Comparative pharmacoeconomic analysis and qualitative evaluation methods of antibiotic prophylaxis during cataract surgery

Purpose. Comparative evaluation of the clinical and cost-effectiveness of perioperative antibiotic prophylaxis systemic fluoroquinolones cataract. Methods. A retrospective randomized trial of postoperative infectious complications after 9 314 cataract surgery performed by «small sections» technology from 2012 to 2014. Group 1 patients received 0,5% levofloxacin instillation (4 times a day for three days before surgery), 2nd group patients received additional systemic levofloxacin (oral, 500 mg / day). Relative risk (RR), relative risk reduction (RRR) and absolute risk reduction (ATS) complications, the number of patients needed to treat (NNT) were сalculated. Results. In group of patients receiving antibiotic prophylaxis just as instillation fluoroquinolones, infection rates were 0,25%, while in the group where the patients received an additional fluoroquinolone systems but - 0,02%. RR 0,08, COP - 0,92 CAP - 0,23%, NNT - amounted to 423. The costs of systemic antimicrobial prophylaxis exceeded the cost of a local antibiotic prophylaxis 1,8 times. At the same time the costs of treatment which developed endophthalmitis in 12 group 1 exceeded the value of systemic antibiotic prophylaxis and treatment of endophthalmitis after systemic use of levofloxacin. Conclusions. System use of fluoroquinolones in the perioperative period of cataract surgery is an effective method of preventing infectious tion of postoperative complications as clinical as the economic aspects

The quality of life of patients with ovarian cancer stage I-III via general questionnaire EQ-5D and the special questionnaire EORTC QLQ-C30

In order to assess the impact of treatment on quality of life of patients with ovarian cancer stage I-III, we have conducted monitoring of 51 patients who were treated in The Primorsky Krai Oncological Clinic from 2014 to 2015, who responded to the overall EQ-5D questionnaire and the special questionnaire EORTC QLQ-C30 before treatment and after 6 cycles of chemotherapy. All patients were subjected to the surgery at the first stage. Laparotomia, hysterectomy with appendages, resection of the greater omentum is made for 41 (80,4%) patients, without resection of the omentum was made for 3 (5,9%) patients. Laparotomia, uppervaginal amputation of uterus with appendages, resection of the greater omentum is made 5 (9,8%), without resection of the omenntum was made for 2 (3,9%) patients. The omentum was not removed owing to a lack of technical capacity for resection. The second stage of the complex treatment is adjuvant chemotherapy scheme TCb (Paclitaxel 175 mg/m2 Carboplatin AUC 6) or Paclitaxel 175 mg/m2, Cisplatin 75 mg/m2 (total 6 cycles). Pronounced changes in the quality of life of patients before treatment was owing to the manifestation of the underlying disease, the lack of «expressed concerns» after treatment indicates the effectiveness of anticancer therapy. The increase of «moderate problem» by the components «daily activity», «anxiety and depression», «health condition», compared with how it was a year ago,» indicates the presence of side effects of chemotherapy. The quality of life assessment via special questionnaire EORTC QLQ-C30 before treatment and after chemotherapy in patients with stage I ovarian cancer shows significant changes in indicators in the growth of dyspeptic symptoms, improvement of the emotional background (decrease anxiety and depression, sleep), reduced performance of significant physical activity. At the stage II ovarian cancer after chemotherapy increase in a general weakness, a limitation in the performance of daily activities and significant physical exertion are marked. At the stage III ovarian cancer substantial significant changes are noticed as the growth of dyspeptic symptoms, emotional depression, but also at the performance of daily activities and physical exercise, in spite of this, patients assessed the overall health status over the last week by 6 points, where 7 points is excellent health condition. Results show the decrease of the quality of life, in the background of the special treatment and the stage of disease

Therapy of Schizoaffective Disorder and Paranoid Schizophrenia with Episodic Course

Background. The use of atypical antipsychotics in schizophrenia contributes to the reduction of psychotic, affective, negative and cognitive disorders.Aims. To evaluate the effectiveness of ziprasidone therapy in patients with schizoaffective disorder and paranoid schizophrenia with episodic course.Materials and methods. In accordance with ICD-10 there were 14 (63.6 %) people with schizoaffective disorder (F25), 8 (36.4 %) people with paranoid schizophrenia, episodic course (F20.x1). Treatment with ziprasidone lasted 42 days. The dose of ziprasidone in 6 patients (27.3 %) was 80 mg, in 10 patients (45.5 %) – 120 mg, in 6 patients (27.3 %) – 160 mg. Evaluation of the effectiveness of ziprasidone therapy was carried out using psychometric scales (PANSS, General clinical impression scale to assess the effectiveness of therapy – CGI-S, CGI-I), adverse events were registered with the UKU scale.Results. The number of respondents was 19 (86.3 %) (reduction of the total score on the PANSS scale > 20 % of the pre-treatment level). Ziprasidone was effective in patients with schizoaffective disorder with a significant decrease in total score on PANSS subscales to the 14 th day of therapy (p < 0.05), with paranoid schizophrenia with episodic course – by the 21st day (p < 0.01). According to the CGI-S scale at the end of therapy, “borderline condition” was observed in 10 patients (52.6 %), mild severity – in 3 (15.8 %), normal condition – in 6 (31.6 %). CGI-I scale showed a significant improvement in 10 patients (52.6 %), marked improvement – in 9 patients (47.4 %). Among the mild adverse events that do not require discontinuation of the drug, we noted: weakness – in 3 patients (15.8 %), drowsiness – in 3 (15.8 %), impaired concentration – in 2 (10.5 %), orthostatic dizziness – in 2 (10.5 %), galactorrhea – in 1 (5.3 %).Conclusions. Ziprasidone is an effective antipsychotic drug that has a safe tolerability profile. It can be used in patients with schizoaffective disorders and paranoid schizophrenia with episodic course

