Local Anti-inflammatory Therapy Research Articles

Microbial landscape of periodontal pockets against local antibacterial therapy of chronic generalized periodontitis: a multicenter clinical trial

Background. A microbial nature of periodontitis requires an accurate analysis of the pathogenic potential of the periodontal pocket microflora thereby enabling correct diagnosis to be made and the most effective pharmacological agent to be selected for treating chronic periodontitis. Metronidazole demonstrates excellent results for anaerobic microorganisms in the periodontal pocket, whereas minocycline hydrochloride, moxifloxacin and amoxicillin/clavulanate are efficient for aerobic microorganisms. However, specialists find considerably relevant to analyze the correlations between specific bacterial associations in the periodontal pocket against local antibacterial therapy, as well as to track the contents of periodontal pockets long after antibacterial therapy. Therefore, a microbiological analysis of periodontal pocket contents is considered necessary in order to select and monitor the effectiveness of local antibacterial therapy.Objective. To evaluate the effectiveness of local antibacterial therapy for chronic generalized periodontitis by means of analysis of changes in the microbiological composition of periodontal pockets.Methods. The clinical trial involved 144 patients with chronic generalized periodontitis. The study included examination of patients and analysis of clinical data bases of the Department for General Practice Dentistry, Kuban State Medical University and the Dentistry Department, Stavropol State Medical University of the Ministry of Health of the Russian Federation. The trial included patients aged 30 to 60 with a diagnosis of chronic generalized periodontitis of different severity. All periodontitis patients were divided into 2 groups depending on the therapy: main and control groups. Each group had three subgroups depending on the severity of the pathologic process. The first subgroup of the control group (chronic generalized periodontitis of mild degree) consisted of 16 people (11.1%), the second subgroup (chronic generalized periodontitis of moderate degree) — 31 people (21.5%), the third subgroup (chronic generalized periodontitis of severe degree) — 7 people (4.9%). The first, second and third subgroups of the main group consisted of 28 (19.4%), 48 (33.3%) and 14 persons (9.7%) respectively. The severity of periodontitis was determined by the depth of the periodontal pocket, degree of bone resorption (according to x-ray examination), and pathologic tooth mobility. A local anti-inflammatory therapy for the patients of the control group included oral baths with propolis (15–20 drops of 10% propolis tincture diluted in 100 ml of warm water) 3 times a day for 7 days starting from the first visit. At the final stage of treatment after preliminary scaling and rootplaning, patients of the control group received antiseptic gel with 10% metronidazole and 2% chlorhexidine bigluconate to be injected into periodontal pockets with over 4 mm depth. Additionally, applications of adhesive dental films Diplene Denta L (with lincomycin) and Diplene Denta M (with metronidazole) were prescribed to be done in the home. In addition to the above-mentioned comprehensive therapy, patients of the main group received a single insufflation of minocycline hydrochloride microspheres into each periodontal pocket. The tools for the patients of the main group included plastic cannulas with minocycline hydrochloride microspheres in the form of powder in the tip of the cartridge, and a special syringe-insufflator. The technique of antibiotic insufflation into the periodontal pocket was preliminary trained on the model of jaws with the studied pathology. Statistical analysis of the results was performed using variance analysis in the Excel Microsoft Office 2016 (Microsoft, USA).Results. According to the systematic observation of the patients from the control group, periodic fluctuations in microbial population in the majority of pathologic pockets obtained a specific regularity: a decrease in the number of microorganisms on day 21 was followed by its increase in the subsequent period of observation after 30 and especially 60 days. According to the ongoing follow-up of the patients of the main group, fluctuations of microbial population in the majority of pathologic pockets obtained a certain regularity: a significant reduction in the number of microorganisms on day 21 was followed by its slight rise in the subsequent period of observation after 30 and a slight increase again in 60 days. Fluctuations in the number of microorganisms of periodontal pockets in the main group reveal their specific character: their number remained invariably lower than that of the control group throughout the observation period, while the total number of detected periodontopathogens decreased.Conclusion. The established correlations between the main indicators of microbiological status of periodontal pockets and the severity of chronic generalized periodontitis within different periods after the local therapy confirm the positive dynamics of treatment in the main group, where patients were insufflated with minocycline hydrochloride microspheres, proved by a change in the typology of microbial status of periodontal pockets and a number of periodontopathogenic microorganisms.

