Duration Of Inpatient Treatment Research Articles

Hepatokines Orosomucoid: Pathogenetic Role in Liver Steatosis

The liver is an endocrine organ because hepatocytes produce a number of biologically active regulators of systemic metabolism and energy balance – hepatokines, which include orosomucoids (seromucoids). According literuture data, orosomucoids reduce the production of activated oxygen forms, protect adipose tissue, regulate immune processes, act as cardioprotectors, and drug carriers. Orosomucoids production is associated with the development of fatty hepatosis too but pathogrenetic role of orosomucoids in liver steatosis needs more investigations. The objective: to evaluate the effects of orosomucoids on systemic metabolism in patients with coronary artery disease with comorbid liver steatosis. Materials and methods. In 104 patients with coronary artery disease, unstable angina the content of orosomucoids was additionally determined by the unified orcin’s method (normal value 0,13–0,23 units). Patients were investigated according modern quidelines and Helsinki declaration of human rights. According liver steatosis presentce patients were divided into two statistically equal groups with comorbid liver steatosis (n=87; 83,65%) and intact liver (n=17; 16,35%). The results were calculated statistically with p<0.05 level. Results. Patients with and without hepatic steatosis had identically elevated orosomucoids levels (0,38±0,02 vs 0,40±0,05 units; p>0.05), but their correlations were different. The level of orosomucoids correlated directly with the duration of inpatient treatment, heart rate, acute-phase indicators of inflammation, fasting blood glucose and prothrombin time, and was conversely associated with total cholesterol and low-density lipoproteins, prothrombin index (all p<0.05). Conclusions. Orosomucoid hepatokines are key regulators of lipogenesis, under conditions of liver steatosis in patients with coronary artery disease, unstable angina, their growth correlates with activation of cellular and serum markers of inflammation, reduction of serum atherogenicity, glucose intolerance, and hypocoagulation.

Efficacy Of Vibroacoustic Therapy In Treatment Of Pneumonia In Children With Bronchopulmonary Dysplasia

Background — Advances in neonatal intensive care have resulted in high survival rates for infants born with extremely low birth weight. Accordingly, the treatment and rehabilitation of premature neonates with bronchopulmonary dysplasia (BPD) is indisputably an urgent problem. Objective — To evaluate the efficacy of vibroacoustic therapy in patients with BPD in the complex of therapeutic measures. Material and Methods — The study was a prospective, non-randomized open-label controlled clinical trial conducted in 2018-2020 in Astana, Kazakhstan. It included 69 children with BPD hospitalized with a concomitant diagnosis of pneumonia between the ages of 1 and 2 years. The study subjects were distributed among two groups: Group 1 (the main group, n=37) receiving vibroacoustic therapy with the VibroLung apparatus in combination with the main treatment and Group 2 (the control, n=32) receiving solely the main treatment. Results — The inclusion of the vibroacoustic method of treatment in the combination therapy of pneumonia in children with BPD resulted in early leveling of the following clinical symptoms: a reduction in the duration of the high fever by 1.18 days vs. the control group (p<0.05), relief of respiratory failure 1.4 days earlier vs. the control group (p<0.05) and a decrease in the duration of inpatient treatment by 2.9 days, compared with the control group (p<0.05). All of these implied the efficacy of this treatment method. Conclusion — Our results demonstrated that vibroacoustic therapy was a relevant addition to the treatment of pneumonia in children with BPD.

The Value of NSE, S100, and E-Selectin Biomarkers for Predicting the Course and Severity of COVID-19 in Children

Objective — to investigate the relationship between the level of NSE, S100 and E-selectin biomarkers with the complicated course and symptoms of the nervous system in children with COVID-19. Materials and methods. We conducted a pilot, cohort, observational, retrospective study involving 88 children aged 1 month to 18 years with laboratory-confirmed COVID-19 by the PCR method, who underwent inpatient treatment at the Kyiv City Children’s Clinical Infectious Disease Hospital in 2021—2022. During the first day of hospital stay, blood serum was collected from patients and the level of NSE, S100 and E-selectin biomarkers was determined by enzyme immunoassay. Results and discussion. A complicated course was observed in 42 (47.7 %) patients. Symptoms from the nervous system were noted in 46 (52 %) patients. In patients with an uncomplicated course, the average level of NSE on the first day of inpatient treatment was (12.1 ± 1.2) μg/l, S100 — (164 ± 8.2) ng/l, E-selectin (12.02 ± 1.7) ng/ml. In patients with a complicated course, the average levels of biomarkers were, respectively: (16.9 ± 1.5) μg/L, (165.9 ± 6.9) ng/L, and (15.04 ± 1.9) ng/mL. An increase in the level of NSE above 15 μg/L and E-selectin above 25 ng/ml was associated with a significant increase in the risk of clinical symptoms from the nervous system and a complicated course in children with COVID-19 (p < 0.05). The value of the S100 index above 150 ng/l was associated with an increased risk of clinical symptoms of nervous system damage (p < 0.05) and a tendency to complications (p < 0.1). The level of all biomarkers was also associated with an increase in the duration of inpatient treatment. Conclusions. Complicated course and onset of nervous system symptoms in children hospitalized with COVID-19 are associated with increased levels of the biomarkers NSE, S100, and E-selectin. Determina­tion of these biomarkers can be used in diagnostics to predict the course and severity of the disease in children undergoing inpatient treatment for COVID-19.

