Introduction. Cardiovascular diseases (СVD) rank first in terms of morbidity and mortality not only in the Russian Federation but throughout the world. Since the end of 2019 a pandemic of Severe Acute Respiratory Syndrome (SARS) or new coronavirus infection (NCI) has spread throughout the world, which contributed to the development and course of CVD. Therefore, genetic markers began to be considered as factors potentially influencing CVD, its development and severity. Objective: To evaluate the association of the nucleotide sequence variant rs12329760 of the TMPRSS2 gene with acute coronary syndrome in patients who have had a new coronavirus infection.Material and methods. The study included 100 patients (women – 50, men – 50) with ACS and previous NCI, who were selected on the basis of a positive PCR test for the presence of SARS-CoV-2 in the anamnesis, hospitalized at the regional vascular center No. 7 of the City Clinical Hospital No. 2 of the city of Novosibirsk. Women age was 59.5 ± 7.2 years, men age was 53.5 ± 9.3 years. The diagnosis of ACS was established according to a set of criteria proposed and established by the Russian Society of Cardiology and in accordance with the updated clinical recommendations of the Ministry of Health of the Russian Federation of 2020. Patients underwent clinical and instrumental examination, coronary angiography with possible stenting, as provided for in the standards of medical care and clinical guidelines. The nucleotide sequence variant rs12329760 of the TMPSS2 gene was determined in patients using PCR with further analysis of restriction fragment length polymorphism. The comparison group consisted of 200 patients with ACS without previous NCI (no positive PCR test, no positive antibodies).Results. Carriage of CC, СТ, TT, genotype variants of the nucleotide sequence rs12329760 of the TMPSS2 gene are not associated with an increased risk of developing ACS in patients with previous NCI. When comparing the frequencies of the rs12329760 genotypes of the TMPSS2 gene in groups with ACS with NCI and ACS without NCI, no statistically significant differences were obtained. In the group with ACS with NCI, carriage of the homozygous genotype was more common (p = 0.011).Conclusions. Variants of the nucleotide sequence rs12329760 of the TMPSS2 gene are not associated with ACS with previous NCI.

The continuing interest in the problem of vibration disease (VD), especially when combined with arterial hypertension (AH), is due to the steady development of industrial sectors associated with vibration acceleration and the tendency towards the early development of AH. Aim of the study was to investigate the features of clinical, nutritional and anthropometric indicators and frequency of occurrence of Ala16Val (rs4880) polymorphic locus of the manganese superoxide dismutase (MnSOD) gene in VD combined with AH. Material and methods. 431 people were examined, among them 104 patients with VD stage I, 101 – with VD stage I in combination with AH I–II stage, 107 – with AH I–II stage, without contact with vibration, and 119 people working at the same enterprise without contact with vibration, without signs of hypertension. A complex of clinical, anthropometric, laboratory, functional and genetic studies has been carried out. Results. In case of VD comorbid with AH, the frequency of complaints, both general and specific, significantly increases compared to other groups. Body mass index, waist circumference / hip circumference (WC/HC) ratio, fat mass increase, extracellular fluid content with a decrease in active cell mass, musculoskeletal mass and phase angle compared with the control group. An imbalance of nutrition in terms of macro- and micronutrients, an increased content of the fat component in the diet with a deficiency in the diet of omega-3 polyunsaturated fatty acids has been established. In persons with VD and AH, the C/C genotype, which is more common in healthy people, is registered in only 16% of cases, while the polymorphic variant T/T is in 29 %, which exceeds the corresponding value in the control and isolated AH groups by 1.9 and 1.5 times, respectively. Discussion. The common pathogenetic features of VD and AH lead to the development of adipose tissue dysfunction and trophological insufficiency. There is no doubt that hypertension is associated with increased body weight, obesity, and adipocytokine serum concentration. An indicator of a high risk of developing cardiovascular pathology, including heart attack, stroke, is an increase in the WC/HC index. The role of the Ala16Val polymorphism of the MnSOD gene in the formation of AH and some variants of occupational diseases has been shown in a number of studies. Conclusions. The variant of VD, comorbid with AH, is characterized by a significant increase in the frequency of detection of the T/T genotype in the polymorphic locus Ala16Val (rs4880) of the MnSOD gene in combination with an altered nutritional and anthropometric status of such patients. The presence of this polymorphism may be associated with an increased risk of developing concomitant vascular pathologies in VD, however, in combination with malnutrition and associated changes in anthropometric parameters, this risk increases many times over. Thus, early diagnosis of the risk of developing comorbid vascular pathology in VD can be aimed at identifying the genotype, and prevention can be aimed at modifying nutrition.

