Aim. An analysis of the epidemiological monitoring of the incidence of chronic respiratory diseases in the Russian Federation, the Far Eastern Federal District and the Amur Region is carried out, allowing to assess the levels and regional characteristics of the spread of pathology among the population and territorial entities, the dynamics of morbidity and the effectiveness of preventive measures.

Materials and methods. In order to organize the study, the methods of structural, comparative and correlation analysis, statistical and informational-analytical methods, databases of the Ministry of Health of the Russian Federation and the Federal State Statistics Service and the results of their own epidemiological studies conducted using sociological and clinical-functional screening methods were used.

Results. Epidemiological analysis shows that chronic respiratory diseases are widespread among the adult population and affect the ability to work and the quality of life of a person. However, the level of their registration in the state statistical monitoring system has significant differences in the constituent entities of the Russian Federation, which is determined not only by the degree of influence of their risk factors, but also by the level of accessibility and quality of medical care determined by the socio-economic conditions of the environment. At the same time, in recent years, in the Russian Federation as a whole, and in the Amur Region in particular, certain positive changes have been achieved in increasing the efficiency of medical care for patients with chronic respiratory diseases, manifested by an increased level of their diagnosis and detection of pathology in the early stages of development. Since 2005, the rates of primary and general adult morbidity in chronic lower respiratory diseases have increased by 29.9%, and in the Amur Region - by 31.2%. The mortality rate in the region due to chronic lower respiratory tract diseases decreased by 25.3% between 2005 and 2017.

Introduction. Previously it was shown that patients suffering from chronic obstructive pulmonary diseases are especially sensitive to changes in weather and climate conditions, in particular to one of the main meteorological elements - relative air humidity. At the same time, there is insufficient information on whether increased relative humidity can trigger the formation of osmotic airway hyperresponsiveness in patients with asthma and its features in different seasons of the year.

Aim. To study the clinical picture of the disease, lung function and the airway reaction to the hypotonic stimulus in asthma patients in seasons of the year which are contrasting in humidity.

Materials and methods. In 82 patients (average age 40.5±1.1 years) with mild persistent asthma, disease control was assessed using the ACT questionnaire. Lung function and airway response (AFEV₁) to 3-minute inhalation of ultrasonically nebulized distilled water (UNDW) were studied in the seasons of the year with low and high relative humidity of atmospheric air.

Results. In the initial examination of patients in a season with low relative humidity of ambient air, FEV₁ for the general group was 98.2±2.2%, MEF_25-75 72.9±3.5%, AFEV₁ -3.7±1.0%, ACT 18.3±0.6 points. Airway hyperresponsiveness to the hypoosmolar stimulus was detected in 12 (15%) patients (ΔFEV₁ -18.1±2.1%), 7 (9%) showed an increase in FEV₁ after UNDV by 12.1±3.3%, 63 (77%) patients did not have a reaction to UNDW (ΔFEV₁ -2.7±0.5%). When re-examining the same patients in the wet season, the lung function impairment was recorded (FEV1 averaged 93.8±2.3, p=0.023; MEF_25-75 6 3.9±3.3, р=0,006), airway reaction the UNDW was increased (ΔFEV₁ -8.1±1.4%, p=0.005), asthma control was decreased (ACT 17.0±0.7 points, p=0.034), the number of patients with altered reactivity to UNDW increased from 23 to 50%. In the wet season, the number of asthma patients with osmotic airway hyperresponsiveness (ΔFEV₁ -19.8±1.9%) reached 40% (33 patients) (χ²=12.3; p<0.001), 8 (10%) were observed with increase in FEV1 to the UNDW (9.4±1.4%), in 41 patients (50%) there was no airway reaction to the UNDV (ΔFEV₁ -2.0±0.7%).

Conclusion. An increase in the environment relative humidity in asthma patients leads to a decrease in control of the disease, worsening of airway patency, an increase in the severity of the airway reaction to acute bronchoprovocation with UNDW, and increase in the number of patients responding to the osmotic stimulus.

