Vol 27, No 5 (2020)

The whole world is experiencing a pandemic of a new coronavirus infection COVID-19 caused by the SARS-CoV-2 virus. Analysis of the SARS-CoV-2 genome showed significant similarity with the previously identified strain of coronavirus, which caused an outbreak of the so-called atypical viral pneumonia or severe acute respiratory syndrome (SARS) in 2003. All age groups are susceptible to the virus, while elderly patients with concomitant diseases are more susceptible to the severe course of the disease. The main clinical manifestations are fever, cough, and asthenia. In some patients, the condition is characterized by dyspnea and hypoxemia, which can quickly (within a week) progress with the development of acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulation function, and multiple organ dysfunction syndrome. It is recommended to perform computed tomography of the chest for all patients to clarify the diagnosis and monitor the development of the disease. Chest X-ray has insufficient information, and therefore its implementation is impractical. In most cases, changes in the lung tissue are characterized by multiple areas of induration of the lung tissue by the type of «frosted glass», and interstitial changes. There are no data on the convincing effectiveness of any antiviral treatment. Currently, in the framework of etiotropic therapy, lopinavir / ritonavir, chloroquine, hydroxychloroquine, and recombinant interferon beta-1b are used. For the timely detection of signs of severe course and complications, constant monitoring of vital signs and laboratory indicators is necessary. The most significant risk factors for severe progressive course and poor outcome are under investigation. This review presents known epidemiological data, features of diagnosis and clinical course, risk factors for poor outcome, the possibility of etiotropic and pathogenetic treatment and prevention.

Community-acquired pneumonia (CAP) remains the one of the leading causes of morbidity and mortality worldwide. In 2019, ATS (American Thoracic Society) and IDSA (Infectious Diseases Society of America) consensus recommendations for the management of adult patients with CAP were published. Previous ATS/IDSA recommendations came out 12 years ago. The article discusses the main provisions of the new revision of the ATS/IDSA consensus recommendations, in some cases - in comparison with the position of Russian specialists. A brief analysis of the new ATS/IDSA-2019 recommendations suggests that the individual provisions contained therein differ only to a minimum extent from those in the 2007 recommendations. So, the key approaches to the diagnosis and treatment of CAP in adults, formulated at the beginning of the XXI century, remain relevant today

The article discusses the problem of allergic rhinitis (AR); its prevalence in different countries of the world is 4-32%, in Russia - 10-24%. Information on the etiology, symptoms, diagnosis and treatment of AR, as well as an algorithm for managing patients with AR depending on the form and severity of the disease is provided. Due to the wide range of drugs used in AR, practicing physician often has a challenge with making rational treatment plan for patients suffering from this disease. The way out of this situation is the appointment of combination drugs widely available on the market. In relation to AR, the combination dimethinden+phenylephrine is such a drug. The use of this combination allows to reduce the duration of the use of second generation antihistamines, prevent exacerbation of AR, reduce the pharmacological burden on the patient and increase his adherence to treatment.

Background. Cicatricial lesions of the vocal folds are one of the most clinically significant among non-life-threatening diseases of the larynx leading to permanent loss of voice. Currently, there is no method to fully restore the normal structure and vibrational characteristics of the vocal folds and, accordingly, the voice function in cicatricial lesions. Objective. The evaluation of morphology of the vocal folds with cicatricial lesions after the introduction of autologous mesenchymal stromal cells (MSCs). Methods. The mature cicatricial process in the vocal folds was chosen as the basis of the experimental model. As laboratory animals, 10 laboratory rabbits were used. They were divided into two groups, and underwent surgical removal of the middle third of the right vocal fold. 90 days after the first surgery, a second intervention was performed: the scar of the vocal fold within the visible borders was excised and saline was injected into the defect in the first experimental group, and suspensions of autologous MSCs from the bone marrow reserve in the second group. In both groups, the evaluation of the results of the experiment was carried out 90 days after the second intervention (180 days from the start of the experiment). Evaluation of the results of the experiment was carried out using optical microscopy of histological preparations with various staining. Results. The study showed a significant regenerative potential of MSCs when they were introduced into the secondary wound of the vocal fold. The most interesting changes were observed in the collagen structures of scar tissue. After cell therapy, scars had a smaller thickness of collagen fibers, their microarchitectonics was represented by a significantly less dense stacking with a longitudinal and mutually parallel orientation compared to the random arrangement of collagen fibrils in scars without the introduction of MSCs. Conclusion. Implantation of MSCs in the wound of the vocal folds after scar removal contributes to their more complete regeneration. MSCs can be considered as a possible source of cell therapy for patients with cicatricial damage to the vocal folds. The reasonability of further research in this direction is justified.

