Frequency Of Infectious Complications Research Articles

The association of preoperative hematologic parameters with short-term clinical outcomes in rectal cancer: A feature importance analysis.

Various hematologic parameters have been proposed as prognostic factors in rectal cancer management, but data are conflicting and unclear. This study is designed to investigate the prognostic factor capability of preoperative hematologic parameters with postoperative morbidities and mortality in rectal cancer patients undergoing curative resection. All 200 consecutive rectal cancer patients diagnosed at Ghaem University Hospital from 2017 to 2022 were retrospectively evaluated. The receiver operating characteristic (ROC) curves and machine learning (ML) algorithms of Random Forest, Recursive Feature Elimination, simulated annealing, Support Vector Machine, Decision Tree, and eXtreme Gradient Boosting were administered to investigate the role of preoperative hematologic parameters accompanied by baseline characteristics on three clinical outcomes including surgical infectious complications, recurrence, and death. The frequency of infectious complications was correlated with the surgical procedure, while tumor recurrence was significantly influenced by T stage and N stage. In terms of mortality, alongside T and N stage, the status of resection margin involvement was significantly correlated. Based on the ROC analysis, the NLR >2.69, MPV ≤9 fL, and PDW ≤10.5 fL were more classified patients to mortality status. Likewise, the PLT >220 109/L, MPV ≤9 fL, PDW ≤10.4 fL, and PLR >13.6 were correlated with recurrence. However, all factors examined in this study were not significant classifiers for the outcome of surgical infectious complications. The results of ML algorithms were also in line with ROC analysis. According to the results of both ROC analysis and ML models, preoperative hematologic parameters are considerable prognostic factors of postoperative outcomes in rectal cancer patients, and are recommended to be monitored by clinicians to prevent unfavorable outcomes.

Characteristics of infectious complications in moderate and severe forms of atopic dermatitis

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

Short-term outcomes after laparoscopic colorectal cancer surgery in patients over 90 years old: a Japanese multicenter study.

The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old has remained unclear. We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an open surgery group (n = 22) and a laparoscopic surgery group (n = 65). The aim of this study was to investigate the effect of laparoscopic surgery on postoperative outcome in elderly colorectal cancer patients, as compared to open surgery. Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (open surgery 146min vs. laparoscopic surgery 203min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, respectively; p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days, respectively; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (p = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159-10.781) as an independent predictor of postoperative infectious complications. Laparoscopic colorectal resection for patients over 90 years old is a useful procedure that reduces postoperative infectious complications.

Improvement of enteral nutrition technologies in patients with a severe course of acute pancreatitis

in the case of severe acute pancreatitis, the early start of enteral nutrition (24-72 hours from the moment of hospitalization) by means of nasogastric or nasojejunal administration of the mixture is considered appropriate, which is associated with a 24% decrease in the frequency of infectious complications and a 32% decrease in mortality. However, 30.5-65.7% of patients may develop intolerance to this type of nutritional support. The aim of the study was to improve the results of treatment of patients with severe acute pancreatitis by improving enteral nutrition technologies. There were 101 patients with severe acute pancreatitis took part in the study, who were divided into the main group, where enteral nutrition was carried out according to the improved protocol - 34 patients, comparison group No. 1, where standard nasogastric nutrition was carried out - 34 patients, and comparison group No. 2, where standard EN – 33 patients. The effectiveness of enteral nutrition in the studied groups was evaluated by analyzing and comparing biochemical indicators of blood serum, frequency of intolerance to nutritional support, infected local complications, mortality, duration of multiple organ failure and stay of patients in the hospital. When using the proposed protocol of enteral nutrition in patients with a severe course of acute pancreatitis, 14 days after the start of treatment, a significant difference was obtained between the content of albumin, creatinine, cholesterol and K+ blood serum (p&lt;0.05) between patients of the main group and the comparison groups , as well as the content of Na+ in blood serum (p&lt;0.05) between patients of the main group and the group of standard nasogastric tube feeding. Application of the proposed protocol of enteral nutrition significantly reduces the frequency of intolerance of nutritional support in the first 7 days of treatment by 23.6% (χ2=5.7, 95% CI 4.41-41.56, p=0.01) compared to the control group patients, where standard nasogastric tube feeding is used, by 21.5% (χ2=4.87, 95% CI 2.34-39.48, p=0.02) compared to the group of standard enteral tube feeding, as well as the duration of multiple organ failure from 12.2±1.7 days to 10.5±1.9 days in comparison with the group of patients where standard nasogastric tube feeding was used (p=0.0002) and from 11.5±1.9 days to 10.5±1.9 days compared to the group of standard enteral tube feeding (p=0.03). The use of the proposed technology of enteral nutrition in patients with a severe course of acute pancreatitis improves treatment results by reducing the duration of multiple organ failure and the frequency of intolerance to this type of nutritional support.

