Acute rhinosinusitis is one of the most common diseases in the world. According to statistics, about 10 million cases are registered in Russia every year.Acute bacterial rhinosinusitis (ABRS) in most cases develops as a result of an acute respiratory viral disease, proceeds easily and it does not require antibiotic therapy. However, it significantly reduces the patient's quality of life in cases of moderate and severe disease, and in the absence of timely treatment, can lead to intracranial complications (meningitis, encephalitis, intracranial abscesses, etc.) and orbital (reactive edema of the eyelid, phlegmon of the orbit, periorbital abscesses, etc.). To avoid complications, with exacerbation of rhinosinusitis, it is necessary to choose the right antibiotic therapy, taking into account the resistance of the microorganisms that caused the disease.The article describes the differential diagnosticprinciples of bacterial rhinosinusitis according to the latest recommendations and research in this area, the most common antibiotic-resistant pathogens in the practice of an ENT doctor are presented, the issue of choosing the correct systemic antibiotic therapy for the treatment of patients with moderate and severe acute bacterial rhinosinusitis is considered according to modern data on the sensitivity of bacterial pathogens to antibacterial drugs prescribed in the otorhinolaryngologist's practice. The article presents data on a new universal cephalosporin of the 3rd generation (the active ingredient is cefditoren), as a second- and third-line drug, due to its high activity against most causative agents of acute bacterial rhinosinusitis, and clinical observation using the above antibacterial agent within the framework of the considered topics.
Chronic Rhinosinusitis with Nasal Polyps (CRwNP) caused by T2 inflammation has a complex pathogenesis, for which treatment options include medical therapy (topical and systemic glucocorticosteroids, leuktriene inhibitors, etc.) and surgical therapy, often recurs and significantly reduces the quality of life for patients. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma and an allergic reaction to nonsteroidal anti-inflammatory drugs. These conditions are in most cases associated with a common pathogenesis, including a type II immune response, hyperproduction of interleukins (IL) 4, 5 and 13, activation of eosinophils and tissue remodeling. Biological therapy which block the effect of IL-4, 5, 13 can significantly improve the condition of such patients. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), thereby blocking the action of IL-4 and IL-13. Currently, dupilumab is approved for asthma, CRwNP and atopic dermatitis. Dupilumab can reduce the number of exacerbations, treatment with systemic corticosteroids, improve the condition of the upper and lower respiratory tract and achieve an increase in FEV1 by 0.2–0.3 L, which leads to a significant control of these diseases. One of the topical issues is the choice of tactics choice of treatment tactics in patients with CRwNP, asthma and nasal septum deviation. This article presents a clinical case of a patient with severe asthma, CRwNP and deviated nasal septum receiving dupilumab for 4 months.
Acute rhinosinusitis is one of the most common diseases in the world, characterized by acute inflammatory processes in the nasal cavity and paranasal sinuses, lasting less than 4 weeks. According to statistics, in Russia, this disease is recorded in 6–15% of the population annually, in European countries in every seventh person, while there is a tendency to an increase in the incidence. Acute viral rhinosinusitis has the highest incidence among all rhinosinusitis and occurs in most patients in a mild form, however, untimely treatment of inflammation of the nasal mucosa can lead to obstruction of the natural anastomoses, impaired physiological ventilation and drainage of the paranasal sinuses, stagnation of secretions with further development acute bacterial rhinosinusitis. The overuse of local vasoconstrictor drugs (intranasal decongestants) leads to the development of drug-induced rhinitis, long-term imbalance of autonomic innervation of the nasal mucosa and edema, called "rebound syndrome". In the article we consider the issues of etiology, pathogenesis, features of the course of rhinosinusitis. The principles of differential diagnosis of viral and bacterial rhinosinusitis are stated, taking into account the latest recommendations and research in this area. The features of the use of the most frequently used topical preparations in acute rhinosinusitis in the practice of an ENT doctor have been analyzed.
Acute inflammatory diseases of the upper respiratory tract (URTI) accompanied by cough are one of the most common groups of diseases in the world. It includes acute respiratory viral infections, often manifested by rhinosinusitis, tonsillopharyngitis and laryngitis. According to statistics, about 90% of all infectious diseases are acute respiratory infections, with cough accompanying acute respiratory infections in 83% of cases. Cough largely determines the severity of the disease, and its duration over 4 weeks indicates a high probability of process chronicity. Cough with difficult to detach sputum dramatically reduces the patient’s quality of life, bringing discomfort in everyday activities. In addition to the cough, the problem of viral diseases lies in the rather difficult diagnosis at the outpatient stage, due to which excessive prescription of antibiotics occurs. In order to avoid the occurrence of complications, chronicization of the disease and reduce the level of inappropriate prescriptions of antibacterial drugs, it is necessary to apply therapy, aimed both at the etiology, the links of pathogenesis, and the symptoms in order to alleviate the condition of the patient and his speedy recovery. The processes leading to the development of cough in URTI are described in the article; principles of differential diagnostics and peculiarities of therapy of URTI are reviewed. The article presents data on the use of a natural remedy, ivy leaf extract, which helps to get rid of cough in a shorter period of time, thereby improving the well-being of the patient, and is notable for its good tolerability and rare occurrence of side effects, which may surpass synthetic alternatives.
