The purpose of the work is to identify the most optimal ways to solve the problem of home parenteral nutrition for patients with short bowel syndrome.Basics. Discussion of the current situation will help optimize the work of the Orphan Diseases Center, lead to a greater introduction of online technology, and aim at the search and implementation of new methods of treating patients in this category.Conclusion. The most optimal strategy has been proposed to improve the interaction between various specialists and patients in need of long-term parenteral nutrition.
Aim. To conduct comparative analysis of histological remission in patients with moderate and severe ulcerative colitis (UC), receiving biological therapy vedolizumab, mesenchymal stem cell (MSC) treatment and combined stem cells and vedolizumab therapy. Materials and methods. We studied biopsies of 75 patients with total or left-sided moderate and severe ulcerative colitis, divided into groups depending on treatment. The first group of UC patients (n=29) received stem cell therapy 2 mln per kg; the second group of UC patients (n=27) received vedolizumab and the third group (n=19) MSC and vedolizumab. The efficacу of treatment was assessed by C reactive protein (CRP), Mayo score (MS), fecal calprotectin (FC) and Geboes score (GS). Results. We determined medium correlation between basic FC and MS before treatment (r=0.6605, p0.05). After 12 weeks of treatment in the first group of UC patients (n=29) CRP was 7.82.1 mg/l, FC 409.344.85 g/g, medium GS 1.20.1 points. After 12 weeks of treatment in the second group of UC patients (n=27) CRP was 8.41.4 mg/l, FC 435.547.3 g/g, medium GS 1.350.15 points. After 12 weeks of treatment in the third group of UC patients (n=19) CRP was 6.41.1 mg/l, FC 290.617.5 g/g, medium GS 0.90.1 points. We proved strong direct relationship between FC and GS after 12 weeks of treatment in UC patients, receiving MSC (r=0.8392, p0.05). The statistically significant majority of patients, achieved histological remission, have less than 5-year duration of disease. Conclusion. Our study showed that clinical and endoscopic remission in UC patients does not always correlate with histological remission. Combined anti-cytokine and stem cells therapy contributes to achieve deep remission and decrease mucosa inflammation rather than single MSC or vedolizumab treatment. Deep remission could be achieved by earlier start of biological therapy. FC could be a predictor and marker of mucosa healing and histological remission
In a clinical case we can see the tactics of nutritional support in a patient with pseudomembranous colitis after repeated consecutive operations on the abdominal organs, which led to significant violations of the nutritional status. Nutritional status was assessed using traditional methods: determination of anthropometric parameters (shoulder circumference (OC), thickness of the skin-fat fold over the triceps (TSA)), assessment of clinical and biochemical blood tests. The main aim of demonstrating a clinical case is to show the significance, timeliness, and adequacy of nutritional support in the complex therapy of Clostridium difficile infection. Competent, individually selected correction of protein-energy deficiency in patients with pseudomembranous colitis allows achieving an effective treatment result, avoiding severe complications such as perforation, toxic dilatation, and bleeding. The peculiarity of this clinical case is that a patient with perforation of Meckel's diverticulum and abdominal abscess developed a complication - secondary widespread peritonitis, phlegmon, which required repeated surgical interventions. Surgical treatment and massive antibiotic therapy led to the development of Clostridium difficile infection, during the treatment the patient developed multiple loose stools and Clostridium difficile toxins A and B were detected. Severe pseudomembranous colitis was accompanied by protein-energy deficiency (hypoproteinemia, hypoalbuminemia), severe dehydration, hypokalemia, hyponatremia, and moderately severe anemia of complex genesis. When selecting nutritional support for patients with clostridial infection, it is important to take into account severe systemic inflammation, which affects the absorption and absorption of the intestinal wall, which in turn determines the route of introduction of nutrient substrates. In this case we need to choose the right method for correcting the nutritional status.
Adhesive disease is a syndrome caused by the presence of adhesions in the abdominal cavity, formed due to various reasons, and characterized by frequent bouts of relative intestinal obstruction.Purpose. Determine the complex of rehabilitation measures for adhesive disease.Material and methods. Patients with the following forms were observed: a) with pain syndrome (84.1%); b) with periodically recurring attacks of intestinal obstruction; c) there may also be asymptomatic SB (not found in observations). All patients had the following symptoms as pain, thirst, nausea (sometimes vomiting that does not bring relief), a feeling of heaviness in the abdomen, tachycardia, discomfort, flatulence, arterial hypertension. Ultrasound of the abdominal organs and laparoscopy, MSCT of the abdominal organs and plain radiography of the abdominal cavity and electrogastroenterography were performed to detect violations of the motor function of the gastrointestinal tract.Results and discussion. The complex of rehabilitation measures included the following rehabilitation. Outside the attack of adhesive disease (an attack of intestinal obstruction) and with adhesive dynamic obstruction, patients were treated conservatively; surgical rehabilitation was prescribed for an attack of adhesive mechanical obstruction. Conservative rehabilitation included exercise therapy, diet, folk remedies, medical correction.
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