Vol 8, No 5 (2022)

COPD is one of the leading causes of morbidity and mortality in the world today. The aim of this study was to identify factors of adverse outcomes in patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). Material and methods. In the study was included 103 patients with COPD who were hospitalized in the Department of pulmonology of Saratov regional clinical hospital. All patients was determined the level N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP), galectin-3, the highly sensitive C-reactive protein, the proteins that bind fatty acids. The study of stiffness of the vascular wall, echocardiography was performed, Charlson index were calculated. A twelve months after study, patients or their relatives were interviewed for revealing adverse outcomes. Results. After one year, 28 (27,2%) patients with COPD developed chronical heart failure (CHF), 13 (12,6%) had cardiovascular complications and 8 (7,8%) patients died. The risk group the development of acute decompensation of heart failure is composed of patients with chronic bronchitis phenotype in COPD, with increased body weight, with arterial hypertension of more than 10 years, past myocardial infarction, with CHF 3-4 functional classes, having signs of decompensation in the small circulation, angina pectoris, value the Charlson comorbidity index more 4 points, the BODE index more 7 points, elevated levels of red blood cells, hemoglobin, urea, NT-proBNP (more 350 pg/ml). The most significant echocardiographic parameters are the left ventricular dilatation, right and left atrium, a decrease in the left ventricular ejection fraction of less than 45% and elevated systolic pulmonary artery pressure (above 50 mmHg). The increase levels of NT-proBNP and pulse wave velocity is associated with cardiovascular outcome in patients with COPD. The increased of mortality is associated with the severity of heart failure, limited physical activity, the severity of COPD, comorbid pathology and increased arterial stiffness. Predictors of mortality in patients with COPD on one year study was the severity of heart failure (points of SHOC), the severity of COPD (index BODE) and increased arterial stiffness (PWV of day, augmentation index of night). Conclusion. The results of this study help defined the group of high risk and could improve diagnosis and treatment of COPD.

Risk stratification in patients with peripheral atherosclerosis is extremely important, since it determines the direction of management tactics for patients with high and very high cardiovascular risk. Aim: development of a method for predicting the development of myocardial infarction (MI) in patients with peripheral atherosclerosis in the long term. Material and methods. The study included 519 patients (mean age 60.0±8,7 years) with atherosclerotic lesions in various vascular regions. All patients underwent standard biochemical studies and a set of instrumental studies. The period of prospective follow-up was 36 months. Results. In the course of binary logistic regression analysis, combinations of factors were identified that demonstrated their statistical significance in relation to the risk of developing MI in the longterm period, namely, «duration of diabetes mellitus, years + history of MI» (p=0,030), «chronic heart failure + duration of diabetes mellitus, years» (p=0,049), «ejection fraction value, % + history of MI» (p=0,0006), «number of affected vascular beds + chronic heart failure» (p <0,001), «number affected vascular pools + MI in anamnesis» (p <0,001) in relation to the point of fatal and non-fatal MI. Conclusions. Nomograms have been developed for assessing the risk of MI in the long-term period, which can be used in real clinical practice.

The pandemic of the new coronavirus infection (COVID-19) has changed the attitude to the treatment of chronic lung diseases and especially bronchial asthma, when a change in the nature of respiratory symptoms will require a reasonable differential diagnosis between an asthma attack (asthmatic attack), exacerbation of asthma and COVID-19 infection. The currently existing «clinical dualism» of perception of an asthma patient is associated with the possibility of controlled asthma to reduce the risks of severe complications, and therefore have a «protective effect», while COVID-19 infection provokes «fatal» exacerbations in such patients. This distorted the practitioner's idea of an «asthma attack», an «asthma exacerbation», a coronavirus infection, making the differential diagnosis of these conditions difficult and poorly understood. The purpose of this review was to analyze the «rules of clinical therapy» and the use of «nebulized budesonide» in patients with bronchial asthma, taking into account real outpatient treatment opportunities and current recommendations.

