Introduction: against the background of the ongoing incidence of coronavirus infection, the selection of therapy often requires individual approaches, especially in comorbid patients. Despite the emergence of specific prevention methods and new antiviral drugs, there are risk groups for severe disease and high mortality.Target. To evaluate the effectiveness and safety of the use of SARS­CoV­2 neutralizing antibodies for the treatment of comorbid patients with coronavirus infection.Materials and methods: A retrospective study was conducted to evaluate the clinical efficacy of virus­neutralizing antibodies for the treatment of comorbid patients with coronavirus infection who were hospitalized in 2022. A total of 244 patient records (mean age 60.0±14.2 years) with confirmed SARS­CoV­2 coronavirus infection were analyzed. The first group consisted of patients who received monoclonal virusneutralizing antibodies (monotherapy with Sotrovimab or Regdanvimab, combination therapy with Casirivimab and Imdevimab, or Bamlanivimab and Etesevimab), and the second group consisted of patients without therapy. All patients were comorbid. The most frequently observed nosologies were: hypertension (74.1%), chronic kidney disease (55.2%), malignant neoplasms (31%), 1–3 degree of obesity (22.4%), diabetes mellitus (17.2%), and autoimmune diseases (17.2%). In the comparison groups, the duration of the disease, the area of lung tissue damage, the duration of respiratory support, the percentage of complications, the need to use immunosuppressive therapy, as well as the percentage of fatal outcomes, were assessed.Results: The duration of the disease in patients who received monoclonal virus­neutralizing antibodies was 16.0±8.1 days, the area of lung tissue damage was on average 14.9±13.0%, the duration of respiratory support was 2.2±3.1 days, complications of coronavirus infection were noted in 31%, the mortality rate decreased to 1.7%. In patients without therapy with these drugs, complications of the disease were detected 2 times more often – in 64% of cases, the duration of the disease was 20.0±6.1 days, the area of lung tissue damage was on average 21.7±12.1%, and the duration of respiratory support was 8.0±6.1 days. Immunosuppressive therapy was used significantly more often in patients without therapy with antiviral monoclonal antibodies (51.2%) than with it (3.4%). A study of the clinical efficacy of various monoclonal antibodies showed an advantage in using Regdanvimab in comorbid patients, as indicated by the absence of fatal outcomes and a reduction in the duration of the disease to 9.8±4.8 days.Conclusions: Preparations of synthetic recombinant monoclonal neutralizing antibodies to SARS­CoV­2, provided that they are used in the early stages of the disease, significantly reduce the severity of coronavirus infection, the development of complications and significantly reduce mortality in comorbid patients.

Introduction. In present, the medical community continues to study the impact of coronavirus infection on various organs and systems of the body. Infection with the SARS-CoV-2 virus causes multifaceted pathological processes and, among other things, affects the cells of the circulatory system. Objective: To assess the degree of DNA damage in peripheral blood lymphocytes of patients infected with the SARS-CoV-2 virus. Material and methods. 200 patients took part in the study. The control group consisted of conditionally healthy individuals matched by gender and age (n=50). The degree of DNA damage was assessed using the DNA comet assay in an alkaline medium. The assessment parameters included: tail length (TL) (pc), percentage of damaged DNA in the tail (Tail DNA, %), tail moment (conventional units) and Olive moment (conventional units). Results. The average values of the parameters of comet DNA of patients in the acute period of coronavirus infection were: TL 95.18±5.7 pc, percentage of damaged DNA in the tail (Tail DNA%) 70.82±7.12%, tail moment 68.52±8.58 conventional units, Olive moment 41.11±4.46 conventional units. When comparing the parameters of comet DNA of lymphocytes of conditionally healthy individuals and patients in the acute period of coronavirus infection associated with the SARS-CoV-2 virus, a significant increase (p < 0.001) in these parameters is noted, which indicates an increase in the content of fragmented and damaged DNA in peripheral blood lymphocytes in sick individuals. Conclusion. The obtained results prove the powerful genotoxic effect of the SARS-CoV-2 virus on human cells

The paper presents a critical analysis of the data on incidence and etiology of pneumonia among patients with human immunodeficiency virus (HIV). The features and prospects of differential diagnosis for various types of pneumonia are considered. The paper emphasizes the urgency of highly sensitive methods for diagnostics of pneumonia and its features in HIV-positive patients.

