Prof Dr Cihangir Kaymaz
dxi (the case of limit circumference), or only one linearly independent solution of (1) belongs to this space (the case of limit point) We can show that (see V.B Lidsky [2] and G.A. Isayev [4], that for the constructed solution i ( xi , ) i ( xi , ) lb ( )i ( xi , ), (lb lb ( ) Cb ( ) i i i i or lb i mbi ( ) ) the following limit re- lation is valid: lim Im i ( xi , ), i&#; ( xi , ) 0, i i . xi bi We now study all-possible cases of belonging and not belonging of he products y1( x1, ) y2 ( x2 , ) to the space L2 (I b , B( x)dx) i.e. determination of the condition B( x) y ( x , ), y ( x , ) dx , xi [ i , bi ], I b [d1 , b1 ][ 2 , b2 ]. 2 1 i 2 2 Ib Here y1( x1, ) and y2 ( x2 , ) one the solutions of the system (1) B( x) detaik ( xi )i ,k 1 2
German International Journal of Modern Science №51, 29 We call the amount of products y1 ( x1, ) y2 ( x2 , ) belongs to L ( I b , B( x)dx) a deficiency index of 2 two-parameter problem (1) in the singular end b (corresponding to the point ) Let R 2 and Im 1 0. Then B( x) y ( x , ), y ( x , ) dx 2 1 1 2 2 [ ,b ] m b1( m ) b2( m ) 1 S (x ,) y (x ,) dx1 a22 ( x2 ) y2 ( x2 , ) dx2 2 2 Im 1 1 1 1 i 1 2 1 b1 b2( m ) (m) S 2 ( x2 , ) y2 ( x2 , ) dx2 a12 ( x1 ) y1 ( x1 , ) dx1 2 2 Im 1 2 1 b1( m ) b2( m ) 1 r (x ) y (x , ) dx1 a ( x2 ) y2 ( x2 , ) dx2 2 2 Im 1 1 1 1 i 22 1 2 (12) b2( m ) b1( m ) 1 r ( x ) y ( x , ) a ( x1 ) y1 ( x1 , ) dx1. 2 2 dx2 Im 1 2 2 2 2 12 2 1 and ~ B ( x) y ( x , ), y ( x , ) dx 2 1 1 1 2 2 [ ,b m ] b1 (m) ( m) b2 S1 ( x1 , ) y1 ( x1 , ) dx1 a22 ( x2 ) y2 ( x2 , ) dx2 2 2 (13) 1 2 b2 (m) (m) b1 S 2 ( x2 , ) y2 ( x2 , ) dx2 a12 ( x1 ) y1 ( x1 , ) dx1 . 2 2 2 1 Now, in the equality (12) assuming y1( x1, ) 1( x1, ), y2 ( x2 , ) 2 ( x1, ) and taking into account formulas (3) and (5), we obtain (considering r 1): B( x) ( x , ), ( x2 , ) dx 2 1 1 2 [ ,b m ] b2( m ) a 1 2 Im 1 Rb( m ) ( ) ( x2 ) 2 ( x2 , ) dx2 2 22 1 2 b1( m ) 2 Im l ( m ) ( ) a12 ( x1 ) 1 ( x1 , ) dx1 2 2 Im 1 1 b1( m ) b2( m ) 1 r (x ) (x , ) dx1 a ( x2 ) 2 ( x2 , ) dx2 2 2 Im 1 1 1 1 i 22 1 2 (14) b1( m ) b1( m ) 1 a ( x1 ) 1 ( x1 , ) dx1 r ( x ) ( x2 , ) dx2 . 2 2 Im 1 12 2 2 2 i i In all 1 2 Here l2 ( m) ( ) Cb ( m ) ( ), and the sign ""("") corresponds to the case 2 the addends of the right hand side of the equality (13), the second factors have finite limits as m if only the following conditions are fulfilled: (1 , 2 ) (1 1 ) (2 2 ), Im 1 0, and
30 German International Journal of Modern Science №51, a22 ( x2 ) r (x ) lim sup , lim sup 1 1 . x2 b2 S 2 ( x2 , ) x2 b2 S1 ( x1 , ) Assume that for the first equation in two-parameter problem (1) we have the case a of limit circle, and fur- thermore, let a12 ( x1 ) r (x ) lim sup ,lim sup 1 1 . x1 b1 S1 ( x1 , ) x1 b1 S1 ( x1 , ) Then all first factors of all addends of the right hand side of the equality (13) have finite limits as m . Thus, subject to the mentioned conditions, the function 1 ( x1 , ) 2 ( x2 , ) L (I b , B( x)dx), 2 i.e. deficiency index of two-parameter problem (1) is not less than two. In a similar way we can show that 2 ( x1 , ) 1 ( x2 , ) L2 (I b , B( x)dx), if for the second equation in two-parameter problem (1) we have the case of a limit circle and the coefficients of equations satisfy the same conditions, only the order in which there terms are presented, changes. Thus, in the case of a limit circle for both equations the products 1 ( x1 , ) 2 ( x2 , ), 1 ( x1 , ) 2 ( x2 , ) and 1( x1, )2 ( x2 , ) 2 belong to the space L ( I b , B( x)dx) . It is easy to see that on this case, the products also belong to the space L2 (I b , B( x)dx) i.e. the deficiency index of the problem (1) is precisely four 1 ( x1 , )2 ( x2 , ) . Thus follows from the equality (12) for yi ( x, ) i ( xi , ), i 1,2. On the other hand, it is easy to see that if only for one of the two-parameter system