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Meditsinskiy sovet = Medical Council

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No 18 (2022)
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CHRONIC PULMONARY DISEASES

11-19 527
Abstract

Introduction. Allergic rhinitis, chronic rhinosinusitis (with/without polyps) are chronic inflammatory diseases of the nose and often accompany asthma, aggravating its severity.

Aim of the study. Тo determine the phenotypes, spectrum of sensitization and severity of chronic inflammatory diseases of the nose in patients with severe bronchial asthma receiving immunobiological therapy in the Sverdlovsk region.

Materials and methods. The territorial register of adult patients with severe bronchial asthma (n = 85) who received immunobiological therapy in the Sverdlovsk region in October 2021 was analyzed. When diagnosing chronic inflammatory diseases of the nose, an examination by an otorhinolaryngologist and computed tomography of the paranasal sinuses were performed; were determined: the  absolute number of  blood eosinophils, specific IgE to inhaled allergens, including the FadiatopTM method; skin tests were performed; assessment of the severity of nasal symptoms was determined using the SNOT-22, VAS.

Results. Chronic inflammatory diseases of the nose were reported in 89.4% of patients. Allergic rhinitis occurred in 54.1% of cases (n = 46). 54.3% (n = 25) were dominated by patients with a moderate course; severe course was observed in 28.3% of cases (n = 13). Allergic rhinitis in 92.3% of cases (n = 36) was accompanied by allergic asthma and in 71.4% (n = 10) – mixed. Sensitization to household allergens was more common, from seasonal allergens to tree pollen. Phadiatop was positive in all patients with allergic rhinitis and negative in patients with chronic rhinosinusitis with/without nasal polyps. Patients with chronic rhinosinusitis occurred in 35.3% of cases (n=30); nasal polyps were in 23.5% (n = 20). The highest rates of blood eosinophilia were in patients with concomitant chronic rhinosinusitis with nasal polyps – 920 cells/µl. This phenotype in 95% of cases was accompanied by non-allergic (eosinophilic) asthma.

Conclusion. Severe bronchial asthma is almost always accompanied by chronic inflammatory diseases of the nose. Phadiatop shows its high informativeness in determining the phenotype of allergic rhinitis.

20-28 536
Abstract

 

The review provides current data on new options for the treatment of severe bronchial asthma. The prevalence of severe asthma ranges from 3% to 10%, but it is for the treatment of this group of patients that more than 80% of the funds allocated for the treatment of the disease as a whole are spent. Patients with severe bronchial asthma make up a special category, since traditional therapy, effective in most patients with bronchial asthma, does not allow controlling the disease. Heterogeneity and multivariate disease dictate the need to develop a personalized approach, which is impossible without significant financial and personnel investments. Understanding the pathogenetic pathways underlying the development of inflammation in asthma was the impetus for  the development of  targeted therapies. Five genetically engineered immunobiological drugs have been developed and approved for  patients with severe allergic and/or eosinophilic bronchial asthma. The choice of  the right medication should depend on the correct diagnosis of severe asthma, understanding the patient’s endotype, and accounting for patient-specific factors. It is worth noting that all approved biologics and most biologics currently in development focus on T2-immune response. To be sure, there is a huge pool of patients who register a different type of inflammation. And therefore, despite the rapid development of knowledge in the field of targeted therapy of bronchial asthma, further decoding and deepening of knowledge about the pathophysiological mechanisms, in particular non-T2 inflammation, as well as an analysis of the experience of using existing drugs to clearly understand the indications, as well as to assess the effectiveness and safety of existing treatments.

 

30-39 583
Abstract

Introduction. Inflammation in viral-induced acute exacerbations of chronic obstructive pulmonary disease (COPD) is not studied enough.

The aim was to establish molecular pattern of inflammation in viral-induced acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in comparison with bacterial AECOPD and to reveal associations with AECOPD phenotype and subsequent COPD progression.

