Treatment Of Hospitalized Patients Research Articles

Factors Associated with Length of Hospitalization in Patients with Diabetes and Mild COVID-19: Experiences from a Tertiary University Center in Serbia.

Background and Objectives: During the COVID-19 pandemic, there was an increased number of hospitalized COVID-19-positive patients suffering from type 2 diabetes mellitus (T2DM). The objective of this research study was to explore factors associated with the length of hospitalization of patients with T2DM and the mild form of COVID-19. Material and Methods: This retrospective cohort study involved all patients who tested positive for COVID-19 and those who were treated in the dedicated COVID-19 department of the University Clinical Center (UCC) in Nis between 10 September 2021 and 31 December 2021. Upon admission, patients underwent blood tests for biochemical analysis, including blood count, kidney and liver function parameters (C-reactive protein (CRP), creatinine kinase, and D-dimer), and glycemia and HbA1c assessments. Additionally, all patients underwent lung radiography. Univariate and multivariate regression analyses were employed to assess the impact of specific factors on the length of hospitalization among patients with T2DM. Results: Out of a total of 549 treated COVID-19-positive patients, 124 (21.0%) had T2DM, while 470 (79.0%) did not have diabetes. Among patients with T2DM, men were significantly younger than women (60.6 ± 16.8 vs. 64.2 ± 15.3, p < 0.01). The average hospitalization length of patients with diabetes was 20.2 ± 9.6 (5 to 54 days), and it was significantly longer than for patients without diabetes, at 15.0 ± 3.4, which ranged from 3 days to 39 (t-test ≈ 5.86, p < 0.05). According to the results of the univariate regression analysis, each year of age is associated with an increase in the length of hospital stay of 0.06 days (95% CI: 0.024 to 0.128, p = 0.004). Patients who received oxygen therapy were treated for 2.8 days longer than those who did not receive oxygen treatment (95% CI: 0.687 to 4988, p = 0.010), and each one-unit increase in CRP level was associated with a 0.02-day reduction in the length of hospitalization (95% CI: 0.004 to 0.029, p = 0.008). Based on the results of the multivariate regression analysis, each year of age is associated with an increase in the length of hospitalization by 0.07 days (95% CI: 0.022 to 0.110, p = 0.003). Patients who received oxygen therapy were treated for 3.2 days longer than those who did not receive oxygen therapy (95% CI: 0.653 to 5726, p = 0.014), and each unit increase in CRP level was associated with a 0.02-day reduction in the length of hospitalization (95% CI: 0.005 to 0.028, p = 0.004). Conclusions: Based on the presented results, COVID-19-positive patients with diabetes had, on average, longer hospitalizations than COVID-19 patients without diabetes. The hospital treatment of patients with T2DM and a milder form of COVID-19 was associated with older age, the use of oxygen therapy, and elevated CRP values. Patients who received oxygen therapy were treated approximately 3 days longer than those who did not receive this therapy.

Few negative effects of psychotherapy in a psychiatric day hospital: a follow-up survey to a multiprofessional treatment with acceptance and commitment therapy.

While there are many studies on psychotherapy and its efficacy - in terms of desired outcomes - there is comparatively little evidence on the possible negative effects of psychotherapy. The aim of this study was to investigate the possible negative effects of a multi-professional psychiatric day hospital treatment for patients with mental health disorders based on Acceptance and Commitment Therapy (ACT), including possible confounding factors. Fifty-one patients with a range of psychiatric diagnoses were assessed three months after an ACT-based psychiatric day hospital treatment. Questionnaires were used to measure negative effects of psychotherapy (INEP), subjective quality of life (WHOQOL-BREF), and symptomatology (BDI-II and SCL-90-R). Correlational analyses and group comparisons were performed to determine the relationship between the sum of reported negative effects on the one hand and symptomology, quality of life, and sociodemographic variables (gender, age, diagnosis, education) on the other hand. At least one negative effect out of a list of 18 possible effects was reported by 45% of participants, and 10% reported more than two. The number of negative effects reported correlates positively with symptomology and negatively with quality of life. The sum of reported negative effects does not correlate with age or gender and does not vary by education level and primary diagnosis. In the light of previous findings, patients included in this study showed lower rates of negative effects, both overall and at item level. Practical implications of these findings are discussed.

Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trial

Addition of macrolide antibiotics to β-lactam antibiotics for the treatment of patients in hospital with community-acquired pneumonia is based on results from observational studies and meta-analyses rather than randomised clinical trials. We investigated if addition of the macrolide clarithromycin to treatment with a β-lactam antibiotic in this population could improve early clinical response-the new regulatory endpoint for community-acquired pneumonia-and explored the possible contribution of modulation of the inflammatory host response to that outcome. The ACCESS trial was a phase 3 prospective, double-blind, randomised controlled trial, in which adults in hospital with community-acquired pneumonia who had systemic inflammatory response syndrome, Sequential Organ Failure Assessment (SOFA) score of 2 or more, and procalcitonin 0·25 ng/mL or more were enrolled in 18 internal medicine departments of public Greek hospitals. Patients were randomly assigned (1:1) by computer-generated block randomisation to standard of care medication (including intravenous administration of a third-generation cephalosporin or intravenous administration of β-lactam plus β-lactamase inhibitor combination) plus either oral placebo or oral clarithromycin 500 mg twice daily for 7 days. Investigators, staff, and patients were masked to group allocation. The primary composite endpoint required that patients fulfilled both of the following conditions after 72 hours (ie, day 4 of treatment): (1) decrease in respiratory symptom severity score of 50% or more as an indicator of early clinical response and (2) decrease in SOFA score of at least 30% or favourable procalcitonin kinetics (defined as ≥80% decrease from baseline or procalcitonin <0·25 ng/mL), or both, as an indicator of early inflammatory response. Participants who were randomly assigned and received allocated treatment were included in the primary analysis population. This trial is complete and is registered with the EU Clinical Trials Register (2020-004452-15) and ClinicalTrials.gov (NCT04724044). Patients were enrolled between Jan 25, 2021, and April 11, 2023, and 278 individuals were randomly allocated to receive standard of care in combination with either clarithromycin (n=139) or placebo (n=139). 134 patients in the clarithromycin group (five withdrew consent) and 133 patients in the placebo group (six withdrew consent) were included in the analysis of the primary endpoint. The primary endpoint was met in 91 (68%) patients in the clarithromycin group and 51 (38%) patients in the placebo group (difference 29·6% [95% CI 17·7-40·3]; odds ratio [OR] 3·40 [95% CI 2·06-5·63]; p<0·0001). Serious treatment-emergent adverse events (TEAEs) occurred in 58 (43%) patients in the clarithromycin group and 70 (53%) patients in the placebo group (difference 9·4% [95% CI -2·6 to 20·9]; OR 0·67 [95% CI 0·42 to 1·11]; p=0·14). None of the serious TEAEs was judged to be related to treatment assignment. Addition of clarithromycin to standard of care enhances early clinical response and attenuates the inflammatory burden of community-acquired pneumonia. The mechanism of benefit is associated with changes in the immune response. These findings suggest the importance of adding clarithromycin to β-lactams for treatment of patients in hospital with community-acquired pneumonia to achieve early clinical response and early decrease of the inflammatory burden. Hellenic Institute for the Study of Sepsis and Abbott Products Operations.

Analysis of growth differentiation factor-15 at the hospital stage of treatment of patients with acute myocardial infarction

