Vol 29, No 10 (2022)

The management of patients with acute bronchitis (AB) still presents significant difficulties. The main problems lie in the field of differential diagnosis, the choice of rational drug therapy. The excess of antibiotic therapy is still associated with the diagnosis of AB, and the variety of medicines for the treatment of cough creates difficulties in the choice of antitussive and mucoactive drugs. An indispensable diagnostic component in patients with suspected AB is the exclusion of more serious causes of cough, such as bronchial asthma, exacerbation of chronic obstructive pulmonary disease, heart failure or pneumonia. Exclusion of community-acquired pneumonia seems to be the most important step., and various tools can be useful for this, including assessment of symptoms and physical findings, radiological imaging, laboratory biomarkers (such as C-reactive protein, procalcitonin). At least 90% of AB cases are caused by a viral infection. This means that the vast majority of patients do not need antibiotics. Cough relief seems to be the most important treatment for patients with OB. The course of OB is often accompanied by a productive cough, so the main task is related to the rational choice of drugs to control cough through a change in the volume and properties of bronchial secretions. In real clinical practice, phytopreparations are the most frequently prescribed drugs for acute respiratory viral infections and are used with the same frequency for all types of cough in adults and children. Bronchipret®, which has anti-inflammatory, secretolytic and broncholytic effects, is one of the actively used phytopreparations with proven efficacy.

Background. The pathogenesis of pulmonary fibrosis (both idiopathic and SARS-Cov-2-associated) is based on microdamages of the alveolar epithelium with impaired mechanisms of its regeneration. This leads to pathological re-epithelialization, fibroblast proliferation, and excess synthesis of extracellular matrix. As a result, the normal lung parenchyma is gradually replaced by fibrous tissue [1, 2]. The prevalence of idiopathic pulmonary fibrosis in the Russian Federation is about 8-12 cases per 100,000 population, and the incidence is 4-7 cases per 100,000 population [3]. Pulmonary fibrosis after COVID-19 may affect about a third of patients hospitalized with SARS-COV-2 [4-8]. Pirfenidone and nintedanib are the leading drugs considered as potentially effective in both idiopathic and post-COVID-19 pulmonary fibrosis. Pirfenidone is currently being studied as an antifibrotic agent after COVID-19 in an RCT [8]. However, nintedanib is produced only abroad, and both drugs are quite expensive, and their use may be associated with potential hepatotoxicity, which is especially undesirable, given the fact that liver dysfunction is common in patients infected with SARS-CoV-2 [9, 10]. Under these conditions, the search for new highly effective and safe compounds capable of preventing or resolving the development of pulmonary fibrosis is an urgent task. Thus, the use of hypertonic sodium solution in combination with hyaluronic acid, given its nonspecific antibacterial and antiviral properties, may be promising in the complex treatment of patients with SARS-CoV-2 infection. Objective. Evaluation of the effectiveness of a medical product based on hypertonic sodium chloride (7%) and sodium hyaluronate (0.1%) [Ingasalin® forte] on a model of bleomycin-induced pulmonary fibrosis. Methods. An experimental study was carried out on outbred male rats weighing 180-200 g (n=30). An experimental model of pulmonary fibrosis was created by a single intratracheal administration of bleomycin at a dose of 5 mg/kg [11]. A hypertonic sodium chloride (7%) and sodium hyaluronate (0.1%) [Inagasalin® forte 7%] was administered to animals daily (2 times a day) by inhalation using a Delphinus F1000 compressor nebulizer (Flaem Nuova, Italy) for 28 days. This route of administration corresponds to the route of administration of the test product in humans. Throughout the experiment, body weight was recorded weekly and clinical examination of animals was carried out in an open area. On the 30th day, blood samples were taken from animals of all groups for hematological analysis, followed by euthanasia and autopsy in order to register signs of changes in internal organs. The organs were fixed in 10% buffered formalin for histological examination. Results. It was found that the incidence of interstitial pneumonia was 3.3 times less common, the incidence of desquamative pneumonia was 2.5 less common, and the incidence of pulmonary fibrosis was 8 times less common in the group of therapy with the medical product Ingasalin® forte compared with the group without treatment. Conclusion. The medical product Ingasalin® forte minimizes the severity of interstitial-desquamative and fibrotic changes in the lungs, it can be recommended for further study as a mean for prevention and treatment of pulmonary fibrosis.

