Algorithm For Management Of Patients Research Articles

Airway management algorithm during circular tracheal resection in adult patients with cicatricial stenosis (a single-center study)

The objective was to present the experience of airway management algorithm in patients with different localization of stenosis during circular tracheal resection.Materials and methods. The retrospective analysis included 84 patients with grade II cicatricial stenosis who underwent circular tracheal resection at the period from 2018 to 2023. The patients were divided into two groups: group 1 with long-segment tracheal stenosis and group 2 with short-segment tracheal stenosis (39 and 45 patients, respectively). The age of patients in group 1 was 43 years [28–55] versus 48 [35–61] years in group 2 (p = 0.19). The patients in the groups were comparable in terms of the main parameters: gender, the ratio of women to men, BMI, class of cardiological risk, degree of risk of respiratory complications and pneumonia, degree of disability. Airway management control during surgery was provided by tracheal intubation with the installation of an endotracheal tube (ETT) proximal to tracheal stenosis or with a supraglottic airway device (laryngeal mask) i-gel (LM) before the main stage, followed by the application of the «apnea-ventilation-apnea» technique at the main stage. In patients with tracheostomy, airway management was performed by inserting endotracheal tube (ETT) into the tracheostomy opening using the «apnea-ventilation-apnea» technique until the completion of the main stage, followed by tracheal intubation through the mouth using a bronchoscope. All patients included in this study underwent tracheoplasty; patients with preserved tracheostomy were not included in the study. The choice of the method of airway management was determined after a joint discussion of the patient with the operating surgeon, endoscopists, as well as after evaluating the predictors of difficult airways and the presence of a tracheostomy in the patient.Results. The incidence of patients with tracheostomy in group 1 – 23 (59%) was higher than in group 2 – 9 (16%) (OR 5.75, 95% CI 2.18–15.17; p < 0.0001), which influenced the choice of tactics for airway management, since LM tracheostomy was not used in this group of patients. The choice of tactics for airway management algorithm also depended on the extent of stenosis, so LM was used more often in group 2 – 28 (62.2%) than in group 1 – 12 (30.8%) (p = 0.004). We associate such differences with the presence of a large number of patients with tracheostomy in group 1. For airway management during surgery, LM was used in 90% of cases with cervical localization of stenosis. In group 1, the time of anesthesia and mechanical ventilation increases compared to group 2: 245 [210–275] versus 215 [180–240] min (p = 0.022) and 265 [220–400] versus 210 [180–320] min (p = 0.015), respectively. The frequency of waking up in the operating room and regaining the ability to breathe independently was higher in patients in group 2: 35 (77.8%) than in group 1 22 (56.4%) (OR 2.7, 95% CI 1.05–6.97; p = 0.036). No difference in length of hospital stay was observed in the extent of stenosis and the chosen airway management algorithm.Conclusion. The choice of airway management algorithm during circular tracheal resection in patients with grade II cicatricial stenosis is depended on the localization and extent of tracheal stenosis. The choice of laryngeal mask i-gel as the airway management algorithm is safe and alternative algorithm with tracheal intubation with short-segment cervical stenosis and absence of tracheostomy.

