The effect of local anesthetics against planktonic forms and film formation of S. aureus strains and its dependence on antiseptics activity

Today surgical site infections (SSIs) remain the second among hospital acquired infections in Europe and the USA. Staphylococcus aureus as a pathogen of nosocomial infections occur more frequently in surgical hospitals. The work was aimed to establish the effect of local anesthetics against planktonic forms and biofilm-formation of S. aureus clinical strains and the relationship between the sensitivity of S. aureus strains to local anesthetics and antiseptics in vitro. The antimicrobial activity of local anesthetics (0.5%, bupivacaine, 2.0% lidocaine, 0.375% ropivacaine) and antiseptics (decamethoxine 0.02%, chlorhexidine 0.05%) against clinical strains of S. aureus was observed and studied their ability to produce biofilms. The antimicrobial effect of local anesthetics was lower compared to antiseptics, but we observed inhibition of growth and reproduction of S. aureus in their presence. The ropivacaine solution and the lidocaine solution demonstrated almost the same activity against the studied microorganism isolates. Along with this, bupivacaine solution had the highest activity against the studied microorganisms. The minimal inhibitory concentration of bupivacaine for S. aureus was 2.2 times lower than the minimal inhibitory concentration of lidocaine and 2.1 times lower than the minimal inhibitory concentration of ropivacaine significantly (p < 0.05). Scientific research on various aspects of the formation of bacterial biofilms is a relevant area that will change approaches to the prophylaxis and treatment of a number of infections, including SSIs.

Adjunctive inhaled amikacin in infants with Ventilator-Associated Pneumonia optimizes the complex antimicrobial therapy: pilot study

BACKGROUND AND AIM

VAP remains the second leading cause of death among the patients with nosocomial infections and its incidence varies significantly from 5% to 60% reaching on average 10 %. It is of crucial importance to develop novel treatment approaches and optimize the existing ones. Thus, the aim of this pilot study was to study the laboratory-microbiological effect of inhaled aminoglycosides in a complex treatment of patients with ventilator-associatedpneumonia(VAP).  Methods: To study the laboratory-microbiological effect of adjunctive inhaled aminoglycosides in the treatment of VAP, twenty enrolled patients were randomly subdivided into 2 groups (n=10). Amikacin was administered via a nebulizer starting from the first day of VAP manifestation. Inhalations were performed BID for 7 days via a nebulizer integrated into the breathing circuit. We assessed: cell membrane alterations in leukocytes, Annexin V/7-AAD staining for leukocytes, ROS detection assay for leukocytes.

RESULTS

Adjunctive administration of inhaled amikacin reduced the fluorescence intensity ratio more efficiently compared with the intravenous antimicrobial treatment with no aerosolized amikacin following both 48 h and 96 h of treatment. The amount of dead necrotic annexin V-negative, 7-AAD-positive leukocytes was significantly lower under the use of inhaled amikacin than at the beginning of treatment. Conclusions In this pilot study, we found that administration of aerosolized amikacin combined with the systemic antimicrobial therapy improves the clinical outcome of patients with VAP, effective early microbial decrease in the sputum, reduces reactive oxygen species generation in leukocytes and the degree of leukocyte apoptosis and necrosis, decreases VAP-mediated cell membrane alterations of circulating leukocytes.

Microbiological Aspects Concerning the Etiology of Acute Odontogenic Inflammatory Diseases in the Soft Tissues of the Head and Neck Region

Odontogenic purulent inflammatory diseases (OPID) make up about 20% of cases in the structure of general surgical pathology and are among the frequent diseases of the maxillofacial region (MFR) with a high (10-40%) mortality rate. Insufficient information about the source state of acute odontogenic inflammation of the peri-mandibular soft tissues significantly reduces the effectiveness of diagnostic measures of OPID in MFR, as evidenced by almost 50% of the diagnostic error rate. Statistically, OPID in soft-tissue of MFR most often occur due to dissemination of pathogens of the necrotized pulp, periodontal pockets in periodontitis or pericoronitis during the difficult eruption of retained teeth. Previously, the quantitative dominance (about 70%) of Staphylococcus spp. among the microorganisms isolated from the odontogenic foci of inflammation was determined. However, in recent years, with the expansion of microbiological diagnostic capabilities, the presence of non-fermenting Gram-negative bacteria and anaerobes with a significant proportional proportion of the total microbiota of OPID in soft tissue of MFR has been increasingly indicated. Recently, there has been a rapid acquisition of resistance of pathogens of odontogenic purulent inflammatory diseases of the maxillofacial region to various groups of antibiotics, which leads to ineffectiveness of their treatment and prompts the revision of existing protocols and treatment regimens in surgical dentistry

Optimization of the target strategy of perioperative infusion therapy based on monitoring data of central hemodynamics in order to prevent complications

Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics - from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient's optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.

