Course Of COVID-19 Disease Research Articles

OP0178 COVID-19 BREAKTHROUGH INFECTIONS IN VACCINATED PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES AND CONTROLS – DATA FROM TWO PROSPECTIVE COHORT STUDIES

BackgroundConcerns have been raised regarding risks of COVID-19 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases (IMIDs) treated with immunosuppressants, but data on COVID-19 breakthrough infections in these patients are still scarce.ObjectivesThe primary objective was to compare the incidence and severity of COVID-19 breakthrough infections with the SARS-CoV-2 delta variant between fully vaccinated IMID patients with immunosuppressants, and controls (IMID patients without immunosuppressants and healthy controls). The secondary objective was to explore determinants of breakthrough infections.MethodsIn this study we pooled data collected from two large ongoing prospective multi-center cohort studies (Target to-B! [T2B!] study and ARC study). Clinical data were collected between February and December 2021, using digital questionnaires, standardized electronic case record forms and medical files. Post-vaccination serum samples were analyzed for anti-RBD antibodies (T2B! study only) and anti-nucleocapsid antibodies to identify asymptomatic breakthrough infections (ARC study only). Logistic regression analyses were used to assess associations with the incidence of breakthrough infections. Multivariable models were adjusted for age, sex, cardiovascular disease, chronic pulmonary disease, obesity and vaccine type.ResultsWe included 3207 IMID patients with immunosuppressants and 1810 controls (985 IMID patients without immunosuppressants and 825 healthy controls). The incidence of COVID-19 breakthrough infections was comparable between patients with immunosuppressants (5%) and controls (5%). The absence of SARS-CoV-2 IgG antibodies after COVID-19 vaccination was independently associated with an increased incidence of breakthrough infections (P 0.044). The proportion of asymptomatic COVID-19 breakthrough cases that were additionally identified serologically in the ARC cohort was comparable between IMID patients with immunosuppressants and controls; 66 (10%) of 695 patients vs. 64 (10%) of 647 controls. Hospitalization was required in 8 (5%) of 149 IMID patients with immunosuppressants and 5 (6%) of 86 controls with a COVID-19 breakthrough infection. Hospitalized cases were generally older, and had more comorbidities compared with non-hospitalized cases (Table 1). Hospitalization rates were significantly higher among IMID patients treated with anti-CD20 therapy compared to IMID patients using any other immunosuppressant (3 [23%] of 13 patients vs. 5 [4%] of 128 patients, P 0.041; Table 1).Table 1.Determinants of the severity of COVID-19 breakthrough infections.Ambulatory care (n = 222)Hospitalized (n = 13)Group - no. (%)IMID patients with immunosuppressants141(64)8(62)IMID patients without immunosuppressants49(22)3(23)Healthy controls32(14)2(15)Patient characteristicsAge, years – mean (SD)51(14)60(11)Female sex – no. (%)143(64)4(31)Comorbidities – no. (%)Cardiovascular disease17(8)5(39)Chronic pulmonary disease17(8)4(31)Diabetes15(7)3(23)Obesity34(15)5(39)Immunosuppressants– no. (%)Methotrexate36(16)2(15)TNF inhibitor48(22)2(15)Anti-CD20 therapy13(6)3(23)Mycophenolate mofetil3(1)0(0)S1P modulator5(2)0(0)Other immunosuppressants70(32)3(23)ConclusionThe incidence of COVID-19 breakthrough infections in IMID patients with immunosuppressants was comparable to controls, and infections were mostly mild. Anti-CD20 therapy might increase patients’ susceptibility to severe COVID-19 breakthrough infections, but traditional risk factors also continue to have a critical contribution to the disease course of COVID-19. Therefore, we argue that most patients with IMIDs should not necessarily be seen as a risk group for severe COVID-19, and that integrating other risk factors should become standard practice when discussing treatment options, COVID-19 vaccination, and adherence to infection prevention measures with patients.Disclosure of InterestsNone declared

The Role of Zinc and Copper in Platelet Activation and Pathophysiological Thrombus Formation in Patients with Pulmonary Embolism in the Course of SARS-CoV-2 Infection.

