Bronchopulmonary Systems Research Articles

Pediatric inflammatory bowel diseases, features of the disease course: a clinical case of complicated course of ulcerative colitis

The article is devoted to one of the urgent problems of pediatric gastroenterology – inflammatory bowel diseases (IBD), which currently include ulcerative colitis (UC) and Crohn’s disease (CD). The prevalence of IBD is inferior to other gastroenterological diseases, but according to the severity of the course, the frequency of complications and the level of mortality, IBD occupy one of the leading places in the structure of diseases of the gastrointestinal tract. The problem of IBD constantly attracts the attention of doctors of various specialties – pediatricians, gastroenterologists, surgeons and others. This is due to an increase in the incidence of this pathology, a variety of clinical manifestations, including extra-intestinal manifestations, faced by doctors of various specialties. In childhood, there is more often a greater prevalence of the lesion, a less specific and erased picture, there is an impact on the physical development of the child. The article provides information on the prevalence, significant factors in the development of the disease; research data revealing the relationship between taking med ications and the risk of IBD onset. The problems of the pathogenesis of the disease, the significance of the genetic status in the development of CD and UC are described. The article presents data on the features of the clinical picture of UC in childhood, recommendations for the primary diagnosis of IBD, including modern laboratory and instrumental research methods. The article also describes the recommended international criteria for assessing the severity of IBD and the problems of differential diagnosis. As a demonstration, the authors’ own observations are presented. The clinical example describes an atypical case of UC in a teenager, occurring with the involvement of the cardiovascular, bronchopulmonary and urinary systems with the development of polyserositis. Early diagnosis of IBD is necessary to prevent disability of patients, ensure further development of the child, improve the quality of life.

Future therapeutic strategies in the treatment of extrapulmonary neuroendocrine carcinoma: a review.

Neuroendocrine neoplasms (NENs) are rare malignancies arising most commonly in the gastrointestinal and bronchopulmonary systems. Neuroendocrine carcinomas (NECs) are a subgroup of NENs characterised by aggressive tumour biology, poor differentiation and dismal prognosis. Most NEC primary lesions arise in the pulmonary system. However, a small proportion arise outside of the lung and are termed extrapulmonary (EP)-, poorly differentiated (PD)-NECs. Patients with local or locoregional disease may benefit from surgical excision; however, this is often not an option, due to late presentation. To date, treatment has mirrored that of small-cell lung cancer, with platinum-etoposide forming the basis of first-line treatment. There is a lack of consensus in relation to the most effective second-line treatment option. Low incidence, an absence of representative preclinical models and a lack of understanding of the tumour microenvironment all present challenges to drug development in this disease group. However, progress made in elucidating the mutational landscape of EP-PD-NEC and the observations made in several clinical trials are paving the way towards improving outcomes for these patients. The optimisation and strategic delivery of chemotherapeutic interventions according to tumour characteristics and the utilisation of targeted and immune therapies in clinical studies have yielded mixed results. Targeted therapies that complement specific genetic aberrations are under investigation, including AURKA inhibitors in those with MYCN amplifications, BRAF inhibitors in those with BRAFV600E mutations and EGFR suppression, and Ataxia Telangiectasia and Rad3-related inhibitors in patients with ATM mutations. Immune checkpoint inhibitors (ICIs) have conferred promising results in several clinical trials, particularly with dual ICIs and in combination with targeted therapy or chemotherapy. However, further prospective investigations are required to elucidate the impact of programmed cell death ligand 1 expression, tumour mutational burden and microsatellite instability on response. This review aims to explore the most recent developments in the treatment of EP-PD-NEC and contribute towards the requirement for clinical guidance founded on prospective evidence.

Heterogeneity of phenotypic manifestations of cystic fibrosis in children and predictors of the disease severity

The aim of the study was to investigate the heterogeneity of phenotypic manifestations of cystic fibrosis (CF) in children depending on the CFTR gene mutation and to determine predictors of the disease severity for the personalization of treatment and prevention of complications. Materials and methods. Fifty-nine children with CF, aged 1 to 18 years (mean age was 12.0 (8.5; 15.0) years), were examined. All patients underwent general clinical, genetic, laboratory and microbiological examination. Instrumental methods of examination included spirometry, chest X-ray and computed tomography, ultrasound densitometry. According to the functional effects of CFTR mutations, the patients were divided into two groups. The group with “severe” genotypes (n = 40) included patients with two class I and/or II mutations, and the group with “mild” genotypes (n = 10) included patients with at least one class IV or V mutation. Mutations were not identified in 9 patients. Results. Analysis of the spectrum of genetic variants in the CFTR gene showed that 10 patients (20.0 %) were identified with the “mild” genotype, and 40 patients (80.0 %) with the “severe” genotype. The most common mutation was F508del predominantly in the compound heterozygous state (42.4 %). It was found that patients with the “mild” genotype were characterized by a more favorable course of the disease than patients with the “severe” genotype. No statistically significant phenotypic features of the CF course in children depending on the F508del mutation status (F508del/F508del or F508del/nonF508del) were found, except for earlier formation of pulmonary hypertension in patients with the homozygous condition (47.1% vs 16.0 %, P < 0.05). Conclusions. Examination of the relationship between CFTR genotype and phenotype has revealed associations between CFTR mutations and lesion severity of both the digestive and bronchopulmonary systems. Identification of disease severity predictors can provide a more accurate prediction of the disease course, that will determine the patient management and prevent the development of complications.

