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Background.In the absence of a vaccine against SARS-CoV-2, seasonal influenza vaccination during the pandemic contributed to lowered COVID-19 susceptibility and severity. The study was aimed to assess the state of post-influenza vaccination immunity, pneumonia frequency and severity in medical workers after using various flu vaccination regimens, between the 1st and 2nd peaks of COVID-19 epidemic rise.Materials and methods.Comparatively analyzed data on the levels of antibodies against influenza virus strains and pneumonia incidence in 487 medical workers was carried out: 1st group — unvaccinated in 2020–2021 (n = 281), 2nd group — vaccinated against influenza (Sovigripp), (n = 98), 3rd group — received combined vaccination against influenza and pneumococcus (Prevenar 13), (n = 108).Results.6 months after vaccination, the highest rates of influenza virus were detected in the A(H3N2), the level of seroprotection (≥ 1:40) ranged from 49.0% in unvaccinated (1st group) to 53.4–53.2% in those who received combined vaccination (group III), as well as influenza alone (2nd group), p 0.05; for strain A(H1N1) the level of seroprotection in 1st group is 24.5%, lower (p 0.04) than in 2nd group — 32.7%, but does not differ from the levels of 40.4% in group III; for strain B the level of seroprotection is the lowest ranging from 19.4% in the group of unvaccinated subjects up to 22.4% in 2nd group and 23.4% in 3rd group. The pneumonia incidence in 1st group (3.9%), 2nd group (3.1%), 3rd group (4.6%) did not differ, however, among all vaccinated subjects severity of pneumonia clinical course was mild, whereas in unvaccinated employees, except for mild course (45.4%, 5 out of 11 people) pneumonia in 36.4% (4 out of 11 people) cases was assessed as moderate and in 18.2% (2 out of 11 people) cases — severe with fatal outcomes.Conclusion.The study showed that 6 months after seasonal influenza immunization between the 1st and 2nd peaks of COVID-19 epidemic rise, the immunogenicity of the vaccine meets the CPMP criterion for the A(H3N2) strain. In vaccinated patients, the proportion of pneumonia with COVID-19 clinical picture was mild in 100% of cases, and in unvaccinated patients in 36.4% of cases — of moderate severity and in 18.2% — severe with fatal outcome.

Aim: to demonstrate the need for a detailed differential diagnosis and selection of therapy in a patient with decompensated liver cirrhosis of combined etiology (HCV infection and primary sclerosing cholangitis). Key points. The patient came to the clinic with complaints of shortness of breath with minimal physical activity, abdominal enlargement, swelling of the legs, yellowness of the skin, and severe weakness. The complaints arose two months after suffering from left-sided focal pneumonia. Laboratory tests revealed signs of systemic inflammation, liver failure, and acute kidney injury. According to the results of instrumental studies, massive hydrothorax was noted in the right pleural cavity. The patient underwent a series of thoracentesis, and a total of about four liters of non-inflammatory pleural fluid was evacuated. Differential diagnosis was based on the presence of dyspnea and respiratory failure. The patient received effective antiviral therapy with drugs using an interferon-free regimen. Subsequently, conservative therapy was carried out, against the background of which the symptoms regressed and the patient’s condition improved. Conclusions. Hepatopleural syndrome is a serious complication in patients with decompensated liver cirrhosis, although it does not always appear secondary to massive ascites. To resolve hepatic hydrothorax, it is necessary to carry out diuretic therapy, replacement transfusion therapy with albumin preparations, and if there is a large amount of fluid in the pleural cavities, therapeutic and diagnostic thoracentesis is recommended.

RELEVANCE. Among the deadly complications of severe poisoning, pneumonia occupies a leading position, and therefore the search for new solutions aimed at prevention and treatment of this complication is relevant. AIM OF THE STUDY. To study the role of intestinal translocation in the pathogenesis of pneumonia in acute poisoning and to evaluate the contribution of intestinal lavage to its prevention and resolution. MATERIAL AND METHODS. Here at the N.V. Sklifosovsky Research Institute for Emergency Medicine, we analyzed the outcomes of treatment of 1124 patients with severe oral poisoning: by psycho-pharmacological drugs (PPD) — 172 and corrosive substances (CS) — 325 people; with intravenous administration of methadone (M) — 575, as well as 50 patients with alcoholic delirium (AlD) as a complication of PPD and CS poisoning. In cases of PPD and M poisoning, the patients’ Glasgow Coma Scale (GCS) scores ranged from 3 to 5, with respiratory disorders requiring mechanical ventilation. The severity of CS poisoning was due to the 2nd-3rd degree chemical burn of the mucous membrane of the mouth, pharynx, esophagus and stomach. The condition of patients with AlD was severe and corresponded to 29.0 (27.0; 30.0) points on the DELIRIUM RATING SCALE – R – 98. In cases of PPD and CS poisoning, the state of the intestinal microbiocenosis, the permeability of the intestinal barrier, the endotoxin content of gram-negative bacteria in the blood and integral indicators of intoxication were studied. Intestinal lavage (IL) was used in the observed groups (655). Patients in the comparison groups (469) received standard therapy. RESULTS. Initially detected: intestinal dysbiosis of II–III degree, increased permeability of the intestinal barrier — 3.8–4.9 times higher than normal, a tenfold increase in the content of endotoxin in the blood and a 6-fold increase in the leukocyte index of intoxication. It was established that intestinal lavage effectively cleanses the entire gastrointestinal tract, eliminates intestinal dysbiosis, reduces excessive permeability of the intestinal wall, and is accompanied by a 2-fold decrease in the endotoxin content in the blood and the leukocyte index of intoxication. As a result, pneumonia was registered in cases of PPD poisoning 2.1; M —1.9; CS — 2.4, and AlD — 9.8 times less often than in the comparison groups. Mortality among the patients with PPD poisoning decreased by 7 times, and with M and CS poisoning, as well as with AlD, there were no deaths, while in the respective comparison groups, the mortality rate for pneumonia was 5.1, 7.4, and 17.4 %, respectively. The differences were statistically significant. CONCLUSION. A pattern in the form of intestinal dysbiosis, excessive permeability of the intestinal barrier, and increased levels of endotoxin in the blood may indicate that the source of the infectious-inflammatory process in the lungs during acute poisoning is the intestine; and the cause-and-effect relationship between the sanitation of the gastrointestinal tract by intestinal lavage and a reduction in the incidence of pneumonia and mortality confirms this hypothesis.

The aim of the research is to determine the clinical-pathogenetic and prognostic value of nitrotyrosine levels in the blood serum of patients with COVID-19 with pneumonia in the development of oxygen dependence and the risk of fatal outcome. Materials and methods. 123 patients with COVID-19 with pneumonia were examined, who were examined and treated according to the Order of the Ministry of Health of Ukraine dated March 28, 2020 No. 722. Patients were divided into groups: I group – 32 patients with a moderate course without oxygen dependence; II group – 91 patients with a severe course with the presence of oxygen dependence. Patients in the II group were additionally divided into subgroups: II-A subgroup – 45 patients who recovered; II-B subgroup – 46 patients who died. The content of nitrotyrosine (Hycult Biotech, the Netherlands) was determined in the blood serum by the immunoenzymatic method. Statistical data processing was carried out in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. The content of nitrotyrosine in the blood serum of patients with COVID-19 with pneumonia in a severe course with the development of oxygen dependence is higher (p < 0.001) than in patients with a moderate course of the disease without signs of oxygen dependence. The level of its increase has an inverse correlation with the oxygen saturation index (r = -0.53, р < 0.05). When hospitalized for 9.0 [7.0; 12.0] day of the disease, under the condition of nitrotyrosine level >481.97 nmol/ml (AUC = 0.909, p < 0.001), the probability of developing oxygen dependence is significant. And under the conditions of nitrotyrosine level >521.96 nmol/ml during this observation period, the probability of a fatal outcome of the disease is significant (AUC = 0.842, p < 0.001). The established correlations confirm the clinical-pathogenetic role of nitrotyrosative stress in the development of the “cytokine storm” and multiorgan failure. The content of nitrotyrosine correlates with the level of C-reactive protein (r = +0.25, p < 0.05), the ratio of absolute neutrophil count to absolute lymphocyte count (r = +0.26, p < 0.05), alanine aminotransferase activity (r = +0.26, p < 0.05) and glomerular filtration rate (r = -0.27, p < 0.05). The diagnostic value of determining the level of nitrotyrosine in predicting the course of COVID-19 with pneumonia against the background of treatment after 7 days lies in the possibility of predicting the probability of a fatal outcome of the disease. Namely, the preservation of the level of nitrotyrosine >507.98 nmol/ml (AUC = 0.681, p < 0.001) during the specified period of observation indicates a high probability of a fatal outcome of the disease. Conclusions. In patients with COVID-19 with pneumonia, the level of nitrotyrosine elevation in the blood serum depends on the appearance of oxygen dependence and the outcome of the disease. The highest level of nitrotyrosine is in patients with COVID-19 with pneumonia with a severe course, and the degree of increase of this indicator has diagnostic value in predicting the probability of an unfavorable disease course.

