Severe Course Research Articles

Clinical characteristics and predictive indictors of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a retrospective study

IntroductionMacrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) cases have been rapidly increasing. The primary reason for this increased incidence is the pathogen's acquisition of resistance through mutations in 23S rRNA genes. Due to the unfeasibility of testing for macrolide susceptibility at the time of admission, this study aimed to assess the clinical features of pediatric MUMPP, using insights from laboratory tests and patterns of chest radiographic resolution.Material and methodsWe conducted a retrospective review of 161 patients with M. pneumoniae pneumonia (MPP) between January 2023 and December 2023. These patients were categorized into two groups based on their responsiveness to macrolides: 72 patients were in the MUMPP group, and 89 patients were in the macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP) group.ResultsMUMPP patients experienced a longer duration of fever and hospital stay. A higher proportion of MUMPP patients had shortness of breath, transcutaneous blood oxygen saturation (SpO2) lower than 94%, bilateral lobar infiltrates, lobar pneumonia and pleural effusion. The serum level of serum ferritin (SF), interleukin-6(IL-6), D-dimer, lactate dehydrogenase to albumin rate (LAR), and neutrophil to lymphocyte rate (NLR) were higher in MUMPP group.ConclusionsOur findings revealed that patients with MUMPP exhibit more severe initial radiographic indicators and clinical course compared to those with MSMP. Therefore, it is crucial to promptly administer alternative therapeutic agents besides macrolides for the management of MUMPP.

Recurrence of acne after treatment with systemic isotretinoin: causes and methods of prevention

Isotretinoin is an effective method of treating patients with severe forms of acne, which has been proven in a large number of studies and is enshrined in the clinical recommendations of dermatological communities in various countries. Despite this, the multifactorial etiology and complex pathophysiological processes of acne development determine the risk of relapse of the disease. Determining prognostic factors for exacerbation of acne after isotretinoin therapy is a significant problem that has been actively discussed in scientific publications in recent years.The article focuses on the fact that the effectiveness of isotretinoin in patients with acne depends both on a competent treatment strategy and on the characteristics of the course of the disease (genetic burden, comorbid pathology), which are individual for each patient. An analysis of our own clinical observations of patients with acne, in whom relapses of the disease were the result of either an incorrect dosage regimen of the drug, or the lack of correction of concomitant pathology, or an early onset and initially severe course of dermatosis, is provided. It is noted that a personalized approach to the management of such patients and the prevention of factors that provoke relapse allow the doctor and patient to form realistic expectations from isotretinoin therapy, increase its effectiveness and reduce the likelihood of disease progression.

Antibody response to SARS-CoV2 before and after the third vaccination in patients with Inflammatory Bowel Disease.

Introduction Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy might have an increased risk of developing a severe course of SARS-CoV-2 infection. The aim of this study was to investigate the development of antibodies in immunosuppressed patients with IBD compared to a healthy control group and to determine the effect of immunmodulators on the level of anti-SARS-CoV-2 IgG antibody levels before and after a third vaccination against SARS-CoV-2. Methods This is a single-center study with a retrospective observational design. Seventy-one IBD patients matched by propensity score to 71 healthy employees (control group) were included. Blood was taken from both groups at predetermined times before and after the third booster vaccination. Results All patients with IBD (n=71, 100%) received immunomodulatory therapy. The mean antibody level before the third vaccination was 1352.88 U/ml (SD= 1011.489) in the IBD group and were not lower compared to the control group (p= 0.088). Gender, age, and disease duration had no significant impact on the development of antibody levels. Patients with TNF-alpha blockers had significantly lower antibody titers (p=0.011) compared to the control group. Patients with integrin inhibitor therapy had significantly higher antibody titers (p=0.003) than the controls. After the third vaccination, an increase in antibody titers was recorded in all patients in the IBD group. Conclusion We recorded an antibody titer in all patients with IBD that was not significantly lower compared to healthy controls despite immunomodulatory therapy. The booster vaccination led to an increase in antibody levels in all patients with IBD.

