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The article presents the results of domestic and international studies of the use of the fourth-generation fluoroquinolone moxifloxacin in the treatment of commu-nity-acquired pneumonia and pneumonia caused by SARS-CoV-2. Analysis of the clinical use of moxifloxacin in the treatment of complications of the respiratory tract infec-tions indicates its high efficiency and bioavailability, a low risk of resistance, which makes it possible to recommend it for widespread use in the work of a practicing doctor. Ge-neric drug Maxicin (Yuria-Pharm), available as a 20 mg/ml concentrate in a 20 ml vial, can significantly reduce the cost of treatment and optimize infusion therapy by choosing both volume and solvent.

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

Occupying a leading position in the structure of general injuries, burn injuries in children remain an urgent issue of combustiology in particular and medicine in general. At the same time, many issues related to the organization of first aid to such patients still remain unregulated. To this end, a study aimed at conducting a comparative analysis of the clinical effectiveness of emergency care for children with burn injuries, including the use of the suggested algorithm, was conducted. Materials and methods. 153 cases of burn injuries with boiling water of IIab–III degree on the area of 10–40% of the body surface in children aged from 8 months to 16 years, who were treated at the Clinical Center for Thermal Injury and Plastic Surgery of the Municipal Non-profit Enterprise «Vinnytsia Regional Pirogov Clinical Hospital Vinnytsya Regional Council» in the period of 2015–2020 were analyzed. All patients underwent comprehensive diagnosis and treatment including surgery. Depending on the nature of first aid, children were divided into two groups: patients of the main group (n=97) underwent prompt neutralization of the traumatic effects of exogenous hyperthermic factors on the injured areas from the moment the injury was sustained. Childrenin the control group (n=56) sought help on the 5th–14th day after the injury. The duration of prompt neutralization did not exceed 15 minutes or was not performed at all. It was often combined with the irrational use of pharmacological agents and folk remedies. Results. Comparative analysis of the course of the disease in children of the main group and the comparison group reliably confirmed the benefits of prompt neutralization of traumatic effects of hyperthermic exogenous and endogenous damage factors in burn injuries manifested by a more favorable course of the disease, faster improvement, lower local and systemic inflammatory response, shorter hospital stay with less occurrence of various complications, repeated surgical interventions, better aesthetic and functional results. Conclusions. The obtained results objectively confirmed the importance and effectiveness of the suggested system of organization of care for children with burn injuries, especially at the stages of self-help, mutual assistance and first aid. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: burn injuries, children, first aid, traumatic hyperthermic agents, neutralization.

One of the most complex problems of modern surgery is the treatment and prevention of anaerobic infection. Main place in overcoming of this infectious complication is devoted to urgent surgical intervention and correct early empiric antibacterial therapy. Special place in the combined empiric antibacterial treatment is devoted to 5-nitroimidazoles. Modern data about clinical efficacy of ornidazole in the treatment of surgical infectious complications is presented in the article. We performed a comparison of therapeutic activity and physical-chemical properties, pharmacokinetic and pharmacodynamic features of ornidazole with the first representative of 5-nitroimidazole class – metronidazole. Taking into account antiprotozoal and antianaerobic activity of ornidazole, it is recommended to be used in the schemes of combined therapy of severe generalized anaerobic infections and purulent processes of different localization; treatment and prevention of surgical infections after intraabdominal, thoracic, proctological and dental surgical interventions.

