Course Of Coronavirus Infection Research Articles

Trends in Morbidity and Hospital Lethality from Neoplasms before and during the New Coronavirus Infection COVID-19

Background. Taking into account the special medical and social significance of oncological diseases, as well as taking into account that patients suffering from neoplasms are a special risk group for developing complications of coronavirus infection, it seems relevant to study the impact of the COVID-19 pandemic on the level of morbidity and hospital lethality of patients with neoplasms.
 Aims to study the trends of morbidity and hospital lethality due to neoplasms in the Russian Federation before and during the pandemic of the new coronavirus infection COVID-19.
 Methods. The indicators of primary and general morbidity, hospital lethality from neoplasms of the adult population were calculated on the basis of federal statistical observation data contained in reporting forms No. 12 and No. 14 of all subjects of the Russian Federation for 20152020.
 Results. During the period from 2015 to 2019, an increase in the general (by 14.8%) and primary (by 4.8%) incidence of neoplasms was noted in the Russian Federation. In 2020, compared with 2019, on the contrary, the indicators of general (by 5.0%) and primary (by 17.4%) incidence of neoplasms decreased. Hospital lethality due to neoplasms also increased during 20152019, in total it increased by 19.2%, in one year (2020) hospital lethality increased by 6.6%. A similar situation has developed in all federal districts and most regions of the country.
 Conclusions. The decline in the incidence of neoplasms in 2020, with their previous continuous growth, reflects the difficult situation that has developed during the pandemic of a new coronavirus infection in the healthcare of the Russian Federation. The increase in hospital lethality from neoplasms indicates a more severe course of coronavirus infection in adult patients with malignant neoplasms and a more frequent development of fatal complications in them.

Clinical case of an unusual course of coronavirus infection in patient with chronic disseminated pulmonary tuberculosis and human immunodeficiency virus infection

Introduction: The coronavirus 2019 (COVID-19) pandemic demonstrated a negative influence on many underlying diseases, their course, and prognosis. A combined course of active tuberculosis, human immunodeficiency virus (HIV) infection, and COVID-19 is a rare case in the routine clinical practice; therefore, it is of scientific and practical interest. In a 41-year-old patient with severe chronic disseminated pulmonary tuberculosis and HIV infection, presence of tuberculosis mycobacteria, resistance to streptomycin and isoniazid, chronic respiratory failure, cachexia, and immunodeficiency, COVID-19 was manifested only by the detection of SARS-Cov-2 virus from the nasopharynx and did not influence the treatment and prognosis of tuberculosis.
 Conclusion: The described case of a combination of active tuberculosis with HIV infection and COVID-19 demonstrated that effective treatment of specific tuberculosis process is quite possible.

Respiratory viral infections including caused by coronaviruses in oncological and oncohematological patients

BACKGROUND: Patients with cancer are prone to developing infectious complications. They significantly aggravate the course of the underlying disease and worsen the quality of life of patients. The emergence of infections is largely promoted by immunosuppression associated with the use of cytostatic drugs, high-dose chemotherapy and hematopoietic stem cell transplantation in hematological cancer patients. Among infectious agents, respiratory viruses, especially influenza viruses, play an important role. The urgency of this problem has increased many times in connection with the development of the COVID-19 pandemic.
 AIM: To study the features of the course of respiratory infections, including coronavirus (seasonal and COVID-19), infections in cancer and oncohematological patients during hospitalization and in outpatient settings.
 MATERIALS AND METHODS: The study of the frequency and course of infectious complications in cohorts of patients with oncological diseases, who were under dispensary supervision in the polyclinic in Kirovsk, Leningrad region. Retrospective analysis of the frequency and characteristics of the course of coronavirus infection caused by HCoVs (OC43, 229E, NL63, HKU1) in patients treated at the clinics of the Russian research institute of Hematology and Transfusionology. Prospective study of the coronavirus COVID-19 of patients hospitalized at the Russian research institute of Hematology and Transfusionology and at the Kirov interdistrict hospital in Leningrad Region during the period of its conversion to specialized infection diseases hospital.
 RESULTS: Coronavirus infection caused by HCoVs (OC43, 229E, NL63, HKU1), occurs in hematological cancer patients more often in association with other respiratory viruses. In the cases of detection of the SARS-CoV-2 in hospitalized patients, they need to be transferred to specialized infectious hospitals.
 CONCLUSIONS: Respiratory viral infections are risk factors in cancer and oncohematological patients. Outpatient oncological and oncohematological patients require constant dispensary observation and special attention during the COVID-19 pandemic, outbreaks of influenza and other viral infections.

