INTRODUCTION: In recent years, the production and regulation of synthesis of hyaluronic acid in COVID-19 has been actively studied. Hyaluronan plays a significant role in development of severe lung damage in COVID-19 and is a potential therapeutic target the action on which will probably improve prognosis for patients with COVID-19. AIM: To study prospects of using bovhyaluronidaze azoximer in complex treatment of patients with COVID-19 with lung damage at the inpatient stage. MATERIALS AND METHODS: Thirty five patients (6 men and 29 women) aged 58.9 12.9 years hospitalized with COVID-19 infection, were examined. Capillary blood saturation (SpO2) was 80.1 8.6%, the volume of lung damage in X-ray computed tomography (X-ray CT) was 45.1 19.4% on the right and 40.0 19.5% on the left. All the patients received treatment according to the Temporary Guidelines: prevention, diagnosis and treatment of novel coronavirus infection. Ver. 14 (27.12.2021). Besides, as part of complex treatment for COVID-19, bovhyaluronidaze azoximer was administered intramuscularly on the 21.9 6.8th day of illness with a course of 10 injections (once in 3 days). RESULTS: In the course of comprehensive treatment including bovhyaluronidaze azoximer, increase in SpO2 was recorded: in 7 patients ― after 1 injection (4.2 1.7%), in 24 ― after 2 injections (5.4 0.6%), another 4 patients did not show any significant increase in SpO2 after the first two injections. Increase in SpO2 after the 1st injection inversely correlated with age (r = -0.34; p 0.05) and the initial saturation (r = -0.38; p 0.05). Increase in SpO2 after the second injection correlated with the day of illness on which treatment with bovhyaluronidaze azoximer began (r = -0.36; p 0.05). CONCLUSION: Use of bovhyaluronidaze azoximer in complex treatment for COVID-19 with the lung damage at the inpatient stage can be effective in younger patients with more expressed initial reduction of SpO2, and also in case of administration of the drug in the early stages of the disease. The data obtained in the pilot study, dictate the necessity of studying the level of hyaluronic acid in blood of patients with COVID-19 and lung damage and its role in risk stratification of such patients.

Bronchial asthma and chronic obstructive pulmonary disease are the most common obstructive diseases of the respiratory system. 230 million people suffer from chronic obstructive pulmonary disease, from bronchial asthma - 300 million people worldwide. Annually 200-300 people in Europe and 2.74 million of world population die from chronic obstructive pulmonary disease, from asthma - 250 thousand people a year. The social and economic significance of these diseases determine the need for in-depth study of their combination in the same patient. Each disease has its own phenotypes, but in 10-20% of patients, there are symptoms of both chronic obstructive pulmonary disease and asthma. In spite of clear diagnostic criteria, in some cases it is difficult to distinguish these diseases. Morphological basis of these diseases is a chronic inflammation in the bronchial tree that causes damage to the epithelial continuity that initiates bronchoconstrictive reaction and leads to irreversible airway obstruction attributable for both severe bronchial obstruction and chronic obstructive pulmonary disease. However, the treatment strategy of bronchial asthma and chronic obstructive pulmonary disease has significant differences, it is important to have a clear diagnostic criteria to distinguish different phenotypes, including those of combined phenotype of asthma and chronic obstructive pulmonary disease. Rational starting therapy of asthma and chronic obstructive pulmonary disease overlap syndrome includes drugs acting on the pathogenic mechanisms of both diseases, and is a combination of inhaled corticosteroids with combined bronchodilator therapy - long-acting β2-agonists and long-acting anticholinergics.

Рязанский государственный медицинский университет имени академика И.П. Павлова, Рязань, Российская Федерация _____________________________________________________________________________ Обоснование. Важная роль среди экстрапульмональных проявлений при хронической обструктивной болезни легких (ХОБЛ) принадлежит когнитивным нарушениям. Однако на данный момент нет чѐткого понимания роли хронической обструктивной болезни легких в их формировании. Цель. Изучить роль хронической обструктивной болезни легких в формировании когнитивных нарушений и их особенностей на различных стадиях ХОБЛ. Материалы и методы. В исследование включено 55 мужчин, разделѐнных на две группы: 28 пациентов с хронической обструктивной болезнью легких и 27 условно здоровых добровольцев в группе контроля. Всем исследуемым выполнено общеклинической обследование, спирометрия, пульсоксиметрия, оценочный тест CAT и оценка когнитивных функций с помощью MoCA-теста. Результаты. У пациентов с ХОБЛ отмечается снижение когнитивных функций по данным MoCA-теста (24 балла против 27 баллов в контрольной группе, p=0,003). Наибольший вклад в снижение когнитивных функций у пациентов с ХОБЛ вносят двигательные нарушения (p=0,032), изменение памяти (p=0,016), координаторные нарушения (p=0,010) и нарушения сна (p<0,001). Установлено, что у больных ХОБЛ общий балл MoCA-теста коррелирует с баллами оценочного теста CAT (r=-0,580, p=0,001) и сатурацией (r=0,420, p=0,026). У пациентов ХОБЛ группы D отмечаются более низкие показатели когнитивной функции, по сравнению с группой C (20 баллов против 28 баллов соответственно, p=0,011). Пациенты с ХОБЛ имеют тенденцию к более высокой частоте нарушений сна (61% против 33%) и головокружениям (25% против 7%). Заключение. У больных хронической обструктивной болезнью легких отмечается выраженное снижение когнитивных функций. Увеличение выраженности бронхиальной обструкции и нарастание симптомов сопровождается прогрессирующим снижением когнитивных функций. У больных хронической обструктивной болезнью лѐгких чаще отмечаются нарушения сна и памяти, страдают речь и способность к абстракции, а также зрительно-конструктивные и исполнительные навыки. Ключевые слова: хроническая обструктивная болезнь легких, MoCA-тест, когнитивные нарушения.

Background. Chronic obstructive pulmonary disease and bronchial asthma, when combined in one patient, are characterized by a low level of control. Excess weight aggravates the course of obstructive diseases. The study of the features of this syntropy will improve the effectiveness of therapeutic measures. Aim. The study of the level of cytokines and carbonylated proteins in patients with a combination of bronchial asthma and chronic obstructive pulmonary disease with overweight and normal weight during an exacerbation. Material and methods. The study included 136 people: the first group a combination of bronchial asthma and chronic obstructive pulmonary disease (n=30), the second bronchial asthma (n=36), the third chronic obstructive pulmonary disease (n=29), the fourth volunteers without respiratory diseases (n=41). Each group was divided into two subgroups depending on the body mass index (less than 25 kg/m2 or 25 kg/m2 and more). The concentrations of interleukins-6 and -8, tumor necrosis factor in blood plasma were determined by enzyme immunoassay. The level of carbonylated plasma proteins was assessed spectrophotometrically. Statistical processing was performed in the Statistica 10.0 program using nonparametric criteria. The correlation of the studied parameters was assessed using the Spearman coefficient. Results. In patients with a combination of bronchial asthma and chronic obstructive pulmonary disease, statistically significant positive correlations between the levels of interleukins-6 and -8, tumor necrosis factor and carbonylated proteins were found 0.51, 0.59 and 0.55, respectively (p 0.05). Patients of the first group with overweight differed by 37.5% in higher levels of interleukin-6 compared with patients with body mass index 25 kg/m2. Conclusion. The intensity of systemic inflammation in patients with a combination of bronchial asthma and chronic obstructive pulmonary disease during exacerbation correlates with the intensity of oxidative damage.

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients.