Biological antiseptics. Asepsis.

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Biological antiseptics provides use of agents of a biological parentage, and also influence on immune system of the macroorganism. On microbes we render depressing, and on immune system a promoting effect. The largest bunch of agents of a biological parentage - antibiotics, as a rule, is products of vital activity of funguses of various kinds. Some of them are applied in not variated kind, some are exposed to an additional chemical treatment (semisynthetic preparations), there are also synthetic antibiotics. Antibiotics are sectioned into various bunches, is especially widely applied bunches of Penicillinums, offered in 30th years Fleming. Penicillinum introduction in medical practice has caused revolution in medicine. That is illnesses which were fatal for the human we will tell a pneumonia of which millions humans all over the world died began to give in to successful treatment. In surgery steels are much rarer to meet purulent complications. However misuse of Penicillinum within 20 years has led to that already in 50th years physicians have completely compromised it. It has descended because strict indications to Penicillinum application were not considered; prescribed Penicillinum at a flu, in order to avoid complications - a pneumonia caused by staphilococcuses or pneumococcuses. Or surgeons, doing operation concerning an inguinal hernia prescribed antibiotics in order to avoid purulent complications. Now with the preventive purpose to apply antibiotics it is impossible, except for cases of emergency preventive maintenance. The second circumstance - that that prescribed it in low doses. As a result not all microbes were exposed to Penicillinum influence, and persisted after application of Penicillinum microbes, started to develop protective mechanisms. The most known protective mechanism is a development of a penicillinase - enzymes which blasts Penicillinum. This property is characteristic for staphilococcuses. Microbes began to include antibiotics of a tetracycline number in the recycling. Strains which are capable to live only in the presence of these antibiotics were developed. Some microbes have reconstructed receptors of the cellular membranes so that not to accept a molecula of antibiotics.On the pharmacological properties the betaxolol is a selective blocker of b1-adrenoreceptors. It does not possess intrinsic sympathomimetic activity and membrane-stabilising (local anaesthetic) action. As well as other b-blockers, from the ophthalmotonus at the expense of reduction of production of intraocular fluid reduces, however exact mechanisms of this effect are not studied till now definitively. Besides it, some enriching of outflow of a watery moisture though in the majority of researches outflow change appears statistically doubtful is observed. Different explorers specify about identical efficacyy of a betaxolol in respect of ophthalmotonus depression. Irrespective of the medicinal form (Betoptic or Betoptic S), the preparation reduces an ophthalmotonus to necessary level at 85-88 % of patients. Comparing hypotensive action of a betaxolol and Timololum, explorers result varied results. One consider, that it reduces an ophthalmotonus more weakly, than Timololum, others specify in absence of statistically authentic difference in hypotensive action of two preparations. But also those, and others agree in opinion, that the betaxolol surpasses Timololum in the ability to keep visual functions at sick of a glaucoma.

For the first time more expressed, than at Timololum, positive action of a betaxolol on fields of vision at sick of a glaucoma has been noted in the late eighties - the beginning of 90th years when independently from each other there were some works confirming this position. In spite of the fact that schemes of construction of experiment and procedure of processing of the received data in different works is essential differed from each other, authors have received very similar results. So, in work Colignon-Brach comparison of action of a betaxolol and Timololum on an ophthalmotonus and sensitivity of a retina at patients with a Primary Open Angle Glaucoma and an ophthalmic hypertensia within 2 years was spent. The ophthalmotonus was defined by means of Goldman's tonometer, sensitivity of a retina in the central field of vision (30 °) - by means of the automated perimetre Octopus. It has been shown, that despite more weak hypotensive action of a betaxolol in comparison with Timololum, after 12 months of therapy average sensitivity of a retina at patients receiving it has statistically authentically raised, whereas at the patients receiving Timololum, it has decreased. Prolongation of research till four years has shown, that such tendency completely remains: average sensitivity of a retina at the patients receiving a betaxolol, statistically authentically above, than at receiving Timololum.