Введение. Грипп представляет серьезную социально-экономическую проблему несмотря на то, что в последние 3 года регистрируемая заболеваемость встречалась в виде локальных вспышек. Это было связано с преимущественной диагностикой новой коронавирусной инфекции, ассоциированной с SARS-CoV-2, и парадигмой в отношении моноинфекции у одного пациента. Тем не менее реальная клиническая практика и широкие возможности лабораторной диагностики показали возможность сосуществования нескольких инфекционных агентов в организме одного человека одновременно. С конца 2022 года заболеваемость гриппом начала расти в структуре инфекционной патологии. При этом стали регистрироваться случаи коинфекции гриппа и новой коронавирусной инфекции COVID-19. Цель работы. Представить клинический случай, демонстрирующий течение коронавирусной инфекции, осложненной пневмонией, в сочетании с гриппом и присоединением трех инфекционных агентов – Streptococcus pneumoniae, Mycoplasma pneumonia, Candida albicans у молодого пациента без предикторов тяжелого течения. Заключение. Наше клиническое наблюдение показывает значимость тщательного обследования пациента при таких респираторных вирусных инфекциях, как новая коронавирусная инфекция COVID-19, грипп А(H1N1)pdm09, при которых часто развивается поражение легких. В период подъема заболеваемости в разгар эпидемиологического сезона настороженность врача в отношении присоединения у таких пациентов бактериального процесса в легких должна оставаться на высоком уровне. Широкое распространение коронавирусной инфекции COVID-19, массовость поступлений в инфекционные и терапевтические стационары, наличие схожей рентгенологической картины легких должны настораживать врача в отношении адекватного и рационального использования противомикробных и противовирусных лекарственных средств, исключая возможности для лекарственной иммуносупрессии и последующей активации собственной флоры, способной вызвать бактериальное и грибковое поражение организма пациента. Background. Influenza represents a serious socio-economic problem, despite the fact that in the last 3 years the reported incidence has occurred in the form of local outbreaks. This was due to the predominant diagnosis of a new coronavirus infection associated with SARS-CoV-2 and the paradigm for monoinfection in one patient. Nevertheless, real clinical practice and wide possibilities for laboratory diagnostics have shown the acceptability of several infectious agents in one person at the same time. Starting from the end of 2022, the incidence of influenza began to grow in the structure of infectious pathology. At the same time, cases of co-infection with influenza and the new coronavirus infection COVID-19 began to be recorded. Objective. This clinical case demonstrates the course of a coronavirus infection complicated by pneumonia in combination with influenza and the addition of three infectious agents Streptococcus pneumoniae, Mycoplasma pneumonia, Candida albicans in a young patient without predictors of a severe course. Conclusion. Our clinical observation shows the importance of a thorough examination of the patient for such respiratory viral infections as the new coronavirus infection COVID-19, influenza A(H1N1)pdm09, which often develops with lung damage. During the period of rising incidence at the height of the epidemiological season, the doctor’s alertness regarding the development of a bacterial process in the lungs in such patients should remain at a high level. The widespread spread of coronavirus infection COVID-19, the massive number of admissions to infectious diseases and therapeutic hospitals, the presence of a similar X-ray picture of the lungs should alert the doctor regarding the adequate and rational use of antimicrobial and antiviral drugs, excluding the possibility of drug immunosuppression and subsequent activation of one’s own flora that can cause bacterial infections and fungal infection of the patient’s body.

BACKGROUND: The reports on the neurological and psychiatric consequences of coronavirus infection are of particular relevance owing to their limited availability. The molecular patterns of nerve tissue damage are an important task for understanding the underlying mechanisms of neurodegeneration. AIM: To study the dynamics of changes in the content of markers of neurodegeneration and neuroplasticity in patients with coronavirus infection in the acute and long-term periods. MATERIALS AND METHODS: A total of 200 patients aged 5183 years were assessed and categorized into two age groups: 5165 years and 6683 years. The levels of neurodegeneration markers were determined in the blood serum: neurofilament heavy chains (NEFH), S100 A6 protein, S100 B protein, -amyloid 1-42 (A1-42), microfilament associated tau protein (MAPt), serum amyloid P (SAP), and neuroplasticity: neurotrophin 3 (NT3), neurotrophin 4 (NT4). The study was performed thrice in the acute period of the disease at the time of admission to the hospital and at 6 and 12 months after discharge. RESULTS: In the first group of patients, in the acute period of coronavirus infection, women showed higher concentrations of S100 A6 (3.20.2), S100 B (0.40.06), NT3 (1.10.1), and MAPt (0.130.02), while the values for the men were NEFH (0.150.03), A1-42 (2.10.1), and SAP (4.50.06). In the long-term, a general tendency of long persistence of high levels of the markers of neurodegeneration and neuroprotection was noted in young men compared to women, indicating a long period of rehabilitation. After 12 months, the level of calcium-binding proteins S100 A6 and S100 B in men was 1.50.2 pg/mL and 0.30.04 ng/mL, which was 1.10.1 pg/mL and 0.20.04 ng/mL, respectively, in women. The level of SAP in men during the long-term period after 12 months was 4.30.1 versus 3.90.2 ng/mL in women, indicating a significant difference. Analyses of the results for the patients in the second group indicated a higher level of S100 A6 and A1-42 in the acute period for women, while men showed higher levels of S100 B, NT3, and SAP. CONCLUSION: The changes in patients with coronavirus infection both in the acute and late periods indicated active neurodegeneration processes in different age groups, which manifested as a result of an increase in the concentration of specific proteins in the blood serum.

