Prevention Of Possible Complications Research Articles

Important aspects of carbohydrate metabolism disorders development in hematology/oncology patients during therapy with glucocorticosteroids: a review of the literature

Glucocorticosteroids are highly effective anti-inflammatory and immunosuppressive agents. The drugs were introduced into therapeutic practice from the mid-20th century and are still widely used in the treatment of various diseases. They are an integral part of the treatment of patients with hematological malignancies. One of the clinically significant complications of glucocorticosteroid therapy is steroid-induced carbohydrate metabolism disorders. Diabetes mellitus is one of the main risk factors for the development of cardiovascular diseases, which are the main non-oncological cause of death in the population and a significant treatment complication in patients with malignant neoplasms. Early detection of the disease and improved treatment efficiency increase the survival rate of patients with various types of neoplasms. It is also important to pay attention to quality of life improving in cancer patients after treatment.The aim of this review is to analyze the pathogenesis features, as well as predictors of early detection and prevention of possible complications of persistent hyperglycemia in patients with hematological malignancies.

Anatomy of Maxillary Sinus: Focus on Vascularization and Underwood Septa via 3D Imaging.

The study of the maxillary sinus anatomy should consider the presence of two features of clinical importance. The arterial supply course and the presence of the so-called Underwood septa are two important factors to consider when planning surgical treatment to reduce the risk of surgical complications such as excessive bleeding and Schneiderian membrane perforations. This study aimed to investigate the above-mentioned anatomical structures to improve the management of eventual vascular and surgical complications in this area. This study included a total of 200 cone-beam computed topographies (CBCTs) divided into two groups of 100 CBCTs to evaluate the arterial supply (AAa) course through the lateral sinus wall and Underwood's septa, respectively. The main parameters considered on 3D imaging were the presence of the AAa in the antral wall, the length of the arterial pathway, the height of the maxillary bone crest, the branch sizes of the artery in the first group, and the position of the septa, the length of the septa, and their gender associations in the second group. The CBCT analysis showed the presence of the arterial supply through the bone wall in 100% of the examined patients, with an average size of 1.07 mm. With regard to the septa, 19% of patients presented variations, and no gender difference was found to be statistically significant. The findings add to the current understanding of the clinical structure of the maxillary sinus, equipping medical professionals with vital details for surgical preparation and prevention of possible complications.

Геморрагический инсульт: клинические проявления, исходы и факторы, модифицирующие течение заболеванияS

The article presents the causes, features of the clinical course and outcome of hemorrhagic strokes in 254 patients aged 40 to 92 years. Hemorrhagic strokes were often found in elderly and senile men (in the range from 60 to 89 years), with bad habits suffering from arterial hypertension in combination with obesity and diabetes, in the absence of adherence to the treatment of background pathology and the prevention of possible complications. A hemorrhagic stroke prevailed by the type of small hemata intracerebral hematomas. Risk factors for hemorrhagic strokes are clarified – arterial hypertension, dyslipidemia, obesity, diabetes, complications of which are strokes. The importance of the prevention of background diseases in patients frthom risk groups is confirmed. The total mortality in hemorrhagic stroke reached 49.61 %. In persons who received conservative treatment, mortality remained extremely high (88.32 %); It was caused by a special severity of patients and an unfavorable combination of risk factors. The lethal outcome were 1.86 times more in male patients than in female patients. Moreover, in cases of small and medium hematomas, death was often observed in male patients. The survival of patients with large intracerebral hematomas was minimal (1.89 %), wiout reliable gender differences. The clinical case of successful surgical treatment of a large intracerebral hematoma is given in the article.

Effect of topical nitroglycerin application on flap survival and complications post reconstructive microsurgery: A systematic review and meta-analysis study of the literature

Background and Aims: Several methods have been used in plastic and reconstructive surgery to reduce post-surgical complications, such as partial or complete flap loss due to ischemia and necrosis. Nitroglycerine application has been introduced as a viable alternative to papaverine to act as a local vasodilator to improve perfusion and reduce vasospasm. However, the literature has not thoroughly studied its efficacy and administration dose. This systematic review and meta-analysis study has been designed to assess the efficacy of topical nitroglycerine applications in reducing post-surgical flap necrosis and complications. Methods and Materials: A systematic literature search was performed on PubMed, Scopus, and Web of Science from inception to January 2023 with relevant keywords and terms. Case reports, review articles, letters, articles in any language other than English, and animal studies were excluded. The Newcastle-Ottawa and Jadad scales were used to assess the quality of the included studies. The pooled effect sizes were calculated using the random effect model with the Mantel-Haenszel method. Results: Overall, 2031 studies were obtained, among which 454 articles were duplicated and removed. Of the remaining 1577 articles, based on the eligibility and exclusion criteria, 20 articles were retrieved for full-text review. Finally, eight articles were included in our study. Three thousand nine hundred six patients had undergone reconstructive microsurgery and received topical nitroglycerin for the prevention of possible complications. The pooled rate of flap complication was 15% (95% CI: 8% to 25%, I2 = 96%, p-value < 0.01), and the pooled odds ratio of flap complication was 0.35 (95% CI: 0.15 to 0.83, I2 = 91%, p-value = 0.02). The heterogeneity of the included studies was significantly high. The dose and regimen of application significantly differed between each study. Conclusion: Topical administration of nitroglycerin compounds post reconstructive microsurgery can reduce the risk of flap necrosis. However, the precise dosage, duration of application, and possible underlying factors affecting drug efficacy are yet to be discovered.

N33 Experience of inflammatory bowel disease patients in relation to the practice of anal intercourse

Abstract Background Sexual health should be part of the management of people with chronic diseases. Receptive anal intercourse is a relatively common practice, and in Inflammatory Bowel Disease (IBD) it can be clearly compromised by the perianal and rectal involvement that many patients present. Understanding the experience of people with IBD in relation to anal intercourse will provide information to help them live their sexuality in a full and healthy way. Methods Observational, descriptive, cross-sectional study. Creation of ad-hoc online questionnaire through the REDCap platform. The study population was people between 18 and 75 years with IBD who have or have had sexual intercourse. The survey was distributed through social networks, advanced practice nurses and patient associations (ACCU). The study was approved by the Ethical Committee for Clinical Research of Hospital Universitari Germans Trias i Pujol, (reference PI-22-255, approval date November 11, 2022) Results 1111 surveys answered, 766 (68.8%) completed. Mean agewas 41.86 years (SD10.32), 560 (73.3%) were women, and 50% had a university education. Sixty per cent (460) have Crohn's disease and 765 people (75.4%) are on immunosuppressive treatment. 22.4% (171) report perianal disease. 34.8% (266) practice anal sex, of these more than 60% do not use a condom during anal sex. 7.6% clean their bowels, 32.4% dilate their anus beforehand, and 60.5% use lubricants. Injuries, tearing and bleeding are reported after anal sex, with 78.5% of women reporting pain. More than 30% think that anal sex increases the urge to go to the toilet and 22% think that it worsens their IBD. Conclusion As nurses results obtained in this study direct us towards two main themes. We have to be aware of focusing on health education for the prevention of sexually transmitted diseases and the prevention of possible complications produced by anal sex.

Синкопальные состояния у военнослужащих: клинико-диагностическое сопоставление, оказание медицинской помощи в многопрофильном лечебном учреждении

The article provides general information about clinical manifestations, modern approaches to the diagnosis and interpretation of clinical and instrumental methods in patients with various types of syncopal conditions, as well as provides own data from the analysis of medical care for this category of patients in the conditions of 432 main military clinical medical center. The emphasis is placed on the possibilities of diagnosis after the initial examination, the expediency of using simple and affordable diagnostic techniques (active orthostatic test, vegetative Kerdo index, scale for detecting permanent autonomic dysfunction), treatment tactics, prevention of possible complications, and solving expert issues.

