卷 10, 编号 6 (2024)

Dysregulation of the endogenous vasodilator nitric oxide (NO) is one of the possible common components of pathogenesis of chronic obstructive pulmonary disease (COPD) and hypertension (HTN). That makes it urgent to search for possible biomarkers reflecting these correlations.

The aim: to study the clinical significance of determination of L-arginine, arginase-1 and asymmetric dimethylarginine (ADMA) in blood plasma of COPD patients in conditions of cardiovascular comorbidity.

Material and methods. 133 individuals aged 40 to 64 years (mean age 56 [52; 60] years) were involved in the study. All the participants were divided into 2 groups: the main group included 109 patients with COPD, control group included 24 practically healthy persons. The groups were comparable by gender (p = 0.341) and age (p = 0.055), as well as by smoking status: all subjects had a history of tobacco smoking and were active smokers. Determination of L-arginine, arginase-1 and ADMA levels in blood plasma was made by means of enzyme immunoassay methodic using Cloud-Clone Corp. laboratory kits (China).

Results. Presence of COPD has a significant effect on the level of arginase-1: corresponding indexes were 1.40 [0.90; 5.90] ng/ml in the main group versus 1.07 [0.57; 1.75] ng/ml in control one (p = 0.013). There was also a tendency towards the influence of the disease on ADMA content, which was significantly lower in the group of patients with COPD: 98.8 [21.1; 114.5] versus 104.3 [96.3; 109.7] ng/ ml in the control group (p = 0.053). ADMA level in COPD patients with mild (79.05 [42.60; 129.15]), moderate (101.15 [92.08; 108.78]) and severe (109,80 [87,40; 179,80]) severity of bronchial obstruction was significantly higher than in patients with extremely severe (10.70 [10.40; 11.18]) burden of the disease (p = 0.007). Concentration of arginase-1 was higher in the group of COPD with concomitant arterial hypertension: 2.11 [0.99; 8.9] versus 1.10 [0.90; 1.2] ng/ml in the COPD group without hypertension and 1.07 [0.57; 1.75] ng/ml in control group (p < 0.01). The level of L-arginine was statistically significantly lower in the COPD group with concomitant arterial hypertension comparatively to COPD group without hypertension and the control group: 9.6 [7.10; 12.30] versus 11.2 [9.28; 15.03] µg/ml and 10.95 [9.97; 11.83] µg/ml, respectively (p = 0.029).

Conclusion. The levels of arginase-1 and ADMA are associated with the presence of COPD in a patient. The levels of ADMA, L-arginine, arginase-1 and the ADMA/L-arginine ratio observed in the blood are associated with the characteristics of the clinical course of COPD. The presence of COPD and hypertension comorbidity in a patient also significantly affects the content of arginase-1 and L-arginine.

Mechanism of post-COVID symptoms formation is not fully studied yet. Studies comparing the condition of ventilation function (VFL) and diffusing lung capacity (DLC) with the severity of dyspnoea in the long term after COVID-19 have had conflicting results.

The aim: to compare the functional parameters of breathing with the severity of dyspnoea in the post-Covid period, with the initial characteristics of patients and indicators of the severity of coronavirus pneumonia clinical course.

Material and methods. In 3–12 months passed after coronavirus pneumonia of varying severity, 109 patients underwent spirometry, body plethysmography and DLC examinations. The severity of dyspnea was assessed using a 10-point scale and the MRC scale. Data on acute period of COVID- 19’ indexes and comorbidities were collected from medical documentation.

