Bronchopulmonary Diseases Research Articles

Results of surgical treatment of infective endocarditis complicated by acute heart failure

Objective. To evaluate the results of surgical treatment of infective endocarditis complicated by acute heart failure. Materials and methods. The clinical data of 72 patients with infective endocarditis complicated by preoperative acute heart failure who underwent cardiac surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.01.2019 to 30.12.2022 were studied. All patients were assigned to functional class IV according to the functional classification of the New York Heart Association. Results. The average duration of infective endocarditis from its first signs (hyperthermia above 38 °C) to diagnosis was 2 months (2; 4 months). Among the causes of infective endocarditis, bronchopulmonary diseases dominated – 24 (33.3%) observations, general surgical interventions – 7 (9.7%) and hospital infection – 7 (9.7%). Urologic surgical interventions caused the development of infective endocarditis in 6 (8.3%) patients, hypothermia in 4 (5.6%), drug addiction in 4 (5.6%), and dental procedures in 1 (1.4%) patient. In 19 (26.4%) patients, the causes of infective endocarditis were not established. In 62 (86.1%) patients, a multi–valve correction was performed, and in 10 (13.9%) – a single–valve correction. The most common were two main options: aortic valve prosthetics in combination with mitral and tricuspid valve surgery in 13 (18.1%) patients and mitral and tricuspid valve surgery in 14 (19.4%) patients. Surgical intervention for combined lesions of the valvular apparatus of the left and right heart was performed in 51 (70.8%) patients with infective endocarditis complicated by acute heart failure. Frequent intracardiac abscessing – in 20 (27.8%) patients with aortic valve lesions and in 9 (12.5%) patients with mitral valve lesions – indicated a high rate of extensive infection spread. Hospital mortality in the surgical treatment of infective endocarditis complicated by acute heart failure was 13.9%. 10 patients died. Conclusions. In 96.1% of patients with infective endocarditis complicated by preoperative acute heart failure, multivalve surgical correction was performed. In the initial acute heart failure in the setting of infective endocarditis, intracardiac abscessing was often recorded: 27.8% in aortic valve lesions and 12.5% in mitral valve lesions. Hospital mortality in the surgical treatment of infective endocarditis complicated by preoperative acute heart failure was 13.9%.

Assessment of the disease course, diagnosis, and treatment of the new coronavirus infection in a Stavropol multidisciplinary hospital during the COVID-19 pandemic

Aim. To evaluate the disease course, laboratory diagnosis, and treatment results of COVID-19 patients. Materials and methods. In the period from January to December 2021, the moderate and severe COVID-19 forms complicated by polysegmental community-acquired pneumonia were monitored in 861 patients admitted to Stavropol Clinical City Hospital No. 3. Patients were assessed according to laboratory data, body mass index, concomitant diseases, gender, age, duration of inpatient treatment, and disease outcome. Results. More than half of the COVID-19 patients were overweight and had concomitant diseases at the time of admission, which significantly worsened the course and prognosis of the disease. The inflammation predictors (C-reactive protein, procalcitonin, fibrinogen, D-dimer, lactate dehydrogenase) were found to have an important role, with their indicators correlating significantly with the severity of the patient’s condition. Dynamic monitoring of these laboratory parameters served as a marker of the adequacy of the therapy; however, these were not always a criterion for prescribing antibacterial therapy. Bacteriological diagnostics was applied only in 9.4% of cases. Conclusion. Although the COVID-19 severity was not associated with gender, it correlated significantly with age and the presence of comorbid cardiovascular, bronchopulmonary, and endocrine diseases. A retrospective analysis revealed characteristic laboratory markers of the severity of COVID-19 infection. It was revealed that the initial empirical ABT was initiated in 94% of cases in the absence of reliable objective signs of bacterial infection.