Provision of Medical-psychological and Psychiatric Care to Patients with Post-covid Syndrome in Telemedicine Conditions

Objective. The need for scientific understanding of the revolutionary changes that have occurred associated with the situation of the COVID-19 pandemic, both in the organization of psychological and psychiatric care, and in the direction of developing effective treatment and prevention measures, determines the relevance of this study, the purpose of which is to study the clinical manifestations of psychopathological symptoms in patients, survivors of the COVID-19 disease, and develop a conceptual model for providing them with medical care in telemedicine. Materials and methods. We studied the psychopathological manifestations of post-covid syndrome in 129 patients who had recovered from COVID-19 and who applied to us for remote medical counseling psychological and psychiatric help for 10 months, from March to December 2020, using clinical psychopathological and psychodiagnostic test research methods. Results and Discussion. The high level of stress, anxiety and depression identified in the studied patients is primarily associated with the negative situation of the pandemic and the COVID-19 disease. A follow-up study proved the effectiveness of a treatment carried out in a telemedicine setting and combining cognitive-behavioral therapy with antidepressants and non-benzodiazepine tranquilizers. In patients who underwent a severe form of COVID-19, in the presence of premorbid chronic bronchopulmonary pathology, in addition to long-lasting psychopathological symptoms, somatic post-covid complications were also observed, and the stressfulness of the situation was perceived at a deeper personal level. For such patients, the course of treatment in telemedicine conditions should be extended and medical and psychological support provided during the entire period of convalescence. Conclusion. Chronic premorbid diseases of the bronchopulmonary and immune systems are predictors of long-term psychopathological symptomatology and the occurrence of post-covid somatic complications. The treatment tactics of patients with post-covid mental health disorders in telemedicine should be based on the protocols of cognitive-behavioral therapy for hypochondriacal and generalized anxiety disorder, in combination with antidepressants and tranquilizers of the non-benzodiazepine series, which ensures the stability of the positive results of therapeutic interventions, confirmed by our studies. The conceptual patientcentered model developed by us for the provision of psychological and psychiatric care for post-covid syndrome in telemedicine can be recommended as a universal algorithm for psycho-psychiatric interventions when providing remote assistance to patients with post-covid mental disorders. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 719-730

Abstract P119: Severe Paroxysmal Hypertension In Patient With Gastric Neuroendocrine Tumor Detected By PET Dotatate Imaging

Neuroendocrine tumors (NET) are rare neoplasms originating from neuroendocrine cells in the endocrine, gastrointestinal, or bronchopulmonary systems. When symptomatic, patients may present with paroxysmal HTN. A 51-year-old woman with CAD and prior CABG presented to the hospital with sudden onset headache and BP in the 200s/90s. Her physical exam was unremarkable. ECG showed new T wave inversions in leads V1 and V2 and high-sensitivity troponin was elevated at 1827 ng/L. CT angiography of her head and neck was normal. Her HTN improved with IV labetalol and pain control. We admitted her for BP control and secondary HTN evaluation. Initial lab findings were unremarkable (see table). A renal artery ultrasound showed no renal artery stenosis. CT of her chest, abdomen, and pelvis showed no evidence of NET. She continued to have paroxysms of severe HTN, initially controlled with IV medications, then transitioned to an oral four-drug regimen prior to discharge. Fractionated plasma metanephrines and catecholamines, and 24-hour urine fractional metanephrines were obtained (results pending at time of discharge).Follow up testing showed elevated urinary metanephrines and Chromogranin levels (see table), suggestive of NET. A Ga-68 PET-DOTATE scan showed a focus of increased activity in the anterior stomach. Endoscopy revealed a gastric body lesion, identified as grade 2, well-differentiated NET on biopsy. The patient underwent laparoscopic wedge gastrectomy with clear margins. Her headaches resolved, and BP improved. This case demonstrates the utility of Ga-68 PET DOTATE imaging in determining the presence of NET, not detected by CT images, as the reason for severe, paroxysmal HTN.

