ENDOBILIARY INTERVENTIONS AT ACUTE NECROTIC PANCREATITIS

The study included patients with acute necrotic pancreatitis and confirmed biliary hypertension. The endoscopic retrograde cholangiopancreatography (ERSP) and endoscopic papillosphincterotomy (EPST) supplemented with lithoextrac- tion were conducted immediately. We concluded that in cases when intraduct pathology causes biliary hypertension and initial severity of patient's condition doesn't exceed 11 physiological status severity (PSS) scale conducting ERSP with EPST and lithoextraction is more preferable than drainage of gall bladder

МЕТОД ЛОКАЛЬНОГО ОТРИЦАТЕЛЬНОГО ДАВЛЕНИЯ В ПРОФИЛАКТИКЕ ИНФЕКЦИОННЫХ РАНЕВЫХ ОСЛОЖНЕНИЙ ПРОМЕЖНОСТНОЙ РАНЫ ПОСЛЕ БРЮШНО-ПРОМЕЖНОСТНОЙ ЭКСТИРПАЦИИ ПРЯМОЙ КИШКИ

The authors present a review of published data on the problem of wound complications after abdominoperineal resection, and the data of their own randomized controlled study on 24 patients. In a group using local negative pressure method, the duration of antibiotic therapy was 5.0 ± 0.9 days, length of stay of 14.1 ± 2.8 days, infectious wound complications was not; in the comparison group, the duration of antibiotic treatment was 12.9 ± 1.6 days, length of stay of 28.4 ± 2.3 days and in 2 (16.7 %) cases wound complications were noted. Авторы приводят обзор данных литературы, посвященный проблеме раневых осложнений после брюшно-промежностной экстирпации прямой кишки, и данные собственного рандомизированного контролируемого исследования с включением 24 пациентов. В группе с использованием метода локального отрицательного давления длительность антибактериальной терапии составила 5,0 ± 0,9 сут, длительность госпитализации – 14,1 ± 2,8 сут, инфекционных раневых осложнений не было; в группе сравнения длительность антибактериальной терапии составила 12,9 ± 1,6 сут, длительность госпитализации – 28,4 ± 2,3 сут и в 2 (16,7 %) случаях были отмечены раневые осложнения

Pathogenetic role of tumor necrosis factor (TNF-α) for the development of peritoneal tuberculosis in an experiment

Currently tuberculosis is considered as a group of diseases united by one etiological factor. The pathogenesis of certain localizations of tuberculous inflammation, in particular peritoneum tuberculosis, hasn’t been sufficiently studied. The role of cytokine mechanisms in the development of the disease and the elaboration of non-sterile immunity requires further experimental studies, in particular the creation of a reproducible model on laboratory animals.The aim: to study the effect of TNF-α on the development of tuberculosis of the serous coat of the abdominal cavity, as well as to evaluate the possibility of modeling tuberculous peritonitis in laboratory animals using infliximab.Materials and methods. The studies were conducted on 18 male rabbits, which were simulated peritoneal tuberculosis by intra-abdominal administration of a suspension of Mycobacterium tuberculosis. 10 rabbits of the experimental group were intravenously injected with an infliximab solution and an iron (III) hydroxide sucrose complex intraperitoneally a day before infection.Results. In the control group of animals, tuberculosis either didn’t develop, or in a third of cases it affected only the pulmonary parenchyma, while proliferative processes prevailed. On the contrary, in animals with inactivated TNF-α, in 100 % of observations, tuberculous peritonitis was detected with associated lung damage and the predominance of alterative caseous processes.Conclusion. The created model of tuberculous peritonitis shows the leading role of TNF-α in the activation of macrophages, as well as in attracting cells to the site of infection. This is the primary signal necessary for the formation and stability of granulomas since the neutralization of this cytokine leads to a loss of control over the infection and the destruction of the granuloma with the development of destructive tuberculosis in the serous coat of the abdominal cavity

THE RUSSIAN DATA OF INTERNATIONAL ENDORSE REGISTER (EPIDEMIOLOGIC INTERNATIONAL DAY FOR THE EVALUATION OF PATIENTS AT RISK OF VENOUS THROMBOSIS IN ACUTE HOSPITAL CARE SETTING)

Aim. To estimate a risk factor frequency of venous thromboembolism (VTE) in patients urgently hospitalized in hospitals, and also to estimate of patients part having effective prevention of VTE.Material and methods. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Setting) is the international register. Patients of 40 years and older hospitalised in therapeutic departments as well as patients of 18 years and older hospitalised in surgical departments (358 hospitals in 32 countries) were included in the register. The case history analysis of all patients was performed for estimation of risk VTE and evaluation of preventive therapy quality according to American College of Chest Physicians (ACCP) Recommendation 2004.Results. Totally 68 183 patients (including 30 827 (45%) surgical patients and 37 356 (55%) therapeutic patients) were enrolled in Global ENDORSE Register. Russian centers enrolled 4 788 patients (including 2 829 (59%) surgical patients and 1 959 (41%) therapeutic patients). Totally 35 329 (51,8%) patients enrolled in Global ENDORSE Register (64,4% of surgical patients (19 842) and 41,5% of therapeutic patients (15 487)) had VTE risks. In Russia 2 188 enrolled patients (45,7%) had VTE risks (52% of surgical patients (1 470) and 36,7% of therapeutic patients (718). Totally 17 732 (50,2%) patients enrolled in Global Register ENDORSE and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. In Russia 521 (23,8%) patients enrolled in Global ENDORSE Register and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. It is more than 2 times less in comparison with world level (р<0.001).Conclusion. There are a lot of patients with VTE risks in hospitals. It is necessary to improve preventive therapy of VTE due to better hospital management and more active use of АССР Recommendations 2004

Use of Janus kinase inhibitors in COVID-19: a prospective observational series in 522 individuals

Janus kinase (JAK) inhibitors for the treatment of hospitalised patients with COVID-19 have been extensively studied. Initially, at the start of the pandemic outside of China, baricitinib was shown using artificial intelligence to have a potential dual anticytokine and antiviral effect, computer predictions that were then supported by mechanistic data.1–3 This included kinase assays demonstrating inhibition of host numb-associated kinases, notably AP-2-associated protein kinase 1 (AAK1) and cyclin G-associated kinase (GAK), responsible for activating protein-1 (AP-1)-mediated viral propagation and super-resolution microscopy which showed inhibition of SARS-CoV-2 entry into primary human liver spheroids.4 Based on double-blind randomised data from the Adaptive COVID-19 Treatment Trial-II (ACTT-II) under the National Institutes of Allergy and Infectious Diseases,5 it received an Emergency Use Authorisation from the United States Food and Drug Administration in November 2020, in combination with remdesevir for the treatment of hospitalised individuals with COVID-19...</p