OBJECTIVE. Assessment of patients with impaired consciousness is a priority task in the department intensive care. The Glasgow Coma Scale (GCS), which includes assessment of motor , speech and ocular reactions, was the first scale developed for this purpose. The absence of versions of the GCS that passed validation research, reduces quality of its application in Russia and other Russian-speaking countries and limits the possibility of obtaining objective clinical results during evaluation patients with reduced level of wakefulness, significantly decreased availability of the scale for scientific and clinical use.

AIM OF STUDY. Rating psychometric parameters of the Glasgow Coma Scale as part of the 2nd stage of the multicenter validation research.

MATERIAL AND METHODS. In a group of 171 patients over 18 years old with different levels decreased wakefulness, as well as in clear consciousness, hospitalized in the department resuscitation and intensive care therapy performed assessment psychometric properties (reliability, validity, sensitivity).

RESULTS. For the Russian version of the GCS received high levels of validity (p<0.0001, Spearman correlation coefficient r=0.91), reliability (p<0.001, coefficient correlations Spearman r=0.88; p<0.0001, Cronbach’s alpha coefficient α=0.78; p<0.001, Cohen’s kappa coefficient κ=0.74) and sensitivity (Wilcoxon test p=0.426 in the main group and Wilcoxon test p=0.782 in the group “without speech function assessment”).

CONCLUSION. In the conducted research demonstrated a sufficient level psychometric properties of the Russian version of the Glasgow Coma Scale, which opens up the possibility of its application in Russia and Russian-speaking countries. The scale is available for downloading on the Validation Group website international scales and questionnaires of the Federal State Budgetary Scientific Institution Scientific Center of Neurology.

INTRODUCTION. The study of the disease, including sudden cardiac death (SCD), as a consistent pathological process makes it possible to discover its mechanisms of formation, progression, and determine methods of prediction and prevention.

AIM OF THE STUDY. To determine the risk of developing SCD in the chain of events of the cardiorenal continuum (CRC) using the example of 7,959 initially healthy workers of locomotive crews of the Trans-Baikal Railway.

MATERIAL AND METHODS. Based on the material of a 6-year observation of a natural group of 7,959 men aged 18–66 years, predictors of microalbuminuria (MAU), creatininemia (CR), reduced glomerular filtration rate (rGFR), retinopathy (RP), and SCD were determined for 22 positions. A 2×2 table and multivariate analysis were used, the relative risk of risk factors (RF) was estimated, and survival analysis was performed, which made it possible to construct a chronic kidney disease (CKD) continuum from the studied prepared symptomatic blocks: MAU, RP, CR, rGFR using the synthesis method, to which the SCD block was added according to this principle. In the Cox proportional hazard model, the hierarchical significance of predictors of SCD, CKD, and the increase in risk when predictors are added to the SCD continuum were determined.

RESULTS. The formation of SCD can occur from a risk factor from any peripheral point of the SCD continuum and depends on the set of risk factors, the proximity of the trigger to the outcome, its independent effect and (or) interaction with other risk factors. The most dangerous predictor of SCD is excessive alcohol consumption (EAC), causing damage to the heart and (or) kidneys, closing the dysfunctional circle of re-entry CRC, forming cardiorenal syndrome and the risk of events in the sequential chain of CRC:

EAC→^+2677%ВСС^+9367%↔^+10491%sGFR^+6660%↔^+3419%CR^+343%↔^+304%RP^+793%↔^+1257%MAU^+1486%←EAC. All other risk factors for SCD and CKD also worsen the condition and bring SCD closer.

CONCLUSION. Further research is needed into the continuum of sudden cardiac death to determine the primary nature of cardiac or renal involvement, the quantitative effects of risk factor damage, their increasing power with prolonged exposure, and the likelihood and timing of sudden cardiac death.

RELEVANCE. Diaphragmatic dysfunction (DD) is common in critically ill patients, and is often the cause of respiratory failure requiring respiratory support. A generally accepted method for noninvasive dynamic evaluation of diaphragm function has not yet been proposed.

the AIM OF STUDY. To develop a method for ultrasound examination of diaphragm mobility and relative thickening, to propose standard parameters of diaphragm excursion and relative thickening depending on gender and age.

MATERIAL AND METHODS. In 81 healthy volunteers aged 25 to 84 years (mean age 55±15 years), we used ultrasound to determine the thickness of the diaphragm on the right and left at the attachment site of the muscular part on end-expiration, tidal and forced inspiration; to calculate the fractional thickening (FT), diaphragm excursion during quiet and maximum inspiration, as well as indices of functional reserve by thickening (IFR(t)) and by diaphragm excursion (IFR(e)). We traced the dependence of the determined parameters on the age, gender, height, body mass index (BMI) and body surface area (BSA) of the subjects. To assess interobserver reproducibility, we calculated the limits of agreement and the intraclass correlation coefficient of the ultrasound parameters of the diaphragm function.

