Abstract. Introduction. The challenges that have been facing the Syrian population inside the Syrian Arab Republic varied during the last 12 years. The ongoing war and its general impacts on the country and population made it nearly impossible to face any new challenges. In such difficult environment, the COVID-19 pandemic arrived to the country adding salt to injury. Aim. This article aims to gather the reliable information that explains the breakout of COVID-19 pandemic in Syria, its consequences on the war-torn country, the measures taken to restrain the pandemic, and the difficulties that have been faced while constraining the pandemic. Materials and Methods. This study review focuses on the published articles and surveys that examine the COVID-19 pandemic in Syria. Results and Discussion. Between March 2020 and April 2022, different regions in Syria reported 197,244 confirmed cases all around the country. Also, 7,182 deaths from COVID-19 have been reported. The government-controlled areas have shown practically larger death numbers than other areas, followed by north-west and north-east Syria. COVID-19 cases in government-controlled areas and north-east Syria have been declining since April and February 2022, respectively. Limited testing and lack of transparency make it difficult to accurately track the virus’s spread. High-density residential areas and internally displaced persons camps (IPD) are front on to burdensome threat due to the lack of basic prevention equipment and hygiene measures. While only 58 out of 111 public hospitals are fully functioning and many healthcare workers have fled, the pandemic spreads among people and cases show a high increase. Based on available ICU beds with ventilators, Syria can adequately treat around 6,500 COVID-19 cases which is not close to the quarter of the total number of actual affected cases. Conclusions. Making it much more tough for the Syrian fragile health care system, the COVID-19 pandemic has burdened the general situation with more pressure and affected cases. The destruction of health facilities and the exodus of healthcare providers have left the remaining medical staff overburdened and psychologically stressed. The limited access to reliable information has hindered accurate tracking and documentation of the virus’s spread. The poor living situation in high-density residential areas and IDP camps have mainly led to the spread of the pandemic. Despite efforts by humanitarian organizations and international partners, support and supplies remain insufficient. The pandemic has also had a significant psychological impact on healthcare providers and exacerbated the economic crisis and social injustices in the region. Addressing these challenges requires targeted interventions to support healthcare providers’ mental well-being, collaboration and aid from international partners, and efforts to improve vaccine acceptance rates. Sustainable development goals can provide potential solutions for Syria’s recovery and resilience against future pandemics.

Community-acquired pneumonia is one of the most common acute infectious diseases, especially in organized groups. Community-acquired pneumonia in military personnel is a serious problem of the medical service and is diagnosed 2–3 times more often than among civilians. The purpose of the study. To study the clinical features of the action of “Immunovac-VP-4 ®” in the complex treatment of community-acquired pneumonia in new recruits. Materials and methods. The study group included 88 conscripted military personnel from among the new recruits who were hospitalized with a diagnosis of mild community-acquired pneumonia. The main group of the study included 35 patients receiving basic antibacterial therapy in combination with the therapeutic vaccine “Immunovak-VP-4 ®”. The control group included 53 patients who received only standard basic antibacterial therapy. Results. In the main study group, the frequency of repeated respiratory infections in all nosologies was lower than in the control group, statistically significant differences were noted in relation to pneumonia and acute rhinosinusitis. A decrease in the level of IL-1β in blood serum was revealed after 15 days (p = 0.05) and 6 months after discharge from the hospital (p = 0.002) in the main group compared with the control group. After 15 days, in the group of patients receiving “Immunovak-VP-4 ®”, there was a decrease in IL-6 levels relative to the baseline (p = 0.04) and it became lower than the control group (p = 0.04). Conclusion. The use of the “Immunovak-VP-4 ®” vaccine can be considered as a way to improve the treatment of community-acquired pneumonia: it can be a drug for treatment, prevention of complications, and an instrument in immunorehabilitation. The use of “Immunovak-VP-4 ®” in the complex treatment of community-acquired pneumonia of mild course is accompanied by a decrease in the activity of systemic inflammation: a decrease in serum levels of IL-1β, IL-6.