Association of hANP (rs5065) gene polymorphism with dust lung pathology and accompanying structural and functional changes in the myocardium among miners

Introduction. An important role in the mechanisms of regulation of the cardiovascular system is played by atrial natriuretic peptide, ANP, which is synthesized by the atria of the heart in response to physiological or pathogenetic stimuli. The polymorphism of the hANP (rs5065) gene has been studied in people with cardiovascular diseases, however, its contribution to the mechanisms of development of occupational and industrially caused pathology needs to be studied, since the complex impact of unfavorable factors of the production environment leads to the risk of developing combined pathology of the bronchopulmonary and cardiovascular systems in coal miners. The purpose was to study the association of hANP (rs5065) gene polymorphism with dust lung pathology and accompanying structural and functional changes in the myocardium among Kuzbass miners. Materials and methods. For genetic research, venous blood was taken from 179 Kuzbass miners. The main group consisted of 114 miners of the main professions with a previously proven diagnosis of "dust lung pathology", the comparison group included 65 individuals without a proven diagnosis working in similar sanitary and hygienic conditions. Isolation of genomic DNA from blood cells was carried out by phenol-chloroform extraction method followed by precipitation with ethanol. The polymorphic variant of the hANP (rs5065) gene was analyzed using real-time polymerase chain reaction. All workers underwent transthoracic echocardiography with the determination of structural and functional parameters of the left ventricle of the heart. Results. The chance of detecting the homozygous A/A genotype of the hANP gene in miners with dust pathology is 2.5 times higher than in the comparison group (χ2 - 7.190; p<0.008; OR - 2.453, CI 95% 1.262-4.768). The G/G genotype of the hANP gene is protective against the development of bronchopulmonary pathology in coal miners. In the miners with long-term work experience, a relationship between the presence of dust lung pathology and the development of diastolic dysfunction of the left ventricle of types 1 and 2 (χ2 - 9.922; p=0.002; OR - 5.117, CI 95% 1.842-14.218) was found. The heterozygous mutant A/G genotype of the hANP (rs5065) gene is a risk factor for the development of diastolic dysfunction of types 1 and 2 in underground workers of main professions (χ2 - 4.442; p=0.0036; OR - 2.433, CI 95% 1.057-5.879). Limitations. The study was limited to the number of miners who underwent periodic medical examinations and were hospitalized at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. The polymorphism of the hANP (rs5065) gene is associated with the development of occupational lung pathology and accompanying structural and functional changes in the myocardium among miners of the South of Kuzbass. Ethics. The examination of the patients corresponded to the ethical standards of the Bioethical Committee of the Research Institute for Complex Problems of Hygiene and Occupational Diseases developed in accordance with the Helsinki Declaration of the World Medical Association "Ethical Principles of Conducting Scientific Medical Research with Human Participation" (2000), as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation" approved by Order of the Ministry of Health of the Russian Federation No. 266 dated 19.06.2003. All patients signed an informed consent before the examination.

SYNCHRONUS TUMORS: A RARE COMBINATION

TYPE: Late Breaking Abstract TOPIC: Lung Cancer INTRODUCTION: Synchronous tumors refers to cases in which the second primary cancer is diagnosed within 6 months of primary cancer. Carcinoid tumors are rare slow growing tumors arising from the enterochromaffin cells disseminated through out the gastrointestinal and bronchopulmonary systems. Carcinoid tumors are innocuous at time of presentation emphasizing the need for multidisciplinary approach for the diagnosis. CASE PRESENTATION: A 80 year old male patient came with complaints of cough with expectoration on and off for 3 years increased since 1 week with occasional minimal hemoptysis, loose stools, loss of weight and loss of appetite. Chest X-Ray showed ill-defined opacity in the left lower zone. CECT showed two well defined heterogenous enhancing lesion in the superior and lateral basal segment of left lower lobe. Bronchoscopy guided biopsy revealed typical carcinoid. In view of recurrent diarrhea patient underwent endoscopy which revealed poorly differentiated adenocarcinoma. DISCUSSION: Gastrointestinal symptoms along with lung symptoms can be attributed to disseminated carcinoid or carcinoid syndrome. Carcinoid syndrome occurs in fewer than 5% of cases.It presents with symptoms like diarrhea, wheezing, palpitation’s, hypotension. In this case we were attributing the gastric symptoms to carcinoid syndrome. Endoscopy was done in view of diarrhoea which revealed a second malignancy. We lost the patient in view of dual primary within a month. Synchronous tumors with gastric carcinoid have been reported but to our knowledge carcinoid lung with adenocarcinoma of stomach have not been reported. CONCLUSIONS: All symptoms in a tumor patient should not be attributed to paraneoplastic syndromes and metastasis further workup should be done using a multidisciplinary approach. DISCLOSURE: No significant relationships. KEYWORD: Synchronous tumor

