General Condition Of Patient Research Articles

Covid-19 mimicking breast cancer progression

In February 2019, a 73-year-old woman reported with a tumour of the right breast and enlarged lymph nodes in the right axilla. A core-needle biopsy of the tumour was performed, which confirmed the diagnosis of invasive breast carcinoma NST G2, oestrogen-dependent, HER2-negative;ki 67 was 2%. Imaging showed metastases in the lungs and liver, and numerous osteolytic lesions in the bones. The patient was qualified for ribociclib therapy in combination with letrozole and zoledronic acid, and she received palliative irradiation of Th6-Th8 and Th12-L2. The treatment stabilized the cancer and the patient's general condition by February 2020. In a PET scan performed at that time previously unobserved lymph nodes in the mediastinum and liver recess were described;the lesions were ambiguous. In July 2020, there was progression of metastatic changes in the lymph nodes. CDK4/6 inhibitor and letrozole were discontinued, tamoxifen was included, and zoledronic acid therapy was continued. After the treatment change there was a rapid deterioration of the patient's general condition;she patient was drowsy and confused. The spread of cancer to the central nervous system (CNS) was suspected. The patient's husband and daughter (physicians) were diagnosed with a coronavirus infection. The patient's test was also positive;thus, she was referred to the infectious diseases ward. The dominant symptom was progressive weakness, followed by neurological symptoms: confusion, dizziness, and disinhibition reaction. Her general condition did not allow CNS imaging diagnostics. During hospitalization the patient was treated symptomatically, but her general condition did not improve. The patient died after 16 days of hospitalization.

Factors Associated with Maternal Mortality at Gynecology and Obstetrics Department in Departmental University Hospital Center of Borgou

Introduction: Maternal mortality is a robust indicator of human development. Most of it occurs in developing countries. Objectives: This study aims to determine the factors associated with maternal mortality in Gynecology and Obstetrics Department of Borgou Departmental University Hospital Center (CHUD-B). Study method: Our study took place at Gynecology and Obstetrics Department in Borgou Departmental University Hospital Center. This was a descriptive and analytical case-control study, covering a period of 7 years from January 1, 2012 to December 31, 2018. Results: Two hundred and twelve patients have been recruited consisting of 106 deceased women and 106 controls. The intra-hospital mortality ratio was 1100 deaths per 100,000 live births (LB). The mean age of deceased women was 27.06 ± 6.45 years with the extremes of 15 and 45 years. Direct obstetric causes were the most frequent causes of maternal death. They were dominated by immediate postpartum hemorrhage (32.93%), followed by High Blood Pressure (26.83%) and infections (17.07%). The general condition of patients on admission (p-0.000) and inadequate management (p-0.001) was associated with maternal mortality. Conclusion: Patients’ general condition on admission and inadequate management was factors associated with maternal mortality.

Carotid endarterectomy with stent removal in a patient with early bilateral restenosis of the internal carotid arteries in the acute period of recurrent ischemic stroke

We present a rare clinical observation of a patient with an early reoperation performed up to 2 weeks after a recurrent stroke. Carotid endarterectomy with removal of previously installed stents for critical stenoses of the internal carotid arteries after the first stroke was performed. Early bilateral restenosis up to 80-90% of the lumen in the stents of both internal carotid arteries was observed 6 months after stenting. Open interventions were performed in the acute period of recurrent ischemic stroke in two stages with a favorable outcome. No data on the increase of neurological symptoms were obtained for 2 years of observation. Treatment and application of early rehabilitation methods, improved the patient's general condition, strength in the left extremities increased up to 4.5 points, left-sided hemihypesthesia decreased, speech disorders regressed. The patient walks and serves himself independently.

