Course Of Coronavirus Disease 2019 Research Articles

Cutaneous manifestations associated with COVID-19 infection at a university hospital in eastern China.

Coronavirus disease 2019 (COVID-19) affects different organ systems, including the skin. A retrospective analysis of skin manifestations in Chinese outpatient and inpatient settings is lacking. The study aims to analyze cutaneous manifestations in COVID-19 patients and the recurrence or aggravation of previous skin diseases. A retrospective cross-sectional study was conducted from November 2022 to July 2023 in a university hospital in eastern China. It involved reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 patients, documenting various skin manifestations and the recurrence or aggravation of pre-existing skin conditions. The pattern of skin lesions and other variables were assessed. The study included 303 patients, with 127 males and 176 females. Maculopapular rash was the predominant new cutaneous manifestation (54.92%), mainly in middle-aged individuals. Other findings included urticaria (16.39%), herpes zoster (11.89%), and herpes simplex (4.10%), vesicular rashes (2.46%), purpura (2.05%), erythema multiforme (1.64%), livedo reticularis (0.41%) and so on. Severe disease was associated with herpes zoster and livedo reticularis. Critical COVID-19 cases were linked to vesicular rashes, purpura, and erythema multiforme. The mean time for skin lesion emergence post-infection varied from 3 days for seborrheic dermatitis to 17.48 days for herpes zoster. Vasculitic manifestations correlated with elevated D-dimer levels. A total of 59 cases (19.47%) of recurrent or aggravated skin diseases were reported following infection with COVID-19, with dermatitis being the most common, followed by acne and folliculitis, psoriasis, urticaria, bullous pemphigoid, pemphigus, tinea corporis and androgenetic alopecia. The cutaneous phenotypes delineated in this study expand the dermatologic spectrum associated with COVID-19. Cutaneous manifestations may result from overactive immune responses, complement activation, and microvascular damage. Herpes zoster typically occurs in elderly COVID-19 patients with weaker immune systems or more severe diseases. Purpura and livedo reticularis, although rare, may indicate disease severity. It is possible to predict the course of COVID-19 with different severity through cutaneous manifestations. Recognizing these skin manifestations could aid in predicting COVID-19 severity and guide dermatologists in managing the pandemic response.

Clinical characteristics and disease course before and after SARS-CoV-2 infection in a large cohort of systemic sclerosis patients.

The objective of this study is to evaluate the clinical presentations and adverse outcomes of Coronavirus Disease 2019 (COVID-19) in patients with systemic sclerosis (SSc) and assess the impact of SSc features on the clinical course of COVID-19. In this multicenter, retrospective study, SSc patients with COVID-19 were included. Clinical features of SSc, along with detailed COVID-19 data, were extracted from medical records and patient interviews. The study included 112 patients (mean age 51.4 ± 12.8 years; 90.2% female). SSc-associated interstitial lung disease (ILD) was evident in 57.1% of the patients. The findings revealed hospitalization in 25.5%, respiratory support in 16.3%, intensive care unit admission in 3.6%, and a mortality rate of 2.7% among SSc patients with COVID-19. Risk factors for respiratory failure, identified through univariate analysis, included ILD (OR: 7.49, 95% CI: 1.63-34.46), ≥1 comorbidity (OR: 4.55, 95% CI: 1.39-14.88), a higher physician global assessment score at the last outpatient visit (OR 2.73, 95% CI: 1.22-6.10), and the use of mycophenolate at the time of infection (OR: 5.16, 95 %CI: 1.79-14.99). Notably, ≥1 comorbidity emerged as the sole significant predictor of the need for respiratory support in COVID-19 (OR: 5.78, 95% CI: 1.14-29.23). In the early post-COVID-19 period, 17% of patients reported the progression of the Raynaud phenomenon, and 10.6% developed new digital ulcers. Furthermore, progression or new onset of dyspnea and cough were detected in 28.3% and 11.4% of patients, respectively. This study suggests a potential association between adverse outcomes of COVID-19 and SSc-related ILD, severe disease activity, and the use of mycophenolate. Additionally, it highlights that having comorbidities is an independent risk factor for the need for respiratory support in COVID-19 cases.