Simple SummaryRecent studies associated COVID-19 with coagulation dysfunction and increased risk of thromboembolism. Consequently, pulmonary embolism (PE) development and higher odds of mortality were observed in this group of patients. CRP levels, which are considered a sensitive marker of systemic inflammation, were linked to the higher rates of PE and immunologic processes associated with atherosclerosis development and thrombus formation. Several microelements, including zinc and copper, were shown to present anti-inflammatory and anti-oxidative characteristics. Due to these properties, and they’re in-fluence on platelets activation and thrombus formation, zinc and copper should be evaluated as a potential therapeutic option during COVID-19.To date, many studies have proved that COVID-19 increases the incidence of thrombus formation and coagulopathies but the exact mechanism behind such a disease outcome is not well known. In this review we collect the information and discuss the pathophysiology of thrombus formation in patients with pulmonary embolism in the course of COVID-19 disease and the role of zinc and copper in the process. Supplementation of zinc and copper may be beneficial for COVID-19 patients due to its anti-inflammatory and anti-oxidative properties. On the other hand, excess of those microelements in the organism may be harmful, that is why marking the level of those micronutrients should be done at first. We also propose further investigation of diagnostic and therapeutic options of zinc and copper in course of COVID-19 thrombus formation to their potential in patient care, with particular emphasis on the dosage and the duration of their misbalance.

Management of acute abdomen during the active disease course of COVID-19 and multisystem inflammatory syndrome in children.

PurposeTo evaluate the management of children with severe gastrointestinal symptoms during the disease course of COVID-19 and multisystem inflammatory syndrome (MIS-C).MethodsAfter ethical approval, we reviewed the medical records, retrospectively, of children with COVID-19 or MIS-C requiring surgical consultation for severe gastrointestinal symptoms.ResultsThe subjects comprised 15 children, 13 with MIS-C and 2 with COVID-19. Twelve children (80%) had been in known close contact with a person with SARS-CoV-19 and 13 were positive for Anti-SARS-CoV-2 IgG. All the children had experienced fever for at least 1 day and had signs of involvement of two or more systems. Three patients required surgical intervention: one underwent surgical exploration with a presumptive diagnosis of acute appendicitis in the referring center and was transported to our center following clinical deterioration, where a diagnosis of MIS-C was confirmed; and the remaining two developed appendicitis during hospitalization for COVID-19. All three patients had a longer duration of abdominal pain, a higher number of lymphocytes, and a lower level of inflammatory markers than the non-surgically managed patients. None of the patients presenting with MIS-C underwent surgical exploration.ConclusionGastrointestinal involvement may mimic acute abdomen in children with COVID-19. Thus, children presenting with acute abdomen in the pandemic era require careful evaluation and prompt diagnosis to avoid unnecessary surgical intervention.

The effect of hypertension and antihypertensive therapies on the course of COVID-19 infection: Turkish national health system data

ABSTRACT Aim The effect of hypertension (HT) and antihypertensive therapies such as renin-angiotensin-aldosterone system (RAAS) blockers on the disease course in COVID-19 patients is controversial. The purpose of this study was to evaluate the effect of HT and antihypertensive therapies on the course of COVID-19 disease. Method The age, sex, comorbid diseases, and antihypertensive therapies of 132,790 patients with positive COVID-19 real-time transcriptase polymerase chain reaction (RT-PCR) tests in the Turkish Health Ministry National COVID-19 database between 11 March and 31 May 2020, were examined and analyzed. Results Forty-one percent of the 132,790 patients in this study (median age: 40, 47.3% female) were hospitalized for treatment, and 4.5% were followed-up in the intensive care unit (ICU). The most frequent comorbid disease, at 19.5%, was HT (n = 25,863). Mortality was determined in 4.9% of HT patients and 1.9% of non-HT patients (p < .001). HT, age, and male gender emerged as independent predictors of hospitalization and admission to the ICU, while HT was not a predictor of mortality. In addition, no adverse effect of any antihypertensive treatment, including RAAS inhibitors, on mortality was detected. Conclusion Based on Turkish national data, HT is common in COVID-19 patients, but does not appear to be an independent predictor of mortality, and no adverse effect of RAAS inhibitors on COVID-19-related mortality was observed.

