Vol 28, No 3 (2026): Otorhinolaryngology and pulmonology

Pharyngeal diseases play a leading role in the structure of seeking ENT care, and sore throat is one of the most common complaints when a patient visits an otorhinolaryngologist. There are many possible causes of sore throat. Acute pain is more often associated with acute inflammation of the pharyngeal mucosa caused by microorganisms (viruses, bacteria, fungi) or injury. In chronic pain, non-infectious factors are more important: environmental conditions, bad habits, concomitant diseases, and taking medications. But whatever the nature of the pain, when contacting a doctor, patients primarily expect treatment that can remove the pain component. Therefore, choosing an effective and safe drug is an important task. For diseases accompanied by sore throat, a wide range of medications belonging to various groups (antiseptics, antibiotics, local anesthetics, etc.) is used. One of these groups with pathogenic effects is the group of nonsteroidal anti-inflammatory drugs (NSAIDs). The work demonstrates the effectiveness of using domestic drugs from the group of topical NSAIDs Ketoprofen-LOR gargle solution and Flurbiprofen-Pharmstandard lozenge in patients with infectious diseases of the pharynx. A retrospective analysis of three clinical cases of drug use in patients with herpangina and acute tonsillitis was performed. The high effectiveness of the drugs in relieving pain was shown, and it was noted that the combination of drugs provided a stable analgesic effect, allowing for confident control of even severe pain throughout the day. The combination of the two drugs demonstrated good tolerability, and no adverse reactions were reported. It is concluded that the drugs Ketoprofen-LOR and Flurbiprofen-Pharmstandard in combination and individually are convenient, effective and safe medications for the symptomatic treatment of pain associated with inflammatory diseases of the pharynx. The described cases are accompanied by a literature overview reflecting the worldwide experience of using local NSAIDs for sore throat. It is shown that the results and conclusions obtained in the work correspond to the data demonstrated in other studies.

Ambroxol is one of the best studied mucoactive agents used in respiratory diseases associated with productive cough, mucus hypersecretion, and impaired mucociliary clearance. This article summarizes current data on its pharmacological properties, mechanisms of action, clinical efficacy, and safety in children and adults. Ambroxol has a multimodal activity profile: it reduces the viscosity of tracheobronchial secretions, facilitates their clearance, stimulates mucociliary transport, modulates the synthesis and secretion of pulmonary surfactant, and also demonstrates antioxidant and anti-inflammatory effects. Experimental studies show that the drug influences mucin secretion, ciliary epithelial activity, protection of alveolar structures, and the intensity of the inflammatory response. Clinical evidence confirms that ambroxol helps reduce cough severity, facilitates sputum expectoration, and improves patients’ subjective well-being and quality of life. Of particular importance are the results of studies of inhaled formulations, including in children with lower respiratory tract infections and in adult patients in real-world clinical practice, where a rapid clinical effect and good tolerability have been demonstrated. The favorable safety profile of ambroxol has been confirmed by numerous studies and many years of clinical use. From a practical perspective, ambroxol may be regarded as a rational component of mucoactive therapy in acute and chronic respiratory diseases with wet cough, especially when a robust evidence base, predictable clinical effect, and good tolerability are required. This is particularly important in pediatric practice, because the evidence supporting the efficacy and safety of many herbal and homeopathic remedies remains limited. The availability of different dosage forms allows therapy to be individualized according to age, clinical setting, and the characteristics of bronchial secretions. The totality of experimental, randomized clinical, and observational data supports its widespread use in everyday pulmonology and pediatric practice for infectious-inflammatory and chronic bronchopulmonary diseases in various patient categories.

Background. The hallmark of the new coronavirus infection (COVID-19) was high mortality in older adults.

Aim. To analyze and evaluate the sex and age structure of COVID-19 mortality on the example of the Samara region.

Materials and methods. The study was conducted according to the data of the Operational Headquarters under the Government of Samara Region, which reflect the number of diseases and deaths from COVID-19. The period of 2020–2021 is considered. The method of comparative analysis and generalization of the obtained results, statistical methods – structural and dynamic analysis of population mortality is used.

