The aim of this study was to analyze relationships between hepcidin concentration in blood and other nflammation mediators, blood erythropoietin and iron metabolism in patients with community-acquired pneumonia complicated by anaemia. Methods. Blood hepcidin concentration in 64 patients with community-acquired pneumonia has been measured. Results. Abrupt increase in hepcidin concentration in these patients seemed to demonstrate its relationship to inflammation through the interleukine6 production. Hepcidin was also related to increased ferritin concentration and could induce hypoferremia and inflammation-related anaemia while blood erythropoietin concentration was inversely related to hemoglobin, erythrocyte and hepcidin concentrations. Conclusion. The results allow us suggestion that synthesis of hepcidin is regulated not only by inflammation but also by anaemia and hypoxia.

Asthma is a chronic inflammatory airway disease with bronchial hyperresponsivenes causing recurrent episodes of wheezing, dyspnea, chest tightness and cough which typically occur at nighttime or early in the morning. These episodes are due to generalized airway obstruction which is commonly reversible spontaneously or with treatment. Asthma is mainly diagnosed clinically and should be based on the patient's symptoms and signs, lung function testing with investigations of bronchial obstruction reversibility, allergy testing and after exclusion of other diseases. The aim of asthma therapy is achievement and maintenance of asthma control that is maximal resolution of clinical symptoms of the disease.

Cysteinyl leukotrienes which are products of lipoxygenase pathway of arachidonic acid metabolism play an important role in all phenotypes of bronchial asthma (BA). They are involved in immune and non-immune stimulation of different cells and inflammatory mechanisms in BA. Leukotrienes cause bronchoconstriction, increase vascular permeability and bronchial mucosa oedema, stimulate mucus secretion. Knowledge of
leukotriene as inflammation mediators has allowed development leukotriene receptor antagonists and their implementation in clinical practice. Antiinflammatory properties of leukotriene receptor antagonists facilitate achievement asthma control while using both as monotherapy in mild asthma and in combinations with other antiasthmatic drugs in more severe disease. Currently, ongoing research of asthma phenotypes could define
certain phenotypes with more important role of leukotrienes.

Introduction. Patients with cystic fibrosis (CF) are in a high risk of a particular type of diabetes mellitus. The aim of this study was to investigate predictive factors for development of CF-related diabetes mellitus.
Methods. Allele and genotype frequencies of 3 gene transcription factor 7-like 2 (TCF7L2) polymorphisms (rs12255372, rs7903146, rs11196205) were investigated in adult patients with СF with or without carbohydrate metabolism disorders, in patients with diabetes mellitus and in controls.
Results. Russian population of rs12255372 polymorphism carriers is in a higher risk of diabetes development. Investigations of rs7903146 polimorphism of TCF7L2 showed that C allele frequency was higher than T allele frequency in all the patients' groups.
Conclusion. C allele and C/C + C/G genotypes seemed to play a protective role and were related to lower risk of carbohydrate metabolism disorders in CF patients. On the contrary, G allele and G/G homozygous genotype were related to 2.0 – 2.5-fold increase in the risk of carbohydrate metabolism disorders.

Introduction. Vascular invasion in operable lung cancer is an important prognostic factor. Vascular invasion worsens prognosis even in absence of metastases and could require adjuvant chemotherapy. The aims of this study were: 1) to investigate vascular invasion in surgical specimens of non-small cell lung carcinomas (NSCLC) using immunohistochemical detection of CD34+, actin, and cytokeratine expression; 2) to estimate prognostic values of these markers.
Methods. Surgical specimens were obtained from 60 patients with NSCLC Т2N0М0 to T3N2M0 stages aged 51 to 73 years (88.3 % were males).
Results. Vascular invasion found in primary malignancy significantly worsened outcomes (р = 0.0184) and survival.
Conclusion. Vascular invasion is an important predictive factor in patients with malignancies including NSCLC. Immunohistochemistry allowed better detection this process. The most valuable marker is to be CD34+.

Introduction. Comorbidity greatly contributes to progression and severity of chronic obstructive pulmonary disease (COPD). The aim of this study was to describe the nature and severity of gastrointestinal paraendocrine disorders in patients with COPD.
Methods. This cross-sectional open randomized controlled study included 84 patients with COPD. We measured blood serotonin concentration and performed immunohistochemical investigation of gastrointestinal APUD cells.
Results. Our results suggested an effect of gastrointestinal disease on the severity of COPD. Hyperserotoninemia and structural and functional disorders in enteroendocrine system were noted even in patients with mild COPD.
Conclusion. The severity of bronchial obstruction could correlate with functional activity of serotonin-producing enteroendocrine cells.

