Risk Of Severe Course Research Articles

СРАВНИТЕЛЬНАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ РАЗЛИЧНЫХ СХЕМ ТЕРАПИИ КАМПИЛОБАКТЕРИОЗА У ДЕТЕЙ РАННЕГО ВОЗРАСТА

Campylobacteriosis is one of the most common bacterial intestinal infections with a high risk of severe course in childhood. The treatment of children with campylobacteriosis is complex and requires further study. Objective of the study: to study the clinical efficacy of various drug therapy regimens for campylobacteriosis and their effect on intestinal microbiocenosis in young children. Materials and methods of research: From 2018 to 2020 in the Pediatric Research and Clinical Center for Infectious Diseases of the Russian Federal Biomedical Agency, a comprehensive singlecenter prospective dynamic open observational study of 84 children aged 6 to 18 months with campylobacteriosis was carried out (41 boys, 43 girls, mean age 12,7±4,7 months). A comparison was made between patients who did not receive an antibacterial drug (n=30), received azithromycin (n=30), and received several antibacterial agents (n=24). Clinical and laboratory parameters and indices of the intestinal microbiocenosis composition were assessed by real-time PCR. Results: antibacterial drugs of the macrolide group are most effective in the etiotropic therapy of severe and moderate forms of campylobacteriosis in infants. The appointment of antibacterial drugs of the cephalosporin group for campylobacteriosis leads to a slowdown in the recovery process (an increase in the duration of diarrhea, fever and abdominal pain), accompanied by significant damage to the intestinal microbiocenosis (a decrease in the symbiotic Lactobacillus spp. and Bifidobacterium spp.). The combination of these factors predisposes to more frequent re-isolation of the pathogen observed in this group of patients. For children who are on mixed or artificial feeding, the inclusion of nutritional mixtures with probiotics in the complex of therapeutic measures has a pronounced therapeutic effect and can be used as one of the main means of rehabilitation of campylobacteriosis convalescents.

Оценка клинического течения COVID-19 у пациентов, вакцинированных «Спутник V», изменчивости RBD-домена S-белка SARS-CoV-2 и вируснейтрализующих свойств сыворотки

The COVID-19-associated mortality remains high. Studying the features of the COVID-19 course in vaccinated patients, who have got ill on different dates after vaccination, compared to unvaccinated individuals is relevant. The study was aimed to assess clinical and immunological features of the COVID-19 course, as well as to assess humoral immunity (virus neutralizing activity, VNA) and SARS-CoV-2 S protein RBD domain variation in the groups of patients, previously vaccinated with Sputnik V, and unvaccinated patients. A total of 251 patients with confirmed diagnosis of COVID-19 were enrolled, of them 116 individuals were previously vaccinated with one or two Sputnik V vaccine components, and 135 patients were not vaccinated (comparison group). Individuals over 50 years of age prevailed (82.8%). The patients, who received two vaccine components, had mild to moderate COVID-19 (92.1%). In the group of unvaccinated patients, 11 individuals received treatment in the ICU, 10 of them died. The viral load was significantly lower in vaccinated patients. Mutations of SARS-CoV-2, such as S477N, S477N+A522S, E484K and E484K+S494P, were identified both in vaccinated and unvaccinated patients. Assessment of the neutralizing activity of sera revealed no significant differences in VNA against different variants of SARS-CoV-2 mutations. The data obtained demonstrate that the lack of vaccination is an aggravating factor and is capable of increasing the risk of severe course and death in patients with COVID-19.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»).

