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Это определяет необходимость своевременного выявления данного патологического состояния, с последующим проведением попыток его коррекции до и в процессе проведения специфического противоопухолевого лечения.
Литература:
1. Баллюзек М.Ф., Ионова А.К. Кардиоонкология в программах лечения и реабилитации онкологических больных // Российский кардиологический журнал. 2014. 5 (109): 75-80.
2. Morley J. E, Thomas D. R, Wilson M-M. G., Cachexia: pathophysiology and clinical relevance // The American Journal of Clinical Nutrition. 2006. 83 (4): 735743.
3. Donohoe C.L., Ryan A.M., Reynolds J.V., Cancer Cachexia: mechanisms and clinical implications // Gastroenterology Research and Practice. 2011. Vol. 2011. Article ID 601434: 1-13.
Ключевые слова: синдром кахексии, кардиотоксичность, диагностические критерии синдрома кахексии.
Keywords: cachexia syndrome, cardiotoxicity, diagnostic criteria of cachexia syndrome.
УДК.616
Миетулис А., Сучков А.И.
ПРОЦЕСС РЕКОНВАЛЕСЦЕНЦИИ ПАЦИЕНТОВ ОЖОГОВОГО ПРОФИЛЯ
С ВИЧ-ИНФЕКЦИЕЙ И БЕЗ НЕЕ 10
Санкт-Петербургский государственный университет, A.mietulis@inbox.lv
St. Petersburg State University
Данная работа нацелена на установление разницы между исходом лечения у ВИЧ-инфицированных и неинфицированных пациентов ожогового профиля. Для исследования были проработаны 2434 истории болезней, по которым были составлены две группы пациентов - экспонированная и контрольная. В
10 Mietulis A., Suchkov A.I. Reconvalescence process in burned patients with and without HIV infection, St. Petersburg State University, Russia
результате исследования было выявлено, что ВИЧ-инфекция более pacnpocrpaHeHa среди пациентов ожогового профиля, чем в общей популяции; прогноз по выздоровлению для ВИЧ-положительнных пациентов с уровнем лимфоцитов, превышающим 20%, не отличается от пациентов без ВИЧ инфекции, однако ВИЧ-инфицированным пациентам для полной реконвалесценции может потребоваться более длительный период лечения (уровень пациентов, находившихся на стационарном лечении более 30 суток, составляет 38.59% среди ВИЧ-положительных против 17.6% в контрольной группе); ВИЧ-инфицированным пациентам чаще требуется операция по некректомии, но реже требуется пересадка кожного лоскута; не было выявлено разницы в уровне смертности между экспонированной и контрольной группами.
Introduction
HIV became a global pandemic [1], thuswise may appear in a burn unit. This study was conducted to ascertain if there is a difference in outcome of treatment between HIV positive and HIV negative patients.
Patients and methods
This is a retrospective cohort study involving 60 HIV positive and 2374 HIV negative burn injury patients admitted to the Burn department of Saint-Petersburg I.I.Dzhanelidze Research Institute of Emergency Medicine between January 2004 and December 2011. Data was collected using statistical database of the Research Institute and analyzed using Calc version 4.0.1 by Apache Software Foundation.
Results
HIV positive patients aged up to 44 years formed the study (exposed) group. They were compared with the control (unexposed) group of HIV negative patients in the same age range.
Exposed group was formed by 57 patients, while unexposed was formed by 1010 patients.
In the HIV-positive group, mean age was 30.3 ± 6.7, while in HIV-negative 49.92 ± 4.96 .
Sex ratio in the exposed group was 1:2.56 (Female to Male ratio) , while in unexposed group 1:3.05 (Female to Male ratio) .
40.36% of HIV-positive patients reported to have risk factors for HIV infections,
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mainly Mental and behavioural disorders due to psychoactive substance use (P = 0,01). The lymphocyte count for HIV infected parients were 20.4 ± 7.4 % of WBC on arrival and 22.17% ± 12.2 % on discharge, while 20 to 40 % expected normally [2] in non-infected persons, what makes the differency statistically significant (P = 0,01). Skin grafting was carried out in 24.56% of HIV positive patients and 25.24% of HIV negative patients with no significant difference in skin graft take and the degree of healed burn on discharge was the same (P = 0,01). The only significant difference in hospital stay duration between HIV positive and negative patients was found amond those treated more than 30 days (38.59% in HIV positive versus 17.6% in HIV negative patients). The overall mortality rate in exposed group was 7 % comparing to 5.25 % in control group.
