Infectious Diseases Hospital Research Articles

Efficacy of Lamivudine and Dolutegravir simplification therapy compared with triple therapy in Northeast Brazil (LAMDO Study)

Background: Modern antiretroviral therapy provides numerous effective and well-tolerated treatment options for individuals living with HIV. However, due to medication tolerability, toxicity, and cost optimization associated with the emergence of highly potent drugs, dual therapy has emerged as a new therapeutic alternative for patients with viral suppression. Observational studies worldwide are being conducted to assess the effectiveness of dual therapy in people living with HIV/AIDS. A real-world study is important to validate the findings obtained in controlled studies. Objective: Assess the effectiveness of dual therapy with lamivudine and dolutegravir compared to triple therapy in real-life settings. Methods: The study was conducted at São José Infectious Diseases Hospital, a tertiary referral hospital in the state of Ceará, northeast Brazil, for the treatment of PLWHA. Results: A total of 521 patients were taking double therapy with lamivudine plus dolutegravir and 450 patients were in triple therapy, mostly in the use of association with dolutegravir, were analyzed. Patients on dual therapy had a higher median age compared to those on triple therapy. A statistically significant higher viral suppression was observed in patients on dual therapy compared to triple therapy (p < 0,001). Viral suppression on dual therapy under 200 copies was 97.2%. There was a statistically significant higher percentage of patients with higher CD4/CD8 ratio using triple therapy compared to dual therapy. Conclusion: The current study suggests a higher effective response to dual therapy compared to triple therapy in PLWHA in the real-world, supporting therapy simplification as a sustainable option to maintain virological suppression in patients experiencing toxicity or comorbidities.

Microbial associations for pneumonia causative agents and level of their resistance to antimicrobial drugs during a new coronavirus infection pandemic

Introduction. Bacterial coinfection and secondary bacterial infection are considered critical risk factors for the severity and mortality of SARS-CoV-2-caused pneumonia. The aim of the study was to analyze a pattern of microbial associations between K. pneumoniae and A. baumannii isolated from the lower respiratory tract discharge and sectional material (lung tissue) of patients diagnosed with pneumonia, and to compare resistance level in monoculture and associations during new coronavirus infection pandemic. Materials and methods. A bacteriological study of 2689 sputum and bronchial washing samples from patients at infectious diseases hospitals, and 1411 lung pathological material samples was carried out. Bacterial isolates were identified by mass spectrometry. Antibiotic sensitivity for isolates was determined by the disk diffusion method. Genetic determinants of resistance to beta-lactam antibiotics were detected by PCR. Statistical data processing was performed using SPSS version 22 software. Results. K. pneumoniae and A. baumannii isolates were predominantly found in two- and three-pathogen associations. It was established that the resistance level of K. pneumoniae isolates in association with A. baumannii is significantly higher compared to that in monoculture for all antimicrobial drugs studied. At the same time, K. pneumoniae in combination with Candida spp. vs monoculture showed significantly lower level of resistance to ciprofloxacin, amikacin, cefotaxime, ceftazidime and amoxicillin/clavulanic acid. K. pneumoniae isolates carried resistance determinants to extended-spectrum beta-lactamases: OXA-48 — (22.5%), OXA-51 — (5.6%), OXA-23 — (4.2%), KPC — 70.9%, NDM — 7%. Of these, 14.1% of strains had the ability to co-produce serine carbapenemases OXA-48 and KPC. Sputum and lung tissue A. baumannii isolates exhibited extremely high multiple resistance regardless of their associations with other microorganisms. Microbiome species similarity in the lower respiratory tract and lung tissue discharge was revealed. The proportion of lung tissue vs sputum resistant strains of K. pneumoniae and A. baumannii was significantly higher. Conclusion. The detection of of multiple drug resistant K. pneumoniae and A. baumannii isolates as well as their associations may indicate aggravated pneumonia severity.

ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ИССЛЕДОВАНИЯ УРОВНЕЙ МАРКЕРОВ АПОПТОЗА – БЕЛКОВ P53 И BCL-2 У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА С ВИРУСНОЙ ПНЕВМОНИЕЙ, ВЫЗВАННОЙ SARS-COV-2

Abstract. Introduction. Тo date, the prognostic value has been proven for some laboratory biomarkers and biomarker panels for risk stratification in patients with viral pneumonia caused by SARS-CoV-2. In studies related to the research in the leading pathogenetic mechanisms of COVID-19, much attention is paid to apoptosis and its markers, such as proteins P53 and BCL-2. Aim: To study the levels of P53 and Bcl-2 proteins and their prognostic significance in lethal outcomes among elderly patients with viral pneumonia caused by SARS-CoV-2, hospitalized in an infectious hospital. Materials and Methods. For the period December 2021 – February 2022, in accordance with the inclusion criteria, a sample of 67 patients was formed from elderly patients (60-74 years old) hospitalized in the hospital of infectious diseases. During the follow-up, 18 patients (26.9 %) had fatal outcomes and 49 patients (73.1 %) had favorable outcomes. Biochemical markers of apoptosis, P53 and BCL-2, were detected using the enzyme immunoassay method. Results and Discussion. The analysis showed the presence of statistically significant differences when comparing the levels of both proteins, P53 (p=0.001) and BCL-2 (p=0.002) in patients with favorable outcomes, compared to those with fatal outcomes. Threshold values of the P53 and BCL-2 proteins at the cut-off point in case of death of elderly patients with viral pneumonia caused by SARS-CoV-2 were 99.3 pg/ml and 78.9 IU/ml, respectively. The classification tree includes the following lethality predictors: Threshold levels of apoptosis markers, the number of comorbid diseases, and the respiratory failure degree. Five terminal nodes were identified. Terminal nodes 6 and 8 were classified as high risk of death. Lethal outcomes were observed in 75.0 % of patients at these nodes. At terminal node 3, fatal outcome was observed in 8.1 % of patients, while there were no fatal outcomes at terminal node 7; therefore, both were classified as low-risk ones in terms of a fatal outcome. The sensitivity of the resulting model was 66.7 %, while its specificity was 91.8%. The total share of correct predictions made 85.1% among the subjects of this sample (p=0.044). Conclusions. The data obtained indicate the prognostic significance of studying the apoptosis markers, i. e., proteins P53 and BCL-2, in elderly patients with viral pneumonia caused by SARS-CoV-2. The classification tree proposed can be used as an auxiliary algorithm to optimize the personalized stratification of the lethality risk in elderly patients with viral pneumonia caused by SARS-CoV-2.

Cure of hemophagocytic lymphohistiocytosis triggered by Epstein–Barr virus infection after early diagnosis and appropriate treatment with etoposide, dexamethasone, and immunoglobulin

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening condition characterized by uncontrolled activation of T lymphocytes and inappropriate activation of mature macrophages secreting excessive cytokines leading to marked hypercytokinemia. It can also be secondary to neoplasms, rheumatologic diseases, or infections. This was a case report, described in Central Brazil, of a 17-year-old female patient diagnosed with HLH after infection by Epstein–Barr virus (EBV), which eventually improved after early diagnosis and treatment with etoposide, dexamethasone, and immunoglobulin. The early diagnosis and treatment of this condition are of utmost importance owing to its high mortality rate. Therefore, this is a case report of a young patient who developed HLH, after EBV infection, requiring transfer to a reference hospital for infectious diseases, with optimization of diagnosis and early initiation of specific treatment after discussion between a medical team made up of several specialists.

Langkah Taktis Gaya Kepemimpinan Lurah Sunter Jaya Dalam Menghadapi Pandemi COVID-19

At the beginning of 2020 the world was hit by the Coronavirus Disease 2019 (Covid-19) disaster, this virus attacked the human respiratory tract. Covid-19 was first discovered in the city of Wuhan, China. . The first Covid-19 case in Indonesia began with 2 (two) residents of Depok, West Java who were given treatment at the Infectious Disease Hospital (RSPI) Prof. Dr. Sulianti Saroso. The spread of this virus has changed the way of life and conditions of society. In this case, it is a test for the village leader to show the characteristics of the leadership style in dealing with the Covid-19 virus. This research is to determine the tactical steps of the leadership of Lurah Sunter Jaya in dealing with Covid-19. Qualitative research methods are research approaches applied in natural situations, where the researcher acts as the main instrument. Data collection using various techniques combined, and data analysis was carried out with inductive and qualitative approaches to explain research findings related to the role of a village head during the Covid-19 pandemic, exemplifying one's own behavior to subordinates, as a leader you must be the front troop, taking a role in strategic matters, conveying to subordinates that sub-district employees are community servants or the foundation of the community to solve the Covid-19 problem, there must be involvement from the community.

