Experience of long-term use of anti-IgE therapy in a patient with chronic spontaneous urticarial

Chronic spontaneous urticaria is an urgent health problem. Recurrent urticarial rashes, angioedema and severe itching reduce the quality of life of patients. The ineffectiveness of standard therapy requires the search for new modern methods of treating this disease. Taking into account the current data on the pathogenesis, the third line of therapy for chronic spontaneous urticaria is the addition of anti-IgE therapy (omalizumab) to antihistamines of the 2nd generation. The presented clinical case is devoted to the experience of long-term use of omalizumab in a patient with chronic spontaneous urticaria. Having a disease duration of about a year, the patient was thoroughly examined, all concomitant diseases were identified and compensated, parasitic invasion was treated, but this did not lead to a regression of symptoms. Antihistamines of the 2nd generation in standard and increased doses (up to 4 times) did not control the disease, systemic glucocorticosteroids stopped the symptoms for a short time, and therefore, in  the future, the  patient began to use them independently and uncontrollably. Almost daily use of  corticosteroids for 6 months caused the development of complications in the form of weight gain and Cushing’s syndrome. Omalizumab completely stopped all the symptoms during the first day, no side effects were detected. The clinical effect lasted from 3 to 4 weeks. Thus, omalizumab therapy allowed the patient to almost completely get rid of the symptoms of CSC, which significantly improved the quality of life and made it possible to cancel systemic glucocorticosteroids. The peculiarity of the presented case is the duration of the use of omalizumab (more than 2 years) with the inability to cancel due to the return of urticarial rashes and itching

Experience with the triple fixed combination in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the most important problems of modern medicine associated with a high mortality rate, high costs of treatment and relief of exacerbations of COPD. The main objectives of COPD treatment are symptom control, reduce the frequency of exacerbations and hospitalizations, and reduced risk of exacerbation in the future. The recommendations of the GOLD initiative propose a treatment approach based on the assessment of exacerbation rates external respiratory function indicators (spirometric classification of GOLD), the severity of symptoms assessed on the CAT test and mMRC. When choosing therapy, the physician must first of all take into account the effectiveness, safety of the drug, adherence to treatment in order to achieve the therapeutic goals of treating patients with COPD. The change in therapeutic approaches in COPD treatment is associated with the accumulation of knowledge in physiology, clinical pharmacology, and the isolation of new clinical phenotypes of COPD. Currently, the main classes of drugs for the treatment of COPD are long-acting beta-agonists (LABA), longacting anticholinergics (LAMA), and inhaled glucocorticosteroids (ICS). The evolution of therapeutic approaches in COPD treatment has led to the creation of new fixed inhalation combinations of the main groups of drugs for COPD treatment. The therapeutic strategies recommended by GOLD and the Russian Federal Guidelines determine the long-term goals of COPD treatment – the impact on the risk of exacerbations in the future. The presented clinical observation of a patient with severe COPD demonstrates the effectiveness of a triple fixed combination vilanterol/umeclidinium/fluticasone furoate 55/22/92 μg as a basic therapy. The  chosen treatment strategy not only reduces the  severity of  the  symptoms of  the  disease, but also reduces the  risk of exacerbations in the future

Efficiency of Using the Hydrogen Peroxide Vapor Generator “Fhileas 75” for Disinfection of the Air Ducts of separately Ventilated system for Infected Animal Housing

The aim of the work was to evaluate the efficiency of using the “Fhileas 75” hydrogen peroxide vapor generator for decontaminating the air ducts of the individually ventilated system, “Bio A.S.”, for housing of infected animals.Materials and methods. The hydrogen peroxide vapor generator “Fhileas 75” (France), a disinfectant manufactured by “FHILEASAFE” (7 % hydrogen peroxide solution and 0.15 % peracetic acid solution), separately ventilated system “Bio A.S.” (Germany) for the infected animal housing were applied in the work. Serratia marcescens 9 was used as test-culture.Results and discussion. The efficiency of using the hydrogen peroxide vapor generator “Fhileas 75” for decontamination of air ducts and internal surfaces of the rack of the individually ventilated system “Bio A.S.” on the test-culture S. marcescens 9 at 1·106 mc/ml concentration has been established (operation parameters of the individually ventilated system unit are as follows: air exchange rate – 60 changes per hour, air flow volume – 28 m3/hour, number of disinfection cycles – 5, disinfectant spraying time – 97 min, exposure time – 24 hours)