Неинвазивные дыхательные тесты с применением изотопно-меченых соединений представляют собой новый высокоточный и безопасный метод функционального исследования печени и билиарной системы. Целью работы было провести биологические испытания острой и субхронической токсичности 13С-меченых линолевой и линоленовой кислот, синтезированных по оригинальной методике и предназначенных для проведения диагностических дыхательных тестов. При однократном внутрижелудочном введении изучаемых соединений лабораторным мышам линии BALB/c и крысам Wistar в дозах, превышающих диагностические в 500–2500 раз, образцы соединений не вызывали смертности экспериментальных животных. При проведении субхронического эксперимента на крысах при дозировках испытываемых соединений, в 5 и 25 раз превышающих терапевтическую дозу для человека, в течение 14 суток было выявлено отсутствие достоверных изменений у животных в экспериментальных группах по сравнению с контрольной по массе тела, гематологическим показателям (содержанию эритроцитов, лейкоцитов и тромбоцитов в крови) и биохимическим показателям сыворотки крови (уровню гемоглобина, общего белка, щелочной фосфатазы, аланинаминотрансферазы, аспартатаминотрансферазы, лактатдегидрогеназы, билирубина). Исследованные меченые кислоты безвредны в дозах, планируемых для перорального введения, и могут быть рекомендованы к доклиническим и клиническим испытаниям.
Noninvasive stable isotope breath tests allow highly accurate and safe estimation of liver and biliary tract function. The aim of this study was to test 13С-labeled linoleic and linolenic acids intended for diagnostic use for acute and subchronic toxicity. The acids were synthesized using the patented method. A single intragastric administration of the tested compounds to experimental BALB/c mice and Wistar rats in the amounts exceeding clinical doses 500 to 2500-fold did not cause animal death. In the subchronic toxicity test, the rats received 5 to 25 times higher doses than recommended for clinical use in humans. In a 14-day follow-up period, no significant differences were observed between the main and the control groups in terms of weight, blood count (red blood cells, white blood cells, platelets), and blood biochemistry (hemoglobin, total protein, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, bilirubin). The studied compounds are safe at doses intended for oral administration and are recommended for further preclinical and clinical trials.
Background. Unreasonable prescription of antibiotics to patients with acute diseases of the upper and lower respiratory tract is a significant problem of modern medicine, as it is associated with a high risk of side effects, an increase in antibiotic resistance and high economic costs. Phytopreparations can help reduce the frequency of inadequate antibiotic prescribing. Aim. To study the effect of the use of herbal medicines on changing the frequency of prescribing antibiotic drugs to patients with infectious respiratory pathology. In addition, the presence of a relationship between the appointment of phytopreparations and the duration of the course of the infectious and inflammatory process was determined. Materials and methods. Materials from the IMS Disease Analyze database were analyzed. The study included patients who were diagnosed with acute respiratory infection between January 2015 and March 2019. According to the prescribed treatment, patients were divided into two groups: the main one, whose patients were prescribed phytopreparations as therapy, and the control group without the appointment of similar treatment. Patients who were prescribed antibiotics on the day of diagnosis were excluded from the study. To assess the relationship between the prescription of phytopreparations, antibiotics and the duration of the period of temporary disability, the logical regression method was used. Results. The first group included 117 182 patients who used herbal medicines. In the control the same number of patients without the appointment of phytopreparations. The following results were obtained: the use of phytopreparations was accompanied by a rarer additional prescription of antibiotics in the process of treatment, the duration of the period of temporary disability in the main group was shorter. Conclusion. The use of phytopreparations in acute respiratory infections statistically significantly causes a decrease in the frequency of prescribing systemic antibiotics and a decrease in the duration of the period of temporary disability.
В настоящее время для диагностики заболеваний печени и билиарной системы требуется разработка простого неинвазивного теста с высокой чувствительностью и специфичностью. Соединения, меченные изотопом углерода, уже имеют широкое применение в диагностике различных заболеваний методами дыхательных тестов, безопасны и способны достоверно выявлять метаболические нарушения или дефицит специфичных ферментов в органах. Целью работы было получить линолевую кислоту, меченную 13С и 14С, по степени очистки пригодную для проведения дыхательных тестов в целях диагностики заболеваний гепатобилиарной системы. В предложенном способе химический выход реакции синтеза 13С-линолевой кислоты по 1-бром-8,11-гептадекадиену составил 86,4%, по 13С-карбонату бария — 96,0%. Химический выход реакции синтеза 14С-линолевой кислоты по 1-бром-8,11-гептадекадиену составил 87,39%, по 14С-карбонату бария — 97,1%. Удельная радиоактивность 14С-линолевой кислоты составила 45,36 ± 0,02 мКи/г. Радиохимический выход реакции — 96,0%. Способ удобен для серийного выпуска готового продукта.
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