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The medical and social significance of cardiovascular diseases remains high. One of the factors that determine cardiovascular risks is metabolic syndrome. As a result of excessive accumulation of lipid and carbohydrate metabolism products in metabolic syndrome, oxidative (oxidative) stress develops. The article considers both domestic and foreign scientific studies, which highlight various aspects of the influence of reactive oxygen and nitrogen species, as well as other free radicals on the formation of oxidative stress in pathological conditions that are part of the metabolic syndrome complex. This describes the mechanisms of the formation of chronic inflammation through excessive secretion of pro-inflammatory cytokines and adipokines, activation of the transcription factor NF-kB, as well as damage to the antioxidant system in obesity. Separately, a number of mechanisms of the stimulating effect of adipokines: leptin, adiponectin, chimerine, omentin 1, resistin, on the formation of oxidative stress have been noted. The ways of activating the polyol pathway, as well as diacyl-glycerol — protein kinase C — the signaling pathway of oxidative stress, the formation of mitochondrial dysfunction is described. As a result of which there is an excessive production of free radicals in insulin resistance, diabetes mellitus and macroand microvascular complications of diabetes. In addition, the influence of oxidative stress directly on the formation of cardiovascular diseases of atherosclerotic genesis, as well as arterial hypertension, has been shown.

The pandemic of coronavirus infection COVID-19 (Coronavirus Disease 2019), caused by a new strain of coronavirus SARSCoV-2 (severe acute respiratory syndrome coronavirus 2), has caused high mortality worldwide. The clinical manifestations of COVID-19 are nonspecific. Diagnostics includes clinical, laboratory and radiological data. The importance of introducing information systems into medical practice in order to improve the quality of medical care is noted. It is stated that the development of medical artificial intelligence is associated with the development of artificial intelligence programs designed to help the clinic in making a diagnosis, prescribing treatment, as well as predicting the outcome of the disease. Such systems include artificial neural networks, fuzzy expert systems, and hybrid intelligent systems. The article analyzes data from a number of studies on the use of artificial intelligence for diagnosing COVID-19, predicting the risk of mortality and studying risk factors for severe course and lethal outcome in various groups. Using clusters of predictors, models have been developed to predict mortality and understand the relationship of various characteristics and diseases with mortality from COVID-19. The article also summarizes the key factors that worsen the prognosis for COVID-19. Scales for detecting or predicting the development of COVID-19-induced “cytokine storm” are marked as a separate item.

Chronic spontaneous urticaria is an urgent health problem. Recurrent urticarial rashes, angioedema and severe itching reduce the quality of life of patients. The ineffectiveness of standard therapy requires the search for new modern methods of treating this disease. Taking into account the current data on the pathogenesis, the third line of therapy for chronic spontaneous urticaria is the addition of anti-IgE therapy (omalizumab) to antihistamines of the 2nd generation. The presented clinical case is devoted to the experience of long-term use of omalizumab in a patient with chronic spontaneous urticaria. Having a disease duration of about a year, the patient was thoroughly examined, all concomitant diseases were identified and compensated, parasitic invasion was treated, but this did not lead to a regression of symptoms. Antihistamines of the 2nd generation in standard and increased doses (up to 4 times) did not control the disease, systemic glucocorticosteroids stopped the symptoms for a short time, and therefore, in the future, the patient began to use them independently and uncontrollably. Almost daily use of corticosteroids for 6 months caused the development of complications in the form of weight gain and Cushing’s syndrome. Omalizumab completely stopped all the symptoms during the first day, no side effects were detected. The clinical effect lasted from 3 to 4 weeks. Thus, omalizumab therapy allowed the patient to almost completely get rid of the symptoms of CSC, which significantly improved the quality of life and made it possible to cancel systemic glucocorticosteroids. The peculiarity of the presented case is the duration of the use of omalizumab (more than 2 years) with the inability to cancel due to the return of urticarial rashes and itching.

