Electrocardiogram QRS Complex Duration as a Predictor of Hospital Prognosis in Patients With COVID-19.

Aim      To determine the effect of major electrocardiographic (ECG) parameters on the prognosis of patients with COVID-19.Material and methods  One of systemic manifestations of COVID-19 is heart injury. ECG is the most simple and available method for diagnosing the heart injury, which influences the therapeutic approach. This study included 174 hospitalized patients with COVID-19. Major ECG parameters recorded on admission and their changes before the discharge from the hospital or death of the patient, were analyzed, and the effect of each parameter on the in-hospital prognosis was determined. Results were compared with the left ventricular ejection fraction (LV EF), laboratory data, and results of multispiral computed tomography (MSCT) of the lungs.Results ECG data differed on admission and their changes differed for deceased and discharged patients. Of special interest was the effect of the QRS complex duration at baseline and at the end of treatment on the in-hospital survival and mortality rate. The Cox regression analysis showed that the QRS complex duration (relative risk (RR) 2.07, 95% confidence interval (CI): 1.17-3.66; р=0.01), MSCT data (RR, 1.54; 95 % CI: 1.14-2.092; р=0.005), and glomerular filtration rate (GFR) (RR, 0.98; 95 % CI: 0.96-0.99; р=0.001) had the highest predictive significance. In further comparison of these three indexes, the QRS duration and GFR retained their predictive significance, and a ROC analysis showed that the cut-off QRS complex duration was 125 ms (р=0.001). Patients who developed left bundle branch block (LBBB) in the course of disease also had an unfavorable prognosis compared to other intraventricular conduction disorders (р=0.038). The presence of LBBB was associated with reduced LV EF (р=0.0078). The presence of atrial fibrillation (AF) significantly predetermines a worse outcome both at the start (р=0.011) and at the end of observation (р=0.034). A higher mortality was observed for the group of deceased patients with ST segment deviations, ST elevation (р=0.0059) and ST depression (р=0.028).Conclusion      Thus, the QTc interval elongation, LBBB that developed during the treatment, AF, and increased QRS complex duration are the indicators that determine the in-hospital prognosis of patients with COVID-19. The strongest electrocardiographic predictor for an unfavorable prognosis was the QRS complex duration that allowed stratification of patients to groups of risk.

USING COVID-GLOBULIN IN COVID-19 TREATMENT

Under auspices of the Eurasian Association of Therapists (EUAT), a Council of Experts (COE) was organized to develop criteria for the timing of administration (day of illness onset) of COVID-globulin, dosing regimens and patient phenotypes depending on comorbid pathology to optimize indications and achieve maximum effectiveness of virus-neutralizing therapy. The need for COE creation is related to the lack of criteria based on large-scale evidence-based studies. That is why the working group of COE includes experts in all fields of internal medicine, in particular, transfusiology specialists. The COE activity was held with the participation of largest plasma transfusion centers for recuperative patients including Clinical Hospitals No. 40 and 52 of the Moscow City Government Department of Health, and the N. V. Sklifosovsky Institute of Emergency Medicine. Copyright © 2022 Authors. All rights reserved.

Symptoms in the Long Period after the Coronavirus Infection: Results of Long-Term Follow-Up

Background: assessment of type, prevalence and duration of residual symptoms after COVID-19 in recent studies is controversial because of differences in design. Aim: to assess the prevalence and severity of symptoms in the long-term period after COVID-19. Materials and methods: patients hospitalized with COVID-19 in the period 13.04.2020-10.06.2020 were interviewed by phone: 195 (58,2 %) convalescents at 143 (131-154) days after disease onset and 183 (54,6 %) of them at 340 (325-351) days. Results: The subjective assessment of health status with 100-point scale before and after the COVID-19 was 95 (80-100) and 80 (70-96) points, p <0,001, at first interview;90 (80-100) and 80 (60-90) points, p <0,001, at second one. Various complaints were detected in 63 % of respondents at the first interview and in 75 % at the second, the number of identified symptoms was 2 (0-6) and 4 (1-8) respectively. The most frequent complaints were weakness/fatigue (31.3 and 47.5 % of respondents), joint pain (31.3 and 47.5 %) and dyspnoe/shortness of breath (31.3 and 43.2 %). The growth of these indicators can be associated with a change in the interview methodology. The severity of the symptoms at second interview was low: fatigue — 3 (0-6) points, shortness of breath — 0 (0-3) points;joint pain, weakness and dyspnoe — 0 (0-5) points each. Conclusion: a decrease of health status can sustain for a long time after COVID-19. Symptoms persist in a significant proportion of convalescents, but their severity in the end of follow-up is quite low.