Клінічна характеристика пацієнтів похилого віку з ураженням основного стовбура лівої коронарної артерії

​The​ ​aim – to analyze the clinical features of elderly patients with left main coronary artery disease (CAD).Materials and methods. This prospective cohort study included 124 patients with left main CAD aged 60 to 75 years (elderly age group) and 100 control patients aged 44 to 60 who underwent coronary angiography between September 2021 and July 2024. Demographic data, history of coronary artery disease and associated diseases, laboratory test results, results of echocardiography and coronary angiography were collected and analyzed. Results. Elderly patients were characterized by a significantly higher (p = 0.030) frequency of myocardial infarction, as well as higher (p = 0.035) frequency of previous percutaneous coronary interventions compared to middle-aged patients. Elderly patients also had a significantly higher functional class according to NYHA compared to middle-aged patients (p = 0.0005), significantly higher rate of arterial hypertension (p = 0.012), diabetes mellitus (p = 0.033), cerebrovascular disease (p = 0.009), chronic kidney disease (p = 0.011) and anemia (p = 0.044), compared to middle-aged patients. Moreover, elderly patients were characterized by significantly higher creatinine, LDL and glucose levels.Conclusions. Elderly patients with left main CAD were characterized by a more severe course of the disease, more severe coronary lesions, and a higher frequency of concomitant cardiac and non-cardiac diseases compared to middle-aged patients.

Electrical stimulation methods for scoliosis in children: a literature review

Introduction. Scoliosis is one of the most common orthopedic diseases of childhood and adolescence, leading to disability and reducing the child’s quality of life. The prevalence of scoliosis in the structure of pediatric orthopedic pathology reaches 30 %. In 50 % of cases, the disease is characterized by a severe progressive course, especially during puberty. Aim. Studying the effectiveness of electrical stimulation methods for scoliosis in children to develop recommendations for their practical use based on the analysis of systematic reviews and randomized controlled trials. Materials and methods. The search was carried out using the database of evidence-based physiotherapy PubMed, Cyberleninka and eLIBRARY using the keywords: «electrical stimulation», «pulse currents», «scoliosis», «children» for the period from 2008–2024.Exclusion criteria: articles published on this topic before 2008. Main content. The main methods of physiotherapy used in the treatment of scoliosis in children are electrotherapy methods, among which electrical stimulation plays a leading role. The advantage of electrical stimulation for scoliosis in children is to provide training in the strength and tone of the back muscles on the side of the deformity. Electrical stimulation is indicated for scoliosis of I and II degrees. The greatest effect in the correction of scoliotic spinal deformity in children is observed with the combined use of electrical stimulation and exercise therapy. This review provides data on the relevance of medical rehabilitation of scoliosis in children, the mechanism of action of electrical stimulation, data on the effectiveness of using electrical stimulation methods for scoliosis in children: sinusoidal modulated currents, diadynamic therapy, transcutaneous electrical neurostimulation, interference therapy, fluctuarization and functional programmable electrical stimulation. Conclusion. Currently, a wide range of electrical stimulation technologies has been developed for the medical rehabilitation of children with scoliosis, among which sinusoidally modulated currents and diadynamic currents are most often used. Transcutaneous electrical neurostimulation, having a predominantly antinociceptive effect, also has an effect on muscle contractions. Functional programmable electrical stimulation of muscles is a promising technology for medical rehabilitation of children with scoliosis, requiring further study and scientific justification.