Drug-Induced Atrial Fibrillation / Atrial Flutter

Drug-induced atrial fibrillation / flutter (DIAF) is a serious and potentially life-threatening complication of pharmacotherapy. Purpose of the work: systematization and analysis of scientific literature data on drugs, the use of which can cause the development of DIAF, as well as on epidemiology, pathophysiological mechanisms, risk factors, clinical picture, diagnosis and differential diagnosis, treatment and prevention of DIAF. Analysis of the literature has shown that many groups of drugs can cause the development of DIAF, with a greater frequency while taking anticancer drugs, drugs for the treatment of the cardiovascular, bronchopulmonary and central nervous systems. The mechanisms and main risk factors for the development of DIAF have not been finally established and are known only for certain drugs, therefore, this section requires further study. The main symptoms of DIAF are due to the severity of tachycardia and their influence on the parameters of central hemodynamics. For diagnosis, it is necessary to conduct an electrocardiogram (ECG) and Holter monitoring of an ECG and echocardiography. Differential diagnosis should be made with AF, which may be caused by other causes, as well as other rhythm and conduction disturbances. Successful treatment of DIAF is based on the principle of rapid recognition and immediate discontinuation of drugs (if possible), the use of which potentially caused the development of adverse drug reactions (ADR). The choice of management strategy: heart rate control or rhythm control, as well as the method of achievement (medication or non-medication), depends on the specific clinical situation. For the prevention of DIAF, it is necessary to instruct patients about possible symptoms and recommend self-monitoring of the pulse. It is important for practitioners to be wary of the risk of DIAF due to the variety of drugs that can potentially cause this ADR.

Клинические проявления постковидного синдрома

Aim: to assess the prevalence of various clinical manifestations in COVID-19 survivors, depending on the time interval after the disease, clinical severity, and the presence of polymorbidity. Patients and Methods: the study included 253 patients (187 females and 66 males), 18–85 years old, who survived COVID-19. The patients were split into two groups based on the disease severity during the acute phase: group 1 consisted of patients with mild COVID-19 illness (n=133); group 2 consisted of patients with moderate and severe COVID-19 illness (n=120). In addition, patients of each of the groups were divided into two subgroups, depending on the time elapsed from the acute phase of COVID-19 illness: in subgroups A the health assessment of patients was performed within 3 months (12 weeks) after the acute phase of the diseases and in subgroups B — 3 months (12 weeks) after the disease, i.e. the time interval ranged from 3 months to one year after COVID-19 illness. A multi-stage phone interview of the patients was used to reveal the presence of symptoms. Also, outpatient medical records of those patients who addressed therapists or narrow specialists, were reviewed. Results: symptoms were revealed both in patients of subgroup 1A (45/52 (86.5%)) and subgroup 2А (42/45 (93.3%)), or, in other words, the symptoms were absent in 7 (13.5%) and 3 (6.7%) patients, respectively. Three months after COVID-19 illness, the symptoms were absent in 34 (42%) patients of subgroup 1B and in 13 (17.3%) patients of subgroup 2B (p<0.001), while at least one symptom persisted in 47/81 (58%) patients of subgroup 1B and 62/75 (82%) patients of subgroup 2B. In both patient groups the most common symptoms comprised fatigue, shortness of breath, and cough. In group 2 patients central nervous and cardiovascular system consequences and arthralgia were frequently reported. The prevalence of comorbidities was higher in group 2 patients than that in group 1 patients, and the difference was statistically significant (p < 0.01). Conclusions: the development of post-COVID-19 syndrome does not depend on the illness severity during the acute phase, and it may occur both in mild and moderate or severe cases. However, in the latter category the patients will have more symptoms. In patients recovered from COVID-19, most of the disease sequela were revealed in central nervous, bronchopulmonary, and cardiovascular systems. Comorbidities are associated with the severity of the novel coronavirus disease during the acute phase. COVID-19 survivors need follow-up care during the first three months after the acute phase and in the later period which should be provided by multidisciplinary team of specialists for achieving complete recovery of the patients’ health and improving the quality of life. KEYWORDS: coronavirus infection, COVID-19, post-COVID-19 syndrome, comorbidities, central nervous system disorders, bronchopul - monary system disorders, cardiovascular system disorders. FOR CITATION: Asfandiyarova N.S., Filippov E.V., Demikhov V.G. et al. Clinical manifestations of post-COVID-19 syndrome. Russian Medical Inquiry. 2022;6(11):612–617 (in Russ.). DOI: 10.32364/2587-6821-2022-6-11-612-617.

