Risk Factors For Severe Course Research Articles

Analysis Of Data Quality/Completeness In Covid-19 Cases: Why A Digital Integrated Data Collection Is Also Necessary For Pandemic Control

Epidemiological data on the corona pandemic collected in the public health sector in Germany have been less useful in estimating vaccine effectiveness and clinical outcomes compared to other countries. In this retrospective observational study, we examined the completeness of selected own data collected during the pandemic. Information on the important parameters of hospitalization, vaccination status and risk factors for severe course and death over different periods were considered and evaluated descriptively. The data are discussed in the extended context of required digital strategies in Germany. From January 1, 2022 to June 30, 2022, we found 126,920 administrative procedures related to COVID-19. With regard to the data on hospitalization, in 19,749 cases, it was stated "No", in 1,990 cases "Yes" and in 105,181 cases (83+%) "Not collected" or "Not ascertainable". Concerning vaccinations, only a small proportion of procedures contained information on the type of vaccine (11.1+%), number of vaccinations (4.4+%) and date of the last vaccination (2.1+%). The completeness of data on chronic conditions/risk factors in COVID-19-related deaths decreased over four consecutive periods between 2020 and 2022 as case numbers increased. Future strategies taking into account meaningfulness and completeness of data must comprise modern technical solutions with digital data collection on infections without putting the principle of data protection at risk.

Severe acute bronchiolitis in children: etiology, therapy, effectiveness of 3% hypertonic saline containing sodium hyaluronate

Introduction. Acute bronchiolitis (АB) is a common infection in children under the age of 2 years. In modern clinical protocols, routine use of the studied drugs is not recommended. The effectiveness of a 3% hypertonic sodium chloride solution (HSCS) at vol.Аim. Тo study the etiology, risk factors, the therapy of acute care in children in intensive care units (ICU), the effectiveness of inhalations with 3% HSCS with hyaluronate sodium (HS) in comparison with therapy without the inclusion of this drug.Materials and methods. The medical documentation of 54 patients with AB from January 2021 to January 2023 who were treated in the ICU was analyzed. An ambispective comparative study of the effectiveness of therapy of 3% HSCS with HS AB was conducted in comparison with historical control.Results. Respiratory syncytial viral (RSV) etiology was established in 50% of patients. The most common risk factor for the disease was the age younger than 3 months (40.7%). The presence of risk factors for severe course of acute respiratory failure had an impact on the average bed-day and on the need for respiratory support (p = 0.04), in addition to which patients often received drug therapy. There were no statistically significant differences in the terms of hospitalization, the duration of respiratory support depending on the appointment of 3% of HSCS with HS (p > 0.05), however, there was an improvement in clinical and functional dynamics estimated by the modified clinical scale of Wood’s asthma by the 2nd day of the disease.Conclusion. AB in ICU patients most often has RSV etiology, developing in the presence of risk factors for severe course. The influence of modern guidelines for the treatment of AB in the ICU remains controversial. The addition of 3% HSCS with HS can improve the flow of AB.

Overview of the Epidemiological Situation and Risk Factors for Severe COVID-19 in Long-Term Care Facilities in the World and Russia

Background: Residents of long-term care facilities are at higher risk of the severe course and outcomes of COVID-19. Objective: To describe the epidemiological situation and risk factors for severe COVID-19 in nursing homes in the world and Russia. Materials and methods: We reviewed Russian and English-language papers published in March 2020 to October 2022 and found in such resources as eLIBRARY.ru, Web of Science, PubMed, Google Academy, and Scopus using the following keywords: long-term care facilities, nursing homes, COVID-19 morbidity in nursing homes, COVID-19 mortality in nursing homes, and COVID-19 risk factors in nursing homes. Availability of information on morbidity and mortality among residents and employees of long-term care facilities in Russia, Europe and the USA and about the risk factors for severe course and adverse outcomes of COVID-19 was the inclusion criterion. Of 1,013 articles initially identified, 40 publications were included in the review. Results: The analysis of the worldwide epidemiological situation has shown that COVID-19 incidence and mortality rates in nursing homes fluctuate, and, as of October 2022, cases of the disease among residents, including multiple cases within a facility, were still registered. In most countries, the highest incidence of COVID-19 in long-term care facilities was observed in January – March 2022, while the lowest was noted in May – July 2021. The number of deaths has decreased significantly over time and remains low. Risk factors for a severe course and death from the novel coronavirus disease include age, male sex, and concomitant diseases. We established, however, that disease severity was also affected by the staff-to-resident ratio, availability of paid sick leave of the personnel, patient isolation opportunities, division of the working area, type of ownership (private), and COVID-19 incidence rates in the local community. Conclusion: We have analyzed the epidemiological situation and risk factors for severe COVID-19 in long-term care facilities at the national and global levels. As of October 2022, the novel coronavirus disease remains a challenge for nursing facilities. The severity of the infection is influenced by personal characteristics of patients and external factors related to the residential care facility.