Clinical and neurological manifestations of COVID-19 and other coronavirus infections: A literature review

As is known, the issues of pathogenesis, diagnosis and treatment of the new coronavirus infection COVID-19 are the most priority areas of scientific research in the modern clinic of internal diseases. The rate of emergence of new scientific data in the leading libraries PubMed, Medline, Cochrane Library and eLibrary, which can potentially be important in the correction of ongoing therapy for infection and its complications, is extremely high. In turn, this dictates the need for a comprehensive discussion of the results of newly published studies. These issues include clinical and neurological manifestations of COVID-19 and other coronavirus infections. The exact mechanism by which the SARS-CoV-2 virus enters the structures of the central nervous system is unknown. Thus, two pathways for the penetration of the COVID-19 pathogen are most actively discussed: the hematogenous pathway (through the systemic circulation into the vessels of the brain with a low linear blood flow velocity, which allows the virus to adhere to the surface of the endothelium and penetrate into the nervous tissue through damage to the latter) and the contact pathway (through the cribriform plate and the olfactory bulb). It should also be noted that a number of experimental works clearly demonstrate the pathogenic effect of other members of the Coronaviridae family on the neurons of the respiratory and vasomotor centers. The review presents an analysis of current literature data on the study of clinical and neurological manifestations of COVID-19 and other coronavirus infections. It is important to emphasize that patients with a severe course of COVID-19 deserve special attention, requiring observation in the intensive care unit in order to prevent the development of fatal neurological complications.

Modifiable risk factors for the development and severe course of diverticular disease: a review

Diverticulosis is a common condition of the bowel, particularly affecting the sigmoid colon with age-dependent increase in prevalence. While often asymptomatic and discovered incidentally during colonoscopies or imaging, some patients experience symptoms like left lower abdominal pain, bloating, and irregular bowel habits. When symptoms arise, it is termed diverticular disease (DD). Approximately 10% of diverticulosis cases progress to diverticulitis, which involves inflammation and can lead to complications like abscesses, perforation, or obstruction. In the U.S., acute diverticulitis accounts for 200,000 hospitalizations annually, costing about $2.2 billion in healthcare. The purpose of this paper is to review the current understanding of modifiable risk factors associated with the development and progression of diverticular disease

Clinical features and natural course of Hidradenitis Suppurativa in Turkey: a multicentre study.

The natural history, the progression of a disease process in an individual over time, has not yet been fully elucidated in hidradenitis suppurativa (HS). In this large multicenter study, we aimed to investigate the natural history of HS and its gender differences. This cross sectional study included 827 patients. The chronological order of the clinical manifestations for each patient were recorded retrospectively. Sociodemographic characteristics, triggering factors, clinical, treatment, and prognostic features were also evaluated. The mean age of disease onset was significantly younger in women than in men (22.42±9.28 vs. 27.06±20.56, p<0.001) and those with a family history (p<0.0001). The mean disease duration was 91.17±83.64 months. The most common symptom was purulent discharge (81%). The mean duration of abscess was shorter in women than in men (3.11±2.65 vs. 3.75±3.75, p=0.01). The axilla was the most common onset area followed by the inguinal and gluteal regions. The disease ran a more severe course in men. Abscess/inflammatory nodule was defined in the last 6 months in 88.6% of the patients; however, the first 5 years of the disease were the most active disease period in 67.5% of the patients. Multivariate analysis revealed being male, older age, family history, involvement of the axillary, inguinal and perianal regions independently associated with HS severity. While antibiotic use was the most important factor in improving the disease symptoms, stress was the most common aggravating factor. Biological therapy in men, laser epilation and pregnancy in women were significant alleviating factors. Whereas, weight gain was a more common aggravating factor for women. HS shows a relentlessly progressive course with inflammatory attacks, but the first years of the disease are the most active period. This study confirms that environmental and hormonal factors may play an important role in the disease course, probably with other endogenous or exogenous factors.