Introduction. The rapid spread of the COVID-19 pandemic caused by SARS-CoV-2 initially indicated a significant immune system involvement, including peripheral blood leukocytes. Hematologic changes have already been described in the first cases of COVID-19; however, only few studies reported morphological cell abnormalities in peripheral blood smears. The aim of the study was to characterize the morphology of peripheral blood leukocytes in patients with COVID-19 and determine the significance of its changes in the immune system dysfunction and for the disease diagnosis. Materials and methods. We studied blood samples of 30 patients infected by SARS-CoV-2 virus (confirmed with PCR tests) who were treated in Regional Clinical Hospital No. 2 in Vladivostok. Peripheral blood buffy coat samples fixed in osmium tetroxide were embedded in epoxy with subsequent preparation of semithin and ultrathin sections. Results. To the best of our knowledge, it is the first study to show nuclear pathological changes in neutrophils and monocytes in blood buffy coat of the patients with coronavirus infection with light and electron microscopy of peripheral blood. We found cells with abnormal nuclear shape and leukocyte apoptotic degeneration absent in healthy individuals. The identified morphological leukocyte abnormalities should be considered as signs of hyporeactivity of these cells, which indirectly indicate a decrease in their bactericidal potential in COVID-19. At the same time, the secretory degranulation of neutrophils with the release of the contents of the granules into the extracellular space was poorly visualized. We observed smooth plasmalemma of leukocytes with a small number of microvilli involved in phagocytosis and numerous apoptotic leukocytes with reduced phagocytic ability. Conclusion. The detection of morphological abnormalities of circulating leukocytes in patients with COVID-19 is of diagnostic and prognostic value in this pathology. Keywords: blood, neutrophils, monocytes, morphology, COVID-19, SARS-CoV-2, karyopathological changes

Стойкие когнитивные нарушения наблюдаются у значительного числа пациентов после перенесенной коронавирусной инфекции (COVID-19). Необходимы исследования, чтобы изучить структуру когнитивных изменений, динамику их появления и длительность сохранения. Целью нашего исследования было охарактеризовать динамику и структуру когнитивных нарушений у пациентов, перенесших коронавирусную инфекцию средней степени тяжести, через 6 и 12 месяцев после выписки из стационара. В исследовании приняли участие 200 пациентов с подтвержденным диагнозом «новая коронавирусная инфекция COVID-19 средней степени тяжести, осложненная дыхательной недостаточностью на фоне двусторонней полисегментарной вирусной пневмонии, вызванной SARS-CoV-2», в возрасте от 24 до 92 лет. Пациенты были разделены на две возрастные группы до и после 65 лет, каждая группа делилась на подгруппы соответственно полу. Когнитивное обследование проводилось дважды – через 6 и 12 месяцев после выписки из стационара. Когнитивные функции оценивали с помощью модифицированной Адденбругской когнитивной шкалы и батареи тестов для оценки лобной дисфункции. Все участники исследования имели нарушения хотя бы в одном когнитивном домене вне зависимости от возраста и пола. Наиболее уязвимыми когнитивными функциями после коронавирусной инфекции оказались антероградный и ретроградный компоненты памяти и речевая активность. Число баллов по данному домену находилось в диапазоне значений от 22,6 ± 2,5 до 17,6 ± 4,3 балла. При этом у обследуемых отмечалась отчетливая тенденция к постепенному снижению данной функции к 12-му месяцу после выписки из стационара. Речевая активность была существенно снижена во всех возрастных группах – у пациентов из первой группы в динамике средний балл составлял 11,2 ± 0,8 через 6 месяцев и 9,9 ± 1,0 балла через 12 месяцев, а во второй группе – 8,4 ± 2,1 и 8,7 ± 2,2 балла соответственно. Установлено, что в отдаленном периоде после перенесенной коронавирусной инфекции возникают серьезные когнитивнные нарушения как у молодых пациентов, так и у людей старшего возраста. Persistent cognitive impairment is observed in a significant number of patients after coronavirus infection (COVID-19). Research is needed to study the structure of cognitive changes, the dynamics of their occurrence and the duration of their persistence. The purpose was to study the dynamics and structure of cognitive impairment in patients who had a moderate coronavirus infection within 12 months after discharge from the hospital. The study involved 200 patients with a confirmed diagnosis of a moderately severe novel coronavirus infection COVID-19, complicated by respiratory failure against the background of bilateral polysegmental viral pneumonia caused by SARS-CoV-2, aged 24 to 92 years. All patients were divided into two main groups by age: the first – persons under 65 years of age, the second – persons over 65 years of age, each group was divided into a subgroup by gender. Conducting a cognitive examination was carried out twice – 6 and 12 months after discharge from the hospital. Cognitive function was assessed using the modified Addenbrugs Cognitive Scale and frontal dysfunction test battery. All study participants had impairments in at least one cognitive domain, regardless of age and gender. The most vulnerable cognitive functions during coronavirus infection were the anterograde and retrograde components of memory and speech activity. The number of points for this domain ranged from 22,6 ± 2,5 to 17,6 ± 4,3. At the same time, the subjects showed a clear trend towards a gradual decrease in this function by 12 months after discharge from the hospital. Speech activity was significantly reduced in all age groups – in patients from the first group in dynamics, the average score was 11,2 ± 0,8 after 6 months and 9,9 ± 1,0 after 12 months, and in the second group 8,4 ± 2,1 points and 8,7 ± 2,2 points, respectively. Our study showed that after a coronavirus infection in the long term, serious cognitive impairments occur in both young and older patients.

