卷 1, 编号 4 (2020)

Background: Dysphagia of various origins is widespread. There is a high risk of developing formidable complications: malnutrition, dehydration, weight loss, airway obstruction, aspiration pneumonia. The product Softia S is used to solve the problems of swallowing liquids. The Ministry of Agriculture, Forestry and Fisheries of Japan financed this study within the framework of the 8-Point Cooperation Plan presented by the Prime Minister of Japan S. Abe to the President of the Russian Federation V. V. Putin in May 2016. Aims: Assessment of the efficacy and safety of NUTRI’s Softia S product for patients with dysphagia of various origins. Materials and methods: Complex assessment of dysphagia included speech therapy, video fluoroscopy and video laryngoscopy with assessment of swallowing function Rosenbek (PAS) and FEDSS scales. Patients were divided into 2 groups (experiment and control). The study lasted 14 days. Examination by a speech therapist and a nutritionist was carried out daily. On the 1st and 14th days, laboratory parameters were monitored, and the patient’s body weight was determined. Results: The study included 30 patients with mild dysphagia. By the end of the study, 8 people in the experimental group showed a restoration of the swallowing function, residual effects in the form of choking persisted in 7 people. In the control group, a slight improvement was observed in 2 patients, 13 had no changes. The most significant changes were found in the experimental group for the indicators "Time of eating" ("Breakfast", on average, 3.7 minutes, p=0.0033; "Lunch", on average, 6.9 minutes, p <0.0001); "The number of chokes after hydration" ("Breakfast" by an average of 7.0, p <0.0001; "Lunch" by an average of 8.1, p <0.0001; "Dinner" by an average of 6.8, p <0.0001); "The number of chokes during hydration" ("Breakfast" by an average of 8.8, p <0.0001; "Lunch" by an average of 12.1, p <0.0001; "Dinner" by an average of 8.7, p <0.0001). The number of dysphonia cases with sputum significantly decreased only in the experimental group. Conclusions: Softia S can be used in complex therapy for dysphagia by reducing the amount of choking after and during hydration and time of eating and dysphonia cases with sputum.

Background: Malnutrition is a frequent medical problem of cancer patients (pts) that negatively impacts of results of antitumor treatment. Aim: To study the problem of malnutrition in cancer hospital. Materials and methods: The observational study included 80 pts (30 males, age 51.6±13.6 years) who underwent examination before antitumor treatment (medical/surgical). Body mass index (BMI), weight loss (WL) over last 6 months, decrease in appetite before admission, reasons for decrease in food intake, physical activity, nosology, cancer staging, the time to diagnosis, therapy status, total protein (TP), albumin, absolute lymphocyte count (ALC) were evaluated. The data were analyzed by SPSS13.0 software. The results were expressed as mean ±SD. Results: The BMI was 25.3±5.4 kg/m², WL 9.0±0.1%. The most common pathology were esophageal/gastric cancer (31%), stage IV (77%). 25% had received treatment within the last 6–12 months, 60% of the pts had received chemotherapy, of whom 36% had received 1st-line chemotherapy. Only 13% had additionally used enteral nutrition. An unwanted reduction of appetite was observed in 75% of pts. Most of them (34%) could not explain the reason of WL, 31% reported nausea/vomiting, 19% referred to anorexia; 13% showed consequences of chemotherapy toxicity (dysgeusia, stomatitis), 3% could not eat properly due to the pain syndrome. Of 60 patients who lost weight unintentionally, 54 (67.5%) had an average WL 14.1±9.1%. WL up to 5% was in 5 pts (6.25%), up to 10% in 14 pts (17.5%) and in 35 pts (43.75%) — more than 10%. 46% retained their usual daily activity, 80% deemed it useful to include a nutritional program in the treatment. The concentration of TP was 63.5±8.1 g/l, albumin 34.9±7.4 g/l, ALC 1.6±0.6×10⁹/l. Conclusions: Cancer patients have direct prerequisites for the development of cachexia, and, according to our study, 6.25% of patients were at the stage of precachexia, and 61.25% already had cachexia at the time of inclusion in the study. Although their compensatory capacity is quite high, the appointment of additional nutritional support is an integral component of the management of these patients. However, according to our data, only one tenth of patients used some kind of nutritional support. Nevertheless, in case of antitumor treatment, nutritional status evaluation must be mandatory in order to address the issue of nutritional support.

Critically ill patients often develop hyperglycemia because of the metabolic response to trauma and stress. In response to any form of damage to the organism, it reacts by increasing its own glucose production which subsequently causes hyperglycemia. This adaptive reaction of the organism is directed to aid in the rapid restoration after the damage. Therefore, glucose is an indispensable substrate in the critically ill which aids the reparation process. Severe and persistent hyperglycemia is associated with unfavorable outcomes and is considered to be an independent predictor of in-hospital mortality. The discussion remains on whether hyperglycemia is just a marker of increased stress which makes it a surrogate indicator of disease severity or if it is the reason for the unfavorable outcome. A few years ago, several published articles suggested that a «tight» glycemic control within the normal range improves treatment outcome. Over time, researchers have changed their point of view and currently there is a discussion on this matter in the scientific literatures. At the same time, the question of what glycemic level should be maintained for patients in the Neurological Intensive Care Unit is a matter of discussion. In this review, the authors analyzed the latest guidelines on treatment of critical patients with neurosurgical and neurological pathologies, specifically the glycemic control in this category of patients.