The aim of this study was to investigate changes in the ultrastructure of lung tissue during the chronic course of pneumonia and the development of respiratory failure against this background. Materials and methods. Research was conducted on 16 male Wistar rats weighing 250-270 g, in which experimental pneumonia (EP) was attributed to aspiration and/or partial post-traumatic pneumonia. The 1st group of rats consisted of control animals (n=6), the 2nd group consisted of experimental animals with experimental pneumonia on the 4-5th day of the development of the disease (n=5), and the 3rd group consisted of experimental animals 6 weeks after EP modeling (n=5). The breathing and gas exchange patterns were recorded using an original automated device consisting of a mass spectrometer MH6202 (Ukraine) and a pneumotachograph with a breathing sensor MPX5050 (Freescale, Netherlands). Structural features of the lungs during pneumonia were studied using electron microscopy. In addition, studies of the ultrastructure of lung tissue were conducted in 2 groups of people: patients with chronic pneumonia and respiratory failure, operated on for medical reasons (n=5) (duration of pneumonia – 6 to 8 weeks) and deceased with a diagnosis of restrictive respiratory failure (n=6) (duration of pneumonia – from 1 to 1.5 years). Results. It has been shown that in experimental pneumonia, there are significant changes in the ultrastructure of lung tissue, resulting in damage to the air–blood barrier, the surfactant system, and the mitochondrial apparatus. Similar changes were observed in patients diagnosed with pneumonia. In both cases, respiratory failure developed against the background of interstitial and/or intra-alveolar pulmonary edema. Conclusions. The chronicity of this process is accompanied by the formation of pneumosclerosis of various degrees of severity with the preservation of changes in breathing patterns, gas exchange, and metabolic processes in lung tissue and pulmonary edema.

To date more than 774 million people worldwide were infected with the SARS-CoV-2 virus (data for February 2024), and approximately 7 million people have already died from COVID-19. Since the beginning of the COVID-19 pandemic, there have been many reports and studies on damage involvement of the SARS-CoV-2 virus not only the respiratory but cardiovascular system as well, including myocardial damage, endothelial dysfunction, acute coronary syndromes, arrhythmias, myocarditis, thromboembolism, heart failure, hypotension, cardiogenic shock and even cardiac arrest. In addition, symptomatic COVID-19 infection with a severe course is more common in comorbid patients with a history of hypertension, diabetes, obesity, cancer or chronic obstructive pulmonary disease. According to the latest literature data, the occurrence of myocarditis associated with a new coronavirus infection is more often observed in young males and is associated with a severe or even fatal prognosis, which determines the relevance of a detailed study of the pathogenetic mechanisms and therapeutic possibilities for myocardial damage prophylaxis, relieving the main disease symptoms and unfavorable prognosis prevention. To date, there are also studies indicating that acute myocarditis could be a complication not only of the infection itself, but even one of the severe post-vaccination against SARS-CoV-2complications. The purpose of this study is to research the lethal clinical case of acute infectious myocarditis complicated the course of a new coronavirus infection. A retrospective analysis of the patient’s medical history with the final diagnosis: acute coronaviral myocarditis against the background of non-compact left ventricle myocardium was carried out.

The aim of the study is to determine the diagnostic significance of immunological parameters in predicting the development of pneumonia in adult patients with measles. Material and methods. The study examined 88 patients aged 21 to 55 years diagnosed with measles according to the World Health Organization’s criteria (2013). Enzyme-linked immunosorbent assay (ELISA) was used to determine IgG levels to the measles virus (Vircell Microbiologists, Spain) and the levels of interferon-γ (IFN-γ) (Invitrogen, Austria). Statistical analysis was conducted using Statistica 13 for Windows (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. According to the results of the study, it was found that upon hospitalization on the 4.8 ± 0.2 day of the disease, 71.6 % of patients were seropositive for IgG to measles virus. The development of measles pneumonia was associated with the lowest level of IgG to measles virus (p < 0.01). When the level of IgG to measles virus at hospitalization of adult patients was ≤20.26 optical units, the probability of developing measles pneumonia was significant (AUC = 0.650, p = 0.016). In adult patients with measles, the serum IFN-γ level at the height of the disease was higher (p < 0.05) than in healthy individuals. Upon hospitalization on the 4.8 ± 0.2 day of the disease, the level of IFN-γ in the setting of pneumonia was the highest (p < 0.05), exceeding the corresponding parameter in patients without complications. The level of IFN-γ at hospitalization >1.90 pg/ml was diagnostic for predicting the likelihood of pneumonia (AUC = 0.643, p = 0.038). The authors present their clinical observation, which demonstrates the informative value of using the established immunological parameters in clinical practice to predict the likelihood of pneumonia in adult patients with measles. Conclusions. The diagnostic significance of such immunological parameters as IgG to measles virus and IFN-γ in predicting the development of pneumonia in adult patients with measles at the time of hospitalization has been proved. Our clinical observation demonstrates the informativeness of the established prognostic markers.

Pulmonary sequestration (PS) is a rare congenital malformation of the lungs referring to an abnormal (non-functioning) segment of the lung that has no connection with the tracheobronchial tree, which receives arterial blood from systemic circulation and has various types of venous outflow. PS is divided into intralobar (intrapulmonary) and extralobar (extrapulmonary) types. The distinctive feature of extralobar pulmonary sequestration is the presence of its own visceral pleura. PS is most common in pediatric practice; in some cases, this disease may remain oligosymptomatic or asymptomatic in children and adolescents. Adults with PS have a higher risk of recurrent pneumonia, chest pain, and episodes of hemoptysis. Cases of the late onset of PS are reported in a few foreign and Russian publications. The special feature was the elderly patients with a long asymptomatic course of PS, "pseudopneumonic" clinical onset, episodes of thoracalgia and hemoptysis. We present a case of an adult male soldier with PS clinically simulated a respiratory infection in the lower lobe of the left lung with severe pain and hemoptysis. In addition, the patient has a concomitant congenital heart defect.

The article presents the pathographic data of the famous doctor and scientist William Osler. The possible causes of his last illness, the features of the course, diagnostic approaches, and the methods of treatment used in medicine in the early twentieth century are discussed. Ironically, William Osler was a victim of a disease he studied almost all his life, becoming the author of one of his famous aphorisms: "Pneumonia is a friend of old people".

Despite significant progress in the field of prevention, early diagnosis and antibacterial therapy, community-acquired pneumonia still retains the status of not only the most common among acute infectious diseases, but is also a frequent source of sepsis, which greatly increases the likelihood of death in this group of patients. The purpose of the study was to perform a comparative analysis of clinical and laboratory parameters and assess the nature of their changes in the first 48 hours from the moment of verification of sepsis that developed against the background of pneumonia in patients of the therapeutic department, depending on the outcome of hospitalization.Clinical groups and research methods. A retrospective comparative study was carried out, which included, using a continuous sampling method, patients with sepsis that developed against the background of pneumonia in patients hospitalized in therapeutic clinics of the Federal State Budgetary Educational Institution of Higher Education Siberian State Medical University of the Ministry of Health of Russia in the period from 01/01/2019 to 04/30/2023. In total, the study included 40 patients of both gender, followed by division into two comparison groups depending on the outcome of hospitalization (discharge from hospital or death) for the dynamic assessment of clinical, anamnestic and laboratory parameters in the early stages of the development of a septic condition (the first 48 hours) in order to determine their relationship with the outcome of hospitalization.Results. All patients were divided into 2 groups. The first group (n=17, 42.5 %) consisted of patients with a favorable outcome of hospitalization (recovery), the second group (n=23, 57.5 %) consisted of patients with a fatal outcome. At the time of verification of sepsis, patients with a favorable outcome had a significantly lower SOFA score (3 (2; 6) points) than patients with a fatal outcome (6 (5; 7) points), p = 0.037. The change in urea concentration in the first 48 hours from the moment of verification of sepsis, which in the group of survivors was -1.3 (-4.4; 1.99) mmol/l, and in the group of deceased 5.5 (-1.5; 12. 2) mmol/l, p=0.020. In the group of deceased patients, 8 people (34 %) at the time of verification of sepsis had a combination of hypotension (5 mmol/l. In the survivor group, hypotension was observed in only 2 people (11 %), and lactate levels in these patients were in the range of 4.5- 4.6 mmol/l. At point 1, the indicators of immature granulocytes were not statistically significantly different between surviving and deceased patients (1.2 (0.7; 2.1)% vs 0.8 (0.6; 1.5)%, respectively, p>0. 05). After 48 hours, the level of immature granulocytes increased in surviving patients to 1.5 (1; 3.2)% and, conversely, decreased to 0.65 (0.45; 1.45)% in the group of deceased patients, and the difference in these indicators between groups became statistically significant, p

BACKGROUND: The COVID-19 pandemic has also affected rheumatic diseases. A clinical case of the development of Waterhouse–Friderichsen syndrome after SARS-CoV-2 infection in a patient with secondary AA adrenal amyloidosis is presented. CLINICAL CASE DESCRIPTION: Patient G., 57 years old, was hospitalized for several hours on May 20, 2023 at the Cheboksary Regional Hospital with the following diagnosis: “Severe viral interstitial pneumonia. Secondary AA adrenal amyloidosis. Acute adrenal insufficiency”. She was admitted with complaints of a febrile temperature up to 38.2°C. Computed tomography of the chest organs showed signs of bilateral viral interstitial pneumonia (the percentage of lung damage was 74%). The diagnosis of COVID-19 was based on a positive polymerase chain reaction test performed on nasopharyngeal swabs. The blood pressure was 80/40 mm Hg, D-dimer 786 ng/ml (with the normal values of not higher than 243 ng/ml). Despite the treatment, the patient died. An autopsy revealed dystelectasis, hyaline membranes, intraalveolar edema in the lungs, and the deposition of amyloid masses, foci of necrosis of the cortical layer and hemorrhage in the adrenal glands. Signs of disseminated intravascular coagulation syndrome were found. CONCLUSION: The peculiarity of the case is the development of Waterhouse–Frideriksen syndrome without signs of sepsis.