Analysis of the results of treatment of patients with gunshotwound to the head in acute and early postoperative period

Objective ‒ to evaluate the results of treatment of gunshot wounds to the head in the conditions of a specialized neurosurgical center and to determine the factors that negatively affected the results of treatment.Materials and methods. The study is retrospective. 109 cases with open and closed craniocerebral injuries, which came to the military medical center during the hostilities in the East of Ukraine in the period from March 2014 to the end of December 2017 were analyzed. All patients were treated at the National Military Medical Clinical Center «Main Military Clinical Hospital». Collected information on demographic indicators, features of assistance provided at the stages of evacuation, type of injury. The Glasgow outcome scale (GOS) was used to evaluate the results. Results. Shrapnel injuries prevailed in 82 (75.23 %) cases, bullet wounds were diagnosed less frequently in 17 (15.6 %) cases, and 10 (9.17 %) servicemen were injured as a result of the blast wave. The vast majority of the wounded were admitted to the military medical center in good condition – 81 (74.32 %) patients, in moderate condition – 15 (13.75 %), in coma I – 5 (4.59 %), in coma II – 3 (2.75 %), in coma III – 3 (2.75 %). Computed tomography was performed in all patients upon admission. The frequency of infectious complications was 31.19 %. 45 patients underwent repeated surgeries, 26 were operated on three times for gunshot wounds in different medical institutions at different stages, 5 patients were operated on more than three times. 52 (47.7 %) of the wounded had a good recovery result (GOS 4, 5). 44 (40.36 %) of the wounded were discharged with the result of GOS 3, 3 patients were in a vegetative state (GOS 2), 10 (9.17 %) patients died (GOS 1). Statistically significant (p&lt;0.05) factors that had a negative impact on the treatment results are GCS &lt;12 at admission, Injury severity score &gt;25, CSF leak, infectious complications, repeated operations.Conclusions. All patients with gunshot wounds to the head should have a CT scan of the head immediately upon admission to a medical facility. Patients should be hospitalized in specialized centers where there is a full examination, CT and the possibility of providing specialized neurosurgical care. This reduces the number of repeated surgical interventions and, accordingly, complications.

Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade: A single-center experience

Liver transplantation for the most critically ill remains controversial; however, it is currently the only curative treatment option. To assess immediate posttransplant outcomes and compare the short (1 year) and long-term (6 years) posttransplant survival among cirrhotic patients stratified by disease severity. We included cirrhotic patients undergoing liver transplantation between 2015 and 2019 and categorized them into compensated cirrhosis (CC), decompensated cirrhosis (DC), and acute-on-chronic liver failure (ACLF). ACLF was further divided into severity grades. Our primary outcomes of interest were total days of intensive care unit (ICU) and hospital stay, development of complications and posttransplant survival at 1 and 6 years. 235 patients underwent liver transplantation (CC = 11, DC = 129 and ACLF = 95). Patients with ACLF had a significantly longer hospital stay [8.0 (6.0-13.0) vs CC, 6.0 (3.0-7.0), and DC 7.0 (4.5-10.0); P = 0.01] and developed more infection-related complications [47 (49.5%), vs CC, 1 (9.1%) and DC, 38 (29.5%); P < 0.01]. Posttransplant survival at 1- and 6-years was similar among groups (P = 0.60 and P = 0.90, respectively). ACLF patients stratified according to ACLF grade [ACLF-1 n = 40 (42.1%), ACLF-2 n = 33 (34.7%) and ACLF-3 n = 22 (23.2%)], had similar ICU and hospital stay length (P = 0.68, P = 0.54), as well as comparable frequencies of overall and infectious post-transplant complications (P = 0.58, P = 0.80). There was no survival difference between ACLF grades at 1 year and 6 years (P = 0.40 and P = 0.15). Patients may benefit from liver transplantation regardless of the cirrhosis stage. ACLF patients have a longer hospital stay and frequency of infectious complications; however, excellent, and comparable 1 and 6-year survival rates support their enlisting and transplantation including those with ACLF-3.

Newborns in the early neonatal period in a group of mothers at high obstetric and perinatal risk