Cardiovascular disease remains the leading cause of death worldwide. The measurement of biological markers has revolutionized the diagnosis and monitoring of the effectiveness of the treatment of cardiac patients. The review article presented by us is devoted to a new promising biological marker, the transcription-modulating factor Jun 2 dimerization protein (JDP2). JDP2 is a bZip-type transcription factor that belongs to the activator protein-1 family. There are studies that allow us to consider the role of this marker in the diagnosis and evaluation of prognosis in patients with a cardiac profile. Studies on transgenic rodents and a number of clinical studies have shown that JDP2 is involved in the development of atrial fibrillation and heart failure.

Tactics of intensive care for patients with a new coronavirus infection caused by the SARS-CoV-2 virus implies an integrated approach both at the stage of the early clinical course of the disease and, importantly, during the rehabilitation period. One of the effective methods to reduce the risk of developing an ongoing infection (long-COVID) and post-COVID syndrome is hyperbaric oxygen (HBO) therapy. The inclusion of HBO in the complex therapy of patients with COVID-19 on the early stages of the disease helps the rapid elimination of hypoxia, the improvement of biochemical and immunological parameters, the normalization of the body's redox homeostasis and apoptosis processes. Due to its multifactorial action (normalization of microcirculation in affected organs, restoration of immunity, pronounced bactericidal effect, restoration of metabolism), HBO is an effective tool at the stages of early rehabilitation of patients with COVID-19.

GORELOV A.V., Chairman of the Council, MD, professor, academician of RAS, professor of the Department of pediatric diseases, I.M. Sechenov First Moscow state medical university of the Ministry of Healthcare of Russia (Sechenov University), deputy director for research work of Central Scientific Research Institute of Epidemiology of Rospotrebnadzor (Moscow) ZAKHAROVA I.N., co-chairman of the Council, MD, professor, head of the Department of pediatrics named after academician G.N. Speransky, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia (Moscow) KHAVKIN A.I., co-chairman of the Council, MD, professor, head of the Moscow Regional Center for Pediatric Gastroenterology and Hepatology, Scientific Research Clinical Institution of Childhood of the Ministry of Healthcare of the Moscow Region (Moscow) KAFARSKAYA L.I., MD, professor, head of the Department of microbiology and virology, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Moscow) USENKO D.V., MD, leading researcher at the clinical Department of infectious pathology, Central Research Institute of Epidemiology of Rospotrebnadzor (Moscow) BELMER S.V., MD, professor, academician of RANS, professor of the Department of hospital pediatrics No. 2 of the pediatric Faculty, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, full member of ESPGHAN (Moscow) KORNIENKO E.A., MD, professor, professor of the Department of pediatric diseases named after professor I.M. Vorontsov, Saint Petersburg State Pediatric Medical University of the Ministry of Healthcare of Russia (Saint Petersburg) PRIVOROTSKY V.F., MD, professor of the Department of pediatric diseases named after professor I.M. Vorontsov, Saint Petersburg State Pediatric Medical University of the Ministry of Healthcare of Russia (Saint Petersburg) KONDYURINA E.G., MD, professor, head of the Department of pediatrics of advanced training Faculty and occupational retraining of doctors, Novosibirsk State Medical University of the Ministry of Healthcare of Russia (Novosibirsk) PANFILOVA V.N., MD, associate professor of the Department of pediatrics of Institute of Postgraduate Education, Professor Voyno-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Healthcare of Russia (Krasnoyarsk) THAKUSHINOVA N.Kh., MD, associate professor, head of the Department of pediatric infectious diseases, Kuban State Medical University of the Ministry of Healthcare of Russia (Krasnodar) PLAKSINA A.N., PhD in Medicine, assistant of the Department of physical and rehabilitation medicine, Ural State Medical University of the Ministry of Healthcare of Russia (Yekaterinburg) RYCHKOVA O.A., MD, head of the Department of infectious diseases, allergology and immunology with a course of dermatovenereology and cosmetology, Tyumen State Medical University of the Ministry of Healthcare of Russia (Tyumen) PECHKUROV D.V., MD, professor, head of the Department of pediatric diseases, Samara State Medical University of the Ministry of Healthcare of Russia (Samara) NIZHEVICH A.A., MD, professor, professor of the Department of hospital pediatrics with the course of outpatient pediatrics, Bashkir State Medical University of the Ministry of Healthcare of Russia (Ufa) FAYZULLINA R.A., MD, professor, head of the Department of propaedeutics of childhood diseases and faculty pediatrics, Kazan State Medical University of the Ministry of Healthcare of Russia (Kazan)

