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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.

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.

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.

Nowadays, isolated angioedema is one of the most complex and urgent problems of modern allergology and immunology. Hereditary angioedema (HA) refers to orphan and life-threatening diseases associated with a deficiency or decrease in C1-inhibitor function and is characterized by recurrent edema in deep dermis of various localization. A doctor of any specialty can encounter this nosology, which obliges all medical officers to have a general overview concerning HA. Late diagnosis is fraught with unnecessary surgical interventions, psychological symptoms, opiate addiction, or life-threatening laryngeal angioedema. To date, the final diagnosis of HA, and, consequently, adequate drug therapy, is delayed by an average of 8.5 years from disease onset. Sudden edema in the vital organs is a source of constant anxiety, a cause of disability, and sometimes fatal outcomes. The article presents a clinical case and discusses therapy principles, existing possibilities of promising treatment and recommendations for further management. KEYWORDS: hereditary angioedema, recurrent edema, orphan diseases, bradykinin; C1-inhibitor; complement system. FOR CITATION: Sobko E.A., Demko I.V., Solovieva I.A. et al. Complex clinical case: hereditary angioedema. Russian Medical Inquiry. 2021;5(1):50–53. DOI: 10.32364/2587-6821-2021-5-1-50-53.

Shortness of breath, a subjective feeling of lack of air, is one of the most common complaints that patients present to a general practitoner or any other primary care doctor. The range of pathological conditions and diseases accompanied by shortness of breath is diverse and often poses a difficult diagnostic task for the doctor. These conditions may include such life-threatening pathologies as myocardial infarction or pulmonary embolism on the one hand, and conditions that are relatively “harmless” from a prognostic point of view, such as hyperventilation syndrome and detraining, on the other. The more experienced a doctor is, the wider this range will be. However, certain stereotypes are usually triggered in the management of such patients in the routine practice and the pathology that the general practitioner faces most often, prevails. Our clinical example clearly shows how the present cardiovascular condition (hypertension) masks other signs, and the shortness of breath is easily explained by a complication of hypertension - heart failure. Nevertheless, this case turned out to be more complicated. This clinical example shows the main problems of differential diagnosis of shortness of breath in the practice of a general practitioner or a family doctor. This case emphasizes that a multidisciplinary approach should be applied to the diagnosis and treatment of patients with dyspnea.

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 aim of the research was to study the characteristics of apoptosis, membrane-released microparticles (MRM) formation and cytokines production in case of lymphocyte damage in young patients with bronchial asthma, depending on body mass index. 224 people were examined. In all the patients there was done an assessment of the excessive weight and determination of obesity degree as well as clinical and functional examination; there was performed a determination of cytokines and adipokines; the lymphocytes were separated from the peripheral blood. The number of apoptotic cells was estimated in accordance with the standard protocol; the number of MRM was counted. It was found out that in case of bronchial asthma and obesity syntropy, even at a young age, more often there are patients with moderate and severe clinical course; besides, the severity of bronchial-obstructive syndrome in patients of this group is more significant with the tendency to decrease in FEV1 and FEV1/FVC. In the group of young patients with obesity combined with bronchial asthma in the peripheral blood there was imbalance of both adipokines and cytokines, characterized by evident increase in the levels of pro-inflammatory leptin, IL-4, IL-6, TNF-α, and the decrease in potential body weight regulator IL-15, and at the same time low levels of anti-inflammatory adiponectin. In patients with obesity, the percentage of cells in apoptosis was significantly lower compared to both those in control with obesity and patients with normal body weight. The number of MRM, as cell damage indicator, significantly increased in the group with obesity. It can be assumed that the imbalance of cytokines, adipokines and mechanisms of programmed cell death is a possible pathogenetic factor in asthma and obesity syntropy.

The article deals with changes in arterial rigidity in patients with bronchial asthma, depending on the presence of concomitant hypertension. The aim was to study the arterial rigidity parameters in patients with bronchial asthma depending on the presence of arterial hypertension on the standard antiinflammatory therapy for early diagnosis of complications of the cardiovascular system. A significant increase of arterial rigidity was shown, manifested by an increase in the pulse wave velocity in the aorta (AoPWV) and augmentation index (Alx) in patients with bronchial asthma of moderate and severe course in comparison with the control. In the study of the main indicators of arterial rigidity, depending on the presence or absence of hypertension, it was shown that in the group of patients with hypertension, changes in AoPWV and IA were more significant than in the group of patients with normal blood pressure. Increasing of BMI contributes to the development of arterial rigidity in patients with bronchial asthma. The formation of arterial rigidity is associated with clinical and functional parameters and hypoxemia

Cardiac amyloidosis - the disease which is characterized by deposition of insoluble protein amyloid in intercellular space is one of the most severe implications of systemic amyloidosis. Primary cardiac amyloidosis possesses a wide range of clinical implications that complicates well-timed diagnostics and, respectively, treatment. The long latent current and the adverse forecast do extremely important diagnostics of cardiac amyloidosis at early stages of a disease. The modern concept of pathogenesis and morphology of an amyloidosis is covered in article, the clinical options of a current, diagnostic methods of dysfunction of heart including bio- and immunochemical blood analysis and urine, a complex of tool methods of a research and «the gold standard» of verification of deposits of amyloid - a biopsy of various organs and tissues are described.

The aim of this work was to determine the optimal strategy for the treatment of patients with severe exacerbation of bronchial asthma based at a specialized clinic from the perspective of quality management as a basis for a universal therapeutic scheme taking account of the social status of the patient and localization of the medical facility. The study included 100 patients with bronchial asthma (BA) admitted to the Allergic Department of Regional Clinical Hospital. Those of group 1 were given systemic glucocorticosteroids (SGCS) parenterally or inhalation glucocorticosteroids (IGCS) through a metered dose inhaler. Patients of group 2 received SGCS parenterally or IGCS through a nebulizer. Examination included determination of external respiratory function, pulse oximetry, and ECG. Both modalities improved the patients’ clinical conditions within the first 4 hours, with the use of bronchodilators and IGCS through the nebulizer in combination with SGCS producing the most pronounced effect on peak expiratory flow rate. The per patient cost of medication therapy in group 1 was 131.5 rubles/day compared with 199.7 rubles in group 2. The cost of the complete treatment course was 1577.44 and 1797.78 rubles respectively. However, the number of one bed-days spent in the hospital for patients of group 2 was smaller than in group 1 which accounted for the cost of the complete treatment course 27 573.60 and 37 431.64 rubles respectively (р=0,04). It is concluded that the optimal therapeutic modality for the patients with severe exacerbation of bronchial asthma includes the use of bronchodilators and IGCS through a nebulizer in combination with SGCS. It not only improves clinical and functional characteristics of the patients but also reduces their hospital stay and the total cost of the treatment.

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.

Aim: to study effectiveness of specific prevention of pneumococcal infection in patients with chronic lung diseases. Materials and Methods: to assess the clinical effectiveness of vaccination, special questionnaire was developed, which included an assessment of anamnesis during the year preceding vaccination and anamnesis of the underlying disease during the year after vaccination. 881 patients with chronic lung diseases were vaccinated. Results: vaccination against pneumococcus in patients with chronic lung diseases has significantly reduced the number of exacerbations of the underlying disease in patients aged 56-60years(RR=0.3(95%CI:0.12-0.73),61-65years(RR=0.3(95%CI:0.12-0.73) and 66-70years(RR=0.17(95%CI:0.06-0.49)(p Conclusions: the results indicate a high efficiency of vaccination against pneumococcal infection in patients with chronic lung disease: in all groups a decrease in the incidence of respiratory infections, reduction in the number of exacerbations of the underlying disease and hospitalizations for exacerbations.

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.

Background. Urticaria is а common disease characterized by the formation on the skin itchy blisters. It is easy to diagnose an urticaria, but it isn’t always simple to treat because of various severity, frequent resistance to antihistamine drugs, a substantial reduction in quality of life. Objective. The purpose of the study is to carry out the retrospective analysis of medical case history of patients with acute and chronic urticaria for identification of the most significant etiological factors of the disease for the optimization of diagnostics and treatment of such patients. Materials and methods. There were analysed 307 medical cards of the patients with various forms of urticaria who were on treatment in the allergology department from 2008 till 2014. The diagnosis was established on the basis on the results of the clinical methods conforming to the standards of diagnosis of this disease, and also specific allergological research. Results. Though patients with acute and chronic urticaria pass examination and treatment in the hospital according to the one medical economic standard, patients with a chronic urticaria demand wider range of diagnostic actions. Respectively, their medical examination is more expensive. Conclusion. Despite on a wide range of the possible reasons of an urticaria, there are patients at whom the provocative factor isn»t taped. Thus, the urticaria is a multicausal disease at which complex examination of the patient is required.