Relationship between the switched memory B level and clinical course of coronavirus disease 2019 in patients with common variable immunodeficiency

Relationship between the switched memory B level and clinical course of coronavirus disease 2019 in patients with common variable immunodeficiency

PATHOMORPHOLOGICAL CHANGES OF THE PLACENTA IN THE ACUTE PERIOD OF COVID-19 IN PREGNANT WOMEN

Introduction. The barrier function of the mature placenta ensures the birth of PCR-negative infants in women during the acute period of coronavirus disease (COVID-19). This was explained by a decrease in the level of activity and concentration of angiotensin-converting enzyme type II protein (ACE2), which is a receptor for the coronavirus SARS-CoV-2 in the placenta. We conducted this study in order to detect compensatory changes in the placenta during COVID-19 in a pregnant woman. The aim of the study: To determine pathomorphological changes of the placenta in the acute period of COVID-19 in a pregnant woman. Materials and methods. The placentas of women with full-term pregnancy who were having COVID-19 confirmed by a positive PCR test (determination of SARS-CoV-2 RNA) during childbirth (n=32) were studied. The duration of the post-COVID interval (time from the diagnosis of COVID-19 to delivery) equaled 1–4 weeks. Macroscopic, organometric, microscopic, statistical, and immunohistochemical (with determination of CD34 monoclonal antibody expression) research methods were used. To determine the percentage of the studied structures that differed in color after histological staining, archival photos (×400) were uploaded to ONLINE JPG TOOLS. Results. Delivery dates: 37 to 42 weeks of gestation (median 40). COVID-19 occurred in the period 34 to 40 weeks of gestation (median 36). Course of coronavirus disease in pregnant women: 10 – mild, 18 – medium-severe, severe condition with bilateral polysegmental pneumonia – 4 women. Evaluation of newborns according to the Apgar score: 21 children (65.6%) – 8–9 points, 9 cases (28.1%) – 7–8 points, and one observation – 3–4 points and 6–7 points. No significant difference was found between the clinical manifestations of COVID-19 or the severity of the course of the disease in the pregnant woman and the morphological changes of the placenta. Microscopic examination of the placenta revealed placentitis: chorioamnionitis – 93.8% (95%CI: 82.4%–99.5%), basal deciduitis – 100% (95%CI: 94.2%–100%), villitis and intervillositis – 28.1% (95%CI: 13.7%–45.4%). The degree of manifestations of chorioamnionitis: (+) and (++) was in 34.4% (95% CI: 18.6%–52.1%), basal deciduitis (+) – 15.6% (95% CI: 5 %–30.6%), p1-2=0.08; and (++) in 28.1% (95% CI: 13.7%–45.4%). Manifestation of chorioamnionitis in (+++) and (++++) in 11.8% (95% CI: 3.2%–26.6%), basal deciduitis (+++) in 28.1% (95 % CI: 13.7%–45.4%) and (++++) in 15.6% (95% CI: 5%–30.6%). The expression of manifestations of basal deciduitis (+++++) was found in 11.8% (95% CI: 3.2%–26.6%), p1-2=0.04. The degree of severity of inflammatory changes of the maternal surface of the placenta from (+++) to (+++++) with minor similar changes in the amniotic membranes (+) and (++) confirmed the vertical route of infection. Edema of the stroma of the terminal villi was detected in 90.6% (95% CI: 77.7%–98.3%) and caused a narrowing of the lumen of the capillaries of the terminal villi of the chorion, and a decrease in the percentage of the intervillous space – 26.0 [20.7; 33.8] vs. 44.9 [40.5; 49.6] as a normal value; p = 0.0005. Percentages in a histological section of the terminal villus: stroma – 72.3 [65.8; 78.7], blood vessels – 29.0 [25.6; 34.2] vs. normal indicators: 32.1 [26.2; 39.6] and 67.8 [60.3; 73.7], respectively; p = 0.0039. Conclusions. Maternal pathomorphological changes in full-term pregnancy in the acute period of COVID-19 were caused by the exudation phase of the inflammatory process, which explained the manifestations of placentitis, swelling of the stroma of terminal villi with narrowing of the lumen of capillaries, dyscirculatory disorders. Live birth with high scores on the Apgar scale was ensured by compensatory changes of the mature placenta: an increase in the number of syncytial nodules, the locality of villitis and intervillositis, as mechanisms of increasing the intervillous space to ensure adequate perfusion.

Impact of COVID-19 Infection and Its Association With Previous Vaccination in Patients With Myasthenia Gravis in Korea: A Multicenter Retrospective Study.

