Aim. To reveal peculiarities of acute respiratory viral infections (ARVI) incidence among population of the Far Eastern Federal District depending on viral etiology during two epidemic seasons (2017-2018 and 2018-2019). Materials and methods. Method of epidemiological analysis by means of ARVI incidence with weekly epidemic thresholds as utilized. Laboratory diagnosis of respiratory viruses was carried out by applying RT-PCR method and test-kits of the Central Research Institute of Epidemiology. In order to determine relations between ARVI incidence and viral etiological structure of ARVI correlation and regression analysis was performed. Results. Identical epidemical tendencies with differences in ARVI incidence intensity were registered in the evaluated constituent entities of the Russian Far East. Utmost intensity of epidemic process was revealed in the Republic Sakha (Yakutia) and Sakhalin Oblast. In the south regions (Khabarovsk and Primorsky Krai, Amur Oblast) ARVI incidence, occasionally excessing epidemic threshold was lower. Territorial and time irregularity is peculiar for etiology of infections in the Russian Far East. During the epidemic season of 2017-2018 statistically significant prevalence was determined for the influenza virus B in Primorsky and Khabarovsk Krai, influenza virus A(H3N2) ‒ in the Sakhalin Oblast, respiratory syncytial virus ‒ in the Republic Sakha (Yakutia), rhinoviruses were dominant in the Amur Oblast. During the 2018-2019 epidemic season influenza virus A(H1N1)pdm09 was mostly prevalent in most of the constituent entities of the Russian Far East. Compared to the other regions of the Far Eastern Federal District in the Amur Oblast were revealed differences in circulation of respiratory viruses predominantly of non-influenza origin during two observed epidemic seasons. Conclusion. Constant evaluation of ARVI epidemics under the conditions of constantly changing landscape of circulating viruses in a particular region can be useful for determination of strategies and tactics of epidemiological response.

Introduction. Chronic obstructive pulmonary disease (COPD) is an actual problem of modern medicine due to the appearance of exacerbations and inevitable progression, but currently known clinical factors cannot fully explain the course of the disease.
Aim. To assess the relationship between the presence of Pneumocystis (PC) infection and the clinical characteristics of COPD, as well as the effect of correcting the activity of PC on the course of COPD.
Materials and methods. 90 patients with COPD of II, III, IV degrees of severity were examined. Against the background of standard therapy for COPD exacerbation and therapy with trimethoprim/sulfamethoxazole, laboratory and functional research methods were performed, the current of COPD was evaluated by validated questionnaires (CAT, mMRC), the titer of IgM and IgG antibodies to PC in the blood serum was determined, and the number of COPD exacerbations was tracked throughout the year.
Results. Markers of active PC infection were detected in 62.2% of patients. PC infection with COPD exacerbation significantly increased the frequency of COPD exacerbations (2.68±0.08 vs. 2.45±0.15; р˂0.05). PC infection was statistically (р˂0.05) more common in individuals with grade II COPD. In the group with PC infection, a significantly higher number of eosinophils was observed than in the group without PC infection in COPD exacerbation of 360.46±15.39 vs. 277.82±13.63 cells/µL (р˂0.01) and remission of 398.87±19.49 vs. 324.21±26.68 cells/µL (р˂0.05). After treatment with trimethoprim /sulfamethoxazole, there was a disappearance of IgM to PC and a decrease in IgG titer, a significant decrease in the level of blood leukocytes (6.08±0.13 vs. 6.91±0.19×10⁹ /L; p<0.01), an improvement in the values of FEV₁ (63.59±1.30 vs. 61.06±1.29% pred.; р˂0.01) and FEV₁ /FVC 54.53±1.0 vs. 52.29±1.03%; р˂0.01). There was a significant decrease in COPD activity according to the CAT test, mMRC, and a decrease in the number of exacerbations during the year.
Conclusion. Active PC infection in COPD is associated with a high number of eosinophils in the blood and an increased risk of frequent exacerbations of COPD during the year. Treatment of PC infection in COPD with a combination of trimethoprim/sulfamethoxazole leads to a significant improvement in clinical and laboratory parameters and a decrease in the frequency of exacerbations of the disease over the next year