Predictors of lethal COVID-19 in patients of intensive care unit

Goal This study aimed to identify potential independent routine laboratory predictors of lethal COVID-19 in critically ill patients admitted to the ICU from August 1st to October 31st 2021, when the SARS-COV-2 delta variant prevailed in the region. Materials and Methods A retrospective single-center study case-control included 120 patients hospitalized to ICU №2 of the Samara Regional Clinical Hospital named after Seredavin from August 1st to October 31st 2021. The infection with SARS-COV-2 virus was verified with a real-time PCR test of the samples obtained from the nasopharynx. Results The study included 120 patients hospitalized to ICU with a severe form of ARDS caused by COVID-19-associated pneumonia. The results of the comparative analysis showed significant differences between the groups of survived and died patients when they were admitted to ICU. Died patients were older, had lower lymphocyte count, higher levels of glucose, ASAT, CPK, LDH, creatinine, BUN, and potassium, had lower cardiac output, and severe pulmonary lesions. Conclusion The single-center study included 120 patients with a severe form of COVID-19 that required their hospitalization to ICU. Univariate and multivariate regression analysis showed that the levels of LDH, BUN, glucose, ASAT, and lymphocyte count can act as independent predictors of the lethal outcome and have to be taken into account by ICU specialists during the evaluation of the clinical condition of patients for timely indication of the relevant therapy. The obtained data agree with previous studies that aimed to identify predictors of the severe course of COVID-19. However, further multi-center studies on larger cohorts of patients should be conducted for the identification of more precise associations between various predictors of lethality. It will help to reveal patients with a high risk of unfavorable outcomes after admission to ICU.

COVID-19 in children with somatic pathology

The coronavirus infection is a pressing issue in modern healthcare, yet the characteristics of the SARS-CoV-2 infection course in children with comorbidities remain insufficiently studied. The aim of this study was to evaluate the clinical form, severity, and duration of SARS-CoV-2 virus shedding in pediatric patients with somatic diseases, depending on the comorbid pathology. Materials and Methods. A comprehensive single-center retrospective study was conducted, analyzing 314 medical records of patients hospitalized in the infectious diseases department of the Russian Children’s Clinical Hospital in Moscow over 11 months in 2022. The inclusion criterion was the presence of a laboratory-confirmed COVID-19 diagnosis. Results. Children with comorbidities were found to be predisposed to a more severe course of SARS-CoV-2 infection compared to the pediatric population in general. Children with hematological diseases were at the highest risk of adverse outcomes from COVID-19. Patients with oncological and hematological diseases and primary immunodeficiencies shed the SARS-CoV-2 virus significantly longer than patients with other somatic pathologies. The duration of SARS-CoV-2 RNA detection in patients with severe COVID-19 was significantly longer, which also correlated with the severity of the underlying somatic disease. Conclusion. Children with comorbidities are at risk for a more severe and prolonged course of SARS-CoV-2 infection.

STUDIES OF ASTHMA CONTROL IN PATIENTS WITH METABOLIC SYNDROME

Every day, a practitioner is faced with the problem of patient comorbidity. Bronchial asthma is a common problem, as is metabolic syndrome. Due to the increase in allergic diseases and lifestyle changes, patients may have a combination of metabolic syndrome and bronchial asthma. This combination has been shown to aggravate the course of asthma. Therefore, we wanted to confirm or refute this with our study. The study design included 94 patients with a diagnosis of asthma. A comparative analysis of the spirographic study data revealed that patients with asthma + MetS had statistically significant differences (p&lt;0.05). The analysis of anthropometric data revealed that patients with the highest BMI and body weight had a significantly more severe course of asthma (p&lt;0,05), which is consistent with the data of available world studies [24, 25], and a positive correlation was found between BMI, percentage of body fat and lower percentage of body fat in patients with severe asthma (ρ=0,89, ρ=0,90, ρ=0,87; r=0,88, r=0,91, r=0,90, respectively). The data obtained indicate the need for individual management of patients with comorbidities, including MetS and asthma, to prevent severe asthma, which is associated with inadequate asthma control and poor quality of life.