During the coronavirus disease 2019 (COVID-19) pandemic, patients with myasthenia gravis (MG) were more susceptible to poor outcomes owing to respiratory muscle weakness and immunotherapy. Several studies conducted in the early stages of the COVID-19 pandemic reported higher mortality in patients with MG compared to the general population. This study aimed to investigate the clinical course and prognosis of COVID-19 in patients with MG and to compare these parameters between vaccinated and unvaccinated patients in South Korea. This multicenter, retrospective study, which was conducted at 14 tertiary hospitals in South Korea, reviewed the medical records and identified MG patients who contracted COVID-19 between February 2022 and April 2022. The demographic and clinical characteristics associated with MG and vaccination status were collected. The clinical outcomes of COVID-19 infection and MG were investigated and compared between the vaccinated and unvaccinated patients. Ninety-two patients with MG contracted COVID-19 during the study. Nine (9.8%) patients required hospitalization, 4 (4.3%) of whom were admitted to the intensive care unit. Seventy-five of 92 patients were vaccinated before contracting COVID-19 infection, and 17 were not. During the COVID-19 infection, 6 of 17 (35.3%) unvaccinated patients were hospitalized, whereas 3 of 75 (4.0%) vaccinated patients were hospitalized (P < 0.001). The frequencies of ICU admission and mechanical ventilation were significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.019 and P = 0.032, respectively). The rate of MG deterioration was significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.041). Logistic regression after weighting revealed that the risk of hospitalization and MG deterioration after COVID-19 infection was significantly lower in the vaccinated patients than in the unvaccinated patients. This study suggests that the clinical course and prognosis of patients with MG who contracted COVID-19 during the dominance of the omicron variant of COVID-19 may be milder than those at the early phase of the COVID-19 pandemic when vaccination was unavailable. Vaccination may reduce the morbidity of COVID-19 in patients with MG and effectively prevent MG deterioration induced by COVID-19 infection.

AVASCULAR NECROSIS OF THE FEMORAL HEAD AFTER COVID-19: A CASE REPORT

Avascular necrosis of the femoral head can traumatic or non-traumatic in origin. Embolism (hemoglobinopathies, dysbaric osteonecrosis), corticosteroid treatment, alcohol usage, pelvic irradiation, and genetic susceptibility are among the causes of this clinical entity. Pathogenesis is influenced by thrombophilia, hypofibrinolysis, and hypoangiogenesis. Coronavirus disease 2019 (COVID-19) infection stands as a cause of non-traumatic osteonecrosis of the femoral head. The condition can be related to the use of corticosteroids throughout the disease course of COVID-19. Yet, there could be other disease-related factors that may contribute to the development of osteonecrosis of the femoral head. The current article aimed to present a case with COVID-19 associated avascular necrosis of the femoral head.

COVID-19 frequency and clinical course in children with asthma.

The epidemic of severe acute respiratory syndrome coronavirus 2 infection, known as the coronavirus disease 2019 (COVID-19), has caused a global health concern. Since its emergence, numerous studies have focused on various clinical manifestations and outcomes in different populations. However, studies are ongoing as the consequences and impact of COVID-19 in children with chronic diseases such as asthma are controversial. To fill this research gap by retrospectively evaluating the course, laboratory, and clinical findings of COVID-19 among 414 asthmatic children followed up from the pediatric allergy outpatient clinic and known to have had COVID-19. The data of 5510 patients over the age of 5 diagnosed with asthma in our hospital's data were retrospectively scanned with specific parameters using protocol numbers from the hospital filing system. The data included retrospective evaluation of pulmonary function test results before and after COVID-19, routine hematological and biochemical parameters, sensitization states (total IgE, specific IgE, and skin prick test results), and radiological (computed tomography) findings. To inquire about the course and symptoms of COVID-19, asthma patients or their parents were then called and evaluated with a questionnaire. As a result of retrospectively scanning the data of 5510 asthma patients over the age of 5, it was determined that 414 (7.5%) patients had COVID-19. The mean age of 414 patients was 17.18 ± 4.08 (min: 6; max: 28) years. Two hundred and three of our 414 patients are male, and 211 are female. When their vaccination status was questioned, 21.5% were vaccinated. When the symptoms of our 290 patients were questioned, it was stated that 59.0% had fever symptoms. The rate of using regular prophylactic asthma medications was 19%. The rate of using salbutamol in asthma was found to be 22%. The rate of patients using methylprednisolone was 1%. Emergency service admission was 17.2%, and hospitalization was found to be 4.8%. Leukopenia (< 4000) was found in 14.1% of patients, and 8.08% of our patients had neutropenia (< 1500). Lymphopenia (< 1500) was detected in 44.4% of patients, and lymphocytosis (> 4000) was found in 5.05% of patients. In 65% of our patients, the C-reactive protein value was elevated. A high aspartate aminotransferase and alanine aminotransferase value was detected in 3.2% and 5.4% of patients were found, respectively. 31% of patients had an elevated lactate dehydrogenase value. Typical radiological findings for COVID-19 were detected in 3/309 of patients. According to our study, there is a correlation between the severity of COVID-19 and asthma symptoms and the course of the disease. However, it is worth noting that the retrospective nature of the study and the differences in sample size, age, and demographic characteristics between the two groups do not allow for an optimal comparison. Therefore, further investigation is needed to explore the relationship between COVID-19 and asthma, and it can be suggested that COVID-19 may trigger asthma attacks and asthma may impact the course of COVID-19.