Objective: to dynamically study the clinical characteristics, the level of growth differentiation factor 15 (GDF-15) during hospital treatment in patients with acute ST-segment elevation myocardial infarction (STEMI). Materials and methods: an analysis of clinical and laboratory data of STEMI patients during hospital treatment and echocardiography parameters was carried out. Scores were calculated on the GRACE scale to assess the prognosis of in-hospital mortality of patients. The characteristics of patients with STEMI were identified taking into account GDF-15 values. Statistical processing using the statistical software package "Statistica 10.0 for Windows". Results: clinical and laboratory characteristics of STEMI patients on the first day of the disease determined the prognosis. GDF-15 values increased on the first day of STEMI development and depended on the risk of in-hospital mortality on the GRACE scale. GDF-15 values tended to decrease during the inpatient phase of treatment. Patients with STEMI with a GDF-15 concentration equal to or more than 1200 ng/ml did not reach reference values in the dynamics of hospital treatment and had higher values of markers of myocardial necrosis, reflecting the impact on the prognosis. Conclusion: the GDF-15 indicator can be used as a marker for the prognosis of STEMI in combination with the GRACE scale assessment. High GDF-15 values during the hospital phase of patient treatment reflect the prognosis of STEMI patients.

Two-year outcomes in patients after hospitalization for COVID-19: data from the TARGET-VIP registry

Aim. To evaluate 24-month outcomes after hospital treatment of patients with coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. Two-year outcomes (2,2±0,5) after hospital treatment for COVID-19 were analyzed in 802 patients (mean age, 59,8±14,5 years, men, 51,0%). We assessed cases of death, non-fatal myocardial infarction (MI) and stroke, revascularization operations, hospitalizations, recurrent COVID-19, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Results. During the follow-up period, 49 (5,9%) patients died, while 7 (0,8%) patients had MI, 7 (0,8%) — stroke. In addition, 222 (26,7%) patients were hospitalized, of which 26 (3,1%) for COVID-19. Recurrent COVID-19 were revealed in 146 (17,6%) patients, while 414 (49,6%) patients were vaccinated for SARS-CoV-2. The factors of age and stay in the intensive care unit were significantly associated (p&lt;0,001) with the risk of all-cause death (hazard ratio (HR)=1,083 per 1 year of life and HR=6,28, respectively) and composite endpoint (death, non-fatal myocardial infarction, stroke, revascularization surgery): HR=1,057 and HR=3,28, respectively. Male sex was associated with the death risk (HR=2,50, p=0,003). Of the 49 deaths, 19 (38,8%) occurred in the first 3 months, and 35 (71,4%) in the first year of follow-up. A lower (1,8 times) incidence of new cases of cardiovascular (CVD) diseases and non- CVDs were associated with initial cardiovascular pathology. Hospitalization was associated with age (odds ratio (OR)=1,027; p&lt;0,001) and CVDs (OR=1,66; p=0,01). The risk of recurrent COVID-19 was higher with CVDs (OR=1,55; p=0,03), lower — among those vaccinated for SARS-CoV-2 (OR=0,49; p&lt;0,001).Conclusion. Over two-year follow-up of patients after hospital treatment for COVID-19, the proportion of deaths was 5,9%: &gt;1/3 of deaths recorded in the first 3 months and &gt;2/3 during the first year. Factors associated with death were age, male sex, and intensive care unit treatment during the hospitalization. The readmission rate was associated with older age and CVDs. The risk of repeated cases of COVID-19 was one and a half times higher in the presence of CVDs, but 2 times lower in those vaccinated for SARS-CoV-2 in the post- COVID-19 period.

Exploring automatic text-to-sign translation in a healthcare setting

Communication between healthcare professionals and deaf patients has been particularly challenging during the COVID-19 pandemic. We have explored the possibility to automatically translate phrases that are frequently used in the diagnosis and treatment of hospital patients, in particular phrases related to COVID-19, from Dutch or English to Dutch Sign Language (NGT). The prototype system we developed displays translations either by means of pre-recorded videos featuring a deaf human signer (for a limited number of sentences) or by means of animations featuring a computer-generated signing avatar (for a larger, though still restricted number of sentences). We evaluated the comprehensibility of the signing avatar, as compared to the human signer. We found that, while individual signs are recognized correctly when signed by the avatar almost as frequently as when signed by a human, sentence comprehension rates and clarity scores for the avatar are substantially lower than for the human signer. We identify a number of concrete limitations of the JASigning avatar engine that underlies our system. Namely, the engine currently does not offer sufficient control over mouth shapes, the relative speed and intensity of signs in a sentence (prosody), and transitions between signs. These limitations need to be overcome in future work for the engine to become usable in practice.

