Assessment of viral load levels in various biological samples taken from the respiratory tract can be an indicator of an ongoing process of active viral replication and may be used to monitor severe respiratory viral infections. The study of the relationship between SARS-CoV-2 viral load and immunological laboratory parameters is an important step in the search for clinical markers of COVID-19.The aim of this research was to quantify viral load in patients with COVID-19 and to identify the relation-ship between viral load and changes in the parameters of the cellular component of the immune system.A laboratory examination was carried out on 74 patients diagnosed with COVID-19, they were divided into 3 groups based on the severity of the disease: mild, moderate, severe. Total viral load in clinical samples was determined by the number of SARS-CoV-2 RNA copies per 100 copies of the reference RNaseP gene. A comprehensive assessment of the cellular component of the immune system was performed using flow cytometry and direct monoclonal antibodies, and the IL-6, and C-reactive protein concentrations were determined.We revealed a relationship between the development of serious clinical conditions in the patients with COVID-19, and the levels of viral load. High levels of viral RNA in biological samples correlate with main indicators of the T cell component of the immune system associated with disease severity. In a subgroup of patients with an extremely high viral load, strong positive correlations were found between the relative numbers of cytotoxic lymphocytes (CD3+CD8+), activated T lymphocytes (CD3+HLA-DR+), as well as absolute and relative numbers of activated B lymphocytes and NK cells (CD3-CD25+).Laboratory monitoring of the cellular component of the immune system, along with the assessment of viral loads, should improve early assessment of clinical condition in the patients with COVID-19. Changes in expression levels of activation markers on immune cells can be potentially viewed as indicators of recovery during COVID-19.

Monoclonal antibodies IL-6 inhibitors (olokizumab) and IL-6 receptor inhibitors (tocylisumab, levilimab) are most widely used for proactive anti-inflammatory therapy in patients with COVID-19. A decrease in blood oxygen saturation after 12–72 hours of anticytokine therapy has been recently observed in some patients treated with MAB. Unfortunately, little attention is paid to this problem. As a rule, the deterioration of the patient’s condition is attributed to the natural course of the disease. The purpose of the study is to identify predictors of reduced blood oxygen saturation against the administration of IL-6 inhibitors and its receptors in patients with new coronavirus infection (COVID-19). Material and methods. The study included 54 patients with COVID-19 who were treated permanently between 2020 and 2021 and were given IL-6 inhibitors or receptors (tocilizumab, olokizumab or levililmab). The results of clinical examination, laboratory and instrumental research were evaluated. Results and conclusions. Clinical-laboratory parameters reliably correlated with decreased blood oxygen saturation against the administration of IL-6 inhibitors and its receptors are as follows: administration of MAB after 2 days of inpatient treatment (OR = 3.52; 95% CI 1.026–12.073; p = 0.04), the presence of hypertonic disease in combination with ischemic heart disease or obesity (OR = 4.0; 95% CI 1.0–16.925; p = 0.049 and OR = 7.353; 95% CI 1.429–37.848; p = 0.009 respectively), increase in the number of monocytes greater than 0.6 × 109/l (OR = 4.929; 95% CI 1.327–18.307; p = 0.014), the decrease of albumin less than 35.1 g/l (OR = 30.0; 95% CI 1.410–638.186; p = 0.033), glucose of venous blood 5.9 mmol/l and above (OR = 11.556; 95% CI 1.223–109.19; p = 0.018). Based on the data obtained in this study, it is recommended to evaluate the predictors listed above before conducting targeted anti-inflammatory therapy, and, if they are available, to dynamically monitor patients for reduced blood oxygen saturation.

Relevance . Seasonal flu vaccination is still the most effective way to protect against flu viruses and help to reduce the burden of flu illnesses. Another possible benefit is the impact of yearly vaccines on severity of breakthrough infection. In this regard, the issue of choosing safe vaccine with high immunogenicity becomes relevant. Aims . To evaluate the prophylactic efficacy of inactivated seasonal flu vaccines (quadrivalent subunit vaccine with adjuvant and trivalent vaccine) and reactogenicity of quadrivalent vaccine. Materials and methods . 491 cases were included in our study: 152 cases received adjuvanted quadrivalent subunit flu vaccine «Grippol Quadrivalent», 118 cases received trivalent inactivated flu vaccine and 221 cases who have received no vaccinations during 2018–2019 epidemic season. Results . inactivated vaccines showed high prophylactic efficacy in preventing seasonal influenza. Incidence of influenza and other viral respiratory disease cases was lowest in «Grippol Quadrivalent» group. Breakthrough influenza cases in individuals vaccinated with inactivated vaccine were predominantly mild, no severe cases were reported. The early post-vaccination period in «Grippol Quadrivalent» group showed no variation in adverse events with other vaccines. Conclusion . Adjuvanted quadrivalent subunit flu vaccine was the most efficacious in preventing influenza in 2018–2019 epidemic season.

