Mild Disease Course Research Articles

Особливості перебігу коронавірусної хвороби у вагітних та частота виникнення перинатальних ускладнень залежно від ступеня тяжкості захворювання

Purpose - to analyze clinical and laboratory changes in women with mild to moderate coronavirus disease, the frequency of gestational complications depending on the course of the disease. Materials and methods. 120 pregnant women of the main group with coronavirus disease were involved in the clinical and laboratory examination. The control group consisted of 40 women with gestational age from 22 to 41 weeks, whose pregnancy was not complicated by coronavirus disease. The course of the disease and the impact of coronavirus infection on the course of pregnancy were evaluated by the results of general - clinical, laboratory and instrumental examinations. Results. The surveyed women underwent treatment in the period from 2021 to 2022 at the Communal Non-profit Enterprise «Kyiv City Center for Reproductive and Perinatal Medicine». The mild course of disease had 48 (40%) pregnant women, the course of coronavirus disease of moderate severity had 72 (60%) pregnant women. Symptoms of coronavirus disease observed in pregnant women: hyperthermia - body t≥37.0oC (85 (70.8%) women), general weakness (103 (85.8%) women), loss of smell and taste (27 (22.5%) women), catarhal phenomena (69 (57.5%) women). Decrease in saturation to 92-94% was noted at 18 (15%) pregnant women. The following complications of pregnancy were observed: the threat of premature birth, oligohydramnios, polyhydramnios, fetal growth retardation, structural changes in the placenta according to ultrasound examination of the fetus, violation of fetal-placental blood flow I-II centuries. Conclusions. Given the data of the analysis, it is possible to identify certain features of clinical and laboratory manifestations of coronavirus disease. The most common clinical manifestations are hyperthermia and general weakness. Features of changes in laboratory blood parameters are as follows: leukopenia, lymphocytopenia, increased C-reactive protein and D-dimer, decreased activated partial thromboplastin time, increased prothrombin time, increased total fibrinogen. The most common complications in pregnant women with mild to moderate coronavirus disease: the risk of premature birth, structural changes of the placenta and oligohydramnios. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author. Keywords: coronavirus disease, pregnant women, extragenital pathology, complications of pregnancy.

SARS-CoV-2 epitope-specific CD4+ memory T cell responses across COVID-19 disease severity and antibody durability.

CD4+ T cells are central to long-term immunity against viruses through the functions of T helper-1 (Th1) and T follicular helper (Tfh) cell subsets. To better understand the role of these subsets in COVID-19 immunity, we conducted a longitudinal study of SARS-CoV-2-specific CD4+ T cell and antibody responses in convalescent subjects who seroconverted during the first wave of the pandemic in Boston, Massachusetts, United States, across a range of COVID-19 disease severities. Analyses of spike (S) and nucleocapsid (N) epitope-specific CD4+ T cells using peptide and major histocompatibility complex class II (peptide:MHCII) tetramers demonstrated expanded populations of T cells recognizing the different SARS-CoV-2 epitopes in most subjects compared to pre-pandemic controls. Individuals who experienced a milder disease course not requiring hospitalization had a greater percentage of circulating Tfh (cTfh) and Th1 cells among SARS-CoV-2-specific cells. Analysis of SARS-CoV-2-specific CD4+ T cells responses in a subset of individuals with sustained anti-S antibody responses following viral clearance also revealed an increased proportion of memory cTfh cells. Our findings indicate efficient early disease control also predicts favorable long-term adaptive immunity.

Preserved recognition of Omicron spike following COVID-19 messenger RNA vaccination in pregnancy

