Vitalii I. Kupaev

BACKGROUND: Bronchial asthma (BA) in older adults is a significant medical and social problem due to population aging, increasing comorbidity, and age-related changes in the immune and respiratory systems. Age-related lung function changes make diagnosis and disease control significantly more difficult. Current research lacks data on older adults with BA in the Russian Federation. AIM: To study the clinical features of bronchial asthma in older adults in real-world practice. METHODS: We conducted a multicenter, cross-sectional cohort study with multivariate cluster analysis of outpatient records of patients aged 65 years from three polyclinics in Saint Petersburg. RESULTS: Among 619 records, BA was found in 1.97% of older adults, but diagnosis was often delayed due to comorbidity and differential diagnostic complexity. The mean age at BA diagnosis was 60 years. A mixed phenotype predominated, with very few childhood-onset or purely allergic cases. Correlations were found between BA severity and the Charlson Comorbidity Index, obesity, glomerular filtration rate, eosinophilia, hyperglycemia, and the mean daily inhaled glucocorticosteroid dose. CONCLUSION: A personalized, interdisciplinary approach is needed for managing older adults with BA.

Bronchial asthma and cancer, particularly lung cancer, are global public health challenges. Although chronic inflammation in asthma is considered a potential procarcinogenic factor, epidemiological data on the association between these diseases remain contradictory. This review aims to systematize current data on the pathogenetic and epidemiological association of bronchial asthma with cancer. We critically analyzed data from modern prospective cohort studies, meta-analyses, and molecular biology research on the relationship between bronchial asthma and cancer risk. We paid special attention to methodological approaches, control for confounding factors, and the role of asthma phenotypes and disease control level. The review demonstrates the dual role of bronchial asthma in oncogenesis. On one hand, persistent uncontrolled inflammation, especially in the non-allergic (non-Th2) phenotype, is associated with an increased risk of lung cancer, most pronounced in patients with partially controlled asthma. On the other hand, the allergic (Th2) phenotype may exert a protective effect against several extrapulmonary tumors. A key modifiable risk factor is the level of asthma symptom control. Evidence indicates that baseline anti-inflammatory therapy (inhaled corticosteroids, leukotriene receptor antagonists) possesses potential anticarcinogenic properties. A pathogenetic link between bronchial asthma and cancer exists and is complex, determined by the type of inflammation and the degree of disease control. These findings justify the need for oncological vigilance in patients with uncontrolled asthma, especially those with asthma-COPD overlap syndrome, and for individualizing lung cancer screening approaches. Achieving complete asthma control is an important strategy not only for managing the respiratory disease but also for potentially preventing lung cancer.

BACKGROUND: Obesity-associated bronchial asthma is a common and difficult-to-treat phenotype of adult asthma. Currently, asthma is classified into two major endotypes: Th2 and non-Th2. The non-Th2 endotype reflects a non-allergic inflammatory mechanism but lacks clearly defined laboratory criteria, unlike the Th2 endotype. In this context, P-selectin and the receptor for advanced glycation end products (RAGE) are of particular interest as potential markers of non-allergic inflammation. However, their role remains insufficiently studied. AIM: This study aimed to evaluate the role of P-selectin and the receptor for advanced glycation end products (RAGE) in the development of bronchial asthma in adults with obesity. METHODS: A cross-sectional consecutive study was conducted. Clinical characteristics, spirometric parameters, and immunological markers were assessed in patients with and without obesity, depending on the presence of bronchial asthma. Immunological markers were evaluated using enzyme-linked immunosorbent assay, including P-selectin, receptor for advanced glycation end products (RAGE), interleukin-4, interleukin-8, tumor necrosis factor alpha, and interferon gamma. RESULTS: 96 participants were divided into four groups: group I, patients with bronchial asthma without obesity (n = 29); group II, patients with bronchial asthma and obesity (n = 27); group III (control), normal-weight individuals (n = 22); group IV (control), individuals with obesity (n = 8). Comparative analysis between the two asthma groups revealed no substantial differences in the analyzed markers; however, both groups differed remarkably from the control group III. Median P-selectin levels in groups I and II were 57.49 (46.82–129.29) pg/mL and 114.4 (58.5–161.5) pg/mL, respectively, which were significantly higher than in the control group III: 44.99 (34.00–60.07) pg/mL (p 0.05). Elevated levels of RAGE and TNF-α were also observed, indicating the presence of a systemic inflammatory response associated with obesity in patients with bronchial asthma. CONCLUSION: The study demonstrated substantial similarity of immunological responses in bronchial asthma and obesity. In the presence of both conditions, P-selectin demonstrated the most specific response, confirming the neutrophilic nature of inflammation.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a significant public health concern, affecting millions of people worldwide. This study aims to use Surface-Enhanced Raman Scattering (SERS) technology to detect the presence of respiratory conditions, with a focus on COPD. Methods: The samples of human serum from 41 patients with respiratory diseases (11 patients with COPD, 20 with bronchial asthma (BA), and 10 with asthma–COPD overlap syndrome) and 103 patients with ischemic heart disease, complicated by chronic heart failure (CHF), were analyzed using SERS. A multivariate analysis of the SERS characteristics of human serum was performed using Partial Least Squares Discriminant Analysis (PLS-DA) to classify the following groups: (1) all respiratory disease patients versus the pathological referent group, which included CHF patients, and (2) patients with COPD versus those with BA. Results: We found that a combination of SERS characteristics at 638 and 1051 cm⁻¹ could help to identify respiratory diseases. The PLS-DA model achieved a mean predictive accuracy of 0.92 for classifying respiratory diseases and the pathological referent group (0.85 sensitivity, 0.97 specificity). However, in the case of differentiating between COPD and BA, the mean predictive accuracy was only 0.61. Conclusions: Therefore, the metabolic and proteomic composition of human serum shows significant differences in respiratory disease patients compared to the pathological referent group, but the differences between patients with COPD and BA are less significant, suggesting a similarity in the serum and general pathogenetic mechanisms of these two conditions.

