YU.A. MANISHENKOVA

 Lugansk State Medical University named after St. Luke, Lugansk

 Contact details:

Manishchenkova Yu.A. — PhD (Medicine), Associate Professor of the Faculty Therapy Department

Address: 1G block of the 50^th anniversary of the Defense of Lugansk, 291045 Lugansk, Lugansk People’s Republic, tel.: +7-959-112-92-70, e-mail: yuliam17@yandex.ru

 The purpose — to evaluate the effectiveness of the inclusion of immunomodulatory, antioxidant and antihypoxic drugs in a comprehensive program of medical rehabilitation of patients with community-acquired pneumonia (CAP) against type 2 diabetes mellitus (DM).

Material and methods. The study included 69 patients who had undergone CAP against type 2 DM. Group I included 32 patients who received a standard rehabilitation program, including basic diabetes therapy, breathing exercises, and physical therapy. Group II consisted of 37 patients who received a standard rehabilitation program with additional medications: N-acetylcysteine (NAC), bacterial lysates (OM-85), a combination of succinic acid, inosine, nicotinamide, and riboflavin (SAINR). The duration of drug rehabilitation therapy was 12 weeks. Clinical parameters (mMRC dyspnea, cough, sputum, oxygen saturation), laboratory parameters (highly sensitive CRP (hs-CRP), general antioxidant status, immunoglobulin A), as well as indicators of carbohydrate metabolism (blood glucose, glycosylated hemoglobin (HbA1c) were evaluated.

Results. After 12 weeks of follow-up, group II showed a significantly more pronounced improvement in clinical parameters compared with standard therapy (p < 0.01), including a decrease in the severity of shortness of breath and cough, a decrease in the frequency of sputum and an increase in oxygen saturation. Group II showed a significant decrease in hs-CRP levels (up to 0.8 ± 0.4 mg/l), an increase in antioxidant status (up to 1.57 ± 0.13 mmol/L) and immunoglobulin A levels (up to 1.7 ± 0.4 g/l) (p<0.01). There was also a more pronounced improvement in carbohydrate metabolism, including a decrease in blood glucose and HbA1c (p < 0.01). Correlation analysis revealed a relationship between reduced inflammation, restoration of antioxidant protection, normalization of metabolic status and improvement of clinical parameters.

Conclusions. Comprehensive rehabilitation therapy in patients after community-acquired pneumonia against diabetes mellitus provides a more pronounced improvement in clinical condition, reduction of inflammation, restoration of antioxidant and immune status, as well as normalization of carbohydrate metabolism, which confirms its high clinical efficacy and pathogenetic validity.

Key words: community-acquired pneumonia, diabetes mellitus, rehabilitation, oxidative stress, CRP, immunoglobulin A, HbA1c

REFERENCES

1. Metlay J.P., Waterer G.W., Long A.C., Anzueto A., Brozek J., Crothers K. et al. Diagnosis and treatment of adults with community-acquired pneumonia. Am. J. Respir. Crit. Care Med, 2019, vol. 200 (7), rr. 45–67. DOI: 10.1164/rccm.201908-1581ST
2. Froes F., Pereira J.G., Póvoa P. Outpatient management of community-acquired pneumonia. Curr. Opin. Pulm. Med, 2019, vol. 25 (3), rr. 249–256. DOI: 10.1097/MCP.0000000000000558
3. Apicella M., Campopiano M.C., Mantuano M., Mazoni L., Coppelli A., Del Prato S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diab. Endocrinol, 2020, vol. 8 (9), rr. 782–792. DOI: 10.1016/S2213-8587(20)30238-2
4. Sul O.J., Ra S.W. Quercetin prevents LPS-Induced oxidative stress and inflammation by modulating NOX2/ROS/NF-kB in lung epithelial cells. Molecules, 2021, vol. 26 (22), r. 6949. DOI: 10.3390/molecules26226949
5. Bhatti J.S., Bhatti G.K., Reddy P.H. Mitochondrial dysfunction and oxidative stress in metabolic disorders — A step towards mitochondria based therapeutic strategies. Biochim. Biophys. Acta Mol. Basis Dis, 2017, vol. 863 (5), rr. 1066–1077. DOI: 10.1016/j.bbadis.2016.11.010
6. Sies H., Jones D.P. Reactive oxygen species (ROS) as pleiotropic physiological signalling agents. Nat. Rev. Mol. Cell. Biol, 2020, vol. 21 (7), rr. 363–383. DOI: 10.1038/s41580-020-0230-3
7. De Flora S., Balansky R., La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID-19. FASEB J, 2020, vol. 34 (10), rr. 13185–13193. DOI: 10.1096/fj.202001807
8. Aldini G., Altomare A., Baron G., Vistoli G., Carini M., Borsani L., Sergio F. N-Acetylcysteine as an antioxidant and disulphide breaking agent: the reasons why. Free Radic. Res, 2018, vol. 52 (7), rr. 751–762. DOI: 10.1080/10715762.2018.1468564
9. Kalyuzhin O.V. OM-85 in the prevention/treatment of respiratory infections and exacerbations of chronic lung diseases: selection criteria, mechanisms, and evidence. Lechashchiy vrach, 2018, no. 3, pp. 77–82 (in Russ.).
10. Marseglia G.L., Benazzo M., Biasci P., Blasi F., Cricelli C., Doria M. et al. OM-85 in the prevention of respiratory infections: State-of-the-art and future perspectives in clinical practice. J. Biol. Regul. Homeost. Agents, 2021, vol. 35 (3), pp. 847–863. DOI: 10.23812/21-147-A
11. Jurkiewicz D., Zielnik-Jurkiewicz B. Bacterial lysates in the prevention of respiratory tract infections. Otolaryngol. Pol, 2018, vol. 72 (5), pp. 1–8. DOI: 10.5604/01.3001.0012.7216
12. Amorim J.A., Coppotelli G., Rolo A.P., Palmeira C.M., Ross J.M., Sinclair D.A. Mitochondrial and metabolic dysfunction in ageing and age-related diseases. Nat. Rev. Endocrinol, 2022, vol. 18 (4), pp. 243–258. DOI: 10.1038/s41574-021-00626-7
13. McCarthy B., Casey D., Devane D., Murphy K., Murphy E., Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev, 2015, vol. 23 (2), p. CD003793. DOI: 10.1002/14651858.CD003793.pub3