Volume 28, Nº 10 (2021)

Cough remains perhaps the most common symptom in the clinical presentation of internal diseases. The article provides information on the epidemiologY., classification of cough according to the duration of the symptom, diagnosis and treatment. Cough assessment is challenging not only for primary care physicians, but also for pulmonologists, allergists and otolaryngologists. Algorithms for examining patients are described. An organized approach, which begins with classification, turns out to be globally high-demand and effective when carrying out a complex of diagnostic studies in a coughing patient.

The National Consensus 2020 «Features of management of comorbid patients during the pandemic of the new coronavirus infection (COVID-19)» notes that the problem of managing comorbid patients in a pandemic requires an integrated approach aimed at optimal management of comorbid conditions both in patients who are in self-isolation with forced restrictions on visits to medical institutions, and in patients with COVID-19. The global clinical experience in the management of comorbid patients with a new coronavirus infection gained over the past year makes it possible to highlight a number of other pressing problems. This review addresses the issues of specific and non-specific prevention of COVID-19 using vitamin and mineral complexes, probiotics and rebamipide.

Oscillating positive expiratory pressure (OPEP) breathing exerciser trainers are portable medical devices for non-drug therapy that enhance mobilization and improve drainage of sputum and mucus from the airways of hypersecreting patients. In most respiratory diseases, especially those accompanied by hypersecretion, drainage and secret expectoration significantly improve pulmonary mechanics and gas exchange, reduce the severity of dyspnea, reduce the number of repeated exacerbations and hospitalizations, and improve the quality of life. We analyzed the available OPEP devices for their effectiveness, cost-effectiveness and benefit for patients based on available clinical studies and formulated proposals for the inclusion of some OPEP devices in airway clearance therapy regimens for patients with respiratory diseases.

A review of modern generalizing data considering the principles and tactics of perioperative antibiotic prophylaxis in elective surgery is presented. Analysis of the literature indicates that perioperative antibiotic prophylaxis is one of the proven ways to prevent surgical site infection and is an integral part of the concept of «Fast Track surgery», which is a set of principles aimed at accelerating various stages of the treatment process. Otorhinolaryngological surgeries require adherence to the established principles of perioperative antibiotic prophylaxis; however, it is necessary to take into account the features of the microbiota of the ENT organs, which affects the choice of the optimal prophylactic antibiotic. It is not possible to assess the state of the issue of antibiotic prophylaxis in surgical otorhinolaryngology and its compliance with international recommendations based on literature data due to the small number of studies with a sufficient level of evidence.

The use of anticytokine drugs for the reversible blocking of an overproduction of certain cytokines is a highly promising direction in medicine. In particular, the use of targeted therapy for inflammatory dermatoses requiring systemic treatment is also in this direction. At the same time, the immunological features of the course of inflammatory dermatoses in HIV-infected patients remain a poorly studied issue. The review article analyzes the identified immunological features in patients with inflammatory dermatoses (psoriasis, atopic dermatitis, seborrheic dermatitis) with HIV infection, describes possible common points of application of modern biological drugs aimed at treating inflammatory dermatoses, taking into account the possible impact on the course of HIV infection. In addition, the authors ask about the effect of the ongoing anticytokine therapy of autoimmune dermatoses in HIV-infected patients on a possible change in the sensitivity and effectiveness of antiretroviral therapy in this category of patients. It is known that from 5 to 30% of HIV-infected patients practically do not respond to antiretroviral therapy. As an example of the effectiveness of the treatment of inflammatory dermatoses, the experience of using interleukin blockers in a limited number of foreign publications is presented.

Background. Despite significant progress in studying the pathogenesis of bronchial asthma (BA), the emergence of knowledge about the disease phenotypes and the development of new pharmacological drugs with the formation of a personalized approach to the therapY., there is a steady trend towards an increase in patients with an uncontrolled course of the disease. According to the guidelines (GINA 2019), in order to achieve control in patients with moderate and severe asthma in the absence of effectiveness of medium-to-high dose of inhaled glucocorticosteroids (IGCS) in combination with long-acting ß2-agonists and/or antileukotriene drugs, the inclusion of genetically engineered anti-IgE drug omalizumab is recommended. Objective. Evaluation of the effectiveness of the use of the genetically engineered drug omalizumab in baseline therapy in children with moderate and severe BA in the city of Astrakhan Methods. The study included 14 patients aged 6 to 17 years (mean age 10.8±2.1 years) with BA who were treated with genetically engineered drug omalizumab in baseline therapy. The study was carried out on the basis of an analysis of medical records and a survey of patients and their parents according to the developed questionnaire. The questionnaire consisted of three blocks of questions. Results. The data obtained indicate that 69.2% of patients achieved stable disease control the in the form of the absence of both nocturnal and daytime asthma attacks (for several months to year), satisfactory exercise tolerance and low demand for short-acting ß2-agonists. In 30.8% of patients, partial disease control was observed, which was expressed in the persistence of mild daytime and nocturnal symptoms 1-2 times per month. The disease control was reflected by indicators of the ACT tesT., which ranged from 18 to 25 points in all patients. Against the background of treatment with omalizumab, a decrease in the volume of baseline anti-inflammatory therapy in the form of a reduction in the dose of IGCS due to long-term drug remission and a high level of disease control was performed in 11 patients (84.6%). The following local and general adverse reactions were noted against the background of use of omalizumab: mild headache and dizziness, mild hyperemia and edema at the injection site. Conclusion. The results of study proved that the use of recombinant humanized monoclonal antibody omalizumab as part of the baseline anti-inflammatory therapy for moderate and severe BA leads to significant decrease in the frequency of exacerbations and the number of emergency calls for medical care, allows to reduce the dose of IGCS, to increase the parameters of pulmonary function, which characterizes achieving asthma control and improving the quality of life of patients.