We aimed to study the influence of prolonged administration of fentanyl on postoperative pain, intra­ab­dominal pressure and mechanical lungs’ changes that may happen in neonates in early post­operative period. 30 newborns (in the period from January 2017 to May 2021) with gastroschisis were divided into two groups ac­cordingly to the method of analgesia (14 – morphine hydrochloride; 16 – prolonged infusion of fentanyl). Lungs’ mechanical characteristics, effectiveness of post­operative analgesia, abdominal wall relaxation was studied by monitoring of dynamic compliance (Cdyn), pressure and flow­volume loops, capnography. Apprising analgesia sta­tus, we measured hemodynamic, SаO2, blood level of cortizol, C­reactive protein (CRP), glucose, analyzed post­operative pain syndrome using visual analogue scales (VAS). Intra­abdominal pressure (IAP) was controlled by Cron. For statistic analysis we used Student’s t­test. In the group with morphine, thete was the increase of IAP by 11–12 cm H2O, being stable during some period of time, and also variable levels of pain according to VAS, the in­creasing of CRP from 0.8 ± 0.25 mg/dl by 5 mg/dl, cortisol by 674.4 nmol/l, and blood glucosae rate – 7.4 mmol/l. Periods with high traumatic effects and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3.4 times, resistance increasing in 2.42 times and PIP rising till 22 cm H2O. Di­rect correlation between IAP increase and lungs’ mechanical changes took place. The study has demonstrated that prolonged administration of fentanyl prevented high increase of IAP, CRP, levels of glucose and cortizol and changes of VAS data, lungs’ mechanical characteristics., В исследовании изучается влияние контину­альной инфузии фентанила на послеоперационную боль, внутрибрюшное давление и механические изме­нения в легких, которые могут возникнуть у новоро­жденных в раннем послеоперационном периоде. По ме­тоду обезболивания 30 новорожденных (январь 2017 – май 2021 г.) с гастрошизисом были разделены на две группы (14­ти был назначен морфина гидро хлорид; 16­ти – континуальная инфузия фентанила). Ме­ханические характеристики легких, эффективность послеоперационной анальгезии, релаксации брюшной стенки изучались путем мониторинга динамического комплайенса, петель давления и потока­объема, кап­нографии. Для оценки качества обезболивания измеря­лись параметры гемодинамики, сатурация кислорода в крови, уровень кортизола, С­реактивного белка, глю­козы, проводилась оценка послеоперационного болево­го синдрома с помощью визуальных аналоговых шкал. Внутрибрюшное давление (IAP) контролировалось при помощи Cron. Для статистического анализа использо­вался t­критерий Стьюдента. В группе пациентов, по­лучавших морфин, отмечалось увеличение IAP на 11–12 см H2O, уровня кортизола и глюкозы в крови. Эти эффекты были связаны с травматичностью операции и недостаточной анальгезией, что стало причиной увеличения IAP, постепенного снижения динамическо­го комплайенса, увеличения резистентности легких. Отмечается прямая корреляция между увеличением IAP и механическими изменениями в легких. Исследова­ние показало, что применение континуальной инфузии фентанила предотвращает все вышеперечисленные нежелательные эффекты., У дослідженні вивчається вплив континуаль­ної інфузії фентанілу на післяопераційний біль, вну­трішньочеревний тиск і механічні зміни в легенях, які можуть виникнути у новонароджених у ранньому піс­ляопераційному періоді. За методом знеболення 30 но­вонароджених (січень 2017 – травень 2021 г.) з га­строшизисом були розділені на дві групи (14­ти було призначено морфіну гідрохлорид; 16­ти – континуаль­на інфузія фентанілу). Механічні характеристики ле­гень, ефективність післяопераційної аналгезії, релак­сації черевної стінки вивчалися шляхом моніторингу динамічного комплаєнсу, петель тиску і петель пото­ку­об’єму, капнографії. Для оцінки якості знеболюван­ня вимірювалися параметри гемодинаміки, сатурація кисню в крові, рівень кортизолу, С­реактивного білка, глюкози, проводилася оцінка післяопераційного больо­вого синдрому за допомогою візуальних аналогових шкал. Внутрішньочеревний тиск (IAP) контролювався за допомогою Cron. Для статистичного аналізу ви­користовувався t­критерій Стьюдента. У групі паці­єнтів, які отримували морфін, відзначалося збільшен­ня IAP на 11–12 см H2O, рівня кортизолу та глюкози в крові. Ці ефекти були пов’язані з травматичністю операції і недостатньою анальгезією, що стало при­чиною збільшення IAP, поступового зниження динаміч­ного комплаєнсу, підвищення резистентності легень. Відзначається пряма кореляція між збільшенням IAP та механічними змінами в легенях. Дослідження по­казало, що застосування континуальної інфузії фен­танілу запобігає всім перерахованим вище небажаним ефектам.