Chronic obstructive pulmonary disease (COPD) is one of the most important problems of modern medicine associated with a high mortality rate, high costs of treatment and relief of exacerbations of COPD. The main objectives of COPD treatment are symptom control, reduce the frequency of exacerbations and hospitalizations, and reduced risk of exacerbation in the future. The recommendations of the GOLD initiative propose a treatment approach based on the assessment of exacerbation rates external respiratory function indicators (spirometric classification of GOLD), the severity of symptoms assessed on the CAT test and mMRC. When choosing therapy, the physician must first of all take into account the effectiveness, safety of the drug, adherence to treatment in order to achieve the therapeutic goals of treating patients with COPD. The change in therapeutic approaches in COPD treatment is associated with the accumulation of knowledge in physiology, clinical pharmacology, and the isolation of new clinical phenotypes of COPD. Currently, the main classes of drugs for the treatment of COPD are long-acting beta-agonists (LABA), longacting anticholinergics (LAMA), and inhaled glucocorticosteroids (ICS). The evolution of therapeutic approaches in COPD treatment has led to the creation of new fixed inhalation combinations of the main groups of drugs for COPD treatment. The therapeutic strategies recommended by GOLD and the Russian Federal Guidelines determine the long-term goals of COPD treatment – the impact on the risk of exacerbations in the future. The presented clinical observation of a patient with severe COPD demonstrates the effectiveness of a triple fixed combination vilanterol/umeclidinium/fluticasone furoate 55/22/92 μg as a basic therapy. The chosen treatment strategy not only reduces the severity of the symptoms of the disease, but also reduces the risk of exacerbations in the future.

The article presents a case of granulomatosis with polyangiitis, which is difficult for clinical diagnosis. Recently, the incidence of systemic vasculitis has increased, and given the similarity of clinical symptoms with other pathologies, a doctor of any specialty should carry out differential diagnosis. Granulomatosis with polyangiitis is characterized mainly by damage to the upper respiratory tract, lungs, and kidneys. The main method for diagnosing granulomatosis with polyangiitis is biopsy with histological examination, which allows to detect inflammation in the affected tissues. A feature of granulomatosis with polyangiitis is detection of antineutrophil cytoplasmic antibodies in the blood serum. However, these antibodies are recorded only in 80% of patients and are not detected in the remission phase, which makes diagnosis much more difficult.

Introduction. One of their main aspects in the treatment of patients with bronchial asthma is maintaining adequate control over the course of the disease.The aim: to assess the level of control, the causes of the uncontrolled course of the disease and the quality of life in patients with severe bronchial asthma.Materials and methods. The study involved 160 patients with severe bronchial asthma taking basic anti-inflammatory therapy. The assessment of adherence to baseline therapy was assessed by questionnaires of patients with a modified Morisky-Green questionnaire and a test to assess adherence to inhalers (TAI). A quality of life questionnaire for patients with bronchial asthma (AQLQ) was used to assess quality of life.Results. It was revealed that all patients had reported daily symptoms and a daily need for short acting beta-agonists; 96.6% of the patients enrolled in the study had night awakenings and physical activity restriction. The survey of patients with the help of the Morisky-Green questionnaire showed that deliberate low adherence to therapy was noted in 45.6% of cases, which was formed due to inattention to the hours of medication – 67.1% and missing the drug in good health in 47.9% of patients. Low motivation and low awareness of their disease is recorded in 24.4% of patients.Conclusions. All patients did not achieve control of the disease. In half of patients with severe asthma, there is low deliberate adherence to basic anti-inflammatory therapy, which is formed mainly by missing the drug in good health and inattention to the hours of medication. Asthma symptoms have the greatest impact on the patient’s emotional state, physical activity, and overall quality of life.

Chronic obstructive pulmonary disease (COPD) today remains one of the most important problems of modern medicine. The social significance of this disease is determined by the annual health care costs for treating patients with exacerbated COPD, as well as the still high mortality and disability rates worldwide. The main goals of COPD treatment are to slow the rate of disease progression, control the symptoms, reduce the frequency of exacerbations and hospitalizations, and reduce the risk of future exacerbations. Currently, the main groups of drugs for basic therapy of COPD are inhaled prolonged bronchodilators from the groups of β2-adrenergic agonists and M-anticholinergics, as well as their combinations. Patients with COPD and bronchial asthma, as well as patients with COPD with elevated levels of eosinophils and frequent exacerbations, inhaled glucocorticosteroids (ICS) are used. It has been proven that the addition of corticosteroids to LABA in patients with moderate to severe COPD and frequent exacerbations has a more effective influence on pulmonary function and the number of exacerbations. Clinical studies have shown the relationship between the level of blood eosinophilia and the clinical effects of preventing future exacerbations when using iCS in combination with LABA. In our clinical observation, in patient with moderate COPD and blood eosinophilia > 300 cells/μL, when prescribing monotherapy with long-acting agonists, frequent exacerbations of the disease were noted. The addition of corticosteroids to monotherapy with a long-acting agonist made it possible to influence the frequency of exacerbations and reduce the level of eosinophils in the blood.

