Том 29, № 5 (2022)

The prevalence of allergic rhinitis (AR) in Russia is about 24%. In addition to nasal and ocular symptoms, patients note a significant impact on performance capability and quality of life. Modern diagnosis of seasonal AR includes skin tests, determination of specific IgE antibodies, nasal provocation test with allergens and requires the participation of an allergist. Pharmacotherapy allows to achieve symptom control and improve the quality of life, the key role is played by intranasal glucocorticosteroids.

Background. According to current data, the development of endothelial dysfunction (ED) is one of the leading causes that determine the severity of the course and prognosis in patients with COVID-19. To date, there are several different biomarkers can be used in clinical practice to assess ED. One such marker is proadrenomedullin (pro-ADM). Objective. Evaluation of the dynamics of pro-ADM levels in patients with COVID-19 infection and determination of the correlation of pro-ADM level with the severity of the condition, as well as with other clinical diagnostic indicators. Methods. A prospective, single-center study included 140 consecutive patients over 18 years of age hospitalized with a diagnosis of novel coronavirus infection. Upon admission to the hospital, the MR-proADM level was determined on the 1st and 3rd days of hospitalization by enzyme immunoassay in addition to standard clinical and laboratory parameters in all patients. Results. Depending on the outcome of the disease, all patients included in the study were divided into two groups: those discharged with recovery or improvement (n=110) and those who died during their stay in the hospital (n=30). The deceased patients had a statistically significantly older age - 76 (63-93) years compared to 66 (62-67) years (P<0.0001), a higher NEWS score of 5 (3-8) points compared to 2 (0-6) points (P<0.0001), more severe lung damage according to computed tomography (CT) - grade 3 (2-4) compared to CT-1 (1-3) grade (P< 0.0001), a longer hospital stay of 17 (7-35) versus 6 (3-14) bed days (P<0.05), and a higher pro-ADM level of 1855.2 pmol/mL (1078.42596.5) compared to 270.7 (155.06-427.1) pmol/mL (P<0.0001). The correlation coefficient between the pro-ADM level and the severity of lung damage was rs=0.7 (P<0.0001). The correlation coefficient between the pro-ADM level and the NEWS score was rs=0.6 (P<0.0001). Conclusions. The pro-ADM level directly depends on the severity of the patient’s condition with COVID-19. High pro-ADM levels were characteristic of patients with more extensive lung tissue damage, as well as patients with higher NEWS scores, indicating a more severe ED, which determined the overall risk and prognosis of such patients.

Background. The article reflects modern ideas about the course of lipid peroxidation processes in bronchitis in children. Much attention is paid to such markers of peroxide homeostasis as malondialdehyde (MDA) and antioxidant activity (AOA). The experience of using natural metabolites of the Krebs cycle to correct peroxide homeostasis is summarized. The data of authors’ own research on the use of dietary supplements based on salts of succinic and fumaric acids as antioxidants in the complex therapy of respiratory pathology in children are presented. Objective. Identification of the features of the dynamics of the MDA and AOA levels in children with bronchitis as a result of various lines of therapy. Methods. The study involved 52 children aged 7 to 14 years who underwent inpatient treatment at the Clinic of the Kazan Medical University. Children were divided into two groups. First group included 29 children who received the traditional regimen of therapy. The second group consisted of 23 children whose treatment was supplemented with potassium fumarate. Results. It has been shown that in the acute period of the disease, disadaptation processes characterized by a significant decrease in the AOA level and an increase in MDA level are developing. It was noted that by the time of clinical recovery, there was no significant normalization of the level of these indicators against the background of traditional therapy. The inclusion of potassium fumarate as an antioxidant in the complex therapy managed to significantly reduce the MDA level and increase the AOA level. Conclusion. Potassium fumarate was well tolerated without side and allergic reactions. The authors substantiate the possibility of using potassium fumarate in children with bronchitis for normalizing peroxide homeostasis. The inclusion of agents with antioxidant properties in the complex of pathogenetic correction of bronchopulmonary pathology in children, according to the authors, will optimize the tactics of managing patients with this pathology both at the outpatient and inpatient stages of treatment.