Retroperitoneoscopic adrenalectomy may be superior to laparoscopic transperitoneal adrenalectomy in terms of costs and profit: a retrospective pair-matched cohort analysis

BackgroundA direct comparison of the cost–benefit analysis of retroperitoneoscopic adrenalectomy (RPA) versus the minimally invasive transperitoneal access (LTA) approach is currently lacking. We hypothesized that RPA is more cost effective than LTA; promising significant savings for the healthcare system in an era of ever more limited resources.MethodsWe performed a monocentric retrospective observational cohort study based on data from our Endocrine Surgery Registry. Patients who were operated upon between 2019 and 2022 were included. After pair-matching, both cohorts (RPA vs. LTA) were compared for perioperative variables and treatment costs (process cost calculation), revenue and profit.ResultsTwo homogenous cohorts of 43 patients each (RPA vs. LTA) were identified following matching. Patient characteristics between the cohorts were comparable. In terms of both treatment-associated costs and profit, the RPA procedure was superior to LTA (costs: US$5789.99 for RPA vs. US$6617.75 for LTA, P = 0.043; profit: US$1235.59 for RPA vs. US$653.33 for LTA, P = 0.027). The duration of inpatient treatment and comorbidities significantly influenced the cost of treatment and the overall profit.ConclusionsRPA appears not only to offer benefits over LTA in terms of perioperative morbidity and length of hospital stay, but also has a superior financial cost/benefit profile.Graphical abstract

Provision of cardiosurgical care during martial law and analysis of the need for bed-places and bed-days

The article analyzes the duration of inpatient treatment of servicemen who needed cardiosurgical treatment during martial law. Diseases of the circulatory system, mine-explosive injuries of the chest with direct involvement of the heart and main vessels are life-threatening conditions. Statistics of combat losses during military conflicts show that 1/3 of servicemen with gunshot wounds or chest trauma die due to bleeding and cardiac arrest. With the resolution of the war in the russian federation, the need to provide highly qualified cardiosurgical care will increase. Therefore, a clear understanding of the planning of bed spaces with the calculation of bed days is necessary to ensure the provision of cardiac surgical care. The purpose of the study is to determine the need for the number of bed-places and bed-days during the stay of a sick/ wounded serviceman in a cardiosurgical hospital. The need for bed-days and the number of bed-places was studied, and a conclusion was made about the need to increase them. The amount of inpatient care provided, as well as the duration of treatment of servicemen during a local military conflict (anti-terrorist operation/joint forces operation) in the conditions of stay in a cardiac surgical hospital and compared with the amount of medical care and the duration of treatment of servicemen during martial law were analyzed. As a result of the study, a conclusion was made about the need to organize separate structural divisions for the provision of highly specialized medical care, which includes cardiovascular surgery. It was established that the need for the number of beds during a full-scale war exceeds the planned by 266.3%, and the number of bed days during the stay of a sick/wounded serviceman in a cardiac surgical hospital during martial law increased by 6.3%. Ensuring an adequate need for the number of inpatient places and a justified duration of treatment allows timely provision of quality treatment of the sick and/or wounded, providing them with timely rehabilitation and returning the serviceman to the ranks of the armed forces of Ukraine. Keywords: inpatient care, diseases of the circulatory system, cardiovascular surgery, organizational measures, provision of adequate needs, hospitalization of patients and victims.

Medical and social problem and organization of medical care for people with disabilities due to respiratory diseases due to the development of COVID-19 infection