RESULTS. The excursion of the diaphragm in women is smaller than in men, and statistically significantly decreases with age. A direct relationship between the thickness of the diaphragm on exhalation and the BSA was demonstrated. The FT during quiet inspiration on the left slightly but statistically significantly decreases with increasing BMI. The IFR(t) on the right slightly but statistically significantly decreases with age. The lower limits of the reference intervals for IFR(e) and IFR(t) do not depend on the factors considered and are the same for the right and left halves of the diaphragm. Inter-study reproducibility of ultrasound indices of diaphragm function is high: intra-class correlation coefficients for various parameters ranged from 0.81 to 0.96, measurement error according to the results of Bland-Altman analysis was small relative to the measured values.

CONCLUSION. A method for ultrasound examination of diaphragm function is proposed. High inter-study reproducibility of the considered ultrasound parameters was confirmed, reference intervals were proposed. Functional reserve indices do not depend on age, gender and constitutional characteristics of the subjects.

RELEVANCE. Acute coronary syndrome (ACS) is one of the most common cardiovascular diseases associated with increased mortality and disability of patients. Regarding the factor of genetic resistance to antiplatelet therapy, and we get an even more serious problem faced by cardiologists around the world. The study of antiplatelet therapy and resistance to it is a pressing issue in modern cardiology. This is important not only for determining the effectiveness of treatment for each patient, but also for personalizing therapy based on genetic characteristics. This allows improving the effectiveness of treatment and preventing recurrent cardiovascular complications. As a result, the study of antiplatelet therapy and resistance to it is an important aspect in the treatment of ACS. This helps prevent recurrent cardiovascular complications, improve the effectiveness of treatment and develop new methods of therapy.

AIM OF THE STUDY. ST-segment elevation ACS (STEMI) based on a personalized approach to antiplatelet therapy and modification of the program to predict the course and outcome. To study the possibilities of various laboratory diagnostic methods for assessing the platelet component of hemostasis in patients with STEMI depending on (1) the combination of antiplatelet drugs used (aspirin + clopidogrel; aspirin + ticagrelor); (2) the presence of factors of genetic resistance to antiplatelet agents.

MATERIAL AND METHODS. The study included patients with STEMI who underwent percutaneous coronary intervention in the infarct-related artery territory , a total of 46 patients (13 women, 33 men) aged 35 to 83 years, average age 61.7 years. Patients were divided into groups according to the received combination of dual antiplatelet therapy (DAPT) aspirin + clopidogrel (23 patients), aspirin + ticagrelor (23 patients), groups with and without genetic determination (GD ) were assessed. The platelet component of hemostasis was assessed in three different ways: standard coagulogram, aggregometry, rotation thromboelasthometry. The following pharmacogenetic markers were determined in all patients: CYP2C19*17, CYP2C19*2, CYP2C19*3, SLCO1B1 , CYP3A5*3 . LOF alleles were detected in 32 patients (67%). Among them, in the group taking aspirin in combination with clopidogrel, three subgroups of patients were distinguished: 7 patients in the slow metabolizer (SM) subgroup, 8 patients in the general rapid metabolizer subgroup , and 8 patients without LOF alleles were designated as normal metabolizers. In the group taking aspirin in combination with ticagrelor, 9 patients with intermediate metabolism were identified. Seven patients in the SM group. Seven patients without LOF alleles were classified as NM group. The course of the disease and its outcomes were assessed.

RESULTS. Against the background of the use of antiplatelet agents, at research points 2 and 3, the values of the CT-EXTEM parameter statistically significantly increased compared to research point 1 and went beyond the reference values, reflecting drug-induced hypocoagulation of the platelet hemostasis link (66.1±2 and 96.3±14.3 s, respectively, p=0.02). It was especially important that in the group with GR, the CT-EXTEM parameter did not change either by research point 2 or by research point 3, reflecting platelet normal or hypercoagulation.

CONCLUSION. Aggregometry parameters do not allow adequate assessment of the state of the platelet hemostasis link and its response to antiplatelet therapy in patients with acute coronary syndrome with ST segment elevation. Among the studied traditional and viscoelastic hemostatic parameters, the only parameter that should be used to assess the state of the platelet hemostasis link and its response to antiplatelet therapy is the CT-EXTEM test.

The choice of treatment tactics for a patient with burns should be based on individual prediction of injury outcome. Known models for predicting the outcome of burn injury are inaccurate and do not allow us to determine the probability of different outcomes for a particular patient.