The goals of the research are to determine the latent morbidity and financial losses of the Russian Ministry of Defense due to the dismissal of service members with HIV infection at symptomatic stages; to establish the supposed clinical and pharmacoeconomic effectiveness of the early detection and treatment of service members.The materials compile 379 case histories of patients of the only specialized department for HIV-positive military personnel in the Armed Forces for 2017–2019, as well as various reporting forms. The study uses the following methods for the analysis: Markov chains are employed to calculate QALYs (Quality Adjusted Life Years), “cost-effectiveness”, and “willingness to pay”. The research compares two competitive models: “Current Situation” - without the introduction of algorithms for early detection and treatment of HIV infection, and “Prognosis” - with the introduction of these algorithms.The following results are obtained: implementing a mandatory triennial screening for HIV-antibodies among military personnel allows to raise the detection of HIV-positive military personnel in the early stages of the disease by 55%. At the same time, early administered antiretroviral therapy prevents the progression of HIV infection, while the number of military personnel who have reached symptomatic stages of HIV infection and the number of deaths decreases by 35,6% and 80,2% (six-fold), respectively. The economic effectiveness of these measures includes a reduced cost of treatment and an increased length of military service. The sensitivity analysis of the method shows that the proposed measures remain pharmacoeconomically highly effective with a wide variability of the initial data.Conclusion. The results of the study demonstrate that a significant improvement of the epidemiological situation in the field of HIV infection in the Armed Forces is achievable at very low economic costs. With the full implementation of the proposed measures, the cohort of military personnel of the Armed Forces is able to achieve the World Health Organization’s “90-90-90”criteria of in 3–5 years.

The article describes action of the Infectious Diseases Service of the Armed Forces in national biosecurity control through leveraging experience of military involvement, emergencies, infectious epidemic outbreaks, including rescue measures rendered during the SARS-CoV-2 pandemic.We utilise experience of military infectiologists to exemplify medical care management under admission influx of contagious patients. Principles are clarified of early clinical diagnostics of potentially pandemic infectious diseases and early active detection, isolation, sorting and evacuation of contagious patients in martial and close field conditions. Besides, specifics of providing specialised medical care to contagious patients, including preventive intensive care, is detailed.In 2020, healthcare and legal authorities worldwide recognised the critical capability to act under conditions close to real combat and so satisfy a minimum qualification standard of a military doctor, including infectiologist’s skills, at both systemic and individual levels of infection control, regardless of primary medical specialty. From this perspective, expertise of the Chair of Infectious Diseases (with training in medical parasitology and tropical diseases) of the Military Medical Academy can be an asset both in practice and teaching in medical universities country-wide.

Meningococcal infection is an acute infectious disease caused by Neisseria meningitidis, characterized by a polymorphism of clinical manifestations from meningococcus carriage to invasive forms. They, in turn, pose a great danger to the patient’s life, since in most cases they have a severe course with the development of complications, fulminant course and high mortality. The success of treatment of invasive meningococcal disease largely depends on the timeliness of diagnosis and the timing of treatment initiation. The article describes a clinical case of a generalized form of severe meningococcal infection with a rapidly developing infectious toxic shock, disseminated intravascular coagulation syndrome in a soldier who had previously refused specific prophylaxis. Despite the mistakes made at the prehospital stage and, accordingly, late hospitalization, this case had a favorable outcome.

The effectiveness and quality of liver biopsy in rats are applicable to the aspiration and automatic liver biopsy system. Histological examination of 240 biopsy specimens in 100% of cases identified portal tracts. The number of portal tracts to determine the stage of liver fibrosis in rats of the 1st group who underwent liver biopsy was performed using an 18 G aspirating needle from the puncture liver set (Menghini type), which is 4-5, you have the 2nd group, which one-time guillotine soft tissue biopsy with a semi-automatic action of 16G×20 cm, Italy) - 7-8 portal tracts. The average size of the biopsy in the 1st group is 0,5 cm, in the 2nd group - 1 cm. Thus, the automatic biopsy system allows you to get liver tissue in 100% of cases. At the same time, the automatic system eliminates the additional traumatization of experimental animals, as well as minimizes efforts to separate the biopsy material from the organ. In addition, the automated system for liver biopsy allows to evaluate 7-8 portal tracts with a biopsy size of 1 cm, this provides a reliable histological assessment of pathological changes in liver tissue to assess the stage of fibrosis and the activity of the inflammatory process over time.