Results. Complaints of dyspnoea of any range of severity were made by 88% of the examined individuals, 94% of them were females and 81% males (p = 0.043). The severity of dyspnoea turned out to be less, and indexes of VFL and DLC were higher in patients with a comparable volume of pulmonary damage in the acute period of COVID-19 with a longer follow-up period, and with a comparable period – with a smaller volume of lung damage. 16% of participants had restrictive VFL disorders, 20% had obstructive ones. Presence of obstructive disorders was associated with older age and a smaller volume of pulmonary damage, and restrictive disorders were associated with a larger volume of lung tissue damage, a higher incidence of coronary heart disease, atherosclerosis and diabetes mellitus, and with a greater severity of dyspnoea. When excluding patients with comorbidities, obstructive and restrictive disorders, Kaplan – Meier analysis demonstrates the association of the probability of dyspnea in the post-COVID period with volumetric and velocity parameters of VFL, as well as with DLCO/VA (diffusing capacity of the lungs for carbon monoxide / alveolar volume), which may indicate at the direct negative impact of SARS-CoV-2 on the alveolar-capillary membrane.

Conclusion. The presence and severity of dyspnoea in the post-COVID period are associated with lower rates of VFL and DLC for any volume of lung damage and at any follow-up period.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder, estimated to affect 17% of female and 34% of male population. At the same time, according to a number of authors, moderate and severe OSAS cases are remaining undiagnosed in approximately 93% of female and 82% of male undividuals.

The aim: to perform primary screening for OSAS in patients with acute coronary syndrome (ACS) using validated questionnaires.

Material and methods. Patients hospitalized for ACS development were included in the study. For primary OSAS screening, STOP-BANG questionnaire, Berlin questionnaire, Epworth sleepiness scale (ESS), test for the presence of obstructive sleep apnea, and a specialized nomogram were used. All the participants were assessed for anthropometric data, medical and life history, and laboratory and instrumental values.

Results. 78 patients were examined – 50 male (64.1%) and 28 female individuals (35.9%) with ACS diagnosis at the moment of hospitalization. When analyzing data on the STOP-BANG scale, 41 (52.6%) of them had a high risk of the disease, average risk degree had 34 (43.6%) patients. According to ESS, 35 (44.9%) of patients had a high risk of OSAS, and 43 (55.1%) of them had a low risk level. Average ESS value in the group was 9.8 ± 4.4 points. According to the screening test for OSAS presence, if there are at least 2 positive answers to 6 questions, the diagnosis of OSAS is highly probable, and such patients should be recommended for further examination at a somnology center. In the studied cohort of patients, there were 43 (55.1%) persons who scored more than 2 points. The average score in the group was 3.7 ± 1.4. Using a specialized nomogram, the risk of moderate/severe OSAS was identified in 30 (38.5%) patients.

Conclusion. Primary screening of OSAS makes it possible to identify a high-risk group among patients having ACS. The members of that group should subsequently be recommended for further examination to verify the diagnosis.

Angiotensin converting enzyme (ACE) affects vascular tone, water and sodium resorption in kidneys, and increases oxidative stress and fibrosis. These effects make it one of the most important enzymes of renin-angiotensin-aldosterone system, which plays a key role in chronic heart failure (CHF) pathogenesis.

The aim: to determine the effect of I/D gene polymorphism at myocardial remodeling and peculiarities of CHF clinical course in patients with stable coronary heart disease (CHD) after coronary artery bypass grafting (CABG).

Material and methods. 105 patients with coronary heart disease were included in prospective study. Patients underwent genetic testing to determine I/D polymorphism (rs1799752) of ACE gene, and echocardiography.

