Volume 27, Nº 10 (2020)

Pneumonia remains a serious public health problem due to unacceptably high morbidity and mortality. Among the issues that need to be addressed, one should first of all include difficulties in establishing the initial clinical diagnosis of pneumonia, stratification of the risk of an unfavorable outcome of the disease, optimization of the choice of empirical antibiotic therapy, the relative shortage of new antibiotics, and the importance of knowing the local characteristics of the microbiological sensitivity of pneumotropic microorganisms. The article discusses the problem of managing adult patients with community-acquired pneumonia (CAP). Information on the epidemiology, diagnosis, stratification of CAP patients according to the risk of an unfavorable outcome of the disease is presented in order to determine patients of this category who could receive outpatient treatment without compromising the ultimate efficacy and safety, as well as antibacterial therapy of CAP patients in outpatient settings, including with the use of new antibiotics.

The purpose of this review is to summarize the global experience in the diagnosis and treatment of the new coronavirus infection COVID-19 in obstetric patients, which can be applied in the practical work of antenatal clinics and maternity hospitals in a pandemic. The current COVID-19 pneumonia pandemic is a serious public health problem, especially for vulnerable populations. Pregnant women and newborns represent a high risk group during outbreaks of infectious diseases. To date, the literature describes the perinatal outcomes of385 pregnant women infected with COVID-19, with no clinical evidence of vertical transmission. The review analyzes published data on the Wuhan coronavirus infectious potential to cause the maternal, fetal and newborn morbidity, and other adverse obstetric outcomes. The controversial issues of the etiotropic treatment of CoV-pneumonia and the existing diagnostic problems are discussed. Particular attention is paid to ensuring safety in obstetric institutions. At present, the most urgent issues include the search for antiviral drugs with the most proven efficacy and safety for the pregnant woman and the fetus, and the validation of vaccines being created.

The continuing increase in the incidence of the new coronavirus infection makes rational therapy for COVID-19 one of the urgent problems of modern medicine. Based on the analysis of modern federal guidelines, the principles of etiotropic and pathogenetic treatment of COVID-19 are considered. The article provides an analytical review of the drugs recommended in the last, eighth version of the temporary Ministry of Health of the Russian Federation guidelines «Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)», dated 03.09.20, and other sources.

Background. In recent years, there has been a significant increase in the incidence of allergic rhinitis (AR). According to official statistics, every third adult Russian suffers from AR, and official statistics do not reflect the real situation. The article presents the experience of using sublingual allergen-specific immunotherapy (SLIT) in patients with perennial and seasonal AR (PAR and SAR) caused by sensitization to pollen allergens and house dust mites in a coronavirus infection (CVI) pandemic. Objective.Evaluation of the efficacy, safety and tolerability of SLIT in AR patients in the COVID-19 pandemic. Methods. 53 patients with AR were examined, including 21 - with PAR and 32 - with SAR. From 2017 to 2020 patients received SLIT with etiotropic allergens. The control of the course of AR in patients was assessed in dynamics according to the frequency and severity of nasal symptoms, taking into account the need for medicines, the visual analogue scale (VAS) score, the need for basic therapy, allergic-immunological parameters (total IgE, asIgE to household and pollen allergens, eosinophilic cationic protein (ECP), diameter of scarification tests with allergens). Results. At the end of the full course of treatment, the clinical efficacy of SLIT with Staloral “Birch pollen allergen”, taking into account excellent and good results, was 95.5%, with Oralair - 100.0%, with Staloral “Mite allergen” - 95.3% . The frequency of exacerbations in patients with PAR decreased by 7 times, in patients with SAR - by 6.2 times. Patients have increased control over the course of AR: the total score of the AR control questionnaire decreased against the background of SLIT by the Staloral «Birch pollen allergen» from 11.0 to 3.3 points, by the drug Oralair - from 10.2 to 4.2 points, by the drug Staloral «Tick allergen» - from 9.1 to 4.0 points; the MS score decreased from 52.1 to 18.1, from 52.0 to 22.2 and from 46.2 to 15.1 points, respectively (p<0.05). Against the background of SLIT in patients with PAR, the total IgE level decreased by 1.9 times, asIgE to household allergens - by 3.4 times (from 4.88 to 1.44 kU/L), the diameter of skin tests - by 1.4 times, ECP - by 2 times (from 32.65 to 16.01 ng/ml; p<0.05). In patients with SAR, the total IgE level decreased by 2.0 times, asIgE to tree allergens - by 3.2 times (from 5.23 to 1.65 kU/L), to cereal grasses - 2.8 times (from 4.64 up to 1.66 kU/L), the diameter of skin tests - by 2.6 times, ECP - by 2.8 times (from 33.98 to 12.11 ng/ml; p<0.05)., Mild adverse events in the form of local reactions were observed in 39.6% of cases. During the CVI pandemic, follow-up of patients was carried out using telemedicine technologies. In only one patient, SLIT was temporarily suspended due to mild COVID-19. Conclusion. SLIT is a safe and high effective method of AR immunotherapy, which can be carried out despite the patient’s self-isolation regimen due to COVID-19 infection.

