Chronic Foci Of Infection Research Articles

Антибактериальная активность хлоргексидина биглюконата по отношению к биопленочным монокультурам

On the background of a high percentage of caries incidence, the prevalence of its complications is increasing – pulpitis, apical periodontitis. Teeth with complicated caries can cause odontogenic inflammatory processes in the maxillofacial region. Being foci of chronic infection and intoxication, they have an adverse effect on the body as a whole. In connection with the above, it is obvious that determining the optimal concentration of chlorhexidine bigluconate and exposure to the dentin of the crown part of the tooth in case of carious lesion of the latter is currently very important. The purpose of the study was to evaluate the antimicrobial activity of chlorhexidine (by suspension and contact method) in various concentrations in relation to monocultures of biofilm formed on tooth sections and in U-shaped 96-well plastic plates. Material and methods. In this work, one of the most relevant pathogens for modern medicine was Staphylococcus aureus, which was one of the most powerful pathogens that form biofilms, was used as a model. The antimicrobial activity of chlorhexidine bigluconate was evaluated on S. aureus and E. coli biofilm cultures formed on dental samples and in polystyrene plastic tablets. Antimicrobial activity was evaluated by the reduction factor was determined by the difference in the number of decimal logarithms of CFU/ml in the experiment compared to the control. The obtained data was subjected to statistical processing. Results and discussion. The study revealed that 2.0 % solution of chlorhexidine bigluconate had a high level of antibacterial activity against tablet biofilm cultures of S. aureus and E. coli. When it was exposed to S. aureus and E. coli tablet biofilm cultures with exposures of 30 and 60 seconds, statistically significant differences were found (p=0.02). Secondly, statistically significant differences in the effect of sensitivity of single-species biofilm cultures of dental samples to the effect of antiseptic at the specified concentration were determined (p=0.007). At the same time, the level of antibacterial activity of 2.0 % chlorhexidine bigluconate solution in respect of tablet biofilm cultures of S. aureus and E. coli was significantly higher than in biofilm cultures of S. aureus and E. coli of dental samples (p<0.05). Conclusion. The obtained results give grounds for using them in clinical practice in order to improve the effectiveness of caries treatment which will help reduce the number of complications and on the one hand, corresponds to the main direction of medicine ‒ prevention and on the other hand, increases the level of specialized medical care provided to the population as a whole

Одонтогенный синусит – мультидисциплинарная проблема

Chronic focal infection is pathologically closely associated with internal pathology and is a serious factor in its aggravation. Systemic inflammatory reactions are associated with metabolic changes, such as oxidative stress, impaired regulatory participation of macro- and microelements with an imbalance in their distribution in biological media. The resulting homeostatic imbalances cannot be ignored by the attraction of chronic foci of infection, such as odontogenic sinusitis. The aim of the study was to substantiate complex approaches to the supervision of patients with chronic odontogenic sinusitis against the background of comorbid multiple chronic focal infection (MCFI). Materials and methods. In patients with chronic odontogenic sinusitis against the background of multiple chronic foci of infection, the activity of systemic inflammatory factors was studied. Levels and ratio of pro- and anti-inflammatory cytokines – interleukins 2, 6, 10, TNF alpha, C-reactive protein in comparison with the oxidation activity of lipids, proteins, low molecular weight thiols, assessment of Zn, Cu, Fe parameters in biological media and hepcidin in blood. In patients with chronic odontogenic sinusitis against the background of MCFI, an increase in the level of pro-inflammatory (TNF alpha, interleukin 6) was found with an imbalance in the distribution of Zn, Cu, Fe with a deficiency of these elements in the intracellular media. Expressed correlations of these changes with the activity of lipid peroxidation and free radical oxidation of thiol compounds were revealed. The data obtained serve as a rationale for the use of antioxidant and mineral replacement therapy in the complex treatment of patients with MCFI.

