Convalescent Period Research Articles

Urine excreted antibodies significance in the hemorrhagic fever with renal syndrome specific diagnosis

Relevance. Hemorrhagic fever with renal syndrome (HFRS) is an acute viral zoonosis. Being widespread in Eurasia, it holds a leading place in Russia among natural focal human diseases. The vast majority of HFRS cases in Russia, about 98%, are associated with Puumala virus. The disease is characterized by a wide range of clinical manifestations. Early specific diagnostics appears to be of a great importance for starting timely pathogenic therapy. The aim of the study was to clarify the diagnostic value of detecting hantavirus antibodies in the HFRS suspected patient urine. Materials and methods. Blood sera and urine samples from 68 patients at the Infectious Diseases Hospital in the city of Ufa, obtained with a 2-day interval, as well as urine and blood serum samples from 15 convalescents 1, 2, 3 and 6 months after disease onset were examined for hantavirus antibodies. 53 blood sera and urine samples from patients residing in Moscow, Moscow and Samara regions collected at different time points during the disease course were investigated in parallel. Antibodies were detected by the indirect immunofluorescence method. Results. On day 3, 4, 5 and 6 of disease, while specific antibodies were detected in the blood serum, antibodies in the urine were found in 85.7%, 89.4%, 93.1% and 100% of patients, respectively. The peak quantity of antibodies was excreted in the urine from days 5 to 11, which corresponds to the oliguric stage of the disease. In the convalescent period, antibodies were still detected in urine 1, 2 and 3 months afterwards in 86.7%, 46% and 20% of cases, respectively, but not detected 6 months later, which probably reflects the process of long-term restoration of the kidneys function. A moderate positive correlation between specific antibodies in serum and urine was observed only in the oliguric period of the disease. Conclusions. Detection of hantavirus antibodies simultaneously in blood serum and urine of febrile patients instead of paired blood sera allows to conduct HFRS diagnostics within the very first days of hospitalization and prevent severe complications due to timely pathogenic therapy.

N-acetylcysteine as a therapeutic approach to post-COVID-19 pulmonary fibrosis adjunctive treatment.

Growing interest is directed to the outcomes of COVID-19 in survivors, both in the convalescent period and in the long-term, which are responsible for morbidity and quality of life deterioration. This article aims to describe the mechanisms supporting the possible use of NAC as an adjuvant treatment for post-COVID-19 pulmonary fibrosis. A search was performed in PubMed/MEDLINE. Interstitial changes have been observed in the CT scan of COVID-19 pneumonia. In patients with respiratory outcomes in the post-COVID-19 stage, glutathione (GSH) deficiency was found and interpreted as a reaction to the inflammatory cascade caused by the viral infection, while the pathophysiological process of pulmonary fibrosis involves numerous cytokines, such as TGF-β, TNF-α, IL-1, PDGF and VEGF. NAC has a good tolerability profile, is easily administered orally and inexpensively, and has antioxidant and anti-inflammatory effects that may target the pathophysiologic mechanisms involved in pulmonary fibrosis. It may revert GSH deficiency, exerts direct and indirect antioxidant activity, anti-inflammatory activity and improves immune T-cell response. The mechanism of action of NAC suggests a role in the treatment of pulmonary fibrosis induced by COVID-19.

Severe diseases of the anterior segment of the eye accompanied by somatic pathology and COVID-19: clinical cases under the pandemic

The article presents three clinical cases of severe pathologies of the anterior segment of the eye, which developed in patients with serious concomitant somatic diseases and COVID-19 under the pandemic. Our observations show that the SARS-CoV-2 virus can contribute to the onset of severe keratitis and keratouveitis, characterized by a long torpid course, relapses, and a poorly predicted outcome. In patients with coronavirus and severe somatic pathology, these diseases have atypical symptoms that complicate the diagnosis, are resistant to treatment, and require an extended period of convalescence. This can be explained by pronounced vascular inflammatory reactions, a possible invasion of eye tissue by viral particles, disruption of tear production, a decrease in local immune defense factors of the eye and systemic immunity, and a violation of the hemato-ophthalmic barrier. Local and general drug treatment brought weakly positive changes. The course of the disease took an undulating character. The description of the clinical cases reflects the polymorphism of symptoms and the multiorganic character of damages associated with COVID-19.