Aggressive Laparoscopic Cholecystectomy in Accordance with the Tokyo Guideline 2018

Objectives:The Tokyo Guidelines 2018 have been widely adopted since their publication. However, the few reports on clinical outcomes following laparoscopic cholecystectomy have not taken into account the severity of the acute cholecystitis and the patient’s general condition, as estimated by the Charlson comorbidity index. This study aimed to assess the relationships between severity, Charlson comorbidity index, and clinical outcomes subsequent to laparoscopic cholecystectomy.Methods:We extracted the retrospective data for 370 Japanese patients who underwent emergency or scheduled early laparoscopic cholecystectomy within 72 hours from onset between February 2015 and August 2018. We compared postoperative factors in relationship to severity (grade I versus grade II/III). Then, we made a similar comparison between those with low (< 4) and high Charlson comorbidity index (≥ 4).Results:According to the Tokyo guideline 2018 levels of severity, there were 282 (76.2%), 61 (16.5%), and 27 (7.3%) patients in grades I, II, and III, respectively. With regards to surgical outcomes, the mean operating time was 62.3 minutes and the mean blood loss was 24.4 mL. The mean hospital stay was 3.6 days, with no mortalities. Blood loss was the only factor affected by severity (20.9 mL versus 60.1 mL, P = 0.0164), and operating time was the only factor affected by high Charlson comorbidity index (53.4 versus 67.8 minutes, P = 0.0153).Conclusion:Our aggressive strategy is acceptable, and severity and Charlson comorbidity index are not critical factors suggesting the disqualification of early laparoscopic cholecystectomy in patients with any grade acute cholecystitis.

Prognostic factors in light-chain cardiac amyloidosis: a retrospective analysis

Among cases of amyloid light-chain (AL) amyloidosis, cardiac amyloidosis is particularly known to be associated with a poor prognosis. However, a few established prognostic indicators exist that consider other organ involvements and a patient's general condition. Between 2012 and 2019, we retrospectively reviewed 27 patients, who were diagnosed with AL amyloidosis at our hospital. The 3-year overall survival rate of patients with cardiac involvement was 20% (95% confidence interval [CI], 0.035-0.461) and that of patients without cardiac involvement was 85.7% (95%CI, 0.334-0.979) (p=0.021). Poor prognostic factors of AL amyloidosis included left ventricular ejection fraction <60%, hemoglobin < 10 g/dl, NT pro-BNP>1,800 pg/ml, BNP>400 pg/ml, difference free light chains>180 mg/l, New York Heart Association classification ≥3, Mayo stage IV disease, and cardiac amyloidosis. A study on four patients who died within 6 months of diagnosis revealed that all the patients had cardiac amyloidosis and Mayo stage IV disease, and they all did not receive sufficient chemotherapy. Although the number of treatment options for AL amyloidosis is expected to increase in the future, patients with poor prognostic factors have a poor prognosis and careful treatment decisions, including palliative care, are required.

PHYSICAL PROCEDURES IN POST-STROKE PATIENTS. CLINICAL AND SOCIAL PROBLEMS

The aim: To assess the effects of physical therapy on the general condition of stroke patients and their level of independence with respect to functioning after stroke. Materials and methods: The study was conducted in patients receiving care and rehabilitation at the "Tęczowe Zacisze" centre in Wola Kopcowa. The study group included both residents and out-patients undergoing rehabilitation at the centre. The study assessed a total of 25 patients (14 women and 11 men) aged 50 years and older and analysed the quality of life with respect to activities of daily living and mobility as well as the effects of physical therapy on functioning in stroke patients. Results: The use of comprehensive rehabilitation in study patients improved their mobility with respect to using the stairs and walking on a flat surface, improved their ability to perform self-care activities when using the toilet, and helped them eat meals, get dressed, and bathe unassisted. Conclusions: 1. Post-stroke rehabilitation should be comprehensive, complex, and adjusted to the current physical and motor abilities of the patient. 2. The number of patients undergoing early and comprehensive rehabilitation remains too low. It is important to inform the public at large about the possibility of receiving physical therapy after stroke.

Evaluation of the Effectiveness of Dietary Plan for Pulmonary Diseases based on Persian Medicine in Patients with Pulmonary Dysfunction with Probable Infection with COVID-19