Until recently, HIV infection does not lose its relevance. In 2022, 630 000 people died and 1.3 million people became infected with the human immunodeficiency virus (HIV). HIV-positive persons develop more infectious diseases than healthy people do; the causative agents are mainly opportunistic microorganisms. Streptococcus pneumoniae is the main causative agent of infection in the lungs in HIV-infected persons. In order to prevent the development of severe pneumococcal infections and to overcome antibiotic resistance, vaccines have been developed. There are polysaccharide (PPV) and conjugate (PCV) vaccines. According to clinical recommendations, vaccination of previously unvaccinated HIV-infected patients is carried out regardless of T-helper cell level. However, no data were found on the effect of PCV13 on immunological memory cells. The purpose of this study is to assess an effect of PCV13 vaccination on the immune system in HIV-infected subjects. Materials and methods. The study included 200 patients with HIV infection, which were divided into two groups: I — received a dose of PCV13 (n = 100) and control group (n = 100). During the first visit, immunological and microbiological studies were carried out. On the second visit, a PCV13 was injected into the deltoid muscle. The third visit was made a year later, where immunological and microbiological studies were repeated. Participants were divided into 4 subgroups depending on CD4+ T cell level. The microbial study was done using a swab collected from the back of the throat. Results. During the immunological examination at visit 1, abnormalities were detected in all examined populations and immune cell subsets. At 12 months post-vaccination, the median levels of CD3+CD4+ and CD45RO+ T lymphocytes in the immunized group were higher than pre-vaccination levels compared to control group, in which the values changed insignificantly. Our data confirm the immunological effectiveness of PCV13 administration in HIV-infected patients. In patients with peripheral blood CD19+ lymphocyte deficiency, had increased microbial detection rate (p = 0.003). Conclusion. As a result, due to the high risk of pneumococcal pneumonia, HIV-infected patients should be immunized with a 13-valent pneumococcal conjugate vaccine.

Introduction. Higher medical education is one of the most sought-after and elite degrees worldwide. Systems of higher medical education differ from country to country, although they have certain features in common. Core differences are as follows: Training duration at various stages, contents of educational programs, learning technologies, etc. Much attention is paid to physicians training, which is determined by the high social significance of medical education. Aim: To provide an overview of the contemporary global trends in the development of higher medical education in the USA, Great Britain, France, and China. Materials and Methods. World literature was analyzed on trends in the development of higher medical education. Results and Discussion. Development of the healthcare system in the UK requires an integrated approach that considers various aspects in higher medical education, personnel policy, and workplace management. French healthcare system is experiencing various problems, such as the affordability of medical services and staffing shortages in remote regions. The Government of France shall continue to invest in healthcare and address the challenges to ensure universal access to quality medical services, including through its higher education system. US medical education keeps pace with the challenges healthcare systems are facing in the 21st century. To address today’s challenges, US medical education is taking a more interdisciplinary and inclusive approach, focusing on public health, interdisciplinary teamwork, and community-based training. Chinese medical universities pay more attention to practical skills and to integrating various disciplines in training, which allows graduates to be the best medical experts able to solve complex practical problems. Conclusions. Global trends identified herein in the development of higher medical education in the USA, Great Britain, France, and China require reflection, while the best practices should be introduced into the Russian system of higher education. However, approaches to be implemented should be first adapted to the historical, cultural, social, geographical, political, and other realities of Russia.

Bronchial asthma is a serious public health issue. It is important to reduce the frequency of attacks for BA patients. Vaccination for pneumococcal infection is an important complementary tool that can improve the clinical pattern of bronchial asthma. The study involved 102 patients with bronchial asthma, who were monitored over 4 years. The patients were divided into 4 groups based on the vaccination scheme used for pneumococcal infection: PCV13, PPV23, PPV23/PCV13, PCV13/PPV23. Sequential vaccination with pneumococcal conjugate and polysaccharide vaccines leads to a decrease in the isolation of pneumococcus from sputum in BA patients, which has a pronounced positive effect on the clinical pattern of this disease, namely, it leads to a decrease in the frequency of attacks, the requirement for courses of antibacterial chemotherapy and hospitalizations, and therefore this vaccination protocol should be included in the standards of BA patient management.