Background. Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (TB) are socially significant diseases with a high socio-economic burden. The combination of these diseases in one patient increases the likelihood of their mutual complication, which determines the importance of using effective and safe therapy for each of them to improve the results of their treatment. Objective. A comparative analysis of the effectiveness of using tiotropium bromide and olodaterol/tiotropium as supporting therapy for the correction of broncho-obstructive syndrome in patients with TB+COPD comorbid pathology. Methods. A prospective comparative study included 62 patients with TB + COPD aged 18 to 75 years, Me (25; 75) 58.0 (48.0; 65.0) years. 56 (90.3±3.8%) patients were diagnosed with Infiltrative TB, 3 (4.8±2.7%) patients - focal TB, 2 (3.2±2.2%) patients - fibrocavernous TB, and 1 (1.6±1.6%) patient - with disseminated TB. COPD: category B - 41 (66.1±6.0%), C - 6 (9.7±3.8%), D - 15 (24.2±5.4%) patients; there were no category A patients among included in the study. Patients were divided into 2 groups: group 1 (n=31) along with TB chemotherapy received DDAC (tiotropium bromide - Tb in handichaler and respimat) 18 pg/day or 2.5 pg 2 doses once a daY., group 2 (n=31) received LAAC/LABA (tiotropium bromide/olodaterol - Tb/O in the respimat) 2.5/2.5 pg 2 doses once a day. Results. There was a positive trend in the severity of dyspnea, CAT tesT., spirometry indicators in the both observation groups. Against the background of use of each drug, a statistically significant decrease in dyspnea according to the MRC scale was achieved in 3 months; by 1 point on from 3.0 to 2.0 points against the background of LAAC (Tb) (Z=2.19; P=0.000) and LAAC/LABA (Tb/O) (Z=3.92; P=0.000), respectively. The increase in FEV1, 1 l for 3 months of therapy with LAAC (Z=3.81; P=0.000) and LAAC/LABA (Z=4.70; P=0.000) per 300 ml in groups, respectively. According to the CAT tesT., a statistically significant benefit in favor of the combined bronchodilator LAAC/LABA was obtained (in group 1, a decrease to 10 points, in group 2 - to 12 points [Z=2.013; P=0.044]). The efficacy of TB therapY., assessed by smear negative reaction after 6 months of follow-up: 88.2% of cases in group 1 (LAAC) versus 94.1% in group 2 (LAAC/LABA), respectively (x2=2.22; P=0.528), cessation of bacterial excretion: 77.8 and 80.0% in groups 1 and 2, respectively (X2=0.608; P=0.896), and closure of decay cavities: 66.7 and 65% in groups 1 and 2 (x2=0.207; P=0.977) was higher in patients receiving combined bronchodilator therapy with LAAC/ LABA. Conclusion. The use of the Tb/O (Spiolto Respimat) 2.5/2.5, combined LAAC/LABA drug with a long 24-hour action, in the complex therapy of broncho-obstructive syndrome in patients with TB+COPD is effective and reasonable, because allows not only to improve the general condition of patients, but also to increase the effectiveness and reduce the duration of TB treatment by increasing treatment adherence.

Symptomatic therapY., including antipyretics, plays center stage in the treatment of the new coronavirus infection COVID-19. The safest drug is paracetamol, which is included in outpatient treatment regimens for a new coronavirus infection (COVID-19). Paracetamol is considered a well-tolerated drug, however, despite this facT., there is a steady increase in the number of reported cases of paracetamol-induced hepatic intoxication worldwide every year. N-acetylcysteine (NAC) is approved by FDA and therefore recognized by the WHO as an essential drug widely used in the treatment of paracetamol (acetaminophen) overdose.

Acute respiratory viral infections (ARVI) are a large etiologically heterogeneous group of infectious diseases occurring with damage to the upper and lower respiratory tract. The development of the inflammatory process in the mucous membrane of the respiratory tract in ARVI significantly increases the sensitivity of the cough receptors, which decreases when the inflammation is stopped. The new concept of the pathogenesis of cough as a manifestation of hypersensitivity assumes that the basis of treatment is drugs that demonstrate both anti-inflammatory and antitussive properties. As a rule, phytopreparations intended for the treatment of cough have such a combination of effects. These drugs are more effective, they are characterized by prolonged and multidirectional pharmacological action.

Background. Fibrous dysplasia (FD) is a benign medullarY., sporadic fibro-bone lesion of the skeleton, which requires surgical treatment in case of impaired function of neighboring organs or compression of critical structures. Description of the clinical case. Patient K., 59 years old with complaints of impaired nasal breathing, postnasal drip of mucoid discharge into the pharynx and recurrent headache localized in the frontal and parietal regions, was admitted for elective surgical treatment to the Clinical Medical Center of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry. Computed tomography of the head revealed FD with damage to the sphenoid bone, deformity of the sella turcica, and nonspecific inflammatory changes in the sinuses. Anterior rhinoscopy revealed a displacement of the nasal septum to the left by a large fibrous node located in the right half of the nasal cavity and occupying almost all of its space. Results. A transnasal endoscopic approach to the tumor node was performed. The node was fragmented and removed. As a result of the surgerY., no defects in the skull base, orbit and posterior wall of the maxillary sinus were observed. Conclusion. The transnasal endoscopic method of removing solitary nodes in the nasal cavity and paranasal sinuses allows to restore the functions of the ENT organs in a short time and to avoid external incisions typical for open surgery.