Comparative Evaluation of the Effectiveness of Atraumatic Dressings &#x0D; for the Treatment of Patients with Burns

Rationale. Atraumatic mesh bandages are most commonly used bandages for treatment of wounds and burns. To date, considerable experience has been gained in the use of Branolind N bandages in clinical practice in treatment of burn wounds.Aim. Comparative evaluation of the results of the use of various atraumatic dressings and evaluation of the effectiveness of the Branolind N bandage in treatment of patients with burns. Materials and Methods. In 222 patients with burns, the comparative clinical and laboratory evaluation of effectiveness of various atraumatic dressings (180 patients) and cotton-gauze dressings with hydrophilic-based ointment Levomekol (42 patients), in various clinical situations, was carried out.Results. All types of atraumatic dressings had similar clinical effectiveness and were most effective for treatment of superficial and borderline burns of I-II degree, as well as for limited burns of II-III degree after surgical necrectomy at the stage preparation of granulating wounds for skin grafting, starting from the second, and especially in the third stage of wound process. The best results were obtained with the use of Branolind N bandages. Conclusions. The use of atraumatic "mesh" bandages Branolind N allows to improve the results of medical care for patients with burns. Their use contributes to a favorable course of wound process, provides comfort to patients and convenience for work of medical staff in treatment of patients in hospital, and on outpatient basis.

Эпидемиология верхнечелюстного одонтогенного синусита и принципы лечения пациентов в стационарных условиях

Целью настоящего исследования было изучение частоты встречаемости одонтогенного синусита в практике врача – стоматолога-хирурга, тактики и принципов лечения пациентов в стационарных условиях. В статье приведены результаты ретроспективного эпидемиологического анализа (РЭА) заболеваемости (инцидентности) по данным историй болезни (70 историй болезни стационарных больных) и журналов записи оперативных вмешательств отделения челюстно-лицевой хирургии ОБУЗ «Ивановская областная клиническая больница» г. Иваново с 2017 по 2020 год, а также приведено сравнение настоящего исследования с современными литературными данными. Частота встречаемости верхнечелюстного одонтогенногосинусита изучена по выявленным признакам-критериям (диагноз, причинные зубы, пол, возраст, срок госпитализации, сезонность и метод лечения). В результате исследования установлено, что к развитию воспалительного поражения верхнечелюстной пазухи одонтогенной этиологии чаще всего приводит некачественное эндодонтическое лечение зубов верхней челюсти. The purpose of this study was to study the frequency of occurrence of odontogenic sinusitis in the practice of a dentist-surgeon, tactics and principles of treatment of patients in a hospital. The article presents the results of a retrospective epidemiological analysis (REA) of morbidity (incidence) according to diseases card (70 case diseases card of inpatients) and journals of records of surgical interventions of the Department of Maxillofacial Surgery of the Ivanovo Regional Clinical Hospital, Ivanovo, from 2017 to 2020. The present study is compared with modern literature data. The frequency of occurrence of maxillary odontogenic sinusitis was studied according to the identified signs-criteria (diagnosis, causative teeth, gender, age, hospitalization period, seasonality and method of treatment). As a result of the study, it was found that the poor-quality endodontic treatment of the teeth of the upper jaw most often leads to development of an inflammatory lesion of the maxillary sinus of odontogenic etiology.