The study aims at evaluating the accuracy of the Anthonisen triad as a criterion for severity of chronic obstructive pulmonary disease during exacerbation. Clinical and endoscopic comparisons were made in 1969 patients (100%) with chronic obstructive pulmonary disease of III-IV degree of severity according to GOLD (2019), group D, severe exacerbation. Shortness of breath was observed in all 1969 patients (100%); and 8 patients with increasing dyspnea as the sole symptom were not enrolled in the study since they had other causes of dyspnea. 75,87% of patients demonstrated reduced amount of produced sputum, and in 26.6% of patients the sputum was non-purulent. However, bronchoscopy revealed increased amount of bronchial secretions containing purulent material in all patients. Adherence to formal criteria of the Anthonisen triad for clinical diagnosis of exacerbation of severe chronic obstructive pulmonary disease may contribute to the occurrence of diagnostic errors.

The objective: development of the best vaccination regimen against pneumococcal infection in patients with chronic obstructive pulmonary disease (COPD) with consideration of changes in microbiological and clinical parameters.Subjects and Methods. 115 patients with COPD were randomized into 4 pneumococcal vaccination groups, they were examined and followed up for 4 years; 112 patients completed the study complying with the protocol. Detail medical history of all subjects was collected. To verify the diagnosis of COPD, all subjects underwent external respiratory function test and bronchodilator test (salbutamol, 400 μg) according to the standard method. The classic microbiological assessment was used in this study. The clinical effectiveness of vaccination was assessed. Statistical processing of the results was performed using StatPlus Pro 6.2.0.0 software (license number 2883).Results. Сonsecutive vaccination with pneumococcal conjugate and polysaccharide vaccines leads to decreased isolation rate of pneuniococcus from the sputum of CODP patients. The frequency of exacerbations, the need for antibiotic chemotherapy and hospitalizations also goes down.

Aim objective. The study aimed at determining the facility for bronchoscopic examination and management of HIV-infected patients.Materials and methods. Results of a total of 1393 bronchoscopic procedures carried out in HIV-infected patients (100%) hospitalized in the pulmonology departments with different pulmonologic disorders. The HIV-infection was a comorbidity at that.Results. In terms of study process organization two patient flows have been discerned. The first flow included patients with asymptomatic infection/carrier state (138 bronchoscopic procedures [9,91%] for 104 patients), for whom bronchoscopy was performed due to general indications. The second flow comprised patients with a full-scale clinical picture of the disease (1255 bronchoscopic procedures [90,09%] for 1099 patients). The second flow was divided into two groups, namely, patients with earlier diagnosed HIV-infection (group IIА amounting to 523 bronchoscopic procedures [37,54%] for 473 patients) and patients newly diagnosed with HIV infection (group IIВ; 732 bronchoscopic procedures [52,55%] for 626 patients). Common to both groups was the absence of urgent indications for bronchoscopy, although the elective indications were different between the groups. In all instances the endobronchial symptoms were either non-specific or reflected mucosal lesions in the large bronchi related to lung tumor or tuberculosis.

Aim. The study aimed at investigating the relationship between severe exacerbations of chronic obstructive pulmonary disease and hemorrhagic component of endobronchial inflammation. Materials and methods. Clinico-endoscopic characteristics of 118 patients presenting with severe infectious exacerbation of chronic obstructive pulmonary disease, bloody expectorations and endoscopically confirmed hemorrhagic component of endobronchial inflammation have been analyzed. All patients underwent a series (5-6) of bronchoscopic examinations accompanied by collection of bronchoalveolar lavage specimens to reveal the presence of acid-resistant mycobacteria and to determine the bacterial flora. The exclusion criteria were the concomitant pulmonary or extrapulmonary pathologic conditions which could lead to hemorrhagic endobronchial manifestations. The other direction of the study was to investigate a correlation between jugulation of the exacerbation and dynamics of such endobronchial symptoms as mucosal edema and hyperemia, quality of bronchial secretions and hemorrhagic component of endobronchial inflammation. Results. All patients were found to have diffuse endobronchitis of severity grade II (39.83%) or III (60.17%) by Lemoine. The neoplastic and tuberculosis genesis of the hemorrhagic component of endobronchial inflammation and its clinical equivalent, the bloody expectorations, had been ruled out. In 50.85% of cases the hemorrhagic component of endobronchial inflammation could not be accounted for by hemolytic properties of cultured microorganisms. The mucosal edema and hyperemia remained stable during jugulation of the exacerbation. Unlike the improvement of quality of bronchial secretions, faster reversal of the hemorrhagic component of endobronchial inflammation showed statistical significance. Conclusion. The hemorrhagic component of endobronchial inflammation can represent a non-obligatory manifestation of severe exacerbation of chronic obstructive pulmonary disease, and its relief is the earliest endobronchial sign of incipient remission from severe COPD exacerbation.

The aim of this study was to assess long-term effects of pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugate vaccine (PCV13) in patients with bronchial asthma. Methods. One hundred and three patients with mild to severe asthma were involved. They were randomly assigned to vaccination with PCV13, or PPV23, or PPV23 followed by PCV13, or vice versa. Clinical efficacy of vaccination was evaluated using number of asthma exacerbation a year before and 1 and 4 years after the vaccination; need in antibiotics a year before and 1 and 4 years after the vaccination; and number of hospitalizations due to asthma exacerbation a year before and 1 and 4 years after the vaccination. Results. In a year after vaccination, number of patients who had not experienced asthma exacerbation increased significantly in PPV23, PPV23/PCV13, and PCV13/PPV23 groups (р < 0.01 to p < 0.001). In 4 years after vaccination, number of patients without exacerbations increased significantly in PCV13/PPV23 group only (48.1%; р < 0.01). Number of patients who did not require hospitalization due to asthma exacerbation increased significantly in PCV13 group only (81.8%; р < 0.05). Conclusion. The authors proposed a hypothesis of impact of pneumococcal vaccines on immunopathogenesis of bronchial asthma. The authors consider vaccination against pneumococcus using PCV13 followed by PPV23 should be a part of the basic therapy of asthma.

The studies of the serotype composition of pneumococci in various countries indicate that over 80% of the most severe invasive diseases are caused by 20 serotypes, and 13 serotypes cause 70–75% of diseases globally [3]. The vaccination of the population is the main way to reduce the incidence of both invasive and non-invasive pneumococcal infections. With evidence of the safety and efficacy of pneumococcal conjugate vaccines, WHO and UNCF consider it necessary to include these vaccines for children in the national immunization programs around the world.

Aim: to study the level of antibodies to strains of the influenza virus in trivalent vaccine, in pregnant women vaccinated in different trimester of the gestation. Materials and methods: according to CPMP criteria the level of postvaccinal antibodies to the strain of influenza A and B virus was determined by the hemagglutination inhibition reaction in sera of 48 women vaccinated in the second and third trimester of gestation. Results: in 1 month after vaccination against influenza in pregnant women the level of the seroprotection, seroconversion and the factor of the seroconversion increased in accordance with CPMP requirements. In six months after the birth, the protective titer of antibodies to different strains was registered in 30,4–70,2% of women wich was vaccinated in second trimester and 52,4–66,7% in the third trimester of gestation. Conclusion: the level of the postvaccination antibodies to influenza virus (except for the strain A / H3N2 / in vaccinated in the second trimester) in pregnant women met the criteria for CPMP irrespective of the trimester of gestation.