The Pathogenetic Concept of the Diagnostic-Treatment Approach for Patients with Purulent-Septic Complications

Background: The significant improvement of immediate and long-term functional results of treating patients is the fundamental problem of modern medical science. A deep understanding of the pathogenesis is the key point in creating the management strategy for patients with various diseases. Information about the mechanisms of origin and development of purulent-inflammatory diseases and sepsis is essential for finding effective ways to prevent and treat them. The aim of the research is to use the method of fluorescence spectroscopy in creating the pathogenetic diagnostic and treatment model for the prevention and treatment of purulent-inflammatory diseases and sepsis, modification of treatment tactics, search for new markers of purulent-septic diseases, as well as monitoring of patients during the treatment. Materials and methods: The proposed approach, along with standard diagnostic methods, was used to organize the treatment process of 100 patients with purulent-inflammatory diseases, including 15 patients with sepsis, 35 with acute inflammatory abdominal pathology, 20 patients with burn injury (main group) and 35 patients with burn injury (comparison group). Results: The behavior of spectral-fluorescent characteristics in their dynamics has been studied, and the new markers for assessing patients’ conditions have been proposed. Their effectiveness for the diagnosis of purulent-septic diseases has been proved, which advances the results of standard research methods by 24 - 48 hours. Conclusions: The proposed diagnostic and treatment approach is fundamentally important for diagnosis and monitoring during the treatment of patients with purulent-septic diseases. Particularly relevant is the proposal to modify the treatment process for these patients, associated with the use of infusion of donor albumin solutions.

Current Problems of the Diagnostics and Treatment of Sepsis and Burn Injuries: The Modified Pathogenetic Concept

Background: The deep understanding of pathogenesis is a key moment in the formation of the modern strategy of modern medicine. We conducted the thorough analysis of the microscopic processes occurring in the bodies of patients with purulent-septic complications. The modified pathogenetic concept of the diagnostic and treatment model of diseases with septic complications is presented. The obtained information about the mechanisms of origin and development of these diseases is fundamentally important for finding the modern effective methods of treating patients. The aim of the research is to modify treatment tactics for patients with sepsis and burn injuries based on the modified pathogenetic concept using modern diagnostics, i.e. the method of fluorescence spectroscopy (MFS) and biomarkers. Materials and Methods: The proposed modified pathogenetic concept of the diagnostic and treatment model of diseases with purulent-septic complications along with standard methods was used successfully for effective treatment of 15 patients with sepsis and 25 with burn injuries. Results: 3 main scenarios of behaviour of spectral-fluorescence characteristics of patients with sepsis are illustrated. Spectral-fluorescence markers of sepsis were studied, which are informative 24 to 48 hours before the appearance of obvious clinical and laboratory signs of significant changes in the general somatic status of patients. Conclusions: The proposed diagnostic and therapeutic approach is new and fundamentally important for diagnostics and monitoring of the process of treatment of patients with purulent-septic diseases and burn injuries. An in-depth understanding of the dynamics of septic complications and the corresponding changes of the main markers of these diseases during treatment is especially relevant. The use of infusion therapy with solutions of donor albumin as an effective pathogenetic treatment is scientifically justified.

Development Ideas for the Multidisciplinary Integrative Diagnosis and Treatment System of Pelvic Floor Medicine

With the rapid growth of the aging population,pelvic floor dysfunction(PFD)has become a new type of high‑incidence disorder.This disorder can be caused by injury,functional deterioration,or coordination disorders of pelvic support structures,such as pelvic floor muscles,connective tissues,and pelvic floor muscle fiber.The symptoms can include dyssynergic defecation,fecal incontinence,overactive bladder,urinary incontinence,pelvic organ prolapse,hemorrhoids,sexual dysfunction,chronic urinary retention,and chronic pelvic pain.PFD often presents itself as a combination of symptoms involving urological,gynecological,anorectal,and psychological aspects.Under such circumstances,the development of multidisciplinary integrative diagnosis for PFD has become a trend.

DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA:SURVEY CONDUCTED IN SOME REGIONS OF CHINA

Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia （CAP） in recent years. We also investigated the procedure of diagnosis us well as the empirical treatment for this disease in OPD （ outpatient department） of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfiUed the questionnaires and information sheets in each center. After that, data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities （ 77. 3% ）, most of those who had medical insurance. Most CAP patients had productive cough （81.1% ）, and 76. 7% and 18. 2 % CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP （43. 2% ）. Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP （ 51.1% ） with oral taken as the main method for drug using （66. 3% ）. Conclusion This survey provides a key point of empirical therapy in China. The procedure for diagnosing us well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.

Crohn’s disease in low and lower-middle income countries: A scoping review

BACKGROUND While Crohn’s disease has been studied extensively in high-income countries,its epidemiology and care in low and lower-middle income countries(LLMICs)is not well established due to a lack of disease registries and diagnostic capacity.AIM To describe the published burden,diagnostic/treatment capacity,service utilization,challenges/barriers to individuals with Crohn’s in LLMICs and their providers.METHODS We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed,Embase and World Health Organization Global Index Medicus.Two independent reviewers screened the titles and abstracts of all of the publications found in this search,reviewed selected publications,and extracted relevant data,which underwent descriptive review and was analyzed in Excel.RESULTS The database search yielded 4486 publications,216 of which were determined to be relevant to the research questions.Of all 79 LLMICs,only 21(26.6%)have publications describing individuals with Crohn’s.Overall,the highest number of studies came from India,followed by Tunisia,and Egypt.The mean number of Crohn’s patients reported per study is 57.84 and the median is 22,with a wide range from one to 980.CONCLUSION This scoping review has shown that,although there is a severe lack of populationbased data about Crohn’s in LLMICs,there is a signal of Crohn’s in these settings around the world.