Aim. To study the effect of complex treatment of patients with arterial hypertension in combination with chronic obstructive pulmonary disease (COPD), including drug treatment and training programs, on the indicators of intracardiac hemodynamics.

Materials and methods. 84 patients with stage II hypertension in combination with COPD were examined. Males made up 69.5% and females 30.5%. The average age of patients was 53.9±0.49 years. All patients underwent clinical and laboratory tests, transthoracic Doppler echocardiography, ambulatory blood pressure (BP) monitoring, and indicators of lung function were determined. The studied patients were prescribed a fixed combination of antihypertensive drugs: amlodipine 5 mg with perindopril 4 mg (Dalneva, KRKA) and COPD therapy according to GOLD (2017). Patients of the 1st group (n=45) on the background of drug treatment were trained in the school of health, patients of the 2nd group (n=39) did not attend the school of health.

Results. By the 6th month of therapy, 97.8% of patients in group 1 the target blood pressure level was achieved, in the 2nd group - in 74.4%. By the end of examination in patients of group 1, left ventricular myocardial mass index (LVMI) decreased by 10.9% (p=0.01). In group 2, on the background of drug therapy, there was a 5.9% decrease in LVMI (p=0.1), but in comparison with group 1, it was less pronounced (p=0.02). Normalization of LVMI was observed in 20.2% of patients in group 1 and 5.1% of patients in group 2, which was accompanied by an improvement in left ventricular myocardial diastolic function. An increase in the mean values of left ventricular stroke volume and left ventricular ejection fraction in group 1 (p=0.01) was registered, indicating an improvement in the systolic function of the left ventricular myocardium. By the 6th month of treatment, there was an improvement in bronchial patency, but in the 2nd group of patients, changes in spirometry indicators were statistically insignificant.

Conclusion. The use of combination therapy, including fixed combinations of antihypertensive drugs and group training programs in patients with arterial hypertension in combination with COPD, contributes to adequate blood pressure control, increases adherence to treatment, which is accompanied by an improvement in hemodynamic parameters and respiratory function. Regression of signs of left ventricular hypertrophy and improvement of its diastolic function in these patients, calls for a wide application of training programs in the treatment of comorbid patients at the early stages of the disease.

Aim. To study the diagnostic value of indicators of elastic resistance of the lungs depending on the value of bronchial resistance (Raw) in patients with asthma and COPD.

Materials and methods. 71 people were examined, including 20 practically healthy volunteers (control group), 18 asthma patients with a normal Raw, 17 asthma patients with a high index of Raw, 16 COPD patients with a high index of Raw. The study of respiratory mechanics was carried out by measuring transpulmonary pressure, the simultaneous recording of spirogram. Transpulmonary pressure was determined by the difference between the pressure in the mouth and in the lower third of the esophagus. The pressure in the esophagus was determined using a special probe, introduced through the lower nasal passage into the lower third of the esophagus. The difference between intra-esophageal pressure and the pressure in the oral cavity was determined using the differential pressure sensor PDP 1000 MD.

Results. In asthma patients with normal bronchial resistance in comparison with the control group there is a decrease in static lung compliance (p<0.05) and a compensatory increase in the total work of breathing (p<0.05). In patients with asthma and increased bronchial resistance there was a reduction of static lung compliance (p<0.05) and dynamic lung compliance (p<0.001), elastic traction (p<0.001) and increase overall work of breathing (p<0.001), due to the elastic work of breathing (p<0.05). In asthma patients with increased Raw, there is an increased residual lung volume (p<0.001), and residual lung capacity (p<0.001), in comparison with the control group and asthmatics with normal Raw. In the group of patients with COPD showed a reduction in static and dynamic lung compliance, elastic traction, total lung compliance and increase overall work of breathing (p<0.001), due to the elastic work of breathing (p<0.001), compared with the control group and asthma patients with normal Raw.

