Coronavirus Infection In Patients Research Articles

Course of coronavirus infection in patients with type 2 diabetes mellitus

The coronavirus infection (COVID-19) pandemic remains a hot topic of study to this day. According to studies, mortality in patients with COVID-19 and a history of diabetes mellitus (DM) is 2-3 times higher than in patients without DM.The purpose of the study is to analyze the course of coronavirus infection in patients with T2DM.Material and methods: A prospective observation of 381 patients with T2DM and COVID-19 in the intensive care unit was carried out in 2020-2021. 2 groups were formed: Group I (comparison group) – patients with a fatal outcome, Group II (control group) – patients discharged from the hospital with an improvement in their condition. An assessment was made of changes in the dynamics of clinical and laboratory parameters upon admission and before discharge in both groups.Results and discussion: Patients with a fatal outcome were more often admitted in a serious condition (75% vs. 12.7% at p ≤ 0.0001). Significantly more often than aches (92.5% vs. 69.58%, p=0.0044), shortness of breath on exertion (92.5% vs. 75.17%, p=0.0245), grade 3 DN (62.5%, p<0.0001), the need for non-invasive lung ventilation (28.95% versus 1.39%, p <0.0001) artificial lung ventilation (81.1% versus 1.75% ( p<0.0001) was noted in group I. In the comparison group, the Charlson comorbidity index was higher: 6.0 [5.0;7.0] versus 4 [4; 4], at p<0.0001. In the group of patients who were discharged with improvement, they more often took metformin and sulfonylureas, in the group of patients who died, they were more often on insulin therapy. In dynamics, the levels of intracellular enzymes such as alkaline phosphatase, creatine phosphokinase, lactate dehydrogenase in the group with an unfavorable outcome significantly increased, in contrast to the group with a positive outcome. Also, in a fatal outcome, there is a deterioration in kidney function, laboratory characterized by an increase in the level of creatinine and urea, a decrease in the glomerular filtration rate and blood albumin. Despite the ongoing anticoagulant therapy, patients with a fatal outcome showed pronounced signs of activation of the hemostasis system, which are characterized by an increase in INR, prolongation of prothrombin time and aPTT, and thrombocytopenia.Conclusion. The risk of death from coronavirus infection in people with diabetes increases with age. DM 2 is a comorbid disease and acute multiple organ disorders develop with the addition of a coronavirus infection. Coronavirus-induced coagulopathy in patients with DM2 and COVID-19 with a fatal outcome is characterized by poor controllability and low efficacy of anticoagulant therapy.

The relationship between disorders of the plasma and platelet components of hemostasis with the severity and timing of coronavirus infection in patients with chronic coronary syndromes

The relationship between disorders of the plasma and platelet components of hemostasis with the severity and timing of coronavirus infection in patients with chronic coronary syndromes

СОЦИОЛОГИЧЕСКАЯ ОЦЕНКА ПОСЛЕДСТВИЙ ПЕРЕНЕСЕННОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ COVID-19 У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ

Relevance: Patients with diabetes mellitus turned out to be the most vulnerable in the conditions of the spread of the new corona virus infection COVID-19 due to the peculiarities of the immune status and immune response to a viral attack, as well as excessively high virus activity in conditions of hyperglycemia, comorbidity and obesity associated with the course of diabetes. The proportion of diabetic patients among COVID-19 patients in the Russian Federation ranges up to 25%. Special attention and in-depth analysis are required by the medical and social aspects of diabetes mellitus, the results of which can affect the course of the disease and the quality of life of this category of patients. Objective: To conduct a sociological study to assess the consequences of COVID-19 coronavirus infection in patients with diabetes mellitus. Materials and methods: Questionnaires of 450 patients with diabetes mellitus were analyzed. The largest number of respondents is represented by the age group of 39-59 years (39.0%), patients aged 60-79 years made up 36.0%, over 80 years 6.0%. The questionnaire included 10 questions about the consequences of coronavirus infection in people with diabetes mellitus. Empirical data were processed and analyzed using the capabilities of the IBM SPSS Statistics 27.0.1 software and analytical complex. Results: a sociological assessment of the impact of COVID-19 coronavirus infection on patients with diabetes mellitus was carried out. The consequences of the disease in the context of this chronic pathology are analyzed in detail and the peculiarities of adaptation, medical and social challenges are revealed. The transmitted coronavirus infection COVID-19 has had a significant impact on the health of patients with diabetes mellitus of all age groups, the consequences of which are manifested in the decompensation of carbohydrate metabolism. The highest percentage of decompensation of carbohydrate metabolism was found in workers (50.0%) and pensioners (39.8%), the vast majority of whom are patients over 80 years old. The results of the survey revealed that 59.0% of patients visited their attending endocrinologist less often, while patients aged 60-79 years - in 64.0% of cases. Irregular visits to their doctor led to a significant decompensation of carbohydrate metabolism in this category of respondents and is the reason for their development of acute and late complications of the disease. Currently, 46.0% of the respondents have not achieved compensation for carbohydrate metabolism. The lack of achievement of glycemic targets is noted in 51.4% of urban residents and 36.4% of rural residents, as well as in 63.5% of working patients. This category of patients is currently at an increased risk of complications. Conclusion: The results obtained require a medical and social assessment and special attention from doctors and the endocrinological service of the region and can serve as a basis for developing a strategy for effective medical support in such clinical scenarios. Adherence of patients with diabetes mellitus to treatment and clinical recommendations for self-control, as well as regular visits to an endocrinologist, will contribute to achieving glycemic targets and preventing the development of late complications of diabetes mellitus.