Conclusion
This study has shown that HIV infection is more prevalent among burn injury patients than in general population.
HIV positive patients with the range of lymphocyte count more than 20% of WBC have similar prognosis as HIV negative patients, although HIV positive patients may be treated for a longer period than HIV negative.
HIV positive patient more often undergo operation but the necessity in skin grafting is lower than in HIV negative patients.
There was no significance between mortality rate in exposed and unexposed groups, therefore HIV infection alone is not a key factor in mortality.
Introduction
HIV became a global pandemic [1] since early 1980s. The first case of HIV within the present-day territory of Russia was discovered in 1985, the first outbrake occured in 1988 in connection with manipulations onsite one of the regional medical facilities. The first death case connected to HIV registered in 1989.
According to Russian Federal AIDS Centre in 2013 almost 800 thousand persons were infected in Russia [2].
There is controversial data on the influence of HIV infection on the outcome of the burn. J.James et al. report that mortality was higher among HIV positive individuals, but there was no difference in duration of hospital stay between HIV positive and negative individuals [3]. Chalya PL et al. reported similar prognosis for HIV positive patients as for HIV negative patients [4].
Burn department of Saint-Petersburg I.I.Dzhanelidze Research Institute of Emergency Medicine consists of Anesthesiology, Reanimation and Intensive therapy Unit and two Burn Units admitting up to 1000 patients with burn injuries annually. In this paper, we analyze if there is a difference in outcome between HIV positive and HIV negative patients.
There are no reports in the literature based on the outcome on European population. Patients and methods
This is a retrospective cohort study involving 60 HIV positive and 2374 HIV negative acute burn patients admitted to the Burn Department of Saint-Petersburg I.I.Dzhanelidze Research Institute of Emergency Medicine between January 2004 and December 2011. Data was collected using statistical database of the Research Institute and analyzed using Calc version 4.0.1 by Apache Software Foundation. No personal data was used in a research. All data was collected and analyzed according with Law of the Russian Federation "On Personal Data".
The study subjects included all burn injury patients of both gender aged up to 44 years and who consented for the study and HIV testing. Patients were stratified into HIV positive (exposed) and HIV negative (unexposed). All patients who met the inclusion criteria were consecutively enrolled into the study. Patients who failed to provide information and had no relative nearby and those who failed to consent for HIV testing were excluded from the study. Patients who were still in the ward at the end of study period were also excluded from the study. Patients admitted 7 days post-burn and patients admitted for post-burn reconstructive surgery were also excluded. On admission, a sample of blood was taken from the patients and used to carry out HIV enzyme-linked immunosorbent assay (ELISA) test and complete blood count. HIV positive patients aged up to 44 years formed the study (exposed) group. They were compared with the control (unexposed) group of HIV negative patients in the same age range. Some variables known to influence outcome from burn injury were matched. These were age, type of burn, length of treatment, name of the operation, lymphocyte count. Patients were followed up until discharge or death.
Results
Patient characteristics
During the period under study, a total of 2434 burn injury patients were admitted to
the Burn Department of Saint-Petersburg I.I.Dzhanelidze Research Institute of
Emergency Medicine. 2.47% of patients were diagnosed HIV. 43 (71.7%) were males
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Table 1. Duration of treatment of different groups of patients
Duration HIV negative < 44 y.o. HIV positive HIV positive < 44 y.o.
of treatment Number % Number % Number %
<10 443 43.86 26 43.3 23 40.35
11-20 267 26.43 8 13.3 8 14.03
21-30 122 12.08 4 6.7 4 7.01
>30 178 17.62 22 36.7 22 38.59
1010 100 60 100 57 100
Mortality rate in the study group was 7%, while in control group 5.25%. The values of duration of stay in exposed group are: 40.25% (N=23) for those spent up to 10 days, 14.03% (N=8) 11 to 20 days, 7.01% (N=4) 21 to 30 days and 38.59% (N=22) more than 30 days; values of duration of stay in unexposed group are 43.86% (N=443) for those spent up to 10 days, 26.43% (N=267) 11 to 20 days, 12.08% (N=122) 21 to 30 days and 17.62% (N=178) more than 30 days
Table 2
Time of death in the burn department facilities. The table provides data on the hospitalisations duration before death of a patient.