of equations (1) we have the case of a limit point, then the defi- ciency index of the problem (1) can be equal to two or four, as a result of dominating near the singular end b (b1, b2 ) of the addend in the right hand side of formula (12), or as a result of mutual paying if features of separate addends. For example if for the first equation from the two-parameter system (1) we have the case of a limit point, circle, and for the second one we have the case of a limit point, then it is easy to see that the product 1( x1, )2 ( x2 , ) does not belong to the space L2 (I b , B( x)dx) subject to the conditions a12 ( x1 ) r1 ( x1 ) lim sup , x1 b1 S1 ( x1 , ) b2 maxa 22 ( x1 , ) , r2 ( x2 ) 2 ( x2 , ) dx2 . 2 Summarizing all the arguments related to the system of equations (1) we arrive at the following statement Theorem. Let (1 1 ) (2 2 ), R2. Assume that if R 2 , the following condition is fulfilled: ai 2 ( xi ) ri ( xi ) lim sup , i 1,2 x1 b1 Si ( xi , ) but if R 2 , then ai1 ( xi ) ri ( xi ) lim , i 1,2 . x1 b1 Si ( xi , )
German International Journal of Modern Science №51, 31 Then the deficiency index of two-parameter prob- 2. Levitan B.M., Sargsyan I.S. Introduction to lem (1) in the singular end b (b1, b2 ) is not less spectral theory. Nauka, Moscow , , than a unit. 3. Lidsky V.B., Strum-Lioville type not self-ad- If for one of two-parameter equations (1) we have joint operator with a discrete spectrum. Trudy mos- the case of a limit circumference, then the deficiency kovsogo math. obshestva. , vol.9, index of the problem (1) is not than two. 4. Isaev H.A., To theory of deficiency indices of But if for the both equations of two-parameter sys- multiparameter differential operators of Strum-Lioville tem (1) we have the case of limit circumferencesm then type. Doklady AN SSSR , vol , no.4, the deficiency index of problem (1) is equal to four. 5. Naimark M.A., Linear differential operators. Nauka, Moscow, , , References 6. Achiezer N.I. Glazman I.M. Theory of linear 1. Coddington E.A., Levinson N. Theory of ordi- operators in Hilbert spaces. Nauka , , nary differential equations IL Moscow, , —
32 German International Journal of Modern Science №51, MEDICAL SCIENCES EPIDEMIOLOGICAL AND CLINICAL ASPECTS OF ANTIBIOTIC-INDUCED DIARRHEA Buruiană D., student, Faculty of General Medicine, SUMPh “Nicolae Testemitanu” Chisinau, Republic of Moldova Cobîltean L. Associate Professor of the Department of Gastroenterology SUMPh “Nicolae Testemitanu” Chisinau, Republic of Moldova DOI: /zenodo Abstract Antibiotic-induced diarrhea (AID), also known as antibiotic-induced intestinal flora imbalance, is a frequent complication of antibiotic therapy, which occurs shortly or up to 8 weeks after the start of drug therapy and is reported in % of cases [1]. Antibiotics cause significant disruption of the normal composition and functional attributes of the gut microbiome [2]. The damage to this ecosystem, especially by reducing its diversity of micro- organisms, can occur in the long term [3]. AID developed with a higher prevalence in women in the age category years, on the background of viral Pneumonia (% of cases) caused by the SARS-CoV-2 virus, independ- ent of the number of antibiotics previously administered. Diarrhea and abdominal pain are the most common man- ifestations appreciated in the clinical picture, in contrast fever is less common. Aim of our study was to evaluate the epidemiological and clinical aspects of antibiotic-induced diarrhea. Keywords: antibiotic-induced diarrhea, Clostridium difficile, SARS-CoV-2 virus, intestinal microflora, stool, fever, abdominal pain, antibiotics, hospitalization. Introduction The intestinal microflora has a crucial role in maintaining both metabolic and immune homeostasis [4]. Among the major functions it performs, the following stand out: maintaining the