[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

Aim      To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods  The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion      Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

DECENTRALIZED FINANCE (DEFI) AS THE BASIS FOR THE TRANSFORMATION OF THE FINANCIAL SECTOR OF THE FUTURE

The paper discusses the influence exerted by financial systems on the change of the financial sector and its further development. The study is relevant since there is need for building up more trust in blockchain. In the course of the research, the main trends of decentralized financial systems were identified and presented, including the problems related to decentralized financial systems and options for resolving them. The study is aimed at defining the problems and searching for ways to tackle them when regulating decentralized finances (DeFi) in order to ensure effective regulation on the part of the Central Bank and control risks. Rather than eliminating the need for regulation, DeFi, in fact, has to be regulated so as to achieve its main decentralization goal. In addition, DeFi presents a potential possibility for developing a fairly new regulation method: the idea of "integrated regulation". The paper considers various approaches to regulation, which can be integrated in the DeFi design. It can potentially lead to the decentralization of both finance and its regulation, which eventually expresses RegTech (Regulatory Technology), which is used by financial organizations for being able to meet the requirements of the regulator more easily. The study defines the problems that are encountered in the course of using DeFi and points out the possible ways for dealing with them, including a way for switching to blockchain independently so that the transaction is not charged in ETH for calculation on blockchain;reducing the complexity and costs of use and understanding of DeFi software by most users. A whole lot of risks that decentralized financial protocols are susceptible to is analyzed: vulnerabilities in the code security of smart contracts, their stacking and layout;oracle risk, which is subject to manipulation in the process of data transfer;the financial risk of high volatility, regulatory risk and crisis of the global economy due to the inability to predict in which way the Covid-19 pandemic is going to be resolved. © 2021 ACM.

Three pandemics at once: Noninfectious (cancer), infectious (COVID-19), and behavioral (hypokinesia)

The narrative review addresses the evidence that physical activity can improve the results of prevention and treatment and of the conditions that feature increased risks of their development with aging. The main attention is paid to cancer and problems arising because of physical activity limitations associated with COVID-19 pandemic. To promote physical activity, which is known to reduce the risks of COVID-19 complications and of cancer, it is important to help patients and physicians in understanding the reasons why physical activity can be beneficial, more than the pharmacological means thought to reproduce some of its effects, in cancer prevention and treatment upon all differences between the locations of tumors and the pathways of carcinogenesis. Therefore, the physiological and molecular mechanisms behind the usefulness of physical activity in oncology are discussed. Based on this discussion, data on quantitative relationships between oncological risks, physical activity, and the use of its alleged pharmacological mimetics are addressed. © 2021 Izdatel'stvo Meditsina. All rights reserved.

Brain morphological changes in covid-19

The aim of the study was to identify the pathomorphology of brain damage in patients who died of COVID-19. Material and methods. Autopsy reports and autopsy brain material of 17 deceased patients with pre-mortem confirmed COVID-19 infection were analyzed. Fatal cases in which COVID-19 was the major cause of death were included in the study. Five people were diagnosed with cerebral infarction. Organ samples were taken for histological examination during autopsy. Sections were stained with hematoxylin and eosin and by Nissl to assess brain histopathology. To study the vascular basal membranes the PAS reaction was used, to detect fibrin in vessels phosphotungstic acid-hematoxylin (PTAH) staining was used, to determine DNA in nuclei sections were stained according to Feulgen, to detect RNA in neuronal nuclei and cytoplasm sections were stained with methyl green-pyronin. Immunohistochemical study of a neuronal marker, nuclear protein NeuN, was performed to assess neuronal damage. Results. The signs of neuronal damage found in patients who died of COVID-19 included nonspecific changes of nerve cells (acute swelling, retrograde degeneration, karyolysis and cytolysis, ‘ghost' cells, neuronophagia and satellitosis) and signs of circulatory disorders (perivascular and pericellular edema, diapedesis, congested and engorged microvasculature). Conclusion. Brain histopathological data indicate damage to the central nervous system in COVID-19 patients. Ischemic stroke in patients with COVID-19 is mostly caused by a combination of hypoxia resulting from respiratory failure and individual risk factors, including cerebrovascular atherosclerosis and hypertension.