BackgroundSARS-CoV-2 infection is associated with enhanced disease severity in pregnant women. Despite the potential of COVID-19 vaccines to reduce severe disease, vaccine uptake remained relatively low among pregnant women. Just as coordinated messaging from the Centers for Disease Control and Prevention and leading obstetrics organizations began to increase vaccine confidence in this vulnerable group, the evolution of SARS-CoV-2 variants of concerns, including the Omicron variant, raised new concerns about vaccine efficacy because of their ability to escape vaccine-induced neutralizing antibodies. Early data point to a milder disease course following infection with the Omicron variant in vaccinated individuals. Thus, these data suggest that alternate vaccine-induced immunity beyond neutralization may continue to attenuate Omicron variant–induced disease, such as Fc-mediated antibody activity.ObjectiveThis study aimed to test whether vaccine-induced antibodies raised during pregnancy continue to bind to and leverage Fc receptors to protect against variants of concern including the Omicron variant.Study DesignThe receptor binding domain or whole spike-specific antibody isotype binding titers and Fc gamma receptor binding directed toward variants of concern, including the Omicron variant, were analyzed in pregnant women after receiving the full dose regimen of either the Pfizer/BioNTech BNT62b2 (n=10) or Moderna mRNA-1273 (n=10) vaccination using a multiplexing Luminex assay.ResultsReduced isotype recognition of the Omicron receptor binding domain was observed following administration of either vaccine with relatively preserved, albeit reduced, recognition of the whole Omicron spike by immunoglobulin M and G antibodies. Despite the near complete loss of Fc receptor binding to the Omicron receptor binding domain, Fc receptor binding to the Omicron spike was more variable but largely preserved.ConclusionReduced binding titers to the Omicron receptor binding domain aligns with the observed loss of neutralizing activity. Despite the loss of neutralization, preserved, albeit reduced, Omicron spike recognition and Fc receptor binding potentially continue to attenuate disease severity in pregnant women.

Even patients with mild COVID‐19 symptoms after SARS‐CoV‐2 infection show prolonged altered red blood cell morphology and rheological parameters

Infection with the novel severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) and the associated coronavirus disease‐19 (COVID‐19) might affect red blood cells (RBC); possibly altering oxygen supply. However, investigations of cell morphology and RBC rheological parameters during a mild disease course are lacking and thus, the aim of the study. Fifty individuals with mild COVID‐19 disease process were tested after the acute phase of SARS‐CoV‐2 infection (37males/13 females), and the data were compared to n = 42 healthy controls (30 males/12 females). Analysis of venous blood samples, taken at rest, revealed a higher percentage of permanently elongated RBC and membrane extensions in COVID‐19 patients. Haematological parameters and haemoglobin concentration, MCH and MCV in particular, were highly altered in COVID‐19. RBC deformability and deformability under an osmotic gradient were significantly reduced in COVID‐19 patients. Higher RBC‐NOS activation was not capable to at least in part counteract these reductions. Impaired RBC deformability might also be related to morphological changes and/or increased oxidative state. RBC aggregation index remained unaffected. However, higher shear rates were necessary to balance the aggregation‐disaggregation in COVID‐19 patients which might be, among others, related to morphological changes. The data suggest prolonged modifications of the RBC system even during a mild COVID‐19 disease course.

110 Clinical Presentations of Adult and Pediatric SARS-CoV-2-Positive Cases in a Community Cohort

OBJECTIVES/GOALS: The spectrum of disease caused by SARS-CoV-2 ranges from asymptomatic detection to severe illness, with varying presentations by age. Therefore, we aimed to compare the clinical characteristics between children and adults with SARS-CoV-2. METHODS/STUDY POPULATION: From March 20, 2020, to August 18, 2021, we conducted SARS-CoV-2 surveillance in individuals from metropolitan Nashville, TN. Children with multisystem inflammatory syndrome were excluded. Analyses were restricted to individuals with SARS-CoV-2 infection confirmed by detection of viral RNA in nasal specimens using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) and/or by detection of serum IgG to the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assay (ELISA). Those with negative RT-qPCR results, but a positive ELISA within 4-6 weeks of symptom onset, were classified as SARS-CoV-2 positive. Clinical characteristics between children and adults were compared with Pearson’s chi square. Illness duration was compared using Kaplan Meier estimators. RESULTS/ANTICIPATED RESULTS: Overall, 426/826 (49%) individuals (children: 57 [13%); adults: 369 [87%]) were SARS-CoV-2 positive, with median ages of 12 and 41 years, respectively. Most individuals were female (54%) and white, non-Hispanic (79%). Compared to adults, children were more likely to be asymptomatic (children: 16% vs. adults: 5%; p=0.001). In contrast, symptomatic adults were more likely to report cough (71% vs. 56%), wheezing (21% vs. 8%), shortness of breath (45% vs. 19%), ageusia (67% vs. 23%), and anosmia (64% vs 27%) than symptomatic children (p<0.05). Mean illness duration was shorter in children than adults: 7 days (95% CI: 5.1, 8.9) vs. 14 days (95% CI: 12.4,15.0), respectively. A total of 5% (18/352) of adults reported symptoms lasting ? 4 weeks (range: 31-96 days), whereas all symptoms in children resolved by 31 days. DISCUSSION/SIGNIFICANCE: Overall, children with SARS-CoV-2 present with a shorter and milder disease course compared to adults. Further studies are needed to understand SARS-CoV-2 illness severity across the lifespan.