The high incidence of drug-induced diseases (DIDs) and the diversity of their clinical manifestations make this problem relevant for doctors of all specialties. Often, practicing doctors do not recognize adverse drug effects insufficiently, and sometimes they do not recognize them at all. This is due to the fact that very often symptoms of the disease can be easily confused with the side effects of drugs. The article analyzes the data of numerous studies on the problem of DIDs. Information on the prevalence, clinical manifestations, hospitalization statistics, mortality, and material costs associated with the development of DIDs is presented. Early detection and correction of side effects can help reduce morbidity and mortality, so this problem is extremely important.

Allergic rhinitis (AR) is one of the global progressively growing problems of modern medicine. In different regions of the Russian Federation, the prevalence of AR ranges from 12 to 24%. Recent studies have shown an increase in the incidence of AR. Symptoms of rhinitis have a pronounced negative impact on the quality of life of patients. AR is not a mild harmless disease, but a harbinger and predisposing factor in the development of more severe, often disabling diseases. Over the past 4 years, new international guidelines for the diagnosis and treatment of AR have been developed, which have helped to significantly improve the management of patients with this nosology. A new concept of step-by-step therapy of AR based on the control of clinical symptoms of the disease has been created. Currently, over 150 names of antihistamines are registered in Russia. Due to the variety of antihistamines, it is quite difficult to make a choice between them for their most effective and rational use in specific clinical cases. In the treatment of patients with AR, it is necessary to use a personalized approach and select the optimal treatment for each patient based on the manifestations of the pathological process. Following the algorithm of AR therapy, depending on the severity of symptoms, II generation antihistamines should be prescribed as starting therapy to patients with any AR severity. II generation antihistamines used to treat AR are effective, safe and well tolerated.

Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease, and its prevalence is increasing worldwide, both in industrialized and developing countries. The prevalence of COPD is about 5% among the general population, and it is the fourth leading cause of death in the world. COPD is closely associated with cardiovascular diseases (CVDs). About 64% of people with COPD are treated for concomitant cardiovascular disease, and approximately one in three patients with COPD dies as a result of cardiovascular diseases. Currently, therapy with selective β1-blockers is considered safe for patients with CVDs and COPD. Regular administration of selective β1-blockers has a significant impact on the survival of patients with COPD in combination with coronary artery disease and chronic heart failure. Bisoprolol, metoprolol or nebivolol are the most safe drugs. There is no convincing data on the benefits of prescribing ß-blockers for patients with COPD without CVD. For safety reasons, it is necessary to start taking ß-blockers with a small dose outside the period of COPD exacerbation and carefully monitor the possible occurrence of new symptoms (for example, shortness of breath, decreased exercise tolerance, cough) or changes in drug intake (for example, increased need for inhaled ß-agonists). The appointment of adequate bronchodilator therapy (preferably long-acting anticholinergics) when taking ß-blockers is considered to be important.

Background. Pulmonary mycobacteriosis (PMB) is a disease difficult to diagnose and treat, developing mainly in immunocompromised patients with HIV, as well as with a number of concomitant lung diseases, including bronchiectatic disease (BED). Description of the clinical case. A dynamic clinical observation of a young patient with a combination of BED and PMB is presented. The key stages of the diagnostic search and the difficulties of establishing a final diagnosis are described. A prolonged unsuccessful treatment of infiltrative tuberculosis of the left lung with the transition to cirrhotic tuberculosis was followed by surgery in the form of a resection of the left lung and a revision of the final diagnosis in favor of PMB. Moreover, the clinical observation demonstrated the interaction of PMB and BED in the form of an unfavorable comorbid situation in which the progression of both diseases is possible due to the ineffectiveness of the therapy. Conclusion The experience gained from the presented clinical observation can be useful to colleagues in the management of such comorbid patients. In therapeutic practice, patients with BED are quite often followed up by a doctor, but diagnostic search in terms of identifying PMB is carried out in detail in rare cases. At the same time, among patients with the presence of acid-resistant bacteria in the sputum and x-ray changes in the lungs, a diagnosis of tuberculosis is immediately established, which also does not exclude the diagnosis of PMB. The accumulation of experience in the therapeutic strategies for such patients will also be useful for creating an agreed document or recommendations for managing patients with a combination of these diseases.