Prevalence of chronic pain after herniorrhaphy, orchiopexy, and bernardi procedure in children. A retrospective-prospective study

Chronic postsurgical pain (CPSP) is defined as pain that develops or increases in intensity after a surgical procedure and persists for at least three months. Its prevalence rate ranges from 5% to 54%. Aim - to assess the prevalence of CPSP among children at the age of 7-18 years residing in the Precarpathian region at three and six months after herniorrhaphy, orchiopexy and Bernardi procedure. Materials and methods. There were observed 92 children at the age of 7-18 years, who underwent treatment for abdominal wall hernia, cryptorchidism, varicocele, and hydrocele at the surgical department. Children were divided into the following groups: Group 1a included children at the age of 7-12 years with acute pain syndrome in the postoperative period; Group 1b comprised children at the age of 13-18 years with acute pain syndrome in the postoperative period; Group 2a included children at the age of 7-12 years with chronic pain syndrome; Group 2b included children at the age of 13-18 years with chronic pain syndrome. Results. The prevalence of CPSP following surgery among children of the Precarpathian region was found to be 33.7%, with a male predominance (р<0.05). There was an increased need for postoperative pain management with paracetamol in children of Group 2a (р<0.05). The mean scores of the Face, Legs, Activity, Cry, Consolability (FLACC) scale were significantly higher in children of Group 2a, 2b as compared to Group 1a, 1b (р<0.05). The Visual Analogue Scale (VAS) confirmed greater pain intensity in children of Group 2a on the second and third days of treatment (р<0.05). Conclusions. The high prevalence of chronic pain in children after herniorrhaphy, orchiopexy by Petrivalsky / Schoemaker technique, Ross and Bernardi procedures is due to ineffective perioperative pain management that requires the use of additional analgesia techniques, including regional ones. 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Research of the activity of local anesthetics and antiseptics regarding clinical isolates of Acinetobacter baumannii as pathogens of postoperative infectious complications

BACKGROUND

About 60% of all nosocomial infections are caused by microorganisms found in biofilms. Acinetobacter baumannii, as a pathogen of nosocomial infections, occur more frequently in surgical hospitals. The aim of the study was to study the in vitro formation of A. baumannii monotype biofilms under the influence of local anesthetics and antiseptics Materials and methods. The antimicrobial activity of local anesthetics (0.25-0.5%, bupivacaine, 2.0% lidocaine, 0.75% ropivacaine) and antiseptics (decamethoxine 0.1%, octenidine 0.1%, chlorhexidine 0.05%) ) against clinical strains of A. baumannii and studied their ability to produce biofilms.

RESULTS

The bacteriostatic effect of local anesthetics on A. baumannii within the current concentrations of these drugs, which provide analgesic effect, has been proven. The given results indicate that A.baumanni cultures have a pronounced ability to form biofilms. Clinical strains of opportunistic microorganisms A. baumannii circulating in the hospital environment are highly sensitive to antiseptics decamethoxine and octenidine, chlorhexidine has a weak bactericidal effect against acinetobacteria. The results of studying the effect of local anesthetics on the process of formation of the strain "young" biofilms showed the presence of a dose-dependent effect. The greatest inhibitory activity against "young" biofilms was detected under the combined action of the antiseptic decamethoxine (in concentrations, not exceeding 3.9 μg / ml) and anesthetics (OD-0,199-0,223) (p <0,05).

CONCLUSIONS

Scientific research on various aspects of the formation (or destruction) of bacterial biofilms is a relevant and promising area that will change approaches to the prophylaxis and treatment of a number of infections, including postoperative infectious complications.

Dependence of the dynamics of changes in the quality of life of patients with bacterial vaginosis on local levels of TNF-α and IL-1β

BACKGROUND AND AIM

Bacterial vaginosis is among serious health problem for women of reproductive age which influences on their local changes in inflammatory mediators and quality of life. The aim was to assess the dependence of the dynamics of changes in the quality of life of patients with bacterial vaginosis on local levels of TNF-α and IL-1β.

METHODS

In the prospective study 37 women aged 19-40 years with bacterial vaginosis were treated according to the Centers for Disease Control and Prevention. Patients received vaginal suppositories of clindamycin phosphate (100 mg) once daily for 3 days before bedtime. TNF-α, IL-1β levels in vaginal secretions by means of ELISA test), as well as the quality of life according to the RAND 36-Item Health Survey 1.0 were studied as in control group (once - to determine the reference values) and in the dynamics (the 1st day - before treatment, on the 7th day - after treatment) in the main group.