Hyperenzymemia after vaccination against COVID-19: complex equation with simple variables

The article presents clinical case of the jaundice development and severe hyperenzymemia in GAM–Covid-VAK (Sputnik V) vaccination against COVID-19 in a 69-year-old patient. History — systematic use of non-steroidal anti-inflammatory drugs due to persisting pain after knee arthroplasty in 2018;frequent trips for several years to another region for sanatorium treatment, the use of mineral water. The diseases caused by hepatitis viruses, drug damage and post-vaccination reaction were included in diagnostic search. The markers of hepatitis B and C infection viruses were not detected during the enzyme immunoassay and polymerase chain reaction. The indicator for determining the relationship of a drug with the liver damage development was 6 points (borderline value) and only indicated the likelihood of drug hepatotoxicity. At the same time, it is known from history that repeated administration of the drug did not cause liver dysfunctions. The diagnosis of coronavirus infection was established based on the identification of SARS-CoV-2 in the hospital with repeated laboratory testing and competing diagnosis of hepatitis A has been confirmed on the basis of hepatocellular damage and the presence of serological marker of hepatitis A virus (immunoglobulin M antibodies). The treatment was continued in the infectious hospital, where the diagnosis of co-infection was confirmed. The pneumofibrotic changes in the S5 region of the left lung were revealed according to computed tomography. The normalization of aminotransferase activity and bilirubin was noted during dynamic observation. Apparently HAV infection led to a decrease in the immune response, the formation of an insufficient level of neutralizing antibodies in vaccinated against COVID-19 patient M. and contributed to the development of a new coronavirus infection with minimal manifestations in contact with SARS-CoV-2. © 2021 Eksperimental'naya i Klinicheskaya Gastroenterologiya. All rights reserved.

The value of indicators characterizing the state of the cardiovascular system in assessing the hospital prognosis of COVID-19 patients.

Background     Heart damage is one of complications of the novel coronavirus infection. Searching for available predictors for in-hospital death and survival that determine the tactic of managing patients with COVID-19, is a challenge of the present time.Aim      To determine the role echocardiographic (EchoCG) parameters in evaluation of the in-hospital prognosis for patients with the novel coronavirus infection, COVID-19.Material and methods  The study included 158 patients admitted for COVID-19. EchoCG was performed for all patients. The role of left ventricular (LV) ejection fraction (EF) was analyzed in various age groups. EchoCG data were compared with the clinical picture, including the severity of respiratory failure (RF), blood oxygen saturation (SрО2), data of computed tomography (CT) of the lungs, and blood concentration of troponin. Comorbidity was analyzed, and the highest significance of individual pathologies was determined.Results LV EF ≤40 % determined the worst prognosis of patients with COVID-19 (p<0.0001), including the age group older than 70 years (р=0.013). LV EF did not correlate with the degree of lung tissue damage determined by CT upon admission (р=0.54) and over time (р=0.23). The indexes that determined an adverse in-hospital prognosis to a considerable degree were pericardial effusion (p<0.0001) and pulmonary hypertension (p<0.0001). RV end-diastolic dimension and LV end-diastolic volume did not determine the in-hospital mortality and survival. Blood serum concentration of troponin I higher than 165.13 µg/l was an important predictor for in-hospital death with a high degree of significance (р<0.0001). Th degree of RF considerably influenced the in-hospital mortality (р<0.0001). RF severity was associated with LV EF (р=0.024). The SpO2 value determined an adverse immediate prognosis with a high degree of significance (р=0.0009). This parameter weakly correlated with LV EF (r=0.26; p=0.0009). Patients who required artificial ventilation (AV) constituted a group with the worst survival rate (р<0.0001). LV EF was associated with a need for AV with a high degree of significance (р=0.0006). Comorbidities, such as chronic kidney disease, postinfarction cardiosclerosis and oncologic diseases, to the greatest extent determined the risk of fatal outcome.Conclusion      EchoCG can be recommended for patients with COVID-19 at the hospital stage to determine the tactics of management and for the in-hospital prognosis.

Association of Computer Tomography Features of COVID-19 with Outcomes, Clinical and Laboratory Parameters

Aim: to assess the results of chest computer tomography (CT) of patients with novel coronavirus infection in correspondence with their outcomes, clinical and laboratory data. Methods: retrospective analysis of 962 chest CT scans, outcomes, clinical and laboratory data of all 354 COVID-19 patients hospitalized from April to June 2020. Results: Sensitivity and specificity of CT with polimerase chain reaction (PCR) as a reference were: 98.0 % and 5.7 % respectively;for PCR with CT as a reference: 54.6 % and 70.7 % respectively. Patients with positive and negative PCR tests had no significant differences in mean CT score and CO-RADS score. Cumulative survival was better in patients with lower CT score (significant only for maximal, not baseline scores). CT score changed during hospitalization in survived patients clinically insignificant (from 2 (1-2) to 2 (1-2), p=0.001), and increased in dead (from 2 (1,5-3) to 4 (4-4), p <0.001). Lower CT score and better survival was in females, patient younger than 59 years, with NEWS score <3, without atrial fibrillation. Diabetes mellitus and obesity was associated with higher CT score, but not with survival. Chronic obstructive pulmonary disease, coronary heart disease and chronic heart failure was associated with lower survival, but not CT score. Conclusion: chest CT significantly increases diagnostic accuracy and assessment of the prognosis in COVID-19 patients.