integrity of the intestinal epithe- lium, digestion and absorbtion of ingested nutrients, efficient regulation of carbohydrate and lipid metabolism, prevention of pathogenic invasion, control of the immune system [5, 12]. Disturbance of the microbiome is the main factor favoring the development of inflammatory and infectious processes in the gastrointestinal tract [6]. Currently, AID is a medical problem with an important epidemiological impact. The clinical picture can take both mild manifestations, such as moderate diarrhea, and a severe evolution that includes pseudomembranous colitis, ileus or toxic megacolon [7, 8, 9]. Coinfection with bacterial pathogens during COVID leads to the administra- tion of broad-spectrum antibiotics, which might severely disturb the normal function and composition of intestinal microflora [11]. Thus, gut dysbiosis caused by high exposure with antibiotics favorizes association with Clostrid- ium difficile infection [10]. Materials and methods Following the analysis of the inpatient records of The study included 92 de novo patients with the 92 patients included in the study with the diagnosis of diagnosis of Enterocolitis caused by Clostridium Dif- Enterocolitis caused by Clostridium difficile, it was ficile, treated in the gastroenterology department of the identified the antibacterial therapy administered prior "Timofei Moșneaga" Republican Clinical Hospital, Re- to hospitalization. AID was found to develop following public of Moldova, during the years The both antibiotic monotherapy 27 (41%) cases and anti- average age of the patients is ±3 years ( biotic polytherapy 38 (59%) cases. The previous ad- years). The Enterocolitis caused by Clostridium Dif- ministration of 2 antibiotics was appreciated in 22 ficile developed more frequently in women - 49 (34%) patients, of 3 antibiotics in 12 (18%) patients, of (%), compared to men - 43 (%). The database 4 antibiotics – 3 (5%) patients and extremely rarely 5 of the selected material was processed statistically us- antibiotics were administered, respectively they in- ing Microsoft Excel, EpiInfo and EpiMax Table duced Enterocolitis caused by Clostridium difficile programs. only in 1 (2%) case. Results
German International Journal of Modern Science №51, 33 41,50% 33,80% 18,50% 4,60% 1,60% 1 antibiotic 2 antibiotics 3 antibiotics 4 antibiotics 5 antibiotics Pic. 1. Distribution of patients with Enterocolitis caused by Clostridium Difficile according to the number of antibiotics. The most frequently administered Meropenem, 30 years, years, years and over 71 years. Imipenem, Ciprofloxacin and Ceftriaxone. More rarely, Men in the age category of years developed AID Enterocolitis caused by Clostridium Difficile has been more frequently. With the same frequency, regardless caused by administration of Cefoperazone, Gentami- of gender, the disease was recorded in patients whose cin, Amoxacillin, Azithromycin. age was years. According to our study, AID developed with a higher prevalence in women in the age categories Women Men 1 2 6 13 7 13 3 2 8 18 8 10 OLDER YEARS YEARS YEARS YEARS YEARS THAN 71 YEARS Pic. 2. DAI frequency distribution according to age and gender. In our study, we found that AID developed most (62%) patients the stool was unformed, in 14 (28%) pa- frequently on the background of viral Pneumonia tients the stool was slurry and only in 3 (10%) cases the (% of cases) caused by the SARS-CoV-2 virus, stool was formed. both considered as major healthcare issues. Patients Abdominal pain was also one of the specific also presented comorbidities including chronic diseases symptoms of AID, being appreciated in 84 (%) pa- of gastrointestinal tract (n=60), ischemic cardiomyopa- tients, but of different intensity from discomfort to in- thies (n=53), type 2 diabetes (n=21), but also oncolog- tense pain. Other