Avidity of IgG to SARS-CoV-2 RBD as a Prognostic Factor for the Severity of COVID-19 Reinfection.

The avidity index (AI) of IgG to the RBD of SARS-CoV-2 was determined for 71 patients with a mild (outpatient) course of COVID-19, including 39 primarily and 36 secondarily reinfected, and 92 patients with a severe (hospital) course of COVID-19, including 82 primarily and 10 secondarily infected. The AI was shown to correlate with the severity of repeated disease. In the group of outpatients with a mild course, the reinfected patients had significantly higher median AIs than those with primary infections (82.3% vs. 37.1%, p < 0.0001). At the same time, in patients with a severe course of COVID-19, reinfected patients still had low-avidity antibodies (median AI of 28.4% vs. 25% in the primarily infected, difference not significant, p > 0.05). This suggests that the presence of low-avidity IgG to RBD during reinfection is a negative prognostic factor, in which a patient’s risk of developing COVID-19 in a severe form is significantly increased. Thus, patients with IgG of low avidity (AI ≤ 40%) had an 89 ± 20.5% chance of a severe course of recurrent COVID-19, whereas the detection of high-avidity antibodies (AI ≥ 50%) gave a probability of 94 ± 7.9% for a mild course of recurrent disease (p < 0.05).

Children Naturally Evading COVID-19—Why Children Differ from Adults

Coronavirus Disease 2019 (COVID-19) has spread across the world, caused lockdowns, and has had serious economic and social consequences. COVID-19 manifests differently in children than adults, as children usually have a milder course of disease, mild symptoms if any, and lower fatality rates are recorded among children. SARS-CoV-2 transmission also seems to be different between children and adults. Many factors are proposed to explain the milder outcome in children, e.g., a more appropriate immune response (especially active innate response), trained immunity, a lack of immunosenescence, and the reduced prevalence of comorbidities. A better understanding of the differences in susceptibility and outcome in children compared with adults could lead to greater knowledge of risk factors for complicated COVID-19 cases and potential treatment targets. We highlight proposed reasons as to why children are less affected by COVID-19 than adults.

Long-Term Antibody Response and Vaccination Efficacy in Patients with COVID-19: A Single Center One-Year Prospective Study from the Czech Republic.

Background: The diagnosis of SARS-CoV-2 is almost exclusively performed by PCR or antigen detection. The detection of specific antibodies has not yet been considered in official diagnostic guidelines as major laboratory evidence for a case definition. The aim the present study is to analyze antibody responses in outpatient and inpatient cohorts of COVID-19 patients in the Czech Republic over a 12-month period, and assess the potential of antibodies as a diagnostic tool. Methods: A total of 644 patients was enrolled in the prospective study. IgA, IgM and IgG antibody levels, as well as virus neutralization titers, were analyzed over a 12-month period. Results: Our study showed low antibody positivity levels at the admission. However, at 2 weeks after infection, 98.75% and 95.00% of hospitalized patients were IgA and IgG positive, respectively. Even in the outpatient cohort characterized by milder disease courses, the IgG antibody response was still sustained at 9 and 12 months. The data show a high correlation between the IgG levels and virus neutralization titers (VNTs). Samples from later time-points showed positive antibody responses after vaccination in both cohorts characterized by high IgG levels and VNT over 1:640. The samples from unvaccinated persons indicated a relatively high level of reinfection at 6.87%. Conclusions: Our results show that the detection of antibodies against the SARS-CoV-2 shows an increasing sensitivity from week 2 after infection and remains highly positive over the 12-month period. The levels of IgG antibodies correlate significantly with the VNTs. This suggests that the serological data may be a valuable tool in the diagnosis of SARS-CoV-2 infection.