Results. In Samara region mortality, as well as in the whole world, prevails among the elderly population. They account for 84.4% of the total number of deaths, of which women account for 60%. The largest share of deaths is observed in the age group 70–79 years – 30.6%. In 2021 compared to 2020, the mortality rate increased by more than 80% in all age groups of the population. The limitations of this study are that it does not consider the entire pandemic period, but covers only 2020 and 2021. Our study is based on data from the Operational Headquarters under the Government of Samara Region, which were published daily from the day of the announced pandemic with the sex and age of each death, but in early 2022 the headquarters began to publish only the total number of deaths, discontinuing detailed record-keeping.

Conclusion. The conducted analysis showed that in the structure of mortality from COVID-19 in Samara Region the female population predominates. By age groups of the population, the predominance of women is observed in age group of 80 years and older. The highest proportion of mortality was found in people with a history of cardiovascular disease. The second year of the pandemic brought a tenfold increase in the number of deaths. The pandemic had a negative impact on demographic processes in the society.

Background. Pathogenetic therapy plays an important role in the treatment of tuberculosis. Such drugs affect not so much the etiological factor itself, as indirectly on the body, increasing its protective properties. Pulmonary surfactant provides molecular mechanisms of innate and acquired immunity of the lungs. Experience in using tauractant therapy (TT) in combination with new anti-TB drugs bedaquiline and linezolid is limited to isolated reports.

Aim. To evaluate the effectiveness of TT in the complex treatment of tuberculosis, including new anti-TB drugs, and its impact on adherence to treatment in patients with extensive drug resistance.

Materials and methods. A single-center, open, cohort, prospective study was conducted at Regional Clinical Anti-Tuberculosis Dispensary for 2022–2025. The study included 60 patients. The patients were randomized into 2 groups. Group 1 included 28 patients who received TT. Group 2 included 32 patients who did not receive TT.

Results. Comparison of patients in groups 1 and 2 demonstrated no differences in the frequency and severity of respiratory symptoms at the beginning of treatment. Most patients in group 1 noted improved sputum expectoration and an increase in its amount. Subsequently, the amount of sputum in these patients decreased, and then it disappeared. Bacteriological excretion at the beginning of treatment was recorded by microscopy in all patients in both groups. At the 2nd control point, the difference between the groups becomes statistically significant, it is 56.2%. At this time, sputum negativity was observed in 75% of cases in group 1 and only in 18.7% in the control group. During the treatment, all patients showed positive radiographic dynamics in the form of resorption of focal infiltrative changes and a decrease in the number and size of decay cavities. Comparison of the comparison groups demonstrated that in group 1, all adherence characteristics were higher than those in patients in group 2.

Conclusion. The study demonstrated the positive effect of TT on the treatment results of one of the most difficult categories of patients – with pre-extensively drug-resistant tuberculosis. Under the influence of TT, normalization of the level of adherence to medical care and a statistically significant improvement in other adherence characteristics were noted.

Background. The global incidence of tuberculosis is rising. Smoking is considered a proven risk factor for the development and more severe course of the tuberculosis process. Smoking patients have distinctive features in the clinical and radiological manifestations of the tuberculosis process compared to non-smokers, which affects the low effectiveness of the anti-tuberculosis treatment. However, a detailed analysis of the smoking status among smoking patients has not been conducted to date.

Aim. To analyze the status of smoking behavior in patients with pulmonary tuberculosis at the inpatient stage of treatment.

Materials and methods. A prospective cohort study was conducted among smoking patients with pulmonary tuberculosis. A total of 75 patients were included in the study, who were divided into two groups: group 1 – newly detected patients (n=43), group 2 – previously treated patients (n=32).

Results. Newly diagnosed and previously treated patients have some clinical and radiological features in the course of the tuberculosis process. When studying the smoking status in both groups, we found significant differences. It was shown that the median index of a smoker in both groups did not differ significantly. However, when assessing the degree of nicotine dependence, we observed a predominance of very low, low, and moderate degrees among newly diagnosed patients, but we did not find statistical significance. At the same time, a high degree of nicotine addiction significantly prevailed in the group of previously treated patients with pulmonary tuberculosis. It is noteworthy that the presence of withdrawal symptoms is observed in the vast majority of both newly diagnosed and previously treated patients. It should be noted that a high motivation to quit smoking is significantly more common among newly diagnosed patients compared to previously treated patients.

Conclusion. The obtained data indicate the need for widespread implementation of smoking cessation programs in clinical practice among patients with pulmonary tuberculosis.