Clinical, laboratory and instrumental indicators in patients who have undergone COVID-19

280 patients with COVID-19 were examined (average age 53.9±8.1 years; gender index 1.37:1.0 (162 men and 118 women). It was revealed that young people (especially women) were more common with a mild course of the disease (64.2%), middle – aged people-with a moderate-severe variant of COVID-19 (54.8%), In the group of patients with a severe course of coronavirus infection, female patients prevailed among the elderly, and among middle –aged men – 47.8% and 48.4%, respectively. The comorbid background before the disease CAVID-19 and the neurological complications that appeared on the background of CAVID-19 in the percentage ratio prevailed in males. There were no significant differences in the frequency of complications from the severity of the COVID-19 disease. It was revealed that at the time of hospitalization, all the studied markers of coagulation activity were changed and statistically significantly differed from the reference interval, which indicated the activation of the procoagulation potential. In the group of female patients, these indicators were more pronounced. CT examination revealed that the percentage of damage to both lungs was significantly higher in female patients compared to male patients.

111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?

Abstract Aim The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects. Method We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020. Results No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality. Conclusions There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.

Clinical case of a new coronavirus infection in a teenager with ulcerative colitis

The relevance of monitoring the course of coronavirus infection COVID-19 in combination with comorbid pathology is obvious, since this new infection with immunopathological pathogenesis is not fully understood.The article presents a clinical case of COVID-19 disease in a 14-year-old teenager from the Moscow region, who developed against the background of severe ulcerative ileocolitis of moderate activity. The new coronavirus infection contributed to the recurrence of ulcerative colitis, which required observation and treatment in a hospital setting.The examination revealed: mild hypochromic posthemorrhagic anemia, signs of hypercoagulation characteristic of the course of ulcerative colitis; excluded: opportunistic infections, pneumonia, acute intestinal infections and intestinal bleeding.The standard complex therapy of ulcerative colitis without the inclusion of immunosuppressors made it possible to avoid a more severe and complicated course of the new coronavirus infection. COVID-19 in the teenager was mild, antiviral therapy was not used.

Surgical treatment of broncho­­pulmonary purulent­inflammatory complications due to permanent coronaviral ihfection — the first experience

Objective — to acquaint doctors of different profiles with thoracic pathology in patients with coronavirus infection.
 Materials and methods. Since the beginning of the SARSCoV-2 pandemic, on the basis of the clinical department for the surgical treatment of tuberculosis and NZL complicated by purulent septic infections 70 patients were treated, of which 39 (55.7 %) had various broncho-pulmonary purulent-inflammatory complications of coronavirus infection.
 Results and discussion. The distribution of treated patients with bronchopulmonary purulent-inflammatory complications of coronavirus infection by nosology is presented in Table 1. According to the table presented, pleural empyema was a frequent bacterial complication of the respiratory system — 18 (46.1 %) cases; only 6 (33.3 %) patients were diagnosed with broncho-pleural communication, while in 12 (66.7 %) patients, already at the stage of hospitalization, a functioning broncho-pleural fistula was observed.17 (94.4 %) patients with empyema underwent videothoracoscopic (VATS) debridement of the pleural cavity with polydrainage and the use of prolonged active aspiration in the postoperative period. The management of such patients was no different, except for 2 points: the need to continue GCS therapy and the obligatory long-term prescription of anticoagulants and antiplatelet drugs.In 1 (5.6 %) case, due to the extremely serious condition of the patient, only drainage of both pleural cavities was performed (this case was fatal). In another case, after 2 VATS of the pleural cavity, bronchial blocking of the upper lobe and intermediate bronchi of the right lung was performed, followed by active aspiration. Nonspecific exudative pleurisy was diagnosed in 8 (20.5 %) patients after coronavirus infection. There were 13 patients with abscess pneumonia and abscesses (33.3 %). This group of patients underwent drug therapy for a long time, which consisted in the appointment of broad-spectrum antibiotics, anticoagulants, pathogenetic therapy and symptomatic treatment.After a course of conservative treatment, 9 (69.2 %) patients underwent the following surgical interventions — sublobar resection for a sanitized lung abscess in 4 (44.5 %) cases, lobectomy in the presence of sanitized residual large cavities in 3 (33.3 %) patients, partial pleurectomy with decortication of the lung and sublobar resection of the lower lobe of the left lung in 2 (22.2 %) patients.Conservative therapy was successful only in 4 (30.7 %) patients. All 13 patients with abscess pneumonia and abscesses were discharged from the institute with full recovery or improvement (small sanitized destruction cavities up to 2 cm in diameter remained in the lung parenchyma). There were no lethal outcomes.The overall effectiveness of the treatment of this contingent of patients was 97.4 %, and the general mortality rate — 2.6 %.Videothoscopic treatment was effective in 25 (64.1 %) patients with pleural empyema and nonspecific pleurisy, and in 4 (16 %) patients it allowed to stabilize the condition and carry out resection surgery. 
 Conclusions. Purulent-destructive complications of the respiratory system in coronavirus infection have a causal component, and therefore timely exposure to all parts of the pathogenesis can significantly reduce their level. Preference should be given to videothoracoscopic intervention in the complicated course of coronavirus infection. The high level of diagnosis (25.4 %) of concomitant pathology of the chest with the widespread use of radiological methods in the pandemic of coronavirus infection may indicate a low level of preventive medicine in the state.

