Background: While acute coronavirus disease 2019 (COVID-19) infections of the oral cavity, with clinical signs such as taste loss, dry mouth, and mucosal lesions, are well-established health problems, involvement of the oral cavity as a sign of long COVID is poorly understood. One of the organs in the oral cavity that is prone to the virus is the salivary gland. Case presentation: We describe the case of an elderly patient with severe generalized xerostomia and left-sided facial swelling involving the submandibular gland, an uncommon presentation, as the parotid gland is typically involved COVID-19 infections. Ultrasound demonstrated marked ductal dilation without glandular tissue changes. The absence of other causes of sialodochitis, together with a history of repeated COVID-19 infections, led to the diagnosis of post-COVID sialodochitis. Management options were limited by the patient’s frailty and polypharmacy. Nevertheless, conservative symptomatic treatment led to clinical recovery, with no evidence of progression to bacterial or necrotizing sialadenitis. Conclusions: This case demonstrates that COVID-19 infection and its history should be included in the differential diagnosis of sialadenitis. Along with the clinical case presentation, a narrative review of similar studies on COVID-19-associated salivary gland disease was conducted, spanning molecular and post-mortem evidence, acute clinical cases, and post-COVID sequelae.

Background: Staphylococcus aureus bacteremia is a major cause of morbidity in hemodialysis patients, often leading to metastatic complications. Sternocleidomastoid muscle phlegmon and sternoclavicular septic arthritis are uncommon but serious infectious complications of S. aureus bacteremia described in immunocompromised patients but rarely described in patients with end-stage renal disease or an indwelling dialysis catheter. Case Presentation: We report a case of a 50-year-old Caucasian woman with end-stage renal disease on maintenance hemodialysis. Her dialysis catheter was removed because of fever and positive blood cultures for methicillin-susceptible S. aureus . Despite a ten-day outpatient course of ceftriaxone and azithromycin, she developed recurrent fever, right-sided neck swelling, trismus, severe lower neck pain, and swelling and tenderness over the sternocleidomastoid muscle. She also had restricted neck movement (torticollis) and a hemorrhagic petechial rash. Odontogenic (dental) or pharyngeal infectious sources were excluded. No internal jugular vein thrombosis was detected at the initial catheter site. Imaging showed a phlegmon in the fascial compartment of the right sternocleidomastoid muscle, septic arthritis of the sternoclavicular joint with erosion of the sternal end of the clavicle, and septic pulmonary emboli with cavitation. The patient underwent surgical incision and drainage of the sternocleidomastoid muscle phlegmon. This was combined with six weeks of targeted intravenous antibiotic therapy and continued hemodialysis. Clinical and radiological improvement was achieved, with complete resolution of the infection and cutaneous manifestations. Conclusion: This case shows an unusual pattern of metastatic dissemination in catheter-related S. aureus bacteremia. The complications included a sternocleidomastoid muscle phlegmon and sternoclavicular septic arthritis, both arising by contiguous spread from the infected catheter tunnel, together with septic pulmonary embolism and a hemorrhagic rash. The case underscores the need for early recognition, prompt source control, and aggressive, multidisciplinary management, including early surgical intervention, for high-risk hemodialysis patients.

Objective — on the basis of investigation of the role of oxidative stress in disruption of arginine/citrulline cycle with the use of citrulline as a marker of intestinal functional capacity, to provide ground for administration of S‑ademetionine (S‑AMe) in combination with Bifidobacterium infantis 35624 (B. infantis 35624) in patients with chronic lymphoproliferative disorders (CLPD) for prophylaxis of cytostatic‑induced mucositis during chemotherapy (CT). Materials and methods. Examinations involved 38 patients with CLPD, including 8 (21%) females and 30 (79%) males aged 30—76 years. Patients with CLPD and registered diarrheal syndrome against the background of CLPD progression have been enrolled in the study. All patients received CT according to the current guidelines. Depending on the type of concomitant therapy, patients were divided into three groups: group І (n=13) included patients with CLPD, who underwent CT only; patients of group ІI (n=12) received CT and S‑Ame in a dose of 1000 mg/day intravenously for 10 days and then in a dose of 500 mg twice a day for 20 days; patients of group ІII (n=13) during CT received S‑AMe, in a dose of 1000 mg/day intravenously for 10 days, then in a dose of 500 mg twice a day for 20 days with concomitant B. infantis 35624 1 capsule/day for 30 days. Control group consisted of 20 practically healthy subjects (9 (45%) females and 11 (55%) males, aged 22 to 26 years. The examinations were conducted twice: before CT and after the three courses of CT. Blood serum examinations included levels of substances that form a trimethine complex (TBARS) with 2‑thiobarbituric acid, assessment of catalase activity, arginine and citrulline levels and arginase activity. Results. At baseline examinations of patients of groups I, II and III, levels of TBARS in blood serum exceeded the norm in 1.4 (p=0.0479), 1.3 (p=0.0122) and 1.4 times (р=0.026), respectively. Blood serum citrulline level in the group I was in 1.2 times (p=0.0171) lower than in controls. The negative correlation was determined between serum citrulline levels and TBARS levels in the group I (r=–0.52; p=0.02). After the 3rd course of CT in patients of I group, the concentration of TBARS was in 1.3 times (p=0.0002) higher vs baseline values, and in 1.8 times (p=0.0012) higher than in controls. In patients of the II and III groups, serum TBARS levels were in 1.39 (p=0.0005) and 1.46 times (p=0.0002) lower compared to the group I of patients. The application of S‑Ame and B. infantis 35624 combination in group III patients allowed an increase serum citrulline levels in 1.4 times (p=0.0002) compared to group І and in 1.1 times (p=0.001) compared to group ІІ. Conclusions. The conduction of chemotherapy in patients with chronic lymphoproliferative disorders is associated with an increased risk of cytostatic‑induced mucositis, oxidative stress plays a crucial role in its pathogenesis. The application of S‑ademetionine in combination with Bifidobacterium infantis 35624 allows to prevent intestinal injury during chemotherapy.

Obesity and periodontal diseases are associated with oxidative stress activation. Periodontitis and gingivitis are inflammatory diseases that cause systemic and local production of reactive oxygen species, leading to tissue damage. Obesity exacerbates systemic free radical oxidation. The aim of the study was to evaluate the influence of cerium oxide nanoparticles (CNPs) as potential pharmaceutical agents for targeting oxidative stress activation in patients with obesity and periodontal disease. Young patients with obesity and generalized gingivitis were randomly allocated into 2 groups. In the first group (n = 28), a professional oral hygiene procedure was performed, followed by the local application of the Nanosept solution (a formulation comprising CNPs and chlorhexidine digluconate (CHG)). Over the next 5 days, the subjects were instructed to administer the Nanosept solution twice a day on the gums using a cotton sponge for 5 min. The second group (n = 30) was additionally prescribed the antioxidant Cerera (CNPs) for 10 days. Following treatment in both groups, a complete resolution of gingivitis was registered. In both groups, a significant decrease in salivary mucopolysaccharides and total nitric oxide synthase (NOS) activity was observed. However, a significant decrease in oxidative and nitrosative stress markers, as well as an increase in catalase activity were registered only after systemic administration of CNPs. Similarly, the normalization of colonization resistance (CR) was observed only in the second group. Systemic administration of CNPs in the treatment of obese patients with generalized gingivitis resulted in a decrease in oxidative and nitrosative stress activation in the oral cavity, enhanced antioxidant capacity of the saliva, and normalized the level of CR of the oral cavity.

Objective — to investigate the influence of the combination of L‑arginine and L‑carnitine on prooxidant‑antioxidant status and arginine‑citrulline cycle in patients with multiple myeloma (MM) and concomitant coronary artery disease (CAD) during the chemotherapy. Materials and methods. 59 patients with multiple myeloma progression and concomitant coronary artery disease were examined. According to the presence of concomitant coronary artery disease and prescribed treatment, all patients were divided into groups: I (n=20) — patients with multiple myeloma and no concomitant diseases of the cardiovascular system, who received the standard chemotherapy, II (n=22) — patients with multiple myeloma and concomitant coronary artery disease, who received standard chemotherapy and basic treatment of coronary artery disease, III (n=17) — patients with multiple myeloma and concomitant coronary artery disease who received standard chemotherapy, basic treatment of coronary artery disease in combination with L‑arginine and L‑carnitine. All patients obtained bortezomib‑containing schemes of chemotherapy. Patients were examined twice: before the initiation of chemotherapy and before the fifth course of chemotherapy. The concentration of L‑arginine, citrulline, thiobarbituric acid reactants (TBAR), and the activity of arginase and catalase in blood serum were measured. Results. During the multiple myeloma progression in patients of groups II and III, the concentration of TBAR‑substances was increased by 1.3 times (р <0.0001) compared with patients of group I. Simultaneously, in patients of groups II and III, the catalase activity decreased by 1.3 times (р <0.0001), and the concentration of serum citrulline was 1.7 times (р <0.0001) and 1.9 times (р <0.0001) higher than in patients of group I. Before the fifth course of chemotherapy in patients of group III, the concentration of serum L‑arginine was 1.1 times ((71.11 (68.74; 77.79) vs. 64.25 (59.41; 69.47)) µmol/l, р=0.0001) higher than in patients of group II. Simultaneously, the concentration of serum citrulline was increased by 1.3 times ((250.5 (205.4; 285.3) vs. 197.0 (175.0; 243.5)) µmol/l. р=0.007) compared with group II. In patients of groups I and III the activity of catalase in blood serum was increased by 1.1 times ((13.77 (12.50; 14.86) vs. 15.37 (14.24; 16.01)) µkat/l. р <0.05) and by 1.4 times ((10.43 (9.55; 10.75) vs. 14.26 (12.45; 15.81)) µkat/l, р <0.001), respectively, compared with the initial examination. However, in patients of group II, it was decreased by 1.3 times ((10.07 (9.40; 10.25) vs. 8.00 (7.74; 8.23)) µkat/l. р <0.001) compared to the initial examination. Multiple myeloma progression was accompanied by prooxidant‑antioxidant status disorders, which were represented by increasing concentrations of TBAR‑substances independent from the presence of concomitant coronary artery disease. However, in patients with multiple myeloma and concomitant coronary artery disease, serum concentration of TBAR‑substances was significantly higher compared with patients with multiple myeloma without concomitant diseases of the cardiovascular system. According to our study, the administration of L‑arginine and L‑carnitine significantly increases the concentration of L‑arginine in the blood serum, which decreases the level of endothelial dysfunction by the augmentation of nitric oxide production in the background of reduced oxidative stress and arginase activity. Conclusions. Addition of L‑arginine and L‑carnitine to the supportive therapy of patients with multiple myeloma with concomitant coronary artery disease leads to a significant decrease of TBAR‑substances concentration in the blood serum with simultaneous augmentation of catalase activity in the blood serum (р 0.05). L‑arginine and L‑carnitine significantly increase the concentration of L‑arginine in the blood serum of patients with multiple myeloma and concomitant coronary artery disease during the chemotherapy (р >0.05), which contributes to the decreasing of oxidative stress severity and improvement of endothelial function by efficient NOS‑dependent L‑arginine unitization with NO formation.