ABSTRACT
BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus.AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021.MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the sur-gical treatment of DFS and in outpatient offices 'Diabetic foot >> (DFO) from 2010 to 2021 were analyzed.RESULTS: The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION: An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quan-titative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality.
ABSTRACT
Objective. Development of local clinical protocols for antibacterial therapy of COVID-19-associated bacterial pneumonia in the therapeutic department of the city clinical hospital based on an analysis of the treatment process in patients with COVID-19-associated pneumonia. Materials and methods. A retrospective analysis of 1382 cases of hospitalization in the therapeutic department of patients with COVID-19-associated pneumonia for the period from 2020 to 2021 was carried out. The structure of etiotropic therapy, the frequency and timing of microbiological studies of the biomaterial, the manifestations of the main markers of bacterial infection during dynamic monitoring of clinical and laboratory parameters in patients prescribed antibiotic therapy, as well as statistics of the stay of patients in the therapeutic department of the hospital were assessed. Based on the results obtained in the course of microbiological studies, an assessment was made of the microbial landscape of the lower respiratory tract of patients with an analysis of the sensitivity of strains of the leading microflora to a wide range of antibiotics. Results. The study found that the dominant flora in COVID-19-associated pneumonia in hospitalized patients was gram-negative bacteria - K. pneumoniae, P. aeruginosa and A. baumannii - their proportion was more than 50%. Among K. pneumoniae strains, 89.4% were ESBL producers, 63.5% of the strains were resistant to carbapenems, which with a high probability allows them to be considered carbapenemase-producing strains. Among the strains of P. aeruginosa, the proportion of strains resistant to carbapenems and with a high degree of probability being strains - producers of carbapenemase was 41.1%. Among strains of Acinetobacter spp. these were 76.4%, and associated resistance to fluoroquinolones and aminoglycosides was also demonstrated. Gram-positive microorganisms were found in 34.3% of cases and were mainly represented by strains of S. aureus (74.9%), only 26.4% of strains of this pathogen were methicillin-resistant. Conclusions. Microbiological monitoring conducted in 2020-2021 revealed the presence, among the pathogens of viral-bacterial pneumonia, at an early stage of hospitalization, a significant proportion of gram-negative bacteria with resistance of the MDR and XDR types. Based on the obtained microbiological data, starting empirical schemes for antibacterial therapy of secondary viral and bacterial pneumonia, which complicated the course of a new coronavirus infection COVID-19 caused by the SARS-CoV-2 virus, were developed and proposed.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality.Copyright © Endocrinology Research Centre, 2022.
ABSTRACT
BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality. Copyright © Endocrinology Research Centre, 2022.
ABSTRACT
BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality. Copyright © Endocrinology Research Centre, 2022.
ABSTRACT
Objective. Development of local clinical protocols for antibacterial therapy of COVID-19-associated bacterial pneumonia in the therapeutic department of the city clinical hospital based on an analysis of the treatment process in patients with COVID-19-associated pneumonia. Materials and methods. A retrospective analysis of 1382 cases of hospitalization in the therapeutic department of patients with COVID-19-associated pneumonia for the period from 2020 to 2021 was carried out. The structure of etiotropic therapy, the frequency and timing of microbiological studies of the biomaterial, the manifestations of the main markers of bacterial infection during dynamic monitoring of clinical and laboratory parameters in patients prescribed antibiotic therapy, as well as statistics of the stay of patients in the therapeutic department of the hospital were assessed. Based on the results obtained in the course of microbiological studies, an assessment was made of the microbial landscape of the lower respiratory tract of patients with an analysis of the sensitivity of strains of the leading microflora to a wide range of antibiotics. Results. The study found that the dominant flora in COVID-19-associated pneumonia in hospitalized patients was gram-negative bacteria – K. pneumoniae, P. aeruginosa and A. baumannii – their proportion was more than 50%. Among K. pneumoniae strains, 89.4% were ESBL producers, 63.5% of the strains were resistant to carbapenems, which with a high probability allows them to be considered carbapenemase-producing strains. Among the strains of P. aeruginosa, the proportion of strains resistant to carbapenems and with a high degree of probability being strains – producers of carbapenemase was 41.1%. Among strains of Acinetobacter spp. these were 76.4%, and associated resistance to fluoroquinolones and aminoglycosides was also demonstrated. Gram-positive microorganisms were found in 34.3% of cases and were mainly represented by strains of S. aureus (74.9%), only 26.4% of strains of this pathogen were methicillin-resistant. Conclusions. Microbiological monitoring conducted in 2020–2021 revealed the presence, among the pathogens of viral-bacterial pneumonia, at an early stage of hospitalization, a significant proportion of gram-negative bacteria with resistance of the MDR and XDR types. Based on the obtained microbiological data, starting empirical schemes for antibacterial therapy of secondary viral and bacterial pneumonia, which complicated the course of a new coronavirus infection COVID-19 caused by the SARS-CoV-2 virus, were developed and proposed. © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
Purpose. To establish the factors influencing the progression of chronic coronary heart disease (CCHD) in patients with postinfarction cardiosclerosis after COVID-19 infection. Materials and methods. Included 45 patients with CCHD and postinfarction cardiosclerosis from among those who were under dynamic observation in the CCHD laboratory of the Republican Scientific and Practical Centre "Cardiology". All included in the study were divided into 2 groups: group I (31 patients) – after COVID-19, group II – patients with CCHD who did not have a COVID infection – 14. The I test was carried out in the pre-Covid period, the II test – within 1-3 months after documented COVID-19. Examination included echocardiography (EchoCG), computed tomographic angiography (CTA) of the coronary arteries (CA), magnetic resonance imaging. Results. Risk factors influenced on the progression of CCHD in patients after COVID-19 are: increased for more than 1 month levels of C-reactive protein (CRP), cardiac troponin, erythrocyte sedimentation rate (ESR), D-dimer. All mentioned factors contributed to the progression of coronary artery atherosclerosis. The coronavirus infection affected the enlargement of the left ventricle and the right parts of the heart, the deterioration of the systolic-diastolic function of both ventricles, including an increase in pressure in the pulmonary artery. The consequence of these changes was the progression of signs of heart failure according to echocardiography and the n-terminal fragment of the natriuretic peptide (NT-proBNP), an increase in the zones of myocardial ischemia compared with the pre-COVID period, and more frequent and significant ventricular arrhythmia. © 2022, Professionalnye Izdaniya. All rights reserved.