Purulent Diseases Research Articles

POSSIBILITIES OF NON-STANDARD METHODS FOR TREATING INFECTED WOUNDS

Summary. Introduction. Some representatives of the microcosm can secrete a variety of biologically active substances that have a detrimental effect on other groups of microorganisms. The geniuses of humanity noticed this, and today medicine has about 1600 antibacterial drugs. However, the struggle for survival at all levels continues. Many bacteria have become resistant to existing antibiotics. Taking this into account, the treatment of purulent-inflammatory diseases faces insurmountable difficulties. Contaminated ulcerative processes and various wounds of the legs are accompanied by suppuration, the treatment of which is extended by weeks and months. The above justifies the relevance of the problem. Aim: to study the possibilities of using non-standard methods for treating purulent and infected wounds and ulcers. Materials and methods. In experimental conditions (patent), we studied and tested the treatment of purulent ulcers (S=2.0–42.0 cm2) and wounds (S=22.0–48.0 cm2) in 21 patients without the use of antibiotics. Apatite polymer drainage bandages (APDB) were applied under compression conditions. Results and discussion. The dressing was changed after 12–24–48 hours, depending on the exudation level. The clinical effect was observed from the 4th day. Epithelization of wound surfaces was observed on days 14–21, of ulcerative defects – on days 18–32. Conclusions. APDB based on zinc oxide may be an alternative to existing standard treatment methods for purulent diseases. Funding. This study was carried out with grant support from the National Research Foundation of Ukraine (project No. 2023.04/0109).

Mini-invasive video thoracoscopic interventions in patients with acute pleural empyema

The use of video thoracoscopic interventions in patients with acute pleural empyema is gaining momentum in modern thoracic surgery. The need of determining the optimal timing of their implementation depending on the duration of the disease and the nature of changes in the parietal and visceral pleura remains open. The nature of changes in the parietal and visceral pleura of 249 patients with acute pleural empyema treated with video thoracoscopic interventions was evaluated. Patients were divided into 5 groups depending on the duration of the disease. It was determined that fibrinous accumulations in acute pleural empyema are replaced by cavity fragmenting formations after 6 weeks from the onset of the disease. The cessation of purulent exudate accumulation and the duration of pleural drainage after thoracoscopy depends on the duration of the disease at the time of thoracoscopy, as evidenced by the duration of pleural drainage in the period up to one month – 8 days from the onset of the disease, up to two months – 15 days, and after 8 weeks of duration – reached 20 days. The main indications for open surgical intervention in this group of patients were the failure of fractional lavage of the empyema cavity due to drainage or the impossibility of adequate rehabilitation according to the presence of a bronchopleural fistula with a duration of its existence of no more than 1 month and no tendency to closure. Inflammatory changes in the pleura in the form of fibrin deposits and cavity fragmentation in pleural empyema increase rapidly enough, the possibility of its effective rehabilitation during thoracoscopy without open surgical interventions is limited to 6 weeks from the onset of the disease. Keywords: acute purulent diseases of the pleura, minimally invasive surgical treatment, sanitation of the pleural cavity, duration of the disease.

Immunological disorders in patients with acute pleural empyema

In case of acute pleural empyema pronounced violations of cellular and humoral factors of immunity as well as non-specific resistance of the body are revealed. Dynamics of laboratory and immunological changes of 64 patients with acute pleural empyema who were treated with classical and minimally invasive surgical methods has been studied. Patients were classified into 5 groups in accordance with severity of the disease, which was determined according to the criteria which comprise such clinical and laboratory parameters as: respiratory rate, heart rate, blood pressure, temperature reaction, the number of affected particles, leukocytosis, SpO2. All the patients underwent a standard examination as well as determination of serum concentration InterLeykin 6 (IL-6), InterLeykin 8 (IL-8), Tumor Necrose Factor α (TNF-α), C-Reactive Protein (CRP). Assessment of cytokine spectrum of blood serum of patients with acute pleural empyema allows stating the condition of hypercytokinemia with an increase in pro-inflammatory cytokines. Meanwhile the degree of their increase differed depending on the severity of course of acute pleural empyema. Study of structure of cytokine status allowed identifying those patients with severe course of pleural empyema had a significant increase in IL-6 and CRP concentrations. Nevertheless, the severe course of the disease is associated with insufficient increase of IL-8 and TNF-α. Deficiency of IL-8 and to a less extent IL-6 is expressed in patients of the older age group. In the general blood test, there have been identified higher indicators of total number of leukocytes, neutrophils, pronounced shift of the leukocyte formula to the left, increases of erythrocyte sedimentation rate in patients with a severe course of the disease. There have been identified factors which affect severe course of acute pleural empyema: decrease in oxygen saturation to less than 94%, severity of shortness of breath, which exceeds 2 points on the Borg scale, damage to 3 or more segments of lung tissue, and also numerous clinical signs of violation of anti-infective protection, pronounced decrease in neutrophils, an increase in the concentration of C-reactive protein and insufficient increase of IL-8 and TNF-α in blood serum. Keywords: acute purulent diseases of the pleura, respiratory failure, interleukin 6, interleukin 8, tumor necrosis factor α, C-reactive protein.

