Consilium Medicum

This article analyzes the literature related to the internal auditory canal (IAC) pathology. The data of epidemiology, histological characteristics, MR and CT scans patterns in diagnosing are presented. All pathology of the IAC is divided into 2 large groups: 1) pathology arising from the structures of the IAC; 2) other pathology arising from the surrounding structures of the IAC (middle ear, middle or posterior cranial fosses). Special attention is paid to vestibular schwannoma, cholesteatoma, meningioma, paraganglioma, osteoma, lipochoristoma – IAC lesions identified in the clinical experience of the Otology and Skull Base Pathology Department of the Scientific and Clinical Center of Otorhinolaryngology; the surgical management and the results treatment will be presented in a separate clinical study.

Aim. To study the diagnostic features, course and outcomes of tuberculosis comorbidity, opportunistic respiratory infections and COVID-19 in patients with advanced stages of HIV infection with immunodeficiency.

Materials and methods. The prospective two-year follow-up included 58 patients aged 26–56 years who were randomized into 2 groups. Group 1 consisted of 29 patients with comorbidity of tuberculosis, opportunistic respiratory infections and COVID-19, stage 4 of HIV infection in the progressive phase and in the absence of ART, and group 2 consisted of 29 similar patients selected according to the “copy – pair” principle and completely identical to patients in group 1, but without COVID-19. To detect mycobacterium tuberculosis, the respiratory tract material was seeded on a dense Levenshtein–Jensen medium both in the automated BACTEC MGIT 960 system and with the determination of drug resistance to anti-tuberculosis drugs. Bacteriological, virological, immunological methods and a polymerase chain reaction of diagnostic material from the respiratory tract were used to detect the pathogens of opportunistic respiratory infections. To diagnose COVID-19, SARS-CoV-2 RNA amplification with reverse transcription and real-time fluorescence polymerase chain reaction detection of respiratory tract material (nasopharyngeal and oropharyngeal swabs, sputum and endotracheal aspirate) was used. Statistical data processing was carried out using the Microsoft Office Excel 2019 program, with the calculation of the average indicator in the group and the standard error of the average confidence interval.

Results. The comorbidity of tuberculosis, opportunistic respiratory infections and COVID-19 in patients with advanced HIV infection is characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions and high levels (more than 70%) MDR and XDR. This determines the similarity of clinical manifestations and the visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical and computed tomographic manifestations. After 2 years of follow-up, no clinical cure has been established in all patients. Significant improvement in patients in groups 1 and 2 was found in 24.1 and 20.7% of cases, respectively, progression in 31.0 and 41.4%, and death in 41.3 and 37.9%. Progression and death are associated with lack of adherence to treatment, drug addiction, severe and generalized tuberculosis, and the progression of acute respiratory viral infections.

Conclusion. Patients with comorbidity of tuberculosis, opportunistic respiratory infections and COVID in the late stages of HIV infection with immunodeficiency represent a high risk group for severe course and death, due to not only comorbid disease, but also social maladjustment and lack of commitment to examination and treatment, this requires mandatory organization of an active examination of such patients to establish a diagnosis in tuberculosis treatment rooms. HIV-infected people in Tuberculosis dispensary for the purpose of their emergency hospitalization and isolation for adequate comprehensive treatment and reduction of mortality in this heavy contingent of patients.

This review summarizes key materials from Symposium II of the Expert Council on idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis, held on October 26, 2024, in Sochi. It highlights recent scientific advances in understanding the pathogenesis of IPF, including genetic factors and the role of fibrosenescence. Discussed are the updated clinical guidelines from the European Respiratory Society (ERS), American Thoracic Society (ATS), Japanese Respiratory Society (JRS), and Asociación Latinoamericana del Thorax (ALAT) (2022) on diagnosis, emphasizing the value of transbronchial lung cryobiopsy and high-resolution computed tomography (HRCT) patterns. Special attention is given to novel therapeutic approaches: antifibrotic drugs (nintedanib, pirfenidone), inhaled formulations, and promising agents in clinical trial phases. Research findings on the prognostic significance of symptoms (cough, crackles) and the efficacy of bioequivalent drugs are reviewed. Data from the Russian IPF patient registry underscore the importance of standardized diagnostics and monitoring. The material includes a clinical case analysis demonstrating long-term pirfenidone therapy. This review is intended for pulmonologists, rheumatologists, and specialists in interstitial lung diseases.

