Consilium Medicum

Dendriform pulmonary ossification (DPO) is a rare manifestation of diffuse lung ossification, typically identified incidentally via X-ray or chest computed tomography (CT) scans. This condition is characterized by the formation of mature bone tissue with bone marrow within the interalveolar septa, often remaining asymptomatic for an extended period. The etiology of DPO remains unclear; such ossification may arise without discernible causes or as a secondary consequence of various pulmonary and other pathological processes. The pathogenesis of DPO is not fully elucidated; however, the prevailing hypothesis posits that the disease results from bone metaplasia of fibroblasts in the context of chronic inflammation and lung injury. Clinically relevant to practitioners is the frequently observed association between lung ossification and idiopathic pulmonary fibrosis, as well as chronic venous hypertension. With the recent widespread use of high-resolution CT imaging, the detection rate of DPO has increased significantly. While a definitive diagnosis can generally be established with CT imaging, histological examination of biopsy specimens is essential to prevent diagnostic inaccuracies and inappropriate treatment. Notably, the presence of DPO is associated with a poor prognosis in patients with fibrosing interstitial lung disease. Currently, there is no specific therapy for DPO. This article presents a clinical case of a young patient with a long-term asymptomatic disseminated pulmonary process, in which DPO was confirmed by morphological examination of lung tissue obtained via lung biopsy. An overview of recent literature on lung ossification is also presented, alongside an exploration of the clinical, histological, and radiological characteristics of DPO. The patient's medical history and radiological findings (including changes over time) are also provided, along with pulmonary function tests and a discussion of the potential administration of antifibrotic agents during the early stages of the patient's disease. This clinical observation emphasizes the necessity for meticulous differential diagnosis in cases of disseminated pulmonary processes and underscores the significance of histological verification in guiding appropriate management for affected patients.

Background. Late-onset asthma (after 40 years) is characterized by more severe disease, frequent exacerbations, fixed bronchial obstruction, and high comorbidity; prognostic tools for this age group, including risk models for rehospitalization and mucus plugs, remain insufficiently developed.

Aim. To develop and validate predictive models for estimating the probability of frequent severe exacerbations and the presence of mucus plugs on chest X-Ray computed tomography (CT) in hospitalized patients with late-onset asthma.

Materials and methods. This prospective study included 130 hospitalized patients with late-onset asthma (71.5% female, mean age 63.5 ± 11.3 years). Clinical, laboratory (IgE, eosinophils, FeNO), and instrumental (spirometry, body plethysmography, chest CT) data were assessed. Logistic regression models with stepwise selection were built for two outcomes: ≥ 2 severe exacerbations within 12 months, and mucus plugs on CT. Evaluation included bootstrap validation (5,000 resamples), the Hosmer–Lemeshow test, and ROC analysis.

Results. A T2 endotype was identified in 115 patients (88.5%); the rate of frequent severe exacerbations (≥ 2/year) was 25.4%. The most common phenotypes were allergic, eosinophilic, nonallergic, and asthma with obesity and fixed obstruction; all patients had combinations of these. Mucus plugs on CT were significantly more common with asthma-COPD overlap. Patients with four phenotypes had poorer symptom control and lower pulmonary function. Independent predictors of frequent severe exacerbations were eosinophilic phenotype (OR 3.2, 95% CI 1.3–8.1; p = 0.013) and diabetes mellitus (OR 3.3, 95% CI 1.3–8.8; p = 0.015); AUC 0.726 (95% CI 0.631–0.821), sensitivity 70%, specificity 66%. Reduced PEF% was the only independent predictor of mucus plugs (OR 0.97 per 1% increase, 95% CI 0.95–0.99; p < 0.001); AUC = 0.735 (95% CI 0.649–0.821), sensitivity 68.9%, specificity 68.1%.

Conclusion. In hospitalized late-onset asthma patients, eosinophilic phenotype and diabetes mellitus are independent predictors of frequent severe exacerbations (OR ~ 3.2–3.3). Reduced PEF% predicts mucus plugs on CT. The models (AUC 0.726–0.735) can be used for risk stratification in routine practice.

Background. Nasal septum perforation, with a population prevalence of up to 3.4%, is associated with chronic dryness, crusting, recurrent epistaxis, and impaired nasal breathing. Current surgical approaches rely on vascularized flap closure and require technically demanding extensive dissection within the nasal cavity; however, they do not restore the lost multilayered histological architecture of the mucosa and the underlying cartilage. Regenerative strategy for reconstructive surgery offers a novel approach.

Aim. To evaluate the efficacy and safety of a biomedical cell product (BCP) consisting of spheroids derived from autologous human adipose-derived mesenchymal stromal cells (MSCs) for the repair of nasal septal defects in a rabbit model of chronic perforation.