Background and aims: to estimate concentration of sMadCAM-1 in peripheral blood at patients with chronic hepatitis C with excess body weight.Materials and methods: The research included 88 patients (67 men, 21 women 41.4±3.2 years of age) with chronic hepatitis C (CHC) and excess body weight (the index of body mass is ³25 kg/m2, and abdominal circumference more than 94 cm in men, and 80 cm in women) with various morfofunktsionalny changes in a liver and a small bowel. From them men there were 67 people, women – 21, middle age was 41.4±3.2 years.To all the patients complex clinical, biochemical, virologic, morphological trial was carried out. The functional condition of intestines was estimated by identification of a small intestinal bacterial overgrowth (SIBO) when carrying out the hydrogen respiratory test (HRT) with lactulose and existence of endoscopic signs of inflammation of a mucous membrane of intestines at a fibroezofagogastroduodenoskopiya. The quantitative assessment of a mucosal addressin cell adhesion molecule -1 was carried out by the definition concentration of its soluble form (sMadCAM-1) in a blood plasma by enzyme immunoassay method.Results: the sMadCAM-1 level of peripheral blood at the patients with excess body weight increased in process of progressing of a stage of chronic hepatitis C (F0 – 349.10 (324.27-373.92) ng/ml; F1/2 – 439.69 (406.43-472.94) ng/ml; F3/4 – 1057.82 (593.38-1522.26) ng/ml; p˂0.05), existence of a syndrome of excess bacterial growth and endoscopic signsof a duodenitis. Besides, patients had its concentration more with the biochemical signs characterizing cytolytic (at ALT˃N: 502.54 (432.04-573.03) ng/ml against 381.04(345.49-416.58) at the ALT normal values), cholestatic (at GGTP˃N: 550.59 (453.31-647.88) ng/ml against 400.86(365.13-436.59) atnormal GGTP, p values 0.05; at ALP N: 572.2 (353.7-790.8) ng/ml against 468.7 (408.5-528.9) ng/ml at normal ALP, p values 0.05) and metabolic syndromes (at glucose of blood, TG, VLDL N: 562.93 (369.59-756.27) ng/ml, 681.15 (387.81-974.49) ng/ml, 809.65(124.04-1495.28) against (438.34(391.36-485.31) ng/ml), (421.69(379.41-463.97) ng/ml), 434.47(389.45-479.48), p values 0.05 at normal values of these indicators respectively). Conclusion: Progressing of fibrosis and functional disturbances in intestines are interconnected with increase in concentration of MadCAM-1 in blood that allows to consider pathological changes in intestines of various genesis as the accessory factor promoting progressing of СHC at patients with excess body weight. Besides, definition of concentration of sMadCAM-1 in peripheral blood can be used as one of markers of noninvasive diagnostics of a stage of fibrosis at the patients with СHC and excess body weight.

Chronic hepatitis C remains one of the most important socially significant infections for world health. The use of modern highly effective drugs with direct antiviral action allowsto achieve a sustained virological response in patients. At the same time, in a significant number of cases after elimination of HCV infection, the progression of fibrosis continues with the development of its terminal stages and an unfavorable outcome for patients. The article focuses on comorbid pathology, which is a leading factor in this process in patients with chronic hepatitis C who have achieved a sustained virological response and presenting a serious challenge to modern hepatology.

The problems of the incidence of meningococcal disease and the epidemiological situation in the world, in the Russian Federation and in the Armed Forces are consecrated. In the past decade, there has been a global decline in the incidence of meningococcal disease, but there is still the possibility of new outbreaks and epidemics. From 1996 to 2016, a decrease in the incidence of meningococcal disease was also noted in Russia. In certain regions of the Russian Federation, an increase in incidence was recorded, which did not affect the general trend. Against this background, the idea was formed that in the coming years, thanks to a favorable epidemiological situation and the possibility of preventing meningococcal infection with the help of a vaccine, it is possible to achieve control of this infection. However, meningococcus showed all the classic properties of variability and fitness. Changes in the structure of circulating serogroups of meningococcus led to the formation of a non-immune layer of the population in the face of increasing pathogenicity of the dominant serogroups. The activity of the epidemic process is indirectly indicated by the high diversity of genetic and serological clonal complexes, serogroups and serotypes of the pathogen. The incidence of meningococcal disease over the past ten years in the Armed Forces of the Russian Federation can be assessed as low, but mortality has high values. The peak incidence was in 2010, but the maximum percentage of mortality was in 2017-18,2%. The increase in mortality from invasive forms of meningococcal infection, on the one hand, is associated with an increase in the total number of sources of this infection, on the other hand, with errors in early diagnosis and, as a consequence, in the incorrect provision of emergency care at the prehospital stage, which recur from year to year and are of a similar nature.

