bluuebunny/crossref_metadata_2025 huggingface dataset:
Kontribusi Rasio Aktivitas dan Ukuran Perusahaan pada Rentabilitas PT. Telekomunikasi Indonesia (Persero), Tbk
Authors: Harris Muh. Ilham , Sjahruddin Herman , S.Themba Orfyanni
Published: October 2020

Kami berupaya menguji kembali kontribusi rasio aktivitas dan ukuran perusahaan pada rentabilitas PT. Telekomunikasi Indonesia (Persero) Tbk sebagai tujuan dilakukannya studi ini. Populasi penelitian adalah Laporan keuangan triwulan Tahun 2009 – 2018 dengan memanfaatkan purposive sampling dalam pengambilan sampel sehingga diperoleh 4 x 10 = 40 unit data sebagai sampel. Analisis data menggunakan regresi linear berganda melalui pemanfaatan SPSS Ver. 25. Temuan studi ini memberikan bukti bahwa rasio aktivitas (TATO) dan ukuran perusahaan (LnTA) memberikan kontribusi positif signifikan pada rentabilitas (ROA) perusahaan
Pengaruh Current Ratio Dan Debt To Equity Ratio Terhadap Return On Asset Pada PT. Gudang Garam, Tbk
Authors: Ilham Ilham
Published: October 2020

Untuk mendapatkan informasi tentang pengaruh “Current Ratio” dan “Debt to Equity Ratio” terhadap ‘Return on Asset’ pada PT. Gudang Garam, Tbk menjadi tujuan dari penelitian ini. Melalui metode explanatory research dan statistik  analisis dengan pengujian regresi linier berganda. Hasil penelitian menunjukkan “Current Ratio” mempengaruhi “Return on Asset” secara positif dan signifikan sebesar 39,1%). “Debt to Equity Ratio” mempengaruhi “Return on Asset” secara  negatif dan tidak signifikan sebesar 39,3%, sedangkan secara simultan  “Current Ratio” dan “Debt to Equity Ratio” mempengaruhi “Return on asset” secara positif dan signifikan sebesar 44,0%.
Pelaksanaan Alokasi Dana Desa Terhadap Manajemen Keuangan Desa dalam Meningkatkan Efektivitas Program Desa Sejahtera Mandiri Di Desa Cihambulu, Kec. Pabuaran, Kab. Subang
Authors: Sunardi Nardi , Lesmana Rosa
Published: October 2020

Penelitian ini bertujuan dalam upaya dan strategi mewujudkan desa sejahtera mandiri di Desa Cihambulu. Dengan metode confirmatory analys factor menggunakan uji regression weight melalui perangkat Amos SPSS 23 . Responden adalah warga desa Cihambulu sebanyak 100 orang. Hasil penelitian menunjukkan Secara langsung Pelaksanaan Pengelolaan Dana Desa (PPDD) berpengaruh signifikan terhadap Manajemen Keuangan Desa (MKD) sebesar 5,144 > 1,96, Manajemen Keuangan Desa (MKD) berpengaruh signifikan terhadap Efektivitas Program Desa Sejahtera Mandiri (EPDS) sebesar 4.288 > 1,96, sedangkan secara tidak langsung Pelaksanaan Pengelolaan Dana Desa (PPDD) berpengaruh tetapi tidak signifikan terhadap Efektivitas Program Desa Sejahtera Mandiri (EPDS) sebesar 1.296.
The Influence of Fundamental Factors of Macroeconomics Against Price Earning Ratio through Dividend Payout Ratio for LQ.45 Non-Banking Companies
Authors: Sanjaya Rudi , Rahayu Krida Puji , Rahayu Krida Puji
Published: October 2020

This study attempts to examine and analyze fundamental factors and to influence Dividend Payout Ratio and its impact on the company to companies 2014-2017 lq-45 period.In the form of financial report data obtained from the Indonesia stock exchange (IDX). The sample as many as 19 companies meet criteria.Analysis method data using analysis the linear regression and Path analysis.The data shows that the results of the analysis of its ROE and DER had an influence on Dividend Payout Ratio. NPM and The Inflation Rate has not been affecting The Dividend Payout Ratio.ROE, NPM, and The Inflation Rate has not been affecting PER. ROE, DER, NPM, and The Inflation Rateinfluential simultaneously against the Dividend Payout Ratio. The Dividend Payout Ratio to depend on the value of PER.There is no cause is an indirect effect between ROE, DER, NPM, and Inflation to PER.
EFFECTIVENESS OF LIDOCAINE CREAM FOR REDUCING PAIN SENSATION OF PRE INJECTION OF SUBCUTANEOUS LIDOCAINE IN LUMBAL PUNCTURE DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Authors: Christin Theresia , Okparasta Andika , Susilaningrum Ratri Wulandari
Published: October 2020

Background: Lumbar puncture is one of the methods that is quite often performed for various purposes. There is no global agreement regarding the use of local anesthesia in subcutaneous or topical infiltration prior to LP. Topical anesthesia injection in lumbar puncture still cause pain, there should be needing additional topical anesthesia. Aim: To compare the effectiveness between lidocaine cream and placebo cream prior lidocaine subcutaneous injection to reduce pain sensation in LP procedures. Methods: The study was conducted in July-October 2019, randomized and clinical trial (RCT) by sampling technique using block randomization method. Sample was divided into two group. Pain scale was assessed when the needle touched the skin, subcutaneously and overall in both groups. Data analysis using SPSS ver 22 for windows. Results: The average age of subjects is 38.50±14.43 years and majority are women (57.9%). There is significance difference of pain scale between groups when needle touched the skin (p=0,035), meanwhile, there is not significance difference when needle subcutaneously (p=0,061) and overall (p=0,182) in both groups. Conclusion: Lidocaine cream has been shown to be significantly more effective in reducing pain pre lidocaine subcutaneous injection compare to placebo cream when needle touched the skin.
EFEKTIVITAS EFIKASI PEMBERIAN TERAPI KONVALESEN PLASMA PADA PASIEN COVID-19 : EVIDENCE BASED CASE REPORT
Authors: Maulana Muhammad Sobri
Published: October 2020

