BACKGROUND:Influenza vaccine is a tool for preventing infection and reducing exacerbations in patients with asthma and chronic obstructive pulmonary disease (COPD). However, the associations between clinical outcomes and changes in the levels of inflammation markers have not been fully delineated. The purpose of this study was to investigate the clinical course and the changes in the levels of inflammation markers in patients with asthma or chronic obstructive pulmonary disease for one year after vaccination against influenza. METHODS:The prospective study for one year included 34 patients with asthma, 20 patients with COPD vaccinated against influenza, both groups being under a basic maintenance therapy, and 26 healthy individuals vaccinated with the trivalent polymer-subunit (adjuvanted) vaccine, containing 5 μg of influenza virus strains and 500 μg of azoximer bromide. The levels of C-reactive protein (CRP) and serum cytokines (IL-2, IL-6, IL-10, and IL-17) were measured by enzyme-linked immunosorbent assay (ELISA) at baseline and 6 and 12 months after vaccination. RESULTS:Over a year after vaccination against influenza, the frequency and duration of bronchopulmonary exacerbations significantly decreased both in patients with asthma and those with COPD: by 1.9-2 and 2.2-2.5 times, respectively. There was also a significant reduction in the frequency and duration of hospitalization (by 2.0-2.5 and 2.3-3 times, respectively). Other changes observed over the one-year follow-up period included a 1.6-fold reduction (р<0.01) in the need for outpatient care and a reduction in the number of courses of systemic corticosteroids (by 16.7%; р<0.05) in asthma patients; and a 3.6-fold decrease (р<0.05) in the number of courses of antibiotics in COPD patients. Twelve months after vaccination against influenza, the study participants had significantly lower IL-6 levels, and COPD patients, additionally, showed a reduction in IL-10 levels compared to baseline. Our study identified certain correlations between positive clinical outcomes of vaccination and levels of inflammation markers. DISCUSSION:Analysis of the immunological, clinical and functional parameters in asthma and COPD patients showed that vaccination not only reduces the risk of influenza and other respiratory infections due to activation of non-specific protection, but also improves the clinical course of asthma and COPD.

A great deal of evidence has accumulated suggesting an important role of mucosal immunity not only in preventing COVID-19 but also in the pathogenesis of this infection. The aim of the study was to evaluate the levels of secretory immunoglobulin A (sIgA) in different compartments of the upper respiratory tract in COVID-19 patients in relation to the severity of the disease and treatment with a bacteria-based immunomodulating agent (Immunovac VP4). The titers of sIgA were determined by ELISA in nasal epithelial swabs, pharyngeal swabs, and salivary gland secretions at baseline and on days 14 and 30 of treatment. The levels of nasal, pharyngeal and salivary sIgA were significantly lower in more severe patients (subgroup A) than in less severe patients (subgroup B), p < 0.01. In subgroup A, the patients who received Immunovac VP4 had higher pharyngeal sIgA levels in convalescent period than those who did not receive the therapy p < 0.05. In subgroup B patients, an increase in immunoglobulin levels was observed from baseline to day 14 of treatment whether they received the add-on therapy or not, p < 0.01. On day 30 of treatment, the sIgA levels in the standard treatment group, however, decreased, while the patients receiving the immunomodulating agent maintained high sIgA levels, p < 0.05. Oxygen saturation significantly increased by day 14 in both groups, p < 0.001. However, it was higher in the Immunovac VP4 group than in the standard treatment group, p < 0.01. Thus, addition of a bacterial lysate-based immunomodulating agent to the treatment regimen for moderate-to-severe COVID-19 induces the production of pharyngeal and salivary sIgA. SIgA production is inversely correlated to CRP levels and percentage of lung involvement on CT scan and is directly correlated to SpO2 levels.

