Interrelation between the parameters of endogenous vascular regulation, oxidative stress and the markers of inflammatory response in COVID-19 patients while on extracorporeal membrane oxygenation

Introduction. Extracorporeal membrane oxygenation has found wide application in clinical practice during the COVID-19 pandemic. Oxidative stress, endothelial dysfunction, and systemic inflammatory response syndrome play an important role in the pathogenesis of COVID-19. Our research was designed to study correlations in-between those factors and the impact of extracorporeal membrane oxygenation on them. Aim. The study of systemic inflammatory response and endothelial function in patients with COVID-19 during extracorporeal membrane oxygenation. Material and methods. In the course of a prospective study, we examined 100 COVID-19 patients aged 26 to 75 years, median 55 years [47;60], who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine, using extracorporeal membrane oxygenation. As a control group (normal), 25 practically healthy people whose median age was 32 years [25;39] were examined. The function of the vascular endothelium was assessed by the content of nitric oxide stable metabolites in the blood serum and the level of angiotensin-converting enzyme. Next, the ratio of nitric oxide metabolite to angiotensin-converting enzyme level was calculated, reflecting the imbalance between endothelium-dependent vasodilation and vasoconstriction. To assess the severity of oxidative stress in blood serum, malondialdehyde was determined as a marker of lipid peroxidation. The state of the antioxidant system was assessed in terms of total antioxidant status of blood serum. The presence of an imbalance in the system of lipid peroxidation and the antioxidant system total antioxidant status was judged by the oxidative stress coefficient, i.e. the ratio of malondialdehyde to the total antioxidant activity. Results. The analysis showed the presence and progression of endothelial dysfunction, impaired vascular regulation, activation of free radical processes, the presence of an imbalance in the prooxidant/antioxidant system, as well as the progression of the inflammatory process with a decrease in the level of markers of the COVID-19 severity. Conclusion. Further studies of the correlation between endothelial damage and the severity of the systemic inflammatory response syndrome may be of fundamental importance for explaining the pathophysiological mechanisms of COVID-19 course and developing new treatments for such patients. © 2023 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

Teacher's Assistant Application

With the start of the online teaching due to the COVID restrictions, the dynamics of the classes changed, and the Internet applications took a big swing in the education process. Before the COVID pandemic, teachers were forced to learn how to use web tools to deliver more productive teaching to pupils. But despite all the efforts of teachers and institutions to invest in quality online education, we are all witnesses that online instruction does not achieve the same effect as the teaching with a physical presence. We conducted several surveys in secondary and primary schools in the local area. The results lead to the conclusion that the attention of pupils and the quality of teaching is reduced compared to education with a physical presence. Teachers use paper notebooks, online teaching tools, online meeting scheduling tools, online assessment tools, and online homework tools from different sources. Surveys with teachers have also shown that they have difficulty dealing with inconsistent tools, paper records and most of the various software they use in their online teaching. This paper will examine the possibilities of the existing online applications for the above-mentioned teacher's needs. Following our survey results, we're creating an online tool that puts all the essential needs together, such as - keeping pupils' attention during classes, digitizing the teacher-led record section, quickly and easily assessing pupils, managing homeworks, working in groups on projects and automation of the previously listed processes. The main focus of this paper will be on our innovative application that will contribute to the work process of the teachers.

Training of Health Care Faculty from Medical University - Plovdiv, for Work in Moodle

The sudden transition to distance learning due to the COVID-19 pandemic has created stress, especially great for healthcare education, where practical skills are built in laboratories and real settings. Training had to be provided for the faculty as they adapted to the new situation. This article presents the results of feedback from teachers for the course "E-learning. Moodle" in terms of expected benefits, satisfaction and motivation. A comparison was made with the results of a similar training conducted in 2011, when Moodie was installed and provided to the teachers in the healthcare specialties of MU - Plovdiv. From the periods of lockdown, the academic staff came out with a lot of new knowledge and skills for working in an electronic environment For the sustainability of the pandemic-catalyzed process of digitalisation of higher education in the best way for students, training must continue and events for presenting good practice organised.

