An excessively pronounced inflammatory response and endothelial dysfunction play a key role in the development of severe and complicated forms of influenza. Objective. To evaluate the role of plasma ICAM-1 in the development of severe influenza forms and in disease prognosis. Patients and methods. A total of 59 patients with influenza, aged 37 to 90 years, who received inpatient treatment between January and April 2025, were examined. Group 1 consisted of 29 patients with uncomplicated influenza, Group 2 – 30 patients whose disease was complicated by pneumonia, and the control group – 10 healthy individuals of comparable age. Among the pneumonia patients, 14 (23.7%) had a fatal outcome. Plasma ICAM-1 levels were measured once during the acute phase of the disease. Results. Elevated blood ICAM-1 levels were detected in patients with influenza complicated by pneumonia: the median was 3.2 times higher than in the control group (p = 0.004). In uncomplicated influenza, ICAM-1 values did not statistically differ from those in the control group (p = 0.2). Among deceased patients, plasma ICAM-1 levels were higher than among survivors (p = 0.01). An ICAM-1 level in blood >700 ng/mL increased the risk of fatal outcome by 8-fold. Conclusion. Elevated plasma ICAM-1 levels are observed exclusively in patients with influenza complicated by pneumonia. The association between high blood ICAM-1 levels and an unfavorable outcome underscores the importance of measuring this parameter for disease prognosis assessment. Key words: endothelial dysfunction, influenza, ICAM-1, pneumonia
Objective. To compare the efficacy and safety of antiviral chemotherapeutic agents when initiated at different time points in the treatment of moderate COVID-19. Patients and methods. A retrospective observational study included 254 patients with moderate COVID-19 who underwent treatment in an infectious diseases hospital during 2021–2022 and met the inclusion criteria. As etiotropic therapy, favipiravir and molnupiravir were used in accordance with the then-current versions of the Interim Guidelines “Prevention, Diagnosis, and Treatment of Novel Coronavirus Infection (COVID-19)”, as well as the drug riamilovir, used off-label. The following groups were formed: patients receiving riamilovir – 82 шndividuals (group 1), favipiravir – 98 individuals (group 2), and molnupiravir – 74 individuals (group 3). The groups were comparable in terms of age and sex. Based on the timing of antiviral therapy initiation, patients in each group were categorized into two subgroups: in the first subgroup, antiviral therapy was initiated within the first 6 days of illness onset, and in the second subgroup – after day 6. Results. Among patients who initiated antiviral chemotherapy within the first 6 days, compared to those who started antiviral therapy after day 6, a reduction in the duration of intoxication symptoms and respiratory system involvement was observed, including fever (p = 0.001), myalgia (p = 0.001), cough, and dyspnea (p = 0.01). With early initiation of etiotropic therapy, symptoms resolved more rapidly in patients receiving molnupiravir. When antiviral therapy was started after day 6, symptom resolution occurred more quickly in patients receiving riamilovir. Conclusion. It has been demonstrated that earlier administration of antiviral drugs results in a clear therapeutic effect, manifested by a reduction in the duration of the main disease symptoms across all compared antiviral agents. Among the SARSCoV-2 virus replication inhibitors used, it was noted that at a later time of initiation of therapy, the clinical effect was more often manifested when using the drug riamilovir. Key words: COVID-19, riamilovir, favipiravir, molnupiravir, timing of antiviral therapy initiation
The article presents the results of an original study investigating the features of neuroendocrine regulation in children with Multisystem Inflammatory Syndrome (MIS-C) associated with SARS-CoV-2. Objective. To investigate blood laboratory parameters characterizing neuroimmunoendocrine dysregulation and identify predictors of severe disease course in MIS-C. Patients and methods. A clinical and laboratory examination of 30 children diagnosed with MIS-C was conducted. Additionally, levels of cytokines (n = 48), immunoglobulins (IgA, IgM, IgG), protein S-100B, neuron-specific enolase (NSE), and cortisol were analyzed. Results. During the acute phase of MIS-C, a significant increase was observed in the levels of 11 cytokines (IL-2Rα, IL-18, MIF, IL-1ra, IL-16, IP-10, MIG, MIP-1α, G-CSF, HGF, M-CSF), protein S-100B, and cortisol, along with a significant decrease in the levels of 9 cytokines (IFN-α2, IL-1α, IL-12(p70), TNF-β, IL-4, TRAIL, IL-3, IL-7, PDGF-BB) compared to the control group. During the convalescence period, normalization of most laboratory parameters was noted; however, a significant reduction compared to controls was observed