A decision rule for identifying patients at high risk for impaired lung diffusion capacity after COVID-19

Aim. To elaborate a decision rule for identifying the main predictors of impaired lung diffusion capacity after COVID-19. Materials and methods. The retrospective study included 341 patients without underlying lung diseases (median age 48 years) who experienced COVID-19 with bilateral pneumonia. The median extent of parenchymal lesion in the acute phase of COVID-19 (CTmax) was 50%. Spirometry, body plethysmography, and lung diffusion capacity for carbon monoxide (DLCO) test were performed. The data were analyzed by descriptive statistics, correlation analysis, one-dimensional logistic regression analysis with an assessment of odds ratios (OR), and multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to assess the quality of the binary classifier model.Results. The initial model for predicting reduced DLCO (< 80% of predicted) included the following predictors: CTmax, time interval from the COVID-19 onset, gender, age, body mass index. Backward stepwise regression was applied, and a binary classifier model that includes CTmax was obtained. The sensitivity and specificity of the model for the training sample were 80 and 67%, respectively, for the test sample – 79 and 70%, respectively. The analysis of OR showed that OR > 1 was observed at СTmax > 40%.Conclusion. The decision rule was obtained for predicting impaired lung diffusion capacity after COVID-19 with virus-associated lung damage in patients without underlying bronchopulmonary diseases. Patients with CTmax > 40% require more thorough clinical follow-up with DLCO monitoring after the acute phase of COVID-19

Pneumococcal infection in children with recurrent respiratory diseases

In frequently ill children with recurrent respiratory diseases (RRD), violations of local immunity and microbiocenosis of the mucous membranes can contribute to the development of acute and chronic bronchopulmonary diseases. Vaccination against major pathogens, including S. pneumoniae, can help prevent respiratory infections in children.Objective: to study the microbiocenosis and local immunological factors of the nasopharyngeal mucosa in children with RRD, the serotype composition of S. pneumoniae in children with community-acquired pneumococcal pneumonia (CAP) and pneumococcal carriers, as well as the correspondence of the serotype landscape to the composition of modern pneumococcal vaccines.Materials and methods: The study included 150 patients (104 children with RRD and 46 patients with CAP). To assess the condition of the nasopharyngeal mucosa cultural methods, morphofunctional, immunological and capsule PCR typing of S. pneumoniae isolates were performed. Statistical analysis was performed using the Statistica 10.0 package.Results: The age structure was dominated by children aged 3 to 6 years (36%). The majority of patients with RRD had pronounced nasopharyngeal mucosal dysbiosis (n=60), as well as destruction of epithelial cells (n=97). These factors may predispose to the development of bronchopulmonary diseases, including community-acquired pneumonia (CAP). Capsule PCR typing of S. pneumoniae isolates from the nasopharynx was performed in 46 patients. It has been established that in the structure of nasopharyngeal carrier S. pneumoniae in children with CAP, serotypes “3” and 19F prevailed, which were also the main pathogens in pneumococcal CAP. In nasopharyngeal pneumococcal carrier, the thirteen–valent pneumococcal conjugate vaccine (PCV13) overlapped 39.6% (95%CI 27.6–53.1%) of serotypes, in pneumococcal VP – 57.2% (95% CI 36.5-75.5%), while PCV20 overlapped 22.6% more S. pneumoniae serotypes in children with CAP.Conclusion: The strategy for the prevention of acute respiratory infections in children is immunization against pneumococcal infection, which should be carried out taking into account the regional prevalence of S. pneumoniae serotypes.

Influence of Bronchopulmonary Diseases on the Course and Outcome of COVID-19: a Literature Review

The SARS-CoV‑2 coronavirus has become a major global health concern. Infection with SARS-CoV‑2 has caused millions of deaths worldwide, and the case fatality rate has been found to be largely related to pre-existing clinical conditions. The main clinical manifestation of COVID‑19 is the presence of respiratory symptoms. Severe complications of COVID‑19 are most often observed in people with significant medical histories. The SARS-CoV‑2 virus primarily attacks the respiratory system, causing pneumonia and acute respiratory distress syndrome, which can lead to severe systemic inflammation, multiple organ dysfunction, and death, especially in patients with pre-existing comorbidities. A number of meta-analyses strongly suggest that comorbid respiratory diseases, including chronic obstructive pulmonary disease and interstitial lung diseases, are factors in the development of severe forms of COVID‑19, worsening patient outcomes and survival rates. Studies have shown an association between adverse outcomes of COVID‑19 and the expression level of the angiotensin-­converting enzyme 2 (ACE2) in these patients. Regarding other respiratory system pathologies, such as bronchial asthma and cystic fibrosis, it is known that the main unfavorable factor is long-term immunosuppressive pharmacotherapy preceding infection. In this article, we highlight the main respiratory comorbidities to better understand the pathogenesis of COVID‑19.