Pandemi infeksi virus corona 2019 (Covid-19) adalah masalah yang sedang dihadapi dilebih dari 200 negara di dunia. Indonesia juga terkena dampak buruk dari Covid-19 dimana tingkat kematiannya mencapai 4,68% pada awal Agustus 2020. Saat ini belum tersedia, rekomendasi tata laksana khusus pasien Covid-19, termasuk antivirus atau vaksin. Tatalaksana yang dapat dilakukan adalah terapi simtomatik dan oksigen. Selain itu, juga terdapat beberapa terapi berupa Terapi Konvalesen Plasma yang sedang dalam uji coba. Untuk Mengetahui Efektivitas Efikasi Pemberian Terapi Konvalesen Plasma pada Pasien Covid-19. Pencarian literature dilakukan pada empat database internet yaitu Pubmed, Scopus, EBSCO dan Cochrane Library berdasarkan kriteria inklusi dan ekslusi yaitu studi terapi, Randomized Controlled Trial, Meta analysis dan Systematic Review. Validitas, Kepentingan dan Aplikabilitas artikel kemudiaan ditelaah lebih lanjut. Artikel yang akan ditelaah harus memiliki masalah, intervensi dan outcome yang sama dengan kasus. Terdapat lima studi terpilih yang menunjukkan bahwa Konvalesen Plasma darah dapat menurunkan mortalitas pada pasien covid-19 dibandingkan dengan terapi-terapi yang masih di uji hingga saat ini. Administrasi Konvalesen Plasma Darah dapat membantu mempersingkat rawat inap dan menurunkan mortalitas pada pasien Covid-19.
Pengembangan Gerakan Literasi Sekolah Menggunakan Majalah Dinding dan Binder Antologi Tematik di Sekolah Dasar
Authors: Sadino S , Nugrahani Farida , Suwarto S
Published: October 2020

Penelitian ini bertujuan untuk mendeskripsikan tentang program, pelaksanaan, hambatan, solusi dan hasil pengembangan Gerakan Literasi Sekolah menggunakan media Mading Batik. Penelitian ini menggunakan metode deskriptif kualitatif. Pengumpulan data menggunakan studi dokumentasi, wawancara, pengamatan, dan Focus Grup Disction (FGD). Hasil penelitian menunjukkan bahwa: Program Pengembangan Gerakan Literasi Sekolah dijabarkan menjadi Program Gerakan Literasi Kelas dan dibentuk Tim Literasi Kelas. Pelaksanaannya menggunakan media Majalah dinding dan Binder Antologi Tematik. Beberapa hambatan antara lain : Beberapa anak kurang mahir dalam membaca. Solusi yang ditempuh dengan membacakan cerita, atau dengan membaca bersama-sama, anak mendengarkan dan menyimak. Sarana prasarana lingkungan fisik sekolah yang belum literat. Solusi dengan pengadaan lingkungan fisik yang literat secara bertahap mengunakan bahan dan alat yang sederhana, unik dan harga terjangkau. Belum ada petugas pustakawan, sehingga perpustakaan kurang tertata bahkan cenderung tampak sebagai gudang, jarang dikunjungi. Solusinya dengan pelibatan Tim Literasi Sekolah dan Tim Literasi Kelas untuk menata, merawat, membersihkan, dan melayani peminjaman buku perpustakaan. Kurangnya bahan bacaan berupa buku cerita anak. Solusi dengan meminjam ke perpustakaan desa, pembelian buku cerita bekas, pemanfaatan koran dan majalah, penggunaan buku elektronik dengan ditayangkan melalui LCD Proyektor. Pengadaan Binder Antologi Tematik merupakan salah satu cara menambah bahan bacaan anak yang orisinil dan unik sesuai dengan dunia anak. Dengan Media Mading Batik tercipta lingkungan akademik, fisik, dan sosial afektif yang lebih literat.
Оцінка функціональної підготовленості підлітків 11–12 років за показниками аеробної й анаеробної продуктивності
Authors: Фурман Ю. , Брезденюк О. , Мірошніченко В.
Published: October 2020

Мета. Встановити стандарти оцінки функціональної підготовленості підлітків 11–12 років. Методи. Педагогічний експеримент із використанням велоергометрії, пульсометрії,сфігмоманометрії, хронометрії; методи математичної статистики. Досліджено показникиаеробної й анаеробної продуктивності 1417 підлітків 11–12 років. Створено стандартифункціональної підготовленості на основі середніх арифметичних та середніх квадратичнихвідхилень показників максимального споживання кисню і максимальної кількості зовнішньої механічної роботи за 10 с (ВАнТ10), 30 с (ВАнТ30), за 1 хв (МКЗР).Результати. Розроблено критерії функціональної підготовленості за рівнями: «середній»;«вище середнього»; «нижче середнього»; «високий»; «низький»; «дуже високий»; «дуже низький». За середній рівень взяли діапазон похибки середнього квадратичного відхиленнявід середнього арифметичного варіаційного ряду значень дослідженого нами контингенту. На основі даних, отриманих експериментальним шляхом розробили критерії оцінки аеробної і анаеробної продуктивності дівчат і хлопців віком 11–12 років. Висновки. Стандарти функціональної підготовленості слід розробляти за середнім значенням показника, отриманого в результаті обстеження великої кількості осіб однорідного контингенту.Розроблені стандарти охоплюють увесь спектр функціональної підготовленості підлітків 11–12років.
Acute diffused purulent peritonitis: conceptual aspects of the modern surgical tactics
Authors: Andriuschenko V.P.
Published: October 2020

Objective. To accentuate an attention on conceptual aspects of surgical treatment of patients on acute purulent diffused peritonitis (APDP).

