bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the effectiveness of the pharmacotherapy scheme “TRIO” in patients with chronic arterial insufficiency of IIb-III degree
Authors: Petrushenko V.V. 
Published: July 2021

Background. Occlusive peripheral arterial disease (OPAD) of the lower extremities is a pathological condition; its pathogenetic substrate is an obstruction or narrowing of the lumen of peripheral vessels of various calibres. About 200 million people worldwide suffer from OPAD. The incidence and severity of the disease increase with age. Patients with diabetes are 2-4 times more likely to develop OPAD than those without diabetes. Smoking increases the risk of OPAD by 2.5 times.
Objective. To evaluate the effectiveness of the pharmacotherapy regimen “TRIO” in patients with chronic arterial insufficiency of IIb-III degree.
Materials and methods. The study included 45 people with confirmed OPAD of the lower extremities and chronic arterial insufficiency of IIb-III degree (62.2 % males, 37.8 % females, mean age – 61 years). Patients in the experimental group (n=20) were prescribed a “TRIO” scheme, which included: 1) a multicomponent isoosmolar solution containing Ringer’s lactate and pentoxifylline (200 ml per day); 2) multicomponent hyperosmolar solution containing sorbitol and sodium lactate (400 ml per day); 3) a solution of L-arginine hydrochloride (100 ml per day). Comparison group was treated by the solution 2 (200 ml per day) and solution 3 (100 ml per day) only. The effectiveness criteria included the distance of painless walking, the intensity of pain according to the visual-analogue scale (VAS), ankle brachial index, and peripheral oxygen saturation.
Results and discussion. In the experimental group there was a shorter length of hospital stay (7.9±0.97 days vs. 9.8±1.63 days in the comparison group) and better dynamics of painless walking distance (1st day – 47.50±30.54 m, 7th day – 126.25±72.16 m, in the comparison group: 1st day – 49.00±27.73 m, 7th day – 54.20±33.59 m). Pain syndrome according to VAS also decreased more markedly in the experimental group: from 5.35±1.81 points on day 1 to 3.25±1.68 points on day 7 (in the comparison group – from 5.32±1.63 points on day 1 to 4.80±1.53 points on day 7). There was no significant difference in the ankle brachial index. Peripheral oxygen saturation increased more markedly in the experimental group (from 75.50±7.10 % on day 1 to 90.65±5.07 % on day 7) than in the control group (from 75.72±6.55 % on day 1 to 79.48±6.91 % on day 7).
Conclusions. 1. Administration of the pharmacotherapy scheme “TRIO” allows to improve the indicators of the functional state of the vascular bed in patients with chronic arterial insufficiency of IIb-III degree. 2. Manifestations of improvement included lengthening of the distance of painless walking, increase of peripheral blood oxygen saturation, and reduction of the pain severity.
eHealth as a united information space for doctors and patients
Authors: Vasyliev V.S. 
Published: July 2021

Background. The national primary healthcare system (PHS) includes 1939 institutions, 27.7 million patients, 24,607 doctors, 1122 pharmacies and 9395 pharmacists. The eHealth informational space was created to coordinate the work of the PHS.
Objective. To describe the features and functioning of the eHealth informational space.
Materials and methods. Analysis of the current situation regarding the work of eHealth.
Results and discussion. An important function of eHealth is the transition to electronic prescriptions and electronic referrals to specialists under the medical guarantee program. Adopted in 2020 budget of this program amounted to 72 billion UAH, which was allocated to primary care, secondary, tertiary, emergency and palliative care, medical care for children, medical care for pregnancy and childbirth, medical rehabilitation. In total, UAH 1758 billion was spent on the diagnosis and treatment of oncological diseases, of which 80.7 % – on diagnosis and chemotherapy, and 29.3 % – on the diagnosis and radiation treatment. The eHealth system provides the cooperation between the Ministry of Health of Ukraine, the National Health Service of Ukraine and medical institutions with medical information systems. Benefits of the united informational system include the elimination of paperwork, creating a united medical card of each patient, online registration for a doctor’s consultation, eliminating the possibility of drug receipt falsification, increasing the availability of telemedicine consultations, improving communication between healthcare professionals, planning and monitoring of strategic procurement. If the patient uses a smartphone, this informational space allows him to transmit his data (for example, the results of blood pressure measurements) through a mobile application to the telemedicine platform with their subsequent analysis and correction of prescriptions. Additional opportunities of the informational space include monitoring of drugs’ side effects, educational programs for doctors, and the possibility of creating professional communities.
Conclusions. 1. The eHealth system enables Ukrainian doctors and patients to use electronic prescriptions and electronic referrals to the specialists. 2. Benefits of this informational system include the elimination of paperwork, the creation of a united medical card of each patient, online registration for a doctor’s consultation, improved communication between health professionals, improved planning of strategic procurement, etc. 3. The eHealth system includes a number of useful services for both doctor and patient.
Pleural empyema from the point of view of a thoracic surgeon
Authors: Sokolov V.V. 
Published: July 2021