for 16 cytokines (IFN-α2, IFN-γ, IL-1α, IL-1β, IL-6, IL-12(p70), IL-15, TNF-α, IL-4, IL-10, IL-13, MCP-3, IL-3, IL-5, IL-7, VEGF). Furthermore, levels of 5 cytokines (IL-18, IP-10, MIG, M-CSF, PDGF-BB), immunoglobulins, and platelets were significantly elevated. Laboratory predictors for the development of cardiovascular complications were identified: levels of platelets, lymphocytes, IgM, eotaxin, TNF-β, ferritin, and vascular endothelial growth factor (VEGF). Conclusion. The study identified laboratory criteria indicative of neuroimmunoendocrine dysregulation and hemostasis system disturbances in MIS-C, which correlate with the disease course severity. These findings provide a rationale for considering the use of Cytoflavin in the treatment regimen. Key words: SARS-CoV-2, S100B protein, immunoglobulins, cortisol, multisystem inflammatory syndrome in children, neuron-specific enolase, cytokines, Cytoflavin
Objective. To study the efficacy and safety of bulevirtide, an entry inhibitor of the hepatitis D/B viruses (HDV/HBV), in patients with chronic hepatitis D (CHD) in real-world clinical practice. Patients and methods. The study group consisted of 63 patients with CHD, predominantly with liver cirrhosis (67%) and high HDV RNA load (median 6.8 log10 copies/mL), including 19 patients with HIV co-infection. Treatment outcomes were analyzed in 48 patients: 29 received monotherapy, and 19 received combination therapy with pegylated interferon α (including 3 who switched to monotherapy). Results. After 96 weeks of treatment, the median HDV RNA level decreased from 6.8 log10 to undetectable levels (median reduction –5.9 log10), with an increase in the rate of virologic response (VR) during treatment to 88%, and complete virologic response (cVR) to 63%. The high rate of early partial virologic response (pVR) (29% at week 12) subsequently decreased due to the conversion of pVR to VR. Combination therapy was associated with higher rates of VR and cVR in the first year of treatment compared to monotherapy, and later normalization of alanine aminotransferase (ALT) activity (at 48 weeks, due to the cytolytic effect of interferon). With monotherapy, early normalization of ALT activity (at 12 weeks) was observed, and VR and cVR rates reached levels comparable to combination therapy by the end of the second year of treatment. All patients with HIV co-infection and available follow-up of HDV RNA levels achieved VR (including cVR) or pVR; the dynamics of biochemical response were consistent with those in the overall group. Treatment was characterized by good tolerability, with no serious adverse reactions, no cases of treatment discontinuation, and no deterioration of liver function in patients with cirrhosis. Conclusion. High virologic and biochemical efficacy, safety, and good tolerability of bulevirtide in the treatment of CHD in realworld practice, including in HIV co-infected patients, were demonstrated. The obtained data support the choice of combination therapy as a first-line treatment and emphasize the importance of treatment duration for increasing its effectiveness. Further accumulation of real-world experience with antiviral therapy is necessary to develop an optimal treatment algorithm aimed at disease cure. Key words: bulevirtide, HIV co-infection, monotherapy, combination therapy, pegylated interferon, chronic hepatitis D
This review focuses on various aspects of the application of a complex immunoglobulin preparation – CIP (Complex Immunoglobulin Preparation), which contains human immunoglobulins of the main isotypes (G, A, M). The preparation is recommended for oral therapy of viral and bacterial intestinal infections in children aged one month and older, as well as in adults. However, over more than thirty years of use, significant experience has been accumulated regarding its application in various infectious diseases accompanied by microbiome alterations and gastrointestinal disorders. CIP exerts a local effect throughout the entire gastrointestinal tract, contributes to the formation of immunological memory alongside the body's own antibodies, and enhances local immunity in all compartments of the mucous membranes. CIP is successfully used for the treatment of salmonellosis, dysentery, rotavirus and norovirus infections, yersiniosis, dysbiosis of various etiologies, and other gastrointestinal diseases. Its broad spectrum of antibodies and ability to restore microbial balance enable its application in acute respiratory infections of diverse etiology and pertussis. The preparation demonstrates therapeutic effects in allergodermatoses and chlamydial infections, corrects the oral microbiota, and the presence of antibodies against SARS-CoV-2 suggests its potential prophylactic activity against novel coronavirus infection. Key words: complex immunoglobulin preparation, CIP, antibodies, mucosal immunity, acute enteric infections, acute viral infections
