Background. Hypersensitivity pneumonitis refers to a rare interstitial lung disease that requires differential diagnosis with a large spectrum of nosologies. However, the prevalence of hypersensitivity pneumonitis in the population remains unclear, partly due to low awareness among healthcare professionals of various specialties regarding this condition, as well as diagnostic challenges. Many authors emphasize the necessity of a detailed analysis of professional and environmental factors affecting the patient as one of the crucial steps in diagnosing hypersensitivity pneumonitis. The prognosis for hypersensitivity pneumonitis in children is more favorable than in adults, with complete clinical and functional recovery possible in most cases if the causative antigen is eliminated.Case description. The paper presents data from a six-year observation of a 9-year-old girl. Within six months prior to her consultation, she developed respiratory complaints (shortness of breath, respiratory distress, fits of dry coughing), poor tolerance to physical exertion, and chronic weakness. She was monitored and treated for bronchial asthma by a pulmonologist without significant clinical improvement. Subsequently, specialists at a regional center conducted extensive work on differential diagnosis and verification of the disease through meticulous collection of anamnesis and clinical data and the use of modern laboratory and instrumental resources. Effective treatment was selected, and recommendations were given in order to correct influencing factors (change of residence and living conditions). A clear improvement in clinical, laboratory, and instrumental data was demonstrated over the observation period, with significant effects achieved within a year from the start of therapy. Improvements were noted in both volume and flow parameters on spirometry, with no restrictive disorders observed; the most indicative changes were revealed in the dynamics of high-resolution computed tomography.Conclusion. The presented clinical case demonstrates the necessity of paying special attention to thorough history-taking and identifying potential causal factors. A distinctive feature of the disease consists in reversible symptoms, sustained remission, and a favorable prognosis under conditions of timely diagnosis, treatment, and removal of the causal factor.

Chronic hypertension (CH) complicates the course of pregnancy in 1-2% of cases, and it is increasingly common. Compared with normotensive women, women with CH have a high risk of maternal and perinatal complications. Antihypertensive treatment of CH halves the risk of severe hypertension but does not reduce the incidence of preeclampsia or serious maternal complications, which may be due to the small number of observations in the studies conducted. In addition, the treatment of CH does not affect the mortality or morbidity of the fetus and/or newborn, regardless of the start date of antihypertensive therapy. Traditionally used antihypertensive drugs have been proven not to be teratogenic, while there may be an increase in the frequency of congenital malformations associated primarily with uncontrolled chronic hypertension. Although prescribing approved antihypertensive agents for all women during pregnancy are effective in lowering blood pressure in the most cases, it remains unclear whether there is an optimal drug for monotherapy and which combinations of antihypertensive drugs are best used. An alternative approach is to individualize treatment using maternal characteristics and blood pressure characteristics, in addition to blood pressure levels (for example, blood pressure variability), which also have prognostic value. This review examines current data on the treatment of pregnant women with CH from the perspective of current national and international recommendations. Discussion of the existing unresolved issues can serve as a basis for a personalized approach in the management and treatment of pregnant women with CH.

Beta-blockers are used to treat various cardiovascular diseases, including hypertension and chronic heart failure. They act by suppressing the effects of catecholamines through various pathways and affect heart rate, strength, and renin release, providing antihypertensive and anti-ischemic effects. The individual effects of various drugs on clinical outcomes in this group were determined according to characteristics of the patient, underlying disease, and type of beta-blocker used. In recent years, beta-blockers have faced a serious obstacle when new guidelines on hypertension suggest their use as second-line therapy after angiotensin converting enzyme inhibitors, angiotensin receptor blockers and slow calcium channel blockers in the absence of clear indications. In fact, these recommendations were based on meta-analyses that showed that beta-blockers have fewer beneficial effects on overall mortality, cardiovascular events, and brain stroke. In addition, according to currently available data, the appointment of beta-blockers for diseases such as heart failure with preserved ejection fraction and stable coronary heart disease can cause more harm than good outcomes. Bisoprolol is a beta-blocker with the highest selectivity for beta1-adrenergic receptors, which determines the rare frequency of side effects that develop because of its use. This review presents current data on the use of beta-blockers for treating cardiovascular diseases, with an emphasis on the use of bisoprolol.