Triple therapy with inhaled corticosteroid (ISC) / long-acting β2 agonist (LABA) / long-acting muscarinic antagonist (LAMA) in single inhaler expanded the possibilities for prevention of chronic obstructive pulmonary disease (COPD) exacerbations. Heterogeneity of COPD determines the needs in search of target population and efficacy markers for each existing therapy. Disease phenotype depends on a complex of factors, with respiratory viral infection among the most significant. Aim of the study was to assess the efficacy of triple therapy with ICS/LABA/LAMA in single inhaler for subsequent COPD exacerbations prevention and to search molecular markers of the efficacy depending the etiology of index exacerbation. Material and methods. It was a prospective observational study of three COPD patients’ strata: after COPD exacerbation required hospitalization with viral (n = 60), bacterial (n = 60) and viral-bacterial (n = 60) infection. Triple therapy in single inhaler (n = 104) or in free combinations (n = 76) were prescribed in real clinical practice. COPD was diagnosed according to spirography criteria. To establish the COPD exacerbation etiology the real time PCR of sputum or bronchoalveolar lavage fluid, standard cultural method, blood procalcitonin, as well as marker blood proteins, hyaluronic acid by ELISA measurement were done. Associations were revealed using Cox regression. Results. Triple therapy in single inhaler in comparison with free combinations decreased time to first re-exacerbation, hazard ratio (HR) in viral-associated index exacerbation strata was 0.38 (95% confidence interval (95% CI) 1.15–0.40), in bacterial – 0.47 (0.39–0.72), in viral-bacterial – 0.39 (0.14–0.39). In strata of COPD patients after viral and viral-bacterial exacerbations, in subgroups treated with triple therapy in single inhaler blood procollagen III N-terminal propeptide (PIIINP) (HR for group after viral index exacerbations was 1.03, 95 % CI 1.02–1.28, HR for group after viral-bacterial exacerbations was 1.04, 95 % CI 1.02–1.28), granulocyte-macrophage colony-stimulating factor (GM-CSF) (HR 1.03, 95 % CI 1.02–1.32, 1.01, 95 % CI 1.00–1.35, respectively) content was associated with time of re-exacerbations. Conclusions. Blood PIIINP and GM-CSF during COPD exacerbation are perspective markers of subsequent exacerbations within 1 year in patients after virus-associated or viral-bacterial index exacerbation. In these groups of patients triple therapy in single inhaler is more effective than free combination for subsequent exacerbations prevention.

Aim. To assess the rs2285666 nucleotide sequence of the angiotensin-converting enzyme 2 (ACE2) gene and its association with acute coronary syndrome (ACS) in patients after coronavirus disease 2019 (COVID-19).Material and methods. The study included 100 patients after COVID-19, including 50 men and 50 women, hospitalized with a diagnosis of ACS. The diagnosis of COVID-19 in all 100 patients was confirmed by a positive polymerase chain reaction (PCR) smear. All patients underwent percutaneous transluminal coronary angioplasty with stenting, standard clinical and paraclinical examination, and genetic testing of the rs2285666 ACE2 gene by PCR followed by restriction fragment length polymorphism analysis. The comparison group consisted of 200 patients with ACS after COVID-19, confirmed by a PCR smear or antibody titer.Results. Statistically significant differences were obtained for the AA genotype, carriage of which among male patients with ACS after COVID-19 was 2,5 times less common than in men in the control group (OR =0,391, 95% CI: 0,167-0,917; p=0,028). On the other hand, carriage of the rs2285666 GA genotype of the ACE2 gene is not associated with an increased risk of ACS in women after COVID-19. There were no significant differences in genotype frequencies in the group of women and in the general group (without division by sex).Conclusion. The data obtained may indicate a protective role of the rs2285666 AA genotype of the ACE2 gene for males regarding ACS development after COVID-19. These results are the first steps towards building a prognostic model to estimate the ACS risk in patients after COVID-19, which will reduce morbidity and mortality for this group of patients.

Justification. Knowledge of the differences in response to therapy between phenotypes of exacerbations of chronic obstructive pulmonary disease (COPD) is necessary to improve treatment outcomes. Objective: to determine the most effective additional pharmacological methods for virus-associated exacerbations of COPD. Material and methods. The study included patients hospitalized with exacerbations of COPD with viral (n = 60) and viral-bacterial (n = 60) infections, and a comparison group with exacerbations of COPD with bacterial infection (n = 60). The diagnosis of COPD was based on spirometric criteria, viral infection — according to the results of PCR-RV of sputum for RNA of respiratory viruses. Treatment was carried out in real clinical practice. The groups were comparable in the use of systemic glucocorticoids, short-acting bronchodilators. Dyspnea was assessed using the TDI index (primary endpoint), lung function (spirometry, diffusion capacity for carbon monoxide), exercise tolerance (6-minute walk test), length of hospital stay (secondary endpoints). The сorrelations were determined with the use of Cox proportional hazards model. Results. In the groups with virus-associated and viral-bacterial exacerbations, unlike bacterial exacerbations, the following types of treatment were associated with achieving TDI +1 (odds ratio — OR, 95 % confidence interval — CI): fixed triple combination (OR 2.69; 95 % CI 1.48–4.90; p = 0.010 and OR 2.74; 95 % CI 1.29–3.80; p = 0.031), inhalation of 3 % sodium chloride solution (OR 3.64; 95 % CI 1.45–5.42; p = 0.001 and OR 3.23; 95 % CI 2.15–5.43;\ p = 0.042), antiviral drugs (OR 2.91; 95 % CI 1.15–3.62; p = 0.009 and OR 2.76; 95 % CI 1.31–3.90; p = 0.008). As a result of treatment, an increase in DLco/Va, SpO2 after a 6-minute walk, and a decrease in the length of hospital stay were observed. Conclusion. Detection of virus-associated infections is a promising marker for determining indications for prescribing long-acting anticholinergic drugs and beta-adrenomimetics, inhaled corticosteroids, inhalations of hypertonic sodium chloride solution, and antiviral drugs for exacerbations of COPD.