Герпетическая инфекция в оториноларингологии как фактор полиморбидности

The search for common links of etiology and pathogenesis in the formation of comorbid pathology in modern patients opens up additional opportunities for increasing the effectiveness of their treatment and is an important problem in scientific and practical medicine. The extreme prevalence of chronic persistence of immunotropic viruses, such as herpes genotypes 4,5,6 types, requires a study of its consequences in the human body and the involvement in its infectious-dependent morbidity, such as the formation of multiple chronic foci of infection in the ear, nose and throat with frequent and prolonged exacerbations. The work shows that chronic sinusitis, nasopharyngitis, tonsillitis associated with chronic herpesvirus persistence form the status of frequently and long-term ill people against the background of pronounced immuno-compromise with quantitative and functional T- and B-cell deficiency, insufficient resources of α and γ- interferon. The study presents a positive experience of replenishing the deficiency of α and γ-interferons with recombinant drugs of the same name in comorbid ENT patients. The aim of the study was to increase the efficiency of treatment of patients with concomitant chronic focal infection in the ear, nose and throat against the background of chronic persistence of herpesvirus infection. Materials and methods: Comprehensive clinical and laboratory examination of 45 carriers of herpes simplex virus genotypes 4,5, 6 at the age of 29 to 52 years made it possible to establish in them a comorbid chronic focal infection in the LOR organs: chronic sinusitis, chronic nasopharyngitis, chronic tonsillitis. Results: The observed patients had a statistically significant (p < 0.01) deficiency of NK cells with receptors CD16+, CD56+ and B cells with markers CD19+, CD5+ against the background of peripheral blood lymphocytosis with an increase in the content of cytotoxic T lymphocytes (CD8 +) marker in some patients. All patients showed a significant decrease in interferon system resources (p < 0.01). Replacement therapy with recombinant preparations of α- and γ-interferons led to restoration of interferon system parameters and was accompanied by improvement of immunological blood indices, both quantitative and functional characteristics of T-and B-lymphocytes, mononuclear phagocytes, this dynamics was matched by improvement of patients, confirmed by results of questionnaire. Conclusions: Thus, the positive experience of antiviral therapy by restoring the resources of the interferon system and immune recovery with recombinant interferon drugs indicates the important role of herpes virus carrier in the formation of comorbidity and the need for etiological treatment to improve the condition and quality of life of patients.

Вплив хронічних вогнищ інфекції у матері на розвиток гострого пошкодження нирок у недоношених дітей з гемодинамічно значущою відкритою артеріальною протокою

Nephrogenesis may be disrupted antenatally because of chronic infection foci (CIF) in the mother, the development of chorioamnionitis, feto-placental insufficiency. As a result, in the postnatal period, the kidneys are more sensitive to hypoperfusion, which occurs in premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) and can lead to the development of acute kidney injury (AKI). Purpose — to study the influence of CIF in the mother on the development of AKI in premature infants with HSPDA. Materials and methods. 74 premature infants (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Neonatal Intensive Care MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council» were examined. Patients were divided into three groups depending on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: Group I — 40 children with HSPDA, Group II — 17 children with PDA without hemodynamic disorders, Group III — 17 children with a closed ductus arteriosus. The presence of CIF in the mother was determined according to medical records, chorioamnionitis on the basis of histopathological examination of the placenta. Patients with HSPDA were divided into two subgroups: 28 children from mothers with CIF, 12 — without CIF. Clinical examination and treatment of premature infants was carried out according to generally accepted methods. Echocardiography with Doppler was performed at 5–11 hours of life and then daily to determine PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. Results. Chronic foci of infection were found in 28 (70.0%) mothers of group I, in 5 (29.4%) — group II, in 6 (35.2%) — group III. Chorioamnionitis in group I — 10 (25%) cases, in group II–ІII — 6 (17.6%). The presence of CIF in the mother caused a significant increase in the size of the PDA on the first day of life in the group of HSPDA against groups II–III: 2.61±0.861 (2.3; 2–3.5) mm against 1.79±0.365 (1.7; 1.5–2) mm, p<0.001. Patent arterial duct with a diameter of >2 mm on the first day of life in premature infants of group I from mothers with foci of infection was observed more often — 19 (67.9%) against 2(6.7%) of groups II–III (OR=10.56; CI: 1.9–58.53, p<0.005). Analysis of the incidence of AKI on the third day of life depending on HSPDA and the presence of CIF showed that 64.3% of preterm infants with HSPDA and maternal infection developed AKI — 6.6 times more often than in groups without HSPDA (OR=8.40; CI: 2.60–27.14; p<0.001), and 2.6 times more often compared to children of the subgroup HSPDA without recorded maternal infection (OR=5.40; CI: 1.18–24.65; p<0.03). On the background of HSPDA and CIF stage II–III AKI was observed in every third child. Comparative analysis within group I depending on the CIF revealed that the frequency of AKI for 10 days in the subgroup with infection was almost three times higher than the level of the subgroup without infection: 71.4% vs. 25.0% (OR=7.50; CI: 1.60–35.07; p<0.009). Conclusions. The presence of CIF in the mother is a risk factor for AKI in premature infants with HSPDA. Therefore, such children should be classified as at risk of developing AKI. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute kidney injury, chronic foci of maternal infection, hemodynamically significant patent ductus arteriosus, premature infants.