Aim To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

Особливості перебігу коронавірусної інфекції COVID-19 у дітей України

Актуальність. Пандемія коронавірусної хвороби COVID-19, спричинена новим коронавірусом SARS-CoV-2, на сьогодні є глобальною проблемою, однак досить обмеженими є дані щодо особливостей перебігу інфекції COVID-19 у дітей. Мета: провести узагальнюючий аналіз демографічних, епідеміологічних і клінічних особливостей перебігу COVID-19 у дітей різного віку з різних регіонів України. Матеріали та методи. З дотриманням принципів біоетики проведено багатоцентрове ретроспективне відкрите когортне дослідження 669 випадків інфекції у дітей, спричиненої коронавірусом SARS-CoV-2, у відділеннях госпітальних баз міст Києва, Вінниці, Чернівців та Одеси. У госпіталізованих дітей визначали комплекс клінічних, лабораторних та інструментальних маркерів перебігу інфекції, спричиненої коронавірусом COVID-19. Результати. До першої (І) групи ввійшли 67 дітей віком до 2 місяців, до другої (ІІ) групи — 320 хворих дітей у віковому проміжку від 60 днів до 6-річного віку, субгрупа зі 127 дітей молодшого та середнього шкільного віку сформувала третю (ІІІ) групу, а до складу четвертої (IV) вікової групи ввійшли 155 підлітків віком від 12 років. Ураження вірусом SARS-CoV-2 систем внутрішніх органів характеризувалося мультисистемним характером і проявлялося змінами з боку верхніх дихальних шляхів у 70,1 % випадків, ураженням нижніх дихальних шляхів — у 54,7 % спостережень, інфекційно-запальними змінами — у 57,2 % випадків, гастроінтестинальними симптомами — у 9,2 %, а також неврологічною симптоматикою — у 17,8 %. Загалом серед клінічних симптомів у загальній когорті пацієнтів найчастіше зустрічались лихоманка (51,1 %), загальна слабкість (51,6 %), біль у горлі (70,1 %), кашель (54,7 %) та зниження апетиту (52,8 %). Ураження паренхіми легень із відповідною клініко-рентгенологічною картиною як прояв коронавірусної хвороби COVID-19 визначалося із частотою від 23,9 до 25,9 % обстежених дітей у різних регіонах України з вірогідним зростанням шансів розвитку пневмонії у підлітковому віці. Найчастішими змінами у додаткових методах обстеження були лейкоцитоз (18,8 % випадків), тромбоцитоз (14,5 % хворих), лейкопенія (11,1 % пацієнтів), збільшення С-реактивного білка у 43,7 % дітей. Підвищений уміст тромбоцитів спостерігався переважно у дітей перших двох місяців життя (у 38,3 % випадків) і вірогідно зростав упродовж періоду стаціонарного лікування, що співпадало з тенденціями до зростання частоти підвищеного вмісту С-реактивного білка у цій віковій когорті. Висновки. Аналіз епідеміологічних, клінічних і лабораторних особливостей перебігу коронавірусної хвороби, викликаної SARS-CoV-2, у дітей різних вікових груп із різних регіональних госпітальних баз України узгоджувався із перебігом у дорослих пацієнтів із COVID-19, але більш високі шанси на легші форми захворювання серед дітей молодшого віку та ураження нижніх дихальних шляхів і вищі шанси тяжкого перебігу серед старших дітей.

Toxoplasmosis is a risk factor for acquiring SARS-CoV-2 infection and a severe course of COVID-19 in the Czech and Slovak population: a preregistered exploratory internet cross-sectional study

BackgroundLatent toxoplasmosis, i.e. a lifelong infection with the protozoan parasite Toxoplasma gondii, affects about a third of the human population worldwide. In the past 10 years, numerous studies have shown that infected individuals have a significantly higher incidence of mental and physical health problems and are more prone to exhibiting the adverse effects of various diseases.MethodsA cross-sectional internet study was performed on a population of 4499 (786 Toxoplasma-infected) participants and looked for factors which positively or negatively affect the risk of SARS-CoV-2 infection and likelihood of a severe course of COVID-19.ResultsLogistic regression and partial Kendall correlation controlling for sex, age, and size of the place of residence showed that latent toxoplasmosis had the strongest effect on the risk of infection (OR = 1.50) before sport (OR = 1.30) and borreliosis (1.27). It also had the strongest effect on the risk of severe course of infection (Tau = 0.146), before autoimmunity, immunodeficiency, male sex, keeping a cat, being overweight, borreliosis, higher age, or chronic obstructive pulmonary disease. Toxoplasmosis augmented the adverse effects of other risk factors but was not the proximal cause of the effect of cat-keeping on higher likelihood of COVID infection and higher severity of the course of infection because the effect of cat-keeping was also observed (and in particular) in a subset of Toxoplasma-infected respondents (Tau = 0.153). Effects of keeping a cat were detected only in respondents from multi-member families, suggesting that a cat could be a vector for the transmission of SARS-CoV-2 within a family.ConclusionsToxoplasmosis is currently not considered a risk factor for COVID-19, and Toxoplasma-infected individuals are neither informed about their higher risk nor prioritised in vaccination programs. Because toxoplasmosis affects a large segment of the human population, its impact on COVID-19-associated effects on public health could be considerable.Graphical abstract