Factors of poor prognosis for new coronavirus infection in patients with cardiovacular pathology

Aim. To assess the structure of cardiovascular pathology in patients with new coronavirus infection (NCI), to identify factors of poor prognosis in these individuals. Material and methods. The study was conducted on the basis of the COVID-19 infectious diseases hospital of the City Hospital No. 33 of Nizhny Novgorod. The study included 284 patients after applying inclusion and exclusion criteria. All subjects were divided into groups: the main group (n = 207) — patients with NCI and cardiovascular diseases (CVD), as well as comorbid diseases, the comparison group (n = 24) with NCI and CVD, the control group (n = 53) with NCI without any comorbid diseases. Demographic indicators, BMI, laboratory parameters, comorbidity and therapy were analyzed. Results. During the study, it was revealed that the most severe course of COVID-19 is characteristic of the main group, and only among them there were fatal outcomes (25% of cases). Analyzing the prevalence of CVD, it turned out that arterial hypertension was the most common in the main group and in the comparison group, coronary heart disease and heart failure were registered somewhat less frequently. The development of acute cardiovascular accidents occurred only in the main group. A mathematical model was developed to determine the risk of death in patients with NCI who are in the hospital. This model is statistically significant (p < 0.001). Conclusion. The older age of patients, the development of acute myocardial infarction, first identified atrial fibrillation and a decrease in saturation contributed to an increased risk of mortality in patients with NCI and CVD. Among drug therapy, the administration of favipiravir, tocilizumab and statins had a beneficial effect on the outcome of diseases.

Clinical features and treatment strategy for patients with multiple myeloma during the COVID-19 pandemic

Background. In March 2020, doctors faced the problem of severe COVID-19 coronavirus infection in patients with multiple myeloma. This required a review of issues related to the selection of patients, the development of new preventive and therapeutic tactics aimed at treating infectious and immunological complications in patients of this category, depending on the nature and status of the underlying disease and the timing of treatment.Aim. To assess the severity of multiple myeloma, the most common complications and features of the COVID-19 course in patients with multiple myeloma at different therapy stages (disease onset, remission, maintenance therapy, progression/refractory disease).Materials and methods. From March 2020 to May 2022, 89 patients diagnosed with multiple myeloma and coronavirus infection caused by the SARS-CoV-2 virus were hospitalized at City Clinical Hospital No. 52 (Moscow). After assessing the severity, a decision was made on patient management, and if necessary, according to indications, the patient received specific antitumor therapy for multiple myeloma and treatment of coronavirus infection simultaneously.Results. Treatment for coronavirus infection was carried out in accordance with the clinical recommendations of the Russian Ministry of Health at that time. It included antiviral, anticoagulant therapy, transfusions of fresh frozen convalescent plasma with a high titer of antibodies, genetically engineered biological drugs and monoclonal antibodies; if necessary, patients received antibacterial and antifungal, hormonal therapy. Specific chemotherapy was also administered according to indications.Conclusion. Patients with multiple myeloma are at higher risk of severe COVID-19 infection. Today, the problem of developing adequate therapeutic tactics for managing patients with multiple myeloma and coronavirus infection still remains relevant. It is necessary to develop an optimal protocol for the management of such patients, including an assessment of prognostic factors, identification of clearly defined indications and contraindications for chemotherapy, and a description of supportive therapy.

