卷 28, 编号 2 (2017)

A clinical example is used to discuss criteria for distinguishing difficult-to-treat asthma from severe asthma in children, to demonstrate different ways of complex monitoring of asthmatic children for the assessment of control over disease course: dynamic assessment of asthma control test values, spirometric data, and nitric oxide and carbon monoxide levels in exhaled air; regular audit of compliance with elimination measures, basic therapy, and inhalation techniques; smoking cessation; and consideration of comorbidities.

In clinical practice, asthma and chronic obstructive pulmonary disease (COPD) are easily distinguishable; however, the asthma-COPD overlap syndrome (OS) in a patient causes both diagnostic and therapeutic challenges. The phenotype of the asthma-COPD OS is characterized by a worse prognosis than that of isolated diseases of asthma or COPD. OS is characterized by a concurrence of eosinophilic and neutrophilic inflammation in the respiratory tract, which is accompanied by obvious obstruction of the distal bronchi and bronchospasm. Patients with OS are a population different from those with asthma or COPD; and the identification of such persons into a special group is justified and appropriate in the context of pathophysiology, clinical presentations, and therapy.

The review evaluates the safety of using inhaled glucocorticosteroids and their combinations with long-acting ß2-adrenomimetics for chronic obstructive pulmonary disease.

The paper presents main areas of pharmacotherapy for atrial fibrillation (AF), such as to reduce the frequency of ventricular contractions and to maintain sinus rhythm. It briefly characterizes the efficacy and safety of antiarrhythmic drugs used to maintain sinus rhythm in patients with AF.

Ultrasound-guided transthoracic aspiration biopsy of the lung is of high diagnostic value; it is associated with the minimal number of complications and presents no radiation hazard to patients and medical staff.

A clinical case of using flupirtine in case of musculo-tonic pain in a patient with dorsopathy. The efficiency of complex treatment using SNEPCO (flupirtine) class of analgesic in a patient with spondylogenic sciatica due to degenerative changes of the spine, concomitant gastropathy, against gastric ulcer in the acute stage

Halitosis is a state reflecting the presence of infectious diseases of the mouth, respiratory and digestive organs. Chronic tonsillitis rates first among the ENT causes of halitosis. The algorithm of actions by an ENT physician when suspecting that a patient has this disease involves the following stages: diagnosis of halitosis (ENT examination, halitometry, and a questionnaire); etiological treatment (systemic and local drug therapy); physiotherapy procedures; individual nonspecific activation of body defenses; psychological assistance; motivation for self-help, and training in its main techniques. A total of 29 patients aged from 20 to 64 years with chronic compensated tonsillitis and halitosis were followed up. To diagnose halitosis, all the patients underwent halitometry using the Breathometer Mint, a compact wireless device synchronized with a smartphone via Bluetooth Mint, which measures the amount of volatile sulfur compounds (VSCs) produced by the oral anaerobic bacteria as part per billion (ppb). All the examinees had moderate halitosis and, according to halitometric data, were in zones B and C (92-156 and 157-275 ppb of VSCs, respectively). All the patients agreed to receive a long therapy cycle: mechanical cleansing of the tonsils (a washing cycle of the lacunae of the tonsils); drug treatment with deodorizing agents and oral antiseptics; cryotherapy in patients receiving adaptogens. This scheme has shown its effectiveness in most patients.

Androgenetic alopecia (AGA) in women is a common multifactorial disease that is resistant to therapy in most cases. Carbohydrate and lipid metabolic abnormalities are noted in women with AGA in most cases. The use of metformin in the combination treatment of AGA has a positive effect.

The study has solved the following tasks: to optimize pharmacotherapy in patients with stable angina and to compare the efficiency of standard therapy for coronary heart disease (CHD) with bisoprolol, valsartan, aspirin, and rosuvastatin and its concurrence with isosorbide dinitrate and nicorandil. Standard therapy for CHD is highly effective in treating patients with stable angina and the addition of nicorandil provides more pronounced and significant anti-anginal, endothelioprotective, and anti-atherosclerotic effects.

The paper considers the problems in the accreditation of phthisiatricians when continuing medical education is introduced. It propose to accelerate the adoption of a professional standard for phthisiology and, with its consideration, to coordinate the elaboration of training modules for dis-tance learning, and to expand the range of forms of loan development by phthisiatricians.