Bronchial obstructive syndrome is a violation of bronchial patency of functional or organic origin, which is manifested by shortness of breath, suffocation attacks, cough, tachycardia. The most common cause of bronchial obstructive syndrome is chronic obstructive pulmonary disease and bronchial asthma. In some cases, the cause of bronchial obstruction is tumors or tumor metastases to the lungs. The article describes a clinical case of bronchial obstructive syndrome, showing that all patients with bronchial asthma, in the absence of an effect from the prescribed adequate basic therapy, with no control over the disease, should be well examined for an alternative diagnosis. In our case, a thorough examination of the patient allowed the allergist to diagnose central lung cancer with metastases to the lymph nodes of the mediastinum. A feature of the case is the primary resistance to tyrosine kinase inhibitors, revealed during a genetic study, which determined the scheme of further polychemotherapy. This clinical case proves the need for differential diagnosis, with a comprehensive approach and the use of various examination methods.

Given a persistent global trend towards an increase in the number of patients with bronchial asthma (BA) over the past decades, researchers are facing challenges related to a comprehensive study of the pathogenesis of BA. Numerous studies have shown that BA is associated with long-term persistence of leukocytes (lymphocytes, macrophages, and eosinophils) in the bronchial tissues. However, the causes of this phenomenon remain understudied. The article provides an overview of modern research on the mechanisms of disorders of lymphocyte apoptosis in patients with BA.Our study considers the main mechanisms of molecular regulation of lymphocyte apoptosis, including transcription factors, the Fas/FasL system, and bcl-2/bcl-XL factors. We present the data on the role of reduced lymphocyte apoptosis in the formation of a severe BA phenotype. Taking into account high prevalence of obesity among patients with BA, we analyzed a few existing articles on the apoptosis of immunocompetent cells in obesity. In addition, the article highlights the key mechanisms of development of lymphocyte plasma membrane blebbing (PMB) with formation of microvesicles, as well as their influence on the course of pathological processes in BA. The authors believe that further in-depth study of apoptosis, lymphocyte necrosis, and plasma membrane blebbing can help improve the principles of diagnosis and treatment of BA.

Primary immunodeficiency is a rare congenital pathology associated with failure of immune system, manifested by disturbances of its functions. These defects lead to increased susceptibility of patients to various infectious agents, as well as the development of autoimmune, malignant and other diseases. Primary immunodeficiency is classified as a rare disease, which was previously associated with a poor prognosis with a high risk of mortality in childhood. To date, the emergence of highly effective treatment methods has changed the course and prognosis of these diseases. Clinicians of various specialties increasingly meet with this pathology in everyday practice, including adult age cohorts. In this regard, early diagnosis of primary immunodeficiency in adults becomes relevant, being associated with choosing optimal therapy, prevention of severe internal organ damage, determination of management strategy for the patient, as well as the need to identify inherited disorders and provide information to the patient’s family. Delayed verification of the diagnosis may cause disability of the patient and development of irreversible, often fatal complications. This article presents our own clinical case with a newly diagnosed clinical condition: Common variable immunodeficiency disorder (CVID), the most common form of primary immunodeficiency in adults. The symptoms of common variable immunodeficiency disorder appear in these patients in adulthood, but a high-quality collected history of the disease will allow you to trace symptoms in the patients even since early childhood. There is a common gap for several years between the onset of the disease and clinical diagnosis, since erroneous diagnosis is often made due to non-specific clinical symptoms that resemble other, more frequent diseases. The prognosis of patients with CVID depends on several factors: frequency of infections, structural disorders in the lungs, the occurrence of autoimmune diseases and the success of infection prevention. Thus, a variety of clinical forms of primary immunodeficiency, lack of awareness of doctors about this pathology, complexity of immunological examination in the general medical network lead to the fact that CVID is not diagnosed for long terms, and patients do not receive the necessary pathogenetic therapy. There is a need for drawing attention of doctors of various disciplines to the fact that the recurrent inflammatory processes of various localization, which are difficult to respond to adequate traditional therapy, may be caused by changes in the immune system, including congenital, genetically determined immunodeficiency.