AIM OF THE STUDY. To develop a method for individual prediction of the outcome of burn injury based on a mathematical model using the revised Frank index.

MATERIAL AND METHODS. 399 patients: men 283 (71%), women 116 (29%); age — 50 (36; 66) years; total burn area — 25 (15; 40) % TBSA, I–II degree — 20 (10; 30) % TBSA, III degree — 8 (3; 20) % TBSA. In 140 (35%) patients, inhalation injury was detected.

Based on the number of revised Frank Index (RFI) scores (in increments of 10), frequency diagrams of different outcomes were constructed. The mathematical model of individual prognosis is based on a regression equation that was derived from an approximated curve of the proportions of a favorable outcome in the optimal RFI range.

RESULTS. Patient survival probability (%) depending on the number of RFI points was distributed as follows: with RFI<72 — ≥99.9%; for RFI ≥72 ≤189, the probability of survival is calculated using the formula obtained as a result of approximation by a 4th degree polynomial of the curve of the dependence of survival on the number of RFI points: 0.0049x⁴ – 0.1027x³ – 0.1624x² + 2.6794x + 96.54 ; where x= (RFI -35)/10; with RFI>189 — ≤0.1%. The probability of a lethal outcome is determined by subtracting the resulting probability of a survival from 100%.

CONCLUSION. The developed method for predicting the outcomes of a burn injury based on a mathematical model allows us to determine the probability of different outcomes for a particular patient.

Acute adhesive intestinal obstruction (AAIO) is one of the most common pathological conditions, making a significant contribution to the spectrum of urgent surgical diseases. Treatment of such patients consists of conservative therapy and surgical treatment, the indications for which vary within the domestic and foreign recommendations. Existing works in the format of observational cohort studies devoted to the comparative efficacy and safety of various terms of non-surgical treatment of AAIO indicate in favor of long terms of conservative therapy, contributing to an increase in its afficacy without a negative impact on the outcomes of operated patients. However, these studies contain a number of features that limit their external validity, due to which conducting a study in a randomized format seemed justified.

AIM OF THE STUDY. Evaluation of the efficacy and safety of extending the duration of non-surgical treatment of patients with AAIO.

RESEARCH MATERIALS. For the study, 216 patients with AAIO were selected, who, in accordance with the chosen randomization method, were distributed into the main (117 patients) and comparison groups (99 patients). During the implementation of the algorithm of actions, it was possible to achieve non-surgical resolution of AAIO phenomena in 86 patients (73.5%) of the main group, which, although statistically insignificant, exceeded the similar indicator of the comparison group, where successful conservative measures were carried out in 61 patients (61.6%) (χ2=3.48, p=0.06). Such results were probably achieved due to the longer duration of inpatient conservative treatment, which in the main group was 47.1±32.4 versus 16.8±14.2 hours in the comparison group (p<0.001). Comparison of the frequency of resection interventions, postoperative complications and average bed-day did not demonstrate statistically significant differences in all compared parameters.

CONCLUSION. The extension of the duration of conservative therapy from 16.8±14.2 to 47.1±32.4 hours demonstrated a positive trend of increasing the frequency of non-surgical resolution of acute adhesive intestinal obstruction without a negative impact on the immediate outcomes of operated patients.

BACKGROUND. A significant role in the course and outcome of COVID-19, alongside other clinical and laboratory factors, is played by comorbidities.

THE AIM OF THE STUDY. We studied the impact of comorbidities on the course and outcomes of severe COVID-19-associated pneumonia.

MATERIAL AND METHODS. The study was conducted at the Yakut Republican Clinical Hospital. We analyzed treatment outcomes of 450 patients with severe COVID-19-associated pneumonia who were hospitalized in the intensive care unit. An observational case-control study was conducted, in accordance with the research objective, comorbidities were analyzed in detail in two groups of patients: survivors — 144 (32.0%) and deceased — 306 (68.0%). The endpoint of the study was a fatal outcome. The modified Charlson comorbidity index was used to assess the patients’ comorbidity status.

RESULTS. The study revealed the presence of concomitant pathology in 446 (99.1%) patients. 57 (12.7%) patients had two concomitant diseases, 369 (82%) patients had three or more pathologies. A statistically significant impact on the risk of death for the following combinations of comorbid conditions were found: chronic central nervous system diseases with chronic kidney disease; hypertension with chronic kidney disease; coronary heart disease with chronic kidney disease; severe obesity (class III) with coronary heart disease and chronic kidney disease; severe obesity (class III) with type 2 diabetes mellitus. The mortality rate of patients increases linearly with the growth of the Charlson comorbidity index (p<0.001).