B cell depletion in immune-mediated rheumatic diseases and coronavirus disease 2019 (COVID-19)

In patients with immune-mеdiated (autoimmune) rheumatic diseases (IMIRD), there are a number of factors (advanced age, uncontrolled inflammation, initially irreversible damage to internal organs, comorbid pathology, genetic and other factors) that can potentially lead to an increase in “sensitivity” to SARS-CoV -2 (severe acute respiratory syndrome coronavirus-2) and concomitant viral and bacterial infections, an increase in the risk of a severe course of COVID-19 (coronavirus disease 2019), a decrease in the effectiveness of therapy for both IMIRDs and COVID-19. An important area of pharmacotherapy for IMIRDs and other autoimmune diseases is associated with the use of anti-B-cell drugs, primarily rituximab (RTX), which is a chimeric (mouse/human) monoclonal antibody (mAb) to the CD20 antigen of B cells. At present, in Russia, the RTM biosimilar, acellbia (BIOCAD), is widely used, which is not inferior to RTX in terms of efficiency and safety. The problems of anti-B-cell therapy during the COVID-19 pandemic in relation to the risk of infection, severe course and insufficient effectiveness of vaccination against SARSCoV- 2 are considered. According to the recommendations of the Association of Rheumatologists of Russia, a more rigorous assessment of indications for induction and maintenance therapy of RTX therapy and harmonization of the timing of drug administration and vaccination is required.

ANALYSIS OF THE ASSOCIATION OF BRONCHIAL ASTHMA CLINICAL COURSE WITH Arg16Gly POLYMORPHIC VARIANT IN THE β2-ADRENOCEPTOR GENE

Relevance. The relevance of the study of Arg16Gly polymorphism of the β2-adrenoceptor (β2-AR) gene is due to the fact that a number of studies have proven its role in the development of bronchial asthma (BA), bronchial hyperactivity, the effectiveness of basic treatment. However, these associations show low reproducibility in various studies, so the question of the possibility of clinical application of the results of genetic testing for Arg16Gly polymorphic variant of the β2-AR gene remains unanswered. The main reasons why the clinical significance of this polymorphism is not confirmed in various studies are - population heterogeneity, insufficient sample size, improper characterization of comparison groups.
 Objective: to study the association of Arg16Gly polymorphism in the β2-adrenoceptor gene with BA clinical course taking into account the age of onset.
 Materials and methods. We examined 553 BA patients (group I included 282 patients with late-onset asthma and group II included 271 patients with early-onset asthma) and 95 apparently healthy individuals. The study has been approved by the Bioethics Committee of Medical Institute of Sumy State University. Arg16Gly polymorphism in the β2-АR gene (rs1042713) was determined using polymerase chain reaction-restriction fragment length polymorphism analysis. Statistical analysis of obtained results was performed using SPSS–17 program.
 Results. There was no significant difference in the distribution of genotypes for Arg16Gly polymorphism in the β2-AR gene depending on asthma severity with no regard for the age of onset (χ2 = 5.14; p = 0.27). With regard for the age of onset, we found out that early-onset BA was linked to a difference in genotype distribution for this polymorphic variant in patients with severe and non-severe course (χ2 = 14.76; р = 0.001). The frequency of Gly/Gly genotype was higher in patients with severe course (41.4%) as compared to patients with mild course (16.4%), while the frequency of Arg/Arg (32.9%) and Arg/Gly (50.7%) genotypes was higher in patients with mild asthma as compared to patients with severe course (24.3% and 34.3%). There was no significant difference in the distribution of genotypes in patients with late-onset asthma with regard to course severity (χ2 = 4.94; p = 0.084).
 The relative risk of severe course for early-onset asthma was 3.84 times higher (95% CI 2.11–7.36; p = 0.001) in the recessive model, 2.58 times higher (95% CI 1.53–4,37, p = 0.001) in the dominant model, and 2.16 times (95% CI 1.56–3.04) higher in the additive model. In patients with late-onset asthma, no association was found in all models.
 Conclusions. There was no significant difference in the distribution of genotypes for Arg16Gly polymorphism in the β2-AR gene depending on asthma severity with no regard for the age of onset. When adjusted for the age of onset, the analysis revealed a difference in genotype distribution for this polymorphic variant in patients with severe and non-severe course having early-onset BA (р = 0.001). The frequency of Gly/Gly genotype was higher in patients with severe course as compared to patients with mild course. For patients with late-onset asthma, no differences were found (p = 0.084). Heterozygous and homozygous Gly allele carriers have a higher risk of early-onset asthma only.