Duration HIV negative < 44 y.o. HIV positive < 44 y.o.
of treatment Number % Number %
<10 36 67.92 3 75
11-20 7 13.2 1 25
21-30 3 5.66 0 0
>30 6 11.3 0 0
53 100 4 100
and 17 (28.3%) were females (Female to Male ratio = 1:2.53). 95% (N=57) of HIV infected patients were aged up to 44 years and only 3 patients were older; 42.54% (N=1010) of non-infected patients were aged up to 44 years.
HIV-positive patients aged up to 44 years formed the study (exposed) group. They were compared with the control (unexposed) group of HIV negative patients in the same age range. Exposed group was formed by 57 patients, while unexposed was formed by 1010 patients.
In the HIV positive group, 41 (71.92%) were males and 16 (28.08%) were females (Male: Female ratio = 2.56). In the HIV negative group, 41 (71.92%) were males and 16 (28.08%) were females (Male: Female ratio = 1:3.05).
In 96.5% of exposed group cases etiology was Burns and corrosions (T20-32 according to ICD-10) and Frostbite (T33-35) in 3.5%; in control group etiology was Burns and corrosions (T20-32) in 98.02% of cases and Frostbite (T33-35) in 1.98% of cases.
40.36% of HIV-positive patiants had concominant disorders (30.4% for Mental and behavioural disorders and 69.5% for others), for HIV-negative patients value was 45.55% (16.74% for Mental and behavioural disorders and 83.26% for others).
Haematological results
The average range of lymphocyte count for HIV positive was 20.4 ± 7.4 % on admission and 22.17% ± 12.2 % on discharge (latest range was accounted in deceased), while average normal range of lymphocyte count is 20 to 40%.
Treatment parameters
42.1% (24) exposed patients underwent the operation, while only 26.43% (267) of unexposed patients did so. Of those who underwent the operation in study group 58.33% underwent Thiersch graft operation and 41.66% underwent simple necrectomy, while in the control group values were 95.5% and 4.5% respectively.
Outcome according to HIV status
Mean length of hospital stay in HIV positive patients was 27.15±29.74 (P value = 0,01), while in HIV negative 17.57±17.27 (P value = 0,01).
Time of death in HIV infected patients was up to 10 days in 75% (N=3) of cases and from 11 to 20 days in 25% (N=1) of cases; time of death in non-infected patients was up to 10 days in 67.92% (N=36) of cases, 11 to 20 days in 13.2% (N=7) of cases, 21 to 30 days in 5.66% (N=3) of cases and 11.3% (N=6) of cases respectively.
Discussion
The overall prevalence of HIV infection in this study was 2.47% that is higher than that in the general population in Russian Federation (0.479%) [2], it may be due to higher prevalence of mental and behavioral disorders in HIV positive patients (mostly IV drug use) [5]. This implies that healthcare workers treating burn patients may face HIV infected patients more often than other specialists, consequently extra precautionary methods should be used to prevent nosocomial transmission. As in other studies, male preponderance was higher [3,6]. Although many reports state that HIV infection do have an impact on burn trauma outcome [3,5,7,8], the present study shows no significant difference in mean length of hospital stay or mortality rate.
The only significant difference in hospital stay duration between HIV positive and negative patients was found amond those treated more than 30 days (38.59% in HIV positive versus 17.6% in HIV negative patients).
There was a dissimilitude in time of death appearance, which present in 10 cases (16.96%) of death after the 20th day of hospitalization in control group versus zero in study group and may occur due to reduced stamina.
Even though HIV positive patients do have immunosuppression [9] comparing to HIV negative population the average range of lymphocyte count in those patients was at the lower limit of normal, unlike in other studies [3,5,7,8].
Limitations.
There are some limitations of this study. Those limitations are connected with the lack of data on TBSA% and CD4+ cells count in the research institute's database. The least but not last for further research is nessesity to take into account parameters such as presence of fever, sepsis ant time of eschar rejection/epithelization. Those limitations require further investigations.
Acknowledgment
This study was supported by the chief officer of the burn department of Saint-
Petersburg I.I.Dzhanelidze Research Institute of Emergency Medicine professor of
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Saint Petersburg State University , doctor of medical science Konstantin Krylov . Also we express our gratitude to candidate of medical science, research associate of Saint-Petersburg I.I.Dzhanelidze Research Institute of Emergency Medicine Peter Dubikaitis.
