The Effect of COVID-19 on Long-Term Cardiac Function in Patients With Chronic Heart Failure.

Aim      To evaluate functional changes in the heart in the long-term following COVID-19 in patients with chronic heart failure (CHF).Material and methods  Case reports of 54 patients aged 69.1±9.7 years who had COVID-19 from January 2021 through January 2022 and had been previously diagnosed with NYHA functional class II-III CHF were studied. Two comparison groups were isolated: HF with LV EF >50 % (n=39) and <50 % (n=15). Echocardiography was used to evaluate changes in LV EF and pulmonary artery systolic pressure (PASP) 5-6 months following COVID-19.Results In all CHF patients after COVID-19 at 5.8 months on average, LV EF decreased (median difference, 2.5 %; 95 % confidence interval (CI): 6.99×10-5- 4.99) and PASP increased (median difference, 8 mm Hg; 95 % CI: 4.5-12.9). In the HF group with LV EF <50 %, the decrease in EF was greater than in the group with LV EF >50 % (6.9 and 0.7 %, respectively; p=0.037); furthermore, the CHF phenotype did not influence the change in PASP (p=0.4). The one-factor regression analysis showed that the dynamics of LV EF decrease was significantly influenced by the baseline decrease in LV EF, whereas the change in PASP was influenced by the dynamics of LV EF decrease, presence of dyslipidemia, and statin treatment. Furthermore, the multifactorial analysis showed that prognostically significant factors for long-term changes in LV EF following COVID-19 were male gender (odds ratio (OR), 5.92; 95 % CI: 1.31-26.75; p=0.014), LV EF at baseline <50 % (OR, 0.88; 95 % CI: 0.8-0.96; p<0.001); changes in PASP depended on the presence of dyslipidemia (OR, 0.08; 95 % CI: 0.01-0.84; p=0.018).Conclusion      This study showed that COVID-19 in the long term can influence the course of CHF; in this process, HF patients with EF <50 % have progression of systolic dysfunction and PASP, whereas patients with EF >50 % have an isolated increase in PASP.

IL-2 (T330G) gene promoter polymorphism and its effect on lymphocyte-platelet adhesion in patients with coronavirus infection SARS-COV- 2 (COVID-19)

Background: Cytokines are signaling molecules and involve lymphocytes and macrophages in the immune response. Lymphocyte-platelet adhesion is one of the mechanisms that ensure the cooperation of various subpopulations of cells and allow them to migrate through the vascular wall into the tissue. Aim(s): To study the function of lymphocyte-platelet adhesion depending on SNP of IL-2 (T330G) gene in healthy subjects and patients with COVID-19. Method(s): The research involved 168 patients with COVID-19 and 100 healthy people of the same age and gender. The participants of the study were Caucasian race and lived in the Trans-Baikal Territory. The examine of LPA was carried out by the method of Yuri Vitkovsky et al. (1999). The SNP of IL-2 (T330G) gene was determined by PCR. Such methods as Equilibrium Hardy-Weinberg, chi2-test, odds ratio descriptive statistics and the mean values (M) and standard deviation (SD) were used. Statistical significance was measured at the value p < 0.05. Result(s): We found all the studied IL-2 mutations in accordance with the Hardy-Weinberg law (p>0.05). The heterozygous T/G of IL-2 gene was registered significantly more frequently in the group of patients in comparison with the control group. Based on the obtained data on frequency distribution, the chance of developing SARS-COV- 2 increased in carriers of the allele T and the T/T genotype of IL-2 gene (p < 0.001). It was found that patients with SARS-COV- 2 had an increase in the LPA index compared to the group of healthy individuals (15.2 +/- 1.1%). The maximum amount of LPA was detected among patients with T/T genotype -39.7 +/- 2.1%, the minimum amount -in the owners of G/G (31.4 +/- 1.9%) (p< \0.001). Conclusion(s): 1) SARS-COV- 2 is accompanied by an increase in LPA function indicators, which depend on SNP of IL-2 (T330G) gene. 2) Carriers of allele T and T/T genotype of IL-2 gene (T330G) predispose to the development of COVID-19.

Immunological efficacy and tolerability of vaccination in patients with noncommunicable diseases