Materials and methods. Subjects hospitalized with acute exacerbations of COPD (AECOPD) of which 60 were viral, 60 were bacterial and 60 were viral-bacterial were recruited to single center prospective (52 weeks) cohort study. Control group – 30 healthy people. COPD were diagnosed previously during stable phase of the disease according to spirographic criteria. Viral AECOPD were confirmed by detection of RNA of influenza A and B, respiratory syncytial virus, rhinovirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in sputum or bronchoalveolar lavage fluid (BALF) using reverse transcription-polymerase chain reaction (RT-PCR). Bacterial AECOPD were confirmed by sputum/BALF neutrophilia or elevated blood procalcitonin levels or by detecting bacteria by standard culture method. Plasma concentrations of  cytokines, fibrotic markers, enzymes were measured by enzyme-linked immunosorbent assay, plasma fibrinogen  – by Clauss method. Complex lung function investigation, Dopplerechocardiography, subsequent AECOPD assessment were done. Kruskal-Wallis and chi-square test were used to compare groups, Cox regression and linear regression – to explore relationships.

Results. Viral AECOPD were characterized by highest plasma concentrations of Eosinophilic cationic protein (62,3 (52,4; 71,0) ng/ml)), interleukin-5 (IL-5) (11,3 (8,4; 15,9) pg/ml), fibroblast growth factor-2 (FGF-2) (10,4 (6,2; 14,9) pg/ml), transforming growth factor-β1 (TGF-β1) (922,4 (875,7; 953,8) pg/ml), hyaluronic acid (185,4 (172,8; 196,3) ng/ml), amino-terminal propeptide of type III procollagen  (PIIINP)  (249,2  (225,1; 263,7) ng/ml), matrix metalloproteinase-1  (MMP-1)  (235,2  (208,6; 254,9) pg/ml). Levels of IL-5 during AE COPD was the predictor of FEV1, bronchodilation coefficient, subsequent exacerbations at remote period, fibrinogen was associated with FEV1, PIIINP and FGF-2  with DLco, PaO2, mean pulmonary artery pressure  (mPAP), exacerbations, MMP-1 – with mPAP.

Conclusions. In virus-induced AECOPD inflammation pattern differed from those in bacterial one and associated with AECOPD phenotype and COPD phenotype at the stable phase.

40-48 489
Abstract

The rising incidence of the disease, severe exacerbations, and risks of death make bronchial asthma an urgent public health problem. Effective control of the disease is recognised as the main goal of modern therapy. Studies conducted in our country and abroad show a low level of bronchial asthma control in most patients. An important condition for achieving control is the patient’s adherence to therapy. Higher adherence rates and, consequently, improved quality of life have been recorded in patients receiving baseline therapy, which involves a single inhalation per day. The long-acting combination powder inhaler fluticasone furoate/ vilanterol is one of the modern drugs with proven efficacy and safety. The drug has been shown to significantly improve lung function and reduce the frequency of asthma exacerbations. Of particular note are the results of a randomised clinical trial carried out in real (everyday) clinical practice. This form of study is non-selective, i.e. it includes a wide group of patients regardless of severity, comorbidities and lifestyle. This approach was used in a study called the Salford Lung Study. It included patients with bronchial asthma who were receiving ongoing maintenance therapy with inhaled glucocorticosteroids or combinations thereof from primary care centres. The study lasted for 52 weeks. The first group consisted of patients treated with the fluticasone furoate/vilanterol combination. Group 2 patients continued to receive baseline therapy. The best response was observed with the fluticasone furoate/vilanterol combination. It was maintained in all subgroups analyzed and was independent of smoking status, baseline control reduction, and number of severe exacerbations in the past year. Adherence to treatment is improved by a single dose and a convenient, intuitive means of delivery. The inhaler requires minimal coordination, is activated with a single movement and has an easy-to-understand dose counter.

