Background. Purulent wound healing is a pressing surgical challenge relevant in 30−35% of patient cases. To the more, wound infectious agents elaborate resistance to available drugs warranting the development of new drug combinations exserting a multidirectional effect on the wound process.

Objective. Using a purulent wound model to experimentally evaluate the efficiency of a new multicomponent wound coating comprised of polyethylene oxide and carboxymethylcellulose sodium-immobilised dioxidine, methyluracil, metronidazole and lidocaine hydrochloride in comparison with a legal approved wound coating drug preparation of beeswax and propolis-based dioxidine ointment.

Methods. The antimicrobial activity range (disk-diffusion method) and local anaesthetic effect (Rainier’s method) of the developed wound coating have been assessed. The healing process was studied in a purulent wound model with 72 Wistar rats divided between two equal groups. The following methods were applied: visual wound inspection (wound cleansing time, absence of wound-surrounding tissue oedema, granulation and epithelisation), planimetric parameter estimation (wound area, healing rate, wound area reduction ratio), wound contamination and pH measurement, wound section cell morphometry (granulocyte, macrophage, lymphocyte and fibroblast counts, cell index estimation). Daily dressings were applied for 15 days.

Results. The developed wound coating exhibited high efficiency against Gram-positive and Gram-negative bacteria in the zone of inhibition tests. Its local anaesthetic effect was significantly superior to the approved drug by the duration of action. The wound area reduction was 94.2 (93.7; 94.8)% in the experimental group and 86 (84.2; 88.8)% in the control (differences statistically significant) already on day 10. A maximal healing rate in both groups was registered in phase 1 of the wound process being 1.4 times higher in experiment compared to the control. The wound contamination was significantly lower in experiment vs. control on day 8 (p = 0.0075). Wound pH negatively correlated with the fibroblast count and positively — with the contamination level.

Conclusion. The study demonstrates high efficiency of the developed wound coating against infectious agents and its positive healing impact via reducing phase 1 and stimulating proliferation in phase 2 of the wound process.

Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.

Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.

Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.

Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, p < 0.01).

Conclusion. A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.

Background. An elevated or inadequate sensitivity to salt intake is an important mechanism for maintaining high blood pressure in patients with arterial hypertension. Chronopharmacotherapy comprises an important approach to control arterial hypertension through personalised correction of blood pressure but requires a further proof of efficacy in salt-sensitive hypertensive patients.

Objectives. An assessment of six-month dynamics of diurnal and nocturnal peripheral and central blood pressure in salt-sensitive patients with arterial hypertension under chronopharmacothe­rapy.

Methods. A controlled randomised trial included 86 salt-sensitive patients with arterial hypertension. Salt sensitivity was estimated with a Kharchenko’s test. All patients had circadian monitoring of the peripheral and central blood pressure and glomerular filtration rate at baseline and in a six-month follow-up. The patients were randomised into 3 cohorts. Cohort A united patients received perindopril and amlodipine in morning, cohort B — perindopril in morning, amlodipine in evening, cohort C — perindopril in evening, amlodipine in morning. Statistica 12 (StatSoftInc, USA) was used for nonparametric statistical analyses.

Results. In six months of chronopharmacotherapy a target arterial pressure was registered in 87.5% patients in cohort A, 96.4 and 96.2% patients in cohorts B and C, respectively. All cohorts exhibited a declining peripheral and central blood pressure over therapy. Cohort A had a greater decline in daytime, and cohorts B and C — both diurnally and nocturnally. Cohorts B and C had more patients with an adequate nocturnal blood pressure decline. Glomerular filtration rate also elevated with perindopril or amlodipine intake before bedtime.

Conclusion. The perindopril or amlodipine intake before bedtime in a combined therapy for arterial hypertension provided for a target blood pressure in the overall majority of patients, effectively reduced peripheral and central blood pressure at all time intervals, contributed to optimising the circadian blood pressure profile and increased the glomerular filtration rate.

Background. Inflammation declares itself with the presence of cellular tissue infiltrate, which composition reflects the inflammation type. Chronic inflammation is predominated by mononuclear cell infiltration with a certain amount of neutrophils, which role and significance are not fully understood to date.

