Management of Chronic Obstructive Pulmonary Disease

The relevance of the study of chronic obstructive pulmonary disease (COPD) can be explained by the persistence of unfavorable dynamics of the disease, even despite the achieved success in the pharmacotherapy of this pathology. In 2016, World Health Organization (WHO) ranked COPD as the third leading cause of death worldwide, far exceeding the experts' predictions, who believed that such an increase in the death rate would occur by 2030. This study aimed to determine the level of senior medical students' knowledge in the management of patients with COPD, based on the method of anonymous questioning. This research work describes the results of the second stage of the ASCO project (Assessment of Senior Medical Students in the Field of COPD) conducted in 2017-2019 among 338 senior medical students from six large cities of Russia and Ukraine. The survey revealed the average level of knowledge among senior medical students, based on the average level of correct answers (56.6%) obtained in the study. The best results were obtained for the questions about COPD risk factors, influenza vaccine prevention, and pneumococcal vaccine prevention in COPD patients. The worst results were recorded on the questions about the severity of COPD clinical symptoms, the choice of initial therapy for COPD with advanced symptoms, a high risk of exacerbations, and the moderate exacerbation of COPD. The obtained results indicated an insufficient level of students' basic knowledge in questions regarding etiopathogenesis, diagnosis, treatment, and prevention of COPD.

[The prospects for the creation of the National Center for Personalized Medicine of Endocrine Diseases]

ФГБУ «НМИЦ эндокринологии» Минздрава России (НМИЦ эндокринологии) получил право реализовать программу развития Научного Центра Мирового Уровня «Национальный Центр Персонализированной медицины эндокринных заболеваний» (НЦПМЭЗ). Задачей НЦПМЭЗ станет не только создание системы персонализированного лечения, но и подготовка новых кадров для медицины. Фундаментальные исследования, проводимые на базе уже существующих институтов и лабораторий НМИЦ эндокринологии, будут расширены за счет создаваемых de novo лабораторий НЦПМЭЗ в соответствии с одобренным проектом.  Данная публикация знакомит читателя с наиболее значимыми лабораториями, которые планируется создать в НЦПМЭЗ: лабораторией общей, молекулярной и популяционной генетики, биоинформатики, фармакогеномики, микробиоты, редактирования генома, математических и цифровых технологий, неинвазивных технологий диагностики эндокринопатий, клеточных технологий, искусственного интеллекта и принципиально новой, не имеющей аналогов, лабораторией метаболической визуализации и радиотераностики.  Авторы надеются, что читатели одного из основных журналов для эндокринологов нашей страны примут активное участие в осуществлении планов НМИЦ эндокринологии, поскольку как у молодых, так и у опытных талантливых исследователей появится шанс стать частью команды Центра. Для выполнения амбициозных задач необходимо кардинально изменить мировоззрение врача в стране, разработать новую систему обучения за счет увеличения числа специалистов по медицинской генетике, транскриптомике, биостатистике и биоинформатике, работающих на стыке экспериментальной и клинической эндокринологии, что обеспечит транзит инновационных технологий в клиническую практику. Созданные лаборатории Научного Центра Мирового Уровня станут местом будничной работы нового поколения врачей, владеющих не только основами клинической работы, но и навыками фундаментальных исследований, что позволит им значительно улучшить методы прогнозирования, диагностики и лечения.

Pharmacogenetic testing in population of South Ural

BACKGROUND

Drug resistance is a phenomenon that has received serious attention in recent years in everyday medical practice. This may also be described as responsiveness or non-responsiveness to drugs, as patients respond partially to medical treatment or have no response at all [1]. The non-responsiveness to clopidogrel in cardiac patients of different populations is due to genetic variations in the cytochrome P450 (CYP) gene [2]. Carriers of at least one 'poor metabolizer allele' of CYP2C19 (either *2 or *3) have lower levels of the active metabolite of clopidogrel and have reduced platelet inhibition [3]. Furthermore, the significant inter-ethnic variability in the allelic frequencies of CYP2C19*2 has been associated with differential clopidogrel resistance [4]. Such mutations in this variant allele are responsible for the inability of the CYP enzyme to convert clopidogrel into its active metabolite, which may result in the increased risk of death, heart attack or stroke among patients who have undergone percutaneous coronary intervention (PCI) [5]. South Ural is a multinational region, a subject of the Russian Federation, where genetic variations have not been studied fully yet.

OBJECTIVE

To examine prevalence of mutant alleles in population of South Ural.

METHODS

We conducted pharmacogenetic testing for specific single nucleotide polymorphisms in 54 patients. The present research was conducted in the alleles CYP2C19*2 and CYP2C19*3. The data were processed using the program SPSS Statistics.

RESULTS

The mean age of patients was 58, 4 years (from 26 to 79 years). Among all patients 59.3% were male, 40.7% of female patients.Among the studied patients in allele CYP2C19*2, the "wild" type GG was detected in 75,9% of patients, GA type in 22.2% and AA variant was detected in 1.9% of all patients. Allele CYP2C19*3 is often found among alleles with reduced function and also associated with resistance to clopidogrel. Functional drug response is observed in patients with type GG. All of the studied patients were carriers of this type. According to literature data the frequency of genotypes associated with resistance to clopidogrel in the Russian population is 11.4%, which is comparable with European ethnic groups [6].

CONCLUSIONS

It was revealed that 75,9% of patients were sensitive to clopidogrel, and for them this drug in its standard dosage will be effective, and 24,1% of patients were not sensitive, therefore, they would require replacement of clopidogrel with another drug.