Background. In many countries, there is an increase in the number of poisoning with antihypertensive and antiarrhythmic drugs taken either accidentally or for suicidal purposes. The mortality rate for these poisonings reaches 6.5%.The aim of the study was to analyze the causes of fatal outcomes in patients with acute poisoning with hypotensive and antiarrhythmic drugs.Material and methods. The inpatient medical records (Form No. 003/y), autopsy reports of forensic chemical and forensic histological studies of 80 people who died from acute poisoning with hypotensive and antiarrhythmic drugs at the N.V. Sklifosovsky Research Institute for Emergency Medicine for the period from 2011 to 2020 were analyzed.Results. The age of patients with acute poisoning with antihypertensive and antiarrhythmic drugs ranged from 16 to 94 years, of which 85% of patients were over 60 years old. Women made up 70%. Twenty five patients died in the toxicogenic stage of poisoning, other 55 died in the somatogenic stage. The causes of poisoning were the intake of hypotensive drugs (mainly calcium channel blockers) in 67% of cases, the intake of antiarrhythmic drugs from the group of beta-blockers in 33%. Poisoning on suicidal intent was recorded in 81.2% of cases. The main causes of death in the toxicogenic stage of poisoning were the following (listed in order of decreasing incidence): exotoxic shock, primary cardiotoxic effect, acute cardiovascular insufficiency. The main cause of patient death in the somatogenic stage was pneumonia.Conclusion. Acute poisoning with antihypertensive and antiarrhythmic drugs, in the vast majority of cases, occurs in patients over 60 years of age. Suicidal attempts make the main cause of poisoning. The main cause of death in the toxicogenic stage of poisoning is exotoxic shock, that one in the somatogenic stage is nosocomial pneumonia.

Background. Community-acquired pneumonia (CAP) remains one of the most common diseases requiring urgent hospitalization, with a significant part of patients already receiving antibiotics before admission to the hospital. Aim. To assess the relationship between outpatient antibacterial therapy and in-hospital mortality and the severity of the CAP. Materials and methods. The retrospective study included the data of adult patients with CAP who were hospitalized in Tomsk from January 1 to December 31, 2017. Results. Among 1412 patients, 22.2% received antibiotics before admission to the hospital, the proportion of deaths in this group was significantly lower – 3.8% compared with 10.6% among patients without antibiotic therapy (p0.001). Subjects who received antibiotics on outpatient basis were less likely to require being in the intensive care unit and administering vasopressors, in contrast to patients without prior antibiotic therapy: 5.1 and 10.6% (p=0.003); 7.1 and 4.7% (p=0.018) respectively. In patients with severe CAP on a scale IDSA/ATS, only 11.8% of cases were detected with antibiotics before hospitalization, while in mild CAP the frequency of administration was 16.6% (p0.001). Conclusion. Ambulatory antibacterial therapy had a positive effect on the subsequent course and outcomes of CAP in a hospital setting. Patients had a predominantly mild course of the disease, needing for vasopressors, and being in the intensive care unit, but was not consistent with the need for invasive mechanical ventilation.

Competent triage of patients with COVID-19 pneumonia is not only about efficient allocation of hospital resources, but also about making timely decisions that can ultimately save the patient's life. When healthcare facility is overloaded, computed tomography to assess the severity of COVID-19-associated pneumonia in each individual case is not always possible. Alternative solutions, however, are opted.The aim of the study was to develop Lung UltraSound (LUS) protocols with high diagnostic potential for assessing the severity of pneumonia caused by COVID-19, which can be reliably used instead of CT during triage in an emergency setting.Materials and methods. We conducted a retrospective analysis of data on 161 hospitalized patients with confirmed pneumonia caused by COVID-19, subjected to both CT and LUS within 24 hours after hospitalization. Three consecutive LUS protocols, including two LUS developed by the NMHC (National Medical Surgical Center) authors, were tested to choose the most reliable protocol for assessing the severity of lung damage in pneumonia caused by COVID-19 (based on correlation with chest CT results). We also checked the applicability of LUS for the prognosis of the disease.Results. Moderate (50% CT) and severe (50% CT) lung damage can be distinguished when using both - the 16-zone and 12-zone LUS NMHC scanning protocols. The AUC for the ROC curves was almost identical: 0.83 (95% CI: 0.75–0.90 and 0.81 (95% CI: 0.73–0.88) for the 16-zone and 12-zone LUS NMHC protocols, respectively. The 16-zone LUS NMHC had an optimal threshold of 20 scores with a sensitivity of 67% and a specificity of 82%, while the 12-zone LUS NMHC provided an optimal threshold of 15 scores with the same sensitivity but lower specificity — only 73%. Neither the 16-zone nor the 12-zone NMHC LUS protocols could predict the outcome.Conclusion. The newly developed 16- and 12-zone LUS NMHC scanning protocols for patients with pneumonia caused by COVID-19 proved to be easy to implement, demonstrating a strong correlation with CT results. The 16-zone LUS NMHC protocol is probably more relevant for triage of patients with more than 50% of pulmonary tissue involvement based on CT data. Both protocols can be useful in emergency settings and in medical institutions with limited or no access to CT.

Mycoplasma pneumoniae is a common etiologic agent of respiratory tract infections and communityacquired pneumonia (CAP) in children and adults. Recently, much new data on this pathogen, its molecular biology, cytoadherence and epidemiology have been accumulated. This review describes in detail the features of the microorganism and the pathogenesis of the diseases caused, clinical manifestations, provides data on the epidemiology of the incidence of respiratory mycoplasmosis and CAP caused by this microorganism in the world, discusses the issues of asymptomatic carriage, considers the problems of laboratory diagnosis, antibiotic therapy and antibiotic resistance of the pathogen.

Introduction. Bacterial coinfection and secondary bacterial infection are considered critical risk factors for the severity and mortality of SARS-CoV-2-caused pneumonia. The aim of the study was to analyze a pattern of microbial associations between K. pneumoniae and A. baumannii isolated from the lower respiratory tract discharge and sectional material (lung tissue) of patients diagnosed with pneumonia, and to compare resistance level in monoculture and associations during new coronavirus infection pandemic. Materials and methods. A bacteriological study of 2689 sputum and bronchial washing samples from patients at infectious diseases hospitals, and 1411 lung pathological material samples was carried out. Bacterial isolates were identified by mass spectrometry. Antibiotic sensitivity for isolates was determined by the disk diffusion method. Genetic determinants of resistance to beta-lactam antibiotics were detected by PCR. Statistical data processing was performed using SPSS version 22 software. Results. K. pneumoniae and A. baumannii isolates were predominantly found in two- and three-pathogen associations. It was established that the resistance level of K. pneumoniae isolates in association with A. baumannii is significantly higher compared to that in monoculture for all antimicrobial drugs studied. At the same time, K. pneumoniae in combination with Candida spp. vs monoculture showed significantly lower level of resistance to ciprofloxacin, amikacin, cefotaxime, ceftazidime and amoxicillin/clavulanic acid. K. pneumoniae isolates carried resistance determinants to extended-spectrum beta-lactamases: OXA-48 — (22.5%), OXA-51 — (5.6%), OXA-23 — (4.2%), KPC — 70.9%, NDM — 7%. Of these, 14.1% of strains had the ability to co-produce serine carbapenemases OXA-48 and KPC. Sputum and lung tissue A. baumannii isolates exhibited extremely high multiple resistance regardless of their associations with other microorganisms. Microbiome species similarity in the lower respiratory tract and lung tissue discharge was revealed. The proportion of lung tissue vs sputum resistant strains of K. pneumoniae and A. baumannii was significantly higher. Conclusion. The detection of of multiple drug resistant K. pneumoniae and A. baumannii isolates as well as their associations may indicate aggravated pneumonia severity.