MICROBIOLOGICAL EFFICACY OF TREATMENT OF PURULENT-INFLAMMATORY DISEASES OF THE MAXILLOFACIAL REGION IN CHILDREN AFTER DIFFERENT METHODS OF TREATMENT

Acute neodontogenic purulent diseases occupy the leading place in maxillofacial surgery. Before the introduction of antibiotics the frequency of these diseases was extremely high in the subsequent period the decrease began, but in recent years there is a tendency to increase and was 59-60%.

Demographic Distribution and Etiological Bacterial Spectrum of Patients with Non-Odontogenic Abscesses and Phlegmons of the Head and Neck

The aims of the present study are to prove that in non-odontogenic abscesses and phlegmons in the head and neck region, the main microbiological agents are representatives of the oral resident microflora, as in odontogenic purulent inflammatory diseases in the same area, and to determine and compare the demo¬graphic distribution between the two analyzed etiological groups. It includes and studies 57 patients with non-odontogenic abscesses and phlegmons of the head and neck. In all of them, as a routine procedure, mate¬rial was taken from the surgical wound for microbiological examination and the identification of the isolated bacteria was confirmed by a microbiological analyzer “VITEK” (“BioMérieux”, France). After analyzing the obtained results, the goal was confirmed - the largest part is of the resident microflora (59.5%, n=34) of which 50.75% (n=29) mixed resident microflora and 8.75% (n=5) mono infections, followed by represen¬tatives of Gram-positive bacteria (15.75 %, n=9), Gram-negative ones (5.25%, n=3) and obligate anaerobes (1.75%, n=1). In the studied group of patients with non-odontogenic abscesses, Gram-positive bacteria are 3 times more than Gram-negative. The causative agents of phlegmons of non-odontogenic origin in the maxil¬lofacial region are Gram-negative bacteria and obligate anaerobes in a 1:1 ratio. Unlike patients with odonto¬genic purulent diseases, in which the young population under the age of 44 is most affected, non-odontogenic abscesses and phlegmons most often affect mature individuals between the ages of 45 and 59.

Video-Thoracic Surgical Treatment of TB-Empyema for Pleuro-Pulmonary Tuberculosis