The value of serum neutralizing antibody in evaluating predictability of COVID-19 after recovery and the validation of vaccine

BackgroundThis work aimed to study natural humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.MethodsChemiluminescent immunoassay (CLIA) was used to detect the neutralizing antibody (Nabs) and IgG.ResultsNabs peaked on days 57–96 after symptom onset and remained detected on days 97–132. The Nabs in the 32 patients who were dynamically monitored showed four changing patterns. The titers of Nabs and IgG were correlated, and three modes of relationship were found between them.ConclusionsNabs showed a regular change in the course of coronavirus disease 2019 (COVID-19). The detection of Nabs is very important for monitoring the course of COVID-19 and predicting the strength of antibody protection.

Importance of timing and training to implement awake prone positioning in patients with COVID-19: a single-center prospective observational study.

Awake prone positioning (APP) is broadly implemented in patients with severe acute respiratory syndrome coronavirus 2 related disease [coronavirus disease 2019 (COVID-19)] admitted to hospital with severe respiratory distress syndrome. This prospective observational study aimed to explore the factors influencing the implementation of APP in patients with acute respiratory failure due to COVID-19. Patients with COVID-19, all hospitalized with positive X-ray findings and oxygen supplementation requirement, in the Respiratory Step-Down Unit of the Peking University Third Hospital between January 6th, 2023, and January 20th, 2023, were included in this study. Data regarding basic information, activities of daily living (ADLs) scores, oxygen therapy, vital signs, and duration of APP were collected to investigate the factors influencing prone positioning. Among the 134 patients included, 55.2% showed an improvement in oxygen saturation 1 hour after APP. Logistic regression revealed that the pre-APP heart rate (HR) [odds ratio (OR) =1.032; P=0.046] and peripheral oxygen saturation (SpO2) (OR =0.720; P<0.001) were the associated factors of the improvement in SpO2 after treatment. Multiple linear regression revealed that the ADL scores and pre-APP respiratory rate (RR) were the associated factors of the duration of prone positioning (P<0.01). The APP technical steering group effectively improved duration of APP. Patients with low SpO2 and increased HR before treatment showed greater improvement in oxygen saturation. Patients with lower tolerance to ADL but lower RRs were those to demonstrate a longer duration of prone positioning. This is pointing towards establishing the most favorable time window for APP during the course of COVID-19: after the ADLs have already decreased, but before significant tachypnea has appeared.

COVID-19 outcome is not affected by anti-CD20 or high-titer convalescent plasma in immunosuppressed patients

The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma in the treatment of Coronavirus Disease 2019 (COVID-19) in immunosuppressed individuals remains controversial. We describe the course of COVID-19 in patients who had received anti-CD20 therapy within the 3 years prior to infection. We compared outcomes between those treated with and those not treated with high titer SARS-CoV2 convalescent plasma. We identified 144 adults treated at Mayo clinic sites who had received anti-CD20 therapies within a median of 5.9 months prior to the COVID-19 index date. About one-third (34.7%) were hospitalized within 14 days and nearly half (47.9%) within 90 days. COVID-19 directed therapy included anti-spike monoclonal antibodies (n = 30, 20.8%), and, among those hospitalized within 14 days (n = 50), remdesivir (n = 45, 90.0%), glucocorticoids (n = 36, 72.0%) and convalescent plasma (n = 24, 48.0%). The duration from receipt of last dose of anti-CD20 therapy did not correlate with outcomes. The overall 90-day mortality rate was 14.7%. Administration of convalescent plasma within 14 days of the COVID-19 diagnosis was not significantly associated with any study outcome. Further study of COVID-19 in CD20-depleted individuals is needed focusing on the early administration of new and potentially combination antiviral agents, associated or not with vaccine-boosted convalescent plasma.