Materials and methods. Were treated a 371 patients on APDP in age from 18 to 87 years; males – 207 (56 %), females – 164 (44 %). In structure of factors of peritonitis development predominated an acute destructive appendicitis (23 %), perforated ulcer of pyloroduodenal part of the stomach (21 %), acute pancreatitis / purulent-necrotic pancreonecrosis (18 %), acute destructive cholecystitis (14 %).

Results and discussion. Carried out analysis allowed to determine the next conceptual aspects of the problem. In particular, according to recommendations of the World Society of Emergency Surgery (WSES, 2016), APDP necessary to interpret as “complicated intraabdominal infection” with evaluation of clinical state of patient, localization of source of infection, its spreading, availability of the multiorgan insufficiency, characteristics of bacterial pathogens and their antibacterial sensitivity. Is appropriate an usage of the single classification of degree of peritonitis spreading with terminological definition its as “local”, “diffused” and “total”. Helping carried out a bacterial investigations were revealed domination of aerobic bacteria as monoculture (37 %) and aerobic-anaerobic associations (39 %) with gram-negative sign (56 %) and species composition as enterobacteria and anaerobic nonclostridial microbs. The initial antibiotic therapy induces the high level of polyresistance of flora, that causes necessarily of permanent determination of bacteria sensitivity to antibiotics and timely change of regimens their administration. Operational intervention, excepting a control of the source of infection, must to foresee a measures of correction of appeared pathologic intraabdominal syndromes, in particular compartment-syndrome, enteral insufficiency and redundant contamination of digestive tract by microflora of the large intestine. The very important compound of treatment is full-fledged infusion therapy. Relaparotomy represents an effective instrument with performing its for regulated clearly indications.

Conclusions. Realization of the outlined medical tactics compaunds will promote to the rise of efficiency of ADPP treatment.
Correction of the acid-alkaline state in patients with asthma
Authors: Bezditko Т.В. , Yeryomenko G.V.
Published: October 2020

Background. The acid-alkaline state (AAS) in physiological conditions is caused by a certain ratio of acids and alkalis in blood plasma as well as in organs and tissues. Imbalances of the above ratio are observed in patients with asthma (As).

Objective. To study AAS in patients with an uncontrolled course of As.

Materials and methods. The study involved 27 patients having a moderately severe course of As with metabolic acidosis and without any controls. Physical examinations were made; respiratory function and AAS were assessed. The patients were divided into two groups: 13 cases – group 1 and 14 cases – group 2. Their basic treatment included budesonide / formoterol fumarate dehydrate 160/4.5 µg, with use of control questionnaires for As (ACQ-5) and life quality (SF-36). Additionally to their therapy patients from group 1 received 250 ml of 4.2 % sodium bicarbonate intravenously by drop infusions thrice daily every other day.

Results and discussion. All the patients had a reduced control over As from 3.5 to 5 points (4 [3.5; 4.5] in group 1 and 4.5 [4; 5] in group 2). According to spirography data, the level of rate values before treatment in cases from group 1 was as follows: forced expiratory volume in 1 sec (FEV1) = 54.00 % [47.00; 59.00], peak expiratory flow (PEF) 25 % = 52.00 % [49.00; 57.00], PEF 50 % = 51.40 % [41.00; 57.00], PEF 75 % = 50.00 % [43.00; 57.10]. In patients from group 2 their level of rate values before treatment was as follows: FEV1 = 57.00 % [52.00; 61.00], PEF 25 % = 56.10 % [52.00; 59.70], PEF 50 % = 54.40 % [47.00; 59.00], PEF 75 % = 54.00 % [47.30; 60.10]. AAS values in cases from group 1 were: рН = 7.32±0.05, РСО2 = 33.8±1.34 mm Hg, ВЕ = -4,8±0,01 mmol/l; in patients from group 2 these were: рН = 7.31±0.04, РСО2 = 32.3±1.13 mm Hg, ВЕ = -4.25±0.01 mmol/l. After the treatment, the following changes were registered: respiratory function indices improved in both groups, but reliable changes versus pre-treatment results were revealed in 1st group – FEV1, PEF 25 % and PEF 75 % (p<0.05), while in 2nd group it was only in PEF 25 %. Both groups demonstrated positive changes of all AAS indices, but reliable changes in all examined indices were found out in patients from group 1 (р<0,05), whose treatment effectiveness was assessed as good in 8 cases and satisfactory in 4. In patients from group 2 the result of treatment was satisfactory in 9 cases, whereas in 5 patients it was unsatisfactory.

Conclusions. Inclusion of sodium bicarbonate into combination therapy for patients with As is not accompanied with development of any adverse events and is recommended for using in combination therapy for exacerbations of As, particularly if metabolic acidosis develops.
Application of sorbitol based infusion preparation for normalization of water-electrolyte exchange in surgery patients with direct rectal cancer
Authors: Varyvoda Ye.S. , Orishchin I.Ya. , Lutsiv V.M. , Varyvoda V.Ye. , Dzis B.R. , Chaban V.Ye. , Dzis R.P. , Karpovich Ye. Р.
Published: October 2020

Objective. To study the effect of intravenous infusions of the complex drug Rheosorbilact polyfunctional action on the indicators of water-electrolyte metabolism in operated patients with rectal cancer after anterior resection of the rectum in the early postoperative period.