Relationships of doctors and patients of the infection hospital during the 1st and 2nd waves of the COVID-19 pandemic

Aim. To conduct a comparative analysis of the relationship between doctors and patients in a regional infectious diseases hospital to combat the complications of COVID-19 during the 1st and 2nd waves of the pandemic.
 Materials and methods. The basis of the study was the infectious diseases hospital deployed in the City Clinical Hospital No. 5 in Nizhny Novgorod. The hospital treated patients with complications of coronavirus infection with concomitant therapeutic or surgical pathology. The study was conducted taking into account the principles of robust management through questioning, on issues related to the social characteristics of patients and their subjective assessments of relationships with medical personnel. The scope of the study was 129 people.
 Results. The study did not reveal any changes in the relationship between medical workers and patients; both in the 1st and in the 2nd wave of the pandemic, they were built on mutual respect and empathy: medical workers do their best to support patients, the latter, in turn, understand the difficulties of staff work in an infectious diseases hospital and feel gratitude. The established facts are convincing proof of the high level of readiness of medical organizations and their employees to work in extreme conditions associated with a tense epidemic situation.
 Conclusion. Thus, the results of this study indicate the formation in the 1st wave of the pandemic of a model of relationships built on the principles of mutual trust, support and avoidance of conflicts between doctors and patients of the regional infectious diseases hospital and the preservation of this model during the 2nd wave of the pandemic.

Comparative Analysis of COVID-19 Outcomes in Type 1 and Type 2 Diabetes: A Three-Year Retrospective Study.

Background and Objectives: This comprehensive retrospective study assesses COVID-19 outcomes in type 1 (T1D) and type 2 diabetes (T2D) patients across three years, focusing on how these outcomes varied with the evolving pandemic and changes in diabetes management. The study aims to determine if COVID-19 outcomes, including severity, intensive care unit (ICU) admission rates, duration of hospitalization, and mortality, are significantly different between these diabetes subtypes. Materials and Methods: The study analyzed data from patients admitted to the Victor Babes Hospital for Infectious Diseases and Pulmonology with confirmed COVID-19 and pre-existing diabetes, from the years 2020, 2021, and 2022. Results: Among 486 patients (200 without diabetes, 62 with T1D, 224 with T2D), T2D patients showed notably higher severity, with 33.5% experiencing severe cases, compared to 25.8% in T1D. Mortality rates were 11.6% in T2D and 8.1% in T1D. T2D patients had longer hospital stays (11.6 ± 7.0 days) compared to T1D (9.1 ± 5.8 days) and were more likely to require ICU admission (OR: 2.24) and mechanical ventilation (OR: 2.46). Hyperglycemia at admission was significantly higher in the diabetes groups, particularly in T2D (178.3 ± 34.7 mg/dL) compared to T1D (164.8 ± 39.6 mg/dL). Conclusions: The study reveals a discernible difference in COVID-19 outcomes between T1D and T2D, with T2D patients having longer hospital admissions, mechanical ventilation necessities, and mortality risks.

Investigating the Contributing Risk Factors toward Sarcopenia Prevalence and its Development in Human Immunodeficiency Virus (HIV) Patients

Background Human Immunodeficiency Virus (HIV) causes immune system impairment, and antiretroviral therapy (ART) given for HIV may increase the risk of morbidity and adverse health outcomes, including sarcopenia. The prevalence of sarcopenia in patients with HIV in non-Asian countries has been well-documented, but not in Asian countries. Objective The study aimed to investigate the prevalence of sarcopenia and its association with HIV in Thai patients. Methods A cross-section study was designed. This study included 114 patients with HIV from a specialized infectious disease hospital aged 20-75 years and receiving ART for more than a year. Gait speed, muscle strength, and muscle mass were measured using the 6-m walking test, handgrip dynamometer, and bioelectrical impedance analysis, respectively. Patient medical records and Global Physical Health Questionnaire scores were assessed. Logistic regression analysis was used to determine the risk of sarcopenia occurrence. Results The prevalence of sarcopenia was 21.93%. Risk factors for sarcopenia included duration of ART (odds ratio [OR]=16.55), advanced age (≥60 years, OR=13.50), duration of living with HIV (OR=9.44), and female sex (OR=3.79). Besides, low physical activity, which is a modifiable behavioral, had an OR of 2.78. Conclusion The prevalence of sarcopenia in people with HIV was 21.93%. The duration of ART was the most prominent risk factor for sarcopenia in patients with HIV. Patients with HIV should increase their physical activity levels to reduce sarcopenia risk.

Ambient Temperature Effects on Hospitalization Risk Among Farmers: A Time-Series Study on Multiple Diseases in Vietnam.