Respiratory diseases require the close attention of medical specialists at all levels of providing medical and diagnostic care to patients, as well as improving preventive measures. In recent years, there has been an increase in the incidence of respiratory diseases, an increase in the number of cases of temporary disability and the disability rate of the population. Disabled people due to respiratory diseases need complex treatment and rehabilitation to improve the quality of life. Purpose of the study. To study the organization of medical care for people with disabilities with respiratory diseases in 2019-2021. given the spread of COVID-19. Materials and methods. For the analysis, the primary registration forms of the State Budgetary Institution of Healthcare of the Republic of Bashkortostan “City Hospital No. 21” in Ufa and the Main Bureau of Medical and Social Expertise of the Republic of Bashkortostan were used. Results. It was found that all disabled people included in the study were hospitalized in 2019 (168.9 hospitalizations per 100 disabled people). The average duration of inpatient treatment was 17.6 days. All disabled people were consulted by general practitioners – 324.2 consultations per 100 disabled people, the least often consultation of a general practitioner was received by disabled people about bronchiectasis – 228.6 per 100 disabled people. Of the total number of disabled people, only 85.6 % were consulted by a pulmonologist (frequency 118.9 consultations per 100 disabled people). Despite the fact that all disabled people underwent certain clinical and laboratory examinations, their frequency was lower than that provided for by regulatory legal acts. During the COVID-19 pandemic, the level of hospitalization of people with disabilities has significantly decreased, the length of stay in the hospital has decreased, and the volume of consultative, diagnostic and rehabilitation assistance has decreased. Conclusion. The analysis carried out indicates the need to improve medical care for the disabled and to plan measures to increase the volume of medical and diagnostic measures during the outbreak of epidemics of infectious diseases.

Application of Combined Laser Irradiation in Postoperative Period in Patients with Complicated Hepatic Echinococcosis

The article presents an analysis of the results of surgical treatment of patients with complicated liver echinococcosis in 102 patients using laser technology in the postoperative period. The patients were divided into 2 groups. Group I 62 (61%) patients with the use of laser technology in the postoperative period. II group 40 (39%) patients with the traditional method. Due to the use of low-energy lasers in the postoperative period with complicated liver echinococcosis, the proportion of complications was reduced by 3-3.5 times, and the duration of inpatient treatment was reduced by 1.5-2 times

Surgical treatment of isolated soft tissue gunshot shrapnel injuries by combining primary delayed sutures with platelet-rich autoplasma injections into mine-explosive wounds

Aim: to assess the treatment effectiveness in patients with soft tissue gunshot shrapnel injuries by applying primary delayed sutures in combination with platelet-rich autoplasma injections into wounds. Materials and methods. The study included 60 (100.0 %) patients with soft tissue gunshot shrapnel wounds. All wounded were divided into two groups. The comparison group consisted of 30 (50.0 %) patients admitted to a hospital with primary delayed sutures (6–7 days). The main group included 30 (50.0 %) patients whose local treatment modification consisted in a combination of primary delayed suturing with platelet-rich autoplasma injection into a wound. A wound channel was observed on the 8th, 11th –14th days from the moment of injury using visual inspection, linear measurements and diagnostic ultrasound system (Mindray M6, 220A). Results. 60 (100.0 %) patients were urgently hospitalized to the third stage of medical evacuation and treated according to standard treatment protocols for this pathology at the third stage of evacuation. According to a wound defect localization, the wounded of the comparison groups, 30 (50.00 %), were distributed as follows: a lower limb wound – 22 (73.33 %) patients, an upper limb wound – 6 (20.00 %), and a trunk wound – 2 (6.67 %). The main group also included 30 (50.00 %) wounded, whose treatment at the third stage of medical evacuation was modified by using a combination of primary delayed sutures and platelet-rich autoplasma injection. On the 8th day after an injury, a visual inspection of the wounds detected no hyperemia or suppuration in both groups. The visual inspection of wounds in the comparison group at 11.0 ± 3.9 days post-injury revealed 24 (80.00 %) patients with complications such as seromas in 17 (56.67 %) cases, hematomas with wound suppuration – in 7 (23.33 %). In the main group, 2 (6.67 %) cases of wound suppuration were detected (U = 120.00, p = 0.000001). The basic parameters of wound linear measurements according to the diagnostic ultrasound system data at the 11th–14th day post-injury after primary and delayed suturing in the studied groups: in the comparison group, upper limb wounds – S (mm2) 43.3 ± 12.6, V (mm3) 53.3 ± 13.9; lower limb wounds – S (mm2) 194.7 ± 50.7, V (mm3) 706.3 ± 190.4; trunk wounds – S (mm2) 20.5 ± 7.2, V (mm3) 22.5 ± 5.4. In the main group, upper limb wounds – S (mm2) 28.2 ± 8.5, V (mm3) 23.2 ± 7.1; lower limb wounds – S (mm2) 56.4 ± 19.6, V (mm3) 102.4 ± 21.1; trunk wounds – S (mm2) 12.3 ± 3.2, V (mm3) 10.4 ± 2.9. The total duration of inpatient treatment at the 3rd stage of medical evacuation in the comparison group wounded was 30.0 ± 2.3 days, and in the main group it was 12.0 ± 3.1 days (U = 290.00, p = 0.0354). Conclusions. In the structure of gunshot shrapnel wounds in both groups, there were 43 (71.67 %) lower limb traumatic injuries, 11 (18.33 %) upper limb, and 6 (10.00 %) trunk injuries. The use of platelet-rich autoplasma in combination with primary delayed suturing stimulated wound healing and accelerated wound-healing process as evidenced by a significant decrease in the wound defect area and volume on the 11th–14th day post-injury in the main group compared to the comparison group. The method for treatment of gunshot shrapnel wounds developed by us reduced the frequency of postoperative complications since 24 (80.00 %) patients were diagnosed with complications in the comparison group, while only 2 (6.67 %) patients in the main group (U = 120.00, p = 0.00001). The use of platelet-rich autoplasma made it possible to reduce the length of hospital stay for patients at the third stage of medical evacuation: in the comparison group, this period was 30.0 ± 2.3 days, and in the main group, 12.0 ± 3.1 days (U = 290.00, p = 0.0354).

