Vol 33, No 2 (2022)

The article is devoted to the issues of practical implementation of antenatal prophylaxis of respiratory distress syndrome (RDS) of the fetus, clinical significance and features of surfactant therapy in the syndrome of respiratory distress of the newborn. Clinical and epidemiological parallels of respiratory pathology in preterm labor are considered. Neonatal features of the respiratory system are discussed and the modern resuscitation concept of the «golden hour» in neonatology is consecrated. The presence, percentage of completeness and completeness of the course of prenatal steroid prophylaxis of fetal RDS was assessed. It has been shown that the screening assessment of this course serves as an important clinical and prognostic predictor in determining the optimal tactics of starting respiratory support in premature infants with extremely low body weight in the neonatal intensive care unit in the early neonatal period.

A review of information on the increasing use of electronic smoking products in modern society - vapes (including electronic cigarettes - ES), their characteristics (structure, composition, mechanism of action, effect on the body) is given. The data of studies that have shown that ES, especially nicotine-containing, have numerous negative effects on many organs and tissues of vapers are presented. The results of our own research on the attitude of students to electronic cigarettes are included. It is shown that a significant part of the respondents are critical of their use, believing that ES are harmful to health, involve young people in the process of smoking and conventional cigarettes. Various strategies for the treatment of nicotine addiction (pharmacological and non-drug) are highlighted. As a pharmacological correction, the possibility of nicotine and nicotine-free pharmacological therapy is considered. It is recommended to include psychological and behavioral and alternative therapy in the arsenal of non-drug correction.

The paper presents the experience of combined therapy with an angiotensin-converting enzyme inhibitor (lisinopril) and Femo-Clim in female patients with arterial hypertension (AH) and its effects on the structural geometric changes of left ventricle (LV), endothelium-dependent vasodilation (EVD) of peripheral arteries, blood pressure (BP) values, the marked clinical manifestations of perimenopause. Material and methods. The study followed 77 women with stage II AH during perimenopause with left ventricular myocardial hypertrophy (LVMH) and peripheral arterial endothelial dysfunction. Mean age was 50.3±4.2 years, mean systolic BP was 171.67±2.81 mm Hg, diastolic BP, 99.7±0.63 mm Hg; mean estradiol level, 0.20±0.05 pkg/mL; mean follicle-stimulating hormone, 24.89±1.12 IU/mL; complaints of hyperhidrosis, hot flashes, disturbance of the general sense of well-being, uneasy sleep, poor appetite and impaired mood. Patients received lisinopril 10 mg daily for 6 months and Femo-Clim 2 tablets daily for 1 month. The patients’ condition was monitored: BP, heart rate, ECG, EKVD test, echocardiography. The study did not include patients with coronary heart disease, chronic heart failure, dyslipidemia, diabetes mellitus, and renovascular disease. Results. The use of lisinopril in patients with AH during perimenopause showed a good antihypertensive effect, slowed the development of LVMH, and had a positive effect on LV remodeling (primarily, on the concentric type). Lysinopril and Femo-Clim combination had a positive effect on peripheral arterial endothelial dysfunction and was well tolerated by the patients. Femo-Klim is combined with cardiotropic therapy and is effective in the therapy of clinical manifestations in patients with AH during perimenopause.

Occupational asthma is a complex and heterogeneous disease. Development of personalized treatment and prevention tactics becomes feasible due to phenotyping, which means identifying of markers to combine cases of occupational asthma with similar manifestations (clinical, instrumental, laboratory) and prognosis to phenotypes. The study aims to determination and comparative analysis of spirographic and immunological parameters for different phenotypes of occupational asthma. Materials and methods. In this study, we included 170 patients with different phenotypes of occupational asthma and 50 participants in control group. The spirographic examination was performed using computer spirograph with determination of the following parameters: forced vital capacity (FVC), forced expiratory volume during the first second (FEV1), Tiffeneau-Pinelli index (FEV1/ FVC), peak expiratory flow (PEF), maximal expiratory flow at 75%, 50%, 25% of the forced vital capacity (MEF75%VC, MEF50%VC, MEF25%VC). Quantification of the immunoglobulins IgA, IgM, and IgG in human serum was conducted by Mancini method. Determination of cytokines IL-1β, IL-10, IFNγ, IgE total and fibronectin levels was hold using a solid-phase enzyme immunoassay. Results. According to spirometry and laboratory results obtained, there is a strong evidence, that the phenotype “occupational asthma - occupational chronic obstructive pulmonary disease" has the lowest values in pulmonary function tests and the most significant changes in immunoglobulins, cytokines and fibronectin levels among other studied phenotypes of occupational asthma. Conclusions. Dynamic determination of spirometry parameters, levels of immunoglobulins, cytokines IL-1β, IL-10, IFNγ and fibronectin in workers who are most at risk of developing occupational asthma may be recommended to be conducted once every six months with further phenotyping of identified cases. This can optimize the diagnosis, the choice of treatment and prevention tactics as well as predict the course of this pathology.

Frequency and variants of aspiration with gastric contents were studied on the basis of 13 328 (100%) primary bronchoscopies performed in patients with nonspecific non-tumor lung pathology. Aspiration into the lower airway with gastric contents was detected in 82 (0.616%) patients. In the majority of patients included in the study group, the clinic of aspiration was masked by the clinic of the underlying disease. Several variants of aspiration with gastric contents were proposed based on the results of the studies: simple aspiration with gastric contents, simple multiple aspiration with gastric contents, complex multiple aspiration with gastric contents and combined multiple aspiration with gastric contents. Maximum problems of visual bronchoscopic diagnosis are associated with simple aspiration of gastric contents, because the presence of gastric juice is often obscured by the presence of bronchial secretion. No correlation of specific lower respiratory tract aspiration variants by gastric contents with specific nosological forms of the leading non-tumor lung pathology was not identified.

Hyperuricemia, an increase in serum uric acid (UA) concentration above 420 pmol/L for men and 360 pmol/L for women (clinical guidelines of the Russian Association of Rheumatologists (2018)), is a common problem in clinical practice. Existing clinical guidelines regulate the management of patients with symptomatic hyperuricemia, primarily gout, urolithiasis, and acute urate nephropathy, but less attention is given to the primary prevention of these diseases and to the treatment of asymptomatic hyperuricemia. It is also known that UA and, consequently, hyperuricemia are also important in the development of cardiovascular diseases, primarily hypertension, heart failure and chronic kidney disease, and meanwhile, the treatment of asymptomatic hyperuricemia in these patients still depends on the doctor’s opinion. This review analyzed current trends in the treatment of patients with symptomatic and asymptomatic hyperuricemia according to current views on the role of UA in the development of gout, renal, cardiovascular, and other diseases.

The article provides up-to-date data on pharmacological effects, mechanism of action and results of clinical experience of the new antiviral drug Rafamin. Rafamin possesses an immuno-mediated antiviral and antibacterial effect and involved in the implementation of the immune response against both viruses and bacteria. The therapeutic efficacy of the drug according to the results of a multicenter placebo-controlled randomized clinical trial was manifested in a significant reduction in the duration of the disease (almost a day) and a 4-fold increase in the proportion of patients with recovery on the 3rd day of therapy compared with placebo. Rafamin possesses its own antibacterial effect, contributes to the prevention of bacterial complications of acute respiratory viral infections, and therefore is of clinical interest.