The Effect of Hemoadsorption with CytoSorb on Severe COVID-19 Complications

The aim of the study was to assess the effect of hemoadsorption with CytoSorb on the inflammatory response, respiratory failure, and mortality in patients with severe novel coronavirus infection.Materials and methods. A retrospective single-center cohort comparative study of hemoadsorbtion using the CytoSorb therapy included data from 124 COVID-19 ICU patients. Patients were divided into two groups: the study arm with hemoadsorption (group 1, N=93) and the control arm without hemoadsorption (group 2, N=31). Patients in group 1 had more severe respiratory failure at baseline, but were otherwise comparable to patients in group 2 in terms of clinical and demographic parameters.Results. After hemoadsorption, group 1 patients showed significant improvement in 9 of 13 monitored clinical, instrumental, and laboratory parameters: fever (P=0.005), lactate dehydrogenase (LDH) (P<0.001), C-reactive protein (CRP) (P<0.001), and IL-6 (P<0.001) levels, as well as an increase in SpO₂/FiO₂ ratio (P=0.041), leukocyte count (P<0.001) and lymphocyte count (P=0.003), as well as no significant changes in SOFA score (P=0.068). The only improvement seen in group 2 patients was a reduction in fever (P=0.003). Other significant changes in group 2 were unfavorable, such as a decrease in SpO₂/FiO₂ ratio (P=0.002), an increase in inspiratory oxygen fraction FiO₂ (P=0.001), leukocyte count (P<0.05), LDH (P=0.038), procalcitonin (P<0.001), and IL-6 (P=0.005), as well as an increase in SOFA score from 3.0 to 7.0 (95%CI, 3.0–9.0) (P=0.001). The all-cause hospital mortality rate was 37,63% in group 1 and 74.20% in group 2.Conclusion. The use of hemoadsorption with CytoSorb as a pathogenetic therapy targeting the hyperinflammatory response in the management algorithm of ICU patients with severe COVID-19 complications resulted in resolution of the inflammatory response and respiratory failure, as well as a significant reduction in mortality.

A proposed algorithm for management of patients with left bundle branch block post-TAVR: 1-year follow-up

BackgroundTAVR has revolutionized the management of aortic stenosis and has become the standard of care across a broad spectrum of patients with aortic stenosis. However, it is still associated with high incidence of conduction abnormalities, particularly new LBBB. Management of these patients remains a challenge. ObjectiveTo assess the clinical outcomes of patients with post-TAVR conduction disorders managed according to a pre-specified institutionally developed algorithm. MethodsA retrospective analysis including all patients undergoing TAVR in our institute between October-2018 to December-2022 was performed. Patients with new LBBB were managed according to the algorithm comprising QRS width and electrophysiology study. In-hospital and one-year clinical outcomes were assessed. ResultsA total of 230 patients were included in the present analysis. Seventy patients (30.4%) developed new LBBB after TAVR. Overall, 44 patients (19.1%) required permanent pacemaker implantation (PPM): 20 patients (8.7%) with Mobitz II, complete AV block or alternating bundle branch block, 21 patients (9.1%) with persistent new LBBB, and 3 others (1.3%) per physician discretion. During 1-year follow-up, only 3 patients required late PPM, of whom only 1 patient with new LBBB. There was no difference in mortality or heart failure hospitalizations between the PPM and No PPM groups. Multivariable analysis identified atrial fibrillation, chronic kidney disease, and pre-TAVR RBBB as independent predictors for PPM following TAVR. ConclusionOur findings suggest that the presented algorithm may serve as a safe and efficacious strategy for management of patient with post-TAVR LBBB, although the PPM rate may be further reduced.

Depression and Parkinson’s disease

Parkinson's disease is a progressive neurodegenerative disease with motor symptoms and non-motor impairments, including depression, observed in 2.7-90% of cases. Depression is frequently underestimated and diagnosed late due to its similarity with symptoms of Parkinson's disease, such as fatigue, sleep disturbances, hypomimia, etc. In approximately 25% of patients, depression precedes motor symptoms, which may indicate its connection with the pathogenesis of Parkinson's disease. The purpose of the study was to analyze current data on the pathophysiology, diagnosis, and treatment of depression in patients with Parkinson's disease. The study results have demonstrated that the pathophysiological mechanisms of depression in Parkinson's disease include neurodegeneration of dopaminergic, noradrenergic, and serotonergic neurons, neuroinflammation, and impaired neuroplasticity. For timely treatment, patients, especially those with changes in motor or non-motor symptoms, should be regularly examined. Treatment is based on a multimodal approach and includes the use of supportive psychotherapy and pharmacotherapy. Alternative methods such as exercise, cognitive behavioral therapy, transcranial magnetic stimulation, and electroconvulsive therapy are also being explored. Thus, treatment of patients with depression and Parkinson's disease requires an individualized approach. Further research into this problem is crucial to develop and improve patient management algorithms.