Non-opioid multimodal analgesia in the immediate postoperative period

Objective. To increase the effectiveness of postoperative multimodal analgesia using contact LED exposure with Russian BASI bracelets emitting in blue range 470 ± 10 nm and including magnesium sulfate in the multimodal postoperative analgesia protocol.Material and methods. To achieve the goal set in the work, the effectiveness of contact LED blood irradiation in blue range of 470 ± 10 nm at the microcirculation state was analyzed in patients of the main group (n = 46) in the immediate postoperative period. We studied the percentage of oxygen, as well as the acid-base state of venous blood before and after contact LED exposure. In the comparison group (n = 42), patients did not have contact LED blood irradiation in the immediate postoperative period.To study the effectiveness of contact LED blood irradiation at blood coagulation parameters, a series of coagulograms of blood samples taken from patients of both groups was done: once (before surgery) in the preoperative period and once in the immediate postoperative period up to 6 hours, because after 6 hours, anticoagulant therapy was administered according to the protocol. Coagulological testing was performed using Sysmex CA-560 apparatus (Japan). The acid-base state of venous blood was evaluated using Gem Premier 3000 apparatus manufactured by Instrumentation Laboratory.Research results. Coagulation tests revealed a positive effect of contact LED blood irradiation in patients of the main group. This effect was manifested in the stable trend of shifts towards moderate hypocoagulation in postoperative hemostatic parameters in all studied stages, what indicates the prevention of possible complications like thromboembolism in the postoperative period.Conclusion. Contact LED blood irradiation in blue range 470 ± 10 nm prevents thromboembolism in the postoperative period and allows to achieve pain relief without narcotic analgesics on the first day after the surgery.

The role of ultrasound assessment of the spleen mass coefficient in the observation dynamics in children with chronic EBV virus

Purpose of the study: to show the significance of ultrasound diagnostics in assessing the dynamics of the spleen mass coefficient in children of various age against the background of a chronic form of EBV virus.Materials and methods. The study was performed on 146 children aged 3 to 18 years suffering from chronic EBV virus. Depending on age, the children were divided into 3 groups. Group 1 included 63 patients aged 3 to 7 years; Group 2 consisted of 28 children aged 8 to 11 years; Group 3 included 55 children aged 12 to 18 years. The clinical, laboratory and ultrasound examination was conducted including ultrasound of the spleen with the further determination of its mass coefficient (SMC).Results. In the acute period of EBV virus, children of all age groups revealed an increase in SMC, while the maximum increase was observed in children aged 3 to 7 years and amounted to 6,88. Against the background of a complete clinical and laboratory recovery in this age group, the SMC remained at the level of 4.66 and did not reach the average values of healthy children of the same age. The follow-up dynamics for 15–18 months demonstrated the normalization of the SMC to the average values of healthy patients in accordance with their age (in children aged 12 years and older).Findings. Children in the age group from 3 to 7 years old had the maximum value of the spleen mass coefficient, both in the acute period and after complete clinical and laboratory recovery. The use of ultrasound technique with the assessment of the spleen mass coefficient in the chronic course of EBV virus allows expanding and determining the children contingent for further dynamic monitoring for prevention of possible complications.

Portable Negative Pressure Wound Dressing in Oncoplastic Conservative Surgery for Breast Cancer: A Valid Ally.

Background and Objectives: The use of oncoplastic techniques has spread widely in the last decade, with an expansion of the indications and demonstration of excellent oncological safety profiles. A potential downside may be the increased complication rates, which could influence the timing of adjuvant therapy. To date, there is increasing evidence that negative pressure therapy on closed wounds can reduce complication rates after surgery. From this perspective, we tested the use of portable negative pressure wound dressings (NPWDs) in oncoplastic surgery to minimize early post-operative admissions to the outpatient clinic and prevent surgical complications. Materials and Methods: An observational prospective cohort study was conducted on a population of patients who underwent quadrantectomy and wise-pattern reduction mammoplasty for breast cancer. The primary objective of the study is represented by the evaluation of the impact of NPWD on post-operative outcomes in an oncoplastic surgery setting. Patients enrolled between January 2021 and January 2023 were divided into two groups, the conventional dressing (CD) group and the NPWD group, by a simple randomization list. Results: A total of 100 patients were enrolled, with 52 in the CD group and 48 in the NPWD group. The use of NPWD significantly reduced the wound dehiscence rate (2.0% vs. 7.7% p = 0.002) and the number of one-month postoperative admissions to our clinic (3.8 ± 1.1 vs. 5.7 ± 1.3 p = 0.0009). Although not significant, it is possible to note a trend of reduction of clinically relevant postoperative total complications in patients treated with NPWDs. Conclusions: NPWDs may represent a useful tool in the post-surgical management of complex oncoplastic procedures, ensuring less wound dehiscence. Furthermore, the use of these dressings led to a significant reduction in admissions to the clinic, promoting a lower use of resources by hospitals and effective prevention of possible complications.