AIM: We aimed at assessing the status of newborns in the early neonatal period in a group of mothers at high prenatal risk for preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PTB), and fetal chromosomal abnormalities (FCA).&#x0D; MATERIALS AND METHODS: We prospectively analyzed the status of 435 singletons. Mothers in the first-trimester underwent prenatal screening with risk assessment. Group 1 (study group, n=231) included high-risk subgroups for FCA (subgroup 1A, n=67), maternal PE (subgroup 1B, n=66), FGR (subgroup 1C, n=46), and PTB (subgroup 1D, n=52). We excluded risk combinations. Group 2 (controls) included 204 children of low-risk women.&#x0D; RESULTS: Group 1 had a higher incidence of mild-to-moderate asphyxia compared with group 2 (p 0.05) and was more frequent in 1B, 1C, and 1D subgroups. Moreover, the frequency of severe asphyxia was similar between the groups (p 0.05). Intrauterine growth restriction (IUGR) and developmental delay were more frequent in group 1 than in group 2 (p 0.05). Moreover, group 1 children required monitoring and treatment more frequently that in group 2 (p 0.05). The frequency of infectious complications in group 1 and 1A, 1B, and 1C subgroups was equally higher than that of group 2 (p 0.05), while respiratory distress syndrome predominated in group 1 (subgroup 1D) and was not observed in group 2. The discharge rate was 95.7% in group 1 and 84.0% in group 2 (p 0.05). On days 3 to 5, 16% and 3.4% of children in groups 1 and 2, respectively, were transferred to the second stage of aftercare (p 0.05).&#x0D; CONCLUSIONS: In the early neonatal period, children born to high-risk mothers, as opposed to those born to low-risk mothers, were significantly more likely to have asphyxia, IUGR, infectious complications, and indications for continued treatment in the second stage of nursing.

Neutrophil to lymphocyte ratio in predicting postoperative complications and prognosis in patients with colorectal cancer.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; Biological markers of inflammation are among the main tools for predicting the risk of developing postoperative infectious complications at the preclinical stage. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in colorectal surgery.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; Aim of the study to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after colon surgery.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; From September 2018 to December 2021, 234 patients were enrolled in the study after colon surgery. The frequency of infectious complications, the differences in the levels of NLR in patients with and without infectious complications were determined.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; One hundred and thirty-seven patients met the criteria of NLR-low, and 97 patients were categorized as NLR-high. The NLR status was significantly correlated with T-stage, perineural invasion, and increased likelihood of complications. Univariate analysis indicated that both low albumin and meeting the criteria for the NLR-high group correlated with an increased occurrence of complications. Multivariate analysis identified NLR-high and low albumin levels as independent predictors for complications.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in colorectal surgery. In addition, low values of this biomarker are a significant criterion for a safe discharge of patients from hospital. The prevalence and availability of this test makes it easily reproducible in clinical practice.&lt;/br&gt.

Interleukin-2 in the Complex Treatment of Surgical Patients

Immunotherapy for surgical diseases remains one of the urgent scientific and clinical issues. Immunodeficiency is manifested in patients with purulent wounds, pancreatic necrosis, osteomyelitis, oncological diseases, echinococcosis, gastroduodenal ulcers and other pathology. Drugs inducing interleukin-2 synthesis have shown high efficacy for the correction of immunodeficiency status. Clinical effects of rIL-2 are due to its ability to activate clonal proliferation of T- and B-lymphocytes, to enhance the effector potential of cytotoxic T-lymphocytes (CTL cells) and natural killer cells (NK cells), functional activity of mononuclear phagocytes and antigen-presenting cells, synthesis of specific immunoglobulins of most isotypes by plasma cells and to reduce apoptosis of mononuclears. This cytokine is a key link determining the development of cellular and humoral immunity. Interleukin-2 provides antitumor, antiviral, antibacterial and antifungal protection, being able to stimulate the processes of tissue regeneration and repair. The high clinical activity of the drug was revealed in the treatment of endotoxicosis, immunological insufficiency, inflammatory diseases in patients with surgical, oncological, traumatological, combustiological, resuscitation profiles, involving abdominal organs, pelvis and retroperitoneal space. It is rational to use recombinant interleukin-2 in case of previous inefficient conventional treatment and the process chronization. The drug has a number of positive aspects: rapid effect; reduced terms of treatment, frequency of infectious complications and sepsis; reduced mortality rate. The negative side of its administration is its high cost. Thus, immunosuppressive conditions are manifested in multiple surgical diseases. High clinical efficacy of recombinant interleukin 2, absence of complications, adverse reactions and undesirable effects, and favourable tolerability of the drug allow recommending it for wider use in surgical practice.

Эндоскопическое лечение дегенеративного стеноза позвоночного канала

Microsurgical decompression technique has been regarded as the standard surgical method in degenerative spinal diseases to date. The conventional method may lead to instability and lead to chronic lower back pain due to injury of facet joints, posterior ligamentous complex, as well as paraspinal muscles. To avoid these complications, the new biportal endoscopic technique has been introduced in our clinical practice. Since 2019, we have been widely using this technique and for the first time in Russia we have accumulated unique experience that allowed us to complete this article. The aim of this study is to demonstrate a new biportal endoscopic spinal surgical technique’s possibility in treatment of degenerative lumbar spine diseases and to report the results of using this technique in our clinic. Study design: retrospective study. One hundred two patients who were suffering from neurologic symptoms by degenerative lumbar spine diseases were included in study. All patients were divided into 3 groups according to the clinical condition: 1st group — patients with degenerative central spinal stenosis who underwent biportal endoscopic bilateral decompression using a unilateral approach, 2nd group — patients with foraminal spinal stenosis who underwent biportal endoscopic foraminotomy using a extraforaminal approach, 3rd group — patients with degenerative monosegmental instability, degenerative or isthmic spondylolisthesis who underwent biportal endoscopic lumbar interbody fusion. Clinical outcomes were analyzed in accordance with modified-Macnab criteria, Oswestry Disability Index (ODI), Numeral rating scale (NRS), also postoperative complications were analyzed. There was a significant improvement in the dynamics of pain syndrome, ODI scale in all 3 groups. According to the McNab scale, no unsatisfactory results were observed in any group. There were 4 cases of durotomy. In all cases, the durotomy did not exceed 3 mm and did not require further treatment. No cases of infectious complications were identified. Biportal endoscopic surgery can be considered an alternative to the traditional microsurgical technique of spinal decompression and spinal fusion in the lumbar spine. The use of this technique can significantly reduce muscle trauma, achieve sufficient decompression, and reduce the frequency of infectious complications.