Background. Given the high prevalence of Bordetella pertussis, patients with respiratory disorders are at risk of getting infected with this pathogen and developing pertussis. Therefore, they should be considered a target group for vaccination against this infection. Aims — the objective of the study was to assess vaccine-induced immunity against pertussis in lung transplant candidates. Methods. Twenty-four patients with severe bronchopulmonary diseases, aged 18 to 60, were vaccinated against pertussis with Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine. Five patients underwent lung transplantation. Immunoglobulin G (IgG) antibodies (Abs) were measured using the RIDASCREEN® Bordetella IgG test system. Results. In the post-vaccination period, only 8.3% of the patients developed such local reactions as tenderness and induration at the injection site. The proportions of patients who were seropositive for pertussis before vaccination, one month and one year after vaccination were 71, 100 and 100%, respectively (p = 0.02). A significant increase in anti-pertussis IgG Ab levels was identified one month after a single vaccine dose, and was still observed after 12 months. In the group of two-dose vaccination, there was no statistical difference between the levels of IgG Abs one month after the first dose and one month after the second dose. A significant increase in anti-Bordetella pertussis IgG Ab levels was observed in the group of initially seronegative patients compared to seropositive patients (p = 0.03). A year after vaccination, there was no statistically significant difference in IgG Ab levels between the patients with and without a history of lung transplantation. Conclusions. The majority (71%) of patients with severe bronchopulmonary disease was seropositive for B. pertussis. Single-dose vaccination against pertussis was safe; it induced the production of additional specific Abs and an increase in their levels in all patients. Therapy administered after lung transplantation did not significantly affect the levels of vaccine-induced Abs.

Among the causes of maternal mortality in the Russian Federation, infectious and inflammatory diseases after childbirth and abortion occupy fourth position. A systematic analysis of the prevalence, structure and dynamics of postpartum diseases is necessary for making adequate organizational decisions. The purpose of the study – to study the frequency, structure and dynamics of postpartum diseases in Novokuznetsk for the period 2020-2022. Research methods. The analysis was carried out according to the reporting documentation of the gynecological department N 2 of the Novokuznetsk City Clinical Hospital N 1 named after G.B. Kurbatov for 2020-2022. Comparisons were made using the Cochran-Mantel-Haenszel test (pgr) with the calculation of the generalized Mantel-Haenszel odds ratio and its 95% confidence interval. Differences were considered statistically significant at p ≤ 0.05. For calculations and plotting, the statistical environment R (v.3d.6, GNU GPL2 license) was used. Results. The prevalence of postpartum diseases during the studied period varies from 6.1 ‰ to 20.1 ‰. Infection of an obstetric surgical wound (29 %) and postpartum endometritis (16 %) were more often recorded. The incidence of postoperative suture seroma and suture failure on the uterus with the development of peritonitis has increased significantly. Postpartum diseases were more often observed in women over 35 years of age, with 3 or subsequent births and high morbidity. In 45.6 % of cases, the diseases were associated with a bacterial factor, while the frequency of detection of microbial associations of opportunistic flora, E. Faecalis and S. Aureus increased 7-8 times. Conclusion. The prevalence of postpartum infectious and inflammatory diseases during the study period remains consistently high. To reduce the incidence of complications in the postpartum period, a balanced approach to the choice of delivery method and a reduction in the length of stay in the obstetric hospital are necessary. At the stage of pre-pregnancy preparation, the following are necessary: timely identification and sanitation of foci of infection, effective diagnosis and treatment of anemia with normalization of weight before pregnancy.

Aim. To analyze dynamic of incidence and mortality of COVID-19 and clinical and epidemiological characteristics of adult patients with a new coronavirus infection during the early period of the Omicron SARS-COV-2 distribution in Russia. Materials and Methods. We conducted a retrospective analysis of the dynamics of COVID-19 incidence and mortality in Russia until 2023. Study included patients aged ≥18 years with a laboratory-confirmed diagnosis of COVID-19, detected in the period from 01/02/2022 to 14/03/2022 (n = 3 582 688) in 85 regions of Russia. Participants were included regardless their COVID-19 vaccination history. Results. We identified 6 periods of rise and decline in the COVID-19 incidence until 2023 in Russia. The 5th (January–July 2022) and the 6th (August-November 2022) periods were associated with the spread of the Omicron SARS-CoV-2. The median age of patients in the early period of Omicron spreading was 49 (36–62) years, 62.7% were women. The largest proportion of patients were represented by the age groups 30–39 and 40–49 years (19.2% each), the lowest – 18–29 years (12.3%). Proportion of patients with mild disease was 90.0%, moderate – 8.5%, severe – 0.9%, extremely severe – 0.6%. Hospitalization rate, proportion of patients treated in the intensive care unit and rate of invasive mechanical ventilation were 7.6%, 9.5% and 6.7% respectively. The median period from the onset of symptoms to the diagnosis was 2 (1–3) days, median of duration of the disease was 8 (6-10) days and median duration of hospitalization was 10 (7–14) days. The median age of the deceased patients was 77 (69–84) years, of which 50.8% were women, 72.6% were persons ≥70 years old. One or more concomitant diseases were detected among 8.7% of patients who became ill and 75.8% of those who died. The probability of hospitalization, admission to the ICU, IMV and death in patients with one or more concomitant diseases were 24.5, 3.2, 3.5 and 35.8 times higher, respectively, compared with patients without concomitant diseases. Conclusion. In the early period of the spread of the Omicron variant in Russia, among adult patients with COVID-19, excluding their vaccine history, the frequency of severe and extremely severe forms of infection was 1.5%. The elderly age and the presence of concomitant diseases remained key risk factors for the development of adverse outcomes of the COVID-19

