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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.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 One patient in Rengalin group and three patients in Codelac group were withdrawn from the study.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.The antitussive effect of rengalin was significantly comparable (p0.025) with that of codelac; the time to complete resolution of cough (both daytime and nocturnal) was 7.2 ± 1.0 days (versus 7.0 ± 1.1 in the group of codelac). Rengalin's efficacy was evidenced by a sufficiently reduced cough severity in the initial few days after treatment onset. As a result of the entire 7-day treatment, the severity score was reduced by 3.1 ± 09 (versus 3.1 ± 1.0 in the group of codelac; p0.05), totaling 0.2 ± 0.5 point in both groups at the end of the administration period. The frequent non-productive/dry cough was fully resolved in 76% of patients. All the participants in Rengalin group achieved either convalescent outcomes or significant improvement; none of the patients developed secondary bacterial complications. Positive changes in the patients' state over the week were finally confirmed by evaluating the total quality of life scores, including physical and mental component scores (SF-36 questionnaire), and total sleep quality scores, which were comparative between patients treated with rengalin and codelac (p0.025). At the end of the administration period, the effect of rengalin was rated by the physician investigators as 'pronounced'. The Clinical Global Impression Scale-Efficacy Indices (CGI-EI) in the groups of rengalin and codelac were comparable, equating a score of 3.7 ± 0.5 (p0.025). The safety outcomes of rengalin treatment were assessed across all 143 randomized patients. The drug's high safety profile was confirmed by the absence of adverse events that could be reliably related to the study treatment, and by monitoring of laboratory variables. Rengalin demonstrated good tolerability and favorable compatibility with other medications for URIs with concomitant pathology. The patients showed 100% treatment compliance.Rengalin is a new efficacious and safe drug indicated for the treatment of URI-induced cough. The severity of daytime and nocturnal cough begins to decrease as soon as on the first day after rengalin administration, with severity reduction observed throughout the whole treatment period. At the completion of the 7-day administration, cough severity is reduced by almost 100% and its changes are comparable with the outcomes of treatment with codelac. By targeting various cough reflex mediators, rengalin enables achieving an antitussive effect in the early days after URI onset (in dry, irritative cough episodes), and a protussive effect at later points of treatment. Rengalin promotes resolution of URI-induced cough without development of secondary bacterial complications.

This work was aimed at estimating the role of special therapy of patients with bronchial asthma, COPD and hyperoxaluria designed to restrict the delivery or eliminate excess of oxalates and producing well apparent beneficial effect confirmed by the disappearance or decrease of clinical and functional manifestations of obstruction, reduction of requirements for broncholytic and anti-inflammatory agents.

The article considers the actual issues of teaching laboratory medicine to students of medical faculty and to physicians getting trained in different programs of postgraduate education. The major models of interaction between clinical physicians and specialists of laboratory diagnostic are considered. The proposed model of teaching of laboratory medicine is developed in collaboration with clinical chairs and is based on the principle of "clinical laboratory council of physicians". The analysis of clinical cases of specific patients and clinical analytical critiques are in the basement of the given system. The algorithm of considering one of situation tasks used in teaching is presented as example.

We studied the role of oxalate release through the airways as a potential injurious factor in the development of inflammation, bronchial obstruction and cough syndrome (respiratory oxalosis). Detection of oxalates in bronhcoalveolar lavage fluid and daily urine is the most valuable method for diagnostics of oxalates. Systemic effects, such as cholelithiasis, urolithiasis, and spinal osteochondrosis are characteristic clinical signs of respiratory oxalosis, besides purely respiratory symptoms.

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.

The prevalence of bronchial asthma and obesity has grown in the recent decades. The mechanisms of these pathologies remain unclear despite a number of publications on the relationship between the two diseases. Analysis of the association of BA with obesity should take into account that both diseases develop in young children undergoing effects of breast milk and specific nutrients, intestinal colonization pattern (neonatal and early childhood), body mass at birth and it growth rate, sedentary lifestyle, and adipokine level in early ontogenesis. The available data suggest that the phenotype of BA associated with obesity is characterized by a number of clear-cut peculiarities (more severe clinical manifestations with frequent exacerbaions and impaired control of the disease). Moreover; such patients show no signs of cellular inflammation. There are several distinct mechanisms characterizing obesity-associated BA, viz. co-morbid conditions such as gastroduodenal reflux disease, sleep apnea, obesity-associated systemic inflammation (elevated cytokine (IL-6, TNF-alpha) levels), oxidative stress, production of obesity hormones (leptin. adiponektin, resistin). Thus, BA and obesity have some common potential mechanisms, including genetic factors, systemic inflammation, mechanical factors, and concomitant diseases. Understanding the common mechanisms of these diseases will promote the development of new therapeutic strategies.

