Vol 22, No 3 (2020)
Articles
NEWS IN PULMONARY MEDICINE: FACTS, NUMBERS, HYPOTHESES, AND REALITY. INTERVIEW
Consilium Medicum. 2020;22(3):9-11
9-11
COVID-19: A RESPIRATORY INFECTION CAUSED BY NEW CORONAVIRUS: NEW DATA ON EPIDEMIOLOGY, CLINICAL COURSE, AND PATIENTS MANAGEMENT
Abstract
At present time there is an ongoing pandemic of a new coronavirus COVID-19 infection caused by SARS-CoV-2 virus. The analysis of SARS-CoV-2 genome showed significant similarity to formerly identified coronavirus strain that caused a breakout of atypical pneumonia or severe acute respiratory syndrome in 2003. All group ages were vulnerable to the virus, but senior patients with multiple comorbid disorders were more susceptible to severe disease course development. Main clinical symptoms include fever, cough, and asthenia. Some patients develop shortness of breath and hypoxemia that can quickly (in 1 week) progress to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulation dysfunction, and multisystemic dysfunction syndrome. It is recommended to perform chest computer tomography in all patients for diagnosis establishment and in disease course follow-up. As chest X-ray lacks informational value, its use is unreasonable. In most cases pulmonary tissue changes are characterized with multiple areas of tissue induration called ground-glass opacity and interstitial changes. Unfortunately, at present there is no convincing data on effectiveness of any antiviral treatment. Constant monitoring of vital parameters and laboratory findings is required for timely detection of signs of severe course and complications development. The most significant factors of severe progressive disease course and unfavorable outcome are being studied. The present review includes available epidemiological data, characteristic features of diagnostics and clinical course, unfavorable outcome risk factors, and possibilities of etiotropic and pathogenic treatment and prevention.
Consilium Medicum. 2020;22(3):12-20
12-20
UNITED STATES (ATS/IDSA, 2019) AND RUSSIAN (RRS/IACMAC, 2019) GUIDELINES ON COMMUNITY-ACQUIRED PNEUMONIA MANAGEMENT IN ADULTS. TWO POINTS OF VIEW ON A PRESSING ISSUE
Abstract
The article presents a comparative analysis of basic provisions of the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guideline and the 2018 Russian Respiratory Society/Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (RRS/IACMAC) draft guideline which consider diagnosis and antimicrobial therapy for community-acquired pneumonia in adults.
Consilium Medicum. 2020;22(3):22-27
22-27
VIRAL PNEUMONIA. RADIOLOGICAL SIGNS: DIAGNOSTIC DIFFICULTIES. BEST PRACTICE
Abstract
Inflammatory lung diseases of viral etiology are infrequent, but very dangerous diseases in clinical practice, requiring the use of special diagnostic and therapeutic measures. Viral pneumonia occupies a leading place in the structure of morbidity in children and among patients with immunodeficiency. However, during the rise in the incidence of acute respiratory diseases and flu epidemics, the diagnosis of viral pneumonia becomes particularly relevant. Respiratory viruses are pathogens of lung tissue damage in 30% of cases of community-acquired pneumonia. Pulmonologists are good at recognizing the clinical manifestations of bacterial pneumonia, but there may be sad errors in the differential diagnosis of viral lung lesions, since their clinical and radiological manifestations may be very similar. Clinical features cause of the physician-pulmonologist to conduct a more thorough history and deep laboratory analysis, with the result that it appears that the process is totally different pathogenetic and morphological features, and thus requires a different treatment strategy. This group of diseases is little known to practitioners and often causes difficulties in making a diagnosis and prescribing adequate treatment. That is why radiologists need to know the techniques of differential diagnosis of such conditions. The purpose of this publication is to highlight the features of radiological manifestations of viral pneumonia and to evaluate the possibilities of radiation diagnostics methods in their recognition based on their own observations and data from domestic and foreign literature.
Consilium Medicum. 2020;22(3):28-33
28-33
SERUM BIOMARKERS OF INFLAMMATION IN ACUTE AND CHRONIC INFLAMMATORY RESPIRATORY DISEASES: PRACTICE AND PROSPECTS
Abstract
Acute and chronic respiratory diseases of inflammatory origin are a huge burden on the health system worldwide. This review of foreign and domestic studies is devoted to the analysis of practical diagnostic and prognostic capabilities of serum biomarkers of inflammatory response, such as C-reactive protein, procalcitonin and presepsin, and the prospects for their use in low respiratory tract infections, including community-acquired pneumonia, as well as exacerbations of chronic obstructive pulmonary disease and asthma.
