Complications Of Coronavirus Infection Research Articles

Relationships of doctors and patients of the infection hospital during the 1st and 2nd waves of the COVID-19 pandemic

Aim. To conduct a comparative analysis of the relationship between doctors and patients in a regional infectious diseases hospital to combat the complications of COVID-19 during the 1st and 2nd waves of the pandemic.
 Materials and methods. The basis of the study was the infectious diseases hospital deployed in the City Clinical Hospital No. 5 in Nizhny Novgorod. The hospital treated patients with complications of coronavirus infection with concomitant therapeutic or surgical pathology. The study was conducted taking into account the principles of robust management through questioning, on issues related to the social characteristics of patients and their subjective assessments of relationships with medical personnel. The scope of the study was 129 people.
 Results. The study did not reveal any changes in the relationship between medical workers and patients; both in the 1st and in the 2nd wave of the pandemic, they were built on mutual respect and empathy: medical workers do their best to support patients, the latter, in turn, understand the difficulties of staff work in an infectious diseases hospital and feel gratitude. The established facts are convincing proof of the high level of readiness of medical organizations and their employees to work in extreme conditions associated with a tense epidemic situation.
 Conclusion. Thus, the results of this study indicate the formation in the 1st wave of the pandemic of a model of relationships built on the principles of mutual trust, support and avoidance of conflicts between doctors and patients of the regional infectious diseases hospital and the preservation of this model during the 2nd wave of the pandemic.

A clinical case of viral myocarditis associated with sars-cov-2 in a health worker

The study of various pathological conditions associated with COVID-19 remains an urgent task. In occupational medicine, COVID-19 is considered as a new biological factor that can occur not only in the environment, but also in production conditions. Medical workers are at an increased risk of infection with the SARS-CoV-2 virus when performing their professional duties, while a new coronavirus infection can be considered as an occupational disease. The presence of severe complications of a new coronavirus infection leading to disability gives relevance to the analysis of the features of occupational diseases of medical workers in order to improve their diagnosis, improve prevention, treatment and rehabilitation. The most important manifestation of a new coronavirus infection is a lesion of the cardiovascular system, one of the possible variants of which may be the development of myocarditis. In the Samara region in 2021–2022, 10 cases of chronic occupational diseases associated with a new coronavirus infection that caused permanent disability were identified to medical workers. Of these, viral myocarditis was diagnosed in four cases and inflammatory dilated cardiomyopathy in one case. The presented clinical case reflects one of the possible serious complications of coronavirus infection – myocarditis, which led to the development of cardiac arrhythmias. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship of the disease with the professional activity of a medical worker. The need for a multidisciplinary approach to the diagnosis of manifestations, treatment of COVID-19 and its complications, with the mandatory participation of a cardiologist, improvement of the examination of the connection of COVID-19 with the profession and admission to work in conditions of high risk of infection with SARS-CoV-2 medical workers is emphasized.

Features of Damage to the Organ of Vision in Coronavirus Infection

Introduction. Recently, there have been a number of reports of damage to the posterior segment of the eyeball (retina and vascular tract) as a complication of coronavirus infection. Moreover, such lesions occur in the long term (after a few weeks or more). We also observed similar changes, sometimes with the development of a second wave of the disease. At the same time, early diagnosis of damage to the microcirculatory bed and phenomena — precursors of thrombosis (blood clotting disorders) is very important.The aim of the study was to determine the types of complications of coronovirus infection on the part of the organ of vision and their clinical form. Creation of methods for early diagnosis of the progression of possible thrombogenic processes in the anterior and posterior segments of the eyeball.Methods. The object of the study were patients with various types of complications due to coronavirus infection. The state of the bulbar microcirculation and the diagnosis of thrombotic symptoms caused by complications of coronavirus infection (COVID-19) were studied.Results. The types of complications of coronovirus infection on the part of the organ of vision and their clinical forms were determined. Methods for early diagnosis of the progression of possible thrombogenic processes in the anterior and posterior segments of the eyeball have been developed.Conclusion. As a result of a survey of 75 patients who had a coronavirus infection, it was revealed that the most common eye complications are anterior and posterior blepharitis, in addition, in some cases, damage to the microcirculatory bed of the bulbar conjunctiva was found in the form of arteriolar and venular angiitis and damage to the vessels of the posterior segment of the eyeball.