Introduction. Macrophages are key cells of the innate immune system possessing high functional plasticity. Previously, some transient receptor potential (TRP) channels were identified on macrophages, including those that are receptors for cigarette smoke and particulate matter, which may play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD).
Aim. The aim of this study was to investigate the expression of TRPV1, TRPV4, TRPM8, and TRPA1 in monocyte-derived macrophages from COPD patients under stimulation with lipopolysaccharides (LPS) and interferon-gamma (IFNγ) or interleukin 4 (IL-4).
Materials and methods. Macrophages were differentiated in vitro in the presence of granulocyte-macrophage colony-stimulating factor from monocytes obtained from COPD patients. The concentration of cytokines was determined in the supernatant of the culture medium after stimulation by multiplex analysis. The expression of TRP genes in macrophages was evaluated at mRNA level by quantitative PCR with reverse transcription.
Results. The effect of LPS/IFNγ was accompanied by the production of both proinflammatory (IL-1β, IL6, IL-12p70, IP-10, TNFα) and some anti-inflammatory cytokines (IL-4, IL-10 and TGFβ1). IL-4 significantly increased the concentration of IL-17A. Stimulation of macrophages with LPS/IFNγ increased the expression of TRPA1 by 5.6 times (p = 0.01) but caused down-regulation of TRPV1 and TRPV4 by 8.5 (p = 0.007) and 3.2 (p = 0.03) times, respectively. IL4 did not exert any effect on the TRP gene expression.
Conclusions. The results obtained may indicate dysregulation of the immune response in patients with COPD, primarily due to a decrease of anti-inflammatory potential of macrophages. The observed LPS-induced changes in the expression of TRP channels apparently have a compensatory nature and are aimed at the limitation of the cellular inflammatory response.

Introduction. The phenomenon of airway hyperresponsiveness in response to changes in air humidity is widespread among patients with asthma. Transient receptor potential channels of the vanilloid subfamily (TRPV) are of interest in terms of study of specific mechanisms of bronchial osmotic hyperresponsiveness.
Aim. The aim of the study was to evaluate the expression TRPV1, TRPV2 and TRPV4 genes at mRNA level in the epithelium of the upper and lower respiratory tract in asthma patients with osmotic airway hyperresponsiveness.
Materials and methods. We examined 35 patients with mild and moderate asthma. All patients underwent bronchoprovocation tests with hypo- and hyperosmotic solutions. Expression of TRPV receptors was studied in brush biopsies of the nasal and bronchial epithelium by quantitative PCR with reverse transcription.
Results. Airway hyperrresponsiveness to hypoosmotic and hyperosmotic stimuli was observed in 25% and 50% of cases, respectively. It was found that patients with lower baseline FEV₁  had overexpression of TRPV1 (3.2 times, p=0.05) and TRPV2 (6.2 times, p=0.013) in the bronchial epithelium. Hypoosmotic airway hyperresponsiveness was associated with increased expression of the TRPV1 (7.4 times, p=0.004) and TRPV2 (18.5 times, p=0.014) genes in the bronchial epithelium. Airway hyperresponsiveness to hypertonic stimulus was also characterized by higher expression of TRPV1 (4.7 times, p=0.013) and TRPV2 (7.6 times, p=0.024). No difference in TRPV4 expression levels was found.
Conclusion. The obtained data indicate the up-regulation of TRPV1 and TRPV2 in the bronchial epithelium of asthma patients with osmotic airway hyperresponsiveness, what, in turn, may indicate the role of these receptors in the development of airway osmotic-induced responses and in the pathogenesis of asthma.

