[Clinic and functional features of chronic obstructive pulmonary disease after virus-induced acute exacerbations.]

AIM: To establish symptoms, lung function and to evaluate subsequent exacerbations of chronic obstructive pulmonary disease (COPD) during a year after virus-induced COPD exacerbations. MATERIALS AND METHODS: Patients hospitalized with viral (n=60), bacterial (n=60) and viral-bacterial (n=60) COPD exacerbations were enrolled to single-center prospective observational study. COPD was diagnosed according spirography criteria. Viral infection was established in bronchoalveolar lavage fluid or sputum by real-time reverse transcription-polymerase chain reaction for RNA of influenza A and B virus, rhinovirus, respiratory syncytial virus and SARS-CoV-2. Symptoms, lung function, COPD exacerbations were assessed. Patients were investigated at the hospitalization onset and then 4 and 52 weeks following the discharge from the hospital. RESULTS: After 52 weeks in viral and viral-bacterial COPD exacerbations groups the rate of forced expiratory volume in one second (FEV1) decline were maximal - 71 (68; 73) ml/year and 69 (67; 72) ml/year versus 59 (55; 62) ml/year after bacterial exacerbations. Low levels of diffusion lung capacity for carbon monoxide (DLco/Va) - 52.5% (45.1%; 55.8%), 50.2% (44.9%; 56.0%) and 75.3% (72.2%; 80.1%) respectively, of 6-minute walk distance; p<0.001 in relation to bacterial exacerbations. In Cox proportional hazards regression analyses viral and viral-bacterial exacerbations were associated with increased risk of subsequent COPD exacerbations by 2.4 times independent of exacerbations rate before index event and FEV1. In linear regression models the relationships between airflow limitation and respiratory syncytial virus, rhinovirus and influenza virus infection, between low DLco/Va and rhinovirus, influenza virus and SARS-CoV-2 infection. CONCLUSION: COPD after virus-induced exacerbations were characterized by progression of airflow limitation, low DLco/Va, low 6-minute walking test distance, subsequent COPD exacerbations risk.

[Diagnostic and Prognostic Markers of Chronic Heart Failure in Patients with Occupational Chronic Obstructive Pulmonary Disease].

Aim      Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are a common comorbidity. Professional chronic obstructive pulmonary disease (PCOPD) is a specific phenotype, which suggests peculiarities in the development of HF. Difficulties of HF diagnosis in such patients determine the relevance of searching for additional markers. The aim of the study was identifying HF markers in patients with PCOPD.Material and methods  This single-site, cohort, prospective, observational study included 345 patients. The main group consisted of PCOPD patients; the comparison group consisted of patients with COPD induced by tobacco smoking; and the control group included conventionally healthy individuals. The groups were matched by the index of coincidence; pairs were matched at 1:1 by the "nearest neighbor index"; covariates for matching included COPD duration, sex, and age. Each group included 115 patients. The major professional adverse factors were silica-containing dust and organic solvents. COPD was diagnosed according to GOLD criteria; HF was diagnosed in accordance with Russian clinical guidelines. The markers were determined by multifactorial logistic regression. Likelihood of events with allowance for the time to the event was analyzed by the Kaplan-Meier method.Results HF in PCOPD patients was characterized by biventricular damage, preserved left ventricular ejection fraction, and frequent hospitalizations for decompensation (17.5 % vs. 9.5 % for COPD in smokers). HF markers in patients with PCOPD included the length of work of more than 20 years, pulmonary artery systolic pressure (PASP) higher than 35 mm Hg according to data of Doppler echocardiography, diffusing capacity of lungs for carbon monoxide (DLCO) less than 50 %, increased serum concentrations of CC-chemokine ligand 18 (CCL18), S-100­beta protein, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Diagnostic sensitivity of the multifactorial model was 84 % and specificity was 81 %. Two models were proposed for purposes of screening, which included the following parameters: length of work, exposure to aromatic hydrocarbons, decreased distance in 6-min walk test by more than 60 m per year and length of work, exposure to inorganic dust, and decreased forced expiratory volume during the first second by more than 55 ml per year.Conclusion      The markers for development of HF in PCOPD patients are length of work >20 years, PASP >35 mm Hg, DLCO <50 %, and increased serum concentrations of CCL18, S-100­beta protein, and NT-pro-BNP.

[Innovative technology full volume lavage of the nasal cavity in the treatment of allergic and vasomotor rhinitis]. / Innovatsionnye tekhnologii polnogo ob''emnogo promyvaniia polosti nosa v lechenii allergicheskogo i vazomotornogo rinitov.