Conclusion. Based on the first results of a study of the elastic properties of the lungs in asthma patients with increased Raw and COPD patients, we can suggest a new pattern of mechanical activity of the lungs - valve bronchial obstruction or “air trap”, which is clearly manifested in COPD, when even small bronchi are subject to significant expiratory narrowing and increase the amplitude of respiratory movements.

Introduction. The pathogenesis of many diseases of the internal organs is based on the microcirculation disturbance. The most preferable method for screening vascular diagnostics is photoplethysmography - a simple, non-invasive, painless and reliable rapid test method based on the evaluation of blood volume in the microvascular bed.

Aim. To evaluate the indices of the contour analysis of photoplethysmogram in healthy individuals of young age.

Materials and methods. The study included 39 healthy individuals aged 20 to 30 years. To analyze the condition of the vascular system, a photoplethysmogram was recorded using “AngioScan-01 M” diagnostic complex. The average values of the pulse rate, the arterial stiffness index, the age of the vascular wall, the stress index, the oxygen saturation of arterial blood, nd the form of pulse wave were measured.

Results. In 5% of the examined, the arterial stiffness index exceeded normal values, which may indicate the beginning of structural changes in the artery wall; in 21% of healthy volunteers, the A-type of pulse curve was revealed, which is more characteristic of elderly people, and the detection of this type of curve in young people indicates an increase in the stiffness of great vessels; 33% of the examined showed a decrease in the degree of oxygen saturation of arterial blood.

Conclusion. The performance a contour analysis of photoplethysmogram in healthy individuals on an outpatient basis is the most preferable method for screening diagnosis of cardiovascular and bronchopulmonary pathology in the early stages of the development of pathological conditions. In addition, a particular emphasis should be given to the study of arterial stiffness index and the type of pulse curve, the change of which may indicate the presence of structural changes in the arterial wall even at the pre-clinical stage of development of bronchopulmonary and cardiovascular pathology.

Aim. To study the features of the etiology and clinical course of pneumonia in patients with hemoblastoses who underwent programmed chemotherapy.

Materials and methods. Case histories and outpatient records of patients with hemoblastoses who were treated in the hematology department of the Amur Regional Clinical Hospital in 2012-2018 were studied, in whom pneumonia was added during programmed chemotherapy: 54 patients with acute leukemia (AL), of which 24 patients with acute lymphoblastic (ALL) and 30 patients with acute myeloid (AML) leukemia; 75 patients with chronic lymphocytic leukemia (CLL) in stages B and C according to the Binet Classification; 43 patients with multiple myeloma (MM). The control group included 30 patients with nosocomial pneumonia without hemoblastosis who were treated in the pulmonology department of Amur Regional Clinical Hospital.

Results. Pneumonia is the most common infectious complication of CLL (39%) and MM (35%). The most common infectious complications of AL during programmed chemotherapy are febrile neutropenia - 30%, mucositis - 30%, pneumonia account for 18% of all infectious complications of acute lymphoblastic and 21% of myeloid leukemia. In patients with AL, gram-positive pneumonia pathogens predominate. In patients with CLL and MM, gram-negative flora predominates. Most pneumonia in patients with hemoblastosis develops into the stage of induced agranulocytosis. The special features of pneumonia during this time period are their atypical, severe and lingering course, often complicated by sepsis and toxic shock syndrome. In such patients, a characteristic auscultatory picture of the inflammatory process in the lungs is often absent; in a traditional X-ray examination, it is also not possible to detect infiltration. In patients with agranulocytosis in the presence of fever, computed tomography of the lungs should be performed regardless of the auscultatory picture and without prior radiography.

