Aleksandr Leonidovich Potapov

INTRODUCTION: Patients with neoplasms are at increased risk of sepsis and adverse outcomes compared with the general population. Selecting an optimal treatment strategy for this patient population remains a challenging clinical task. OBJECTIVE: To identify independent predictors of 14- and 28-day mortality in cancer patients with sepsis. MATERIALS AND METHODS: A retrospective single-center cohort study was conducted including 97 patients with active solid malignancies and sepsis (Sepsis-3 criteria) admitted to the ICU between January 2019 and June 2025. Patients with hematological malignancies, disease remission, or palliative status were excluded. Demographic, clinical, oncological, and laboratory variables were analyzed. The primary outcomes were 14- and 28-day mortality. Independent predictors were identified using Firth-corrected multivariable logistic regression. RESULTS: 14-day mortality was 22.7 % (22/97) and 28-day mortality was 32.0 % (31/97). In multivariable analysis, the SOFA score was independently associated with 14-day mortality (OR 1.25; 95% CI 1.04–1.51; p = 0.015). Independent predictors of 28-day mortality were SOFA score (OR 1.26; 95% CI 1.06–1.52; p = 0.008) and ECOG performance status (OR 2.01; 95% CI 1.04–3.96; p = 0.037). CONCLUSIONS: A higher SOFA score was an independent predictor of both 14- and 28-day mortality, whereas poorer ECOG performance status independently predicted 28-day mortality.

Introduction. Postoperative nausea and vomiting (PONV) remain a major issue, mainly for particular, high-risk patient populations undergoing surgical intervention for thyroid carcinoma. The objective was to evaluate PONV risk factors for non-smoking women under the age of 50 being operated on for thyroid carcinoma by total thyroidectomy. Materials and methods. Seventy non-smoking female patients, aged 18–50 years, undergoing surgical operation for thyroid carcinoma by total thyroidectomy were examined. The female patients were divided into groups based on PONV occurrence, with a subsequent prognostic significance evaluation of various risk factors accompanying this condition. On every occasion, integrated precautions, including dexamethasone and ondansetron, were carried out. Results . The findings identified an examined case frequency of 51.4% for nausea and 35.7% for vomiting. The impact of age, ASA score, BMI category, surgery duration, and intraoperative fentanyl dosage on the determined frequency was not detected. The premedication type demonstrated statistically considerable prognostic value at or above the average. The use of taphalgine versus trimeperidine resulted in the odds of nausea reduction by a factor of 5.45 (OR 0.183; 95% CI: 0.066–0.510; AUC 0.700; 95% CI: 0.578–0.822; p < 0.001) and vomiting by 3.19 (OR 0.314; 95% CI: 0.112–0.879; AUC 0.640; 95% CI: 0.501–0.779; p = 0.026). Conclusions . The premedication type may affect the PONV incidence among non-smoking females under the age of 50 being operated on for thyroid carcinoma by total thyroidectomy.

Perioperative malnutrition and protein-energy wasting remain key modifiable risk factors for complications, prolonged hospital stay, and increased costs in surgical patients. The updated 2026 FAR guidelines on perioperative nutritional support systematize evidence from 2021–2025 and present a comprehensive multidisciplinary approach to diagnosing and correcting malnutrition at all stages of surgical care. In contrast to the 2021 version, the new edition introduces a two-step model for nutritional assessment: expanded risk screening (NRS-2002, MUST, MST, and others) complemented by formal malnutrition diagnosis according to GLIM criteria, incorporating phenotypic and etiologic features as well as instrumental assessment of sarcopenia and clinical frailty. This enables a shift from simple risk stratification to outcome prediction and individualized selection of nutritional support strategies. The guidelines emphasize the pivotal role of the preoperative phase, including prehabilitation: correction of nutritional deficits, use of oral nutritional supplements and, when indicated, immunonutrition combined with exercise training and educational interventions. The postoperative section maintains a focus on early enteral nutrition and refines criteria for tolerance, options for direct oral feeding after selected procedures, and indications for supplemental and peripheral parenteral nutrition. For the first time, a distinct post-discharge phase is outlined, with recommendations on continued oral nutritional supplements in high-risk patients. Dedicated sections address the use of specialized formulas (lipid emulsions, omega-3 fatty acids, glutamine, fiber-enriched enteral feeds) and the prevention of refeeding syndrome, including identification of high-risk groups and initial treatment algorithms. The guidelines are fully integrated with ERAS principles, positioning nutritional support as an essential component of the patient pathway rather than an isolated module. The final section provides quality indicators and metrics for the delivery of nutritional and metabolic care, forming a foundation for the development of local protocols, clinical audit, and continuous improvement of practice In Russian surgical wards and intensive care units.