Ways of spread, detection, clinical course of syphilis and leprosy among the population of the north-eastern districts of Eastern Siberia in the 19th century

BACKGROUND: In the 19th century, the process of annexation of lands in the north-east of the Russian Empire was completed. The influx of newcomers, political exile, criminal hard labor created the prerequisites for an aggravation of the epidemiological situation in the newly annexed territories. The morbidity of the population began to acquire an epidemic character. Syphilis, which spread in the 19th century, leprosy struck foreign communities in the northern and eastern regions of the Pacific Ocean, the Sea of Okhotsk, the Kamchatka Peninsula and the alien population from other territories.&#x0D; AIM: Systematize, as well as identify certain trends in the prevalence and forms of manifestation of syphilis and leprosy among the population of the north-eastern districts of Eastern Siberia of the 19th century. according to the reporting materials of doctors and authorities of that time. Let us explain: in this article, the authors quote from the documents, preserving (if possible) the style and punctuation of the originals, and also use geographical names and names of territories adopted in the Russian Empire in the 19th century.&#x0D; MATERIALS AND METHODS: On the basis of archival materials, the article discusses the ways of importation and spread of syphilis among representatives of individual foreign communities, the clinical course and forms of manifestation. The multiplicity of ways of penetration of syphilis to the outskirts of Eastern Siberia is noted. The reports of seconded staff physicians, doctors, paramedics during the examination of the population and the treatment of patients in hospitals provide the first statistical information on the incidence of men, women, their nationality, and the outcome of treatment. The reports of seconded staff physicians, doctors, paramedics during the examination of the population and the treatment of patients in hospitals provide the first statistical information on the incidence of men, women, their nationality, and the outcome of treatment.&#x0D; RESULTS: The article highlights the issues of studying the role of factors contributing to a high level of the spread of syphilis and leprosy among inorodtsy (indigenous dwellers), describes the symptoms of manifestation, and especially chronic syphilis, and notes the role of unsanitary living conditions and household arrangements in the spread of diseases.&#x0D; CONCLUSIONS: Observation of the clinical manifestations of syphilis allowed doctors to isolate leprosy as an independent form of the disease, and to investigate its causes. These observations were the basis for the development of measures aimed at stopping the spread of the disease among the population. The beginning of the emergence of medical and police supervision aimed at identifying patients, registering them and treating them is noted.

Effects of hospitalist co-management on rate of initiation of osteoporosis treatment in patients with vertebral compression fractures: Retrospective cohort study

BackgroundVertebral compression fractures are common in elderly people and most are due to osteoporosis. Osteoporosis treatment is effective for secondary prophylaxis, so initiation is recommended. Despite the clear benefits, the rate of initiation of osteoporosis treatment is very low. It is reported to be due to several factors including insufficient systems-based approaches for hospitals and post-acute care. Hospitalists, who are physicians dedicated to the treatment of patients in hospital and whose activity is generalist rather than specialized, are reported to be associated with higher-quality inpatient care because of, among other things, closer adherence to guidelines. Co-management by hospitalists for patients with vertebral compression fractures has potential benefits towards improving the outcomes. We compared the rate of initiation of osteoporosis treatment for patients with vertebral compression fractures between conventional orthopedic surgeon-led care (conventional group) and hospitalist co-management care (co-management group). MethodsThis is a single-center retrospective cohort study to evaluate the rate of initiation of osteoporosis treatment and reasons for non-initiation of osteoporosis treatment. Other clinical indicators were also evaluated, including length of hospital stay, preventable complications during hospitalization, and rate of 30-day readmission. ResultsWe identified 55 patients in the conventional group and 93 patients in the co-management group. The rate of initiation of osteoporosis treatment was higher in the co-management group (45.2% vs. 3.6%, OR 21.5; 95%CI 5.12–192.0; P < 0.01). Most of the patients with non-initiation in the co-management group had reasons for it described in the medical records, but in the conventional group the reasons were unknown. There was no significant difference in length of hospital stay, preventable complications during hospitalization, or 30-day readmission between the groups. ConclusionsHospitalist co-management of patients with vertebral compression fractures showed significantly higher rate of initiation of osteoporosis treatment than conventional orthopedic surgeon-led care.