Background. Pleural empyema (PE) is the presence of pus in the pleural cavity. The causes of PE include the diseases of adjacent organs (75 %), direct contamination of the pleural cavity during injuries or operations (20 %), and hematogenous dissemination of infection (5 %).
Objective. To describe the modern views on the treatment of EP.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. Radiography, computed tomography, and ultrasound can be used to diagnose PE. To detect PE, radiography should always be performed in two projections, paying special attention to the posterior sinus and the space above the diaphragm. Computed tomography shows pleural layers’ separation and a “pregnant woman” symptom. Ultrasound can distinguish fluid, pleural thickening and pulmonary infiltration, as well as determine the optimal point for puncture. The ultimate goals of PE treatment include the obliteration of the pleural cavity or creating conditions for the formation of a sterile residual cavity. In case of acute PE, drainage, washing, and antibiotic therapy are applied; correction of concomitant diseases is carried out. Drainage of the pleural cavity should be preceded by a puncture of the pleural cavity to obtain pathological contents. The appearance and odor of the fluid obtained by puncture are the most important indicators of the pathology. Drainage can be performed at the point where the pus was obtained, or in the VII-VIII hypochondrium along the posterior axillary line. Drains from polyvinylchloride with a diameter of 6-8 mm are applied. The length depends on the task. Videothoracoscopy is a modern method of treating PE. This method is minimally invasive, removes fibrin and pus, destroys adhesions, connects cavities and provides drainage at the optimal point. To wash the pleural cavity, it is advisable to use decamethoxine or povidone-iodine. With regard to antibiotic therapy, levofloxacin or third-generation cephalosporins are used in combination with an antianaerobic drug, or carbapenems or glycopeptides.
Conclusions. 1. PE is often a secondary infectious process caused by adjacent structures’ infection. 2. Pleural cavity sanitation during videothoracoscopy and drainage are the main methods of PE treatment. 3. Antibiotic therapy and pleural lavage are integral components of PE treatment.
Organoprotection in patients with COVID-19
Authors: Tashchuk V.K. 
Published: July 2021

Background. Treatment of chronic coronary syndrome (CCS) includes the elimination of acute ischemic pain, prevention of ischemic pain, symptomatic treatment, and influence on the prognosis. The health of patients with CCS during their lifetime is affected by the diet, climate, medication, exposure to toxic substances, and now the COVID-19 epidemic.
Objective. To describe the available options of cardioprotection and metabolic therapy.
Materials and methods. Analysis of literature data on this topic and own research “Smart ECG”.
Results and discussion. A significant number of the foreign scientists’ papers have been devoted to the problems of the excessive release of free radicals, mitochondrial DNA damage, reduction of ATP content and cardiocytoprotection. Even the short-term ischemia depletes ATP depots and slows their recovery. Metabolic therapy is able to protect cardiomyocytes from the hypoxic death due to the mismatch of energy production by mitochondria to the energy needs of the cell. According to the results of the own study “Smart ECG”, L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) activates parasympathetic regulation in stable angina, reducing the risk of adverse events. Vascular, immunomodulatory, antioxidant and cytoprotective properties of L-carnitine and L-arginine make their use reasonable for COVID-19.
Conclusions. 1. Metabolic therapy is an important component of the treatment of CCS. 2. L-carnitine and L-arginine have the pronounced vascular, immunomodulatory, antioxidant and cytoprotective properties. 3. It is reasonable to use these drugs during an epidemic of COVID-19.
Options of severe preeclampsia treatment
Authors: Tkachenko R.O. 
Published: July 2021