Assessment of hemodynamic disturbance in connective tissue dysplasia syndrome of extracerebral and cerebral vessels in children

Syndrome of dysplasia connective tissue are recorded as cerebrovascular structural abnormalities of the vascular system include (deformations of vessels) and they are predisposing factors of dyscirculatory hemodynamic cerebrovascular disturbances.The studying of clinical and ultrasonic data of extra cranial part of brachiocephalic vessels at children allows to reveal the structural peculiarities and direction of internal carotid artery (deformations), its interrelation with cerebrovascular hemodynamic infringements.Early revealing of vessels’ structural abnormalities allow to carry out in due time diagnostics and cerebrovascular pathology preventive maintenance at children’s age. The ultrasound methods are one of the key non-invasive methods in management algorithm of patients with cerebrovascular disturbances

Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an integral part of the management algorithm of patients with severe respiratory failure refractory to evidence-based conventional treatments. Right ventricular injury (RVI) pertaining to abnormalities in the dimensions and/or function of the right ventricle (RV) in the context of VV-ECMO significantly influences mortality. However, in the absence of a universally accepted RVI definition and evidence-based guidance for the management of RVI in this very high-risk patient cohort, variations in clinical practice continue to exist. Following a systematic search of the literature, an international Steering Committee consisting of eight healthcare professionals involved in the management of patients receiving ECMO identified domains and knowledge gaps pertaining to RVI definition and management where the evidence is limited or ambiguous. Using a Delphi process, an international panel of 52 Experts developed Expert position statements in those areas. The process also conferred RV-centric overarching open questions for future research. Consensus was defined as achieved when 70% or more of the Experts agreed or disagreed on a Likert-scale statement or when 80% or more of the Experts agreed on a particular option in multiple-choice questions. The Delphi process was conducted through four rounds and consensus was achieved on 31 (89%) of 35 statements from which 24 Expert position statements were derived. Expert position statements provided recommendations for RVI nomenclature in the setting of VV-ECMO, a multi-modal diagnostic approach to RVI, the timing and parameters of diagnostic echocardiography, and VV-ECMO settings during RVI assessment and management. Consensus was not reached on RV-protective driving pressure thresholds or the effect of prone positioning on patient-centric outcomes. The proposed definition of RVI in the context of VV-ECMO needs to be validated through a systematic aggregation of data across studies. Until further evidence emerges, the Expert position statements can guide informed decision-making in the management of these patients.

Utility of an Alpha-1 Adrenergic Agonist in the Management of Chylothorax: A Case Series and Management Algorithm.

The initial diagnosis of chylothorax is based on clinical suspicion and proper imaging.The clinical success of midodrine use as a first-line medical treatment for chylothorax will support the use of midodrine before considering invasive procedures.We propose a management algorithm for patients with chylothorax that will stimulate researchers to conduct prospective studies to assess its efficacy.

Understanding immune-mediated titanium allergy to in situ orthopaedic implants: a narrative review of the current literature.