Finding Predictors of Azathioprine-Induced Pancreatitis in Patients With Inflammatory Bowel Disease.

Azathioprine (AZA)-induced pancreatitis (AIP) is a common, idiosyncratic adverse effect whose incidence and risk factors data in inflammatory bowel disease (IBD) patients are not fully clarified. We aimed to establish the incidence, clinical course and identify risk factors for AIP. A retrospective study including all IBD patients on AZA between January 2013 and July 2020 was conducted. Patients with AIP were considered. Azathioprine-induced pancreatitis occurred in 33 patients (7.5%; 442 patients on AZA). The mean time receiving AZA until AIP was 25 days, with a mean dose of 88 mg. All patients had a mild course of disease, which resolved with suspension of AZA and with no complications. Smoking (P = 0.02), single daily dose of AZA (P < 0.001), and concomitant budesonide (P = 0.001) were risk factors for AIP. In multivariate analysis, concomitant treatment with budesonide (odds ratio, 5.3; P = 0.002) and single daily dose of AZA (odds ratio, 3.8; P = 0.002) were the only predictors of AIP. Although AIP was a relatively common adverse effect, it presented a mild course in all patients. Smoking, concomitant use of budesonide, and single-dose regimen of AZA should be avoided in IBD patients treated with AZA.

Lung Opacity and Coronary Artery Calcium Score: A Combined Tool for Risk Stratification and Outcome Prediction in COVID-19 Patients

PurposeTo assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System).MethodsThis retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score.ResultsCAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis.ConclusionsCoronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.

COVID-19 Morbidity in Children with Bronchial Asthma and Allergies

Background. The morbidity of new coronavirus infection remains high (in children as well). Children with bronchial asthma are not at risk this disease development and severe course of COVID-19 according to the previous studies results.Objective. The aim of the study is to compare the morbidity rate of COVID-19 among children with and without bronchial asthma between May 2020 and October 2021 with the results from the beginning of pandemics. Methods. Online questionnaires in Google form have been developed and sent to parents of 83 patients aged from 7 to 17 years who have been interviewed at the beginning of the pandemics. The main group includes 49 patients diagnosed with bronchial asthma, and the control group includes 25 children without bronchial asthma.Results. 45% (22) of patients had COVID-19 in the main group and 32% (8) — in the control group (p = 0.636). 80% of patients had mild course of disease and 20% — moderate in the main group, and 62% and 37% in the control group respectively. Febrile fever was observed in 40% of respondents in the main group and in 33% — in the control group; anosmia — in 35% in the main and in 14% — in the control group; pulse oximetry was used by 44% of patients in the main group (SpO2 94–98%) and 42% in the control group (SpO2 98–99%); 66% of patients had baseline therapy and 6% had rescue medications in the main group. No one from both groups has been hospitalized.Conclusion. Pediatric patients both with and without bronchial asthma have COVID-19 more often compared to the pandemics beginning. The disease in most cases had mild course and did not require hospitalization, aggravations of bronchial asthma were rare, and saturation values did not decrease below 94%.

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.

Ocular Manifestations in Patients with Coronavirus Disease 2019 (COVID-19): A Real World Multicenter Observational Study in Egypt

