[Theories of the pathogenesis of polypous rhinosinusitis and the asthmatic triad]. / Teorii patogeneza polipoznogo rinosinusita i astmaticheskoi triady.

Polypous rhinosinusitis (PRS) is a chronic inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses, characterized by the formation and recurrent growth of polyps. Often, PRS is a manifestation of the most severe clinical symptom complex - the asthmatic triad (AT). AT is characterized by three main clinical manifestations: bronchial asthma (BA) itself, PRS, intolerance to acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs (NSAIDs) and NA. However, not all three components of the triad are expressed equally, a variant of the dyad (BA with PRS) is possible. AT is one of the most severe variants of BA, it is more difficult to respond to conservative therapy and significantly reduces the ability of patients to work. In the world, PRS and AT are detected in 0.5-16% of the population, in Russia the number of patients is about 1.5 million people. MATERIAL AND METHODS: The analysis of the medical literature on this problem has been carried out. RESULTS: To date, there is no consensus on the etiology and pathogenesis of the polypous process in the nasal cavity and paranasal sinuses, therefore, many theories of the occurrence of this disease have been proposed, the main ones being: anatomical factors, osteitis, virological, bacterial, allergic, autoimmune theory and the theory of metabolic disorders of arachidonic acid. The key role in modern studies of the pathogenesis of AT is still given to the peculiarities of arachidonic acid metabolism. CONCLUSIONS: The low effectiveness of treatment and the severity of clinical manifestations encourage scientists to further investigate the etiopathogenesis of polypous rhinosinusitis and the asthmatic triad.

[Effect of the elimination diet in psoriasis: a clinical case].

Psoriasis (PS) is a multifactorial disease with a dominant role of genetic predisposition, but the questions of PS etiology and pathogenesis still remain open. The development of PS can be facilitated by environmental factors, as well as a violation of the skin barrier and immune imbalance. In the literature of recent years, an association in clinical practice between PS and atopic diseases (atopic dermatitis, bronchial asthma, allergic rhinitis) has been increasingly reported. As a result of the increase in the prevalence of allergic diseases in the world, a special role is given to the study of nutrition, in particular food allergy in the development of PS. An elimination diet under food allergy is the main type of etiotropic therapy that prevents the launch of immunopathological inflammatory reactions. However, the literature does not provide data on the positive effect of the elimination effect in food allergy in patients with psoriasis. The purpose of this work was to present a clinical case of the effectiveness of the elimination diet for food allergy in a patient with PS. Methods. A specific allergological examination of a 65-year old patient with widespread PS (suffering from the age of 25) was carried out: determination of the concentration of total immunoglobulin E (IgE), eosinophilic cationic protein and allergen-specific IgE to food, pollen, fungal allergens in the blood serum by enzyme-linked immunosorbent assay, skin prick testing with food and pollen allergens. Taking into account the specific allergological examination, the patient was prescribed a diet with the elimination of causally significant allergens, including cross-reacting ones, for a period of 1-3 months (with the exception of chicken eggs, cereals, buckwheat, baker's yeast and products based on yeast fermentation, cereal products (bread, bakery, rolled oats, bran, oatmeal cookies, cereals, pasta); as well as peanuts, smoked sausages, coffee, cocoa, ice cream, sherbet, sesame, sorghum, honey and bee products, strawberries, wild strawberries, citrus, legumes, soybeans, sorrel, herbal teas, tree fruits (raw apples, peaches, cherries; nuts, exotic fruits), celery, raw carrots, tomatoes). Results. The demonstrated clinical case indicates that the appointment of an elimination diet in patients with PS with concomitant food allergies contributes to the rapid regression of the skin process. The increased concentration of total IgE in blood serum revealed during patient examination, the presence of positive reactions to food and pollen allergens according to the results of skin prick testing and the determination of allergen-specific IgE, the positive food elimination effect demonstrate the important role of allergic reactions in the development of skin lesions in PS. The presented observation demonstrates the importance of conducting a specific allergic examination in patients with PS, including an allergic history, determining the concentration of total and allergen-specific IgE, and eosinophilic cationic protein in blood serum, studying the spectrum of sensitization to food, pollen and fungal allergens by skin prick testing. Conclusion. Thus, as a result of the study, it was found that the appointment of an individual elimination diet, taking into account the results of a specific allergological examination, can contribute not only to the effective resolution of foci of psoriatic skin lesions, but also to the prevention of the progression of the systemic inflammatory process, reducing the risk of comorbid conditions and, therefore, improving the life quality of patients with psoriasis.

