Vol 7, No 8 (2021)

It is known that some concomitant pathological conditions can affect the course of COVID-19. Purpose of the study: comparison of the clinical course of mild forms of COVID-19 in patients with COPD and in patients without significant comorbid pathology observed on an outpatient basis. Material and methods. The study was conducted in 36 outpatients. 18 patients with concomitant COPD made up the study group and 18 patients were included in the comparison group. The duration of the disease, the maximum body temperature, the total leukocyte level, the ESR level, the level of C-reactive protein, fibrinogen, and the APTT index were studied. Statistical processing was carried out using the JASP program (version 0.14.1.0). Results. Analysis of the duration of the disease showed that in the main group the average number of days of illness (18,4±6,7) was significantly higher than in the comparison group (14,7±2,8; p=0,026). The maximum body temperature in both groups did not differ significantly (p=0,868). A significant difference in the level of leukocytes was found: in the main group it was higher than in patients without comorbid pathology (6,8±1,7x109/L and 5,6±1,6x109/L, respectively; p=0,046). There was no significant difference in the level of C reactive protein (p=0,759), fibrinogen (p=0,681), APTT (p=0,837) and in the level of ESR (p=0,715) between the two groups. Conclusion. A significant increase in the duration of COVID-19 and an increase in the level of leukocytes were found in the group of patients with COPD. For the rest of the clinical and laboratory parameters, there were no significant differences between the main group and the comparison group. significant difference between groups. The mild course of COVID-19 in patients with concomitant COPD, who were observed on an outpatient basis, has features of the course of a viral infection.

Currently, an active search for minimally invasive laboratory markers available for use in routine clinical practice, which have high sensitivity and specificity and are of diagnostic value in bronchoobstructive diseases is carrying out. The aim of the research is to study periostin as an allergic inflammation marker and indicator of the severity of obstructive disorders and their reversibility in patients with bronchial asthma, chronic obstructive pulmonary disease (COPD) and their combination (ACO, from English «asthma-COPD overlap»). Material and methods. The study involved 87 patients who underwent periostin determination by EIA methodic, spirometry, including a bronchodilator test. Statistical processing was carried out by nonparametric methods due to the absence of normal distribution of periostin. Results. The level of periostin in patients with bronchial asthma was higher than in COPD and ACO patients. Among patients with asthma, its higher values were fixed in case of allergic and mixed variant comparatively with the infectious-dependent one. Patients with bronchial asthma and COPD with a burdened allergic anamnesis had an increased periostin comparatively to similar patients without sensitization. Periostin was higher in patients with bronchial asthma exacerbation than in patients in remission. A positive correlation was demonstrated between periostin and an increase in FEV, after bronchodilator test, and a negative correlation - with Gensler index before the test. Conclusion. The value of periostin as a marker of allergic inflammation was shown not only in patients with bronchial asthma, but also in COPD patients. In this regard, it seems promising to use this protein as a predictor of the efficacy of therapy with inhaled GCS in case of COPD. The structural heterogeneity of the periostin molecule requires standardization of the reagents used for its determination and data validation on a large sample size.

The problem of the comorbidity of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (DM) is relevant and till nowadays insufficiently studied. The aim of the study is to establish the leading factors of unfavorable outcome in patients with a combination of COPD and type 2 diabetes according to the results of a 10-year supervision. Material and methods. The study included 167 patients, divided into two observation groups: the first (n=83) consisted of patients with an isolated COPD clinical course, the second (n=84) - of patients with a combination of COPD and type 2 DM. Results. During long-term observation it was found, that the leading cause of death in both observed groups of patients was community-acquired pneumonia, but the number of deaths among comorbid patients was 2.5 times higher than in the isolated course of COPD. In both groups, died patients had significantly higher rates of smoking intensity and BMI comparatively to patients who continued to be observed. The clinical course of COPD in the group of comorbid patients is characterized by more pronounced shortness of breath; this was confirmed by significant bronchial obstruction, frequent (s2 per year) and long-term COPD exacerbations, repeated hospitalizations (including admission to the ICU) comparatively with the isolated course of COPD, which, in turn, is associated with a risk of poor outcome. Among died patients, both with an isolated course of COPD and with its combination with diabetes, there was fixed a high frequency of inhaled GCS use (81 and 90,6%, respectively), while in the groups that continued to be observed, double bronchodilation therapy was mainly used. Conclusion. According to the results of 10-year supervision, it was found that the combined course of COPD and type 2 diabetes increases the risk of an unfavorable outcome. The main causes of death in these patients in the study were community-acquired pneumonia and cardiovascular diseases. The risk factors for death are high smoking index and BMI, frequent exacerbations of COPD and hospitalizations during the year, as well as excessive use of inhaled GCS.