Interdisciplinary collaboration in the treatment of alcohol use disorders in a general hospital department: a mixed-method study

BackgroundInterdisciplinary collaborations (i.e., where various disciplines work coordinated and interdependently toward shared goals) are stated to yield higher team effectiveness than multidisciplinary approaches (i.e., where various disciplines work in parallel within their professional boundaries) in somatic health care settings. Nevertheless, research is lacking on interdisciplinary approaches for alcohol use disorder (AUD) treatment of hospitalized patients as these types of approaches are still uncommon. This study aims to evaluate an innovative interdisciplinary AUD treatment initiative at a general hospital department by 1) identifying which and to what extent network partners are involved and 2) to explore how network partners experienced the interdisciplinary collaboration.MethodsA mixed-method study was conducted, using 1) measures of contact frequency and closeness in a social network analysis and 2) semi-structured interviews, which were analyzed thematically. Respondents were network partners of an interdisciplinary collaboration in a general hospital department, initially recruited by the collaborations’ project leader.ResultsThe social network analysis identified 16 network partners, including a ‘core’ network with five central network partners from both inside and outside the hospital. The project leader played an important central role in the network and the resident gastroenterologist seemed to have a vulnerable connection within the network. Closeness between network partners was experienced regardless of frequency of contact, although this was especially true for the ‘core’ group that (almost) always consisted of the same network partners that were present at biweekly meetings. Interview data showed that presence of the ‘core’ network partners was reported crucial for an efficient collaboration. Respondents desired knowledge about the collaborations’ effectiveness, and one structured protocol with working procedures, division of responsibilities and agreements on information sharing and feedback.ConclusionsThe design of this interdisciplinary collaboration has potential in improving the treatment of hospital patients with AUD and was evaluated positively by the involved network partners. Interdisciplinary collaborations may offer a critical solution to increase treatment rates of patients with AUD and should be adopted in hospitals on a larger scale. Research towards the effectiveness of interdisciplinary collaborations in the treatment of hospitalized patients with AUD is needed.

Patient with Jaundice, Dyspnea and Hyperferritinemia after COVID-19

The aim: to highlight the importance of considering hemophagocytic lymphohistiocytosis in patients with jaundice of unclear origin and systemic inflammatory manifestations after coronavirus infection.Key points. A 64-y.o. patient was admitted to the hospital with jaundice, pruritus, fatigue, weight loss. The complaints occurred 2 weeks after discharge from the hospital for treatment of patients with coronavirus infection. Laboratory tests revealed signs of hepatic insufficiency, markers of cholestasis and inflammation persisted in time. Upon instrumental examination no signs of hepatosplenomegaly, biliary tree changes, intra- and extrahepatic obstruction were found. S. aureus was identified in blood cultures, CT scan of the facial skull bones showcased the focus of infection in the area of the roots of teeth 2.4 and 2.5. Therefore, antibiotics were prescribed. Subsequently, the patient's condition was complicated by the development of two episodes of acute respiratory distress syndrome, which occurred during the withdrawal of glucocorticosteroid therapy. Liver biopsy was performed, morphological study revealed signs of “vanishing bile duct” syndrome, excessive activation of macrophages and hemosiderosis of sinusoidal cells. Identified lesions can be found in hemophagocytic lymphohistiocytosis (HLH), a life-threatening complication of coronavirus infection. Glucocorticosteroids therapy, transfusions of human immunoglobulin, albumin, and parenteral nutrition have led to patient's condition improvement.Conclusion. COVID-19 provokes the development of secondary HLH 10 times more often than other respiratory viral infections. The possibility of hemophagocytic syndrome development should be considered, including cases of overlap syndrome with sepsis, in patients with unresolved jaundice, hyperferritinemia after coronavirus infection. Routinely used scales and criteria for diagnosis of HLH (H-score, HLH 2004) in such cases lacks sensitivity, therefore, careful analysis of clinical picture and exclusion of other causes of jaundice are required.

Predicting Readmission Following Hospital Treatment for Patients with Alcohol Related Diagnoses in an Australian Regional Health District.

This study aims to investigate the prediction of hospital readmission of alcohol use disorder patients within 28 days of discharge and compare the performance of six machine learning methods i.e., random forest (RF), logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM.

Comprehensive Diagnostic Medical System Based on Notch1 Signaling Pathway to Inhibit the Growth of Small-Cell Lung Carcinoma.