The aim of the research – to study the patterns and patterns of congenital fetal malformations (CHD) in the city of Novokuznetsk for the period from 2012-2021. Materials and methods. The analysis was carried out on the basis of a retrospective analysis of archival data from the gynecological department of the City Clinical Hospital N 1 named after G.P. Kurbatov. To calculate the indicators, data on the number of women of fertile age in the south of Kuzbass was used. Descriptive statistics were calculated using the Clopper-Pearson method. To determine statistically significant changes in the structure of the HF, the Cochran-Armitage test was used. To analyze the trend in the dynamics of relative indicators, the Mann-Kendall test was changed. Results. Frequency of pregnancy terminations due to congenital malformation of the fetus for the period 2012-2021 was generally stable (p = 0.72). Changes in the structure of congenital malformations were established: the frequency of central nervous system defects increased 2,3 times (p = 0.001), the incidence of malformations of the facial bones decreased 2.7 times (p = 0.023), and the incidence of malformations of the musculoskeletal system decreased 3.7 times (p = 0.049) and there is a 1,3-fold decrease in the frequency of multiple malformations (p = 0.001). Conclusion. Frequency of pregnancy terminations (per 100 thousand women of fertile age) due to congenital malformation of the fetus in general for the analyzed period 2012-2021 was stable. The structure of congenital malformations was dominated by multiple malformations. The results of the analysis indicate an increase in the proportion of central nervous system defects in the total number of congenital malformations, and the prevalence of pregnancy terminations for this reason has also increased. At the same time, the number of pregnancy terminations due to malformations of the facial bones has decreased significantly.

A decrease of nonspecific body resistance, an imbalance of local and systemic immunity and a free-radical oxidation abnormality substantially contribute to the pathogenesis of community-acquired pneumonia (CAP).Purpose: To study the efficiency of including immunomodulators into the comprehensive treatment of nonsevere community-acquired pneumonia and assess the long-term effects of the treatment conducted.Patients (n = 55) with non-severe CAP (41 (31-48) years old, with CRB-65 score of 0.15 (0-1)) are included in the study. Group 1 (control) received only standard CAP therapy; the other two groups received immunomodulators concurrently with the standard therapy: bacterial lysate (BL) for group 2 and azoximer bromide (AzB) for group 3. TNFα and IL-6 concentration was determined on the day of visit, on day 13 and day 60 of follow-up. During 2 years, the incidence of low respiratory tract infections (LRTI) was studied in the same patients with CAP in past (n = 55). All patients (n = 55) had clinical signs of non-severe community-acquired pneumonia. The overall duration of all symptoms was lower in immunomodulators groups as compared to the control group: 12 (11-13) days in BL group (p < 0.001) and 12 (11-12) days in AzB group (p < 0.001) with no statistically significant difference between intervention groups (p = 0.36). During treatment, TNFα and IL-6 concentration decreased on day 13 and day 60 in all patients; in patients who received immunomodulators, TNFα and IL-6 were reliably lower as compared to the control. Changes of TNFα and IL-6 concentration in the groups on day 60 of the study as compared to the baseline showed a decrease in BL group by 85 (-89 – -82) % and 86 (-90 – -85) % (p < 0.001; p = 0.001 and control); in AzB group by 82 (-86 – -80) % and 86 (-88 – -84) % (p = 0.002; p = 0.007 and control). Intensity of IL-6 concentration decrease on day 60 in BL and AzB groups did not differ (p = 0.72). Gender- and age-adjusted odds ratio for the development of low respiratory tract diseases (during 2 years after CAP) in AzB group was 0.15 (0.02-0.93) (p = 0.04) suggesting its protective effect. Inclusion of immunomodulators in basic treatment of non-severe community-acquired pneumonia reduces duration of symptoms and is associated with improvement of the proinflammatory cytokine profile. In 2 years of follow-up, long-term effects of the immunomodulatory therapy showed statistically significant lower incidence of low respiratory tract infections in AzB group only.

Background: The problem of identifying vaccine-specific T-cell responses is still a matter of debate. Currently, there are no universal, clearly defined, agreed upon criteria for assessing the effectiveness of vaccinations and their immunogenicity for the cellular component of immunity, even for healthy people. But for patients with inborn errors of immunity (IEI), especially those with antibody deficiencies, evaluating cellular immunity holds significant importance. Aim: To examine the effect of one and two doses of inactivated adjuvanted subunit influenza vaccines on the expression of endosomal Toll-like receptors (TLRs) on the immune cells and the primary lymphocyte subpopulations in patients with common variable immunodeficiency (CVID). Materials and methods: During 2018–2019, six CVID patients received one dose of a quadrivalent adjuvanted influenza vaccine; in 2019–2020, nine patients were vaccinated with two doses of a trivalent inactivated influenza vaccine. The proportion of key lymphocyte subpopulations and expression levels of TLRs were analyzed using flow cytometry with monoclonal antibodies. Results: No statistically significant alterations in the absolute values of the main lymphocyte subpopulations were observed in CVID patients before or after vaccination with the different immunization protocols. However, after vaccination, a higher expression of TLR3 and TLR9 in granulocytes, monocytes, and lymphocytes was found in those patients who received two vaccine doses rather than one single dose. Conclusion: This study marks the first instance of using a simultaneous two-dose vaccination, which is associated with an elevated level of TLR expression in the immune cells. Administration of the adjuvanted vaccines in CVID patients appears promising. Further research into their impact on innate immunity and the development of more effective vaccination regimens is warranted.

Relevance. During and after the COVID-19 pandemic, viruses have become a more common cause of pulmonary infections in adults; therefore, the distinction between viral lung injury and community-acquired bacterial pneumonia is of increasing importance. Aim. Development of a model for differentiating community-acquired bacterial pneumonia and viral lung injury, including COVID-19. Materials and methods. This retrospective case–control study included 300 adult patients with viral lung injury and 100 adult patients with community-acquired bacterial pneumonia. Clinical, laboratory, and instrumental data were analyzed, significant factors were selected by which the samples differed, and a model was developed using logistic regression to distinguish between community-acquired bacterial pneumonia and viral lung damage, including COVID-19. Results. The developed model included the following parameters: total protein level, neutrophil/lymphocyte index, heart rate, unilateral infiltration on CT or chest x-ray, vasopressor prescription in the first 24 h of hospitalization, altered level of consciousness, chills, and fatigue. The model had the following characteristics: AUC = 0.94 (0.92–0.96), AUC_PR = 0.84 (0.76 to 0.92), prediction accuracy — 90%, sensitivity — 76%, specificity — 95%, positive predictive value — 83 %. Conclusion. The use of this model can facilitate the differential diagnosis of community-acquired bacterial pneumonia and viral lung injury, including COVID-19, in adults in general wards and intensive care units.

Objective. To study the etiology of community-acquired pneumonia (CAP) in adult hospitalized patients after the COVID-19 pandemic. Materials and Methods. The prospective multicenter study included patients 18 years and older with confirmed diagnosis of CAP admitted to 6 hospitals in different regions of Russia from July to November 2023. Etiology was confirmed by respiratory samples (sputum, tracheal aspirate) culture, blood culture (severe cases), and urinary antigen tests (Legionella pneumophila serogroup 1, Streptococcus pneumoniae). Mycoplasma pneumoniae, Chlamydia pneumoniae, and common respiratory viruses were identified using the real-time polymerase chain reaction (PCR) in respiratory samples. Qualitative PCR for S. pneumoniae and Haemophilus influenzae DNA tests were also applied. Results. Altogether 152 patients were enrolled, and significant CAP pathogens were identified in 96 (63%) cases; the median age of patients with verified etiology of CAP was 45 [34.8; 66] years, comorbidity index was 0.5 (0; 3.0) points. The most frequently detected pathogens were M. pneumoniae – 42 (44%), rhinovirus – 23 (24%), S. pneumoniae – 17 (18%) and SARS-CoV-2 – 13 (14%). Coinfection was registered in 22% of cases, the most common associations were M. pneumoniae + rhinovirus – 5 (3.3%), S. pneumoniae + rhinovirus – 3 (2%). Pneumococcal bacteremia was detected in 1 patient. In most patients CAP was non-severe; 17 (18%) patients required admission to the ICU. Hospital mortality was 7%. Conclusions. M. pneumoniae, respiratory viruses (mainly rhinovirus and SARS-CoV-2), and S. pneumoniae were the predominant CAP pathogens in hospitalized adults with CAP in the first months after the COVID-19 pandemiс. The use of an integrated approach to etiological diagnosis can significantly increase the proportion of patients with an established etiology of CAP.