Adenovirus keratoconjunctivitis after LASIK as a complication of COVID-19 vaccination: a clinical case

During large-scale vaccination against coronavirus infection, studying possible side effects after the introduction of the vaccine is of great practical value. We present a rare clinical case of a complication of COVID-19 vaccine prophylaxis. A 40-year-old female patient was diagnosed with a bilateral adenoviral keratoconjunctivitis complicated by corneal erosion and iritis after a LASIK refractive intervention and a subsequent (after 5 days) immunoprophylaxis with the Gam-COVID-Vac vaccine followed by a displacement of the corneal flap due to involuntary friction of the left eye. The corneal flap was urgently repositioned; its adhesion and stabilization were achieved usinga bandage soft contact lens. The timely local and systemic anti-inflammatory and antiviral therapy allowed achieving a successful visual result (1.0). Ophthalmologists need to remain vigilant about possible adverse effects after immunoprophylaxis on the part of the eye, specifically the conjunctiva and cornea. A timely diagnosis and treatment are important to prevent complications such as persistent corneal opacities that reduce visual acuity, especially in patients who have undergone refractive surgery aimed at achieving the highest possible vision. In our opinion, it is advisable to perform vaccination at least 1 month after the refractive surgery.

A modern approach to diagnostic methods of the cornea and aqueous humor of anterior chamber of the eye in patients with anterior uveitis, associated with spondyloarthritis

Anterior uveitis is the dominant clinical extra-articular manifestation of spondyloarthritis associated with the carriage of the human leukocyte antigen allele (HLA-B27), which may precede joint and spinal involvement. In 20–30% of cases, uveitis occurs with frequent relapses – up to 5–6 exacerbations per year, often has a protracted character and is poorly amenable to local anti-inflammatory therapy, which leads to a decrease in vision and a deterioration in the quality of life. Timely and accurate assessment of the severity of intraocular inflammation plays an important role in making a diagnosis and in choosing the right treatment tactics for treating anterior uveitis in patients with HLA-B27-associated spondyloarthritis. The current standard clinical approach to assessing inflammation is the presence and number of inflammatory cells in the anterior chamber aqua humor according to the SUN classification using slit lamp imaging. However, the assessment of SUN is very subjective. Moreover, the individual variability in anterior chamber cell count, which is the main diagnostic criterion for uveitis, can be exacerbated by certain testing conditions, such as the brightness of the slit lamp light bar, light beam size calibration, light source intensity. Advances in optical imaging technology, the application of the latest technologies and the improvement of already known methods offer new opportunities for an objective, accurate and quantitative assessment of inflammation. The article describes the possibilities of studying the cornea and the anterior chamber of the eye using anterior segment optical coherence tomography, confocal microscopy of the cornea and keratotopometry.

Suppression of P2X7R by Local Treatment Alleviates Acute Gouty Inflammation.

Gout is the most common inflammatory arthritis associated with interleukin-1β (IL-1β) accumulation during exacerbation. In this study, we aimed to clarify whether potassium channel antagonists attenuate local inflammation in mice with monosodium urate (MSU)-induced gout. We cultured human macrophage THP-1 cells and evaluated the molecular levels of both IL-1β and potassium channels stimulated with MSU and/or potassium channel antagonists. Acute gout models were generated in IL-1β luciferase transgenic male mice using synovium-like subcutaneous air pouches with MSU injection. Their luciferase activities were monitored following potassium channel blocker treatment using the IVIS Spectrum CT imaging system. The lavages and tissues were extracted from their air pouches, followed by cell counting and pathological analysis. MSU stimulation increased the gene expression levels of pro-IL-1β, P2x7r and Kv1.3, whereas the expression of Kcnq1 was decreased in phorbol 12-myristate 13-acetate-induced THP-1 cells. Both high and low concentrations of the P2x7 receptor inhibitor adenosine 5'-triphosphate (ATP) derivative periodate oxidized ATP (oATP) decreased the production of IL-1β in the supernatant of THP-1 cells. The sixth hour was the peak time of IL-1β luciferase activity after MSU intervention in vivo. oATP ameliorated the synovial IL-1β luciferase activity, reduced inflammatory cell infiltration and alleviated the erosive damage in the cartilage. The anti-inflammatory properties of potassium channel inhibitors, especially of oATP, might point to new strategies for local anti-inflammatory therapy for acute gout.

