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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.

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.

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. 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.

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.

Thirty-five patients with non-allergic bronchial asthma (NABA), 22 patients with NABA and diabetes mellitus type 2 (DT2), 23 subjects with DT2, and 31 healthy controls were enrolled into the study. ELISA assays for IL-4, IL-10, IL-6, IFNγ were performed by means of a standardized protocol using immunoassay kits purchased from VectorBest, and Cytokine. In asthma patients complicated by DT2, the pattern of bronchial asthma was ascribed to NABA. This finding may be consistent with a theory of specific insulin-receptor interactions in asthma. The NABA patients with type 2 diabetes mellitus exhibited a significant increase in IL-6, IFNγ, and decrease of IL-4, as compared with healthy controls and NABA. Moreover, we have revealed an increase of IL-4, IL-6, IFNγ, when compared with DT2. Hence, the patients with coexistence of non-allergic bronchial asthma and DT2 were characterized by a specific cytokine profile of pro- and anti-inflammatory cytokines, which may correlate with increased glycation and deterioration of lung function.

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

Sixty patients with allergic bronchial asthma (ABA) and forty-one, with non-allergic bronchial asthma (NABA), as well as 23 healthy controls were under study. Expression of the SOCS5 mRNA from mononuclear blood cells was analyzed by RT-PCR. In patients with bronchial asthma, (ABA and NABA) we determined a significant increase of mRNA expression levels for a SOCS5 negative transcription regulator in peripheral blood mononuclears, in comparison with control group. Thus, an increase of SOCS5-expression, and of the SOCS3 mRNA expression in patients with BA may be associated with protective anti-inflammatory response.

Forty-two patients with allergic bronchial asthma (ABA) forty persons with non-allergic bronchial asthma (NABA), and 47 healthy controls were involved into the study. Expression of FoxP3 mRNA was analyzed by RT-PCR. In patients with bronchial asthma (ABA and NABA) we have revealed a significant decrease in FoxP3 mRNA expression levels, in comparison with control group. The patients with severe BA exhibited lowest levels of the FoxP3 mRNA expression as compared with other groups.We revealed a decreased FoxP3 mRNA expression in mononuclear cells from peripheral blood, and an increased IL-17 level in blood serum of patients with bronchial asthma. These results may be considered a manifestation of serious inflammatory process. Probably, the data may reflect a disregulated expression of FoxP3 transcription factor. Therefore, we may assume a key role of FoxP3 for regulation of inflammatory activity in bronchial asthma.

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.

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

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.

We observed sixty patients with allergic bronchial asthma (ABA) and 54 with non-allergic bronchial asthma (NABA). Quantitative SOCS3 and SOCS5 mRNA expression was evaluated by means of real-time PCR. Eighteen healthy persons served as a control group. In patients with bronchial asthma (irrespectively of pathogenetic form), a significant increase of SOCS3 transcription factor expression was detected in peripheral blood mononuclears, as compared with control group. This increase was more pronounced in NABA group. The mRNA SOCS5 level was significantly decreased in bronchial asthma patients, as compared to control group, especially, in ABA subgroup rather than in NABA patients. Thus, an increased expression of SOCS3 mRNA in BA patients could be regarded as a protective antiinflammatory response Decrease of SOCS5 mRNA expression in patients with bronchial asthma (being more pronounced in ABA), may be indicative for a deficiency in negative feedback regulation of gene transcription in allergic bronchial asthma.

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.

The aim of the study is to establish the features of expression of GATA-3 in peripheral lymphocytes from bronchial asthma patients (BA). Material and methods. 10 healthy controls, 15 patients with allergic (atopic) and 15 persons with non-allergic BA were examined. A transcription factor GATA-3 expressed in peripheral lymphocytes was analyzed by Western blot after the lymphocytes were lysed. Preparation of cell lysates, and Western blotting were performed by means of a standard procedure (Amersham). An antibody against GATA-3 (Abcam, UK) was used. Levels of the protein were analyzed versus β-actin levels using anti-actin antibody (Sigma Aldrich, USA). Results. Expression of GATA-3 was significantly increased in lymphocytes of patients with allergic BA as compared to healthy persons and non-allergic BA patients. The level of GATA-3 negatively correlated with the degree of airflow obstruction and positively correlated with dosage of parenteral steroids administered. Conclusion. GATA-3 may play a key role in the pathophysiology of BA. One may suggest that increased expression of GATA-3 transcription factor in atopic BA underlie high levels of Th2-cytokines production in allergic disease