Cytoprotection in gastroesophageal reflux disease and prospects for the use of cytoprotective agents

The analysis of publications is devoted to the problem of treatment and prevention of gastroesophageal reflux disease with the use of cytoprotectors. Special attention is paid to Gastrotop, the new complex of plant origin. Gastrotop (Еrвоzета S.p.A, San Marino) is a new medication with cytoprotective action, containing Mucosave CG, a standardized complex of polysaccharides from the stems of Indian prickly pear (Opuntia ficus‑indica, 33.5%), leaves of European olive (Olea europaea, 24.0%); a mixture of sodium alginate and salts (sodium alginate — 50 mg, potassium bicarbonate — 10 mg, calcium carbonate — 10 mg), an extract of the leaves of Malva sylvestris L. 50 mg. Its action is aimed at the increasing of protection of esophageal and gastroduodenal mucosa from irritating effects of hydrochloric acid, pepsin, and the detergent effect of bile during reflux by means of formation of a strong mucoadhesive biofilm on the walls of the esophagus. The authors present the results of a randomized, double‑blind, controlled clinical trial evaluating the efficacy and safety of a preparation based on alginate/sodium bicarbonate in combination with extracts obtained from Opuntia ficus indica and Olea europaea related to polyphenols on the dynamics of GERD symptoms. It has been established that Gastrotop is well tolerated and effective in controlling symptoms associated with mild GERD manifestations. The results demonstrated the perspective of administration of a standardized complex of polysaccharides as part of Gastrotop in cases when it’s necessary to cancel antisecretory drugs (in particular, proton pump inhibitors PPIs), for example, before assessing the persistence of Helicobacter pylori infection or for the purpose of monitoring of the eradication effectiveness. The use of cytoprotectors in GERD promotes the reduction of incidence and prevention of possible complications, caused by the long‑term PPIs’ use.

Difficulties of diagnosis and the need for a comprehensive approach to treatment of patients with X-ray non-contrast orbital foreign bodies

Introduction. An orbital foreign body, especially of an organic nature, is often difficult to diagnose during the initial examination. A thorough history taking, clinical examination, and the use of additional imaging techniques are of great importance. Due to the risk of purulent-inflammatory complications, foreign bodies must be surgically removed.The aim of the work was to demonstrate the importance of timely diagnosis and complex approach to treatment of patients with X-ray non-contrast foreign bodies of the orbit using the example of clinical observation.Materials and methods. Patient R. came in with complaints of redness, pain, lacrimation and lack of vision in the left eye after falling and hitting the left side of his face on a metal corner. Left eye visual acuity = 1/∞PrLinc, IOP = T−3 (palpatory).Results. Control X-ray computed tomography (CT) of the orbits and paranasal sinuses (PNS) suspected the presence of a radiopaque foreign body. A rhinoendoscopic examination was performed by an otorhinolaryngologist and a fragment of a large wooden foreign body was found in the nasopharyngeal arch. Surgeons of the ophthalmologic and otorhinolaryngologic departments performed surgery: removal of the foreign body, endonasal endoscopic opening of the labyrinth on the left, endoscopic endonasal maxillary sinus maxillary sinus maxillotomy on the left, left microcoidectomy, resection of trauma-exposed tissue. During his stay in the 2nd Ophthalmologic Department of the Regional Clinical Hospital named after N.A. Semashko. N.A. Semashko Regional Clinical Hospital, the patient’s condition improved, infection was eliminated, prevention of possible complications was carried out. The patient was referred to the Pirogov National Medical-Surgical Center, where the following surgery was performed: microinvasive vitrectomy + FEC + PFOS + retinotomy + endotamponade with silicone oil 1300 of the left eye, and a consultation with a laser surgeon was recommended for laser iridectomy.Discussion The clinical case considers a comprehensive approach to the treatment of intraorbital foreign bodies, the participation of a multidisciplinary team of specialists, while the patient still has a long road to rehabilitation.Conclusion In orbital trauma with penetration of a foreign body, an accurate history, timely diagnosis, and rational surgical and conservative treatment are important. This will help to avoid serious complications and prevent visual and oculomotor disorders of the visual organ.