Effect of repeated intravitreal anti-vascular endothelial growth factor drugs on corneal nerves.

To investigate the potential effect of repeated intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs on corneal nerves. A total of 64 patients were treated with intravitreal injection of anti-VEGF drugs. There were 19 cases of neovascular age-related macular degeneration (AMD), 20 cases of diabetic macular edema (DME) and 25 cases of retinal vein occlusion (RVO). Twenty-nine cases were treated with aflibercept (2 mg/0.05 mL) whereas 35 cases were managed with ranibizumab (0.5 mg/0.05 mL). A corneal confocal microscope was used to collect images of corneal subbasal nerve plexus, and Image J was used for image analysis. The changes in corneal nerve were compared between 1 month after each injection and before injection. There were no significant differences in the density and length of corneal nerve at specific time after the surgery in comparison with baseline in patients who were given 3 intravitreal injections. There was no significant correlation between the numbers of injections and the changes of the corneal nerves. After 3rd injection, the nerve length of the DME group was markedly lower than that of AMD and RVO groups, the difference was statistically significant (P < .05). The nerve density of the DME group was not significantly different from that of AMD and RVO groups, whereas the nerve length and nerve density of the AMD and RVO groups were not statistically significant between each other also. The corneal nerve length after the 2nd and 3rd injections of Aflibercept were lower than that before surgery, the difference was statistically significant. There were no significant differences in nerve density and nerve length at each time point after Ranibizumab injection. The length and density of the corneal nerve after multiple injections in contralateral eye displayed no significant changes compared with the baseline. Repeated intravitreal anti-VEGF drug can reduce the length of corneal nerves. For patients who need repeated intravitreal injections of anti-VEGF drugs, especially in DM, attention should be paid on the changes affecting the corneal nerves. It is also needed to strengthen the local anti-inflammatory therapy to avoid infection and to use artificial tears to protect the microenvironment of the ocular surface after the surgery.

Functional activity of the oral endothelium in persons, with chronic periodontitis during treatment with plasmolifting

Chronic periodontitis as an osteoimmune disease of the oral cavity is accompanied by a change in the functional activity of endotheliocytes. Moreover, abnormal vascularization exacerbates periodontal inflammation, as it promotes the transmigration of a larger number of immunocompetent cells, the influx of inflammatory mediators and cytokines.The aim of our work was to study the functional activity of the endothelium of the vessels of the oral cavity in persons suffering from chronic periodontitis in the treatment of plasmolifting.Materials and methods. Under observation were 30 patients diagnosed with chronic generalized periodontitis of moderate severity at the age of 35 (32.50; 40.00) years, with no severe somatic pathology (main group). The comparison group included 20 people aged 38 (34.00; 45.00) years with no inflammatory diseases in the oral cavity. All patients underwent local anti-inflammatory therapy and sanitation of periodontal pockets, correction of occlusal contacts, curettage, plasma lifting. Oral fluid concentration of soluble adhesion molecules ICAM-1 and VCAM-1, endothelin-1, qualitative and quantitative composition of microflora were determined.Results. After the treatment with plasmolifting, a noticeable relief of the activity of the inflammatory process was observed. In patients with chronic periodontitis, Porphyromonas gingivalis was found in 100 % of cases in a titer of 5.73 (4.9; 6.7) lg (gEq/sample), in 62.5 % – Prevotella intermedia in a titer of 4.5 (3.0; 5.5) lg (gEq/sample). Against the background of therapy, decrease of the occurrence of the microorganism and of the number of microorganisms was observed. The concentration of the soluble form of VCAM-1 in the oral fluid of patients with chronic periodontitis exceeded the values of the control group by 38.3 times (p = 0.000001), and ICAM-1 – by 18.1 times (p = 0.00001). Against the background of plasmolifting therapy, the level of the studied substances decreased, but exceeded the control values by 25.2 and 6.4 times, respectively. The content of endothelin in the oral fluid in patients with periodontitis exceeded the values of healthy individuals by 40.7 % (p = 0.003), during therapy its values decreased, but did not reach the level of healthy volunteers (p = 0.04).

