Antibacterial Therapy for Purulent-Septic Complications in Patientswith Combat Related Penetrating Craniocerebral Gunshot Wounds

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to secondline antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gramnegative aerobic and anaerobic infection pathogens, is recommended

Successful Surgical Treatment of Severe Perforating Diametric Craniocerebral Gunshot Wound Sustained during Combat: A Case Report

Many researchers classify perforating diametric craniocerebral gunshot wounds as fatal because mortality exceeds 96% and the majority of patients with such injuries die before hospitalization. A 23-year-old Ukrainian male soldier was admitted to a regional hospital with a severe perforating craniocerebral wound in a comatose state (Glasgow Coma Scale score, 5). Following brain helical computed tomography, the patient underwent primary treatment of the cerebral wound with primary duraplasty and inflow/outflow drainage. After 18 days of treatment in the intensive care unit, he was transferred to a military hospital for further rehabilitation. This report details our unusual case of successful treatment of a perforating diametric craniocerebral gunshot wound

Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds.

Purpose – to ana­lyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of exa­mination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and  duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001)

Удельное поглощение электромагнитных волн дециметрового диапазона в воде Ладожского озера (Ленинградская область)

Measurements of the attenuation of the electromagnetic waves in fresh water of Lake Ladoga by sounding of the inclined plane installed in the pool are discussed in this paper. GPRs “OKO-2” and “Zond 12e” were used in the investigations. The resistivity of the water was 22 Ω·m at a temperature of about 24°C. According to the results of the measurements the attenuation of the electromagnetic waves at a frequency of 400 MHz is 21 dB/m; of 900 MHz are 38 dB/m and 40 dB/m for different series of experiments, and at a frequency of 1500 MHz is 48 dB/m.В настоящей работе обсуждаются результаты определения удельного поглощения электромагнитных волн в пресной воде Ладожского озера методом зондирования наклонной плоскости. В качестве наклонной плоскости использовался лист плоского шифера толщиной 10 мм, установленный в бассейне. Лоцирование осуществлялось с помощью георадаров «ОКО-2» и «Zond 12e». Удельное сопротивление воды при температуре около 24°С составляло 22 Ω·м. По результатам работ установлено, что удельное поглощение электромагнитных волн на частоте 400 МГц составляет 21 дБ/м, на частоте 900 МГц — 38 и 40 дБ/м для разных серий экспериментов и на частоте 1500 МГц — 48 дБ/м

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Survey on worldwide trauma team activation requirement

PURPOSE : trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level. METHODS : A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups. RESULTS : The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income. CONCLUSIONS : The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.http://link.springer.com/journal/68am2022Surger

IL6-inhibitors in treatment of SARS COVID-19

The aim of this study was to evaluate the clinical efficacy and safety of a two-dose approach in the administration of tocilizumab in patients with SARS COVID19 Material and methods. The study was carried out on the basis of the Odrex Medical House in 2000-2021. The total sample included 4,112 patients hospitalized in a specialized department with coronavirus pneumonia. Of this sample, 150 patients were prescribed tocilizumab at a dose of 8 mg/kg of patient weight, including 36 (24.0 %) cases when tocilizumab was administered in a two-dose regimen. In the case of a two-dose regimen, the second dose was administered no earlier than 24 hours after the first one. All patients were examined according to the current clinical protocols. The hemogram, the content of CRP, ferritin, interleukin-6 were assessed. All patients received dexamethasone intramuscularly at a dose of at least 6 mg per day. Statistical processing was carried out by methods of analysis of variance using the software Statistica 13.0. Results. After the use of tocilizumab, the patients had a decrease in body temperature and a decrease in the need for oxygen support. At the same time, the normalization of indicators of the activity of the systemic inflammatory response was observed. Mortality after the use of tocilizumab was 29.3 %; in all cases, the deaths had an extremely severe course of coronavirus infection and a significant comorbid background. There were no manifestations of anaphylaxis and cases of secondary infection after the appointment of tocilizumab. Conclusions. The use of tocilizumab could significantly improve the condition of patients with SARS COVID19. There were no signs of anaphylaxis and cases of secondary infection after the administration of tocilizumab. In the absence of a pronounced clinical effect within 24 hours after the first dose of tocilizumab in patients with severe SARS COVID19, it is advisable to re-administer the drug (two-dose regimen)

IL6-inhibitors in Treatment of SARS COVID19

The aim of this study was to evaluate the clinical efficacy and safety of a two-dose approach in the administration of tocilizumab in patients with SARS COVID19 Material and methods. The study was carried out on the basis of the Odrex Medical House in 2000-2021. The total sample included 4,112 patients hospitalized in a specialized department with coronavirus pneumonia. Of this sample, 150 patients were prescribed tocilizumab at a dose of 8 mg/kg of patient weight, including 36 (24.0 %) cases when tocilizumab was administered in a two-dose regimen. In the case of a two-dose regimen, the second dose was administered no earlier than 24 hours after the first one. All patients were examined according to the current clinical protocols. The hemogram, the content of CRP, ferritin, interleukin-6 were assessed. All patients received dexamethasone intramuscularly at a dose of at least 6 mg per day. Statistical processing was carried out by methods of analysis of variance using the software Statistica 13.0. Results. After the use of tocilizumab, the patients had a decrease in body temperature and a decrease in the need for oxygen support. At the same time, the normalization of indicators of the activity of the systemic inflammatory response was observed. Mortality after the use of tocilizumab was 29.3 %; in all cases, the deaths had an extremely severe course of coronavirus infection and a significant comorbid background. There were no manifestations of anaphylaxis and cases of secondary infection after the appointment of tocilizumab. Conclusions. The use of tocilizumab could significantly improve the condition of patients with SARS COVID19. There were no signs of anaphylaxis and cases of secondary infection after the administration of tocilizumab. In the absence of a pronounced clinical effect within 24 hours after the first dose of tocilizumab in patients with severe SARS COVID19, it is advisable to re-administer the drug (two-dose regimen