Dynamics of immune system parameters in development of SARS-CoV-2-specific immunity in a patient with common variable immune deficiency

With the accumulation of data on the evolving SARS-CoV-2 infection pandemic, it became clear that the risk factors for severe course of COVID-19 among the patients with primary immunodeficiency include disorders associated with dysregulation of the immune response. In this regard, it is of interest to identify possible predictors of the pronounced inflammatory reaction upon infection with coronavirus in the patients with general variable immune insufficiency. For this purpose, the dynamics of immune system parameters was studied in a patient with CVID who underwent a severe clinical variant of COVID-19, as an example of clinical case.
 We present patient K., 49 years old, with CVID diagnosis verified at the age of 35 years who received regular replacement therapy with IVIG. He suffered from COVID-19 in severe form, received anti-cytokine therapy and an additional course of IVIG during the treatment. He was discharged in satisfactory condition. The quantitative and functional parameters of the T and B lineages of immune system were evaluated by flow cytofluorimetry during routine examinations before the infection and three months after the discharge from the hospital after COVID-19. It has been shown that, before the disease, there were changes in the parameters of B cells characteristic of CVID manifesting as a decrease in switched-memory B cells and plasmoblasts. Alterations in the T cell subsets were also revealed, as redistribution of the subpopulation composition towards T effectors with an increased cytolytic potential of these cells and a weakening of T cell suppression, due to decreased Treg in peripheral blood. After undergoing COVID-19, the patient developed specific IgM and IgG antibodies. The development of immune response was accompanied by an increase in the number of un-switched and switched memory B cells. At the same time, we have registered an increase in memory T cells ready for the proliferative response of T helper cells and Treg cells. The initial pro-inflammatory pattern of the T cell lineage system in our patient with CVID is explained by the implementation of the compensatory capabilities of the immune system, thus leading to activation of the cytolytic effects of cellular compartment in adaptive immune response, along with attenuation of the humoral component. Moreover, it is likely that these changes contributed to the clinical course of COVID-19 in this clinical case. Development of a specific humoral response to SARS-CoV-2 in a patient with CVID after a COVID-19 infection is accompanied by an increased proportion of memory B cells, coordinated dynamics of T cell suppression and activation parameters.

Psychological Burdens among Teachers in Germany during the SARS-CoV-2 Pandemic—Subgroup Analysis from a Nationwide Cross-Sectional Online Survey

Background: Schools underwent massive changes during the SARS-CoV-2 pandemic worldwide. Besides existing occupational health challenges, teachers had to deal with biological and psychological burdens that had the potential to impact their psychological well-being. The aim of the present study was to (i) assess the current state of psychological burdens in German teachers and (ii) identify highly burdened subgroups to derive and address interventions. Methods: A nationwide cross-sectional online survey was conducted among teachers at all school types in Germany in March 2021. Data on psychological strains were assessed using established (e.g., PHQ-4) and new—pandemic-specific—(e.g., COVID-19-associated anxieties) instruments. ANOVAs and Tukey’s post hoc tests were used to identify highly burdened subgroups (e.g., gender, age, and number of risk factors for severe courses of COVID-19) of teachers. Results: Psychological burdens in German teachers (N = 31.089) exceeded the level of the general population, for example, regarding symptoms of depression (PHQ-2, M = 1.93 vs. 1.24) or generalized anxiety (GAD-2, M = 1.72 vs. 1.03). Subgroup analysis revealed that psychological burdens were unevenly distributed among different groups of teachers; for example, younger teachers (18–30 years) showed more depression symptoms compared with their older colleagues (56–67 years) (PHQ-2, M = 2.01 vs. 1.78). Conclusions: The online survey was conducted during the “third wave” of SARS-CoV-2 in Germany, which might have influenced risk perception and psychological strains. Future studies at different times, ideally longitudinal monitoring of the mental health of teachers, are recommended. Based on our results, evidence-based subgroup-specific interventions should be implemented to sustain teachers’ mental health; for example, younger teachers or teachers with risk factors for a severe course of COVID-19 should receive special attention and support. Teachers from special needs schools whose mental health is, on average, good could also be a starting point for identifying the health promotion structural elements of this school type (e.g., fewer students per teacher). However, beyond the specific pandemic-related psychological burdens, the classic occupational health challenges of physical, biological, and chemical stress and their resulting strains should not be disregarded.

