[The role of spectral analysis of cough sounds in the diagnosis of COVID-19].

AIM: To evaluate the possibility of using spectral analysis of cough sounds in the diagnosis of a new coronavirus infection COVID-19. MATERIALS AND METHODS: Spectral toussophonobarography was performed in 218 patients with COVID-19 [48.56% men, 51.44% women, average age 40.2 (32.4; 51.0)], in 60 healthy individuals [50% men, 50% women, average age 41.7 (32.2; 53.0)] with induced cough (by inhalation of citric acid solution at a concentration of 20 g/l through a nebulizer). The recording was made using a contact microphone located on a special tripod at a distance of 15-20 cm from the face of the subject. The resulting recordings were processed in a computer program, after which spectral analysis of cough sounds was performed using Fourier transform algorithms. The following parameters of cough sounds were evaluated: the duration of the cough act (ms), the ratio of the energy of low frequencies (60-600 Hz) to the energy of high frequencies (600-6000 Hz), the frequency of the maximum energy of the cough sound (Hz). RESULTS: After statistical processing, it was found out that the parameters of the cough sound of COVID-19 patients differ from the cough of healthy individuals. The obtained data were substituted into the developed regression equation. Rounded to integers, the resulting number had the following interpretation: "0" - there is no COVID-19, "1" - there is COVID-19. CONCLUSION: The technique showed high levels of sensitivity and specificity. In addition, the method is characterized by sufficient ease of use and does not require expensive equipment, therefore it can be used in practice for timely diagnosis of COVID-19.

[ASSESSMENT OF NOSOLOGICAL STRUCTURE ASSOCIATED WITH ANEMIC SYNDROME].

The anemic syndrome at the stage of primary health care delivery on an outpatient basis is a risk factor for an unfavorable outcome in patients with chronic somatic diseases, primarily cardiovascular and oncological pathologies. In order to understand the true prevalence of anemia among outpatients it is necessary to improve the registration of patients with this disease. Aim: to analyze the features of managing patients with anemia in the primary health care system using a computerized patient monitoring system. The study included 1498 patients aged 18 to 80 who were under dispensary observation by family physicians. For the analysis of the medical records, a computer program developed by the authors "Monitoring system for patients with anemic syndrome" was used. The structure of morbidity in two selected areas of the outpatient department in the context of the main classes of diseases of ICD-10 is analyzed. According to the analysis of the medical records carried out using the program developed by us, anemia was recorded in 208 patients (13.89%), while in the analysis using the computer register according to the WHO criteria, 500 people had anemic syndrome (33.38%), which indicates the underdiagnosis of this pathological condition and the need to direct the efforts of healthcare organizers to the early revealing of patients with anemia.

[Nutrition status and obesity paradox in chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease (COPD) is one of the main causes of increasing morbidity and mortality worldwide, and therefore is becoming a major public health problem. The aim of this research was to summarize the data of observational and clinical studies concerning the influence of nutritional status (both malnutrition and obesity) on the COPD course and outcomes. Material and methods. The databases PubMed, RSCI, MEDLINE, EMBASE were used for the period from January 2008 to February 2021, with a total of 582 works viewed. Searches included the keywords: nutritional status, obesity paradox, chronic obstructive pulmonary disease. Results. In the pathogenesis of malnutrition in COPD, such phenomena as excessively enhanced metabolism, loss of appetite and dietary imbalance are most often described. It is proposed to pay great attention to preventing muscle loss in the correction of these phenomena. More than a third of COPD patients has obesity, which is associated according to some reports with a low quality of life, an increased frequency of hospitalizations for exacerbations, but also with better survival. The issue of the obesity paradox in COPD is increasingly discussed in scientific literature. Many authors emphasize that basic scientific research will help to understand the mechanisms of obesity and COPD relationship, as well as timely adjust the rehabilitation program, improving the quality of patients' life. Conclusion. Nutritional status is the important factor in COPD outcomes. Maintaining muscle mass is a priority in COPD patients, including those with obesity. The proposed dietary therapy should take into account the food intake according to the needs of patients, the correct proportion of macronutrients and the level of the body mass index.

[Hyperammonaemia in patients with chronic obstructive pulmonary disease and obesity: association mechanisms, detection rate and correction].