Background: The aim of the work was to evaluate the ocular manifestations in the patients with COVID-19 and its role in the prediction of the course and the outcome of the disease. Methods: This retrospective study was conducted at two tertiary referral COVID-19 isolation hospitals in two major university hospitals in Egypt. Two hundred and twenty-eight patients were enrolled in the study. The medical records of patients who had clinically confirmed COVID-19 between 1/5/2020 to 15/7/2020 were retrospectively reviewed. Data were collected from patient charts, including age, sex, accommodation, ocular manifestations, fever, headache, cough, dyspnea, anosmia, cyanosis, abdominal pain, anorexia, liver, kidney, cardiac manifestations, CT, X-ray finding, blood tests, and outcome of the disease. Results: Thirty-four patients with ocular manifestation were finally enrolled in the study with a mean age of 42.1 years; 20 patients (58.8%) were men. The incidence of ocular manifestation was 14.9% (34/228). All patients with ocular manifestations had conjunctivitis (redness, epiphora, foreign body sensation), which had been treated and resolved completely within 10 days in all patients without any permanent ocular damage. There was a trend between the presence of ocular manifestations and the associated milder disease course, although this trend was not statistically significant. Conclusion: Ophthalmic manifestation is common in patients with COVID-19 and it occurs more frequently in patients with mild to moderate form of COVID-19, but it could not predict the patient’s mortality.

Ocular Manifestations in Patients with Coronavirus Disease 2019 (COVID-19): A Real World Multicenter Observational Study in Egypt

Background: The aim of the work was to evaluate the ocular manifestations in the patients with COVID-19 and its role in the prediction of the course and the outcome of the disease. Methods: This retrospective study was conducted at two tertiary referral COVID-19 isolation hospitals in two major university hospitals in Egypt. Two hundred and twenty-eight patients were enrolled in the study. The medical records of patients who had clinically confirmed COVID-19 between 1/5/2020 to 15/7/2020 were retrospectively reviewed. Data were collected from patient charts, including age, sex, accommodation, ocular manifestations, fever, headache, cough, dyspnea, anosmia, cyanosis, abdominal pain, anorexia, liver, kidney, cardiac manifestations, CT, X-ray finding, blood tests, and outcome of the disease. Results: Thirty-four patients with ocular manifestation were finally enrolled in the study with a mean age of 42.1 years; 20 patients (58.8%) were men. The incidence of ocular manifestation was 14.9% (34/228). All patients with ocular manifestations had conjunctivitis (redness, epiphora, foreign body sensation), which had been treated and resolved completely within 10 days in all patients without any permanent ocular damage. There was a trend between the presence of ocular manifestations and the associated milder disease course, although this trend was not statistically significant. Conclusion: Ophthalmic manifestation is common in patients with COVID-19 and it occurs more frequently in patients with mild to moderate form of COVID-19, but it could not predict the patient’s mortality.

Characterization of the antibody response to SARS-CoV-2 in a mildly affected pediatric population.

BackgroundWhile children usually experience a mild course of COVID‐19, and a severe disease is more common in adults, the features, specificities, and functionality of the SARS‐CoV‐2‐specific antibody response in the pediatric population are of interest.MethodsWe performed a detailed analysis of IgG antibodies specific for SARS‐CoV‐2‐derived antigens S and RBD by ELISA in 26 SARS‐CoV‐2 seropositive schoolchildren with mild or asymptomatic disease course, and in an equally sized, age‐ and gender‐matched control group. Furthermore, a detailed mapping of IgG reactivity to a panel of microarrayed SARS‐CoV‐2 proteins and S‐derived peptides was performed by microarray technology. The capacity of the antibody response to block RBD‐ACE2 binding and virus neutralization were assessed. Results were compared with those obtained in an adult COVID‐19 convalescent population.ResultsAfter mild COVID‐19, anti‐S and RBD‐specific IgG antibodies were developed by 100% and 84.6% of pediatric subjects, respectively. No difference was observed in regards to symptoms and gender. Mounted antibodies recognized conformational epitopes of the spike protein and were capable to neutralize the virus up to a titer of ≥80 and to inhibit the ACE2‐RBD interaction by up to 65%. SARS‐CoV‐2‐specific IgG responses in children were comparable to mildly affected adult patients.ConclusionSARS‐CoV‐2 asymptomatic and mildly affected pediatric patients develop a SARS‐CoV‐2‐specific antibody response, which is comparable regarding antigen, epitope recognition, and the ability to inhibit the RBD‐ACE2 interaction to that observed in adult patients after mild COVID‐19.

COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center.