Aim of the study was to evaluate the effectiveness of early rehabilitation methods for medical workers with severe or moderate lung damage caused by a new coronavirus infection, who are in intensive care units, to improve lung ventilation, gas exchange and bronchial clearance, correct muscle weakness, increase overall physical endurance, mobility, psycho-emotional stability.Material and methods. We examined 53 COVID-19 women with moderate lung injury at stage I of rehabilitation, divided into two groups: main (n = 31, medical personnel) and control (n = 22, working outside of contact with pulmotropic risk factors, including no risk of SARS-CoV-2 infection). Early rehabilitation was carried out in the intensive care unit and in the infectious diseases hospital of City Clinical Hospital No. 2, for patients with COVID-19 rehabilitation plan was drawn up in accordance with temporary guidelines for the medical rehabilitation of a new coronavirus infection.Results and discussion. It was established, that rehabilitation in the conditions of the intensive care unit and the specialized department can significantly reduce the severity of dyspnea, anxiety and depression, positively affects the increase in exercise tolerance, and helps to reduce the activity of systemic inflammation. In patients who have industrial contact with patients with COVID-19, the effectiveness of rehabilitation measures is lower than in the comparison group.Conclusions. To increase the effectiveness of stage I of the rehabilitation of medical workers with COVID-19 and lung damage, it is necessary to conduct more intensive and longer rehabilitation than indicated in the current guidelines.

Objective: To study the psychocognitive status of patients with arterial hypertension (AH) combined with post-COVID syndrome (PCS). Methods: A prospective cohort study involved 134 patients (84 men and 50 women), mean age 62.4±0.6 years, with AH (controlled arterial hypertension, Grade 1-3). The duration of AH was 5.6±0.2 years. Among them 73 patients and a history of COVID-19 infection (confirmed SARS-CoV-2 infection; duration more than 12 weeks) with subsequent development of PCS, while 61 patients did not have a history of COVID-19. Patients with PCS which were diagnosed with depressive syndrome, were further divided into two subgroups depending on agomelatine intake (those who received this medication and those who refused). A general clinical examination and psychodiagnostics were carried out using validated methods, such as HADS and SPMSQ. Statistical analysis was carried out in the RStudio program. Results: Based on the HADS questionnaire, patients with PCS demonstrated a higher rate of depressive syndrome compared to the patients without a history of COVID-19 (41% vs. 12%, p<0.001). Based on the severity of depressive syndrome, the following rates were found in the groups: subclinically expressed depression – in 26% of patients with PCS vs. 12% of patients without COVID-19 (p<0.001), clinically pronounced depression (only in the group of patients with PCS) – in 15% (p=0.007). Additionally, in patients with PCS psychocogniцtive function was assessed using SPMSQ questionnaire; among them those receiving agomelatine showed significantly less frequent and severe psychocognitive dysfunction compared to those who refuse the medication intake (32% vs. 94%, p=0.001). Conclusion: Patients with PCS are characterized by a more severe manifestation of anxiety-depressive syndrome, and the use of agomelatine shows statistically significant effectiveness in this category of patients.

Both in Russia and worldwide, morbidity and mortality from acute coronary syndrome (ACS) remain high. The emergence of a new coronavirus infection, the active participation of medical workers in its elimination, determined a new phenotype of patients, which determines the relevance of the problem and of a more detailed assessment of this cohort of patients. Aim of the study was to identify and determine the clinical and functional features, phenotype and endotype of the course of ACS in medical workers who have had a new coronavirus infection. Material and methods. An open cohort comparative study was conducted. It included 60 healthcare workers with ACS and a previous novel coronavirus infection, who were selected based on the identification of SARS-CoV-2 and/or its antibodies (positive PCR test) in anamnesis. All patients were admitted to the regional vascular center № 7 of the City Clinical Hospital № 2, Novosibirsk. The comparison group consisted of 60 healthcare workers with ACS without positive PCR test in anamnesis. General clinical and instrumental, coronary angiography with possible stenting. Results. Of the 60 medical workers with ACS after a new coronavirus infection, myocardial infarction with ST segment elevation was detected in 21 people, myocardial infarction without ST segment elevation – in 31, unstable angina pectoris – in 8 people. Within 6 months of undergoing COVID-19, they developed complex rhythm disorders, such as paroxysm of fibrillation or atrial flutter, more frequently than in the comparison group, as well as a full AV-blockade ( n = 25, 41.6 %, p = 0.020), bradyarrhythmias and conductivity disturbances ( n = 8, 13.3 %, p = 0.045), revealed a more than 2-fold increase in the pro-brain natriuretic peptide (proBNP) ( n = 21, 35 %, p = 0.033), observed myocardial dysfunction (ejection fraction less than 50 %) ( n = 6, 10 %, p = 041). Conclusions. The data obtained indicate the formation of a new ACS phenotype in medical workers who have undergone a new coronavirus infection.