Introduction: COVID-19 is a viral disease of the coronavirus family. The virus first attacks the respiratorysystem and then infects important organs such as the heart, liver, brain, kidneys, blood and immune system.This study aimed to evaluate the effectiveness of a diet plan for lung diseases based on traditional Persianmedicine (PM) in patients with pulmonary dysfunction with possible infection with COVID-19.Materials and Methods: This study was performed as a randomized clinical trial in 2020 in the Sevome-Shaban Hospital and Shohada Gomnam Hospital in Tehran, Iran. In this study, patients admitted to thesehospitals were randomly entered into the study. A total of 80 people were included in this study. A normaldiet and a traditional medicine diet were considered for each group of patients. The effectiveness of the dietdesigned for patients was assessed in such a way that the primary outcome of changes in oxygen levels ofCovid 19 patients and the secondary consequences of the number of days of hospitalization and the degree ofchange in respiratory symptoms at discharge compared to hospitalization were examined. Also in this study,the general condition of patients including marital status, type of job, medical history, and drug use wereexamined. Patients enter the study after obtaining consent and will be excluded from the study at any time ifthey wish. Finally, the collected data were evaluated using G-Power. 3.1.9.2 software.Results: The results showed that there is a significant relationship between the use of diet based on traditionalmedicine and length of hospital stay, which has a correlation coefficient of 1.060 at the alpha level of 0.05.There is also a significant relationship between the use of diet based on traditional medicine and the amountof oxygen needed by patients at the alpha level of 0.05 has a correlation coefficient of 1.046. There is anothersignificant relationship between the use of diet based on traditional medicine and the rate of patients’ cough.At the alpha level of 0.05, it has a correlation coefficient of 1.451.Conclusion: According to the results, it can be concluded that the effective use of diet based on traditionalmedicine significantly increases the health of patients (reducing the length of hospital stay, reducing cough,and reducing the severity of oxygen demand in the study group (control In other words, the modified meanof these two groups in these three components (reduction of hospital stay, reduction of cough and reductionof the intensity of oxygen demand) were significantly different.

“TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock

Introduction. Bifurcation lesions on venous Y grafts are rare. We present a case of a woman who developed non-ST segment elevation myocardial infarction complicated by cardiogenic shock due to a bifurcation lesion on the venous Y graft for left anterior descending artery (LAD) and ramus circumflex artery (RCX). Case outline. A 72-year-old woman was admitted to the coronary care unit as an emergency in September 2017 due to acute heart failure followed by the development of cardiogenic shock. Urgent coronarography revealed severe atherosclerotic disease of native coronary arteries with significant bifurcation lesion on venous Y graft for LAD and RCX (medina classification of 1,1,1) with thrombolysis in myocardial infarction (TIMI) grade 2 flow. According to the general condition of patient, a life-saving ad hoc percutaneous coronary intervention (PCI) was performed. Two stents were implanted in the Y graft with T and protrusion (TAP) technique achieving optimal result followed with patient stabilization. On one-year follow-up, the patient was without symptoms of angina, and computed tomography coronarography revealed patent both stents in the Y graft. To the best of our knowledge, this is the first described TAP technique used on the Y graft. Conclusion. The PCI on a vein graft is not uncommon either in elective cases or in cases with acute coronary syndrome due to the poorer persistence and more frequent progression of atherosclerotic disease in the venous grafts. The use of bifurcation techniques for the treatment of lesions on a vein graft and especially on the Y graft is rare, but it can be used the same way it is used in native vessels.

Breast cancer in women aged 75 years and older – tumour characteristics and treatment options

IntroductionAn optimal approach to older women with breast cancer is still a major challenge. In this paper, we present a retrospective analysis of treatment in patients aged 75 years and older who were treated at the Holycross Cancer Centre in 2015–2019.Material and methodsThe analysed group consisted of 259 women. For estimation of the general status of patients, we used the Geriatric 8 questionnaire. For every patient, an individual treatment plan was established. Survival analysis was performed; disease-free survival (DFS), cancer-specific survival, and overall survival (OS) were calculated by the Kaplan-Meier method. For DFS and OS, the Cox proportional-hazard regression was applied.ResultsThe mean age in the analysed group was 80 years. Stage I and II cancer accounted for over 80% of patients. Radical mastectomy was performed in 56% and breast-conserving surgery in over 34% of patients. Sentinel lymph node biopsy was used in 114 patients. Preoperative systemic treatment was applied in 34 and postoperative chemotherapy in 51 patients, respectively. Trastuzumab was used in 23 patients. Postoperative hormonal therapy was applied in 205 and radiotherapy in 178 patients. During the observation after the treatment 32 patients died, while 227 survived. In multivariate analysis for DFS hormonotherapy was statistically significant for OS clinical stage and hormonotherapy.ConclusionsThe treatment plan for older women consisted of surgery and radiation therapy, and systemic treatment should be always considered. The decision should be made by the breast cancer team.