Experience of Surgical Treatment of Complex Forms of Ebstein’s Anomaly through the Method of Hemodynamic Correction

Ebstein’s anomaly (EA) is a rare and complex congenital heart disease, with a prevalence of 4 to 7 cases per 100,000 live births. At this stage of the development of EA surgery, significant progress has been made in our understanding and treatment of EA, but the question of the tactics of treating complex forms, especially in the period of infancy and early childhood, remains open. Due to significant phenotypic heterogeneity, the treatment of EA varies greatly from patient to patient and depends on many factors that require a comprehensive approach. The choice of the method of surgical correction directly depends on the anatomical features: the degree of dysplasia, rotation and displacement of the tricuspid valve, the degree of atrialization of the right ventricle, the combination with other congenital heart diseases, and the severity of hemodynamic disorders.
 The aim. To evaluate perioperative characteristics in patients with complex forms of EA, immediate and long-term results after hemodynamic correction.
 Materials and methods. In the period from 1996 to 2022, at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, one and a half ventricle repair was performed in 18 patients with complex forms of EA. There were 12 (67%) male patients, 6 (33%) female patients. The median age of the patients at the time of surgery was 30 months [3.5; 312]. The main diagnostic method in determining the defect and assessing the immediate and remote results was echocardiography and probing of the heart cavities. In order to qualitatively evaluate the perioperative, immediate and long-term results to determine the optimal tactics and terms of surgical intervention, prevention of possible complications, all the patients were divided into two age groups: I group up to 2.5 years including 9 patients (50%), II group older than 2.5 years including 9 patients (50%).
 Results. In the postoperative period, 2 (11%) deaths were noted in both groups. In all the deceased patients, the cause of death was acute heart failure and acute respiratory failure. The analysis of the postoperative period showed normal results in such a cohort of highly complex patients of both groups, but a more stable course was noted among patients of the I group, as indicated by statistically significant values for the duration of mechanical ventilation, stay in the intensive care unit, stay in the hospital, the average dose of sympathomimetic support and its duration, the total duration of exudation in the comparison groups.
 An uncomplicated course of the early postoperative period was observed in 8 (44%) patients. The remaining 10 (56%) patients of both groups had: I group, 3 (33%) patients: 7 complications; II group, 5 (55%) patients: 13 complications. In 5 patients (2 patients in I group and 3 patients in II group), attention-grabbing acute heart failure was observed, which required high doses and long-term sympathomimetic support, and in 2 patients caused death. The average observation period was 45 months [6; 190]. No deaths were observed during the observation period among 13 (72%) patients of both groups, contact was lost with 3 (17%) patients. There were no violations in the functioning of the right ventricle, but the recovery of the systolic function of the left ventricle occurred only in 8 (44%) patients.
 Tricuspid insufficiency was minimal in 5 (28%) patients, moderate in 6 (33%), severe in 2 (11%) patients.
 Conclusions. Determining the tactics of treatment of complex forms of EA is a serious problem in patients of various ages, especially in newborns and infants, due to pronounced dilatation and systolic dysfunction of the left ventricle, a sharp decrease in systemic output due to changes in the geometry of the left ventricle. The technique of hemiventricular correction shows very promising results and may become the technique of choice for patients with severe forms of EA and pronounced right ventricular insufficiency.

A retrospective study of the effects of anesthesia methods on post-operative delirium in geriatric patients having orthopedic surgery: Anesthesia methods on post-operative delirium

Background/Aim: Post-operative delirium, which usually develops in geriatric patients, also causes an increase in mortality and morbidity for various reasons, such as difficulty in compliance with treatment. Estimating the effects of the anesthesia method on delirium contributes to the prevention of possible complications. In this study, effects due to use of different anesthesia methods on the post-operative delirium development in geriatric patients who underwent orthopedic surgery were investigated. Methods: In our retrospective cohort study, scanning of the patient files was performed for 276 patients who were older than 65 years and who had undergone surgery for lower extremity fractures in Malatya education and research hospital, orthopedics department between May 1, 2022 and October 15, 2022. Demographic data, comorbid conditions, anesthesia type, lengths of surgery, and level of delirium development were recorded for each scanned patient. Results: In our study, 201 patients were included. The mean age of the patients was 74.1 (7.3) (min–max: 65–98); 133 (66.2%) were female, and 68 (33.8%) were male. It was noticed that patients who had undergone regional anesthesia developed a significantly smaller rate of delirium development (8.1%) compared to those who had received general anesthesia (20.6%; P=0.012). Ages (P<0.001), lengths of surgery (P<0.001), and lengths of hospitalization stays (P<0.001) were significantly higher in patients with delirium compared to those without. Conclusion: Based on the data obtained in this study, it was concluded that to reduce the risk of delirium development after orthopedic surgery, regional rather than general anesthesia should be selected, and the time of hospitalization stay should be minimized.

