Course Of Coronavirus Infection Research Articles

Course of coronavirus infection in patients with type 2 diabetes mellitus

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

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.

Clinical and laboratory aspects of the new coronavirus infection in newborns and infants

Purpose: to identify clinical and laboratory aspects of a new coronavirus infection in newborns and infants. Materials and methods: a retrospective analysis of 131 observations of newborns and infants infected with SARS-CoV-2 treated in children's infectious diseases departments of Izhevsk was carried out. Results. The course of coronavirus infection in newborns and infants who became ill on an outpatient basis and were hospitalized did not have significant specific clinical and laboratory features and was similar to the symptoms of major respiratory infections. Among the hospitalized, 80.9% of children had a mild severity of coronavirus infection, the rest of the children had a moderate course. The clinical picture was dominated by cough (86.3%), nasal congestion (74%) and fever (71.8%). Significant clinical differences were obtained in newborns in the form of predominance of nasal obstruction, and in infants in the predominance of fever and dry cough. Pneumonia was diagnosed in 19.1% in the form of a mild, mainly bilateral lesion.

Comparative characteristics of the clinical course of a new coronavirus infection depending on the vaccination status

Objective: to provide a comparative analysis of clinical manifestations of the new coronavirus infection in vaccinated and unvaccinated patients. Materials and methods. А retrospective analysis of 160 medical histories of patients with laboratoryconfi rmed diagnosis of coronavirus infection (COVID-19) was presented, including 80 unvaccinated individuals and 80 vaccinated with “EpiVacCorona”, “CoviVac”, and “Gam-COVID-Vac” vaccines. Results. Vaccination against COVID-19 does not completely eliminate the possibility of infection with the virus, but there are a number of significant advantages and diff erences in the course of coronavirus infection among vaccinated patients. The duration of the disease on average was about 2 weeks, and for unvaccinated individuals — 18.1 ± 0.4 days. Vaccinated patients, regardless of the vaccine used, recovered significantly earlier. Signs of polysegmental pneumonia were not observed in 21.3% of vaccinated patients. Respiratory support lasted for 6.0 ± 0.3 days in unvaccinated patients, and for vaccinated individuals with “EpiVacCorona” — 4.4 ± 0.7 days, “CoviVac” — 3.5 ± 0.6 days, “Gam-COVID-Vac” — 3.2 ± 0.4 days, which was signifi cantly lower than the indicators for the control group (p <0.05). Conclusion. Сlinically, COVID-19 in vaccinated patients was milder compared to unvaccinated individuals, who most commonly experienced weakness, coughing, and extensive lung damage.

The study of the course of the infectious process in lungs of cats during experimental infection with SARS-CoV-2

Aim. To study and characterise the features of the course of coronavirus infection in a domestic cat model, as well as to assess the danger of SARSCoV-2 isolated in Russia for these animals based on the data obtained, with the possibility of extrapolating to wild felines.Material and Methods. For the study, model animals – Felis silvestris catus – were divided into 3 groups. The viral strain of SARS-Cov-2/human/RUS/Nsk-FRCFTM-1/2020 was cultivated on Vero E6 cell culture and then administered intranasally in a volume of 200 μl, 105TCID50/ml, to animals from the first and second groups. Model animals from the first group were euthanized and lung fragments were taken on 6–day post infection (d.p.i.), animals from the second group – on 14 d.p.i. The third group – the control group, was injected with saline in an equivalent volume. Histological sections colored with hematoxylin and eosin were investigated for pathomorphological changes in lung tissue using light microscopy.Results. According to the obtained results the pathomorphological picture in the lungs of experimental animals indicates the course of interstitial pneumonia for both 6 and 14 d.p.i. In addition, it has been determined that by 14 d.p.i. the growth of fibrous tissue in the lungs begins to be visualised, indicating the beginning of light regenerative processes.Conclusion. The study showed that cats are susceptible to the SARS-CoV-2 virus, and these model animals are characterized by the emergence of clinical manifestations and morphological patterns in the lungs, which correspond to interstitial pneumonia.

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

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

ВЛИЯНИЕ ГЕМОСОРБЦИИ С ЭКCТРАКОРПОРАЛЬНОЙ АУТОГЕМОМАГНИТОТЕРАПИЕЙ В СРАВНЕНИИ С МЕДИКАМЕНТОЗНОЙ ТЕРАПИЕЙ АНТАГОНИСТАМИ РЕЦЕПТОРОВ ИЛ-6 НА КЛИНИКО-ЛАБОРАТОРНЫЕ ПАРАМЕТРЫ ПАЦИЕНТОВ С ТЯЖЕЛЫМ ТЕЧЕНИЕМ COVID-19