Introduction. Neutrophils and bronchial epithelium are actively involved in the generation of oxidative stress and the progression of airway inflammation in patients with asthma.
Aim. To study the role of neutrophils and bronchial epithelium as factors contributing to the loss of control over asthma and the formation of the airway response to a cold stimulus.
Materials and methods. A total of 146 patients with a diagnosis of persistent asthma were examined. A survey was conducted on the Asthma Control Test (ACT) questionnaire; a study of the lung function by spirometry with subsequent collection of induced sputum; the next day, a 3-minute isocapnic hyperventilation by cold (-20ºC) air (IHCA) was performed, followed by collection of spontaneously produced sputum. In the sputum, cytosis, cellular composition, and glycoprotein concentration in the goblet-like epithelium were assessed. Group 1 (n=89) included persons with uncontrolled (ACT˂20 points), group 2 (n=57) – with controlled (ACT>20 points) asthma.
Results. Patients of group 1 in comparison with group 2 had a higher increase in FEV₁ to the inhalation of a short-acting β₂ -agonist ‒ 11.0 (5.4; 21.65) vs. 7.55 (4.11; 13.8)%, respectively (p=0.042) and a more pronounced reaction to the IHCA test ‒ -11.0 (-17.6; -2.5) vs. -6.0 (-12.0; - 2.0)% (p=0.031). In patients of group 1, after the IHCA test, an increase in the number of neutrophils was observed from 45.98±2.17 to 52.0±1.78% (p=0.0013) and an increase in the concentration of glycoproteins in mucocytes from 37.9±3.8 to 45.6±4.2% (p=0.002) against the background of a tendency towards an increase in the concentration of goblet cells and a decrease in the number of intact bronchial epithelial cells (from 4.8±0.32 to 3.9±0.30%; p=0.017). Correlation analysis showed the relationship between the level of goblet cell glycoproteins and the initial concentration of neutrophils in sputum (r=-0.49; p=0.039), as well as between the severity of the reaction of the distal bronchi (ΔMEF₅₀) to a cold stimulus and the concentration of neutrophils in sputum after IHCA (r=0.36; p=0.01).
Conclusion. The signs of stimulation of the neutrophilic segment of granulocytes and structural rearrangement of the bronchial epithelium in the sputum of patients with uncontrolled asthma after acute cold exposure were determined. Structural changes in the pool of neutrophils and epithelial parenchyma of the bronchi, indicating an escalation of pro-inflammatory activity, may underlie the emergence and maintenance of the airway response to a cold stimulus and loss of asthma control.

Introduction. The labilization of lysosomal membranes with the release of a wide range of lysosomal enzymes of pro-inflammatory and proapoptotic action, which have a high hydrolytic potential, is one of the essential components of adaptive changes in cells under stress. The participation of hydrolytic enzymes of phagocytes in cellular reactions of inflammation and adaptation to cold stress in patients with asthma has been little studied.
Aim. To study the activity of neutrophil hydrolases of bronchi in patients with asthma under cold-induced stress. Materials and methods. In patients with persistent asthma (n=13), lung function (FEV₁ ,%), airway response (∆FEV_{1 IHCA},%) to standard 3-minute isocapnic hyperventilation with cold air (IHCA) were determined by spirometry. The collection of induced and spontaneously produced sputum after the IHCA was carried out. The activity of acidic (AP) and alkaline (ALP) phosphatases, adenosine triphosphatase (ATPase) was detected in sputum neutrophils by cytochemical methods. The assessment of the reaction to the activity of hydrolases was carried out by the semi-quantitative Kaplow method with the distribution of cells into groups depending on the color intensity of the product formed during the interaction of the enzyme with the substrate, and the subsequent calculation of the average cytochemical index (ACI) of the enzymatic activity.
Results. The baseline FEV₁ , averaged 97.9±5.3%, ∆FEV_{1 IHCA} -2.0 (-8.0; 2.0)%. Under the influence of a cold stimulus against the background of a mixed pattern of bronchial inflammation in patients, the following was recorded: an increase in the ACI AP of neutrophils (from 1.11±0.06 to 1.42±0.06; p˂0.01), an increase in the number of cells with an average degree of AP activity (from 23.4±1.94 to 40.1±4.30%; p˂0.01) and a decrease in the number of cells with a negative reaction to AP (from 15.1±3,58 to 5.2±2.78%; p˂0.05), a tendency to an increase in the number of neutrophils with a high degree of ATPase activity (from 3.50±2.70 to 7.22±2.64%) and ALP (from 13.7±4.22 to 15.7±3.46%).
Conclusion. The activation of AP of neutrophils under cold-induced stress indicates the possibility of an increase in the acidity of the interstitium, stimulation of damage and vulnerability to cold effects of the desmo-epithelial barrier of the bronchi and is regarded as a criterion for a high risk of cold airway hyperresponsiveness in asthma patients with a mixed inflammation phenotype.

