[«Criminal¼ local anesthesia in dentistry: a deliberate risk or a game without rules?] / «Kriminal'naya¼ mestnaya anesteziya v stomatologii: osoznannyi risk ili igra bez pravil?

The effectiveness and safety of drug treatment are the main criteria for its success. Local anesthetics, used in all medical fields, in some cases can cause a wide variety of undesirable side reactions, but in recent years, such manifestations that have arisen in Russian clinical practice tend to qualify as anaphylactic shock. This article presents the types of adverse reactions and global statistics of anaphylaxis to local anesthetics, as well as analyzes the possible reasons for the erroneous diagnosis of fatal outcomes of anaphylaxis. The purpose of the review was to clarify information about reliable markers of clinical and postmortem anaphylaxis, providing unambiguousness and objectivity of forensic medical examination. Attention is focused on the specific postmortem signs of immediate allergic reactions and the sequence of professional interpretation of all the circumstances associated with a fatal adverse reaction against the background of the use of local anesthetics.

New technologies in molecular allergodiagnostics.

The article presents the characteristics of the ALEX2 (MacroArrayDX, Wien, Austria). It is designed for simultaneous detection of IgE total and specific IgE-aB to 120 extracts and 180 molecules by solid-phase enzyme immunoassay. Extracts and allergen molecules combined with nano-particles are sorbed on a solid-phase substrate, forming a macroscopic multiplex matrix - the immune allergy chip. The Institute of Clinical and Laboratory Standards (CLSI) conducted research on the verification and validation of the ALEX2 in relation to the ImmunoCAP macroarray test system (ThermoFisher Scientific, Uppsala, Sweden), which is often used in allergodiagnostics. The results obtained on the two test systems were comparable. One of the most important features of the ALEX2 test system is that unique allergen molecules and allergenic extracts are included in its composition, and a method has been found to inhibit cross-reactive hydrocarbon determinants (CCDs), which cause frequent non-specific binding of IgE-aT. The use of this test system makes it possible to carry out component allergy diagnostics with the determine of the dominant sensitizing factor in cases of mono- and polyvalent sensitization. The test results affect the determination of indications and the effectiveness of ASIT, allow assessing the risk of anaphylaxis and predicting further treatment tactics for the patient.

[Domination of Staphylococcus aureus in microbiocenosis of nasal cavity in children and adults with infectious and allergic rhinitis].

UNLABELLED: Aim. Determine the occurrence of S. aureus in microbiocenosis of nasal cavity of children and adults with allergic and infectious rhinitis. MATERIALS AND METHODS: Content of nasal cavity microflora in patients with infectious and allergic rhinitis was studied. 295 patients were observed, among those--179 children aged 3 months to 14 years and 116 adults aged 15 - 71 years. RESULTS: In 60.3% of cases in children and 52.5% of adults S. aureus was revealed to be the dominating microorganism. Additionally, in 26.8% of children and 35.3% of adults epidermal staphylococcus was isolated. CONCLUSION: Antagonistic properties of these 2 species of microorganisms assume their competition on the nasal mucous membrane.

[Component-resolved diagnosis is a new era in clinical allergology].

The paper describes the fundamentals and benefits of a new allergy diagnostic technique based on recent advances in molecular biology and biotechnology. Component-resolved diagnosis allows IgE antibodies against purified molecules (individual allergen components) to be revealed. Microanalysis is made using microarrays with applied molecules (allergen components) obtained in a recombinant fashion or extracted from natural raw materials. The authors present a current classification of animal and plant allergens and show the value of component-resolved diagnosis in clinical practice, by using specific clinical examples.

[Long-term clarithromycin therapy in patients with chronic polypous rhinosinusitis]. / Dolgosrochnaia terapiia klaritromitsinom bol'nykh s khronicheskim polipoznym rinosinusitom.

Article is dedicated to therapeutic effect of long-term therapy clarithromycin in patients with varying severity of chronic polypous rhinosinusitis. The effectiveness of therapy based on monitoring of symptoms and quality of life on a scale of SNOT-20 in an open clinical trial in the treatment in patients with varying degrees of severity of chronic polypous rhino sinusitis with the macrolide Klaсid 500 SR was assessed in three months. As a result of investigations, good and excellent effect was observed mainly in patients with mild to moderate disease. Obviously, the duration of therapy should be in cases with severe forms of chronic polypous rhino sinusitismore than 3 months.

[Microflora of nasopharynx in patients with urticaria].

Microflora of nasopharynx in 117 patients with urticaria was studied. 589 cultures of gram-negative and Gram-positive bacteria were isolated. Gram-positive bacteria represented the overwhelming majority of isolates from which streptococci dominated with high level of constancy (C=91.4%) and prevalence on mucosa. Several patients had signs of chronic streptococcal infection that support the possible role of streptococci in development of urticaria.

