Bronchopulmonary System Research Articles

Urticaria-like rash in a patient with COVID-19 associated pneumonia of moderate severity: aspects of pathogenesis

In mid 2020, the number of new coronavirus (COVID-19) cases has exceeded globally six million. The clinical manifestations of COVID-19 infection are numerous mostly causing damage to the bronchopulmonary system in the form of a dry cough, rhinitis, dyspnea, fever, myalgia, and general weakness. Skin manifestations of COVID-19 are rare and currently include five types of skin lesions occurring during the infection process, which are reliably recorded in only a limited number of case reports and certain analytical publications. This article describes the clinical case of a 28-year-old patient with urticaria-like disseminated rash and confirmed COVID-19-associated pneumonia.

Role and place of modern innovative medical technologies in treatment of viral pneumonia

Purpose. To show the role of modern innovative medical technologies in the treatment of severe viral pneumonia caused by the COVID-19 virus.Materials and methods. Clinical signs of coronavirus disease (COVID-19) were analyzed. Aspects of treatment of COVID-19 with the use of heated helium-oxygen mixture (HHOM) by applying Ingalit-V2-01 apparatus are shown.Results and discussion. Successful use of Ingalit-V2-01 apparatus in 17 patients is shown.Conclusion. Positive curative effect of modern high-technology innovative Ingalit-V2-01 apparatus, which provides a heated temperature up to 90–100° With a respiratory gas mixture of oxygen and helium together with an anticoagulant and surfactant in the early stages of coronavirus infection, it is associated not only with local (bronchopulmonary system), but also with systemic action on body.

Clinical and experimental studies of immunо-infl ammatory mechanisms of anthracosilicosis formation

Introduction. In the structure of occupational diseases of employees of the main professions of the coal industry, respiratory diseases are widespread, in the process of formation of which the key role belongs to the immune system of the body. Early manifestations of the development of professional pathology, as a rule, remain unnoticed, and therefore there is a need to study the pathogenetic mechanisms underlying its formation, not only in clinical, but also in experimental conditions, allowing to assess the premorbid state of the body for timely diagnosis and treatment and prevention.The aim of the study is to study the immune-infl ammatory mechanisms of anthracosilicosis formation on the basis of clinical and experimental studies.Materials and methods. We examined 204 miners working in underground conditions with a signifi cant dustiness of workplaces exceeding the maximum permissible concentration by 10 or more times. Th e main group consisted of 115 workers with a previously established diagnosis of “anthracosilicosis”. Th e comparison group was formed from 89 miners without a diagnosis of respiratory pathology, working in similar sanitary conditions. To assess the dynamics of immuno-infl ammatory mechanisms in the experiment, modeling of dust pathology of the lungs was performed on 310 white male laboratory rats (220-experimental and 90 — control).Results. In patients with anthracosilicosis, the development of immune failure of humoral immunity mechanisms was revealed, which was manifested by a signifi cant decrease in the level of serum IgG against the background of an increase in the absolute and relative number of B-lymphocytes. Th e formation of anthracosilicosis is characterized by the active development of the immuno-infl ammatory process (an increase in the level of pro-infl ammatory cytokines and proteins of the acute phase of infl ammation), the severity of which increases when the disease is complicated by respiratory failure. Activation of the synthesis of anti-infl ammatory IL-4, which is a powerful inhibitor of macrophage infl ammation and slows down the processes of fi brosis in the bronchopulmonary system, acts as a protective mechanism that prevents the formation of respiratory failure in miners with anthracosilicosis. Experimental modeling of anthracosilicosis revealed phase changes in the immune response. In the early period of exposure to dust factor was observed activation of humoral (increased level of all classes of immunoglobulins) and the subsequent development of the inflammatory process (increased concentrations of acute phase proteins of inflammation) in the background of the balance between subpopulations of T-lymphocytes to ensure proper development of protective immune response. Long-term intake of antigen was characterized by violations of humoral immunity, the predominance of cell-type reactions and the chronization of the infl ammatory process.Conclusions. Th e study of immuno-infl ammatory mechanisms of anthracosilicosis formation in clinical and experimental conditions indicates the activation of urgent adaptation and maintenance of compensatory and adaptive reactions of the body in the early period of contact with dust antigen. Th e chronic form of anthracosilicosis is characterized by an imbalance of regulatory mechanisms, ineffi ciency of local immunity and the intensive development of generalized immune infl ammation, which increases with the addition of infection and complication of respiratory failure.

Intersectoral component of the structural and functional management model: a methodology for developing regional prevention programs and evaluating its effectiveness (for example, the child population of certain administrative regions of Ukraine)

Modern ideas about comprehensive assessments of the level of health are based on synthetic (complex, integral, multidimensional) indicators, the requirement for which is the need to take into account various (by origin and methods of obtaining) health indicators both at the individual and population, regional levels. In recent years, many methodological methods have been processed to obtain a comprehensive qualitative and quantitative assessment of the state of individual health. Obtaining a generalized qualitative and quantitative assessment remains the most important methodological task of modern theory and practice of public administration and public health. The purpose of the study was to develop a methodology for substantiating intersectoral regional prevention programs and an algorithm for evaluating their effectiveness using the example of a dysplastic-dependent pathology of the bronchopulmonary system in children. In developing and justifying population-based management models for early diagnosis and primary prevention, we used systematic population modeling methods. The expected indicators of the pathogenic and sanogenic effects of the most significant regional and environmental factors of the dysplastic-dependent pathology of the bronchopulmonary system among children are determined. Substantiated models of end results for modification of risk factors and the expected effectiveness of the N-factor regional and environmental program for the primary prevention of dysplastic dependent pathology of the bronchopulmonary system in children. Priority areas for the implementation of regional-population programs for the prevention of dysplastic-dependent pathology of the bronchopulmonary system in children due to the impact on controlled environmental environmental factors are determined. An example of calculating the expected effectiveness of children's health management through interdepartmental interaction at the regional level is given. Prospects for further research on this issue related to a prospective evaluation of the effectiveness of intersectoral programs to reduce the influence of regional environmental factors on the health status of the child population, in particular, dysplastic-dependent pathology of the bronchopulmonary system.

Nitrogen leaching in multiple breathing and structural changes in the bronchopulmonary system in adult patients with cystic fibrosis

The aim of this work was to assess the functional and structural disorders of the bronchopulmonary system detected by high-resolution computed tomography (HRCT) in adult patients with cystic fibrosis (CF), and to determine the correlation between them.Methods. A cross-sectional study included patients with CF (n = 54: 20 male and 34 female; median age 25 years) and healthy volunteers (n = 32: 12 male, 20 female; median age 25 years). A complex study of the pulmonary function test (PFT) was carried out; it included spirometry, bodyplethysmography and measurement of the diffusing lung capacity for carbon monoxide (DLCO), nitrogen leaching in multiple respiration (NLMR) and HRCT. Dyspnea was assessed using the Modified Research Council Scale (mMRC). NLMR measurements were performed using the Easy-One Pro module, MBW (NDD Medizintechnik AG, Switzerland). Analysis of HRCT data according to the Bhalla classification was performed by two independent, experienced radiologists.Results. The mean value (± SD) of the forced expiratory volume for 1 second (FEV1) was 63 ± 26% of the proper value, forced vital capacity of the lungs (FVC) was 86 ± 20% of the proper value, the ratio of FEV1/FVC was 61 ± 15%; residual lung volume (RLV) was 220 ± 71% of the proper value, the ratio of RLV/ total lung capacity (TLC) was 48 ± 13%, intrathoracic gas volume was 150 ± 33% of the proper value, DLCO was 80 ± 16% of the proper value, lung clearance index (LCI) was 16.9 ± 5.0; moment ratio (MR2) was 54.7 ± 34.1. Bronchoectases with predominant lesions of > 9 segments and bronchial lesions from V generation and more distal were found in all patients. Peribronchial infiltration and mucoid plugs were also diagnosed in almost all patients (94 and 96%, respectively), while bronchogenic cysts or abscesses, atelectasis/consolidation, bullae or emphysema were rarely detected (in 30, 35, 20, and 17% of cases, respectively). The parameters of NLMR were statistically significantly correlated with both the PFT parameters and the HRTC data.Conclusion. In adult patients with CF, there is a significant unevenness of pulmonary ventilation, progressing as structural damage to the bronchopulmonary system increases and the PFT worsens. With a statistically significant increase in MR, the involvement of not only the central, but also peripheral airways in the pathological process is emphasized. It has been established that in adult CF patients there is a strong correlation between LCI and the severity of structural changes, detected by HRCT, comparable in strength and significance to FEV1.

