Том 35, № 2 (2024)

In patients with residual changes after the treatment of destructive forms of tuberculosis (TB), the risk of recurrence of the disease increases significantly. The study of the surgical material of patients with pulmonary TB as a result of the progression of residual post-tuberculosis changes a year or more after the completion of anti-tuberculosis therapy makes it possible to justify the need for surgery in this category of patients.

Objective. To substantiate surgical tactics in patients with residual post-tuberculosis lung changes.

Materials and methods. The analysis of 1121 adult patients who underwent surgery from 2015 to 2021 for etiologically verified pulmonary TB and completed anti-tuberculosis therapy more than a year before the operation. Of these, 176 patients were divided into two comparable groups: the main group included 37 patients in whom non-tuberculosis mycobacteria (NTMB) DNA was found in the surgical material, the comparison group included 139 patients in whom NTMB was not found in the surgical material. All patients underwent a comprehensive microbiological and morphological examination of the surgical material.

Results. In the comparison group, in the majority of operated patients with microbiological screening of surgical material, the etiological diagnosis was positive: the most informative method for both destructive forms of pulmonary TB and forms without destruction was the real-time PCR method: in 82.0% and 87.2% of positive results, respectively, and luminescent microscopy, which allowed to identify acid-resistant Mycobacteria in 67.2% of cases with destructive forms of TB and in 73.1% – without lung destruction In the comparison group, in 19 (13.2%) patients, no evidence of TB was obtained by any screening method, but morphologic examination of surgical material showed the presence of TB inflammation with high activity in 11 (58.0%) and moderate activity in 8 (42.0%) patients. In the main group species identification of NTMB in the surgical material was obtained in the majority of cases, both in forms without destruction of lung tissue and in destructive forms – in 72.2 and 63.3% of patients, respectively, slow-growing NTMB prevailing. Fast-growing NTMB were detected in isolated cases. Morphological examination of the surgical material in a group of patients with NTMB revealed structural changes in the lungs that affected the air parenchyma and/or small airways in areas of the lungs free from TB foci, which should be taken into account when planning surgical intervention.

Conclusion. Surgical treatment immediately after completion of the course of anti-tuberculosis therapy in case of formation of residual post-tuberculosis changes is the method of choice in the complex treatment of this category of patients.

The role of intestinal microbiota in aging and maintaining active longevity is considered. The second part examines the issues of DNA damage by metabolites of various bacteria, which increases the risk of cancer. The interactions between the microbiota and the immune system, the connection between dysbiosis and the aging of the immune system, indicating specific molecular mechanisms, are described in detail. Particular attention is paid to lymphocytes of the Th17 subpopulation. Changes in the microbiome that are observed in individuals with cardiovascular diseases (arterial hypertension, coronary heart disease, chronic heart failure) are shown. The role of trimethylamine oxide and new mechanisms of damage to the cardiovascular system associated with the migration of immune cells from Peyer's patches to atherosclerotic plaques is revealed. Ideas about the relationship between the microbiome and cognitive function are given. Changes in the microbiome against the background of increased physical activity are considered.

The final part of the article presents microbiome interventions aimed at increasing life expectancy and quality of life. These include diet, the use of prebiotics, probiotics, synbiotics, and medications that affect the microbiota.

Fluoroquinolones, which were actively studied in the 1980s, are a completely synthetic group of antibiotics with no prototype in nature. The modern classification of fluoroquinolones includes four generations. Of greater practical interest are fluoroquinolones that act on respiratory pathogens and gram-negative bacteria.

Purpose. To systematize the data accumulated to date on the importance of fluoroquinolones in the treatment of lung diseases.

Material and Methods. A systematic search for publications that reviewed data on the importance of fluoroquinolones in the treatment of lung diseases was performed.

Results. Fluoroquinolones are bactericidal drugs. They inhibit two vital enzymes of the microbial cell, DNA gyrase and topoisomerase-4, fluoroquinolones disrupt DNA synthesis, which leads to bacterial death. It is this property that is in demand in the search for drugs for the treatment of tuberculosis in the period of increasing drug resistance of Mycobacterium tuberculosis and the lack of new tuberculosis drugs. Simultaneously with the evidence of the effectiveness of «respiratory» fluoroquinolones in the treatment of pulmonary tuberculosis, there was a trend towards banning on their use for broad indications and limited use in the treatment of lung diseases. It is currently debated whether the widespread use of multidrug-resistant tuberculosis is related to previous treatment with fluoroquinolones in patients with lung disease without tuberculosis exclusion measures.

Conclusion. Thus, fluoroquinolones are a strong and modern weapon in our hands, requiring a competent and thoughtful approach to practical use.

The Russian Federation is one of the countries with a high prevalence of chronic obstructive pulmonary disease (COPD). In the last decade, the list of families of chemical regulators of vascular inflammation in COPD has been supplemented with information about growth factors, whose participation in the processes of regulation of vascular function seems significant. The study of the role of angiogenesis factors in patients with isolated COPD disease is insufficient at this stage and needs to be clarified.

Objective. To study was to identify diagnostic and prognostic criteria for the severity of vascular inflammation and to assess its relationship with clinical and functional features in patients with COPD without concomitant cardiovascular pathology in comparison with the clinical phenotype of the disease.