Six-Month Follow-up for Infectious Complications after Lymphodepletion and Application of CD19-Chimeric Antigen Receptor T (CAR-T) Cell Therapy

Background: In the past years, chimeric antigen receptor T (CAR-T) cell therapy targeting CD19 have been shown to be a new and effective treatment option in patients with relapsed/refractory non-Hodgkin lymphoma (NHL) and acute lymphoblastic leukemia (ALL). However, infections with severe and potentially life-threatening complications can be induced by either lymphodepleting chemotherapy and/or the infusion of CAR-T cells, while side effects such as cytokine release syndrome (CRS) might further complicate differential diagnosis.Methods: Infections and complications were evaluated during inpatient treatment as well as in a follow-up period of the first six months after dosing. Eighty-one dosings of CAR-T cells in seventy-three adult patients with either NHL (88%) or ALL (12%) were analyzed. Bacterial and viral pathogen were detected with blood cultures or examination of potential sources of infection such as catheter tips. Panel and serum testing for viral infection was carried out either as a screening or in case of suspicion, while fungal infections were diagnosed according to the 2008 revised European Organization for Research and Treatment of Cancer (EORTC) Consensus Group criteria to determine proven, probable and possible invasive fungal disease.Results: In 52 patients (64%, Table 1) fever was detected following lymphodepletion and CAR-T cell dosing . Microbiological or radiological findings were seen in 20% of cases. Of those, eight were of bacterial (10%), three of viral (4%), and five of fungal (6%) origin. Overall, more lines of therapy as well as more severe CRS were associated with early infection. Cytokine release syndrome was diagnosed in 41 patients (51%, Table 1), with a simultaneous detection in five bacterial (6%), two viral (2%), and five fungal (6%) infections (Figure 1). In the six months follow-up period seven patients with fever (9%) had microbiological or radiological findings, in most cases during the first 90 days after CAR T cell infusion (6 patients, 7%). Only one patient died of infection (pathogen: cytomegalovirus).Conclusions: Infections are common in CAR-T cell patients; therefore, fast and suitable identification and initiation of treatment are important in the heavily pretreated and immunocompromised patient population. While infectious complications are mostly manageable, the frequency of infectious complications in patients receiving CAR-T cell therapy underlines the value of standardized anti-infective prophylaxis and supportive therapy for reduction of morbidity and mortality. [Display omitted] DisclosuresSchubert: Gilead: Consultancy. Sauer: Pfizer: Consultancy, Speakers Bureau; Abbvie: Consultancy, Speakers Bureau; Matterhorn Biosciences AG: Consultancy, Other: DSMB/SAB Member; Takeda: Consultancy, Other: DSMB/SAB Member. Schmitt: Hexal: Other: Travel grant; TolerogenixX Ltd: Current Employment; Therakos/Mallinckrodt: Research Funding; Jazz Pharmaceuticals: Other: Travel grant. Müller-Tidow: Bioline: Research Funding; Pfizer: Research Funding; Janssen: Consultancy, Research Funding. Dreger: AbbVie: Consultancy, Speakers Bureau; AstraZeneca: Consultancy, Speakers Bureau; Bluebird Bio: Consultancy; BMS: Consultancy; Novartis: Consultancy, Speakers Bureau; Janssen: Consultancy; Gilead Sciences: Consultancy, Speakers Bureau; Riemser: Consultancy, Research Funding, Speakers Bureau; Roche: Consultancy, Speakers Bureau. Schmitt: Bluebird Bio: Other: Travel grants; MSD: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: Travel grants, Research Funding; Hexal: Other: Travel grants, Research Funding; Kite Gilead: Other: Travel grants; Apogenix: Research Funding; TolerogenixX: Current holder of individual stocks in a privately-held company.

Association Between Blood and Lymphocyte Levels of Cyclosporin A and Infectious Complications in Renal Transplant Patients.

