Some patients with severe community-acquired pneumonia develop fatal complications in the form of acute respiratory distress syndrome and/or septic shock despite the timely adequate antibacterial therapy and presumably due to an excessive uncontrolled systemic inflammatory response and inadequate adrenal response to infection due to the critical illness-related corticosteroid insufficiency (CRICI). Therefore, the additional use of systemic corticosteroids can significantly improve the survival of patients with severe community-acquired pneumonia.Aim. To present the most current preclinical and clinical studies and meta-analyses assessing the effectiveness and safety of the use of systemic corticosteroids for communityacquired pneumonia.The results of these studies demonstrate that the most optimal regimen for the use of systemic corticosteroids in terms of risk and benefit is early (the first 3 days), low-dose (the dose equivalent of 6 mg/day dexamethasone) short-course (5 – 7 days) therapy with immediate withdrawal of the drugs. This regimen produces the best effect in patients with severe community-acquired pneumonia who require ventilation (invasive or non-invasive) with PEEP ≥ 5 cm H2O or high-flow oxygen therapy with FiO2 ≥ 50% and a PaO2/FiO2 ratio less than 300 and/or vasopressor support.Conclusion. Currently, the federal clinical guidelines do not recommend the routine use of corticosteroids in adult patients with community-acquired pneumonia, with the exception of patients with refractory septic shock. However, this narrative review presents evidence supporting the use of adjunctive corticosteroid therapy in adult patients with severe community-acquired pneumonia, particularly when complicated by septic shock, acute respiratory distress syndrome, comorbid asthma and/or chronic obstructive pulmonary disease, provided there is no pulmonary suppuration, severe influenza or mycotic infection. Undoubtedly, this is a compelling argument in favor of revising existing domestic clinical guidelines regarding the use of systemic corticosteroids. Thus, further research is needed to identify subgroups of patients who may benefit from or potentially be harmed by corticosteroids. In addition, it is necessary to determine the optimal regimen for the use of corticosteroids in terms of specific drugs, their dose, routes of administration, frequency and duration of therapy, as well as the withdrawal.

Pneumonia is the most common and deadly nosology among all respiratory diseases associated with microorganisms. Despite advances in antibacterial and antiviral therapy, mortality due to pneumonia is not decreasing. It should be noted that the problem of infectious pathology has always been discussed only in narrow circles of specialists, which led to its underestimation, including during the pandemic of a new coronavirus infection. At present, scientific possibilities have not reached their perfection in the etiological diagnosis of pneumonia. Of no small concern is the lack of sections on immunology in the training program for general practitioners and pulmonologists and, as a result, the lack of knowledge by most medical specialists of the basics of the immune response in various infectious diseases, in particular, the differences in the immune response of a macroorganism in viral and bacterial infections, the stages of the immune response, differences between innate and adaptive immune responses, possibilities of immunocorrective therapy. Being followers of the scientific school of pulmonology of academician N.S. Molchanov, in this review, we evaluated the features of etiological factors and immune characteristics of the body on the course and out-comes of pneumonia, taking into account modern scientific knowledge. The current definition of pneumonia is formulated, the issues of the etiology of pneumonia from the perspective of the lung microbiome, the features of the immune response of the macroorganism in viral and bacterial pneumonia, the inconsistency of immune protection and the impact of comorbidity on this are covered in detail. Understanding the processes that lead to the disruption of the respiratory microbiome, the multiplication of pathobionts, the attachment of multiresistant microorganisms and the reactivity of the macroorganism will contribute to the development of new therapeutic approaches in the treatment of pneumonia.

Pulmonary surfactant is an important structure of the lungs, providing basic vital functions: reducing alveolar surface tension and facilitating breathing, preventing collapse of the airways and ensuring their patency, protection against infections and pathological environmental factors. Although disturbances of surfactant homeostasis are usually considered in the context of respiratory distress syndrome in preterm infants, it has been established that many lung diseases in adults are accompanied by significant disturbances of surfactant homeostasis. However, preclinical and clinical studies of bronchopulmonary pathology too often overlook the potential role of changes in the qualitative or quantitative composition of pulmonary surfactant in the pathogenesis and development of disease symptoms. In many lung diseases, whether these disturbances in homeostasis are cause or effect remains contravertial field. This review will examine current data on the composition, main functions of pulmonary surfactant and the role of its dysfunction in the pathogenesis of the most frequently encountered bronchopulmonary diseases in the practice of pulmonologists, therapists and rehabilitation specialists, in particular, such as acute respiratory distress syndrome in adults, including associated with a new coronavirus infection, pneumonia of various etiologies and their consequences, bronchial asthma, chronic obstructive pulmonary disease. The review presents the current best practices of replacement therapy with exogenous surfactant preparations and the prospects for pharmacological modulation of surfactant homeostasis disorders in the above nosological forms.