Перинатальні фактори ризику та клінічні особливості гемодинамічно значущої відкритої артеріальної протоки в недоношених новонароджених

The clinical features of the hemodynamically significant patent ductus arteriosus (HSPDA) depend on its diameter, which determines the frequency and severity of early complications of the disease. There are conflicting data on the relationship between perinatal factors and the development of large-diameter HSPDA in premature infants. Purрose — to determine the most significant risk factors in the perinatal history affecting the diameter of the ductus arteriosus and early complications of HSPDA in premature infants. Materials and methods. We examined 40 premature babies (gestational age — 29–36 weeks) with HSPDA, who were admitted for observation in the first day of life in the department of anesthesiology and intensive care of newborns of the MI «Dnipropetrovsk Regional Children's Clinical Hospital» DRC». To analyze the effect of the perinatal history on the diameter of the HSPDA in the first day of life, patients were divided into two groups: Group I (n=19) — children with HSPDA diameter <2 mm, Group II (n=21) — children HSPDA diameter >2 mm. The presence of chronic foci of infection in the mother was determined according to the medical documentation, chorioamnionitis based on the pathological examination of the placenta. Clinical examination and treatment of premature infants was carried out according to the generally accepted methods. Echocardiography with dopplerometry was performed at 5–11 hours of life to determine HSPDA. Results. The risk of developing HSPDA >2 mm in diameter in premature infants whose mothers had early gestosis is 4.72 (CI=1.15–19.41; p<0.03). A high degree of risk of development of a HSPDA diameter >2 mm was also established in premature infants in the presence of chronic foci of infection in the mother (OR=10.56; CI=1.9–58.53; p<0.005), chorioamnionitis (OR=13.5; CI=1.51–120.78, p<0.009). Intrauterine infection in premature infants predetermined an increase in the size of HSPDA >2 mm. On the first day of life, a HSPDA diameter >2 mm in premature infants is a risk factor for such early complications as necrotizing enterocolitis (OR=14.55; CI=1.6–131.96, p<0.007), intraventricular hemorrhage (OR=4,29; CI=1.14–16.18, p<0.03), acute kidney injury on the third (OR=15.94; CI=3.38–75.10, p<0.001) and the fifth day of life (OR=35.63; CI=5.73–221.50, p<0.001). Conclusions. A complicated perinatal anamnesis in premature infants is a risk factor for the development of large-diameter HSPDA, determines the occurrence of early complications of the disease, therefore, prevention of HSPDA should be started during pregnancy. The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent was obtained from the parents of the children for the research. The authors declare no conflicts of interest. Key words: premature infants, perinatal risk factors, hemodynamically significant patent ductus arteriosus, clinical features.

Presence of preoperative Modic changes and severity of endplate damagescore are independent risk factors for developing postoperative surgical site infection: a retrospective case-control study of 1124 patients.

There is increasing evidence of an association between Modic changes (MC) and subclinical infection. However, the association of MC with postoperative surgical site infection (SSI) has not been adequately probed. This study primarily aimed to investigate a probable association between preoperative MC, total endplate damage score (TEPS), and SSI. A retrospective analysis of 1124 patients who underwent surgery in a single institution (2016-2018) was performed, using both univariate and multiple logistic regression analyses to identify independent risk factors for SSI. The prevalence of SSI was 4% (44/1124 patients), with no association with age or sex. The prevalence of MC in the SSI group was significantly higher-79.54% (35/44) compared to 58.79% (635/1080) (p value = 0.006) in the control group with no specific relation to type or location of MC. A higher TEPS was associated with SSI (p value = 0.009). A receiver operating characteristic (ROC) curve for TEPS values to assess predictiveness of SSI showed TEPS ≥ 5.5 to have a better sensitivity of 84% than 72% for a TEPS ≥ 6.5. Univariate analysis showed TEPS > 6 (odds ratio 3.887) to have a stronger association with SSI than the presence of MC (odds ratio 2.725). Among various types of surgeries, discectomy had a higher association with SSI (p value = 0.03) when compared to fusion (p value = 0.071). However, multiple logistic regression analysis revealed only TEPS > 6, presence of MC and hypothyroidism as independent risk factors for SSI. Our data suggest that preoperative MC and TEPS > 6 are independent risk factors for developing surgical site infections. MC could be foci of chronic subclinical infection and not mere markers of degeneration, as initially described.