Use of fibrin glue in the treatment of decubital ulcers in patients after brain damage, as a stage of conservative treatment

BACKGROUND: Patients with brain damage require specific treatment for decubitus ulcers. Given the seriousness of their condition and decompensation of concomitant pathology, surgical treatment is not always possible. Conservative therapy can take a long time, which is aggravated by the unsolvable problem of patient immobilization, microcirculatory tissue disorders, and inevitable chronicity of the purulentinflammatory process. Most authors and practitioners are inclined toward a combined approach in the treatment of decubitus ulcers. AIM: To evaluate the results of using fibrin glue in the treatment of bedsores in patients with severe brain damage. MATERIALS AND METHODS: The article presents the experience of using fibrin glue in the conservative treatment of bedsores. The study included patients in a chronic critical state because of severe brain damage, with a decubitus ulcers area of 80 cm2 (stage III according to the Agency For Health Care Policy and Research classification). In the main group, treatment included the use of fibrin glue in accordance with the Russian Federation Patent No. 2777483 dated 08/04/2022. In the control group, treatment included standard dressings with levomekol ointment. Both groups received treatment for 21 days. Changes in the wound process were assessed using the BatesJensen scale and cytological examination at control points. RESULTS: The study analyzed 58 patients, who were divided into two groups: group 1 (main) included 32 patients (15 men, 17 women), and group 2 (control) included 26 patients (12 women, 14 men). In the main group, after 1 week of applying dressings with fibrin glue, positive changes were noted, such as active marginal epithelialization, disappearance of undermining and swelling of wound edges, appearance of juicy bright granulations, and absence of exudates. After 22.5 weeks, epithelialization exceeded 50% of the total area of the decubitus ulcers (56.2% of cases), and exudation was completely absent. In a cytological study, the percentage of cells responsible for tissue proliferation increased and inflammation decreased in the main group. No significant effect was noted in the control group. In 7.7% of cases, 50% epithelialization was noted on days 2835; in three patients, re-infection of the decubitus ulcers occurred, and ischemia developed, which significantly lengthened the total duration of inpatient treatment and rehabilitation by 1.01.5 months. CONCLUSION: The use of fibrin glue promotes decubitus ulcers epithelization, thereby reducing their size, up to complete healing.

Short-term prehabilitation of patients with colorectal cancer — protocol of a randomized trial

AIM: to estimate effect of unimodal short preabilitation on functional reserves of patients, hospital stay, complication rate and quality of life.PATIENTS AND METHODS: a single-centre, prospective, randomized study will include 128 patients undergoing colon resection for colorectal cancer. Patients will be divided into an intervention group that will receive 14 days of unimodal prehab (Group 1) and a control group that will not receive prehab (Group 2). Perioperative management of patients in both groups will be carried out in accordance with the guidelines for accelerated recovery after surgery (ERAS). The primary endpoint of the study will be the six-minute walk test (6MWT). Secondary endpoints will be: number of postoperative complications (by Clavien-Dindo), duration of the postoperative period, postoperative mortality, quality of life of patients and adherence of patients to the passage of the prehabilitation program.DISCUSSION AND CONCLUSION: it is expected that short-term unimodal prehabilitation will improve the functional reserves of patients, reduce the duration of inpatient treatment and reduce the number and severity of postoperative complications, which can lead to a decrease in postoperative mortality and an improvement in the quality of life of patients. The adherence of the domestic cohort of patients to prehabilitation will be analyzed.