Introduction. The high labor intensity of instrumental tests to detect cold/osmotic hyperresponsiveness of the airways raises the question of finding alternative options for identifying individuals sensitive to cold air and high ambient humidity.
Aim. Development and validation of questionnaires for the detection of cold and osmotic airway hyperresponsiveness.
Materials and methods. A survey was conducted according to a specially developed questionnaire of 191 patients with mild and moderate persistent asthma in order to identify clinical symptoms of response to low temperature and high humidity of the environment in everyday life and after performing acute bronchoprovocation tests: 3-minute isocapnic hyperventilation with cold (-20ºC) air and 3-minute inhalation of ultrasonically nebulized distilled water.
Results. The main clinical symptoms in individuals sensitive to cold and/or high environmental humidity are the occurrence of breathlessness and/or shortness of breath, coughing, labored breathing, distant wheezing under the influence of cold or moisture triggers. In individuals with cold airway hyperresponsiveness, a high predictive value was obtained for the “breathlessness/shortness of breath” symptom (sensitivity and specificity 88.2 and 86.9%). In individuals with osmotic airway hyperresponsiveness, a high predictive value included two symptoms – “breathlessness/shortness of breath”, “appearance of distant wheezing”(sensitivity and specificity 88.4 and 85.3%). On the basis of the data obtained, two screening questionnaires have been developed, containing keys for a quick diagnosis of cold and osmotic airway hyperresponsiveness. The questionnaires were tested on 840 respondents from the Amur Gas Processing Plant.
Conclusion. The information provided is important for assessing the health of the population living in severe climatic conditions, the population of people involved in working in these regions. The proposed screening questionnaires can be used to develop prevention programs for people whose profession is associated with a high risk of respiratory infections when working in cold conditions or high humidity conditions.

Aim. To assess the state of pulmonary function in patients with mild asthma, depending on the state of the small airways.
Materials and methods. The study included 114 patients with partially controlled mild asthma (average age 45.12±2.18 years). Depending on the state of the small airways, patients were divided into two groups: first group ‒ 94 patients without small airways dysfunction (SAD) (82%); second group – 20 patients with SAD (18%). The control group consisted of 25 healthy volunteers.
Results. It was found that in the group of asthma patients with SAD, in comparison with healthy, a decrease in almost all spirometry indicators was detected, and generalized bronchial obstruction was diagnosed in 55% of cases. Characteristic of asthma patients with SAD was a decrease in the vital capacity of the lungs (VC) by 16% (p<0.001) and the inspiratory capacity (IC) – by 14% (p=0.005) in comparison with patients without SAD. These indicators are used to determine the total lung capacity (TLC=VC+RV and TLC=IC+FRC), where RV is the residual volume, and FRC is the functional residual capacity. It follows that in the case of normal values of TLC, according to spirometry data, with a decrease in VC, it is possible to indirectly judge an increase in RV and the formation of “air traps”, with a decrease in IC – an increase in FRC and the development of hyperinflation of the lungs.
Conclusion. The study showed that in patients with mild asthma, SAD was diagnosed in 18% of cases, and it makes a significant contribution to changes in lung function. In mild asthma, SAD is accompanied by generalized bronchial obstruction in 55% of cases. With a decrease in VC and IC according to spirometry data in patients with mild asthma, it is possible to indirectly judge the formation of “air traps”, the development of lung hyperinflation, and consequently, the small airways dysfunction.

An important stage in the study of COVID-19 and its impact on quality of life is the study of lung function during the period of convalescence.
Aim. To assess the influence of complex medical rehabilitation (MR) on pulmonary function, dyspnea, muscle weakness, quality of life, anxiety and depression in patients after COVID-19.
Materials and methods. The study included 19 patients after COVID-19 (17 men and 2 woman, median age – 45 years), who were treated at the Main Military Clinical Hospital of the Ministry of Defense named after N.N.Burdenko. The second stage of complex MR included medical and physical therapy, and physiotherapy. Before and after the MR pulmonary function tests were performed, also the scores of mMRC, MRSweakness, HADS scales, the scores of EQ-5D Questionnaire were assessed.
Results. Before the start of MR, on average, the severity of dyspnea in the group was mild, muscle strength was slightly reduced, the quality of life score was 80 points, anxiety and depression were not detected. The medians of all pulmonary function parameters were within normal values unless anomaly of the lung diffusion capacity in 14 (74%) cases. Repeated examination showed a statistically significant reduction in the degree of dyspnea, increased muscle strength, improved quality of life, increased VC, FVC, FEV₁ , DL_CO, with a median increase of 5% pred. or 230 mL, 5% pred. (260 mL), 6% pred. (210 mL) and 6% pred. (1,75 mL/min/mmHg), respectively.
Conclusion. Our study demonstrated the importance and effectiveness of complex rehabilitation after COVID-19.

