Influence of the type of anaesthetic support on the development of postoperative cognitive dysfunction in gynecologic oncology patients

Aim. Determination of the influence of age and type of anesthesia on the patient’s cognitive abilities. Methods. 30 females who underwent surgical intervention were examined. The first group consisted of 14 patients who received general inhalational anesthesia, group 2 included 16 patients who received general inhalational anesthesia in combination with epidural anesthesia. All patients underwent neuropsychological testing at several stages: one day before the surgery, the first day after surgery, on day 28 after the surgery. Cognitive status was assessed using Mini-Mental State Examination (MMSE) and the clock-drawing test (CLOCK). Results. Given the combination of indices of both types of neuropsychological testing, postoperative cognitive dysfunction was diagnosed when a decrease by 10% or more of both MMSE and clock-drawing test and the MMSE score in patients with diagnosed postoperative cognitive dysfunction was less than 24 on both days 1 and 28. It should be noted that the results of testing before surgery in all groups of patients showed mild cognitive dysfunction. After the surgery, the measures of intellectual ability significantly decreased. The results of the analysis in the early recovery period in the group of patients who underwent combined anesthesia were significantly higher. And in the group of patients with combined anesthesia compared to the group that received only general anesthesia on day 28, cognitive indices were significantly higher: MMSE — pMW=0.041 and CLOCK — pMW Conclusion. General anesthesia combined with epidural anesthesia affects cognitive function of female patients less negatively than the use of general anesthesia alone

Features of Medical Care Providing to Patients with Digestive Diseases in the Krasnodar Region during the COVID-19 Pandemic

The aim of the study: optimization the medical care provision to patients with diseases of the digestive system (DD) in the Krasnodar Region during the COVID-19 pandemic.Material and methods. The analysis of the features of the DD course in the Krasnodar Region was carried out according to the data of form C 51 “Distribution of the dead by sex, age groups and causes of death” of the Territorial Federal State Statistics Service in the Krasnodar Region, as well as monitoring the quality of medical care for patients with DD for the period from 2019 to 2021 years.Results. During the COVID-19 pandemic, the routing of gastroenterological patients, dispensary observation and preventive measures have undergone some changes. In the structure of total mortality in the Krasnodar Region, mortality from DD was 21.6 % in 2020 and 4.0 % in 2021. The decrease in the growth of mortality rate, including from DD, in the second year of the pandemic is associated with the completed healthcare systems reformatting. The increase in hospital mortality in patients with gastric and duodenal ulcers, ulcerative colitis, and diverticular disease had a significant impact on mortality rates from DD. The decreasing number of hospitalizations was explained due to the conversion of a number of hospitals into hospitals for the treatment of patients with COVID-19. The hospitalization was mainly carried out for emergency indications and patients with a more severe course of the disease. The pandemic has increased the need for telemedicine: 378 tele-consultations on the gastroenterological profile was carried out in the Krasnodar Region in 2021.Conclusion. Healthcare system workload in the Krasnodar Region increased significantly during the coronavirus pandemic that required a number of structural adjustments. In recent times, the regional health care is returning to the planned mode of providing medical care

Surgical treatment of portal hypertension complications in patients with liver cirrhosis

Objective: Improving the results of surgical treatment of portal hypertension complications in patients with liver cirrhosis.Material and methods: The results of medical care for 328 patients with liver cirrhosis, who were treated in the surgical departments of the central district and city hospitals of the Krasnodar Region, were analyzed. The effectiveness of minimally invasive surgical treatment of portal hypertension complications in 832 patients with liver cirrhosis treated at the Regional Clinical Hospital no. 2 of the Ministry of Health of the Krasnodar Region were also evaluated.Results: The mortality rate in patients with liver cirrhosis, admitted in first-level institutions of medical care due to acute bleeding from esophageal varices, reached 26.3%. In conditions of surgical treatment of complications of portal hypertension in a third-level institution of specialized care it did not exceed 4.7%.Conclusion: The optimal approach to the surgical treatment of patients with liver cirrhosis is to stop the bleeding from esophageal varices at the first stage of medical care and to treat portal hypertension complications using minimally invasive technologies in a multidisciplinary clinic involving a multidisciplinary team of doctors

Biological markers as predictors of postoperative neurocognitive disorders

Aim of the study: to highlight the main discussed tactical points of anesthesiologist's management of patients, to outline more promising aspects of biochemical laboratory diagnosis of postoperative neurocognitive disorders.Цель исследования — выделить основные обсуждаемые тактические моменты ведения анестезиологом пациентов, обозначить более перспективные аспекты биохимической лабораторной диагностики послеоперационных нейрокогнитивных расстройст

Managing Liver Cirrhosis: a Multidisciplinary Approach

Aim. Analysis of the experience of managing patients with liver cirrhosis (LC) at the Regional Clinical Hospital No. 2 of the Ministry of Health of Krasnodar Krai.Materials and methods. In this retrospective study, we assessed data on routine outpatient monitoring of 832 patients with LC and oesophageal varices by the outpatient and inpatient services of the Regional Clinical Hospital No. 2 during 2009-2019.Results. Endoscopic oesophageal variceal ligation was performed in 832 patients, with total 1149 surgeries and 1 to 8 banding repeats per individual. Transjugular intrahepatic portosystemic shunting (TIPS) was implemented in 2014 and performed 51 times in 5 years, coupled in 20 patients with simultaneous gastric variceal embolisation. Oesophageal variceal ligation preceded TIPS in 34 (66.7 %) patients; 62 patients were included in the liver transplant waiting list. Among 17 liver transplant patients, 6 had oesophageal variceal bleeding in history. Endoscopic ligation was performed in 5, and TIPS — in 3 patients awaiting a transplant. Successful adoption of health telecom technologies in Krasnodar Krai renders high-quality specialised medical aid publically accessible, also in remote regions.Conclusion. A model is presented for providing high-tech specialised assistance to LC patients, which engages a surgeon, a gastroenterologist, an endoscopist, an X-ray physician, an endovascular surgeon and an infectionist. A resident physician should coordinate the multidisciplinary team at the outpatient stage, and a surgeon — upon the patient's admission in case of surgical LC complications