Materials and methods. Clinical application of the complex drug Rheosorbilact of multifunctional action was carried out in 30 patients with rectal cancer after the operation of anterior resection of the rectum in the early postoperative period. Studies of plasma electrolytes in operated patients were performed before surgery, on the 1st day after surgery, and on the 2nd, 3rd, 5th day after administration of the drug Rheosorbilact.

Results. As a result of studies in patients with colorectal cancer after anterior resection of the rectum in the first days after surgery revealed a decrease in potassium, sodium, calcium in blood plasma. To correct the indicators of water-electrolyte metabolism in operated patients after anterior resection of the rectum immediately after surgery intravenously injected infusion drug Rheosorbilact multifunctional action. After repeated, within 5 days, intravenous infusions of the drug Rheosorbilact, revealed normalization of the concentrations of potassium, sodium, calcium in blood plasma in operated patients with colorectal cancer.

Conclusions. Repeated intravenous infusions of the complex drug Rheosorbilact multifunctional action lead to normalization of water-electrolyte metabolism in patients with colorectal cancer after anterior resection of the rectum in the early postoperative period. Normalization of water-electrolyte metabolism in operated patients is confirmed by the content of potassium, sodium and calcium ions in the infusion drug Rheosorbilact. Rheosorbilact is recommended for widespread medical use in such patients, especially in the early postoperative period.
Features of infusion therapy in therapeutic patients during the COVID-19 pandemic
Authors: Halushko O.A.
Published: October 2020

Objective. To determine the features of infusion therapy (IT) in therapeutic patients with COVID-19.

Materials and methods. The publications were searched using PubMed and Google Scholar engines by such terms: COVID-19, infusion therapy, crystalloids, colloids. 68 publications were identified, which were published from December 2019 to August 15, 2020.

Results and discussion. Unfortunately, very few publications characterizing the features of IT in patients with COVID-19. The most complete recommendations are set out in the Surviving Sepsis Campaign: guidelines on the management of critically ill adults with COVID‑19. Indications for IT in COVID-19: hemodynamic instability, shock, heart disease and comorbidities (especially diabetes and cardiovascular disease). It is recommended not to use colloids, but buffered and balanced crystalloids for acute resuscitation of adults with COVID-19 and shock. In Ukraine, among balanced buffered crystalloids, the most popular and widespread solution is Rheosorbilact, which has a large number of positive reviews in domestic and foreign publications, including pneumonia and sepsis. Recommendations for the use of colloids: dextrans, gelatin and hydroxyethylated starches in COVID-19 are not recommended; albumin can be used for special indications (eg, severe hypoalbuminemia), but it is not recommended for routine and initial resuscitation; convalescent plasma transfusion appears to be a promising method that can provide passive immunity to SARS-CoV-2-specific antibodies, but is currently not recommended for routine use due to lack of evidence. It is proposed to use a conservative rather than a liberal strategy of fluid administration for the acute resuscitation of adults with COVID-19 and shock. In the meta-analysis of 11 randomized clinical trials (n=2051), it was shown that patients with severe acute respiratory syndrome or sepsis who received fluid according to a conservative strategy had more days without artificial ventilation and a shorter period of stay in the intensive care unit (ICU). At fever at patients with COVID-19 it is offered to use paracetamol. In severe cases, a solution of paracetamol (eg, Infulgan) can be administered intravenously at a dose of up to 4 g per day. Body temperature control does not reduce the risk of death, length of stay in ICU, but is effective for lowering associated symptoms (headache, dizziness, weakness), which is important to increase patient comfort.

Conclusions. In the treatment of patients with COVID-19 of great importance is the use of rational and balanced IT. The infusion program should be calculated not only in terms of hemodynamic effects, but also taking into account the quality of life and maximize patient comfort.
Clinical assessment of homeostasis parameters in evaluation of operation stress
Authors: Hasanov F.J. , Gasimova S.A.
Published: October 2020

Background. The expansion of the range of clinical and physiological methods, also the development of ideas related with operational stress caused the increase in the number of indicators used to judge the adequacy level of anaesthetic protection.

Objective. The research aim was clinical evaluation of the informational content of homeostasis parameters in determining the adequacy of anaesthesia.

Materials and methods. The research was conducted on 92 patients, aged 21-79, who underwent large-scale surgical operations in abdominal cavity. Continuous monitoring was conducted to identify hemodynamic indicators: systolic, diastolic, medium and pulse arterial pressure, central venous pressure and heart rate. In the course of the anaesthesia the level of anaesthesia and consciousness of the patient were defined with the aid of BIS (Bispectral Index) monitor and the state of myorelaxation was evaluated according to the indicators of frontal muscle electromyography. Cortisol, adrenocorticotropic hormone (ACTH) and prolactin levels were defined in three stages: I – preoperative, II – at the peak of surgical aggression, III – 30 min after the end of the surgery. In addition to continuous monitoring of other indicators of anesthesia adequacy, comparisons were also made with the data obtained during these stages.

Results. At the peak of surgical aggression, which means during the II stage, the level of stress hormones (ACTH, cortisol) were considerably above their upper norm limit despite the fact that the hemodynamics, BIS monitor and electromyography indicators corresponded with the adequate anaesthesia state. At this stage of the operation the attempts to normalize stress hormones values require high doses of analgesics and anaesthetics which can contribute to an increase in anaesthetic risk.