Epigenetic immunophenotyping in monitoring of SARS-CoV2 vaccine response and COVID-19 disease course

Abstract The objective was to explore whether epigenetic immune cell counting can advance efficiency and quality of diagnostic and immune monitoring related to COVID-19. Application areas were monitoring disease course, therapeutic clinical development, and measurements of SARS-CoV2 vaccine responses. Immune cell type specific epigenetic assays have been developed over the last decade. They are primarily used in therapeutic clinical research in oncology and autoimmune disease. Due to the high sample stability and low amount requirements for epigenetic measurements and available assay portfolio for key immune cell populations relevant in COVID-19, the method promised to be useful and practical in the pandemic setting. Epigenetic immunophenotyping using whole blood of hospitalized Covid19 patients was applied and CD3, CD4, CD8 and regulatory T cell populations, NK cells, naïve and memory B cells were quantified, and measurement results show to predict mild or severe COVID-19 disease courses. Furthermore, nasopharyngeal swab and saliva samples were applied demonstrating that epigenetic immune monitoring can measure immune cell content in such non-invasive sample types. Due to the low sample volume and handling requirements and availability of 35 assays for relevant immune cell populations, epigenetic immune monitoring is suitable for therapeutic COVID-19 clinical trials. Another possibility for sample collection is single drops of capillary blood deposited on filter paper (dried blood spots), which have been collected pre and post SARS-CoV2 booster vaccinations in healthy subjects. Such measurements revealed vaccine response for example in changes of cell populations epigenetically active in the markers CCR7 and TIGIT.

Sinovac vaccination and the course of COVID-19 disease in hospitalized patients in Turkey.

BACKGROUND: The Alpha variant of SARS-CoV-2 has a higher transmission rate than the first variant identified. The efficacy of vaccines is affected by the characteristics of SARS-CoV-2 variants.OBJECTIVE: Investigate the relationship of vaccination and virus variant on the course of the disease in patients who were hospitalized with a diagnosis of COVID-19.DESIGN: Retrospective, cohort studySETTING: Tertiary health institutionPATIENTS AND METHODS: The study included patients older than the age of 18 years who were hospitalized in a COVID-19 service or the intensive care unit with a diagnosis of COVID-19 between 1 January 2021 and 30 April 2021. Demographic characteristics, vaccination and the Alpha virus variant status, comorbidities, and information about hospitalization were obtained from the hospital automation system and patient files.MAIN OUTCOME MEASURES: Vaccination rate and relationship with course of disease.SAMPLE SIZE: 608RESULTS: Most of the patients (n=482, 79.3%) were admitted to the COVID-19 service. More of the COVID-19 service patients had the Alpha variant than the patients admitted to ICU (P<.009). The Alpha variant was also more common in younger patients (P<.001). There was no relationship between the Alpha virus and comorbid diseases such as diabetes mellitus and hypertension. Mortality was lower in the patients who had received a second dose of the Sinovac vaccine (P=.004) compared with unvaccinated patients.CONCLUSION: Although the Alpha variant spreads faster, it has a milder course. If only the Sinovac vaccine is available, we recommend that the two doses of the Sinovac vaccine be administered.LIMITATIONS: Our study is single-center and did not include pregnant and pediatric patients.CONFLICT OF INTEREST: None.

Relationship between platelet parameters and disease severity and coagulpathy in covid 19

Objectives: Coagulopathy plays an important role in the clinical course of Covid-19 disease. The aim of our study is to examine the factors affecting the severity of this disease and to examine whether there is a relationship between platelet parameters and disease severity and coagulopathy markers.&#x0D; Methods: The study was planned single-center, retrospective, and cross-sectional. 189 patients diagnosed with Covid-19 were admitted to the Internal Medicine Department. Patients were divided into 3 clinical categories according to the severity of the disease. The relationship between mean platelet volume and other platelet parameters, and disease severity and coagulopathy parameters were statistically analyzed.&#x0D; Results: The study included 189 patients.182 of whom were discharged and 7 of whom died. The average age of the patients was 54.13 ± 14.21. D-Dimer levels were compared between the groups and were found to be significantly higher in cases of severe pneumonia. The group with severe pneumonia group had a higher PDW level than other groups. MPV was detected over 10 fl in the severe pneumonia group, but no statistically significant difference was found with the other groups. PT and INR levels are higher in patients with upper respiratory tract infection (URTI) compared to patients with mild to moderate pneumonia. APTT levels were found to be higher in patients with URTI than in patients with severe pneumonia. &#x0D; Conclusion: In our study, PDW height and MPV height were determined from the findings showing platelet activation in patients with severe pneumonia. If an increase in these parameters is detected in patients diagnosed with the Covid 19 disease, close follow-up should be performed in terms of the development of complications.

