Local antibiotic therapy options for treating acute rhinosinusitis in children

The article presents various types of acute rhinosinusitis progression in pediatric practice depending on the duration of the disease, based on the available modern consensus papers and clinical guidelines. The main clinical terminology of the nosological forms of rhinosinusitis was determined, and aspects of their differential diagnosis and stages of the treatment were studied. The authors provided insight into disease pathogenesis, taking into account literature review data on the spectrum of the most common bacterial agents of the nose and paranasal sinuses pathologies. The available data on the treatment of rhinosinusitis are summarized from the perspective of consensus papers and modern clinical guidelines of the Ministry of Health of the Russian Federation, the use of which for the prescription of treatment is the most important quality criterion for medical care provided. A clinical case of the treatment of acute bacterial uncomplicated rhinosinusitis in a 12-year-old child is described. In this case, an aerosolized form of topical antibiotic therapy combined with a mucolytic component was used as a drug of choice alongside with the standard irrigation-elimination therapy and nasal decongestants, which gives an advantage in achieving the maximum effective concentration of the active substance at the site of inflammation. A drug with a mucoactive effect helps to decrease mucus viscosity and discharge, and at the same time facilitates the entry of an active substance into the tissues and inhibits bacterial adhesion to the epithelium of the respiratory tract. Antibacterial component – thiamphenicol, a derivative of chloramphenicol with a mechanism of action associated with inhibition of bacterial protein synthesis has a broad spectrum of action and a maximum degree of accumulation and action in the site of inflammation due to the method of delivery to the epithelium of the respiratory tract

Влияние способа поддержания проходимости дыхательных путей при эндоскопических риносинусохирургических вмешательствах на кровоточивость в области операционного поля

The objective: to conduct a comparative assessment of the severity of intraoperative bleeding with different methods of airway management (using a laryngeal mask and endotracheal tube) during endoscopic rhinosinussurgical procedures.Subjects and Methods. A prospective randomized cohort single-center study of 160 cases of endoscopic rhinosinussurgical procedures under general anesthesia was conducted.Tracheal intubation (TI) was used in 79 cases (Group 1), a laryngeal mask (LM) – in 81 (Group 2). The evaluation criteria in the groups included the bleeding intensity (BI) by 6-point scale of average categories (Fromme-Boezaart Score), indicators characterizing the state of blood circulation during surgery: HR, BPsys., BPdiast., MAP, and perfusion index.Results. Significantly lower BI values were observed in Group 2 at all time points of the study (at the 10th, 30th and 60th minute of surgery). This was due both to using a laryngeal mask, and to lower HR, BPsys., BPdiast, and MAP.Conclusion. The use of a laryngeal mask for airway management during general anesthesia in endoscopic rhinosinussurgical procedures helps to reduce the intensity of surgical field bleeding.Управление степенью интраоперационного кровотечения играет ведущую роль в улучшении видимости операционного поля и снижении риска осложнений при эндоскопических риносинусохирургических (ЭРСХ) вмешательствах.Цель: провести сравнительную оценку выраженности интраоперационного кровотечения при разных способах поддержания проходимости дыхательных путей (с помощью ларингеальной маски и эндотрахеальной трубки) во время ЭРСХ-вмешательств.Материалы и методы. Проспективное рандомизированное когортное одноцентровое исследование 160 случаев ЭРСХ-вмешательств в условиях общей анестезии. Интубация трахеи (ИТ) использована в 79 случаях (1-я группа), ларингеальная маска (ЛМ) – в 81 (2-я группа). Критерии оценки в группах включали интенсивность кровотечения по 6-балльной шкале средних категорий (Fromme ‒ Boezaart Score) и показатели, характеризующие состояние кровообращения в ходе оперативного вмешательства (ЧСС, АДсист, АДдиаст, САД, перфузионный индекс).Результаты. Значимо меньшие показатели интенсивности кровотечения во всех точках исследования (на 10, 30 и 60-й мин операции) наблюдали во 2-й группе. Это было связано как с самим фактом использования ларингеальной маски, так и с более низкими значениями показателей ЧСС, АДсист, АДдиаст и САД.Вывод. Использование ларингеальной маски для поддержания проходимости дыхательных путей во время общей анестезии при ЭРСХ-вмешательствах способствует уменьшению локальной кровоточивости

