Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals.

Design: Registry, multicentre, prospective observational study.

Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class).

Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%).

Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT.

Aim: To study the correlation of laboratory and instrumental indicators with the severity of the COVID-19 and to assess the dynamics of changes of the lipid profile and the electrical axis of the heart of patients in the acute period of the disease and after recovery.

Design: Retrospective observational study.

Materials and Methods. A retrospective analysis of medical histories of 30 young patients (18–44 years) without cardiovascular diseases, who underwent two-stage treatment at the Military Medical Academy named after S.M. Kirov with diagnoses: «COVID-19, virus identified» (U07.1, ICD-10) and «Post COVID-19 condition» (U09.9, ICD-10) in the period from April to December 2021.

Results. The study found that individuals after COVID-19 had an increase in total cholesterol concentrations (6.51 [5.62–6.79] mmol/l), low-density lipoprotein (3.89 [3.34–4.52] mmol/l) and very low-density lipoprotein (1.06 ± 0.72 mmol/l) as opposed to acute period of COVID-19, where the lipid spectrum remained within normal values. In addition, an electrocardiogram analysis showed dynamics of the alpha angle changed from 42 ± 11 to 25 ± 17 degrees of patients after the elimination of SARS-CoV-2, with the deviation of the electrical axis of the heart to the left was detected of the first time in 5 (17%) patients after COVID-19.

Conclusion. Individuals after COVID-19, who have been identified for the first time as having dyslipidemia and deviation of the electrical axis of the heart to the left, as well as high levels of inflammation markers can be considered by candidates for high-tech imaging techniques to eliminate damage of the cardiovascular system.

Aim: to study the effect of a two-week course of sanatorium treatment using both iodine-bromine baths (IBB) and physical training (PT) on physical performance of coronary heart disease (CHD) patients with stable angina when using their different combinations.

Design: the randomized, controlled, prospective study.

Materials and methods. The study included 126 CHD patients, divided into 3 groups. 42 patients (Group 1) were prescribed IBB and PT on a bicycle ergometer; with PT performed 1,5–2 hours before taking IBB (Complex No. 1). 43 individuals (Group 2) were prescribed IBB and PT, with the latter performed 1,5–2 hours after taking IBB (Complex No. 2). 41 patients (Group 3, control) received IBB and therapeutic exercises (TE) Complex No. 3). Physical factors in the groups of CHD patients were prescribed every other day, with the treatment duration being 2 weeks (14 days). The evaluation of the results in CHD patients was carried out using 24-hour Holter ECG monitoring, spiro- and bicycle ergometry.

Results. A spiro- and bicycle ergometry showed that the rehabilitation courses for CHD patients with the Complex No. 1 gives a more pronounced training effect and an increase in coronary reserve than the Complex No. 2 or when prescribing IBB and TE. The decrease in myocardial ischemia while 24-hour Holter ECG monitoring in CHD patients was also the largest after the Complex No. 1 rehabilitation. The training effect of the Complex, i.e. when PT was prescribed before taking IBB, led to both a greater increase in the coronary reserve and a decrease in myocardial ischemia in CHD patients, compared with either prescribing PT after taking IBB or when using IBB and TE.

Conclusion. Thus, the rehabilitation effectiveness for CHD patients with a shortened time of using iodine-bromine baths and physical training up to fourteen days depends on their combinations. The best result was obtained when prescribing PT before taking IBB.

Objective of the Review: To demonstrate the complexity in diagnosing postural orthostatic tachycardia syndrome.

Key Points. Clinical manifestations of postural orthostatic tachycardia syndrome vary and can have a clinical phenotype that is similar to a number of neurological and somatic conditions.

Conclusion. The case studies presented demonstrate the significance of diagnostic manoeuvres in differentiating this syndrome from other types of impairment of consciousness. An active test in standing position which is easy to conduct can be a diagnostic prompt, if it is verified with a history of typical chronic orthostatic intolerability, postural heart acceleration, and a variety of accompanying complaints.

Aim: to compare the clinical manifestations in patients with genotypes 1 and 3 of viral hepatitis C (HCV) depending on the severity of liver fibrosis (LF).

Study Design: a comparative study of randomized groups of patients treated in an inpatient or outpatient setting.

Materials and methods. A total of 297 patients with HCV genotype 1 and 231 patients with HCV genotype 3 were examined. The diagnosis of chronic viral hepatitis C was established according to the recommendations of the European Association for the Study of the Liver. All patients underwent clinical and biochemical blood tests, ultrasound examination of the liver and pancreas. LF was studied by shear wave transient elastometry with METAVIR score.

Results. Severe LF was associated in both groups of patients with an increase in the frequency of liver complaints, hepatomegaly and splenomegaly, an increase in the content of bilirubin and alanine aminotransferase in the blood, a decrease in the number of platelets and the concentration of albumin in the blood. Only in patients with HCV genotype 3 was an increase in viral load and a trend towards a decrease in the proportion of neutrophils in the blood in patients with stages 3–4 LF compared with 0–2 stages of LF according to METAVIR.

Conclusion. We think that the explanation for the higher incidence of severe LF in patients with HCV genotype 3 is probably a more significant deformation of the immune response, leading to an increase in viral load and an aggressive course of pathology.

Aim: to determine the diagnostic efficiency of contrast-enhanced ultrasound of the liver in patients with chronic viral hepatitis B and C.

Study Design: open randomized study.

Materials and methods. 240 people were examined on the basis of the Smolensk Clinical Hospital No. 1 from 2019 to 2021: patients with chronic viral hepatitis who have been examined by contrast-enhanced ultrasound; patients with chronic viral hepatitis who have not been examined by contrast-enhanced ultrasound to determine the diagnostic effectiveness of the method in assessing the complicated course development, patients without chronic viral hepatitis who have been examined by contrast-enhanced ultrasound to determine the standardized CEUS parameters. Liver biopsy and shear wave elastography were used as reference methods.

