Vol 93, No 3 (2021)

The article was prepared after materials of the report at the 22.12.2020 International Scientific Forum “COVID-19 and Human Safety” in partnership with the World Academy of Arts and Science and the Rome Club on the virtual platform of the Faculty of Global Processes of the Federal State Budgetary Educational Institution of Higher Education “Lomonosov Moscow State University”.

Aim. Comprehensive study of the negative regulation components of cell signaling in the bronchial asthma (BA) patients with metabolic disorders.

Materials and methods. 113 people were examined: 63 patients with allergic BA (ABA), 50 patients with a non-allergic variant of the disease (NABA). SOCS1 mRNA expression was evaluated by reverse transcription PCR (RT-PCR). SOCS1 protein expression was investigated by immunoblotting. The determination of cytokine levels was carried out according to the standard protocol on a Bio-Plex flow fluorimeter.

Results. A significant and multidirectional change in the expression of SOCS1 mRNA was found at a body mass index >25 (greater than normal) in ABA and NABA. The positive correlations between SOCS1 mRNA expression and body mass index indicate the regulatory role of SOCS1 in leptin signaling. The spectra of correlations in ABA and NABA are different, it indicates the probable existence of specificity in the pathogenesis of these variants of the diseases.

Conclusion. The obtained data allow us to consider the complexity of regulation disorders occurring at different levels of cell signaling. The multifunctionality of the SOCS1 regulator provides complex control of cytokine signaling simultaneously in different signaling pathways in the BA with metabolic disorders.

Aim. To study the relationship between the indicators of dynamic capnography and pulse oximetry with the indicators of the 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD).

Materials and methods. 67 patients of both sexes were examined: 45 patients with COPD (age 60.0±2.74 years) and 25 patients of the control group (age 47.60±3.46 years). The study of the functional capabilities of the patient’s respiratory system was carried out before, during and after the 6MWT on the equipment LifeSense LS1-9R capnograph-pulse oximeter (MedAir AB).

Results and discussion. In the comparison group, the parameters of dyspnea at rest were higher than the control group (p<0.05), the spirometry indices were significantly lower (p<0.05). Shortness of breath as a reason for stopping/slowing down the pace during the 6MWT was noted by patients of both groups (p<0.05). When analyzing the PETCO₂ trend graphs, periodic breathing (PВ) was revealed. In the group of patients with COPD, signs of PВ in the analysis of the PETCO₂ trend were found in 80.95% (p<0.05). Regression analysis of Cox proportional risks of mortality in patients with COPD revealed the prognostic value of the following parameters of a comprehensive assessment of the patient: body mass index (BMI), BODE index, dyspnea index on the mMRS scale, Borg, forced expiratory volume in 1 second (FEV1), index Tiffno, signs of PВ, distance 6MWT, signs of PВ and desaturation during 6MWT. At the same time, the total contribution of these indicators to the risk of a lethal event was assessed (p=0.003).

Conclusion. When analyzing the correlation dependence, it was revealed that the presence of PВ was a prognostically unfavorable sign in patients with COPD. Predictors of an unfavorable course of COPD were BMI (<23.0 kg/m²), BODE index, dyspnea indices on the mMRS, Borg, FEV1 scales, Tiffno’s index, signs of PH, distance 6MST, signs of PD and desaturation during 6MST (reliability of the model coefficient p=0.003) in terms of forecast.

Aim. Evaluation of the possibilities of a new semi-quantitative rapid test for procalcitonin in the diagnosis of multisegmental community-acquired pneumonia.

Materials and methods. A one-stage comparative study involved 123 patients hospitalized in a hospital with a confirmed diagnosis of community-acquired pneumonia. The mean age of the patients was 49.5±21.0 (M±SD) years. On the first day of hospitalization, all patients underwent a general clinical examination, chest x-ray, and a plasma procalcitonin level was determined using a semi-quantitative rapid test.

Results. Indicators of a new semi-quantitative rapid test for procalcitonin of at least 2 ng/ml are directly related to laboratory and instrumental indicators reflecting the severity of community-acquired pneumonia, namely, the severity of respiratory failure (p=0.001), respiratory rate (p=0.001), and heart rate contractions (p=0.001), systolic blood pressure (p=0.025), oxygen saturation (p=0,001), erythrocyte sedimentation rate (p=0.021), fibrinogen (p=0.003) and high CRB-65 scores (p=0.001). They are also associated with multisegmental community-acquired pneumonia (÷²=4.7; p=0.030) and complications of this disease, such as hydrothorax (p=0.029) and death (÷²=22.1; p=0.001).