Long-term follow-up of minimally invasive surgery for the management of major bile duct injury due to cholecystectomy

Presenter: Gabriel Rangel-Olvera MD, MSc | Hospital General "Dr. Manuel Gea Gonzalez" Background: The post-cholecystectomy bile duct injury (BDI) is a life threatening condition, where severe cases require surgical intervention with a bilioenteric reconstruction. The results from minimally invasive (MI) approaches for the BDI repair studies have proven short term safety and feasibility; however they lack of middle long term follow-ups. The aim of the study is to show the patency and follow-up after 5 years of MI BDI repair. Methods: This is a retrospective comparative study of our prospectively collected database of patients with BDI who underwent robotic or laparoscopic hepaticojejunostomy; demographic and surgical variables were collected. Follow-up medical appointments were made at one month, three months, six months, 1 year, and then every year. At each appointment patency evaluation was done by evaluating the patient general condition, signs of cholangitis, stenosis, liver function tests and other postoperative complications. Results: Forty-six bile duct repairs(37, 80.43% by laparoscopic and 9, 19.57% by robotic-assisted approach) treated from June of 2012 to February of 2016 that have completed at least 5 year follow-up were evaluated. 37(80.43%) were female and 9(19.57%) male, the mean age was 41.28(19-77). The types of BDI were as follow: E1 (3,6.52%), E2 (11,23.91%), E3 (17,36.96%), E4 (12,26.09%) and E5 (3,6.52%); dividing the BDI by severity 31(67.39%) were Grade 2 and 15(32.61%) were Grade 3; also 11(23.91%) presented arterial injury and 4(8.7%) bilioenteric fistula (3 to the duodenum and one to the colon). All patients achieved the primary patency after the 90 days of the index treatment; during the follow-up. Three patients lost their primary patency, two of them requiring endoscopic intervention and 1 surgical re-intervention; achieving secondary patency after this intervention and maintaining this condition during the rest of the follow-up. Conclusion: The present study demonstrates good long-term results of bile duct injury reconstructions using laparoscopic and robotic surgery. These approaches are safe and effective alternative giving the benefits of MIS even in this complex entity.

Primary Postpartum Hemorrhage and Maternal Health-Effects and Outcome

Objective: To assess outcome of different management strategies in women presenting with primary postpartum hemorrhage (PPH). Study Design: Observational, prospective. Settings: Department of Obstetrics &amp; Gynecology Unit-III, Liaquat University of Medical and Health Sciences, Jamshoro Pakistan. Duration: From May 2016 to November 2017. Methodology: Total 50 delivered women fulfilling the inclusion criteria were included in study. All relevant variable like a detailed demographic characteristics, details about labour, symptomatology, general conditions of patient, amount of blood loss, clinical examination, finding such as condition of the uterus, genital tract trauma, retained placenta, uterine inversion. Investigation like complete blood picture blood group, blood sugar, coagulation profile, serum electrolytes, virology status, liver function test, renal function test, ultrasound examination, maternal effects and outcome were recorded on proforma and analyzed by using SPSS. Results: Among 50 women (with primary PPH) included in this study, all were managed medically, in 24 patients medical treatment was unsuccessful so surgical treatment offered. Most common cause identified was uterine atony, however anemia 50(100%).&nbsp; Hypovolemic shock 5(10%), puerperal sepsis 8(16%), complication of anesthesia 4(8%), blood reactions 6 (12%) were the morbidities observed in present study, 2 patients (4%) died inspite of all measures. Conclusion: It was concluded that best results were obtained with use of AMTSL, combination of more than on medical option and surgical management were equally effective in treating the PPH.