Results. It was found that the greatest changes in contrast-enhanced ultrasound parameters were observed in patients with F4 fibrosis stage according to the METAVIR score. It was also found that the assessment of qualitative parameters according to the proposed standardized program has the highest diagnostic potential, and among the quantitative parameters — the difference of quantitative parameters in the proximal and distal zones (time of arrival, time to peak, peak intensity, half-time washout).

Conclusion. The use of a contrast agent increases the value of the ultrasound method in the diagnostic algorithm for patients with chronic viral hepatitis.

Aim: To research the relationship between laboratory and instrumental manifestations of pathology and polymorphisms of inflammatory cytokine genes in patients with Opisthorchis felineus invasion.

Design. During 2022, we conducted a comparative study of patients who were hospitalized for etiotropic therapy of O. felineus invasion.

Materials and methods. 139 patients with O. felineus invasion were examined. All patients underwent clinical and biochemical blood tests, ultrasound of the abdominal organs and liver elastometry with an assessment of liver fibrosis according to the METAVIR scale. Genotyping of single nucleotide polymorphisms of the IL28b, IL6, TNFA, and IFNG genes was performed using real-time PCR.

Results. In patients with opisthorchiasis, liver fibrosis was associated with the presence of the minor allele A of the rs1800630 TNFA polymorphism and the TC genotype of rs2069705 IFNG. Polyps in the gallbladder were associated with the CC genotype of rs1800630 TNFA, while an increase in alkaline phosphatase and an increase in the proportion of eosinophils in the blood were associated with the CC genotype of rs2069705 IFNG. We did not find differences in the studied parameters depending on the genetic polymorphisms rs12979860 IL28b and rs1800795 IL6 in patients with O. felineus invasion.

Conclusion. The obtained regularities should be used to increase the efficiency of dispensary observation in order to prevent the development of complications of parasitic invasion.

Aim: To assess the quality of life, the level of anxiety and depression in patients with ulcerative colitis (UC) depending on disease active/inactive status.

Design: comparative prospective study.

Materials and methods. In 2018–2020, a clinical study was conducted in Prof. S. V. Ochapovskiy Regional Clinical Hospital No. 1, which enrolled 218 patients: 178 patients with UC (139 patients with active disease and 39 patients with inactive disease) and 40 healthy volunteers (control group). In addition to routine examinations and faecal inflammatory markers, all patients underwent a quality-of-life assessment using The Short Form-36 (SF-36) and Inflammatory Bowel Disease Questionnaire (IBDQ), Clinical Activity Index (CAI), anxiety and depression evaluation using the Hospital Anxiety and Depression (HADS) scale.

Results. The lowest mean values for SF-36 and the strongest correlations with CAI were observed in UC patients for the following domains: viability scale, overall health and emotional functioning (р < 0.05). Significant differences were recorded for IBDQ in mean values and correlations between the points on the scale and CAI for all domains (р = 0.0001). The strongest correlations were observed for the overall points and the “intestinal factor” domain (р = 0.0001). Lower mean values for SF-36 were in patients with chronic diseases not related to UC; for IBDQ, the situation was opposite — patients with extraintestinal UC signs had lower mean values. We found a correlation between HADS and CAI points which shows severity of an UC episode (r = 0.560; р = 0.01).

Conclusions. The results demonstrate the importance of evaluation of the quality of life of patients with UC using both specific and non-specific questionnaires, since they complement each other and allow personalising therapeutic approaches for patients with UC.

Aim: To identify the incidence and the characteristics of adverse reactions, to mitigate them, and to determine possible adjustments in antimicrobial therapy.

Design: Observational retrospective long-term study.

Materials and methods. We examined 125 patients with nontuberculous lung mycobacteriosis. 73.6% of cases had concomitant diseases.

Results. The therapy for nontuberculous mycobacteriosis was prescribed in 115 patients, depending on drug susceptibility, and included at least 3 drug products. 31.3% of patients had adverse reactions; one third of these patients had allergic reactions. Hepatotoxic reactions were recorded in 16.5% of cases, cardiotoxic — in 12.2%, ototoxic — in 10.4%, optic neuritis was diagnosed in 5 % of cases. In 31.3% of cases, the therapy was adjusted, in 13.9% of cases, the therapy was reviewed and alternative treatment was offered. The complete antibacterial course was prescribed to 79 (68.7%) patients.

Conclusion. The therapy for nontuberculous mycobacteriosis should be selected in inpatient settings with laboratory and functional monitoring.

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.

Objective of the Review: To summarise the data from literature sources on respiratory rehabilitation of patients with the novel coronavirus infection; to assess the current state and perspectives.

Key Points. The novel coronavirus infection (COVID-19) is a highly contagious acute respiratory disease with primary involvement of upper and lower respiratory tract, organs and systems of the body. The symptoms of the disease vary from asymptomatic carrier to clinically severe viral pneumonia that requires oxygen therapy and respiratory support. Respiratory rehabilitation is vital for patient recovery. Globally, there is more and more professional information and databases on respiratory rehabilitation of COVID-19 patients, since the common methods of rehabilitation after a respiratory disease can be ineffective or unsafe.

Conclusion. Respiratory rehabilitation should be an integral part of COVID-19 therapy, starting from ICU once the patient’s condition has stabilised. Rehabilitation should be personalised. Future studies will help in understanding the development path of pulmonary rehabilitation in order to improve the quality of patients’ life and to facilitate faster activity restoration.