BackgroundThe COVID-19 pandemic started a little later in Ethiopia than the rest of the world and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting.ObjectiveThe study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity.MethodsA cross-sectional study was conducted from June to August 2020 among 686 randomly selected patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify factors associated with COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing.ResultsHaving moderate as compared with mild disease was significantly associated with having hypertension (AOR = 2.30, 95%CI = 1.27,4.18), diabetes mellitus (AOR = 2.61, 95%CI = 1.31,5.19for diabetes mellitus), fever (AOR = 6.12, 95%CI = 2.94,12.72) and headache (AOR = 2.69, 95%CI = 1.39,5.22). Similarly, having severe disease as compared with mild disease was associated with age group (AOR = 4.43, 95%CI = 2.49,7.85 for 40–59 years and AOR = 18.07, 95%CI = 9.29,35.14for ≥ 60 years), sex (AOR = 1.84, 95%CI = 1.12,3.03), hypertension (AOR = 1.97, 95%CI = 1.08,3.59), diabetes mellitus (AOR = 3.93, 95%CI = 1.96,7.85), fever (AOR = 13.22, 95%CI = 6.11, 28.60) and headache (AOR = 4.82, 95%CI = 2.32, 9.98). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR = 4.87, 95%CI = 2.85, 8.32 for 40–59 years and AOR = 18.91, 95%CI = 9.84,36.331 for ≥ 60 years), fever (AOR = 2.16, 95%CI = 1.29,3.63) and headache (AOR = 1.79, 95%CI = 1.03, 3.11).ConclusionsSignificant factors associated with severe COVID-19 in Ethiopia are being older than 60 years old, male, a diagnosis of hypertension, diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in the country were the relatively younger with fewer health problems.

P266 Elderly-onset Inflammatory Bowel Disease: a retrospective single-center study with current follow-up

Abstract Background Elderly-onset inflammatory bowel disease (IBD) will be seen more frequently with the ageing of the population and the increasing incidence of IBD. However, to date there are few studies focusing in the medical management of IBD in this patient population. The aim of our study was to describe the main clinical features of elderly-onset IBD. Methods Patients diagnosed with IBD after the age of 65 years (elderly-onset IBD) until December 2020 with current follow-up in a specialized IBD consultation in a tertiary hospital center (by June 2021) were included in this retrospective study. The hospital electronic medical records were searched in order to retrieve demographic and clinical data of the patients. Results A total of 61 patients were included, with mean age of 72.0 years (range 65–86); 34 (55.7%) were male. All patients were alive and with current follow-up. Mean follow-up duration was 84 months (interquartile range 35–97). The most common type was ulcerative colitis in 36 (59%) patients, whereas Crohn’s disease was diagnosed in 25 (41%). Among patients with ulcerative colitis, 14 (38.9%) had pancolitis, 11 (30.6%) left-sided colitis and 11 (30.6%) proctitis. Crohn’s disease was most often ileal in 48% of patients, followed by colonic in 44% and only 8% of patients presented ileocolonic disease. Non-stenosing non-penetrating behavior was present in 19 (76%) patients, followed by stenosing behavior in 6 (24%), with no case of penetrating phenotype; associated perianal disease was detected in 5 (20%) patients. Salicylates were used as single maintenance therapy in 44 (72.1%) of all patients with IBD; 11 (18%) patients required immunosuppressant therapy with biological agents including infliximab (n=5), vedolizumab (n=5) or ustekinumab (n=1) whereas 4 (6.6%) patients required no specific treatment. Surgery was necessary in only 3 (4.9%) patients: 2 performed total colectomy for refractory ulcerative colitis, whereas the other required right ileocolectomy for stenosing Crohn’s disease. At the time of diagnosis, anemia was present in 23 (37.7%) patients. In 21 (34.4%), levels of C-reactive protein were significantly elevated (&amp;gt;10 mg/L) and hypoalbuminemia was present in 12 (19.7%). Vitamin D levels were measured in 44 patients, among these 41 (93.2%) presented abnormally low levels. Conclusion Patients with elderly-onset IBD appear to have a mild disease course, with low use of biological agents and surgery. Ileocolonic involvement and penetrating phenotype in Crohn’s disease appear to be rare. Nevertheless, other comorbidities are often present and IBD may contribute to a higher prevalence of laboratory abnormalities including anemia and vitamin D deficiency.

Evidence and rationale for vaccinating children and adolescents against SARS-CoV-2: a comprehensive narrative review

Vaccines remain the most rigorous and cost-effective weapon of the public health care system against infectious diseases. The development of safe and effective vaccines against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as an imperative response to the unprecedented morbidity and mortality of the Coronavirus Disease 2019 (COVID-19) pandemic and the subsequent immense pressure on health care systems, families and global society. Despite the typically mild disease course of SARS-CoV-2 in minors, the associated rare but potentially life-threatening complications, as well as the emergence of new highly transmissible variants, led promptly to the extension of COVID-19 vaccine clinical trials in children and adolescents. To date, various COVID-19 vaccine candidates have been successfully trialed in pediatric populations, followed by their incorporation into corresponding vaccination campaigns in both high- and low-income countries. However, the universal COVID-19 vaccination of children and adolescents remains a matter of debate, along with skepticism about their overall safety and benefits in this age group. In this narrative review, we attempt to summarize the multi-faceted burden of COVID-19 on minors, highlighting the favourable safety/effectiveness profile of COVID-19 vaccines in this age group, elucidating the raised concerns and presenting the current implemented vaccination strategies.

Состояние здоровья близнецов с генотипом F508del/R334W при муковисцидозе и возможности таргетной терапии

The CFTR gene contains 27 exons and is located at position 31.1 of the long arm of chromosome 7 (7q31.1). More than 2000 variants of the CFTR gene have been described so far. The R334W variant is associated with the mild disease course. Objective. To perform comprehensive assessment of the health status, functional CFTR activity, and efficacy of CFTR modulators in twins with the F508del/R334W genotype. Materials and methods. Data from medical records, intestinal current measurement (ICM), intestinal organoid culture. Results. We examined two twins with moderate cystic fibrosis who had similar clinical manifestations, including rhinosinusitis with nasal polyps and respiratory infections caused by gram-negative bacteria. Both patients also had polyvalent allergy. One child presented with a decrease of pancreatic elastase 1 in stool from 500 μg/g to 125 500 μg/g, which required administration of pancreatin and dosage increase later. Both children had reduced chloride channel function as demonstrated by ICM. The administration of a corrector (VX-809) and a potentiator (VX-770) effectively restored the channel function; their simultaneous use ensured an additive effect. The quantitative results obtained in both cultures of intestinal organoids were very similar. Key words: cystic fibrosis, CFTR gene, pathogenic variant R334W, intestinal current measurement, intestinal organoids, forskolin-induced swelling assay, correctors, potentiators, targeted therapy, ivacaftor, lumacaftor

Клинические особенности патогенного варианта нуклеотидной последовательности L138ins в гене CFTR при муковисцидозе

In this study, we analyzed phenotypic manifestations and clinical course of cystic fibrosis (CF) in patients with the pathogenic variant L138ins of the CFTR gene. The L138ins variant is rarely detected in CF patients worldwide, but is quite common in different regions of the Russian Federation, particularly in the Middle Urals. Before the neonatal screening implementation, the majority of CF patients with the L138ins variant were diagnosed late because of the mild disease course and dubious results of sweat tests. Such patients usually have elevated levels of immunoreactive trypsinogen (IRT) in the neonatal period, which enables early diagnosis; however, false-negative results in CF patients have also been reported. There were cases of male infertility among CF patients with the L138ins variant, while women had their reproductive function preserved. There were also cases of asymptomatic pancreatic hyperenzymemia in children. Respiratory infections caused by Pseudomonas aeruginosa are not very common in this group of patients. However, adult patients have more severe respiratory manifestations (even with a fatal outcome) than children. Thus, despite the mild disease phenotype in patients with the L138ins variant, the residual function of the protein is not sufficient to ensure normal functioning of lungs. Key words: cystic fibrosis, pathogenic CFTR variants, L138ins