Background: The progression of infectious diseases depends on the characteristics of a patient’s innate immunity, and the efficiency of an immune system depends on the patient’s genetic factors, including SNPs in the TLR genes. In this pilot study, we determined the frequency of alleles in these SNPs in a subset of patients with pneumonia. Methods: This study assessed six SNPs from TLR genes: rs5743551 (TLR1), rs5743708, rs3804100 (TLR2), rs4986790 (TLR4), rs5743810 (TLR6), and rs3764880 (TLR8). Three groups of patients participated in this study: patients with pneumonia in 2019 (76 samples), patients with pneumonia caused by SARS-CoV-2 in 2021 (85 samples), and the control group (99 samples). Results: The allele and genotype frequencies obtained for each group were examined using four genetic models. Significant results were obtained when comparing the samples obtained from individuals with pneumonia before the spread of SARS-CoV-2 and from the controls for rs5743551 (TLR1) and rs3764880 (TLR8). Additionally, the comparison of COVID-19-related pneumonia cases and the control group revealed a significant result for rs3804100-G (TLR2). Conclusions: Determining SNP allele frequencies and searching for their associations with the course of pneumonia are important for personalized patient management. However, our results need to be comprehensively assessed in consideration of other clinical parameters.

Состав сообщества микроорганизмов в дыхательных путях у здоровых лиц и больных бронхиальной астмой (С.В. Федосенко, Л.М. Огородова, М.А. Карнаушкина, Е.С. Куликов, И.А. Деев, Н.А. Кириллова)

Questions of differential diagnosis of syndrome-similar diseases in the medical literature is still not enough, but it is-the most difficult stage of medical practice. This article discusses the stages of diagnostic search in pleural effusion-a syndrome that sometimes confuses the most experienced Clinician. The frequency of this syndrome according to statistics is 300–320 cases per hundred thousand population. This is one of the most common pathologies in therapy, occurring in every tenth patient who turned to the doctor. If you suspect the presence of fluid in the pleural cavity, the doctor must first confirm the presence of fluid and determine its amount, then using the data of the clinical picture of the disease, the results of clinical, functional and laboratory research methods to build a differential diagnostic series and to identify the cause of this syndrome. The article consistently presents several simple and easily perceived diagnostic algorithms that demonstrate the optimal scheme of diagnostic actions of a doctor when diagnosing. The ability to correctly analyze the data of anamnesis, clinical and functional methods of examination and correctly interpret the results of the study of pleural fluid, allow in 90% of cases to correctly diagnose and prescribe effective treatment. Key words: pleural effusion, pleural cavity, computed tomography, pneumonia, darkening syndrome in pulmonary tissue. For citation: Karnaushkina M.A., Strutynskaya A.D. Pleural effusion. Consilium Medicum. 2019; 21 (3): 21–26. DOI: 10.26442/20751753.2019.3.190214

The «bronchiolitis» unites a heterogeneous group of diseases of inflammatory nature, the anatomical substrate of which are Airways without cartilage wall-bronchioles. Despite the etiological diversity of bronchiolitis, pathomorphological they manifest a certain set of changes in the lung tissue. This determines the similarity of visualization of different types of bronchiolitis during computed tomography of the chest. The key to successful diagnosis of bronchiolitis is a clear understanding of the definition of this pathology and a comprehensive analysis by a Clinician of anamnestic, clinical, laboratory and radiological data. In this article, we will consider three types of cellular bronchiolitis, which are combined by imaging on computed tomography of the chest pattern «tree in the kidneys»: infectious, aspiration bronchiolitis and diffuse panbronchiolitis.

As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.The aim of the studywas to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations.