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Objective. Data of the clinical picture forms of the disease, management and diagnostic capabilities of patients with COVID-19 continue to be studied. Our study presents results from the analysis of clinical and laboratory parameters of patients with COVID-19 in the period May-June 2020, who were treated in an infectious diseases hospital in Moscow. Patients and methods. The analytical cohort included 444, 198 men, 246 women aged 18 to 95 years, who were identified with SARS-CoV-2 RNA. The severity of the disease was determined in accordance with the temporary clinical recommendations (version 6 effective April 28, 2020), NEWS. Results. The study of the clinical picture showed the variability of the spectrum of clinical manifestations of COVID-19. The most common symptoms were fever, weakness, myalgia, dry cough, shortness of breath, diarrhea. The severity of the infection was not associated with the patient's gender, but was significantly correlated with age and the presence of comorbid status, which included chronic lung diseases, obesity, diabetes mellitus, and cardiovascular diseases. Observations of patients with severe and extremely severe course revealed characteristic laboratory markers of severity. The main method of etiological diagnosis was the RT-PCR method for detecting SARS-CoV-2 RNA in the nasopharyngeal secret. To verify COVID-19, we used an additional PCR method, fecal testing for the detection of SARS-CoV-2 RNA. Key words: COVID-19, clinical features, risk factors, SARS-CoV-2 RNA, biological substrates

The aim of the investigation was to study the potential of an innovative microfluidic technology for the isolation of circulating tumor cells (CTCs) from the peripheral blood samples of cancer patients. Materials and methods Peripheral blood samples from 5 patients with disseminated malignant tumors of epithelial origin were processed with the use of the microfluidic technology (based on a specifically designed silicone chip). The cells were separated according to their density criterion based on the lateral migration of solid particles in a liquid due to inertial forces. With the help of the designed chip configuration, the cells over 13 μm in size which is larger than the standard size of blood cells were isolated. The resulting target cell fraction was stained by the Romanowsky-Giemsa method. Staining with the fluorescent Anti-Cytokeratin (CK3-6H5)-FITC antibody was carried out to confirm the epithelial nature of the cells, and the DAPI dye was used to contrast the nucleus. The blood of a healthy volunteer and tumor cells of the A549 line were used for the immunocytochemical studies. Results The tumor cells in peripheral blood (in the number of 1 to 9) were detected in all 5 patients. CTC clusters of 2-5 cells were identified in blood samples from the patients with laryngeal cancer, non-small cell lung cancer, and floor of the mouth cancer. A bright saturated staining of the A549 tumor cells was obtained using the Anti-Cytokeratin (CK3-6H5)-FITC antibody, corresponding to the staining of the cytoskeleton of epithelial cells. Successful nuclear staining with DAPI confirmed that the isolated target cells are not damaged during microfluidic separation. Conclusion The microfluidic technology that has been used enables effective intact CTCs isolating from the peripheral blood of cancer patients. The epithelial nature of the isolated cells can be confirmed by immunocytochemical studies.

To study the clinical course, diagnosis of pertussis in pregnant women.Under observation were 25 pregnant women with whooping cough. The age structure was dominated by patients from 6 to 35 years old, amounting to 64%. At the time of hospitalization in 2 (8%) patients the gestation period corresponded to the first trimester, in 7 (28%) II, in 9 (36%) III. In 7 (28%) patients, the diagnosis of whooping cough was made during childbirth. The following methods were used to verify pertussis: bacteriological, PCR and serological (ELISA).Clinical analysis showed that pregnant women with pertussis who came to the hospital were admitted to hospital mainly in the late stages of the disease (at 45 week in 68.6% of cases). Pertussis infection in all cases was typical: in moderate form 96%, mild at 4%. In 64% of patients, whooping cough accompanied by other respiratory diseases, which were the main cause of development of bronchitis. The use of ELISA allowed to confirm the clinical diagnosis in 91.7% of patients.The course of whooping cough in pregnant women is characterized by a typical symptom complex. To improve the verification of the diagnosis, it is advisable to use modern laboratory tests (PCR, ELISA).Цель. Изучить особенности клинического течения, диагностики коклюша у беременных женщин. Материалы и методы. Под наблюдением находились 25 беременных, больных коклюшем. В возрастной структуре преобладали пациентки от 26 до 35 лет, составившие 64%. На момент госпитализации у 2 (8%) больных сроки беременности соответствовали I триместру, 7 (28%) II, 9 (36%) III. У 7 (28%) пациентов диагноз коклюша установлен в периоде родоразрешения. Для верификации коклюша использованы следующие методы: бактериологический, полимеразная цепная реакция (ПЦР) и серологический (иммуноферментный анализ ИФА). Результаты и обсуждение. Клинический анализ показал, что больные коклюшем беременные женщины поступали в стационар преимущественно на поздних сроках болезни (на 45-й неделе в 68,6% случаев). Коклюшная инфекция во всех случаях протекала типично: в среднетяжелой форме у 96%, легкой у 4%. У 64% больных коклюшу сопутствовали другие респираторные заболевания, которые являлись основной причиной развития бронхитов. Применение метода ИФА позволило подтвердить клинический диагноз у 91,7% пациенток. Заключение. Для течения коклюша у беременных женщин характерен типичный симптомокомплекс. Для улучшения верификации диагноза целесообразно применение современных лабораторных тестов (ПЦР, ИФА).

The COVID-19-associated mortality remains high. Studying the features of the COVID-19 course in vaccinated patients, who have got ill on different dates after vaccination, compared to unvaccinated individuals is relevant. The study was aimed to assess clinical and immunological features of the COVID-19 course, as well as to assess humoral immunity (virus neutralizing activity, VNA) and SARS-CoV-2 S protein RBD domain variation in the groups of patients, previously vaccinated with Sputnik V, and unvaccinated patients. A total of 251 patients with confirmed diagnosis of COVID-19 were enrolled, of them 116 individuals were previously vaccinated with one or two Sputnik V vaccine components, and 135 patients were not vaccinated (comparison group). Individuals over 50 years of age prevailed (82.8%). The patients, who received two vaccine components, had mild to moderate COVID-19 (92.1%). In the group of unvaccinated patients, 11 individuals received treatment in the ICU, 10 of them died. The viral load was significantly lower in vaccinated patients. Mutations of SARS-CoV-2, such as S477N, S477N+A522S, E484K and E484K+S494P, were identified both in vaccinated and unvaccinated patients. Assessment of the neutralizing activity of sera revealed no significant differences in VNA against different variants of SARS-CoV-2 mutations. The data obtained demonstrate that the lack of vaccination is an aggravating factor and is capable of increasing the risk of severe course and death in patients with COVID-19.

The aim of the work was to assess the possibility of the cytological method in the diagnosis of epithelial liver tumors and to determine the cytomorphological criteria in the differential diagnosis of liver carcinomas. The authors analyzed the data of 106 fine-needle aspiration biopsies and 167 smears-prints during cor-biopsy of masses of the liver in patients who were examined at the polyclinic of the oncological dispensary in Nizhny Novgorod in 2016. - 2017 As a result, full-fledged material for cytological examination in the form of smears-prints from cor-biopsy and fine-needle aspiration biopsies was obtained in 75.4% (n=126) and 95.2% (n=101), respectively. The great possibilities of the cytological method are shown: an affirmative diagnosis of the presence of primary or metastatic liver lesions was made in 88.8% (n=112) based on smears of sorbiopsy prints and in 87.1% (n = 88) with fine-needle aspiration biopsies. Typical cytomorphological criteria for primary and metastatic liver carcinomas made it possible to determine the origin of the primary tumor in 56.6% of cases (n=98).

The purpose of this work was to show the effectiveness of the cytological method on a small number of observations, excluding all possible errors of the preanalytical stage. The paper presents several simple and easily reproducible algorithms for the cytological study of serous pleural effusions with small cellular content. On the example of 20 observations of the study of the cellular composition of serous exudates, a direct dependence of the research results on the preanalytical stage is shown. A complete study of effusion fluids in compliance with all stages of preanalytics and the use of modern methods of cytological diagnostics makes it possible to nullify the options for false-negative.