Dynamics of Students’ Opinions in the Context of the Transition to Online Learning Based on Social Network Data

The article presents the results of the analysis of users’ sentiment in social networks, performed using big data tools. The research was aimed at developing the methodology, which enables to analyze the content of social networks, assess students’ attitude to the transition to online learning in conditions of COVID-19 pandemic, identify dynamics and main trends in student satisfaction with the quality of educational process. We explored about 2 million posts and comments posted in university social networks (more than 1000 university public pages) for the period from Sept 2020 to July 2021. Special attention was paid to the problems of communication between students and teachers, strategies to solve them, an emotional reaction. PolyAnalyst software was applied for data precleaning. It has been found that the main problem affecting the quality of education is a change in the mechanisms of interaction between students and teachers. Based on student publications in social networks, we have identified the strategies for adapting students to online learning. We came to a conclusion that teachers’ support of students is crucial in preventing and solving social and academic problems in conditions of online learning. One of the ways to improve interaction between students and teachers, raise students’ involvement is using discussion forums, chats in messengers for academic purposes, and providing teachers’ methodical support. © 2022 Moscow Polytechnic University. All rights reserved.

[Guillain-Barre syndrome associated with COVID-19]. / Sindrom Giiena­Barre, assotsiirovannyi s COVID-19.

This paper reports two cases of Guillain-Barre syndrome associated with coronavirus infection COVID-19. The clinical symptoms and neurological status of patients, the data of the additional examination and the features of the prescribed therapy are described in detail. The issue of the tropicity of the SARS-CoV-2 virus to human nervous tissue and its possible ways of affecting the peripheral nervous system is discussed.

Teacher's Assistant Application

With the start of the online teaching due to the COVID restrictions, the dynamics of the classes changed, and the Internet applications took a big swing in the education process. Before the COVID pandemic, teachers were forced to learn how to use web tools to deliver more productive teaching to pupils. But despite all the efforts of teachers and institutions to invest in quality online education, we are all witnesses that online instruction does not achieve the same effect as the teaching with a physical presence. We conducted several surveys in secondary and primary schools in the local area. The results lead to the conclusion that the attention of pupils and the quality of teaching is reduced compared to education with a physical presence. Teachers use paper notebooks, online teaching tools, online meeting scheduling tools, online assessment tools, and online homework tools from different sources. Surveys with teachers have also shown that they have difficulty dealing with inconsistent tools, paper records and most of the various software they use in their online teaching. This paper will examine the possibilities of the existing online applications for the above-mentioned teacher's needs. Following our survey results, we're creating an online tool that puts all the essential needs together, such as - keeping pupils' attention during classes, digitizing the teacher-led record section, quickly and easily assessing pupils, managing homeworks, working in groups on projects and automation of the previously listed processes. The main focus of this paper will be on our innovative application that will contribute to the work process of the teachers. © 2022 IEEE.

Using Agent-Based Simulator to Assess Interventions Against COVID-19 in a Small Community Generated from Map Data

During the COVID-19 pandemic, governments have struggled to devise strategies to slow down the spread of the virus. This struggle happens because pandemics are complex scenarios with many unknown variables. In this context, simulated models are used to evaluate strategies for mitigating this and future pandemics. This paper proposes a simulator that analyses small communities by using real geographical data to model the road interactions and the agent's behaviors. Our simulator consists of three different modules: Environment, Mobility, and Infection module. The environment module recreates an area based on map data, including houses, restaurants, and roads. The mobility module determines the agents' movement in the map based on their work schedule and needs, such as eating at restaurants, doing groceries, and going to work. The infection module simulates four cases of infection: on the road, at home, at a building, and off the map. We simulate the surrounding areas of the University of Tsukuba and design three intervention strategies, comparing them to a scenario without any intervention. The interventions are: 1) PCR testing and self-isolation if positive;2) applying lockdown measures to restaurants and barbershops 3) closing grocery stores and restaurants and providing delivery instead. For all scenarios, we observe two areas where most infection happens: hubs, where people from different occupations can meet (e.g., restaurants), and non-hubs, where people with the same occupation meet (e.g., offices). The simulations show that most interventions reduce the total number of infected agents by a large margin. We observed that interventions targeting hubs (2-4) did not impact the infection at non-hubs. In addition, the intervention targeting people's behavior (1) ended up creating a cluster at the testing center. © 2022 International Foundation for Autonomous Agents and Multiagent Systems (www.ifaamas.org). All rights reserved