[Clinical and immunological changes in atopic dermatitis patients treated with purified staphylococcal toxoid]. / Klinicheskie i immunologicheskie izmeneniia u bolnykh atopicheskim dermatitom pri terapii anatoksinom stafilokokkovym ochishchennym.

32 patients with atopic dermatitis (AD), complicated by pyoderma, were treated with purified staphylococcal toxoid (PST). Changes in clinical and laboratory characteristics in the course of treatment were evaluated. PST was shown to produce a satisfactory therapeutic effect, arresting the symptoms of local staphylococcal infection. An increase in the levels of alpha- and gamma-interferons and decreased content of CD25+ lymphocytes were found. Thus prospects appear for using this preparation as an interferon inductor, as well a for the immunotherapy of AD patients sensitized to Staphylococcus aureus.

[Microflora of the nasal mucosa in allergic perennial and infectious rhinitis]. / Mikroflora slizistoi nosa pri allergicheskom kruglogodichnom i infektsionnom rinitakh.

The microbiological study of 69 patients with allergic annual rhinitis (AAR) and infectious rhinitis (IR) was carried out. In AAR the isolated representatives of 15 genera and 40 species were distributed in 2 to 7 component; in IR the isolated representatives of 16 genera and 25 species were grouped in 2 to 4-component associations. In AAR Staphylococcus aureus was found to belong to the main species and in IR, S. aureus and S. epidermidis, while the number of species regarded as occasional in AAR was 7 (S. auricularis, S. cohnii, S. hominis, S. haemolyticus, S. warneri, S. apitis, S. schleiferi). Differences in the distribution of Neisseria, nonfermenting Gram negative bacteria, Streptococcus in associations in cases of AAR and IR were established. In AAR Corynebacterium pseudodiphthericum and in IR C. pseudotuberculosis were the dominant species.

[Effect of purified staphylococcal toxoid preparation on the in vitro production of interferon by leukocytes from patients with atopic dermatitis]. / Vliianie preparata stafilokokkovogo ochishchennogo anatoksina na produktsiiu interferona leikotsitami in vitro u bol'nykh atopicheskim dermatitom.

The impact of purified staphylococcal toxoid (PST) on the in vitro production of interferon (IFN) by blood leukocytes was evaluated. PST was found to produce a stimulating effect on the production of alpha-IFN in patients with atopic dermatitis (AD): in 88% of cases a two-fivefold increase in IFN production was observed in AD patients in comparison with healthy donors. In addition, the incubation of leukocytes obtained from atopic and nonatopic patients with PST was shown to stimulate the production of gamma-IFN by these leukocytes fivefold, on the average. These results give theoretical basis for use of PST (as an inducer of endogenic IFN) for AD patients treatment.

[Changes in the cytological analysis of nasal secretions during a nasal secretion]. / Izmeneniia v tsitologicheskom analize nosovogo sekreta pri provedenii nazal'nogo provokatsionnogo testa.

Changes of cytological parameters in the course of the nasal provocative test (NPT) we studied in 30 patients aged 14-43 years with chronic rhinitis of unknown etiology. Solutions of allergens in various concentrations were used for NPT and skin testing. NPT results were estimated clinically according to four-point scale and rhinocytogram 20 minutes after injection of different concentrations of allergens to nasal cavity. The results of the provocative tests coincide with case history data more frequently than skin test results. The discrepancy between anamnesis and results of skin tests in the group of patients reached 30.7%. A mean 8-fold increase in eosinophil count in nasal secretion was observed in patients with clinically confirmed NPT (76% cases) 20 minutes after injection of a minimal concentration of allergen extract to the nasal cavity. This eosinophil infiltration of nasal secretion preceded the occurrence of clinical symptoms. An unusual cytological picture of nasal secretion was observed in three patients with positive anamnestic data, results of skin testing and NPT. Eosinophil infiltration of nasal recreation was absent but neutrophil number increased. Increased eosinophil count on rhinocytogram after injection of allergen extract to nasal cavity can serve as an objective criterion of NPT. The described cases of neutrophil infiltration of nasal secretion testify to possible participation of these cells in acute allergic inflammation in patients with clinically positive NPT.

[Humoral immune response in patients with bronchopulmanory infections to immunotherapy]. / Gumoral'nyi immunnyi otvet u patsientov s bronkholegochnymi zabolevaniiami pri provedenii immunoterapii.

The content of IgA, IgM, IgG and the level of specific antibodies in the blood serum of patients with bronchopulmonary diseases after a course of immunotherapy with polycomponent vaccine B[symbol: see text]-4 was studied. A rise in the concentration of IgM due to the synthesis of specific antibodies to Proteus vulgaris, Escherichia coli and Klebsiella pneumoniae was found to occur. The examination of sick children revealed that a high proportion of them (54%) showed a pronounced decrease in the level of IgA. The use of the preparation made it possible to enhance the level of IgA.