Coronavirus infection after blood stem cell transplantation

Background. In March 2020, oncohematologists faced the problem of severe COVID-19 coronavirus infection in patients after a high-dose chemotherapy and autologous or allogeneic bone marrow transplantation. This required a review of issues related to the selection of patients for blood stem cell transplantation (HSCT), the development of new preventive and therapeutic tactics aimed at treating infectious and immunological complications in patients of this category, depending on the nature and status of the underlying disease and the timing of treatment.Aim. To assess the severity, most typical complications and course of COVID-19 in patients during early and late posttransplant periods.Materials and methods. We analyzed the data of patients after HSCT with active coronavirus infection hospitalized in the hematology department from 2020 to 2021. A total of 25 patients were hospitalized: 4 after allogeneic transplantation, 21 after autologous transplantation. According to the timing of HSCT, patients were divided into 2 groups: early period (ETP) (2-90 days after HSCT) - 14 patients, late period (LTP) (3-24 months after HSCT) - 11 patients.Results. Severe coronavirus infection (grades III-IV according to computed tomography) was more often observed in patients in the ETP group (65 %) than in the LTP group (18 %). The incidence of respiratory failure was 70 and 36 % in the ETP and LTP groups, respectively. In the ETP group, agranulocytosis and the development of severe infectious complications (bacterial, fungal and viral) were observed significantly more often than in the LTP group, which required the appointment of reserve groups antibacterial therapy and antifungal therapy. Mortality in the ETP group was 35 %, while no deaths were recorded in the LTP group. The median duration of hospitalization for patients in the ETP and LTP groups was 20 and 13 days, respectively.Conclusion. Patients early after HSCT are at higher risk of developing lower respiratory tract infections, are more likely to require hospitalization in the intensive care unit, and have a greater risk of death from COVID-19. Therapy with genetically engineered biological drugs is not contraindicated in the case of leukopenia and agranulocytosis in this group of patients.

Basic therapeutic approaches to the management of hematology/oncology patients with new coronavirus infection (COVID-19)

In December 2019, cases of severe respiratory infection were reported in Wuhan, China. The disease was caused by a new, previously undescribed coronavirus, structurally similar to the then known SARS-CoV virus. The World Health Organization has named the new virus SARS-CoV-2 and the disease it causes COVID-19. The problem of COVID-19 is exacerbated by the rapid spread of the SARS-CoV-2 virus and the development of life-threatening complications, the main of which is pneumonia. Due to the severity of the condition, from 5 to 10 % of patients are treated in intensive care units.SARS-CoV-2 initially attacks the respiratory system and causes symptoms such as fever, vomiting, headache, dizziness, general weakness, and diarrhea. Then these symptoms intensify in different directions, and the disease can often lead to death.Initially, only a few methods of symptomatic treatment were available and clinical trials of drugs that had previously shown their effectiveness against infection with the MERS-CoV and SARS-CoV viruses began. Temporary recommendations have appeared suggesting the use of some drugs both in monotherapy and in combination.In patients with hematologic malignancies, the immune response to the SARS-CoV-2 coronavirus is significantly reduced, which explains the high mortality rate (up to 38 %) of these patients hospitalized for SARS-CoV-2 infection. Recently, antiviral drugs and monoclonal antibodies have become available for pre- or post-exposure prophylaxis, as well as for early treatment of COVID-19. These treatments should be offered to patients at high risk of severe COVID-19 and to those who have not responded to vaccination. However, as changes in the genetic structure of the virus accumulate, some treatments may lose their clinical effectiveness against new variants.The combination of hematological malignancies and new coronavirus infection causes a more severe course of COVID-19 compared to the population and high mortality. Factors for an unfavorable prognosis for new coronavirus infection in patients with hematological malignancies include age over 60 years, a high comorbidity index, diagnoses such as acute leukemia, especially acute myeloid leukemia and myelodysplastic syndrome, disease status (relapse, progression, as well as newly diagnosed acute leukemia), severe COVID-19, agranulocytosis (myelotoxic or tumor).

Роль загальноклінічних показників крові для прогнозування перебігу коронавірусної інфекції у хворих на COVID-19: систематичний огляд

Abstract. The course of coronavirus infection in patients with COVID-19 can cause systemic inflammation of the organism, and dysregulation of the immune system and the hemostasis system. Given the possibility of severe and recurrent cases of SARS-CoV-2 infection, it is imperative for clinicians to find reliable, cost-effective, and at the same time accessible blood-specific parameters that can serve as stratification markers for patients with confirmed COVID-19. The purpose of our review article is to highlight the modern research results on the characteristics of general clinical hematological parameters (complete blood count) in patients with COVID-19 and their use for predicting the course of the coronavirus infection. We used bibliosemantic, analytical, and logical methods when writing a systematic review, as well as a generalization method. We searched and selected scientific publications by keywords in bibliographic databases, analyzed and summarized the results. The indicators of the general blood analysis (an absolute count of neutrophils, lymphocytes, platelets, and monocytes) allow calculating several newly introduced indices of inflammation, such as NLR, dNLR, PLR, MLR, NLPR, AISI, SIRI, SII. The use of such indices at the stage of hospitalization in patients with confirmed COVID-19 can be used to predict the course of the disease and the probability of a critical condition or lethal outcome.