Predictors of length of hospital stay in patients with acute COVID-19

The aim of the study was to identify the predictors of length of hospital stay in patients with acute COVID-19, based on the pathophysiological particularities of SARS. Materials and methods: The study was conducted from December 2020 to May 2021 on 103 randomized patients (59 men, mean age 62±13 years, body mass index 30.3±5.5 kg/m2 ) with moderate to severe acute COVID-19 infection who were hospitalized for emergency non-invasive oxygen therapy. Log-regression models were used to assess the suitability of some functional spirometric variables and/or SpO2/FiO2 surrogate oxygenation index to predict the duration of inpatient treatment from the day of the examination (≤ 7 vs. > 7 days). Results: The analysis of the receiver operating characteristic curves showed that the relative indicator of the “ventilatory reserve” (the ratio of maximum voluntary ventilation to minute ventilation at rest, VR= MVV / MV) has sufficient sensitivity (82%), specificity (69%) and the area under the curve (AUC=0.7), although the SpO2/FiO2 ratio has a better predictive capacity (78%, 84% and 0.8 accordingly). The model combining these two integral indicators of gas exchange and the respiratory muscles reserve showed the best sensitivity (89%), specificity (84%) and area under the curve (0.9). Conclusion: The proposed model for determining of the hypoxia vector by assessing the severity of ventilation-perfusion dissociation with indicators of oxygenation and ventilation showed that the MVV/MV ratio and SpO2/FiO2 ratio can be used alone and especially in combination, as effective outcome predictors of the acute phase of the infectious process caused by SARS-CoV-2.

Ускоренное выздоровление. предоперационная подготовка и преабилитация.

Fast Track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery after surgery programs) or ERP (enhanced recovery program, in russian) is a multimodal and multidisciplinary treatment strategy designed to reduce the duration of disability and improve the quality of medical care. This program includes preparation at the preoperative stage, the use of minimally invasive techniques for performing surgical intervention and active management of the postoperative period to reduce the duration of inpatient treatment, rehabilitation time and the fastest possible return of patients to normal life. In the context of this review, the features of preparation and prehabilitation at the preoperative stage of the enhanced recovery program are considered. The main elements of the strategy are reviewed: correction of eating disorders, carbohydrate loading, preoperative education and problems of multidisciplinary interaction, sarcopenia, lifestyle changes, pharmacogenomics, correction of anemia and preoperative bowels preparation. Prehabilitation and preoperative preparation together help make the patient for surgery and subsequent recovery. The main elements of training are patient and staff training, multidisciplinary interaction, correction of concomitant somatic disorders and diseases, nutrition optimization and lifestyle changes.

Kosten potenziell ambulant erbringbarer endoskopischer Leistungen in Fällen mit 1-Tages-Verweildauer gegenüber einer längeren Verweildauer

The transfer of patient care and medical interventions that was previously provided on an inpatient basis to outpatient settings is a stated goal of health politics. It is unclear to what extent costs of an endoscopic procedure and the disease severity depend on the duration of inpatient treatment. We therefore examined whether endoscopic services for cases with a one-day length of stay (VWD) are comparably expensive to cases with a longer VWD. Outpatient services were selected from the DGVS service catalog. Day cases with exactly one such gastroenterological endoscopic (GAEN) service were compared with cases with VWD>1 day regarding their patient clinical complexity levels (PCCL) and mean costs. Data from the DGVS-DRG project with §21-KHEntgG cost data from a total of 57 hospitals from 2018 and 2019 served as the basis. Endoscopic costs were taken from cost center group 8 of the InEK cost matrix and plausibility checked. A total of 122,514 cases with exactly one GAEN service were identified. Statistically equal costs were shown in 30 of 47 service groups. In 10 groups, the cost difference was not relevant (<10%). Cost differences >10% existed only for EGD with variceal therapy, insertion of a self-expanding prosthesis, dilatation/bougienage/exchange with PTC/PTCD in place, non-extensive ERCP, endoscopic ultrasound in the upper gastrointestinal tract, and colonoscopy with submucosal or full thickness resection, or foreign object removal. PCCL differed in all but one group. Gastroenterology endoscopy services provided as part of inpatient care but potentially performable on an outpatient basis are predominantly equally expensive for day cases as for patients with a length of stay greater than one day. The disease severity is lower. Calculated §21-KHEntgG cost data thus form a reliable basis for the calculation of appropriate reimbursement for hospital services to be provided as outpatient services under the AOP in the future.

Joint Crisis Plans and Crisis Cards in Inpatient Psychiatric Treatment—a Multicenter Randomized Controlled Trial.

Joint Crisis Plans (JCP) and crisis cards (CC) are both instruments designed to improve the management of future psychiatric crisis situations, but they differ, for example, in terms of resource use, legal validity, and aims. International research findings for JCP are inconsistent. From January 2018 to December 2020, a single-blinded, two-armed multicenter RCT was carried out, with assessments at T0 (baseline) and T1 (18 months later). The patients included had schizophrenia or schizoaffective disorder and were aged between 18 and 62 years. The primary outcome was the cumulative duration of inpatient treatment (voluntary/involuntary), and coercive measures comprised the secondary outcome. Trial registration: DRKS00013985. Of the 266 study participants, 157 completed the study. In the CC group 57.8% and in the JCP group 64.9% were admitted to psychiatric hospitals between the index treatment and T1 (p = 0.367); 8.4% of the CC group and 12.2% of the JPC group were admitted against their will (p = 0.441). The cumulative treatment duration was not significantly shorter (p = 0.631) in the JPC group (mean 42.43 days, SD = 48.60) than in the CC group (50.16 days, SD = 74.16). Thus, JPCs did not achieve the expected improvement with regard to the primary endpoint. There were also no relevant differences regarding the secondary endpoint. Major effects in favor of the JCP were observed, however, in patients' development of conficence in the treatment teams and in their active participation in the treatment procedure. Although the study showed no superiority of JCP over CC with regard to the primary and secondary outcomes, JCP should be used more frequently in routine practice as an intervention to support a participative approach to treatment.