Introduction . Part of the reconvalescents after new coronavirus infection (NCI), have residual respiratory structural and functional abnormalities. Aim . To evaluate the efficacy and safety of low-dose systemic glucocorticoids (SSG) in patients with respiratory symptoms and residual “fibrosis-like” changes in lung tissue after a moderately severe NCI with up to 50% lesion volume. Materials and methods . Reconvalescents with moderate NKI who had respiratory symptoms and residual fibrosis-like changes in lung tissue at the time of discharge were randomly divided into two groups: those receiving systemic glucocorticoids (n = 15) and those not (n = 27). Complaint assessment, 6-minute walk test (6-MHT), spirometry, and high-resolution computed tomography (HRT) were performed at baseline, 2, and 9 months later. The primary endpoint of the study was complete disappearance of pathological changes in the lungs according to CTVR. Secondary endpoints of the study were: disappearance of respiratory complaints, increase in the distance traveled in 6-MCG test, regression of functional ventilatory disturbances according to spirometry data. Results and discussion . In both groups by the 9th month of the study there was a significant positive dynamics: respiratory symptoms regressed, tolerance to physical activity improved, residual changes of lung tissue according to CTBPR decreased and in most cases completely disappeared. However, respiratory symptoms and residual changes in lung tissue remained in 9% of cases. Significant improvement of ventilatory lung function and exercise tolerance by the 9th month of follow-up was established in the systemic glucocorticoids group, with no adverse events detected. Conclusions . In the acute phase of moderate NKI, both spontaneous resolution of respiratory symptoms and residual lung tissue changes and their effective and safe resolution due to the use of systemic glucocorticoids can be assumed.

Introduction. Morbidity and mortality of COVID-19 actualizes the identification of groups with the greatest risk of primary and re-infection, persons in need of priority vaccination or revaccination.Objective. To study the factors affecting the content of IgG antibodies to the S-protein SARS-CoV-2 in convalescents after suffering COVID-19 for 6 months.Materials and methods. The study of the Military Medical Academy and the Helix Laboratory Service was carried out from 06/01/2020 to 08/01/2021 on the basis of the Military Medical Academy and the Helix centers. The study included 1421 people – both sexes from 18 to 70 years old. 1205 with asymptomatic and mild disease (outpatient group). 216 with moderate or severe form (inpatient group). The outpatient group underwent a quantitative determination of IgG to the spike (S) protein SARS-CoV-2 by immunochemiluminescence analysis at 30, 45, 60, 90, 180 days from diagnosis. The diagnosis was verified by a positive RT-PCR result. The inpatient group underwent an identical study on the 1st, 14th, 45th, 60th, 90th and 180th days from the moment of admission to the hospital. The diagnosis was verified in the same way.Results. In convalescents, post-infectious immunity is formed from 30 days. Older age was associated with a more pronounced production of IgG to the S-protein SARS-CoV-2, mainly in older women. Moderate and severe course is characterized by higher concentrations of IgG to the SARS-CoV-2 S protein. A high level of IgG to the S-protein SARS-CoV-2 persists for up to 90 days, with a subsequent decrease by 180 days. Body weight, days of oxygen therapy, hyperthermia, the volume of lung tissue lesions and the level of C-reactive protein correlate with the concentration of IgG to the S-protein SARS-CoV-2. The use of glucocorticoids (GCS) is characterized by the presence of a higher concentration of IgG to the S-protein SARS-CoV-2 up to 6 months. There is a dose-dependent effect of using GCS.Conclusion. The formation and maintenance of the level of neutralizing antibodies for 6 months depends on the severity of the disease, the gender and age of the patients, and the fact of using GCS. This must be taken into account when carrying out therapeutic and preventive measures, planning vaccination.