The purpose of the study was to examine the relationship between functional parameters, arterial rigidity, lipid profile, markers of systemic inflammation and endothelial dysfunction in patients with COPD and COPD + coronary heart disease. We examined 110 subjects divided into 3 groups. Ggroup 1 included 40 patients with severe and very severe COPD, group 2 consisted of 40 patients with severe and very severe COPD + coronary artery disease, the control group was comprised of 30 healthy volunteers. We studied parameters of respiratory function, the level of blood oxygenation, the main characteristics of arterial rigidity, plasma lipid, TNF-a, CRP, fibrinogen, sPECAM-1 levels and the expression of CD38/ADP-ribosylcyclase in peripheral blood lymphocytes. The study revealed increased rigidity of the central arteries in the patients of groups 1 and 2 regardless of the duration of observation and the presence of coronary artery disease, as evidenced by the increase of the pulse wave velocity in the aorta. Patients of both groups had elevated levels of TNF-a, CRP and fibrinogen indicating systemic inflammatory response. Taken together, the enhanced expression of CD38 in peripheral blood lymphocytes, elevated concentration of soluble CD31 (sPECAM-1) in both groups related to bronchial obstruction and neutrophil elastase activity as well as increased rigidity of the vascular bed gives evidence that the CD38 and sCD31 relationship plays a role in the formation of endothelial dysfunction, and dysregulation of vascular tone in COPD patients. Disorders of lipid metabolism combined with increased rigidity of the vascular wall, elevated levels of markers of systemic inflammation and endothelial dysfunction, suggest that patients with COPD are at risk of cardiovascular events.

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.

Chronic lympholeukosis is the commonest form of leucosis in adults. Recent highly efficient methods of its treatment markedly increased life expectancy of the patients but simultaneously contributed to transformation of one tumour species into another. The article describes a case of Hodgkin lymphoma in a patient with the primary diagnosis chronic lympholeukosis.

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.

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.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).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 (p0.001) and disease duration, which were interrelated with a reduction in the forced expiratory volume in one second/forced vital capacity ratio (r=-0.63; p=0.001 and r=-0.71; p=0.0034, respectively).Patients with ACOS show more severe clinical manifestations and a substantial increase in functional residual capacity and intrathoracic volume throughout the follow-up period, suggesting that the distal bronchi are impaired and pulmonary hyperinflation develops.Цель исследования. Изучить клинико-функциональные параметры у больных ACOS-синдромом по сравнению с пациентами, страдающими хронической обструктивной болезнью легких (ХОБЛ) и бронхиальной астмой (БА). Материалы и методы. Обследовали 129 человек. В 1-й группе наблюдался 51 пациент с ACOS-синдромом, во 2-ю группу вошли 38 больных БА тяжелого течения, в 3-ю - 40 пациентов с ХОБЛ тяжелого течения. Всем больным проводили клиническое обследование: сбор анамнеза, осмотр, оценка симптомов заболевания и исследование функции внешнего дыхания (спирометрия, бодиплетизмография). Результаты. ACOS-синдром клинически характеризуется значительной потребностью в препаратах неотложной помощи, более частыми приступами удушья и обострениями, при которых требуется госпитализация. Установлено, что параметры сопротивления бронхов при ACOS-синдроме повышены на протяжении всего периода наблюдения и сопоставимы с показателями при ХОБЛ. У больных с ACOS-синдромом выраженность избыточной воздушности легочной ткани ассоциирована с более частой потребностью в препаратах для неотложной помощи (r=0,59; p=0,015). Фиксированная обструкция бронхов при ACOS-синдроме может быть обусловлена интенсивностью и длительностью курения, ассоциированной с повышением бронхиального сопротивления выдоха (r=0,51; p=0,003) и внутригрудного объема (r=0,71; p=0,0001), а также повышенным индексом массы тела (р0,001) и продолжительностью заболевания, взаимосвязанными со снижением отношения объем форсированного выдоха за 1-ю секунду/форсированная жизненная емкость легких (r=–0,63; p=0,001 и r=–0,71; p=0,0034 соответственно). Заключение. Для больных с ACOS-синдромом характерны более выраженные клинические проявления и существенное повышение функциональной остаточной емкости легких и внутригрудного объема на протяжении всего периода обследования, что свидетельствует о поражении дистальных бронхов и развитии избыточной воздушности легочной ткани.

Background. To study the clinical and functional features in interrelationship between the level of proinflammatory and antiinflammatory cytokines in young patients with bronchial asthma and alimentary obesity for optimization of therapy. Methods. 133 persons were examined: 93 patients with bronchial asthma were divided into 2 groups depending on body weight index (BWI): the 1st group included patients with bronchial asthma with BWI less than 25 kg/m2, the 2nd group included patients with bronchial asthma with BWI 30 kg/m2 and more. The group of control included 40 almost healthy persons. We studied external respiration function, cellular structure of the induced sputum, the level of TNFα, IL-2, IL-4, IL-6, IL-15, Creactive protein in blood. Results. The results of cytokines at patients with bronchial asthma depending on BWI out of an exacerbation of the disease within the last 2 months. We found the signs of more significant systemic inflammation in the group with obesity the increasing of the level of IL2, IL6, TNFa and Creactive protein in plasma was found. Conclusion. We found that there was more sever course of bronchial asthma in young patients with obesity, decreased external respiration functions, increased level of proinflammatory cytokines and proteins of acute phase in peripheral blood.