Conclusion. Using a new semi-quantitative rapid test for procalcitonin allows you to optimize the diagnosis of complications of community-acquired pneumonia and determine the high risk of multisegmental pneumonia.

Aim. In this study we evaluated the effects of Riamilovir on SARS-CoV-2 viral shedding and on admission duration in patients with moderate COVID-19.

Materials and methods. We have used data from 69 health records of patients with moderate severe PCR confirmed SARS-CoV-2 infection. Control group included 34 patients treated with off-label riamilovir 1250 mg per day for 5 days (250 mg 5 times a day), comparison groups – 35 patients, who received ribavirin and umifenovir 800 mg a day for 5 days. The antiviral therapy was administered within 72 hours from the onset of the disease. The primary endpoints were elimination of virus in oropharyngeal and nasopharyngeal swabs on 7 day of admission and discharge from the hospital by 14 day.

Results. Patients assigned to riamilovir had significantly shorter time to clinical improvement as well as increased PCR negative rate by day 7.

Conclusion. Yearly administration of riamilovir as opposed to the umifenovir and ribavirin in therapy of moderate SARS-CoV-2 infection was associated with significant shorter time to clinical improvement by 14 day of hospitalization. PCR negative rate by 7 days of hospitalization is significantly more likely in riamilovir group.

We herein report a case of interstitial lung disease secondary to the use of methotrexate in a patient with rheumatoid arthritis. Differential diagnosis between pneumonitis caused by methotrexate in patients treated with basic methotrexate therapy and interstitial pulmonary disease associated with rheumatoid arthritis is based on the clinical examination and instrumental data. The main condition for favorable clinical outcome in all drug-induced lung disease is drug withdrawal, what was proven in our report.

The article considers the issues of therapeutic management of patients with so-called “difficult” pneumonia, particularly, patients with diagnosed syndrome slowly resolving / nonresolving pneumonia, who do not respond to the treatment. The reasons and significant risk factors potentially affecting the effectiveness of therapy are analyzed, the therapeutic tactics of managing patients with no “response to treatment” are considered, the list of necessary diagnostic methods and directions of antibiotic therapy is updated. The article analyses the tactics of managing patients with pneumonia during a pandemic caused by SARS-CoV-2 coronavirus. It also provides directions of diagnostics with priority discussion of biological markers of the inflammatory response as well as antimicrobial therapy strategy.

The article is devoted to the differential diagnosis of chylous pleural effusion. The spectrum of traumatic and non-traumatic causes of chylothorax is discussed in detail. Examples of necessary diagnostic measures are given for the accumulation of milky fluid in the pleural cavity in order to verify chylothorax.

The article presents the evolution of views on one of the current problems of present pulmonology – idiopathic interstitial pneumonias. On the basis of many years of experience in diagnosis and treatment of patients of IIPs in the clinic of pulmonology of Interstitial and Orphan Lung Diseases Research Institute of Pavlov First Saint Petersburg State Medical University, the authors formulated a new understanding of this pathology and proposed to unite all IIPs under the term “idiopathic fibrosing pulmonary disease”. Using the concept of “idiopathic fibrosing pulmonary disease” will make it possible to substantively address the issues of early diagnosis, determine the criteria for the activity of the pathological process, and there by develop an evidence base for the adequate prescription of antifibrotic drugs and corticosteroids.

The SARS-CoV-2 virus enters the body through the angiotensin-converting enzyme 2 (ACE-2), which is the entry point of the virus into the cell. The most dense fabric of ACE-2 is the lungs. The small intestine also contains large amounts of ACE-2 in the enterocyte membrane and is often involved in this process. Intestinal symptoms can appear at different stages of the disease. The review describes the mechanisms of interaction of SARS-CoV-2 with enterocytes, the fecal-oral route of infection, diagnosis and treatment of COVID-19 with intestinal symptoms.

An analysis of the publication of the outstanding Russian therapist and cardiologist D.D. Pletnev (1871–1941) is given in the article. In 1925, he published an article “On the issue of lifetime differential diagnosis of right and left coronary artery thrombosis” in the journal “Russian Clinics” in Russian and German languages. Timely diagnosis of right myocardial infarction determines the prognosis and treatment tactics of this disease, and the case itself has a priority for the Russian science. The authors emphasize the outstanding talent of D.D. Pletnev as a physician and scientist, whose name is associated with the emergence of one of the most brilliant therapeutic schools (A.L. Myasnikov, E.I. Chazov, etc.).