ИЗМЕНЕНИЕ ПЛОЩАДИ ПОРАЖЕНИЯ ЛЁГКИХ У ПАЦИЕНТОВ С COVID-19 В СВЯЗИ С ГЕНДЕРНО-ВОЗРАСТНЫМ АСПЕКТОМ

The method of computed tomography has been widely used in the differential diagnosis of a new coronavirus infection. Thanks to it, a quantitative analysis of the patterns of manifestation of coronavirus pneumonia is possible. The aim of the study was to study the features of anatomical and morphological manifestations and complications of coronavirus infection, to determine the correlation of the data obtained with the gender and age structure of patients. Materials and methods. The study is based on a retrospective analysis of medical records of patients hospitalized in the State Medical Institution of the Republic of Moldova "Republican Clinical Hospital No. 4", Republic of Mordovia, Saransk. The case histories of 20 hospitalized patients (10 men and 10 women) with COVID-19 diagnostic criteria ranging from 28 to 84 years (average age 62 years) were analyzed. The correlation analysis of the results of quantitative evaluation of the detected patterns with gender-age structure was performed. Results: the distribution by gender structure revealed no patterns. A large proportion of cases belong to the range of 61-70 years (40%). The most common pattern is frosted glass. Most of the patients were assigned to the first group of CT lung lesions. In addition, all patients had out-of-hospital bilateral polysegmental pneumonia, with varying degrees of severity, which corresponded to the course of coronavirus infection. The study found that the average duration of disability was 23 days, the minimum – 6 days, the maximum – 58 days. Conclusion: a correlation has been established between gender and age and coronavirus infection: in the range of 60-80 years, 33% more men are ill than women, and men in this cohort have a more severe course of coronavirus infection.

Combination of granulomatosis with polyangiitis with COVID-19: difficulties in differential diagnosis and treatment

The article presents a prospective clinical observation with a fatal outcome in a patient with severe granulomatosis with polyangiitis (GPA) complicated by COVID 19 on the background of immunosuppression. At the onset of the disease, there were difficulties in making a diagnosis; differential diagnosis between eosinophilic granulomatosis with polyangiitis (EGPA) and GPA was carried out. Against the background of combined therapy — the use of high and ultra-high doses of glucocorticoids (GC) and cytostatic drugs, a short-term improvement was noted. However, within a year and a half of treatment, it was not possible to achieve remission of the disease. Taking into account the ineffectiveness of the therapy, by the decision of the medical commission, the patient was prescribed genetically engineered biological therapy rituximab (RTM). There was a decrease in the activity of the disease, the achievement of depletion of B-cells. During the pandemic period, despite observing the isolation regime, the patient fell ill with a coronavirus infection. Immunosuppression contributed to severe infection. After the infection was treated, the activity of vasculitis increased, which required the repeated administration of RTM for health reasons. During the therapy it was short-term stabilization of the condition. But after short period — fever, an increase in respiratory failure, the development of neutropenia. Taking into account the initial lesion of the lungs in the patient, differential diagnostics was carried out between the complications of coronavirus infection and the activity of the underlying disease. Despite anti-inflammatory, anticoagulant, antibacterial therapy, the patient's condition progressively worsened, respiratory failure increased, hemoptysis appeared. Spontaneous pneumothorax on the right was diagnosed, pneumomediastinum. After repeated negative PCR results, the causative agent of SARS COV-2 was again detected in smears. The immediate cause of death, according to clinical observation and autopsy, was severe respiratory failure, thrombosis in small vessels of the lungs in a patient with a new coronavirus infection against the background of immunosuppression for GPA.