Aim. To identify predictors of cardiovascular events (CVEs) in patients with heart failure (HF) and P. aeruginosa pneumonia.Material and methods. The study included 92 patients with HF with mildly reduced or reduced ejection fraction and nosocomial pneumonia. Based on sputum or bronchoalveolar lavage microbiological examination, patients were divided into 2 following groups: group I — 51 patients with HF and P. aeruginosa pneumonia, group II — 41 patients with HF and pneumonia caused by other pathogens (Staphylococcus aureus, Streptococcus pneumoniae). During the hospital stay, the following morbidities were assessed: cardiovascular death, acute coronary syndrome, non-fatal cerebrovascular accident, pulmonary embolism, lower extremity venous thrombosis.Results. CVEs were significantly more often observed in patients with HF and P. aeruginosa pneumonia — 30 (58,8%) than in patients with HF and pneumonia caused by S. aureus or S. pneumoniae — 5 (12,1%). Complete blood count in group I patients revealed a decrease in hemoglobin level to 114 [95; 133] g/l, when compared with patients in group II — 139 [118; 150] g/l (p11×109/l (RR 2,412; 95% CI 1,399-4,158; p=0,048), CRP >133 mg/l (RR 3,115; 95% CI 1,611-6,025; p

Aim. To assess the contribution of Pseudomonas aeruginosa pneumonia to the development of cardiovascular events in patients with heart failure (HF).Material and methods. The study included 219 patients who were divided into a group of patients with pneumonia caused by P. aeruginosa (Group I) and a group of patients with pneumonia caused by S. aureus, S. pneumoniae (Group II). All patients underwent chest computed tomography (CT), blood tests, echocardiography, electrocardiography (ECG), 24-hour Holter ECG monitoring, pulse oximetry (SpO2), and Doppler ultrasound of the lower limb veins.Results. According to the study, cardiovascular events were more often observed in the group of patients with P. aeruginosa pneumonia as follows: death from cardiovascular events was registered in 11,4% of patients in group I and 0% of patients in group II (p=0,001); acute coronary syndrome — in 8,7 vs 0% (p=0,002), lower limb thrombosis — in 14 vs 1,9% (p=0,001). The occurrence of P. aeruginosa pneumonia in patients with HF increased the cardiovascular death risk by 8,8 times (95% confidence interval (CI): 1,2-65,7; p=0,005), acute coronary syndrome — in 8,0 times (95% CI: 1,1-60,2; p=0,014), lower limb thrombosis — in 9,6 times (95% CI: 1,3-71,2; p=0,004).Conclusion. Patients with HF and P. aeruginosa pneumonia are at greater risk of cardiovascular events than patients with pneumonia caused by S. pneumonia and S. aureus.

INTRODUCTION. Lung ultrasound has been widely used to diagnose bacterial pneumonia, pulmonary congestion in heart failure, pneumo- and hydrothorax, and other pathological conditions. With the onset of the COVID-19 pandemic, the need for various methods of lung imaging has dramatically increased. AIM. To estimate the value of lung ultrasound in the diagnosis and severity assessment of COVID-19. MATERIAL AND METHODS. Patients with a positive PCR test result for SARS-Cov-2 were included and divided into a moderate, severe, or critical severe group. There were 30 patients involved. All the patients underwent clinical assessment, complete blood count, biochemical blood profile, pulse oxymetry, bedside lung ultrasound, and chest CT scan. To evaluate LUS findings thorax into 16 lung regions and each of these areas was quantitatively scored and summed up in total LUS score. A total severity score for chest CT was compared with the total LUS score. RESULT AND DISCUSSION. All patients had positive LUS findings, as well as positive CT findings. Most common lung ultrasound findings were the following: subpleural consolidations (100.0%, 30/30), large consolidations (73.3%, 22/30) and an irregular pleural line (43.3%, 13/30). A higher total lung ultrasound score was seen in patients with a more severe course of illness and a larger number of lung areas affected; they were older and had a significantly higher incidence of comorbidities and lower SpO2. Spearman correlation coefficient revealed a statistically significant correlation between CT chest scan and lung ultrasound – rs=.52, p= 0.003011. CONCLUSION. During the COVID-19 pandemic, lung ultrasound is a great tool for assessing lung tissue in patients with varying severity of the disease. The advantages of the method are accessibility, ease of implementation and the absence of radiation exposure.

Pneumonia is clearly differentiated from other focal inflammatory lung diseases of non-infectious origin. A patient with community-acquired pneumonia (CAP) should receive antibacterial drugs no later than 4 hours after the diagnosis. Initial antibacterial therapy in CAP should be based on factors affecting the potential causative agents and the risk of drug-resistant microorganisms. Rational use of amoxicillin in terms of dose and frequency in CAP patients without severe comorbidities and risk factors for PES pathogens, the use of -lactam in combination with a macrolide or moxifloxacin monotherapy in high-risk groups of patients is the most effective strategy of empirical antibacterial therapy.

In contrast to trivial bacterial pneumonia, the diagnosis of septic pulmonary embolism poses a fundamental task for the doctor to search for primary sources of emboli, including right side infective endocarditis, and to change the tactics of managing the patient accordingly. The similarity of the main clinical common and respiratory symptoms of septic pulmonary embolism with symptoms of other inflammatory processes in the lung makes their differential diagnosis difficult without the involvement of additional radiologic investigation methods. The review describes the special features of etiology and pathogenesis, as well as the clinic, complications and principles of diagnosis of septic embolic pneumonia.

We present a clinical observation of a patient whose cause of death was a new coronavirus infection COVID-19 complicated by bilateral viral interstitial pneumonia and adult acute respiratory distress syndrome. The presence of background diseases-rheumatoid arthritis and secondary AA-adrenal amyloidosis-worsened the prognosis. Waterhouse-Friderichsen syndrome with hemorrhage and foci of necrosis in the adrenal cortex developed against a background of SARS-CoV-2 infection. The unique feature of this case is the long-term favorable course of the disease and its rapid progression after infection with SARS-CoV-2. The associated syndrome of disseminated intravascular coagulation further aggravated the patient's condition.

Background. A novel coronavirus infection in newborns seems to be an unexplored problem, which encourages pediatric specialists to conduct in-depth research in this direction. The aim of the study is the impact of COVID status of mothers on the condition of newborns. Material and methods. A retrospective analysis of 554 newborn histories (form 097/y) born from January 2021 to May 2022 was carried out in the Maternity Hospital in Krasnodar: 226 children from SARS-CoV-2 positive women at the time of delivery (group 1), 165 children from women who had SARS-CoV-2 during pregnancy (group 2) and 165 children from women who did not have SARS-CoV-2 in history during pregnancy (control group). Results. 42% of newborns from group 1 had positive results of the PCR (polymerase chain reaction) study, of which 36% had pneumonia. The frequency of preterm birth was: 29% in the group 1, 21% in the group 2, 13% in the control group. The gestational age 32–34 weeks was more common in group 1. Children from the group 1 had a more severe condition when assessed on the APGAR scale both at the first and fifth minutes. Congenital pneumonia was more common among patients of the groups 1 and 2 relative to the control, children from the group 1 more often needed respiratory support compared with the group 2 and control group. Conclusions: The SARS-CoV-2 virus was verified in 42% of children born to mothers with a positive PCR at the time of birth, while every third disease was accompanied by the development of pneumonia. Coronavirus infection, regardless of the mother’s COVID status, is a risk factor for preterm birth, congenital pneumonia, and asphyxia. COVID-positive maternal and neonatal status is associated with an increased need for respiratory support.

Background. During the three years of the new coronavirus infection (NCI) pandemic, young women of low infectious risk made a certain contribution to the severe maternal morbidity and mortality from COVID-19. Aim. To establish risk factors for morbidity and give a clinical assessment of COVID-19 during epidemic outbreaks in 2020, 2021, and 2022 in low-risk pregnant women. Materials and methods. The study included three groups of pregnant women with clinically manifested and laboratory-confirmed SARS-CoV-2 infection: 163 pregnant women who became ill in the first wave of the epidemic in October-December 2020, 158 in the second and third epidemic wave in July and October 2021, and 160 in the fourth epidemic wave in JanuaryFebruary 2022. Each comparison group included 100 pregnant women who did not become ill during the same periods of the pandemic. Patients of all groups were in the III trimester of gestation, comparable in age (1835 years), social status, parity, and body mass index, and had no known risk factors for COVID-19. Results. Iron-deficiency anemia, tobacco smoking, and belonging to the East Asian ethnic group showed a stable association with the incidence of COVID-19 in low-risk pregnant women. In the first year of the pandemic (strains zero and Alpha), the clinical presentation of NCI was dominated by a loss of smell and/or taste (87.7%), drowsiness (68.7%), and dyspnea even with a mild degree of lung damage (68.1%). The epidemics of the second year of the COVID-19 pandemic (Delta strain) were characterized by a more severe course of the disease than in the first year: fever was more often reported above 38C (19.6% vs 7.4%; p2=0.006), pneumonia confirmed by computed tomography (61.4% vs 21.4%; p20.001), severe lung damage (CT-3: 11.4% vs 4.9%; p2=0.040; CT-4: 0 vs 6.3%; p20.05), intensive care unit admission (11.4% vs 6.4%; p2=0.041); there were cases of invasive mechanical ventilation (1.89% vs 0; p2=0.118) and deaths (0.63% vs 0; p2=0.492). In the epidemic of the third year of the pandemic (Omicron strain), the COVID-19 clinical presentation was similar to seasonal acute respiratory viral infection: the predominant symptoms included runny nose (66.7%) and cough (54.4%); pneumonia was rare (3.8%). Conclusion. Iron deficiency anemia, tobacco smoking, and belonging to the East Asian ethnic group are confounders of COVID-19 disease in pregnant women without known infectious risk factors. Unlike the epidemics of the first and third year of the pandemic with dominant zero, Alpha, and Omicron strains, epidemic outbreaks of the second year of COVID-19 caused by the Delta strain were characterized by the most severe disease course, a high rate of pneumonia and deaths even in low-risk patients.