Туберкулезный спондилит грудопоясничной локализации: выбор оптимального метода хирургического лечения на основе систематизированного обзора литературы

Introduction Tuberculous spondylitis is the most common extrapulmonary tuberculosis. The thoracolumbar lesion due to tuberculous spondylitis is one of the most difficult locations for surgical treatment. Analysis of the recent literature shows a limited amount of data on the results of various current surgical reconstruction techniques. Purpose To review the literature on surgical treatment of thoracolumbar tuberculous spondylitis published during the last five years and judge upon an optimal method. Materials and methods A systematic literature review was performed of the sources from eLibrary, PubMed, Cochrane Library databases. Inclusion criteria: etiologically verified tuberculous spondylitis of thoracolumbar location, follow-up ≥ 1 year, patients older than 18 years. Twenty-one studies that summarize 1,209 cases were selected. Patients were divided into three groups depending on the method of spinal reconstruction (group 1 – ventral approach, group 2 – combined approach, group 3 – dorsal approach). Surgical indicators, correction of kyphotic deformity and its dynamics in the long-term period, rates of complications and the length of hospital stay were analyzed. Results and discussion Blood loss and duration of the intervention were significantly lower in the reconstruction of the thoracolumbar spine from the dorsal approach (599.6 ± 195.1 ml and 196.3 ± 35.6 min). Correction of kyphotic deformity from posterior and combined approaches was higher than in the reconstruction from the ventral approach (64 and 69 %, respectively). At the same time, an inverse proportional dependence of the degree of correction loss in the long-term period was revealed, which was higher with anterior fusion (7.3° ± 1.7° according to Cobb). The duration of hospital stay was shorter in patients with reconstructions from the dorsal approach (13.7 ± 8.2 days). The rate of complications in group 3 was significantly lower (p &lt; 0.0001), while the assessment of their structure indicates prevalence of neurological deficits in dorsal reconstructions, while in ventral and combined reconstructions, infectious complications, pneumothorax, and chronic pain syndrome in the area of autologous costal graft harvesting. Conclusion The optimal method of surgical treatment of thoracolumbar tuberculous spondylitis is a three-column reconstruction from the dorsal approach. The advantages of the method are a decrease in the rate of postoperative complications, a reduction in the duration of inpatient treatment, surgical blood loss and duration of surgical intervention.

Mapping length of inpatient treatment duration and year-wise relapse rates in eating disordered populations in a well-defined Western-European healthcare region across 1998-2020.

Updated international guideline recommendations for AN inpatient care rely on expert opinions/observational evidence and promote extended inpatient stays, warranting investigation using higher-level ecological evidence. The study was conducted according to Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Data encompassing 13,885 ED inpatients (5336 adolescents and 8549 adults) was retrieved from Swedish public health registries. Variables analyzed included (1) ED inpatient care opportunities, (2) unique number of ED inpatients and (3) mean length of ED-related inpatient stays in age groups 15-19 and 20-88+, across 1998-2020. Mean length of inpatient stays was inversely correlated to relapse to ED-related inpatient care within the same year (p<0.001, R-squaredadj =0.5216 and p<0.00001, R-squaredadj =0.5090, in the 15-19 and 20-88+ age groups, respectively), independent of number of ED inpatients treated within a year in both age groups. Extending mean adolescent inpatient duration from 35 to 45days was associated with a ∼30% reduction in the year-wise relapse rate. Mean length of ED-related inpatient treatment stays was associated with reduced relapses to inpatient care within the same year, which could be interpreted as support for recommendations to include a stabilization phase in inpatient ED treatment.