[Food allergy as a risk factor for acne].

Acne is a multifactorial disease in which genetic, hormonal, environmental and nutritional factors are involved. Data on the role of food and other etiological forms of allergy in the development of acne, as well as the nature of the sensitization spectrum, are extremely scarce, which makes the study relevant. The purpose of the study was to analyze the features of the spectrum of sensitization to food, pollen, fungal allergens in patients with acne and establish the role of food allergy in the development of the pathology. Material and methods. The study included patients with papulo-pustular acne of moderate severity aged 11 to 46 years (n=57). All patients underwent a specific allergologic examination, including skin prick testing with food, pollen and fungal allergens (Allergopharma, Germany). Results and discussion. The most significant food allergens in patients with acne were whole chicken egg, chicken egg protein and chicken meat (66.7, 61.4 and 52.9% respectively). Sensitization to barley and oat groats was noted in 50.0 and 47.9% of cases. Sensitization to cow's milk protein and beef was determined in 43.9 and 44.2% of cases. Meadow and cereal grasses were the most common among pollen allergens: 64.8 and 62.5% of cases, respectively. Among fungal allergens, a high frequency in the occurrence of sensitization to Alternaria alternata was revealed (67.9%). A positive clinical effect in the form of regression of skin inflammatory manifestations against the background of an elimination diet was noted in 71.9% of cases. Conclusion. The conducted study, based on the established high frequency of sensitization to food allergens in combination with the positive effect of elimination, taking into account the presence of common antigenic determinants, allows us to make an assumption about the role of food allergy as a risk factor for acne.

[The comparative analysis of the spectrum of sensitization to food, pollen and fungal allergens in patients with atopic dermatitis and psoriasis].

The relevance of the study of psoriatic disease is due to the insufficient effectiveness of existing etiotropic and pathogenetic methods of treatment, which confirms the necessity to search for new approaches in the research of psoriasis, including those from the standpoint of etiopathogenesis. In the literature, there is information about the combination of atopic dermatitis and psoriasis, which does not exclude a commonality of the causes and mechanisms leading to damage to the skin. The aim of the work was to study and conduct a comparative analysis of the sensitization spectrum of patients with psoriasis and atopic dermatitis to food, pollen and fungal allergens. Material and methods. A prospective study was conducted on patients with psoriasis (1st, n=20) and atopic dermatitis (2nd group, n=20) aged 18 to 57 years. A specific allergological examination was performed (collection of an allergological history, determination of the spectrum of sensitization to food, pollen and fungal allergens by prick testing). Statistical data processing was carried out by methods of variational analysis using the t-criterion for qualitative characteristics. Results and discussion. No statistically significant differences in sensitization to allergens of animal origin between the examined groups were detected. The sensitization to rice and soy was statistically significantly more often noted in patients with psoriasis, in comparison with patients with atopic dermatitis: 33.3 (n=6/18) vs 5.2% (n=1/19), p=0.03 and 66.7 (n=10/15) vs 29.4% (n=5/17), p=0.04. It was determined that sensitization to plant pollen allergens was statistically significantly more often detected in patients with atopic dermatitis compared to the group with psoriasis (72.5 vs 54.4%, p=0.02). It was noted that in the group of patients with psoriasis compared to the group of patients with atopic dermatitis, sensitization to fungi of the genus Candida albicans, Alternaria alternata, Penicillium notatum was more often, however, the differences did not reach statistical significance. Conclusion. Thus, in our study, we determined the presence of sensitization to food, pollen and fungal allergens not only in patients with atopic dermatitis, but also in psoriasis. So, sensitization to food and pollen allergens is more often determined in atopic dermatitis, and to some food and fungal allergens - in psoriasis. Preliminary prick testing guides us in further application of other methods of specific allergological diagnostics: elimination and provocative tests, and the appointment of personalized therapy.

[The role of nutritional factors and food allergy in the development of psoriasis].