Comparison of clinical features of COVID-19 infection in children with asthma and their healthy peers.

AimWe aimed to assess the impact of COVID‐19 on asthma exacerbations and to compare the severity of symptoms of SARS‐CoV‐2 infection of asthmatic children with those of healthy children.MethodsThe clinical course of COVID‐19 was compared among 89 children with asthma and 84 healthy children with age‐ and gender‐matched. Demographic factors, severity of asthma, duration of asthma, presence of atopy, type of treatment, and compliance to treatment in asthmatic children on clinical course of infection and to determine the risk factors for severe course for asthma exacerbation during COVID‐19 were evaluated retrospectively. Demographic characteristics, clinical symptoms, duration of complaints, and hospitalization rates were statistically compared between the two groups.ResultsBoth groups had similar rates of symptomatic disease, hospitalization, and duration of fever. Among children with asthma mean age was 10.3 years, 59.6% were male, and 84.3% had mild asthma. Dyspnea was more prevalent in asthmatic children (p:0.012), but other clinical findings were not different from those of healthy controls. 12.4% (n:11) of asthmatic children had asthma exacerbation, 2.2% (n:2) of them were hospitalized; one (1.1%) of which was due to asthma exacerbation.ConclusionThe course of COVID‐19 in patients with mild to moderate asthma, who were followed up regularly and who were compliant with their treatment, was similar to their healthy peers. Since there was no severe asthma case in our study, the results could not have been generalized to all asthmatic patients. Further comprehensive and multicenter studies are required in pediatric population.

Possibilities of information systems for prediction of outcomes of new coronavirus infection COVID-19

The pandemic of coronavirus infection COVID-19 (Coronavirus Disease 2019), caused by a new strain of coronavirus SARSCoV-2 (severe acute respiratory syndrome coronavirus 2), has caused high mortality worldwide. The clinical manifestations of COVID-19 are nonspecific. Diagnostics includes clinical, laboratory and radiological data. The importance of introducing information systems into medical practice in order to improve the quality of medical care is noted. It is stated that the development of medical artificial intelligence is associated with the development of artificial intelligence programs designed to help the clinic in making a diagnosis, prescribing treatment, as well as predicting the outcome of the disease. Such systems include artificial neural networks, fuzzy expert systems, and hybrid intelligent systems. The article analyzes data from a number of studies on the use of artificial intelligence for diagnosing COVID-19, predicting the risk of mortality and studying risk factors for severe course and lethal outcome in various groups. Using clusters of predictors, models have been developed to predict mortality and understand the relationship of various characteristics and diseases with mortality from COVID-19. The article also summarizes the key factors that worsen the prognosis for COVID-19. Scales for detecting or predicting the development of COVID-19-induced “cytokine storm” are marked as a separate item.

Pulmonary embolism in COVID-19

COVID-19 pandemic is recognized as a present day major public health burden. Risk factors for developing a more severe course of COVID-19 include increased levels of C-reactive protein and D-dimer. Pulmonary embolism (PE) is challenging in patients with COVID-19. The purpose: to analyze clinical and paraclinical manifestations of PE in patients with COVID-19 in order to develop a system for its early diagnosis, prediction of complications, prevention and treatment. 52 patients aged 28 - 81 y.o. with a diagnosis "Acute respiratory disease COVID-19" have been examined during 2020-2021. (98.08±1.9)% of PE patients had a history of one or more comorbidities, including obesity (80.77%), coronary heart disease (96.15%), hypertension (98.08%), peripheral arteries (92.3%), type 2 diabetes mellitus (48.08%). Evaluation of laboratory parameters revealed increasing lymphocytopenia, leukocytosis, neutrophilia, thrombocytopenia (p<0.05). Biochemical parameters showed high CRP, increase in creatinine, decrease in glomerular filtration rate (p<0.05). A direct relationship was found between overweight and an increase in the content of C-RP in COVID-19 and PE patients. Conclusions: age over 65, hypertension and obesity are risk factors for severe course of COVID-19 and PE.

