Obstructive Bronchitis Research Articles

Association of Respiratory Morbidities with Particulate Air Pollution in Delhi, India- A Prospective Study

Abstract Background: Elevated levels of air pollution and long-term exposure can lead to detrimental health conditions, mainly affecting cardiorespiratory systems. Materials and Methods: A prospective observational study was conducted in five sampled hospitals in Delhi. A pre-designed, pre-tested, semi-structured questionnaire was filled out for each patient with data from hospital records. The admission rates were recorded daily over the study period along with the air quality with reference to particulate matter (PM). The trends of the hospital admissions for respiratory morbidity were corroborated with PM 2.5. Descriptive statistics and correlation amongst emergency admissions and air pollutants were analysed using Microsoft Excel. The impact of air quality on the rate of hospitalisation due to respiratory conditions was projected by mathematical modelling. Results: The rate of hospitalisation due to bronchial asthma, chronic obstructive pulmonary disease, bronchitis and lower respiratory tract infections was found to be directly proportional to an increase in PM2.5. Conclusion: The healthcare system is increasingly strained and thus, the additional burden due to rising air pollution needs to be prevented by making people aware about the methods of reducing air pollution.

CLINICAL AND IMMUNOLOGICAL FEATURES OF THE COURSE OF ACUTE OBSTRUCTIVE BRONCHITIS IN CHILDREN INFECTED WITH CHLAMYDIA

Aim. To improve the prognosis of the course of acute bronchitis based on the study of the etiological factor, clinical and anamnestic and laboratory and instrumental characteristics of acute bronchitis in children infected with chlamydia. Materials and methods. 73 children with acute obstructive bronchitis (AOB) were studied, including 32 children with AOB infected with chlamydia and 41 children with AOB not infected with intracellular infection (ICI). Results. For patients with AOB infected with chlamydia, in comparison with non-infected patients, the presence of febrile fever, intoxication syndrome, absence of expiratory shortness of breath and whistling wheezes, as well as a longer duration of treatment (more than 10 days) are characteristic. In patients infected with chlamydia compared to the norm, there is an increase in the number of T- and B-lymphocytes, which is manifested by an increase in the absolute number of CD3, CD8, CD25, CD4, CD22, the relative content of CD8, CD4, CD16 and CD22, as well as the level of serum IgA, IgG and IgM on against the background of suppression of innate immunity in the form of a decrease in the absorbing function of phagocytes, phagocytosis, phagocytic number and their digestive function; spontaneous and stimulated HST-test, the index of activity of stimulated neutrophils and the level of lysosomal-cationic proteins. That is, the child's immune system in conditions of persistence of ICI is in the mode of overload and imbalance. In patients with chlamydia infection, compared to patients without infection, in relation to T-lymphocytes, the following were found: higher values of the absolute number of CD3, CD4, CD8 and the relative number of CD3, as well as lower values of the absolute number of CD4, CD16, CD25 and the relative content of CD16; relative to B-lymphocytes: higher values of the relative amount of CD22, the level of serum IgA and a low level of IgG in the blood serum; in relation to indicators of innate immunity: a higher value of the phagocytic number, spontaneous HCT test and low values of phagocytosis, phagocytic index; relative to the non-specific humoral link of immunity – a higher level of CIC with 3.5% PEG. Conclusions. The revealed reliable differences in clinical and immunological indicators between groups of patients with AOB, depending on the presence of chlamydia infection, provide a basis for their use for diagnostic purposes as a supplement to traditional, protocol methods of diagnosis.

Catalase: A Potential Pharmacologic Target for Hydrogen Peroxide in the Treatment of COVID-19.

This manuscript is a meta-analysis performed according to PRISMA guidelines. It shows that acute respiratory distress syndrome in COVID-19 complicated by airway obstruction with sputum and mucus, as well as cases of asphyxia with blood, serous fluid, pus, or meconium, can sometimes cause hypoxemia because the medical standard does not include intrapulmonary solutions that release oxygen. One promising avenue for finding and developing the necessary drugs may be the physical-chemical repurposing of hydrogen peroxide solution from antiseptics into inhaled and intrapulmonary mucolytics, pyolytics, and oxygen-releasing antihypoxants by replacing the acidic properties of hydrogen peroxide with alkaline properties. The fact is that an alkaline hydrogen peroxide solution liquefies said biological masses through alkaline saponification of lipid and protein-lipid complexes and simultaneously "blasts" the masses through catalase cleavage of hydrogen peroxide into water and oxygen gas, since these masses are rich in catalase. The results of the first experiments show that inhalation and intrapulmonary injections of alkaline hydrogen peroxide solutions can significantly optimize the treatment of suffocation and hypoxemia. Value of the data: 1. Why are these data useful? These data provide a new perspective way for intrapulmonary drugs and new technologies for the emergency increase of blood oxygenation through the lungs in asphyxia with thick sputum, mucus, pus, meconium and blood. 2. Who can benefit from these data? New drug developers, drug manufacturers, medical professionals providing emergency medical care, as well as pulmonologists, physiatrists, obstetricians and gynecologists can benefit from the data presented in this article. 3. How can these data be used/reused for further insights or development of experiments? These data can be used to develop new drugs and new technologies for the treatment of suffocation and hypoxia in the final stage of COVID-19, severe asthma attacks, purulent obstructive bronchitis, blood asphyxia in cancer and wounded lung in intensive care and anesthesiology departments. In addition, these data can be used to modernize expectorant, mucolytic, pyolytic, hemolytic and meconiolytic and expand the arsenal of intrapulmonary drugs.