According to WHO, the emergence of purulent diseases with superinfection is observed due to the formation of resistance of microorganisms, mixed specific and nonspecific flora to the main anti-tuberculosis drugs. The rational choice of diagnosis and surgical intervention significantly reduces the formation of suppuration resistance for pleura-pulmonary tuberculosis. Objective — to improve the surgical treatment of pleural tuberculosis empyema due to minimally invasive diagnostics and video-assisted thoracic resections. Materials and methods. A retrospective analysis was conducted on our own studies involving 685 cases of patients with stage I—III pleuro-pulmonary complications of tuberculosis empyema. This included a review of minimally invasive video-surgical diagnostics and operations conducted over the past decade. The treated patients were divided into two groups: Group 1, consisting of 351 patients (51.25 %), underwent operations using minimally invasive technologies (video-thoracoscopy (VTS), video-assisted surgical resection (VATS)); Group 2, comprising 334 patients (48.75 %), underwent open wide thoracotomy. In Group 1, 301 patients had acute pleural TB-empyema and 50 had chronic cases. Among the patients in Group 2, acute pleural TB empyema was observed in 284 cases and chronic TB empyema in 50 cases. Results and discussion. According to our data, only VTS is a highly informative method for detecting tuberculosis, pleural TB-empyema in the 1st, 2nd and 3rd stages of its development. Minimally invasive technologies have advantages over open thoracotomies and significantly reduce intraoperative bleeding, the number of posto­perative complications and mortality from surgical treatment. The analysis of our own researches proves that video­thoracoscopic interventions (VTS, VATS) in tuberculous suppurations have some disadvantages, namely: the inability to palpably assess the condition of altered structures within the pleural cavity, the technical complexity involved in performing marginal resection of a bronchial fistula. All this requires further development of high-tech surgical techniques in our country. In a comparative analysis of the frequen­cy and nature of complications during surgery, we found that, overall, in the main group, they occurred 2.1 times less frequently than in the comparison group (p < 0.05). Conclusions. To improve surgical treatment of pleural tuberculosis empyema through minimally invasive diagnostics and video-assisted thoracic resections (VATS). The greatest diagnostic difficulties were encountered in patients with localization of pleural TB empyema in the area of active tuberculous and metatuberculous changes. In 48.7 % of patients, the pleural TB empyema is diagnosed at a late stage of the purulent process.

Delta Neutrophil Index as a New Marker of Purulent Inflammation in Men With Non-odontogenic Abscesses of the Neck.

Introduction If non-odontogenic abscesses and phlegmons (all purulent inflammations where the etiology is not a diseased tooth) of the neck are not promptly treated, they can lead to serious complications and even end in the death of the affected patient. Classical markers of inflammation such as plasma concentration of leukocytes (WBC), neutrophils (Neu), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) are elevated in inflammatory neck diseases, but none of them has been proven as a definite marker in the prediction of this type of pathology. This necessitates the search and analysis of new indicators that could be used in the diagnosis, follow-up, and prognosis of patients with purulent neck infections. Potentially, such a marker could be the delta neutrophil index (DNI), which is increasingly entering clinical practice as a prognostic indicator in critically ill patients with life-threatening illnesses, including sepsis and systemic inflammatory response syndrome (SIRS). In the world literature, there are no data that have been studied in patients with purulent diseases of the neck of non-odontogenic origin, which is the aim of this original article. Materials and methods This retrospective study included 40 men with an average age of 46 (18-87) years with non-odontogenic abscesses and phlegmons of the neck who were hospitalized and operated on. In all of them, the concentration of leukocytes, eosinophils (Eo), neutrophils, and mature polymorphonuclear neutrophil leukocytes (PMN) was examined on an automatic 5-Diff hematology analyzer, ADVIA 2120i (SiemensMedical Solutions USA, Malvern, PA). Thus, it was calculated according to the formula for calculating DNI (DNI% = (Neu%+Eo%) - PMN%). Retrospectively, 30 healthy men with an average age of 42 (18-81) years were used as a control group, in which the same indicators were examined during a preventive examination. Results and discussion Comparing the mean values of WBC, Neu, and DNI between the studied patients with non-odontogenic purulent neck infections (n=40) and the healthy male controls (n=30) it was found that all three indicators of inflammation are significantly higher in the ill men, and these differences are statistically significant (p<0.05): 10.19 ±2.68x103/L versus 7.37 ±1.93x103/L for leukocytes, 7.68 ±2, 76x103/L versus 4.13 ±1.48x103/L for neutrophils, and 1.11±0.83% versus -1.07±1.22% for DNI. Therefore, the high mean numbers of measured WBC and Neu in men with non-odontogenic purulent neck infections were associated with an increase in their mean calculated DNI. This gives us reason to think that while WBC and Neualone are not sufficient for definitive diagnosis, treatment follow-up, and prediction of disease outcome, in combination with DNI they become reliable indicators in purulent neck infections. Conclusions The DNI correlates well with other well-known and established indicators of inflammation, such as the concentration of leukocytes and neutrophils in the peripheral blood of patients. Its calculation is fast as an implementation procedure and is economically beneficial. Its independent use in the diagnosis and treatment of these diseases is about to be investigated and analyzed.