The article presents modern data on the use of N-acetylcysteine in the treatment of infectious diseases of the respiratory tract in the practice of a physician. Its antioxidant, mucolytic, anti-inflammatory, pulmoprotective and antitoxic properties are described. The emphasis is placed on the antioxidant properties of N-acetylcysteine, which are expressed when used in high doses of 1200 mg/day or more. There is a review of the literature on the use of high doses of N-acetylcysteine in the treatment of pneumonia, cystic fibrosis, COPD, ARDS. The effect of N-acetylcysteine on individual risk factors for prolonged pneumonia is analyzed. Given the epidemiological situation around the world, the antioxidant properties of N-acetylcysteine in the treatment of pneumonia, including complicated COVID-19, are relevant and require further study.

Linezolid – a first representative of the new class of synthetic antibiotics oxazolidones. Its antibacterial spectrum includes Gram-positive microorganisms, including multi-resistant strains. Its unique mechanism of action conditions absence of cross-resistance with other antibiotics. This drug is presented in peroral and parenteral forms. Unlike vancomycin, it has optimal pharmacokinetic profile. Linezolid was approved by Food and Drug Administration (FDA) in 2000 for the treatment of the following diseases: hospital- and community-acquired pneumonia, skin and soft tissue infections with or without complications caused by Gram-positive bacteria, vancomycin-resistant enterococci and pneumococcal meningitis, caused by penicillin-resistant Streptococcus pneumoniae.

Lower respiratory tract infections are the third mortality cause in the world and the first mortality cause in low-income countries. Community-acquired pneumonia (CAP) is a dangerous infectious pathology, especially in children younger than 5 years, elderly people and patients with compromised immunity. Antibiotic therapy is a standard treatment method for CAP. But an increase in antibiotics use caused a development of resistance in bacteria and onset of adverse events in humans. A new class of fluorchinolones is widely used nowadays in clinical practice. They have good activity against Gram-negative bacteria, as early chinolones, as well as against Gram-positive bacteria, such as pneumococci and atypical bacteria. An increasing amount of penicillin-resistant streptococcal pneumonia leads to more intensive studies of the use of new chinolones. In this review the data of 750 mg levofloxacin is presented. It is used in short courses for the treatment of severe and moderate CAP. Taking into account the broad spectrum of activity of levofloxacin ad bactericidal activity of this antibiotic, it can be a potential alternative therapy for the treatment of children and adults with CAP, especially with a tendency of an increase in antibiotic resistance of pneumococcus.

Mycobacterium tuberculosis is endowed with resistance to adverse factors and rapidly forms drug resistance. The aim is to study of the connection of tuberculosis infection and the development of brain damage with signs of spongymorphic changes. There were investigated canned 10% formalin fragments of the brain of 2 goats with signs of central nervous system damage by histological, microbiological methods. For microbiological examination, 3–5 years brain samples after were sowed on the MycСel DW nutrient medium with a growth stimulator. The molecular genetic study was performed using a polymerase chain reaction on a Molecular Imager GelDoc TM XR + (BioRad) device. The polypeptide profile was studied electrophoretically. In the goats, who died with symptoms of central nervous system damage, spongiform changes were detected in the brain. In the brain samples, DNA and mycobacterium tuberculosis with a defective cell wall have been detected, accumulation of mycobacterial antigens has been observed in the cells of the brain and in the intercellular space. Despite the fact that brain samples were in 10% formalin for 1 month, 3 years and 5 years, in all cases mycobacterium tuberculosis with a defective cell wall was isolated. Their viability was comparable to the infectiousness of prions. The isolation of mycobacterium tuberculosis with a defective cell wall from the brain did not differ in morphology and polypeptide composition from isolates from tuberculin, FLK-BLV, lymph nodes of cows, patients with tuberculosis. This indicates a high probability that mycobacterial infection, depending on the infectious dose, the characteristics of the strain and host genome, as well as the state of the immune system, can cause oncogenic action, cause active tuberculosis, brain damage, and the cardiovascular system.

