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ABSTRACT
In patients with purulent-necrotic processes in diabetes mellitus, the condition of the IL-1B, IL-2, IL-4, IL-6, IL-8, IL-10,
TNF-
α, INF system based on the dynamics of cytokine levels was studied. Complex surgical treatmen
t of the drug
Reomannisol corrects the balance of cytokines, allowing them to have an antioxidant effect on the cytokine system.
Research Article
OPTIMIZATION OF COMPLEX TREATMENT OF PURULENT-NECROTIC
WOUNDS ON THE FOOT IN DIABETES MELLITUS
Submission Date:
Sep 19, 2024,
Accepted Date:
Sep 24, 2024,
Published Date:
Sep 29, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue09-07
Zokhirov Adkhamjon Rafiqovich
Assistant Of General Surgery No.2, Tashkent Medical Academy, Tashkent City, Uzbekistan
Abdukarimov Sarvar Azizbek Ogli
3rd Year Student Of Faculty Of Medicine, Tashkent Medical Academy, Tashkent City, Uzbekistan
Khakimova Dilyora Ulugbekovna
4th Year Student Of Faculty Of General Medicine Kimyo International University In Tashkent, Tashkent City,
Uzbekistan
Solijonova Umidaxon Ilhomjonovna
3rd Year Student Of Faculty Of General Medicine Kimyo International University In Tashkent, Tashkent City,
Uzbekistan
Sherkulov Bobur Bahodir Ogli
3rd Year Student Of Faculty Of General Medicine Kimyo International University In Tashkent, Tashkent City,
Uzbekistan
Fayzullayeva Dilnoza Baxtiyor Qizi
2nd Year Student Of Faculty Of General Medicine Kimyo International University In Tashkent, Tashkent City,
Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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KEYWORDS
diabetic foot syndrome, cytokine system, complex treatment, Rheomannisol.
INTRODUCTION
Diabetes mellitus (DM) is a chronic autoimmune
disease. When purulent-necrotic lesions of diabetic
heel syndrome appear, an inflammatory reaction
appears and manifests itself in the form of a local
reaction, which can lead to a systemic response. As a
result of bacterial action, under the influence of
humoral factors, activation occurs in the main
phagocytosis cells
–
neutrophils (polymorphonuclear
leukocytes), monocytes (macrophages) and platelets.
Activated cells begin to produce inflammatory
mediators (cytokines) into the blood, which are
involved in the regulation of vascular tone, hemostasis,
and cell proliferation. Atherosclerosis of blood vessels
in patients with diabetes occurs 8-10 years earlier than
in the general population. Therefore, an inflammatory
reaction occurs against the background of changes in
metabolism
and
circulatory
disorders.
The
pathogenetic mechanism of diabetes is complex, but
the latest research data suggests that the participation
of cytokines plays a large role in this disease. Cytokines
are conditionally anti-inflammatory: natural immune
regulators involved in inflammatory formation (IL-1, IL-
2, IL-6, IL-12, TNF-
α) and anti
-inflammatory by
pancreatic β
-cells that depressant to insulin
production:
special
immune
regulators
of
inflammatory response (IL-4, IL-10, IL-13, INF-
γ) these
cytokines have protective and antidiabetic effects. In
addition, there are cytokines that regulate specific
immune reactions (IL-2 and IL-4, transformative
growth factor (TGF-
β va et al.). It is involved in protein
activation, differentiation and growth of mature
lymphocytes. A number of cytokines (IL-1, IL-6, TNF-
α,
erythropoietin) can also have effects such as
distension, which is simple hormones. In addition, a
similar single cell can secrete several different
cytokines and the same cytokines at the same time, or
different cells can produce several different or
identical cytokines. Therefore, the importance of
cytokines in the formation of diabetes mellitus, on the
one hand, and in the formation of an inflammatory
reaction, on the other, is interesting to obtain
information about the state of the cytokine in patients
with DFS. The state of the cytokine system at the time
of the development of purulent-necrotic processes in
patients with DFS is completely unclear. Given the lack
of research, DFS is solved by the dynamic state of the
cytokine system in patients with purulent-necrotic
processes and recurrence of purulent-necrotic
processes. It was decided to study the dynamics of
cytokine levels in the blood serum of anti -
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inflammatory cytokines-interleukins IL-
1β, IL
-2, IL-6, IL-
8, tumor necrosis factor-TNF-
α, as well as gamma
-
interferon (IFN-
γ) and anti
-inflammatory interleukins
IL-4, IL-10 patients. In our opinion, perhaps the
imbalance of cytokines will help predict the course of
the purulent-necrotic process and determine the
tactics of surgical treatment. In addition, the state of
the cytokine balance is of interest in patients with
recurrence of purulent-necrotic complications of DFS.