Psoriasis is a chronic relapsing disease that affects about 2% of the world's population and leads to medical and social losses. There is evidence of the effect of nutritional factors on the course of psoriasis in modern literature. The aim of the research was to analyze modern domestic and foreign literature on the role of nutritional factors, food allergies and the state of the gastrointestinal tract in the etiopathogenesis of psoriasis Material and methods. The electronic resources were used in preparing the article: the PubMed/MEDLINE portal, "Scientific Electronic Library eLIBRARY.RU". The following filters and keywords were requested: psoriasis and nutrition, food allergies and psoriasis, gastrointestinal manifestations and psoriasis, diet and psoriasis, obesity and psoriasis. Results and discussion. The role of nutrition as a predictor of the development of psoriatic skin rashes and exacerbation of the disease has been discussed. The mechanisms of the positive influence of the correction of metabolic disorders on skin processes in patients with psoriasis have been analyzed. It has been noted that further studies are needed to study the effectiveness of a lowcalorie diet for psoriasis treatment. Particular attention has been paid to the role of food allergy and pathology of the gastrointestinal tract in the etiopathogenesis of psoriatic disease. It is noted that in patients with psoriasis, structural and functional disorders in the gastrointestinal tract are observed, which lead to metabolic changes, endotoxinemia and autosensitization of the body. The role of intolerance to certain foods in the development of psoriasis has been discussed. Most of the available data indicate a high incidence of celiac disease and gluten intolerance in patients with psoriasis, however, information about the effectiveness of a gluten-free diet is controversial. Attention is drawn to the "non-celiac gluten sensitivity" associated with psoriasis, which represents a syndrome of neither allergic nor autoimmune genesis, which is manifested by gluten intolerance and characterized by symptoms similar to celiac disease. An increase in the frequency of occurrence of a high concentration of specific IgE to potato and carrot allergens in patients with psoriasis is noted, which most likely reflects cross-reactions with pollen allergens. An interesting hypothesis is the discussion of a lesion of the gastrointestinal tract in the presence of food allergies in patients with psoriasis, which may be a reflection of the systemic dermatogastrointestinal process and manifest psoriatic rashes on the skin. The mechanism of the anti-inflammatory effect associated with adhering to the Mediterranean diet for psoriasis is described in detail. Conclusion. The data presented allow us to consider the role of nutrition in the etiopathogenesis of psoriasis as significant, both from the point of view of the influence of nutritional factors and food allergens, that must be taken into account when prescribing therapeutic nutrition and elimination diet in combination with standard systemic therapy.

Deuterium Oxide Enhances Escherichia coli SOS Response Induced by Genotoxicants.

It has been demonstrated that deuterium oxide enhances the SOS response of Escherichia coli cells induced by chemical genotoxicants and mutagens. This demonstrates that the heavy nonradioactive hydrogen isotope deuterium can be considered to be a comutagen.

[FEATURES OF MICROBIOCENOSIS OF NOSE MUCOUS MEMBRANE DURING ATOPIC AND POLYPOUS RHINOSINUSITIS].

AIM: Study of microbiocenosis of nose mucous membrane during allergic rhinosinusitis. MATERIALS AND METHODS: Patients with polypous (PRS) and atopic (ARS) rhinosinusitis were examined, as well-as a control group.. Standard general clinical methods taking differential diagnostics ofatopic diseases and rhinitis into consideration were used for the PRS and ARS diagnosis. RESULTS: Microbial content during different forms of rhinosinusitis has varying directionality that is deter- mined by different pathogenetic mechanisms. ARS microflora has a significantly extended range and was characterized by an increase of concentration. of opportunistic microorganisms not characteristic for normoflora. Microbial composition for PRS was significantly depleted by a lack of certain permanent members of microflora, whereas the quantity of opportunistic bacteria was significantly above normal.. CONCLUSION: Disturbance of microbiocenosis in patients with allergic rhinosinusitis was detected, more pronounced in the PRS group. Staphylococcus strains isolated from patients with ARS and PRS possess pathogenic properties in equal ratios, wherein the per- centage of strains in ARS group that have persistence properties is higher than in other studied groups. This could give evidence regarding their role in development of inflammatory process on the nose mucous membrane.

[Hepatobiliary System Diseases as the Predictors of Psoriasis Progression].