RESULTS

After the treatment microscopy of smears-imprints of vaginal secretions showed the complete absence of pathological microflora. The treatment was well tolerated by all patients. In the result there was proved the role of bacterial vaginosis in a violation of the quality of life of patients mainly due to the mental component of health, even after clinical and laboratory recovery.

CONCLUSIONS

There was proved the relation of vaginal TNF-α and IL-1β with physical and mental health in patients with bacterial vaginosis which can have a prognostic significance of the disease.

CCL2/MCP-1 serum chemokine level in patients with odontogenic infectious and inflammatory diseases of the soft tissues of the maxillofacial area and mediastinum

Aim. The paper was aimed at determining the CCL2/MCP-1 level in patients with odontogenic infectious and inflammatory diseases of soft tissues of the maxillofacial area and mediastinum. Methods. The study involved 46 patients with odontogenic infectious and inflammatory diseases of soft tissues of the maxillofacial area and 12 healthy volunteers. The level of patients' plasma CCL2/MCP-1 level was determined using a kit for specific ELISA. Results. The findings of the studies showed a statistically significant increase in the concentration of plasma CCL2/MCP-1 in patients of all study groups. Our study shows a significant increase in plasma CCL2/MCP-1 level in patients with odontogenic phlegmonas, abscesses and mediastinitis, compared to the group of healthy subjects. Conclusion. CCL2/MCP-1 may play an important role in the pathogenesis of odontogenic infectious and inflammatory diseases of soft tissues of the maxillofacial area and mediastinum, which requires a careful follow-up study.

Determination of CCL2 / MCP-1 levels in the serum of children with melanocytic nevus in the postoperative period after using different methods of surgical treatment

To date, there are many methods and ways to remove pigmented skin tumors, which have their own indications and contraindications for use, early or late complications.The aim of the study was to determine the level of CCL2 / MCP-1 in the serum of patients with melanocyte skin nevi in the postoperative period with different methods of their removal.Materials and methods of research. The study involved 60 children with melanocyte skin nevi of different localization, who were hospitalized in the pediatric surgery clinic in the period from 2018 to 2020. All patients were divided into 3 groups : I group - the excision of the formation took place with a scalpel, group II - excision of the formation was performed using a high-intensity surgical laser, group III - excision of the formation using a high-frequency electrosurgical device "BOWA-ARC 350.Results and discussion. The results of studies showed an increase in the level of CCL2 / MCP-1 in the plasma of patients of group I in 2,6 times 12 hours after surgery and 3,15 times in 24 hours after surgery. A similar dynamics of increase in the level of CCL2 / MCP-1 in plasma was observed in patients of group II, but was more pronounced. The largest increase in CCL2 / MCP-1 levels was in comparison group III.Conclusions. High levels of CCL2 / MCP-1 in the plasma of patients of groups II and III 12 and 24 hours after surgery convincingly indicate the presence of a pronounced inflammatory reaction under the influence of thermal damaging factor on skin tissues.

Effectiveness of Perioperative Local Use of Anesthetics and Antiseptics in Patients with Purulent-necrotic Lesions of Lower Extremities in Diabetes Mellitus

Background: Every second patient with the diabetes mellitus (DM) needs surgery due to purulent-necrotic changes in the feet. The aim of the study was comparative morphological examination of the course of the wound process in purulent-necrotic lesions of the lower extremities of patients with DM with different approaches to local treatment in the perioperative period. Materials and Methods: We investigated changes in the histological structure and the nature of the reactions of skin tissues, muscles and fascia during the healing of an ulcer in patients with the diabetes mellitus after various types of local treatment. Then the specimens were photographed and analyzed using the OLIMPUS BX 41 light microscope. Results: In the first comparison group, which used standard anesthesia techniques and locally antiseptic povidon-iodine - granulation tissue was characterized by the complete absence of fibrous structures and the presence of a small number of small-sized neoplastic vessels with swollen endothelium. And in patients of the II observation group who received locally decamethoxin and infiltration anesthesia with a 2% solution of lidocaine after surgery during the study of histological preparations of the affected tissues, a significant decrease in signs of pathological vascular reaction was established compared with the comparison group. Conclusions: In group 1 (control) healing of wounds on the third-seventh day 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 decamethoxin.

