Search

The use of medicated procedural sedation in ambulatory surgery and in intensive care units has become popular due to increased treatment options for the doctor and increased comfort for the patient. The purpose of this literature review is to highlight studies reporting the efficacy and safety of midazolam as a sedative in adults and children for procedural sedation.

Adequate perioperative pain relief is an integral part of anesthesia. Opioid analgesics occupy one of the key places in the purchase of acute and chronic pain in the world. The article presents current data on the clinical effectiveness of remifentanil, a derivative of fentanyl, which is a selective ultra-short-acting μ-opioid receptor agonist when used in the perioperative period for the treatment of acute and chronic pain. Comparisons of the therapeutic activity and physicochemical properties, pharmacokinetic and pharmacodynamic characteristics of remifentanil with other opioids (fentanyl, sufentanil, alfentanil) are provided. Its unique properties (eg, organ function-independent metabolism, non-accumulation, rapid onset of action, and short duration of action) distinguish it from other opioid agents. Remifentanil is at least as effective as comparator opioids such as fentanyl, sufentanil in relieving pain and sedating patients during the perioperative period. In addition, it provides rapid and predictable extubation and is associated with shorter duration of mechanical ventilation and shorter length of hospitalization than comparators in some studies. In addition, remifentanil is well tolerated in both adults and children. Thus, remifentanil is a desirable addition to currently available pharmacologic agents used to treat period pain in patients

Although numerous clinical guidelines for pain management have been published over the past decade, inadequate pain relief remains a major public health problem. Currently, several methods of analgesia are available for the treatment of acute pain, including intravenous analgesia, epidural anesthesia, and oral administration of medications. However, the existing methods of analgesia still do not cover all the needs of proper analgesia, the search for new forms of release, methods of administration and methods of analgesia continues. Currently, non-invasive methods of analgesia are being actively implemented, which include a transdermal delivery system of analgesics (in particular, fentanyl hydrochloride), intranasal and inhalational analgesia, in which the delivery of analgesics is controlled by both the doctor and the patient. The purpose of this article is to review the inhaled analgesic methoxyflurane, which is administered by means of an individual inhaler and is used for the treatment of acute pain.

The use of medicated procedural sedation in ambulatory surgery and in intensive care units has become popular due to increased treatment options for the doctor and increased comfort for the patient. The purpose of this literature review is to highlight studies reporting the efficacy and safety of midazolam as a sedative in adults and children for procedural sedation.

Background The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. Methods The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). Results Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2, and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. Conclusions In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.

Today surgical site infections (SSIs) remain the second among hospital acquired infections in Europe and the USA. Staphylococcus aureus as a pathogen of nosocomial infections occur more frequently in surgical hospitals. The work was aimed to establish the effect of local anesthetics against planktonic forms and biofilm-formation of S. aureus clinical strains and the relationship between the sensitivity of S. aureus strains to local anesthetics and antiseptics in vitro. The antimicrobial activity of local anesthetics (0.5%, bupivacaine, 2.0% lidocaine, 0.375% ropivacaine) and antiseptics (decamethoxine 0.02%, chlorhexidine 0.05%) against clinical strains of S. aureus was observed and studied their ability to produce biofilms. The antimicrobial effect of local anesthetics was lower compared to antiseptics, but we observed inhibition of growth and reproduction of S. aureus in their presence. The ropivacaine solution and the lidocaine solution demonstrated almost the same activity against the studied microorganism isolates. Along with this, bupivacaine solution had the highest activity against the studied microorganisms. The minimal inhibitory concentration of bupivacaine for S. aureus was 2.2 times lower than the minimal inhibitory concentration of lidocaine and 2.1 times lower than the minimal inhibitory concentration of ropivacaine significantly (p