Further 4 times a day began to apply Penicillinum. If to introduce Penicillinum a parenterally its therapeutic dose is reached approximately in 30 minutes after introduction and it is kept in a vascular bed no more than 4 hours, and further the dose sharply decreases. Time turns out at 6 o'clock, that introducing antibiotics, we give to microbes 2 hours that they have adapted to an antibiotic. Thus, the dose of the use of Penicillinum is now raised from 1 gramme a day to 10-20 gramme a day and to introduce it it is necessary each 4 hours.

In 60th years there was a new bunch of antibiotics - antifungal antibiotics. The matter is that as a result of scale application of antibiotics at humans began to be observed depressing of own microflora of a colon, it is depressed E. coli, and vital to the human, for example, for mastering of vitamins (K, В12). Recently one more mechanism of interaction of a human body with an intestinal rod has been found: it is E. coli soaked up in pots of intestinal villi and on mesenteric veins gets to a portal vein, and further in a liver and there are killed by Kupffer cells. Such bacteriemia as a part of blood of a portal vein matters for maintenance of a constant tonus of immune system. And so at depressing of an intestinal rod these mechanisms are broken. Thus, antibiotics reduce activity of immune system.

Because the normal microflora, is depressed by antibiotics, microflora absolutely unusual to the healthy human can educe. Among this microflora on the first place - funguses of sort Candida. Development of a fungoid microflora leads to Candida albicans occurrence. At us in a city 10-15 cases of a sepsis caused Candida albicans annually become perceptible. That is why there was a bunch of antifungoid antibiotics which are recommended to be applied at dysbacterioses. Levorinum, nystatin concerns these antibiotics, Metrogyl, etc.On the pharmacological properties the betaxolol is a selective blocker of b1-adrenoreceptors. It does not possess intrinsic sympathomimetic activity and membrane-stabilising (local anaesthetic) action. As well as other b-blockers, from the ophthalmotonus at the expense of reduction of production of intraocular fluid reduces, however exact mechanisms of this effect are not studied till now definitively. Besides it, some enriching of outflow of a watery moisture though in the majority of researches outflow change appears statistically doubtful is observed. Different explorers specify about identical efficacyy of a betaxolol in respect of ophthalmotonus depression. Irrespective of the medicinal form (Betoptic or Betoptic S), the preparation reduces an ophthalmotonus to necessary level at 85-88 % of patients. Comparing hypotensive action of a betaxolol and Timololum, explorers result varied results. One consider, that it reduces an ophthalmotonus more weakly, than Timololum, others specify in absence of statistically authentic difference in hypotensive action of two preparations. But also those, and others agree in opinion, that the betaxolol surpasses Timololum in the ability to keep visual functions at sick of a glaucoma.

Main principles of the rational antibioticotherapia

Purposefully application of antibiotics: under strict indications, in no event for the preventive purpose

Knowledge of the originator. Results of bacteriological research appear only in 12 hours, and the human should be treated now. Every third case of a surgical infection contamination is caused not by a monoculture, and at once many originators. Them can be 3-8 and more. In this association any of microbes is in the lead and it is most pathogenic, and the others can be fellow travellers. All it are complicated by originator identification, therefore in the head of an angle it is necessary to put a cause of illness. If the human is threatened with serious complication or mors then it is necessary to apply reserve antibiotics - cephalosporins.

Correct choice of a dosage and frequency rate of appointment of an antibiotic proceeding from maintenance in blood of necessary level of concentration of an antibiotic.

Preventive maintenance possible collateral action and complications. The side effect - an allergy is most extended. Before antibiotic application the dermal sensitivity test to an antibiotic should be put. To reduce danger of toxic action between antibiotics. There are antibiotics which enhance unfavorable action each other. There are antibiotics which relax it. For a choice of antibiotics there are tables of compatibility of antibiotics.

Before to begin an antibioticotherapia it is necessary to find out a condition of a liver, nephroses, hearts from the patient (especially at application of toxic preparations).