Nowadays, the interaction between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is in no doubt. The aim of the study was to study the parameters of the daily profile of the vascular wall rigidity and assess the interaction with indicators of the functional state of lungs in patients with COPD of varying severity. Material and methods. 96 patients with COPD without concomitant cardiovascular diseases (CVD) at the age of 40-75 years were examined. In accordance with the classification of COPD severity (GOLD 1-4), 4 groups of patients were identified. The participants underwent general clinical examination, spirometry, 24-hour pulse oximetry, and 24-hour measurement of vascular wall stiffness. Results. An increase in the average daily, daytime and nighttime values of aortal pulse wave velocity (PWVao) was revealed with COPD progression: the highest values were observed in the GOLD group 4. The correlation between PWVao and FEV1 (r=-0,454; p <0,001) and SpO2 (r=-0,380; p=0,004) was fixed. The predictive value of FEV1: Wald x2 = 7,195 (p=0,008) and SpO2: Wald x2=5,624 (p =0,01). Average daily and nighttime variability indexes of PWVao (var. PWVao) in the GOLD 4 group were significantly higher than in the GOLD 1 group. The correlation relationship of var. PWVao with fEv1 (r=-0,300; p=0,007) and Evd (r=-0,412; p=0,001) was revealed. Prognostic value of Evd: x2 Wald=7,925 (p=0,006); FEV1: Wald's x2=6,895 (p=0,007); SpO2: Wald x2=4,264 (p=0,02). The study of the circadian rhythm of arterial stiffness (AR) revealed the highest values in the GOLD groups 2 and 4. In the GOLD 2 group, a significant increase in PWVao and its variability during the daytime, augmentation index (Aix), Aix variability (Aix) and arterial stiffness index were revealed (ASI) at night time. In the GOLD 4 group, higher values of PWVao var. were determined during daytime, and Aix and var. Aix at night time. Conclusion. During the study process it was revealed an increase in vascular wall stiffness and AR circadian rhythm disorder as the severity of COPD progressed. Along with the traditional risk factors for PWVao increase (age, BMI, heart rate, SBP and DBP), the influence of the saturation level and FEV1 was revealed. The correlation between var. PWVao and Evd, FEV1 and SpO2 was determined. The results may indicate a negative effect of COPD functional parameters at AR parameters, which may be one of the reasons for the formation of CVD in patients with COPD.

To date, there is no final opinion on the prognostic significance of risk factors in assessing the severity of the prognosis of patients with multifocal atherosclerosis, and there are no reliable tools for its assessment. Aim: to study the effect of atherosclerotic lesions of various vascular regions on long-term outcomes during a 3-year prospective follow-up. Material and methods. The study included 519 patients with lesions of various vascular basins, who were treated in specialized departments, of whom 360 (69,4%) were men, 159 (30,6%) were women. The average age of the examined patients was 60,0±8,7 years. Results. The study demonstrated that as the number of affected vascular pools increased, the likelihood of developing fatal and non-fatal cases of myocardial infarction and fatal cases of heart failure increased. Conclusions. An original model is proposed that can be used to predict the risk of vascular events in the long term.