The impact of COVID-19 infection in pediatric and adult patients with primary immunodeficiency: a single center analysis

Background: The global impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been profound, with over 760 million confirmed infections and almost 7 million deaths from coronavirus disease 2019 (COVID-19). The pandemic, officially declared in March 2020, has caused significant and irreversible changes in society. COVID-19 continues to pose a serious threat, ranging from asymptomatic cases to severe outcomes such as acute respiratory distress syndrome and organ failure, putting immense pressure on healthcare systems worldwide. The effects of SARS-CoV-2 infection on individuals with primary immunodeficiency (PID) are not yet fully understood. To date, the available research remains scarce, and the results do not yet provide conclusive evidence of a definitive link between PID and severe SARS-CoV-2 infection. In this study we present the clinical course and outcome of COVID-19 in individuals with PID. Methods: This study is a retrospective analysis involving 65 patients, comprising both pediatric and adult individuals diagnosed with PID, who exhibited symptoms of SARS-CoV-2 infection and tested positive at The Hospital for Sick Children in Toronto, Ontario, Canada. The data was collected from October 2020 to December 2022. Results: Sixty-five patients (36 children and 29 adults) were enrolled in our study. Our patients were diagnosed with primary immunodeficiency, and categorized as combined immunodeficiency, antibody deficiency, immune dysregulation disorder, phagocyte defect, intrinsic and innate immunity, or autoinflammatory disorder. Each of our patients had their COVID-19 infection confirmed through serology, rapid antigen test, and/or PCR. Among the study participants, 24 individuals had pre-existing lung conditions. At the time of contracting the infection, 42 patients had been vaccinated against SARS-CoV-2. The majority of patients in the study experienced mild to moderate symptoms of COVID-19. Conclusion: Our patients with PID exhibited mild to moderate symptoms of COVID-19, and all made a full recovery without any complications. Statement of Novelty: This study sheds light on impact of COVID-19 in individuals with primary immunodeficiency, revealing a noteworthy observation that patients exhibited mild to moderate symptoms, and remarkably, all experienced a complete recovery devoid of complications.

Клініко-лабораторні особливості перебігу коронавірусної хвороби та рівень цистатину С у госпіталізованих пацієнтів

The course of coronavirus disease is often accompanied by renal dysfunction, which is the result of comorbid pathology, namely diabetes mellitus, hypertension and precisely nephrological diseases. The most common and affordable way to monitor the condition of the kidneys is by determining the level of creatinine and calculating the glomerular filtration rate. However, serum cystatin C level is the «gold standard» for assessing renal function. This study aims to examine the clinical and laboratory aspects of coronavirus disease and establish the correlation between cystatin C and kidney function in hospitalized patients. 79 patients with coronavirus disease ranging from 24 to 73 years were involved in the study. The percentage of women in the group was 40,5%, while the percentage of men was 59,5%. The current protocol for the treatment of coronavirus disease, approved in Ukraine, was followed by all patients. Additionally, to assess renal dysfunction, cystatin C was determined biochemically using the SPINREACT test system (Spain). Results. Creatinine level was 123.0 (96,0; 151,0) μmol/l. Glomerular filtration rate was 52 (42,5; 71,0) ml/h/l.73m 2 , suggesting renal dysfunction. The cystatin C concentration was 1,27 (0,81; 1,87) mg/l. Cystatin C correlated with creatinine concentration (r = 0,62, p &lt; 0,05) and negatively correlated with GFR (r = -0,65; p &lt; 0,05), while, unlike creatinine, its level did not depend on age and gender. Increasing the concentration of cystatin C in the future could be a prognostic marker for the severe course of coronavirus disease, not just for renal dysfunction. Conclusions. Clinical manifestations and laboratory parameters during hospital admission depended on the premorbid background and were characterized by the presence of the following syndromes: systemic inflammatory response, respiratory failure, hypercoagulation and renal dysfunction. An elevated level of cystatin C is an indicator of kidney dysfunction, as well as a prognostic marker of severe coronavirus disease.

