Course Of Coronavirus Infection Research Articles

КОРОНАВИРУСНАЯ ИНФЕКЦИЯ COVID-19 У ПАЦИЕНТОВ С МНОЖЕСТВЕННОЙ МИЕЛОМОЙ: ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫй ОПЫТ

The presented literature review presents studies, including our own, on the peculiarities of the course of coronavirus infection in patients with hemoblastosis, in particular in patients with multiple myeloma (MM). It has been shown that in patients with MM attachment of the SARS-CoV-2 COVID-19 coronavirus infection, the prognosis of the patient’s life significantly worsens, which makes significant changes in the overall survival and mortality rates. Factors that worsen the prognosis of life in patients with MM are old age, male gender, uncontrolled/active disease and/or high risk of MM, concomitant diseases, MM beyond remission, acute course of SARS-CoV-2 COVID19, interruption of treatment without subsequent resumption. Patients with MM are at high risk of severe coronavirus infection COVID-19 and mortality, however, this risk is lower compared to coronavirus infection SARS-CoV-2 and Delta. MM patients receiving anti-BCMA therapy do not respond to vaccination and have a risk of developing severe course and progression of coronavirus infection due to the lack of an immune response of some Omicron variants. Patients with MM should be vaccinated with updated mRNA-based booster vaccines adapted to Omicron. In case of COVID-19 coronavirus infection, patients with MM should be prescribed oral effective antiviral drugs or remdesivir. Treatment of SARS-CoV-2 COVID19 patients with MM should be carried out in full according to the clinical guidelines for the treatment of SARS-CoV-2 COVID19.

КОРОНАВИРУСНАЯ ИНФЕКЦИЯ COVID-19 У ПАЦИЕНТОВ С ОСТРЫМ МИЕЛОИДНЫМ ЛЕЙКОЗОМ СТАРШЕЙ ВОЗРАСТНОЙ ГРУППЫ: ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫЙ ОПЫТ

The presented literature review presents studies, including our own, on the characteristics of the course of coronavirus infection in patients with acute myeloid leukemia in the older age group. Patients with acute leukemia, myelodysplastic syndrome are often over 65 years of age and have a burdened comorbid background and have profound immunodeficiency due to the underlying disease and the antitumor treatment received, and delaying treatment is often impossible due to the urgent need to start antitumor therapy. Management of this cohort of patients with concomitant COVID-19 is a challenge for hematologists around the world and requires interdisciplinary collaboration between hematologists and infectious disease specialists, clinical pharmacologists. There is a need to develop criteria to determine clear indications for starting antitumor treatment against the background of COVID-19 and the optimal timing for resuming the next course of chemotherapy after a coronavirus infection. The analysis of the literature and our own experience showed high hospital mortality taking into account the state of deep immunodeficiency of patients, despite the treatment of COVID-19, secondary bacterial and fungal infections and demonstrated the need to develop, first of all, preventive strategies in elderly patients with acute leukemia.

КОРОНАВИРУСНАЯ ИНФЕКЦИЯ COVID-19 У ПАЦИЕНТОВ ПОСЛЕ ТРАНСПЛАНТАЦИИ ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОК: ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫЙ ОПЫТ

The presented literature review presents studies, including our own, on the peculiarities of the course of coronavirus infection in patients after hematopoietic stem cell transplantation (HSCT). It has been shown that patients after HSCT represent an increased risk group for severe COVID-19 and adverse outcomes. The factors that worsen the prognosis of life of patients after HSCT were old age, male gender, uncontrolled/active disease, concomitant diseases, acute course of SARS-CoV-2 COVID19. It is necessary to carry out monitoring, early diagnosis (regular and timely testing for the virus) and the use of effective prevention and treatment protocols in patients after HSCT in a pandemic. Early diagnosis of infection can prevent the spread of the virus, start treatment quickly and take measures to isolate the patient. In the early period after HSCT, patients are at higher risk of developing lower respiratory tract infection, more often need the appointment of antifungal drugs, antibacterial drugs of reserve groups and have greater risks 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. As a result of the analysis, there were no differences in the survival rates of patients after autologous and allogeneic HSCT.

