Terapevt Arkh
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Review
[Pulmonary embolism and diffuse alveolar bleeding: combination options and therapy features].
The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome primary antiphospholipid syndrome and Goodpastures syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.
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The SARS-CoV-2 virus enters the body through the angiotensin-converting enzyme 2 (ACE-2), which is the entry point of the virus into the cell. The most dense fabric of ACE-2 is the lungs. ⋯ Intestinal symptoms can appear at different stages of the disease. The review describes the mechanisms of interaction of SARS-CoV-2 with enterocytes, the fecal-oral route of infection, diagnosis and treatment of COVID-19 with intestinal symptoms.
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Case Reports Classical Article
[Methotrexate-induced lung damage in a patient with rheumatoid arthritis].
We herein report a case of interstitial lung disease secondary to the use of methotrexate in a patient with rheumatoid arthritis. Differential diagnosis between pneumonitis caused by methotrexate in patients treated with basic methotrexate therapy and interstitial pulmonary disease associated with rheumatoid arthritis is based on the clinical examination and instrumental data. The main condition for favorable clinical outcome in all drug-induced lung disease is drug withdrawal, what was proven in our report.
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The review provides data on one of the phenotypes of severe bronchial asthma it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. ⋯ Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.
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The article presents the evolution of views on one of the current problems of present pulmonology idiopathic interstitial pneumonias. On the basis of many years of experience in diagnosis and treatment of patients of IIPs in the clinic of pulmonology of Interstitial and Orphan Lung Diseases Research Institute of Pavlov First Saint Petersburg State Medical University, the authors formulated a new understanding of this pathology and proposed to unite all IIPs under the term idiopathic fibrosing pulmonary disease. Using the concept of idiopathic fibrosing pulmonary disease will make it possible to substantively address the issues of early diagnosis, determine the criteria for the activity of the pathological process, and there by develop an evidence base for the adequate prescription of antifibrotic drugs and corticosteroids.