Aim. To study functional state of respiratory muscles in patients with obstructive sleep-disordered breathing (oSDB) of varying severity based on changes in electrical activity when using a stepwise-increasing respiratory load.
Materials and methods. According to results of cardiorespiratory monitoring, the examined patients were divided into 4 groups. Group 1 included 16 patients without oSDB, group 2 – 16 patients with mild oSDB, group 3 – 8 patients with moderate oSDB, group 4 – 8 patients with severe oSDB. The assessment of electrical activity of inspiratory muscles and expiratory muscles was carried out using electromyography (EMG) when performing tests with a stepwise-increasing inspiratory and expiratory load.
Results. During inspiratory test, a decrease in EMG frequency was observed, indicating respiratory muscles fatigue development, with a simultaneous increase in EMG amplitude due to the involvement of additional motoneurons in muscle contraction. In all cases, degree of increase in EMG amplitude prevailed over degree of decrease in EMG frequency. In patients of groups 3 and 4, there were no signs of diaphragm fatigue. Results of expiratory test in group 1, degree of increase in EMG amplitude prevailed over degree of decrease in EMG frequency. In the groups of patients with oSDB, prevalence of decrease in the EMG frequency over increase in EMG amplitude was observed, which indicates development of neuromuscular fatigue of expiratory muscles.
Conclusion. Changes in functional state of respiratory muscles are associated with severity of oSDB and are characterized by different dynamics of the electrical activity of inspiratory and expiratory muscles in response to a functional test.

Aim. To establish the clinical and laboratory features of the pleurisy course in patients with chronic lymphocytic leukemia (CLL) living in the Amur Region.
Materials and methods. We studied the case histories and outpatient records of 75 patients with CLL in stages B and C according to the J.Binet classification who were treated in the hematology department of the Amur Regional Clinical Hospital in 2012-2018.
Results. Exudative pleurisy was found in 28 patients (37%). The most common cause of pleurisy in patients with CLL was lymphoid infiltration of the pleura (18 patients), less often – infectious pleurisy developed (10 patients). Based on the study of the peculiarities of the course of specific lymphoproliferative and infectious pleurisy, significant differences in the clinical course and laboratory data were established. With infectious pleurisy, “pleural” manifestations and clinical manifestations of pneumonia, the complication of which it was, prevailed; in laboratory examination of exudate, neutrophils prevailed. The prognosis of infectious pleurisy is favorable in most cases. The clinical picture of the tumor process prevailed in specific lymphoproliferative pleurisy, in the laboratory study of exudate ‒ tumor lymphocytes, the hemorrhagic nature of the fluid. Specific lymphoproliferative pleurisy occurs at the stage of malignant transformation of CLL, often being its first manifestation.
Conclusion. The attachment of the specific lymphoproliferative pleurisy is an unfavorable prognostic factor for patients with CLL.

Aim. To investigate non-gas exchange functions of the lungs in alcohol addiction and its combination with traumatic brain injury (TBI).
Materials and methods. Experiments were conducted in 107 adult male rats. In animals of the first group the alcohol addiction was simulated by substitution of water for 20% ethanol solution during 20 weeks. In rats of the second group simulation of alcohol addiction and mild TBI were combined. TBI was modeled by weightdrop of 175 g from 30 cm level method. Intact animals were assumed as reference.
Results. Alcohol addiction resulted to a decrease of the total number of alveolar phospholipids with change of their fractional composition that leads to aggravation of lung surface activity; alveolar macrophages absorbing activity was deteriorated and increase of total fluid and lung blood filling was observed in the setting of arterial and venous blood NO level increase. Combination of prolonged ethanol intake and TBI caused to the increase of total surfactant phospholipids; however, low phosphatidylcholine level in its composition promoted increase of lung surface tension. The grade of changes of alveolar macrophages phagocytes activity and lung water balance revealed after ethanol intake was increased in the setting of additional TBI.
Conclusion. The obtained results provide evidences of imbalance of lipid and water lung metabolism, lung endothelium dysfunction, decrease of alveolar macrophages activity in alcohol addiction and its combination with TBI.

