Hashimoto thyroiditis amid COVID-19 pandemic: A clinical study

During COVID-19 era, a special attention was considered for autoimmune disorders (AD), including at thyroid, which are regarded at higher risk knowing that stress and infections might aggravate the pattern of anti-thyroid antibodies as well as thyroid dysfunction. In this study, we aim to analyse how COVID-19 infection influenced the evolution of HT parameters versus patients with HT who did not go through infection. Study design: an observational, bi-centric study in Romania during first 14 months of pandemic. By the end of April 2022, Romania registered 1,047,520 total cases of COVID19 infection (a morbidity rate calculated for entire Romanian population of 5.23%) with 27,267 total deaths (a lethality rate of 2.6%) and around 2000 new patients a day. From our database of 2210 HT patients, a number of 386 HT subjects were assessed (14 months). Among them, 33/386 patients had a different form of COVID-19 infection. The prevalence of COVID19 infection among HT patients was 9.35% which is statistically significant higher when compare with official ratio for entire Romanian population (a morbidity rate of 5.23%, z = 3.162, p = 0.00033). A feminine prevalence was identified (89.37%, N=31/33), while age was not different between subgroups (average age over 50 y). At the moment of diagnostic, thyroid function was similar between the two subgroups (?2=2.02,p=0.35). we checked ATPOs levels at every visits. Mean ATPO levels at the diagnostic time was 650 UI/mL in group 1 versus 840 UI/mL in group 2 (both groups had very high ATPO values, normal cut-offs below 34 UI/mL) with not statistical significance difference - student ttest (t?),p=0.16.Group 1: the pattern of ATPO evolution was undulatory in 74.07% of patients, decreasing - 3.7%, increasing - 11.11%, unmodified (stationary) 11.11%, similarly with group 2, meaning that ATPOs had the same profile, regardless the fact that some subjects went through COVID-19 infection. The rate of associated AD was 28.24% (N=2210), COVID-group of 42.42%, non-COVID group of 38.53% (z = 0.44, p = 0.66). In our COVID cohort of 33 patients with HT, we registered the following clinical stages of coronavirus infection: 4/33 patients who were asymptomatic;all women, average age: 65.65 years;2/33 patients with lack of smell and taste;women, over 65 years old;14/33 patients with mild form;from 31 years old to 70.5 years old (only one man);10 patients with a moderate form;all women, from 34 to 71 years old;one 87-year- old male with a severe form;one 50-year old female with a very severe form in addition to a hematologic disease and a history of severe allergic reactions;and a single patient (a 68-year-old, obese female with a severe allergic background) died of COVID-19 infection (thus generating a lethality rate of 3.03%). Conclusion. Our study showed a higher prevalence of COVID-19 infection among HT patients. These individuals do not associate increased levels of ATPO or a elevated prevalence of AD when compare with nonCOVID - HT group, and have similar age and sex ratio. Whether HT exposes the subjects to coronavirus infection is an open issue.

Severe osteoporosis: Pandemic pick ups

Objective: During COVID-19 pandemic, the access to skeleton investigations for osteoporosis was in many cases postponed, thus consequences on fracture risk (FR) might be expected in terms of not continuing the antiosteoporotic medication or not initiating it if needed. Reduced physical activity might reduce the risk of fall, on one hand, but associated sarcopenia and inhibition of bone formation due to lack of physical exercise increase the FR, on the other hand (1-5). This is a case report of a female with severe osteoporosis who delayed the presentation for diagnostic during first 15 months of pandemic. Case report: This is a 73-year-old female, known with a history of osteoporosis since 2005. She also associates FR: chronic therapy with different SSRIs for depression, multinodular goiter-related hyperthyroidism (which was treated with radioiodine therapy). She has chronic therapy for arteria hypertension, hyperlipemia and hiatal hernia. At diagnostic, after initial lumbar T-score=-3.5 SD, she refused therapy until 2015 (when T-score decreased to -4 SD), thus she began therapy with intravenous ibandronate until 2017 when she experienced a vertebral fracture and daily 20 μg of teriparatide was initiated, starting from a DXA-BMD of 0.783 g/cm2, T-score of 3.1 SD. After 8 months, the treatment was stopped because of her lack of compliance, so she continued with annual zolendronic acid 5 mg until of T-score of -2.6 SD, BMD=0.856 g/cm2. In March 2020, when lockdown pandemic were initiated, she had to come to reassessment, but delayed it, and refused medication based on telemedicine recommendations, except for daily 1000 UI vitamin D. 14 months later, central DXA showed lumbar L1-3 BMD of 0.824 g/cm2, T-score of -2.9 SD, Z-score of -0.7 SD, hip BMD of 0.682 g/cm2, T-score of -2.6 SD, Z-score of -0.4 SD;25-hydroxyvitamin D of 29 ng/mL, PTH of 55 pg/mL, suppressed CrossLaps of 0.287 ng/mL (normal: 0.33-0.782 ng/mL), osteocalcin of 17 ng/mL (normal: 15-46 ng/ mL), P1NP of 27 pg/mL (normal: 15-45 pg/mL);an additional T4 thoracic fracture. Zolendronic acid was further recommended. Conclusion: During pandemic lockdown, the usual serial assays and decision of therapy were less adequate based on telemedicine.