Background. Preeclampsia (PE) occurs in 2-8 % of all pregnancies. Every day 210 women die from PE, and neonatal losses are even greater (1380 children per day). Fatal complications of severe PE include cerebral hemorrhage, cerebral edema, pulmonary edema, placental abruption, adrenal hemorrhage, dissecting aortic aneurysm, HELLP syndrome, disseminated intravascular coagulation syndrome. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE.
Objective. To describe the options of severe PE treatment.
Materials and methods. Analysis of literature data on this issue.
Results and discussion. The pathogenesis of PE is based on total damage to the vascular endothelium, which leads to an increase in its permeability, including for albumin molecules. Plasma protein loss is accompanied by a drop in oncotic blood pressure and fluid leakage into the interstitial space. Thus, in patients with PE there is an associated disturbance of fluid and electrolyte balance: along with intravascular dehydration there is extravascular hyperhydration. Infusion therapy (IT) allows to overcome this imbalance and to increase the colloid-osmotic pressure. According to modern views, a restricted IT regimen improves the effects of PE treatment. There are two ways to correct this disorder: an increase in oncotic blood pressure due to infusion of albumin (indicated in case of blood albumin levels <25 g/L) and the administration of osmotically active drugs, such as Reosorbilact (“Yuria-Pharm”). The latter option prevents the loss of fluid from the vascular bed and promotes its return to the vessels from the intercellular space. The total fluid volume should be limited to physiological needs, taking into account pathological losses (not more than 1 ml/kg/h). The maximum IT volume should not exceed 800 ml per day. The drugs of choice for IT before delivery are balanced isotonic saline solutions and solutions containing 6 % sorbitol. Fresh-frozen plasma is not recommended for the correction of colloid-oncotic pressure. Influence on the redistribution of fluid in the interstitial space without the introduction of significant volumes of infusion solutions is the main principle of low-volume IT. Recommendations for the administration of Reosorbilact comply with this principle. The low osmolarity of Reosorbilact and its ability to improve the osmotic properties of blood justify the use of this drug in women with PE.
Conclusions. 1. PE occurs in 2-8 % of all pregnancies. 2. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE. 3. Restricted IT mode improves the consequences of PE treatment. 4. Osmotically active drugs (Reosorbilact) are prescribed for this purpose.
Tranexamic acid for upper gastrointestinal bleeding
Authors: Fenger-Eriksen C. 
Published: July 2021