Introduction. The surveillance of influenza viruses in ARVI structure and study of their properties in epidemic season 2019–2020 in Russian Federation are actual for investigations due to tasks of Global Influenza Strategy initiated by WHO in 2019.Material and methods. The data of epidemiological surveillance on influenza- and ARVI-associated morbidity and hospitalization in different age groups of population were analyzed; virological, genetic and statistical methods were used.Results. Preschool children were involved in epidemic the most. Meanwhile, the highest rate of hospitalization was observed in patients of 18–40 years old. Influenza A(H1N1)pdm09 virus dominated in etiology of ARVI in hospitalized patients and pneumonia. The role of respiratory viruses in severe cases of pneumonia and bronchoalveolar syndrome in children was shown. The differences in spectrum of circulating viruses caused ARVI in different regions of Russia were found. Influenza A(H1N1)pdm09 and B/Victoria-like viruses were the main etiological agents that caused of epidemic; its activity among all ARVI was 7.3 and 8.0%, respectively. The differences in antigenic properties of influenza A(H3N2) and B epidemic strains compared to vaccine viruses were found. The populations of epidemic strains were presented by following dominant genetic groups: 6B1.A5/183P for A(H1N1)pdm09, 3С.2а1b+137F for A(H3N2) and V1A.3 line B/Victoria-like for B viruses. The good profile of epidemic strains susceptibility to anti-neuraminidase inhibitors has been saved. The most of the studied influenza strains had the receptor specificity characteristic of human influenza viruses.Conclusions. Obtained results identified the peculiarities of viruses caused the influenza and ARVI in epidemic season 2019–2020 in different regions of Russia. These results suggested the important role of influenza A(H1N1) pdm09 in severe cases and pneumonia in adults 18–40 years old. The continuing drift in influenza viruses was found, which, apparently, could not but affect the efficacy of vaccine prophylaxis and was also considered in the recommendations of WHO experts on the composition of influenza vaccines for the countries of the Northern Hemisphere in the 2020–2021 season.