With the gradual application of big data and other technologies to the medical field, more and more people tend to get online medical services. This article mainly studies the comprehensive diagnostic medical system based on Notch1 signaling pathway to inhibit the growth of small-cell lung carcinoma. In the experiment, we used the rapid thawing method to recover the cells and took the logarithmic growth phase cells for cell passage. We calculated the cell concentration and diluted the cells according to the experimental requirements. According to the standard curve, the corresponding sample protein concentration was calculated; at the same time, the Trizol method was used to extract the total RNA, the NanoDrop8000 spectrophotometer was used to determine the RNA concentration, and the RNA quality was detected by agarose gel electrophoresis. We used immunohistochemical staining to complete the staining of lung cancer cells. Finally, black box testing was used to test the functional modules of the system. Experimental data show that the accuracy rate of data obtained by the system reaches 98%, which greatly facilitates doctors and patients. The results show that the system has good ease of use and reliability and improves the diagnosis and treatment of hospital patients.

Errors and complications in the treatment of patients with primary tumors of the lower limb long bones by the Ilizarov method

Based on the analysis of the treatment results of 133 patients with primary tumors of the lower limb long tubular bones, we describe the errors and complications of the Ilizarov method. We identified and analyzed the main groups of errors (organizational, tactical, and technical) and studied the treatment complications associated with them. These complications are not accompanied by significant anatomical and functional disorders, in the vast majority are treated by conservative measures and do not lead to the necessity to stop osteosynthesis. Systematization of errors and related complications determines a set of therapeutic and preventive measures for their prevention, while providing a more effective and high-quality rehabilitation of patients, reducing the time of hospital treatment of patients with tumor pathology of the long tubular bones.

In adults hospitalized with COVID-19, adding remdesivir to standard care did not reduce in-hospital mortality.

Ali K, Azher T, Baqi M, et al. Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial. CMAJ. 2022;194:E242-51. 35045989.

Long-term outcomes in patients after COVID-19: data from the TARGET-VIP registry

Aim. To assess long-term outcomes within 12 months after hospital treatment of patients with coronavirus disease 2019 (COVID-19) as part of a prospective registry.Material and methods. Outcomes in the posthospital period were assessed in 827 patients diagnosed with COVID-19 (age, 58,0±14,8 years; men, 51,3%). For periods of 30-60 days, 6 and 12 months after discharge from the hospital, cases of death, nonfatal myocardial infarction (MI) and stroke, hospitalization, acute respiratory viral infections/influenza were assessed. The follow-up period was 13,0±1,5 months.Results. During the follow-up period, 35 (4,2%) patients died, 6 (0,73%) and 4 (0,48%) cases of MI and stroke were registered. In addition, 142 (17%) patients were hospitalized, while 217 (26,2%) patients had acute respiratory viral infections/ influenza. Factors of age and length of intensive care unit stay were significantly associated (p&lt;0,001) with the risk of all-cause death (hazard ratio (HR)=1,085 per 1 year of life and HR=6,98, respectively), with the risk of composite endpoint (death, non-fatal MI and stroke): HR=1,081 per 1 year of life and HP=4,47. Of the 35 deaths, 11 (31%) were within the first 30 days of follow-up, and 19 (54%) — 90 days after discharge from the hospital. A higher probability of hospitalization was associated with older age (odds ratio (OR)=1,038; p&lt;0,001), while a higher probability of acute respiratory viral infections/influenza was associated with younger age (OR=0,976 per 1 year of life; p&lt;0,001) and female sex (OR=1,414; p=0,03).Conclusion. A prospective follow-up of 827 patients in the TARGET-VIP registry revealed that 12-month mortality was 4,2%, while more than half of the deaths (54%) were registered in the first 90 days, including 31% — for the first month after discharge from the hospital. The most common events were hospitalizations (17,0%) and acute respiratory viral infections/influenza (26,2%), while the rarest were myocardial infarction (0,73%) and stroke (0,48%). The key factors associated with 12-month mortality in the post-COVID-19 period were older age and intensive care unit stay during the reference hospitalization. A higher readmission rate during the follow-up period was associated with older age, and the prevalence of acute respiratory viral infections /influenza during the follow-up period was associated with younger patients and female sex.