Introduction. Asthenic disorders due to COVID-19 infection are generally classified under a recently introduced category in ICD-10: U09.9 Condition after COVID-19, unspecified. In this regard, it is necessary to study the clinical manifestations and systematize the asthenic syndrome after coronavirus infection in order to better understand the tactics of treatment and rehabilitation of this group of patients.Objective. To assess the prevalence of asthenic syndrome in patients who have had a coronavirus infection, to characterize and present its dynamics.Materials and methods. The study involved 200 people with a confirmed diagnosis of COVID-19, aged 51 to 83, who were undergoing inpatient treatment. After discharge from the hospital after 6 months and 12 months, these patients again underwent a physical examination, anamnesis, complaints, and a questionnaire to identify symptoms of asthenia and other psychopathological syndromes.Results. Asthenic symptoms were found in 2/3 of the examined persons. Autonomic disorders were noted with a slight decrease from 81.5% after 6 months to 74.2% after 12. Sleep disorders and increased fatigue progressed during the observed period from 70.4% to 80.6% and 63.0 to 74.2% respectively. Emotional lability of patients as a whole did not change.Conclusion. Polymorphic symptoms of asthenic syndrome were revealed, the most common phenomena were sleep disorders and symptoms of fatigue.

Objective: to provide a comparative analysis of clinical manifestations of the new coronavirus infection in vaccinated and unvaccinated patients. Materials and methods. А retrospective analysis of 160 medical histories of patients with laboratoryconfi rmed diagnosis of coronavirus infection (COVID-19) was presented, including 80 unvaccinated individuals and 80 vaccinated with “EpiVacCorona”, “CoviVac”, and “Gam-COVID-Vac” vaccines. Results. Vaccination against COVID-19 does not completely eliminate the possibility of infection with the virus, but there are a number of significant advantages and diff erences in the course of coronavirus infection among vaccinated patients. The duration of the disease on average was about 2 weeks, and for unvaccinated individuals — 18.1 ± 0.4 days. Vaccinated patients, regardless of the vaccine used, recovered significantly earlier. Signs of polysegmental pneumonia were not observed in 21.3% of vaccinated patients. Respiratory support lasted for 6.0 ± 0.3 days in unvaccinated patients, and for vaccinated individuals with “EpiVacCorona” — 4.4 ± 0.7 days, “CoviVac” — 3.5 ± 0.6 days, “Gam-COVID-Vac” — 3.2 ± 0.4 days, which was signifi cantly lower than the indicators for the control group (p <0.05). Conclusion. Сlinically, COVID-19 in vaccinated patients was milder compared to unvaccinated individuals, who most commonly experienced weakness, coughing, and extensive lung damage.