Objectives. Assessment of the infiltrated neutrophil count at various chronic endometritis severity and its dependency on the functional and metabolic activity in neutrophilic leucocytes in peripheral blood.

Methods. This prospective non-randomised controlled trial estimated the CD45⁺ leucocyte and activated CD16b⁺ neutrophil counts in inflammation infiltrate using immunohistochemistry protocols. Cell counts per section 1 mm² were measured with computer morphometry. The content of and NADPH oxidase activity in activated neutrophilic leucocytes in venous blood were estimated with a nitroblue tetrazolium reduction test.

Results. The study included 40 women with a history of chronic endometritis (CE) divided in two cohorts by endometrial biopsy data, with inactive (n = 25) and active CE (n = 15). A control cohort comprised 20 women with no signs of CE. The inactive CE cohort had higher counts of CD45⁺ leucocytes and activated CD16b⁺ neutrophils in infiltrate compared to control. Higher content of activated neutrophilic leucocytes with higher NADPH oxidase activity were found in peripheral blood. Morphological exacerbation markers of EC were associated with sharper peaks of CD45⁺ and CD16b⁺ cell counts in infiltrate and an elevated functional metabolic activity in circulating neutrophilic leucocytes. A strong direct correlation was revealed between blood activated neutrophil and endometrial CD16b⁺ neutrophil counts, as well as NADPH oxidase activity in blood neutrophils and infiltrate CD16b⁺ cell counts.

Conclusion. Even minor morphological markers of exacerbated endometrial inflammation are accompanied by the elevated infiltrate counts of both total CD45⁺ leucocytes and activated CD16b⁺ neutrophils. The functional metabolic activity of peripheral blood neutrophilic leucocytes is interlinked with the inflammatory infiltrate cell composition and reflects severity of chronic endometrial inflammation.

Background. Ixodes tick-borne borreliosis (TBB) is a clinically multifaceted disease posing a serious threat in most territories of the Russian Federation. New TBB outbreaks emerge and spread to the country’s south.

Objectives. The review highlights the TBB clinical diversity to physicians in order to improve the diagnosis quality and opportune aid. It focuses on the early and late clinical presentation of localised and disseminated polysystemic TBB.

Methods. Sources were mined in the MEDLINE, PubMed and national electronic databases (Сyberleninka, eLibrary, etc.) with keywords “tick-borne borreliosis” [клещевой боррелиоз], “Lyme disease” [болезнь Лайма], “Lyme arthritis” [Лайм-артриты], neuroborreliosis [нейроборрелиоз] for the period of 2014–2020. Selected impactive publications within 2007–2013 were also included. Research was considered eligible if borreliosis was diagnosed using specific techniques like immune-enzyme assays, immunoblotting or PCR.

Results. TBB is a common and cross-disciplinary situation. The disease may progress occult or manifest in a variety of forms, from annular erythema to cardiac, peripheral and central nervous system involvement or arthritis. The polysystemic nature of lesions, often long-term of the tick bite, forces multiple specialist visits ending with misdiagnoses, late aetiotropic therapy and transition into a chronic phase through ignorance of the patient’s epidemiological record. Some patients may have the acute phase followed by irreversible neurological damage associated with memory loss, cognitive decline, arthrosis and sclerotic skin change reducing the quality of life.

Conclusion. TBB can be mimicked by therapeutic, neurological, skin and ophthalmic illnesses, which warrants the physician’s attention to the epidemiological record and knowledge of specific diagnostic techniques. Further research is necessary into the pathogenesis and clinical presentation of chronic TBB and its residual manifestations.

Background. Metabolic diseases are growing, also in paediatric practice. Metabolic nephropathy is becoming more prevalent comprising 27–64% total paediatric nephrological cases, according to various published evidence. In this concern, the correct diagnosis, dietary and drug therapy acquire particular importance.

Objectives. An overview of current methods for laboratory and instrumental diagnosis and treatment of metabolic nephropathies in children.

Methods. National and foreign literature sources were mined in the RSCI, VAK, Scopus, Web of Science, PubMed, Cochrane Library and eLibrary databases at a search depth limited to seven years. The query keywords were: metabolic nephropathy [обменная нефропатия], children [дети], calcium oxalate crystalluria [оксалатно-кальциевая кристаллурия], therapy [терапия]. Content and descriptive analyses were used as research tools.