INFLUENCE OF GENE POLYMORPHISM, SEVERITY OF CLINICAL COURSE OF THE DISEASE AND COMBINATION WITH COMORBIDITIES ON CELLULAR AND GENERAL REACTIVITY IN PATIENTS WITH COVID-19

Background. In the pathogenesis of COVID-19 development, cellular and general reactivity of the patient's body in response to exo- and endo-intoxication are important indicators, they are diagnostic markers of the severity of the disease. Aim: to find out and analyze the effect of gene polymorphism, severity of the clinical course of the disease and combination with comorbidities on the cellular and general body reactivity of patients with COVID-19. Materials and methods. The study included 204 patients with mild, moderate, and severe COVID-19-associated pneumonia who had comorbidities: cardiovascular disease (82 patients), endocrinopathy (46 patients), and comorbidities of the ENT organs, connective tissue, gastrointestinal tract, chronic kidney disease (CKD), who were grouped into the group "other comorbidities (76 patients). Among the patients were 51.97% (106) women and 48.03% (98) men. The average age of patients was 55.93±8.75 years. The polymorphism of the TMPRSS2 (rs12329760), FGB (rs1800790) and NOS3 (rs2070744) genes was investigated by real-time polymerase chain reaction (Real Time PCR). The level of cellular and general reactivity of the body of patients with coronavirus infection was determined by the cellular resistance index and leukocyte indices of intoxication (LII) according to J.Y. Kalf-Kalf, Reis, Himich, modified leukocyte index, intoxication index, hematological index of intoxication according to V.S. Vasiliev and nuclear index of endotoxemia. Results. It was found that patients with coronavirus infection carry mutational T-alleles of the gene (especially TT genotype) of the TMPRSS2 gene (rs12329760), A-allele of the FGB gene (rs1800790) and T-allele of the NOS3 gene (rs2070744) have the highest level of cellular resistance and cellular reactivity in response to endo- and exo-intoxication, which leads to a probable decrease in intoxication and is an adaptive defense response of the body. It was found that in the mild clinical course of coronavirus infection, the highest level of cellular reactivity and cellular resistance is observed, in the moderate course, the cellular reactivity of the body decreases by 81.34%, and in the severe course - by 45.35%, while high to moderate endo- and exo-intoxication, respectively, persists. In comorbidity with endocrinopathies or cardiovascular diseases (CVD), lower cellular resistance (especially in CVD) was found than in the combination of COVID-19 with other comorbidities in the remission/compensation phase - by 32, 64% (p<0.001) and 38.60% (p<0.001) against the background of higher endogenous intoxication according to the modified intoxication index and Reiss LI - by 30.21-40.0% (p≤0.032-0.017), respectively. Conclusion. The severity of the clinical course, the presence of comorbidities, polymorphism of the genes TMPRSS2 (rs12329760), FGB (rs1800790), NOS3 (rs2070744) have a multidirectional effect on cellular and general reactivity in patients with COVID-19.