COVID-19 in a medical worker and issues of examination of the relationship between disease and occupation

One of the most important complications of the novel coronavirus infection is damage to the nervous system. From the point of view of pathogenesis, neurological disorders in COVID-19 can be caused by a "cytokine storm", hypoxemia, homeostasis disorders (encephalopathy of critical conditions), neurotropy and neurovirulence of SARS-CoV-2 (isolated cranial nerve damage, focal and diffuse central nervous system lesions), as well as mixed effects of these factors. COVID-19 also affects the course of chronic neurological diseases. The range of neurological disorders in COVID-19 is wide: from cranial mononeuropathy, clinically manifested by anosmia and ageusia/dysgeusia, to acute Guillain-Barré inflammatory polyneuropathy and severe lesions of the brain and spinal cord in the form of acute hemorrhagic necrotizing encephalopathy and myelopathy. The new coronavirus infection can be regarded as an occupational disease in medical workers if the infection occurred while they were performing their professional duties. In the presented clinical case, one of the possible serious complications of the coronavirus infection is described, i.e. lesion of the central nervous system (encephalopathy) in a medical worker. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship of the disease and professional activity. The need for a multidisciplinary approach to the diagnosis and treatment of COVID-19 and its complications with the mandatory participation of a neurologist is emphasized.

A clinical case of inflammatory cardiomyopathy due to subacute viral myocarditis associated with the novel coronavirus infection in an ambulance worker (issues of diagnosis and examination of the relationship between disease and occupation

Medical workers are a group at increased risk of infection with the SARS-CoV-2 virus when providing medical care in modern conditions. The novel coronavirus infection can be considered as an occupational disease in medical workers if the infection occurred while performing their professional duties. One of the most important complications of the new coronavirus infection is the lesion of the cardiovascular system. The presented clinical case reflects one of the possible serious complications of the coronavirus infection that developed in a medical worker against the background of chronic autoimmune pathology, i.e. severe myocarditis with pulmonary embolism, which led to the formation of inflammatory cardiomyopathy with congestive heart failure. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship between the disease and professional activity.

Provision of psychiatric community treatment in the context of a pandemic of a new coronavirus infection abroad (review article)

This review analyzes the foreign experience of providing community psychiatric care in the context of a pandemic of a new coronavirus infection. The situation that has arisen in the context of a pandemic of a new coronavirus infection has become unprecedented and has made adjustments in the provision of medical care, including psychiatric. Patients with mental illness are themselves more vulnerable to infection, spread and complications of coronavirus infection. They often violate the self-isolation regime, do not perform protective measures, and suffer from comorbid pathology (obesity, diabetes, hypertension). As it turned out, the coronavirus affects the concentration of some psychotropic drugs in the blood, and it also becomes difficult to prescribe others with the development of complications of COVID-19. The need to convert the hospital bed capacity into infectious diseases has led to a reduction in the number of places in round-the-clock psychiatric hospitals and the duration of treatment in them. All these aggravating factors contributed to the priority development of outpatient psychiatric care in comparison with inpatient in a pandemic. Assertive community treatment has undergone a number of changes: the number of home visits compared to visits to health facilities has increased, prescription durations or medication provision have been increased for stable patients, and there has been an increase in the switch from oral to long-acting injectables. Many researchers note that the pandemic has positively contributed to the rapid introduction and spread of telemedicine, but also emphasize that this should not be to the detriment of the patient. The experience of providing psychiatric care in a pandemic is gradually accumulating and systematizing, which is necessary in the future, since these realities are likely to be repeated.

On the issue of post COVID-19 condition in patients with rheumatic diseases

Actual problems of rheumatology include the possibility of developing a wide range of long-term consequences of COVID-19, so-called post-COVID syndrome (PCS). The results of our own research are presented, during which among 45 patients over 18 years with rheumatic diseases (RD) PCS was detected in 20% cases: 6 of them had ANCAassociated vasculitis (AAV) and one each for rheumatoid arthritis, juvenile arthritis and osteoarthritis. In AAV cases PCS was more severe and varied than in other RD: lung lesions according to computed tomography (up to the damage 75% of the lung parenchyma), skin an d nervous (Guillain–Barré syndrome) lesions, myalgias, arthralgias were present. In most patients PCS ended in recovery, sudden death occurred only in the patient with AAV. The frequency of RD’s relapses in patients with PCS was 9%. Relapses were not noted in AAV, against the background of anti-B cell therapy with rituximab. Our own results and literature data indicate that patients with RD after COVID-19 need careful continuous monitoring to detect long-term complications of coronavirus infection and early diagnosis of relapses of the underlying disease.