Mucosal immunity plays a major role not only in the prevention but probably also in the outcomes of COVID-19. An enhanced production of secretory immunoglobulin A (sIgA) might contribute to the activation of the immune response mechanisms. To assess the levels of sIgA produced by epithelial cells in the nasal and pharyngeal mucosa and those measured in salivary gland secretions and to study the course of COVID-19 following the combined scheme of intranasal and subcutaneous administration of a bacteria-based immunostimulant agent. This study included 69 patients, aged between 18 and 60, who had moderate COVID-19 infection. They were divided into two groups: Group 1 (control group) included 39 patients who received only background therapy, and Group 2 was made up of 30 patients who received background therapy in combination with the Immunovac VP4 vaccine, a bacteria-based immunostimulant agent, which was given for 11 days starting from the day of admission to hospital. The levels of sIgA were measured by ELISA in epithelial, nasal and pharyngeal swabs, and salivary gland secretions at baseline and on days 14 and 30. The combined scheme of intranasal and subcutaneous administration of the Immunovac VP4 vaccine in the complex therapy of patients with COVID-19 is accompanied by increased synthesis of sIgA in nasal and pharyngeal swabs, more intense decrease in the level of C-reactive protein (CRP) and reduction in the duration of fever and length of hospitalization compared to the control group. Prescribing a immunostimulant agent containing bacterial ligands in complex therapy for COVID-19 patients helps to enhance mucosal immunity and improves the course of the disease.

Introduction. The role of comorbid conditions in susceptibility to SARS-CoV-2 infection and the severity of associated COVID-19 disease has been an area of ongoing research since the pandemic began.Objective. To evaluate the impact of elderly asthma on the clinical course and outcomes of severe COVID-19.Materials and methods. Elderly patients (WHO, 2020) (> 60 years, n = 131) with bronchial asthma (BA) hospitalized for severe COVID-19 were included in the study. The presence of COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a confirmed diagnosis of bronchial asthma (GINA, 2020). Follow-up was performed at the hospital stage and for 90 days after discharge from the hospital.Results. In the groups of patients with lethal outcome (regardless of the stage) there were statistically significantly higher Charlson index, respiratory rate, CT lung lesion volume, leukocyte, neutrophil and neutrophil to lymphocyte ratios, lower absolute eosinophil count. In the group of patients who died during hospitalization, severe (IV–V) asthma (p = 0.03), steroid use during the previous year (p = 0.02), chronic heart failure (p = 0.009), and the atopic asthma phenotype was less common (p = 0.02). Those who died in the 90-day posthospital period had greater lung lesion volume on CT scan, and diabetes mellitus was more common (p < 0.001). The most significant predictors of mortality were identified.Conclusion. The common most significant predictors of hospital and 90-day posthospital mortality in older patients with bronchial asthma were comorbidity index and lower eosinophil levels. Hospital mortality is further characterized by a higher neutrophil to lymphocyte ratio and lower total protein; 90-day posthospital mortality by the amount of lung damage on CT scan and the presence of diabetes mellitus.