Tolerance to uncertainty and the choice of coping strategies in the professional activities of lawyers

The article examines the personality traits characteristic of people involved in advocacy, namely the level of tolerance to uncertainty and preferred coping strategies. It was revealed that lawyers are able to accept the tension that arises in a situation of contradictions, to resist the incoherence of information, to accept the unknown. The most common coping strategies among lawyers are considered, the connection between the acceptance of situations of uncertainty and coping is revealedВ статье рассматриваются личностные особенности, характерные для людей, занимающихся адвокатской деятельностью, а именно уровень толерантности к неопределенности и предпочтительные копинг-стратегии. Выявлено, что адвокаты способны принимать напряжение, что возникает в ситуации противоречий, противостоять несвязанности информации, принимать неизвестное. Рассмотрены наиболее часто встречающиеся среди адвокатов копинг-стратегии, выявлена связь между принятием ситуаций неопределенности и копингам

Structural and Luminescence Properties of Silica-Based Hybrids Containing New Silylated-Diketonato Europium(III) Complex

A new betadiketonate ligand displaying a trimethoxysilyl group as grafting function and a diketone moiety as complexing site (TTA-Si = 4,4,4-trifluoro-2-(3-trimethoxysilyl)propyl)-1-3-butanedione (C4H3S)COCH[(CH2)3Si(OCH3)3]COCF3) and its highly luminescent europium(III) complex [Eu(TTA-Si)3] have been synthesized and fully characterized. Luminescent silica-based hybrids have been prepared as well with this new complex grafted on the surface of dense silica nanoparticles (28 (+/-3 nm) or on mesoporous silica particles. The covalent bonding of Eu(TTA-Si)3 inside the core of uniform silica nanoparticles (40 (+/- 5 nm) was also achieved. Luminescence properties are discussed in relation to the europium chemical environment involved in each of the three hybrids. The general methodology proposed allowed high grafting ratios and overcame chelate release and tendency to agglomeration, and it could be applied to any silica matrix (in the core or at the surface, nanosized or not, dense or mesoporous) and therefore numerous applications such as luminescent markers and luminophors could be foreseen

Deciphering Three Beneficial Effects of 2,2 '-Bipyridine-N,N '-Dioxide on the Luminescence Sensitization of Lanthanide(III) Hexafluoroacetylacetonate Ternary Complexes

Lanthanide hexafluoroacetylacetonate ternary complexes with 2,2'-bipyridine-N,N'-dioxide, [Ln(hfa)3(bpyO2)], were synthesized for Ln = Eu, Gd, Tb, and Lu and fully characterized by elemental, thermal, and mass-spectrometric analyses. The X-ray crystal structure of [Eu(hfa) 3(bpyO2)].0.5C6H6 reveals an octa-coordinate metal ion lying in a severely distorted trigonal dodecahedron geometry; the Eu-O distances lie in the range 2.36-2.44 Å with no significant difference between hfa- and bpyO2. A detailed comparative photophysical investigation has been carried out to determine the exact influence of the introduction of bpyO2 in the inner coordination sphere of the metal ion in replacement of the two water molecules in [Ln(hfa)3(H2O)2]. While this replacement is detrimental for Tb, it leads to a 15-fold increase in the overall quantum yield for Eu. This large improvement originates from (i) a better sensitization efficiency, the ancillary ligand being responsible for 3/4 of the energy transfer, (ii) elimination of nonradiative deactivation pathways through harmonics of O-H vibrations, and (iii) reduction in the radiative lifetime. The latter influence is rarely documented, but it accounts here for ã25% increase in the intrinsic quantum yield, so that more attention should be given to this parameter when designing highly luminescent lanthanide complexes. © 2011 American Chemical Society

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

<p>Abstract</p> <p>Background</p> <p>Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.</p> <p>Methods</p> <p>A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO₂insufflation at the 10 cm of water. TIR was evaluated at the 24^th, 72^nd, 120^thand 168^thhour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.</p> <p>Results</p> <p>More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24^thand 72^nd; p < 0.01 - 120^thand p < 0.001 - 168^thhrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.</p> <p>Conclusions</p> <p>MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO₂insufflation however, led to moderate inflammation and less adhesion formation.</p

Генерализованный туберкулез при системной красной волчанке на фоне пульс-терапии метилпреднизолоном: трудности диагностики и лечения

Systemic lupus erythematosus (SLE) and a high-dosage corticosteroid therapy both are risk factors of tuberculosis development. The clinical case presented demonstrates the difficulties of diagnostics and simultaneous therapy of comorbid diseases, which are followed by a multisystemic tuberculosis on the one hand, and a highly active SLE resulting from tubercular regimen on the other. Our experience shows the importance of antituberculosis drug prescription in accordance with a personal chemotherapy acceptability. Высокая суммарная доза кортикостероидов при терапии системной красной волчанки (СКВ) и само заболевание являются факторами риска развития туберкулеза. Клинический случай освещает проблемы диагностики и одновременной терапии коморбидных заболеваний, сопровождающихся, с одной стороны, распространенным полиорганным туберкулезом, с другой, – чрезмерно выраженной активностью СКВ, усугубляющейся на фоне применения противотуберкулезных средств. Данный опыт подчеркивает важность назначения индивидуального режима химиотерапии туберкулеза с учетом переносимости противотуберкулезных препаратов и наличия побочных эффектов.