СТРУКТУРА И ДИНАМИКА ИЗМЕНЕНИЯ МИКРОФЛОРЫ ГНОЙНЫХ ЗАБОЛЕВАНИЙ МЯГКИХ ТКАНЕЙ У ПАЦИЕНТОВ ОТДЕЛЕНИЙ ХИРУРГИЧЕСКОГО ПРОФИЛЯ В СОВРЕМЕННЫХ УСЛОВИЯХ

Background. To develop effective means of combating pathogenic microflora, as well as effective etiotropic treatment it is necessary to know the structure and emerging trends of surgical infection pathogens. Aim of the research – assessment of the structure and current dynamics of changes in the microbiological spectrum of causative agents of purulent processes in soft tissues of surgical patients at the present time. Material and methods. The results of microbiological cultures taken in the departments: surgical, burn, traumatology № 3 and anesthesiology, resuscitation and intensive care of the Emergency hospital in Grodno from 2016 to 2022 were analyzed. The microbiological spectrum of purulent diseases of soft tissues was compared with the results of cultures of all microflora isolated from patients of the studied departments to identify existing trends in pathogenic microflora in the hospital. Results. Despite the fact that the pathogenic microflora isolated from surgical patients was very diverse, most often Staphylococcus aureus was cultured from Gram-positive microorganisms, and Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Proteus mirabilis were cultured from Gram-negative microorganisms. A fungus of the genus Candida (Candida spp.) was cultured in a small but practically stable ratio of about 1 %. At the same time, there are no significant changes in the structure of the circulation of the leading microflora in patients with purulent processes of soft tissues over the studied period of time. Conclusions. The structure of the cultured microbial flora of the studied surgical departments, as a whole, when compared with microbes isolated from patients with purulent processes of soft tissues is almost identical. There are no significant changes in its structure in these patients. The most significant cultured organisms were Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Proteus mirabilis.

Prospects for the application of bacteriophages in the treatment of sinusitis caused by antibiotic-resistant bacterial strains

Purulent diseases in otorhinolaryngology are of great interest due to their widespread prevalence and the objective difficulties of treatment. One of the most frequently encountered nosological forms is purulent sinusitis. A key element in the complex treatment of bacterial sinusitis is systemic antibiotic therapy aimed at the eradication of pathobionts from the focus of infection. However, the increasing worldwide drug resistance of etiologically significant microorganisms complicates antibacterial chemotherapy of purulent sinusitis and raises questions about its future feasibility. The threat of a change from a resistance era to a post-antibiotic era is very significant, given the acute shortage of new antibiotics and the relatively rapid adaptation of bacterial microorganisms to them. The global community is therefore faced with the challenge of finding other drugs with antimicrobial activity. In recent decades, genetically modified virulent bacteriophages and phagolytes isolated on their basis are becoming increasingly attractive in the fight against purulent infections of various localizations caused by drug-resistant bacteria. This literature review focuses on the potential of phage therapy for acute bacterial sinusitis in an era of globally increasing bacterial strain resistance. The article details the causative agents of community-acquired and hospital-acquired acute sinusitis, the main mechanisms of bacterial antibiotic resistance, the effect of virulent phages on bacteria, and studies on the efficacy of phage therapy in the treatment of acute sinusitis. The facts outlined herein clearly indicate the efficacy of phage therapy, as well as therapeutic perspectives on using bacteriophages in the complex treatment of purulent sinusitis caused by antibiotic-resistant microbiota.

N.M. Aleksandrov, maxillofacial surgeon, professor, major-general of medical service (to the 100th anniversary of his birth)