Case report of unusual presentation of COVID-19 in a patient with pulmonary hypertension

Objective: COVID-19 has now become a worldwide health problem with many new cases diagnosed every day. people with underlying heart diseases are more likely to get infected and have poor prognosis. Of them, adult patients with congenital heart disease need special attention due to their different symptoms and course of the disease. Case Presentation: Here, we report the unusual presentation and course of COVID-19 disease with rapid progression of right ventricle failure and pulmonary hypertension in patient who was infected with new SARS-CoV-2 virus. She is a 39-year-old woman, known case of ventricular septal defect and pulmonary hypertension with a history of open-heart surgery at the age of seven that arrived to our clinic due to exacerbation of dyspnea; progressive lower extremity edema and mild ascites from 10-days ago. Conclusion: Any changes in the condition of adult patients with congenital heart disease in this epidemic should be considered as a potential infection by this virus and the necessary and accurate evaluation should be done.

The Concept of Intrauterine Programming and the Development of the Neonatal Microbiome in the Prevention of SARS-CoV-2 Infection.

The process of intrauterine programming is related to the quality of the microbiome formed in the fetus and the newborn. The implementation of probiotics, prebiotics, and psychobiotics shows immunomodulatory potential towards the organism, especially the microbiome of the pregnant woman and her child. Nutrigenomics, based on the observation of pregnant women and the developing fetus, makes it possible to estimate the biological effects of active dietary components on gene expression or silencing. Nutritional intervention for pregnant women should consider the nutritional status of the patient, biological markers, and the potential impact of dietary intervention on fetal physiology. The use of a holistic model of nutrition allows for appropriately targeted and effective dietary prophylaxis that can impact the physical and mental health of both the mother and the newborn. This model targets the regulation of the immune response of the pregnant woman and the newborn, considering the clinical state of the microbiota and the pathomechanism of the nervous system. Current scientific reports indicate the protective properties of immunobiotics (probiotics) about the reduction of the frequency of infections and the severity of the course of COVID-19 disease. The aim of this study was to test the hypothesis that intrauterine programming influences the development of the microbiome for the prevention of SARS-CoV-2 infection based on a review of research studies.

Pre-Pandemic Dietary Assessment of Elderly Persons Residing in Nursing Homes-Silesia (Poland).

Background. Residents of nursing homes (NHs) are one of the most vulnerable social groups to SARS-CoV-2 infection. It seems obvious that all preventive methods, including nutrition, should be a priority for these homes. Objective. The aim of this study was to evaluate the menus of elderly people residing in nursing homes and to compare them with the recommendations and especially with the scientific literature that proves the protective effect of nutrition on the course of COVID-19 disease. Material and methods. The material investigated in the research were decade menus selected at several nursing homes between 2017 and 2020. The total number of 4640 daily menus from 58 NHs located in Silesia (Poland) were analyzed in the research. Data analysis included mathematical tools of Kruskal–Wallis and U Mann–Whitney tests for multiple comparisons in scarcely observed samples (p = 0.05). Results. It has been noted that the energy value provided with food scored 1780.22 kcal, which denoted 102.72% of the daily standard for females and 98.23% for males. The investigated menus differed in terms of energy and nutrition value. The mean content of proteins totaled 47.95 g/day, which covered 93.83% of the daily requirements for this nutrient. When it came to fat content, a level of 109.12 g/day was observed; this covered 160.47% of the daily requirement for females and 143.58% for males. Absorbable carbohydrates constituted 116.60% of the daily standard, i.e., 151.59 g/day. It was stated that values for vitamin D reached 7.01 (±0.63) µg per day, which can be interpreted as 41.00% of the recommended intake for females and 42.00% for males. It was also noted that the values for vitamins A and E were respectively two and fifteen times lower than the recommendations. Conclusions. The evaluated menus must not be an aid in the prevention and treatment of COVID-19. The content of energy from food, fats, and carbohydrates substantially exceeded recommended standards, whereas the content of proteins, vitamins A, E, D, zinc and calcium did not meet requirements regarding nutrition standards for the analyzed group.