Comparison of the Effect of Unfractionated Heparin and Enoxaparin Sodium at Different Doses on the Course of COVID-19-Associated Coagulopathy.

Background: COVID-19-associated coagulopathy (CAC) exacerbates the course of coronavirus infection and contributes to increased mortality. Current recommendations for CAC treatment include the use of low-molecular weight heparins (LMWH) at prophylactic or therapeutic doses, as well as the use of unfractionated heparin (UFH). Methods: A randomised, controlled trial enrolled 126 patients hospitalised in the intensive care unit with severe COVID-19 complicated by CAC. The effects of LMWH at preventive and therapeutic doses and UFH at therapeutic doses on mortality and intubation rates were compared. Results: The number of intubations and deaths showed no significant difference depending on the anticoagulant therapy used. However, multivariate logistic regression models revealed an increased risk of intubation (p = 0.026, odds ratio (OR) = 3.33, 95% confidence interval (CI) 1.15–9.59), and an increased risk of death (p = 0.046, OR = 3.01, 95% CI 1.02–8.90), for patients treated with LMWH at a prophylactic dose but not at a therapeutic dose as compared to patients treated with UFH when controlling for other risk factors. Conclusions: The use of unfractionated heparin in the treatment of COVID-19-associated coagulopathy seems to be more effective at reducing the risk of intubation and death than enoxaparin at prophylactic doses.

Current conception about the pathogenesis and intensive care of severe COVID-19 (review)

The aim of the research. The aim of this work was to summarize the scientific literature data on the pathogenesis and intensive care of the severe course of coronavirus infection.
 Materials and methods. Databases such as PubMed, Google Scholar, Scopus and Web Of Science 2020-2021 were used for literary searches.
 Results. An intense inflammatory response against the SARS-CoV-2 virus in COVID-19 patients causes a cytokine storm and hypercoagulability with the development of acute respiratory distress syndrome (ARDS) and multiple organ failure. Approximately 17 % to 35 % of hospitalized patients with COVID-19 are treated in the intensive care unit, most often due to hypoxemic respiratory failure and the development of ARDS, and between 29 % and 91 % of patients in intensive care units require invasive ventilation.
 In addition to acute respiratory failure, hospitalized patients may have acute renal failure (9 %), liver dysfunction (19 %), coagulation disorders (10 %–25 %), and septic shock (6 %).
 More than 75 % of hospitalized patients require additional oxygen therapy. Respiratory support could vary from the need for oxygen supplementation through a nasal catheter to invasive ventilation or extracorporeal membrane oxygenation in patients with the most severe ARDS.
 The uncontrolled inflammation and coagulation seen in COVID-19 patients is similar to multifactorial ARDS, where a plethora of evidence has demonstrated the ability of long-term corticosteroid therapy (CST) to reduce inflammation-coagulation-fibroproliferation and accelerate recovery.
 With regard to the assessment of the benefits of therapeutic anticoagulation in patients with elevated D-dimer, the question has not yet been finally resolved, and research devoted to this is still ongoing.
 Conclusions. The approaches to respiratory, anticoagulant, anti-inflammatory therapy in critically ill patients with COVID-19 require further research to determine the optimal treatment tactics