A novel angiographic classification of pseudoaneurysms of the pulmonary chronic inflammatory cavity based on selective angiograms and therapeutic implications.

BackgroundHemoptysis is a common clinical symptom. In the chronic tuberculosis cavity and chronic necrotizing pneumonia cavity, pseudoaneurysms (Pas) easily form and are prone to massive hemoptysis and repeated hemoptysis and can even endanger patient's life. However, it remains to be further analyzed whether Pas of the pulmonary chronic inflammatory cavity selectively affect the peripheral pulmonary branches. This study is based on selective angiography to classify peripheral pulmonary arterial Pas (PAPs) of the pulmonary chronic inflammatory cavity and to determine treatment options for PAPs, thereby guiding individualized clinical treatment.MethodsAngiographic data of 392 noncancer patients undergoing hemoptysis were retrospectively analyzed. All of the patients underwent pulmonary and selective pulmonary angiography and bronchial and nonbronchial systemic collateral arterial angiography. A total of 9 patients had Pas of the pulmonary chronic inflammatory cavity, and a pseudoaneurysm systemic artery collateral (Pasac), inflow and outflow sections of the parent vessels, and direction of blood flow in the parent vessels were clearly observed with digital subtraction angiography (DSA) and/or C-arm cone-beam flat-panel detector computed tomography angiography (CBCTA). Patients with underlying disease had pulmonary tuberculosis (n=8) or lung abscess (n=1). The angiographic types of Pas were analyzed.ResultsEight patients with chronic pulmonary tuberculosis and 1 patient with a necrotizing pneumonia cavity in the convalescent period were included in the study. Pas of the pulmonary chronic inflammatory cavity presented the following types: (I) pulmonary artery pseudoaneurysm (PAPa) (n=2 cases); (II) body arterial Pa (n=3 cases); and (III) systemic-pulmonary anastomosis Pa. Each type could be divided into two subtypes (n=4 cases). In nine cases, embolization and hemostasis were technically and clinically successful.ConclusionsPas of the pulmonary chronic inflammatory cavity are diverse (especially in cases of pulmonary tuberculosis). Angiographic typing plays a guiding role in the selection of an embolization strategy.

Concomitant acute lower extremity arterial and deep vein thrombosis developing in a patient under anticoagulant therapy after COVID 19 infection.

The hypercoagulable state continues after the Coronavirus 2019 (Covid 19) infection and prophylactic anticoagulants are recommended in this period. However, arterial and venous thromboembolic events can be observed during the convalescence period after the Covid 19. Here, we present the case of acute lower extremity arterial and venous thromboembolism developed in the post-Covid 19 period in a 77-years-old patient, under therapeutic doses of anticoagulant therapy (enoxparin 1mg/kg of weight every 12 hours). The patient, who had no previous history of arterial or venous thrombosis, was taken to emergency surgery with the diagnosis of ALI (acute limb ischemia) due to acute arterial thrombosis. An arterial thrombectomy was performed with the help of a 4F Fogarty catheter inserted from the left femoral artery under local anesthesia. All distal pulses of the patient were palpable in the postoperative period. After the platelet count became >100,000 mm3, 100 mg of acetylsalicylic acid daily was added to the therapeutic dose of enoxaparin sodium treatment. The patient was discharged, uneventfully, except for a minimal diameter increase secondary to deep venous thrombosis (DVT) on the fifth postoperative day, with a combination of enoxaparin and acetylsalicylic acid treatment. Endothelial injury, chronic immuno-thrombogenicity, and increased platelet aggregation in the post-Covid 19 recovery period can cause major thrombotic events, even weeks after the recovery. Anticoagulant therapy is recommended for thromboprophylaxis when the following statuses exist: ≥65 years, critical illness, cancer, prior VTE, thrombophilia, severe immobility, and elevated Ddimer. Combination treatment with long-term antiaggregant therapy may be prudent in thromboembolic events developed under anticoagulant therapy.

