Vol 29, No 3 (2023)

BACKGROUND: Patients with brain damage require specific treatment for decubitus ulcers. Given the seriousness of their condition and decompensation of concomitant pathology, surgical treatment is not always possible. Conservative therapy can take a long time, which is aggravated by the unsolvable problem of patient immobilization, microcirculatory tissue disorders, and inevitable chronicity of the purulent–inflammatory process. Most authors and practitioners are inclined toward a combined approach in the treatment of decubitus ulcers.

AIM: To evaluate the results of using fibrin glue in the treatment of bedsores in patients with severe brain damage.

MATERIALS AND METHODS: The article presents the experience of using fibrin glue in the conservative treatment of bedsores. The study included patients in a chronic critical state because of severe brain damage, with a decubitus ulcers area of >80 cm² (stage III according to the Agency For Health Care Policy and Research classification). In the main group, treatment included the use of fibrin glue in accordance with the Russian Federation Patent No. 2777483 dated 08/04/2022. In the control group, treatment included standard dressings with levomekol ointment. Both groups received treatment for 21 days. Changes in the wound process were assessed using the Bates–Jensen scale and cytological examination at control points.

RESULTS: The study analyzed 58 patients, who were divided into two groups: group 1 (main) included 32 patients (15 men, 17 women), and group 2 (control) included 26 patients (12 women, 14 men). In the main group, after 1 week of applying dressings with fibrin glue, positive changes were noted, such as active marginal epithelialization, disappearance of “undermining” and swelling of wound edges, appearance of “juicy” bright granulations, and absence of exudates. After 2–2.5 weeks, epithelialization exceeded 50% of the total area of the decubitus ulcers (56.2% of cases), and exudation was completely absent. In a cytological study, the percentage of cells responsible for tissue proliferation increased and inflammation decreased in the main group. No significant effect was noted in the control group. In 7.7% of cases, 50% epithelialization was noted on days 28–35; in three patients, re-infection of the decubitus ulcers occurred, and ischemia developed, which significantly lengthened the total duration of inpatient treatment and rehabilitation by 1.0–1.5 months.

CONCLUSION: The use of fibrin glue promotes decubitus ulcers epithelization, thereby reducing their size, up to complete healing.

BACKGROUND: Nowadays, minimally invasive procedures are mainly performed in the treatment of hemorrhoidal diseases. However, the feasibility of using ultrasound navigation for hemorrhoidal artery ligation-rectoanal repair (HAL-RAR) is still discussed because digital palpation of hemorrhoidal arteries for ligation is safe and easy to perform.

AIM: To evaluate the long-term results of HAL with mucopexy by digital examination in comparison with traditional HAL-RAR in the surgical treatment stage II–III hemorrhoidal disease.

MATERIALS AND METHODS: The controlled randomized trial included 150 patients with stage II–III hemorrhoidal disease. The study group (n=75) included patients who underwent surgery using digital palpation with mucopexy, and in the control group (n=75), the HAL-RAR was used. The primary endpoint was a recurrence of the main symptoms. Secondary endpoints included patient satisfaction and discomfort, pain intensity, prolapse of hemorrhoidal piles, and rectal bleeding.

RESULTS: The groups did not differ in sex, age, body mass index, and stage, and symptoms of hemorrhoidal disease. During the 12-month follow-up, no difference in the prolapse of hemorrhoidal piles (p=0.49), patient satisfaction (p=0.95), and discomfort (p=0.67) was found. Periodic bleeding occurred in 5.3% and 17.3% of the patients in the study and control groups, respectively (p=0.037). After 2 months of follow-up, pain recurred in 8 (10.6%) patients in the study group and 22 (29.3%) in the control group (p=0.037). At 18 months follow-up, no difference in patient satisfaction (p=0.95) and discomfort (p=0.89) was noted; however, the rate of hemorrhoidal prolapse was significantly higher in the study group (16.3%) than in the control group (13.5%) (p=0.045), and bleeding was reported in 10.2% and 15.4% of the patients in these groups, respectively (p=0.86). Open hemorrhoidectomy for relapse of hemorrhoidal prolapse was performed in 2 (2.6%) patients in the study group and 4 (5.3%) patients in the control group (p=0.68).

CONCLUSION: Ligation of hemorrhoidal arteries in combination with mucopexy without ultrasound guidance is a safe, easy, and reproducible technique, with comparable effectiveness, and long-term results to HAL-RAR. This procedure can be recommended for the surgical treatment of stage II–III hemorrhoids.

Cardiovascular diseases are the leading cause of invalidity and mortality in the majority of developed countries and are recognized by the international community as a pandemic problem. An important task of modern cardiology is the search and study of new biological markers.

This literature review aimed to consider chemerin as a new diagnostic and prognostic marker for cardiovascular pathologies. Thus far, studies on chemerin indicate the possibility of its use as a marker of cardiovascular pathology. Evidence points to the important role of chemerin in the development and progression of cardiovascular diseases. As an adipokine, chemerin modulates glucose, and lipid levels, thereby influencing lipid deposition in the endothelium and progression of atherosclerosis. As a chemoattractant, it facilitates the mobilization and interaction of macrophages with dendritic cells and natural killer cells in the vascular system and induces endothelial angiogenesis. The established role of chemerin in vascular inflammation, angiogenesis, and blood pressure modulation opens serious prospects for the development of therapeutics targeting this biomarker for the treatment of cardiovascular diseases. Several candidates targeting chemerin and the CMRK1 signaling pathway have shown promising potential in reducing vascular dysfunction in in vitro and in vivo studies. Further studies analyzing the efficacy and safety of new chemerin-targeting drugs are needed to assess their potential.

Infectious diseases are still the leading causes of morbidity and mortality worldwide, which prompts the need to prioritize research and development of new antimicrobial drugs with high pharmacological activity and favorable safety profile. One of the key directions in this field is the study of the potential of natural compounds, such as humus acids. Recent studies have shown that humus acids can exhibit multidirectional activity against various microorganisms and demonstrate synergistic pharmacological interaction with other drugs.

This review aimed to present a generalized and systematic analysis of currently available information on the known pharmacological effects and possible mechanisms of the antibacterial, antiviral, and antifungal activities of humus acids.

The article is devoted to the transformation of the scientific directions of the Department of Maxillofacial Surgery and Dentistry of the Pirogov Russian National Research Medical University over a 100-year period of development, the history of the creation of the first department of this profile in Russia, modern work on clinical bases.