This article is presented in form of a current literature review on bacterial complications of the early post-liver transplantation period and promising areas for studying the effect of bacterial flora in patients after liver transplantation. The paper describes the problem of the emergence, spread, and pathogenesis of various bacterial complications, as well as current concepts of various bacterial complication’s impact on the results of liver transplantation. The results of ventilatorassociated pneumonia in patients after liver transplantation are given. A theoretical analysis of bacterial complications from the standpoint of microbiota effects on the biliary tree was carried out. The review also highlights a relatively new conceptual approach in examining the results of scientific research using the "Machine Learning Method”. The so-called CDC “Big Four” was chosen as the main infectious nomenclature in this article. However, catheter-associated bacterial complications, which pathogenesis has been sufficiently studied to date, have been replaced by a relatively new group of complications – bacteriobilia. This review also contains a brief statistical data collected in the frames of the NCT04281797 study. Own cohort data consisted of 57 patients who underwent orthotopic liver transplantation from a post-mortem donor. Surgical site infection was the most common bacterial complication of the early postoperative period. The most common causative agent of bacterial infection was Klebsiella pneumonia and Enterococcus.

Objective. To assess the cystatin C (CysC) prognostic value for probability of death in patients with severe and extremely severe pneumonia associated with COVID-19.Material and methods. A single-center prospective study included 72 patients with severe and extremely severe pneumonia associated with COVID-19 undergoing treatment in the ICU of multifunctional medical center from September 2020 to October 2021. Recovered survivors (N=55) were analyzed as a Group 1, nonsurvivors (N=17) were considered as a Group 2.Results. The serum (s-CysC) and urine (u-CysC) CysC concentrations were significantly lower in Group 1 patients vs Group 2, averaging 1.31 mg/l vs 1.695 mg/l (P=0.013550), and 0.25 mg/l vs 0.94 mg/l (P=0.026308), respectively. Significant differences were also revealed in the subgroups differed by age (P=0.0094), platelet count (P=0.001), serum fibrinogen concentration (P=0.016), as well as CURB (P=0.02334), CRB-65 (P=0.032564), and SOFA (P=0.042042) scores. Therefore, s-CysC and u-CysC were statistically significant predictors of death in patients with pneumonia associated with severe and extremely severe COVID-19: 16.273 (95% CI: 2.503–105,814), P=0.003 and 1.281 (95% CI: 1.011–1.622), P=0.040, respectively. Urine and serum CysC were established as predictors of death in pneumonia associated with severe and extremely severe COVID-19, where u-CysC was defined as highly informative (ROC AUC 0.938 (95% CI: 0.867–1.000; P=0.000), with 90% sensitivity and specificity), and s-CysC — as informative (ROC AUC 0.863 (95%CI: 0.738–0.988; P=0.000) with 80% sensitivity and 72% specificity) predictive markers.Conclusion. Levels of S-CysC and u-CysC are of high prognostic significance and may contribute to identifying patients at a high risk of unfavorable outcome (death) due to pneumonia associated with severe and extremely severe COVID-19. Both S-CysC and u-CysC concentrations increasing up to 1.44 mg/l and 0.86 mg/l, respectively, were associated with high probability of death.

Over the past ten years, the small ruminant population in the Russian Federation grew sharply, especially goat population in backyards and on small-scale farms. Alongside with the population growth, clinical signs of some sporadic diseases or diseases that had not been previously registered were detected in animals. Caprine arthritis-encephalitis (CAE) is one of such diseases. It is a chronic infectious disease caused by a small ruminant lentivirus (SRLV) of the Retroviridae family, which includes four genotypes, of which genotypes A (maedi-visna – MVV virus) and B (caprine arthritis-encephalitis virus – CAEV) are of epizootic significance. The disease is characterized by long asymptomatic viral transmission and is associated with progressive lesions in the respiratory organs, joints and udder. The disease also affects nervous system in kid goats aged between 2 and 3 months. Clinical signs of caprine arthritis-encephalitis are not pathognomonic; therefore, it is often misdiagnosed, thus, resulting in a barrier to effective treatment. Given the fact, the issue of antemortem and postmortem diagnosis of caprine arthritis-encephalitis is still urgent, because most veterinary specialists have never encountered this disease and the data available in the literature often do not fully cover all clinical details and pathomorphological features. Therefore, the purpose of the work is to study CAE clinical signs and pathomorphological changes. The article describes in detail clinical manifestation of this disease, postmortem lesions in organs and tissues of the sick animals. The results obtained suggest that the destructive changes in the exposed organs are irreversible and, consequently, there is no effective treatment.

An experiment was conducted in the conditions of an industrial complex specializing in the intensive fattening of young cattle, to study the development patterns of respiratory and gastrointestinal pathologies in calves with a history of previous proventriculus dysfunction. The object of the research were calves aged 120 days, which were divided into three groups: control, and two experimental groups - with a difference in using or the absence of phytosorbent. The diet included cereal hay and compound feed (CP 21.5%) according to the norms and regimen of feeding, for animals of this age. It appeared that for calves shortening of the adaptation period to the consumption of a large amount of compound feed had a negative impact on the rumen contractile function and the processes of digestion in it with the formation of a complex of symptoms of frothy tympany and rumen acidosis. After a course of appropriate treatment, the specific symptoms of these pathologies of the rumen disappeared, but the imbalance between the depression of symbiotic and activation of abdominal digestion remained, with the formation of a constant pre-threshold level of local autointoxication. The transfer of animals to the technological diet activated the processes of rumen metabolism and increased biochemical imbalance, which caused the progression of the endogenous intoxication syndrome and vegetative dystonia with a corresponding increase in the risk of developing respiratory and gastrointestinal pathologies. The use of a combined native premix based on the enterosorbent Rigatirin against the background of residual pathological phenomena after proventriculus dysfunctions reduced the level of toxic substances in the rumen, which excluded the generalization of autointoxication with an increase in the functional load on the digestive organs. As a result, the mechanism of pathogenetic integration (predisposition) formation in the body was leveled with a corresponding decrease in the incidence of the lungs, rumen and intestines. As a result, the mechanism of pathogenetic integration (predisposition) formation in the body was leveled, which caused a 6.7-fold decrease in the level of morbidity in animals and a 22.9 % increase in their growth.

Introduction and Purpose: Pneumonia's severity demands a thorough assessment, guided by CRB-65 and CURB-65 scales. This article underscores the crucial role of accurate interpretation and effective use of these scales, emphasizing the need for a comprehensive understanding of pneumonia for proficient severity assessment. Material and Method: The article identifies populations disproportionately affected by pneumonia, stressing the necessity of standardized severity assessment due to diverse clinical manifestations. It highlights the importance of accurate diagnosis through the integration of clinical evaluation, imaging, and laboratory tests. While CRB-65 and CURB-65 offer a systematic approach, potential pitfalls are discussed, emphasizing the risk of misinterpretation. Results: Principles for correct interpretation are outlined, emphasizing holistic evaluation, timely application, and clinical acumen. Common mistakes, including overreliance on scores and incomplete data collection, are identified. The discussion introduces advanced diagnostic techniques like biomarkers and imaging, enhancing severity assessment. Cardiac biomarkers and computed tomography contribute to refined evaluation, aligning with recommendations from renowned organizations. Conclusion: The integration of traditional tools with advanced diagnostics signifies a paradigm shift in pneumonia assessment. Emphasizing correct interpretation and avoiding common mistakes ensures a comprehensive approach. Recent research supports advanced diagnostic techniques, aligning with recommendations. The article advocates for continuous education and collaboration among healthcare professionals, contributing to improved patient outcomes and overall healthcare efficacy.

Relevance. Elderly people have become the fastest growing segment of the global population over the past few decades. The number of people over the working age in Russia, and with them citizens living in closed long-term care facilities (CLTFS), is growing. Residents of these organizations belong to the risk group, and CLTFS have a number of characteristics that turn these institutions into a unique environment for the spread of infectious diseases.Aims. To analyze the CLTFS residents infectious morbidity in the "pre-covid stage" (according to literature sources). A scientific review of research in Russian and English using information portals and platforms has been carried out eLIBRARY. ru , Web of Science, PubMed, Google Academy and Scopus for the period 1981-2022. The search was carried out by keywords. Information about the most frequent infectious diseases affecting residents of closed long-term care institutions was the criterion for inclusion in the sample of publications. Out of 16171 initially identified articles, 61 publications were selected after initial analysis.Conclusions. According to various estimates, the leading infectious diseases in CLTFS were: acute respiratory infections, pneumonia, urinary tract infections, skin and mucous infections, acute intestinal infections. The article describes pathogens and their prevalence in CLTFS including pathogens with multiple drug resistance (MDR), describes the resistance of bacteria to antimicrobial drugs formation problem in these organizations, as well as development of certain diseases risk factors. Studies conducted in various CLTFS in Europe, Russia, the USA, and Asia indicate a high prevalence of infectious diseases among their residents, high colonization of residents with antimicrobial-resistant pathogens, as well as the infection transmission probability from the CLTFS and its spread to other long-term care institutions and medical and preventive organizations.