The specific features of bronchial epithelial cell apoptosis in asthma were studied, by evaluating the activity of the apoptosis-regulating genes Bcl-2, Bax, and caspase-3. Fibrobronchoscopy with target biopsy of the bronchial mucosa was carried out in 21 asthmatic patients (the latter had given informed consent). The expression of Bcl-2, Bax, and CPP32 (caspase-3 activity) was determined in the bronchial epithelial cells by the immunohistochemical technique using the DAKO kits. Allergic asthma is characterized by higher Bcl-2 and lower Bax expression than non-allergic asthma and in patients receiving systemic glucocorticosteroids. The similar nature of changes was found in the analysis of the Bcl2/Bax ratio. Regardless of the type of asthma, the expression of caspase-3 was rather high. The specific features of impaired bronchial epithelial cell apoptosis in different types of asthma can determine the pathogenetic value of apoptotic disorders in the persistence of allergic inflammation.

To study dynamics ofclinico-immunological parameters in patients with chronic obstructive pulmonary disease (COPD) of intermediate severity after administration of Pbeumo 23 vaccine.Forty-five patients with COPD of intermediate severity comparable to sex, age, duration of smoking and COPD history were divided on two groups: main group (I)--20 patients vaccinated with Pneumo 23 vaccine, and control group (II)--25 patients, which received only standard treatment. Complete blood count, sputum cytology, expiratory function as well as immunological parameters (levels of CD4+, CD8+, CD20+, CD25+, and IFN-gamma) were studied at baseline as well as 21 days, 3 months, and 6 months after vaccination.Stable remission of the disease (during 6 months) was noted in all patients in group I and in 20% of patients in group II. In group I, levels of CD4+ and CD8+ lymphocytes did not change significantly, whereas number of activated T-lymphocytes (CD25+) significantly increased. There were substantial increase of IFN-gamma level and decrease of IgE level in serum in group I that could point to predominance of Thl-dependent immune response and activation of cellular immunity. There were no such changes in group II.Administration of Pneumo 23 resulted in decrease of intensity of local inflammation and prolonged remission of COPD that allowed to recommend inclusion of vaccination to standard protocols of treatment for such patients.

To reveal disturbances of peripheral blood lymphocytes apoptosis in different variants of bronchial asthma (BA).Apoptosis was studied in 20 healthy subjects, 70 BA patients: 32 patients with allergic BA (ABA) and 26 patients with non-allergic (NABA), 12 patients with BA treated with oral glucocorticosteroids. The following parameters of apoptosis were assessed: cell readiness for apoptosis (expression of CD95/Fas/APO-1 receptors), an early reversible stage of apoptosis (expression of phosphatidylserine on outer leaflet of lymphocyte membrane) and a late stage of apoptosis (the key effector caspase 3 activity).ABA is characterized by increased peripheral blood lymphocytes resistance to apoptosis: a decrease in expression of CD95/Fas/APO-1 receptors and phosphatidylserine on lymphocyte surface and caspase 3 activity. NABA is characterized by peripheral blood lymphocyte apoptosis activation at all stages: high expression of CD95/Fas/APO-1 receptors, expression of phosphatidylserine and caspase 3 activity. BA patients on systemic glucocorticosteroids are characterized by maximal expression of CD95/Fas/APO-1 receptors and phosphatidylserine on lymphocyte surface and the highest caspase 3 activity.The findings allow more accurate definition of the features of peripheral blood lymphocytes apoptosis in different variants of bronchial asthma and characteristics of relations between disturbed apoptosis and inflammation. Disturbances of apoptosis may be of pathogenetic importance in persistence ofallergic inflammation.

To assess efficacy of vaccine therapy with ribomunil in prevention of exacerbations and prolongation of remission in patients with obstructive pulmonary disease (COPD).Fifty three COPD patients were divided into two groups: 28 patients of the study group received ribomunil plus standard therapy; 25 controls received only standard treatment. The examination of the patients included blood count, sputum cytology, external respiration function test, immunological investigation (CD4+, CD8+, CD20+, CD25+ and CD95+; IL-4, IFN-gamma, complement). The examination was made before the treatment, 21 days, 3 and 6 months after its beginning. Ribomunil was given 3 tablets in the morning before meal for 4 days in a week for 3 weeks, 4 days each month for the following 5 months.As a result of ribomunil treatment lymphocyte subpopulation normalized, immune response shifted to Th-1 dependent immune response, external respiration flow indices improved, remission prolonged.Ribomunil is recommended for wide application in the practice of COPD treatment

Purpose of the investigation was to develop a technique of irradiation sterilization of batch syringes with concentrated salt solutions (CaCl2 solution and a mixed solution of MgSO4, NaHCO3 and K2SO4). The syringes are used for mineralization of water produced by orbital systems of electrochemical regeneration of air humidity condensate, and deionized or distilled water from other sources. The paper describes composition of resultant potable water and analyzes quality of irradiation sterilization and stability of concentrated salts inside the syringes irradiated on gamma-source RTs-100M.