Введение. Нередко считают, что подагра – это нераспространенное заболевание и поэтому она не представляет большого интереса для врачей широкого профиля. Однако заболеваемость подагрой в мире неуклонно растет, что объясняется увеличением в популяции лиц с гиперурикемией. Аллергические реакции, несоблюдение режима лечения, лекарственные взаимодействия, а иногда и неэффективность гипоурикемической терапии приводят к тяжелому течению заболевания. Подагра нередко протекает в сочетании с такими патологиями, как ожирение, сахарный диабет, артериальная гипертензия, и другими. В настоящее время представляет большой интерес течение коронавирусной инфекции на фоне подагры. Учитывая Временные методические рекомендации Минздрава России (версия 17 от 14.12.2022) «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)», пациенты с иммуновоспалительными ревматическими заболеваниями представляют особые группы больных. При их инфицировании вирусом SARS-CoV-2 необходимо прервать лечение стандартными базисными противовоспалительными препаратами (метотрексат, лефлуномид, азатиоприн), генно-инженерными биологическими препаратами (ингибиторы фактора некроза опухоли-α, интерлейкинами-6, 17, 12/23, 23, блокаторами костимуляции Т-клеток, анти-В клеточными препаратами (ритуксимаб, белимумаб). Госпитализация в стационар должна осуществляться только по ургентным показаниям с предоставлением лабораторных данных об отсутствии инфицирования SARS-CoV-2. Цель работы. Данная статья раскрывает детали течения коронавирусной инфекции у пациентки с иммуноопосредованной подагрой с аллергией на все противоподагрические препараты и отсутствием в течение более 30 лет специфической гипоурикемической терапии. Результаты. Тяжесть состояния определяли состоявшееся кровотечение из стероидной язвы желудка, вторичная недостаточность надпочечников на фоне регулярного и бесконтрольного приема кортикостероидов и нестероидных противовоспалительных препаратов. Также состояние расценивалось как тяжелое за счет симптомов интоксикации, гипертермии, астеновегетативного и диарейного синдромов. У пациентки была визуализирована хроническая инфекция кровотока в виде вегетации на трикуспидальном клапане, повышение маркеров сепсиса и системного воспаления, что было интерпретировано как проявление бактериального сепсиса. Однако в связи с отсутствием динамики на фоне проводимой антибактериальной терапии (сохранение лихорадки, увеличение количества тофусов в области кистей и стоп, прогрессирование артралгии) было предположено, что это связано с основным заболеванием и развитием самостоятельного иммунного механизма повреждения внутренних органов и отложением тофусов на трикуспидальном клапане. Учитывая клиническую картину заболевания и данные лабораторно-инструментального обследования, диагноз бактериального сепсиса был исключен и состояние расценено как иммуноопосредованное сепсисоподобное тяжелое течение подагры при отсутствии лечения с вторичным амилоидозом внутренних органов и отложением тофусов в том числе на трикуспидальном клапане. Дополнительно к лечению с целью купирования системной иммунной воспалительной реакции был назначен олокизумаб (160 мг/мл – 0,4 мл подкожно). После введения препарата отмечались постепенная нормализация температуры тела, уменьшение болевого, суставного синдрома и показателя уровня интерлейкина-6. Таким образом, терапия олокизумабом принесла существенный положительный эффект и способствовала стабилизации состояния пациентки. Заключение. Следует учитывать, что у пациентов с иммуноопосредованными заболеваниями острые инфекции могут протекать в сепсисоподобной форме и должны оцениваться комплексно, а также должна инициироваться ранняя упреждающая противовоспалительная терапия. Background. It is often believed that gout is an uncommon disease and therefore of little interest to general practitioners. However, the incidence of gout in the world is steadily increasing, which is explained by the increase in the population of persons with hyperuricemia. Allergic reactions, non-compliance with the treatment regimen, drug interactions, and sometimes the ineffectiveness of hypouricemic therapy leads to a severe course of the disease. Gout often occurs in combination with diseases such as obesity, diabetes, arterial hypertension. At present, the course of coronavirus infection against the background of gout is of great interest. Taking into account the Interim Guidelines of the Ministry of Health of Russia, version 17 of December 14, 2022 ″Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)″, patients with immunoinflammatory rheumatic diseases represent special groups of patients. In case of infection of such patients with the SARS-CoV-2 virus, it is necessary to interrupt treatment with standard basic anti-inflammatory drugs (methotrexate, leflunomide, azathioprine), genetically engineered biological drugs (tumor necrosis factor-α inhibitors, IL-6, IL-17, IL-12 /23, IL-23, T-cell co-stimulation blockers, anti-B cell drugs (rituximab, belimumab) Hospitalization should be carried out only for urgent indications with the provision of laboratory data on the absence of SARS-CoV-2 infection. Objective. This article discloses the details course of coronavirus infection in a patient with immune-mediated gout with an allergy to all anti-gout drugs and the absence of specific hypouricemic therapy for more than 30 years. Results. The severity of the condition was determined by bleeding from a steroid gastric ulcer, adrenal insufficiency secondary to regular and uncontrolled intake of corticosteroids and non-steroidal anti-inflammatory drugs. Also, the condition was regarded as severe due to the symptoms of intoxication, hyperthermia, asthenovegetative syndrome, diarrheal syndrome. The patient was visualized chronic infection of the bloodstream in the form of vegetation on the tricuspid valve, increased markers of sepsis and systemic inflammation, which was interpreted as a manifestation of bacterial sepsis. However, due to the lack of dynamics against the background of ongoing antibiotic therapy – the persistence of fever, an increase in the number of tophi in the area of the hands and feet, the progression of arthralgia, it was assumed that this is due to the underlying disease and the development of an independent immune mechanism for damage to internal organs and the deposition of tophi on the tricuspid valve. Taking into account the clinical picture of the disease and the data of laboratory and instrumental examination, the diagnosis of bacterial sepsis was excluded and the condition was regarded as an immune-mediated sepsis-like severe course of gout in the absence of treatment with secondary amyloidosis of internal organs and deposition of tophi, including on the tricuspid valve. Olokizumab 160 mg/ml – 0.4 ml subcutaneously was prescribed for treatment in order to stop the systemic immune inflammatory response. After the introduction of the drug, there was a gradual normalization of body temperature, a decrease in pain, articular syndrome and an indicator of the level of IL-6. Conclusion. Thus, olokizumab therapy brought a significant positive effect and contributed to the stabilization of the patient's condition. It should be noted that in patients with immune-mediated diseases, infectious acute diseases can occur in a sepsis-like form and should be assessed comprehensively and early preventive anti-inflammatory therapy initiated.