The article analyses the state of the aviation industry in Ukraine during the first years of the Soviet regime in January-March 1918 and its policies in this sphere. The establishment of the Soviet regime in Ukraine during this period was the result of offensive actions by Bolshevyk and pro-Bolshevyk troops against the Ukrainian People’s Republic. Therefore, the Soviet regime had transient nature in Ukraine amidst the unfinished First World War. In these settings, it established a management system in the field of aviation, which was aimed at auditing and evacuating aviation property and personnel. The study found that the aviation industry in Ukraine functioned quite efficiently in general and was manageable despite the difficulties of the revolutionary times. In this work, the authors used archival documents, which were first introduced into circulation. The socio-economic and political conditions, this industry operated in, were taken as a basis for the analysis of the aviation industry status in Ukraine. During this period of the First World War, warfare on the Eastern Front had its final phase, and peace talks were held in Brest-Litovsk, in which delegations of the Ukrainian People’s Republic and the Soviet Russia took part. Since the conclusion of the armistice on December 10, 1917 between Soviet Russia and the countries of the Quadruple Alliance, a state of chaos has spread across the territory of Ukraine, which was associated with the mass movement of soldiers back from the front. Social chaos intensified as the Soviet authorities gained control over almost entire territory of the Ukrainian People’s Republic. However, some air force units were able to maintain their material base. The Soviet regime was able to audit their condition and restore control over the available resources in the aviation industry, however, the facts of theft of goods, which belonged to these air force units was also established. Attempts were made to form an effective management system of the aviation industry and its scheme started to be developed. However, due to the political situation, these attempts were in vain. As early as the beginning of March 1918, Bolshevyk troops have been losing ground of most of Ukraine to the UPR troops and their allies, i.e., the German-Austrian troops. The short period of attempts to build a management system of the aviation industry by the Soviet regime in extreme military-political conditions is quite interesting, as it demonstrates approaches to the effective management of the high-tech sphere in a difficult situation.

On the eve of the season of respiratory infections, we would like to draw the attention of outpatient doctors to the fact that 80–90 percent of winter diseases affecting the nose, ears, throat and lungs are of viral origin. Improper and excessive consumption of antibiotics increases the risk of antibiotic resistance, and thus humanity enters the post-antibiotic era. The World Health Organization warns that the problems that antibiotic resistance could cause in the future can be compared to the spread of AIDS in the 1980s. The principles of rational use of antibiotics should always be based on the assumption that antibiotics are causal drugs, and their overuse very often leads to resistance, which negatively affects the entire population. Irrational antibiotic therapy can also lead to discomfort, worsening of acute and chronic pain. It is also important to know that in the post-antibiotic era, science has other options for fighting bacteria, such as vaccination, immunotherapy, and strengthening individual immunity. The correct attitude of doctors to the prevention of diseases and rational treatment with antibiotics can help reduce the resistance of bacterial strains, discomfort and pain.

Introduction. Nosocomial infections are risk factors associated with in-hospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, a central venous catheter (CVC) is one of the most common causes of catheter-related bloodstream infection (CRBSI). Background. To investigate the effectiveness of antimicrobial chlorhexidine dressings compared with standard dressings in the prevention of central venous catheter-related bloodstream infections. Methods. 20 children who were treated in the intensive care unit were randomly divided into two groups of 10: a group that used chlorhexidine dressings and a group that used standard dressings (comparison group). Patient care was carried out in accordance with asepsis and antisepsis rule. The primary outcomes were a comparative study of microbiological researches of peripheral blood blood culture and catheter blood sample. But the final results were cultures from the tip of the catheter (at least 5 cm) after removal of the catheter in case of clinical symptoms of KAIK or in case of planned removal of the catheter due to the lack of its further need. Results. Catheter colonization occurred in 3 patients in the control group (3 %) and in 2 patients in the chlorhexidine dressing group (2 %). Catheter-related bloodstream infections occurred in 3 patients in the control group (3%), and in patients in the chlorhexidine group, no microorganisms were isolated by microbiological examination of the implantation sites (0 %). Although more patients in the comparison group had catheter-related bloodstream infections, the difference in infection rates between the two groups was insignificant (P = 0.07). Conclusions. The use of chlorhexidine-impregnated dressings reduced the incidence of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in the pediatric intensive care unit, but there was no significant difference compared with the use of standard dressings. This study needs further study in pediatric patients.

Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics – from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient’s optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.

Background: The causes of many pathological conditions in neonates with very low gestational weight and fetal growth retardation remain unclear. One such condition is massive, rapid-onset skin necrosis in various parts of the body. In this article, we present the case of a small for gestational age neonate with extensive necrosis of the skin and subcutaneous tissues of the upper extremities and back. Aim: To provide a detailed review of a clinical case of skin necrosis of the upper extremities and back in a small for gestational age infant. Method: A report of a single case with a detailed description of an improved skin micro-autografting technique. Result: Skin integrity was successfully restored after multiple debridements by using this micro-autograft technique in a small for gestational age infant. Conclusion: Timely appropriate debridement followed by micro-autografts, as part of a comprehensive and interdisciplinary care approach, resulted in the successful treatment of a small for gestational age infant with extensive skin necrosis.

Sedation is an important aspect of adequate treatment of patients in the intensive care unit. Recent drug developments and new ventilation strategies provide improved sedation management that allows for better adaptation to the clinical condition and individual needs of the patient. This article provides an overview of the general principles of sedation of patients in intensive care units and focuses on a relatively new drug in the pharmaceutical market of Ukraine — dexmedetomidine. Given the pandemic of coronavirus disease COVID-19, there was carried out a review of the international and domestic literature describing the use of dexmedetomidine as a sedative and analgesic in patients with acute respiratory distress syndrome caused by SARS-COV-2 virus. Its anti-inflammatory and antioxidant properties are also described, which will allow the use of the drug in complex therapy in the treatment of COVID-19 in severe patients.

We aimed to study the influence of prolonged administration of fentanyl on postoperative pain, intra­ab­dominal pressure and mechanical lungs’ changes that may happen in neonates in early post­operative period. 30 newborns (in the period from January 2017 to May 2021) with gastroschisis were divided into two groups ac­cordingly to the method of analgesia (14 – morphine hydrochloride; 16 – prolonged infusion of fentanyl). Lungs’ mechanical characteristics, effectiveness of post­operative analgesia, abdominal wall relaxation was studied by monitoring of dynamic compliance (Cdyn), pressure and flow­volume loops, capnography. Apprising analgesia sta­tus, we measured hemodynamic, SаO2, blood level of cortizol, C­reactive protein (CRP), glucose, analyzed post­operative pain syndrome using visual analogue scales (VAS). Intra­abdominal pressure (IAP) was controlled by Cron. For statistic analysis we used Student’s t­test. In the group with morphine, thete was the increase of IAP by 11–12 cm H2O, being stable during some period of time, and also variable levels of pain according to VAS, the in­creasing of CRP from 0.8 ± 0.25 mg/dl by 5 mg/dl, cortisol by 674.4 nmol/l, and blood glucosae rate – 7.4 mmol/l. Periods with high traumatic effects and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3.4 times, resistance increasing in 2.42 times and PIP rising till 22 cm H2O. Di­rect correlation between IAP increase and lungs’ mechanical changes took place. The study has demonstrated that prolonged administration of fentanyl prevented high increase of IAP, CRP, levels of glucose and cortizol and changes of VAS data, lungs’ mechanical characteristics.

The article presents the results of domestic and international studies of the use of the fourth-generation fluoroquinolone moxifloxacin in the treatment of commu-nity-acquired pneumonia and pneumonia caused by SARS-CoV-2. Analysis of the clinical use of moxifloxacin in the treatment of complications of the respiratory tract infec-tions indicates its high efficiency and bioavailability, a low risk of resistance, which makes it possible to recommend it for widespread use in the work of a practicing doctor. Ge-neric drug Maxicin (Yuria-Pharm), available as a 20 mg/ml concentrate in a 20 ml vial, can significantly reduce the cost of treatment and optimize infusion therapy by choosing both volume and solvent.