Zolendronic acid after teriparatide: Pandemic observations

Objective: Teriparatide for sever osteoporosis is followed by antiresorptive drugs, and one option in patients with gastric intolerance is zolendronic acid or denosumab (1-5). During pandemic lockdown, the access to bone assessment was limited (1-5). Type 1 diabetic patients are particularly at risk for bone loss, but also for COVID-19 infection, thus the importance of respecting the pandemic rules (1-5). We aim to introduce a female case diagnosed with severe menopausal osteoporosis that was followed during post-teriparatide sequence of medication, including during pandemic days. Case report: This is a type 1 diabetic female of 77 y who was first diagnosed with menopausal osteoporosis 8 y ago (lumbar T-score of-3.1 SD) and started medication with weekly alendronate in addition to vitamin D supplements. After 3 y, she suffered a single spontaneous vertebral fracture thus teriparatide was initiated for 2 y (with good tolerance): lumbar T-score went from -3.1 to -1.9 SD. In the meantime, due to bilateral coxarthrosis she needed bilateral hip replacement. Further on, she continued with biannually denosumab for 8 injections, reaching a lumbar BMD-DXA 0.942 g/cm2, T-score of -2 SD, Z-score of -0.8 SD so an intravenous perfusion with zolendronic acid 5 mg was administered plus vitamin D supplements. While she had no additional fracture and glycated haemoglobin A1c remained around 6.2-6.4%, one year later, the pandemic started, so only bone turnover markers (BTM) were assessed, not DXA: suppressed CrossLaps=0.22 ng/mL (normal: 0.33-0.782 ng/ mL), osteocalcin=11 ng/mL (normal: 15-46 ng/mL), P1NP=27 pg/mL (normal: 15-45 pg/mL). She continued with vitamin D, and 20 months after injection CrossLaps remained low (=22 ng/mL) with normal osteocalcin (=15 ng/mL), P1NP (=28 pg/mL) and stationary BMD. Conclusion: Zolendronic acid effect in osteoporotic patients is easy to access by blood assays if DXA is not available, while lack of BTM increase is suggestive for a good outcome.

Hypovitaminosisd on an adult female: From autoimmune conditions to pandemic days

Objective: COVID-19 pandemic was associated with increased risk of hypovitaminosis D due to lockdown regulations and limited outdoor activities, while young adult patients with autoimmune conditions may associated decreased values of 25-hydroxyvitamin D due to copresence of celiac disease, glucocorticoid exposure, malabsorption, overtreatment of autoimmune hypothyroidism, etc. (1-5).We aim to introduce a female case known with autoimmune conditions who was admitted for vitaminD deficiency related symptoms during pandemic. Case report: A 41-year-old, nonsmoker female is admitted for nonspecific muscle cramps, and joints pain, asthenia which is persistent for the last several months in addition to chronic low back pain (which required chronic use of nonsteroid anti-inflammatory medication). Her personal medical background reveals a diagnosis of HLA-B27-positive ankylosing spondylitis that was established seven years before current admission. She is also known with autoimmune thyroiditis with negative antibodies, a diagnostic that was based on suggestive ultrasound features with highly hypoechoic pattern of relative small thyroid gland (and normal thyroid function). She is also confirmed with thrombophilia. She has a negative personal history of confirmed COVID-19 infection and she followed the lockdown restrictions for several weeks. The family medical history is irrelevant. On admission, clinical examination of the thyroid is within normal limits on amenstruated normal weighted female. Biochemistry data points out normal total calcium of 9.45 mg/dL (normal: 8.4-10.3 mg/dL). Endocrine panel shows TSH=1.28 μUI/mL (normal: 0.5-4.5 μUI/mL), free levothyroxine=11.65 pmol/L (normal: 9-19 pmol/L), anti-thyroperoxidase antibodies=10.88 UI/mL (normal: 0-35), anti-thyroglobulin antibodies=10 UI/mL (normal: 0-115 UI/mL). 25-hydroxyvitamin D=10 ng/mL (normal >30 ng/mL) with increased PTH levels and negative antibodies for celiac disease. Supplementation with daily 2000 UI of vitamin D for 12 weeks followed by daily 1000 UI was recommended. Conclusion: The association thrombophilia-hypovitaminosis D has been reported in some patients, but it is rather incidental. Chronic use of antiinflammatory medication may cause malabsorption, and also the potential of a second autoimmune disease at intestinal level may cause this deficiency, but the current pandemic reality has become a new cause of it.