CONCLUSION. The obtained data indicate a significant increase in the risk of death in patients with severe COVID-19-associated pneumonia in the presence of comorbidities. Therefore, when predicting the outcome and improving the treatment results of this category of patients, one should take into account the patient’s comorbidity.

The incidence of tandem internal carotid artery (ICA) lesions, according to various sources, is 15–30% of all ischemic strokes (IS) caused by occlusion of a large intracranial artery. However, due to the lack of randomized clinical trials, the optimal revascularization strategy in this cohort of patients remains uncertain and requires further study.

AIM OF THE STUDY. The aim of this study is to investigate the efficacy and safety of different endovascular approaches to the treatment of patients with acute ischemic stroke caused by tandem ICA lesions.

MATERIAL AND METHODS. The study included 94 patients with acute ischemic stroke caused by tandem ICA lesions. After successful intracranial reperfusion (mTICI 2b-3), all patients were divided into two groups. In the study group (48 patients), after achieving successful intracranial reperfusion, patients were implanted with a stent in the area of the lesion of the extracranial ICA with the administration of loading doses of dual antiplatelet therapy. In the comparison group (46 patients), after achieving successful intracranial reperfusion, patients were prescribed optimal drug therapy in accordance with current international recommendations, including antiplatelet therapy (in this group, revascularization of the extracranial ICA was considered after achieving a favorable functional outcome; assessed using the modified Rankin scale 0–2). The statistical program Stattech was used to analyze the obtained data.

RESULTS. The frequency of favorable functional outcome after 90 days (mRs 0–2) in the study and comparison groups were 64.6% and 41.3%, respectively (p=0.024), and there was also a statistically significant difference in the frequency of early patency of the extracranial ICA in the study and comparison groups — 89.6% and 67.4%, respectively (p=0.009). The frequency of symptomatic intracerebral hemorrhage in the groups was comparable: 6.2% and 4.3%, respectively (p=1.000). In the comparison group, death was observed more often, but the difference was not statistically significant — 19.6% and 10.4%, respectively (p=0.255). Patients with early patency of the extracranial ICA statistically significantly more often achieved a favorable functional outcome (p=0.019) and statistically significantly less often died within three months (p=0.032).

CONCLUSION. This study showed that intravascular thromboembolectomy from an occluded large intracranial artery in combination with emergency stenting of the internal carotid artery is the most effective endovascular treatment for patients with acute ischemic stroke caused by its tandem lesion.

The risk of complications of anaesthesia is significantly increased in some circumstances specific to emergency patients with pelvic and lower limb injuries. Therefore, in recent years, anaesthesiologists have given preference to regional anaesthesia in operations on pelvic organs and lower extremities.

AIM OF THE STUDY. Comparative evaluation of the methods of general and regional anaesthesia in operations for pelvic and lower limb injuries.

MATERIAL AND METHODS. The data of 101 patients aged from 21 to 78 years, operated in the early posttraumatic period, were included in the study. In group 1 (27 patients) multicomponent endotracheal anaesthesia was used, patients of group 2 (16 patients) were operated under epidural anaesthesia. Patients of the 3rd group (36 patients) underwent surgical intervention under subarachnoid anaesthesia. Group 4 (22 patients) included patients operated under spinal anaesthesia — bupivacaine combined with morphine hydrochloride in a dose of 0.07–0.08 mg.

RESULTS. The most adequate method of postoperative analgesia was the method used in patients of group 4. A single injection of bupivacaine 10–15 mg in combination with morphine (0.08–0.1 mg/kg) provided rapid-onset, adequate, long-lasting (24–72 hours) analgesia without hemodynamic depression. Respiration and SpO₂ were adequate, patients were in a light sedation (level II) and a state of emotional calm and comfort.

CONCLUSION. Spinal anaesthesia with bupivacaine combined with morphine hydrochloride at a dose of 0.07–0.08 mg is the method of choice of anaesthetic aid in orthopedic trauma surgeries, which provides good analgesia and hemodynamic stability with adequate spontaneous breathing of the patient during surgery.

We have to state with a great regret the fact that armed conflicts do not cease to arise in the modern world. Therefore, life-saving measures are of primary importance, so the prevention of complications in case of gunshot wounds of the pelvis in women deserves special attention.

AIM OF THE STUDY. Determination of prognosis of complications in gunshot wounds of the pelvis in women received in armed conflict.

MATERIAL AND METHODS. The study included 86 women with shrapnel gunshot wounds to the abdominal cavity, which resulted in damage to the internal genital organs. All victims were civilians, their age ranged from 18 to 45 years, the average age was 34±5 years. Taking into account the admission time, all the wounded were divided into two subgroups: the 1st (Group A) included 45 people (52.3%), whose delivery time did not exceed 1.5 hours; the 2nd (Group B) included 41 women (47.7%), the delivery time from the moment of injury exceeded the specified time. Mathematical processing of the results was carried out using descriptive statistics methods.