ObjectivesThis study aims to investigate a potential association between whole blood and lymphocyte Cyclosporin A (CyA) levels and the occurrence and frequency of infectious complications in kidney transplant patients.MethodsThe study involves 130 kidney transplant recipients who received CyA in addition to Mycophenolate Mofetil and steroids. CyA whole blood trough and maximum level (CyA BL0 and CyA BLm) as well as the corresponding levels in the lymphocytes (CyA L0 and CyA Lm) were measured for 6 months post-transplantation.ResultsCytomegalovirus (CMV) as well as urinary tract infections (UTIs) were the most commonly diagnosed with an incidence of 24.6% and 26.2%, respectively. Only CyA L0 showed a significant association with CMV infection occurrence (adjusted OR = 1.051, 95% CI .997–1.025, P-value 0.046). A positive linear correlation was found between CyA BL0, CyA BLm and CyA Lm and the number of CMV episodes per patient.ConclusionWe showed an association between the CMV infections occurrence and the trough lymphocyte level of CyA (CyA L0). Both lymphocyte CyA levels also correlated with the frequency of CMV infections. Further studies are needed to establish the optimal range of both CyA blood and lymphocyte levels and decrease the risk of opportunistic infections in high risk patients.

MP56-10 COMPARATIVE ANALYSIS OF THE RESULTS OF TREATMENT OF PATIENTS WITH RECURRENT URETHRAL STRICTURE USING PLATELET-RICH PLASMA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-10 COMPARATIVE ANALYSIS OF THE RESULTS OF TREATMENT OF PATIENTS WITH RECURRENT URETHRAL STRICTURE USING PLATELET-RICH PLASMA Sergey Kotov, and Mikhail Iritsyan Sergey KotovSergey Kotov More articles by this author , and Mikhail IritsyanMikhail Iritsyan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of patients with recurrent urethral stricture requires not only the improvement of surgical techniques, but also the influence on the pathogenetic mechanisms of the formation of urethral stricture. We have previously demonstrated that platelet-rich plasma (PRP) leads to stimulation of regeneration and organization of the intercellular matrix in an experimental model of urethroplasty. To evaluate the clinical effectiveness of reconstructive plastic surgery using platelet-rich plasma in patients with recurrent urethral stricture. METHODS: A comparative analysis of the results of surgical treatment of patients with recurrent urethral stricture with and without the use of platelet-rich plasma was carried out at the University Clinic of Urology of the Pirogov Russian National Research Medical University. A total of 60 patients were included in the study. The main group consisted of 30 patients who were injected with PRP into the spongy body in the operation area. In the control group (30 patients), phys. solution was entered in the same volumes. According to the medians of length and age, localization and etiology, urethral strictures were comparable in the groups. The median maximum urination rate before surgery was 4.7 ml /s (1,7 - 11). According to etiological factors there were iatrogenic strictures in 45 (75%) cases, traumatic – 7 (11.7%), infectious – 2 (3.3%), posthypospadial - 6 (10%). The urethral catheter was removed after surgery in the absence of a contrast agent leak during urethrography. RESULTS: In the main group: anastomotic urethroplasty – 17 patients, augmentation urethroplasty - 9, multi - stage urethroplasty/perineostomy-4. The following operations were performed in the control group: anastomotic urethroplasty in 24 cases, augmentation urethroplasty-in 4 cases, с in 2 cases. The median (min-max) follow – up after surgery was 12 years (6-22 months). The effectiveness in the main group was 93.3%. In 2 cases, a relapse was noted. In the control group, the efficiency was 76.7%. Relapse occurred in 7 cases. The median period of bladder drainage with a urethral catheter after surgery was 14 and 7 days in the control and main groups, respectively (p< 0, 05). The frequency of infectious complications (urethritis, orchepididymitis, p/o wound suppuration) was significantly lower in the main group (p<0.05). The median postoperative Qmax in the control group at the time of observation was (min-max) 19.85 ml/sec (9-23.8), in the main group – 24 ml/sec (10-40) (p>0.05). CONCLUSIONS: The results of urethroplasty with the combined use of platelet-rich plasma in patients with recurrent urethral stricture demonstrate a decrease in the frequency of early relapses of urethral stricture, a reduction in the duration of bladder drainage and the frequency of infectious complications. Source of Funding: No source of funding. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e972-e973 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Kotov More articles by this author Mikhail Iritsyan More articles by this author Expand All Advertisement Loading ...

The importance of the prevention of treatment induced neutropenia in patients with malignant neoplasms of the head and neck

Hematological toxicity is the most common complication of chemotherapy. The most dangerous manifestation of hematological toxicity is febrile neutropenia (FN). FN reduces survival, increases the risk of death, the frequency of infectious complications, hospitalizations, the cost of treatment. The risk of FN should be assessed before the beginning of the therapy, using the general algorithm from the protocol to prevent FN applying the granulocyte colony-stimulating factors (G-CSF). G-CSF for the prevention is required throughout all cycles of myelosuppressive therapy. For the prevention of FN, the most effective is the use of PEGylated G-CSF. Patients with head and neck squamous cell carcinoma, receiving the TPF or DCF regimen, combined with docetaxel and cisplatin, are included in the group of routine primary prophylaxis for neutropenia. In case of developing 34 grade FN in these patients, the use of PEGylated G-CSF (empegfilgrastim) is preferable.

On the features of the preperitoneal space multifascial structure in clinical and anatomical issues

AIM: to determine the prospects for the preventive endoprosthetics of the abdominal wall at preventing the development of postoperative ventral hernias.&#x0D; MATERIALS AND METHODS: A meta-analysis of the literature data performed to determine the effectiveness of preventive endoprosthetics for the prevention of ventral hernia formation. Topographical study has been conducted to explore the most promising levels of the mesh location.&#x0D; RESULTS: During the meta-analysis it has been found that performing preventive endoprosthesis of the anterior abdominal wall t in the preperitoneal space reduces the frequency of ventral hernias. There were no significant differences in the frequency of infectious complications and serom in the experimental and control groups according to studied publications. During the preparation it has been distinguished that between the transverse fascia and the peritoneum there is a preperitoneal fascia consisting of two leaves, which is most manifest in the lateral parts. In the umbilical region above linea arcuata the preperitoneal fascia is thinned and represented by separate fibers that are difficult to differentiate as a structure between the transverse fascia and the peritoneum. In the lateral parts of the abdominal wall, the preperitoneal fascia is well expressed. It has been distinguished that the retroperitoneal fascia, formed by the junction of two sheets of the Gerot fascia continues into the fascia between the transverse fascia and the peritoneum.&#x0D; CONCLUSION: Preventive endoprosthesis of the anterior abdominal wall is an effective and safe method of preventing the formation of postoperative ventral hernias. The anterior abdominal wall is characterized by a complex multifascial structure, which is of fundamental importance for various types of surgery. Between the transverse fascia and the peritoneum there is preperitoneal fascia which is represented by two leaflets. Its continuation is the retroperitoneal fascia (5 figures, 2 tables, bibliography: 8 refs).

Rituximab for rheumatic diseases in children: Results of a retrospective study of the safety of therapy

Objective: to analyze the safety of rituximab (RTM) in children with various rheumatic diseases.Materials and methods. The retrospective study included 81 pediatric patients with a confirmed diagnosis of rheumatic disease. Data on the safety of RTM were analyzed for all patients who received at least one infusion of the drug. All patients underwent a standard clinical, laboratory and instrumental examination in accordance with the verified diagnosis before the appointment of RTM therapy. The dose of RTM for administration was calculated based on 375 mg/m 2 of body surface area, the drug was administered once a week for 1 to 4 consecutive weeks, depending on the number of CD19 lymphocytes determined after the infusion, and the tolerability of therapy.Results. Among the patients included in the study, 38 (46.9%) were with systemic lupus erythematosus (SLE), 16 (19.75%) – with juvenile idiopathic arthritis (JIA), polyarticular variant (14 (87,5%) of them – RF-positive), 9 (11,1%) – with juvenile idiopathic arthritis with systemic onset (sJIA), 6 (7.4%) – with systemic sclerosus (SSc), 5 (6.2%) – with primary Sjogren’s syndrome, 2 (2.5%) – with juvenile dermatomyositis, 4 (4.9%) – with mixed connective tissue disease, and 1 – with livedoid vasculopathy. 53 (65.4%) patients underwent more than one course of RTM therapy, with a maximum of 10 courses. The total number of infusions was 198. The median time between each course was 182 [156–315] days. RTM was effective in 67 (95%) patients, ineffective in 2 (2.5%) patients with sJIA, 2 (2.5%) patients with SLE and macrophage activation syndrome (MAS).Adverse reactions (AE) of mild to moderate severity were reported in 23 (28.4%) patients, including upper respiratory tract infections – in 7 (8.6%), urinary tract infections – in 2 (2.5%), mild infusion reactions that did not require discontinuation of therapy – in 2 (2.5%), clinically insignificant neutropenia (I–II degree) – in 4 (4.9%), a decrease in IgG levels – in 14 (17.5%) patients (median – 5.5 [4.0; 6.9] g/l). Two patients with sJIA had persistent hypogammaglobulinemia for 3 and 5 years after the last RTM infusion, respectively. The incidence of infections in patients with low IgG levels was 35.7%, and no cases were registered in patients with neutropenia. Serious AE was reported in 16 (19.7%) patients: sepsis – in 4 (4.9%), pneumonia – in 3 (3.7%), herpes zoster – in 1 (1.2%), serious infusion reactions – in 2 (2.5%), serious postinfusion reactions within 3–10 days – in 4 (4.9%) (in 3 patients (3.7%) – MAS, in 1 (1.2%) – hemorrhagic vasculitis); death was registered in 2 cases of SLE and MAS (therapy of RTM was inefficient). In general, various AE were reported in 55.6% of patients with sJIA, 52.6% of patients with SLE, 50% of patients with SSc and juvenile dermatomyositis, and 80% of patients with primary Sjogren’s syndrome. Discontinuation of therapy due to serious AE was observed in 15 (18.5%) patients.Conclusion. Our study demonstrated that RTM therapy is highly effective with an acceptable safety profile in children with rheumatic diseases. The safety data obtained indicate the need for careful monitoring of therapy, primarily taking into account the risk of infection, despite the fact that in this study the frequency of infectious complications was not high. A decrease in IgG level was observed in a small proportion of patients and did not correlate with the incidence of infections.