Conclusions. Of all the criteria for assessing the adequacy of the anesthesia, the indicators of hemodynamics and gas exchange together with BIS monitoring data are sufficiently informative and easy to provide in the operating period, which is also very important. These indicators respond fairly quickly to the body stress impact.
Application infusion drugs based on sorbitol for normalization of aminotransferase activity blood cancer patients operated cardia of the stomach
Authors: Dzis B.R. , Prymak S.V. , Dzis R.P. , Novak V.L. , Dzisiv M.P. , Karpovich Ye.P. , Chaban V.Ye. , Ivasyk V.V.
Published: October 2020

Objective. To study the effect of intravenous infusions of Rheosorbilact on the activity of alanine aminotransferase and aspartate aminotransferase in the plasma of operated patients with gastric cardiac cancer after proximal gastrectomy.

Materials and methods. Alanine aminotransferase and aspartate aminotransferase activity levels were studied in plasma of 40 operated patients with gastric cardiac cancer after proximal gastrectomy immediately after surgery, on the 1st, 2nd, 3rd, 5th day after intravenous infusions of the drug. The infusion of Rheosorbilact was administered intravenously, drip, for 5 days at a rate of 40 drops per minute. The daily dose of the drug was 1000.0 ml.

Results. In patients with gastric cardiac cancer after proximal gastrectomy in the first days after surgery revealed changes in aminotransferases, which are accompanied by an increase in the activity of alanine aminotransferase and aspartate aminotransferase in blood plasma. To correct the activity of plasma aminotransferases in such patients, Rheosorbilact was administered intravenously immediately after surgery. After repeated intravenous infusions of Rheosorbilact for 5 days, a significant decrease in the activity of alanine aminotransferase and aspartate aminotransferase in blood plasma in the operated patients was revealed.

Conclusions. In the first days after proximal gastrectomy in patients with gastric cardiac cancer, an increase in the activity of aminotransferases in blood plasma was revealed. Repeated intravenous infusions of Rheosorbilact normalize the activity of alanine aminotransferase and aspartate aminotransferase in the blood plasma of such patients in the early postoperative period. Infusion drug Rheosorbilact is recommended for widespread medical use in patients with cardiac gastric cancer after proximal gastrectomy, especially in the early postoperative period.
Transfusion surgeries and infusion therapy in patients with malignant non-Hodgkin’s lymphoma after splenectomy
Authors: Yevstakhevych Yu.L. , Semerak M.M. , Yevstakhevych I.Y. , Novak V.L. , Lototskyi R.M. , Lohinskyi V.Ye.
Published: October 2020

Objective. To present the immediate results of the splenectomy and preferable variants of transfusion therapy performance in patients with malignant non-Hodgkin’s lymphoma (MNHL).

Materials and methods. 109 splenectomies were performed in patients with MNHL at the Department of General and Hematological Surgery of the institute from 1987 to 2020. The surgery was conducted by upper middle laparotomy under general anesthesia with intubation and, in particular cases, under spinal anesthesia.

Results and discussion. The indications for splenectomy in patients with MNHL were as follows: massive splenomegaly, abdominal syndrome, associated hemocytopenia, inefficacy of cytostatic therapy, absence of diagnosis. All patients underwent vaccination against capsular bacteria for prevention of post-splenectomy infection in 10-14 days prior to the surgery. In case of anemia, which has been observed in 55 % of patients, the RBC concentrate was applied. All the patients, who received corticosteroid hormones prior to splenectomy, were administered prednisolone and hydrocortisone in the amount of 3 mg/kg of body mass at similar doses in an hour before the surgery for prevention of adrenal insufficiency during the surgery. The patients, who did not receive those medications, were also intramuscularly administered prednisolone at a dose of 0.5 mg/kg of body mass in an hour before the surgery for the same aim. The patients with PLT value <150.0×109/L were administered 1-2 doses of PLT concentrate immediately before the laparotomy. M-gradient was found in blood serum of 3 patients prior to the surgery. They underwent courses of therapeutic plasmapheresis due to the risk of intraoperative hemorrhage. 2 patients with hyperleukocytosis (WBC >80.0×109/L) underwent two courses of leukapheresis. The patients with concomitant regional portal hypertension and in case of manipulations close to the pancreatic tail were administered somatostatin drugs in the course of the splenectomy. The splenectomy proved to be effective in 100 (92 %) of patients with MNHL: the great tumor mass was removed, the abdominal syndrome and concomitant hemocytopenia were neutralized, the signs of hypersplenism ceased, the hemolysis ceased, the cytostatic therapy became less necessary or unnecessary, the final diagnosis was established. The most serious postsurgical complications were acute adrenal failure (n=3), postsurgical intra-abdominal hemorrhage (n=2), pancreonecrosis (n=6). The postsurgical lethality was 2.7 %.

Conclusions. The splenectomy proved to be effective in 92 % of patients with MNHL. The infusion therapy is individual for each patient and may include transfusion surgeries if indicated. The main objective of the infusion therapy in patients with MNHL is prevention and elimination of intra- and postsurgical complications.
Hypodiploidy in patients with acute lymphoblastic leukemia
Authors: Zotova O.V. , Lukianova A.S. , Valchuk M.O. , Rymar M.M. , Kostyk Kh.Ya. , Shalay O.O. , Loginsky V.O.
Published: October 2020

Background. Acute lymphoblastic leukemia (ALL) is characterized by different clinical course and different sensitivity to therapy. Taking into consideration their significant prevalence an intensive search for new prognostic criteria is conducted that may determine individual prognosis and choose the most appropriate treatment approach for patients with ALL, who often require transfusion therapy and replacement therapy with blood components.

Objective. To detect the frequency, diagnostic and prognostic significance of hypodiploidy in patients with ALL.

Materials and methods. Standard cytogenetic investigation of bone marrow and/or peripheral bloodcells was performed according to the standard techniques from 57 adult patients with ALL.