Pulmonary alveolar microlithiasis is a rare genetic disease characterized by the formation of intraalveolar calcium phosphate microliths. Clinical and radiological manifestations are similar to pneumoconiosis, which makes it difficult to diagnose a comorbid condition. This article presents a case from clinical practice: a 30-year-old male patient, non-smoker was referred to a occupational pathology center with a preliminary diagnosis of pneumoconiosis. He worked for 8 years under conditions of exposure to highly fibrogenic dust with the maximum allowable concentrations in the air of the working area exceeding by 2.3–2.1 times. During this period, preliminary and 3 periodic medical examinations were carried out which did not reveal any contraindications for continuing work. Examination at the center of occupational pathologists revealed signs of respiratory failure of the 2nd degree, severe pulmonary hypertension and radiological diffuse dissemination syndrome with small shading of two types - a large number of high (calcium) density foci with clear edges and a moderate number of medium density foci. Histological examination revealed signs of pulmonary fibrosis and interstitial inflammation of the type of nonspecific interstitial pneumonia, microliths located intraalveolarly, as well as a small amount of granulomas with hyalinosis in the center, a concentric arrangement of collagen fibers, fibroblasts, alveolar macrophages. A comorbid disease was diagnosed – pulmonary alveolar microlithiasis in combination with pneumoconiosis confirmed by the results of genetic testing – the c.1328delT mutation of the SLC34A2 gene was detected. The further course of the disease was characterized by progression of dyspnea and desaturation, an increase in the number of high-density foci in the lungs. 2 years after diagnosis – death due to respiratory failure. The presented case demonstrates the possibility of a combination of pulmonary alveolar microlithiasis with pneumoconiosis and an unfavorable prognosis of a comorbid disease.

Aim. To evaluate the association of the nucleotide sequence variant rs1799752 (I/D) of the angiotensin-converting enzyme ( ACE ) gene with acute coronary syndrome ( ACS ) in patients after a coronavirus disease 2019 (COVID-19). Material and methods. The study included 100 patients (women — 50, men — 50) with ACS and prior COVID-19, verified by a polymerase chain reaction (PCR), hospitalized in the regional vascular center № 7 of the City Clinical Hospital № 2 city of Novosibirsk. The mean age of women and men was 59,5±7,2 years and 53,5±9,3 years, respectively. The diagnosis of ACS was established according to a set of criteria proposed and established by the Russian Society of Cardiology and in accordance with the updated 2020 guidelines. Patients underwent examinations, coronary angiography with stenting, as provided for in the standards of care and guidelines. In patients, the nucleotide sequence variant rs1799752 of the ACE gene was determined using PCR. The comparison group consisted of 200 patients with ACS without COVID-19 (no positive PCR or antibodies). Statistical analysis was carried out using the SPSS 17.0.5 software package. Results. When comparing the frequencies of rs1799752 genotypes of the ACE gene in groups with ACS with COVID-19 and ACS without COVID-19, significant differences were obtained (p=0,013). In the group with ACS and COVID-19, carriage of the heterozygous genotype was less common (p=0,005) and there was an accumulation of carriers of the homozygous DD genotype (1,6 times higher; 26% vs 16%; p=0,044). Conclusion. The nucleotide sequence variant rs1799752 (I/D) of the ACE gene is associated with ACS in patients after COVID-19.