ACTIVITY OF ANGIOTENSIN-CONVERSING ENZYME-2 IN ACUTE PULMONARY INFLAMMATION

Relevance. Angiotensin converting enzyme-2 (ACE2), which is the gateway to coronavirus, is also an important component of the tissue renin-angiotensin system with a number of anti-inflammatory effects. It is known that ACE2 is expressed in the lungs of patients with coronavirus pneumonia, but it is not clear how this depends on the stages of development and the severity of inflammation.
 Objective: to establish the effect of acute inflammation on pulmonary expression of angiotensin-converting enzyme-2.
 Material and methods. In Wistar rats (n=20), in compliance with bioethical standards, a sterile nylon thread 2.5 cm long and 0.2 mm thick to a depth of 2.5 cm was introduced into the trachea. The animals were observed and removed from the experiment at 7, 14, 21 and 28 days, microscopic and immunohistochemical (monoclonal antibodies against ACE2; clone 4G5.1; EMD Millipore Corporation; Temecula, CA US) studies were performed.
 Results. The microscopic picture of the lungs indicated the development of acute bronchopulmonary inflammation during the first week, the formation of peribronchial and alveolar abscesses in the second week with the onset of resolution of bronchopneumonia with the organization of abscesses in the third week and the development of diffuse fibrosis of the parenchyma and vascular hyalinosis in the fourth week of observation. The exudative phase of acute inflammation was accompanied by inhibition of ACE2 activity in bronchial epithelial cells, type II alveolocytes and vascular endothelium. With the transition of inflammation to the stage of proliferation and fibrosis, ACE2 activity was restored.
 Conclusion. The detected phase change in ACE2 activity can cause a wavy recurrent course of coronavirus infection, since an increase in the amount of ACE2 protein during attenuation of acute inflammation contributes to an increase in target cell infection.

Current state of the obesity research: genetic aspects, the role of microbiome, and susceptibility to COVID-19

Obesity affects over 700 million people worldwide and its prevalence keeps growing steadily. The problem is particularly relevant due to the increased risk of COVID-19 complications and mortality in obese patients. Obesity prevalence increase is often associated with the influence of environmental and behavioural factors, leading to stigmatization of people with obesity due to beliefs that their problems are caused by poor lifestyle choices. However, hereditary predisposition to obesity has been established, likely polygenic in nature. Morbid obesity can result from rare mutations having a significant effect on energy metabolism and fat deposition, but the majority of patients does not present with monogenic forms. Microbiome low diversity significantly correlates with metabolic disorders (inflammation, insulin resistance), and the success of weight loss (bariatric) surgery. However, data on the long-term consequences of bariatric surgery and changes in the microbiome composition and genetic diversity before and after surgery are currently lacking. In this review, we summarize the results of studies of the genetic characteristics of obesity patients, molecular mechanisms of obesity, contributing to the unfavourable course of coronavirus infection, and the evolution of their microbiome during bariatric surgery, elucidating the mechanisms of disease development and creating opportunities to identify potential new treatment targets and design effective personalized approaches for the diagnosis, management, and prevention of obesity.

КЛИНИКО-ЛАБОРАТОРНЫЕ ОСОБЕННОСТИ ТРОМБОЭМБОЛИИ ЛЁГОЧНОЙ АРТЕРИИ У ПАЦИЕНТОВ С КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ SARS-COV-2 И АБДОМИНАЛЬНЫМ ОЖИРЕНИЕМ