Neutrophil Extracellular Traps Are Induced by Coronavirus 2019 Disease-Positive Patient Plasma and Persist Longitudinally: A Possible Link to Endothelial Dysfunction as Measured by Syndecan-1.

Background: Neutrophil extracellular trap (NET) formation is a mechanism that neutrophils possess to respond to host infection or inflammation. However, dysregulation of NETosis has been implicated in many disease processes. Although the exact mechanisms of their involvement remain largely unknown, this study aimed to elucidate NET formation over the time course of coronavirus disease 2019 (COVID-19) infection and their possible role in endothelial injury. Patients and Methods: Plasma samples from COVID-19-positive patients were obtained at six timepoints during hospitalization. Neutrophils were extracted from healthy donors and treated with COVID-19-positive patient plasma. Myeloperoxidase (MPO) assay was used to assess for NETosis. Syndecan-1 (SDC-1) enzyme-linked immunosorbent assay (ELISA) was run using the same samples. Immunocytochemistry allowed for further quantification of NETosis byproducts MPO and citrullinated histone 3 (CitH3). The receiver operating characteristic (ROC) curve discriminated between admission levels of SDC-1 and MPO in predicting 30-day mortality and need for ventilator support. Results: Sixty-three patients with COVID-19 were analyzed. Myeloperoxidase was upregulated at day 3, 7, and 14 (p = 0.0087, p = 0.0144, p = 0.0421). Syndecan-1 levels were elevated at day 7 and 14 (p = 0.0188, p = 0.0026). Neutrophils treated with day 3, 7, and 14 plasma expressed increased levels of MPO (p < 0.001). Immunocytochemistry showed neutrophils treated with day 3, 7, and 14 plasma expressed higher levels of MPO (p < 0.001) and higher levels of CitH3 when treated with day 7 and 14 plasma (p < 0.01 and p < 0.05). Admission SDC-1 and MPO levels were found to be independent predictors of 30-day mortality and need for ventilator support. Conclusions: Neutrophil dysregulation can be detrimental to the host. Our study shows that COVID-19 plasma induces substantial amounts of NET formation that persists over the course of the disease. Patients also exhibit increased SDC-1 levels that implicate endothelial injury in the pathogenesis of COVID-19 infection. Furthermore, MPO and SDC-1 plasma levels are predictive of poor outcomes.

Pathobiological alterations affecting the distinct clinical courses of pediatric versus adult COVID-19 syndrome.

The clinical presentation of pediatric coronavirus disease 2019 (COVID-19) is associated with a milder disease course than the adult COVID-19 syndrome. The disease course of COVID-19 has three clinicobiological phases: initiation, propagation, and complication. This study aimed to assess the pathobiological alterations affecting the distinct clinical courses of COVID-19 in pediatric age groups versus the adult population. We hypothesized that critical biogenomic marker expressions drive the mild clinical presentations of pediatric COVID-19. Blood samples were obtained from 72 patients with COVID-19 hospitalized at Ankara City Hospital between March and July 2021. Peripheral blood mononuclear cells were isolated using Ficoll-Paque and density-gradient sedimentation. The groups were compared using a t-test and limma analyses. Mean standardized gene expression levels were used to hierarchically cluster genes employing Euclidean Gene Cluster 3.0. The expression levels of identified genes were determined using reverse transcription-polymerase chain reaction. This study found that ANPEP gene expression was significantly downregulated in the pediatric group (p < 0.05, FC: 1.57) and IGF2R gene expression was significantly upregulated in the adult group (p < 0.05, FC: 2.98). The study results indicated that the expression of critical biogenomic markers, such as the first-phase (ACE2 and ANPEP) and second-phase (EGFR and IGF2R) receptor genes, was crucial in the genesis of mild clinical presentations of pediatric COVID-19. ANPEP gene expression was lower in pediatric COVID-19. The interrelationship between the ANPEP and ACE2 genes may prevent the progression of COVID-19 from initiation to the propagating phase in pediatric patients. High IGF2R gene expression could potentially contribute to a protective effect and may be a contributing factor for the mild clinical course observed in pediatric patients.