Cytokine management balance is currently seen as a
new direction of immunotherapeutic effects in the
treatment of patients with purulent-necrotic lesions of
DFS.
The purpose of the work. By studying the dynamics of
anti-inflammatory cytokine levels: analysis of the need
and possibility of immunocorrection by studying
cytokine status in IL-
1β, IL
-2, IL-4, IL-6, IL-8, IL-10, TNF-
α,
INF-
γ patients on the development and recurrence of
purulent-necrotic processes of DFS.
Table 1. In normal patients, the amount of cytokines and the number of
cells in the peripheral blood serum
Cytokines
Concentration of
cytokines in
blood plasma,
pg/ml
Production of cells in blood culture,
pg/ml
Spontaneous
Induced
IL-1β
0-50
0-50
1000-5000
IL-2
0
0
2-10 ED/ml
IL-4
0-50
30-50
100-400
IL-6
0-50
30-50
1000-3000
IL-8
0-50
30-100
1000-5000
IL-10
0-50
30-50
1000-3000
TNF-α
0-50
30-50
500-3000
INF-γ
0-10
10-100
1000-5000
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Table 2. Characteristics of operations in group I
Type of operation
Frequency of operations (n=60)
abs.
%
Amputations at the hip
level
20
33,3
Amputations at the
lower leg level
6
10
Amputations at the foot
level
12
20
Amputations at the
level of the fingers
11
18,3
Amputations at the
level of the fingers
7
11,7
Necrectomy
4
6,7
MATERIALS AND METHODS
The concentration of cytokines in the blood plasma
was determined using the StatFax 2100 immunological
complex (manufactured by Cytokin LLC, St.
Petersburg) by enzyme immunoassay (IFA). The
obtained results are carried out using descriptive and
non-parametric statistical methods on a personal
computer with mathematical processing using
Statistica 6.0 software (Table 1). Control parameters of
the manufacturer's cytokine norms were used - the
normative parameters obtained as a result of testing
the donors were obtained from the manufacturer
Cytokin LLC, St. Petersburg, Russian Federation.
Plasma collection and cytokine level testing were
performed on day 1 before surgery and on days 3, 5, 7,
and 10 after surgery. The study was conducted in three
phases and, accordingly, the patients were divided into
3 research groups: Group I (control group) - blood
serum of patients with purulent-necrotic lesions of
diabetes for the study of the cytokine system; II group
(comparison group) - blood serum obtained during the
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treatment of patients with purulent-necrotic lesions of
diabetes with ozone therapy and peosorbilact - 200.0
ml (YURIYA-FARM LLC, Ukraine); Group III (main
group) - blood sera obtained during the treatment of
patients with purulent-necrotic lesions of diabetes
with ozone therapy and reomannisol - 200.0 ml (REKA-
MED FARM LLC, Uzbekistan).