COVID-19 impact on thrombotic complications in cancer patients

Aim: to study the features of thrombotic complications in cancer patients during COVID-19 infection, and identify the most significant diagnostic and prognostic criteria.Materials and Methods. Within the framework of cohort non-randomized study, there were analyzed the course of coronavirus infection in 72 hospitalized patients with uterine cancer (n = 22), cervical cancer (n = 19), ovarian cancer (n = 24) as well as vaginal and vulvar cancer (n = 7). All patients hospitalized for COVID-19 were examined and treated in accordance with the Interim guidelines “Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)” effective at the time of therapy. Additionally, on days 3–7 after hospitalization, a blood test was performed once to determine the level of metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), ADAMTS-13 activity, ADAMTS-13 inhibitor and von Willebrand factor (vWF) level.Results. It was shown that the average age of the patients was 56.96 ± 7.55 years, the length of hospitalization ranged from 7 to 19 (13.0 ± 3.79) days. The disease severity was assessed by the degree of lung tissue damage based on computed tomography (CT), respiratory failure and development of systemic inflammatory response syndrome (SIRS). During hospitalization, CT-2 was detected in 46 (63.9 %) patients, CT-3 – in 26 (36.1 %) patients; 37 (51.4 %) patients were transferred to the intensive care unit (ICU). Clinically significant deep vein thrombosis (DVT) was diagnosed in 9 (12.5 %) patients, and pulmonary embolism (PE) – in 4 (5.6 %) patients. Of these, 6 cases of DVT and 3 cases of PE were fatal. A total of 14 (19.44 %) patients deceased due to developing acute cardiopulmonary failure. A vWF/ADAMTS-13 ratio greater than 2.1 was found in all ICU patients. Despite anticoagulant therapy, patients with DVT and PE had this ratio higher than 3.3 (4.00 ± 0.48), whereas in all 14 deceased patients it exceeded 2.98.Conclusion. Venous thromboembolism, including PE and DVT, has been identified as а serious complication of COVID-19. An opportunity to predict them early is of special importance because they may lead to serious complications such as disseminated intravascular coagulation, SIRS, cardiopulmonary failure, and death. In patients suffering from cancer infected with COVID-19, not only a decline in ADAMTS-13 activity and level was detected, but also a parallel increase in vWF level. A vWF/ADAMTS-13 ratio may be an early indicator of COVID-19 severity in such patients: a vWF/ADAMTS-13 ratio exceeding 2.1 was common for all ICU patients. Hence, it evidences about a potential for using this parameter to early identify such risk patients who may require more intensive care and medical intervention.

Assessment of the therapeutic effect of the drug Molixan in the treatment of Syrian hamsters experimentally infected with the SARS-CoV-2 virus

Background. Studying the characteristics of the course of coronavirus infection caused by SARS-CoV-2 remains relevant due to the high mutagenicity of the virus and the prevalence of the disease in the world. The search for new drugs to eliminate clinical manifestations of COVID-19, as well as against its agent, is essential. During the pandemic caused by SARS-CoV-2, dexamethasone was recognized as the only effective anti-inflammatory drug for the treatment of patients with severe form of the disease, but its use leads to a large number of side effects.The aim. To study the therapeutic effect of the drug Molixan in the treatment of coronavirus infection in model animals – Syrian hamsters.Methods. To assess the effectiveness of the drug Molixan, we carried out a visual assessment of the condition of the lungs using light microscopy and the morphometry of the lung tissue of experimentally infected Syrian hamsters on the day 6 after infection under different Molixan treatment regimens and during dexamethasone therapy. The test drug was administered using three different doses (22.2 mg/kg, 44.4 mg/kg and 88.8 mg/kg, which are equivalent to doses of 3 mg/kg, 6 mg/kg and 12 mg/kg of human body weight) once daily or dividing the dose into two within 12 h interval in case of multiple (5 days) intramuscular administration. Dexamethasone (comparison drug) was administered at a dose of 20 mg/kg once daily for 5 days.Results. The studies showed statistically significant effectiveness of using Molixan at a dose of 44.4 mg/kg, divided into two doses, during 5 days. When compared with untreated hamsters, this treatment regimen reduces the degree of generalization and severity of the inflammatory process in the lungs; and the pathomorphological picture is similar to that observed during treatment with Dexamethasone.Conclusion. The studied drug Molixan is effective as an anti-inflammatory drug in the treatment of the disease caused by SARS-CoV-2.

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.

Prolonged course of novel coronavirus infection COVID-19 with the formation of pulmonary fibrosis in an HIV-infected patient

A description of a clinical case of a severe, protracted course of coronavirus infection (COVID-19) in a patient with advanced stage HIV infection, characterized by prolonged release of the SARS-CoV-2 virus and the formation of pulmonary fibrosis against the background of an active viral infection, is presented. COVID-19 infection occurred in an immunosuppressed patient without ART. During the period of inpatient treatment, a comprehensive examination was carried out to exclude HIV-associated lung lesions; no evidence of viral, fungal, or bacterial pathology was obtained; mycobacterial infections were also excluded. Despite two courses of antiviral therapy, the use of anti-Covid plasma and complex pathogenetic therapy, persistence of SARS-CoV-2 replication was observed for eight months, with a steady progression of the disease, ending in death.