The article studies the Carpathian Ukraine’s factor in the policy of European countries according to the political configuration in the Central Europe in late 1930s after the Munich Conference, 30 September — 2 October, 1938. The author has used both historical research methods and methodological techniques of jurisprudence. It is analysed international legal documents, in particular, the Treaties of Saint-Germain and Trianon determining the Central Europe’s policy after the end of World War I. The provisions of the Czechoslovak Constitution of 1920 are also analysed. The process of revising the Treaty of Saint-Germain and initiating the revision of the Treaty of Trianon determining the Carpathian Ukraine’s status iss analysed. It is underlined the German and Italian positions on the Carpathian Ruthenia’s situation. Diplomatic correspondence of the German Ministry of Foreign Affairs, covering the position of not only Germany but also Italy, Poland, Hungary, and Romania appealing to the Central Europe’s policy after launching the procedure of revising the peace treaties summing up the results of World War I, is used to address that problem. It is analysed the political and legal conditions of the Ukrainian state-established forces triying to realize the right to self-determination of the Ukrainian people in the Carpathian Ruthenia. The study of the problem of the Carpathian Ukraine’s factor in the policies of big European states with respect to structuring the Central Europe’s policy reveals that the strengthening of the policies of Poland and Italy towards the regional bloc foundation became possible after the Munich Conference of 1938. Such bloc provided for strategic consolidation of such Central European countries as Poland (which was expected to play a leading role in that bloc), Hungary, and Romania, while Italy assigned itself the role of a strategic partner of the bloc. However, the fact of existence of the Carpathian Ukraine (initially, as an autonomous territory within Czechoslovakia) obstructed such geopolitical formation. The bloc in the Central Europe with Polish domination and Italian strategic partnership was wholly at odds with geopolitical interests of Germany. Actually, that was the reason behind German support to the Carpathian Ukraine. However, the change in the German strategic plans regarding the future of Poland caused the revision of the policy to support the Carpathian Ukraine.

The article presents modern data on the use of N-acetylcysteine in the treatment of infectious diseases of the respiratory tract in the practice of a physician. Its antioxidant, mucolytic, anti-inflammatory, pulmoprotective and antitoxic properties are described. The emphasis is placed on the antioxidant properties of N-acetylcysteine, which are expressed when used in high doses of 1200 mg/day or more. There is a review of the literature on the use of high doses of N-acetylcysteine in the treatment of pneumonia, cystic fibrosis, COPD, ARDS. The effect of N-acetylcysteine on individual risk factors for prolonged pneumonia is analyzed. Given the epidemiological situation around the world, the antioxidant properties of N-acetylcysteine in the treatment of pneumonia, including complicated COVID-19, are relevant and require further study.

Infectious complications in surgery occupy a significant place among the causes of death and increase in the cost of medical care for various pathologies. Antibiotic prophylaxis takes one of the first places in the perioperative period, in addition to surgical treatment and compliance with the rules of asepsis and antiseptics. Laxers is a new drug in the cephalosporin group, consisting of a combination of cefoperazone and sulbactam. It has a wide range of action on gram(-) and anaerobic flora and antistaphylococcal activity, which is not inferior to cefoperazone. Due to sulbactam, it has antimicrobial activity against Pseudomonas aeruginosa and Acinetobacter spp. This article describes the main properties and advantages of Laxers over other cephalosporins in this group as the drug of choice in the treatment of surgical pathologies and alternative antibiotic prophylaxis in the perioperative period in severe patients at risk of contamination of the operating field with hospital flora.