COVID-19 Infection and Acute Kidney Injury: About 43 Cases Report Collected at the Nephrology Department of the Farah Polyclinic in Abidjan

Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) during Coronavirus disease (COVID-19) in Abidjan, C?te d’Ivoire. Material and Method: This was a monocentric retrospective analytical study of all patients over 18 years of age with AKI during COVID-19 at the Farah Polyclinic in Abidjan, C?te d’Ivoire. AKI was defined and ranked according to Kidney Disease Improving Global Outcomes (KDIGO) 2012. The data were collected from the medical record and processed using RStudio. Results: Forty-three cases were collected. The average age was 58.5 12 years. The sex ratio (M/F) was 4.4. The main comorbidities were high blood pressure (60.4%) and diabetes (37.2%). AKI was at KDIGO stage 3 in 58%, KDIGO 2 in 21% and KDIGO 1 in 21%. The diagnosis of acute tubular necrosis was retained in 44.2% of patients followed by acute functional kidney injury in 32.6%. Hemodialysis was initiated in 48.8% of cases. The main indication of dialysis was anuria (46.6%). In total, 55.8% of patients died. Factors associated with death were KDIGO stage (p = 0.049), and invasive ventilation (p < 0.001) associated with the risk of death in univariate analysis. Conclusion: Mortality is high in patients with AKI during COVID-19 infection.

CT Diagnosis of Complications Arising from the Natural History and Treatment of COVID-19

Computed tomography for coronavirus infection (COVID-19) is effective not only in making a diagnosis, but also in timely and accurately detecting some complications of this disease in different organs and systems. The paper shows various complications of coronavirus infection that a radiologist may face in practice, which develop both in the natural course and due to therapy for COVID-19, including hemorrhagic and thrombotic events in coagulopathy, pneumothorax, and pneumomediastinum as a result of the direct cytotoxic effect of SARS-CoV-2 on pneumocytes, and barotrauma during mechanical ventilation, as well as pathological fractures due to osteoporosis, including steroid osteoporosis that has developed during therapy with glucocorticosteroids. It considers the main causes and pathogenesis of various complications of coronavirus infection.

Our experience of rare otolaryngological complications of coronavirus infection

Introduction: COVID-19 disease can lead to serious complications of the ENT organs. Among them are the developments of aseptic thrombosis of the arteries of the ENT organs and face, as well as auditory dysfunction. Purpose: to investigate changes in auditory function and blood supply to the ENT organs of patients which underwent coronavirus COVID-19. Materials and methods: examination and treatment of patients with complications of coronavirus infection: facial soft tissue thrombosis (2) and auditory dysfunction (38). The results obtained: Coronavirus infection in two patients resulted in thrombosis of the soft branches of the internal and external carotid arteries with the development of necrosis of the mucous membrane of the lateral wall of the nose, nasal sinuses, septum and palate, which required surgical treatment. Acute sensorineural hearing loss with an increase in thresholds of sound perception to 40 dB was observed in 23 (60.5%) patients, and most of them (19 people) suffered from severe coronavirus infection and received comprehensive treatment (hormones, anticoagulants, etc.). Hearing loss with an increase in the threshold of sound perception to 40-60 dB was determined in 15 (39.5%) patients, of whom only 5 underwent severe COVID-19. Conclusions: Patients who have undergone a coronavirus infection caused by the SARS-CoV-2 virus may develop otolaryngological complications in the form of auditory dysfunction or arterial thrombosis. More severe bilateral damage to the auditory analyzer occurs in patients who underwent mild COVID-19 and did not receive anti-inflammatory therapy. The use of glucocorticoids and anticoagulants for the treatment of coronavirus infection on time prevents the development of complications from the auditory analyzer and blood coagulation system.

COVID-19 Associated Spontaneous Bowel Perforation

The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients’ demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.

ХІРУРГІЧНЕ ЛІКУВАННЯ ТОРАКАЛЬНОЇ ПАТОЛОГІЇ У ХВОРИХ НА КОРОНАВІРУСНУ ІНФЕКЦІЮ

THORACIC SURGICAL TREATMENT IN PATIENTS WITH CORONAVIRUS INFECTION M. S. Opanasenko, B. M. Konik, S. M. Belokon, O. V. Tereshkovich, S. M. Shalagai, L. I. Levanda, M. I. Kalinichenko, V. I. Lysenko, M. U. Shamrai, A. M. Stepanyuk, O. D. Shestakova Abstract Aim. To familiarize physicians of different specialties with thoracic pathology in patients with coronavirus infection (COVID-19). Materials and methods. Since the beginning of the COVID-19 pandemic 63 patients were treated at the department of surgical treatment of tuberculosis and NLD, complicated by purulent-septic infections: 47 (74.6%) — with various complications of coronavirus infection, and 16 (25.4%) — COVID-19 and conditions, requiring thoracic surgery, not associated with COVID-19. Results. Pleural empyema was the most common bacterial complication — 18 (28.5%) cases. Only 6 (9.5%) patients were diagnosed with broncho-pleural fistula, while 12 (19.6%) patients already had a functioning broncho-pleural fistula at the stage of hospitalization. In 15 (23.8%) patients, the destructive cavities remained on admission, and only 3 (4.7%) had isolated pleural empyema without destruction of pulmonary parenchyma (complete scarring of abscesses). 17 (26.9%) patients with empyema underwent videothoracoscopic (VATS) drainage of the pleural cavity with polydrainage and the use of long-term active aspiration in the postoperative period. In 1 (1.5%) case, due to the extremely severe condition of the patient, only drainage of both pleural cavities was performed. 1 (1.5%) patient with bilateral pleural empyema died of progressive respiratory and cardiovascular failure. Nonspecific exudative pleurisy was diagnosed in 8 (12.6%) patients after coronavirus infection. Spontaneous pneumothorax without development of pleural empyema was diagnosed in 7 (11.1%) patients and in 3 (4.7%) cases pneumo hemothorax occurred. in 2 (3.1%) cases there was a need for parietal pleurectomy (there was a significant area of detachment of the visceral pleura and the impossibility of imposing intracorporeal sutures). All patients were discharged from the hospital with recovery. 6 (9,5 %) patients with necrotizing pneumonia comprised a challenging group of patients with large, treatment-resistant cavities. In 4 (6.3%) cases antibacterial therapy was ineffective, so transthoracic cavity drainage was performed. All 6 patients underwent radical resection interventions following long pre-operative period: 3 (4.7%) cases - pleurolobectomy, 2 (3.1%) — sublobar resection and 1 (1.5%) - resection of the 6th segment of right lung). Conclusions. Pulmonary purulent-destructive COVID-19 complications may occur much more rarely if timely treatment was used. Videothoracoscopic intervention is a preferred option of treatment of these conditions. Key words: COVID-19, thoracic pathology pneumohemothorax, pleurodesis. Ukr. Pulmonol. J. 2021;29(3):31–35:

Reader response: Neurologic complications of coronavirus infections.

I read the editorial by Dr. Nath1 with interest. One aspect of the CNS involvement in SARS-CoV-2 infection that has attracted little interest so far is the medium- or long-term consequences on patients with neurodegenerative diseases (NDD). It is known that chronic neuroinflammation has been associated with the neuropathophysiology of some NDDs such as multiple sclerosis, Parkinson disease, Alzheimer disease (AD), and others.2 In the case of AD, in the presence of proinflammatory cytokines/chemokines, the microglia loses ability to phagocytize the Aβ protein, favoring the pathogenic deposits.3 Similar evidence exists in other NDD.4 The cytokine storm of SARS-CoV-2 infection involves the activation of a neuroinflammatory cascade similar to that described in NDD.5 Furthermore, the possibility that this molecular movement may be persistent over time after acute infection is eliminated in a similar way to what occurs in the so-called “persistent inflammation-immunosuppression and catabolism syndrome.”5 Finally, we do not know whether SARS-CoV-2 may have the ability to remain latent in the CNS in a similar way as other coronaviruses do,6 increasing the possibility of sustained neuroinflammation. The repercussion on the population vulnerable to NDD is unknown but will force us to be attentive to the future of our patients.