Vol 23, No 9 (2021)

Nasal decongestants (ND) are representatives of the pharmacological group of а-adrenomimetics and are widely used in clinical practice. These drugs are successfully used as symptomatic therapy of acute rhinosinusitis (AR), as well as as part of the complex therapy of acute otitis during unloading therapy for the auditory tube. The use of ND is necessary before conducting an endoscopic examination of the nasal cavity, for a better assessment of the state of the ostiomeatal complex, the olfactory cleft, as well as differential diagnosis of various forms of rhinitis and dysosmia. ND are indispensable in the prevention of complications of AR, such as acute eustachiitis, exudative otitis media and acute otitis media. Also, these drugs are used in the prevention of the development of aerotitis and ear barotrauma. The most commonly used nasal medications of medium and long duration of action, such as xylometazoline and oxymetazoline. This article presents clinical studies demonstrating the high efficacy and safety of these drugs as part of the treatment of AR. It is shown that oxymetazoline and xylometazoline are well tolerated by patients with a minimum number of adverse events. Modern representatives of ND are such drugs as Otrivin express 0.05% with the aroma of menthol, the main active ingredient of which is oxymetazoline, Otrivin 0.1% Moisturizing formula and Otrivin 0.1% with menthol and eucalyptus, which includes xylometazoline as the main active ingredient. These drugs have confirmed their effectiveness and safety in a large number of clinical studies and can be recommended as local vasoconstrictors.

Xerostomia is a condition that develops with a decrease in saliva secretion (hyposialia) or cessation of saliva secretion (asialia) and is characterized by dryness in the oral cavity. Xerostomia is widespread in different age groups, but is most common in older age groups. In a number of diseases, for example, in Sjogren's disease, xerostomia is the leading symptom complex and determines the severity of the clinical picture. Chronic inflammatory diseases of the pharynx, such as chronic tonsillitis and chronic pharyngitis, may be accompanied by a pronounced decrease in saliva secretion. Timely conservative treatment of inflammatory diseases of the pharynx has a positive effect on the dynamics of the course of xerostomia. To diagnose this condition, patients are advised to undergo sialometry. Xerostomia can be observed in the long term after bilateral tonsillectomy and, which forces patients to seek medical help. To eliminate dryness in the oral cavity after otorhinolaryngological interventions, in particular after bilateral tonsillectomy, saliva substitutes are widely used in practical otorhinolaryngology. Data on the relationship between the state of the lymphoid-pharyngeal ring and xerostomia syndrome are presented in the modern literature by single publications, and therefore, studies of the relationship between inflammatory diseases of the pharynx and the level of saliva secretion are certainly of significant scientific and practical interest. Treatment of patients suffering from both subjective and objective xerostomia requires an interdisciplinary approach with the participation of a dentist, otorhinolaryngologist and doctors of other specialties (gerantologist, endocrinologist, rheumatologist, psychotherapist). Modern methods of surgical treatment of patients with chronic tonsillitis and xerostomia using radio wave methods, high-energy laser radiation, coblator should be considered as an alternative to classical bilateral tonsillectomy.

General background. The overuse of antibiotics, including for the treatment of uncomplicated acute rhinosinusitis (ARS), has contributed to the emergence of antibiotic-resistant bacterial strains and has led to the need for alternative therapies. The review provides an assessment of the quality of evidence for the use of phytotherapy in ARS in order to determine its position among other therapies and future directions of research. The MEDLINE database was searched for randomized controlled studies of Sinupret®, Pelargonium sidoides extract (pelargonium), Cyclamen europaeum (cyclamen), cineole and GeloMyrtol®. We also searched for results from studies of a nasal spray with N-acetylcysteine and mometasone furoate (MF) in order to compare the effectiveness of herbal preparations with these traditional agents indicated for ARS. Main content. The strongest evidence was obtained for Sinupret®, followed by Pelargonium sidoides extract. Their use for treatment of ARS is supported by double-blind, placebo-controlled studies demonstrating both clinical efficacy and safety. Comparisons with traditional treatments such as topical glucocorticosteroids were found only for Sinupret® and they showed comparable efficacy, but in a small group of patients. For other herbal drugs, the pooled level of evidence was low. The search identified 2 small, placebo-controlled, randomized studies of cyclamen nasal spray. In two studies, it was impossible to make conclusions about the safety and efficacy of cyclamen nasal spray and reported no efficacy of cyclamen in reducing symptoms. We found only one randomized placebo-controlled study of GeloMyrtol® and cineol. The mention studies have showed a reduction in ARS symptoms with these two drugs, but larger studies are needed to confirm these findings. There are few studies that directly compared herbal drugs. In one randomized study, cineol was compared with Sinupret®, but the results need to be confirmed in further studies. Studies of N-acetylcysteine are limited to small clinical trials, while the use of MF nasal spray has been confirmed with results comparable in evidence to Sinupret® for the respective indications. Conclusions. There are modern studies that demonstrate the efficacy and safety of herbal drugs for ARS treatment. Given that the evidence for Sinupret® is the strongest and comparable to that for the widely available topical corticosteroid, MF, Sinupret could be considered for the treatment of uncomplicated ARS.

Relevance. Medicinal products of plant origin have long been successfully used in the treatment of various diseases, including those of viral etiology. Nevertheless, their effect on the replication of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has not been studied so far. Objective. To evaluate the potential of drugs based on validated plant extracts - RE (Bronchipret, Bronchipret TP, Tonsilgon N, Sinupret extract, Tonsipret) with respect to their ability to suppress SARS-CoV-2 replication in vitro. Materials and methods. Vero cells (Vero) incubated with RE of different concentrations were infected with SARS-CoV-2 virus. After 48 h the virus replication (the number of viral RNA copies in cell culture supernatant) was determined by quantitative polymerase chain reaction. Results. SARS-CoV-2 RNA copy number under the action of non-cytotoxic concentrations of Bronchipret TP decreased by 1000 times and by 10 times under the action of drugs Tonsilgon N and Tonsipret. Conclusion. Some of the studied REs in vitro demonstrated promising antiviral activity. It is advisable to conduct further, including clinical, studies of their activity against SARS-CoV-2 in the treatment of coronavirus infection (COronaVirus Disease 2019 - COVID-19).

Tuberculosis, caused by the obligate intracellular microorganism Mycobacterium tuberculosis, is one of the oldest known infectious diseases in humans. Modern therapy of tuberculosis, consisting of several antibacterial drugs, is long-term, toxic and requires high compliance from the patient, therefore, the development of new therapeutic strategies that would minimize the duration of treatment and prevent the formation of drug-resistant forms of mycobacteria is relevant and important. Cellular therapy now holds the promise of potential complementary therapeutic options for the treatment of drug-resistant tuberculosis. In recent years, the possibilities of using mesenchymal stem cells in the treatment of tuberculosis of various localization have been widely studied. The use of such cells in conjunction with standard anti-tuberculosis therapy holds great promise for shortening the duration of treatment and reducing the formation of drug-resistant mycobacteria. This article describes the possibilities of using mesenchymal stem cells in the treatment of tuberculosis in patients, including those with extensive and multidrug resistance, as well as the mechanisms of interaction of mesenchymal stem cells with M. tuberculosis.