Background: SARS-CoV-2 infection in 10-20% of cases is characterized by hypercytokinemia, and in this context, the use of interleukin-6 (IL-6) receptor blockers, in particular tocilizumab and levilimab, is pathogenetically justified, but anticytokine hemosorption is also used in such cases. It is impossible to determine which method is preferable in patients with severe COVID-19 due to the lack of large comparative studies of medical and extracorporeal anticytokine therapies. Purpose: To evaluate the effect of hemosorption through the Нemo-Рroteasosorb hemorosorbent in combination with extracorporeal autohemomagnetic therapy and medical therapy with IL-6 receptor antagonists on the respiratory status, hemostasis, acid-base state of the blood, the detoxification function of the liver and kidneys in patients with severe COVID-19 infection. Material and methods: The clinical and laboratory findings of 102 patients with a severe course of coronavirus infection, who developed cytokine storm, were evaluated. All patients were divided into three groups: hemosorption with magnetic blood treatment («HS+MBT») (41 patients), Tocilizumab group (40 patients) and Levilimab group (20 patients). The following indicators were studied: erythrocyte count and platelet count; hemoglobin level; concentration of total protein, creatinine, urea, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fibrinogen, D-dimers; acid-base state and blood gas composition. To assess the respiratory status, the respiratory index (RI), ROX index, total oxygen flow, and dynamics of the level of respiratory support were evaluated. To assess hemodynamics, mean arterial pressure and heart rate were determined, the body temperature of the patients was also measured. Results: The results obtained demonstrate that with the combined use of MBT and hemosorption through the Hemo-Proteasosorb sorbent in patients with severe COVID-19, there were no significant fluctuations in hemodynamic parameters, levels of urea, creatinine, total bilirubin, AST and ALT. At the same time, the use of tocilizumab was associated with an increase in the levels of urea, total bilirubin and ALT. In the Levilimab group there was an increase in the concentration of urea. The use of HS+MBT was associated with a decrease in the level of fibrinogen, which was noted on the next day, as well as a tendency to a decrease in D-dimers. At the same time, during the treatment with IL-6 receptor blockers, a significant decrease in the level of fibrinogen was noted only on days 6-8. The number of thromboembolic complications was also lower in the patients with extracorporeal detoxification. With HS+MBT, an increase in the respiratory status indicators (RI, ROX-index, decrease in total oxygen flow) was observed already on the next day, while in the Tocilizumab and Levilimab groups, an increase in these indicators was noted only on days 6-8. A decrease in the ROX index and the absence of dynamics in the total oxygen flow were found on the next day in both groups. In the HS+MBT group, the obtained results indicated that the given technique both prevents more significantly the transition to the next level of respiratory support and contributes to its decrease as compared to IL-6 receptor blockers. Analysis of the acid-base state of the blood following HS + MBT showed a decrease in the level of lactate and an increase in HCO3, as well as deficiency/excess of bases, which indicated compensation for metabolic acidosis. Similar results with the use of IL-6 receptor blockers were obtained only on the 6th-8th day of the study, but no normalization of the lactate concentration in the blood of patients was found at any stage. Conclusion: The use of HS+MBT has a number of advantages over the treatment with IL-6 receptor blockers, which is manifested by the absence of cardio, hepato- and nephrotoxicity, as well as more significant positive effect on hemostasis, respiratory status and acid-base status of patients.

METHODOLOGY FOR ASSESSMENT OF THE QUALITY OF LIFE OF CHILDREN WITH CORONA VIRUS INFECTION AND THE POST-VIDAL SYNDROME

Background. The urgency of the problem is due to the rapid spread of the coronavirus infection in the world, as well as the frequent occurrence of a wide range of post-coronavirus complications in children, which significantly affect the quality of life. These changes also remain in the post-Covid period. Assessment of the quality of life in children with post-covid syndrome in Ukraine is at the stage of formation, therefore, methodologically, the creation and validation of children's questionnaires with subsequent assessment of the quality of life remains an urgent problem.
 Aim: to summarize data from the literature regarding the study of health-related quality of life in children with SARS-CoV-2 infection and post-covid syndrome.
 Materials and methods. An assessment of literature data on the frequency and course of coronavirus infection, its manifestations, damage to the respiratory system and other organs and systems in children, and asthenic manifestations was carried out.
 Results. Based on the analysis of the scientific literature, the possibilities of using the quality of life assessment method in pediatric practice, in particular in children with COVID-19 and the consequences of the infection, were considered. One of the most frequently used questionnaires for assessing the quality of life in children is the PedsQL 4.0 questionnaire, which, due to good psychometric qualities, the availability of parallel forms for children and parents, a wide age range, simplicity and ease of filling out, can be recommended for determining the health-related quality of life in children. It is shown how the study of the quality of life related to health allows to study the impact of the disease and treatment on the components of the child's health.
 Conclusions. Research on quality of life allows monitoring the condition of a child with post-covid syndrome during treatment and rehabilitation, as well as evaluating the effectiveness of these measures.