Vol 19, No 11-1 (2017)

Cough is the most common symptom in both outpatient and hospital practice. The multifactoriality of the cough complicates its etiologic diagnosis, especially in the context of primary care. The article presents current data on the different genesis of cough depending on its duration and clinical features, shows the results of our own research, diagnostic algorithms for cough in children are considered. The development of clinical guidelines for the differential diagnosis of diseases accompanied by a prolonged cough in childhood, which determines differential therapy, is particularly relevant and has demand in practice.

Chronic obstructive pulmonary disease (COPD) remains a disease which prevalence in the world is not decreasing, and mortality is increasing. Over the past 10 years, the recommendations for the classification and treatment of COPD have changed many times. The aim of the work was assessing the condition of patients with COPD and the features of their treatment in pulmonology departments of Kazan. Material and Methods. Sixty patients with COPD were examined in a hospital - 59 (98.3%) men and 1 (1.7%) woman, whose average age was 63.8±1.0 years. All patients underwent a physical examination, a survey was conducted on standardized CAT and mMRC questionnaires, and a spirogram of forced expiration was recorded. Result. According to the GOLD 2007 classification, the patients were distributed in the following way: GOLD I - in 5%, GOLDII - 20%, GOLDIII - 51.7% GOLDIV - 23.3%. According to ABCD classification, GOLD 2017 to subgroup C was assigned 1 patient and 59 - to subgroup D. Completely compliant were 28.3% of patients, 65% of patients were well trained by the paramedic for correctly use of their inhalers. Patients preferred short-acting bronchodilators and metered-dose aerosol inhalers among all drugs, they would like to use them only as required. 25% of patients received long-acting beta-adrenoceptor agonist in combination with short-acting drugs, 23.3% of patients mixed a combination of an inhaled steroid with a long-acting bronchodilator and a short-acting bronchodilator as needed, 20% inhaled two long-acting bronchodilators. Conclusion. The study revealed a discrepancy between actual practice and clinical recommendations. The authors linked it with the training of doctors once in 5 years, whereas the recommendations were updated annually. It was suggested that the compliance of patients and their commitment to long-acting bronchodilators would increase with the widespread use of drugs with a rapid start of action.

The article presents information on the relevance of the treatment of infections of ENT-organs in children. The principles of rational prescription of antibacterial drugs taking into account the sensitivity of major pathogens in otorhinolaryngology. The efficiency of the use cefixime - oral cephalosporin III generation, combining a broad range of antimicrobial activity, good pharmacokinetic properties, a favorable profile of tolerability and ease of use (1 per day) in pediatric patients.

In otorhinolaryngologist practice tumors of the nasopharynx occur quite often. Neoplasms are usually asymptomatic and manifest only when choanae obturation and pharyngeal orifice of the auditory tubes squeezing develops. Such patients mainly complain on ears congestion, hearing loss and, more rarely, nasal blockage. When the diagnosis of cancer is confirmed, a course of radiation treatment or chemoradiotherapy is conducted. There are also reports of effective photodynamic treatment. During the course of the therapy, phenomena of post-radiation epithelitis develops, affecting not only the nasopharynx and the oral cavity, but also paranasal sinuses. Most often the maxillary sinuses are affected. Post-radiation sinusitis isn’t sensitive for medical therapy, so surgical treatment is more effective. The article presents a clinical case of patient with nasopharyngeal cancer received a course of radiation and photodynamic therapy. Upon the gamma-ray therapy course (total dose 60 Gr) completed non-sensitive for medical treatment right maxillary sinusitis developed, and so endoscopic antrostomy was performed. After tumor photodynamic therapy session maxillary sinusitis on the left side developed and antrostomy was also performed. In the follow up period complete tumor regression was achieved and no signs of sinus pathology were detected.

The article describes modern approaches to the diagnosis and treatment of fungal lesions of the ENT organs. Among 5618 patients with chronic inflammatory pathology of ENT organs, fungal infection was established in 1303 (23.2%). Pharyngomycosis was diagnosed in 689 patients (53%), otomycosis in 495 patients (38%), laryngomycosis in 65 patients (5%), mycosis of nose and paranasal sinuses - in 53 patients (4%). Otomycosis was identified in 23% of all otitis cases, pharyngomycosis with chronic pharyngitis was detected in 26%, laryngomycosis with chronic laryngitis - in 17%, and mycosis with chronic inflammation of the nose and paranasal sinuses was found in 7%. Among all patients with otomycosis, fungal infection of the external ear predominates - 67% of patients, fungal otitis media - 17% and fungal infection of the postoperative ear cavity - in 16%. In 97-98% of patients with pharyngomycosis and laryngomycosis, yeast-like Candida fungi are the causative agent. In 65% of patients with external fungal otitis, in 20% of patients with medium fungal otitis, 95% with inflammation of the postoperative ear cavity and in mycosis of nose and paranasal sinuses, we detected mold fungi, most often represented by the genus Aspergillus spp. In 35% of patients with external otitis, 80% of patients with otitis media and 5% of patients with inflammation of the postoperative ear cavity, the fungi Candida spp. where found.

Pathologic processes in the paranasal sinuses in a large percentage of cases are the cause of inflammatory diseases of the adjacent anatomical structures such as the orbit, middle and inner ear, are the predictor of occurrence of diseases of broncho-pulmonary system. Given the similar clinical picture of diseases of the sinuses, sometimes it is difficult without further research to determine the nature and prevalence of pathological process in such a complex anatomical region. Successfully applied X-ray examination, the choice of which depends on the severity of the process and complexity of clinical manifestations. Traditionally how basic research is widely used classic radiography of the paranasal sinuses in various projections. However, with the advent of computer technologies entered clinical practice techniques such as computed tomography and magnetic resonance imaging.