The aim of the investigation is to reveal scientific, clinical, pedagogical and social activity of the eminent maxillofacial surgeon Doctor of medical sciences, professor, major-general of the medical service N.M. Alexandrov and his merits in the sphere of the military dentistry.&#x0D; Material and methods. On the basis of analysis of the national literature, as well as life and professional activity and scientific labors of general, major-general of medical service N.M. Alexandrov to present his role in military dentistry development and maxillofacial surgery in Russia.&#x0D; Results. The analysis of the information about N. M. Alexandrov showed that he was one of pioneers in developing and implementing in the USSR the endotracheal anesthesia in surgical interventions on the organs and tissues of face and neck, the author of some methods of reconstructive surgeries: upper jaw resection with primary plasty; otoplasty with using the Philatov stalk and local tissue; lower lip plasty using two symmetrical upper lip flaps and others. Methods of treatment of purulent diseases of maxillofacial region and neck with the use of hyperbaric oxygenation, laser therapy and low-frequency ultrasound, laser therapy of temporomandibular joint diseases, as well as cryosurgery of new growths of face and mouth organs, a number of methods of microsurgery and electric anesthesia in dentistry, hemostatic drug "Kaprofer" were developed under his scientific guidance and introduced into the clinical practice.&#x0D; Conclusions. N.M. Alexandrov was an excellent clinician, a brilliant teacher and surgeon, a prominent scientist and organizer of military health care; his colleagues and pupils remember him today and honour his merits in the field of maxillofacial surgery and military health care.

Reprofiling Hydrogen Peroxide from Antiseptics to Pyolytics: A Narrative Overview of the History of Inventions in Russia

Pyolytics are drugs that dissolve thick pus when applied topically. This group of drugs was discovered in early 21st century in Russia as a result of successful repurposing of antiseptics hydrogen peroxide, sodium bicarbonate and sodium chloride from antiseptics to pyolytics. Prior to this watershed event in pharmacy, the problem of effective treatment of purulent diseases had not been solved. The fact is that before that in the treatment of various purulent diseases mainly antiseptics and disinfectants solutions were used, of which hypertonic sodium chloride solution and 3 - 6% hydrogen peroxide solutions took the leading role as "antipurulent" drugs. However, the use of the known antiseptics and disinfectants solutions provided disinfection of the treated surface, but not dissolution of thick pus masses, as the solutions had no effective pyolytic action. Pyolytic activity, i.e. activity of dissolution of thick pus masses, was fantastically increased in hydrogen peroxide solutions only after the possibility of transformation of "old" drugs into "new" drugs by means of artificial changes in physical and chemical properties of their dosage forms was discovered. The greatest (explosive) effect was achieved by developing warm alkaline hydrogen peroxide solutions enriched with oxygen gas under increased pressure. In chronological order, an overview is given of Russian inventions, which formed the basis for the physicochemical repurposing of hydrogen peroxide solutions into pyolytics as well as the basis of temperature and physicochemical pharmacology and pharmaceutics.

Efficiency of Prontosan in Complex Treatment of Purulent Wounds

The treatment of purulent wounds is still one of the primary and not fully resolved problems of surgery. This is due to the fact that in the structure of patients in general surgical hospitals, patients with purulent diseases of soft tissues account for 30-35%, and the number of patients with postoperative purulent complications increases, which is associated with an increase in the admission of patients with destructive processes, the imperfection of preventive measures used in the moment of the operation and after it, the appearance of antibiotic-resistant forms of microflora and a decrease in the immunobiological reactivity of the population. To improve the results in the complex treatment of purulent wounds through the use of Prontosan. The research was carried out on the basis of surgery, obstetrics and gynecology department of Osh State University and in the surgical departments of the Osh City Clinical Hospital and the Osh Interregional United Clinical Hospital. Complications contribute to changes in the structure and nature of purulent lesions of soft tissues and an increase in the number of patients with purulent wounds and their complications. Introduction of measures for prevention and treatment of purulent-inflammatory complications improves results of treatment in patients with acute appendicitis and cholecystitis, as well as with purulent diseases of soft tissues. Surgeons received reasonable recommendations on the prevention of complications with the use of Prontosan.

Inhibitory effect of extracts of hainosan (painongsan) and its constituent crude drugs on production of monocyte chemoattractant protein‐1 and interleukin‐6 in murine fibroblasts treated with Porphyromonas gingivalis