PURPOSE OF THE STUDY: To assess the state of the hepatobiliary system in psoriasis andpsoriatic arthritis in order to establish a causal relationship and to identify clinical and functional predictors of psoriatic disease progression. METHODS: The study includedpatients with extensive psoriasis vulgaris (n = 175) aged 18 to 66 years old and healthy donors (n = 30), matched by sex and age: Group 1--patients with psoriasis (PS, n = 77), group 2--patients with psoriatic arthritis (PsA, n = 98), group 3--control. The evaluation of functional state of the hepatobiliary system was performed by the analysis of the clinical and anamnestic data and by the laboratory-instrumental methods. RESULTS: We identified predictors of psoriasis: triggers (stress and nutritionalfactor), increased total bilirubin, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, eosinophilia, giardiasis, carriers of hepatitis C virus, ductal changes andfocal leisons in the liver, thickening of the walls of the gallbladder detected by ultrasound. Predictors ofpsoriatic arthritis: age over 50 years, dyspeptic complaints, the presence of hepatobiliary system diseases, the positive right hypochondrium syndrome, the clinical symptoms of chronic cholecystitis, excess body weight, high levels of bilirubin, cholesterol and low density lipoprotein, hepatomegaly, non-alcoholic fatty liver disease. CONCLUSION: High activity of hepatocytes cytolysis, cholestasis, inflammation, metabolic disorders let us considerpsoriatic arthritis as a severe clinical stage psoriatic disease when the hepatobiliary system, in turn, is one of the main target organs in systemic psoriatic process. Non-alcoholic fatty liver disease and chronic cholecystitis are predictors of psoriatic disease progression.

[Peculiar features of immunological and metabolic status associated with polypous rhinosinusitis].

The objective of the present work was to study peculiar features of immunological and metabolic status associated with polypous rhinosinusitis (PRS). We determined the population and subpopulation composition of blood lymphocytes, concentration of cytokines in blood sera and nasal secretion as well as the level of intracellular enzymes in blood lymphocytes of the patients presenting with polypous rhinosinusitis and of the control subjects. It was shown that PRS was associated with activation of Th1-lymphocytes and determined the character of the immune response largely of the cell-mediated type. The study has demonstrated the differently directed changes in the activation of the intracellular processes in blood lymphocytes. Specifically, the intensity of the aerobic processes and lipid anabolism was increased while that of the anaerobic processes and amino acid metabolism (NAD-GDG and NADH-GDG) was suppressed.

[Mycoplasma and Chlamydia as ethiological factors of bronchial asthma in terms of ethnogenesis].

AIM: The study of the prevalence and clinical peculiarities of Mycoplasmosis and Chlamydiosis in patients with different pathogenic forms of bronchial asthma (BA) taking into account ethnicity of a patient. SUBJECTS AND METHODS: The research covered 239 subjects--both the Europeoids and the Mongoloids in the city of Krasnoyarsk and the town of Kyzyl, all of them being BA patients of different stages, including acute stage and practically healthy. We had determined antigens Mycoplasma pneumoniae, Mycoplasma hominis, Chlamydophila pneumoniae, Chlamydophila psittaci and Chlamydia trachomatis in smears of mucosa of pharynx and antibodies to these antigens in peripheral blood serum. RESULTS: We found high frequency of Mycoplasmosis and Chlamydiosis in the inhabitants of Eastern Siberia, BA patients with different pathogenic forms as compared to control group. We had determined ethnic peculiarities of specific immune response: IgM to M. pneumoniae was revealed in the Europoids more frequently than in the Mongoloids, but IgM to C. pneumoniae and to C. trachomatis, C. trachomatis antigens had been revealed more often in the Mongoloids than in the Europoids. We accepted as clinical equivalents of Mycoplasmosis and Chlamydiosis diagnostics the following signs: temperature around 37C (subfebrile temperature), non-intensive but stable coughing with scanty mucous and muco-purulent sputum, dyspnea of mixed character. CONCLUSIONS: Mycoplasma and Chlamydia are meaningful etiologic factors of bronchial asthma. We have found the peculiarities of immune response depending on ethnicity of a patient (ethnic belonging). Clinical markers of Mycoplasmosis and Chlamydiosis should be taken into account in bronchial asthma in order to provide diagnostics timely as well as eradication of infection agents. Because of insufficient knowledge of problem of bronchial asthma related to contamination with Mycoplasma and Chlamydia we put the goal to study the frequency of Mycoplasmosis and Chlamydiosis occurrence in bronchial asthma patients and determine the characteristics clinical course of diseases. We defined antigens Mycoplasma pneumoniae, Mycoplasma hominis, Chlamydophila pneumoniae, Chlamydophila psittaci, Chlamydia trachomatis in smears of oropharynx mucosa and antibodies to them in blood serum.

[Thoracoscopic thymectomy in children by myasthenia gravis].