Epidemiology of tumors of the spinal cord and spine in Ukraine in 2000-2019

Objective. To determine the dynamics and state of neurosurgical care for tumors of the spinal cord and spine (TSCS) in Ukraine. Materials and methods. The work is based on the analysis of hospitalizations and surgical treatment of patients with TSCS in neurosurgical departments of Ukraine in 2000-2019. Results. In 2019, 1,325 patients with TSCS were hospitalized in neurosurgical departments of Ukraine, which is 2,3 times more than in 2000 (567), per 1 million population - almost 3 times (34,7 vs. 11, 6 ). Over 20 years, the number of operated patients increased 2,8 times (from 385 to 1079), per 1 million population - 3,6 times (from 7,9 to 28,3), there was an increase in surgical activity by 20% (from 67,9 to 81,4%), a decrease in the general and postoperative mortality - twice (from 2,6 to 1,2% and from 2,6 to 1,3% respectively). Patients with TSCS account for 1,5% of all patients hospitalized in neurosurgical departments of Ukraine, 12,8% of all CNS neoplasms and 5,2% of all spinal pathology. Vertebral tumors account for 42,64% of all TSCS and extramedullary tumors have an incidence rate similar to vertebral tumors (42,64%), intramedullary tumors account for 14,72%. In 2019, 74.4% more patients with extramedullary tumors were hospitalized than in 2000 (565 and 324 respectively), and 84.5% more were operated on (463 and 251 respectively). The rate of increase is even higher per 1 million population. In 2019, there were 14.8 hospitalizations per 1 million population for extramedullary tumors, which is 2.2 times greater than in 2000 (6,6 hospitalizations), and 12,1 operations, which is 2,4 times greater than in 2000 (5,1 operations). In 2019, patients with intramedullary tumors were hospitalized 2,2 times more than in 2000. (195 and 89 respectively), were operated 2,5 times more (151 and 61 respectively). The rate of increase is even 4higher per 1 million population. In 2019, there were 5,1 hospitalizations for intramedullary tumors per 1 million population, which is 2,8 times greater than in 2000 (1,8 hospitalizations), and 4,0 operations, which is 3,2 times greater than in 2000 (1,2 operations). In 2019, patients with vertebral tumors were hospitalized 3.7 times more than in 2000 (565 and 154 respectively), were operated 6,4 times more (465 and 73 respectively). The rate of increase is even higher per 1 million population. In 2019, there were 14,8 hospitalizations per 1 million population for vertebral tumors, which is 4,7 greater than in 2000 (3,1 hospitalizations), and 12,2 surgeries, which is 8,2 greater than in 2000 (1,5 operations). Сonclusions. The introduction of modern neuroimaging methods and advanced treatment methods into clinical practice has contributed to an increase in the number of hospitalizations and surgical interventions in TSCS

An overview of the world practice of brain death diagnosis

Ця оглядова стаття висвітлює актуальність проблеми створення єдиних критеріїв діагностики смерті мозку. Наведено перелік клінічних та інструментальних діагностичних критеріїв, тривалість і кратність виконання тестів, склад консиліуму згідно з наказом № 821 від 23.09.2013 р. МОЗ України. Розглянуто два незалежні дослідження. Перше дослідження, проведене у 2013 році, виявило значні відмінності у виконанні клінічних і підтверджуючих тестів. У ньому брали участь 28 країн Європи. Було надіслано електронні анкети спеціалістам, які взяли участь у встановленні діагнозу. Друге дослдження опубліковане Американською академією неврології у 2015 році. Воно включало анкетування спеціалістів із 120 країн, які стикалися зі встановленням діагнозу смерті мозку. Було виявлено: відсоток країн, які мають правове положення та відомчі протоколи з діагностики смерті мозку; залежність наявності протоколів, відмінностей у виконанні тестів від рівня доходу країн та рівня розвитку трансплантаційної ланки; відмінності у виконанні клінічних діагностичних тестів (тест апное), їх тривалості та перерви між ними; частоту використання підтверджувальних тестів та яким надавалася перевага; склад консиліуму лікарів.This review article is focused on importance of developing the standardized criteria of brain death diagnosis. Initially, it offers a list of clinical and ancillary diagnostic criteria, duration and repetition of tests and a structure of the multidisciplinary team according to the Order No. 821 of the Ministry of Health of Ukraine dated 23.09.2013. Then two independently conducted studies have been described. One of them was carried out in 2013. Electronic questionnaires were sent to the experts from 28 European countries. The study found significant variations in clinical and ancillary tests. The authors described percentage of countries which have legal provisions and institutional protocols for brain death diagnosis; variations in the use of protocols and testing process depending on country’s income and presence of an organised transplant network; discrepancies in clinical diagnostic tests, including their duration, repetition and intervals; frequency of using ancillary tests; the structure of a multidisciplinary team. Another study was published by the American Academy of Neurology in 2015. It included a global electronic survey of physicians from 120 countries who would encounter diagnostic process of brain death in their practice