Background. Mortality and COVID-19 related factors are thoroughly analyzed. Given the large number of hospitalized patients, the potential short- and long-term COVID-19 related complications, further research is needed on the possible consequences of hospitalization, especially in higher-risk patients, after prolonged hospitalization and intensive care admission. Aim. To study the clinical course and outcomes of severe COVID-19 in elderly patients with asthma at the hospital and early post-hospital stages. Materials and methods. The study included 131 elderly patients (WHO, 2020) 60 years old, n=131 with asthma, hospitalized for severe COVID-19. Of these, 86 (65.6%) patients survived, 30 (22.9%) died in the hospital, and 15 (14.9%) patients died after discharge from the hospital (in the 90-day post-hospital period). COVID-19 was confirmed by laboratory tests (SARS-CoV-2 PCR RNA test) and/or clinically and radiologically. All patients had a documented history of asthma. Patients were followed up during the hospital stay and for 90 days after discharge. Results. Comparison of outcomes showed that in the groups of patients with a fatal outcome (regardless of the stage), the Charlson comorbidity index, respiratory rate, extent of lung damage assessed by computed tomography, the absolute leukocyte and neutrophil number and the ratio of neutrophils to lymphocytes were statistically significantly higher. The absolute number of eosinophils was lower in these groups. In the group of patients who died during hospitalization, severe (IVV) asthma (p=0.03), steroid use during the previous year (p=0.02), chronic heart failure with a reduced ejection fraction (p=0.009) were more common, and atopic asthma phenotype was less common (p=0.02). In those who died after discharge, more common were non-invasive ventilation and diabetes mellitus (p0.001). The multivariate regression analysis model revealed the most significant predictors of mortality at the hospital and early post-hospital stages. Conclusion. Adverse outcomes of severe COVID-19 in elderly patients with asthma include hospital and post-hospital mortality. The most significant predictors of mortality are the comorbidity index and low eosinophil count. Hospital mortality is associated with a higher ratio of neutrophils to lymphocytes and lower total protein levels; early (90-day) post-hospital mortality is associated with extensive lung damage shown by computed tomography and diabetes mellitus.

У статті встановлено роль та значення фінансових ресурсів та управління ними для забезпечення конкурентоздатності підприємства і умовах конкурентного середовища та під час військових дій. Визначені особливості застосування окремих методів управління фінансовими ресурсами, зокрема фінансове планування, методи прогнозування та сценаріїв. Розглянуто специфіку змісту традиційних та прогресивних методів управління фінансовими ресурсами підприємства. Ідентифіковані критерії ефективності системи управління фінансовими ресурсами та такі його цілі: зростання обсягів виробництва та реалізації продукції, збільшення прибутку, лідерство серед конкурентів, створення конкурентоспроможної бази підприємства, збільшення ринкової вартості підприємства, уникнення банкрутства. Визначені особливості управління фінансовими ресурсами під час війни. Зокрема встановлено, що однією з ключових загроз для фінансової безпеки підприємства є економічна нестабільність у країні, яка виявляється через погіршення основних макроекономічних показників, таких як зменшення обсягу валового внутрішнього продукту, зростання рівня безробіття, інфляції та девальвації національної валюти. Ідентифіковано базові підходи до забезпечення та підтримки фінансової безпеки підприємства в таких умовах: системний підхід до управління фінансовими ресурсами, формування «фінансових подушок безпеки», адаптування системи управління підприємства відповідно до зовнішніх загроз, впровадження сучасних інструментів бізнесу (електронної комерції). Результати опитування менеджерів і працівників ТОВ «ЕКО» свідчать про те, що більшість учасників опитування (83,3%) вважає, що недостатність фінансових ресурсів є значущою перешкодою для здійснення підприємницької діяльності, 53,3% вважають фінансово-економічний стан ТОВ «ЕКО» задовільним, впровадженням цифрових технологій у бізнес-процеси підприємства задоволені 56,7%. Доведено доцільність впровадження цифрових технологій у бізнес-процеси ТОВ «ЕКО», що дозволить перетворити модель його розвитку, використовуючи передові інструменти цифрової трансформації.