Urinary pH: its regulation and relevance in urolithiasis metaphylaxis

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence

ВОЗМОЖНОСТИ ЛУЧЕВОЙ ДИАГНОСТИКИ У ПАЦИЕНТОВ С СИНДРОМОМ СОННОГО АПНОЭ

This article examines the literature about possibilities of radiology in patients with snoring and obstructive sleep apnea in ENT and maxillofacial surgery in pediatric patients and adult ages.Проведен анализ данных литературы о возможностях лучевой диагностики феномена храпа и синдрома обструктивного апноэ сна в оториноларингологии и челюстно-лицевой хирургии у пациентов детского и взрослого возраста

Differential diagnosis of maxilla and maxillary sinus cysts

Even nowadays some difficulties in diagnostic of maxillary sinus cysts and maxillary cysts can appear. The most impartial kind of diagnostic of such pathology is computed tomography. However the proper diagnose can be get only by pathomorphological checkup. We represent a clinical cases

Treatment options of the nasal cavity and paranasal sinuses diseases

Currently, the pathology of the nasal cavity and paranasal sinuses is an urgent public health problem. Rhinosinusitis is one of the leading causes of patients seeking medical attention. In addition to traditional anti-inflammatory, antibacterial, decongestant and antihistamine therapy, agents with mucolytic properties are widely used. The basis of rhinosinusitis is a process of violation of mucociliary clearance. Sinonasal secretions in rhinosinusitis are more viscous,elastic, and adhesive than normal nasal mucus. A change in the composition of the nasal secretion leads to stagnation of the contents in the sinuses, promotes bacterial colonization. The appointment of mucolytics regulates secretion and normalizes the viscosity of the secretion. The article provides an example of the clinical use of Sinupret®

The role of herbal medicine in the treatment of chronic tonsillitis

The article presents our own research data on systemic immunity status in patients with chronic tonsillitis (CT) and microbiological profile of the flora isolated from the tonsils in CT. The study showed that phagocytic index in neutrophils decreased by 81.9% and the phagocytosis in neutrophils reduced by 67.2% in patients with CT. We studied microbial flora of the tonsils and its persistent properties in CT. The steps for that were as follows: we evaluated the antilysocyme (ALA), anti-interferon (AIA), anticomplementary (ACA) activities of the isolated microorganisms as possible ways to stand against the oxygen-independent mechanism of phagocytosis. Most strains of Staphylococcus aureus had ALA, AIA and AСA, while most strains of Streptococcus pyogenes had ALA, less frequently AСA and did not show AIA. We found antibacterial polyresistance in 56.0% of pathogens among the selected strains in the examined patients with CT. A comparative analysis of species antibiotic resistance showed that the largest number of multiresistant strains were S.aureus - 62.0%. The set of revealed persistent properties of chronic tonsillitis pathogens serves as underlying rationale for the search for new methods of therapy using drugs of non-antibacterial origin, affecting the factors of bacteria resistance to inborn and acquired immunity. It is possible, and necessary that attention be paid to phytotherapy in the search for such new methods. Tonsilgon N is one of the complex phytotherapeutic products, which efficacy and safety has been proven in clinical trials, and the main pharmacological properties are confirmed in in vitro and in vivo preclinical studies. It contains marshmallow root, chamomile flowers, horsetail grass, walnut leaves, yarrow grass, oak bark, and dandelion grass. The clinical studies revealed that it has positive effect on the dynamics of both clinical and microbiological, immunological parameters in patients with chronic tonsillitis. All these things allow us to recommend that this complex herbal product be more often included into the comprehensive treatment of chronic tonsillitis