OZONE THERAPY IN PATIENTS WITH THE NEW CORONAVIRUS INFECTION COVID-19

Aim. In our work we seek to develop new approaches for treating patients with COVID-19. The first reports about new coronavirus infection, COVID-19, came out in China in 2019. It was recognized by WHO as a pandemic crisis on March 11, 2020. Currently, there is no standard therapy protocol for COVID-19 and the drugs are used off label. Materials and methods. We have implemented ozone therapy into clinical practice as an adjuvant treatment regimen for patients with SARS-CoV-2 infection. In our study, 19 patients received ozone therapy and 18 patients were members of the control group. All patients had a positive PCR test for SARS-CoV-2 infection and were matched by the following features: sex, age, severity of symptoms, imaging data and clinical history. Patients in the study group received ozone therapy in the form of daily intravenous infusions of ozonized physiological solution (concentration: 2.2-2.4 mg/l). Conclusion. We observed a statistically significant improvement in laboratory, radiological and clinical tests of patients in the study group compared to the control group on the 14th day. Thus, we have demonstrated the benefits of using ozone therapy in patients with the new coronavirus infection COVID-19. Taking into consideration the physiological processes underlying such approach, ozone therapy should be justified for both phases: the beginning and at the peak of the disease. Цель. Поиск новых направлений в терапии COVID-19. Новая коронавирусная инфекция COVID-19, возникшая в конце 2019 г в Китайской Народной Республике, признана ВОЗ пандемией 11 марта 2020 г. В настоящее время не разработана этиотропная терапия данной инфекции. Препараты в протоколах лечения используются off label. Материалы и методы. Нами была использована озонотерапия в качестве адъювантной у пациентов с SARS-CoV-2-инфекцией. Озонотерапия проводилась 19-ти пациентам, 18 больных составили контрольную группу. Все пациенты имели положительный ПЦР-тест на инфекцию SARS-CoV-2, были сопоставимы по полу, возрасту, степени тяжести, учитывая данные МСКТ и клинической картины. Пациентам в изучаемой группе проводилась озонотерапия в виде ежедневных внутривенных инфузий озонированного физиологического раствора в концентрации 2.2-2.4 мг/л. Выводы. По результатам проведённого исследования мы получили статистически значимое улучшение лабораторных, рентгенологических, клинических данных на 14-й день исследования у пациентов в изучаемой группе, по сравнению с контрольной. Таким образом, нами продемонстрирована эффективность озонотерапии у пациентов с новой коронавирусной инфекцией COVID-19. С учетом механизмов действия данного метода, его применение обосновано как в начале, так и в разгаре заболевания.

[Organizing the medical care for the COVID-19 patients in non-infectious Moscow hospital: reassignment experience].

AIM: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed. MATERIALS AND METHODS: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days. RESULTS: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died. CONCLUSION: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

The role of computed tomography in differentiation of coronavirus pneumonia, its complications and comorbidities. Case reports

Background: computer tomography (CT) features of COVID-19, their temporal changes and differences from other pulmonary (viral and bacterial pneumonia) and non-pulmonary diseases are well described in recent publications. The prevalence and characteristics of signs of concomitant problems that could be identified at chest CT are less studied. Aim: to analyze the prevalence and characteristics of chest CT features of COVID-19, its complications and comorbidities. Methods: retrospective analysis of CT and clinical data of 354 patients hospitalized with suspected COVID at April and May of 2020. Results: 962 CT scans were analyzed (3 (2-3) scans per patient). First CT was performed at 8 (5-11) day of sickness. Several roentgenological scenarios could be highlighted: patients with coronavirus pneumonia (n=295;83%);with combination of COVID-19 and another pathology (n=36;10%);with complications of COVID-19 (n=12;3%);with alternative pathology (n=2;1%);without any pathological signs (n=9;3%). Several cases, illustrating CT signs of coronavirus pneumonia, its complications and comorbidities are reported. Conclusion: CT possibilities are not limited to detect typical COVID-19 signs, it also helps to differentiate pulmonary and other thoracis pathology.

COVID-19 and liver damage

An outbreak of unknown pneumonia, caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), was reported in China at the end of December 2019. On February 11, 2020, the World Health Organization officially named SARS-CoV-2 infection COVID-19 (Coronavirus Disease 2019). The most common clinical manifestation of COVID-19 is pneumonia. However, with the spread of the COVID-19 pandemic and analysis of clinical data, symptoms that are not characteristic of "atypical" pneumonia have been identified in patients. Neurological symptoms, skin and eye damage, etc., are described. The extrapulmonary presence of SARS-CoV-2 was also detected in cholangiocytes. Virus-induced effects, systemic inflammation ("cytokine storm"), hypoxia, hypovolemia, hypotension in shock, druginduced hepatotoxicity, etc., are considered possible factors of liver damage. In 14-53 % of COVID-19 patients, changes in biochemical parameters, which usually do not require drug therapy, can be recorded. Acute hepatitis is very rare. However, special attention should be given to COVID-19 patients at risk: after liver transplantation;receiving immunosuppressants and antiviral drugs;and in cases of decompensated cirrhosis, acute-on-chronic liver failure, and hepatocellular carcinoma. Constant data sharing and open access to research data, new technologies, and up-to-date guidelines are required.