Conclusion. With timely diagnosis of the inflammatory process in the lungs of patients with hemoblastoses, compliance with the appropriate sanitary and hygienic regimen, the availability of modern antibacterial and antimycotic drugs, granulocyte colony stimulating factor drugs and other concomitant therapy, the prognosis of pneumonia is favorable in most cases (in the absence of uncontrolled tumor growth).

Introduction. Intrauterine infections are of particular importance to perinatal mortality as they are preventable causes. This is meant to be the base to create efficient medical and preventive interventions to reduce perinatal losses.

Aim. This study was conducted to assess a share of intrauterine infections in the structure of causes of perinatal deaths.

Materials and methods. 62 autopsy reports were analyzed using materials of the pathology department of Khabarovsk Kray Perinatal Center as of 2018, including 35 cases of antenatal fetal death in inevitable miscarriage, 11 cases of induced medical abortions, and 9 cases of intranatal fetal death. In addition, 7 death cases of newborns who died in the early neonatal period were studied. Postmortem examination was performed to the accepted standards, including morphological analysis of autopsy material.

Results. Respiratory disorders come first as the cause of stillbirths (90.9% of cases). Congenital anomalies of internal organs, placenta, membranes and umbilical cord rank second (56.4% of cases). Infectious inflammation of secundines were found in 54.5% of cases. Immediate cause of death in the early neonatal period was found to be respiratory disorders resulting from prior disease or concurrent diseases (anomalies of internal organs, congenital infection, and hemolytic disease of newborns). In all cases of early perinatal death, an infectious condition was identified as primary, concurrent (28.5% - 2 cases out of 7) or background disease (100% of secundines infection).

Conclusion. Congenital infections have been found to be a significant factor in perinatal mortality. Thorough analysis of causes of death, better etiologic verification of congenital infections and morphological diagnosis of autopsy material will enable to assess a risk of recurrent fetal and neonatal loss in subsequent pregnancies, and contribute to the improvement of medical and preventive interventions.

Aim. To study the systemic inflammatory response during exacerbation of cytomegalovirus infection (CMVI) in women in the second trimester of pregnancy.

Materials and methods. 120 women were examined at 21-24 weeks of pregnancy, uncomplicated and complicated CMVI. The 1st group included 30 seronegative healthy pregnant women, the 2nd group - 30 patients with similar gestational periods, complicated by latent CMVI and placental insufficiency, the 3rd group - 30 pregnant women with exacerbation of CMVI and placental insufficiency, and the 4th group - 30 pregnant women with exacerbation of CMVI, leading to placental insufficiency and the threat of miscarriage.

Results. In women of the first group, the concentration of TNF-a in the blood serum was 13.5 (11.5-30.3) pg/mL, IFN-y - 134.4 (114.2-151.3) pg/mL, IL-1P - 18.0 (13.4-36.3) pg/mL, IL-6 - 1.90 (1.40-3.30) pg/mL, IL-4 - 26.2 (20.3-55.4) pg/mL and IL-2 - 27.9 (18.2-38.0) pg/mL. In group 2, compared with group 1, an increase in the median of TNF-a was 1.37 times (p=0.043) and IL-2 was 1.25 times (p=0.025), which was explained by moderate activation of systemic inflammation in latent CMVI. In group 3, in contrast to group 2, the level of TNF-a increased by 3.45 times (p=0.000001), IFN-y - by 1.69 times (p=0.000001), IL-1P - by 4.37 times (p=0.000001), IL-6 - 1.78 times (p=0.000001), IL-2 - 2.21 times (p = 0.000001) and the concentration of IL-4 decreased 2.11 times (p=0.000063). This indicated an imbalance of pro- and antiinflammatory cytokines, increasing the risk of miscarriage. In group 4, in comparison with group 3, a 1.5-fold increase in TNF-a was recorded (p=0.0052), IFN-y was 1.38 times (p=0.00015), IL-1P was 1.67 times (p=0.0000001), IL-6 - 1.67 times (p=0.0035), IL-2 - 1.37 times (p=0.008) with a decrease in the level of IL-4 in 1.29 times (p=0.0030) in the setting of clinical and sonographic signs of placental insufficiency and the threat of termination of pregnancy.

