Видання англійською мовою. Кафедра анестезіології та інтенсивної терапії

New aspects of pedagogical activity in the distant form of pathological physiology teaching to medical university students

2021-11-04T11:27:52Z

New aspects of pedagogical activity in the distant form of pathological physiology teaching to medical university students Vastyanov, R. S.; Yermuraki, P. P.; Stoyanov, A. N.; Tiron, O.I.; Beseda, Ya. V.; Ostapenko, I. O.; Dobrovolsky, V. V.; Lapshin, D. Ye.; Stecenko, A. V. Distance learning (DL) is a completely new and unique form of education, which got forced to switch to by the current pandemic of coronavirus disease. Note that until now, distance learning technologies have been used at the department of general and clinical pathological physiology and some other departments of the Odessa National Medical University (ONMedU). The aim of this analytical article is to analyze the efficacy of ONMedU General and Clinical Pathological Physiology Department staff during the one and a half year period of the coronavirus infection pandemic with an accent to psychological approach to students modified teaching. The urgent need of time and the primary desire to protect students and their own lives during 2020-2021 requires us to improve our own pedagogical approaches in the further on-line teaching of students. We see success in systematic methodological work with students, the implementation of which will make it possible to evoke and increase their motivation to study histology. The importance of this methodological technique, supported in the senior years of medical universities by the integration of teaching theoretical and clinical disciplines, the approximation of teaching to specific clinical cases will help optimize the assimilation of morphological knowledge by students at least and, undoubtedly, in the near future will lead to a better assimilation of clinical disciplines. In connection with the ideas of individualized and developmental learning, the use of psychological capabilities of learning tools in the virtual environment brings both pedagogy and psychology to a new level of understanding the mediation of mental, creative, communicative and executive learning and learning activities. The use of distance learning helps the students to acquire skills of independent work, creates comfortable conditions for creativity, increases the creative and intellectual potential of the student through self-organization, the ability to interact with computer technology and make responsible decisions, creates favorable conditions for individual creative expression in the process of learning, for the development of the student's personality. The authors are convinced that the optimization and improvement of the educational process in medical universities is to draw students' attention to the problems that the medical community is dealing with on a daily basis today.

Surgical treatment of newborns with coarctation of aorta and severe distal aortic arch hypoplasia by modified amato method

2020-07-23T07:59:03Z

Surgical treatment of newborns with coarctation of aorta and severe distal aortic arch hypoplasia by modified amato method Lekan, R. Y.; Buzovskyi, V. P.; Buriachenko, I. E.; Bosenko, V. I.; Lekan, I. R.; Popsuiko, O. V.; Tomak, A. I.; Rudometkin, O. V. The purpose of this study is to evaluate the effectiveness of surgical treatment of newborns with coarctation of the aorta and severe hypoplasia of the distal aortic arch in a modified Amato method according to the data of the immediate and mid-term results. Methods: 33 newborns with coarctation of aorta and severe distal aortic arch hypoplasia were subjected through left posterior thoracotomy using for plasty of arch tissue the left carotid artery and the left subclavian artery and then classic resection coarctation next extended end-toend anastomosis.. Eight of them had associated difficult concomitant cardiac abnormality of large overload blood and associated of high pulmonary hypertension required pulmonary artery banding before distal aortic arch plasty and extended end-to-end anastomosis. Mean age and weight were 9 (6–21) days and 3,4 (2,5–3,9) kg, respectively. Median preoperative Z-score of distal aortic arch was – 3,26 (-4,56 to -2,12) and istmus -3,66 (-5,16 to -2,76). Results: Thirty one patients had successfully operated by this approach. The nonischemic and ischemic aortic cross clamping mean time were 28 min and 25 min accordingly. The immediate postoperative mean Z-score of the distal aortic arch was 0.58, and after the average mid-term period of 4.7 (1–9) years it was – 0.17 (-0.36 to 0.75), which allows it to be affirmed these indicators as normal. Conclusions: Tissues the left carotid artery and the left subclavian artery after plasty give growth to distal arch of aorta in the mid-term period more than 93,9% of cases.

