THE INFLUENCE OF CRYOCORSERVED PLACENTA ON THE DYNAMICS OF CHANGES IN CLINICAL INDICATORS IN THE TREATMENT OF PATIENTS WITH PHLEGMONS OF JAW-FACIAL LOCALITIS

Today, information about circadian rhythms is widespread. Circadian rhythms are generated by clocks that are endogenous in nature and fluctuate even in the absence of environmental signals. Circadian clocks affect a wide range of biological processes, including neuronal, endocrine, metabolic, and behavioral functions. One of the key factors influencing behavioral patterns is the chronotype, which is defined as the human circadian typology and is a behavioral manifestation of the human internal circadian clock system that can be assessed using several methodologies that classify people into morning or evening chronotypes[1]. The aim of our study was to establish how to use a standardized protocol for medical care for odontogenic phlegmons of maxillofacial localization, taking into account the biological rhythm of patients.A total of 30 patients with odontogenic phlegmons of maxillofacial localization (2-3 cell spaces), aged 35 to 60 years, without systemic chronic diseases, regardless of gender, who underwent surgery in the form of opening and drainage of phlegmon with intravenous introduction of cryopreserved placenta.For clinical characterization of the process of purulent wound healing we used the proposed standardization tables of quantitative values of indicators that determine the dynamics of changes in general condition (P-1), the dynamics of local changes in patients with phlegmons of maxillofacial localization (P-2) and the dynamics of changes in a purulent wound (indicator P-3).Analyzing the dynamics of changes in the P-1.1 indicator, it should be emphasized that this indicator reached its maximum values for 1 day after surgery, which is probably due to the body's response to iatrogenic trauma on the background of the inflammatory process. Analyzing the decrease of this indicator during the 3rd and 5th days, it should be noted that its significant value is observed in the period between the 3rd and 5th days closer to the 5th, on average by 1.78 ± 0.24. Analysis of the dynamics of the indicator P-1.2 gives grounds to show its uniform decrease during 1, 3 and 5 days after the operating period with normalization of the indicator for 7 days. The change in the dynamics of the P-1.3 indicator by its significant decrease on the 3rd day in 28% of cases and on the 5th day in 72% of cases with normalization of quantitative data on the 7th day is noteworthy. In the study of masticatory disorders (indicator P-4) should be noted the maximum value of this indicator on the 1st day, which is associated with known complications onthe background of purulent inflammatory process and the presence of additional inflammatory process. A significant decrease in this indicator by 0.31 ± 0.09 points on the 5th day in 62% of cases with partial normalization on the 7th day in 62.3% and full normalization in 37.7% of cases is noteworthy. A similar picture was observed in the study of the dynamics of changes in P-1.5, but in contrast to the previous indicator, normalization on day 7 occurred in 82.9% of cases.In the study of indicators showing the dynamics of local changes deserves special attention indicator P- 2.1, which on the 1st day after the operating period reached maximum values with a gradual decrease throughout the postoperative period, but the largest difference in its reduction by an average of 0.23 ± 00.9 scores were recorded on the 5th day in 56.9% of cases in patients with morning chronotype, operated on in the first half of the day.According to the study, it was found that intravenous cryopreserved placenta have an impact on the course of reparative processes in patients with purulent-inflammatory diseases of the maxillofacial localization, depending on the time of surgery.

Complementary Effect of Non-Persistent Silver Nano-Architectures and Chlorhexidine on Infected Wound Healing

Surgical site infection (SSI) substantially contributes each year to patients’ morbidity and mortality, accounting for about 15% of all nosocomial infections. SSI drastically increases the rehab stint and expenses while jeopardizing health outcomes. Besides prevention, the treatment regime relies on an adequate antibiotic therapy. On the other hand, resistant bacterial strains have currently reached up to 34.3% of the total infections, and this percentage grows annually, reducing the efficacy of the common treatment schemes. Thus, new antibacterial strategies are urgently demanded. Here, we demonstrated in rats the effectiveness of non-persistent silver nano-architectures (AgNAs) in infected wound healing together with their synergistic action in combination with chlorhexidine. Besides the in vivo efficacy evaluation, we performed analysis of the bacteriological profile of purulent wound, histological evaluations, and macrophages polarization quantifications to further validate our findings and elucidate the possible mechanisms of AgNAs action on wound healing. These findings open the way for the composition of robust multifunctional nanoplatforms for the translation of safe and efficient topical treatments of SSI.

