Therapeutic Drug Monitoring for Evaluation of the Efficacy and Safety of Vancomycin in Patients with Orthopaedic Infections

Vancomycin is a drug of choice for the infections caused by methicillin-resistant strains of staphylococci. Its use requires individualised dosing and renal function monitoring.The aim of the study was to evaluate, using therapeutic drug monitoring (TDM), the frequency of reaching target trough serum concentrations (TSCs) and the frequency of renal function impairment in orthopaedic infection patients receiving vancomycin therapy.Materials and methods: the authors carried out a retrospective analysis of vancomycin TSC test results of 457 patients admitted to a purulent osteology department in 2019–2021. The results were grouped according to the number of TSC determination performed as part of TDM (tests 1, 2, and 3). Each of the 3 groups was further divided into 4 subgroups according to the TSCs of vancomycin: ≤9.9 µg/ml (extremely low), 10–14.9 µg/ml (recommended for mild infections), 15–19.9 µg/ml (recommended for bone and joint infections), ≥20 µg/ml (potentially toxic). The results obtained in each group were analysed separately.Results: according to the 1st TDM test, only 9.6% of patients achieved the TSCs of vancomycin recommended for bone and joint infections. Extremely low TSCs, insufficient for treatment of the infections, were found in 64.8% of patients. According to the 2nd and 3rd TSC determinations, dose corrections decreased the percentage of patients with extremely low TSCs to 49.9% and 41.2%, respectively. Potentially toxic TSCs of vancomycin were detected in 48 (10.5%) patients, but renal dysfunction was observed only in 8 (1.75%) of them. The authors exemplify the use of TDM to control the efficacy and safety of vancomycin in patients with pronounced signs of renal function impairment by two clinical cases.Conclusion: with a standard dose of vancomycin, the concentrations recommended for bone and joint infections were reached only in every tenth patient. There was a large percentage of patients with extremely low serum concentrations of the medicinal product (64.8%), but it decreased after dose adjustments. Monitoring of vancomycin concentrations allows for individualised dosing, efficacy control and significant reduction of the risk of adverse kidney reactions

Dynamics of postsurgical wound local changes and healing rate during the use of alpha-glutamyl-tryptophan in combination therapy of patients with skin and soft-tissue infections

Skin and soft-tissue infections (SSTI) take the lead in surgical disorders. Changes of local and systemic immunoreactivity highlight the SSTI and hinder treatment due to disease chronicity. The immunotropic therapy could be the useful tool in SSTI treatment. The aim of the study was to assess the dynamics of local changes and and duration of wound healing during the use of alpha-glutamyl-tryptophan (AGT/Thymogen) in the combination therapy of SSTI patients. Material and methods. A sample of 77 individuals aged 18–55 years with moderate SSTI of different localization and with signs of infectious intoxication participated in the randomized, double-blind, parallel group, placebo-controlled clinical trial. The patients were divided into the main (39 people) and control (38 people) groups. The combination therapy of the main group included 100 μg of AGT by intramuscular injection daily during 7 days, whereas the control group received placebo (0,9 % sodium chloride) along the same schedule. Results and discussion. The combination therapy of SSTI patients with AGT significantly decreased the local inflammation, i.e. pain intensity, hyperemia, edema (p = 0,022), infiltration within damage area (p = 0,03). Besides, AGT treatment leads to statistically and clinically significant reduction in the duration of septic wound healing by an average of 2 days as compared to control group. Thus, statistically, and clinically significant superiority of efficacy of alpha-glutamyl-tryptophan in comparison with placebo in reducing the time of healing of purulent wounds of patients with SSTI has been established

Analysis of the efficiency of production of whole-muscle turkey products with vegetable sprinkles

