Хронический риносинусит у взрослых больных муковисцидозом: клинические проявления и подходы к лечению

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS. Хронический риносинусит (ХРС) с полипами носа (ПН) или без таковых распространен среди взрослых больных муковисцидозом (МВ) в 90–100 % случаев. Околоносовые пазухи (ОНП) являются резервуаром хронической инфекции, что отрицательно сказывается на общем состоянии и прогнозе у пациентов с МВ. При этом методы лечения ХРС у больных этой категории в мире определены недостаточно.Целью настоящего исследования явилось определение распространенности ХРС с ПН или без таковых среди взрослых пациентов с МВ в России, изучение особенностей течения ХРС, выработка оптимальной тактики лечения.Материалы и методы. Изучение структуры оториноларингологической патологии выполнялось на выборке пациентов (n = 348) – граждан Российской Федерации (осмотр, опрос, компьютерная томография (КТ) пазух носа и аудиометрия по показаниям). Изучение ХРС производилось у пациентов (n = 28) с ХРС с ПН II степени с обеих сторон; больные были распределены на 2 равные группы. В обеих группах проведены эндоскопический осмотр, сбор анамнеза и жалоб при помощи опросника SNOT-20, КТ ОНП, риноманометрия, микробиологическое исследование мокроты и образцов из ОНП (полученных при пункции или интраоперационно), спирометрия, лабораторное исследование воспалительных маркеров в периферической крови). В 1-й группе (n = 14) выполнена эндоскопическая полисинусотомия, во 2-й – только консервативное лечение. Больные 1-й и 2-й групп получали консервативное лечение в течение 6 мес. (мометазон в полость носа, ингаляции муколитических и антибактериальных препаратов в область пазух носа через PARI SinusTM). Оценены результаты обследования до и после лечения, частота обострений легочной патологии.Результаты. У больных обеих групп выявлено уменьшение жалоб пациентов, достоверное улучшение показателей КТ, риноманометрии, эндоскопической картины. В группе хирургического лечения отмечена более высокая положительная динамика перечисленных показателей. Понижение степени инфицирования патогенной флорой пазух носа и частоты обострений легочной патологии, повышение сатурации периферической крови кислородом и понижение достигнуто только у больных 1-й группы. Лечение ХРС не оказало значимого влияния на показатели спирометрии, микробный состав мокроты и уровень маркеров воспаления в периферической крови.Заключение. Эндоскопическая полисинустотомия с последующей муколитической и антибактериальной терапией области пазух носа является эффективным и хорошо переносимым методом лечения ХРС для взрослых больных МВ.

Osteomalation under the mask of spondyloarthritis

Objective. To demonstrate the possibility of having a spondyloarthritic mask of osteomalacia in patients of both sexes.Materials and methods. Two clinical cases of osteomalacia occurring under the mask of spondyloarthritis in patients treated at the Clinical Rheumatology Hospital of Saint-Petersburg, Russia, as well as similar cases described in the literature, were analyzed.Results. In the cases described, patients were diagnosed with a disease from the group of spondyloarthritis based on a number of individual symptoms, such as pain in the lower back and stiffness, as well as instrumental examination data. At the same time, with in-depth evaluation, the pain in the lower back did not did not met to the inflammatory pain ASAS criteria, and there were also no signs of general laboratory activity of the disease. The conventional therapy for spondyloarthritis was ineffective. With the re-evaluation of clinical, laboratory and instrumental data, the diagnosis was changed to osteomalacia. Appointment of adequate therapy with vitamin D after a review of the diagnosis resulted in both a regression of clinical symptoms and an improvement in laboratory parameters.Conclusions. If the patient has pain in the lower back, especially without clear signs of inflammatory, no signs of general laboratory activity, further examination is necessary to clarify possible osteomalacia. Spondyloarthritis should be only diagnosed in cases with the secondary nature of symptoms excluded

MICROFLORA OF THE RESPIRATORY TRACT IN PATIENTS WITH CYSTIC FIBROSIS AND SENSITIVITY TO ANTIBIOTICS BASED ON A 15-YEAR FOLLOW-UP (2000–2015 YEARS)

Chronic lower respiratory tract infection in patients with cystic fibrosis (CF) is the major factor determining the severity of the clinical course and prognosis of the disease. The purpose of the study was to investigate the prevailing respiratory microflora in patients with CF and changes in the activity of antibacterial medicines (ABM) during the period 2000–2015 in order to optimize guidelines for antibiotic therapy. Bronchial secretion was evaluated in CF patients from 2000 till 2015. 9774 samples were studied, 16.703 microbial strains were obtained. In 2000–2015, P. aeruginosa (smooth and mucoid morphological types) was the most widespread gram-negative strain. Typical strains of P. aeruginosa were isolated more often than mucoid morphotypes. In 2000–2015, isolation rates for P. aeruginosa decreased from 41.2 to 20.0% (p <0.001). The proportion of B. cepacia complex increased from 1.1 to 7.3%, up to 11.3% in 2008–2011, and a rise in the proportion A. xylosoxidans was registered from 2.9 to 4.9% (p <0.001). During the follow-up period, the diversity of isolated species has grown.ABM such as colistin (active against 100% of strains), carbapenems (imipenem is active against 70.3–72.2% of strains, and meropenem against 75.8 and 78.9%) remain active against P. aeruginosa. The effect of piperacillin/tazobactam is similar to that of carbapenems. Cefepime is less effective than ceftazidime. Fluoroquinolones and tobramycin also remian active