The aim of the study was identifying the features of infection in the site, clinical course of the disease, amount and frequency of patient examinations, family doctor communications and treatment of patients with pneumonia caused by SARS-Cov2. Materials and methods. We examined 23 families of 2–6 members (a total of 78), among them 41 patients with SARS-COV-2 pneumonia. The amount of patient examination (PCR, plain X-ray and CT of the thoracic cavity, coagulogram, blood oxygen saturation) and treatment extent (antibacterial, anticoagulant and oxygen therapy) were considered. Results. The contagiousness of the disease in the families of patients was from 33 % to 100%. The thoracic CT overuse: 73.3 % repeated, 33.0 % triple. Family doctors monitored the treatment only in 14.6 % of cases. The antibacterial therapy administration was 2 times more often than necessary; the treatment was changed by patients themselves or their acquaintances. A hospitalization was offered to patients with a decreased blood oxygen saturation of 92 % and below (29.3 %), and only 2 patients agreed to it. In a lack of treatment efficacy, the patients used respiratory fluoroquinolones (levofloxacin, moxifloxacin), meropenem, linezolid, amikacin, which are among the main drugs for the treatment of resistant tuberculosis. Extensive misuse of antibacterial drugs unnecessarily will result in an alarming increase in antibiotic-resistant infections after the COVID-19 pandemic. Conclusions. Pneumonia caused by SARS-COV-2 is a highly contagious disease in a family cluster (33–100 %). Routine administration of antibacterial drugs (especially levofloxacin, moxifloxanemine, meropenem, linezolid, amikacin) for patients with suspected SARS-COV-2 pneumonia by thoracic CT or PCR-confirmed without proven need is not only unnecessary, but even dangerous due to the potential increase in resistance to these drugs, which are the primary in the treatment of resistant tuberculosis. The anamnesis of the disease, oxyhemometry and coagulogram are of great importance when examining a patient with this pathology.
Цель работы-проанализировать методику бронходилатационного теста (БДТ) на обратимость на различные дозы сальбутамола у больных бронхиальной астмой и хронической обструктивной болезнью легких (ХОБЛ). Материалы и методы. Обследовали 80 больных с бронхообструктивным синдромом: 50 человек с легкой персистирующей бронхиальной астмой (I группа) и 30 пациентов с ХОБЛ средней тяжести (тяжесть В, II группа). У всех больных применяли рутинные методы исследования: общеклинические, лабораторные, исследование функции внешнего дыхания, рентгенография органов грудной полости (при необходимости), статистические методы. Результаты. Для исследования пациентов с БА и ХОБЛ использовали 2 методики проведения БДТ, которые отличались дозой сальбутамола. Сначала всех 50 больных БА обследовали на обратимость бронхообструкции с 200 мкг сальбутамола, затем (как правило, через 2 недели) 400 мкг сальбутамола. У больных БА обратимость имела место у всех больных БА после 200 мкг сальбутамола уже через 15 минут, но у 30 больных (60 %) она была полной (12 % и более от предыдущей, >200 мл), у 20 больных-частичной (менее 12 %, или 200 мл); через 30 минут полная обратимость получена у 46 из 50 больных (92 %), через 45 минут она составляла 12 % и более (>200 мл) у всех пациентов. При использовании дозы сальбутамола в 400 мкг при БДТ получены следующие результаты: через 15 минут полная обратимость установлена у 47 (94 %) больных, через 30 минут еще в 3 пациентов, то есть в всех больных БА. Сальбутамол в дозе 200 мкг через 15 мин не дал обратимости у 16 (53,3 %) больных ХОБЛ, частичная обратимость была у 14 (46,7 %) больных; через 30 мин частичную обратимость получили еще у 10 пациентов (33,3 %), у 6 больных (20,0 %) не получили обратимости или она была в пределах 2-3 %; только через 45 мин неполную обратимость получили еще у 4 из 6 больных (всего 93,24 %), у 2 больных обратимость отсутствовала после 60 минут исследования. БДТ при дозе сальбутамола в 400 мкг через 15 минут показал неполную обратимость у 26 (86,6 %) больных ХОЗЛ, через 30 минут еще у 3 (96,6 %) пациентов, через 45 минут у всех больных; полной обратимости не обнаружили.
Background: Despite the increasing number of X-ray endovascular operations on infrainguinal lesions of lower limb arteries open surgery remains highly relevant. The operating time of open surgeries cannot be considered satisfactory, especially when combined shunts are used in the infrainguinal position. Research objective is to improve the results of shunt operations at atherosclerotic lesions of the femoropopliteal segment by advancing the technique of determining the required extent and applying the autotransplant material. Material and methods. 72 patients were involved in the research. All the patients underwent the femoropopliteal shunt procedure. The instruments designed by us (autovenous shunt length meter and the device for tunnel formation and for applying the shunt into the tissues) were used in the first group. Patients from the second group were operated on with the use of the classical technique and equipment. Results. No combined shunts were used in the first group of patients in comparison with the second group (n=5). Statistically significant results (p<0.05) between the studied groups were obtained according to such criteria as number of cases of intraoperative shunt torsion (p=0.0171), length of unused autograft material (p=0.0001), ankle brachial index increase (p=0.024), the number of early postoperative complications (p=0.028), the number of shunt dysfunctions (p=0.0203) and shunt functioning duration (p=0.013). Conclusions. The use of the patented instruments when performing femoropopliteal shunting allows to determine precisely the required amount of autotransplanted material and to provide its more convenient applying in the subcutaneous tunnel. The use of the patented instruments when performing femoropopliteal shunting with a reversed autovein made it possible to improve the technique of this revascularization operation: to accurately determine the required amount of autograft material which excluded the presence of patients with combined shunt in the first group, as well as to perform the simultaneous creation of a tunnel in the soft tissues of the thigh, shin and reliable shunt placement, excluding it’s rotation along the axis. The use of the patented instruments when performing femoropopliteal shunting allowed to get positive results in the first group, in comparison with second group of patients both in the early and late postoperative periods.
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