Results. Depending on the genotypes of rs1799752 polymorphic variant of ACE gene, patients were divided into two groups. The 1st group included 57 patients with II and ID genotypes (78% male, 22% female patients, average age 63 ± 8 years), the 2nd group included 48 patients with the DD genotype (79% males, 21% females, average age 61 ± 7 years). Unlike the 1st sample, where no statistically significant changes in the volumes and sizes of the left ventricle (LV) were detected, in the 2nd group there was progression of LV remodeling: before CABG, the LV end-diastolic volume was 107.9 ± 5.8 ml, LV end-systolic volume 53.9 ± 4.9 ml, LV end-diastolic size 51.1 ± 1.3 mm, LV end-systolic size 36.4 ± 1.8 mm, after 18 months after CABG – 128.3 ± 7.6 ml, 66.1 ± 6.8 ml, 54.1 ± 1.2 mm and 38.3 ± 1.8 mm, respectively (p < 0.05). Quality of life according to the Minnesota scale before CABG in the 1st cohort was 28.8 ± 2.2, after 18 months – 19.9 ± 1.8 points (p < 0.001). In group 2, similar indexes were 27.4 ± 2.7 and 22.4 ± 2.3 points, respectively (p > 0.05). In 18 months of observation, acute decompensation of CHF (ADCHF) was registered in 10.7% of patients in the 1st sample and in 30.4% in the 2nd sample (odds ratio 3.27; 95% confidence interval: 1.05–10.57; p = 0.022).

Conclusion. In patients with DD genotype of ACE gene, an increase of LV size and volume, LV diastolic function deterioration, and also a three-time increase of ADHF-developing chances within 18 months observations after CABG are taking place. Life quality according to Minnesota scale in the long-term period after CABG among patients with II and ID genotypes became significantly better than in patients with the DD genotype.

Article presents a review of the literature devoted to the study of oxidative stress (OS) influence at the pathogenesis and clinical course of chronic obstructive pulmonary disease (COPD). It follows from the analyzed works that in the pathogenesis of such a multifactorial disease as COPD, OS plays a significant role, supporting chronic inflammation, causing cellular aging and disorders of autophagy of reactive oxygen species. In recent years, biomarkers have been actively studied. They can be used to assess the severity and progression of COPD, which will allow the development of effective antioxidant therapy. Basing on the analysis of available studies, it could be considered to be promising to determine 8-isoprostane, nitric oxide, and melatonin levels as diagnostic markers of oxidative and nitrosative stress in case of COPD.

Remote monitoring (RM) could be as a tool to improve the management of patients with chronic obstructive pulmonary disease (COPD).

The aim: to evaluate the impact of RM and counseling services on severity and relapse rates in patients with COPD.

Material and methods. A systematic review was performed to evaluate and compare the data from articles analyzing the efficacy of RM comparatively with standard care in COPF patients. Strategy of electronic search was based on identifying studies published in PubMed, Elibrary libraries from 2010 to 2024. The search was performed using the following keywords: telemedicine, telemonitoring, COPD, teleconsultation.

Results. The results of the analysis indicate heterogeneity in the efficacy of telemonitoring of COPD patients. First, 7 of 15 (45%) publications reported that patient outcomes were improved overall with telemonitoring, while 6 of 15 (38%) reported no improvement. And in 2 out of 15 publications, the authors concluded that RM has both positive and negative sides.

Conclusion. The diversity of articles and the types of telehealth care they covered resulted in contradictive conclusions from the systematic review. As the digital medical technology sphere continues to develop, the integration of RM into COPD care promises to improve patient care, enhance patient self-management facilities and optimize resources allocation.

Adjusting of pharmacological therapy for cough-manifesting respiratory diseases treatment may require a multi-stage diagnostic search. To increase the efficacy of sputum discharge in case of productive cough, patients are prescribed mucoactive drugs, which are divided into several pharmacological groups. The article highlights current data concerning possible therapeutic approaches to cough treatment, and presents two clinical observations illustrating the principles of choosing therapy for acute and chronic diseases of the bronchopulmonary system, accompanied by productive cough.

Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Growing evidence indicates an interaction between hypokalemia and AF. The presented clinical case demonstrates one of the life-threatening complications of hypokalemia in a patient with HF and AF – development of ventricular fibrillation, which was successfully terminated by electropulse therapy and did not recur in the presence of antiarrhythmic therapy and hypokalemia correction. Low potassium level could be eliminated by titrating mineralocorticoid receptor antagonists. In addition, to increase K⁺ level in tissues, it is advisable to take drugs containing high doses of potassium and magnesium aspartate. This clinical example emphasizes the critical importance of adequate drug therapy to prevent life-threatening complications such as ventricular fibrillation.