49-54 674
Abstract

Inhaled bronchodilators are the basis of pharmacological therapy of chronic obstructive pulmonary disease. Bronchodilation can be reached in two different ways: by stimulation of β2 -adrenoreceptors and inhibition of M3-cholinoreceptors. Combined long acting bronchodilators show additional effect on lung function and clinical outcomes of the disease. This article covers the issues of efficacy and safety of different combined bronchodilators. Chronic obstructive pulmonary disease (COPD) is a disease characterized by the limitation of air flow velocity, which is reversible incompletely. The restriction of air flow velocity is usually progressive and is associated with inflammatory response of the lungs to pathogenic particles or gases, with tobacco smoking being the main cause. COPD leads to a number of significant systemic effects that can worsen the course of the disease. It is important that COPD can be prevented and treated. The Global Strategy for the Diagnosis, Treatment and Prevention of Chronic Obstructive Pulmonary Disease  (GOLD) considers long-acting inhaled bronchodilators as the  basis for  long-term maintenance therapy of  chronic obstructive pulmonary disease. GOLD recommends the  use of  both long-acting anticholinergic drugs  (LAMA) and long-acting β2-agonists (LABA) in all categories of patients, including as the first line in people with severe symptoms and low risk of exacerbations. bronchodilators reduce the severity of shortness of breath and other symptoms of the disease, and also increase exercise tolerance. The individual components have different application points: LAMA inhibit the effect of acetylcholine mainly on M1- and M3-muscarinic receptors, LABA stimulate β2-adrenergic receptors, increasing the content of intracellular cAMP and causing bronchodilation. Both classes of drugs potentiate each other’s activity, increasing the relaxing effect on the smooth muscles of the bronchi.

CYSTIC FIBROSIS

56-63 462
Abstract

The article describes the mechanisms of mucostasis and lung damage in cystic fibrosis. Types of mucolytic therapy and importance of inhalation therapy are considered. The authors presented their own classification of mucoactive agents. The principle of action, advantages and efficacy of mucoactive drugs based on the mannitol molecule are discussed based on the results of multicenter randomized clinical trials, including those conducted in children with cystic fibrosis. The authors present their own experience in the use of mannitol at the Morozovsky Municipal Children Clinical Hospital and 42 BIDA tests for its tolerability, of which 38 tests were passed satisfactorily. We present various clinical cases demonstrating the failure of a tolerance test due to increased signs of respiratory failure (dyspnea), an example of a repeat test 8 months later with satisfactory results, the development of hemoptysis in a patient seen in the pulmonology department of the National Medical Research Center for Children’s Health. The case was described in an adolescent, and after mannitol inhalation was added to the existing basic therapy, there was a clear positive trend in flowmetry: FEV1-74% (a significant increase of 14%). Thus, the authors noted that mannitol is effective in children with cystic fibrosis over 6 years of age; its use is characterized by good compliance and general adherence to therapy due to convenience of use: no need for additional technical means to perform inhalation in the form of solutions outside the home and saving overall free time. An important observation noted by the authors is that the BIDA test should be performed in complete clinical and laboratory remission to obtain objective results.

64-73 374
Abstract

Introduction. In cystic fibrosis (CF), a thick secret with pathogenic microflora in the respiratory tract and other factors lead to a decrease in lung function, repeated hospitalizations and a decrease in the quality of life of patients.

Aim. To evaluate the influence of endogenous and exogenous factors on lung function in children and adolescents with CF with the F508del variant in the homozygous state.

Materials and methods. Spirometry parameters were analyzed in 379 patients with the F508del variant in the homozygous state at the age of 6–18 years according to the National Register of CF Patients 2019.

Results. In children with CF at the age of 6–10 years, FEV1 and FVC were significantly higher than in children aged 11–14 and 15–18 years. P. aeruginosa and Achromobacter spp. infection had a negative effect on lung function. A weak correlation was found between nutritional status and respiratory function (for FEV1 r = 0.229; p <0.001; for FVC r = 0.206; p <0.001). In the Southern, Urals, and North Caucasian federal districts of the Russian Federation, the parameters of respiratory function in patients were significantly lower than in the Central Federal District.

Conclusions. For a group of patients, carriers of the F508del genotype in the homozygous state, factors that negatively affect respiratory function were identified: adolescence, low nutritional status, respiratory tract infections P. aeruginosa, Achromobacter spp., Burkholderia cepacia complex, liver cirrhosis with portal hypertension and features of organizational assistance to patients. Some factors are correctable in the organization of preventive measures, which can have a positive impact on reducing the rate of damage to the bronchopulmonary system. Regular monitoring and timely correction of nutritional status, monitoring of respiratory tract infections, their prevention and timely completion of eradication therapy courses are required. Adolescent patients require special attention.