Background. At the present time more than 185 million people are infected with the new coronavirus infection (CVI) SARS-CoV-2, which caused COVID-19 pandemic according to WHO. The issue of increased risk of pulmonary embolism (PE) and associated severe course of the disease in persons with abdominal obesity (AO) is actively discussed in national and foreign publications. Objective of the study. To determine the clinical and laboratory features of PE in patients with abdominal obesity infected with SARS-CoV-2 Material and Methods. An analysis of 11.056 medical records of inpatients treated in the infectious disease departments for patients with COVID-19 of the 4th City Clinical Hospital named after N.E. Savchenko of Minsk during the period from April 1, 2020 to May 31, 2021 was performed. AO in subjects included in the retrospective analysis was determined according to WHO criteria as a body mass index greater than or equal to 30 kg/m2, waist circumference greater than 94 cm in men and 80 cm in women, respectively. To determine clinical and laboratory features of PE, as well as the effect of AO on the severity of this complication, inclusion/exclusion/exclusion criteria were developed and a sample of medical records of patients with COVID-19 (n=33), whose diagnosis of PE was verified by computed tomographic angiography of the chest (CTA chest) was formed. Clinical and instrumental parameters and laboratory characteristics were analyzed in the studied groups at the moment of admission to the hospital and at the time of PE development. Results. According to the results of a retrospective analysis of 11 056 medical records, the proportion of patients in whom the final diagnosis of PE was present was 3.68% (n=407), among whom AO was observed in 22.11% (n=90) of patients. The prevalence of subjects with impaired lipid metabolism among those included in the analysis was 11.38% (n=1259). PE developed in 90 patients with CVI and AO (0.81%) and in 317 patients without AO (2.87%). The prevalence of patients with PE (n=90) in the CVI and AO group (n=1259) was 7.15%; among those with CVI without AO (n=9797) - 3.24% (n=317). In the formed group with AO, C-reactive protein (CRP) and fibrinogen levels at hospitalization were higher than in the group of patients without AO: 116.64 (80.38-134.08) mg/L versus 30.21 (15.11-57.21) mg/L (U=36.04; p<0.01) and 6.97 (6.11 to 8.03) g/L versus 4.71 (4.02 to 5.59) g/L (U=12.0, p<0.01) respectively. On the day of suspected PE, CRP levels were higher in the group of patients with AO and COVID-19 than in the group of patients without AO: 71.01 (50.59-105.06) mg/L versus 34.01 (18.85-60.81) mg/L (U=49.00; p<0.05). In patients with CVI and PE, there was a moderate positive relationship between the presence of AO and the severe course of COVID-19 (r=0.41; p<0.05), AO and elevated fibrinogen levels on admission to the hospital (r=0.58 p <0.05), a strong positive relationship between the presence of AO and increased serum CRP level at the time of hospitalization (r = 0.76; p < 0.01), a moderate positive relationship between AO and CRP level determined at the time of development of PE (r = 0.51; p < 0.01). Conclusion. Among the patients with COVID-19 and AO complicated by the development of PE in comparison with patients without AR was determined a higher prevalence of individuals with a severe course of CVI (χ2=5,18; p<0.05), lower oxygen saturation values at admission and at the time of PE development (U =46.5; p<0.05) and (U=49.5; p<0.05), respectively, higher fibrinogen and CRP levels at the time of hospitalization (U=12.0; p<0.01) and (U=36.04; p<0.01), respectively, higher CRP values at the manifestation of PE (U=49.00; p<0.05). The obtained data indicates in favor of the fact that AO can be considered as a risk factor for the severe course of COVID-19. The pathophysiological basis of the development, course and prognosis of thromboembolic complications in patients with COVID-19 and AO requires further clarification during prospective follow-up of this category of patients.

The Role of Ferritin in Assessing COVID-19 Severity

Ferritin is one of the biomarkers requiring special attention; its blood level increases significantly especially in the severe course of COVID-19. Information on the effect of hyperferritinemia on the disease outcome is very contradictory as are the ideas about the causes of its development.The objective: to study the effect of hyperferritinemia on the disease outcome and analyse the possible causes of its development in severe COVID-19.Subjects and Methods. Data on 479 patients with severe course of coronavirus infection treated in intensive care units (ICU) were retrospectively analyzed. Of them, the proportion of patients with a favorable outcome (Group 1) was 51.0% (n = 241), and with an unfavorable outcome (Group 2) - 49.0% (n = 235). The following parameters were assessed: the levels of ferritin, C-reactive protein, fibrinogen, IL-6, IL-10, IL-18, procalcitonin, complement C5a, total, direct and indirect bilirubin, ALT, AST, and the blood level of lactate dehydrogenase (LDH). The changes of erythrocyte count and hemoglobin blood level were also monitored. In order to form a clear view of iron metabolism, free iron, transferrin, and myoglobin levels were assessed in several patients with high ferritin values (more than 1,500 pg/L).Results. In the unfavorable outcome, ferritin levels increase very significantly, reaching maximum by day 6 of patients' stay in ICU. The difference in the level of ferritin between the groups of survivors and deceased during this period is clear and significant (p = 0.0013). The association of ferritin values with the outcome is detected as early as day 1, but by day 4 it becomes highly significant (the cut-off point is 1,080 pg/l). No data have been obtained that would indicate the association of hyperferritinemia with impaired iron metabolism, the development of hepatic dysfunction, or cellular destruction. In contrast to survivors, those who died on day 6 had elevated IL-6 while C5a level remained unchanged. Conclusions. The rapid increase in ferritin blood levels to 1,000 pg/L or higher is an unfavorable prognostic sign indicating a high probability of a lethal outcome. When assessing genesis of hyperferritinemia in COVID-19, the crucial significance should be attributed to the cytokine storm rather than disorders of iron metabolism or hemotoxic effects of the virus. The persistent increase of ferritin level in blood during 4-6 days of stay in ICU should be considered as a reason to intensify anticytokine therapy.