The development of protein-energy malnutrition (PEM) syndrome is a pressing issue in surgical settings. The risk of malnutrition developing is determined in the majority of patients admitted to surgical wards. 30–70% of patients demonstrate signs of PEM upon admission, and during treatment, this syndrome can progress, reaching 50–60%. The severity of PEM is closely connected with clinical outcome indicators: length of stay in the intensive care unit and hospital increases, infectious complications occur more frequently, and treatment costs increase significantly. These guidelines, based on the principles of evidence-based medicine, describe methods for diagnosing and correction of PEM at all stages of surgical treatment. Also practical algorithms and criteria for evaluation the quality of nutritional and metabolic support during the perioperative period are included in this paper.

Objective. To evaluate the effect of intravenous ibuprofen on hemostatic parameters in patients undergoing colorectal cancer (CRC) surgery and concomitant thromboprophylaxis with low-molecular-weight heparin (LMWH). Material and methods. An open randomized study was conducted. To prevent thrombosis, all patients received the first LMWH injection 12 hours before surgery. Paracetamol 1000 mg (group 1, n=34) or ibuprofen 400 mg (group 2, n=35) were administered intravenously 30 min before the end of surgery. On the first postoperative day, hemoglobin, platelet count, drainage output and thromboelastography parameters were measured. Results. No major bleedings were observed. Hemoglobin, platelet count and drainage output did not differ significantly between groups. Clot formation time was prolonged in the 1st group to 1.4 (1.1—1.6) min compared to 1.1 (1.0—1.3) min in another group (p=0.04). Clot formation rate (angle A) was lower in group 1 — 69.5 (67.1—74.5) and 73.8° (71.7—75.2), respectively (p=0.002). Maximum amplitude was lower in group 1 (69.5 (67—71.7) compared to 72.4 (69.7—75.7) mm, p=0.01). Clot strength was also lower in group 1 (11.1 (9.7—12.6) vs. 13.1 (11.5—15.6) dyn/s, p=0.02). These changes indicate higher inhibition of platelet function in the paracetamol group compared to ibuprofen. Conclusion. For patients undergoing CRC surgery and receiving LMWH for thromboprophylaxis, perioperative analgesia with ibuprofen is safe regarding hemorrhagic complications and impact on hemostatic system.

In critically ill patients systemic hypoperfusion can lead to gastrointestinal (GI) mucosal injury, predisposing patients to clinically significant or non-significant bleeding. Bleeding from stress ulcers leads to prolonged intensive care unit (ICU) stays and an increased risk of negative clinical outcomes. A wide range of potential risk factors (prolonged mechanical respiratory support, sepsis, traumatic brain and spinal injury, severe burns, coagulopathy, ulcer history, etc.) leads to the indiscriminate use of pharmacological agents and to the wide routine administration of antisecretory drugs in more than 80–85 % of critically ill patients. The guidelines present the basic principles of upper gastrointestinal stress ulcer prophylaxis in intensive care patients.

The problem of postoperative nausea/vomiting (PONV) remains actual, especially for high risk patients. Objective. To analyze the effect of premedication with trimeperidine and taphalgin on the risk of PONV after thyroid surgery in young non-smoking females. Material and methods. There were 70 non-smoking female patients younger 50 years after thyroid surgery: group 1 (n=35) — premedication with trimeperidine, group 2 (n=35) — premedication with selective agonist of μ1 opioid receptors (taphalgin). The incidence and intensity of PONV within a day after surgery were assessed. Results. The absolute risk of postoperative nausea was 71.4% (95% CI 55.0—85.4%) and 31.4% (95% CI 16.9—48.2%) (p=0.0008), vomiting — 48.6% (95% CI 31.8—55.5%) and 22.9% (95% CI 10.3—38.6%) (p=0.023), respectively. The absolute risk reduction for nausea and vomiting was 40% (95% CI 16.6—57.8%) and 25.7% (95% CI 3.3—0.95%), respectively. The NNT score was 2.5 (95% CI 1.7—6.0) for nausea and 3.9 (95% CI 2.2—30.6) for vomiting. NRS scores of nausea were similar in both groups: 4 (3—6) and 4 (2—4) points, respectively (p=0.36). Course of anesthesia and early postoperative period, including the incidence of other complications, did not differ between groups. Conclusion. Premedication with taphalgin instead of trimeperidine is advisable in patients with high risk of PONV.