МЕМБРАННЫЙ ПОТЕНЦИАЛ МИТОХОНДРИЙ ЛЕЙКОЦИТОВ ПРИ ИНФЕКЦИИ, ВЫЗВАННОЙ ВИРУСОМ SARS-CoV-2Михайлов А.О. 1 , Плехова Н

Abstract. The purpose of the study: to conduct an epidemiological analysis of the incidence of coronavirus infection in the Primorsky Territory, to identify risk groups depending on gender, age, social status. Evaluate the effectiveness of vaccination. Materials and methods: this study uses data from infectious morbidity in the Primorsky Territory of the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Primorsky Territory and the Population Register for Coronavirus Infection. Results and discussion: an analysis of the incidence of a new coronavirus infection in the Primorsky Territory for 2020-22 was carried out. The incidence is presented in general for 2020-2021 and the beginning of 2022. The incidence rate for each month since the beginning of the pandemic is presented. Features of the monthly morbidity were revealed, an analysis was carried out. The rises and declines in morbidity are shown and analyzed. The distribution of patients by sex, age, social status was carried out. Risk groups have been identified. Analysis of the incidence of coronavirus infection by severity. The vaccination of the population of the Primorsky Territory is analyzed. Vaccination coverage and efficacy were evaluated. Conclusion: the incidence of coronavirus infection since the beginning of the pandemic is analyzed, the periods of increase in the incidence rate by year and the risk group, primarily those subject to vaccination, are shown.

Objective. To model the current and future impact of the chronic hepatitis C disease burden if the current treatment paradigm continues and is effective and if WHO strategy is implemented successfully. Materials and methods. A dynamic disease progression model was constructed in Microsoft Excel (Microsoft Corp., USA) in collaboration with CDA (Center for Disease Analysis, USA) similar to that used in previous studies. As no accurate data on HCV prevalence in Russia and its federal subjects is available, calculations were based on the prevalence of 2.5% and 4.1%. Results. The modelling suggests that, unless the treatment paradigm is changed, the chronic hepatitis C prevalence will remain the same, whereas the mortality and the rate of other HCV-related outcomes (HCC, decompensated cirrhosis) will more than double by 2030. Achieving WHO global strategy targets in Russia will help reduce the total number of infected individuals by 90% and the number of liver-related deaths by 65% saving >45,000 or >77,000 lives under the scenarios with 2.5% and 4.1% prevalence respectively. However, such trends will only take place if WHO strategy is implemented successfully. Conclusion. Regardless of the epidemiologic input data, elimination of HCV infection in Russia appears feasible; however, it requires financial support from the government and a range of organizational measures. Key words: HCV infection, chronic HCV infection, WHO strategy, antiviral therapy

