ГУ «днепропетровская медицинская академия мЗ Украины», г. днепр Авторами статьи на основании аналитического обзора мировой литературы проанализирована фармакологическая активность мелатонина в аспекте клинического применения при COVID-19. мелатонин традиционно считается гормоном эпифиза, который обеспечивает взаимодействие организма с окружающей средой для информирования о световом режиме окружающей среды. до недавнего времени основной сферой применения данного препарата были различные нарушения сна. Однако последующие исследования выявили у мелатонина способность оказывать противосудорожное, антидепрессивное, антинеопластическое, нейропротекторное, антиоксидантное и гонадотропное действие и обладать некоторой терапевтической активностью при фармакотерапии шума в ушах, мигрени, нейродегенеративных заболеваниях, эпилепсии, раке грудной железы, заболеваниях дыхательной и сердечно-сосудистой системы. Выявлено, что ценным эффектом мелатонина является способность снижать высвобождение провоспалительных цитокинов, что способствует снижению интенсивности воспаления и «цитокинового шторма» у пациентов с COVID-19. В статье отмечено, что мелатонину отводится роль не только как антиоксиданту, снижающему риски оксидативного стресса при воспалении, но и как фактору профилактики развития «цитокинового шторма», с развитием которого связывают высокие риски летальности при COVID-19. мелатонин эффективен у пациентов, госпитализированных с COVID-19, за счет снижения проницаемости сосудов, уровня общей тревожности, использования седативных средств и улучшения качества сна. Установлено, что мелатонин можно применять в комбинации с лекарствами и средствами лечения COVID-19. Например, мелатонин и альфа-липоевая кислота могут уменьшить повреждение почек от окислительного стресса, вызванного комбинацией противовирусных препаратов лопинавир/ритонавир. Использование мелатонина для ослабления медицинских и общественных проблем в условиях всемирной вспышки пандемии может быть существенной и социально ответственной мерой сохранения и поддержания здоровья населения. Авторами установлено, что фармакологическая активность мелатонина в аспекте клинического применения при COVID-19 связана с его антиоксидантной и антистрессовой активностью, что может быть эффективно использовано в условиях коронавирусной инфекции.

Vaginal infections are highly spread among the female population and they impact the woman’s organism, fetal development and child health. They remain an important medical and social problem, so the optimizing the treatment is very important. The article is a review of the modern domestic and foreign publications about the etiological factors, pathogenesis, and local pharmacotherapy of nonspecific and candidiasis vaginitis and bacterial vaginosis, including their manifestation during pregnancy. The issues of vaginal infections in non-pregnant and pregnant women, the main risk factors for their development, the range of pathogens of infectious lesions of the vagina, which are the most common - bacterial vaginosis (G. vaginalis and A. vaginae), nonspecific vaginitis (Streptococcus spp., S. aureus, coagulase-negative staphylococci, E. coli, etc.), candidiasis vaginitis (C. albicans and C. non-albicans), and the importance of changes in the composition of the vaginal microbiome in the development of these diseases are demonstrated. Based on the data from scientific publications, the article presents the analysis of the sensitivity of pathogenic flora to anti-infective methods. The attention is drawn to the risks of nonspecific and candidiasis vaginitis and bacterial vaginosis during pregnancy (miscarriage and premature birth, placental insufficiency, etc.), the advantages and disadvantages of systemic and local therapy for these diseases, the comparative characteristics of individual drugs for topical therapy are given, taking into account the composition and pharmacodynamics of their components.The clinical and pharmaceutical benefits of a complex preparation that includes ternidazole, neomycin sulfate, nystatin and prednisolone sodium metasulfobenzoate and has the bactericidal (including antianaerobic), fungicidal, antiprotozoal, and anti-inflammatory effects have been analyzed. Data on the microbiological and clinical efficacy of the drug, its storage effect on the vaginal microbiome, and features of innovative technology for the manufacture of its dosage form are presented.

Aerococci have certain cultivation characteristics. A well-known method of aerococcal cultivation uses indicator media which included the complex "oxolinic acid – etonium", but data indicating cases of conditionally pathogenic flora contamination due to the accumulation of microorganisms that are resistant to this complex have been obtained. Therefore, there was a need to search for new substances that would have a wide range of antagonistic activity in relation to the conditionally pathogenic flora and at the same time would not inhibit the growth of aerococci, and which would also be available and safe. The sensitivity of the A. viridans symbionts and conditionally pathogenic flora to the substances with antimicrobial activity of different groups was determined by the method of "wells". For research, A. viridans symbionts isolated from different microbiocenoses have been used. P. aeruginosa, S. aureus, K. pneumoniae, E. coli and C. albicans were used as conditionally pathogenic flora. Norfloxacin, pefloxacin, ofloxacin, gatifloxacin, levofloxacin, miramistin, decamethoxine, chlorhexidine, octenidine and boric acid were used as investigational drugs. Also, the optimal concentration of drugs which would suppress the growth of conditionally pathogenic flora, and would not show a negative effect on A. viridans was determined by serial dilutions. It was found that miramistin, norfloxacin and boric acid meet the necessary criteria. The serum dilutions method was used to determine the minimum inhibitory concentration (MIC) of these drugs in the experiment. Norfloxacin in a dosage of 12.5–50.0 μg/ml effectively inhibited the growth of the conditionally pathogenic flora, but also reduced the number of aerococci. The dose of 8.3 μg/ml met the criteria we needed, namely suppressing the growth of the conditionally pathogenic flora and not affecting aerococci. The concentration of miramistin and boric acid in a culture medium that showed a stong depressant effect on conditionally pathogenic flora and practically did not affect A. viridans was 50 μg/ml. In addition, miramistin and boric acid exhibited fungicidal action against C. albicans. Antimicrobial effects of the investigated drugs on the conditionally pathogenic flora was not complete in some cases, or inhibited the growth of aerococci at higher doses, so the effect of their rational combination on the conditionally pathogenic flora was investigated. As a result, an antimicrobial complex with optimal concentrations of substances (norfloxacin 8.3 μg/ml, myramistin 50 μg/ml, boric acid 50 μg/ml), which effectively suppresses UPMF and does not affect the growth of symbionic A. viridans, was determined. The specified antimicrobial complex can be used for the production of modified media for isolation, cultivation and study of biochemical activity of A. viridans microorganisms. Properties of aerococci, grown on the nutrient medium with the studied drugs did not differ from aerococci, grown on nutrient media without additives.