Reassessment of disease severity routine laboratory tests in the COVID-19 infection

Introduction. Publications demonstrate some limitations of National Early Warning Score 2 (NEWS-2) accuracy in assessment on coronavirus infection severity. The purpose of this study was to determine the value of the patient’s age and routine laboratory parameters in the assessment of patient’s general condition in coronavirus pneumonia and their relation to NEWS-2 scale parameters. Materials and methods. 50 case reports of patients with COVID-19 infection observed in the Sechenov University in January–March 2021 were analyzed. 34 % of patients were males aged 31 to 89 years (average age 55 years) and 66 % — females aged 40 to 91 (mean age 63). The diagnosis of pneumonia was confirmed by computed tomography. NEWS-2 scale total score was assessed. Results. According to the physician’s subjective assessment the condition was significantly more often assessed as moderate and severe. There was only a weak correlation between the blood oxygen saturation and the total NEWS-2 score (r = 0.165, α = 0.1). We found a mild correlation (r = 0.341, α = 0.1) between the patient’s age and NEWS-2 score. Among the most significantly interrelated parameters were age, neutrophil count, serum creatinine, CRP, fibrinogen level. Seven interrelated parameters (age, body temperature, blood oxygen saturation, the neutrophils count, creatinine, CRP, fibrinogen), for which a reliable relation with other tests has been shown, were assigned with its special index according to their contribution to the assessment of the overall condition severity. An aggregated score (criterion X) was proposed for assessment of disease severity according to equation. The proportions of mild, moderate, and severe cases according to criterion X were 12 %, 64 % and 24 %. Conclusion. The preliminary results obtained in the study emphasize the importance of routine laboratory tests in assessment of coronavirus infection severity. An evident discrepancy between NEWS-2 score and X criterion may be very important for practice. © Russian Journal of Neurosurgery.All rights reserved.

CLINICAL AND MORPHOLOGICAL FEATURES OF KIDNEY DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION DIED OF SARSCOV- 2 INFECTION

Objective: To assess clinical and pathomorphological features of kidney damage in patients with arterial hypertension (AH) who died of the new coronavirus infection COVID-19. Design and method: A complex analysis of 268 kidney autopsies was carried out, including the study of macro- and microscopic changes reflected in the protocols of pathological and anatomical autopsies and identified during the histological examination. In 224 patients (83.6%) with AH, the diagnosis was confirmed by isolating the SARS-CoV-2 RNA using the polymerase chain reaction;in 44 (16.4%) - through computed tomography of the lungs. The causes of deaths were the following: in 31 patients (11.6%) acute myocardial infarction;in 40 (14.9%) cerebrovascular accident;in 11 (4.1%) pulmonary embolism;222 patients (83%) had acute respiratory distress syndrome. The analysis included 130 men aged 36 to 92 (72.6 years old on average) and 138 women aged 40 to 106 (77.1 years old on average). Results: In the kidneys we detected ischemic changes caused by disturbances in the microvasculature. These are stases, sludges, erythrocyte and fibrin thrombi predominantly in the medulla. In the glomeruli diapedesis hemorrhages, mesangial cells proliferation, basement membrane thickening and fibrinoid necrosis of the capillary wall were observed. In the epithelium of the convoluted tubules, a granular, hyaline-drop dystrophy and a necrosis as the extreme degree of the damage were noted. In the kidneys, a pronounced lymphoid and leukocyte infiltration was detected. These changes were accompanied by inflammation and renal failure symptoms. In particular, the level of C-reactive protein was 140.6 ± 7.42 mg/l;blood ferritin 1258.0 ± 110.1 mcg/l;blood leukocytes 15.0 ± 0.67 10