The aim of the study is to assess the effect of high temperatures on hospitalization for all causes and heat-sensitive diseases among Vietnamese farmers. The Poisson generalized linear model and distributed lag nonlinear model were used to investigate the temperature-hospitalization association for all causes and seven cause-specific disease groups. Every 1°C increase in daily mean temperature above the threshold increased the estimated relative risk (95% CI) of all-cause hospitalization by 1.022 (0.998-1.047) at the country level, 1.047 (1.007-1.089) in the south, and 0.982 (0.958-1.006) in the north. Infectious disease hospitalization was most affected by high temperatures (1.098 [1.057-1.140]). High temperatures significantly increased the risk of all-cause hospitalization for farmers 60 years and younger in three of the six provinces. The findings emphasized the need for health promotion programs to prevent heat-related health issues.

Dynamics of main markers of protein metabolism and microelements in patients with new coronavirus infection

Objective. To study the dynamics of the main markers of protein metabolism and microelements in patients with a new coronavirus infection. Materials and methods. A prospective clinical and laboratory study of the dynamics of the main markers of protein metabolism and microelements was carried out in 62 patients with a new coronavirus infection complicated by the development of pneumonia with a moderate course on the basis of Perm regional clinical hospital of infectious diseases in 2021–2022. On the 1st and 14th days of hospitalization all patients underwent general clinical and biochemical studies. The concentrations of total protein, albumin, transferrin, Fe, Zn and Cu was also determined. Statistic processing of the results was carried out using Microsoft Excel 2000 and “Statistica 10”. Results. A decrease in visceral pool proteins was revealed. It indicated their active consumption and formation of hypermetabolism - hypercatabolism syndrome in a moderate course of the infection. A progressive deficiency of Fe and Zn, correlating with life-threatening complications and deaths was revealed. Conclusions. The course of a new coronavirus infection contributes to the development of metabolic disorders, and the identified deficiency of macro- and microelements is a predictor of a severe course of the infection.

Assessing the Quality of Life, Coping Strategies, Anxiety and Depression Levels in Patients with Long-COVID-19 Syndrome: A Six-Month Follow-Up Study.

This longitudinal study investigates the psychosocial effects of long-COVID Syndrome, a domain still not extensively researched. It specifically evaluates the quality of life, coping mechanisms, anxiety and depression levels in COVID-19 survivors, differentiating between those with and without long-COVID Syndrome. Conducted at the Victor Babes Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania, the study utilized a cohort of patients diagnosed with mild to moderate COVID-19. The following standardized tools: WHOQOL-BREF for quality of life, COPE-60 for coping strategies, and the Hospital Anxiety and Depression Scale (HADS), were employed for the assessment. The sample consisted of 86 patients displaying persistent post-acute symptoms and 432 asymptomatic patients at the 6-month post-discharge mark. Patients with frequent post-acute symptoms reported significantly higher levels of fatigue (8.2 ± 1.4), cognitive difficulties (7.5 ± 1.6), and respiratory challenges (7.8 ± 1.3), along with a markedly lower overall quality of life (7.0 ± 1.5) compared to their asymptomatic counterparts. HADS scores revealed elevated depression (6.8 ± 1.9) and anxiety (7.1 ± 2.3) in the symptomatic group. Quality of life, as evaluated through the use of WHOQOL-BREF, showed lower scores in the symptomatic cohort across physical (58.8 ± 15.8), mental (56.3 ± 16.4), and social domains (50.2 ± 17.5). COPE-60 findings indicated a higher prevalence of disengagement (56.4%) and emotion-focused coping strategies (61.8%) in the symptomatic group, in contrast to 30.1% and 37.0%, respectively, in the asymptomatic group. The study highlights that long-COVID Syndrome significantly deteriorates the quality of life and is associated with increased depression and anxiety levels. The prevalent use of disengagement and emotion-focused coping strategies among patients with persistent symptoms suggests a need for enhanced psychosocial support tailored to this subgroup.

