DYNAMICS OF INDICATORS IN PLATELET HEMOSTASIS IN POLYTRAUMA AND ENLARGED BODY MASS INDEX.

OBJECTIVE: The aim: Analyze the dynamics of indicators in platelet hemostasis in polytrauma and enlarged body mass index. PATIENTS AND METHODS: Materials and methods: A comprehensive study of hemostasis was performed in 224 sick with polytrauma and high body mass index within a month and on the 360th day. RESULTS: Results: In Group I, the aggregation time was shortened during stimulation of ristomycin by 25% from day 1 to day 3. In patients in the II group, with the addition of ADP, the presence of hyperaggregation of platelets was determined from the 1st to the 3rd day and from the 30th to the 360th (a 36% reduction in time compared to the control was determined). In patients in the III group, ADP-aggregation was reduced on the 1st day (by 34%), after which hypoaggregation was noted (from the 3rd to the 14th and on the 360th day) with an increase in the rate of approximately 33% compared to the control group, after which there was a persistent hyperaggregation from 30 to 360 day with a 25% reduction in aggregation time. CONCLUSION: Conclusions: An individual response of platelets to damage was established depending on the severity of polytrauma and increased body mass index.

EFFICACY OF COMBINATION OF TIOTROPIUM/OLODATEROL IN PATIENTS WITH COPD IN REAL CLINICAL PRACTICE.

OBJECTIVE: The aim: Show the efficacy of the Tiotropium / olodaterol combination in real clinical practice. PATIENTS AND METHODS: Materials and methods: 100 patients with the diagnosis of COPD were included onto the study during the period of 2019-2020, an average age was 64.09±1.94 years, 66 were men (66 %) and 34 were women (34 %). There were 68 % of smokers with the average smoking experience of 24.44±4.84 pack-years. Average COPD duration was 9.35±2.42 years. There were 3 visits in the study - visit 1 (baseline), visit 2 (4-6 weeks) visit 3 (1 year). Source documentation was assessed at visit 1 and visit 3 for amount of exacerbations, antibiotic, glucocorticosteroid, methylxanthines use; mMRC and CAT were assessed at all visits. RESULTS: Results: Combined therapy with tiotropium/olodaterol improves clinical course of COPD, which is characterized by the significant decreased of the amount of exacerbations (2.63±0.29 to 1.63±0.21) and hospital admissions (1.2±0.2 tо 0.37±0.11). Improvement of symptoms and amount of exacerbation leads to much less use of antibiotics and glucocorticosteroids. A part of patients that used antibiotics decreased from 86±6.9 % to 67±9.3 %, amount of antibiotic courses from 1.37±0.17 tо 0.88±0.15, duration of treatment with antibiotics from 10.85±1.53 to 6.12±1.17 days. Part of the patients that used glucocorticosteroids decreased from 50±9.9 % tо 30±9.1 %, duration of treatment with antibiotics reduced from 3.97±1.06 tо 1.86±0.91 days. There also was a tendency towards a lesser used of methylxanthines. Combined therapy with tiotropium/olodaterol significantly decreased symptoms of COPD according to the mMRC (2.3±0.14 to 1.87±0.15) and САТ (23.28±1.71 to 15.77±1.58). CONCLUSION: Conclusions: Tiotropium/olodaterol combination showed its efficacy in real clinical practice. There was significant reduction in amount of exacerbation and antibiotic, gluco¬corticosteroid use during the study, which was also accompanied by the reduction is symptoms.

5-HT3 SEROTONIN RECEPTOR BLOCKERS FOR INTENSIVE THERAPY OF TRAUMATIC DISEASE IN PATIENTS WITH MULTIPLE TRAUMA.

OBJECTIVE: The aim: To find the most rational choice of drugs that have anti-emetic effect in patients with polytrauma in acute and early periods. PATIENTS AND METHODS: Materials and methods: We examined 82 patients with polytrauma, 62 men and 20 women. The age of patients ranged from 19 to 50 years. Patients were divided into the main and control group with 36 and 46 people respectively, who did not differ significantly by sex, age, anthropometric data, the nature and severity of injuries, and the time from injury to admission to hospital. RESULTS: Results: Full antiemetic effect was achieved in 72.4% of patients, where metoclopramide was used. Сomplete antiemetic effect was achieved in 96.3% of patients, where sturgeon was used. Decrease of peristaltic activity does not increase postoperative intestinal paresis, and also prevents irritable bowel syndrome and diarrhea caused by dysbacteriosis on the background of antibiotic therapy. Anxiolytic effect without sedative effect and impairment of motor coordination, decrease of the somatic and psychopathological symptoms intensity in alcohol-toxic withdrawal syndrome contributes to the correct interpretation of the traumatic disease. CONCLUSION: Conclusions: Use of drugs with antiemetic effect is an important part of the complex of traumatic disease treatment in patients with polytrauma. The use of osetron is rational in patients with polytrauma with cranio-abdominal injuries.

PROGNOSTIC PARAMETERS OF THE SUSCEPTIBILITY OF STAPHYLOCOCCUS SPP. TO AMINOGLYCOSIDES AND DOXYCYCLINE.

OBJECTIVE: The aim: To perform microbiological investigation and analytic mathematic prediction of clinical isolates of S. aureus to aminoglycosides in patients with severe burns. PATIENTS AND METHODS: Materials and methods: We analyzed resistance of 199 S. aureus strains to aminoglycosides (gentamicin, tobramycin and amikacin) and doxycycline from 435 patients treated in the regional hospital due to burns for the period from 2011-2017. RESULTS: Results: We created predictive curves for the prediction of susceptibility of S. aureus strains to aminoglycosides and doxycycline based on the changes in S. aureus resistance during the years of observation and expressed in mathematic equations. Susceptibility of S. aureus to gentamicin was 42.86 % at the end of observation and will decline in future. Despite tobramycin was efficient against 72.86 % of strains in 2017, mathematic modeling indicates rapid decline in its efficacy in future. Efficacy of amikacin was dropping during the last years, but according to the equation it efficacy will increase over 60 % in 2018. S. aureus susceptibility to doxycycline was 65.38 % in 2017 and mathematic modeling indicates its gradual decline in the nearest future. CONCLUSION: Conclusions: Predicitive values of S. aureus susceptibility indicates not sufficient efficacy of these drugs in patients with infectious complications of burns. Tendency of the slight decline of S. aureus susceptibility to doxycycline still indicates sufficient levels of its efficacy in the nearest future. This justify its use as a second-line therapy with the causative agent in patients with burns.

influence of anesthesia type on intraocular pressure during spine surgery in prone position.

OBJECTIVE: The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. PATIENTS AND METHODS: Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) - under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) - under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. RESULTS: Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. CONCLUSION: Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.