Comorbidity and extra pulmonary manifestations in hospitalized patients with coronavirus disease (COVID-19) depending on age and sex

Nowadays, knowledge about the causal relationships between concomitant chronic diseases and the course of coronavirus infection (COVID-19) can make a huge contribution to saving the lives of patients. Determining the impact of concomitant pathology on the severity of the course of COVID-19 will contribute to the identification and assessment of the risk of deterioration of the condition, as well as the implementation of preventive measures in high-risk individuals (vaccination). The aim of the work was to assess the influence of age and sex on the presence of comorbid pathology and the course of the disease in patients who were hospitalized with community-acquired viral pneumonia associated with COVID-19. We carried out a retrospective analysis of the case histories of 260 patients with community-acquired pneumonia associated with coronavirus disease, who were treated in the therapeutic departments of the Covid Center of ME “Dnipropetrovsk regional clinical hospital named after Mechnikov” DRC in 2020-2021. (September-December 2020, January- December 2021), single-center study. All patients included in the analysis underwent general clinical and laboratory methods of research regulated by national recommendations for the management of patients with COVID-19, PCR tests (polymerase chain reaction) for verification of coronavirus disease, CT(computed tomography)/radiography of the lungs. Comorbidity was assessed as the development of the disease before the onset / verification of coronavirus disease according to a patient survey recorded in medical records. One or more comorbid conditions were recorded in 195 (75%) patients. Multimorbidity was recorded in 111 (56.9%) patients from the total number of patients with COVID-19 and comorbid pathology. Analyzing the influence of gender in patients with comorbid pathology, men were significantly more likely to have coronary artery disease (CAD) (p=0.04) and chronic obstructive pulmonary disease (COPD) (p=0.04). A significant difference in age among hospitalized patients with a diagnosis of COVID-19 was revealed, depending on sex (p<0.001). So at the age of up to 65 years, male patients predominated (60.4%), over the age of 65 years – women (68.9%). There was no significant difference in the frequency of occurrence of moderate severity and severe course of the disease of COVID-19, depending on age and sex. At the age of over 65, the presence of type 2 diabetes (p<0.001), hypertension (R<0.001), coronary artery disease (p<0.001) and COPD (p<0.001) was significantly more common.

Purification technology design, biochemical and immunological characteristics of the recombinant chimeric antigen for evaluation of T cell immunity against coronavirus infection