Course Of Post-Infarction Depression Taking Into Account The Time Of Its Once

A study of 341 patients with an established diagnosis of acute myocardial infarction was carried out. The patients are divided into 2 groups. The first, main, included 233 patients with acute myocardial infarction, who subsequently developed depressive disorders, confirmed clinically and using diagnostic scales; the second group consisted of 108 patients who also had acute myocardial infarction, but did not subsequently suffer from symptoms of depression. Clinical and dynamic observation of patients in the postinfarction period was carried out with control of the condition in a month, three months, six months, 12 months after myocardial infarction. Clinical observation was used to detect the presence of symptoms of depression. Among patients with MI with DS in the first days after MI, more than half (51.1%) reported a permanent decrease in mood more often than other symptoms, i.e. these patients showed an affective component of depression, while the ideator component of depression, which manifested itself in thinking retardation to one degree or another, was in 27.5% of patients, motor retardation (motor component) was detected in 21.5% of those observed. In patients with almost the same frequency, the anxious and melancholic type of affect was noted (47.0% and 41.2%, respectively), the dysphoric type of affect was found in 11.8% of cases, which is 4 times less than anxious and 3.5 times less than the melancholic type. In cases of prolonged depression, the severity of affective disorders more often directly correlated with the severity of the physical condition. If not so long-term depressive episodes were largely due to "their own vision of the disease", the severity of their symptoms depended on the conversation with the doctor and the information received from him, the degree of awareness of his diagnosis, possible complications, and not very much depended on the general somatic status itself. then the course of prolonged depression in patients worsened with the aggravation of the cardiological and general somatic condition of patients. Psychosomatic parallelism in the majority of protracted depressions was manifested by the generalization of asthenic symptom complexes (increased general weakness, intolerance to exertion, lethargy, adynamia, severe daytime sleepiness in combination with early insomnia) with deterioration of the somatic state. At the same time, it was noted that with prolonged depression, there were always more or less pronounced cognitive disorders (reduced memory for past events, limited ability to comprehend what was happening around, remember new information, impaired concentration). Postinfarction depressive episodes lasting up to six months can be attributed to nosogenies; depressive episodes of postinfarction genesis with a protracted course, probably with a high degree of confidence can be attributed to somatogenias.

Decompensated Acute Heart Failure Accompanied with Cardiac Cirrhosis and Chronic Disease Anemia in Child

Continuous heart failure can lead to complications to other systems, one of which is the hepatic system. Heart failure results in venous congestion in the portal vein so that the portal vein pressure increases, which is called portal hypertension. Portal hypertension causes fluid to pass through the walls of blood vessels and into the tissues. Management of decompensatory heart failure accompanied by comorbid disease in cardiac cirrhosis includes drugs management that does not aggravate the liver, namely angiotensin converting enzyme inhibitors and loop diuretic agents. Also, non-pharmacological management such as resting position and a diet sufficient in protein and low salt help improve the patient's general condition. This case report aims to present a decompensated heart failure accompanied by cardiac cirrhosis and anaemia of chronic disease in a child.

Decompensated Acute Heart Failure Accompanied with Cardiac Cirrhosis and Chronic Disease Anemia in Child

Continuous heart failure can lead to complications to other systems, one of which is the hepatic system. Heart failure results in venous congestion in the portal vein so that the portal vein pressure increases, which is called portal hypertension. Portal hypertension causes fluid to pass through the walls of blood vessels and into the tissues. Management of decompensatory heart failure accompanied by comorbid disease in cardiac cirrhosis includes drugs management that does not aggravate the liver, namely angiotensin converting enzyme inhibitors and loop diuretic agents. Also, non-pharmacological management such as resting position and a diet sufficient in protein and low salt help improve the patient's general condition. This case report aims to present a decompensated heart failure accompanied by cardiac cirrhosis and anaemia of chronic disease in a child.

Significance of erythrocyte hemolysis in determining the prognosis of burn injury

