[Severe asthma: Characteristics of patients in clinical practice].

AIM: To provide clinical characteristics of severe asthma (SA) patients encountered in clinical practice. SUBJECTS AND METHODS: A cross-sectional cohort study was performed to cover 119 outpatients aged 22-82 years. SA was diagnosed according to the ERS/ATS criteria (2014). Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; inhalant allergen hypersensitivity (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed. RESULTS: 77% of the patients were found to have allergic asthma; in this case, house dust mites were leading allergens in the spectrum of sensitization. 82% of the patients were observed to have uncontrolled asthma and 76% had incompletely reversible bronchial obstruction. The airway eosinophilic inflammation markers (FeNO more than 25 ppb and eosinophil counts of more than 150 cells/µ) were elevated in 63% of the patients. Good compliance was noted in 61% of the patients. There were 27% of active smokers who had lower lung function and FeNO levels. The smokers showed a low compliance with inhaled glucocorticosteroid treatment. SA was concurrent with chronic obstructive pulmonary disease in 37% of the cases. CONCLUSION: SA is a heterogeneous disease. Traditional treatment is not always effective, as many patients, despite their treatment, have uncontrolled SA and continuously increased markers of airways eosinophilic inflammation. Monoclonal antibody therapy may promote success in treating this cohort of patients.

[Left ventricular hypertrophy and thickening of common carotid artery wall in men aged 40 - 54 years with I degree arterial hypertension].

We carried out clinical-instrumental examination of 456 men aged 40-54 years. First degree arterial hypertension was revealed in 165 men. Left ventricular hypertrophy was found in 48 (30%), increased intima-media thickness (IMT) - in 67 (41%) patients. There was significant medium power relationship between IMT and left ventricular myocardial mass (correlation coefficient 0.41). Formation of left ventricular hypertrophy was related to parameters of 24 hour blood pressure monitoring, arterial hypertension in brothers and sisters, body weight, and duration of obesity. Significant medium power relation was obtained between tension of endothelial system of hemostasis (protein C) and severity of left ventricular hypertrophy (correlation coefficient - 0,3). Age, heredity, low density lipoprotein, cholesterol, uric acid level mattered for IMT increase.

[Occupational stress as a factor of left ventricular myocardial remodeling in people with normal arterial pressure].

The authors studied correlations between occupational stress, caused by high tension at work, and disturbances in 24-hour arterial pressure (AP), lipid level, and left ventricular (LM) myocardial remodeling in locomotive engineers with normal AP. Two hundred and five locomotive engineers with NAP (according to 2004 classification by Russian Scientific Society of Cardiologists) aged 20 to 45 years were included in this cross-sectional study; the subjects present a whole sample of the locomotive crew of Chelyabinsk railway station. The control group consisted of III persons working eight fixed working hours a day whose work was not associated with high tension (turners and metalworkers). The examination of the both groups included bifunctional 24-hour AP and ECG monitoring during the subjects'days off, Echo CG, measurement of blood lipids, and measurement of table salt sensitivity threshold. Also evaluated were the prevalence of horizontal and vertical family background of arterial hypertension, excessive body weight, hypokinesia, and smoking. The study demonstrated that the prevalence of the chief factors of chronic non-infectious diseases as well as the values of office and 24-hour systolic and diastolic arterial pressure (SAD; DAD) were the same in both groups. At the same time, the locomotive engineers with normal AP had unfavorable hemodynamic AP profile (24-hour SAD index (p = 0.008) was lower indicating insufficient SAD decrease at night; the speed of morning SAD and DAD increase was elevated 1.5 to 2 times; heart rate was higher as well) which can be considered signs of hypersympathicotonia. By comparison with the controls, the locomotive engineers had more pronounced morphofunctional changes in the left ventricular (LV), myocardium; LV mass was greater, and LV myocardial hypertrophy was more frequent in this group (17.9 and 1.8%, respectively). The data demonstrate the contribution of occupational stress-related non-hemodynamic factors to myocardial remodeling and atherogenic lipid shift in individuals whose occupational activity is connected with high tension.

[Bronchoobstructive syndrome in bronchoectasias]. / O bronkhoobstruktivnom sindrome pri bronkhéktaziiakh.

AIM: To specify mechanisms of bronchial obstruction in bronchoectasia (BE). MATERIAL AND METHODS: Clinical, x-ray, bronchological and spirographic examinations with broncholytic test were made in 26 BE patients aged 16-66 years (14 males, 12 females). The membrane-receptor complex of erythrocytes was based on the effect of adrenoantagonist propranolol on osmotic erythrocytic resistance (obsidan test) and effect of adrenoagonist adrenalin on dynamics of ESR. RESULTS: Allergological anamnesis was detected in 69% of BE patients, hereditary allergological anamnesis--in 22%, membrane-receptor changes characteristic for atopic condition by obsidan test--in 46%, fractional erythrocytic sedimentation with adrenalin--in 42%. Bronchoobstruction syndrome occurred in 37% cases with mean values FEV1 46 +/- 6.2%, MSV50 17.4 +/- 3%, MSV75 14.4 +/- 0.9%. The broncholytic test detected a mean increment of FEV1 by 12.2 +/- 3.1%. Latent bronchospasm was revealed in 33% patients with BE. CONCLUSION: The correlation analysis suggests that among mechanisms of bronchial obstruction in bronchoectasia, bronchospasm is of great importance especially in allergological anamnesis pathogenesis of which involves disorders of membrane-receptor complex.