Diagnosis of specific T cell immunity to the antigenic determinants of SARS-CoV-2 in patients seems to be an increasingly important task due to accumulation of data about the role of T cell immune response in course of coronavirus infection and clearance of SARS-CoV-2 in case of secondary infection. Previously, we designed the recombinant CorD_PS antigen for evaluation of T cell antiviral immunity, containing conservative and immunogenic sequences of structural proteins of the SARS-CoV-2 coronavirus. E. coli CorD_PS producing strain with stable expression of the recombinant CorD_PS antigen was obtained. Aim of the present work is to design a laboratory technology for the production of recombinant antigen CorD_PS, to control the quality of the obtained chimeric protein and to study its immunological activity. Development of the cultivation conditions for E. coli CorD_PS cells was carried out in conical flasks in LB-M_Km medium at 37 °C, then scaled in a fermenter with a volume of 30 liters. Expression was induced by the addition of IPTG. Expression was controlled in culture lysates in 12% SDS-PAGE. The resulting biomass was lysed using an ultrasonic disintegrator with followed by centrifugation. The compositions of lysing and solubilizing buffers were selected, as well as conditions for refolding of the recombinant protein. Cation exchange (SP-sepharose), hydrophobic (Butylsepharose) and exclusive (Sephacryl S-200 HR) chromatography were used sequentially to purify the dissolved protein. Protein impurities in the preparation were determined by reverse-phase HPLC and electrophoresis in 12% SDS-PAGE, residual lipopolysaccharides were determined using a gel-thrombin variant of the LAL test, residual proteins of the producer strain were determined by enzyme immunoassay, residual DNA of the producer strain was determined by binding with PicoGreen dye. Specificity was controlled by indirect enzyme immunoassay. The evaluation of cytokine production by CD4+T lymphocytes in response to their stimulation by recombinant antigen ex vivo was performed on a flow cytofluorimeter. The biomass yield during cultivation of E. coli CorD_PS in a 30L fermenter was up to 20 g/L for 4 hours of 0.1 mM IPTG induction. Sequential washing of inclusion bodies from bacterial cellular components and their subsequent solubilization in a buffer containing 8 M urea allowed to obtain a solution of denatured antigen with a concentration of 10 mg/mL. The efficiency of refolding by dilution was 75%. After three stages of chromatographic purification, protein samples with a concentration of 1.2-1.4 mg/mL, HPLC purity of 98.43%, corresponding to key quality parameters according to the OFS.1.7.1.0007.15, were obtained. The recombinant antigen showed specific binding to a sample of the First WHO International Standard and sample Company Reference Standard No. 3 of anti- SARS-CoV-2 human immunoglobulins in a specified concentration range. CD4+T lymphocytes effectively responded to recombinant antigen treatment by increasing IFNγ production. The optimal concentration of recombinant coronavirus antigen was 5 μg/mL. The developed technological process makes it possible to obtain 5-7 grams of coronavirus recombinant CorD_PS antigen in one cultivation cycle in 30 liters of fermentation medium with key quality parameters according to the OFS.1.7.1.0007.15. As a result of specific immunological activity studies of the recombinant coronavirus antigen CorD_PS, the concept of its possible use as a diagnostic tool for determining the formation of a T cell immune response was confirmed.

The Influence of Coronavirus Infection on the Results of Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

Objective — to determine the impact of coronavirus infection incidence on the post-procedural condition of patients after percutaneous coronary intervention (PCI). Materials and methods. This single-centre study was conducted at the «Ukrainian Children’s Cardiac Center, Clinic for Adults» from June 1, 2020, to December 31, 2021. A total of 158 patients participated, of whom 78 had a history of COVID-19 infection and 80 did not, all with stable obstructive coronary artery disease (CAD). All patients underwent PCI, and their long-term outcomes were evaluated within a 6-month period. The study endpoints included repeated myocardial revascularization (defined as narrowing of the stented lumen by more than 70 % in diameter or acute stent thrombosis) and an assessment of CAD progres­sion (formation or progression of atherosclerotic plaques compared to baseline coronary angio­graphy). Results and discussion. The frequency of repeated coronary angio in the first 6 months after PCI due to tension angina or acute coronary syndrome was equal to 10 (12.8 %) patients in the COVID-19 +-group and 3 (3.8 %) cases in the COVID-19 — –group (p < 0.05). According to the study data, patients with coronavirus infection tended to reach endpoints more quickly during the 6-month follow-up, in contrast to patients who did not have the incidence of COVID-19 during the same period. The frequency of repeated PCI within 6 months after the primary PCI in the group of patients with previous PCI was higher — 8 cases out of 78 patients compared to patients in the second group who did not suffer from COVID-19 in the first 6 months after the initial PCI (2 cases out of 80, c2 = 4 .0, p = 0.045). Conclusions. Patients with a mild and moderate course of coronavirus infection and existing stable coronary heart disease with atherosclerotic lesions of the coronary arteries were more likely to undergo repeat PCI within 6 months of the initial PCI. The most common causes of repeat PCI in patients with previous COVID-19 were thrombosis and restenosis of the stent, as well as progression of stenosis at a site other than the location of the previous PCI.