Eighteen Months Follow-up In Patients With Tachycardia-induced Cardiomyopathy

One of the causes of chronic heart failure (HF) may be tachycardia-induced cardiomyopathy (TIC) - a heart disease that occurs with persistent supraventricular tachyarrhythmia, characterized by partially or completely reversible dysfunction and dilatation of the ventricles. The long-term prognosis in these patients is poorly understood. Objective: To evaluate the rate of rehospitalisation and the dynamics of the left ventricular ejection fraction in patients with TIC in 6 to 18 months after discharge from the hospital. Materials and methods: A retrospective analysis of patients diagnosed with TIC was carried out from January 2019 to February 2021. The diagnosis of TIC corresponded to the following signs: a stable tachycardia with more 100 beats per min;left ventricular ejection fraction (LVEF) <45%;exclusion of other causes of heart failure;partial or complete restoration of LVEF after restoration and maintenance of sinus rhythm or heart rate control. Patients were monitored by phone calls and called for follow-up of a transthoracic echocardiography. A total of 52 patients were examined, including 40 men (76.9%) 64.4 ± 10.3 (33;88) years old. The most common cause of TIC was atrial fibrillation, recorded in 48 (92.3%) patients, in 4 (7.69%) patients - atrial flutter. In 46 (88.5%) patients, arterial hypertension was previously diagnosed, and in 12 (23.1%) cases - type 2 diabetes mellitus. Initial LVEF at hospitalization was 40.3 ± 8.2%, while LVEF <35% was recorded in 15 (28.85%) patients. Patient management was in accordance with clinical guidelines. Patients were treated during an episode of tachyarrhythmia and after restoration of sinus rhythm. Dynamic monitoring of echocardiography was possible in 26 patients. Differences were considered statistically significant at p <0.05. Results: The average follow-up period was 18,4 ± 6 [4;27] months. With control echocardiography in 17 (32.69%) people the LVEF was more than 45%. During the observation period, 7 patients (13.46%) died, non-cardiovascular causes predominated in the mortality structure: in 4 patients (7.69%), death was due to oncopathology and in 1 patient (1.92%) due to coronavirus infection. The mean value of LVEF with control echocardiography was 47.8 ± 9.3% [31;66] (p <0.0001) (Pic.1). In 3 (3.85%) patient, LVEF remained <35%. In 5 (9.62%) patients, LVEF after treatment increased, but remained <45%. Conclusion: The data of the presented long-term follow-up of patients with TIC indicate a favorable course in most cases, regardless of (or in despite of) the initial LVEF.

Course in E-learning and Moodle for Academic Staff - Development, Provision, Evaluation, Satisfaction

The COVID-19 pandemic created challenges for education systems. Many university lecturers did not have enough training to teach in an electronic environment, for others there was no such experience at all. This paper discusses the evaluation of a course "E-learning. Moodle." designed to prepare faculty to teach online and users' satisfaction with the training. The influence of demographic and professional factors was analysed. Results indicate that confidence in computer skills and pedagogical qualification are strong predictors of the success of such training. Micro-learning with short video clips is most suitable.

Myocardial infarction versus COVID-19 blood secretome

Background: Both myocardial infarction (MI) and COVID-19 are characterized by cytokine storm in blood. Purpose: The objective of this study was to compare the concentration of 39 cytokines, chemokines, and growth factors in blood sera of patients with MI, COVID-19 (COV), and healthy donors. Methods: Patients' blood was collected within 1-2 days after hospitalization in the cardiovascular or COVID intensive care units. All COV patients were in a severe condition;all had increased C reactive protein, 86 and 95% had increased ferritin and D-dimers levels accordingly, 8-10 times decreased lymphocyte numbers. The analysis of the humoral factors in blood serum of MI (n=22), COV (n=23) and donors (n=27) was performed using a 39-plex cytometric analysis. Results: Among all factors analyzed TGFa, IL-1b, 2, 3, 5, 9, 13, 17A were almost not detectable both in patient and donor sera. The concentrations of the other 31 humoral factors in normal sera differed significantly from 0 to 22000 pg/mL. We divided them into house-keeping factors HKF ranged from 1000 to 22000 pg/mL;sentinel innate immunity factors SIF (30-200 pg/mL), and acute phase factors APF (0-30 pg/mL). HKF were detected in all samples. Among SIF and APF IL-1a, G-CSF, IFNa2, IL-7, MIP-1a, IL- 12, and IFNg were detected in 56-80% donor blood while IL-1RA, MCP-3, IL-2, 6, 10, 12, 15, FLT-3F, GM-CSF, TNF-b - only in 10-55%. At the same time all MI patients were 100% positive in all these factors showing extensive activation of blood secretome. Among low incidence APF cytokines in COV patients, percentage of IL-1RA, MCP-3, IFNa2, IL-6, 10, 15, FLT-3L negative sera decreased 3-5 times;and all sera were positive for MIP-1a and IL-12. At the same time TNF-a level decreased significantly from 0 in control to 85% of negative sera in COV patients. Summarized results are shown as the ratios of factor concentrations in MI or COV sera to normal control (Fig). Blood secretome of MI changed more significantly than of COV patients. The major factors (shown in red) in MI were IL-6, IL-12, IFNg, FLT-3L, GM-CSF, and IL-15, which increased 12, 9, 6, 6, 6, and 5 times accordingly. In COV sera IL-6, IL-10, IP-10, and MCP-3 increased by 28, 12, 10, and 9 times accordingly. Less expressed however significant increases are marked with asterisks. Conclusions: Acute MI is characterized by severe disturbances in blood secretome with an increased level of 25 out of 39 factors studied. Contrary to it, in COV patients the levels of IL-6, 10, IP-10, and MCP-3 were more enhanced while only 15 out of 31 exceeded normal levels.