Working out of antibacterial strategy: it is necessary to apply antibiotics in various combinations. One and too a combination to apply it is necessary no more than 5-7 days, in the course of treatment if effect does not come, it is necessary to change an antibiotic for another.

At disease of the human of an infectious aetiology it is necessary to watch a condition of immune system. It is necessary to apply procedures of research of humoral and cellular immunodefence available for us in time to tap defect in immune system.

There are three pathes of influence on immunodefence:

The active immunization when antigens are introduced, in surgery is vaccines, anatoxins.

Passive immunization by Serums, scale globulin. In surgeons it is widely applied antitetanic, antistaphylococcal gamma-globulins.

immunemodulation. Application of various stimulators of immunodefence: an aloe extract, an autohemotherapy, etc. methods, but a promoting effect disadvantage that we react blindfold, not on what that the certain immune mechanism. Along with the normal pathological immune responses - autoimmune aggression take place also. Therefore not the immunostimulation, and an immunemodulation, that is action only on a defective part of immunodefence now takes place. Now as immunomodulating factors use various lymphokines, interleukines, interferons, preparations received of a thymus influencing T-population of lymphocytes. It is possible to apply also various extracorporal procedures immunemodulation: an ultra-violet radioscopy of blood, a hemosorption, hyperbaric oxygenation, etc.On the pharmacological properties the betaxolol is a selective blocker of b1-adrenoreceptors. It does not possess intrinsic sympathomimetic activity and membrane-stabilising (local anaesthetic) action. As well as other b-blockers, from the ophthalmotonus at the expense of reduction of production of intraocular fluid reduces, however exact mechanisms of this effect are not studied till now definitively. Besides it, some enriching of outflow of a watery moisture though in the majority of researches outflow change appears statistically doubtful is observed. Different explorers specify about identical efficacyy of a betaxolol in respect of ophthalmotonus depression. Irrespective of the medicinal form (Betoptic or Betoptic S), the preparation reduces an ophthalmotonus to necessary level at 85-88 % of patients. Comparing hypotensive action of a betaxolol and Timololum, explorers result varied results. One consider, that it reduces an ophthalmotonus more weakly, than Timololum, others specify in absence of statistically authentic difference in hypotensive action of two preparations. But also those, and others agree in opinion, that the betaxolol surpasses Timololum in the ability to keep visual functions at sick of a glaucoma.

Asepsis

Asepsis is a complex of preventive surgical actions referred on the prevention of hit of an infection contamination in a wound. It can achieve by sterilisation of all of that to it adjoins. The asepsis was offered by German surgeon Bergman. It has descended on 9 congress of surgeons in Berlin. Bergman has offered physical procedures of a decontamination - boiling, burning, autoclaving.

Asepsis and antiseptics represent a uniform complex of actions, they cannot be parted.

On an infection contamination source divide on exogenous and endogenous. Pathes of penetration of an endogenous infection contamination: lymphogenous, hematogenous, on intercellular spaces, especially quaggy tissue, contact (for example, with the surgical instrument). For surgeons of the special problem the endogenous infection contamination does not represent, unlike the exogenous. Depending on a penetration path the exogenous infection contamination is sectioned on air drop, contact and implantation. An air infection contamination: so in air it is not a lot of microbes, the probability of air infestation is not great. The dust enlarges probability of occurrence of infestation from air. Basically, measures of struggle against air infection contaminations are reduced to struggle against a dust and include an aeration and an ultra-violet irradiating. Cleaning is applied to struggle against a dust. There are 4 kinds of cleaning:

The preliminary consists that since morning prior to the beginning of operational day is wiped all horizontal surfaces by a napkin moistened of 0.5 % with solution of Chloraminum.

Current cleaning is effected during operation and consists that that drops all on a floor immediately was cleaned

Final cleaning - after operational day also consists it of washing of floors and all equipment of 0.5 % solution of Chloraminum and including of ultra-violet lamps. To sterilise air by means of such lamps it is impossible, and they are applied in a place of the greatest sources of a becoming infected.