Introduction. Cytokines regulate intercellular and intersystem interactions and are involved in the development and prevention of various pathologies. Purposes of work were a comparative assessment of the dynamics of the levels of pro- and anti-inflammatory blood cytokines (TNF-α and IL‑10) in patients with community-acquired viral-bacterial pneumonia (CAVBP) with ceftriaxone monotherapy with antibiotic and combined use this antibiotic with the antiviral drug Kagocel, and comparison of getting data with native (reference) indicators of healthy patients.Materials and methods.The study included 60 patients, aged 18–65 years, with a confirmed diagnosis of community-acquired pneumonia of moderate severity, divided into two groups equal in number, comparable by gender, age and timing of admission to the hospital. The first group received intravenous monotherapy only with the antibacterial drug Ceftriaxone, and the second group received a combination of Ceftriaxone with the oral antiviral drug Kagocel.Results. A pronounced imbalance of the levels of proand anti-inflammatory cytokines in patients with CAVBP of both groups was demonstrated both during the onset of the disease and on the 7th day hospitalization. When analyzing the concentration ratio of TNF-α / IL‑10, it was found that monotherapy with an antibacterial drug did not lead to a decrease in this indicator, while when using a combination of an antibiotic with an antiviral drug, a significant decrease in its values to normal was observed on the 7th day treatment. Good tolerance of the combination therapy and the absence of adverse reactions were noted.Conclusion.The addition of Kagocel to the treatment regimen for CAVBP with ceftriaxone contributed to the decrease the concentration of TNF-α and increases the level of IL‑10, which is clinically reflected in a reduction in the duration of fever, symptoms of general intoxication, catarrhal phenomena and the duration of hospitalization (by 1 day) compared with ceftriaxone monotherapy.

An open prospective comparative study of the efficacy of influenza monotherapy with antiviral drug versus combination therapy of two antiviral drugs with different mechanisms of action (within the limits of registered medical use for the drug) was performed in 200 patients with influenza A (H1N1) pdm09. In all patients, the clinical diagnosis was confirmed by the indication of the virus in nasopharyngeal washings by polymerase chain reaction with pre-reverse transcription (RT-PCR) in real time. All patients were randomly divided into 4 groups of 50 people, they were equivalent in terms of admission to hospital, age, sex, and the length of treatment from the onset of the disease. Group 1 received monotherapy with Umifenovir 800 mg/day in 4 divided doses for 5 days; Group 2 - monotherapy with Oseltamivir 150 mg/day in two doses for 5 days; Group 3 - Umifenovir according to the described scheme in combination with Kagocel 72 mg/day in 3 doses for the first 2 days and 36 mg/day in 3 doses in the following 2 days; Group 4 - Oseltamivir according to the described scheme in combination with Kagocel 72 mg/day in 3 doses for the first 2 days and 36 mg/day in 3 doses in the following 2 days. Criteria for the clinical efficacy of antiviral therapy were the time of temperature normalization, decrease of intoxication, catarrhal symptoms, frequency of the main clinical manifestations, and the frequency of complications development after the end of treatment in comparison with the state before it began. In assessing the duration of the symptomatology, the end point was the absence of symptoms of the disease within 24 hours. The study showed that the combination of etiotropic drugs Oseltamivir (Tamiflu®) and Umifenovir (Arbidol®) with the antiviral agent Kagocel® makes it possible to significantly improve the therapeutic efficacy compared with the corresponding monotherapy, which is expressed by a decrease in the frequency of manifestation of the main clinical indicators, a reduction in the duration of clinical symptoms, and a decrease in the frequency of complications. Good tolerability of treatment by patients was noted.

Ixodes tick-borne borreliosis is a natural focal transmissive infectious multi-system disease featured with complex pathogenesis, which multiple aspects remain unclarified. The persistence stage during this infection associated with prolonged Borrelia presence in metastatic foci and repeated multiple dissemination is most complicated for clinical practice. It is assumed that the chronic process can be caused by an inadequate immune response associated with activated autoimmune mechanisms leading to emergence of permanent irreversible (degenerative and atrophic) changes in affected organs. Patients who experienced tick-borne borreliosis need dynamic observation for assessing disease prognosis providing a maintenance therapy. The purpose of the study was to evaluate an opportunity of using cellular immunity indices for predicting disease transition to a chronic course.Materials and methods. The study was carried out at the Medical Association of the Far East Branch of the Russian Academy of Sciences. Case report form data, serum and blood plasma samples collected from 22 patients aged 29–83 years old were examined. Immunological examination data from patients with ixodes tick-borne borreliosis (12–18 months after the onset of acute period) were analyzed. Specific IgM and IgG against Borrelia burgdorferi were determined by using the OMNICS diagnostic test system (St. Petersburg). Lymphocyte immunophenotyping was performed on BD FACSCalibur flow cytometer (Becton Dickinson, USA) by using doublelabeled monoclonal antibodies (Beckman Coulter, France).Results. A variability of activated peripheral blood lymphocytes was found in patients with tick-borne borreliosis evidencing about individual immune response. An imbalanced cellular immune response recorded in seronegative convalescents from tick-borne borreliosis, may be an indirect finding of ongoing Borrelia infection. Finding of specific serum IgG and IgM antibodies in convalescents at late stage coupled to impaired immune system is a warning sign presuming a risk to developing autoimmune reactions. Detection of specific IgM antibodies at late timepoint combined with increased immune cytotoxic potential may be referred to a marker of possible disease transition to chronic course.