Conclusion
This study has shown that HIV infection is more prevalent among burn injury patients than in general population.
HIV positive patients with the range of lymphocyte count more than 20% of WBC have similar prognosis as HIV negative patients, although HIV positive patients may be treated for a longer period than HIV negative.
HIV positive patients more often undergo operation but the necessity in skin grafting is lower than in HIV negative patients.
There was no significance between mortality rate in exposed and unexposed groups, therefore HIV infection alone is not a key factor in mortality.
[1] Cohen, MS; Hellmann, N; Levy, JA; DeCock, K; Lange, J (April 2008). "The spread, treatment, and prevention of HIV-1: evolution of a global pandemic". The Journal of Clinical Investigation 118 (4): 1244-54. doi:10.1172/JCI34706. PMC 2276790. PMID 18382737. Retrieved 17 September 2012.
[2] Federal HIV Centre: year 2013 report on HIV in Russian Federation (Федеральный центр СПИД: Справка ВИЧ-инфекция в Российской Федерации в 2013 г.)
[3] James J, Hofland HW, Borgstein ES, Kumiponjera D, Komolafe OO, Zijlstra EE. The prevalence of HIV infection among burn patients in a burns unit in Malawi and its influence on outcome. Burns. 2003 Feb;29(1):55-60.
[4]Phillipo L Chalya, Robert Ssentongo, and Ignatius Kakande. HIV seroprevalence and its effect on outcome of moderate to severe burn injuries: A Ugandan experience. J Trauma Manag Outcomes. 2011; 5: 8. Published online Jun 9, 2011. doi: 10.1186/1752-2897-5-8
[5] Des Jarlais DC, Friedman SR, Stoneburner RL. HIV infection and intravenous drug use: critical issues in transmission dynamics, infection outcomes, and prevention. Rev Infect Dis. 1988 Jan-Feb;10(1):151-8.
[6] Mzezewa S, Jonsson K, Sibanda E, Aberg M, Salemark L. HIV infection reduces skin graft survival in burn injuries: A prospective study. Br J Plast Surg.
2003;56:740-5. doi: 10.1016/j.bjps.2003.08.010.
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[7] Edge JM, Vander Merwe AE, Pieper CH, Bouic P. Clinical outcome of HIV positive patients with moderate to severe burns. Burns. 2001;27:111-4. doi: 10.1016/S0305-4179(00)00090-5.
[8] Mele JA, Linder SA, Calabria R, Ikeda CJ. HIV seropositivity in a burn center's population. J Burn Care Rehabil. 1998;19(2):138-41. doi: 10.1097/00004630199803000-00011.
[9] Smith RD. The pathobiology of HIV infection. A review. Arch Pathol Lab Med. 1990 Mar;114(3):235-9.
Ключевые слова: ВИЧ, ожог, ожогового, исход, экспонированная, контрольная, Санкт-Петербург, Россия.
Keywords: HIV, burn injury, burned, outcome, exposed, unexposed, Saint Petersburg, Russia.
УДК.616
Молостова А.С., Варзин С.А.
ХАРАКТЕР ТЕЧЕНИЯ ОСЛОЖНЕННОЙ ХРОНИЧЕСКОЙ ЯЗВЫ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ У ЖЕНЩИН11
Санкт-Петербургский государственный университет
Язвенная болезнь двенадцатиперстной кишки встречается в 4-13 раз чаще, чем язва желудка [1]. Лица, страдающие язвенной болезнью двенадцатиперстной кишки, составляют 30% всех пациентов гастроэнтерологического профиля. В течение жизни у 15% взрослого населения регистрируются язвы луковицы ДПК [2]. Соотношение мужчин и женщин при язвенной болезни ДПК колеблется от 2:1 до 10:1 [3]. В настоящее время отмечается тенденция к росту заболеваемости язвенной болезнью двенадцатиперстной кишки среди женщин, которая составляет, по данным литературы, 4-8% от общего числа населения
[4].
Частота возникновения и наследственная отягощенность ЯБДПК характеризуется отчетливыми тендерными различиями [5]. Наследственная отягощенность чаще обнаруживается у мужчин, чем у женщин [6]. Возраст
11 Molostova A.S., Varzim S.A., Course complication of chronic duodenal ulcer in women, Saint Petersburg State University, Russia
