Therapy

Sleep disorder is one of the common complaints of patients with chronic obstructive pulmonary disease (COPD). Sleep in patients with COPD can be accompanied by desaturation, which subjectively and objectively worsens its quality.

The aim: to identify and characterize sleep phenotypes in patients with COPD.

Material and methods. 60 male individuals (mean age 65.6 ± 8.3 years) with COPD outside of exacerbation were included in the study. All patients completed CAT (COPD Assessment Test) questionnaire to assess the severity of COPD symptoms, modified Medical Research Council Dyspnea Scale (mMRC) in points to determine the intensity of dyspnea, HADS (Hospital Anxiety and Depression Scale), Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index (PSQI). In addition, spirometry and nocturnal monitoring pulse oximetry by a portable oximeter with a finger sensor were performed. Patients who reported a history of snoring and/or who had a sawtooth pattern of the saturation curve according to the results of night monitoring pulse oximetry were referred to an in-depth sleep study followed by a consultation with somnologist.

Results. According to the results of the studies, patients with COPD were divided into three sleep phenotypes: COPD + obstructive sleep apnea syndrome (OSAS) (n = 7); COPD with nocturnal desaturation (n = 25); COPD without nocturnal desaturation (n = 28). COPD + OSAS phenotype, comparatively with the other two, was characterized by a significantly higher body mass index, greater sleepiness according to the Epworth scale, and more pronounced COPD symptoms according to CAT. Phenotypes with and without nocturnal desaturation did not have significant differences in forced expiratory volume in 1 second and body mass index, but daytime and minimum saturation values differed significantly. In terms of sleep quality according to the PSQI, no significant differences were obtained between the different phenotypes.

Conclusion. Identification and characterization of sleep phenotypes in COPD facilitates their early detection and personalized approach to treatment.

Arterial hypertension (AH) is one of the most common diseases of cardiovascular system. AH can be both a cause of chronic kidney disease (CKD) and its consequence. Screening for early stages of CKD among patients with arterial hypertension will not only slow down the rate of decline in kidney function and delay the onset of renal replacement therapy, but also reduce cardiorenal risk and preventable cardiovascular mortality.

The aim: to determine the frequency of CKD detection among patients with arterial hypertension observed in a large medical organization in Omsk, to identify areas of ineffectiveness in CKD diagnosis by local doctors.

Material and methods. A one-time retrospective study was performed. It included 90 patients over 18 years of age with proven diagnosis of arterial hypertension who visited the clinic from January 2022 to December 2023. The presence of data in the outpatient card that are markers of CKD was assessed. Glomerular filtration rate was calculated using the 2021 CKD-EPI formula.

Results. CKD was diagnosed in 27% of patients with AH, stage 3 CKD was the most common (54%). However, a higher actual incidence of CKD could be assumed, since in 19% of study participants this disease could not be reliably confirmed or excluded due to the lack of sufficient information on CKD markers in outpatient records (urine test results, creatinine measurement results, kidney imaging). In most cases (70%), local physicians did not calculate the glomerular filtration rate based on creatinine, especially if the creatinine level was within reference values (up to 115 μmol/l). Other areas of ineffectiveness in CKD diagnosing by local physicians were also identified.

Conclusion. The incidence of CKD among AH patients observed in primary care institutions is at least 27%. Despite the fixed criteria and algorithms for CKD diagnosing, it causes difficulties for physicians of primary care institutions.

Extrahepatic complications of liver cirrhosis (LC) are beyond the manifestations of liver failure and understanding of direct classical complications of portal hypertension. Lung damage was one of the first described LC-associated diseases. However, over the years, interest in pulmonary complications of liver diseases has faded, in contrast to other manifestations of LC decompensation. Despite the fact that hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax affect up to 10–15% of patients with progressive liver diseases and have proven prognostic value, doctors often make mistakes in diagnosing these complications and choosing treatment tactics for these conditions. This may lead to their delayed referral to specialized centers, increased mortality, and decreased chances for successful liver transplantation. The aim of the article: to increase awareness of physicians concerning pulmonary complications of chronic liver diseases by providing a brief overview of each of these complications.

Cardiovascular pathology is a frequent comorbid condition in case of bronchial asthma (BA) presence. BA exacerbations and uncontrolled use of short-acting bronchodilators (SABA) increase cardiorespiratory risk. The use of a combination of inhaled glucocorticosteroids (ICS) / long-acting β₂-agonists or ICS/SABA instead of SABA as symptomatic therapy for bronchial asthma reduces the risk of exacerbation of cardiovascular diseases. The use of ICS/SABA becomes more justified in the presence of the Arg16Gly allele of the ADRB2 receptor gene, which suggests a better response to SABA comparatively to long-acting β₂-agonists.