Objective: to establish clinical and epidemiological patterns of chickenpox in adults in the Primorsky Territory to improve treatment and prevention work. Materials and methods: The study used statistics on the incidence of chicken pox in the Primorsky Territory from 2009 to 2017 and demographic data on the population for the specified period. A clinical characteristic of 102 cases of varicella in patients hospitalized in the infectious disease ward of Primorsky Regional Clinical Hospital No. 2 (Vladivostok) in 2015-2017 is given. Results: From 2009 to 2017, the incidence of chickenpox in the Primorsky Territory was consistently high, with an average of 636.2 per 100,000 population. Analysis of the structure of patients showed that the maximum proportion of cases of chicken pox occur in organized children 3-6 years old (55.9%), schoolchildren (19.1%) and children 1–2 years old (11.6%). The proportion of 15–17 year olds was 3.0%. Adults, from 18 years old – 4.9%. The proportion of unorganized children 3–6 years old (2.9%) and children in the first year of life (2.6%) is not high. High risk of infection was detected in Vladivostok (57.8 per 100.000), Yakovlevsky (52.1% ooo), Olginsky (45.9% ooo), Lazovsky (42.8% ooo) and Shkotovsky (40, 2% ooo) areas. In the annual dynamics, a pronounced spring-summer seasonal rise was formed. The clinical course of varicella in the group of adults was characterized by an average duration of the initial period of the disease of 1.4 ± 0.7 days. For clinical diagnosis, an important time was the appearance of the rash, which varied within four days. The phenomenon of “spillage” was noted in 97% of patients. The rash was polymorphic, with the formation of crusts. The period of height was characterized by the presence of catarrhal manifestations. The granularity of the posterior pharyngeal wall was observed in all patients without exception. In 84.3% of patients there was a bright hyperemia of the pharynx. In 14.7% of cases, enantema was detected on the soft palate, palatine arches, and posterior pharyngeal wall. Dry cough was detected in 28 of 103 patients, which probably increased their epidemiological significance. Findings: The clinical picture of varicella was typical and was represented by a combination of intoxication, exanthema, and catarrhal syndrome. The epidemic process of varicella in adults in Primorsky Krai was characterized by relative autonomy of manifestations in adults, children up to one year old, and unorganized children. When implementing chickenpox epidemiological surveillance, priority should be given to interventions in epidemic foci.

Viruses that cause acute respiratory infections are currently widespread and are reported worldwide. Among the most dangerous among them are influenza viruses, with a difficult to predict course and the possibility of rapidly developing life-threatening complications that can lead to death.The purpose of the research work: to analyze the effectiveness and safety of the treatment of community-acquired viral-bacterial pneumonia in hospital patients using only antibacterial therapy as an etiotropic treatment in comparison with the combined use of antibacterial therapy and the antiviral drug Kagocel®.Materials and methods. An open, prospective comparative study was conducted (from January 1 to December 31, 2018) to study the effectiveness of monotherapy compared with combination therapy with the antiviral drug Kagocel® for 60 patients diagnosed with community-acquired pneumonia who were admitted during the period of an epidemic rise in the incidence of acute respiratory viral infections and influenza. All patients were treated in the infectious ward of the Regional Clinical Hospital No. 2, (Vladivostok, Russia). Patients were divided into 2 groups, 30 people each, comparable in age, gender and timing of admission to the hospital. The age of patients ranged from 18 to 65 years. The first group consisted of patients who received an antibacterial drug (control group) as an etiotropic therapy, the second group — those who received a combination of antibacterial and antiviral (Kagocel®) drugs (experimental group).Results. In the group of patients receiving both antibacterial and antiviral therapy with Kagocel®, there was a significant reduction in the duration of the febrile period and catarrhal manifestations compared with patients taking only antibiotics as part of etiotropic therapy. An analysis of the data showed that the use of Kagocel® in the treatment of viral-bacterial pneumonia significantly facilitates the patient’s condition during the illness, shortens the duration of the disease, reduces the duration of the main clinical symptoms of pneumonia, namely the duration of intoxication, catarrhal syndromes, and physical changes in the lungs.Conclusions. The use of the antiviral drug Kagocel® in the treatment of community-acquired viral-bacterial pneumonia leads to a more rapid relief of the main symptoms of the disease and reduces the duration of the disease. Good tolerance of the therapy, the absence of adverse reactions was noted.