Immune Cell Response of the Spleen in COVID-19

Objective. To study the morphometric characteristics and splenic immune cell response in patients with COVID-19.Material and methods. A prospective observational study included 70 patients. Of these, 45 patients admitted to the infectious diseases hospital with Coronavirus infection caused by the SARS-CoV-2 virus diagnosis were included in the COVID-19 group, and 25 patients were included in the acute respiratory viral infection (ARVI) comparison group. Spleen linear dimensions, including length, width, and thickness were assessed using ultrasound imaging, and calculations of the spleen weight and spleen weight coefficient (SWC) were obtained. Additionally leukocyte count and formula, erythrocyte sedimentation rate (ESR) were estimated, and the leukocyte index (LI) and neutrophil-to-lymphocyte ratio (NLR) were calculated.Results. Microsplenia was common in the acute period of COVID-19 with mean SWC value 1.6±0.2. In 17 (37.8%) patients the SWC varied from 1.0 to 1.5, and in 9 (20%) microsplenia was critical with SWC <1.0. Leukocyte count was lower, and ESR — higher in patients with COVID-19, compared to ARVI group (5.4±2.1×10⁹/l and 10.8±4.8×109/l, respectively P<0.00001, and ESR — 36.1±13.8 mm/h and 23.0±5.1 mm/h, respectively P=0.03). The course of COVID-19 was characterized by a slight decrease in LI — from 0.29±0.02 to 0.22±0.01 (P=0.19), and significant increase in NLR from 3.7±0.1 to 4.3±0.12 (P=0.002). Opposite trends were documented in patients with ARVI. On Day 5 since initiation of treatment LI was significantly lower in the COVID-19 vs ARVI group (0.22 [0.16; 0.39] vs. 0.48 [0.29; 0.93], P=0.003), and NLR was significantly higher (4.3 [2.5; 6.1] vs. 2.1 [0.9; 2.9], P=0.002).Conclusion. The course of coronavirus infection caused by the SARS-CoV-2 virus is characterized by significant immunological shifts. Microsplenia verified by ultrasonography stays as one of the pathognomonic signs. This phenomenon is explained by rapid «depletion» of the spleen as a secondary immune organ, and is associated with a high risk of developing acute immune deficiency.

Effect of Vitamin D Receptor Gene Polymorphism (ВsmI, FokI) and its Concentration on the Severity of Covid-Associated Lung Damage

Objective. To identify the relationship between the serum vitamin B content and the polymorphism of the vitamin B receptor gene with the severity of the course of COVID-19-associated lung damage.To identify the relationship between serum vitamin D content and polymorphism of the vitamin D receptor gene with the severity of COVID-19- associated lung damage. Materials and methods. The paper presents the results of an examination of 200 people, after 1 month suffering COVID-associated lung damage in the period from June 1 to October 31, 2020. The patients were divided into groups of 50 people depending on the degree of lung damage based on the results of computed tomography: group 1 (CT-1), median by age was 51.5 [50.5; 54.8]; group 2 (CT-2), median by age 57.0 [53.1; 57.0]; group 3 (CT-3), median by age 52.5 [51.9; 55.0]; group 4 (CT-4), median 55.0 [53.2; 56.4]. The control group included 56 relatively healthy people who did not have coronavirus infection; the median age was 55.0 [51.1; 55.0]. All groups were comparable in age and gender. The concentration of total 25-hydroxyvitamin D (25(OH)D) was studied in blood serum. A molecular genetic study of the vitamin D receptor gene was also carried out: 283 A>G (BsmI) and 2 A>G (FokI). Results. It was revealed that insufficient levels of 25(OH)D in the blood are one of the risk factors for the development of COVID-19 infection, as well as a risk factor for worsening the course of COVID-19-associated lung damage. Analysis of the polymorphism of the vitamin D receptor gene VDR: 283 A>G showed the predominant inheritance of allele A and homozygote A/A in patients with a high level of damage to lung tissue due to COVID-19 infection — KT-3, 4. Study of polymorphism of the vitamin D receptor gene VDR: 2 A>G showed preferential inheritance of homozygote A/A among patients compared to the control group. When studying the concentration of vitamin D in patients with COVID-19-associated lung damage depending on the polymorphism of the vitamin D receptor genes VDR: 283 A>G (BsmI) and VDR: 2 A>G (FokI), no differences were found. Conclusion. Insufficient levels of 25(OH)D in the blood may be one of the factors contributing to the complicated course of coronavirus infection. Analysis of the vitamin D receptor gene polymorphism VDR: 283 A>G showed preferential inheritance of the A allele and homozygote A/A in a more severe category of patients — with more than 50 % damage to the lung tissue (CT-3, 4) against the background of COVID-19 infection. A study of the polymorphism of the vitamin D receptor gene VDR: 2 A>G revealed the most common carriage of the A/A homozygote among patients compared to the control group.

