Vol 24, No 3 (2022)


Interview with Dmitry B. Giller



Consilium Medicum. 2022;24(3):147-149
pages 147-149 views

The effect of a new coronavirus infection (COVID-19) on clinical and radiological manifestations in patients with comorbidity of respiratory tuberculosis, HIV-infection and opportunistic lung diseases: prospective study design

Mishin V.Y., Mishina A.V., Lezhnev D.A., Sobkin A.L., Sergeeva N.V., Kononets A.S., Babaeva I.Y.


Aim. To study the features of clinical and radiological manifestations and diagnosis of COVID-19, respiratory tuberculosis and opportunistic lung infections (OIL) coinfection in patients with late stages of HIV-infection with immunodeficiency.

Materials and methods. The study included 29 patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency (group 1) and 29 patients similar in all parameters without COVID-19 (group 2). All patients were underwent clinical and laboratory, radiation and bronchological examination, and microbiological, immunological, molecular genetic, cytological and histological examination of diagnostic material of the respiratory tract, cerebrospinal and pleural fluid, blood, urine and feces to identify pathogens of coinfection. Statistical data processing was carried out using the Microsoft Office Excel 2010 program with the calculation of the average in the group and the standard error of the average, confidence interval.

Results. It has been established that co-infection with COVID-19, respiratory tuberculosis and opportunistic lung infections in patients with late stages of HIV-infection with immunodeficiency is manifested by a pronounced intoxication syndrome, bronchopulmonary manifestations and symptoms of damage to other organs and systems, which is due to the generalization of tuberculosis with extrapulmonary lesions and the development of opportunistic lung infections, as in patients without COVID-19. A computed tomogram of the chest organs with this coinfection visualizes the syndrome of dissemination, the syndrome of adenopathy and the syndrome of pathology of the pulmonary pattern, represented by the compaction of interstitial tissue in the «frosted glass» type, which is associated with the simultaneous layering of various pathologies, which complicates their differential diagnosis. This determines the similarity of clinical and radiological manifestations of COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in patients with late-stage HIV-infection with immunodeficiency, as in patients without COVID-19. This requires complex microbiological and molecular genetic research methods to identify specific pathogens for the appointment of timely treatment.

Conclusion. Patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency pose a high risk of infection in a healthy population, taking into account their social maladaptation and non-adherence to examination and treatment. This requires an active diagnosis of COVID-19 in all patients with respiratory tuberculosis and HIV-infection who are registered in the office of anti-tuberculosis care for HIV-infected in an anti-tuberculosis dispensary, for emergency isolation and treatment.

Consilium Medicum. 2022;24(3):150-156
pages 150-156 views

Therapy correction of concerned chronic heart failure and chronic obstructive pulmonary disease in a patient with first identified pulmonary tuberculosis. Case report

Bagisheva N.V., Mordyk A.V., Trukhan D.I., Viktorova I.A., Moiseeva M.V.


Chronic heart failure and chronic obstructive pulmonary disease in some cases are comorbid conditions characterized by a more severe course of each of the diseases and worsening the prognosis for the patient. Additional efforts from the doctor are required when pulmonary tuberculosis is added in this category of patients to improve treatment outcomes. A clinical example of the correction of therapy for chronic heart failure and chronic obstructive pulmonary disease in a patient with pulmonary tuberculosis is given.

Consilium Medicum. 2022;24(3):157-159
pages 157-159 views

High-resolution computed tomography in the diagnosis of fibrotic hypersensitivity pneumonitis: A review

Kuleshov D.A., Tyurin I.E.


Aim. Assess the detection of rare computed tomographic features and their combination to detect cases of fibrotic hypersensitivity pneumonitis (HP). A retrospective analysis of data from high-resolution computed tomography of the lungs was performed in 52 patients with fibrotic hypersensitivity pneumonitis (fHP), in whom the clinical diagnosis was confirmed by morphological examination of lung biopsy. The analysis of the identified changes was carried out by qualitative and quantitative methods. The study included signs common to non-fibrotic and fibrotic hypersensitivity pneumonitis of HP, including ground glass symptom, mosaic density, centrilobular lesions, and emphysema. Separately, features related to pulmonary fibrosis in fHP, such as reticular changes, traction bronchiectasis, and honeycombing, were analyzed. In addition, the distribution parameters of these signs were determined separately in the cranio-caudal direction and in the axial plane. To search for combinations of tomographic features that are significant in the diagnosis, a correlation analysis of the identified changes was carried out.