TUBERCULOSIS

75-80 513
Abstract

Introduction. The continued decline in the number of patients shedding multidrug-resistant mycobacteria (MDR MDR), which has continued since 2018, determines the priority of measures to improve the effectiveness of treatment of newly diagnosed patients, including HIV-associated tuberculosis, with the mandatory inclusion of new anti-tuberculosis drugs in the treatment regimens of patients. drugs.

Aim. To evaluate the efficacy and safety of bedaquiline in the complex treatment of patients with HIV-associated respiratory tuberculosis.

Materials and methods. In the  prospective study was included 60  patients with newly diagnosed HIV-associated respiratory tuberculosis, randomized into 2 groups: group 1 – 30 patients who received bedaquiline in the combination of anti-tuberculosis drugs; group 2 – 30 patients who received therapy without the addition of bedaquiline. Bacterial excretion was detected in all patients of the 1st and 2nd groups, the MBT drug sensitivity test confirmed the presence of pre-XDR MBT. Patients in both study groups received antiretroviral therapy. The follow-up period for patients was 12 months.

Results. In the group of patients treated with bedaquiline, higher treatment results were noted both in terms of the criterion “closing of decay cavities” (by 14.7%) (p > 0.05) and by the criterion “cessation of bacterial excretion” (by 23.3%) ((p <0.05).

Conclusions. The high clinical efficacy and safety of the use of bedaquiline in the complex treatment of patients with HIV-associated respiratory tuberculosis has been demonstrated. The data obtained make it possible to recommend the use of bedaquiline in the treatment of patients with newly diagnosed HIV-associated tuberculosis, isolating MBT with pre-XDR, to increase the effectiveness of the main course of chemotherapy, prevent the amplification of MBT drug resistance and develop extensive MBT drug resistance.

RATIONAL PHARMACOTHERAPY

82-89 717
Abstract

Mucoactive drugs are commonly used in  the treatment of  respiratory diseases such as chronic bronchitis  (CB) or chronic obstructive pulmonary disease (COPD), in which hypercrinia is one of the main clinical features. Erdostein is one of the most commonly used mucoactive agents for the treatment of respiratory diseases. Erdostein is a drug approved for the treatment of acute and chronic lung diseases, originally developed as a mucolytic agent. It belongs to a family of thiol-based drugs, which, in  addition to mucolytic action, also have antioxidant and anti-inflammatory properties and exhibit antibacterial activity against various types of bacteria. Erdosteine is a prodrug that is converted to the active metabolite M1 (MET 1), which has mucolytic properties. Experimental studies have confirmed that erdosteine prevents or reduces damage to lung tissue caused by oxidative stress, and also regulates the production of reactive oxygen species. The RESTORE study, the only study that examined the effect of a thiol-based drug in chronic obstructive pulmonary disease (COPD) with frequent exacerbations, confirmed that erdosteine significantly reduces the risk of acute exacerbations of COPD, reduces their duration, and also reduces the risk of hospitalization for COPD. The preventive effect of erdosteine against exacerbations of COPD was not affected by the presence or absence of inhaled corticosteroids (ICS) or the number of eosinophils in the blood. Recent studies on the pharmacological effects of erdosteine have shown promising results, which paves the way for the use of additional pharmacological effects of erdosteine as promising therapeutic strategies in patients with pulmonary diseases.

90-94 649
Abstract

This article is a literature review on the management of patients with acute cough. The classification of cough, the main causes of acute and subacute cough, the current view on the etiology and pathogenesis of chronic cough are presented. Cough is an important protective mechanism, but in acute and chronic diseases of the bronchopulmonary system cough significantly reduces the quality of life and causes numerous complications. The most common cause of acute and subacute cough is respiratory viruses. Chronic cough is currently explained by the theory of cough hypersensitivity, according to which chronic refractory cough is the result of hypersensitivity of the cough receptors. Before the cause of chronic cough is identified, and when treating patients with acute and subacute cough, symptomatic therapy with cough suppressants that eliminate increased cough reflex activity to normal levels regardless of cough etiology, although not affecting the pathophysiological mechanisms of cough, or with combined drugs with suppressant and expectorant effects, is often required. Peripheral suppressants reduce the activity of peripheral cough receptors of the upper airway mucosa by softening, moistening and enveloping. Central cough suppressants include butamirate. Central non-narcotic cough suppressants in various combinations with muco- and bronchodilators and antihistamines form part of many anti-cough medicines. Butamirate has a non-specific anticholinergic and therefore bronchodilator effect. This article presents a review of clinical studies on the efficacy of butamirate.