The first stage: to determine the imbalance of
cytokines, it consists in taking the blood plasma of 60
patients with purulent-necrotic lesions of diabetes and
determining the amount of cytokines in it. 60 patients
were treated at various levels in the Yiringli surgical
department of the Yakkasaroy District Medical
Association between 2021 and 2023. The age range of
the patients was between 48-60 years. Neuropathic
form of DFS - 25 people (type 1 DM - 2 patients, type 2
DM - 23): 12 were men and 13 women, and
neuroischemic form of DFS - 35 patients (all with type 2
DM): 15 men and consisted of 20 women. The
characteristics of operations performed in this group
of patients are presented in Table 2. Most often,
amputations were performed at the thigh level - 33.3%,
heel area - 20%, finger level - 18.3%, necrotomy - 6.7%,
sequestrectomy - 11.7%. Upper amputations were also
performed as the main option, as a result of the failure
of the approach to save vital organs: at the thigh level
- in 33.3% of cases, at the heel level - in 20%.
Results and discussions in the first group. The dynamics
of the level of cytokines in the first group is presented
in Table 3. In the analysis of the indicators of the level
of cytokines, the picture of growth was revealed:
inflammatory cytokines: IL-
1β, IL
-2, IL-6, IL-8, TNF-
α and
anti-inflammatory cytokines: IL-4, IL- 10, IFN-
γ.
IL-
1β: ranged from 7.25±0.24 to 2.9±0.1 pg/ml, but all
changes were within the acceptable range. IL-1b
appears in the blood plasma when a pathogenic agent
enters the div for the first time or in autoimmune
type 1 DM. Perhaps, with the first purulent-septic injury
of DFS, the biological activity of this cytokine does not
increase, that is, due to the insufficient activity of
macrophages, monocytes, lymphocytes due to the
endothelial reaction, as well as the functional activity
of fibroblasts decreases.
IL-2: ranges from 6.97±0.13 to 1.09±0.48 pg/ml, which is
3-2 times higher than normal values, especially in
lymphocytes responsible for the immune system is
explained by activation. In the postoperative period,
the cytokine level decreases, but it is higher than the
norm during discharge from the hospital, which allows
us to consider this decrease as a residual reaction of
the immune system, which can be associated with
positive clinical dynamics.
IL-6: ranged from 90.1±0.76 to 12.59±1.9 pg/ml. A high
level of cytokines on the first day, a decrease to normal
by the 7th day, an acute phase with a decrease after
the clinical relief of the inflammatory process, as well
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as an indirect reaction of the endothelial system in the
purulent-necrotic focus indicate high protein activity.
IL-8: ranged from 129±0.13 to 579±0.11 pg/ml by day 7
and decreased to 51.8±0.11 pg/ml at hospital discharge,
suggesting that indicates the presence of an acute
purulent-necrotic process and the possibility of
chronicity, since cytokine levels remain at higher levels
during clinical recovery.
Table 3. Level of cytokines (in pg/ml) in patients of the first group
Cytokin
es/
Days
Day 1
Day 3
Day 5
Day 7
Day 10
Discharge (11-
12 days)
IL-
1β
7,25±0,24
*
5,67±0,1
3*
4,56±0,1
*
4,14±0,
14*
2,9 ±0,1*
6,2±0,7*
IL-2
6,22±0,3
*
6,97±0,1
3*
6,1±0,2
*
6,5±0,1
5*
5,1±0,11*
1,09±0,48*
IL-4
235±0,13
*
255±0,5
*
280±0,1
2*
199±0,1
6*
101±0,1*
45±0,2*
IL-6
90,1±0,7
6*
80,5±0,
6*
60±0,12
*
16,02±0,
23*
13±0,5*
12,59±1,9*
IL-8
129±0,13
*
199,3±0,
11*
245,5±0,
1*
579±0,
11*
65,7±0,1
5*
50,8±0,11*
IL-10
59,08±0,7
2*
58,12±0,
3*
50±0,4
*
51,68±0,
73*
36±0,15
*
6,65±1,33*
TFN-
α
51,51±0,7
*
55±0,1*
56±0,14
*
51,01±0,
94*
40±0,16
*
2,2±0,52*
INF-
γ
68,3±0,1
*
105,1±0,
14*
101±0,11
*
45,8±0,
13*
40±0,11
*
10,4±0,14*
Note:*
–
р
<0,05.