Impact of Mobile Learning on Stress and Self-Efficacy among Diabetic Patients with COVID-19

Currently, the whole world is struggling with a crisis known as the COVID-19 pandemic, which has been proven as a highly fatal and contagious disease. Many diabetic patients who are currently recovering from the convalescence period of the COVID-19 disease face some other problems caused by this disease such as depression, loneliness, and stress, as well as lack of sufficient knowledge in self-care other than the physical and psychological problems that they have already experienced due to diabetes. Accordingly, this situation was particularly intensified since the existence of various and sometimes contradictory sources of information and the absence of media literacy provided the context for the emergence of anxiety and inability in making decisions on the accurate and appropriate use of the relevant information. The easy and wide access to mobile services, including SMS service, has nowadays provided specific features, which could effectively serve in health interventions such as providing low-cost and available care for everyone.

Assessment of neutrophil degranulation intensity and changes in neutrophil phenotype by FCᵧRIIIB expression level in blood of patients with COVID-19 and convalescents

Introduction. Disease severity in hospitalized COVID-19 patients correlates with the relative content in the blood of a specific low-density neutrophilic granulocyte (NG) population, whose cells are characterized by reduced granularity, high heterogeneity in the expression of FcᵧRIIIb (CD16) and a tendency to spontaneous autolysis (netosis).The aim of the study was to compare the intensity of NG degranulation and the FcᵧRIIIb expression by these cells in blood of patients with COVID-19 and convalescents.Materials and methods. The blood leukocytes of 40 patients diagnosed with COVID-19, 33 convalescents and 20 healthy donors (control) were examined using flow cytometry. To identify NG (CD16+-granulocytes) and to assess the surface expression of the netosis molecular trigger (FcᵧRIIIb), a single-color reagent of labeled monoclonal antibodies CD16-FITC was used. Immunophenotyping of lymphocytes was performed using two four-color reagents. In addition, cell debris content was determined in each Lyse/No-Wash-stained whole blood sample. The presence of neutrophils at the stage of netosis was confirmed by microscopy. Cytokine production was determined on an automatic enzyme immunoassay analyzer.Results. Against the background of characteristic changes in the lymphocyte subpopulation composition and cytokine production, in blood of COVID-19 patients with acute pneumonia, hypoxia and tachycardia a more intense degranulation of NG (2.6 times), higher degree of CD16 expression heterogeneity (1.8 times) and an increased leukocytolysis intensity (1.6 times) were observed compared to convalescents who have undergone severe and moderate forms of the disease. In convalescents, the degree of differences of these indicators compared to control values varied in concordance with the disease severity.Conclusion. The nature of changes in the parameters studied in COVID-19 patients in the acute phase of the disease and during the period of convalescence confirms the possible mechanism of the development of complications due to an imbalance between the activity of elastase released from NG granules and its plasma inhibitor α1 -antitrypsin.

Correlation between Post-COVID-19, Chemosensitive Function, Blood Group, and Oral Health-Related Quality of Life.

Materials and Methods A cross-sectional information on demographics, symptomatic disease status, ABO blood group, and oral health-related quality of life (OHRQoL) was collected among 100 patients who were earlier tested positive for COVID-19 reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and were now reporting to the College of Dentistry for routine treatment after recovery. Objective evaluation of olfactory and gustatory disturbances was elicited using the Connecticut Chemosensory Clinical Research Center (CCCRC) test and gustatory function testing. Furthermore, OHRQoL was assessed using Oral Health Impact Profile (OHIP-14). Results More than half of the patients (62%) had some form of olfactory dysfunction/alteration, and 42% had poor CCCRC scores. About 14% reported ageusia, while 68% reported some form of taste alterations, and 55% reported poor OHRQoL. A statistically significant difference was reported between different ABO blood groups and subjective loss of smell (p < 0.05). The subjective loss of taste, CCCRC score, and dysgeusia were found to be independent of OHIP-14 (p > 0.05), but the taste intensity score was dependent on OHIP 14 (p < 0.05). Moreover, a majority (70.8% and 70.0%) with poor OHIP-14 scores had taste intensity scores of 3 and 4, respectively, while those with moderate (68.4% and 48.6%) OHIP-14 had scored 1 and 2, respectively. Conclusion Olfactory and gustatory disturbances were found to be a long-term feature in post-COVID-19 patients. The blood group is a predisposing factor for persistent smell alterations in post-COVID-19 patients.