ПОРАЖЕНИЕ ПОЧЕК У ДЕТЕЙ ПРИ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ, ВЫЗВАННОЙ SARS-CoV-2: СИСТЕМАТИЧЕСКИЙ ОБЗОР

This bibliographical review is based on studies published in the PubMed Central® (PMC) database between Mar. 2020 and Dec. 2022 using the keywords as follows: “SARS-CoV-2,” “COVID-19,” “kidney damage” and “children.” Information on clinical criteria, laboratory symptoms, possible pathogenetic response pathways and expected long-term outcomes of kidney damage associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) infection in children was analyzed. An attempt was made to trace the features of manifestations of the new coronavirus infection depending on previous renal pathology. The polyetiological nature of renal tissue lesion is evident, which is the result of direct effect of SARS-CoV-2 virus on the renin-angiotensin-aldosterone system (RAAS), ischemia, hypercoagulation, cytokine storm, rhabdomyolysis, pulmonary-renal pathogenic reaction etc. Kidney damage in the pediatric population has been found to be more frequent in the severe COVID-19 in children with multisystem inflammatory syndrome (MIS) in the setting of admission at the intensive care unit (ICU). Manifestations range from minor urinary syndrome to the development of acute kidney injury (AKI). A number of consequences and cases of the course of some diseases after coronavirus infection in children as well as clinical and laboratory features of coronavirus infection in patients with previous renal pathology are described. The findings initiated the need for the long-term follow-up of children with COVID-19 both with and without renal insufficiency.

Percutaneous coronary intervention in patients admitted with acute coronary syndrome within 6 months after COVID-19 (retrospective single-center study)

BACKGROUND: Assessing clinical manifestations in patients during the period of destabilization of the course of coronary artery disease after COVID-19 coronavirus infection remains a clinical problem. Identifying features of coronary artery lesions in such patients will help to prevent the development of complications and may influence the tactics of active dynamic monitoring.
 AIM: To evaluate the structure of coronary artery lesions and clinical manifestations in patients with acute coronary syndrome that developed within 6 months after COVID-19 new coronavirus infection.
 MATERIALS AND METHODS: A comparative analysis of the results of coronary artery stenting in 157 patients admitted with acute coronary syndrome has been carried out. The 1st group included 69 patients who had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; in the 2nd — 88 patients without a history of COVID-19 (vaccinated — 42%). All the patients had drug-eluting stents implanted in the infarct-related artery. Long-term results have been observed in 151 (96.2%) patients.
 RESULTS: Before the development of acute coronary syndrome, dispnoe was more often observed in patients of the 1st group (36; 52%) than in patients of the 2nd group (13; 14.8%). There were no focal neurological symptoms in the patients of both groups. Dizziness more often preceded acute coronary syndrome in the patients of the 1st group (26; 38.2%) compared to the control group (5; 5.7%). Decreased motivation and fatigue were detected in 27 (67.5%) patients in the 1st group, which was more common than in the 2nd group (13; 32.5%). Acute coronary syndrome with ST elevation was treated in 47 % and 38.6% of the patients in the 1st groups and the 2nd, respectively. The development of acute coronary syndrome with ST segment elevation with previous clinical manifestations of post-covid syndrome in the 1st group was observed in 95.8%, whereas in the absence of post-covid syndrome in 53.3%. The mean value of LVEF in patients who had COVID-19 was 55.9 ± 14%, which was significantly lower than in the patients in the control group (63.2 ± 5.5%; р 0.001). During the course of coronavirus infection in the patients in the first group, lung damage of degrees I–II according to CT scan data was observed in 76.8% of the patients and in 23.2% of degrees III–IV. The frequency of lesions of the circumflex branch in the 1st group was 15.9%, in the 2nd — 11.4% (р = 0.403); of the right coronary artery — 33.3%, and 22.7% (р = 0.41); of the diagonal branch — 5.8%, and 3.4% (р = 0.47); of the left main coronary artery — 5.8%, and 6.8% (р = 0.79), of the left anterior descending branch — 52.2%, and 35.2% (р = 0.033), respectively. The incidence of vasospastic angina in the 1st group was 53.6%, in the 2nd — 15.9% (р 0.0001). ST segment elevation in lead AVR as a manifestation of subendocardial ischemia was registered in the 1st group — 40.6%, the 2nd — 11.4% (р 0.0001). All the patients had drug-eluting stents implanted in the infarct-related artery. Overall survival (in-hospital and long-term) was 100% for the first group and 100 % for the second one.
 CONCLUSIONS: In the structure of coronary arteries lesions after COVID-19 new coronavirus infection in patients with acute coronary syndrome, damage to the anterior interventricular artery dominates (52.2%). The likelihood of having a left anterior descending lesion during the development of acute coronary syndrome with ST segment elevation in patients who have had COVID-19 is 1.5 times higher. The structure of clinical manifestations after COVID-19 in patients before the development of acute coronary syndrome is dominated by shortness of breath (52 %) and decreased motivation and fatigue (67.5 %).