Morphometric and genetic studies of the mechanisms of damage to the cardiovascular system in Kuzbass miners with dust lung pathology

Introduction. The combined impact of unfavorable factors of the production environment in miners leads to the development of associated pathology of the bronchopulmonary and cardiovascular systems, the predisposition to which depends on the individual susceptibility of the body. In this regard, it is important to comprehensively study the pathogenetic mechanisms underlying the formation and course of occupational and work-related diseases for a personalized approach to the diagnosis, prevention and therapy of this pathology. The purpose of this study was to study the mechanisms of damage to the cardiovascular system in miners with dust lung pathology on the basis of morphological and genetic studies. Materials and methods. For genetic studies, venous blood drawing was conducted in 190 Kuzbass miners. The main group included 126 miners of the main professions with the previously proven diagnosis "dust lung pathology", the comparison group consisted of 64 workers without a proven diagnosis working in similar sanitary and hygienic conditions. Morphometric studies were carried out using autopsy material obtained during 80 forensic medical examinations of miners in the Kemerovo region. All the miners were divided into 4 groups depending on their underground work experience. The control group was formed from 20 cases of forensic medical examinations of men who died in road accidents and did not have organ pathology according to the results of autopsies. Results. The study of the autopsy material revealed the presence of morphostructural changes in the vascular walls of the miners’ hearts in the form of hypertrophy of the smooth muscle cells of the medial layers, thickening of the endothelial lining, and the development of fibroplastic changes in the perivascular zones. These changes began to form from the first years of work in the underground conditions and progressed with increasing work experience contributing to the "recalibration" of the heart vessels with the formation of the lumen "obstruction". One of the mechanisms of endothelial damage in miners was a change in the expression of the EDN1 gene, which regulates the synthesis of endothelin-1. The risk and resistance genotypes of the development of dust lung pathology for the rs5370 polymorphism of the EDN1 gene were identified. Morphostructural rearrangement of the endothelium in the combination with its pathological activation contributed to the occurrence of endothelial dysfunction in miners. Conclusions. The conducted studies of the parameters of the vascular endothelium indicate its key role in the pathogenesis of bronchopulmonary and cardiovascular pathology in miners of the main professions. Getting into the body of workers, particles of coal-rock dust lead to morphostructural rearrangement of the cells of the endothelial layer and its pathological activation. The contribution of molecular and genetic mechanisms to the development of occupational lung pathology and associated diseases of the circulatory system in miners is revealed. Ethics. The studies were carried out in compliance with the ethical standards of the Bioethical Committee of the Research Institute for Complex Problems of Hygiene and Occupational Diseases, elaborated on the basis of the Helsinki Declaration of the World Medical Association "Ethical Principles for Conducting Human Scientific Medical Research" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation" approved by the Order of the Ministry of Health of the Russian Federation No. 266 dated 19.06.2003. All workers were informed about their participation in the molecular-genetic study and gave written consent to carry it out. The research of the dead miners was based on the secondary examination of blocks and ready-made histological micro-preparations of the material of the Bureau for Forensic Medical Expert Examination of the cities of Novokuznetsk, Osinniki, and Prokopyevsk. The study of pathomorphological material was carried out in accordance with the Federal Law of 21.11.2011, No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation", in particular, with Article 67 "Carrying out pathological and anatomical autopsies", Federal Law of 12.01.1996, No. 8-FZ "On burial and funeral business" (Article 5, paragraphs 1, 2), as well as on the basis of the Order of the Ministry of Health of April 29, 1994, No. 82 "On the procedure for conducting pathological and anatomical autopsy" (Annex to the Order of the Ministry of Health and Medical Industry of 29.04.1994 No. 82), the Order of the Ministry of Health of Russia of 24.03.2016. No. 179n "On the rules for conducting pathological and anatomical examinations".

Risk factors for the development of arterial hypertension in patients with anthracosilicosis

Introduction. Prolonged exposure to coal-rock dust affects the formation of the pathology of the bronchopulmonary and cardiovascular systems. Pneumoconiosis occupies one of the leading places among occupational diseases. On the other hand, arterial hypertension occupies a top place among production-related diseases. Timely identification and correction of traditional and professional risk factors is a main point in preventing diseases of the circulatory system in workers in harmful working conditions. Thus, identifying the most significant risk factors for the development of arterial hypertension of miners with anthracosilicosis is an urgent task. The study aims to identify the most significant professional and non-professional risk factors for the development of arterial hypertension in miners with anthracosilicosis. Material and methods. We examined 269 miners working in underground dust conditions: 139 miners with a previously established diagnosis of anthracosilicosis and 130 miners of the control group without dust pathology of the lungs. The researchers conducted a comprehensive laboratory and clinical and instrumental examination to detect arterial hypertension and risk factors for the development of cardiovascular pathology. Results. Arterial hypertension among miners with anthracosilicosis is two times more common (42.4%) than in the control group (20.8%). Miners aged 50 years and older have the greatest risk of developing arterial hypertension. Also, the presence of fasting hyperglycemia, hyperhomocysteinemia, abdominal type of obesity, hypersthenic constitutional-morphological type according to the Rice-Eysenck index, blood group AB (IV). We identified professional risk factors for the development of arterial hypertension: work experience in harmful working conditions of 25 years or more, the level of the dustiness of the active area exceeding the maximum permissible concentrations by ten or more times. Conclusions. In coal mine workers with anthracosilicosis, arterial hypertension is more common than in the control group, which may indicate that this occupational pathology is an independent risk factor for the development of arterial hypertension. Scientists identified the most significant professional and non-professional risk factors, the elimination of which will reduce the likelihood of developing arterial hypertension in miners with anthracosilicosis.