COVID-19 in a Neuroimmunological Outpatient Cohort: The Bernese Experience

The COVID-19 pandemic specifically affects the management and treatment of patients with autoimmune neurological disorders. Major concerns include potentially higher risks of infection or severe disease course under certain immunotherapies used to treat those disorders and the influence of COVID-19 on the underlying disease. We present data of the neuroimmunological outpatient department of the University Hospital of Bern (Switzerland). 24 cases were analyzed, 19 of them suffered from Multiple Sclerosis. Of these 24 patients, 6 were hospitalized, 2/6 were treated in the Intensive Care Unit. Possible risk factors for severe course (defined as need for hospitalization) observed in our cohort included cardiovascular risk factors, treatment with B-cell depleting agents, Sphingosine-1 Phosphate Receptor Modulators, and oral steroid therapies. These data are based on a small, retrospective observational cohort and should be interpreted with caution, although they are in line with several other cohort studies.

Risk Factors of Severe Disease and Methods for Clinical Outcome Prediction in Patients with COVID-19 (Review)

Large population studies using statistical analysis and mathematical computer modeling could be an effective tool in studying COVID-19. The use of prognostic scales developed using correlation of changes in clinical and laboratory parameters and morphological data, can help in early prediction of disease progression and identification of patients with high risk of unfavorable outcome.Aim of the review. To assess the risk factors for severe course and unfavorable outcome of COVID-19 and to evaluate the existing tools for predicting the course and outcome of the novel coronavirus infection. PubMed, Medline, and Google Scholar were searched for the relevant sources. This review contains information on existing tools for assessing the prognosis and outcome of the disease, along with the brief data on the etiology, pathogenesis of the novel coronavirus infection and the known epidemiological, clinical and laboratory factors affecting its course.Conclusion. It is essential to develop predictive models tailored to specific settings and capable of continuous monitoring of the situation and making the necessary adjustments. The discovery of new and more sensitive early markers and developing marker-based predictive assessment tools could significantly impact improving the outcomes of COVID-19.

How COVID-19 crisis influenced kidney transplant recipients in Slovakia.

The aim of our analysis was to evaluate the impact of the COVID-19 pandemic on the procurement program and kidney transplantation in Slovakia and to identify the risk factors for a severe course of COVID-19 disease, as well as the risk factors for COVID-19 fatalities, with the focus on the parameters preceding the infection. We compared morbidity and mortality from COVID-19 before and after the spread of the alpha variant of the virus and the same among transplant (KTRs) and haemodialysis patients in Slovakia. 305 KTRs (68.8 % males) with confirmed SARS-CoV-2 positivity were included in the multicentric retrospective analysis. The patients were split into subgroups based on the time of falling ill and their clinical course. The procurement program and kidney transplants in Slovakia dropped in the observed period by 28.6 % (p<0.0001) and by 33.5 % (p<0.0001) respectively. Age over 59 years (p=0.0088) and diabetes mellitus (p=0.0106) were identified as independent risk factors for severe course of the disease. Risk factors for death were the age over 59 years (p=0.0003) and graft dysfunction with CKD-EPI<0.5 mL/s (p=0.0029). The prevalence of the alpha variant in Slovakia was associated with a severe course in KTRs treated with corticoids (p=0.0273) and in graft dysfunction with CKD-EPI<0.5 mL/s (p=0.0076); the risk of death was higher in KTRs over 59 years (p=0.0173) and again with CKD-EPI<0.5 mL/s (p=0.0393). KTRs had a 3.7 times lower risk of infection compared to the haemodialysis patients (p<0.0001), with mortality of 9.8 % vs 30 % (p<0.0001). The procurement and transplant program is sustainable even during apandemic, provided that measures are set up quickly. Morbidity and mortality from COVID-19 in KTRs was comparable to the situation in EU countries. Patients in the haemodialysis program had aworse prognosis (Tab. 5, Fig. 1, Ref. 21) Keywords: COVID-19, kidney transplantation, dialysis, immunosuppression, obesity, diabetes mellitus.