Purpose: an assessment of clinical efficiency and carrying out the pharmacoeconomic analysis of allergen immunotherapy at patients with mild and moderate allergic bronchial asthma. Materials and methods. 108 patients were examined with mild and moderate allergic bronchial asthma, of both sexes who were divided into 4 groups depending on their therapy. The period of observation was 12 months. The 1st group were included 35 patients of mild allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory therapy; the 2nd group were consisted of 22 patients of mild allergic bronchial asthma using only basic therapy; in the 3rd group 17 patients of moderate allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory medicine were observed; the 4th group was made by 34 patients of moderate allergic bronchial asthma receiving only basic therapy. At all patient were investigated the function of external respiration, scarification tests, test АСТтм. For the pharmacoeconomic analysis we used the cost-effectiveness ratio. Results. Our analysis showed that the scheme of treatment at patients of the 3rd group was economically more profitable in comparison with the scheme of treatment at patients of the 4th group. So at the 3rd group in the end of the period of observation was noted significant improvement of the following indicators: FEV1, decrease of day and night dyspnea attacks, quantity of exacerbations, increase of total point of АСТтм test. Despite the larger value of coefficient of expensive efficiency at patients of the 1st group in comparison with the 2nd group, it is necessary to consider that the allergen immunotherapy interferes the progressing of the disease that will compensate the cost of this method of treatment in the future. Conclusion. We received the results that showed the efficiency of the timely done allergen immunotherapy at patients with the mild and moderate allergic bronchial asthma, and is able tto reduce financial expenses considerably.

The article presents a case of hypersensitive pneumonitis in young 21-year-old patient. Currently there are no accurate data on the prevalence of this pathology. The complexity of the diagnosis of hypersensitive pneumonitis is explained by the low awareness of the doctors about this disease and the need for special high-tech methods of examination.

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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.

Purpose: To study features of parameters of function of external respiration, X-ray pattern and level of neutrophylic elastase at ACOS. Materials and Methods: 129 people were examined in total. The 1st group included 51 patients with asthma-COPD overlap syndrome (ACOS), into 2nd group - 38 patients with severe asthma, in the 3rd - 40 patients with severe COPD. The control group was made by 40 volunteers. Assessment of function of external respiration, results of a computer tomography of high resolution, quantity of neutrophils was carried out. In the blood plasma determined the content of the neutrophylic elastase. Results: Rising of the level of neutrophylic elastase was interconnected with the maintenance of neutrophils of the peripheral blood at patients with ACOS (r=0.56, p=0.035) and severe COPD (r=0.51, p=0.04) that can demonstrate formation of mainly neutrophylic type of an inflammation in these groups. At patients with severe COPD and patients with ACOS rising the volume of pulmonary tissue with formation of emphysema according to computer tomography of high resolution was observed. At patients with severe bronchial asthma emphysematous changes were expressed least. Formation of emphysema at patients with severe bronchial asthma and severe COPD was interconnected with rising of an indicator of the relation of bronchial resistance of exhalation to the bronchial resistance of inspiration (r=0.79; r=0.81 respectively, р˂0,001). At patients with ACOS the level of neutrophylic elastase in blood plasma was interconnected with rising of volume of a pulmonary tissue according to computer tomography of high resolution (r=0.90, р =0.03) and requirement in short-range s-agonists (r=0.76, р =0.02).

The purpose of this research was to evaluate asthma control in Krasnoyarsk patients using E.Bateman's criteria, GOAL and ACTTM . We examined 480 patients (both genders; 18 to 70 years old) with asthma of different severity. The patients were divided into 2 groups: the 1st group (n = 1250) was examined by primary care practitioners using the ACT™ alone and received different basic medications, the 2nd group patients (n = 230) had been taught at asthma-schools; they were treated with fixed combination of fluticasone and salmeterol (Seretide) and were tested with E. Bateman's criteria, GOAL and ACTTM . According to the ACTTM , 16 % of the 1st group patients had asthma controlled and 86 % had < 19 points. In the 2nd group, asthma control was achieved in 87 % of the patients. When compared ACT TM with E.Bateman's criteria and GOAL, results were equal. Basic therapy adequate to asthma severity, regular follow-up, continuous education of patients allowed achievement of asthma control. The ACT TM use led to objective results with similar interpretation in various patients which allows assessing asthma control and efficacy of treatment.