Background. Leukotrienes (LT) are involved in the pathogenesis of inflammation in bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). LT is a metabolic product of arachidonic acid. There are cystenyl (C4, D4, E4) and dihydroxyl (B4) LT. LT C4, D4, E4 have a powerful bronchoconstrictor effect, LT B4 serves as a chemoattractant for neutrophils. Objective. Comparative assessment of the role of LT in patients with different phenotypes of BA and COPD. Methods. Four groups of patients were examined: 1st (n=57) - patients with allergic BA (ABA), 2nd (n=68) - patients with non-allergic BA (NABA), 3rd (n=43) - patients with aspirin-induced asthma (AIBA), group 4 (n=65) - patients with COPD. Results. A high total LT C4, D4, E4 level was observed in patients with ABA, to a lesser extent in AIBA compared to their values in patients with NABA, COPD and the control group. LT B4 values were significantly increased in patients with AIBA and COPD compared with ABA, NABA and the control group. There was a statistically significant positive correlation of total LT C4, D4, E4 with the blood eosinophil number (r=0.62, p<0.05) and with the eosinophilic type of inflammation (r=0.70, p<0.05). There was a correlation between LT B4 and neutrophils (r=0.52, p<0.05) and neutrophilic type of inflammation (r=0.56, p<0.05). Conclusion. LT plays an important role in the pathogenesis of airway inflammation in BA and COPD. In the pathogenesis of eosinophilic inflammation in ABA, total LT C4, D4, E4 prevail. LT B4 plays a significant role in neutrophilic inflammation in NABA and COPD. AIBA is characterized by a mixed type of inflammation (eosinophilic-neutrophilic), with increased level of both total LT C4, D4, E4, and LT B4. Thus, LT can be considered as markers of types of inflammation. Clarification of the types of inflammation will make it possible to personalize therapy and increase the effectiveness of treatment of patients with BA and COPD.

Background. To date, the practice of clinical observations suggests that chronic bronchopulmonary diseases in children have undergone a significant transformation over the past 10 years. This is attributable to a better understanding of etiopathogenetic mechanisms, improvement of diagnostic methods, transformation of patient therapy using new genetically engineered drugs. Objective. Comparison of the course, the nature of functional changes, and the characteristics of the microbiota of the respiratory tract in children with various forms of chronic lung disease at the present stage. Methods. 98 children were examined during the research period. All patients were divided into two main groups. The first groupwas composed of children with primary chronic lung diseases (n=42): chronic (n=30) and obliterating bronchitis (n=12). The second group included children with lung diseases that developed either against the background of malformations (n=10) or due to a genetic mutation: cystic fibrosis (n=34), immunodeficiencies (n=12). Results. According to the data obtained, exacerbations were diagnosed significantly less frequently in patients of the second group than in the first ones. According to statistical analysis, moderate exacerbations prevailed in children of both subgroups. The main characteristic of the severity of exacerbations is respiratory failure. In patients with mendelian diseases, reactive changes in the pancreas and liver were significantly more likely to occur, while in primary chronic lung diseases, damage to the central nervous system were significantly more frequent. An analysis of the nature of the microbiota and the incidence of chronic carriage of gram-negative microflora revealed the leadership of patients of the second group. Conclusion. Thus, at the present stage, despite the fact that there is a more aggressive character of the microflora of the respiratory tract and a greater decrease in functional indicators in patients with a chronic bronchopulmonary process due to genetic mutations or malformations, the frequency and severity of exacerbations are inferior to those in patients with primary chronic lung diseases.

Background. Bronchial asthma (BA) is one of the most common non-communicable chronic diseases, affecting up to 339 million people worldwide. Asthma is a global health problem, and WHO is coordinating international efforts to control the disease. The pronounced burden of the disease is determined not only by a significant decrease in the quality of life of patients, cases of patient disability, but also by the risk of premature death. To improve the prognosis in BA, it is necessary to adhere to existing guidelines for diagnosis, treatment and prevention, as well as educate patients on how to control the existing disease. That is why it is especially important to conduct research aimed to increasing the practical knowledge of not only doctors, but also future healthcare workers. Objective. Determination of the level of basic knowledge on BA among 5th-6th year students (specialties «General Medicine» and «Pediatrics») of medical universities. Methods. Analysis of an anonymous multicenter questionnaire survey in the framework of the second phase of the ASSA project (Assessment of senior medical students in the field of bronchial asthma), conducted in 2017-2019 in 6 cities of Russia and Ukraine. Results. According to the results of the study, the level of knowledge of senior students in basic issues of etiology, pathogenesis, clinic and treatment of BA is at an above average level. The best results are shown in answers to questions № 2 (BA triggers), № 6 (BA severity) and № 9 (determination of a prolonged asthma attack), the worst - to questions № 1 (BA definition), № 3 (BA pathogenesis) and № 12 (selection of a combination of drugs in one delivery device). Conclusion. The survey showed that senior students have a sufficient knowledge base in the clinical picture and diagnosis of BA, while a number of fundamental issues related to the definition, pathogenesis and treatment of this disease still require more in-depth study.

Persistent eosinophilic inflammation in the mucous membrane of the lower respiratory tract in patients with severe bronchial asthma determines their propensity for an uncontrolled course of the disease against the background of standard pharmacotherapy, and also increases the risk of an unfavorable prognosis, including more frequent and severe exacerbations, emergency care and hospitalizations, the need for high doses inhaled and systemic glucocorticosteroids. Mepolizumab is humanized monoclonal antibody that bind free interleukin-5, as a result of which a pronounced decrease in the number of eosinophils in the blood and respiratory tract is observed. In randomized clinical trials, mepolizumab significantly reduced the frequency of asthma exacerbations and related hospitalizations, reduced the dose of oral glucocorticosteroids, significantly improved the quality of life and control of clinical symptoms, and also improved respiratory function in patients with severe eosinophilic asthma. At the same time, it is difficult to generalize data from controlled studies to the patient population in real life. This review discusses the published results of a number of open-label observational studies on the efficacy and safety of mepolizumab in patients with severe asthma in real clinical practice.