Results. The review surveyed 74 literature sources, with 50 selected for further analysis.

Discussion. Modern views on metabolic nephropathies are highlighted in terms of classification, clinical progression, methods of diagnosis, treatment and prevention. A current trend in these diseases is earlier-age morbidity. The most studied metabolic nephropathy is calcium oxalate crystalluria. The article also discusses the role of Oxalobacter formigenes bacteria in secondary oxalate nephropathy.

Conclusion. Therapies for metabolic nephropathies as polyaetiologic diseases are multicomponent to target both a causal factor and lithogenesis-contributing mechanisms. Current treatment approaches to metabolic nephropathies in children are highlighted in the light of published knowledge.

Background. Lichen planus ruber is a common inflammatory disease of skin and mucous membranes with a chronic relapsing course, resistance to conventional therapy, diverse clinical manifestations and capacity of tumourisation. Dermatosis is often comorbid with various underlying gastrointestinal, cardiovascular illnesses and endocrinopathies. Women are more impacted than men (ratio 1.4:1), the disease lasts from 5 to 40 years.

Objectives. Assessment of the efficacy and safety of current therapies for lichen planus ruber.

Methods. The PubMed, Web of Science, Medline, eLibrary and Scopus databases were mined for randomised controlled studies on treatment of this dermatosis in the period of 2014–2020, and selected impactive publications within 1991–2012 were also included in the review. The following keywords were used: lichen planus [красный плоский лишай], systemic and local drugs [системные и местные препараты], phototherapy [фототерапия], physiotherapeutic methods of treatment [физиотерапевтические методы лечения]. Publications in peer-reviewed journals had priority. Content and descriptive analyses were used as research tools.

Results. Therapy for lichen planus ruber is multicomponent including a wide range of techniques, mostly immune-stimulating but often unproved for efficacy and safety. Selected studies are small-sample. The review presents feasible drug-based and physiotherapeutic methods to tackle lichen planus ruber, their application by the disease clinical presentation and prevalence, patient’s personal discomfort, psycho-emotional status and comorbidity. We describe the mechanisms of action, clinical efficacy, application types and noxious side effects in practiced albeit sometimes contentious therapies.

Conclusion. Further well-designed research is warranted to aim at enhanced efficacy, safety and long-term remission in therapy for lichen planus ruber.

Background. Management of multiple gestation complicated by the foeto-foetal transfusion syndrome is among most intricate modern obstetric issues. The syndrome develops in 10–20% of monochorionic diamniotic twins leading to 80–100% mortality in one or both twins if left uncorrected, especially in early syndrome cases. Although foeto-foetal transfusion usually develops with monochorionic placentae, there are notable exceptions of vascular placental anastomoses reported with dichorionic monozygotic twins. The disease supposedly entails from an imbalanced blood interflow between dichorionic twins due to placental vascular anastomoses.

Clinical Case Description. Patient S., 32 yo, visited perinatal diagnostics at the Territorial Perinatal Centre of the Children’s Territorial Clinical Hospital with a preliminary diagnosis: 22 weeks and 5 days’ pregnancy. Dichorionic diamniotic twins. Threat of extremely preterm birth. Two caesarean uterine scars. Gestational diabetes mellitus.

Medical files: patient history, pregnancy calendar. Pregnancy was regularly monitored with main ultrasound foetometry, foeto-foetal transfusion dynamics control and Doppler velocimetry.

Ultrasonographic signs of abnormal haemodynamics underlying the foeto-foetal transfusion syndrome were detected at the first scan at 11–13 weeks 6 days’ term as collar space thickening in one foetus. Hydramnios in one foetus and oligohydramnios in the other were diagnosed at 28 weeks’ gestation conclusively indicating the foeto-foetal transfusion syndrome. This evidence suggested the formation of placental anastomoses, which was confirmed morphologically in placenta examination.

Conclusion. A timely diagnosis and correction of emerging complications allowed prolongation of pregnancy in hospital conditions to 33–34 weeks. Both boys were live-born with Apgar score 7–8.

Background. Middle ear neoplasm is a rare pathology accounting for about 0.7% total head and neck tumours. The article describes the clinical presentation, diagnostic methods and surgical treatment for neoplasms of mastoid process, a quite rare tumour localisation.