Chronic obstructive pulmonary disease (COPD) is currently one of the most socially significant diseases that leads to a significant decrease in the daily activity and productivity of patients, as well as their rapid invalidization. In this regard, its treatment remains the most important problem of medicine. Currently, the main goals of treatment of patients with COPD are: relief of symptoms, improvement of exercise tolerance, improvement of General health, prevention and effective treatment of complications, prevention and effective treatment of exacerbations, prevention of disease progression, and reduction of mortality. The article presents a clinical case from the practice of a patient with COPD who received olodaterol + Tiotropium bromide. In view of the patient’s low adherence to therapy, further progression of the disease was observed, which led to a significant violation of airway patency during spirometry, and a decrease in exercise tolerance. The patient was assigned a new representative of combined drugs with 24-hour action - Vilanterol + Umeclidinium 22/55 mcg, with a new method of drug delivery. After 6 months of therapy with Vilanterol + Umeclidinium, the patient’s exercise tolerance increased, lung function improved, and quality of life improved.

Introducrion. Due to the peculiarities of the Krasnoyarsk krai (a huge territory, low population density, different levels of health development in the districts, personnel shortage), there is a need to increase the availability and quality of medical care to district patients. For this purpose, since 2016, the Regional telemedicine system has started functioning online monitoring for patients with severe pneumonia, which provides full-fledged curation of patients from all over the region.Objective. To evaluate the results of RTS monitoring of patients with severe pneumonia.Materials and methods. 770 cases of severe community-acquired pneumonia registered in RTS from 2016 to 2018 were analyzed. Statistical data processing was performed using variational statistics using the “Excel-7” software package. For all values, the minimum significance level (p) of 0.05 was taken into account.Results. The risk factor for severe flow was male. Among comorbid diseases, cardiovascular and bronchopulmonary diseases, diabetes, alcoholism and HIV infection prevailed. The lack of flu vaccination in 97% of patients increased the number of deaths by 4.5 times. The greatest need for consultation arose in the Central district hospitals of low capacity. The majority of patients are registered in the system on the first day of hospitalization and are consulted by a pulmonologist of the Regional clinical hospital within 2 hours. Air ambulance of the Regional clinical hospital evacuated 174 patients, the need for flights decreased by 3.5 times. The main mistakes of district hospitals in the management of patients were the irrational selection of antibacterial drugs, the volume of detoxification therapy, the late start of antiviral therapy and ventilators, and the lack of prescription of anticoagulants.Conclusions. Along with the presence of comorbidities, the outcome of the EAP is affected by the quality of medical care, which depends on the professional training of medical workers, continuity in the work of regional medical institutions and air ambulance, which causes difficulties, given the specifics of the region. RTS allows you to solve this problem at minimal cost.

The purpose of this study was to conduct the analysis of the structure and the rationality of cost in particular of providing preferential medicines patients with сhronic obstructive pulmonary disease (COPD) in Krasnoyarsk region.Materials and methods. The database of Ministry of Health of Krasnoyarsk region and Territorial fund of obligatory medical insurance of Krasnoyarsk region on the released preferential preparations to patients with the code J44 on the territory of Krasnoyarsk region for 2014 was used. For the diagnosis of rationality costs method of pharmaco-economic analysis — АВС/VEN analysis — was applied.Results. Most of the costs amounted to vital medicines (99.8%) of which the maximum share of costs associated with bronchodilators (73.9%) and a combination of DDBA and inhalation GCS (18.5%). In this research the most finances was spent on Tiotropium bromide (51%), Fenoterolum/Ipratropium bromide (18.7%) and Salmeterol/ Fluticasonum (11%). The nomenclature of International unlicensed name of the drugs which are released according to preferential prescriptions for 98.9% is bound to pathogenetic therapy of COPD and doesn't contradict to the modern recommendations on a pharmacotherapy of this pathology. Most of patients were provided with the following drugs of International unlicensed name: the combined preparation of Fenoterolum/ Ipratropium bromide (72.2%), a lond-acting cholinoblocker Tiotropium bromide (38.9%) and mucolytic preparation N- Acetylcysteinum (38.7%). To the category N is referred only 3 drugs of International unlicensed name the necessary of which is in doubt.Conclusion. The ABC/ VEN analysis showed rational use of financial means on pharmacotherapy patients with COPD in Krasnoyarsk region. The list of drugs of International unlicensed name is consistent with the current recommendations for management of such patients.