Correlation analysis of clinical and laboratory markers in COVID-19 and acute cerebrovascular accident

Coagulopathies developing with COVID-19 are a serious problem. Increased fibrinogen levels, activation of coagulation, a direct damaging effect of the virus on the endothelium, and increased interaction of the platelet with the vascular endothelium play an important role in the development of thrombotic complications and the occurrence of acute cerebral circulatory disorders. Case histories of COVID-19 patients and those with secondary CHF were analysed. Among the biochemical blood parameters in COVID-19, an increased level of D-dimer, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin were revealed more frequently.
 Results: Among biochemical blood parameters in COVID-19, an increase in D-dimer level, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin, is more frequently detected. In correlation analysis, a positive correlation was observed between the level of ferritin, CRP and stage of CT as well as between the level of D-dimer and the number of platelets

COVID-19 in patients with acute leukemia: 3 years' experience of pandemic

Patients with acute leukemia are one of the most vulnerable risk groups for infection with SARS-CoV-2 and severe course of coronavirus infection. During the first 2 years of the pandemic, the mortality rate of patients with acute leukemia was 11-48 %, depending on leukemia type, and only reached population levels in 2022. Risk factors for severe COVID-19 in patients with acute leukemia are old age, concomitant cardiac pathology, metabolic syndrome, and the absence of acute leukemia remission. Chemotherapy administered one month before hospitalization with COVID-19 diagnosis showed statistical significance in influencing hospital mortality only in the group of patients with acute myeloid leukemia. Despite this, the international medical community has recommended delaying the start of chemotherapy until clinical symptoms of coronavirus infection have completely resolved and a negative test result for SARS-CoV-2 has been obtained for all types of leukemia. Currently, the most optimal tactic is to prevent SARS-CoV-2 infection by vaccinating patients with acute leukemia receiving antitumor treatment. If the immunological response to vaccination is insufficient, it is possible to use virus-neutralizing monoclonal antibodies as a safe and effective method of primary prevention of COVID-19.

Predictors of an unfavorable outcome in patients with severe pneumonia against the background of COVID-19 infection