clinical manifestations that accompa- ical affections (n=9). Association of comorbidities with nied diarrhea and abdominal pain in patients with anti- older age and prolonged hospitalization leads to a biotic induced diarrhea where abdominal bloating higher risk of complicated evolution of Clostridium dif- (%), nausea (14,1%) and ascites (13%). ficile infection [11]. In contrast to the previously presented clinical Diarrhea manifested by increasing the frequency manifestations, fever at the time of hospitalization was of defecation acts and/or the fluidity of faecal matter present in only 13 (20%) patients. In 5 patients, the tem- was appreciated as the most frequent symptom appre- perature of was maintained. Fever higher ciated in the patients included in the study. In most pa- than was present in 8 patients. tients it was one of the causes of alteration of the quality Conclusion of life and reason for seeking medical assistance. Ac- Antibiotic induced diarrhea developed with a cording to the results of the coprological exam, in 45 higher prevalence in women in the age category (90%) cases stool malfunction was mentioned: in 31 years, on the background of viral Pneumonia (% of
34 German International Journal of Modern Science №51, cases) caused by the SARS-CoV-2 virus, independent 6. Thursby E., Juge N. Introduction to the human of the number of antibiotics previously administered. gut microbiota. Biochem J. ; (11): – Diarrhea and abdominal pain are the most common doi: /BCJ manifestations appreciated in the clinical picture, in 7. Rineh A., Kelso M. J, Vatansever F., Tegos G. contrast fever is less common. P, Hamblin M. R. Clostridium difficile infection: mo- lecular pathogenesis and novel therapeutics. Expert References Rev Anti Infect Ther. ;12(1) doi: 1. AMekonnen S., Merenstein D., MFraser C., / LMarco M. Molecular mechanisms of probiotic pre- 8. Lopes G., Silva R., Rupnik M. et. al. Clinical ep- vention of antibiotic-associated diarrhea. Current Opin- idemiology of Clostridium difficile infection among ion in Biotechnology. ; ISSN hospitalized patients with antibiotic-associated diarrhea , funduszeue.info in a university hospital of Brazil. Anaerobe. ; 2. Shi Y., Kellingray L., Le Gall funduszeue.info The diver- gent restoration effects of Lactobacillus strains in anti- 9. Association of Medical Microbiology and Infec- biotic-induced dysbiosis, Journal of Functional Foods. tious Disease Canada treatment practice guidelines for ; Clostridium difficile infection. Journal of the Associa- funduszeue.info tion of Medical Microbiology and Infectious Disease 3. Thursby E., Juge N. Introduction to the human Canada. ; 3(2) gut microbiota. Biochem J. ; (11): – Boeriu A., Roman A., Dobru D. The Impact doi: /BCJ of Clostridioides Difficile Infection in Hospitalized Pa- 4. Kho ZY and Lal SK () The Human Gut Mi- tients: What changed during the Pandemic. ; crobiome – A Potential Controller of Wellness and Dis- funduszeue.info: /diagnostics ease. Front. Microbiol. 9: Azimirad M., Noori M., Raeisi H. How Does doi/fmicb COVID Pandemic Impact on Incidence of Clostrid- 5. Ghosh, S., Pramanik, S. Structural diversity, ioides difficile Infection and Exacerbation of Its Gas- functional aspects and future therapeutic applications trointestinal Symptoms? ; of human gut microbiome. Arch Microbiol. , – Lobionda S., Sittipo P., Kwon Y. H.. The (). funduszeue.info Role of Gut Microbiota in Intestinal Imflammation y. with respect to Diet and Extrinsec factors. ; funduszeue.info: /microorganisms