CLINICAL AND HISTOPATHOLOGICAL FEATURES OF LUNG IN JURY IN COVID-19 INFECTION

The aim of the study was to evaluate the histopathological changes in the lungs of patients who died of a new coronavirus infection (COVID-19) in relation to the length of hospital stay. We evaluated lung autopsy material, autopsy reports, and death summaries of 39 patients who died of COVID-19. The length of hospital stay ranged from a few hours to 25 days. At all stages of the disease, lung alterations (desquamation of bronchial and alveolar epithelium), circulatory disorders (alveolar edema and hemorrhages, congestion in small blood vessels, thrombosis), compensatory response (fibrosis) were identified. The patients who died during the first week of hospitalization demonstrated predominant signs of circulatory disorders (alveolar edema, hyaline membranes, alveolar hemorrhages, congestion in small blood vessels). Fibrosis, usually not typical for the first week of acute respiratory distress syndrome, was detected in 46% of the deceased during the first week of hospitalization, which may be due to late hospitalization or patterns of fibrosis development in COVID-19. For those who died in the 2nd and 3rd weeks of hospitalization, the compensatory response and progression of fibrosis were noted. By the 3rd week, pulmonary fibrosis was detected in 91% of patients. Thrombotic complications (thrombosis, pulmonary artery thromboembolism) were observed in almost half of fatalities occurring during weeks 2-3. Hemorrhagic infarction was found in 43% (6 patients) who died during week 2 of hospitalization, three of them were diagnosed with pulmonary embolism, indicating progression of pulmonary vascular damage.

Dicom network implementation and usage in the context of the covid-19 pandemic

This article is targeted to show solutions based on the technical information technologies to help patients, medical professionals and institutions for using DICOM Network application in the context of special requirements during pandemic. The objective of the study was to show how to minimize contacts with the patients by using telemedicine and online consultations based on the information technologies solutions. Material and methods. The data used in this study are based on the DICOM Network informational system, that is targeted to collect medical images based on DICOM format. This system collects all type of DICOM investigations, including tomography investigations, X-Ray images, ultrasonography and others. The average flow of the data is about 10 TB per year. In this study, we used input data collected by this system from 4 medical institutions. Results. There were defined the gaps in the existing software solutions for telemedicine. Based on the existing workflow analysis and urgent requirements of the medical institutions with COVID-19 patients, it was implemented a set of new modules and functionalities for existing DICOM Network system to limit direct contacts with the patients and to reduce the costs of the imaging investigations. Conclusions. All the DICOM Network changes were done in parallel with the spreading of the pandemic "on the fly", but all the functionalities were implemented in time and have helped, on one hand, to reduce the direct contact of physicians with the infected patients and, on the other hand, to reduce the costs for an investigation for about 2 EUR per investigations and 3000 EUR per month only for X-Ray investigations for COVID-19 patients. Copyright © 2021 Balkan Medical Union.

Theory and Practice of Aging during the COVID-19 Pandemic

Abstract: Never before in history has population aging been a driving factor in epidemics to the same extent as with the current COVID-19 pandemic, with its dramatic shift in mortality towards older age groups. The paper presents the results of an analysis of the COVID-19-related mortality data for Spain, Italy, and Sweden, which show that within the 30- to 90-year age range, the logarithms of mortality rate depend on age linearly, and all regression lines are strictly parallel to the lines corresponding to the dependencies of the general mortality on age in accordance with the Gompertz law. In all cases, irrespective of the countries and epidemic stages, the mortality doubling times within this age range are close to 7.5 years. The probabilities of infection with the SARS-CoV-2 coronavirus, the causative agent of COVID-19, and of the development of the clinical symptoms of infection depend on age to a much lesser extent. Based on these observations, three main points are proposed for discussion: (1) Older people have become the main victims not only of SARS-CoV-2 itself but also of the measures undertaken to prevent its spread;(2) At the same time, older people are not the main force driving the spread of SARS-CoV-2, and (3) Older people can and should participate in the fight against the pandemic and in overcoming its consequences, but not through their selective isolation and other forms of discrimination. People over 65 years of age make up a considerable segment of the population and have at least as much right as other age groups to have their needs and interests be respected and observed, including the right to as high quality of life as is accessible even in extreme situations. The prospects for full control over SARS-CoV-2 are vague. This is why those who are in charge of decisions that concern people over 65 years of age should mind that, unlike the situation in the Middle Ages, the age of 65+ is the individual future of almost everyone. © 2020, Pleiades Publishing, Ltd.