Frequency of infectious complications and features of systemic inflammatory response in patients with prolonged disorders of consciousness

Objective: investigate epidemiology of infectious complications, intensity of antibacterial therapy, and features of the systemic inflammatory response in patients with prolonged disorders of consciousness.Materials and methods: retrospective case histories analysis of 102 patients with prolonged disorders of consciousness who were treated in the department of anesthesiology and intensive care of Polenov Neurosurgical Institute from 2010 to 2019.Results: during hospitalization all patients (100%) had signs of tracheobronchitis, 86 patients (84,3%) had urinary tract infection, 34 (33,3%) pneumonia, 10 patients (9,8%) meningoventriculitis, and in 9 (8,8%) cases sepsis was diagnosed. Identified bacterial complications required systemic antibacterial therapy. With an average length of hospital stay of 51±42 days, duration of antibiotic therapy was 37±41 days. One-component therapy was applied in half of the cases (54%), slightly less often (43,2%) treatment consisted of two antibiotics, in some cases patient’s condition required prescription of three antibiotics (2,8%). Even in the absence of a focus of infection, temperature and laboratory markers of inflammation in blood samples of patients with prolonged disorders of consciousness were higher than the reference values. CRP was increased with addition of any bacterial complications. Count of white blood cells significantly increased only in case of pneumonia and sepsis. Procalcitonin test was positive in 16,6% observations of urinary tract infection, 30,4% of pneumonia, and 28% of meningoventriculitis.Conclusion: most informative proinflammatory marker of bacterial complications in patients with prolonged disorders of consciousness was CRP. Mild leukocyte response can be explained by immunosuppression in long-term ill patients. Limited value of procalcitonin test may be due to the insufficiency of the semi-quantitative method sensitivity with a threshold level of 0,5 ng/ml, as well as reduced proinflammatory response to local infection in patients with prolonged disorders of consciousness as a result of massive antibacterial therapy, colonization of opportunistic microflora and presence of sympathicotonia (non-infectious systemic inflammatory reaction).

Strategy and Control of Antimicrobial Therapy Program Implementation at the B.V. Petrovsky National Research Center of Surgery

The introduction of local programs for the rational use of antibiotics in a multidisciplinary hospital is aimed at reducing the level of antibiotic resistance and the frequency of healthcare associated infections (HAI). The aim of the study was to analyze the frequency of infectious complications caused by pathogens with multidrug resistance and the level of resistance at the B.V. Petrovsky National Research Center of Surgery based on the implementation of the SCAT program. Material and methods. A retrospective analysis of the SCAT program implementation results on the basis of the B.V. Petrovsky National Research Center of Surgery was carried out. 1850 case histories of the surgical profile for 2018 were analyzed (male —1095, average age 56.2±14.9 years; female — 755, average age 53.7±11.9 years) and 1502 case histories for the January–October period for 2019 (male — 1114, average age 58.3±12.1 years, and female — 388, average age 55.4±12.6 years). Results. The incidence of HAI in 2018 and 2019 was 354 and 159 cases, respectively. Of these, the incidence of nosocomial pneumonia (NP) was 64 cases (61.5%) and 40 cases (38.5%); skin and soft tissue infection (SSTI) — 93 cases (57.4%) and 69 cases (42.6%); surgical site infections (SSI) — 69 cases (82.1%) and 15 cases (17.9%) in 2018 and 2019, respectively. The drug resistance index (DRI) for the most clinically significant strains of the causative agents of HAI was: Klebsiella pneumoniae — 0.14, Acinetobacter baumannii — 0.22, Klebsiella spp. — 0.11, Enterobacter cloacae — 0.15, Enterococcus faecalis — 0.18, Enterococcus faecium — 0.21. Conclusion. The proposed measures for the implementation of the SCAT program at the level of a medical organization reduce the incidence of HAI and the local level of the drug resistance index.

