Anal Monkeypox Disease: Description of 65 Cases.

BACKGROUND: Monkeypox is a zoonosis endemic in Africa caused by 3 orthopoxvirus clades. Knowledge of the disease is limited, but a worldwide outbreak involving a new route of transmission was declared in April 2022. OBJECTIVE: This study aimed to describe anal symptoms and outcomes in patients infected with Monkeypox virus presenting to an emergency proctology unit in Paris. DESIGN: This was an observational study. SETTING: We reported anal symptoms of all consecutive patients with monkeypox anal infection in a single proctology center between June 16, 2022, and July 26, 2022. Association with sexually transmitted infections and outcomes were also recorded. PATIENTS: Sixty-five men with a mean age of 39.6 (19.9-64.6) years with confirmed monkeypox anal infection were included in the study. MAIN OUTCOME MEASURES: Anal symptoms and their severity were clinically assessed. A favorable outcome consisted of a complete resolution of clinical manifestation. RESULTS: Sexual transmission was reported in 51 patients (78.4%), among whom 63 (97%) were men who have sex with men. Twenty-eight (43%) were living with HIV, and 24 (36.9%) were taking tenofovir/emtricitabine for HIV preexposure prophylaxis. Anal symptoms appeared first in 36 patients (55.4%) and skin rash or other general symptoms in 22 patients (33.8%). Incubation time was 6.9 (1-26) days. Symptoms included painful perianal (n = 42 patients; 64.6%), anal (n = 28, 43%), and rectal (n = 25; 38.4%) ulcerations and perianal vesicles (n = 24; 36.9%). Proctitis was observed in 49 patients (75.4%). It was mild in 20 (40.8%) and intense in 29 (59.2%), and severe proctitis mimicking high intersphincteric suppuration was found in 4 (8.2%). Fifteen patients (23.1%) had concurrent sexually transmitted infection and 3 were hospitalized. Complete symptom resolution occurred within 12 days. LIMITATIONS: We performed a single-center study during a short period of time. CONCLUSIONS: Proctological symptoms are frequent in the current outbreak of monkeypox disease, probably linked to the route of transmission. Rectal ulcerations mimicking high intersphincteric suppuration should be recognized to avoid unnecessary surgery. See Video Abstract . ENFERMEDAD ANAL DE LA VIRUELA DEL MONO DESCRIPCIN DE CASOS: ANTECEDENTES:La viruela del simio mono es una zoonosis endémica en África causada por tres clados de orthopoxvirus. El conocimiento de la enfermedad es limitado, pero en abril de 2022 se declaró un brote mundial que implica una nueva vía de transmisión.OBJETIVO:Describir los síntomas anales y los resultados en pacientes que sufren de infección por Monkeypox que asistieron a una unidad de proctología de emergencia en París.DISEÑO:Un estudio observacional.ESCENARIO:Informamos los síntomas anales de todos los pacientes consecutivos con infección anal por viruela del mono en un solo centro de proctología entre el 16/6/2022 y el 26/7/2022. También se registró la asociación con infecciones de transmisión sexual (ITS) y el resultado.PACIENTES:Sesenta y cinco hombres de 39,6 [19,9-64,6] años con infección anal confirmada.PRINCIPALES MEDIDAS DE RESULTADO:Los síntomas anales y su gravedad se evaluaron clínicamente. Un resultado favorable consistió en una resolución completa de la manifestación clínica.RESULTADOS:La transmisión sexual se informó en 51 (78,4%) pacientes, de los cuales 63 (97%) eran hombres que tuvieron sexo con hombres. Veintiocho (43%) vivían con el VIH y 24 (36,9%) tomaban Emtricitabina/Tenofovir para profilaxis previa por exposición al VIH. Los síntomas anales aparecieron primero en 36 (55,4%) pacientes y la erupción cutánea u otros síntomas generales en 22 (33,8%). El tiempo de incubación fue de 6,9 [1-26] días. Los síntomas incluyeron ulceraciones perianales dolorosas (n = 42 pacientes, 64,6%), anales (n = 28, 43%), rectales (n = 25, 38,4%) y vesículas perianales (n = 24, 36,9%). Se observó proctitis en 49 (75,4%) pacientes. Fue leve en 20 (40,8%) e intensa en 29 (59,2%) y proctitis severa simulando supuración interesfinteriana alta en 4 (8,2%). Quince (23,1%) pacientes presentaban ITS concurrentes y 3 fueron hospitalizados. La resolución completa de los síntomas ocurrió dentro de los 12 días.LIMITACIONES:Estudio de un solo centro y durante corto período de tiempo.CONCLUSIÓN:Los síntomas proctológicos son frecuentes en el brote actual de la enfermedad de la viruela del mono, probablemente relacionados con la vía de transmisión. Las ulceraciones rectales que simulan una supuración interesfinteriana alta deben reconocerse para evitar una cirugía innecesaria. (Traducción-Dr. Fidel Ruiz Healy ).

Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification.

AIM: This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND: Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION: This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION: During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE: Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.

Exploring Diagnostic Strategies for Streptococcal Throat Infection Remotely: A Feasibility Study.

Context: Acute sore throat is a common presentation in primary care and often results in antibiotic prescription. The Covid pandemic has driven changes in consultation with less face to face visits. Scoring tools are available to target antibiotics and widely used in the UK but it is not clear whether patient self assessment is feasible and sufficiently precise to enable remote use of scoring tools. Objective: A feasibility study to develop and test remote assessment of acute sore throat. Design: Observational study Setting: UK primary care Population: Adults and children with sore throat were asked to use the online tool and report their clinical findings directly Intervention: An online tool was developed that could help patients or parents of children with sore throat assess the clinical features that make up clinical prediction rules and to take a photograph of the throat Results: 221 patients with sore throat were screened and 45 (33 adults and 12 children) were recruited. 44/45 (97.8%) participants were able to complete all elements of the clinical assessment. It was possible to calculate a FeverPAIN score for 25 (75.8%) adults and 10 (83.3%) children. 35 participants (25 (75.8%) adults and 10 (83.3%) children) provided a throat photograph but many of these were not of sufficient quality to enable assessment of throat pus and inflammation. Poor lighting and focus were the main problems. Photos that were of sufficient quality were available from 13 (39.4%) adults and 5 (41.7%) children. Three GPs independently assessed these photographs to assess for inflammation and pus. Using the clinician assessment as the reference standard, self/parent/carer assessment of inflammation had a sensitivity of 100%, specificity of 46.7%, positive predictive value (PPV) of 27.3% and negative predictive value (NPV) of 100%. The sensitivity, specificity, PPV and NPV for pus were 76.5%, 100%, 71.4%, 42.9% and 100%. Conclusions: Self assessment of sore throat was possible. Photographs were of sufficient quality for clinical assessment less than half the time. Patients/parents/carers are very good at ruling out pus and inflammation, but have a tendency to overcall these findings, especially inflammation. Further implications for self assessment and future work will be described.

Internet Tool to Support Self-Assessment and Self-Swabbing of Sore Throat: Development and Feasibility Study.

BACKGROUND: Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics. OBJECTIVE: We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats. METHODS: We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients' throat photographs. RESULTS: A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples. CONCLUSIONS: Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples.

Combination of St. John's Wort Oil and Neem Oil in Pharmaceuticals: An Effective Treatment Option for Pressure Ulcers in Intensive Care Units.

Background and Objectives: Phytotherapeutically, various herbal remedies, such as St. John's wort oil, have been introduced as wound care options. Recently, Neem oil has been considered a herbal option for the management of superficial wounds. Wound care is a complex process that involves several factors including the patient, caregiver, and medications. Herbal combinations could be an alternative to the chemical counterparts in the wound care area. This report includes an investigation of the possible supportive impacts of the St. John's wort and Neem oil containing ointment (W Cura G Plus ®) in the management of pressure ulcers (PUs) in three intensive care unit (ICU) patients. Materials and Methods: The ointment was administered to individuals once daily for 42 consecutive days. The status of individuals was macroscopically monitored by measuring the PU area and histopathological assessment of the tissue sections taken on the first and last days of wound treatment. Results: The outcomes of the macroscopic and histopathological techniques exhibited that St. John's wort and Neem oil containing ointment provided a remarkable supportive impact on the patients that suffered from PUs in the ICUs. Conclusions: The combination of St. John's wort and Neem oil could be suggested as an efficient active phytoconstituent for the management of PUs. The herbal ointments may be suggested as an alternative for the patients that have PUs in the ICUs.