RESULTS. The conducted study shows that the immediate postoperative period for gunshot wounds of the pelvis in women proceeds more favorably in group A, which is confirmed by both laboratory data and data on the restoration of bowel function. At the same time, any peritonitis is dangerous due to its complications. In our observations, the total number of complications was 26 (30.2%), while in the overwhelming majority of observations (17; 19.7%) they were purulent-septic in nature. In group A, the number of complications was 9 (10.4%), in group B there were 17 (19.7%) complications (r=0.63, p<0.05).

CONCLUSION. Taking into account the fact that the prediction of the development of such a formidable complication as peritonitis and its complications is of great clinical importance, we, using artificial intelligence, analyzed the main indicators influencing the development of complications, which, in turn, made it possible to create two programs: “A system for predicting the likelihood of complications after surgery for patients with peritonitis” and “An Internet service for predicting the likelihood of postoperative complications in patients with peritonitis”, for which patents of the Russian Federation have already been received.

RELEVANCE. In patients suffering from alcohol dependence admitted to hospital with an intercurrent disease, the probability of delirium tremens (DT) is high, so the search for means of its prevention is relevant.

THE AIM OF STUDY. To study the incidence of DT in patients with poisoning by psychopharmacological drugs and corrosive substances, and to evaluate the effectiveness of intestinal lavage as its prevention.

MATERIAL AND METHODS. We conducted a prospective study that followed 287 patients (observation group). Of these, 162 patients had psychopharmacological drug poisoning (PPDP) and 125 patients had corrosive substance poisoning (CSP), who underwent intestinal lavage (IL) for the purpose of detoxification and correction of metabolic disorders.

A retrospective analysis of the examination results of 211 patients with PPDP and 102 with CSP (a total of 313 patients — comparison group) who did not receive IL was conducted. The patients in the groups were comparable in terms of gender, age, and severity of the same poisonings.

The severity of PPDP corresponded to stage 2b, and the severity of CSP corresponded to 2nd-3rd degree chemical burn of the upper gastrointestinal tract, including the stomach. All the patients had metabolic disorders that required correction.

The study endpoints were the incidence of DT, and the duration of treatment in the intensive care unit (ICU).

RESULTS. In the comparison group, DT in PPDP and CSP developed in 57.8% and 56.9%, respectively. In the observation group, with the same nosological forms of poisoning, DT developed in 6.8% and 12% of cases, respectively. The intergroup differences in the incidence of DT in the same types of poisoning were statistically significant (p<0.05; U curve).

The ICU stay of patients with DT in CSP who had previously underwent IL was 10 days shorter than in the comparison group, and in PPDP — 11 days shorter than in the comparison group. This difference was statistically significant (p<0.05; U curve).

CONCLUSION. The obtained results showed the effectiveness of intestinal lavage as a method for preventing delirium tremens in individuals with alcohol dependence. The observed phenomenon of decreased risk of delirium tremens development in patients who underwent intestinal lavage suggests that the pathogenesis of delirium tremens is associated with morphological and functional disorders of the gastrointestinal tract, the key link of which is the excess proliferation of microflora, for the vital activity of which ethanol is necessary. The decreased risk of delirium tremens in the group of patients who underwent intestinal lavage in the complex treatment is obviously associated with the therapeutic mechanisms of the latter — detoxification of the body and correction of homeostasis disorders, including intestinal microbiota, by eliminating ethanol-dependent microflora and its toxins.

FINDINGS. 1. In individuals suffering from alcoholism with poisoning by psychopharmacological drugs and corrosive substances, delirium tremens occurs in 57.8% and 56.9% of cases, respectively.

2. When using intestinal lavage in complex treatment for the same poisonings, the incidence of delirium tremens is 6.8% and 12.0%, respectively, which is 8.5 and 4.7 times less than in case of standard treatment. This difference is statistically significant (p<0.05).

3. The use of intestinal lavage in acute poisoning by psychopharmacological drugs and corrosive substances reduces the stay of patients with delirium tremens in the intensive care unit by 2.6 and 2.7 times, respectively. This difference is statistically significant (p<0.05).

LIMITATIONS OF THE STUDY: age from 28 to 55 years, clinical diagnosis of “Alcohol related disorders” (ICD-10 code F10) in patients with poisoning by psychopharmacological drugs or corrosive substances, intestinal lavage in a volume of at least 12 (9; 15) l.

RELEVANCE. Patients with a systemic reaction to inflammation are often observed after adequate surgical intervention and/or treatment of the underlying disease. Laboratory tests indicate the presence of a pronounced inflammatory process, and instrumental diagnostic methods (ultrasound, computed tomography, radiography) do not always help in detecting the source of inflammation.