[Risk factors and their influence on chronic respiratory diseases prevalence among population of the Novgorod region]. / Faktory riska i ikh vliianie na rasprostranennost' khronicheskoi bronkholegochnoi patologii sredi naseleniia Novgorodskoi oblasti.

The authors revealed that actual prevalence of various COLD exceeded the registered value 3.3 times. The actual prevalence appeared to be under influence from tobacco smoking habits distribution, effects of industrial dust pollutants, chronic nasopharyngeal infections, respiratory infections, age, and atmospheric pollution.

[Experience with rovamycin and roxithromycin in patients with chronic bronchitis in the presence of posttuberculous changes]. / Opyt primeneniia rovamitsina i roksitromitsina u bol'nykh khronicheskim bronkhitom na fone posttuberkuleznykh izmenenii.

Rovamycin and roxithromycin were comparatively studied for their effects in 25 patients with chronic bronchitis and posttuberculous changes in the lung. Ten patients received oral rovamycin, 3,000,000 IU, twice daily and 15 had oral roxithromycin, 150 mg, twice daily. The therapy averaged 9 days. Clinical cure was observed in 90% of cases on rovamycin and in 86.7% on roxithromycin. There were no adverse effects of these drugs. The findings suggest that due to their high therapeutical and bacteriological activities, both rovamycin and roxithromycin show their good clinical efficacy in the treatment of exacerbations of chronic bronchitis in patients with residual posttuberculous changes.

[Characteristics of pneumonia in patients with pulmonary tuberculosis]. / Osobennosti techeniia pnevmonii u bol'nykh tuberkulezom legkikh.

In healed tuberculosis, pneumonia more frequently arises in the zones of pronounced residual changes. In active tuberculosis combination of tuberculosis with pneumonia often takes place in intact bronchopulmonary segments. Pneumonia in tuberculous patients takes a lingering course in the presence of pneumosclerotic changes in the lungs, tends to acquire bronchial forms, is characterized by slow involution of inflammation, runs atypically in combination of pneumosclerotic changes in the lungs, bronchial stenoses and abnormal cell composition of bronchoalveolar washout. The diagnosis and treatment present difficulties in pneumonia location in the zone of distinct post-tuberculous pneumosclerosis with small segmental lesion. Resolution of inflammatory foci in the lungs in lingering pneumonia may course as long as 8-10 weeks.

[Prevalence of post-tuberculous changes in the bronchopulmonary system in the patients with chronic bronchitis]. / Rasprostranennost posttuberkulëznykh izmenenii v bronkholegochnoi sisteme u bolnykh khronicheskim bronkhitom.

The prevalence of chronic nonspecific pulmonary diseases was studied in 1880 industrial workers from Russia. The diseases were reported in 26.5% of the examinees. Fluorograms of chronic bronchitis patients indicated residual posttuberculous bronchopulmonary changes in 28.5% of the cases (p < 0.01). By form the bronchitis depended on the variety of the posttuberculous alterations: 76.4% of the asthmatic bronchitis sufferers had minor residual posttuberculous changes (petrifaction of intrathoracic lymph nodes), those with irritative bronchitis had extended posttuberculous changes in 72.7%.

[Analysis of lethal outcomes in patients with chronic bronchitis]. / Analiz letal'nykh iskhodov u bol'nykh khronicheskim bronkhitom.

A study was made of the clinical data and autopsy protocols of 197 persons who died at a hospital of the machine-building plant. Varying bronchopulmonary pathology was discovered in 129 persons, chronic bronchitis in 80 persons. Patients with CB died in the active period of life. Acute pneumonia, cardiovascular diseases and cancer intoxication are among the most frequent causes of death of CB patients. Decompensation of chronic cor pulmonale ranks fourth in frequency, being seen in men engaged in hard physical labour, with concomitant cardial pathology, suffering from chronic alcoholism.

[The principles of the organization of individualized treatment for bronchial asthma patients]. / Printsipy organizatsii individualizirovannogo lecheniia bol'nykh bronkhial'noi astmoi.

The authors relate the principles according to which the individualized treatment of bronchial asthma patients may be organized: the permanent treating physician, active participation of the patient in the process of treatment, flexibility of the individualized complex of treatment measures under constant control of the treatment efficacy. Provide the experience gained with such organization of the treatment of 35 patients with grave bronchial asthma ("schools for bronchial asthma patients").

[Status of hemodynamics and its response to exercise in patients with acute pneumonia]. / Sostoianie gemodinamiki i ee reaktsiia na fizicheskuiu nagruzku u bol'nykh ostroi pnevmoniei.

The patients with croupous and focal pneumonia were examined for the response of systemic hemodynamics (HR, SV, MV, BP, PR) to bicycle ergometry in the acute disease period (after temperature normalization, before discharge from hospital and in 6 months following the clinical recovery). Appreciable disorders of the adaptation mechanisms have been demonstrated. They were especially remarkable in the patients with croupous pneumonia and persisted even after 6 months following the patients' discharged from hospital.