Efficacy of stage I rehabilitation of medical workers with moderate course of interstitial lung damage associated with COVID-19

Aim of the study was to evaluate the effectiveness of early rehabilitation methods for medical workers with severe or moderate lung damage caused by a new coronavirus infection, who are in intensive care units, to improve lung ventilation, gas exchange and bronchial clearance, correct muscle weakness, increase overall physical endurance, mobility, psycho-emotional stability.Material and methods. We examined 53 COVID-19 women with moderate lung injury at stage I of rehabilitation, divided into two groups: main (n = 31, medical personnel) and control (n = 22, working outside of contact with pulmotropic risk factors, including no risk of SARS-CoV-2 infection). Early rehabilitation was carried out in the intensive care unit and in the infectious diseases hospital of City Clinical Hospital No. 2, for patients with COVID-19 rehabilitation plan was drawn up in accordance with temporary guidelines for the medical rehabilitation of a new coronavirus infection.Results and discussion. It was established, that rehabilitation in the conditions of the intensive care unit and the specialized department can significantly reduce the severity of dyspnea, anxiety and depression, positively affects the increase in exercise tolerance, and helps to reduce the activity of systemic inflammation. In patients who have industrial contact with patients with COVID-19, the effectiveness of rehabilitation measures is lower than in the comparison group.Conclusions. To increase the effectiveness of stage I of the rehabilitation of medical workers with COVID-19 and lung damage, it is necessary to conduct more intensive and longer rehabilitation than indicated in the current guidelines.

Erectile function in men with COVID-19 six months after recovery

Background. Based on the results of epidemiological studies, it was found that coronavirus disease 2019 (COVID-19) affects men more often than women. Among COVID-19 complications, erectile dysfunction is considered a marker of endothelial dysfunction and one of the main factors for the development of cardiovascular diseases. Lower total and free testosterone levels are predictors of adverse prognosis in males with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Testosterone deficiency syndrome is considered an independent risk factor of cardiometabolic disorders. The purpose of the study is to investigate the state of erectile function in men who suffered from COVID-19 six months after recovery. Materials and methods. Seventy-two men suffering from COVID-19 and being treated in an infectious disease hospital were examined 6.90 ± 0.29 months after recovery. Their average age was 45.23 ± 3.01 years. The control group included 18 conditionally healthy men aged 43.18 ± 2.90 years. The state of erectile function was assessed using the International Index of Erectile Function (IIEF). The concentration of testosterone was determined by the enzyme-linked immunosorbent assay with DRG (Germany) and DiaMetra (Italy) kits. All measurements were performed on the Stat Fax 3200 analyzer. Statistical comparison of the obtained results between groups was performed according to the Student’s test. A value of p < 0.05 was considered to be signifi­cant. Results. In addition to erectile dysfunction, as evidenced by a reduced corresponding integrative indicator “erectile function” of IIEF-15 in men with COVID-19, a decrease in sexual desire was found, as well as a deterioration of sensations in the form of a decrease in ejaculation frequency and orgasmic sensations during sex contacts. The average serum level of total testosterone was 10.9 nmol/l and was significantly reduced compared to that in the control group. Analysis of individual indicators showed that testosterone level was decreased in 10 patients and was within the normal range in 13 men with COVID-19. The average serum concentration of total testosterone in the examined men after the disease was 10.73 ± 1.07 nmol/l and was significantly reduced compared to that of the control group. Conclusions. There was an erectile dysfunction in men who suffered COVID-19, it was confirmed by a probable decrease in IIEF-15 score and integrative indicators of erectile function. A significant decrease in the blood concentration of total testosterone was detected in the examined men, which may be one of the causes of erectile dysfunction. Large-scale prospective, randomized, controlled trials in patients infected with SARS-CoV-2 are needed to provide an understanding of the molecular mechanisms that cause erectile dysfunction.

Economic Burden of Invasive Meningococcal Infection in Children in the Republic of Belarus

Relevance Invasive meningococcal infection (IMI) is a significant clinical problem and is associated with a high probability of severe complications and death. Vaccination programs against meningococcus can achieve significant clinical effectiveness and require significant financial costs. This makes it relevant to study the economic burden of meningococcal infection in the conditions of modern healthcare in order to obtain basic data for subsequent research in the field of evaluation of medical technologies.Aims. To assess the economic burden of IMI in children in the conditions of healthcare in the Republic of BelarusMaterial and methods: a retrospective study using the "cost of illness" method was conducted for 22 children hospitalized in the city children's infectious clinical diseases hospital in 2018-2019. All values are presented in belarusian rubles. The average ± standard deviation, minimum – maximum values, median [Q1, Q3], cost shares (%) are calculated for the cost values. The minimum– maximum values and median [Q1, Q3] were calculated for the age of the patients.Results: taking into account the costs of treatment in healthcare organizations of all patients studied, the share of direct costs of hospitalization was 29.0%, the share of direct costs of diagnosis – 7.2%, the share of direct costs of pharmacotherapy - 8.3%. A significant part of the costs accounted for observations after discharge and amounted to 55.4%.Conclusion: a retrospective study of the economic burden of MI in the Republic of Belarus using the "cost of illness" method in patients hospitalized in a public health organization demonstrates a significant economic burden of this disease, which in the long term is primarily due to the presence of complications in the patient, as well as the impact of the patient's death on the value of total costs. The data obtained can be used in conducting national research on the evaluation of medical technologies.

Analysis of influencing factors on long COVID in COVID-19 patients infected with omicron variant three months after discharge: a cross-sectional study

BackgroundThe purpose of this study is to analyze the influencing factors associated with Long-COVID in patients infected with Omicron variant of COVID-19 in Changchun City, Jilin Province, China three months after discharge in March 2022.MethodsIn this study, we conducted a telephone follow-up based on the real-world data collected from the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun Tongyuan Shelter Hospital and Changchun Infectious Disease Hospital during the COVID-19 epidemic in Changchun in March 2022. We used the Global COVID-19 Clinical Platform Case Report Form for Post COVID condition as a follow-up questionnaire to collect the general information, past medical history, clinical symptoms, COVID-19 vaccine inoculation doses, and other relevant information to analyze the symptom characteristics of COVID-19 patients three months after discharge from the hospital and related factors affecting Long COVID.ResultsA total of 1,806 patients with COVID-19 were included in this study, 977 males and 829 females, with a mean age of 38.5 [30.0, 49.4] years, and the number of female patients suffering from Long COVID (50.87%) was greater than male patients (p = 0.023). The binary logistic regression analysis of factors influencing Long COVID showed that smoking history (OR (95%CI) = 0.551(0.425–0.714), p < 0.001, taking never smoking as a reference), allergy history (OR (95%CI) = 1.618 (1.086–2.413), p-value 0.018, taking no allergy as a reference), first symptoms (OR (95%CI) = 0.636 (0.501–0.807), p < 0.001, with no first symptoms as reference) and COVID-19 vaccine inoculation doses (OR (95%CI) = 1.517 (1.190–1.933), p-value 0.001, with ≤ 2 doses of COVID-19 vaccine inoculation doses as reference) constituted its influencing factors. The first symptoms of patients on admission mainly included fever (512 cases, 71.81%), cough (279 cases, 39.13%) and dry or itchy throat (211 cases, 29.59%). The most common symptoms of Long COVID were persistent fatigue (68 cases), amnesia (61 cases), insomnia (50 cases) and excessive sweating (50 cases).ConclusionThe first symptoms on admission were predominantly fever, cough and dry or itchy throat. The most common symptoms of Long COVID were persistent fatigue, amnesia, insomnia and excessive sweating, and female patients were at a higher risk of Long COVID.

Investigation of SARS-CoV-2 antibody levels after COVID-19 vaccine in chronic hepatitis Bpatients.

The aim was to compare SARS-CoV-2 IgG antibody levels in chronic hepatitis Bpatients and healthcare personnel selected as the control group and to determine factors such as age, gender, vaccine type, and number of vaccines that may affect the antibody levels. 87 chronic hepatitis B(CHB) patients followed in Ankara Training and Research Hospital Infectious Diseases Clinic and Mamak State Hospital Infectious Diseases outpatient clinic and 89healthcare personnel selected as the control group were included in the study.SARS-CoV-2 IgG antibody levels in the serum samples of patients and healthcare personnel who received the COVID-19 vaccine were studied with the ELISA method in the Microbiology Laboratory of Ankara Training and Research Hospital, using acommercial ELISA kit (Abbott, USA) in line with the recommendations of the manufacturer. In the study, SARS-CoV-2 IgG levels were compared in CHB patients and healthcare personnel. In addition, the relationship between SARS-CoV-2 antibody level, gender, average age, natural history of the disease, number of vaccinations, vaccine type (Coronavac TM vaccine alone, BNT162b2 vaccine alone or Coronavac TM and BNT162b2 vaccine (heterologous vaccination)), treatment duration of CHB was investigated. Statistical analyses were made in the SPSS program. Avalue of p≤ 0.05 was considered statistically significant. Atotal of 167 people, including 87 CKD patients and 80 healthcare personnel as the control group, were included in the study. SARS-CoV-2 IgG antibody levels were detected above the cut-off level in the entire study group, regardless of the vaccine type. No difference was detected in SARS-CoV-2 IgG titers after COVID-19 vaccination between CHB patients and healthcare personnel. There was astatistically significant difference in SARS-CoV-2 IgG antibody levels among individuals participating in the study according to vaccine types. Compared to those who received Coronavac TM vaccine alone, the average SARS-CoV-2 IgG level was found to be statistically significantly higher in those who received BNT162b2 vaccine alone or heterologous vaccination with Coronavac TM + BNT162b2 vaccine. There was no difference between the groups in terms of age, gender, number of vaccinations, natural transmission of the disease, and duration of antiviral therapy in the CHD patient group. As aresult, SARS-CoV-2 IgG antibody levels above the cut-off value were achieved with Coronavac TM and BNT162b2 vaccines in both CHD patients and healthy control groups. however, both CHD patients and healthcare personnel had higher antibody levels than those who received BNT162b2 alone or those who received heterologous vaccination had higher antibody levels than those with Coronavac TM alone. Therefore, if there are no contraindications, BNT162b2 vaccine may be preferred in CHB and health personnel (Tab. 2, Ref. 14).