Vaccination is the most effective method of influenza prophylaxis resulting in reduced frequency and severity of complications. Currently, for the prevention of influenza, inactivated split and subunit vaccines as the safest and promoting formation of protective level of strain-specific virus neutralizing antibodies are used. It is known that not all inactivated vaccines are effective enough for select human groups. While nowadays the level of public health is low, there is a need to improve the effectiveness of vaccines that should activate all chains of the immune system. In order to enhance intensity of influenza virus strain-specific antibody production, adjuvant vaccines exerting other mechanisms to activate humoral and cellular immunity compared to non-adjuvant vaccines have been used. The aim of the study was to examine lymphocyte immunophenotype in 27 healthy donors treated with polymer-subunit (immunoadjuvant) and non-adjuvanted split and subunit influenza vaccines. Materials and methods. Peripheral blood lymphocyte subpopulations were studied in vitro by flow cytometer FC-500 Cytomics (Beckman Coulter, USA) using FITC- and PE-labeled monoclonal antibodies (mAbs). Results. All examined influenza vaccines activate the effectors of cellular immunity, increasing the number of NK-cells (CD16/56), NKT-lymphocytes (CD3/CD16/56), B-lymphocytes (CD45/CD20), activated (CD3/HLA-DR) and cytotoxic (CD8/HLA-DR) T-lymphocytes, as well as cells bearing early activation marker (CD45/CD25). Among them the immunoadjuvant vaccine showed the greatest potential to induce cellular response eliciting regulatory mechanisms that prevent hyperactivation, stimulating growth of NK (CD16/56), NKT-cells (CD3/CD16/56), B-lymphocytes (CD45/CD20), activated (CD3/HLA-DR) and cytotoxic (CD8/HLA-DR) T-lymphocytes, T-regulatory cells (Tregs, CD4/CD25/Foxp3). Conclusion. Vaccination against influenza besides the formation of specific antibodies render a transient, immunomodulating effect that is more noticeable after immunoadjuvant vaccine. It can be assumed that vaccination of people with dysfunctions of the immune system an additional prophylactic effect will be observed.

Background: Although extensive research has been conducted on the role of local immunity in patients with SARS-CoV-2, little is known about the production and concentrations of secretory IgA (SIgA) in different mucosal compartments. This article aims to assess the secretion of SIgA in the nasal and pharyngeal compartments and saliva of patients with COVID-19 and to investigate the possibility and efficiency of correction of their secretion using combined intranasal and oral administration of a pharmaceutical containing antigens of opportunistic microorganisms. Methods: This study included 78 inpatients, aged between 18 and 60 years, who had confirmed COVID-19 with moderate lung involvement. The control group (n=45) received basic therapy, and the treatment group (n=33) was additionally administered the bacteria-based pharmaceutical Immunovac VP4 from day 1 to day 10 of hospitalization. SIgA levels were measured by ELISA at baseline and on days 14 and 30. Results: No systemic or local reactions associated with Immunovac VP4 were reported. We observed a statistically significant reduction in the duration of fever and hospitalization in patients who received Immunovac VP4 compared with those from the control group (p=0.03 and p=0.05, respectively). Changes over time in SIgA levels in nasal swabs were found to be significantly different in the two treatment groups (F=7.9, p[78.0]<0.001). On day 14 of observation, patients in the control group showed a statistically significant reduction in SIgA levels from baseline (p=0.02), whereas patients in the Immunovac VP4 group had stable SIgA levels (p=0.07). On day 30 after the start of treatment, there was a statistically significant increase in SIgA levels in the Immunovac VP4 group compared with baseline (from 77.7 (40.5–98.7) μg/L to 113.4 (39.8–156.7) μg/L; p=0.05) and the levels measured on day 14 (from 60.2 (23.3–102.9) μg/L to 113.4 (39.8–156.7) μg/L; p=0.03). The control group showed a statistically significant decrease in levels of nasal SIgA (to 37.3) on day 30 (p=0.007 for comparison with baseline values and p=0.04 for comparison with levels measured on day 14). Changes over time in SIgA levels measured in pharyngeal swabs were also different between the two treatment groups, and this difference reached statistical significance (F=6.5, p[73.0]=0.003). In the control group, this parameter did not change throughout the study (p=0.17 for a comparison between the levels measured on day 14 and the baseline values, and p=0.12 for a comparison between the levels measured on day 30 and the baseline values). In the Immunovac VP4 group, there was a statistically significant increase from baseline in SIgA levels on study day 30: from 1.5 (0.2–16.5) μg/L to 29.8 (3.6–106.8) μg/L (p=0.02). Changes over time in salivary SIgA did not show a significant difference between study groups (F=0.3, p[66.3]=0.75). Conclusion: As part of combination therapy, the bacteria-based immunostimulant agent Immunovac VP4 increases SIgA levels in the nasal and pharyngeal compartments and induces clinical improvement. Induced mucosal immunity is central to the prevention of respiratory infections, particularly in patients with post-COVID-19 syndrome.