Мета роботи – дослідження мікрофлори периімплантатного мукозиту та чутливості домінуючих збудників до антибіотиків й антисептиків.Матеріали та методи. Обстежили 43 пацієнти, яким діагностовано периімплантатний мукозит. Під час дослідження від них виділено та ідентифіковано 162 клінічні штами мікроорганізмів. Культивування клінічних ізолятів здійснили за загальноприйнятою методикою, завершальну ідентифікацію – за допомогою автоматичного бактеріологічного аналізатора Vitec – 2compact bioMérieux (Франція). Визначення чутливості збудників до антибіотиків виконали диско-дифузійним методом, до антисептиків – методом подвійних серійних розведень за стандартною методикою відповідно до наказу МОЗ України № 167 від 05.04.2007 р. «Про затвердження методичних вказівок «Визначення чутливості мікроорганізмів до антибактеріальних препаратів».Результати. Визначили, що до складу мікрофлори периімплантатної ділянки хворих на мукозит входили умовно-патогенні мікроорганізми, домінуючими серед них були представники Streptococcus spp., Staphylococcus spp. Часто від хворих мукозитом виділяли Kocuria spp., Enterobacter spp. і дріжджоподібні гриби Candida spp. Клінічні штами мікроорганізмів, що досліджували, мали різну чутливість до антибактеріальних препаратів. Усі клінічні штами мікроорганізмів були чутливими до дії фторхінолонів, але в чималої кількості встановлена стійкість до пеніцилінів, макролідів, лінкозамідів. Своєю чергою, горостен, декасан і хлоргексидин біглюконат володіли потужною протимікробною дією щодо домінуючих збудників периімплантатного мукозиту в пацієнтів. Причому дія антисептиків на основі декаметоксину щодо деяких із них вірогідно перевищувала активність хлоргексидину біглюконату.Висновки. Мікрофлора периімплантатної ділянки хворих периімплантатним мукозитом представлена переважно аеробними та факультативно анаеробними мікроорганізмами, що належать до нормофлори порожнини рота. Більшість збудників мукозиту виявляють стійкість до антибіотиків (пеніциліни, макроліди, лінкозаміди). Сучасні антисептики горостен, декасан хлоргексидин біглюконат володіють потужною протимікробною дією щодо етіологічнозначущих збудників мукозиту, що відкриває перспективи застосування цих антисептиків у стоматологічній імплантології., The purpose was to examine the peri-implant mucositis microflora and sensitivity of dominant pathogens to antibiotics and antiseptics.Materials and methods. The study involved 43 patients with peri-implant mucositis. During the study 162 clinical strains of microorganisms were isolated and identified. Cultivation of clinical isolates was performed by the standard method, final identification was carried out with using bacteriological automatic analyzer Vitec – 2compact bioMérieux (France). Determination of sensitivity to antibiotics of pathogens was carried with disc-diffusion method; the study of sensitivity to antiseptics was carried by means of double serial dilutions method by the standard procedure approved by the Order № 167 of the Ministry of Public Health of Ukraine on “On Approval of Training Guidance “Assessment of the sensitivity of microorganisms to antibiotics”, dated by April, 5, 2007.Results. It is The microflora of peri-implant area of patients with mucositis was revealed to consist of opportunistic species. Representatives of Streptococcus spp. and Staphylococcus spp. were dominating among them, although Kocuria spp., Enterobacter spp. and yeast-like fungi Candida spp. were detected quite common. Investigated clinical strains of microorganisms had different sensitivity to antibiotics. All cultures were sensitive to fluoroquinolones, but very significant number of them showed resistance to penicillins, macrolides and lincosamides. In turn, horosten, dekasan and chlorhexidine had powerful antimicrobial effect on dominant pathogens of periimplant mucositis in patients. Moreover, the effect of decametoxine-based antiseptics on some of them significantly exceeded the activity of chlorhexidine.Conclusions. Microflora from peri-implant area of patients with peri-implant mucositis consists mainly of aerobic and facultative anaerobic microorganisms, belonging to normal oral microflora. Most of pathogens of mucositis obtaine resistance to antibiotics (penicillins, macrolides, lincosamides). Modern antiseptics horosten, decasan and chlorhexidine provide a strong antimicrobial activity against etiological pathogens of mucositis, that makes them promising for use in dental implantology., Цель работы – исследовать микрофлоры периимплантатного мукозита и чувствительность доминирующих возбудителей к антибиотикам и антисептикам.Материалы и методы. Обследовано 43 пациента, которым диагностирован периимплантатный мукозит. В ходе исследования от них выделено и идентифицировано 162 клинических штамма микроорганизмов. Культивирование клинических изолятов проводили по общепринятой методике, заключительную идентификацию – с помощью автоматического бактериологического анализатора Vitec – 2compact bioMérieux (Франция). Определение чувствительности возбудителей к антибиотикам проводили диско-диффузионным методом, к антисептикам – методом двойных серийных разведений по стандартной методике в соответствии с приказом МОЗ Украины № 167 от 05.04.2007 г. «Об утверждении методических указаний «Определение чувствительности микроорганизмов к антибактериальным препаратам».Результаты. Обнаружено, что микрофлора периимплантатной области больных мукозитом состоит из условно-патогенных видов, доминирующими среди которых есть представители Streptococcus spp. и Staphylococcus spp., хотя довольно часто встречаются представители родов Kocuria spp., Enterobacter spp. и дрожжеподобные грибы Candida spp. Исследуемые клинические штаммы микроорганизмов имеют разную чувствительность к антибактериальным препаратам. Все культуры были чувствительными к действию фторхинолонов, однако довольно значительное их количество проявило устойчивость к пенициллинам, макролидам и линкозамидам. В свою очередь, горостен, декасан и хлоргексидин биглюконат обладают мощным противомикробным действием в отношении доминирующих возбудителей периимплантатного мукозита у пациентов. Причём действие антисептиков на основе декаметоксина относительно некоторых из них достоверно превышало активность хлоргексидина биглюконата.Выводы. Микрофлора периимплантатной области больных периимплантатным мукозитом представлена преимущественно аэробными и факультативно – анаэробными микроорганизмами нормофлоры полости рта, большинство из которых проявили устойчивость к определённым группам антибиотиков. В то время как современные антисептики горостен, декасан и хлоргексидин биглюконат проявили мощное противомикробное действие в отношении них. Это делает их перспективными для использования в стоматологической имплантологии.