Objective. To determine the predictors of an unfavorable outcome in patients with severe pneumonia against the background of COVID-19 infection.Materials and methods. A retrospective analysis of the case histories of deceased patients (control group, n = 40) for January 2021 (a continuous sample — 15.01.21–31.01.21) and surviving patients for the same period (n = 40) with a confirmed PCR diagnosis of coronavirus infection, who were on inpatient treatment at the state healthcare institution “Gomel City Clinical Hospital No. 3” (SHI “GCCH №3”) in Gomel. The Ethical Committee of SHI “GCCH №3” found no violations contradicting ethics and morality in conducting the study. Treatment of patients, assessment of the severity of the condition were carried out according to modern protocols for the diagnosis and treatment of COVID-19 infection, approved by the Ministry of Health of the Republic of Belarus (No. 1195 of 11.11.2020). The group of surviving patients was represented by 11 men and 29 women versus 24 men and 16 women in the control group (p < 0.05).According to computed tomography of chest organs (CT CO), all 80 patients had signs of bilateral viral pneumonia characteristic of COVID-19. When processing and describing CT data, a semi-quantitative scale was used to estimate the volume of infiltration and consolidation zones of the lungs, recommended by temporary protocols. The total volume of lung damage in COVID-19 infection (“frosted glasses”, “cobblestone pavement”, “consolidation sites”) was > 55% in both groups, p > 0.05. CT CO was performed on Somatom Emotion 6 (Siemens) with a spiral type of scanning.Patients of both groups were comparable in age, concomitant comorbid pathology: coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus (DM), etc., however, they had differences in gender (the proportion of males prevailed in the group of deceased). A feature of the study was a solid sample among deceased patients. Taking into account the group differences by gender, in this study, an additional comparison of the results by gender was carried out. Results. The course of COVID-19 infection at the stationary stage is characterized by large-scale negative clinical dynamics, fever, “explosion” of acute phase indicators, thrombosis, distress syndrome with a drop in saturation and unfavorable outcomes. The indicators obtained using the NEWS-2, SHOCK-COVID scales (scales for predicting the severity of the clinical course of coronavirus infection) in severe patients, although they indicate a worsening of the patient’s clinical condition, but rather late, when the “cytokine storm”, powerful inflammation, thrombosis, significant damage to lung tissue already dominate among clinical syndromes, the decrease in saturation and the effectiveness of drug therapy is significantly limited.Conclusion. According to the results of the study, it is recommended to divide patients into groups of moderate and high risk of adverse outcome based on clinical, instrumental, laboratory data in dynamics. In patients with moderate risk, protocol therapy in most cases is sufficient to stabilize the general condition. In patients with an unfavorable outcome, this therapy does not restrain the growth of lung tissue damage with negative clinical, laboratory dynamics, which requires additional decisions, changes in the doses of drug therapy to prevent fatal outcomes.

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.

Influence of the age factor and <i>АСЕ</i> and <i>PAI-1</i> gene polymorphism on the severity of the new coronavirus infection (SARS-CoV-2).

The paper investigates the role of the association of polymorphic variants of the tissue plasminogen activator inhibitor 1 (PAI-1) and angiotensin-converting enzyme (ACE) genes in 244 patients with coronavirus infection with varying degrees of disease severity (mild, moderate, and the group of deaths). The influence of the age factor in conjunction with various genotypes on the course of coronavirus infection is also being studied. An analysis of the frequencies of alleles and genotypes of ACE found statistically significant differences: the D allele is associated with the severity and outcome of COVID-19. The I/D genotype is associated with a milder course of the disease, while the D/D genotype increases the likelihood of death.

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 %).

КЛИНИЧЕСКИЙ СЛУЧАЙ ЛОНГ ИНФЕКЦИИ SARS-COV-2

Вackground. Coronavirus (COVID-19) infection caused by SARS-CoV-2 virus is associated with a wide spectrum of clinical respiratory syndromes ranging from mild upper respiratory tract symptoms to progressive viral pneumonia and systemic multinflammatory syndrome, as well as endothelial dysfunction and thrombotic complications. Despite the decline of the pandemic, the problem of the prolonged course of SARS-CoV-2 remains relevant. Aim of the study. To present a clinical case of Sars-Cov-2 long infection with development of severe lung and myocardial damage with negative results of PCR-analysis of pharyngeal and nasal swabs. Characteristics of patients and methods of research. A clinical case demonstrating a variant of prolonged course of coronavirus infection accompanied by the development of pneumonitis and myocarditis is presented in this work. Blood smear morphometry, monocyte analysis (flow cytometry), T lymphocyte analysis were performed in addition to standard methods of examination. Results and Conclusion. The presented clinical case demonstrates a variant of prolonged course of coronavirus infection, in which SARS-CoV-2 virus was encapsulated in the lungs and avoided the formation of a specific immune response. Severe lung and myocardial damage with negative results of PCR analysis of pharyngeal and nasal swabs was observed. Pulse therapy with corticosteroids resulted in regression of the disease.