ОСОБЕННОСТИ ФУНКЦИОНАЛЬНОЙ АКТИВНОСТИ НЕЙТРОФИЛОВ И УРОВНЯ ЦИТО У ПАЦИЕНТОВ С ХРОНИЧЕСКИМ ПЕРИОДОНТИТОМ

Subject. The risks of an unfavorable outcome of simultaneous implantation in most cases are associated with the installation of an implant in the tooth wells with chronic foci of odontogenic infection.
 The goal is to study the effector indicators of phagocytes and the level of cytokines of the local focus of inflammation in patients with various forms of chronic periodontitis.
 Methodology. The study involved 65 dental patients with a diagnosis of "K 04.5―K 04.9" (ICD-10, 1997), a comprehensive examination using laboratory immunological methods which included the study of the functional activity of neutrophils (phagocytic activity and intensity on a model of latex particle absorption; lysosomal activity and index of the total luminescence of lysosomes; HCT-reducing activity and intensity according to spontaneous and induced tests) and the concentration of IL-1-RA IL-1β, IL-2, IL-8, IFN–α, IFN-γ (PCG/ml) wound detachable wells of the extracted tooth.
 Results. A study of the immunological parameters of the local foci of periapical inflammation in patients with various forms of chronic periodontitis revealed some features of the cytokine profile and the functional activity of neutrophils in the wound detachable hole of the extracted tooth. The data obtained in patients with chronic fibrous periodontitis allowed us to determine the signs of activity of chronic inflammation. In subjects who had their teeth removed due to chronic granulating periodontitis, immunological predictors of a prolonged course of inflammatory and reparative processes were revealed. In patients with chronic granulomatous lesions of the periapical zone, evidence of prolonged contamination of the periapical zone was obtained, which may lead to changes in effector parameters against the background of the preserved bactericidal potential of neutrophilic granulocytes.
 Findings. Immunological predictors of the development of infectious and inflammatory complications were identified in the context of the planned simultaneous dental implantation when implants are inserted into the wells of the teeth with chronic periodontal foci.

Results of allogeneic hematopoietic stem cell transplantation in patients with chronic granulomatous disease at the Russian Children’s Clinical Hospital

Relevance. Chronic granulomatous disease (CGD) belongs to the group of primary immunodeficiencies. Patients with CGD have an impaired quality of life, severe infections and inflammatory organ damage. Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective treatment method for CGD. The authors of the article presented the experience of HSCT in patients with CGD in the Russian Children’s Clinical Hospital.Materials and methods. 20 (19 primary and 1 repeated) HSCT during the period from 2009 to 2020 were performed in nineteen patients with CGD. All patients had a long history of infections, three or more foci of chronic infection, 9 patients had a generalized BCG infection. Bone marrow (ВМ) from a related HLA-identical donor was the source of hematopoietic stem cells (HSC) for 4 (21 %) patients, peripheral blood stem cells (PBSC) for 2 (10.5 %). ВМ from a unrelated fully HLA-identical donor was performed in 9 (47.4 %) patients, PBSC – 2 (10.5 %). ВМ from a unrelated 9/10 HLA-compatible donor was performed in one (5.3 %) patient. In one case (5.3 %) the HSC source became PBSC from a unrelated 9/10 HLA-compatible donor after TcRαβ/CD19+ depletion. In 68.5 % (n = 13) cases the conditioning regimen included threosulfan, fludarabine, melphalan, and antithymocyte globulin. In 2 (10.5 %) patients, melphalan was excluded from the conditioning regimen; in 4 (21 %), it was replaced by thiotepa.Results. The overall survival (OS) was 88.9 ± 10.5 %, the event-free survival (EFS) was 88.1 ± 7.9 %, and there was no transplant mortality. Transplant rejections were observed in two patients who received HSC from a unrelated 9/10 HLA-compatible donor with a previous conditioning regimen that included only one alkylating agent. In 4 patients (21 %) there was a prolonged persistence of mixed chimerism after HSCT without clinical and laboratory signs of CGD. After successful transplantation all patients were cured of the infectious and inflammatory diseases characteristic of CGD.Conclusion. Results of HSCT in patients with CGD can be considered satisfactory, the OS and EFS are high. Failure of HSCT is associated with transplant rejection, which is most likely due to the donor and patient mismatch, as well as the use of conditioning modes with reduced intensity.

