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The aim: To find the most rational choice of drugs that have anti-emetic effect in patients with polytrauma in acute and early periods. Materials and methods: We examined 82 patients with polytrauma, 62 men and 20 women. The age of patients ranged from 19 to 50 years. Patients were divided into the main and control group with 36 and 46 people respectively, who did not differ significantly by sex, age, anthropometric data, the nature and severity of injuries, and the time from injury to admission to hospital. Results: Full antiemetic effect was achieved in 72.4% of patients, where metoclopramide was used. Сomplete antiemetic effect was achieved in 96.3% of patients, where sturgeon was used. Decrease of peristaltic activity does not increase postoperative intestinal paresis, and also prevents irritable bowel syndrome and diarrhea caused by dysbacteriosis on the background of antibiotic therapy. Anxiolytic effect without sedative effect and impairment of motor coordination, decrease of the somatic and psychopathological symptoms intensity in alcohol-toxic withdrawal syndrome contributes to the correct interpretation of the traumatic disease. Conclusions: Use of drugs with antiemetic effect is an important part of the complex of traumatic disease treatment in patients with polytrauma. The use of osetron is rational in patients with polytrauma with cranio-abdominal injuries.

The aim: To review the available results for genetic influences on pain syndrome development. Materials and methods: In the period from 2009 to 2020, a total of 45 research papers describing the key points of genetic influences on pain mechanisms in both adults and children were published in Ukrainian and English and they are now included in the PubMed, EMBASE, Cochrane, and Google Scholar research databases. Conclusions: Pain is a comprehensive characteristic of a person; therefore, it is inevitable that several genes with little individual effect interact with each other and environmental factors, influencing pain susceptibility and chronic pain syndrome manifestation. This requires searching for biomarkers for diagnosing and predicting the development of acute and chronic pain syndromes, especially in pediatric practice.

The aim: Show the efficacy of the Tiotropium / olodaterol combination in real clinical practice. Materials and methods: 100 patients with the diagnosis of COPD were included onto the study during the period of 2019-2020, an average age was 64.09±1.94 years, 66 were men (66 %) and 34 were women (34 %). There were 68 % of smokers with the average smoking experience of 24.44±4.84 pack-years. Average COPD duration was 9.35±2.42 years. There were 3 visits in the study – visit 1 (baseline), visit 2 (4-6 weeks) visit 3 (1 year). Source documentation was assessed at visit 1 and visit 3 for amount of exacerbations, antibiotic, glucocorticosteroid, methylxanthines use; mMRC and CAT were assessed at all visits. Results: Combined therapy with tiotropium/olodaterol improves clinical course of COPD, which is characterized by the significant decreased of the amount of exacerbations (2.63±0.29 to 1.63±0.21) and hospital admissions (1.2±0.2 tо 0.37±0.11). Improvement of symptoms and amount of exacerbation leads to much less use of antibiotics and glucocorticosteroids. A part of patients that used antibiotics decreased from 86±6.9 % to 67±9.3 %, amount of antibiotic courses from 1.37±0.17 tо 0.88±0.15, duration of treatment with antibiotics from 10.85±1.53 to 6.12±1.17 days. Part of the patients that used glucocorticosteroids decreased from 50±9.9 % tо 30±9.1 %, duration of treatment with antibiotics reduced from 3.97±1.06 tо 1.86±0.91 days. There also was a tendency towards a lesser used of methylxanthines. Combined therapy with tiotropium/olodaterol significantly decreased symptoms of COPD according to the mMRC (2.3±0.14 to 1.87±0.15) and САТ (23.28±1.71 to 15.77±1.58). Conclusions: Tiotropium/olodaterol combination showed its efficacy in real clinical practice. There was significant reduction in amount of exacerbation and antibiotic, gluco¬corticosteroid use during the study, which was also accompanied by the reduction is symptoms.