The choice of an intravascular cannula (catheter) is a rather difficult and important issue in modern medicine, especially in the anesthesiology and intensive care unit. In today’s market there are many variants of cannulas, which differ in size and material. As for the size of the cannula, the issue is resolved. The American Medical Device Manufacturers Association proposed measuring the outer diameter of cannulas in “gauge” G. The European Standard ISO 10555.5 regulates the outer diameter of cannulas in millimeters and states that each catheter should have a color marker indicating the nominal outer tube. Color marking helps to find quickly the right size of cannula in extreme situations. The marking of cannulas in “gauge” G and mm is made on the packaging of the product. As to the choice of material, the question remains open. Therefore, in this article, we decided to cover the issue of choice of intravascular cannulas on the material. We have also developed some practical guidelines that facilitate catheterization of peripheral veins and allow cannula to stay longer in the vein. This article will be interesting for doctors and nursing staff.

Background. Burn injury, as one of the most common types of trauma, requires a comprehensive approach to treatment, including surgical and conservative treatment with effective post-burn wound protection. One of the main obstacles to wound healing is purulent-infectious complications, for prevention of which antiseptics are widely used. The aim is to study the microbiological, histological features of the wound healing course in the acute period of burn disease with the use of various antiseptics. Materials and methods. In the research there were involved 44 patients with burns (burn area 10–20 % of the body surface), treated in the Clinical Center for Thermal Injury and Plastic Surgery of Communal Non-Commercial Enterprise “Vinnytsia Regional Clinical Hospital named after M. I. Pirogov” (2018–2019). Depending on the antiseptic therapy, these patients were divided into three observation groups. Patients in the 1st study group (n = 15; mean age 48.07 ± 12.05 years) were treated with 2.0 % povidone-iodine during dressing. In the 2nd group (n = 15; mean age – 48.53 ± 14.76 years) antiseptic based on 0.02 % decamethoxin was used. In patients of the comparison group (n = 14; mean age – 47.71 ± 12.39 years) a solution of 10.0 % NaCl was administrated for topical wound management. Microbiological assessment of the condition of the wound surface (on 3, 7, 14, 21 days) and histological examination of tissue samples from the bottom of the wound (on 3, 7, 14 days) were carried out by means of standard methods. Results. Under the use of antiseptic agents based on 2.0 % povidone-iodine and 0.02 % decamethoxin during the treatment period in patients with burns up to 14 days, an effective reduction in the number of conditionally pathogenic microorganisms on the wound surface to lg (4.8 ± 0.4) and lg (3.06 ± 0.5) CFU/ml, respectively, was registered and it was significantly 1.5 times lower than that based on 10 % sodium chloride solution (p < 0.05). When applying decamethoxin for 14 days at the same time as the eradication of conditionally pathogenic microorganisms, moderate colonization of wounds was registered by representatives of normal skin microbiota (Corynebacterium spp., S. epidermidis). Histologically, there was found that with the use of 2.0 % povidone-iodine, the wound healing course was accompanied by a marked decrease in inflammation signs, as well as a pronounced inhibition of the formation of granulation tissue (10–14 days). The use of 0.02 % decamethoxin was accompanied by the formation of granulation tissue of sufficient maturity for atodermoplasty, in the presence of signs of inflammatory cellular reaction with the presence in the superficial parts of the bottom of the post-burn wounds of the fibrinoid layer, with signs of permanent formation of new hemocapillaries in it, surrounded by a thin argyrophilic mesh. When using a hypertonic sodium chloride solution before autodermoplasty, the granulation tissue had signs of uneven inflammatory cell infiltration. Signs of leukocyte-necrotic tissue changes, fibrinoid-leukocyte layers with fragments of tissue detritus, signs of resuscularization of granulation tissue were recorded. Conclusion. Microbiological data strongly suggest the efficacy of 0.02 % decamethoxin and 2.0 % povidone-iodine in reducing microbial wound colonization infection compared to 10.0 % NaCl. The use of antiseptics and hypertonic sodium chloride solution in the acute period of burn disease provides a marked reduction in histological signs of inflammation in the wound with a noticeable positive effect of decamethoxin and 10.0 % NaCl on the formation of granulations and their revascularization compared with povidone-iodine (p < 0.001).

