[Acute and chronic rhinosinusitis age characteristics]. / Vozrastnye osobennosti techeniya ostrogo i khronicheskogo rinosinusita.

Children's and adults' rhinosinusitis are two diseases that have both similarities and differences in anatomy, epidemiology, causes, pathogenesis, diagnosis and treatment. At the same rhinosinusitis is one of the most common in otorhinolaryngology's practice, both in children and adults. The of adults paranasal sinuses (PNS) anatomy differs from children's PNS anatomy. Although ostiomeatal complex occlusion is recognized as a major cause of poor ventilation and drainage of the adult paranasal sinuses, it does not have a strong effect on pediatric rhinosinusitis, but adenoids play a key role. Adenoids are bacteria and biofilms reservoirs that cause chronic refractory rhinosinusitis regardless of pharyngeal tonsil size. The prevalence of chronic rhinosinusitis (CRS) is lower in children than in adults. Diagnosis of children's rhinosinusitis is more difficult because nasal cavity endoscopic examination is performed rarely due to the occasional need of general anesthesia during the procedure. Moreover, it's necessary to take into account prevailing etiological role of viruses in ARS at children's age and chronic adenoiditis often accompanies pediatric CRS, which requires attention prescribing medical therapy as the basis of rhinosinusitis treatment. The DysheLORz based on Pelargonium sidoides roots is highly effective and safe for children's and adults ARS and CRS treatment, both as monotherapy and in combination with topical steroids and antibiotics. This herbal medicine immunomodulatory effect is mediated mainly by stimulating the production of TNF-α, IL-1, IL-12 and IFN-γ. It activates macrophages and improves their phagocytic activity. IL-12, together with TNF-α, enhances NK and cytotoxic CD8+ lymphocytes' activity against infected cells. IL-12 effect on Th1 lymphocytes maturation provides a link between innate and adaptive immunity. This is also increasing MCP-1, IP-10 and MIP-1ß chemokines synthesis and decreasing MIP-1α, ENA-78, GROα and IL-8 production in PNS and nasal mucosa. This leads to decrease of neutrophils chemotaxis to the inflammation site, and decline of serine proteases concentration (neutrophils main enzymes), that increases mucous membrane epithelial barrier permeability, reducing bacterial infections risk. Additionally, Pelargonium sidoides increases epithelial cells beating cilia frequency and inhibits hemagglutinin and neuraminidase present on influenza virus surface. The drug increases antimicrobial peptides production as defensins, human neutrophil peptides (HNP) and bactericidal permeability-increasing protein (BPI), which is also important for rapid inflammation regression in rhinosinusitis. It causes bacterial adhesion to epithelial cells inhibition, phagocytosis stimulation, nitric oxide (NO) release and oxidative burst. The medicine had a direct effect on Streptococcus pneumoniae, Staphylococcus aureus, Neisseria, Moraxella catarrhalis and Haemophilus influenza. Based on these data, it is possible to explain the high effectiveness and safety of the drugs based on Pelargonium sidoides in ENT organs inflammation treatment, for both adults and children over 1 year old.

PO-59 - Hemorheologic disturbances as thrombosis risk factor in patients with some myeloproliferative neoplasms.

INTRODUCTION: In today's antithrombotic prevention we forget that hemorheologic abnormalities are part of Virchow's triad. Isn't this one of reasons that venous thromboembolism (VTE) including catheter-related thrombosis (CRT) retain high frequency despite of modern antithrombotic therapy? AIM: The aim was to investigate rheological behavior of blood in patients with some myeloproliferative neoplasms. MATERIALS AND METHODS: The study included 16 adults with Polycythemia Vera (PV), 42 young with acute lymphoblastic leukemia (ALL), and 67 healthy donors as control group. Of patients 38% had thrombosis. We measured plasma viscosity, and whole blood viscosity (WBV) by shear rate from 300 to 5 s-1. Then indices were calculated for erythrocyte aggregation, and deformability, and non-Newtonian behavior of blood. Hematocrit, erythrocytes count, erythrocyte indices, leukocyte count, fibrinogen and B-type natriuretic peptide (BNP) were analyzed simultaneously. RESULTS: Increased WBV revealed totally in PV-patients but not by all shear rates in ALL-patients. Unlike donor, in patients WBV values had no equivalence under sequential one sample measurements with a decrease and then an increase of shear rates. We speculated this difference becomes diagnostic meaning like one and by its size. WBV dependent on leukocytes count, on MCH and mainly on MCV. Forty percent of patients had elevated BNP assuming subclinical cardiac dysfunction. The latter explains discoordinated changes in shear stress values required for fully reversible erythrocyte aggregation. As a result, residual units like "erythrocyte-erythrocyte" and/or "erythrocyte-leukocyte" interferes blood stream and violates mechanically blood flow in small vessels. Moreover in PV-patients but not in ALL-patients we found loss of non-Newtonian behavior of blood later than in control group. Both myeloproliferative neoplasms lead to increased erythrocyte aggregation but not impair deformability of red blood cells. In total these facts explains chronic hypoxia in these patients. CONCLUSIONS: Patients with some myeloproliferative neoplasms has abnormal blood flow properties. Revealed hemorheologic disturbances could be as a trigger to start of VTE or to growth of blood clot in the area of permanent venous catheter. These non-hemocoagulation conditions leaded for thrombus formation makes hemorheologic therapy looking attractive for antithrombotic management. The choice of targeted methods requires to continue this study.