Коклюш у детей раннего возраста: риски неблагоприятного течения и современные подходы к профилактике

Objective. To analyze the features of whooping cough in patients under 1 year of age and the state of transplacental protection in children under 1 month of age in modern conditions. Patients and methods. The clinical analysis of whooping cough features in children under 1 year of age is based on observations of 424 patients hospitalized in the Clinical Hospital of Infectious Diseases No 1 in the period of 2017–2019. To verify whooping cough, PCR and ELISA methods were used with the Ridascreen/Bordetella pertussis test system (R-biofarm AMG, Germany), which allows detecting antibodies of various classes (IgM, IgG, IgA). Serological screening to detect antibodies to pertussis antigens was carried out in 52 children under the age of 1 month, hospitalized in various hospitals for newborns in Moscow. Results. Analysis of clinical forms showed that among hospitalized patients, severe forms were observed much more often among children aged 1–3 months, accounting for 38.0 ± 3.8% (63 children) versus 7.0 ± 2.4% (8 children) aged 4–6 months (p &lt; 0.001) and 5.6 ± 1.9% (8 children) aged 7–12 months (p &lt; 0.001). In all age groups, moderate severity of the disease prevailed, occurring in 59.6 ± 3.8%, 86.8 ± 3.2%, and 90.3 ± 2.5% of children, respectively. Analysis of antibodies transplacental transfer in newborns showed that IgG antibodies were detected below the threshold level in 37 (71.1 ± 6.3%) blood serum samples, 3 (5.8 ± 3.2%) corresponded to the threshold values, and 12 (23.3 ± 5.8%) were above the threshold. The predominance of seronegative children proportion suggests a possible high risk of the disease in children of this age with severe forms of whooping cough. Conclusion. Given the severe course and the presence of fatal outcomes in children of the first months of life, it is advisable to vaccinate pregnant women to create passive immunity in newborns. Key words: whooping cough, clinical forms, antibodies, newborns, passive immunity

Investigation of hospital-acquired infections prevalence and analysis of influencing factors: a case study of a specialized infectious disease hospital in Chongqing, 2017-2023.

This study aimed to investigate the prevalence of hospital-acquired infections (HAIs) and their main influencing factors in a specialized infectious disease hospital in Chongqing from 2017 to 2023, providing reference for the formulation of precise infection control measures. A retrospective cross-sectional survey method was employed, combining bedside investigations with medical record reviews. Surveys were conducted on all hospitalized patients on a certain day of the last week of October each year from 2017 to 2023. Data collected included patients' basic information, diagnosis, and hospital infection status. Statistical analysis, including retrospective case-control and multivariable logistic regression analysis, was performed to identify the risk factors for hospital infections. The investigation compliance rate for the prevalence of HAIs in the specialized infectious disease hospital in Chongqing from 2017 to 2023 was greater than 96% each year. The prevalence rate of HAIs ranged from 0.89 to 2.52%. Hospital infection departments were mainly concentrated in general internal medicine, tuberculosis, and HIV/AIDS departments, accounting for 31.25, 26.25, and 23.75%, respectively. The most common infection site was the lower respiratory tract (54.22%), followed by bloodstream and urinary tract infections, each accounting for 9.64%. The predominant pathogens of hospital infections were Klebsiella pneumoniae and fungi. The utilization rate of antimicrobial drugs ranged from 20.75 to 33.25%, primarily for monotherapy. The rate of pathogen testing for therapeutic antimicrobial drug use was 82.84%, meeting national requirements. Multivariable logistic regression analysis revealed that the use of antibiotic (OR = 7.46, 95%CI 2.54-21.89, p < 0.001) and the presence of cardiovascular diseases (OR = 26.69, 95%CI 6.69-106.54, p < 0.001) increased the risk of HAIs. The prevalence of HAIs in specialized infectious disease hospitals remains stable, primarily concentrated in departments such as general internal medicine, tuberculosis, and HIV/AIDS. The lower respiratory tract is the main infection site, and comorbid cardiovascular diseases and antibiotic use are risk factors for HAIs. Therefore, to reduce the risk of hospital infections, it is necessary to strengthen the daily monitoring of key departments and the care of key patients. Further implementation of precise and effective infection control measures, including rational antibiotic use, regular infection monitoring and pathogen culture is warranted.