Two types of humoral response in acute myocardial infraction

Background: Atherothrombosis and myocardial infarction are accompanied by the development of an inflammatory reaction. The severity of the immune reaction and its role in the acute myocardial infarction (AMI) remain contradictory to date. Purpose: The objective of this study was to analyze 39 cytokines and chemokines in the serum of patients hospitalized with AMI compared to the healthy volunteers. Methods: All patients included in the study were COVID-19 negative. Patients' blood was collected within 1-2 days after hospitalization in the cardiology department. Cytokine and chemokine detection in the serum of patients (n=20) and donors (n=20) was performed using a 39-plex set of cytometric beads. Results: Among all factors analyzed TGFa, IL-17A, IL-1b, 3, 5, 9 were not detected both in patient and donor sera. Three groups of factors were identified in the normal serum: housekeeping chemokines and vascular factors (F1) ranged from 1000 to 22000 pg/mL (Fig. a);sentinel innate immunity factors F2 (Fig. b), 30-200 pg/mL;and acute phase factors F3 (Fig. c, d), 0-30 pg/mL, detected only in 0-30% of donors but in all AMI patients. Severe imbalance was found in AMI sera at all three levels including chemokine, growth factors, and cytokines. Among AMI patients 65% (Gr1) demonstrated 2-4 times increased level (Fig. a, grey brackets) while 35% (Gr2) had a decreased level of F1 factors in a comparison with donor sera. There was not significant difference between clinical features of the patients in Gr1 and Gr2. GRO, PDGF-AA, and sCD40L levels decreased 35, 15, and 10 times accordingly. Gr1 and Gr2 also differed in F2 and some F3 concentrations: Gr1 had 3-5 times increased level of multiple factors (Fig, b), among them - IL-6, IL-8, and IL-10 were increased 5, 6, and 14 times. At the same time Gr2 had a normal level of these factors (Fig, b, blue brackets). Finally, multiple cytokines and growth factors F3 were significantly increased in both AMI groups (Fig, b, d, red brackets). Of note, IL-12, IFN-g, IL-15, GM-CSF, FLT-3T were increased 8, 6, 5, 5, 5 times accordingly in pooled Gr1+Gr2. There were no correlations found between cytokine profiles in Gr1 and Gr2 and their clinical parameters. Conclusions: Two types of humoral response in AMI patients were identified which differed in the levels of GRO, PDGF-AA, and sCD40L. IL-6 as well as TNF-a can not serve as master cytokines because their levels were increased only in Gr1 patients. These data show that Th1 cytokine increase is specific for AMI. Further studies are needed to identify groups of patients who may be exposed to new therapeutic targets.

COVID-19 and lessons from multi-hazard early warning systems

Having a common framework for early action to cope with complex disasters can make it easier for authorities and other stakeholders, including populations at risk, to understand the full spectrum of secondary and tertiary effects and thus where to focus preparedness efforts, and how best to provide more targeted warnings and response services. Meteorological and hydrological services world-wide have developed and implemented Multi-Hazard Early Warning Systems (MHEWS) for weather and climate related hazards that are now being expanded and transitioned towards Multi-Hazard Impact-based Early Warning Systems (MHIEWS). While it is still early days it is becoming clear that there are useful lessons from this approach in the COVID-19 global pandemic, and some valuable insight to be gained in risk communication, risk analysis and monitoring methodologies and approaches. The ability to understand and respond effectively to warnings through appropriate behaviours and actions is central to resilient societies and communities. By avoiding physical, societal and economic harm to the greatest extent possible, recovery from a hazard is likely to be faster, less costly and more complete. MHIEWS can be a common approach for all hazards and therefore more likely to become a trusted tool that everyone can understand and use as a basic element of their national disaster risk management system. The interconnectedness of hazards and their impacts is a strong motivator for a common approach. One of the lessons from the COVID-19 pandemic and extreme weather events is the need to understand the vulnerability of individuals, communities and societies so as to provide reliable, targeted guidance and warnings and the willingness and capacity to prepare for a reasonable worst-case scenario based on informed long-term planning. Meteorology and hydrology are making good progress in this direction and the process can be readily applied to health and other sectors.