Введение. У больных с частыми обострениями хронической обструктивной болезни легких, протекающей на фоне артериальной гипертонии, наблюдаются высокий уровень личностной невротизации и признаки, характерные для депрессивного реагирования в эмоциональном состоянии и поведении, а также снижение потребности в общении и значительные перепады эмоционального состояния. Цель работы. Выявить психосоматические особенности течения артериальной гипертонии при хронической обструктивной болезни легких с частыми обострениями. Материалы и методы. В обсервационное аналитическое когортное исследование были включены 183 пациента с артериальной гипертонией и хронической обструктивной болезнью легких в возрасте 45-60 лет Государственного бюджетного учреждения здравоохранения Новосибирской области «Городская клиническая больница № 2», которых разделили на две группы: I – артериальной гипертонии и хронической обструктивной болезни легких без частых обострений и II – артериальной гипертонии с частыми обострениями хронической обструктивной болезни легких (два и более в год либо одно обострение, потребовавшее госпитализации). В работе оценивались данные домашнего и офисного мониторинга артериального давления и психодиагностических инструментов. Оценка тревожно-депрессивного статуса проводилась с использованием валидизированных диагностических методик – госпитальной шкалы тревоги и депрессии (Hospital Anxiety and Depression Scale) и шкалы Гамильтона для оценки депрессии (Hamilton Rating Scale for Depression). Помимо формализованной автоматизированной оценки по приведенным критериям проводилась экспертная оценка данных психологического тестирования. Компьютерный анализ результатов настоящего исследования проводили с помощью пакета прикладных статистических программ SAS, USA с применением стандартных алгоритмов вариационной статистики. При анализе межгрупповых различий показателей, измеренных по интервальной шкале, рассчитывали значения t-критерия Стьюдента по соответствующим формулам. Результаты. Выявлена статистически значимая частота тревожно-депрессивного синдрома у пациентов с частыми обострениями хронической обструктивной болезни легких при артериальной гипертонии. Так, по результатам госпитальной шкалы тревоги и депрессии смешанное тревожное и депрессивное расстройство отмечалось у 68%, значимо (р < 0,05) чаще в сравнении с больными артериальной гипертонией и хронической обструктивной болезнью легких без частых обострений. Из них 72% пациентов имели тревожный синдром и 32% – депрессивный синдром, р < 0,001 и р = 0,001 соответственно. Установлено, что у лиц с частыми обострениями хронической обструктивной болезни легких и тревожно-депрессивным синдромом неконтролируемая артериальная гипертония выявляется достоверно чаще по сравнению с обследованными без тревожно-депрессивного синдрома (р < 0,0001). Доказано, что люди с признаками тревожно-депрессивного синдрома отличаются более высокими уровнями систолического артериального давления (р < 0,003) по сравнению с теми, у кого нет его признаков (р = 0,001). Для уточнения характера депрессивных нарушений была использована шкала Гамильтона для оценки депрессии, согласно которой у большинства пациентов группы II были обнаружены депрессивные нарушения (77%; р = 0,003). Экспертная оценка данных психологического тестирования показала, что субклиническое депрессивное состояние отмечалось у 24%, клинически значимая депрессия – у 46%, а большая депрессия – у 8% больных артериальной гипертонией с частыми обострениями хронической обструктивной болезни легких. Background. In patients with frequent exacerbations of chronic obstructive pulmonary disease occurring against the background of hypertension, there is a high level of personal neuroticism, the presence of signs characteristic of a depressive response in the emotional state and behavior, as well as a decrease in the need for communication and significant changes in the emotional state. Objective. To reveal psychosomatic features of the course of arterial hypertension in chronic obstructive pulmonary disease with frequent exacerbations. Materials and methods. The observational analytical cohort study included 183 patients with AH and chronic obstructive pulmonary disease aged 45-60 years, from Novosibirsk City Clinical Hospital No. 2, which were divided into 2 groups I – arterial hypertension and chronic obstructive pulmonary disease without frequent exacerbations and II – Hypertension with frequent exacerbations of chronic obstructive pulmonary disease (more than 2 times a year. Data from home and "office" blood pressure monitoring and psychodiagnostic tools were evaluated. Anxiety and depression status was assessed using validated diagnostic methods: the Hospital Anxiety and Depression Scale and the Hamilton Rating Scale for Depression.In addition to the formalized automated evaluation of the above criteria, an expert evaluation of psychological testing data was carried out. Computer analysis of the results of this study was carried out using the SAS, USA statistical software package using standard variational algorithms. statistics. When analyzing intergroup differences in indicators measured on an interval scale, the values of Student's t-test were calculated using the corresponding formulas. Results. The presence of a statistically significant frequency of anxiety-depressive syndrome was revealed in persons with frequent exacerbations of chronic obstructive pulmonary disease in arterial hypertension, so, according to the results of the Hospital Anxiety and Depression Scale "Mixed anxiety and depressive disorder", it was noted in 68%, significantly (p < 0.05) more often in compared with patients with hypertension and chronic obstructive pulmonary disease without frequent exacerbations. Of these, 72% of patients had an anxiety syndrome and 32% – a depressive syndrome, p < 0.001 and p = 0.001, respectively. It was found that in persons with frequent exacerbations of chronic obstructive pulmonary disease and anxiety-depressive syndrome, uncontrolled hypertension was detected significantly more often than in those examined without TDS (p < 0.0001). It has been proven that persons with signs of TDS had higher levels of SBP (p < 0.003) compared to persons without TDS (p = 0.001). To clarify the nature of depressive disorders, the Hamilton Rating Scale for Depression was used, according to which depressive disorders of 77% were found in most patients of the 2nd group (p = 0.003). An expert evaluation of psychological testing data showed that subclinical depression was observed in 24%, clinically significant depression was observed in 46%, and major depression in 8% of hypertensive patients with frequent exacerbations of chronic obstructive pulmonary disease.