Background. In patients with trauma and significant bleeding or risk of significant bleeding it is advised to administer tranexamic acid (TXA) intravenously as early as possible at a loading dose of 1 g for 10 minutes, followed by 1 g for 8 hours. The effectiveness of TXA has been proven in various pathological conditions in large trials. TXA has been shown to reduce the need for blood transfusions.
Objective. To describe the use of TXA for upper gastrointestinal tract (GIT) bleeding.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. The mechanism of TXA action is to inhibit plasminogen activation and reduce fibrin degradation, however, its features are not clear. With the use of TXA, the strength of the blood clot and its resistance to lysis increases. The use of TXA in gastrointestinal bleeding was analyzed in the Cochrane Review (2012) of seven randomized controlled trials involving 1,654 patients. TXA was compared with placebo, lansoprazole or cimetidine. There was a lower mortality in the TXA group, however, after taking into account possible bias, this trend did not persist. A randomized placebo-controlled study of HALT-IT included 12,009 patients with gastrointestinal bleeding who were prescribed TXA (loading dose of 1+3 g for 24 hours) or placebo. The primary endpoint was death from bleeding within 5 days. There were no differences in mortality or re-bleeding. The TXA group had a higher frequency of deep vein thrombosis and pulmonary embolism. One of the reasons for the lack of benefits of TXA in gastrointestinal bleeding is that the onset of such bleeding is difficult to detect immediately, and to achieve the effect of TXA as early as possible administration is necessary. In this case, >80 % of patients sought medical help >3 hours after the onset of bleeding. In addition, in 50 % of patients, the bleeding was due to esophageal varices due to liver disease. It is known that most coagulation factors are synthesized in the liver, so liver failure is a common cause of coagulopathies. When the liver is affected, the levels of vitamin-K-dependent procoagulants (coagulation factors II, VII, IX and X), coagulation factor V, as well as anticoagulants (proteins C and S, antithrombin) decrease. Levels of fibrinogen and acute phase proteins remain normal or increase. In case of liver failure, hyperfibrinolysis occurs and at the same time the risk of thrombosis increases significantly. In such patients there is a decrease in hemostatic blood reserve. In general, contraindications to the use of TXA include severe renal failure, seizures, disseminated intravascular coagulation without bleeding, arterial or venous thromboembolism, active bleeding from the upper urinary tract.
Conclusions. 1. TXA is effective for most types of bleedings, however, there are some exceptions. 2. One should remember the side effects of TXA and follow the recommended method of administration. 3. TXA is not suitable for the treatment of gastrointestinal bleeding.
Intoxication syndrome in the practice of internist
Authors: Halushko O.A. 
Published: July 2021

Background. Intoxication syndrome (IS) is one of the most common syndromes in the medical practice, but its exact scientific outline has not yet been established. This is due to a variety of toxic factors, a large polymorphism of symptoms, and complex interactions between the processes of toxin production and detoxification.
Objective. To describe the main features of IS and its treatment.
Materials and methods. Analysis of literature sources on this issue.
Results and discussion. The morphological basis of IS is the subcellular interaction between the toxin and the receptor. IS develops if the toxins’ entry or formation outweigh their elimination. Intoxications are divided into exogenous and endogenous. The diagnostic criteria for exogenous intoxications are the contact of the patient with the substance that caused the intoxication and the corresponding damage to the organs. Exogenous intoxications have a clear clinical picture, and the introduction of specific antidotes or antitoxins is the best treatment. In turn, endogenous IS is mediated by the accumulation of bacterial endotoxins, excess amounts of physiological metabolic products, biologically active substances and mediators. Natural ways of detoxification include metabolism, excretion and immune mechanisms. Infusion detoxification (IDT) with a significant load by crystalloids and multicomponent drugs is a mandatory treatment for both exogenous and endogenous IP. In most cases, the volume of infusion should be 25-35 ml/kg body weight. Requirements for the ideal drug for detoxification include hypervolemia, improving microcirculation and rheological properties of blood, correction of electrolyte disorders and disorders of acid-base balance, increase of diuresis and peristalsis. All these effects are typical for Reosorbilact (“Yuria-Pharm”). In general, the IDT program may include classical and balanced crystalloids (800-1500 ml), Reosorbilact (600-800 ml), specialized solutions (100-200 ml), and symptomatic drugs. The optimal duration of treatment with Reosorbilact is 7 days.
Conclusions. 1. Exact scientific characteristics of IS are still missing. 2. IDT is the mandatory method of treatment of exogenous and endogenous IS. 3. Reosorbilact is the main component of IDT in any IP, as it affects the main links of the pathogenesis of the latter.
Treatment of trophic ulcers of the lower extremities
Authors: Cherniak V.A. 
Published: July 2021