THE AIM OF THE STUDY. Is to present the possibilities of radionuclide imaging (RI) using labelled autologous leucocytes to identify the source of infection.

MATERIAL AND METHODS. 95 patients with fever of unknown origin were examined by the radionuclide diagnostic method. The data of computed tomography (CT), ultrasound, radiography (RG), laboratory tests (CRP, PCT, IL-6), the results of morphological examination in comparison with the results of RI were analyzed. Clinical examples are presented.

RESULTS. With the help of RI, foci of inflammation were identified. Based on the data obtained, the treatment was adjusted, which contributed to the recovery of 80 patients. In 15 patients, because of generalized infection, a systemic inflammatory reaction and sepsis developed, leading to a fatal outcome.

CONCLUSION. Radionuclide imaging (RI) using labelled autologous leucocytes in patients with fever of unknown origin allows us to obtain reliable visualization of areas of pathological infiltration and physiological distribution of cells. Based on the data obtained, it is possible to adjust the therapy, which helps increase treatment effectiveness.

Disruption of intestinal homeostasis is a leading factor in the pathogenesis and progression of systemic inflammation in patients with acute severe pancreatitis. The development of systemic complications occurs due to both mesenteric hypoperfusion and dysregulation of intestinal motility, as well as destruction of the intestinal barrier, with translocation of bacterial bodies and their substrates. This increases the risk of developing multiple organ failure and increased mortality. With the advent of high-throughput sequencing methods for microbiome samples, for example, in the 16S rRNA format, the possibilities for studying the structure of microbial communities have expanded significantly. In this regard, there is increasing evidence of the relationship between human health and the microflora inhabiting various parts of the body.

AIM OF THE STUDY. Description of the microbiota composition of the initial sections of the small intestine in patients with severe acute pancreatitis.

MATERIAL AND METHODS. The study included 7 patients with a diagnosis of severe acute pancreatitis (6 men, 1 woman), the average age was 54.1±14.4 years. Patients were divided into two groups. Group 1 (n=4) included patients admitted on the 2nd–4th day from the onset of a pain attack. Group 2 (n=3) included patients admitted no later than 24 hours from the onset of the disease. The bacterial composition of jejunal swab samples was studied using 16S RNA sequencing. The severity of the condition was assessed using the integral APACHE II, SOFA, SAPS II scales. In patients of the main group, APACHE II was score 22±2.83, SOFA was score 6.8±0.5, SAPS II was score 32.9±6.4, in patients of the comparison group, APACHE II was score 18.0±3.7, SOFA was score 4.0±2.6, SAPS II was score 24.4±5.0.

The material was collected at the time of insertion of a sterile multifunctional intestinal catheter behind the Treitz ligament, no later than 6 hours after admission to the intensive care unit. At the time of material collection, the patients did not receive antibacterial therapy or enteral nutrition.

RESULTS. More severe disease was associated with reduced representation of Nesseria species in the microbiome mucosa and parvimonas micra, inhabiting the mucosal layer, as well as Megasphaera micronuciformis. The proportion of the genera Streptococcus (species S. rubneri / parasanguinis / australis) and Actinomyces and a number of genera from the Enterobacteriaceae family in such patients was, on the contrary, higher.

INTRODUCTION. The high incidence of closed liver injuries, general and postoperative mortality dictate the need to find optimal treatment options for those patients.

AIM OF STUDY. To conduct a systematic review of the literature on the comparative evaluation of various treatment options for patients with blunt liver injury.

MATERIAL AND METHODS. A systematic search for non–randomized studies was conducted from 01 October 2015, and randomized studies - without time limits, until December 31, 2023.

RESULTS. There is a clear trend towards non-operative management of hemodynamically stable or stabilized patients, and in case of hemodynamic instability, the use of liver tamponade with angioembolization at the second stage.

CONCLUSION. A larger number of well-planned randomized clinical trials are required to concretize the surgical approach to patients with liver injury.

Intestinal fistulas remain a multidisciplinary, often life-threatening problem of clinical medicine. Such patients in the process of their conservative and surgical stages of treatment remain in a state of systemic metabolic dysfunction for a long time, which is usually accompanied by phenomena of trophological insufficiency of varying severity. In this regard, one of the most important areas of treatment for this category of patients is nutritional-metabolic therapy (NMT), aimed at minimizing the consequences, and, if possible, stopping the catabolic orientation of metabolism, which will help stabilize the trophological status of patients and improve the results of their treatment. NMT of patients with intestinal fistulas still remains a very complex and insufficiently resolved problem that requires further study. This article discusses the features and controversial issues of NMT for this category of patients, as well as a rational choice of nutritional accesses and optimal energy and protein supply when implementing clinical nutrition depending on the anatomical affiliation of the fistula and the degree of its production.