Viewed 60 men and women (mean age 26.2±2.4 years) with rhinitis, including: 30 people (18 women and 12 men) 20-45 years with verified diagnoses of persistent allergic rhinitis and 30 patients (16 males and 14 females) 18-35 years (mean age 22.5±1.7 years) - neurovegetative form of chronic vasomotor rhinitis in the phase of exacerbation, receiving basic therapy with antihistamines of the II generation, stabilizers of membranes of mast cells and decongestants, divided by random sampling into 4 groups: 1A (20 patients with allergic rhinitis) and 2A (20 patients with vasomotor rhinitis) were received within 30 days in addition to the basic therapy of the nasal cavity washing procedure with the device Dolphin; in the groups 1B (10 patients with allergic rhinitis) and 2B (10 patients with vasomotor rhinitis) only basic treatment was carried out. By the end of the treatment course, the severity of the symptom 'difficulty in nasal breathing' in patients in groups 1A and 2A, decreased 2.6 times and met the criterion of 'minor violation', while in groups 1B-decreased only 1.3 times, and in 2B-changes were not significant and corresponded to 'moderate violation'. Manifestations of rhinorrhea after therapy decreased in the group of 1A 2.0 times, and in the group of 2A 1.7 times, which was regarded as' a slight manifestation of the symptom', whereas in the groups of 1B and 2B only a tendency to improve was revealed. At the end of the follow - up period, the severity of the symptom 'sneezing' decreased in patients in group 1A by 4.0 times, in group 2A-3.3 times and corresponded to 'no disturbance', while in groups 1B and 2B changes were less than 3.0 and 2.7 times respectively. At the end of the treatment course in patients in groups 1A sense of smell was restored in the group 2A -the degree of severity of olfaction decreased 3.0 times, while in the group of 1B-only 1.2 times, and in the group of 2B-has not changed. According to the visual analog scale (VAS), on the background of treatment optimized by nasal lavage with the device Dolphin complex, the greatest decrease in the degree of violations of household activity was revealed in patients with allergic rhinitis - 2.9 times. After treatment, the effect of rhinitis symptoms on sleep disturbance decreased in groups 1A and 2A 1.9 times, while in groups 1B and 2B - only 1.3 times. The use of nasal lavage with device Dolphin complex in the treatment of allergic and vasomotor rhinitis contributed to a decrease in the frequency of use of intranasal vasoconstrictive drugs by the 10th day of observation by 1.8 and 1.6 times, respectively, and by the 15th day-by 2.3 and 2.4 times, respectively. In the groups of standard treatment (1B and 2B) revealed a significant reduction in the frequency of decongestants was observed only after 15 days of treatment. Thus, the inclusion of a full volumetric nasal lavage with the device Dolphin complex in the treatment of patients with persistent allergic and neurovegetative form of chronic vasomotor rhinitis contributes to the reduction of clinical simtomatics, reduces the severity of violations of everyday life and the frequency of decongestants, improves night sleep of patients.

Efficacy of 13-valent pneumococcal conjugate vaccine in healthcare workers.

AIM: To establish the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) for healthcare workers protection from occupational acquired infection and impact of healthcare staff vaccination on the risk of transmission to patients. MATERIALS AND METHODS: Healthcare personnel (n=157 of whom 105 critical care department staff) and 1770 patients of that critical care department observed. Healthcare workers received PCV13. Infections caused by Str. pneumoniae, respiratory infections regardless of etiology, work absenteeism in healthcare workers during 12 month before and after vaccination assessed. In the same time monitoring of hospital-acquired infections in patients of critical care department performed. Statistical analysis was done using SPSS 24, relationships were assessed by rate ratio, Cox regression, logistic regression and Kaplan-Meier estimator. RESULTS: Healthcare workers' vaccine coverage in critical care department was 97.2%. In healthcare personnel the rate of all pneumococcal infections, asymptomatic carriage of Str. pneumoniae and respiratory pneumococcal infections were decreased after vaccination by 2.1, 2.2 and 2.1 times accordingly. The rate of respiratory infections regardless of etiology was decreased by 30%, р<0.05. Cumulative percent of subjects without pneumococcal respiratory infections during 12 month was 87.9 before and 94.3 after vaccination, р=0.015. Work absenteeism due to respiratory infections was reduced. In patients of critical care department decreasing of all respiratory infections by 58%, pneumococcal respiratory infections by 66%, hospital acquired pneumonias by 46% were seen, р<0.05. CONCLUSION: Healthcare personnel vaccination with PCV 13 is effective in protection from occupational acquired pneumococcal respiratory infections and asymptomatic carriage and promotes decreasing of hospital acquired infections among patients.

[Occupational chronic obstructive lung disease: phenotypic characteristics.]

