Introduction. Inflammation is one of the leading components in the pathogenesis of acute lower limb ischemia (ALLI). Interleukin-18 (IL-18), a pleiotropic proinflammatory cytokine that regulates innate and adaptive immune responses, plays a significant role in the development of chronic inflammation in atherosclerosis, creating the prerequisites for the development of ALLI. Increased IL-18 production causes autoinflammation, destabilization of atherosclerotic plaques, development of thrombosis and ALLI. Objective. To study the contribution of interleukin-18 during ALLI, its relationship with markers of inflammation, lipid metabolism, tissue destruction and endothelial dysfunction. Materials and Methods. 71 patients with ALLI and basic therapy aged 70 (60; 83) years and 15 patients aged 75 (77; 88) years with vasaprostan therapy were examined in the Department of Vascular Surgery of the I. I. Dzhanelidze Research Institute of Emergency Care. The comparison group consisted of volunteers of the same age. On admission to the department before surgery, on days 1 and 10 after reconstructive surgery the following blood levels were examined: cytokines IL-6, IL-10, IL-18, C-reactive protein; tissue damage factors (creatine kinase, myoglobin) and endothelial dysfunction factor (homocysteine), glucose, total protein, and blood lipids. Results. After surgery, an increase in C-reactive protein and inflammatory cytokines, as well as signs of energy deficiency (hyperglycemia, hypopoproteinemia, and hypolipidemia) was observed. An increase in creatine kinase activity, myoglobin and homocysteine levels was more pronounced in deceased patients. The use of vasaprostan reduces inflammatory markerscompared to baseline therapy. Conclusion. IL-18 plays a significant role in the development of inflammation in ALLI. Vasaprostan therapy reduces C-reactive protein levels, inflammatory cytokines, and systemic inflammation and can be recommended for the treatment of ALLI.
Based on a retrospective analysis, the OBJECTIVE was to develop an algorithm for predicting the risk of complications of abdominoplasty in overweight patients (BMI 25-29.9 kg/m2) using laboratory markers of carbohydrate metabolism and cytokine status, as well as to evaluate the efficacy of a modified surgical technique in high-risk patients.METHODS AND MATERIALS. The study was conducted in two stages: 1) a retrospective analysis of 49 patients (2016-2018) who underwent standard abdominoplasty to identify predictors of complicated wound healing; 2) a prospective cohort study of 30 patients (2022-2023) with a BMI of 25-29.9 kg/m2 and identified risk predictors (HOMA-IR≥3.1, insulin level>14.0 µIU/mL, interleukin-1β level (IL-1β)≥45.0 pg/ml), who underwent modified abdominoplasty with limited dissection, preservation of suprapubic tissue, Scarpa’s fascia and flap fixation. The main evaluation criteria were the duration of the operation, the frequency of seromas, hematomas, and ligature fistulas.RESULTS. The retrospective analysis revealed three independent predictors of the development of local wound complications: HOMA-IR≥3.1, insulin level≥14.0 µIU/mL and lL-1β level≥45.0 pg/ml. The use of the modified technique in female patients with these predictors led to a statistically significant decrease in the incidence of complications compared with the retrospective group of similar risk: the incidence of seromas decreased from 43% to 3% (p=0.001), hematomas from 10% to 0% (p=0.04). The average surgery time was reduced by 40%.CONCLUSION. The proposed algorithm, combining preoperative detection of markers of insulin resistance, carbohydrate metabolism disorders and systemic inflammation with the use of a gentle modified abdominoplasty technique, makes it possible to objectify the risk and significantly reduce the frequency of postoperative local wound complications in overweight patients, which can serve as a basis for individualizing surgical tactics.