PHOTODYNAMIC THERAPY IN COMPLEX TREATMENT OF PHLEGMON OF THE MAXILLOFACIAL AREA AND NECK

Background. The treatment of phlegmon of the maxillofacial area and neck at the present moment remains difficult and insufficiently effective. Aim. To develop a method of using photodynamic therapy (PDT) for the treatment of phlegmon of the maxillofacial area and neck and to evaluate its effectiveness. Material and methods. A total of 92 patients with phlegmons of the maxillofacial area and neck were under observation. They were divided into 3 groups: group 1 – “control group 1” (30 patients) – where traditional treatment was used, group 2 – “control group 2” (30 patients) – in which low-intensity laser radiation was used in addition to topical treatment and group 3 – “experimental” (32 patients) – where PDT was used for topical treatment. Results. The data of clinical, cytological and bacteriological studies show that the local application of PDT has an anti-inflammatory effect and stimulates the reparative processes in the wound, and shortens the treatment period for patients. Conclusion. PDT improves the results of complex treatment of patients with phlegmons of the maxillofacial area and neck. Its application leads to the purification of a purulent wound on the 3rd (3;4) day, allows to apply secondary sutures on the 7th day and to shorten the period of inpatient treatment in comparison with the control groups from 3 to 9 days.

Comparative Assessment of Dynamics of Pathohistological Picture of Purulent Wound in Experimental Animals with a Model of a Boil in Head and Neck Area in Standard Treatment and when Using Electroa

The most common neodontogenic infectious and inflammatory processes affecting the skin are furuncles in the maxillofacial area. The task of effective treatment of patients with this disease is now becoming increasingly urgent which is largely due to the deterioration of the environmental situation, changes in the nature of nutrition and chronic stress. The purpose of the study is to make a comparative assessment of the results of the standard method of postoperative treatment and complex treatment using electroacupuncture based on the dynamics of the pathohistological picture of a purulent wound in experimental animals with a model of a boil in the head and neck. Materials and methods. Experimental studies were carried out on 20 guinea pigs of the same age and body weight, on which a model of a boil in the submandibular area was created. The boil was formed within 3 days, after which all experimental animals under local infiltration anesthesia underwent primary surgical treatment of the infectious and inflammatory focus with wound drainage. Then the animals were divided into two series. Series 1 received a standard treatment package in the postoperative period (antibiotics, daily dressings with mandatory drainage changes, instillation of the wound with antiseptic solutions). For series 2 of animals, the standard treatment was combined with an electroacupuncture treatment. The material for pathohistological examination was collected in the following terms: 3, 7, 14 and 21 days after the operation. Serial sections were made according to the standard procedure. The micro-preparations were examined using a light microscope. For comparison a descriptive method was used. Results and discussion. The most significant differences were found on the 21st day of observation when diffuse mononuclear cell infiltration of all layers of the dermis was detected in most of the series 1 micro-preparations which indicated the presence of productive inflammation. During the same period of observation, all the micro-preparations of series 2 showed a multilayered flat keratinizing epithelium without violating the integrity throughout. The papillary and reticular layers of the dermis showed no signs of inflammation. The appendages of the skin were traced throughout the entire field of vision without visible pathological changes. All of the above indicated no signs of inflammation. Conclusion. The results obtained clearly indicate the positive effect of electroacupuncture on both wound cleansing and the course of the processes of reparative regeneration of the skin

Multicomponent coating in purulent wound healing: A randomised controlled experimental study

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.

