According to the literature, the risk of death in patients with chronic obstructive pulmonary disease (COPD) increases with both frequency and severity of the disease exacerbations. However, the clinical burden and healthcare resource utilization associated with severe COPD exacerbations in the Russian population have not been adequately studied.The aim of this study was to assess the clinical burden of severe COPD in Russia by examining the relationship between frequency of severe exacerbations, clinical outcomes, and healthcare utilization among the Russian patients.Methods. The EXACOS International Study on Exacerbations and Outcomes was an observational, cross-sectional study that collected retrospective data from medical records over a five-year period. The study population included a broad range of COPD patients monitored by pulmonologists. The purpose of the study was to assess the frequency of severe exacerbations that were defined as hospitalizations (with or without admission to an intensive care unit) or emergency department visits due to worsening of COPD symptoms.Results. A total of 326 patients with COPD were included (mean age: 64.8 years, 87.1% male). Most participants had moderate (137 (42.0%)) or severe COPD (135 (41.4%)), as well as comorbidities (275 (84.4%)). The most common comorbidities included hypertension, heart failure, and diabetes. During the study period, 120 (40.0%), 158 (48.5%), and 247 (75.8%) patients received courses of oral corticosteroids, injectable corticosteroids and antibiotics, respectively. 250 (76.7%) patients experienced at least one severe COPD exacerbation, with a total of 1,026 events; and 102 (31.3%) had more than 3 exacerbations. The annual number of exacerbations increased from 128 in 2019 to 294 in 2021 (p < 0.0001), and the proportion of patients with severe exacerbations also increased from 23.6% in 2009 to 54.7% in 2021.Conclusion. The high clinical burden of severe COPD exacerbations among the Russian population indicates a significant need for further research into factors leading to these events, modification of these factors and optimization of therapy to prevent the exacerbations.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used,  of representative  selection  of non-organized  male and  female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol  (TC), cholesterol  of lipoproteids low and high density were measured at SSRCPM and RSPCC. Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased  level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached  of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively. Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment  of the persons with high and very high cardiovascular  risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity  of development  and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions.Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used, of representative selection of non-organized male and female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol (TC), cholesterol of lipoproteids low and high density were measured at SSRCPM and RSPCC.Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively.Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment of the persons with high and very high cardiovascular risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity of development and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness. Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study. Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)). Result. EQ-5D index of Russian population was 0,87 with no  gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p<0,05). Wealth level negatively associated with LQ. Most common (p<0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p<0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions. Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors.

The aim of the study was to investigate enzymatic and chemiluminescent activity in blood neutrophils of patients with moderate and severe communityacquired pneumonia (CAP). Methods. The study involved 48 patients with moderate CAP and 40 patients with severe CAP; they were examined on admission. Synthesis of primary and secondary reactive oxygen species (ROS) was evaluated using the chemiluminescence assay. Neutrophil NAD(P)dependent dehydrogenase activity was assessed using the bioluminescent method. Results. The «respiratory burst» was found in neutrophils of CAP patients. Terminal reactions of the anaerobic glycolysis and the tricarbonic acid cycle were intensified in patients with severe CAP only. Increased lipid anabolism activity and substrate outflow from the tricarbonic acid cycle via NADHdependent glutamate dehydrogenase were shown regardless of CAP severity. The canonical analysis showed abnormalities of metabolic mechanisms of the «respiratory burst» in blood neutrophils in CAP. Conclusion. The metabolic disorders and «respiratory burst» intensity in CAP arize the need for pathogenic correction. High NADHdepend ent dehydrogenase activity and lower chemiluminescent activity in blood neutrophils could be used as additional markers of severe course of CAP.