Rheumatic diseases and coronavirus infection: levilimab use experience

Background. Rheumatic diseases (RD) of autoimmune origin are considered as an important risk factor for infectious processes due to characteristic native immune system disorder, as well as due to the adverse effect of immunosuppressants and glucocorticoids on the mechanisms of anti-infective protection.Aim. To highlight the problem of RD and concomitant viral infection which becomes critical in the era of COVID‑19.Results. According to the current national guidelines for the management of patients with COVID‑19, patients with RD represent an increased risk group for the adverse course of coronavirus infection. Presented article provides basic information on the use of interleukin‑6 (IL‑6) inhibitors in patients with COVID‑19 focusing on the benefit of this therapeutic option in those with prior RD. The article presents an analysis of two clinical cases demonstrating high efficacy and good tolerability of levilimab (Ilsira®) in the treatment of coronavirus pneumoniae in the setting of autoimmune diseases: polymyositis (PM) and rheumatoid arthritis (RA).Conclusion. Our own clinical experience confirms the feasibility of including an IL‑6 receptor inhibitor in the treatment regimen for coronavirus pneumonia in patients with RD characterized of immune inflammation.

Roles of active forms of vitamin D in supporting innate immune systems and in reducing excess inflammation in COVID-19

A reduced supply of micronutrient vitamin D leads to a more severe course of coronavirus infection (COVID-19). Vitamin D deficiency is combined with a decrease in innate antiviral immunity and excess of inflammation. Vitamin D supplementation stimulates the synthesis of antibacterial peptides and is important for weakening the cytokine storm, reducing excessive acute and chronic inflammation, and also for compensating for chronic comorbid pathologies. Active forms of vitamin D (alfacalcidol, etc.) are of particular importance for compensating for vitamin D deficiency in elderly patients, endocrine-immune dysfunction, sarcopenia, chronic renal failure (in which the metabolism of vitamin D in the kidneys is disturbed).

СОВРЕМЕННОЕ СОСТОЯНИЕ ИССЛЕДОВАНИЙ В ОБЛАСТИ ОЖИРЕНИЯ: ГЕНЕТИЧЕСКИЕ АСПЕКТЫ, РОЛЬ МИКРОБИОМА И ПРЕДРАСПОЛОЖЕННОСТЬ К COVID-19

Obesity affects over 700 million people worldwide and its prevalence keeps growing steadily. The problem is particularly relevant due to the increased risk of COVID-19 complications and mortality in obese patients. Obesity prevalence increase is often associated with the influence of environmental and behavioural factors, leading to stigmatization of people with obesity due to beliefs that their problems are caused by poor lifestyle choices. However, hereditary predisposition to obesity has been established, likely polygenic in nature. Morbid obesity can result from rare mutations having a significant effect on energy metabolism and fat deposition, but the majority of patients does not present with monogenic forms. Microbiome low diversity significantly correlates with metabolic disorders (inflammation, insulin resistance), and the success of weight loss (bariatric) surgery. However, data on the long-term consequences of bariatric surgery and changes in the microbiome composition and genetic diversity before and after surgery are currently lacking. In this review, we summarize the results of studies of the genetic characteristics of obesity patients, molecular mechanisms of obesity, contributing to the unfavourable course of coronavirus infection, and the evolution of their microbiome during bariatric surgery, elucidating the mechanisms of disease development and creating opportunities to identify potential new treatment targets and design effective personalized approaches for the diagnosis, management, and prevention of obesity.