AbstractAimHainosan (painongsan), composed of Platycodon grandiflorum root (PG), Paeonia lactiflora root (PL), and Citrus aurantium immature fruit (AF), is a formula used in traditional Japanese (Kampo) and Chinese medicine to treat purulent diseases, including gingivitis. In this study, we investigated the anti‐inflammatory effects of hainosan extract (HNS) using both traditional direct and serum pharmacological techniques.MethodsBALB/c mice were orally treated with HNS or extracts of its constituent crude drugs for one week. Murine RCB2767 fibroblasts were incubated with a medium containing heat‐killed Porphyromonas gingivalis and HNS, extracts of the constituent crude drugs, or serum samples collected from mice orally treated with these extracts. The monocyte chemoattractant protein 1 (MCP‐1) and interleukin (IL)‐6 in the medium were measured by enzyme‐linked immunosorbent assay (ELISA). The effect of HNS and its constituent crude drugs on the proliferative potential of fibroblasts was evaluated by radioisotope‐labeled thymidine uptake capacity.ResultsThe concentrations of MCP‐1 and IL‐6 in the culture supernatants were significantly increased by treatment with heat‐killed bacteria. In addition, PG and PL extracts significantly inhibited MCP‐1 and IL‐6 production. Furthermore, supplementation of serum samples from mice orally treated with the extracts to the culture medium resulted in significant inhibition of induction of these cytokines. HNS, extracts of PG, PL and AF, and serum samples collected from mice treated with these extracts significantly augmented 3H‐thymidine uptake in fibroblasts.ConclusionOur results demonstrated that HNS has anti‐inflammatory effects in murine fibroblasts and that PL and PG could contribute to the effects of hainosan.

Ускорение заживления экспериментально моделированных гнойных ран при локальном криовоздействии

BACKGROUND: Purulent diseases of the skin and subcutaneous tissue remain a widespread and urgent problem. The most promising methods of treatment with the active use of physical factors affecting the purulent focus are in the conditions of modern increasing resistance of microorganisms. AIM: To determine the effect of local ultra-low temperatures on the inflammatory and reparative processes in an experimental septic wound of soft tissues for planning a subsequent clinical study of the effectiveness of debridement using cryotherapy. MATERIALS AND METHODS: The experiment was conducted on 40 Wistar–Kyoto male rats of 9-month age, weighing 200 to 230 grams. The wound was created by excising an oval skin flap 2.0 × 1.5 cm in the withers region, followed by injection of 1.5 ml of Staphylococcus aureus solution at a concentration of 109 CFU/1 ml into the hypodermis. The animals were divided to 4 groups: a control group with the natural course of the healing process, and the main groups, which included a group with single daily treatment of the wound with Levomekol ointment, a group with a single daily treatment of the wound with vapor-drop jet of liquid nitrogen, and a group with single daily treatment with a combination of the above methods. The treatment was carried out during the exudative phase of the wound process. With the disappearance of exudation and of paravulnar edema and hyperemia, debridement in the main groups was stopped. In the dynamics, a comparative observation and study of planimetric changes in the wound were carried out. RESULTS: A more rapid decline of the severity of hyperemia, paravulnar edema and exudation, accelerated filling the wound with granulation tissue, accelerated epithelialization were seen in treatment with cryotherapy compared with treatment with Levomekol. These effects led to increase in the rate of wound healing due to the shortening of all phases of the wound process by at least 2 days. There were no statistically significant side effects, healing and survival occurred in all animals. CONCLUSION: In was found in the study that the use of cryotherapy leads to a rapid subsidence of symptoms, activates the processes of granulation and epithelization. Mutual potentiation of the positive effects of debridement using ultra-low temperatures and antibacterial agents has been established. Cryotherapy proved to be a safe and effective means of treating septic wounds, which does not prevent and makes it possible to conduct further clinical studies.

Review of methods of impact on the wound process animals (literary review)

The present work is devoted to the study of the course of the wound process in animals as well as possible factors influencing it. The topicality of the research in this topic consists in the fact that the experimental results help to increase the survival rate among the animals which have undergone the operation, to accelerate healing, to reduce the organism rehabilitation time, to avoid the bacterial contamination of wounds, purulent diseases and re-infection, to reduce the trauma level in animals, promote the introduction of new efficient pharmacological methods of prevention and suppression of surgical infections, application of laser and ultrasound equipment, discover and use new medicines. The aim of the study. The aim of this work is to conduct a general literature review on the methods of wound management in animals. This review focuses on papers from 2012 to 2022, citing various factors that influence the wound process in order to outline the need for wound management. To make it more manageable and to speed up wound healing in animals, as well as to point out the need for additional wound management models. Conclusion. The use of a complex graft and matrix based on dextran phosphate gel, stem cells and miliacyl has been shown by biological factors to promote healing. A positive alkaline environment has been shown to promote reepithelisation, as it has no adverse effect, in contrast to a strongly acidic environment. In addition, gamma radiation treatment was found to accelerate healing. From this we can conclude that the literature review conducted on this topic indicates the relevance of the area under consideration, and further developments and more in-depth studies are required, as wound processes are a scientific problem that needs to be solved.