Tactics of surgical treatment of deep intermuscular gluteal region phlegmons

Purpose. The purpose is to improve the results of treatment of patients with phlegmon of the gluteal region soft tissues by diagnosing the stage of tissue hypertension and determining the tactics of surgical treatment depending on this indicator. Materials and methods. Clinical studies were performed on 74 patients suffering from phlegmon of the gluteal region. All the patients were divided into 2 groups: in the main group (as opposed to the control group), acute tissue hypertension syndrome was diagnosed and decompressive fasciotomy was performed in tissue hypertension (30–35 mm Hg) (patent). The authors performed ultrasound cavitation and ozone therapy of a purulent wound. Results. With phlegmon of the gluteal region of soft tissues, an increase in tissue pressure by 25% above the norm is an indication for fasciotomy in the area of fascial nodes. The time of purulent wound cleaning against the background of normal tissue pressure (8–10 mm Hg) of the surgery in patients of the main group was reduced to 5 days (8 days in the control). In the long-term (0.5–1 years), good results were obtained in 92.8% of patients in the main group (64.7% in the control group). Conclusion. The developed tactics of treatment of patients with phlegmon of the soft tissues of the gluteal region are highly effective due to the development and application of new technologies for the diagnosis and treatment of tissue hypertension.

STAPHYLOCOCCUS WARNERI CLINICAL ISOLATE SUSCEPTIBILITY TO ANTIBIOTICS AND ITS MODIFICATION BY EMOXYPINE

Background. S. warneri is a common commensal organism, but it can cause serious infections. One of the ways to increase a susceptibility of this microorganism to antibiotics is their combining with adjuvant remedies. Objectives. The aim of the research is to study the susceptibility of S. warneri clinical isolate to antibiotics and its modification by emoxypine - 2-ethyl-6-methyl-3-hydroxypyridine hydrochloride. Methods. Samples of purulent wound exudation were obtained from a patient with infective complications after a bone fracture and osteosynthesis by metal plates. Susceptibility of S. warneri clinical isolate to antibiotics and their combinations with emoxypine (1000 μg/disk) was studied by a standard disc diffusion technique. In the case of microbial resistance, the susceptibility of the investigated isolate to such antibiotic was determined by a serial broth dilutions method without or with emoxypine and evaluated according to the minimum inhibitory concentration (MIC). Results. By the disk diffusion method, S. warneri isolate was susceptible to all tested antibiotics, except chloramphenicol. The growth inhibition zones also were formed around disks containing emoxypine, but the susceptibility of S. warneri to this agent was low. Applying of emoxypine on the disks with antibiotics resulted in the increase of S. warneri growth inhibition in all cases, except using the amikacin, gentamicin, and fusidic acid. The most significant changes were evidenced for a composition chloramphenicol / emoxypine. Using chloramphenicol alone in the liquid medium, the MIC was over a cut-off point. Adding of emoxypine (209 μg/ml) decreased the MIC of the antibiotic and restored the susceptibility S. warneri to chloramphenicol. Conclusions. The susceptibility of S. warneri clinical isolate to antibiotics can be increased by combining with emoxypine, which among other overcomes the resistance of the studied microorganism to chloramphenicol.

Research of blood viscosity in patients with purulent and inflammatory diseases of the maxillofacial region during wound healing

The article presents the study of changes in blood viscosity during purulent wound healing in patients with purulent and inflammatory diseases of the maxillofacial region.

Complex treatment of experimental purulent wound of soft tissues

Objective. To study the impact of estrogens and liposomes on course of healing process in purulent wounds of soft tissues in experiment. Маterials and methods. Еxperimental investigation was done on 21 sheep. In the laboratory animals purulent-inflammatory process was simulated. Тhe laboratory animals were distributed into two groups: a control - 6 sheep and investigated - 15. All the animals obtained conventional therapy. In laboratory animals of the investigated group estrogens and liposomes were added to complex of the conventional treatment measures. The healing process course was controlled, using cytological, biochemical, planimetric and mathematic-statistical methods of investigation. Results. Application of combined estrogen-liposomal therapy in complex treatment of experimental purulent wound of soft tissues have enhanced the levels of оxyprolene, ribonucleic and deoxyribonucleic acids in the wound area, raised a value of estradiol/testosteronic index, accelerated the wound cleansing, the granulations creation and shortened the wound healing process by (2.12 ± 0.24) days. Conclusion. Including of estrogens and liposomes into the treatment complex for experimental purulent wound of soft tissues enhances cellular biosynthetic activity, activity of reparative processes in the wound area, accelerates the wound cleansing and the granulation creation, shortens the wound healing process and may be applied for improvement of the purulent wounds treatment in elderly and senile patients.