Pathogenic characteristics of intracellular infection in chlamydiosis

This review analyzes scientific data and systematized information regarding microbiological aspects and pathogenesis of chlamydia infection. Chlamydia are obligate intracellular microorganisms that are sensitive to any human cells where energy parasitism is possible: various types of epithelium, fibrocytes, histiocytes, glial and muscle cells, squamous epithelium of the meninges and eyeball, neurons, monocytes, macrophages. Structure, chemical composition and enzymatic activity of Chlamydia closely resemble those in Gram-negative bacteria, as they retain their morphological identity throughout the life cycle, possess cell wall, ribosomes, DNA, RNA, biochemical elements of glycolysis, tissue respiration, peptose production being sensitive to some broad-spectrum antibiotics, and are able to vegetative form division. In recent decades, the pathogenesis and clinical symptoms of chlamydial lesions in the urogenital tract, nervous, cardiovascular, musculoskeletal and bronchopulmonary systems have been actively studied, and new approaches and treatment schemes for chlamydia-infected patients are still developing. Over many decades, Chlamydia infection has been an important and urgent problem, not only due to its high prevalence, but also because of high rate of complications negatively affecting populational health and related demographic parameters. Chlamydia causes multiple diseases resulting in chronization of inflammatory process in all human organs and systems, and affects reproduction of population. Mandatory statistical recording of chlamydiosis cases introduced as early as in 1994 in the Russian Federation does not reflect the actual incidence rate. A rise in number of inflammatory diseases of the upper respiratory tract caused by Chlamydia undoubtedly increases its etiological importance, but data regarding etiopathogenetic role of Chlamydia in ENT pathology are ambiguous and contradictory. Available publications describe a large range of variation in rate of detected Chlamydia due to poor awareness of doctors about the microbiological properties of chlamydia, pathogenetic and clinical features of clinical signs of this infection, and lack of common and clear understanding on the algorithms for identifying and treating chlamydiosis. Since the majority of chlamydia-associated nosological forms are asymptomatic, knowing pathogenetic features of related will allow to prevent the spread of the infection and reduce subsequent socio-economic consequences.

Analysis of the structure and severity of comorbid pathology in patients with arterial hypertension

The purpose of the research is to study the structure and severity of comorbid pathology in hospitalized patients with arterial hypertension. Material and methods. The study included 140 adult patients (29% men and 71% women) with arterial hypertension and comorbidity receiving therapy in the cardiology department. The average age of the patients was 64.3 ± 12.0 years. The Charlson index was used to assess comorbidity. Results. The average Charlson index in our study was 3.97 ± 2.0 points. Moderate and severe comorbidity was observed in 77.6% of patients with arterial hypertension. When analyzing the frequency of concomitant pathology, one disease was detected in 7% of the examined, two in 28%, three in 14%, four in 23%, five or more in 28%. The structure of concomitant pathology is represented mainly by chronic cerebral ischemia (26.3%), rhythm and conduction disturbances (20%), diseases of the bronchopulmonary (14.8%) and digestive (12.7%) systems. Analysis of risk factors for comorbidity revealed heredity aggravated by cardiovascular diseases in 33.3% of patients with arterial hypertension, smoking in 7.3%, overweight in 27%, obesity in 62%, and abdominal obesity in 87%. Obesity was not diagnosed in all men and 85.4% of women, which indicates that this risk factor for comorbidity was not taken into account. Conclusion. The introduction into the practice of managing patients with arterial hypertension and comorbidity of scoring the presence of concomitant diseases by calculating the Charlson comorbidity index will increase the accuracy of assessing the prediction of their ten-year survival. Identifying and correcting the main risk factors for comorbidity and concomitant pathology in patients with arterial hypertension can reduce disability and mortality.