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

ГБОУ ВПО Красноярский государственный медицинский университет им.проф.В

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

Cytological features and chemiluminescent activity were studied in phagocytes from bronchoalveolar lavage fluid (BALF) sampled from patients with bronchial asthma (BA). A total of 53 patients were examined before and after gaining pharmaceutical control over the disease. Of these patients, 28 were older than 60 years and 25 were younger. The control group included 16 practically healthy persons aged below 60 years. The inflammation process in elderly (>60 years) patients was accompanied by significantly higher contents of neutrophils and lymphocytes and lower contents of alveolar macrophages. The chemiluminescent responses of BALF phagocytes in patients with BA followed the same trend in the two age groups but showed a quantitative difference. Respiratory tract inflammation in elderly patients with BA was characterized by less pronounced recruitment of effector cells and lower chemiluminescent activity of phagocytes in comparison to the younger group of patients.

Aim. The aim of the study was to investigate luminol-dependent and lucigenin-dependent neutrophil granulocyte chemiluminescence in patients with community-acquired pneumonia (CAP). Methods. Forty-eight patients with moderate CAP and 40 patients with severe CAP were examined during two-week treatment. Primary and secondary reactive oxygen species (ROS) production was investigated using the chemiluminescence assay. Results. Patients with moderate CAP maintained a high-level ROS production for 2 weeks of the treatment; a trend towards improving neutrophil functional activity was seen after 7 days of the treatment. In patients with severe CAP superoxide radical production improved to the end of the study, whereas secondary ROS synthesis remained elevated during the entire treatment period with slowing secondary ROS accumulation rate to the end of the study which adversely affected neutrophilic granulocyte reactivity. Conclusion. Thus, neutrophil granulocyte chemiluminescence disorders as well as clinical risk factors could be considered as predictors of severe CAP.

Демко Ирина Владимировна -доктор медицинских наук

Aim. The aim of the study was to investigate luminol-dependent and lucigenin-dependent neutrophil granulocyte chemiluminescence in patients with community-acquired pneumonia (CAP). Methods. Forty-eight patients with moderate CAP and 40 patients with severe CAP were examined during two-week treatment. Primary and secondary reactive oxygen species (ROS) production was investigated using the chemiluminescence assay. Results. Patients with moderate CAP maintained a high-level ROS production for 2 weeks of the treatment; a trend towards improving neutrophil functional activity was seen after 7 days of the treatment. In patients with severe CAP superoxide radical production improved to the end of the study, whereas secondary ROS synthesis remained elevated during the entire treatment period with slowing secondary ROS accumulation rate to the end of the study which adversely affected neutrophilic granulocyte reactivity. Conclusion. Thus, neutrophil granulocyte chemiluminescence disorders as well as clinical risk factors could be considered as predictors of severe CAP.

The aim of the study was to investigate cytological features and chemo luminescent activity of bronchial lavage phagocytic cells in 58 patients (28 of them are over 60 years old and 25 patients younger than 60 years) with bronchial asthma (BA) before and after achievement of medicinal disease control. Bronchial inflammation process in elderly patients (> 60 years) was characterized by significant higher content of neutrophils and lymphocytes as well as lower proportion of alveolar macrophages. Chemo luminescent responses of bronchial lavage phagocyte cells in patients with BA were unidirectional in two comparative aging groups, albeit with quantitative differences. In conclusion, respiratory tract inflammatory process in elderly patients with BA is characterized by less pronounced involvement of effector cells, lower chemo luminescent activity of phagocytes in comparison with similar parameters in the patients younger than 60 years old.

Severe pneumonia is characterized by acute inflectional inflammation with respiratory insufficiency, sings of severe sepsis and septic shock. The modern view for this process describes it as a system inflammation to inflectional loci which formally takes place in every case of severe pneumonia. However sepsis in severe pneumonia is diagnosed only when the organic insufficiency develops. To enhance the treatment efficiency we need to unify the definitions of sepsis, severe sepsis, and septic shock in pneumonia.

Authors present a case of unusual pseudopneumonic form of bronchial-alveolar lung cancer, manifested with the symptoms of pneumonia, progressing dyspnoe, disseminated focal and infiltrating changes in lungs. The difficulties of disease verification and differential diagnosis are discussed.