Background. The article presents data on the use of C-reactive protein in clinical practice, showing its importance in the diagnosis of various diseases, such as lung pathology, cardiovascular diseases, hematological diseases, and modern military conflicts. The article also presents the main biochemical properties and characteristics of C-reactive protein, as well as its involvement in the pathogenesis of various diseases. The article also discusses the use of point-of-care devices for measuring C-reactive protein and their compatibility with standard biochemical analyzers. The advantages and difficulties of using point-of-care devices for determining C-reactive protein have been studied and discussed.

Aim. To conduct a retrospective study of the literature data on the use of C-reactive protein levels and their quantification in various clinical conditions and diseases, to consider the possibilities of using point-of-care devices for determining C-reactive protein, and to compare the results obtained on different analyzers.

Materials and methods. In the course of the work, a comparison and comparative characteristics of the results of the C-reactive protein study on different analyzers: biochemical analyzer – Cobas Integra 400 plus (Roche Diagnostics, USA) and point-of-care device – NycoCard READER II (Abbott Diagnostics Technologies AS, USA) were carried out. 188 quantitative studies of C-reactive protein in 94 patients with acute bronchitis, who took part in modern military conflicts. The analysis was conducted in three C-reactive protein ranges: 5(8)–29.9 mg/L (n=39); 30–89.9 mg/L (n=20); more than 90.0 mg/L, (n=10). The results were presented in the charts of the range and dispersion of the results for each C-reactive protein range, with the calculation of the Spearman correlation coefficient.

Results. The results of the present comparative study showed that the methods for quantifying C-reactive protein implemented on modern POCT platforms demonstrate high convergence with the results obtained on classical biochemical analyzers. A high correlation (r) between the C-reactive protein level and the groups and devices used was shown: in the range of 5(8)–29.9 mg/L the correlation was 0.8; in the range of 30–89.9 mg/L the correlation was 0.55; in the range of more than 90.0 mg/L the correlation was 0.67. The differences between the methods are within the acceptable analytical deviations and do not have a clinically significant impact on the interpretation of the results in the working range of C-reactive protein concentrations.

Conclusion. POCT technologies for C-reactive protein detection can be considered as a full-fledged alternative to traditional laboratory methods, especially in outpatient settings, emergency departments, and in cases with limited access to centralized laboratories.

Pneumococcal disease remains a major cause of morbidity and mortality among adults, particularly in older individuals and those with underlying comorbidities. In the Russian Federation, the incidence of community-acquired pneumonia (CAP) rose sharply in 2024 to 866.6 cases per 100,000 population – twice the long-term average – accompanied by a twofold increase in pneumococcal etiology. This trend is further driven by increasing antimicrobial resistance in Streptococcus pneumoniae, with penicillin non-susceptibility reaching 29.3%. Since 2025, the 20-valent pneumococcal conjugate vaccine (PCV20, Prevnar 20) has been introduced in Russia. It expands coverage by including all PCV13 serotypes along with seven additional serotypes that are highly relevant in adult populations. Clinical and real-world evidence indicates that PCV20 elicits immune responses comparable to PCV13 for shared serotypes and similar to the 23-valent polysaccharide vaccine (PPSV23) for most of the additional serotypes. The vaccine demonstrates a favourable safety profile with a low rate of serious adverse events. In a large real-world study (A. Miles et al., 2026), PCV20 was associated with a 25.6% reduction in invasive pneumococcal disease and a 15.2% reduction in CAP of any cause, corresponding to the prevention of 758 cases per 100,000 person-years. The greatest benefit was observed in individuals aged 85 years and older and in immunocompromised patients. In patients with chronic obstructive pulmonary disease, the incidence of pneumococcal infection is 18 times higher than in the general population. Streptococcus pneumoniae is the most common cause of bacterial community-acquired pneumonia in hospitalized patients of this group. Vaccination in this group has been shown to reduce CAP incidence by 67–71% and improve disease control. PCV20 provides robust immunogenicity in adults with risk factors comparable to that seen in the general population and may be considered a preferred option for patients with chronic respiratory conditions. Importantly, it can be administered concomitantly with influenza and coronavirus disease 2019 (COVID-19) vaccines without compromising immunogenicity or safety.