Diabetes, Diabetic Retinopathy, and Inflammatory Disorders

ABSTRACT This review summarizes the impact of systemic and ocular inflammatory disorders on diabetes mellitus (DM) and diabetic retinopathy (DR). Local inflammation is a key pathology in diabetic retinopathy (DR) and is also an evolving target for clinical therapy. The legacy effects of local inflammation at the intracellular level make DR a persistent self-driven vicious process. Ocular inflammation is accompanied as well as incited by systemic inflammation due to diabetes mellitus (DM) itself. Over the years, a multitude of studies have evaluated the impact of systemic inflammatory disorders (SIDs, like rheumatoid arthritis, lupus, psoriasis, etc.) and anti-inflammatory drugs prescribed for managing them on manifestations of DM. Recent studies have indicated increased insulin resistance to be a result of chronic inflammation, and the anti-inflammatory drugs to have a protective effect towards DM. Very few studies have evaluated the impact of SIDs on DR. Furthermore, the evidence from these studies is conflicting, and while local anti-inflammatory therapy has shown a lot of clinical potential for use in DR, the results of systemic anti-inflammatory therapies have been inconsistent. The impact of local ocular inflammation due to uveitis on DR is a crucial aspect that has not been evaluated well at present. Initial pre-clinical studies and small-sized clinical reports have shown a strong and positive relationship between the presence of uveitis and the severity of DR as well as its progression, while larger cross-sectional patient surveys have refuted the same. The long term impact of ocular inflammation due to uveitis on DR needs to be studied while adjusting for confounders.

Isolation of Clinical Microbial Isolates during Orthodontic Aligner Therapy and Their Ability to Form Biofilm.

The purpose of this study is to calculate microbiological composition of aligners after a day of wearing them. To date, the dental market for orthodontists offers many ways to correct bites. Aligners are transparent and almost invisible from the teeth. They are used for everyday wear to correct the incorrect position of the teeth, which was once considered the prerogative of braces. Scientists worldwide have repeatedly considered questions regarding the interaction between aligners and the oral cavity's microflora; however, the emphasis has mainly shifted toward species composition and antibiotic resistance. The various properties of these microorganisms, including biofilm formation, adhesion to various cells, and the ability to phagocytize, have not been studied so widely. In addition, these characteristics, as well as the microorganisms themselves, have properties that change over time, location, and in certain conditions. In this regard, the problem of biofilm formation in dental practice is always relevant. It requires constant monitoring since high contamination of orthodontic materials can reduce the effectiveness of local anti-inflammatory therapy and cause relapses in caries and inflammatory diseases of the oral cavity. Adhesive properties, one of the key factors in forming the architectonics of biofilms, provide the virulence factors of microorganisms and are characterized by an increase in optical density, determining the duration and retrospectivity of diagnostic studies. This paper focuses on the isolation of clinical microbial isolates during aligner therapy and their ability to form biofilms. In the future, we plan to use the obtained strains of microorganisms to create an effective and safe biofilm-destroying agent. We aimed to study morphometric and densitometric indicators of biofilms of microorganisms persisting on aligners.

Possibilities of differential diagnosis of chronic diseases of the nasal cavity after surgical treatment and topical antibiotic therapy