Clinical features and recurrence of Corynebacterium kroppenstedtii infection in patients with mastitis.

BACKGROUND: Few studies have investigated the differences in clinical features of patients with mastitis following Corynebacterium kroppenstedtii infection, and most focused on the bacterial antimicrobial susceptibility, detection methods and therapy. METHODOLOGY: There were 133 patients with mastitis infected by C. kroppenstedtii between August 2016 and September 2019. C. kroppenstedtii was identified using mass spectrometry. The demographics, clinical diagnosis, laboratory test results of different types of mastitis combined with bacillus infection, and the effects of different treatments in reducing recurrence were compared. RESULTS: The incidence of pus following C. kroppenstedtii infection was higher in patients with non-granulomatous lobular mastitis (NGLM; 56.6%) than in those with granulomatous lobular mastitis (GLM; 33.3%; χ2 = 7.072, p = 0.008). While C-reactive protein (CRP) was higher in the GLM group (12.50 mg/L) than in the NGLM group (6.05 mg/L; Z = - 2.187, p = 0.029). Treatment with local lavage (triamcinolone acetonide) and antibiotics (cefuroxime) showed a recurrent rate of 25.9% in C. kroppenstedtii infection. CONCLUSION: Increased pus, large masses, and an elevated CRP level may occur in patients with mastitis infected by C.kroppenstedtii. These clinical features may guide the determination of the bacterial infection in patients with mastitis. Combining an antibiotic with a triamcinolone acetonide lavage, preferably cefuroxime, may reduce the recurrence.

Efficacy of Human-Recombinant Epidermal Growth Factor Combined with Povidone-Iodine for Pressure Ulcers and Its Influence on Inflammatory Cytokines.

Purpose: To determine the clinical efficacy of recombinant human epidermal growth factor (rh-EGF) combined with povidone-iodine (PVI) on patients with pressure ulcers (PUs). Methods: One hundred and five PU patients treated between January 2018 and January 2021 were enrolled and retrospectively analyzed. Of them, 50 patients who received conventional treatment were assigned to the control group (Con group), while 55 patients treated with rh-EGF combined with PVI were assigned to the observation group (Obs group). The two groups were compared in clinical efficacy, PU alleviation (total area reduction rate, total depth reduction rate, and total volume reduction rate), healing time, pain degree (Visual Analog Scale [VAS] score), inflammatory indexes (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitive C reactive protein [hs-CRP]), and hydroxyproline content in the wound. Results: The Obs group yielded a higher total effective rate than the Con group (P < 0.05). The Obs group also experienced statistically shorter healing time and milder pain, with better PU alleviation and lower levels of inflammation indexes compared with the Con group (all P < 0.05). In addition, a higher hydroxyproline content in the wound was found in the Obs group. Conclusions: All in all, rh-EGF combined with PVI has a definite curative effect on patients with PUs. It can promote PU alleviation and hydroxyproline secretion in the wound and inhibit pain and inflammatory reactions, which is worthy of clinical promotion.

Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment.

PURPOSE: The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS: All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS: Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION: S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.

Observation and analysis of the efficacy of dexamethasone in combination with anti-infectious treatment on the pediatric refractory purulent meningitis.

To analyze the pathogenic bacteria, feature of drug resistance and the efficacy of dexamethasone as the auxiliary medication in pediatric refractory purulent meningitis (PM). The 190 refractory PM child patients were selected for the culture of pathogenic bacteria and analysis of drug resistance. In total, 190 pathogenic bacteria were detected, consisting of gram-positive bacteria (77.37%). Of the gram-positive bacteria, the resistance rate of patients with staphylococcus epidermidis, streptococcus pneumoniae or Staphylococcus haemolyticus to levofloxacin was 100%, while in gram-negative bacteria, the resistance rate of patients with klebsiella pneumoniae to gentamycin was 100%. In the observation group, patients had a higher effectiveness rate. Besides, patients in the observation group recovered rapidly from the fever and anomalies in cerebral spine fluid and peripheral white blood cells, and the inflammation was greatly improved. However, difference in the incidence rates of adverse reactions of patients between two groups showed no statistical significance. Pediatric refractory PM involves the pathogenic bacteria, mainly including staphylococcus epidermidis and streptococcus pneumoniae, showing a high resistance to levofloxacin, while the auxiliary medication of dexamethasone can improve the efficacy, and inhibit the inflammation.