Maternal diabetes during pregnancy, regardless of the type, is a risk factor for macro-somia or excessive fetal growth. Macrosomia and subsequent complications are the main short-term consequences of intrauterine exposure to gestational diabetes mellitus (GDM). Additionally, they have an increased risk of neonatal complications, such as congenital heart defects (CHDs) and cen-tral nervous system (CNS) congenital birth defects, hyperbilirubinemia, hypoglycemia, hypocalce-mia, and polycythemia with their subsequent complications. More and more indisputable data are evidencing long-term consequences on offspring health in the case of diabetes. While most of this research has focused on metabolic and cardiovascular consequences, there is a growing body of ev-idence suggesting an impact of maternal diabetes on respiratory health, which is influenced by in-trinsic and extrinsic environmental factors during fetal and postnatal development, with important implications for respiratory disorders in later life.

АНТИТРОМБОТИЧЕСКАЯ ТЕРАПИЯ У КАРДИОХИРУРГИЧЕСКИХ ПАЦИЕНТОВ Чулков Вас.С. 1 , Чулков Вл.С. 2 , Эктова Н.А. 2 , Минина Е.Е. 2 , Жмайлова С

This article presents an overview of modern statements of the induced sputum method; detailed description of the methods and protocols for taking sputum in adults and children, methods for processing the obtained substance. The paper describes in detail the features of the cellular composition of induced sputum in healthy individuals and in patients with bronchial asthma, emphasizes the importance of the eosinophilia level as a prognostic and diagnostic criterion of asthma and also determines the functions of other induced sputum cells such as neutrophils, macrophages, basophils. The article is illustrated with photographs of sputum microscopy. In addition to sputum cytology, we give accent to the possibility of using other research methods such as an identification of viral and bacterial pathogens, genomics, proteomics, lipidomics, metabolomics, determination of the concentration of various mediators in the sputum supernatant. The paper presents the ideas on biochemical inflammatory markers and remodelling of the respiratory tract in asthma, which can be determined in sputum (C3a anaphylatoxin, clusterin, periostin, eosinophil-derived neurotoxin, folliculin). In addition, we summarize the information on inflammatory phenotypes of bronchial asthma, emphasize their variability and modification depending on the period of the disease, prescribed treatment, intercurrent respiratory infections, and smoking. The article also presents detailed characteristics of eosinophilic, neutrophilic, mixed and small granulocyte phenotypes of bronchial asthma, and describes the most frequent correlations of phenotypes with the severity and course of the disease, with lung function parameters and other indicators. The paper gives an account of the possibilities of using the induced sputum method for a comprehensive assessment of the course, asthma controllability and the effectiveness of drug therapy, as well as for a personalized selection of an antiinflammatory drug considering the inflammatory phenotype.

Background and Aims : Aim. To compare body composition, lipids and adipokine levels in young individuals with normal weight, overweight and obesity.Methods: . Study design: a cross-sectional study. The study included 254 patients. Patients were divided into two groups: gr. 1 - individuals with normal body weight (n = 175), aged 31.8 ± 7.1 years; gr. 2 - individuals with overweight/obesity (n = 79), aged 36 ± 7.0 years. Anthropometric data, body composition parameters, blood levels of lipids and adipokines were compared among two groups. MedCalc statistical software package (2021). p<0.05 were taken as statistically significant.Results: . Individuals overweight/obese had higher levels of systolic BP, visceral fat percentage and total fat percentage compared to normal-weight subjects. We found that subjects in the overweight/obese group had the highest levels of triglycerides and LDL-C (p < 0.05). Adiponectin and resistin levels in the overweight/obese subject group were significantly lower (p < 0.05). Plasma levels of leptin and PAI-1 were not different among the two groups.Conclusions: . In overweight/obese young individuals, adipokine imbalance along with traditional risk factors could be a good predictor of cardiovascular and metabolic risk assessment. Background and Aims : Aim. To compare body composition, lipids and adipokine levels in young individuals with normal weight, overweight and obesity. Methods: . Study design: a cross-sectional study. The study included 254 patients. Patients were divided into two groups: gr. 1 - individuals with normal body weight (n = 175), aged 31.8 ± 7.1 years; gr. 2 - individuals with overweight/obesity (n = 79), aged 36 ± 7.0 years. Anthropometric data, body composition parameters, blood levels of lipids and adipokines were compared among two groups. MedCalc statistical software package (2021). p<0.05 were taken as statistically significant. Results: . Individuals overweight/obese had higher levels of systolic BP, visceral fat percentage and total fat percentage compared to normal-weight subjects. We found that subjects in the overweight/obese group had the highest levels of triglycerides and LDL-C (p < 0.05). Adiponectin and resistin levels in the overweight/obese subject group were significantly lower (p < 0.05). Plasma levels of leptin and PAI-1 were not different among the two groups. Conclusions: . In overweight/obese young individuals, adipokine imbalance along with traditional risk factors could be a good predictor of cardiovascular and metabolic risk assessment.