Abstract 504: Atherosclerotic Plaque Residing T Cells Display Cross Reactivity Between Viral And Self-epitopes

Background: Vascular thrombosis has been described in patients actively infected with influenza and, more recently, with the coronavirus. The risk may persist during the convalescence period. The underlying mechanisms mediating these events remain unclear. Objective: To determine whether human coronary plaque T cells reactive to influenza virus are also activated by self-proteins. Methods/Results: Using single cell targetRNAseq, we mapped the T cell repertoire in 19 patients with a range of coronary artery disease severity. To determine the potential peptides activating coronary plaque T cell receptors (TCRs), we matched TCR alpha and beta identity with HLA restriction to a database of known specificities. We found that plaque TCRs were potentially activated by viral epitopes, including those from the influenza M1 protein. We used a computational algorithm to identify self-proteins in the endothelial cells and vascular smooth muscle cells that may have peptides with similar homologies to viral epitopes predicted to bind our plaque TCRs. We then introduced plaque TCRs into the Jurkat T cells, exposed these cells to T2 (HLA-2 antigen presenting cells), viral peptides (e.g., M1) and self-epitopes (e.g., TSPAN17; ZIP9), and demonstrated T cell cross reactivity in vitro ( Figure 1 ). TSPAN17 is a transmembrane protein that regulates VE-cadherin expression and promotes T cell transmigration. Zip9, in contrast, is a protein that regulates zinc homeostasis, serves as an androgen receptor on endothelial cells, and has been shown to promote endothelial proliferation. Conclusion: Taken together, our findings suggest that T cell cross reactivity may be a potential mediator of viral-induced arterial thrombosis.

Profile of antiphospholipid antibodies and complement system in COVID-19 patients of different severity

COVID-19, a severe acute respiratory syndrome caused by SARS-CoV-2, may predispose to thrombotic events, especially when combined with antiphospholipid antibodies (aPL). However, there are limited data on prevalence and antigenic specificity of aPL in COVID-19. Complement activation is assumed to play an important role in pathogenesis of COVID-19-associated coagulopathy. During the SARS-CoV-2 pandemic, it is necessary to identify important biomarkers for predicting severe course of COVID-19 and risk of thrombotic complications. Our objective was to evaluate the aPL profile, quantitative content and activity of complement and its components in COVID-19 patients graded by severity in the course of time. IgM and IgG antibodies to cardiolipin (CL), phosphatidylserine (PS), β2-glycoprotein-I (β2-GP-I), prothrombin (PT), annexin V (An V), as well as C1q complement component, content of its C3 and C4 components and total complement activity were determined in blood serum using ELISA approach. 141 patients with COVID-19 were included in the study. Group 1 consisted of 39 patients with mild form, group 2 (65 patients) presented with moderate form, and group 3 included 37 patients with severe form of COVID-19. Blood samples were obtained on day 3-7 of the disease (1st point) and after 14-28 days (2nd point). The results were as follows: aPL were detected in 29.1% of the total COVID-19 cohort, frequency of aPL detection by the severity grade did not differ (33.3%, 24.6% and 32.4%). In 8.5% of the patients, aPL were detected only at the 1st time point; in 14.2%, only at the 2nd point; and in 6.4% of the cases, at the both time points. Antibodies to PT (16.3%) and An V (11.3%) were revealed more frequently. The detection frequency of antibodies to PT was significantly higher than antibodies to CL and PS (7.1%), β2-GP-I (7.8%). The prevalence of aPL in groups 1 and 3 did not differ. At the 1st point in group 3, increased levels of C4 (89.2%) and C3 (24.3%) in blood, and a decrease in complement activity (35.1%) were more often observed than in group 1. At the 2nd time point in group 3, a decrease in complement activity was often detected (59.5%). The C3 levels exceeding 720 μg/ml were found to predict a 2.6-fold increased risk of severe COVID-19, and this risk became 3.3 times higher at C4 levels of &gt; 740 μg/ml. The antibodies to PT and An V are often detected in COVID-19 patients, along with low prevalence of antibodies to CL and β2-GP-I. These antibodies can be involved in pathogenesis of COVID-19-associated coagulopathy, being detectable at the late stage of the disease, and they may trigger APS in predisposed patients and reconvalescents. Although presence of aPL antibodies is not associated with COVID-19 severity, their persistence over the period of convalescence may be an additional risk factor for thromboembolic complications. The COVID-19 patients are characterized by activation of the complement system, which increases in severe cases, and manifests with increased or decreased levels of C3 complement component, increased levels of C4 component in blood, and a decreased total complement activity. Quantitative determination of C3 and C4 complement components over the period of COVID-19 progression is of prognostic value, with respect to severity of the disease.