[Complex treatment of patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome]. / Kompleksnoe lechenie bol'nykh s gnoino-nekroticheskimi oslozhneniyami pri neiropaticheskoi forme sindroma diabeticheskoi stopy.

OBJECTIVE: Of study is improving the results of treatment of patients with pyo-necrotic complications of diabetic foot syndrome by including the method of negative pressure wound treatment in the complex treatment program in combination with using of the combined antibacterial drug Cifran ST and immunocorrective therapy. MATERIAL AND METHODS: The results of examination and treatment of 184 patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome were analyzed. According to choice of treatment methods in the postoperative period all patients were divided into two groups. In 95 patients (group I), iodine-containing ointments based on polyethylene glycol were used for local treatment of purulent foot wounds and standard systemic antibacterial therapy was performed. In 89 patients (group II), negative pressure wound treatment (NPWT) was used to treat wounds in the postoperative period. In addition to standard parenteral antimicrobial therapy, these patients also received an oral combined antibacterial drug Cifran ST and immunocorrective cytokine therapy (Leukinferon). The analysis of the dynamics of the wound process was carried out based on the clinical picture and the results of cytological, bacteriological and immunological studies of the wound exudate. RESULTS: The presented strategy of complex treatment of pyo-necrotic complications of the neuropathic form of diabetic foot syndrome allowed group II patients to significantly reduce the degree of microbial contamination of wounds, to achieve a faster regression of the content of proinflammatory and inflammatory cytokines in the wound exudate, as well as to reduce the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage in comparison with group I patients. This allowed group II patients to reduce the time of plastic closure of the wound from 24.3±0.5 to 15.6±1.7 days, to avoid generalization of infection, death and high level amputation of the limb. At the same time, 11.6% of patients in group I had high level limb amputation due to generalization of infection. The mortality rate in group I was 5.3%. CONCLUSIONS: Adding of vacuum therapy of wounds, systemic antimicrobial therapy using the combined antibacterial drug Cifran ST and immunocorrective cytokine therapy in the complex treatment program for patients with neuropathic form of diabetic foot syndrome after radical surgical treatment of the pyo-necrotic lesion allows reducing the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage. On the other hand, this makes it possible for this category of patients to perform plastic closure of the wound at an earlier date, avoid generalization of infection and high level amputation of the limb.

[Modern problems of modelling and treatment of soft tissues abscesses]. / Sovremennye problemy modelirovaniya i lecheniya abstsessov myagkikh tkanei.

Increase of the frequency of soft tissues pyoinflammatory diseases and purulent-septic complications against the background the antibiotic-resistance of organism dictates the necessity of search of rational new surgical technologies and preparations with the intense bactericidal effect. Period of the connective tissue (cicatrix) formation on a place of wound defect of the operated purulent abscess of soft tissue (PAST) is defined by the speed of the granulations and epithelial tissue formation. Therefore, one of the task of experimental surgery is search of new methods of the effective postoperative influence on terms of the regeneration and complete obliteration of the PAST cavity. The perspective direction in treatment of surgical infection is application of metals nanoparticles. In treatment of pyoinflammatory processes it is applied the preparation Eplan and also zinc oxide nanoparticles which have bactericidal, antiinflammatory and regenerative effects. However, till now it was not carried out experimental works on modelling and surgical treatment of PAST with local application of the laser technologies in combinations with Eplan and metals nanoparticles.

TREATMENT OF PYOINFLAMMATORY COMPLICATIONS WITH INDIVIDUALLY SELECTED OZONE DOSE IN PATIENTS WITH DIABETES.

The severity of purulent-inflammatory process in patients with diabetes mellitus is determined by lymphocytotoxic test. The test shows that application of intravenous ozone therapy with individually selected ozone dose significantly decreases the spread of necrotic suppurative focus already on the third day of treatment. Granulation tissue and marginal epithelization in the wound develops on the 6-8th day of hospitalization; normalization of glycemic levels shorten of the period of the hospital stay up to 3-5 days, compared to the control group.

