MODERN METHODS OF ETIOLOGICAL DIAGNOSING OF ACUTE COMMUNITY-ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS

MODERN METHODS OF ETIOLOGICAL DIAGNOSING OF ACUTE COMMUNITY-ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS O. L. Bororova, Y. O. Dziublyk, V.A. Iachnyk Abstract The review presents the possibilities presented by various methods of etiological diagnostics used in pulmonology. The main method of diagnosing acute community-aquired lower respiratory tract infections is the microbiological approach which includes microscopy of patient’s material with Gram staining, cultures on nutrient media, isolation of culture, identification and determination of susceptibility of a microorganism to antibiotics. But unfortunately the etiologocal factor cannot be detected in about half of patients. Recently, the popularity of molecular methods of etiological diagnosis has grown. They are characterized by greater sensitivity to microbiological methods and allow to get results faster. Molecular diagnostic tests are divided into four categories depending on the mechanism based on them: immunoassay, hybridization methods, amplification and sequencing methods. Among the tests based on the principles of immunoassay, noteworthy are rapid tests, which are most consistent with the idea of an ideal diagnostic tool in the field of laboratory medicine. They are fast, simple, cheap, highly sensitive and highly specific. However, as the appearance of specific antibodies in the body takes some time, the results of tests based on immunoassay remain positive for several weeks after the delayed episode of acute community-acquired lower respiratory tract infection, so they have diagnostic value only in the presence of clinical manifestations of the disease. The genetic approach allows the detection of infectious agents in the early stages of the disease, when serological and immunological methods are ineffective. Tests based on nucleic acid amplification, including PCR, have also become increasingly common recently. These methods should be used for the diagnosis of atypical pathogens and respiratory viruses, because their cultivation in culture is difficult. Sequencing and mass spectrometry methods are being actively developed, but there are limitations that prevent their use in everyday clinical practice. So the combination of microbiological approach with molecular diagnostic methods is the most optimal for the identification of the causative agent of acute community-acquired lower respiratory tract infections and the use of targeted etiotropic treatment. Key words: acute community-acquired lower respiratory tract infections, etiological diagnosis, microbiological, serological, immunological, molecular genetic methods, ICA, PCR, sequencing, mass spectrometry. Ukr. Pulmonol. J. 2021;29(3):58–65

THE CASE OF COMBINATION OF MULTIPLE ENDOCRINE NEOPLASIA SYNDROME (MEN SYNDROME) AND ASPERGILOMA (CLINICAL OBSERVATION)

The clinical case of staged surgical treatment of multiple endocrine neoplasia and aspergilloma syndrome in a 21-year-old patient is presented. The patient was admitted to NIFP with the diagnosis: adrenocorticotropic hormone-producing tumor of the anterior mediastinum; diabetes mellitus, insulin dependent; secondary hypothyroidism; shingles; cavitary lesion of the upper lobe of the left lung, the lesion of the upper lobe of the right lung; hirsutism, edema syndrome. At the first stage, the patient underwent a sternotomy with removal of the tumor of the anterior mediastinum with adipose tissue and mediastinal lymph dissection, removal of the tumor of S3 of the right lung. At discharge, the patient was recommended to returm to NIFP in 2 months for elective surgery for aspergilloma of the upper left lung. But one month after discharge, the patient developed hemoptysis. She underwent a video-assisted typical resection of S1-S2 of the left lung. Removal of hormone-producing tumors allowed to normalize glycemia, discontinue insulin, normalize thyroid function and lead to regression of hirsutism and osteoporosis, restored muscle strength and normalized water-electrolyte balance. Key words: multiple endocrine neoplasia syndrome, aspergilloma, surgical treatment.

FEATURES OF RESISTANCE TO HYPOXIA IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

FEATURES OF RESISTANCE TO HYPOXIA IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE E. O. Asanov, Yu. I. Golubova, I. A. Dyba, S. O. Asanova Abstract Aim: to study the features of resistance to hypoxia in elderly patients with COPD. Material and methods. We examined 46 elderly patients with COPD and 18 apparently healthy elderly people. Hypoxia resistance was determined by performing a hypoxic test with inhalation of 12 % O2 for 20 minutes. The state of ventilation and blood saturation were assessed. Results. Hypoxia caused the reduction of SpO2 and the development of arterial hypoxemia in elderly patients with COPD, which were more significant than in healthy elderly people. It was found that among elderly patients with COPD and healthy elderly subjects there were people with preserved and reduced resistance to hypoxia. However, reduced resistance to hypoxia was much more common in elderly patients with COPD. Decreased resistance to hypoxia in elderly patients with COPD was associated with the degree of bronchial obstruction: deterioration of bronchial passability led to reduced resistance to hypoxia. Elderly patients with COPD with reduced resistance to hypoxia had a decrease in the ΔVE/ ΔSpO2 ratio and a slow ventilation response to hypoxic exposure. Conclusions. Among healthy elderly people and elderly patients with COPD there were subjects with reduced and preserved resistance to hypoxia. Decreased resistance to hypoxia was much more common in elderly patients with COPD. Decreased resistance to hypoxia was more common in patients with moderate than mild bronchial obstruction. Elderly patients with COPD with reduced resistance to hypoxia had reduced ventilation response to hypoxia and chemoreflex sensitivity. Key words: COPD, older age, resistance to hypoxia, ventilation, saturation. Ukr. Pulmonol. J. 2021;29(3):36–40:

CASE OF THORACIC ACTINOMYCOSIS IN A CHILD

A. Rechkina, N. V. Promskaya, I. V. Liskina, O. M. Kravtsova Abstract The article presents a rare clinical case of a complex way of diagnosis and treatment of thoracic actinomycosis with lung and chest soft tissues lesions in 12 years old child. About six months passed from the time of the first complaints until the final clinical diagnosis was made. This delay led to significant destructive changes in the lungs and adjacent soft tissues. During this time, the child went through all stages of health care. Differential diagnosis with lung neoplasm was performed. The diagnosis was verified by histological and immunohistochemical studies. The biopsy material revealed separately rounded dense clusters of fungi, which morphologically most corresponded to actinomycetes. The treatment consisted of two stages (inpatient and outpatient), which lasted more than three months. Significant clinical and radiological improvement has been achieved. The child continues treatment on an outpatient basis under the regular supervision of a pulmonologist. Key words: thoracic actinomycosis, diagnosis, treatment, children. Ukr. Pulmonol. J. 2021;29(3):48–52.

PECULIARITIES OF CLINICAL MANAGEMENT OF ASTHMA DURING CORONAVIRUS DISEASE (COVID-19) PANDEMIC

PECULIARITIES OF CLINICAL MANAGEMENT OF ASTHMA DURING CORONAVIRUS DISEASE (COVID-19) PANDEMIC L. I. Konopkina Abstract The review is dedicated to the problem of interrelations between asthma (A), COVID-19 and inhaled corticosteroid (ICS) therapy. According to Global Initiative for Asthma (GINA) long-term treatment with systemic corticosteroids may lead to significant immunosuppression. Potentially, this is associated with higher risk of incidence and severity of viral infections. That was the reason why WHO in the beginning of 2020 had not granted recommendation for using systemic corticosteroids in COVID-19 patients if not indicated for other causes (including A and COPD exacerbations, usually requiring short course of oral corticosteroids). In Spring 2021 GINA renewed its recommendations on COVID-19 in A patients considering the grade of A symptoms control. It was demonstrated that patients with well-controlled A (mild to moderate) were neither at higher risk of COVID-19 occurrence nor of its more severe course. The risk of death from COVID-19 was also not increased in patients with well-controlled A. Moreover, in A patients 50 years of age and older, regularly taking ICS and admitted to hospital due to COVID-19, the mortality rate was lower than in other hospitalized patients. Today, it is important to debate whether ICS may interfere with the possibility of getting infected by coronavirus. It is well known that budesonide is one of most often prescribed ICS molecule. Budesonide in vitro has demonstrated a potential antiviral effect against different types of SARS-CoV-2. There are several ongoing studies in vivo: NCT04416399 (Great Britain; completed), NCT04355637 (Spain), NCT04193878, NCT04377711 (USA), NCT04331470 (Iran), NCT04330 (South Korea). The results of STOIC study, organized and conducted by Oxford university scientists, are of special interest. It was demonstrated that outpatient use of budesonide in COVID-19 patients reduced the risk of hospitalization and emergency care utilization by 90 %. There was a statistically significant reduction in symptoms intensity and time to clinical cure. Interim results of PRINCIPLE study suggested that early treatment with inhaled budesonide shortetens recovery time by a median of three days (comparing with usual care). In Budesonide Turbohaler group 32 % patients reached sustain recovery within 14 days of randomization (comparing with 22 % of patients in usual care group). Conclusion. Despite interim character of presented clinical trials data in this review, use of inhaled budesonide in COVID-19 patients, from our point of view, may be considered in particular clinical cases after a obligatory discussion with the patient.

ANTIVIRAL ACTIVITY OF AMINOCAPROIC ACID AGAINST INFECTIOUS BRONCHITIS CORONAVIRUS IN VITRO

I. V. Dziublyk, O. P. Trokhimenko, S. O. Soloviov, G. L. Gumeniuk, O. Ya. Dziublyk, N. I. Gumeniuk, O. K. Yakovenko Abstract The aim of the study is a preclinical evaluation of the antiviral activity of aminocaproic acid (ACA) against the prototype strain IBV (Infectious bronchitis virus) of Coronavirus family in vitro. Material and methods. During the research, modern methods were used to determine the cytotoxic effect of the evaluation on a monolayer of BHK-21 cell culture in vitro; cultivation, accumulation and determination of the infectious titer of IBV by cytopathic action on a monolayer of cell cultures; assessment of the antiviral effect of the drug — the establishment of the inhibitory concentration and the chemotherapeutic index (CTI) of ACA in various modes of drug administration: 2 hours before infection, simultaneously with infection and 2 hours after infection. Results. With the introduction of ACA 2 hours before infection, a decrease in the infectious titer of the IBV virus was not established. The antiviral activity of ACA was detected when the drug was added in 2 modes: simultaneously and 2 hours after infection. The introduction of ACА into the medium for cell cultivation at non-toxic concentrations of 7.91–15.82 mg / ml led to a decrease in the infectious titer of the virus by 1.4–2.0 lg TCD50 / 0.1 ml. The CTI of the ACA was 6 in the indicated concentrations and modes, which is an indicator of its promising potential for further studies of antiviral activity in vivo, including clinical studies. Conclusions. The direct antiviral effect of ACA against the prototype H-120 virus strain from the Coronaviridae family in vitro was revealed. The suppression of viral reproduction with an established low toxicity of the drug, a decrease in the infectious titer of IBV by 1.4–2.0 lg TCD50 / 0.1 ml and with a CTD equal to 6.0, indicate the prospects for further study of the antiviral properties of ACA in clinical trials. Key words: aminocaproic acid, coronavirus, antiviral activity.