The aim of this study was to determine early predictors of COPD course.
Methods. In 88 COPD patients (GOLD II) aged 41–79 years, clinical data, spirometry, body plethysmography, bronchial hyperresponsiveness (BHR) in methacholine challenge test, and blood concentrations of IL-6 and IL-8 were analyzed. The patients were divided into two groups according to dyspnea severity: the 1st group (MRC 0–2) included 48 patients, the 2nd group (MRC 3) included 40 patients. Determinants of different severity of dyspnea were identified using the discriminant analysis.
Results. FEV1 values were similar in both groups. The most important determinants of severe dyspnea in COPD patients were duration of the disease (p < 0.001), frequency of exacerbations (p < 0.001), BHR (p < 0.001), lung hyperinflation (p = 0.006), and the patient's age (p = 0.023).

The aim of this study was to improve efficacy of treatment and preventive measures in outpatients with COPD using computed monitoring system.
Methods. Clinical course of the disease and outpatient treatment effectiveness in 59 patients with COPD II–III stage (of them, 46 were males) have been analyzed using computed pulmonology register. The age of patients was 59.66 ± 0.74 years. Thirty eight patients were vaccinated against influenza infection and 21 patients were not vaccinated.
Results. The computed programme "Monitoring system for patients with chronic obstructive pulmonary disease" demonstrated that vaccination of COPD II to III stage patients reduced rate of acute respiratory infection episodes, hospitalisations, visits to a physician and emergency calls.
Conclusion. The computed programme allowed to improve treatment and to analyze efficacy of preventive measures in COPD patients. Vaccination against influenza in COPD patients was highly effective and safe.

The aim of this study was to investigate the right heart function in patients with moderate-to-severe chronic obstructive lung disease (COPD).
Methods. The study involved 25 patients with moderate COPD, 11 patients with severe COPD and 20 healthy controls. Lung function testing and echocardiography were performed in all the patients.
Results. Reliable features of the right heart structural remodeling were found in both patient groups. Doppler spectrum of the tricuspid flow demonstrated the right ventricle diastolic dysfunction, evaluation of amplitude and tricuspid annulus motion velocity showed a reduction in the right heart global productivity, analysis of haemodynamic parameters diagnosed moderate pre-capillary pulmonary hypertension in both patient groups.
Conclusion. The global longitudinal (systolodiastolic) right heart dysfunction was found in COPD patients with moderate capillary pulmonary hypertension. The most reliable diagnostic method was tissue Doppler-echocardiography

In primary care, the most common lower respiratory tract infections are acute bronchitis, acute exacerbation of chronic bronchitis / chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia. A general practitioner should make a decision about management of such patient considering clinical and laboratory data. Two cases of an acute exacerbation of COPD and community-acquired pneumonia were discussed in the article. Issues of optimal antibacterial therapy were reviewed. The main pathogens causing acute exacerbation of chronic bronchitis / COPD are S. pneumoniae, H. influenzae, M. catarrhalis, so preferable antibiotics in this case could be aminopenicillines, macrolides, newer fluoroquinolones. According to the results of PeGAS survey josamycin is a macrolide with the highest activity against S. pneumoniae.

The aim of this study was to analyze specialized healthcare for patients with orphan diseases and activity of a regional clinical immunology center in term of patients with primary immunodeficiency.
Methods. Common problems of patients with orphan diseases were identified using a model of a regional clinical immunology and primary immunodeficiency center. An experience of the center has been analyzed.
Results. A register of patients with orphan diseases living at the Sverdlovsk region includes 483 patients, of them, 255 patients with primary immunodeficiency. This register is not full. Medication therapy is needed for 108 patients. The average cost of orphan drugs is about 204,167.1 RUB.
Conclusion. Management of patients with primary immunodeficiency encounters several difficulties, such as: this disease is not included in the list of orphan disease; late diagnosis because of insufficient knowledge of this disease by a general practitioner; inadequate therapy leading to disability; high drug cost; high burden of this disease due to disease progression, disability, complications, days-off work.