Vol 20, No 11 (2018)

Allergic rhinitis is a common disease that greatly affect a quality of life and can contribute to the development of concomitant pathology of the upper airway tract. The main aim of the treatment is reducing or riddance of symptoms, prevention of acute conditions and complications. Appropriate treatment should allow patients to keep their normal pattern of life. Intranasal corticosteroids is the first-line treatment considering allergic rhinitis. According to multitude investigations fluticasone propionate proved its effectiveness in a control of the symptoms of allergic rhinitis along with low incidence of side effects.

The article covers modern problems of chronic tonsillitis (CT) diagnostics and treatment. The authors discuss the background for chronic inflammation focus formation in tonsils, etiology and pathogenesis of CT, and the role of group A b-hemolytic streptococcus in development of local and systemic concomitant diseases. CT classification by Preobrazhenskiy-Palchun is presented as well as differential diagnosis criteria for different CT forms. The basic CT treatment methods including conservative therapy and sanitation intervention are also discussed. The article presents the study of Tonsilgon® N effectiveness and safety in CT treatment that assessed dynamics of main clinical symptoms. Authors conclude that the medication has high clinical effectiveness and good safety profile, they recommend it to be used in combined CT treatment.

One of the main complaints that caused patients to visit an otolaryngologist is sore throat. This problem is widespread, and therefore socially and clinically significant. There are many reasons of the sour throat, one of the key is inflammatory diseases of the pharynx, such as acute and chronic pharyngitis. A variety of drugs is used for the treatment of this kind of pathology. In most cases, the drugs of choice are nonsteroidal anti-inflammatory drugs, the main properties of them are analgesic and anti-inflammatory.

The characteristics of comorbid chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) still remain very important. The systemic inflammation, leading to the major clinical and functional manifestations, plays a very important role in the genesis of this disease. The main attention is paid to preventive vaccination due to the important role of Streptococcus pneumonia in developing the relapse of COPD. The aim of the study is to examine the impact of 13-valent pneumococcal conjugate vaccine (PСV13) on the clinical and functional features of systemic inflammation in patients with COPD and IHD. Materials and methods. The study included 36 vaccinated patients with COPD and IHD and 42 non-vaccinated patients with COPD and IHD. We have analyzed the number of relapses of COPD and IHD, major adverse cardiac events, the number of admissions to hospital and of pneumonia cases and functional parameters. We have been monitoring the inflammatory markers, such as C-reactive protein (CRP), fibrinogen and procalcitonin. Results. The vaccine PСV13 allows achieving statistically significant reduction of the basic indicators of inflammation (such as CRP and fibrinogen: 12 and 20%, respectively) within a year of observation. The significant systemic inflammatory indicators show significant clinical manifestations of relapse of COPD and IHD. One year after receiving vaccination the patients will have not only statistically significant reduction of CRP and fibrinogen, but also will show statistically significant reduction of adverse cardiac events (4.3 times) and the number of admissions to hospital (2.6 times). Even more indicative results can be seen in the example of reducing relapses of COPD (9 times), the number of admissions to hospital (7.4 times) and pneumonia cases (6 times). Conclusions: 1. Such indicators of systemic inflammation as CRP and fibrinogen can play a role of predictors of adverse cardiac events in patients with comorbid course of COPD and IHD. 2. The dynamic monitoring of procalcitonin can be used as an additional highly informative method of assessing the probability of bacterial infection and the effectiveness of applied therapy. 3. The vaccine PKV13 allows reducing the level of systemic inflammation after 1 year of the application.

Aim. The study of the frequency and severity of hepatotoxic reactions to antituberculosis drugs in a comparative aspect when initially 4th regimens were used and initially 1 and then 4th chemotherapy regimens in new detected patients with multi-drug-resistant (MDR) tuberculosis. Material and methods. We studied 261 new cases of MDR tuberculosis. Patients were divided into 2 groups. The first group included 164 patients. The resistance of Mycobacterium tuberculosis to rifampicin in these patients determined by using the GeneXpert MTB/RIF method. Treatment of this group of patients was initially conducted according to the 4th regimen of chemotherapy (pyrazinamide, kanamycin/amikacin/capreomycin, fluoroquinolones, cycloserine/terizidone, protionamide, para-aminosalicylic acid). The second group included 97 patients who, before receiving data on MDR Mycobacterium tuberculosis by sputum culture method (2-3 months of treatment), were treated according to the 1st standard chemotherapy regimen (isoniazid, rifampicin, pyrazinamide, ethambutol/streptomycin), followed by correction of treatment with re-registration for 4th regimen. Results and conclusion. It was found that hepatotoxic reactions in patients without initial liver function abnormalities in the appointment of 4 regimens of chemotherapy occurred in 31.3% of cases, when initially treated by 1st regimen, followed by correction for 4th regimen in 87.8% of cases (p<0.001). In the course of treatment, signs of liver damage in patients who initially received 4th regimen of chemotherapy were more likely to occur in the first 2 months of treatment, whereas in patients treated initially with 1st regimen followed by correction for 4th regimens - during the first 4 months. In the overwhelming majority of cases, hepatotoxic reactions were of mild severity, both groups. At the same time, severe hepatotoxic reactions were more frequent in patients of the second group.

Eosinophilic granulomatosis with polyangiitis (previously designated as Churg-Strauss syndrome) is an eosinophilic granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small and medium-caliber vessels, combined with asthma and eosinophilia.A brief review of the literature on the problem of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) and an analysis of one’s own observation demonstrating the difficulties of diagnosing this clinical condition are presented.