Senile asthenia as a predictor of the severity of the perioperative period in elderly and senile patients

The aim. To evaluate the effectiveness of the diagnosis of senile asthenia using the Edmonton Frail scale in emergency abdominal surgery and to determine its impact on the severity of the perioperative period. Materials and methods. The study included 81 patients with acute cholecystitis on the background of gallstone disease, who were assessed for senile asthenia using the Edmonton Frail scale. For the reliability of the obtained results, only patients who were urgently hospitalized to the surgical department with gynecology beds of the emergency hospital with clinical symptoms of acute cholecystitis were included. All patients received treatment in only one department and according to the standards and clinical protocols of this clinic. Based on the Edmonton Frail score, all patients were divided into two groups. The comparison group included 50 (61.7 %) patients who did not have senile asthenia. The main group included 31 (38.3 %) patients diagnosed with senile asthenia. Results. Surgical treatment in both groups was carried out on an urgent basis using total intravenous anesthesia with artificial lung ventilation. According to the type of surgical intervention in both groups, preference was given to minimally invasive methods. Laparoscopic cholecystectomy in the comparison group was performed in 49 (98.0 %) patients, and only one patient (2.0 %) was converted and operation continued from the mini-access. In the main group, all surgical interventions were performed by the laparoscopic method, U = 759.50, P = 0.8841. Analyzing the results of the duration parameters and the need for prolonged mechanical ventilation, it can be seen that it progressively increases in patients with asthenia: in the comparison group 61.50 (48.00; 75.00) minutes, and in the main 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. Also, we noted that in patients with senile asthenia, the number of postoperative complications increases: in the comparison group, there were only 2 (4.0 %) postoperative complications, while in the main group – 7 (22.6 %), U = 556.00, Р = 0.0337. Summarizing the results, it can be seen that due to increase of the frequency of postoperative complications and increase of the need for prolonged artificial ventilation of the lungs, the length of hospital stay of patients with senile asthenia increased: in the comparison group it was 7.9 ± 2.2 days, and in the main group 9.7 ± 3.2 days, U = 530.50, P = 0.0177. Conclusions. In our opinion, the Edmonton Frail scale is effective in diagnosing the severity of senile asthenia in elderly and senile patients in emergency abdominal surgery due to its simplicity and speed of use. The overall severity of the condition, heart failure in patients with senile asthenia lead to increase in the duration of surgery and the total duration of artificial lung ventilation: in the comparison group 39.52 (30.00; 45.00) minutes, while in the main group 49.19 (35.00; 50.00) minutes, U = 482.50, P = 0.0046. The duration of mechanical ventilation also differed significantly, in the comparison group 61.50 (48.00; 75.00) minutes, and in the main – 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. The severity of senile asthenia negatively affects the course of the perioperative period, the frequency of postoperative complications increases: 2 (4.0 %) patients in the comparison group, while in the main group of 7 (22.6 %) patients, U = 556.00, P = 0.0337 and, as a consequence, the duration of inpatient treatment increases: in the comparison group it was 7.9 ± 2.2 days, in the main – 9.7 ± 3.2, U = 530.50, P = 0.0177. Modification of the approaches to preoperative preparation and postoperative management of elderly and senile patients diagnosed with senile asthenia will reduce the frequency of postoperative complications and reduce the length of hospital stay.

Principles of fast-track surgery in the treatment of giant uterine fibroids: а clinical case

The article addresses the treatment of uterine fibroids, which is still relevant. According to numerous studies, about 70% of females under 50 have uterine fibroids, the most common condition among perimenopausal women. The prevalence of giant forms is not high and accounts for less than 5% of all cases, especially at early diagnosis. The surgical strategy in such cases is individual and depends on many factors: size, location of nodes, and women's reproduction plans. In these clinical cases, the management of patients with giant uterine fibroids is presented according to the multimodal principles of fast-track surgery in a modern gynecological hospital. We described the main approaches in diagnosis, preoperative preparation, surgery features, and subsequent recovery to reduce the complication rate, the duration of inpatient treatment, and postoperative rehabilitation in the treatment of giant uterine fibroids.

Possibilities of physical therapy and electrophysical modalities in the complex therapy of pneumonia

Pneumonia is one of the most common infectious diseases and the leading infectious cause of death worldwide. High rates of morbidity, frequency of complications, mortality, the emergence of new highly virulent strains of pneumonia pathogens, antibiotic resistance determine the global medical and social problem of community-acquired pneumonia. The economic consequences of pneumonia are represented not only by direct medical costs (the cost of maintaining a patient in a medical institution, the cost of medical services, the cost of medicines, laboratory and instrumental studies, other medical procedures, etc.), but also include non-material costs from pneumonia, which include pain, psycho-emotional experiences of the patient due to a decrease in the quality of life during the illness. One of the directions of increasing the effectiveness of pneumonia therapy is the widespread introduction of physical therapy (PT) and electrophysical modalities (EM) into complex treatment, which are an important part of the medical rehabilitation for pneumonia, aimed at the speedy restoration of the health and working capacity of patients. The effectiveness of EM in the treatment of pneumonia is due to the versatile therapeutic effect of physical factors that have anti-inflammatory, desensitizing, bacteriostatic, broncholytic, mucolytic, immunostimulant effects, improve blood supply to the lungs. PT contributes to the normalization of pulmonary ventilation, has an expectorant effect, strengthens the respiratory muscles, accelerates the resorption of the inflammatory focus, prevents the formation of pleural adhesions, activates blood and lymph circulation. PT and EM are relevant in the comprehensive treatment of community-acquired pneumonia since they accelerate the regression of clinical symptoms, decrease the drug load, reduce the duration of inpatient treatment, that is confirmed by the results of clinical studies. We assume that the inclusion of PT and EM in the comprehensive treatment of pneumonia can lead to minimizing the total cost of the disease while reducing the duration and volume of drug treatment.