RELEVANCE. Wernicke encephalopathy (WE) is an acute life-threatening neurological disease caused by thiamine deficiency. Vitamin B1 is a coenzyme that is involved in the process of maintaining the integrity of cell membranes, and, consequently, the normal functioning of the nervous system, muscles and heart. The prevalence of WE in the population is 0.4–2.8%. In the absence of timely treatment, WE leads to the development of severe disability, and in 20% of cases — to death.

AIM OF STUDY. Systematization of data on the role of thiamine in the development of Wernicke encephalopathy.

MATERIAL AND METHODS. To achieve this goal, the results of scientific research on WE were analyzed. The literature search was carried out in Scopus, eLibrary, PubMed electronic search engines using the following keywords: Wernicke encephalopathy, thiamine, alcohol abuse, thiamine deficiency. Scientific articles published between 1881 and 2024 were selected for analysis.

RESULTS. The most common cause of WE is chronic alcoholism, which accounts for 50% of all cases. However, there are many other diseases and conditions that can lead to the development of WE. Vitamin B1 deficiency plays an important role in the development of WE.

CONCLUSIONS. Vitamin B1 deficiency can develop as a result of a malfunction at various stages of the metabolic chain, during various pathological processes in the human body. Wernicke encephalopathy occurs not only in people who abuse alcohol, but also in pregnant women, cancer patients, patients with diseases of the gastrointestinal tract, liver and thyroid gland, after bariatric and other abdominal surgeries, as well as in patients on long-term parenteral nutrition. Thiamine deficiency, and, as a consequence, Wernicke encephalopathy, can lead to irreversible brain damage, severe disability and death.

The literature review is devoted to modern principles of acute pain management of traumatic genesis in the practice of emergency medical care. It describes the capability of pain intensity evaluation, and available methods of analgesia and pain relief medication. Special emphasis is laid on current data on inhaled methoxyflurane analgesia.

INTRODUCTION. In the State Budgetary Healthcare Institution N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department (hereinafter referred to as the Institute), the number of visits to the admission and diagnostic departments has more than doubled over the past 15 years. Emergency patients are considered potentially infected, therefore, it is necessary to carry out high-quality and timely disinfection of open surfaces and air. The use of pulsed ultraviolet disinfection technologies is effective and cost-effective.

AIM OF THE STUDY. Evaluation of the microbiological efficiency and economic feasibility of using a portable pulsed ultraviolet unit for disinfecting air and open surfaces during emergency patient reception in conditions of intensive patient flow for the purpose of preventing healthcare-associated infections.

MATERIAL AND METHODS. To disinfect the air and surfaces of the premises, we used the “Alpha-09 portable pulse ultraviolet unit” (hereinafter referred to as the Unit) manufactured by NPP Melitta LLC, Russia.

To conduct the study, three rooms were designated in the admissions department: two experimental rooms and one control room.

Routine wet cleaning of the premises was carried out twice a day, and also as needed. Preventive disinfection of work surfaces was carried out after each patient by wiping with the use of approved products.

The experimental premises were treated according to a single standard algorithm, including treatment with the Installation.

To collect microbiological swabs, sampling points were defined in the studied premises (4 in each). The sampling frequency was three times a week, twice a day. A surface swab collection table was filled in for each of the premises. Surface swab samples were signed accordingly and transferred to the bacteriological laboratory for testing. Surface swabs were collected in accordance with MUK 4.2.2942-11. The species affiliation of microorganisms was confirmed by MALDI-TOF-MS.

The obtained results were processed by standard means of mathematical statistics using R, a free software computing environment. The reliability of differences in numerical values was determined using Student’s t-test, and categorical values were determined using the χ2-test or McNamara test .

To assess the economic efficiency of using pulsed UV devices, methods of economic analysis and investment assessment were used.

RESULTS. 1. An additional 3-fold irradiation of the procedure room with a pulsed ultraviolet installation during an 8-hour shift reduced the number of positive surface swab samples 12-fold; 2-fold irradiation – 5-fold, compared to the standard procedure for processing rooms.

2. Comparison of annual comparable costs of pulsed ultraviolet devices with annual effects from their use showed the economic feasibility of their use.

CONCLUSION. The use of short-term pulsed UV irradiation for disinfection of premises between patient visits is epidemiologically effective and economically feasible.

AIM OF THE STUDY. To study the features of hospital period after pulmonary endarterectomy (PEA) and coronary artery bypass grafting (CABG) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and surgically significant coronary artery (CA) stenosis, and to conduct a comparative analysis with hospital period after PEA in patients with CTEPH without CA lesions.