The authors' experience of surgical treatment of myasthenia gravis in children was analyzed. 32 patients were operated on, mean age was 13±3 (5-21 years); girls were 26, boys were 6 (19%). Disease severity was IIB-IVB by the MGFA classification, all patients were on anticholinesterase and pednisolone therapy. The operation was indicated by certified neurologists, specialized in myasthenia. All patient were thoracoscopically thymectomized using left- or rightside access. There were no conversions and intraoperative complications. The operation duration was 77±23 min. The postoperative hospital stay was 6.6±3.6 (3-9) days. Excellent long-term results were achieved in 6 (25%) patients, good - in 20 (62.5%) children, no changes were registered in 2 and deterioration of myasthenia in 2 (6.25%) patients. The study proved that thoracoscopic thymectomy obtains the radicalism of open technique, proposing the easier postoperative period and being the method of choice for the surgical treatment of myasthenia gravis in children.

[Manifestations of immune deficiency in children with perinatal HIV infection in the treatment dynamics].

Clinical and immunological parameters in the children with perinatal HIV infection were investigated in the dynamics of the long-term prospective observation. It was revealed, that all the HIV infected children had clinical signs of immunodeficiency and laboratory signs of combined damage of the immune system. The complex of therapeutic measures, including antiretroviral therapy, prevention of opportunistic and acute respiratory infections, rational immunotherapy to stimulate production of endogenous interferon and normalization of the balance of cytokines significantly reduced the frequency of the clinical manifestations of the infectious syndrome and improved the patients resistance to infections.

[Properties of nasal mucosal microflora in patients with allergic rhinosinusitis].

Analysis of microbial composition of nasal mucosa in patients with allergic rhinitis revealed marked changes in microflora compared with healthy subjects. Specifically, the overall diversity of staphylococci decreased while the abundance of S. aureus increased. The number of strains with pathogenic and persisting properties in patients with allergic rhinitis was greater than in controls.

[Microbiocenosis of nasal mucous membrane during allergic rhinosinusitis].

Overall quantity of microorganisms and their relative prevalence on nasal mucous membrane in patients with allergic rhinosinusitis are determined. Microbial flora in studied group was characterized qualitatively and quantitatively. Obtained results showed that there were changes of microbiocenosis of nasal mucous membrane during allergic rhinosinusitis and in characteristics of species in Staphylococcus genus.

[The assessment of the immunograms of children with allergic diseases]. / Otsenka immunogramm detei s allergicheskimi zabolevaniiami.

Analysis of immunograms of 189 children with allergic diseases of the reagin type (55 with atopic bronchial asthma, 33 with atopic dermatitis, 101 with respiratory allergosis) helped single out a complex of immunological parameters which markedly and statistically reliably change in this type of allergy in comparison with a group of healthy children (n = 25). This complex is recommended to be used for the detection of the principal pathogenetic factor of the reagin-type allergic diseases and monitoring the therapy efficacy.

[Effect of biotechnological industrial factors on immune system reactivity]. / O vliianii faktorov biotekhnologicheskogo proizvodstva na reaktivnost immunnoi systemy.

Screening in employees of enterprise producing antibiotics has revealed higher occurrence of allergic (39.6%) and gastrointestinal diseases. Some examinees (5.4%) demonstrated immune deficiency, the share of 8.3% were diagnosed as having cardiovascular neurosis. Further investigations involved bioluminescent and cytochemical studies of oxidation-reduction enzymes in white blood cells. Those studies proved lower serum activity of the enzymes in all the examinees including apparently healthy individuals. There was no significant difference between the health and ill employees, apart from the patients with immune deficiency. Ratio of CA to serotonin concentrations in the cells provided the most valuable information, being a diagnostic criterion for the diseases mentioned.

Hydrophobic probe's fluorescence intensity. 3-methoxybenzanthrone (3-MBA) in bronchial asthma and urticaria patients lymphocyte membranes.

The intensity of fluorescence (IF) of the 3-methoxybenzantrone (3-MBA) probe in blood lymphocyte membranes was determined in bronchial asthma and urticaria patients. A marked drop in IF was revealed during acute stages in the patients with atopic and infectious-allergic bronchial asthma and aspirin intolerance asthma. In the remission stage, the normalization or approach to normal IF levels takes place in these patients. In patients with allergic urticaria there are similar changes. In patients with pseudo-allergic urticaria an opposite type of change is observed a rise in IF in the aggravation stage and partial or full approach to standard in the remission stage. We concluded that changes in the average IF do not depend so much on changes in the ratio T- and B-lymphocytes as they do on the changes in the physical state of their membranes and that this physical state differs from each other in allergic and pseudo-allergic urticaria. The 3-MBA probe may be used for the differential diagnosis of allergic and pseudo-allergic urticaria.