Background. There are known adverse effects of anti-tuberculosis drugs (ATDs) that can limit the effectiveness of treatment: nephrotoxicity of aminoglycosides, cardiotoxicity of fluoroquinolones, gastrointestinal toxicity of ethionamide or para-aminosalicylic acid, toxicity of cycloserine in relation to the central nervous system. Meanwhile, the increase in the number of cases of multidrug-resistant tuberculosis (MDR-TB) is the basis for the search for new ATDs that are safe for long-term use in the context of MDR-TB therapy. Objective. Evaluation of subchronic toxicity of thiozonide, a new domestic anti-tuberculosis drug from the group of diarylquinolines. Methods. The subchronic toxicity of two forms of the thiozonide (P1 and P2 - different pairs of stereoisomers) was studied in an experiment on dogs for 3 months. Animals received doses ranging from human therapeutic dose (HTD) equivalent up to 10-times-equivalent-HTD (10 HTD). Results. The drug in the studied doses did not cause significant changes in appearance, behavioral reactions, and food and water consumption. There were no changes in the cellular composition of peripheral blood, hemostasis indicators. There were a transient elevated liver transaminase levels in the serum of animals receiving 10 HTD, a decrease in the of serum proteins levels in the same groups. Histological changes were insignificant and reversible. Conclusion. Thus, the new anti-tuberculosis drug thiozonide does not have toxic properties limiting its long-term use, that suggests the prospect of using this drug for long-term treatment of tuberculosis.

Background. Professional burnout (PB) is usually defined as a syndrome of emotional exhaustion, depersonalization and personal derealization, which can manifest itself in many professions, but primarily in helping ones. It is common knowledge that caregivers are among the professionals most at risk of burnout and psychological vulnerability. During the COVID-19 pandemic, the mental health of healthcare workers has been exposed to various risk factors. Recent studies have found high PB rates among medical staff working with patients with novel coronavirus infection. Objective. Assessment and analysis of the levels of the components of the burnout syndrome among medical workers. Methods. To assess and analyze the levels of components of the PB syndrome, a Maslach Burnout survey was conducted among medical workers in COVID hospitals (n=201); outpatient medical workers (n=186); medical workers of multidisciplinary hospitals (n=195), as well as the control group (n=190). Results. Qualitative analysis using the Maslach Burnout Inventory (MBI) found that 11 (5.5%) medical workers in COVID hospitals had extremely high levels of PB. This is significantly higher than that of 1 (0.5%) medical worker of the outpatient clinics (pa-c=0.012). Medical workers of multidisciplinary hospitals did not have an extremely high level of burnout. The frequency of occurrence of a high level of burnout is significantly higher among medical workers in COVID hospitals compared with medical workers in multidisciplinary hospitals (pa-b=0.014), but there were no significant differences compared with outpatient medical workers (pa-c=0.202). The frequency of occurrence of the moderate level of burnout was significantly higher among medical workers in COVID hospitals compared with medical workers in multidisciplinary hospitals (pa-b=0.004), but there were no significant differences compared with outpatient medical workers (pa-c=0.161). It was found that the incidence of low burnout was significantly lower among medical workers in COVID hospitals compared with medical workers in multidisciplinary hospitals (pa-b=0.017), but there were no significant differences compared to medical workers in outpatient clinics (pa-c=0.096). The frequency of occurrence of an extremely low level of burnout among medical workers in multidisciplinary hospitals was significantly higher compared with medical workers in outpatient clinics (pb-c=0.045). Among medical workers, COVID hospitals, no person with an extremely low level of burnout was registered. Conclusion. Medical workers in COVID hospitals were the most susceptible to PB syndrome: 22.4% of medical workers in COVID hospitals had high and extremely high levels of burnout, 41.3% had a moderate level, and only 36.3% had a low level of burnout. Among outpatient healthcare workers, 12.3% had high and extremely high levels of burnout, 33.9% had a moderate level, and 53.8% - low and extremely low levels of burnout. Among medical workers in multidisciplinary hospitals, 8.2% had a high level of burnout, 27.2% -a moderate level, and 64.6% of medical workers - low and extremely low levels of burnout.

Background. The importance of timely diagnosis of new-onset pulmonary tuberculosis (TB) in modern clinical practice is beyond doubt. Chronic obstructive pulmonary disease (COPD) and stable coronary artery disease (CAD, angina pectoris) mutually aggravate each other and worsen the patient’s condition, negatively affecting the prognosis. Description of the clinical case. The objective of the analysis of this clinical case included evaluation of the features of clinical manifestations, diagnostic tests and therapy in a patient with new-onset pulmonary TB and comorbid pulmonary-cardiac pathology: COPD and stable coronary artery disease (angina pectoris). In this clinical case, the patient had a combination of COPD and stable coronary artery disease (angina pectoris), and was also diagnosed with new-onset TB. The patient had general symptoms characteristic of TB, COPD and stable coronary artery disease (angina pectoris), characteristic changes in the results of laboratory and instrumental diagnostic methods. Treatment of new-onset TB was conducted according to regimen I at the settings of Clinical TB Dispensary. The patient took combined bronchodilator drugs: LAMA + LABA (tiotropium bromide/olodaterol); anti-ischemic therapy: non- dihydropyridine calcium antagonists (NDCA, verapamil) and trimetazidine. Conclusion. Against the background of anti-ischemic therapy with the use of NDCA and a myocardial cytoprotector (trimetazidine), the minimization of attacks of retrosternal pain with a sufficient rhythm-reducing effect was achieved.