Statin use and mortality in COVID-19 patients: Updated systematic review and meta-analysis

Background and aimsStatin therapy is administered to patients with high cardiovascular risk. These patients are also at risk for severe course of coronavirus disease 2019 (COVID-19). Statins exhibit not only cardioprotective but also immunomodulatory and anti-inflammatory effects. This study performed a systematic review of published evidence regarding statin treatment and COVID-19 related mortality. MethodsA systematic PubMed/Embase search was performed from February 10, 2020 until March 05, 2021 for studies in COVID-19 patients that reported adjusted hazard or odds ratio for death in statin users versus non-users. Results22 studies fulfilled the inclusion criteria and were included in the systematic review. Meta-analysis of 10 studies (n = 41,807, weighted age 56 ± 8 years, men 51%, hypertension 34%, diabetes 21%, statin users 14%) that reported adjusted hazard ratios for mortality in statin users versus non-users showed pooled estimate at 0.65 (95% confidence intervals [CI] 0.53, 0.81). Meta-analysis of 6 studies that reported continuation of statin therapy during hospitalization (58–100% of patients) revealed a pooled hazard ratio of 0.54 (95% CI 0.47, 0.62). Meta-analysis of 12 studies (n = 72,881, weighted age 65 ± 2 years, men 54%, hypertension 66%, diabetes 43%, statin users 30%) that reported adjusted odds ratios for mortality showed pooled estimate at 0.65 (95% CI 0.55, 0.78). Multivariable meta-regression analysis did not reveal any significant association of hazard or odds ratios with anthropometric characteristics or comorbidities. ConclusionsThis meta-analysis of retrospective observational studies showed that statin therapy was associated with an about 35% decrease in the adjusted risk of mortality in hospitalized COVID-19 patients.

AB0670 THE COURSE AND OUTCOMES OF COVID-19 IN PATIENTS WITH ANCA-ASSOCIATED SYSTEMIC VASCULITIS, RECEIVING ANTI-B CELL THERAPY WITH RITUXIMAB