Features of the chemical composition of fine suspended particles in the atmospheric air of residential and industrial zones of the city of Sibay, Republic of Bashkortostan

Introduction. Atmospheric particulate matter as a negative environmental factor can be a significant hazard depending on their size, morphometric and physicochemical characteristics. The purpose of the study. To investigate the elemental composition of finely dispersed suspended particles in the atmospheric air of the industrial zones of the mining center of the Bashkir Trans-Urals - the city of Sibay. Materials and methods. Air sampling was carried out in the industrial area of ​​Sibay using an AVA-3-240/180-01 automatic three-channel air aspirator with AFA-VP-20 filters. Microscopy of samples and determination of the elemental composition of dust emissions were carried out at the Interdisciplinary Center “Analytical Microscopy” of the Kazan Federal University (Kazan) on a universal analytical complex for scanning field emission electron microscopy Merlin (Carl Zeiss). Results. On electron micrographs, there were identified particles of various sizes, mostly round in shape with clear edges, located solitary. In the automatic mode of processing the spectra, the peaks of the elements in the spectrum were automatically recognized and identified. In addition to carbon and oxygen, the calcium, iron, silicon, potassium, aluminium, copper, sulphur, sodium and magnesium are main chemical constituents of particulate matter encountered at all sampling points. Zinc was present in dust samples at three points, scandium, titanium, cobalt, barium, and manganese – only at one point. The possibility of the relation between the content of fine particles in the air and the increased incidence of cardiovascular, bronchopulmonary diseases, including asthma, in the population of Sibay is discussed. Limitations. The study of the elemental composition of fine dust in the city of Sibay was carried out using atmospheric air samples taken at 5 points located in residential and industrial areas. Conclusion. The increased content of fine particles in the atmospheric air of the city of Sibay increases the risks of respiratory and cardiovascular diseases, as well as other health abnormalities, in the population permanently residing near industrial zones. The obtained data on the parameters of dust particles are the basis for assessing the share contribution of industrial enterprises to air pollution and making management decisions to improve the environmental situation in the industrial center of the mining region.

Vaccine-Induced Immunity Against Pertussis in Lung Transplant Candidates

Background. Given the high prevalence of Bordetella pertussis, patients with respiratory disorders are at risk of getting infected with this pathogen and developing pertussis. Therefore, they should be considered a target group for vaccination against this infection. Aims — the objective of the study was to assess vaccine-induced immunity against pertussis in lung transplant candidates. Methods. Twenty-four patients with severe bronchopulmonary diseases, aged 18 to 60, were vaccinated against pertussis with Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine. Five patients underwent lung transplantation. Immunoglobulin G (IgG) antibodies (Abs) were measured using the RIDASCREEN® Bordetella IgG test system. Results. In the post-vaccination period, only 8.3% of the patients developed such local reactions as tenderness and induration at the injection site. The proportions of patients who were seropositive for pertussis before vaccination, one month and one year after vaccination were 71, 100 and 100%, respectively (p = 0.02). A significant increase in anti-pertussis IgG Ab levels was identified one month after a single vaccine dose, and was still observed after 12 months. In the group of two-dose vaccination, there was no statistical difference between the levels of IgG Abs one month after the first dose and one month after the second dose. A significant increase in anti-Bordetella pertussis IgG Ab levels was observed in the group of initially seronegative patients compared to seropositive patients (p = 0.03). A year after vaccination, there was no statistically significant difference in IgG Ab levels between the patients with and without a history of lung transplantation. Conclusions. The majority (71%) of patients with severe bronchopulmonary disease was seropositive for B. pertussis. Single-dose vaccination against pertussis was safe; it induced the production of additional specific Abs and an increase in their levels in all patients. Therapy administered after lung transplantation did not significantly affect the levels of vaccine-induced Abs.