Features of the course of severe acute bronchiolitis of Human Metapneumovirus еtiology in сhildren

Objective. To study the characteristics of severe acute bronchiolitis (AB) caused by hMPV (hMPV-AB). Materials and Methods: This retrospective comparative study included 27 patients aged 2 to 12 months, who were hospitalized from 2021 to 2023 in the Intensive Care Unit (ICU) of the «Kommunarka» Moscow Multidisciplinary Clinical Center. The etiology of AB was determined using polymerase chain reaction. Results. Patients with hMPV-AB had a longer stay in the ICU compared to patients with AB of another etiology (9.0 [5.0; 11.0]; 3,0 [2.0; 4.0] days, p = 0.007). Ratio SpO2/FiO2 was lower in patients with hMPV-AB (190.2 [131.0; 203.3]) compared to patients with AB of another etiology (275.0 [253.0; 340.0], p = 0.001). Rating on the Pediatric Sequential Organ Failure Assessment (pSOFA) was higher in patients with hMPV-AB (5.0 [3.45; 11.0] vs. 1.0 [0.54; 1.93], p = 0.002). One lethal outcome was recorded in the hMPV-AB group. Conclusions. hMPV-AB in children is characterized by a more severe course and requires more intensive treatment compared to AB of other etiologies.

Characteristics of the respiratory season in 2022—23 and 2023—24 according to data from the city children's hospital

The end of the COVID-19 pandemic in the respiratory disease season of 2022—23 was characterized by an increase in the number of cases, a shift in the classic peaks of morbidity for various infections, and a predominance of influenza and respiratory syncytial virus infection (RSVI). Materials and methods. When compared with the last pandemic season, a later start of the 2023—24 respiratory season was noted with a gradual shift to the usual pre-pandemic period timing of viral morbidity increases. Results. The currently prevailing SARS-CoV-2 Omicron variant has acquired the properties of a common respiratory viral infection, currently all-season, with a mild course, without the need for hospitalization. The number of patients with influenza has decreased and there were no patients with a severe course of this infection. A feature of the first post-pandemic season was the outbreak of mycoplasma infection, which was a reason of large number of pneumonia cases.

Dengue Fever—Diagnosis, Risk Stratification, and Treatment.

Dengue fever is a common infectious disease in the tropical and subtropical zones, with more than 100 million symptomatic cases per year. Mosquitoes of the genus Aedes (Aedes aegypti, Aedes albopticus) are vectors of the disease, and their spread has led to rising case numbers around the world. Physicians in Europe, too, are increasingly being confronted by this challenge. This review is based on the findings of a selective search in international publication databases, as well as on the WHO guideline of 2009 and the current recommendations of the Robert Koch Institute. Dengue fever takes a mild course in more than 90% of cases. Severe dengue fever, up to and including shock and/or mucosal hemorrhages, is rare and carries a mortality of 1-5%. The disease characteristically takes a triphasic course (febrile phase, critical phase, recovery phase). It is diagnosed by the direct demonstration of the pathogen (e.g., with the reverse transcriptase polymerase chain reaction [RT-PCR] up to day 5 of the illness) or by serology. Patients are classified into one of three risk groups depending on their findings and comorbidities and are then treated either as outpatients or in the hospital. The treatment is symptomatic, as no treatment directed against the cause of the disease is available. The key measures are adequate volume replacement and, in patients with hemorrhage, the transfusion of blood products. Preventive steps include vaccination after a documented initial infection and the meticulous avoidance of mosquito bites. Climate change and global mobility have led to a worldwide increase in dengue fever. The disease only rarely takes a severe course. In such cases, rapid symptomatic treatment as needed is the key to the avoidance of severe complications.

Viral hepatitis A in children: a false prosperity?