Background:Currently, the issues of the effect of anti-B cell therapy on the risk of severe course of COVID-19 in patients (pts) with ANCA-associated vasculitis (AAV) has not been completely studied.Objectives:We present an analysis of the COVID-19 incidence and outcomes in 126 AAV pts treated with rituximab (RTX) from one rheumatology center registry.Methods:Data were collected with telephone/online surveying between 11-15th November 2020 from all 126 AAV pts (58- granulomatosis with polyangiitis, GPA; 38- microscopic polyangiitis, MPA; 22- eosinophilic granulomatosis with polyangiitis, EGPA (54% ANCA-negative); and 8- uncertain AAV). Pts age was 51 (20-81) yr, 62% women. Due to AAV activity or risk of relapse, during the pandemic RTX was prescribed in 48% pts.Results:The incidence of COVID-19 in AAV pts was 3.5% during the first 3 months of the pandemic, the course was uneventful, and all pts recovered. Since September 2020 a 4-fold increase in the incidence alongside with more severe course of COVID-19 were reported. After 8 months of the pandemic, COVID-19 was diagnosed in 21 (16.6%) pts with median age 55 yr, 57% women. COVID-19 incidence was lower in GPA (15.5%) vs MPA (21.1%) or EGPA (27.7%). The mortality rate was 14.3% (2- MPA, 1- GPA). When analyzing the 5-year survival rate of AAV pts treated with RTX, prognosis worsening was noted; in 2020 there were 3 deaths due to COVID-19, in the previous 5 years- only 2 deaths.Conclusion:Taking into account the fact the mechanisms of AAV and severe COVID-19 are largely synergistic (Table 1), primarily in the context of obstructive thromboinflammation as manifestation of acute inflammatory syndrome in COVID-19 [1], AAV can potentially contribute to the severe course of COVID-19. Anti-CD20 therapy seems to have a protective effect against severe COVID-19 [2], which, however, can be insufficient in AAV pts with active disease and multiple organ damage. Further analysis of COVID-19 cases in pts with AAV and other rheumatic diseases is exceptionally important.Table 1.Comparison of AAV and severe COVID-19ParameterAAVSevere COVID-19Lung damageHigh frequency of lung damagePossibly destructive lung damageDamage to other organsTypically affects the upper and lower airways and kidneys; Other organs can be involvedPossible extrapulmonary localizationVascular involvementSystemic necrotizing vasculitis of small vessels; In the active phase, hypercoagulationObstructive thromboinflammation of the microcirculation of lungs and extrapulmonary vessels; Increased incidence of Kawasaki syndrome during the pandemicInflammationHigh or very highVery highAutoantibodiesANCA pathogenetic roleDominant extrafollicular B cell responses; Сorrelation between SARS-CoV-2 antibody titer and severity of COVID-19; High titers of IFN-α2/ω autoantibodiesNeutrophilNeutrophils are the most important effector cells in the pathogenesisChanges in the morphology of neutrophils were noted; Netosis, the release of proteases from neutrophils promote the complement system activation, hypercoagulation, endotheliitis, production of pro-inflammatory cytokines; An increase of neutrophils in the blood and bronchoalveolar lavage fluid were notedComplementComplement is crucial in the pathogenesis; C5a receptor antagonist Avacopan efficacyActivation of alternative/lectin complement pathways; C5 antagonist Eculizumab has been reported to be effectiveTreatmentImmunosuppressants; In the active phase, anticoagulantsAnticoagulants; Glucocorticoids, pro-inflammatory cytokine antagonists, JAK inhibitors, cyclosporinePrognosisSeriousHigh mortality rate

Effect of anticoagulant therapy on the course of COVID-19 in comorbid patients

Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases. Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)» (https://static-0.minzdrav.gov.ru/system/attachments/attaches/). The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs. Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.

COVID-19 and rheumatology: A year later

An enormous body of evidence on various aspects of the coronavirus disease 2019, COVID-19 associated with the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2) has been accumulated over the past year. Meanwhile, investigated relationship between COVID-19 and rheumatic immune-mediated inflammatory diseases (IMIDs) and certain identified similarities were of paramount importance. It was shown that the incidence of COVID-19 in patients with rheumatic diseases does not significantly differ from that in general population. The risk of severe course and unfavorable COVID-19 outcomes in patients with rheumatic IMIDs is significantly associated with older age and comorbidities – as in general population, and is not aggravated by preceding use of the majority of antirheumatic drugs. Gaining better insights into pathogenesis of COVID-19 provided sound prerequisites for anti-rheumatic drugs repurposing and substantiated their use for treatment of COVID-19 infection. Under current COVID-19 pandemic circumstances, accelerated development and invention of various COVID-19 vaccines offers a great hope to curb the tide of pandemic. However, the efficacy, immunogenicity, and safety of these vaccines in patients with rheumatic IMIDs must be studied in controlled clinical trials. Generally speaking, there are still numerous blind spots in our knowledge of rheumatological aspects of such a versatile and polymorphous condition as COVID-19 infection.

COVID-19 Inmate Risk Appraisal (CIRA): development and validation of a screening tool to assess COVID-19 vulnerability in prisons.

To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). Cross-sectional study with a representative sample (development) and a case-control sample (validation). The two largest Swiss prisons. (1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors). The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer. Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category “elevated risk” maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity =0.89, specificity =0.97). The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.

COVID-19 Inmate Risk Appraisal (CIRA): development and validation of a screening tool to assess COVID-19 vulnerability in prisons.

To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). Cross-sectional study with a representative sample (development) and a case-control sample (validation). The two largest Swiss prisons. (1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors). The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer. Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category “elevated risk” maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity =0.89, specificity =0.97). The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.