Under conditions of wide increased resistance of pathogens of infectious complications to antimicrobial agents, a considerable attention is paid to the use of antiseptic drugs. The research of their antimicrobial efficacy remains valid for substantiation of the rational use. The purpose was to carry out a comparative study of the antimicrobial efficacy of medicinal antiseptic agents based on decamethoxine and povidone-iodine. In the study there was examined antimicrobial activity of mentioned antiseptics against 682 clinical strains of microorganisms (A. baumannii, S. aureus, P. aeruginosa, Enterococcus spp., E. coli, Enterobacter spp., K. pneumoniae, Proteus spp.), isolated from patients with infectious complications. Minimum inhibitory and bactericidal concentrations of 1–2– 10 % iodine, 0.02 % decamethoxine (decasan) were determined. Antimicrobial efficacy of medicines, based on studied antiseptics was evaluated with the use of an index of antiseptic activity, calculated by means of commonly used methods. The study revealed high bactericidal properties of decasan against clinical strains of S. aureus, Enterococcus spp., E. coli, K. pneumoniae and Enterobacter spp. The advantages of antimicrobial activity of decamethoxine-based antseptis (decasan, p < 0.001) were proved. Iodine has expressed antimicrobial properties against Enterococcus spp., S. aureus, A. baumannii, bacteria of the Enterobacteriаcеae family and P. aeruginosa. It is proven that the dissolution of povidone-iodine leads to the reduction of the antimicrobial efficacy of 2 % antiseptic solution. There was found inefficacy of 1 % povidone-iodine against infectious agents (p < 0.001). Thus, the leading Gram-positive (S. aureus, Enterococci) and Gram-negative pathogens (Escherichia, Klebsiella, Enterobacteria, Acinetobacteria, Pseudomonas) have a sensitivity to iodine and to domestic preparation based on decamethoxin 0.02 % (decasan), with a definite advantage of the antimicrobial properties of the latter to Gram-positive and some Gram-negative microorganisms (p < 0.001).

Dmytriiev Dmytro, Nazarchuk Oleksandr. Pre-emptive administration of intravenous acetaminophen with transversus abdominis plane block (tap-blocke) in the prevention of fentanil-induced hyperalgesia in pediatric oncological patient undergoing abdominal surgery. Journal of Education, Health and Sport. 2015;5(10):98-107. ISSN 2391-8306. DOIhttp://dx.doi.org/10.5281/zenodo.32514 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%2810%29%3A98-107 https://pbn.nauka.gov.pl/works/659929 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.08.2015. Revised 05.09.2015. Accepted: 20.10.2015. UDC: 616-089.5-053.2: 616-006 PRE-EMPTIVE ADMINISTRATION OF INTRAVENOUS ACETAMINOPHEN WITH TRANSVERSUS ABDOMINIS PLANE BLOCK (TAP-BLOCKE) IN THE PREVENTION OF FENTANIL-INDUCED HYPERALGESIA IN PEDIATRIC ONCOLOGICAL PATIENT UNDERGOING ABDOMINAL SURGERY Dmytro Dmytriiev, Oleksandr Nazarchuk Department of Anesthesiology and Intensive care, Vinnytsya National Pirogov Memorial Medical University Abstract Background: Acetaminophen is a selective COX-2 agonist that has been shown to decrease the intensity of opioid-induced hyperalgesia (OIH) in children. We aimed to investigate the effects of preemptive administration of intravenous acitomenofen in the prevention of high-dose fentanil-induced hyperalgesia in pediatric patients. Methods: 45 patients of American Society of Anesthesiologists physical status 1-3 undergoing abdominal surgery were randomly assigned to one of the following three groups. each of which received either IV acetaminophen (an initial dose of 1.5 ml/kg for 40 min before before the induction of anesthesia) or placebo saline 40 min before the induction of anesthesia and intraoperative fentanil infusion: group LFH received a placebo and 0.05 μg/kg/min fentanil; group FH received a placebo and 0.3 μg/kg/min fentanil; and group AFH received IV preemptive administration acetaminophen and TAP-blocke bupivacaine 0,3 mg/kg. Results: The mechanical hyperalgesia threshold 12 hr after surgery was significantly lower in group FH than in the other two groups. Postoperative pain intensity using visual analog scale (VAS) and cumulative volume of a patient controlled analgesia (PCA) containing morphine over 12 hr were significantly greater in group FH than in group AFH. The time to the first postoperative analgesic requirement was significantly shorter in group RH than in the other two groups. The sevoflurane requirement was significantly greater in group LFH than in the other groups. The frequency of hypotension and bradycardia was significantly higher, but shivering and postoperative nausea and vomiting were significantly lower in group AFH than in the other two groups. Conclusions: High-doses of fentanil induced hyperalgesia, which presented a decreased mechanical hyperalgesia threshold, enhanced pain intensity, a shorter time to first postoperative analgesic requirement, and greater morphine consumption, but IV preemptive administration acetaminophen alleviated those symptoms. IV preemptive administration acetaminophen may be an effective treatment option for preventing or attenuating OIH. Key words: IV preemptive administration acetaminophen, Opioid-induced hyperalgesia, fentanil, TAP-blocke.