Materials and methods. The revealed CT-signs of fHP in most cases correspond to the clinical recommendations for the diagnosis of HP. However, in fHP, signs were found with a high frequency that did not correspond to the typical picture of HP, in particular, the "ground glass" symptom. On the contrary, a relatively low percentage of occurrence was observed in relation to centrilobular lesions and "mosaic density", which were also an important part of the typical HP pattern. Emphysema, which is not included in any of the HP patterns, was noted with a relatively high frequency, and in some cases was combined with the "honeycomb lung" symptom. The greatest strength of the correlation was found in such combinations of signs as "frosted glass" + reticular changes; "frosted glass" + "mosaic density"; reticular changes + "mosaic density"; emphysema + centrilobular foci, as well as reticular changes + bronchiectasis. These combinations occurred with a relatively high frequency among the examined patients.

Results. Most of the identified changes correspond to current recommendations for the diagnosis of HP. A weak correlation between the signs does not allow us to identify combinations of signs with sufficient reliability that can help in the early diagnosis of HP.

Consilium Medicum. 2022;24(3):160-165
pages 160-165 views

Lymphangioleiomyomatosis of the lungs: features of the clinical picture, diagnosis and treatment. Case report

Ignatova G.L., Blinova E.V., Bel'sner M.S.


The article highlights the main issues of etiology, pathogenesis, clinical picture, diagnosis and treatment of patients with lymphangioleiomyomatosis. The clinical observation presents the features of the condition, the rate of progression, diagnostic approaches and management programs for a patient with a rare cystic lung pathology.

Consilium Medicum. 2022;24(3):166-169
pages 166-169 views

Registry analysis of patients with severe allergic asthma and clinically relevant sensitization to fungal allergens treated with genetically engineered biologics

Fomina D.S., Mukhina O.A., Lebedkina M.S., Bobrikova E.N., Sinyavkin D.O., Chernov A.A., Mikhailova V.I.


Background. Fungal sensitization (FS) often escapes the attention of clinicians when assessing the spectrum of sensitization in patients with atopic diseases. According to cohort studies is found in 3–10% of the general population and in 7–20% of asthmatics; the proportion of patients with severe bronchial asthma (SBA) with HS ranges from 35 to 75%. Fungal conidia have a 1000-fold higher exposure and are among the most important clinically relevant allergens in asthma. Exposure to fungal allergens is capable of generating a sustained T2 response with production of proinflammatory cytokines such as IL-5 and 13, which is indirectly related to the severity of airway eosinophilia. The identification of specific serum IgE is considered the benchmark diagnostic sign of FS, and the encapsulated hydrophobic carrier polymer system is considered preferable to skin prick tests. The process of reclassifying diseases with fungal lung lesions is confusing treatment strategies, leaving the FS problem underestimated. A series of publications have shown that omalizumab and other biologics targeting IL-5 or IL-5 receptor (IL5R) alpha are effective in treating SBA with FS. However, there remains an unmet need in real clinical practice for standardized approaches to genetically engineered biological therapies (BT) for different phenotypes of SBA, especially those associated with impaired microbiological homeostasis and this type of sensitization.

Aim. Using retrospective analysis of clinical-dynamic observational data from patients on BT treatment in a real clinical setting to determine phenotypic features of severe allergic bronchial asthma with FS and to perform additional detailed analysis of a cohort of patients on anti-IgE therapy.

Materials and methods. A retrospective observational single-center registry study was conducted between June 2017 and August 2021 at the City Reference Center for Allergology and Immunology. The baseline cohort consisted of 198 patients with severe allergic AD who were in the initial phase of BT. Inclusion criteria: age of patients over 18 years; presence of severe allergic bronchial asthma. Complex initial examination of patients included determination of FS by two methods: ImmunoCap ISAC to fungal allergic components – alt a1, alt 6 (fungi of genus Alternaria) and asp f1, asp f3, asp f6 (fungi of genus Aspergillus). Specific IgE determinations on fungal panels. Sensitization to fungi was detected in 47 people during allergy examination. The following criteria were considered in evaluation of response to omalizumab: AST score less than 19 and/or difference between initial AST score and this score in dynamics less than 3 points; FEV 1 score less than 80; combination of 2 listed criteria. The minimum period of BT was 16 weeks. Nonparametric methods of descriptive statistics were used: median, interquartile range. Differences were considered significant at p<0.05. Data were statistically processed using nonparametric methods in IBM SPSS Statistics V-22 program. Mann–Whitney U-test and Kruskal–Wallis one-way analysis of variance were used to compare quantitative characteristics. Fisher's χ2 test was used to compare qualitative characteristics.