The study was performed to assess the endoscopic state of the nasal mucosa after the use of local anti-inflammatory and antibacterial therapy, in particular, Polydexa nasal spray with phenylephrine containing Dexamethasone sodium metasulfobenzoate + Neomycin + Polymyxin B + Phenylephrine, and for the treatment of granulomatosis with polyangiitis. The study included 940 patients who underwent examination and treatment for chronic rhinosinusitis in the clinic of otorhinolaryngology of I.P. Pavlov SPbSMU surgical treatment of the paranasal sinuses underwent 907 patients. In the postoperative period, the first group (211 patients) underwent toileting of the nasal cavity. The second group (307 patients) received irrigation therapy. The third group (389 patients) received a topical treatment combined of Polydexa with phenylephrine. The dynamics of the condition was assessed on the 1st, 3rd and 7th days of treatment, the evaluation of the effectiveness of the treatment was carried out on the 3rd and 7th days. Differential diagnosis with granulomatosis with polyangiitis was carried out in 33 patients. All patients with granulomatosis with polyangiitis showed signs of chronic rhinosinusitis. Patients were prescribed local anti-inflammatory and antibacterial therapy with Polydexa with phenylephrine for 7 days with endoscopic control of the nasal cavity. The use of the combined topical drug Polydexa with phenylephrine in patients with chronic rhinosinusitis and in patients with granulomatosis with polyangiitis has a positive effect, which reduces the clinical manifestations of chronic rhinosinusitis.

Особенности лечения синдрома «сухого глаза» у пациентов с хроническим периферическим увеитом

Introduction. The development of inflammation and violations of the homeostasis of the tear film are of fundamental importance for the occurrence of dry eye disease (DED). In 28–57 % of cases, intermediate uveitis (IU) is accompanied by signs of irritation of the ocular surface and symptoms characteristic of DED. Purpose. Analysis of the effectiveness of complex treatment of DED and IU, including tear replacement and anti-inflammatory therapy in combination with laser retinal coagulation at the extreme periphery of the fundus. Material and methods. The results of treatment of 98 patients were analyzed: the main group – 78 patients – were prescribed complex treatment of DED, the comparison group – 20 patients – only local tear replacement and anti-inflammatory therapy. Evaluation of the effectiveness of the developed method of treatment of combined pathology was carried out after 3 and 6 months. based on the dynamics of OSDI indices, hyperemia of the bulbar conjunctiva, LIPCOF test and Norn test. Results. The use of complex treatment of DED in patients with IU contributes to a statistically significant (p &lt; 0.05) decrease in signs of discomfort according to the results of OSDI to 34.8 %, a decrease in the bulbar conjunctiva hyperemia index to 51.4 %, a decrease in the LIPCOF test index to 22.2 %, an increase in tear film rupture time to 23.3 % with stable CP relief for 6 months observations. Conclusions. Thus, the results obtained clearly demonstrate the effectiveness of the use of complex treatment of DED in patients with IU. The developed method contributes not only to increasing the stability of the tear film, but also to reducing subjective feelings of discomfort and ensuring relief of inflammation at the extreme periphery, which allows us to recommend its wide application. Keywords: dry eye disease, intermediate uveitis, laser coagulation of the extreme periphery of the retina

Sensitization to Malassezia Sympodialis is Associated with Low Efficacy of Local Anti-inflammatory Therapy in Patients with Contact Dermatitis

IgE sensitization to Malassezia Sympodialis can lead to severe exacerbations in patients with atopic eczema and contact dermatitis. The mechanisms of this exacerbation lie in the exacerbation of inflammation by concurrent types I and IV hypersensitivity reactions.

Efficacy of Platelet-rich Fibrin in the Treatment and Rehabilitation of Patients with Peri-implant Mucositis

Aim: To evaluate the effectiveness of injectable platelet-rich fibrin (i-PRF) in the complex treatment and rehabilitation of patients with peri-implant mucositis. Materials and Methods: Clinical examination and treatment of 23 patients with peri-implant mucositis were carried out. Patients of the main group (n=11) were injected with liquid platelets-rich fibrin. In patients of the control group (n=12) the treatment protocol involved local antibacterial and anti-inflammatory therapy. The assessment of peri-implant tissues condition was performed on the basis of visual inspection, generally accepted instrumental and X-ray examination and was based on the data of periodontal tests and indexes. Results: In 72.7% of patients after i-PRF usage, reduction of inflammation was observed on the 3rd day of treatment; on the 7th day the clinical status corresponded to the norm. At the same time, in the control group a decrease of inflammation signs was revealed only in 33.3% of patients on the 3rd day and in 66.7% on the 7th day; complete elimination of inflammation in all patients was registered on the 14th day of observation. In 12-month follow-up examination the positive dynamic of peri-implant mucositis treatment was maintained in 81.8% of patients of the main group and in 50.0% of patients of the control group. Conclusions: The use of i-PRF in the complex treatment of peri-implant mucositis contributes to the rapid elimination of inflammation signs and bleeding of the gums surround the implants, accelerates the soft tissues regeneration, shortens treatment times and provides long lasting stabilization of the process.

