Cold urticaria (CU) is an allergic reaction that manifests itself as hives-like rashes or red spots in response to general or local cooling of the body. Th e disease can be acquired or hereditary, ...and in the cold season it can affect all segments of the population. Th is pathological condition, at first glance, does not seem to be a very dangerous variant of a local cold injury, but in persons who are prone to exposure to low temperatures, especially with a burdened cold history, it may be accompanied by chronicity of the process and complicated by neurovasculitis, obliterating endarteritis and secondary Raynaud’s syndrome, may decrease the quality of life of the victims and become a cause of disability. The pathophysiology of CU is largely unknown, but it is likely to be related to immunoglobulin E (IgE) and mast cell activation. Cooling has been reported to induce the release of neutrophilic and eosinophilic chemotactic factors, prostaglandin D2, and tumor necrosis factor (TNF-α). Less common immunologic fi ndings in patients with CU include cryoglobulinemia consisting of monoclonal IgG and mixed IgG/IgM and IgG/IgA cryoglobulin types. The mechanisms of development of CU are mainly determined by the formation of cryoglobulins (cold hemolysins) and subsequent degranulation of mast cells. Th e diagnosis of CU depends on the patient’s history and the results of cold provocation tests. Patients with CU are recommended first of all not to overcool, to take warm showers, to wear warm clothes and a hat, and not to consume cold food and drinks. Treatment options include second-generation H1 antihistamines and glucocorticosteroids. New promising option is omalizumab, a humanized monoclonal antibody derived from a recombinant DNA molecule that targets and selectively binds to circulating IgE and affects mast cells function. In patients with CU undergoing general anesthesia, premedication including antihistamines and corticosteroids is recommended, along with strict maintenance of perioperative normotermia.
Холодова кропивниця (ХК) є алергічною реакцією, яка проявляється висипаннями за типом кропив’янки або червоних плям у відповідь на загальне або локальне охолодження тіла. Захворювання буває набутим або спадковим і в холодну пору року може уражувати всі верстви населення. Цей патологічний стан на перший погляд видається не дуже небезпечним варіантом локальної холодової травми, але в осіб, які схильні до впливу низьких температур, особливо з обтяженим холодовим анамнезом, може супроводжуватися хронізацією процесу й ускладнюватись нейроваскулітом, облітеруючим ендартеріїтом і вторинним синдромом Рейно, може знизити якість життя постраждалих і стати причиною інвалідності. Патофізіологія ХК мало вивчена, але ймовірно пов’язана з імуноглобуліном Е (IgE) та активацією тучних клітин. Охолодження тканин індукує викид хемотактичних факторів нейтрофілів та еозинофілів, простагландину D2 та фактора некрозу пухлин альфа (TNF-α). Менш частою імунологічною знахідкою у пацієнтів з ХК є кріоглобулінемія з моноклональними IgG та змішаними IgG/ IgM або IgG/IgA типами кріоглобулінів. Механізм розвитку ХК здебільшого визначається формуванням кріоглобулінів (холодних гемолізинів) та наступною дегрануляцією тучних клітин. Діагностика ХК залежить від анамнезу пацієнта та результатів холодових тестів. Пацієнтам з ХК рекомендують насамперед не переохолоджуватися, приймати теплий душ, носити теплий одяг та головний убір, не вживати холодну їжу та напої. Варіанти терапії включають H1-гістаміноблокатори другого покоління та глюкокортикоїди. Новою перспективною опцією є омалізумаб — моноклональне антитіло, яке отримують з рекомбінантної молекули ДНК і яке селективно зв’язує циркулюючий IgE і впливає на функцію тучних клітин. У пацієнтів з ХК, які підлягають загальній анестезії, в премедикацію рекомендовано включати антигістамінні та кортикостероїди, разом із суворим дотриманням періопераційної нормотермії.
Background
Perfectionism today is understood as an individual's psychological conviction that the ideal can and should be achieved, and the imperfect result of work (physical, intellectual, etc.), in ...their opinion, has no right to exist.