Conclusion. The increase in the concentration of pro-inflammatory cytokines (TNF-a, IFN-y, IL-1P, IL-2, IL-6) and the decrease in the level of anti-inflammatory cytokine (IL-4) in patients with exacerbation of CMVI in the second trimester of pregnancy, complicated by placental insufficiency, associated with the threat of miscarriage, confirm the role of activation of the systemic inflammatory response in the pathogenesis of initiation of premature labor.

Aim. To establish the role of lipid peroxidation (LPO) products in the development of iron deficiency anemia in pregnant women of the first trimester during exacerbation of cytomegalovirus infection.

Materials and methods. A prospective case-control study included 60 women in the first trimester of pregnancy (8-12 weeks), of which 35 were cytomegalovirus-positive with mild iron deficiency anemia (main group) and 25 - cytomegalovirus-seronegative (control group). Antibodies of IgM and IgG to CMV, low avid IgG (avidity index), and serum ferritin concentration were determined by enzyme-linked immunosorbent assay. In order to assess the intensity of LPO processes in blood serum spectrophoto-metric method was used to measure the levels of molecular products of oxidation: diene conjugates and active products of thiobarbituric acid. The concentration of arachidonic acid in blood serum was analyzed by means of the method of capillary gas-liquid chromatography. The concentration of total hemoglobin in red blood cells was measured by photometry. The study of iron metabolism included: evaluation of serum iron by spectrophotometric method, the total iron binding capacity of serum using commercial kits of the company “Lachema” (Czech Republic), transferrin saturation coefficient by means of calculation method.

Results. Activation of LPO processes was noted in women of the main group, as evidenced by an increase in the concentration of diene conjugates by 1.54 times (p<0.001), active products of thiobarbituric acid by 2.4 times (p<0.001) and arachidonic acid by 1.3 times (p<0.001) compared with similar indicators of the control group. It has been found that hemoglobin levels were reduced by 1.2 times (p<0.001), serum iron and ferritin, respectively, by 1.4 (p<0.001) and 2 times (p<0.001), in the setting of an increase in the total iron binding capacity of serum while reducing the coefficient of iron saturation with transferrin.

Conclusion. The data obtained indicate the important role of LPO products in the pathogenesis of iron deficiency anemia during exacerbation of cytomegalovirus infection in the first trimester of gestation.

Aim. To give an echographic and biochemical characterization of the hepatobiliary system in case of congenital cytomegalovirus infection (CMVI) in dead full-term infants.

Materials and methods. A research was carried out at birth and during the first day of 59 children who died on the 2^nd-5^th day of life. Group 1 (control) consisted of 25 full-term newborns from mothers who did not have moderate and severe obstetric and somatic pathologies, as well as respiratory viral diseases and sexually transmitted infections. Group 2 (experimental) included 18 newborns whose mothers suffered from an exacerbation of CMVI in the second trimester of pregnancy without markers of congenital viral infection in their offspring. Group 3 (main) was represented by 16 newborns with congenital CMVI. The main cause of death in 1st group of children was prolonged intranatal hypoxia, atelectasis and hyaline membrane of the lungs; in group 2 - ante-, intra- and postnatal hypoxia, as well as common lung atelectasis; in group 3 - cerebral ischemia of moderate and severe degrees, ventriculomegaly, pseudocysts of the vascular plexus and subarachnoid hemorrhages, local and generalized forms of congenital infection. Ultrasound analysis determined the size, echostructural picture of the liver and the structure of the gallbladder. The activity of alanine aminotransferase, aspartate aminotransferase, y-glutamyltranspeptidase and alkaline phosphatase was evaluated by biochemical methods in blood serum from the umbilical vein.