The Effectiveness of Therapeutic and Prophylactic Complexes in the Treatment of Chronic Generalized Periodontitis in Patients with Diabetes Mellitus

Local drug anti-inflammatory therapy is an integral part of the comprehensive treatment and prevention of periodontal diseases. Preparations used for topical use in periodontics are often poorly fixed at the place of application, as a result of which the exposure of the drug is not maintained. In addition, they are combined arbitrarily, without taking into account their compatibility and dosage, during one course of treatment, drugs with a different mechanism of action are used each time, the multiplicity of procedures is not maintained. The selection of medicines is carried out by the doctor empirically. The aim of the study was to determine the effectiveness of the use of various therapeutic and prophylactic complexes in the treatment of periodontitis in patients with diabetes mellitus.

Новый подход к лечению синдрома «сухого глаза» на фоне хронического периферического увеита

Aim. To study the clinical and functional effectiveness of a complex method of treatment of dry eye syndrome against the background of chronic peripheral uveitis, including local tear-replacement and anti-inflammatory therapy in combination with laser retinal coagulation on the extreme periphery of the fundus. Materials and methods. The study was performed among 98 patients who made up 2 follow-up groups: the main group (78 people) and the comparison group (20 people). All patients underwent OSDI questionnaires, visometry, pneumotonometry, biomicroscopy of the anterior segment of both eyes, binocular ophthalmoscopy with sclerocompression, and the Schirmer I test. In the main group, along with conservative treatment, laser coagulation of the extreme periphery of the retina was performed, in the comparison group - conservative treatment. The follow-up period was 3 months. Results and discussion. The use of a complex method of treatment of «dry eye» syndrome against the background of chronic peripheral uveitis significantly reduces the number of complaints according to the OSDI questionnaire, improves the condition of the eye surface (reducing the overhang of the conjunctival fold, the severity of «sluggish» hyperemia of the conjunctiva of the eyelids and transitional folds, reducing the amount of conjunctival discharge). The indicator of total tear production in the main group after 3 months. it increases by 1,5 times in comparison with the initial data, and in 100% of cases, stable relief of inflammation of the chorioretinal structures on the extreme periphery of the fundus is provided. Conclusion. A new effective method for the treatment of dry eye syndrome against the background of chronic peripheral uveitis, including local tear-replacement and anti-inflammatory therapy in combination with laser retinal coagulation on the extreme periphery of the fundus, has been developed and introduced into clinical practice. The use of this method provides stable clinical and functional results in the long-term period and can be recommended for the treatment of «dry eye» syndrome of mild to moderate severity against the background of chronic peripheral uveitis. Key words: dry eye syndrome, chronic peripheral uveitis, laser coagulation of the extreme periphery of the retina.

Эффективность комплексного лечения синдрома «сухого глаза» на фоне хронического периферического увеита

Purpose to evaluate the effectiveness of a comprehensive method of treating dry eye syndrome against the background of chronic peripheral uveitis. Material and methods. The study was performed among 98 patients (196 eyes), who made up 2 observation groups: the main group (78 people) and comparison group (20 people). The main group was treated with a new method, the comparison group was prescribed local anti-inflammatory and tear replacement therapy. Results. Application of the combined treatment showed a significant decrease in OSDI and occurrence of changes in ocular surface (up to 100%), characteristic for the syndrome of «dry eye». The indicators of total tear production became higher up to 2 times from the initial level after the therapy. Conclusion: The use of a new complex method of treatment significantly reduces the subjective and objective manifestations of the "dry eye" syndrome, contributes to an increase in total tear production against the background of relief of inflammation on the extreme periphery of the fundus compared to traditional pharmacotherapy. Key words: dry eye syndrome, chronic peripheral uveitis, combined treatment method, laser coagulation of the extreme periphery of the retina.