Disorders of cardiovascular system in influenza and other acute respiratory viral infections

The results of numerous studies indicate the high importance of infectious agents in the formation of pathology of the cardiovascular system. Timely and correct management of patients with these disorders is important to prevent adverse outcomes. Purpose of research . To evaluate the clinical significance of detected cardiovascular disorders in influenza and other acute respiratory viral infections (ARVI) of various etiologies. Materials and methods . The study included 60 male and female patients aged 18 to 65 years who sought emergency care for shortness of breath, chest pain, palpitations, heart failure, and hypertension. The main group included 30 patients with confirmed ARVI (influenza, RS-infection, parainfluenza, adenovirus infection) at the time of examination. The comparison group consisted of 30 patients without ARVI, including the last three months. Assessed the medical history, the value of oxygen saturation, blood pressure, electrocardiogram data. Criteria not included: the duration of ARVI more than 7 days at the time of examination, the presence of severe chronic diseases: rheumatological and oncological pathology, HIV infection, as well as injuries that explain the analyzed complaints. Results . Against the background of influenza and ARVI, complaints of shortness of breath and a feeling of insufficiency of the inhaled volume were noted in 80 % of patients, obsessive painful cough was noted in 73 %. Less often (43 %) there was pain, discomfort or tightness in the chest. The average oxygen saturation index in patients with ARVI and influenza was significantly lower: 95.400 ± 0.935 %, and in the comparison group – 97.400 ± 0.935 %, p < 0.0001. ST-segment depression (53 %) and decreased R-wave voltage (27 %) were significantly more common in patients with acute respiratory viral infections and influenza. Conclusions . Patients with ARVI and influenza often present complaints that require differential diagnosis between the natural manifestations of the infectious and inflammatory process and developing complications associated with lesions of the bronchopulmonary and cardiovascular systems. Complaints of shortness of breath and chest discomfort are often accompanied by a decrease in oxygen saturation and significant changes in the ECG, which requires mandatory examinations to determine the risk of adverse course due to hypoxic and ischemic changes and determine the patient’s further management tactics in patients with ARVI and influenza.

The "Polonium In Vivo" Study: Polonium-210 in Bronchial Lavages of Patients with Suspected Lung Cancer.

Few studies have reported on polonium-210, a decay breakdown product of radon-222 and lead-210, in human lungs and there has been no study in patients with suspected lung cancer. The main aim of this “Polonium in vivo” study was to evaluate polonium-210 radioactivity in bronchopulmonary systems of smoker, ex-smoker and never smoker patients with suspected lung cancer. Alpha-spectrometric analyses were performed on bronchial lavage (BL) fluids from two Italian hospitals in 2013–2016. Socio-demographic, smoking, occupational and spirometric characteristics, lung cancer confirmation and histologic type and radon-222 concentration in patients’ homes were collected. Seventy BL samples from never (n = 13), former (n = 35) and current smokers (n = 22) were analyzed; polonium-210 was detected in all samples from current and former smokers and in 54% of samples from never smokers (p < 0.001; median values: 1.20, 1.43 and 0.40 mBq, respectively). Polonium-210 levels were significantly higher in COPD versus no COPD patients (median value: 3.60 vs. 0.97 mBq; p = 0.007); former and current smokers, without and with COPD, had significantly increased polonium-210 levels (p = 0.012); 96% of confirmed versus 69% of non-confirmed lung cancer patients recorded detectable polonium-210 levels (p = 0.018). A polonium-210 detectable activity was measured in BL samples from all current and former smokers. Polonium-210 in the lungs could be the result of lead-210 entrapment, which, with its half-life of 22 years, could provide a continuous emission of alpha radioactivity, even many years after quitting, thus proposing a possible explanation for the onset of lung cancer, particularly in former smokers.

Features of clinical course, morphological diagnosis and prognosis factors for neuroendocrine neoplasms of rare localizations

Currently, neuroendocrine neoplasms (NENs) of the gastroenteropancreat-ic and bronchopulmonary systems are well studied and the most common, the share of which is 73 and 25 % of cases, respectively. The remaining 2 % of cases are attributed to NEN of more rare localizations, the static registration of which is difficult due to their rarity, and clinical cases are presented by episodic descriptions of single observations. Such tumors include NEN of the prostate gland from 0.5 to 1.0 %, NEN of ovaries 0.5 %, NEN of the mammary gland from 0.3 to 0.5 %, NEN of the kidney (practically devoid of static data), bladder 0.48-1.00 %. The retrospective study included 92 patients with NEN of rare localizations who were examined and treated of the N. N. Blochin National Medical Research Center of Oncology from 1990 to 2019. Currently, there are no generally accepted methods of treatment for this group of patients due to the rarity of the pathology, and it is carried out according to the NEN of other localizations. NEN of rare localizations have high survival rates (the observation period was from a month to 14 years), both general and without progression and require long-term monitoring and observation. At the time of assessment of long-term results, 20 (21.8 %) patients died of progression, 12 (13.1 %) patients dropped out of observation. The rest were alive at the date of the last control.