Background. Сhronic obstructive pulmonary disease (COPD) is a heterogeneous disease with different etiologies. As lung function declines and the disease progresses, patients are at increased risk of long-term nocturnal hypoxemia (NH) with consequent tissue hypoxia. It is supposed that tissue hypoxia with NH plays a key role in a number of pathologic processes with the development of metabolic disorders.

Аim. Тo investigate the relationship between NH and metabolic disorders in stable COPD patients.

Materials and methods. A cross-sectional observational study included 106 stable COPD patients managed at a respiratory medical center between 2019 and 2024 who completed ambulatory computerized somnography, pulmonary function testing, questionnaire and laboratory screening. NH was defined according to a time to saturation under 90% (T90) index >10%. Based on the absence/presence of NH, patients were classified into groups of patients with NH (NH+) and without NH (NH-). Factors that affect NH were identified using univariate analysis and logistic regression models.

Results. The group of COPD patients with NH+ was represented by men (92.9%) with a mean age of 59.9±10.9 years, with an increased body mass index (32,14 [21.04–35.96] kg/m²); with moderate-to-severe impairment of forced expiratory volume in 1st second (FEV1) (56.19±21.17% of predicted); with decreased lung diffusing capacity for carbon monoxide (60.61±21.36% of predicted). NH+ patients compared to the NH- group had a statistically significant increase in: insulin resistance index – HOMA-IR (3.6 [3.01; 4.21] vs 2.46 [1.85; 2.88]; p<0.05); low-density lipoprotein – LDL-C (3.16 [2.83; 3.62] vs 2.49 [2.23; 2.88]; p<0.05); triglycerides (1.89 [1.70; 2.03] vs 1.58 [1.45; 1.7]; p<0.05). At the same time, high-density lipoprotein – HDL-C had a statistically significant decrease (1.00 [0.92; 1.09] vs 1.14 [1.04; 1.22]; p<0.05). Univariate regression analysis based on clinical and laboratory data showed a statistically significant association with NH for the following parameters: age (OR 1.06, 95% CI [1.02–1.12]; p=0.011), COPD Assessment Test (CAT) score (OR 1.48, 95% CI [1.10–2.00]; p=0.009), FEV1 (% of predicted) (OR 0.96, 95% CI [0.93–0.99]; p=0.015), HDL-C levels (OR 1.02, 95% CI [1.00–1.04]; p=0.034).

Conclusion. COPD patients with NH have statistically significant correlations of metabolic disorders with NH that has effect on clinical characteristics and functional disturbances. The established correlations are useful to take into consideration in current algorithms of therapy of stable COPD patients.

Chronic suppurative otitis media (CSOM) is a common pathology in the practice of an otolaryngologist. Modern conservative therapy and surgical correction methods have made it possible to achieve good functional results. However, in some cases, standard treatment is ineffective, then such a course of CSOM is usually called ”atypical”. Under its mask, a number of systemic diseases may be hidden, which are accompanied by inflammatory changes in the cavities of the middle ear. The article describes a clinical case of ”atypical” bilateral purulent otitis media in a female patient. During surgical treatment, morphological features were noted indicating a possible specific nature of inflammation in the middle ear. During further examination by a phthisiatrician, a tuberculoma of the right lung was detected, chemotherapy was started, during which, after 4 months, the symptoms of exacerbation of CSOM were stopped. Thus, an interdisciplinary approach is necessary for diagnosis and correct tactics of management of patients with ”atypical” sluggish CSOM.