A comprehensive analysis of the health effects associated with smoking in the largest population using UK Biobank genotypic and phenotypic data

BackgroundSmoking is a widespread behavior, while the relationship between smoking and various diseases remains a topic of debate. ObjectiveWe conducted analysis to further examine the identified associations and assess potential causal relationships. MethodsWe utilized seven single nucleotide polymorphisms (SNPs) known to be linked to smoking extracting genotype data from the UK Biobank, a large-scale biomedical repository encompassing comprehensive health-related and genetic information of European descent. Phenome-wide association study (PheWAS) analysis was conducted to map the association of genetically predicted smoking status with 1,549 phenotypes. The associations identified in the PheWAS were then meticulously examined through two-sample Mendelian randomization (MR) analysis, utilizing data from the UK Biobank (n = 487,365) and the Sequencing Consortium of Alcohol and Nicotine Use (GSCAN) (n = 337,334). This approach allowed us to comprehensively characterize the links between smoking and disease patterns. ResultsThe PheWAS analysis produced 34 phenotypes that demonstrated significant associations with smoking (P = 0.05/1460). Importantly, sickle cell anemia and type 2 diabetes exhibited the most significant SNPs (both 85.71% significant SNPs). Furthermore, the MR analyses provided compelling evidence supporting causal associations between smoking and the risk of following diseases: obstructive chronic bronchitis (IVW: Beta = 0.48, 95% confidence interval (CI) 0.36-0.61, P = 1.62×10−13), cancer of the bronchus (IVW: Beta = 0.92, 95% CI 0.68-1.17, P = 2.02×10−13), peripheral vascular disease (IVW: Beta = 1.09, 95% CI 0.71-1.46, P = 1.63×10−8), emphysema (IVW: Beta = 1.63, 95% CI 0.90-2.36, P = 1.29×10−5), pneumococcal pneumonia (IVW: Beta = 0.30, 95% CI 0.11-0.49, P = 1.60×10−3), chronic airway obstruction (IVW: Beta = 0.83, 95% CI 0.30-1.36, P = 2.00×10−3) and type 2 diabetes (IVW: Beta = 0.53, 95% CI 0.16-0.90, P = 5.08×10−3). ConclusionThis study affirms causal relationships between smoking and obstructive chronic bronchitis, cancer of the bronchus, peripheral vascular disease, emphysema, pneumococcal pneumonia, chronic airway obstruction, type 2 diabetes, in the European population. These findings highlight the broad health impacts of smoking and support smoking cessation efforts.

Factors of postembryonic ontogeny: relationship with the effectiveness of tuberculosis chemoprophylaxis in children

Background. A child’s body as a functional system is formed starting from the fetal period. Therefore, analysis of even distant in time situations allows to identify factors that affect the functioning of the child’s body in the present time and, possibly, the effectiveness of chemoprophylaxis in children. Materials and methods. To study the presence of a correlation between factors of postembryonic ontogeny and the effectiveness of chemoprophylaxis of tuberculosis in children, an analysis was carried out of 300 patients aged 0 to 17 years in the early period of primary tuberculosis infection, who underwent a 3-month course of chemoprophylaxis with isoniazid. The dynamics of shin sensitivity according to the Mantoux test with 2 tuberculin units was used as a criterion for the effectiveness of chemoprophylaxis. Depending on the latter, the exa­minees were divided into two groups: a group with effective chemoprophylaxis (n = 200), in which the size of a wheal after the end of the course decreased by 4 mm or more, and a group with ineffective chemoprophylaxis, in which skin sensitivity to tuberculin increased or remained at the previous level or decreased in the size of a wheal by 3 mm or less. Results. The analysis showed that in the group with ineffective chemoprophylaxis compared to the alternative group, the following occurred significantly more often: short-term (up to 4 months) breast feeding, a history of acute bronchitis (p < 0.001) in a child, acute obstructive bronchitis. In addition, the following were characteristic of this group: the presence of tuberculosis contact (p < 0.001), tuberculosis contact with a patient with confirmed bacterial excretion (p < 0.001), age of child under 6 years (p < 0.001), the number (two and more) of concomitant pathologies (p < 0.001), a single BCG vaccination (p < 0.001), as well as the winter seasona­lity of chemoprophylaxis (p < 0.05). Conclusions. Significant correlations have been found between many factors of postembryonic ontogeny and the effectiveness of tuberculosis chemoprophylaxis in children, which allows them to be used for prognostic purposes. The closest connections with the effectiveness of chemoprophylaxis of tuberculosis in children was revealed for the presence of tuberculosis contact (ϕ = 1.08; p < 0.001), especially with a patient with confirmed bacterial excretion (ϕ = 1.72; p < 0.001), as well as the number of concomitant pathologies in a child (ϕ = 0.70; p < 0.001) and manifestations of allergy (ϕ = 0.67; p < 0.001).

Mitochondria-DNA copy-number in osteoporosis and osteoarthritis among middle-aged women - A population-based cohort study

BackgroundMitochondrial DNA copy number (mtDNA-CN) is associated with aging. A relationship between mtDNA-CN and degenerative disorders, e.g. osteoarthritis (OA) and osteoporosis (OP), has been suggested. We aimed to investigate the relationship of mtDNA-CN and incident OA and OP. Materials and methodsMtDNA-CN was studied in relationship to incident OA and OP in a population-based cohort study of 6916 middle-aged women (52–63 years). Totally 2521 women with sufficient quality of mtDNA were analyzed. After exclusions, 1978 women remained in the study population. Four different endpoints obtained from the National Patient register were studied: 1) OA, 2) OP 3) OA surgery, and 4) OP fracture. In the multivariate model adjustments were made for potential OA and OP risk factors. ResultsWomen with low mtDNA-CN were older and had more activity at work. 125 women (6.32%) were affected by incident OP and 254 women (12.84%) had an OP fracture. Incident OA affected 451 women (22.80%) and 175 women (8.85%) had OA surgery. There were no associations between mtDNA-CN and incident risk of OA (Hazard ratio ​= ​1.00, 95% confidence interval 0.83–1.20), OA surgery (0.79, 0.58–1.07), OP (0.89, 0.62–1.27), or OP fracture (1.00, 0.78–1.29). However, incident OP was significantly associated with T-score (bone density), smoking, diabetes mellitus, and chronic obstructive bronchitis (COPD). OA was associated with body mass index and COPD. ConclusionsThe present study suggests that mtDNA-CN, reflecting mitochondrial dysfunction, is not a major predictor for incident OA or OP. However, due to the limited study size minor associations cannot be excluded.

THE ROLE OF IL6 GENE POLYMORPHISM –174C/G IN THE DEVELOPMENT OF RECURRENT BRONCHIAL OBSTRUCTION IN CHILDREN OF EARLY SCHOOL AGE

The purpose of our work was to analyze the polymorphism of the IL6 gene –174C/G in the development of recurrent bronchitis in children of the Uzbek population of preschool age. Material and methods. To achieve this goal, 73 cases of the disease were analyzed, of which group 1 included children with acute obstructive bronchitis (AOB), group 2 - with recurrent bronchial obstruction (RBO) aged 7 to 11 years. Determination of IL-6 and total IgE in blood serum was carried out by enzyme-linked immunosorbent assay using a commercial kit of enzyme-linked immunosorbents. Total genomic DNA was isolated using the DNA-Express kit (Litekh). Single nucleotide polymorphism of the IL-6 gene 174G/C was determined by PCR. Statistical processing of the obtained data was carried out using Microsoft Excel 2013. Differences were considered statistically significant at p < 0.05. Results. A comparative analysis of IL6 and total IgE in AOB and RBO showed a significant increase in IL-6 and an increase in the level of IgE in RBO compared with the AOB group and healthy children. A study of the IL6 –174C/G gene polymorphism showed that the G/G mutacin genotype was observed significantly more often in the group of patients with RBO than in the healthy group. Conclusion: It follows that the main allele G is associated with an increased level of IL-6 expression and is a prognostic factor for the development of RBO in children. The obtained clinical, genetic and immunological results of the study allow us to predict RBR in children.

Interdisciplinary approach to diagnosis of life-threatening form of albinism: Germanic-Pudlac syndrome case type 1

The Hermansky-Pudlak syndrome (OMIM#203300) is a hereditary genetically heterogeneous disease with an autosomal recessive type of inheritance. There are 11 clinical-genetic subtypes with similar clinical manifestations, but some type may difference with each other clinically. The most common is type 1 Hermansky-Pudlak syndrome. Purpose: Describe the features of the clinical picture and diagnosis of Hermansky-Pudlak syndrome type 1. Materials and methods: complex clinic-instrumental and molecular-genetic results from 2 patients from one family with incoming diagnosis of albinism are used. Result: An interdisciplinary approach to the diagnosis of albinism and a step-by-step molecular-genetic study help to verify the clinical-genetic diagnosis in a family. The clinical case demonstrated clinical polymorphism within one family. Two patients have similar dermatological and ophthalmological clinical picture, but have difference in bronchopulmonary system and the blood system. Probang-female has a history of prolonged repeated bleeding, coagulogram changes, obstructive bronchitis, albino phenotype and eyes failure. Her brother has a similar albino phenotype and eyes failure. The pathogenic variant NM_000195.5: c.1189del was revealed in a homozygous state in 13 exon of the HPS1 gene and Hermansky-Pudlak syndrome type 1 was confirmed by molecular analysis. Conclusion: On the example of this clinical observation of a family with Hermansky-Pudlak syndrome 1 type features of differential diagnosis of albinic states are shown, it is noted that complex examination of patients is necessary, molecular-diagnostics genetic analysis and constant follow up of a hematologist, ophthalmologist, pulmonologist, allergologist, dermatologist, gastroenterologist, geneticist and pediatrician.

Metapneumovirus infection in children in modern conditions: clinical and immunological parallels

Aim. The study of metapneumovirus infection clinical and immunological features in children of different ages. Patients and methods. An analysis of 22 patients with mono-metapneumovirus infection is presented. There were 7 (31.8%) children under the age of 1 year, 8 (36.4%) — 1—3 years old, 7 (31.8%) — 4—7 years old. Diagnosis of metapneumovirus infection was based on clinical data and on PCR analysis of nasopharyngeal mucus. Immunological studies in 10 patients included immunophenotype of patient's blood lymphocytes and analysis of the interferon system. Results. Among children under the age of 1 year 71.4 ± 17.1% were diagnosed with obstructive bronchitis and 28.6 ± 17.1% had pneumonia. In patients aged 1—3 years pneumonia was observed more often (55.6 ± 17.6%), obstructive bronchitis — less often (33.3 ± 16.7%), and in 11.1 ± 11.1% bronchitis occurred without symptoms of bronchial obstruction. In children aged 4—7 years only the upper respiratory tract was affected in 14.3 ± 13.2% of cases, 57.1 ± 18.7% developed bronchitis and 28.6 ± 17.1% — pneumonia. The immune system state was characterized by a low content of T-helpers (CD3 + CD4 + ) and NK-cells (CD3-CD16 + CD56 + ) detected in 7 (70%) and 5 (50%) patients respectively. IFNγ production was reduced in 70% of children and IFNα in 80%. Conclusion. Metapneumovirus infection in children in modern conditions is characterized by the frequent development of inflammatory changes in the bronchopulmonary system in the early stages of the disease. The disease severity was due to both manifestations of respiratory failure and severe symptoms of intoxication. Immunological studies revealed changes in the cellular link and the interferon system in all age groups.

Складність діагностики рефрактерної хвороби Кавасакі під «маскою» гемобластозу: клінічний випадок із досвіду гематолога

Kawasaki disease (KD) is an acute systemic vasculitis that is the most common cause of acquired heart disease in children under 5 years of age with hyperthermia. Diagnosis of KD is a clinical challenge, given the wide range of clinical manifestations and similarities with many viral and bacterial diseases. Purpose - to describe a clinical case of refractory КD in a three-month-old girl with an emphasis on the importance of echocardiography and coronary angiography for the final verification of the disease, urgent initiation of treatment with minimal suspicion of КD. Clinical case. The article reports on a three-month-old patient with a difficult diagnosis of refractory form of КD. The disease debuted with hyperthermia, enterocolitis, obstructive bronchitis, and hepatoliver syndrome. The manifestations of skin exanthema were initially considered as an allergic dermatitis to the use of a cephalosporin antibiotic. Multisystemic inflammatory syndrome associated with SARS-CoV-2 infection was suspected. After the use of immunosuppressive therapy with mega-doses of dexamethasone and intravenous human immunoglobulin 2 g/kg/day for 3 days, clinical improvement was achieved. Subsequently, the haemogram showed an increase in neutrophilic hyperleukocytosis to the appearance of blast cells, hyperthrombocytosis and severe anaemia. A differentiation was made between a leukemic reaction, the debut of myeloproliferative disease, juvenile myelomonocytic leukaemia. Against the background of a rapid decrease in the number of leukocytes, the girl developed hyperthermia, migratory intermittent maculopapular rash, and foots edema. Laboratory findings included thrombocytosis and an increase in acute-phase parameters. Echocardiography revealed left ventricular dilation, a small amount of excess fluid in the pericardium, dilatation of the left coronary artery evenly to the bifurcation. Computed tomography revealed giant coronary artery aneurysms, which gave grounds to diagnose KD. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the parents of child was obtained for the study. No conflict of interests was declared by the authors.

Vitamin D supply, respiratory viral infections and persistent wheezing in children: how significant is the relationship?

The review discusses the multifaceted effect of vitamin D on antiviral immunity, induction of antimicrobial peptides, functional activity of immunocompetent cells, autophagy processes, clearance of viruses and viral fragments. The relationship between vitamin D and allergic inflammatory cells, its modulating and tolerogenic potential is considered. The inhibitory effect of vitamin D on eosinophils, mast cells, the production of pro-inflammatory and proallergic mediators, and the synthesis of IgE has been shown. The protective role of vitamin D in the development of remodeling and hyperresponsiveness of the respiratory tract has been established by reducing the number of goblet cells, mucus hypersecretion, and the expression of metalloproteinases. The effects of vitamin D on the replication of respiratory viruses and experimental resistance to them through the induction of antimicrobial peptides and other mechanisms have been demonstrated. Data from clinical studies on the preventive effect of vitamin D on the incidence of respiratory infections and episodes of persistent wheezing in children are presented. Children with respiratory syncytial infection and vitamin D deficiency were more likely to require respiratory support and mechanical ventilation. The preventive role of vitamin D in the development of obstructive bronchitis in children and severe bronchiolitis in infants has been shown. It has been established that normal levels of 25(OH)D in the mother significantly reduce the risk of developing bronchial obstruction in the child. Alternative data that do not support a protective effect of vitamin D on respiratory morbidity and wheezing in children are discussed. Further monitoring studies that take into account geographic location and analysis of the dose of cholecalciferol used to assess its preventive role in the development of wheezing and bronchial asthma in children are advisable.