КОРОНАВИРУСНАЯ ИНФЕКЦИЯ COVID19 У ПАЦИЕНТОВ С ОСТРЫМ МИЕЛОИДНЫМ ЛЕЙКОЗОМ: ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫЕ ОПЫТ

The presented literature review presents studies, including our own, on the peculiarities of the course of coronavirus infection in patients with hematological malignancies, in particular in patients with acute myeloid leukemia (AML). A modern classification of AML is presented. It has been shown that in patients with AML, the addition of coronavirus infection SARS-CoV-2 COVID-19 significantly worsens the prognosis of the patient’s life, which makes significant changes in overall survival and mortality. Factors worsening the prognosis of life in patients with AML are advanced age, comorbidities, AML out of remission, the critical course of SARS-CoV-2 COVID19, interruption of treatment without subsequent resumption. In patients with AML and SARS-CoV-2 COVID19, the most optimal treatment tactic is temporary discontinuation of the course of chemotherapy followed by resumption after the regression of the viral infection (both at the onset of the disease and when chemotherapy is already underway). If it is not possible to postpone the course of chemotherapy, treatment can and should be carried out with the provision of adequate accompanying therapy simultaneously with ethological and pathogenetic therapy for SARS-CoV-2 COVID19. Even in the presence of hematological contraindications in patients with AML, SARS-CoV-2 COVID19 treatment should be carried out in full according to clinical guidelines for the treatment of SARS-CoV-2 COVID19.

Clinical course and consequences of coronavirus infection in patients with arterial hypertension

Clinical course and consequences of coronavirus infection in patients with arterial hypertension

ВАКЦИНАЦИЯ ПРОТИВ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ У ПАЦИЕНТОВ С ОНКОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

With a new coronavirus infection caused by SARS-CoV-2, cancer patients with malignant neoplasms are the most vulnerable group of people. Cancer patients are at a higher risk of severe COVID-19, and for them the vaccination of a new coronavirus infection is crucial. For cancer patients, the study of the effectiveness and safety of vaccination of a new coronavirus infection in large groups was not carried out. The available recommendations are based on data obtained on the safety and effectiveness of vaccines against SARS-CoV-2 in the general population, as well as on the study of the effectiveness and safety of other vaccines in cancer patients. It is believed that the potential benefits of vaccines against a new coronavirus infection outweigh the risks and therefore vaccination in these patients is recommended by cancer communities. All guidelines for the immunoprophylaxis of a new corona-virus infection in patients with oncopathology are temporary and will change as new data become available. It is necessary to personalize vaccination against COVID-19 in cancer patients. The problem of vaccination against SARS-CoV-2 in cancer patients requires in-depth study, conducting clinical tri-als from the standpoint of evidence-based medicine and evaluation on a sufficiently large number of patients.

ВАКЦИНАЦИЯ ПРОТИВ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ У ПАЦИЕНТОВ С ОНКОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

With a new coronavirus infection caused by SARS-CoV-2, cancer patients with malignant neoplasms are the most vulnerable group of people. Cancer patients are at a higher risk of severe COVID-19, and for them the vaccination of a new coronavirus infection is crucial. For cancer patients, the study of the effectiveness and safety of vaccination of a new coronavirus infection in large groups was not carried out. The available recommendations are based on data obtained on the safety and effectiveness of vaccines against SARS-CoV-2 in the general population, as well as on the study of the effectiveness and safety of other vaccines in cancer patients. It is believed that the potential benefits of vaccines against a new coronavirus infection outweigh the risks and therefore vaccination in these patients is recommended by cancer communities. All guidelines for the immunoprophylaxis of a new corona-virus infection in patients with oncopathology are temporary and will change as new data become available. It is necessary to personalize vaccination against COVID-19 in cancer patients. The problem of vaccination against SARS-CoV-2 in cancer patients requires in-depth study, conducting clinical tri-als from the standpoint of evidence-based medicine and evaluation on a sufficiently large number of patients.