Імбир як спеція в харчуванні з багатогранними лікувально-профілактичними властивоcтями: перспективи застосування в сучасних умовах (огляд літератури)

Actuality. The rapid growth of morbidity, age-related poly- and comorbidity complicate and increase the cost of the treatment process of such patients, leading to the search for prophylactic and therapeutic agents of multisystem and diverse metabolic action. Aim of the Research. Coverage of modern scientific advances in the studies of therapeutic and prophylactic properties of ginger as a spice and source of drugs, as well as justification for its wider use under different conditions of the human body. Materials and Methods. Information search in printed and electronic publications, search databases; methods of analysis, comparison and generalization of data. Results. The healing properties of ginger have been proven on the basis of historical and modern data. Thus, it posesses hypolipidemic, antisclerous, disaggregating, hypoglycemic, antioxidant, anti-inflammatory, analgesic, vasodilating properties, and the ability to regulate secretory and motor disorders of the digestive system. Gastro-, hepato-, cardio-, neuro-, arthroprotective features of ginger products are indisputable, as well as the effectiveness of their application for the diseases of the digestive, cardiovascular, bronchopulmonary systems, musculoskeletal system and prospects for their use for endocrine diseases, in neurology, oncology , immunology. Conclusions. Ginger as a universal spice and a source of drugs of prophylactic and therapeutic action with multisystem and diverse metabolic properties should be used more widely in patients with age related poly-and comorbidity, which can improve their rehabilitation outcomes and increase economic efficiency. Key Words: ginger, properties, poly- and comorbidity, application, prophylaxis.

Neuroendocrine neoplasms of lung, pancreas and gut: a morphology-based comparison.

The bronchopulmonary (BP) and gastroenteropancreatic (GEP) organ systems harbor the majority of the neuroendocrine neoplasms (NENs) of the body, comprising 20 and 70% of all NENs, respectively. Common to both NEN groups is a classification distinguishing between well- and poorly differentiated NENs associated with distinct genetic profiles. Differences between the two groups concern the reciprocal prevalence of well and poorly differentiated neoplasms, the application of a Ki67-based grading, the variety of histological patterns, the diversity of hormone expression and associated syndromes, the variable involvement in hereditary tumor syndromes, and the peculiarities of genetic changes. This review focuses on a detailed comparison of BP-NENs with GEP-NENs with the aim of highlighting and discussing the most obvious differences. Despite obvious differences, the principle therapeutical options are still the same for both NEN groups, but with further progress in genetics, more targeted therapy strategies can be expected in future.

Neuroendocrine neoplasms of kidney

The most common anatomical localization of neuroendocrine neoplasms (NEN) are the digestive and bronchopulmonary systems, the total proportion of which exceeds 90 % of cases of this group of tumors. In turn, the remaining cases are represented by extremely rare primary neuroendocrine neoplasms of the head and neck, skin, female genital organs, mammary gland, bladder and kidney. Due to the extremely rare observations and the lack of standardized approaches to the diagnosis and treatment of neuroendocrine neoplasms of the kidneys are of significant clinical interest. The true incidence of NENs of the kidney has not yet been established. We carried out a retrospective analysis of patients undergoing treatment in National Medical Research Centre of Oncology n. a. N. N. Blokhin (Moscow, Russia) from 1992 to 2015. According to the results of a sample of patients among registered 12,013 cases of malignant neoplasms of the kidney with NEN of the kidney, the number of morphologically verified cases of NEN of the kidney was 9 cases (0.07 %). Among the patients included in the study group, the main part was represented by highly differentiated neuroendocrine tumors (7 cases; 77.8 %), small cell cancer (1 case; 11.1 %), large cell neuroendocrine cancer (1 case; 11.1 %). The average age of the patients was 51 years (40–63 years; median – 55 years), among which there were 4 women and 5 men. In addition, we conducted an analysis of the clinical, morphological and molecular biological characteristics of tumors with the study and assessment of the grade Ki-67, which was a determining factor in predicting survival and choosing treatment tactics.

Effects of bronchial asthma control on cardiovascular disorders in early school age children

The course of bronchial asthma (BA) is accompanied by pathological changes in the bronchopulmonary and cardiovascular systems. The severity of heart functional disorders depends on the severity of the BA Course, the level of control and the frequency of application of short-acting β 2 -agonists (SAβ 2 A). The aim of the study was to analyze the impact of BA control on the development of cardiovascular disorders in children of early school age. Methods . Children ( n = 95) aged 7–12 years with BA of varying severity and different levels of control were examined. The analysis of indicators of the clinical and functional state of the vegetal nervous system (VNS) and cardiovascular system tone using standard electrocardiography, echocardiography with calculation of the left ventricular myocardial mass index, сardiointervalography was performed. Results . Changes in VNS with signs of its depletion and decrease in adaptive capacity, cardiac rhythm and conduction disorders, connective tissue dysplasia syndrome, hemodynamic disorders and signs of adaptive heart remodeling have been detected. Conclusion . Lack of control over BA and the use of SAβ 2 A promote cardiovascular disorders.