A comparative study on the effectiveness of application of different types of biological matrixes on mandibular alveolar mucosa lesion healing

Periodontal diseases is one of the most relevant and important problem in modern dentistry due to their increasing prevalence in population, association with the occurrence of focus of chronic infection, progressive development and irreversibility which, in case of severe damage of periodontal tissues, eventually leads to a loss of the number of teeth. All of the named factors eventually lead to the development of irreversible inflammatory-dystrophic and destructive changes in periodontal tissues. During the recent years the method of guided tissue regeneration that uses membranes is being successfully used for the treatment of periodontal diseases.A comparative study on the mandibular alveolar mucosa lesion healing during application of different types of biological matrixes containing decellularized amniotic membrane, decellularized amniotic membrane in combination with platelet-rich plasma (PRP) growth factors, and decellularized amniotic membrane in combination with PRP growth factors and hyaluronic acid was performed. The study proved the acceleration of the processes of wound area reduction. Under experimental conditions, the wound healing lasted from day 3 to day 5 of the study; however, the rate of reduction of the wound area was slower, which indicates an alterative stage of the acute inflammatory process. During days 5 – 7 (stage of regeneration, the 2nd phase of wound process) the wound area reduced rapidly and by day14 a complete epithelization of the surgical wound was observed in all groups using decellularized amniotic membrane. In the group using the combination of PRP growth factors and hyaluronic acid the epithelization of wound was already observed on the day5. In the control group healing occurres with scar formation.

Features of preparation of patients with chronic maxillary sinusitis for sinus lifting and dental implantation

An important point in dental implantation is considered to be the preparatory stage, which includes the elimination of foci of chronic infection in the oral cavity and the entire maxillofacial region as well as in the nasal cavity and sinuses. The article covers the clinical features of preparation for sinus lifting, compares the methods of rehabilitation of the maxillary sinuses.

Dental rehabilitation of total adentia at pensioners of the Ministry of defense and contingent attached to military medical organizations

Legal, economic and clinical aspects of treatment of military personnel, retired military personnel, as well as the attached contingent in the conditions of hospitals of the Ministry of defense are presented. The study is based on the results of studying the number of dental implants installed in patients from 2014 to 2019 based on the medical records and outpatient records of a dental patient in two specialized departments of multidisciplinary hospitals of the Ministry of defense of the Russian Federation. Primary medical records were studied, data on the sex and age of patients, the presence (absence) of opportunistic diseases used implant system, the installation of dental implants and their amount and frequency of soft tissue and osteoplastic operations (to increase the volume of the bone and soft tissues of the alveolar bone (part) jaws) and the Protocol of the temporary and permanent prosthesis. Based on the analysis, we describe the current possibilities of medical and diagnostic work and present various types of orthopedic structures on dental implants for the dental rehabilitation of the above-mentioned contingents with complete adentia of the jaws (including in cases where absolute indications require the removal of all teeth due to foci of chronic odontogenic infection or periodontitis). The methods of treatment of patients in cases of combination of adentia with varying degrees of atrophy of the alveolar processes (parts) of the jaws are analyzed in detail. Clinical examples of dental rehabilitation are shown both with and without the use of methods for increasing the volume of jaw bone tissue, using various modern protocols for fixing orthopedic structures on zygomatic and root dental implants, and the frequency of their use in military medical organizations of the Ministry of defense of the Russian Federation during the reporting period. Based on the presented results, it is shown that the military medical organizations of the Ministry of defense of the Russian Federation have a full range of opportunities to provide comprehensive dental care to patients with complete secondary adentia, even in the presence of extreme bone atrophy of the jaws.

THE RELATIONSHIP BETWEEN THE EFFECT OF IMMUNOGLOBULIN THERAPY AND THE FUNCTIONAL POTENCIES OF THE CELLULAR LINK OF THE IMMUNE SYSTEM IN X-LINKED AGAMMAGLOBULINEMIA

Objective:to evaluate the effectiveness of intravenous immunoglobulins in X-linked agammaglobulinemia, to identify changes in the cellular link of the innate and adaptive immune response associated with an insufficient effect of replacement therapy.Materials and methods:12 patients with X-AGH were under dynamic observation. BTK genetic defect confirmed using next generation sequencing technology. After verification of the diagnosis, patients received IVIG replacement therapy at a saturation dose and then at a maintenance dose. The data of prospective observation for a full year of regular IVIG therapy with an assessment of the severity of the disease, monthly monitoring of the pre-transfusion IgG level and determination of the quantitative and functional parameters of the components of the adaptive and innate immune response every three months are presented.Results:regular replacement therapy contributed to a decrease in the frequency of exacerbations of foci of chronic infection, a decrease in the frequency and duration of antibiotic therapy, however, in 30 % of cases, the frequency of exacerbations remained high, and antibiotic courses were doubled than the standard ones. A comparative analysis of the parameters of the immune system showed that with a smaller effect of IVIG, the functional potentials of T-effectors are less significant than in the comparison group and the properties of neutrophils and natural killers are more inhibited.Summary:the relationship between the severity of the clinical manifestation of XLA on the background of replacement therapy and the preservation of the functional potencies of the cellular components of the immune system provides the basis for a possible combination of IVIG therapy with drugs that affect the properties of cellular elements of the immune system.