Background: This study investigates the efficiency of two different types of immunomodulators for the treatment of non-severe community-acquired pneumonia (CAP) and assesses their long-term effects. Methods: The study included 55 patients with non-severe CAP. Group 1 (control) received only standard CAP therapy; the other two groups received immunomodulators simultaneously with the standard therapy: bacterial lysate for group 2 and azoximer bromide (AzB) for group 3. TNF and IL-6 concentrations were determined on the day of hospitalization as well as on days 13 and 60 of follow-up. For 2 years, we monitored the incidence of low respiratory tract infections (LRTIs) in the same patients with CAP (n=55). n =55). Results: The overall duration of all symptoms was lower in the immunomodulator groups compared with the control group. During treatment, TNF and IL-6 concentrations decreased on days 13 and 60 in all patients; in patients who received immunomodulators, TNF and IL-6 were reliably lower than in control patients. IL-6 concentration decreased on day 60 in the bacterial lysate and AzB treatment groups and did not differ (p=0.72). p =0.72). The odds ratio for the development of LRTIs in the AzB group was 0.15 (0.02-0.93) (p=0.04), p =0.04), suggesting its protective effect. Conclusion: Inclusion of immunomodulators in the basic treatment of non-severe CAP reduces the duration of symptoms and is associated with improvement of the pro-inflammatory cytokine profile. In 2 years of follow-up, the long-term effects of the immunomodulatory therapy showed a statistically significant lower incidence of LRTIs in the AzB group only. However, given the small sample size of this study, further clinical studies are needed.

Background: Influenza vaccine is a tool for preventing infection and reducing exacerbations in patients with asthma and chronic obstructive pulmonary disease (COPD). Purpose of this study is to investigate dynamics of CRP and serum cytokines (IL-2, IL-6, IL-10, IL-17) in patients with asthma and COPD, as well as to perform a correlation analysis with the clinical parameters of the disease manifestation. Methods: The study included 34 patients with asthma, 20 patients with COPD vaccinated against influenza during a period of remission from 2 to 4 weeks, both groups being under a basic maintenance therapy, and 26 healthy individuals vaccinated with the trivalent polymer-subunit vaccine Grippol® Plus, containing 5 µg of influenza virus strains and 500 µg of azoximer bromide. Results: Observing patients with asthma and COPD, during a year after the vaccination, has revealed a significant reduction in exacerbations frequency (p < 0.05) and duration (p < 0.05) of the bronchial obstructive syndrome (BF). Before the vaccination the IL-6 level in patients with asthma had a direct moderate correlation with duration of exacerbations of the underlying disease (p < 0.05), along with the number of systemic corticosteroids courses during exacerbations (p < 0.05). In 12 months after the vaccination, while assessing cytokine profile of all study groups, a significant reduction in the level of IL-6 was observed, compared to the baseline values (p< 0.05). Conclusion: Conducted analysis of immunological, clinical, and functional parameters of patients with asthma and COPD has proven for influenza vaccine to be effective in BF patients.

Objectives: To identify risk factors for nosocomial bloodstream infections (BSIs) in intensive care unit (ICU) patients with COVID-19 and to build a predictive model for BSIs.Patients and methods: The retrospective case-control study included 236 ICU COVID-19 patients with BSIs group and 234 patients in the control group. Demographic and laboratory data, comorbidities, drug use, invasive procedures and identified pathogens were recorded separately for patients directly admitted and transferred to ICU. Fine and Gray's multi-variate competing risk model was used to build a predictive model for patients transferred to ICU.Results: The risk factors were: interleukin inhibitors (HR = 6.1 (95% CI: 2.0-18.5)) and dexamethasone (HR = 3.0 (95% CI: 1.3-7.1)) use in previous hospitalization, glomerular filtration rate <60 mL/min per 1.73 m2 (HR = 4.0 (95% CI: 2.1-7.6)) and blood glucose >9 mmol/L (HR = 2.5 (95% CI: 1.4-4.6)) in patients directly admitted to ICU; and dexamethasone use in previous hospitalization (HR = 4.5 (95% CI: 1.8-11)), the total dexamethasone dose before transfer to ICU (HR = 1.2 (95% CI: 1.06-1.37)), diabetes mellitus (HR = 1.4 (95% CI: 1.1-1.9)), alanine transaminase (ALT) >35.5 U/L on hospital admission (HR = 1.5 (95% CI: 1.1-2.1)), and the use of low-flow oxygen versus high-flow oxygen therapy or non-invasive mechanical ventilation on admission to ICU ((HR = 2.7 (95% CI: 5.6-11.1)) in patients transferred to ICU. A predictive model had sensitivity of 63-73% and specificity of 71-83% at different times of ICU stay.Conclusions: Our findings may help clinicians detect patients at high risk of developing BSIs.& COPY; 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.