Materials and methods. The preclinical study was conducted on 14 rabbits. A model of chronic nasal septal perforation was established, with a 2-month chronicization period (14 rabbits: 6 in the BCP group, 6 in the control group without BCP, and 2 intact animals). Treatment was initiated 2 months after defect creation. In the BCP group, 500 autologous MSC spheroids suspended in 0.5 mL of carrier were implanted into the defect site using a combination of gelatin sponge, fibrin glue, and a collagen membrane. In the control group, only fibrin glue and collagen membrane were implanted, without the BCP. Assessment included endoscopic monitoring (on days 14, 30, and 60 of chronicization, and on days 7, 14, 30, and 60 post-implantation), histological and immunohistochemical examination (hematoxylin-eosin, Mallory's trichrome, safranin O, and α-SMA staining), as well as morphometric and statistical analysis (two-way ANOVA with Tukey's post-hoc test; p ≤ 0.05).

Results. Implantation of the BCP did not induce toxic reactions, significant inflammation, or graft rejection. At 2 months post-implantation, complete defect closure was observed in 4 out of 6 animals (83%) in the BCP group. Morphometric and statistical analyses revealed that across all evaluated histological parameters (epithelial regeneration, chondrogenesis, vascularization, and glandular regeneration), nasal septum specimens from the BCP group did not differ significantly from those of the intact group (p > 0.05). In the control group, regeneration of respiratory epithelium, mucous glands, and hyaline cartilage was several-fold weaker than in both the intact and BCP-treated groups, while the extent of fibrosis and inflammation was significantly higher (p ≤ 0.001). Immunohistochemically, α-SMA expression in the BCP group was localized exclusively to vascular smooth muscle cells, whereas numerous myofibroblasts were detected in the control group.

Conclusion. The BCP based on autologous adipose-derived MSC spheroids is safe and effective in stimulating comprehensive regeneration – restoring hyaline cartilage, respiratory epithelium, and glandular structures – in chronic nasal septal defects. These findings support the transition to clinical trials.

Background. Chronic tonsillitis is a significant issue in otorhinolaryngology and often co-occurs with chronic pharyngitis. This condition accounts for a significant proportion of inflammatory airway diseases. Existing treatment methods do not always ensure sustained remission, necessitating the search for new approaches. Laser technologies appear promising due to their high efficacy.

Aim. Improving treatment outcomes for chronic tonsillitis using a pulsed-periodic CO₂ laser.

Materials and methods. A total of 36 patients were enrolled and divided into two groups of 18. The study group comprised 13 children (72.3%) aged 8–18 years and 5 adults (27.7%) aged 20–40 years. The control group consisted of 10 children (55.6%) aged 8–18 years and 8 adults (44.4%) aged 20–40 years. All patients underwent a comprehensive assessment (including microbiological analysis of tonsillar crypt secretions) and received treatment. Patients in the study group underwent partial laser ablation of the palatine tonsils using a specialized pulsed CO₂ laser (pulse power > 2 kW, pulse duration < 20 μs, pulse energy 20, 30, and 40 mJ, and pulse repetition rate 15, 25, 30, and 50 Hz). Statistical analysis was performed.

Results. A positive effect (no complaints, exacerbations, reduction, disappearance of local signs) was observed in 14 main group patients (77.8%) versus 10 control group patients (55.6%). In 16 main group patients (88.9%), pathogenic flora growth inhibition was documented after laser treatment: before the procedure, 11 (68.75%) – Staphylococcus aureus and 5 (31.25%) – Streptococcus pyogenes, after – no growth was detected in any of these 16 patients.

Conclusion. Laser ablation with a pulsed-periodic CO₂ laser is an effective, gentle method for treating chronic tonsillitis, with a positive effect in 77.8% and bactericidal action in 88.9% of cases. The method is suitable for outpatient use, broadening its clinical application.