[Sensitivity of Corynebacterium diphtheriae isolated in Saint-Petersburg to antibacterial drugs]. / Chuvstitel'nost' k antibakterial'nym preparatam Corynebacterium diphtheriae, vydelennykh v Sankt-Peterburge.

One hundred and thirty strains of Corynebacterium diphtheriae isolated in St. Petersburg (42 toxigenic and 88 nontoxigenic) were tested with the method of serial dilutions in solid media for their susceptibility to 20 antibacterial drugs. The MICs of the drugs for the isolates ranged from < or = 0.015 to > or = 32.0 micrograms/ml. 13 per cent of the isolates was resistant at least to one antibacterial drug. The isolates resistant to erythromycin (11.5 per cent), lincomycin (11.5 per cent) and trimethoprim (8.5 per cent) were most frequent. 3 isolates (2.3 per cent) had multiple resistance to 8 drugs: benzylpenicillin, ampicillin, oxacillin, chloramphenicol, erythromycin, lincomycin, trimethoprim, and nitroxolin. No significant differences in the susceptibility of the toxigenic and nontoxigenic strains of C. diphtheriae were detected. Gentamicin, rifampicin, tetracycline, doxycycline and pefloxacin were the most active antibiotics.

A plasmid-mediated beta-lactamase conferring resistance to cefotaxime in a Salmonella typhimurium clone found in St Petersburg, Russia.

Four clinical and two environmental isolates of cefotaxime-resistant Salmonella typhimurium strains collected in St Petersburg, Russia, were studied. Molecular typing demonstrated that they constituted a single clone. The isolates expressed a cefotaxime-hydrolysing beta-lactamase with a pl of 8.4. The enzyme was encoded by a 12 kb plasmid which did not hybridize with TEM, SHV or ampC probes.

[Susceptibility of Corynebacteria isolated in St Petersburg to antibacterial drugs]. / Chuvstvitel'nost' k antibakteral'nym peparatam korinebakteril, vydelennykh v Sankt-Peterburge.

Susceptibility of 150 Corynebacterium isolates (91 strains of C.pseudodiphtheriticum and 59 strains of the ANF group corynebacteria) to 21 antibacterial drugs was determined by the method of serial dilutions in a solid medium. It was shown that the MIC of the drugs for the diphtheroids was within the ranges of < 0.015 to > 32.0 micrograms/ml. 66 per cent of the Corynebacterium strains circulating in St. Petersburg was resistant at least to 1 antibacterial drug. The Corynebacterium isolates with moderate resistance to erythromycin and lincomycin (57.3 per cent) and resistant to trimethoprime (16.7 per cent) were the most frequent. 8.0 per cent of the diphtheroids was resistant at least to 4 antibacterial drugs. No significant difference in the susceptibility of the ANF group corynebacteria and C.pseudodiphtheriticum to the drugs was observed. Gentamicin, rifampicin, tetracycline and doxycycline showed high activity against the corynebacteria at present circulating in St. Petersburg. When antibacterial therapy of the infection due to corynebacteria fails it is necessary to estimate antibioticograms of Corynebacterium pure cultures.