Background. The development of new laboratory methods for the diagnosis of HIV infection and the assessment of the dynamics of the disease is relevant. Objective. The purpose of the study is a comprehensive analysis of the processes of lipid peroxidation, the state of the antioxidant system and the content of medium-weight molecules in blood plasma (SMP) in HIV-infected people. Methods. 76 respondents participated in the study (18 HIV-positive women and 58 men aged 16 to 43 years). Antiretroviral therapy of patients consisted of immunocorrection and detoxification. To determine the processes of POL and total antioxidant activity (AOA) in blood plasma, the method of determining the antioxidant parameters of blood (Chevari S. et al.) and thiobarbituric acid (Ushiama M. et al.). Results. When studying the parameters of the oxidative status in HIV-infected, changes in indicators were revealed. At the onset of the disease, when the first symptoms appear in HIV-infected people, the parameters of peroxidation increase, reaching maximum values during the onset of opportunistic infections due to severe immune deficiency in AIDS. Conclusion. Unidirectional changes in the content of SMP were revealed in patients with HIV infection in stage III-IV. At the same time, there is a significant decrease in the total antioxidant activity of the final POL products due to accumulation in blood plasma. During the therapy, a positive dynamics of changes in the free radical status was revealed, which, nevertheless, does not lead to the restoration of the body’s systems. To assess the severity of endogenous intoxication, we recommend the proposed research methods.

Background. The article deals with the urgent medical and social problem of preserving the health of young and working-age people against the backdrop of a high prevalence of modifiable risk factors (RF) for chronic non-communicable diseases (CNCD) due to low adherence to a healthy lifestyle (HLS) and the lack of proper effectiveness of state preventive programs. Objective. Analysis of the dynamics of the prevalence of RF for CNCD in patients examined at the Regional Health Center (2010-2022) and development of the universal algorithms for prenosological screening diagnostics (questionnaire self-diagnosis) and preventive counseling (non-drug and drug correction of the main RF for CNCD). Methods. The comparative results of the screening assessment of the health status of 1347 people (examined in 2010-2022 at the Regional Health Center, City Polyclinic № 10, Rostov-on-Don), as well as the experience and results of introducing of additional multifactorial questionnaires, including general questions, questions about nutrition (including DEBQ), physical activity (IPAQ-SF test), smoking (Fagerstrom, J. Lagrue, D. Horn tests), mental disorders - assessment of social adaptation (T. Holmes, R. Rhea), the HADS scale, the level of stress according to the Reeder test (and the scale of O.S. Kopina et al., 1989), the severity of autonomic disorders (according to A.M. Wein), sleep disorders (Ya.I. Levin questionnaire, Epworth scale) in the practice of therapist of the Health Center were analyzed. Results. During the 2010-2022 years analyzed, the prevalence of modifiable risk factors for CNCD remains high among people of different ages (including young people) examined in the Health Center: deviations in body mass index (BMI) in 50.6-56.4% (preobesity in 20.6-32.9%, obesity - in 20.6-25.5%), arterial hypertension in 34.7-38.2% (excluding young people under 30); about a quarter of patients have dyslipidemia, hyperglycemia. 66.3% of people do not keep to diet and 33.3% have physical inactivity (IPAQ-SF). Disorders of the autonomic nervous system were detected in 36.4-92% of the patients (according to the A.M. Vein questionnaire - in 76.6%), reduced adaptive reserves (according to R.M. Baevsky and A.P. Berseneva) were detected in 31,1-35.8%, increased stress level - in 35% (according to Holmes-Ray), and in 64.4% (according to Reeder), anxiety - in 45% and depression - in 27.2% (according to the HADS scale), night sleep disturbances - in 52.2% (according to Ya.I. Levin). The number of active smokers has decreased by 7%, but 35% of respondents are exposed to passive smoking. Almost 58% do not visit a doctor for preventive purposes, 82% have never visited a health center before, and 74.5% of respondents have not undergone medical examinations. Detailed author’s algorithms (schemes) of individual preventive counseling (healthy lifestyles, diets, physical activity, consultations and additional examinations with specialized specialists, drugs for drug correction of risk factors for CNCDs), the Internet sources and social networks for group preventive counseling are given. Conclusion. The use of multifactorial questionnaires compiled by the author at medical appointments expands the possibilities of prenosological screening by self-diagnosis to identify additional risk factors in young people and the working population. Structured algorithms for preventive counseling (non-drug and drug correction of the main RF for CNCDs) will accelerate the provision of planned preventive medical care. Working with patients through social networks and the Internet contributes to raising the awareness of the population about Health Centers and the formation of adherence to a healthy lifestyle.