ПРОГНОЗ ГИПЕРПЛАЗИИ ЭНДОМЕТРИЯ С АТИПИЕЙ У ЖЕНЩИН, РАБОТАЮЩИХ В УСЛОВИЯХ ВОЗДЕЙСТВИЯ ОРГАНИЧЕСКИХ РАСТВОРИТЕЛЕЙМаринкин И.О. 1 , Шпагина Л.А. 1 , Лисова Е

Objective: to establish clinical and molecular features of endometrial hyperplasia in conditions of organic solvents exposure in patients with obesity. Materials and methods: postmenopausal women with endometrial hyperplasia (morphological criteria) were included to observational cross-sectional study. The main group included 140 subjects with occupational organic solvents exposure, aged 57,5 (46;64) years, of whom 70 had obesity and 70 had normal weight. Comparison group — 140 women without of occupational health risks, aged 56,5 (46;65) years, 68 with and 72 without obesity. Investigated workers were painters in machine building industry with length of service above 10 years, in post-contact period lasted for 1-5 years were 29 (20.7%) of participants. Organic solvents concentrations at the workplace’s areas were 1.5-5.5 times above occupational exposure limits. Linear and logistic regression were used to explore relationships. Level of significance p<0.05. Results: workers exposed to organic solvents had maximal percent of atypical endometrial hyperplasia: 34.3% in obesity subjects and 18.6% in those without obesity, in the comparison group 10.3% in subjects with and 6.9% in those without obesity, p=0.004. Subgroup with toxicant exposure with obesity characterized by maximal expression of Ki-67 (55,9±2,51, 51,4±4,95, 41,5±3,29 and 30,1±2,18 scores respectively), higher rate of uterine bleeding, M-echo thickness, blood interleukin 1β concentration. Atypical endometrial hyperplasia was associated with length of service (OR 1.80), maximal short-term exposure concentration of toluene (OR 2.51), waist circumference (OR 1.68), Ki-67 (OR 2,01), estrogen receptors on epithelium (OR 1.92). Conclusions: organic solvents exposure in postmenopausal women with endometrial hyperplasia contributes to development of atypical hyperplasia, systemic inflammation, Ki-67 expression, higher grades in subjects with obesity.

ДИАГНОСТИКА ПЕРВИЧНОГО ГИПЕРАЛЬДОСТЕРОНИЗМА НА ФОНЕ СОЧЕТАНИЯ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА И НЕКОНТРОЛИРУЕМОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИКозик В