The authors studied homeostasis in 182 patients, including 126 patients with exudative pleuritis of tuberculous etiology and 56 with parapneumonic pleuritis. They determined the adaptive reactions of the body by the leukograms and the types of its responsiveness, established their relationship with other homeostatic parameters. Impaired responsiveness in patients with exudative pleuritis substantially affected the efficiency of etiotropic treatment. At the end of the basic course of therapy, the rate of marked residual pleural changes was 84.6% in patients with tuberculous pleuritis (Subgroup 1). Activation pathogenetic therapy with methyluracil promoted a reduction in the number of patients with significant residual pleural changes (32.8% in Subgroup 2).

An experiment was performed to study the biocide effect of ultraviolet treatment of simulated space station milieu. UV generated by low and moderately power-intensive sources (from 10 W to 1 kW) showed a good promise for decontaminating, within the reach, solid structural materials, and the air and water in the cabin. For instance, within 10 minutes of the UV-treatment aerial bacteria in 20 m3 were reduced in 12 to 30 times while fungal microflora was fully suppressed. Water containing spores and vegetative cells of both pathogenic and nonpathogenic microorganisms became essentially sterile after 4 to 10 minutes of treatment with low UV (in the order of 0.01 W/cm2). Different UV modalities can lay the basis for development of specific technologies of microbial decontamination of various spacecraft.

Magnesium and calcium levels in the serum, red cells, lymphocytes, circadian urine and exhaled air condensate were measured in 40 patients with hormone-dependent bronchial asthma (BA) and 15 BA patients receiving glucocorticoids in inhalations (beclamete, becotide) and injections (hydrocortisone, prednisolone, dexasone). Nuclear absorption spectrophotometry (AAC-508, Hitachi, Japan) and selective ionometry (Mycrolyte, Kone, Finland) were employed. Short-term (10-14 days) intravenous infusions and inhalations of steroids in medium therapeutic doses do not change much homeostasis of two-valent cations. Complications resultant from disturbance of mineral metabolism developed more frequently in BA patients on long-term (4 years more longer) oral glucocorticoids. Increased renal and bronchial excretion of magnesium and calcium in patients with hormone-dependent BA having complications of glucocorticoid therapy suggests that derangement of mineral metabolism is involved in the onset of steroid osteopathy and myopathy.

The development of nonspecific bronchial hypersensitivity and hyperreactivity in bronchial asthma and effectiveness of its correction with acupuncture were investigated in 152 patients with asthma and preasthma. 94 of them were subjected to acupuncture. The authors employed a complex of diagnostic methods with determination of 241 parameters processed later with the use of systemic modelling. Bronchial hypersensitivity as indicated by the response to acetylcholine was related to impaired coordination of bronchomotor tone regulating systems: parasympathetic part of the autonomic nervous system, eosinophilic and monocytic bronchial inflammation, glucocorticoid homeostatic alterations. The corrective role of acupuncture consists in reduction of nonspecific bronchial hyperreactivity, normalization of blood acetylcholine, resensitization of cell beta-adrenergic receptors, elevation of mean concentrations of 11-OCS and T-lymphocytes.

Nuclear-absorption spectrophotometry (AAC-508, Hitachi, Japan) and selective ionometry (microlyte, Kone, Finland) were employed to measure magnesium and calcium concentrations in the serum, red cells, lymphocytes, 24-h urine and exhaled air moisture in 40 patients with hormone-dependent asthma (BA) and 15 BA patients given beclomet, becotid in inhalations and injections of hydrocortisone, prednisolone and dexason. Intravenous infusions and steroid inhalations in moderate doses for 10-14 days induce only insignificant changes in bivalent cation homeostasis. Complications associated with deranged mineral metabolism occurred more frequently in BA patients on long-term (at least 4 years) courses of oral glucocorticoids. Increased renal and bronchial excretion of magnesium and calcium in patients with hormone-dependent BA with complications of glucocorticoid therapy shows its significant contribution to development of steroid osteopathy and myopathy.

The article deals with the results of experimental studies and clinical experience in the use of the plasma scalpel in 25 unbred dogs and 192 patients with diseases of the liver and gallbladder. Histological studies of the hepatic tissue after treatment with the laser scalpel allowed the conclusion that such manipulations are safe. The advantages of using the device for arresting bleeding and the flow of bile from the resected hepatic areas were revealed. The accumulated experience in operations on the liver and gallbladder with a plasma scalpel made it possible to develop optimal approaches to the use of the plasma flow in resections of the liver and to suggest three methods for removal of the gallbladder. Their introduction into practice improved the intraoperative possibilities of treatment of the gallbladder bed.