Human health is largely determined by the nature, level and structure of nutrition. A promising direction in the development of new food products is the expansion of the base of used ingredients used to partially replace meat raw materials with vegetable ones, in order to maximize the saturation of products with nutrients that contribute to the maintenance of normal life of the consumer. The use of new food ingredients contributes to the actual task set by the State policy in the field of healthy eating — expanding the range of enriched and functional food products. The work is devoted to the study of baked whole-muscle products using turkey meat and vegetable dressing as sources of high protein content, which solves the problem of deficiency of this component in the diet. A recipe for brine with the addition of the food additive “Glimalask”, which has a complex effect on the products under study, has been presented. The evaluation of quality indicators of finished products has been carried out, the article presents the results of a comparative analysis of baked whole-muscle turkey meat products, calculations of the product cost price. The comparative analysis has shown that, in comparison with the control sample, the baked whole-muscle products from turkey meat with vegetative dressing have improved physical and chemical properties, outstanding organoleptic characteristics, the yield of the product increases by 9.0–12.0%, depending on the formulation. Differences in the dynamics of microbial growth in the experimental and control samples were insignificant, the vegetable dressing helps to slow the growth of microorganisms on the surface of the product. The presented baked whole-muscle turkey meat products using optimized brine and vegetable sprinkles of chickpeas, sesame and paprika are recommended to a wide range of consumers of different age groups

VREDEN RUSSIAN RESEARCH INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS

Currently, the use of bone allografts for reconstructive orthopedic surgery in clinical practice around the world is becoming a common procedure. Bone allografts are the first substitute material to the autologous bone and the best alternative to any artificial substituting material. The methods used for the preservation, processing and sterilization of bone are changing and evolving with time. The main goals remain the same including exclusion of infections and creation of the material with sustained properties of the normal bone.The present review reflects the essential methods for biological tissue processing, sterilization and preservation with the analysis of the key requirements for manufacturing of safe allogeneic osteoplastic materials with osteoinductive, osteoconductive and osteogenic properties

Effect of recombinant Sox9 protein on the expression of cartilage-specific genes in human dermal fibroblasts cell culture

As a result of the experiments, it was shown that the recombinant Sox9 protein has practically no effect on chondrogenic differentiation and does not significantly change the expression of chondrogenesis gene

EVALUATION OF DEBRIDEMENT EFFECTIVENESS FOR THE TREATMENT OF PERIPROSTHETIC JOINT INFECTIONS OF THE HIP

Purpose - evaluation of the effectiveness of debridement in the treatment of periprosthetic infection and detection of possible factors affecting the outcome. Material and methods: Analysis of the effectiveness of treatment in 125 patients with periprosthetic infection operated at Vreden Russian Research Institute of Traumatology and Orthopedics in 2008-2012 was carried out. All patients underwent endoprosthesis-saving sanitation surgery at different times. The effectiveness of surgery was evaluated using clinical, X-ray, laboratory, and statistical methods. To estimate a subjective component, Harris and visual analog scales were used. Results: Recurrent infections after sanitation surgery were detected in 20 (15.7%) patients (Group 1). 105 (84%) patients in the follow-up of above 12 months demonstrated remission of infectious process (Group 2). Cardiovascular pathology and obesity were significantly more common in Group 1 patients (

Сравнительное исследование эффективности и безопасности препарата Хондрогард ® при комбинированном (внутрисуставное и внутримышечное) и внутримышечном введении у пациентов с остеоартритом коленных суставов

Objective: to evaluate the efficacy and safety of Chondroguard® in the combined (intra-articular (IA) + intramuscular (IM)) and IM injection in patients with knee osteoarthritis (OA).Patients and methods. The study enrolled 150 patients with knee OA who were divided into two groups with 75 patients in each group. Group 1 received the drug (100 mg/ml) intramuscularly: 25 injections every other day, the first three injections at a dose of 100 mg, the fourth injection was started with a dose of 200 mg. Group 2 had five IA injections into the target joint at a daily dose of 200 mg with an interval of 3 days between injections, then 16 IM injections at 200 mg every other day. All the patients were prescribed nonsteroidal anti-inflammatory drugs (NSAIDs), such as meloxicam 15 mg. To determine the efficiency of treatment, the investigators estimated the following parameters: pain intensity on a visual analogue scale (VAS), the total WOMAC index and its components (pain, stiffness, and functional insufficiency), sensory and affective-emotional pain characteristics (for the target joint) according to McGill Pain Questionnaire (MPQ) scores. Clinical and biochemical blood tests, clinical urinalysis, coagulogram, and electrocardiography were performed in all the patients at the beginning and the end of the study.Results and discussion. Comparison of two Chondroguard® regimens showed that by the end of treatment, the pain intensity on VAS was significantly lower in Group 2 (IA + IM administration) than in Group 1 (16.81±13.49 and 21.88±13.24, respectively; p<0.0001). Analysis revealed that there were no significant differences between Groups 1 and 2 in the changes of the overall WOMAC index and its components (pain, stiffness, and functional performance), as well as in MPQ pain scores. No serious adverse events (AEs) were recorded in the study. There were 11 AEs in 3.3% (n = 5/150) of the patients throughout the study. By its end, resolution/termination of AEs was noted in 100% of cases. There were no clinically significant pathological laboratory and ECG findings.Conclusion. The test drug during any (IM or combined) route of administration quickly and effectively reduces pain syndrome and stiffness and improves joint functional performance and at the same time it is a safe drug. Its important advantage is a quick effect achieved by IA and IM administration. This makes it possible to reduce the dose of NSAIDs or to discontinue the latter, which is very important for OA patients with comorbidity. Цель – оценить эффективность и безопасность препарата Хондрогард® при комбинированном (внутрисуставное, в/с + внутримышечное, в/м) и внутримышечном введении у пациентов с остеоартритом (ОА) коленных суставов.Пациенты и методы. В исследование были включены 150 пациентов с ОА коленных суставов. Пациенты были разделены на две группы (по 75 пациентов в каждой группе). Первая группа (R) получала изучаемый препарат (100 мг/мл) внутримышечно: 25 инъекций через день, первые три инъекции в дозе 100 мг, начиная с 4-й инъекции – в дозе 200 мг. Вторая группа (N) получала 5 внутрисуставных инъекций в целевой сустав по 200 мг с перерывом 3 дня между введениями, далее 16 внутримышечных инъекций по 200 мг через день. Всем пациентам назначали нестероидные противовоспалительные препараты (НПВП, мелоксикам 15 мг). Для определения эффективности лечения оценивали следующие параметры: интенсивность боли по визуальной аналоговой шкале (ВАШ), индекс WOMAC общий и его составляющие (боль, скованность и функциональная недостаточность), сенсорные и аффективно-эмоциональные характеристики боли (для целевого сустава) по опроснику MPQ (McGiIl Pain Questionnaire). Всем пациентам в начале и в конце исследования выполняли клинический и биохимический анализы крови, клинический анализ мочи и анализ показателей коагулограммы, электрокардиографию.Результаты и обсуждение. При сравнении двух режимов введения Хондрогарда® интенсивность боли по ВАШ к концу лечения в группе N (в/с + в/м введение) была достоверно ниже, чем в группе R (16,81±13,49 и 21,88±13,24; р<0,0001 соответственно). Анализ динамики общего индекса WOMAC и его составляющих (боль, скованность, функциональное состояние), а также оценки боли по опроснику MPQ достоверных различий между группами N и R не выявил. Серьезных нежелательных явлений (НЯ) в исследовании не зарегистрировано. За весь период исследования выявлено 11 НЯ у 3,3% (5/150) пациентов. К концу исследования разрешение/прекращение НЯ отмечено в 100% случаев. Клинически значимых отклонений лабораторных показателей и данных ЭКГ не наблюдалось.Выводы. Изучаемый препарат при любом способе введения (в/м или комбинированный) быстро и эффективно уменьшает болевой синдром и скованность, улучшает функциональное состояние суставов и при этом является безопасным препаратом. Важное его преимущество – быстрый эффект за счет в/с и в/м введения. Это позволяет снизить дозу НПВП или отменить их, что очень важно для больных ОА с коморбидностью.

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

PCR IN TRAUMATOLOGY AND ORTHOPAEDICS: METHOD DESCRIPTION AND APPLICABILITY

Review brief presents description of polymerase chain reaction method (PCR) and its most common variants. Three PCR-based lines of research, carried out in the traumatology and orthopaedics, include identifying a causative agents of the implant-associated infection after orthopaedic surgery; detection of antibiotic resistance genes and biofilm forming genes. It was shown that PCR can be used as additional method for detection of genetic disorders, significant for traumatology and orthopaedics, and for investigation of cartilage and bone regeneration