СТРУКТУРА ЗАБОЛЕВАЕМОСТИ И ИСХОДЫ У ДЕТЕЙ, РОДИВШИХСЯ С ОЧЕНЬ И ЭКСТРЕМАЛЬНО НИЗКОЙ МАССОЙ ТЕЛА В РЕГИОНАЛЬНОМ ПЕРИНАТАЛЬНОМ ЦЕНТРЕ

Introduction. The provision of medical care to children born with very low body weight (VLBW) and extremely low body weight (ELBW) belongs to the category of tertiary level neonatal intensive care (TINC) and reflects the effectiveness of regional obstetric-gynecological, neonatology and pediatric services; and the study of the structure of morbidity and outcomes in this category of newborn babies determines methodological, organizational and medical problems of the territory. The aim of the study. To assess the structure of morbidity and outcomes in premature newborns with ELBW and VLBW at birth in the setting of a Regional Perinatal Center during one year follow-up. Materials and methods. As part of the study, a retrospective analysis of 132 inpatient medical records of infants born preterm with VLBW and ELBW in the Regional Perinatal Center of the Novosibirsk State Regional Clinical Hospital in 2022 was performed. Patients were divided into two groups. Group 1 included 80 babies born with VLBW (birth weight 1000–1499 g), group 2 included 52 babies with ELBW at birth (less than 1000 g). Results. These children with VLBW and ELBW at birth are heterogeneous in the structure of prematurity, which is due to the presence of intrauterine growth retardation (IUGR) in some of them. At the same time, only the group of children born with VLBW is heterogeneous: 77.5% were registered as extremely premature, of which 63.7% were very preterm, and 13.7% were moderately preterm and 8.8% were late preterm. The category of extremely preterm prevailed among children with ELBW – 71,2%. 28% of children born prematurely had IUGR. Its structure was also heterogeneous: among children with VLBW at birth, there were equally wasty for gestational age (GA) – 15% and small for GA – 13.8%. Among children with ELBW, the small for GA – 21.1% dominated, against 5.8% – light for GA. Operative delivery (cesarean section) was chosen as the predominant method in both groups – 77.5 and 78.8% of cases, respectively. Diseases associated with prematurity were more often registered among children with ELBW at birth: severe asphyxia at birth (34.6%) vs VLBW (5%), p &lt; 0.001; HS PDA (38.5%) vs VLBW (17.5%), p &lt; 0.01; IVH III deg. (13.5%) vs VLBW (1.3%), p &lt; 0.01; RP = retinopathy (32.7%) vs VLBW (8.8%), p &lt; 0.001; severe form of BPD (23.8%) vs VLBW (5.6%), p &lt; 0.05; NEC II-III stages (17.3%) vs ONMT (5%), p &lt; 0.05; neonatal sepsis (34.6%) vs VLBW (12.5%), p &lt; 0.01. The duration of inpatient treatment is 2 times higher in children with ELBW at birth: 92 ± 6.4 vs 48.8 ± 2 bed/patient days In the structure of morbidity, there were no differences in grade II IVH, PVL, mild and moderate BPD and Congenital Disorder (p &gt; 0.05). Children with ELBW needed more treatment at birth: treatment of RP required intravitreal administration of ranibizumab (53%) vs VLBW (28.6%); surgical treatment of NEC stage III was carried out only in children with ELBW; the duration of respiratory support, regardless of the method, was longer in children with ELBW and amounted to 686.9 ± 130.3 vs 156.3 ± 26 hours . The mortality rate among all premature infants born with ONMT and ENMT was 13.6% and was 5 times higher in the group of children with ELBW who were mostly born extremely preterm. In terms of nosology, the main cause of death among all children with ELBW and VLBW is neonatal sepsis – in 50% of cases, mortality is 1.9 times higher in the group of children with ELBW at birth (38.8%) vs VLBW (20%), p &lt; 0.05. Conclusion. The presented analysis indicates that preterm neonates with VLBW and ELBW in the setting of a Regional Perinatal Center are a rather heterogeneous group in the structure of prematurity, which, among other things, affects the formation of both extremely negative outcomes (lethal) and the structure of morbidity, the amount of care provided to them at different stages, its comprehensiveness and specialization, as well as the duration of inpatient treatment. Based on the all above, it follows, that of the entire category of preterm children born with VLBW and ELBW, the most difficult, economically costly, with prognostically worse outcomes, is the category of extremely preterm newborns.