Prospective cohort observational study covered phenotypic features of COLD formed under influence of various occupational etiologic factors vs. COLD caused by tobacco smoking. The study included totally 170 COLD patients (2011 criteria of COLD). In accordance with exogenous etiologic factor, the authors selected examinees in 3 strata simultaneously: COLD due to toxico-chemical aerosols (n = 42), COLD due to inorganic dust (n = 55), COLD due to tobacco smoking (n = 73). Evaluation covered influence of ecologic and industrial conditions on main mainfestations of the disease. Statistic analysis: comparison of quantitative variables - Kruskal-WaRIisANOVA, quantitative variables - criteria c(2), influence of independent variable on the dependent one - single-factor and multi-factor regression, p = 0,05. For COLD due to toxico-chemical aerosol, characteristics are rare but severe exacerbations .(total amount is 366/427 person-years, severe ones - 312/427 person-years), severe dyspnea (mMRC 2,5 ± 0,12 points), minimal decrease of FEVI (65,7% ? 3,21%) and minimal speed of bronchial obstruction progress (decrease of FEV1 by 0,08 ml ± 0,006 ml per year), emphysema, pulmonary hypertension, low serum level of VEGFA. For COLD due to dust, characteristics were bronchial hyperreactivity (in 45% of patients), cough, rare severe exacerbations (total exacerbations 825/537 person- years, severe ones - 227/537 person-years), lower dyspnea intensity (mMRC 1,9 ± 0,13 points), concomitant interstitial fibrosis, "average" level of VEGFA.

[Complex use of naphthalane and nonselective chromotherapy in gonarthrosis treatment in rolling stock workers].

Complex treatment using naphthalane applications with nonselective chromotherapy covered 64 engine operators of locomotive crews, aged 40-69 years, having 1-3 stage knee osteoarthrosis. Findings are that optimized treatment schedules effectively reduce intensity of pain, improve functional state of the joints involved, increase life quality of the patients, have no side effects. Comparative analysis of the treatment results showed that efficiency of combined naphthalane and nonselective chromotherapy exceeds isolated naphthalane effects.

[Prenosologic criteria of health disorders and cardiovascular risk factors in workers engaged into nuclear industry].

Prophylactic study among workers engaged into main production of Siberian chemical enterprise (Seversk city) revealed high frequency of cardiovascular risk factors (overweight, hypodynamia, dyslipidemia, arterial hypertension), low level of adaptational potential and integral somatic health parameter as prenosologic criteria of cardiovascular diseases. The results necessitate recommendations to supplement periodic medical examinations with studies aimed to reveal early criteria of health disorders, and determine priority directions to specify prophylactic measures in nuclear industry workers.

[State of vegetative regulation in workers exposed to vibration at work during industrial implementation of hi-tech pneumoinstruments].

The study was conducted on aircraft-building enterprise during production microcycle (before working shift start, during last working hour and in an hour after the shift end)--spectral analysis covered variability of heart rhythm in 70 male assembler riveters aged 25-59, divided into 2 groups in accordance with industrial equipment used. The group 1 used standard vibroinstrument, the group 2--pneumoinstruments with low vibration velocity parameters. Triple study during the working shift revealed in group 2 an adequate reaction of vegetative nervous system to vibration, in group 1 a negative trend was seen with centralization of regulatory processes and absence of adequate recovery in an hour after work.

Cytokine-producing function of human blood cells in chronic atrophic gastritis and gastric adenomas and adenocarcinomas.

The cytokine-producing potential of blood cells has been studied in the atrophic gastritis-adenoma-adenocarcinoma progression of pathological states of the stomach. It has been revealed that, at the initial stage of carcinogenesis, namely adenoma, immunocompetent cells have the highest cytokine-producing proto-oncogenic potential as compared to both atrophic gastritis, which presents a precancerous condition, and completely formed malignant tumor (gastric adenocarcinoma).

[FEDERAL CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS, PREVENTION AND TREATMENT OF PNEUMOCONIOSIS].

The purpose of development of this clinical practice guidelines was to provide evidence-based protocols that help the practitioner and the patient make the right decision for the health assessment, treatment and prevention of pneumoconiosis. Pneumoconiosis is the interstitial lung disease of occupational origin caused by prolonged inhalation of inorganic dust, characterized by chronic diffuse aseptic inflammation in lung tissue with the development of pulmonary fibrosis. Currently, thereare no treatment that provide a cure pulmonary fibrosis and changes in the dynamics of decline in lung function. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and some clinical symptoms of pneumoconiosis, as well as the prevention of complications. To enhance the effect of pharmacotherapy is recommended to use non-drug therapies that enhance the functionality of the respiratory system.

[Experience With Serelaksin for Acute Right Ventricular Failure due to Pulmonary Embolism in Acute Ischemic Stroke].

OBJECTIVE: to demonstrate effects of serelaxin in treatment of acute right ventricular failure (ARVF) caused by pulmonary embolism (PE).

