Modern methods of diagnosis and treatment of pulmonary hemorrhage.

По материалам: Parsons J.P., Hallstrand T.S., Mastronarde J.G. et al. An Official American Thoracic Society Clinical Practice Guideline: Exercise(induced Bronchoconstriction. Am. J. Respir. Crit. Care Med. 2013; 187 (9): 1016–1027. DOI: 10.1164/rccm.201303(0437ST. Internet address: www.atsjournals.org

Summary. In the Republic of Tatarstan, a comparison was made of medical care for patients with community-acquired pneumonia with a favorable outcome in 1999, 2000 and 2010 years. It is noted that at the stationary phase of care has improved, reduced time before setting a definitive diagnosis. At the pre-hospital stage completeness of surveys has been inadequate. Spectrum antibiotics prescribed is changed. There was a replacement for penicillins by III generation cephalosporins. Frequency of use of macrolides increased, but the frequency of treatment with aminoglycosides, lincosamides and sulfonamides reduced significantly. The role of fluoroquinolones has increased. Raised the hypothesis that therapy of large groups of patients with identical drugs can contribute to resistance of respiratory pathogens. Expressed concern that the treatment of large groups of patients with identical drugs may promote the formation of bacterial resistance.

Summary. The objective of the study was to analyze electrocardiographic (ECG) and echocardiographic findings in diagnosis of right heart disease in patients with chronic obstructive pulmonary disease (COPD) including those with concomitant arterial hypertension (AH). ECG and echocardiography were performed in 146 patients with COPD, AH and COPD + AH and in healthy individuals. Routine ECG and echocardiographic examinations of COPD patients found signs of right ventricular hypertrophy in 7.8 % and 72.7 % of patients, respectively. The relative risk of right ventricular hypertrophy in patients with COPD and AH compared to patients with COPD alone was 1.6. In 86.4 % of patients with COPD + AH and cor pulmonale, moderate right ventricular hypertrophy was diagnosed which was associated with dilated right ventricle in several cases.

Summary. Soluble forms of differentiation membrane molecules in immune cells are involved in pathogenesis of respiratory diseases. In this study, we investigated serum soluble forms of CD50, CD54, CD38, CD25, CD8, CD95, HLA I, and HLA-DR molecules in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Serum markers of activation of the immune cells (sCD25, sCD8 and sCD38), adhesion molecules (sCD50 and sCD54), apoptosis inhibitor (sCD95), sHLA I, and sHLA-DR were decreased in severe COPD. Relationships were found between the tested molecule concentrations and the lung function parameters. Long-term smoking was found to effect on the immune response of patients with COPD.

Summary. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide resulting in significant everincreasing economic and social burden. Treatment of patients with COPD should take into account clinical characteristics, frequency of exacerbations and quality of life of the patient and the treatment cost. The objective of this study was to evaluate quality of life of patients with COPD 3 stage GOLD with frequent exacerbations receiving different regimens of maintenance therapy. The results showed that in patients with COPD 3 stage GOLD with frequent exacerbations inhaled steroids did not influence on the quality of life and did not have any advantage over combined therapy with long-acting bronchodilators. Further research is needed to estimate the effect of inhaled steroids on frequency of exacerbations.

Summary. In penitentiary healthcare facilities of Russia, infiltrative pulmonary tuberculosis (TB) with cavitation was more prevalent in patients aged 20 to 39 years. More than 90 % of them had co-morbidities. Pulmonary lesions limited by one or two lung segments were seen more often in patients with this TB form. Drug-resistant Mycobacterium tuberculosis was yielded in 56.3 % of sputum cultures and multi-drug resistant M. tuberculosis was yielded in 25 % of cases. In 15 % of MRD-TB, M. tuberculosis was resistant to the first-line and reserve antituberculosis drugs. Therefore, treatment of first-diagnosed TB patients with the chemotherapeutic I regimen (four first-line anti-TB antibiotics) could be less effective and should be started with chemotherapeutic IIB regimen (four first-line and one reserve anti-TB antibiotics).

Summary. A contribution of age, gender and social factors to probability of pulmonary tuberculosis occurrence in various cohorts of population was analyzed. On the basis of the obtained data, a computer system was developed to define a total individual risk of pulmonary tuberculosis occurrence. This approach could allow estimation of rate of preventive fluorographic investigation in different population cohorts.

Summary. Drug resistance and genotype of Mycobacterium tuberculosis were analyzed in 266 DNA samples isolated from clinical material of patients with TB using an experimental test system TB-TEST. This method is bases on oligonucleotide microarray technology and allows determination most prevalent in Russia genotypes of M. tuberculosis and genomic mutations responsible for drug resistance to the main medications used for treatment of TB: rifampicin, isoniazid, ethambutol, fluoroquinolones, aminoglycosides, and capreomycin. As a result, drug resistance profiles and genotypes were identified for all samples. The test results were highly related to results of conventional microbiological tests. The TB-TEST could be used as a preferred laboratory method for diagnosis of TB.

Summary. This study was aimed at estimation of the predictive value of clinical and anthropometric data for obstructive sleep apnea syndrome (OSAS). Of 91 subjects, 74 male and 17 female with mean age of 43.3 ± 12.6 yrs underwent respiratory polygraphy with snoring, nasal breathing, oxygen saturation and pulse rate being recorded. Subjects with apnea / hypopnea index (AHI) equal to or higher than 15 were diagnosed with OSAS. Clinical symptoms were revealed by a special questionnaire. Neck circumference, weight / hip ratio, body mass index and Mallampati score were measured. This study reveals a high accuracy of this clinical model for predicting OSAS. This means that the clinical prediction model allows accurate selection patients at high risk of OSAS who may benefit from early diagnosis and treatment of OSAS.

Co-morbidity of bronchial asthma and chronic obstructive pulmonary disease.

Novel effects of antiinflammatory therapy of chronic obstructive pulmonary disease.

Strategy of rational antibacterial therapy of acute exacerbation of chronic obstructive pulmonary disease: an approach based on minimal hazard risk.

Tobramycin inhalations in therapy of chronic infection Pseudomonas aeruginosa in cystic fibrosis.

Croupous pneumonia.

Efficiency of intensive therapy of community-acquired multilobar pneumonia in patients with the only lung (a case report).

Valve bronchial blocking and local fibrinolytic therapy in a patient with severe combined trauma including chest trauma.

From Handihaler to Respimat: tiotropium delivery systems.

Jury A. Koshelev. To the 75th birthday.