Biochemical markers of the severity and emergence of non-smooth progression of pseudotuberculosis in children

Background. Currently, pseudotuberculosis is characterized by a high incidence in children and it is the second acute intestinal infection by frequency after shigellosis. The search for relationships between early changes in cell metabolism, dysfunctions of some organs and body systems under the pathogenic effect of an infectious agent and the severity, the occurrence of a non-smooth course of pseudotuberculosis in children is relevant.&#x0D; Aim. Search for biochemical markers to predict the severity and occurrence of a non-smooth variant of the course of pseudotuberculosis in children.&#x0D; Material and methods. A prospective study was performed in 125 patients with pseudotuberculosis during periods of the disease height, early convalescence and recovery: 17 patients with mild severity and a smooth course of the disease; 64 with moderate severity and smooth course of the disease; 28 with moderate severity and non-smooth course, 16 with high severity and non-smooth course of the disease. The comparison group consisted of 45 children from the IIA health group. The distribution of the examined children by sex was equal, the age ranged from 9 to 13 years. The spectrophotometric method determined the following: in blood plasma the content of malondialdehyde; in erythrocytes the concentration of reduced glutathione, the activity of glutathione reductase, glutathione peroxidase, glutathione-S-transferase and catalase. The following ratios were calculated: reduced glutathione/malondialdehyde, reduced glutathione/glutathione reductase, reduced glutathione/glutathione peroxidase, reduced glutathione/glutathione S-transferase, glutathione peroxidase/catalase. Normality of the obtained data distribution was checked using the ShapiroWilk test, and the statistical hypotheses about the difference between the studied groups were checked using the nonparametric MannWhitney test at a significance level of p 0.05.&#x0D; Results. In the acute period of the disease, based on the analysis, a statistically significant decrease in the ratios of reduced glutathione/malonic dialdehyde, reduced glutathione/glutathione reductase, reduced glutathione/glutathione peroxidase by 3.0, 3.5 and 3.1 times, respectively, was established (p 0.05) in patients with mild severity and smooth course; 5.3, 5.1 and 3.8 times (p 0.05) with moderate severity and smooth course; 5.8, 4.0 and 3.0 times (p 0.05) with moderate severity and non-smooth course; by 8.1 and 6.1 times (p 0.05) with heavy severity and non-smooth course relative to control values. However, during the period of early convalescence of a non-smooth course, these indicators significantly decreased by 2.2, 4.4 and 1.8 times (p 0.05) in patients with moderate severity and by 3.4, 6.8 and 2.2 times ( p 0.05) with heavy severity relative to control values.&#x0D; Conclusion. Prognostically significant criteria for an increase in the severity and occurrence of a non-smooth course of pseudotuberculosis in children in the acute period of the disease are a decrease in the ratios of reduced glutathione/malonic dialdehyde less than 17.0, reduced glutathione/glutathione reductase below 38.0 and reduced glutathione/glutathione peroxidase less than 12.0.

Time to Resolution of Infection in COVID-19 Patients: the Experience of a Tertiary Medical Center in Israel.