Chronic obstructive pulmonary disease (COPD) is a world-wide problem. It is characterized by comorbidity. Among the numerous comorbidity obesity is considered. The common pathogenetic factors cause the more severe course of COPD. Obesity is a complex metabolic condition affecting many physiological systems, in particular, the metabolic liver affection is developing in the type of non-alcoholic liver disease. In patients with different stages of non-alcoholic liver disease detoxification function is reduced. Toxic ammonia does not convert in urea. Ammonia begins to affect the whole organism. AIM: To identify the frequency of hyperammonemia in patients with COPD and obesity, to analyze the degree of its influence on the COPD course and the quality of patients life, to assess the possibility of hyperammonemia correction with L-ornithine L-aspartate (LOLA). MATERIALS AND METHODS: The study included 50 patients with non-acute COPD (GOLD 2), Group D, phenotype with frequent exacerbations, central-type obesity. At the 1st stage of the investigation, COPD course was evaluated, specific evaluation tests (mMRC, CCQ, CAT, SGRQ, SF-36) were used, the biochemical blood test was performed, hyperammoniemia was detected on a Pocket Chem BA PA-4140, and Number Connecting Test was performed. In the 2ndstage of the investigation, all patients were prescribed a course of treatment with LOLA and after 4 weeks the estimated parameters were compared in dynamics. RESULTS: After 4 weeks, comparative analysis showed reliable positive dynamics of subjective assessment of weakness, 2 scales of SGRQ questionnaire, all scales of SF-36 questionnaire, as well as reliable reduction of ammonia level by 18.26 mol/l, normal value of Number Connecting Test. CONCLUSION: Detection of hyperammoniemia in patients with COPD and obesity and its correction with LOLA seems rational in order to reduce toxic effects of ammonia on organs and systems in this category of patients.

[Systemic inflammation in patients with chronic obstructive pulmonary disease and obesity].

Chronic obstructive pulmonary disease (COPD) is an important public health problem. According to various studies, the prevalence of obesity in patients with COPD is as high as 50%. AIM: To evaluate pro- and anti-inflammatory cytokine profile, lung diseases biomarkers levels and adipokines levels in patients with COPD and obesity. MATERIALS AND METHODS: The study included 88 patients with COPD (GOLD 24, group D). Patients were divided into two groups. The first group consisted of 44 patients with COPD and normal body weight: 35 men and 9 women. The second group 44 patients with obesity and COPD: 34 men and 10 women. The levels of pro- and anti-inflammatory cytokines were determined interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor  (TNF-), interleukin-4 (IL-4), interleukin-10 (IL-10), as well as the concentration of highly sensitive C-reactive protein (CRP), surfactant protein D, elastase, leptin, adiponectin, 1-antitrypsin, receptors of tumor necrosis factor 1 and 2 (TNF-R1, TNF-R2). RESULTS: In patients with COPD and obesity, compared with patients with COPD and normal body weight, the levels of CRP, interferon-, TNF-, TNF-R1, TNF-R2 were significantly higher. At the same time, the levels of IL-4, IL-6, IL-8, IL-10 did not differ significantly. The level of leptin in patients with COPD and obesity was significantly higher than in patients with COPD and normal body weight. CONCLUSION: In patients with COPD and obesity, in contrast to patients with COPD with normal body weight, the severity of systemic inflammation is significantly higher. However, further research is needed in this area.

[The characteristics of application of computer registry in organization of ambulatory polyclinic care of patients with iron-deficiency anemia].

Anemia is a clinical hematological syndrome and also a risk factor for the adverse outcome of many chronic somatic diseases. To assess effectiveness of out-patient polyclinic care for patients with anemia, the computer program "Patient Monitoring System with Anemic Syndrome" was used. The study included 1498 patients (males - 491; females - 1007) aged from 18 to 80 years old, who were under medical observation by general practitioners. The prevalence of anemic syndrome in different age and gender groups varied from 11 to 58%. Statistically significant differences between subgroups of men and women were found in the categories 18-30 years, 31-40 years and 41-50 years. In adult patients of working age, anemic syndrome during routine examination was detected in 37% of cases of seeking outpatient medical care (anemic syndrome in women was three times more common than in men). In patients older than working age, the prevalence of anemic syndrome was lower and averaged 25.7%. In the structure of anemia, 48.4% are hypochromic, 5.4% are hyperchromic, 46.2% are normochromic. The study for serum iron was prescribed in 33.9% of cases of hypochromic anemia, in 22.5% of cases of normochromic anemia and in 11.1% of cases of hyperchromic anemia. Serum iron was detected in every second patient with diseases of the urogenital system, every third patient with neoplasm. Therapy with iron preparations was prescribed in 30.6%, and the administration of vitamin B12 - in 1.4% of cases.