The purpose of the study
Our goal was to investigate levels and types of perfectionism among anesthesiology interns in comparison with the indicators of practicing anesthesiologists.
Materials and methods
An anonymous survey of 92 anesthesiology interns and 124 practicing anesthesiologists was conducted according to the Big-Three Perfectionism Scale (BTPS).
Results
The mean general level of perfectionism was average, with the total BTPS score of 124,38 ± 14,47 out of 225 in interns and 105,97 ± 10,31 in practicing anesthesiologists (p < 0,05). Both interns and practicing doctors leaned toward rigid perfectionism (mean score 32,32 ± 3,32 out of 50 in interns and 33,33 ± 3,23—in practicing doctors, p < 0,05) and self-critical perfectionism, with the average score of 52,08 ± 4,37 out of 90 in interns and 42,87 ± 4,76 in postgraduates (p < 0,05). Narcissistic perfectionism is the factor with the least relative score in both groups (39,99 ± 7,61 out of 85 in interns and 29,77 ± 4,20 in practicing doctors, p < 0,05).
Conclusions
Neither anesthesiology interns nor practicing anesthesiologists in general exhibited high levels of perfectionism. In both groups there was a moderate leaning towards rigid and self-critical perfectionism, which indicates a tendency for the individuals to set high standards for themselves and base their own self-worth on meeting these standards. In interns, the general perfectionism levels were significantly higher than in practicing doctors. Also the self-critical type was more prominent among interns. This might indicate a sense of pressure to meet unrealistic outside expectations and an impostor syndrome which is common for the people at the start of their careers, but it’s also a significant risk factor for future burnout.
Patients with traumatic brain injury (TBI) are the largest group of victims at the emergency departments. Up to 20% of patients with severe TBI require endotracheal intubation and prolonged ...mechanical ventilation. The ventilation parameters choice should be focused on the normal arterial blood gas composition. Hypoxia causes secondary damage to the brain tissue, and hyperoxia carries risks of oxygen toxicity. Hypercapnia leads to cerebral vasodilatation, increased intracranial pressure (ICP) and the risk of cerebral edema. Hypocapnia promotes cerebral vasoconstriction, which reduces cerebral blood flow and ICP, but also leads to cerebral tissue ischemia, so prolonged hyperventilation in TBI is not currently recommended. Patients with TBI often require sedation to synchronize with the respirator. The drugs of choice are propofol and midazolam. Routine use of muscle relaxants is not recommended. The initial ventilation mode should provide a certain respiration rate to achieve normocapnia, while allowing the patient to make breathing attempts. Support ventilation modes are used while weaning from mechanical ventilation. Promising in predicting extubation success is the assessment of the VISAGE score, which includes visual pursuit, swallowing, age, and the Glasgow coma score. Modern principles of respiratory support in severe TBI include: tracheal intubation by Glasgow coma score ≤8 ; early mechanical ventilation; PaO2 80-120 mm Hg (SaO2 ≥95%); PaCO2 35-45 mm Hg; tidal volume ≤8 ml/kg; respiratory rate ≈20/min; PEEP ≥5 cm H2O; head elevation by 30°; sedation in poor synchronization with the respirator; weaning through support ventilation modes; extubation when reaching 3 points on the VISAGE scale; early (up to 4 days) tracheotomy in predicted extubation failure.