INTRODUCTION: Nutritional support is an integral part of the treatment process in the intensive care unit (ICU). Patients in critical care receive some methods of enteral or parenteral nutrition based on often conflicting guidelines and controversial strategies. OBJECTIVE: To identify key trends in the use of metabolic control and nutritional support technologies in ICUs of different profiles. MATERIALS AND METHODS: The project of this screening study was developed by members of the FAR RF Committee on Nutritional Support and Metabolic Control. The design trial was simple random sampling. The study included 569 ICU patients. Results. The mean age of the patients was 59.22 ± 17.93 years. APACHE II scale — 1.3 ± 3.9 points, according to SOFA scale — 3.7 ± 1.5 points. 56 % of patients underwent surgical interventions, 45 % were on mechanical ventilation, 28-day mortality — 24 %. In 25 % of oncological patients the total protein was below 50 g\l. Serum albumin level was statistically significantly lower (p = 0,013) in the group of patients with acute cerebral insufficiency (ACI) in comparison with oncosurgical patients. In 25 % of multidisciplinary ICU patients albumin concentration was below 25 g/l. Energy requirement was determined empiricaly in 44 % of oncologic patients, in 50 % of patients with ACI the method of c equations was used, and indirect calorimetry was used in all groups in no more than 1 % of cases. Protein requirements were empirically determined in 20 % of cases in all groups. 35 % of physicians estimated the protein requirement based on the value of 1.2–1.5 g/kg/day. Enteral tube feeding was more frequently used by 70 % of ACI patients and 29 % in the oncology group. In contrast, 29 % of oncologic patients received parenteral nutrition. Only 5 % of patients with ACI required parenteral nutrition. CONCLUSIONS: The majority of ICU patients are characterized by such manifestations of protein-energy deficiency as hypoproteinemia, hypoalbuminemia, hypotransferrinemia. Enteral tube feeding is the prevailing method of nutritional support in ICU. The main problem identified in the course of screening should be considered the very rare use of metabolic monitoring technologies and the lack of a personalized approach to the selection of the nutritional support program.

Postoperative pain management remains unsatisfactory. Thus, searching for new methods of adequate pain control is still important. This review is devoted to novel opioids for postoperative analgesia. These opioids have comparable and even greater effectiveness compared to traditional opioid analgesics with lower rate of adverse side effects. This is achieved due to new capabilities, i.e. antagonism with β-arrestin (oliceridine), noradrenaline reuptake inhibition (tapentadol), impact on nociceptin/orphanin receptors (cebranopadol), significant prolongation of duration of action (dinalbuphine), high selectivity to type 1 µ-receptors (tafalgin), impact on concentration of endogenous opioid peptides (DENKIs, CYT-1010). Data from experimental and clinical studies are presented for each drug. Despite development of opioid-sparing techniques, opioid analgesics keep their place in the treatment of pain after surgery. Some novel opioids (tapentadol, tafalgin) are available In Russia.

Introduction. The role of peptides in antinociceptive system regulation has became a subject of interest for scientists worldwide. The first registered peptide analgesic tyrosyl-D-arginyl-phenylalanyl-glycinamide acetate which currently can be used in clinical practice was developed in Russia under the name Taphalgin® (PharmFirma “Sotex”, Russia). The effectiveness and safety of this pharmaceutical in postoperative pain management was evaluated in the all-Russia multicenter prospective observation program NICITA (Non-interventional Clinical Trial of Taphalgin ®).Aim. To analyze the effectiveness and safety of Taphalgin® in postoperative pain management in various surgical fields.Materials and methods. The observational program NICITA included 887 patients including patients with malignant tumors of various locations from 15 study centers in different Russian cities. All patients underwent surgical interventions in various anatomical areas under general, regional and combination anesthesia. The principal scheme of postoperative pain management was based on the multimodal approach which included peptide opioid agonist alongside acetaminophen, cyclooxygenase inhibitors in combination with regional anesthesia or without it. The study also included patients who underwent small-volume surgeries, and pain was managed through Taphalgin® monotherapy with subsequent switch to cyclooxygenase inhibitors. The primary endpoint of the NICITA observational program was response to therapy after the first Taphalgin® administration. Decreased pain syndrome per the numerical rating scale 15–60 min after subcutaneous injection and maintenance of analgesic effect 3 h later were considered treatment response. The secondary endpoints included mean time to analgesia start after administration of the 1st single drug dose (in min), duration of effect, types and frequency of adverse reactions including serious in the central nervous system, pulmonary system, gastrointestinal tract developed during the observational program, as well as patient and research physician satisfaction with pain management. To evaluate the significance of pain intensity change at rest and in motion in time, analysis of variance with repeat measurements was used; for pairwise comparison of two time periods, Student’s t-test for dependent samples was used. The differences were considered significant at p = 0.05.Results. Statistically significant decrease in pain intensity in the total patient group was observed 15 minutes after Taphalgin® administration; it reached its minimum 40 min after the injection (р 0.05). The percentage of patients responding to analgesic therapy with Taphalgin® was 96.5 %. During administration of the drug, insignificant decrease (10–15 mmHg) in arterial blood pressure (1.7 % of cases) and vertigo (1 % of cases) were observed. In some patients, several adverse reactions were observed. Satisfaction with analgesic effect of Taphalgin® was relatively high both in patients and research physicians.Conclusion. Taphalgin® has pronounced analgesic effect and is effective for pain management after surgical interventions of various volumes and injury level. The use of this drug is associated with low rate of adverse reactions and absence of pulmonary depression characterizing opioid agonists. Therefore, Taphalgin® can be recommended for clinical use for postoperative pain management after various types of surgical interventions.