Results and discussion. Chromosomal aberrations of various kinds were found in 37 (65 %) patients with ALL. Among them presence of one karyotype abnormality was established in 9 (24 %) patients, two abnormalities – in 10 (27 %) and multiple structural and/or numerical changes (≥3) – in 18 (49 %). Samples from 20 (35 %) patients showed a normal female or male karyotype without cytogenetically visible changes. The most common abnormalities in ALL were: trisomy 8, rearrangements of 7q, 17p and 11q23, translocations t(4;11)(q21;q23), t(9;22)(q34;q11), marker chromosomes, acentric structures, hypodiploidy, hyperdiploidy, complex karyotype (≥3 changes) etc. Hypodiploidy was found in 2 (4 %) patients with ALL. One patient, except for abnormal ones, had normal metaphases in him karyotype. Of two patients with hypodiploidy, one had only numerical abnormalities, whereas other one had also structural cytogenetic aberrations, except the numerical changes, namely t(1;6)(q32;q27), add(12)(q24), del(17)(p11), r(17)(p13q25). Hypodiploidy is an unfavorable marker in ALL and a near haploidy is an extremely unfavorable factor.

Conclusions. Cytogenetic abnormalities of various kinds were found in 37 (65 %) patients with ALL. The frequency of hypodiploidy was 4 %. ALL patients with hypodiploidy were classified into cytogenetic categories of ALL with a poor risk prognosis. Thus, cytogenetic investigations should be included in the standard examination of patients with ALL for diagnosis, prognosis and selection the optimal treatment strategy.
Results of prevention of massive postural bleeding in women with preeclampsy
Authors: Kamilova M.Ya. , Amin-Zade N.
Published: October 2020

Objective. To evaluate the effectiveness of a tranexamic acid for the prevention of critical bleeding in women with preeclampsia.

Materials and methods. 31 puerperas with postpartum hypotonic bleeding. Inclusion criteria: reproductive age, severe preeclampsia, postpartum hemorrhage, volume of blood loss – 700 ml, voluntary consent to the administration of the tranexamic acid. Exclusion criteria: delivery by the caesarean section. When providing emergency care, along with other standard measures, 14 women (the main group) were injected with the tranexamic acid when blood loss reached 700 ml, 17 women (the comparison group) did not receive the tranexamic acid. Research methods: measurement of the volume of blood loss (by the calculation method and by the method of measuring blood loss), statistical analysis – comparison of populations by qualitative characteristics.

Results and discussion. A bleeding with a blood loss of 700-800 ml was registered in 7 women of the main group and in 6 women of the comparison group, with a blood loss of 800-900 ml – in 6 and 4 women, with the blood loss 900-1000 ml – in 1 and 7 women, respectively. There was a significant difference in outcomes (blood loss – 900-1000 ml) depending on the use of the tranexamic acid (Fisher’s exact test – 0.04537; p<0.05). Evaluation of the strength of the relationship between the frequency of aggravation of bleeding and the use of the tranexamic acid for the prevention of massive bleeding established a relationship of average strength (Cramer’s criterion – 0.387). Pregnant women with severe preeclampsia are at risk of the developing obstetric bleeding, which is associated with secondary changes in the hemostatic system in women with preeclampsia. With obstetric bleeding in women with preeclampsia, the balance between the coagulation, anti-coagulation and fibrinolytic systems is disturbed faster. Fibrinolysis is activated faster due to the limitation of thrombus formation due to the breakdown of fibrin in thrombi and the fibrinolytic properties of the fibrin breakdown products themselves. The use of the tranexamic acid in the obstetric bleeding is justified by the antifibrinolysis effect of the drug. Further research on the use of the tranexamic acid for the prevention of massive bleeding, confirmed by laboratory data, is highly relevant.

Conclusions. The use of tranexamic acid with the onset of obstetric bleeding in women with risk factors for the secondary thrombocytopathy will prevent the aggravation of coagulopathy and reduce the incidence of massive obstetric bleeding caused by a disseminated intravascular coagulation.
Topical issues in the treatment of thrombocytopenia caused by chemotherapy: the view of a hematologist
Authors: Mikhalska L.V. , Kylivnyk O.V. , Yamenko O.O.
Published: October 2020

Objective. Thrombocytopenia is a common complication of chemotherapy, which is characterized by a decrease in platelet count <150×10⁹/l duration. Early diagnosis and correction of thrombocytopenia are important points in the treatment of patients with cancer. Currently, thromboconcentrate transfusions, recombinant human thrombopoietin, and eltrombopag are used to treat thrombocytopenia.

Materials and methods. 200 patients were treated with recombinant human thrombopoietin in the hematology department from 2019 till 2020.

Results and discussion. Patients were divided into two groups. 150 patients received thrombopoietin to prevent predicted chemotherapy-induced thrombocytopenia at a dose of 300 IU/kg subcutaneously after 4 consecutive days. In 50 patients Rl-TPO was used for therapeutic purposes, in the presence of thrombocytopenia, at a dose of 300 IU/kg subcutaneously daily 10-14 consecutive injections. In the 1st study group, the level of platelets when using Rl-TPO according to the scheme did not decrease by less than 150×10⁹/l. In the 2nd group, the level of platelets from 50-65×10⁹/l when using thrombopoietin for therapeutic purposes in 87 % patients began to rise for 4-5 days after administration, normalized on day 12-13, in 13 % patients began to rise on day 7-8, normalized for 15-16 days.