Results. In newborns of group 2, hepatomegaly was detected in 5.6%, increased echogenicity of blood vessels and portal tracts in 11.1%, and S-shaped deformation of the gallbladder in 5.6%. However, statistically significant differences in the frequency of increase in echogenicity of the parenchyma in children of groups 2 and 1 were not established (p>0.05). In the cord blood serum of newborns in group 2, the level of alanine aminotransferase was 19.4±2.16 IU/L, aspartate aminotransferase - 21.7±2.31 IU/L, γ-glutamyltranspeptidase - 124.7±15.51 IU/L and alkaline phosphatase - 136.3±13.39 IU/L (in group 1, respectively, 16.6±1.61 IU/L, p>0.05; 21.7±2.31 IU/L, p>0.05; 120.8±13.98 IU/L, p>0.05; 130.7±11.21 IU/L, p>0.05). In children of group 3 compared with group 2, the frequency of detection of hepatomegaly (43.8%, p<0.05), increased echogenicity of the parenchyma (50%, p<0.01), blood vessels and portal tracts (56%, p2<0.05). Twice more often S-shaped deformation of the gallbladder was detected (p>0.05). The activity of y-glutamyltranspeptidase increased to 185.2±19.83 IU/L (р2<0.05) and alkaline phosphatase to 192.2±16.89 IU/L (p<0.05), which are markers of cholestasis in the setting of the absence of statistically significant differences between the indices of alanine aminotransferase (p>0.05) and aspartate aminotransferase (p>0.05). However, in three cases, the highest rates of alanine aminotransferase (more than 40 IU/L) were diagnosed, indicating the dominance of cytolysis and inflammation in the liver.

Conclusion. The above ultrasound and biochemical changes confirm the important role of the echostructure picture of the hepatobiliary system and its biochemical assessment in the diagnosis of inflammation and cholestasis in the liver in newborns with congenital CMVI.

Introduction. The study of the possibility of correct free radical lipid oxidation of membranes in conditions of ultraviolet radiation by the introduction of succinate-containing drugs is of interest, since the search for antioxidant agents is an important area of research in experimental and clinical pharmacology.

Aim. Evaluation of the comparative effectiveness of Reamberin and Cytoflavin (Scientific and technological pharmaceutical company “Polysan”, St.Petersburg) to correct free radical lipid oxidation of rats’ organism membranes induced by ultraviolet radiation.

Materials and methods. The animals were divided into 4 groups and each of them had 20 rats: intact animals (1) which were held in standard conditions of vivarium; the control group (2) in which rats were exposed to ultraviolet radiation during three minutes daily; the experimental group (3) in which before ultraviolet radiation animals had a daily intraabdominal intake of the Reamberin in a dose of 100 mg/kg of succinate (20 mL/kg); the experimental group in which before ultraviolet radiation animals had a daily intraabdominal intake of the Cytoflavin in a dose of 100 mg/kg of succinate (1 mL/kg).

Results. It was found out that in the blood of experimental animals a daily ultraviolet radiation during three minutes contributes to the increase of lipid hydroperoxides level (by 48-53%), of diene conjugate (by 43-48%), and of malonic dialdehyde (by 48-61%) in the setting of the decrease of antioxidant system activity in the blood of intact animals. The introduction of the succinate-containing drugs to rats in the conditions of oxidative stress contributes to the increase of the duration of rats swimming by 11-28% in 7 days of the experiment. The introduction of the succinate containing Reamberin to rats contributes to the decrease in the blood of lipid hydroperoxides by 16-22%, of diene conjugates - by 16-20%, and of malonic dialdehyde by 15-20% in comparison with the rats of the control group. The introduction of the succinate containing Cytoflavin to rats in the conditions of oxidative stress contributes to the decrease in the blood of lipid hydroperoxides by 23-25%, of diene conjugates - by 23-25%, and of malonic dialdehyde by 24-27% in comparison with the rats of the control group. While analyzing the effect of the succinate containing drugs on the activity of the components of antioxidant system it was shown that the level of ceruloplasmin in the blood of animals was significantly higher by 26-37%, of vitamin E by 25-34%, of catalase by 18-47% in comparison with the same parameters of the rats of the control group.