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TNF-
α: ranged to 56±0.14 pg/ml by day 5 and decreased
to 2.2±0.52 pg/ml at hospital discharge. It shows the
immunomodulatory and anti-inflammatory effects of
the cytokine caused by the activation of macrophages,
neutrophils, eosinophils and endothelial cells, as well
as the metabolic disorders associated with
hyperglycemia.
IL-4: increased to 280±0.12 pg/ml by day 5 and
fluctuated between 235±0.13 pg/ml, and decreased to
45±0.2 pg/ml at hospital discharge. Such dynamics can
be explained by the growth and activity of
macrophages, lymphocytes, and, accordingly, a high
level of anti-inflammatory cytokines. IL-4 performs
regulatory functions.
IL-10: ranged from 59.08±0.72 to 6.65±1.33 pg/ml. It is
an antagonist of anti-inflammatory cytokines and
performs a regulatory function, reduces its level,
shows a favorable direction of this process with clinical
improvement.
IFN-
γ: fluctuated from 105.1±0.14 pg/ml to 10.4±0.14
pg/ml with a decrease on day 3. This dynamic can be
explained by clinical recovery. IFN-
γ has a wide
spectrum of immunomodulatory activity, regulates
and protects it, establishes a balance of activity with
fibroblasts and macrophages and monocytes. In
addition, on the first day, high levels of inflammatory
and anti-inflammatory cytokines are observed, their
number increases slightly, and on the fifth day, it
decreases with a clinically favorable level. A high level
of IL-8 indicates activation in response to acute
inflammation and the possibility of the process
becoming chronic. This stage of the research made it
possible to study the state of the cytokine system in
purulent-necrotic lesions of DFS.
The second stage: studying the dynamics of cytokines
in recurrent purulent-necrotic lesions of diabetes.
Materials and methods of the second stage -
comparison group. The second group of the study
included 40 patients (men and women aged 45 to 74).
In 2021-2023, patients with DFS with recurrent
purulent-necrotic lesions of diabetes were taken in the
Department of Purulent Surgery of the Yakkasaroy
District Medical Association. With the neuropathic
form of DFS - 15 people: 5 men and 10 women and the
neuroischemic form of DFS - 25 patients: 9 men and 16
women. The characteristics of operations performed in
this group of patients are presented in Table 4. All
patients, regardless of the severity of the disease, were
treated locally with ozonized physiological solution,
and 200.0 ml of Reosorbilact was administered
intravenously once, the course of treatment was 7
days.
Determination of ozone concentration. To prepare an
ozonated physiological solution, we ozonate 200.0 ml
of physiological solution for 10 minutes at a
concentration of 3-4 mg/l at a concentration of 3-4 mg/l
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and for 10 minutes in the apparatus "Medozons
Beauty" (MEDOZONS LLC, Russia), then its dose is
determined by the following formula:
D
–
ozone concentration dose;
C
–
ozone concentration, mg/l;
V - oxygen exit rate, l/min;
t
–
time, min;
The purulent area of each patient is washed 3 times a day with ozonized physiological solution for 15-20 minutes. The
number of operations is greater than the number of patients. This is explained by the fact that various operations
were performed in one patient to preserve the quality of life and ability to work: necrotomy - 20%, amputation at the
level of fingers - 22.9%, amputations at the level of the foot - 2.9%.
Table 4. Characteristics of operations in group II
Type of operation
Frequency of operations (n=40)
abs.
%
Amputations at the hip level
23
65,7
Amputations at the lower leg
level
0
0
Amputations at the foot level
2
5,0
Amputations at the level of
the fingers
8
22,9
Amputations at the level of
the fingers
5
14,3
Necrectomy
7
20
D=C x V x t;
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However, high amputations were performed when the
tactics of saving vital organs were ineffective or when
there was no prospect of saving the leg at the time of
the initial examination - 65.7%.