The article presents current data on the state of the issue of Hepatitis A (HA) in children in the Russian Federation and describes clinical and epidemiologic features of rare cases of severe course of the disease, as well as pathogenetic mechanisms of liver damage mediated by cell immune response. Objective. To identify clinical and epidemiologic features of the modern course of HA and its outcomes in children of Saint Petersburg within the period of 2018— 2023. Materials and methods. The study included 89 children diagnosed with HA, undergoing treatment at the Children's Research and Clinical Center for Infectious Diseases from 2018 to 2023. The analysis of disease progression in this group of patients was presented using clinical-anamnestic, epidemiologic, biochemical, virologic and instrumental data. Results. The analysis of infection sources showed a high frequency of HA infection within the family (44.9 ± 0.8%) and significantly less in childcare facilities and schools (7.9 ± 1.0%). The frequency of children with unidentified sources of infection remained high (47.2 ± 0.7%). One-third of all disease cases were imported from southern regions. Most hospitalized children had icteric HA (64.0 ± 0.6%) of moderate severity (79.8 ± 0.5%). Severe HA was observed in 6 patients (6.7 ± 1.0%). During the study, 17 patients (19.1 ± 0.9%) had a prolonged, complicated course of the disease, including ascites and aplastic anemia (12.6 ± 2.2%). Ascites was found in 4 patients with severe severity and in 5 patients with moderate severity of HA. Conclusions. Currently, there is an upward trend in the incidence of HA in the Russian Federation and Saint Petersburg, especially among schoolchildren (56.2%). A rather high frequency of severe (6.7%) and complicated forms (19.1%) of the disease is observed, and the growth of ascites and aplastic anemia cases in HA draws particular attention.

Influence of intestinal permeability and endotoxinemia on the course of asthma in obese patients

Objective. To study the characteristics of asthma with a severe course in obese patients and to evaluate the relationship of the level of intestinal endotoxin (ET) and fecal zonulin with clinical, laboratory and instrumental indicators in such patients. Materials and methods. The study included 98 patients with asthma combined with obesity (group 1 – mild asthma (n = 47), group 2 – severe asthma (n = 51)) and 45 obese patients without asthma composed the comparison group. A complete standard examination and tests were conducted in all the patients. Intestinal ET, fecal zonulin, TNF-a, IFN-g, IL-4, 6, 10, 17, total IgE levels were assessed as well. The IBM SPSS Statistics 26.0 application software package was used for statistical calculations. The results were considered as statistically significant at the level of p 0,05. Results. In patients of both groups, the average age of onset was 43 years. The median duration of BA characteristics was higher in patients of group 2: 14 [10; 19] years (p = 0.013). In all groups, CRPhs values increased significantly and the highest ones were in patients with severe asthma (p 0.001). Significantly lower levels of FVC, FEV1, FEV1/FVC, IL-10 (p0.001) with uncontrolled course of asthma (p = 0.008) and rare control (p = 0.009) occurred in patients of group 2. Higher levels of TNF-a, IFN-g, IL-6,17, intestinal ET, fecal zonulin were revealed in patients of group 2 (p≤0.001). The level of fecal zonulin positively correlated with the level of intestinal ET in patients of group 2 (p0.001, rs=0.813). In patients of group 2 direct correlations of the fecal zonulin and intestinal ET with BMI, WC, HC, WC/HC, lack of BA control, CRPhs, TNF-a, IL-6,17, IFN-g, LDL were established and inverse correlations were with IL-10, HDL, FEV1, AST; a negative correlation of fecal zonulin levels with FVC was also revealed. Conclusions. The obtained results allow us to speak about the existence of a clinical complex “severe asthma – obesity – intestinal endotoxemia and increased intestinal permeability” which is characterized by the predominance of pro-inflammatory markers, increased levels of intestinal ET and fecal zonulin, reduced function of external breathing.