Trauma-induced coagulopathy - prothrombin complex concentrate vs fresh frozen plasma

2020-06-27T18:55:44Z

Trauma-induced coagulopathy - prothrombin complex concentrate vs fresh frozen plasma Tarabrin, O.; Shcherbakow, S.; Gavrychenko, D.; Mazurenko, G.; Ivanova, V.; Chystikov, O. The mortality in the in patients with traumatic injuries in a case of bleeding is the most frequent cause of preventable death after severe injury. Methods: The study involved 91 patients who entered the Odessa Regional Hospital with traumatic injuries: concomitant skeletal trauma, fractures of femur and humerus.

Comparison of perioperative changes in hemostatic potential with low-frequency piezoelectric thromboelastography (LPTEG) in patients with benign prostatic hyperplasia during radical retropubic prostatectomy

2020-06-15T10:16:48Z

Comparison of perioperative changes in hemostatic potential with low-frequency piezoelectric thromboelastography (LPTEG) in patients with benign prostatic hyperplasia during radical retropubic prostatectomy Suslov, O. S.; Суслов, О. С. Мета. Порівняти періоперативні зміни у НПТЕГ пацієнтів, котрим проводилася операція відкритої черезміхурової радикальної простатектомії (ЧРПЕ) з приводу доброякісної гіперплазії простати (ДГПЗ), під загальною або епідуральною методикою анестезії. Матеріали та методи. Проспективно оцінювалися дані пацієнтів (n=69) з діагнозом ДГПЗ (підтвердженим гістологічно та рівнем PSA), котрим проводилося оперативне втручання у обсязі ЧРПЕ у період з листопаду 2017 р. по листопад 2019 р. на базі Одеської обласної клінічної лікарні. Пацієнти були розподілені на дві групи: групу А (n=33) склали пацієнти, що проходили ЧРПЕ з використанням епідуральної анестезії (ЕДА) через катетер; групу В (n=36) – ЧРПЕ з використанням загального наркозу та внутрішньовенної анальгезії опіоідами. Усім учасникам проведено дослідження гемостатичного потенціалу за допомогою НПТЕГ при надходженні до лікарні перед проведенням будьякої терапії, безпосередньо перед оперативним втручанням та на 60 хвилині оперативного втручання. Статистична обробка отриманих даних проводилася за допомогою програмного забезпечення MATLAB. Результати. Вихідні данні перед операцією у пацієнтів обох груп демонстрували компенсований гіперкоагуляційний стан та співпадали з такими на момент надходження. Однак дані на 60 хвилині у групі А демонструють тромбоеластограму, котра тотожна нормальній; у групі В чітко відображені порушення агрегації при нормальних показниках коагуляції та фібрінолізу. Відмінності були статистично значущими (Р <0,0001). Висновок. При компенсованому гіперкоагуляційному розладі, котрий реєструється у пацієнтів з ДГПЗ що потребують ЧРПЕ, під час оперативного втручання з використанням ЕДА через катетер значення НПТЕГ тотожні нормі. В той самий час, дані НПТЕГ при ЧРПЕ з використанням загальної анестезії та внутрішньовенною анальгезією опіоідами демонструють гіпоагрегантний стан при нормальних показниках гемокоагуляції та фібрінолізу. Причинами вищевказаного можуть бути сприятлива дія епідуральної анестезії на симпатичну нервову систему, а також зменшення потреби у введенні інфузійних розчинів при ЕДА через менші показники крововтрати. Однак, необхідні подальші дослідження серед пацієнтів урологічного профілю для підтвердження цих результатів та можливості їх інтерпретації для всієї когорти урологічних пацієнтів.; Objectives. To compare perioperative changes in LPTEG of patients undergoing open radical retropubic prostatectomy (ORRP) surgery for benign prostatic hyperplasia (BPH), under general or epidural anesthesia. Materials and methods. The data of patients (n = 69) diagnosed with BPH (confirmed histologically and by PSA level), who underwent surgery for ORRP in the period from November 2017 to November 2019 at the Odessa Regional Clinical Hospital, were prospectively evaluated. Patients were divided into two groups: group A (n = 33) consisted of patients undergoing ORRP using epidural anesthesia (EDA) through a catheter; group B (n = 36) - ORRP using general anesthesia and intravenous opioid analgesia. All participants were tested for hemostatic potential using LPTEG upon admission to the hospital prior to any therapy, immediately before surgery, and at 60 minutes of surgery. Statistical processing of the obtained data was performed using MATLAB software. Results. The baseline data before surgery in patients in both groups demonstrated a compensated hypercoagulable state and coincided with those at the time of admission. However, data at 60 minutes in Group A show a thromboelastogram that is identical to normal; Group B clearly reflects aggregation disorders with normal coagulation and fibrinolysis. The differences were statistically significant (P <0.0001). Conclusion. In compensated hypercoagulative disorder, which is registered in patients with BPH who require ORRP, during surgery with EDA through the catheter, the values of LPTEG are identical to the norm. At the same time, the LTPEG data for ORRP using general anesthesia and intravenous opioid analgesia show a hypoaggregative state with normal hemocoagulation and fibrinolysis rates. The reasons for the above may be the favorable effect of epidural anesthesia on the sympathetic nervous system, as well as reducing the need for the introduction of infusion solutions for EDA due to a comparatively lower level of the blood loss. However, further studies are needed among urological patients to confirm these results and to interpret them for the entire cohort of urological patients.