Peculiarities of Seroprovalence to SARS-CoV-2 in the Population of the Middle and Southern Urals in the Early Period of the COVID-19 Pandemic

Relevance. At the end of 2019, the world was confronted with a novel coronavirus (SARS-CoV-2), In January 2020, WHO declared an epidemic related to SARS-CoV-2, a health emergency of international importance, and in March characterized the spread of the world. diseases like a pandemic.Purpose of the study. Conduct a comparative analysis of the seroprevalence of the population of the Sverdlovsk and Chelyabinsk regions – the largest administrative territorial entities of the Middle and Southern Urals – against the backdrop of the COVID-19 pandemic.Materials and methods. The work was carried out under the program of the first stage of assessing the seroprevalence of the population of the Russian Federation according to a unified methodology developed by Rospotrebnadzor of the Russian Federation with the participation of the Saint Petersburg Pasteur Institute. The selection of participants was carried out by the method of questioning and randomization. The presence of antibodies to the SARS-CoV-2 nucleocapsid was determined in blood serum by the enzyme immunoassay.Results. Comparative analysis of the results showed that the incidence rate of COVID-19 in the Chelyabinsk region was consistently lower, and the seroprevalence at the first stage of the study was statistically significantly higher (p <0/05) than in the Sverdlovsk region. It was found that the incidence in both regions had a direct correlation with population density (r = 0.59; p <0.05). There were no differences between the compared areas in terms of seroprevalence among convalescents, people who had contact with COVID-19 patients, and asymptomatic volunteers with a positive PCR test. When analyzing seroprevalent volunteers in both regions, it was shown that the number of asymptomatic individuals varied within 94.4 ± 1.2% – 95.0 ± 0.95%. These data indicate that the majority of volunteers tolerated COVID-19 asymptomatically.Conclusions. A comparative study showed a statistically significant predominance of seroprevalence among the population of the Chelyabinsk region. It was found that an increase in seroprevalence at the population level was accompanied by a decrease in morbidity. Shown is a direct relationship between population density and the incidence rate. More than 90% of seropositive individuals in the compared areas showed asymptomatic course of coronavirus infection.

Coronavirus infection in patients with HIV infection, features of the course

Purpose. Analyze and identify the features of the course of the new coronavirus infection (COVID-19) in HIV-infected patients.Materials and methods. An analysis of the course of coronavirus infection (COVID-19) was carried out in 16 patients with HIV infection who were hospitalized at the St. Petersburg State Budgetary Healthcare Institution Center for the Prevention and Control of AIDS and Infectious Diseases from April to October 2020. All patients underwent a study of biological material from the oropharynx and nasopharynx for COVID-19 and diagnosed based on a positive PCR result.Results. In HIV-infected patients with diagnosed coronavirus infection caused by COVID-19, signs of progression of HIV infection, clinical, immunological, virological (75%), opportunistic diseases and comorbidities (chronic viral hepatitis in the cirrhotic decompensated stage, cardiovascular diseases and others) (94%). A small sample of patients did not allow to determine with reliable accuracy the mutual influence of existing diseases and pathologies, but, of course, multiple comorbid pathologies play a role in the development of severe conditions and unfavorable outcomes. A clinical case is presented.Conclusion. The provoking factors have been identified that play a role in the development of infection and more severe forms of coronavirus infection caused by COVID-19 in HIV-infected patients (injecting drug use, alcohol abuse, late stage of HIV infection (4B, 4C) and progression of earlier stages (4A ), a low number of CD4 lymphocytes (less than 200 cells / μl), multiple comorbid pathology (HIV infection, opportunistic diseases, comorbidities, especially chronic liver damage in the stage of decompensated cirrhosis), absence, interrupted antiretroviral therapy, multiple changes of regimens, absence prevention of opportunistic diseases). A patient with HIV infection at ART. 4B with multiple comorbidity, the possibility of long-term persistence of the COVID-19 virus coronavirus with positive and negative results for more than 2 months and later development of lung damage caused by COVID-19 was established.