Структура информационного хранилища системы поддержки принятия клинических решений

The construction of an information repository for a clinical decision support system (CDSS) in the weakly formalized subject area of treating bronchopulmonary diseases is considered. An overview of approaches to creating knowledge bases in this subject area is provided. A method for extracting knowledge is described, which is based on rules from clinical recommendations and the search for dependencies between words in sentences, taking into account the se-quence of rule application. The information repository of the CDSS is populated with ontological and production knowledge bases using the proposed knowledge extraction method. An ontology for the selected subject area was de-veloped, and studies of its quality were conducted through an analysis of the graph topology using cognitive ergonom-ics metrics. The effectiveness of the described knowledge extraction method is demonstrated. An original architecture for a clinical decision support system has been developed.

6-minute walk test in patients hospitalized with COVID-19

Introduction. The 6 Minute Walk Test (6MWT) plays a key role in assessing functional exercise tolerance and prognosis for a wide range of chronic respiratory and cardiovascular diseases. In acute bronchopulmonary diseases, in particular COVID-19, there is practically no data on the possibilities of using 6MWT.Aim. To compare the results of a 6-minute walk test with clinical and laboratory parameters of patients hospitalized with new coronovirus infection.Materials and methods. The prospective, non-randomized comparative study sequentially enrolled 117 patients hospitalized with a confirmed diagnosis of COVID-19. Upon admission to the hospital, all patients performed 6MWT in accordance with international recommendations.Results. During the 6-minute trial, patients walked an average of 390 m (340.0; 420.0). In 96.6% of patients, there was a marked limitation of physical activity. Desaturation during the 6-minute test was registered in 25 (21.4%) patients. When conducting a correlation analysis, it was found that the result of the test with physical activity (the number of meters traveled) is associated with both initial and final SpO2, the presence of desaturation and the severity of dyspnea according to Borg, with the age of patients, the severity of the course of new coronovirus infection, laboratory signs of the activity of the inflammatory process upon admission. Relationships between the results of 6MWT (the number of meters covered and the % decrease in SpO2) and the duration of hospitalization, the maximum volume of lung damage according to CT data, the maximum severity of laboratory signs of inflammation (CRP, ferritin) during hospitalization, the need for oxygen therapy, the volume of anti-inflammatory therapy (doses of systemic glucocorticoids, pulse therapy with methylprednisolone). Patients with desaturation during exercise had a more severe course of the disease with a large amount of lung tissue damage, as well as higher laboratory indicators of the activity of the inflammatory process. It was also found that patients who desaturate during the exercise test more often required oxygen therapy during hospitalization, more often pulse therapy with methylprednisolone was performed.Conclusion. Patients with COVID-19 develop a decrease in physical performance, which is multifactorial. These include respiratory failure due to lung tissue damage, muscle weakness, nervous system damage (anxiety, depression), and systemic inflammation, which characterizes the severity of the infection and the associated immune response. The results of 6MWT may have a certain prognostic value in terms of the severity of the course of the disease, the severity of systemic inflammation, the need for oxygen therapy, and pulse therapy with glucocorticoids.

Micronutrient Level Among Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a serious health problem today. Every year there is an increase in the number of cases of COPD around the world, which is accompanied by a deterioration in the quality of life of patients, temporary loss of ability to work, and even death. Deficiencies of macro- and microelements are currently recognized by world medicine as a global problem. These conditions have a significant impact on the body, presenting an urgent need for the development of effective health strategies to address them. According to available data, nutritional deficiencies are quite common in patients with COPD. Numerous studies highlight the impact of micronutrient deficiencies on disease progression. Currently, the connection between bronchopulmonary diseases and low levels of vitamin D and magnesium in the body of patients is being actively studied. Insufficient outdoor activity, infrequent exposure to sunlight, poor diet, alcoholism, smoking, decreased ability of the skin to synthesize vitamin D in smokers, general exhaustion of the body, and the use of certain antibiotics can be the causes of low levels of vitamin D and magnesium. Many studies indicate that deficiencies of these elements may be associated with decreased lung function and increased exacerbations in COPD, which contributes to disease progression. Deficiency conditions, which often remain undiagnosed, can negatively affect the prognosis of the disease. This study identifies the incidence of low blood levels of vitamin D and magnesium and demonstrates the relationship between low levels of these elements and the severity of COPD

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia.