Topical antibiotic therapy for perforated otitis in the COVID-19 pandemic

The developing resistance of microorganisms to the effects of antibacterial drugs creates difficulties in the treatment of purulent diseases. This is especially reasonable in the pandemic of a new coronavirus infection (COVID-19). The aggressive effect of new strains of the virus on the mucous membrane of the nasal cavity and nasopharynx contributes to the occurrence of complications such as acute purulent otitis media and exacerbation of chronic purulent otitis, both during coronavirusinfection and in the postcovid period. Even before the start of the pandemic, antibiotic resistance was already one of the big problems in most countries of the world, this was due to the frequent unjustified appointment of systemic antibacterial agents for viral infection, as well as uncontrolled self-medication of the population with all available drugs. Due to the fear of people getting sick with COVID-19 and disagreements among doctors in treatment tactics, the use of systemic antibiotics and hormonal drugs increased already in the first months of the pandemic. In the future, the unjustifiability of this tactic was proved, but many doctors continued to prescribe several systemic antibacterial drugs to patients with uncomplicated viral infection. Under the current conditions, when there is evidence of bacterial infection, it is rational to use local antibacterial drugs, which allows you to quickly reach high concentrations in the focus of inflammation and avoid side effects of systemic antibiotics. Among the existing means in the complex therapy of perforated otitis, a special place belongs to the preparations of the group of quinoxaline derivatives, which include hydroxymethylquinoxalindioxide (Dioxidine). The advantage of the drug is its effectiveness against resistant microorganisms, as well as stimulation of marginal tissue regeneration. This property is especially important in the treatment of perforated otitis media.

USING NITRIC OXIDE DONOR SOLUTION WITH VACUUM THERAPY IN THE TREATMENT OF PURULENT WOUNDS OF SOFT TISSUES

In recent years, the incidence of purulent septic soft tissue diseases has decreased insufficiently. In order to improve the results of surgical treatment of purulent soft tissue processes, vacuum therapy with instillations of L-arginine, a nitric oxide donor solution, has been developed. This method is complementary to the complex surgical treatment: it accelerates wound cleaning, reduces microbial contamination, and causes a wound surface decreasing, promotes the development of tissue granulation and epithelisation processes. This article presents the clinical case of successful application of vacuum therapy with the nitric oxide donor (L-arginine) installation in a patient after the drainage of phlegmon in the right thigh. The patient underwent a course of vacuum instillation therapy, which consisted of three changes of sponge and tubes after their use for three days. After a course of local instillation vacuum therapy, the patient's condition became better. Starting from day 3, there was a decrease in the number of leukocytes and erythrocyte sedimentation rate in the general blood test and, accordingly, decreased leukocyte intoxication index, and on day 4 there was no hyperaemia and oedema. When opening the phlegmon from the wound infected by St. aureus, and during vacuum instillation therapy with a solution of donor nitric oxide microbial decontamination the results of intermediate cultures were not observed. The wound was completely cleaned, filled with pale pink granulations, which allowed for 10 days to put secondary sutures on the wound, which were removed on the 7th day in the ambulatory after complete healing of the wound.

Alkaline Hydrogen Peroxide Solution is an Expectorant, Pyolytic, Mucolytic, Hemolytic, and Bleaching Drug for Treating Purulent Diseases, Hematomas and Bruising