Infection rates of human immunodeficiency virus in Army forces have a clear structure divided into stages. Each stage characterized by objective socio-economic, political, epidemical prerequisites, which reflected conditions of epidemic developing, activeness of mechanisms and transmission factor, structure and possibilities of a protective system against infection in country and army. There are three stages of epidemic development. The first stage - infiltration (invasion), 1987 - 1995 years. The common feature this period of developing and functioning counteraction system against infection, produced by human immunodeficiency virus, and acquired immune deficiency syndrome in our country is «recognition by the state of the growing threat of the epidemic spread of infection caused by the human immunodeficiency virus in the absence of a real epidemic and limited material resources». The second period - epidemical infection spreading, produced by human immunodeficiency virus, 1995-2003 years. Significant efforts of counteraction system against infection, produced by human immunodeficiency, and acquired immune deficiency syndrome in the army was concentrated on improving diagnostic and approximation of the possibilities of military-medical expertise to the places where patients are identified. The third period - generalized - in the last2004 year to current period. Stabilization indicators identifying soldiers, infected by human immunodeficiency, archived as a result of barrier preventive measures (examination at the stage of conscription to the Armed Forces) are not accompanied by methodological and regulatory changes that have occurred in civilian health care, which contributes to negative trends in the later detection of the disease. So, the current system of medical help for soldiers, infected by human immunodeficiency, does not provide medical help enough, regulated by the governing documents of the Department of Health of the Russian Federation and state medical standards.

Organisation of medical care to military personnel with viral hepatitis A during the local armed conflicts. The article provides an analysis of medical care organisation system to patients with viral hepatitis A during conducting counterterror operations on the North Caucasus (1994-1996 and 1999-2002). The authors provided information on the main problems of medical support in modern local armed conflicts and shortcomings of organization of medical care to patients with viral hepatitis A in the following conditions: multistage, discrepancy between calculation of forces and facilities and character of military conditions, shortcoming of staff structure of medicalfacilities, inappropriate level ofproficiency ofphysicians of infectious profile and absence of regulations, concerning the use for equipment of infectious hospitals. 'Possible -ways for resolving these problems are showed.

Late diagnosis of meningococcal disease leads to high mortality. Early diagnosis of its generalized forms plays a crucial role in the pre-hospital phase and mainly based on the clinical picture of the disease. In most cases, pre-hospital typical mistake is late diagnosis of meningococcal disease: We propose an algorithm of early diagnosis of generalized forms of the disease in order to reduce the number of diagnostic errors. Proper and timely diagnosis will enable the physician pre-hospital fully implement measures to provide emergency and urgent care in generalized meningococcal infection, leading to. a more.favourable course and a significant improvement in the outcomes of the disease in the course of further hospital treatment.

This article presents the main historical stages of Russia's first department of infectious diseases, has made a huge contribution to the science of infectious diseases and the establishment of effective treatment and prevention of these diseases.

For the purpose of clinical laboratory and virologic characteristics of chronic HCV-infection, depending on the gene polymorphisms of IL-28B were examined 104patients. In 70 patients (50 – with genotype 1 and 20 – with genotypes 2 and 3) treated with pegylated interferon-α2a (PIFN) and ribavirin (RBV), evaluated the frequency of sustained virologic response (SVR). According to the results of the study it was found that the patients with HCV had a sufficiently high frequency of registration of «favorable» prognostic single nucleotide polymorphisms (SNPs) rs12979860 CC (23.1%) and rs8099917 TT gene IL-28B (50,9%). On therapy of PIFN and RBV SVR frequency rate in patients with chronic hepatitis C (genotype 1)and SNPs CC rs12979860 (82,4%) was significantly higher than the efficiency of treatment in patients without this polymorphism (45,5%). In chronic HCV-infection (genotypes 2 and 3) SVR was observed significantly more frequently in patients who have both IL28B CC polymorphism rs12979860, and TT for rs8099917 (88,8%).