Развитие анестезиологической и реанимационной служб

Завдання кафедри різноманітні. Це, насамперед, навчання студентів найважливішим навичкам з інтенсивної терапії невідкладних станів, підготовка лікарів-анестезіологів у інтернатурі, загальне та передатестаційне удосконалення анестезіологів, лікарів швидкої допомоги та лікарів, які працюють із барокамерами. Традиційно значне місце у роботі кафедри належить вихованню майбутніх фахівців і науковців у студентському науковому гуртку. Гуртківці активно працюють у лікувальних закладах клінічної бази кафедри, виступають на студентських наукових конференціях, виконують наукові дослідження.Katashinsky In the article there is a brief description of the basic stages in the establishment of the anaesthetic and intensive care services in Odessa and in the Regional Clinical Hospital in particular, a presentation of history of foundation and development of the department of anaesthesiology and intensive care in the Odessa State Medical University, and a general trend in the functioning of the department of anaesthesiology and intensive care of the ORCH.В работе освещены основные этапы становления анестезиологической и реанимационной служб в Одессе и в Областной клинической больнице в частности, представлена история создания и развития кафедры анестезиологии и интенсивной те рапии Одесского государственного медицинского университета, показаны главные направления в работе отделений реанимации и анестезиологии ООКБ

Технология низкочастотной пьезотромбоэластогра- фии в мониторинге противотромботической терапии

Представлена информация о новой технологии оценки гемостатического потенциала цельной крови в процессе коагуляции — низкочастотной пьезотромбоэластографии, позволяющей проводить интегративную оценку его характеристик. На примере оценки эффектов антиагрегантов (ингибитора ЦОГ-1 — ацетилсалициловой кислоты, блокатора АДФ-рецепторов тромбоцитов — клопидогрела) и антикоагулянтов (нефракционированного гепарина — гепарината натрия, низкомолекулярного гепарина — эноксапарина) продемонстрированы возможности оперативной и персонифицированной оценки их фармакодинамики. Получены новые данные о специфических и плейотропных эффектах противотромботических лекарственных средств. Специфическим еффектом гемостатического потенциала в ответ на прием антиагрегантов является снижение агрегационной активности форменных элементов крови, проявляющееся повышением суспензионной стабильности крови и снижением интенсивности контактной коагуляции. Плейотропные эффекты антиагрегантных препаратов проявляются тенденцией к изменению гемостатического потенциала в сторону структурной и хронометрической гипокоагуляции. По результатам оценки фармакодинамики антикоагулянтов выявлено время их максимального действия на гемостатический потенциал, а также длительность антикоагулянтного эффекта. Специфическим ответом гемостатического потенциала после введения антикоагулянтов является развитие структурной и хронометрической гипокоагуляции, реализующейся за счет снижения протеолитического этапа фибриногенеза и активности процессов латеральной сборки фибрина.The article presents information about new technology for whole blood haemostatic potential evaluation in haemocoagulation process — low-frequency piezotromboelastography, that allows to perform integrative evaluation of its characteristics. According to data, which was received for antiplatelet (COX-1 inhibitor — acetylsalicylic acid, platelets ADP-receptors blocker — clopidogrel) and anticoagulant (unfractionated heparin — heparinate, LMWH — enoxaparine) agents, affordances for perioperative and personalized evaluation of their pharmacodynamic were shown. New data about specific and pleiotropic effects of antitrombotic drugs was received. Specific response of haemostatic potential to intake of antiplatelet agents is decrease hemocytes aggregation activity, that representing as increase in blood suspense stability and decrease of contact coagulation intensity. Pleiotropic effect of antiplatelet treatment is represented as tendency of haemostatic potential shift to structural and chronometric hypocoagulation. As results of anticoagulant drugs pharmacodynamic evaluation, their maximal duration of action on haemostatic potential was revealed as well as the duration of anticoagulant effect. Specific response of haemostatic potential to intake of anticoagulant agents is a development of structural and chronometric hypocoagulation, which occur due to decrease of proteolytic stage of fibrinogenesis and inhibition processes of lateral assembly of fibrin activity

Growing a circular economy with fungal biotechnology: a white paper.

Fungi have the ability to transform organic materials into a rich and diverse set of useful products and provide distinct opportunities for tackling the urgent challenges before all humans. Fungal biotechnology can advance the transition from our petroleum-based economy into a bio-based circular economy and has the ability to sustainably produce resilient sources of food, feed, chemicals, fuels, textiles, and materials for construction, automotive and transportation industries, for furniture and beyond. Fungal biotechnology offers solutions for securing, stabilizing and enhancing the food supply for a growing human population, while simultaneously lowering greenhouse gas emissions. Fungal biotechnology has, thus, the potential to make a significant contribution to climate change mitigation and meeting the United Nation’s sustainable development goals through the rational improvement of new and established fungal cell factories. The White Paper presented here is the result of the 2nd Think Tank meeting held by the EUROFUNG consortium in Berlin in October 2019. This paper highlights discussions on current opportunities and research challenges in fungal biotechnology and aims to inform scientists, educators, the general public, industrial stakeholders and policymakers about the current fungal biotech revolution