Cardiovascular events in patients with novel coronavirus infection covid-19

The World Health Organization (WHO) officially announced the beginning of the COVID-19 pandemic in March 2020. So far, according to official WHO data, more than 195 million people worldwide have been infected with coronavirus infection, and the number of deaths has exceeded 4.1 million. At the beginning of the pandemic, the focus of the medical community was predominantly on the tropism of the virus to respiratory system, but the data accumulated today from national and foreign studies demonstrate the multiorgan nature of lesions in SARS-CoV-2, including atherothrombosis- associated cardiovascular diseases (CVDs). Patients with COVID-19 and concomitant cardiovascular disease and those who had cardiovascular events (CVE) are reported to have an increased risk of adverse outcomes. CVE in individuals infected with SARS-CoV-2 primarily consists of acute myocardial injury, acute myocardial infarction, myocarditis, rhythm disorders, heart failure, and thromboembolic events. The team of authors analyzed electronic medical records of 10 908 patients aged from 18 to 90 years, who were treated from June 01, 2020 to May 31, 2021 at the infectious disease departments of the 4th City Clinical Hospital named after N.E. Savchenko for patients with coronavirus infection (SARS-CoV-2). Individuals with rhythm disorders prevailed in this analysis - 13.38% (n=1460). The prevalence of persons with myocarditis and acute myocardial infarction developed on the background of SARS- CoV-2 infection was 0.29% (n=32) and 2.80% (n=305), respectively. The prevalence of patients with COVID-19 and thromboembolic events was 5.97% (n=651). SARS-CoV-2 can lead to CVE or decompensation of concomitant CVDs through direct or mediated mechanisms, including direct viral toxicity, excessive systemic inflammatory response, dysregulation of the renin-angiotensin- aldosterone system (RAAS), endothelial dysfunction and thrombosis, ventilation-perfusion failure, electrolyte imbalance, as well as on the background of ongoing therapy, which may potentially have cardiotoxic effects. The published article reviews the main proposed pathophysiological mechanisms and factors that lead to development of CVEs and provides the data on the contribution of CVEs to the course and outcomes in patients with COVID-19. Understanding the potential mechanisms underlying the pathophysiology of SARS-CoV-2 effects on the cardiovascular system is essential for providing comprehensive medical care for patients with CVDs and COVID-19. © 2021, Professionalnye Izdaniya. All rights reserved.

Digital twins of building physics experimental laboratory setups for effective e-learning

Hands-on experiments in laboratories are fundamental educational tools for technical sciences. However, laboratories are expensive and not always accessible to students: lockdown and in-person meeting restrictions due to the ongoing Covid-19 pandemic, distant location of teachers and students, facilities used for higher-priority purposes. Moreover, creating specific experimental setups for teaching only can be costly. In that context, digitalizing laboratory setups provides an attractive teaching alternative for remote e-learning. Digital twins are not meant to replace real-world experiments but should enable flexible teaching and effective learning at a lower cost. They complement physical setups and can be virtual extensions, allowing for larger and more complex study cases. e-learning is now popular and many educational institutions provide open-access videos of entire courses. However, the digitalization of practical exercises for engineering is yet limited. The e-learning effort presented in this paper aims to establish a series of digital twins of experimental setups for teaching building physics, energy in buildings and indoor environment. The development of the two first digital twins is detailed here. They are designed for teaching operation and balancing hydronic heating systems. Their numerical models and graphical user interfaces are created with the LabVIEW programming environment. © 2021 Institute of Physics Publishing. All rights reserved.

[The psychological characteristics of food behavior of the youth in conditions of self-isolation].

The article presents the results of psychological study of characteristics of food behavior in young people in the conditions of forced self-isolation and COVID-19 coronavirus infection pandemic. The common research methods were applied to establish actual food disorders and intensification of their symptoms during isolation. The food behavior of each individual can be considered as network of interactions between various natural factors (physiological, psychological, economic, sociocultural ones). It is conditioned by stress level due to pandemic. The comparative analysis of study results concerning specifics of food behavior in conditions of self-isolation in young and middle-aged people demonstrated that there is significant relationship between external, emotionogenic food behavior, restrictive food behavior and age of subjects. The correlation analysis established statistical significance of a number of scales. In sample of middle-aged objects, relationships between external and emotionogenic food behavior were established. The emotionogenic condition was associated with dissatisfaction with one's own body, and body image - with restrictive food behavior. The direct statistical significance of dependence of restrictive behavior from age was revealed. In all cases, more intensive manifestation of food disorders was detected in sampling of young people that confirms hypothesis that middle-aged people are inclined to other types of food disorders as compared with young people. The severity of disorders is also less pronounced. The actuality of the analyzed problem is determined by both trends in development of scientific knowledge and existing needs of social practice.

THE SEVERITY OF SITUATIONAL AND PERSONAL ANXIETY AMONG UNIVERSITY STUDENTS WITH DISABILITIES DURING THE PANDEMIC

The paper presents the results of a study of situational and personal anxiety among university students with disabilities during the COVID-19 pandemic (Spring 2020). The study involved 35 students with disabilities from Russian State Social University aged 18-26 (21 men and 14 women). We used 2 questionnaires for measuring anxiety: Spielberger State-Trait Anxiety Inventory and Taylor Manifest Anxiety Scale. The results allowed us to make conclusions about the increased level of situational anxiety, as well as about pronounced personal anxiety in the studied category of students. The study has practical importance for the organization of psychological support for students with disabilities at the university.