This article describes the relationship between the pathogenetic mechanisms of obesity and chronic obstructive pulmonary disease. Particular attention is paid to the role of systemic inflammation, metabolic disorders and mechanical influence of excess adipose tissue on the external respiratory function. Understanding the peculiarities of multifactorial pathophysiologic interaction in patients with such combined pathology allows to set the accents in the complex approach in treatment. Rational approach, taking into account both pharmacotherapy and non-medication methods when choosing treatment tactics, positively affects clinical outcomes. The authors suggest that targeting and influencing the common therapeutic targets of both diseases should be considered as a priority. The data of the analysis can serve as a basis for the development of new algorithms for the treatment of patients with obesity and COPD, as well as for the improvement of existing clinical guidelines.

The article presents current data on the effect of elevated uric acid levels on the course and prognosis of such significant diseases as acute coronary syndrome (ACS) and chronic obstructive pulmonary disease (COPD). The authors have convincingly shown that hyperuricemia (HY) is associated with higher mortality and a higher frequency of cardiovascular events after ACS, as well as significantly worsens the course of COPD. Thus, the level of uric acid can be considered as a marker for the prognosis of the course and risk of progression of these diseases, considering of its availability, is of interest for practical medicine.

More and more new data, concerning extraoral bitter taste receptors (TAS2R), appear now. Current data on SREBP-2, its role in cholesterol synthesis, participation of TAS2R in the local protective mechanisms in a ciliated epithelium of the respiratory tract and its activation by “quorum sensing” system molecules and its connection with the components of mucociliary clearance are presented.

The role of extraoral TAS2Rs and mechanisms of its regulation remain uncertain, that requires further research, including the field of respiratory pathology.

Traditionally, hand osteoarthritis is diagnosed with clinical classification criteria, while radiography is necessary for stage stratification and differential diagnosis with other joint diseases. Ultrasound as a method with no contraindications virtually, high degree of accessibility and information value is a promising tool for differential diagnosis with other inflammatory joint diseases, as well as early diagnosis, monitoring and, possibly, the choice of treatment tactics and the prognosis in patients with hand osteoarthritis. The literature review presents an analysis of the latest publications on the ultrasound possibilities as an auxiliary method in patients with this pathology.

Pneumococcal infection remains a serious problem in practical health care, being one of the most common causes of death from infectious diseases. Vaccination is the only way to significantly affect the morbidity and mortality from pneumococcal infection and reduce the level of resistance to antibacterial drugs. The article analyzes the experience of vaccination against pneumococcal infection in adults from risk groups.

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the frequent diseases that most multimorbid patients have and, in turn, is one of the most important comorbid conditions that negatively affects the outcomes of other diseases.

Aim: Study of comorbid conditions in respondents with COPD and variable obstruction aged 35 to 70 years, residents of two cities in the NorthWest region of Russia

Materials and methods. Cohort study with variable obstruction (n=90) and COPD patients (n=53) identified at the population phase of the RESPECT study was performed. Demographic data and risk factors were studied, spirometry with bronchodilator test were performed. Comorbidity was considered using the modified Charlson index, quality of life was assessed.

Results and discussion. The mean age of the participants was 57.5±8.2 years, and did not differ between those with variable obstruction and COPD. Respondents with COPD were predominantly male (79.2% vs 43.3%), ever smokers (94.3% vs 67.4%); this group had a higher proportion of individuals with severe symptoms. The proportion of persons with high risk of exacerbations was equally low in both groups. The most common comorbidity was arterial hypertension (56.3%). The frequency of comorbidity and the level of comorbidity index did not differ between the two groups. The modified comorbidity index was associated with the number of years of smoking (β=0.025, p=0.034), anxiety and depression (β=0.092, p=0.009). More than half of those with COPD and variable obstruction were multimorbid (52.8% and 53.3%, p>0.05). Self-assessed quality of life worsened with age (β=0.027, p=0.045), was associated with multimorbidity (β=0.80, p=0.000), was not dependent on gender, and did not differ between respondents with COPD and those with variable obstruction.