Conclusion. The application of the succinate containing antioxidants in the conditions of ultraviolet radiation of the organism of animals under experiment leads to the stabilization of the processes of peroxidation against the increase of physical endurance of rats. The intraabdominal introduction in laboratory animals of the Cytoflavin in a dose of 100 mg/kg of succinate prevents the accumulation of lipoperoxidation products and increases the activity of main components of the antioxidant system in rats’ blood plasma, which indirectly exceeds similar effect of the Reamberin in a dose of 100 mg/kg of succinate in the conditions of ultraviolet radiation.

Postpericardiotomy syndrome (PCTS) develops after cardiosurgical operations as part of the non-specific systemic inflammatory responses syndrome of the body (SIRS) and manifests signs of general intoxication and symptoms of involvement in the autoimmune inflammatory process of pulmonary pleurae and/or pericardial layer to form efflux in the pleural and/or pericardial cavities. PCTS is not a rare pathological condition and often accompanies heart surgeries, especially those which are carried out under cardiopulmonary bypass. However, it can occur in the guise of lung and pleura diseases, cardiac decompensation and other complications of cardiological diseases and cardiosurgical interventions. In the light of the specificity of the therapy of this syndrome, its correct and timely diagnosis is intended to alleviate the already unsatisfactory condition of the patient who has undergone heart surgery and his postoperative prognosis. Although this pathology was described in the middle of the last century, its methods of treatment are still under discussion, in particular the effectiveness of glucocorticosteroids and colchicine is compared and the use of the latter for the prevention of PCTS is considered. This paper presents the case history of PCTS tolerant to hormone therapy and managed with colchicine.

The literature describes the high prevalence of a combination of the upper and lower obstructive pathology of respiratory tract, the main of which are asthma, obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD). Thus, according to the results of a meta-analysis, the average prevalence of OSAS among AD patients is approaching 50%. The chance of the OSAS presence in patients with asthma is 2.64 95%CI (1.76; 3.52) times higher than in individuals who do not have asthma (p<0.001). A study in Europe showed that about 1% of the total population and 9.2% of patients with OSAS had COPD according to spirometry. Such a high prevalence of the combined course indicates the presence of a pathophysiological pairing of these pathologies, which has yet to be revealed. The most obvious common pathogenetic link of these disorders can be genetically caused disorders that occur at the receptor level. Several neuropeptide systems are known to control muscle tone of the respiratory tract, one of which is GABAergic. In this review, we described the prevalence of GABAergic transmission, its role in regulating the tone of the respiratory muscles, the localization and functional significance of GABA receptors, not only in the central nervous system, but also in the respiratory epithelium and smooth muscles of the respiratory tract. Thus, an imbalance in the neurotransmitter system can lead to the development of obstructive diseases of both the upper and lower respiratory tract. In addition, GABAergic receptors may be an obvious target for the treatment of obstructive airways diseases.

The article presents modern data on exosomes - microscopic extracellular vesicles with a diameter of 30-180 nanometers, released into the intercellular space by cells of the respiratory organs. The cells of the body’s respiratory system secrete exosomes into the intercellular space in a normal state, as well as during the development of the disease. The concentration of exosomes depends on the type of cell and includes mRNA, miRNAs, DNA and signaling proteins. Some exosomal proteins, such as CD63, CD81, CD9, CD24 and heat shock protein (Hsp70) are universal and they are usually used as exosomal markers. In respiratory diseases, in particular in patients with chronic obstructive pulmonary disease, IL-1P and miRNAs such as miR-15b, miR-223, miR-1274a, miR-424, mir-210 are significantly increased; miR-21 is the most common miRNA isolated from lung tissue, increased expression of this RNA is associated with symptoms of asthma, idiopathic pulmonary fibrosis and lung cancer. Exosome analysis makes it possible to distinguish between pulmonary and extrapulmonary forms of tuberculosis based on exosomal markers such as MPT64. Circulating exosomes are stable in biological fluids; therefore, analysis of exosomal microRNAs may indicate the state of the human respiratory system. This review opens up the possibility of using new diagnostic and therapeutic targets for various diseases of the respiratory system.