95-99 402
Abstract

Introduction. At the present time, the incidence of acute respiratory viral infections (ARVI) remains at a high level. Some patients who have undergone ARVI and COVID-19 have been disturbed by astheno-neurotic syndrome and chronic fatigue syndrome for quite a long time.

Aim. To study the efficacy and safety dietary supplement treatment in the rehabilitation of patients recovered after acute respiratory viral infections.

Materials and methods. We have examined 50  patients diagnosed with acute respiratory viral infections  (38  people) and COVID-19 (12 people). Age of patients: from 25 years to 60 years old, average age 35 ± 11.84 years old. All patients were randomized into two study groups: the  first group  (25  people) received a  biologically active food supplement and the  second group (25 people) did not receive such complex. Сomplex was prescribed to the participants of the first group in amount of two capsules once a day. The course of therapy was 14 days. Before and after taking, all patients were assessed for shortness of breath on the MRC scale, depression on the Beck scale, chronic fatigue syndrome on the FAS scale, and the level of C-reactive protein (CRP) was assessed as well.

Results. In the course of the observation, no significant difference between the groups was recorded in the dynamics of the state of assessment for dyspnea, depression and hemoglobin level. The average level of CRP before taking in the first group was 4.4 mg/l (from 0 to 22 mg/l), in the second – 3.8 mg/l (from 0 to 14 mg/l). When comparing the dynamics in the first group, there was more pronounced decrease in the level of CRP. In the first group, decrease in manifestations of pathological fatigue was revealed, characterized by decrease in FAS scores compared to the control group, where the number of scores, on the contrary, increased.

Conclusions. Сomplex has a corrective effect on astheno-neurotic symptoms after suffering from acute respiratory viral infections or post-COVID syndrome.

100-106 587
Abstract

Bronchial asthma is a  current problem of  health care in  connection with high prevalence and heterogeneity of  a  disease. Development and deployment in clinical practice of genetically engineered biological medicines for treatment of patients with severe eosinophilic bronchial asthma allowed to change cardinally the course of a disease and to considerably improve quality of life of such patients. The presented clinical case focuses on the experience of using benralizumab, an interleukin-5 receptor antagonist in a patient with T2-endotype of severe bronchial asthma in combination with polypous rhinosinusitis. The diagnosis of bronchial asthma was established to the patient in 36 years. The patient had the burdened allergological personal and family anamnesis, intolerance of nonsteroid anti-inflammatory medicines, polyps in a nose were revealed later. It is known that the clinical phenotype of a combination of bronchial asthma to a polypous rhinosinusitis is difficult for treatment in connection with the inflammation which was more expressed, difficult giving in to control in airways. Over time the course of a disease was made heavier, control of symptoms was lost and, despite the therapy volume corresponding to the 5th step on GINA, including reception of system glucocorticosteroids, an exception of all factors interfering achievement of control regular symptoms and frequent aggravations remained. In accordance with the Federal Guidelines, the patient was prescribed targeted therapy with benralizumab, which suppresses eosinophilic inflammation in the respiratory tract. During the treatment, a rapid significant improvement in the patient’s condition was noted in the form of a decrease in asthma symptoms, normalization of spirography indicators, and cessation of exacerbations. The persistent clinical effect allowed to abandon the use of systemic glucocorticosteroids without losing control of  the disease. There were no adverse reactions to the  drug administration. Thus, therapy with benralizumab in patients with the T2-endotype of severe bronchial asthma in combination with polypous rhinosinusitis is safe and highly effective and allows it to be recommended for widespread use in clinical practice.

DISSERTANT

107-112 473
Abstract

Introduction. Hearing impairments in schoolchildren affects learning and communication. Reliable data on hearing loss prevalence in this group are necessary for planning the audiological care.