Dynamics of resistance of Streptococcus pneumoniae strains to antibacterial drugs for the period 2015–2019 in Samara: opportunities for overcoming

According to the World Health Organization (WHO), diseases caused by Streptococcus pneumoniae are one of the most dangerous diseases, that can be completely prevented by vaccination. Studies conducted in various regions of the Russian Federation and other countries have revealed certain features in the prevalence of pneumococcus strains, resistant to different antibacterial drugs, which requires local studies among patients of different age groups.The aim of the study was to determine the level of sensitivity of S. pneumoniae, isolated from adult patients, to antibacterial drugs (ABD) and the dynamics of resistance to ABD in Samara for the period of 2015–2019.Methods. A retrospective analysis of data from the microbiological department of clinical diagnostic laboratories of the Clinics of Samara State Medical University, Healthcare Ministry of Russia for 2015–2019 was carried out. The microorganism resistance to several groups of ABD was studied – macrolides (erythromycin, azithromycin, clarithro mycin), cephalosporins (ceftriaxone, cefotaxime), fluoroquinolones (levofloxacin) and penicillin. The sensitivity was determined by the disk diffusion method. Statistical processing was performed using the SPSS Statistic 22.0 program. When comparing groups, the χ2 criterion was used; to compare small groups (n < 5), the exact Fisher test was used.Results. Since 2017, there has been a tendency to increase the frequency of pneumococcus isolation in the carrier group. At the same time, a 3-fold decrease in S. pneumoniae excretion from patients with ENT pathology occurred. The highest sensitivity was detected for cephalosporins – 100% sensitivity of all S. pneumoniae strains, detected from ENT organs and during carriage. There is a low level of pneumococcus resistance to levofloxacin. The general sensitivity to ABD from penicillin group is 96.4–98.8%, while the most common resistant strains were found in patients with respiratory tract damage. The highest resistance of S. pneumoniae was revealed to ABD from the macrolide group with a tendency to increase from 4.6% in 2016 to 14.0% in 2019.Conclusion. According to the study results, a rather low level of resistance of S. pneumoniae to most ABD groups, with the exception of macrolides, was demonstrated in Samara. The greatest number of ABD-insensitive pathogens was isolated in patients with pathology of the bronchopulmonary system. A mandatory microbiological examination of the sputum of such patients is necessary with a determination of the sensitivity of the isolated microorganisms to ABD and subsequent correction of therapy upon the identification of resistant strains. Given the increasing resistance of S. pneumoniae in carriers, it is necessary to vaccinate patients in this group.

Risk and management of patients with mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) pandemic: Expert opinions

The coronavirus disease 2019 (COVID-19) (caused by severe acute respiratory syndrome coronavirus 2) pandemic has massively distorted our health care systems and caused catastrophic consequences in our affected communities. The number of victims continues to increase, and patients at risk can only be protected to a degree, because the virulent state may be asymptomatic. Risk factors concerning COVID-19–induced morbidity and mortality include advanced age, an impaired immune system, cardiovascular or pulmonary diseases, obesity, diabetes mellitus, and cancer treated with chemotherapy. Here, we discuss the risk and impact of COVID-19 in patients with mastocytosis and mast cell activation syndromes. Because no published data are yet available, expert opinions are, by necessity, based on case experience and reports from patients. Although the overall risk to acquire the severe acute respiratory syndrome coronavirus 2 may not be elevated in mast cell disease, certain conditions may increase the risk of infected patients to develop severe COVID-19. These factors include certain comorbidities, mast cell activation–related events affecting the cardiovascular or bronchopulmonary system, and chemotherapy or immunosuppressive drugs. Therefore, such treatments should be carefully evaluated on a case-by-case basis during a COVID-19 infection. In contrast, other therapies, such as anti–mediator-type drugs, venom immunotherapy, or vitamin D, should be continued. Overall, patients with mast cell disorders should follow the general and local guidelines in the COVID-19 pandemic and advice from their medical provider.