Purpose — to study rationality of financial expenses on the treatment of patients with the severe pneumonia.Materials and methods. It was selected 30 medical histories of patients with severe community-acquires pneumonia passing hospitalization in pulmonology department and department of intensive care in 2004, 2011 and 2014. The frequency analysis was applied to studying the structure of the carried-out drug treatment and identification of frequency of the separate medicinal preparations. We have data about the cost of drug which were received from the database of «1C: Drugstore» of regional clinical hospital.Results. Expenses on the treatment of severe community-acquires pneumonia according to 2014 year are rational, 92.23% of expenses are vitally necessary drug entering into modern clinical references. According to the ABC/VEN analysis during the period from 2004 till 2014 we found positive dynamics of increase of expenditure of money at category V. The appreciable attention should be paid to the treatment of accompanying pathology in the therapy of severe communityacquires pneumonia which can make heavier a current of basic disease and become the reason of complications, often fatal. Costs of the medicinal preparations for treatment of the accompanying pathology in 2014 year was made 6.27% that it is necessary to consider at advance planning of provision of medicines in pulmonology department.Conclusion. The results received by us testify about rational use of financial costs on treatment of patients with severe community-acquires pneumonia.

In the article, a case presented of primary amyloidosis of the heart and pericardium, with severe resistant heart failure. That kind of case witnesses that diagnostics and management of patients with this disease, is a complicated issue in cardiology practice. That is related to its rarity, absence of key simptoms in clinical practice and delayed diagnostics with lack of expected efficacy of modern treatment.

Clinical presentation of myxomas is diverse, so it is not easy to diagnose this pathology even with available modern instrumental methods. With its “natural” course this pathology is associated with poor outcome, most patients die in several years from the first clinical signs onset.

Aim. To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. Materials and methods. 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. Results. There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. Conclusion. Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient.

Aim. To investigate the clinical and functional parameters in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) versus those with chronic obstructive pulmonary disease (COPD) and asthma. Subjects and methods. A total of 129 people were examined. 51 patients with ACOS were followed up in Group 1; Group 2 included 38 patients with severe asthma; Group 3 consisted of 40 patients with severe COPD. All the patients underwent clinical examination: history data collection, physical examination, evaluation of disease symptoms, and study of respiratory function (spirometry, body plethysmography). Results. ACOS is clinically characterized by considerable demands for emergency drugs and by more frequent asthmatic fits and exacerbations, which require hospitalization. The parameters of bronchial resistance in ACOS were established to be increased throughout the follow-up period and to be comparable with those in patients with COPD. In the patients with ACOS, the severity of pulmonary hyperinflation was associated with increased demands for emergency drugs (r=0.59; p=0.015). Fixed bronchial obstruction in ACOS can be caused by smoking intensity and duration associated with increased bronchial resistance in expiration (r=0.51; p=0.003) and intrathoracic volume (r=0.71; p=0.0001); as well as increased body mass index (p

The problem of modern medicine is to optimize the treatment of patients with comorbidity, whose number has been growing steadily in recent years. The concurrence of asthma and obesity determines the severity of disease, low-level control, and resistance to basic therapy in conjunction with more frequent use of β-agonists for relief of symptoms, and frequent hospitalizations for a disease exacerbation. Currently, there are only a few known pathogenetic components that are responsible for the negative impact of visceral obesity on the course of asthma.