APPLICATION OF PROBIOTIC ANTISEPSIS FOR PURULENT COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

OBJECTIVE: The aim: To improve the results of surgical treatment of patients with type 2 diabetes and purulent-necrotic wounds by using probiotic antiseptics. PATIENTS AND METHODS: Materials and methods: 66 patients with type 2 diabetes and purulent-necrotic complications took part in this study. Probiotic antiseptics were used for local treatment in the experimental group (n=31), and traditional antiseptics were used in the control group (n=35). The levels of pro-inflammatory markers in the blood (IL-6, TNF-a, CRP) were studied; microscopic material was taken to study the type of cytogram during bandaging, before wound treatment with antiseptics or debridement on admission to the hospital (1st day), on the 3rd day and on the 7th day. RESULTS: Results: Analysis of dynamic changes in pro-inflammatory markers between the first and seventh days proved that only in the experimental group there was a statistically significant difference (IL-6 (Р=0.004), TNF-a (Р=0.001), CRP (Р=0.018)). Detection of regenerative-inflammatory and regenerative cytogram types on the 7th day in the experimental group had a statistically significant difference compared to the control group (p=0.002 and p<0.001, respectively). CONCLUSION: Conclusions: the use of probiotic antisepsis accelerates wound healing in patients with type 2 diabetes and purulent-necrotic complications.

SURGICAL ISCHEMIC ASPECTS OF COVID-19: MANAGEMENT OF PATIENTS WITH COVID TOES AND FINGERS.

OBJECTIVE: The aim: Study of clinical manifestations and management of patients with COVID toes and fingers. PATIENTS AND METHODS: Materials and methods: 1,841 patients with laboratory-confirmed SARS-CoV-2 infection were hospitalized. All patients were divided into two groups: without surgical pathology - 1,693 (91.96%) and with surgical pathology (patients with COVID toes and fingers and abdominal syndrome) - 148 (8.04%). The diagnosis of COVID-19 was made on the basis of clinical data, laboratory test results (PCR test for SARS-CoV-2) and computed tomography of the chest. On admission, in addition to the general laboratory tests, mandatory special methods of examination included determination of D-dimer, procalcitonin (PCT), C-reactive protein, and interleukin-6 (IL-6). RESULTS: Results: Surgical ischemic manifestations were observed in 8.04% of all patients with COVID-19, of which 86.48% presented with ischemic abdominal syndrome and 13.52% with COVID toes and fingers. C-reactive protein and procalcitonin are the markers that may indicate the development of ischemic surgical problems. A direct statistically significant linear correlation was found between the severity of the underlying disease and the mean D-dimer (r = 0.815; p = 0.01). CONCLUSION: Conclusions: The confirmed phenomenon of COVID toes and fingers does not require active surgical tactics. It is necessary to conduct pathogenetic treatment of COVID-19 and dynamic monitoring of its clinical course.

Mri and ultrasound criteria for the diagnosis of a sports hernia in football players.

OBJECTIVE: The aim of the study is to specify diagnostic MRI and ultrasound criteria for a sports hernia in order to verify its diagnosis in football players. PATIENTS AND METHODS: Materials and methods: The study included 50 professional and amateur football players aged 15 to 34 from 2016 to 2019. The criteria for inclusion in the study were: the presence of groin pain in football players, which prevented them from continuing to actively participate in sports activities. RESULTS: Results: The findings of the study revealed that during MRI the two factors, which had the strongest influence, were "increased MR signal intensity on PDfs observed from the structures of the inguinal canal" and "increased MR signal intensity on PDfs observed from bone marrow of superior ramus of the pubic bone". During ultrasound of the inguinal area, the main criterion for a sports hernia diagnosis was "increased size of the inguinal canal". The verification of the diagnosis was carried out on the basis of the presence of a protrusion in the posterior wall of the inguinal canal. For a sports hernia diagnosis the MRI sensitivity is 91.67% (95% CI 77.5 - 98.2), specificity -78.57% (95% CI 49.2 - 95.3) and the sensitivity of ultrasound is 88.89% (95% CI 73.9 - 96.9), the specificity - 50% (95% CI 23.0 - 77). CONCLUSION: Conclusions: The combination of MRI and ultrasound makes it possible to accurately detect the presence of a sports hernia in the football player. Based on the findings of our study, we formulated MRI and ultrasound criteria for a sports hernia diagnosis.

Strength comparison of different methods of closing the anterior abdominal wall defect (experimental study).

OBJECTIVE: The aim of the study is to compare the mesh implantation and the strength of the mesh fixation to the anterior abdominal wall by modelling the intraperitoneal onlay mesh repair (IPOM) with and without aponeurotic defect closure. PATIENTS AND METHODS: Materials and methods: The experimental animals were randomly divided into 2 groups of 6 rabbits. In experimental group IPOM was modelled without hernia defect closure, in control group - with its suturing. The macroscopic assessment of the severity of adhesions, histological examination of the removed "anterior abdominal wall - mesh" complex and strength of the mesh fixation to the anterior abdominal wall were performed on the 90th day. RESULTS: Results: In both groups, the displacement or complete separation of the mesh from the parietal peritoneum was not observed. The extent of adhesion formation in the abdominal cavity and strength of the mesh fixation are comparable in both groups (p > 0.05). In the experimental group, the mesh was surrounded by scar tissue, mesothelioma lining was not traced. There were also moderate signs of inflammation, which were not seen in the control group. CONCLUSION: Conclusions: The strength of the mesh fixation to the parietal peritoneum and its implantation into the anterior abdominal wall is comparable with or without aponeurotic defect closure during the experimental modelling of IPOM.

Type 2 diabetes mellitus remission and its prediction after two-stage surgical treatment of patients with morbid obesity.

OBJECTIVE: Introduction: Morbid obesity (MO) has a significant impact on mortality, health and quality of life of patients. Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with MO. The aim is to study T2DM remission and to develop a prediction model for T2DM remission after two-stage surgical treatment of patients with MO. PATIENTS AND METHODS: Materials and methods: The study included 97 patients with MO. The mean BMI was 68.08 (95% CI: 66.45 - 69.71) kg/m2. 70 (72,2%) patients with MO were diagnosed with T2DM. The first stage of treatment for the main group (n=60) included the IGB placement, for the control group (n=37) - conservative therapy. In the second stage of treatment the patients underwent bariatric surgery. The study addresses such indicators as BMI, percentage of weight loss, percentage of excess weight loss, ASA physical status class, fasting glucose level, HbA1c, C-peptide. RESULTS: Results: Two-stage treatment of morbidly obese patients with T2DM promotes complete T2DM remission in 68.1% of patients. The risk prediction model for failure to achieve complete T2DM remission 12 months after LRYGB based on a baseline C-peptide level has a high predictive value, AUC = 0.84 (95% CI: 0.69-0.93), OR = 0.23 ( 95% CI: 0.08-0.67). CONCLUSION: Conclusions: Two-stage treatment of patients with MO promotes improvement of carbohydrate metabolism indicators. With a C-peptide level > 3.7 ng/ml, prediction of complete T2DM remission 12 months after Laparoscopic Roux-en-Y Gastric Bypass is favorable.