A RARE CASE OF BILATERAL OBSTRUCTIVE MEGAURETER WITH A GIANT URETRAL URETEROCELE ON THE LEFT

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

Drug Safety Issues in Therapy COVID-19

One of the serious problems of modern Health care is a new coronavirus infection — COVID-19, which has been declared a global pandemic by the World Health Organization and has covered more than 190 countries. Despite the measures has been taken to limit contacts between people and isolate patients with suspected coronavirus infection, the number of cases grows exponentially every day. Leading laboratories are working on a vaccine, but according to some optimistic forecasts, it may be available no earlier than 11-12 months. According to published data on attempts using various drug regimens in clinical trials, methodological manuals and clinical guidelines for patient management are constantly being developed and updated depending on the severity of the condition. The appointment of a number of drug combinations should be carried out taking into account the definition of an individual assessment of the benefits and risks, because there is ample evidence of serious side effects. More serious lung tissue lesions are characteristic of patients of an older age group (over 60 years old) with the presence of concomitant diseases, such as cardiovascular, cerebrovascular, diabetes mellitus and obesity, diseases of the bronchopulmonary system and kidneys, which implies taking basic therapy in a constant mode. The appointment of a number of drug combinations should be carried out taking into account the definition of an individual assessment of the benefits and risks, because there is enough evidence of serious side effects, such as the QT interval prolongation, hepatotoxicity, adverse events from the central nervous system. It is necessary to evaluate the interaction of drugs used to treat infections caused by the COVID-19 virus with drugs used in outpatient practice.

Diagnosis and Treatment of Developmental Defects of the Bronchopulmonary System in Children

Diagnosis and Treatment of Developmental Defects of the Bronchopulmonary System in Children

Peculiarities of respiratory pathology of young cattle in the lower Volga region Russian Federation

An important element in solving problems relating to the preservation of young cattle livestock and production increase of livestock products is a timely diagnosis, prevention and treatment of diseases of non-communicable etiology, among which one of the most common is bronchopneumonia. Therefore, the development of effective methods of treatment and prevention of this pathology is an urgent problem of veterinary medicine. Despite a large number of scientific researches, many issues of etiology, pathogenesis, treatment and prevention of this disease remain insufficiently studied, especially the state of the natural resistance of calves suffering from catarrhal bronchopneumonia, which is the basis for choosing a method of treatment and prevention of this disease. The disease leads to calves deep, sometimes irreversible disturbances of bronchopulmonary system functions. Lung function is one of the first to be disrupted, playing an important role in the protective immunological reactions of the body, through which there is an increase in virulence of microorganisms, which leads to the general intoxication and severe bronchopneumonia. The situation on non-specific bronchopneumonia of calves in the Lower Volga region is tense, but it is to the same extent as in other regions having problems with this pathology. It is obvious that the susceptibility of calves to respiratory diseases is formed under the influence of antenatal influences and is manifested in the presence of adverse environmental factors leading to depletion of reserves adaptation in the first months of animal life. The obtained set of regional characteristics of bronchopneumonia of non-infectious etiology allows to consider this pathology as an indicator of the ecological unwell-being of big cattle herds in the Lower Volga region.