Cerebral microangiopathy is the most common cause of cognitive impairment in patients with cardiovascular disease. Purpose: to assess the effect of meldonium (Mildronate®) on microcirculation parameters, the degree of cognitive impairment and health status in general therapeutic patients with arterial hypertension (AH) and chronic ischemic diseases of the central nervous and cardiovascular system. Material and methods. The study included 31 patients with AH in combination with chronic cerebral ischemia; 71% of patients suffered from coronary artery disease (angina pectoris 1-2 FC). In addition to standard antihypertensive therapy, 21 patients received Mildronate® (1000 mg/day) for 6 weeks. All patients twice (before the beginning and after 6 weeks of therapy) underwent: capillaroscopy of the bulbar conjunctiva and the limbus of the eye using an ophthalmic capillaroscope «OKO» with the determination of quantitative and qualitative indicators of microcirculation; static perimetry (SP), during which the boundaries of the patient's field of vision and the area of the loss of a part of the field of view (scotomas) were established; assessment of the level of cognitive impairment on the MoCA scale and quality of life using the EQ-5D questionnaire. Results and conclusion. After 6 weeks of therapy with meldonium, a significant improvement in the quantitative indicators of capillaroscopy was noted: an acceleration of the blood flow rate both in arterioles (by 12%) and venules (by 5%). Qualitative characteristics also showed positive dynamics: the severity of erythrocyte sludge (p <0,05), focal stasis (p <0,05), arteriovenous shunts (p <0,05) significantly decreased. The change in microcirculation indices was accompanied by a significant increase in the number of objects perceived by patients during SP from 156 (137; 168) to 163 (148; 178; p <0,05), which indicated an expansion of the visual field during therapy with Mildronate®. According to the MoCA scale and the EQ-5D questionnaire, the patients' cognitive functions and quality of life also significantly improved: the score on the MoCA test increased from 21 (19; 22) to 25 (22; 26; p <0,05), and the health assessment by the patient himself - from 75 (70; 80) to 85% (80; 85) (p <0,05).

Programs for the primary prevention of infectious diseases, which begin in childhood and continue throughout a person's life, are among the priority areas of development of the modern healthcare system. Vaccine prophylaxis is considered as a strategy aimed at maintaining a lost immune response due to an increase in human life expectancy, the emergence of additional opportunities for managing infections that contribute to the development of chronic non-communicable diseases, or new infections, an example of which is COVID-19. Among the variety of problems associated with the need for constant hard work in the field of developing a national vaccination calendar for adults, vaccination against seasonal and epidemic influenza, pneumococcal infection and COVID-19 is of particular interest. Maintaining an adequate collective immune response is possible only when achieving high targets for vaccination with the use of proven organizational, methodological techniques and principles of immunization at the international and national levels.

Today, the search and study of new biomarkers that can help the diagnosis of cardiovascular diseases, serve as a tool for assessing the effectiveness of therapy, be a prognostic criterion of clinical outcomes and an indicator in risk stratification remains relevant. In our literature review, we discussed the pathophysiological aspects of sindecan-1 (SDC-1), many of which are not completely clear. There are more and more publications demonstrating the importance of identifying SDC-1 as a new biological marker for the diagnosis and assessment of prognosis in cardiac patients.

Leydig cell tumor of the ovaries is a rare tumor of the genital cord, which makes up less than 0,5-1,0% of ovarian tumors. Leydig cell tumors of the ovaries are not only a medical problem for clinicians, but also a cosmetic and social problem. The symptoms and signs of hyperandrogenism dominate the clinical picture of the disease and usually force women to seek medical advice relatively early. This paper presents a clinical case of a patient with a leydig cell tumor and discusses the diagnostic features of this ovarian tumor.

The article is devoted to a review of foreign and domestic studies, which studied the therapy of chronic ischemic syndromes and cardiovascular complications in patients with coronary heart disease (CHD), taking into account the metabolism of cardiomyocytes. The modern view of myocardial ischemia pathogenesis from the standpoint of intracellular energy metabolism concept significantly expands the therapeutic approaches to solving this problem in clinical practice. In light of this, the use of trimetazidine (fatty acids beta-oxidation selective inhibitor) in the anti-ischemic therapy of chronic coronary syndromes is an important and justified component of complex treatment. This is confirmed by the results of numerous clinical studies in which the effectiveness of the use of trimetazidine was established in order to improve intracellular energy metabolism, reduce the severity and duration of ischemia periods.

An increase in life expectancy is one of the reasons for the increase in the prevalence of cognitive disorders, primarily associated with neurodegenerative diseases. The development of methods of structural and functional neuroimaging, technologies of histochemical studies made it possible to identify new forms of dementia caused by the accumulation of toxic protein products. These dementias include limbic-predominant age-related TDP-43 encephalopathy (LATE), the diagnostic criteria for which were published in 2019. Distinctive features of LATE are late onset (in persons aged 80 years and older), the predominance of amnestic syndrome in the absence of speech and behavioral disorders, as well as a frequent combination with hippocampal sclerosis. This review is devoted to the pathogenetic and clinical features of this new form of dementia.