High prevalence of upper and lower respiratory tract infectious diseases accompanied by cough makes to be relevant the problem of choosing effective drugs with mucoregulatory action. Long-term experience of using carbocysteine in clinical practice as part of pathogenetic therapy for cough in respiratory diseases allows it to significantly increase the efficacy of treatment, reduce the risk of overlaying bacterial infection in case of viral lesions, significantly reduce the number of infectious exacerbations, improve life quality of patients and reduce periods of their disability.

Atrial fibrillation (AF) is one of the most common arrhythmias in the clinic of internal medicine. Structural remodeling of atria with development of their significant dilation and fibrosis indicates a severe course of AF and allows predicting the progression of arrhythmia to its more stable forms. Current review discusses a new classification of AF suggested in recommendations of American College of Cardiology and American Heart Association in 2023, which extends the possibilities of prevention and early detection of the disease. New portable devices play a major role in the diagnosis of such kind of arrhythmia. Modern clinical studies have proven the advantage of early rhythm control strategy comparatively to ventricular rate control. That results in a significant reduction in all-cause mortality, stroke, and major adverse cardiovascular events. These promising results are prognosticating a fundamental change in the approach of cardiologists to the management of patients with AF.

Pain when swallowing is the 6th most common reason for seeking medical help. Most often it is caused by infectious pharyngitis of viral etiology. In addition, non-infectious factors such smoking, mouth breathing while snoring, inflammation process in nasal cavity, nasopharynx or paranasal sinuses, trauma of mucous membrane of the oropharynx during intubation/extubation of trachea or exposure to gastric contents flowing into the upper respiratory tract during relaxation time are also predisposing to its arising. In case of reactive pharyngitis associated with gastroesophageal and laryngopharyngeal reflux, pain when swallowing and accompanying symptoms (sensation of a lump or foreign body in the oropharynx, periodic hoarseness of the voice, the need to expectorate contents from the oropharynx) increases in supine position and after eating. The article presents a clinical case of curation a patient with exacerbation of chronic catarrhal pharyngitis associated with gastroesophageal reflux, the regression of which occurred with the prescription of antireflux therapy and topical use of ketoprofen in the form of a rinse solution.

Therapy of chronic obstructive pulmonary disease (COPD) begins with smoking cessation. An attempt to quit nicotine addiction becomes successful if patient receives adequate bronchodilator therapy.

The aim: to make a comparative analysis of the clinical efficacy of indacaterol and glycopyrronium bromide combination in COPD patients at the stage of smoking cessation.

Material and methods. 111 patients with a high degree of nicotine dependence and irreversible bronchoobstruction were involved in the study. All of them received bronchodilator therapy in accordance with clinical guidelines. The participants were divided into two groups: patients who quit smoking (group 1, n = 53) and patients who continued smoking (group 2, n = 58). In turn, each group was divided into two subgroups depending on the drug used – glycopyrronium bromide 50 mcg or a combination of indacaterol / glycopyrronium bromide (110/50 mcg). Changes in forced expiratory volume in 1 second (FEV₁) and the dynamics of COPD assessment test were estimated.

Results. The study revealed an increase of FEV₁ and a decrease of COPD assessment test value in both groups. In patients of the 1st group who quit smoking and received a combination of indacaterol and glycopyrronium bromide, the changes had obvious statistically significant differences from the comparison groups (p = 0.0001).

Conclusion. At the stage of smoking cessation in COPD treatment, a combination of indacaterol and glycopyrronium bromide (110/50 mcg) demonstrated high clinical efficacy, which should be recommended to all quitting smoking patients.

2024 marks 110 years since N.K. Goryaev chamber was introduced to the world. Its appearance contributed to significant improvement in hematological research in our country and throughout the world. N.K. Goryaev chamber is still used in Russia and CIS countries and is considered to be the most convenient device for manual counting of blood cells.