ANTIOXIDANT PROVISION AND INSTRUMENTAL METHODS FOR EXAMINING PATIENTS WITH CHRONIC BRONCHITIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE, WHO ARE EMPLOYED IN ENGINEERING INDUSTRY

Introduction. In the pathogenesis of inflammatory diseases of the bronchopulmonary system, free radical oxidation is known as one of the leading chains, which is able to damage the pulmonary structures. Activation and deepening of lipid peroxidation processes, which play an important role in the progression of pathology, promote toxic effects of metabolites onto the myocardium, bronchial wall and aggravate ischemic changes. Chronic bronchitis and chronic obstructive pulmonary disease are quite prevalent among employees at the machine-building industry due to occupational environment. Materials and methods. The study included 66 machine-building industry employees with chronic bronchitis: 34 of them working at places harmful to their health make up the main group of patients, and 32 patients, who are not exposed to any occupational harm, make up the control group). Among 66 surveyed women, 34 and 32 men and 64 patients with chronic obstructive pulmonary disease I and II classes. 33 of the employees working at the places with unfavourable conditions make up the main group of patients, and 31 patients are not being exposed to occupational harm (control group). 66 subjects involved into the study include 33 women and 31 men. All the subjects were compared with the group of comparison made up of 31 healthy individuals. The average age of the subjects was 48.0 ± 2.5 years, the average length of their employment was 15.8 ± 3.2 years. The study was carried out at the Municipal Clinical Hospital №1 in Poltava. Results. The main pathogenetic feature of chronic obstructive pulmonary disease demonstrated by the patients is the more pronounced intensity of the inflammatory process in the bronchopulmonary apparatus that is manifested by more marked changes in different organs and systems. Harmful occupational factors have been found out to produce adverse effect on the cardiovascular system: the patients with chronic bronchitis are found out to have atrial fibrillation (15.8%), and the patients with chronic obstructive pulmonary disease have premature heartbeats (30.3%) and signs of overload of the right heart chambers (42.4%). The effect of harmful factors onto the patients with chronic bronchitis led to more serious disorders in the state of lipid metabolism and lipid peroxidation that was manifested by the significant increase in the blood serum content of β-lipoproteins, malonic dialdehyde and ceruloplasmin by 6.3% ± 0.41%, 12,66 ± 0.83% and 12,0% respectively, compared to the patients who worked in healthier occupational environment. The patients with chronic bronchitis working at various places did not differ in catalase activity, but differed in the content of ceruloplasmin (the employees working in harmful conditions its content was higher by 12.0%). In chronic obstructive pulmonary disease, the effect of harmful occupational factors contributed to the activation of lipid peroxidation in the form of a significant increase in serum β-lipoprotein content by 6.45 ± 0.63%, as well as increase in the level of spontaneous erythrocyte haemolysis by 20.35 ± 1.8% and malonic dialdehyde by 10.11 ± 0.47 % compared to the employees working in the healthy occupational environment. Disturbance of antioxidant supply in these patients were manifested by reduced catalase activity by 20.74 ± 1.39% and increased content of ceruloplasmin, by 14, 32 ± 0.84% ​​compared with those working in the safe environment. In general, both in chronic bronchitis and chronic obstructive pulmonary disease, the effect of occupational harmful factors has contributed to the additional activation of lipid peroxidation and the reduction of the body antioxidant provision, more pronounced in chronic obstructive pulmonary disease. Conclusions. Thus, the influence of occupational harmful factors leads to a more severe clinical course of chronic bronchitis and chronic obstructive pulmonary disease accompanied by more pronounced disorders of free-radical lipid oxidation, which adversely affect the cardiovascular system.

Peculiarities of bronchopulmonary pathology depending on polymorphic variants of MMP-1 and a1-AT genes

The presence of unfavorable variants of the MMP-1 G1 gene in 47% and G2 in 15% of patients with occupational diseases of the bronchopulmonary system was shown. In patients with occupational chronic bronchitis revealed the presence of hypersecretory variant of the gene MMP-1 in 87% (x2=5,32, р=0,021). The combination of unfavorable variants of genes MMP-1 and a1-at leads to a more severe course of occupational bronchopulmonary pathology.

PREOPERATIVE AND POSTOPERATIVE PULMONARY REHABILITATION IN PATIENTS WITH LUNG CANCER AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study was to analyze the world experience in the objective assessment of the functional state of the bronchopulmonary system in lung cancer patients with chronic obstructive pulmonary disease (COPD) using modern diagnostic tools and techniques as well as correction of ventilation disorders in the perioperative period using long-acting inhaled bronchodilators. Material and methods. A literature search was conducted using the Medline, Elibrary etc. databases. Out of 112 publications concerning the study of the incidence of lung cancer and COPD, external respiration function and rehabilitation of patients, 37 were included in this review. R esults. COPD was shown to be the major cause of postoperative non-surgical complications and the main predictor of perioperative mortality in lung cancer patients. Modern techniques for studying the function of external respiration, such as bodyplethysmography, spirography, high-resolution computed tomography, ventilation and perfusion lung scintigraphy, were highlighted. It was shown that preoperative correction of obstructive syndrome and postoperative pulmonary rehabilitation, including drug therapy with long-acting bronchodilators in combination with smoking cessation, eradication of foci of chronic infection and respiratory gymnastics were necessary to detect functional respiratory disorders in lung cancer patients with COPD. Conclusion. To date, there are no standards clinical practice guidelines for diagnostic testing and the correction of ventilation disorders in lung cancer patients with COPD in the pre- and postoperative periods. Therefore, further studies aimed at developing a diagnostic algorithm to improve the accuracy of detecting bronchial obstructive syndrome, especially in the early stages of COPD, as well as compensation for respiratory disorders using modern bronchodilator therapy are needed.

Occupational malignant neoplasms in the enterprise workers in the Russian Arctic

The purpose of the study was to investigate the risk factors, prevalence and structure of occupational malignant neoplasms (OMN) in the Arctic zone of Russia. Materials and methods. The monitoring data «Working conditions and occupational morbidity» of the population of the Arctic zone of Russia in 2007–2018 were studied. Results. It was established that in 2007–2018, the risk of forming OMN was created by dust aerosols and carcinogenic chemicals, as well as ionizing radiation. Their average annual shares in the overall structure of harmful production factors were 0.66 %, 1.10 % and 0.45 %. OMN (67 cases) developed mainly among male workers of non-ferrous metallurgy enterprises, miners of coal and copper-nickel mines (86.6 %) aged 51–60 years and with the experience of 21–30 years. The main risk factors were nickel compounds and, to a lesser extent, carbon and silicon dioxide dust, exposure to which arose due to imperfection of technological processes and sanitary installations, design flaws of machines and other equipment. The risk of OMN when exposed to chemical carcinogens was higher than to dust aerosols (RR = 3.64; CI 1.79–7.38).The typical localizations for neoplasms were the broncho-pulmonary system (56.7 %) and the stomach (23.9 %). In 2007–2011, the share of OMN in the structure of occupational pathology was 0.84 %, decreasing in 2014–2018 to 0.44 %. Conclusion. The priority in the prevention of cancer pathology in the Russian Arctic is to reduce the exposure of workers to nickel compounds by improving working conditions and personal protective equipment, especially for respiratory organs.

An analysis of how senior students of the Medical Institute know basic concepts of bronchopulmonary system diseases

Respiratory diseases are one of the most pressing problems of modern internal medicine, which is associated with their prevalence, significant impact on the quality of life and social activities of a person. This study is done not only by the complexity of diagnosis and treatment of major respiratory diseases, but also by the rapid development of modern pulmonology. The paper determines the level of knowledge of COPD and community-acquired pneumonia basic concepts among students of 5-6 courses at the Medical Institute of National Research Ogarev Mordovia State University majoring in General medicine with the use of an anonymous questionnaire. The survey was conducted using questionnaires developed on the basis of clinical national recommendations for chronic obstructive pulmonary disease and community-acquired pneumonia. The study found that less than half of senior students do not give correct answers to basic questions about the etiology, pathogenesis, clinical picture or treatment of chronic obstructive pulmonary disease (COPD). More than half of 5-year-students have difficulties answering questions about the etiology, classification, diagnosis, and treatment of community-acquired pneumonia. The results of the survey predispose to additional educational solutions in the field of chronic obstructive pulmonary disease, community-acquired pneumonia and to focus more on prevention and therapy.