MATERIAL AND METHODS. An analysis of 141 patients with CTEPH was carried out. The average age is 53.5 (42.7-68.9) years. The 1st group (38 people) consisted of patients with CTEPH and surgically significant CA lesions, the 2nd group (103 people) — without surgically significant CA lesions. An intergroup analysis of clinical and functional data and the course of the early postoperative period was carried out.

RESULTS. According to clinical data, the 1st group of patients with CTEPH was characterized by older age (p=0.003), a larger proportion of patients with concomitant type 2 diabetes (p=0.004), arterial hypertension (p<0.001), atherosclerosis of the brachiocephalic arteries ≤ 50% (p<0.001), a history of myocardial infarction (p=0.008), and a higher comorbidity index (p=0.03) compared to the 2nd group of patients. The early postoperative period was more severe in the 1st group of patients with CTEPH, where a higher proportion of patients with the development of neurological disorders (p=0.02), newly diagnosed atrial fibrillation (p=0.04), and a higher proportion of patients with prolonged artificial ventilation (p=0.03) were identified. No intergroup differences were found in hospital mortality (p=0.74).

CONCLUSIONS. 1. In patients who underwent PEA in combination with myocardial revascularization, the hospital period is characterized by a more severe course in comparison with patients with CTEPH but without coronary artery disease. This is reflected in a higher incidence of neurological disorders, rhythm disturbances, and prolonged mechanical ventilation. 2. In-hospital mortality between the group of patients who underwent combined intervention and isolated PEA did not differ, despite the impact of concomitant pathology.

Arteriovenous malformations are formations consisting of dysplastic, dilated blood vessels in which blood, bypassing the capillary network, enters the venous bed and causes significant expansion of the veins. In addition, arteriovenous malformations can cause nutritional disorders (trophism) of the soft tissues located near them. Extracranial arteriovenous malformations are rare and dangerous vascular anomalies. At present, there are no universal algorithms for their treatment. This article presents the experience of surgical combined treatment of a patient with extracranial arteriovenous malformation. First, staged endovascular occlusion of the formation was performed , and then its complete removal in a hybrid operating room. This approach allowed performing a radical intervention with a positive result.

The article presents a clinical case of treating a 42-year-old patient with acute aortic dissection (type I according to DeBakey classification), who underwent an individual cardiac rehabilitation program in the early postoperative period after surgical treatment in the volume of reconstruction of the thoracic aorta using hybrid technology under conditions of artificial circulation and circulatory arrest. Early rehabilitation after aggressive surgical intervention ensured the most complete restoration of health, psychological status and working capacity of the patient in a minimum period of time.

Tracheostomy is the most frequently performed operation in the intensive care unit. According to some data, the frequency of performance fluctuates within 0.1–0.5 cases per 1000 patients on artificial ventilation. In recent years, dilation techniques for applying a tracheostomy cannula have been actively developed due to their low trauma , the ability to perform the operation at the patient’s bedside, and rapid healing of the tracheostomy wound. Today, the “gold standard” of tracheostomy is puncture-dilation tracheostomy under fiberoptic bronchoscopic guidance.

This method has its drawbacks, which is confirmed by a large number of complications. Thus, one of the complications of tracheostomy that is difficult to correct is the “gas” syndrome, which includes pneumomediastinum, subcutaneous emphysema and pneumothorax. These complications are considered to be a consequence of damage to the posterior wall of the trachea. Our clinical example demonstrates another mechanism for the development of the above complications.

We present a clinical example of the development of subcutaneous emphysema, pneumomediastinum and pneumothorax without damage to the posterior wall of the trachea.

This article discusses some of the considerations in planning a revision total knee arthroplasty (RTKA). Total knee arthroplasty (TKA) involves replacing all parts of the knee joint to restore functionality and function. TKA is one of the most common and reliable surgical treatments for knee disorders. However, some patients require revision total knee arthroplasty (RTKA) after TKA for a variety of reasons, including mechanical wear, implant loosening, subsidence, infection, instability, periprosthetic fracture, and stiffness. Unfortunately, the overall outcome of RTKA is not as satisfactory as that of primary TKA due to many factors, including success rates and risk factors. Our approach to improving RTKA outcomes includes the use of linked, rotating-hinge revision prostheses, as well as the treatment of patients with metaphyseal bone loss. In preoperative planning of RTKA, we use the classification of bone defects, options for restoring the joint line, which allows for individual selection of the type (kind) and components of a modular revision endoprosthesis. A clinical example also allows for substantiation of the choice of the type (kind) of endoprosthesis, namely a revision endoprosthesis with a rotating hinge.