With the spread of coronavirus disease, reports have indicated that young patients are usually asymptomatic with a short convalescence period. The current study compared the time to resolution of infection in symptomatic and asymptomatic patients. Seventy-six patients aged 44.4 ± 23.3 years were admitted to the coronavirus disease 2019 (COVID-19) unit during the study period. Data were collected from patient records. Throat and nasal swabs for COVID-19 were collected for reverse transcriptase-polymerase chain reaction (RT-PCR). Time to resolution of infection was defined as the number of days from the date of the first COVID-19 positive outcome to the second consecutive negative PCR results. Most patients showed COVID-19 signs and symptoms (71.1%) between 1 and 6 days, and the rest were asymptomatic. No association was found between the time to resolution of infection and the presence of COVID-19 signs and symptoms (symptomatic: median [Md] 10.0, 95% confidence interval [CI] 8.4-11.6; asymptomatic: Md 15.0, 95% CI 10.5-15.5; P = 0.54). Age was not correlated with the number of COVID-19 signs and symptoms (r = 0.13, P = 0.37) or with the time to resolution of infection (r = 0.06, P = 0.58). In patients with mild to moderate symptoms, the time to resolution of infection from COVID-19 is not different from that in asymptomatic patients.

Global Trends and Research Hotspots in Long COVID: A Bibliometric Analysis

Long COVID is a condition distinguished by long-term sequelae that occur or persist after the convalescence period of COVID-19. During the COVID-19 pandemic, more and more people who tested positive for SARS-CoV-2 experienced long COVID, which attracted the attention of researchers. This study aims to assess the pattern of long COVID research literature, analyze the research topics, and provide insights on long COVID. In this study, we extracted 784 publications from Scopus in the field of long COVID. According to bibliometric analysis, it is found that: developed countries in Europe and America were in leading positions in terms of paper productivity and citations. The International Journal of Environmental Research and Public Health and the Journal of Clinical Medicine were leading journals in the perspective of publications count, and Nature Medicine had the highest number of citations. Author Greenhalgh T has the highest number of papers and citations. The main research topics were: pathophysiology, symptoms, treatment, and epidemiology. The causes of long COVID may be related to organ injury, inflammation, maladaptation of the angiotensin-converting enzyme 2 (ACE2) pathway, and mental factors. The symptoms are varied, including physical and psychological symptoms. Treatment options vary from person to person. Most patients developed at least one long-term symptom. Finally, we presented some possible research opportunities.

Comparison of Seroconversion in Children and Adults With Mild COVID-19

The immune response in children with SARS-CoV-2 infection is not well understood. To compare seroconversion in nonhospitalized children and adults with mild SARS-CoV-2 infection and identify factors that are associated with seroconversion. This household cohort study of SARS-CoV-2 infection collected weekly nasopharyngeal and throat swabs and blood samples during the acute (median, 7 days for children and 12 days for adults [IQR, 4-13] days) and convalescent (median, 41 [IQR, 31-49] days) periods after polymerase chain reaction (PCR) diagnosis for analysis. Participants were recruited at The Royal Children's Hospital, Melbourne, Australia, from May 10 to October 28, 2020. Participants included patients who had a SARS-CoV-2-positive nasopharyngeal or oropharyngeal swab specimen using PCR analysis. SARS-CoV-2 immunoglobulin G (IgG) and cellular (T cell and B cell) responses in children and adults. Seroconversion was defined by seropositivity in all 3 (an in-house enzyme-linked immunosorbent assay [ELISA] and 2 commercial assays: a SARS-CoV-2 S1/S2 IgG assay and a SARS-CoV-2 antibody ELISA) serological assays. Among 108 participants with SARS-CoV-2-positive PCR findings, 57 were children (35 boys [61.4%]; median age, 4 [IQR, 2-10] years) and 51 were adults (28 women [54.9%]; median age, 37 [IQR, 34-45] years). Using the 3 established serological assays, a lower proportion of children had seroconversion to IgG compared with adults (20 of 54 [37.0%] vs 32 of 42 [76.2%]; P < .001). This result was not associated with viral load, which was similar in children and adults (mean [SD] cycle threshold [Ct] value, 28.58 [6.83] vs 24.14 [8.47]; P = .09). In addition, age and sex were not associated with seroconversion within children (median age, 4 [IQR, 2-14] years for both seropositive and seronegative groups; seroconversion by sex, 10 of 21 girls [47.6%] vs 10 of 33 boys [30.3%]) or adults (median ages, 37 years for seropositive and 40 years for seronegative adults [IQR, 34-39 years]; seroconversion by sex, 18 of 24 women [75.0%] vs 14 of 18 men [77.8%]) (P > .05 for all comparisons between seronegative and seropositive groups). Symptomatic adults had 3-fold higher SARS-CoV-2 IgG levels than asymptomatic adults (median, 227.5 [IQR, 133.7-521.6] vs 75.3 [IQR, 36.9-113.6] IU/mL), whereas no differences were observed in children regardless of symptoms. Moreover, differences in cellular immune responses were observed in adults compared with children with seroconversion. The findings of this cohort study suggest that among patients with mild COVID-19, children may be less likely to have seroconversion than adults despite similar viral loads. This finding has implications for future protection after SARS-CoV-2 infection in children and for interpretation of serosurveys that involve children. Further research to understand why seroconversion and development of symptoms are potentially less likely in children after SARS-CoV-2 infection and to compare vaccine responses may be of clinical and scientific importance.