Introduction. Pulmonary complications are common in children with acute lymphoblastic leukemia (ALL). The assessment of phospholipids (PL) in the exhaled breath condensate can provide more information about pathological processes in the lungs in children with ALL. Purpose - to assess the level of PL in the exhaled breath condensate (EBC) in children with ALL and its prognostic value. Materials and methods. 40 children with ALL aged 6-17 years were examined. 1st group included newly diagnosed children with ALL (n=18). 2nd group involved ALL survivors, who had completed the total course of chemotherapy (n=22). The control (С) group consisted of 15 healthy children. The levels of PL in the EBC were investigated by spectrophotometric thin-layer chromatography using an SPh 46 spectrophotometer. Results. The frequency of pulmonary complication was 82.5% during chemotherapy protocols and 18.4% in ALL survivals. The statistically significant increase in the level of phospholipids in 1st (150.75 (137.62; 158.45) mmol/l) and 2nd (130.12 (120.59; 138.34) mmol/l) ALL groups compared with the group C (54.80 (48.30; 60.80) mmol/l) has been detected (p1-C=0.0000; p2-C=0.0000). Children of the 1st group had significantly higher levels of PL in the EBC than children of the 2nd group (p1-2=0.002911). PL level in EBC collected during induction phase of chemotherapy >132.15 mmol/l can be prognostic for the development of acute pulmonary complications (Sensitivity 93.75%; Specificity 100%). PL level in EBC collected after a complete course of chemotherapy >133.28 mmol/l can be predictive for persistent pulmonary complications (Sensitivity 100.00%; Specificity 83.33%). Conclusions. PL level in EBC can be prognostic for the development of pulmonary complications, both during chemotherapy and in long-term remission after completed chemotherapy course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Objective. To evaluate a potential of cystatin C blood concentration to predict acute kidney injury (AKI) in patients with severe and extremely severe pneumonia associated with a COVID-19.Materials and methods. An observational prospective study of 117 patients with severe and extremely severe pneumonia associated with a COVID-19 in an ICU setting was conducted in 2020-2022 (site: multi-functional Medical Center, 1586 Military Clinical Hospital of the Ministry of Defense of Russia, Moscow Region, Russia). Routine laboratory tests and instrumental examinations were performed according to generally accepted protocols. Cystatin C concentrations in blood (s-CysC) and urine (u-CysC) were measured by immunoturbidimetric method.Results. AKI was diagnosed in 21 (17.9%) patients, kidney dysfunction without AKI was found in 22 (18.8%) patients with severe and extremely severe pneumonia associated with COVID-19. s-CysC and u-CysC levels in the group of patients with AKI were statistically significantly higher compared to the levels in the group of patients without AKI. The levels of s-CysC obtained within Day 1 — T (-1), and Day 2 — T (-2) prior to AKI onset turned out to be the independent factors for AKI development in patients with severe and extremely severe pneumonia associated with COVID-19: OR 5.37, Wald chisquare 5.534 (CI: 1.324; 21.788); P=0.019 and OR 3.225, Wald chi-square 4.121 (CI: 1.041; 9.989); P=0.042, respectively. s-CysC T (-2) value is informative, and s- CysC T (-1) is a highly informative predictor of AKI development in severe and extremely severe pneumonia associated with COVID-19: ROC AUC 0.853 (95% CI, 0.74-0.966), P

In modern rheumatology, comorbid infections have a significant impact on morbidity and mortality, especially in immuno-inflammatory rheumatic diseases (IIRD). One of the ways to solve this problem is the study and active use of various vaccines. This article analyzes the recommendations for vaccination of patients with acute respiratory infections, proposed in 2022 by experts of the American College of Rheumatology (ACR). The safety and immunogenicity of vaccination associated with the prevention of various infections in patients with IVR are discussed. It is emphasized that the decision to suspend taking the drug before or after vaccination should be made taking into account the existing IIRD, its activity and the risk of vaccine-controlled infection. A key component of any vaccination strategy (especially for conditional recommendations) is decision-making together with the patient. The main directions of future research on the problem under consideration are outlined.

Extensive spread of the coronavirus disease (COVID-19) prompted an investigation of its diagnostic features. Acute viral pneumonia associated with COVID-19 has been described in detail using CT, radiography, and MRI. There is no data in the literature on the descriptive picture observed with dynamic MRI. Considering a comprehensive diagnostic approach, radiologists should know how to correctly recognize and interpret COVID-19 on MRI. This case series demonstrated the ability of dynamic MRI to detect the cloudy sky sign and distinguish it from consolidation in COVID-19 patients, thus presumably distinguishing between early or mild changes and a progressive clinical course. These changes in dynamic lung images on MRI can be recorded depending on the phase of the respiratory cycle. Thus, MRI, as a radiation-free tool that can be used to examine a patient with acute viral pneumonia COVID-19, can be useful in cases where access to computed tomography is limited and dynamic morphofunctional imaging is required.

Aim of the study was to analyze the course of coronavirus pneumonia in patients with pneumomediastinum. Material and methods. The study included 139 patients, 71 of whom developed spontaneous pneumomediastinum against the background of coronavirus pneumonia. Laboratory, clinical and radiological data were analyzed and compared. Results. The relationship between the severity of viral pneumonia (3rd–4th degree of severity according to MSCT) and pneumomediastinum was revealed. It was found that spontaneous mediastinal emphysema in patients with COVID-19 signifcantly more often leads to the development of acute respiratory distress syndrome, multiple organ failure and can be a predictor of negative prognosis of the disease outcome. Conclusions. Pneumomediastinum in patients with viral pneumonia caused by a new coronavirus infection is a predictor of severe disease and poor prognosis. With an increase in spontaneous mediastinal emphysema without pneumothorax, it is recommended to perform mediastinotomy according to Razumovsky’s indications, and in case of clinically signifcant concomitant pneumothorax – drainage and revision of the mediastinum.

The aim of the study. To identify the frequency of occurrence of TLR4 Asp299Gly (rs4986790) gene polymorphism and to establish its contribution to the development of organ dysfunction in patients with severe pneumonia associated with A/H1N1 influenza.Materials and methods. The study included 55 patients with severe pneumonia associated with A/H1N1 influenza. Inclusion criteria: severe pneumonia; consolidation/ground-glass syndrome according to chest X-ray/CT. Exclusion criteria: unstable hemodynamics; body mass index > 30; diabetes mellitus; HIV; tuberculosis, oncopathology. Verification of the pathogen in the respiratory swab was carried out using PCR method: A/H1N1 influenza virus RNA was identified. The age of the patients was 47 [38; 62] years. Among all the patients the proportion of men was 47.8 %, of women – 52.2 %. Patients were divided into 2 groups: group 1 included patients with SOFA scale (Sequential Organ Failure Assessment) score ≥ 2 points; group 2 – patients with SOFA scale score ˂ 2 points. Gene SNPs were determined by PCR method using standard kits developed by Research and Production Company “Litekh” (Moscow). Amplification of the TLR4 gene fragments was carried out in a thermocycler Bis-M111 (Bis-N LLC, Novosibirsk). Genomic DNA isolated from whole blood leukocytes using the “DNA Express Blood” reagent was analyzed followed by an amplification reaction. The amplification product was detected in a 3% agarose gel.Results. Multiple organ dysfunction (SOFA scale score ≥ 2 points) in patients with severe pneumonia associated with A/H1N1 influenza was registered in 24 (43.6 %) cases. When analyzing the frequency of occurrence of the minor Gly allele, according to genetic models, the differences were established between patients of the groups 1 and 2 in codominant (p = 0.023; odds ratio (OR) – 8.82 (0.95–81.89)) and dominant (p = 0.005; OR = 12.35 (1.40–109.07)) models.Conclusion. Severe pneumonia associated with A/H1N1 influenza is accompanied by a high incidence of organ dysfunction. The risk of organ failure development is 2.1 times increased in patients with severe pneumonia with identified TLR4 Asp299Gly gene polymorphism, which probably requires further study.