Application of Preparations Containing Copper Nanoparticles for the Treatment of Experimental Septic Wounds.

Regenerative activity of locally applied drugs based on copper nanoparticles was compared on white male rats with an experimental purulent wound infected with clinical polyantibiotic resistant strains of Staphylococcus aureus. The use of a suspension of copper nanoparticles and complex drugs based on chitosan and starch with copper nanoparticles led to a rapid reduction of the wound area and elimination of the wound-contaminating agent, which confirmed high antibacterial and regenerative activity of copper nanoparticles in the composition of the studied drugs.

DEFINITION OF ETIOLOGICAL ANTIBIOTIC SENSITIVITY FACTORS IN PURULENT-INFLAMMATORY PROCESSES.

The purpose of the study - assessment of purulent-inflammatory processes etiologic factors and determination of microbial agents' in forms of plankton and biofilms sensitivity to antibiotics. Clinical microbial strains isolated from patients with purulent-inflammatory processes were the subject of the study. The study material comprised of wound tissue, pus, bandage and suture, catheters and drainage devices. Sensitivity of isolates to antimicrobial preparations with various mechanism of activity on the microbial cells was studied with the help of micro-test system. Formation of biofilms was studied with the help of definition of bacteria strains ability to adhesion to the surface of polystyrene flatbeds. It was revealed that one of the leading factors of purulent-inflammatory process development is S.aureus, which disseminated in 36,5% of cases; E.coli disseminated in 17,3% of cases. Among the agents of purulent-inflammatory processes the specific gravity attributed to: Proteus spp. - 14,6%, S.рyogenes - 12,8%, P.aeruginosa - 6,9%, K.pneumoniae - 6,7%. It was revealed that all isolates formed dense biofilms. It was demonstrated that most isolates in plankton form were sensitive to Novapime, Cefepime, Gatifloxacin, Imipenem; sensitive strains were registered in a smaller quantity to Gentamicin, Clindamycin and Doxycycline. In terms of sensitivity of isolates in the form of biofilm to antibacterial preparations it was revealed that most isolates were polyresistant to them. Thus, the study of the sensitivity of allotted microbial strains to antimicrobial preparations demonstrated, that there were strains among cultures with multiple resistances which was the consequence of a wide and not always effective use of antimicrobial preparations.

[COMPARATIVE ESTIMATION OF THE APPLICATION EFFICACY FOR THE COMPOSITION, BASING ON NANODISPERSE SILICA, OWING ANTIMICROBIAL PROPERTIES FOR LOCAL TREATMENT OF PURULENT-INFLAMMATORY PROCESSES].

Comparative estimation of the local treatment results for purulent-inflammatory diseases of soft tissues, using standard methods and composition, owing sorption and antimicrobial properties and basing on a nanodispersedsilica, was conducted. The composition application in complex of treatment have promoted more rapid clearance from necrotized tissues and microorganisms, rapid appearance of granulations, the intoxication severity reduction, the phase I of the wound process duration shortening, what have permitted to put secondary sutures on the wound on the 6 ­ 7th postoperative day, and total duration of the patients' stationary treatment have reduced by 3.7 days.

Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age.

BACKGROUND: Undifferentiated acute respiratory infections (ARIs) are a large and heterogeneous group of infections not clearly restricted to one specific part of the upper respiratory tract, which last for up to seven days. They are more common in pre-school children in low-income countries and are responsible for 75% of the total amount of prescribed antibiotics in high-income countries. One possible rationale for prescribing antibiotics is the wish to prevent bacterial complications. OBJECTIVES: To assess the effectiveness and safety of antibiotics in preventing bacterial complications in children aged two months to 59 months with undifferentiated ARIs. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to August week 1, 2015) and EMBASE (1974 to August 2015). SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs comparing antibiotic prescriptions with placebo or no treatment in children aged two months to 59 months with an undifferentiated ARI for up to seven days. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted and analysed data using the standard Cochrane methodological procedures. MAIN RESULTS: We identified four trials involving 1314 children. Three trials investigated the use of amoxicillin/clavulanic acid to prevent otitis and one investigated ampicillin to prevent pneumonia.The use of amoxicillin/clavulanic acid compared to placebo to prevent otitis showed a risk ratio (RR) of 0.70 (95% confidence interval (CI) 0.45 to 1.11, three trials, 414 selected children, moderate-quality evidence). Methods of random sequence generation and allocation concealment were not clearly stated in two trials. Performance, detection and reporting bias could not be ruled out in three trials.Ampicillin compared to supportive care (continuation of breastfeeding, clearing of the nose and paracetamol for fever control) to prevent pneumonia showed a RR of 1.05 (95% CI 0.74 to 1.49, one trial, 889 selected children, moderate-quality evidence). The trial was non-blinded. Random sequence generation and allocation concealment methods were not clearly stated, so the possibility of reporting bias could not be ruled out.Harm outcomes could not be analysed as they were expressed only in percentages.We found no studies assessing mastoiditis, quinsy, abscess, meningitis, hospital admission or death. AUTHORS' CONCLUSIONS: There is insufficient evidence for antibiotic use as a means of reducing the risk of otitis or pneumonia in children up to five years of age with undifferentiated ARIs. Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.