Aim. To compare data from a  population-based study of  the hearing loss prevalence in  schoolchildren and estimates from the Global Burden of Disease (GBD) study in the Republic of Yemen.

Materials and methods. Data extraction was performed from the GBD database on the prevalence of bilateral hearing loss >20 dB among children aged 5–9 years in the Republic of Yemen. A two-stage study of hearing loss prevalence among primary school students aged 6–9 years in Sana’a, Republic of Yemen, in a sample of 2200 children using screening audiometry at 20 dB at 0.5, 1, 2, and 4 kHz is school settings, followed by tonal threshold audiometry and tympanometry in a specialized clinic. Hearing loss was assessed as unilateral or bilateral when hearing thresholds were higher than 25 dB.

Results. According to GBD estimates, bilateral hearing impairment in this population is 2.2%, including 1.4% of mild degree. According to the results of a Yemenian population study, mild and moderate hearing impairment was detected in 10.6%, of which 6.8% – unilateral, 3.8% – bilateral hearing loss. There were no cases of severe or profound hearing loss. The prevalence of otitis media with effusion was 6%, chronic suppurative otitis media – 1.8%, sensorineural hearing loss – 1.6%.

Conclusion. Bilateral hearing impairments occur in 2.2–3.8% of primary school students, with unilateral impairments the prevalence is up to 10.6%. Of these, at least 65% have conductive hearing loss due to pathology of the middle ear. The data obtained will improve the efficiency of ear and hearing care for schoolchildren.

COVID-19

113-121 438
Abstract

Introduction. COVID-19 is a highly contagious infectious disease caused by the novel coronavirus SARS-CoV-2. After the acute phase and discharge from the hospital, convalescent people continue to have respiratory symptoms, changes in pulmonary function (PF) and indicators of chest computed tomography (CT).

Aim. To evaluate changes in PF and quantitative CT data in patients after severe coronavirus pneumonia.

Materials and methods. A cross-sectional observational study was conducted: 55 patients (including 28 men, aged 32–78 years) with a diagnosis of “lung interstitial process due to a coronavirus infection” were examined. All patients underwent a study of PF (spirometry, body plethysmography, measurement of the diffusion lung capacity: DLCO) in the interval of 24–305 days after discharge from the  hospital. CT scan of  the chest was performed simultaneously with the  functional examination (±30 days), the parameters were calculated: ground glass areas, functional lung tissue volume (FV), affected tissue volume (AV), CovidQ (AV/FV ratio).

Results. A decrease in DLCO was found in 28 patients. Restrictive disorders – in 13 patients, obstructive disorders – in 2 patients. At the time of the CT examination, all patients had residual changes in both lungs of varying severity. Functional parameters (FVC, TLC and DLCO) were statistically significantly correlated with the CT data.

Conclusion. During the  recovery period in  patients after COVID-19, lung structural changes, according to CT scans, persist for at least 3 months. Pulmonary ventilation indicators in most patients normalize during this time, half of the patients retained a decrease in diffusion lung capacity. Acknowledgment. The study was carried out as part of the state task on the topic: “The impact of the new coronavirus infection SARS-CoV-2 on the functional parameters of the respiratory system during the convalescence period” (code: “PostCOVID-functional diagnostics”).

122-130 483
Abstract

The goal of Asthma treatment is to achieve a controlled condition, that is, to minimize the burden of symptoms and the risk of exacerbations. Many factors hinder the achievement of this goal: non-compliance with recommendations for drug therapy, the influence of concomitant diseases, the impact of triggers, low patient adherence to prescribed treatment, violation of inhalation technique. In general, there is no significant difference in the risk of hospitalization or mortality due to COVID-19 in patients with Asthma. At the same time, studies show that non-allergic Asthma, severe Asthma, Asthma in combination with obesity, lack of adequate basic therapy can create the greatest risk of infection and severe clinical outcomes of COVID-19. Asthma can be a predictor of a prolonged intubation period in severe respiratory failure during COVID-19, especially in people younger than 65 years. GINA experts agree that during a pandemic, it is especially important that patients with Asthma continue taking basic therapy, including inhaled corticosteroids (ICS), as prescribed by the recommendations. ICS therapy in combination with long-acting β2-agonists (LABA) is the main pharmacological method of treating moderate and severe Asthma in adolescents and adults. A single inhaler regimen with the use of a combination of ICS/formoterol is associated with a lower risk of severe exacerbations compared with supportive treatment of ICS/LABA in combination with SABA on demand. Studies show that the technique of inhalation maneuver can significantly affect the success of therapy. A wide variety of DPI causes problems with the choice and use by patients.