Streptococcus pneumoniae is one of the leading causes of mortality and morbidity worldwide. The dramatic increase in in-vitro resistance of antimicrobial agents, particularly beta-lactams and macrolides, makes pneumococcal infections difficult to treat. The aim of this study was to describe the drug resistance rate, assess the prevalence of macrolide-resistant genes and review the clinical complications of pneumococcal infections among patients presented to Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. This is a descriptive cross-sectional study. All S. pneumoniae isolates collected from clinical specimens within a 1-year period were subjected to selected antimicrobial susceptibility testing using E-test strips. Polymerase chain reaction (PCR) analysis was conducted to detect macrolide-resistant determinants. The patient's clinical data were obtained from clinical notes. A total of 113 patients with a positive growth of S. pneumoniae were included in the study. The most common predisposing factors among them were bronchopulmonary diseases (15.9%). The penicillin-resistant rate was 7.1%, with minimal inhibitory concentration (MIC) ranging between 0.012 μg/mL and >32 μg/mL, and the erythromycin-resistant rate was 26.5%, with a MIC range of 0.03 μg/mL-> 256 μg/mL. Most of the erythromycin-resistant isolates were found to have the mef(A) gene (50.4%) and the erm(B) gene (20%); 16.7% had a combination of genes mef(A) and erm(B), and 13.3% had none of the two genes. Community-acquired pneumonia is the predominant type of pneumococcal infection. There was no significant association between the presence of macrolide resistance determinants and mortality (P = 0.837) or complications (P > 0.999 for empyema and cardiac complication; P = 0.135 for subdural abscess). The majority of erythromycin-resistant isolates were found to have the mef(A) gene, followed by the erm(B) gene and a combination of genes mef(A) and erm(B).

Pulmonary "cannonball" metastasis from endometrial cancer: a rare case report

Endometrial cancer is the most common gynecological neoplasm in Italy and developed countries. Pulmonary metastases, though uncommon, signify advanced disease, with "cannonball" metastases being a distinctive pathological finding requiring careful management. Despite advancements in bronchoscopy technology, fundamental diagnostic procedures like Bronchoalveolar Lavage (BAL), Transbronchial Lung Biopsy (TBLB), and Transbronchial Needle Aspiration (TBNA) remain essential for evaluating bronchopulmonary diseases. These techniques enhance the diagnosis and staging of oncological diseases of the genitourinary system with pulmonary involvement. Traditional bronchoscopic procedures continue to play a vital role in managing lung disorders effectively.

Some Aspects Of Acute Bronchitis In Children

The article presents data on the structure of morbidity and features of the modern course of respiratory diseases in children of Andijan. The relevance, place among bronchopulmonary diseases, and features of the course of modern bronchitis in childhood are determined. A brief clinical description is given and the main approaches to the treatment of acute bronchitis are identified. Data from clinical experience with the use of the non-steroidal anti-inflammatory drug fenspiride hydrochloride (Erespal) in children are presented. High anti-inflammatory, bronchodilator, indirect mucoactive and antitussive effects of the drug in the complex treatment of bronchitis in children were noted

The results of an experimental toxicological assessment of the pharmaceutical substance ambroxol hydrochloride, justification of the maximum permissible content in the air of the working area