EuCARE-hospitalised study protocol: a cohort study of patients hospitalised with COVID-19 in the EuCARE project

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), can lead to hospitalisation, particularly in elderly, immunocompromised, and non-vaccinated or partially vaccinated individuals. Although vaccination provides protection, the duration of this protection wanes over time. Additional doses can restore immunity, but the influence of viral variants, specific sequences, and vaccine-induced immune responses on disease severity remains unclear. Moreover, the efficacy of therapeutic interventions during hospitalisation requires further investigation. The study aims to analyse the clinical course of COVID-19 in hospitalised patients, taking into account SARS-CoV-2 variants, viral sequences, and the impact of different vaccines. The primary outcome is all-cause in-hospital mortality, while secondary outcomes include admission to intensive care unit and length of stay, duration of hospitalisation, and the level of respiratory support required.MethodsThis ongoing multicentre study observes hospitalised adult patients with confirmed SARS-CoV-2 infection, utilising a combination of retrospective and prospective data collection. It aims to gather clinical and laboratory variables from around 35,000 patients, with potential for a larger sample size. Data analysis will involve biostatistical and machine-learning techniques. Selected patients will provide biological material. The study started on October 14, 2021 and is scheduled to end on October 13, 2026.DiscussionThe analysis of a large sample of retrospective and prospective data about the acute phase of SARS CoV-2 infection in hospitalised patients, viral variants and vaccination in several European and non-European countries will help us to better understand risk factors for disease severity and the interplay between SARS CoV-2 variants, immune responses and vaccine efficacy. The main strengths of this study are the large sample size, the long study duration covering different waves of COVID-19 and the collection of biological samples that allows future research.Trial registrationThe trial has been registered on ClinicalTrials.gov. The unique identifier assigned to this trial is NCT05463380.

COVID-19 Seyrinde NLR, LMR, PLR, d-NLR, LeCR, LCR, NMR Biyoparametrelerinin Etkinliğinin Değerlendirilmesi

Background/Objective: Severe inflammatory response of the immune system has a serious role in the progression of Coronavirus disease 2019 (COVID-19). The clinical benefits of early diagnosis of immune activation of COVID-19 have been emphasized repeatedly in the trials to this date. In this study, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), derived neutrophil-to-lymphocyte ratio (d-NLR), lymphocyte-to-C reactive protein ratio (LCR), leukocyte-to-C reactive protein ratio (LeCR), neutrophil-to-monocyte ratio (NMR) biomarkers were evaluated for predicting clinical course of COVID-19. &#x0D; Methods: In this retrospective cohort study, 383 laboratory-confirmed COVID-19 cases, who had been hospitalized in a tertiary care hospital between April and November 2020, were included. Patients, including 279 mild and 104 severe cases, were sequentially selected. Blood tests, conducted at the time of admission, were examined. Data was analyzed and ROC analysis was performed by using SPSS 22.0 program. &#x0D; Results: 44.3% of the patients included in the study were female, 99.2% of the patients had viral pneumonia, 27.2% met clinical criteria for severe disease and median age was 58 years. Age, duration of hospitalization, white blood cell count, neutrophil count, ferritin, CRP, procalcitonin, D-dimer, troponin levels were higher and lymphocyte, monocyte counts were lower in the group with clinically severe disease. The diagnostic sensitivities of LCR, CRP, d-NLR, NLR, LeCR were found to be high (AUC&gt; 0.8) for the prediction of clinical severity with cut-off values of 15, 74.65, 2.55, 4, 133 respectively. &#x0D; Conclusion: High CRP, d-NLR, NLR and low LCR, LeCR are early predictors of the clinical severity, these patients should be under hospital follow-up for close monitoring and early intervention.

Analysis of Leukocyte Subpopulations by Flow Cytometry during Hospitalization Depending on the Severity of COVID-19 Course.

The mechanisms underlying the immune response to coronavirus disease 2019 (COVID-19) and the recovery process have not been fully elucidated. The aim of the study was to analyze leukocyte subpopulations in patients at significant time points (at diagnosis, and 3 and 6 months after infection) selected according to the analysis of changes in the lungs by the CT classification system, considering the severity of the disease. The study groups consisted of severe and non-severe COVID-19 patients. There was a significant decrease in CD8+ T cells, NK and eosinophils, with an increasing percentage of neutrophils during hospitalization. We noticed lower levels of CD4 and CD8 T lymphocytes, eosinophils, basophils, and CD16+ monocytes and elevated neutrophil levels in severe patients relative to non-severe patients. Three months after infection, we observed higher levels of basophils, and after 6 months, higher CD4/CD8 ratios and T cell levels in the severe compared to non-severe group. Non-severe patients showed significant changes in the leukocyte populations studied at time of hospitalization and both within 3 months and 6 months of onset. The CT CSS classification with parameters of the flow cytometry method used for COVID-19 patients determined changes that proved useful in the initial evaluation of patients.