Clinical recognition of potential immune-mediated allergic responses to implanted metal devices is increasing. For orthopaedic implants, while 'pure' compounds are used in specific circumstances, the majority of components are alloys - a combination of two or more distinct metals. Titanium is found commonly in many orthopaedic devices and is often championed as a 'hypoallergenic' option or inclusion. In the absence of a relevant previously published summary on the topic, this paper explores the current state-of-understanding of titanium allergy and proposes a patient management algorithm whereby such immune reactions are clinically-suggested. A structured, systematic literature review was performed following PRISMA search principles to provide a contemporary summary-of-understanding in this area and to highlight clinical and knowledge deficiencies. Thirty-five topic-related articles were identified, the majority reflecting small case series' or proof-of-concept studies. The general standard of scientific evidence available was poor. Justification for arthroplasty utilization of titanium as a 'hypoallergenic' option is largely extrapolated from non-orthopaedic domains. Both ionic and conjugated titanium particles released from implant surfaces have the potential to trigger innate immune responses and true allergy. There exists no simple, high-sensitivity, screening test for titanium allergy. Conventional skin-patch testing is unreliable due to poor dermal penetration. Given established lymphocyte and macrophage activation pathways for allergy responses, in vitro methods using both cell-types show diagnostic promise. Surgical biopsy analysis from host-implant interfaces remains the contemporary 'gold-standard', however this represents an invasive, costly and highly-specialized approach not readily available in most settings. Further research to establish reliable/accessible diagnostic methods are indicated.

Gestion des patients avec protéine C réactive élevée après chirurgie colorectale élective : étude pilote sur une attitude diagnostique et thérapeutique proactive (GESPACE)

Study objective. To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery.Patients and methods. Prospective study including patients with CRP > 125 mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15 days. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit.Results. One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay < 15 days. Major deviations from the management algorithm occurred in 38% of cases. Early endoscopy was not applicable. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed.Conclusion. It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management.

Management of patients with high C-reactive protein levels after elective colorectal surgery: Pilot study on a proactive diagnostic and therapeutic approach (GESPACE)

To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery. Prospective study including patients with CRP>125mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15d. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit. One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay<15d. Major deviations from the management algorithm occurred in 38% of cases. No patients had an early endoscopy. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed. It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management.

Hereditary human diseases with skeletal pathology – molecular pathogenesis and clinical characteristics

Differential diagnosis of hereditary diseases is challenging due to similar clinical manifestations, diversity of nosologies, wide clinical variability and genetic heterogeneity, severity, rare frequency and complex molecular etiology. In some of them, connective tissue as a whole is involved in the pathological process, affecting almost all organs and systems of the human body, and in particular bone tissue, disrupting its remodeling and microarchitecture. The defect can occur at any of the stages of remodeling: during the initiation process, during bone resorption, osteoblast differentiation, osteoid mineralization, etc. Violation of the microarchitecture of bone tissue is accompanied by the development of low-traumatic fractures and deformities, early osteoarthritis, the formation of contractures and chronic pain syndrome. Genetic studies of patients have expanded knowledge about the molecular signaling pathways that coordinate bone development and metabolism, the nature of disease inheritance, clinical features, and specific bone biomarkers. This article provides an overview of key cellular mechanisms, features of diagnosis and treatment of hereditary human diseases that affect the condition of bone tissue and skeleton: osteogenesis imperfecta, EhlersDanlos syndrome, Marfan syndrome, juvenile osteoporosis, hypophosphatasia, osteopetrosis, progressive diaphyseal dysplasia, mucopolysaccharidoses, achondroplasia, multiple hereditary exostoses. Doctors of different specialties can encounter these diseases, and making a correct diagnosis will make it possible to determine the correct algorithm for patient management and begin timely treatment, the ability to prevent the development of severe complications, improve the quality of life of patients, restore maximum working capacity and reduce the percentage of disability.

PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONGENITAL HEART DISEASE: RATIONALE FOR MANAGEMENT ALGORITHM BASED ON A LITERATURE REVIEW