Синтетичні каннабіноїди спайс: актуальні питання клінічної діагностики та екстреної медичної допомоги

Поширення за останні роки практики вживання трав’яних сумішей для паління (так званих спайс) призвело до виникнення в Україні численних отруєнь із смертельними наслідками. Новий різновид психоактивних речовин створив для лікарів суттєві труднощі в проведенні клінічної і лабораторної діагностики та лікуванні постраждалих. Клінічна картина гострого отруєння при вживанні продуктів спайс значно відрізняється від типових симптомів отруєнь героїном і марихуаною, а хімічний склад продуктів постійно змінюється, що практично унеможливлює їх своєчасне визначення в біологічних рідинах. Основними патологічними синдромами, що спостерігаються при отруєнні сумішами спайс, є синдроми збудження, пригнічення, галюцинаторний і змішаний. У випадках отруєння тяжкого ступеня пацієнти госпіталізуються до відділення інтенсивної терапії у тяжкому стані. Типовими проявами смертельно небезпечного отруєння є токсична кома, набряк мозку, судоми, дихальна та серцево-судинна недостатність. Клінічні прояви залежать від композиції токсичних речовин у кожній окремій партії продукту спайс. Це пояснює той факт, що пацієнти протягом декількох діб потрапляють до токсикологічного відділення зі схожою симптоматикою. Сьогодні у вітчизняній і зарубіжній літературі недостатньо систематизованих даних про клінічні прояви отруєнь, диференційну діагностику та лікування невідкладних станів, що обумовлені новими наркотичними засобами. Стаття являє собою спробу короткого огляду практичних питань з клінічної і диференційної діагностики та невідкладного лікування хворих в умовах стаціонару.

Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial.

Background:The role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems.Methods:We performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard care alone. The primary outcome was in-hospital mortality. Secondary outcomes included changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates. We performed a priori subgroup analyses according to duration of symptoms before enrolment, age, sex and severity of symptoms on presentation.Results:Across 52 Canadian hospitals, we randomized 1282 patients between Aug. 14, 2020, and Apr. 1, 2021, to remdesivir (n = 634) or standard of care (n = 648). Of these, 15 withdrew consent or were still in hospital, for a total sample of 1267 patients. Among patients assigned to receive remdesivir, in-hospital mortality was 18.7%, compared with 22.6% in the standard-of-care arm (relative risk [RR] 0.83 (95% confidence interval [CI] 0.67 to 1.03), and 60-day mortality was 24.8% and 28.2%, respectively (95% CI 0.72 to 1.07). For patients not mechanically ventilated at baseline, the need for mechanical ventilation was 8.0% in those assigned remdesivir, and 15.0% in those receiving standard of care (RR 0.53, 95% CI 0.38 to 0.75). Mean oxygen-free and ventilator-free days at day 28 were 15.9 (± standard deviation [SD] 10.5) and 21.4 (± SD 11.3) in those receiving remdesivir and 14.2 (± SD 11) and 19.5 (± SD 12.3) in those receiving standard of care (p = 0.006 and 0.007, respectively). There was no difference in safety events of new dialysis, change in creatinine, or new hepatic dysfunction between the 2 groups.Interpretation:Remdesivir, when compared with standard of care, has a modest but significant effect on outcomes important to patients and health systems, such as the need for mechanical ventilation. Trial registration: ClinicalTrials.gov, no. NCT04330690.

Черепно-мозкова травма: інтенсивна терапія, моніторинг, порогові значення цільових показників

У статті подано основні принципи інтенсивної терапії, моніторингу та порогових значень внутрішньочерепного тиску, церебрального перфузійного тиску, розширеного церебрального моніторингу при тяжкій черепно-мозковій травмі, що базуються на основі останніх рекомендацій «Керівництва з лікування тяжкої черепно-мозкової травми — 2016», в умовах реанімаційного відділення стаціонару.