[Clinico-microbiological assessment of therapeutic antifungal drugs therapeutic activity in patients with atopic dermatitis sensitized to yeast fungi]. / Kliniko-mikrobiologicheskaia otsenka terapevticheskoi éffektivnosti protivogribkovykh preparatov u bol'nykh atopicheskim dermatitom, sensibilizirovannykh k drozhzhepodobnym gribam.

AIM: To study of therapeutic activity of local (natamycine) and systemic (fluconasol) antifungal drugs in patients with atopic dermatitis (AD) with mycogenic sensitization and candida carriage. MATERIALS AND METHODS: 29 patients with severe AD and diagnosed contamination of the skin lesions with yeast fungi have received antifungal treatment with fungicidal drugs in low-dose long-term course. RESULTS: The drugs were effective in 83% of patients: poor effect was in 28%, moderate--in 21% and good--in 34% of cases. 5 (17%) patients did not respond. Mild, moderate and severe AD responded in 87, 36 and 60% of patients, respectively. The highest response was registered in patients without sensitization to yeast fungi (78%) or low sensitization (83%). In high sensitization the effect occurred in 57% of the cases. CONCLUSION: The authors have developed indications for treatment with antifungal drugs in AD patients with mycogenic sensitization.

[Yeast-like fungi on the skin of patients with atopic dermatitis]. / Drdozhzhepodobnye griby na kozhe bol'nykh atopicheskim dermatitom.

Colonization by yeast-like flora and its composition on the skin of patients with atopic dermatitis (AD) in comparison with those on the skin of patients with skin diseases of nonatopic etiology and healthy subjects were studied. Inoculations from affected and unaffected sites of the skin were made by the contact method with the use of bacteriological plates with antibiotic-containing solid agar medium. The study revealed that 39% of AD patients, 45% of patients with other skin diseases and 3% of healthy subjects had yeast-like fungi of their skin, Candida spp. (53%) and Rhodotorula spp. (21%) occurring most frequently. In patients with a severe course of AD the tendency towards the preferable colonization of affected sites of the skin was observed: in these cases yeasts occurred 2.5-5 times more frequently than in patients with the mild and moderate course of AD.

[Yeast-like fungi malassezia (pityrosporum): clinical and immunological aspects fo study]. / Kliniko-immunologicheskoe izuchenie drozhzhepodobnykh gribov malasszia (pityrosporum).

The normal flora is typified by the yeast-like fungi Malassezia (Pityrosporum). Successful attempts at treating patients with atopic and seborreic dermatitis, pityriasis versicolor, and psoriasis with antifungicides confirm the involvement of these fungi in the etiology and development of these diseases. In patients with various skin diseases, an immune response to M. furfur is specific. In those with psoriasis, it is characterized by the higher chemoatractant activity of polymorphonuclear leukocytes stimulated by a M. furfur extract and by the immune response of IgG antibodies with immunoreactive proteins having a molecular weight of 100-120 kD. Patients with atopic dermatitis show a hyperimmune IgE-mediated response to M. furfur, with its specific Th2-lymphocytes inducing the atopic cytokines (IL-4, IL-10) that stimulate allergic reactions to other allergens. Those with pityriasis versicolor had impaired keratinocytic pigment exchange due to azelainic acid produced by M. furfur. The cause of transformation of the yeast phase of M. furfur to the mycelial one is presumably to be changes in the composition of fatty acids of the sebaceous glands due to increased androgen concentrations.

[Candida albicans sensitization in patients with atopic bronchial asthma and atopic dermatitis]. / Sensibilizatsiia k Candida albicans u bol'nykh atopicheskoi bronkhial'noi astmoi i atopicheskim dermatitom.

Candida albicans, a component of normal human microflora, can induce synthesis of specific IgE-antibodies in patients with atopic bronchial asthma and atopic dermatitis. The study included 25 patients with atopic dermatitis sensitized to C.albicans and 23 patients with atopic dermatitis non-sensitized to C.albicans. The sensitization was determined by the skin test and enzyme immunoassay. The patients had the history of atopic dermatitis exacerbation after taking food containing baking yeasts. Atopic dermatitis with sensitization to C.albicans is characterized by severe course correlating with the following indices: high total IgE (r = 0.6), level of IgE antibodies to C.albicans (r = 0.6), level of serum IgG (r = 0.46) and IgA (r = 0.33). Contrary to adults, children with sensitization to C.albicans had decreased relative number of CD4+, CD8+ and CD72+ of lymphocyte subpopulations. Thus, sensitization to C.albicans manifests in severe atopic dermatitis which in children is often associated with immune deficiency.