/h, the temperature in the burn rooms should be maintained at 26-30 °C. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of healthcare workers (HCW). The latter are the cause of the hospital infections in 50-80 % of cases, so when caring for different patients and before the transition from a bacteria-contaminated area of the body to a clean one, the gloves should be changed. All works near the patient must be carried out in the nitrile gloves without powder, as the latter increases the risk of infection and allergies. It is advisable to use high-strength gloves with an elongated cuff. After removing the gloves, hand hygiene must be carried out. To disinfect the hands of HCW in order to prevent the spread of transient microflora, you can use Gorosten (“Yuria-Pharm”) – a solution based on decamethoxine. Gorosten has antibacterial, antifungal, antiviral, anti-inflammatory and desensitizing properties. Hand hygiene should be performed before the contact with the patient, before clean/aseptic procedures, after contact / risk of contact with the patient’s biological fluids, after contact with the patient and his surroundings, after contact with him-/herself and personal protective equipment. In case of big burn area, bandages are changed under general anesthesia, in some cases after a bath with 0.05-0.1 % potassium permanganate solution. Improper care of patients with burns and other patients with severe conditions can cause the following complications: contractures, bedsores, infectious processes in the lungs, injuries and more. For the prevention and treatment of bedsores, it is advisable to use modern dressings: hydrocolloid, semi-permeable film, sponge, and silicone. \u0000Conclusions. 1. Indications for the transporting people to the burn center include the area of the burn >10 % of the body surface in adults","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86830722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}