Hantavirus nephropathy (CVI) is considered to be acute kidney injury (AKI) associated with hantavirus infection (CVI). This infection in the countries of the European and Asian continents causes hemorrhagic fever with renal syndrome (HFRS). However, up to 60% of kidney damage is manifested by pathological changes in urinary sediment without signs of AKI, in connection with which the problems of terminology and diagnosis of kidney damage in HFRS were discussed. A review of the world literature of recent years, devoted to the study of modern data on the pathogenesis of CVI, is presented. The data were revealed that explain the organ specificity of the pathological process in different variants of CVI. The data were revealed that explain the organ specificity of the pathological process in different variants of CVI. The mechanisms related to various aspects of the pathogenesis of hantavirus nephropathy are considered. The factors that alter the functional activity of target cells through the direct action of the virus and the factors mediated by the immune response of the biological host to viral proteins in the form of the action of cytokines ("cytokine storm") causing damage to target organs (indirect factors) are listed. The influence of the hantavirus serotype, genetic factors, and the nature of the immune response of the biological host organism on the severity of renal dysfunction was shown. The concept of "acute damage to podocytes" is disclosed, which explains massive protein uria at the onset of the disease. The molecular and cellular mechanisms of damage to the main compartments of the kidney during hantavirus infection are presented. Disorders of hemostasis and mechanisms of hypercoagulation were demonstrated that underlie glomerular AKI due to acute microvascular syndrome, which is realized in the form of disseminated intravascular coagulation (DIC), hemolytic uremic syndrome (HUS), and thrombotic microangiopathy (TMA). The results of experimental data obtained on a laboratory model of infection and in cell culture, histological studies of autopsy material, and nephrobiopsy specimens from patients with hantavirus nephropathy are demonstrated.

The relevance of pneumonia remains at the forefront and has recently attracted the attention of not only the entire medical community, but also all political and economic institutions of most countries of the planet. This nosology continues to be in the center of attention, identifying one of the key causes in the frequency of mortality of the population. The presented article accumulates the most up-to-date theses regarding viral pneumonia on the basis of a review of a large number of scientific literature, domestic and foreign studies. Although the term “viral pneumonia” has been used in medical practice for more than a century, nevertheless, there is no final diagnostic algorithm and an established final concept. The article reflects special historical medical and philosophical aspects in the study of pneumonia from the time of Hippocrates to the present. The epidemiological features, etiology, and also the terminological base of viral pneumonia are updated, thereby the concept of viral pneumonia in medical categories is fixed. A promising classification of viral pneumonia according to ICD-XI is presented. Attention is drawn to the autopsy morphological characteristics of the bronchopulmonary organ complex in viral pneumonia, post-mortem descriptions are given with links to authoritative research sources. The main modern diagnostic capabilities of the scientific medical community in the detection of pneumonia are described, the issues of the formation of new diagnostic algorithms are reflected. The clinical picture of viral pneumonia is described in detail, the clinical concept of the phase course of the disease based on pathomorphological data is presented for the first time. The main modern groups of drugs for etiotropic and pathogenetic treatment of the disease are considered. The conclusion reflects the main problematic postulates and prospects for further study of the disease.

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19.Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease.Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: the main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators.Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group.Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease.

The lack of effective etiotropic methods of treatment and prevention of the new coronavirus infection (COVID-19), which caused the pandemic in 2020, determines the relevance of the review of researches of medicines for etiotropic and pathogenetic therapy. Most patients are diagnosed with pneumonia, the disease is especially difficult in people with concomitant chronic diseases, since COVID-19 leads to their decompensation, which can lead to death. To assess risk factors for mortality, scientists are developing programs to transfer the patient to appropriate treatment in a timely manner. This article analyzes the clinical efficacy of various agents for etiotropic and pathogenetic treatment of a new coronavirus infection based on data from international researches. Etiotropic medicines used at the beginning of the pandemic did not show their effectiveness in reducing the duration of treatment, the development of death, and preventing the transition to the use of mechanical ventilation. There are described researches of vaccines against a new coronavirus infection, developed in the Russian Federation, the USA, Germany and the UK, which showed the greatest efficiency (more than 90%) in preventing COVID-19. The World Health Organization initiated the international clinical research SOLIDARITY, according to which all medicines participating in the trials have little or no effect on overall mortality, the onset of ventilation requirements and the length of hospital stay in hospitalized patients. Now, only systemic glucocorticosteroids have proven effective against severe and critical forms of COVID-19. Thus, effective etiotropic drugs for the treatment of COVID-19 have not been developing, however, an active search for these funds and the development of vaccines to prevent the incidence of coronavirus infection are underway.

The data of the literature and our own research of clinical and epidemiological features of hantavirus infection the North-West region of Russia, showing the loss of endemicity of hemorrhagic fever with renal syndrome. It is noted mostly airborne infection in young and middle-aged men, year-round nature of the disease with seasonal peaks. The clinical picture is moderately prevalent the disease with no or minimal systemic manifestation of hemorrhagic syndrome, often marked by thrombocytopenia, moderate dysfunction and kidney damage in half the time without reducing urine output. The introduction of acute kidney damage concept allows significantly improve the diagnostic efficiency and stratification of renal dvsfunction severity in Datients with hantavirus infection.