Treatment of tonsillopharyngitis in children

Tonsillopharyngitis is a common disease among pediatric patients. Visits associated with sore throat account for 6 to 8% of all visits to pediatricians and general practitioners. Tonsillopharyngitis can have both infectious and non-infectious etiologies. In pediatric practice, most cases of upper respiratory tract infections are of viral origin, especially in children of early and preschool age. In most cases, uncomplicated course and non-infectious etiology of the disease do not require the administration of antibacterial drugs. The bacterial nature of the disease can be distinguished from the viral one using the data of culture analysis and rapid test for group A β-hemolytic streptococcus (GABHS) or Streptococcus pyogenes. The etiotropic therapy of streptococcal tonsillopharyngitis is antibiotic therapy. In GABHS, antibiotic therapy shortens the duration and reduces the severity of symptoms, reduces the Likelihood of purulent complications, post-streptococcal diseases and prevents the generalization of streptococcal infection. The use of modern antiseptic herbal medicines may be an additional and alternative line of therapy. The authors presented a literature review of the clinical trials results of a modern herbal medicine and provided the results of their own case of the combined treatment of a 10-year-old child with a diagnosis: acute moderate tonsillopharyngitis, bilateral cervical lymphadenitis; acute rhinitis; chronic adenoiditis, exacerbation; degree 2 adenoids. Antibacterial therapy included amoxicillin: oral: 100 mg/kg/day in 2 divided doses for 10 days, combined with an anti-inflammatory and antiseptic herbal medicine due to the complicated course of the disease in the form of concomitant regional lymphadenitis. The course of therapy resulted in clear positive changes: overall well-being improved as early as on the second day of treatment, sore throat and submandibular region ceased to cause pain by 5th day of treatment, the temperature became normal by 5th day of the disease. This clinical observation shows the possibility to introduce an anti-inflammatory herbal medicine to the complex treatment of acute tonsillopharyngitis in children, including cases of complicated course of the disease

A modern approach to the comprehensive treatment of allergic rhinitis

The problem of allergic rhinosinusopathies is one of the most pressing in modern rhinology. It has drawn the attention of clinicians for several decades. Allergic rhinitis is a common disease, the onset of which often come in early childhood. In later life, this disease significantly reduces the quality of life. The widespread prevalence of allergic rhinitis among children and able-bodied adults, growing incidence rates of the disease represent a significant medical and social problem. Allergic rhinitis should be treated by otorhinolaryngologists and allergists-immunologists. Given the pathogenetic mechanisms of the disease, it is necessary to act upon the local symptoms and total body. Extension of disease remissions, teaching patients the principles of elimination therapy and how to maintain a healthy microclimate at home, relapse prevention are the main directions in the treatment of allergic rhinitis. The primary task of otorhinolaryngologists and allergists-immunologists is to restore unlabored nasal breathing in such patients. Symptomatic therapy includes administration of vasoconstrictor drugs, anticholinergics, cromons, local and systemic antihistamines, leukotriene receptor blockers, topical and systemic glucocorticosteroids (GCS), sorbents, pre- and probiotics. Despite the fact that the symptomatic therapy methods cannot provide a long-lasting effect after cancellation, local symptomatic treatment of allergic rhinitis using topical corticosteroids is generally accepted and widely used in the otorhinolaryngology practice. Flixonase is one of the topical corticosteroids that are often prescribed for allergic rhinitis. The aim of our paper was to evaluate the effectiveness of the treatment regimen of allergic rhinitis using Flixonase as a local GCS. 24 people with perennial allergic rhinitis aged from 19 to 38 years were under our observation. The following therapy was prescribed to the patients: decongestants, rinsing the nasal cavity with saline (saltwater) solutions, corticosteroids (Flixonase), mild sedatives. Flixonase showed its efficacy in our study

Clinical approach to the selection of topical decongestants in paediatric otolaryngology practice

This article describes the mechanism of action of topical decongestants from the perspective of their efficient and safe use in paediatric otorhinolaryngology. It also presents the structure of the most common nosologies in the outpatient unit of otorhinolaryngological practice