Background. In 50 % of cases trophic ulcers (TU) are caused by chronic venous insufficiency, in 10 % – by arterial insufficiency, in 5 % – by disorders of nerve trophic. Treatment of ischemic TU includes conservative and surgical tactics, wound dressings, pain management, use of hydrogel dressings, antibacterial therapy, measures to improve blood circulation.
Objective. To describe the treatment of TU of the lower extremities.
Materials and methods. Analysis of literature data on this issue.
Results and discussion. The pathogenesis of chronic venous ulcers includes persistent venous hypertension and microcirculation disorders. Varicose veins, postthrombotic disease and congenital vascular malformations are the main causes of such ulcers. In postthrombotic disease affecting the veins of the lower extremities in patients with severe symptoms, surgery (femoro-femoral or femoro-caval bypass), percutaneous endovascular recanalization (stenting, balloon angioplasty), combined surgical-endovenous desobliteration, transposition of the segmentary vein valves and relocation of autoveins may be considered. After the operations on veins, surgical interventions for TU are performed. Antibiotic therapy (Leflocin, “Yuria-Pharm”, 500 mg intravenously once before surgery), topical antiseptic Dekasan (“Yuria-Pharm”) and skin disinfectant Gorosten (“Yuria-Pharm”) are used to accompany interventions for postthrombotic disease. Vasodilation disorders, which are one of the links in the TU pathogenesis, are the result of endothelial dysfunction and nitric oxide (NO) deficiency. To eliminate these factors, L-arginine (Tivortin, “Yuria-Pharm”) is used. Tivortin catalyzes the synthesis of NO in endothelial cells, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium, prevents the formation and progression of atherosclerotic plaques. In the treatment of lower extremity ischemia and TU, it is advisable to use the infusion therapy scheme “TRIO”: Reosorbilact 400 ml + Latren 400 ml + Tivortin 100 ml (“Yuria-Pharm”).
Conclusions. 1. Minimally invasive methods are effective and minimally traumatic option of TU treatment, which should actively displace open methods. 2. Conservative TU treatment includes the microcirculation improvement, the use of antiseptics, strengthening of the vascular wall, antibacterial and rheological support.
Personalized oncology as a global uniting aim of clinical experience, unified protocols and modern technologies on the way to the victory against neoplastic processes
Authors: Herasymenko O.V. 
Published: July 2021

Background. According to the prognoses, by 2025 the global cancer incidence will increase to 24 million cases per year, and mortality – up to 16 million cases. The annual growth rate of tumors number exceeds the growth rate of global population, which justifies the feasibility of improving the diagnosis, treatment and prevention of these diseases.
Objective. Describe the main features of personalized oncology.
Materials and methods. Analysis of regulatory documents and literature sources on this topic.
Results and discussion. In their work Ukrainian oncologists are guided by the domestic documents and the documents of international societies. Personalization of treatment involves taking into account such characteristics of the disease as its stage, morphological affiliation of cells and molecular genetic characteristics of the tumor, as well as such patient characteristics as sex, age, general somatic status, comorbidities, and place of residence. Personalized medicine is a set of methods for diagnosis, treatment and prevention of pathological conditions, based on the individual characteristics of the patient (genetic, epigenetic, transcriptomic, proteomic, metagenomic markers, phenotypic features). For the introduction of personalized medicine into oncology it is necessary to use the molecular genetic profiling of the tumor, to assess the risks with the help of several specialists, to involve the patient in decision-making regarding treatment and diagnostic measures. The main tools for the widespread introduction of personalized medicine include qualified specialists, laboratories of pharmacogenetics and pharmacokinetics, the formation of competencies in health care providers and the development of personalized pharmacy. The main result is the widespread implementation of treatment programs using personalized protocols with targeted delivery of the drug to the appropriate targets, taking into account the state of the body of the particular patient at the specific time.
Conclusions. 1. The incidence of cancer is steadily growing. 2. Personification of treatment involves taking into account the stage of the disease, morphological affiliation of cells and molecular genetic characteristics of the tumor, as well as individual characteristics of the patient. 3. For the introduction of personalized medicine in oncology it is necessary to use molecular genetic profiling of the tumor, to assess the risks with the help of several specialists, to involve the patient in decision-making regarding treatment and diagnostic measures.