THEORY AND PRACTICE OF AGING UPON <i>COVID</i>-19 PANDEMIC

Never before in history, aging was such a significant factor for epidemics as it is now for the current COVID -19 pandemic, which features a drastic shift of mortality towards older ages. Our analysis of data on COVID -19-related mortality in Spain, Italy, and Sweden has shown that, in the range of 30 to 90 years of age, each dependency of the logarithm of mortality upon age is linear, and all regression lines are strictly parallel to those related to the total mortality in accordance with the Gompertz law. In all cases, irrespective of the stage and place of epidemic, mortality doubling time in this age range is close to 7,5 years. The rates of being infected with the SARS-CoV- 2 coronavirus and of being diagnosed due to the symptomatic manifestations of the infection are dependent on age to a far lesser degree. With account for these observations, three messages are put forth: 1) Older persons are the principal victims of both SARSCoV- 2 and measures undertaken to control its spread;2) Older persons are not the principal driving force of SARS-CoV- 2 spread;3) Older persons can and should be engaged in combating the pandemic and its consequences;however, not via selective social distancing and other discriminative measures. People aged over 65 years constitute a signifi cant part of the current population. They have specific interests and needs, which deserve no less respect than those of any other age group. This includes the right for the quality of life that remains sustained under the emergency conditions. Since the prospects for controlling the SARS-CoV- 2 are dubious, those in charge of decisions concerning «people aged above 65» should mind that currently, unlike in the medieval ages, 65+ is the individual future of almost everyone. Никогда прежде в истории старение населения не было фактором развития эпидемий в такой степени, как при текущей пандемии COVID -19 с ее резким сдвигом смертности к старшим возрастным группам. Представленные в настоящей статье результаты анализа данных по смертности от COVID -19 в Испании, Италии и Швеции показывают, что в диапазоне 30-90 лет зависимости логарифмов смертности от возраста ложатся на прямые, строго параллельные линиям зависимости общей смертности от возраста в соответствии с законом Гомпертца. Во всех случаях, независимо от стадии эпидемии и страны наблюдения, периоды удвоения смертности в этом возрастном диапазоне близки к 7,5 годам. Вероятности заражения возбудителем COVID -19, коронавирусом SARS-CoV- 2, и симптоматического проявления инфекции зависят от возраста в гораздо меньшей степени. На этих основаниях обсуждены три положения: 1) люди пожилого возраста стали главными жертвами не только самого SARS-CoV- 2, но и мер, предпринимаемых против его распространения;2) при этом люди пожилого возраста не являются основными агентами распространения SARS-CoV- 2;3) люди старшего возраста могут и должны быть включены в борьбу с пандемией и в преодоление её последствий, но не путем избирательной изоляции и других форм дискриминации. Люди старше 65 лет составляют значительную часть населения и имеют не меньшее, чем граждане другого возраста, право на уважение и соблюдение их нужд и интересов, включая право на качество доступной жизни даже в экстремальных ситуациях. Перспективы полного контроля SARS-CoV- 2 неясны. Поэтому всем, кто принимает решения относительно лиц старше 65 лет, надо иметь в виду, что в настоящее время, в отличие от средневековья, 65+ - это личное будущее практически для каждого.

[Theory and practice of aging upon COVID-19 pandemic.]

Never before in history, aging was such a significant factor for epidemics as it is now for the current COVID-19 pandemic, which features a drastic shift of mortality towards older ages. Our analysis of data on COVID-19-related mortality in Spain, Italy, and Sweden has shown that, in the range of 30 to 90 years of age, each dependency of the logarithm of mortality upon age is linear, and all regression lines are strictly parallel to those related to the total mortality in accordance with the Gompertz law. In all cases, irrespective of the stage and place of epidemic, mortality doubling time in this age range is close to 7,5 years. The rates of being infected with the SARS-CoV-2 coronavirus and of being diagnosed due to the symptomatic manifestations of the infection are dependent on age to a far lesser degree. With account for these observations, three messages are put forth: 1) Older persons are the principal victims of both SARS-CoV-2 and measures undertaken to control its spread;2) Older persons are not the principal driving force of SARS-CoV-2 spread;3) Older persons can and should be engaged in combating the pandemic and its consequences;however, not via selective social distancing and other discriminative measures. People aged over 65 years constitute a significant part of the current population. They have specific interests and needs, which deserve no less respect than those of any other age group. This includes the right for the quality of life that remains sustained under the emergency conditions. Since the prospects for controlling the SARS-CoV-2 are dubious, those in charge of decisions concerning «people aged above 65» should mind that currently, unlike in the medieval ages, 65+ is the individual future of almost everyone.