Case series of acute kidney injury in children with SARS-CoV2 associated multisystem inflammatory syndrome

PurposeIn the first part of 2021 in Khimki regional hospital was eight-times increase of hemolytic-uremic syndrome (HUS) in children vs 2020. There are some data on association of HUS and COVID-19 in the literature. Our aim to describe case series of HUS in children with SARS-Cov2 associated multisystem inflammatory syndrome (MIS-C).Methods & MaterialsWe developed 8 children, age 1-11 yrs. (Me 4,5), 3M/5F. All had anemia (Hb 58 - 105, Me 83,8 g/l), thrombocytopenia (45 -136, Me 84*109/l) and kidney injury (azotemia, diuresis decrease, reduced GFR).ResultsIn anamnesis nobody had COVID-19, SARS-Cov2 RNA (oropharyngeal swab) was negative. 6 had anti-SARS-Cov2 IgG. 3 patients had antibody inversion during hospitalization. That means, they developed acute kidney injury (AKI) in early convalescence period of COVID-19. 6 children had fever, vomiting and diarrhea in anamnesis. 1 had only myalgia, 1 had transient hemorrhagic rush.All children had SIRS: ESR acceleration (15-43 mm/h), CRP increase in 6 cases (not more 5 norms), elevated ferritin (307-648 mkg/l) and D-dimer (3,24-8 mkg/ml). Mixed urinary syndrome was noted: proteinuria (0,1 - 6 g/l), hematuria (RBC 6-50). 100% had azotemia: urea (12,7-65,3, Me 35 mmol/l), creatinine (74-1450,2, Me 499 mkmol/l). GFR by Schwartz formula was reduced in all cases (1,7-58,1 ml/min/1,73 m2). 3 had anuria, 2 oliguria. Renal replacement therapy (RRT) performed in 5 cases: 3 hemodiafiltration (HDF) only; 2 - HDF + plasma exchange (1 - 7 procedures). All children were complex treated and discharged with normal clinical urine test and creatinine level, diuresis 1,6-2,4 ml/kg/h.ConclusionIn MIS-C pathogenesis thrombotic microangiopathia is one of the key points. We saw elevation of HUS in children in the COVID-19-pandemia period. 6 from 8 described cases had connection of AKI with previous COVID-19. In addition, they all had SIRS markers, corresponding diagnostic criteria of SARS-Cov2 associated multisystem inflammatory syndrome.

Persistent cardiac injury - An important component of long COVID-19 syndrome.

Persistent cardiac injury - An important component of long COVID-19 syndrome.

THE ROLE OF HERBAL IMMUNOMODULATORS AS ADJUVANT THERAPY FOR ASYMPTOMATIC AND MILDLY SYMPTOMATIC COVID-19: AN EXPLORATORY CLINICAL STUDY