131-140 610
Abstract

Intriduction. In the last decade, conflicting data has appeared that the presence of obesity in patients with several diseases not only does not worsen, but even improves their prognosis, which is called the “obesity paradox”. The role of elevated body mass index in patients with coronavirus pneumonia (COVID-19) remains unclear.

Aim. To study the features of the course of pneumonia in young and middle-aged men depending on the body mass index.

Materials and methods. A retrospective analysis has investigated and it included 451 young and middle-aged men who underwent inpatient treatment for COVID-19 pneumonia. Patients were randomized according to body mass index into groups: normal nutrition (N), overnutrition (On), obesity (Ob). Clinical and laboratory parameters were assessed using statistical analysis.

Results and discussion. In patients with obesity, the causative agent of pneumonia was detected in 91.9% of cases, in contrast to group N (65.75%). At the onset of pneumonia, group Ob differed significantly from group N in terms of erythrocyte sedimentation rate (17 versus 9 mm/h), C-reactive protein (18.3 versus 7.2 mg/l), D-dimer (304 versus 230 ng/ml), glycemia (6.2 versus 5.2 mmol/l), lymphocytes 9 (1.3 versus 1.5 × 109/l). In the dynamics in the group Ob, in comparison with the group N, there is a higher level of platelets (307 versus 1 × 109/l), neutrophils (6.3 versus 3.7 × 109/l), monocytes (0.8 versus 0.6 × 109/l) and a smaller number of lymphocytes (1.4 versus 2.0 × 109/l). It was revealed that the lymphocytic index and the index of the ratio of lymphocytes to monocytes in dynamics significantly increase in group N (from 0.5 to 0.7 and from 3.5 to 4.5, respectively), in group On only the lymphocyte index significantly increases (from 0.4 to 0.5), in the obesity group they do not change (from 0.4 to 0.5 and 3 from.0 to 2.7, respectively). The greatest need for respiratory support had group Ob (21.1%) in comparison with GNP (6.0%).

Conclusions. The level of adipose tissue in the body has a direct impact on the course of pneumonia.

141-146 542
Abstract

Coronavirus infection has become one of the biggest shocks of our time. Coronaviruses are viruses with a positive RNA chain, most often affecting the respiratory tract. The virus penetrates into human type II alveolar cells using receptors for angiotensin converting enzyme 2 (APF2). SARS-CoV uses specific host cell factors throughout its infection cycle. The virus replicates inside cells, distracting the body’s own cellular mechanisms, and binds the virion to the APF2 receptor. The number of COVID-19 patients is more than 100 million people. Many recovered people note the persistence of symptoms for several months after an acute illness. Most often, patients complain of shortness of breath, fatigue, general weakness, pain behind the sternum, palpitations. Many studies have clearly demonstrated the effect of COVID-19 on metabolic disorders, the development and progression of cardiovascular diseases and mortality. The studies have shown that inflammation is formed in the myocardium. Its pathogenesis is not fully elucidated. According to two main theories, APF2 plays an important role in myocardial damage, as well as a  hyperimmune response, which can independently lead to myocarditis. The frequency and prognostic effect of COVID-19 myocarditis are unknown. This article analyzes the current literature data on the epidemiology, pathogenesis and clinical manifestations of  postcovid syndrome, in  particular subacute COVID-19 in  the focus of  cardiovascular disorders. The search for relevant literature was carried out on the basis of Web of Science, PubMed, by keywords: long COVID-19, cardiovascular diseases, postacute COVID-19 syndrome, SARS-CoV-2. The analysis included systematic reviews, meta-analyses, clinical studies, literature reviews published over the past 2 years.