Perioperative management of patients with post Covid rhino-orbito-cerebral mucormycosis: Prospective observational study

Mucormycosis is a life-threatening, locally invasive, rapidly progressive, opportunistic fungal infection, associated with several anaesthetic challenges. We aimed to study its relation with patient’s comorbidities, covid treatment strategies, also to observe the intubation difficulties, changes in hemodynamic parameters, post anaesthesia recovery status and perioperative complications. In this time bound study, total 160 patients were included. During pre-anaesthetic evaluation, presence of associated co-morbidities, course of Covid-19 disease, requirement of O2 therapy were noted. On the day of surgery, premedications and sedation were given. Induction was done with propofol/etomidate along with sevoflurane/desflurane. Intubation was done with succinyl choline/ atracurium and difficulties in intubation were graded according to Modified Intubation Difficulty Scale. Anaesthesia was maintained with the mixture of Oxygen, Air and inhalation agent along with intermittent Atracurium. Hemodynamic parameters, intra operative and post operative outcome were noted. Unstable patients were shifted to intensive care unit. Among patients of rhino-orbito-cerebral mucormycosis, most common co morbidity found was diabetes mellitus (42%). Here, 61% were on room air, rest needed oxygen therapy. Total 52% patients required &amp;#62;/= 2 intubation attempts, in which 9% were video laryngoscope assisted and 11% required additional maneuvers. 22% patients were started on intravenous nitroglycerin to manage intraoperative hypertension. 9.3% patients required ICU admission, of which 2.5% could not survive. Possibilities of developing rhino-orbito-cerebral mucormycosis in patients having diabetes mellitus are high. The anaesthetic management requires eternal vigilance to encounter difficult intubation, delayed recovery, and higher rate of morbidity and mortality.

Intermediate Monocytes with PD-L1 and CD62L Expression as a Possible Player in Active SARS-CoV-2 Infection.

Monocytes play a role in viral biology, but little is known about the monocyte subpopulation in the course of COVID-19 disease. The aim of the study was the analysis of classical, intermediate and non-classical monocytes with expression of PD-L1 and CD62L, TIM-3 and CD86 molecules in peripheral blood (PB) to distinguish patients with SARS-CoV-2 infection from convalescent patients. The study group consisted of 55 patients with SARS-CoV-2 infection and 51 convalescent patients. The cells were analyzed by flow cytometry. The number and proportion of monocytes were lower in patients with COVID-19 than convalescent patients. We observed a lower proportion of non-classical monocytes in COVID-19 patients than convalescent ones. There was a higher proportion of PDL-1-positive intermediate monocytes in COVID-19 patients than convalescent ones. We noticed a higher geometric mean fluorescence intensity (GeoMean) of PD-L1 on intermediate monocytes in COVID-19 patients than convalescent patients, and a higher proportion of CD62L-positive monocytes in COVID-19 patients in comparison with convalescent ones. We found a higher GeoMean of CD62L on monocytes in COVID-19 patients than convalescent ones. Assessment of PD-L1- and CD62L-positive monocyte subsets may identify patients with a possible predisposition for rapid recovery. The monitoring of monocyte subsets in PB might be a useful test in COVID-19 patients.

Early Th2 inflammation in the upper respiratory mucosa as a predictor of severe COVID-19 and modulation by early treatment with inhaled corticosteroids: a mechanistic analysis