[Topical problems of pulmonology in contemporary occupational medicine].

Respiratory tract diseases are very common in occupational medicine. The present literature review is aimed to specify topical directions of research in this sphere. The review is based on search in databases (e. library.ru, pubmed. com and Cocran library). Molecular genetic and proteome studies make a fundamental basis for better prophylaxis, diagnosis and treatment of occupational respiratory diseases. Other problems of maximal scientific and practical importance are: phenotyping of chronic obstructive lung disease (COLD) for differential approach to patients management, new methods for early diagnosis of COLD, improved classification of pneumoconiosis according to contemporary view of occupational interstitial lung diseases pathogenesis, studies of immune suppression efficiency in rapidly progressing pneumoconiosis, understanding etiology of infectious complications of lung diseases with subsequent specifying the recommendations on rational antibacterial therapy.

[Spirometry and veloergometry in evaluating physical performance of individuals exposed to organic solvents].

Increased length of service in house-painters causes longer half-periods of adaptation and recovery, larger their total, lower coefficient of recovery and lower coefficient of myocardial resources expenditure. That indicates lower efficiency of heart action under exertion, poor adaptive reactions to physical exertion and latent heart failure formation.

[Features of hemostasis system and vascular epithelium growth factor in arterial hypertension with high occupational risk].

Study covered vascular, platelet, coagulation and fibrinolytic parts of hemostasis and vascular endothelial growth factor in individuals with arterial hypertension in various occupational groups.

[Features of changes in joints structure, in lipid spectrum and vascular remodelling with occupational arthrosis].

Studies covered features of intraarticular cartilage and soft tissue components of knee joints, lipid spectrum and structures of peripheral arteries in occupational knee osteoarthrosis. Findings are relationships between lipid metabolism disorders and frequency of cartilage degeneration in knee joints, with vascular remodelling parameters.

[Role of genetic factors in development of occupational obstructive lung disease].

The authors represent associative study of 180 patients having chronic obstructive lung disease 1-2 stages, who exposed at work to industrial pollutants (58.3% exposed to moderately fibrogenous dust and 41.7%--to a complex of aromatic organic solvents). Findings are increased (p < 0.05) concentration of IL-1beta in individuals exposed to chemicals, when compared to those exposed to dust at work. Relation was seen between transforming growth factor beta1 (rs1804470 of TGFB1 gene) and rs1828591 of HHIP gene with propensity to COLD formation. Genotype AA and AG demonstrated protective effect against the disease.

[Genetic aspects of occupational chronic obstructive lung disease under exposure to various risk factors].

The article deals with data on association of SNP rs1828591 of HHIP gene with COLD development under exposure to dust and chemical factors. SNP rs1800470 of TGFbeta1 gene is associated with occupational COLD under exposure to dust and did not show connection with COLD under exposure to chemical aerosols. No association was seen between SNP rs4129267 of IL-6R gene and SNP rs1051730 of CHRNA3 gene with occupational COLD under exposure to the studied factors. SNP rs1828591 of HHIP gene is associated with occupational COLD development under exposure to dust and chemical factors. Study of association of genotype and phenotypic features of COLD revealed the following trends: "dust" COLD patients with genotype AA SNP rs1800470 of TGFbeta1 gene show lower level of C-reactive protein and TNF-alpha, if compared with other genotypes.

[Depending on exposure, functional state of left ventricle in combined cardiovascular disease among chronic uranium intoxication patients].

State of left heart contractility in patients having IHD and AH during long-term period of chronic uranium intoxication depends on duration of exposure to toxic radiation factor. The authors revealed left ventricle myocardium weight decreased by 11.7% on exposure up to 10 years and that decreased by 18.9% on the exposure over 10 years, when compared to the reference group. Longer length of service was connected with higher share of patients with pathologic remodelling of left ventricle, mostly due to increased concentric remodelling.

[Psychosomatic disorders in combined occupational and cardiovascular diseases].

A group of individuals with occupational diseases caused by chemical factors demonstrate higher incidence and severity of depression, frustration, rigidity, cognitive and sleep disorders, if compared to the group of individuals with occupational diseases caused by physical factors. In the occupational diseases group, encephalopathy is seen more frequently, individuals subjected to physical factors have prevailing encephalopathy of I and II grades, those subjected to chemical factors--of II-III and III grades, more severe encephalopathy in the group of chemical factors is seen among the individuals subjected to uranium compounds.

[Prospects of hi-tech medicine development in occupational pathology (exemplified by joints diseases model)].

Recommendations for patients with occupational locomotory disorders include ultrasonography, diagnostic and therapeutic arthroscopy, target therapy of systemic osteoporosis with monohydrate zoledronic acid (aclasta)--that enables prolong remission (up to 46.2 months).