Langerhans cell histiocytosis (LCH) is a rare disease. In 50–60% of cases, only lungs are affected. The age of patients with this disease varies from 20 to 40 years. The article presents a clinical case of a 28-year-old patient with a smoking history of 36.5 packs/years, who developed chest pain and discomfort, shortness of breath, heaviness in the back, and a dry cough before admission to the hospital. Computed tomography of chest organs described nodules up to 2 cm in diameter and cystic thin-walled cavities in the upper and middle lobes of the lungs. Over two years, the patient had three spontaneous pneumothoraces. Computed tomography scan of the lungs revealed congenital familial bullous pulmonary disease, serum alpha-1 antitrypsin level was 1.67 g/l. Videothoracoscopic lung biopsy histologically let to reveale macrophage and giant cell pleurisy. A repeat examination of the same biopsy revealed LCH with immunohistochemical confirmation. The patient was diagnosed with LCH three years after the first episode of spontaneous pneumothorax.

A clinical case of acutely developed false left ventricle (LV) aneurysm in the area of a true aneurysm of the cardiac apex in an elderly polymorbid patient with repeated myocardial infarction, previously stented, having angiographic signs of occlusion of the anterior interventricular artery and critical stenosis of two more arterial branches is presented. Initial clinical manifestations of pseudoaneurysm include cerebrovascular accident of cardioembolic genesis, recurrent pain syndrome, rapid decrease of the left ventricular ejection fraction, and a multiple increase in the level of C-reactive protein. Typical for a false aneurysm blood flow in the cavity, was quickly limited by the formation of thrombotic masses with simultaneous stabilization of the condition and improvement of echocardiographic hemodynamic parameters. After rehabilitation stage, the patient maintains physical and age-appropriate intellectual activity for more than a year.

The article is devoted to the analysis of modern methods of diagnosis and therapy of acute bronchitis (AB). Many practicing physicians mistakenly understand AB as an intermediate condition between acute respiratory viral infection and pneumonia, so differential diagnostics of this disease is extremely important for choosing the right treatment tactics. Mostly often, AB is caused by viral agents, however, according to some studies, in Russia in 85.7% of cases antibiotics are prescribed for its treatment, which is associated with general stereotypes in curation or with a lack of understanding by doctors the etiology of AB. Prescribing antibiotics for AB for the purpose of preventing bacterial complications is questionable, since the efficacy of such kind of approach does not have a serious evidentiary base. The article considers modern approaches to the selection of antitussive remedies and mucolytics, analyzes data on the efficacy of essential drugs belonging to the specified pharmacotherapeutic groups.

Bacterial external otitis is a disease with which patients often apply to otolaryngologist, therapist, and general practitioner. In recent years, in the presence of growing polyresistant strains of microorganisms, a reasonable limitation of the systemic use of antibiotics and their possible replacement by local treatment remedies is appreciated. Current article discusses the possibility of combined use of topical drugs having antibacterial, anti-inflammatory and analgesic effects in order to quickly relieve the main symptoms of that disease. Basing on the analysis of literary data, it was concluded that ear drops containing neomycin, polymyxin B and lidocaine are effective in the treatment of acute and chronic forms of external bacterial otitis, including those caused by Pseudomonas aeruginosa, are able to quickly relieve pain and other signs of inflammation, significantly improving general well-being of the patient without the need for additional use of anti-inflammatory and analgesic drugs.

The article considers the main aspects of diagnostics and treatment of insomnia, relevant for practicing physicians. Insomnia, being one of the most common sleep disorders, significantly affects life quality of patients with diseases of internal organs, many manifestations of which in themselves contribute to the chronification and aggravation of insomnia disorder, forming a vicious circle. Important aspects of managing patients with insomnia are timely diagnostics, correction of behavioral factors, and use of affordable and safe sleeping remedies. These measures help prevent the transformation of acute insomnia into a chronic form and improve the prognosis for life quality of patients having therapeutic pathology.

Treatment of patients with acute rhinosinusitis (ARS) involves direct action on the causative agent and elimination of the product of inflammation of the mucous membrane. It was previously found that antibiotic therapy in Russia is prescribed by 62% of doctors at the initial visit of patients with ARS, mostly often for a 7-day course (52.48% of cases). Considering that the treatment of ARS should be comprehensive, the purpose of the presented study was to analyze the prescription of different groups of drugs for symptomatic and pathogenetic treatment in adult patients with that kind of disease.

Material and methods. According to the sociological online survey of 627 otolaryngologists via e-mail (using the author’s technology), the prescriptions of different groups of drugs in real clinical practice for ARS were studied.

Results and conclusion. Topical glucocorticosteroids are prescribed by 83.99% of otolaryngologists. Of these, mometasone furoate is prescribed by 67.68% of them, the rest – other drugs of this class that are not indicated in the instructions for ARS treatment. Mucolytics are recommended by 92% of doctors, more often at the first appointment (in 60.83% of cases), mainly for 7–10 days. The most popular drug of this group is Sinupret^®, which specialists prescribe in 66.03% of cases. Irrigation of the nasal cavity with various solutions is recommended by 85.64% of otolaryngologists, 83.2% of doctors perform this manipulation by themselves during an appointment, in 80.65% of cases using a saline solution. The method of questioning doctors makes it possible to assess the real situation in the treatment of patients and develop measures to improve the efficacy of medical care.