Can orbital artery resistive indexes detect complications of diabetes in the prediabetic phase?

Prediabetic patients have generalized microvascular dysfunction, which leads to end-organ damage, just like diabetes. Therefore, prediabetes is not just a mild elevation in blood sugar, and early detection and prevention of possible complications should be the main goal. Color Doppler imaging (CDI) provides morphologic and vascular information on various diseases. The Resistive Index (RI) is a widely used measure of resistance to arterial flow and is calculated from the CDI. CDI evaluation of vessels in the retrobulbar region may be the first sign of micro- and macrovascular complications. Consecutively, 55 prediabetic patients and 33 healthy subjects were recruited for the study. Prediabetic patients were divided into three groups according to their fasting and postprandial blood glucose values. The groups included an impaired fasting glucose (IFG) group (n = 15), an impaired glucose tolerance (IGT) group (n = 13), and an IFG+IGT group (n = 27). The RI of the ophthalmic artery, posterior ciliary artery, and central retinal artery were measured in all patients. The orbital artery, central retinal artery, and posterior cerebral artery mean RI of prediabetic patients (0.76 ± 0.06, 0.69 ± 0.03, and 0.69 ± 0.04, respectively) were significantly higher than those of the healthy group (0.66 ± 0.04, 0.63 ± 0.04, and 0.66 ± 0.04, respectively; p < 0.001; Student's t-test). The mean ophthalmic artery RI of the healthy, IFG, IGT, and IFG+IGT groups were 0.66 ± 0.39, 0.7 ± 0.27, 0.72 ± 0.29, and 0.82 ± 0.16, respectively, with a significant difference between the groups (p < 0.001, ANOVA). The mean central retinal artery RI of the healthy, IFG, IGT, and IFG+IGT groups were 0.63 ± 0.04, 0.66 ± 0.02, 0.7 ± 0.02, and 0.71 ± 0.02, respectively (p < 0.001, post-hoc Tukey). The mean posterior cerebral artery RI of the healthy, IFG, IGT, and IFG+IGT groups were 0.66 ± 0.04, 0.66 ± 0.04, 0.69 ± 0.03, and 0.71 ± 0.03, respectively, with a significant difference between the groups (p < 0.001 Fisher ANOVA). Increased RI may be the first sign of developing retinopathy, as well as the first sign of microangiopathies occurring simultaneously in the coronary, cerebral, and renal vessels. Precautions to be taken during the prediabetic stage can prevent many possible complications.

Intranasal Esketamine administration in catatonia: a case report.

IntroductionCatatonia is a complex psychomotor syndrome that often goes unrecognized and, consequently, untreated. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. Benzodiazepines and electroconvulsive therapy (ECT) are the most widely studied treatment methods. However, no uniform treatment method has yet been brought forward and no previous attempts to treat catatonia on a patient suffering concomitant major depressive disorder (MDD) with NMDA receptor antagonists have been documented so far.ObjectivesTo describe the unknown and novel management of catatonia and MDD with intranasal esketamine, a NMDA receptor antagonist.MethodsA 55-year-old woman with a diagnosis of long-standing recurrent major depressive disorder who was admitted to the psychiatric inpatient unit of UniversityHospital Marqués de Valdecilla (Santander, Spain) suffering a complex catatonic, mutative state framed on a severe MDD. Different ineffective therapeutic interventions were deployed during the course of her illness. After failing to improve under conventional pharmacological treatment and ECT, and given the complexity of peripheral venous access on this patient (which disabled the option for iv ketamine use), we decided to initiate compassionate treatment with intranasal esketamine.ResultsIntranasal esketamine was effective in the resolution of patient’s complex catatonic state. Clinical response from catatonia was observed after 6 intranasal esketamine administrations (2-week follow-up), reaching full catatonia and MDD remission after 12 sessions in absence of significant adverse eventsConclusionsEsketamine showed promising effectiveness for the treatment of catatonia in the context of MDD, although further research on this topic is needed.Disclosure of InterestNone Declared