Conclusions. Prevention of thrombocytopenia due to early administration of recombinant human thrombopoietin to the patient, rather than correction of pre-existing thrombocytopenia, can increase the effectiveness of chemotherapy through strict adherence to the schedule and recommended dosage, to avoid possible side effects directly from the patient.
Disorders of carbohydrate metabolism in critical conditions
Authors: Nedashkivsky S.M. , Halushko O.A.
Published: October 2020

Objective. To characterize the features of the occurrence and treatment of disorders of carbohydrate metabolism in critical conditions.

Materials and methods. The search of publications was conducted using the engines PubMed and Google Scholar and analyzed the available domestic literature sources on the topics: carbohydrate metabolism disorders and critical conditions.

Results and discussion. In critical conditions, the following disorders of carbohydrate metabolism develop: diabetic and non-diabetic ketoacidosis, hyperosmolar syndrome, hypoglycemia and lactic acidosis. Carbohydrate disorders in critical conditions develop against the background of the underlying disease, masked by it and worsen the patient’s condition. To diagnose these conditions, a nitroprusside ketonuria test is often used, which does not reflect the actual level of ketonuria (β-oxybutyric acid) and responds to their level in a delayed manner, so most ketosis is diagnosed late – in a decompensated state. Therefore, it is necessary to be guided first of all by a condition of the patient and clinical signs of existence of ketoacidosis. Xylitol (Xylat) solutions are used to treat these conditions. It is believed that xylitol has the greatest antiketogenic effect among all known substances. In particular, Xylat reduces the amount of free fatty acids; increasing of the formation of pyruvic acid, which promotes the oxidation of acetyl-coenzyme A in the Krebs cycle; enhances glycogen production in the liver; stimulates insulin secretion. Do not wait for the appearance of “4+” acetone in the urine analysis. If the patient has nausea, vomiting, dizziness, drowsiness, dry skin and dry mouth, deep noisy breathing and frequent urination on the background of hyperglycemia (>13.9 mmol/l) – should use xylitol-containing drug (Xylat) at a dose of 6-10 ml/kg intravenously.

Clinical case. Patient M., 67 years old, was admitted to the trauma department with a hip fracture. He was treated conservatively (skeletal traction) for 3 weeks. Sudden deterioration of state of health is registered: periodically non-contact, loses consciousness. Blood pressure is not determined, heart rate cannot be calculated due to high frequency. On ECG – ventricular tachycardia. Bolus administration of amiodarone had no effect. Carefully analyzed history (diabetes does not get sick, but 3 weeks did not eat enough, almost starved). The level of glycemia is 5.2 mmol/l, ketonemia is 8.4 mmol/l (N=1.7 mmol/l). Diagnosed with non-diabetic ketoacidosis. Xylat infusion (7.5 ml/kg) was performed and amiodarone was reintroduced. As a result, sinus rhythm was restored, the patient regained consciousness.

Conclusions. With the development of critical conditions, patients often have disorders of carbohydrate metabolism, which are often stopped by the introduction of xylitol (Xylat).
Peculiarities of antimicrobial therapy of viral-bacterial pneumonia in patients with coronavirus disease
Authors: Nesterenko O.M.
Published: October 2020

Abstract. The tactics of examination and treatment of 19 patients before and after laboratory confirmation of coronavirus disease (COVID-19) are given. It is concluded that antimicrobial therapy of viral and bacterial pneumonia in patients with COVID-19 requires a conscious approach with strict adherence to the principles of selection, timely initiation and control of antimicrobial efficacy as an essential component of comprehensive intensive care of patients with this pathology.
Infusion intravenous IgG replacement therapy for hypogammaglobulinemia after anti-CD20 monoclonal antibodies at patients with non-hodgkin’s malignant lymphomas
Authors: Savchenko Ya.B. , Guseva S.A.
Published: October 2020

Objective. Determining the risk of infectious complications in patients with non-hodgkin’s lymphomas (NМL) who received anti-CD20 monoclonal therapy and the effectiveness of intravenous immunoglobulin G (IgG) replacement therapy.

Materials and methods. A prospective analysis of data of 37 persons with NML who were treated in the hematology clinic of the National Military Medical Clinical Center “Main Military Clinical Hospital” from January to December 2019. Statistical data processing was performed using computer programs Microsoft Office Excel (2007) and statistical processing package Statistica 6.0 using the procedure 2×2 Tables (YI/VI/Phil, McNemar, Fisher Exact) module Nonparametric Statistics, which uses the analysis of a four-cell conjugation table.

Results and discussion. The mean age of patients was 56.5±1.4 years; 12 (32.43 %) were female patients. Baseline IgG levels before anti-CD20 monoclonal therapy were not determined in 17 (45.94 %) patients. Hypogammaglobulinemia was detected in 20 (54.05 %) subjects who were tested for IgG levels prior to anti-CD20 therapy. After administration of anti-CD20 monoclonal therapy, hypogammaglobulinemia worsened. There was an increase in severe infections after anti-CD20 therapy (from 9.4 to 40.7 %; p<0,001). An analysis of patient survival within 6 months of starting anti-CD20 monoclonal therapy revealed an increased mortality associated with an increase in age (hazard ratio (HR) 1.05; 95 % confidence interval (CI) 1.00-1.02; p<0.005), male (HR 1.12; 95 % CI 1.01-1.18; p<0.005), severe infectious complications (HR 5.18; 95 % CI 3.16-4,72; p<0.001). Only 10 (27.02 %) patients received IgG replacement therapy after anti-CD20 monoclonal therapy. Among these patients, a higher cumulative dose of immunoglobulin replacement therapy was associated with a reduced risk of serious infectious complications (HR 1.00; 95 % CI 0.98-1.02; p<0.005).