Annotation. Red blood cells are one of the first cellular structures that respond to thermal damage to the body. Thus, reactive oxygen species play an important role in the activation of complement and damage to erythrocyte cell membranes (intravascular hemolysis) during thermal injury. Based on the increased death of erythrocytes in the first days after burns, burn anemia can be observed, which, as a rule, refers to hemolytic. In severe burn shock, up to 20-30% of circulating erythrocytes are destroyed on the first day. The aim of the work is to reduce the frequency of complications of severe burn injuries in patients with erythrocyte microcirculation disorders in the capillary bed by applying an algorithm aimed at improving their architectonics and functional status. We examined 96 patients with burn injuries with a Frank index of 31–60, which consisted of 3 groups (32 patients in each), which differed in the composition of the intensive care unit: group I – treatment of patients was carried out according to the generally accepted protocol of the medical institution; group II – to the main complex of intensive care was added the appointment of a solution of ceruloplasmin intravenously, group III – in addition to the main complex of intensive care was prescribed a solution of D-fructose-1,6-diphosphate sodium salt of hydrate intravenously. The criterion for assessing the effect of treatment on the course of burn disease was to determine the level of free hemoglobin in the blood plasma, which was determined by the benzidine method. The significance of the obtained data was checked using Student’s t-test with the calculation of the Fisher Snedecor test. Data were obtained that the additional introduction of a solution of D-fructose-1,6-diphosphate sodium salt of hydrate into the complex of intensive therapy has a protective effect on the membrane of erythrocytes, promotes its stabilization, reduces the negative effect of lipid peroxidation and increases its resistance to violations of the rheological properties of blood. The appointment of this substance contributed to the acceleration of the restoration of the functional state of erythron, a decrease in the severity of intravascular hemolysis, and an improvement in the general condition of patients. Damage to erythrocyte cell membranes and impairment of functional status require further research.

Transfusional disease of female genital parts and its influence on the dispatch of these organs and the general condition of patients

(Doctor; 1897, No. 3).

Role of disarticulation and guillotine amputation of the shin in the lower limb ischemic gangrene surgical treatment strategy

Ischemic foot gangrene is one of the most common reasons of nontraumatic low limb amputations all over the world. Objective: to analyze the clinical effectiveness of an individual treatment strategy application for patients with absolute indications for high limb amputation, aimed to reduce amputation level, the number of postoperative complications and mortality. Materials and methods. This article presents the results of comparative clinical trial executing a lower-extremity amputation in 992 patients with ischemic gangrene. Applied in this study strategy of surgical treatment included usual below-knee, above-knee amputations and guillotine amputations in the lower third of the shin also the shin exarticulation without wound plastic. Guillotine amputations was used as an intermediate stage of treatment in cases where due to the severe general condition of patients to perform a classic myoplastic amputation with stump formation was impossible, since it is accompanied by a very high risk of postoperative complications and mortality. Results. Using guillotine amputations and shin exarticulation as the first stage of complex surgical strategy aimed to rapid elimination of the purulent focus with minimal risks and the speedy stabilization of the patients general condition, emaciated and weakened by developing gangrene, led to reduce general lethality by 17.1 % and increased the quantity of below-knee amputations by 23.0 % compared with the comparison group. Conclusion. Patients with ischemic gangrene require the development of an individual strategy for surgical treatment (taking into account the severity of the patients general condition, the prevalence of the purulent-necrotic process in the lower limb, the nature and degree of peripheral macroangiopathy), which can reliably and significantly reduce the number of amputations at the hip level (by 46.2%), as well as reduce mortality after high amputations of the lower extremities (by 17.1%) in an emergency city hospital. We consider it extremely important to reduce the number of primary amputations at the hip level!