Обструктивная резекция кишки в лечении травматических повреждений кишечника в условиях перитонита

Treating bowel injuries is challenging. Although the failure of anastomosis or suture of the intestine remains a dangerous complication and multiplies in conditions of peritonitis, multistage tactics before the tactics of maintaining intestinal continuity during the first operation is becoming an increasingly preferred strategy. The aim of the research. To evaluate the treatment results for delayed formation of the inter-intestinal anastomosis in patients with bowel injury complicated by peritonitis. Material and Methods. A total of 69 patients were enrolled in the study, among which 40 were included in the retrospective group and 29 were included into the prospective group. All included patients underwent surgery for bowel injuries at the NCHKH 29 and at the NCHKH 1 within the period from 2011 to 2019. The patients’ mean age amounted to 33.4±9.2 years. A total of 35 patients were admitted with blunt trauma and 34 had stab wounds. The retrospective group received treatment with bowel resection with application of anastomosis during the initial surgery while patients of the prospective group had their anastomosis formation delayed to the time after peritonitis management. The postoperative course was analysed in regard to the frequency and severity of postoperative complications and mortality. Results. Among the 69 patients, 78% had a small bowel injury and 47% had a colon injury. A total 39.1% of the lesions in the small intestine and 21.7% of the lesions in the colon were treated with wound closure or bowel resection with primary anastomosis, regardless of the site of injury (p = 0.381). Mortality was 33%, of which 47.5% in the control group and 13.8% in the comparison group. A severe course of the disease was noted in 32% and complications in the abdominal cavity occurred in 32% of patients. The risk factors for severe course of the disease were formed intestinal stomas (p = 0.036), massive blood loss (p = 0.005) and delayed seeking medical care (p = 0.023). The incidence of intestinal suture incompetence was 28.2%. All failures occurred in the early postoperative period. Conclusion. Multi-stage surgical tactics in treatment of patients with intestinal injury complicated by peritonitis should be the preferred option, regardless of the site of injury – small or large intestine. The imposition of an intestinal stoma is an important factor in the development of postoperative complications, which can be compared with the risk of an intestinal suture or anastomosis in peritonitis

Primary Analysis of the Risk Factors for Severity and Mortality in COVID-19 Patients in Uzbekistan

A retrospective analysis of 561 patients with confirmed COVID-19 was performed to determine the risk factors for severity and mortality which could predict the disease outcome in early stages. Patients were divided into 4 groups in accordance with disease severity: mild, moderate, severe and critical. And initial clinical and laboratory parameters of patients at admission were studied. The age of severe and deceased patients was significantly higher than patients with mild and moderate course (р=0.003). Patiens with severe disease and fatal outcome had higher incidence of concomitant diseases compared to patients with mild and moderate course (p=0.01). The time passed from onset of first symptoms and hospital admission was shorter in patients with mild and moderate disease than patients with severe and critical disease (р=0.0001). The leukocytosis, significant lymphopenia (р=0.0001), high D-dimer and ferritin levels were associated with severe disease. Male gender, old age, presence of concomitant diseases should be considered as risk factors for severe course and death at COVID-19.

SARS-CoV-2 infection in pregnancy during the first wave of COVID-19 in the Netherlands: a prospective nationwide population-based cohort study (NethOSS).