PREOPERATIVE AND POSTOPERATIVE PULMONARY REHABILITATION IN PATIENTS WITH LUNG CANCER AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study was to analyze the world experience in the objective assessment of the functional state of the bronchopulmonary system in lung cancer patients with chronic obstructive pulmonary disease (COPD) using modern diagnostic tools and techniques as well as correction of ventilation disorders in the perioperative period using long-acting inhaled bronchodilators. Material and methods. A literature search was conducted using the Medline, Elibrary etc. databases. Out of 112 publications concerning the study of the incidence of lung cancer and COPD, external respiration function and rehabilitation of patients, 37 were included in this review. R esults. COPD was shown to be the major cause of postoperative non-surgical complications and the main predictor of perioperative mortality in lung cancer patients. Modern techniques for studying the function of external respiration, such as bodyplethysmography, spirography, high-resolution computed tomography, ventilation and perfusion lung scintigraphy, were highlighted. It was shown that preoperative correction of obstructive syndrome and postoperative pulmonary rehabilitation, including drug therapy with long-acting bronchodilators in combination with smoking cessation, eradication of foci of chronic infection and respiratory gymnastics were necessary to detect functional respiratory disorders in lung cancer patients with COPD. Conclusion. To date, there are no standards clinical practice guidelines for diagnostic testing and the correction of ventilation disorders in lung cancer patients with COPD in the pre- and postoperative periods. Therefore, further studies aimed at developing a diagnostic algorithm to improve the accuracy of detecting bronchial obstructive syndrome, especially in the early stages of COPD, as well as compensation for respiratory disorders using modern bronchodilator therapy are needed.

РОЛЬ ИНФЕКЦИИ В ВОЗНИКНОВЕНИИ, ТЕЧЕНИИ, РЕЗУЛЬТАТАХ ЛЕЧЕНИЯ ТОКСИЧЕСКОГО ЗОБА

To date, the question of the causes of toxic goiter has not been resolved. Purpose: to analyze the role of infection in the occurrence, course, treatment outcome of toxic goiter. Observed in the dynamics of 64 patients with toxic goiter. In 36% of cases, thyrotoxicosis manifested itself after acute infections. Foci of chronic bacterial infection were detected in 59 (92.2%) patients. Serological indices of persistence of herpes simplex virus, Epstein- Barr, cytomegalovirus (HSV, EBV, CMV) were high in all patients with suspected viral persistence (n = 20). In 1/3 of the observations a combined infection was established. The infection was cured in 34 patients. The infection was not cured in 30 patients. The observations showed that acute and chronic bacterial and viral infections can provoke the onset of toxic goiter, worsen its course, reduce the effectiveness of therapy, affecting the main link in the pathogenesis of the disease - the activity of the autoimmune process in the thyroid gland. Infection exacerbations stimulate the production of AT-rTTG, leading to relapses thyrotoxicosis. Conclusion: although infection is not the main etiological factor of toxic goiter, its role in the manifestation, course of toxic goiter, the effectiveness of therapy, and the distant prognosis is undeniable. Starting treatment for toxic goiter, in including planning surgical treatment or radioiodine therapy, it is necessary to identify and sanitize foci of infection, to check the possible persistence of common viruses of herpes simplex, Epstein-Barr, cytomegalovirus. This will improve the prognosis, reduce the high risks of thyrotoxicosis relapses.