Multicentre trials of cefixime (Cefspan, Fujisawa Pharmaceutical Co., Ltd., Japan) were performed in 1992. The trials involved 137 children and 269 adult patients with inflammatory infections of the respiratory organs and urinary tracts and otorhinolaryngologic affections. Positive clinical and bacteriological results of the trials were stated in 76-90 per cent of the cases. The adverse reactions such as skin eruption and dyspepsia were rare and did not require the specific treatment.

The techniques employed to produce drug-containing liposomes and to control the disperse composition of the included preparation are discussed. The method of cryoradiation sterilization of liposomes containing different types of drugs is detailed. The applications of the described methodologies for obtaining the optimal technological parameters of liposome production are exemplified.

Altered bronchial sensitivity and reactivity are the basis of different variations of bronchospasm. In addition to exogenous agents, endogenous regulation factors such as adrenal and ovarian hormones are believed to make an important contribution to their development. Asthmatics showed the lowest sensitivity and the highest hyperreactivity to acetylcholine as compared to patients with preasthmatic conditions or chronic bronchitis and healthy consanguins of asthmatic patients. Disturbances of glucocorticoid homeostasis, related to various (adrenal, extra-adrenal (transcortin) and cellular) mechanisms of corticosteroid insufficiency, occurred in the majority of asthmatics and asthmatic bronchitis patients. Identification of various mechanisms of glucocorticoid insufficiency opens up actual approaches to increasing the efficiency of an individual therapy.

On the basis of the anonymous questionnaires filled by 131 therapeutic interns from 18 higher medical establishments young specialists distinguished certain personality traits which, in their opinions, should be inherent in a doctor; they evaluated training in the institute and during internship and pointed out its shortcomings. The information obtained is important for further improvement of the medical training.

Hydrocortisone absorption by lymphocytes and red blood cells was reduced in patients with bronchial asthma (BA). Adrenaline produced the stimulatory effect on hydrocortisone absorption by lymphocytes and red blood cells in practically normal subjects and in BA patients in whom that effect was decreased. In patients with the steroid-dependent clinico-pathogenetic pattern of BA, hydrocortisone absorption by lymphocytes was reduced to a considerable degree. It is stressed that cellular mechanisms of glucocorticoid insufficiency are implicated in the BA pathogenesis.

A total of 31 patients with bronchial asthma were examined with the use of the brief dexamethasone test. Some patients with bronchial asthma seemed to have impaired glucocorticoid function of the adrenals. Based on the own investigations and the reported data it is concluded that patients with bronchial asthma may have different types of glucocorticoid deficiency, particularly at the expense of the impairment of the central mechanism of the regulation of glucocorticoid hormones. It has been demonstrated that the brief dexamethasone test can be used for studying the disorders of glucocorticoid function of the adrenals.

Background We investigated the efficacy and safety of AZD3199, a novel inhaled ultra-LABA, with the main aim of establishing a dose that would maintain 24-hour bronchodilation in patients with COPD. Methods Patients (n = 329) were randomized to AZD3199 (200, 400 or 800 μg o.d.), formoterol (9 μg b.i.d.) or placebo via Turbuhaler® in a parallel group study. The primary objective of the study was to compare the clinical efficacy of three doses of AZD3199 inhaled once daily with 9 μg formoterol twice daily and placebo, over a 4-week treatment period in adults with moderate-to-severe COPD. After 4 weeks, peak (0–4 h) and trough (24–26 h) forced expiratory volume in 1 second (FEV1) were assessed as the primary efficacy outcome variables. Results All AZD3199 doses significantly increased mean peak and trough FEV1 versus placebo (106–171 ml and 97–110 ml increases, respectively), but with no clear dose–response; the level of bronchodilation was comparable to or greater than that achieved with formoterol. Forced vital capacity (FVC) at peak bronchodilation also significantly increased with AZD3199 versus placebo (153–204 ml). COPD symptom scores and reliever use were reduced with AZD3199, while FEV1 reversibility was unaltered. Adverse events were mild-to-moderate, with no safety concerns identified. Drug exposure was dose-proportional, but lower than predicted from healthy volunteers. Conclusions All three doses of AZD3199 produced 24-hour bronchodilation, but with no clear dose–response, suggesting that doses of 200 μg or less may be sufficient to maintain bronchodilation over 24 hours in patients with COPD. No safety concerns were identified. Further studies are required to determine the once-daily AZD3199 dose for COPD. Trial registration Clinicaltrials.gov, NCT00929708