[Mechanisms of resistance to quinolones and current level of sensitivity of clinically important microorganisms to ofloxacin]. / Mekhanizmy ustoichivosti k khinolonam i sovremennyi uroven' chuvstvitel'nosti klinicheski znachimykh mikroorganizmov k ofloksatsinu.

The data on the mechanisms of microbial resistance to fluoroquinolones are presented. Comparison of the susceptibility levels of the microorganisms isolated on the territory of Russia showed that among the gram-negative opportunistic isolates 84 per cent was susceptible to ofloxacin, 45 per cent to ampicillin/sulbactam, 70 per cent to cefotaxime, 80 per cent to ceftazidime, 85 per cent to amikacin and 62 per cent to gentamicin. Among the Salmonella, Shigella and Vibrio cholerae isolates no strains were resistant to ofloxacin. Among the Salmonella isolates from patients more than 30 per cent was resistant to ampicillin, chloramphenicol, trimethoprim/sulmethoxasole and tetracycline. Among the Salmonella isolates 65 to 90 per cent was resistant to the antibiotics. Among the V.cholerae isolates 59 per cent was resistant to trimethoprim/sulmethoxasole.

[Plasmids of antibiotic-resistant strains of Salmonella of varying origin, circulating the Saint-Petersburg and Leningrad region]. / Plazmidy antibiotikorezistentnykh shtammov sal'monell razlichnogo proiskhozhdeniia, tsirkuliruiushchikh v Sankt-Peterburge i Leningradskoi oblasti.

Two hundred and twenty Salmonella strains of various serovars isolated from different source in St. Petersburg and the Leningrad Region in 1984-1991 were investigated. It was shown that drug resistance in 39.3 per cent of the strains was determined by conjugative R plasmids with the molecular weights of 28 to 90 mD which transferred at a rate of 10(-4) to 10(-8). Thirteen detected types of the Salmonella conjugative R plasmids differing in the resistance markers, molecular weights and conjugative transfer rates most frequently contained the genes responsible for the resistance to tetracycline (97.7 per cent), chloramphenicol (92.0 per cent), streptomycin (83.0 per cent), kanamycin (76.1 per cent), monomycin (76.1 per cent) and neomycin (76.1 per cent). The conjugative R plasmids were mainly detected in S> typhimurium (92.9 per cent), especially in the isolates from humans (97.6 per cent). The most frequent plasmid type in the Salmonella strains of this serovar was that with the molecular weight of 90 mD carrying the genes of resistance to chloramphenicol, tetracycline, streptomycin, kanamycin, monomycin and neomycin.

[Sensitivity to antibacterial drugs of Salmonella isolated from various sources in Saint-Petersburg and Leningrad region]. / Chuvstvitel'nost' k antibakterial'nym preparatam sal'monell, vydelennykh iz razlichnykh istochnikov v Sankt-Peterburge i Leningradskoi oblasti.

The position of antibiotic resistant cultures among 1706 strains of 85 Salmonella serovars isolated from various sources in St. Petersburg and the Leningrad Region in 1984-1991 amounted to 16.4 per cent. The highest position of such cultures was among the isolates from humans (20.9 per cent). The positions of the isolates from animals, birds and environment were practically equal (13.8, 13.8 and 13.7 per cent respectively). Strains resistant to streptomycin (11.9 per cent), tetracycline (11.5 per cent) and chloramphenicol (11.2 per cent) were the most frequent Salmonella isolates from the different sources. Rifampicin, amikacin, thienamycin, nitroxolin, oxolinic acid, dioxidin, ciprofloxacin and pefloxacin proved to be highly active against the isolates. No significant difference in the antibiotic resistance spectra of the Salmonella strains circulating in different biotopes was detected. However, among the Salmonella isolates from humans there undoubtedly predominated polyresistant strains with the resistance spectra including 10 and 6 antibacterial drugs (42.4 and 28.8 per cent of the resistant strains respectively). Sometimes there was observed correlation between the serovars of the Salmonella strains (independent of the isolation source) and the most characteristic spectra of their antibiotic resistance. Thus, the antibiotic resistant spectra of 79 per cent of the S. typhimurium strains and 82.5 per cent of the S. haifa strains resistant to one and more antibacterial drugs were the following: CmTcSmKmMmNm and ApCbCmTcSmKmMmNmGmNal respectively.

[Plasmids of antibiotic-resistant strains of Shigella isolated in Leningrad and Leningrad region]. / Plazmidy antibiotikorezistentnykh shtammov shigell, vydelennykh v Leningrade i Leningradskoi oblasti.

