Vol 21, No 3 (2019)

The article provides an analysis of current information about the diagnostic value of the C-reactive protein in therapy and pulmonology in the context of the differential search for pathology of the respiratory system organs, as well as nosological forms that have common elements of clinical symptoms characteristic of community-acquired pneumonia. The history of discovery, main effects, biological significance and features of laboratory diagnosis of C-reactive protein content in blood are reflected. The results of studies on the use of C-reactive protein concentration as a biological marker of the occurrence of community-acquired pneumonia, its complications and severity, as well as the adequacy of the selected antibacterial therapy are critically disclosed.

The rates of pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the diagnostic and treatment of PcP in patients with HIV, hematologic, and solid-organ transplant recipients is available Although for many other populations with immune disorders there remains an urgent need for recommendations. The main drug for treatment of PcP is trimethoprim/sulfamethoxazole. The possibilities of mycological diagnosis in routine clinical practice are very limited and require significant expansion. Outbreaks PcP in immunocompromised patients, likely caused by human-to-human spread, is highlighting the need for efficient infection control policies, sensitive diagnostic assays and Guidance for treatment in not-HIV patients.

This article discusses approaches to diagnosis of TB, have changed in the twenty-first century in the light of new knowledge and capacity. In the work of phthysiologists and general practitioners need to abandon previously prevailing simplified stereotypes of diagnosis of TB. Knowledge of trends in TB epidemiology, in particular, a high risk of developing it in HIV-infected and socio-maladjusted persons will help doctors of all specialties to better identify patients with TB. Widespread nontuberculous mycobacteriosis in the declining incidence and prevalence of TB and similar manifestations of these diseases require physicians to consider the possibility of an alternative diagnosis.

The article presents a brief literature review on the problem of cardiopulmonary comorbidity, namely, chronic heart failure (CHF) against ischemic heart disease (CHD) in combination with chronic obstructive pulmonary disease (COPD). The issues of epidemiology, the relationship of pathogenetic mechanisms in the development and progression of heart failure and COPD are considered. The questions of optimization of CHF and COPD treatment in the light of modern recommendations, controversial issues of safety and effectiveness of correction of bronchial obstructive syndrome are discussed. The results of our own study are presented in which 110 patients with chronic heart failure II-III FC with postinfarction cardiosclerosis (LVEF≤45%) and COPD 2-3 st. severity. It was shown that the inclusion of tiotropium and indacaterol both in mono and in combination in the complex therapy of CHF II-III FC ischemic genesis with COPD after 6 months of observation is safe and effective: the clinical state of patients improved, the quality of life improved significantly CHF, the degree of dyspnea, the frequency and duration of episodes of ischemia decreased. Improvement of parameters of intracardiac hemodynamics, a decrease in pulmonary hypertension, a positive effect on the bronchopulmonary system were noted.

Chronic tonsillitis is a very common disease, often occurs in patients with somatic pathology, such as enterocolitis against the background of lactase deficiency, diabetes, kidney disease. Chronic tonsillitis is accompanied by halitosis, and with comorbidities, this symptom may become dominant. With exacerbation of chronic tonsillitis, patients are forced to increase the drug load, which is due to concomitant somatic diseases. To prevent polypragmasy, doctors more often began to turn to modern means of bioregulatory therapy, providing detoxification and anti-inflammatory effects. Of the diseases of the internal organs, giving an unpleasant smell from the mouth, in the first place is diabetes. Treatment of diabetes, especially in the newly ill, takes a lot of time and effort, and a more rapid deposition of plaque and the formation of tartar in violation of microcirculation and deterioration of tissue supply, including in the oral cavity and pharynx, contributes to halitosis. The appearance of an unpleasant odor in diseases of the kidneys, liver, endocrine system, intestines in exhaled air, due to metabolites in the blood, is persistent and does not respond well to correction. In this regard, the search for detoxification drugs is relevant. Having studied the pharmacodynamic capabilities of the drug Engystol we paid attention to its ability to improve the condition of patients with viral infections, allergic reactions, restore metabolic processes in tissues, maintain general homeostasis. Unlike many drugs that have a toxic effect on the liver, this bioregulatory drug is safe.

Allergic rhinitis (AR) is one of the most common chronic diseases of the upper respiratory tract throughout the world. Despite advances in understanding the mechanisms of allergic inflammation, the symptoms of AR in most cases are not completely controlled by modern methods of treatment. AR is a precursor and a predisposing factor for the development of other respiratory diseases, one of which is bronchial asthma. Therefore, it is important to diagnose AR in time and select the most effective and modern drugs that will not only help control the course of AR, but also improve the quality of life of patients. Intranasal glucocorticosteroids are recommended as first-line therapy for patients with varying severity of AR. The experience of using intranasal fluticasone propionate in Russia and abroad testifies to the effectiveness of this drug in the treatment of various forms of AR, both as mono-therapy and in combination with antihistamines and decongestants.

Allergic rhinitis (AR) is the most common allergic disease. Rational drug therapy should be aimed at nonspecific suppression of the clinical symptoms of AR without taking into account the properties of the allergen. Histamine is the main mediator of allergic inflammation. Fexofenadine is an effective H1-antihistamine and a drug of choice for the treatment of all kinds of AR.