Some aspects of diagnosis, course and prediction of outcomes of a new coronavirus infection in patients with diabetes mellitus

Introduction. By 2023 it has been detected more than 600 million cases of COVID-19. One of the most significant risk factors for the severe course of a new coronavirus infection (NCVI) is the presence of comorbid diseases, especially the presence of diabetes mellitus (DM).Aim. To investigate the laboratory and clinical features of a new coronavirus infection in people with diabetes mellitus, to identify predictors of an adverse outcome of COVID-19.Material and methods. We carried out data from medical records of 248 patients treated in “Voronezh Clinical Emergency Hospital № 10” in the departments “COVID-5” and “COVID-8”. Data collection and statistical processing were performed with Microsoft Excel 10.0 and StatSoft STATISTICA 12.0 programs.Results. The most frequent complaints of patients were general weakness, hyperthermia and dry cough. The analysis of the age characteristics revealed that the peak incidence of NCVI in hospitalized patients without DM falls on 70-79 years, with concomitant DM — on 60-69 years.Among comorbid pathologies, hypertension, coronary heart disease and chronic heart failure prevailed. The presence of these diseases is a predictor of adverse outcomes in NCVI, along with cerebrovascular diseases and anemia.Evaluation of laboratory data revealed the link of elevated levels of ferritin, C-reactive protein and D-dimer with an increased risk of death of NCVI.Conclusion. Estimation the risk factors of a fatal outcome is crucial for the choice of patient treatment tactics.

Impact of Kidney Damage on the Course and Prognosis of COVID-19 Infection According to the International Registry «Analysis of Chronic Non-Infectious Diseases Dynamics After Covid-19 Infection in Adult Patients»

Objective. To study the course of the new coronavirus infection in patients with chronic kidney disease (CKD), to identify cases of acute kidney injury (AKI) in the setting of COVID-19 infection, and to access the impact of renal function on prognosis in these categories of patients during the acute phase and after hospitalization, at 3, 6, and 12 months after recovery. Materials and methods. The ACTIV and ACTIV 2 registries included men and women older than 18 years with a diagnosis of COVID-19 based on a positive PCR test for COVID-19 and a characteristic chest X-ray or computed tomography chest scan. Results. A total of 9364 patients (4404 men, average age59 [48-69]) were included in the analysis. 716 (7.67 %) patients had CKD. 8496 (90,7 %) patients had their glomerular filtration rate (GFR) measured during hospitalization, and the values were distributed as follows: ≥90 ml/min/1.73m2 – in 4289 (50,5 %) patients, 89-60 ml/min/1.73m2 — in 3150 (37,1 %) patients, 59-45 ml/min/1.73m2 — in 613 (7,22 %), 44-30 ml/min/1.73m2 — in 253 (2,98 %), 29-15 ml/min/1.73m2 — in 110 (1,29 %), <15 ml/min/1.73m2 — in 81 (0,95 %) patients. 11.6 % of the subjects (n=1068) developed AKI during hospitalization. This complication was reported more often than cytokine storm (in 7.46 % in 687 patients, р<0,001) or sepsis (in 0.17 % in 16 patients, p=620). CKD increased the risk of death by 3.94-fold in patients with COVID-19 during hospitalization compared with patients without CKD. The mortality of patients with AKI during hospitalization was 3.94 times higher than the mortality of those without AKI. CKD also affected long-term survival after hospitalization: within 3 months of follow-up, the risk of death in patients with CKD increased 4.88-fold, within 6 months — 4.24-fold, after 12 months – 8.36-fold. Conclusion. The prevalence of CKD in COVID-19 patients is similar to that in the general population. AKI developed in 11.6 % of cases with COVID-19 infection and was observed more frequently in patients with overweight and hyperglycemia. CKD and AKI increased the risk of hospital mortality in patients with COVID-19. In the group of patients with CKD, mortality increased in the post-COVID period, 3, 6 and 12 months after. The high mortality rate of patients who had AKI during the coronavirus infection was observed only in the first 3 months of follow-up in the post-COVID period.