ObjectiveTo describe characteristics, risk factors and maternal, obstetric and neonatal outcomes of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).DesignMulti‐centre prospective population‐based cohort study.SettingNationwide study in the Netherlands.PopulationPregnant women with confirmed SARS‐CoV‐2 infection admitted to hospital or in home‐isolation: 1 March 2020 to 31 August 2020.MethodsPregnant women with positive polymerase chain reaction or antibody tests were registered using the Netherlands Obstetrics Surveillance System (NethOSS). (Selective) testing occurred according to national guidelines. Data from the national birth registry (pregnant pre‐coronavirus disease 2019 [COVID‐19] cohort) and an age‐matched cohort of COVID‐19‐positive women (National Institute for Public Health and the Environment; fertile age COVID‐19 cohort) were used as reference.Main outcome measuresIncidence of SARS‐CoV‐2 infection in pregnant women. Maternal, obstetric and neonatal outcomes including hospital and intensive care admission.ResultsOf 376 registered pregnant women with confirmed SARS‐CoV‐2 infection, 20% (74/376) were admitted to hospital, of whom 84% (62/74) were due to SARS‐CoV‐2; 10% (6/62) were admitted to intensive care and 15% (9/62) to obstetric high‐care units. Risk factors for admission were non‐European country of origin (odds ratio [OR] 1.73, 95% CI 1.01–2.96) and being overweight/obese (OR 1.86, 95% CI 1.51–3.20). No maternal or perinatal deaths occurred. Caesarean section after labour‐onset was increased (OR 1.58, 95% CI 1.09–2.28). Hospital and intensive care admission were higher compared with the fertile age COVID‐19 cohort (OR 6.75, 95% CI 5.18–8.81 and OR 2.52, 95% CI 1.11–5.77, respectively).ConclusionsNon‐European country of origin and being overweight/obese are risk factors for severe course of SARS‐CoV‐2 infection in pregnancy, risk of caesarean section and hospital and intensive care unit admission are increased.Tweetable abstractPregnant women with SARS‐CoV‐2 in the Netherlands show increased hospital/ICU admission and caesarean section.

POS1257 HYPOGAMMAGLOBULINEMIA IS A SIGNIFICANT RISK FACTOR FOR MORTALITY IN PATIENTS WITH ANCA ASSOCIATED VASCULITIS AND COVID-19

Background:The negative impact of COVID-19 in patients with ANCA associated vasculitis (AAV) and patients on rituximab (RTX) treatment have been reported (1). Risk factors for severe course of COVID-19 and increased mortality in these patients are unclear.Objectives:To evaluate the course of COVID-19 in our AAV cohort and identifying risk factors for mortality.Methods:Patients with AAV who were classified according to CHCC and whose scheduled last visit were after December 2019 were screened and evaluated for COVID-19 either by phone call or in the clinic. Records of patients with a history of hospital admission due to COVID-19 were evaluated. Cumulative clinical findings and treatment history were noted. Hypogammaglobulinemia (hIgG) was defined as IgG level below 700 mg/dl. All inpatients with a diagnosis of COVID-19 were screened for hIgG and IVIG was administered if necessary.Results:Eighty-nine patients (47.2% female, mean age 56 + 12.5 (28-81)) were included into the study. The diagnosis was GPA in 56 (62.9%) and MPA in 33 (37.1%) patients. Mean follow up time was 91 + 53.4 (26-272) months. Anti-PR3 and anti-MPO were positive in 46 (51.7%) and 32 (35.9%) patients, respectively. Lower respiratory tract (LRT) involvement was present in 72 (80.9%) and 10 patients had a history of diffuse alveolar haemorrhage (DAH). Sixty-one patients (68.2%) had a history of rapidly progressive glomerulonephritis (RPGN) and 21 (23.6%) had peripheral nervous system (PNS) involvement.Fifteen (16.9%) patients had COVID-19; 14 of them were PCR positive, one patient had symptoms and thorax CT findings compatible with COVID-19. Pulmonary infiltrates were observed in 13 patients (86.7%); 9 (60%) had severe pneumonia. Twelve patients (85.7%) were hospitalized, 6 patients (42.9%) needed ICU admission and 5 patients (35.7%) died. Tocilizumab and anakinra for hyperinflammation during COVID-19 were used in 1 (6.7%) and 4 (26.7%) patients, respectively.Four out of five deceased patients (3 on RTX treatment, 1 with renal transplant) were in remission at the time of COVID-19. COVID-19 was detected in a patient with disease flare and DAH, during treatment with high dose steroids and plasmapheresis. hIgG was detected in all deceased patients from COVID-19 during hospital admission (mean IgG: 495±113.2 mg/dL).Symptomatic COVID-19 was more frequent in patients with a history of DAH, RPGN and hIgG. hIgG during the follow-up was significantly associated with COVID-19 in multivariable analysis (p=0.01, OR=20,6 %95 CI (2-210). Comparison of patients who died of COVID-19 and survived showed that female sex, PNS involvement and hIgG during the clinical course and hospital admission were risk factors for increased mortality (Table 1). Age, smoking, treatments, history of flares or serious infections, remission status and chronic renal insufficiency did not differ between groups.Conclusion:The frequency and mortality from COVID-19 is found to be high in our AAV cohort compared to previous reports (1). Patients with serious lung or renal involvement are prone to symptomatic COVID-19. Previously reported severe outcomes on RTX therapy might be related to consequent hIgG. High dose IVIG treatment may not be sufficient in improving survival in AAV patients with severe COVID-19 and hIgG.