Postoperative MRI is the conventional method for assessing the radicalness of hemispherical tumors excision, but the method has limitations on sensitivity in the assessment of tumor infiltration of the peritumoral zone. The 'gold standard' for detecting tumor cells is the microscopic visualisation.To study the possibilities of a cytological study of the excision margins of glial and metastatic tumors for an objective assessment of the radical nature of the operation.The study included 35 patients with intracerebral tumors who underwent open surgery at a university clinic of Volga Research Medical University in 2018-2019: 15 patients with metastasis, 13 patients with MRI-contrasting gliomas Grade III-IV and 7 patnents with non-MRI-contrasting gliomas Grade II-III. During the surgery, samples for cytological examination were taken from the following sites: from the tumor, from the nearest perifocal zone, and at a distance of 5-7 mm, along the border of the extended resection. 154 samples were examined: from 2 to 5 for each patient.The data on the radicalness of the operation, obtained by methods of cytological analysis of the resection margins and postoperative MRI, are not only consistent (p=0.001), but also complement each other, in particular, in some cases, tumor cells were found even in those areas where the tumor tissue was not detected with MRI. In cases of cerebral metastases excision, tumor cells in the nearest perifocal zone were found in 8 out of 28 samples (28.6%), at the extended resection margins - in 3 out of 29 (10.3%). In cases of resection of MRI-contrasting gliomas Grade III-IV, tumor cells in the nearest perifocal zone were found in 22 out of 32 samples (68.8%), at the extended resection margins - in 14 out of 20 (70%). In cases of excision of diffuse gliomas Grade II-III, tumor cells in the nearest perifocal zone were found in 10 out of 17 samples (58.9%), at the extended resection margins - in 4 out of 11 (36.4%).The first data obtained demonstrated sufficient informativeness of the cytologic examination of the peritumoral zone as an additional tool for assessing the radicalness of glioma and metastasis surgery. Cytologic analysis of the perifocal zone shows that the extension of the borders of the removal of Grade III-IV gliomas has no advantages, because tumor cells were found both in the nearest perifocal zone and at the extended resection margins with with approximately the same frequency.Введение. Общепринятым методом оценки радикальности удаления полушарных опухолей является послеоперационная магнитно-резонансная томография (МРТ), но она имеет ограничения по чувствительности в отношении опухолевой инфильтрации перитуморальной зоны. 'Золотым стандартом' обнаружения опухолевых клеток остается их визуализация под микроскопом. Цель исследования - изучить возможность цитологического исследования границ удаления глиальных и метастатических опухолей для объективной оценки радикальности операции. Материал и методы. В исследование включено 35 пациентов с внутримозговыми опухолями, которым проведено открытое хирургическое вмешательство в университетской клинике ФГБОУ ВО 'Приволжский исследовательский медицинский университет' в 2018-2019 гг., среди которых: 15 - с метастазами, 13 - с контрастируемыми на МРТ глиомами Grade III-IV, 7 - с неконтрастируемыми глиомами Grade II-III. При удалении опухоли материал для цитологического исследования брали из следующих участков: из опухолевого узла, ближайшей к нему перифокальной зоны и на расстоянии 5-7 мм по линии границы расширенной резекции. Изучено 154 образца, взятых от 2 до 5 у каждого пациента. Результаты. Данные о радикальности операции, получаемые методами цитологического анализа границ окончательной резекции и послеоперационной МРТ, не только согласуются (p=0,001), но и дополняют друг друга, в частности, в ряде случаев опухолевые клетки обнаружены даже в тех зонах, в которых по данным МРТ опухолевая ткань не определялась. При удалении церебральных метастазов опухолевые клетки в ближайшей перифокальной зоне обнаружены в 8 (28,6%) из 28 образцов, на границе расширенной резекции - в 3 (10,3%) из 29. При резекции контрастируемых глиом Grade III-IV в ближайшей перифокальной зоне опухолевые клетки выявлены в 22 (68,8%) из 32 образцов, на границе расширенной резекции - в 14 (70%) из 20. При удалении диффузных глиом Grade II-III в ближайшей перифокальной зоне опухолевые клетки обнаружены в 10 (58,9%) из 17 образцов, на границе расширенной резекции - в 4 (36,4%) из 11. Вывод. Первые полученные данные показали достаточную информативность цитологического исследования перитуморальной зоны как дополнительного инструмента оценки радикальности хирургии глиом и метастазов. Анализ цитологической картины перифокальной зоны показывает, что расширение границ удаления глиом Grade III-IV не имеет преимуществ, так как опухолевые клетки примерно с одинаковой частотой обнаружены как в ближайшей перифокальной зоне, так и на границе расширенной резекции.

The article describes the clinical observation with an unfavorable outcome of the generalized form of salmonella infection caused by Salmonella typhimurium group B in a woman of 60 years without immunodeficiency, complicated by the development of multiple abscesses of the lower parts of abdominal cavity, probably of appendicular origin. In a short literary review, the pathogenetic mechanisms that contribute to the formation of generalized and extraintestinal forms of salmonella infection are discussed.

Pathogenic properties of Blastocystis spp. - widespread of this protozoan organism remains debatable. Data on clinical observations demonstrating that the manifest forms of invasive Blastocystis spp . can occur from mild diarrhea, dysentery-like, to severe ulcer-necrotizing bowel perforation with complications and poor prognosis. However, one should not exaggerate the pathogenic properties of these protozoa because most infected people are asymptomatic carriers, or have symptoms of diarrhea syndrome of varying severity and duration.

Here, we present the results of a study in which 639 samples obtained between October 2018 and April 2019 from patients with symptoms of acute gastroenteritis were tested for the presence of a rotavirus infection. The antigen of group A rotavirus was detected in 160 samples (25% of those tested). To study the genetic diversity of group A rotavirus, RNA was isolated from the samples, and polymerase chain reaction combined with reverse transcription (RT-PCR) with primers specific for the VP4, VP6, and VP7 genes of group A rotaviruses was performed. At least one fragment of the group A rotavirus genome was found in 101 samples (15.8%). These fragments were sequenced, and their G and P genotypes-as well as their combinations-were determined. The predominant G genotypes were G9 (35.8% of all genotyped samples) and G4 (28.4%), but the rare G12 genotype was also found (3.0%). The dominant P genotype was P[8]. The spectrum of certain G/P combinations of genotypes included seven variants. The most common variants were G9P[8] (37.2%) and G4P[8] (30.2%).