The Treatment Algorithm for Meibomyitis, Hordeolum and Halazion

Despite the fact that the frequency of treatment the eyelids inflammatory diseases affecting the modified sebaceous glands (Meibomian glands, Zeiss glands) is very high in outpatient clinical practice, and the basic principles of treating this pathology are well known to everyone, there are always many questions. Therefore, interdisciplinary approach with gastroenterologists, dermatologists, endocrinologists and other specialists is often required treatment of this patients group. In addition, the transition of the inflammatory process to a chronic form and the encapsulation of the inflammatory focus and / or the formation of a halazion requires an accurate algorithm of actions from the practitioner, which depends on the duration of the pathological process. There is always a question — what form of an antibacterial drug is better to prescribe — ointment or drops? In addition, there is no consensus on the use of hormone therapy in the treatment of meibomyitis, hordeolum and chalazion. This article presents an algorithm for the prevention and treatment of this group of patients, which involves a certain sequence of therapeutic and preventive measures, depending on the severity and duration of the inflammatory process. Eyelid hygiene (warm compresses + self-massage of the eyelids with gel) is recommended in case of chronic blepharitis clinical signs, complaints of dryness, discomfort, wearing contact lenses. In case of the acute inflammatory process — meibomyitis and/or hordeolum in addition to eyelid hygiene, local antibiotic therapy is recommended. If a halazion is forming the choice of treatment tactics (local instillation therapy, intracapsular administration of a prolonged corticosteroid or surgical treatment) depends on the halazion duration (more or less than 2 months). The presented algorithm has the practical importance, since adequate treatment will not only eliminate the focus of chronic infection on the eyelids, but also improve the patient’s quality of life, since the presence of such a disease gives pronounced psycho-emotional discomfort because of its localization zone.

Infectious Complication of Revision Knee Replacement

The article presents the case of the patient having an infectious complication in the area of the endoprosthesis after performing revision knee replacement. Revision surgery was performed six months after the primary knee replacement due to the instability of the components of the endoprosthesis. In analyzing the case of an infectious complication, a six-point risk factor for the development of infectious complications was given taking into consideration the following factors: body mass index; ASA physical status evaluation; the presence of diabetes mellitus, concomitant systemic diseases; the presence of allergic reactions; the presence of previous operations on the joint; index of the ratio of segmented neutrophils and monocytes. The analysis made it possible to establish that the patient had a high risk of infectious complications before the surgery of the endoprosthesis replacement and determine the list of necessary preventive and therapeutic measures (glycemia correction, bacteriological examination of the knee joint puncture, rehabilitation of existing and possible foci of chronic infection, examination and treatment at the center of osteoporosis) that had not been held. The implementation of surgical treatment - revision knee replacement - against the background of a high risk of infectious complications led to the development of the infectious process. To stop the infection process, surgical treatment was performed, including necrectomy, debridement, drainage of the knee joint, without removing the components of the endoprosthesis. Remission was achieved. The clinical case of an infectious complication of revision knee arthroplasty is of interest, as it shows the importance of assessing adverse prognostic factors, establishing the degree of risk of infectious complications, and conducting the necessary preventive and therapeutic measures in the preoperative period to reduce the risk of developing an infectious process in the endoprosthesis area.

To the 150 anniversary of the Military medical academy department of dermatology and venerology

Abstact. Described the stages of the formation of one of the first in Russia departments of skin and venereal diseases of the Military medical academy. S.M. Kirov. The contribution of eminent dermatovenerologists of the department leaders is noted: A.G. Polotebnova, V.M. Tarnovsky, T.P. Pavlova, P.A. Velikanova, M.G. Mgebrova, S.T. Pavlova, О.K. Shaposhnikova, A.N. Rodionov. So, A.G. Polotebnov is considered to be the founder of Russian dermatology and venereology. V.M. Tarnovsky was the initiator of the creation of the first in Europe Russian Syphilidological and Dermatological Society. T.P. Pavlov is known for his works on the histopathology of dermatoses, and also raised a large school of dermatology. S.T. Pavlov described for the first time in the world acantholytic cells in pemphigus, and Academician OK Shaposhnikov was the country’s leading specialist in immunology and histopathology of skin vasculitis. Currently, the department’s priorities are: the study of the molecular genetic basis of psoriasis, lymphoproliferative, bullous skin diseases, the study of foci of chronic infections in various dermatoses, the creation of teledermatology and teledermatohistopathology systems in medical institutions of the Ministry of Defense of the Russian Federation, pathohistology, trichology, psychodermatology, development of new external agents for the prevention and treatment of infectious skin diseases using liposomal yy technologies. It is shown that as a result of the work done, the Department of Skin and Venereal Diseases of the Military medical academy. S.M. Kirov reliably secured the status of Russia’s leading scientific and methodological center for the study and treatment of skin diseases.