Results and discussions in the second group. The
dynamics of the state of the cytokine system in the
blood plasma of patients in this group of patients is
presented in Table 5. It should be noted that 1 day
before the operation, only an increase in the level of IL-
8 up to 182.7 pg/ml is detected. It increased to 245.5
pg/ml by day 5 and decreased to 60.9 pg/ml on days 11-
12. The activity and level of IL-8 is considered to be
related to the activity of IL-
1β, IL
-4, and TNF-
α, as well
as the effects of endotoxins of gram-negative bacterial
microorganisms. In addition, IL-8-producing cells are
monocytes, macrophages, T-lymphocytes, neutrophils,
fibroblasts, keratinocytes, hepatocytes, endothelial
cells, epithelial cells, chondrocytes. IL-8 as a mediator
stimulates
chemotaxis
of
subpopulations
of
neutrophils, T-lymphocytes and basophils; lysosomal
enzymes activate neutrophils.
Table 5. Level of cytokines (in pg/ml) in patients of the second group
Cytokin
es/
Days
Day 1
Day 3
Day 5
Day 7
Day 10
Discharge (11-
12 days)
IL-
1β
10,2±0,
2*
13±1,19
*
7±1,12
*
3,4±0,14
*
5±1,1*
2,2±0,4*
IL-2
0
0
0
0
0
0
IL-4
32±1,14
*
30±1,12
*
31±1,11
*
25±1,13
*
17±1,4*
9±1,1*
IL-6
18,1±0,7
*
15±1,2*
23±1,1
*
15,02±1,3
*
14,9±1,9
*
10,59±1,9*
IL-8
182,7±1,
1*
201,5±1,1
*
245,5±1
,3*
210,1±1,2
*
103,7±1,
4*
70,9±1,9*
IL-10
9,08±0,
7*
23,1±0,9
*
19,3±0,
8*
10,68±1,
3*
14,5±1,1
*
15,65±1,2*
TFN-
α
21,5±
1,14*
19,6±1,11
*
15,6±0,
9*
14,1±0,1
*
12,5±1,1
*
10,2±0,5*
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INF-
γ
0,9±1,1
*
2,6±1,1*
1,1±1,3
*
8,1±1,1*
0,8±1,1*
0,3±0,9*
Note: *
–
р
<0,05.
In addition, it has receptors that react with monocytes
and neutrophils, which have the ability to cause a
specific appearance, and stops these cells in the
capillaries located in the area of inflammation. Such a
high level of IL-8 indicates that the inflammatory
process in the leg becomes chronic in a positive way.
The dynamics of cytokine levels are more clearly shown
in Figure 2. At the same time, changes in the level of IL-
1β, IL
-2, IL-4, IL-6, IL-10, TNF-
α, INF
-
γ cytokines were
noted, but within normal limits. Locally, in 2 cases,
variants of purulent-necrotic injuries, which included
not only two anatomical areas of the leg, but also with
the spread of the process to the border of the upper
and middle third of the leg, and in 3 cases - ended with
gangrene of the distal parts of the leg. Cytokine
regulation of the inflammatory reaction is insufficiently
activated in patients with chronic DFS and secondary
immunodeficiency with recurrence of the purulent-
necrotic process. This leads to a lack of growth factors
and slow healing. Perhaps this condition can be
considered as a weak proliferative response.
Accordingly, as a local process, the functional status of
functional
mononuclear
phagocytes,
platelets,
macrophages, fibroblasts, keratocytes, endothelial
cells and other cells slows down with slow resorption
of the infiltrate and the formation of necrosis.
Materials and methods of the third stage
–
main group.