COVID-19 КОРОНАВИРУСТЫҚ ИНФЕКЦИЯСЫ БАР ПАЦИЕНТТЕРДІ КЕШЕНДІ ЕМДЕУДЕГІ РЕМДЕСИВИР ВИРУСҚА ҚАРСЫ ПРЕПАРАТЫНЫҢ КЛИНИКАЛЫҚ ТИІМДІЛІГІ

Introduction. Currently, one of the promising antiviral drugs for the treatment of COVID-19 is remdesivir. For a final decision on the inclusion of this drug in the international recommendations for the treatment of COVID-19, further studies are needed to evaluate its effectiveness and safety in patients with COVID-19. The aim of the study is to study the clinical efficacy of remdesivir in the comprehensive therapy of patients with moderate severity of COVID-19. Materials and methods of research. In the study data was analyzed from 80 medical records of an inpatient patient with a moderate form of COVID-19. The work was carried out in accordance with the task of the Ministry of Health of the Republic of Kazakhstan as part of a clinical study which is an open retrospective study to evaluate the effectiveness of remdesivir in the comprehensive treatment of patients with COVID-19. The experimental group (the main group) consisted of 40 patients with a moderate form of COVID-19 were prescribed remdesivir at a dose of 200 mg IV on 1st day, then 100 mg IV daily, for a total of 5-7 days in addition to standard therapy. The comparison group (control group) consisted of 40 patients who received pathogenetic and symptomatic therapy without remdesivir in accordance with the clinical protocol. Statistical processing of the obtained data was carried out by methods of descriptive statistics, using a comparative analysis by the T-test Student method, frequency analysis, Chi-square calculations with the IBM SPSS Statistics 20.0 and Jamovi programs. Results and discussion. The study showed that an early start of antiviral therapy with Remdesivir compared to standard therapy without an antiviral drug in patients with a moderate form of COVID-19 is associated with a statistically significant clinical improvement and a large percentage of virus elimination from the upper respiratory tract proved by molecular genetic study. In the group of patients receiving remdesivir, complete remission of the disease with normalization of body temperature and no complaints for 7 days of hospitalization was significantly more often than in the comparison group. Antiviral therapy with the remdesivir was prescribed to patients with concomitant pathology (diabetes mellitus, obesity, arterial hypertension), which is a risk factor for a severe, unfavorable course of the disease. There were no cases of deterioration of the patient's condition due to the progression of the infectious process during the use of remdesivir. Whereas in the control group, 10% of patients had progression of the disease with the development of complications. All these patients had risk factors for the development of severe COVID-19. Conclusion. The results obtained showed that the remdesivir is an effective antiviral drug in the comprehensive treatment of COVID-19 coronavirus infection of moderate severity. Early administration of the drug in patients with a moderate form of the disease can prevent the progression of the disease to a more severe condition and the development of complications that require additional medical interventions. This drug can be used in patients with concomitant pathologies that are risk factors for a severe, unfavorable course of coronavirus infection caused by SARS-CoV-2.

CHANGES IN THE INDICATORS OF THE GENERAL BLOOD TEST AND COAGULOGRAM IN A MILD COURSE OF CORONAVIRUS INFECTION

In 2020 the pandemic of a new coronavirus infection spread in almost all countries of the world. The danger of this infection lies in the damage to the lungs, which can lead to fatal outcomes. The success of treatment is largely determined by the early diagnosis of the disease and its timely treatment. In order to find the ways of early laboratory diagnosis of coronavirus infection, we studied changes in peripheral blood indicators, coagulograms and C-reactive protein in 56 outpatient patients with mild course of coronavirus infection, whose average age was 49±2 years (among them, 23.2% were men and 66.8% were women). In all patients, coronavirus infection was confirmed by the detection of SARS-CoV-2 RNA by polymerase chain reaction (PCR) in nasopharyngeal or oropharyngeal smears. Signs of lung damage were detected in 66% of patients according to computed tomography findings. The number of red blood cells and the level of hemoglobin in all patients were normal. In 7% of patients, thrombocytopenia was detected, in 5.3% of patients – thrombocytosis. The most pronounced changes are foundin the leucoformula and indicators of the blood coagulation system. In 12.5% of patients without signs of viral pneumonia, leukocytosis was detected. All cases of leukopenia were noted only against the background of lung damage, at this, in 16% lymphopenia was found, 43% had relative lymphocytosis. The coagulogram of more than half of the patients with pneumonia showed shortening of blood clotting in the activated partial thromboplastin time (APTT) test, an increase in prothrombin index(PI) and the content of fibrinogen. The level of C-reactive protein was increased in only a quarter of patients with mild lung damage. Thus, changes in the leucoformula against the background of a tendency to hypercoagulation in blood clotting indicators should cause doctors' apprehensive attitude when treating a patient with clinical symptoms similar to COVID-19.