Local anti-inflammatory therapy for osteoarthritis with high comorbidity

Osteoarthritis (OA) is a widespread disease, the leading symptom of which is pain in the load-bearing joints, and the incidence increases with age. Many patients with OA have several comorbidities, such as arterial hypertension, coronary heart disease, diabetes mellitus, gastric and duodenal ulcers. Currently, there are different approaches to the treatment of OA with and without comorbidity. In particular, oral non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended for OA with high comorbidity. The literature review discusses the prospects and popularity of the use of local forms of NSAIDs associated with their equal analgesic efficacy relative to oral drugs, but with a smaller number of adverse events. Data on transcutaneous forms of diclofenac are analyzed, which can provide at least oral equivalent analgesia, improved physical function and reduced stiffness in osteoarthritis of the hands and knee joints, while showing fewer systemic adverse events. This feature of topical NSAIDs allows them to be considered as an effective first-line treatment option, especially in elderly patients and those with severe comorbidity. Topical medications containing diclofenac as the main active ingredient are popular among both patients and doctors, and their use has an extensive evidence base. Diclofenac ethylenediamine salt has advantages over sodium salt in its penetrating properties, and the form of an emulsion gel containing a hydrophobic phase that slows down the drying of the substance applied to the skin provides ease of use and improves the consumer properties of agents for local antiinflammatory therapy of osteoarthritis.

Modern approaches to the treatment of meibomian gland dysfunction

The eyelids are a delicate and complex dynamic structure with primary function to protect the eye surface. The term «meibomian gland dysfunction» (MGD) first appeared in the mid-1980s. This lesion is known to result in a disturbance of the tear film, eye irritation symptoms, clinically significant inflammation and diseases of the eye surface. The progression of MGD leads to hyperosmolarity of the tear film, its instability, an increase in the bacterial load of the eyelid margin, blepharitis and generalized inflammation of the ocular surface. For patients who require surgical treatment, a healthy eyelid is very important. Despite postoperative functional recovery, most of these patients experience dry eye syndrome (DES), which can lead to symptoms of eye irritation and deterioration of visual acuity due to instability of the tear film. In the early stages of MGD, it is advisable to begin treatment with a conversation about correct frequent blinking, rest during visual activity, adequate water intake, and a specific diet. Later, patients are advised to use an ultrasonic air humidifier, warm dry compresses, practice proper eyelid hygiene and perform massages, apply preservative-free lubricants, azithromycin, omega-3 preparations, and undergo local anti-inflammatory therapy. In case of a tick-borne infestation, the International Expert Group recommends the use of scrubs with 50% tea tree oil for treating the eyelids. In order to achieve a long-term effect or permanent remission, it is necessary to practice daily eyelid hygiene with the help of gels, special napkins and shampoos over a long period of time. Correctly selected medical treatment in accordance with the stage of the disease supplemented with massages and warm dry compresses lead to a significant improvement in the quality of life of patients with MGD and DES. The simplicity of eyelid hygiene is currently ensured by the availability of tools specially designed for the safe treatment of its edges, which have a complex histological and anatomical structure.

Acute viral otitis media: etiology, diagnosis, treatment

Acute otitis media (OSA) is one of the most common diseases in children and adults and the most common cause of antibiotic therapy, often unreasonable. 20–70% of respiratory infections in adults and children is complicated by the development of CCA. Despite the fact that only 10% of CCA has a viral etiology, the vast majority of CCA are also viral-bacterial co-infection. The article presents the main pathogenetic mechanisms of the development of CCA, such as viral and virus-induced. The term “heat-generating” microorganisms is introduced. A review of the most common pathogens of CCA viral and bacterial. An otomicroscopic picture is described based on the generally accepted domestic classification of CCA. The main tympanometric curves and their types during CCA are presented. Much attention is paid to the modern principles of pathogenetic and symptomatic therapy. In particular, local anti-inflammatory and analgesic therapy using ear drops containing lidocaine. Some progress in the prevention of acute otitis media is discussed, which has led to a decrease in the frequency of visits to doctors about otitis media and the appointment of antibiotics. This is due to the widespread use of vaccines, as well as the introduction of “wait-and-see” tactics in mild and moderate cases of CCA without initial antibiotic treatment. Success in reducing the incidence of CCA will depend mainly on preventing the colonization of the nasopharynx by otopathogens, as well as reducing the incidence of viral infections. According to international and domestic recommendations, the basis for the prevention of acute otitis media is vaccination against pneumococcus, hemophilus bacillus and influenza virus.