Objectives: The objective of the study is to evaluate herbal immunomodulators (Septilin and Bresol) as a possible adjuvant therapy for the treatment of asymptomatic and mildly symptomatic COVID-19. Methods: Randomized, open-label, comparative clinical study. Subjects were randomized to either arm I [Septilin and Bresol+standard of care (SOC)] or arm II (SOC). This study was registered on CTRI (CTRI/2020/06/025801). Results: Subjects in arm I showed a greater reduction in levels of interleukin-6 tumor necrosis factor-α following treatment than in arm II. Subjects in arm I showed a greater increase in levels of interferon (IFN)-β and IFN-λ than those in arm II. There was a greater reduction in D-dimer in arm I than in arm II subjects (64.28% vs. 35.59%) and all arm I subjects had D-dimer values in the normal range compared to 70% of arm II subjects. There were statistically significant reduction in lactate dehydrogenase and neutrophil-to-lymphocyte ratio in arm I (p&lt;0.016 and p&lt;0.013, respectively). Clinical assessments during the post-illness convalescence period showed significant improvements in fatigue assessment scores and quality of life. Conclusion: This herbal combination as an adjuvant to SOC may provide additional long-term benefits in COVID-19 infection by reducing inflammation. This treatment may offer a good addendum for the management of post-COVID-19 illness.

Patient-reported health-related quality of life from a randomized phase II trial comparing standard-dose with high-dose twice daily thoracic radiotherapy in limited stage small-cell lung cancer

ObjectivesIn a randomized phase II trial, twice daily (BID) thoracic radiotherapy (TRT) of 60 Gy/40 fractions improved survival compared with 45 Gy/30 fractions in limited stage small-cell lung cancer (LS SCLC). Notably, the higher dose did not cause more toxicity. Here we present health related quality of life (HRQoL) reported by the trial participants during the first 2 years. Materials and methods170 patients were randomized 1:1 to TRT of 45 Gy or 60 Gy concurrently with cisplatin/etoposide chemotherapy. The 150 patients who commenced TRT and completed a minimum of one HRQoL-questionnaire were included in the present study. Patients reported HRQoL on the European Organization for Research and Treatment of Cancer Core 30 and Lung Cancer 13 Quality of Life Questionnaires. Questionnaires were completed weeks 0, 4 (before TRT), 8 (end of TRT), 12 (response evaluation after chemoradiotherapy) and 16 (end of prophylactic cranial irradiation), then every 10 weeks year one, and every 3 months year two. Primary HRQoL endpoints were dysphagia and dyspnea. A difference in mean score of ≥10 was defined as clinically significant. ResultsMaximum dysphagia was reported on week 8, with no significant difference between treatment arms (mean scores 45 Gy: 44.2, 60 Gy: 51.1). The 60 Gy arm had more dysphagia in the convalescence period, but dysphagia scores returned to baseline levels at week 16 in both arms. For dyspnea there were no significant changes, or differences between treatment arms, at any timepoint. There were no significant differences between treatment arms for any other HRQoL-scales. ConclusionTRT of 60 Gy did not cause significantly higher maximum dysphagia, though patients on the 60 Gy arm reported more dysphagia the first 8 weeks of convalescence. The higher dose was well tolerated and is an attractive alternative to current TRT schedules in LS SCLC.Trial reg Clinicaltrials.gov NCT0204184.

The phenomenon of acceleration of the conduction of excitation through the CNS in patients with tick-borne encephalitis

We have previously established that in the acute period of tick-borne encephalitis (TBE), which occurs with damage to the membranes and substance of the brain, the latent periods of recorded responses are increased. In dynamics, in the period of convalescence, these same patients showed an improvement in the conduction of excitation in the form of a decrease in the latent periods of the recorded responses. Due to the continued long-term disability (8-10 months after the acute period), 19 patients were referred for a consultation at the Bureau of Medical and Social Expertise to study the conduction pathways of the CNS. In 3 patients, signs of acceleration of the conduction of excitation were registered in comparison with the normal values ​​obtained in neurologically healthy patients.

Динаміка біохімічних параметрів і функціонального стану вегетативної нервової системи у хворих на гострий гепатит B із хронічним уживанням алкоголю в гепатотоксичних дозах

В роботі показано, що у хворих на гострий гепатит В із хронічним уживанням алкоголю в гепатотоксичних дозах відбуваються більш виражені функціональні порушення стану вегетативної нервової системи з розвитком вегетативного дисбалансу у бік ваготонії, які зберігаються і в періоді реконвалесценції.