Perspectives of treatment of influenza and influenza-like illnesses with Enisamium yodide – Antiviral with anti-inflammatory effect

Background: Enisamium iodide (EI) is a Russian drug whose molecule was developed in the Institute of Pharmacology and Toxicology of Ukraine as an anti-inflammatory and antipyretic agent. Later, other properties of EI were found: inhibition of the influenza virus hemagglutinin, increasing the production of interferon-γ, level of Th1, blood antioxidant activity, inhibition TNF-α and other pro-inflammatory cytokines, activation of macrophages and lysozyme activity. The aim of study was to evaluate the efficacy of antiviral therapy with EI in out-patient patients with influenza and influenza-like illnesses (ILI) without risk factors for severe course of disease. Methods and materials: 124 patients aged 18–55 years with influenza and ILI within 6–48 h of symptoms onset were randomized into 2 groups. 1st group (n = 66) was treated with EI 500 mg tid 5 days, 2nd group (n = 63) received placebo according to the same scheme. In the 1nd group the proportion between influenza and other respiratory viruses was 32.2%: 67.8%, in the 2nd group 31.7%: 68.3%, accordingly. Duration of disease and main clinical symptoms, frequency of complications and speed of the virus elimination from the nasopharynx were estimated. Results: The number of cases with complete recovery within 96 h was 56 (84.8% ± 4.2%) in 1st group and 44 (69.8% ± 5.8%) in 2nd group (p = 0.047). The duration of fever was 68.0 ± 2.8 h in 1th group and 77.1 ± 2.9 h in 2nd group (p = 0.044), muscle pain – 52.3 ± 2.3 and 60.6 ± 2.6 h (p = 0.041), headache-52.1 ± 2.6 and 65.1 ± 2.5 h (p = 0.032), weakness – 75.5 ± 2.3 and 90.4 ± 2.5 h (p = 0.001), accordingly. On the 4th day of treatment the viruses were isolated in 37.8 ± 5.9% of cases in the 1st group and 57.1 ± 6.2% in 2nd group; p = 0.048. Bacterial complications were observed in 3.0 ± 2.1% and 12.6 ± 4.2% accordingly, p = 0.048. Conclusion: The study is demonstrated the effectiveness of EI in the treatment of influenza and ILI in adult outpatient patients. The antiviral and anti-inflammatory effects of the drug, which was administered within 48 h of the symptoms onset were demonstrated by a more rapid reduction of clinical symptoms, frequency of bacterial complications and reduction in the time of virus elimination. Continuation of EI clinical trials are necessary for more full evaluation of its effectiveness.

Obesity, vitamin D deficiency and old age a serious combination with respect to coronavirus disease-2019 severity and outcome.

Old age, obesity and vitamin D deficiency are considered as independent risk factors for severe courses of COVID-19. The aim of the review is to discuss common features of these risk factors and the impact of vitamin D. The recently discovered relationship between vitamin D and the infection pathway of the virus via the renin--angiotensin system (RAS) and the adipokines leptin and adiponectin play an important role. The frequency of studies showing a relationship between a low vitamin D status in comorbidities and severe COVID-19 courses makes an impact of vitamin D effects likely. There is a direct relationship between vitamin D, body fat and age in COVID-19 courses. With age, the ability of the skin to synthesize vitamin D decreases, and leads to vitamin D-deficits. If the skin is insufficiently exposed to sunlight, severe deficits can develop. As vitamin D plays an important role not only in the immune system but also in the RAS, and thus at the point where the virus attacks, a good vitamin D supply is an important basis for reducing the risk of severe COVID-19 processes. Treatment with vitamin D supplements should be based on severity of the vitamin D deficiency.

Why Do People With Diabetes Have a High Risk for Severe COVID-19 Disease?-A Dental Hypothesis and Possible Prevention Strategy.

The SARS-CoV-2 virus causes symptoms in infected individuals ranging from mild flu symptoms via severe COVID-19 pneumonia requiring ventilation to death. Risk factors for severe courses are age, di...