Introduction. Ambroxol hydrochloride is a biologically active substance used as a pharmaceutical substance in the manufacture of medicines for secretolytic therapy in the case of acute and chronic bronchopulmonary diseases. To date, there is no hygienic standard for the safe content of substances in the air of the working area in the republic.
 The study aims to substantiate and develop the maximum permissible concentrations and hazard class of the pharmaceutical substance ambroxol hydrochloride in the air of the working area.
 Materials and methods. The authors have conducted experimental toxicological studies of the pharmaceutical substance on animals (rats, mice, rabbits) in accordance with the requirements of technical regulatory legal acts and recommendations of methodological documents regulating the justification of hygienic standards.
 Results. Scientists have found that the pharmaceutical substance ambroxol hydrochloride, when injected into the stomach and inhaled, is classified as a low-hazard substance at an average lethal dose/concentration (according to GOST 12.1.007-76), has a mild irritant effect on the skin and moderate on the mucous membranes of the eyes, does not exhibit a skin-resorptive effect, is characterized by a weak cumulative effect and does not it has sensitizing activity. Under the conditions of inhalation of the substance into the body of laboratory animals (rats), the threshold values of acute and chronic harmful effects of this pharmaceutical substance were at the level of 90 mg/m3 (in terms of the effect on the functional state of the nervous activity of rats) and 30 mg/m3, respectively (in terms of changes in behavioral indicators, weight and mass coefficient spleen, blood glucose, alanine aminotransferases and urea) accordingly.
 Conclusion. Based on the experimental results of the toxicological assessment, the authors have justified the standard of permissible content of the pharmaceutical substance ambroxol hydrochloride in the air of the working area at the level of 4.0 mg/m3, they also have established the hazard class of the substance according to GOST 12.1.007-76 (class 3, medium-hazard substances).
 Ethics. The Bioethics Commission of the State Enterprise "SPCH” has approved the use of laboratory animals for experimental purposes (Protocol No. 1 dated 03/04/2020). The treatment of animals was in accordance with the provisions of Directive 2010/63/EU of the European Parliament and of the Council of the European Union of September 22, 2010 on the protection of animals used for scientific purposes.

Modern Treatment of Dry Post-viral Cough. Focus on Efficiency and Safety

Cough is the most common symptom of bronchopulmonary diseases, about which patients consult the doctors of both primary and secondary care. Cough can be caused by diseases of the respiratory tract, digestive tract, and cardiovascular diseases. However, cough most often develops during acute respiratory viral infections (ARVI), which disrupts the patient’s normal activities and limits his work capacity. Since most respiratory infections are viral in nature, the use of antibacterial drugs will not only be of no benefit, but will also significantly worsen the patient’s condition. The objective: to analyze the effectiveness and tolerability of a combined antitussive agent, which includes codeine, thermopsis extract, licorice root and sodium bicarbonate, in the treatment of dry post-viral cough. Materials and methods. The study included 60 patients with a dry cough that caused by ARVI, namely: 49 (82%) men and 11 (18%) women. The average age of the patients was 46±4.7 years. Most of the subjects (90%) had smoking experience of more than 20 years. The research participants were divided into two groups of 30 people each. The groups were comparable by age, duration and severity of symptoms, as well as clinical manifestations of respiratory disease. The patients of the first group took a combined antitussive drug containing codeine, thermopsis extract, licorice root, and sodium bicarbonate for 5 days. Patients of the second group received alternative antitussive drugs. At the beginning and at the end of treatment, the severity of cough was determined on a visual analog scale and the physical, psychological and social conditions of patients in both groups were assessed using the Leicester Acute Cough Questionnaire. Results. As a result of the research, it was found that the patients of the first group, who received the combined antitussive drug, have achieved the desired treatment result much earlier and more effectively than the patients of the second group. The intensity of their cough decreased by 2.5 times during the treatment period. The patients of the first group also had better results of treatment, comparing indicators of physical, psychological and social conditions. In the control group, positive results of treatment were determined, although a less significant effect was found. Conclusions. The conducted study confirmed the high efficiency of the combined antitussive agent, which includes codeine, thermopsis extract, licorice root and sodium bicarbonate, in the treatment of dry debilitating cough caused by ARVI. Thanks to the use of this drug, the severity of cough significantly decreased, which led to a significant improvement in the general condition and quality of life of patients.

Community-acquired pneumonia in young children living in various climatogeographic zones of the Republic of Dagestan