Clinical assessment of the condition of women of reproductive age with adenomyosis after experiencing COVID-19

Annotation. The relevance of the gynecological disease adenomyosis (N80.0) is beyond doubt, as this pathology is a serious problem today both in medicine and in society. The aim is to study the clinical condition of women of reproductive age with adenomyosis after suffering COVID-19. 150 women of reproductive age were examined after suffering COVID-19 disease, 120 of them with adenomyosis. The results obtained were processed using the methods of mathematical statistics and using the MS Excel XP, Statistica 6.0 software package using Student's parametric test. At the same time, differences were considered statistically significant at p&lt;0.05. A clinical assessment of the condition of women of reproductive age with adenomyosis after suffering COVID-19 confirmed a significantly more severe course of adenomyosis in the early post-COVID period. After undergoing COVID-19, the frequency of complaints of general malaise, headaches, lethargy, pain in the joints, muscles, and pelvis in women aggravated by adenomyosis significantly increased. The more severe the degree of the disease (I-II, III-IV), the worse was the general condition of the examined patients. The frequency of complaints about general malaise, exacerbation of extragenital diseases (cardiovascular system, gastrointestinal tract, hepatobiliary system, anemia, etc.), gynecological pathology, including disorders of menstrual function, volume of menstrual blood loss, pelvic pain syndrome, presence of processes of inflammatory (infectious) etiology increased significantly. Determining the clinical assessment of the condition of women of reproductive age with adenomyosis after suffering COVID-19 is of fundamental practical importance for determining the tactics of managing this cohort of patients with the aim of timely qualified prevention of possible complications. Prospects for further research are aimed at developing and implementing an algorithm for managing women of reproductive age with adenomyosis after suffering COVID-19.

СИНДРОМ ЗАПЯСТНОГО КАНАЛА У ВОЕННОСЛУЖАЩИХ: КЛИНИКО-ДИАГНОСТИЧЕСКОЕ СОПОСТАВЛЕНИЕ, ОКАЗАНИЕ МЕДИЦИНСКОЙ ПОМОЩИ В МНОГОПРОФИЛЬНОМ ЛЕЧЕБНОМ УЧРЕЖДЕНИИ

The article presents general information about clinical manifestation, modern approaches to the diagnosis and treatment of patients with carpal tunnel syndrome, as well as own data of the analysis of the provision of medical care to the category of patients in the conditions of 432 MMCMC. The emphasis is placed on the possibilities of iagnosis, treatment tactics, prevention of possible complications, solving expert issues.

Systematic review of the clinical efficacy of various methods of surgical treatment of patients with ventral hernias

BACKGROUND: To date, the problem of relapse-free treatment in herniology has not been solved. In recent years, the development and wider application of modern technologies in herniology, including endovideosurgical, has been noted. The principles of preparation for surgical interventions, postoperative management and the choice of surgical treatment have also changed significantly, which has affected the improvement of the quality of surgical care for patients with ventral hernias. AIM: To determine the clinical effectiveness of various methods of surgical treatment of patients with ventral hernias by conducting a systematic review and identifying differences associated with statistical heterogeneity in the study findings. MATERIALS AND METHODS: More than 1400 domestic publications devoted to surgical treatment of ventral hernias have been preliminarily studied. Taking into account the inclusion and exclusion criteria, the review included 35 domestic scientific publications dated from 2007 to 2020. 8906 cases of surgical treatment of patients with ventral hernias have been analyzed to assess the results of treatment and the clinical effectiveness of various methods. RESULTS: The wider introduction of endovideosurgical operations into practice has demonstrated the best result in assessing the risk of relapses and postoperative complications. However, the total share of endovideosurgical operations remains small compared to other types of surgical treatment. CONCLUSIONS: Standardized approaches to the management of surgical patients and the prevention of possible complications due to the principles of evidence-based medicine can improve the overall effectiveness of the treatment of patients with ventral hernias.

