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Introduction. Cytokine imbalance is a topical issue of researches in the field of comorbid pathology, in particular, chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (DM2).The objective was to establish the characteristics of serum IL-6 levels in patients with a combination of COPD and DM2.Methods and materials. In the groups of patients with COPD (51 people), DM2 (42 people), COPD with DM2 (39 people), the control group (39 people), IL-6 was determined by enzyme immunoassay (standard test systems) on a StatFax 303Plus spectrophotometer. Computed tomography of the chest was performed on Optima 660 GE and Optima 540 tomographs using an image processing program on the AW SERVER 2.0. IBM SPSS Statistics software was used for statistical processing of the results.Results. A negative correlation was found between the level of IL-6 and the duration of COPD in patients with COPD in combination with DM2 (r=–0.373, p=0.033). In this group, there was a positive correlation between the level of IL-6 and the dose of dexamethasone (r=0.802, p=0.030). Among COPD patients, IL-6 levels were significantly lower in the subgroups of patients receiving glucocorticosteroid through a nebuliser (p=0.046), as well as patients receiving antibiotics (p=0.004). An algorithm for radiological methods of examination in patients with a combination of COPD and DM2 is proposed.Conclusion. The study of the features of the pathogenesis of a combination of COPD and DM2 is of practical interest for the individualization of management tactics in patients of this group.

The lecture is dedicated to the idea of a role of psychosomatic disorders in the occurrence and development of asthma, on the diagnosis and treatment of the neuropsychic type of its course, and on possibilities for psychotherapeutic correction.

Objective. To assess the dynamics of bronchial asthma (BA) and allergic rhinitis (AR) caused by house dust mites (HDM) in children during 3 years of allergen specific immunotherapy (ASIT) with HDM allergens and 1 year after treatment cessation.Research methods. 50 patients completed an open, prospective, controlled 5-year study. 25 patients of the main group with BA and sensitization to HDM underwent a year of preliminary observation, 3 years of ASIT with HDM allergens, and 1 year of follow-up: 16 boys (64%), 9 girls (36%), 5 years to 13 years (8.3 [6.7; 11.5]) at inclusion. The control group of 25 patients, who did not receive ASIT, was selected as pairs copies. At inclusion, the concentration of periostin and thymic stromal lymphopoietin (TSLP) in blood serum and nasal material was determined in all patients. The dynamics BA and AR was assessed based on the total index of symptoms and medications for each year of observation.Results. During 3 years of treatment, a significant clinical effect of ASIT was formed, which persisted for 1 year of follow-up after the end of ASIT. At the end of the follow-up year, the overall index of symptoms and medications was 8.77 ± 1.06 points in the ASIT group and 22.01 ± 2.18 points in the control group (p=0.00001). The concentration of periostin before the start of treatment did not affect the effectiveness and features of the ASIT treatment course. A high serum TSLP concentration (>750 pg/ml) is characteristic of the subgroup with a higher incidence of adverse events associated with ASIT; the final effectiveness of ASIT does not depend on the concentration of this marker.Conclusion. ASIT with HDM sublingual drops is the method of first choice in the treatment of children with BA and AR, in cases where the role of HDM allergens in the genesis of the disease has been proven. A successful ASIT has a prolonged effect (at least 1 year of follow-up), which indicates the possibility of changing the natural course of asthma in children. The study of biomarkers does not allow us to predict the effectiveness of ASIT.