Background: The effectiveness of barrier function of the respiratory mucosa largely depends on interferons type I (IFNs-α/β) and type III (IFNs-λ) The IFNs-λ forms the first level of innate immune protection The single-nucleotide polymorphisms (SNPs) affecting IFN- λ3 production were found previously The study aimed to investigate a putative association of SNPs rs8099917 T/G located upstream IFNL3 gene and rs12979860 C/T within IFNL4 gene with a risk of pneumonia developing after infection with respiratory viruses Methods: The nasopharyngeal swabs, lavages, and blood samples from 318 patients infected with respiratory viruses were analyzed Of these, 168 participants were shown to have community-acquired pneumonia, while the rest patients were diagnosed with bronchitis The respiratory virus genomes were detected by real-time polymerase chain reaction (PCR) using commercially available kits The DNA samples from all patients were used to detect SNPs rs8099917 T/G and rs12979860 C/T by real-time PCR using a commercially available kit COVID-19 morbidity and mortality data were obtained from the WHO website Results: No association was found between different rs8099917 allelic variants and the development of pneumonia The rs12979860 TT genotype was significantly more often detected in patients with pneumonia (p = 0 039;OR = 2 400;95% CI 1 310 - 3 706) IFN-λ3 production has been early found to be maximal with rs12979860 TT genotype An association was established between rs12979860 T allele frequency and COVID-19 mortality rate in 13 countries Conclusions: The rs12979860 TT genotype is a genetic marker of increased risk of pneumonia after infection with respiratory viruses High T allele frequency may be an indicator of a higher COVID-19 mortality rate Patients with rs12979860 TT genotype have an increased risk of developing COVID-19 pneumonia

Hemolytic uremic syndrome (HUS) is a rare, but menacing condition registered mainly in children. The paper gives a detailed description and analysis of a clinical case of HUS with a favorable outcome in an adult woman who developed the syndrome in the presence of bloody diarrhea. It considers an update on the etiology, pathogenesis, and clinical features of HUS associated with diarrheal syndrome and discusses differential diagnostic features, diagnostic problems, and characteristics of management tactics for patients.Гемолитико-уремический синдром (ГУС) - редкое, но грозное состояние, регистрируемое преимущественно у детей. В статье приводятся подробное описание и анализ клинического наблюдения с благоприятным исходом ГУС у взрослой женщины, который развился на фоне кровянистой диареи. Рассматриваются современные сведения об этиологии, патогенезе, особенностях клинической картины ГУС, ассоциированного с диарейным синдромом, обсуждаются трудности дифференциальной диагностики, проблемы диагностики и особенности тактики ведения больных.

The goal was to establish the frequency of detection of LPS O antigens of common causative agents of intestinal infections in HIV-infected patients at the stage of secondary diseases. Materials and methods. The study included 48 HIV-infected patients at the stage 4A, 4Б, 4B (25 men and 23 women), without diarrhea, a mean age ofpatients was 36,78 ± 7,8 years. Stool samples (2-4 samples from patient in interval of 5-7 days) were studied for the presence of LPS/O-antigens of S.sonnei, S.flexneri 1-5, 6, Salmonella sgr. B, C1, C2, D, E, Y.pseudotuberculosis I, III, Y.enterocolitica 03, 09, Campylobacter (C.jejuni, C.coli, C.lari) in coagglutination. Results. It was found that HIV-infected patients at the stage of secondary diseases have relatively high presence of LPS/Oantigens of various pathogens - Shigella, Salmonella, Yersinia, in feces (72, 55%). But Campylobacter antigens were relatively rare. In stages 4A, 4Б and 4В overall detection rate of LPS/O-antigens in stool samples did not differ significantly and was 64,3%, 91,3%, 68,6%, respectively (r ≥ 0,05). Conclusion. The high content of LPS/O-antigens may increase the toxic load in patients with HIV infection, including the immune system.

The paper describes a case of imported babesiasis caused by Babesia microti. This is an account of the second case of babesiasis in the Russian-language medical literature. Its clinical picture and laboratory data in the course of the disease are depicted and analyzed. Its clinical differential diagnosis with malaria and an update on the diagnosis and treatment of babesiasis are discussed.