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В настоящее время высокоспециализированным методом дифференциальной диагностики этиологии верхнечелюстного синусита является конусно-лучевая компьютерная томография. Цель исследования. Выявить наиболее патогномоничные признаки осложненных и неосложненных форм одонтогенного верхнечелюстного синусита на основании оценки результатов компьютерной томографии. Материалы и методы. Были оценены результаты конусно-лучевой компьютерной томографии 58 пациентов с верхнечелюстным синуситом различной этиологии средним возрастом 43,6 года в период с 2006 по 2017 год. С помощью одно-и многофакторного статистического анализа были выявлены маркеры (предикторы) наличия у пациентов неосложненных и осложненных форм одонтогенного верхнечелюстного синусита. Результаты. Предрасполагающими факторами развития неосложненной формы верхнечелюстного синусита при проведении конусно-лучевой компьютерной томографии являлись наличие причинного зуба (ОШ = 8,8; р < 0,001), выраженный альвеолярный карман (АК) (ОШ = 5,7; р = 0,029), фистула периапикального абсцесса (ОШ = 5,3; р = 0,019), нарушение проходимости среднего носового хода (ОШ = 12,1; р = 0,007); вариантная анатомия остиомеатального комплекса (ОШ = 3,3; р = 0,016). Лучевые предикторы осложнений одонтогенного верхнечелюстного синусита включали: наличие причинного зуба (ОШ = 6,0; р < 0,001), этмоидит (ОШ = 44,7; р < 0,001), блок соустья ВЧП (ОШ = 2,6; р = 0,026), расширение периодонтальной щели (ОШ = 6,2; р = 0,001), костную деструкцию альвеолы (ОШ = 14,0; р < 0,001), утолщение заднебоковой стенки верхнечелюстной пазухи (ОШ = 2,4; р = 0,037). Заключение. Улучшению результатов лучевой диагностики одонтогенных заболеваний ЛОР-органов может способствовать использование разработанных логистических моделей и выявленных предикторов наличия одонтогенного верхнечелюстного синусита при интерпретации данных конусно-лучевой компьютерной томографии. Ключевые слова: одонтогенный верхнечелюстной синусит, предикторы осложнений, конусно-лучевая компьютерная томография, дифференциальная диагностика, осложнения синусита.

(1) Introduction: An imbalance of the genetically determined cytokine response plays a key role in the etiology of ENT-associated encephalitis. In recent years, an attempt has been made to evaluatethe prognostic role of chronic pathology of the paranasal sinuses in the development of acute, subacute and chronic encephalitis and meningitis, which in clinical practice are manifested both as cerebral and focal neurological symptoms and as mental disorders: from borderline to psychotic ones. The problem requires a multidisciplinary approach on the part of the specialists in the following clinical disciplines: neurology (as well as neurobiology), psychiatry, immunology, experimental medicine, otorhinolaryngology, and pharmacogenetics. The solution of this problem is possible with the involvement of preventive and personalized medicine.(2) The purpose: Evaluation the prognostic role of genetic polymorphisms of pro- and antiinflammatory cytokines in the development of ENT-associated encephalitis.(3) Materials and Methods: We conducted a keyword-based analysis of the English and Russian-language articles published within the past 30 years (from 1988 to 2018). The following databases were used in the study: PubMed, MedLine, Web of Science Core Collection (Clarivate Analytics), Web Science, Russian Science Citation Index, Scopus, Scientific Research, Google Scholar, Oxford Press, and eLibrary.(4) Results: In a number of the analyzed works, regardless of the causative agent and viral load, an increased level of pro-inflammatory cytokine production was noted in patients with more severe disease progression, neurological complications and unfavorable outcomes, both in viral encephalitis and in bacterial one. Based on this, 30 single nucleotide variants (SNV), their influence on the expression of pro- and anti-inflammatory cytokine genes, as well as their predictor role in the development of ENT-associated encephalitis were analyzed. Due to the nature of the systemic immune response, the analysis included both cerebral and extracerebral pathology-associated SNV. The inconsistency of the previously obtained results was noted, an attempt to explain this phenomenon was made. The analysis of the dynamics and geography of publications on the stated topic was made, the leading Russian scientific centers in the field were defined. The most promising SNV for further studies were identified.(5) Conclusion: The risk of developing ENT-associated encephalitis is associated with a genetically determined status of the cytokine response and its regulation. Studies of the association of various SNV of genes encoding pro- and anti-inflammatory cytokines in the Russian Federation need to be continued.

