Aim. To present a clinical case of a 19-year-old patient with community-acquired pneumonia (CAP) caused by Mycoplasma pneumoniae, which was complicated by a rare extrapulmonary manifestation in the form of rhabdomyolysis. Key points. The clinical case demonstrates a variant of mycoplasma CAP in an adult patient. M. pneumoniae infection was confirmed by a positive PCR test. Characteristic is contact with a patient with mycoplasma CAP in an infectious focus, a flu-like onset of the disease. Unlike most mild mycoplasma infections with a minimally expressed clinical picture and inflammatory response, the patient had a long period of febrile temperature and severe intoxication, significant laboratory changes and bilateral polysegmental lung damage. The development of signs of rhabdomyolysis (myalgia, increased creatine phosphokinase (CPK) to 2066 U/L, myoglobinuria) in the acute period of the disease is a rare extrapulmonary manifestation of mycoplasma CAP in adults, dangerous for the development of acute renal failure (ARF). Conclusion. The patient's young age, timely initiation of hydration, and antibacterial therapy aimed at M. pneumoniae made it possible to prevent the development of acute renal failure due to rhabdomyolysis. An increase in CPK, in the absence of other explanations for this phenomenon, should include mycoplasma CAP in the differential diagnosis of rhabdomyolysis. Keywords: community-acquired pneumonia, Mycoplasma pneumoniae, creatine phosphokinase, rhabdomyolysis.

Aim. Purpose of the study. Using the In-Check DIAL G16 device, determine the values of peak inspiratory flow (PIF) in bronchial asthma (BA) to assess the suitability of the inhaler used to the patient's capabilities and select the optimal inhaler. Design. Cross-sectional cohort study. Materials and methods. 60 patients with asthma were examined: 16 people with complete and 22 with partial control of the disease, 22 people with exacerbation of asthma. The control group consisted of 29 healthy people. Among patients with asthma, elderly women predominated. The patients were diagnosed with various asthma phenotypes: mild — in 7, moderate — in 34, severe — in 19 people. 16 out of 22 patients had a severe exacerbation of the disease. The determination of PIP is carried out using the In-Check DIAL G16 device. Results. Limitation of PIP was detected with complete control of asthma in 6.25–56.2%, with partial control — in 9.1–59.1%, with exacerbation of the disease — in 9.1–86.4% of cases, depending on the level of resistance of the device. Conclusion. Inhalation therapy for asthma can be personalized based on direct measurement of PIP using devices such as In-Check DIAL G16, which will allow treating physicians to select an inhaler in different periods of asthma, taking into account the degree of control, the period of the disease, the severity of bronchial obstruction and the individual characteristics of the patient. In order to optimize inhalation therapy for asthma, it is recommended to replace a powder inhaler with a high resistance device (R3–R5) with an inhaler with a low resistance (R0 — metered dose aerosol inhaler, respimat, R1 — breathhaler), and in case of exacerbation of the disease — use of a nebulizer.In order to optimize inhalation therapy for asthma, it is recommended to change the PI with a high resistance device (R3–R5) to an inhaler with a low resistance (R0 — MDI, respimat, R1 — breezhaler), and in case of exacerbation of the disease, use a nebulizer. Keywords: peak inspiratory flow, spirometry, bronchial asthma, inhaler.

Aim. To review the literature on topical issues of possible complications of the use of androgenic anabolic steroids (AAS) from the cardiovascular system and the role of abuse of AAS in increasing individual cardiovascular risk. Key points. The article reflects the historical stages of the application of AAS. The main pathophysiological mechanisms of the development of undesirable effects from the cardiovascular system have been established. Potential strategies for reducing the risk of side effects and complications from the circulatory system are proposed. Conclusion. There is a trend of steadily increasing consumption of AAS in the absence of medical recommendations and control, which creates significant prerequisites for increasing cardiovascular risk in people engaged in recreational physical activity who do not fall into the field of preventive cardiology. Keywords: androgenic anabolic steroids, testosterone, cardiovascular system, side effects, complications, risk reduction strategies.