Experimental Study of the Effect of Serum Hydrogen Sulfide on the Course of the Inflammatory Process in the Vaginal Wall

Introduction: Various pathological conditions are characterized by the influence of hydrogen sulfide level on the course of the pathological process. This study examines the effect of serum hydrogen sulfide levels on the inflammatory process in the vaginal wall of rats. Aims: To evaluate the effect of excess and deficiency of serum hydrogen sulfide on the course of the inflammatory process in the vaginal wall of rats. Methodology: The study was performed on 125 female Wistar rats under 1 year of age and weighing 160.0 to 200.0 grams. All animals were divided into 7 groups: control (intact rats) and 6 experimental groups with different H2S levels and different treatment approaches of inflammation in the vaginal wall. The level of serum hydrogen sulfide was studied and the levels of TNF-α and IL-1β in the tissue homogenate of the vaginal wall were determined. In all experimental groups, the study was performed in dynamics - 10 min, 4, 8 and 24h after simulation of inflammation. Results: The dynamics of local levels of TNF-α and IL-1β in all groups had a similar trend and was characterized by the rapid development of the inflammatory process from its simulation to 4 hours of study, followed by gradual attenuation of inflammation and almost complete normalization of the studied indicators for 24 hours. Preliminary serial introduction of sodium hydrosulfide, as a donor of hydrogen sulfide, allowed to reduce the degree of manifestation of the inflammatory process and to achieve faster normalization of the studied parameters. At the same time, the artificially created deficiency of serum hydrogen sulfide (previous serial administration of propargylglycine) prolonged the duration and increased the studied indicators of inflammation in the vaginal wall. Conclusions: The course and intensity of the inflammatory process in the vaginal wall of rats are directly dependent on the background level of serum hydrogen sulfide.

Continuous fentanyl infusion reduces intra-abdominal pressure, postoperative pain and normalizes lungs’ mechanical changes in newborn with viscera-abdominal disproportion in early post-operative period

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.

MORPHOLOGICAL CHARACTERISTICS OF SMALL INTESTINE MUCOSA IN DYSBIOSIS AND AFTER ITS CORRECTION BY PROBIOTICS AND ENTEROSORBENTS

This study was aimed at investigating morphological and functional changes in the small intestine mucosal layer of mice with antibiotic-induced dysbiosis and following its correction with probiotics and enterosorbents. The study was carried out on BALB / c line white laboratory mice. Samples of the small intestine, liver, and spleen were taken to be processed for electron microscopy. To determine qualitative and quantitative composition of intestinal lumenal microbiome, animals' faeces were studied. Bacteria were isolated and identified by standard methods. This study has experimentally confirmed the ability of antibacterials to induce dysbiotic conditions in animals that are accompanied by significant shifts in the composition of normal microflora, manifested with cytodestructive disorders in the small intestinal epithelium. We have demonstrated the property of probiotics and, to a lesser extent, of sorbents to reduce the intensity and extension of cytodestructive disorders in the course of antibiotic-induced dysbiosis and to normalize the body immune responses that accompany the development of dysbiotic conditions.

Common mistakes in the choice of topical agents for emergency care of burns: Experimental study

The aim of the research was a histological study of the tissue structure of experimental animals with burns in dynamics using various topical agents after the injury. Experimental simulation of burn injuries was performed on 40 rats, which were divided into the main and control groups. Depending on the nature of care provided, the animals of the main group were divided into subgroups: in the 1st subgroup a uniform layer of sunflower oil was applied, in the 2nd subgroup dexpanthenol was sprayed, in the 3rd subgroup prompt neutralization of traumatic action was performed with a gauze napkin soaked in water. Animals from the control group were not treated. The examination involved a histological study. The results confirmed the negative impact of applying oil to the burnt area as a means of first aid, which caused more pronounced degenerative changes of the dermis and its structures with the involvement of hypodermis in the pathological process, prolonging the duration of healing. As for the use of dexpanthenol spray for burn injuries, the histological changes of tissues did not differ much from those in animals of the control group, which did not receive any care. At the same time, histological findings of the tissues of animals treated with moistened wipes was characterized by less pronounced pathological changes. Histological analysis of tissue changes of the burnt area in dynamics objectively proved the effectiveness of water as the main pathogenetic element of emergency care in an experiment.

A way to improve neuro regional analgesia: what adjuvant is the best? A narrative review

Introduction. The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics in order to determine adjuvant with the best effect among all others. More precisely the time of action onset, depth of the effect, duration of the block and some additional effects such as “marker of intravascular injection”, safety and toxicity profile, along with the adjuvant, which have all these properties in a sufficient degree. Materials and methods. We searched for information in Medline, PubMed, Scopus, Embase. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this article. Results. Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All them try to find to find “ideal” adjuvant, that have all needed effects at sufficient degree, but we think that due to the different groups that adjuvants belong to some adjuvants are better than another. Combination of adjuvants is not positive at all times. Conclusion. A variety of adjuvants to local anesthetics are available now, but yet data about most of them remains controversial, so more studies are required to found out best adjuvants and their adverse effects