The application of chitosan (Ch) as a promising biopolymer with hemostatic properties and high biocompatibility is limited due to its prolonged degradation time, which, in turn, slows the repair process. In the present research, we aimed to develop new technologies to reduce the biodegradation time of Ch-based materials for hemostatic application. This study was undertaken to assess the biocompatibility and hemostatic and tissue-regeneration performance of Ch-PEO-copolymer prepared by electrospinning technique. Chitosan electrospinning membranes (ChEsM) were made from Ch and polyethylene oxide (PEO) powders for rich high-porous material with sufficient hemostatic parameters. The structure, porosity, density, antibacterial properties, in vitro degradation and biocompatibility of ChEsM were evaluated and compared to the conventional Ch sponge (ChSp). In addition, the hemostatic and bioactive performance of both materials were examined in vivo, using the liver-bleeding model in rats. A penetrating punch biopsy of the left liver lobe was performed to simulate bleeding from a non-compressible irregular wound. Appropriately shaped ChSp or ChEsM were applied to tissue lesions. Electrospinning allows us to produce high-porous membranes with relevant ChSp degradation and swelling properties. Both materials demonstrated high biocompatibility and hemostatic effectiveness in vitro. However, the antibacterial properties of ChEsM were not as good when compared to the ChSp. In vivo studies confirmed superior ChEsM biocompatibility and sufficient hemostatic performance, with tight interplay with host cells and tissues. The in vivo model showed a higher biodegradation rate of ChEsM and advanced liver repair.
Ключові слова: генералізований тяжкий правець, вакцинація, специфічна профілактика правця. Резюме. Внаслідок низького рівня планової вакцинації в Україні в останні роки спостерігається високий рівень захворюваності на правець серед дитячого населення. У роботі проаналізований клінічний випадок захворювання на правець у невакцинованої дитини дошкільного віку, висвітлені проблеми, з якими стикається лікар під час лікування генералізованої тяжкої форми цієї хвороби. Мета роботи-з'ясувати причини розвитку, особливості перебігу та лікування генералізованої форми правця у дітей. Результати. Доведена необхідність підвищення рівня планової вакцинації для створення колективного імунітету проти правця. Також потребують оновлення підходи до лікування правця в Україні. Висновок. Проблема профілактики, діагностики та лікування правця в Україні залишається актуальною. Це підтверджує наведений клінічний випадок. Збільшення кількості вакцинованих осіб запобігатиме захворюваності на правець і розвитку особливо складних у лікуванні генералізованих форм цієї хвороби. Лікування тяжких форм правця потребує сучасних знань і підходів для зменшення інвалідизації хворих та зниження летальності.
Currently, anesthesiologists-resuscitators have a large number of sedatives (hypnotics, general anesthetics, anxiolytics), but many of them, in addition to the main action, give a number of side effects or do not provide optimal sedation. On the other hand, there are new modern drugs for sedation, thus, the need to correct existing regimens of sedative therapy is quite timely and necessary. The aim of the study was to examine the advantages and disadvantages of different sedation methods in patients with urological profile operated under spinal anesthesia. 80 patients (54 men and 26 women) who underwent urological surgery under balanced anesthesia (spinal anesthesia in combination with drug sedation) were examined. Patients were randomly divided into two groups. Group 1 (n = 40) – sedation with dexdor, group 2 (n = 40) – sedation with diprivan. The level of sedation was assessed using the RAMSEY scale, the degree of post-anesthesia recovery on the Bidway five-point scale, and anesthesia satisfaction was assessed using the Lowa Satisfaction with Anesthesia Scale (ISAS). The degree of hemodynamic disorders was determined by continuous monitoring of heart rate, blood pressure and ECG. The normality of the distribution was checked using the Shapiro–Wilk method. The Mann–Whitney test was used to assess the statistical significance of the difference between the two independent groups. Results. The study showed that a deeper level of sedation during surgery was observed in the second group (sedation with diprivan). In this group, postoperative drowsiness was also higher both during the first 15 minutes and 30 minutes after surgery. Despite the fact that patients receiving dexdor had more superficial sedation, they generally showed significantly higher overall satisfaction with anesthesia. The study proved the effectiveness and safety of both drugs for sedation in urological patients under spinal anesthesia. However, a number of important advantages of dexdor were found as compared to diprivan. Dexdor, due to its ability to cause mild to moderate sedation, allows the patient to contact staff, almost does not suppress respiration, lets the patient feel comfortable and causes sufficient retrograde amnesia.
The study focuses on the problem of severe tetanus cases, which continue to be reported worldwide. The population of countries with low vaccination rates, including Ukraine, is particularly at risk. Despite the increase in the level of DPT vaccination in our country among adults and children, it remains insufficient, which leads to the registration of new cases of tetanus. The aim of the study was to analyze the main directions in the treatment of tetanus. The authors searched for information in electronic databases such as MEDLINE/Pub Med and Google Scholar for the last 20 years. The search was performed on such terms as tetanus, treatment, benzodiazepines, tetanus immunoglobulin (medical topics). The main components of modern treatment are analyzed in the paper, which include removal of the pathogen by careful surgical treatment of wounds, rational antibiotic therapy. Drugs of choice for the eradication of vegetative forms of the pathogen are benzylpenicillin and metronidazole, but can also be used antibacterial drugs of other groups (macrolides, tetracyclines, cephalosporins). Specific immunotherapy with tetanus immunoglobulin can neutralize the toxin that freely circulates in the blood. Those who do not have vaccination data are also indicated for the introduction of tetanus toxoid. Intrathecal administration of anti-tetanus immunoglobulin remains a debatable issue. In the treatment of convulsions, drugs of the benzodiazepine group are preferred. Infusions of high doses of magnesium, dexmetomedin, baclofen, propofol or their combination can also be used. In the case of severe muscular rigidity, muscle relaxants of nondepolarizing action are used. If the spasms are prolonged, botulinum toxin A may be recommended as an injection into peripheral muscles. B-blockers (esmolol), dexmetomedin, clonidine are used to overcome autonomic dysfunction of the nervous system. Supportive therapy is important. It is aimed at providing the patient with complete nutrition. Adequate ventilation with early tracheostomy helps to avoid complications of prolonged intubation. The above methods can significantly reduce mortality from tetanus from 100% (in the absence of treatment) to 10%–20%. Keywords: tetanus, management, benzodiazepines, magnesium sulfate, tetanus immunoglobin, tracheostomy.
Background: There are different approaches to the assessment of the severity of trauma in a victim and to the provision of specialized health care. Some of them are based on the development of scales and logistic models, using expert systems or statistical methods, to assess the severity of injury and the probability of a particular outcome. This article presents the results of a study on the feasibility of developing and applying various statistical models in order to predict the outcome in the case of different types of trauma, based on data on the status of victims with severe trauma. Patients and methods:
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