Влияние барьерных методов профилактики острых респираторных вирусных инфекций на функциональное состояние назального цилиарного эпителия у детей с рецидивирующей бронхиальной обструкцией

Aim. Study effect of cellulose powder on the functional state of the ciliary epithelium in children with bronchial obstruction. Design. Open prospective non-randomized clinical study. Material and methods. The study involved 60 children from 3 to 11 years, with a history of frequent acute respiratory viral infections (ARVI), occurring with bronchial obstruction or exacerbation of bronchial asthma. Motor activity of the ciliary epithelium was registered with the digital high-speed videomicroscopy method initially and 3 months after the start of the three-month course of its application. Patients were also assessed for the frequency of acute respiratory viral infections; the objective and subjective symptoms of ARVI episodes were evaluated with a point scale during the follow-up period. Results. After completing the three-month course of cellulose powder with wild garlic extract usage, it was revealed that 55 (91.7%) children did not get ARVI during follow-up, 5 (8.3%) children had ARVI once. There was a reduction in the duration of the disease, a decrease in the severity of symptoms compared with those in previous years, on the scale of severity assessment of symptoms in patients with ARVI: in previous years — 17 (16; 18) points, when interviewed after the use of the studied drug — 9 (7; 10) points (p < 0.05). Of the five children who were ill, only one child developed obstructive bronchitis on the background of a viral infection. The relative number of cells with motile cilia: the middle nasal concha (MNC) — 25% (20%; 30%), the inferior nasal concha (INC) — 25% (15%; 30%); 3 months after the start of taking the cellulose powder: MNC — 40% (30%; 45%), INC — 35% (35%; 45%) (p < 0.01). Ciliary beat frequency in patients initially: MNC — 4.7 (4.2; 5.9) Hz, INC — 4.9 (4.2; 5.7) Hz; 3 months after MNC — 5.9 (5.7; 7.9) Hz (p < 0.01), INC — 6.2 (5.5; 7.2) Hz (р < 0.05). Conclusion. The use of cellulose powder for preventive purposes prevents infection with ARVIs, protects against reinfection, and also helps to reduce the duration and the severity of the disease manifestations. There is a positive dynamics in the functional status of the ciliary epithelium of the upper respiratory tract, which may reflect a more complete restoration of the mucosa against the background of the absence of ARVI. Keywords: ciliary epithelium, cilia, prevention of acute respiratory viral infections, children, fine cellulose powder.

Возможности профилактики рецидивов обструктивного бронхита у детей в сезон острых респираторных инфекций

The possibility of preventing episodes of bronchial obstruction (BO) in order to reduce the risk of bronchial asthma formation attracts the attention of many researchers and doctors. Ammonium glycyrrhizinate (Reglisam, "VIFITECH") is of practical interest in the search for promising anti-inflammatory drugs in this matter. Patients and methods. The study involved 110 children aged 3 to 7 years with symptoms of acute obstructive bronchitis, who had a history of at least 2 episodes of BO in the previous 6 months. Formed: the comparison group (n = 30) – received inhalations of ICS up to 1 month and SABA on demand and the main group (Reglisam) (n = 80) – additionally, the drug was prescribed to Reglisam for 24 weeks. The duration of patient follow-up was 24 weeks, five visits to the clinic were performed (day 1, week 1, week 4, week 12, week 24) and two telephone contacts (weeks 8 and 16). During visits, the following indicators were evaluated: computed bronchophonography (CBFG), cough on a visual analog scale (VAS), and the volume of additional therapy. Results. In the main Reglisam group, by the 3rd day of treatment, the intensity of daytime and nighttime cough was 30% lower relative to the comparison group (1.92 ± 0.05 vs 2.74 ± 0.03 points and 1.8 ± 0.04 vs 2.6 ± 0.04 points, respectively (p < 0.05)), 70% of patients in the Reglisam group showed a decrease of CBFG to normal values, the proportion of such patients in the comparison group did not exceed 50%. In the Reglisam group, the average duration of BO was 38% less relative to the comparison group (6.9 ± 0.2 vs 11.2 ± 0.8 days, (p < 0.05)), the duration of SABA use was 46% less relative to the comparison group (4.13 ± 0.7 vs 7.62 ± 0.8 days, p < 0.05). When patients were followed up for the next 23 weeks in the main Reglisam group, the average number of ARI was 41% and BO was 83% less relative to the comparison group (1.3 ± 0.05 vs 2.2 ± 0.1 cases, 0.3 ± 0.001 vs 1.8 ± 0.21, respectively (p < 0.05). In the Reglisam group, the average duration of ARI cases did not exceed 6.6 ± 0.2 days, in the comparison group it was significantly 40% longer (10.9 ± 0.4 days (p < 0.05)). In the treatment of ARI in the main Reglisam group, the need for the use of ICS and SABA was 2 times lower relative to the comparison group (35% vs 77% and 50% vs 100%, respectively (p < 0.05). Conclusion. The inclusion of Reglisam in the complex therapy of acute obstructive bronchitis contributed to a rapid and effective reduction in the intensity of cough symptoms by the 3rd day of treatment, reducing the duration of use of SABA and the duration of the disease in general. In dynamics, against the background of a prophylactic course of Reglisam (23 weeks) during the epidemiological season of ARI, there was a significant decrease in the frequency of ARI, virus-induced relapses of OB and, as a consequence, the need for the use of ICS and SABA. Key words: coronavirus infection, COVID-19, post-COVID syndrome, children, rehabilitation, bronchial asthma, ammonium glycyrrhizinate, glycyrrhizic acid