Aim. To study the state of the immune system in women with exacerbation of cytomegalovirus infection (CMVI) in the third trimester of pregnancy.
Materials and methods. The study involved 120 women in the third trimester of pregnancy, uncomplicated and complicated by CMVI. The first group was represented by 30 seronegative women with physiological pregnancy, the second − 30 pregnant women with latent CMVI, leading to the development of placental insufficiency, the third − 30 patients with exacerbation of CMVI and placental insufficiency, and the fourth − 30 women with exacerbation of CMVI, initiating the development of placental insufficiency and the threat of miscarriage. The concentration of immunoglobulins (sIgA, IgA, IgG and IgM) and circulating immune complexes (CIC) in blood serum was studied.
Results. It was shown that in women of the first group the concentration of sIgA in the blood serum was 5.0 (4.10-7.10) mg/ml, IgA − 2.32 (2.09-2.48) mg/ml, IgG – 13.8 (13.0-14.4) mg/ml, IgM − 1.08 (0.98-1.19) mg/ml and CIC − 0.097 (0.076-0.113) AU. In the second group, compared with the first one, the IgG concentration increased to 14.3 (13.3- 15.3) mg/ml (p=0.0284), at the same time there were no statistically significant changes in the sIgA level (p=0.697), IgA (p=0.085), IgM (p=0.197) and CIC (p=0.476). In the third group, in contrast to the second one, an increase in IgG concentration was recorded by 1.09 times (p=0.0016), IgM – by 1.88 times (p=0.000001) and CIC – by 1.70 times (p=0.000001) against the background of a 1.24-times decrease in IgA levels (p=0.000001) and no difference in sIgA concentration (p=0.208). In patients of the fourth group, in comparison with the third one, a decrease in the level of sIgA was diagnosed by 1.66 times (p=0.0000089) and IgA − by 1.41 times (p=0.00048) with an increase in IgG by 1.26 times (p=0.000001), IgM − 1.21 times (p=0.0011) and CIC − 1.09 times (p=0.0199).
Conclusion. With exacerbation of CMVI in the third trimester of pregnancy, complicated by placental insufficiency, severe dysimmunoglobulinemia and autoimmune changes in the female body lead to the development of symptoms of the threat of miscarriage.

Aim. To determine the indices of vascular endothelial growth factor and docosahexaenoic acid in women with threatened early pregnancy associated with cytomegalovirus infection exacerbation.
Materials and methods. The study included 74 women at a gestation period of 7-12 weeks, of which 38 women with exacerbation of cytomegalovirus infection and the onset of spontaneous miscarriage (main group) and 36 without such pathology (control group). The material for the study was peripheral blood, urine, and scraping of the buccal epithelium. Antibodies IgM and G to cytomegalovirus, low avidity IgG (avidity index) were determined by enzyme-linked immunosorbent assay. Cytomegalovirus DNA was detected by real-time PCR analysis. Indicators of vascular endothelial growth factor were established by enzymelinked immunoassay. The concentration of docosahexaenoic acid was analyzed using capillary gas-liquid chromatography.
Results. The concentration of vascular endothelial growth factor in the blood serum in pregnant women in the main group was 1.7 times (p<0.001) lower than in the control group. A similar dynamics of changes was established for docosahexaenoic acid, the concentration of which was 1.4 times lower than that of the control group (p<0.001).
Conclusion. The data obtained indicate that the exacerbation of cytomegalovirus infection in early pregnancy is associated with a significant decrease in vascular endothelial growth factor and docosahexaenoic acid, which has adverse effects on angiogenesis and growth of placenta, and pregnancy outcome.