Conclusion. Comorbidity should be assessed not only in individuals with COPD, but also in individuals with variable obstruction with mutual risk factors.

Introduction. Smoking is a leading risk factor for the development of chronic bronchitis, chronic obstructive pulmonary disease (COPD), cardiovascular pathology, cancer, diabetes mellitus. The main role in helping smoking patients and identifying their respiratory pathology in outpatient practice belongs to the primary care physicians The paper analyzes the problems of managing smoking patients with a pulmonological profile in real outpatient practice, shows the need for psychological support for patients during the period of quitting smoking.

Purpose. To identify signs of bronchoobstructive syndrome in smokers, assessment of smoking status, formation of tobacco cessation groups, analysis of routing of patients with respiratory complaints in real outpatient practice.

Material and methods. In state institutions of the Kalinsky district of St. Petersburg, screening examinations were conducted for smoking women and men of working age with an average socio-economic status. The examination was completed by 140 smoking patients aged 20 to 60 years, including 41 men (average age 43.5-+) and 67 women (45.9+1.1 years). In addition to the questionnaire, all subjects underwent spirometry and determination of CO (ppm) in exhaled air.

Results. Women started smoking later than men. The number of cigarettes smoked per day, the smoking index, and the degree of nicotine dependence in women were significantly lower, which was naturally accompanied by a significantly lower content of CO in the exhaled air. Bronchoobstructive syndrome was detected in 56% of men and 40% of women; the degree of nicotine dependence and respiratory symptoms were interrelated only in women (r = 0.50, p < 0.01). With almost identical levels of motivation to quit smoking and the number of attempts to get rid of tobacco dependence, the duration of abstinence from smoking in women turned out to be more significant

Conclusion. The identified problems of managing smoking patients with a pulmonological profile in real outpatient practice dictate the need for clear routing of these patients with mandatory psychological support during the period of smoking cessation.

The relevance of this topic is due to the rare occurrence of cholangiocarcinoma in clinical practice, which influences the difficulties in diagnosis. An important fact is also the low awareness of doctors about Klatskin’s tumor. A clinical case of portal cholangiocarcinoma in a 69-year-old man is presented, and the difficulties of diagnosis due to the lack of specific complaints are considered. The features of laboratory and instrumental research methods are reflected.

A case study of a 71-year-old patient with non-tuberculous mycobacteriosis (NTML) of the lungs is presented, caused by a combination of two types of non-tuberculosis mycobacteria: M. avium and M. abscessus.

The aim is to demonstrate the complexity of the diagnosis and therapy of NTML in outpatient settings, as well as the need for repeated cultural studies, species typing and determination of sensitivity to biomaterial drugs.

Materials and methods: clinical and biochemical blood tests, general sputum and VC analysis, examination of the function of external respiration, computed tomography of the chest organs, fibrobronchoscopy, cultural examination of bronchial flushes in liquid medium (Middlebrook 7H9M7H9) in the automated BACTEC MGIT 960 (Bactec 960) system, cytological examination were performed and the detection of acid-resistant mycobacteria (ARM) in the flushes of their bronchi, ECG and echocardiography.

Results: in January 2023, the patient was diagnosed with nontuberculous mycobacterium (NTML) caused by Mycobacterium avium, which was sensitive to macrolides, aminoglycosides, and fluoroquinolones. After three months of antibacterial treatment, cultures from the bronchi on liquid medium did not detect any non-tuberculosis mycobacteria. The antibacterial treatment was stopped. However, in January 2024, the patient experienced a relapse of the illness (associated with a viral infection) and Mycobacterium abscessus was detected in the bronchial cultures, requiring a repeat course of antibacterial medication.

Conclusions: this clinical case highlights the key points regarding the specific aspects of the diagnosis and treatment process for NTML in an outpatient setting.

Tatyana Mikhailovna Sinitsina is a well-known doctor of functional diagnostics among clinical respiratory physiologists, a wonderful person and a great friend. She was actively involved in the physiology of respiration, especially pulmonary gas exchange and alveolar ventilation. She introduced into practical work an automated system for input, control, storage and interpretation of data from a comprehensive study of external respiration function.