BACKGROUND: Pulmonary sequestration is one of the most common malformations of the lungs in clinical practice. However, difficulties are possible in the interpretation of the radiological data, which leads to a violation of the examination technique in such patients and, accordingly, to the lack of success of the therapy and proper routing. AIM: To demonstrate the clinical case of a patient with intralobar pulmonary sequestration, describing the characteristic radiographic picture, and suggesting research methodology for the identified features of the aberrant vessel. METHODS: Clinical and radiological data of a 27-year-old patient with acute respiratory symptoms and suspected abscessed pneumonia based on X-ray and computed tomography (CT) findings were presented. Due to the absence of clinical and radiological dynamics, atypical CT semiotics of abscesses, CT angiography of the thoracic aorta was performed after intravenous contrast enhancement with 80 ml of iodine-containing preparation (350 mg/mL). RESULTS: A pulmonary tissue thickening was revealed in the lower left lobe with lumpy clear contours, which consisted of a system of cystic cavities with contents, particularly well differentiated after contrast enhancement. On the native study, an additional vascular structure following from the subdiaphragmatic space was traced paravertebrally, which was the reason for extending the CT angiography scanning area to the epigastric region of the abdomen. A large-caliber arterial vessel was detected, which departed as a branch from the celiac trunk and passed to the above-described thickening of the pulmonary tissue. The combination of these signs is typical for intrapulmonary sequestration. CONCLUSIONS: The correct interpretation of the identified changes allowed the patient to be routed to a hospital with a thoracic surgery department, since the sequestration must be removed in the vast majority of cases to prevent recurrent inflammatory episodes. Extension of the scanning area below the diaphragm may be useful, since part of the sequesters is supplied with blood from the abdominal aorta and its visceral branches. This will prevent the need for repeat CT angiography, and information about the source of the blood supply is extremely important for surgeons.

Introduction and aim. Nowadays, the increasing resistance of bacteria is a concerning and challenging issue in terms of effective treatment of bacterial infections. The amount of available antibiotics has been quite constant for many years. The search for substances alternative to older classes of drugs, among which resistance is growing, has been ongoing for years. One of the newly introduced available alternatives is lefamulin. The aim of this paper is to present the potential benefits of its use in comunity-acquired bacterial pneumonia (CABP). Material and methods. A review of the available literature was performed by searching the PubMed and GoogleScholar databases using the following key words: lefamulin; BC3781; pleuromutilin; CABP; community acquired pneumonia. Analysis of literature. Lefamulin is a bacteriostatic antibiotic from the group of pleuromutilins, which has a unique mechanism of action consisting in binding to the bacterial 50S ribosomal subunit in the peptidyl transferase center. Thanks to this, it rarely causes resistance among other groups of antibiotics and is characterized by a safe action profile. Its spectrum of action includes bacteria causing CABP. In phase III studies, the efficacy of lefamulin monotherapy was comparable to that of moxifloxacin with or without linezolid in CABP. Thanks to broad spectrum of action its usefulness may also extend to treatment of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and multidrug-resistant organisms associated with sexually transmitted infections, e.g., Neisseria gonorrhoeae, Mycoplasma genitalium, although more additional clinical and pharmacodynamic data is needed. Conclusion. Lefamulin is a promising addition to the antibiotic armamentarium for treating CABP. Its unique mechanism of action, activity against typical and atypical bacteria, flexible dosing options, and favorable safety profile make it a beneficial choice for clinicians.

Pneumonia is one of the most common infectious diseases and the leading infectious cause of death worldwide. High rates of morbidity, frequency of complications, mortality, the emergence of new highly virulent strains of pneumonia pathogens, antibiotic resistance determine the global medical and social problem of community-acquired pneumonia. The economic consequences of pneumonia are represented not only by direct medical costs (the cost of maintaining a patient in a medical institution, the cost of medical services, the cost of medicines, laboratory and instrumental studies, other medical procedures, etc.), but also include non-material costs from pneumonia, which include pain, psycho-emotional experiences of the patient due to a decrease in the quality of life during the illness. One of the directions of increasing the effectiveness of pneumonia therapy is the widespread introduction of physical therapy (PT) and electrophysical modalities (EM) into complex treatment, which are an important part of the medical rehabilitation for pneumonia, aimed at the speedy restoration of the health and working capacity of patients. The effectiveness of EM in the treatment of pneumonia is due to the versatile therapeutic effect of physical factors that have anti-inflammatory, desensitizing, bacteriostatic, broncholytic, mucolytic, immunostimulant effects, improve blood supply to the lungs. PT contributes to the normalization of pulmonary ventilation, has an expectorant effect, strengthens the respiratory muscles, accelerates the resorption of the inflammatory focus, prevents the formation of pleural adhesions, activates blood and lymph circulation. PT and EM are relevant in the comprehensive treatment of community-acquired pneumonia since they accelerate the regression of clinical symptoms, decrease the drug load, reduce the duration of inpatient treatment, that is confirmed by the results of clinical studies. We assume that the inclusion of PT and EM in the comprehensive treatment of pneumonia can lead to minimizing the total cost of the disease while reducing the duration and volume of drug treatment.

The incidence of pneumocystis pneumonia (PCP) in patients with rheumatic diseases (RD) continues to increase. This is facilitated by the increasing use of genetically engineered biological agents in addition to the use of cytostatics and glucocorticoids. Mortality due to PCP among patients with RD is extremely high, so the issues of its prevention are relevant. European and American scientists focus on the frequency of detection of PCP and the determination of the proportionality of certain risk factors, while the recommendations for prevention are formulated cautiously. Asian medical communities are unanimous in their opinion about the need to prevent PCP, only the dosage of drugs and the duration of the course of treatment are discussed.

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19.Objective: to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate.Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire.Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5±5.62 years versus 5.12±3.24 years) and had a more pronounced (III–IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake.Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.

Mycoplasmas are bacteria that are extremely unstable in vitro as they lack a rigid cell wall. They are most often detected in association with other pathogens, including those that can become L-forms if treated with antibiotics. Mycoplasma colonies, as well as colonies of L-form bacteria, have a typical «fried egg» appearance, therefore it is necessary to differentiate them for the accurate diagnosis and choice of treatment. The paper presents data on mycoplasma infection diagnosis in cattle and results of differentiation of isolated mycoplasma and L-form bacteria colonies using multiple passaging and real-time polymerase chain reaction. For that, 177 samples were collected from animals with mycoplasmosis clinical signs, 45 of them were tested using molecular genetic method, 132 samples were subjected to bacteriological testing. Mycoplasma DNA was detected in 71.1% of samples, and specific colonies were detected in 3.8% of samples. Such biochemical tests of mycoplasma species identification as arginine hydrolysis, blood serum liquefaction, film and grain formation, inoculation into Tween-80-containing medium, hemadsorption and hemolysis of erythrocytes do not allow an objective assessment of the species belonging to mycoplasmas, but, according to the results obtained, the isolated species most likely belongs to Mycoplasma dispar, which is pathogenic for cattle. Real-time polymerase chain reaction is undoubtedly the most accurate and rapid diagnostic method for mycoplasmosis, but a preliminary diagnosis can also be established bacteriologically within 2–7 days. In addition, during microbiological testing, it is possible to assess the antibiotic resistance of mycoplasma isolates, thereby developing an optimal and high-quality scheme of the disease treatment and prevention.

The COVID-19 epidemic is being revealed from a new angle every month. In particular, with the appearance of the delta strain, mucormycosis began to manifest in some patients, which had previously been extremely rare. Mucormycosis is a rare, aggressive infection caused by filamentous fungi of the Mucorales family and associated with high morbidity and mortality rates. The main risk factors for the mucormycosis in patients with COVID-19 are diabetes mellitus and diabetic ketoacidosis, uncontrolled hyperglycemia and massive use of glucocorticoids, vascular damage, thrombosis, lymphopenia, which often occur against the background of COVID-19 and make a person vulnerable to secondary or opportunistic fungal infection. We present a clinical case of mucormycosis in a 21-year-old female patient with COVID-19-associated severe pneumonia and concomitant type I diabetes mellitus. The patient was hospitalized and received standard therapy during inpatient treatment, including glucocorticosteroids in accordance with the severity of the course of COVID-19. On the 12th day from the hospitalization, the patient's condition deteriorated significantly, and the visible changes in the skin and soft tissues of the face, characteristic of mucormycosis appeared. Despite the drug therapy correction, the patient died because of the acute respiratory failure in combination with septic fungal damage of the brain stem.

The aim is to study the frequency and symptoms of post-COVID syndrome in patients with pneumonia caused by SARS-CoV-2, who were treated in an outpatient setting. Materials and methods. Personal monitoring results of the health state of 62 patients who suffered pneumonia caused by the SARS-CoV-2 and were treated in the outpatient setting between May 2020 and September 2021 were analyzed. The patients were divided into 3 clinical groups depending on age, concomitant diseases, and extent of the process in the lungs. The examination results were processed on a personal computer using the statistical package Statistica program, version 10. Results. The prevalence of post-COVID syndrome with the symptoms that characterize it is significantly higher in patients who have not been vaccinated with the COVID-19 vaccine, who have suffered pneumonia caused by SARS-CoV-2 of a moderate-to-severe course with the process extent in the lungs from 25 % to 50 %, with its repeated cases, regardless of age and the presence of concomitant pathologies. Prolonged COVID-19 (early post-COVID syndrome) and post-COVID syndrome are main complications of COVID-19 with the most common symptoms such as general fatigue, depression, impaired memory concentration, sleep disorder, myalgia/arthralgia. Conclusions. Even a mild course of pneumonia caused by SARS-CoV-2 is accompanied by post-COVID syndrome, which requires long-term supervision and practice of rehabilitation techniques for such patients. Treatment of pneumonia caused by the SARS-CoV-2 with the moderate-to-severe course in outpatient conditions leads to an increase in the frequency and severity of the post-COVID syndrome course. Vaccination with a vaccine against COVID-19 to prevent the development of a severe course of pneumonia caused by the SARS-CoV-2 remains an urgent issue. Identified dental manifestations (stomatitis, periodontitis, and periodontal disease) should be considered by dentists in the early period of post-COVID syndrome, and dental pathology examination should be continued during the treatment of pneumonia caused by SARS-CoV-2 in post-COVID syndrome.