The substantial progress achieved in cardiology and paediatric cardiac surgery has led to a considerable increase of life expectancy of patients with congenital heart disease (CHD), and at the same time to growing number of adult patients developing pulmonary arterial hypertension (PAH) associated with congenital heart defects. Nowadays guidelines were developed and updated for PAH, but no expert recommendations exist for effective management of PAH associated with CHD. Thus, it is important to develop an algorithm for managing these patients, based on international standards and a comprehensive understanding of prognostic markers of worsening the course of pulmonary arterial hypertension (PAH), considering local cardiac tertiary hospitals' capabilities.&#x0D; The aim. To highlight the pathophysiology and clinical characteristics of PAH-CHD patients, identify prognostic markers for its onset and progression, and develop a management algorithm for patients.&#x0D; Results. The article presents the pathophysiology of PAH-CHD, the mechanisms of right ventricle adaptation to pressure overload, which determine the functional abilities of patients and prognosis, PAH formation, and progression after defects correction. The accurate identification of stages in PAH-CHD (volume overload, mixed, stage of pulmonary vascular disease) is essential for the timely determination of surgical intervention, selecting conservative treatment strategies, and predicting the outcomes of surgical defect correction. The type of defect, its size, and the volume of blood flow through the defect influence the onset and progression of PH-CHD. We review the pathophysiology and clinical features of PAH-CHD, as well as the reasons for the late diagnosis of heart failure at the stage of severe decompensation and irreversible remodelling of the lung vessels when diuretic therapy is not effective enough and inotropic support, circulatory mechanical support and heart / lung complex transplantation are required. The necessity of developing new scales for stratifying the risk of PAH-CHD is justified considering the particularities of the disease course and cardiac hemodynamic in different anatomical types of the defects. Based on this literature review, at the Municipal Enterprise «Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment» of the Dnipropetrovsk Regional Council» the algorithm for managing patients with PAH-CHD was devised and implemented into clinical practice.&#x0D; Conclusions. PAH is a common complication of CHD. The prevalence of PAH-CHD is substantial and it can manifest and progress even in patients with previously corrected heart defects. To effectively manage patients with PAH-CHD, an algorithm has been devised and implemented in clinical practice. It includes factors that have demonstrated associations with poor prognosis which are more than two hospitalizations for HF in the last year, pulmonary vascular resistance (PVR) (or index of PVR), mean pressure in the pulmonary artery, pulmonary capillary wedge pressure, left ventricular ejection fraction, heart failure with a reduced ejection fraction, right ventricle heart failure, NYHA FC, high risk of atrial fibrillation or flutter, 6-minute walking test distance, NTproBNP, highly sensitive C-reactive protein, B-lines on lung ultrasound, glomerular filtration rate, haemoglobin, platelet count, sodium, Model for End-Stage Liver Disease scale.

Magnetic resonance imaging-guided renal biopsy shows high safety and diagnostic yield: a tertiary cancer center experience.

To evaluate the technical success and outcomes of renal biopsies performed under magnetic resonance imaging (MRI) using a closed-bore, 1.5-Tesla MRI unit. We retrospectively reviewed our institutional biopsy database and included 150 consecutive MRI-guided biopsies for renal masses between November 2007 and March 2020. We recorded age, sex, BMI, tumor characteristics, RENAL nephrometry score, MRI scan sequence, biopsy technique, complications, diagnostic yield, pathologic outcome, and follow-up imaging. Univariate logistic regression was used to assess the association between different parameters and the development of complications. McNemar's test was used to assess the association between paired diagnostic yield measurements for fine-needle aspiration and core samples. A total of 150 biopsies for 150 lesions were performed in 150 patients. The median tumor size was 2.7 cm. The median BMI was 28.3. The lesions were solid, partially necrotic/cystic, and predominantly cystic in 137, eight, and five patients, respectively. Image guidance using fat saturation steady-state free precession sequence was recorded in 95% of the biopsy procedures. Samples were obtained using both fine-needle aspiration (FNA) and cores in 99 patients (66%), cores only in 40 (26%), and FNA only in three (2%). Tissue sampling was diagnostic in 144 (96%) lesions. No major complication developed following any of the biopsy procedures. The median follow-up imaging duration was 8 years and none of the patients developed biopsy-related long-term complication or tumor seeding. MRI-guided renal biopsy is safe and effective, with high diagnostic yield and no major complications. Image-guided renal biopsy is safe and effective, and should be included in the management algorithm of patients with renal masses. Core biopsy is recommended. • MRI-guided biopsy is a safe and effective technique for sampling of renal lesions. • MRI-guided biopsy has high diagnostic yield with no major complications. • Percutaneous image-guided biopsy plays a key role in the management of patients with renal masses.