Consilium Medicum. 2020;22(3):34-39
34-39
FEATURES OF MYCOPLASMA INFECTION OF RESPIRATORY ORGANS IN CLINICAL PRACTICE
Abstract
Background. Diseases of the respiratory system, in which the etiological factor is Mycoplasma microorganisms, have a number of important features: the nonspecific clinical picture, which often leads to an incorrect diagnosis and, as a result, the inefficiency of prescribed medical measures, the need to conduct highly sensitive research methods taking into account the microbiological characteristics for accurate verification of the infectious agent, as well as the use of antimicrobial drugs with the presence of activity against atypical pathogens. Description of the clinical case. The article presents three clinical cases of extrahospital pneumonia of Mycoplasma etiology from the practice of a pulmonologist: two of them are devoted to extrahospital R-negative pneumonia in children, and the third one reflects a mild course of extrahospital peribronchial pneumonia in adults. There are indications of patient management tactics prior to contacting a pulmonologist. In all three clinical cases, there is a tendency to highlight the main and permanent symptom, which is cough. At the same time, there were no pronounced changes in laboratory and instrumental indicators. From the physical data of the examination, it should be noted that significant changes only affected the auscultative picture. Enzyme-linked immunosorbent assay and polymerase chain reaction methods played an important role in diagnostics. The importance of the role of crowded, organized groups in the spread of the pathogen, in particular the family, is noted. In the treatment, antimicrobial drugs of the macrolide group were used, against which there was an improvement in the dynamics of the patient's condition. Conclusion. Mycoplasma infection of the respiratory system has a poor clinical picture, in which an important place is occupied by cough, and also requires other, not related to routine, methods of diagnosis and treatment. These circumstances determine the need for alertness of specialists in relation to it, the thoroughness of collecting anamnesis and conducting a physical examination, as well as knowledge in the selection of antimicrobial drugs, not only in relation to the treatment of typical pathogens, but also atypical.
Consilium Medicum. 2020;22(3):40-45
40-45
CHRONIC BRONCHITIS: PHARMACOTHERAPEUTIC FOCUS ON COUGH HYPERSENSITIVITY COMPONENT
Abstract
Chronic productive cough is considered a marker of lower respiratory tract disorders such as chronic bronchitis, chronic obstructive pulmonary disease, bronchial asthma, and bronchiectasis. Chronic bronchitis pathogenesis includes prominent symptoms of muco-ciliary clearance disturbance (bronchial mucous viscosity, expectorations disorders, ciliated epithelium activity disorders). In the meantime it was shown that in chronic cough pathogenesis hypersensitive component that develops in consequence of increased sensitivity of peripheral and central components of coughing reflex plays an essential role. Treatment of cough that developed as a result of multifactorial pathogenesis is of concern. For example it requires using mucoactive therapy and medications that directly influence increased sensitivity to cough ( anti-tussive medications). A well known medication that is a fixed combination of salbutamol, bromhexine, and guaiphenesine (Ascoril) has shown its effectiveness in treatment of productive cough in patients with chronic respiratory disorders allowing solve all formulated problems.
Consilium Medicum. 2020;22(3):46-54
46-54
INHALATION DEVICE CHOICE FOR PATIENTS WITH BRONCHO-OBSTRUCTIVE DISORDERS
Abstract
Medicinal aerosol inhalation is the main medication administration route in treatment of broncho-obstructive disorders. Inhalation therapy effectiveness depends not only on the right choice of medication, but also on adequacy of its delivery to respiratory tract. Personalized approach with consideration of device technical characteristics and evaluation of possibilities of its use by the patient should be acknowledged to be an optimal tactics of inhalation device choice. A new dosed aerosol inhaler containing budesonide/formoterol with dose counter system appeared on Russian market in 2019. That opens new opportunities of the medication use that was previously available for patients with broncho-obstructive disorders only in the form of dosed powder inhaler.
Consilium Medicum. 2020;22(3):55-60
55-60
POSSIBLE AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS
Abstract
Pulmonary alveolar proteinosis is a rare pulmonary syndrome characterized with accumulation of lipoprotein complexes in alveoli as a result of disturbance of utilization of surfactant by alveolar macrophages. Lack of pathognomonic symptoms and signs as well as pathological changes in routine examination methods is one of the reasons of its untimely diagnosis. The article presents a clinical case of a 51-year-old patient with progressive shortness of breath and ling infiltrates that were interpreted as a sign of bilateral pneumonia. High-resolution computer tomography of chest organs showed a typical pattern for this syndrome, so-called crazy paving (segments of pulmonary tissue induration, ground-glass opacity, with visualized reticular structures). Changes typical to alveolar proteinosis were also found when bronchoalveolar lavage was studied and lung diffusion capacity was evaluated.
Consilium Medicum. 2020;22(3):61-64
61-64
EXAMPLE OF DEATH OF A PATIENT FROM A GENERALIZED TUBERCULOSIS PROCESS AT A LATE STAGE OF HIV INFECTION. CLINICAL CASE
Abstract
The article presents an example of a lethal outcome in a patient with disseminated tuberculosis comorbid with advanced stage of HIV infection. Patient’s medical history and anatomico-pathological results were analyzed in order to improve diagnostics of disseminated tuberculosis in patients with advanced stage of HIV infection according to clinical and radiological data, and immune status changes. Puncture biopsy of different organs is of significant diagnostic value for tuberculosis detection in patients with HIV infection. The authors emphasize that tuberculosis comorbid with HIV infection has a high risk of process dissemination with involvement of all organs and tissues, has an acute course and results in patients’ death in a short time.