Sensitivity of 232 strains of Shigella spp. isolated in Leningrad and the Leningrad Region in 1984-1989 (193 strains of S. sonnei and 39 strains of S. flexneri) was tested by the method of serial dilutions with respect to 14 antibacterial drugs. 94 per cent of the isolates were resistant to 2 and more antibiotics, strains resistant to streptomycin and tetracycline being the most frequent, i.e. 94 and 91.8 per cent respectively. Among the 6 antibiotic resistance spectra detected, 2 predominated, i.e. TcSm and ApCbCmTcSm resistance spectra (47.2 and 39.9 per cent of the resistant strains respectively). The drug resistance in 49.5 per cent of the resistant strains was determined by conjugative R plasmids. Five types of conjugative R plasmids were revealed. They mainly contained genes determining resistance to streptomycin (100 per cent), ampicillin (97 per cent), carbenicillin (97 per cent), tetracycline (96 per cent) and chloramphenicol (90.1 per cent). The conjugative plasmid type with the molecular weight of 64 mD carrying the genes of resistance to ampicillin, carbenicillin, chloramphenicol, tetracycline and streptomycin was the most frequent in the Shigella isolates.

[Detection of the determinants of tetracycline A, B and C resistance in Shigella and Salmonella using DNA probes]. / Opredelenie determinant resistentnosti k tetratsiklinu klassov A, B i C u shigell i sal'monell s pomoshch'iu DNK-zondov.

Genetic determinants of tetracycline resistance of classes A, B and C were detected with DNA probes labeled with radioactive phosphorus (32P) in Shigella (44 strains) and Salmonella (50 strains). It was shown that in the Shigella strains the frequency of the Tet A gene amounted to 66 per cent, the frequency of the Tet B gene was equal to 84 per cent, the frequency of their combination was equal to 50 per cent and the frequency of the Tet C gene was nil. In the Salmonella strains the frequency of the Tet A, Tet B and Tet C genes was equal to 0.100 and 20 per cent, respectively, and that of their combination amounted to 20%. Possible use of the DNA probes in epidemiological analysis of outbreaks of Shigella and Salmonella infections is suggested.

[Sensitivity of antibiotic-resistant strains of Salmonella to new antibiotics and chemotherapeutic agents]. / Chuvstvitel'nost' antibiotikoustoichivykh shtammov Sal'monell k novym antibiotikam i khimiopreparatam.

One hundred and sixty two antibiotic resistant strains of Salmonella isolated within 1984-1988 in Leningrad and the Leningrad Region were tested with respect to their sensitivity to new antibiotics and chemotherapeutics developed or being developed in the USSR. At the background of high numbers of circulating Salmonella strains resistant to the routinely used antibiotics such as doxycycline, streptomycin and gentamicin they appeared to be highly sensitive to amikacin, ciprofloxacin, pefloxacin and the 3rd generation cephalosporins i.e. ceftazidime and cefotaxime as well as to thienamycin. These modern antibacterial agents are possibly to be the drugs of choice in etiotropic treatment and chemoprophylaxis of septic acute intestinal infections due to Salmonella strains with multiple resistance. Resistance of individual Salmonella strains to cefotaxime and ceftazidime indicated that it was possible to use their property for additional labeling of the pathogens within a serological type of Salmonella while conducting epidemiological examinations during outbreaks of acute intestinal infections of Salmonella etiology.

[Antibiotic resistance plasmids in Salmonella strains isolated from various sources]. / Plazmidy antibiotikorezistentnosti shtammov sal'monell, vydelennykh iz razlichnykh istochnikov.

Resistance of 60 Salmonella strains to aminoglycoside antibiotics was studied. It was found that 51 strains had a multiple resistance to the antibiotics used. By the antibiotic resistance phenotypes, the strains were divided into three major groups. Analysis of the extrachromosomal DNA revealed the presence of plasmids in 48 antibiotic resistant strains and 6 antibiotic sensitive strains. The plasmids transferred by conjugation to the E. coli recipient from 21 antibiotic resistant strains. The 150-kb plasmids transferred in all the strains. The 100-kb plasmids additionally transferred in 5 strains. The high molecular weight plasmids that transferred to the recipient strain by conjugation encoded resistance to all the aminoglycosides used.