Clinical Case Description. Patient G., 66 yo, was admitted to a otorhinolaryngological unit with a preliminary diagnosis of left mastoid neoplasm and complaints of non-transient headache on the left and slight hearing loss in both ears. The symptoms have been persisting since childhood. Laboratory tests without abnormalities. Voluminous invasive neoplasm of left temporal bone mastoid in CT. Left mastoidectomy with mastoid neoplasm resection was performed routinely, with a histological examination of surgical material. Benign angiofibroma in morbid histology. Definitive diagnosis: neoplasm of left mastoid. Relief from headache and overall improvement were reported by the patient in two months after surgery.

Conclusion. Benign mastoid angiofibroma is a rare tumour in terms of localisation and morphology reluctant to diagnosis in an asymptomatic form. We suggest computed tomography as the main diagnostic and surgery — as main treatment method in this pathology. The disease has a life-favourable prognosis.

Background. Imbalanced pro- and anti-inflammatory systems can unfavourably condition carrying of pregnancy and provoke gestation complications, such as premature rupture of membranes.

Objectives. Assessing the contribution of SNP variants -137G>C (rs187238), -607G>T (rs1946518) and -656A>C (rs5744228) of the IL-18 gene promoter to the incidence of extremely preterm premature rupture of membranes.

Methods. A case-control study enrolled 120 pregnant women managed at the Perinatal Centre. The women were divided in two cohorts. The study cohort comprised 80 women with premature rupture of membranes at 22–27 weeks 6 days’ gestation hospitalised in a high-risk pregnancy unit, a control cohort consisted of 40 women with physiological pregnancy at 22–27 weeks 6 days’ gestation following outpatient counselling. The cohorts had comparable obstetric and gynaecological histories. The study exclusion criteria were: multiple gestation, foetal chromosomal anomalies, congenital foetal malformations, pregnancy due to assisted reproduction. Genotyping was performed at positions -137G>C, -607G>T and -656A>C of the IL-18 gene promoter with determining a peripheral blood IL-18 level in cohorts.

Results. The premature rupture of membranes cohort had a statistically higher serum interleukin-18 concentration compared to control (p = 0.001). Genotyping of the IL-18 gene promoter revealed a statistically higher rate of homozygous -137G>C mutation (CC genotype) in the premature rupture of membranes cohort at 22–27 weeks 6 days’ term (p <0.001), 67 vs. 27% in control.

Conclusion. A homozygous IL-18 -137G>C polymorphic variant associated with elevated blood IL-18 levels is statistically more common in pregnant women having premature rupture of membranes at 22–27 weeks 6 days’ gestation.

Background. The main hay fever agent in Krasnodar Krai is ragweed pollen (Ambrosia gen.). An important alerting guide for medical practitioners and allergic citizens is the seasonal anthetic calendar and pollen peak times.

Objectives. Obtaining of relevant data on ragweed pollen air contamination rate in Krasnodar in a three-year-dynamics (2018–2020) to estimate the anthetic activity correlation with abiotic and anthropogenic factors and the role of pollen indicators in allergic morbidity.

Methods. We surveyed the daily average ragweed pollen values in Krasnodar air. Allergic medical visits were analysed in terms of the ragweed anthetic activity and pollen air contamination of the city.

Results. A maximal daily average ragweed pollen peak occurs in August: 663.35 p.g./m3 in 2018, 209.89 p.g./m3 in 2019, 80.62 p.g./m3 in 2020. Numbers of medical visits for pollinosis per a selected municipal medical facility: 314 in 2018, 335 in 2019 and 146 in 2020, with a peak period in September--October. Analyses of the air pollution impact on ragweed pollen production revealed a correlation between the pollen rate and values of CO (correlation coefficient r-0.356), NH3 (r-0.198) and dust pollution (r-0.361) in July, August, September and October 2018–2020.

Conclusion. Analyses of climatic factors uncovered clear patterns: strongest anthesis corresponds to minimal humidity (<60%), the pollen grain content diminishes with lower humidities dropping to minimal with precipitations and increases at temperatures 20 °C and above. No significant dependency was observed between air pollution and the allergic pollen content. Anthesis in ragweed moderately correlates with the rate of medical visits.