Absolute Neutropenia and Infection Development in Premature Infants in Early Neonatal Period: Cross-Sectional Study

Background. Premature infants have high risk of developing of neutropenia and infections in the early neonatal period. The correlation of these events requires further studies.Objective. The aim of the study was to investigate the frequency of absolute neutropenia and infectious complications cases in premature infants in the early neonatal period with estimation of phenotypical and functional features of cord blood neutrophils.Methods. The study included premature infants (gestational age 25–36 weeks) with APGAR score &lt; 8 on the 1st and 5th minutes of life. The frequency of absolute neutropenia (at least once &lt; 1.5109/l) and infectious complications (localized infections of bacterial etiology, early neonatal sepsis) cases in the first 14 day of life was analysed. Additionally, we have determined the expression of CD64, CD16, CD32 by cord blood neutrophils in premature (n = 102) and mature infants (n = 30) via method of flow cytofluorometry. We have used FITC labeled Escherichia coli to estimate their phagocytic activity, and stimulation of E. coli neutrophils in the presence of 5 mM of dihydrorhodamine 123 to estimate their stimulation index (ratio of mean fluorescent intensity (MFI) of activated neutrophils in stimulated samples and in negative controls, E. coli free samples).Results. The episodes of absolute neutropenia in the first 14 days of life were recorded in 17 cases, infectious complications — in 87 children (in 24 cases — sepsis) in the group of premature infants. The frequency of infectious complications in premature children did not correlate with the frequency of absolute neutropenia episodes. Cord blood neutrophils in premature infants had higher CD64 expression and, on the contrary, lower CD16 expression, as well as low phagocytic activity and stimulation index value (in all cases p &lt; 0.001).Conclusion. Absolute neutropenia in premature infants in early neonatal period does not correlate with high risk of bacterial infections. However, cord blood neutrophils in premature infants had lower functional activity.

Administration of intravenous immunoglobulin in patients with chronic lymphocytic leukemia and infectious complications

Background. Chronic lymphocytic leukemia (CLL) is one of the most frequent malignant blood disorders in adult patients. For the last several decades treatment of CLL made its way from simple chemotherapy agents (chlorambucil, cyclophosphamide, fludarabine) to highly technological innovative medications (monoclonal antibodies, targeted agents, CAR T-cell therapy). Despite quite high rate of remissions induced by the novel treatment methods significant proportion of the patients develop infectious mostly bacterial complications in the long term. Various infections often become the cause of mortality in CLL patients in remission. They develop in about 70 % of the patients and become severe in about 30 % of them (requiring inpatient hospitalization and/or intravenous antibacterial treatment). Novel agents for treatment of CLL influencing the immune B-cells lead to immune suppression (secondary hypogammaglobulinemia, immunoglobulin G (IgG) deficiency), distribution and severity of infectious complications. Substitutive treatment with intravenous IgG changed clinical course of the secondary hypoimmunoglobulinemia reducing significantly incidence of the infectious events in CLL patients as well as in patients undergoing immunochemotherapy (ICT) and immunosuppressive treatment.&#x0D; Objective. To determine the necessity for immunocorrection in patients with CLL requiring ICT.&#x0D; Materials and methods. Patients with the diagnosis of CLL undergoing ICT within hematology department developing infectious complications were observed.&#x0D; Results and discussion. Patients with CLL undergoing ICT were tested and analyzed and according to the results in 31 of these patients hypogammaglobulinemia and reduced levels of IgG were revealed. In 8 of the patients reduction of IgG was detected already at the primary diagnosis of CLL (Binet stages B and C). Depending on the performed treatment of CLL frequency of infectious complications differed and was the highest in subjects with progressive course of leukemia and in those who were treated with RFC (rituximab, fludarabine and cyclophosphamide) ICT. Levels of IgG ranged from 0.86 to 5.55 g/L (median – 3.49 g/L, lower-upper quartile – 2.62-4.76 g/L). Levels of hypogammaglobulinemia in the whole group ranged from 4.49 to 16.87 g/L (median – 12.11 g/L, lower-upper quartile – 11.44-12.88 g/L). Patients underwent the substitutive treatment with intravenous immunoglobulin with the dose of 0.4 g/kg every month. The medication was administered according to standard recommendations. There were no side effects registered within 24 h of infusion. Additionally, patients with infectious complications were treated with antibacterial, antifungal and antiviral agents. After application of intravenous immunoglobulin general condition of the patients improved, body temperature normalization and reduction of recurrent infectious events were observed. The mean time from the diagnosis of persistent hypogammaglobulinemia to complete resolution of infectious complications was 12.5 months (ranging from 3.6 to 27 months). Our results suggested that patients with IgG deficiency without signs of infection responded better to this treatment. Levels of IgG increased from 6.57 to 13.5 g/L (median – 9.35 g/L, lower-upper quartile – 7.57-10.70 g/L) and levels of γ-globulin grew from 14.4 to 17.69 g/L (median – 16.70 g/L, lower-upper quartile – 15.96-17.30 g/L).&#x0D; Conclusions. Secondary hypogammaglobulinemia and deficiency of the serum IgG often develop in patients with blood malignancies, especially in those involving clonal proliferation of the B-cells, like in CLL. According to our study immunocorrection by intravenous immunoglobulin resulted in resolution of infectious complications in all cases of confirmed immunodeficiency. In order to prevent severe infections in CLL patients it is expedient to perform screening of the humoral immunity status before initiation of ICT and in case of development of febrile conditions.