Nazarchuk Serhii, Sukhodolia Anatolii, Nazarchuk Oleksandr. Clinical and immunological research of qualities of antimicrobial disepidermic cryolyophylized xenoderm grafts. Journal of Education, Health and Sport. 2015;5(8):434-442. ISSN 2391-8306. DOI10.5281/zenodo.31322 http://dx.doi.org/10.5281/zenodo.31322 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%288%29%3A434-442 https://pbn.nauka.gov.pl/works/632549 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 26.08.2015. Revised 05.09.2015. Accepted: 24.09.2015. UDC: 616+615.47.014.47-616.5-089-74 CLINICAL AND IMMUNOLOGICAL RESEARCH OF QUALITIES OF ANTIMICROBIAL DISEPIDERMIC CRYOLYOPHYLIZED XENODERM GRAFTS Serhii Nazarchuk1, Anatolii Sukhodolia2, Oleksandr Nazarchuk3 1Khmelnytskyi Regional Clinical Oncological Dispensary, Department of Abdominal Surgery 2Vinnytsya National Pirogov Memorial Medical University, Department of Surgery of the Faculty of Postgraduate Study 3Vinnytsya National Pirogov Memorial Medical University, Department of Microbiology, Virology and Immunology Abstract In the article the results of the research of immunological changes after the using of antimicrobial disepidermic cryolyophilized xenoderm grafts in the model of intestinal anastomosis forming; clinical effectiveness of their use for prevention intestinal sutures’ and anastomosis’ insolvency in patients with oncological pathology are presented. In experiment, it is shown, that while using DCXG the essential changes of local immune reactivity have place. It is proved that the tendency of unevenly and not proportionally increasing of cells with main classes Ig A, Ig M, Ig G, Ig E shows highly active and non-stable local immunologic reactions of intestinal mucosa on using DCXG; the intensity of local immune reactions significantly decreases by the 25th day and is nearby to normal ones. DCXG were used in 50 patients, who underwent surgery in Khmelnytskyi Regional Clinical Oncological Dispensary and Khmelnytskyi Regional Clinical Hospital in 2009–2013 years. The incidence of purulent-inflammatory complications of intestinal anastomosis’ insolvency in the main group of patients was above 4,3 % and 16 % in control one. Key words: sutures’ insolvency, anastomosis, xenoderm grafts, antimicrobial materials.

