The association of TLR4 gene polymorphisms with the severity of peritonitis in acute inflammatory diseases of the abdominal cavity organs.

OBJECTIVE: Aim: To determine the role of TLR4 gene polymorphisms as risk factors for peritonitis severity in patients undergoing surgery for acute inflammatory diseases of the abdominal cavity. PATIENTS AND METHODS: Materials and Methods: The study included 139 patients who were operated on for acute abdominal diseases (acute appendicitis and cholecystitis, perforated gastric or duodenal ulcer, etc.). Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: Group 1 - 1-3 points (63 patients, 45.3%) and Group 2 - 4 or more points (76 patients, 54.7%). Polymorphisms rs1927911, rs2149356 and rs4986790 were determined by polymerase chain reaction. RESULTS: Results: The rs1927911 polymorphism of the TLR4 gene was protective for the development of peritonitis (according to the allelic model, OR 0.48; 95% CI 0.27-0.84; p=0.015). Regression analysis revealed a reduced (p=0.015) risk of severe peritonitis in rs1927911 A/A or G/A genotype carriers (OR 0.42; 95% CI 0.21-0.84) compared with G/G genotype carriers. There was no effect on the severity of peritonitis of TLR4 polymorphisms rs2149356 and rs4986790. There was a tendency to increase the frequency of the mutant G rs4986790 allele in patients with severe peritonitis (χ2=2.17; p<0.001). The analysis of the association of TLR4 gene polymorphisms with the phenotype of patients showed that carriers of mutant homozygotes and heterozygotes in the presence of severe peritonitis were older, had a tendency to coagulopathy, higher leukocytosis and leukocyte clotting rate. CONCLUSION: Conclusions: Thus, the importance of TLR in the development of severe peritonitis was confirmed and the protective role of the rs1927911 promoter polymorphism was established.

ORNIDAZOL-BASED APPLICATION SORBENT WITH NANO SILICA AND ITS ANTIMICROBIAL ACTIVITY.

OBJECTIVE: The aim: To investigate the effect of application sorbent based on ornidazole with nanosilicon in experiment and clinic. PATIENTS AND METHODS: Materials and methods: In order to study the effectiveness of the Ornidasil application sorbent for the treatment of purulent wounds, we conducted an experimental study in rats. Also, we studied the effectiveness of the Ornidasil in the clinic for the treatment of patients with diabetic foot syndrome and to prevent the suppuration of postoperative wounds in patients with purulent peritonitis in toxic and terminal stages. RESULTS: Results: The formation of active substance complexes with hydroxylated matrices is due to hydrogen bonds between the oxygen atom of the silanol group of the silica surface and the hydrogen atom of the alcohol group of the ornidazole molecule. This promotes the gradual release of ornidazole from the surface of such a matrix into the wound exudate. Thus, on day 13, 9 experimental rats of group I healed completely, 11 rats had a small wound surface, complete healing occurred on day 15. We also investigated the effectiveness Ornidasil in the clinic. In the comparison group, postoperative wound suppuration occurred in 6 patients (31.6%), and in the main group - in 3 patients (12.5%). CONCLUSION: Conclusions: A study of the effectiveness Ornidasil in the complex treatment of Diabetic foot syndrome showed that in the experimental groups, wound healing occurred 1.6 -1.9 times faster. The use of polyurethane wound protector in combination with Ornidasil reduced the suppuration of postoperative wounds in patients of the main group by 2.5 times relative to patients in the comparison group.

Comparative Clinical Study of the Wound Healing Effects of a Novel Micropore Particle Technology: Effects on Wounds, Venous Leg Ulcers, and Diabetic Foot Ulcers

OBJECTIVE: The purpose of this study was to determine the wound healing effects of Acapsil, a white, odorless powder based on micropore particle technology (MPPT) (Willingsford Ltd, Southampton, UK) by comparing it to Gentaxane (Gentaksan, Borshchagovsky CCP, Kyiv, Ukraine) (polydimethylsiloxane powder with gentamicin antibiotic) and Ioddicerin (Farmak, Kyiv, Ukraine) (iodine with dimethyl sulfoxide [DMSO]). MATERIALS AND METHODS: The study included 266 patients with primarily trophic ulcers caused by pancreatic diabetes and venous insufficiency of the lower extremities, carbuncles, phlegmons, infected third- or fourth-degree heat burns, and infiltrations of postoperative wounds. The products were applied once daily to the wound until it was clean (ie, free from necrosis, pus, and fibrinogenous thickenings). RESULTS: The number of days (mean ± standard deviation) to a clean wound was 3.0 ± 0.9 for MPPT (n = 88) compared with 7.0 ± 1.2 and 8.0 ± 1.1 for Gentaxane (n = 90) and iodine/DMSO (n = 88), respectively. Thus, MPPT reduced the time to reach a clean wound by 57% and 62%, respectively. Products were used once daily until a clean wound was reached, which also reflects the number of applications. Days to onset of granulation for MPPT, Gentaxane, and iodine/DMSO were 4.5 ± 0.8, 9.2 ± 1.4, and 10.3 ± 1.5 days, respectively; and days to onset of epithelialization were 7.8 ± 1.1, 14.1 ± 1.9, and 16.4 ± 2.7 days, respectively. Subgroup analysis of patients with diabetic foot and venous leg ulcers found that each of these demonstrated the same pattern of healing as the overall study. The number of hospitalization days was 14.6 ± 5.6 for MPPT, 21.0 ± 10.7 for Gentaxane, and 24.0 ± 7.9 for iodine/DMSO. Compared with Gentaxane, patients receiving MPPT had a 31% reduction in hospitalization duration and a 39% reduction compared with iodine/DMSO. CONCLUSION: These findings demonstrate that MPPT represents a valuable new approach to wound care.