Optimization of Therapy of Patient with Genetic Defect Antibody Production

Development of molecular genetics and immunological diagnostics, disclosure of pathogenesis of various forms of primary immunodeficiency (PID), improvement of therapeutic techniques contributed to the formation of a generation patients with PID older than 18 years. Experience shows that isolated replacement therapy, leading to a reduction in the frequency and severity of reactivation chronic foci of infection, is not able in some cases to fully stabilize the condition of patients, and the use of antibiotics remains inevitable. Interesting is the development and implementation of the concept of combined therapy of PID humoral therapy, the ideology of which is based on the combination of substitution therapy with exposure on the functional potential of the cellular link of the immune system. One of the perspective variants of influence on functions of cellular components of immune is the use of innate immunity receptor agonists. From the position of the specific clinical application deserves the attention medication Likopid (glucosaminilmuramyl dipeptide) - semi-synthetic analogue of muramyldipeptide, minimally biologically active substance peptidoglycan fragment of the cell wall of all known bacteria. Presented clinical case of X-linked agammaglobulinemia. The patient, despite regular replacement therapy with intravenous immunoglobulins with maintaining a pretransfusion IgG level of at least 8 g/l, continued to register episodes of exacerbation of chronic conjunctivitis up to 10 times a year. Application of licopid in addition to IVIG therapy contributed to the improvement quality of life, reducing the frequency of exacerbations, conjunctivitis and duration of use antibiotics. This example illustrates the role of cellular components innate immune response in clinical manifestation of insufficiency humoral link adaptive immunity, and confirms the possibility of additional correction of these parameters to improve the efficiency of the standard substitution therapy.

ACUTE RESPIRATORY RECURRENT INFECTIONS IN CHILDREN

Introduction. Insufficient research work on the study of local immunity in children with frequent respiratory recurrent diseases has become the basis for this work. Goal. To study the negative impact of various pathogenic factors on the formation of acute respiratory recurrent infections in children. Materials and methods. 201 children under 3 years of age and 219 children from 3 to 7 years old who attended children's preschools in Kyiv were observed in the dynamics. Indices of local immunity, by the content of immunoglobulins in the secretion of the nasal passages, were studied in comparison with the data of the anamnesis and clinical examination of children; with functional condition of the nasal mucosa (presence of catarrhal phenomena); with the presence and excretion of viral and bacterial microflora in the upper respiratory tract; with the presence of chronic foci of infection in the nasopharynx (tonsillitis, adenotonitis); with a period that has elapsed after preventive vaccinations and transferred respiratory diseases. Research results. Based on the obtained data, changes in local immunity in the examined children were detected under the influence of factors of external and internal environment: birth of children from pathological pregnancy and childbirth; presence of hypochromic anemia, exudative diathesis, chronic tonsillitis of staphylococcal etiology, adenotonsillitis, recurrent and asthmatic bronchitis in children; high infection rate of children with viruses, pathogenicity of pathogenic staphylococcus and streptococcus, fungi of the genus Candida. It was found that the lowest frequency of detection of immunoglobulins of all classes was observed in children with streptococcus in pharynx and its associations with staphylococcus. Conclusions. The published data on the value of local immunity in terms of immunoglobulins in children with frequent respiratory recurrent diseases and its tendency to various changes under the influence of external and internal environmental factors indicate the feasibility of improving treatment and prevention measures, which include the use of agents that enhance the effectiveness of local respiratory protection.

Влияние десинхронизирующих эффектов трансмеридианных перелётов на хронорезистентность организма спортсменов

Objective: to study the effect of transmeridian air movements in contrasting geosocial conditions of competition on the direction and duration of stabilization of the chrono-resistance of athletes during periods of desynchronosis. Materials and methods: the study involved 103 highly skilled athletes – men of various specialties (age 22.6 ± 4.2 years). On the model of air movements across 7 time zones, the frequency, structure, and focus of reducing or increasing medical circulation reflecting the body's resistance during chronoadaptation were analyzed. Results: before the flight, athletes' visits to the doctor were rare exceptions. After air travel, pathological manifestations in health status were detected in more than 40% of migrants. Over 50% of the medical treatment accounted for well-compensated foci of chronic infection, relapses of erased diseases and injuries. The maximum frequency of medical treatment was observed at the 2-3rd week after the flight, at the 5th week - sporadic, but higher than in the home conditions. Conclusions: for the relative stabilization of the body's resistance in athletes in contrasting geo-modern regions, more than a month of acclimatization is required. The minimal decrease in the chrono-resistance direction is manifested at 2-3 weeks after the flight in the stage of transition of «acute» desynchronosis to hidden.