Covidogram as a simple tool for predicting severe course of COVID-19: population-based study

ObjectivesCOVID-19 might either be entirely asymptomatic or manifest itself with a large variability of disease severity. It is beneficial to identify early patients with a high risk of severe course....

COVID-19 in decompensated cirrhosis

Elderly patients with diabetes, hypertension and obesity are at risk of severe course of the novel coronavirus infection COVID-19. Patients with chronic liver disease are also at high risk of severe course and death due to SARS-CoV-2. Case report . Patient D., 65 years old, since 2010, was observed for Child-Pugh class B-C cirrhosis of mixed etiology (alimentary and metabolic), type 2 diabetes. He was hospitalized on May 17, 2020 due shortness of breath, increased encephalopathy and CT signs of bilateral polysegmental pneumonia, involving about 75% of the lung tissue (CT-scan indicates possible COVID-19-associated pneumonia). Despite repeated negative results of PCR test targeting SARS-CoV-2 viral RNA, the clinical picture and CT scans pointed at the novel coronavirus infection COVID-19 (virus not identified). Because of decompensated cirrhosis, the patient decided to refrain from antiviral and anticytokine therapy. Oxygen therapy, positional therapy, antithrombotic therapy (fondaparinux sodium), antibacterial therapy (ceftriaxone, then levofloxacin), infusion of 20% albumin solution and fresh frozen plasma were carried out. Due to increasing hypoxemia, the patient was transferred to the ICU and placed under mechanical ventilation. Despite all measures, he developed symptoms of multiple organ failure and died of asystole. Discussion. Mortality in chronic liver diseases, including cirrhosis, under the novel coronavirus infection caused by SARS-CoV-2, reaches 40% [4]. Factors aggravating the novel coronavirus disease in such patients include immune-mediated liver cell damage, direct cytotoxicity resulting from viral replication in hepatocytes, hypoxia, drug-induced liver injury, and reactivation of previously latent liver diseases (including hepatitis B and C virus). C onclusion . In the above clinical case, end-stage lung disease (CT stage 3–4), complicated by disseminated intravascular coagulation (DIC) syndrome, with progressive respiratory and multiple organ failure, led to the death of the patient suffering from cirrhosis and COVID-19.

Влияние SARS-CoV-2 на эндокринную систему

SARS-CoV-2 rapidly spread worldwide and resulted in an unprecedented pandemic. Considering the novelty of this disease, its potential effects on the endocrine system remain elusive. This virus is known to utilize the extracellular domain of angiotensin-converting enzyme (ACE) and transmembrane protein TMPRSS2. Broad expression of ACE-2 and TMPRSS2 is a potential cause of extrapulmonary manifestations of SARSCoV- 2, including endocrine ones. The most common presentations are direct or indirect damage of the endocrine part of the pancreas, hypothalamicpituitary- adrenal and hypothalamic-pituitary-thyroid axes, and possible long-term effects on the reproductive system. It was demonstrated that obesity and diabetes increase the risk of severe course and death in COVID-19. Similarly, patients with transitory hyperglycemia have a higher risk of severe disease course. Primary and secondary adrenal insufficiency of various origins potentially accounts for severity. The most common thyroid complications of the COVID-19 infection are euthyroid sick syndrome and transient destructive thyroiditis, including subacute thyroiditis. KEYWORDS: SARS-CoV-2, COVID-19, endocrinopathies, diabetes, adrenal insufficiency. FOR CITATION: Petunina N.A., Shkoda A.S., Telnova M.E. et al. Effects of SARS-CoV-2 on the endocrine system. Russian Medical Inquiry. 2021;5(9):575–578 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-575-578.