Aim. To study the change in the physico-biochemical properties of the nasopharyngeal aspirate in newborns with congenital cytomegalovirus infection (CMVI).
Materials and methods. The pH, the concentration of medium molecular weight peptides, seromucoid, total cholesterol, triglycerides, and the activity of lactate dehydrogenase in the nasopharyngeal aspirate in 59 full-term infants with intrauterine development, uncomplicated and complicated by congenital CMVI, who died at 2-5 days of life, were studied. The first group included 25 children of early neonatal age (control group), whose mothers did not have moderate and severe obstetric and somatic pathologies during pregnancy, as well as respiratory viral infections and sexually transmitted infections. The second group was represented by 18 newborns (comparison group) from mothers with exacerbation of CMVI in the second trimester of gestation, which does not lead to antenatal infection of their offspring. The third group consisted of 16 newborns (main group) with diagnosed intrauterine CMVI.
Results. In the nasopharyngeal aspirate in the newborns of the second group, in comparison with the first one, there were no statistically significant differences in pH (7.02±0.016 and 7.05±0.016, respectively, p>0.05). At the same time, there was a decrease in the concentration of total cholesterol (0.196±0.006 and 0.238±0.003 mmol/L, respectively, p<0.001), an increase in the concentration of medium molecular weight peptides (0.595±0.032 and 0.345±0.005 mmol/L, respectively, p<0.001), seromucoid (0.112±0.002 and 0.098±0.001 optical density units, respectively, p<0.001), triglycerides (0.160±0.005 and 0.145±0.004 mmol/L, respectively, p<0.05) and lactate dehydrogenase activity (345,0±14.16 and 287.6±10.23 IU/L, respectively, p<0.01). In the third group, in comparison with the second one, a decrease in pH by 1.01 times (p<0.01) and in total cholesterol by 1.35 times (p<0.001), an increase in the concentration of medium molecular weight peptides by 1.32 times (p<0,05), seromucoid – 1.13 times (p<0.001), triglycerides – 1.24 times (p<0.001) and the level of lactate dehydrogenase – 1.15 times (p<0.05).
Conclusion. In dead newborns with intrauterine CMVI, a change in the physico-biochemical properties of the nasopharyngeal aspirate in the first minutes after birth indicates an antenatal direct and indirect negative effect of the infection on the state of the amniotic membrane, placenta and organs of the intrauterine fetus.

Introduction. Monocytes and macrophages are cells that play an important role in the function of the innate immune system and may be involved in the pathological process in various diseases. For this reason, in vitro studies of the functional activity of these cells are of great scientific interest. The literature indicates a large number of methods used to isolate primary monocytes but the approaches are often controversial.
Aim. To perform a comparative analysis of the influence of various conditions on monocytes adhesion efficiency to determine the most optimal combinations of factors providing the highest yield and purity of the obtained cells.
Materials and methods. Peripheral venous blood samples were obtained from 6 healthy volunteers. Peripheral blood mononuclear cells (PBMC) were isolated by standard centrifugation on Ficoll density gradient (1.077 g/ml). After the centrifugation, PBMC were plated in wells of a 24-well plate, coated with collagen or uncoated, and incubated for 2 or 24 hours in RPMI-1640 medium containing 10% fetal calf (FCS) or autologous human serum (AHS). The number of attached monocytes was assessed by epifluorescence microscopy after staining with Hoechst 33342 with automatic counting of nuclei in ten fields of view.
Results. It has been established that incubation of cells for 2 hours in wells without coating in the presence of 10% FCS allows obtaining the largest number of monocytes with median purity of 80.9 (66.5-89.1)%. The number of monocytes obtained by adhesion in collagen-coated wells tended to be lower, regardless of the type of serum used. In our experiment, the adhesion capacity of monocytes was reduced when cells were plated in uncoated wells with 10% AHS. Extended to 24 hours incubation time was accompanied by a significant decrease in the number of attached monocytes in most cases.
Conclusion. Incubation of PBMC for 2 hours on uncoated tissue culture plastic in the presence of 10% FCS provides the highest yield and purity of monocytes in comparison with other tested conditions.