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The importance of the intracranial complications problem in acute and chronic focal processes of ENT organs is determined by their dominating position among the reasons of the fatal outcomes. The authors made retrospective analysis of all the clinical cases of inpatient treatment of 127 adult patients with acute and chronic otitis media, complicated with pyoinflammatory cerebral pathology. Chronical suppurative otitis media predominated in the general structure of the revealed otitis media pathology structure – 75 (59.0%) cases. Purulent meningitis was diagnosed in 52 (40.9%) received patients, in acute otitis it constituted 63.5% of the total intracranial complications, and in chronic otitis media – only 25.3%. Meningocephalitises have been diagnosed with equal frequency both in acute otitis media – 15.4%, and in chronic otitis media – 22.7%. Otogenic brain abscesses have been diagnosed only in 13.5% cases of acute suppurative otitis media, whilst in chronic suppurative otitis media they have been revealed twice more frequent – 33.3%. 124 (98%) patients underwent surgery due to otogenic intracranial complications. For the purpose of sanation of the primary focus of infection in the ear the following therapy was conducted: in acute supportive otitis media – extended mastoidotomy, antromastoidotomy; in chronic suppurative otitis media – extended radical ear surgery. In surgical therapy of otogenic brain abscess, craniotomy and complete removing of the brain abscess using advanced neuronavigation systems proved higher clinical efficacy compared to transtemporal access in the course of sanation intervention in the ear with the abscess incision and drainage. Nowadays, the main clinical features of otogeneous intracranial complications are: severe central nervous system inflammatory damage with prevalence of cerebral and meningeal symptoms, high severity of the general state of the patients with the development of purulent septic complications with mortality level.

The purpose was to assess the possibilities of applying a personalized approach to the appointment of macrolides in acute bacterial rhinosinusitis, depending on the carrier of single-nucleotide polymorphism genes. Materials and methods. An analysis of Russian and English-language publications was conducted with a search depth of 30 years. Results. The main enzymes involved in macrolide pharmacokinetics are P-gp, OATP1B1, OATP1B3, CYP3A4, MRP2. P-gp activity is higher in carriers of the homozygous genotype in the major allele C (3435CC, 48.33%) and the heterozygous genotype (3435CT, 45.90%) of the SNPs rs1045642, whereas the lowest activity was detected in the carriers of the homozygote genotype in the minor allele T (3435 TT, 31.62%), P = 0.02. SNPS 521 T> C (rs4149056) in the SLCO1B1 gene, encoding because of the need for OATP1B1*5, associated with changes in the activity of the protein that carries and erythromycin metabolizing, respectively, in homozygous carriers of the major T allele (P = 0.0072). The activity of the 3A4 isoenzyme in the liver in homozygous carriers of negative T (CC) alleles was 1.7 and 2.5 times higher than in heterozygous (ST) and homozygous (TT) carriers of the minor T allele (rs35599367). The homozygous carriage of the G major allele (rs717620) is associated with a reduced protein function, the homozygous carriage of the minor A allele is associated with an increase in the activity of the MRP2 protein. Conclusion. Genetically determined differences in the pharmacokinetics and pharmacodynamics of macrolides were detected depending on the gene carrier of the SNP ABCB1, SLCO1B1, CYP3A4, АВСС2. Knowledge of the genetically determined metabolism of macrolides in humans can provide new insights into the systemic effects that are available and clinically interesting from their appointment.