CEREBRAL OXIMETRY AS A PREDICTOR OF THE OUTCOME OF THE DISEASE IN PATIENTS WITH SECONDARY BRAIN LESIONS

This study is devoted to the study of the prognostic value of cerebral oximetry of the brain and indicators of the outcome of brain damage. The purpose - to study the prognostic role of cerebral oximetry indicators as a predictor of mortality in vascular and traumatic brain injuries. A prospective cohort study involving 129 patients. Cerebral gas exchange and oxygenation, arteriovenous difference, neuron-specific markers (S100ß, NSE) and glucose, acid-base state and gas composition of arterial blood were studied during follow-up periods: at admission, on the 3rd, 5th and 7th days of patients' stay in the intensive care unit. The most significant risk factor for an unfavorable outcome is a marker with a threshold value or with a cut-off point rSO2<45%. Statistically significant direct connections were determined between dependent rSO2<45% with independent variables, such as: S100ß<0.6 mcg/l - OR is 4.22 (95%CI:10.76-1.66), p=0.0025; joining in a patient with a diagnosis of pneumonia - OR 6.21(95% CI:12.0-3.21), p<0.0001 and the patient's diagnosis was 8.13 (95% CI:25.59-2.59), p=0.0003. The measure of certainty of the obtained model was according to the criterion of pseudo R2 Nagelkerke -137.8; log Likelihood - 175.83. The cut-off point of 97.1% had the best predictive value of the model, the area under the AuROC curve was 0.846; sensitivity - 68.47%; specificity - 90.16%; NPV - 61.11%; PPV - 92.68%. The quantitative indicator rSO2 was obtained in relation to the independent variables GCS, ABP, NSE and pH and the quality characteristic of the model has: R2 = 16.7%; R2 (adjusted) = 15.5%; p<0.0001. This model can be used to predict the outcome in patients with acute cerebral pathology.

FACTORS OF AGGRESSION AT THE STAGES OF OPEN SURGICAL TREATMENT OF SEVERE FORMS OF PERITONITIS

There are many unresolved questions regarding the features of surgical aggression in the open method of treatment of severe forms of peritonitis. There are isolated publications in the literature on the risk features of these interventions, despite the high prevalence of the problem. The purpose of this study was to study the features of surgical aggression in the open method of treatment of severe forms of peritonitis. The study included 205 patients with severe forms of purulent peritonitis treated at the Emergency Hospital in Aktobe (n=205). To assess the factors of surgical aggression, the reliability of the results was evaluated by variational statistics according to the Student's t-criterion, taking into account the degree of freedom, at p<0.05 and p<0.01, with the calculation of arithmetic averages and their average errors (M+m). The data are presented as an average value±standard deviation or median and percentiles, p-values less than 0.05 were considered significant. Based on the results obtained, it was found that the frequency of repeated laparosanation surgical interventions in one patient was 2.8±0.3 times against the background of purulent-inflammatory process in the abdominal cavity, a high degree of stress index of the regulatory systems of the body during sanitation was revealed - up to 1460.9±101.5 units, postural reactions of blood circulation and respiration in 7.55% and metabolic disorders homeostasis. Aggressive factors affecting patients and causing the risk of multiple laparosanation interventions at the stages of open surgical treatment of severe forms of peritonitis have been identified. The data obtained can be used to develop therapeutic and preventive measures to improve the results of treatment of severe peritonitis.

Establishing prognostic significance of hypoxia predictors in patients with acute cerebral pathology

OBJECTIVES

This research aims to study the prognostic role of serum S100 as a predictor of mortality in vascular and traumatic brain injuries.

METHODS

This prospective cohort study involved 219 patients. In the blood serum, neuron-specific markers (S100, NSE) and glucose, acid-base state and gas composition of arterial blood were obtained at admission, on the 3rd, 5th and 7th days of patients' stay in the intensive care unit.