Background. Systemic inflammation is an important indicator of the immune response in chronic diseases. At the same time, it can act as a link between the mutual influence of various diseases among themselves. A convenient, simple indicator of the activity of systemic inflammation is the proportions of blood cells in a complete blood count. Evaluation of the indicators allows to estimate the intensity of inflammation and the mutual influence of chronic diseases. Objective. Evaluation of the role of systemic inflammation in the combination of HIV infection and psoriasis before and after the use of genetically engineered biological therapy (GIBT) and antiretroviral therapy (ART). Methods. 30 patients (10 patients with HIV infection+ psoriasis, 10 HIV-infected patients and 10 patients with psoriasis) were examined at the Infectious Clinical Hospital № 2 of the Moscow Healthcare Department, Polyclinic № 1 of the Administrative Department of the President of the Russian Federation and Pirogov Russian Gerontological Research and Clinical Center. PASI values in all patients corresponded to the moderate and severe dermatosis. HIV-infected patients began to receive ART, patients with psoriasis additionally received GIBT. PLR and NLR parameters were assessed in all patients; in HIV-infected patients, the viral load and the number of CD4+ lymphocytes were assessed before the start of treatment and 8 weeks after in dynamics. Results. Over 8 weeks, in HIV-infected patients with psoriasis the median PLR values shifted from 496.5 to 225.3 (P<0.05), in HIV-infected patients without psoriasis - from 406.3 to 348.6, respectively (P≤0.1). Median NLR values at week 0 in patients with HIV-infection + psoriasis was 2.3, at week 8 - 1.5; in the HIV-infected group - 2.2 and 1.5, respectively. Viral load of HIV RNA copies (log10) in patients with HIV+ psoriasis at week 0 was 5.8±1.6, and decreased to 3.1±0.7 at week 8 (P<0.05); in HIV-infected patients without psoriasis at week 0 - 5.7±1.1, and at week 8 - 4.2±0.9. The number of CD4+ cells/ml in partients with HIV+psoriasis was 307.5±12.7 and 336.3±14.2, respectively (P<0.05), in HIV-infected patients - 298.2±13.2 and 312.6±10.7. The Psoriasis Severity Scale in HIV-infected patients with psoriasis before treatment was 18.7±4.2, after 8 weeks - 5.3±2.1. Initially, joint pain according to the VAS was 71.2±6.3 points, after 8 weeks - 9.7±4.7. Conclusion. Systemic inflammation indicators, PLR and NLR, are directly related to PASI values in HIV-infected patients with psoriasis. A higher viral load and a decrease in the number of CD4+ lymphocytes correspond to increased PLR and NLR values. The combination of an IL-17 inhibitor (netakimab) and ART has a beneficial effect on indicators of systemic inflammation in HIV-infected patients with psoriasis.

Background. The article is devoted to the problem of finding effective ways to optimize online study modes and e-learning in medical education. Objective. Identification of the features of adaptation of medical students to the online education during the COVID-19 pandemic. Methods. The study was conducted online in 2021, and included 600 junior and senior students who studied at modern medical universities. As a diagnostic tool, three methods focused on assessing the degree of neuropsychic stress of students in a situation of changed conditions for their educational activities and life in general, as well as identifying the characteristics of their reactions to such situations were chosen. Results. Based on the results of the study, it was concluded that in a situation of forced transition of higher medical education to online study modes, it is necessary to organize special classes to help students adapt to the new conditions of their educational activities. Conclusion. The main directions of such work should be not only teaching the methods of self-regulation of the emotional state and activity, but also the formation of the need for self-education and self-development.

The article reflects data on the etiology and pathogenesis of Kaposi’s varicelliform eruption (KVE), its clinical manifestations, as well as the tactics of managing patients with this pathology. KVE is most often a manifestation of a disseminated herpesvirus infection that develops exclusively against the background of chronic dermatoses, among which atopic dermatitis plays a leading role. In the pathogenesis of KVE against the background of atopic dermatitis, a combination of damage to the skin barrier and immune pathology play an important role that serves as the main predictor of the development of severe forms of herpesvirus infection in this category of patients. The article also describes treatment options for KVE patients.

Background. In recent years, there has been an understanding that atopic dermatitis (AD) and atopic bronchial asthma (BA) in childhood are diseases associated with T2 inflammation, which determines the development and introduction of pharmacological agents for biological therapy with monoclonal antibodies into clinical practice. However, this therapy is not always successful, which prompts the search for other methods of treatment to control allergic diseases. Description of the clinical case. This article presents a clinical case of the course and treatment options for BA combined with other intercurrent diseases and comorbid conditions. A clinical example of dermatorespiratory syndrome of atopic genesis in a 13-year-old patient is discussed, variants of basic therapy in the context of clinical response are presented, and algorithms for the clinical search for possible causes and conditions that impede the achievement of control over the course of a severe BA in combination with AD are demonstrated. The development of a side effect with the use of dupilumab, which led to the withdrawal of the drug, is described. Conclusion. Despite the developed therapy algorithms, the treatment of combined allergic pathology remains a challenge that requires an individual approach. The issue of prescribing immunobiological therapy for patients with a severe therapy-resistant course of the disease should be raised in a timely manner; however, it is necessary to take into account comorbid conditions and the possibility of adverse side effects that serve as an obstacle to targeted therapy. Thus, the therapy of BA and AD will remain complex and strictly personalized task.