Conclusions. Monitoring of IgG levels both before and after rituximab therapy may allow for earlier identification of risk for developing significant infection and identify patients who may benefit from IgG replacement, which may in turn help to avoid excess morbidity and mortality.
Applications of infusion therapy in the difficult form of tuberculosis
Authors: Todoriko L.D. , Pidverbetska О.V. , Semianiv І.О. , Yeremenchuk І.V. , Kuzhko М.М.
Published: October 2020

Objective. Analysis of the prevalence of the difficult cases of tuberculosis (TB) and assessment of the effectiveness of the treatment when using infusion anti-TB drugs in standard regimens.

Materials and methods. A retrospective analysis was carried out for 2017-2019 of the electronic database the register of patients and the inpatient case history KU “Chernivtsi Regional Clinical TB Dispensary”.

Results and discussion. From 16 to 46 % of patients with TB infection have concomitant signs of diabetes mellitus. In 58.9 % of patients with sensitive TB, the absorption capacity of the small intestine significantly decreases with a predominant decrease in the intestinal permeability index from 3.1 to 6 (in 21.9 % of cases). At multiple-drug resistance TB decrease the absorptive function of intestines is observed in 76,1 % of cases with the prevalence of severe degree of disturbance (in 42,3 % of patients). The proportion of severe forms of sensitive TB is more than 42 % of cases, of which 69.6±1.6 % were diagnosed with destruction. The share of common forms of TB among all cases of drug-resistant TB (DRTB) treated in 4th categories is 47 %, of which with destructive forms – 78.5±3.6 %. The frequency of adverse reactions increases in severe forms of DRTB and amounts to 38 % of all analyzed cases.

Conclusions. Early detection of patients with severe forms of TB, especially in the presence of concomitant pathology, and their allocation into a separate category of “severe patients with TB” using parenteral forms of anti-TB drugs, especially in the early stages of treatment (during the intensive phase, which is the most critical period), it facilitates to reduce the unfavorable prognosis of the course of the underlying disease.
Optimization of therapy in patients with renal hypertension by stabilizing hemovascular hemostasis
Authors: Bobieva N.Kh. , Gadoev S.Kh. , Rashidov I.M.
Published: October 2020

Objective. To study the aggregation activity of platelets in patients with renal hypertension.

Materials and methods. The research work was carried out on the basis of the nephrological department of the State Institution NMC RT “Shifobakhsh”. The study included 46 patients aged 25 to 60 years with chronic pyelo- and glomerulonephritis. The patients were divided into two equal groups: first, the control group received standard therapy in accordance with the clinical protocol of the Tajik Association of Nephrologists; second, the main group, along with complex pathogenetic therapy in order to stabilize the hemostasis system and improve endothelial dysfunction, used the drugs Tivortin (intravenously drip and then long-term per os Tivortin aspartate) and Rheosorbilact intravenously drip. In addition to the generally accepted studies of patients with kidney pathology, emphasis was placed on the criteria for platelet quality (number, mean platelet volume, platelet distribution index, thrombocyte and large erythrocyte ratio) and studies of the hemostasis system (fibrinogen, prothrombin time, activated partial thromboplastin time, prothrombin relation).

Results. There were found the hemostasis in microvessels, increases of the blood viscosity, the activation of systemic thrombus formation, and the progression of endothelial dysfunction in patients with renal hypertension. The results of observation of the dynamics of platelet aggregation activity under the influence of the combination of the studied drugs in this category of patients prove an effective decrease in its level. It is also necessary to emphasize the antiplatelet effect of this combination in relation to the prevention of microthrombosis and the pronounced endothelioprotective effect in patients with renal pathology.

Conclusions. The complex therapy of patients with renal hypertension with Tivortin and Rheosorbilact is an effective way to stabilize hemovascular hemostasis. The effects of this therapy contributed to the improvement of the clinical condition of the patients, and during repeated examinations, there was a stable preservation of the decrease in the level of platelet aggregation activity.
Influence of Rhesorbilact on rheological properties of blood in patients with acute peritonitis
Authors: Khamidov D.B. , Kosimov Z.K. , Boboev B.R. , Khalifaev U.R. , Kholnazarov Sh.E.
Published: October 2020

Objective. Study of the effect of Rheosorbilact on the rheological properties of blood in patients with acute peritonitis.

Materials and methods. 62 patients with acute peritonitis at the age from 20 to 87 years were examined. The patients were divided into two groups depending on the inclusion of Rheosorbilact solution in the infusion therapy program. The first group (control) included 30 patients with the infusion therapy program consisted of conventional crystalloid and colloidal infusions. The second (main) group included 32 patients with the treatment of Rheosorbilact infusion therapy program at an average dose of 5.7-6.6 ml/kg (400 ml per day). The rheological properties of blood were studied by determining the relative blood viscosity with a VK-4 viscometer, hematocrit, fibrinogen and ESR according to generally accepted methods.

Results. In patients with acute peritonitis, when Rheosorbilact (main group) is included in the infusion therapy program, there is a significant improvement in the rheological properties of blood compared with the results of the control group who received crystalloids and colloids. After treatment in patients of the control group, the indicators of the rheological properties of blood were characterized by a decrease in hematocrit – by 16.5 %, blood viscosity – by 11.6 %, fibrinogen content – by 15.2 %, ESR – by 18.2 % compared to the initial data. In patients of the main group who received Rheosorbilact in the infusion therapy program, the rheological properties of the blood significantly improved and amounted to 24.0 % in comparison with the initial data on hematocrit, 18.7 % in blood viscosity, 21.0 % in fibrinogen, and 23.4 % in ESR.

Conclusions. In patients with acute peritonitis, a significant violation of the rheological properties of blood is observed. The inclusion of Rheosorbilact in the infusion therapy program contributes to the correction of impaired blood.