Classification of primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a rare hereditary disease from the group of ciliopathies with extensive locus and allelic heterogeneity (ORPHA 244, 98861; OMIM 242650, 244000). This disease is inherited by autosomal dominant or autosomal recessive type and, less often, by X-linked type (OMIM 300424). Retinitis pigmentosa develops in the X-linked PCD variant. The overall minimum global prevalence of PCD according to European data is 1 : 7554. There is no generally accepted classification of PCD in the international classification of diseases (ICD), 10th revision. PCD is not presented in ICD-10 as a separate medical entity, and the code Q32.4 – Other congenital bronchial anomalies – is used for coding. In the new edition of ICD-11, the code LA75.Y is highlighted – Other specified structural abnormalities of the lungs.Primary ciliary dyskinesia. However, there is no generally accepted classification of PCD. The aim of the study was to develop a classification of primary ciliary dyskinesias to improve the efficiency of medical care for patients during follow-up.Methods. European and Russian clinical recommendations, as well as ICD 10th and 11th revision, Classification of Respiratory Insufficiency (2020), Order of 27.08.19 No.585n “On classifications and criteria used in the implementation of medical and social expert assessment of citizens by federal state institutions of medical and social expert assessment” (as amended on 06.10.21) were used to create the classification.Results. The classification of PCD was created and can be recommended for use in clinical practice. The classification was based on the presence or absence of the Sievert – Kartagener syndrome (complete, not complete), as well as clinical and instrumental characterization of bronchopulmonary changes based on the presence of chronic obstructive bronchitis, bronchiectasis (specifying the type and localization), pneumofibrosis with the process activity (exacerbation, remission), and the degree of respiratory failure. It is recommended to take into account extrapulmonary manifestations of PCD, such as rhinosinusitis, media otitis, congenital heart defect, and complications. It is recommended to use the PICADAR (PrImary CiliAry DyskinesiA Rule) score and to include the results of video microscopy, DNA diagnosis, and microbiological examination in the diagnosis.Conclusion. The application of the proposed classification can be useful in the dynamic observation of the patient, therapy and in the conduct of medical and social expert assessment.

PREDICTORS OF THE DEVELOPMENT OF RECURRENT BRONCHIAL OBSTRUCTION IN CHILDREN

Abstract. Purpose of the study: to determine the significance of risk factors for the development of recurrent bronchial obstruction in children. Material and methods of research. A total of 240 children were examined and divided into 3 groups: Group I - patients with acute obstructive bronchitis (AOB), acute bronchiolitis (ABL), Group II - children with recurrent obstructive bronchitis (ROB) and bronchial asthma (BA), Group III - patients with acute bronchitis without bronchial obstruction (BA). To assess the significance of risk factors for the development of recurrent and relapsing course of BOS, we analysed genealogical, biological and social anamnesis, premorbid and family background, in children of the studied groups, characterising the state of family health and features of child development in the ante- and postnatal periods, as well as in the first years of the child's life. Results of the study and discussion. When studying the causes and factors influencing the development and course of BOS in children, the most important is the study of background diseases that aggravate and prolong the course of bronchial obstruction. The study of pre-mobilisation background in patients of the compared groups showed that a number of factors were significantly more frequent in patients with acute and recurrent course of bronchobstructive syndrome. Conclusions. It was found that the risk factors for the development of recurrent course of bronchial obstruction in children are: artificial feeding (P<0.002; OR=4.80), rickets (P<0.02; OR=2.15), overweight (P<0.002; OR=5.40), atopy (P<0.001; OR=18.32), first episode of BOS before the age of 1 year (P<0.002; OR=3.01), absence of fever (P<0.002; OR=12.95) and catarrhal syndrome (P<0.001; OR=60.0) during the episode of illness.

