[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.

[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.

[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.

Cough: the evolution of views and modern approaches to an objective assessment.

The article is a review of literature, that provides information on ways to assess cough, how those ways have improved over recent years, the latest data in the field of an objective assessment of cough and the possibility of its use in scientific and clinical practice. Search for articles was carried out in such databases as Pubmed, CyberLeninka, RSCI in English and Russian.

[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.

[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.

[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.

Chronic obstructive pulmonary disease and diabetes: a look at the epidemiology, pathogenetic mechanisms, treatment.

Lately, increasingly studied the negative impact of diabetes type 2 on chronic obstructive pulmonary disease (COPD). According to literary data diabetes type 2 is more often diagnosed in patients with COPD in comparison with the general population: diabetes type 2 occur among patients with COPD in 18.7%, in comparison with patients without COPD - in 10,5%. The complexity of this association is primarily that chronic obstructive lung disease is regarded as a risk factor for diabetes type 2. The results of some researches show existence of close connection between the glycemic status and spirometric indicators - forced expiratory volume 1-second, forced vital capacity. Obstructive, restrictive, mixed ventilatory lung dysfunction observed in the states prior to the beginning of diabetes, such as impaired glucose tolerance and / or in patients with metabolic syndrome. The associations between lungs function and diabetes type 2 is explained by biochemical changes in airways, in lungs tissue. In patients with diabetes type 2 the decrease of lungs function is considered as a result of diabetes type 2 and as risk of development and progressing of COPD. Communication between the two complex nosologies - COPD and diabetes type 2 is confirmed by epidemiological data, common pathogenetic mechanisms - chronic systemic inflammation, oxidative stress, hypoxia, chronic hyperglycemia, side effects of drugs used in the treatment of two diseases - inhaled and / or systemic corticosteroids, inhaled bronchodilators, oral hypoglycemic agents. However, the pathogenetic mechanisms underlying the high prevalence of diabetes type 2 in patients with COPD is still unclear and requires a detailed study. Thus, it is actually and reasonable to conduct scientific and clinical work on identifying and better understanding of the exact mechanisms of the association between COPD and diabetes type 2 to develop methods for their correction, prevention and selection of adequate combination regimens in patients with these comorbid pathologies.

[BRONCHIAL ASTHMA AND METABOLIC SYNDROME].

UNLABELLED: Bronchial asthma (BA) and metabolic syndrome (MS) are important socio-medical problems with complicated pathogenetic relations between them that account for the development of mutually aggravating conditions making it dificult to control BA and deteriorating quality of life. AIM: To study the clinical picture of BA in patients with MS and analyse the influence of MS components on BA control. MATERIALS AND METHODS: The study included 95 patients with partly controlled BA divided into 2 groups. Group 1 comprised 35 patients with BA without MS, group 2 consisted of 60 patients with BA and MS. Their comprehensive clinical and instrumental examination included evaluation of clinical symptoms and BA control, quality of life, anthropometric and spirometric data, arterial pressure, carbohydrate metabolism, blood lipid spectrum. RESULTS AND DISCUSSION: Patients with BA and MS suffered more pronounced changes of bronchial patency (forced expiratory volume during the first second) and the spread of daily peak exhalation rates than patients without MC. Also, they showed a tendency toward a decrease of vital lung capacity and Tiffeneau index. The assessment of the quality of life based on the Short Form-36 questionnaire revealed marked negative effect of BA +MS combination. Results of the first stage of the study were confirmed by correlation analysis of MS components, BA picture and control, spirometric data and quality of life characteristics. Among MS components, abdominal obesity and BMI showed the best correlation with the parameters characterizing the clinical picture of BA, such as apnea, BA control, results of spirometry (forced expiratory volume during the first second), and the spread of daily peak exhalation rates. CONCLUSION: The presence of MS components (obesity, arterial hypertension, disordered lipid and carbohydrate metabolism) increases severity of BA and accounts for the deterioration of the patients' quality of life.

[Asthma and metabolic syndrome: Clinical and pathogenetic relationships]. / Bronkhial'naia astma i metabolicheskii sindrom: kliniko-patogeneticheskie vzaimosviazi.

Asthma and metabolic syndrome (MS) are common and social diseases. External and internal factors influencing the development and manifestations of asthma are identified; among which there is obesity that is a major risk factor for MS. Accordingly, the concurrence of asthma and MS and to study their clinical and pathogenetic relationships are a topical problem. There is a tendency to identify a particular asthma phenotype that is characterized by later-onset disease in the presence of obesity; the low prevalence of atopy, low serum level of IgE, and a poorly-controlled course with a trend of standard therapy resistance. It is necessary to understand the essence of asthma cause-effect relationships in the presence of obesity for defining management tactics for this group of patients.