Background: Our objectives were to evaluate the effectiveness and safety of sucrose in newborns undergoing medical procedures within 7 days of birth. Methods: We performed a double-blind, randomized controlled trial. We included 27 newborns (29,4±2,0 weeks gestation). Each newborn received 2 ml of a 24%-sucrose or placebo solution before all procedures. We used the Premature Infant Pain Profile to assess pain during intramuscular injection, venipuncture for the newborn screening test and the first 3 heel lances for glucose monitoring. Scores ranged from from 0 (no pain) to 18 (maximum pain). Results: We included 21 newborns. The overall mean pain score was lower among newborns who received sucrose than among those who received a placebo (mean difference [MD] -1.42, 94% confidence interval [CI] -1.82 to -0.61). We found that pain scores during intramuscular injection did not differ significantly between the sucrose and placebo groups for newborns( 1 group: MD -1.34, 96% CI -2.30 to 0.2; 2 group: MD -1.0, 90% CI -2.38 to 0.4). During venipuncture, newborns who received sucrose had lower pain scores compared with those who received a placebo ( 1 group: MD - 3.62, 94% CI -4.2 to -1.91; 2 group: MD -2.04, 93% CI -3.3 to -1.1). Conclusion: We found a modest reduction of pain in newborns when sucrose was used for all medical procedures performed in the first 7 days after birth. However, when each procedure was analyzed separately, we found that the effectiveness of sucrose was limited to venipuncture for the newborn screening test.