[Regional intraosseous thrombolytic therapy in comprehensive treatment of patients with diabetic foot syndrome]. / Regionarnaia vnutrikostnaia tromboliticheskaia terapiia v kompleksnom lechenii sindroma diabeticheskoi stopy.

The authors assessed efficacy of regional intraosseous administration of urokinase medac in comprehensive treatment of patients with complicated forms of diabetic foot syndrome by means of analysing therapeutic results in a total of 65 patients presenting with pyonecrotic complications of diabetic foot. The patients were subdivided into 2 groups. The control group was composed of 35 patients receiving basic therapy. The study group comprised 30 patients subjected to comprehensive treatment including regional intraosseous (into the heel bone of the affected limb) administration of urokinase medac at a dose of 100 thousand IU for 5 days. Efficacy of treatment was evaluated by the course of the wound process, indices of haemostasis, free radical oxidation, results of surgical treatment. In patients of the Study Group the terms of wound purification from pyonecrotic masses amounted to 9.8±0.3 days, which was by 4.7 days less than in the Control Group patients (p<0.01), marginal epithelialization of wounds also occurred averagely by 6.4 days faster. On day 22 of using the basic therapy alone, the haemostasis system preserved the condition of coagulation activity. The Study Group patients as early as on day 5 of treatment demonstrated shifts towards normocoagulation. In the Control Group by day 22 of treatment, the level of malonic dialdehyde decreased by 18.5%, the index of catalase activity increased by 24.6% (p<0.05); in the Study Group the level of malonic dialdehyde decreased by 42.6% and catalase activity increased by 69.4% (p<0.01). On the background of using urokinase the number of high amputations decreased by 18% and the number of operations with the supporting function preserved decreased by 12% as compared with basic therapy alone. A conclusion was made that additional use of regional intraosseous administration of urokinase medac as compared with basic therapy alone promoted a more significant decrease in the coagulation activity of blood and the level of free-radical lipid oxidation, stimulation of regenerative processes, as well as improvement of outcomes of surgical treatment.

[COMBINED LAPAROSCOPICALLY AND RETROPERITONEOSCOPICALLY ASSISTED PANCREATONECRSEQUESTRECTOMY].

Combined method of laparoscopically and retroperitoneoscopically assisted necrsequestrectomy, consisting of staged application of miniinvasive methods with simultaneous laparoscopic and retroperitoneoscopic control of necrsequestrectomy, was elaborated with the objective to improve surgical treatment of an acute pancreatitits. The procedure has significant advantages over open operative intervention in purulent complications of necrotic purulent pancreatitis: reduction of the local and systemic operative treatment severity, minimization of microbial metabolites coming into the blood, total visual control of intervention, reduction of the vascular injuries risk, аdequate surgical sanation with saving of viable pancreatic parenchyma, absence of conditions for the purulent complications occurrence while the operative wound healing is going on, preservation of possibility for an adequate draining, using drains of a large diameter.

Acute suppurative parotitis in a 33-day-old patient.

Acute suppurative parotitis is a rare disease in childhood. Its incidence is higher in premature newborns. Parotid swelling and pus drainage from Stenson's duct is pathognomonic, and Staphylococcus aureus is the causative agent in most cases. Here, a 33-day-old patient with acute suppurative parotitis is presented.