Повышение приверженности пациентов стационаров и амбулаторно-поликлинических подразделений к лечебно-реабилитационным программам и факторы, оказывающие влияние на комплаентность

The article discusses the problem of compliance, i.e. patients’ adherence to treatment and rehabilitation measures. The authors present data on possible methods for assessment of the patient’s compliance to the treatment, factors having an effect on the formation of compliance, and special techniques to be used by doctors to improve patients’ compliance to treatment.Обсуждаются вопросы комплаенса — приверженности пациентов к лечебно-реабилитационным мероприятиям. Приведены данные о возможных методах оценки степени приверженности к лечению пациента, факторах, влияющих на формирование комплаенса, а также специальных приемах для врачей, используемых с целью повышения приверженности пациентов к лечению

Epidemiology and impact of colonization by multidrug-resistant Gram-negative bacteria on bloodstream infections in early phase of allogeneic hematopoietic stem cell transplantation

Objective. To study epidemiology and impact of colonization by multidrug-resistant Gram-negative bacteria (MDRGNB) on bloodstream infections (BSI) during allogeneic hematopoietic stem cell transplantation (allo-HSCT). Materials and Methods. The retrospective study included 288 patients received the first allo-HSCT between 2018 and 2019. The median age was 32 (18–66) years, male – 53% (n = 152). The majority of patients had acute leukemia – 62% (n = 178) and received transplant from matched unrelated – 42% (n = 120) or haploidentical donor – 26% (n = 75). Relapse of underlying disease at the moment of all-HSCT was registered in 23% (n = 66) of patients. Results. Colonization of non-sterile sites before allo-HSCT by at least one MDRGNB was detected in 28% (n = 64). In most cases resistance is due to extended spectrum beta-lactamases (ESBL) – 86% (n = 55), while carbapenemases in combination with ESBL were detected in 14% (n = 9) of patients. After allo-HSCT the colonization was significantly higher than before transplantation (n = 161, 56%, p = 0.001), mainly due to carbapenemase- and ESBL-producing bacteria – 73% (n = 118) (p = 0.001). BSI in the early period after transplantation developed in 26% (n = 76), and in 56% (n = 43) was caused by MDRGNB. The etiology of BSI included K. pneumoniae – 51% in mostly cases. The etiology of BSI was the same bacteria that colonized non-sterile sites 2 weeks before the detection bacteria in bloodstream in 69% (n = 30) patients. Colonization by MDRGNB was associated with the development of BSI (p < 0.0001). The 100-day overall survival (OS) after all-HSCT was significantly lower in patients with colonization of non-sterile sites by MDRGNB compared with patients without colonization (60.6% vs 88.2%, p = 0.001). Conclusions. Colonization of MDRGNB after allo-HSCT reached 56%. K. pneumoniae was predominant etiology in both colonization and bloodstream infections. Colonization by MDRGNB was associated with the development of BSI and decreased OS after allo-HSCT

MODERN CONCEPTS OF FARMACOTHERAPY OF HERPES ZOSTER

In the reviewofmodern concept ofpathology and pharmacotherapyofherpes zostervirus were analyzed. Complex therapy of varicella-zoster virus includes antiviral, immunobiological agents and drugs, affecting pathogenesis of the disease. Now acyclic nucleozydes are widely used as specific antiviral agents

Alimenti vegetali a Bilancino e a Kostienki 16: il progetto dell' IIPP "Le risorse vegetali nel Paleolitico"

Istituto Italiano di Preistoria e Protostoria has approved financial support for a Project entitled ”Vegetable resources in the Palaeolithic time”. The background to the Project is set by a number of studies, currently being carried out in the Bilancino Gravettian site near Florence by some of the proponents of the project; these have led to the discovery of evidence of vegetable remains on lithic implements/artifacts (Noailles Burins and grindstone). The Project aims to apply new non-destructive techniques for the recovery and the identification of vegetable remains in Palaeolithic sites, in particular, the project focus on tools made from unknapped stone likely to be used in the treatment of plant-substances, such as pestles, grinders, grindstone, hearth-stones, etc. with the aim to acquire new evidence on the importance of the use of plants in the Palaeolithic and gain a better understanding of the economy and the diet of these most ancient humans. The procedure to analyze sediments eventually preserved on utilized pebbles is absolutely not invasive. Amog the numerous pebbles selected from the most important Italian Paleolithic sites only a grindstone and a pestle-grinder from Bilancino and a pestle-grinder from Kostenki have given starch residues. The discovery in Italy and Russia of a technique for the production of vegetable flour during the early phases of the Upper Paleolithic provides new evidence of a polycentric origin of such innovation anticipating by over 20,000 years the so-called Neolithic Revolution. The results obtained are also encouraging the systematic search for microresidues of vegetable origin in Paleolithic sites: for this aim we propose a protocol about the sampling and analysis modalities of vegetal residue from excavation to laboratory