The recruitment of microcirculatory-mitochondrial of critical obstetric situations in the complex multi-organ support therapy reduces pCO2 (AV gap) and the development of the syndrome of acute multi-organ dysfunction

2020-06-15T10:15:06Z

The recruitment of microcirculatory-mitochondrial of critical obstetric situations in the complex multi-organ support therapy reduces pCO2 (AV gap) and the development of the syndrome of acute multi-organ dysfunction Vasiliev, I.; Vasilieva, M.; Vasilieva, I.; Ghicavîi, V.; Litarczek, G.; Friptu, V.; Gladun, S.; Diug, V.; Vartanov, V.; Stavrou, I.; Tarabrin, O.; D Ambra Mirta Aretrospective analysis of the 35-year absence of maternal mortality in critical obstetrics, in different countries, was due to the timely decentralization of macro-circulation, detoxification and analgesia. Macro-circulation was decentralized once the systemic perfusion pressure has been established; which is the difference between the mean blood pressure and the pressure of the capillary resistance, and what contribute to by decreasing the tissue hypoxia marker pCO2 (pCO2 AV gap >6 mm Hg) due to micro-circulatory-mitochondrial recruitment, through improved microcirculation at the level of the capillary-cell metabolic area: metabolic capillary – cells – mitochondria; with ameliorate of the venous return compliance and reduction (pCO2 AV gap <6 mm Hg), and respectively, diminishes of the microcirculatory-mitochondrial distress syndrome (MMDs), and stopping expansion syndrome of acute multi-organ dysfunction.

Utility of low- frequency piezoelectric thromboelastography (LPTEG) for comparison of mono- and combined antithrombotic therapy results in patients with morbid obesity

2020-06-15T09:19:34Z

Utility of low- frequency piezoelectric thromboelastography (LPTEG) for comparison of mono- and combined antithrombotic therapy results in patients with morbid obesity Tarabrin, O.; Sukhonos, R.; Suslov, O.; Volodychev, D.; Vorotyntsev, S.; Tarabrin, P. Patients with morbid obesity (MO) have a high risk of thromboembolic events. In patients with a BMI >35, the hypercoagulable state is due to impairment of all parts of the blood coagulation as well as anticoagulation mechanisms by obesity. Combined therapy of thromboembolic complications in patients with obesity Sodium Enoxaparin sodium and Pentoxifylline is more effective than Enoxaparin sodium monotherapy because it affects all parts of the hemostatic system.