The functional responsibilities of general practitioners (family doctors) (GPs) have changed significantly over the past decade. The number of GP functions has expanded. Despite the increasingly complex professional activities of GPs, there is no scientific evidence for the qualification characteristics of GPs expressed in knowledge, skills, abilities, and competencies in the theory and practice in training. In this regard, a study was conducted to determine the priority of GP competencies that make up the qualification characteristics of a specialist. Aim. To analyze, generalize and rationale the research results, as well as to develop preliminary guidelines for GP training. Material and methods. The information base for the study was the results of ranking competencies according to their importance in the professional activities of GPs in Russia. It was obtained during the ascertaining experiment, implemented using the Delphi method as a method of expert assessment and strategic planning of training specialists. Conclusion. The analysis of competencies developed and agreed upon by experts showed its compliance with the job functions of GPs, the requirements of the Federal State Educational Standard for the General Medical Practice (Family Medicine) and the WONCA guidelines. A summary of the study results to determine the priority of competence in GP activities showed the following: — all competencies (25) were defined as necessary and constitutive of GP qualification; — 21 competencies were considered significant and highly significant for GPs; — 4 competencies were considered as of moderate significance and below moderate significance. The analysis of the priority of competences revealed insufficient methodological support for GP training in accordance with the social order. The results obtained showed the need to continue the study within the project "Quality Management of Training of General Practitioners (Family Doctors)".

Клиническое улучшение некоторых показателей активности неалкогольной жировой болезни печени после коррекции дисбиоза кишечника с помощью пищевых волокон

BACKGROUND: Arterial hypertension is a common cardiovascular disease that requires constant monitoring by a doctor of drug therapy to achieve the target blood pressure level. AIM: To analyze pharmacotherapy of essential hypertension in patients, who have achieved a controlled course of the disease. MATERIALS AND METHODS: In this study 274 patients with controlled course of stage 2 arterial hypertension and no comorbidities were recruited. Blood pressure indicators, anthropometric data, results of laboratory and instrumental studies, the volume of drug therapy for hypertension were analyzed. RESULTS: We analyzed 543 drug prescriptions for 274 patients with stage II hypertension. In 97 (35.3%) patients only one drug was prescribed, in 112 (40.7%) two drugs, in 46 (16.7%) three drugs from various pharmacological groups, among which monodrugs were in the lead: angiotensin-converting-enzyme inhibitors 31.86%, cardioselective -blockers 23%, angiotensin 2 receptor blockers 9.3%. Combined drugs were present in 18.4% of general doctors prescriptions. Fixed forms of combined antihypertensive drugs were taken by only 50 (18.4%) patients. To prevent cardiovascular complications of arterial hypertension, 75 (26%) patients were prescribed statins (atorvastatin or rosuvastatin) and 56 (19.5%) antiplatelet monotherapy with Cardiomagnyl, Thrombo ACC or clopidogrel. CONCLUSIONS: To achieve the target blood pressure level and control arterial hypertension in patients with stage II hypertension, general practitioners used all main

The article presents an analytical review of the published data on the features of protein glycosylation in multiple sclerosis (MS). The search in the PubMed database with the keywords "multiple sclerosis, glycosylation", for the period of 2012-2022, resulted in 12 sources presenting the studies on N-glycosylated plasma proteins and immunoglobulins G in multiple sclerosis, clinically isolated syndrome, neuromyelitis optica spectrum disorders and meningitis of viral etiology in patients' cerebrospinal fluid and blood serum. The studies revealed specific changes in glycoproteins in multiple sclerosis. Glycome changes correlated with the age and sex of patients, with the clinical form of the disease, as well as with the degree of disability on the EDSS scale. These findings can contribute to the early diagnosis of MS, the definition of the form of the disease and its course prediction. Given the diversity of the glycome expression, the differences in its modifications in different environments (serum and blood plasma, cerebrospinal fluid), as well as the variety of approaches to its study (many quantitative and qualitative biochemical methods), there is a prospect of further search for markers and predictors of the course of multiple sclerosis.

In healthcare, a new digital branch of medicine has emerged – telemedicine, which is especially relevant for primary healthcare. To ensure the quality functioning of telemedicine centers, it is important to provide timely and high-quality training of medical personnel in the relevant field of knowledge. The solution of this problem is entrusted to the leading medical universities of the country. The article is devoted to the generalization of the experience of teaching telemedicine technologies at the Department of Family Medicine with the course of telemedicine technologies of the Samara State Medical University at the levels of specialist, residency, advanced training of doctors and primary retraining of doctors in the specialty "General Medical Practice (Family Medicine)" and «Therapy». A successful combination of presenting theoretical material and developing practical skills for conducting telemedicine consultations in practical classes in the form of training simulation telemedicine consultations in real conditions of outpatient practices, including using the capabilities of the Center for Remote Medicine Clinics of the Samara State Medical University, made it possible to train more than 300 specialists who have the skills to conduct telemedicine consultations, who use telemedicine consultations in real medical practice in medical institutions of the Samara region.