ОСОБЕННОСТИ ТЕЧЕНИЯ КОРОНАВИРУСНОЙ ИНФЕКЦИИ У РЕЦИПИЕНТА ПОЧЕЧНОГО ТРАНСПЛАНТАТА

The new coronavirus infection poses a particular threat to patients receiving immunosuppressive therapy, including those with a history of organ transplantation. The article provides a clinical observation of coronavirus infection in a kidney transplant recipient. Patient M., 61 years old, was admitted to the infectious diseases department of the Kursk City Clinical Hospital No. 4 with complaints of high fever, cough, shortness of breath, severe weakness, loss of appetite. When examining a swab from the nose and throat by PCR for SARS-Cov-2 RNA, a positive result was obtained. Based on the clinical picture, computed tomography of the lungs, positive PCR result for SARS-Cov-2 RNA, the diagnosis was made: Coronavirus infection Covid-19 confirmed, moderate form. Bilateral polysegmental pneumonia of moderate severity. RF - 0-I degree (CT-1). Bilateral nephrosclerosis. Condition after kidney transplant (2006). On the fifth day, the patient's condition worsened, which was combined with the progression of lung damage according to CT of the chest to 45% (CT-2), the appearance of signs of acute respiratory distress syndrome. Taking into account the severity of the patient's condition, a consultation was held with a transplantologist and a decision was made to correct immunosuppressive therapy with temporary withdrawal of cyclosporine. Over the next two days, the patient's condition remained stably grave. Subsequently, against the background of complex therapy, including glucocorticosteroids, antibacterial drugs, monoclonal antibodies to the interleukin-6 receptor, positive dynamics was noted in the form of a decrease in shortness of breath, cough, normalization of body temperature, and an increase in SpO2 up to 95%. This was combined with the restoration of disturbed laboratory parameters and the positive dynamics of the inflammatory process in the lungs according to CT scans. The treatment of kidney transplant recipients with Covid-19 has a number of features due to a pronounced suppression of the immune system against the background of immunosuppressive therapy and, as a result, the development of a severe infection, often with impaired graft function. At the same time, despite the severity of the course of the infectious process, the complete abolition of immunosuppressive therapy is not carried out, but its correction is carried out in the form of the exclusion of one of the drugs and a decrease in the dose of other immunosuppressants. Coronavirus infection in patients with a history of organ transplantation justifies the need for timely hospitalization and correction of immunosuppressive therapy to prevent a severe course of the disease and adverse outcomes.

The course of heart failure in patients after COVID-19 and the diagnostic role of furin

Objective — to assess the impact of coronaviral diseases 2019 (COVID‑19) on the general state, laboratory and clinical indicators of patients with chronic heart failure (HF) with moderately reduced left ventricular ejection fraction (mrEF) and to investigate activity of furin. Materials and methods. A comprehensive examination involved 72 patients with HF with mrEF (main group) and 18 apparently healthy individuals (control group). The main group was divided into two subgroups: 36 subjects had COVID‑19 history, and 32 subjects without COVID‑19 history. The mean age of patients was (63.6±4.1) years. All study participants underwent anthropometric (height, weight, BMI), laboratory (clinical blood analysis, biochemical blood analysis with determination of AST, ALT, creatinine, glucose, lipid spectrum, potassium, sodium and magnesium, ELISA with determination of glycated hemoglobin, NT‑proBNP and furin), instrumental (EchoCS, ECG) examinations and surveys to assess the quality of life (EQ‑5D‑5L). Statistical processing of the obtained results was carried out using the SPSS v.19.0 statistical program package. Results. In the group of patients with a history of coronavirus infection compared to the patients without COVID‑19 history the following findings were established: significantly higher blood serum levels of NT‑proBNP (1002.79±215.94 pg/ml and 405.37±99.06 pg/ml, respectively, p‑value 0.01), uric acid (429.08±27.01 mmol/l vs. 354.44±28.75 mmol/l, p‑value 0.04) and a lower furin to NT‑proBNP ratio (0.87±0.26 and 1.38±1.16, p‑value 0.05). Results of EQ‑5D‑5L questionnaire demonstrated significant deterioration of quality of life indicators (64.21±3.04 points vs. 72.81±1.82 points by VAS, p‑value 0.02); higher indicators of left ventricular myocardial mass (LVMMi) (157.39±6.14 g/m2 and 138.68±6.02 g/m2, p‑value 0.03), dimensions of the left (43.74±0.95 mm and 41.12±0.85 mm, p‑value 0.04) and right atrium (40.76±1.23 mm and 37.75±0.85 mm, p‑value 0.04). Conclusions. Coronavirus infection in patients with heart failure with moderately reduced left ventricular ejection fraction resulted in the disorders of intracardiac hemodynamics and persistent negative structural changes of the heart. The ratio of furin to NT‑proBNP serum levels can be used to determine the impact of the HF syndrome itself on the patients’ subjective assessment of their quality of life.