Free-radical oxidation as a pathogenetic factor of metabolic syndrome

The medical and social significance of cardiovascular diseases remains high. One of the factors that determine cardiovascular risks is metabolic syndrome. As a result of excessive accumulation of lipid and carbohydrate metabolism products in metabolic syndrome, oxidative (oxidative) stress develops. The article considers both domestic and foreign scientific studies, which highlight various aspects of the influence of reactive oxygen and nitrogen species, as well as other free radicals on the formation of oxidative stress in pathological conditions that are part of the metabolic syndrome complex. This describes the mechanisms of the formation of chronic inflammation through excessive secretion of pro-inflammatory cytokines and adipokines, activation of the transcription factor NF-kB, as well as damage to the antioxidant system in obesity. Separately, a number of mechanisms of the stimulating effect of adipokines: leptin, adiponectin, chimerine, omentin 1, resistin, on the formation of oxidative stress have been noted. The ways of activating the polyol pathway, as well as diacyl-glycerol — protein kinase C — the signaling pathway of oxidative stress, the formation of mitochondrial dysfunction is described. As a result of which there is an excessive production of free radicals in insulin resistance, diabetes mellitus and macroand microvascular complications of diabetes. In addition, the influence of oxidative stress directly on the formation of cardiovascular diseases of atherosclerotic genesis, as well as arterial hypertension, has been shown

Features of cellular structure of the induced sputum and profile of cytokines at sintropiya of bronchial asthma and obesity at young patients

Aim. To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. Materials and methods. 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. Results. There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. Conclusion. Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient

Исследование влияния процесса модификации на групповой состав битума и модификаторов методом Фурье-ИК-спектроскопии

Objectives. This study evaluates the effect of the modification process on the group composition of bitumen and bitumen binders containing rubber powder and hybrid modifier that is based on styrene–butadiene thermoplastic elastomer and rubber crumb. The aim of the study was to determine the presence or absence of functional groups that reflect the direction of physicochemical processes during the preparation of a hybrid modifier in rotary dispersers and during the modification of bitumen binders. Methods. Rubber powder and hybrid modifier were obtained by high-temperature shear grinding using a rotary disperser. Bitumen and modified bitumen binders were investigated via Fouriertransform infrared spectroscopy. Using the method of spectral subtraction, it was determined that during the process of manufacturing modified bitumen binders, structural changes occur in both bitumen and modifiers. During this study, the extraction of modifiers (rubber powder and hybrid modifier) in toluene was performed. Results. The quantitative analysis of changes in the group composition of modifiers before and after the modification procedure was carried out. The active polymer and structural indices were determined. The general trend of the change in the active polymer and structural indices was noted for the initial spectra of the rubber powder and hybrid modifier, and their spectra were obtained after the procedure of subtraction from the spectra of bitumen binders. Conclusions. The interdiffusion of aromatic compounds between the bitumen component and modifier particles was confirmed. On the basis of the results of the extraction of modifiers in toluene, and by taking into account the infrared spectroscopy data, it was determined that during the production of hybrid modifier during the simultaneous grinding of rubber crumb and styrene– butadiene thermoplastic elastomer, there was a chemical interaction between them. Цели. В статье проанализировано влияние процесса модификации на групповой состав битума и битумных вяжущих, содержащих резиновый порошок и гибридный модификатор на основе бутадиен-стирольного термоэластопласта и резиновой крошки. Целью исследования было определение наличия или отсутствия функциональных групп, отражающих направленность физико-химических процессов при получении гибридного модификатора в роторных диспергаторах и при модификации битумных вяжущих. Методы. Резиновый порошок и гибридный модификатор получены методом высокотемпературного сдвигового измельчения на роторном диспергаторе. Битумы и модифицированные битумные вяжущие исследованы методом инфракрасной спектроскопии с Фурье преобразованием. С помощью метода вычитания спектров установлено, что в процессе изготовления модифицированных битумных вяжущих происходят структурные изменения как в битуме, так и в модификаторах. В работе также проведена экстракция модификаторов (резинового порошка и гибридного модификатора) в толуоле. Результаты. Проведен количественный анализ изменений, происходящих в групповом составе модификаторов до и после процедуры модификации. Определены активный полимерный и структурный индексы. Отмечена общая тенденция в изменении активного полимерного и структурного индексов для исходных спектров резинового порошка и гибридного модификатора и их спектров, полученных после процедуры вычитания из спектров битумных вяжущих спектра битума.Выводы. Подтверждена взаимодиффузия ароматических соединений между битумной составляющей и частицами модификаторов. На основании результатов экстракции модификаторов в толуоле и с учетом данных ИК-спектроскопии найдено, что в процессе производства гибридного модификатора совместным соизмельчением резиновой крошки и бутадиен-стирольного термоэластопласта между ними происходит химическое взаимодействие.

Common variable immunodeficiency disorder: a clinical case

Primary immunodeficiency is a rare congenital pathology associated with failure of immune system, manifested by disturbances of its functions. These defects lead to increased susceptibility of patients to various infectious agents, as well as the development of autoimmune, malignant and other diseases. Primary immunodeficiency is classified as a rare disease, which was previously associated with a poor prognosis with a high risk of mortality in childhood. To date, the emergence of highly effective treatment methods has changed the course and prognosis of these diseases. Clinicians of various specialties increasingly meet with this pathology in everyday practice, including adult age cohorts. In this regard, early diagnosis of primary immunodeficiency in adults becomes relevant, being associated with choosing optimal therapy, prevention of severe internal organ damage, determination of management strategy for the patient, as well as the need to identify inherited disorders and provide information to the patient’s family. Delayed verification of the diagnosis may cause disability of the patient and development of irreversible, often fatal complications. This article presents our own clinical case with a newly diagnosed clinical condition: Common variable immunodeficiency disorder (CVID), the most common form of primary immunodeficiency in adults. The symptoms of common variable immunodeficiency disorder appear in these patients in adulthood, but a high-quality collected history of the disease will allow you to trace symptoms in the patients even since early childhood. There is a common gap for several years between the onset of the disease and clinical diagnosis, since erroneous diagnosis is often made due to non-specific clinical symptoms that resemble other, more frequent diseases. The prognosis of patients with CVID depends on several factors: frequency of infections, structural disorders in the lungs, the occurrence of autoimmune diseases and the success of infection prevention. Thus, a variety of clinical forms of primary immunodeficiency, lack of awareness of doctors about this pathology, complexity of immunological examination in the general medical network lead to the fact that CVID is not diagnosed for long terms, and patients do not receive the necessary pathogenetic therapy. There is a need for drawing attention of doctors of various disciplines to the fact that the recurrent inflammatory processes of various localization, which are difficult to respond to adequate traditional therapy, may be caused by changes in the immune system, including congenital, genetically determined immunodeficiency

Effectiveness of the “Sterius 60” SHF Radiation Installation for Disinfection of Objects Contaminated with PBA of Groups I–IV, when Working with Infected Biomodels