The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. HamazakiWesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome.

Background. Production of pro-inflammatory cytokines including interleukin 6 (IL-6) is activated in COVID-19. Using olokizumab which inhibits IL-6 production in treatment of COVID-19 is pathogenetically justified.The aim. To study in real clinical practice the efficacy and safety of using the IL-6inhibitor (olokizumab) in treatment of patients with confirmed COVID-19 pneumonia.Materials and methods. The first group included 41 hospitalized patients with confirmed COVID-19 pneumonia having complex therapy including olokizumab. The control group consisted of 66 patients with confirmed COVID-19 pneumonia who did not have therapy with IL-6 inhibitor. We analyzed clinical (volume of lung involvement, respiratory failure degree, body mass index) and laboratory data (levels of T-troponin, lactate, procalcitonin, natriuretic peptide, C-reactive protein, fibrinogen, D-dimer, ferritin, erythrocyte sedimentation rate, glomerular filtration rate).Results. The groups did not differ in gender, age, body mass index of patients, volume of lung tissue injury, and duration of hospitalization (p > 0.05). Respiratory failure of 2–3rd degree was more common in patients of the first group (χ2 = 6.3; p = 0.010). The initial levels of C-reactive protein (50.9 [34.2; 76.2] and 32.2 [9.9; 69.1] mg/L respectively; p = 0.009) and fibrinogen (6.0 [5.3; 6.7] and 5.2 [4.3; 6.2] g/l respectively; p = 0.005) in patients having therapy including olokizumab were significantly higher than in the control group. The levels of erythrocyte sedimentation rate, fibrinogen and ferritin, D-dimer, detected upon admission of patients to the hospital, didn’t have statistically significant differences. At discharge, the erythrocyte sedimentation rate in patients receiving olokizumab was statistically significantly lower (9.0 [5.5; 14.5] and 13.0 [7.0; 27.0] mm/h; p = 0.018).Conclusions. Using olokizumab in the treatment patient with COVID-19 pneumonia has demonstrated a positive effect on clinical and laboratory parameters (erythrocyte sedimentation rate, fibrinogen level) in patients with pronounced inflammatory changes and respiratory impairment.

Radiological findings were evaluated in 98 patients (pts) with hematologic malignancies treated in Cancer Research Center between 1999 and 2005. We analysed radiological evidences of nonmalignant pulmonary lesions caused by bacteria and fungi at different stages of tumors.Obtained data shows specified radiological signs typical for every infective agent. The area of destruction with honeycomb changes (like sponge) inside focus or infiltration is the distinctive feature of pulmonary candidiasis. Lung cavities are the signs of pulmonary aspergillosis. The typical symptom of Pneumocystic carinii pneumonia is bilateral subpleural lung infiltrations predominantly in the middle or lower lobes looks like different size areas of “ground-glass” with noncontrast boundary and airless foci of lung tissue.

Relevance. Patients with diabetes mellitus have an increased risk of developing various infections, including those of the lower respiratory tract. Immunization with anti-pneumococcal vaccines reduces pneumonia-related hospitalizations and deaths.Aim. Evaluate the cost-effectiveness of vaccination against pneumococcal infection in 40and 65-year-old patients with type 2 diabetes mellitus (DM2).Material and methods. The analysis was carried out from the perspective of the healthcare system. The Markov model based on Russian epidemiological data, taking into account the results of foreign studies, was used. Vaccination schedules with 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 1 dose of pneumococcal 23-valent polysaccharide vaccine (PPV23) and vaccination with only 1 dose of PCV13 were evaluated. The time horizon of the study is 5 years. Costs and life expectancy were discounted by 3.5% per year.Results. Vaccination of 65-year-old patients with type 2 diabetes is characterized by extremely high cost-effectiveness (the incremental cost effectiveness ratio – ICER – for PCV13+PPV23 vaccination is 189.27 thousand rubles/QALY, and PCV13 vaccination entails a cost reduction of 371.92 rubles per 1 vaccinated). When vaccinating 40-year-old patients, the ICER for PCV13 + PPV23 vaccination is 491.31 thousand rubles/QALY, and for PCV13 – 55.31 thousand rubles/QALY.Conclusion. Vaccination against pneumococcal disease in 40and 65-year-old patients with DM2 reduces the associated morbidity and mortality and is highly cost-effective. Compared to PCV13 vaccination alone, vaccination with PCV13 followed by the introduction of PPV23 provides an increase in the number of prevented cases of the disease and the deaths caused by it, but at the same time requires additional costs.

Viral infections are the first ranked conditions among infectious diseases causing 515% of all community-acquired pneumonia. The aim of the study was to describe a case of COVID-19 infection, proceeding with acquired bacterial infection and developing abscess pneumonia in a young patient. Material and methods. The accompanying medical documentation was examined, clinical and morphological analysis was carried out for assessing macro- and micropreparations. Results. Patient A.E., 31 years old, within 5 hours 10 minutes was at in-hospital treatment with a diagnosis of Coronavirus infection, severe course. Community-acquired bilateral polysegmental pneumonia. The patient admitted with complaints of respiratory difficulty, shortness of breath, weakness, fever up to febrile level, severe pain in the right groin area, both lower extremities, swelling in hands and feet. However, despite initiated treatment, the patients condition worsened and biological death was verified. The postmortem examination revealed signs of total bilateral hemorrhagic pneumonia. Histological examination showed areas of necrosis in the alveolar epithelium and signs of marked edema with a hemorrhagic component; hemolyzed erythrocytes were found in alveolar lumen. Focal hemorrhages were visualized in the pulmonary parenchyma, sometimes merging along with lung tissue with forming microabscesses. a well-defined shaft consisting of granular leukocytes and congested vessels with erythrocyte sludge was noted on the periphery of necrosis area. In the alveoli located closer to the abscesses, fibrinous and serous exudate was detected. Signs of edema were observed in the brain; histological examination revealed perivascular, pericellular optical voids with vascular congestion, erythrocyte sludge and minor hemorrhages. SARS-CoV-2-caused pneumonia and acquired bacterial infection, in this case due to staphylococcus, led to abscess pneumonia and severe respiratory failure with developing acute distress syndrome. Obviously, the high frequency of destructive processes in staphylococcal pneumonia is due to the pathogenic staphylococci characterized by production of high-level proteolytic enzymes destroying body tissues. Thus, the current case of COVID-19 infection in a young patient is of particular importance and relevance, because it demonstrates an unfavorable disease outcome despite patient young age and lack of concomitant pathology.

Introduction. The novel coronavirus infection caused by the SARS-CoV-2 remains the main problem, which is being studied by all the efforts of the global scientific community. Large clinical recourse has been accumulated that allows to conduct more effective treatment of patients, but there are still unresolved issues on the pathogenesis for development and course of the disease. Materials and methods. The study included 163 patients admitted to the infectious diseases hospital diagnosed with Novel coronavirus infection caused by the SARS-CoV-2. Upon admission, all patient serum samples were quantified for IL-6 level that allowed to stratify patients into three groups: A 55 patients with IL-6 below 5.0 pg/ml. The mean age in the group was 57.314.9 years, body mass index (BMI) was 28.25.6 kg/m2; C 52 patients whose serum IL-6 level was in the range of 549 pg/ml. The average age in the group was 60.811.8 years, BMI 29.65.5 kg/m2; C 56 patients in whom the level of IL-6 in the blood serum ranged within 50300 pg/ml. The average age in the group was 62.515.6 years, BMI 28.85.6 kg/m2. Patients at admission were analysed for serum level of IL-6, IL-8, and C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) were also determined on day 3 and 7. Results. The minimum production of IL-6 within the range of 0.15 pg/ml, corresponds to the minimum changes in IL-8, CRP, and ferritin as well as LDH that was within the range of physiological values. Moderate cytokinemia, IL-6 is within the range of 549 pg/ml was associated with elevated ferritin and LDH not tending to decline by the end of treatment. Significant cytokinemia, the level of IL-6 within the range of 50300 pg/ml was associated with hyperferritinemia and increased LDH. The course of COVID-19 in such patients is characterized by increased ferritin by day 3 of treatment, consistently high level of LDH, without a significant trend towards a decline in the studied markers by the end of treatment. Conclusion. The risk of developing macrophage activation syndrome is not observed of the serum IL-6 level was below 5 pg/ml, whereas ferritin and LDH were within the range of physiological values, with no/degree I ARF. Moderate macrophage activation syndrome is characterized by increased serum IL-6 level within the range 549 pg/ml, a moderate increase in LDH and ferritin, as well as signs of ARF III degree. Severe signs are diagnosed in case of serum IL-6 level exceeded 50 pg/ml, along with significant increase in LDH and ferritin, as well as signs of IIIII degree ARF.