Preliminary Recommendations on the Timing of Lung Surgery after Novel Coronavirus Infection in Patients with Pulmonary Nodules and Lung Cancer

In recent years, the corona virus disease 2019 (COVID-19) pandemic has had a huge impact on the global medical, political and economic fields. Since the beginning of the COVID-19 epidemic, our understanding of the impact of COVID-19 has grown exponentially. Recently, the COVID-19 epidemic has changed rapidly in China, and there has been controversy over how to carry out surgical operations for patients with lung neoplastic lesions. Some studies have shown that lung cancer patients undergoing surgery are more likely to experience respiratory failure and perioperative death after contracting COVID-19 than the general population, however, delays in cancer treatment are also associated with increased mortality among these patients. In particular, the novel coronavirus Omikron variant has a higher transmissibility and may escape the immunity obtained through the previous novel coronavirus infection and vaccination. In order to minimize the risk of novel coronavirus infection in surgical patients, it is necessary to develop new treatment guidelines, expert consensus and preventive measures. However, the current rapid change of the epidemic situation has led to insufficient time and evidence to develop guidelines and consensus. Therefore, thoracic surgeons need to evaluate specific patient populations at higher risk of severe complications before surgery and weigh the benefit of surgical treatment against the risk of novel coronavirus infection. We try to give some recommendations on lung surgery during the current domestic epidemic situation based on the guidelines and consensus of oncology and thoracic surgery organizations in different regions on lung surgery. .

New coronavirus infection in patients with chronic non-communicable diseases in primary care

BACKGROUND: The pandemic of a new coronavirus infection, which began in the Chinese city of Wuhan in December 2019, has spread to more than 200 countries and territories. There are a number of studies, the results of which indicate that deaths are mainly registered among the middle-aged and elderly population with chronic non-communicable diseases. Most of these studies are based on the study of cases of COVID-19 with severe course or in hospitalized patients. At the same time, a greater number of patients, including those with chronic non-communicable diseases, carry COVID-19 to a mild degree and remain under the supervision of primary care physicians.
 AIM: To identify risk factors for the development of severe COVID-19 in patients with chronic non-communicable diseases who sought outpatient care during various periods of increased incidence of new coronavirus infection from March 2020 to February 2022.
 MATERIALS AND METHODS: The study was carried out on the basis of the Family Medicine Center of North-Western State Medical University named after I.I. Mechnikov, which provides primary health care to the population attached under compulsory health insurance. The design of the study was published earlier. A retrospective cohort study was conducted based on the analysis of outpatient records of patients who sought medical care at the Family Medicine Center during various periods of increased incidence of COVID-19: from 19.03.2020 to 30.06.2020 (group 1), from 1.10.2021 to 30.11.2021 (group 2) and from 18.01.2022 to 28.02.2022 (group 3).
 RESULTS: 343 patients were included in the study: 137 men (39.9%) and 206 women (60.1%). The number of patients with at least one chronic non-communicable disease was 232 (67.9%). It was found that the severity of COVID-19 is not affected by the presence of one or more chronic non-communicable diseases of mild severity in the patient. At the same time, grade II obesity and grade III hypertension are independent factors that significantly increase the risk of developing severe COVID-19 by 13.4 and 5.4 times, respectively (p 0.05). It should be noted that the combination of these diseases significantly increased the likelihood of developing severe COVID-19 by 11.9 times (p 0.05).
 CONCLUSIONS: Regardless of the period of morbidity, the clinical manifestations of COVID-19 in patients with chronic non-communicable diseases have their own characteristics: weakness, sweating, dry and wet cough are significantly more common (p 0.05). With each subsequent wave of increase in the incidence of COVID-19 in patients with chronic non-communicable diseases, there is a significant tendency to decrease the frequency of severe and very severe course of the disease, pneumonia and hospitalization, as in patients without chronic non-communicable diseases. It was found that the severity of the COVID-19 course is not affected by the presence of mild chronic non-communicable diseases in the patient. At the same time, grade II and higher obesity or grade III hypertension are independent factors that significantly increase the risk of developing severe COVID-19 by 11.9 and 5.4 times, respectively (p 0.05). The combination of these diseases significantly increased the probability of developing severe COVID-19 by 13.4 times (p 0.05).