RESUMEN
The article presents a case of intravital diagnosis of a rare heart disease, isolated primary amyloidosis. The clinical onset of the disease was heart failure (HF) that was resistant to treatment; chemotherapy was ineffective and was poorly tolerated by the patient. The diagnostics was based on a combination of refractory HF and changes in echocardiography data (atrial dilatation, small size of the left ventricular cavity, interventricular septal hypertrophy with the presence of hyperechoic inclusions of the "granular fluorescence" type), and changes detected by contrast-enhanced cardiac magnetic resonance imaging. The diagnosis of amyloidosis was confirmed by results of pathohistological examination of the material obtained during autopsy.
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Amiloidosis , Cardiomiopatías , Cardiopatías , Insuficiencia Cardíaca , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Ecocardiografía , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , HumanosRESUMEN
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.
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Asma , Citocinas , Obesidad , Adolescente , Asma/complicaciones , Asma/inmunología , Niño , Citocinas/metabolismo , Humanos , Inflamación , Obesidad/complicaciones , Obesidad/inmunología , Esputo/inmunologíaRESUMEN
AIM: To investigate the clinical and functional parameters in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) versus those with chronic obstructive pulmonary disease (COPD) and asthma. SUBJECTS AND METHODS: A total of 129 people were examined. 51 patients with ACOS were followed up in Group 1; Group 2 included 38 patients with severe asthma; Group 3 consisted of 40 patients with severe COPD. All the patients underwent clinical examination: history data collection, physical examination, evaluation of disease symptoms, and study of respiratory function (spirometry, body plethysmography). RESULTS: ACOS is clinically characterized by considerable demands for emergency drugs and by more frequent asthmatic fits and exacerbations, which require hospitalization. The parameters of bronchial resistance in ACOS were established to be increased throughout the follow-up period and to be comparable with those in patients with COPD. In the patients with ACOS, the severity of pulmonary hyperinflation was associated with increased demands for emergency drugs (r=0.59; p=0.015). Fixed bronchial obstruction in ACOS can be caused by smoking intensity and duration associated with increased bronchial resistance in expiration (r=0.51; p=0.003) and intrathoracic volume (r=0.71; p=0.0001); as well as increased body mass index (p<0.001) and disease duration, which were interrelated with a reduction in the forced expiratory volume in one second/forced vital capacity ratio (r=-0.63; p=0.001 and r=-0.71; p=0.0034, respectively). CONCLUSION: Patients with ACOS show more severe clinical manifestations and a substantial increase in functional residual capacity and intrathoracic volume throughout the follow-up period, suggesting that the distal bronchi are impaired and pulmonary hyperinflation develops.
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Asma , Broncodilatadores/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica , Pruebas de Función Respiratoria/métodos , Fumar/epidemiología , Resistencia de las Vías Respiratorias , Asma/diagnóstico , Asma/epidemiología , Asma/fisiopatología , Asma/terapia , Comorbilidad , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Examen Físico/métodos , Pletismografía Total/métodos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Factores de Riesgo , Federación de Rusia , Índice de Severidad de la Enfermedad , Estadística como Asunto , Evaluación de Síntomas/métodosRESUMEN
AIM: To study the peripheral blood level of leptin and adiponectin and their possible effect on the functional status of the respiratory system in young asthmatic patients in relation to body mass index (BMI) for the optimization of asthma therapy. MATERIALS AND METHODS: Examinations were made in 133 people, including a study group of 93 patients with asthma who were divided into 2 groups according to BMI: 1) those with a BMI of less 25 kg/m2 and 2) those with a BMI of 30 kg/m2 or more, as well as a control group of 40 apparently healthy patients. The investigators studied external respiratory function (ERF), the peripheral blood levels of leptin and adiponectin, the biochemical composition of plasma, by determining total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. RESULTS: Lipid metabolic disorders as dyslipidemia and hypercholesterolemia, increased severity of disease, and decreased ERF were recorded in the concomitance of obesity and asthma. The peripheral blood level of leptin in young asthmatic patients with obesity was found to be associated with higher BMI. CONCLUSION: A more severe course of disease presenting with decreased ERF, impaired lipid metabolism, and elevated peripheral blood leptin levels were noted in the concomitance of asthma and obesity at a young age.
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Adiponectina/sangre , Asma/sangre , Dislipidemias/sangre , Hipercolesterolemia/sangre , Leptina/sangre , Obesidad/sangre , Adulto , Asma/epidemiología , Asma/fisiopatología , Índice de Masa Corporal , Comorbilidad , Dislipidemias/epidemiología , Femenino , Humanos , Hipercolesterolemia/epidemiología , Masculino , Obesidad/epidemiología , Obesidad/fisiopatología , Adulto JovenRESUMEN
A case of late manifestation ofmucoviscidosis is reported. In the past, this pathology was dealt with by pediatricians, but to-day the management of this problem involves a number of different specialists. The progress in clinical practice makes it possible to significantly prolong the life span of patients with this condition. The present case shows that its clinical manifestations may appear at any age.
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Fibrosis Quística , Pulmón , Manejo de Atención al Paciente/métodos , Adulto , Fibrosis Quística/diagnóstico , Fibrosis Quística/genética , Fibrosis Quística/fisiopatología , Fibrosis Quística/terapia , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Humanos , Pulmón/diagnóstico por imagen , Pulmón/microbiología , Pulmón/fisiopatología , Masculino , Pruebas de Función Respiratoria/métodos , Tomografía Computarizada Espiral/métodos , Resultado del TratamientoRESUMEN
AIM: To study cytokine status and to reveal a possible relationship of clinical and functional indicators and systemic inflammation in patients with severe asthma to tobacco smoking. Subjects and methods. Examinations were made in 139 patients with severe asthma during its exacerbation and without the latter after 12 months. Groups 1 and 2 included 98 nonsmoking and 41 smoking patients with severe asthma, respectively. A control group consisted of 40 apparently healthy volunteers. External respiratory function, plasma TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-8, IL-10, C-reactive protein, and neutrophil elastase levels, and integral cytokine index were studied. RESULTS: Systemic inflammation that was more marked on a disease exacerbation and mediated by elevated TNF-α, IL-2, and C-reactive protein levels was detected in severe asthma in both groups. The smoking patient group showed a statistically significant increase in IL-8 and neutrophil elastase levels, which may be indirectly indicative of the active participation of neutrophils in the development of chronic persistent inflammation. CONCLUSION: Tobacco smoking is a clinically significant risk factor that aggravates both the course of asthma and the magnitude of inflammation during a disease exacerbation.