Background. Assessment of lung injury in oncohematological patients is a relevant problem, since the spectrum of pathological changes is wide and includes pulmonary infections, tumor cell infiltration, cardiogenic and non-cardiogenic pulmonary edema, bronchiolitis obliterans, interstitial pneumonitis, post-radiation and post-inflammatory pneumofibrosis, pulmonary vasculopathy and pleural effusion. At the moment there are no approved recommendations with criteria of differential diagnosis for these conditions, in particular, with differences between the most common therapy complication represented by pulmonary infections and poorly explored drug-induced toxic lesions.Aim. Identification of criteria for pneumotoxicity, allowing for differential diagnosis with pulmonary infections developing during chemotherapy, according to data routinely obtained in real clinical practice.Materials and methods. The study group included 38 patients with cytotoxic and autoimmune lung injury caused by specific therapy (group 1); the comparison group included 38 patients with infectious lesions receiving the same antitumor drugs (group 2). The data of the anamnesis, clinical course, instrumental studies and standard laboratory tests was studied retrospectively. For statistical analysis, the Mann–Whitney, χ2, Kruskal–Wallis tests were used. ROC analysis was performed to assess the sensitivity and specificity of various factors in relation to toxic damage.Results. Patients with lymphomas predominated in group of toxic lung injury (63 %). In patients who underwent allogeneic hematopoietic stem cells transplantation, toxic complications developed in the period from 35 to 1289 days, infectious – from 4 to 43 days. Statistically significant differences were obtained in the presence of a concomitant state of an altered immune response: 32 % of patients in the toxic lesion group versus 5 % in the infectious group had a history of allergy, and, in contrast to the infectious lesion group, in the toxic lesion group autoimmune diseases were detected. The main symptom in patients of the first group was shortness of breath, which was observed in 68 % of cases, of the second – an increased body temperature, observed in 92 % of cases; cough was also a common symptom – in 19 % and 13 % of patients respectively. In 58 % of patients of the second group, concomitant mucositis was detected, while in the first group this complication did not occur in any of them. The most common radiological pattern (71 % of cases in each group) was ground-glass opacities, in patients of the second group often combined with infiltrative changes and thickening of the bronchial walls (in 53 and 42 % of cases respectively). Among laboratory results, the largest differences between groups were observed in the leukocyte levels (with an average level of 2.5 . 109 / L in the infectious group versus 6 . 109 / L in the toxic group), eosinophils (with an average of 3.6 % in the toxic group versus 1.75 % in the infectious group), C-reactive protein (with an average level of 146.7 mg / L in the infectious group versus 52.4 mg / L in the toxic group), and creatinine (with an average of 0.085 mmol / L in the toxic group versus 0.071 mmol / L in the infectious group).Conclusion. The data obtained in this research indicates the value of taking an anamnesis and the importance of performing additional studies in patients with suspected drug-induced lung injury, as well as identifies risk groups. Based on the revealed differences, a scale for the differential diagnosis of drug-induced toxic and infectious lung damage, which includes the results of publicly available research methods, with high sensitivity and specificity, was proposed. Further research for more specific, but, at the same time, universal for various drugs, criteria for toxic lung damage is relevant.

Rengalin is a release-active combination antitussive drug based on antibodies to bradykinin, to histamine and morphine. It acts at various mechanisms of cough reflex by modifying endogenous target molecules and their interaction with receptors. The drug's efficacy, as demonstrated previously in experimental and clinical studies, is mediated by specific release-activity obtained as a result of the production process. Methods. Efficacy and safety assessment of rengalin in the treatment of cough induced by acute upper respiratory tract infections (URIs) in comparison with a complex codeine-containing drug (codelac®) was performed as part of a multicenter, randomized clinical trial involving 143 patients. All the participants presented with dry/non-productive cough caused by URIs (pharyngitis, laryngitis, tracheitis, tracheobronchitis, bronchitis). The duration of cough varied between 12 hours and 7 days. Rengalin was administered in 73 patients receiving 2 tablets 3 times daily for initial three days, and half reduced doses - for the subsequent four days; codelac® was administered in 70 patients who were given 1 tablet 3 times daily for the entire treatment period (7 days). Primary efficacy endpoints were time to cough resolution and reduction in the severity of the cough (scored using a Cough Severity Scale). One patient in Rengalin group and three patients in Codelac group were withdrawn from the study. The article presents treatment outcomes obtained for 139 participants who completed the study in accordance with the protocol (Per Protokol-analysis). The data analysis was based on a non-inferiority (or comparability) statistical design for efficacy endpoints. Results. The antitussive effect of rengalin was significantly comparable (р

The increase in the number of patients with mental disorders in general hospitals with the shorter patient length of stay there requires diagnostic and therapeutic measures as soon as possible. Group hypnotic suggestive psychotherapy (HSPT) is an effective psychotherapeutic technique that is capable of covering a large number of patients in a short time.Objective: to evaluate the efficiency of short-term group HSPT in multidisciplinary hospital patients with borderline psychic disorders accompanying the underlying disease and to determine the impact of a single session of such therapy on the patients' condition.Patients and methods. A study group consisted of 78 patients who received HSPT; a control group included 37 patients who did not have such therapy. Treatment-induced changes in their mental state were evaluated using the Symptom Checklist-90-Revised questionnaire; the patients' current state was rated with the Mood and Feelings (health, activity, and mood) questionnaire, and the situational anxiety subtest of the integrative anxiety test (IAT-st).Results and discussion. The study group showed a more pronounced reduction in mental disorders, especially the symptoms of anxiety and depression, than that in the control group. A single HSPT session was shown to have a positive impact on the current state of patients, considerably improving their well-being and reducing the manifestations of anxiety. Improving both the somatic and mental state of patients immediately before their discharge from a hospital seems to be an important therapeutic and social factor also for successful outpatient treatment.Conclusion. It is necessary to conduct a follow-up study to clarify how long the impact of short-term intervention using HSPT can persist. The latter can be effective in multidisciplinary hospital patients.

Introduction. In systemic autoimmune diseases with joint damage (SADJD), impaired angiogenesis occurs, which plays a key role in the progression of proliferative synovitis and in the development of lesions of the internal organs. Excessive production of vascular endothelial growth factor VEGF-A, the main mediator of angiogenesis, leads to an increase of the inflammatory process.The objective of the work was to study the relationship of VEGF-A with glutathione metabolism parameters, activity of the process and immune status in systemic autoimmune diseases with joint damage.Material and methods. 58 patients with systemic autoimmune diseases with joint damage were examined. The comparison group consisted of 45 healthy individuals. The main clinical parameters and rheumatoid factor (RF) were analyzed. To determine the activity of the process, we calculated the indices DAS28 for patients with rheumatoid arthritis (RA) and BASDAI for patients with ankylosing spondylarthritis (AS). The activities of the enzymes glutathione peroxidase (GPO), glutathione reductase (GR), superoxide dismutase (SOD) and the content of GSH were determined in erythrocytes.Results. The level of serum VEGF-A in patients with systemic autoimmune diseases with joint damage was increased more than 30 %, in erythrocytes the concentration of GSH and GPO activity were 2 times lower and almost 2 times lower respectively, and GR activity was reduced by about 20 % compared with donors. A correlation was found between the level of VEGF-A and GR activity (R = 0.579; P = 0.03) in RA patients with moderate activity of the process, and absence of relationship between these parameters and the activity of the process in AS. The activity of both GPO and GR in patients with RF was lower by more than 1.5 times, and SOD activity was twice lower than control. The VEGF-A level in the blood plasma was determined by the method of non-competitive enzyme immunoassay.Conclusion. The increase in VEGF-A level in the blood plasma of patients with systemic autoimmune diseases with joint damage is most pronounced in RA patients with moderate activity of the process and is associated with the presence of RF. The relationship of VEGF-A and GR activity indicates a special role for this enzyme in the regulation of angiogenesis in RA.

Antimicrobial chemotherapy is a keystone of the treatment of pneumonia. Prescription of antibacterial drugs does not always ensure the success of treatment due to the secondary immune deficiency developing in the process of the disease and the rapid growthof acquired antibiotic resistance. The article presents experience and clinical and immunological effectiveness of the use of recombinant interleukin-2 (rIL-2) in the treatment and prevention of pneumonia in order to reduce the risk of pneumonia in cerebral strokes and severe exogenous poisoning.In our study, we analyzed two clinical cases with of pneumonia. In patients with severe forms of pneumonia using complex therapy with recombinant interleukin-2, the time to achieve clinical and laboratory remission is reduced, the manifestations of respiratory failure and intoxication syndrome are stopped.Thus, аccumulated clinical experience the administration of the recombinant drug interleukin-2 in combination with antimicrobial drugs in basic therapy showed positive effectiveness, validity and expediency, in order to improve the clinical course, normalize immunological parameters, as well as for the rapid and complete treatment of the inflammatory process in patients of different ages with severe pneumonia.

Introduction. According to WHO data, COPD is the 4th cause of death in the world. The important problems of COPD are frequent exacerbations, comorbid conditions and late diagnosis. One of the most important factors in the formation of COPD is smoking. Recently, special attention is paid to the peculiarities of the course of COPD in women.The objective of this study was to reveal the peculiarities of smoking status in people of different sexes with different severity of respiratory symptoms in order to further creating the groups of patients on tobacco cessation.Material and methods. 108 smoking patients aged 20 to 60 years were examined in real outpatient practice. Besides the questionnaire, all examined underwent spirometry and CO determination (ppm) in exhaled air.Results. Analysis of the results of the study showed that women started smoking later than men. The number of day-today smoked cigarettes, the smoking index, and the degree of nicotine addiction in women were significantly less that was naturally accompanied by a significantly lower content of CO in the exhaled air. Broncho obstructive syndrome was found in 56% of men and 44% of women; the degree of nicotine addiction and respiratory symptoms were interrelated only in women (r=0.50, p

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is one of the most widespread pulmonary diseases. The important feature of conditions of emergence of COPD is long influence of etiological factors and risk factors. Detection of risk factors is urgent and necessary for well-timed diagnosis, purpose of adequate treatment, improvement of scheduled maintenance. The objective is to show the negative impact of individual etiological factors and of risk factors of COPD among adult population in one of the regions of the Komi Republic for the 2013–2016 period. Material and methods. Materials of medical examination among the adult population in the urban-type settlement Zheshart of the Komi Republic for the period of 2013–2016. The patients were divided into three age groups: from 21 to 36 years, from 39 to 60 years, from 60 years and older; men and women. Among the unfavorable etiological and risk factors a special attention was paid to climate, smoking, low physical activity, irrational nutrition. Results. The Komi Republic is characterized by a cold and severe climate. The adverse climatic factors promote development of COPD, especially in patients with genetic predisposition to pulmonary diseases. The percentage of smokers is high among the population and male smokers on average by 40.6 % more than women smokers. Smoking is mainly common at the age from 21 years old up to 36 years old. The number of patients with low physical activity remains at steadily high level. The number of women with low physical activity exceeds number of men in two and more times. Most of all patients with low physical activity (as well as with irrational nutrition) are noted at the age of 39–60 years. An alarming tendency is prevalence of an irrational nutrition. The number of the women eating irrationally exceeds the number of men in 1.5 -2 times. The number of patients with irrational nutrition is less at the age of 21–36 years. Conclusions. The serious risk factors of COPD are negative climatic conditions, low physical activity, smoking, irrational nutrition. Pulmonary rehabilitation is necessary for patients with COPD. A basis of pulmonary rehabilitation is the physical exercises. Identification and accounting of risk factors of COPD is important for improvement of scheduled maintenance, early diagnostics and purpose of adequate therapeutic treatment.

Relevance. The use of inhaled glucocorticosteroids (IHCs) is one of the main basic treatment options forbroncho-obstructive diseases.IHCs suppress chronic inflammation in the bronchial tree, but can be associated with the risk of pneumonia due to impairment of bronchus mucosal immunity and increased microbial colonization in the mucosa.Aim. The aim of this study was to evaluate the incidence and risk factors of pneumonia during the IHCs therapy in patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA), and with combination of COPD and asthma.Materials and methods. The retrospective study included patients with confirmed COPD, BA and combined COPD and asthma. The endpoint of this analysis was the incidence of pneumonia. Potential additional risk factors (age, gender, smoking, diagnosis, duration of the disease) were analyzed.Results. A total of 220 patients with broncho-obstructive pathology were included in the retrospective analysis. 184 patients received IHCs. 34 patients obtaining the basic therapy with IHCs developed pneumonia with a cumulative incidence of 36 % after 10 years. The primary diagnosis, gender, age and smoking did not significantly impact the risk of pneumonia.Conclusions. IHCs therapy is associated with a risk of pneumonia, which should be taken into account when planning long-term control of broncho-obstructive pathology.

Severe bronchial asthma is a serious healthcare and social challenge. Severe asthma in both in children and adults may have an unfavorable course, has heterogeneous clinical phenotypes and is very difficult to treat. Treatment of patients with inadequately controlled severe asthma requires significant resources from the healthcare system.At the same time, severe asthma in children, adolescents and adults has a number of specific features making it a separate phenotype. These groups of patients are at high risk of hospitalization and mortality.