Paliy Gordiy, Nazarchuk Oleksandr, Osadchuk Neonila, Paliy Dmytro, Kovalenko Iryna. Prognostic criteria of sensitivity to antibiotics of staphylococcus clinical strains. Journal of Education, Health and Sport. 2015;5(7):26-33. ISSN 2391-8306. DOI 10.5281/zenodo.19076 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%287%29%3A26-33 https://pbn.nauka.gov.pl/works/574289 http://dx.doi.org/10.5281/zenodo.19076 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 21.04.2015. Revised 28.05.2015. Accepted: 24.06.2015. UDC: 576.851.252:577.18 PROGNOSTIC CRITERIA OF SENSITIVITY TO ANTIBIOTICS OF STAPHYLOCOCCUS CLINICAL STRAINS Gordiy Paliy, Oleksandr Nazarchuk, Neonila Osadchuk, Dmytro Paliy, Iryna Kovalenko Department of Microbiology, Virology and Immunology, Vinnytsya National Pirogov Memorial Medical University Ministry of Health of Ukraine Abstract In the article, the new data of sensitivity to antibiotics in clinical strains of Staphylococci are presented. For the first time, analytic dependence of dynamic prognostic criteria of the change of sensitivity of S. aureus clinical strains, isolated from patients, was obtained by means of mathematical prediction. There were investigated prognosticated indexes of Staphylococcus strains’ sensitivity to beta-lactams (oxacillin, ceftriaxone, imipenem and meropenem), vancomycin and linezolid. The dynamic of sensitivity decreasing to oxacillin, ceftriaxone, carbapenems (imipenem, meropenem), vancomycin (92,5 %) and high sensitivity to linezolid in clinical strains of S. aureus were found out. Key words: sensitivity, antibiotics, Staphylococcus, prognostic indexes.

Nazarchuk Oleksandr, Nahaichuk Vasyl, Paliy Viktor, Kovalenko Iryna. Microbiological aspects of the effectiveness of antimicrobial drugs. Journal of Education, Health and Sport. 2015;5(6):19-28. ISSN 2391-8306. DOI 10.5281/zenodo.18203 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%286%29%3A19-28 https://pbn.nauka.gov.pl/works/562794 http://dx.doi.org/10.5281/zenodo.18203 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 20.05.2015. Revised 28.05.2015. Accepted: 31.05.2015. UDC: 615.28:616-001.17 MICROBIOLOGICAL ASPECTS OF THE EFFECTIVENESS OF ANTIMICROBIAL DRUGS Nazarchuk Oleksandr1, Nahaichuk Vasyl2, Paliy Viktor2, Kovalenko Iryna1 1Department of Microbiology, Virology and Immunology, Vinnytsya National Pirogov Memorial Medical University Ministry of Health of Ukraine 2Department of General Surgery, Vinnytsya National Pirogov Memorial Medical University Ministry of Health of Ukraine Abstract Introduction. It is well known, that patients with deep burns belong to the category of critically ill ones. According to the data of National Nosocomial Infections Surveillance (2004), Staphylococcus spp. are among leading opportunistic pathogens of infectious complications in such patients. Nowadays much attention is given to the problem of antibiotic resistance of Staphylococcus clinical strains. More often antiseptics are used in treatment of infectious complications, caused by antibiotic resistant miсroorganisms. The aim of the research was to study microbiological aspects of the effectiveness of antimicrobial drugs. Materials and methods. There were examined 372 critically ill patients with burns, having infectious complications. In all patients microbiological examinations were carried out during the first 7 days after burn trauma. There were isolated 115 clinical strains of Staphylococcus spp.. Their morphological, cultural, biochemical qualities and sensitivity to antibiotics, antiseptics were studied. Rresults of the study. We found, that clinical strains of S. aureus, S. epidermidis were highly resistant to oxacillin (46,9; 59,1 % respectively); were insensitive to clavulanate and sulbactam potentiated beta-lactams; ceftriaxone; meropenem, imipenem; ciprofloxacin. Sensitivity of Staphylococcus to amikacin, linezolid, vancomycin was found. There was shown the sensitivity of antibiotic resistant strains of Staphylococcus to decamethoxin, its polymer composition, chlorhexidine digluconate. In the research there was proved the decreasing of the effectiveness of chlorhexidine digluconate against Staphylococcus in conditions of increasing microbial load to 109 CFU/ml in 6,6 times comparably to decamethoxin drugs (p