German International Journal of Modern Science №51, 35 SYMPTOMS OF PATIENTS IN THE FIRST HOURS AFTER THE ONSET OF ACUTE CORONARY SYNDROME Coropceanu I., Student, Faculty of General Medicine "Nicolae Testemitanu" State University of Medicine and Pharmacy Republic of Moldova, Chisinau Grib L. University professor, head of the cardiology department of the "Nicolae Testemitanu" State University of Medicine and Pharmacy Republic of Moldova, Chisinau DOI: /zenodo Abstract The study involves the evaluation and determination of patient&#;s symptoms that appear in the first hours after the onset of acute coronary syndrome with the aim of raising the level of health culture that is the basis of the primary prevention of cardiovascular diseases. The research was conducted on a group of patients diagnosed with acute myocardial infarction with ST-segment elevation, acute myocardial infarction without ST-segment el- evation and unstable angina pectoris. Keywords: acute coronary syndrome, acute myocardial infarction with ST-segment elevation, acute myocar- dial infarction without ST-segment elevation, unstable angina pectoris. Introduction The medical education of patients regarding the Cardiovascular diseases are the pathologies with responsibility for their own health constitutes one of the the highest risk of mortality, reaching million extra-medical functions of the medical staff. It is nec- deaths annually. Worldwide, ischemic heart disease essary that early intervention and preventive checks ranks first in this category, with million deaths an- dominate the causes of referrals to doctors. Prevention nually. In the European countries the incidence reaches instead of treatment must be cultivated in the patient&#;s between per inhabitants per year [2, 3, consciousness [10]. 8, 9]. Materials and methods The symptoms preceding the onset of acute coro- The study was conducted on a group of pa- nary syndrome (ACS) are the main trigger for patients tients including 30 patients with ST-segment elevation who request emergency services. Recent studies acute myocardial infarction (STEMI), non-ST-segment demonstrate that typical symptoms in female patients elevation acute myocardial infarction (NSTEMI) and are more predictive of an ACS event compared to male unstable angina pectoris (API). Of these patients, the patients [4, 6]. onset symptoms of ACS were analyzed, including: pre- According to studies, the most common reason for cordial pain, dyspnea, pain in the neck and mandible referral to the emergency department and hospitaliza- region, as well as palpitations. tion in case of ACS is chest pain [1]. Results At the same time, the age of patients has a partic- The patients included in the study are aged be- ular importance in the appearance of symptoms in case tween years, being divided into 5 groups. The of ACS, being also an important predictor of mortality, first group is represented by patients aged (8%), given the fact that approximately 80% of all deaths fol- of which 5% patients with STEMI, 1% – with NSTEMI lowing an episode of ACS occur in individuals over 65 and 2% – with API. In the group of patients aged years of age. According to the studies carried out, it is years (18%), the highest rate is represented by patients stated that patients older than 65 years may have asso- with API (7%), followed by NSTEMI (6%) and STEMI ciated symptoms and not just the presence of the pain (5%). The group with the largest number of registered syndrome. Therefore, it is very important to know and patients is the one in the age range (38%) where identify the symptoms of patients with ACS from the 15% are patients with API, 13% – with NSTEMI and multitude of associated symptoms, as quickly as possi- 10% – with STEMI. The group of patients aged ble [5, 7]. years (21%) recorded STEMI in 7% cases, NSTEMI in The continuous increase in the number of popula- 4% and API in 10%. The last group of years tion suffering from cardiovascular pathologies is (15%) recorded the highest value in patients with largely due to the indifference towards one&#;s own health NSTEMI and API (6%), then STEMI (3%). and primary prevention.
36 German International Journal of Modern Science №51, 15% 16% 13% 10% 14% 12% 7% 10% 6% 10% 6% 7% 6% 8% 1% 2% 5% 4% 5% 6% 3% API 4% NSTEMI 2% STEMI 0% years years years years years STEMI NSTEMI API Fig. 1. Distribution of ACS patients according to age group. According to the analyzed data, the onset of ACS was predominantly anginal type in 92 cases, and asthmatic type in 8 cases. In the 92 cases, patients with STEMI were included - in 29%, patients with NSTEMI - in 26% and patients with API - in 37% of cases. And the asthmatic type was detected with the lowest value of 1% in the case of STEMI patients, 3% – with API and 4% – with NSTEMI. 37% 40% 29% 35% 26% 30% 25% 20% 15% 10% 4% 3% 1% 5% 0% Anginal type Asthmatic type STEMI NSTEMI API Fig. 2. Type of onset of ACS. Early detection of ACS symptoms is vital. The 62%, palpitations - in 18%, pain in the neck and man- symptoms encountered in the patients during the study dibular region - in 6%, syncope - in 1%, respectively. were: precordial pain in 92% of cases, dyspnea - in
German International Journal of Modern Science №51, 37 1% 6% 18% 92% 62% Precordial pain Dyspnea Pain in the neck and mandibular region Palpitations Syncope Fig. 3. The presence of symptoms on patients with ACS. Precordial pain as the predominant symptom was found equally in patients with STEMI and NSTEMI recorded in 30% of patients with STEMI, 25% – with (3%). Palpitations were present in patients with API NSTEMI and 37% – with API. Dyspnea was highest in (14%) and NSTEMI (4%). Syncope was present in only patients with API (30%), NSTEMI (19%) and STEMI 1% of patients with NSTEMI. (13%). Pain in the neck and mandibular region was 40% 37% 35% 30% 30% 30% 25% 25% 19% 20% 13% 14% 15% 10% 0% 5% 3%3% 0% 4% 0% 0%1% 0% Precordial pain Dyspnea Pain in the Palpitations Syncope neckk and mandibular region STEMI NSTEMI API Fig. 4. Distribution of symptoms according to the diagnosis of ACS. References and dyspnea had the highest values in patients with API 1. Among patients with ACS, the most common (30%), NSTEMI (19%) and STEMI (13%). symptom is retrosternal pain. Thus, in the study we 3. The highest mortality rate is for patients over 65 evaluated which type of onset is most frequently regis- years of age. Patients with the highest risk of an ACS tered in patients with ACS, this being the anginal type episode were those aged years (38%), followed (92%). In the case of patients with STEMI, they pre- by the group of patients aged years (21%). sented 29%, with NSTEMI – 26% and with API – 37% cases. Reviewer 2. In the case of patients with ACS, the present 1. Adam L. Sharp MD, Aniket A. Kawatkar PhD, symptoms are of major importance and very useful in Aileen S. Baecker PhD, Rita F. Redberg MD, Ming- detecting the pathology and formulating the diagnosis. Sum Lee MD, Maros Ferencik MD, Yi-Lin Wu MS, The predominant symptoms present in patients with Ernest Shen PhD, Chengyi Zheng PhD, Stacy Park ACS were chest pain (92%) and dyspnea (62%). Pre- PhD, Steve Goodacre PhD, Praveen Thokala PhD & cordial pain with the highest rate was present in patients Benjamin C. Sun MD. Does Hospital Admission/Ob- with API (37%), STEMI (30%) and NSTEMI (25%),
38 German International Journal of Modern Science №51, servation for Chest Pain Improve Patient Outcomes af- Pan African Medical Journal. ; doi: ter Emergency Department Evaluation for Suspected /pamj Acute Coronary Syndrome? Journal of General Internal 6. I. Mateo-Rodríguez, A. Danet, J. Bolívar- Medicine. , 37, pp – doi: /s Muñoz, F. Rosell-Ortriz, L. Garcia-Mochón, A. Daponte-Codina. Gender differences, inequalities and 2. Alvi HN, Ahmad S. Prevalence of depression in biases in the management of Acute Coronary Syn- patients of Acute Coronary Syndrome. Pak J Med dromeDiferencias, desigualdades y sesgos de género en Health Sci. ;10(2) el manejo del síndrome coronario agudo. Journal of 3. Borja Ibanez, Stefan James, Stefan Agewall, Healthcare Quality Research. , 37(3), pp. Manuel J Antunes, Chiara