THE IMPORTANCE OF MODIFIED BRONCHOPHONOGRAPHY IN THE DIAGNOSIS OF RECURRENT BRONCHOOBSTRUCTIVE SYNDROME IN CHILDREN

Abstract. Purpose of the study: to establish the diagnostic and prognostic significance of modified bronchophonography in bronchobstructive syndrome in children. Material and methods of research. The paper presents the results of examinations of children with bronchoobstructive syndrome. The patients were divided into 3 groups of 60 patients: Group I - patients with acute obstructive bronchitis (AOB), acute bronchiolitis (ABL), Group II - children with recurrent obstructive bronchitis (ROB) and bronchial asthma (BA), Group III - patients with acute bronchitis without bronchial obstruction (BA). Results of the study and discussion. Analysis of modified bronchophonography indices in groups I-II showed that on admission, E:I index>1.6 indicating bronchial obstruction of the II degree (P<0.001). On the 2nd day of observation, E:I index significantly decreased in patients with ROB, BA and was significantly lower in comparison with indices of patients with OOB, OBL (P<0,05). On the 3rd day of observation and at discharge, the indices were relatively equal, no significant difference was observed (P>0.2; P>0.1). When constructing the ROC-curve and analysing the curve coordinates, it was found that in determining the risk of ROB and AD in children, the diagnostic significance of the E:I index≥1.78, with a sensitivity of 71.7% and specificity of 61.1%. Conclusions. The values of E:I index≥1.78 are predictors of the risk of ROS and BA development, the diagnostic significance of which is confirmed by high sensitivity and specificity, which can be recommended for detecting the risk of recurrent course of BOS in children.

2020–2021 rhinovirus genetic diversity in Saint Petersburg

Introduction. Rhinoviruses represent one of the most common respiratory viruses and belong to the Picornoviridae family, genus Enterovirus, being divided into three types: A, B, C, which account for 169 types. Rhinoviruses predominate in autumn and spring periods, although they circulate throughout almost entire epidemic season. The rhinovirus genome is represented by a single-stranded 7.2 thousand base-long +RNA. According to the publications, the most common rhinovirus species is rhinovirus A (HRV-A), followed by rhinoviruses C (HRV-C) and finally rhinovirus B (HRV-B). The aim of our study was to define rhinovirus genetic diversity in Saint Petersburg . Materials and methods. The study was conducted at the Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza. Samples (smears from the nasopharynx and oropharynx) were delivered from the S.P. Botkin Clinical Infectious Diseases Hospital, St. Olga’s Children's City Hospital, N.F. Filatov Children's City Clinical Hospital No. 5. Outpatient samples were used as well. Samples received from December 2020 to October 2021 were analyzed. Detection of rhinoviruses was carried out by real-time PCR, typing — by Sanger sequencing, with primers developed by da Costa Souza L. et al. (2021). Results. According to total specimen testing, rhinoviruses comprise 3.2% total number of specimens tested. Of these, 71 rhinoviruses were typed, representing 17.03% total number of rhinovirus-positive specimens. The most common was HRV-A (55%), among which 21 types were found (the most common HRV-A46 is 13%, n = 5). HRV-B and HRV-C were found in equal numbers — 23% (n = 16) of each species out of total number of typed rhinoviruses. Among HRV-B, 8 types were found; the most common HRV-B06 comprised 33% (n = 5). Among HRV-C, 7 types were found (the most common types are HRV-C42, HRV-C32 and HRV-C15 — 19% each, n = 3). HRV-A was detected mainly in patients aged 18 to 65 years (57.5%, n = 23). HRV-B was detected only in adult patients (100%, n = 16). HRV-C was detected in children under 2 years of age (43.75%, n = 7) and adults aged 18–65 years (31.25%, n = 5). In some cases, HRV-A and HRV-C were associated with various respiratory tract syndromes such as acute nasopharyngitis, laryngotracheitis, obstructive bronchitis, and pneumonia. HRV-B was related to clinical manifestations of pneumonia in seven cases. Conclusion. Rhinovirus type A prevails in Saint Petersburg . Rhinoviruses can be associated with diverse respiratory tract syndromes.

A clinical case of primary ciliary dyskinesia in a child under one year old with a pathogenic genetic variant of the DNAH5 gene described for the first time

Relevance: primary ciliary dyskinesia (PCD) is a rare hereditary autosomal recessive disease from the group of ciliopathies, which is based on a defect in the ultrastructure of the cilia of the epithelium of the respiratory tract and similar structures, leading to a violation of their motor function. It is characterized by the defeat of all parts of the respiratory tract with the formation of a chronic inflammatory process and bronchiectasis. About half of patients with PCD have a complete or incomplete reverse arrangement of internal organs with various variants of heterotaxy (situs inversus). Primary ciliary dyskinesia should be differentiated from cystic fibrosis, primary immunodeficiency conditions, congenital anomalies of the structure of the bronchial tree, bronchiectasis of other origin, bronchial asthma, congenital anomalies of the cardiovascular system. Objective: describe the clinical case of a PCD patient with the first-described pathogenic variant of the nucleotide sequence (chr5:13700862CCATAGA>C) of the DNAH5 gene to familiarize doctors with the clinical features of the disease and modern diagnostic capabilities. Materials and methods: the data from the patient’s medical history, transmission electron microscopy to detect anomalies in the structure of cilia in the biopsy of the nasal mucosa and the results of molecular genetic diagnostics were used. Results. The patient was admitted for 8 months for examination and treatment in June 2022. A child from the 1st pregnancy, the first birth at 43 weeks. From anamnesis: suffered intrauterine pneumonia, otitis media without hearing loss, obstructive bronchitis, episodes of apnea. Neonatal screening for cystic fibrosis is negative. According to the PICADOR scale, 12 points were obtained. On high-speed video microscopy of cilia, there is a violation of the movements of the cilia. On computed tomography of the chest organs, the reverse location of the internal organs was noted, there were no pathological changes in the lungs. The total absence of external and internal dynein handles on transmission electron microscopy was revealed. Exome sequencing revealed the previously described variant of the nucleotide sequence in exon 68 of the DNAH5 gene (chr5:13735348G> A) in a heterozygous state. Also, a previously undescribed variant of the nucleotide sequence (chr5:13700862CCATAGA> C) in a heterozygous state was detected in exon 78 of the DNAH5 gene. Conclusion: modern possibilities of PCD diagnostics are demonstrated by the example of clinical observation. It is noted that patients with suspected PCD need a comprehensive examination. A pathogenic variant of the nucleotide sequence (chr5:13700862CCATAGA>C) of the DNAH5 gene in a heterozygous state has been described for the first time, leading to the deletion of two amino acids without shifting the reading frame (c.13604_13609del p. (Val4535_Tyr4536del); NM_001369.3), which will help for the diagnosis of PCD in the future.

Errors in the diagnosis and therapy of bronchial asthma in children

The analysis of outpatient records of children with bronchial asthma was carried out to identify the timeliness of the diagnosis of bronchial asthma, which showed that the diagnosis was made with a delay of 3.8 years. In children with prolonged persistent cough, repeated acute obstructive bronchitis, bronchophonography revealed latent bronchospasm, the subsequent appointment of preventive anti-inflammatory therapy to these patients made it possible to clarify the diagnosis of bronchial asthma in 58.9 % of cases. Analysis of the register of patients with bronchial asthma revealed the absence of basic therapy in 2/3 of children with a mild persistent course of the disease. The frequency of emergency medical calls and hospitalizations was higher in children with mild bronchial asthma who did not receive control therapy. An analysis of the expenditure of short-acting β2-agonists in 96 children with asthma indicates their excessive use in 50% of patients. Conducting training seminars increased the knowledge of district pediatricians on modern thera-peutic and diagnostic approaches to bronchial asthma.

COVID-19 IN NEWBORNS: OWN EXPERIENCE ON THE EXAMPLE OF CLINICAL CASES

Introduction. Currently, there is controversial information regarding the epidemiologic characteristics and severity of COVID-19 in pregnant women and newborns. Most researchers report the same severity of disease in pregnant and non-pregnant women, and a milder course of disease in the neonatal period, with the possibility of critical illness in some infants. Ideas about the possibility of transmission of SARS-CoV-2 to a newborn have changed. Since intrauterine transmission of the novel coronavirus is currently considered rare, COVID-19 in newborns is usually associated with postnatal transmission of the virus.The aim of the work was to analyze the epidemiologic and clinical features of the COVID-19 in newborns based on the analysis of clinical cases.Material and methods. On 2020, at the beginning of the COVID-19 pandemic, 11 newborns were admitted to the infectious diseases departments of Chernivtsi Regional Children's Clinical Hospital, 9 children were referred from home by a family physician, and 2 children were transferred from maternity care facilities. Diagnosis was confirmed by PCR-RT detection of SARS-CoV-2 RNA in nasal/oropharyngeal swabs.The research was conducted in accordance with the principles of bioethics, the conclusion of the Commission on Biomedical Ethics of the Bukovinian State Medical University on the observance of moral and legal rules for conducting medical-scientific research, Protocol No. 6 dated March 16, 2023.The research was carried out within the framework of scientific and research activity of the Department of Pediatrics and Infectious Diseases of Children of the Bukovinian State Medical University "Modern epidemiological, clinical-paraclinical and diagnostic features of the most common inflammatory infectious and non-infectious diseases in children", state registration number: 0122U002208.Results. The analysis of the epidemiologic data allowed to identify an intrafamilial source of infection in all identified cases (in one case the source of infection could not be identified), in most cases it was the mother, in one case the source of infection was the father and the grandmother. In most families there are older siblings who could serve as a potential additional source of infection, but respiratory symptoms in siblings were identified in one third of the families.In the late neonatal period, cases of horizontal virus transmission were characterized by mild symptoms of upper respiratory tract infection as acute nasopharyngitis, one case - as a mixture with secretory diarrhea. COVID-19 in another child was accompanied by acute gastroenteritis and moderate dehydration. The clinical picture of coronavirus infection in the remaining third of cases was characterized by lower respiratory tract infection as acute tracheobronchitis, acute obstructive bronchitis and bronchiolitis.Two infants were transferred from the maternity hospital after delivery because of COVID-19 maternal symptoms and SARS-CoV-2 RNA detection in the infants' nasal/oropharyngeal swabs on the first day of life. These children were asymptomatic with no clinical or laboratory evidence of an infectious-inflammatory process during observation.Conclusions. The presence of an exclusively family source of infection can be considered an epidemiological feature of COVID-19 in the neonatal period. In the case of horizontal transmission of the SARS-CoV-2 virus in newborns, the disease COVID-19 in most cases proceeds as mild upper respiratory tract infection, less often – as lower respiratory tract infection and/or secretory diarrhea. In the case of maternal COVID-19 disease before childbirth the vertical and/or antenatal infection mode and the subsequent asymptomatic neonatal COVID-19 cannot be denied.