Taking into account the information obtained about
the state of the cytokine system in patients with
purulent-necrotic processes of DFS, it was decided to
study the antioxidant effect of ozone therapy and the
drug Reomannisol. The research group consists of 40
patients. With the neuropathic form of DFS - 16 people:
4 men and 12 women, and the neuroischemic form of
DFS - 24 patients: 8 men and 16 women, aged 50 to 75
years. In the anamnesis, there were multiple
recurrences of purulent-necrotic complications (from 2
to 4 times). The duration of diabetes is from 5 to 20
years. The goal of surgery and conservative treatment
algorithm is to preserve the function of the leg or
reduce the level of amputation. Reomannisol was used
from the first day of hospitalization to study the
antioxidant and peripheral blood circulation effects of
the drug in complex treatment. According to the
scheme, 200.0 ml of solution was administered
intravenously 1 time per day for 10 days. Plasma
sampling and cytokine levels were performed on the
first day before and/or after surgery, and then on days
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3, 5, 7, 10, and 12 again blood plasma was taken and the
level of cytokines was determined.
Results and discussions in the third group. Table 6 lists
the procedures performed in patients of group III.
Table 6. Characteristics of operations in group III
Type of operation
Frequency of operations (n=35)
abs.
%
Amputations at the hip level
10
28,6
Amputations at the lower leg
level
1
2,9
Amputations at the foot level
1
2,9
Amputations at the level of
the fingers
15
42,8
Amputations at the level of
the fingers
11
31,3
Necrectomy
15
42,9
Operations performed to save the leg: necroctomies - 42.9%, sequestrectomy - up to 31.3%, amputations at the level of
toes - 42.8%, amputations at the level of the heel - 34.3%. In addition, the number of high amputations: at the hip level
- 28.6%, at the heel level - 2.9%. Compared to the second group, the number of upper amputations decreased from
65.7% to 28.6%. In addition, the antioxidant effect of Reomannisol, manifested in the induction of inflammatory and
anti-inflammatory cytokines, was determined. Cytokine levels in patients of study group III are presented in Table 7.
Table 7. The amount of cytokines after ozonotherapy + reomannisol treatment in group III patients, pg/ml
Cytokines/
Days
Day 1
Day 3
Day 5
Day 7
Day 10
Discharge (11-
12 days)
IL-
1β
64,59±3,
3*
74,48
±1,9*
95,27±2,2
*
71,48±
1,8*
31,49
±1,9*
20±1,8*
IL-2
1,2±0,3*
1,7±0,
13*
1,1±0,2*
0,54±
0,15*
0,2±0,
11*
0
IL-4
41,56±2,3
43,96
39,29±4,1
30,7±3
32,9±
20,58±2,2*
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2771-2265)
VOLUME
04
ISSUE
09
P
AGES
:
38-52
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
*
±3,1*
*1
,2*
3,5*
IL-6
228,92±5
,1*
138±3
,2*
50,8±2,1*
42,6±3
,1*
38±2,
1*
8,5±1,1*
IL-8
181,14±4,
1*
197,31
±3,1*
245,47±5,9
*
222,6±
4,5*
109,6
±5,1*
53±1,1*
IL-10
48,8±2,8
*
25,81
±1,6*
34,2±2,1*
40,2±3
,2*
38,7±
2,5*
21,2±1,3*
TFN-
α
147,86±4
,6*
150,6
±5,3*
121,96±5,4
*
91,58±
4,3*
41,1±2
,1*
21,87±1,1*
INF-
γ
194±3,4
*
205,9
±6,5*
89±4,1*
47,8±2
,1*
7,8±0
,4*
5,39±0,3*
Note: *
–
р<0,05.
IL-
1β: high level of cytokine up to 64.59±3.3 pg/ml on
the first postoperative day, increased to 95.27±2.2
pg/ml on the fifth day and decreased to 20 ± 1.8 pg/ml.
IL-1b promotes the proliferation of monocytes,
macrophages, neutrophils, endothelium, smooth
muscle cells, fibroblasts, keratinocytes, T- and B-
lymphocytes, along with other cytokines; increases the
stimulation of receptors for IL-2; activates endothelial
cells; induces an acute phasic response.
IL-2: increases to 1.2±0.3 pg/ml on the first
postoperative day, to 1.7±0.13 pg/ml on the third day,
and to 0 at discharge. After an increase in IL-2, the
active implementation of the immune response and
the activation of T cells show.