RESULTS

The most significant risk factor for an unfavorable outcome is the marker S100 with a cut-off point of 0.2 mcg/l. The analysis results indicate a statistically significant direct relationship between S100 > 0.2 mcg/l and NSE ≥ 18.9 ng/ml compared to other variables, while the chance ratio (OR) is 11.9 (95%CI:3.2927-1.6693;). With blood sugar increase above 7.4 mmol/l, the OR is 3.82 (95% CI: 2.1289-0.5539;); with a Glasgow scale below 13 points, the OR is 3.69 (95% CI: 2.1316-0.4819;); with an increase in pCO2 < 43.5 mm Hg, the OR was 3.15 (95% CI: 1.8916- 0.4062;). The obtained model certainty measure according to pseudo R2 Nagelkerke criterion is 263.5, showing the excellent quality of the mathematical model's predictive ability. The developed prognostic model, including the dependent variable S100 and independent variables as predictors of a poor outcome of NSE, pCO2, GCS and Hb, reached a cut-off point of 84.51%, AUC - 0.88 with high levels of sensitivity and specificity: 91.89% and 64.14%, respectively.

NOVELTY

This model can be used to predict the outcome in patients with acute cerebral pathology.

Dermabond-adhesive glue versus polypropylene sutures for cesarean section-skin closure

OBJECTIVES

To compare the Dermabond-adhesive glue versus polypropylene sutures for cesarean section (CS) skin closure.

MATERIAL AND METHODS

One hundred women admitted for elective CSs (ECSs) were randomized into two groups; Dermabond group including women underwent CS-skin closure using Dermabond-adhesive glue and polypropylene group including women underwent CS-skin closure using polypropylene sutures. Participants were evaluated weekly for two months after the ECSs to detect the post-CS surgical site infection (SSI). Participants were asked to complete a modified Patient Scar Assessment Scale (PSAS) to detect the CS-scar related symptoms and overall satisfaction.

RESULTS

The superficial post-CS SSI was reported in 10% (5/50) of participants; 2 cases (4%) in Dermabond group and 3 cases (6%) in polypropylene group (p = 0.6). No statistical differences were reported between studied groups regarding, ECS duration (44.78 ± 3.44 min for Dermabond group vs 45.6 ± 3.78 for polypropylene group) (p = 0.7) or CS-skin closure duration (2.46 ± 0.34 min for Dermabond group vs 3.6 ± 0.36 for polypropylene group) (p = 0.6). Third-day post-CS pain score was statistically lower, and overall satisfaction was statistically higher when Dermabond group was compared to polypropylene group [2.34 ± 0.47 and 2.9 ± 0.3, respectively (p = 0.02) vs 2.86 ± 0.35 and 2.34 ± 0.47, respectively (p = 0.001)].

CONCLUSIONS

Dermabond-adhesive glue was a safe and successful alternative to polypropylene for CS-skin closure. Third-day post-CS pain score was statistically lower, and overall satisfaction was statistically higher when Dermabond group was compared to polypropylene group.

[THE LEVEL OF S100Β IN BLOOD SERUM AS A PROGNOSTIC FACTOR OF OUTCOME IN SECONDARY BRAIN LESIONS]

This study is devoted to the study of the prognostic value of neuron-specific markers of the brain and indicators of the outcome of brain damage. The purpose of the study. To study the prognostic role of serum S100 as a predictor of mortality in vascular and traumatic brain injuries.A prospective cohort study involving 219 patients. In the blood serum, neuron-specific markers (S100, NSE) and glucose, acid-base state and gas composition of arterial blood were obtained during follow-up periods: at admission, on the 3rd, 5th and 7th days of patients' stay in the intensive care unit. The most significant risk factor for an unfavorable outcome is the marker S100 with a cut-off point of 0.2 mcg/l. The results of the analysis indicate the presence of a statistically significant direct relationship between S100>0.2 mcg/l and NSE ≥18.9 ng/ml compared to other variables, while the chance ratio (OR) is 11.9 (95%CI:3.2927-1.6693;). With an increase in blood sugar above 7.4 mmol/l, the OR is 3.82 (95% CI: 2.1289- 0.5539;); with a Glasgow scale below 13 points, the OR is 3.69 (95% CI: 2.1316-0.4819;); with an increase in pCO2 <43.5 mm Hg, the OR was 3.15 (95% CI: 1.8916- 0.4062;). The measure of certainty of the obtained model according to the criterion of pseudo R2 Nagelkerke is 263.5, which corresponds to the excellent quality of the predictive ability of the mathematical model. The developed prognostic model, including the dependent variable S100 and independent variables as predictors of a poor outcome of NSE, pCO2, GCS and Hb, reached a cut-off point of 84.51%, AUC - 0.88 with high levels of sensitivity and specificity: 91.89% and 64.14%, respectively. This model can be used to predict the outcome in patients with acute cerebral pathology.