EXPERTS: ALEKSEEVA L.I., MD, professor, head of the Department of metabolic diseases of bones and joints, V.A. Nasonova Scientific Research Institute of Rheumatology, professor of the Department of rheumatology, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia (Moscow) BARANTSEVICH E.R., MD, professor, head of the Department of neurology and manual medicine, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia, chief neurologist of the Northwestern Federal District of the RF, member of the board of experts of the Association for Interdisciplinary Medicine (Saint Petersburg) VASILKIN A.K., PhD in Medicine, deputy chief physician for medical rehabilitation, R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia (Saint Petersburg) GAYDUKOVA I.Z., MD, deputy director of the Research Institute of Rheumatology, professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, 1.1. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia (Saint Petersburg) KARATEEV A.E., MD, head of the Department of inflammatory joint pathology, V.A. Nasonova Research Institute of Rheumatology (Moscow) KOCHISH A.Yu., MD, professor, deputy director for scientific and educational work, R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia (Saint Petersburg) LILA A.M., MD, professor, corresponding member of RAS, director of V.A. Nasonova Scientific Research 120 Institute of Rheumatology, head of the Department of rheumatology, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia (Moscow) MAZUROV V.I., MD, professor, academician of RAS, chief scientific consultant, director of the Research Institute of Rheumatology, head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia, chief freelance specialist rheumatologist of the Health Committee of the Government of Saint Petersburg, Honored Scientist of the Russian Federation (Saint Petersburg) MARTYNOV A.I., MD, professor, academician of RAS, head of the Department of internal diseases No. 1 of the Faculty of general medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia, president of RSMSIM (Moscow) TASKINA E.A., PhD in Medicine, senior researcher at the Department of metabolic diseases of bones and joints, V.A. Nasonova Scientific Research Institute of Rheumatology (Moscow) TROFIMOV E.A., MD, deputy director of the Research Institute of Rheumatology, associate professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia (Saint Petersburg) CHICHASOVA N.V., MD, professor, leading researcher at V.A. Nasonova Scientific Research Institute of Rheumatology, professor of the Department of rheumatology, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia (Moscow) SHOSTAK N.A., MD, professor, Honored Doctor of the Russian Federation, head of the Department of faculty therapy named after A.I. Nesterov, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Moscow)

There are two major clinical periods during COVID-19: the period of active viral reproduction and the period of immunologic mechanisms dysregulation, hyperinflammatory response. Thus, the early administration of antiviral therapy during is pathogenetically substantiated approach as it limitates virus replication and prevents life-threatening conditions development. One of the established antiviral drug with proven efficacy against the wide spectrum of respiratory viruses in adults and children is Ingavirin®. Ingavirin® activity against highly pathogenic coronavirus SARS-CoV has been proven during pre-clinical studies even before COVID-19 pandemic. Therefore, there were reliable reasons for studying the clinical efficacy of the drug in patients with new coronavirus infection. The aim of the phase III clinical study was to evaluate the efficacy and safety of Ingavirin®, 90 mg capsules, in outpatients with COVID-19. Material and methods. The study screened 234 patients of both sexes aged from 18 to 75 years with laboratory-confirmed mild COVID-19 233 of which were randomized in two groups: Ingavirin® group and placebo group. The maximum treatment duration was 7 days. The follow-up for 21±1 days was performed after the end of drug administration. Results and conclusion. The obtained results demonstrate the superiority of Ingavirin® therapy over placebo in the treatment of mild COVID-19 in terms of time to clinical recovery with a difference of 47,8 hours and faster regression of intoxication and catarrhal symptoms. Evaluation of adverse events and laboratory data confirm Ingavirin® favorable safety profile and tolerance.

Taking into account the high incidence and duration of asthenic syndrome (AS), one can say that therapy of it is an urgent clinical problem in the practice of primary care physicians. Current article provides actual data on the prevalence of its main symptoms among patients with chronic noncontagious diseases and after surviving a novel coronavirus infection. Clinical manifestations and principles of AS diagnosing, including those in the post-COVID period, are discussed, perspectives for the management and treatment of patients with this condition are considered, and the mechanism of action of Stimol medicine in relation to that category of patients is analyzed in details.