Bucciarelli-Ducci, Héctor doi: /funduszeue.info Bueno, Alida L P Caforio, Filippo Crea, John A 7. Michael McGarry, Christina L. Shenvi. Identifi- Goudevenos, Sigrun Halvorsen, Gerhard Hindricks, cation of Acute Coronary Syndrome in the Elderly. Adnan Kastrati, Mattie J Lenzen, Eva Prescott, Marco Emerg Med Cli. , 39(2), pp. – doi: Roffi, Marco Valgimigli, Christoph Varenhorst, Pascal /funduszeue.info Vranckx, Petr Widimský, ESC Scientific Document 8. Regitz-Zagrosek V, Oertelt-Prigione S, Prescott Group. Task Force for the management of acute myo- E. Gender in cardiovascular diseases: impact on clinical cardial infarction in patients presenting with ST- manifestations, management, and outcomes. Eur Heart segment elevation of the European Society of Cardiol- J. ; 37(1), pp. doi: ogy. European Heart Journal. , 39,(21): /eurheartj/ehv funduszeue.info 9. Udell JA, Koh M, Qiu F, Austin PC. Outcomes 4. Holli A. DeVon, Sahereh Mirzaei and Jessica of women and men with acute coronary syndrome Zègre‐Hemsey. Typical and Atypical Symptoms of treated with and without percutaneous coronary revas- Acute Coronary Syndrome: Time to Retire the Terms? cularization. J Am Heart Assoc. ;6(1):e Journal of the American Heart Association. doi: /JAHA ;9:e funduszeue.info Vera Bittner. The New AHA/ACC 5. Hyder Osman Mirghani. Age related differences Guideline on the Primary Prevention of Cardiovascular in acute coronary syndrome presentation and in hospi- Disease. , , pp. – doi: tal outcomes. A cross-sectional comparative study. The /CIRCULATIONAHA
German International Journal of Modern Science №51, 39 COMPLICATIONS AFTER LIVER RESECTIONS- POST-RESECTION LIVER FAILURE Dimitar Rusenov Dr., MD., Clinic of Liver-biliary, Pancreatic and General Surgery Acibadem City Clinic Tokuda Hospital EAD Bul. „Н. Vaptsarov ”51 B Sofia DOI: /zenodo Abstract Liver surgery is historically one of the "youngest" areas in abdominal surgery, but at the same time it marks very rapid progress and continuous development, which continues even today. Development of liver resection surgery has been linked to a parenchymal dissection techniques and reliable hemostasis and biliostasis, The International Study Group of Liver Surgery (ISGLS) provides definitions and criteria for The assessment of Specific pastresection complications. Keywords: liver resections, complications after liver resections, liver failure. Introduction: - cystotomies and cyst resections, practically with- Prerequisites for the rapid development of liver out removal of functioning or pathologically altered resection surgery are the established anatomical liver parenchyma; knowledge of segmental hepatic anatomy, the -liver biopsies, alcoholization of tumors. liver bi- improvement of techniques for parenchymal dissection opsies, alcoholization of tumors; and definitive hemo- and biliostasis, the improvement - interruption of trunk branches of the hepatic ar- of hepatoprotection methods and means, the tery and/or portal vein with the aim of hypoperfusion development of anesthesia and resuscitation care for of a given area (segments, lobe); operated patients. - suture of the liver in trauma; Objective: Thus, a total of cases of liver resections were Determination of a possible prognostic role of the included in the series type of liver resection (anatomic or atypical) for the risk of occurrence, frequency and severity of postoperative Results: specific complications- liver failure. In modern liver resection surgery, acute liver failure is a major cause of fatal outcome. In our study, Materials and methods: we found signs of liver failure in 17 patients, of whom For the period from January, - March, 10 were after Anatomic liver resection, as a stand-alone in Clinic of liver, biliary pancreatic and general sur- procedure (%) or as part of multivisceral resection gery, Acibadem City Clinic Tokuda Hospital , in- (%) compared to Atypical liver resection (% as terventions were performed on the liver: stand-alone and % in