The development of respiratory distress in traumatic brain injury (TBI) is associated with the occurrence of non-cardiogenic, neurogenic pulmonary edema (NPE) and neuroinflammation. According to modern concepts, there are several theories for the development of NPE: due to neuro-cardiac or neurohemodynamic edema; “blast theory”; due to adrenergic hypersensitivity of the pulmonary venule; theory of “double strike”. The latter is based on the assertion that pulmonary injury in TBI occurs in response to a systemic inflammatory reaction when mediators of this process produced by glial tissue appear. It has been shown that with TBI, a neuro-inflammatory response develops, which contributes to the formation of acute respiratory distress syndrome. TBI causes a neuro-inflammatory response, which contributes to the formation of acute respiratory distress syndrome. The inflammation after TBI is caused by the production and activation of complement, cytokines, adhesion molecules, and other multifunctional peptides. Along with this neuroinflammatory activity is initiated by microglia and astrocytes; therefore, cells of the central nervous system are a powerful source of inflammatory mediators in TBI. It has also been demonstrated that the development of acute lung injury after TBI is associated with the expression of a systemic inflammatory response and NPE, pneumonia, etc. In the lung tissue, the initiation of the functional activity of innate immunity cells is observed against the background of massive sequestration by interstitial neutrophils, which then migrate to the alveoli. At the moment, there is a need to study the role of various molecular mediators, including endothelin-1 in the development of respiratory system pathology due to TBI.

The aim is to study the complications of pregnancy, childbirth and the condition of newborns in women with pneumonia based on the conducted analysis of scientific literature. The incidence of pneumonia and mortality rate due to its complications in pregnant women is higher than in non-pregnant women. This fact is associated with immune suppression during pregnancy, the presence of chronic diseases, nicotine intoxication and the emergence of new pathogens. The analysis of articles, systematic reviews of domestic and foreign authors indicates the inequality of the results and factors that influence the outcomes of pregnancy, childbirth and health of the newborns. Frequent complications of women pregnancy with acute respiratory diseases are: placental disorders (15.2-100%), preeclampsia (25%), oligohydramnios and polyhydramnios (20%). According to the literature analysis the incidence of spontaneous miscarriage in the early stages is from 13 to 42%, in the later stages is from 20 to 25%. Premature birth is diagnosed in 16-52.3% of pregnant women. The rate of pregnancy complications depends on the body mass index, the presence of anemia during pregnancy and the gestational period of pneumonia. During the analyzed data, we can say that the condition of the newborns will depend on the severity of pneumonia. The newborns of pneumonia-positive mothers have a high risk of low birth weight, intrauterine infection, and cerebral ischemia. Summarizing the published information on complications in pregnant women with pneumonia caused by COVID-19, it is impossible to draw a definitive conclusion. In a number of researches in pregnant women with pneumonia caused by COVID-19, spontaneous miscarriage was diagnosed in every third, premature birth in every fourth, of which 20.7% were diagnosed with premature rupture of membranes. Other studies do not confirm a high percentage of pregnancy complications, but a high risk of surgical delivery in this group of pregnant women is shown. The perinatal mortality rate in the researches reached 11.1%. In each research, the vertical transmission pathway was evaluated by taking amniotic fluid, umbilical cord blood, and a throat swab from a newborn. There is no evidence of COVID-19 vertical transmission in the sources. A review of the data shows the need for further research in this area.