Acute bronchitis: issues and options

Introduction. Acute bronchitis (AB) is a very common disease of viral etiology. In real-life practice, the treatment of AB is associated with widespread irrational antibiotic prescribing, which requires the overall implementation of patient management algorithms comprising the identification of biomarkers of inflammation, including C-reactive protein. Mucoactive therapy remains the mainstay of treatment for patients with AB, however the debate over the most effective treatments continues to this day. The emergence of new original drugs, in particular, Erdosteine, expands efficient therapeutic opportunities for AB.Aim. To analyse the clinical effectiveness of the use of the mucoactive agent Erdostein (Edomari) vs routine use of mucolytics in AB.Materials and methods. We reviewed the management of 60 patients with AB, 30 of which received Erdosteine (Group 1), the remaining 30 patients received standard mucoactive therapy (Acetylcysteine, Ambroxol, etc.). The following variables were assessed: the time required for reversal of all symptoms of the disease expressed as a total BSS scale score (Bronchitis Severity Score), the time required for reversal of productive cough that needs the use of mucolytics, the period of temporary disability, and levels of C-reactive protein.Results and discussion. The average CRP level at disease onset was 18.4 ± 8.2 mg/L. The average WBC count was 7.8 ± 3.5 (×109/l). In AB, the duration of productive cough in the Erdosteine group was 5.7 ± 1.4 days, while in group 2 (real-life practice) the duration of mucolytics therapy was 7.1 ± 1.3 days (p &lt; 0.05). The total BSS scale score in group 1 on day 7 was 3.2 ± 0.9, in group 2 – 3.5 ± 0.9. The reversal of physical signs of AB required 5.3 ± 1.2 days in the Erdosteine group, and 5.7 ± 1.4 days in group 2. The period of temporary disability in group 1 was 8.7 ± 1.2 days, in group 2 – 9.1 ± 1.3 days.Conclusion. Thus, we collected objective data supporting the possibility of using C-reactive protein test in deciding the issue of antimicrobial therapy prescribing. The CRP level observed (18.4 ± 8.2 mg/l) indicated a viral etiology of AB. The use of original Erdosteine (Edomari) in the treatment of acute bronchitis is estimated as highly effective. The average duration of effective mucolytics therapy in AB is 5–7 days.

Multidisciplinary Approach To The Problem Of Managing Children With Frequent Respiratory Infections Of The Upper Respiratory Tract: Key Results

Background. Recurrent upper respiratory diseases in children are an urgent and common issue in pediatrics. Comorbidities often lead to prolonged, complicated, or chronic course of the inflammatory process in the upper airways.Objective. The aim of the study — scientific evidence and complex technology development for the management of children with recurrent upper respiratory diseases according to implemented multidisciplinary personalized approach, complex of modern methods for diagnosing and health monitoring to achieve long-term remission.Materials and methods. The study included 115 children aged from 2 years 6 months to 17 years 11 months with recurrent upper respiratory diseases. Examination included: nasal cavity, nasopharynx and larynx endoscopy, abdomen ultrasound with aqueous-siphon test, tympanometry, and laboratory tests (total and specific IgE levels, antistreptolysin-O, microbiological study of nasopharynx and oropharynx discharge, enzyme-linked immunosorbent assay of feces on Helicobacter pylori.Results. The study has revealed high prevalence of associated allergic pathology in children with recurrent upper respiratory diseases. Allergic rhinitis was the most common (55 (48%) children). There was also a high prevalence of gastroesophageal reflux disease (GERD) (37 (32%) children). Clinical signs of GERD were revealed in patients with chronic diseases significantly more often than in children with acute ENT pathology (27 (38%) and 10 (23%) children, respectively). It confirms the role of this comorbid condition in the development and course of chronic inflammatory process of the upper airways. Obtained data analysis has shown high prevalence of allergic and gastrointestinal pathology in children with recurrent upper respiratory diseases. Diagnostic and management algorithm for patients with recurrent upper respiratory diseases as well as practical guidelines were prepared based on the study data. This algorithm will allow to implement the personalized multidisciplinary approach for the management of prior and comorbid diseases via modern informative diagnostic methods. The complex approach to timely physical examination and pathogenetic treatment will ensure control of the patient’s condition and prevent the development of chronic ENT organ pathology in children.

Patient outcomes following integration of palliative care into the management algorithm for patients with pancreatic ductal adenocarcinoma in a South African Teaching Hospital

Patient outcomes following integration of palliative care into the management algorithm for patients with pancreatic ductal adenocarcinoma in a South African Teaching Hospital

Роль предоперационной подготовки к кохлеарной имплантации у пациентов с тяжелой сопутствующей патологией

The own experience of managing patients with severe hearing loss and severe somatic concomitant pathology at all stages of cochlear implantation (CI) under local anesthesia is presented. Patients and methods. On the basis of the Center for Otorhinolaryngology, CI was performed under local anesthesia in 25 patients with sensorineural hearing loss grade IV or deafness with concomitant somatic pathology, 25 patients consisted of 17 men (68%) and 8 women (32%). The average age was 53.2±2.6 years. CI was performed under local anesthesia with 2% lidocaine solution using 1 mg adrenaline for 20 mL 2% lidocaine. The operation was performed using the classical method under the control of an OMPI Sensera S8 Karl Zeiss operating microscope. Results. Before the operation, all patients in the conversation were familiarized with each stage of the operation and with visual tables for contact between the doctor and the patient during the operation to monitor their subjective feelings. During the operation, anesthesia was well tolerated, and there were few complications. None of the patients showed feelings of anxiety, worry, or fear during the operation. After surgery, patients were questioned to identify early postoperative symptoms. Pain in the wound area of mild and moderate severity, mainly on the 1st day after the operation, was experienced by all patients; systemic dizziness, 7 patients (28%), hematoma around the implant was noted in 2 patients (8%). These symptoms were relieved by standard therapy by the 3rd day after surgery. Deterioration of the general condition associated with concomitant pathology was not observed in any of the patients. Conclusion. Compliance with the patient management algorithm at all stages of CI under local anesthesia with high-quality psychological preparation ensures good tolerability of the operation, psychological comfort of the patient during the operation, and a small number of complications, both during and after the operation.

Consensus on the preoperative management of patients with chronic moderate to severe shoulder pain to improve postoperative outcomes: Delphi results

BackgroundAn appropriate preoperative management of patients with chronic moderate to severe shoulder pain who are candidates for surgery due to rotator cuff disease or glenohumeral osteoarthritis may improve surgery and patient outcomes, but published evidence in this regard is scarce. Therefore, the availability of recommendations on preoperative interventions based on expert consensus may serve as guidance. MethodsA Delphi study was conducted to develop a preoperative management algorithm based on a national expert consensus. A Delphi questionnaire was developed by a Scientific Committee following a systematic review using PRISMA criteria of the relevant literature published during the last 10 years. It consisted of 48 statements divided into five blocks (I. Assessment/diagnosis of preoperative pain; II. Preoperative function/psychosocial aspects; III. Therapeutic objectives; IV. Treatment; V. Follow-up/referral), and 28 experienced shoulder surgeons from across the country were invited to answer. ResultsAll participants responded to the Delphi questionnaire in the first round and 25 in the second round (89.3% of those invited). Overall, 46/49 final statements reached a consensus, based on which a final preoperative management algorithm was defined by the Scientific Committee. First, surgeons should assess shoulder pain intensity and characteristics, shoulder functionality and psychosocial aspects using specific validated questionnaires. Preoperative therapeutic objectives should include shoulder pain control, depression/nocturnal sleep improvement, opioid consumption adjustment and substance abuse cessation. Postoperative objectives regarding the degree of shoulder pain reduction or improvement in functionality/quality of life should be established in agreement with the patient. Treatment of preoperative chronic moderate to severe shoulder pain should comprise non-pharmacological as well as pharmacological interventions. Follow-up of shoulder pain levels, treatment adherence and mental health status of these patients may be carried out by the surgical team (surgeon and anesthesiologist) together with the Primary Care team. Patients with very intense shoulder pain levels may be referred to the Pain Unit, following specific protocols. ConclusionA preoperative management algorithm for patients with chronic moderate to severe shoulder pain who are candidates for surgery due to rotator cuff disease or glenohumeral osteoarthritis was defined based on a national expert consensus. Main points include a comprehensive patient management starting with an objective assessment of shoulder pain and function, quality of life, establishment of preoperative and postoperative therapeutic targets, prescription of individualized therapeutic interventions and multidisciplinary patient follow-up. Implementation of these recommendations to clinical practice may result in better preoperative shoulder pain management and more successful surgery outcomes and patient satisfaction.

USE OF INDIVIDUAL PREDICTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS IN OBESE PATIENTS DURING DISPENSARY OBSERVATION

COPD is one of the main public health problems. 40.0% of all COPD patients tolerate at least 1 moderate or severe exacerbation within a year, and up to 16.0% - 2 or more. GOLD (2022) proposed for clinical practice a strategy based on "treatable traits," the key of which are exacerbations and persistent shortness of breath, but there are other numerous pulmonary and extrapulmonary features, the definition and consideration of which is useful when leaving individual management algorithms for patients with COPD.&#x0D; Purpose. To evaluate the clinical effectiveness of the use of individual prediction of COPD exacerbations in obese patients during clinical observation.&#x0D; Materials and methods. 106 people diagnosed with COPD between the ages of 18 and 80 were examined. The patient examination included an assessment of the number of outpatient exacerbations and hospitalizations to medical organizations over the past 12 months, a BMI calculation, a comprehensive assessment of COPD symptoms with CAT, the functional status of patients, and an assessment of biochemical blood parameters. Results. According to the examination results and BMI calculation, 80 patients (75.5%) were overweight (55 patients) or obese of various degrees (grade 1 obesity - 21 patients, grade 2 - 1 patient and grade 3 - 3 patients). According to GOLD (2023), all patients were classified as "high risk of exacerbations" - group E. The probability index of COPD exacerbation was calculated over the next 12 months using regression analysis. To prevent predicted exacerbations of COPD, individual treatment and rehabilitation programs were developed for patients, designed for use for 12 months of follow-up: treatment modification, personalized programs for optimizing physical activity, dietary recommendations, vaccination against influenza and pneumococcal infection, course therapy with melatonin, consultation with an endocrinologist. At the end of 12 months, compliance with the recommendations of the index of the probability of exacerbation of COPD for the next 12 months was low.&#x0D; Conclusions. In patients with frequent exacerbations of COPD, in order to achieve disease control, it is advisable to develop individual treatment and rehabilitation programs within the framework of clinical observation, given the "treatable signs," the correction of which has a significant positive effect on the course of COPD, achievement of control and prognosis of the disease.

Учебная лаборатория ВЕТЛАБ – современный подход к подготовке офтальмохирургов

The article presents the results of Wetlab work in Ufa Eye Research Institute for 2014–2023. The described method of teaching includes theoretical training, step-by-step mastering of phacoemulsification in the training class, work at the operation unit as well as the algorithm for diagnosis and management of patients in the postoperative period. The successful work of Wet Laboratory in Ufa Eye Research Institute has made phaco training more accessible for opthtalmologists from Russia and neighbouring countires. Key words: Ufa Eye Research Institute; Wetlab; results of work.