Clinical efficacy of acute respiratory viral infections prevention in patients with chronic heart failure.

AIM: The aim of the study was to evaluate the ARVI prevention effectiveness in patients with chronic heart failure (CHF) using interferon inducer amixin. MATERIALS AND METHODS: Conducted a comprehensive survey, dynamic monitoring and treatment of 60 patients aged from 49 to 70 years (mean age 60.25±4.57 years, 17 men and 43 women) with CHF with preserved ejection fraction of left ventricle (LVEF) (≥50%), II-III functional class (FC) according to the classification of new York Heart Association (NYHA), which developed as a result of coronary heart disease (CHD), hypertensive disease (HD). Of these, 30 patients (group 1) on the background of standard therapy for CHF received for the prevention of ARVI tiloron (Amixin) at a dose of 125 mg once a week for 6 weeks, two courses for 1 year. Group 2 patients received only standard therapy for CHF. RESULTS: A decrease in the frequency of ARVI in patients with CHF treated with Amixin was found, which was accompanied by a decrease in the severity of subclinical inflammation by reducing the production of proinflammatory (IL-1ß) and increasing the production of anti-inflammatory (IL-10) cytokines, reducing neurohumoral activation (reducing levels of aldosterone and Nt-proBNP), increasing the level of α- and γ-interferon. The positive dynamics of biomarkers of systemic inflammation and neurohormonal activation explains the improvement of the clinical course in patients with CHF (increase of tolerance to physical loads, reducing the number of visits to General practitioner and hospital admissions in the hospital during 12 months of observation). CONCLUSION: A promising approach to the prevention of SARS in patients with CHF is course therapy with Amixin (2 times a year before the seasonal rising in the incidence of respiratory viral infections and influenza), which allows to achieve both decreasing in the frequency of SARS per year, and improvement the clinical course of CHF.

[On the Issue of Register of Patients of Gynecological Profile with Anemia Syndrome].

The abundant menorrhagia is the most prevalent cause of iron-deficient conditions in women. Though diagnostic of anemia is a simple task deficiency of knowledge in the area of hematology favors spreading and aggravation of anemia processes. The implementation of the register of patients with anemia syndrome into practical activities of physicians of all specialties is a modern direction of studying the given pathology. The proposed system of management of treatment diagnostic process permitted to optimize data collection related to disease, to ameliorate diagnostic search and to rationalize treatment of patients.

[Clinico-Pathogenetic Relationship of Cardiovascular Diseases and Chronic Obstructive Pulmonary Disease].

Close relationship between cardiovascular diseases and chronic obstructive pulmonary disease (COPD) has attracted attention over the past 15 years as one of the aspects of systemic manifestations of COPD. The high prevalence of cardiovascular diseases in patients with COPD is explained within the concept of low-level persistent systemic inflammation. This review presents current data on the prevalence of cardiovascular diseases and mortality in the population of patients with COPD.

[Chronic obstructive pulmonary disease concurrent with metabolic syndrome: Pathophysiological and clinical features]. / Sochetanie khronicheskoi obstruktivnoi bolezni legkikh i metabolicheskogo sindroma: patofiziologicheskie i klinicheskie osobennosti.

Chronic obstructive pulmonary disease (COPD) still remains a serious public health problem, which is a common cause of disability and death in the able-bodied population. Furthermore, the number of patients with metabolic syndrome (MS) is steadily increasing worldwide. Recently, there is also an increase in the number of patients with COPD concurrent with MS, which is a mutually confounding risk factor for concomitant cardiovascular disease and adversely affects prognosis in these patients. Systemic subclinical inflammation is a common link between COPD and the components of MS. Systemic inflammation in patients with comorbidity is complemented by an inflammatory process in the abdominal visceral adipose tissue that serves as a source of proinflammatory adipokines (leptin, resistin, and tumor necrosis factor-α). Patients with COPD in the presence of MS components have in general higher ventilation needs, more obvious clinical manifestations of bronchopulmonary diseases, and more frequent COPD exacerbations and frequently require higher doses of inhaled glucocorticosteroids. As compared with normal-weight patients with COPD, obese patients with this condition have more limited physical activity and much more exercise intolerance. There are currently no practical recommendations for the management of patients with comorbidity; patients with COPD concurrent with MS need an individual therapeutic approach. It is important to elaborate a package of preventive measures to improve quality of life in patients, to reduce the incidence of systemic complications, and to achieve symptomatic improvements. Thus, to develop and implement practical guidelines for physicians and patients are an urgent issue.

[ANEMIA OF CHRONIC DISEASES AS A SYSTEMIC MANIFESTATION OF CHRONIC PULMONARY OBSTRUCTIVE DISEASE].

Anemia of chronic disease (ACD) is one of the most frequent forms of anemia is often observed in patients with infections, cancer and chronic inflammatory or autoimmune diseases. The underlying mechanisms are complex and include dysregulation of iron homeostasis and erythropoietin production, impaired proliferation of erythroid progenitor cells and reduced life span of red blood cells. Moreover, ACD is often superimposed by malnutrition, bleeding and renal failure. ACD is mediated through inflammatory cytokines and characterized by low serum iron (hypoferremia) and often increased reticuloendothelial stores of iron. ACD is usually normocytic, normochromic anemia, but it can become microcytic and hypochromic as the disease progresses. Hepcidin, the main regulator of iron homeostasis and its synthesis, is inhibited by iron deficiency and stimulated by inflammation. In many patients the disease is associated with several extrapulmonary manifestations regarded as the expression of the systemic inflammatory state of chronic obstructive pulmonary disease (COPD). Recent studies showed that anemia in patients with COPD is more frequent than expected, with its prevalence ranging from 8 to 33%. Systemic inflammation may be an important pathogenic factor, but anemia in COPD can also be the result of a number of factors, such as the treatment with certain drugs (angiotensin-converting enzyme inhibitors or theophylline), endocrine disorders, acute exacerbations and oxygen therapy. Anemia in COPD patients is strongly associated with increased functional dyspnea, decreased exercise capacity and is an independent predictor of mortality. Treatment options to correct anemia used in other chronic diseases, such as congestive heart failure, cancer or chronic kidney disease have not been explored in COPD (i.e. erythropoietic agents, iron supplements or combined therapy). It is not known whether treating the underlying inflammation could improve hematological characteristics. It is important to develop basic diagnostic modalities for this group of patients and formulate methods of anemia correction.

[THE HISTORY OF DEPARTMENT OF FACULTY THERAPY, AT THE VORONEZH HIGHER EDUCATION INSTITUTION (ON THE OCCASION OF THE CENTENARY ANNIVERSARY OF N.N. BURDENKO VORONEZH STATE MEDICAL UNIVERSITY)].

The article is devoted to the history of the Department of Faculty Therapy, N.N. Burdenko Voronezh State Medical University. The history of its creation is inextricably linked to the Derpth (Yurievsky) University that was transferred to Voronezh in 1918. While the Department of Faculty Therapy remained in Voronezh, it several times changed location making use of various city hospitals as its branches. It simultaneously expanded its activities by organizing courses of physical therapy, endocrinology, and other medical disciplines. The article focuses on the events pertaining to the formation and development of the Department of Faculty Therapy, main directions and achievements of its scientific work.

[Melatonin and hypertension: a possible role in combination therapy]. / Melatonin i arterial'naia gipertoniia: vozmozhnaia rol' v kompleksnoi terapii.

This literature review gives the results of clinical trials studying the association of the level of endogenous melatonin and blood pressure (BP), the effects of exogenous melatonin on BP (particularly at night) in relation to the used rapid- or controlled-release formulation of melatonin.

[Pulmonary rehabilitation as an effective method for optimizing therapeutic and preventive measures in patients with chronic obstructive pulmonary disease concurrent with metabolic syndrome]. / Legochnaya reabilitatsiya kak effektivnyi metod optimizatsii lechebno-profilakticheskikh meropriyatii u bol'nykh khronicheskoi obstruktivnoi bolezn'yu legkikh s metabolicheskim sindromom.

AIM: to evaluate the impact of a pulmonary rehabilitation (PR) cycle based on patient education, smoking cessation, physical exercises, and balanced nutrition in addition to standard therapy for chronic obstructive pulmonary disease COPD in patients with this condition. SUBJECTS AND METHODS: 70 patients (27 (38.6%) women and 43 (61.4%) men) aged 18 to 60 years (mean age, 48.31±0.64 years) with moderate COPD in remission concurrent with MS were examined. The comprehensive examination of the patients encompassed assessment of clinical, instrumental, and laboratory findings at baseline and 12 months. The patients were randomized into two groups: 1) 35 patients who underwent a RH cycle in addition to standard therapy for COPD; 2) 35 patients who received standard COPD treatment only. RESULTS: Group 1 was found to have significant differences in reducing the number of patients with COPD exacerbations, emergency calls, hospitalizations, severity of clinical symptoms of COPD and their impact on the physical activity and health of the patients, as well as better quality of life and exercise tolerance. CONCLUSION: The therapeutic and preventive measures for patients with COPD and MS should involve educational programs and physical trainings, which are developed, by taking into account of a comorbidity in order to optimize therapeutic and preventive measures and to improve quality of life in this category of patients.

[ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA].

Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis and elevated mortality. Not infrequently, anemia is not diagnosed during the hospital stay und therefore remains uncorrected. Severe anemia results in enhanced hypercapnia and slowed maturation of red blood cells in the bone marrow which facilitates the development of ischemic syndrome. Hepcidin, a mediator of inflammation and iron-regulatory hormone, plays an important role in the clinical course of community-acquired pneumonia. Hepsidin production increases during inflammation; it suppresses erythtropoiesis and depletes the iron depot leading to so-called anemia of inflammation. Hypoxia and anemia activate erythtropoiesis, and the released erythropoietin inhibits hepsidin production. During pneumonia resolution, hepsidin promotes recovery from anemia by activating iron absorption. The curreni literature contains few data on the use of hepcidin as a diagnostic marker of anemia. The necessity oftreating anemia in patients with pneumonia under hospital conditions is a matter of discussion. Direct involvement of hepcidin in iron metabolism creates a prerequisite for the treatment of anemia. Medicamental suppression of its activity by stimulating erythtropoiesis can facilitate normalization of iron metabolism and restoration of hemoglobin level.

[Anemias in chronic obstructive pulmonary disease].

According to different studies, anemia occurs in 8--33% of patients with chronic obstructive pulmonary disease (COPD). The paper describes the most important various causes of anemia in COPD, such as systemic inflammation and endocrine disorders, the use of some medications (theophylline, angiotensin-converting enzyme inhibitors), frequent COPD exacerbations, and long-term oxygen therapy. Lower hemoglobin levels in COPD patients are accompanied by increased shortness of breath, reduced exercise tolerance, and lower quality of life. Furthermore, some investigations have shown that anemia is an independent predictor of death in patients with COPD. In spite of the fact that anemia may be successfully in these patients, the evidence suggesting the importance of its impact on the prognosis of COPD is limited.

[Clinical manifestations of asthma during combination therapy using ceruloplasmin].

AIM: To estimate the time course of clinical changes in patients with asthma during combination therapy using ceruloplasmin (CP). MATERIALS AND METHODS: A total of 92 asthmatic patients were examined. Their medical history data were collected; external lung function testing and clinical, laboratory, and instrumental examinations, involving the determination of the indicators of lipid peroxidation (LPO) (malonic dialdehyde (MDA), methemoglobin, carboxyhemoglobin) and the antioxidant system (superoxide dismutase (COD), sulfhydryl groups), were performed in all the patients over time. According to the therapy used, the patients were divided into 2 groups matched for gender, age, and clinical manifestations of the disease. A study group consisted of 45 patients who took CP in addition to conventional therapy. A comparison group included 47 patients receiving standard therapy. RESULTS: During the combination therapy using CP, the asthmatic patients showed a reduction in the elevated concentrations of MDA, methemoglobin, and carboxyhemoglobin and increases in the activity of COD and in the levels of sulfhydryl groups, which was followed by a considerable clinical improvement. During the conventional therapy, the indicators of LPO remained high and those of the antioxidant system did low, suggesting permanent oxidative stress. CONCLUSION: CP incorporation into the combination therapy of asthmatic patients contributes to elimination of prooxidant-antioxidant imbalance, which is followed by a marked positive clinical effect.

[CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ANEMIA: CLINICAL MANIFESTATIONS AND THERAPEUTIC STRATEGY].

Anemia refers to manifestations of systemic inflammation in chronic obstructive pulmonary disease (COPD) and a factor aggravating the disease. Objective: To study gender characteristics of anemia in patients with COPD, to increase the effectiveness of treatment through the use of pharmacological agents erythropoietin and enteral iron. Materials and methods: The paper presents clinical data on 74 patients with stage II/III COPD and anemia along with results of the treatment of 49 patients who received standard therapy in addition to epoetin and Sorbiferdurules. Results: Patients with COPD much more frequently presented with iron deficiency anemia (IDA): 63 patients (85.1%) dominated by women (39 or 61.9% ) with men accounting only for 24 or 38.1% of the total. 11 patients (14.9%) had normochromic normocytic anemia with the parameters of anemia of chronic disease. The incidence of IDA in both groups correlated with age; it was largely a moderately severe condition that much more frequently occurred in women (24 out of 39 patients - 61,5%) than in men in whom the mild form of iron deficiency prevailed (14 of 24 patients - 58,3%). Conclusion: The overall prevalence of anemia concomitant with COPD was estimated at 26.5%. It was documented in44 women (33.7%), i.e. in each third patient. It occurred less frequently in men (30 or 20,7%). The presence of anemia deteriorates conditions of the patients, especially female ones, who more often suffer from shortness of breath, impaired general health status , fatigue, and depression; moreover, they more frequently need hospitalization. Correction of anemia with erythropoietin and iron preparations for the internal use can improve physical endurance of the patients, reduce cough intensity and shortness of breath, promote positive dynamics of physical tolerance for a prolonged period after the completion of antianemic therapy.

[The role of inflammation in the pathogenesis of chronic heart failure]. / Rol' vospaleniia v patogeneze khronicheskoi serdechnoi nedostatochnosti.

The review considers the main points of the concept of progressive chronic heart failure (CHF). The neurohumoral model of CHF pathogenesis could create novel approaches to treating these patients. However, recent studies have shown that the ways of activating the neurohumoral systems in CHF are much more complex. The increased local synthesis of hormones causes the activation of proinflammatory cytokines and proto-oncogenes, which have a number of negative effects. Multiple studies have formulated the immunoinflammatory concept of CHF pathogenesis, according to which the increased concentration of interleukin-6 is a marker of poor prognosis in CHF, and the level of tumor necrosis factor-α directly correlates with the severity of its clinical manifestations and the activity of the neurohumoral background in decompensation. The review gives a classification of cytokines and describes the reasons for their elevated plasma concentration, their possible role in the occurrence and progression of CHF, and their prognostic significance. The pathogenesis of CHF, which includes cytokine aggression, requires further studies of the effect of the inflammatory component on the course of heart failure.

[Differential diagnostics of febrile conditions in an emergency care clinic].

We undertook the analysis of 157 cases of fever at the stages of polyclinic - admission department - hospital treatment for the purpose of elucidating the structure of febrile syndrome. Pneumonia developed in 45 patients, infectious endocarditis in 34, chronic alcoholic hepatitis in 21, rheumatoid arthritis (pseudoseptic variant) in 2, systemic lupus erythematosus in 1, polymyositis in 2, acute pyelonephritis (exacerbation of chronic pyelonephritis) in 15, tumours of different localization in 37 patients. We evaluated the informative value of some acute-phase blood characteristics obtained, results of X-ray and ultrasonic studies for early diagnostics of pneumonia and infectious endocarditis.