multivisceral resections) Cases of intervention other than liver resection by (Table 1). definition were excluded ISGLS, "removal of part of Our criteria for the occurrence of acute liver the liver parenchyma due to involvement by a disease failure were based on the definition of ISGLS () - process or traumatic injury resulting in devitalization of "disturbance in the synthetic, excretory and the parenchyma". detoxification function of the liver manifested by an Thus, the study did not find the cases of: increase in INR and hyperbilirubinemia recorded on or - hepatotomy; after the 5th postoperative day this&#;. Table 1. Incidence of post-resection acute liver failure after Anatomic and Atypical liver resections Another operation acute liver failure Statistics Anatomic resection Atypical resection Total P N No % 97,4% 99,5% 98,8% No 0, N 3 1 4 Yes % 2,6% ,5% 1,2% N No % 93,9% 98,5% 97,5% Yes 0, N 7 6 13 Yes % 6,1% 1,5% 2,5%
40 German International Journal of Modern Science №51, All patients after liver resection received a as a stand-alone procedure and as part of a multivisceral hepatoprotector as an element of resuscitation therapy, resection, as well as Human albumin 20%, ml and a proton pump inhibitor. References In 4 patients, we found acute liver failure as Grade 1. Balzan S, Belghiti J, Farges O, et al. The “ A, not requiring a change in the therapeutic scheme. criteria” on postoperative day 5dan accurate predictor of liver failure and death after hepatectomy. Ann Surg. The remaining 13 cases had more severe ;– violations. Nine of them were Grade B, which 2. Jaffe BM, Donegan WL, Watson F, Spratt JS., Jr necessitated a change in resuscitation therapy. In 4 Factors influencing survival in patients with untreated patients, hemofiltration was included as an invasive hepatic metastases. Surg Gynecol Obstet. ;– procedure (Grade C). 5 of the 13 patients with Grade B and C were excited, and in all five we reported the " 3. Janson.E.T., Holmberg.L. , Stridsberg.M. et al., 50 criteria" of Balzan and Belghiti: the "intersection" of “Carcinoid tumors: analysis of prognostic factors and the prothrombin index <50% and serum bilirubin >50 survival in patients from a referral center,” Annals μmol/L on the 5th postoperative day&#;, i.e. these criteria of Oncology, – indeed proved to be an early and accurate predictor of 4. Rahbari NN, Wente MN, Schemmer P et al. mortality. Systematic review and meta-analysis of the effect of portal triad clamping on outcome after hepatic Discussion: resection. Br J Surg. ;95(4) Five patients in our series developed acute liver 5. Rusenov.D. Postresection hemorrhage—a failure, leading to a fatal outcome. Post-resection specific complication after anatomic and atypical liver hemorrhage Grade B was registered in two of them, and resections. -Medical magazine, 79, , No. 79, Grade C in two. Hemorrhage with tissue and organ 6. Rusenov. D. Comparative analysis of anatomic hypoperfusion, as well as liver hypoperfusion is a and atypical liver resections for occurrence of specific prerequisite for hepatocellular failure with a negative post-resection complications (biliraghia). – Medical impact on the final result. Review, 56, , No. 5, We registered two other exits after internal 7. Rusenov. D. Post-resection liver failure-an early bilirubin, peritonitis, sepsis and MODS, which postoperative specific complication in anatomic and necessitated reoperation atypical liver resections.-Medical magazine 79, , №79, Conclusion: 8. Rusenov. D. Comparative analysis of Liver resection surgery should be performed in anatomical and atypical liver resections for occurrence centers with sufficient experience in this field, working of non-specific post-resection complications (non- according to established standards and algorithms. specific morbidity). – Medical Review, 56, , No. Acute liver failure is a typical specific post- 5, resection complication after anatomic liverresections -
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