Кандидозный эзофагит у пациентов с COVID-19

The purpose is to examine the incidence and clinical characteristics of сandidiasis esophagitis in COVID-19 patients. Material and methods. We conducted a retrospective observational study by analyzing the medical records of 68 patients with COVID-19 and esophageal candidiasis. All of the patients received in-patient treatment at the Republic Clinical Infectious Diseases Hospital in Kazan from 2020 to 2022. Results. From 2020 to 2022, 1177 fibrogastroduodenoscopies (FGDS) were performed on patients with COVID-19 at the Republic Clinical Infectious Diseases Hospital in Kazan. Esophageal candidiasis was diagnosed in 68 (5.8%) of the examined patients, Mostly often, elderly patients with chronic pathology of the gastrointestinal tract (65%) and diabetes mellitus (29%). Esophageal candidiasis developed in patients with different severity of COVID-19, including mild forms of infection. According to the Kodsi scale, grade I of esophageal damage was diagnosed in 63.3%, grade II in 27.9%, grade III in 4.4%, grade IV in 4.4% of patients. Patients complained of epigastric pain (34.6%), chest pain (7.7%), dysphagia (7.7%), nausea and vomiting (13.4%), heartburn (1.9%), hiccups (1.9%). 41.5% of patients had no “esophageal” complaints. Antimycotic therapy for candidal esophagitis was carried out with fluconazole at a daily dose of 400 mg, then 200 mg for 14 days. 92.5% of patients were discharged with improvement or clinical recovery. Death occurred in 5 (7.5%) patients. The cause of death was COVID-19 complications (ARDS, PE, multiple organ failure syndrome, acute kidney failure, etc.). Conclusion. The development of esophageal candidiasis is possible in patients with any severity of COVID-19. Esophageal candidiasis can be asymptomatic. The severity of fungal infection of the esophagus correlates with the severity of coronavirus infection. Patients with severe forms of COVID-19 may develop grades III and IV of esophageal damage. If esophageal candidiasis is detected in a patient with COVID-19, a mycological test of blood, urine and bronchoalveolar lavage should be performed to identify other localizations of invasive candidiasis.

Dynamics of clinical and laboratory parameters of patients with COVID-19 on the background of treatment

The article presents the results of the analysis of the dynamics of the main indicators of the blood coagulation system and cytokines (IL-6, D-dimers, C-reactive protein and procalcitonin) on the background of thromboprophylaxis in patients with COVID-19. The aim of our study was to determine the dynamics of the main indicators of the blood coagulation system and cytokines in the setting of thromboprophylaxis. The study was conducted at the Department of Infectious and Pediatric Infectious Diseases, Parasitology, Phthisiology and Pulmonology of the Kharkiv National Medical University and at the Municipal Non-Profit Enterprise "Kharkiv Regional Infectious Diseases Hospital" of the Kharkiv Regional Council, in 2020–2024 with compliance of the existing recommendations of bioethical norms and rules. All patients singed informed consent. We examined 179 patients aged 20–88 years (average age of [58.75±13.82] years) with COVID-19. The diagnosis of COVID-19 was confirmed by enzyme-linked immunosorbent assay and polymerase chain reaction. Medical and statistical calculations were performed using the SPSS 25.0 software package. The mean value and standard square deviation were calculated. The probability of differences was determined using the Mann-Whitney U-test with a threshold value of statistical significance of p=0.05. According to the results of the study, a significant (p&lt;0.001) dynamic of restoration of D-Dimers’ levels was noted against the background of the applied therapy (on days 9–10, a decrease of 166.3 Fibrinogen Equivalent Unit (FEU), ng/ml, and on days 12–15 – of 376.7 FEU, ng/ml) and procalcitonin (on days 6–7 the content was by 0.04 ng/ml, p=0.006; on days 10–11 – 0.01 ng/ml, p&lt;0.001; on days 12–15 – also 0.01 ng/ml, p=0.027). Keywords: D-dimers, C-reactive protein, procalcitonin.