BackgroundCommunity-based clinical trials of the inhaled corticosteroid budesonide in early COVID-19 have shown improved patient outcomes. We aimed to understand the inflammatory mechanism of budesonide in the treatment of early COVID-19.MethodsThe STOIC trial was a randomised, open label, parallel group, phase 2 clinical intervention trial where patients were randomly assigned (1:1) to receive usual care (as needed antipyretics were only available treatment) or inhaled budesonide at a dose of 800 μg twice a day plus usual care. For this experimental analysis, we investigated the nasal mucosal inflammatory response in patients recruited to the STOIC trial and in a cohort of SARS-CoV-2-negative healthy controls, recruited from a long-term observational data collection study at the University of Oxford. In patients with SARS-CoV-2 who entered the STOIC study, nasal epithelial lining fluid was sampled at day of randomisation (day 0) and at day 14 following randomisation, blood samples were also collected at day 28 after randomisation. Nasal epithelial lining fluid and blood samples were collected from the SARS-CoV-2 negative control cohort. Inflammatory mediators in the nasal epithelial lining fluid and blood were assessed for a range of viral response proteins, and innate and adaptive response markers using Meso Scale Discovery enzyme linked immunoassay panels. These samples were used to investigate the evolution of inflammation in the early COVID-19 disease course and assess the effect of budesonide on inflammation.Findings146 participants were recruited in the STOIC trial (n=73 in the usual care group; n=73 in the budesonide group). 140 nasal mucosal samples were available at day 0 (randomisation) and 122 samples at day 14. At day 28, whole blood was collected from 123 participants (62 in the budesonide group and 61 in the usual care group). 20 blood or nasal samples were collected from healthy controls. In early COVID-19 disease, there was an enhanced inflammatory airway response with the induction of an anti-viral and T-helper 1 and 2 (Th1/2) inflammatory response compared with healthy individuals. Individuals with COVID-19 who clinically deteriorated (ie, who met the primary outcome) showed an early blunted respiratory interferon response and pronounced and persistent Th2 inflammation, mediated by CC chemokine ligand (CCL)-24, compared with those with COVID-19 who did not clinically deteriorate. Over time, the natural course of COVID-19 showed persistently high respiratory interferon concentrations and elevated concentrations of the eosinophil chemokine, CCL-11, despite clinical symptom improvement. There was persistent systemic inflammation after 28 days following COVID-19, including elevated concentrations of interleukin (IL)-6, tumour necrosis factor-α, and CCL-11. Budesonide treatment modulated inflammation in the nose and blood and was shown to decrease IL-33 and increase CCL17. The STOIC trial was registered with ClinicalTrials.gov, NCT04416399.InterpretationAn initial blunted interferon response and heightened T-helper 2 inflammatory response in the respiratory tract following SARS-CoV-2 infection could be a biomarker for predicting the development of severe COVID-19 disease. The clinical benefit of inhaled budesonide in early COVID-19 is likely to be as a consequence of its inflammatory modulatory effect, suggesting efficacy by reducing epithelial damage and an improved T-cell response.FundingOxford National Institute of Health Research Biomedical Research Centre and AstraZeneca.

188P Efficacy of SARS-CoV-2 based mRNA vaccines for patients with thoracic malignancies with 6 months follow up: A prospective observational study

Vaccination against SARS-CoV-2 in patients (pts) with thoracic malignancies is crucial since they are at high risk of having severe COVID-19 disease course. Still, data on efficacy of vaccination in this pt population are scarce.

Clinical Course of COVID-19 Disease in Children Treated With Neoplastic Diseases in Hungary.

We report on children with cancer in Hungary suffering from COVID-19, surveying a 13-months-long period of time. We performed a retrospective clinical trial studying the medical documentation of children treated in seven centers of the Hungarian Pediatric Oncology-Hematology Group. About 10% of children admitted to tertiary hemato-oncological centers for anti-neoplastic treatment or diagnosis for de novo malignancies were positive for SARS-CoV-2 infection. Nearly two-thirds of the infected patients were asymptomatic or had only mild symptoms but showed seropositivity by 1–4.5 months after positive PCR. One third of the SARS-CoV-2-positive children were hospitalized due to symptomatic COVID-19. Five children required antiviral treatment with remdesivir. One child was referred to the intensive care unit, requiring intubation and mechanical ventilation. Delay in the scheduled anti-cancer treatment did not exceed 2 weeks in the majority (89%) of cases. There was only one patient requiring treatment deferral longer than a month. There was no COVID-19-related death in patients under 18 years of age, and nor was multisystem inflammatory syndrome diagnosed. In conclusion, SARS-CoV-2 infection did not represent an untoward risk factor among children with cancer in Hungary.

Risk and protective factors for severe COVID-19 infection in a cohort of patients with sickle cell disease

Continued investigation of comorbid conditions that increase the mortality rate of COVID-19 is necessary to provide the best care for those affected. This continued push to find answers is even...

Impact of vitamin D level and supplementation on systemic lupus erythematosus patients during COVID-19 pandemic