CLINICAL CASE OF SUCCESSFUL TREATMENT OF INFERTILITY IN A PATIENT WITH FAILURE IVF RESULTS IN ANAMNESIS

Genital endometriosis is a disease of women of reproductive age, accompanied by infertility in 50% [1]. Adenomyosis can be considered as an endometriosis of the uterus. Histologically, this process is represented by ectopic, non-tumor endometrial glands, and stroma surrounded by hypertrophic and hyperplastic myometrium [2]. Adenomyosis is accompanied by pelvic pain of varying intensity as well as menstrual disorders [1]. The disease is accompanied by significant violations of reproductive function (infertility, unsuccessful attempts at pregnancy and miscarriage, abnormal uterine bleeding). Adenomyosis can be accompanied by a violation of the function of adjacent organs (such as the bladder, rectum). Often, one of the clinical manifestations of adenomyosis is the development of sideropenic syndrome, which is also caused by the development of chronic post-hemorrhagic iron deficiency anemia. This is accompanied by a deterioration in the general condition of patients, a decrease in their ability to work. Despite a large number of publications in Russian and foreign scientific sources devoted to this problem, reproductive doctors and obstetricians-gynecologists often underestimate the role of adenomyosis in pregnancy planning using assisted reproductive technologies. Without interpreting the anamnesis data obtained through an active survey, doctors do not prescribe additional methods for diagnosing this pathology, which is not complex and expensive. To confirm the diagnosis, a transvaginal ultrasound examination of the pelvic organs during the premenstrual period is sufficient. In cases that are difficult to diagnose, the MRI method of the corresponding anatomical area can be used. Underestimation of the clinical picture and under-examination of the patient did not allow prescribing timely correction of the pathology and led to unsuccessful attempts to implement the generative function using assisted reproductive technologies. The conducted examination with clarification of the cause of IVF failures and the prescribed reasonable treatment made it possible to achieve regression of endometriosis foci in this clinical situation, followed by the patient's ability to realize generative function.

METHODS FOR ASSESSING THE RISKS OF COMPLICATIONS IN PATIENTS WITH HERNIAS OF THE ANTERIOR ABDOMINAL WALL. REVIEW

The work is based on the analysis of literature data devoted to the problem of assessing postoperative complications in patients with primary and incisional hernias of the anterior abdominal wall. The main purpose of this review is identifying existing methods for assessing local, general perioperative complications and determining of the most reliable prognostic scales and methods for assessing risk factors among the existing ones.The first part of the article is devoted to the assessment of the general condition of patients with hernias of the anterior abdominal wall. The existing scales for assessing modifiable risk factors (MFR), methods of preventing complications, including abdominal bandage, are considered. The main risk factors were determined: CDC wound class, patient age, hernia size, smoking, diabetes, risk 3 and higher according to ASA.In the second part, the assessment of risk factors for complications from the surgical site is considered. The problem of terminology standardization, the difference between surgical site infection (SSI), adverse surgical events (SSO) and surgical site occurrences requiring procedural interventions (SSOPI) is described. Scales for assessing the risks of perioperative complications are presented. The evolution of SSO assessment methods from a four level to a three level scale is described. The Russian experience in assessing the combination of MFR is presented.The third part describes the importance of evaluating post traumatic stress disorder in patients as a risk factor for an unfavorable course of the postoperative period. The European EuraHS QoL Questionnaire, recommended for use in the European Hernia Registry, is presented. The section also highlights the relevance of the selection of patients with hernias in outpatient surgery and one day hospitals.The main idea of developing modern methods for assessing complications after hernioplasty is a comprehensive assessment of the patient's individual profile before operations for primary and incisional hernias in different risk groups. Priority should be given to tailored specific electronic questionnaires.

Treating hard-to-heal ulcers: biocellulose with nanosilver compared with silver sulfadiazine.

Controlling infection and promoting healing should be the aims of hard-to-heal diabetic ulcer treatment, along with improving a patient's general condition and their blood sugar control. Many hard-to-heal diabetic ulcers present with cavities, tracks or a combination of these. There is a new biocellulose (with a nanosilver dressing) which has the ability to contour around and conform to the irregular surface of a wound bed. The purpose of this study was to evaluate its efficacy compared with a silver sulfadiazine cream, for hard-to-heal diabetic ulcer treatment. In this randomised control trial, patients with hard-to-heal diabetic ulcers were divided into two equal-sized groups: treatment with the biocellulose with blue nanosilver (experimental group), and treatment with silver sulfadiazine cream group (control group). Cotton gauze was used as the secondary dressing for both groups. Demographic data, wound size, wound classification, wound photography and bacterial cultures were recorded at the beginning of the study. Wounds were debrided as necessary. Dressings were changed twice daily in the control group, and every three days in the experimental group. A total of 20 patients took part in the study (10 patients in each group). The highest mean wound healing rates were 91.4% in the experimental group and 83.9% in the control group. No wound infections or adverse effects from the dressings were detected in either group. In this study, biocellulose with blue nanosilver adapted well to the wound bed. Wound reduction was greater in the experimental group than the control group. Biocellulose with blue nanosilver could therefore be a good choice for hard-to-heal diabetic ulcer treatment, due to its good healing rates and minimal care requirements.