Umifenovir in treatment of influenza and acute respiratory viral infections in outpatient care

Purpose: Umifenovir - antiviral drug of a wide range of activity, acting in the early stages of virus reproduction. it disrupts the process of fusion of the viral lipid membrane with intracellular membranes. The virus-specific target of the drug in the cycle of reproduction of the influenza virus is hemagglutinin. The aim of study was to evaluate the efficacy of antiviral therapy with umifenovir in outpatient patients with influenza and acute respiratory viral infections (ARVI) without risk factors for severe course of disease. Methods & Materials: 215 patients aged 18–74 years with influenza and ARVI within 5–36 hours of symptoms onset were randomized into 2 groups. 1th group was treated with umifenovir 200 mg qid 5 days (n = 109), 2nd group (=106) received placebo according to the same scheme. Duration of disease, duration and severity of the main clinical symptoms, frequency of complications and speed of the virus elimination from the nasopharynx were estimated. Results: The number of cases with complete recovery within 96 hours was 58.7 ± 4,7% in 1st group and 44.3 ± 4,7% in 2nd group (p = 0.04), after 108 hours - 67.9% ± 4,5 and 50.4 ± 4,9% (p = 0.04). The duration of fever was 67.0 ± 2,7 hours in group 1 and 76.9 ± 2,5 hours in group 2 (p = 0.02), muscle pain-51.1 ± 2,1 and 59.7 ± 2,5 hours (p = 0.023), headache-51.3 ± 2,5 and 64.4 ± 2,3 hours (p = 0.01), weakness – 75.3 ± 2,2 and 89.8 ± 2,3 hours (p = 0.001), respectively. On the 4th day of treatment the virus was isolated in 34.9 ± 4,6% of cases in the 1st group and 57.8 ± 4,8% of patients in 2nd group; p = 0.03. Bacterial complications were observed in 3,7 ± 3,3% and 13,2 ± 3,3% accordingly, p = 0.04. Conclusion: The study is demonstrated the effectiveness of umifenovir in the treatment of influenza and ARVI in adult outpatient patients. The antiviral effect of the drug, which was administered within 36 hours of the symptoms onset is manifested by a more rapid reduction of clinical symptoms and their severity, frequency of bacterial complications and reduction in the time of virus elimination.

Influenza and influenza-like illnesses in risk groups: evaluation of antiviral therapy with umifenovir in hospitalized patients

Background: Bacterial complication and prolonged course of influenza and influenza-like illnesses (ILI) are often observed among patients with risk factors for severe course of disease. The aim of study was to evaluate the efficacy of antiviral therapy with arbidol (umifenovir) in hospitalized patients with influenza and ILI who had risk factors for severe course of disease. Methods & Materials: 3285 medical charts of patients with influenza and ILI who treated in 2010-2015 years in 80 hospitals in Russia have been retrospectively reviewed. Laboratory confirmation of disease was available in 31.0% patients; of these, influenza viruses were found in 60.7% samples (influenza A/H1N1 - 48.8%, A/H3N2 - 16.3%, influenza A subtype–10.6%, influenza B - in 24.3%, other respiratory viruses - 39.7%). Patients were divided into 2 groups depending on therapy. Antivirals were not administered to patients in the 1th group. 2th group of patients was treated with umifenovir from the first 24-48 hours after symptom onset. Additionally each of group was divided into 2 subgroups. Patients in subgroups 1a (n = 183) and 2a (n = 2319) had no risk factors for severe course of influenza and ILI. Patients in subgroups 1b (n = 155) and 2b (n = 628) had risk factors (children younger than 2 years old and adults over 65, pregnant women, people with chronic somatic diseases and obesity). Duration of clinical symptoms and frequency of bacterial complications were evaluated. Results: Duration of fever and frequency of complications in patients without risk factors were significantly lower in 2a group versus 1a group: 2.86 ± 1.57 days and 3.76 ± 2.83 days, 13.1 ± 1.3% and 20.0 ± 3.2%, accordingly. Duration of fever and frequency of complications in patients with risk factors were significantly lower in 2b group versus 1b group: 3.0 ± 1.48 days and 4.1 ± 2.2 days, 9.9 ± 1.2% and 42.6 ± 3.6%, accordingly. Conclusion: The efficacy of antiviral therapy was higher in patients with risk factors than in patients who are not at risk. In patients treated with umifenovir the duration of fever and frequency of complications were lower than in patients who did not receive antiviral therapy.