Material and methods. 96 patients with COPD were examined, the median age was 61 years. In addition to standard clinical, functional and laboratory research methods, the severity of vascular inflammation was assessed in all examined patients with the determination of quantitative indicators of human platelet growth AA factor and tumor necrosis factor-α (TNFα) by quantitative solid-phase enzyme immunoassay

Results. In all patients with isolated COPD, regardless of the risk of developing the underlying disease, an increase in the level of platelet growth AA factor and TNFα was noted. The level of platelet growth AA factor and TNFα in patients with COPD, regardless of the risk of exacerbation, was correlated with the functional state of the lungs, clinical phenotype and severity of clinical manifestations of the disease. The value of platelet growth AA factor above 317 ng/ml in patients with COPD may be an early marker of endothelial dysfunction and a predictor of the development of hemostatic disorders and concomitant cardiovascular pathology.

Purpose. To study gender characteristics of the severity of hematuria and compensatory mechanisms of the proaggregant component of hemostasis in patients with nephrolithiasis when prescribing litokinetic therapy (LCT), including nonsteroidal anti-inflammatory drugs (NSAIDs).

Material and methods. The prospective study included 60 patients (group 1 – 30 men; group 2 – 30 women) with imaging signs of the presence of stones in the urinary tract. For 7 days, patients underwent standard LCT, including NSAIDs, an α_1A-blocker (tamsulosin) and antibiotics. In vitro, the activity of the TP receptor for TxA2 and purine P2Y receptors (P2Y₁ and P2Y₁₂) was studied on a platelet suspension after 24, 48, 72 hours, 5 and 7 days. Platelet aggregation was assessed using the turbidimetric method using a ChronoLog analyzer (USA).

Results. At the hospitalization stage, in both groups (before the introduction of NSAIDs), hyperreactivity of the TP-receptor was observed, and in men the activity of the TP receptor was lower, and hematuria (p<0.05) was higher than in women. The pharmacokinetics of NSAIDs in men was characterized by inhibition of cyclooxygenase (COX) in two time periods – 72 hours and 7 days, as a result of which the synthesis of TхA2 in platelets decreased and hematuria increased 4.4 times (p<0.001) compared with the hospitalization stage. In women, COX inhibition occurred within 5 days; At the same time, the preservation of normal reactivity of the TP-receptor and purine P2Y receptors ensured the implementation of a compensatory platelet response, limiting the severity of hematuria.

Conclusion. Analysis of the mechanisms of gender differences in hematuria in nephrolithiasis is important for developing a personalized medicine strategy when prescribing NSAIDs.

An analysis of clinical symptoms, indicators of external respiration and quality of life (QoL) of patients with various phenotypes of occupational asthma (OA) was carried out (according to the analysis of the results of the MOS SF-36 questionnaire). For all OA phenotypes, there was a decrease in forced expiratory parameters, as well as indices of both mental and physical health compared to the control group (conditionally healthy) (p<0.001). Significantly low quality of life indicators were detected in patients with the “OA with metabolic syndrome” phenotype on the scales of physical functioning, general health, vital activity, social functioning and role functioning due to emotional state. In the group of patients with the non-allergic phenotype of OA, higher quality of life indicators were observed compared to other phenotypes of the disease.

The paper provides a review of the literature on pathologoanatomical features of different organs affected by SARS-CoV-2 virus. Signs of necrosis and dystrophy, various circulatory disorders were mainly detected. Morphologic features are not specific for COVID-19; they can also be detected in other systemic infections and shock. This should be taken into account during the pathological autopsy. At the same time, some studies show a connection between SARS-CoV-2 and some diseases with an etiology that is not fully understood, so additional research is required.

In modern conditions, telecommunication technologies (TMT), designated by the term “telemedicine,” are increasingly used to provide medical services at a distance.

Purpose. To analyze the work of telemedicine consultations (TMK) during the COVID-19 pandemic.

Material and methods. The experience of using TMT (telemedicine) in a city hospital, on the basis of which a “Covid hospital” was opened during the spread of COVID-19 from September 2020 to September 2021, is presented. Patients applied for TMK through call centers or the clinic’s registry.

Results. The operating principles of telemedicine have been formed, the possibilities of outpatient patient management in a remote format, a minimum list of examinations at home, routing rules and indications for inpatient treatment have been determined. Based on the identification of key complaints and diagnostic criteria, a questionnaire was created that reduces consultation time. The experience gained allows us to make wider use of remote management technologies, TMK, medical consultations, to develop and implement monitoring technologies for monitoring patients at home to optimize the work of primary healthcare.

Calcium-containing drugs occupy an important place in the list of anti-osteoporotic agents. Their consumption, often in combination with high doses of vitamin D, has increased significantly over the last couple of decades. Cases of uncontrolled intake of the macronutrient have become more frequent. Aggressive advertising of high-dose calcium supplements with calciferol of foreign production on television played its role in this. Nowadays doctors of various specialties have to face more and more often the consequences of using such preparations. The article describes the mechanism of calcium deposits formation in vessels and kidneys against the background of calcium supplementation. The results of large-scale studies proving the close relationship between high intake of calcium and vitamin D with calcification of vessels, development of cardiovascular diseases and nephrolithiasis are presented. Doubts are raised about the validity and necessity of high-dose calcium supplements in the treatment of skeletal diseases. The possibilities of successful therapy of postmenopausal osteoporosis without the use of such agents are presented on the example of the preparation Osteo-Vit D₃, which does not contain calcium and high doses of calciferol, but increases the mineral density of bone tissue and reduces the volume of calcificates in blood vessels and kidneys.