Perithonsillar and parapharyngeal abscess: microbiological and morphological features

Introduction. The most dangerous local complication of acute and exacerbations of chronic inflammatory diseases of the pharynx is the formation of abscesses in the structure of the cellular spaces of the neck. Paratonsillar abscess (PTA) is the most common abscessing lesion. In turn, parapharyngeal abscess (PFA) is often found in patients with PTA as its complication.Aim. To study the clinical, microbiological and pathomorphological features of parapharyngeal complications in patients with PTA.Materials and methods. The analysis of medical records of 50 patients with diagnoses of parathonsillar and parapharyngeal abscesses who underwent inpatient treatment at the otorhinolaryngological department of the N.I. Pirogov State Clinical Hospital No. 1 in the period from September 2021 to April 2023 was carried out. The studied patients were divided into 2 groups. In group 2 of patients (n = 25; F 10, M 15; average age -37.2 years ± 10.8 years) an isolated PTA was diagnosed. In the 2 group of patients (n = 25; F 10, M 15, the average age was 44.6 years ± 14.8 years) PTA was complicated by the development of PFA.Results and discussion. Associations of facultative anaerobic and obligate anaerobic microorganisms were found in all pus aspirates obtained from PTA and PFA. Monocultures of microorganisms were not isolated in any case. The detection of Fusobacterium necrophorum was associated with pronounced necrotic changes in the tissues of the tonsils and surrounding structures; Peptostreptococcus anaerobius with purulent melting of fiber tissue; Veillonella dispar with pronounced infiltrative processes in tissues combined with oral pathology in patients.Conclusions. The most common microorganisms in patients with PTA and PFA were Streptococcus pyogenes and Fusobacterium necrophorum. The activity of Fusobacterium necrophorum is associated with a more severe course of the inflammatory process in the near-pharyngeal space.

Paramagnetic rim lesions are associated with inner retinal layer thinning and progression independent of relapse activity in multiple sclerosis.

Paramagnetic rim lesions (PRLs) are chronic active lesions associated with a severe disease course in multiple sclerosis (MS). This study was undertaken to investigate an association between retinal layer thinning (annualized loss of peripapillary retinal nerve fiber layer [aLpRNFL] and ganglion cell-inner plexiform layer [aLGCIPL]) and PRLs in patients with MS (pwMS). In this study, pwMS with brain magnetic resonance imaging and ≥2 optical coherence tomography scans were included. Cox proportional hazard regression models were performed using progression independent of relapse activity (PIRA) as the dependent variable, and aLpRNFL, aLGCIPL, or the number of PRLs as independent variables, adjusted for covariates. We analyzed data from 97 pwMS (mean age = 35.2 years [SD = 9.9], 71.1% female, median disease duration = 2.3 years [interquartile range = 0.9-9.0]). The number of PRLs was associated with aLpRNFL and aLGCIPL. PIRA was observed in 18 (18.6%) pwMS, with aLpRNFL (hazard ratio [HR] = 1.44 per %/year), aLGCIPL (HR = 1.61 per %/year), and the number of PRLs (HR = 1.24 per PRL) being associated with increased risk of PIRA. The number of PRLs is associated with inner retinal layer thinning and increased risk of PIRA. A combination of PRLs and retinal layer thinning could serve as a surrogate for pwMS at highest risk of disability progression.

Clinical and etiological characteristics and cytokine profile in school-age children with community-acquired pneumonia