It has been established that warm alkaline solutions of hydrogen peroxide with local interaction with thick pus, mucus, sputum and blood have local pyolytic, mucolytic and hemolytic effects. It was found that the dissolving effect is associated with the alkaline properties of the drug, which are provided by sodium bicarbonate. Sodium bicarbonate provides the process of alkaline saponification of proteins and protein-lipid complexes. It is shown that hydrogen peroxide intensively decomposes into water and oxygen gas under the action of the catalase enzyme. In turn, catalase is always present in blood, mucus, sputum, pus, fibrous and serous fluid. At the same time, the released oxygen forms gas bubbles that literally tear apart biological masses during cold boiling and turn them into fluffy white foam. At the same time, the appearance of oxygen in an alkaline environment ensures the process of discoloration of biological pigments, such as hemoglobin and its color metabolites. The indicated pharmacological effect of a warm alkaline solution of hydrogen peroxide at local interaction is proposed to be used for the treatment of purulent diseases, thrombosis, bruising and hematomas. The technologies of using the drug for urgent restoration of breathing in obstructive purulent bronchitis, for urgent discoloration of the skin and nail plate with bruising and hematoma, as well as for urgent and safe peeling of a bloody bandage from a wound are listed.

Abdominal pain in children with intraabdominal purulent diseases and acute complications of type I diabetes mellitus: a non-systematic review

Annotation. The prevalence of type I diabetes mellitus (T1DM) among children in Ukraine reached 9105 patients in 2018 and continues to rise. Differential diagnosis of abdominal pain in ketoacidosis and intraabdominal purulent diseases is an important factor contributing to prompt and appropriate management of such patients. We analyzed the prevalence of T1DM in different age groups and specific features of abdominal pain related to its complications and concomitant intraabdominal purulent diseases in childhood in this article. Scientific research for the period from 2008 to 2021 was carried out according to the primary search strategy “type I diabetes mellitus” (T1DM, pediatric, children, prevalence), “ketoacidosis” (ketoacidosis, diabetic ketoacidosis, children), “abdominal pain” (acute abdominal pain, children), “acute appendicitis” (acute appendicitis, pediatric, children) and the combination of AND/OR in the scientometric databases MEDLINE (PubMed), Scopus, Web of Science. The leading role in the pathogenesis of pain belongs to electrolyte imbalance (acidosis) arising from the accumulation of intermediate products of fat oxidation. Abdominal pain in intraabdominal purulent diseases includes visceral, somatic parietal, and irradiating elements. The coincidence of onset peaks of intraabdominal purulent diseases, accompanied by acute abdominal pain and T1DM in this population requires the development of a standardized algorithm for the differential diagnosis of these pathologies.

The Prevalence and Structure of ENT Diseases in Children

The purpose of the study was to analyze information on the structure and prevalence of ENT diseases in children. Materials and methods. For the analysis of morbidity, the structure of diseases, long-term morbidity, its trends and periodicity were assessed. The intensity and dynamics of the epidemic process of diseases of the upper respiratory tract were studied. According to the developed questionnaire, an anamnesis was collected, the conditions and place of residence, the frequency of visits to medical institutions, the level of medical care provided, the presence of diseases of the ENT organs and other organs and systems of the body were clarified. A detailed statistical analysis of the structure and prevalence of diseases of the ENT organs was carried out according to the extract from the case histories of patients in the ENT departments of the clinical hospital during 2015-2019. The bulk of the examined children were aged 4-7 years (40.0%) and 8-14 years (60.0%). Results and discussion. Angina and chronic tonsillitis can be a common reason for the high incidence of various forms of infectious heart disease and cardiomyopathies. The transnasal route of penetration provides the damaging effect of the new coronavirus infection (COVID-19) on the ENT organs. In the study of the structure of the incidence of ENT organs for the period from 2015 to 2019 on the basis of specialized medical institutions and ENT departments, we found that the largest nosological group is diseases of the nasal cavity and paranasal sinuses, an average of 55.7%, which corresponds to the data of international literary sources. In second place in terms of frequency of occurrence is ear pathology – an average of 37.5%. Diseases of the pharynx and larynx are in third place in terms of general ENT morbidity, on average 6.9%. In the structure of diseases of the nasal cavity and paranasal sinuses, on average for 5 years, purulent diseases of the paranasal sinuses prevail: acute sinusitis 20.7% and chronic sinusitis 7.8%. Conclusion. When studying the incidence of the upper respiratory tract and ear according to statistical data, reflecting the main indicators of the health of the child population of the country aged 4 to 14 years, it was found that diseases of the nose and paranasal sinuses have the largest share in the structure of the incidence of children. The share of chronic ear diseases in the structure of the total morbidity is 37.5±1.2%, while there is a tendency to increase in prevalence in the first four years