IL-4: fluctuations were noted within normal limits and
an increase was observed in only one case, that is, 76
pg/ml in a patient with an allergic background, which
increased due to the development of postoperative
traumatic dermatitis on the limbs after surgery. . It is
possible that reomannisol stimulates the production of
this cytokine by mononuclear cells in the peripheral
blood of allergic patients. However, as a result of
antioxidant activity, there are fluctuations in the group
of cytokines with pro-inflammatory effects, but only
within normal limits.
IL-6: a high level of cytokine up to 228.92±5.1 pg/ml was
recorded on the first postoperative day. Then it
gradually returns to normal, and by the time of
discharge from the hospital, it was back to normal. IL-
Volume 04 Issue 09-2024
50
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
09
P
AGES
:
38-52
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
6 is produced by T-lymphocytes, monocytes,
macrophages, fibroblasts. Hematopoiesis causes the
differentiation of progenitor cells, stimulates the
development and production of megakaryocytes,
promotes the growth and differentiation of platelets,
T- and B-lymphocytes, and stimulates the production.
IL-8: peak cytokine levels increased to 181.14 ± 4.1 pg/ml
on the first postoperative day, 245.47 ± 5.9 pg/ml on
the fifth day, and 53 ± 1.1 pg/ml at hospital discharge.
decreased to ml. As revealed in the study of the
previous two groups, the growth of this cytokine
characterizes the transition of the process to a chronic
form.
IL-10: An anti-inflammatory cytokine produced by T-
lymphocytes, macrophages, keratinocytes, and B-
lymphocytes. It blocks the functional activity of
macrophages, the production of anti-inflammatory
cytokines by monocytes and macrophages. It increases
the proliferation of B-lymphocytes and the secretion of
immunoglobulins IgE. However, IL-10 can stimulate the
synthesis of IL-4 in a balanced state. By preventing the
systemic response to the inflammatory process, IL-10
ensures a balanced level of inflammatory and anti-
inflammatory cytokines, controls the immune
response, which has a positive effect on the prevention
of purulent-necrotic recurrence.
TNF-
α: produced by macrophages, monocytes,
keratinocytes,
T-lymphocytes,
B-lymphocytes,
neutrophils, endothelial cells. TNF-
α has a variety of
effects, occurs due to the modulation of the
expression of genes for cell growth factors, cytokines,
transcription factors, cell surface receptors and acute
phase proteins, and plays an important role in
protection against them. The increase of this cytokine
on the third day up to 150.6±5.3 pg/ml after the
operation is included in the high activity and the
cytokine itself.
INF-
γ: on the first day, a high level was recorded to
194±3.4 pg/ml, on the third day it increased to
205.9±6.5 pg/ml and decreased to 5.39±0.3 pg/ml, this
indicates
its
immunomodulatory
value
and
involvement in the regulation of the anti-inflammatory
response.
CONCLUSION
In the case of purulent-necrotic processes in DFS, the
adequate introduction of the cytokine system is
characterized by the slowing down of the local
process, corresponding to acute inflammation, but
increases the tendency of the process to go into a
chronic state. With the recurrence of purulent-necrotic
inflammation, there is a chronization of the process
and a secondary immune deficiency, which does not
allow the cytokine system to adequately join the anti-
inflammatory system. Reomannisol allows us to
consider it a physiologically active compound with
clear antioxidant activity. Reomannisol has an
Volume 04 Issue 09-2024
51
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
09
P
AGES
:
38-52
OCLC
–
1121105677
Publisher:
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antioxidant effect on the cytokine system, correcting
the cytokine balance. It can decrease the function of
pro-inflammatory and anti-inflammatory cytokines,
interferons. Reomannisol is effective in preventing
recurrence of purulent-necrotic lesions of DFS in
conditions of secondary immunodeficiency, so it is a
necessary drug in the main therapy complex.
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OCLC
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Publisher:
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Servi
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