Introduction. Sepsis is one of the main causes of high mortality in oncohematological patients. Sepsis is diagnosed using different scoring scales, but the accuracy of the diagnosis varies.Aim — to determine the effectiveness of SIRS, qSOFA and MEWS scales for the diagnosis of sepsis in oncohematological patients.Materials and methods. Study participants included 202 patients hospitalized in the intensive care unit with infectious complications — 112 (55 %) male, 90 (45 %) female. The median age was 57 years. The estimated predictors were the criteria of SIRS, qSOFA and MEWS scales and other significant indicators. The Boruta method was employed to select the predictors. A multiple binomial logistic regression model was used to determine the prognostic value of the predictors. The probability of sepsis was calculated based on the regression equation. The correlation between sepsis probability and the prognostic scales was assessed using correlation analysis (Kendall rank correlation coefficient).Results. Diagnoses were confirmed by scales in 95 of 202 (47 %) patients: SIRS — in 77 (81 %), qSOFA — in 31 (33 %), MEWS — in 65 (68 %). Of the 19 predictors initially included in the study, the final logistic regression model included 6: respiratory rate, heart rate, impaired urine output, systolic blood pressure, body temperature, and Glasgow coma scale level, which matched MEWS criteria. The median probability of sepsis was 0.38 (0.079–0.921). The results of the calculated probability of sepsis, according to the logistic regression model, correlated most closely with the score on the MEWS scale, to a lesser extent — with that on SIRS and qSOFA.Conclusion. The MEWS scale is a more suitable tool for the diagnosis of sepsis than SIRS and sofa in oncohematological patients.

The wide antibiotics use in different areas of medicine has significantly increased the incidence of pseudomembranous colitis caused by Clostridium difficile. Strong necessity of antibacterial therapy in hematological patients is the reason of a higher frequency of this complication after programmed chemotherapy and hematopoietic stem cell transplantation. The atypical course of clostridial colitis makes it difficult to diagnose, leads to delay of treatment and fatal complications. We presented the case of clostridial colitis with atypical clinical manifestations in the 8-year-old child with Hodgkin’s lymphoma. Disease was complicated by colon perforation and fecal peritonitis, which required surgery and long-term rehabilitation. The analysis of publications devoted to clostridial colitis in patients with hematological malignancies was carried out and possible reasons of its atypical course was reviewed. The ways to improve the diagnosis, treatment and prevention of this serious complication are presented.

Проведение химиотерапии и сопроводительного лечения в онкогематологии невозможно без обеспечения центрального венозного доступа. При долгосрочном программном лечении для снижения количества осложнений при повторных катетеризациях необходим длительный доступ к центральной вене. Применение полностью имплантируемых венозных порт-систем улучшает качество жизни пациентов. Анализ данных проведён у 149 больных гемобластозами, которым были установлены полностью имплантируемые венозные порт-системы. Периоперационные осложнения развились у 7 (4,7 %) больных. Период использования порт-систем в среднем составил 638 катетеродней. Инфекционные осложнения выявлены в 0,12 случаев на 1000 катетеро-дней и послужили причиной удаления устройства у 7 (4,7 %) пациентов. У 5 (3,3 %) больных порт-системы удалены в связи с развитием тромботических осложнений, еще у 5 (3,3 %) причиной удаления стали осложнения механического характера. Использование венозных порт-систем у больных гемобластозами в течение длительного периода времени является эффективным и безопасным средством обеспечения центрального венозного доступа.Ключевые слова: онкогематология, химиотерапия, центральный венозный доступ, полностью имплантируемое устройство, катетер-ассоциированные осложнения Chemotherapy and adjuvant treatment in haemato-oncology is impossible without providing central venous access. Durable access to the central vein is necessary to reduce the number of complications of repeated catheterization with longterm programmed treatment. The use of fully implantable venous port systems for this purpose improves the quality of life of the patients. Data analysis was carried out in 149 patients with hematological malignancies, who received fully implantable venous port systems. Perioperative complications developed in 7 (4.7 %) patients. The period of use of port systems averaged 638 catheter-days. Infectious complications were detected in 0.12 cases per 1000 catheter-days and caused the removal of the device in 7 (4.7 %) patients. In 5 (3.3 %) patients, port systems were removed due to the development of thrombotic complications, and in 5 (3.3 %) persons complications of a mechanical nature were the reason for the removal. The study showed that the use of venous port systems in patients with hemoblastosis for a long period of time is an effective and safe means of providing central venous access.