Aim. To study the efficacy and tolerability of Sputnik V vaccination in patients with noncommunicable diseases (NCDs) compared with healthy individuals. Material and methods. The retrospective analysis included data from 800 men and women aged 18 to 90 who were vaccinated from February to May 2021 at the National Medical Research Center for Therapy and Preventive Medicine. Sputnik V (Gam-COVID-Vac, Russia), consisting of two doses, was used as a vaccine. The mean age of the patients was 50,46±13,16 years. Patients were questioned in two stages: Before vaccination and after the first dose of vaccination. The following clinical and paraclinical investigations were carried out: Saturation assessment, measurement of temperature, blood pressure and heart rate at rest, pharynx examination, auscultation of the heart and respiratory organs. The blood concentration of antibodies (IgM and IgG) was determined after 21 days and 42 days. For analysis, patients were divided into three groups. The first group included healthy individuals (n=238, 29,8%), the second group — patients with one NCD (n=385, 48,1%), and the third group — patients with two or more NCDs (n=177, 22,1%). Results. The sex composition was comparable in all three groups, while the mean age differed. In the first group, the mean age was 43,93±10,80 years, while in the second and third groups — 50,51±12,55 and 59,12±12,37 years, respectively (p<0,001). Statistical analysis was performed with adjustment for age and sex. The median blood concentration of immunoglobulin G of vaccinated individuals of the cohort after 21 days was within 4,60 [2,00;8,40]. A comparative analysis of the groups did not reveal significant differences. After 42 days, the median concentration of immunoglobulin G increased by 4 times, which is significant (p<0,001) and amounted to 16,20 [15,80;16,40]. In the group of healthy individuals, the concentration of immunoglobulin G was significantly higher compared to groups of individuals with one, as well as two or more NCDs. Forty-two days after vaccination, the concentration of immunoglobulin M both in the cohort and in individual groups did not change significantly compared to the level after 21 days. In addition, 47%, 38% and 40% of participants from the first, second and third groups, respectively, reported some symptoms. A temperature increase on average was detected in 13% of vaccinated individuals. The largest number of persons with fever was registered in the group of healthy individuals — 19%, in the group of patients with one NCD — 14%, and in the group with two or more diseases, the temperature increase was the lowest and amounted to 3% (p<0,001). After the first dose, 18,6% of patients reported taking additional drugs as follows: First group — 23,9%, second group — 15,1%, third group — 19,2%. These are mainly analgesic, non-steroidal anti-inflammatory and antihistamine drugs. Conclusion. Vaccination with Sputnik V increases the immunoglobulin G level in the blood after 42 days by four times compared to after 21 days. This pattern is observed both in the group of healthy individuals and in patients with one, two or more chronic NCDs. Tolerability of vaccination in all groups was comparable and did not lead to visits to healthcare facilities.

The experience of online therapeutic education for parents of children with type 1 diabetes during the COVID-19 pandemic

Introduction: The therapeutic education for patients with type 1 diabetes (T1D) is an integral part of achieving good metabolic control, which has significant limitations during a pandemic. Objectives: To assess distant therapeutic education for parents of children and adolescents with T1D in the Moscow region (the total area of which is 44,329 km2, the number of children population - 1,489,778 people, the number of children with T1D - 2,520). Methods: The education was organized by Public Organization “Russian Diabetes Association” and supported by charitable Alfa-Endo Program (as a part of CAF). For 9 months pediatric endocrinologists, psychologist and representatives of patients' organizations conducted educational online workshops (webinars) for 176 parents of children with T1D. The program consists of 8 webinars including insulin therapy, food, glycaemia self-monitoring, physical activity, CSII, CGM system, psychological issues. Informational support was also provided by telephone messenger (WhatsApp) for any participants' questions. After educational program the parents were asked to fill out an online questionnaire to assess their satisfaction with the distant educational program. Results: The responses were received from 144 parents (81,8% of all participants). All respondents highly appreciated the webinars with very important information for them, convenience of online training, interactive style, friendly environment, immediate feedback on any questions. The participants advised to expand the program by discussions of clinical cases, provide new data about possibility to cure T1D, include more social and psychological support sessions, continue the training program in future. Conclusions: Interactive educational webinars were very useful and important for families of children with T1D in the conditions of COVID-19 pandemic. This successful experience of distance training would be useful for all large regions.

Lymphocyte-platelet adhesion and lymphocyteplatelet clusters in patients with coronavirus infection SARSCOV-2 (COVID-19)

Background : Lymphocyte-platelet adhesion (LPA) is the ability of lymphocytes with CD3 + , CD4 + , CD16 + cell surface markers to form coaggregates with platelets using adhesion molecules, that allows lymphocytes to adhere to the damaged endothelium and migrate into the damaged surface of the vascular wall. Aims : Investigation of the amount of lymphocyte-platelet aggregates and lymphocyte-platelet clusters in patients with COVID-19. Methods : The research involved 168 patients with SARS-CoV-2 (COVID-19) and 100 healthy people of the same age and gender. Patient ' s blood samples were taken on the 1st-2d, 10th-12th, 21st-24th days. The participants of the study were Caucasian race and lived in the Trans-Baikal Territory. The examine of LPA was carried out by the method of Yuri Vitkovsky et al. (1999). The number of lymphocyte-platelet clusters (LPC) was estimated and expressed in rel. units per 100 free-standing cells. The results were expressed in averages and the standard deviation (M ± SD) was calculated. Significant differences were considered for P < 0.05. Results : The authors revealed that on the 1st-2d day of disease among patients the number of LPA increased to 28.9 ± 3.2%, LPC -to 5.0 ± 2.3% as compared with the control group ( P < 0.001). The average platelets volume LPA-rasio also increased by 2.9 times ( P < 0.05). Among patients during 10-12 days of the disease there was a notable increase of LPA and LPA-rasio up to 41.3 ± 1.9% and 5.8 ± 0.48 respectively (higher by 3 times as compared to the control group). On the 21-24th days of the disease with patients being in the hospital, there were no significant differences in the studied parameters among the patients and the control group. Conclusions : There is an increase in the ability of lymphocytes to adhere platelets to their surface and contact with other lymphocytes while forming clusters in the acute phase of COVID-19. Probably the process of clustering is mediated by platelet and leukocyte adhesive molecules.