Prevention of disorders of blood coagulation at the patients after total hysterectomy

2020-06-15T09:11:54Z

Prevention of disorders of blood coagulation at the patients after total hysterectomy Tarabrin, O.; Mazurenko, A.; Tarabrin, P.; Sazhyn, D.; Volodychev, D. Acquired factor V deficiency (AFVD) is a rare but challenging bleeding disorder with approximately 150 cases reported in the literature. Its clinical presentation may span from the asymptomatic laboratory abnormalities to the life-threatening bleeding. Current recommendations emphasize the importance of decreasing the anti-FV antibody titre only if bleeding symptoms are present. (1) Based on this report, a new proposal for the treatment of asymptomatic AFVD patients could be made.

Comparison of hemostatic potential and analgesia methods of elderly patients who underwent major urological surgery during their stay in ICU

2020-06-15T08:49:35Z

Comparison of hemostatic potential and analgesia methods of elderly patients who underwent major urological surgery during their stay in ICU Tarabrin, O.; Suslov, O.; Sukhonos, R.; Basenko, I.; Volodychev, D.; Tarabrin, P. Deep vein thrombosis (DVT) is a major problem in ICU and affects overall lethality. DVT is widespread complication in ICU, especially in elderly patients, when early activisation may not be achieved. Aim of this study is comparison of haemostatic potential and analgesia methods of elderly patients who underwent major urological surgery during their stay in ICU. Use of epidural catheter analgesia provides moderate decrease of anticoagulants dosage compared to opioid analgesia patients; however strict control of TEG data must be presented. Comorbidity need to be monitored for early detection and prevention of DVT events.

Role of pCO2 (AV gap) of Multi Organ Dysfunction Syndrome

2020-06-15T08:15:19Z

Role of pCO2 (AV gap) of Multi Organ Dysfunction Syndrome Vasiliev, I.; Groppa, S.; Ghicavii, V.; D' Ambra Mirta; Friptu, V.; Gladun, S.; Diug, V.; Spinei, L.; Vartanov, V.; Stavrou, I.; Tarabrin, O.; Litarczek, G. Recruitment of Microcirculatory-Mitochondrial (RMM) reduces Microcirculatory-Mitochondrial Distress Syndrome (MMDs), and Syndrome of Multi-Organ Dysfunction (MODs), by accelerated speed of delivery and return of blood flow which directly leads to a decrease in tissue hypoxia marker pCO2 (AV gap) and respectively with ↓ many other Endogenous Toxic Substances (ETS). In cases of pulmonary damage with ↑ pCO2 & ↓ Oxygenation Index PaO2/FiO2 ↓ 300 the development of Acute Respiratory Distress Syndrome (ARDs), MMDs are also aggravated at ↑ with pCO2 AV gap. RMM also needs additional support of Multiple Organ Therapies-Multi-Organ Supportive Therapy (MOST), Alveolar Recruitment, Extracorporeal Life Support Organization (ELSO), Modeling of the Index of Extravascular Lung Fluid, EVLWI, Th4- Th5 Thoracic Epidural Block, Active detoxification methods. The absence of decreasing of the pCO2 tissue hypoxia marker at the pCO2 AV gap ↓ 5.0 mmHg, after RMM proves the mitochondrial eu-energetic metabolic remodeling with the elimination of the hypo(an)ergic mitochondria performed by lysosomal clearance (mitophagy) makes the predominance eu-ergic mitochondria with the normalization of mitochondrial Ca++-uniporter-channel and mitochondrial permeability pore transition which productively inactivate the toxic forms of oxygen and nitrogen.

Prothrombin Complex Concentrate Vs Fresh Frozen Plasma in Obstetric Massive Bleeding

2020-06-27T18:59:32Z

Prothrombin Complex Concentrate Vs Fresh Frozen Plasma in Obstetric Massive Bleeding Tarabrin, O.; Tyutrin, I.; Shcherbakov, S.; Gavrychenko, D.; Mazurenko, G.; Chystikov, O. The severe capillary leak-induced respiratory and renal failure limit large-volume resuscitation with crystalloids and blood components. The combined use of low volumes of crystalloids and “damage control resuscitation” (DCR), a blood product resuscitation goal of a 1:1:1 ratio of packed red blood cells (PRBC), fresh frozen plasma (FFP) has recently been applied to obstetric patients in hemorrhagic shock.