The aeration - very effective method - after it microbes drops impurity on 70-80 %.

Very longly was considered that the air infection contamination is not dangerous at operations, however with development of transplantation with application immunodepressants operational steels to divide into 3 classes:

The first class - no more than 300 microbic cells in 1 cubic metre of air.

Class - to 120 microbic cells - this class is designed the second for cardiovascular operations.

The third class - a class of an absolute asepsis - no more than 5 microbic cells in air cubic metre. It can achieve in tight operational, with ventilation and an air sterilisation, with building in operational region of a supertension (that air aspired from operational outside). And also special doors-sluices are established.

Droplet infection are those bacteria which can be excreted in air from respiratory tracts, all who is in the operational. Microbes are excreted from respiratory tracts with water pairs, the water steam is condensed and together with these droplets microbes can get to a wound. To reduce danger of diffusion of a droplet infection in the operational there should not be superfluous conversations. Surgeons should use 4 layer masks which reduce probability of a becoming infected a droplet infection by 95 %.

Contact infection contamination is all microbes which are capable to inpour into a wound with any toolkit, with all that adjoins to a wound. A dressing material: the gauze, cotton wool, threads tolerates a heat, therefore there should not be less than 120 degrees, the exposition should compound 60 minutes.

Sterility control. There are 3 bunches of means of the control:

Physical: the tube where fill any material, melt undertakes at temperature about 120 degrees - sulphur, Acidum benzoicum. The disadvantage of this mean of the control consists that we see that the powder has fused and to mean necessary temperature is reached, but we cannot be assured that it was such throughout all time of an exposition.

Chemical control: take a filter paper, place it in starch solution then dip in a Lugol's solution. It gets dark-brown colour. After an exposition in an autoclave starch at temperature over 120 degrees is blasted, the paper is decolorized. The method has the same disadvantage as physical.

Biological control: it is a method the most reliable. Samples of a sterilised stuff take and sow on nutrient mediums, have found microbes - means everything is all right. Have found microbes - means it is necessary to spend sterilisation repeatedly. The disadvantage of a method that we receive the answer only later 48 hours, and is considered a stuff sterile after autoclaving in a drum within 48 hours. Means, a stuff are used even before reception of the answer from bacteriological laboratory.

Most dangerous source of a contact infection contamination - arms of the surgeon. For skin sterilisation physical methods, besides, complexity still are inapplicable consists that after processing of arms they again become soiled at the expense of a secret of sebaceous, sudoral glands. Therefore apply a tanning of a skin alcohol, tannin, the sharp spastic stricture of lead-out ducts sudoral is thus observed, sebaceous glands and the infection contamination which there is is incapable to leave outside.

Last years began to apply basically chemical methods of processing of arms: eurysynusic processing of arms pervomure. This methods is extremely reliable: glovebox the juice formed within 12 hours, after have put on gloves (in experiment) remained sterile.On the pharmacological properties the betaxolol is a selective blocker of b1-adrenoreceptors. It does not possess intrinsic sympathomimetic activity and membrane-stabilising (local anaesthetic) action. As well as other b-blockers, from the ophthalmotonus at the expense of reduction of production of intraocular fluid reduces, however exact mechanisms of this effect are not studied till now definitively. Besides it, some enriching of outflow of a watery moisture though in the majority of researches outflow change appears statistically doubtful is observed. Different explorers specify about identical efficacyy of a betaxolol in respect of ophthalmotonus depression. Irrespective of the medicinal form (Betoptic or Betoptic S), the preparation reduces an ophthalmotonus to necessary level at 85-88 % of patients. Comparing hypotensive action of a betaxolol and Timololum, explorers result varied results. One consider, that it reduces an ophthalmotonus more weakly, than Timololum, others specify in absence of statistically authentic difference in hypotensive action of two preparations. But also those, and others agree in opinion, that the betaxolol surpasses Timololum in the ability to keep visual functions at sick of a glaucoma.

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