Among the main factors of pathological changes that accompany acute abdominal pathology are the inflammatory process of the peritoneum and fluid deficiency due to its pathological losses. The aim of ...our study was to analyze the initial state of fluid compartments of the body and hemodynamics in high surgical risk patients with acute surgical abdominal pathology. There were examined 157 patients with acute abdominal pathology who underwent emergency laparotomy. The presence and severity of fluid deficiency were determined clinically by tissue hydrophilicity test by P.I. Shelestiuk, biochemically – by assessing the levels of hematocrit, hemoglobin, erythrocytes, blood electrolytes, vasopressin (ADH) and brain natriuretic propeptide (proBNP), as well as the mean erythrocyte volume and plasma osmolarity. Variables of fluid compartments of the body and central hemodynamics were studied using the non-invasive bioimpedancemetry. Based on the values of oxygen concentration in arterial and venous blood, total oxygen consumption (VO2) and delivery of oxygen (DO2), oxygen extraction ratio (O2ER) were calculated. The detected changes indicate intravascular fluid deficiency and concomitant hemoconcentration with normal electrolytes levels and plasma osmolarity. In patients with high surgical risk and moderate dehydration according to P.I. Shelestiuk, urgent surgical pathology of the abdominal cavity reduces extracellular fluid volume by 19.1% (p=0.019) of the reference by reducing the volume of the interstitium and intravascular fluid respectively by 20.7% (p=0.002) and 16.3% (p=0.001) of regional values, which forms in patients a state of "volume depletion" of moderate severity. This is accompanied by an increase in the ADH concentration by 16.7% (p=0.041) above reference and normal proBNP levels. Stroke volume decreases by 28.8% (p=0.021) against tachycardia (increase in heart rate by 39.7% (p=0.001) above normal) and vascular spasm (increase in systemic vascular resistance by 86.9% (p=0.001) above reference), which supports the normodynamic type of blood circulation (cardiac index – 3.2 (0.4) l/min/m2) with the decrease in stroke index and peripheral perfusion index by 41.3% (p=0.002) and 55.2% (p=0.002) from reference, respectively. DO2 decreases by 11.1% (p=0.011) from reference with VO2 increased by 16.3% (p=0.004) above reference, which leads to a decrease in oxygen utilization by 7.2% (p=0.041) from reference.
The article presents the data obtained during the examination of children with acute surgical pathology. The frequency of development, the severity of hyponatremia, and the effect of the syndrome of ...inadequate secretion of antidiuretic hormone on the development of hyponatremia have been established.
There was carried out an anonymous questioning– a survey of 6th-year students who received an internship assignment in the specialty «General Practice – Family Medicine», interns and students doing ...courses in the same specialty in order to diagnose the presence of «clip-on» thinking. M.B. Litvinova test method which is characterized by criterial and categorical validity and corresponds to reliability criterion was used. «Clip on» thinking was diagnosed in 36.5% of the surveyed students on training a budgetary basis and 37.8% of students studying on a contract basis, plus 38.5% of them were at risk. At the stage of postgraduate education (internship training), the percentage of «screen people» (with «clip» type of thinking) was significantly lower, but at the same time the share of the risk group on formation of a «clip» type of thinking was increased. The predominant increase in «people of the book» («long» thinking) among physicians with a certain length of service mainly is due to their age characteristics. Modern medical postgraduate education requires the formation of a qualitatively new approach to the educational process, based on the formation and development of clinical thinking, taking into account psychological characteristics of the modern youth and older colleagues. This phenomenon requires detailed social, andragogical and medical research, the creation of new educational technologies based on «live» communication.
Within recent years, we have conducted a series of investigations on the diagnostics of mosaic thinking since presently, the process of substitution of the fragmented (mosaic) thinking for the ...medical judgment is progressively going on among the individuals getting the postgraduate medical education (Yekhalov, Yehorov, Pavlysh, & Barannik, 2020). For the purpose of verbal estimate of the quality of thinking of the internship doctors, we have used a modified test of thinking and creativity, which was created by Bruner, an American psychologist. Over three years, an anonymous testing has been held in four peer groups of the 1st year internship doctors majoring in Anesthesiology, Stomatology and Neurology (exactly 100 respondents in each group). The test questionnaire was focused on the preference of the textual or pictorial information; on the character of the representation of information (i.e., as a text, as a visual imagery, or both these characters equally); on the using of the symbolic information coding; on the selection of a solution as for the representation of pictorial information; on the interrelation between the actions themselves and the discussing of such actions; on the extent and rate of the information handling; on the way-finding in a non-homogenous informational space; on the fatigue level, and so on.
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