The urgent task of modern pediatrics is the study of the etiology and pathophysiology of community-acquired pneumonia in school-aged children due to difficulties in diagnosis and treatment, as well as the high risk of life-threatening complications and death.Purpose. To investigate the activity of pro-inflammatory and anti-inflammatory responses as measured by cytokine levels in the peripheral blood of children with community-acquired pneumococcal and non-pneumococcal pneumonia.Material and methods. The etiology of community-acquired pneumonia was confirmed by comparing the results of rapid testing of pneumococcus in urine and data from traditional bacteriological methods. The study included 118 children (57 boys and 61 girls) aged 7 to 16 years with various morphological variants of community-acquired pneumonia, which were divided into 2 groups. The first group included 28 children with pneumococcal etiology of community-acquired pneumonia, and the second group included 90 patients with non-pneumococcal community-acquired pneumonia. Levels of interleukins IL-1, IL-4, IL-8 and TNF-α were determined in all children by enzyme immunoassays.Results. In the etiology of community-acquired pneumonia in school-age children, atypical pathogens are responsible for more than 50% of cases. The clinical effectiveness of rapid testing of pneumococcal antigens in urine has been shown, and their use in routine pediatric practice has made it possible to timely identify a group of severe community-acquired pneumonia and reasonably prescribe antibacterial medications. It has been demonstrated that pneumococcal-induced pneumonia is characterized by higher levels of proinflammatory cytokines. These levels, along with the clinical course of the disease, confirm the high level of systemic inflammation. Relatively lower levels of proinflammatory cytokines corresponded to a more mild clinical picture of community-acquired pneumonia of non-pneumococcal etiology, which on the one hand may reflect a relatively «balanced» inflammatory response, and on the other hand determine the protracted and polyclinic course of the infectious process.Conclusion. The etiology of community-acquired pneumonia in school-age children is dominated by atypical pathogens. Community-acquired pneumonia of pneumococcal etiology has more severe clinical courses, and their early identification will allow for the appropriate prescription of initial antibacterial treatment.

Role of immunohistochemical prognostic factors in various types of immunotherapy for metastatic melanoma: A retro-prospective study

Background. Anti-PD-1 immunotherapy (IT) is the standard of care for patients with metastatic melanoma. However, in the real world, IT is effective only in a fraction of patients. The lack of valid prognostic factors for various immunotherapy agents warrants a comprehensive and advanced study of this topic. Aim. To improve the outcomes of the first-line therapy for disseminated melanoma based on identifying immunohistochemical predictors of IT efficacy. Materials and methods. Data from 130 patients who were treated with immune checkpoint inhibitors nivolumab or prolgolimab in the first-line therapy for disseminated melanoma between 2017 and 2024 were analyzed. Results. The expression of PD-L110 on tumor cells was found to be a predictor of effective therapy: in the nivolumab group, the 2-year disease-free survival (DFS) with PD-L1 level 10% was high at 79% (95% confidence interval – CI 61–100); the 1-year DFS was 89% (95% CI 78–100) compared to 17% (95% CI 3.2–88) with a lower level of PD-L1 expression (p0.0001). In the prolgolimab group, the 2-year DFS with PD-L110% was also high at 78% (p0.0001; CI 54–100), the 1-year DFS was 94% (95% CI 84–100) compared to 35% (95% CI 17–73) with a lower level of PD-L1 expression (p0.0001). A less severe course of the disease was observed in patients with both peritumoral and intratumoral locations versus those with only peritumoral locations of the immune infiltrate. The study of the presence and form of lymphoid infiltration of the tumor showed the following direct relationship: in the nivolumab group, the 2-year DFS was 94% (95% CI 83–100) compared to 8.3% (95% CI 1.3–54), in the prolgolimab group, the 1-year DFS was 82% (95% CI 68–100) compared to 15% (95% CI 2.6–86); p0.0001. It was found that the predominance of CD8+ over CD4+ is associated with better results of IT: in the nivolumab group, the 2-year DFS was 87% (95% CI 74–100) compared to 19% (95% CI 4–91) in the absence of CD8+ predominance over CD4+; in the prolgolimab group, the 2-year DFS was 73% (95% CI 51–100) in patients with CD8+ predominance over CD4+ (p=0.0001). In patients without CD8 predominance over CD4, 2-year DFS was not achieved. The one-year DFS was 85% (95% CI 70–100) and 25% (95% CI 8.4–76), respectively; p=0.0001. Conclusion. The results of the study suggest that immunohistochemical characteristics such as a PD-L1 expression level 10%, the simultaneous presence of peri- and intratumoral lymphoid infiltration of the tumor, the ratio of the intensity of lymphoid infiltration with tumor-infiltrating lymphocytes (TILs), and the predominance of CD8+ over CD4+ can be considered predictors of IT efficacy with nivolumab and prolgolimab.