The role of ozone therapy in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19): a review.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has rapidly swept across the world. As new knowledge regarding treatment options for COVID-19 has emerged, the use of ozone therapy in the context of SARS-CoV-2 infection as an integrative therapeutic option supplementary to standard treatment regimen has been assessed in the present literature. We reviewed, critically analyzed, and summarized all present published literature on ozone therapy in association with COVID-19 via the PubMed database. Various reports and studies on the use of ozone (major autohemotherapy, rectal ozone insufflation, ozone inhalation) in patients affected by COVID-19 indicate that ozone therapy may reduce morbidity and accelerate recovery, while exhibiting a high safety profile with no relevant adverse effects. Current literature suggests that integrating ozone therapy into the existing standard of care and best available therapy for the treatment of COVID-19 patients offers major advantages in terms of superior clinical outcome parameters and amelioration of laboratory results. Further prospective studies are warranted to guide the next steps in the clinical application of ozone therapy and examine its impact on the course of COVID-19.

CHARACTERISTICS OF RESPIRATORY MANIFESTATIONS OF COVID-19 AGAINST THE BACKGROUND OF AN ACCOMPANYING ONCOLOGICAL PATHOLOGY IN PEDIATRIC PRACTICE (CASE FROM PRACTICE)

Abstract. During the pandemic caused by the spread of a new coronavirus SARS-CoV-2,respiratory symptoms were the most common and decisive in determining the severity ofCOVID19, and in some cases, had a direct causal- consequential mortality impact. Unlikeadults, children had a milder course of coronavirus disease. However, children with thecomorbidities such as diabetes, immunodeficiency, obesity, etc. also had an increased riskof hospitalisation with further required mechanical ventilation.The article presents a clinical case of coronavirus infection in a child with cancer.The patient had a severe course of COVID-19 with signs of post-hospital extralobarviral- bacterial pneumonia complicated by exudative pleurisy, respiratory insufficiencyand exudative pericarditis with a background of initially diagnosed asymptomatic nonHodgkin’s T-cell lymphoma.The complex treatment (oxygen therapy, infusion therapy,combined antibiotic therapy, steroids, diuretics, chest tube drainage) was characterisedby a positive dynamics followed by targeted cancer therapy. The defined patient developedsevere COVID-19 due to cardiovascular complications and formation of an inflammatorycascade due non-Hodgkin’s lymphoma.

Temporal evolution of laboratory characteristics in patients critically ill with COVID‑19 admitted to the intensive care unit (Review).

In the context of coronavirus disease 2019 (COVID-19), laboratory medicine has played a crucial role in both diagnosis and severity assessment. Although the importance of baseline laboratory findings has been extensively reported, data regarding their evolution over the clinical course are limited. The aim of the present narrative review was to provide the dynamic changes of the routine laboratory variables reported in patients with severe COVID-19 over the course of their critical illness. A search was made of the literature for articles providing data on the time-course of routine laboratory tests in patients with severe COVID-19 during their stay in the intensive care unit (ICU). White blood cell, neutrophil and lymphocyte counts, neutrophil to lymphocyte ratio, platelet counts, as well as D-dimer, fibrinogen, C-reactive protein, lactate dehydrogenase and serum albumin levels were selected as disease characteristics and routine laboratory parameters. A total of 25 research articles reporting dynamic trends in the aforementioned laboratory parameters over the clinical course of severe COVID-19 were identified. During the follow-up period provided by each study, the majority of the laboratory values remained persistently abnormal in both survivors and non-survivors. Furthermore, in the majority of studies, the temporal trends of laboratory values distinctly differentiated patients between survivors and non-survivors. In conclusion, there are distinct temporal trends in selected routine laboratory parameters between survivors and non-survivors with severe COVID-19 admitted to the ICU, indicating their importance in the prognosis of clinical outcome.