Aim. Analysis of scientific publications related to issues concerning basics of pathogenesis, laboratory diagnosis and radiological patterns as well as co-infection peculiarities in patients with COVID-19 was performed.
Results. The pathogenesis of COVID-19 is based on injury of alveolocytes and other organs (kidneys, heart and other) that have angiotensin II receptors on the cell membrane. “Cytokine storm”, disseminated intravascular coagulation syndrome that are at the basis of acute respiratory distress syndrome pathogenesis with a high probability of death are common in patients with COVID-19. Apart of homeostasis dysregulation, emerging coinfection of bacterial, viral and fungal etiology notably deteriorates the disease. Biological material is a key aspect in accurate laboratory diagnosis of pneumonia caused by SARS-CoV-2. Thus, biological material of choice are sputum or preferably bronchoalveolar lavage that give less falsenegative results. Only in case of their absence evaluation of nasopharyngeal swabs via PCR are justified. Apart of laboratory diagnosis of the novel coronavirus disease, computer tomography of lungs is also effective. Computer tomography can be even more sensitive than PCR of nasopharyngeal swabs in early stages of the disease. The most frequent radiographic symptoms are bilateral, basal-predominant, peripheral, round ground glass opacities, halo sign.
Conclusion. Thereby in order to execute most effective diagnosis of pneumonia, caused by SARS-CoV-2 it is necessary to utilize epidemiological anamnesis alongside with laboratory diagnosis and radiological imaging.

The cardiovascular system experiences the greatest overload, morphological and functional changes in elite sport, which in a number of athletes undergoes non-adaptive (pathological) remodeling both functional and morphological. The latter is characterized by certain objective features, including echocardiography indicators, which occupies a special place in sports cardiology. Structural and functional changes beyond the generally accepted norm (pronounced cardiac hypertrophy or dilatation, high arterial hypertension) can be associated with systolic or diastolic myocardial dysfunction and impaired electrical properties, some of which are predictors of severe complications up to sudden cardiac death and pose a serious problem regarding the admission of athletes to training and competition. This review is devoted to summarizing the views of authoritative specialists in the field of sports medicine on the criteria of pathological remodeling of the heart muscle, the role of echocardiography in its diagnosis, the discussion of the limits of the norm of response to blood pressure load, the analysis of the main causes of sudden cardiac death of athletes, the realities and prospects of genetic selection in sports.

The review is devoted to poisoning with rodenticides containing indirect anticoagulants – vitamin K antagonists (VKA). The work describes the main groups of anticoagulants that are used in such preparations, describes the mechanism of their action. The authors analyzed a significant number of foreign and local literary sources on the poisoning of the rodenticides of this group. It was concluded that VKA intoxication occurs much less frequently than other rodenticides; it is mainly the occasional intake of drugs, most of the victims are children. The use of rodenticides-VKA by psychiatric patients and criminal cases are not common. Analysis of the literature has shown that the overwhelming number of poisonings occurs when using VKA, which are contained in ready-made rodent-control baits available to the majority of the population. Intoxication with modern rodenticides-VKA – superwarfarins is possible with oral, dermal exposure and contact with the mucous membranes of the eye; they have a cumulative effect. The main clinical manifestation of superwarfarin poisoning is hemorrhagic syndrome. The clinical signs of coagulopathy are much more pronounced in case of deliberate poisoning than in case of accidental poisoning, since for the appearance of hemorrhagic syndrome, a large amount of the substance contained in the finished bait is required. The principles and features of diagnosis, differential diagnosis and treatment of coagulopathy of this genesis are described. All patients have changes in the coagulogram, characteristic of vitamin K-dependent coagulopathy: an increase in the international normalized ratio, prothrombin time and activated partial thromboplastin time, a decrease in the levels of II, VII, IX and X blood coagulation factors, physiological anticoagulants – proteins C and S. Determine the concentration of superwarfarin in the blood using high performance liquid chromatography is not possible in every medical institution. In the clinical diagnosis of coagulopathy and the identification in the coagulogram of changes characteristic of vitamin K deficiency, even if its etiological cause has not been established, it is immediately necessary to prescribe adequate therapy: the introduction of fresh frozen plasma and/or concentrates of prothrombin complex factors, prescription of vitamin K preparations, symptomatic therapy. Taking into consideration the long half-life of superwarfarins, coagulopathy can persist for several months, during which treatment should be continued. With timely diagnosis and the appointment of adequate therapy, the prognosis in most cases is favorable. The mortality rate among people with superwarfarin poisoning is not high. As an illustration, the authors cite two clinical cases from personal practice.