Ceftobiprole medocaril is a fifth-generation cephalosporin antibiotic with expanded activity against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus, and the activity against Gram-negative bacteria characteristic of third- and fourth-generation cephalosporins. The aim was to determine the role of ceftobiprole medocaril in the treatment of patients with community-acquired and nosocomial pneumonia in the context of increasing antibiotic resistance and post-infectious immune disorders based on an analysis of current literature and our own clinical experience. Results . The first clinical case demonstrates the efficacy of empirical ceftobiprole therapy in a hospitalized patient with community-acquired pneumonia and signs of lung tissue destruction, clinical predictors of challenging pathogens, and predictors of the ineffectiveness of initial antibacterial regimens in the prehospital setting. The second case demonstrates the successful use of the drug in a patient with severe neurological deficit requiring tracheostomy and gastrostomy, recurrent nosocomial lower respiratory tract infections associated with pan-resistant gram-negative bacteria, and exhaustion of various antibacterial treatment options. Ceftobiprole medocaril is included in our clinic’s internal empirical antibacterial therapy protocols for community-acquired and early nosocomial pneumonia, and extensive experience has been accumulated in this patient population. Conclusion . We recommend scaling up our experience in using ceftobiprole in patients with community-acquired pneumonia and the risk of challenging pathogens. The approach described in the second case study can be considered in complex clinical situations associated with exhaustion of antibacterial treatment options and requires further research.
Accurate preoperative assessment of functional reserve in patients with lung diseases is critical for surgical risk stratification. The “gold standard” for functional reserve assessment, cardiopulmonary exercise testing (CPET), has limited availability. The 6-minute walk test (6MWT) is considered a simpler alternative tool; however, its clinically significant thresholds for patients with pulmonary tuberculosis (PTB) require validation. The aim was to determine 6MWT threshold values corresponding to clinically significant levels of peak oxygen consumption (VO 2 peak ) measured by CPET for preoperative risk stratification in patients with PTB and lung cancer (LC). Methods . The study enrolled 81 patients with PTB and 89 patients with LC in the preoperative period. All patients underwent both 6MWT and CPET. The association between 6MWT parameters and VO 2 peak was assessed using low-risk (≥ 20 ml/kg/min) and high-risk (< 15 ml/kg/min) criteria. Threshold values were determined by ROC analysis, with AUC comparisons performed using the DeLong test. Results . The 6MWT distance (m) demonstrated a consistent correlation with VO 2 peak in both groups (r = 0.59 – 0.65; p < 0.05). A distance threshold of ≤ 434 m showed high accuracy for identifying high-risk patients (VO 2 peak < 15 ml/kg/min) with both PTB (AUC 0.91; sensitivity 92%, specificity 87%) and LC (AUC 0.82; sensitivity 89%, specificity 68%). Comparison of ROC curves revealed no significant differences between the groups in AUC for absolute distance (p = 0.19), whereas the percentage of predicted distance showed nosology-specific differences (p = 0.032). Conclusion . Absolute 6MWT distance is a valid screening tool with comparable accuracy in both medical conditions. The threshold of ≤ 434 m may serve as a universal criterion for high functional risk (VO 2 peak < 15 ml/kg/min), enabling optimized patient selection for comprehensive assessment (CPET).