A group of 112 patients with chronic obstructive pulmonary disease of severity were included into the study. Differential cell counts, IL-8, TNFα, and IL-10 concentrations were assayed in sputum and bronchial lavage. The results were compared in groups with different severity of the disease. High levels of macrophages in sputum and bronchial lavage were revealed in COPD of grade 1 and 2. More severe COPD was characterized by mean higher levels of neutrophils in sputum and bronchial lavage. Increased levels of IL-8 and TNFα cytokines have been found in bronchial secretions, independently on COPD severity. Interestingly, maximal levels of these cytokines were associated with mild /moderate stage of the disorder. We have confirmed distinct effects of inhaled corticosteroids upon cytokine levels in sputum and bronchial lavage samples. Sputum proved to be a useful biological material for studies of local inflammatory events in COPD.

Abstract. A group of patients with bronchial asthma (BA) was under investigation, being classified according to their disease activity, and exacerbation risk factors. We studied expression of specific mRNAs for chemokines and their receptors in nasopharyngeal mucosa (n = 70) and amounts of those chemokines in blood serum (n = 59). In the patients with BA exacerbations after acute respiratory infections, an increased expression of eotaxin, MIP-1α, MIP-1β, CXCR1 mRNAs was observed, along with decreased CCR3 mRNA, as compared to a control group. In blood serum of these patients, a decreased levels of eotaxin and MIP-1β mRNA was accompanied by increase of MIP-1β and eotaxin-2 amounts. For the patients with allergen-provoked BA attacks, an increased expression of eotaxin, eotaxin-2, MIP-1β, CXCR1, CXCR1 was revealed, as well as decreased CCR1 mRNA expression, whereas serum samples showed significantly decreased contents of eotaxin and MIP-1β, along with increase in MIP-1α, RANTES and eotaxin-2 mRNAs. In BA remission state, a decreased mRNA expression was found for eotaxin, CCR1 and CXCR2 was observed, with increased serum contents of MIP-1α, RANTES and eotaxin-2. Hence, the changes of chemokine system detected in BA may be sought as markers of the disease exacerbation, depending on its primary origin, as well as potential biomarkers of the disease itself.

Abstract. Chemokines are a key factor that ensures the participation of different cell types in the immunological protection of mucosa. In our study we chose some chemokines that ensured the chemotaxis of neutrophils (CXCL8/IL-8), eosinophils (CCL11/eotaxin, CCL24/eotaxin-2), monocytes and T-lymphocytes (CCL3/MIP-1α, CCL4/MIP-1β, CCL5/RANTES), as well as their receptors (CCR1, CCR3, CCR5, CXCR1, CXCR2). mRNA expression of chemokines and their receptors in nasopharyngeal mucosa brush-biopsy specimens determined by RT-PCR in healthy persons, the level of the same chemokines in serum determined by multiplex chemiluminescent assay were analyzed according to smoking. The level of mRNA expression of IL-8 (p < 0.001) and RANTES (p < 0.001) in nasopharynx brush-biopsy specimens and serum levels of IL-8 (p

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.

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.

The purpose of the study is to build the agricultural land market subjects’ economic behavior models. The formation of rational land use in the agrarian sphere indicates influence of institutional factors – motives and interests of land owners that allow to ensure land distribution included in the market turnover between the most efficient users. The structural scheme of the agricultural land market subjects’ behavior motives has been proposed. The motives of sellers in the land market are to optimize income that is achieved by increasing a land plot attractiveness. Buyers are guided by the possession motives, use and disposal of land by acquiring a land plot. Sellers and buyers of land plots are individuals and legal entities. Agricultural organizations, individual entrepreneurs, farms, personal subsidiary plots, and citizens (rural population) participate in land sailing. Buyers in the market are owner, land user, landowner, and tenant. The functions of sellers and buyers have been systematized considering the purpose and action of the actors. Destructive and rational models of the agricultural land market actors’ economic behavior have been presented and developed. The application of the destructive model is associated with negative consequences characterized by land withdrawal from economic turnover, change of its intended purpose, and land transfer to another category. The rational model includes finding an optimal alternative under a set of constraints and provides for a high level of human intelligence and knowledge to make right decisions. Factors of this model are coordination of land ownership institutions and creation of a legal framework. It is characterized by strict administrative and legal regulation that contributes to eradication of shadowing in land relations. The area of application of the developed rational model of the agricultural land market subjects’ economic behavior is scientific organizations, agro-industrial complex management bodies at the regional and municipal levels, and agricultural producers.