Modern teaching to young physicians has become increasingly limited because of rising clinical workload, due to the epidemiological situation, new requirements for medical documentation, the lack of a clear timetable of working hours and other educational features. Additionally, today’s residents expect that the training sessions will provide focused content integrated into their clinical workflow. One of the classical teaching methods that is ideally suited to meet these needs is a focused thematic training session, usually conducted with the help of simple but accessible visual aids and extensive audience participation. However, most listeners will benefit from structured content and guidance on the delivery of this content, also known as a learning scenario. A good learning scenario resident’s misconception, highlights a certain number of learning moments, uses strategies to engage students and provides a cognitive basis for teaching a topic that the teacher can improve over time. The proposed pedagogical concept of teaching sections of clinical hemostasiology for residents in the specialty "Therapy" orients the professional and cognitive interest of a young specialist against the background of constantly updated new knowledge in this field with the integration of scenarios of the content of training into clinical practice.

ЦЕЛЬ ИССЛЕДОВАНИЯ Выявить наиболее распространенные факторы риска и оценить риск развития венозных тромбоэмболических осложнений (ВТЭО) у госпитализированных пациентов терапевтического профиля с избыточной массой тела и ожирением. МАТЕРИАЛ И МЕТОДЫ Тип исследования — поперечный срез на базе когортного исследования. В исследование включены 150 пациентов терапевтического профиля, находящихся на лечении в многопрофильном стационаре. Пациенты разделены на три группы: 1-я группа — 50 больных с ожирением; 2-я группа — 50 больных с избыточной массой тела; 3-я группа — 50 больных с нормальной массой тела. Оценку по шкале Caprini определяли путем суммирования баллов для всех факторов и расчета риска развития ВТЭО. РЕЗУЛЬТАТЫ У пациентов с ожирением чаще встречались такие факторы риска развития ВТЭО, как возраст 41—60 лет, отеки нижних конечностей и варикозное расширение вен нижних конечностей. При оценке риска развития ВТЭО по шкале Caprini умеренный риск определен у 40% пациентов с ожирением, у 30% — с избыточной массой тела, у 6% — с нормальной массой тела; высокий риск развития ВТЭО имели 16% пациентов с ожирением и 12% — с избыточной массой тела. У пациентов с нормальной массой тела риск развития ВТЭО не выявлен. По данным многофакторного логистического регрессионного анализа, независимо ассоциированными факторами с умеренным и высоким риском развития ВТЭО оказались избыточная масса тела и ожирение (ОШ 7,46; p=0,002), прием комбинированных гормональных контрацептивов (ОШ 13,02; p<0,001), постельный режим (ОШ 16,14; p<0,001), варикозная болезнь нижних конечностей (ОШ 38,61; p=0,001) и отеки нижних конечностей (ОШ 63,40; p=0,002). ЗАКЛЮЧЕНИЕ Оценка по шкале Caprini позволяет провести стратификацию находящихся на лечении в стационаре больных с ожирением и избыточной массой тела в соответствии с риском развития венозных тромбоэмболических осложнений, идентифицировать лиц с высоким риском и разработать персонифицированные рекомендации по тромбопрофилактике.

The article provides an overview of modern concepts of induced sputum analysis and a description of the methodology and protocols for the collection of induced sputum in adults and children. This paper describes the cellular composition of induced sputum in healthy people and in patients with asthma in detail, analyses the significance of the sputum eosinophil count as a prognostic and diagnostic criterion and the role of other cells, such as neutrophils, macrophages, basophils. In this article, we review a number of asthma biomarkers of inflammation and remodeling of the airways in asthma, which can be determined in sputum (anaphylatoxin C3a, clusterin, periostin). In addition, we summarize recent data about asthma phenotypes and describe the possibilities of using induced sputum analysis as a diagnostic and therapeutic tool for personalized anti-inflammatory therapy for asthma.

Aim. To carry out a comparative assessment of cardiometabolic risk factors in men and women aged 18–44 years.Methods. The cross-sectional study included 251 patients divided into 2 groups. Group 1 consisted of 124 men; group 2 had 127 women in it. All participants of the study underwent anamnesis collection, blood pressure measurement, and assessment of anthropometric parameters, physical examination, biochemical and immunological tests.Results. The most significant gender differences were noted in the levels of leptin and adiponectin, fibrinogen and plasminogen activator inhibitor type 1, angiotensin II and interleukin-10 in the blood serum with no differences in cardiometabolic risk factors, including glucose and lipid metabolism.Conclusion. The revealed features of changes in adipokines and cytokines, indicators of hemostasis and vasoconstrictors in men and women expand the current knowledge about the role of some pathophysiological mechanisms in the development of cardiovascular pathology at a young age in the context of cardiometabolic risk concept.

Metabolic syndrome (MS) is widespread which explains high relevance of the topic. The MS development depends on various factors (age, race, social and economic status, level of physical activity, cultural development, diet, genetic background and educational level). Traditionally, the MS assessment and cardiovascular risk stratification includes measurement of total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, as well as glucose and insulin levels. Some other factors are being investigated and might serve as the surrogate endpoints for the effectiveness of treatment and prevention strategies in addition to insulin resistance indices (HOMA-IR, Caro). These include some systemic biomarkers such as highly sensitive C-reactive protein, leptin and adiponectin, which mediate the link between inflammation and obesity, as well as potentially prognostic markers of cardiovascular diseases. The paper considers the gender specificity of the MS and main components of the MS, such as hypertension, insulin resistance, obesity, and dyslipidemia. We review different approaches of international guidelines and specific regional and national characteristics and analyze gender-related peculiarities of each component of the MS in order to justify an individualized choice of management approach.

A prospective cohort study was conducted to assess the effect of a recombinant interferon alpha-2b prophylactic course on cyto-immunological parameters of induced sputum in children with mild asthma, the main trigger of exacerbation of which was respiratory viral infections.We examined 40 children aged 1 to 7 years with (mean age — 4.8 ± 0.2 years), half of whom received a course of recombinant interferon alpha-2b. The authors detected respiratory viruses in scrapings from throat and nose (PCR method) and evaluated the different cell counts, also the levels of interleukin-10, tumor necrosis factor alpha, interferon alpha and immunoglobulin E on the 1st and 30th day of the study (ELISA method) were determined in sputum.The number of asthma exacerbations, triggered by respiratory viral infection, decreased in 4.5 times against. In children who received recombinant interferon alpha-2b the count of sputum eosinophils and the number of children with sputum eosinophilia (≥3 %) reduced. After two months the level of nasal eosinophils was 30% lower than the start level. The level of IgE in induced sputum decreased by 35%, but the level of IL-10 was increased by 1.5 times. 75% of parents whose children received recombinant interferon alpha-2b, note positive effect of this drug.There were no adverse events to receive the drug in any case. Thus, the use of recombinant interferon alpha-2b in children with virus-induced asthma to reduce episodes of exacerbations associated with acute respiratory diseases can be recommended.

РЕПРОДУКТИВНОЕ ЗДОРОВЬЕ И КАРДИОМЕТАБОЛИЧЕСКИЙ РИСКВ. С. Чулков, Е

The abilities of tilorone to modulate an inflammatory response in acute respiratory viral infections (ARVI) and proofs of its clinical efficacy were the basis for investigating the effect of tilorone (Amixin) on the cytoimmunological parameters of induced sputum and on the frequency of asthma exacerbations caused by respiratory viral infection in children.Objective: to evaluate the clinical course of the disease and the cellular composition and immunological indices of induced sputum in children with an asthma exacerbation in the presence of the acute respiratory disease on addition of Amixin to standard basic therapy. Thirty children aged 7 to 16 years with an asthma exacerbation in the presence of ARVI were examined. Pharyngeal and nasal swabs were tested by PCR forrespiratory viruses; externalrespiratory function was determined before and after a pharmacological test; and nasal secretions and induced sputum were also cytologically investigated. A follow-up group (n=19) received treatment with Amixin according to the regimen.The predominant inflammatory phenotype in children with an asthma exacerbation in the presence of ARVI was ascertained to be neutrophilic (53.9%). Pathogen identification revealed rhinovirus in two-thirds of cases. Addition of tilorone (Amixin) to standard basic therapy for an asthma exacerbation caused by ARVI declined the number of recurrent ARVIs over the next 6 weeks; the number of bacterial complications did reduce that of asthma exacerbations if the latter occurred. The children treated with Amixin showed elevated levels of macrophages, reduced concentrations of eosinophils and IL-8, IL-1β in the induced sputum, and improved spirometric parameters reflecting permeability at the level of small and medium-sized bronchi.