Introduction. Community-acquired pneumonia (CAP) in early childhood continues to cause significant morbidity and remains one of the most common serious infections in childhood. Each region of the Russian Federation exhibits specific manifestations of CAP morbidity. Knowledge of CAP etiology is crucial for planning therapeutic and preventive measures. 
 Aim. To determine the etiological and immunological features of CAP in early childhood, residing in various climatogeographical zones of the Republic of Dagestan.
 Materials and methods. The material includes the results of examination and treatment of CAP 204 young children. living in lowland, foothill and mountain climatogeographical zones of the Republic of Dagestan. The selection criterion was the clinical-radiological diagnosis of CAP, using the classification of clinical forms of bronchopulmonary diseases in children.
 Results. The study revealed a rise in the incidence of respiratory organ diseases, including CAP, among children in the Republic of Dagestan (RD) over the past 5 years. Among infants under one year, the CAP rate was twice as high. The prevalence can be attributed to the climatogeographical conditions of children’s living environments. Streptococcal infection was also observed to predominate in the ethnostructure of CAP in early childhood across all climatogeographical zones. Streptococcus pneumoniae (48.1%) was more frequently isolated in all climatogeographical zones, while Staphylococcus aureus (13.3%) dominated in the mid-mountain zone. In mild pneumonia, cellular immunity components, represented by reduced CD3, CD4, CD25, CD71, react primarily. Disease exacerbation leads to depletion of CD8, CD16, CD20. Severe pneumonia triggers the involvement of humoral immunity, leading to changes in clinical blood analysis — leukocytosis and an increase in mature and immature forms of neutrophils. The levels of IL-1, IL-6, IL-8 in blood serum increase depending on the area of inflammation and the CAP severity. In observed children with focal-draining and segmental CAP, their levels significantly increased. For empirical antibacterial therapy of CAP, recommendations include amoxicillin, protected ampicillins, third-generation cephalosporins, macrolides, and vancomycin in mono- or combination therapy.
 Conclusion. The conducted research highlights the need for managing ethnological monitoring with antibiotic sensitivity testing of infectious agents causing CAP in children.

Our experience in treating patients with bullous dystrophy complicated by pneumothorax

Our experience in treating patients with bullous dystrophy complicated by pneumothorax. Bullous emphysema of the lung is a local alteration of lung tissue characterized by the destruction of alveolar septa and the formation of air cysts with a diameter of more than 0.5 cm (bullae), the walls of which are lined with alveolar epithelium (with lung tissue density below -860 HU). The aim of the study was to determine effective tactics and select a rational type of surgical intervention in cases of spontaneous pneumothorax where complete lung re-expansion was not achieved through drainage. It was found that men are affected 5-10 times more often than women, predominantly among patients with bronchopulmonary diseases. By draining the pleural cavity, complete lung re-expansion was achieved within 7-10 days in 273 patients (66.3%), within 11-30 days in 16 patients (3.9%), while 123 patients (29.9%) required surgical intervention for full lung re-expansion.

MODERN VIEW ON THE PROBLEM OF ANTIBIOTIC RESISTANCE IN PULMONOLOGY AND PHTHISIATRY (LITERATURE REVIEW)

Introduction. The problem of antibiotic resistance (AR) is threatening for patients with respiratory tract diseases (RTD). The use of antibiotics in the treatment of pneumonia, which can be prescribed in the schemes for the tuberculosis (TB) treatment, creates the prerequisites for the formation of chemoresistance of mycobacterium tuberculosis (MBT). The purpose of our research is to analyze the scientific literature on the causes and factors of the occurrence of AR of the сommon RTD pathogens (pneumonia, tuberculosis). Materials and methods. The information on AR of pneumonia and tuberculosis causative agents obtained from scientific publications published in the «pubmed» and «scopus» databases has been analyzed. Results. The main factors causing AR in European countries today are: low awareness of the public and medical professionals about AR, over-the-counter purchase of antibiotics, use of antibiotic residues, the desire of doctors to avoid complications of the disease, advertising of pharmaceutical products, frequent lack of diagnostic tests to detect common infections. The vast majority of antibiotic prescriptions in ambulatory practice are for the treatment of respiratory tract infections, but up to 90% of them are unwarranted. Сoncomitant diseases of the patient (chronic kidney disease, bronchopulmonary diseases, liver diseases), previous colonization of the oropharynx with AR pathogens, bedridden state, age up to 2 years can be risk factors for AR of pneumonia pathogens. The physician should be alert for M. tuberculosis infection and perform appropriate diagnosis in patients with suspected pneumonia, especially in children, the elderly, and patients with HIV and comorbidities. It has been established that less than 65 years of age, living in a large family, history of TB treatment, contact with TB patients, history of hospitalization and visits to medical institutions, TB/HIV co‑infection, bad habits (smoking, alcohol consumption), glycosylated hemoglobin level ˃ 7% were risk factors for chemoresistant TB in adults. Risk factors for chemoresistant extrapulmonary TB in children were: up to 1 year of age, living in a village, poor family income, contact with bacterial isolates of resistant MBT strains, lack of BCG vaccination, concomitant pathology. Conclusions. In order to reduce the prevalence of AR of the RTD pathogens, clear algorithms for prescribing antibiotics should be developed, patients should be trained in their correct use, and methods of diagnosing common infections should be improved. In order to overcome CR TB, it is necessary to detect patients in time and block the transmission of infection, develop clear control algorithms for the detection and treatment of CR TB in risk groups, for example, among patients with diabetes, intensify the development of drugs with new mechanisms of action, initiate testing for the detection of TB in risk groups with suspected pneumonia.

Анализ состояния микрососудистого русла и планирование реабилитационных мероприятий у детей после перенесенной новой коронавирусной инфекции

Aim: to analyze microcirculation in children who recovered from coronavirus disease 2019 (COVID-19) in order to identify microcirculatory disorders and their association with clinical symptoms and to design rehabilitation measures Patients and Methods: the study included 78 children aged 7–15 years who recovered from COVID-19. All children had negative SARS- CoV-2 RNA tests (oropharyngeal and naso-pharyngeal swabs) by PCR and positive blood SARS-CoV-2 immunoglobulin class G (IgG). The control group included 30 healthy age-matched children who did not experience COVID-19. Microcirculation was evaluated by slit lamp biomicroscopy for imaging bulbar conjunctival microvasculature with further morphometric processing of images. Exclusion criteria included inflammatory eye diseases, acute bronchopulmonary diseases or their exacerbation, arterial hy-pertension, and obesity grades 2 to 4. Results: a decrease in the count of capillaries, pre- and postcapillaries, and 1 st-order ar-terioles, as well as a decrease in the percentage of 1st-order arterioles were identified in indi-viduals who had been asymptomatic or had experienced mild COVID-19 symptoms 3 to 12 months prior. Additionally, an increase in the count of 1st-order venules and arteriolar venular anastomoses, 2nd-order arterioles and venules, and 1st-order arteries and veins was revealed. The coefficient of irregularity in venular caliber in severe cases of COVID-19 was 0.62±0.05, which was significantly (p<0.023) greater than that in asymptomatic cases of COVID-19 (0.43±0.03). This indicates a persistent reduction in venous tone Conclusions: our study demonstrated microvascular disorders in children in the long-term period following COVID-19, indicating a long-term maladaptation of microcirculation These children can be classified as belonging to the risk group for microcirculatory disorders in the post- COVID period. KEYWORDS: children, COVID-19, long COVID, microvasculature, capillaries, venules, arterioles, microcirculation. FOR CITATION: Mikheeva I.G., Kurasova O.B., Milekhina M.Yu., Moiseev A.B., Kuznetsova N.I., Kalinovskaya I.I., Zimina N.A., Vereshchagina T.G. Study of microcirculation and the scheduling of rehabilitation measures in children who have recovered from coronavirus disease 2019. Russian Journal of Woman and Child Health. 2024;7(2):171–176 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-13.

Influence of adipocytokines on the bronchopulmonary system in abdominal obesity

Pathogenesis of chronic lung diseases is assumed to involve systemic inflammation factors, as well as hormone-like substances adipokines produced by adipose tissue, which is an independent endocrine organ. Adipokines cause systemic inflammation under the influence of hypoxemia due to obesity and associated respiratory disorders such as obstructive sleep apnea syndrome, chronic obstructive pulmonary disease, hypoventilation syndrome, etc. However, the influence of specific adipocytes on the development and course of bronchopulmonary diseases remains unclear.Purpose of this review was to evaluate the contribution of some adipocytokines to the development of bronchopulmonary conditions against abdominal obesity. We collected data on adiponectin, adipsin, lipocalin-2, interleukin 6, insulin, glucagon, leptin, monocyte-chemoattractant protein type 1, tumor necrosis factor-α, amylin, glucose-dependent insulinotropic polypeptide, ghrelin, and pancreatic polypeptide in patients with abdominal obesity and bronchopulmonary disorders.Conclusion. The presented data confirm that hormone-like substances produced by adipose tissue make a significant contribution to the severity of respiratory disorders.