The study was conducted to evaluate the activity parameters of local and systemic inflammation in women suffering from bronchial asthma (BA). 119 women with asthma were studied, and 48 with a regular menstrual cycle and 71 in menopause; 38,7% of BA was mild, 61,3% – moderate severity. All patients were examined in the remission phase of the disease. On the background of normal values of conventional indicators of inflammation it was showed a significant increase of IL 1 alpha and IL 8 more in the group of women with regular menstrual cycles and normal body weight, IL1 alpha amounted to 489±80 pg/ml and IL8 – 631±122 pg/ml (p

The article provides literature review on the subject: chronic obstructive pulmonary disease: pathogenesis, principles of treatment, the course of heart failure in elderly people with comorbide pathology (chronic obstructive pulmonary disease and cardio-vascular diseases). Role of NT-pro BNP as marker of heart failure in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) was analyzed. Influence в-blockers and m-anticholinergic drug on cardiovascular system, and possibility of reception of β-blockers at people with COPD and HF was studied.

Comprehensive pulmonary rehabilitation is gradually becoming the «gold standard» in the treatment of chronic obstructive pulmonary disease. It includes physical training, correction of nutritional status, patient education, psychological and social support.

Gastroesophageal reflux disease is the most common disease of the esophagus, through the development of which is impaired motor function of the upper gastrointestinal system, allowing the disease to be quite be classified as psychosomatic, especially in the early stages of development, when no apparent organic complications that affect the structure of tissues. A significant percentage of mental disorders is observed in patients even before the development of somatic complaints. Patients in number of 105 people are examined. The first group — experienced (71 patient) received complex treatment, which includes the basic pathogenetic, symptomatic, and psychotropic treatment in the form of anxiolytics and antidepressants. The choice of drug was based on the results of psychological testing. The second group — the comparison group (34 patients) received only conventional treatment, without psychiatric support. Analysis was conducted of the astheno-vegetative syndrome, psychological characteristics of patients in relation to their disease, indicators of anxiety level and severity of depression. Patients with not erosive reflux disease have a frequency of detection of a depression and uneasiness was more than twice higher, than at patients with erosive reflux disease. After carrying out psychotropic treatment these indicators were practically made even. Prescription of psychotropic therapy in the form of antidepressants and anxiolytics has allowed to minimize the timing regression of clinical and psychosomatic manifestations of disease.

Reduction in antioxidant status with low activity of superoxide dismutase, glutathione peroxidase and glutathione reductase red blood cells at a low level of reduced glutathionein the background and increased NOx levels in blood plasmawas detected in patients with systematic connective tissue and joint diseases: rheumatoid arthritis and ankylosing spondylitis. Detected violations are not correlated with the activity of theprocess, and seropositivity.

The article presents data on the efficacy and safety of ciclesonide in the treatment of patients with bronchial asthma; the drug is compared with other inhaled corticosteroids

Modern internal medicine was typified by the presence of the so-called problem patients whose diagnosis and treatment pose special problems.G.B. Fedoseev and Yu.D. Ignatov have created the electronic thesaurus “Syndromic diagnosis and basic pharmacotherapy of visceral diseases” to facilitate their diagnosis and choice of personalized therapy.

Therapy resistant asthma (TRA) is most difficult to treat and its course is least predictable. TRA remains least studied despite the fact that its many mechanisms have been detected. There is still no clear definition of TRA phenotype, and the terminology has not been widely used so far. The purpose of the study was to evaluate the role of pharmacogenetic factors in therapy with glucocorticosteroids and β2-agonists in TRA patients and work out criteria for predicting therapy resistance based on genetic markers. The paper presents the results of the studies which helped to identify the phenotype of TRA taking into account its pathogenetic and clinical heterogeneity, to determine predictors of the disease and establish uniform criteria for diagnosis taking into account genetic determinants.

Osteoporosis (OP) is a progressive multifactorial systemic skeletal disease resulting from a loss of bone mass and damage of bone structure (microarchitectonics). Chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) are major contributors to the development of osteoporosis.