Objectives In this study, we aimed to assess the impact of serum vitamin D level in systemic lupus erythematosus (SLE) patients with novel coronavirus-2019 (COVID-19) disease on severity of infection, duration of COVID-19 disease course, and fatigue development as a complication of both SLE and COVID-19.Patients and methods Between April 2020 and January 2021, a total of 38 patients (31 males, 7 females; mean age: 49.2±8.1 years; range, 38 to 65 years) who were previously diagnosed with SLE and on different lines of lupus management were included. The patients presented to chest outpatient clinic and emergency hospital with manifestations suggesting COVID-19 infection. Vitamin D levels were measured in serum by enzymelinked immunosorbent assay (ELISA). Vitamin D supplement was added to treatment protocols for COVID-19.Results Thirteen (34.2%) patients had normal baseline serum vitamin D levels (≥30 ng/mL), nine (23.7%) patients had vitamin D insufficiency (21 to 29 ng/mL), and 16 (42.1%) patients had vitamin D deficiency (≤20 ng/mL). Low vitamin D levels (insufficiency & deficiency) patients had long SLE disease duration (p=0.06). Also, there was a significant long time spent until recovery from COVID-19 infection in low vitamin D levels (insufficiency & deficiency) patient groups versus those with normal vitamin D (p=0.019). Low baseline vitamin D level patients mainly presented with severe COVID19 symptoms (p=0.04). Patients recovered from COVID-19 had normal vitamin D levels than those who died or were lost to follow-up (p=0.07). After recovery from COVID-19, fatigue was more common in SLE patients with low baseline vitamin D level.Conclusion Vitamin D seems to play a certain role in the management of COVID-19 infection in SLE patients. Patients with normal vitamin D levels have less severe symptoms, shorter time to recovery, improved COVID-19 outcomes, and less development of fatigue after COVID-19 infection.

How electrolyte values affect COVID-19 patients at the time of application to the hospital?

Aim: COVID-19 disease is life threatening. we aimed to evaluated the effect of electrolyte disturbances on the course of COVID-19 disease. Material and methods: Patients hospitalized with the diagnosis of COVID-19 were included in the study. Demographic characteristics, comorbidities, symptoms, clinical course, and laboratory parameters were recorded. Results: Totally 130 COVID-19 patients, 70 (54%) of whom were female, were included in the study. The mean age was 56.6 ± 16.4 years. The most common symptom was cough (57%) and the accompanying disease hypertension (45%). 68% of the patients had hyponatremia and 29%&#x0D; had hypocalcemia. 95% of the patients were discharged. 5% died. There was a relationship between the need for oxygen and advanced age, male gender, presence of diabetes mellitus, cardiovascular disease, bilateral involvement in chest CT, lymphopenia, CRP, low calcium level, hypocalcemia, and secondary infection (p = 0.024., p= 0.001, p = 0.030, p = 0.045, p = 0.002, p =0.010, p = 0.000, p = 0.022, p = 0.048, p = 0.001, respectively). There was a relationship between the need for intensive care, male gender, low calcium level, hyponatremia conclusion the presence of secondary infection. (respectively, p = 0.045, p = 0.023, p = 0.011, p = 0.001). There was a correlation between the duration of hospitalization and low calcium level and low sodium level (p = 0.026, p = 0.022). Conclusion: The severity of COVID-19 appears to be associated with&#x0D; low serum sodium and calcium concentrations, and regular electrolyte monitoring can be useful in follow-up.

Memo on the procedure in case of asymptomatic or mild course of the disease COVID-19

SOGAZ-Med informs about the procedure of citizens' actions in case of asymptomatic or mild course of COVID-19 disease according to the memo of the Ministry of Health of the Russian Federation dated 27.01.2022.

Immune transcriptome analysis of COVID-19 patients infected with SARS-CoV-2 variants carrying the E484K escape mutation identifies a distinct gene module

Fast-spreading variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) energize the COVID-19 pandemic. While viral infections elicit a conserved immune response, it is not known whether SARS-CoV-2 variants, which display enhanced binding to the ACE2 receptor and reduced neutralizing activity by vaccine-elicited antibodies, prompt specific genomic immune responses. To test this, we generated and investigated the transcriptomes in BCs from hospitalized patients infected with either the Alpha variant (n = 36) or with the Alpha variant that had acquired the E484K escape mutation (Alpha+E484K) (n = 13). We identified a gene module preferentially activated in patients infected with the Alpha+E484K variant and in patients infected with the Beta (n = 9) and Gamma (n = 3) variants that also carry by the E484K escape mutation. The E484K signature was enriched for genes preferentially expressed in monocytes and linked to severe viral infection. However, both cohorts had undergone similar treatments and no differences in disease severity were reported suggesting that this signature reflects a variant response and does not necessarily associate with disease outcome. Additionally, longitudinal transcriptome analyses revealed a more persistent retention of immune signatures in Alpha+E484K patients throughout the entire course of COVID-19 disease and convalescence. While the OAS1 Neanderthal mutation has been linked to a milder COVID-19 pathology, we did not identify significant immune transcriptomes differences in the 25 patients homozygous for this mutation. Our study offers insights into distinct molecular immune responses elicited by SARS-CoV-2 variants carrying the E484K escape mutation throughout the COVID-19 disease.