Authors group raises the issue of legal regulation of cardiopulmonary resuscitation in the Russian Federation. Domestic legislation lacks clarity in matters concerning the effectiveness criteria and time frames of the extended resuscitation measures. The current protocols for declaration of death are not applicable in ECMO (extracorporeal membrane oxygenation) conditions. Thus, there is a need to improve the legal regulation of issues of establishing a person’s death, including the development of a united protocol, containing precise criteria for TOR (Termination of Resuscitation) measures, regardless of the technologies used. All this effort would reduce the number of hopeless, prospectless evacuations to hospitals, as well as ensure legal protection for medical personnel.
BACKGROUND: Adequate compensation for protein-energy losses and timely correction of metabolic disorders are key components of intensive care for critically ill patients. Currently, nutritional support (NS) is regarded as an essential component of intensive care for critically ill patients, as it helps reduce the incidence of infectious complications, shorten the duration of hospitalization, lower treatment costs, and improve survival rates. However, the practical implementation of NS in the intensive care unit (ICU) setting is associated with various organizational challenges and requires specific professional knowledge and skills to minimize the risk of technical and metabolic complications. AIM: The work aimed to assess the theoretical knowledge and practical skills of anesthesiologists–intensivists in providing NS to patients in ICUs of healthcare institutions in the Russian Federation. METHODS: This multicenter cross-sectional observational study was conducted via an anonymous remote survey. A total of 121 certified anesthesiologists-intensivists actively working in ICUs participated between September 4 and September 18, 2018. The survey evaluated physician adherence to NS practices, the frequency of monitoring protein-energy balance, the level of knowledge regarding NS, and the impact of material and technical resources on its effectiveness. Data were analyzed by comparing responses among three groups of participants. RESULTS: In current clinical practice, anesthesiologists-intensivists employ various methods to assess patients’ nutritional status, although none are universally accepted. According to the data obtained, not all physicians routinely assess patients’ protein and energy needs—such assessments are conducted by 80% and 72% of respondents, respectively. A significant issue identified was the insufficient provision of ICU equipment for administering NS. One-third of respondents rated the availability of specialized formulas for parenteral and enteral nutrition in their hospitals as unsatisfactory. Notably, the vast majority of respondents (98%) expressed a desire to improve their knowledge in the field of NS, indicating the high relevance of this topic within the professional community. CONCLUSION: The study revealed that many practicing physicians often lack sufficient theoretical knowledge regarding the practical implementation of NS. The material and technical support in ICUs remains unsatisfactory, with a shortage of nutritional formulas and equipment necessary for the adequate administration of enteral and parenteral nutrition.
Ethylene glycol poisoning is recorded in many countries of the world, but it is especially relevant in the Russian Federation, being one of the main reasons for hospitalization of patients with acute poisoning of chemical etiology. Ethylene glycol poisoning has severe medical, social and economic consequences. Purpose of the study : analytical toxicological analysis, features of diagnosis and intensive care of patients hospitalized with acute ethylene glycol poisoning in the toxicology center of a specialized hospital. Materials and methods of research . Medical documents of patients admitted to the Center for the Treatment of Acute Poisoning of the State Budgetary Institution of St. Petersburg Research Institute for Emergency Medicine named after. I.I. Dzanelidze in 2019–2022 with a diagnosis of «ethylene glycol poisoning.» ICD-10 rubric: T52.3. A statistical and chemical-toxicological study was carried out when patients were admitted to the hospital and over time after intensive care. Research results . According to the toxicological center of the State Budgetary Institution of St. Petersburg Research Institute of SP named after I.I. Dzanelidze, the number of patients with ethylene glycol poisoning was: 2019–1 admission; 2020–1 patient; 2021 — out of 2 patients admitted, 1 patient died; 2022 — out of 2 patients admitted with ethylene glycol poisoning, 1 patient died. All patients admitted with ethylene glycol poisoning were in critical condition with severe impairment of vital organs. Conclusion : ethylene glycol poisoning occupies one of the leading places among acute poisonings of chemical etiology in terms of the number of adverse outcomes. Characterized by severe medical, social and economic consequences.