Pneumonia in the Covid-19 Era – Emergency Room Physician’s Perspective. Part II – Diagnosis and Therapy

In case of suspected pneumonia, as part of the work of the physician at the Emergency Department, imaging examinations and laboratory testing, including microbiological tests, can be used to confirm diagnosis. However, all diagnostic options have their limitations. Clinical and laboratory signs are nonspecific in most patients and are frequently present in other severe conditions. Biomarkers, have more value in ruling out particular etiology of infection than in establishing a definitive diagnosis. Similarly, errors in radiological interpretation occur relatively frequently. However, despite these limitations it is important that patients at high risk of severe course of disease and death receive appropriate diagnostic and therapeutic support from the suspicion of infection. The assessing of pneumonia severity is critical to make decisions regarding patient management, in particular, it is needed to decide on: site-of-care, scope of tests needed, urgency of the therapy, type of therapy. Viruses are an important cause of pneumonia and require early recognition. As a result of the global SARS-CoV-2 pandemic, patients with clinical symptoms suggestive of pneumonia are treated with the highest attention. According to instructions by the Polish Ministry of Health, the principles of triage and separation should be adapted taking into account a suspicion of Covid-19. It is important to test patients for the presence of the virus. The indications for testing as well as virological methods vary from the beginning of the pandemic, depending on the epidemiological situation. The current pandemic makes it even more difficult to manage patients with pneumonia.

Immunopathogenetic features and prognostic criteria for severe hemorrhagic fever with renal syndrome

Aim. Assessment of the features of cellular immunological mechanisms at the early stage of HFRS of varying severity and development of prognostic criteria for the risk of a severe course of the infectious process. Materials and methods. An immunological blood test (flow cytofluorimetry method) was performed in 12 patients with severe HFRS and 53 patients with moderate course in the dynamics of the disease. Statistical data processing was performed based on the SPSS software package. Results. At the initial stages of HFRS, immunological features of the severe course of the disease were established in the form of a higher content of T-helper and regulatory T-cells in the blood and a reduced number of CTL, including their activated pool. Based on these changes, an immunological prognostic coefficient of HFRS was developed, which allows determining the risk of severe course in the early days (febrile period) of the disease with high prognostic accuracy. Conclusion. The results obtained allowed us to identify previously unknown features of the immune process at the initial stages of HFRS development, which allowed us to propose a new approach to predicting the severe course of the disease.

Intra-cardiac microcomputer allows for innovative telemedicine in chronic heart failure during coronavirus disease-2019 pandemic: a case report.

Background Heart failure patient management guided by invasive intra-cardiac and pulmonary pressure measurements through permanent intra-cardiac micro-sensors has recently been published as a strategy to individualize the therapy of patients with chronic heart failure to reduce re-hospitalization and optimize quality of life. Furthermore, the use of telemedicine could have an important impact on infective disease spread during the current coronavirus disease-2019 pandemic.Case summary Emergent hospitalization of a patient with acute on chronic heart failure, who is currently in self-isolation as a result of his comorbid profile that exposes him to high risk for severe course and mortality in case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was prevented using a last generation telemedicine tool.Discussion Further implementation of invasive telemedicine could prevent hospitalization for acute decompensated heart failure and consecutive exposure to a potential hospital infection with SARS-CoV-2 in high-risk patients.

Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes

ABSTRACT Introduction Procalcitonin (PCT) is an emerging prognostic marker in coronavirus disease 2019 (COVID-19). Whether PCT can detect secondary bacterial infections or reflect target tissue injury in this setting is still unclear. Here we performed a meta-analysis to review the prognostic value of PCT for severe disease and adverse outcome events in COVID-19. Methods We searched relevant publications in online databases. Studies were included if they reported categorical data according to disease severity and/or outcomes. We analysed extracted data using fixed or random-effects meta-analysis models, as appropriate, depending on the presence of significant heterogeneity. Results Data from 14 studies (3492 patients) were included in the analysis. Overall, 163 of 256 patients with elevated PCT had severe disease (63.7%) compared with 553 of 2047 with negative PCT (27.0%) (OR: 5.92; 95% CI: 3.20 to 10.94). Elevated PCT was also associated with adverse outcomes (OR: 13.1; 95% CI: 7.37 to 23.1). PCT was increased in 22.8% and 30.6% of patients with the severe course and adverse outcome, respectively. Rates of secondary bacterial infections ranged from 4.7% to 19.5% and were associated with increased risk of severe course or fatal outcomes (OR: 20.8; 95% CI: 11.6 to 37.4). Conclusions Elevated PCT levels could identify a subset of COVID-19 patients at increased risk of severe disease and adverse outcome. Its limitations include low sensitivity and undefined cost–utility ratio. Whether PCT may be used for detecting secondary bacterial infections and guiding antibiotic therapy in COVID-19 is still undefined.