Анализ этиологии и антимикробной чувствительности возбудителей грибковых кератитов в серии клинических случаев

Purpose. To analyze pathogens of keratomycosis resistant to antifungal therapy, the spectrum of sensitivity to antimicotic agents in series of fungal keratitis. Material and methods . There is a retrospective analysis of fungal keratitis in 12 patients (12 eyes) who underwent an inpatient treatment from August 2018 to January 2020 (18 months). Clinical data of patients was recorded in specially developed forms. Results. Keratomycosis was confirmed in 12 cases of keratitis with resistantce to the local antimicrobial and anti-inflammatory therapy during the study period. All patients used contact lenses from different manufacturers, had a history of outpatient treatment with antibacterial, non-steroidal anti-inflammatory eye drops, and keratoprotectors, topical glucocorticosteroids and antiherpetics for 2 weeks to 2 months. Identification of the pathogen was carried out by the direct microscopy method, followed cultural research in the mycological laboratory, as well as clinical manifestations. In 10 cases, Fusarium spp was detected, in 1 case – Penicillinum, in 1 case – Candida. According to the conclusion of the mycological study, 100% of fungal agents has resistance to fluconazole and amphotericin B. The sensitivity of agents to antimicotic agents was analyzed, and the equipment of antifungal drugs required for use on the basis of the study was revised. Conclusion. In a series of clinical cases of fungal keratitis, the dominant pathogen was Fuzarium. The found broad resistance to fluconazole and amphotericin B, high sensitivity to nystatin, terbinafine, and ketoconazole shows that each case of keratomycosis has an original clinical picture, must be considered in detail, and requires a careful diagnosis and individual treatment tactics.

Evaluation of the effect of the combined effects of local anti-inflammatory therapy (Ivermectin) and a pulsed dye laser (595 nm) on LL-37 induced rosacea-like inflammation on mice

Introduction.Rosacea is a chronic inflammatory dermatosis characterized by the presence of pathogenesis of inflammation and vascular changes caused by exposure to antimicrobial peptides (LL-37) and toll-like receptors (TLR2). It has been established that the pathogenetic link is a target for a new therapy of rosacea.Objective– to evaluate the potential combined effect of local Ivermectin 1 % cream and a pulsed dye laser (PDL) with a wavelength of 595 nm on a model of rosacea-like inflammation on mice after 4-fold introduction of recombinant antimicrobial peptide LL-37.Material and methods.Adult female BALB/c white mice weighing 23.5±0.66 g were used, divided into 4 groups: control; group 2 (biodistillate water was introduced in a volume of 40 μl, within 48 hours); group 3 (without treatment, intracutaneously injected paravertebrally into the lumbar region 40 μl of peptide LL-37 (320 μM), 4 times every 12 hours); group 4 (with treatment, 1 % Ivermectin cream was applied after each peptide injection, 60 hours after the first injection, the PDL device with a wavelength of 595 nm was treated, the area irradiated with a surface of 50 mm2).Results.The result indicates that the local injection of LL-37 into the skin of mice caused a dramatic expansion and fullness of the vessels of both the arterial and venous link. The integrity of the walls of the blood vessels of the microcirculatory bed in the dermis and the hypodermis has broken, resulting in multiple small hemorrhages in the tissues. In the remaining vessels, the endothelium was swollen, the adventitia was infiltrated with leukocytes. The number of mast cells increased significantly, but only some of them degranulated.Conlusions.As a result of the combined local anti-inflammatory and laser effects, leukocyte infiltration of the dermis and hypodermis decreased, in the dermis a part of the vessels was desolate, the endothelium in them was swollen. Enlarged full blood vessels remained in the hypodermis, the endothelium was absent in them, insignificant adventitia infiltration remained. The proposed combination of effects, taking into account the morphological picture, is promising and requires additional study in patients with rosacea without the use of invasive research methods.