Clostridium difficile infection in a COVID-19 Patient

Aim. The clinical observation highlights plausible compound origins of diarrhoea, fever and neutrophilic leucocytosis in COVID-19 and the rationale to exclude Clostridium difficile infection in such patients. Key points. A 57-yo female patient was admitted in May 2020 with the complaints of 39 °C fever, general weakness, polymyalgia, diarrhoea to 3–4 times a day (mushy stool, no morbid inclusions). Initial diarrhoea was non-severe and likely triggered by the coronavirus infection. A background antibiotic and putative-immunosuppressive therapy proceeded with watery diarrhoea to 7–8 times a day and C. difficile toxins A and B detected in stool. The C. difficile infection relapsed on day 10 of vancomycin withdrawal and associated with elevated body temperature, diarrhoea and neutrophil leucocytosis;signs of colitis determined in ultrasound and CT. Exacerbation was successfully treated in a repeated metronidazole-combined vancomycin course. Conclusion. Patients with COVID-19 are at risk of clostridial colitis due to massive antibiotic, systemic glucocorticoid and biologics-based therapy they receive. The opportunistic bacterial infection of C. difficile often proceeds undetected due to its potential mirroring of COVID-19 presentation. A screening algorithm in COVID-19 patients with diarrhoea should imply steps for C. difficile detection. © 2021 The Pharmaceutical Society of Japan

Economics of corn production: regional aspect

The article is devoted to the economy of maize production in the Krasnodar Territory - one of the main regions of its cultivation. The main indicators of economic efficiency of the production of this crop for grain, silage and green feed for the main natural and climatic zones of the region were considerate. Key problems of increase in production efficiency of corn for the purpose of restoration and development of domestic cattle breeding are investigated that is especially relevant in the conditions of the global economic crisis and consequences of a pandemic of COVID-19. The article contains an analysis of the structure of the cost of maize production. The greatest influence on its value of both grain and green mass is the level of crop yield and the labour intensity of one centner of the produced products. In order to identify unused reserves in improving the efficiency of maize production, the method of grouping was used. At the same time, when setting the goal and objectives of the study, the abstract-logical method was used, as well as comparative analysis - when comparing the indicators of crop production in agricultural organizations of various zones of the region. Studies have found that in order to increase the efficiency of grain production and green corn mass in the Krasnodar Territory, the main importance is: the optimal concentration of its crops, the size of production costs, their share in fertilizers, growth in yield levels and the optimal composition of the farm fleet. This integrated approach will better meet the internal needs of the Russian Federation in this economically viable culture. It was noted that the results obtained can be widely used in the practice of corn-growing regions of the country. Статья посвящена экономике производства кукурузы в Краснодарском крае - одном из основных регионов ее возделывания. Рассмотрены основные показатели экономической эффективности производства данной культуры на зерно, силос и зеленый корм по основным природно-климатическим зонам региона. Исследованы ключевые проблемы повышения эффективности производства кукурузы с целью восстановления и развития отечественного скотоводства, что особенно актуально в условиях мирового экономического кризиса и последствий пандемии COVID-19. В статье проведен анализ структуры себестоимости производства кукурузы. Наибольшее влияние на ее величину, как зерна, так и зеленой массы оказывает уровень урожайности культуры и трудоемкость одного центнера произведенной продукции. С целью выявления неиспользованных резервов в повышении эффективности производства кукурузы в работе применялся метод группировок. Наряду с этим, при постановке цели и задач исследования использовался абстрактно-логический метод, а также сравнительного анализа - при сопоставлении показателей производства культуры в сельскохозяйственных организациях различных зон региона. Исследованиями установлено, что для повышения эффективности производства зерна и зеленой массы кукурузы в Краснодарском крае основное значение имеют: оптимальная концентрация ее посевов, величина производственных затрат, их доля на удобрения, рост уровня урожайности и оптимальный состав парка сельскохозяйственных машин. Такой комплексный подход позволит полнее обеспечить внутренние потребности Российской Федерации в этой экономически выгодной культуре. Отмечено, что полученные результаты могут быть широко использованы в практике кукурузосеющих регионов страны.