147-153 530
Abstract

Despite the development and implementation of vaccines in various countries of the world, COVID-19 remains a significant medical and social problem. This is directly related to the characteristic feature of SARS-CoV-2 to form new strains, which reduces the effectiveness of vaccination. In connection with the foregoing, the priority in the prevention of COVID-19 is to improve and maintain the normal functioning of the human immune system. Recently, more and more scientists have noted the significant role of micronutrients in ensuring immune function. However, most research focuses on micronutrients such as zinc, selenium, iron and copper, while it is known that the balance of micronutrients depends on all its constituents. Consequently, any change in the content of one mineral substance can affect the level of others, leading to an imbalance of trace elements in the body. The aim of this work was to analyze literature data on less studied microelements in the context of the COVID-19 pandemic, both essential and toxic, that can affect the state of the immune system and, as a result, the incidence and risk of complications and adverse outcomes in COVID-19. An analysis of the literature on the effect of manganese, chromium, iodine, cadmium, mercury, lead, arsenic and lithium on human antiviral protection, including in the case of a disease caused by SARS-CoV-2, showed that the determination of the microelement status, taking into account the above microelements and, with necessary, the appointment of preparations containing minerals is promising for the purpose of prevention and as an additional therapy for COVID-19.

154-161 600
Abstract

The respiratory system is the main target of the novel coronavirus infection (COVID19) spread by the SARS-CoV-2 virus. The interim guidelines of the Ministry of Health of the Russian Federation “Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)” (14th version of December 27, 2021) discuss pneumonia in COVID-19 in detail. The issues of the course of other respiratory diseases (chronic obstructive pulmonary disease-COPD, bronchial asthma) are considered in them very briefly. Other diseases and pathological conditions of the respiratory organs are ignored. The federal clinical guidelines Bronchial Asthma, Chronic Obstructive Pulmonary Disease, Community-Acquired Pneumonia in Adults published in 2021 do not discuss the  course of  these diseases in  the context of  the COVID-19  pandemic. A  search was made for  literature on the association of major diseases and pathological conditions of the respiratory organs with the new coronavirus infection COVID-19 in the electronic search engines PubMed and Scopus. The literature sources found indicate that the new coronavirus infection COVID-19 certainly has a specific, often negative, effect on the respiratory system as a whole, and in particular, on certain respiratory diseases and pathological conditions. However, this influence is sometimes ambiguous. Thus, patients with COPD, along with patients with arterial hypertension, diabetes mellitus, and other cardiovascular and cerebrovascular diseases, belong to a vulnerable group of the population during the COVID-19 pandemic, but there was a decrease in the frequency of  exacerbations of  COPD during the  pandemic, especially hospitalizations. due to severe exacerbations. A  number of meta-analyses and systematic reviews have shown that the risk of contracting COVID-19 in people with asthma is lower than in  people without asthma. There is no association between asthma and a  more severe course and worse prognosis of COVID-19. The relationship of diseases/pathological conditions of the respiratory system and COVID-19, therefore, requires further study and clarification.

162-169 579
Abstract

Introduction. The new coronavirus infection continues to be an urgent health problem worldwide. At the moment, the consequences of the transferred COVID-19 need to be studied.

Objective. To study the clinical features, the severity of lung damage in patients with different body weights, 12 weeks after a new coronavirus infection with lung damage.

Materials and methods. The prospective study included 52 patients (28 women, 24 men, aged 63.4 ± 13.3 years [30–84 years], hospitalized in the therapeutic department of the Sechenov University UKB No. 1 3 months after COVID-19 with lung damage > 50%. The need for respiratory support, the degree of lung tissue damage were assessed according to high-resolution computed tomography (HRCT), the results of spirometry with DLCO, data from a 6-minute walking test (6MWT). The analysis of the indicators was carried out taking into account the body mass index (BMI), which was used as a criterion for determining overweight and obesity.

Results. In obese patients, 12 weeks after the disease, shortness of breath and cough were more common. It was revealed that a high BMI significantly affected the diffusion capacity of the lungs in patients after COVID-associated pneumonia, the preservation of pathological patterns according to the results of HRCT. Conclusions. Obesity is not only a risk factor for the severe course of COVID–19, but also in many ways the reason determining the long-term rehabilitation of patients after infection.



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ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)