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(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.

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.

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.

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

Introduction. The problem of phonosurgery remains relevant today since the prevalence of benign and tumor-like laryngeal lesions is up to 55%–70% among diseases of the upper respiratory tract. Photoangiolytic lasers are actively used among laser systems in phonosurgery today. A new 445 nm surgical laser (TruBlue, A.R.C. Laser Company), having a high hemostatic and resection effects, was certified for the medical market in 2018. TruBlue laser operation is possible in an atmosphere of inert gas (helium) by connecting the optional Flow Control unit. To date, there are very few works in foreign and Russian literature devoted to the use of that laser device in ENT practice, particularly, in laryngology. Objective. To select the optimal 445 nm laser mode for use in phonosurgery based on an experimental study of biological material. Material and methods. An experimental study was conducted on a model of the larynx (chicken muscle tissue) using a 445 nm laser in contact constant and pulsed modes, including an atmosphere of an inert gas (helium). The zones of destruction, coagulation necrosis, and ischemia were measured by histological examination using a morphometry system. The total number of experiments was 142, the total number of micro-preparations studied was 284. Results. While working in continuous wave mode, we received an extensive zone of thermal exposure, which in clinical practice correlates with deep damage of the vocal fold and violation of its vibratory function. This confirms the axiom that the optimal mode for laryngeal surgery is a pulsed one. According to the evaluation results of the pulse mode at standard laser settings (without helium supply), the parameters with the smallest pause between pulses—that is, 8 W pulse 10–20 ms, 9–10 W pulse 10 ms with a pause of 150 ms—were the most optimal for practical activity in terms of combined resection and coagulation effect. These parameters are acceptable for use in phonosurgery since the maximum destruction zone does not exceed 600 nm. While working in an inert gas atmosphere, we recommend using a laser at a power of 6–8 W with a pulse duration of 10 ms and a pause of 100–130 ms; with an increase in the pulse, lengthen the pause 6–7 W 20 ms 120–130 ms, 8 W 20 ms with a pause of 130 ms. Conclusion. During the experiment, blue laser showed high resection and coagulation effects. According to the results of the study, the parameters of laser exposure were obtained, which are optimal for the surgical treatment of benign and tumor-like laryngeal lesions.

Nowadays the problem of treating of acute respiratory viral infections, primarily manifested with the clinical picture of acute rhinitis, remains an important problem due to the high prevalence and variety of etiological factors of this disease. Pathogenesis of rhinitis, regardless of the etiology, includes the swelling of the nasal mucosa, the increase in nasal secretion, which blocks nasal breathing and significantly reduces the quality of life. In uncomplicated forms of acute infectious rhinitis, symptomatic treatment is traditionally used, including the elimination therapy and drugs for reducing the nasal mucosa swelling. Topical decongestants have a sympathomimetic effect, affect α1- and α2-adrenergic receptors and help to eliminate swelling of the nasal mucosa and improve nasal breathing, and as a result, restore the patency and aerodynamics of the airways, recover the drainage function of the paranasal sinuses and auditory tube. To date, the pharmaceutical market offers many intranasal decongestants that differ in the duration of exposure, frequency of use, the occurrence of side effects or adverse events. The article shows the pharmacological and pharmacokinetic characteristics of the drug xylometazoline, highlights the results of Russian and foreign studies that demonstrate the efficacy and good tolerability of xylometazoline with a short-term topical course of treatment. The conclusion is made about a good profile of the efficacy and safety of the drug and confirmed that in compliance with the recommendations for the frequency and duration of application, xylometazoline could be recommended for use in a complex symptomatic treatment of acute rhinitis in adults and children.