The aim was to evaluate the effectiveness of using the “Sterius 60” microwave disinfection system (Russia) for decontamination of objects infected with PBA of groups I–IV emerging as a result of working with infected laboratory animals.Materials and methods. Effectiveness verification of disinfection of biological waste generated as a result of the life of laboratory animals by SHF radiation was carried out in the microwave system “Sterius 60”, recommended by the manufacturer for disinfection of epidemiologically hazardous and extremely dangerous medical waste, including biological ones (classes B and C), by volumetric SHF heating. Carcasses of uninfected laboratory animals (white mice, Guinea pigs, suckling rabbits), granulated feed and bedding material (wood shavings), which are objects directly in contact with biomodels, were used as vivarium waste to be decontaminated. The following microorganisms were utilized as model test ones: Bacillus subtilus VKM B-911, Bacillus stearothermophilus VKM B-718, Bacillus licheniformis G VKM B-1711-D, Alcaligenes faecalis 415, Yersinia pestis EV, Bacillus anthracis STI. Laboratory utensils (plastic Petri dishes, porcelain mortars and pestles) were used as a mock-up chamber filler for model test microorganisms.Results and discussion. As a result of the study, data were obtained indicating that the microwave system for disinfection of medical waste “Sterius 60” is ineffective for decontamination of biological waste in laboratories working with biomodels infected with PBA of groups I–II. The established standard mode of disinfection of this system was effective only for non-spore forms of microorganisms, pathogenicity groups III–IV. Therefore, in our opinion, it is advisable to use it for decontamination of laboratory utensils infected with PBA of groups III–IV, directly at sites of waste generation

Особенности апоптоза и блеббинга цитоплазматической мембраны лимфоцитов при бронхиальной астме

 Given a persistent global trend towards an increase in the number of patients with bronchial asthma (BA) over the past decades, researchers are facing challenges related to a comprehensive study of the pathogenesis of BA. Numerous studies have shown that BA is associated with long-term persistence of leukocytes (lymphocytes, macrophages, and eosinophils) in the bronchial tissues. However, the causes of this phenomenon remain understudied. The article provides an overview of modern research on the mechanisms of disorders of lymphocyte apoptosis in patients with BA.Our study considers the main mechanisms of molecular regulation of  lymphocyte apoptosis, including transcription factors, the Fas/FasL system, and bcl-2/bcl-XL factors. We present the data on the role of reduced lymphocyte apoptosis in the formation of a severe BA phenotype. Taking into account high  prevalence of obesity among patients with BA, we analyzed a few existing articles on the apoptosis of immunocompetent cells in obesity. In addition, the article highlights the key mechanisms of development of lymphocyte plasma membrane blebbing (PMB) with formation of microvesicles, as well as their influence on the course of pathological processes in BA. The authors believe that further in-depth study of apoptosis, lymphocyte  necrosis, and plasma membrane blebbing can help improve the principles of diagnosis and treatment of BA.  С учетом стойкой общемировой тенденции к нарастанию численности больных бронхиальной астмой (БА) за последние десятилетия перед исследователями встает  задача всестороннего изучения патогенеза бронхиальной астмы. В многочисленных исследованиях доказано, что течение БА сопряжено с длительной персистенцией лейкоцитов (лимфоцитов, макрофагов, эозинофилов) в тканях бронхов. Однако остается открытым вопрос о причинах данного явления. В данной статье представлен обзор современных научных исследований, посвященных изучению механизмов нарушения апоптоза лимфоцитов у  больных бронхиальной астмой.Рассматриваются основные механизмы молекулярной  регуляции апоптоза лимфоцитов, например  транскрипционные факторы, система Fas/FasL, факторы bcl- 2/bcl-XL и др. Приводятся данные об участии снижения  апоптоза лимфоцитов в формировании фенотипа с тяжелым течением бронхиальной астмы. Учитывая высокую  распространенность ожирения среди больных  бронхиальной астмой, проанализированы немногочисленные статьи, касающиеся апоптоза  иммунокомпетентных клеток при ожирении. Кроме того, в статье освещаются ключевые механизмы развития  блеббинга цитоплазматической мембраны (ЦПМ) с формированием лимфоцитарных микровезикул, а также их  влияние на течение патологических процессов при астме.Авторы считают, что дальнейшее углубленное изучение  процессов апоптоза и некроза лимфоцитов, а также блеббинага ЦПМ сможет помочь в улучшении принципов диагностики и  лечения бронхиальной астмы.