Hyaluronic acid as a marker for remodeling of bronchopulmonary system in patients with occupational pulmonary pathology

Currently there is no convincing evidence concerning pathogenetic mechanisms of fibrous and sclerotic processes in pulmonary tissue as well as processes of bronchopulmonary system remodeling in patients with chronic obstructive pulmonary disease (COPD) of occupation etiology (OE).The purpose of the study was to identify relationship between the serum hyaluronic acid (HA) level and severity of obstructive pulmonary ventilation impairment according to spirometry data in subjects with COPD associated with the impact of silica-containing dust and chronic occupational non-obstructive (common) bronchitis (CONB) of occupational etiology.Materials and Methods. Patients (n = 153) with the diagnosis OE COPD (n = 92), OE CONB (n = 36) and healthy subjects participated in the study.Results. The study data demonstrated that serum HA level in patients with OE COPD and CONB was 3–5 times higher than that in healthy subjects (p = 0.0001). In patients with OE COPD HA concentration was significantly higher, than that in subjects with OE CONB (p = 0.039). Negative correlation between HA concentration and forced expiratory volume in 1 second value was observed (p = 0.006; R = –0.31). There was statistically significant positive correlation between HA level and disease duration (р = 0.021; R = 0.21).Conclusion. Serum HA level in patients with OE-related COPD and CONB may be used as a biomarker of fibrous and sclerotic process in pulmonary tissue, reflecting progression of obstruction and remodeling of small bronchi.

Participation of Free-Radical Processes in Structural and Metabolic Disturbances in the Lung Tissues Caused by Exposure to Coal-Rock Dust and their Adaptogenic Correction.

Adaptive correction of structural and metabolic disturbances in the lungs caused by longterm exposure to coal-rock dust were studied in experiments on rats. It was shown that the complex antioxidant preparation containing dihydroquercetin compensated disturbances in the redox balance in the lung tissue, prevented the formation of dust granulomas, and reduced the severity of degenerative changes in the bronchopulmonary system.

Health management at the regional level: multivariable performance assessment

This article provides an analysis of areas for improving the state policy bases in public health services. The purpose of the research is to substantiate and develop systematized regulatory support for the structural-functional care model for children in particular regions. The authors systematized the legislative acts on the health technologies introduction in the structural-functional model. To achieve the study goal, the authors used a systematic approach to provide quantitative and qualitative analysis of the organization and optimization of medical-social justification of the structural-functional model; bibliosemantic – for the analysis of national and international experience in providing medical care to patients; epidemiological – to determine the levels, structure and dynamics of morbidity and prevalence of pathology in childhood; statistical – for collecting, processing and analyzing received information. The article presented the authors’ development on regulatory support for the structural-functional medical model components for children. Besides, special attention was paid to the improvement of health technologies in regional health care systems. The authors identified areas for implementing the legislative initiative to improve the regulatory support for medical care provision. This paper provides the author’s regulatory support of structural-functional medical model’s components toward children with bronchopulmonary dysplasia and dysplastic pathology of the bronchopulmonary system. The authors emphasized the improvement of health technologies in regional health care systems. To improve the area of legislative and regulatory support, the study identified the directions for implementing the legislative initiative. Based on the study results, the authors proposed considering 7 legislative acts of Ukraine on improving the normative-legal provision of components of the structural-functional model. The obtained results could further assess their impact on implementing health technologies at the regional, municipal and family levels.

Difficulties in diagnosing of measles inclusion body encephalitis in a child with acute lymphoblastic leukemia

The measles epidemic was observed in Ukraine during 20172019. According to WHO, in Ukraine there was registered the highest number of measles cases in Europe during that period [8]. Measles is characterized by an acute course with fever, maculopapular rash, cough, conjunctivitis and can lead to central nervous system complications (encephalitis, encephalomyelitis) and bronchopulmonary system complications (laryngotracheobronchitis, bronchiolitis, pneumonia). In immunocompetent patients, viremia ends after the end of clinical signs, in contrast to immunosuppressed individuals, who could develop viremia from one month up to a year. We have described a case of measles inclusion body encephalitis (MIBE) or subacute measles encephalitis (SME) in an unvaccinated child with an acute lymphoblastic leukemia (ALL). The diagnosis was confirmed by the synthesis of IgG antibodies to the measles virus in the cerebrospinal fluid and by the MRI results. The disease had a dramatic course and ended in death.