Введение. Вибрационная болезнь имеет принципиальное значение в ухудшении качества жизни, нуждаясь в регулярном наблюдении в центрах профпатологии. В настоящее время важным вопросом сохраняется ранняя диагностика, профилактика и реабилитация пациентов с коморбидным течением вибрационной болезни. Цель. Изучение диагностических критериев у больных коморбидным фенотипом вибрационной болезни в cочетании с артериальной гипертензией в условиях воздействия вибрации в клинике профессиональной патологии. Материалы и методы. Выполнен межсистемный корреляционный анализ клинико-функциональных и нутритивно-метаболических показателей с определением взаимосвязи методом логической регрессии. Обследованы 431 человек, из них: 104 пациента с диагнозом вибрационной болезни I ст., 101 пациент c вибрационной болезнью в сочетании с артериальной гипертензией, 107 пациентов с артериальной гипертензией I-II ст., не имеющих контакта с вибрацией, и 119 человек, работающих на том же предприятии вне контакта c вибрацией. Длительность исследования составила 5 лет. Исследуемым проведён комплекс клинических, лабораторных и функциональных исследований с особым вниманием на диагностические параметры коморбидной патологии. Критический уровень значимости р=0,05. Результаты. В ходе анализа было установлено, что течение вибрационной болезни в условиях коморбидности влияет на прогноз профессионального заболевания. Для вибрационной болезни в условиях коморбидности, в отличие от изолированной вибрационной болезни, характерно более тяжелое течение с худшими нутритивно-метаболическим статусом, клинико-функциональными и лабораторными показателями. У больных с фенотипом вибрационной болезни в сочетании с артериальной гипертензией полиморфный вариант T/Т Ala 16 Val (rs4880) гена медь-цинк супероксиддисмутазы выявляется в 30% случаев, что превышает показатели в группах контроля и сравнения в 1,9 и 1,2 раза соответственно. Заключение. Течение вибрационной болезни и прогнозируемые особенности зависят от наличия коморбидности, а также интенсивности и продолжительности воздействия производственного фактора вибрации. Сочетание вибрационной болезни и артериальной гипертензии является отдельным фенотипом и характеризуется клинико-функциональными и нутритивно-метаболическими особенностями. Приобретенные знания могут быть направлены на построение алгоритмов ранней диагностики и профилактики вибрационной болезни в сочетании с артериальной гипертензией. Introduction. Vibration disease is of fundamental importance in deteriorating the quality of life, requiring regular monitoring in occupational pathology centers. Currently, early diagnosis, prevention and rehabilitation of patients with comorbid vibration disease remains an important issue. Target. Study of diagnostic criteria in patients with a comorbid phenotype of vibration disease in combination with arterial hypertension under conditions of exposure to vibration in an occupational pathology clinic. Materials and methods. An intersystem correlation analysis of clinical-functional and nutritional-metabolic indicators was performed with the relationship determined using the logical regression method. 431 people were examined, of which: 104 patients diagnosed with stage I vibration disease, 101 patients with vibration disease in combination with arterial hypertension, 107 patients with stage I-II arterial hypertension who do not have contact with vibration and 119 people working in the same enterprise out of contact with vibration. The duration of the study was 5 years. The subjects underwent a complex of clinical, laboratory and functional studies with special attention to the diagnostic parameters of comorbid pathology. Critical significance level p=0.05. Results. During the analysis, it was found that the course of vibration disease in conditions of comorbidity affects the prognosis of an occupational disease. Vibration disease in comorbid conditions, in contrast to isolated vibration disease, is characterized by a more severe course with worse nutritional-metabolic status, clinical, functional and laboratory parameters. In patients with the phenotype of vibration disease in combination with arterial hypertension, the polymorphic variant T/T Ala 16 Val (rs4880) of the copper-zinc superoxide dismutase gene is detected in 30% of cases, which is 1.9 and 1.2 times higher than in the control and comparison groups respectively. Conclusion. The course of vibration disease and predicted features depend on the presence of comorbidity, as well as the intensity and duration of exposure to the production factor of vibration. The combination of vibration disease and arterial hypertension is a separate phenotype and is characterized by clinical, functional and nutritional-metabolic features. The acquired knowledge can be used to develop algorithms for early diagnosis and prevention of vibration disease in combination with arterial hypertension. Кіріспе. Діріл ауруы өмір сапасының нашарлауында принципті маңызы бар, кәсіптік патология орталықтарында тұрақты бақылауды қажет етеді. Қазіргі уақытта ілеспе діріл ауруы бар науқастарды ерте диагностикалау, алдын алу және оңалту маңызды мәселе болып қала береді. Мақсат. Кәсіби патологиялық диспансерде діріл әсер ету жағдайында артериялық гипертензиямен біріктірілген діріл ауруының фенотипінің ілеспе түрі бар науқастардың диагностикалық критерийлерін зерттеу. Материалдар мен тәсілдер. Логикалық регрессия әдісі арқылы анықталған байланыспен клиникалық-функционалдық және тағамдық-метаболикалық көрсеткіштердің жүйеаралық корреляциялық талдауы жүргізілді. 431 адам тексерілді, оның ішінде: 104 адамда діріл ауруының I сатысы, 101 адамда діріл ауруымен біріктірілген артериалды гипертензиямен, 107 адам дірілмен байланыста емес I-II артериялық гипертензиямен және 119 адам дірілмен байланыста емес. сол кәсіпорын дірілмен байланыссыз. Оқу мерзімі 5 жыл болды. Субъектілер ілеспелі патологияның диагностикалық параметрлеріне ерекше назар аудара отырып, клиникалық, зертханалық және функционалдық зерттеулер кешенінен өтті. Критикалық маңыздылық деңгейі p=0,05. Нәтижелер. Талдау барысында ілеспе ауру жағдайында діріл ауруының ағымы кәсіптік аурудың болжамына әсер ететіні анықталды. Біріктірілген діріл ауруынан айырмашылығы, ілеспелі жағдайдағы діріл ауруы тамақтану-метаболикалық күйі, клиникалық, функционалдық және зертханалық көрсеткіштері нашарлаған ауыр ағымымен сипатталады. Артериялық гипертензиямен біріктірілген вибрациялық аурудың фенотипі бар науқастарда мыс-мырыш супероксидті дисмутаза генінің полиморфты T/T Ala 16 Val (rs4880) нұсқасы 30% жағдайда анықталады, бұл 1,9 және 1,2 есе жоғары. бақылау және салыстыру топтарында сәйкесінше. Қорытынды. Діріл ауруының ағымы және болжамды ерекшеліктері қатар жүретін аурулардың болуына, сондай-ақ дірілдің өндірістік факторының әсер ету қарқындылығы мен ұзақтығына байланысты. Вибрациялық ауру мен артериялық гипертензияның қосындысы жеке фенотип болып табылады және клиникалық, функционалдық және тағамдық-метаболикалық ерекшеліктерімен сипатталады. Алынған білімді артериалды гипертензиямен бірге діріл ауруын ерте диагностикалау және алдын алу алгоритмдерін әзірлеу үшін пайдалануға болады.