The available scientific research does not sufficiently describe the specific polysomnographic (PSG) characteristics of obstructive sleep apnea (OSA) in obese patients. The aim was to determine the clinical and PSG characteristics of OSA in obese patients. Methods . The study included retrospective analysis of medical histories, assessment of the frequency of concomitant and previous diseases, and analysis of PSG results (Сomet PSG, Grass Technologies, USA). Results . The study included 2 groups of patients: the main group with OSA and BMI > 30 kg/m2 (n = 100) and the control group with OSA and BMI 18 – 25 kg/m2 (n = 44). In the main group, the Charlson comorbidity index (p = 0.012), the likelihood of hypertension (OR 6.4 (95% CI 2.9 – 14.2)), type 2 diabetes mellitus or impaired glucose tolerance (OR 29.9 (95% CI 3.9 – 225.7)), dyslipidemia (OR 2.4 (95% CI 1.1 – 4.9)), and ahistory of pneumonia (OR 3.2 (95% CI 1.1 – 8.9)) were higher than in control group. The PSG analysis revealed that severe OSA was detected in mostpatients (52%) of the main group and in none of the patients in the control group. Duration of SpO 2 < 90% was longer in the main group (42.4 min), than in the control group (0.9 min). The apnea-hypopnea index was increased in the REM sleep stage and in supine position in the main group. Duration of sleep stages was different: stage 1 was longer in the main group and stage 2 was longer in the control group. There were no differences in REM and stage 3. Obese patients had more frequent arousals, due to episodes of apnea and hypopnea and snoring. Conclusion . Our study identified certain characteristics of PSG in OSA and obesity, which may explain the higher incidence of concomitant severe diseases that may be associated with cardio-renal-metabolic syndrome.
Gonadotropin-releasing hormone (GnRH) medications are used to treat a wide range of reproductive disorders. GnRH regulates not only the maturation and growth of the gonads, but also the immune system and metabolism, thereby affecting non-reproductive, somatic tissues. GnRH affects the lungs, but research findings are limited and not generalized. The aim was to summarize the effects of GnRH on the lungs based on a literature review. Results . The presence of specific receptors for GnRH (GnRHR) in various lung cells and in the cells of some forms of cancer allows the use of GnRH-agonists and antagonists for the treatment of pulmonary disease and for both malignant tumors and their metastases to the lungs, especially those originating from the reproductive organs. The presence of GnRHR in tumor cells impels binding GnRH both to antitumor drugs for their targeted delivery and to magnetic nanoparticles for magnetic resonance imaging of cancer. Various forms of cytostatics conjugated with GnRH are less toxic and more effective than the cytostatics themselves. A large surface area with good vascularization and the ability to exchange various substances allow for systemic delivery of GnRH via inhalation into the lungs. Inhalation administration of anticancer drugs associated with a GnRH analogue is promising for the treatment of lung cancer with GnRHR expression. One of the pulmonary complications that develops when using both GnRH analogues and antagonists is interstitial lung disease, which can lead to death. An increased risk of classical pneumonia has been described after androgen deprivation therapy. Also, GnRH can enhance the development of lung pathology during radiation exposure. However, some publications report the absence of negative effects of GnRH on the pulmonary system in the experiments and in clinical practice and report that an increased level of GnRH even protects the lungs from edema and inflammatory damage, reduces the severity of sclerosis and fibrosis. Pulmonary macrophages, type 1 and 2 alveolar cells can be directly involved in the degradation of GnRH and have the necessary enzyme complexes. Conclusion . The obvious scarcity and inconsistency of publications on all aspects of GnRH action on the lungs indicates the need for further continuation of not only applied research, but also fundamental research, due to the high prospects. The GnRH drugs have advantages and disadvantages. Hormonal therapy should be prescribed with caution, taking into account all indications and contraindications, as well as the endocrinologist’s experience, aiming for the most favorable long-term result.
Chronic obstructive pulmonary disease (COPD) remains one of the leading causes of morbidity and mortality worldwide. Over the past decade, international experts have introduced changes in the understanding of the etiology and definition of COPD, particularly with the launch of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). However, the transfer of diagnostic interpretations into domestic practice without proper analysis has led to significant confusion in clinical recommendations and therapeutic decisions. The aim . This position paper examines the historical context of the development of the COPD concept in Russia, analyzes current contradictions between international and domestic approaches to defining the disease, and discusses the practical implications of these differences for patient management. Conclusion . Our position is that there must be a clear distinction between COPD as a nosological entity and the syndrome of reversible or irreversible bronchial obstruction, which may accompany other diseases and conditions.