Aim: To determine the values of peak inspiratory flow (PIP) for choosing an inhaler in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and to evaluate the possibility of optimizing inhalation therapy considering PIP in real clinical practice. Design: Open cohort controlled prospective study. Materials and methods. 76 people were examined. Group 1 included 32 patients with COPD exacerbation, 18 of them were re-examined before discharge and completed a survey 3 months after discharge from the hospital. Group 2 consisted of 15 patients with stable COPD. Group 3 included 29 healthy individuals. PIF using various inhalers was studied using the In-Check DIALTM G16 Clement Clarke International Limited (Great Britain), fixing the level without resistance (R0) and 5 levels of resistance (R1–R5). Suboptimal PIF (sPIF) values were considered at R0 < 90, R1–R4 < 60, R5 < 30 l/min. Spirometry was performed on a Flowscreen II spirometer (Jaeger) with a flow-volume curve recording, calculation of generally accepted indicators, and on a PTS-14P-01 pressure-tachospirograph to determine the peak inspiratory rate. Statistical data processing was carried out using the Statistica v. 10. According to the Bonferroni principle, differences were considered significant at p < 0.005. Results. During exacerbation of COPD, a decrease in PIF from 120 to 40 l/min (p < 0.001 compared with the control) and the presence of sPIF in 5–75% of cases, depending on the type of inhalation device, were revealed (no sPIF was noted in the control). Most patients were free to use a nebulizer, a metered-dose aerosol inhaler (MAI), a liquid inhaler (Respimat) and a breathhaler upon admission to the hospital. Patients could not create the necessary inspiratory effort when using the ellipt in 47% of cases, turbuhaler — in 63%, nexthaler — in 75%, handihaler — in 31%. With proven positive clinical and functional dynamics during treatment (increase in FEV1 from 37% (28; 53) to 55% (37; 62), p < 0.004), the identified changes persisted by the time of discharge from the hospital and did not reach the values of PIF and sPIF, determined in stable COPD. Analysis of PIF and sPIF in patients in real clinical practice, depending on the drugs received, showed that by the time they were discharged from the hospital, half of the patients had sPIF, continued to use turbuhaler and handihaler inhalers, and were not able to create an adequate PIF for effective inhalation of drugs. A survey of patients 3 months after discharge from the hospital showed that patients with optimal PIF values, who used drugs with the help of PPI, Respimat and Breezhaler, did not have exacerbations within the indicated periods. Patients with CPIP who continued to use the combination of turbuhaler and handihaler had moderate exacerbations. Conclusion. Optimization of inhalation therapy based on PIP in patients with COPD exacerbation should include: 1) the possibility of choosing the optimal inhaler, considering the direct determination of PIF; 2) replacement of a high-resistance powder inhaler with a PDI/Respimat or a low-resistance powder inhaler (breather, ellipta); 3) education of COPD patients in the correct technique of inhalation. PIF testing in COPD exacerbations may help clinicians identify patients at higher risk of readmission and personalize powder inhaler selection. Keywords: chronic obstructive pulmonary disease, peak inspiratory flow, inhalation therapy, inhaler resistance.

Дифференцированный подход к проведению профилактических и противоэпидемических мероприятий среди военнослужащих на основе шкалы оценки

Abstract. Рresents the possibilities of various visualization methods for assessing heart fat depot in patients with cardiovascular disease, as well as the effect of adipose tissue on myocardial function. The prospects of using the heart fat depot as a therapeutic target are considered on the example of the successful use of various groups of antidiabetic drugs, in particular glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Thus, it has been established that an ectopic fat depot makes a certain contribution to atherogenesis due to its effect on lipid metabolism, participation in the formation of a chronic inflammatory reaction of low intensity, potentiation of endothelial dysfunction, and activation of a coagulant shift. In addition, local organ dysfunctions, such as increased intrarenal pressure, mitochondrial disorders, increased lipogenesis, the formation of insulin resistance and lipotoxicity additionally create prerequisites for an increase in cardiovascular risk. Defines diagnostic and useful methods that not only quantitatively, but also qualitatively describe the relationship of fat depot and potential comorbid pathology. The effect of reducing cardiovascular risk, consisting in reducing the amount of epicardial adipose tissue in the studied, was observed when taking the preparation of the biguanide group, as well as its combination with drugs - analogues of glucagon-like peptide 1 and dipeptidyl peptidase-4 inhibitor. A similar effect was also observed in the case of the use of type 2 sodium-glucose cotransporter-2 inhibitors.

Purpose. To assess the impact of professional factors on the biological age of the cardiovascular system (BA CVS) of the Navy personnel serving in the conditions of deep submergence vehicles (GSV).Materials and methods. Personnel of the GSV crews in the quantity of 77, who were not exposed to high pressure of the gas and water environment were examined. Indicators of the magnitude of BA CVS characterizing the state of the vascular wall were studied.The results of the study. Professionally determined hemodynamic changes were revealed.Conclusion. The results of the study can improve the cardiologic screening of Navy specialists.