Viral respiratory infection is one of the main etiologic factors for acute exacerbations of COPD (AECOPD). The disease course after virus-associated AECOPD and the response to treatment have not been studied adequately.The aim was to evaluate the efficacy of single-inhaler triple therapy (SITT) of long-acting anticholinergic drugs (LAMA)/long-acting β2-agonists (LABA) of adrenergic receptors/inhaled glucocorticosteroids (ICS) on COPD symptoms, lung function, exercise tolerance, and inflammatory activity compared with multiple-inhaler triple therapy (MITT) after a virus-associated COPD exacerbation.Methods. This was an observational prospective cohort study of COPD patients (spirographус criterion) hospitalized for AECOPD with viral (n = 60) or viral-bacterial (n = 60) infection. The comparison group included patients with bacterial AECOPD (n = 60). Viral infection was diagnosed by PCR-RT of sputum or bronchoalveolar lavage fluid for RNAs of rhinovirus, RS virus, influenza A and B viruses, or SARS-CoV-2 virus. Bacterial infection was demonstrated by sputum purulence and/or procalcitonin test results and/or standard culture data. During AECOPD, blood cytokines were measured by ELISA. The patients were treated with SITT (investigational treatment) or MITT (comparison treatment) of LAMA/LABA/ICS in real-world clinical practice. The follow-up started 4 weeks after AECOPD regression and discharge from hospital.Results. After 52 weeks of treatment, FEV1 decline was smaller than in the SITT group. Differences from the MITT group were greater in patients with viral AECOPD (–69 (–75; –10) ml vs –75 (–78; –72) ml) or viral-bacterial AECOPD (–67.5 (–69; –37.25) ml vs –75.5 (–84; –70.25) ml). An increase in DLCO/Va, 6-minut walk test (6MWT) results, a decrease in bronchodilation coefficient, blood eosinophils and fibrinogen was seen only in subjects who received SITT and had viralor viral-bacterial AECOPD. A multiple regression model revealed a direct association between blood interleukin-5 and improvement in FEV1 (В = 0.848) and DLCO/Va (B=0.117) and a negative correlation with blood levels of amino-terminal propeptide of type-III procollagen and improvement in DLCO/Va (В = –0.021).Conclusion. SITT with LAMA/LABA/ICS was more effective in preventing FEV1 decline, increasing DLCO, 6MWT results, and decreasing airway inflammation in virus-associated or viral-bacterial AECOPD.

Introduction. Currently, the occupational etiological factors of vibration disease are well studied, but the management of this group of patients against the background of comorbid pathology, the impact on the quality of life of patients and the long-term prognosis of the disease remains an urgent problem. Aim. Study of nutritional and metabolic status in patients with vibration disease in combination with arterial hypertension. Materials and methods. A survey of 336 patients with vibration disease in combination with arterial hypertension was conducted in the conditions of the regional center of occupational pathology on the basis of a specialized department of occupational pathology. A comprehensive assessment of the clinical, nutritional and metabolic status of patients with vibration disease in combination with hypertension was carried out, including the study of clinical parameters, the daily profile of blood pressure, protein, lipid and carbohydrate metabolism, the component composition of the body of patients and the assessment of the profile of adipokines and cytokines. Results and discussion. Insufficient reduction of pressure at night (non-dippers) was revealed, an increase in fat mass and extracellular fluid was determined against the background of lean mass deficiency and a decrease in phase angle, proatherogenic dyslipidemia, protein deficiency, impaired carbohydrate metabolism, high levels of adipokine and cytokine activity. Conclusion. As a result of the study, additional markers for the diagnosis of nutritional disorders in the combined course of vibration disease and arterial. Conclusions. As an early diagnosis of nutritional and metabolic disorders in vibration disease in combination with arterial hypertension, the most informative integral indicators characterizing nutritional and metabolic disorders in this phenotype were identified – the waist circumference/hip circumference index and active cell mass.

ПОРАЖЕНИЕ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ НОВУЮ КОРОНАВИРУСНУЮ ИНФЕКЦИЮ: СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫКозик В.А. 1 , Шпагин И

Introduction. The etiology and pathophysiological links of hand-arm vibration syndrome have been sufficiently studied today, but the issue of early diagnosis, prevention and treatment of patients with a comorbid phenotype remains relevant. Aim. Study of nutritional and metabolic status in patients with the comorbid phenotype of hand-arm vibration syndrome in combination with arterial hypertension. Materials and methods. An analysis of nutritional and metabolic parameters was carried out on the basis of the Regional Center for Occupational Pathology in Novosibirsk in 431 people working at the aircraft plant named after V.P. Chkalov, Novosibirsk. Of these: 104 patients diagnosed hand-arm vibration syndrome of the stage I, 101 patients with hand-arm vibration syndrome in combination with arterial hypertension, 107 patients with stage I-II arterial hypertension and 119 people working at the same enterprise without contact with vibration. Results. The analysis revealed a worse nutritional-metabolic situation in the group of a comorbid variant of hand-arm vibration syndrome in combination with arterial hypertension, and also showed the relations between indicators of nutritional status and actual nutrition indicators. Conclusion. As a result of studying nutritional-metabolic status of the multifactorial model of hand-arm vibration syndrome in combination with arterial hypertension, the most informative integral data are presented that determine the disorders in the studied phenotype. The acquired knowledge can be aimed at optimizing early diagnosis and prevention, as well as predicting nutritional and metabolic disorders in hand-arm vibration syndrome in combination with arterial hypertension.