Tongue-and lip-tie beyond breastfeeding difficulties

The diagnosis and treatment of tethered oral tie tissues, such as ankyloglossia (tongue-tie) and lip-tie, have grown substantially. Although robust evidence indicates that these abnormal anatomic variations are associated with breastfeeding difficulties, impaired craniofacial growth, sleep, speech and posture in children, both diagnosis and treatment of oral ties remain controversial. The oral cavity displays considerable morphological variation across individuals. One of these variations includes tight, restrictive connective tissue between oral structures known as tethered oral tie tissues (TOTs). The clinical view regarding these anomalies has evolved with increasing interest not only in tongue-tie (ankyloglossia) but also in lip-tie [1-3]. Ankyloglossia has been considered a risk factor for breastfeeding difficulties [4-16]. Recent evidence indicates that TOTs can be also associated with whole-body consequences, such as reflux, dental malocclusion, and respiratory disorders, ultimately increasing the risk of sleep and speech disorders, and detrimental changes in posture and eating patterns [13, 17-25]. The prevalence of TOTs is highly variable across populations and is still a matter of ample debate. Currently, there is a lack of consensus on diagnosis criteria, best surgical treatment techniques, and pre- and post-surgery care [19, 26, 27]. Yet, the diagnosis and surgical treatment of TOTs have substantially increased in recent years [28-31]. This mini-review will summarize evidence-based data regarding the cascade of consequences of tongue-tie and lip-tie in children and the main signs and symptoms of these anomalies in newborns. It will also discuss the available evidence on treatment options for TOTs, including pre- and post-surgical care that may enable better outcomes and prevention of possible complications. For a better understanding, tongue-tie and lip-tie will be addressed separately.

Фармакотерапевтичні особливості ведення пацієнтів із вторинними артеріальними гіпертензіями ендокринного генезу

Secondary arterial hypertension is the arterial hypertension, the etiology of which can be established. Secondary arterial hypertension becomes the cause of elevated blood pressure in 5–10% of patients with hypertension. More than 50 diseases and clinical conditions contributing to the development of secondary arterial hypertension have been identified. In most cases, such arterial hypertension is characterized by high blood pressure, an unfavorable prognosis of the disease, and a high frequency of cardiovascular complications. However, in some forms of it, timely diagnosis and adequate treatment allow to achieve normalization of blood pressure and prevent the development of complications. In cases of the secondary arterial hypertension, in addition to antihypertensive therapy, drug treatment or surgical treatment of the underlying disease that caused hypertension is required. Knowledge of modern diagnostics and principles of treatment of these conditions has to improve the quality of care for patients suffering from hypertension. The purpose of the study was to consider the main clinical, pathogenic, diagnostic and pharmacotherapeutic aspects of the secondary arterial hypertension of endocrine genesis. Secondary endocrine arterial hypertensions develop in diabetes mellitus, hyperaldosteronism primary (Kon's syndrome) and pseudoprimary (idiopathic hyperplasia of the adrenal cortex), Itsenko-Cushing syndrome, pheochromocytoma, pheochromoblastoma, paraganglioma, acromegaly, hypothyroidism, hyperthyroidism, hyperparathyroidism, etc. Each of these diseases has a special etiopathogenesis of arterial hypertension, which makes it necessary to carry out special screening and diagnostic tests in order to prescribe reasonable therapy. In the management of patients with secondary endocrine arterial hypertension, there cannot be universal approaches to the appointment of antihypertensive drugs, instead, an individualized approach contributes to effective control of the disease and prevention of possible complications. Conclusion. So, taking into account the high and progressive incidence of arterial hypertension worldwide, the high frequency of life-threatening complications, a large number of risk factors, constant updating of knowledge on the clinical, pathogenic, diagnostic and pharmacotherapeutic aspects of the management of such patients becomes extremely relevant. A significantly large part of secondary arterial hypertension in the structure of this pathology requires special attention of practicing doctors regarding differential diagnosis, especially in the cohort of young patients. Information about features of the pathogenic therapy of the secondary arterial hypertension of endocrine origin is necessary for a wide range of doctors of various specialties for the maximum effective management of such patients