ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация Для пациентов на программном гемодиализе (ПГД) характерна двухкомпонентная гипергидратацияинтермиттирующая (ИГ) связана с прибавкой в весе в междиализные промежутки, персистирующая (ПГ)-с неправильно определенным сухим весом. Целью данного исследования явилась разработка комплекса мероприятий, направленных на минимизацию обоих компонентов гипергидратации. Материалы и методы. Применялся биоимпедансный многочастотный анализ (БИА), мониторинг относительного объема крови (ООК) и проводимости плазмы по данным монитора ионного диализанса у пациентов, поступавших для подготовки к трансплантации почки. Результаты. Анализ серийных (от 2 до 18) измерений у 380 пациентов в сравнении с 26 здоровыми субъектами выявил экспансию исключительно внеклеточного объема даже при массивной (от 3,5 до 15 л) гипергидратации. Гипергидратация, превышающая 15% внеклеточного объема, отмечалась у 41% пациентов при поступлении, отклонение от референсного значения уменьшалось в процессе лечения с 3,7 ± 1,4 л, до 1,9 ± 1,2 л. В ходе сеансов ПГД снижение относительного объема крови (ООК) у пациентов с ПГ не превышало 2,5% на 1 литр ультрафильтрации. При отработанном сухом весе данная величина служила суррогатным показателем активности сосудистого восполнения. Минимизация градиента натрия между диализатом и плазмой позволила снизить величину ИГГ. Заключение. Проблема устранения гипергидратации у пациентов на ПГД требует комплексного подхода и дальнейших исследований.
The aim: To determine the current prevalence of healthcare-associated tubo-ovarian infections in female and antimicrobial resistance of the responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on healthcare-associated infections surveillance data. Definitions of health¬care-associated tubo-ovarian infections were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST. Results: Among all the 1,528 of women in this study, the prevalence of healthcare-associated tubo-ovarian infections was 31.2%. Of these cases, Salpingitis, Oophoritis, and tubo-ovarian abscess were 47.5%, 34% and 18.5%, respectively. Of all cases tubo-ovarian infections in female, 74.7% were detected after hospital discharge. The predominant pathogens were: Escherichia coli (27.7%), Enterobacter spp. (12.2%), Klebsiella pneumoniae (9.6%), Staphylococcus aureus (8.2%), Pseudomonas aeruginosa (8.1%), and Enterococcus faecalis (7.5%), followed by Proteus mirabilis (5.1%), Streptococcus spp. (4.5%), Staphylococcus epidermidis (4.4%), and Acinetibacter spp. (4%). Methicillin-resistance was ob¬served in 16.8% of S. aureus (MRSA). No strains S.aureus and E. faecalis resistant to vancomycin. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 24.7%. The prevalence of ESBL production among E. coli isolates was 28.6% and among K. pneumoniae 12.8%. Resistance to third-generation cephalosporins was observed in 14.9% E.coli and 11.3% K. pneumoniae isolates. Carbapenem resistance was identified in 11.3% of P.aeruginosa isolates. Conclusions: A healthcare-associated tubo-ovarian infections of the female in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics.
The aim: To obtain the first estimates of the current incidence, and risk factors for Surgical Site Infection (SSI) after laparoscopic hysterectomy, and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a multicenter prospective cohort study was patient-based on surveillance data for SSIs were according to CDC/NHSN methodology. This study included women’s undergoing a laparoscopic hysterectomy in 8 hospitals from different regions of Ukraine from January 2018 to December 2020. Results: A total of 1184 women underwent a laparoscopic hysterectomy and 14.9% SSI were identified within 30 days of the operation. Majority of SSI were deep/organ-space. The deep/organ-space SSI incidence rate was 9.2% in total laparoscopic hysterectomy, 15.2% in laparoscopic-assisted vaginal hysterectomy, and 17% in laparoscopic supracervical hysterectomy. The predominant SSI types were Pelvic abscess or cellulitis (19.1%), Salpingitis (16%), Oophoritis (15.3%), Adnexa utery (14.5%), Vaginal cuff infections (13.7%), Endometritis (11.1%), and Chorioamnionitis (9.9%). 93.8% of SSIs were detected post discharge. The most commonly identified pathogen were Escherichia coli (21.6%), Enterobacter spp. (13.1%), followed by Klebsiella spp. (8,1%), Streptococcus spp. (7%), and Pseudomonas aeruginosa (7%). The overall proportion of extended spectrum beta-lactamase production (ESBL) among Enterobacteriaceae was 17.1% and of methicillin-resistance in S. aureus (MRSA)15.8%. Resistance to third-generation cephalosporins was observed in 13.7% E.coli and 8.5% Klebsiella spp. isolates. Carbapenem resistance was in 9.7% of P.aeruginosa strains. Conclusions: Our study identified high incidence rates of SSI within 30 days surveillance of the laparoscopic hysterectomy in Ukraine, and many cases were caused by pathogens that are resistant to antibiotics.
Diagnosis and treatment of acute surgical diseases in gynecology, despite the modern achievements of medical science, has been and remains a difficult and responsible task. In urgent situations, there is always a danger of operating the patient when it was not necessary, or viewing the acute surgical process with prolonged observation, which contributes to the development of complications and even death of the patient. Often, not only health, but also the woman’s life depends on how quickly and correctly the doctor will orient in the situation and apply the right organizational and medical measures. The development of endoscopic technology has allowed us to go from a simple visual examination of the abdominal cavity and pelvic organs to complex surgical interventions without an abdominal incision, and in emergency conditions, in case of acute abdominal pathology, in most cases, resolve diagnostic doubts. The article describes the advantages and disadvantages of endoscopic treatment of the most common urgent gynecological pathologies, especially the postoperative management of patients, rehabilitation and preventive measures to restore their reproductive health. Key words: urgent gynecological conditions, ectopic pregnancy, laparotomy, laparoscopy, semi-operative management, rehabilitation, prevention.
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