Acute respiratory viral infections (ARVI) and acute bronchitis are the most common respiratory tract diseases, in which cough remains the leading clinical symptom. Current understanding of the pathogenesis of these diseases places inflammation at the center, which affects damage to the respiratory epithelium, mucus hypersecretion, impairment of mucociliary clearance, and the development of cough. The aim of this review is to summarize current data on the role of inflammation in the pathogenesis of ARVI and acute bronchitis, to analyze the molecular mechanisms of virus-induced inflammation with an emphasis on the NF-κB, HMGB1, NLRP3 inflammasome signaling pathways, oxidative stress, and their role in the development of clinical manifestations and complications. Modern approaches to pathogenetic therapy based on modulation of the inflammatory response are reviewed, and the pathogenetic rationale for the use of glycyrrhizic acid is discussed. The review is presented in the format of a narrative literature review. Particular attention is given to the relationship between inflammation, cough, and impaired mucociliary clearance in the respiratory tract. Glycyrrhizic acid is a multitarget anti-inflammatory agent that acts on several key links of the inflammatory cascade, including inhibition of the HMGB1–TLR4–NF-κB signaling pathways, suppression of NLRP3 inflammasome activation, reduction of oxidative stress, and limitation of inflammation-mediated damage to respiratory tract tissues. One of the clinical implementations of this mechanism is the inclusion of glycyrrhizic acid in the combination drug Codelac Broncho. Experimental and clinical data substantiating the use of glycyrrhizic acid as part of the combination drug Codelac Broncho are presented. The mechanisms of complementary action of ambroxol and sodium glycyrrhizinate are discussed, as well as their place in modern pathogenetic therapy of patients with ARVI and acute bronchitis accompanied by non-productive or productive cough.

Acute rhinosinusitis is one of the most common conditions encountered in outpatient practice. In Russia, 30–40 million cases of acute upper respiratory tract infections are recorded annually; however, the actual number of cases is higher due to the widespread practice of self-medication. Its high prevalence presents a significant medical, social, and economic challenge: the disease impairs patients' quality of life and ability to work, places a burden on the healthcare system, and carries the risk of severe, potentially life-threatening complications (such as meningitis, abscesses, and orbital cellulitis) that often require surgical intervention. Patients with acute rhinosinusitis account for up to 20% of admissions to ENT hospital departments, while the incidence of orbital and intracranial complications ranges from 3% to 20%. According to the EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyps) classification, acute rhinosinusitis is categorized into three forms: viral, post-viral, and bacterial. Notably, the bacterial form occurs in only 0.5–2% of patients, whereas the majority of cases are of viral origin. The primary goals of therapy are symptom relief, reduction of disease duration, and prevention of complications. This article reviews scientific literature, systematizing current treatment principles for acute rhinosinusitis and evaluating the role of various therapeutic approaches within clinical algorithms, including an analysis of their efficacy, limitations, and potential risks. Particular attention is given to the use of the herbal preparation Sinupret® Extract – a dry native extract derived from five medicinal plants which exhibits secretolytic, anti-inflammatory, antiviral, and antimicrobial properties. Clinical study results are presented, confirming that its use facilitates faster symptom resolution, improves mucociliary clearance, reduces the need for antibiotics, and shortens the period of work incapacity. Based on the data presented, the drug can be considered as an option for initial monotherapy for viral rhinosinusitis, as a key component of combination therapy for post-viral rhinosinusitis, and as an adjunct to antibiotic therapy for the bacterial form. This approach helps minimize the unnecessary use of antibacterial agents and reduce the risk of complications.

Inflammatory and infectious diseases of the oropharynx and oral cavity are among the most common reasons for visiting primary care outpatient specialists. The key challenge is the excessively frequent use of systemic antibacterial agents, although in most cases the disease has a viral etiology. This practice directly contributes to the increase in antimicrobial resistance. The aim of this work is to demonstrate the role of local antiseptic therapy as a tool for limiting the growth of resistance and to identify the most appropriate agent for topical use. The available scientific data and clinical guidelines on the problem of antimicrobial resistance were analyzed. A comparative analysis of the mechanisms of inflammatory processes in periodontal tissues and the pharyngeal mucosa was performed. Information on indications, regimens, and criteria for evaluating the effectiveness of local therapy was systematized. Particular attention was paid to such aspects as the diagnostic minimum, patient routing, and outpatient practice in infectious and inflammatory diseases of the oropharynx and infectious and inflammatory diseases of the oral cavity. The management of such conditions as pharyngitis, tonsillitis, stomatitis, and gingivitis was considered. According to the analysis, β-hemolytic group A streptococcus is detected in only 5–15% of adult patients complaining of sore throat, while antibacterial agents are prescribed in 64% of such cases. In this context, rational local antiseptic therapy is of particular importance, as it allows direct action on the inflammatory focus and helps limit the unjustified use of systemic antibacterial agents. The clinical and pharmacological properties of the local antiseptic drug Miramistin® − benzyldimethyl-[3-(myristoylamino)-propyl] ammonium chloride monohydrate − were reviewed. The drug at a concentration of 0.01% demonstrates a broad spectrum of activity against bacteria, fungi, and viruses, exerts an immunomodulatory effect, and does not lead to the development of resistance in pathogens. The use of the drug Miramistin® as the first-choice agent for local antiseptic therapy of infectious and inflammatory lesions of the oropharynx and oral cavity is pathogenetically justified, especially within the framework of a comprehensive approach to patient treatment.