Results. Characteristics of the eosinophilic phenotype of SBA combined with FS: middle-aged patients, more often women, with relatively early onset of AD and high baseline eosinophil levels before prescription of biological drug therapy. Concomitant atopic dermatitis and food allergies are additional frequent features of this phenotype. Analysis of the effect of FS on achieving response to omalizumab and further consideration of switching to alternative therapy in SBA and FS patients showed the need to avoid premature revision and perform no earlier than the 10th month of therapy due to delayed response formation. Given the aggressive impact of FS on the barrier functions of the bronchial tree epithelium, it is advisable to test patients for FS at the initial diagnosis of AD. In the presence of atopic dermatitis and/or food allergy as T2 comorbidities in patients with SBA, early testing for FS and increased control of local and systemic inflammation are appropriate, which may improve long-term outcomes and reduce risks of further damage to natural barriers.

Conclusion. Further research on various aspects of FS and its role in allergic diseases is extremely relevant in the current context.

Consilium Medicum. 2022;24(3):170-176
pages 170-176 views

Therapeutic possibilities of rehabilitation of patients who have undergone COVID-19 with residual changes in the lungs: A review

Ignatova G.L., Antonov V.N.


The article presents data on the mechanisms of formation of preservation of residual changes in lung tissue lesions in patients with a new coronavirus infection COVID-19. The main risk factors leading to the formation of lung tissue damage, such as age, severity of the disease, being on a ventilator, smoking, chronic alcoholism, are considered. The main directions of the search for antifibrotic drugs are presented. The rationale for the use of the pharmaceutical drug Longidaze is given, based on experimental and clinical studies. The main problems faced by doctors during the ongoing COVID-19 pandemic are identified. The schemes of administration of the drug Longidaze in patients with pulmonary fibrosis after a new coronavirus infection are considered.

Consilium Medicum. 2022;24(3):177-181
pages 177-181 views

New approaches to the treatment of acute respiratory viral infections and the prevention of bacterial complications: A review

Miroshnichenko N.A., Lvov N.I.


The article discusses the current problems of the treatment of acute respiratory infections, excessive use of antibiotics and the growth of resistance to them, which is ahead of the development of effective antimicrobial drugs. The results of the research of a new drug (Rafamin) are presented. Rafamin is combining antiviral and antibacterial effects, and may be in demand both for the treatment of acute respiratory viral infections and for the prevention of bacterial complications. The mechanism of action of the drug is associated with the activation of immune mechanisms involved in the recognition of pathogens of both viral and bacterial nature and the launch of a subsequent humoral and cellular response that ensures the elimination of the pathogen. The effects of Rafamin are realized due to targeted effects on the system of the major histocompatibility complex, interferon gamma and CD4-receptor of T-lymphocytes.

Consilium Medicum. 2022;24(3):182-185
pages 182-185 views

Herbal medicinal product Sinupret extract (BNO 1016) is safe and effective in the treatment of acute viral rhinosinusitis

Jund R., Mondigler M., Stammer H., Stierna P., Bachert C.


Aim. The pooled efficacy data of two similar randomized placebo-controlled clinical trials were analyzed. Safety was evaluated on the basis of the individual trials.

Materials and methods. The efficacy analysis was based on 589 patients. Treatment was performed orally with either 3×160 mg BNO 1016 (n=294) or 3×1 tablet placebo (n=295) for 15 days. In both trials patients underwent five visits to the investigational sites. Symptoms were evaluated according to the EPOS 2012 guideline. Ultrasonography was used to confirm the diagnosis at onset of treatment and the remission of symptoms at the last visit. Efficacy was evaluated by the investigator as the mean major symptom score (MSS) at the end of treatment (visit 5, day 14). Patients reported symptoms and social/emotional consequences of rhinosinusitis using a quality of life questionnaire (SNOT-20 GAV).

Results. MSS improved during the treatment period by a mean of 10.02±1.61 score points to 2.47±2.55 for BNO 1016 and of 9.87±1.52 to 3.63±3.63 for placebo. Differences between treatment groups at end of therapy (1.16±3.14 score points; p<0.0001) and patient-assessed quality of life (p=0.0015) were statistically significant in favor of BNO 1016.

Conclusion. Daily intake of 480 mg of BNO 1016 for 15 days is an effective treatment in acute viral rhinosinusitis.

Consilium Medicum. 2022;24(3):186-192
pages 186-192 views

Treatment principles of children with pharyngeal tonsil pathology in the background of allergic rhinitis (literature review): A review

Orlova Y.E., Svistushkin V.M., Nikiforova G.N., Shevchik E.A.


This article provides a review of different treatment for children with adenoids against a background of allergic rhinitis. An analysis of 35 papers published in Scopus and PubMed was carried out. Evaluation of the research results has shown that treatment of patients with pathology of lymphoid structures of the pharynx on the background of allergic rhinitis should be complex and individual in each clinical case.

Consilium Medicum. 2022;24(3):193-198
pages 193-198 views

Functional disorders of the respiratory system in patients with penetrating lung wounds: study prospective design

Savushkina O.I., Zaytsev A.A., Malashenko M.M., Aseeva N.A., Astanin P.A., Davydov D.V., Kryukov E.V.