OBJECTIVE The aim: To perform microbiological investigation and analytic mathematic prediction of clinical isolates of S. aureus to aminoglycosides in patients with severe burns. PATIENTS AND METHODS Materials and methods: We analyzed resistance of 199 S. aureus strains to aminoglycosides (gentamicin, tobramycin and amikacin) and doxycycline from 435 patients treated in the regional hospital due to burns for the period from 2011-2017. RESULTS Results: We created predictive curves for the prediction of susceptibility of S. aureus strains to aminoglycosides and doxycycline based on the changes in S. aureus resistance during the years of observation and expressed in mathematic equations. Susceptibility of S. aureus to gentamicin was 42.86 % at the end of observation and will decline in future. Despite tobramycin was efficient against 72.86 % of strains in 2017, mathematic modeling indicates rapid decline in its efficacy in future. Efficacy of amikacin was dropping during the last years, but according to the equation it efficacy will increase over 60 % in 2018. S. aureus susceptibility to doxycycline was 65.38 % in 2017 and mathematic modeling indicates its gradual decline in the nearest future. CONCLUSION Conclusions: Predicitive values of S. aureus susceptibility indicates not sufficient efficacy of these drugs in patients with infectious complications of burns. Tendency of the slight decline of S. aureus susceptibility to doxycycline still indicates sufficient levels of its efficacy in the nearest future. This justify its use as a second-line therapy with the causative agent in patients with burns.

Objective The aim of the study was to find the most rational approach to postoperative pain relief in the complex of intensive care for the acute and early periods of traumatic diseasein elderly patients. Patients and methods Materials and methods: 132 gerontology patients with multiple trauma were included in the study. Respiratory and cardiovascular systems parameters were assessed, coagulogram and inflammatory response markers, pain severity and analgesia quality were assed. Results Results: According to the data obtained from the evaluation of VAS and Likerts scale, as well as other results, it was found that the use of NSAIDS and mu-opioid antagonists in the acute and early period of traumatic disease reduces significantly the severity of pain at a minimum daily dose (0.15 mg / kg), decreased the period of anaesthesia on demand, minimized negative respiratory and cardiovascular effects. Presence of sedative effect contributes to the improvement of emotional state of these patients. Conclusion Conclusions: Age-related changes and concomitant pathology in geriatric patients define the need for the safe pain relief in this patients, in order to decrease possible adverse events. Optimal combination in geriatric patients with perioperative pain syndrome due to polytrauma is NSAIDs with antagonists-agonists. This combination reduce the prevalence and severity of negative respiratory and cardiovascular.

OBJECTIVE The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. PATIENTS AND METHODS Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) - under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) - under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. RESULTS Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. CONCLUSION Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.

Objective The aim: Investigate the effect of 0.9% NaCl, HES 130, HAES-LX-5% and mannitol 15% on cerebral hemodynamics in patients with AIS. Patients and methods Materials and methods: The study included 100 patients with AIS. As the investigated solutions were used: isosmolar 0.9% NaCl, hyperosmolar mannitol 15%, colloid-isoosmolar HES 130, colloid-hyperosmolar HAES-LX-5%. The control group received only 0.9% NaCl compared: 0.9% NaCl+HES 130, 0.9% NaCl+HAES-LX-5%, 0.9% NaCl+mannitol 15%. Evaluation of cerebral hemodynamic (indexes of cerebral blood flow) was performed using doppler ultrasound of cerebral arteries. Results Results: The dynamics of specific volume velocity of blood flow per 100 grams of brain substance indicates that in the group of 0.9% NaCl and 0.9% NaCl+mannitol is the tendency to decrease the blood flow of the brain during 7 days of treatment, respectively: 2.8% and 7.5%. In patients with HES 130 solution cerebral blood flow increases by 14.2%, whereas when applied HAES-LX-5% during 7 days, it increases by 43.2% (p=0.004). Conclusion Conclusions: The analysis of the data of treatment the patients with AIS showed the best effect (p=0.004) of improvement of the cerebral circulation in the use of the polyfunctional infusion solution HAES-LX-5% unlike the 0.9% NaCl group and group of 0.9% NaCl+mannitol where was a decrease of the dynamics of cerebral blood flow, which could lead to hypoperfusion of the brain.