Consilium Medicum. 2020;22(3):65-69
65-69
NECROTIZING (MALIGNANT) EXTERNAL OTITIS: A MODERN REVIEW OF DIAGNOSIS AND MANAGEMENT
Abstract
A review of modern principles of diagnosis and treatment of necrotic external otitis, which is a rare disease, is conducted, however, as it progresses and in the absence of adequate treatment, the treatment tends to spread to the bones of the skull base, which can lead to death. The risk group includes elderly patients with diabetes mellitus and patients with various immune disorders. The main infectious agents in the development of necrotic external otitis, the main of which is Pseudomonas aeruginosa, are considered. Mandatory and additional diagnostic criteria, which should be followed when establishing a diagnosis are presented. In therapeutic tactics, antibiotic therapy the main place. The fluoroquinolones and cephalosporins of the third generation are the drugs of choice, with scientists still discussing the duration of therapy, which most often is 6 weeks. The question of surgical treatment remains debatable, the indications and results of this method in patients with necrotizing external otitis are highlighted.
Consilium Medicum. 2020;22(3):70-73
70-73
A CONTEMPORARY VIEW ON DIAGNOSIS AND TREATMENT OF MENIERE’S DISEASE
Abstract
Meniere's disease is an idiopathic condition of the inner ear, characterized by episodic attacks of vertigo, aural fullness, tinnitus and a sensorineural hearing loss. Meniere's disease has a progressive course despite of the treatment. This implies that the pathogenesis of Meniere's disease is not well understood and the treatment methods used are ineffective. The aim of this review is to summarize the contemporary theories of the pathogenesis of Meniere's disease, as well as to analyze different methods of diagnosis and treatment.
Consilium Medicum. 2020;22(3):74-79
74-79
INFLUENCE OF LOCAL APPLICATION OF POLYOXIDONIUM ON SYMPTOMS AND COURSE OF ACUTE RESPIRATORY VIRAL INFECTION IN CHILDREN: RESULTS OF MULTICENTER DOUBLE-BLIND PLACEBO CONTROLLED STUDY
Abstract
Aim. To confirm advantages of Polyoxidonium® local application therapeutic effect in comparison with placebo when being used as a part of complex therapy in children aged 1 to 12 years diagnosed with acute respiratory viral infection (ARVI). Materials and methods. The study included 155 children aged 1 to 12 years diagnosed with ARVI. The study group included 76 children in whom complex therapy included Polyoxidonium® and comparison group included 79 children who received placebo as a part of complex therapy. The study outcome measures evaluating therapy effectiveness included intoxication symptoms, nasal mucosa inflammation dynamics, total sum of the symptoms points at the 3rd, 5th, and 8th days of treatment, and the duration of fever. Results. According to study results the advantage of Polyoxidonium® use in comparison with placebo in complex treatment of children aged 1 to 12 years diagnosed with ARVI was established. Inclusion of Polyoxidonium in complex ARVI treatment in children allows to provide better control of intoxication symptoms to decrease severity of symptoms such as “nasal discharge” and “nasal blockage” by the 5th day of treatment, to double the amount of patients without the “nasal discharge” symptom by the 3rd and 5th days of treatment, and to decrease the severity of infection inflammatory process. Conclusion. Local application of Polyoxidonium® in complex treatment of ARVI in children aged 1 to 12 years showed clinical effectiveness and safety.
Consilium Medicum. 2020;22(3):80-86
80-86
DYNAMICS OF STUDENTS' KNOWLEDGE IN THE MANAGEMENT OF PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA AFTER ADDITIONAL EDUCATIONAL EVENTS
Abstract
Background. Community-acquired pneumonia (CAP) is an acute infectious disease characterized by a focal lesion of the respiratory parts of the lungs with in-traalveolar exudation, detected by objective and x-ray examination, expressed in varying degrees of fever and intoxication. The mortality rate from CAP is 5%, but among patients requiring hospitalization, it reaches 21.9%, and among the elderly - 46% Aim. To evaluate the impact of additional educational activities on the dynamics of knowledge of senior students in CAP. Materials and methods. In the study, KNOCAP conducted a two-stage questionnaire study 114 students in primary and 91 student control groups V-VI courses medical Institute, Belgorod State National Research University and Burdenko Voronezh State Medical University. The first stage of this project was implemented during the period 2017-2018, the second - for 2018-2019 academic years. Between the two stages of the survey, additional educational activities of the above respondents were conducted in the main group (as part of the cycle of "clinical pharmacology"). Results. During the initial survey, the average level of knowledge on the questionnaires in the main group was 40.6%, in the control group 41.2%, after the educational events, there was a significant increase in ARC in the main group 53.6% and a slight (43.2%) in the control group. At the same time, the analysis of the aggregate correct, partially correct and erroneous answers to all questions of repeated questionnaires revealed a statistically significant relationship between factor and performance indicators (p<0.001, criterion x2 is 36.826). Conclusion. We can talk about the need to optimize educational activities in the management of patients with CAP, which will increase the knowledge levels of young specialists, reduce the number of iatrogenic complications, and improve the quality of treatment for this category of patients.
Consilium Medicum. 2020;22(3):87-93
87-93