Background. Lung function tests should be performed to patients with penetrating wounds of the lungs to identify lung function disorders, and the data obtained should be taken into account when correcting medical treatment and prescribing individual medical rehabilitation programs.

The aim was to study the impact of penetrating lung wounds on the lung function in the early recovery period.

Materials and methods. 13 patients were enrolled in the study, 100% male, median age 26 [21; 31] years. Spirometry, body plethysmography, and a diffusion test were performed on an average of 14 days from the injury.

Results. A prospective cross-sectional study was performed. A moderate decrease in the vital capacity (VC), the forced vital capacity (FVC), the volume of forced exhalation in the first second (FEV1) was revealed while the total lung capacity (TLCpl) and the FEV1/FVC ratio were within normal values. However, in 2 (15.4%) and 3 (23%) patients, a restrictive ventilation disorders (TLC < lower limit of normal) was detected when using Global Lung Function Initiative (GLI) and European Community for Steel and Coal (ECSC) 1993 predicted value system, respectively. The residual lung (RV) and RV/TLCpl were increased. Functional residual capacity (FRC), FRCpl/TLCpl, airway resistance remained within normal values. The diffusion lung capacity impairment was detected in 92.3% and 61.5% cases according to the ECSC 1993 and the GLI system, respectively.

Conclusion. In the early period of recovery after penetrating lung wounds, a nonspecific pattern of ventilation disorders was the most often abnormality namely a decrease in VC while TLC and FEV1/FVC were within normal values. Less frequently, the classic restrictive pattern of ventilation disorders was diagnosed. Besides, the diffusion lung capacity impairment was detected. The system of predicted values has a significant impact on the frequency of detection of the lung function disorders. The revealed functional disorders should be taken into account for adjusting medical and rehabilitation interventions.

Consilium Medicum. 2022;24(3):199-204
pages 199-204 views

Pulmonary toxicity induced by the use of bleomycin in patients with germ cell testicular tumors

Ognerubov N.A., Antipova T.S., Ognerubov S.A.


Introduction. Pulmonary toxicity induced by bleomycin is a dangerous complication of polychemotherapy in patients with germ cell tumors. It occurs with a frequency of up to 46%, and in 1–4% of cases it is fatal.

Aim. To present cases of pulmonary toxicity during polychemotherapy with the inclusion of bleomycin for testicular germ cell tumors.

Materials and Methods. Two patients aged 43 and 33 years old with testicular germ cell tumors were under observation after orchifuniculectomy who underwent chemotherapy according to the BER scheme (bleomycin + etoposide + cisplatin) in the steady-state mode in 4 and 6 cycles respectively. Positron emission tomography combined with computer tomography (PET/CT) with 18F-fluorodeoxyglucose was performed when clinical symptoms appeared at the end of treatment.

Results. Histologically, the tumor in a 33-year-old patient was a mixed tumor – seminoma, embryonal cancer with teratoid cancer elements. Abdominal spiral computed tomography revealed metastases to retroperitoneal lymph nodes. In a 43-year-old patient, the tumor had the structure of fetal cancer with multiple metastases to the lungs, mediastinal lymph nodes and retroperitoneal lymph nodes. Six and four cycles of polychemotherapy according to the BER regimen were administered, respectively. The cumulative dose of bleomycin was 540 and 360 mg in 18 and 12 injections. Treatment was accompanied by the development of febrile neutropenia with G-CSF correction. These risk factors should be considered the most significant. The appearance of respiratory symptoms during treatment should be regarded as a manifestation of pulmonary toxicity. PET/CT is the method of choice for diagnosis. The clinical picture in the observed patients, as well as changes on PET/CT, were detected 2 weeks after chemotherapy was completed.

Conclusion. Pulmonary toxicity induced by the use of bleomycin in patients with germ cell testicular tumors is a very dangerous complication, sometimes with a lethal outcome. Therefore, its early diagnosis taking into account risk factors is of great importance in clinical practice. Among medical imaging methods, a special role is played by PET/CT, which allows predicting toxicity before the clinical and radiological debut.

Consilium Medicum. 2022;24(3):205-208
pages 205-208 views

Ongoing symptomatic COVID-19 – practical advice: A review

Zaitsev A.A., Leshchenko I.V.


Studying the consequences of COVID-19 is a global priority in various countries around the world. The term “long-covid” or “ongoing symptomatic COVID-19” should include situations with clinical manifestations of the disease lasting more than 4 but less than 12 weeks from the onset of the disease. The most urgent problem today remains the management of patients with persistent symptoms of past COVID-19.

Consilium Medicum. 2022;24(3):209-212
pages 209-212 views

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